Multiple Myeloma with primary manifestation in the mandible: a case report

Multiple myeloma is a monoclonal malignant proliferation of plasma cells that causes osteolytic lesions in the vertebrae, ribs, pelvic bone, skull and jaw. We report on a clinical case of an 81-year-old male patient who presented with a tumefaction in the mandibular symphysis region, which had evolved over the previous seven months. In the radiographic examination, an extensive osteolytic lesion was observed in the region mentioned above. An incisional biopsy was performed and a histopathological study revealed a malignant hematopoietic neoplasm formed by plasmacytoid cells. During the bone gammagraphy a dissemination of the disease was detected in the scapula, clavicle and ribs. The diagnosis was multiple myeloma. Knowledge about the maxillofacial manifestations of multiple myeloma is important for the early diagnosis of the disease, since its primary form can manifest itself in the jaw. In the clinical case presented here, we highlight the interdisciplinarity needed to obtain a diagnosis and treatment of multiple myelom

Tratamento adjuvante do ceratocístico odontogênico: série de casos/Adjuvant treatment odontogenic keratocyst: case séries

O Ceratocisto Odontogênico (CO) é uma lesão benigna, localmente agressiva e de potencial destrutivo. Comumente acomete a região posterior de mandíbula e ramo ascendente, com forte associação a presença de dentes inclusos. As altas taxas de recidiva associadas ao CO tornam a eleição da opção de tratamento ideal para cada caso um real desafio ao cirurgião. O presente artigo objetiva relatar uma série de casos de pacientes diagnosticados com CO em mandíbula, tratados inicialmente por descompressão e, em segundo tempo cirúrgico, realizada enucleação seguida de crioterapia adjuvante ou ostectomia. Foi realizado estudo retrospectivo, descritivo e analítico de pacientes atendidos no ambulatório de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Regional do Agreste, Caruaru-PE, Brasil. Foram acompanhados 06 pacientes, sendo 02 do sexo feminino e 04 do sexo masculino. Apresentavam idade entre 18 anos a 54 anos. Acometeram com maior frequência a região posterior de mandíbula direita. Todos apresentaram imagem unilocular ao exame radiográfico. O tratamento instituído para estes pacientes foi por descompressão e, em segundo tempo cirúrgico, realizada enucleação seguida de crioterapia adjuvante ou ostectomia. O tratamento selecionado foi eficaz para os casos relados, sem sinais de recidiva, necessitando de mais estudos para sua eficácia e evidencia científica.

Removal of a broken dental needle in the pterygomandibular space using an image intensifier: two case reports

Introduction: Accidents and complications are elements that can occasionally be associated with the procedures realized within work dentist environment. Among some accidents related to dental practice, needle fracture during local anesthesia is noteworthy due to its rarity. Objective: This work seeks to report two cases of removal of a broken dental needle in the pterygomandibular space using an image intensifier. Material and Methods: In both cases, the accident happened during an inferior alveolar nerve block. The surgeons requested image exams to locate the objects using general anesthesia. In the surgery, a transoral incision was made to remove the broken needle from the pterygomandibular space, guided by an image intensifier. Results: Both surgeries were a success. The broken needles were found quickly with the use of the image intensifier, and no postoperative complications were observed. Conclusion: The correct assessment of fractured dental position is essential for its removal. The use of the image intensifier has been showing advantages, such as offering fast transoperative dynamic images and at different angles, thus providing opportunity for calmer surgery and with less risk for the patient and the operator.Introdução: Acidentes e complicações são elementos que ocasionalmente podem estar associados a procedimentos realizados em ambiente de trabalho odontológico. Dentre alguns acidentes relacionados à prática odontológica, a fratura por agulha durante a anestesia local destaca-se pela raridade. Objetivo: o presente estudo tem como objetivo relatar dois casos de retirada de uma agulha dentária quebrada no espaço pterigomandibular com intensificador de imagem. Material e Métodos: Em ambos os casos, o acidente ocorreu durante um bloqueio do nervo alveolar inferior. Os cirurgiões solicitaram exames de imagem para localizar os objetos por meio de anestesia geral. Na cirurgia, foi realizada uma incisão transoral para retirada da agulha quebrada do espaço pterigomandibular, guiada por um intensificador de imagem. Resultados: Ambas as cirurgias foram um sucesso. As agulhas quebradas foram encontradas rapidamente com o uso do intensificador de imagem, sem complicações pós-operatórias. Conclusão: A correta avaliação da posição dentária fraturada é fundamental para sua remoção. O uso do intensificador de imagem tem mostrado vantagens, como oferecer imagens dinâmicas transoperatórias rápidas e em diferentes ângulos, trazendo assim uma oportunidade para cirurgias mais tranquilas e com menor risco para o paciente e o operador

Oral angioleiomyoma: a case report and considerations on differential diagnosis

Angioleiomyomas are benign mesenchymal tumors derived from smooth muscle, which rarely occur in the oral cavity. We report a case of an angioleiomyoma occurring in the maxillary gingiva. The lesion was painless, with a lobulated surface, fibrous in consistency, and firm upon palpation. Microscopic examination showed an encapsulated tumor mass composed of large vascular channels of varying calibers, surrounded by thick walls of irregularly arranged, spindle-shaped cells, which were immunopositive for smooth-muscle actin. It is sometimes difficult to differentiate an angioleiomyoma from other spindle-cell tumors, thus we emphasize its histological differential diagnosis

Multiple Myeloma with primary manifestation in the mandible: a case report

Multiple myeloma is a monoclonal malignant proliferation of plasma cells that causes osteolytic lesions in the vertebrae, ribs, pelvic bone, skull and jaw. We report on a clinical case of an 81-year-old male patient who presented with a tumefaction in the mandibular symphysis region, which had evolved over the previous seven months. In the radiographic examination, an extensive osteolytic lesion was observed in the region mentioned above. An incisional biopsy was performed and a histopathological study revealed a malignant hematopoietic neoplasm formed by plasmacytoid cells. During the bone gammagraphy a dissemination of the disease was detected in the scapula, clavicle and ribs. The diagnosis was multiple myeloma. Knowledge about the maxillofacial manifestations of multiple myeloma is important for the early diagnosis of the disease, since its primary form can manifest itself in the jaw. In the clinical case presented here, we highlight the interdisciplinarity needed to obtain a diagnosis and treatment of multiple myelom