Diagnóstico y tratamiento del granuloma piógeno oral: serie de casos / Oral pyogenic granuloma diagnosis and treatment: a series of cases

Resumen Este artículo tiene el propósito de mostrar en una serie de casos la aplicación de la técnica de biopsia excisional con gingivoplastia como tratamiento del granuloma piógeno. También se puede observar que la correcta extirpación; así como la eliminación de los factores con tribuyentes disminuye considerablemente la probabilidad de recidiva. En este reporte de serie de casos se ha descrito la presencia del granuloma piógeno relacionado al estado de gestación, a factores locales como ausencia de contacto interproximal, presencia de cálculo e índices de higiene oral malos. Además, se recomienda que la Instrucción de higiene oral sea el primer paso en el tratamiento del granuloma piógeno y que posteriormente a la extirpación de la lesión los pacientes reciban terapia periodontal de soporte.

Abstract The present article purports the aim of showing, in a series of cases, the application of excisional biopsy with gingivoplasty technique as treatment of pyogenic granuloma. It can be observed that accurate excision as well as elimination of contributing factors considerably decreases recurrence probabilities. Presence of pyogenic granuloma has been described in this report of a series of cases related to pregnancy, local factors such as absence of interproximal contact, presence of calculi and poor oral hygiene indexes. Moreover, it is recommended that oral hygiene instruction be the first step in treatment of pyogenic granuloma, and that after lesion excision patients receive supporting periodontal therapy.

Pyogenic granuloma associated with mandibular odontoma / Granuloma piógeno asociado a odontoma mandibular

Background: pyogenic granuloma is a kind of inflammatory hyperplasia of multifactorial origin, which is usually related to trauma or constant irritation, drug use, hormonal factors, among others. Meanwhile the odontoma is a benign tumor odontogenic composed of epithelial and mesenchymal cells, their development is usually associated with trauma, infections, inherited disorders or hyperactivity odontoblast. Objectives: The objective is to present the clinical case of a patient that presented a case of pyogenic granuloma related to the presence of a mandibular odontoma, and therapeutic management and postoperative results. Case report: The case shows a female patient of 32 years old with a history of multinodular goiter and hypothyroidism, developing a mandibular odontoma of the left side associated with pyogenic granuloma in the same area, which was treated with surgical excision and reconstructed affected tissues with lyophilized bone and collagen membrane. Favorable outcome after surgery without evidence of recurrence, with proper osseointegration of alloplastic materials and soft tissues. Conclusions: The irritant effect of the presence of a tumor (odontoma) in developing confirmed pyogenic granuloma.

Antecedentes: el granuloma piógeno es una especie de hiperplasia inflamatoria de origen multifactorial, que suele relacionarse a trauma o irritaciones constantes, uso de drogas, factores hormonales, entre otras. Por su parte el odontoma es una tumoración odontogénica benigna, compuesta de células epiteliales y mesenquimatosas, su desarrollo suele relacionarse con traumatismos, procesos infecciosos, alteraciones hereditarias o hiperactividad odontoblástica. Objetivos. El objetivo es presentar el caso clínico de una paciente la cual presento un caso de granuloma piógeno relacionado a la presencia de un odontoma mandibular; así como el manejo terapéutico y los resultados posoperatorios. Caso clínico: El caso muestra a una paciente del sexo femenino de 32 años de edad con antecedentes de bocio multinodular e hipotiroidismo, desarrollando un granuloma piógeno asociado al desarrollo de un odontoma mandibular del lado izquierdo, el cual fue tratado con extirpación quirúrgica y los tejidos incidido reconstruidos con hueso liofilizado y membrana de colágeno. Evolución favorable pos quirúrgica, sin evidencia de recidiva, con correcta osteointegración de materiales aloplásticos y tejidos blandos. Conclusiones: se confirma el efecto irritante de la presencia de una tumoración (odontoma) en el desarrollo de un granuloma piógeno.

Granuloma telangiectásico: presentación de un caso significativo / Telangiectatic Granuloma: A Meaningful Case

El granuloma telangiectásico bucal es una hiperplasia reactiva inflamatoria que afecta lamucosa y el tejido gingival de la cavidad oral. Se presenta como una reacción del tejidoconectivo a estímulos como traumas, irritación local por placa dental, procesos infecciososy factores hormonales. Es una patología muy frecuente en la región suramericana, que sedescribe clínicamente como una lesión tumoral de color rojo, tamaño variable, superficielisa o rugosa, de base pediculada con mayor frecuencia, consistencia blanda y tendenciaa sangrar cuando es manipulado. La remoción quirúrgica es el tratamiento de elección. Sereporta el caso clínico de un paciente con diagnóstico de granuloma telangiectásico degran tamaño, que acudió a la clínica odontológica de la Corporación Universitaria RafaelNúñez en Cartagena, Colombia. Se describen las características clínicas e histopatológicas,así como su tratamiento...

Oral granuloma telangiecticum is a reactive inflammatory hyperplasia that affects oralmucosa and gingival tissues. It is a reaction of the connective tissue to trauma, dentalplaque-induced irritation, infections and hormonal factors. This pathology is often found inthe South American region and is clinically described as a red tumorous lesion with variablesize, smooth or rough surface, frequently pedicled, soft consistency, and tends to bleedwhen it is manipulated. Treatment consists of surgical enucleation. This is a case report ofa patient with diagnosis of large-sized granuloma telangiecticum who attended the dentalclinics of Corporación Universitaria Rafael Núñez in Cartagena Colombia. Clinical characteristics,histopathology, and treatment provided are described...

Análisis clínico e histomorfológico de la mucosa oral normal, hiperplasia fibroepitelial inflamatoria oral y displasia oral / Clinical and histomorphological analysis of normal oral mucosa, oral inflammatory hyperplasia and oral epithelial displasia

El desarrollo del cáncer oral puede darse a partir de una mucosa aparentemente normal o a partir de una lesión precursora inicial, las cuales pueden representar pasos diferentes del proceso de carcinogénesis epitelial oral. El objetivo de este estudio fue analizar morfológicamente, a través de la técnica de la hematoxilina / eosina, la mucosa oral normal, con hiperplasia fibroepitelial oral y displasia epitelial oral, con el propósito de obtener mayor información sobre las alteraciones epiteliales que pueden preceder al establecimiento y evolución de una neoplasia propiamente tal. Fue observado que muchas de las alteraciones morfológicas observadas en las hiperplasias fibroepiteliales orales probablemente eran asociadas al proceso inflamatorio, donde es conocida la acción de mediadores químicos con capacidad de promover modificaciones morfológicas celulares y en la estructura tisular y no necesariamente representan alteraciones comunes de lesiones potencialmente malignas. Correlacionando el aspecto clínico de las lesiones con el diagnóstico histopatológico de displasia epitelial oral, no fue observada diferencia expresiva; sin embargo, la mayoría de los especímenes tuvo diagnostico clínico de leucoplasia. Se concluyó que la simple observación de las características morfológicas de las alteraciones de la mucosa oral puede ayudar el establecimiento del diagnóstico de las lesiones sufridas por la mucosa; sin embargo, no ofrecen muchas información sobre cuáles serían los eventos que llevarían al establecimiento de una determinada lesión.

The oral cancer development can be from apparently normal mucosa, or from precursory lesions, that can represent different step of oral epithelial carcinogenesis process. This study aimed to analyze morphologically trough the hematoxilina/eosine technique normal oral mucosa, oral fibroepithelial inflammatory hyperplasia and oral epithelial dysplasia (OED) to get more informations about the epithelial alterations that can to precede the installation and evolution of oral cancer. Its was observed that some of the morphologic alterations in the oral fibroepitelial hyperplasia were provably associated to the inflammatory process, where exist the action of chemical mediators with capacity to promote cellular morphologic modifications and alterations of the tissue architecture but not to common alterations of lesions potentially malignant. Correlating the clinical aspect of the lesions with the histopatologic diagnosis of oral epithelial dysplasia its was not observed expressive difference, however the majority of the OED specimens had clinical diagnosis of leucoplasia. Its was concluded that the simple observation of the morphologic characteristics of epithelial alterations in the oral mucosa can to improve the diagnostic of the lesions suffered by this mucosa, however, its not offers much informations about which would be the events that would lead to the establishment of a determined lesion.

Avaliação estrutural e diagnóstica de três lesões fibrosas da cavidade bucal / A structural and diagnostic evaluation of three oral fibrous lesions

O objetivo do presente trabalho é analisar os componentes celulares e de fibras do tecido conjuntivo nas hiperplasias inflamatórias (HI), nos fibromas (F) e na fibromatose gengival hereditária (FGH), além de investigar a imunocompetência e efetuar análises moleculares de pacientes com FGH. Para atingir os objetivos foram desenvolvidos 4 artigos, com diferentes metodologias e universos amostrais. No 1° artigo, pretendeu-se estabelecer critérios microscópicos validos para diferenciar F e HI. Foram avaliadas em microscópio óptico 136 lesões coradas pela Hematoxilina-eosina (HE) e pelo Tricrômico de Masson quanta às características microscópicas. Os resultados mostraram que uma área central de fibras colágenas dispostas de forma enovelada e mais densa, circundada por uma camada de fibras dispostas de forma paralela são características dos F, enquanto a presença de hiperplasia epitelial, infiltrado inflamatório e fibras colágenas organizadas de forma paralela são características das HI. Tais resultados motivaram o 2° artigo, no qual estudamos 18 lesões de F e 13 de HI, que foram preparadas histologicamente e coradas pelo picrosírius red e pelo direct blue para avaliação quantitativa das fibras colágenas e de fibras do sistema elástico, respectivamente, em microscopia a laser confocal. Os resultados confirmaram a disposição estrutural das fibras colágenas observada no 1° artigo, além de apontarem diferenças nas áreas ocupadas pelas fibras colágenas em todas as regiões estudadas. A fim de proceder a uma avaliação dos componentes fibroso e celular das 3 lesões fibrosas, foi desenvolvido o 3° artigo. Especimes das 3 lesões foram estudados em microscopia ótica, a fim de avaliar suas populações de fibroblastos e de células inflamatórias e os seguintes componentes fibrosos do tecido conjuntivo...

The objective of this study was to analyze the cellular and fibrous components of connective tissue in inflammatory hyperplasia (IH), oral fibroma (OF) and hereditary gingival fibromatosis (HGF), and to investigate the immuno competence and to perform molecular analysis in HGF patients. To achieve the goals were developed 4 articles, with different methodologies and sample universes. In the 1st article, we intended to establish microscopic criteria to differentiate F and IH. The microscopic characteristics of the lesions (n=136) stained by hematoxylin-eosin (HE) and Masson trichrome were evaluated in an optical microscope. The results showed that a central area of wound collagen fibers and arranged in a higher density, surrounded by a layer of parallel fibers are characteristic of F, while the presence of epithelial hyperplasia, inflammatory infiltrate and parallel collagen fibers are characteristics of HI. These results led the 2nd article, which studied 18 F and 13 and IH, histologically prepared and stained by picrosirius red and direct blue for the direct quantitative assessment of collagen fibers and elastic fibers of the system, respectively, in the confocal laser microscope. The results confirmed the structural arrangement of collagen fibers found in Article 1, and indicate differences in the areas of collagen fibers in all regions studied. In order to evaluate the cellular and fibrous components of the 3 fibrous lesions, was developed the 3rd article. Specimens of the 3 lesions were studied in optical microscopy, to assess their populations of fibroblasts and inflammatory cells and the following components of fibrous connective tissue: collagen fibers, elastic fiber system, reticular fibers and oxytalan fibers. The results showed different arrangement and concentration of collagen fibers in the 3 lesions and a higher concentration of reticular fibers in HGF. The analysis of...

Expressão imuno-histoquimico das integranas a2B1, a3B1, e a5B1, em mucosa oral norma hiperplasia fibroepitalial inflamatória oral e displasia epitelial oral

Este estudo se propôs analisar através da técnica da estreptoavidina-biotina a expressão imuno-histoquímica das integrinas α2ß1, α3ß1 e α5ß1 em 11 espécimes de mucosa oral normal (MON), 16 de hiperplasia fibroepitelial inflamatória oral (HFIO) e 25 de displasia epitelial oral (DEO) (16 leves, 2 moderadas e 7 graves), procurando determinar se existe alteração qualitativa na expressão destas integrinas e se a mesma guarda relação com as modificações sofridas pelo epitélio oral. Para a integrina α2ß1 a maioria dos espécimes exibiu uma marcação predominantemente intensa e difusa nos contatos intercelulares e no citoplasma celular das camadas basal e suprabasal, sem diferença desse perfil entre os diferentes tipos de espécimes, porém com uma tendência a fraca ou perda da expressão em 21.1% das DEOs, sendo todos os espécimes que não expressaram marcação para este heterodímero DEOs graves. Para a integrina α3ß1 a maioria da amostra exibiu uma marcação fraca ou ausente predominantemente em camada basal. A integrina α5ß1 exibiu uma forte marcação difusa nos contatos intercelulares e citoplasmática na camada suprabasal, com diferença apenas na intensidade de marcação entre os tipos de espécimes, residindo essa diferença nas DEOs, onde 12 (48%) espécimes exibiram uma fraca marcação. Concluiu-se que as integrinas avaliadas podem estar envolvidas nas interações célula-célula e célula-MEC que garantem a diferenciação celular e manutenção do arranjo estrutural tecidual. A variável expressão da integrina α5ß1 nas DEOs, poderia sugerir, respectivamente, um papel dessa molécula na sobrevida celular, com o intuito de perpetuar o fenótipo alterado nessas lesões, ou uma ação supressora desse fenótipo devido à falta de interação desta molécula com a fibronectina da MEC (AU).

The objective of this study was perform by the streptoavidin-biotin technique an immunohistochemical analysis of α2ß1, α3ß1 e α5ß1 integrins in 11 normal oral mucosa (NOM), 16 oral inflammatory fibroepithelial hyperplasia (OIFH) and 25 oral epithelial dysplasia (OED) (16 mild, 2 moderates and 7 severe), to determine if exists qualitative alteration in the expression of these integrins and if this guard relation with the oral epithelial modifications. It was observed that for the α2ß1 integrin the majority of the sample showed a predominantly intense labeling diffusely distributed in the intercellular contacts and the cytoplasm of cells of the basal and suprabasal layers, without difference of this profile between the different types of specimens, however with a trend to weak or loss of expression in 21.1% of the OEDs, being all the specimens that had not expressed this heterodimer, severe OEDs. For the α3ß1 integrin the majority of the sample showed a weak or absent labeling in basal layer. The α5ß1 integrin showed a predominant strong diffuse labeling in the intercellular contacts and cytoplasm in the suprabasal layer, with difference only in the labeling intensity between the types of specimens, inhabiting this difference in the OEDs, where 12 (48%) specimens had shown a weak labeling. It was concluded that the evaluated integrins can be involved in the cell-cell, cell-ECM interactions modulating the cellular differentiation and maintenance of the epithelial structural arrangement. The variable expression of the α5ß1 integrin in the OEDs, could suggest, respectively, a role of this molecule in the cellular survival, with intention to perpetuate the modified phenotype in these lesions, or a suppressor role on the modified phenotype due to lack of interaction of this molecule with the fibronectina of the MEC (AU).