Reabilitação com prótese oculopalpebral após exenteração de órbita: relato de caso / Rehabilitation with oculopalpebral prosthesis after orbit exenteration: a case report / Rehabilitación com prótesis oculopalpebral después de la exenteración de la órbita: reporte de un caso

Introdução: A ressecção cirúrgica de tumores em região de cabeça e pescoço é um tratamento eficaz, mas que implica em significativa desfiguração facial dependendo da localização da lesão. Aqueles pacientes considerados curados precisam ser reabilitados estética e funcionalmente para que possam ser reintegrados às funções sociais. A prótese maxilofacial é um artefato de baixo custo, que pode resolver essa necessidade. Relato de caso: Esse artigo relata o caso de uma paciente de 19 anos submetida à exenteração de órbita para tratamento de Tumor Fibroso Solitário Retrorbitário que, após a cirurgia e radioterapia adjuvante, foi reabilitada por meio de prótese óculopalpebral em silicone. Conclusão: O caso foi considerado um sucesso e ressalta a importância do cirurgião dentista na equipe oncológica e o positivo impacto psicológico e social da reabilitação(AU)

Introduction: Surgical resection of head and neck tumors is an effective treatment, but it implies significant facial disfigurement depending on the location of the lesion. Those patients considered cured need to be rehabilitated aesthetically and functionally so that they can be reintegrated into social functions. The maxillofacial prosthesis is an artifact of low cost, which can solve thisneed. Case Report: This article reports the case of a 19-year-old patient who underwent orbit exanteration for the treatment of Solitary Retrorbital Fibrous Tumor, which, after surgery and adjuvant radiotherapy, was rehabilitated using an oculopebral prosthesis made of silicone. Conclusion: The case was considered a success and highlights the importance of the dental surgeon in the oncology team and the positive psychological and social impact of rehabilitation(AU)

Introducción: La resección quirúrgica de los tumores de cabeza y cuello es un tratamiento eficaz, pero implica una desfiguración facial significativa según la ubicación de la lesión. Aquellos pacientes considerados curados necesitan ser rehabilitados estética y funcionalmente para que puedan reintegrarse a las funciones sociales. La prótesis maxilofacial es un artefacto de bajo costo que puede resolver esta necesidad. Reporte del caso: Este artículo informa el caso de una paciente de 19 años que se sometió a una exenteración de órbita para el tratamiento del tumor fibroso retrorbital solitario, que, después de la cirugía y la radioterapia adyuvante, fue rehabilitada con una prótesis oculopalpebral de silicona. Conclusión: El caso se consideró un éxito y destaca la importancia del cirujano dental en el equipo de oncología y el impacto psicológico y social positivo de la rehabilitación(AU)

Photobiomodulation Therapy and Dexamethasone in the Management of Oral Acute Graft-Versus-Host Disease: Case Report.

Background: Acute graft-versus-host disease (GVHD) in the oral cavity is a rare complication of hematopoietic stem cell transplantation (HSCT) and treatment has a varying length of time for wound healing. Objective: This case report present a 63-year-old female patient with a diagnosis of acute lymphoid leukemia, submitted a related allogeneic HSCT, which after 6 months evolved with oral acute GVHD, presenting odynophagia, dysphagia, and difficulty of hygiene. Methods: We started the mouthwash dexamethasone and nystatin oral suspension and five sessions of photobiomodulation therapy (PBMT) (660 nm, 100 mW, 0.028 cm2, 2 J, 70 J/cm2, 20 sec/point) has been used with daily applications in the oral cavity (at the lesion sites and in healthy areas). Results: Complete healing of the oral lesions was observed in 5 days although the patient had acute skin and gastrointestinal GVHD. Conclusions: The treatment of oral acute GVHD with PBMT is still rare in the literature, but due to a good result in wound healing with PBMT, we have used this therapeutic option in combination with dexamethasone and have been successful in healing and reducing pain.

Systematic review of photobiomodulation for the management of oral mucositis in cancer patients and clinical practice guidelines.

PURPOSE: To systematically review the literature and update the evidence-based clinical practice guidelines for the use of photobiomodulation (PBM), such as laser and other light therapies, for the prevention and/or treatment of oral mucositis (OM). METHODS: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO) using PubMed and Web of Science. We followed the MASCC methods for systematic review and guidelines development. The rigorously evaluated evidence for each intervention, in each cancer treatment setting, was assigned a level-of-evidence (LoE). Based on the LoE, one of the following guidelines was determined: Recommendation, Suggestion, or No Guideline Possible. RESULTS: Recommendations are made for the prevention of OM and related pain with PBM therapy in cancer patients treated with one of the following modalities: hematopoietic stem cell transplantation, head and neck (H&N) radiotherapy (without chemotherapy), and H&N radiotherapy with chemotherapy. For each of these modalities, we recommend 1-2 clinically effective protocols; the clinician should adhere to all parameters of the protocol selected. Due to inadequate evidence, currently, No Guideline Possible for treatment of established OM or for management of chemotherapy-related OM. The reported clinical settings were extremely variable, limiting data integration. CONCLUSIONS: The evidence supports the use of specific settings of PBM therapy for the prevention of OM in specific patient populations. Under these circumstances, PBM is recommended for the prevention of OM. The guidelines are subject to continuous update based on new published data.

Systematic review of laser and other light therapy for the management of oral mucositis in cancer patients.

BACKGROUND: The aim of this study was to review the available literature and define clinical practice guidelines for the use of laser and other light therapies for the prevention and treatment of oral mucositis. METHODS: A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guideline possible. RESULTS: A new recommendation was made for low-level laser (wavelength at 650 nm, power of 40 mW, and each square centimeter treated with the required time to a tissue energy dose of 2 J/cm(2) (2 s/point)) for the prevention of oral mucositis in adult patients receiving hematopoietic stem cell transplantation conditioned with high-dose chemotherapy, with or without total body irradiation. A new suggestion was made for low-level laser (wavelength around 632.8 nm) for the prevention of oral mucositis in patients undergoing radiotherapy, without concomitant chemotherapy, for head and neck cancer. No guideline was possible in other populations and for other light sources due to insufficient evidence. CONCLUSIONS: The increasing evidence in favor of low-level laser therapy allowed for the development of two new guidelines supporting this modality in the populations listed above. Evidence for other populations was also generally encouraging over a range of wavelengths and intensities. However, additional well-designed research is needed to evaluate the efficacy of laser and other light therapies in various cancer treatment settings.

The prevention of induced oral mucositis with low-level laser therapy in bone marrow transplantation patients: a randomized clinical trial.

BACKGROUND DATA AND OBJECTIVE: Patients who have received high doses of chemotherapy, either alone or in combination with total body irradiation often cite oral mucositis (OM) as the most debilitating side effect. The aim of this study was to investigate the clinical effects of low-level laser therapy (LLLT) on the prevention of conditioning-induced OM in hematopoietic stem cell transplantation (HSCT). METHODS: We randomized 42 patients who underwent autologous or allogeneic HSCT. A low-level InGaAlP diode laser was used, emitting light at 660 nm, 40 mW, and 4 J/cm(2). An evaluation of OM was carried out using the World Health Organization scale. RESULTS AND CONCLUSION: In the LLLT group, 57.1% of patients had an OM grade 0, 9.6% had grade 1, and 33.3% had grade 2, whereas in the control group, only 4.8% of patients were free of OM (grade 0). Our results indicate that the preventive use of LLLT in patients who have undergone HSCT is a powerful instrument in reducing OM incidence.

Utilização da terapia com laser de baixa potência para prevenção de mucosite oral: revisão de literatura / Low-power laser therapy in the prevention of induced oral mucositis: literature review

A utilização da quimioterapia e da radioterapia, isoladas ou em conjunto como protocolo para o tratamento oncológico, pode induzir a mucosite oral que é um dos principais efeitos colaterais agudos observados no paciente com câncer. Essa toxicidade surge em média de sete a dez dias após a quimioterapia e a partir da segunda semanade radioterapia. Apesar de ser uma toxicidade estudada há muito tempo, somente recentemente os mecanismos moleculares e celulares começaram a ser desvendados, o que contribuiu para o surgimento de novos protocolos de prevenção. No universo de modalidades terapêuticas estudadas na prevenção da mucosite oral e de inúmeros insucessos, a terapia com o laser de baixa potência se destaca como uma alternativa eficaz na prevenção e no tratamento da mucosite oral, apresentando-se como um tratamento não traumático, de baixo custo e com bons resultados. Diversos estudos randomizados com pacientes submetidos ao transplante de medula óssea e à radioterapia na região de cabeça e pescoço comprovaram a diminuição da incidência de mucosite oral e de dor durante o período de tratamento. O objetivo deste trabalho foi conceituar mucosite e fazer uma revisão de literatura sobre osestudos clínicos que utilizaram o laser de baixa potência para prevenir mucosite oral.

O uso da terapia com laser de baixa potência como método de prevenção de mucosite oral nos pacientes submetidos ao transplante de medula óssea

O tratamento com quimioterapia de altas doses no condicionamento do transplante de medula ósea, produz efeitos indesejáveis na cavidade oral e o de maior magnitude c a mucosite oral (MO). Através do uso do laser de baixa potencia como terapia aplicada a mucosa oral, o autor avaliou a possibilidade da redução da incidência e/ou do grau de severidade da MO em pacientes submetidos ao transplante de medula óssea auto logo ou alogênico. Durante o período de janeiro de 2004 a maio de 2005, trinta e oito pacientes portadores de doenças hematol6gicas foram randomizados em um grupo composto de 19 pacientes que receberam radiação laser e outro grupo composto de 19 pacientes que não receberam a radiação laser. O laser utilizado foi um diodo de InGaAIP, com compril11ento de onda de 660 nm e 50 mW de potencia. A técnica utilizada foi pontual, tocando a mucosa, dosimetria de 4 J/cm2, ca1culado sobre a área do feixe de 0,196 cm2. A análise dos resultados mostrou que 0 grupo que recebeu a aplicação do laser teve uma menor incidência de mucosite oral e os pacientes que apresentaram mucosite neste grupo a apresentaram em menor proporção. Baseado nestes dados pode-se afirmar que o laser de baixa potencia e um instrumento capaz de reduzir a incidência de MO.

High-dose chemotherapy followed by bone marrow transplant produces undesirable effects in the oral cavity leading to oral mucositis (OM). Mucositis may be a painfull and debilitating side-effect. Through the use of the low power laser as therapy applied to the oral mucosa membrane, the author evaluated the potencial for a reduction in the incidence and/or severity of oral mucositis in patients submitted to autologus or alogenic bone marrow transplant. From January 2004 to May 2005, thirty eight patients bearers of hcmatological diseases were randomized into a group composed of 19 patients that received laser radiation and a group composed of 19 patients that did not receive the laser radiation. For the irradiation was used an diode InGaAIP, emiting light at 660 nm wavelenght with output power of 50 mW, giving an energy density of 4 J/cm2 measured at the end of fiberoptic with 0, 196cm2 of section area during the experiment. The tip of the laser device touched the oral mucosa.The results showed that the group which received the application of the laser had a smaller incidence of OM and even in the patients that presented mucositis in this group, it occurred in lower incidence. Based on these results we can affirm that the low level laser therapy is an instrument capable of reducing the incidence of OM.

The Impact of low power laser in the treatment of conditioning-induced oral mucositis: a report of 11 clinical cases and their review.

We have investigated the clinical effects of low power laser therapy (LPLT) on the treatment of conditioning-induced oral mucositis (OM) in patients submitted to hematopoietic stem cell transplantation (HSCT). The evaluation of OM was done using the Oral Mucositis Assessment Scale (OMAS) and World Health Organization (WHO) scale. In the context of a randomized placebo-controlled trial with 38 patients for the evaluation of preventive LPLT, eleven individuals were submitted to allogeneic (AL) HSCT and developed oral mucositis grade 4 (WHO) or a total area of OM of 12 cm (OMAS) and due to that were treated with LPLT with the purpose of symptom relief. The irradiation used was a diode InGaAlP, emitting light at 660 nm, 50 mW and 8 J/cm(2) measured at the end of fiber optic with 0.196 cm(2) of section area during the treatment. The tip of the laser device touched the oral mucosa and patients recovered on average 6 days (3-12 days) from the beginning of the laser application. Our results have indicated that the use of LPLT in HSCT patients is a powerful instrument in the treatment of overt OM and is now a standard procedure in this group of patients in our hospital.