Queilite actínica ("Lábios de Marinheiro"): uma Revisão para o Clínico / Actinic cheilitis ("sailor's lips"): A review for the clinician

A Queilite Actínica (QA), também conhecida como "lábios de marinheiro", é uma patologia com potencial de malignização e, ainda que seja de fácil diagnóstico e prevenção, casos diagnosticados tardiamente podem evoluir para carcinoma de lábios. Seu principal fator etiológico é a exposição aos raios ultravioletas, e por este motivo, indivíduos que se expõem muito ao sol, incluindo militares, podem ser considerados grupo de risco para a doença. O objetivo principal deste trabalho foi descrever os principais fatores de risco e prognósticos da QA e apresentar uma revisão para o cirurgião-dentista, facilitando a identificação e conduta. Para tal, foi realizada busca de artigos pertinentes ao tema nas bases de dados Medline, Lilacs, SciELO e PubMed, de 1987 a 2022. O seguinte perfil do paciente com QA foi identificado: homem, na quinta década de vida, pele clara, com lesões no lábio inferior e com histórico de longo tempo de atividades ocupacionais ao ar livre/intensa exposição solar. O cirurgião-dentista possui papel fundamental na identificação dos grupos de risco, no reconhecimento precoce da doença e, em casos mais avançados, realizar o diagnóstico e o correto encaminhamento para atendimento especializado.

Actinic Cheilitis (AC), also known as "sailor's lips", is a premalignant pathology, and although it is easy to diagnose and prevent, late diagnosed cases may progress to lip carcinoma. Since its main etiological factor is exposure to ultraviolet rays, individuals often exposed to the sun, including military personnel, can be considered a risk group for the disease. The aim of this study was to describe the main risk and prognostic factors of AC and to create a clinical protocol for dental surgeons, making easier to identify and conduct each case. For this purpose, a search for articles relevant to the topic was carried out in Medline, Lilacs, SciELO and PubMed databases, from 1987 to 2022. The following AC patient profile was identified: male, in the fifth decade of life, fair skinned, with lesions on the lower lip and with a long history of outdoor occupational activities/intense sun exposure. The dentist has a fundamental role in identifying risk groups, early recognition of the disease and in more advanced cases, making the correct diagnosis and recommendation to specialized care.

Melkersson Rosenthal Syndrome: A Case Report

Introduction: Melkersson-Rosenthal Syndrome (MRS) is a rare neuro-mucocutaneous condition. It mainly includes three triads as orofacial swelling, facial palsy and fissured tongue. All of the classical triad may not be seen at the same time, as symptoms may appear in different interval of time and has a recurrence. MRS is diagnosed based on oligosymptomatic when two or more clinical features are present or monosymptomatic cases when there evidence of a non-necrotising, granulomatous cheilitis in patients with isolated facial or lip edema can be noted in biopsy. Case Presentation: In this case report a 18 year old male patient all the three classic clinical characteristic features as granulomatous cheilitis, unilateral facial muscle palsy and a fissured tongue are seen. The clinical features of this rare condition along with treatment procedure are presented. Conclusion: Oral corticosteroids are the mainstay in the treatment of MRS. Intralesional triamcinolone acetonide used in oro-facial edema. In recurrent cases of MRS need second-line immunosuppressants like methotrexate and thalidomide. In refractory recurrent facial nerve palsies Surgical decompression of the facial nerve may be considered.

Desordens orais potencialmente malignas: o que o cirurgião-dentista precisa saber? / Oral potentially malignant disorders: what do dentists need to know?

Introdução:as desordens orais potencialmente malignas (DOPMs) são condições que podem preceder o aparecimento do câncer em cavidade bucal. Objetivo: descrever os principais aspectos clínicos, histológicos e tratamento da leucoplasia, eritroplasia, queilite actínica e líquen plano oral. Metodologia: trata-se de uma revisão da literatura atual, em que foram consultados artigos nas bases do MEDLINE/PUBMED e Biblioteca Virtual em Saúde, publicados nos últimos 10 anos. Os descritores foram localizados usando o vocabulário controlado do MeSH, sendo eles: Leukoplakia; Erythroplakia, Actinic cheilitis, Oral lichen planus, Diagnosis, Therapeutics. Resultados: asapresentações clínicas das DOPMs são diversas. A leucoplasia é a mais comum e deve ser distinguida da leucoplasia verrucosa proliferativa que tem uma apresentação clínica generalizada e uma tendência à recorrência após a excisão; a eritroplasia, embora rara, tem maior chance de malignização. A queilite actínica acomete com frequência o lábio inferior, tem forte relação com exposição solar e pode progredir para o carcinoma escamocelular labial; o líquen plano oral tem uma variedade de apresentações clínicas, sendo a forma reticular a mais comum. O tipo erosivo, atrófico ou bolhoso é acompanhado de sintomatologia dolorosa variável. A biópsia é essencial para confirmar a suspeita clínica das DOPMs e o encaminhamento oportuno para um especialista é indicado. Conclusão: as DOPMs podem ser encontradas durante o exame bucal, possibilitando assim, o diagnóstico precoce, e o correto encaminhamento a um especialista e a intervenção adequada, podendo reduzir a taxa de progressão dessas condições para câncer.

Introduction: Oral Potentially Malignant Disorders (OPMDs) are conditions that may precede the onset of cancer in the oral cavity. Objective: To describe the main clinical features, histological aspects and treatment of leukoplakia, erythroplakia, actinic cheilitis and oral lichen planus. Methodology: this is a review of the current literature, in which articles in the databases of MEDLINE/PUBMED and the Virtual Health Library, published in the last 10 years, were consulted. The descriptors were located using the MeSH controlled vocabulary, namely: Leukoplakia; Erythroplakia, Actinic cheilitis, Oral lichen planus, Diagnosis, Therapeutics. Results:the clinical presentations of OPMDs are diverse. Leukoplakia is the most common and must be distinguished from proliferative verrucous leukoplakia which has a generalized clinical presentation and a tendency to reoccur after excision; erythroplakia, although rare, has a greater chance of becoming malignant. Actinic cheilitis frequently affects the lower lip, is strongly related to sun exposure and can progress to labial squamous cell carcinoma; oral lichen planus has a variety of clinical presentations, with the reticular form being the most common. The erosive, atrophic or bullous type is accompanied by different levels of pain. Biopsy is essential to confirm the clinical suspicion of OPMDs and timely referral to a specialist is indicated. Conclusion: OPMDs can be found during oral examination, thus enabling early diagnosis, correct referral to a specialist and appropriate intervention, which may reduce the rate of progression of these conditions to cancer.

Diagnostic study of actinic cheilitis by reflectance confocal microscopy / 口腔疾病防治

Objective @#To explore the clinical application value of reflectance confocal microscopy(RCM) in the diagnosis of actinic cheilitis(AC).@*Methods@#After approval by the hospital ethics committee and informed consent given by the patients, from October 2020 to July 2022, 17 patients who were diagnosed with actinic cheilitis in the Ninth People's Hospital affiliated with Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The white keratotic lesions of the lips were scanned with reflectance confocal microscopy, and the image characteristics were summarized and analyzed, including epithelial hyperplasia/atrophy, hyperkeratosis, inflammatory cell infiltration, blood vessel dilatation, solar elastosis, atypical keratinocytes, widening of intercellular spaces, degeneration of basal cell layer, and pigmentation. We used the sample compliance rate to measure the correlation between RCM parameters and histopathological diagnostic criteria for AC and kappa concordance analysis to calculate the concordance between RCM and pathological diagnosis. @* Results@# Under RCM, the sample correct rates for epithelial hyperplasia/atrophy, hyperkeratosis, inflammatory cell infiltration, vasodilation, and solar elastosis were 76.5%, 100%, 100%, 64.7%, and 70.6%, the sample accuracy compared with pathological diagnosis was 82.4%, 47.1%, 94.1%, 88.2% and 76.5%, respectively. We also observed that 100%, 88.2%, 76.5%, and 88.2% of AC patients showed RCM features of atypical keratinocytes, widening of intercellular spaces, degeneration of the basal cell layer, and pigmentation, respectively. The kappa value of hyperkeratosis and inflammatory cell infiltration was 1. The kappa value of blood vessel dilatation was 0.645. @* Conclusion @#Reflectance confocal microscopy is noninvasive and versatile and has clinical application value in the diagnosis of actinic cheilitis.

Possible role of ALDH1 and CD44 in lip carcinogenesis

Abstract Lip squamous cell carcinoma (LSCC) accounts for 12% of all head and neck cancers. It is caused by chronic exposure to ultraviolet light solar radiation and related to previous actinic cheilitis (AC). This study aimed to investigate the immunostaining of the putative cancer stem cells (CSC) markers ALDH1 and CD44 in AC (n=30) and LSCC (n=20). ALDH1 positivity was found to be statistically higher in LSCC than in AC lesions (p=0.0045), whilst CD44 expression was statistically higher in AC than in LSCC lesions (p=0.0155). ALDH1+ cells in AC lesions were associated with specific clinical features: a younger age (<60 years old), the female gender, white skin, not smoking or consuming alcohol, and a fast evolution, and not associated with the chronic exposure to UV radiation (p<0.0001). CD44 positivity was associated with patients who were male, feoderm, smoked, consumed alcohol, underwent occupational exposure to UV-radiation, and demonstrated lesions with log-time evolution (p<0.0001). ALDH1 + cells were associated with mild dysplasia using a system from the World Health Organization (WHO), and with a low risk of malignant transformation, according to the binary system (p<0.0001). CD44+ cells were also associated with moderated dysplasia, according to the WHO system. In LSCC, ALDH1 + cells were positively associated with patients who were older (≥ 60 years old), smokers, and with those who consumed alcohol (p<0.0001). CD44 + cells in LSCC were associated with older (≥ 60 years old) patients as well, but also with female patients, white skin, non-smokers, and individuals who did not consume alcohol (p<0.0001), all of whom showed distinct patterns in pre- and malignant lesions of both markers. Additionally, in LSCC, both ALDH1 and CD44 staining were associated with smaller tumor sizes (T1/T2; p<0.0001). In summary, although both ALDH1 and CD44 were associated with the presence of dysplasia in AC lesions, the present findings suggest that ALDH1 and CD44 may be activated by different etiopathogenic pathways, predominantly in distinct steps of oral carcinogenesis. CD44 would thus be more significantly related to the potentially malignant lesion, while ALDH1 would be closely linked to malignancy.

Actinic cheilitis in rural workers: prevalence and associated factors

ABSTRACT Objective To evaluate the prevalence of actinic cheilitis in rural workers and factors associated with the development of this condition. Methods A cross-sectional study was conducted in a city in Northeastern Brazil. Data were collected by clinical examination and use of a questionnaire validated with 300 rural workers. The χ2 test was employed to identify possible associations between the presence of actinic cheilitis and clinical and demographic variables. Multiple logistic regression analysis was performed using forward stepwise selection. A p value of 0.05 was considered significant. Results The prevalence of actinic cheilitis was 12.0% in the sample. The highest prevalence of actinic cheilitis was observed in white males, with low educational level, and an approximately 40-year history of sun exposure. Chronic lesions were commonly found in the lower lip and were characterized by scaling, dryness, and mild edema. Skin color, sex, educational level of patients, and cumulative sun exposure (in years), were identified as predictors of development of actinic cheilitis. Conclusion Our results suggest the need to implement educational health strategies aimed to orient the population about risk factors and preventive measures of the disease. Appropriate clinical management of patients with actinic cheilitis is important for prevention of lip cancer.

Allergic contact cheilitis caused by propolis: case report

ABSTRACT Propolis is a lipophilic resin extracted from plants by bees. The purpose of this case report was to show the importance of this substance as cause of allergic contact cheilitis. A 21-year-old female patient complained of pruritic perioral eczema for 5 years. In the past months it also affected the neck. After diagnosing contact dermatitis, she was submitted to a patch test with a Latin American baseline series. The result was strongly positive for propolis (++) and weakly positive for perfume mix I (+). After the test, the patient revealed she had been using propolis drops, per oris, for 10 years. The worsening of the condition was due to increased dose, aiming "to improve immunity", during the coronavirus disease 2019 (COVID-19) pandemic. The contact allergy to propolis might be increasing due to the widespread use of natural products. Propolis is a sensitizer to be considered in patients with long-lasting cheilitis.

Immunoexpression of PD-L1, CD4+ and CD8+ cell infiltrates and tumor-infiltrating lymphocytes (TILs) in the microenvironment of actinic cheilitis and lower lip squamous cell carcinoma

Abstract Lower lip squamous cell carcinomas (LLSCC) could be associated with a previous history of potentially malignant oral diseases (PMOD), especially actinic cheilitis (AC), with high sun exposure being a well-described risk factor. Immune evasion mechanisms, such as the PD-1/PD-L1 (programmed cell death protein 1/programmed death-ligand 1) pathway has been gaining prominence since immunotherapy with immune checkpoint inhibitors showed a positive effect on the survival of patients with different types of neoplasms. Concomitant with the characterization of the tumor microenvironment, the expression of either or both PD-1 and PD-L1 molecules may estimate mutual relations of progression or regression of the carcinoma and prognostic values of the patient. Objective: Considering the importance of tumor microenvironment characterization, this study aims to determine the immunoexpression of PD-L1 and correlate with the frequency of CD4+ and CD8+ cells in AC and LLSCC lesions and with tumor-infiltrating lymphocytes (TILs) in LLSCC and its relationship with histopathological characteristics. Methodology: This sample includes 33 cases of AC and 17 cases of LLSCC. The cases were submitted to histopathological analysis and to CD4+, CD8+, and PD-L1+ cell determination by immunohistochemistry. Results: There was a significant difference among the frequencies of CD4+, CD8+, and PD-L1+ cells between AC and LSCC cases, higher in the last group. Moreover, histopathological and atypical changes in AC and LLSCC were correlated with the frequencies of PD-L1+, CD4+, and CD8+ cells. In AC, PD-L1+ cases had a low frequency of CD4+ cells, but on the other hand, PD-L1+ cases of LLSCC had a higher frequency of CD4+ and CD8+ cells. Conclusion: Therefore, the PD-L1 molecule may be a potential escape route for the immune response in oral lesions, but the mechanisms differ between AC and LLSCC. Future studies related to immune evasion and immunotherapy in oral lesions should consider the analysis of inflammatory infiltrate and TILs.

Prevalência da queilite actínica em agricultores de uma região do sertão brasileiro / Prevalencia de queilitis actínica en agricultores de una región del interior brasileño / Prevalence of actinic cheilitis in Brazilian semi-arid region farmers

Introdução: A queilite actínica é uma lesão inflamatória com potencial de transformação maligna e desenvolvimento associado à exposição solar excessiva. Objetivo: Avaliar a prevalência de queilite actínica em um grupo de agricultores, bem como a percepção e conhecimento desse grupo sobre a lesão. Métodos: O estudo observacional de levantamento epidemiológico envolveu uma população de agricultores de uma região do sertão brasileiro. A amostra foi obtida por acessibilidade a essa população, e alcançou-se o total de 219 agricultores. Além do exame físico intraoral, utilizou-se um questionário estruturado para coleta dos dados. Resultados: A queilite actínica foi diagnosticada em 30,6 porcento dos agricultores examinados. A lesão foi encontrada com maior frequência no sexo masculino (86,6 porcento), com mais de 60 anos (64,2 porcento) e leucodermas (58,2 porcento). A maioria dos indivíduos com queilite actínica se expunham à radiação solar por mais de 30 anos (65,7 porcento), por mais de 6h por dia (73,1 porcento) e não se protegiam adequadamente (94 porcento). Sexo, idade, escolaridade, hábito de beber e tempo de exposição solar tiveram uma correlação estatisticamente significante com a presença da queilite actínica (p<0,05). Verificou-se que 76,1 porcento dos participantes não notavam sinais e 61,2 porcento não percebiam sintomas da lesão. O conhecimento sobre queilite actínica foi baixo para 97 porcento dos indivíduos com lesão. Conclusões: Os resultados demonstraram alta prevalência de queilite actínica, além de uma baixa percepção e conhecimento sobre esta lesão, o que indica a necessidade de realização de ações de educação em saúde(AU)

Introducción: La queilitis actínica es una lesión inflamatoria con potencial de transformación maligna y desarrollo asociado con la exposición excesiva al sol. Objetivo: Evaluar la prevalencia de queilitis actínica en un grupo de agricultores brasileños y la percepción y conocimiento que estos tienen sobre la lesión. Métodos: Estudio observacional epidemiológico. Incluyó una población de agricultores de una región rural brasileña. La muestra, constituida por 219 agricultores, se obtuvo por accesibilidad a esta población. Además del examen físico intraoral, se utilizó un cuestionario estructurado para recopilar los datos. Resultados: Se diagnosticó queilitis actínica en el 30,6 por ciento de los agricultores examinados. La lesión se encontró con mayor frecuencia en hombres (86,6 por ciento), mayores de 60 años (64,2 por ciento) y leucodermos (58,2 por ciento). La mayoría de las personas con queilitis actínica estuvieron expuestas a la radiación solar durante más de 30 años (65,7 por ciento), más de seis horas al día (73,1 por ciento) que no se protegieron adecuadamente (94 por ciento). El género, la edad, el nivel de educación, los hábitos de bebida y el tiempo de exposición al sol tuvieron una correlación estadísticamente significativa con la presencia de queilitis actínica (p < 0,05). Se encontró que el 76,1 por ciento de los participantes no notó signos y el 61,2 por ciento no percibió síntomas de la lesión. El conocimiento sobre la queilitis actínica fue bajo para el 97 por ciento de las personas con lesiones. Conclusión: Los resultados mostraron una alta prevalencia de queilitis actínica, además de una baja percepción y conocimiento al respecto de esta lesión, lo que indica la necesidad de acciones de educación para la salud(AU)

Introduction: Actinic cheilitis is an inflammatory, potentially malignant lesion associated with excessive sun exposure. Objective: To evaluate the prevalence of actinic cheilitis in a group of farmers, as well as the perception and knowledge of that group about this lesion. Methods: The observational epidemiological study included Brazilian semi-arid region farmers. The sample was obtained for accessibility to this population and a total of 219 farmers was reached. A structured questionnaire was used to collect the data in addition to the intraoral physical examination. Results: Actinic cheilitis was diagnosed in 30.6 percent of the examined farmers. The lesion was found more frequently in males (86.6 percent), older than 60 years (64.2 percent), and leukoderma (58.2 percent). Most individuals with actinic cheilitis were exposed to solar radiation for more than 30 years (65.7 percent), for more than 6 hours a day (73.1 percent), and did not adequately protect themselves (94 percent). Sex, age, education level, drinking habits, and time of sun exposure had a statistically significant correlation with the presence of actinic cheilitis (p < 0.05). It was found that 76.1 percent of the participants did not notice signs and 61.2 percent did not perceive symptoms of this injury. Knowledge about actinic cheilitis was low for 97 percent of individuals with the lesion. Conclusions: The results showed a high prevalence of actinic cheilitis, in addition to low perception and knowledge about it, which indicates the need for health education actions(AU)

Abordagens terapêuticas não-cirúrgicas para a queilite actínica / Non-surgical therapeutics approaches for actinic cheilitis

A queilite actínica (QA) é uma desordem potencialmente maligna que se desenvolve principalmente no lábio inferior, decorrente da exposição crônica a luz solar. O objetivo desse estudo é elucidar, a partir de uma revisão da literatura, as abordagens não cirúrgicas mais atuais para o tratamento da QA. Foi realizada uma busca nas bases de dados PubMed, Scielo e Cochrane, sendo obtidos 280 artigos e após aplicação dos critérios de elegibilidade, foram utilizados no presente traba lho 16 estudos. Várias abordagens, como, diclofenaco sódico, mebutato de ingenol, imiquimode, 5-fluorouracil, fludroxicortida e terapia fotodinâmica, são apontadas e estudadas como forma de tratamento para a QA. Entretanto, faltam trabalhos para que se estabeleça um consenso sobre a terapêutica não-cirúrgica mais adequada... (AU)

Actinic cheilitis (AC) is a potentially malignant disorder that develops mainly on the lower lip, result ing from a chronic exposure to sunlight. The objective of this study is to elucidate, from a literature review, the most current non-surgical approaches for the treatment of AC. A search was performed in the PubMed, Scielo and Cochrane databases, obtaining 280 papers and after applying the eligibility cri teria, 16 studies were used in the present study. Various approaches, such as diclofenac sodium, ingenol mebutate, imiquimod, 5-fluorouracil, fludroxycortide and photodynamic therapy are pointed out and studied as a form of treatment for AC. However, there is a lack of work to establish a consensus on the most appropriate non-surgical therapy... (AU)

Avaliação do conhecimento de acadêmicos da área da saúde sobre queilite actínica, como lesão precursora do câncer bucal / Evaluation of health academics' knowledge of actinic cheilitis as a precursor oral cancer injury

Dentre as doenças mais letais em todo o Brasil, o câncer encontra-se como um dos principais, podendo se desenvolver em diversas áreas. Com relação ao câncer bucal, ele é considerado um dos mais prevalentes. Podendo ser justificado em decorrência do estilo de vida adotado por muitos, como tabagismo, alcoolismo, má alimentação e exposição excessiva ao sol. Produzindo um aumento no número de casos de forma progressiva. Em grande parte dos casos de câncer bucal, há o aparecimento de lesões potencialmente malignas, destacando-se a leucoplasia, eritroplasia e queilite actínica. A queilite actínica, decorrente do excesso de radiação ultravioleta, é uma lesão potencialmente maligna, altamente prevalente em pessoas que estão propensas a esta exposição sendo frequente em áreas cuja atividade econômica está pautada na agricultura, que requer exposição à radiação solar, como o noroeste do Paraná. Portanto, é essencial que todos os profissionais de saúde saibam reconhecer este como sendo um fator causador do câncer bucal e fiquem atentos às mudanças que ocorrem previamente à malignização, principalmente, lesões em lábios, onde a queilite manifesta-se. Logo, é importante que os profissionais saibam reconhecê-la precocemente, devendo ser vislumbrado já durante a universidade. Sendo assim, o objetivo do presente trabalho é avaliar o conhecimento de acadêmicos de diferentes áreas da saúde, sobre sinais e sintomas da queilite actínica, que é uma das lesões cancerizáveis mais importantes e prevalentes... (AU)

Among the most lethal diseases in Brazil, cancer is one of the main and can develop in several areas. Re garding oral cancer, it is considered one of the most prevalent. It can be justified due to the lifestyle adopt ed by many, such as smoking, alcoholism, poor diet and excessive sun exposure. Producing an increase in the number of cases in a progressive way. In most cases of oral cancer, there is the appearance of poten tially malignant lesions, highlighting the leukoplakia and actinic cheilitis. Actinic cheilitis, resulting from excess ultraviolet radiation, is a potentially malignant lesion, highly prevalent in people who are prone to this exposure being frequent in areas whose economic activity is based on agriculture, which requires exposure to solar radiation, such as the northwest Paraná. Therefore, it is essential that all health professionals know how to recognize this as a factor causing oral cancer and be aware of the changes that occur prior to malignancy, especially lip lesions, where cheilitis manifests. Therefore, it is important that profes sionals know how to recognize it early, and should be glimpsed already during the university. Therefore, the objective of this work is to evaluate the knowledge of scholars from different health areas about signs and symptoms of actinic cheilitis which is one of the most important and prevalent cancerizable lesions... (AU)

Cross-cultural adaptation of a quality of life questionnaire for individuals with oral potentially malignant disorders in the Brazilian context / Adaptapao transcultural do questionàrio de qualidade de vida para individuos com desordens orais potencialmente malignas para o contexto brasileir

ABSTRACT The aim ofthis article is to describe the cross-cultural adaptation of a quality of life (QoL) questionnaire for individuals with potentially malignant oral diseases (OPMD) in the Brazilian context. This methodological study consisted of the following stages of content validation process: (1) Conceptual and item equivalence: stage during which a comprehensive literature review on the construct was performed; (2) Semantic equivalence. The extensive literature review showed that the questionnaire enables evaluation of QoL, and that domains and items are also considered and relevant to the Brazilian context. Semantic equivalence was evaluated as satisfactory by a committee of judges. The scope of the domains was analyzed according to the agreement rate and presented results equal to or greater than 84%. The general Content Validity Calculation (CVC) was 0.84 for clarity and 0.92 for representativeness. Of the 20 items, 18 presented CVC values above 0.8. The indicator for content validation, pre-test and operational equivalence indicate that the Brazilian version of the OPMD QoL questionnaire is a promising instrument and a tool that seems valid to evaluate the quality of life of people with oral potentially malignant disorders. As a next step, it is important to measure equivalences to evaluate the psychometric properties of this instrument.

RESUMO Este artigo objetiva adaptar transculturalmente um questionário de qualidade de vida para individuos com doenças orais potencialmente malignas para o contexto brasileiro. Este estudo metodológico consistiu nas seguintes etapas do processo de validaçâo de conteúdo: (1) Equivalência conceitual e de itens - etapa em que foi realizada uma ampla revisao da literatura sobre o construto; (2) Equivalência semántica. A extensa revisao da literatura mostrou que o questionário permite avaliar a QV e que os dominios e itens também sao considerados e relevantes para o contexto brasileiro. A equivalência semántica foi avaliada pelo comité de juízes de forma satisfatória. A análise do escopo dos dominios foi realizada pela taxa de concordância e apresentou resultados iguais ou superiores a 84%. Para a análise de clareza e representatividade, o resultado do cálculo geral do Cálculo de Validade de Conteúdo (CVC) foi de 0,84 e 0,92 respectivamente. Dos 20 itens, 18 apresentaram valores de IVC acima de 0,8. Os indicadores de validaçâo de conteúdo, pré-teste e equivalência operacional indicam que a versâo brasileira do QoL-OPMD é um instrumento promissor e que parece válido para avaliar a qualidade de vida de pessoas com doenças orais potencialmente malignas. Como próximo passo, é importante avaliar as propriedades psicométricas desse instrumento.

Queilitis granulomatosa, a propósito de dos casos / Granulomatous cheilitis, regarding two cases

La queilitis granulomatosa es una entidad granulomatosa no infecciosa, poco frecuente, que se presenta como un aumento de volumen persistente de la región orofacial. El estudio histológico, junto con la exclusión de otras patologías granulomatosas son necesarios para su diagnóstico, especialmente cuando no se presenta con la triada clásica del Síndrome de Merkelsson Rosenthal. Presentamos dos casos de queilitis granulomatosa y una revisión de la literatura disponible.

Granulomatous cheilitis is a rare, non-infectious, granulomatous entity that presents as a persistent swelling of the orofacial region. Histological study together with the exclusion of other granulomatous diseases are necessary for the diagnosis, especially when the presentation is not the classic triad of Merkelsson Rosenthal Syndrome. We present two cases of granulomatous cheilitis and a review of the available literature.

Cutaneous horn occurring on the oral tissues: report of a case and review of literature / Corno cutâneo nos tecidos orais: relato de caso e revisão da literatura

ABSTRACT The aim is to describe the clinical-pathological and treatment data of a patient with a cutaneous horn (CH) arising on oral tissues and to compare this with a literature-review. This case affects the lower-lip of an 86-years-old female. After excisional biopsy, the histopathological examination revealed a CH associated with actinic cheilitis. Only 23 similar cases have been reported in literature. At this site CH mainly affects the lower-lip of white males in a wide-age range. Excision should be the treatment of choice to enable pathological examination of the underlying lesion, since most cases were associated with pre-malignant/malignant lesions.

RESUMEN El objetivo es describir los datos clinicopatológicos y de tratamiento de una paciente de 86 años con un cuerno cutáneo (CC) en los tejidos orales (labio inferior) y compararlos con una revisión de la literatura. Tras la biopsia escisional, el examen histopatológico reveló un CC asociado a queilitis actínica. Solo se han informado 23 casos similares en la literatura. El estudio ha revelado que el CC afecta principalmente al labio inferior de los hombres blancos en un amplio rango de edad. La escisión debe ser el tratamiento de elección para permitir el examen patológico de la lesión subyacente, ya que la mayoría de los casos se asociaron con lesiones premalignas/malignas.

RESUMO O objetivo deste relato é descrever os dados clinicopatológicos e de tratamento de uma paciente, 86 anos, com corno cutâneo (CC) nos tecidos orais (lábio inferior) e compará-los com outros estudos publicados, fazendo uma revisão da literatura. Após biópsia excisional, o exame histopatológico revelou CC associado a queilite actínica. Apenas 23 casos semelhantes já foram relatados. Durante nossa pesquisa, verificamos que o CC afetou principalmente o lábio inferior de homens brancos em uma ampla faixa etária. A excisão deve ser o tratamento de escolha, pois ela possibilita a realização de exame histopatológico da lesão subjacente, já que a maioria dos casos foi associada a lesões pré-malignas/malignas.

The mechanism of chloroquine/hydroxychloroquine and its application in stomatological diseases / 口腔疾病防治

@#Chloroquine and hydroxychloroquine are both classic 4-aminoquinoline antimalarial drugs with similar chemical structures and mechanisms of action. As the toxicity and side effects of hydroxychloroquine are lower than those of chloroquine, hydroxychloroquine is the main clinical application at present, with good efficacy and safety. Chloroquine and hydroxychloroquine are widely used in the clinic because of their immunosuppressive, anti-inflammatory, antiviral, antitumor and photoprotective effects. The main mechanisms by which chloroquine/hydroxychloroquine inhibits immunity include inhibiting lysosome activity, autophagy, immune response signaling pathways production of proinflammatory cytokines. Chloroquine stabilizes the lysosomal membrane and reduces the release of lysosomal enzymes. As a prostaglandin antagonist, chloroquine can reduce the production of prostaglandins and leukotrienes, thus playing an anti-inflammatory role. Chloroquine/hydroxychloroquine can inhibit virus proliferation in the early stage of virus replication by inhibiting the glycosylation of the angiotensin converting enzyme 2 receptor. At present, hydroxychloroquine has been found to have significant efficacy in discoid lupus erythematosus, oral lichen planus, chronic cheilitis, pemphigus foliaceus, Sjögren’s syndrome and other stomatological diseases. However, eye damage is the most important adverse reaction of hydroxychloroquine, and its occurrence is related to the cumulative dose of drugs.

New diagnostic classification of cheilitis and its clinical diagnostic pathway / 华西口腔医学杂志

Cheilitis is a general term for various types of inflammatory diseases that occur on the lips. The etiology differs and the clinical manifestations and pathological features overlap, leading to difficulties in clinical diagnosis. Reasonable classification is conducive to the diagnosis of cheilitis. However, its classification is difficult because of its cha-racteristics. At present, scholars have proposed two different classification schemes, but a unified classification standard has not yet been established. We classified cheilitis based on its etiology, clinical manifestations, pathological characteristics, and relationship with systemic and special diseases on the basis of special medical reports and by combining clinical practice experience and summarizing previous cheilitis diagnosis and treatment literature. In accordance with this classification method, we proposed suggestions for the clinical diagnosis of cheilitis to provide a reference for the clinical diagnosis and treatment of complex cheilitis.

Prevalencia de lesiones bucales en tejido blando encontradas en la Clínica de Estomatología de la Facultad de Odontología de la Universidad de los Andes: periodo 2015-2018 / Prevalence of oral lesions in soft tissue found in the Clinic of Stomatology of the Faculty of Dentistry of the University of los Andes: 2015-2018 period

Introducción: La epidemiología sobre alteraciones en tejidos blandos bucales es limitada cuando se compara con caries, enfermedades periodontales y maloclusiones, por lo que su estudio representa un paso adelante en la odontología más allá de los dientes. Objetivo: Describir la prevalencia de las lesiones bucales en tejido blando encontradas en la Clínica de Estomatología de la Facultad de Odontología de la ULA, del 2015 al 2018, con la finalidad de proporcionar una fuente de datos actualizada, que oriente a una mejor prevención y oportuno diagnóstico. Material y métodos: Se realizó una investigación descriptiva, documental, retrospectiva y multivariable. Resultados: De 1,000 fichas clínicas estudiadas, las patologías más frecuentes fueron: lengua saburral (50.6%), queilitis (33.4%), traumatismo de la mucosa de los carrillos (27.6%), várices linguales (18.3%), anquiloglosia (13.7%) y agrandamiento de rugas palatinas (11.7%). La zona con mayor alteración fue la lengua (92.1%), mientras que el paladar fue la menos afectada (29%). De los hábitos predisponentes a la formación de lesiones, el mordisqueo de mucosa fue el más común (16.5%). En cuanto a los factores locales asociados, una higiene oral regular/ deficiente resultó el principal (53.8%). Conclusión: La educación del paciente sigue siendo considerada la clave para disminuir la aparición de patologías y su evolución a entidades más graves (AU)

Introduction: Epidemiological studies on soft tissue alterations in the mouth are limited when compared with caries, periodontal diseases and malocclusions, so their study represents a step forward in dentistry beyond the teeth. Objective: To describe the prevalence of soft tissue oral lesions found in the Stomatology Clinic of the ULA School of Dentistry, from 2015 to 2018, in order to provide an up-to-date data source, to guide better prevention and timely diagnosis. Material and methods: A descriptive and documentary, retrospective and multivariable research was carried out. The statistical package IBM SPSS Statistics v 23 was applied for the analysis. Results: 1,000 clinical records studied, the most frequent pathologies were: saburral tongue (50.6%), cheilitis (33.4%), traumatism of the cheek mucosa (27.6%), lingual varices (18.3%), ankyloglossia (13.7%) and enlargement of palatal rugas (11.7%). The tongue was the most affected (92.1%), while the palate was the least affected (29%). Of the predisposing habits to the formation of lesions, mucosal nipping was the most common (16.5%). Regarding the associated local factors, a regular / deficient oral hygiene was the main one (53.8%). Conclusion: Patient education is still considered the key to diminish not only the appearance of pathologies but their evolution to more serious entities (AU)

Diagnosis and treatment experience of granulomatous cheilitis: case report and literature review / 口腔疾病防治

Objective@#To investigate the etiology, diagnosis and treatment of granulomatous cheilitis（GC）.@*Methods@# For a patient with recurrent granulomatous cheilitis for more than 1 year in whom no medical treatment was used, only systemic treatment of the teeth was performed, and its efficacy was observed. We also reviewed the relevant literature. @*Results@#The vermilion of the right lower lip of the patient was obviously swollen and soft. There was rebound and no pitting edema with palpation. A large dark red rash with local desquamation was observed on the skin over the right mandible. There were residual roots in tooth 35, 46, and 47, a porcelain bridge on 11-24, deep caries in 15, 16, 26, and 36, and many calculi in the whole mouth, and the gingival margin was obviously congested and swollen. Histopathological examination showed many lymphocytes infiltrated the superficial dermis, and granulation tissue, plasma cells and eosinophils infiltrated locally. The diagnosis was as follows: ① GC; ② 35, 46, and 47 residual roots; ③ 15, 16, 26, and 36 deep caries; ④ gingivitis. The treatment included extraction of 35, 46, and 47 residual roots, periodontal basic treatment, and fillings for 15, 16, 26, and 36. No drugs were administered except for 3 days after tooth extraction. After 5 weeks of treatment, the swelling of the lower lip and the skin rash completely disappeared. There was no recurrence in the follow-up observation at six months. Through a literature review and analysis, we found that GC may be related to various factors such as immunity, infection, and genetics. Local oral infections may be closely related to the incidence of GC.@*Conclusion @#Resolution of local oral infections is effective for the treatment of granulomatous cheilitis, and local oral infections may be closely related to the onset of granulomatous cheilitis. In the treatment of granulomatous cheilitis, attention should be paid to the systematic examination of the oral condition, and the treatment of suspected lesions in the oral cavity should begin in the early stages of treatment.

Tratamiento quirúrgico del carcinoma epidermoide de un 40 % del labio inferior. Reporte de caso / Surgical treatment of squamous cell carcinoma of 40 % of the lower lip. Case report

RESUMEN Fundamento: La técnica del tonel de Schuchardt, está indicada cuando el defecto en el labio compromete del 30-75 % del labio, de localización central y paramedial que afecta bermellón y piel; en este caso se usó el colgajo para reconstruir una lesión tumoral más lateral. La técnica aparece descrita para extraer el tonel de espesor parcial, sin embargo, teniendo en cuenta el margen oncológico recomendado en este caso la excéresis abarcó todo el espesor del labio. Objetivo: Presentar un caso de un paciente con un carcinoma epidermoide del 40 % en el labio inferior intervenido en el Hospital General Camilo Cienfuegos. Presentación del caso: Paciente masculino de 43 años de edad tratado durante un año por queilitis actínica, portador de una lesión exofítica, infiltrante que ocupaba el 40 % del labio inferior. Se estableció como impresión diagnóstica un carcinoma epidermoide y se decidió el tratamiento quirúrgico. Atendiendo a las características individuales del paciente y a las de la lesión, se eligió la técnica del tonel descrita por Schuchardt. Conclusiones: Las lesiones malignas de los labios pueden incidir enmascaradas por el cuadro clínico de lesiones premalignas como la queilitis actínica por lo que es importante mantener un seguimiento estrecho de estos casos. Al aplicar el método clínico puede decidirse la intervención quirúrgica con diagnóstico presuntivo de carcinoma epidermoide, deben respetarse entonces los márgenes oncológicos recomendados. La técnica del tonel inicialmente descrita para pérdidas de tejidos mediales y paramediales del labio, de espesor parcial puede emplearse en defectos de localización más lateral y de espesor total con resultados satisfactorios.

ABSTRACT Background: The barrel of Schuchardt technique, is indicated when the defect in the lip compromises 30-75 % of it, from central to paramedial location which affects both, vermilion and skin; in this case, the flap was used for rebuilding a more lateral tumor lesion. The technique is described to extract the partial thickness barrel; however, taking into account the oncological margin recommended in this case, the hysteresis covered the entire thickness of the lip. Objective: To present a case of a patient with 40 % squamous cell carcinoma in the lower lip intervened at Camilo Cienfuegos General Hospital. Case report: A 43-year-old male patient treated for a year having actinic cheilitis, with an infiltrated exophytic lesion, occupying 40 % of the lower lip. A squamous cell carcinoma was diagnosed, so surgical treatment. Based on the individual characteristics of the patient and those of the lesion, the barrel technique described by Schuchardt was chosen. Conclusions: Malignant lesions of the lips can affect masked by the clinical picture of premalignant lesions such as actinic cheilitis, so it is important to keep a close follow-up of these cases. When applying the clinical method, the surgical intervention with presumptive diagnosis of squamous cell carcinoma can be decided, then the recommended oncological margins must be respected. The barrel technique initially described for losses of medial and paramedial tissues of the lip, of partial thickness can be used in defects of more lateral location and of total thickness with satisfactory results.

Development and evaluation of the efficiency of ointment for cheilitis treatment in patients with dental and jaw anomalies

Cheilitis is a group of chronic diseases of the vermilion border that are diverse in etiology, pathogenesis and clinical picture. The development of various forms of cheilitis is facilitated by defects of the architectonics of the lips, unhealthy lifestyle, anatomical features of the lip structure, adverse meteorological effects, decrease in specific and non-specific factors for protecting the oral cavity, the patient's psycho-emotional state, immuno-allergic factors and accompanying general somatic and dental pathologies. The issues of prevention and comprehensive treatment of lip diseases are especially relevant in dental practice. The article presents data on the prevalence of cheilitis and dentoalveolar anomalies and the need for their treatment in young people. Furthermore, the authors provide a composition justification and develop an ointment for the treatment of cheilitis in this category of patients.