Assessment of mouth opening before and after head and neck radiotherapy in patients with intraoral stents.

Background: We evaluated the evolution of mouth opening before and after radiotherapy of the head and neck in patients using intraoral stents. Materials and methods: Twenty-one patients with head and neck cancer who were indicated for radiotherapy participated in this study. Maximum interincisal opening measurements were performed before and after radiotherapy. Paired analyses of the pre- and post-radiotherapy groups were performed using paired samples t-tests and correlation analyses using Spearman's correlation test, with p < 0.05 considered statistically significant. Results: Paired analyses of the pre- and post-radiotherapy groups revealed a statistically significant reduction in post-radiotherapy maximum interincisal opening (p < 0.001). However, only four individuals were diagnosed with trismus after radiotherapy. Regarding the correlation tests, no statistically significant differences were observed between the differences in pre- and post-radiotherapy maximum interincisal opening values and the study variables. Conclusion: The use of prosthetic devices during head and neck radiotherapy can reduce radiation doses in areas of no interest, thereby preventing the acute and late toxicities associated with cancer therapy.

Hamartomatous Polyp of the Palatine Tonsil: A Case Report and Critical Literature Review.

BACKGROUND: Hamartomatous polyp of the palatine tonsil is a rare benign tumor poorly recognized by clinicians and pathologists. We present a novel case report and provide a literature review about this diagnosis, highlighting its clinicopathological features and treatment modalities. METHODS: We herein report a case of a 22-year-old female patient who complained of a foreign body sensation in her throat. She presented with a pedunculated polyp attached to her right palatine tonsil, which was noticed 15 years ago. An excisional biopsy was performed under local anesthesia, and the microscopic aspect confirmed the diagnosis of the hamartomatous polyp of the palatine tonsil. The literature review was performed using the "palatine tonsil polyps" term in PubMed and Google Scholar. Only English-language publications showing clinical and microscopic descriptions were selected as inclusion criteria. RESULTS: As in our case report, this poorly understood lesion usually presents as a solitary, unilateral pedunculated mass attached to the palatine tonsil surface with nonspecific symptoms. The literature shows less than 100 cases reported, which reveals a lesion preference for male and young adult patients. Microscopically, it is characterized by disorganized proliferation of the connective tissue components indigenous to the involved site, with variable lymphangiectasia, which accounts for the diversity of the diagnostic term and its unknown incidence. Its treatment consists of excision of the polyp with or without tonsillectomy, and no recurrence or malignant transformation of these polyps has been reported. CONCLUSION: The hamartomatous polyp of the palatine tonsil is challenging due to its rarity and lack of standardization of the terminology used in the literature. Including this diagnosis in the 5th edition of the World Health Organization Classification for Head and Neck Tumors is expected to contribute to a better understanding of this pathology.

An unusual clinical manifestation of oral melanocytic nevus.

Melanocytic nevi are acquired or congenital benign neoplasms, often found in skin but rarely in the oral mucosa. This article reports an atypical case of oral hypopigmented melanocytic nevus in a 39-year-old woman referred for evaluation of a well-circumscribed papule with discrete brownish spots in the buccal mucosa. An excisional biopsy was performed, the results of which led to a clinical diagnosis of inflammatory fibrous hyperplasia. The histopathologic analysis resulted in a diagnosis of hypopigmented intramucosal melanocytic nevus. This unusual clinical manifestation of melanocytic nevus reinforces the importance of including nonpigmented or hypopigmented melanocytic nevi in the differential diagnosis of papules arising in the oral mucosa. A biopsy and subsequent histologic examination of the specimen are recommended to establish an accurate diagnosis.

Risk profile for antiangiogenic agent-related osteonecrosis of the jaws.

To establish the profile of patients who developed antiangiogenic agent-related osteonecrosis of the jaws, and identify the treatments currently used in dental management. We searched the PubMed®/Medline® and Scopus databases using the words "osteonecrosis AND antiangiogenic therapy", with the following inclusion criteria: articles published in English, case reports, available online, and for an unlimited period. Of the 209 articles retrieved, 18 were selected, for a total of 19 case reports, since one article included two cases that met the inclusion criteria for this study. Medication-related osteonecrosis of the jaws is characterized by exposure of necrotic bone in the oral cavity that does not heal over a period of 8 weeks in patients with no previous history of radiation therapy. Antiangiogenic drugs are indicated in the treatment of certain tumors, since they stop the formation of new blood vessels, controlling tumor growth and the chance of metastasis. Dental prevention is essential in patients who will be put on antiangiogenic agents, to minimize the risk for osteonecrosis.

Desafios da abordagem interdisciplinar de indivíduo cardiopata grave com abcesso odontogênico agudo / Challenges of the interdisciplinary approach in an individual with severe heart disease and acute dental abcess

Os indivíduos sistemicamente comprometidos e com múltiplas comorbidades são um desafio para a abordagem cirúrgica. Pacientes com flutter atrial fazem uso de anticoagulantes para diminuir o risco de eventos tromboembólicos, porém há maior risco de hemorragia durante procedimentos cirúrgicos. As infecções de origem odontogênica podem ter disseminação hematogênica e agravar ainda mais o quadro clínico geral do indivíduo. A abordagem cirúrgica deve sempre visar à segurança e à qualidade de vida do paciente, levando em consideração os riscos e benefícios do procedimento e o preparo do profissional frente a possíveis acidentes e complicações, haja vista o risco de mortalidade perioperatória. O presente caso relata o desafio de estabelecer plano de tratamento e conduta diante de infecção odontogênica em indivíduo cardiopata grave polimedicado ASA IV com histórico de doença renal crônica sob hemodiálise, hipertensão arterial sistêmica, diabetes mellitus, anemia, insuficiência coronariana, flutter atrial, aterosclerose e pé diabético. Para o procedimento sob anestesia geral, foi instituída a terapia de ponte prévia, utilização de medidas hemostáticas locais e antibioticoterapia pré e pós-operatória. A atuação interdisciplinar mostrou-se essencial para estabelecer critérios de segurança e decidir o melhor momento para a atuação cirúrgica

Systemically compromised individuals with multiple comorbidities represent a challenge in terms of the surgical approach. Patients with atrial flutter take anticoagulants to reduce the risk of thromboembolic events, but there is a greater risk of hemorrhaging during surgical procedures. Infections of odontogenic origin may involve hematogenous dissemination and further aggravate the patient's overall clinical condition. The surgical approach should always target the patient's safety and quality of life, considering the risks and benefits of the procedure and the professional's preparedness to cope with possible accidents and complications, given the risk of perioperative mortality. This is a case report of the challenge of establishing a treatment plan and course of action for dental infection in an ASA IV polymedicated patient with a history of chronic kidney disease undergoing hemodialysis, systemic arterial hypertension, diabetes mellitus, anemia, coronary insufficiency, atrial flutter, atherosclerosis and diabetic foot. Prior bridge therapy, use of local hemostatic measures, and pre- and postoperative antibiotic therapy were instituted for the procedure to be carried out under general anesthesia. Interdisciplinary action has proved to be essential for establishing safety criteria and deciding on the best time for surgical intervention

Risk profile for antiangiogenic agent-related osteonecrosis of the jaws / Perfil de risco para osteonecrose dos maxilares associada a agentes antiangiogênicos

ABSTRACT To establish the profile of patients who developed antiangiogenic agent-related osteonecrosis of the jaws, and identify the treatments currently used in dental management. We searched the PubMed®/Medline® and Scopus databases using the words "osteonecrosis AND antiangiogenic therapy", with the following inclusion criteria: articles published in English, case reports, available online, and for an unlimited period. Of the 209 articles retrieved, 18 were selected, for a total of 19 case reports, since one article included two cases that met the inclusion criteria for this study. Medication-related osteonecrosis of the jaws is characterized by exposure of necrotic bone in the oral cavity that does not heal over a period of 8 weeks in patients with no previous history of radiation therapy. Antiangiogenic drugs are indicated in the treatment of certain tumors, since they stop the formation of new blood vessels, controlling tumor growth and the chance of metastasis. Dental prevention is essential in patients who will be put on antiangiogenic agents, to minimize the risk for osteonecrosis.

RESUMO Traçar o perfil dos pacientes que desenvolveram osteonecrose dos maxilares associada a agentes antiangiogênicos e identificar os tratamentos realizados atualmente no manejo odontológico. Foi realizada busca nas bases de dados PubMed®/Medline® e Scopus por meio dos descritores "osteonecrosis AND antiangiogenic therapy", sendo utilizados os critérios de inclusão: artigos publicados em inglês, relato de caso, disponíveis on-line e por período ilimitado. Após análise dos 209 artigos encontrados, foram selecionados 18 artigos para este estudo, resultando em 19 relatos de caso, visto que um dos artigos apresentou dois casos que se enquadravam nos critérios de inclusão. A osteonecrose dos maxilares associada a medicamentos é caracterizada pela exposição de osso necrótico na cavidade oral que não cicatriza em um período de 8 semanas em pacientes que não foram submetidos à radioterapia. Os medicamentos antiangiogênicos são indicados no tratamento de alguns tumores, pois impedem o crescimento de novos vasos sanguíneos, controlando o crescimento do tumor e a chance de metastização. Torna-se imprescindível a realização de prevenção odontológica do paciente a ser submetido a uso de antiangiogênicos visando a minimizar as chances de desenvolvimento da osteonecrose.