Recurrent solid ameloblastoma of the maxillary sinus: A case report

Introduction. Ameloblastomas are clinically the most important type of odontogenic tumors. Solid or multicystic form most commonly affects mandible, it is highly aggressive and shows high rates of recurrence. The aim was to report aggressive behavior of a rare maxillary solid ameloblastoma, emphasizing the clinical, tomographic and histological aspects. Case Report. A young and asymptomatic patient, presenting a solid ameloblastoma initially located in the maxillary sinus with rapid spreading to the adjacent tissues, had early recurrence despite radical surgical approach. Conclusion. Multicystic or solid ameloblastoma has lower incidence in maxilla and extremely aggressive behavior, justifying careful follow-up of the patients

Estudo radiográfico da ossificação dos ligamentos pterigoespinhoso e pterigoalar pela técnica axial de Hirtz invertida

A correta identificação radiográfica da ossificação dos ligamentos pterigoespinhoso e pterigoalar é de grande importância nos procedimentos cirúrgicos no tratamento da nevralgia trigeminal. A maioria desses procedimentos é feita via forame oval, local onde é possível encontrar esses ligamentos ossificados parcial ou totalmente. Estudou-se, pela técnica axial de Hirtz invertida, as características radiográficas desses ligamentos ossificados e sua localização em relação ao forame oval. Para isso foram radiografados 93 crânios secos, pertencentes à Disciplina de Anatomia da Faculdade de Odontologia de São José dos Campos - UNESP, que apresentavam a ossificação parcial ou total dos referidos ligamentos. Encontrou-se o ligamento pterigoespinhoso em 27,97% das radiografias, sendo parcialmente ossificado em 19,36% e totalmente em 8,61%. O ligamento pterigoalar estava presente em 62,35% das radiografias, estando parcialmente ossificado em 49,44% e totalmente em 12,91%. O ligamento pterigoespinhoso foi encontrado parcial e totalmente ossificado, numa mesma radiografia, em 3,23% dos casos, enquanto o ligamento pterigoalar apareceu parcial e totalmente ossificado, na mesma radiografia, em 6,45% dos casos. Observou-se ainda que o ligamento pterigoespinhoso era menos espesso e localizado mais para medial em relação ao forame oval, enquanto o ligamento pterigoalar formava uma larga barra óssea lateralmente ao forame oval, obliterando muitas vezes o lúmen do mesmo. A técnica axial de Hirtz invertida é um excelente meio para a observação da ossificação total ou parcial destes ligamentos, quando de procedimentos cirúrgicos que utilizam o forame oval para o tratamento da nevralgia trigeminal.The correct radiographical identification of ossification of pterigospinous and pterigoalar ligament has great importance in surgical procedures in nevralgia trigeminal treatment. Most of them were made by ovale foramen where it is possible to find the ligament partial or total ossificated. The radiographical characteristics of this ligament and the relation of them with ovale foramen were studied by inverted Hirtz axial technique. Ninety-three dried skulls, belonging to the UNESP Subject of Anatomy-University of Dental School of São José dos Campos having ossified pterigospinous and pterygoalar ligament, were x-rayed. Pterigospinous ligament was found in 27,97% of x-rays, partially ossified in 19,36% and totally ossified in 8,61%. In 3,23% of them it was found partially and totally ossified in the same radiography. Pterygoalar ligament was found present in 62,35% of the x-rays, partially ossified in 49,44% and totally ossified in 12,91%. In 6,45% of them it was found partially and totally ossified in the same radiography. It was still observed that pterigospinous ligament was a more fine bar and placed in a medial position in relation of ovale foramen, however, pterigoalar ligament formed a large bar placed in a lateral position in relation of ovale foramen, which hidden the lumen of this foramen. The inverted Hirtz axial technique allows us excelent observation of the ossified ligament and procedures for nevralgia trigeminal treatment, by ovale foramenCoordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Evaluation of renal osteodystrophy in the dental clinic by assessment of mandibular and phalangeal cortical indices

Abstract Objectives Secondary hyperparathyroidism (SHPT) is a disease that affects patients with chronic kidney disease, and is characterized by mineral disturbance and bone loss, known as renal osteodystrophy. The aim of this study was to assess the validity of using intraoral phosphor storage plates to take radiographs of the middle phalanges to evaluate bone loss resulting from SHPT during follow-up of these patients. Methods The sample consisted of 24 patients with chronic kidney disease, 12 with parathyroid hormone (PTH) levels ≥500 pg/ml, and 12 with PTH levels <500 pg/ml, who underwent hemodialysis weekly. For each patient, a panoramic radiograph and digital radiographs of the ring, index, and middle fingers of both hands were taken. The Mandibular Cortical Index (MCI) and the Trabecular Bone Pattern Index (TBP) were applied to the panoramic radiographs, while the Phalangeal Cortical Index (PCI) was applied to the digital radiographs of the phalanges. Three evaluators performed all analyses. Results Significant correlations were found between the PTH levels and the MCI (p = 0.023), the PCI (p = 0.039) and the TBP index (p = 0.032). These parameters were also significantly interrelated (MCI × PCI = 0.001; MCI × TBP = 0.004 and PCI × TBP = 0.009). The PCI was shown to have the highest correlation with PTH levels. Conclusion In patients with chronic renal disease, it is clinically relevant to use panoramic and digital radiographs using intraoral storage plates to assess a number of quantitative parameters that can be linked to PTH levels.status: publishe

Evaluation of renal osteodystrophy in the dental clinic by assessment of mandibular and phalangeal cortical indices

OBJECTIVES: Secondary hyperparathyroidism (SHPT) is a disease that affects patients with chronic kidney disease, and is characterized by mineral disturbance and bone loss, known as renal osteodystrophy. The aim of this study was to assess the validity of using intraoral phosphor storage plates to take radiographs of the middle phalanges to evaluate bone loss resulting from SHPT during follow-up of these patients. METHODS: The sample consisted of 24 patients with chronic kidney disease, 12 with parathyroid hormone (PTH) levels ≥500 pg/ml, and 12 with PTH levels <500 pg/ml, who underwent hemodialysis weekly. For each patient, a panoramic radiograph and digital radiographs of the ring, index, and middle fingers of both hands were taken. The Mandibular Cortical Index (MCI) and the Trabecular Bone Pattern Index (TBP) were applied to the panoramic radiographs, while the Phalangeal Cortical Index (PCI) was applied to the digital radiographs of the phalanges. Three evaluators performed all analyses. RESULTS: Significant correlations were found between the PTH levels and the MCI (p = 0.023), the PCI (p = 0.039) and the TBP index (p = 0.032). These parameters were also significantly interrelated (MCI × PCI = 0.001; MCI × TBP = 0.004 and PCI × TBP = 0.009). The PCI was shown to have the highest correlation with PTH levels. CONCLUSION: In patients with chronic renal disease, it is clinically relevant to use panoramic and digital radiographs using intraoral storage plates to assess a number of quantitative parameters that can be linked to PTH levels.status: publishe

EL USO DE SIALOGRAFÍA EN EL DIAGNÓSTICO Y TRATAMIENTO DE LA PAROTIDITIS RECURRENTE JUVENIL: PRESENTACIÓN DE UN CASO

La parotiditis recurrente juvenil (PRJ) es una enfermedad inflamatoria de la gl&aacute;ndula par&oacute;tida, generalmente se caracteriza por episodios recurrentes de hinchaz&oacute;n, dolor y fiebre. Despu&eacute;s de la parotiditis epid&eacute;mica, es la PRJ en los ni&ntilde;os, la segunda enfermedad m&aacute;s frecuente de las gl&aacute;ndulas salivales. La aparici&oacute;n de PRJ se produce alrededor de 6 a&ntilde;os de edad y hay una ligera predilecci&oacute;n por los varones. La etiolog&iacute;a de la enfermedad sigue siendo poco clara y los s&iacute;ntomas tienden a desaparecer con la pubertad. Este estudio reporta el caso de un joven de 12 a&ntilde;os que se present&oacute; a la Facultad de Odontolog&iacute;a de la Universidad Estadual Paulista, Sao Jos&eacute; dos Campos, con una historia de episodios recurrentes de hinchaz&oacute;n de la gl&aacute;ndula par&oacute;tida izquierda asociada con dolor, fiebre y secreci&oacute;n purulenta en los primeros eventos. Terminada la anamnesia, se decidi&oacute; por obtener sialograf&iacute;as de las dos gl&aacute;ndulas par&oacute;tidas con el uso de material de contraste Lipiodol UF 38% y radiograf&iacute;as panor&aacute;micas, seguidas por las evaluaciones morfol&oacute;gicas y funcionales. El paciente se encuentra hoy sin presentar recurrencia de la enfermedad y est&aacute; bajo seguimiento cl&iacute;nico. ABSTRACT The Juvenile Recurrent Parotitis (JRP) is an inflammatory disease of the parotid gland, usually characterized by recurrent episodes of swelling, pain and fever. After mumps, the PRJ in children is the second most prevalent disease of salivary glands. The emergence of PRJ occurs around 6 years old and there is a slight predilection for males.The etiology of the disease remains unclear and the symptoms tend to disappear with puberty. This study reports the case of a twelve years old boy who presented to the Dentistry School of S&atilde;o Paulo State University - campus S&atilde;o Jos&eacute; dos Campos- with a history of recurrent episodes of swelling of the left parotid gland associated with pain, fever and purulent discharge in the early events . Finished the anamnesis, sialography were performed with the use of Lipiodol UF 38% contrast material and panoramic radiographs on both parotid glands, followed by morphological and functional assessments. There was no recurrence of the disease and the patient is under follow-up

Severe secondary hyperparathyroidism and panoramic radiography parameters

Renal osteodystrophy (RO) are skeletal abnormalities seen in patients with secondary hyperparathyroidism (SHPT). This study aims to evaluate the effects of RO using panoramic radiography parameters. Furthermore, the correlation between these parameters and parathyroid hormone (PTH) levels was tested.status: publishe

Severe secondary hyperparathyroidism and panoramic radiography parameters

Renal osteodystrophy (RO) are skeletal abnormalities seen in patients with secondary hyperparathyroidism (SHPT). This study aims to evaluate the effects of RO using panoramic radiography parameters. Furthermore, the correlation between these parameters and parathyroid hormone (PTH) levels was tested.Qualitative (mandibular cortical index/trabecular bone pattern) and quantitative parameters (mental index/calcification and resorption foci) were applied from panoramic radiographs of chronic kidney disease (CKD) patients and controls. Frequency distribution and descriptive analysis were used to compare the results of both groups. Spearman's correlation coefficient evaluated the correlation between serum PTH levels of CKD patients and the radiographic parameters. Intra- and interobserver agreement was tested using the intraclass correlation coefficient and kappa index.Intra- and interobserver agreement was respectively excellent (0.81-1.00) and good (0.61-0.80). Qualitative parameters demonstrate significant difference compared with the control group. Mean mental index was lower in patients with CKD (3.17 +/- 1.35 mm), but the difference was not significant. Calcification/resorption foci (3.63 +/- 2.07) of CKD patients were significantly more present than in the control group (p = 0.0001). PTH levels were correlated with mental index, mandibular cortical index and trabecular bone pattern (respectively, 0.0034, 0.0315, and 0.0370).RO presented a number of characteristic bone metabolic effects in the jaws that could be observed on panoramic radiographs. Radiographs of CKD patients demonstrate significantly more calcification and resorption.The mental index, mandibular cortical index, and trabecular bone pattern are good parameters for evaluating the effects of RO on severe secondary hyperparathyroidism.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Correlation between hand/wrist and panoramic radiographs in severe secondary hyperparathyroidism

Objectives: Hand/wrist and dental radiographs are important for osteoporosis analysis in secondary hyperparathyroidism (SHPT). This study evaluated whether a correlation exists between the effects of the disease on the hands and jaws, and investigated the association between osteoporosis progression in the hands and parathyroid hormone (PTH) levels in chronic kidney disease (CKD) patients. Materials and methods: Four panoramic radiographic parameters (mental index, mandibular cortical index, trabecular bone pattern, and calcification/resorption) and four corresponding hand/wrist radiographic parameters (metacarpal cortical thickness, phalangeal cortical index, trabecular bone pattern, and calcification/resorption) were applied to investigate possible correlation between the effects of SHPT on the jaws and hands/wrists, by Spearman's correlation coefficient. PTH levels and the hand/wrist radiographic parameters were also tested by spearman's correlation coefficient (p < 0.05). The presence of brown tumors, vascular calcifications, and acroosteolysis on the hands was also evaluated. Results: Mandibular cortical index was strongly correlated with the phalangeal cortical index (p = 0.000). Phalangeal cortical index and trabecular bone pattern of hand/wrist correlated with PTH levels (0.002 and 0.000, respectively). Brown tumors occurred in four CKD patients, while both vascular calcifications and acroosteolysis were observed in 19 patients. Conclusion: There is a significant correlation between the morphological changes caused by secondary hyperparathyroidism in hand and jaw bones. The morphological status can be assessed using the mandibular cortical index, besides the phalangeal cortical index. The latter correlates well with parathyroid hormone levels of advanced chronic kidney disease. Clinical relevance: Panoramic images reveal morphological changes in the jaw bone, indicating likewise changes in the hand/wrist in severe secondary hyperparathyroidism. The severity of the bone changes may be a reflection of the parathyroid hormone levels in advanced chronic kidney disease. © 2012 Springer-Verlag