Resumo Diversas manobras já foram descritas para o acesso ao segmento distal cervical da artéria carótida interna ou à bifurcação carotídea alta; entretanto, há divergências na sistematização dessas técnicas. O objetivo deste estudo é revisar as técnicas descritas e propor um protocolo prático que auxilie na seleção da técnica mais adequada para cada caso. Para isso, foi realizada uma busca nas bases de dados PubMed Central, Biblioteca Virtual em Saúde e SciELO por artigos sobre o tema, em língua inglesa ou portuguesa, publicados entre os anos de 1980 e 2021. Entre as manobras descritas, parece razoável que as duas etapas iniciais sejam a abordagem ao músculo esternocleidomastóideo, seguida pela secção/retração do ventre posterior do músculo digástrico. Caso necessário, a subluxação mandibular temporária unilateral é um recurso adicional e preferível à divisão do aparato estiloide, devido ao menor potencial de morbidade. Exposições ainda mais amplas podem ser obtidas com as osteotomias mandibulares.

Abstract Several different maneuvers have been described for obtaining access to the distal cervical segment of the internal carotid artery or to a high carotid bifurcation. However there are different approaches to systematization of these techniques. The objective of this study is to review the techniques described and propose a practical protocol to support selection of the most appropriate technique for each case. The review is based on the results of database searches on PubMed Central, the Virtual Health Library (BVSalud), and SciELO for articles on the subject published in English or Portuguese from 1980 to 2021. Among the different maneuvers described, it appears reasonable that the first two steps should be to obtain access at the sternocleidomastoid muscle, followed by section or retraction of the digastric muscle posterior belly. If needed, temporary unilateral mandibular subluxation is an additional resource that is preferable to division of the styloid apparatus process, because of its lesser potential for morbidity. Even wider exposure can be obtained using mandibular osteotomies.

ABSTRACT: Actinomycosis is a bacterial infection caused by Actinomyces species, which usually affect the soft tissues of the cervicofacial region of adult males. Clinically, it’s characterized by a slow-growing indurated mass, especially in the submandibular area. However, in a few cases, the jaws bones can be affected developing osteomyelitis characteristics. The aim of this paper is to report a rare clinical case of Actinomycotic Osteomyelitis affecting the maxilla of a child, involving the maxillary sinus, orbital and zygomatic areas that was treated by the association of antibiotic therapy and surgical debridement. The patient’s 2 years follow-up was uneventful and no signs of the lesion recurrence.

RESUMEN: La actinomicosis es una infección bacteriana causada por la especie Actinomyces, que generalmente afecta los tejidos blandos de la región cervicofacial de los hombres adultos. Clínicamente, se caracteriza por una masa endurecida de crecimiento lento, especialmente en la zona submandibular. Sin embargo, en algunos casos, los huesos de las mandíbulas pueden ser afectados desarrollando características de osteomielitis. El objetivo de este trabajo es reportar un caso clínico poco frecuente de osteomielitis actinomicótica que afecta el maxilar de un niño, envolviendo el área del seno maxilar, y zonas orbitales y cigomáticas que fueron tratadas con la asociación de terapia con antibióticos y desbridamiento quirúrgico. El seguimiento del paciente por 2 años ocurrió sin incidentes y sin signos de recidiva de las lesiones.

Abstract The aim of this study was to identify the immunoexpression of methallothionein in oral squamous cell carcinoma as well as to address the correlation with clinical features, histological grade and patient survival. Samples were collected from 93 patients with tongue squamous cell carcinoma who presented for follow-up. Immunohistochemical expression of methallothionein in all groups was performed. The scoring system has previously been published by Tsurutani in 2005, which is based on intensity and distribution of staining. We used Kappa index to evaluate the degree of observers’ agreement under metallothionein immunostaining and histological grade. Associations between methallothionein expression and clinical parameters (age, gender, smoking, tumor size, lymph node metastasis and disease stage) were examined for statistical significance using the chi-squared test. The overall survival rates were estimated by the Kaplan-Meier method and the relationship between protein expression and survival was compared using the log-rank test (p < 0.05). Our results showed no statistically significant association between methallothionein immunostaining and the selected clinicopathological variables. Immunohistochemistry results showed positive nuclear immunostaining for metallothionein in 62,37% (58/93) and negative for metallothionein 37,63% (35/93). The degree of examiners agreement by Kappa varied from substantial to perfect and both metallothionein immunostaining and histological grade were explored. The present study suggests that positive methallothionein expression found in tongue squamous cell carcinoma may not help to predict survival in the analyzed samples, as well as no relation between the protein and histological grade and clinical features was observed. In conclusion, the present study suggests that metallothionein is not associated with tongue squamous cell carcinoma clinicopathological characteristics and aggressiveness.

Abstract The main objective of this study was to cause bisphosphonate-related osteonecrosis of the jaws to develop in a rodent model. Adult male Holtzman rats were assigned to one of two experimental groups to receive alendronate (AL; 1 mg/kg/week; n = 6) or saline solution (CTL; n = 6). After 60 days of drug therapy, all animals were subjected to first lower molar extraction, and 28 days later, animals were euthanized. All rats treated with alendronate developed osteonecrosis, presenting as ulcers and necrotic bone, associated with a significant infection process, especially at the inter-alveolar septum area and crestal regions. The degree of vascularization, the levels of C-telopeptide cross-linked collagen type I and bone-specific alkaline phosphatase, as well as the bone volume were significantly reduced in these animals. Furthermore, on radiographic analysis, animals treated with alendronate presented evident sclerosis of the lamina dura of the lower first molar alveolar socket associated with decreased radiographic density in this area. These findings indicate that the protocol developed in the present study opens new perspectives and could be a good starting model for future property design.

Chronic osteomyelitis with proliferative periostitis is a kind of osteomyelitis that is characterized by a great periosteal reaction resulting of low grade stimulation, usually a caries lesion associated a periapical pathology. It affects especially children and young adults, with the mandible as the most common site, usually in the inferior aspect. Clinically presents as a painless hard swelling intra and/or extra-oral. Radiographic aspects include bone layers new formed, parallel to each other and to the underlying cortical surface, giving the characteristic appearance of "onion skin". Treatment includes elimination of the cause, with or without antibiotics, being restored the facial symmetry of patient. The present article is a clinical case report of chronic osteomyelitis with proliferative periostitis affecting a female 11 year old patient, caused by a caries lesion in the left permanent first molar, that was submissed to a exodontia and the facial symmetry of the patient was restored with management.

La osteomielitis crónica con periostitis proliferativa es un tipo de alteración caracterizada por una reacción periosteal exacerbada causada por un estimulo de baja intensidad, generalmente una lesión cariosa con patología periapical asociada. Actúa principalmente en niños y adolescentes con predilección por la región basilar de mandíbula. Clínicamente, se manifiesta a través de un aumento de volumen doloroso intra o extraoral, de consistencia endurecida. Radiográficamente presenta laminas óseas neoformadas, paralelas entre si con superficie cortical, observándose el aspecto típico de "cascara de cebolla". El tratamiento incluye el retiro del factor etiológico con o sin antibioterapia y posterior restablecimiento de la simetría facial del paciente. Este trabajo presenta un caso de osteomielitis crónica con periostitis proliferativa en una paciente de sexo femenino de 11 años de edad, causada por una lesión cariosa en el primer molar inferior izquierdo, quien fue sometida a exodoncia del diente comprometido con posterior restablecimiento de la simetría facial.

Hemangiomas são tumores benignos da infância que se caracterizam por uma fase de crescimento rápido com proliferação de células endoteliais, ocorrendo em 10 a 12% das crianças com 1 ano de idade. Sua localização mais comum é nos lábios, na língua, mucosa jugal e no palato. Aproximadamente 50% dos casos de hemangioma mostram completa resolução e 90% deles resolvem-se até os 9 anos de idade. As complicações ocorrem em apenas 20% dos casos e o problema mais comum é a ulceração com ou sem infecção. O tratamento depende da localização, do tamanho e do estágio evolutivo da lesão, bem como da idade do paciente. A cirurgia geralmente é indicada quando não há resposta aos tratamentos sistêmicos ou por razões estéticas, podendo ser empregada sob forma de exérese simples com ou sem plástica. Este artigo apresenta um caso de hemangioma cavernoso labial em uma criança de 4 anos de idade, a qual, devido ao tamanho da lesão, foi submetida a 3 sessões de esclerose vascular seguido de exérese simples da lesão, com acompanhamento clínico de 2 anos de pós-operatório.

Hemangiomas are benign tumors of infancy and childhood, characterized by a phase of fast growth with endothelial cell proliferation, occurring in 10-12% of children at 1 year of age. It is known that hemangiomas of infancy are most commonly located on the head and neck region (around 60% of cases) and occur more frequently in the lips, tongue, and palate. Approximately 50% of hemangiomas have complete resolution, and 90% of them are resolved up to the age of 9. Complications occur in only 20% of the cases, the most common problem being ulceration with or without infection. The treatment depends on lesion location, size and evolution stage, and the patient's age. Surgery is usually indicated when there is no response to systemic treatments, or even for esthetic reasons, being performed as a simple excision in combination or not with plastic surgery. This paper reports a case of lip cavernous hemangioma in a 4-year-old child, who was submitted to 3 sessions of vascular sclerosis due to the size of the lesion, before undergoing simple excision of the hemangioma. Two years of postoperative clinical follow-up shows treatment success with no recurrence of the lesion.