Jordi | Journal of Oral Diagnosis Online Submission Review an Article SOBEP - Sociedade Brasileira de Estomatologia e Patologia Oral
Current Number: V4 - 2019

Review Article

1 - Endodontic treatment in patients previously subjected to head and neck radiotherapy: a literature review

Wellington Hideaki Yanaguizawa1; Solange Kobayashi-Velasco1; Ivan Onone Gialain1; Celso Luiz Caldeira2; Marcelo Gusmão Paraiso Cavalcanti1

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The head and neck region is an expressive site of malignant neoplasms. Radiation therapy is a type of cancer treatment that can be used before or after surgical procedures, or in contraindicated surgery cases. Radiotherapy can cause various side effects in the patient's mouth, including xerostomia, mucositis, radiation cavities, and osteoradionecrosis. Due to the risk of osteoradionecrosis after dental extractions, endodontic treatment ends up being the best preventive and therapeutic method. The purpose of this study is to review the literature on endodontic treatment in cancer patients undergoing radiotherapy.

Keywords: Radiotherapy, Osteoradionecrosis, Endodontic treatment.

Original Article

2 - Unusual bone-forming lesion affecting complete denture wearer: two case reports

Luciana Yamamoto Almeida1; Ana Terezinha Marques Mesquita2; Cássio Roberto Rocha dos Santos2; Alfredo Ribeiro-Silva3; Lana Kei Yamamoto Almeida4; Jorge Esquiche León5

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INTRODUCTION: The use of complete removable dentures is associated with a high frequency of oral mucosal lesions. Among them, denture-induced fibrous inflammatory hyperplasia is one of the most common. Interestingly, some oral lesions occurring beneath complete dentures can present exuberant new bone formation, creating diagnostic difficulties. PATIENTS: We present two interesting cases affecting complete denture wearers, showing each one unusual bone-forming lesion. The first was diagnosed as extensive mature bone formation with osteochondromatous metaplasia foci and the second as an exuberant exostosis. DISCUSSION: Oral soft tissue lesions caused by ill-fitting dentures may present distinct microscopic variations such as osseous and chondromatous metaplasia arising of the connective tissue. These cases evidence that contributing factors for exostosis may be the chronic oral mucosa irritation at the tissue/denture base interface and a response to stresses transferred to the alveolar bone by the ill-fitting denture. CONCLUSION: Awareness of these lesions is essential to avoid unnecessary procedures, prevent misdiagnosis, reduce patient anxiety, consequently influencing oral health related-quality of life of edentulous patients.

Keywords: Exostoses, Osteochondroma, Metaplasia, Denture, Complete.

Case Report

3 - Solitary keratoacanthoma of the lip vermilion: case report and comprehensive review of literature

Aneliza de Fatima Moraes da Silva1; José Humberto Damante2; Luiz Antônio Assis Taveira3; Kellen Cristine Tjioe4

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Solitary keratoacanthoma (S-KA) is a benign epithelial proliferation that affects the sun-exposed skin of elderly. It presents rapid growth often followed by spontaneous remission. S-KA clinical and microscopic features are very similar to the squamous cell carcinoma’s (SCC) and differentiating them can be a challenge. S-KA involving the lip is rare and frequently is managed as SCC, leading to overtreatment. Despite of few investigations aiming at differentiate S-KA and SCC are available, there is no compilation of case reports of lip S-KA. Thus, our aim was to conduct a comprehensive review of the literature and report a case of lip S-KA. The review was conducted until 2016 and only 21 cases were found. Lip S-KA was more common in elder man, lower lip, and most of them were asymptomatic. The lesions measured 16.7mm on average with duration of approximately 12 weeks. The most performed treatment was excisional biopsy of lesion despite of the self-healing potential of the lesion.

Keywords: Keratoacanthoma; Carcinoma, Squamous Cell; Lip; Neoplasm Regression, Spontaneous.

Original Article

4 - Clinicopathological parameters of oral squamous cell carcinoma in Florianópolis: A 10-year study

Georgia Martini1; Gustavo de-Los-Santos2; Natalia Bordignon1; Carla Girardi3; Fernanda Viviane Mariano4; Filipe Ivan Daniel1; Rogério Oliveira Gondak1

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Oral squamous cell carcinoma (OSCC) is one of the most common cancers and presents the highest mortality rate of head and neck tumours. The aim of this study was to evaluate the clinical and histological features of patients with OSCC in Florianópolis, Santa Catarina, Brazil between 2006 and 2016. Demographic and clinical characteristics such as age, gender, tobacco and alcohol consumption, anatomical site, clinical stage, and treatment were retrospectively collected from histopathological and medical reports. Of 196 patients with OSCC, 82.14% were male with a mean age of 58.28±10.45 years. Tobacco and alcohol consumption was reported in 88.76% and 75.9% of patients, respectively. The tongue was the anatomical site most affected (25.13%) and ulcers were the most prevalent clinical aspect (95.21%). A total of 103 (52.55%) patients were diagnosed with advanced stage (III/IV). Regarding treatment, 59.24% received more than one type of therapy, while 39.67% were treated exclusively with surgery. Regarding histological differentiation, 72.9% of the cases were moderately/poorly differentiated, 23.8% had vascular invasion, 17.9% had lymphatic invasion, and perineural invasion was observed in 29.5% of the patients. The survival rate showed a worse prognosis for patients diagnosed at stage III/IV and the primary tumour was located in the inferior level of the mouth in 80% of these cases. The results showed that the majority of cases were diagnosed at an advanced stage, compromising treatment and prognosis. Educational and preventive measures should be improved in an effort to allow for early diagnosis.

Keywords: Carcinoma, Squamous Cell; Head and Neck Neoplasms; Ulcer; Tongue..

Case Report

5 - A rare case of enamel pearl in canine tooth

Ana Carolina Ramos Mariz1; Gabriela Meyge de Brito2; Daniela Adorno Farias3; André Wilson Machado2; Paulo Sérgio Flores Campos1

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The enamel pearl (EP) is a dental developmental anomaly that usually manifests in furcation areas, and is uncommon in uniradicular teeth. We present a case of EP on the vestibular surface of tooth 13 in a 38-year-old patient, who was submitted to multislice computed tomography (MSCT) for orthognathic surgery planning. The attenuation coefficient (3.070 HU) allowed the condition to be classified as a true EP.

Keywords: Tooth Abnormalities; Multidetector Computed Tomography; Tooth, Impacted.

Original Article

6 - Giant cell lesion and traumatic bone cyst: pathologically related lesions?

Bianca de Bem Prunes; Natália Batista Daroit; Júlia Silveira Nunes; João Júlio da Cunha Filho; Pantelis Varvaki Rados; Fernanda Visioli

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INTRODUCTION: Synchronous lesions of the jaws are reported in the literature and the etiopathogenesis can be similar in some cases. The oral surgeon must know the diseases that may occur simultaneously. OBJECTIVE: The aim of this study was to report a case of synchronous lesions, your management, additionally discuss the etiopathogenesis correlation among these lesions and the possible evolution from one disease to the other in order to aid the professional about the management of this occurrence. METHODS: This study reported a case of a 14-year-old female patient presenting a reddish sessile nodule in mandibular left premolars gingival region. RESULTS: Radiographically, a well-defined radiolucent area involving left mandibular body was observed. An incisional biopsy of the extra-osseous lesion was performed and a giant cell lesion was histopathologically diagnosed. A surgical bone exploratory procedure revealed an empty cavity; therefore curettage to stimulate bleeding was performed in addition to the extra-osseous lesion excision. The final diagnosis was synergistic peripheral giant cell lesion and traumatic bone cyst. The 12 months follow-up did not show any relapse, moreover, the complete bone neoformation was observed. CONCLUSIONS: The pathogenesis of both lesions remains uncertain and a complete and detailed clinical and histopathological examination added to rigorous follow up with image exams resulted in a correct diagnosis and good prognosis of this case.

Keywords: Peripheral Giant Cell Granuloma; Bone Cysts; Jaw Cysts; Jaw Cysts/Etiology..

Case Report

7 - Von Recklinghausen disease/type I neurofibromatosis and its association with orofacial changes: Literature review and case report

Monah Sampaio Santos1; Wladimir Gushiken de- Campos2; Camilla Vieira Esteves2; Camila Eduarda Zambon1; André Caroli Rocha1; Gustavo Grothe Machado1; Celso Augusto Lemos2

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Neurofibromatosis is an autosomal dominant genetic disorder and an inherited condition. This pathology represents 90% of the cases found in the general population. Oral manifestations of neurofibromatosis type I can occur in 70 to 92% of cases, especially when a detailed clinical examination is performed associated with complementary imaging tests. Because of this, it is not uncommon for the dental surgeon to be the first health professional to perform the diagnosis of the disease. The importance of having an early diagnosis correlates with the possible complications of the disease. The carrier may have offspring that manifest the disease in its severe form because of the large capacity for variation, which can be avoided with prior genetic counseling. In this study we report a case of a woman diagnosed and treated for central giant cell lesion 44 years ago, with dental, spine and mandible alterations, also with a family history of neurofibromatosis.

Keywords: Neurofibromatosis 1; Maxilla; Mandible; Oral Manifestations..

Original Article

8 - Dermoid and epidermoid cysts of the mouth: Clinicopathological and cytokeratin profile

Osvaldo Schitini Schitini-Junior1; Águida Cristina Gomes Henriques1; Valéria Souza Freitas2; Clarissa Araújo Gurgel1; Patrícia Ramos Cury1; Lélia Batista Souza3; Eliabe Almeida dos Santos1; Roberto Almeida De Azevedo1; Viviane Palmeira da Silva1; Jean Nunes dos Santos1

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INTRODUCTION: The mechanisms of cell differentiation and pathogenesis in oral epidermoid cysts and dermoid cyst is poorly know. OBJECTIVE: To report clinicopathological features and investigate cytokeratin profile of oral epidermoid cysts and dermoid cyst. MATERIAL AND METHODS: Eight cases of epidermoid cysts, 4 of dermoid cyst, and 2 Fordyce granules were included. For analysis of the immunohistochemical expression of cytokeratins (6, 7, 8, 10, 13, 14, 18 and 19), brown staining in the sections examined were defined as positive considering three layers: superficial, intermediate and basal. RESULTS: In dermoid cyst, cytokeratins 7, 8, 9 and 19 were expressed in one case. Cytokeratin 6 was detected in six cases of epidermoid cysts. Cytokeratins 10, 13 and 14 were expressed in all cysts. Cytokeratin 18 was absent in all cysts. Cytokeratins 10 and 14 was observed in Fordyce granules. Cytokeratin 10 was more expressed in peripheral cells and immature sebaceous glands. As these glands became more differentiated, cytokeratin 10 was not detected, while cytokeratin 14 was expressed in mature sebocytes. Cytokeratins 10, 13 and 14 were expressed in the lining mucosa adjacent to Fordyce granules, similar to normal oral mucosal lining. CONCLUSION: cytokeratin profile is altered in dermoid cyst and epidermoid cysts compared to lining oral mucosa.

Keywords: Dermoid Cyst; Epidermal Cyst; Keratins..

Case Report

9 - Botryoid odontogenic cyst: Report of case found in routine imaginological examinations and an update of the literature

John Lennon Silva Cunha1; Amanda Feitoza da Silva2; João Vitor Rocha Silva1; Juliana Batista Melo da Fonte3; Bruno Torres Bezerra2; Sílvia Ferreira de Sousa4; Ricardo Luiz Cavalcanti de Albuquerque-Júnior1

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Botryoid odontogenic cyst (BOC) is a rare variant of the lateral periodontal cyst (LPC). As the biological behavior of BOC is variable and the literature is limited to that of individual case reports, there is no accepted consensus on the best management strategy. A 43-year-old Caucasian male was referred to a private dental clinic for routine radiographic examination. Extraoral and intraoral evaluations revealed no alterations. Panoramic radiography, periapical radiography, and cone beam computed tomography revealed a well-circumscribed osteolytic lesion of 2.0 cm in diameter, extending from the region of teeth 33 to 35. The provisional diagnostic was odontogenic keratocyst or lateral periodontal cyst. Histological analysis of the incisional biopsy revealed multiple cystic cavities lined by a thin nonkeratinized epithelium, exhibiting focal plaque-like thickenings, surrounded by a dense fibrous capsule. The diagnosis was BOC. The purpose of this study was to critically analyze the clinical and radiologic features of BOC based on case reports and case series published in the literature from 1973 to 2018 and to add a new one from our files.

Keywords: Bone Diseases; Odontogenic Cysts; Mandible..

Original Article

10 - Interrelation study between drugs and oral lesion development in patients with special needs

Briana Góes Monteiro1; Maria Cecília Fonsêca Azoubel2; Juliana Borges de Lima Dantas3; Alena Ribeiro Alves Peixoto Medrado4

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INTRODUCTION: Special dentistry is an area that of dentistry that concerns itself with treating patients with special needs. To greater knowledge of the specific special needs by the dentist, there is an urgent need to emphasize the importance of proper odontologic treatment, whether in office or in a hospital environment to this population OBJECTIVES: The aim of this study was to correlate the use of drugs in patients with special needs with the development of oral lesions and to better characterize this population. MATERIALS AND METHODS: This was a quantitative and qualitative cross-sectional study which included special needs patients from the Brazil's Universal Health-Care System. Analysis of medical records and intraoral physical examination was performed for 88 patients and descriptive data was extracted. RESULTS: The patient population was predominantly female (54.5%) and older than 18 years of age (62.5%). A higher frequency of neurological and psychomotor disorders (54.5%), hypertension (29.5%) and diabetes mellitus (15.9%) was found. A total of 21.6% patients reported a"dry mouth." sensation. The drugs most frequently used were anticonvulsants (46.5%), anxiolytics (35.2%) and anti-hypertensives (34%). The highest percentage of lesions corresponded to gingival enlargement (19.3%), followed by gingivitis (10.2%) and candidiasis (7.9%). CONCLUSION: It is expected that results derived from this research can contribute to a better understanding of the interrelationship between the use of pharmaceutical agents and the appearance of lesions in the oral mucosa, as well as to indirectly improve oral health of certain patient populations.

Keywords: Disabled Persons; Pathology, Oral; Pharmacology; Mouth Mucosa; Metabolic Side Effects of Drugs and Substances..

11 - Crohn's disease: Low-Level Laser Therapy (LLLT) as an adjuvant treatment of oral lesions

Cíntia de Souza Alferes Araújo1; Carolina Eurich Mazur2; Vitória Maria de-Melo Nardino1; Hanagleicy Souza1; Roberta Targa Stramandinoli-Zanicotti2; Mirella Lindoso Gomes Campos3; Edimar Rafael Oliveira2; José Miguel Amenábar2

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Classified as a chronic inflammatory bowel disease, Crohns disease (CD) has a multifactorial etiology. Individual with CD can present signs/symptoms such as abdominal pain, fever, diarrhea with a serious risk of hemorrhagic progression, weight loss, anemia and malnutrition. Extra-intestinal complications of CD such as at mouth are probable in some cases. In the mouth, it may presents ulcers, verrucous lesions, swelling of the lips, recurrent aphthous stomatitis, and predisposition to fungal, bacterial and viral infections. In view of the patient´s clinical condition, oral manifestations variable, painful symptomatology and challenge in the choice of oral lesions treatment, this study presents a case of Chron´s Disease´s oral manifestations and its management with Low-Level Laser Therapy (LLLT).

Keywords: Crohn Disease, Mouth, Laser Therapy.

Case Report

13 - Gorham stout syndrome in maxilla and femur

Jaqueline Colaço1; Henrique Cesca1; Gisele Rovani2; Mateus Ericson Flores3; Ferdinando De Conto4

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Gorham Stout syndrome (SGS) is a rare disease that affects the bones causing idiopathic osteolysis. The prognosis of SGS is quite variable and impossible to predict, in most cases, bone destruction progresses from months to years, the affected area does not regenerate or repair itself. The etiology of the disease is unknown. The aim of the present study is to report a case in female patient showing a lesion in the left jaw compatible with the SGS. A 45-year-old female patient, was referred to the CTBMF team. After performing imaging tests to perform the differential diagnosis, they suggested as differential diagnosis of maxillary ossifying fibroma lesion and fibrous dysplasia, in relation to femoral lesion, was suggestive and enchondroma. The proposed treatment was surgical removal with curettage of the lesion in the femur and maxilla. With the result of the histopathological examination, the diagnosis of SGS was concluded. During the postoperative follow-up period, the lesion showed no signs of relapse, guaranteeing success in the treatment.

Keywords: Osteolysis; Maxilla; Neoplasms; Diagnosis..

14 - Labial osteolipoma, clinical and surgical management of an infrequent disease

Ignacio Panico1; Gerardo Marcelo Gilligan2; Liliana Gelman3; René Luis Panico4

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Lipomas are relatively infrequent benign neoplasms of connective tissue that can involve oral mucosa. Different histological subtypes of oral lipomas were previously described in current literature. The aim of this work is to report a clinical case of an 83-year-old male, who presented with a 20-years-old labial mass. Surgical removal was performed, and the histopathological diagnosis reported an oral Osteolipoma (OL). Discussion: There are previous reports of oral lipomas that have histologically presented a combination with other cell lines such as bone and cartilaginous tissue within the tumor. The rarity of its presentation makes this entity an infrequent diagnosis for clinicians and specialists in Oral Medicine. The provisional diagnosis could be aided with X-ray when the mass exam revealed indurated areas and calcifications. There are few cases described of OL in this oral subsite. Because of its unusual presentation, OL of the oral mucosa is a true challenge in oral diagnosis.

Keywords: Lipoma. Soft Tissue Neoplasms. Surgical Procedures, Operative. Diagnosis, Differential.



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