Introduction and importance Fibrous Dysplasia (FD) is a benign fibro-osseous lesion, characterized by replacement with fibrous connective tissue instead of normal bone. The best treatment option for the condition has not yet been established, although several therapeutic approaches have been reported. The present case report describes the clinical, imaging and therapeutic aspects of an atypical bilateral presentation of FD in the mandible. Case presentation A 26-year-old afro-descendent woman, who had previously undergone surgery to remove FD in the right hemimandible, complained of asymptomatic swelling in the left hemimandible. Imaging analysis showed an ipsilateral extensive multilocular mandibular lesion, with thinning of the cortical bone. After diagnosis of FD, complete surgical removal was performed, associated with immediate local reconstruction with xenograft and covering membrane, with primary wound closure. Clinical discussion Bilateral presentation of FD is uncommon, and its diagnosis by means of clinical data, imaging and histopathological analysis, is relevant in order to establish the correct therapy. Conclusion Complete surgical removal associated with immediate local bone reconstruction, has shown satisfactory clinical results, when adequate follow-up is performed.

Sialolithiasis is the most common cause of sialadenitis in the submandibular gland, in which the highest incidence of this condition occurs, among the major salivary glands. This could be explained by the anatomy of Wharton's duct, and the chemical composition of the saliva produced by this gland. There are several alternatives and techniques for the treatment of sialolithiasis, including lithotripsy, sialoendoscopy, and conservative removal of the sialoliths or complete removal of the submandibular gland, through the transoral and extraoral routes for access to the gland. To determine the form of treatment, characteristics such as topography, diameter, and location of the sialolith in the duct are observed. The aim of this case series was to show our experience gained in two clinical cases of submandibular gland excision through an extraoral approach, using the submandibular access technique. In addition, we discussed the cause of sialolithiasis in these patients and after follow-up, compared the clinical results we obtained with this technique with those reported in the current literature. The submandibular approach or Risdon access continues to be a safe approach to removing the submandibular gland, as it is a commonly used technique and obtained satisfactory results, as shown in these cases. However, the major disadvantages were the less favorable esthetic results and paralysis of the marginal mandibular branch of the facial nerve.

Pleomorphic adenoma, considered the most frequent benign mixed neoplasm of the minor salivary glands, occurs mainly in the region of the hard palate, with slight predilection in females and peak of incidence between the third and fifth decades of life. An increase in recurrence rates has been associated with the histopathological variants of the tumor, cellular characteristics, stroma, and capsule rupture during surgical removal of the lesion. The present case report aims to describe the surgical approach performed on the patient, a 45-year-old woman with a recurrent Pleomorphic Adenoma (PA) in the region of the hard palate on the right side, 10 years after initial enucleation of the lesion; her main complaint was an increase in volume in the palatal region. After extensive local surgical excision of the tumor and 2 years of follow-up, there were no signs of recurrence. Computed tomography and a correct histopathological diagnosis are essential to enable the establishment of an appropriate surgical treatment, with the purpose of achieving complete removal of the lesion, with wide surgical margins, including the lining mucosa and the underlying periosteum, as described in the present case.

MARTINS, I. S.; GOULART, D. R.; PRATI, A. J.; DE MORAES M.; PASTORE, P. R. & DE TOLEDO, M. C.Surgical management of mandibular ameloblastoma and immediate reconstruction with nonvascularized bone graft and hyperbaric oxygen therapy. Int. J. Odontostomat., 10(3):409-417, 2016.ABSTRACT: Extensive resection of tumor often results in bone and soft tissue defects that cause functional and esthetic consequences. The reconstructive surgery is extremely important for the rehabilitation of these patients. The purpose of this study is to report on the use of Hyperbaric Oxygen therapy (HBO) in the case of a large ameloblastoma treated with segmental resection and reconstructed immediately with nonvascularized bone graft (NVBGs) from iliac crest. A 41-year-old woman was referred to our department because of paresthesia of the inferior alveolar nerve and history of swelling in the molar and ramus region of the left mandible. Panoramic radiograph depicting well-defined multilocular radiolucency extending from second premolar region to the left ramus region. An incisional biopsy confirms the diagnosis of solid ameloblastoma. The treatment of choice was segmental mandibular resection and immediate mandibular reconstruction using NVBGs from iliac crest, followed by removal of internal fixation and placement of dental implants with immediate loading. The patient received preoperative HBO (a 90-min session at 2.2-2.4 atmospheres, five times per week for two weeks, for a total of up to 10 sessions). Postoperative HBO (10 further 90-min sessions) was administered within 2 weeks. The patient received rehabilitation with a mandibular implant-supported fixed complete dental prosthesis. The present study showed successful management of mandibular ameloblastoma that associated extensive surgery, immediate reconstruction with NVBGs from iliac crest, hyperbaric oxygen therapy and dental implants. These combined procedures allowed removal of lesion and reestablishment of mandibular contour and function.

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Highlights There are few clinical reports about unusual presentation of tori palatinus associated a systemic disorder. New technologies for surgical planning are become more sutiable for clinicians and oral amnd maxillofacial surgeons. Surgical treatment is still the gold standard approach for treating exostoses.