Diagnosis at different stages of paracoccidioidomycosis with oral manifestation: Report of two cases.

Paracocciodiomycosis (PCDM) is a chronic systemic fungal infection, mainly affecting residents and rural workers, being characterized by a long incubation period, which it can take months or years without clinical manifestations, making diagnosis late and difficult. Depending on the stage of the disease, it can cause sequelae and low quality of life, so its correct diagnosis is of great importance for the accurate treatment. Therefore, the aim of this report is to present two cases of diagnosis of patients with PCDM at different stages, who developed chronic manifestations, pain, clinical involvement of the oral cavity and in one case also presented lung injury with fibrosis, as well as to weight loss, dysphagia and cachexia. Both of patients were treated with antifungal therapy and it was observed total remission of the lesions and no recurrences were detected.

Medicamentos en pacientes con riesgo quirúrgico y su repercusión en Estomatología / Medicine use in surgery risk patients and repercussion in Dentistry

RESUMEN • Introducción: Con el envejecimiento creciente de la población, la práctica estomatológica exige la utilización del conocimiento para identificar y tratar pacientes con enfermedades sistémicas cada vez más frecuentes, lo cual puede requerir el uso de medicamentos capaces de interactuar con el tratamiento farmacológico de su enfermedad de base. La literatura refleja esta relación de manera fragmentada y carente de un enfoque sistémico. Objetivo: Identificar en la literatura el uso de medicamentos en pacientes con riesgo quirúrgico y describir su repercusión durante el tratamiento estomatológico. Material y Métodos: Se realizó una revisión bibliográfica y se consultaron artículos científicos, tesis de titulación de especialistas, maestrías y doctorales entre otras referencias principalmente de los últimos 5 años mediante Google. Desarrollo: Se abordan las generalidades, manejo estomatológico y las interacciones medicamentosas de cada una de las enfermedades a estudiar (Diabetes Mellitus, hipertensión arterial y cardiopatía), así como las situaciones que requieren profilaxis antibiótica. Conclusiones: Los pacientes con riesgo quirúrgico utilizan medicamentos que producen interacciones importantes con fármacos como AINES, anestésicos locales y glucocorticoides que habitualmente se emplean en los tratamientos estomatológicos; existen además enfermedades sistémicas en las cuales hay que tener en cuenta la profilaxis antibiótica antes de realizar determinados procederes estomatológicos.

ABSTRACT • Introduction: With the growing of population aging, the dental practice requires the adequate knowledge to identify and treat patients with increasingly frequent systemic diseases, which may require the use of drugs capable of interacting with the pharmacological treatment of their underlying diseases. The literature reflects this relationship in a fragmented manner and lacking a systemic approach. Objective: To identify the drugs used in risk patients undergoing surgery and describe their repercussion during dental treatment. Material and Method: A bibliographic review was carried out. Scientific articles, specialists´ theses, Master´s and PhD degrees among other references were consulted, mainly the ones obtained from the search carried out in Google during the last 5 years. Results: The generalities, dental management and drug interactions between the diseases studied (diabetes mellitus, arterial hypertension and heart disease) were addressed, as well as the situations that require antibiotic prophylaxis. Conclusions: The surgical risk patients studied use drugs that produce important interactions with drugs such as NSAIDs, local anesthetics and glucocorticoids that are usually used in dental treatments. There are also systemic diseases in which antibiotic prophylaxis must be taken into account before performing certain dental procedures.

Oral Juvenile Xanthogranuloma: Report of Two Cases.

Juvenile xanthogranuloma is a rare non-Langerhans cell histiocytosis that usually occurs in the skin of children. Extracutaneous involvement is rare, and few cases affecting the oral cavity have been reported. The purpose of the present study was to report two cases of oral juvenile xanthogranuloma affecting the lower lip of a 14-year-old girl and the soft palate of a second 14-month-old girl, both present as yellowish papules. The lesions were surgically excised, and histological and immunohistochemical analysis showed a proliferation of non-Langerhans cells histiocytes and foamy cells, fulfilling the morphologic features of juvenile xanthogranuloma. The patients have been followed up, respectively, for 36 and 49 months with no signs of recurrence. Based on these results, juvenile xanthogranuloma should be included in the differential diagnosis of oral yellowish soft-tissue swellings in children and adolescents and should be managed through conservative surgical excision.

Quiste epidermoide gigante en reloj de arena del piso de la cavidad oral / Giant hourglass shaped epidermoid cyst in the floor of mouth

El quiste epidermoide es un quiste de tejido blando de origen ectodérmico que se encuentra con poca frecuencia en la cavidad oral. Clínicamente se caracteriza por ser una lesión asintomática, de larga evolución, recubierta con mucosa normal, y usualmente se diagnostica cuando el aumento de volumen genera molestias en el paciente. El tratamiento varía de acuerdo a su tamaño y localización anatómica. Presentamos el caso de una paciente de 29 años de edad con un quiste epidermoide de gran tamaño, en reloj de arena, del piso de boca. Se describen las características específicas histológicas y clínicas, y se discute la conducta terapéutica seguida.

The epidermoid cyst is a soft tissue cyst of ectodermal origin found infrequently in the oral cavity. Clinically, it is characterized by an asymptomatic lesion, of long evolution, covered with normal mucosa, and is usually diagnosed when the volume increases and generates patient discomfort. Treatment varies according to its size and anatomical location. We report the case of a 29 year old patient with a large, hourglass shaped, epidermoid cyst in the floor of the mouth. Specific histological and clinical characteristics are described and the therapeutic behavior followed is discussed.

Parry-Romberg syndrome in a pediatric patient: a case report / Síndrome de Parry-Romberg en paciente pediátrico: informe de caso

The Parry-Romberg syndrome is a rare degenerative disease of unknown etiology that has dental implications. It is characterized by a progressive hemifacial atrophy that appears in the early stages of life. It causes aesthetic, functional and psychological alterations, and has social implications for the patient. There is no definitive treatment for the Parry-Romberg syndrome. Systemic and immune alterations produce oral and maxillofacial manifestations, which need to be managed by specialized dental professionals. The aim of this paper is to do a literature review of the Parry-Romberg syndrome and describe the oral and clinical characteristics of this condition in a 12-year-old male pediatric patient, who had a history of neurological disorders and facial asymmetry on the left side. Dentists require an adequate knowledge of the clinical and dental characteristics of this syndrome. With early diagnosis and appropriate surgical and orthodontic treatment at an early age, they can improve the quality of life of patients and minimize invasive long-term effects...

El síndrome de Parry-Romberg es una rara enfermedad degenerativa de etiología desconocida con implicaciones odontológicas. Se caracteriza por una atrofia progresiva que aparece a temprana edad, generalmente hemifacial. Tiene alteraciones estéticas, funcionales, psíquicas y sociales, no existiendo un tratamiento definitivo. Las manifestaciones orales y maxilofaciales de este síndrome son parte de una afectación sistémica e inmunológica, lo cual resalta la necesidad de su conocimiento y manejo por parte de los profesionales de la odontología. El objetivo de este reporte es describir las características clínicas y orales del Síndrome de Parry-Romberg en un paciente pediátrico masculino de 12 años de edad con antecedentes neurológicos que presenta una asimetría facial izquierda, presentado en conjunto una revisión bibliográfica de este síndrome. Las características clínicas y dentales de este síndrome como parte de una afectación sistémica requieren de un adecuado conocimiento por parte del profesional dental, el cual con un diagnóstico precoz y un adecuado tratamiento quirúrgico y ortodontico a temprana edad para mejorar la calidad de vida del paciente y minimizar los efectos invasivos a largo plazo...

Nd:YAG laser photocoagulation of benign oral vascular lesions: a case series.

Vascular anomalies of the head and neck are common lesions usually associated with functional and/or aesthetic limitations. The aim of the present paper was to report a case series of oral vascular malformations treated with Nd:YAG laser photocoagulation, highlighting the clinical evolution and post-surgical complications. Fifteen patients diagnosed with oral vascular malformations were treated with Nd:YAG laser followed by three sessions of biostimulation. None of the patients presented post-surgical pain, but 6 of 15 patients (40%) experienced minimal post-surgical complications. All cases presented complete resolution of the lesions after laser treatment. More importantly, 12 out of 15 (80%) resolved after a single session. Low morbidity, minimal patient discomfort, and satisfactory aesthetic results point Nd:YAG laser photocoagulation as a promising option for the management of benign oral vascular lesions.

Cryosurgery as an effective alternative for treatment of oral lesions in children.

Children can exhibit a wide variety of oral pathologies, such as oral lesions, bone lesions, tumors, cysts and cutaneous lesions. Different techniques have been described for the treatment of these lesions, but all of them are invasive. This paper presents a series of cases that demonstrate the clinical efficacy of cryosurgery as an alternative to invasive surgical treatments of the most common oral lesions in children. This technique has been well tolerated by patients due to the absence of anesthesia, rapid healing and minimal bleeding. Cryotherapy has many applications in oral medicine and is an extremely useful alternative in patients to whom surgery is contraindicated due to age or medical history. It is a simple procedure to perform, minimally invasive, low-cost and very effective in pediatric dentistry clinic.

Cryosurgery as an Effective Alternative for Treatment of Oral Lesions in Children

Children can exhibit a wide variety of oral pathologies, such as oral lesions, bone lesions, tumors, cysts and cutaneous lesions. Different techniques have been described for the treatment of these lesions, but all of them are invasive. This paper presents a series of cases that demonstrate the clinical efficacy of cryosurgery as an alternative to invasive surgical treatments of the most common oral lesions in children. This technique has been well tolerated by patients due to the absence of anesthesia, rapid healing and minimal bleeding. Cryotherapy has many applications in oral medicine and is an extremely useful alternative in patients to whom surgery is contraindicated due to age or medical history. It is a simple procedure to perform, minimally invasive, low-cost and very effective in pediatric dentistry clinic.

As crianças podem apresentam uma grande variedade de patologias bucais, como lesões da mucosa oral, lesões ósseas, tumores, cistos e lesões cutâneas. Diferentes técnicas têm sido descritas para o tratamento destas lesões, mas todas elas são invasivas. O objetivo deste trabalho é relatar, por meio de uma revisão de literatura e apresentar clinicamente a eficácia da criocirurgia como alternativa para tratamentos cirúrgicos não invasivos das lesões bucais mais comuns em crianças. Esta técnica tem sido bem tolerada por pacientes pela ausência de anestesia, hemorragia mínima e rápida cicatrização. A crioterapia tem muitas aplicações na medicina oral e é uma alternativa extremamente útil em pacientes nos quais a cirurgia é contra-indicada devido a idade ou história médica. É uma técnica simples de se executar, minimamente invasiva, barata e muito efetiva na clinica de odontopediatria.

Oral myiasis in two children.

The term myiasis refers to growth of parasitic diptera in the living or dead tissue of vertebrate animal. Most cases of myiasis in humans are mild and rarely present in the mouth. We describe 2 children with severe oral myiasis that evolved to oral and maxillofacial mutilations. We discuss preventive measures.

High-power diode laser versus electrocautery surgery on human papillomavirus lesion treatment.

The use of high-power lasers has facilitated and improved human papillomavirus (HPV) treatment protocols and has also become very popular in recent years. This application has been more frequently used in hospitals, especially in gynecology. The present study aimed to evaluate the effects of high-power diode laser to remove oral lesions caused by HPV and the consequent effects on virus load following the wound tissue healing process compared with one of the most conventional surgical techniques involving electrocautery. Surgeries were performed on 5 patients who had 2 distinct lesions caused by HPV. All patients were submitted to both electrocautery and high-power diode laser. Following a 20-day period, when the area was healed, sample material was collected through curettage for virus load quantitative analysis.Observation verified the presence of virus in all the samples; however, surgeries performed with the laser also revealed a significant reduction in virus load per cell compared with those performed with electrocautery. The ease when handling the diode laser, because of the flexibility of its fibers and precision of its energy delivery system, provides high-accuracy surgery, which facilitates the treatment of large and/or multifocal lesions. The use of high-power diode laser is more effective in treatment protocols of lesions caused by HPV.

Micro-marsupialization as an alternative treatment for mucocele in pediatric dentistry.

BACKGROUND: Mucocele is a common oral lesion in children and adolescents. Different techniques have been described for the treatment; however, all of them are invasive. AIM: This work studied the efficacy of micro-marsupialization for the treatment for mucoceles in paediatric patients. DESIGN: A retrospective review was performed using the clinical records of patients aged between 0 and 18 years with a clinical diagnosis of mucocele. The following data were obtained: age, gender, location and size of the lesion, duration of mucocele development, and type of treatment and its results. RESULTS: The mean age of the patients was 11.1 ± 3.95 years. Mucoceles were found in the lower lip (83.7%), buccal mucosa (11.6%), and tongue (4.7%). From the overall cohort of 86 cases, 33 were treated by micro-marsupialization, of which five developed a recurrence that required surgical excision. The other 53 cases were treated by surgical excision, and three of these had recurrent disease. No statistically significant difference was found between the treatment methods. CONCLUSIONS: Micro-marsupialization can be used to treat mucoceles in paediatric dentistry. It is simpler to perform, minimally invasive, requires no local infiltration of anaesthesia, has a lower postoperative complications rate, and is well-tolerated by patients.

Knowledge of the physical properties and interaction of laser with biological tissue in dentistry.

The trend in dentistry is to incorporate less invasive methods to minimize pain and discomfort during and after dental intervention. Therefore, it is believed that laser therapy is an excellent treatment option, since it has beneficial effects for the irradiated tissues, such as activation of microcirculation, production of new capillaries, inflammatory and analgesic effects, in addition to stimulation of growth and cell regeneration. The comprehension of the interaction between lasers and tissue is based mainly on understanding the reactions that can be induced in those tissues by laser. This work intends to show how important it is to know the physical properties of laser as well as its interactions with biological tissues, since its effects and mechanisms of action are complex and are the object of various studies to better understand its forms of application and indications.

Conhecimento das propriedades físicas e da interação do laser com os tecidos biológicos na odontologia / Knowledge of the physical properties and interaction of laser with biological tissue in dentistry

A tendência da odontologia é a incorporação de métodos menos invasivos com a finalidade de minimizar a dor e o desconforto durante e após as intervenções odontológicas. Por isso, acredita-se que a laserterapia seja uma excelente opção de tratamento, já que apresenta efeitos benéficos para os tecidos irradiados, como ativação da microcirculação, produção de novos capilares, efeitos anti-inflamatórios e analgésicos, além de estímulo ao crescimento e à regeneração celular. O entendimento da interação entre os lasers e os tecidos baseia-se principalmente no entendimento das reações que podem ser induzidas nesses tecidos pela luz laser. Este trabalho se propõe a mostrar a relevância do conhecimento das propriedades físicas do laser, bem como sua interação com os tecidos biológicos, considerando que os efeitos e os mecanismos de ação da luz laser são complexos e alvos de inúmeras pesquisas com vistas a um melhor delineamento de suas formas de aplicação e indicações.

The trend in dentistry is to incorporate less invasive methods to minimize pain and discomfort during and after dental intervention. Therefore, it is believed that laser therapy is an excellent treatment option, since it has beneficial effects for the irradiated tissues, such as activation of microcirculation, production of new capillaries, inflammatory and analgesic effects, in addition to stimulation of growth and cell regeneration. The comprehension of the interaction between lasers and tissue is based mainly on understanding the reactions that can be induced in those tissues by laser. This work intends to show how important it is to know the physical properties of laser as well as its interactions with biological tissues, since its effects and mechanisms of action are complex and are the object of various studies to better understand its forms of application and indications.

Oral and maxillofacial myiasis: a case series and literature review.

OBJECTIVE: The aim of this study was to describe a series of 10 cases of oral-maxillofacial myiasis, discussing its main features, demographic distribution, and treatment aspects. STUDY DESIGN: A retrospective study was carried out involving male and female patients of any age with oral-maxillofacial myiasis. The sample was determined by spontaneous demand at the emergency ward of a hospital between January 2005 and January 2011 (6 years). After treatment of each case, data were gathered on the presence of associated systemic disorders, time elapsed since onset of the disease, and treatment established. A review of the literature on this topic was also carried out. RESULTS: The sample was made up of 10 patients, all treated with surgical debridement whether or not associated with the use of oral ivermectin. Mean time elapsed since the onset of the disease ranged from 4 to 36 months. The middle third of the face was the most frequently affected region (7 cases). Oral-maxillofacial myiasis predominantly affected the male gender (70%). CONCLUSIONS: Oral-maxillofacial myiasis affects individuals with poor hygiene and neurologic and/or psychologic alterations. It occurs predominantly in countries near the tropics. The treatment of choice is surgical debridement.

Lymphoepithelial cyst in jugal mucosa / Quiste linfoepitelial en la mucosa yugal

Mouth lymphoepithelial cyst is rare, with few cases reported in literature. The aim of this article is to describe a clinical case, focusing on clinical and diagnostic aspects, treatment and prognosis. The lesion was one year old and had developed as a fibrous nodule in the jugal mucosa of a 71-year-old leucoderma patient. Considering focal inflammatory fibrous hyperplasia, fibroma and mucocele as differential diagnosis, excisional biopsy was carried out. A cystic cavity limited by pseudostratified epithelium without projections into the conjunctive tissue, with lymphoid tissue within, was microscopically identified. Without postoperative adverse events, the one-year clinical followup confirmed the favorable prognosis of this kind of lesion.

Un quiste linfoepitelial bucal es raro, con pocos casos reportados en la literatura. El objetivo de este artículo es describir un caso clínico, centrándose en los aspectos clínicos y diagnósticos, tratamiento y pronóstico. La lesión tuvo un año de evolución, y se había desarrollado como un nódulo fibroso en la mucosa yugal de un paciente de 71 años de edad con leucoderma. Teniendo en cuenta la hiperplasia fibrosa inflamatoria, fibroma y mucocele como diagnósticos diferenciales, se llevó a cabo una biopsia por escisión. Una cavidad quística limitada por epitelio pseudoestratificado sin proyecciones en el tejido conjuntivo, con tejido linfoide en el interior fue identificado microscópicamente. No se observaron eventos adversos postoperatorios, y el seguimiento clínico al año confirmó el pronóstico favorable de este tipo de lesión.

Extensive oral lesion colonized with 601 myiasis larvae.

Myiasis is a type of infection caused by the larvae of flying insects. This paper reports a case of a 72-year-old Caucasian man who was referred to the Infectology Department of Oswaldo Cruz University Hospital (Pernambuco-Brazil) for urgent treatment as he was malnourished and dehydrated. He had a facial and buccal lesion colonized with larvae and was extremely debilitated. The surgical and clinical treatment indicated at the first moment was the surgical removal of the larvae. But, after two days, some larvae were still present and therefore 12 mg of ivermectin was administered. At the end of the treatment, 601 larvae had been removed and the therapeutics established were suitable.

Oral myiasis in a captive hippopotamus.

Causes of dental infections can be related to failed dental eruption, malocclusion, abrasion, fractures with or without exposure of the dental pulp, and periodontal disease. Reports of oral myiasis in megavertebrates in captivity are infrequent, perhaps due to the difficulty in observing the oral cavity in such species. This report describes a case of oral myiasis in an adult male hippopotamus in the gingival area and alveolar mucosa of the left mandibular canine tooth.

Lichen sclerosus of the oral mucosa: clinicopathological features of six cases.

Lichen sclerosus is a chronic inflammatory mucocutaneous disease, rarely involving the mouth. There are only 20 well-documented cases of oral lichen sclerosus reported in the English-language literature. This report describes the clinicopathological features of 6 cases of oral lichen sclerosus; 5 in women. There were 12 lesions, mainly on the lips (50%) and buccal mucosa (25%). The affected areas appeared as irregular whitish patches, harder than the surrounding tissue. Half of the patients were symptomatic and presented with no associated skin and/or genital lesions. All cases were biopsied, and histopathological features were evaluated using hematoxylin-eosin and Verhoeff's stains, S-100 immunohistochemical reaction and transmission electron microscopy. Management of the oral lesions consisted of surgical excision, intralesional triamcinolone acetonide, oral colchicine, and regular follow-up. There is no effective curative treatment, but there are some options for patient management; and colchicine may be considered an additional choice.

Oral foreign body granuloma: unusual presentation of a rare adverse reaction to permanent injectable cosmetic filler.

A variety of injectable permanent fillers have been used in orofacial tissues for cosmetic purposes. Most of these substances seem to be well tolerated but adverse reactions have been reported. Foreign body granulomas are a rare adverse reaction to injectable permanent fillers. The authors report the unusual case of a 56-year-old woman with a foreign body granuloma located exclusively in the oral cavity that was due to injection of a permanent filler.