Utilidad de colgajos locales para reconstrucción de mejillas en lesiones oncológicas de piel / Usefulness of local flaps for cheek reconstruction in skin cancer lesions

Introducción: el cáncer de piel afecta con frecuencia la región facial por su alta exposición a la radiación ultravioleta. La mejilla es un sitio frecuente y como consecuencia de la exéresis, quedan amplios defectos que requieren de técnicas reconstructivas. Este estudio tuvo como objetivo evaluar la utilidad del uso de colgajos locales para la reconstrucción de mejilla en pacientes intervenidos de lesiones tumorales de piel. Métodos: se realizó un estudio prospectivo en 27 pacientes atendidas en el Instituto Nacional de Oncología y Radiobiología desde julio de 2013 hasta julio de 2015. Resultados: el grupo etario predominante estuvo integrado por mujeres entre 67-77, el tipo histológico que predominó fue el carcinoma basocelular. Predominó la mejilla izquierda. El colgajo que más se realizó fue el de rotación (Mustardé) y la complicación más frecuente fue el ectropión. Conclusiones: todos los casos fueron reconstruidos de forma inmediata, independientemente del tamaño del defecto(AU)

Introduction: Skin cancer frequently affects the facial area, due to high exposure to ultraviolet radiation. The most frequent affected area is the cheek. The wide excisions resulting from excision require reconstructive techniques to repair them. Objective: to evaluate the usefulness of local flaps for the cheek reconstruction in skin cancer lesions. Methods: A prospective study was conducted in 27 patients seen at the National Institute of Oncology and Radiobiology from July 2013 through July 2015. Results: The predominant age group comprised women aged 67-77 years, being the basal cell carcinoma the predominant one. The left cheek was the most affected. The most used flap was the rotation flap(Mustarde) and the most common complication was ectropion. Conclusions: All the cheek defects were immediately reconstructed regardless of their size(AU)

Lesiones de la mucosa bucal en una población infantil de Montevideo, Uruguay / Oral mucosal lesions in a child population of Montevideo, Uruguay

Justificación: Existen escasos estudios que documenten la frecuencia de lesiones de la mucosa bucal en niños y adolescentes, y todos revelan resultados dispares.Materiales y método: Se realizó un estudio observacional, descriptivo, transversal, en niños de 3 a 12 años de edad que participan del Programa de Salud Bucal de la Facultad de Odontología de la Universidad Católica del Uruguay. Se tomaron en cuenta lesiones en la totalidad de la cavidad bucal, describiendo y registrando cada uno de los hallazgos. Se seleccionaron las 7 lesiones más frecuentes enla bibliografía consultada. Se realizó un análisis estadístico según edad, género y tipo de dentición.Resultados: Se estudiaron 191 sujetos; 103 presentaron alguna lesión. La lesión identificada con mayor frecuencia fue Morsicatio buccarum es decir, mordisqueo de mucosa yugal (trauma inflingido). La siguiente lesión más frecuente fue Lengua geográfica.Conclusiones: Las niñas tuvieron mayor probabilidad de presentar algún tipo de lesión que los niños. El rango de edades de 6-9 años tuvo mayor riesgo de presentar alguna lesión que el grupo de 9-12 años. Los sujetos con dentición mixta tuvieron más riesgo de presentarMorsicatio buccarum que el grupo de dentición permanente. Asimismo, los individuos de 6-9 años tuvieron mayores posibilidades de presentar Morsicatio buccarum que el grupo de 9-12 años. No se encontró un estudio epidemiológicamente comparable que describa las mismas lesiones que éste; esto lleva a concluir que es necesario realizar otros estudios con la misma metodología y ampliando los criterios diagnósticos.

Justification: There are few studies that document the frequency of oral mucosal lesions in children and adolescents, and all of them reveal different results.Materials and method: This was an observational, descriptive, transversal survey, in children between the ages of 3 and 12, that participate in the “Programa de Salud Bucal de la Facultad de Odontología de la Universidad Católica del Uruguay”/ Oral Health Program of the Dentistry School of Uruguayan Catholic University. Lesions in the whole oral cavity were taken into account, describing and registering each one of the findings. The 7 lesions more frequent in the bibliography consulted were selected. A descriptive statisticalanalysis was made using the variables age, gender and dentition stages.Results: 191 children were examined; lesions were found in 103 children. Morsicatio buccarum, meaning the bitening of the cheek mucosa (self inflicted trauma), was the most common lesion. The second most frequent lesion was Geographic tongue. Conclusions: Girls had higher probability of presenting a lesion than boys. The age range between 6-9 had more risk of developing a lesion than the group ranging in age from 9-12. The children with mixed dentition had more risk of having Morsicatio buccarumthan the children with permanent dentition; and the children ranging in age from 6-9 had more probabilities of presenting Morsicatio buccarum than the children ranging 9-12. We could not find any other survey epidemiologically comparable that described the samelesions than ours. This leads to the conclussion that it is necessary to perform further studies with the same methodology and a wider range of diagnosis criteria.

Manejo de lesões por mordedura animal: relato de casos / Management of animal bite injuries: case reports

Lesões faciais decorrentes de mordedura animal são comumente relatadas na literatura. Essas injúrias, com prevalência de 15% em face, apresentam-se desde abrasões superficiais até ferimentos profundos com grande perda de substância, causando prejuízos estéticos e funcionais às vítimas. Crianças são mais acometidas que os adultos, com maior probabilidade de envolver regiões de nariz, orelhas, bochechas e lábios. O momento ideal para abordagem do ferimento e a avaliação da necessidade de antibioticoterapia profilática, visto o risco potencial de infecção desses ferimentos, ainda continuam discussões controversas na literatura, embora cada vez mais se defenda a abordagem por fechamento primário de ferimentos não infectados, ao invés do reparo tardio, e emprego de medicação antimicrobiana em situações específicas a serem avaliadas ao exame clínico. A profilaxia antirrábica e antitetânica devem ser sempre empregadas, quando bem indicadas. Anamnese e exame físico iniciais detalhados são de grande importância para determinar a abordagem terapêutica mais apropriada para cada caso. O presente estudo relata casos de pacientes jovens e idoso vítimas de mordedura animal, tratados por reparo primário e antibioticoterapia profilática, obtendo-se sucesso da terapia, com ausência de infecção... (AU)

Facial injuries resulting from animal bites are commonly reported in the literature. This kind of injuryoccusr approximately about 15% in the face and is presented as superficial abrasions or deep wounds with great tissue loss, causing aesthetic and functional damages to the victims. Children are more commonly affected than adults, generally involving nose, ears, cheeks and lips. The ideal time to approach the injury and the need for prophylactic antibiotics are still controversial, although most advocate for primary surgical closure of uninfected wounds, rather than delayed surgical repair, and restricteduse of prophylactic antibiotics in specific situations evaluated on clinical exam. Prophylaxis against rabies and tetanus should always be administered when well indicated. Clinical exam and detailed physical examination are of great importance to determine which therapeutic approach is most indicated for each case. This study reports cases of animal bite victims, young and elderly, treated by primary repair and prophylactic antibiotics, achieving good results, without signs of infection... (AU)

Toothbrush injury in an adult.

Tooth brushing is an oral hygiene measure. Keeping the toothbrush in the mouth and doing other works with both arms may lead to injury of the oral tissues. We hereby report a case of severe injury to the oral mucosal tissues caused by the toothbrush, which was treated surgically.

Hemangioma periorbitario tratado con propranolol / Periorbital hemangioma treated with propranolol

Presentamos una paciente de 10 meses de edad portadora de un hemangioma superficial y profundo en párpado inferior y mejilla izquierdos que fue tratada desde el comienzo con metilprednisona oral a dosis de 2mg/kg/día (mayo 2008). A los dos meses de iniciada la terapéutica presentó apertura ocular completa y se suspendieron los corticoides en forma lenta. Continuó con buena evolución. A los 8 meses de edad (octubre 2008)consultó por aumento brusco del tamaño de la lesión, que comenzó a ocluir el ojo izquierdo, ligera impetiginización. Se palpaba tumoración profunda subcutánea, de 2cm de diámetro, dolorosa, ubicada en mejilla homolateral. Se decidió internación, se indicó metilprednisona 2 mg/kg/día, cefalexina 100 mg/kg/día y analgésicos. Se inició tratamiento con propranolol con una dosis inicial de 1 mg/kg/día y a las 48 horas con 2 mg/kg/día, dividido en 2 tomas diarias. Se observó buena y rápida respuesta a la medicación. A la fecha (50 días de tratamiento con propranolol) la tumoración no se palpa y el hemangioma superficial es apenas perceptible. Consideramos que el propranolol es una droga a utilizar en los hemangiomas complicados y/o severos cuando no responden en forma adecuada al tratamiento corticoideo.

The patient is a 10 months old female carrier of a superficial and deep hemangioma in the left lower eyelidand cheek, who was treated in the beginning with an oral dose/dosage of metilprednisona of 2 mg/kg/day(May 2008). After two months of treatment it presented full eye opening the corticoids were suspended gradually. It presented a good progress. At 8 months of age (October 2008), the patient made a consult due to a sudden increase in size of the lesion, that had begun to occlude the left eye, light signs of infection. A deep subcutaneous tumour could be palpated, of 2 cm of diameter, painful, located in the homolateral cheek. It was decided to admit the patient, 2 mg/kg/day of metilprednisona, 100 mg/kg/day of cefalexina and painkillers were prescribed. The treatment began with propranolol with an initial dose of 1 mg/kg/day and after 48 hours with 2 mg/kg/day, divided in two doses per day. A good and fast response to the medication was observed. To the date (50 days of treatment with propranolol), the tumour cannot be palpated/felt and the superficial hemangioma is hardly/scarcely perceptible. We consider that propranolol is a drug to be used in the cases of complicated and/or severe hemangiomas when they do not respond properly to the treatment with corticoids.

An unusual injury from a toothbrush: a case report.

The use of toothbrushes has significantly improved oral hygiene. However, if brushing of the teeth is not done judiciously, it could result in severe trauma to the soft tissues of the oral cavity. This is particularly true in the young age group, since children tend to be very playful while brushing their teeth. This article describes the case report of a child who sustained a penetrating injury while brushing his teeth. A detailed plan for the management of such injuries is also presented.

Selamento de fístula buco sinusal utilizando o corpo adiposo da bochecha. Breve revisão da literatura e relato de caso clínico / Oroantral fistula closure using buccal fat pad. Brief review of literature and report of clinical case

As fístulas buco sinusais são complicações geralmente relacionadas com as exodontias dos dentes superiores posteriores, devido à proximidade existente entre os ápices desses elementos dentais e o assoalho do seio maxilar. O presente trabalho objetiva, com base em berve revisão da literatura e na experiência dos autores, mostrar as vantagens e desvantagens da utilização do corpo adiposo da bochecha para o selamento das fístulas oroantrais e apresentar um caso clínico incomum de um paciente portador de fístula buco sinusal bilateral que se submeteu a essa modalidade de tratamento.

Herniation of the buccal fat pad into the oral cavity: a case report.

An interesting lesion is presented, wherein a tiny traumatic perforation of the buccal mucosa and buccinator muscle forced a large portion of the buccal fat pad to extrude into the oral cavity. Such a situation can alarm any clinician & reinforces the importance of careful history taking and thorough examination, before treating patients.

Oral habits in children--a prevalence study.

This epidemiological study was conducted upon 4,590 school children to find the prevalence of oral habits in Mangalore in relation to their age and sex and to find the correlation, if any, between the habits and the malocclusion status. We noted that 29.7% of the population had habits of which 3. 1% had digit sucking, 4.6% mouth breathing, 3.02% tongue thrusting, 6.2% bruxism, 6% lip/cheek biting, 12.7% nail biting, 9.8% pencil biting and 0. 09% masochistic habits respectively. Digit sucking, pencil biting and tongue thrust were highly prevalent among Group 1 (3-6 years) children. Mouth breathing and bruxism were significant in Group 2 (7-12 years) cases whereas lip/cheek biting and nail biting were more common in Group 3 (13-16 years) cases. Digit sucking, tongue thrust, mouth breathing and bruxism were more prevalent among the boys whereas lip/cheek biting, nail biting and pencil biting were more prevalent among the girls. 28.95% of the children in Group 2 and 3 with habits had malocclusion. There was a significant correlation between class I type 2, class II div 1 and tongue thrust and mouth breathing whereas children with digit sucking showed a high correlation with class I type 2 malocclusion.

Experimental paracoccidioidomycosis of hamster inoculated in the cheek pouch

We comparaed the granuloma morphology and immune response of hamsters inoculated with Paracoccidioides brasiliensis (Pb) into the cheek pouch, which lacks lymphatic drainage, and the ffotpad, which is rich in lymphatics. Our objective was to better understand the modulation of Pb granuloma in an immunocompetent animal inoculated in an immunologically privileged site. The humoral immune response (ELISA) and cell mediated immunity (footpad test) became positive on days 7 and 14, respectively in animal inoculated into footpad and on days 35 and 60 in animals inoculated into the pouch. Typical epithelioid granulomas were observed at both sites on day 14. The number of fungi gradually decreased from the beginning of the experiment in footpad lesions, but only after day 35 in pouch granulomas, when cell mediated immunity was detectable. The results indicate that typical epithelioid paracoccidioidomycotic granulomas may develop in the absence of a detectable immune response; however, they are incapable of controlling fungal reproduction. Lack of lymphatic drainage delays the appearance of a detectable immune response, but with time fungi escape from the pouch, elicit an immune response and reach other organs. Our results further indicate the importance of the lymphatics in the pathogenesis of paracoccidioidomycosis.