Ocorrência de carcinoma espinocelular labial não melanocítico em usuários crônicos de hidroclorotiazida / Occurrence of non-melanoma labial squamous cell carcinoma in chronic users of hydrochlorothiazide

Diversos autores desenvolveram estudos acerca da potencial associação entre a etiocarcinogênese do carcinoma espinocelular não melanocítico (CECNM) labial e o uso crônico da hidroclorotiazida (HCTZ). Objetivo: A atual revisão objetivou investigar a relação do diurético HCTZ e o risco de CECNM labial. Métodos: Realizou-se uma revisão de literatura nas bases de dados LILACS, PUBMED/MEDLINE e Periódico CAPES, em que foram incluídos artigos em inglês, português e francês, publicados no período de 2017 a 2022. Foram propostos 60 documentos e, dentre esses, 30 foram selecionados para compor a amostra no estudo. Resultados: Foi evidenciada uma relação entre o uso da HCTZ e a ocorrência de CENM com relação dose cumulativa devido às alterações provocadas pelo fármaco, no entanto, em virtude da heterogeneidade de desenhos metodológicos e concentração dos estudos em populações semelhantes, existem limitações quanto à confiabilidade dessas informações. Conclusão: Identificou-se uma desproporção entre a ocorrência e relevância do CENM e a produção científica vigente, demonstrando a necessidade de estudos com metodologias padronizadas que abranjam diferentes especificidades socioeconômicas e demográficas.(AU)

Several authors have developed studies about a potential association between the etiocarcinogenesis of non-melanocytic lip squamous cell carcinoma (NMSCC) and the chronic use of hydrochlorothiazide (HCTZ). Objective: The current study aimed to investigate the relation between the diuretic HCTZ and the risk of lip NMSCC. Methods: A literature review was carried out in the LILACS, PUBMED/MEDLINE and CAPES Periodical databases, which included articles in English, Portuguese and French, published between 2017 and 2022. Sixty documents were collected and, among these, 30 were selected to compose the sample in the study. Results: There was evidence of a relationship between the use of HCTZ and the occurrence of MSCC with a cumulative dose relationship due to changes caused by the drug, however, because of the heterogeneity of methodological designs and concentration of studies in similar populations, there are limitations regarding the reliability of this information. Conclusion: A disproportion between the occurrence and relevance of the NMSCC and the current scientific production was identified, demonstrating the need for studies with standardized methodologies that cover different demographic socioeconomic specificities.(AU)

Queiloplastia de Castañón: una técnica viable y efectiva en la reconstrucción parcial del labio inferior / Castañón Cheiloplasty: a viable and effective technique in the partial reconstruction lower lip

Introducción: Para el tratamiento del carcinoma epidermoide labial existen varias modalidades terapéuticas, pero la cirugía constituye la primera elección. Numerosas técnicas han sido descritas para el manejo de lesiones que afectan más de un tercio del labio inferior. Sin embargo, la selección de alguna en particular depende del cumplimiento de los principios reconstructivos de esta unidad. Objetivo: Ejemplificar los beneficios de la utilización de la queiloplastia de Castañón, para la reconstrucción labial parcial, en un paciente con carcinoma epidermoide de labio inferior. Presentación de caso: Se presenta un paciente masculino de 68 años de edad, con antecedentes de hábito de fumar y alcoholismo, que acudió a consulta de Cirugía Oncológica de Cabeza y Cuello por presentar lesión localizada en bermellón de labio inferior. Se realizó biopsia, mediante incisión, que informó un carcinoma epidermoide moderadamente diferenciado. Se estudió como un T2N0M0, etapa II y se trató quirúrgicamente mediante queilectomía subtotal y reconstrucción con técnica de Castañón. Conclusiones: Se presentó el caso clínico de un paciente con carcinoma epidermoide de labio inferior, entidad patológica de alta incidencia. La cirugía constituyó la única modalidad de tratamiento utilizada. Una vez realizada la resección quirúrgica de la lesión, se reconstruyó el defecto, para lo que se utilizó la queiloplastia descrita por Castañón, opción útil para lograr el cumplimiento de los principios estéticos y funcionales(AU)

Introduction: For the treatment of labial squamous cell carcinoma there are several therapeutic modalities, but surgery is the first choice. Numerous techniques have been described for the management of lesions affecting more than a third of the lower lip. However, the selection of any particular one depends on the fulfillment of the reconstructive principles of this unit. Objective: Exemplify the benefits of using Castañón cheiloplasty for partial lip reconstruction in a patient with squamous cell carcinoma of the lower lip. Case presentation: A 68-year-old male patient with a history of smoking and alcoholism was presented, who went to the Head and Neck Oncological Surgery consultation for presenting a lesion located in vermilion of the lower lip. An incisional biopsy reported moderately differentiated squamous cell carcinoma. It was studied as a T2N0M0, stage II and was treated surgically by subtotal cheilectomy and reconstruction with Castañón technique. Conclusions: The clinical case of a patient with squamous cell carcinoma of the lower lip, a pathological entity of high incidence, was presented. Surgery was the only treatment modality used. Once the surgical resection of the lesion was performed, the defect was reconstructed, for which the cheiloplasty described by Castañón was used, a useful option to achieve compliance with the aesthetic and functional principles(AU)

Tinción con azul de toluidina en biopsia dirigida de lesiones displásicas de la mucosa bucal: informe de casos clínicos / Toluidine blue guided biopsy of dysplastic lesions of the oral mucosa: clinical cases report

Objetivo: Los desórdenes de mucosa bucal potencialmente malignos pueden presentar áreas displásicas. En estos casos, la biopsia es un procedimiento imprescindible para un correcto diagnóstico. La inspección visual y la palpación, como método de selección del área de biopsia, ofrecen sensibilidad y especificidad adecuadas pero mejorables. El objetivo de este artículo es presentar una serie de casos clínicos en los que se describen el empleo y la interpretación de la tinción vital con azul de toluidina como método complementario para contribuir a una mejor elección del área de biopsia. Casos clínicos: Se trata de siete casos de lesiones con sospecha de displasia epitelial en mucosa bucal. En cada uno se detalla la correlación de las áreas teñidas con las manifestaciones clínicas y con el diagnóstico de displasia. Además, se muestran patrones de tinción considerados falsos positivos. En la interpretación de la tinción positiva, se tuvieron en cuenta el aspecto superficial y el color de la lesión teñida. El empleo combinado de inspección, palpación y tinción vital podría constituir un procedimiento integral de utilidad para obtener mayor precisión en la determinación del sitio de biopsia en comparación con los mismos procedimientos aplicados de manera individual. En la interpretación de la tinción positiva con azul de toluidina deberían considerarse el aspecto superficial y el color de la lesión teñida (AU)

Aim: Potentially Malignant Disorders in the oral cavity can present dysplastic areas. In these cases, the biopsy is an essential procedure for a correct diagnosis. Visual inspection and palpation, are adequate methods to select the area for the biopsy, however there is margin for improvement. The objective of this article is to present a series of clinical cases in which the use and interpretation of vital staining with Toluidine Blue is described as a complementary method to contribute to a better choice of the biopsy area. Clinical cases: Seven clinical cases that presented lesions with suspected epithelial dysplasia in the oral mucosa were presented. The correlation of the stained areas with the clinical manifestations and with the diagnosis of dysplasia is detailed in each case. Staining patterns considered false positives are also shown. In the interpretation of the positive staining, the superficial appearance and color of the stained lesion were considered. The combined use of inspection, palpation and vital staining could constitute a useful comprehensive procedure to obtain greater precision in determining the biopsy site in relation to the same procedures applied individually. In the interpretation of the positive staining with Toluidine Blue, the superficial appearance and color of the stained lesion should be considered (AU)

Reconstrucción de defectos de labio superior con colgajos locales. Presentación de casos y revisión bibliográfica / Reconstruction of upper lip defects with local flaps. Case presentation and literature review

Introducción. La reconstrucción de lesiones del labio superior supone un reto para lograr conservar la función, la competencia labial y la obtención de resultado estético satisfactorio. Se estudian pacientes con lesiones malignas en labio superior y su respectivo tratamiento resectivo y reconstructivo, y se realiza revisión bibliográfica de los principios del abordaje labial y las técnicas reconstructivas con colgajos locales. Material y métodos. Presentación de cuatro casos de pacientes con carcinoma basocelular en labio superior, en quienes se realiza resección con margen de seguridad y técnicas de reconstrucción en "V", en forma pentagonal, avance en VY, colgajo digital nasogeniano y colgajo de avance de mejilla según el defecto obtenido tras la escisión de la lesión cutánea maligna. Resultados. Adecuada coloración y vitalidad de los colgajos, conservación de competencia labial y función de apertura y cierre bucal, cicatrices emplazadas en pliegues naturales. Discusión. Evaluación de opciones reconstructivas para defectos de labio superior según bibliografía. Conclusión. La reconstrucción de labio mediante las técnicas expuestas constituyen excelentes opciones para el tratamiento de defectos de hasta un tercio de longitud del labio superior, ya que conservan la competencia labial y proveen un resultado estético satisfactorio.

Introduction. The reconstruction of defects of the upper lip is a challenge in order to preserve function, lip competence and obtain a satisfactory aesthetic result. Patients with malignant lesions in the upper lip and their respective resective and reconstructive treatment were studied, and a bibliographic review of the principles of the labial approach and reconstructive techniques with local flaps was carried out. Material and methods. Presentation of four cases of patients with basal cell carcinoma of the upper lip, in whom resection is performed with a safety margin and reconstruction techniques in a "V" shape, in a pentagonal shape, VY advancement flap, nasogenian digital flap and cheek advancement flap. Results. Adequate color and vitality of the flaps, preservation of lip competence and function of mouth, scars located in natural folds. Discussion. Evaluation of reconstructive options for upper lip defects according to bibliography. Conclusion. Lip reconstruction using the exposed techniques are excellent options for the treatment of defects of the upper lip, since they preserve lip competence and provide a satisfactory aesthetic result

Resultados estéticos y funcionales de la reconstrucción de los labios con colgajos / Aesthetic and functional results of the reconstruction of the lips with flaps

Introducción: Los labios representan la unidad anatómica principal del tercio inferior de la cara. Por lo tanto, su reconstrucción quirúrgica representa un desafío para el cirujano, quien busca la excelencia en la restauración de las funciones, la estética y la apariencia facial. Muchas técnicas de reconstrucción han sido descriptas, cada una con sus ventajas y desventajas. Objetivos: evaluar los resultados estéticos y funcionales en todos los pacientes operados por lesiones oncológicas de los labios que requirieron colgajos locales, regionales y libres. Diseño: Observacional retrospectivo Lugar de Aplicación: Hospital público de atención terciaria en tumores. Material y Método: 19 pacientes 11 mujeres y 8 hombres, edad media de 65 años (31-77). Se incluyeron todos los pacientes con patología tumoral de los labios, con defectos mayores a un 1/3 del labio. Fueron 10 carcinomas escamosos, 7 carcinomas basocelulares, 1 hemangioma venoso y 1 queratosis actínica. En la resección un paciente requirió una mandibulectomía marginal y otro una maxilectomía parcial. Se le realizó vaciamiento ganglionar a 2 pacientes. Como reconstrucción se realizaron un colgajo bilobulado, 3 colgajos de avance, 1 comisuroplastia con colgajo romboidal , 2 de Abbe-Esländer, 5 de Karapandzic, 2 de mejilla, 1 Bernard-Burow y otro de Fujimori y 3 libres radiales con palmar largo. Todos los pacientes fueron evaluados en el postoperatorio inmediato, enfatizando la vitalidad de los colgajos y la cicatrización y en el postoperatorio tardío resultados funcionales y estéticos. Resultados: Todos los colgajos sobrevivieron. Sufrieron dehiscencia de la herida quirúrgica 4 pacientes. Con respecto a los resultados funcionales, la continencia oral completa fue obtenida en aquellos defectos , que pudieron reconstruirse con colgajos obtenidos del labio residual. Los defectos mayores reconstruídos con colgajos de mejilla, vecindad o especialmente con colgajo libre radial con tendón del palmar largo, obtuvieron muy buenos resultados. Tres pacientes sufrieron microstomía, La inteligibilidad del habla fue satisfactoria en todos. Los resultados estéticos fueron calificados como excelentes especialmente en los colgajos libres. Conclusión: Se han obtenido resultados satisfactorios, tanto funcionales como estéticos, en las reconstrucciones de grandes defectos de labio, con el colgajo microquirúrgico radial utilizando el tendón de palmar largo como un arnés de tensión logrando continencia oral y suspensión adecuada. La elección de uno u otro colgajo va a depender de cada paciente, edad, factores de riesgo y la elección y experiencia de cada cirujano

Bloqueo de nervio mentoniano para braquiterapia de carcinoma de labio / Mental nerve block for brachytherapy of lip carcinoma

Introducción: El cáncer de labio es el tumor más frecuente de la cavidad oral que afecta, sobre todo, el labio inferior. La braquiterapia es un tratamiento único eficaz en estadios tempranos y como terapia adyuvante a la cirugía en estadios avanzados. Esta técnica es un proceso doloroso por lo que para su realización se han empleado sedaciones profundas, infiltraciones intramusculares de anestésico local y técnicas de anestesia regional, entre otras. Objetivo: Presentar una técnica anestésica diferente y poco descrita como alternativa para disminuir el dolor de la intervención. Presentación del caso: Paciente con carcinoma de labio programado para braquiterapia. Se realiza bloqueo del nervio mentoniano de manera bilateral para el tratamiento en labio inferior. Conclusiones: Este tipo de bloqueo, por su sencillez y eficacia, es una alternativa útil a la sedación profunda para la realización de braquiterapia en el labio inferior(AU)

Introduction: Lip cancer is the most frequent tumor of the oral cavity that affects, above all, the lower lip. Brachytherapy is a unique treatment which is effective in early stages and, as adjuvant therapy to surgery, it is also effective in advanced stages. This technique is a painful process, a reason why deep sedation, intramuscular infiltrations of local anesthetic, and regional anesthesia techniques, among others, have been used. Objective: To present a different and scarcely described anesthetic technique as an alternative to reduce the pain of this intervention. Case presentation: Patient with lip carcinoma scheduled for brachytherapy. Bilateral mental nerve block is performed in the lower lip. Conclusions: This type of block, due to its simplicity and effectiveness, is a useful alternative to deep sedation for brachytherapy in the lower lip(AU)

Modification in clic4 expression is associated with p53, tgf-ß, tnf-α and myofibroblasts in lip carcinogenesis

Abstract Chloride intracellular channel-4 (CLIC4) is regulated by p53 and tumor necrosis factor-α (TNF-α), it is linked to the increase of transforming growth factor-β (TGF-β), and myofibroblastic differentiation in skin carcinogenesis. This study analyzed the immunoexpression of CLIC4, p53, TGF-β, TNF-α, and α-SMA in 50 actinic cheilitis (AC) and 50 lower lip squamous cell carcinoma (LLSCC). AC and LLSCC immunoexpression were categorized as score 1 (<5% positive cells), 2 (5-50%) or 3 (>50%). For CLIC4, nuclear and cytoplasmic immunostaining of epithelial cells was considered individually. For morphologic analysis, the World Health Organization criteria were used to epithelial dysplasia grade of ACs, and Bryne grading of malignancy system was applied for LLSCC. Higher nuclear CLIC4 (CLIC4n) and TGF-β were observed in ACs with low-risk of transformation, while cytoplasmic CLIC4 (CLIC4c), p53 and TNF-α were higher in the high-risk cases (p<0.05). In LLSCCs, CLIC4c was higher in cases with lymph node metastasis, advanced clinical stages, and histological high-grade malignancy. p53 expression was higher in high-grade LLSCCs, whereas TGF-β decreased as the clinical stage and morphological grade progressed (p<0.05). ACs showed an increased expression of CLIC4n and TGF-β, while CLIC4c and α-SMA were higher in LLSCCs (p<0.0001). Both lesions showed negative correlation between CLIC4n and CLIC4c, while in LLSCCs, negative correlation was also verified between CLIC4c and p53, as well as CLIC4c and TGF-β (p<0.05). Change of CLIC4 from the nucleus to cytoplasm and alterations in p53, TGF-β, TNF-α, and α-SMA expression are involved in lip carcinogenesis.

Resumo O canal intracelular de cloreto 4 (CLIC4) é regulado pela p53 e fator de necrose tumoral α (TNF-α) e está relacionado ao aumento do fator de crescimento transformador β (TGF-β) e na diferenciação miofibroblástica na carcinogênese cutânea. Este estudo analisou a imunoexpressão de CLIC4, p53, TGF-β, TNF-α e α-SMA em 50 queilites actínicas (QA) e 50 carcinomas de células escamosas de lábio inferior (CCELI). A imunoexpressão da QA e CCELI foram categorizadas em escore 1 (<5% de células positivas), 2 (5-50%) ou 3 (>50%). Para CLIC4, a imunomarcação nuclear e citoplasmática das células epiteliais foi considerada separadamente. Para análise morfológica, foram utilizados os critérios da Organização Mundial da Saúde para a gradação das displasias epiteliais nas QAs, e o sistema de gradação de malignidade de Bryne foi utilizado para os casos de CCELIs. Alta imunoexpressão de CLIC4 nuclear (CLIC4n) e TGF-β foi observada em QA de baixo risco de transformação, enquanto CLIC4 citoplasmática (CLIC4c), p53 e TNF-α foram elevadas nos casos de alto risco (p<0.05). No CCELI, a imunoexpressão de CLIC4c foi maior em caos com metástase linfonodal, estágio clínico avançado e alto grau histológico de malignidade. A expressão de p53 foi elevada em CCELI de alto grau, enquanto o TGF-β diminuiu à medida que o estádio clínico e o grau morfológico progrediram (p<0.05). QAs exibiram uma elevada expressão de CLIC4n e TGF-β, enquanto o CLIC4c e α-SMA foram elevados em CCELIs (p<0.0001). Ambas as lesões mostraram correlação negativa entre CLIC4n e CLIC4c, enquanto nos CCELIs, também se verificou correlação negativa entre CLIC4c e p53, assim como entre CLIC4c e TGF-β (p<0.05). Alteração do CLIC4 do núcleo para o citoplasma e alterações na expressão de p53, TGF-β, TNF-α, e α-SMA estão envolvidas na carcinogênese labial.

A capillary angioma of the lips: an extremely rare situation in the oral cavity / Angioma capilar de los labios: una situación extremadamente rara en la cavidad oral

Hemangiomas are tumors identified by rapid endothelial cell proliferation in early infancy, followed mostly by involution over the time. However, 10-12 % of true hemangiomas don't involute and require surgical treatment. Hemangiomas are classified on the basis of their histological appearance as capillary, mixed and cavernous. We report a case of capillary angioma in a 13-year old boy who presented with a budding into the lower lip. The lesion was excised and histopathological report confirmed the diagnosis.

Los hemangiomas son tumores identificados por la rápida proliferación de células endoteliales en la primera infancia, seguidos principalmente por involución a lo largo del tiempo. Sin embargo, entre el 10 y el 12 % de los hemangiomas no intervienen y no requieren tratamiento quirúrgico. Los hemangiomas se clasifican en función de su aspecto histológico como capilares, mixtos y cavernosos. Reportamos un caso de angioma capilar en un niño de 13 años que presentó un brote en el labio inferior. La lesión fue extirpada y el informe histopatológico confirmó el diagnóstico.

Immunohistochemical expression of DNA repair proteins in oral tongue and lower lip squamous cell carcinoma

Abstract The DNA repair system involves genes and proteins that are essential for the maintenance of genome integrity and the consequent control of various cellular processes. Alterations in these genes and proteins play a role in tumor development and progression and might be associated with prognosis. The aims of this study were to analyze the immunoexpression of two DNA repair proteins, XPF and XRCC1, in lower lip squamous cell carcinoma (LLSCC) and oral tongue squamous cell carcinoma (OTSCC), and to investigate possible associations with clinical and histopathological parameters. The immunohistochemical expression of XPF and XRCC1 was analyzed semi-quantitatively in 40 cases each of LLSCC and OTSCC. The chi-squared test or Fisher's exact test, when appropriate, was used to investigate the association between expression of the proteins and clinicopathological characteristics. The cytoplasmic immunoexpression of XPF was high in OTSCC (95% of the cases analyzed) but low in LLSCC (52.5%). Among the clinicopathological parameters evaluated, a statistically significant association was observed between high nuclear expression of XRCC1 and the absence of regional lymph node metastasis in patients diagnosed with OTSCC (p=0.006). The high protein expression of XPF and XRCC1 in OTSCC and LLSCC suggests an important role in the development and progression of these tumors. Our study found an association between high nuclear expression of XRCC1 and the absence of loco-regional metastasis in cases diagnosed as OTSCC, suggesting a role of this protein in tumor progression.

Carcinoma epidermoide de lábio inferior: análise da incidência e mortalidade no Brasil / Lower lip epidermoid carcinoma: analysis of incidence and mortality in Brazil

O carcinoma epidermoide de lábios tem suas manifestações clínicas iniciais como atrofia, ressecamento e fissuras do vermelhão do lábio inferior com margem indefinida entre o vermelhão e a pele. O diagnóstico precoce é de fundamental relevância nos casos dessa patologia. O cirurgião dentista tem um papel extremamente importante neste caso. Objetivo: Realizar uma revisão da literatura pertinente sobre o carcinoma epidermoide oral. Metodologia: Essa revisão foi realizada empregando a base de dados do SCIELO, LALICS e BBO - Odontologia, foram pesquisados artigos da literatura com língua inglesa e portuguesa publicados no período de 2013 a 2018 com auxílio dos termos: câncer oral, diagnóstico e fatores associados. Foram excluídos os artigos cujas abordagens antes de 2013, outras línguas as não citadas, teses, projetos e produções não relacionadas a temática. Resultados: Os métodos tradicionais de tratamento oncológico são: cirurgia, radioterapia e a quimioterapia. O tratamento a ser estabelecido estará na dependência da localização, grau histológico de malignidade, estadiamento do tumor e da condição de saúde do indivíduo. Conclusões: O cirurgião-dentista deve estar preparado para diagnosticar e lidar com pacientes que apresentam lesões cancerizáveis com o propósito de diminuir as taxas de incidência e mortalidade e, então, melhorar a qualidade de vida das pessoas(AU)

Cancer is a cellular modification that is related to the loss of its metabolic regulation and intercellular control in which it differs depending on its type and behaves, biologically, different from a normal cell. From this point of view, lower lip cancer is one of the most frequent manifestations of oral cancer. The most frequent risk factors are stimulated from the practice of harmful habits such as: exposure to sunlight, alcohol consumption and smoking. Squamous cell carcinoma of the lips has its initial clinical manifestations such as atrophy, dryness and fissures of vermilion of the lower lip with indefinite margin between the vermilion and the skin. Early diagnosis is of fundamental relevance in cases of this pathology. The dentist surgeon plays an extremely important role in this case. The traditional methods of cancer treatment are: surgery, radiotherapy and chemotherapy. The treatment to be established will depend on the location, histological grade of malignancy, tumor staging and the individual's health condition. Therefore, the dental surgeon must be prepared to diagnose and deal with patients who have cancerous lesions in order to reduce incidence and mortality rates and thus improve people's quality of life(AU)

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.

Aspectos clínico-patológicos de queilite granulomatosa: relato de caso / Clinical and pathological aspects of Granulomatosis Queilite: Case Report

Introdução:A queilite granulomatosa (QG) é uma lesão oral rara, apresentando clinicamente inchaço de aspecto granulomatoso no lábio.Objetivo:O presente estudo, tem como objetivo apresentar um relato de caso de QG, tendo em vista, a dificuldade do diagnóstico e tratamento de condições inflamatórias com etiologias desconhecidas que acometem a cavidade oral.Relato de caso:Paciente do sexo feminino, apresentou aumento de volume no lábio superior exibindo sintomatologia dolorosa, porém, sem relatar associações com alterações sistêmicas. Durante o exame clínico notou-se que o lábio superior apresentava fissuras profundas, observando tambémedema que se estendia da comissura labial, atravessando a linha média. Levantou-se então, a hipótese diagnóstica de QG. Foi realizada uma biópsia incisional para confirmação do diagnóstico. A análise histopatológica evidenciou, presença de granulomas não caseosos e infiltrado inflamatório linfoplasmocitário perivascular. De acordo com os dados clínicos e análise histopatológica foi dado o diagnóstico inicial de QG. Após o diagnóstico inicial de QG, a paciente foi encaminhada para uma avaliação médica, a fim de avaliar possíveis alterações intestinais que pudessem caracterizar a síndrome de Melkersson-Rosenthal ou Cronh, como também possível reação de hipersensibilidade tardia. Conclusões:O cirurgião-dentista deve estar preparado para diagnosticar aumentos de volume significativos nos lábios, a fim de manejar corretamente o tratamento do paciente, estabelecendo desta forma, prognósticos favoráveis para essas condições (AU).

Introduction:Granulomatous cheilitis (HQ) is a rare oral lesion, presenting clinically granulomatous swelling on the lip. Objective: This study aims to present a case report of HG, considering the difficulty of diagnosis and treatment of inflammatory conditions with unknown etiologies that affect the oral cavity.Objective:This study aims to present a case report of HG, considering the difficulty of diagnosis and treatment of inflammatory conditions with unknown etiologies that affect the oral cavity.Case report:A female patient presented increased volume in the upper lip showing painful symptoms, but without reporting associations with systemic alterations. During the clinical examination it was observed that the upper lip presented deep fissures, also observing edema that extended from the labial commissure, crossing the middle line. The diagnostic hypothesis of GQ was then raised. An incisional biopsy was performed to confirm the diagnosis. Histopathological analysis revealed the presence of non-caseous granulomas and perivascular lymphoplasmacytic inflammatory infiltrate. According to the clinical data and histopathological analysis the initial diagnosis of GH was given. After initial diagnosis of HG, the patient was referred for medical evaluation to evaluate possible intestinal changes that could characterize Melkersson-Rosenthal syndrome or Cronh, as well as possible late hypersensitivity reactions.Conclusions:The dentist should be prepared to diagnose significant volume increases in the lips in order to correctly manage the patient's treatment, thus establishing favorable prognoses for these conditions (AU).

Immunoexpression of human leukocyte antigen-DR in actinic cheilitis and lower lip squamous cell carcinoma

Abstract The aim of this study was to evaluate the immunoexpression of human leukocyte antigen-DR (HLA-DR) in actinic cheilitis (AC) and lower lip squamous cell carcinoma (LLSCC), and to correlate the findings with clinical (tumor size/extent, regional lymph node metastasis, and clinical stage) and histopathological (grade of epithelial dysplasia and inflammatory infiltrate for AC and histopathological grade of malignancy for LLSCC) parameters. Twenty-four AC and 48 LLSCC cases (24 with regional nodal metastasis and 24 without regional nodal metastasis) were selected. The scores of immunopositive cells for HLA-DR in the epithelial component of the lesions were assessed and the results were analyzed statistically using the nonparametric Mann-Whitney test. Epithelial expression of HLA-DR was observed in only five (20.8%) cases of AC (two low-grade and three high-grade lesions), with a very low median score of immunopositivity. By contrast, expression of HLA-DR was found in most LLSCC (97.9%), with a relatively high median score of positive cells. The score of HLA-DR-positive cells tended to be higher in tumors with regional lymph node metastasis, tumors in advanced clinical stages, and low-grade tumors, but the difference was not statistically significant (p > 0.05). In addition, there was a tendency towards higher expression of HLA-DR in highly/moderately keratinized tumors, and tumors with little/moderate nuclear pleomorphism (p > 0.05). The results suggest a potential role of HLA-DR in lip carcinogenesis, particularly in the development and progression of LLSCC. The expression of this protein can be related to the degree of cell differentiation in these tumors.

Immunohistochemical evaluation of HLA-G and FoxP3+ T regulatory cells in oral cavity and lower lip squamous cell carcinomas

Abstract: Human Leukocyte Antigen G (HLA-G) is a molecule involved in the tumor immunosuppression and also in the generation of regulatory T (Treg) cells, thus leading to evasion to the immune system host, and consequently, contributing to tumor progression in several cancers. The aim of this study was to evaluate the immunoexpression of HLA-G by tumor cells and FoxP3+ Treg cells in 25 oral tongue squamous cell carcinomas (SCCs) and 25 lower lip SCCs and analyze their relationship with clinical parameters. HLA-G expression was higher in oral tongue SCCs than in lower lip SCCs. In oral tongue SCCs and lower lip SCCs, no association between HLA-G expression and clinical parameters (tumor size, lymph node status, distant metastasis, and clinical stage) was verified (P>0.05). FoxP3+ Treg cells were detected along the tumor invasive front in all cases of oral tongue and lower lip SCCs. In oral tongue SCC cases, the number of Treg cells tended to be higher in smaller tumors, tumors without regional lymph node metastasis, and tumors in early clinical stages, but the difference was not statistically significant (P>0.05). A significant positive correlation was found between the expression of HLA-G by neoplastic cells and Treg cells in lower lip SCCs (p = 0.008). Our findings suggest the involvement of HLA-G and Treg cells in the modulation of immune responses in oral tongue and lower lip SCCs. This interaction between HLA-G and Treg cells may represent an evasion mechanism in these malignancies.

Escleroterapia em lesões vasculares de boca: relato de dois casos clínicos / Sclerotherapy in vascular lesions of the mouth: report of two clinical cases

O hemangioma é uma neoplasia de comportamento benigno, determinada pela proliferação anormal de vasos sanguíneos. São lesões assintomáticas, porém, seu crescimento progressivo pode acarretar danos traumáticos locais, ocasionando dor, ulcerações e até sangramentos, que, dependendo da localização, se tornam de difícil controle, principalmente quando de natureza arterial. Com considerável incidência na região de cabeça e pescoço e na cavidade bucal, acomete mais frequentemente a região de mucosa jugal, lábios e língua. Tendo em vista a sua relevância clínica, por estar presente na sua área de atuação e ser relativamente comum, o conhecimento acerca dessa neoplasia benigna é de fundamental importância ao cirurgião-dentista. Entre os recursos terapêuticos, a escleroterapia química tem sido empregada, apresentando resultados satisfatórios tanto clínicos quanto estéticos. Objetivo: apresentar as características clínicas do hemangioma, os métodos de diagnóstico e o tratamento realizado por meio de escleroterapia química. Relato de caso: são descritos dois casos clínicos de hemangiomas, diagnosticados em duas pacientes do sexo feminino, localizados um em lábio superior e outro em mucosa jugal, tratados por meio de injeção de solução esclerosante. Considerações finais: em ambos os casos, foi possível proporcionar a involução das lesões mediante procedimentos não cirúrgicos, favorecendo, no período pós-operatório, o conforto e a estética, demonstrando a eficiência e a segurança na utilização do oleato de monoetanolamina a 5% (Ethamolin ®). (AU)

Hemangioma is a neoplasm of benign behavior, determined by abnormal proliferation of blood vessels. They are asymptomatic lesions, however, their progressive growth can cause local traumatic injuries, causing pain, ulcerations and even bleeding, which, depending on the location, becomes difficult to control, especially when of an arterial nature. With a considerable incidence in the head and neck region, in the oral cavity, it most frequently affects the region of jugal mucosa, lips and tongue. Due to its clinical relevance, because it is present in the area of practice of the dental surgeon and is relatively common, knowledge about this benign neoplasm is of fundamental importance. Among the therapeutic resources, chemical sclerotherapy is employed presenting satisfactory clinical and aesthetic results. Objective: the purpose of this study is to present the clinical characteristics of hemangioma, the diagnostic methods and the treatment performed through chemical sclerotherapy. Case report: this article describes the description of two clinical cases of hemangiomas diagnosed in two female patients, one located in the upper lip and the other in the jugal mucosa treated with sclerosing solution injection. Final considerations: in both cases, it was possible to provide the involution of the lesions by non-surgical procedures, favoring, in the postoperative period, comfort and aesthetics, demonstrating the efficiency and safety in the use of 5% monoethanolamine oleate (Ethamolin®). (AU)

Elastosis en la queilitis actínica. Revisión de literatura / Elastosis in Actinic Cheilitis. Literature Review

Resumen La matriz extracelular (MEC) juega un papel importante en la regulación de los eventos biológicos, tales como, el desarrollo de la migración celular, proliferación y diferenciación. La exposición crónica a la luz ultravioleta (UV) provoca elastosis (en distintos grados), que corresponde a una degeneración basófila de la MEC. La queilitis actínica (QA) es una lesión potencialmente maligna del labio inducida por la exposición regular y prolongada a la luz UV, que afecta principalmente al bermellón del labio inferior. Las lesiones de QA tienen un estroma complejo, se observa siempre la presencia de elastosis, infiltrado inflamatorio crónico de distinta intensidad y la aparición de vasos sanguíneos telangiectásicos. Dentro de este infiltrado inflamatorio se ha descrito un aumento significativo de mastocitos (MCs), localizados especialmente alrededor de las zonas de elastosis y en la zona subepitelial. Se ha propuesto que la elastosis actínica se produce tanto por procesos degenerativos como de síntesis anormal de fibras elásticas por parte de fibroblastos con daño solar, lo que va acompañado de cambios morfológicos del colágeno. A pesar de que el fibroblasto tendría un rol preponderante en la formación de la elastosis actínica, diversos estudios sugieren que otros tipos celulares como el MC también contribuirían en forma significativa al daño actínico de la MEC. El propósito de esta revisión es analizar las características de la elastosis en la QA.

Abstract The extracellular matrix (ECM) plays an important role in the regulation of biological events, such as cell migration, proliferation and differentiation. Chronic exposure to ultraviolet (UV) light causes elastosis (to varying degrees), which corresponds to a basophilic degeneration of the ECM. Actinic cheilitis (AC) is a potentially malignant lip lesion induced by regular and prolonged exposure to UV light, which mainly affects the vermilion. AC lesions have a complex stroma characterized by the presence of elastosis, chronic inflammatory infiltrate of different intensity and the appearance of telangiectatic blood vessels. Within this inflammatory infiltrate a significant increase of mast cells (MCs) has been described, located especially around areas of elastosis and at the subepithelial zone. It has been proposed that actinic elastosis is produced both, by degenerative processes and by abnormal synthesis of elastic fibers by photodamaged fibroblasts, which is accompanied by morphological changes in collagen. Although the fibroblast would play a major role in actinic elastosis formation, several studies suggest that other cell types such as MCs also contribute significantly to actinic ECM damage. The purpose of this review is to discuss the characteristics of elastosis in AC.

Reconstrução de lábio inferior pela w-plastia / Lower lip reconstruction using W-plasty

O CEC do lábio inferior representa entre 20% e 30% de todos os cânceres da cavidade oral. Atinge principalmente homens com mais de 50 anos que têm histórico prévio de tabagismo, etilismo e exposição solar. O diagnóstico é clínico e confirmado pela análise histopatológica. O presente trabalho relata caso de uma paciente que apresentava carcinoma espinocelular acometendo mais de 1/3 do lábio inferior, mas que devido à grande mobilidade apresentada pela região após a ressecção da lesão primária, optou-se por reconstrução conservadora para preservar a funcionalidade sem comprometer o resultado estético.

Lower lip squamous cell carcinomas (SCC) correspond to 20-30% of all oral cavity cancers. It mainly affects men over 50 years of age who have previous history of smoking, alcoholism and exposure to the sunlight. The diagnosis is clinical, confirmed by histological analysis. The present paper describes a case of a patient with a SCC affecting more than 1/3 of the lower lip, who underwent resection of the primary lesion and a conservative reconstruction of the lesion's region, due to the great local mobility, aimed at preserving the functionality without compromising the aesthetic outcome.

Tratamento de hemangioma labial por meio da escleroterapia / Labial hemangioma treatment through sclerotherapy: case report

O hemangioma é considerado como uma neoplasia vascular benigna, caracterizado por uma fase de crescimento rápido, com proliferação de células endoteliais, seguida por uma estabilização gradual. A principal queixa dos pacientes portadores dessa neoplasia é referente à estética e, por esse motivo, a escleroterapia vem sendo uma boa opção de tratamento para obter resultados estéticos satisfatórios. Para esse tipo de tratamento, são utilizadas aplicações com oleato de monoetanolamina a 0,05 g/ml (Ethamolin), que promovem a regressão da lesão por fibrose dos espaços endoteliais. No presente artigo, é descrito um relato de caso clínico de uma paciente do sexo feminino, portadora de um hemangioma no lábio superior esquerdo. Foram realizadas três aplicações do agente esclerosante Ethamolin no interior do tumor, até que ele regredisse o suficiente para ser removido cirurgicamente com maior segurança e eficiência. As aplicações com oleato de monoetanolamina proporcionaram a involução do hemangioma de forma rápida e segura, de modo a promover uma esclerose dos vasos tumorais, favorecendo a remoção cirúrgica.

The hemangioma is considered as a benign vascular neoplasm, characterized by a phase of rapid growth, with proliferation of endothelial cells, followed by gradual estabilization. The main complaint of patients with this neoplasm is related to aesthetics and, for this reason, sclerotherapy has been a good treatment option to obtain satisfactory aesthetic results. For this type of treatment, applications with 0.05 g/ml Monoethanolamine Oleate (Ethamolin), which causes regression of the lesion by fibrosis of the endothelial spaces, are used. In the present article a clinical case report of a female patient with a hemangioma in the upper left lip will be described. As a treatment, three applications of the Ethamolin sclerosing agent were performed inside the tumor until it regress to be excised with greater safety and efficiency. The applications with Monoethanolamine Oleate provided a quick hemangioma involution, in order to promote sclerosis of tumor vessels, favoring it surgical removal.

Potential Years of Lost Life of the Lip, Oral Cavity and Pharynx Neoplasms in Slovak Population - 2010-2015

Objective: To analyse Potential Years of Life Lost (PYLL) rates trends of lip, oral cavity and pharynx neoplasms in the Slovak population by age and gender. Material and Methods: The study analyses PYLL rates (age-standardized) of lip, oral cavity and pharynx neoplasms (C00-C14) per 100,000 in the period of six years (2010-2015). The study sample was divided into two age sub-categories (all ages: 0-69y. and working group: 20-69y.) National mortality data (C00-C14) (3,138 mortality causes) were analysed from the Statistical Office of the Slovak Republic. Results: The highest PYLL rate was found in sub-category 20-69 years in males (378 per 100,000) in 2012 and in females (64 per 100,000) in 2013. The highest PYLL rate was observed in sub-category all age groups in males (296 per 100,000) in 2012 and in females (50 per 100,000) in 2013. The PYLL rates of lip, oral cavity and pharynx neoplasms had in the period 2011- 2015 upward trend in both sexes, however, in the 2014 was found the opposite trend. In 2015 the highest PYLL rates (non-standardized) in both sexes was found in age subcategory 55-59y. Conclusion: Our study should contribute to the development of oral cancer intervention programs.

A Case of Soft Tissue Metastasis in Contralateral Submandibular Space by Regional Recurrence of Lower Lip Cancer / 대한이비인후과학회지

The most common cause of treatment failure in oral cavity cancer is when it is found to have local recurrence, usually occurring in the ipsilateral cervical lymph node. On the contrary, it is extremely rare to find local recurrence in soft tissue metastasis (STM) in the contralateral neck. Furthermore, lung cancer and malignant lymphoma are most commonly confined to their primary sites. The poor general condition increases the likelihood of STM, which indicates bad prognosis. A 72-year-old man with a hard and fixed mass on the right submandibular space visited our clinic. He had received a wide excision with local flapreconstruction for squamous cell carcinoma in the left corner of lower lip 18 months ago. We performed the wide excision with bilateral selective neck dissection (I–III), and he was finally diagnosed as STM from contralateral lip cancer. We report this unique and rare disease entity with a literature review.