Manifestaciones orales del COVID-19 en Paraguay: resultados de una encuesta en línea

Introducción: Estudios previos han reportado que pacientes infectados con el virus del COVID-19, podrían manifestar sintomatologías a nivel de la cavidad oral. Objetivo: Evaluar la frecuencia de manifestaciones orales asociadas a COVID-19 en un segmento de la población paraguaya y determinar cuáles son las más prevalentes. Metodología: Estudio descriptivo de corte transversal. Fue realizada una encuesta electrónica de enero a marzo del 2022. Los datos fueron presentados como frecuencias y porcentajes y analizados mediante la prueba de chi-cuadrado. El análisis estadístico se realizó con el software R versión 4.0.3. Resultados: La muestra estuvo compuesta por 478 personas. El 79,50 % correspondió al sexo femenino y el 45,19 % tenía entre 25 y 34 años. El 65,48 % informó haber experimentado al menos 1 síntoma o signo oral durante el curso de COVID-19. La pérdida de la sensación de sabores amargos, seguida de la alteración del sabor de los alimentos y la pérdida de la percepción dulce, fueron los síntomas más comunes. Se encontró una proporción significativamente mayor de manifestaciones orales en el rango de 18-24 años (χ²; p= 0,003). Entre las personas que desarrollaron COVID-19 de forma moderada a severa hubo mayor número de manifestaciones de síntomas orales (χ²; p= 0,044). Discusión: Se identificó una alta frecuencia de manifestaciones orales en pacientes con casos de moderados a severos de COVID-19, destacándose los trastornos del gusto como los más predominantes. Los individuos más jóvenes fueron los más afectados.

Introduction: Previous studies have reported that patients infected with the COVID-19 virus could manifest symptoms in the oral cavity. Objective: To evaluate the frequency of oral manifestations associated with COVID-19 in a segment of the Paraguayan population and determine the most prevalent ones. Methods: Descriptive cross-sectional study. An electronic survey was conducted from January to March 2022. The data were presented as frequencies and percentages and analyzed using the chi-square test. Statistical analysis was performed with R software version 4.0.3. Results: The sample consisted of 478 individuals. 79.50% were female, and 45.19% were between 25 and 34 years old. 65.48% reported having experienced at least 1 oral symptom or sign during the course of COVID-19. The loss of the sensation of bitter tastes, followed by the alteration of the taste of foods and the loss of sweetness perception, were the most common symptoms. A significantly higher proportion of oral manifestations was found in the 18-24 age range (χ²; p= 0.003). Among people who developed COVID-19 in a moderate to severe form, a greater number of oral symptom manifestations were observed (χ²; p= 0.044). Discussion: A high frequency of oral manifestations was identified in patients with moderate to severe cases of COVID-19, with taste disorders standing out as the most predominant. Younger individuals were the most affected.

Extensive carcinoma cuniculatum of the maxilla: A rare variant of oral carcinoma

Carcinoma cuniculatum (CC), is a rare well-differentiated, low-grade variant of squamous cell carcinoma. However, diagnosis of oral CC has remained very difficult, because many pathologists and clinicians remain un acquainted with oral CC, because there are very few reported cases of this disease in the oral cavity. To our knowledge, no more than 60 head and neck cases have been reported since Flieger and Owinski first described a case involving the mandible in 1977, because there are very few published cases of this disease in the oral cavity, the aim of this report is to provide a detailed clinical and histopathologic description of carcinoma cuniculatum of the maxila, provide a brief review of the literature, and highlight the difficulties in arriving at the correct diagnosis.

Importancia del diagnóstico precoz en el carcinoma mucoepidermoide. Relato de caso clínico / Importance of early diagnosis in mucoepidermoid carcinoma. Case report

El carcinoma mucoepidermoide es el tumor maligno más frecuente de las glándulas salivales menores localizándose por lo general en el paladar. El objetivo del presente reporte de caso es evidenciar en la literatura científica la importancia del diagnóstico precoz de carcinomas orales, así como, el rol fundamental que cumple el odontólogo general para identificar, guiar y derivar al paciente a un especialista. Se presenta el caso clínico de un paciente de sexo masculino que acudió a la Facultad de Odontología de la Universidad Nacional de Asunción, quien fue derivado por su odontóloga tras percibir un pequeño pero perceptible cambio en la coloración normal de la mucosa y molestias ocasionales en la zona del paladar duro. Al examen intraoral se observó en el paladar duro, a la altura de los premolares en la hemiarcada izquierda, una lesión nodular ovoidea, color violáceo, de 1cm de diámetro, depresible a la palpación. Se realizó una biopsia incisional para su estudio histopatológico, reportando un carcinoma mucoepidermoide. El diagnóstico precoz de este tipo de patologías es un desafío para el odontólogo general, quien debe orientar al paciente, ante cualquier cambio de la estructura normal de la cavidad bucal, para que acuda a un especialista.

Mucoepidermoid carcinoma is the most frequent malignant tumor of the minor salivary glands, usually located in the palate. The objective of this case report is to demonstrate in the Paraguayan scientific literature the importance of early diagnosis of oral carcinomas as well as the fundamental role of the general dentist in identifying, guiding and referring the patient to the corresponding specialist. The clinical case presented is about a male patient who attended the Faculty of Dentistry of the National University of Asuncion. His dentist referred him after noticing a small but perceptible change in the normal coloration of the mucosa and occasional discomfort in the area of the hard palate. In the intraoral examination, an ovoid nodular lesion, purplish in color, 1cm in diameter, depressible on palpation, observed on the hard palate at the level of the premolars in the left hemiarch. An incisional biopsy performed for histopathological study, reporting a mucoepidermoid carcinoma. Regarding the early diagnosis of this type of pathology, the challenge for the general dentist will continues to be his continuous training in order to be able to successfully guide the patient in seeking care from the right specialist in case of any change in the oral cavity.

Líquen Plano Oral e seu Potencial de Malignização / Lichen Planus and its potencial for malignancy

Objetivos: Instruir e orientar ao cirurgião dentista e demais profissionais de saúde a importância da detecção e rastreio precoce de lesões pré-malignas. Revisão de Literatura: O Líquen Plano Oral é uma condição dermatológica crônica, de origem auto-imune, relativamente comum na população, que atinge o epitélio de mucosa e pele, sendo considerada, pela Organização Mundial de Saúde (OMS), uma desordem potencialmente maligna quando associado a áreas de ulceração. A revisão de literatura foi realizada nas bases de dados PubMed e Lilacs. Buscamos investigar o potencial de malignização do Líquen Plano Oral associado a condições erosivas, analisando o processo de carcinogênese no processo inflamatório. Conclusão: Conclui-se que o objeto de estudo ainda é um assunto pouco explorado pela literatura, porém há indícios etiopatológicos que enfatizam o processo de malignização oriundo de uma lesão pré-maligna como o Líquen Plano Oral. Além disso, enfatizamos a importância do diagnóstico precoce das lesões estomatognáticas, para que assim possamos aumentar as chances de cura do paciente.(AU)

Objectives: To instruct and guide dentists and other health professionals on the importance of early detection and screening of pre-malignant lesions. Literature Review: Oral Lichen Planus is a chronic dermatological condition, of autoimmune origin, relatively common in the population, which affects the epithelium of the mucosa and skin, being considered, by the World Health Organization (WHO), a potentially fatal disorder. malignant when associated with areas of ulceration. A literature review was performed on the PubMed and Lilacs databases. We sought to investigate the potential for malignancy of Oral Lichen Planus associated with erosive conditions, analyzing the process of carcinogenesis in the inflammatory process. Conclusion: It is concluded that the object of study is still a subject little explored in the literature, but there are etiopathological accusations that emphasize the process of malignancy arising from a pre-malignant lesion such as Oral Lichen Planus. In addition, we emphasize the importance of early diagnosis of stomatognathic lesions, so that we can increase the patient's chances of cure.(AU)

Mixoma odontogénico de larga data en el maxilar. Reporte de caso / Long-Standing odontogenic myxoma of the maxilla. Case Report

Introducción: el mixoma odontogénico es una neoplasia benigna, poco frecuente, de origen mesenquimal proveniente del órgano dentario, es localmente invasivo y no hace metástasis. Su localización más frecuente es a nivel de la mandíbula y poco frecuente en el maxilar. Objetivo: describir las características que presenta un mixoma odontogénico de larga data en el maxilar. Presentación del caso: paciente de sexo masculino de 23 años de edad, soltero, de profesión comerciante, acude a la Catedra de Patología Bucal de la Facultad de Odontología de la Universidad Nacional de Asunción por presentar una deformidad en la región facial del lado derecho, presente desde la infancia con crecimiento lento sin sintomatología dolorosa. Se realizó una biopsia incisional, tomando una muestra de más de 1 cm de la capsula tumoral para su estudio histopatológico; a partir de la cual se informa sobre un tumor odontogénico mesenquimal compatible con el mixoma odontogénico. Se realizó el tratamiento de una maxilectomía con márgenes de seguridad y el estudio anatomopatológico de todo el tumor extirpado confirmó el diagnóstico de Mixofibroma odontogénico de 2,5 cm de diámetro máximo. Conclusión: un diagnóstico precoz de tumores como los mixomas, que son de crecimiento lento e infiltrante, podría garantizar terapéuticas menos agresivas e invasivas como las del caso presentado, otorgando así mejor pronóstico como calidad de vida a los pacientes.

Introduction: Odontogenic myxoma is a rare benign neoplasm of mesenchymal origin originating from the dental organ, it is locally invasive and does not metastasize. Its most frequent location is at the level of the mandible and infrequently in the maxilla. Objective: To describe the characteristics of a long-standing odontogenic myxoma in the maxilla. Presentation of the case: Male patient, 23 years of age, single, businessman, came to the Department of Oral Pathology of the Faculty of Dentistry of the National University of Asuncion for presenting a deformity in the facial region on the right side, present since childhood with slow growth and no painful symptomatology. An incisional biopsy was performed, taking a sample of more than 1cm of the tumor capsule, for histopathological study; reporting a mesenchymal odontogenic tumor compatible with odontogenic myxoma. A maxillectomy treatment with safety margins performed and the anatomopathological study of the entire excised tumor confirmed the diagnosis of odontogenic myxofibroma with a maximum diameter of 2.5 cm. Conclusion: An early diagnosis of tumors such as myxomas, which are slow-growing and infiltrative, could guarantee less aggressive and invasive therapies such as those in the case presented, thus providing patients with a better prognosis and quality of life.

Accuracy of two methods to detect the presence of halitosis: the volatile sulfur compounds concentration in the mouth air and the information from a close person

Abstract This study aimed to analyze the accuracy of two methods for detecting halitosis, the organoleptic assessment by a trained professional (OA) with volatile sulfur compounds (VSC) measurement via Halimeter® (Interscan Corporation) and information obtained from a close person (ICP). Methodolody Participants were patients and companions who visited a university hospital over one year period to perform digestive endoscopy. A total of 138 participants were included in the VSC test, whose 115 were also included in the ICP test. ROC curves were constructed to establish the best VSC cut-off points. Results The prevalence of halitosis was 12% (95%CI: 7% to 18%) and 9% (95%CI 3% to 14%) for the OA and ICP, respectively. At the cut-off point >80 parts per billion (ppb) VSC, the prevalence of halitosis was 18% (95%CI: 12% to 25%). At the cut-off point >65 ppb VSC, sensitivity and specificity were 94% and 76%, respectively. At the cut-off point >140 ppb, sensitivity was 47% and specificity 96%. For the ICP, sensitivity was 14% and specificity 92%. Conclusions VSC presents high sensitivity at the cut-off point of >65 ppb and high specificity at the cut-off point of >140 ppb. ICP had high specificity, but low sensitivity. The OA can express either occasional or chronic bad breath, whereas the ICP can be a potential instrument to detect chronic halitosis.

Impact of different evaluation methods for diagnostic tasks in panoramic radiography / Impacto de diferentes métodos de evaluación durante el diagnóstico en la radiografía panorámica

Abstract The aim of this study was to evaluate the observers diagnostic performance in panoramic radiography using monitor, tablet, X-ray image view box, and against window daylight as a visualization method in different diagnostic tasks. Thirty panoramic radiography were assessed by three calibrated observers for each visualization method, in standardized light conditions, concerning dental caries, widened periodontal ligament space, and periapical bone defects from the four first molars; mucosal thickening and retention cysts in maxillary sinus; and stylo-hyoid ligament calcification and atheroma. A five-point confidence scale was used. The standard-reference was performed by two experienced observers. Diagnostic values using window light were significantly lower for caries and periapical bone defect and retention cyst, stylo-hyoid ligament calcification detection (p<0.05). For atheroma detection, X-ray image view box, tablet, and widow light had lower accuracy than the evaluation on the monitor (p<0.05). Observers diagnostic performances are worsened using window light as an evaluation method for panoramic radiography for dental, sinus, and calcification disorders, while the monitor was the most reliable method.

Resumen El objetivo de este estudio fue evaluar el desempeño diagnóstico de los observadores en la radiografía panorámica utilizando monitor, tablet, caja de visualización de imágenes de rayos X y contra la luz del día de la ventana como método de visualización en diferentes tareas de diagnóstico. Treinta radiografías panorámicas fueron evaluadas por tres observadores calibrados para cada método de visualización, en condiciones de luz estandarizadas, con respecto a caries dental, espacio del ligamento periodontal ensanchado y defectos óseos periapicales de los cuatro primeros molares; engrosamiento de la mucosa y quistes de retención en el seno maxilar; y calcificación y ateroma del ligamento estilohioideo. Se utilizó una escala de confianza de cinco puntos. La referencia estándar fue realizada por dos observadores experimentados. Los valores diagnósticos con luz de ventana fueron significativamente menores para caries y defecto óseo periapical y quiste de retención, detección de calcificación del ligamento estilohioideo (p <0.05). Para la detección de ateroma, la caja de visualización de imágenes de rayos X, el tablet y la luz de viuda tuvieron una precisión menor que la evaluación en el monitor (p <0.05). El rendimiento diagnóstico del observador empeora al utilizar la luz de la ventana como método de evaluación de la radiografía panorámica para los trastornos dentales, de los senos nasales y de la calcificación, mientras que el monitor fue el método más fiable.

Hallazgos intraorales en pacientes de una población colombiana infectados con SARS-CoV-2: informe de casos / Intraoral findings in patients in a Colombian population infected with SARSCoV-2: series of case

Objetivo. Identificar y describir las lesiones orales encontradas en los pacientes con infección por SARS-CoV 2. Métodos. Serie de casos con descripción de 11 pacientes confirmados de infección por SARS-CoV-2 por hisopado nasofaríngeo o prueba serológica para confirmar la infección; con la presencia de manifestaciones intraorales de diferentes tipos. A todos los pacientes se les realizó teleconsulta por parte de un estomatólogo y se recopilaron los datos relevantes como edad, sexo, antecedentes de enfermedades preexistentes, tipo de lesión estomatológica presente, sitio y sintomatología, entre otros. Todos los pacientes firmaron un consentimiento informado. Resultados. De los 11 casos positivos para SARS-CoV-2, el 63,63% de los pacientes corresponden al sexo femenino (n=7) y 36,36% (n=4) sexo masculino. El 100% de los pacientes fueron diagnosticados por pruebas moleculares y serológicas; así, el 90,90% se diagnosticaron con PCR viral y 9,09% diagnosticado por prueba para antígeno. Las lesiones ulcerativas predominaron en el 54,54%; seguidas de pseudoplaca y eritema en 18,18% respectivamente. Las vesículas y costras se presentaron en el 9,09% respectivamente. El 72,72 (n=8) presentó ageusia y anosmia, y el 45,45 % (n=5) manifestaron comorbilidades como diabetes, hipertensión arterial e hipotiroidismo. Conclusiones. Esta enfermedad viral cursa con lesiones bucales y muchas veces es la primera e incluso la única manifestación que se presenta durante su curso, por eso es importante tener en cuenta e identificar estas lesiones y saber su relación con el manejo terapéutico, compromiso inmunológico o la propia enfermedad.

Objective. To identify and describe the oral lesions found in patients with SARS-CoV-2 infection. Methods. Series of cases with description of 11 patients with SARS-CoV-2 infection confirmed by nasopharyngeal swab or serological test to confirm the infection; with the presence of intraoral manifestations of different types. All patients underwent tele-consultation by a stomatologist and relevant data such as age, sex, history of pre-existing diseases, type of stomatological lesion present, site and symptomatology, among others, were collected. All patients signed an informed consent form. Results. Of the 11 positive cases for SARS-CoV-2, 63.63% (n=7) of the patients were female and 36.36% (n=4) were male. All patients (100%) were diagnosed by molecular and serological tests, 90.90% were diagnosed by viral PCR and 9.09% were diagnosed by antigen test. Ulcerative lesions predominated in 54.54%; followed by pseudoplaque and erythema in 18.18% of patients, respectively. Vesicles and crusts were present in 9.09% respectively. Ageusia and anosmia were present in 72.72 (n=8), and 45.45% (n=5) of patients showed comorbidities such as diabetes, arterial hypertension and hypothyroidism. Conclusions. This viral disease presents with oral lesions and it is usually the first and even the only manifestation during its course. That is why it is important to take into account and identify these lesions, and know their relationship with the therapeutic management, immunological compromise or the disease itself.

Solitary fibrous tumor of the tongue

ABSTRACT Solitary fibrous tumor (SFT) is a benign mesenchymal neoplasm originally described in pleura with a rare presentation in the oral cavity. Herein, we report a case of a 28-year-old male patient who presented an asymptomatic slow-growing mass in the anterior part of the tongue. Intraoral examination revealed a well-circumscribed mass covered by normal mucosa with a fibrous consistency. Due to non-specific clinical findings, the initial diagnostic hypotheses include benign submucosal neoplasms such as leiomyoma, neurofibroma, SFT, and others. An excisional biopsy was performed. Microscopically, the tumor was surrounded by a thick fibrous capsule; hypo and hypercellular areas were arranged in a storiform pattern with a stroma formed by collagen and abundant vascularization. Tumor cells showed immunopositivity for CD34 and STAT-6 and no expression of CD99, AML, S-100, and Ki-67. According to these findings, the diagnosis of SFT was established. After 24 months, the patient is asymptomatic and has no evidence of recurrence. Although oral involvement is rare, SFT should be included in the differential diagnosis of oral submucosal lesions.

Lingual amyloidosis associated to multiple myeloma: case report / Amiloidose lingual associada a mieloma múltiplo: relato de caso

ABSTRACT Oral amyloidosis is a disease characterized by extracellular and irreversible deposition of amorphous and fibrillar proteins in the oral cavity, being strongly associated with Multiple Myeloma. The objective of this study is to report a case of a 62-year-old woman diagnosed with Multiple Myeloma who, approximately 2 years after starting treatment for the underlying disease, presented a lesion on the lateral border of the tongue with exophytic growth, pinkish color, vascularized, painless, measuring 3cm in its largest diameter. After histopathological analysis through incisional biopsy, a final diagnosis of amyloidosis was obtained. As a local treatment, we opted for complete excision of the lesion. The patient evolved to death due to Multiple Myeloma influenced by the diagnosis of systemic amyloidosis. Oral amyloidosis is usually associated with the systemic presentation of the disease, making it necessary to conduct a thorough investigation of other organs. Its diagnosis is important since the prognosis is directly related and can negatively influence survival rates and treatment of the underlying disease.

RESUMO A amiloidose oral é uma doença caracterizada pela deposição extracelular e irreversível de proteínas amorfas e fibrilares na cavidade bucal, sendo fortemente associada com Mieloma Múltiplo. O objetivo deste trabalho é relatar o caso de uma mulher com 62 anos de idade diagnosticada com Mieloma Múltiplo que, aproximadamente 2 anos após o início do tratamento para a doença de base, apresentou lesão em borda lateral de língua com crescimento exofítico, de coloração rósea, vascularizada, indolor, medindo 3 cm em seu maior diâmetro. Após análise histopatológica através de biópsia incisional, obteve-se diagnóstico final de amiloidose. Como tratamento local, optou-se pela exérese completa da lesão. A paciente evoluiu para óbito por consequência do Mieloma Múltiplo com complicações associadas à amiloidose sistêmica. A amiloidose oral geralmente está associada com a apresentação sistêmica da doença, tornando necessária uma investigação aprofundada nos demais órgãos. Seu diagnóstico é importante uma vez que pode influenciar diretamente no prognóstico e, consequentemente, negativamente nas taxas de sobrevida e no tratamento da doença de base.

Manejo cirúrgico combinado de comunicação buco-sinusal e reconstrução de tábua óssea vestibular usando fibrina rica em plaquetas e leucócitos / Combined surgical management of oroantral communication and buccal bone plate reconstruction using leukocyte- and platelet-rich fibrin

Introdução: A comunicação buco-sinusal é tida como uma comunicação entre a cavidade bucal e o seio maxilar, cuja qual possui variadas etiologias, sendo a mais comum a extração de dentes posteriores superiores, pela proximidade de seus ápices radiculares com o assoalho do seio maxilar. O diagnóstico é obtido a partir da combinação de anamnese, exame físico e exames imaginológicos, podendo ser por meio de radiografias ou tomografia. Há diversas abordagens para o tratamento, incluindo o uso de membranas de Fibrina Rica em Plaqueta e Leucócitos para obstrução local da comunicação. O objetivo deste trabalho é relatar e discutir o emprego de membrana de Fibrina Rica em Plaqueta e Leucócitos para manejo de uma comunicação buco-sinusal associado à reconstrução de tábua óssea vestibular com Stick Bone. Relato de caso: Mulher, 61 anos, compareceu ao atendimento odontológico relatando incômodo na região do dente 16 e história de extração do mesmo há cerca de 8 meses. Ao exame intra-oral, observou-se a presença área hiperemiada no alvéolo da região da extração e, ao exame tomográfico, foi observada solução de continuidade no assoalho do seio maxilar, sugerindo comunicação buco-sinusal associado à perda de tábua óssea vestibular local. Considerações Finais: Portanto, o uso destas membranas são adequados para obstrução destas comunicações, sendo um plugue adequado devido às suas propriedades adesivas na área de perfuração, não estar vinculado a nenhuma reação imunológica, preparação fácil e rápida, altamente biocompatível, baixo custo, prevenção da profundidade do sulco vestibular e não apresentar nenhum risco de infecção... (AU)

Introduction: The oroantral communication is a communication between the oral cavity and the maxillary sinus, which has different etiologies, being the most common the extraction of upper posterior teeth, due to the proximity of their root apexes to the floor of the maxillary sinus. Diagnosis is obtained from a combination of anamnesis, physical examination and imaging exams, which may be through radiographs or tomography. There are several approaches to treatment, including the use of Leukocyte- and Platelet-RichFibrin membranes for local obstruction of communication. The aim of this work is to report and discuss the use of a Leukocyte- and Platelet-Rich Fibrin membrane for the management of oroantral communication associated with the reconstruction of the buccal bone plate with Stick Bone. Case report: A 61-year-old woman reported discomfort in the region of right maxillary first molar and a history of extraction of the same for about 8 months. The intraoral evaluation revealed the presence of a hyperemic area in the alveolus of the extraction region, and the tomographic examination revealed an oroantral communication associated with loss of local vestibular bone plate. Final considerations: Therefore, the use of these membranes are suitable for obstructing these communications, being a propper plug due to its adhesive properties in the perforation area, not being associated to any immunological reaction, easy and fast preparation, highly biocompatible, low cost, prevention of the depth of the vestibular sulcus and do not present any risk of infection... (AU)

Accuracy of the dental pulp sensibility test using cold spray for the diagnosis of pulp diseases: an observational clinical study

The dental pulp sensibility test is one of the main auxiliary resources for the diagnosis of pulp pathologies, and its accuracy is still debatable. This cross-sectional observational study evaluated the accuracy of the pulp sensibility test (PST) using cold spray (1,1,1,2-tetrafluoroethane) for the diagnosis of pulp diseases and determined the effect of individual and clinical variables on the reliability of this test. The paper was designed following the STROBE statement. Sixty patients with indications for primary endodontic treatment were selected and examined from August 2017 to July 2018. Data collection was performed through interviews, clinical/radiographic examinations and the PST. The results of the cold test, along with data on sex, age, the tooth type regarding the root number, and the presence of restorations and caries, as well as the recent consumption of analgesics, were recorded. The presence of bleeding within the pulp chamber was used as the gold standard to compare with the clinical diagnosis and to identify the true-positive, false-positive, true-negative, and false-negative responses. The accuracy of PST achieved in subgroups of individual and clinical variables was compared using the chi-square test with a significance level of 5% (p < 0.05). The PST with the use of cold spray showed a sensitivity of 0.88, a specificity of 1.00, a positive predictive value of 1.00, a negative predictive value of 0.86, and an accuracy of 0.93. The accuracy of the cold spray was not affected by individual or clinical variables. The PST with the use of cold spray is an accurate and reliable method for determining the diagnosis of pulp diseases, especially in cases of pulp vitality or irreversible pulpitis.

An Unusual Early Oral Presentation of Acromegaly: A Case Report

ABSTRACT@#Acromegaly is a devastating chronic slowly progressive disease. Its early diagnosis is a challenging issue that necessitates clinical suspicion of signs and symptoms as a first step. This report introduces an unusual early sign in the oral cavity that lead to the early diagnosis of an acromegaly case. A case of a healthy 40-year-old male patient presented with progressively growing multiple hard swellings in the upper and lower jaws. Clinical examination revealed bony hard multiple small spiky exostosis-like swellings, located at the maxillary and mandibular alveolar bones. An array of investigations revealed a 2-mm diameter pituitary tumour in MRI of sella. To the best of the author’s knowledge, this is the first report of spiky exostosis-like growths in the alveolar bone as an early sign of acromegaly. In this case, thorough examination of oral signs and symptoms was the first step for early diagnosis and hence, better prognosis for acromegaly.

Carcinoma escamocelular em soalho de boca causando destruição mandibular / Squamocellular carcinoma of the mouth floor causing mandibular destruction

O carcinoma espinocelular (CEC) representa o tumor mais frequente dentre todos os cânceres da cavidade oral, com uma média de idade de 60 anos e maior ocorrência no sexo masculino. A característica clássica da lesão é de um nódulo endurecida, com sinais e sintomas que se diferem de acordo com a região oral acometida, muitas dessas lesões são indolores, o que pode causar um retardo no diagnóstico e tratamento da doença. Objetivo: relatar um caso clínico de um paciente com CEC em soalho bucal, ressaltando a importância de o cirurgião-dentista reconhecer e diagnosticar essa doença em estágios iniciais. Relato de caso: paciente do sexo masculino, 60 anos de idade, faioderma, tabagista, foi encaminhado para avaliação de lesão indolor em soalho de boca. No exame clínico, observou-se lesão nodular endurecida em soalho de boca com aproximadamente 3 cm de diâmetro, com presença de placas leucoplásicas em sua extensão e associada à ulceração na região de rebordo alveolar. O exame radiográfico panorâmico mostrou reabsorção óssea na região de ulceração. Foram realizadas a biópsia incisional da lesão e a análise histopatológica, em que foi compatível com CEC. O paciente foi encaminhado para tratamento oncológico. Considerações finais: assim, é imprescindível ressaltar a importância de um adequado exame clínico, bem como do diagnóstico precoce destas lesões malignas, favorecendo um bom prognóstico ao paciente.(AU)

Squamous cell carcinoma (SCC) represents the most frequent tumor among all cancers of the oral cavity, with an average age of 60 years and greater occurrence in males. The classic characteristic of the lesion is a hardened nodule, with signs and symptoms that differ according to the affected oral region, many of these lesions are painless, which can cause a delay in the diagnosis and treatment of the disease. Objective: to report a clinical case of a patient with CPB on the oral floor, emphasizing the importance of the dental surgeon in recognizing and diagnosing this disease in early stages. Case report: male patient, 60 years old, phaderoderma, smoker, was referred for painless lesion on the floor of the mouth. On clinical examination, a hard nodular lesion was observed on the floor of the mouth, approximately 3 cm in diameter, with the presence of leukoplastic plaques in its extension and was associated with ulceration in the region of the alveolar ridge. The panoramic radiographic examination showed bone resorption in the ulceration region. Incisional biopsy of the lesion and histopathological analysis were performed, in which it was compatible with CPB. The patient was referred for cancer treatment. Final considerations: thus, it is essential to emphasize the importance of an adequate clinical examination, as well as the early diagnosis of these malignant lesions, favoring a good prognosis for the patient.(AU)

Lipoma oral: Revisión de literatura y reporte de caso / Oral lipoma: Review of literature and case report

Resumen Los lipomas son considerados los tumores de origen mesenquimatoso más comunes del tejido blando; de ellos el 13% del total se ubican en cabeza y cuello, pero es difícil encontrarlos en la región oral y maxilofacial. La localización más común de lipomas dentro de la región oral y maxilofacial ha sido reportada en la mucosa bucal, lengua y piso de boca. Los lipomas son neoplasias que se presentan típicamente como una masa suave, de superficie lisa, nodular, amarillenta y asintomática. Histopatológicamente, el lipoma clásico asemeja un tejido normal adiposo y tiene múltiples variantes. Este artículo presenta el reporte de caso de un lipoma oral extenso en un paciente femenino de 46 años de edad en la mucosa yugal, tratado quirúrgicamente con adecuada evolución. Asimismo se realiza la revisión de literatura con sus variantes histopatológicas.

Abstract Lipomas are considered the most frequent mesenchymal tumors of soft tissue, 13% are located in head and neck but it´s difficult to find them in the oral and maxillofacial region. The most common location of lipomas within the oral and maxillofacial region has been reported in the buccal mucosa, tongue and floor of the mouth. Lipomas are neoplasias that typically present as a soft, smooth-surfaced, nodular, yellowish, and asymptomatic mass. Histopathologically, the classical lipoma resembles normal adipose tissue and it has multiple variants. This article presents a case report of a relatively large oral classical lipoma in a 46 year-old woman on mandibular buccal vestibule, along with a review of the literature and its histopatho-logical variants.

Amelogênese imperfeita do tipo hipoplásica: relato de dois casos familiares / Amelogénesis imperfecta del tipo hipoplásico: informe de dos casos familiares / Hypoplastic amelogenesis imperfecta: report of two family cases

RESUMO Introdução: Diariamente o cirurgião dentista se depara com diversos casos que exigem acurácia no diagnóstico inicial e atenção para o tratamento que irá ser proposto, uma dessas é a amelogênese imperfeita, que é uma rara alteração dentária de caráter hereditário. As características principais da amelogênese imperfeita são hipomineralização ou hipoplasia da matriz de esmalte, o que ocasiona descoloração, sensibilidade e fragilidade deste tecido, apresentando diferentes subtipos clínicos, sendo a variante hipoplásica a mais prevalente. Objetivo: Relatar dois casos de amelogênese imperfeita do tipo hipoplásica entre membros de uma mesma família, correlacionando-os. Apresentação do caso: O diagnóstico foi feito através dos exames clínico e radiográfico, além da correlação entre os achados clínicos encontrados em cada paciente e com outros familiares, sendo proposto um plano de tratamento multidisciplinar e consistente com a condição adequada. Conclusões: É importante para o cirurgião dentista estudar e conhecer essas alterações raras para poder estabelecer diagnóstico preciso. Além disso, deve-se ampliar a conduta clínica através de um planejamento individualizado e/ou familiar, tratando não apenas aspectos estéticos e funcionais, mas também psicológico e sociais(AU)

RESUMEN Introducción: Diariamente el cirujano dentista se enfrenta a varios casos que exigen precisión en el diagnóstico inicial y atención para el tratamiento que se propondrá, una de las cuales es la amelogénesis imperfecta, que es un rara alteración dental de carácter hereditario. Las características principales de la amelogénesis imperfecta son hipomeralización o hipoplasia de la matriz de esmalte, lo que ocasiona decoloración, sensibilidad y fragilidad de este tejido, con la presencia de diferentes subtipos clínicos, siendo la variante hipoplásica la más prevalente. Objetivo: Informar dos casos de amelogénesis imperfecta del tipo hipoplásica entre miembros de una misma familia, correlacionándolos. Presentación del caso: El diagnóstico se realizó a través de los exámenes clínicos y radiográficos, además de la correlación entre los hallazgos clínicos encontrados en cada paciente y con otros familiares, por lo que fue propuesto un plan de tratamiento multidisciplinario y consistente con la condición adecuada. Conclusiones: Es importante para el cirujano dentista que estudie y conozca estos cambios raros para poder establecer un diagnóstico preciso. Además, se debe ampliar la conducta clínica a través de una planificación individualizada y / o familiar, tratando no solo aspectos estéticos y funcionales, sino también psicológicos y sociales(AU)

ABSTRACT Introduction: Dental surgeons are confronted every day with several cases that require accuracy in the initial diagnosis and attention to the treatment that will be proposed. One of these is amelogenesis imperfecta, a rare hereditary tooth alteration. The main features of amelogenesis imperfecta are hypomineralization or hypoplasia of the enamel matrix resulting in discoloration, sensitivity and fragility of this tissue. Of the existing clinical subtypes, the hypoplastic variant is the most prevalent. Objective: Report and correlate two cases of hypoplastic amelogenesis imperfecta in members of the same family. Case presentation: The diagnosis was based on clinical and radiographic examination, as well as analysis of the correlation between the clinical findings obtained from each patient and other relatives. The treatment plan proposed was therefore multidisciplinary and appropriately consistent with the condition. Conclusions: It is important for dental surgeons to study and be aware of these rare changes to be able to establish an accurate diagnosis. On the other hand, clinical management should be broadened through individualized and/or family planning, paying attention not only to esthetic and functional aspects, but psychological and social as well(AU)

Clinical-pathological aspects of oral lymphoepithelial cyst: case report / Aspectos clinicopatológicos de cisto linfoepitelial oral: relato de caso

ABSTRACT Oral lymphoepithelial cyst (OLEC) is an uncommon lesion whose pathogenesis remains poorly understood. The purpose of this paper is to report a case of OLEC. Female patient, white, 62 years old, presented asymptomatic nodular swelling of soft consistency in the lateral border of the tongue. Under the clinical hypothesis of lymphoid tissue hyperplasia, an excisional biopsy was performed. Histopathological examination revealed a pathological epithelial-lined cavity and a cystic connective tissue capsule containing lymphoid tissue. The diagnosis of OLEC was established and the patient showed no signs of recurrence after surgical removal of the lesion.

RESUMEN El quiste linfoepitelial (QLE) oral es una lesión infrecuente, cuya patogénesis es aún poco conocida. El objetivo del presente estudio es reportar un caso de QLE oral. Mujer blanca de 62 años presentó un crecimiento nodular asintomático de consistencia blanda, en borde lateral de la lengua. Bajo la hipótesis clínica de hiperplasia del tejido linfoide, se realizó una biopsia excisional. El examen histopatológico reveló cavidad patológica revestida de epitelio y una cápsula quística de tejido conectivo, conteniendo tejido linfoide. Se estableció el diagnóstico de QLE oral. La paciente no ha presentado recidiva tras extirpación quirúrgica de la lesión.

RESUMO O cisto linfoepitelial oral (CLEO) é uma lesão incomum, cuja patogênese ainda é pouco elucidada. O objetivo deste estudo é relatar um caso de CLEO. Paciente do sexo feminino, leucoderma, 62 anos, apresentou aumento de volume nodular assintomático de consistência amolecida, em borda lateral da língua. Sob a hipótese clínica de hiperplasia de tecido linfoide, biópsia excisional foi realizada. O exame histopatológico revelou cavidade patológica revestida por epitélio e uma cápsula cística de tecido conjuntivo, contendo tecido linfoide. O diagnóstico de CLEO foi estabelecido. A paciente não apresentou sinais de recidiva após a remoção cirúrgica da lesão.

Gardner syndrome imaging features in plain radiographs and computed tomography: a case report / Síndrome de Gardner: Características imaginológicas por meio da radiografia convencional e tomografia computedorizada

Gardner syndrome (GS) is a genetic disease with high penetration characterized by a signal triad of colonic polyposis, multiple osteomas and mesenchymal tumors in the soft tissues and skin. The colonic polyposis is associated to the development of malignant disease. Patients may also present maxillomandibular alterations such as impacted teeth, supernumerary teeth, congenital missing teeth and odontomas. Bone lesions and maxillomandibular alterations usually precedes the gastrointestinal alterations; hence dentists should be aware of GS syndrome main radiographic signals, in order to detect the disease and proper referred the patient to medical treatment and surveillance. Thus, in this report, it is described a case of GS in a male patient, as well as discussed GS features.(AU)

A síndrome de Gardner (GS) é uma doença genética caracterizada pela seguinte tríade: polipose colônica, múltiplos osteomas e tumores mesenquimais em tecidos moles e pele. A polipose colônica está associada ao desenvolvimento de tumores malignos. Os pacientes também podem apresentar alterações maxilomandibulares, como dentes impactados, dentes supranumerários, agenesia congênita e odontomas. Lesões ósseas e alterações maxilomandibulares geralmente precedem as alterações gastrointestinais; portanto, os dentistas devem estar cientes dos principais sinais imaginológicos da GS, a fim de detectar a doença e encaminhar adequadamente o paciente para tratamento. Neste relato de caso é descrito um caso de GS em um paciente do gênero masculino, além de discutir as características da GS.(AU)

Manifestações bucais da epidermólise bolhosa: relato de caso / Oral manifestations of epidermolysis bullosa: case report

Introdução: a epidermólise bolhosa é uma doença genética rara, que causa a formação de bolhas na pele e na mucosa, por conta de trauma e calor excessivo. Diversas alterações bucais são observadas nesse perfil de indivíduos, como cárie e gengivite devido à dificuldade de higienização. Além disso, devido ao rompimento das bolhas em mucosa, observa-se a formação de úlceras que, ao cicatrizar, podem levar à microstomia, à perda do vestíbulo e à anquiloglossia. Por conta dessas alterações em mucosa bucal, é importante a presença do cirurgião dentista no cuidado desses pacientes, realizando orientações de higiene, assim como tratamento curativo. Objetivo: relatar o caso de uma paciente com diagnóstico de epidermólise bolhosa distrófica recessiva, descrever suas manifestações clínicas bucais e o manejo odontológico. Metodologia: trata-se de um relato de caso de paciente do sexo feminino, com 5 anos de idade, com diagnóstico de epidermólise bolhosa distrófica recessiva. Ao exame clínico, observou-se microstomia, múltiplas lesões ulceradas, gengivite e cáries extensas em diversas unidades dentárias. Foi realizado tratamento das lesões bucais com aplicação de fotobiomodulação a laser, orientações de higiene bucal, profilaxia e controle de biofilme, fluorterapia, além de tratamento das lesões cariosas. Conclusão: o cirurgião dentista tem papel fundamental na equipe multidisciplinar, a fim de promover a saúde bucal desses indivíduos e, consequentemente, melhorar sua qualidade de vida.

Introduction: bullous epidermolysis is a rare genetic disease that causes blisters to form on the skin and mucosa due to trauma and excessive heat. Several oral changes are observed in this profile of individuals, such as caries and gingivitis due to the difficulty of hygiene. In addition, due to the rupture of mucosal blisters, ulcers are formed, which, when healing, can lead to microstomy, loss of the vestibule and ankyloglossia. Because of these changes in the oral mucosa, the presence of the dentist in the care of these patients performing hygiene guidelines, as well as curative treatment is important. Objective: to report a case of a patient diagnosed with recessive dystrophic bullous epidermolysis, to describe her oral clinical manifestations and dental management. Methodology: female patient, 5 years old, diagnosed with recessive dystrophic bullous epidermolysis. Clinical examination revealed microstomy, multiple ulcerated lesions, gingivitis and extensive caries in several dental units. Oral lesions were treated with laser photobiomodulation, oral hygiene guidelines, prophylaxis and control of biofilm, fluorotherapy, and carious lesions treatment. Conclusion: the dental surgeon plays a fundamental role in the multidisciplinary team, in order to promote oral health in these individuals and consequently improving their quality of life.