Jordi | Journal of Oral Diagnosis Online Submission Review an Article SOBEP - Sociedade Brasileira de Estomatologia e Patologia Oral
Current Number: V1 - 2016

Original Article

1 - Surgical approach to pleomorphic adenomas arising in the palate: a 10-year retrospective study in a Brazilian population

Eduardo Costa Studart Soares1; Fábio Wildson Gurgel Costa2; Tácio Pinheiro Bezerra3; Carlos Bruno Pinheiro Nogueira4; José Rômulo de Medeiros4; Ivo Cavalcante Pita Neto5

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Salivary gland tumors represent an important group of neoplasms characterized by a great diversity of types and morphological variants. Pleomorphic adenoma is the most common benign tumor occurring in the major and minor salivary glands. The majority of case series described in the literature refers to epidemiological data of major and minor salivary gland tumors, generally being of a benign or malignant nature. Studies reporting exclusively surgical treatment experience with pleomorphic adenomas of the palate are scarce. Therefore, the aim of this study was to report data on the treatment experience with surgical removal of pleomorphic adenoma of the palate together with to nearby mucosal lining with or without ostectomy. Clinical records of all patients diagnosed with pleomorphic adenoma of the palate seen at Brazilian public service dental clinic (Oral and Maxillofacial Surgery Division) and at a private clinic between March 1999 and November 2010 were reviewed. The analysis of the biopsied specimens yielded 10 cases during the 10-year period. Of all the patients 8 were women, with mean age 39 years. The most common main complaint was asymptomatic increase in volume (n = 9), with mean tumor size 2.1 cm. Most patients (n = 8) underwent excision of tumor and mucosal lining. One patient underwent bone ostectomy and in another, the tumor regressed after incisional biopsy. The mean follow-up was 26,8 months (12-42 months) with no recurrences, and the main complication was local discomfort and dysphonia (n = 2). In summary, surgical excision of the tumor and mucosal lining, with or without ostectomy, was shown to be an effective treatment modality for pleomorphic adenomas of the palate.

Keywords: epidemiology, oral pathology; salivary gland neoplasms..

2 - Prevalence of oral and maxillofacial diseases diagnosed in an Oral Medicine service during a 7-year period

Simone de Macedo Amaral1; Águida Maria Menezes Aguiar Miranda2; Juliana de Noronha Santos Netto3; Fábio Ramôa Pires4

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Prevalence of oral and maxillofacial diseases is highly variable depending on the region, country and source of the data. The aim of this study was to determine the prevalence of oral and maxillofacial diseases diagnosed in an Oral Medicine service during a 7-year period. All clinical charts from patients attending the service in the period were reviewed to retrieve demographic and clinical data; diagnosis were classified in groups, distributed in absolute and relative values and analyzed with respect to their frequency. A total of 1075 clinical charts were reviewed and females represented 60% of the sample. Mean age of the patients was 41 years (ranging from 1 month to 94 years old) and most patients were in their fourties to fifties. A total of 1444 oral diseases were diagnosed and the most prevalent groups were soft-tissue tumors (184 cases, 12.7%), developmental defects (161, 11.2%) and epithelial diseases (127, 8.8%). Individually, the most frequent diseases included fibrous hyperplasias (120 cases, 8.3%), candidosis (77, 5.3%), periradicular inflammatory lesions (72, 5.0%) and potentially malignant disorders (52, 3.6%). Oral carcinomas represented 2.5% of the sample (36 cases). The present results reflect the frequency of oral diseases diagnosed in a specialized service in southeastern Brazil and will allow the establishment of preventive strategies and the adequacy of the clinical services offered to the target population.

Keywords: disease; epidemiology; mouth; oral medicine..

3 - Treatment modalities of oral lichen planus: an update

Santosh Patil1; Suneet Khandelwal2; Nidhi Sinha3; Sumita Kaswan4; Farzan Rahman5; Shoaib Tipu6

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Oral lichen planus is an immunologically based, chronic, inflammatory, mucocutaneous disorder of undetermined etiology. It is a relatively common disorder affecting stratified squamous epithelia. It is of special importance due to its malignant potential and can be a source of morbidity. The management of oral lichen planus should therefore address both the transformation rate as well as the patient symptoms. Care and management of such patients challenges even the most experienced clinician. There is currently no cure for OLP. Treatment is aimed primarily at reducing the length and severity of symptomatic outbreaks. The review critically analyses the various options in the literature and discusses the practical management from the Indian perspective.

Keywords: lichen planus, oral; management..

4 - Schwannoma of the upper lip: a 66-year single-center retrospective analysis in southern Brazilian population and literature cases review

Marina Curra1; Manoel Sant'Ana Filho2; Marco Antonio Trevizani Martins3; Juliana Romanini4; Vinicius Coelho Carrard2; Manoela Domingues Martins2

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Schwannoma is a benign tumor of neural origin. This condition is uncommon in the upper lip. The aim the present study was to perform an analysis of lip lesions at an oral pathology laboratory to determine the frequency of schwannoma of the upper lip and perform a literature review to correlate with the cases of this study. A retrospective analysis was performed at the oral pathology laboratory and the histopathological records from 1946 to 2012 were retrieved and organized in a database. Cases of schwannoma of the upper lip were identified and analyzed. Moreover, a literature review was performed on schwannomas found in this same anatomic site. In this period, 1195 lip lesions were diagnosed, among which four were cases of schwannoma on the upper lip (0,33%). Of these, 3 cases were in women; the mean age of patients was 45 years old. In all cases the clinical diagnosis hypothesis involved reactive lesion or benign neoplasm. The final diagnosis of schwannoma was obtained following the histopathological examination of the surgical specimens. This study emphasizes the low frequency of schwannoma in the upper lip and the importance of histological evaluation to define the final diagnosis which usually represents unexpected outcomes.

Keywords: lip; lip neoplasms; neurilemmoma; soft tissue neoplasms..

5 - Reconstitution of the immunological defence and Candida albicans infection in oral mucosa of HIV+ patients under HAART

Marinho Del Santo

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The HIV infection is a worldwide spread disease which with the HAART (highly active antiretroviral therapy) application has became a chronicle disease. The HAART promotes the reduction of the HIV viral load and partial and temporary reconstitution of the immunological defence system of the HIV-infected subject, although for that its toxicity and patient adherence to the treatment might be well monitored. With the HAART, the past high prevalence of oral and oropharyngeal lesions decreased significantly, although in a non-homogeneous pattern. The fungus Candida albicans is a commensal microorganism of the human gut tract which provokes an opportunistic infection, when there is an imbalance between its virulence and the defence conditions of the host. The pathogenicity of the Candida albicans influences the degree of opportunistic infection; however, the fungical colonization is mainly dependent of the current immunological status of the patient. The host defence against Candida albicans is also provided by non-immunological barriers, physical as the keratinocytes of the oral epithelium, serological as the neutrophils, polymorphonuclear leukocytes and macrophages or humoral as the saliva, although the role of the salivary immunoglobulins is still unclear. Independently of the immunosuppression, the sensitive control to balance immunological innate and immunological acquired actions is complex and it prevents against an indiscriminate immunological acquired response. Dendritic cells and lymphocytes are the main defensive immunological cells of the oral mucosa. The dendritic cells phagocytise and deplete microorganisms, presenting the products of such depletion as antigens to the T lymphocytes, which provide acquired immunological defence for excellence. Specific Th1 type provides cell-mediated immunological protection against Candida albicans and other pathogens. Moreover,Th2 type cells provide immunological tolerance against external and auto-antigens. Treg and Th17 cells are actors of vital importance in the switching between Th1 type and Th2 type responses, although the complete understanding of their roles in this balance is still an ongoing process.

Keywords: candida albicans; HAART; HIV+ patients; immunological defence; oral mucosa..

6 - Herpetic Oral Manifestation In Acute Myeloid Leukemia: case report

Thiago Pires Brito1; Alexandre Caixeta Guimarães1; Guilherme Machado de Carvalho2; Tammy Fumiko Messias Takara3; Felipe Henrique Yazawa Santos3; Icléia Siqueira Barreto4; Ana Cristina Dal Rio5; Maria Elvira Pizzigatti Corrêa5; Ester Maria Danielli Nicola6

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Viral infections in the oral cavity are frequent complications in patients with immunosuppression. The herpes simplex virus is among the most frequent causes of these infections. In immunocompromised patients the presentation may be atypical, with more extensive lesions, painful and with slower recovery. The goal of this article is to present a illustrative case of herpes oral infection in an immunosuppressed patient. CASE REPORT: Female patient, 43 years old, 32 days after the start of chemotherapy for acute myeloid leukemia, began complaining of odynophagia and painful emergence of lesions in the oral cavity. She presented multiple whitish ulcerated lesions with an erythematous halo, measuring around 0.5 cm in diameter across the mouth and the posterior wall of oropharynx. Treated with acyclovir with rapid improvement of symptoms and lesions. Cytological changes were found compatible with herpes simplex. DISCUSSION: In most cases of infection with herpes simplex the presentations are self-limited but severe infections may occur and atypical in immunosuppressed individuals. Additional exams help in diagnosis as diagnostic cytology, ELISA and direct immunofluorescence. Acyclovir is the drug of choice for the treatment recommended dose of 1 g/day for a minimum period of 10 days. CONCLUSION: The oral lesions of herpes virus in immunosuppressed patients may have varied presentations and can often go unnoticed, as in mild or asymptomatic cases. However, due to the possibility of systemic spread of infection and the occurrence of severe manifestations, one should be highly suspected before the appearance of any oral lesion in the immunosupressed patients.

Keywords: herpes simplex; immunosuppression; leukemia, myeloid, acute; oral medicine..

7 - Calcified fibrous nodules in masseter muscle - A case report and possible etiologies

Renata Cunha Barros1; Gabriela Mendes Gonçalves1; David Moreira2; Miguel Andrade Setubal3; Eduardo Gonçalves Ramos4; Alena Ribeiro Alves Peixoto Medrado5

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Fibro-calcified nodules represent a rare group of lesions that are composed of fibrous connective tissue with calcified areas. The etiology of fibro-calcified nodules may be related to secondary changes that are caused by trauma, infectious and autoimmune diseases, or calcified thrombi. The purpose of this paper is to report the presence of a lesion of a fibro-calcified nature in the masseter muscle and its possible etiologies. The patient, a 35-year-old melanoderm female, presented with a nodule in the left masseter region with 12 months of progression. Considering the accessibility of the lesion, an excisional biopsy was performed. A histopathological examination revealed residual fibro-calcified nodules with central foci of coagulation necrosis surrounded by fatty tissue and striated skeletal muscle fibers. The test for acid-alcohol-resistant bacillus (BAAR) was negative. Two years after the surgical procedure, there were no signs of lesion recurrence. Thus, the results of histochemical staining ratified the fibro-calcified aspect of the lesion, which suggested dystrophic calcification.

Keywords: autoimmune diseases; calcification, physiologic; latent tuberculosis, soft tissue infections..

8 - Oral manifestation of thrombocytopenia in immunosuppressed patient - Report of case

Antonio Adilson Soares de Lima1; Norma Suely Falcão de Oliveira Melo2; Francisca Berenice Dias Gil3

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Thrombocytopenia (or thrombopenia) is a relative decrease of platelets in blood. This condition is associated with increased mortality rates in critically ill patients. It is especially present in cases of sepsis, but can also be caused by medications or associated with the use of foreign materials. Many physiological mechanisms (immune-mediated, consumption or destruction) are involved in the decrease of platelet count. This manuscript describes a case of severe thrombocytopenia with oral manifestation in immunosuppressed patient. A 39-year-old male was admitted to the Hospital Oswaldo Cruz complaining of bleeding in the lower lip. Epistaxis, crusts on the lips and red lesions in the hard palate were observed.

Keywords: acquired immunodeficiency syndrome; lood platelets; platelet count; thrombocytopenia..

9 - Hutchinson-Gilford Progeria Syndrome (HGPS): relevant aspects of a rare syndrome diagnosed in a Brazilian child

Alexandre Simões Nogueira1; Carlos Bruno Pinheiro Nogueira2; Rômulo Medeiros2; Ana Cristina Beviláqua3; Paulo Sérgio da Silva Santos4; Izabel Regina Fischer Rubira-Bullen5; Eduardo Sanches Gonçales6

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Hutchinson-Gilford Progeria Syndrome (HGPS) is an extremely rare genetic condition characterized by premature aging and it's about one case for every four to eight million people. Children affected usually have premature death due to cardiovascular problems. The gene that causes progeria was recently discovered and it has attracted the interest of the scientific community worldwide not only by the possibility of cure of this genetic pathology but also because of the possibility to retard or to minimize the effects of premature aging caused by the disease in human beings. Among the oral and facial findings is remarkable the delay in tooth eruption, the micrognathia and the disproportion between the skull and face. Dental treatment is directed to preventive aspects and strict supervision of oral conditions in order to minimize the need for more invasive treatments. The authors highlight the most relevant aspects related to that syndrome, emphasizing the important aspects to all the oral and maxillofacial surgeons, reporting a case of progeria in a five-year old Brazilian child.

Keywords: cell aging; oral manifestations; progeria..

10 - Painful keratocystic odontogenic tumor due to secondary infection associated to pulp necrosis

Isadora Peres Klein1; Manoela Domingues Martins2; Marco Antonio Trevizani Martins2; Manoel Sant'Ana Filho3; Pantelis Varvaki Rados3; Vinicius Coelho Carrard2

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The keratocystic odontogenic tumor (KCOT) is defined as a benign, odontogenic, uni- or multicystic intraosseous tumor with infiltrative behavior. KCOTs occur over a broad age range, predominantly in the second and third decades of life. This odontogenic tumor is usually asymptomatic and diagnosed incidentally on routine radiographs. Growth is typically medullary and there is no bone expansion in the majority of cases. In the present case, the patient exhibited pain and expansion of buccal cortical bone, unusual findings in this tumor. This could be related to pulp necrosis of the adjacent decayed tooth, leading to a secondary infection of the KCOT. These circumstances become the diagnosis difficult, because the clinical signals and symptoms strongly mimic an inflammatory lesion.

Keywords: odontogenic keratocyst; odontogenic tumors; recurrence..

11 - A rare case of intraoral trichilemmal cyst

Aline Corrêa Abrahão, DDS, PhD1,3; Felipe Perozzo Daltoé, DDS, MS1; Valdirene Alves dos Santos, DDS, MS2; Norberto Nobuo Sugaya, DDS, PhD2; Décio dos Santos Pinto Jr, DDS, PhD1

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Trichilemmal cysts, also known as pilar cysts, are slow-growing lesions commonly found on the scalp of elderly women. They arise from outer root sheath epithelium and have a distinctive pattern of keratinization called trichilemmal keratinization. Here, we describe a rare case of a trichilemmal cyst on the lower lip mucosa of a 29-year-old man. The infrequency of intraoral hairs unquestionably results in the shortage of reported cases of trichilemmal cysts into the oral cavity.

Keywords: intraoral hair, pilar cyst, trichilemmal cyst..

12 - Canalicular adenoma of the minor salivary gland in the upper lip: case report

Roberta Targa Stramandinoli-Zanicotti, DDS, MSc1; Thiago Serafim Cesa, DDS1; Jean Della Giustina, DDS1; João Augusto Bahr, MD2; Juliana Lucena Schussel, DDS, PhD1; Laurindo Moacir Sassi, DDS, PhD1

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Canalicular adenoma is a rare benign tumor of the minor salivary glands that is the most prevalent in older adults (mean age, 60 years). The upper lip is the most commonly affected site, followed by the buccal mucosa and palate. It presents as a nodular lesion without a tendency for recurrence. Here, we describe a case of canalicular adenoma presenting as a nodular, painful mass in the upper lip of a 62-year-old man with a history of trauma. Fine needle aspiration biopsy yielded inconclusive results but excluded malignancy. The lesion was enucleated, and a definitive diagnosis of canalicular adenoma was established by histological and immunohistochemical analyses. No signs of recurrence were noted at the 8-month follow-up examination. The case emphasizes the importance of differential diagnosis of nodular lesions in the oral mucosa for appropriate treatment and histological analysis for definitive diagnosis.

Keywords: adenoma, lip, salivary gland neoplasm..

13 - Expression of EGF and its receptor and histomorphometric analysis of epithelial tissue in gingival fibromatosis

Carolina de Oliveira Santos1; Thiago Fonseca Silva1; Paulo Rogério Bonan1; André Luiz Sena Guimarães1; Ricardo Della Coletta2; Hercílio Martelli-Júnior1

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Gingival fibromatosis, a relatively rare condition, develops as a slowly progressing, benign, and localized or generalized enlargement of keratinized gingiva. The purpose of this study was to investigate the expression of epidermal growth factor and the epidermal growth factor receptor and perform histomorphometric analysis of epithelial tissue in gingival fibromatosis. Immunohistochemistry with antibodies against the aforementioned antigens was performed in gingival tissues from a family with hereditary gingival fibromatosis and a family with syndromic dental anomaly-associated gingival fibromatosis ; normal gingiva was used for comparison. The height of epithelial papillae and area and perimeter of epithelial layers were measured for histomorphometric analysis. Immunoreactivity to epidermal growth factor was found in the cytoplasm of epithelial cells, and immunopositivity for epidermal growth factor receptor was detected in the cytoplasm and membrane of epithelial cells. No differences in the expression of these proteins were observed among the groups. The gingival fibromatosis groups had higher epithelial papillae and larger epithelial areas that the normal gingiva group. Our findings suggest that enlargement of epithelial layers is associated with both forms of gingival fibromatosis.

Keywords: epidermal growth factor, epidermal growth factor receptor, gingival fibromatosis, normal gingiva..

14 - Hepatitis C infection: challenges in dental management and diagnosis of extrahepatic manifestations

Cláudia Misue Kanno, DDS, PhD1; Alvimar Lima de Castro, DDS, PhD2; Marcelo Macedo Crivelini, DDS, PhD2

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Hepatitis C is associated with autoimmune diseases, hepatocellular carcinoma, and extrahepatic manifestations that, in conjunction, may seriously compromise the patient's quality of life. We herein describe a case of chronic hepatitis C with oral manifestations and discuss some implications for diagnosis and treatment. A 63-year-old woman complaining of spontaneous bleeding of the oral mucosa presented with bilateral asymmetric ulcers surrounded by white papules and striae on the buccal mucosa. Her medical history revealed leucopenia, thrombocytopenia, and skin lesions associated with chronic hepatitis C. Propranolol and ranitidine had recently been prescribed. Lichen planus, lichenoid reaction, and erythema multiforme were considered in the differential diagnosis. Histopathological analysis revealed lymphocytic infiltrate in a lichenoid pattern. The lesions partially healed after 1 week and completely regressed after 6 months, despite the maintenance of all medications; no recurrence was observed. The final diagnosis was oral lichen planus associated with hepatitis C. Chronic hepatitis C may present oral manifestations, which demand adjustments in dental treatment planning. Medication side effects may interfere with the clinical presentation and course of the disease and should be accounted for in the differential diagnosis. The possibility of spontaneous remission of oral lichen planus should always be considered, especially when putative etiological factors of a lichenoid lesion are withdrawn in an attempt to differentiate oral lichen planus from lichenoid lesions. This case emphasizes the importance of recognizing the extrahepatic manifestations of hepatitis C as a cause of increased morbidity.

Keywords: chronic hepatitis c, leucopenia, oral diagnosis, oral lichen planus, thrombocytopenia..

15 - Nevoid basal cell carcinoma syndrome: an analysis of four familial and two sporadic cases

Lucielma Salmito Soares Pinto, DDS, PhD1; Román Carlos-Bregni, DDS2; Hercílio Martelli Júnior, DDS, PhD3; Mário Rodrigues Melo Filho, DDS, MSc3; Wilson Delgado Azañero, DDS4; Jorge Esquiche León, DDS, PhD1; Márcio Ajudarte Lopes, DDS, PhD1; Oslei Paes Almeida, DDS, PhD1; Jacks Jorge, DDS, PhD1

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The nevoid basal cell carcinoma syndrome (NBCCS) is an autosomal dominant disorder with complete penetrance and variable expressivity. It is caused by mutations in the patched gene, mapped to chromosome 9q22.3-q31. Its characteristics include multiple basal cell carcinomas, odontogenic keratocysts, vertebral and rib anomalies, and intracranial calcifications. Here, we describe the features of 4 familial and 2 sporadic cases of the NBCCS.

Keywords: congenital malformations, nevoid basal cell carcinoma syndrome, odontogenic keratocyst, ptch, skeletal anomalies..

16 - Orofacial manifestations of the Levy-Hollister syndrome

Denis Damião Costa1; Candice Belchior Silva Duplat2; Mariana Mota Campos Mariano2; Bruno Campos Nascimento3; Caroline Chaves Maia2; Antônio Fernando Pereira Falcão4

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The Levy-Hollister syndrome, also known as the lacrimo-auriculo-dento-digital (LADD) syndrome, shows different phenotypes, resulting in a variety of local and systemic signs and symptoms. It is a rare hereditary disorder that mainly causes lacrimal, auricular, and auditory apparatus disturbances and dental and digital anomalies. Here, we describe a case of the Levy-Hollister syndrome in a 24-year-old woman and focus on its orofacial manifestations. The patient had chronic lacrimation, low-set ears, thumb agenesis, elbows with limited pronation and supination movements, pronounced hallux on the left foot, concave facial profile, and tooth roots with atypical morphology. The case emphasizes the importance of a multidisciplinary approach for early diagnosis of the Levy-Hollister syndrome.

Keywords: dental anomalies, diagnosis, digital anomalies, hereditary disorder..

17 - Paracoccidioidomycosis prevalence in a public laboratory of the Brazilian unified health system

Artur Aburad de Carvalhosa1; Fabiano Tonaco Borges2; Diurianne Caroline Campos França3; Raíssa Rezende Queiroz4; Suzely Adas Saliba Moimaz5; Cléa Adas Saliba Garbin6

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Paracoccidioidomycosis (PCM) is a systemic fungal disease with oral manifestations that is the most prevalent in Latin America. The purpose of this cross-sectional epidemiological study was to examine the prevalence of PCM in the Public Laboratory (MT Laboratory) of the Brazilian Unified Health System in Mato Grosso. The following data from 3670 cytological and histopathological reports of oral lesions issued by the MT Laboratory over a 4-year (2004-2008) period were analyzed: diagnostic method (oral exfoliative cytology or biopsy), diagnosis by year, origin of cases (urban or rural), and patient gender and age. In the assessment period, 96 cases (2.6%) of PCM were diagnosed. Most cases originated from rural areas (94%), and PCM was the most prevalent in men (97.9%) and in the fifth decade of life (35.4%). These results show that Mato Grosso had a considerable number of PCM cases over a small period, suggesting that this state is an endemic region for PCM in Brazil.

Keywords: epidemiology, laboratories, oral diseases, paracoccidioidomycosis, public health..

18 - Gingival Enlargement as a Manifestation of Osseous Choristoma: Case Report and Management

Roberta Rezende Rosa*; Luiz Fernando Barbosa de Paulo; Anísio Domingos de Oliveira Júnior; Antonio Francisco Durighetto Junior

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The term choristoma describes a hamartomatous tumor-like lesion composed of normal tissue in an abnormal location and are designated according to the tissues from which they are derived. Typically, osseous choristomas of the oral cavity present as slow growing masses in the tongue, and rare cases are reported in the buccal mucosa and in the alveolar ridge. To our knowledge, few cases of gingival osseous choristoma have been reported, and the clinical differential diagnoses are very important for the practitioners. This report presents a rare location of a choristoma which by the clinical appearance and microscopic findings was shown to be an osseous choristoma presented in alveolar mucosa.

Keywords: Choristoma; Pathology, Oral; Hamartoma; Mouth Mucosa.

19 - Osteoid osteoma of the mandible: case report

Sergio Elias Vieira Cury1,*; Brunno Santos de Freitas Silva2; André Caroli Rocha3; Celso Augusto Lemos-Junior4; Décio dos Santos Pinto Junior4

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We present a rare case of a 39-year-old woman who had a painless mass in the mandibular symphysis. Histological findings showed a benign osteoid osteoma.

Keywords: Osteoblastoma; Osteoma, Osteoid; Mandibular Diseases; Diagnosis, Differential.

20 - Pigmented lesion in hard palate: a graphite tattoo

Patricia Roccon Bianchi Molini1; Tânia Regina Grão Velloso2; Daniela Nascimento Silva2; Rossiene Motta Bertollo2; Sergio Lins Vaz de Azevedo 2; Teresa Cristina Rangel Pereira2; Liliana Aparecida Pimenta de Barros2

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Oral pigmented lesions are commonly noted in odontologic practice. Clinical features of malignant and benign lesions show enough similarity that makes clinical differentiation difficult or impossible. Exogenous pigmentations in orign are usually due to a foreign-body implantation in the oral mucosa and the graphite as an exogenous source of pigmentation in the oral cavity has been reported sporadically. This report is presents a case of a graphite tattoo in hard palate of a young female adult and discusses the diferential diagnosis with blue nevus and early oral melanoma. It reinforces that oral pigmented lesions must be carefully evaluated and a malignant lesion should not be ignored until a final diagnosis be established.

Keywords: Diagnosis, Oral; Diagnosis, Differential; Pigmentation; Graphite.

21 - Brown tumor as a result of secondary hyperparathyroidism in chronic renal disease

Letícia de Santana Mascarenhas1; Antonio Márcio Teixeira Marchionni1,2; Deyvid Silva Rebouças1; Júlia dos Santos Vianna Neri1; Alena Ribeiro Alves Peixoto Medrado3,*

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INTRODUCTION: Brown tumor is a focal lesion of giant cells that develops in association with hyperparathyroidism. OBJECTIVE: To report a case of brown tumor that occurred in the mandibular symphysis region, associated with secondary hyperparathyroidism. CASE REPORT: A 45-year-old male patient with chronic renal failure exhibited increased volume with comorbid local paresthesia in the mandibular symphysis region. Radiographs showed a unilocular radiolucent area with partially defined edges in the anterior mandible region. The histopathological findings revealed connective tissue, rich in oval, notched cells and giant cells with hemosiderin pigments. Laboratory tests showed increased serum levels of parathyroid hormone. An attempt to control the hormone levels with medication while the patient awaited a kidney transplant was unsuccessful. Therefore, as a transplant was not imminent and injury continued to develop, the lesion was surgically excised. Three years later, the lesions recurred in the paranasal region. Following partial removal of the lesions, the patient is now under follow-up care. CONCLUSION: Correct diagnosis and effective treatment of brown tumor requires correlation of biochemical data with the patient's clinical, imaging, and histological profile.

Keywords: Hyperparathyroidism; Kidney Failure, Chronic; Giant Cells.

22 - Macrostomia in association with pre-auricular tags: a case report

Rodrigo Soares de Andrade1; Renato Assis Machado1,*; Edimilson Martins de Freitas2; Osiris José Dutra Martuscelli3; Daniella Reis B. Martelli2; Ricardo D. Coletta 1; Hercílio Martelli-Júnior2

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Macrostomia is a rare congenital anomaly with an incompletely described pathogenesis and several distinct non-syndromic phenotypes are associated. Macrostomia and pre-auricular tags usually can be correlated with syndromes, but in isolated cases are less common. CASE REPORT: In this case show a girl presenting macrostomia and pre-auricular tags isolated without association syndromic or other apparent causes. In the anamnesis, parents reported having a pregnancy without complications. In ectoscopic tests, ultrasound, and intra-oral physical examination were not significant alterations found beyond macrostomia and pre-auricular tags. It performed surgery to correct macrostomia and withdrawal of pre-auricular tags. DISCUSSION: Macrostomia is a rare malformation that can only be treated surgically. Various surgical techniques have been described in the literature for the correction of these defects. In this case, the surgical option was the Z-plasty technique, however others techniques can be chosen according to the position of facial cleft. CONCLUSION: Although rare in occurrence, requires further studies to a better knowledge leading to a more effective diagnosis and treatment of the patient.

Keywords: Macrostomia; Craniofacial Abnormalities.

23 - Behçet's Disease: a systemic case with recurrent oral ulcers

Evandro Barbosa dos Anjos1,*; Edimilson Martins de Freitas2; Daniella Reis Barbosa Martelli2; Verônica Oliveira Dias2; Renato Assis Machado3; Jamile Pereira Dias dos Anjos4; Hercílio Martelli-Júnior2,3

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Behçet's disease is a chronic multisystem inflammatory disorder of unknown etiology and characterized mainly by recurrent oral ulcers, ocular involvement, genital ulcers, and skin lesions, presenting with remissions and exacerbations. CASE REPORT: The case report presents a patient with recurrent oral ulcers history and extracutaneous ulcers to 10 years who was diagnosed as having Behçet's disease and was successfully treated. DISCUSSION: Although complications involving the gastrointestinal, cardiovascular, renal, pulmonary, urological, artery, and central nervous system can be observed, some patients can remain asymptomatic for a long period after the diagnosis. CONCLUSION: This report emphasises that systemic diseases, including Behçet's disease, can have variable presentations and can be frequently misdiagnosed.

Keywords: Vasculitis; Oral Ulcer; Skin Ulcer; Behçet Syndrome.

24 - Generalized gingival enlargement associated with aggressive periodontitis in a 20-year-old patient: case report and literature review

Marcos Custódio*; Paula Verona Ragusa da Silva; Norberto Nobuo Sugaya; Celso Augusto Lemos; Claudio Mendes Pannuti; Paulo Henrique Braz-Silva

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The association of a pronounced gingival enlargement (GE) and severe aggressive periodontitis (AP) without underlying diseases or syndromes is rarely reported. We aimed to report a rare case of such association in a young female patient and to review the literature regarding the coexistence of these two diseases. A 20-year-old female patient was referred due to an extensive and generalized gingival enlargement along with teeth mobility with one-year length. Medical and family histories were non-contributory. Intraoral examination revealed a diffuse and smooth-surfaced overgrowth, normal in color with fibrous consistence covering nearly all molars crowns of both upper and lower arches. Histopathological examination revealed excessive amounts of collagen fibers and mild inflammation. The clinical and histopathological features did not fit in any known syndrome or disease. Thus, the diagnosis of generalized idiopathic gingival enlargement associated with severe aggressive periodontitis was concluded and the patient was referred to specialized periodontal treatment. The real meaning of the association between GE and AP remains unknown. Further investigation is desirable to understand the coexistence of these two diseases.

Keywords: Gingival Hyperplasia; Aggressive Periodontitis; Periodontal Diseases.

25 - Enlargement of the genial tubercles: a case report

Luciana Soares de Andrade Freitas Oliveira1; Manuela Torres Andion Vidal2; Ludmila Faro Valverde2,*; Iêda Margarida Crusoé-Rebello3

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The genial tubercles are small bony protuberances located in the cortical lingual of the mandible, in the midline. The enlargement of the genial tubercles is more common in edentulous mandibles exhibiting bone resorption, is generally asymptomatic and diagnosed by routine imaging methods. This study describes a case of enlargement of the genial tubercles detected by cone-beam computed tomography prior to the placement of dental implants. Cone-beam computed tomography showed an unusual increase in size and volume on the inner surface of the mandible, in the midline, which had a pedunculated aspect and was similar in density to cortical bone, suggested enlargement of the genial tubercles. In conclusion, this bone prominence should be observed during the planning of rehabilitation treatment since its presence can influence the adaptation of dentures. Additionally, patients should be monitored regarding painful symptoms and the presence of fractures, with surgical removal being required in some cases.

Keywords: Cone-Beam Computed Tomography; Mandible; Diagnosis.

26 - Early Detection of a Calcifying Cystic Odontogenic Tumor associated with Odontoma

Camilla Vieira Esteves*; Giovanna Piacenza Florezi; Sabrina Araújo Pinho Costa; Marilia Trierveiler; Cibele Pelissari; Celso Augusto Lemos Júnior

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A 15-year-old male patient was referred for diagnosis and treatment of a radiographic lesion located in the anterior region of the maxilla. Clinically, the patient presented a prolonged retention of the element 63 and absence of the element 23. No swelling around the alveolar ridge was observed. The radiographic findings were characterized by few tooth-like radiopaque structures surrounded by a radiolucent halo around the impacted element 23. The clinical hypothesis was stablished as dentigerous cyst associated with compound odontoma. The excisional biopsy was performed keeping the impacted tooth in place, to which an orthodontic bracket was bond for posterior traction. The surgical piece was taken to histopathological examination and the final diagnosis was calcifying cystic odontogenic tumor (CCOT) associated with compound odontoma. The calcifying cystic odontogenic tumor (CCOT) is a rare benign neoplastic lesion that represents less than 2% of all cysts and odontogenic tumors; it is usually found at the canine region and is associated with odontoma. Knowledge on the lesion characteristics, a detailed clinical exam, and complementary exams are essential to a differential diagnosis aiming to provide appropriate treatment for the patient, which currently consists of complete enucleation, with good prognosis. The 12-month follow-up shows an injury-free patient

Keywords: Diagnóstico Diferencial; Odontogenic Cyst, Calcifying; Odontogenic Tumors; Surgery, Oral.

27 - Diagnosis and treatment of resistant periapical pathoses at the maxillary anterior region: a case report

Antonione Santos Bezerra Pinto1; Neiandro dos Santos Galvão 2,*; Luis Paulo da Silva Dias3; Jean de Pinho Mendes3; Sérgio Lúcio Pereira de Castro Lopes4; André Luiz Ferreira Costa5

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The objective of this study was to report a clinical case of periapical pathosis at the maxillary anterior region which was resistant to conventional endodontic treatment and discuss the contribution of the magnetic resonance imaging (MRI) to the diagnostic process. Female patient aged 43 years old was referred to specialised dental care following unsuccessful endodontic treatment of tooth #11, which had been carried out after presumptive diagnosis of granuloma or root cyst. For a better evaluation, periapical radiography, cone beam computed tomography and MRI exam were all indicated. By means of these exams, one could observe the presence of another lesion at the region of tooth #13, which was suggestive of residual cyst. On MRI scan, the T2WI of the lesions showed hypersignal areas compatible to inflammatory process. Surgery excision of the lesions and apicoectomy of tooth #11 were the treatments chosen, including further referral for histopathological exam. Final diagnosis of both lesions was non-specific inflammatory process or dental granuloma. Clinical-radiographic control showed area of new bone formation, thus evidencing bone repair process. One can conclude that the diagnosis and treatment of periapical pathoses may be challenging and that MRI contributed by providing important information on the nature and content of these lesions.

Keywords: Diagnosis, Oral; Periapical Granuloma; Magnetic Resonance Imaging.



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