Influência da via hippo em carcinomas de células escamosas de língua oral / Influence of the hippo pathway on oral tongue squamous cell carcinomas

O carcinoma de células escamosas de língua oral (CCELO) apresenta altas taxas de morbidade e mortalidade. Apesar dos progressos alcançados nesta área, os pesquisadores continuam em busca de biomarcadores moleculares que tenham valor preditivo no prognóstico dos pacientes e que possibilitem o desenvolvimento de novas estratégias terapêuticas. Neste contexto, várias pesquisas têm destacado o papel da via Hippo com esta finalidade. Portanto, esta pesquisa teve como objetivo avaliar se as proteínas relacionadas à Via Hippo, LATS2 e YAP1, exercem alguma influência sobre o comportamento biológico dos CCELOs. A amostra foi constituída por 26 casos de CCELO e 8 casos de mucosa oral normal como controle. Para avaliar a morfologia dos CCELOs foram utilizadas as gradações propostas pela OMS (2005) e por Almangush et al. (2014). O perfil imunoistoquímico de LATS2 e YAP1 foi avaliado por escores (0-3), com base na sua imunoexpressão em localização intracelular (núcleo e/ou citoplasma) e distribuição epitelial. Para a análise entre os parâmetros estudados foram realizados os testes estatísticos Qui-quadrado de Pearson e Exato de Fisher. A análise de sobrevida foi realizada através do método de Kaplan Meier e do teste log-rank. Para todas as avaliações foram considerados valores significativos com p<0,05. Foi observada alta expressão da LATS2 tanto em mucosa oral normal (100%) quanto na maioria dos CCELOs (73,1%), sem diferença estatística significativa (p=0,160). Foi possível evidenciar o aumento da imunoexpressão da YAP nos casos de CCELO em comparação à mucosa oral normal (p<0,001). Verificou-se ainda que a baixa expressão da LATS2 foi associada com menores taxas de sobrevida livre da doença (p=0,039). Além disso, constatou-se que a elevada expressão da YAP foi associada à classificação de alto risco do modelo BD (p=0,034), sugerindo que a imunoexpressão desta proteína pode estar associada a TEM e invasão celular em CCELO. A elevada expressão de ambas as proteínas, na maioria dos CCELOs, sugere que outras vias de sinalização, além da regulação através da LATS2, podem estar induzindo a expressão nuclear de YAP nestes tumores. Portanto, conclui-se que a via Hippo pode influenciar o comportamento biológico dos CCELOs (AU).

Oral tongue squamous cell carcinoma (OTSCC) has high morbidity and mortality rates. Despite the progress made in this area, researchers continue to search for molecular biomarkers that have predictive value in the prognosis of patients and allow the development of new therapeutic strategies. In this context, several studies have highlighted the role of the Hippo pathway for this purpose. Therefore, this research aimed to evaluate whether the proteins related to the Hippo pathway, LATS2 and YAP1, have some influence on the OTSCC biological behavior. The sample consisted of 26 OTSCC cases and 8 normal oral mucosa cases as control. For the morphological assessment of OTSCC, the gradations proposed by the WHO (2005) and by Almangush et al. (2014) were performed. The immunohistochemical profile of LATS2 and YAP1 was evaluated by scores (0-3), based on their immunoexpression in intracellular location (nucleus and/or cytoplasm) and epithelial distribution. Pearson's Chi-square and Fisher's Exact statistical tests were performed for the analysis of the studied parameters. Survival analysis was performed using the Kaplan-Meier method and the log-rank test. For all evaluations, values with p<0.05 were considered significant. High expression of LATS2 was observed both in normal oral mucosa (100%) and in most OTSCC (73,1%), with no statistically significant difference (p=0,160). It was possible to observe the increase in YAP immunoexpression in cases of OTSCC compared to the normal oral mucosa (p<0.001). It was also found that the LATS2 low expression was associated with lower rates of disease-free survival (p=0.039). Furthermore, YAP high expression was found associated with the BD model's high-risk classification (p=0.034), suggesting this protein immunoexpression may be associated with EMT and cell invasion in OTSCC. The high expression of both proteins in most OTSCC suggests that other signaling pathways, in addition to regulating through LATS2, may be inducing the nuclear YAP expression in these tumors. Therefore, it is concluded that the Hippo pathway can influence the OTSCC biological behavior (AU).

Hemangioma capilar lobular: granuloma piógeno en lengua / Lobular capillary hemangioma: pyogenic granuloma of tongue

El granuloma piógeno es una lesión benigna, reactiva y multifactorial que resulta de le- siones repetitivas, microtraumatismos e irritación local en piel o mucosas y cambio hormonal. Cuando aparece en la cavidad oral tiene predilección por la encía vestibular, pero es importante que el odontólogo esté consciente y familiarizado con el hecho de que puede estar localizado en otras áreas anatómicas. Clínicamente se presenta como lesión hiperplásica altamente vascularizada, de tamaño generalmente no mayor a 2 cm, pediculada en la base o sésil y de lento crecimiento. Sin mostrar preferencia por edad o sexo, tiende a aparecer principalmente en encías, labios y mucosa oral, siendo muy pocos los casos reportados en el área lingual. Es por ello que, en este artículo, nos referimos a un caso de ubicación inusual, en conjunto con una revisión de la literatura (AU)

Pyogenic granuloma is a benign, reactive, and multifactorial lesion caused by repetitive injuries, microtrauma and local irritation on the skin or mucous membranes, and hormonal change. When it appears in the oral cavity, it has a predilection for the vestibular gingiva, but the dentist must be aware and familiar with the fact that it can be present in other anatomi- cal areas. Clinically, it is presented as a hyperplasic injury highly vascular-related, with a size generally no bigger than 2 cm, pedunculated in base or sessile, and slow in growth. Without showing any preference in age or gender, it tends to appear mainly on the gums, lips, and oral mucosae, with very few, reported cases in the lingual area. Therefore, in this study, we refer to a case of unusual localization with a literature review (AU)

Linfangioma cavernoso de la lengua / Cavernous lymphangioma of the tongue

Los linfangiomas son malformaciones congénitas de los vasos linfáticos. Son raros en la cavidad oral y cuando se presentan en la misma pueden provocar trastornos funcionales del sistema estomatognático. El objetivo es presentar un caso de linfangioma cavernoso del dorso de la lengua, revisando los aspectos clínicos y de tratamiento de la enfermedad, con énfasis en la ubicación en la cavidad oral, fundamentalmente en la lengua. Un paciente de 17 años de edad se presenta con una lesión en el dorso de la lengua de aproximadamente 10 años de evolución. La lesión tiene una apariencia pedregosa y una base sésil, y mide aproximadamente 3 cm. El paciente es sometido a escisión quirúrgica de la lesión, sin intercurrencias. Actualmente el paciente se encuentra en seguimiento, sin signos clínicos de recidiva del tumor después de 2 años de tratamiento. La escisión quirúrgica de la lesión parece ser el tratamiento más apropiado para los linfangiomas de la lengua, con bajas tasas de recidiva(AU)

Lymphangiomas are congenital malformations of the lymphatic vessels. They are rare in the oral cavity and when present in this area they may cause functional disturbances of the stomatognathic system. The objective is to report a case of cavernous lymphangioma of the dorsum of the tongue, reviewing the clinical and treatment features of the disease, with emphasis on the oral cavity location, mainly the tongue. A 17-year-old male patient presented with a lesion on dorsum of his tongue of approximately 10 years of evolution. The lesion had a pebbly appearance and a sessile base, and measured about 3 cm. The patient was submitted to surgical excision of the lesion, without any intercurrences. Currently, the patient is under clinical follow-up, without any clinical sign of tumor recurrence after 2 years of treatment. Surgical excision of the lesion seems to be the most adequate treatment for tongue lymphangiomas, with low rates of recurrence(AU)

Granuloma piogênico associado à gravidez / Pyogenic granuloma associated with pregnancy ­ case report

O granuloma piogênico ­ ou granuloma gravídico ­ é uma hiperplasia reativa do tecido conjuntivo, em resposta a irritantes locais. Na boca, é comum na gengiva; todavia, pode acometer a língua e as mucosas palatina e jugal. O presente relato de caso é de uma paciente de 13 anos que, em seu sétimo mês de gestação, se apresentou com uma lesão avermelhada, de superfície lisa, consistência endurecida à palpação, base pediculada e indolor na superfície anterior da língua. Foi realizada biopsia excisional, com prognóstico favorável, e a mesma se encontra em acompanhamento.

The pyogenic granuloma ­ or pregnancy tumor ­ is a reactive connective tissue hyperplasia in response to local irritants. Although being common in the gingival tissues, it can affects the tongue and palatal mucosa. This case reports a 13 years-old female in her seventh month of pregnancy, who presented a reddish lesion with a smooth surface, hard consistency on palpation, pedicled base and painless on the anterior surface of the tongue. Excisional biopsy has done with a favorable prognosis and the patient is being following has been followed-up.

Distribution of traumatic injuries after the installation of complete dentures in adult patients

Aim Describe the location of traumatic lesions of the oral mucosa that develop after the installation of complete dentures, as well as to quantify the number of post-operative controls that are required. A descriptive study was conducted by examining 84 patients who attended the dental center of Universidad de Los Andes, San Bernardo, during the period from July 2012 to July 2013. A sample of 120 edentulous patients was obtained. After the fabrication and installation of the complete dentures, at least 3 post-operative controls were performed and the location of oral lesions was recorded. Documentation of the association between the patient's clinical variables and the appearance of oral lesions during the first 3 controls was performed using a logistic regression. Results For maxillary dentures, 5 post-operative visits were made and 6 controls for mandible dentures. In the upper jaw the anatomical areas of higher incidence of traumatic injuries were: canine fossa (23.9%), average bridle (23.1%), and distobuccal sulcus (20.1%). In the lower jaw, the highest number of lesions were recorded on the anterior lingual flank (16.5%), anterior and posterior lingual flank (13.4%), and distobuccal sulcus (12.8%). A significant association was observed between subjects who reported consumption of cholesterol-lowering medications and the development of traumatic lesions of the oral mucosa (OR: 0.25 and 95% CI: 0.055-0.939). The installation of complete dentures does not determine that the treatment has ended. Post-operative controls are needed to assess areas of erythema and ulceration.

Objetivo Describir la ubicación y frecuencia de las lesiones traumáticas de la mucosa oral que se generan después de la instalación de las prótesis dentales completas, y cuantificar el número de controles postoperatorios necesarios. Se realizó un estudio descriptivo, examinando a 84 pacientes que asistieron al centro dental de la Universidad de Los Andes, durante el período comprendido entre de julio de 2012 y julio del de 2013. Se obtuvo una muestra de 120 pacientes edéntulos. Después de la fabricación e instalación de las dentaduras completas se realizaron por lo menos 3 controles postoperatorios y la localización de las lesiones orales fue registrada. La documentación de la asociación entre las variables clínicas de los pacientes y la aparición de lesiones orales durante los 3 primeros controles fue realizado por medio de una regresión logística. Resultados Para prótesis maxilar 5 visitas de controles postoperatorios fueron realizados y 6 para mandibulares. En el maxilar superior las zonas de mayor incidencia de lesiones traumáticas fueron: fosa canina (23,9%), flanco medio (23,1%) y distovestibular del surco (20,1%). En la mandíbula se registraron mayor frecuencia de las lesiones en el flanco lingual anterior (16,5%), anterior y posterior (13,4%) y distovestibular del surco (12,8%). Una asociación significativa se observó entre los sujetos que reportaron consumo de medicamentos reductores del colesterol y el desarrollo de las lesiones traumáticas de la mucosa oral (o: 0,25 e IC: 0,055-0,939). La instalación de las prótesis dentales completas no determina que el tratamiento haya terminado. Los controles postoperatorios son necesarios para evaluar las áreas de eritema y ulceración.

Human papilloma virus in oral mucosa and its association with periodontal status of gynecologically infected women

El objetivo del estudio fue identificar la presencia del virus Papiloma Humano en lengua y periodonto de mujeres sanas y enfermas periodontales con lesiones genitales del mismo. Se evaluarontreinta mujeres, no menopáusicas, de entre 18 y 50 años de edad, derivadas del Servicio de Ginecología del Hospital Universitario Materno Neonatal de la ciudad de Córdoba, sistémicamentesanas y con diagnóstico gineco lógico de lesiones por HPV. Se realizó, anamnesis, inspec ción de mucosas bucales, examen clínico periodontal y la toma de tres escobillados por paciente, dos de un mismo sitio periodontal (epitelio externo de encía y epitelio interno del surco/bolsa periodontal) y el otro de lengua. Las 90 muestras obtenidas fueron sometidas a estudios citológicos de Papanicolau y a estudios moleculares de amplificación de ácidos nucleicos por Reacción en Cadena de la Polimerasa. Los datos fueron agrupados y analizados por el “Test Chi Cuadrado” (χ2)y el “Índice de Kappa” (κ). Fue demostrada la alta prevalencia de la presencia del virus papiloma tanto en lengua (30 por ciento), como en tejidos periodontales (15 por ciento). El genotipo -16 de alto riesgo (HR) fue identificado en mayores porcentajes (67 por ciento) encontrando, también, el genotipo -52 y el -6. Siempre que el HPV estuvo presente en los sitios periodontales fue detectado, también, en la lengua de las mismas pacientes, de las cuáles el 88,89 por ciento practicabasexo oral. Se destaca el hallazgo clínico de lesiones estomatológicas compatibles con papilitis foliada en las pacientes HPVintrabucales positivas. Se señala en la población femenina de Córdoba, Argentina, la alta prevalencia de la presencia de HPV donde el genotipo -16 fue detectado en mayor porcentaje. En lamuestra analizada No fueron positivamente correlacionados lapresencia de HPV y la mayor incidencia y severidad de lesiones periodontales...

Doença de Riga-Fede: relato de dois casos - um conservador e outro radical / Riga-Fede disease: double case report - a conservative and other radical

A lesão de Riga-Fede é uma ulceração traumática na superfície ventral da língua comumente associada a dentes natais ou neonatais. Esta lesão pode resultar em uma inadequada sucção do leite e alimentação, colocando o recém-nascido em risco de deficiências nutricionais. Nestas circunstâncias, intervenções dentais devem ser feitas com tratamento conservador (suavização da borda incisal) ou radical (exodontia). A decisão pelo tratamento radical é feita na presença de debilidade nutricional causada pela dificuldade de amamentação, em casos de mobilidade dentária avançada, rizogênese em estado inicial e diante de lesões com maiores extensões. O atual trabalho visa discutir dois casos com diferentes tratamentos, um conservador em que o paciente apresentava 28 dias de vida, discreto comprometimento na alimentação e não estava perdendo peso; e outro radical, em que o paciente apresentava 6 dias de vida dificuldade na alimentação e perda de peso

Riga-Fede disease is a traumatic ulceration on the ventral region of the tongue, usually associated with natal or neonatal teeth. This lesion can result in an inappropriate milk suction and feeding, leading the newborn in risk of inadequate nutrients intake. Under this circurnstances, dental intervention must be done as a conservative treatment (smoothening off the incisors edges) or radical (extraction). Oecision for the radical treatment is taken due the pre sence of nutritional deficiency by breastfeeding difficulty, in cases of advanced dental mobility teeth with initial rhizogenesis and larger lesions. The main objective of the present study is discuss two cases with different treatments, a conservative over a patient with 28 days of life quiet deficiency feeding and no weight 1055. And other radical, on a 6 days life patient with inappropriate feeding and and weight loss

Successful intubation with air-Q in Pierre Robin syndrome

Airway access is particularly difficult in infants and children with some anatomical deformities, usually associated with congenital syndromes. Craniofacial abnormalities are commonly seen in the Pierre Robin Syndrome [PRS], Treacher Collins and Goldenhar syndromes. The Pierre Robin sequence consists of micrognathia and relative macroglossia with or without cleft palate. In the severe case, airway obstruction and feeding difficulties are present. Endotracheal intubation may be difficult, or in some case even impossible. We present a case report of intubation of a child, suffering from PRS, by using air-Q, a new intubating LMA, and use of tongue stitches to maintain airway during recovery

Piercing y lesiones bucodentales / Piercing and oral and perioral lesions

La instalación de piercing oral y perioral aumentó su popularidad en los años recientes, sobre todo en la población adulta joven. En este trabajo se analizan los riesgos, complicaciones y contraindicaciones de esos aditamentos. También se consideran las lesiones de tejidos duros y blandos de la boca producidas por los piercings

Sublingual traumatic ulcerative lesions caused by the eruption of first primary mandibular molars: a case report / Lesión ulcerativa traumática sublingual causada por la erupción del primer molar temporal: reporte de un caso

Traumatic ulceration of the ventral surface of the tongue is an uncommon condition in infants and toddlers, which is often associated with natal and neonatal teeth in newborns. The aim of this report is to present a case of bilateral ulcerative ulcers on the ventral surface of the tongue caused by the eruption of first primary mandibular molars in a 14-month-old male child. The child was able to point to the lesions and also refused to consume certain beverages and foods, which favored an early diagnosis. Clinical treatment consisted of manual smoothing of the sharp edges of both mandibular first molars and a home regimen of lidocaine hydrochloride solution (Xylocaine®, Astra) and a steroid solution of triamcinolone acetonide (Omcilon ­ A, Brystol-Myers) for symptoms relief and lesion healing, respectively. Complete healing of both lesions and normal feeding were both observed at a one-week follow-up exam. Early detection of the lesions and parental compliance with recommended home regimens were key factors for a successful treatment outcome, since untreated cases of tongue ulcerative lesions may evoke feeding difficulties and failure to thrive. Although there are several reports of ulcerative lesions on the tongue caused by dental eruption, they are usually associated with the eruption of mandibular primary incisors (Riga-Fede disease). However, there are no reports of ulcerative lesions caused by other primary teeth.

La ulceración traumática de la superficie ventral de la lengua es una condición poco común en bebés y niños pequeños, la cual se asocia a menudo con los dientes natales y neonatales en los recién nacidos. El objetivo de este reporte es presentar un caso de úlceras bilaterales en la superficie ventral de la lengua causada por la erupción de los primeros molares mandibulares temporales en un infante de sexo masculino de 14 meses de edad. En niño fue capaz de señalar las lesiones y se negó a consumir ciertas bebidas y alimentos, lo que favoreció un diagnóstico precoz. El tratamiento clínico consistió en el suavizado manual de los bordes afilados de los primeros molares inferiores y un régimen casero de solución de clorhidrato de lidocaína (Xilocaína®, Astra) junto a la solución esteroidal de acetónido de triamcinolona (Omcilon - A, Brystol-Myers) para el alivio de los síntomas y curación de la lesión respectivamente. La curación completa de ambas lesiones y la alimentación normal se observó en una semana del control de seguimiento. La detección temprana de las lesiones y el cumplimiento de los padres con los regímenes caseros recomendados, son factores claves para un resultado exitoso del tratamiento, ya que los casos no tratados de estas lesiones ulcerosas pueden provocar dificultades en la alimentación y una evolución inadecuada. Aunque existen varios informes de lesiones ulcerosas en la lengua causada por la erupción dental, que se asocian generalmente con la erupción de los incisivos mandibulares temporales (enfermedad de Riga-Fede). Sin embargo, no existen informes de lesiones ulcerosas causadas por otros dientes temporales.

Piercings bucales y peribucales: ¿qué debemos saber? / Oral and perioral piercings: what must we know about it?

El término piercing significa "penetrante" y corresponde a la perforación de los tejidos blandos en cualquier parte del cuerpo. Es una costumbre que se emplea desde la antiguedad. En la actualidad es una tendencia que va en aumento debido a su gran aceptación social, particularmente en los jóvenes. En este trabajo se describen los distintos tipos de piercing bucales y peribucales, sus posibles localizaciones y las complicaciones derivadas de su uso. También las contraindicaciones, las recomendaciones y los cuidados de la zona de perforación.

Ligature of external carotid artery as an optional technique in a patient with von Willebrand disease

The von Willebrand disease (vWD) is a hereditary coagulopathy. There is no gender predilection. Clinically characterized by mucocutaneous bleeding, especially nose bleeding, menorrhagia and bleeding after trauma. This article reports a case of a 52-year-old Caucasian male patient with vWD, who presented with extensive bleeding in the tongue after a lacerating injury caused by accidental biting, and describes some clinical, pathological and treatment aspects of vWD. After repeated attempts to suture the wound and replace clotting factors, a decision was made to perform the ligature of the external carotid artery ipsilateral to the injury. There was favorable resolution of the case, with a good aspect of the scar 2 months after ligation. This case reinforces that it is extremely important to make a thorough review of medical history of all patients, searching for possible bleeding disorders or previous family history.

A doença de von Willebrand (DvW) é uma coagulopatia hereditária. Não há predileção por sexo. Clinicamente caracteriza-se por hemorragias mucocutâneas, sobretudo nasais, menorragias e hemorragias pós-trauma. Este artigo relata um caso clínico de DvW em paciente de 52 anos de idade, leucoderma, do sexo masculino, que apresentou extensa hemorragia em bordo lateral de língua após ferimento lacerante, além de descrever alguns aspectos clínicos, patológicos e terapêuticos da DvW. Após repetidas tentativas de sutura do ferimento e reposição dos fatores de coagulação, optou-se pela ligadura da artéria carótida externa ipsilateral ao ferimento, com resolução favorável do caso, notando-se bom aspecto cicatricial 2 meses após a ligadura. Este caso reforça que é de extrema importância a realização de anamnese criteriosa, buscando-se identificar possíveis distúrbios hemorrágicos prévios ou antecedentes familiares.

Complicações decorrentes da utilização do piercing bucal: avaliação e conduta clínica / Complications due use of oral piercing: clinical evaluation and management

Objetivo: apresentar três casos clínicos de pacientes portadores de piercing bucal, nos quais foram motivados a remover os adornos e, quando não admitiram a remoção, foram orientados preventivamente para evitar maiores complicações. Descrição do caso: a conduta do Cirurgião-dentista frente ao paciente portador do piercing na cavidade bucal foi descrita. O estudo ainda enalteceu a importância da intervenção do Cirurgião-dentista no esclarecimento dos possíveis prejuízos à saúde ocasionados pelo piercing bucal. Conclusão: o Cirurgião-dentista e particularmente o periodontista desempenham papel relevante na orientação evitando a instalação do piercing bucal, ou na recomendação de cuidados quando o paciente não aceita a remoção do adorno.

Aim: present 3 clinical cases of patients with oral piercing, who was guided to remove the ornaments, and when the patient did not admit the piercing removal, the patient was preventively warned to avoid more complications. Case description: the dentist management on the patient with oral piercing was described. This study also enhances the importance of the dentist intervention in the explanation of possible health injury occasioned by oral piercing. Conclusion: the dentist and particularly the periodontist play relevant role in guiding avoiding the installation of oral piercing, or the recommendation of care when the patient does not accept the removal of adornment.

Riga-Fede disease: A histological study and case report.

Acute traumatic ulcerations and granulomas of the oral mucosa may result from physical damage via sharp foodstuffs, accidental biting, or talking. Most ulcerations heal within days. Others become chronic, reactive, and exophytic. A histopathologically unique type of chronic traumatic ulceration is the traumatic ulcerative granuloma with stromal eosinophilia (TUGSE). TUGSE exhibits a deep "pseudoinvasive" inflammatory reaction. This lesion may occur under the tongue in infants as a result of chronic mucosal trauma caused by mandibular anterior primary teeth during nursing and is termed Riga-Fede disease (RFD). The clinical presentation many resemble squamous cell carcinoma causing concern. RFD, although not uncommon, is not frequently reported. Thus, dental practitioners are unfamiliar with such lesions. We present a large Riga-Fede lesion in an infant along with the clinical management.

A new way to resist rape.

In a case of sexual assault, rape was prevented by biting of portion of the tongue of the accused by the victim. This case is reported to highlight an almost unheard-of measure the victims girl adopted to prevent rape.