Unveiling an oral hemangiolymphangioma

ABSTRACT Hemangiolymphangioma is a very rare vascular malformation that develops as a combination of dilated venous and lymphatic vessels. We describe an unusual case of hemangiolymphangioma of the tongue affecting an adult man who complained of an uncomfortable, slowly progressing exophytic irregular dark red-violaceous nodular mass on his tongue that impaired speech and swallowing for two weeks. The clinical differential diagnoses were Kaposi's sarcoma and a COVID-19-related lesion. A complete blood count and serology for HIV-1 and 2 and RT-PCR for COVID-19 were requested and results were negative. An incisional biopsy was performed. Microscopically, the lesion exhibited several dilated vessels lined by normal-appearing endothelial cells, some filled with prominent intravascular erythrocytes and others containing proteinaceous eosinophilic material resembling lymphatic vessels, in close association with hyperkeratosis, papillomatosis, and acanthosis. From immunohistochemical analysis, most vessels were found to be CD34 positive, some highlighted by α-SMA, whereas D2-40 was focal. Positive staining for some lymphatic and blood vessel markers, i.e., D2-40 and CD34, respectively, indicates a mixed derivation of the lesion. HHV-8 was negative. Clinical features, the congested blood vessels with ectasia in intimate association with hyperplastic epithelium, and the immunohistochemical profile supported the final diagnosis of oral hemangiolymphangioma. The patient underwent minimally invasive surgical excision with no intercurrences. After 18 months of follow-up, there were no signs of relapse.

Sucking habits and anterior open bite among Venezuelan and Brazilian children

AIM: To investigate the associations between nutritive and non-nutritive sucking habits and the prevalence of anterior open bite, in children from Aragua-Venezuela and São Paulo-Brazil. METHODS: Seven calibrated examiners (κ = 0.89-1.0) performed clinical assessments in Venezuelans (N = 809) and Brazilians (N = 1,377) aged 3-6 years. Sucking habits were investigated using questionnaires answered by the mothers. Data were analyzed using logistic regression models (α = 0.05). RESULTS: Among 380 children with anterior open bite, 309 were Brazilians. Approximately 65% of Brazilians with pacifier-sucking habit lasting beyond 3 years of age had this malocclusion. Brazilians who prolonged pacifier and digit-sucking habits beyond 3 years of age have, respectively, 68.5 and 14.5 times more chances of presenting anterior open bite than children without sucking habits (p < 0.001). In Venezuelans with open bite, 37.7% had digit-sucking habits beyond 3 years of age, resulting in a high odds ratio (9.3; p < 0.001) when compared to children without this habit. No significant effect was found for bottle feeding. However, non-breastfed Venezuelan children or those breastfed for periods shorter than 6 months have a two-fold higher chance of presenting anterior open bite than children who were breastfed for longer periods, p = 0.008. CONCLUSIONS: Infant feeding had some effect on Venezuelan children, since insufficient breastfeeding was related to a higher prevalence of anterior open bite. Pacifier-sucking was more prevalent in Brazilians, corresponding to pronounced chances (8-68 times greater) of diagnosing anterior open bite in pacifier users compared to non-users. Among Venezuelans, on the other hand, digit-sucking effect surpassed that of pacifier use and was associated with far higher chances (6-9 times) for this malocclusion...

Estudo da discrepância osteodentária, pré e pós-tratamento ortodôntico, em más-oclusões de Classe I / Study of bone and tooth discrepancy before and after orthodontic treatment in Class I malocclusions

Esta pesquisa teve como objetivo analisar a discrepância osteodentária nas fases pré e pós-tratamento ortodôntico, em casos de más-oclusões de Classe I. Foram selecionados modelos de estudo em gesso de 25 pacientes (19 do sexo feminino e seis do sexo masculino) com médias de idade de 14,2 anos ± 3,2 ao início do tratamento e 17,6 anos ± 2,7 ao final. Todos tiveram más-oclusões de Classe I tratadas sem extrações dentárias. Um examinador calibrado realizou mensurações das larguras mesiodistais dos dentes e do perímetro do arco mandibular com um paquímetro digital Mitutoyo, com precisão de 0,01 mm, por duas vezes. Foram calculados os valores mínimo e máximo, bem como medianas, médias e desvios-padrão das discrepâncias osteodentárias pré e pós-tratamento ortodôntico. A reprodutibilidade das mensurações foi avaliada pelo teste t de student pareado (α = 0,05). Não houve diferenças estatísticas entre a primeira e a segunda mensuração, indicando boa reprodutibilidade. Em, pelo menos, 60% dos casos ocorreu redução da discrepância de modelo para valores clinicamente aceitáveis. Na fase inicial do tratamento, 50% da amostra apresentavam falta de espaço no arco dentário mandibular (mediana: -0,54 mm). A discrepância média também foi negativa (média: -0,16 mm ± 3,36). Ao final, mediana (0,63 mm) e média (0,65 mm ± 0,85) foram positivas e mais próximas, denotando acréscimo aceitável de espaço na maioria dos arcos dentários. Concluiu-se que o tratamento ortodôntico melhorou as condições de espaço nos arcos dentários mandibulares, reduzindo discrepâncias negativas de até 4 mm e discrepâncias positivas de até 9 mm, sem a necessidade de exodontias.

The aim of this study was to analyze pre- and post-treatment bone and tooth discrepancy in Class l malocclusions. Study casts from 25 patients (19 females, six males) with mean ages of 14.2 years ± 3.2 at the beginning of treatment and 17.6 years ± 2.7 at the end were selected. All of them had their malocclusions treated without tooth extractions. One calibrated examiner performed measurements of mesiodistal tooth width and mandibular arch perimeter using a digital caliper (Mitutoyo) accurate to 0.01 mm, twice. Bone and tooth discrepancy minimum and maximum values, as well as medians, means and standard deviations, were calculated from pre- and post-treatment casts. Measurements reproducibility was assessed using paired student’s-t test (α = 0.05). No statistical differences were found between first and second measurement, indicating good reproducibility. In at least 60% of cases bone and tooth discrepancy was reduced to clinically suitable values. In the pre-treatment phase, 50% of the sample had lack of space in the mandibular dental arch (median: -0.54 mm). The average discrepancy was also negative (mean -0.16 mm ± 3.36). In the post-treatment phase, median (0.63 mm) and mean (0.65 mm ± 0.85) values were positive and closer, pointing out an acceptable space gain in most dental arches. It may be concluded that orthodontic treatment improved space conditions in the mandibular dental arches, by decreasing negative and positive discrepancies of up to 4 mm and 9 mm, respectively, without the need for extractions.

Effects of masticatory hypofunction on mandibular morphology, mineral density and basal bone area

AIM: This experimental study investigated the association between masticatory hypofunction and mandibular morphological dimensions and internal bone characteristics. METHODS: Twentyfour 21-day-old male Wistar rats were randomly divided into two groups, according to the diet consistency. The control group (CG) was fed a solid diet (pellets) and the experimental group (EG) received a powdered diet during 50 days. All animals were euthanized and their mandibles removed and processed for histomorphometric analysis. A calibrated examiner performed linear and angular measurements (mandibular body length and height, mandibular lengths, ramus depth and height, mandibular base depth, mandibular head and gonial angle) on photographs, estimated bone density in the mandibular ramus region on digital radiographs and assessed the area of cortical and trabecular bone tissue in the second molar region, in 5-µm-thick serial cuts stained with Cason's Trichrome. Measurements for the study groups were compared using Mann-Whitney test (α=0.05). larvae to induce experimental candidiasis, and after 24 hours, the survival rate was assessed. RESULTS: some of the macroscopic dimensions evaluated on photographs were significantly smaller in EG compared to CG, specifically mandibular ramus height (10.77 mm vs. 11.11 mm, p=0.0375), mandibular body length (21.67 mm vs. 22.36 mm, p=0.0165) and height (4.24 mm vs. 4.54 mm, p=0.0016), as well as mandibular base depth (1.24 mm vs. 1.47 mm, p=0.0325). The relative mineral bone density was significantly decreased in EG (1.04) compared to CG (1.25), p<0.001. Rats in the EG also presented smaller trabecular and cortical bone area (2.36 mm²) than those in CG (3.16 mm²), p<0.001. CONCLUSIONS: Based on the above-mentioned measurements, it may be concluded that masticatory hypofunction induced by a powdered diet affected mandibular morphology and was associated with significantly reduced bone content.

Mapping of proximal enamel thickness in permanent teeth

Aim: Knowledge of enamel thickness is relevant to perform stripping during orthodontic treatment. Thus, proximal enamel measurements of human permanent teeth were compared in this study. Methods: The measurements were previously obtained on cut sections of mandibular central (n = 30) and lateral (n = 30) incisors, canines (n = 20), first (n = 40) and second (n = 40) premolars; maxillary central (n = 20) and lateral (n = 20) incisors, canines (n = 20), first (n = 40) and second (n = 42) premolars. Comparisons between thicknesses by arch side and proximal surface were carried out using Student’s t-tests (á = 0.05). Teeth were compared according to the mesial and distal thicknesses by ANOVA and Tukey’s test. Results: No significant differences were found between right and left teeth. For the mesial surface, the mandibular second premolar presented the highest mean value (1.376 mm ± 0.198; p<0.001). The mandibular central incisor had the smallest thickness in relation to the other teeth (0.675 mm ± 0.144), although not significant compared with the mandibular lateral incisor and canine (0.734-0.781 mm). The mandibular second premolar also presented the higher distal thickness in relation to the others (1.450 mm ± 0.172), although not significant compared with the maxillary first premolar (1.322 mm ± 0.195). Mandibular incisors had the lowest means for distal thickness (0.872-0.879 mm), although not statistically different compared with maxillary incisors and mandibular canine (1.002-1.015 mm). Distal thickness was greater than mesial (p<0.001). Conclusions: Interproximal stripping should be less marked in incisors and mesial surfaces.