Manejo clínico e cirúrgico da miíase em face: relato de caso / Clinical and Surgical Management of Myiasis in the Face: Case Report / Manejo Clínico Quirúrgico de Miasis en la Cara: Reporte de Caso

Objetivo: O presente trabalho tem como objetivo relatar um caso de miíase em face, descrevendo as suas características e tratamento. Relato de caso: Paciente do sexo masculino, leucoderma, 39 anos, em condições de rua. Ao exame físico, havia perda de substância tecidual em região labial inferior, com extensão a tecidos adjacentes periorais, lábio superior e base nasal. Notava-se presença de miíase na região. Ao exame intra-oral, observou-se região endurecida à palpação pela extensão interna total do lábio inferior. Optou-se pela remoção cirúrgica das larvas, irrigação e debridamento do tecido necrosado. A condição acomete predominantemente indivíduos com deficiência neurológica e/ou locomotora, de baixo nível socioeconômico, com higiene precária, dependentes químicos e com lesões prévias. Conclusão: Quanto ao tratamento, há diferentes formas, como remoção manual de larvas e desbridamento cirúrgico, aplicação de substâncias asfixiantes e antibioticoterapia, principalmente com uso de ivermectina. A miíase é uma doença tratável que atinge populações específicas. Devido à agressividade da lesão, a prevenção e tratamento adequado em tempo hábil são necessários. O tratamento instituído neste caso foi eficaz e restabeleceu as condições do paciente... (AU)

Objective: The present work aims to report a case of myiasis in the face, describing its characteristics and treatment. Case report: Male patient, leucoderma, 39 years old, in street conditions. On physical examination, there was loss of tissue substance in the lower labial region, extending to adjacent perioral tissues, upper lip and nasal base. The presence of myiasis was noted in the region. On intraoral examination, a hardened region was observed on palpation due to the total internal extension of the lower lip. We opted for the surgical removal of the larvae, irrigation and debridement of the necrotic tissue. The condition predominantly affects individuals with neurological and/or locomotor disabilities, of low socioeconomic status, with poor hygiene, chemical dependents and with previous injuries. Conclusion: As for the treatment, there are different ways, such as manual removal of larvae and surgical debridement, application of asphyxiating substances and antibiotic therapy, mainly with the use of ivermectin. Myiasis is a treatable disease that affects specific populations. Due to the aggressiveness of the lesion, prevention and adequate treatment in a timely manner are necessary. The treatment instituted in this case was effective and restored the patient's conditions... (AU)

Objetivo: El presente trabajo tiene como objetivo reportar un caso de miasis en la cara, describiendo sus características y tratamiento. Reporte de caso: Paciente masculino, leucoderma, 39 años, en condiciones de calle. En el examen físico, había pérdida de sustancia tisular en la región labial inferior, que se extendía a los tejidos periorales adyacentes, el labio superior y la base nasal. Se notó la presencia de miasis en la región. Al examen intraoral se observa región endurecida a la palpación por extensión interna total del labio inferior. Optamos por la extirpación quirúrgica de las larvas, irrigación y desbridamiento del tejido necrótico. La condición afecta predominantemente a personas con discapacidad neurológica y/o locomotora, de nivel socioeconómico bajo, con mala higiene, dependientes de sustancias químicas y con lesiones previas. Conclusión: En cuanto al tratamiento, existen diferentes vías, como la extracción manual de larvas y desbridamiento quirúrgico, aplicación de sustancias asfixiantes y antibioticoterapia, principalmente con el uso de ivermectina. La miasis es una enfermedad tratable que afecta a poblaciones específicas. Debido a la agresividad de la lesión, es necesaria la prevención y el tratamiento adecuado en el momento oportuno. El tratamiento instituido en este caso fue efectivo y restableció las condiciones del paciente... (AU)

Solitary fibrous tumor: Two cases report with a focus on the differential diagnosis / Tumor Fibroso Solitário: Relato de dois casos com foco no diagnóstico diferencial

Solitary fibrous tumor (SFT) is a neoplasm of fibroblastic/myofibroblastic origin with intermediate biological behavior. We report here two cases of SFT affecting an unusual anatomical site in 58-year-old and 40-year-old female patients and discuss the differential diagnosis of this lesion. In case 01, the lesion showed the clinical appearance of an asymptomatic "blister" with normal color, rubbery consistency, measuring 0.3 cm, and affected the lower lip; while in case 02, a symptomatic red nodular lesion with a soft consistency and measuring 0.5 cm affected the floor of the mouth. Excisional biopsies were performed. Microscopically, two well-delimited benign neoplasms were observed, exhibiting the proliferation of ovoid to spindle-shaped mesenchymal cells, vascular spaces with staghorn arrangement, and the absence of mitosis figures. Immunohistochemistry was performed in case 01 to assist in the diagnosis. Weak and diffuse immunostaining was observed for α-SMA and intense and diffuse immunopositivity for Bcl-2 and CD34. Based on histopathological and immunohistochemical features, a diagnosis of SFT was rendered in both cases. The low occurrence and nonspecific clinical features of oral SFT may make its clinical diagnosis difficult. Also, morphological and immunohistochemical are essential for differential diagnosis with other mesenchymal neoplasms.(AU)

O tumor fibroso solitário (TFS) é uma neoplasia de origem fibroblástica/miofibroblastica com comportamento biológico intermediário. Nesse artigo relatamos dois casos de TFS afetando sítios anatômicos incomuns em pacientes do sexo feminino de 58 anos e 40 anos e discutir os seus diagnósticos. No caso 01 clinicamente a lesão apresentou um aspecto de "bolha" assintomática, coloração normal da mucosa, consistência borrachoide medindo 0,3 cm, em região de lábio inferior, enquanto que no caso 02, como uma lesão sintomática, vermelha, nodular com consistência mole e medindo 0,5 cm afetando o assoalho bucal. As biópsias excecionais foram realizadas. Microscopicamente, observamos duas lesões neoplásicas bem delimitadas exibindo uma proliferação de células mesenquimais variando de ovoides a fusiformes, vasos sanguíneos em formato de "chifre de veado", com ausência de figuras de mitoses. No caso 01 foi realizado análise imuno-histoquímica para auxiliar no diagnóstico. Foi observado uma marcação fraca e difusa de α-SMA e uma intensa e difusa imunopositividade para o Bcl-2 e CD34.Baseado nos achados histopatológicos e imuno-histoquímicos o diagnóstico de TFS foi estabelecido em ambos os casos. A baixa ocorrência e os achados clínicos inespecíficos do TFS oral podem dificultar o diagnóstico clínico. Além disso, as análises morfológicas e imuno-histoquimicas são essenciais para realização do diagnóstico diferencial com outras neoplasias mesenquimais.(AU)_

Molusco contagioso: actualización y casos clínicos / Molluscum contagiosum: an update and clinical cases

El molusco contagioso es una patología viral benigna muy frecuente, exclusiva del ser humano, y causada por un virus no clasificado del grupo de los Poxvirus. Las manifestaciones clínicas de la enfermedad inclu-yen lesiones en la piel, que pueden variar desde una pequeña pápula a un nódulo de mayor tamaño, pre-sentándose en forma solitaria o múltiple, dependien-do del estado inmunitario del paciente y del tiempo de evolución del proceso morboso. El estudio histo-patológico es importante para el diagnóstico, aunque en numerosas ocasiones éste se define clínicamen-te. Además del patrón histológico tradicional, y más frecuente, que exhibe hiperplasia e hipertrofia de la epidermis, se han descripto variantes poco usuales, cuyas características dependen, entre otros factores, de la sobreinfección y de la respuesta inmunitaria del paciente. En este trabajo se describen los rasgos ge-nerales del molusco contagioso y luego se presentan varios casos clínicos, uno de los cuales exhibe ma-nifestación inusual en la semimucosa del labio. Por último, se realizan comentarios referentes a la im-portancia que tiene para el odontólogo conocer esta patología y estar capacitado para detectarla, de modo de evitar sus complicaciones y su diseminación (AU)

Molluscum contagiosum is a very common benign viral pathologythat affects exclusively humans and is caused by an unclassified virus of the Poxvirus family. Clinical manifestations include skin lesions such as papule or nodule, which may range from a small papule to a larger nodule, presenting either solitary or multiple, depending on the immune status of the patient and the time of evolution of the morbid process. Histopathological study is important for the diagnosis, although in numerous occasions it is defined clinically. Classical and more frequent histology pattern exhibits hyperplasia and hypertrophy of the epidermis; however, distinct characteristics may occur depending on factors like superinfection and immune response of patients. This article describes general aspects of molluscum contagiosum and exposes several clinical cases, one of which exhibits an unusual manifestation in the semimucosa of the lip. Finally, comments are made regarding the importance for dentists to learn about the existence of this pathology and be able to recognize it in order to avoid its complications and spread (AU)

Manifestación de impétigo y herpes zóster relacionado con el uso de mascarilla durante la pandemia de COVID-19. Informe de caso / Mask-related manifestation of impetigo and herpes zoster during the COVID-19 pandemic. Case report

Objetivo: Presentar un caso clínico en el que el paciente cursa impétigo que podría estar relacionado con el uso de mascarillas faciales por un tiempo prolongado. Caso clínico: Se reporta el tratamiento y la evolución de un caso clínico en un paciente adulto que consultó en un centro clínico privado por la presencia de lesiones vesiculares en la región labial superior con aumento de volumen generalizado en ambos labios. El cuadro clínico es compatible con infección por impétigo y herpes zóster asociado al uso prolongado de una mascarilla de tela. Se describe la importancia del empleo correcto de estas mascarillas que se están usando como medida de protección personal en el contexto de la pandemia por COVID-19, ya que las mismas pueden contribuir a generar infecciones faciales si no se mantiene una higiene apropiada (AU)

Aim: To present a clinical case in which the patient has impetigo that could be related to the use of facial masks for a long time. Clinical case: The treatment and evolution of a clinical case of an adult patient who attended a private clinical centre due to the presence of vesicular lesions in the upper labial region with generalized increase volume in both lips is reported. The clinical presentation is compatible with impetigo and herpes zoster infection associated with prolonged use of a cloth mask. The importance of the correct use of cloth masks that are being used as a personal protection measure in the context of the COVID-19 pandemic is described, since they can contribute to facial infections if proper hygiene is not observed (AU))

Prevalence of Lip and Tongue Squamous Cell Carcinoma (Scc) at a Pathological Anatomy Service in Northeast Brazil / Prevalencia del Carcinoma de Celulas Escamosas en Labios y Lengua (SCC) en un Servicio de Anatomía Patológica en el Noreste Brasil

The aim of this work was to trace an epidemiological and clinical profile of oral squamous cell carcinoma (SCC) cases diagnosed as lip and tongue SCC from June 2001 to 2018 at a pathology anatomy service located in Northeastern Brazil. Age, sex, duration, location, growth type, staining, metastasis, etiologic agents and lesion size data were obtained fr om patient clinical files and histopathological reports. A total of 124 cases were recorded, with tongue SCC being the most preval ent. The common characteristics of both assessed SCCs included higher frequency in men, mean age of 60 years old, evidence mostly of exophytic lesions and maximum size of 4 cm, predominantly diagnosed after a maximum of 1 year of appearance. Regarding divergent findings, lip SCC occurred mostly in the lower portion of the lip, presenting a predominantly leukoplastic color, with regular smoking habits and sunlight identified as the main etiological agents, and no strong relation to metastasis. On the other hand, tongue SCC mostly exhibiting predominantly erythroleukoplastic staining, with a greater relationship to alcohol - associated smoking and regular smoking habits. The highest percentage of patients with metastasis presented tongue SCC. Although lip and tongue SCC display a male preference, an increasing amount of female involvement has been noted over the years, due to the adoption of deleterious habits such as smoking and alcoholism. Tongue SCC presented a greater relationship with metastasis and clinical leukoeritroplastic evidence. This greater aggressiveness could be related to the unfavorable locat ion of these lesions in relation to lip SCC, sometimes making it difficult to identify in their early development stages.

El objetivo de este trabajo fue rastrear un perfil epidemiológico y clínico de los casos de carcinoma oral de células escamosas (CCE) diagnosticados como CCE de labios y lengua entre junio de 2001 y 2018 en un servicio de anatomía patológica ubicado en el Noreste de Brasil. Los datos de edad, sexo, duración, ubicación, tipo de crecimiento, tinción, metástasis, agentes etiológicos y tamaño de la lesión se obtuvieron de los archivos clínicos de los pacientes y los informes histopatológicos. Se revisaron un total de 124 casos, siendo el CCE de lengua el más prevalente. Las características comunes de ambos CCE evaluados incluyeron mayor frecuencia en hombres, edad promedio de 60 años, evidencia mayoritariamente de lesiones exofíticas y tamaño máximo de 4 cm, diagnosticado predominantemente después de un máximo de 1 año de aparición. En cuanto a los hallazgos divergentes, el CCE labial se presentó mayoritariamente en la porción inferior del labio, presentando un color predominantemente leucoplásico, con el hábito de fumar habitualmente y la luz solar identificados como los principales agentes etiológicos, sin una fuerte relación con las metástasis. Por otro lado, el CEC de la lengua presenta en su mayoría tinción predominantemente eritroleucoplásica, con una mayor relación con el tabaquismo asociado con el alcohol y con los hábitos habituales de tabaquismo. El mayor porcentaje de pacientes con metástasis presentó CCE de lengua. Aunque el CCE de labios y lengua muestra una preferencia en hombres, se ha observado una cantidad cada vez mayor prevalencia en mujeres a lo largo de los años, debido a la adopción de hábitos nocivos como el tabaquismo y el alcoholismo. El CCE de lengua presentó una mayor relación con la metástasis y la evidencia clínica leucoeritroplásica. Esta mayor agresividad podría estar relacionada con la ubicación desfavorable de estas lesiones en relación al CCE labial, dificultando en ocasiones su identificación en sus primeras etapas de desarrollo.

Tratamento cirúrgico de hemangioma infantil nasal e labial na fase involuída: relato de caso / Surgical treatment of infantile nasal and labial hemangioma in the involuted phase: a case report

Hemangioma infantil (HI) é o tumor vascular mais comum e a neoplasia benigna mais frequente da infância, com maior incidência no sexo feminino e na população branca. Quase 60% dos casos ocorrem em cabeça e pescoço, sendo o tratamento ativo durante a fase proliferativa mais frequentemente indicado, em decorrência dos possíveis problemas funcionais e do potencial desfigurante. Relatamos um caso de paciente com hemangioma infantil involuído de ponta nasal e lábio superior, tratado de forma expectante durante a infância, submetida à correção da deformidade residual com técnicas de rinoplastia, associado à zetaplastia e lipoenxertia do lábio superior com bom resultado e satisfação do paciente.

Infantile hemangioma (IH) is the most common vascular tumor and the most frequent benign neoplasm in childhood, with the highest incidence in females and the white population. Almost 60% of cases occur in the head and neck, and active treatment during the proliferative phase is the most frequently indicated, due to possible functional problems and disfiguring potential. We report a case of a patient with involute infantile hemangioma of the nasal tip and upper lip, treated expectantly during childhood, submitted to residual deformity correction with rhinoplasty techniques, associated with zetaplasty and upper lip grafting with good results and patient satisfaction.

Sclerotherapy as an esthetic indication in oral vascular malformations: a case series

Abstract Background The use of monoethanolamine oleate 5% is effective for the treatment of vascular malformations with low blood flow. Objectives To report a case series of vascular malformations in the mouth and oral cavity treated with monoethanolamine oleate 5%. Methods A retrospective descriptive study was performed in electronic patient charts covering seven years. Patient demographics, diagnostic resources, lesion site, size, and number of applications of monoethanolamine oleate 5% were collected. Results A total of 21 vascular malformations were recorded, located mostly on the lower lip (52.3%) and resolved in a single application in 14 patients. The authors found 19 patients treated with sclerotherapy. Thirteen were women and six were men, with a mean age of 61 years. Study limitation Small sample size. Conclusions Sclerotherapy is an effective treatment for vascular malformations of the lips and oral cavity, with resolution after only one or two applications (n = 16).

Oral mucosa lesions as atypical manifestation of adult-onset Still´s disease

Abstract: Adult-onset Still's disease is a systemic inflammatory disorder of unknown etiology, characterized by skin rash, spiking fever, arthralgias or arthritis, and leukocytosis. The typical skin rash is evanescent, salmon-pink, nonpruritic and maculopapular, predominantly on the extremities. It is considered one of the major Yamaguchi's criteria in adult-onset Still's disease. However, atypical skin lesions are also described. Here, a 61-year-old woman with sore throat, spiking fever, polyarthritis and evanescent salmon-pink nonpruritic maculopapular skin rash on the extremities was diagnosed with adult-onset Still's disease. In addition, atypical brown macules on oral mucosa, localized on the inner lips and tongue were also observed. Biopsy revealed a neutrophilic infiltrate. Despite treatment and improvement of the adult-onset Still's disease, the atypical oral mucosal lesions persisted.

Do you know this syndrome? Ascher´s syndrome: clinical findings of little known triad

Abstract: Ascher's syndrome consists of double lip, blepharochalasis and sometimes non-toxic thyroid enlargement. It is a rare, benign, rarely reported, and sometimes misdiagnosed condition that most often affects patients under 20 years old. The etiology remains unknown, although factors such as trauma, hormonal dysfunction and heredity have been suggested. Treatment based on surgical intervention is indicated to improve aesthetics or function. The presented case shows a patient diagnosed with Ascher's syndrome based on clinical findings such as double lip and blepharochalasis.

Oral phaeohyphomycosis in a patient with squamocellular carcinoma of the lip: second case report

Abstract This communication reports the second known case of oral phaeohyphomycosis in a patient with squamocellular carcinoma of the lip. The patient, an 82-year-old black woman, a former smoker (for more than 30 years), suffering from an ulcerous vegetative lesion in the middle third of the lower lip for approximately 12 months. The result of the histopathological analysis indicated carcinoma, with well-differentiated keratinized squamous cells and the presence of septate mycelial filaments. In the direct mycological examination, thick and dematiaceous septate mycelial filaments were observed. After the resection surgery, the patient did not need to use an antifungal drug to treat the phaeohyphomycosis, and no follow-up radiotherapy was needed to treat the squamocellular carcinoma. We stress that the presence of the squamocellular lesion of the lip was a possible contributing factor to the infection.

Furuncular Myiasis Affecting the Lower Lip of a Young Patient

Abstract Furuncular myiasis is a parasitic infection caused by the larvae of Dipteran insects after penetrating healthy skin, causing an erythematous nodule with a central pore. Additionally, the patient may feel a sensation of movement and intermittent pain. Furuncular myiasis affecting the oral and perioral region is rare, usually leading to misdiagnosis. This paper describes a rare case of furuncular myiasis in a 20-year-old healthy male patient who presented an erythematous nodule in the lower lip. An exploratory surgery was indicated for both diagnostic and curative purposes, with successful healing observed in the following appointment. After 3 years of follow-up, the patient is recovered, with no clinical signs or symptoms of the disease.

Resumo A miíase furuncular é uma infecção parasitária causada pelas larvas de insetos Dipterans após penetrar na pele saudável, causando um nódulo eritematoso contendo um poro central. Adicionalmente, uma sensação de movimento e dor intermitente pode ser sentida. Miíase furuncular acometendo a região oral e perioral é rara, frequentemente causando erros diagnósticos. Este artigo descreve um caso raro de miíase furuncular em um paciente do sexo masculino de 20 anos de idade que apresentou um nódulo eritematoso no lábio inferior. Uma cirurgia exploratória foi indicada para fins diagnósticos e curativos, com sucesso observado já na sessão seguinte. Após 3 anos de acompanhamento, o paciente está recuperado, sem sinais clínicos ou sintomas da doença.

The effect of hippophae rhamnoides extract on oral mucositis induced in rats with methotrexate

ABSTRACT Objective: To investigate the effect of HRE (Hippophae rhamnoides extract) on oral mucositis induced in rats with MTX. Material and Methods: Experimental animals were divided into groups as healthy (HG), HRE+MTX (HMTX), and control group, which received MTX (MTXC). HMTX group received 50 mg/kg HRE while MTXC and HG groups received equivolume distilled water with gavage once a day. After one hour of HRE and distilled water administration, HMTX and MTXC groups received a single dose of oral MTX 5 mg/ kg. This procedure was repeated for one month. Results: The levels of MDA, IL-1β, and TNF-α were found to be significantly higher in the cheek, lower lip, and tongue tissue of the animals receiving MTX, compared with HG and HMTX groups; however, these parameters were lower in the cheek and low lip tissue, and a milder damage ocurred in these tissues, compared with the tongue tissue in MTXC group. No histopathologic damage was observed in the cheek, lower lip, and tongue tissues of the rats treated with HRE. Conclusion: This findings indicate that HRE as a natural product is an important advantage compared with synthetic drugs for prophylaxis of oral mucositis developed due to MTX.

Plasmoacanthoma

Abstract Plasmoacanthoma is an extremely rare verrucous tumor located on periorificial regions characterized by dense dermal plasmacytic infiltrates. Some authors classify it as a form of reactive plasma cell proliferation which represents a heterogeneous spectrum of mucocutaneous disorders. These plasma cell proliferations have been considered to be a benign immunologic inflammatory reaction to known or unknown stimuli. However, the etiology of plasmoacanthoma remains highly speculative. We report the case of a 40-year-old woman who presented with a lobulated warty lesion affecting the lower lip. Biopsy from the lesion was compatible with plasmoacanthoma, which remains an underreported disease in the dermatology literature.

Accuracy of clinical diagnosis for the identification of potentially malignant disorders and malignant lip lesions

Abstract: The aim of this study was to assess the accuracy of clinical diagnosis for lip lesions based on sensitivity and specificity. The retrospective analysis focused on the detection of lesions caused by potentially malignant disorders (PMDs) and malignant lesions (n = 1195). All cases were classified as benign, PMD, and malignant lesions. Concordance between diagnoses based on clinical examination and those based on histopathological analysis was assessed, and accuracy for the identification of PMD and malignant lesions was calculated. Histopathological analysis revealed 44 lesion types; PMD and malignant lesions comprised 8.3% of all cases. Compared with histopathological analysis, clinical examination showed 97.4% accuracy for the identification of non-malignant and potentially malignant/malignant cases. Degrees of specific sensitivity ranged from 34% to 77% for different lesions, and were highest for autoimmune (77%) and reactive (72%) lesions. Positive and negative predictive values for the identification of PMD and malignant lesions were 81.9% and 98.9%, respectively. Clinical examination showed a high degree of accuracy for the detection of PMD and malignant lip lesions, indicating good reliability.

Factors associated with lip and oral cavity cancer / Fatores associados ao câncer de lábio e cavidade oral

This study aimed to identify factors associated with the occurrence of primary cancer of the lip and oral cavity regions compared to other types of head and neck cancers according to demographic, socioeconomic data and lifestyle, in Brazil, from 2000 to 2011.

Objetivou-se identificar fatores associados à ocorrência de câncer primário nas regiões de lábio e cavidade oral frente aos demais tipos de cânceres de cabeça e pescoço segundo dados demográficos, socioeconômicos e de estilo de vida, no Brasil, no período de 2000 a 2011.

Adenoma pleomórfico em lábio inferior: relato de caso / Pleomorphic adenoma in lower lip: case report

O adenoma pleomórfico é o tumor benigno mais comum de glândulas salivares, acometendo, com mais frequência, as glândulas salivares maiores, especialmente a glândula parótida. Geralmente se apresenta como nódulo firme, indolor e de crescimento lento. Suas localizações mais comuns, em glândulas salivares menores, são o palato mole, duro e lábio superior, podendo ser encontrado em outras regiões com menos frequência. Essa lesão tem ligeira preferência pelo gênero feminino e seu tratamento consiste na excisão cirúrgica. O prognóstico é bom para as lesões benignas enucleadas. O objetivo deste trabalho é relatar o caso de um paciente portador de adenoma pleomórfico em lábio inferior. O paciente foi tratado sem intercorrências por meio da excisão cirúrgica da lesão e encontra-se em acompanhamento pós-operatório de um ano sem sinais de recidiva e sem queixas funcionais ou estéticas. No entanto, um acompanhamento mais prolongado se faz necessário para indicar cura do paciente... (AU)

Pleomorphic adenoma is a benign tumor most common of salivary glands, it usually occurs in major salivary glands, especially the parotid gland. Normally, it is seen as a firm nodule, painless with slow growth. Its locations most common, in minor salivary glands, are the soft and hard palate and upper lip, it can be found in other regions less frequently. This lesion has slight preference for females and its treatment consists on surgical excision. The prognosis is good to the removed benign lesions. The aim of this work is to report the case of a patient with the diagnosis of pleomorphic adenoma in lower lip. The case was treated without complications, and a year follow-up patient showed no recurrence, but longer follow is necessary to indicate patient's cure... (AU)

Cheilitis granulomatosa associated with lupus erythematosus discoid and treated with methotrexate: report of a case

We present the rare case of a 47-year-old patient, suffering from cheilitis granulomatosa and lupus erythematosus discoid: this association is really exceptional because only once reported in English literature. In addition, the treatment of cheilitis granulomatosa is a challenge for the dermatologist: the gold standard, represented by steroids, is in fact designed as a short-time option. Our report confi rms the good efficacy of methotrexate as a steroid-sparing agent.

Craniofacial changes and symptoms of sleep-disordered breathing in healthy children

INTRODUCTION: The main cause of mouth breathing and sleep-disordered breathing (SDB) in childhood is associated with upper airway narrowing to varying degrees. OBJECTIVE: The aim of this study was to assess the prevalence of morphological and functional craniofacial changes and the main clinical symptoms of SDB in healthy children. METHODS: A cross-sectional observational study was conducted. A sample comprising 687 healthy schoolchildren, aged 7-12 years old and attending public schools, was assessed by medical history, clinical medical and dental examination, and respiratory tests. The self-perceived quality of life of mouth breathing children was obtained by a validated questionnaire. RESULTS: Out of the total sample, 520 children were nose breathers (NB) while 167 (24.3%) were mouth breathers (MB); 32.5% had severe hypertrophy of the palatine tonsils, 18% had a Mallampati score of III or IV, 26.1% had excessive overjet and 17.7% had anterior open bite malocclusion. Among the MB, 53.9% had atresic palate, 35.9% had lip incompetence, 33.5% reported sleepiness during the day, 32.2% often sneezed, 32.2% had a stuffy nose, 19.6% snored, and 9.4% reported having the feeling to stop breathing while asleep. However, the self-perception of their quality of life was considered good. CONCLUSION: High prevalence of facial changes as well as signs and symptoms of mouth breathing were found among health children, requiring early diagnosis and treatment to reduce the risk of SDB. .

INTRODUÇÃO: a principal causa da respiração bucal e dos distúrbios respiratórios do sono (DRS) está associada ao estreitamento das vias aéreas superiores, em diferentes graus. OBJETIVO: avaliar a prevalência de alterações morfológicas e funcionais da face e os principais sintomas clínicos de DRS em crianças saudáveis. MÉTODOS: estudo transversal, observacional, com amostra de 687 escolares saudáveis, provenientes de escolas públicas, com idades entre 7 e 12 anos. Foram avaliados pela história clínica, exame clínico médico e odontológico e testes respiratórios. A autopercepção da qualidade de vida dos escolares com respiração bucal foi obtida por meio de um questionário validado. RESULTADOS: na amostra total, 520 crianças eram respiradoras nasais (RN) e 167 (24,3%) eram respiradoras bucais (RB); 32,5% tinham hipertrofia das amígdalas palatinas, 18% tinham índice Mallampati obstrutivo (III e IV); 26,1% tinham overjet exagerado e 17,7%, mordida aberta anterior. Entre os RB, 53,9% tinham palato atrésico; 35,9% com ausência de selamento labial; 33,5% relataram sonolência diurna; 32,2%, espirros frequentes; 32,2%, nariz entupido; 19,6% roncavam e 9,4% relataram ter a sensação de parar de respirar durante o sono. Entretanto, a autopercepção da qualidade de vida desses escolares foi considerada boa. CONCLUSÃO: foi encontrada alta prevalência de alterações faciais, de sinais e de sintomas clínicos de respiração bucal nos escolares saudáveis examinados, necessitando diagnóstico e tratamento para reduzir o risco de DRS. .

Plexiform Neurofibroma: An Unusual Diagnosis of Lip Swellings.

Neurofibromas (NF) are seen either as a solitary lesion or as part of the generalized syndrome of NF (NF-1, also known as Von Recklinghausen disease of the skin). In plexiform neurofibroma (PN), there is proliferation of Schwann cells from the inner aspect of the nerve sheath, thereby resulting in an irregularly thickened, distorted, tortuous structure. Oral involvement by a solitary and peripheral PN in patients with no other signs of NF is rarely seen. It is reported that only 4-7% of patients affected by NF display oral manifestations. A solitary PN in a patient with no other symptoms is a diagnostic challenge, more so when the location of the lesion is one of the rarest sites.