RESUMO
BACKGROUND: We report a clinically challenging and unusual case of L. donovani oral mucosal leishmaniasis. CASE PRESENTATION: Israeli resident with a former travel to central and North Africa, with no documented or prior cutaneous lesions presented with oral lesions of the maxillary gingiva and the upper lip. A delay in diagnosis and treatment have led to progression of the maxillary gingival lesions towards the hard palatal and the soft palate that could have potentially compromised the upper airway. CONCLUSIONS: This case highlights the importance of early diagnosis of leishmaniasis in patients with oral lesions and the laboratory workup necessary to appropriately characterize and treat the disease.
Assuntos
Leishmaniose Cutânea , Leishmaniose Mucocutânea , Leishmaniose , Úlceras Orais , Humanos , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/patologia , Leishmaniose Mucocutânea/diagnóstico , Leishmaniose Mucocutânea/tratamento farmacológico , Lábio/patologia , Mucosa BucalRESUMO
This paper is a retrospective report of the treatment of six patients with severely resorbed maxillae. Patients were treated, based on the amount of maxillary retrognathia, with either a Le Fort I downfracture or a "horseshoe" interpositional sandwich osteotomy, along with sinus elevation. Recombinant human bone morphogenetic protein-2 in an absorbable collagen sponge carrier was used for grafting in all patients, either alone or in combination with other grafting materials. Implants were placed and the patients were restored with fixed prostheses. Both grafting techniques are described, and the treated patients are presented.
Assuntos
Proteína Morfogenética Óssea 2/administração & dosagem , Doenças Maxilares/cirurgia , Osteotomia de Le Fort/métodos , Retrognatismo/cirurgia , Levantamento do Assoalho do Seio Maxilar/métodos , Fator de Crescimento Transformador beta/administração & dosagem , Idoso , Implantação Dentária Endóssea/métodos , Feminino , Esponja de Gelatina Absorvível , Humanos , Arcada Edêntula/cirurgia , Masculino , Maxila , Ilustração Médica , Pessoa de Meia-Idade , Osteotomia de Le Fort/instrumentação , Proteínas Recombinantes/administração & dosagem , Estudos RetrospectivosRESUMO
A 58-year-old woman presented to the Oral and Maxillofacial Surgery Clinic experiencing severe limited mouth opening and exposed bone in the socket of the right mandibular third molar 8 months following the extraction of the tooth. The patient had been treated during the year before her presentation with sunitinib, an antiangiogenic drug, for renal cell carcinoma. The clinical, radiographic, and histologic picture of a chronic nonhealing extraction socket was consistent with osteonecrosis of the jaw (ONJ), although she had never been treated with bisphosphonates or corticosteroids. The treatment with sunitinib was discontinued and the patient was treated with antibiotics and physiotherapy for 12 weeks with complete recovery. Sunitinib may cause osteonecrosis of the jaw after oral surgical interventions with no previous exposure to bisphosphonates. The pathogenesis may be related to its antiangiogenic mechanism and impaired wound healing. Full recovery may require long-term cessation of the insulting drug combined with prolonged antibiotic treatment.
Assuntos
Inibidores da Angiogênese/efeitos adversos , Antineoplásicos/efeitos adversos , Indóis/efeitos adversos , Mandíbula/cirurgia , Doenças Mandibulares/induzido quimicamente , Osteonecrose/induzido quimicamente , Pirróis/efeitos adversos , Actinomyces/isolamento & purificação , Actinomicose/tratamento farmacológico , Amoxicilina/uso terapêutico , Antibacterianos/uso terapêutico , Carcinoma de Células Renais/tratamento farmacológico , Ácido Clavulânico/uso terapêutico , Feminino , Humanos , Neoplasias Renais/tratamento farmacológico , Mandíbula/irrigação sanguínea , Doenças Mandibulares/tratamento farmacológico , Doenças Mandibulares/microbiologia , Pessoa de Meia-Idade , Dente Serotino/cirurgia , Osteonecrose/tratamento farmacológico , Osteonecrose/microbiologia , Sunitinibe , Extração Dentária/efeitos adversos , Alvéolo Dental/patologiaRESUMO
We describe the management of BRONJ triggered by dental implants in a patient on oral bisphosphonates. The sequestrum in the body of the mandible was large and involved the inferior alveolar nerve, causing a painful neuropathy. A successful outcome was obtained by combining conservative and surgical interventions.
Assuntos
Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/complicações , Queixo/inervação , Hipestesia/etiologia , Doenças Mandibulares/complicações , Doenças do Nervo Trigêmeo/etiologia , Idoso , Alendronato/efeitos adversos , Amitriptilina/uso terapêutico , Analgésicos não Narcóticos/uso terapêutico , Osteonecrose da Arcada Osseodentária Associada a Difosfonatos/cirurgia , Conservadores da Densidade Óssea/efeitos adversos , Doenças dos Nervos Cranianos/etiologia , Desbridamento , Implantes Dentários/efeitos adversos , Remoção de Dispositivo , Feminino , Seguimentos , Humanos , Doenças Mandibulares/cirurgia , Nervo Mandibular/fisiopatologia , Medição da Dor , Dor Referida/etiologiaRESUMO
Proteomic characterization of human whole saliva for the identification of disease-specific biomarkers is guaranteed to be an easy-to-use and powerful diagnostic tool for defining the onset, progression and prognosis of human systemic diseases and, in particular, oral diseases. The high abundance of proteins, mainly alpha amylase, hampers the detection of low abundant proteins appearing in the disease state and therefore should be removed. In the present study a 2-DE was used to analyze human whole saliva following the removal of alpha amylase by affinity adsorption to potato starch. After alpha amylase removal whole saliva was analyzed by SDS-PAGE showing at least sixfold removal efficiency and by an alpha amylase activity assay showing 97% reduced activity. MS identification of the captured alpha amylase after elution demonstrated specific removal; 2-DE analysis showed the selective removal of alpha amylase and consequently increased gel resolution. MS identification of protein spots in the 60 kDa area revealed 15 proteins, which were masked before alpha amylase removal. In conclusion, treatment of human whole saliva with an alpha amylase removal device increases gel resolution and enables a higher protein sample for analysis.