RESUMO RACIONAL: O tumor sólido pseudopapilar do pâncreas tem sido relatado na literatura com mais frequência nas últimas duas décadas. A cirurgia continua sendo o tratamento indicado, sendo o fígado o local mais frequente de metástases. OBJETIVOS: Apresentar a opção de tratamento cirúrgico de paciente feminino, 18 anos, com lesão sólida no corpo e cauda do pâncreas associada a lesões metastáticas em ambos os lobos hepáticos. MÉTODOS: Dois procedimentos cirúrgicos foram agendados. No primeiro procedimento foi realizada pancreatectomia corpo-caudal com esplenectomia, associada à ressecção de 3 lesões do lobo esquerdo do fígado. A hepatectomia direita foi realizada seis meses após, evoluindo sem complicações. RESULTADOS: O paciente continua sem queixas clínicas no último retorno, e a ressonância magnética do abdomem realizada 28 meses após o segundo procedimento não mostra lesões hepáticas ou na cavidade abdominal. CONCLUSÕES: O conhecimento do comportamento biológico dos tumores, a evolução e os riscos de recidiva, permitem a indicação de técnicas cirúrgicas mais racionais e que melhor beneficiam os pacientes.

ABSTRACT BACKGROUND: Solid pseudopapillary tumor of the pancreas has been frequently reported in the past two decades. Surgery remains the treatment of choice, with the liver being the most frequent site of metastases. AIMS: The study aimed to present an option of surgical treatment for an 18-year-old female patient with a solid lesion in the body and tail of the pancreas associated with metastatic lesions in both hepatic lobes. METHODS: Two surgical procedures were scheduled. In the first procedure, body-caudal pancreatectomy with splenectomy was performed, associated with the resection of three lesions of the liver's left lobe. A right hepatectomy was performed 6 months later, progressing without complications. RESULTS: The patient continues without clinical complaints on the last return, and abdominal magnetic resonance performed 28 months after the second procedure does not show liver or abdominal cavity lesions. CONCLUSIONS: The knowledge on the biological behavior of tumors, evolution, and recurrence risks allows the indication of more rational surgical techniques that best benefit patients.

RESUMO - RACIONAL: Apesar da recomendação atual que o cistoadenoma seroso deva ser tratado de forma conservadora, significativa parte dos pacientes com essa condição ainda é operada por dúvida diagnóstica. OBJETIVO: Analisar causas da baixa acurácia diagnóstica do cistoadenoma seroso. MÉTODOS: Estudo retrospectivo de portadores de cistoadenoma seroso de um banco de dados de dois ambulatórios de cirurgia hepatopancreaticobiliar entre 2006 e 2020. Foram incluídos pacientes com lesões típicas de cistoadenoma seroso aos exames de imagem (tomografia computadorizada, ressonância magnética e ecoendoscopia) e pacientes que o anatomopatológico confirmasse esse diagnóstico. RESULTADOS: 27 pacientes foram incluídos. 85,18% eram do sexo feminino. A idade média foi de 63,4 anos. Apenas um apresentava sintomas típicos de pancreatite. A Ressonância magnética foi o exame mais realizado (62,9%). A lesão era única em 88,9% e o tamanho médio foi 4 cm. O aspecto típico microcístico foi encontrado em 66,6% dos casos, os demais foram considerados atípicos. A ecoendoscopia foi realizada em 29,6%. O valor médio de antígeno carcinoembrionário nos pacientes submetidos à punção do cisto foi de 198,25 ng/mL. O tratamento cirúrgico foi realizado em 10 casos (37%). Em 7, a causa cirúrgica foi a suspeita do cistoadenoma mucinoso mediante identificação de lesões atípicas (unilocular com ou sem septos e macrocística). Em 2, a suspeita de neoplasia papilar intraductal mucinosa com “fatores preocupantes” foi a indicação cirúrgica. O último foi submetido à cirurgia por lesão de aspecto sólido e suspeita de câncer. O índice de complicações > ou = Clavien-Dindo 2 foi 30%, o índice de fístula pancreática clinicamente relevante (B e C) foi 30%. A mortalidade foi nula. CONCLUSÃO: A apresentação morfológica atípica do cistoadenoma seroso, particularmente lesões uniloculares e macrocísticas, é a principal responsável pela indicação cirúrgica. Apenas a implementação de novos, eficientes e reprodutíveis métodos diagnósticos poderá reduzir o número de cirurgias desnecessárias nesses pacientes.

ABSTRACT - BACKGROUND: Many patients with serous cystadenoma of the pancreas (SCP) underwent surgery due to diagnostic doubt. AIM: The aim of this study was to analyze the causes of low accuracy in diagnosing SCP. METHODS: This is a retrospective study of patients with SCP from a database of two hepatopancreatic biliary surgery outpatient clinics between 2006 and 2020. Patients with typical SCP lesions in imaging exams (e.g., tomography, magnetic resonance imaging [MRI], and endoscopic ultrasound [EUS]) and patients whose pathological testing confirmed this diagnosis were included. RESULTS: A total of 27 patients were included in this study. Most patients were women (85.18%), and the mean age was 63.4 years. Only one patient had typical pancreatitis symptoms. MRI was the most performed method (62.9%). The lesion was single in 88.9%, and the average size was 4 cm. The typical microcystic aspect was found in 66.6%. EUS was performed in 29.6% of cases. The mean carcinoembryonic antigen value in patients undergoing cyst puncture was 198.25 ng/mL. Surgical treatment was performed in 10 cases (37%). The cause of surgery in seven of these cases was due to a suspicion of mucinous cystadenoma based on an identification of atypical lesions (unilocular with or without septa and macrocystic) in imaging exams. A suspicion of intraductal papillary mucinous neoplasm with “worrying factors” was the indication for surgery in two cases. The last case underwent surgical treatment for a solid-looking lesion which was suspected of cancer. The complication rate ≥Clavien-Dindo 2 was 30%, and the clinically relevant pancreatic fistula rate (B and C) was 30%. Mortality was nil. CONCLUSION: The atypical morphological presentation of SCP, particularly unilocular and macrocystic lesions, is the main indication for surgery. Only the implementation of new, efficient, and reproducible diagnostic methods can reduce the number of unnecessary surgeries among these patients.

Abstract A randomized, blind and prospective clinical trial was conducted to compare two clinical rehabilitation protocols in patients submitted to orthognathic surgery, during the first 60 days after surgery. Pain, edema, mandibular movement, masticatory efficiency and quality of life were evaluated. Nineteen (19) patients were separated into control and experimental groups. The control group consisted of 10 patients followed by oral and maxillofacial surgeons and submitted to a rehabilitation protocol that involved active and passive mouth opening exercises. The experimental group had 9 patients and followed the surgeons’ protocol, in addition to an Early Recovery After Surgery (ERAS) protocol performed by speech therapists, and involving specific motricity exercises and lymphatic drainage. The Student’s t-test was applied to compare the results, and the Fisher’s exact test of independence, to analyze the quality of life and the masticatory efficiency variables. The statistical significance was set at 5% (p < 0.05) for all the tests. The results showed that the ERAS protocol made a positive difference in pain perception in the first 14 days. However, it did not improve the other variables. Although many variables showed no significant difference, it was concluded that the surgeons can delegate patient rehabilitation to qualified professionals, so that they can optimize their postoperative clinical time.

RESUMO Objetivo: Avaliar a concordância entre grandezas cefalométricas obtidas através dos softwares Dolphin Imaging 11.7® e Radiocef Studio 2® . Métodos: Trinta telerradiografias laterais digitais (200 dpi, 2100 x 2092 pixels) foram analisadas em cada um dos softwares através da demarcação de 11 pontos cefalométricos por um único examinador calibrado. As grandezas cefalométricas geradas foram correlacionadas estatisticamente por meio dos coeficientes de correlação intra classe (CCI). A fim de avaliar a concordância intra-examinador, 10 telerradiografias selecionadas aleatoriamente foram retraçadas em cada um dos softwares após um intervalo de 8 dias. Resultados: As grandezas SNB e Pog-NB mostraram forte concordância entre os softwares, enquanto que as grandezas SNA, ANB, 1-NA, 1-NB, 1.NB, 1.1 e Go-Gn.SN revelaram concordância moderada. Somente a grandeza 1.NA demonstrou fraca concordância. Conclusão: Os softwares podem ser aplicados intercambiavelmente na prática clínica.

ABSTRACT Objective: To evaluate the agreement between cephalometric measures obtained from two different software programs: Dolphin Imaging 11.7® and Radiocef Studio 2® . Methods: 30 digital lateral teleradiographies (200 dpi, 2100 x 2092 pixels) were analyzed on each of the software programs through demarcation of 11 cephalometric points by a single calibrated examiner. Then, the generated cephalometric magnitudes were statistically correlated by means of the intraclass correlation coefficients (ICC). Then 10 randomly selected radiographies were retraced on each of the programs in order to evaluate the intra-examiner concordance after a time interval of 08 days. Results: The SNB and Pog-NB magnitudes showed strong concordance between the software, while the SNA, ANB, 1-NA, 1-NB, 1.NB, 1.1 and Go-Gn.SN magnitudes unveiled moderate concordance. Only the 1.NA magnitude showed weak concordance. Conclusion: The software can be interchangeably applied in clinical practice.

O hemangioma é uma neoplasia benigna comum na região de cabeça e pescoço, e é relativamente rara na cavidade oral, podendo causar prejuízo estético e funcional a depender da sua localização. Sua localização mais frequente é o lábio superior, mas pode ocorrer em outras regiões, como língua, mucosa jugal e palato. O seu tratamento depende, principalmente, do correto diagnostico da lesão, bem como da localização anatômica da mesma. A proposta deste artigo é relatar um caso de hemangioma em lábio superior tratado com esclerose terapêutica com oleato de monoetanolamina (Ethamolin®), considerando as características clínicas e os métodos de diagnóstico desta lesão. Por meio de um diagnóstico preciso e uma conduta terapêutica adequada, o caso apresenta-se com um acompanhamento de um ano, sem sinais de recidiva, e com um resultado estético funcional satisfatório, com regressão total da lesão.

Hemangiomas are benign neoplasms that are common in the head and neck, but relatively rare in the oral cavity. They can cause esthetic and functional impairment, depending on location. The most common site is the upper lip, but they can occur in other areas, such as the tongue, buccal mucosa and palate. Treatment is primarily dependent on correct diagnosis of the lesion and on its anatomic location. The purpose of this article is to provide a description of a case of a hemangioma on the upper lip, treated by therapeutic sclerosis with monoethanolamine oleate (Ethamolin®), covering clinical characteristics and methods for diagnosing these lesions. Precise diagnosis and appropriate therapeutic management resulted in satisfactory esthetic and functional results, with total regression of the lesion and no signs of relapse at 1-year follow-up.

Objetivo:Esta pesquisa objetiva estabelecer a prevalência, os fatores associados ao surgimento e as características clínicas e histopatológicas das leucoplasias e eritroplasias orais, a fim de que estes dados possam contribuir na estratégia de prevenção ao desenvolvimento dessas lesões e, consequentemente, do câncer oral.Material e método:Foi realizado estudo retrospectivo em um serviço de referência da Universidade Federal do Rio Grande do Norte (UFRN) no período de 2000 a 2012. Para verificar a associação das variáveis foi utilizado o teste qui-quadrado e o exato de Fisher (p ≤ 0,05).Resultados:Foram investigados 6.560 prontuários, tendo sido selecionados 54 casos, dos quais 44,4% do sexo masculino e 55,6% do feminino, com idade média de 56,93 anos. Com relação aos hábitos, 72,2% eram fumantes e 25% usuários de álcool, sendo que 17,9% exibiam associação dos dois hábitos. As leucoplasias orais foram as lesões mais prevalentes (0,65%), e as eritroplasias orais apresentaram maior associação com apresentação maligna no diagnóstico histopatológico (p = 0,001). A maioria das lesões não apresentou sintomatologia (p = 0,004). A leucoplasia oral foi mais frequente em mulheres fumantes com média de idade de 57 anos.Conclusão:O conhecimento dos fatores associados e das características clínicas das eritroplasias e leucoplasias orais é essencial para o estabelecimento do correto diagnóstico e tratamento.

Objective:This research aims to establish the prevalence, factors associated with the onset, and clinical and histopathological features of oral leukoplakia and erythroplakia, so that these data can contribute to the prevention of these lesions and, consequently, of oral cancer.Material and method:A retrospective study was conducted at a reference service of Universidade Federal do Rio Grande do Norte (UFRN) from 2000 to 2012. To verify the association of variables, Pearson's chi-squared test and Fisher's exact test (p ≤ 0.05) were used.Results:Among 6,560 investigated records, 54 cases were selected, of which 44.4% were male and 55.6% female, with mean age of 56.93 years. Regarding habits, 72.2% were smokers and 25% were alcohol users; 17.9% showed association of both habits. Oral leukoplakia lesions were the most prevalent (0.65%) and oral erythroplakia showed greater association with malignancy in the histopathological presentation (p = 0.001). Most lesions showed no symptoms (p = 0.004). The most frequent was oral leukoplakia in smoking women, with mean age of 57 years.Conclusion:Knowledge of associated factors and clinical characteristics of oral leukoplakia and erythroplakia is essential for establishing the correct diagnosis and treatment.

AIM: To evaluate the proliferative capacity of mesenchymal cells derived from human periodontal ligament on polished and plasma-treated titanium surfaces. METHODS: Eighteen titanium disks were polished and half of them (n=9) were submitted to plasma nitriding using the cathodic cage technique. Mesenchymal cells were isolated from periodontal ligament of impacted third molars (n=2) and cultured on titanium disks (polished and nitrided) and on a plastic surface as a positive control of cell proliferation. Cell proliferation was analyzed and growth curves were constructed for the different groups by determining the number of cells adhered to the different surfaces at 24, 48 and 72 h after plating. RESULTS: Higher cell number was observed for the nitrided surface at 24 and 48 h. However, no statistically significant difference in cell proliferation was observed between the two different surface treatments (p>0.05). CONCLUSIONS: We concluded that plasma nitriding produced surfaces that permitted the proliferation of human periodontal ligament mesenchymal cells. Associated to other physical and chemical properties, it is possible to assume the feasibility of plasma nitriding method and its positive effect on the early cellular events of osseointegration.

Os cistos odontogênicos ortoceratinizados (COOs) são cistos de desenvolvimento revestidos por epitélio ortoceratinizado constituído por uma camada granulosa proeminente e uma camada basal de células cuboidais achatadas que não mostram tendência à paliçada. Esses cistos foram considerados uma entidade distinta dos ceratocistos, uma vez que apresentam um comportamento menos agressivo e uma taxa muito baixa de recorrência. Cistos odontogênicos de desenvolvimento pode tornar-se infectados, mas complicações graves como a celulite, potencialmente ameaçadora da vida, são raros. Este relato descreve um caso raro de celulite facial secundária a um COO infectado localizado na mandíbula de um homem de 27 anos de idade. A literatura relevante sobre as características clínicopatológicas do COO foi revisada.

Orthokeratinized odontogenic cysts (OOCs) are relatively uncommon developmental cysts lined with orthokeratinized epithelium consisting of a prominent granular layer and a basal layer of low cuboidal flattened cells that show no tendency for nuclear palisading. These cysts have been considered a distinct entity from odontogenic keratocysts since they exhibit a less aggressive behavior and a very low rate of recurrence. Developmental odontogenic cysts can become infected but serious complications, such as potentially life-threatening cellulitis, are rare. This report describes a rare case of facial cellulitis secondary to an infected OOC located in the mandible of a 27-year-old man. The relevant literature about the clinical-pathological features of OOC is reviewed.