Aggressive Surgical Resection of Enormous Cervical Metastasis from Nasopharyngeal Carcinoma

Dok nazofaringealni karcinom (NPK) obično prate limfoidne metastaze, golema cervikalna metastaza koja uzrokuje disfagiju i ograničava pokrete vrata nije uobičajen simptom za većinu slučajeva NPK-a. Opisan je slučaj 23-godišnjeg muškarca s nediferenciranim rakom nazofarinksa stupnja T3N2M0, koji je prvi put bio podvrgnut agresivnoj kirurškoj bilateralnoj resekciji velike mase u vratu, nakon čega je slijedila istodobna kemo- i radioterapija s terapijama na temelju cisplatina. Postoperativni klinički tijek bio je bez osobitosti, a na kontroli dvije godine poslije nije otkrivena ponovna pojava ni primarne lezije, ni metastaze u vratu. Ako bolesnici s NPK-om pate od kliničkih simptoma zbog velikih metastaza u vratu, preporučujemo da se u obzir uzme agresivna kirurška resekcija.While nasopharyngeal carcinoma (NPC) commonly presents lymphoid metastases, the enormous cervical metastasis causing dysphagia and limitation of neck motion is not a familiar symptom for most of NPC cases. We report a 23-year-old male with undifferentiated carcinoma of the nasopharynx, stage Ⅲ (T3N2M0), who had undergone aggressive surgical resection of bilateral huge cervical mass first followed by concurrent chemo-radiotherapy with cisplatin-based regimens. The postoperative clinical course was uneventful and follow-up, 2 years later, revealed no recurrence of primary lesion and neck metastases. We recommend that aggressive surgical resection may be considered when NPC patients significantly suffer clinical symptoms from a huge cervical metastasis

Surgical and Orthodontic Treatment of Severely Intruded Permanent Incisors: A Case Report

Traumatic dental intrusion is a serious injury and results in significant damage to the periodontal ligament, dentin-pulp complex, and alveolar bone. This article presents a case of severe intrusion of the two upper permanent central incisors where the treatment option was the combination of the surgical and orthodontic technique. The difficulty of accessing the crowns of these teeth to bond the brackets was solved by lifting a full thickness flap. To disengage the teeth from the alveolus, a careful dislocation motion was performed. After suturing the flap, a removable orthodontic appliance was installed and an extrusive force was applied for 8 weeks. After 10 weeks, the endodontic treatment was performed and the crowns were restored. The 10-year clinical control showed normal mobility. Radiographically, minor losses of the cervical alveolar cortical bone and integrity of the periodontal ligament were observed.Keywords: Dental Trauma; Intrusive Luxation; Orthodontic Extrusio

Delayed Tooth Replantation after Root Surface Treatment with Papain and Sodium Fluoride in Rats: A Histological and Histomorphometrical Evaluation

Introduction: The aim of this study was to examine the histological effect of papain and sodium fluoride in delayed replantation of rat incisor teeth on the repair process. Methods and Materials: Forty upper incisors of Wistar rats were randomly assigned to four groups (n=10). In group I, the dental papilla and the pulp tissue of extracted teeth were removed before immediate replantation in their sockets. In the other groups, the extracted teeth were maintained in dry storage for 60 min and subjected to different root surface treatments. In group II, the teeth were immersed in 10% papain for 20 min, scrubbed with gauze soaked in saline for 1 min, and immersed in a 2% acidulated-phosphate sodium fluoride solution for 20 min. In group III, the teeth were immersed in saline for 20 min, scrubbed with gauze soaked in saline for 1 min, and immersed in a 2% acidulated-phosphate sodium fluoride solution for 20 min. In group IV, root surface treatment was not applied. The root canals were treated and filled with a calcium hydroxide paste and the teeth were replanted. The animals were euthanized after 60 days and anatomic specimens containing the teeth were subjected to routine histochemical processing and staining with hematoxylin and eosin. The Kruskal-Wallis test was used, followed by the Dunn’s test for multiple comparisons. Results: Groups I and II had less inflammatory root resorption and total area of root resorption (P<0.05) than groups III and IV respectively. Conclusions: Based on this animal study, root surface treatment with papain and sodium fluoride in delayed tooth replantation showed greater efficacy in controlling inflammatory root resorption and may be a viable option for clinical application

Estudo sobre métodos utilizados para a determinação da atividade antimicrobiana de extratos de plantas medicinais: elucidações e limitações das técnicas / Study on methods used to determine the antimicrobial activity of medicinal plants extracts: clearance and limitations of the techniques

Esse estudo realizou uma revisão de literatura sobre os métodos utilizados para a determinação da atividade antimicrobiana de extratos de plantas medicinais sobre microrganismos patogênicos. No teste de difusão em ágar avalia-se comparativamente frente a um padrão biológico de referência com medição da zona de inibição de crescimento. Na diluição em ágar, os extratos são diluídos no meio de cultura fundido em várias concentrações e os microrganismos são inoculados após a gelificação do meio. Outras técnicas incluem o uso de discos de papel de filtro, cilindro inoxidável, a perfuração em ágar, além da bioautografia para identificação de constituintes bioativos de extratos vegetais e a medição da impedância para detecção da atividade bacteriana com determinação da concentração inibitória mínima (CIM) e da concentração bactericida mínima (CBM). Para avaliação da atividade antimicrobiana, os métodos mais utilizados e recomendados são difusão em ágar, para triagem da atividade, e microdiluição, para determinação da CIM

Antifungal Activity of Essential Oils against Candida albicans

Objective. The objective of this study was to analyze the antifungal activity of citral, selected by screening natural products, against Candida albicans isolates from subjects who use dental prostheses. Methodology. Screening of essential oils, including those from Mentha piperita L. (Briq), Origanum vulgare, and Zingiber officinale L., and the phytoconstituents citral and limonene, to select an appropriate natural product. Citral, which mediated the best antifungal response, was selected for biological assays. The minimum inhibitory concentrations (MICs) and minimum fungicidal concentrations (MFCs) for citral and nystatin were determined by the microdilution method. Micromorphological analyses, time-kill curve, and modulation tests were performed. Results. The MIC and MFC of citral were established as 32 μg/mL, consistent with fungicidal activity. The clinical strains were resistant to nystatin. Citral caused micromorphological alteration in the strains. In the time-kill curve, the growth of the clinical strain was reduction in growth equal to 3 log10 colony-forming units per milliliter after exposure to the MIC and MIC×2 of citral for 2 h. Citral did not modulate the resistance of the studied strains to nystatin. Conclusion. This study revealed the potential of citral as a fungicidal agent and highlighted the resistance of clinical strains of C. albicans to nystatin

Self locking zip ties temporary displaced mandibular fracture reduction

The article addresses mandibular fractures, which are common today, often resulting from traffic accidents, violence and falls. Surgical management is crucial to avoid future complications. The work describes a specific case in which Nylon tape (clip) was used to reduce a mandibular fracture in a male patient who was a victim of physical aggression. The patient, a homeless individual involved with narcotic substances, was treated by neurosurgery and trauma surgery teams. The fracture was initially reduced with nylon tape during primary care. The patient was subsequently transferred to the oral and maxillofacial surgery (BMF) team for definitive treatment. The treatment involved several steps, including nasotracheal intubation, antisepsis, local anesthesia, submandibular surgical access, removal of nylon tape, tooth extraction, cleaning of the fracture, manual reduction, plate fixation and occlusion review. The patient received conventional clinical support and was released on the second postoperative day for outpatient follow-up. The choice of fixation with replaced load of the 2.4 mm system (load bearing) stands out due to the need for high rigidity in contaminated fractures. The extraction of teeth 43 and 44 was carried out to avoid risks of contamination. The article concludes by highlighting the effectiveness and accessibility of using nylon tape for the temporary stabilization of mandibular fractures, providing local pain relief and reducing the distress associated with bone movement.The article addresses mandibular fractures, which are common today, often resulting from traffic accidents, violence and falls. Surgical management is crucial to avoid future complications. The work describes a specific case in which Nylon tape (clip) was used to reduce a mandibular fracture in a male patient who was a victim of physical aggression. The patient, a homeless individual involved with narcotic substances, was treated by neurosurgery and trauma surgery teams. The fracture was initially reduced with nylon tape during primary care. The patient was subsequently transferred to the oral and maxillofacial surgery (BMF) team for definitive treatment. The treatment involved several steps, including nasotracheal intubation, antisepsis, local anesthesia, submandibular surgical access, removal of nylon tape, tooth extraction, cleaning of the fracture, manual reduction, plate fixation and occlusion review. The patient received conventional clinical support and was released on the second postoperative day for outpatient follow-up. The choice of fixation with replaced load of the 2.4 mm system (load bearing) stands out due to the need for high rigidity in contaminated fractures. The extraction of teeth 43 and 44 was carried out to avoid risks of contamination. The article concludes by highlighting the effectiveness and accessibility of using nylon tape for the temporary stabilization of mandibular fractures, providing local pain relief and reducing the distress associated with bone movement

Citral inibe proliferação de Candida albicans isoladas de usuários de próteses dentais removíveis

Removable prostheses are considered to be potentially facilitators of prosthetic stomatitis. Candida sp. infection is a very common cause, with Candida albicans being the most prevalent and most frequently associated with this pathology. The study of natural herbal products to combat this type of infection appears as an alternative method of treatment, since the resistance of the species to the licensed antifungal agents as well as the adverse effects and toxicity of these drugs has increased. This research analyzed the antifungal activity of citral, selected from a screening, against clinical strains of C. albicans isolated from prosthesis users. Twenty-one isolates were identified and identified as one standard (ATCC 76645). Initially, a screening was performed for the selection of a natural product, with the following essential oils: Mentha piperita L. (Briq); Origanum Vulgare; Zingibre officinale L. and citral and limonene phytochemicals. Among them, citral produced better antifungal response and was selected for biological assays. The test products were composed by the citrus phytoconstituent and nystatin. The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) were determined by the microdilution method. Micromorphological analysis, microbial death kinetics and modulation were performed. Data were analyzed descriptively. The CIM and MFC of citral were established at the concentration of 32 μg/mL, showing fungicidal activity. All yeasts of clinical origin were found to be resistant to nystatin, but C. albicans ATCC 76645 was sensitive, with MIC corresponding to 256 μg/mL. There was a change in the micromorphology of the strains exposed to the citral, verifying less fungal structures. In the kinetics of microbial death, the clinical strain showed a reduction in growth equal to 3 log10 CFU/mL in two hours of citral exposure in the MIC and CIMx2. There was no fungal growth in the evaluated times of the standard strain when exposed to citral concentrations, as well as clinical C. albicans submitted to CIMx4. Citral did not modulate the activity of nystatin on the resistance of the studied strains. This research revealed the promising potential of citral, being characterized as a fungicidal agent, and the highlight of the resistance of clinical strains of C.albicans to nystatin.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESPróteses removíveis são consideradas potencialmente facilitadoras de estomatite protética. A infecção por Candida sp. é uma causa bastante comum, sendo Candida albicans a espécie mais prevalente e mais frequentemente associada a essa patologia. O estudo de produtos naturais à base de plantas medicinais para combater esse tipo de infecção mostra-se como um método alternativo de tratamento, visto que a resistência das espécies frente aos agentes antifúngicos licenciados, assim como os efeitos adversos e toxicidade desses medicamentos tem aumentado. Essa pesquisa analisou a atividade antifúngica do citral, selecionado a partir de um screening, frente a cepas clínicas de C. albicans isoladas de usuários de próteses. Foram utilizadas 21 cepas isoladas e identificadas, sendo uma padrão (ATCC 76645). Inicialmente, foi realizado um screening para a escolha de um produto natural, com os seguintes óleos essenciais: Mentha piperita L.(Briq); Origanum Vulgare; Zingibre officinale L. e os fitoconstituintes: citral e limoneno. Dentre eles, o citral produziu melhor resposta antifúngica e foi selecionado para os ensaios biológicos. Os produtos-teste foram compostos pelo fitoconstituinte citral e pela nistatina. Foram determinadas a concentração inibitória mínima (CIM) e a concentração fungicida mínima (CFM) pelo método de microdiluição. Em seguida foi realizada a análise micromorfológica, cinética de morte microbiana e ensaio de modulação. Os dados foram analisados descritivamente. A CIM e CFM do citral foram estabelecidas na concentração de 32 μg/mL, apresentando atividade fungicida. Todas as leveduras de origem clínica, demonstraram ser resistentes à nistatina, mas C.albicans ATCC 76645 foi sensível, com CIM correspondendo a 256 μg/mL. Houve alteração na micromorfologia das cepas expostas ao citral, verificando menos estruturas fúngicas. Na cinética de morte microbiana, a cepa clínica demonstrou redução no crescimento igual a 3 log10 UFC/mL em duas horas de exposição ao citral na CIM e CIMx2. Não houve crescimento fúngico nos tempos avaliados da cepa padrão quando exposta às concentrações do citral, assim como da C.albicans clínica submetida à CIMx4. O citral não modulou a atividade da nistatina sobre a resistência das cepas estudadas. Essa pesquisa revelou o potencial promissor do citral, sendo este caracterizado como um agente fungicida, e o destaque da resistência das cepas clínicas de C.albicans frente a nistatina

Applications of platelet- and leukocyte-rich fibrin (L-PRF) in Oral and Maxillofacial Surgery

Introduction: Oral and maxillofacial surgery plays a crucial role in the reconstruction and restoration of facial structures, seeking to improve both aesthetics and function. The use of platelet-rich fibrin (L-PRF) represents a notable advance, accelerating healing and improving surgical outcomes. Materials and Methods: This review covers 710 studies from various electronic databases (PubMed, Scopus, Web of Science, Science Direct and Google Scholar). The aim is to thoroughly investigate the applications of platelet- and leukocyte-rich fibrin (L-PRF) in Oral and Maxillofacial Surgery and Traumatology. Results: The analysis reveals that L-PRF stands out as an effective autologous therapy in oral and maxillofacial surgery. Its application shows remarkable potential for accelerating the healing process, contributing significantly to the effectiveness of procedures. Discussion: L-PRF has emerged as an excellent choice in oral and maxillofacial surgery and traumatology, improving both the aesthetic and functional aspects of facial reconstructions. This highlights the relevance of this autologous therapy and its benefits in surgical practice. Conclusion: The applications of platelet and leukocyte-rich fibrin (L-PRF) in Oral and Maxillofacial Surgery and Traumatology are fundamental and promising. This advance represents not only a means of accelerating healing, but also a significant contribution to better aesthetic and functional results in surgical procedures in this area.Introduction: Oral and maxillofacial surgery plays a crucial role in the reconstruction and restoration of facial structures, seeking to improve both aesthetics and function. The use of platelet-rich fibrin (L-PRF) represents a notable advance, accelerating healing and improving surgical outcomes. Materials and Methods: This review covers 710 studies from various electronic databases (PubMed, Scopus, Web of Science, Science Direct and Google Scholar). The aim is to thoroughly investigate the applications of platelet- and leukocyte-rich fibrin (L-PRF) in Oral and Maxillofacial Surgery and Traumatology. Results: The analysis reveals that L-PRF stands out as an effective autologous therapy in oral and maxillofacial surgery. Its application shows remarkable potential for accelerating the healing process, contributing significantly to the effectiveness of procedures. Discussion: L-PRF has emerged as an excellent choice in oral and maxillofacial surgery and traumatology, improving both the aesthetic and functional aspects of facial reconstructions. This highlights the relevance of this autologous therapy and its benefits in surgical practice. Conclusion: The applications of platelet and leukocyte-rich fibrin (L-PRF) in Oral and Maxillofacial Surgery and Traumatology are fundamental and promising. This advance represents not only a means of accelerating healing, but also a significant contribution to better aesthetic and functional results in surgical procedures in this area

COVID-19 pandemic impacts to Dentistry

ABSTRACT Objective: To achieve a literature review on the impacts of COVID-19 on dentistry. Methods: Analysis of scientific articles contained in the LILACS and PubMed platforms that fulfill the informative purpose of the research. Results: The production of aerosols during dental procedures could be highlighted as the most dangerous agent, the literature recommends restricting the type of service only to emergencies and reducing the use of rotating instruments or cough-inducing equipaments. New protective measures must be taken, such as the type of PPE used and the frequency of asepsis of the workplace, since any surface that has been exposed to oral or pharyngeal secretions may contain a load of viral particles, an online triage is also recommended before any assistance. Due to the easy spreading of this disease and the possibility of asymptomatic patients, the current best measure is avoiding the execution of procediments. Conclusion: COVID-19 will be a milestone for the current generations of health professionals, it could also be an advance for use distance technologies and integration of new biosafety techniques