Diagnostic performance of p16 staining in atypical squamous cells 'cannot exclude high-grade squamous epithelial lesion' in predicting high-grade cervical pathology.

Atypical squamous cells 'cannot exclude high-grade squamous epithelial lesion' (ASC-H) cytology represents clear risk and has been a controversial issue in clinical practice. The objective of this study is to investigate the diagnostic performance of p16(INK4A) immunohistochemistry (IHC) among ASC-H Pap smears in predicting high-grade cervical intraepithelial lesions. Decolourisation and staining process with p16(INK4A) is applied to 27 ASC-H diagnosed conventional Pap smears, which were all managed with colposcopy-directed cervical biopsy priorly. Staining characteristics of ASC-H Pap smears were compared with histopathological data and sensitivity-specificity values of p16 triage to detect CIN2 + histopathology were determined. The sensitivity and specificity of positive p16(INK4A) immune staining to detect CIN2 + histopathology were as 87.5% and 68%, respectively. The positive predictive value of p16 triage is found as 53.8% and negative predictive value was as 92.8%. p16(INK4A) IHC seems applicable for conventional Pap smears and may provide an alternative triage option in ASC-H category.

Subconjunctival amniotic membrane free graft in rabbit eyes: effects on fibrovascular reaction.

PURPOSE: The purpose of our study is to investigate the effect of subconjunctival amniotic membrane free graft on subconjunctival fibrovascular reaction. METHODS: Twelve healthy male white New Zealand rabbits were used for the study. The rabbits were divided randomly into two groups: Study Group (n=6) and Control Group (n=6). In the Study Group, a 4mm limbal incision was made and a 4×4mm subconjunctival pocket was created with blunt dissection. A 4×4mm single layer of free amniotic membrane was placed in the pocket in an epithelium-up fashion without suturing. The limbal opening was secured with 10-0 nylon sutures on both sides. In the Control Group, a 4mm limbal incision was made, a 4×4mm subconjunctival pocket was created with blunt dissection, and the limbal opening was closed with 10-0 nylon sutures on both sides. After the first month, sclero-conjunctival blocks were obtained from the operated area and sections were stained with hematoxylin and eosin, Masson trichrome, and Ki67, SMA and CD34 antibodies. RESULTS: The number of fibroblasts, lymphocytes and macrophages was significantly higher in the Study Group than in the Control Group. The number of Ki67- and SMA-positive cells, and CD34-positive vessels was also significantly higher in the Study Group. Amniotic membrane appeared to form folds in all the specimens. CONCLUSION: The higher fibrovascular reaction shown by our histopathological examination indicates that free human amniotic membrane grafting without suturing is not useful in decreasing the subconjunctival fibrovascular reaction at the first postoperative month in rabbit eyes.

Resveratrol inhibits postoperative adhesion formation in a rat uterine horn adhesion model.

AIM: Adhesion formation is one of the most important problems occuring after pelvic surgery in the majority of women. The aim of this experimental study was to investigate the effects of the antioxidant resveratrol (3,5,4'-o-trihydroxystilbene) on adhesion formation in a rat uterine horn adhesion model. MATERIALS AND METHODS: Thirty Wistar-Albino female rats were randomly divided into three groups with equal numbers. In Group A, 5.9 mg/kg/day resveratrol was applied by the orogastric route for 10 days before and 20 days after surgery. In Group B, resveratrol was given only for 20 days after surgery. In the control group, no drug was applied before or after surgery. A uterine serosal injury was created using a standard technique after laparotomy in all rats. All animals were sacrificed 3 weeks after surgery and intrapelvic adhesions determined macroscopically and microscopically. RESULTS: Adhesion formation, total adhesion score and the severity of adhesions were all significantly lower in both resveratrol treatment groups than in the control group (p < 0.05). Notably, the severity of adhesions was much less in Group A in which the rats received resveratrol before and after surgical operation. CONCLUSIONS: This study suggests that 5 ± 1 mg/kg/day perioperative resveratrol administration is an effective strategy for the prevention of postoperative peritoneal adhesion formation after pelvic surgery in a rat model.

Topical cyclosporine A for the dry eye findings of thyroid orbitopathy patients.

PURPOSE: To determine the beneficial effect of topically administered Cyclosporine A (CsA) for the dry eye findings of thyroid orbitopathy patients. PATIENTS AND METHODS: This prospective pilot study included 73 eyes of 42 patients with thyroid orbitopathy who had documented dry eye findings. Patients were randomly assigned into two groups: in group 1 (48 eyes), patients received topical artificial tear-drop treatment. In group 2 (25 eyes), patients received topical CsA and artificial tear-drop treatment. During a mean follow-up of 6 months, change in Schirmer's test with aneasthesia, tear break-up-time (BUT) and impression cytology results were analyzed and were compared between groups. RESULTS: The two groups were age (P=0.449) and gender (P=0.942) matched. The Schirmer's test (P=0.441), tear BUT (P=0.718) and impression score (P=0.103) were also similar before the treatment in both groups. In group 1, all three parameters improved significantly with treatment (P<0.001 for all). In group 2, Schirmer's test (P=0.001) and tear BUT (P<0.001) improved, but the impression score (P=0.175) did not change significantly after treatment. The percentage of patients with improved tear BUT (P=0.04) and improved impression score (P<0.001) were higher in group 1. At the end of follow-up, group 1 patients had better Schirmer's test (P=0.004), tear BUT (P=0.021) and impression scores (P<0.001), than group 2 patients. CONCLUSIONS: The combined CsA use with artificial tear drops is not more advantageous than the use of artificial tear drops alone, for the dry eye findings of thyroid orbitopathy patients.

A histopathological approach: when papulopustular lesions should be in the diagnostic criteria of Behçet's disease?

UNLABELLED: BACKGROUNDPapulopustular lesions (PPL) are commonly seen cutaneous lesions in Behçet's disease (BD). Some authorities do not recommend using cutaneous lesions for diagnostic criteria because these lesions are confused with acne vulgaris. Objective To understand if PPL have diagnostic value in BD. METHODS: Biopsy was performed on papulopustular lesions of Behçet's patients for histopathological examination to compare with the control group composed of patients with acne vulgaris. Forty two patients with BD and 21 control patients with acne vulgaris were enrolled in the study. Histopathological findings were classified as leukocytoclastic vasculitis, lymphocytic vasculitis, superficial and/or deep perivascular infiltration, and folliculitis and/or perifolliculitis. RESULTS: Of the specimens from 42 Behçet's disease patients, 7 (16.7%) revealed leukocytoclastic vasculitis and 3 (7.1%) had lymphocytic vasculitis, 15 (35.7%) had superficial perivascular and/or interstitial infiltration, 12 (28.6%) had superficial and deep perivascular and/or interstitial infiltration, 5 (11.9%) had folliculitis or perifolliculitis. Of the control group patients, 9 (42.9%) had folliculitis or perifolliculitis, 8 (38.1%) revealed superficial perivascular inflammation and 4 (19.0%) revealed mixed superficial and deep perivascular inflammation. Vasculitis was not encountered in any control group specimens. Vasculitis ratio was statistically higher in Behcet's disease patients (P = 0.016). CONCLUSIONS: We evaluated more patients than previous related studies reported in the literature. Histopathological findings of vasculitis were encountered only in BD group. Non-vasculitis histopathological findings were also encountered in the control group patients. In conclusion, PPL can be used as a diagnostic criterion of BD subsequent to finding vasculitis in histopathological examination of the biopsy specimen of the PPL.

E-cadherin expression in endometrial malignancies: comparison between endometrioid and non-endometrioid carcinomas.

This study examined the frequency of E-cadherin expression in endometrial biopsy or hysterectomy specimens from patients diagnosed with endometrial adenocarcinoma and in normal endometrial tissue specimens. E-cadherin expression was detected by immunohistochemistry using monoclonal antibody to E-cadherin. Specimens were classified as positive when >or= 5% of the tumour cells showed staining for E-cadherin, irrespective of the pattern of staining. Twenty-three endometrioid carcinomas and nine non-endometrioid (four papillary serous and five clear cell) carcinomas were studied, along with 10 normal endometrial tissue specimens as controls. E-cadherin expression was significantly less frequent in non-endometrioid carcinomas compared with endometrioid carcinomas and controls. There was no statistically significant difference in the frequency of E-cadherin expression between endometrioid carcinomas and controls. In conclusion, this study demonstrated that uterine non-endometrioid (papillary serous and clear cell) carcinomas were less likely to express E-cadherin compared with endometrioid carcinomas and normal endometrial tissue. This may help to explain the more aggressive behaviour of non-endometrioid carcinomas.

Bonbon toffee sign: a new dermatoscopic feature for sebaceous hyperplasia.

INTRODUCTION: Sebaceous hyperplasia is a benign proliferation of the sebaceous gland. In this study, we tried to define the dermatoscopic features of sebaceous hyperplasia, which will help to minimize misdiagnoses. MATERIAL AND METHOD: Seventeen patients with 30 sebaceous hyperplasia lesions were included in the study. All the lesions were evaluated dermatoscopically. RESULTS: Cumulus sign, crown vessels, and milia-like cysts were detected in 100%, 86.6%, 53.3% of the lesions, respectively. In 80% of the lesions, the bonbon toffee sign was detected. CONCLUSION: During this study, we observed a feature with central umbilication surrounded by cumulus sign in 80% of our cases, and we named this entity as the 'Bonbon toffee sign', which resembled us 'bonbon toffee'. We think the 'bonbon toffee sign' is a simple and easily recognizable phrase, and it can be used as a new terminology in dermatoscopic diagnosis of sebaceous hyperplasia.

Propofol reduces nitric oxide-induced apoptosis in testicular ischemia-reperfusion injury by downregulating the expression of inducible nitric oxide synthase.

BACKGROUND: The aim of the present study was to investigate the underlying mechanisms in the preventive effects of intravenous anesthetics on testicular ischemia-reperfusion injury. METHODS: Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. Anesthesia was induced and maintained with thiopental in groups 1 and 2 and with propofol in groups 3 and 4. Groups 2 and 4 received left testicular ischemia (torsion) for 1 h and reperfusion (detorsion) for 24 h. Groups 1 and 3 (control groups) had no testicular torsion and detorsion. At 24 h of reperfusion, animals were killed and ipsilateral testes were removed for determination of tissue nitric oxide (NO) levels and immunohistochemical evaluation of endothelial nitric oxide synthase (eNOS), inducible NOS (iNOS), and apoptosis protease-activating factor 1 (APAF-1). RESULTS: Between groups 1 and 3, there were no differences in tissue NO levels and eNOS, iNOS, and APAF-1 expressions. iNOS and APAF-1 expressions were markedly increased in group 2, but these parameters were at the mild to moderate level in group 4 at 24 h of reperfusion. Also, elevated expression of iNOS was accompanied by a high NO production in group 2 compared with group 4. Although eNOS expressions were increased in both the groups (groups 2 and 4), there were no significant differences between these groups. CONCLUSIONS: Propofol as an anesthetic agent may attenuate germ cell-specific apoptosis and decrease NO biosynthases through downregulation of iNOS expression in an animal model of testicular torsion and detorsion.

Pulmonary parenchymal alveolar histological study in experimental tracheo-oesophageal malformations / Estudio histológico alveolar y parenquimal pulmonar en malformaciones tráqueo-esofágicas experimentales

OBJECTIVE: Children operated on for tracheo-oesophageal malformation (TOM) often suffer from postoperative respiratory system difficulties. There is little current literature about this subject. This study aimed to investigate the causes of these problems in rats with experimental TOM by evaluating the lung alveolar histology. SUBJECTS AND METHODS: Twenty Wistar albino rats were used for the experiment. Twelve rats with a sperm positive vaginal smear received 1.75 mg/kg intraperitoneal adriamycin on days six to nine of gestation. A sham group was infused with saline instead of adriamycin. A control group was not subjected to any additional procedure. Their fetuses were dissected under surgical microscope. After examining the trachea and oesophagus, the lungs were dissected and fixed in 10% formalin. The groups were compared with respect to alveolar flat cell (Type-1), capillary density and air space percentage in the samples obtained under light microscopy. Statistical evaluation was performed through Mann-Whitney-U tests and Pearson Chi-squared tests. RESULTS: Type-1 cell ratio and air space percentage were the highest for the control and sham groups. However, the group that received adriamycin and developed TOM had the lowest values. There were no statistically significant differences between the groups with respect to capillary density. CONCLUSION: In rats with experimentally produced TOM, the pulmonary parenchyma showed delayed maturation. This could be the cause of the frequently seen respiratory system pathologies in children suffering from TOM. Further studies should be done to elucidate this.

OBJETIVO: Los niños operados por malformaciones tráqueo-esofágicas (MTE) sufren a menudo de dificultades postoperatorias en el sistema respiratorio. En el presente, existe poca literatura sobre este problema. Este estudio va encaminado a investigar las causas de estos problemas en ratas con MTE experimentales, mediante la evaluación de la histología alveolar del pulmón. SUJETOS Y MÉTODOS: Veinte ratas albinas Wistar fueron usadas en el experimento. Doce ratas con frotis vaginal positivo de esperma recibieron 1.75 mg/kg de adriamicina intraperitoneal en los días seis al nueve de gestación. A un grupo de simulación (sham group) se le dio una solución salina en lugar de adriamicina. El grupo de control no fue sometido a ningún procedimiento adicional. Sus fetos fueron disecados bajo microscopio quirúrgico. Luego de examinar la tráquea y el esófago, los pulmones fueron disecados y puestos en formaldehído al 10%. Recurriendo a la microscopía lumínica, los grupos fueron comparados con respecto a células alveolares planas (tipo 1), densidad capilar y porcentaje de espacio de aire en las muestras obtenidas. La evaluación estadística se realizó mediante tests U de Mann-Whitney y tests de Chi-cuadrado Pearson. RESULTADOS: La proporción de células de tipo 1 y el porcentaje de espacio de aire, fueron los más altos para los grupos de simulación y control. Sin embargo, el grupo que recibió adriamicina y desarrolló MTE, tuvo los valores más bajos. Con respecto a la densidad capilar, no hubo diferencias estadísticamente significativas entre los grupos. CONCLUSIÓN: En ratas con malformación MTE producida experimentalmente, el parénquima pulmonar mostró retardo en su maduración. Esto podría ser la causa de las patologías del sistema respiratorio observadas con frecuencia en niños que padecen de MTE. Se requieren estudios ulteriores a fin de dilucidar esta cuestión.

Pulmonary parenchymal alveolar histological study in experimental tracheo-oesophageal malformations.

OBJECTIVE: Children operated on for tracheo-oesophageal malformation (TOM) often suffer from postoperative respiratory system difficulties. There is little current literature about this subject. This study aimed to investigate the causes of these problems in rats with experimental TOM by evaluating the lung alveolar histology. SUBJECTS AND METHODS: Twenty Wistar albino rats were used for the experiment. Twelve rats with a sperm positive vaginal smear received 1.75 mg/kg intraperitoneal adriamycin on days six to nine of gestation. A sham group was infused with saline instead of adriamycin. A control group was not subjected to any additional procedure. Their fetuses were dissected under surgical microscope. After examining the trachea and oesophagus, the lungs were dissected and fixed in 10% formalin. The groups were compared with respect to alveolar flat cell (Type-1), capillary density and air space percentage in the samples obtained under light microscopy. Statistical evaluation was performed through Mann-Whitney-U tests and Pearson Chi-squared tests. RESULTS: Type-1 cell ratio and air space percentage were the highest for the control and sham groups. However, the group that received adriamycin and developed TOM had the lowest values. There were no statistically significant differences between the groups with respect to capillary density. CONCLUSION: In rats with experimentally produced TOM, the pulmonary parenchyma showed delayed maturation. This could be the cause of the frequently seen respiratory system pathologies in children suffering from TOM. Further studies should be done to elucidate this.

Evaluation of lung pathology in an experimental model of tracheal foreign body.

AIM: This experimental study was undertaken to evaluate the pathological changes caused by foreign body aspiration (FBA) on the lungs. MATERIAL AND METHODS: The study was performed on 19 Wistar albino rats. The rats in the control group (n = 5) were not subjected to any procedures. The rats in the sham group (n = 5) underwent tracheostomy, and a feeding tube was inserted into each rat. In nine rats in Group 1 (the study group), small lead marbles were placed into their trachea in addition to the procedures applied in the sham group. Lung tomography was performed on all the rats. The lungs, heart, and trachea were removed en bloc under ketamine hydrochloride anesthesia and fixed in 10 % formalin solution at the end of one week. The lung tissues were examined for FB, perivascular and peribronchial inflammatory cell infiltration, intra-alveolar bleeding, and post-obstructive emphysema. RESULTS: Tomography revealed FB in 4 rats and pathological evaluation showed FB in 7 rats. All the rats in Group 1 had peribronchial inflammation, while 7 rats (77.8 %) had perivascular inflammation. The sham and control groups were collectively referred to as Group 2 because of statistically similar findings. Group 1 and Group 2 significantly differed with respect to the findings of perivascular and peribronchial inflammation, intra-alveolar hemorrhage, and emphysema (p < 0.05). In Group 1, inflammation was detected in the opposite lobe of the lungs, although there was no FB. CONCLUSION: The presence of inflammation in the opposite lobe of the lungs where no FB was placed and in even those rats that expectorated the FB suggests that FBA is not a local pathology but a general pathology inducing inflammation in the whole lung. Thus, urgent removal of a foreign body is vital.

Effects of beta-D-glucan on steroid-induced impairment of colonic anastomotic healing.

BACKGROUNDS/AIMS: Inflammation during the early phase of anastomotic wound healing is an essential cellular response and is suppressed by corticosteroids. The anti-inflammatory effect of corticosteroids is largely responsible for its impairment of wound healing in bowel anastomosis. Beta-D-glucan, a commonly used macrophage activator, has been shown to improve anastomotic wound healing under normal conditions. In the present study, we have investigated the effects of beta-D-glucan on anastomotic wound healing in rats treated with long-term corticosteroid. METHODOLOGY: 92 male Sprague-Dawley rats were randomized into four groups. 1 : control, 2: control + beta-D-glucan, 3 : steroid, 4 : steroid + beta-D-glucan. Methylprednisolone (5mg/kg) was injected IM daily for 14 days in groups 3 and 4. After 14 days, following anaesthesia and laparotomy, colonic anastomosis was performed 3 cm away from the peritoneal reflection of rectum. In groups 2 and 4, 100mg/kg beta-D-glucan was administered orally for 7 days before laparotomy. On postoperative day 3, relaparotomies were performed and bursting pressures, hydroxyproline levels and histopathological specimens were studied. RESULTS: The mean values of bursting pressures groups were 50.8 (95% CI 46.99-56.50), 58.2 (95% CI 54.49-61.90), 32.0 (95% CI 29.21-34.98), 45.9 (95% CI 43.09-48.80) respectively. The differences of the mean values of the groups between group 1 and 2 and also 3 were significant (p = 0.002, p < 0.001). The mean values of hydroxyproline of the groups were 3.8 (95% CI 3.56-4.06), 4.7 (95% CI 4.50-5.04), 2.9 (95% CI 2.73-3.20), 3.9 (95% CI 3.65-4.22) respectively. The differences of the values of the groups between control (group1) and group 2 and also group 3 were significant (p = 0.001, p < 0.001). In histopathological examination, increased macrophages and fibroblast population were observed in specimens from beta-D-glucan-treated animals. CONCLUSION: The results indicate that in rat model, oral administration of beta-D-glucan causes a significant improvement in the healing of anastomotic wound impaired by long-term corticosteroid administration.

Effects of exposure to new inhalational anesthetics on spermatogenesis and sperm morphology in rabbits.

The effects of chronic exposure to new inhalation anesthetics (sevoflurane and isoflurane) on spermatogenesis and sperm morphology were examined in 23 rabbits, randomly divided in 3 groups. Rabbits received 20 exposure hours (four hours/day x 5 days), as follows: group I: 2.3% (1.2 MAC) sevoflurane + 2L/min oxygen, group II: 1.3% (1.2 MAC) isoflurane + 2L/min oxygen, and group III (control): 2L/min oxygen. Semen was collected on the 12th, 19th, 26th, 33rd, and 41st days of exposure. Sperm concentration, motility and morphological changes were evaluated. On the 41st day, testicular biopsies were taken and observed with light microscopy. Sperm concentration and motility significantly decreased in the sevoflurane and the isoflurane groups, compared to control. There were no significant changes in the control group. It is concluded that chronic exposure to the new inhalational anesthetics had negative effects on spermatogenesis and sperm morphology.

Is metoclopramide an alternative to tramadol in management of post-operative pain? An experimental study.

In this study, metoclopramide was compared with other pharmacological agents for preventing post-operative pain. Sixty Sprague-Dawley male rats, weighing 310-345 g were included in the study; 1 cm surgical incision, including skin, facia, and muscle was made to the plantar surface of rear foot of all anaesthetized rats. Rats were randomized into four groups. In group 1 (group S) 2 cm3 saline, in group 2 (group M) 2 cm3 metoclopramide (5 mg/kg) in group 3 (group T) 2 cm3 tramadol (45 mg/kg), in group 4 (group M+T) half doses of group M and group T was given intraperitoneally. Post-operative pain was assessed after 2 h, first and second days of incision. Post-operative pain scores were found to be significantly lower in group M, group T and group M+T when compared with the control group. But there was no significant difference between these groups. We concluded that metoclopramide, with low cost, fewer side-effects and being significantly effective for preventing post-operative pain, can be an alternative to tramadol.

Effects of magnesium sulphate and clonidine on propofol consumption, haemodynamics and postoperative recovery.

BACKGROUND: This placebo-controlled, double-blind study was designed to assess the effects of magnesium sulphate and clonidine on peroperative haemodynamics, propofol consumption and postoperative recovery. METHODS: Sixty ASA I-II patients undergoing spinal surgery were randomized into three groups. Group M received magnesium sulphate 30 mg kg(-1) as a bolus before induction and 10 mg kg(-1) h(-1) by infusion. Group CL received clonidine 3 microg kg(-1) as a bolus before induction and 2 microg kg(-1) h(-1) by infusion during the operation period. The same volume of isotonic solution was administered to the control group (group CT). Anaesthesia was induced with propofol and was maintained with propofol infusion [dose according to the bispectral index (BIS)], fentanyl and cisatracurium. Analysis of variance and the Bonferroni test were used for statistical analysis. RESULTS: Induction of anaesthesia with propofol was rapid in the presence of magnesium sulphate and clonidine. The time for BIS to reach 60 was significantly shorter in group M and group CL (P<0.0001) but postoperative recovery was slower with magnesium sulphate compared with the clonidine and control groups (P<0.0001). There was no statistical difference in heart rate and arterial blood pressure between the groups. Propofol requirements for induction and maintenance of anaesthesia were significantly lower with magnesium and clonidine (P<0.0001). CONCLUSION: Clonidine caused bradycardia and hypotension and magnesium sulphate caused delayed recovery, but can be used as adjuvant agents with careful management.

Nocardia farcinica brain abscess, a case report and review of the literature

La infección por nocardia no es rara, como se cree y su tasa de mortalidad es alta. Se aisla en las plantas y en el suelo en muchas regiones del mundo. Los huéspedes reúnen factores predisponentes y se adquiere a través del tracto respiratorio o de la piel. Estos microorganismos tienen tendencia a diseminarse por vía hematógena desde el punto de la infección hasta el cerebro, riñon, articulaciones, huesos y ojos. Se prefieren las sulfami-das, empíricamente, para el tratamiento. A causa del gran número de recurrencias, el tratamiento debe continuar durante 12 meses. En la infección por nocardia farcinica, debe tenerse en cuenta la resistencia característica a las cefalosporinas. En este artículo, se presenta un caso raro de infección por nocardia farcinica, con un absceso cerebral solitario. Se revisa la literatura (AU)

Nocardia infection is not rare as generally been assumed and its mortality rate is high. It is isolated from plants and soil in most regions of the worid. The hosts usually have predisposing conditions and the infection is acquired through the respiratory tract or skin. Nocardial organisms have a tendency to dissemi¬nate hematogenously from the primary site of infection to brain, kidney, joints, bones and eyes. Sulfonamides are preferred empirically for the treatment. Because of high relapse rates, the treatment must be continued for 12 months. In nocardia farcinica infection, the characte¬ristic resistance pattem to cephalosporines must be kept in mind. In this article, a rare case of nocardia farcinica infection with a solitary cerebral abscess is presented and the literature is reviewed (AU)

Oral lichen planus: an unusual cause of facial and abducens nerve paralysis associated with conjunctival and oesophageal involvement.

Lichen planus (LP) is a T-cell-mediated disorder that may involve the skin, nails and mucosal surfaces. Conjunctival, laryngeal and oesophageal involvement were reported to be extremely rare manifestations of the disease. In this report, we present an oral LP case who complained of severe burning pain on his tongue and oral mucosa caused by ulcerative lesions and associated with conjunctival, laryngeal and oesophageal involvement. In addition, neurological examination revealed facial and abducens nerve palsy. To the best of our knowledge, we are presenting the first case of erosive oral LP associated with facial and abducens nerve paralysis. Although this association may be coincidental, according to an immunological concept proposed to explain the pathogenesis of Bell's palsy, degranulation of mast cells activated by complement or specific allergens with the release of histamine and other substances were to be presented responsible from nerve oedema, ischaemia and paralysis. As mast cell mediators are likely to be involved in the immunopathogenesis of OLP, we think that the cause of facial and bilateral abducens nerve palsy could be explained by the same mechanism. This case is a good example of the need for team work in lichen planus patients undergoing interdisciplinary consultations.