Mandibular metastasis of cutaneous melanoma.

Melanoma is a malignant neoplasm of melanocytes that can metastasize to every organ of the body, but metastasis to the oral cavity is uncommon. We describe a case of metastatic malignant melanoma to the mandible in a 33-years-old woman. The patient had a 2 cm × 4 cm firm, ulcerated nodule, distal to the second mandibular right molar. Incisional biopsy revealed epithelioid cells and immunohistochemistry was positive for HMB-45, S-100 protein and vimentin. The patient was referred to the local cancer hospital for treatment but died 3 months later. Metastatic malignant melanomas of the oral cavity are rare and unusual. Early diagnosis of the primary tumor is essential for successful treatment and to improvement of patient prognosis.

Gingival proliferative lesions in children and adolescents in Brazil: A 15-year-period cross-sectional study.

BACKGROUND: Studies assessing the prevalence of oral lesions in children and adolescents, particularly in gingiva are scarce in the literature. The aim of the study was to describe the distribution of gingival proliferative lesions based on clinical and histopathological diagnoses in children and adolescents. MATERIALS AND METHODS: A review of clinical charts of children and adolescents aged between 0 and 18 years old, admitted to the Oral Medicine Outpatient Unit, of Universidade Federal do Paraná, for 15 years (1994-2009) was performed. RESULTS: Six hundred and sixty-nine out of 5,129 patients treated during this period were aged between 0 and 18 years old, and 45 of these had gingival lesions. The largest number of lesions was observed between 11 and 16 years old. The majority of the patients were referred by Curitiba's public health system. Pyogenic granuloma was the most frequent lesion (19 = 42.2%), followed by peripheral giant cell lesion (11 = 24.4%), gingival fibromatosis (10 = 22.2%), and peripheral ossifying fibroma (5 = 11.1%). CONCLUSION: Gingival proliferative lesions can show similar clinical characteristics. Appropriate clinical and histopathological diagnoses are necessary to guide the healthcare professional to establish the adequate treatment and to estimate the risk of recurrence.

Diagnóstico à distância de lesões bucais com fotografias de smartphones / Remote diagnosis of oral lesions with smartphone photos

Objetivos: Avaliar o acerto diagnóstico entre a avaliação presencial de lesões bucais e a hipótese diagnóstica proposta à distância para uma amostra de imagens digitais obtidas por meio de um smartphone. Materiais e Métodos: O estudo teve desenho observacional transversal com amostra de conveniência. Os dados foram coletados no ambulatório de Estomatologia da Universidade Federal do Paraná, e obtidos a partir de exame físico oral, história da doença e registro fotográfico de lesões bucais realizado com um smartphone. Todos os pacientes que apresentaram lesões bucais visíveis à inspeção foram convidados a participar do estudo. A história clínica e as imagens dos participantes foram enviadas por e-mail para dois avaliadores, que foram solicitados a formular um mínimo de uma e máximo de duas hipóteses diagnósticas para cada caso. As hipóteses diagnósticas formuladas à distância foram comparadas com o padrão-ouro em cada caso clínico proposto, e medidas pelo coeficiente kappa. Resultados:O estudo avaliou uma amostra de 42 fotografias de lesões bucais obtidas de 23 pacientes. Em 91% e 87% dos casos, para os avaliadores 1 e 2, respectivamente, houve concordância do diagnóstico à distância comparado ao padrão-ouro. Os valores de concordância obtidos foram considerados ótimos de acordo com os valores de kappa (K = 0,864 - 0,909). Conclusão: O diagnóstico de lesões bucais por meio de imagens obtidas com um smartphone mostrou boa concordância e acerto diagnóstico comparável com aquele obtido presencialmente e pode ser sugerido como uma ferramenta auxiliar na referência de casos entre a atenção primária e a média complexidade em Estomatologia.

To evaluate the diagnostic accuracy between presential assessments of oral lesions and the diagnostic hypothesis proposed at distance with the use of a sample of photographs obtained with a smartphone.The study had a cross-sectional observational design with a convenience sample. The data were collected at the oral medicine ou patient clinic of Federal University of Paraná. They were obtained from clinical oral examination, a brief clinical history and photographic record of oral lesions taken with as martphone camera. The participants were all the patients with oral lesions visible to inspection. The clinical information and the photographs of were sent by email for two remote consultants, who weresolicited to formulate a maximum of two diagnostic hypotheses for each case. The diagnostic hypotheses formulated by the remote consultant were compared to the gold standard in each clinical caseand measured by the kappa coefficient. The sample was composed by 42 photographs of oral lesions obtained from 23 patients. In 91% and 87% of the cases, there was agreement from distant diagnosis when compared to the gold standard for consultants 1 and 2, respectively. The concordance obtained between the diagnostic hypotheses and the gold standard was considered “excellent” according to thevalues of kappa index (K = 0,864 - 0,909). The diagnosis of oral lesions through images obtained with as martphone showed good diagnostic accuracy and was comparable to that obtained in person. It canbe suggested as an auxiliary tool in refererring cases from primary to secondary care in oral medicine.

Maxillary squamous cell carcinoma: diagnosis and evolution of an inoperable case

Introduction: Squamous cell carcinoma (SCC) is a malignant neoplasia, originating from the oral lining epithelium, responsible for approximately 90-95% of malignancies in this location. Incidence and mortality rates for oral SCC may vary due to personal habits, socioeconomic characteristics, environmental factors and quality of health care. This study reports the aggressive evolution of SCC with a delayed diagnosis and the impossibility of immediate curative therapy. Case report: A 47-year-old brown male patient, smoker and drinker was referred by a primary health care center to the Stomatology Clinic at UFPR (Federal University of Paraná). The diagnosis of well-differentiated SCC was confirmed by histopathological examination. The patient was referred to a specialized service where an oncology team defined the case as inoperable due to lung function limitations and advanced tumor staging. The patient underwent lung physiotherapy sessions until reaching clinical conditions to undergo oncologic therapy which included radiotherapy and chemotherapy. Conclusion: The reported case highlights the importance of establishing an early diagnosis for SCC. There is a need of facilitating and speeding the access to both health care services and information that lead patients to seek professional assistance as soon as the first disease signs appear.

Teledentistry: distant diagnosis of oral disease using e-mails.

OBJECTIVE: The purpose of this study was to evaluate the applicability of telediagnosis in oral medicine, through the transmission of clinical digital images by e-mail. SUBJECTS AND METHODS: The sample included 60 consecutive patients who sought oral medicine services at the Federal University of Paraná, in the state of Paraná, located in southern Brazil. The clinical history and oral lesion images were recorded using clinical electronic charts and a digital camera, respectively, and sent by e-mail to two oral medicine consultants. The consultants provided a maximum of two clinical hypotheses for each case, which were compared with biopsy results that served as the gold standard. RESULTS: In 31 of the 60 cases (51.7%), both consultants made the correct diagnosis; in 17 cases (28.3%), only one consultant made the correct diagnosis; and in 12 cases (20%), neither consultant made the correct diagnosis. Therefore, in 80% of cases, at least one consultant provided the correct diagnosis. The agreement between the first consultant and the gold standard was substantial (κ=0.669), and the agreement between the second consultant and the gold standard was fair (κ=0.574). CONCLUSIONS: The use of information technology can increase the accuracy of consultations in oral medicine. As expected, the participation of two remote experts increased the possibility of correct diagnosis.

Cisto nasolabial: relato de caso clínico / Nasolabial cyst: a case report

O cisto nasolabial é um cisto raro de tecidos moles, de origem não-odontogênica que resulta de uma alteração do desenvolvimento ectodérmico, apresentando-se clinicamente por um aumento de volume na região de lábio superior, base e asa do nariz. Geralmente, é assintomático, exceto nos casos de infecção, podendo provocar comprometimento estético dada a sua evolução progressiva. O tratamento de escolha é a excisão cirúrgica, tendo bom prognóstico e raras recidivas. O objetivo deste trabalho foi apresentar um caso de cisto nasolabial unilateral, bem como, uma revisão da literatura sobre a doença.

The nasolabial cyst is an uncommon,nonodontogenic, soft tissue cyst characterized by its extra bone located in the nasal region. This cyst is generally asymptomatic, except in cases of infection,and can cause complaints arising from aesthetic appearance. The treatment of choice is surgical excision, which presents a good prognosis and rare recurrence. This case report presents a unilateral nasolabial cyst as well as a literature review on the disease.

Massive growth of an intraoral lipoma.

AIM: The aim of this report is to present a case of one of the largest intraoral lipomas reported in the literature along with a description of its management in an outpatient clinic setting. BACKGROUND: Lipoma, a benign tumor of adipose tissue, is rarely seen in the oral cavity. When it does occur it is usually found in the cheek or tongue, followed by the lip, gingival, and floor of the mouth. The lesions appear as asymptomatic, freely movable masses. Size of the lesions varies from 3 to 50 mm with an average of 20 mm. REPORT: A 71-year-old male with a movable and huge mass located in the buccal mucosa region, which was first noticed approximately 25 years earlier, was referred to the Maxillofacial Surgery Clinic at the Universidade Federal do Paraná. A clinical diagnosis of lipoma was established, and the treatment consisted of complete excision of the mass under local anesthesia. SUMMARY: Although some larger oral masses are better managed surgically at hospital facilities, the present case was treated with local anesthesia with no complications. The lesion evolution and clinical characteristics precluded an incisional biopsy so the excisional surgical approach was used. CLINICAL SIGNIFICANCE: This case report emphasizes the slow growth and benign characteristics of oral lipomas. Even though the lesion presented with a remarkable size, surgical management could be conducted on an outpatient clinical basis.

Paracoccidioidomicose bucal: apresentação de casos clínicos / Oral paracoccidoidomycosis: report of clinical cases

Na grande maioria dos casos de paracoccidioidomicose as primeiras manifestações clínicas ocorrem na boca. Salienta-se, assim, a importância do cirurgião-dentista na detecção precoce da doença. Relatamos neste trabalho 04 casos clínicos de paracoccidioidomicose diagnosticada em mucosa bucal, discutindo-se a possibilidade da região noroeste do Paraná ser zona endêmica da enfermidade

Aspectos clínicos das lesöes de líquen plano na mucosa bucal: pacientes da Disciplina de Diagnóstico Bucal da Universidade Federal do Paraná / Clinical aspects of lichen planus lesions in the oral mucosis: patients of the department of oral diagnosis, the Federal University of Parana State

A freqüencia considerável da ocorrência do líquen plano nos consultórios odontológicos justifica o conhecimento das manifestaçöes clínicas desta doença pelo cirurgiäo-dentista. Este conhecimento serve de subsídio no exame clínico para elaboraçäo de um diagnóstico é estabelecido clinicamente, sendo sua confirmaçäo realizada através de exames complementares (histopatológico). Em 448 fichas pesquisadas nos arquivos da Disciplina de Diagnóstico Bucal da Universidade Federal do Paraná, foram encontrados 9 casos de líquen plano, os quais foram analisados quanto à incidência por sexo e idade. Determinou-se também a localizaçäo mais freqüente e a principal forma das lesöes correlacionadas com a sintomatologia relatada pelo paciente na anamnese. Foram considerados o estado emocional e o estresse nervoso dos pacientes, devido a possibilidade de serem fatores desencadeantes da patologia

Aspectos clínicos das lesöes de paracoccidioidomicose na mucosa bucal / Clinical apects of paracoccidioidomycosis lesions in the oral mucosis

A paracoccidioidomicose é uma doença micótica crônica causada pelo Paracoccidioides brasilienses. Limita-se à America do Sul, principalmente no Brasil, em regiöes consideradas endêmicas: Säo Paulo, Rio de Janeiro, Minas Gerais. Entre as manifestaçöes que envolvem a pele, linfonodos e alguns órgäos internos, as lesöes bucais com frequência permitem sua caracterizaçäo, sendo no entanto necessário biópsia para diagnóstico definitivo. A partir dos dados obtidos das fichas clínicas de sete pacientes atendidos no ambulatório da Disciplina de Diagnóstico Bucal da Universidade Federal do Paraná, apresenta-se os aspectos clínicos das lesöes que aparecem na mucosa bucal, as mais freqüentes e onde se localizam