Paediatric head and neck malignant neoplasms: A brazilian retrospective study.

BACKGROUND: To assess the prevalence of oral and maxillofacial malignant neoplasias in children and adolescents diagnosed through biopsies sent to the Oral Pathology Laboratory at the University of Sao Paulo School of Dentistry. MATERIAL AND METHODS: A retrospective analysis of anatomopathological reports on patients between 1 and 18 years old issued by the oral and maxillofacial pathology laboratory between 1997 and 2021 was performed for demographic data, lesion site, type of biopsy, diagnostic hypothesis and final diagnosis. RESULTS: The laboratory issued 76,194 anatomopathological reports during this period, of which 10.77% were of children and adolescents. Of this total, only 32 biopsies (32/8.204; 0.39%) were neoplasias in children and adolescents. Sarcomas were the most prevalent malignant neoplasms (19/32; 59%), followed by carcinomas (7/32; 22%), lymphomas (5/32; 16%) and ganglioneuroblastomas (1/32; 3%). Of these 32 patients, the most affected individuals were aged between 4 and 11 years old (47%), 18 (56%) were male, and the mandible was the main anatomical site involved (28%). In 41% of the cases (13/32), the diagnostic hypothesis of the biopsied lesion was mistakenly considered benign and there was no diagnostic hypothesis in 18% of the cases. CONCLUSIONS: Oral and maxillofacial malignant neoplasms in children and adolescents are uncommon and the accuracy of provisional diagnoses is low in these cases. Better knowledge on oral and maxillofacial malignant lesions in this population would help professionals to reduce the diagnostic time and consequently improve the patient's prognosis.

Orofacial features and medical profile of eight individuals with Kabuki syndrome.

BACKGROUND: To evaluate oral, craniofacial and systemic characteristics of eight patients with Kabuki syndrome (KS), aged between 3 and 16 years old. MATERIAL AND METHODS: in this retrospective study, medical records of all patients were reviewed for information on family history, growth and development, medications in use, general systemic complications and oral and craniofacial characteristics. RESULTS: the medical alterations found included recurrent infections such as pneumonia and otitis media (n = 6), cardiovascular malformations (n = 4), kidney abnormalities (n = 2), epilepsy (n = 2) and visual deficiency (n = 2). The individuals exhibited dental caries (n = 5), agenesis (n = 5), delayed tooth eruption (n = 4), cleft lip/palate (n = 2) enamel hypoplasia (n = 2), fusion (n = 1) and microdontia (n = 1). CONCLUSIONS: There was a great diversity of oral, craniofacial and systemic characteristic among the KS patients, suggesting that an inter-disciplinary approach should be taken for their dental treatment.

Bleeding during and after dental extractions in patients with liver cirrhosis.

Little is known about the prevention and management of acquired coagulopathies, such as those affecting cirrhotic patients. The objective of this analytic retrospective observational study was to evaluate patients on the liver transplant waiting list according to the following outcomes: (1) presence of unusual intraoperative bleeding (>10min after routine haemostatic procedures); and (2) presence of postoperative haemorrhagic complications. The outcomes were analysed according to clinical and laboratory variables. A total of 190 visits were performed for extraction of 333 teeth (ranging from 1 to 9 teeth per visit), with platelet count ranging from 16,000 to 216,000 and international normalized ratio (INR) below 3. Twelve cases (6.31%) had unusual intraoperative bleeding and 12 had postoperative haemorrhagic complications. All the events were controlled by local measures. Intraoperative bleeding was associated with low count of platelets (P=0.026). However, this counting could explain only 16% (adjusted R2=0.16) of the cases of bleeding (P=0.44), meaning that platelet function changes might be involved. Our results show that cirrhotic patients presenting platelet count above 16,000 and INR below 3 need no previous blood transfusion, with local measures being enough to manage haemorrhagic events.

Detection of human polyomaviruses JC and BK in liver pretransplant patients.

OBJECTIVE: This study aimed to identify and quantify polyomaviruses (BKPyV and JCPyV) in the saliva, mouthwash, blood and urine of liver pretransplant patients. MATERIALS AND METHODS: A case-control study was performed using a convenience sample of 21 end-stage liver disease patients (EG = experimental group) and 20 normoreactive controls (CG = control group). In total, 162 samples were collected. Detection and quantification of polyomaviruses were performed using real-time PCR method. RESULTS: In the EG, 21 samples (25%) were positive for BKPyV and 10 (11.90%) for JCPyV, while in the CG, 27 samples (34.61%) were positive for BKPyV and six (7.69%) for JCPyV. With regard to the number of samples positive for BKPyV and JCPyV, there was no statistically significant difference between EG and CG (p = .52 and p = .25). In the EG, we observed a panorama similar to that of the CG regarding the presence of polyomaviruses in mouthwash, blood and urine. The greatest difference between the samples was that regarding the identification of BKPyV in saliva. CONCLUSION: Cirrhotic patients on the liver transplant waiting list did not show higher prevalence of BKPyV and JCPyV compared to normoreactive controls.

Quantification of bleeding during dental extraction in patients on dual antiplatelet therapy.

In spite of the possibility of triggering thromboembolic events, many professionals indicate the suspension of antiplatelet agents before dental surgical procedures. The aim of this study was to perform a quantitative assessment of intraoperative bleeding in patients on dual antiplatelet therapy. A case-control study was conducted in patients on dual antiplatelet therapy (APT group) and in patients who did not use these medications (control group). The following examinations were requested: complete blood cell count, blood coagulation tests, and platelet aggregation. The quantity of bleeding was measured intraoperatively by collection of aspirated blood. The mean volume of blood lost during the surgical procedure was 6.10ml in the control group and 16.07ml in the APT group (P=0.002). The mean volume of blood lost per minute was 0.60ml/min in the control group and 1ml/min in the APT group (P=0.001), with local haemostatic methods being sufficient to control the bleeding. There was no postoperative bleeding complication in any case. Patients on dual antiplatelet therapy presented a larger volume of bleeding, but this could be controlled by means of local haemostatic measures. Therefore, there is no need to stop either of the two dual antiplatelet therapy medications before dental extractions.

The global burden of oral diseases in pediatric HIV-infected populations: a workshop report.

OBJECTIVES: To achieve a comprehensive understanding about the global burden of oral diseases in HIV-infected children and to identify research needs. MATERIALS AND METHODS: A literature search was conducted in PubMed (2009-2014) to address five questions: (i) prevalence of oral diseases in HIV-infected compared with uninfected children, (ii) impact of oral diseases on quality of life, (iii) effect of antiretroviral exposure in utero on craniofacial and dental development, (iv) important co-infections and antiretroviral complications, and (v) value of atraumatic restorative treatment. RESULTS: Studies showed a high prevalence of dental caries in HIV-infected children but the relationship between HIV infection and dental caries remains unclear. Also quality of life needs further investigation supported by better study designs and improvement of the instruments used. Up-to-date evidence suggested long-term harms associated with in utero antiretroviral exposure were minor but would require long-term follow-up through National Registries. The reviews also revealed the wide spectrum of metabolic disease due to antiretroviral therapy and co-infections such as tuberculosis. Finally, atraumatic restorative technique appears to be a simple and safe technique to treat dental caries but outcomes need further evaluation. CONCLUSIONS: The impact of antiretroviral therapy in HIV-infected children has raised novel challenging questions in the field of oral health warranting future research.

Oral hairy leukoplakia diagnosis by Epstein-Barr virus in situ hybridization in liquid-based cytology.

OBJECTIVE: To establish a definitive diagnosis of oral hairy leukoplakia (OHL) by in situ hybridization for Epstein-Barr virus (EBV) detection with liquid-based cytology (LBC), using the ThinPrep® Pap Test, and to compare its efficacy with the traditional method of performing biopsy. METHODS: Thirty-three individuals divided into three groups were included in this study. Group 1 consisted of 15 human immunodeficiency virus (HIV)-positive patients with a clinical and histopathological diagnosis of OHL on the lateral border of the tongue. Group 2 consisted of 10 HIV-positive individuals with neither OHL nor other oral lesions. Group 3 consisted of 10 immunocompetent HIV-negative individuals with neither OHL nor other oral lesions. For each patient from the three groups, exfoliative LBC was performed on the lateral border of the tongue using ThinPrep. For the patients from group 1, a 6-mm-diameter punch biopsy was obtained from the same anatomic site as the brush collection to confirm the diagnosis of OHL by histopathology with in situ hybridization. Slides were prepared for morphological cellular analysis using Papanicolaou (Pap) staining, and for EBV detection using in situ hybridization. RESULTS: Thirteen of the 15 patients from group 1 were confirmed on punch biopsy as OHL, providing the gold standard for the study. The sensitivity of LBC followed by a Pap-stained smear was 62% and the specificity was 90%. The sensitivity of LBC followed by in situ hybridization was 100% and the specificity was 100%. CONCLUSIONS: Exfoliative LBC associated with EBV in situ hybridization is a simple, effective and non-invasive diagnostic tool for OHL.

Oral koilocytic dysplasia: long-term clinical control. A case report.

Leukoplakia, a common lesion in the oral cavity, is considered a premalignant lesion that can develop into carcinoma. In 1986, a group of pathologists described a variant of epithelial dysplasia and named it "koilocytic dysplasia" (KD). This article presents a case of KD that was identified for 12 years as "carcinoma in situ". Even after removal of the lesion, it recurred with no signs of malignancy. The histopathological findings revealed all of the signs of KD (koilocytosis, acanthosis, multinucleated keratinocytes and atypical mitoses). Liquid-based cytology and hybrid capture were performed to confirm the diagnosis. Despite a professional recommendation to have the lesion removed surgically, the patient chose periodic clinical control. The mechanism of HPV transmission in the oral cavity still remains partially unknown. Additional studies on this subject are required to better understand the role of HPV in cell transformation in the oral cavity.