Parasitological association between human leishmaniosis mucosa and paracoccidioidomycosis. Case report.

INTRODUCTION: Leishmaniasis Mucosa (LM) is a tropical disease that affects the upper respiratory tract and/or oral mucosa. Its etiological agent is Leishmania spp. Paracoccidioidomycosis disease caused by the fungus Paracoccidioides brazilienses. The aim is to report a case of Leishmaniasis Mucosa in association with Paracoccidioidomycosis. PRESENTATION OF CASE: A male patient, 24 years old; Intraorally, presence of a non-bleeding erythro-leucoplastic lesion that affected the soft palate and oropharynx; 3 years of evolution. On the face Computerized Tomography (CT) examination, it was possible to observe muco-periosteal thickening in the soft palate region; immunohistochemical markings for Paracoccidiodes brasiliensis. He was diagnosed with Leishmaniasis by Montenegro intradermoreaction (MIDR). DISCUSSION: The predisposition to Paracocodioidomycosis after Leishmaniasis infection is justified by factors already elucidated - hygiene, nutrition habits and immunodeficiency, but the reason for the non-progression of the fungus after years of evolution could be related to its inhibition due to the presence of the protozoan in the same wound. CONCLUSION: This phenomenon may be explained by future studies that need to be performed to answer such questions.

Bioactive glass granules S53P4 in osteotomy Le Fort I.

We evaluated bioactive glass graft (S53P4) in patients undergoing Le Fort I osteotomy, with non-grafted patients as controls. Computed tomography facial scans of the 25 patients submitted for Le Fort I were divided into two groups: Group 1-S53P4 group and Group 2-without grafting. CT scans were analyzed in the immediate postoperative period (T1) and 6 months later (T2), for linear bone gap measurements, tomographic radiodensity and behavior of the maxillary sinus. A Kruskal-Wallis test on bone gap data adopted α significance levels (p ≤ 0.05). The Friedman test (p ≤ 0.05) was used to evaluate sinus reaction cores. For gap measurements, we observed a decrease in median data between T1 and T2 in both groups, with statistical significances observed between groups in T0; G1 presented statistical difference in its two studied times (p ≤ 0.0001). For bone density, the studied data behaved inversely. G1's bone density decreased from T1 to T2, whereas in G2 there was an increase from T1 to T2. S53P4 did not elicit increased reactions and/or sinus infections in the G1 group (p ≥ 1.00). S53P4 did not impact on Le Fort I osteotomies as a coadjuvant and a favorable factor in bone formation, and appeared innocuous in the maxillary sinus.

A rare case of invasive sinonasal carcinosarcoma.

INTRODUCTION: Carcinosarcomas are rare malignant neoplasms formed by embryonic tissues (ectoderm and mesoderm) and present remarkably aggressive character with unfavourable prognosis. These lesions are rarely diagnosed in the sinonasal cavity and only a few cases are reported in the literature. This manuscript aimed to report a rare case of a large and aggressive sinonasal carcinosarcoma that involved the facial middle third and to discuss the proposed treatment. PRESENTATION OF CASE: A 54-year-old female patient sought treatment for a large swelling on the left side of the face. A CT-scan revealed an expansive hypodense image in the facial middle third. An incisional biopsy was performed under local anaesthesia and the material was sent for histopathological analysis. DISCUSSION: Due to the extremely aggressive character of carcinosarcomas, the optimal management of carcinosarcomas remains uncertain and a challenge for clinicians. In this case report, the prognosis of such a large tumour became unfavourable since the patient sought late for treatment. Therefore, suspicion and early detection are crucial for improving the prognosis and quality of life of the patients with such neoplasia. CONCLUSION: Besides being rare and extremely aggressive, sinonasal carcinosarcomas present worse patient survival when compared to other carcinosarcomas in the head and neck region. Thus, this report may contribute to a better understanding of this tumour behaviour.

Effect of sodium ascorbate on bond strength and metalloproteinases activity in bleached dentin.

AIM: This study evaluated the effect of sodium ascorbate (SA) on the proteolytic activity of matrix metalloproteinases (MMPs) and investigated the related effects on the bond strength of bleached dentin. MATERIALS AND METHODS: Eighty freshly extracted human third molars were randomly divided according to treatment (bleaching or SA application), type of analysis (microshear or measuring MMP activity), and post-bleaching time to assess bond strength (24 hrs or 30 days). Data from both analyses were subjected to one-way analysis of variance to detect differences among groups, followed by Tukey's multiple comparison test (p≤0.05). RESULTS: Dental bleaching significantly reduced bond strength values when the adhesive strategy was performed after 24 hrs (despite the SA treatment) or 30 days after the bleaching procedure. However, after 30 days, the bond strength values of the groups who received bleaching or SA application were similar to those of the unbleached group. Dental bleaching caused the activation of MMPs, and SA did not influence this activity. CONCLUSION: It was concluded that SA does not affect the activity of MMPs or the bond strength in bleached dentin immediately after the bleaching treatment.

Use of refrigerant spray of a propane/butane/isobutane gas mixture in the management of keratocystic odontogenic tumors: a preliminary study.

PURPOSE: Keratocystic odontogenic tumor (KCOT) is an aggressive benign tumor and the management by complete enucleation followed by cryotherapy maintains the inorganic bone matrix, resulting in better repair and reduces the rates of recurrence. A refrigerant spray with a propane/butane/isobutane gas mixture has been pointed to as an alternative to liquid nitrogen, because the device is easy to handle and contain within the cavity, providing better control and lower risk of injury to the adjacent soft tissue. Thus, the aim of this study was to evaluate the outcome of enucleation followed by cryosurgery using a refrigerant spray of this gas mixture in ten patients diagnosed with KCOT. METHOD: The biggest lesions received a prior treatment consisting of marsupialization to decrease the tumor size. During the surgeries, the lesions were removed by enucleation and the surgical site was sprayed with the gas mixture. RESULTS: Wound dehiscence was observed in all cases, which healed by the second intention. The mean follow-up period was 64.3 months (range 24-120 months). Eight of the ten patients showed no evidence of clinical or radiographic recurrence. Pathologic fractures and infections were not observed. CONCLUSIONS: The results obtained suggest that enucleation followed by cryosurgery is an effective therapy for managing KCOT.