We report the case of a 75-year-old-woman who presented with bilateral scalp ulcerations and blindness, accompanied by severe headache and scalp tenderness, due to bilateral temporal arteritis without systemic involvement. A biopsy taken from the border of an ulceration showed evidence of giant cell arteritis. She was treated with oral prednisone, 60 mg per day. The ulcerations healed in a few weeks but the vision loss was irreversible.This case highlights for temporal arteritis the importance of accurate and timely diagnosis as well as the need for prompt therapy with systemic steroids in order to avoid major complications, namely loss of vision. It also demonstrates that scalp necrosis and ulcerations are skin signs associated with a poor prognosis.

Erythema elevatum diutinum is a chronic and rare cutaneous leukocytoclastic vasculitis, characterized by red, purple and yellow papules, plaques and nodules, distributed symmetrically on the extensor surfaces of the limbs. It is associated with several autoimmune, neoplastic and infectious processes, mainly hematological malignancies in about 30% of the cases. Joint pain and arthritis are frequent symptoms, affecting approximately 40% of the patients, indicating the need for its inclusion in the differential diagnosis of rheumatic diseases, chiefl y the other presentations of leukocytoclastic vasculitis, which are characterized by the combination of rheumatic manifestations and peculiar cutaneous lesions. We report the case of an 18-year-old female patient who developed erythema elevatum diutinum and whose diagnosis was based on the morphologic characteristics, the distribution pattern of the cutaneous lesions and the histopathological fi ndings of leukocytoclastic vasculitis. The major systemic symptom was severe arthritis.

Background Temporomandibular joint osteoarthritis (TMJOA) is a progressive degenerative disease caused by imbalance between anabolic and catabolic stimuli. Objective The aim of this study was to evaluate histopathological changes, collagen degeneration and the expression of eleven TMJOA biomarkers in articular discs. Methods Specimens were obtained from eight female patients submitted to discectomy. Discs were divided into anterior band (AB), intermediate zone (IZ) and posterior band (PB) for computerised histomorphometric analyses. Each was assigned a histopathological degeneration score (HDS). Collagen degeneration was assessed with Picrosirius‐polarisation method. Biomarkers were evaluated through immunohistochemistry, including IGF‐1, OPG, VEGF, TNF‐α, FGF‐23, IHH, MMP‐3, MMP‐9, TGF‐β1, BMP‐2 and WNT‐3. Image processing software was used to calculate average immature collagen ratios and immunostained areas. Spearman rank tests were applied to verify correlations, with significance level of 0.05. Results The HDS showed negative correlation with expression of VEGF in IZ and PB (P < .05) and positive with TNF‐α in AB (P < .01). Collagen degeneration correlated with TGF‐β1 (P < .05), BMP‐2 (P < .01) and IHH (P < .05) immunostained areas in the IZ; TGF‐β1, BMP‐2 and IHH expression correlated among each other in AB and IZ (P < .05). Conclusion Angiogenesis and tissue fragmentation may result from aberrant physiologic responses mediated by VEGF and TNF‐α, compromising TMJ discs during OA progression. The expression of TGF‐β1, BMP‐2 and IHH could be related to collagen degeneration in displaced discs and may participate in TMJOA pathogenesis.

Introdução: a cirurgia ortognática é uma modalidade de tratamento voltada para a correção das deformidades dentofaciais que envolve uma equipe multidisciplinar, conduzida pela interação do cirurgião bucomaxilofacial com o ortodontista. O tratamento ortodôntico associado a técnicas cirúrgicas, como osteotomia sagital bilateral dos ramos mandibulares e osteotomia Le Fort I, trouxe grandes avanços para a correção das más oclusões esqueléticas com o objetivo de obter uma oclusão funcional, visando a saúde das estruturas orofaciais, harmonia facial e dentária, e estabilidade dos resultados. Objetivo: o presente trabalho exemplifica o tratamento ortodôntico-cirúrgico contemporâneo com o relato de um caso clínico de deformidade dentofacial Classe III. Relato de caso: paciente do sexo masculino, 23 anos de idade, portador de má oclusão Classe III esquelética com histórico de tratamento ortodôntico compensatório prévio, com indicação de tratamento ortodôntico- cirúrgico com a finalidade de aprimorar as funções mastigatória, respiratória e de fonação, aliada à melhora da estética facial e do sorriso. Resultados: após 16 meses de preparo ortodôntico, foi realizada cirurgia ortognática com avanço de maxila, recuo de mandíbula e mentoplastia de avanço. No controle pós-operatório de 6 meses, com o tratamento ortodôntico finalizado, apresentou resultados funcionais e estéticos favoráveis. Conclusões: a correta indicação do tratamento ortodôntico-cirúrgico representa um método eficaz para a correção das más oclusões esqueléticas, proporcionando resultados funcionais satisfatórios, com previsibilidade e estabilidade adequadas.

Fractures should be treated by a multi-professional team to minimize sequels. The surgery aims to establish a good maxillary, mandibular relationship to improve mastication and phonetics and may benefit esthetics. Objective: to report the surgical procedure with Le Fort II osteotomy for correction of class III dentofacial deformity and the nasomaxillary deficiency caused by trauma. Case report: Patient victim of aggression for 10 years suffered a Le Fort II fracture. The fracture was not treated and the patient developed a severe anteroposterior defect of the nasomaxillary complex and Class III occlusion. The surgery for correcting deformities was performed with the bicoronal, lower eyelid and intraoral accesses. Le Fort II pyramidal osteotomy was performed with a piezoelectric motor to advance 7 mm the nasomaxillary complex. Conclusion: Le Fort II osteotomy is considered satisfactory for advancing the nasomaxillary complex, improving the patient´s psychosocial function and development.