Ligadura de la arteria lingual: estrategia para hemorragias por lesión de la arteria en la base de la lengua: informe de dos casos / Lingual Artery Ligation: Strategy for Bleeding from Artery Injury at the Base of the Tongue: Report of Two Cases

La hemorragia producida por lesión de la arteria lingual en la base de la lengua por cirugías o por tumores es infrecuente. La mayor frecuencia en la indicación de abordajes transorales para tratar diferentes patologías que afectan la orofaringe requiere que el equipo quirúrgico tenga experiencia en el manejo de esta complicación. La ligadura de la arteria lingual en el cuello es una técnica quirúrgica muy eficaz para solucionar la hemorragia, pero es importante conocer las posibles variantes anatómicas que puede tener la arteria en su trayecto cervical. Debido a su baja incidencia se propone como objetivo describir dos casos clínicos de pacientes que tuvieron hemorragias graves por lesión de la arteria lingual en la base de la lengua, producidas por daño quirúrgico y por erosión por tumor. [AU]

The bleeding caused by injury to the lingual artery at the base of the tongue due to surgery or tumors is infrequent. The increased frequency in the indication of transoral approaches to treat different pathologies affecting the oropharynx requires the surgical team to have experience in managing this complication. Ligation of the lingual artery in the neck is a very effective surgical technique to solve the bleeding; however, it is essential to be aware of the possible anatomical variants the artery may have in its cervical trajectory. Due to its low incidence, we propose to describe two clinical cases of patients who had severe bleeding due to a lesion of the lingual artery at the base of the tongue, produced by surgical damage and erosion due to a tumor. [AU]

Tratamiento integral de fisura palatina con injerto de lengua: reporte de caso / Sinus floor elevation with a lateral window technique and simultaneous dental implants placement: case report

RESUMEN: La fisura labio palatina (FLP) es una alteración del desarrollo, congénita, de etiología desconocida. La fístula oronasal es la complicación más común de la reparación del paladar con fisura. Los problemas más comunes incluyen hipernasalidad al hablar y el pase de fluidos y comida hacia la cavidad nasal. El caso corresponde a un paciente de 16 años de edad, sexo masculino, con fístula buconasal de 2,1 cm de diámetro mayor en sentido transversal, como secuela de FLP unilateral derecha. Además relata problemas en la alimentación, traspaso de fluidos a la cavidad nasal, problemas de habla por insuficiencia velo faríngea (IVF) valor 9, alteraciones en sus relaciones interpersonales y baja autoestima. Se realizó el injerto de lengua en fístula buconasal, tratamiento de ortodoncia y rehabilitación oral para dar solución estética y funcional. El éxito del tratamiento integral le permitió al paciente mejorar sus relaciones sociales debido a una mayor autoestima.

ABSTRACT: The cleft lip and palate (CLP) is a developmental and congenital anomaly of unknown etiology. The oronasal fistula is the most common complication of the cleft palate reparation. The most common problems are hypernasality on speech and the passage of fluids and food to the nasal cavity. This case is about a sixteen- year-old boy with a 2,1 cm diameter oronasal fistula due to a right unilateral CLP sequel. He also presented alimentation problems, fluid passage to the nasal cavity, speech defects by velopharyngeal insufficiency (VFI), relationships problems and low self-esteem. A tongue graft in the oronasal fistula, orthodontic treatment and oral rehabilitation were made to give an aesthetic and functional solution. The success of the treatment allowed the patient to improve his relationships due to a greater self-esteem.

Malformación arteriovenosa en cavidad oral: a propósito de un caso y revisión de la literatura / Arteriovenous malformation in the oral cavity: a case report and a literature review

Las malformaciones arteriovenosas (malformaciones A-V) de alto flujo en la cavidad oral no son una patología frecuente, existen pocos datos publicados sobre su tratamiento y sigue siendo muy controvertido debido a la alta tasa de complicaciones vitales que conlleva y la alta tasa de recurrencia. El único tratamiento curativo es la resección radical, con las consecuencias no sólo vitales, sino también desfigurativas que supone. Presentamos un caso de malformación A-V congénita en región submandibular, suelo de boca derecho y lengua, que tras varios episodios de dolor y aumento de tamaño, sin realizar ninguna medida agresiva, en el último control se observa trombosis espontánea de la misma. En este caso, la evolución con un tratamiento expectante sin cirugía, ha sido la trombosis con mejoría clínica, sin presentar nuevo episodio de aumento de tamaño, ni sangrado doce meses después, a pesar de seguir con una lesión de gran tamaño en el suelo de la boca.

he high-flow arteriovenous malformations (A-V malformations) in oral cavity are not a common disease, there are few published data on treatment and it remains highly controversial because of the high rate of vital complications and the high rate of recurrence. The only curative treatment is radical resection, with not only vital consequences but also the disfigurement involved. We present a case of congenital A-V malformation in right submandibular region, floor of the mouth and tongue. After several episodes of pain and enlargement, in the last control without any aggressive action, the lesion presented spontaneous thrombosis. In this case, despite following with a large lesion on the floor mouth, the evolution with an expectant non-surgical treatment has been the thrombosis with clinical improvement, without presenting new episode of enlargement, nor bleeding twelve months later.

Morfologia da língua do cervo do pantanal (Blastocerus dichotomus) / Morphology of the tongue of the Marsh deer (Blastocerus dichotomus)

Objetivou-se descrever a morfologia da língua do cervo do pantanal (Blastocerus dichotomus), o maior cervídeo da fauna brasileira, pois poucas são as informações detalhadas sobre sua morfologia. Línguas e fragmentos linguais de oito cervos do pantanal, adultos, provenientes do Projeto Cervo-do-Pantanal de Porto Primavera foram analisados quanto aos seus aspectos macroscópicos e à microscopia de luz. A língua do cervo do pantanal ocupa grande parte da cavidade oral, onde a raiz e o corpo estão fixados caudalmente pelo osso hióide e, em sua porção média, pelo frênulo lingual; seu ápice, achatado e plano é livre; apresenta torus lingual pouco proeminente, não havendo delimitação da fossa lingual. Na superfície dorsal encontram-se as seguintes papilas: filiformes, cônicas, lenticulares, fungiformes e valadas. Histologicamente verificou-se que a mucosa reveste-se de epitélio estratificado pavimentoso queratinizado, a lâmina própria constitui-se de tecido conjuntivo, rico em fibras colágenas dispostas em várias direções, onde se verifica abundante vascularização, além de acúmulo de tecido linfático.

The aim was to describe the morphology of the tongue of the Marsh deer (Blastocerus dichotomus), the largest deer of the Brazilian fauna, since there is little detailed information on their morphology. Tongues of eight adult Marsh deers, belonging to Projeto cervo-do-pantanal de Porto Primavera were analyzed for their macroscopic aspects and by light microscopy. The Marsh deer tongue occupies most of the oral cavity, where the root and body are fixed caudally by the hyoid bone, and in its middle portion by the frenulum linguae; its free apex is flat and plane, has little prominent torus lingae and there is no demarcation of fossa linguae. The lateral and ventral surfaces are covered by a thin mucosa; however the dorsal surface is covered by thick mucosa, although soft. On the dorsal surface are the papillae: filiform, conical, lenticular, fungiform and vallate. Histologically was found that the mucosa has a stratified squamous epithelium, the lamina propria consists of connective tissue rich in collagen fibers arranged in several directions, where there is abundant vascularization and accumulation of lymphoid tissue.

Lingual-facial trunk arising from the external carotid artery: a case report / Tronco linguo-facial como rama de la arteria carótida externa: reporte de un caso

The variations in the origin of the facial and lingual arteries are very important in maxillofacial, head and neck surgery procedures. This study is a case report in which the common origin is described in the facial and lingual artery in a lingual-facial trunk (LFT) on the left side of a female corpse from Spain. In the examination, a diameter of 2.17 mm and a length of 8.84 mm are shown. It was located 12.04 mm from the carotid bifurcation and 9.31 mm from the origin of the superior thyroid artery. The variation in biometric values shown, are anatomical findings in the neck dissection of a corpse. Moreover, taking into account the surgical procedures, which involve the origin of facial and lingual artery, because it is the most common variation and could cause complications.

Las variaciones del origen de la arteria facial y lingual son importantes en los procedimientos de cirugía maxilofacial y de cabeza y cuello. Reportamos un caso en el que se describe el origen común de las arterias facial y lingual en un tronco linguofacial en el lado izquierdo en el cadáver de una mujer de origen español. En la examinación, el tronco presentó un diámetro de 2,17 mm y una longitud de 8,84 mm. Se ubicó a 12,04 mm de la bifurcación carotidea y a 9,31 mm del origen de la arteria tiroidea superior. La variación en los valores biométricos presentados constituyen un hallazgo anatómico en una disección de cuello de un cadáver, además ser tomada en cuenta en los procedimientos quirúrgicos que involucren el origen de la arteria facial y lingual, pues al ser la variación más común podría generar complicaciones.

Evaluación de la microcirculación sublingual en un paciente en shock séptico / Sublingual microcirculation asessment in a patient with septic shock

Introduction: Septic shock involves a complicated network of circulatory, inflammatory and metabolic disturbances,leading to cellular energetic disruption. Microcirculatory alterations are frequently observed in septic shock, being characteristic the presence of weak microcirculatory units and heterogeneous microcircu-latory flow. Clinical case: A female patient, two months of age, with a pulmonary process-originated septic shock is presented. The description of microcirculation alterations at 24, 72 and 120 hrs was performed while the patient underwent therapy. A MicroScan®, (MicroVision Medical, Amsterdam, Holland) was utilised on the sublingual area. The patient received ventilation support, reanimation fluids, vasoactive drugs and antibiotics. The patient presented low proportion of perfused capillary vessels, low ratio of microcirculatory flow and a high heterogeneity in flow in the first measurement, all of them independant from systemic hemodynamics and disoxia indicators. These severe alterations improved progressively at 72 and 120 hrs of therapy. Discussion: Microcirculatory alterations and its time evolution may be a tool for dynamic diagnostic and severity staging assesment in septic shock. Further studies should assess microcirculation as a target for therapeutic intervention (microcirculatory resuscitation), being also of prognostic value for septic shock and severe sepsis in children.

Introducción: El shock séptico involucra una compleja red de alteraciones circulatorias, inflamatorias y metabólicas que conducen a una disrupción energética celular. En el shock séptico se observan frecuentemente alteraciones microcirculatorias, siendo característico la existencia de unidades microcirculatorias débiles y un flujo microcirculatorio heterogéneo. Caso clínico: Se presenta una paciente de dos meses de edad con shock séptico de foco pulmonar, en la que realizamos una descripción de las alteraciones microcirculatorias a las 24, 72 y 120 h durante su tratamiento. Se utilizó MicroScan®, (MicroVision Medical, Amsterdam, Holanda) en el área sublingual. La paciente recibió soporte ventilatorio, fluidos de reanimación, drogas vasoactivas y antibióticos. En la medición inicial la paciente presentaba una baja proporción de capilares perfundidos, un bajo índice de flujo microcirculatorio y una alta heterogeneidad de flujo, todas ellas con independencia de la hemodinamia sistémica e indicadores de disoxia. Estas alteraciones graves mejoraron progresivamente a las 72 y 120 h de tratamiento. Discusión: Las alteraciones microcirculatorias y su evolución temporal pueden ser una herramienta diagnóstica dinámica y de estratificación de gravedad en estados de shock séptico. En estudios futuros la microcirculación deberá ser evaluada como un objetivo de intervención terapéutica (resucitación microcirculatoria) presentando a su vez un rol pronóstico en el shock séptico y sepsis grave en niños.

Endoglin [CD105] positive microvessel density and its relationship with lymph node metastasis in squamous cell carcinoma of the tongue

Neovascularization is an important factor for predicting tumor behavior. Evidence suggests that endoglin [CD105] is a powerful marker of neovascularization and determination of microvessel density in several malignancies, and can be used as an agent to predict lymph node metastasis. However, it is controversial, particularly in head and neck squamous cell carcinoma. We studied CD105-MVD in tongue squamous cell carcinoma and evaluated its correlation with lymph node metastasis in relation to sex, age, and histopathologic grade. This study analyzed a total of 40 cases of tongue squamous cell carcinoma by dividing patients into two groups, a] with meta-static lymph nodes [N+] and b] without metastatic lymph nodes [N-]. By CD105 immunostaining, microvessel density was determined in three different areas [intratumoral, invasive front and adjacent normal tissue] of all cases. Statistically, we evaluated the relation between microvessel density and lymph node involvement, in addition to other clinicopathologic factors by using the Kolmogorov-Smirnov test, f-test, and other analyses. CD105-MVD in the invasive front [P<0.001] and intratumoral [P<0.006] areas of the N+ group was significantly higher than in the N-group. In addition, there was a correlation between CD105-MVD and differentiation in the invasive front area [P< 0.013] No relation existed between CD105-MVD and other clinicopathologic features. CD105-MVD, as a prognostic factor, may be helpful for determining the possibility of lymph node metastasis of primary SCC of the tongue

Anatomía quirúrgica del drenaje venoso en la región del triángulo carotídeo / Surgical anatomy of jugular vein tributaries

Background: The main tributaries of the internal jugular vein join at cervical level through the venous thyrolinguofacial trunk. This trunk is classically described as formed by the union of the facial, superior thyroid and lingual veins. Aim: To evaluate variations in the formation of the thyrolinguofacial trunk in human cadavers. Material and Methods: Thirty hemi-necks were dissected in human cadavers of nine men and six women, with ages ranging between 29 and 50 years, and analyzed by direct observation. Results: In 16 hemi-necks (53.3 percent), the trunk was thyrolinguofacial; in seven (23.3 percent), it was linguofacial; in six (20 percent), it was thyrolingual and in one case (3.3 percent) it was thyrolinguo pharyngofacial. No thyrofacial trunk formation was found. There was a correlation between the diameter of the internal jugular vein and of the venous trunk formed by these veins. Conclusions: There are morphological changes in the formation patterns of facial, lingual and superior thyroid veins. This information is useful for surgical oncology, plastic surgery, head and neck surgery and radiology.

Los principales afluentes de la vena yugular interna se incorporan a nivel cervical por medio del tronco venoso tirolinguofacial. Clásicamente se ha descrito su formación por la unión de la vena facial, lingual y tiroidea superior. El objetivo de este estudio fue determinar las variaciones en la presentación del tronco tirolinguofacial en cadáveres humanos de la región del Maule, Chile. Se disecaron 30 hemicuellos pertenecientes a 15 cadáveres humanos de ambos sexos, con un rango de edad entre 29 y 50 años, y se analizaron mediante observación directa. Se observó la formación de tronco venoso en la totalidad de los casos, siendo 53,3 por ciento correspondiente al tronco de tipo tirolinguofacial, 23,3 por ciento linguofacial, 20 por ciento tirolingual y sólo un 3,3 por ciento el tronco tirolinguofaringofacial. No se encontró la formación del tronco venoso de tipo tirofacial. Además se encontró una correlación significativa entre el diámetro de la vena yugular interna y el tronco venoso conformado por estas venas. Por lo tanto, existen variaciones morfológicas en los patrones de conformación de las venas facial, lingual y tiroidea superior, siendo estos datos de importancia para áreas de cirugía oncológica, cirugía plástica, cirugía de cabeza y cuello y radiología.

Correlation of " in vivo" microcirculation and degeneration of the basal cells of the epithelium in lingual lichen planus.

Background: Oral lichen planus is an inflammatory chronic disease with an autimmune pathogenesis and unknown etiology that affects oral mucosa, with or without the involvement of the skin and other mucous membranes. The principal histological characteristics are the degeneration of the basal cell layer and the abnormal infiltration of inflammatory cells into the subepithelial layer of connective tissue. Objectives: This study is aimed to appraise if lingual lichen planus (LLP) is sustained by alteration of the oral microcirculation and if this abnormal vascularisation increases the degeneration of basal keratinocytes and the disruption of the basement membrane. Materials and Methods: Fifteen patients with a histological diagnosis of LLP with higher degree of degeneration of the basement membrane, fifteen LLP patients with lower degree of basement membrane (BM) degeneration and fifteen healthy patients were included in the study. The microcirculation of the left margin of the lingual mucosa of all the patients and subjects was analysed with the videocapillaroscopy. The following parameters were analyzed on each capillaroscopic image: c0 apillary loop length, loop diameter, and capillary density. The results obtained by videocapillaroscopy software were subjected to statistical analysis using Mann Whitney U-test (P < 0.001). Statistical analysis was performed using PAST software, v. 1.53. Results: Capillary density, loop length, and total diameter showed statistically significant differences between LLP patients with histologically lower degree of BM degeneration and healthy subjects and a meaningful significant difference between LLP patients with higher degree of BM degeneration. Conclusions: A remarkable increase in capillary density was showed by videocapillaroscopic exam. The increased value of the density could be associated with angiogenesis mechanism and it could be an indicator of the evolutionary condition of LLP. Videocapillaroscopy may be useful for the evaluation of the evolution or regression of the disease.

Comparison between eletrosurgery and cold blade in tongues of rats: a preliminary experimental study / Estudo comparativo entre eletrocirurgia e bisturi frio em língua de ratos: estudo preliminar experimental

PURPOSE: To compare tissue cicatrization in the tongue of rats using electrosurgery and the cold blade. METHODS: Ten adult male Wistar rats were divided into two groups of 5 animals each, according to the time of sacrifice (3 and 7 days). Each animal had two incisions, one made with a cold blade and the other with an electric blade, both of which were approximately 0.5 mm in length. Following sacrifice of the animals, the tongues were submitted to a histological study in order to classify the presence of angiogenesis, fibroblastic proliferation, epithelial proliferation and inflammatory cells as good, moderate and weak. RESULTS: The wound made with electric blade presented a delay in the healing process and a greater inflammatory response as compared with the cold blade, despite the fact that there was no statistically significant difference (p<0.05). CONCLUSION: There were no significant statistical differences between electrosurgery and the cold blade in relation to angiogenesis, fibroblastic proliferation, epithelial proliferation or the presence of inflammatory cells at any time of evaluation.

OBJETIVO: Comparar a cicatrização tecidual com bisturi elétrico e frio em língua de ratos. MÉTODOS: A amostra foi de 10 ratos Wistar, divididos em dois grupos com 5 animais em cada, de acordo com o tempo de sacrifício (3 e 7 dias).Cada animal teve duas incisões transversais, com 0,5 mm de comprimento, no dorso da língua, sendo a mais anterior com a eletrocirurgia (experimento), e a mais posterior, com bisturi convencional (controle). Após o sacrifício dos animais, as línguas foram submetidas a análise histológica para classificação da presença de angiogeneses, proliferação fibroblástica e epitelial e células inflamatórias em boa, moderada e fraca. RESULTADOS: Os resultados indicaram que as feridas realizadas com bisturi elétricos apresentaram um retardo no processo cicatricial e uma maior resposta inflamatória quando comparadas com as feridas do bisturi frio, apesar de não ter havido diferença estatisticamente significante (p<0.05). CONCLUSÃO: Não houve diferença significante entre o bisturi elétrico e frio em relação a presença de angiogeneses, proliferação fibroblástica e epitelial e células inflamatórias para nenhum dos dois tempos de avaliação.

Tiroiditis de Hashimoto: microcirculación lingual y labial en pacientes afectados por macroglosia / Hashimoto's thyroiditis: lingual and labial capillary microcirculation in patients affected by macroglossia

The aim of this study is to estudy lingual and labial microcirculation differences among healthy subjects and those with Hashimoto's thyroiditis affected by macroglossia. Twenty healthy patients and 20 patients suffering from Hashimoto's thyroiditis were examined. Labial and lingual capiUaroscopy were used to investigate the characteristics of microcirculation. For each patient we evaluated visibility, course, tortuosity and the possible presence of microhaemorrhages, average calibre of capillary loops and the number of visible capillary loops per square millimetre. The investigations of the labial and lingual mucous were simple, non invasive and repeatable for each patient. In Hashimoto's thyroiditis patients it was possible to observe a wide vascular architectural disorganisation, morphologic anomalies of the capillary loops, loosening of the U shape, reduced capillary diameter This study shows that capillary alterations in patients suffering from Hashimoto's thyroiditis occur in the labial and lingual mucous microcirculation. In the patients affected by macroglossia a reduced number of capillary density was observed and it was correlated to the deposition of proteinaceous ground substance.

El objetivo de este estudio fue verificar las diferencias en la microcirculación lingual y labial entre sujetos sanos y con tiroiditis de Hashimoto afectados por macroglosia. Fueron examinados 20 pacientes sanos y 20 que sufrían de tiroiditis de Hashimoto. Fue utilizada capiloroscopía labial y lingual para investigar las características de la microcirculación. Para cada paciente examinamos visibilidad, curso, tortuosidad y la posible presencia de microhemorragias, el calibre medio de curvaturas capilares y el número visible de curvaturas capilares por milímetro cuadrado. La investigación de la mucosa labial y lingual fue simple, no invasiva y repetible para cada paciente. En pacientes con tiroiditis de Hashimoto fue posible observar una desorganización arquitectónica vascular, anomalías morfológicas de las curvaturas capilares, pérdida de la forma de U y reducción del diámetro capilar. Este estudio demuestra que las alteraciones capilares en pacientes que sufren de tiroiditis de Hashimoto ocurren en la microcirculación de la mucosa labial y lingual. En los pacientes afectados por macroglosia fue observada una reducción de la densidad capilar y esto está correlacionado a la deposición de...

Angioarchitectural arrangements in corrosion casts of the tongue of young malnourished rats

Casts of the microvascular of three types of lingual papillae have been investigated by scanning electron microscopy (SEM) employing the corrosive resin cast technique. The microvascular arrangements of the filiform papillae exhibit both a simple and a twisted capillary loops. The fungiform papillae which are formed by capillary network resembles a cylinder with a central hole on it. At a high magnification, the venulaeexhibit nuclear imprint of the endothelial cells. The data presented in this study show the general arrangement and angioarchitecture of the lingual papillae in rats on a protein-free diet.

Hereditary haemorrhagic telangiectasia.

Hereditary haemorrhagic telangiectasia (Osler-Rendu-Weber syndrome) is an autosomal dominant vascular disorder, manifesting with telangiectases and bleeding in different parts of the body. We report a patient who presented with bleeding from various sites.

Gangrena de lengua: modo de presentación de la arteritis temporal / Gangrene of the tongue: form of presentation of temporal arteritis

Se presenta el caso clínico de un varón de 85 años, con odinogafia, los moniliasis bucal y deterioro del estado general, síntomas y signos que precederon la aparición de gangrena de lengua. Se postula como causa de la misma el compromiso de las arterias linguales por arteritis, lo cual fue confirmado por biopsia de la arteria temporal izquierda. El enfermo debió sufrir amputación de los tercios anteriores de la lengua, mejorando su cuadro general con la cirugía y la administración de corticosteroides