Abstract Clear cell odontogenic carcinoma (CCOC) is a rare odontogenic tumor of the jaws, histologically characterized by the presence of agglomerates of cells with eosinophilic cytoplasm. The patient, a 62-year-old Caucasian woman, presented an intraosseous lesion in the mandibular symphysis. A clinical examination revealed a discrete volumetric increase with a hard consistency, palpable to extraoral and intraoral examinations. Imaging studies revealed an extensive radiolucent area, without defined limits, extending from the region of the right second premolar to the left canine. Incisional biopsy analysis indicated a diagnosis of CCOC. The treatment proposed was segmental resection of the mandible with a safety margin. After six months without recurrence, definitive mandibular reconstruction was performed using an iliac crest graft, followed by rehabilitation with implant-supported denture after five months. After three years of post-resection follow-up, the patient has shown no evidence of recurrence or metastasis. She continues to be under follow-up. To conclude, CCOC must be considered a malignant tumor with aggressive behavior. Previous studies have shown that resection with free margins is a treatment with a lower rate of recurrence. Nevertheless, long-term follow-up is necessary for such patients.

Para a reabilitação bucal com as próteses implantossuportadas é necessário a realização de procedimentos para criar o volume ósseo necessário para a instalação dos implantes. Com isso, os enxertos ósseos provenientes de áreas doadoras intrabucais ou extrabucais, representam uma possibilidade bastante favorável. O presente trabalho objetivou realizar uma revisão da literatura em que procurou discutir parâmetros para as indicações, as vantagens e complicações para as técnicas dos enxertos ósseos autógenos.

For oral rehabilitation with implant-supported prostheses, there are required procedures to create the bone volume needed for installation of the implants. Thus, bone grafts from intraoral or extraoral donor sites represent a very favorable opportunity. This study aimed to review the literature on the subject, seeking to discuss parameters for the indications, advantages and complications of techniques for autogenous bone grafts.

Calvaria grafts provide good bone quantity for the reconstruction of the atrophic maxilla, and have lower morbidity and resorption rates when compared to iliac crest. The aim of this paper is to present the technique for obtaining a graft of the skull. Initially, the depth of the osteotomy is determined by a manually conducted bur, which establishes the limits of the structures of the skull (outer table, diploe and inner table), making the removal of bone blocks easier and safer. Thus, osteotomies of the blocks are made with greater security, avoiding the complications inherent to surgical technique. The case that will be presented it is from a male patient of 65 years who refused to submit to the iliac crest graft, opting for the calvaria, despite being bald, that is a contraindication for this treatment modality. A delicate suture associated with placement of titanium mesh to maintain the conformation of the patient's skull in the region of the bone defect, created after removal of the graft, provided a good cosmetic result at the donor site. The use of titanium mesh for re-anatomization of bone defects created in the grafts is well indicated for bald patients.

Los injertos de calvaria proporcionan una buena cantidad de hueso para la reconstrucción del maxilar atrófico, y tienen menores tasas de morbilidad y reabsorción en comparación con la cresta ilíaca. El objetivo de este trabajo es presentar la técnica para la obtención de un injerto del cráneo. Inicialmente, la profundidad de la osteotomía se determina mediante una fresa manualmente, lo que establece los límites de las estructuras del cráneo (tabla externa, diploe y tabla interna), lo que hace la eliminación de bloques óseos más fácil y segura. Por lo tanto, las osteotomías de los bloques se hacen con mayor seguridad, evitando las complicaciones inherentes a la técnica quirúrgica. Se presenta el caso de un paciente hombre de 65 años que se negó a ser sometido a injerto de cresta ilíaca, optando por la bóveda craneal, a pesar de ser calvo, que es una contraindicación para esta modalidad de tratamiento. Una sutura cuidadosa asociada con la colocación de malla de titanio para mantener la conformación del cráneo del paciente en la región del defecto óseo creado después de obtención del injerto, deja un buen resultado cosmético en el sitio donante. El uso de malla de titanio para la re-anatomización de defectos óseos creados en los injertos está bien indicada para pacientes calvos.

A doença de von Willebrand (DvW) é uma coagulopatia hereditária. Não há predileção por sexo. Clinicamente caracteriza-se por hemorragias mucocutâneas, sobretudo nasais, menorragias e hemorragias pós-trauma. Este artigo relata um caso clínico de DvW em paciente de 52 anos de idade, leucoderma, do sexo masculino, que apresentou extensa hemorragia em bordo lateral de língua após ferimento lacerante, além de descrever alguns aspectos clínicos, patológicos e terapêuticos da DvW. Após repetidas tentativas de sutura do ferimento e reposição dos fatores de coagulação, optou-se pela ligadura da artéria carótida externa ipsilateral ao ferimento, com resolução favorável do caso, notando-se bom aspecto cicatricial 2 meses após a ligadura. Este caso reforça que é de extrema importância a realização de anamnese criteriosa, buscando-se identificar possíveis distúrbios hemorrágicos prévios ou antecedentes familiares.

The von Willebrand disease (vWD) is a hereditary coagulopathy. There is no gender predilection. Clinically characterized by mucocutaneous bleeding, especially nose bleeding, menorrhagia and bleeding after trauma. This article reports a case of a 52-year-old Caucasian male patient with vWD, who presented with extensive bleeding in the tongue after a lacerating injury caused by accidental biting, and describes some clinical, pathological and treatment aspects of vWD. After repeated attempts to suture the wound and replace clotting factors, a decision was made to perform the ligature of the external carotid artery ipsilateral to the injury. There was favorable resolution of the case, with a good aspect of the scar 2 months after ligation. This case reinforces that it is extremely important to make a thorough review of medical history of all patients, searching for possible bleeding disorders or previous family history.

OBJETIVO: a proposta desse trabalho foi analisar a fidelidade dos traçados predictivos realizados para cirurgias ortognáticas, por meio de análise cefalométrica do pré e pós-operatório de sete dias, em pacientes submetidos à correção de deformidade mandibular. MÉTODOS: foram utilizadas telerradiografias cefalométricas de perfil de 17 pacientes submetidos à cirurgia ortognática de mandíbula. Foram realizados traçados cefalométricos do pré e do pós-operatório de 7 dias com marcação dos pontos côndilo (Co), pogônio (Pog), goníaco (Go), mento (Me), ponto B (B) e incisivo (I). A análise foi baseada na diferença obtida pela sobreposição dos traçados pré-operatório, predictivo e pós-operatório. Os pontos foram projetados em um plano cartesiano para medição das suas distâncias em milímetros. Os dados obtidos foram submetidos à análise estatística por meio do teste t de Student pareado (± = 0,05). RESULTADOS: no eixo horizontal, foi observada diferença média, entre a mudança planejada e a obtida nos traçados cefalométricos pós-operatórios, estatisticamente significativa nos pontos Pog (p = 0,014) e I (p = 0,008). No eixo vertical, não verificou-se diferença estatística significativa para os pontos cefalométricos marcados (p > 0,05). CONCLUSÕES: o traçado predictivo contribuiu para a avaliação pré-operatória do paciente e, consequentemente, para a otimização do tratamento. Entretanto, ele não se mostrou totalmente fiel nos casos analisados, com leve subestimação das alterações esqueléticas horizontais. Essas alterações devem ser consideradas no planejamento e acompanhamento pós-operatório dos pacientes submetidos à cirurgia ortognática em mandíbula.

OBJECTIVE: The purpose of this study was to assess the accuracy of cephalometric prediction tracings-performed for orthognathic surgery-by means of the cephalometric analysis of preoperative and seven-day postoperative tracings, in patients subjected to correction of mandibular deformities. METHODS: The lateral cephalograms of 17 patients who had been submitted to mandibular orthognathic surgery, three years earlier, were used. Cephalometric tracings were performed in the preoperative and seven-day postoperative periods and the following landmarks were traced: condyle (Co), pogonion (Pog), gonial (Go), menton (Me), B (B) and incisor (I). The analysis was based on the difference obtained by superimposing preoperative, prediction and postoperative tracings. The landmarks were projected onto a Cartesian plane for measuring distances between points in millimeters. The data were statistically analyzed using the paired Student t test (a = 0.05). RESULTS: A statistically significant mean difference was observed between the planned change and the change effectively achieved in the postoperative cephalometric tracings for points Pog (p = 0.014) and I (p = 0.008) on the horizontal axis. No statistically significant difference was found for the aforementioned cephalometric points on the vertical axis (p > 0.05). CONCLUSIONS: Cephalometric prediction tracings contributed to the preoperative evaluation of the patients and consequently to treatment optimization. However, they was not entirely reliable in these cases due to a slight underestimation of horizontal skeletal changes. These changes should be considered in planning and postoperative follow-up of patients subjected to orthognathic surgery in the mandible.

From a biological standpoint, the best material for reconstruction of bone defects is the autogenous bone graft. However, as tissue healing is affected under diabetic conditions, major changes might take place in the revascularization, incorporation, replacement and remodeling phases of the grafted area. The purpose of this study was to assess the bone healing process in surgical wounds prepared in tibiae of diabetic rats and filled with autogenous bone. Forty male rats (Rattus norvegicus albinus, Wistar) were randomly assigned to receive an endovenous injection (penile vein) of either citrate buffer solution (Group 1 - control; n=20) or streptozotocin dissolved in citrate buffer solution (35 mg/kg) to induce diabetes (Group 2 - diabetic; n=20). After determination of glycemia, the animals were anesthetized and the anterolateral regions of the tibiae of both limbs were shaved, antisepsis was performed and longitudinal incisions were made in each limb. The tibiae were exposed and two 2mm-diameter surgical cavities were prepared: one in the right limb, filled with particulate autogenous bone and the other in the left limb, filled with blood clot. The animals were euthanized at 10 and 30 postoperative days. The anatomic pieces were obtained, submitted to laboratory processing and sections were stained by hematoxylin and eosin and Masson's Trichrome for histomorphologic and histometric analyses. In both groups, the wounds filled with autogenous bone graft showed better results than those filled with blood clot. The control group showed higher new bone formation in wounds filled with autogenous bone graft at 30 days than the diabetic group, but without statistical significance. It may be concluded that, in general, the new bone formation occurred with autogenous graft was quantitatively similar between control and diabetic groups and qualitatively better in the control group.

Lesiones de células gigantes son un grupo de diversas patologías con etiología desconocida, poco entendidas y con dificultad de diagnostico. Son procesos no neoplásicos de crecimiento lento, circunscrito, normalmente asintomático. Las lesiones de celulas gigantes se manifiestan generalmente en huesos largos, siendo raro su aparición en los maxilares. A seguir describiremos un caso de tumor de celulas gigantes en el hueso maxilar removido a través de procedimiento quirúrgico. Paciente del género femenino, 33 años, raza negra, se presento al servicio de Cirugía y Traumatología Bucomaxilofacial del Hospital Regional "José de Simone Neto", en junio de 2003, reclamando de inchazo cerca de la nariz. Nel plan de tratamiento se opto por la biopsia incisional, obteniendo de esta forma el diagnostico y así poder realizar posteriormente el procedimiento quirúrgico correspondiente. Los resultados de la biopsia con los aspectos radiográficos en las diferentes etapas de la lesión, concluimos que se trataba de un caso de Tumor Central de Células Gigantes. Es prudente la realización de una biopsia incisional para el diagnóstico histopatológico definitivo de determinadas lesiones para la ejecución de un plan de tratamiento correcto y seguro.

Giant cells lesions are a group of diverse pathologies with unknown etiology, few knowledge and difficulty diagnostic. They are non-neoplasics processes with slow growth, circumscribed, normally asymptomatic. The giant cells lesions occur generally in long bones, being rare his appearance in maxillaries. We will describe a case of giant cells tumor in the maxilla removed through surgical procedure. Female patient, 33 years, black race, appeared in the service of Bucomaxilofacial Surgery and Traumatology of the Hospital Regional "Jose de Simone Neto", in June of 2003, complaining of a growth near the nose. The treatment plan was incisional biopsy, obtaining from this, the diagnosis to make the corresponding surgical procedure later. Result of the biopsy with the radiographic aspects in different stages of the lesion, concluded that was a case of Central Tumor of Giant Cells. It is prudent the realization of an incisional biopsy to have the histopathologic diagnosis to determine the correct and safe treatment plan for those lesions.