Abstract In the modern world, cancer is a growing cause of mortality, but archeological studies have shown that it is not exclusive to modern populations. The aim of this study is to examine the epidemiologic, social, and clinicopathologic features of head and neck cancers in ancient populations. To do this, we extracted all records that described malignant lesions in the head and neck region available in the Cancer Research in Ancient Bodies Database (CRAB). The estimated age, sex, physical condition of the remains (skeletonized, mummified), anatomic location of tumors, geographic location, chronology, tumor type, and methods of tumor diagnosis were collected. One hundred and sixty-seven cases were found, mostly originating from Europe (51.5%). Most records were of adults between 35 and 49 years of age (37.7%). The most involved site was the skullcap (60.4%), and the most common malignancies were metastases to the bone (65.3%) and multiple myeloma (17.4%). No primary soft tissue malignancies were registered. The results of our study indicate that head and neck cancers were present in ancient civilizations, at least since 500,000 BCE. The available data can help to improve the current understanding of the global distribution of head and neck cancer and its multidimensional impacts on populations in the contemporary world.

Abstract The aim of this study is to report an original case series of synchronous jawbone diseases. Data of patients seen over 13 years were extracted from the files of three Oral Radiology and Pathology diagnostic centers in Brazil. The clinical, radiographic, and laboratory characteristics were tabulated and analyzed by the authors; the patients were described according to lesion type. Seventy-two synchronous jawbone diseases were included in this study. Florid osseous dysplasia, Gorlin-Goltz syndrome, and cherubism were the most frequent disorders reported in this case series. In addition, the posterior mandible area was the main site of manifestation. Florid osseous dysplasia and Gorlin-Goltz syndrome represented two-thirds of our samples. With the utilization of adequate demographic, clinical, and radiologic information, it is possible to diagnose most of the synchronous lesions of jawbones. Sometimes, however, we need complementary exams, such as histopathologic and biochemical analysis or dosing of calcium, phosphorus, and alkaline phosphatase.

ABSTRACT The Numb Chin Syndrome (NCS) is defined as facial and oral numbness restricted to the mental nerve’s distribution involving the lower lip, skin of the chin, or gingiva of the lower anterior teeth. Hypoesthesia can occur unilaterally or bilaterally. Although this syndrome is rare, its importance is related to the fact that it represents the clinical manifestations of malignant diseases. Breast cancer and non-Hodgkin lymphoma are the most common cause of NCS. The patient, a 58-year-old woman, treated for a Burkitt Lymphoma (BL) nine years ago, described a two-week history of change in sensitivity and pain in the chin region, without relief with the use of analgesics. She had no headache, speech disturbance, dysphagia, visual disturbance, or other neurological symptoms. No surgical intervention has been performed recently. The intraoral examination revealed a healthy oral mucosa and a small area adjacent to the right mental nerve region that was uncomfortable to palpation. No changes were found in the bone trabeculae at cone-beam computed tomography. The contrasted magnetic resonance features made it possible to identify a change in the mandibular body extending to the entire right side, coinciding with the patient’s complaint, indicating a probable mandibular medullary invasion. The patient was submitted to a biopsy to rule out a possible recurrence of BL. The microscopic findings were consistent with the diagnosis of BL. The present report described a very unusual presentation of late recurrent BL nine years after the first treatment, which manifested as an NCS.

ABSTRACT Antiresorptive therapy is the main form of prevention of osteoporotic or fragility fractures. Medication-related osteonecrosis of the jaw (MRONJ) is a relatively rare but severe adverse reaction to antiresorptive and antiangiogenic drugs. Physicians and dentists caring for patients taking these drugs and requiring invasive procedures face a difficult decision because of the potential risk of MRONJ. The aim of this study was to discuss the risk factors for the development of MRONJ and prevention of this complication in patients with osteoporosis taking antiresorptive drugs and requiring invasive dental treatment. For this goal, a task force with representatives from three professional associations was appointed to review the pertinent literature and discuss systemic and local risk factors, prevention of MRONJ in patients with osteoporosis, and management of established MRONJ. Although scarce evidence links the use of antiresorptive agents in the context of osteoporosis to the development of MRONJ, these agents are considered a risk factor for this complication. Despite the rare reports of MRONJ in patients with osteoporosis, the severity of symptoms and impact of MRONJ in the patients' quality of life make it imperative for health care professionals to consider this complication when planning invasive dental procedures.

Resumo Tumor neuroectodérmico melanótico da infância (TNMI) é um neoplasma raro que afeta principalmente crianças com idade abaixo de 1 ano. Um menino de 4 meses foi referenciado para avaliação de uma lesão com 1 mês de evolução. O exame intra-oral detectou uma massa nodular submucosa firme à palpação, medindo 1,5 cm de diâmetro, afetando rebordo alveolar anterior da maxila e recoberta por mucosa de coloração levemente azulada com telangiectasia evidente. O paciente foi submetido à biopsia incisional e as análises histológica e imunohistoquímica revelaram ninhos compostos por células com abundante pigmento de melanina, positivas para AE1/AE3. Outro tipo celular, semelhante à neuroblastos, também estava presente e foram positivas para CD56, sinaptofisina e enolase. O diagnóstico de TNMI foi estabelecido e o paciente encaminhado para tratamento. Ressecção cirúrgica conservadora sob anestesia geral ao longo de 3 dentes adjacentes foi realizada. O paciente está em acompanhamento há 1 ano e meio sem sinais de recorrência. O tratamento cirúrgico conservador do TNMI pode ser uma alternativa à maxilectomia, contribuindo para a qualidade de vida do paciente.

Abstract Melanotic neuroectodermal tumor of infancy (MNTI) is a rare neoplasm that affects mainly children under 1 year of age. A 4-month-old boy was referred for evaluation of a lesion with 1 month of evolution. Intra-oral examination detected a firm upon palpation submucosal nodular mass, measuring 1.5 cm in diameter, affecting the anterior maxillary alveolar ridge and covered by a slightly blue mucosa with evident telangiectasia. The patient underwent an incisional biopsy and histological and immunohistochemical analyses revealed nests of AE1/AE3 positive epithelioid cells with abundant melanin pigmentation. Other cell types, resembling neuroblasts, were also present and positive for CD56, synaptophysin and enolase. The diagnosis of MNTI was established and the patient was referred for treatment. Conservative surgical resection was performed along with 3 adjacent teeth under general anesthesia. The patient is in follow-up for 1,5 year without recurrence. Conservative surgical management of MNTI may be an alternative to maxillectomy, contributing to the patient´s quality of life.

RESUMO O ameloblastoma é um tumor odontogênico benigno que pode ser tratado com diferentes abordagens cirúrgicas, variando desde procedimentos conservadores a radicais, devido à sua baixa frequência, crescimento lento e capacidade localmente invasiva. A variante convencional deste tumor é mais agressiva e frequente com uma maior taxa de recorrência comparado aos tipos unicísticos e extraósseo/periférico. Um paciente do gênero masculino, 13 anos de idade, apresentou-se com a queixa de uma tumefação na região mandibular posterior no lado esquerdo da face. Ao exame físico intrabucal, observou-se o deslocamento dos dentes 36 e 37 para lingual. A avaliação clínica, imaginológica e histopatológica confirmaram o diagnóstico de ameloblastoma do tipo histológico plexiforme. O paciente foi tratado com curetagem e osteotomia periférica. A proservação de 5 anos mostrou uma completa cicatrização da área sem sinais de recidiva da lesão. O manejo do ameloblastoma permanece baseado na abordagem cirúrgica radical, no entanto, tumores extensos tratados com cirurgia conservadora apresentam menor comprometimento da estética e função, e podem demonstrar um bom prognóstico sem recorrências em 5 anos de proservação, semelhante ao presente caso relatado.

ABSTRACT Ameloblastoma is a benign, odontogenic tumor that, due to its low rate of incidence, slow growth and local invasiveness, can be treated with a variety of surgical approaches, ranging from conservative to radical procedures. The conventional variant of ameloblastoma, though, is more aggressive and common, presenting a higher rate of recurrence than the unicystic and extraosseous/peripheral types; usually, the treatment of choice for this variant employs more invasive procedures. This report is of a 13-year-old male patient who presented with a swelling on the posterior mandibular region, on the left side of his face. Intraoral examination revealed lingual displacement of teeth 36 and 37. The clinical, radiographic and histopathological analyses confirmed the diagnosis of ameloblastoma (plexiform histological type). The patient was treated with curettage and peripheral osteotomy and a 5-year follow-up examination showed the area to have healed completely, with no evidence of recurrence. Consequently, although the clinical management of ameloblastoma is often based on invasive surgical approaches, large tumors treated with conservative surgery are less aesthetically and functionally impaired, and may demonstrate good prognosis with no recurrence in the 5-year follow-up period, as in the case reported here.

O tumor odontogênico cístico calcificante normalmente se manifesta como uma massa indolor, de crescimento lento, que acomete tanto a maxila como a mandíbula, tendo predileção pelo segmento anterior (área dos incisivos e caninos). Geralmente, ocorre em adultos jovens, na terceira a quarta década de vida, sem preferência por gênero. Imagens de tomografia computadorizada revelaram características importantes não detectadas na radiografia panorâmica, tais como fenestração, calcificação e estruturas dentiformes. A característica microscópica típica dessa lesão é a presença de células epiteliais aberrantes anucleadas, em quantidades variáveis, denominadas "células fantasmas". Também se pode encontrar dentina displásica e, ocasionalmente, os cistos estão associados a tecido dentário duro, semelhante ao odontoma. O tratamento do tumor odontogênico cístico calcificante incluiu simples enucleação e curetagem. O objetivo deste trabalho foi mostrar duas manifestações diferentes do tumor odontogênico cístico calcificante, em que a tomografia computadorizada, associada às características clínicas, foi ferramenta importante para o diagnóstico, o planejamento cirúrgico e o acompanhamento dos pacientes.

The calcifying cystic odontogenic tumor normally presents as a painless, slow-growing mass, involving both maxilla and mandible, primarily the anterior segment (incisor/canine area). It generally affects young adults in the third to fourth decades, with no gender predilection. Computerized tomography images revealed important characteristics that were not detected by panoramic radiography, such as fenestration, calcification and tooth-like structures. The typical microscopic feature of this lesion is the presence of variable amounts of aberrant epithelial cells, without nuclei, which are named "ghost cells". In addition, dysplastic dentine can be found and occasionally the cyst can be associated with an area of dental hard tissue formation resembling an odontoma. The treatment for calcifying cystic odontogenic tumor involves simple enucleation and curettage. The purpose of this article is to present two different manifestation of calcifying cystic odontogenic tumor in which computerized tomography, associated to clinical features, served as an important tool for diagnosis, adequate surgical planning and follow-up of patients.

INTRODUÇÃO: O cisto dermoide é um cisto de desenvolvimento incomum na face e envolve mais frequentemente o assoalho bucal. A maioria das lesões ocorre em adultos jovens, com ligeira predileção pelo gênero masculino. As lesões neonatais e em crianças são extremamente raras. Manifesta-se como tumefação flutuante, assintomática e de crescimento lento e progressivo, atingindo dimensões variadas. Sua cápsula pode conter um ou mais anexos cutâneos, como glândulas sebáceas, pêlos ou unhas. O tratamento é cirúrgico, através de enucleação, sendo sua recidiva incomum. O aspecto clínico, histopatológico, diagnóstico diferencial e tratamento de um caso de cisto dermoide congênito, e de sua recidiva, são discutidos pelos autores. Palavra chave: cisto dermoide; soalho de boca; recorrência.

INTRODUCTION: The dermoid cyst is a cyst of unusual development in the face and more often involves the mouth floor. Most injuries occur in young adults with a slight predilection for males. Lesions in neonatal and children are extremely rare. It manifests as swelling floating asymptomatic and slow-growing and progressive, reaching dimensions. His capsule may contain one or more skin appendages such as sebaceous glands, hair or nails. The treatment is surgical, by enucleation, and its recurrence uncommon. The clinical appearance, histopathology, differential diagnosis and treatment of a case of congenital dermoid cyst, and its recurrence, are discussed by the authors.

PROPOSIÇÃO: Avaliar o perfil dos pacientes, com traumatismo dento-alveolar, atendidos no Pronto-Socorro do Serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (Brasil). MÉTODOS: Foi realizado um estudo prospectivo, através de um questionário aplicado, durante o primeiro atendimento desses pacientes, em um período de oito meses. RESULTADOS: Os dados obtidos foram analisados estatisticamente e verificou-se que dos pacientes atendidos 4,7% apresentavam traumatismo dento-alveolar, e destes, 74% eram do gênero masculino; as crianças de 0 a 5 anos eram as mais acometidas, a etiologia mais comum foi a queda; e o tipos de traumas mais freqüentes foram a avulsão e fratura dental. A medida que a idade avança os fatores etiológicos mais comuns são os acidentes de trânsito e as agressões físicas. CONCLUSÃO: A incidência de trauma de dentoalveolar diminuiu com a idade e o principal fator etiologico nos pacientes adulto foi acidentes de tráfico e agressão física.

PURPOSE: This prospective study evaluated the profile of patients with dentoalveolar trauma assisted at the emergency room of the Oral and Maxillofacial Trauma and Surgery Service at the Hospital das Clínicas, São Paulo University Medical School (Brazil). METHODS: A prospective study by a questionnaire applied during the first attendance of those patients, in a period of eight months. RESULTS: The collected data were statistically analyzed. It was observed that 4.7% of the patients that sought treatment at the Service had sustained dentoalveolar trauma and among these 74% were male. The most affected individuals were children aged 0 to 5 years and fall was the most prevalent etiologic factor. Avulsion and coronal/crown-root fractures were the most common types of dentoalveolar traumatic injures. As the age increases, the most common etiologic factors are traffic accidents and physical assault. CONCLUSION: The incidence of dentoalveolar trauma decreased with age and the main etiologic factors in adult patients were traffic accidents and physical assault.