Analysis of the psychopathological profile, quality of life, and cost-effectiveness of oral lichen planus patients treated with photobiomodulation.

OBJECTIVES: To evaluate the effect of PBM on the psychological profile and quality of life of patients with oral lichen planus (OLP) in comparison to corticoid and to investigate the cost-effectiveness of both treatments. MATERIALS AND METHODS: Patients were randomized into two groups: Control (clobetasol propionate 0.05%) and Photobiomodulation (660 nm, 100mW, 177 J/cm2, 5 s, 0.5 J) twice a week for 30 days. The Hospital Anxiety and Depression Scale (HADS) and OHIP-14 were used in different treatment time points and at follow-up. The cost-effectiveness was calculated using the improvement in OHIP-14 after treatment. RESULTS: OLP patients showed detected levels of anxiety, depression, and poor quality of life at baseline. No improvement in anxiety and depression was noticed after treatments. However, PBM and corticoid significantly improved the quality of life of OLP patients, considering the OHIP-14-T and the physical pain domain. The treatment with corticoid was more cost-effective than PBM. CONCLUSIONS: Psychological distress was not improved after both treatments and PBM is as effective as corticoids in promoting a better quality of life in OLP patients, despite its higher cost. CLINICAL RELEVANCE: This study highlights the need for additional therapeutic interventions in OLP patients, to early recognize and to manage the alterations in their psychological profile. Moreover, PBM is an effective therapy in OLP patient's quality of live and although it was a more expensive, the advantage of being a minimally invasive therapy associated with no side effects must be considered in clinical practice, especially in those patients with refractory disease. TRIAL REGISTRATION: This study is registered at ClinicalTrials.gov; the registration number is NCT03320460, registered in 17/10/2017.

Photobiomodulation in oral mucositis in patients with head and neck cancer: a systematic review and meta-analysis followed by a cost-effectiveness analysis.

BACKGROUND: Oral mucositis (OM) is an oral toxicity caused by cancer treatment, found often in patients with head and neck cancer. Low-intensity laser therapy for OM has anti-inflammatory, analgesic, and tissue reparative properties. OBJECTIVE: The objective of this work is to perform a systematic review and meta-analysis of the randomized clinical trials of OM laser therapy in patients undergoing treatment for head and neck cancers, followed by a cost-effectiveness analysis of the therapy. METHOD: The search terms, mucositis and phototherapy, laser therapy and mucositis, photobiomodulation and mucositis, and low-level laser therapy and mucositis, were used to search the databases of PubMed, Web of Science, and MEDLINE. Randomized clinical trials were divided into two groups: one treated with laser therapy and the other given a placebo. Only 13 studies were included in the systematic review, and 6 studies in the meta-analysis. RESULTS: The results of the systematic review and meta-analysis show that the laser therapy presented good results in clinical improvement and pain reduction, decreasing the patients' likelihood of developing OM, with degrees of debilitating lesions, to 64% (RR = 0.36 [95% CI = 0.29-0.44]). The cost-effectiveness analysis revealed an incremental cost of R$ 3687.53 for the laser group, with an incremental effectiveness of 132.2. The incremental cost-effectiveness ratio (ICER) was 27.89, for the severe OM cases that were avoided. CONCLUSION: It was concluded, therefore, that photobiomodulation for OM in patients receiving head and neck cancer treatment was clinically effective and cost-effective.

Tratamento da fratura mandibular bilateral com o uso de fixação interna rígida na pediatria / Treatment of the bilateral mandibular fracture with the use af rigid internal fixatian in the pediatrics

O tratamento cirúrgico da fratura mandibular bilateral com o uso da fixação interna rígida na criança é muito variável, e depende mais da filosofia do cirurgião do que do tipo de injúria sofrida pelo paciente. O manejo e tratamento das fraturas mandibulares em pacientes pediátricos sofreram alterações ao longo do tempo, com o advento de novas técnicas e produtos disponíveis no restabele- cimento da função normal do paciente traumatizado. O uso de fixação interna rígida mostrou- se uma alternativa bastante útil em algumas situações, pois apresenta vantagens sobre outras técnicas, tais como a redução imediata correta e eficaz da fratura, o rápido restabelecimento da função mastigatória e a rapidez no processo de reparo ósseo. Atualmente, alguns autores preconizam o uso desta técnica sempre que possível e quando bem indicada. O caso ilustra fratura de mandíbula na região de parassínfese e corpo de mandíbula, tratado com placa, parafuso e a técnica do parafuso posicional.

The cirurgical treatment of bilateral mandibular fracture with the usage of rigid internal fixation in children is very variable, and it depends more on the surqeon's philosophy than the type of injury which the patient has suffered. The handling and treatment of mandibular fractures of pediatric patients has changed over the time, with the advent of the new techniques and products available in order to reestablish the regular function of the traumatized patient. The use of rigid internal fixation has shown to be a very useful alternative in many situations, which demonstrate advantages when compared to other techniques, such as: the immediate reduction, correct and effective of the fracture, the recovery of masticatory function and fast healing processo Nowadays, some authors advocate the use of this technique whenever possible and when well indicated. The case shows mandibular fracture in the parassinfises region and in the body of the jaw, treated with a plate, a screw and the positional screw technique.