Jordi | Journal of Oral Diagnosis Online Submission Review an Article SOBEP - Sociedade Brasileira de Estomatologia e Patologia Oral
Current Number: V2 - 2017

Original Article

1 - Homeopathic treatment in oral lichen planus control: Case Report

Rafaela Savio Melzer B. F. Wastner; Fernando Luiz Zanferrari; Laurindo Moacir Sassi

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Lichen planus, considered an inflammatory disease of the stratified squamous epithelium of unknown aetiology, is a condition that often affects the oral mucosa. This pathology is more prevalent in female caucasian patients and the signs and symptoms range from asymptomatic to completely debilitating painful mucosal lesions. OBJECTIVE: To report a case of a patient affected by lichen planus, whose treatment was homeopathic. CASE REPORT: Female patient with pain complaints in oral mucosa and presence of whitish plaques in bilateral buccal mucosa that exacerbate during periods of stress. The lesions were controlled by homeopathy medication, which leaded to regression of the lesions and provided comfort to the patient. CONCLUSION: The use of homeopathy in Dentistry is a new concept, which has been growing and proving to be effective, especially when related to autoimmune diseases, where the stress is a factor linked to the development/ exacerbation of the signs and symptoms.

Keywords: Mouth; Homeopathy; Lichen Planus, Oral.

2 - Supernumerary bilateral tooth germs mimicking radiolucent bone pathology

Isadora Luana Flores1; Natanael de Alencar Samarcos Mahon2; Thiago de Oliveira Gamba3; Afonso Celso Assis2; Ana Paula Neutzling Gomes4; Sérgio Lúcio Pereira de Castro Lopes5

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The immature tissues of teeth germs may mimicking odontogenic and non-odontogenic lesions. About this, an asymptomatic bilateral well-circumscribed radiolucency found during the routine evaluation is considered an uncommon finding and both supernumerary and maxillomandibular bone pathologies should be listed. Quite often, it is one clinical exercise to suggest diagnostic hypotheses to unspecific radiolucency image since cysts, neoplasms and dental anomalies are possible. Here, we reported a case of bilateral supernumerary teeth germs in a 12-years-old Caucasian patient highly suspicious of bone pathology due to completely radiolucent aspect. So, this is the first article to presents a case of bilateral teeth germs as an alert to early stage of tooth crypts in the differential diagnosis of mandibular circumscribed radiolucencies.

Keywords: Tomography, X-Ray Computed; Tooth, Supernumerary; Tooth Germ..

3 - Management of oral adverse effects related to cetuximab plus radiotherapy

Danilo da Silva Corrêa; Thaís Feitosa Leitão de Oliveira; Paulo Sérgio da Silva Santos

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Squamous cell carcinomas of head and neck have an incidence of more than five hundred thousand cases a year worldwide. The standard treatment of this condition consists of platinum-based chemotherapy and radiotherapy. Nevertheless, in case of advanced age or reduced general condition the chemotherapy agent utilized is Cetuximab, a molecular targeted drug, used for metastatic colorectal cancer and head and neck cancer. Adverse effects associated with Cetuximab can be potentiated by the radiotherapy leading to oral mucositis and skin toxicities. We report a case of a 70-year-old caucasian woman who had removed a gingival squamous cell carcinoma at the left side of the mandible. During intensity modulated radiotherapy and Cetuximab chemotherapy she began to develop severe oral mucositis and perioral and neck skin toxicities. The pain associated with the oral mucositis prevented the patient from eating, causing a break in radio and chemotherapy. The treatment with systemic and topical medications and low-level lasertherapy was applied. The patient tolerated well the treatment and fifteen days after it began, radio and chemotherapy was reinitiated and concluded with no more adverse effects. It is important to the medical team to be aware of it, since the early identification and treatment of its signs and symptoms reduces the risks of breaks in the treatment and provides better quality of life to these patients.

Keywords: Antibodies, Monoclonal, Humanized; Cetuximab; Drug-Related Side Effects and Adverse Reactions; Mucositis..

4 - Surgical treatment of Schwannoma in lower lip: Case Report

Rafaela Savio Melzer; Vitor Hugo Candido Ferreira; Guilherme Klein Parise; Juliana Lucena Schussel; Laurindo Moacir Sassi

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INTRODUCTION: Of unknown aetiology, the schwannoma is a benign tumor that originates from the Schwann cells of the peripheral nerves. Around 25% to 45% of these tumors affect the head and neck region and are rare when affect the oral cavity. Presents itself as a lump of smooth surface, soft consistency and sessile. Histologically presents two standards, being the first known as Antoni A and the second, called Antoni B. OBJECTIVE: To present a case of schwannoma in lower lip. CASE REPORT: Male patient sought specialized care of a maxillofacial surgeon due to volume increase painless in lower lip. An incisional biopsy was performed and the diagnosis was of schwannoma. The lesion was removed in your entirety, the patient is well and no signs of recurrence. CONCLUSION: The schwannomas occur infrequently in head and neck region, and it is rare when the lip is the site of involvement. The treatment of choice is surgical excision.

Keywords: Schwann Cells; Lip; Neurilemmoma.

5 - Idiopathic Bilateral Central Giant Cell Granuloma of Jaw- A Case Report and Brief Review of Reported Cases

Aarfa Nasim; Ravi Prakash Sasankoti Mohan; Nagaraju Kamarthi; Vijay Wadhwan

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Central giant cell granuloma (CGCG) is a benign intraosseous reactive lesion of jaw with diverse clinical and radiological behaviour pattern. It accounts for 7% of neoplastic bone lesion of jaw with 70% occurring in mandible. CGCG was first considered as giant cell tumor mostly found in epiphyseal region of long bone having both aggressive and non-aggressive pattern. The etiology of the lesion is not defined. Multiple CGCGs of the jaw bones is very rare and, if it occurs, it is usually associated with hyperparathyroidism in majority of the cases. We report an interesting case in which a 33 year old female came with a swelling present on right side of mandible which was asymptomatic. Another swelling was present on left side which was non-evident and asymptomatic. Clinical, radiological and histopathological examination confirmed the lesions as central giant cell granuloma. Biochemical examination showed no signs of hyperparathyroidism. This report represents a very rare entity in which there is idiopathic bilateral CGCG having both aggressive and non-aggressive type of lesion.

Keywords: Giant Cells; Granuloma; Hyperparathyroidism; Mandible..

6 - Familial case of Gorlin-Goltz syndrome associated with craniosynostosis

Ravi Prakash Sasankoti Mohan; Akanksha Gupta; Nagaraju Kamarthi; Sangeeta Malik

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Gorlin-Goltz Syndrome is inherited as an autosomal dominant disorder and occurs due to mutations in the PTCH1 (Patched 1) gene. It is characterized by multiple keratocystic odontogenic tumors, multiple basal cell carcinomas, skeletal, ophthalmic, neurological abnormalities and facial dysmorphism. Craniosynostosis is the premature fusion of calvarial bones leading to an abnormal head shape. In addition to all the classical features, presence of craniosynostosis in one of our cases was an interesting finding which has never been reported previously in Gorlin-Goltz syndrome. Giant congenital melanocytic nevus was also present making the case more unique.

Keywords: Basal Cell Nevus Syndrome; Odontogenic Tumors; Nevus, Pigmented; Cranial Sutures..

Case Report

7 - Reemerging syphilis: diagnosis from oral lesions

Ingrid da Silva Santos1; Daniela Brito Bastos1; Vitor Bonetti Valente1; Solange Pires D'Ávila2; Kellen Cristine Tjioe1; Éder Ricardo Biasoli1; Glauco Issamu Miyahara1; Daniel Galera Bernabé1

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BACKGROUND: Syphilis cases have increasing worldwide recently, indicating a resurgence of the disease. Its clinical features vary widely and often challenge the establishment of the diagnosis. CASE REPORT: A 23-year-old woman presented with multiple erosive and patchy oral lesions, dysphagia, and pain with onset of two months. Her medical history revealed that she also presented skin macules which were misdiagnosed as pityriasis by a dermatologist. Nontreponemic test was reagent. An incisional biopsy of an oral lesion was performed and the histopathological aspects were suggestive of syphilis. Treponemic test was positive, confirming secondary syphilis. The treatment consisted of penicillin for 3 weeks. After the 6-months follow-up, clinical and serological exams did not show any sign of the disease. CONCLUSIONS: Diagnosing syphilis by oral lesions can be difficult once it can mimic other affections. Additionally, the reemergence of this sexually transmitted disease in the last years demands its inclusion in the differential diagnosis of either erosive or ulcerate lesions.

Keywords: Syphilis; Treponema pallidum; Diagnosis, Oral; Sexually Transmitted Diseases..

Original Article

8 - Clinical, morphological and immunohistochemical findings in canalicular adenoma

Leorik Pereira da Silva; Luiz Arthur Barbosa da Silva; Éricka Janine Dantas da Silveira; Patrícia Teixeira de Oliveira; Márcia Cristina da Costa Miguel

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Canalicular adenoma (CAd) is an uncommon benign salivary gland tumor, usually located in the upper lip. We carried out a survey of cases of CAds among the all salivary gland tumors submitted to an Oral Pathology service over a 36-year period, and performed a comprehensive literature review of all CAds reported from 2006 to 2016. Among 161 salivary gland tumors, only two were diagnosed as CAds. A detailed clinical, morphological and immunohistochemical (IHC) study of the two cases was performed. Morphologically, the tumors were characterized by cuboidal to columnar neoplastic cells lining cystic spaces and forming tumor cords. The IHC reactions (positive for cytokeratin-7, AE1/AE3, S-100, p63, and negative for α-SMA) supported a luminal/ductal cell proliferation without myoepithelial cells. The clinical features of the cases were similar to that shown in the literature, while the morphological and IHC findings confirmed the epithelial nature of the tumor, and highlighted important differential diagnostic aspects.

Keywords: Salivary Gland Neoplasms; Adenoma; Immunohistochemistry..

9 - Osteocartilaginous choristoma of the tongue: a case report and review of the literature

Priscilla Rodrigues Câmara1; Jefferson Ferreira dos Santos2; Maria Carolina de Lima Jacy Monteiro1; Rafaela Elvira Rozza de Menezes1; Adriele Ferreira Gouvêa1; Karla Bianca Fernandes da Costa Fontes1; Rebeca Souza Azevedo1; Renata Tucci1

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The purpose of the present article was to report a clinical case of a 53-year-old male patient with a tongue osteocartilaginous choristoma. Additionally, we made a brief review of the literature to identify all cases reported in English-language literature of oral osteocartilaginous choristoma and, to the best of our knowledge, there are only nine reported cases. Choristoma is a lesion characterized by the development of a histologically normal tissue in an abnormal site. Occurrence of osseous or cartilaginous choristomas in oral soft tissues are rather uncommon. Cases presenting both bone and cartilage simultaneously, named osteocartilaginous choristomas, are even rarer. After the literature search, we also compare the pathogenesis, clinical and histopathological features of our osteocartilaginous choristoma with the literature about osseous or cartilaginous choristomas. The present case report contributes with an additional case of osteocartilaginous choristoma of the tongue, which is suggestive of metaplasia, and it had an unusual histopathological aspect with cartilage structure as principal component.

Keywords: Choristoma; Diagnosis, Oral; Pathology..

10 - Evaluation of CD57+ cells in oral squamous cells carcinoma and their relationship with clinicopathological parameters

Maria Luiza Diniz de Sousa Lopes1; Caio César da Silva Barros2; Maurília Raquel de Souto Medeiros2; Márcia Cristina da Costa Miguel1; Lélia Batista de Souza1; Pollianna Muniz Alves3; Éricka Janine Dantas da Silveira1

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INTRODUCTION: The immune response occurring in the tumor microenvironment is very complex. Surface molecule CD57 can be expressed by natural killer cells and/or activated T lymphocytes, which are key cellular types in the cancer immunity. OBJECTIVES: This study investigated CD57 immunoexpression in immune cells of oral squamous cell carcinoma (OSCC) and verified its association with clinicopathological features. METHODS: Paraffin-embedded sections of 45 OSCCs were submitted to morphological and immunohistochemical analysis using anti-CD57 antibody. Relationship between the expression of CD57 and clinicopathological parameters (age, metastasis to regional lymph nodes, clinical stage and histopathological grade of malignancy) was verified by Pearson's Chi square, and Fisher exact statistical tests. RESULTS: The majority (64.4%) of the OSCCs analyzed affected subjects of male gender and over 40 years old (68.9%). There was a significant association between histological grade of malignancy and presence of lymph node metastasis, as well as clinical stage (p<0.05). CONCLUSIONS: The results suggest that CD57+ cells immune cells infiltration is a consistent finding in OSCC, regardless of clinicopathological features of these tumors.

Keywords: Mouth Neoplasms; Antigens, CD57; Immunohistochemistry.

11 - Trabecular juvenile ossifying fibroma in the mandible: clinical, radiographic and histopathologic features

Monica Ghislaine Oliveira Alves1; Bruna Fernandes do Carmo Carvalho2; André Caroli Rocha3; Carlos Ishida 4; Yasmin Rodarte Carvalho1; Janete Dias Almeida1

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Juvenile ossifying fibroma is an uncommon, aggressive, asymptomatic fibro-osseous lesion. An 11-year-old white boy was seen at the stomatology outpatient clinic with a complaint of pain and a one-year history of tooth mobility and extensive swelling in the mandible. Extraoral clinical examination showed major facial asymmetry and swelling in the left mandibular body. Intraoral examination revealed expansion of the buccal and lingual cortical bones. Imaging identified a multilocular mixed lesion in the mandible with hyperdense areas. An incisional biopsy was performed and the combination of clinical, imaging and histopathologic data led to the final diagnosis of juvenile ossifying fibroma. Treatment consisted of segmental mandibulectomy and reconstruction with a microsurgical fibular flap, after 5 years of follow up, no local recurrence was observed. Strategies for the clinical management and treatment of pediatric patient should be designed to offer the best prognosis and quality of life for the patient.

Keywords: Jaw Abnormalities; Jaw Diseases; Oral Medicine..

12 - Extensive osteolytic disease in the mandible of a pediatric patient: Case report

Tila Fortuna1; Deyvid Silva Rebouças2; Gabriela Santos Lopes3; Ana Carolina Lemos Pimentel1; Alena Ribeiro Alves Peixoto Medrado1,4; Carlos Elias de Freitas1,5

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INTRODUCTION: Gorham's disease, correspond to a massive osteolytic disease of the bones, characterized by destruction and resorption of one or more bones, spontaneous and progressive. The etiology of the disease is still unknown. The destroyed bone does not have the ability to regenerate or repair and is replaced by dense fibrous tissue. Bones of the skull and pelvis are the most commonly affected and in maxillofacial bones, the mandible is particularly affected. CASE REPORT: This study reports the case of an 11-year-old female, referred to the Oral and Maxillofacial Surgery service showing extensive area of spontaneous bone resorption, in which only the alveolar portion of the mandibular symphysis and the head of the left jaw were present. The history and clinical features observed indicated Gorham's disease. FINAL CONSIDERATIONS: When in progressive stages Gorham's disease is difficult to be diagnosed by histopathological evaluation, due to limited remaining bone quantity, leaving only clinical and complementary exams to make allowances. The treatment is controversial in the literature. Therapy is individualized in accordance with the severity of the patient's condition and the site of involvement.

Keywords: Bone Diseases; Pathology; Bone Resorption; Osteolysis, Essential..

Case Report

13 - Recurrent ameloblastoma 30 years after surgical treatment

Fábio Vieira de Miranda1; Liogi Iwaki Filho2,3; Valthierre Nunes de Lima4; Osvaldo Magro Filho1; Leonardo Perez Faverani1

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INTRODUCTION: Ameloblastoma is a locally invasive, slowly growing odontogenic epithelium, which can reach large proportions. It is preferentially located in the region of mandibular molars. The most indicated treatment is resection with safety margin, since its potential for recurrence is high. OBJECTIVE: To report a case of recurrence the ameloblastoma. CASE REPORT: A 60-year-old female patient came to the hospital with difficulty speaking and eating because of the mass inside the mouth and earaches. The extra-buccal physical examination had an increase in volume in the jugal and right temporal regions. At the intra-buccal physical examination there was a nodule approximately 5X6X7 cm, firm at palpation with normal overlying mucosa in color and continuity. The patient reported that 30 years ago she had undergone a surgical procedure to remove an ameloblastoma in the region of the right mandibular body. Imaging revealed a wide extension of the lesion, extending from the symphysis to the cranial base, in the middle cranial fossa region. Previous incisive biopsy revealed the diagnosis of follicular ameloblastoma. CONCLUSION: Ameloblastoma should be followed for a long period of time because it is a locally infiltrative benign neoplasm that, even when treated with surgery and safety margin, may recur late. The approach taken was the removal of the lesion associated with mandibular reconstruction.

Keywords: Ameloblastoma; Jaw Neoplasms; Mandibular Reconstruction; Odontogenic Tumors..

Original Article

14 - Influence of vitamin D in bone healing

Rafaela Pignatti de Freitas1; Fernanda Parini Nunes1; Livia Marcela dos Santos2; Paulo Henrique Weckwerth1; Elcia Maria Varize Silveira1; Jéssica Lemos Gulinelli1; Pamela Leticia Santos3

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INTRODUCTION: Vitamin D is an hormone whose function is to maintain calcium and phosphorus homeostasis in order to ensure bone mineralization. Vitamin-D deficiency can lead to severe diseases, including an atypical mineralization of bone, because it decreases osteoblasts activity. It has become increasingly common and it has been mainly observed in obese people who avoid direct sunlight exposure to their skin and have a vitamin D-deficient diet. OBJECTIVES: Due to the high incidence of hypovitaminosis D in the world population, this study sought to provide an analytical and minute literature review associating vitamin D deficiency with bone healing. METHODS: To accomplish this, a bibliographic research was conducted in the following database: Medline (PubMed), Science Direct, Scielo, Periódicos CAPES (Brazilian database), and Bireme (Latin-American database). RESULTS: From the main longitudinal and meta-analytic studies, as well as the main studies conducted on animals, published between 1995 and 2015, 20 articles were selected according to the inclusion criteria. CONCLUSION: From this review, it was concluded that vitamin D influences the cellular process of bone healing and that the exact mechanism of this influence is still unclear.

Keywords: 25-Hydroxyvitamin D 2; Vitamin D Deficiency; Bone Diseases, Endocrine; Bone Regeneration..

15 - Inflammatory myofibroblastic tumor in the retromolar region of mandible: a case report and literature review

Fabrício Tinôco Alvim de Souza1; Elisa Carvalho de Siqueira1; Viviane Carvalho da Cunha Trajano2; Júlio César Tanos de Lacerda3; Maria Cássia Ferreira de Aguiar1; Ricardo Alves de Mesquita1

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Inflammatory myofibroblastic tumor (IMT) is a soft tissue tumor that is most common in lungs but it can be located in a large variety of anatomical sites. The occurrence in the oral cavity is rare and exhibits a wide spectrum of clinical behavior. This article is a case report and review of the literature of oral IMT presentation. Here, we report an unusual IMT in retromolar region on the left side in a 21-year old female patient. This is the second case of IMT in this anatomic region reported in English-language literature. IMT case reports are important to better understand the clinical, histopathological and behavioural aspects of this tumor. The complete surgical excision of the tumor seems to be the effective treatment.

Keywords: Oral Pathology; Granuloma, Plasma Cell; Soft Tissue Neoplasms; Mouth..

16 - Influence of orotracheal intubation on preterm infant palate shape between 12 and 24 months old

Soraya Carvalho da Costa1; Maria Teresa Botti Rodrigues dos Santos2; Werther Brunow de Carvalho1; Denize Gomes Miyazato3; Maria Esther Jurfest Rivero Ceccon1; Edna Maria de Albuquerque Diniz1

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INTRODUCTION: Mechanical ventilation (MV) is indicated in diverse clinical situations in which the individual develops acute or chronic respiratory failure. OBJECTIVE: To evaluate the palate shape of preterm infants aged 12 to 24 months who were submitted to orotracheal intubation (OTI) and mechanical ventilation. METHODS: This cross-sectional observational study included preterm infants submitted to MV by OTI for at least seven days, who weighed less than 2000 g at birth, and were attended at the Preterm Infant Care Outpatient Clinic of the University Hospital of the University of São Paulo and the Premature Infant Outpatient Clinic of the Children's Institute of the Clinics Hospital of the School of Medicine of the University of São Paulo. Sociodemographic data were collected from neonatal medical records of the participating children. The oral cavity was examined to classify palate shape into square, narrow or ovoid. Statistical analyses were performed using the ANOVA F, Kruskal-Wallis and Chi-square tests, with a 5% significance level. RESULTS: The mean period of OTI was 25.3 ± 25.8 days, and the children presented a significantly higher percentage of narrow shaped palate (p<0.001). CONCLUSION: The palate in preterm infants submitted to invasive MV by OTI is predominantly narrow and deep.

Keywords: Preterm Infant; Respiration, Artificial; Intubation; Palate..

17 - Hemangioma of the face and neck with phleboliths: Diagnostic imaging with X-ray and CT

Claudia Scigliano Valerio; Pedro Augusto Oliveira Santos Xambre; Bruno César Ladeira Vidigal; Beatriz de Carvalho Silva Rocha; Flávio Ricardo Manzi

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Hemangiomas found in the head and neck regions can cause functional and aesthetic complications. The therapeutic approach to this condition presents both challenges and risks, mainly when surgical procedures must be performed due to the risk of hemorrhaging. In this context, the need for tooth extraction can represent a factor of great concern. The present study describes the case of extensive cavernous hemangioma, associated with a large quantity of phleboliths, affecting the orofacial and neck region in an adult woman. Embolization and controls were performed as a means of surgical treatment.

Keywords: Hemangioma; Cone-Beam Computed Tomography; Angiography; Diagnosis..

18 - Analysis of profiles of patients on oral anticoagulants undergoing dental extraction - A retrospective study

Natália Batista Daroit1; Fábio Luis Festugatto2; Luiz Felipe Beltrame2; Júlio César Córdova Maciel2; Pantelis Varvaki Rados1

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INTRODUCTION: Many oral surgeons, in clinical practice, face the challenge of management of patients under anticoagulants treatment. The main reason for this concern is the post-operative problems. OBJECTIVE: The objective is to demonstrate the profiles of patients on oral anticoagulants, who underwent exodontia and did not have complications. MATERIAL AND METHODS: This review was performed using the records of all cases of Special Care Dental Ambulatory during a period of two years. RESULTS: Records of a total of 60 patients, 82 procedures, and 145 extracted teeth were found. The anticoagulant utilized for the sample was warfarin, the mean INR was 2.47 (SD ± 0.53), the majority of teeth extracted was monoradicular was extracted one/time. CONCLUSION: Can be inferred that is safe to perform dento-alveolar surgeries in anticoagulants patients since additional care measures such as INR monitoring, minimally traumatic technique, and local hemostasis are adopted. This research clarifies some aspects related to routinely surgical procedures in patients under oral anticoagulant therapy.

Keywords: Oral Surgical Procedures; Anticoagulants; Warfarin..

19 - Verrucous carcinoma with foci of invasive squamous cell carcinoma: Report of a case and discussion of current concepts

John Lennon Silva Cunha2; Caetano Guilherme Carvalho Pontes3; Juliana Batista Melo da Fonte1; Simone Alves Garcez Guedes3; Maria de Fátima Batista de Melo1; Ricardo Luiz Cavalcanti de Albuquerque-Júnior2

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Verrucous carcinoma (VC) is an uncommon type of low-grade, well differentiated and non-invasive squamous cell carcinoma (SCC). The development of invasive SCC within a VC is rare and distinction from the classical oral SCC is a frequent dilemma for pathologists. We report a case of a 78 years old male former smoker, alcoholic, presenting a painless leukoplastic verrucomatoous lesion in mandibular alveolar ridge measuring approximately 4cm diameter, with 2 months evolution. Histological examination of the incisional biopsy revealed proliferation of well-differentiated squamous epithelium forming high exophytic hyperkeratinized papillary projections and deep blunt buds. In focal areas, invasive tumor epithelial nests with more apparent cytologic atypia were observed. Immunohistochemical analysis showed intense expression of p16 but weak positivity for ki-67. The diagnosis was VC with microinvasive SCC areas. The patient underwent surgery with a safety margin and is under follow-up. "Hybrid" lesions composed of typical VC and invasive SCC accounts for about 20% of oral VC. A discussion on the criteria of differential diagnosis and biological behavior of these lesions is also provided.

Keywords: Carcinoma, Verrucous. Carcinoma, Squamous Cell. Ki-67 Antigen..

20 - Oral hyperpigmentation as adverse effect to capecitabine

Paula Verona Ragusa Silva; Gabriela Moura Chicrala; Luiz Alberto Valente Soares-Junior; Rafael Rodrigues Dias; Paulo Sérgio Silva Santos

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Capecitabine (Xeloda®) is an antineoplastic drug normally used as adjuvant chemotherapy for metastatic colorectal and breast cancer. A common adverse effect of capecitabine is hand and foot syndrome (HFS), a condition that, although not life threatening, can reduce drastically quality of life and result in patient withdrawal from treatment. Palmoplantar hyperpigmentation is a condition that has been found as the initial manifestation of HFS in most patients. The association of palmoplantar and oral hyperpigmentation as an adverse effect to capecitabine has rarely been described in the literature. We report a case of oral and palmoplantar hyperpigmentation in a 61-year-old woman receiving capecitabine for metastatic colon cancer. At the chemotherapy 2nd cycle, the patient referred burning mouth, and clinical inspection revealed brownish spots measuring between 2 and 10 mm, in addition to similar hyperpigmentated macules in palms and soles of feet, both asymptomatic. A 7-month-follow-up, still under chemotherapy with oral Xeloda®, showed regression of mouth manifestations while the palmoplantar spots intensified, with progression of dryness and tingling. This report highlights the importance of early diagnosis of HFS through the oral hyperpigmentation, which is a manifestation easily detectable by the dentist.

Keywords: Capecitabine, Hyperpigmentation, Mouth Mucosa, Drug-Related Side Effects and Adverse Reactions.

21 - Rare mucinous cystadenoma of minor salivary glands: Clinicopathologic analysis of 2 cases and review of literature

Denise Hélen Imaculada Pereira de Oliveira1; Valéria Souza Freitas3; Domingos Flávio Saldanha Pacheco2; Pedro Paulo de Andrade Santos2; Lélia Maria Guedes Queiroz2; Lélia Batista de Souza2

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Cystadenoma is a rare benign tumor of the salivary glands exhibiting clinical findings very similar to mucocele and, microscopically it may be confused with other lesions such as salivary duct cyst and cheilitis glandularis. It may be classified into two variants: papillary and mucinous, papillary variety being more common than mucinous with very few cases reported in literature. The aim of this work was reporting two cases of oral mucinous cystadenoma, and reviewing the literature regarding clinicopathologic aspects, differential diagnosis and therapeutic management specific to these tumors.

Keywords: alivary Gland Neoplasms; Minor Salivary Glands; Adenolymphoma.

22 - Surgical Treatment Of Peripheral Ossifying Fibroma: A Case Report

Beatriz Terumi Barreto Kanehira1; Marina Rolo Pinheiro1; Valber Barbosa Martins2; Joel Motta Júnior2; Gustavo Cavalcanti de Albuquerque2; Flavio Tendolo Fayad2; Marcelo Vinícius de Oliveira2

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The peripheral ossifying fibroma is a non-neoplastic gingival growth classified as a reactive hyperplastic inflammatory lesion. The pathogenesis is unknown. It is an injury that usually affects the anterior region of the maxilla and mandible and has a predilection for women that is most frequently found during the second decade of life. The purpose of this study is to report a case of peripheral ossifying fibroma in a 44-year-old patient with a history of increased volume in the anterior lingual region of the mandible with a 3-year history. Clinically it presented a well-delimited, pediculated lesion with firm and elastic consistency, with pale pink coloration and some erythematous patches. Computed tomography was requested, in which no image of cortical resorption or bone expansion was evidenced, however it was possible to visualize an image that suggested a small bone formation in the region of the lesion. Posteriorly, the patient underwent an excisional biopsy of the lesion. In the findings, the presence of oral mucosa with spindle cell proliferation was verified in the middle of a stromal with osteoid matrix and mature bone production. The treatment was the excision of the lesion with 1 year and 3 months follow-up without relapse.

Keywords: Fibroma, Ossifying; Bone Neoplasms; Diagnosis, Oral; Oral Hygiene..

23 - Histological analysis of a clinical case of central giant cell lesion treated with triamcinolone

Júlia dos Santos Vianna Neri1; Tila Fortuna2,3; Milena Couto2; Antônio Márcio Teixeira Marchionni2,4,5; Sílvia Regina de Almeida Reis2,6; Alena Ribeiro Alves Peixoto Medrado7

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INTRODUCTION: Central giant cell lesion (CGCL) is an osteolytic lesion mainly found in gnathic bones of children and young adults. It is a benign lesion with variable clinical and radiographic behavior but it may be aggressive. Intralesional corticoid application has been proposed as an alternative and complementary procedure to radical surgical treatment, to minimize functional and aesthetic damage. OBJECTIVES: This paper aims to report a case of a pediatric patient with CGCL of the jaw, which was treated withconservative treatment of two intralesional applications of triamcinolone and discuss if there is an ideal waiting period between nonoperative treatment and the need for surgical intervention. METHODS: This report shows a quantitative analysis of histological alterations induced by intralesional infiltrations of triamcinolone into a clinical resistant CGCL. A 7-year-old patient was submitted to a conservative treatment of two intralesional applications of triamcinolone into a mandible CGCL. RESULTS AND CONCLUSION: Histological evaluation showed reduction in the number of blood vessels and of giant multinucleated cells, beside an increased collagen production. The triamcinolone induced histological alterations seem to interfere in the clinical behavior of the lesion thus, recommending a less radical surgical treatment.

Keywords: Giant Cells; Triamcinolone; Histology.

24 - Fine needle aspiration biopsy of mandible: an effective alternative to conventional biopsy for the differential diagnosis between metastasis and osteonecrosis in oncologic patients treated with bisphosphates - Case report

Débora Silva Baldi1; Fabiano Saggioro Pinto2; Tatiane Cristina Ferrari3; Lara Maria Alencar Ramos4; Leandro Dorigan de Macedo5

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Bisphosphonates are the drugs of choice for the prevention and treatment of bone metastases of breast cancer, especially in more advanced cases. Osteonecrosis of the jaw (BRONJ) is the most common, debilitating complication of the use of this drug, caused mainly by bone manipulation. Because of this, the indication for biopsy for differential diagnosis is critical in cases of radiographic findings without mandibular exposure, and less invasive diagnostic methods have been discussed in the literature. The objective of this study was to describe a case of differential diagnosis of mandibular metastasis of breast cancer and BRONJ by fine needle aspiration (FNA). A 67-year-old woman was referred to the Dentistry and Stomatology Service of Ribeirao Preto General Hospital, Brazil, in January 2015, for investigation of pain followed by paresthesia in the lower lip. The patient had a history of mixed breast carcinoma in 1999, recurrent in 2010, treated with chemotherapy and Zometa from 2010 to 2013. Although no significant alterations were detected at clinical examination, the CT scan revealed osteolytic lesions involving the anterior and posterior right jaw. Because of the risk of bone necrosis after biopsy, FNA was chosen as the diagnostic method. Cytology confirmed metastasis of breast cancer and the patient had no complications in the puncture area. FNA was shown to be a viable, safe option for differential diagnosis between BRONJ and mandibular bone metastasis.

Keywords: Biopsy, Fine-Needle; Breast Neoplasms; Neoplasm Metastasis; Bisphosphonate-Associated Osteonecrosis of the Jaw..

25 - Oral squamous cell carcinoma involving a blue cell nevus in the palate

Luan Éverton Galdino Barnabé1; Alexandre Rolim Paz2; Daliana Queiroga Castro Gomes3; Jozinete Vieira Pereira4; Cassiano Francisco Weege Nonaka5; Pollianna Muniz Alves6

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INTRODUCTION: Squamous Cell Carcinoma (SCC) is the most common malignant neoplasm of the oral cavity; however, there is no report in the literature of SCC involved with blue nevus. CASE REPORT: We report the case of a patient, a 54-year-old woman who exhibited a brownish spot associated with whitish area, surrounded by a hyperemic area in the soft palate. After an incisional biopsy and histopathological analysis, the presence of invasive squamous cell carcinoma was shown, in addition, in other fragment, to the presence of fusiform cells disposed parallel to the epithelium, exhibiting intense brownish cytoplasmic pigments. Immunohistologically, the neoplastic epithelial cells demonstrated intense immunoexpression for the anti-pan Cytokeratin antibody, while the fusiform cells showed strong immunopositivity for the anti-S-100 and anti-Melan-A antibodies, and weak immunomarking for anti-HMB-45. Based on the microscopic findings described, the final diagnosis was Oral Squamous Cell Carcinoma (OSCC) involving a blue cell nevus. CONCLUSION: Therefore, we sought to relate the first case of involvement of OSCC and blue cell nevus, up to the present time.

Keywords: Nevus, Blue; Mouth Neoplasms; Immunohistochemistry..

26 - Osteolipoma in posterior maxilla: A case report

Ana Lia Anbinder1; Noala Vicensoto Moreira Milhan2; Benjamín Sánchez Trocino3; Adalberto Mosqueda Taylor4

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Osteolipoma is a histologic variant of lipoma characterized by bone formation, which rarely occurs in the oral cavity. This condition usually is easily recognized by microscopic examination and it has a good prognosis. However, this lesion may occur in different sites of the oral cavity and may present different clinical aspects, being a diagnostic challenge at the time of clinical examination. The aims of this article are to report a case of osteolipoma located in the buccal aspect of the posterior maxilla and discuss the main clinical and histological findings of this rare oral lesion. A 46-year-old woman presented with a painless mass of about 2 cm in the vestibular portion of the posterior maxilla. The lesion had a hard consistency and color similar to adjacent mucosa. Imaging findings revealed a well-defined and circumscribed hypodense lesion with hyperdense areas. The histopathological examination showed mature adipose tissue among trabeculae of vital lamellar bone, which was consistent with the diagnosis of osteolipoma. No signs of recurrence were observed after 3 years of follow-up.

Keywords: Lipoma; Neoplasms, Adipose Tissue; Mouth; Maxilla..

27 - Oral signs in juvenile dermatomyositis

Mauricio Rocha Dourado1; Tiago João da Silva Filho2; Tuula Salo3

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Juvenile Dermatomyositis (JDM) is a severe inflammatory myopathy characterized by multisystemic vasculopathy during childhood. The general profile consists of symmetric proximal muscle weakness and the presence of characteristic rashes. This case describes an 11-year-old girl with hyperplastic gingival inflammation, telangiectasia and lichenoid retroalveolar striae detected by dental examination visit, when she also showed rash and papules in her hands. Histopathological diagnosis of the retroalveolar mucosa was indicative of unspecific chronic inflammation. Later when muscle symptoms and serum changes were present the JDM diagnosis was confirmed. The patient was successfully treated with systemic corticosteroids and regular professional dental cleaning. In order to get an early diagnosis and effective treatment for the patients, it is important that oral health care providers are aware of the oral manifestations related to systemic diseases, such as JDM.

Keywords: Dermatomyositis; Telangiectasis; Gingiva; Mouth Mucosa..

28 - Oral sarcoid granuloma associated with discoid lupus erythematosus: Case report

Maria Elisa Quezado Lima Verde1; Isabelly Vidal do Nascimento2; Thinali Sousa Dantas3; Fabrício Bitu Sousa4; Ana Paula Negreiros Nunes Alves5; Mário Rogério Lima Mota6

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Sarcoidosis is a chronic systemic disorder characterized by the formation of non-caseous granulomas. Oral manifestations are less frequent and may present as submucosal nodules. Because of its heterogeneity and similarity to other diseases, the diagnosis becomes challenging. OBJECTIVE: To report a case of oral sarcoid granuloma in a patient with discoid lupus erythematosus. CASE REPORT: A female patient, complaining of a three-month swelling of the lower lip. Previous nasal lesion with a diagnosis of granulomatous dermatitis was also reported. The labial biopsy was performed, showing sarcoid granulomas. Other complementary exams were requested to verify systemic involvement by sarcoidosis. The lesion spontaneously regressed, and an 18-month follow-up showed no recurrence. Due to the absence of a probable etiological factor associated with the lesion triggering, the histological and clinical evidences, a probable coexistence of discoid lupus erythematosus and sarcoid reaction or early-stage sarcoidosis was suggested. CONCLUSION: This rare case highlights the possibility of association between lupus and sarcoid granulomas, emphasizing the need for the dental surgeon to contemplate the differential diagnosis of sarcoidosis or sarcoid reaction in patients with lupus who present oral lesions similar to those of the present case, since the oral lesions of lupus are polymorphic and have a varying presentation.

Keywords: Lupus Erythematosus, Discoid; Granuloma; Pathology, Oral; Sarcoidosis..

29 - Frequency and histoclinic pathology of malignant and potentially malignant disorders of oral cavity in Chile

Juan Pablo Aitken-Saavedra1; Angélica Diaz Valdivia2; Daniela Adorno-Farias3; Andrea Maturana-Ramirez4; Sandra Chaves Tarquinio5; Karine Duarte da Silva6; Ricardo Fernandez-Ramires7

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INTRODUCTION: Oral squamous cell carcinoma (OSCC) is the sixth most common type of cancer worldwide. Oral potentially malignant disorder (OPMD) represents a tissue where is more probably to occur a cancer in comparison with the apparently normal counterpart. Objective the purpose of this study was to determine the frequency and histoclinicpathology of these diseases in a Chilean population. This was a descriptive retrospective study. MATERIAL AND METHODS: Patients diagnosed with DPMO, OSCC and verrucous carcinoma (VC) treated in the Oral Medicine Clinic of University of Chile between 2005 and 2015 were selected, being revised the medical records and histopathological diagnoses. RESULTS: From a sample of 241 patients, 60% were women and the mean age was 58 years. The prevalence of DPMO was 15%. The most prevalent of them was oral lichen planus (45%) follow by a 36% of leucoplakias, 16% of actinic cheilitis and 3% of erythroplakias. OSCC and VC accounted to 3.4% and 0.5% of the sample, respectively. The disease-free survival in 5 years for patients with OSCC was 39%. CONCLUSIONS: The results were similar to those reported by national and international studies must survival found was lower than reported.

Keywords: Mouth Neoplasms; Precancerous Conditions; Chile..

30 - Pathological pigmentation of the skin and palate caused by continuous use of chloroquine: Case Report

Kívia Linhares Ferrazzo1; Márcia Rodrigues Payeras2; Patrícia Surkamp3; Cristiane Cademartori Danesi4

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INTRODUCTION: Chloroquine diphosphate is an antimalarial drug commonly used in the treatment of autoimmune diseases, such as systemic lupus erythematosus and rheumatoid arthritis. Chronic use of this drug may cause toxicity and lead to irreversible visual loss. OBJECTIVE: To report a case of pathological pigmentation of the skin and oral mucosa caused by the use of chloroquine diphosphate. CASE REPORT: A 40-year-old female patient used daily doses of chloroquine (250 mg) to treat rheumatoid arthritis. After using this antimalarial drug for two years, the patient exhibited pathological pigmentations in the hard palate and skin of the lower limbs. To prevent retinal damage, given the toxicity observed in the skin and mucous membranes, the medical team replaced this antimalarial drug. CONCLUSION: Pathological pigmentation is a sign of drug toxicity and may serve as a warning for health professionals in order to prevent macular diseases caused by antimalarial agents. We emphasize the importance of dental surgeons for the differential diagnosis of pathological pigmentation of the oral mucosa, as well as the importance of multidisciplinary work involving other health sectors to prevent the onset or worsening of clinical problems in these patients.

Keywords: Pigmentation; Chloroquine; Antimalarials; Drug Toxicity..

31 - Eight-year follow-up of central giant cell lesion treated with corticosteroid: Case report

Tila Fortuna Costa1,2; Juliana Borges de Lima Dantas1; Daniel Santana Silva1; Silvia Regina de Almeida Reis3; Antônio Márcio Teixeira Marchionni4; Alena Ribeiro Alves Peixoto Medrado5

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INTRODUCTION: Central giant-cell granulomas (CGCL) are benign, but occasionally aggressive, lesions that traditionally have been treated surgically. Nonsurgical treatments, such as intralesional corticosteroid injections, systemic calcitonin and interferon have been reported. The advantages of this therapy include its less-invasive nature, the probable lower cost to the patient and the preservation of important structures. OBJECTIVES: This paper aims to report a case of a pediatric patient with CGCL of the jaw, which was successfully treated with intralesional corticosteroid injections as it's only therapy and discuss if there is an ideal waiting period between nonoperative treatment and the need for surgical intervention. METHODS AND MATERIALS: an eight-year-old boy with a central giant cell lesion on the right side of the mandible was treated with intralesional corticosteroids injections. RESULTS AND CONCLUSION: After an eight-year follow-up, the patient's bony architecture was near normal. The panoramic radiography showed areas of new bone formation and neither recurrence nor side effects of the medication have been also detected. Is there an ideal waiting period between nonoperative treatment and the need for surgical intervention? It is estimated that a monitoring period of 6-8 years is necessary to determine the success of such treatment.

Keywords: Granuloma, Giant Cell; Triamcinolone Acetonide; Drug Therapy; Pathology, Oral..

32 - Ozone therapy influence in the tissue repair process: A literature review

Júlia dos Santos Vianna Néri1; Erielma Lomba2; Alexandre Melo Karam3; Silvia Regina de Almeida Reis4; Antônio Márcio Teixeira Marchionni5; Alena Ribeiro Alves Peixoto Medrado6

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INTRODUCTION: The ozone therapy is a bio-oxidation therapy, based on a gaseous mixture with oxygen and ozone. It can be considered an alternative therapeutic tool the treatment of many systemic and locals diseases. It induces acute oxygenation stress and is not deleterious, which allows the restoration of oxidation and reduction balance. Within the therapeutic effects, it has been associated to the improvement metabolism and the peripheral tissue oxygenation. In addition, ozone is an important antimicrobial agent against bacteria, fungi, protozoa and viruses. In Dentistry, the ozone therapy has been used in several clinical situations due to its mechanisms of action. OBJECTIVES: The purpose of this literature review is to discuss the chemical and physical properties of ozone and its mechanisms of action in tissue repair. METHODS: It is a narrative review based on research articles searched in Pubmed and LILACS database, from December 2015 to May 2016. The following descriptors in English: "ozone", "oxidative stress" and "tissue repair" used. Finally, 36 articles were included in this narrative literature review. RESULTS AND CONCLUSION: The use of ozone as treatment seems to be promising in health areas, including dentistry due to its biological and biochemical properties. However, there is a need for more methodologically adequate studies so it can be safely and efficiently applied.

Keywords: Ozone; Soft Tissue Injuries; Wound Healing..

33 - Simultaneous oral, bone, and lung manifestations of tuberculosis

Antonione Santos Bezerra Pinto1,2; Cristiane Furuse3; Haroldo Arid Soares4; Luiz Alexandre Thomaz2; Lucas Novaes Teixeira2

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Tuberculosis (TB) is a chronic granulomatous disease caused by Mycobacterium tuberculosis, which is transmitted by saliva droplets from patients with active pulmonary disease to persons in close contact with those infected. TB remains a leading cause of morbidity and mortality in developing countries, including Brazil. This disease primarily occurs in the lungs; however, other organs can be affected. Cervical tuberculous lymphadenitis or scrofula is the commonest form of extrapulmonary TB, particularly in immunocompromised patients. In the stomatognathic system, the tongue is the site most often affected by TB, whereas bone is rarely affected. The diagnosis of the active form of TB is made based mainly on clinical and radiographic findings, histopathologic features and sputum culture for M. tuberculosis, while the latent form of TB can be detected by tuberculin skin test or an interferon-γ release assay. The present article aimed to report a case of TB occurring concurrently in the oral cavity, bone and lungs.

Keywords: Tuberculosis; Communicable Diseases; Oral Medicine..

34 - Calcifying cystic odontogenic tumor of maxila: A case report

José Narciso Rosa Assunção-Júnior1; Letícia Almeida Oliveira1; Ana Maria Hoyos Cadavid3; Celso Augusto Lemos-Júnior2; Victor Perez Teixeira1,4

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The calcifying cystic odontogenic tumor (CCOT) is an uncommon pathology, representing about 2% of all odontogenic cysts and tumors. Generally, is presented as slow growth, asymptomatic, without predilection of gender or location. The most common radiographic presentation is radiolucent image with radiopaque areas, especially in the lesion periphery, unilocular, expansive and well- defined margin. The purpose of this report is to describe the case of a 16-year-old boy with a painless and progressive increase of volume on the face, which started 7 months ago. In oroscopy, we observed an expansive increase of volume in right maxilla, extending from premolars to molars on the same side. In computed tomography, it was possible to observe an unilocular, expansive image in right maxilla. After incisional biopsy, the histopathological analysis evidenced epithelial neoplasia of odontogenic origin that presents cystic portions and solid portions. In the cystic portions, there is an epithelial lining which basal cells are cuboidal or cylindrical arrangement in palisade, presence of ghost cells and dystrophic mineralization, confirming the diagnosis of calcifying cystic odontogenic tumor. Excision and curettage were performed under general anesthesia. The excised tumor was analyzed, confirming the diagnosis of CCOT and the patient has been in clinical and radiographic follow- up for a period of 5 years, without signs of relapses.

Keywords: Odontogenic Tumors; Maxilla; Pathology, Oral..

35 - Association of Treatment and a 3-D image follow-up on a Recurrent Keratocyst - Case Report

Claudine Thereza-Bussolaro1; Arlindo Aburad2; Camila Pachêco-Pereira1; Carlos Flores-Mir1

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INTRODUCTION: Accordingly to the latest edition of the World Health Organization (WHO) the previously known Keratocyst Odontogenic Tumour (KCOT) has now returned to the simple odontogenic cyst (OKC) classification. We present a case successfully treated by a combination of minimal-invasive approaches. CASE PRESENTATION: A large OKC was identified extending from tooth 3.8 through the condylar process in the mandible and staged surgical conservative approaches were performed. Total healing was achieved and followed-up over 8 years. The case was well documented via panoramic radiographs, CBCTs, and a 3D image tool illustrates the cortical bone destruction (before treatment) and the cortical bone healing after treatment. DISCUSSION: Agreement regarding terminology and treatment of OKC has been reached. In this case, a complete healing of a recurrent OKC was achieved by decompression, enucleation, and blurring of the bone walls. Rigorous follow-up enriched by a 3D reconstruction imaging allows an educational view of the healing. CONCLUSION: This case suggests that a staged surgery approaches concurrent to rigorous patient follow-up could be a feasible alternative to extensive OKT treatment. And, reinforces the importance of collaboration between orthodontist, pathologist, OMS, and the patient have crucial importance in the conservative management of the lesion.

Keywords: Odontogenic Cysts; Recurrence; Pathology, Oral; Treatment Outcome; Imaging, Three-Dimensional.

36 - Prevalence of oral precancer and cancer in south kerala population

Anuna Laila Mathew1; Mathew Pothen Daniel2; Sunu Alice Cherian3

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INTRODUCTION: Oral cancer is a major concern in developing countries. India accounts for one third of worlds oral cancer and has a high rate of oral precancer. Early detection of premalignant conditions can improve the prognosis of the disease. OBJECTIVE: 1.To evaluate the prevalence of oral precancer and oral cancer among patients in south Kerala, India. 2. To evaluate the association of tobacco related oral precancer and oral cancer with abusive habits. METHODS: A total number of 10999 patients, aged 20-80yrs, who visited the outpatient department of a dental college for the diagnosis of various complaints over a period of 8 months were interviewed for oral risk habits, duration and frequency of the habit and current usage of any medications. Patients were clinically examined by trained professionals. RESULT: The prevalence of oral precancer and cancer was seen in 1.08 % of the population. The prevalence of oral lichen planus was 0.72 % followed by leukoplakia 0.23 %, oral submucous fibrosis .072 %, oral cancer .036%, and erytroplakia .009%. Tobacco related oral lesions like leukoplakia, oral submucous fibrosis, oral cancer, erythroplakia were more prevalent among men as compared to women. The tobacco related abusive habits like smoking and chewing tobacco were more prevalent among men. CONCLUSION: This study provides the prevalence of oral precancer and oral cancer among patients in South Kerala. It also reinforces the association between tobacco products and tobacco related oral precancerous lesions.

Keywords: Tobacco; Leukoplakia, Oral; Oral Submucous Fibrosis; Lichen Planus, Oral.

37 - Verruciform xanthoma of the upper anterior gingiva

Janderson Teixeira Rodrigues1; Juliana de Noronha Santos Netto2; Águida Maria Menezes Aguiar Miranda2; Simone de Macedo Amaral2; Fábio Ramôa Pires1,3

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INTRODUCTION: Verruciform xanthoma (VX) is a reactive oral mucosal lesion that can resemble other papillary conditions. OBJECTIVE: To report a case of gingival VX clinically mimicking other papillary swellings. CASE REPORT: A 66-year-old female presented for evaluation of a painless papillary growth in the gingival margin of the upper right central incisor. Clinical diagnosis included papillary gingival hyperplasia and VX. An excisional biopsy was done and histology revealed a proliferative surface epithelium with papillary projections and CD68+ xanthomatous cells on the upper papillary superficial connective tissue. Diagnosis was VX and the patient remains in clinical follow-up with no signs of recurrence for 4 months. CONCLUSION: VX should be considered in the differential diagnosis of gingival papillary swellings.

Keywords: Gingiva; Xanthomatosis; Mouth Mucosa; Mouth Diseases..

38 - Anatomic Variation of Paranasal Sinuses

Natália Myrrha Simões; Pollyanna Moura Rodrigues Carneiro; Amaro Ilidio Vespasiano Silva; Paulo Eduardo Alencar de Souza; Flávio Ricardo Manzi

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INTRODUCTION: The sinus are very important on the upper respiratory tract, formed by the ostrich complex (COM) and by the paranasal sinuses. The deep knowledge of the anatomy and variations of the ostium-meatal complex and the paranasal sinuses is a skill expected from the radiologist as well the possible variations with the disease states. OBJECTIVE: The aim of this study was to evaluate the prevalence of anatomic variations and pathological processes in the paranasal sinuses and the ostiomeatal complex in a population of a large city. Furthermore, association among the presence and localization of anatomic variations and the occurrence of pathological processes was also accessed. MATERIALS AND METHODS: This study evaluated 1005 CT scans of the sinuses obtained by multislice technique (64 apparatus detectors) with axial and coronal reconstructions, both with 1 and 2 mm thick. Patients of both sexes, aged between 12 and 92 years, who were referred by otolaryngologists were included. RESULTS: Our results showed high prevalence of paranasal sinus CT alterations. The most common were: septal deviation (80.7%), concha bullosa (35.1%), Haller cells (9.6%), and ethmoidal bulla (3.3%). Among the pathological processes, mucoperiosteal thickening associated with acute and chronic inflammation of the sinuses were the most frequent. Ocasionally, it caused obstruction of drainage ostiomeatal complex, in addition to sinusitis (acute and chronic). Odontogenic sinusitis, fungal sinusitis, osteomas, fibrous dysplasia and nasal diseases were also found. There was no association among anatomical variations (changes in the nasal septum, bone spur, concha bullosa, nasal turbinate hypertrophy) and increased chances of obstruction of drainage of frontal, ethmoid and maxillary sinuses. CONCLUSION: Association between obstruction of the drainage and the occurrence of sinusitis on all paranasal sinuses were also detected. As the population has a high frequency of anatomical variations of the paranasal sinuses, the incorrect interpretation of the images of the sinonasal complex should cause misdiagnosis, compromising patient care. In conclusion, knowledge of the prevalence and characteristics of paranasal sinus CT alterations should be useful for defining specific diagnosis criteria.

Keywords: Cone-Beam Computed Tomography; Paranasal Sinuses; Radiology Department, Hospital; Otorhinolaryngologic Diseases..

39 - An unusual presentation of osteoblastoma

Victor Perez Teixeira1,2; José Narciso Rosa Assunção Júnior1; Letícia Almeida Oliveira1; Ana Maria Hoyos Cadavid3; Celso Augusto Lemos Júnior4; João Alberto Lopes Sousa Júnior5

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Osteoblastoma is a rare benign bone tumor that accounts for less than 1% of all primary bone tumors. Due to a low occurrence and varied histopathological aspects, this pathology becomes a diagnostic challenge. Therefore, our objective of reporting a case of osteoblastoma in the maxilla is to discuss another presentation of this tumor. Male patient, suffering from leucoderma, 50 years old, presented an expansion in right superior vestibular groove with pain during palpation and an extensive osteolytic lesion in the right maxilla, of solid content, observed in computed tomography. With an anatomopathological diagnosis of osteoblastoma by an incisional biopsy, conservative surgery was performed to remove the lesion. The definitive analysis of the excised tumor confirmed the preoperative diagnosis. The patient has been followed up for a period of 5 years without relapses of the neoplasia. Therefore, due to the rarity and the difficult diagnosis, describing cases like this one and their presentation characteristics is extremely important to enhance knowledge of this pathology among professionals in the area of diagnosis and maxillofacial surgery.

Keywords: Osteoblastoma; Diagnosis, Oral; Maxilla..

Case Report

40 - Association of Treatment and a 3-D image follow - up on a Recurrent Keratocyst

Claudine Thereza-Bussolaro1; Camila Pachêco-Pereira1; Carlos Flores-Mir1; Arlindo Aburad 2

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INTRODUCTION: Accordingly to the latest edition of the World Health Organization (WHO) the previously known Keratocyst Odontogenic Tumour (KCOT) has now returned to the simple odontogenic cyst (OKC) classification. We present a case successfully treated by a combination of minimal-invasive approaches. CASE PRESENTATION: A large OKC was identified extending from tooth 3.8 through the condylar process in the mandible and staged surgical conservative approaches were performed. Total healing was achieved and followed - up over 8 years. The case was well documented via panoramic radiographs, CBCTs, and a 3D image tool illustrates the cortical bone destruction (before treatment) and the cortical bone healing after treatment. DISCUSSION: Agreement regarding terminology and treatment of OKC has been reached. In this case, a complete healing of a recurrent OKC was achieved by decompression, enucleation, and blurring of the bone walls. Rigorous follow-up enriched by a 3D reconstruction imaging allows an educational view of the healing. CONCLUSION: This case suggests that a staged surgery approaches concurrent to rigorous patient follow-up could be a feasible alternative to extensive OKT treatment. And, reinforces the importance of collaboration between orthodontist, pathologist, OMS, and the patient have crucial importance in the conservative management of the lesion.

Keywords: Odontogenic Cysts; Recurrence; Pathology; Oral; Treatment Outcome; Imaging; Three-Dimensional.

Original Article

41 - Melanoma of the oral mucosa: report of an aggressive case and review of the literature

Isabella Jardelino Dias; Iroildo Jacinto Ferreira Filho; Jozinete Vieira Pereira; Bárbara Vanessa de Brito Monteiro; Cassiano Francisco Weege Nonaka; Polliana Muniz Alves; Daliana Queiroga de Castro Gomes

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INTRODUCTION: Melanoma is an aggressive malignant neoplasm of uncertain etiology. Although the third most common skin cancer, melanoma is rare in the oral cavity, accounting for less than 1% of all melanomas and for 0.5% of all malignant oral tumors. OBJECTIVE: This study reports a case of melanoma diagnosed and followed up by the dentistry team of the Napoleão Laureano Hospital, João Pessoa, Paraíba, Brazil. CASE REPORT: A 69-year-old dark-skinned male patient was referred to the stomatology service of the hospital reporting pain and bleeding in the upper alveolar ridge, as well as the presence of a "lump" at the same site. Intraoral physical examination revealed a purple nodule of soft consistency in the anterior maxilla, which measured 2.0 cm in diameter and exhibited superficial ulcerations. An incisional biopsy was performed and histopathological analysis revealed intense proliferation of atypical melanocytes characterized by variable degrees of pleomorphism and nuclear hyperchromatism. The diagnosis was melanoma of the oral mucosa. The patient underwent surgical resection consisting of complete removal of the tumor with wide safety margins, chemotherapy, and adjuvant radiotherapy. The patient continues under follow-up and showed no recurrence of the lesion one year after surgery. CONCLUSION: Melanoma of the oral mucosa exhibits an aggressive behavior and rapid growth, as observed in the present case. Knowledge of the clinical and etiopathogenic features is important for the early diagnosis of the disease in order to improve patient survival.

Keywords: Melanoma; Mouth Neoplasms; Pigmentation; Oral Health..

42 - Antral pseudocysts of the maxillary sinus: relationship between radiographic and clinical features

Cleomar Donizeth Rodrigues1; José Alcides Almeida de Arruda2; Luciano Barreto Silva3; Carolina dos Santos Guimarães4; Ana Paula Veras Sobra3; Marcia Maria Fonseca da Silveira3; Carlos Estrela4

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Antral pseudocysts of the maxillary sinus are the second most common lesions in the maxillary sinus region. The aim of this study was to analyze the frequency of antral pseudocysts of the maxillary sinus diagnosed with panoramic radiographs, cone beam computed tomography and a clinical questionnaire. This was a cross-sectional study involving patients of a private radiology institute. A total of 185 panoramic radiographs with images suggestive of antral pseudocysts were selected out of 6,000. The patients were invited to attend the service and 28 were selected for this study. Panoramic radiographs were obtained and, when the image was suggestive of antral pseudocysts, the patient was invited to undergo cone beam computed tomography and to answer a clinical questionnaire. The control group consisted of 30 patients without antral pseudocysts on panoramic radiographs who had undergone cone beam computed tomography and who had filled out the clinical questionnaire. Pearson's chi-square test and Fisher's exact test were used to determine differences in the frequency of the variables among study groups, adopting a p value of 0.05 and a 95% confidence interval. The relationship between cone beam computed tomography and the diagnosis of antral pseudocysts, and with the data collected with the clinical questionnaire was established. A statistically significant difference was found regarding atrophy of the turbinates and obstruction of the meatal ostium. In addition, patients with antral pseudocysts had significantly more histories of allergy, allergy persistence, and use of topical nasal medication compared to the control group, as well as nasal obstruction, thick nasal discharge, a runny nose and postnasal drip. The use of topical nasal medication and the presence of atrophy of the turbinates and obstruction of the meatal ostium suggest a relationship with the occurrence and persistence of antral pseudocysts.

Keywords: Radiography, Panoramic; Cone-Beam Computed Tomography; Maxillary Sinus..

43 - Use of digital panoramic radiography to detect cervical calcifications in obese individuals

Saulo Gonçalves de Abreu1; Natália Myrrha Simões2; Ana Paula Zanini3; Marcelo Gomes Girundi4; Amaro Ilidio Vespasiano Silva5; Flavio Ricardo Manzi5

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INTRODUCTION: Cardiovascular diseases and stroke in particular are the leading causes of death worldwide. The most common reason for this interruption is a buildup of fatty deposits on the inner walls of blood vessels; upon calcification, these deposits are termed atheromas. OBJECTIVE: The aim of this study was to identify calcified atherosclerotic plaque-like soft tissue calcifications in obese subjects using panoramic radiography. MATERIALS AND METHODS: Sixty-three obese patients undergoing digital panoramic radiography in a radiology clinic in Belo Horizonte, Brazil, were selected and diagnosed with grade II obesity with comorbidities and grade III obesity according to the World Health Organization (WHO) body mass index (BMI) score table. The radiographs were examined by two trained oral and maxillofacial radiologists, and their evaluations were analyzed using the kappa test. Statistical analysis was performed using the X2 test, and the odds ratio was determined with a 95% confidence interval. A 5% significance level was used. RESULTS: The weight and BMI (p < 0.01) differed significantly between individuals in the grade II with comorbidities and grade III groups, but no difference was observed for age and height. Of 63 radiographs, 45 (71.42%) showed calcifications in the cervical region, with no statistically significant difference between the grade II and grade III groups. Neither gender nor side was significantly correlated with the presence of soft tissue calcification. CONCLUSION: This study demonstrates the importance of panoramic radiography in identifying calcified atheromatous plaques. Such images may have critical diagnostic value for the early detection of carotid artery atheromas in obese subjects and thus may contribute to an increase in the length and quality of life of such individuals.

Keywords: Obesity; Carotid Artery Diseases; Radiography, Panoramic; Atherosclerosis..

Review Article

44 - Global frequency of benign and malignant odontogenic tumors according to the 2005 WHO classification

Leorik Pereira da Silva1; Rômulo Augusto de Paiva Macedo1; Marianna Sampaio Serpa2; Ana Paula Veras Sobral3; Lélia Batista de Souza1

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Odontogenic tumors are a heterogeneous group of lesions with variable clinical behavior. This manuscript aimed to determine the global frequency and distribution of OT based on the 2005 WHO classification. The manuscript performed a systematic search conducted in only one database (PubMed/Medline). We identified 8,658 articles, of which 495 articles were evaluated. After applying the inclusion and exclusion criteria, 42 papers were selected. Summed up, a total of 13,490 cases of OT were diagnosed. Most cases were found in Asia (n=6,472) and North America (n=2,599). Keratocystic odontogenic tumor (KCOT) (32.1%) was the most frequent neoplasm, followed by ameloblastoma (AMB) (30.6%) and odontoma (ODO) (17.3%). Malignant tumors were uncommon, accounting for 4.7% of all tumors. Of those, malignant ameloblastoma (n=184) and ameloblastic carcinoma (n=115) were the most common tumors. Overall, OT were more prevalent in men (n=4,896), with a male:female ratio of 1.2:1. The age ranged from 1 to 92 years; however most tumors occurred between the second and fourth decades of life. The mandible was the most common anatomical site, with a mandible:maxilla ratio of 2.8:1. The prevalence profile of OT shows a geographical variation; moreover, studies based on prior WHO classifications present a different incidence and frequency. The 2005 WHO classification of OT altered the distribution of these lesions and possibly made KCOT the most common OT observed worldwide.

Keywords: Odontogenic Tumors; Epidemiology; Jaw Neoplasms..

Case Report

45 - A clinical case report of dens in dente in an unusual location

Alexandre Camisassa Diniz Leite Greco; Carolina Drumond de Barros e Azevedo; Cláudia Assunção e Alves Cardoso; Fábio Oliveira Cardoso; Morena Maureem Nogueira Soares Rios; Natália Myrrha Simões; Flávio Ricardo Manzi

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INTRODUCTION: Dens in dente or dens invaginatus is an anomaly of tooth formation, result of the invagination of coronary tissue in the pulp chamber, which occurs previously to tissue calcification. The majority of dens in dente cases are discovered by routine imaging exams, in which it is possible to identify an invagination of enamel into the pulp chamber, where the enamel appears well delineated, giving the impression of "a small tooth inside the other". OBJECTIVE: Approach the clinical and radiographic aspects, as well as diagnose this pathology using imaging exams, through an atypical clinical case report of Oehlers type II dens in dente in the left maxillary third molar. CASE REPORT: Female patient, 20 years old, went to the Dental Clinic of the Odontology Scholl at PUC Minas, to have the third molars extracted. The panoramic radiograph examination showed shape change in the left maxillary third molar. Considering the atypical form, a cone beam computed tomography was requested. CONCLUSION: The case related showed how important are the image exams to do the precise diagnosis on this anomaly. The cone bean computer tomography should be ask if the conventional imaging tests aren't able to value the disease and plan the treatment.

Keywords: Dens in Dente; Tooth Abnormalities; Cone-Beam Computed Tomography..



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