Oral manifestation of histoplasmosis on the palate

Abstract This case report describes an uncommon manifestation of histoplasmosis on the soft palate. The importance of appropriate treatment and follow-up in complex cases is emphasized, especially in patients with chronic diseases. Oral lesions may occur as multiple, granular and painful ulcers, as well as verrucous growths. Lesions may also be deep, with infiltrative edges and erythematous or with white areas, accompanied by local lymphadenopathy, resembling a carcinoma on clinical examination. In this sense, a fast and accurate diagnosis is essential to the success of treatment of oral histoplasmosis.

Incidência de fistula após palatoplastia à Von Langenbeck com veloplastia intravelar estendida / Incidence of cleft palate fistula after von Langenbeck palatoplasty with extended intravelar veloplasty

Introdução: A fissura labiopalatina é a deformidade craniofacial mais frequente e sua incidência é estimada em 1:600 nascidos vivos no Brasil. O objetivo desse estudo é avaliar a incidência de fístulas para os pacientes submetidos à palatoplastia com veloplastia intravelar estendida. Métodos: Trata-se de estudo descritivo retrospectivo com 25 pacientes que foram operados pelo mesmo cirurgião no período de setembro de 2011 a setembro de 2012. A técnica de Von Langenbeck, juntamente com a veloplastia intravelar estendida, foi realizada em todos os pacientes. Foram excluídos do estudo os pacientes com fístulas palatinas, portadores de síndromes ou outras malformações. A idade média da realização da palatoplastia foi de 30,6 meses, variando de 12 meses a 159 meses. Foram selecionados 19 pacientes: onze (58%) do gênero masculino e oito (42%) do gênero feminino. A fissura palatal isolada foi a mais comum, encontrada em nove (47%) pacientes. A fissura transforame esquerda estava presente em sete (37%) pacientes e três (16%) pacientes eram portadores de fissura transforame bilateral. Resultados: Somente dois (11%) pacientes evoluíram com fístula palatina até o acompanhamento pós-operatório de 6 meses. Conclusão: A técnica de Von Langenbeck associada à veloplastia estendida mostrou-se com baixa incidência de fístulas palatinas (11%) quando comparada ao índice encontrado na literatura mundial (7% a 42%).

Introduction: Cleft lip and palate is the most common craniofacial deformity, with an estimated incidence of 1 case per 600 live births in Brazil. The aim of this study was to determine the incidence of fistula among patients undergoing palatoplasty with extended intravelar veloplasty. Methods: This retrospective descriptive study evaluated 25 patients operated between September 2011 and September 2012 by the same surgeon. The von Langenbeck technique combined with extended intravelar veloplasty was performed in all patients. The study excluded patients with palatal fistulas, syndromes, or other malformations. The age at palatoplasty varied between 12 and 159 months, and the average age was 30.6 months. Nineteen patients were selected, comprising 11 (58%) male patients and 8 (42%) female patients. Isolated cleft palate was the most common deformity, found in 9 (47%) patients. Unilateral (left) trans-foramen cleft was present in 7 (37%) patients, and bilateral trans-foramen cleft was seen in 3 (16%) patients. Results: Only 2 (11%) patients had palatal fistula in a postoperative follow-up period of 6 months. Conclusion: The von Langenbeck technique associated with extended veloplasty resulted in a low incidence of cleft palate fistulas (11%) compared with the rate found in previous studies (7%-42%).

Cephalometric analysis for the diagnosis of sleep apnea: a comparative study between reference values and measurements obtained for Brazilian subjects

OBJECTIVE: To verify if the reference values of Sleep Apnea cephalometric analysis of North American individuals are similar to the ones of Brazilian individuals presenting no craniofacial anomalies. The study also aimed to identify craniofacial alterations in Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS) patients in relation to individuals without clinical characteristics of the disease through this cephalometric analysis. METHOD: It were used 55 lateral cephalograms consisting of 29 for the control group of adult individuals without clinical characteristics of OSAHS and 26 apneic adults. All radiographs were submitted to Sleep Apnea cephalometric analysis through Radiocef Studio 2.0. The standard values of this analysis were compared, by means of z test, to the ones obtained from the control group and these were compared to values from apneic group through Student's t test. RESULTS: There were no significant differences between values obtained from control group and standard values. On the group of OSAHS patients it was observed a decrease on the dimensions of upper airways and an increase on the soft palate length. CONCLUSIONS: The standard values of Sleep Apnea analysis can be used as reference in Brazilian individuals. Besides, through lateral cephalograms it was possible to identify craniofacial alterations in OSAHS patients.

OBJETIVO: verificar se os valores de referência da análise cefalométrica para apneia do sono, referentes a indivíduos norte-americanos, são semelhantes aos de indivíduos brasileiros não portadores de anomalias craniofaciais. Identificar, também por meio dessa análise cefalométrica, alterações craniofaciais em indivíduos portadores de síndrome da apneia obstrutiva do sono (SAOS) em relação a indivíduos sem características clínicas da doença. MÉTODOS: foram utilizadas 55 radiografias cefalométricas laterais advindas de arquivos, sendo 29 radiografias para o grupo controle, sendo composto de indivíduos adultos sem características clínicas de SAOS, e 26 de indivíduos adultos apneicos. Todas as radiografias foram submetidas à análise cefalométrica para apneia do sono por meio do software Radiocef Studio 2.0. Por meio do teste z, valores-padrão dessa análise foram comparados aos valores obtidos do grupo controle, e esses, por sua vez, foram comparados aos valores do grupo de apneicos por meio do teste t de Student. RESULTADOS: não houve diferenças significativas entre os valores obtidos do grupo controle e os valores-padrão. No grupo de indivíduos portadores de SAOS, observou-se diminuição nas dimensões das vias aéreas superiores e aumento do comprimento do palato mole. CONCLUSÕES: os valores-padrão da análise de apneia do sono podem ser utilizados como referência em indivíduos brasileiros. Além disso, por meio da radiografia cefalométrica lateral foi possível identificar alterações craniofaciais em indivíduos portadores de SAOS.

Pleomorphic adenoma of the soft palate: Myoepithelial cell predominant.

The pleomorphic adenoma is the most common salivary gland tumor. A remarkable morphological diversity can exist from one tumor to the next. We present here a case of pleomorphic adenoma of minor salivary glands of the soft palate which had predominantly myoepithelial cells with minimal stroma, ductal cells, or tubular elements.

Evaluation of craniofacial morphology in patients with obstructive sleep apnea using lateral cephalometry and dynamic MRI.

Context: Obstructive sleep apnea (OSA) is a potentially life-threatening disorder, characterized by repeated collapse of the upper airway during sleep with cessation of breathing. The altered mouth breathing produces morphological changes in craniofacial region. Aim: This study was designed to compare and validate the craniofacial morphological characteristics in patients with OSA using lateral cephalometry and to investigate the dentofacial characteristics of patients with OSA with respect to the obstructive sites determined by dynamic magnetic resonance imaging (MRI) to more accurately clarify the pathophysiological features. Materials and Methods: 10 patients with OSA were divided into two groups of five each according to their obstructive site determined by dynamic MRI. (1) Obstruction at the retropalatal and retroglossal region (Rp + Rg group) and (2) obstruction at the retropalatal region (Rp group). Lateral cephalogram both in upright and supine position was taken for all the subjects. In addition, dynamic MRI was performed to identify the sites of obstruction of the upper airway. Statistical analysis used: Independent t-test was performed to evaluate the significant difference in the upright cephalometric variables between the study and control group and between the two groups. The changes in skeletal and soft tissue parameters with change in posture was assessed within the study and control group by paired t test. P value of ≤0.05 was considered as statistically significant. Results: The study indicated that the first group of patients with both retropalatal and retroglossal obstruction showed signs of skeletal discrepancy that predisposed to obstruction at the retroglossal level and the soft tissue components like the soft palate and tongue that contributed to retropalatal obstruction. However, the second group of patients with only retropalatal obstruction had primarily soft tissue components associated with increased BMI that contributed to retropalatal obstruction. Conclusion: Evaluation of craniofacial morphology in OSA patients is bound to help the concerned specialist in recognizing the morphological changes induced by altered sleep pattern so as to provide the appropriate treatment.

Impact of delayed prosthetic treatment of velopharyngeal insufficiency on quality of life.

Palatopharyngeal dysfunction may take place when palatopharyngeal valve is unable to perform its own closing due to a lack of tissue (palatopharyngeal insufficiency) or lack of proper movement (palatopharyngeal incompetence). Palatopharyngeal insufficiency induces nasal regurgitation of liquids, hypernasal speech, nasal escape, disarticulations and impaired speech intelligibility. Prosthetic management of palatopharyngeal insufficiency requires a close co-operation between an otolaryngologist and a speech pathologist. As a result, the patient can be socially and physically rehabilitated with the improved speech quality as well as prevention of leakage of liquids.

Carcinoma espinocelular de paladar: presentación de un caso / Spinocellular carcinoma of palate: a case presentation

El cáncer en Cuba es la segunda causa de muerte para todos los grupos de edades y el carcinoma espinocelular de la cavidad bucal ocupa el sexto lugar en frecuencia, con mayor incidencia a partir de la quinta década de la vida y raramente en pacientes jóvenes. Se presenta el caso de un hombre blanco de 25 años, con antecedente de retardo mental ligero, que acude a consulta de Cirugía Máxilo Facial por presentar aumento de volumen en región posterosuperior de paladar. Se realizan exámenes complementarios y biopsia. El Departamento de Anatomía Patológica informa diagnóstico de carcinoma espinocelular.

Cancer is the second case of death in Cuba for all ages group and spinocellular carcinoma of oral cavity occupies the sixth place, the highest incidence was from the fifth decade of life and rarely in young patients. A case of a 25 years old white man is presented, with mild mental retardation antecedents, he arrives to maxillofacial surgery for presenting volume increase in posterosuperior region of palate. Complementary exams and biopsy are carried out. The Pathological Anatomy Department informs spinocellular carcinoma diagnosis.

Embryonal rhabdomyosarcoma of the adult soft palate.

Embryonal rhabdomyosarcoma is the most common soft tissue sarcoma in children. We report a rare case of embryonal rhabdomyosarcoma of the soft palate in a 32-year-old Caucasian female. Detailed histology of the tumor is described. Positive staining with desmin, myogenin and myoD1 confirmed the tumor to be embryonal rhabdomyosarcoma. A genetic association between rhabdomyosarcoma, polycystic ovary syndrome and the FEM1A gene on the human chromosome is speculated upon.

Immunohistochemical evaluation of inflammatorychanges in soft palate and tongue base in patientswith multilevel obstructive sleep apnea

To asses the presence of inflammatory celP infilteration in the mucosa and musculature of the soft palate and tongue base in patients with multilevel obstructive sleep apnea. Biopsies were obtained from the soft palate mucosa and muscle and from the tongue base muscle of 21 patients with multilevel obstructive sleep apnea operated by uvulopalatopharyngoplasty and modified genioglossus advancement [16 men, 5 women; age range, 27-54 years] and from 10 control non smoker non snoring subjects. Specimens were examined for the expression of CD45, CD4, CDS and CD la markers using immunohistochemistry technique. Inflammatory cell infilteration in the obstructive Sleep apnea group are compared to those in control group. CD45 and CD4 markers expression were found to be significant in the mucosa and muscle of soft palate and in the muscle of tongue base. Significant expression of CDS marker was present only in the mucosa of soft palate but not in the musculature of soft palate or tongue base.CDla marker was not found to be significant in any of the specimens. The mucosa and muscle of the soft palate and the muscles of the tongue base showed prominent inflammatory cellular infiltration mainly in the form of T lymphocytes in patients with multilevel obstructive sleep apnea. These inflammatory cell infiltrations may play a role in the pathogenesis of Obstructive sleep apnea with reteopalatal and retroglossal airway collapse.The authors do not have any financial interest or any other conflict of interests

Adenoma pleomórfico em palato mole / Pleomorphic adenoma of the soft palate

Adenoma pleomórfico (AP) é a neoplasia de glândula salivar mais comum. A lesão apresenta-se como uma massa firme de crescimento lento e indolor. Pode ocorrer em qualquer idade, sendo mais comum em adultos jovens entre 30 e 50 anos. A diversidade do padrão morfológico histopatológico é um dos seus aspectos mais característicos. Este artigo relata um caso de adenoma pleomórfico de palato mole, enfatizando aspectos diagnósticos e terapêuticos.

Pleomorphic adenoma (PA) is the most common salivary gland neoplasm. The lesion present as firm mass with slow rate of growth and asymptomatic. It can occur at any age, but young adults between 30 and 50 years are common. The diversity morphologic pattern is one of the most characteristic aspects of this lesion. This article report a case of pleomorphic adenoma of the soft palate emphasizing diagnostic aspects and therapeutics.

A study to determine whether the anterior and posterior vibrating lines can be distinguished as two separate lines of flexion by unbiased observers: a pilot study.

CONTEXT: By convention, the posterior palatal seal area is located on the palate between the anterior and posterior vibrating lines. However, there are opposing views on whether the anterior and posterior vibrating lines can be distinguished as two separate lines of flexion. AIMS: The study was carried out to determine whether the anterior and posterior vibrating lines can be distinguished as two separate lines of flexion by unbiased observers. A second part of the study was formulated to evaluate whether the palpatory method correlated with the nose-blowing method in locating the anterior line of flexion. MATERIALS AND METHODS: Twenty-three dental undergraduate clinical students were selected as observers. Twenty-three edentulous patients were randomly selected. The students were asked to record the anterior and posterior vibrating line on one patient each using two differently colored marking pencils. Also, the anterior vibrating line was marked by the palpatory method (using T burnisher) using a third colored marking pencil. The marked lines were then transferred onto the previously made impression of modeling plastic. RESULTS: Of the 23 recorders used in the study, 19 could locate separate anterior and posterior lines of flexion. In 4 cases, the anterior and posterior lines of flexion coincided and were not distinct. In 20 cases, the palpatory method produced a line anterior to the line located by the Valsalva maneuver. CONCLUSIONS: The anterior and posterior vibrating lines could be located by the undergraduate students as two separate lines of flexion when the appropriate action was elicited for each of them; and the palpatory method produced a line slightly anterior to the anterior vibrating line located by the Valsalva maneuver.

White spongy nevus: a nonhereditary presentation.

White spongy nevus (WSN) is a rare hereditary dyskeratotic hyperplasia of the mucous membranes. It is an autosomal dominant disorder with variable penetrance. A few cases of WSN occur due to de novo mutations. We report a case of WSN in a 12-year-old female child, with none of her family members having similar lesions.

Aspectos clínicos e histopatológicos de tumores de palato mole / Clinical and histopathological aspects of soft palate tumors

Introdução: Os tumores do palato mole podem ser classificados de acordo com seu comportamento em benignos e malignos. Os tumores benignos mais freqüentes são os papilomas, os tumores mistos (adenoma pleomórfico) e os schwannomas. Entre os tumores malignos, 95% são carcinomas espinocelulares e os outros 5% agrupam os tumores de glândulas salivares menores, linfomas, melanomas e outras entidades raras. Objetivo: O objetivo deste trabalho foi avaliar a ocorrência de tumores malignos e benignos de palato mole, bem como os tipos de tumores mais freqüentes em cada um destes dois grupos e relacioná-los com a faixa etária, sexo e aspecto macroscópico das lesões. Método: Foi realizada uma análise retrospectiva entre os anos de 1995 e 2005 dos pacientes atendidos no ambulatório de Cirurgia de Cabeça e Pescoço da Instituição. Resultados: Dos 43 pacientes, 10 apresentaram tumores malignos (23%) e 33 pacientes tumores benignos (77%). Dentre todos os tipos de tumores, 26 eram papilomas (60,5%); 9 eram carcinomas espinocelulares (21%); 4 eram hemangiomas (9,3%); 2 eram adenomas pleomórficos (4,6%); 1 era adenocarcinoma (2,3%) e 1 era lipoma (2,3%). Conclusão: Observou-se um predomínio de neoplasias de origem epitelial, tanto nos tumores benignos quanto nos malignos, o que é devido à maior proporção de tecido epitelial em relação aos demais no palato mole.

Introduction: The tumors of the soft palate can be classified according to its benign and malignant behavior. The most frequent benign tumors are the papillomas; the mixed tumors (pleomorphic adenoma) and the schwanomas. Among malignant tumors, 95% are squamous cell carcinoma and the 5% left are represented by minor salivary glands tumors, lymphomas, melanomas and other rare entities. Objective: The objective of this work was to evaluate the frequency of benign and malignant tumors of the soft palate, as well the most frequent kinds of tumors in each group and to relate them with age, gender and macroscopic aspect. Method: A retrospective analysis included the patients seen at the Head and Neck Surgery clinic of the Institution. Results: From the 43 patients, 10 of them presented malignant tumors (23%) and 33 presented benign tumors (77%). Among all of the tumors, 26 were papillomas (60.5%); 9 were squamous cell carcinomas (21%); 4 were hemangiomas (9.3%); 2 were pleomorphic adenomas (4.6%); 1 was adenocarcinoma (2.3%) and 1 was lipoma (2.3%). Conclusion: It was noticed that epithelial tumors are the most frequent in both malignant and benign groups, what is related to the predominant epithelial tissue in soft palate.

Associação de marcadores de proliferação e de apoptose com a resposta à radioterapia e sua importância prognóstica em carcinoma epidermóide de palato mole / Proliferation and apoptosis markers in association with radiotherapy response and their prognostic in squamous cell carcinoma of soft palate

Carcinoma epidermóide de palato mole (CECPM) é raro e a radioterapia exclusiva é freqüentemente utilizada no tratamento para evitar as seqüelas do tratamento cirúrgico. O objetivo deste trabalho foi avaliar a função de alguns marcadores tumorais na avaliação da resposta à radioterapia em portadores de CECPM. Foram revisados os registros de 73 pacientes com CECPM tratados entre 1970 a 2000 com radioterapia exclusiva. A média de idade foi de 60 anos e a grande maioria dos pacientes eram homens, usuários de tabaco e álcool e apresentavam tumores em estádios avançados. Não foi observada relação entre a expressão de p53, Ki-67, Bcl-2 e Bax e os fatores demográficos, clínicos e histológicos. A sobrevida atuarial em 5 anos foi de 27,1 por cento e mostrou que pacientes com estádios clínicos iniciais tiveram melhor prognóstico.

Soft palate squamous cell carcinoma (SPSCC) is rare, and radiotherapy is the most used therapy aiming to avoid the functional sequelae of surgical ablation. The purpose of this study was to evaluate the role of several biologic tumor markers in the assessment of response to radiotherapy in SPSCC. The medical records of 73 patients with SPSCC treated from 1970 to 2000 with radiotherapy alone were reviewed. The mean age was 60 years and the majority was male, tobacco and alcohol consumption, and advanced stage tumors. No relationship was observed between immunostaining for p53, Ki-67, Bcl-2 and Bax to demographic, clinical and histological factors. The five-year actuarial survival, was 27,1 per cent and showed that patients with earlier stage tumors had a better prognosis.

Calcifying fibrous pseudotumor of the soft palate--a case report.

Calcifying fibrous pseudotumor has recently been described in the soft tissues. It is a rare benign lesion characterized by the presence of abundant hyalinized collagen with psammomatous or dystrophic calcification, and lymphoplasmacytic infiltrate. We report one such rare case in an 18 year old female with a nodular mass in the soft palate treated by complete resection. The mass had all the pathologic features of a calcifying fibrous pseudo-tumor.

Pharyngeal airway changes following mandibular setback surgery.

Treatment of dentofacial deformities with jaw osteotomies has an effect on airway anatomy and therefore mandibular setback surgery has the potential to diminish airway size. The purpose of this study was to evaluate the effect of mandibular setback surgery on airway size. 8 consecutive patients were examined prospectively. All patients underwent mandibular setback surgery. Cephalometric analysis was performed preoperatively and 3 months post operatively with particular attention to pharyngeal airway changes. Pharyngeal airway size decreased considerably in all, patients thus predisposing to development of obstructive sleep apnea. Therefore, large anteroposterior discrepancies should be corrected by combined maxillary and mandibular osteotomies.

Fibrolipoma em palato mole: relato de caso / Soft palate fibrolipoma: case report

O presente artigo relata um caso de fibrolipoma em palato mole. Esta neoplasia benigna é considerada por muitos autores como uma variante histológica do lipoma, onde ocorre a presença marcante de fibras colágenas interpostas com células adipócitas o que designa seu nome. A ocorrência desta lesão no palato mole é considerada rara e o tratamento de eleição é a excisão cirúrgica total.

Primary tuberculosis of soft palate.

Primary tuberculosis of upper respiratory tract including oral cavity is a rare disease. One such unusual case is reported.

Computer analysis of th cephalometric parameters on radiographs from patients with obstructive sleep apnoea

This research utilized computer image analysis to study radiographic cephalometric parameters of both skeletal-and soft-tissues in order to compare the parameters in male obstructive sleep apnea [OSA] patients with those in normal male subjects within the same age range. In addition, histological picture of soft palate biopsies from OSA patients was compared with that from normal subjects. The cephalometric parameters showed statistically significant differences in OSA from normal persons. A histological examination revealed that swelling of soft palate in OSA was not due to fat accumulation, but there were observed histological evidences of increased secretory glandular activity, interstitial edema and cellular infiltration