Computed tomography evaluation of alterations in the masticator space due to invasion by malignant head and neck neoplasms / Avaliação das alterações do espaço mastigador decorrentes de invasão de neoplasias malignas de cabeça e pescoço por meio de tomografia computadorizada

Abstract Objective: To evaluate alterations in the masticator space due to the dissemination of malignant neoplasms originating from the tonsillar fossa, retromolar trigone, maxillary sinus, or nasopharynx, using computed tomography (CT), as well as to correlate the presence of trismus with the CT findings and the dimensions of the tumor. Materials and Methods: We evaluated the medical records of 65 patients with malignant tumors in the regions described. The images were analyzed by two physician examiners, working independently, who were blinded to the clinical data. In the evaluation of the masticator space, the following parameters were considered: symmetry with the contralateral space; obliteration of the fat plane, retromolar trigone, or pharyngeal space; edema/atrophy of the medial or lateral pterygoid muscles; and destruction of the mandibular ramus. Results: Obliteration of the fat plane was found in 69.2% of the patients. Asymmetry, edema/atrophy, and bone destruction were detected in 27.7%, 26.2%, and 20.0% of the patients, respectively. Trismus was identified in 15.4% of the patients. Of the patients with trismus, 90.0% had stage T4 tumors, compared with only 43.8% of those without trismus. Trismus was 11.6 times more common among the patients with stage T4 tumors than among those with lower-stage tumors. Neoplasms of the tonsillar fossa and retromolar trigone collectively accounted for 95.0% of the cases. The CT scans showed edema/atrophy of the pterygoid muscles in 60.0% of the patients with trismus and in 21.8% of those without. An association was observed between T4 tumor stage and edema/atrophy of the pterygoid muscles. In addition, the risk of trismus was 5.4 times higher among the patients with stage T4 tumors. Conclusion: In our patient sample, the most common finding was obliteration of the fat plane, followed by asymmetry and edema/atrophy. Most of the patients with T4 tumors had trismus, together with edema/atrophy of the pterygoid muscles.

Resumo Objetivo: Avaliar, por meio de tomografia computadorizada, alterações do espaço mastigador (EM) decorrentes de disseminação de neoplasias malignas originárias da loja tonsilar, trígono retromolar, seio maxilar e nasofaringe, e correlacionar presença de trismo com achados tomográficos e dimensões do tumor. Materiais e Métodos: Foram selecionados prontuários de 65 pacientes portadores de tumores malignos nas regiões descritas. A análise das imagens foi realizada por dois examinadores médicos, separadamente, sem o conhecimento das informações clínicas. Na avaliação do EM, foram considerados: simetria com o EM contralateral; obliteração do plano gorduroso, do trígono retromolar e do espaço faríngeo; edema e/ou atrofia dos músculos pterigóideos medial e lateral; destruição do ramo da mandíbula. Resultados: Foram observados obliteração do plano gorduroso em 69,2% dos pacientes, assimetria em 27,7%, espessamento/atrofia em 26,2% e destruição óssea em 20,0%. Presença de trismo foi encontrada em 15,4% dos pacientes. Na associação entre dimensão do tumor e trismo, foram observados trismo em 90,0% dos tumores em estágio T4, enquanto a porcentagem de tumores em estágio T4 sem trismo foi de 43,8%. Pacientes com tumores T4 apresentaram 11,6 vezes mais trismo que os dos demais estágios. Neoplasias da loja tonsilar e trígono retromolar perfizeram 95,0% dos casos. Em 60,0% dos pacientes com trismo havia edema e/ou atrofia dos músculos pterigóideos na tomografia computadorizada e em 21,8% nos sem trismo. Observou-se associação entre tumores T4 e edema e/ou atrofia dos músculos pterigóideos e 5,4 vezes mais chance de apresentarem trismo. Conclusão: A maioria dos pacientes apresentou obliteração do plano gorduroso, seguido de assimetria e espessamento/atrofia. O trismo estava presente na maioria dos pacientes T4 com espessamento/atrofia dos músculos pterigóideos.

A formação humanística para estudantes e profissionais da Odontologia uma dimensão esquecida / Formación humanística para estudiantes y profesionales de odontología: una dimensión olvidada / Humanistic training for dental students and professionals: a forgotten dimension

As Humanidades compõem um agrupamento de conhecimentos sobre artes, literatura e ciências humanas voltadas para a área da saúde, que surgiram como contraponto à excessiva tecnologização da saúde. Seu pressuposto é auxiliar o profissional da saúde a desenvolver conhecimentos além dos saberes técnicos, suportados nas ciências humanas e humanidades, e que permitam interagir com o paciente em todas as suas dimensões: espirituais, éticas, psíquicas, culturais e sociais. O objetivo desta revisão de literatura foi trazer uma reflexão sobre a importância das Humanidades para a atuação do cirurgião-dentista apontando alguns caminhos para seu desenvolvimento. A estratégia de busca de artigos foi a seleção de uma amostra de conveniência proveniente de três bases de dados (LILACS, PubMed e SciELO), além de excertos de livros sobre o tema, no período de 1995 à 2021. Observou-se que a discussão sobre as Humanidades está mais avançada na área médica, com iniciativas nos currículos de graduação e espaço próprio em alguns periódicos científicos. Na Odontologia, o tema ainda é pouco discutido nas instituições de ensino e na formação continuada dos profissionais. No Brasil, alguns grupos, como o Centro de História e Filosofia das Ciências da Saúde (CeHFi), da Universidade Federal de São Paulo (Unifesp), desenvolvem um trabalho pioneiro com acadêmicos de saúde envolvendo a leitura reflexiva de obras clássicas da literatura. Especificamente na área odontológica, não foram encontrados registros de iniciativas similares. Mais estudos no cenário odontológico são necessários para maior conhecimento do assunto (AU).

Las Humanidades conforman un conjunto de saberes sobre artes, literatura y ciencias humanas centrado en el área de la salud, que surgió como contrapunto a la excesiva tecnologización de la salud. Su premisa es ayudar a los profesionales de la salud a desarrollar conocimientos más allá de los conocimientos técnicos, apoyados en las ciencias humanas y humanidades, y que permitan interactuar con el paciente en todas sus dimensiones: espiritual, ética, psíquica, cultural y social. El objetivo de esta revisión bibliográfica fue traer una reflexión sobre la importancia de las Humanidades para la actuación del cirujano dentista, señalando algunos caminos para su desarrollo. La estrategia de búsqueda de artículos fue la selección de una muestra por conveniencia de tres bases de datos (LILACS, PubMed y SciELO), además de extractos de libros sobre el tema, de 1995 a 2021. Se observó que la discusión sobre las Humanidades está más avanzada en el campo de la Medicina, con iniciativas en los planes de estudio de pregrado y con espacio propio en algunas revistas científicas. En Odontología, el tema aún es poco discutido en las instituciones educativas y en la formación continua de los profesionales. En Brasil, algunos grupos, comoel Centro de Historia y Filosofía de las Ciencias de la Salud (CeHFi), de la Universidad Federal de São Paulo (Unifesp), desarrollan un trabajo pionero con académicos de la salud que implica la lectura reflexiva de obras clásicas de la literatura. Específicamente en el área odontológica no se encontraron registros de iniciativas similares. Se necesitan más estudios en el escenario odontológico para un mayor conocimiento del tema (AU).

Humanities include knowledge about arts, literature, and human sciences focused on the area of health, which emerged as a counterpoint to excessive health technologization of health. The assumption is to help health professionals develop beyond technical knowledge, supported by human sciences and humanities, in interacting with the patient in all dimensions: spiritual, ethical, psychic, cultural, and social. This literature review reflects on the importance of the Humanities for the performance of dental surgeons, highlighting some paths for its development. The article search strategy was A convenience sample from three databases (LILACS, PubMed, and SciELO) and excerpts from books on the subject from 1995 to 2021 was adopted as the article search strategy.The discussion on the Humanities is more advanced in the medical field, with initiatives in undergraduate curricula and space in some scientific journals. In dentistry, the topic is still little discussed in educational institutions and continuing professional education. In Brazil, some groups such as the Center of Health Sciences History and Philosophy (CeHFi) of the Federal University of São Paulo (Unifesp), are developing pioneering work with health students involving the reflective reading of classic literature. No records of similar initiatives were found specifically in the dental area. More studies in the context of dentistry are needed to increase knowledge on the subject (AU).

Computed tomography evaluation of alterations in the masticator space due to invasion by malignant head and neck neoplasms.

Objective: To evaluate alterations in the masticator space due to the dissemination of malignant neoplasms originating from the tonsillar fossa, retromolar trigone, maxillary sinus, or nasopharynx, using computed tomography (CT), as well as to correlate the presence of trismus with the CT findings and the dimensions of the tumor. Materials and Methods: We evaluated the medical records of 65 patients with malignant tumors in the regions described. The images were analyzed by two physician examiners, working independently, who were blinded to the clinical data. In the evaluation of the masticator space, the following parameters were considered: symmetry with the contralateral space; obliteration of the fat plane, retromolar trigone, or pharyngeal space; edema/atrophy of the medial or lateral pterygoid muscles; and destruction of the mandibular ramus. Results: Obliteration of the fat plane was found in 69.2% of the patients. Asymmetry, edema/atrophy, and bone destruction were detected in 27.7%, 26.2%, and 20.0% of the patients, respectively. Trismus was identified in 15.4% of the patients. Of the patients with trismus, 90.0% had stage T4 tumors, compared with only 43.8% of those without trismus. Trismus was 11.6 times more common among the patients with stage T4 tumors than among those with lower-stage tumors. Neoplasms of the tonsillar fossa and retromolar trigone collectively accounted for 95.0% of the cases. The CT scans showed edema/atrophy of the pterygoid muscles in 60.0% of the patients with trismus and in 21.8% of those without. An association was observed between T4 tumor stage and edema/atrophy of the pterygoid muscles. In addition, the risk of trismus was 5.4 times higher among the patients with stage T4 tumors. Conclusion: In our patient sample, the most common finding was obliteration of the fat plane, followed by asymmetry and edema/atrophy. Most of the patients with T4 tumors had trismus, together with edema/atrophy of the pterygoid muscles.

Objetivo: Avaliar, por meio de tomografia computadorizada, alterações do espaço mastigador (EM) decorrentes de disseminação de neoplasias malignas originárias da loja tonsilar, trígono retromolar, seio maxilar e nasofaringe, e correlacionar presença de trismo com achados tomográficos e dimensões do tumor. Materiais e Métodos: Foram selecionados prontuários de 65 pacientes portadores de tumores malignos nas regiões descritas. A análise das imagens foi realizada por dois examinadores médicos, separadamente, sem o conhecimento das informações clínicas. Na avaliação do EM, foram considerados: simetria com o EM contralateral; obliteração do plano gorduroso, do trígono retromolar e do espaço faríngeo; edema e/ou atrofia dos músculos pterigóideos medial e lateral; destruição do ramo da mandíbula. Resultados: Foram observados obliteração do plano gorduroso em 69,2% dos pacientes, assimetria em 27,7%, espessamento/atrofia em 26,2% e destruição óssea em 20,0%. Presença de trismo foi encontrada em 15,4% dos pacientes. Na associação entre dimensão do tumor e trismo, foram observados trismo em 90,0% dos tumores em estágio T4, enquanto a porcentagem de tumores em estágio T4 sem trismo foi de 43,8%. Pacientes com tumores T4 apresentaram 11,6 vezes mais trismo que os dos demais estágios. Neoplasias da loja tonsilar e trígono retromolar perfizeram 95,0% dos casos. Em 60,0% dos pacientes com trismo havia edema e/ou atrofia dos músculos pterigóideos na tomografia computadorizada e em 21,8% nos sem trismo. Observou-se associação entre tumores T4 e edema e/ou atrofia dos músculos pterigóideos e 5,4 vezes mais chance de apresentarem trismo. Conclusão: A maioria dos pacientes apresentou obliteração do plano gorduroso, seguido de assimetria e espessamento/atrofia. O trismo estava presente na maioria dos pacientes T4 com espessamento/atrofia dos músculos pterigóideos.

Langerhans cell histiocytosis simulating endodontic periapical lesion: Are we prepared to diagnose and manage it? A case report.

Many aggressive non-endodontic radiolucent lesions show very similar clinical and radiographical features to periapical lesions of endodontic origin. Since the treatments of endodontic and non-endodontic lesions differ markedly, a precise diagnosis is imperative. Thus, the present study aimed at presenting a clinical case on the diagnosis and management of a Langerhans cell histiocytosis (LCH) lesion mimicking a periapical lesion of endodontic origin. A 51-year-old male patient was referred to a private dental office due to slight pain from the region of tooth 36. Although no sign of prosthetic or endodontic failure was noted, radiographical examination revealed a radiolucent image with poorly defined borders associated with the periapical region of the tooth. Apicoectomy and bone curettage were then performed and, given the clinical and laboratory features, the definitive diagnosis of solitary eosinophilic granuloma was made. The surgical treatment was sufficient for the remission of the symptoms, and recurrence was not observed. Given the current case, dentists should be aware of LCH lesions as they may mimic endodontic periapical pathoses, leading to misdiagnosis and therapeutic complications. Moreover, alveolar bone lesions may be the first or only sign of LCH in many cases.

Oral medicine (stomatology) in Brazil: the first 50 years and counting.

This review outlines the historical perspective, status, and future challenges of oral medicine (stomatology) in Brazil based on the records of the Brazilian Society of Stomatology and Oral Pathology (SOBEP) and the Brazilian Federal Dental Council as well as expert evidence input from academic leaders from 3 different generations of Brazilian oral medicine specialists. The beginning of oral medicine in Brazil dates to 1969, followed by the organization of SOBEP in 1974; however, official recognition as an independent specialty was achieved more recently within the Brazilian Federal Dental Council in 1992. After a 50-year maturation period of oral medicine in Brazil in terms of specialty crystallization across dentistry, medicine, and research, it is now time to follow the historical trends of the specialty internationally and establish a standard curriculum at a post-graduate level that will lead to uniformity of training for oral medicine in Brazil.

Knowledge of dentistry students on bisphosphonate-related osteonecrosis of the jaw / Conhecimento de alunos do curso de Odontologia sobre osteonecrose dos maxilares relacionada ao uso de bisfosfonatos

Objective: Bisphosphonates are anti-resorptive drugs used in the control and treatment of calcium and bone metabolism disorders. Despite their high clinical efficacy, these drugs have been associated with bisphosphonate-related osteonecrosis of the jaw. The goal of this study is to evaluate the knowledge of final year undergraduate dentistry students on bisphosphonate-related osteonecrosis of the jaw. Material and Methods: A sample of 100 students from private institutions in the state of São Paulo was invited to complete a questionnaire relating to bisphosphonates and the risk factors associated with the development of osteonecrosis of the jaws. Results: 66% of the students did not recognize any bisphosphonate (p=0.0019) and 79% did not recognize their trademark names (p<0.0001). 60% of the students recognized osteonecrosis of the jaws as a side effect of bisphosphonates (p<0.0001) and 56% identified at least one risk factor associated with the drug that may contribute to the side effect (p<0.0001). 66% of the students stated that their course did not provide any lectures on the topic (p<0.0001). Conclusion: The knowledge of dentistry students about bisphosphonates and bisphosphonate-related osteonecrosis of the jaw is variable. This may be related to an inadequate discussion of this topic during their undergraduate studies(AU)

Objetivo: Os bisfosfonatos são medicamentos antirreabsortivos utilizados no controle e tratamento de desordens do cálcio e do metabolismo ósseo. Apesar da elevada eficácia clínica, a terapia com estes medicamentos tem sido associada a uma importante complicação denominada de osteonecrose dos maxilares relacionada ao uso de bisfosfonatos. O objetivo deste estudo é avaliar conhecimento sobre a osteonecrose dos maxilares relacionada ao uso de bisfosfonatos entre os alunos do último ano do curso de graduação de Odontologia. Material e Métodos: Uma amostra de 100 alunos de instituições privadas do estado de São Paulo foi convidada a responder um questionário sobre as principais informações dos bisfosfonatos e fatores de risco associados com o desenvolvimento da osteonecrose dos maxilares. Resultados: Os 100 questionários foram respondidos: 66% dos estudantes não reconheceram algum bisfosfonato (p=0,0019), 79% não reconheceram seus nomes de marcas comerciais (p<0,0001); 60% dos alunos reconheceram a osteonecrose dos maxilares como um efeito colateral dos bisfosfonatos (p<0,0001) e 56% apontaram pelo menos um fator de risco associado com o medicamento que pode causar o desenvolvimento do efeito colateral (p<0,0001); 66% dos estudantes afirmaram que o curso não forneceu alguma aula abordando esta temática (p<0.0001). Conclusão: O grau de conhecimento dos alunos de Odontologia sobre bisfosfonatos e osteonecrose dos maxilares relacionada ao uso de bisfosfonatos é variável e está relacionado com a pouca discussão deste tema durante a graduação(AU)

Antibiotic therapy for the prevention of osteoradionecrosis following tooth extraction in head-and-neck cancer patients postradiotherapy: An 11-year retrospective study.

INTRODUCTION: One of the most important complications of radiotherapy (RT) for head-and-neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, which mostly arises from tooth extractions. The ORN treatment still represents a great challenge; therefore, the prevention is of paramount importance. Thus, the present study aimed to evaluate retrospectively a perioperative systemic antibiotic therapy protocol for the prevention of ORN following tooth extraction in head-and-neck patients post-3D conformal RT. MATERIALS AND METHODS: A retrospective medical record review was performed considering HNC patients submitted to RT in the period between 2008 and 2019. They necessarily received oral antibiotic therapy with Clindamycin 300 mg every 8 h for 10 days, with the first dose 3 days before the tooth extraction. RESULTS: Forty-nine patients met the study criteria, with a total of 107 teeth extracted. Regarding the 47 patients who did not develop ORN, 103 tooth extractions were identified (96.3%). Only two patients developed ORN at two adjacent teeth sites (3.7%). CONCLUSION: The proposed perioperative systemic antibiotic therapy protocol seems to be efficient to prevent ORN following tooth extraction in postirradiated HNC patients.

Leukocyte- and platelet-rich fibrin does not provide any additional benefit for tooth extraction in head and neck cancer patients post-radiotherapy: a randomized clinical trial

BACKGROUND: One of the most important complications of radiotherapy (RT) for head and neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, arising mainly from tooth extractions. Thus, the present study aimed to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in preventing ORN following tooth extraction in post-irradiated HNC patients, as well as other postoperative complications. MATERIAL AND METHODS: 23 patients previously submitted to conventionally fractionated 3D-conformational RT for HNC underwent atraumatic tooth extractions with perioperative antibiotic therapy. Besides, they were randomly as-signed to receive L-PRF clots to fill and cover the extraction sockets (n = 11, Test Group) or not (n = 12, Control Group). A visual analog scale was used to quantify postoperative pain on the 3rd and 7th days. For ORN diagnosis, patients were clinically assessed for up to 180 days. Other postoperative complications (edema, alveolitis, suture dehiscence, continuous bleeding, and oroantral communication) were also evaluated within this period. RESULTS: No case of ORN or another surgical complication was observed and there were no differences in the postoperative pain scores between the groups on the 3rd and 7th days. CONCLUSIONS: L-PRF did not seem to provide any additional benefits than those achieved by the combination of the surgical and drug protocols used for tooth extractions in the post-irradiated HNC patients

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Impact of radiotherapy on mandibular bone: A retrospective study of digital panoramic radiographs.

PURPOSE: The purpose of this study was to investigate the impact of radiotherapy on mandibular bone tissue in head and neck cancer patients through an analysis of pixel intensity and fractal dimension values on digital panoramic radiographs. MATERIALS AND METHODS: Thirty patients with radiographic records from before and after 3-dimensional (3D) conformational radiotherapy were selected. A single examiner carried out digital analyses of pixel intensity values and fractal dimensions, with the areas of interest unilaterally located in the right angle medullary region of the mandible below the mandibular canal and posterior to the molar region. RESULTS: Statistically significant decreases were observed in the mean pixel intensity (P=0.0368) and fractal dimension (P=0.0495) values after radiotherapy. CONCLUSION: The results suggest that 3D conformational radiotherapy for head and neck cancer negatively affected the trabecular microarchitecture and mandibular bone mass.

Neurofibrosarcoma of the mandible derived from neurofibromatosis

Neurofibrosarcoma is a rare malignant neoplasm of the head and neck region and accounts for 8% to 16% of all cases. Its origin is varied and may stem from cells of the peripheral nerves, develop de novo, or result from malignant transformation of preexisting neurofibromas. Because the features of neurofibrosarcomas are heterogeneous, the data retrieved during clinical examinations are of great aid for diagnosis. In this case, owing to clinical features and the fact that the patient had neurofibromatosis type 1, the hypothesis of neurofibrosarcoma was promptly established. The final diagnosis was confirmed by associating clinical, imaging, and pathological data. After the treatment, the patient has been followed up for 10 years, with no evidence of recurrence.

Neurofibrosarcoma of the mandible derived from neurofibromatosis.

Neurofibrosarcoma is a rare malignant neoplasm of the head and neck region and accounts for 8% to 16% of all cases. Its origin is varied and may stem from cells of the peripheral nerves, develop de novo, or result from malignant transformation of preexisting neurofibromas. Because the features of neurofibrosarcomas are heterogeneous, the data retrieved during clinical examinations are of great aid for diagnosis. In this case, owing to clinical features and the fact that the patient had neurofibromatosis type 1, the hypothesis of neurofibrosarcoma was promptly established. The final diagnosis was confirmed by associating clinical, imaging, and pathological data. After the treatment, the patient has been followed up for 10 years, with no evidence of recurrence.

A novel method to evaluate salivary flow rates of head and neck cancer patients after radiotherapy: a pilot study / Um novo método para avaliar as taxas de fluxo salivar em pacientes com câncer de cabeça e pescoço após radioterapia: estudo piloto

Abstract Introduction The procedure used to evaluate salivary flow rate is called sialometry. It can be performed through several techniques, but none appears to be really efficient for post-radiotherapy patients. Objective To adequate sialometry tests for head and neck cancer patients submitted to radiotherapy. Methods 22 xerostomic patients post-radiotherapy (total radiation dose ranging from 60 to 70 Gy) were included in this study. Ten patients were evaluated using sialometries originally proposed by the Radiation Therapy Oncology Group and twelve were assessed by our modified methods. Unstimulated and stimulated sialometries were performed and the results were classified according a grading scale and compared between both groups. Results There was no statistically significant difference between the salivary evaluations of both groups (p = 0.4487 and p = 0.5615). Also, most of these rates were classified as very low and low. Conclusion This novel method seems to be suitable for patients submitted to radiotherapy.

Resumo Introdução O procedimento utilizado para avaliar a taxa de fluxo salivar é denominado sialometria. Pode ser realizado por meio de várias técnicas, mas nenhuma parece ser realmente eficiente para pacientes pós-radioterapia. Objetivo Adaptar sialometrias para pacientes com câncer de cabeça e pescoço submetidos à radioterapia. Método 22 pacientes xerostômicos pós-radioterapia (dose de radiação total variando de 60-70 Gy) foram incluídos neste estudo. Dez pacientes foram avaliados utilizando sialometrias originalmente propostas pelo Radiation Therapy Oncology Group e doze foram avaliados por nossos métodos modificados. Sialometrias não estimuladas e estimuladas foram conduzidas e os resultados foram classificados de acordo com uma escala de graduação e comparados entre os dois grupos. Resultados Não houve diferença estatisticamente significante entre as avaliações salivares de ambos os grupos (p = 0,4487 e p = 0,5615). Além disso, a maioria dessas taxas foi classificada como muito baixa e baixa. Conclusão Esse novo método parece ser adequado para pacientes submetidos à radioterapia.

A novel method to evaluate salivary flow rates of head and neck cancer patients after radiotherapy: a pilot study.

INTRODUCTION: The procedure used to evaluate salivary flow rate is called sialometry. It can be performed through several techniques, but none appears to be really efficient for post-radiotherapy patients. OBJECTIVE: To adequate sialometry tests for head and neck cancer patients submitted to radiotherapy. METHODS: 22 xerostomic patients post-radiotherapy (total radiation dose ranging from 60 to 70Gy) were included in this study. Ten patients were evaluated using sialometries originally proposed by the Radiation Therapy Oncology Group and twelve were assessed by our modified methods. Unstimulated and stimulated sialometries were performed and the results were classified according a grading scale and compared between both groups. RESULTS: There was no statistically significant difference between the salivary evaluations of both groups (p=0.4487 and p=0.5615). Also, most of these rates were classified as very low and low. CONCLUSION: This novel method seems to be suitable for patients submitted to radiotherapy.

Mantle cell lymphoma: involvement of nodal and extranodal sites in the head and neck, with multifocal oral lesions.

Mantle cell lymphoma (MCL) is a malignant B-cell neoplasm, which comprises monomorphic and small- to medium-sized mantle zone-derived lymphoid cells. It is characterized by chromosomal translocation t(11;14)(q13;q32) and CCND1 truncation, resulting in cell cycle deregulation. It is an aggressive type of non-Hodgkin lymphoma with a propensity to present with extranodal involvement. This study shows the case of an 80-year-old Caucasian male who complained of a 2-month progressive swelling on the right side of his face. The magnetic resonance imaging exam showed multifocal involvement of the head and neck, including oral manifestations, bilateral parotid glands, palate, tongue, and floor of the mouth. An incisional biopsy of the tumor mass was performed. The morphological and immunophenotypic findings were consistent with the diagnosis of MCL. The patient died 4 months later, without any chance of undergoing a therapeutic approach. Although MCL is a rare condition, it should be subjected to a differential diagnosis when affecting the maxillofacial area. Imaging exams and both immunohistochemical and morphological analyses are needed to reach the correct diagnosis. Here, we present an unusual MCL with multifocal involvement of the head and neck.

Mantle cell lymphoma: involvement of nodal and extranodal sites in the head and neck, with multifocal oral lesions

Mantle cell lymphoma (MCL) is a malignant B-cell neoplasm, which comprises monomorphic and small- to medium-sized mantle zone-derived lymphoid cells. It is characterized by chromosomal translocation t(11;14)(q13;q32) and CCND1 truncation, resulting in cell cycle deregulation. It is an aggressive type of non-Hodgkin lymphoma with a propensity to present with extranodal involvement. This study shows the case of an 80-year-old Caucasian male who complained of a 2-month progressive swelling on the right side of his face. The magnetic resonance imaging exam showed multifocal involvement of the head and neck, including oral manifestations, bilateral parotid glands, palate, tongue, and floor of the mouth. An incisional biopsy of the tumor mass was performed. The morphological and immunophenotypic findings were consistent with the diagnosis of MCL. The patient died 4 months later, without any chance of undergoing a therapeutic approach. Although MCL is a rare condition, it should be subjected to a differential diagnosis when affecting the maxillofacial area. Imaging exams and both immunohistochemical and morphological analyses are needed to reach the correct diagnosis. Here, we present an unusual MCL with multifocal involvement of the head and neck.

Cytological and cytomorphometric evaluation of the oral mucosa in HIV-infected patients undergoing antiretroviral therapy.

BACKGROUND: To evaluate HIV infection-induced alterations in the oral mucosa by comparing inflammation, cell maturation, and cytomorphometric changes in oral mucosal cells between HIV-infected patients undergoing highly active antiretroviral therapy (HAART) and non-HIV-infected patients. METHODS: Thirty HIV-infected patients undergoing HAART and 30 non-HIV-infected patients were studied. Four smears were obtained from the lateral border of the tongue and floor of the mouth with a cytobrush. One sample was stained by the Papanicolaou technique, and three samples were processed for Feulgen staining. Papanicolaou-stained smears were analyzed by light microscopy, and the cytoplasmic (CA) and nuclear (NA) area were measured with the Software AxioVision 4.7. RESULTS: The Wilcoxon signed-rank test showed a significant difference in intermediate epithelial cell types between the HIV-infected and non-HIV-infected groups (P=.005). However, this difference was not observed for superficial epithelial cell types with (P=.672) and without a nucleus (P=.069). Comparative analysis revealed no significant difference in CA (P=.604), NA (P=.298) or NA/CA (P=.456) between the HIV-infected and non-HIV-infected groups. Keratohyalin granules were more frequent in the non-HIV-infected group (P=.0001). CONCLUSIONS: The results showed alterations in cell maturation in HIV-infected patients undergoing HAART with undetectable viral load, but no morphometric changes were observed.

Impact of low-level laser therapy on hyposalivation, salivary pH, and quality of life in head and neck cancer patients post-radiotherapy.

Late effects of radiotherapy for head and neck cancer treatment have been increasingly investigated due to its impact on patients' quality of life. The purpose of this study was to evaluate the effect of low-level laser therapy on hyposalivation, low salivary pH, and quality of life in head and neck cancer patients post-radiotherapy. Twenty-nine patients with radiation-induced xerostomia received laser sessions twice a week, during 3 months (24 sessions). For this, a continuous wave Indium-Gallium-Aluminium-Phosphorus diode laser device was used punctually on the major salivary glands (808 nm, 0.75 W/cm2, 30 mW, illuminated area 0.04 cm2, 7.5 J/cm2, 10 s, 0.3 J). Six extraoral points were illuminated on each parotid gland and three on each submandibular gland, as well as two intraoral points on each sublingual gland. Stimulated and unstimulated salivary flow rate, pH (two scales with different gradations), and quality of life (University Of Washington Quality of Life Questionnaire for Patients with Head and Neck Cancer) were assessed at baseline and at the end of the treatment. There were significant increases in both mean salivary flow rates (unstimulated: p = 0.0012; stimulated: p < 0.0001), mean pH values (p = 0.0002 and p = 0.0004), and mean score from the quality of life questionnaire (p < 0.0001). Low-level laser therapy seems to be effective to mitigate salivary hypofunction and increase salivary pH of patients submitted to radiotherapy for head and neck cancer, thereby leading to an improvement in quality of life.

Effect of HIV infection in the micronuclei frequency on the oral mucosa.

BACKGROUND: The genotoxic impact of HIV infection on the oral cavity malignancies is unknown. The aim of this study was to evaluate the effect of HIV infection in micronucleus (MN) frequency on the oral mucosa of HIV+ patients and establish a relationship with early cytogenetic changes in oral carcinogenesis. METHODS: Thirty HIV+ individuals who are under highly active antiretroviral therapy (HAART) and 30 non-HIV patients were evaluated. Two smears were taken from the lateral border of the tongue and mouth floor and stained by Feulgen. The frequency of MN was examined in 3000 cells per subject under common microscopy. RESULTS: MN analysis showed no significant difference between groups by Mann-Whitney U-test for total MNs (P = 0.178). The presence of single MN was greater in control group with statistical significance (P = 0.009), while in HIV group, multiple MNs were exhibited in higher mean. CONCLUSIONS: HIV patients under HAART therapy and low viral load values showed higher frequency of multiple MNs, which, although not statistically significant, may be caused by the action of the Vpr gene, an accessory gene of HIV. These results corroborate the theory of HIV infection cytogenetic damage.

Fibrosarcoma ameloblástico en la mandíbula / Ameloblastic fibrosarcoma arising in the mandible

Ameloblastic fibrosarcoma is a rare odontogenic neoplasm and is considered the malignant counterpart of ameloblastic fibroma. The diagnosis is made by histopathological and immunohistochemical evaluation, since the epithelial component remains benign and the mesenchymal component becomes malignant. Until 2012, only 72 cases were published in English-literature. This article presents a case of intraoral mass at the posterior mandible of a 23 year-old female patient. Panoramic radiography showed a multilocular radiolucent lesion with ill-defined borders and tooth involvement. The mandibular canal presented loss of architecture also. The computed tomography images (bone window) showed hypodense lesion leading to expansion, tapering and irregular destruction of cortical, and tooth involvement. Incisional biopsy was performed for histopathological evaluation. The results revealed a mixed lesion with epithelial and mesenchymal cellular proliferation. At immunohistochemical analysis, the mesenchymal portion was vimentin positive and the epithelial component was positive for cytokeratin AE1-AE3. It also showed p53 intense labeling in all tumorous cells. The final diagnosis was ameloblastic fibrosarcoma. The lesion was surgically excised with clear margins. The radiographic appearance, even imperative for treatment planning, poorly contributed to final diagnosis, which was reached by histopathological and immunohistochemical evaluations. The treatment is still controversial, without a definition regarding chemotherapy and radiotherapy as coadjutant treatment(AU)

El fibrosarcoma ameloblástico es una neoplasia odontogénica poco frecuente y es considerada la contraparte maligna del fibroma ameloblástico. El diagnóstico se realiza mediante la evaluación histopatológica e inmunohistoquímica, ya que el componente epitelial sigue siendo benigno y el componente mesenquimal se convierte en maligno. Hasta 2012, solo 72 casos fueron publicados en la literatura inglesa. En este artículo se presenta un caso de masa intraoral en la mandíbula parte posterior, de una paciente de 23 años de edad. La radiografía panorámica mostró una lesión radiolúcida multilocular con bordes mal definidos y con un diente incluso en la lesión. El canal mandibular también presentaba pérdida de la arquitectura. La tomografía computarizada (TC) (ventana de hueso) presentó lesión hipodensa que provocaba una expansión que se estrechaba y destruía irregularmente la cortical, además envolvía la pieza dentaria. Se realizó biopsia incisional para evaluación histopatológica. Los resultados revelaron una lesión mixta con proliferación celular epitelial y mesenquimal. En el análisis inmunohistoquímico, la porción mesenquimal fue positivo para vimentina y el componente epitelial fue positivo para citoqueratina AE1-AE3. También mostró marcación intensa para p53 en todas las células tumorales. El diagnóstico final fue de fibrosarcoma ameloblástico. La lesión fue extirpada quirúrgicamente con márgenes de seguridad. El aspecto radiológico, aunque imprescindible para la planificación del tratamiento, poco contribuyó al diagnóstico final, que fue alcanzado por las evaluaciones histopatológicas e inmunohistoquímicas. El tratamiento sigue siendo controvertido, sin una definición respecto de la quimioterapia y la radioterapia como tratamiento coadyuvante(AU)

New uses for rehabilitation protocol for oral sinus communications in ARONJ patients.

This report presents a new use for rehabilitation protocol for oral sinus communications in patients with antiresorptive agent-induced osteonecrosis of the jaw. The treatment plan consisted of constructing an atraumatic complete denture with rounded edges, made with nontoxic resin, to prevent any injury to the mucosa and recurrence of the disease. The patient was followed up for 4 years, without any complications, and was socially reintegrated by resuming the normal life he experienced before tooth loss.