Mucosal vitiligo in angles of the mouth: clinical and fluorescence aspects

SUMMARY Vitiligo is the most common depigmenting, chronic acquired disease of the skin and mucosa. However, vitiligo of an unclassified type and mucosal subtype affecting only one area of the mucosa is considered quite uncommon. The diagnosis of vitiligo, regardless of its type, is clinical. Nonetheless, a device that allows the visualization of the tissue fluorescence may be useful for confirming the diagnosis. We present the use of wide-field optical fluorescence device for complementary examination and diagnosis of unusual cases of mucosal vitiligo located only in angles of the mouth.

RESUMO O vitiligo é a doença crônica adquirida despigmentante mais comum da pele e/ou da mucosa. Entretanto, o vitiligo do tipo não classificado e subtipo de mucosa afetando apenas uma área da mucosa é considerado bastante incomum. O diagnóstico de vitiligo, independentemente do seu tipo, é clínico. No entanto, o uso de um dispositivo que permite a visualização da fluorescência tecidual pode ser útil para a confirmação do diagnóstico de vitiligo. Apresentamos o uso do dispositivo de exame complementar de fluorescência óptica de campo amplo para o diagnóstico de um caso incomum de vitiligo de mucosa localizado apenas em ângulos da boca.

Evaluation of the extent of interstitial fibrosis in oral squamous cell carcinoma compared with normal oral mucosa and oral epithelial dysplasia

Objective: to evaluate the extent of interstitial fibrosis in samples of normal oral mucosa (NOM), oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). Materials and method: descriptive study. eighteen samples of NOM, 15 samples of OED, and 13 samples of OSCC were analyzed; all stained with Masson's trichrome stain. the areas of greatest fibrosis underlying the normal, dysplastic, and malignant neoplastic oral epithelium were identified in order to determine the extent of interstitial fibrosis. interstitial fibrosis was classified according to its proportion in the total image, being 0 (without fibrosis), +1 (1-25 percent), 2+ (26-50 percent), 3+ (51-75 percent) and +4 (76-100 percent). variables were analyzed using the Kruskal-Wallis test and Dunn's Pairwise post-hoc test. Results: the samples of NOM and OED did not present interstitial fibrosis (type 0) in the majority of the cases respectively. OSCC samples were characterized by an extension of type 2+ interstitial fibrosis in 45 percent of all cases of OSCC. the extent of interstitial fibrosis was different between NOM and OSCC (p<0.001), and between OED and OSCC (p<0.001). Conclusion: the extent of interstitial fibrosis is directly proportional to the malignization of the analyzed samples, being an adequate marker for OSCC.

Uso de métodos não invasivos para avaliação da espessura muco-gengival: a tecnologia a favor do diagnóstico / Use of non-invasive methods to evaluate muco-gingival thickness: the technology in favor of diagnosis

O objetivo no presente estudo foi realizar uma revisão atualizada da literatura sobre os diferentes métodos não invasivos utilizados para avaliação da espessura muco-gengival. O biotipo gengival é considerado um dos principais elementos de influência no resultado do tratamento estético. Pacientes com gengiva espessa demonstram ser mais resistentes à recessão gengival após terapia cirúrgica e/ou restauradora. Em contrapartida, pacientes com biotipo fino apresentam maior risco de recessão, sendo necessário, muitas vezes, o enxerto de tecido conjuntivo. O palato é a principal área doadora para enxerto de tecido conjuntivo subepitelial, sendo que a determinação da espessura da mucosa palatina é de grande importância para a previsibilidade dos procedimentos cirúrgicos. Existem diversos métodos para mensurar a espessura muco-gengival, alguns considerados invasivos, como: a avaliação transgengival (ou transmucosa); e outros, mais recentes, considerados não invasivos, como as imagens seccionais de ultrassom, tomografias computadorizadas ou imagens de ressonância magnética. Apesar de diversos estudos demonstrarem resultados positivos do uso de exames por imagens para avaliação da espessura dos tecidos muco-gengivais, concluiu-se que os métodos invasivos ainda parecem ser os mais utilizados.

The aim of the present study was to carry out an updated review of the literature on the different non-invasive methods used to evaluate muco-gingival thickness. The gingival biotype is considered one of the main influential elements in the result of the aesthetic treatment. Patients with thick gingiva demonstrate to be more resistant to gingival recession after surgical and/or restorative therapy. On the other hand, patients with fine biotype are at greater risk of recession, often requiring the grafting of connective tissue. The palate is the main donor area for subepithelial connective tissue graft, and the determination of the thickness of the palatal mucosa is of great importance for the predictability of surgical procedures. There are several methods to measure muco-gingival thickness, some considered invasive, such as: transgingival (or transmucosal) evaluation; and others, more recent, considered noninvasive, such as sectional images of ultrasound, computed tomography or magnetic resonance imaging. Although several studies show the positive results of the use of images in the assessment of thickness of mucogingival tissues, invasive methods still appear to be the most used.

As principais lesões enegrecidas da cavidade oral / Las principales lesiones ennegrecidas en cavidad oral / Main blackened lesions of the oral cavity

Introdução: as lesões pigmentadas podem ser encontradas na cavidade oral, essas pigmentações são provenientes de diversos fatores, tais como, locais, sistêmicos, fisiológicos ou patológicos. A cor, localização, distribuição e duração são características essenciais para o diagnóstico destas lesões, não devendo- se negligenciar a história médica, odontológica e familiar, bem como o consumo de drogas. Apesar de algumas lesões apresentarem características bastante específicas que as confere um diagnóstico apenas através do exame clínico, é importante que o profissional lance mão de métodos adicionais, como biópsias e exames laboratoriais, afim de alcançar um diagnóstico confiável e consequentemente, executar o tratamento adequado. Objetivos: essa revisão de literatura tem como objetivo discorrer sobre as principais lesões orais enegrecidas da cavidade oral, enfatizando o diagnóstico diferencial para cada uma delas, já que tal abordagem implicará diretamente na conduta profissional e no estabelecimento do tratamento adequado para cada paciente. Métodos: para isso foi realizada uma revisão de literatura através da busca de artigos no PubMED/Medline, Lilacs e Scielo. Resultados: a literatura estudada destacou que as lesões pigmentadas orais e maxilofaciais podem clinicamente simular o melanoma, uma lesão maligna. Conclusões: devemos ter especial atenção durante o exame clínico deste tipo de ocorrência, saber questionar o paciente para obter informações importantes a respeito da lesão, ter conhecimento dos diferentes tipos de lesões pigmentadas que acometem a cavidade oral e face, assim como ter em mente a necessidade do exame histopatológico para se obter o diagnóstico definitivo de lesões pigmentadas suspeitas(AU)

Introducción: las lesiones pigmentadas que se encuentran en la cavidad bucal pueden provenir de diversos lugares, tales como de la localidad, sistémicas, fisiológicas o patológicas. El color, la localización, la distribución y la evolución clínica son características esenciales para el diagnóstico de estas, sin pasar por alto la historia médica, la odontológica o familiar, y sin menospreciar el consumo o no de drogas. A pesar de que algunas lesiones presentan características bastante específicas que permiten establecer un diagnóstico acertado con solo un examen clínico, es importante que el profesional tenga en cuenta métodos adicionales, como biopsias y exámenes de laboratorio, con la finalidad de obtener un diagnóstico confiable y consecuentemente ejecutar un tratamiento adecuado. Objetivos: en esta revisión bibliográfica se pretende describir las principales lesiones orales pigmentadas en cavidad bucal, enfatizando el diagnóstico diferencial para cada una de ellas, ya que tal abordaje de ellas recae directamente en la conducta del profesional, asi como también el plan de tratamiento adecuado para cada caso. Métodos: se realizó una revisión de la literatura a través de los buscadores PubMed/Medline, Lilacs y Scielo. Resultados: en esta revisión se destaca que las lesiones pigmentadas bucales y maxilofaciales pueden simular clínicamente un melanoma o una lesión maligna. Conclusiones: se debe tener especial cuidado durante el examen clínico en este tipo de lesiones, saber cómo interrogar al paciente para obtener información contundente con respecto al caso estudiado, tener conocimiento de los diferentes tipos de lesiones pigmentadas que podrían encontrarse en la cavidad bucal y en la cara, así como también la necesidad de un examen histopatológico para poder obtener un diagnóstico definitivo preciso en estas lesiones pigmentadas sospechosas(AU)

Introduction: pigmented lesions of the oral cavity may be due to local, systemic, physiological or pathological factors. Diagnosis of these lesions is largely based on their color, location, distribution and clinical evolution, alongside other characteristics, such as medical, dental or family antecedents and drug use. Despite the fact that some lesions exhibit rather specific features allowing accurate diagnosis in just one clinical examination, other procedures should also be performed, such as biopsies and laboratory tests, to reach a reliable diagnosis and apply the appropriate treatment. Objectives: the present bibliographic review is aimed at describing the main pigmented lesions of the oral cavity with emphasis on their differential diagnosis, an important element in their clinical management and treatment. Methods: abibliographic review was conducted in databases PubMed/Medline, Lilacs and Scielo. Results: the review revealed that oral and maxillofacial pigmented lesions may clinically simulate a melanoma or malignant lesion. Conclusions: special attention should be paid to these lesions during clinical examination. Appropriate questions should be asked of patients in order to obtain relevant information about the case under study, acquire knowledge about the different types of oral and facial pigmented lesions, and determine the need for histological examination to reach an accurate final diagnosis(AU)

Analysis of micronuclei in buccal epithelial cells in patients subjected to panoramic radiography.

Context: Ionizing radiation is a well-known carcinogen in humans. Chromosomal aberrations and formation of micronuclei in cell cytoplasm are early biological evidence of carcinogenesis. Aims: This study was undertaken to assess the genotoxic effect of panoramic radiography in the buccal epithelial cells. Materials and Methods: The study included 60 healthy individuals (median age 23.5 years; age range 12-65 years) who underwent panoramic radiographic examination. Exfoliated buccal epithelial cells were obtained immediately before and 10 days after radiation exposure. The cells were stained with Giemsa and evaluated for micronuclei by scoring 1000 cells per sample. Statistical analysis used: The paired 't ' test was used to find out the significance of difference in the number of micronuclei before and after x-ray exposure. The Karl Pearson correlation coefficient was used to find out the correlation between age and micronucleated cell frequencies and number of micronucleus per 1000 cells. The ANOVA test was used to find out if there were significant differences in micronucleated cell frequencies between different age-groups. Student's unpaired 't' test was used to find out the significance of difference in micronucleated cell frequencies and number of micronucleus per 1000 cells between genders. Results: The paired 't' test showed that micronucleated cell frequencies (P = 0.02) and number of micronucleus per 1000 cells (P = 0.047) were significantly higher after radiographic exposure. The mean number of micronucleated cells before and after radiation exposure were 0.48 ± 0.14 and 0.51 ± 0.15, respectively. There was statistically significant increase in the frequency of micronuclei in buccal epithelial cells after exposure to panoramic radiography. The correlation of micronucleus frequency with age and gender was statistically nonsignificant. Conclusions: The results indicate that panoramic radiography may induce genotoxic effects in buccal epithelial cells. Considering this risk, panoramic radiography should be used cautiously.

Ultrasonographic evaluation of inflammatory swellings of buccal space.

Objectives : The main objective of the study was a) to differentiate cellulitis and abscess in buccal space region, b) to study the ultrasonographic anatomy of cheek region and c) to investigate the use of ultrasound in the diagnosis of inflammatory swellings of cheek region. Patients and Methods : The study consisted of 25 patients with unilateral buccal space inflammatory swellings of odontogenic origin. The contra lateral side was used as control. Toshiba ultrasonographic device with a linear array transducer (5-8 MHz) was used. The areas of interest were scanned under both transverse and longitudinal sections and were interpreted by a single observer. The clinical diagnosis of cellulitis or abscess was confirmed by the absence or presence of pus respectively both sonographically and by aspiration. Also various anatomical structures present in buccal space were studied. Results : Clinically 23(92%) were diagnosed as buccal space abscess and 2 (8%) were cellulitis. Ultrasonographically and therapeutically 24 (96%) were buccal space abscess and 1 (4%) was cellulits. The sensitivity of clinical criteria over ultrasonographic diagnosis was 96% with a specificity of 100%. Also the cheek thickness in males and females varied from 8.2 to 17.1mm with a mean of 11.6mm±2.1 (SD) and 8.2 mm to 14.2 mm with a mean of 11±1.8 (SD). The subcutaneous tissue appeared moderately echogenic, buccinator - highly echogenic, deep adipose tissue - less echogenic and parotid duct was appreciated as a thin hyperechogenic band crossing the buccinator muscle. Buccal space, masticator space and parotid space were appreciated. Conclusion : This study supports the ultrasonographic method of imaging of orofacial inflammatory swellings with high sensitivity and specificity. This imaging modality can also help in aspiration of pus in different spaces. We have described the ultrasonographic anatomy of the above mentioned spaces which can help a beginner in this field.