Escleroterapia con etanol de las malformaciones vasculares de la cavidad oral / Alcohol sclerotherapy to treat vascular malformations in the oral cavity

Objetivo. Presentamos nuestra experiencia en la inyección intralesional de etanol como tratamiento único y efectivo de las malformaciones vasculares (MV) de la cavidad oral. Material y métodos. Se trataron 26 pacientes (12 varones y 14 mujeres) con malformaciones orales. El diagnóstico se estableció por los hallazgos clínicos (n = 26), los estudios de resonancia magnética (n = 19), de arteriografía (n = 5) y de flebografía percutánea por punción directa (n = 2). Para la esclerosis de las lesiones se empleó etanol absoluto mediante punción directa. Todas las intervenciones se realizaron con sedación profunda. Resultados. Se trataron 28 MV de diferentes tamaños, con una mediana de diámetro máximo de 24,5 mm (7-60), presentes en la cavidad oral durante una media de 13,6 años (0,2-54) en 26 pacientes. La mediana de edad fue de 44,5 años (12-87). Los criterios para el tratamiento de las malformaciones fueron: aumento de tamaño (n = 8), sangrado local (n = 11), riesgo de sangrado durante una extracción dental (n = 5), dolor (n = 1), trastorno estético (n = 3). Localización de las lesiones: 12 en la mucosa yugal, 5 en la encía vestibular, 6 en la mucosa labial, 3 en la lengua, una en la región pterigomandibular y una en el paladar. La dosis mediana de etanol fue de 3,2 ml. Veinte lesiones desaparecieron tras una única inyección, 5 tras 2 sesiones, 2 tras 3 sesiones, y una tras 5 sesiones. En 20 casos las lesiones desaparecieron, en 6 persistió una mácula azulada y en 2 persistió un efecto de masa. Los síntomas mejoraron en todos los pacientes. Las complicaciones asociadas a la escleroterapia intralesional fueron pasajeras: inflamación local, parestesia perioral en 2 pacientes, y necrosis de la mucosa yugal en uno. Conclusiones. La esclerosis con etanol es un procedimiento eficaz para el tratamiento de pacientes con MV de la cavidad oral (AU)

Objective: To present our experience in treating vascular malformations in the oral cavity solely by injecting ethanol into the lesions. Material and methods: We treated 26 patients (12 men and 14 women) with oral malformations. The diagnosis was based on clinical findings (n=26), magnetic resonance imaging studies (n=19), angiography findings (n=5), and direct puncture venography (n=2). To achieve sclerosis, we administered absolute ethanol through direct puncture. All interventions were performed under deep sedation. Results: The vascular malformations treated ranged from 7 mm to 60 mm (median: 24.5 mm) in maximum diameter and had been present in the oral cavity for 0.2 to 54 years (mean: 13.6 years). The median age of the patients was 44.5 years (range: 12-87 years). The reason for treatment of the malformation was: an increase in size (n=8), local bleeding (n=11), risk of bleeding during dental extraction (n=5), pain (n=1), and esthetic purposes (n=3). Lesions were located in the mucosa of the cheek (n=12), in the facial gingiva (n=5), in the labial mucosa (n=6), in the tongue (n=3), in the pterygomandibular region (n=1), and in the palate (n=1). The median dose of ethanol was 3.2 mL. Twenty lesions disappeared after a single injection session, five after two sessions, two after three sessions, and one after five sessions. In 20 cases all signs of the lesions disappeared, in 6 a bluish macule persisted, and in 2 a mass effect persisted. The symptoms improved in all patients. Only transient complications of sclerotherapy were observed: local inflammation, perioral paresthesia in two patients, and necrosis of the mucosa of the cheek in one. Conclusions: Alcohol sclerotherapy is an efficacious procedure for treating vascular malformations in the oral cavity (AU)

Alcohol sclerotherapy to treat vascular malformations in the oral cavity.

OBJECTIVE: To present our experience in treating vascular malformations in the oral cavity solely by injecting ethanol into the lesions. MATERIAL AND METHODS: We treated 26 patients (12 men and 14 women) with oral malformations. The diagnosis was based on clinical findings (n=26), magnetic resonance imaging studies (n=19), angiography findings (n=5), and direct puncture venography (n=2). To achieve sclerosis, we administered absolute ethanol through direct puncture. All interventions were performed under deep sedation. RESULTS: The vascular malformations treated ranged from 7mm to 60mm (median: 24.5mm) in maximum diameter and had been present in the oral cavity for 0.2 to 54 years (mean: 13.6 years). The median age of the patients was 44.5 years (range: 12-87 years). The reason for treatment of the malformation was: an increase in size (n=8), local bleeding (n=11), risk of bleeding during dental extraction (n=5), pain (n=1), and esthetic purposes (n=3). Lesions were located in the mucosa of the cheek (n=12), in the facial gingiva (n=5), in the labial mucosa (n=6), in the tongue (n=3), in the pterygomandibular region (n=1), and in the palate (n=1). The median dose of ethanol was 3.2mL. Twenty lesions disappeared after a single injection session, five after two sessions, two after three sessions, and one after five sessions. In 20 cases all signs of the lesions disappeared, in 6 a bluish macule persisted, and in 2 a mass effect persisted. The symptoms improved in all patients. Only transient complications of sclerotherapy were observed: local inflammation, perioral paresthesia in two patients, and necrosis of the mucosa of the cheek in one. CONCLUSIONS: Alcohol sclerotherapy is an efficacious procedure for treating vascular malformations in the oral cavity.

Diagnóstico de síndrome de Cowden a partir de una fibropapilomatosis oral múltiple: un caso excepcional en la edad pediátrica / Diagnosis of Cowden’s syndrome based on the identification of oral fibropapillomas: a rare case in pediatric age

El síndrome de Cowden es una enfermedad hereditaria rara, caracterizada por la presencia de una poliposis gastrointestinal de tipo hamartomatoso, anomalías cutaneomucosas y riesgo aumentado de neoplasias, sobre todo de mama, tiroides y genitourinarias; de ahí la importancia de su diagnóstico temprano. Presentamos el caso de una niña de 10 años de edad, remitida al servicio de pediatría desde el de estomatología por la sospecha de un síndrome de Cowden, dada la presencia de fibropapilomas orales. En el estudio realizado se constata la presencia de criterios clínicos mayores (macrocefalia) y menores (nódulos tiroideos, poliposis intestinal) que permiten su diagnóstico, pendiente de los resultados del gen supresor tumoral PTEN. Este diagnóstico precoz permitirá realizar revisiones periódicas para prevenir o detectar inicialmente enfermedades malignas, por lo que consideramos muy importante que el pediatra piense en este síndrome ante lesiones orales en apariencia banales(AU)

Cowden syndrome is a rare hereditary disease characterized by hamartoma-type gastrointestinal polyposis, mucocutaneous anomalies and high susceptibility to develop malignant neoplasia, mainly in the breast, thyroid and genitor-urinary tract, so early diagnosis is very important. We present the case of a ten years-old child diagnosed with Cowden syndrome after consultation for oral fibropapillomas to stomatologist. She presented major diagnostic criteria (macrocephaly) and minor diagnostic criteria (thyroid lesion and gastrointestinal polyps). We are wating for mutation in the tumor suppressor gene PTEN. This early diagnosis makes possible an adequate tumoral screening after a correct diagnosis of a banal pathology of oral mucosa, so is very important that paediatricians know this syndrome(AU)

[Oral leukoplakia: clinical, histopathologic, and molecular features and therapeutic approach]. / La leucoplasia oral: definición de parámetros clínicos, histopatológicos y moleculares y actitud terapéutica.

Dermatology departments are currently seeing an increase in the number of cases of oral diseases. Of note among the range of lesions covered by this broad area of knowledge is oral leukoplakia-the most common precancerous lesion and the most problematic in terms of both diagnosis and therapeutic management. In addition to defining leukoplakia, this review also establishes a differential diagnosis with the other most important oral diseases and analyzes the different clinical, histologic, and molecular features that can provide an indication of the risk of malignant transformation. Finally, a therapeutic algorithm is presented to help us optimize clinical management of the disease.

Number V Oral lichen planus: clinical features and management.

Oral lichen planus (OLP) is a relatively common chronic inflammatory disorder affecting stratified squamous epithelia. Whereas in the majority of instances, cutaneous lesions of lichen planus (LP) are self-limiting and cause itching, oral lesions in OLP are chronic, rarely undergo spontaneous remission, are potentially premalignant and are often a source of morbidity. Current data suggest that OLP is a T cell-mediated autoimmune disease in which auto-cytotoxic CD8+ T cells trigger apoptosis of oral epithelial cells. The characteristic clinical aspects of OLP may be sufficient to make a correct diagnosis if there are classic skin lesions present. An oral biopsy with histopathologic study is recommended to confirm the clinical diagnosis and mainly to exclude dysplasia and malignancy. The most commonly employed and useful agents for the treatment of lichen planus (LP) are topical corticosteroids but other newer agents are available.

Drug-induced disorders of teeth.

It is essential that every health care professional who is involved with the prescription or recommendation of drugs be fully aware of any resultant disorders that may arise as a side-effect. A range of drugs can affect the teeth. In this review article, drugs that have the potential to induce changes in teeth have been classified as those leading to tooth discoloration (intrinsic and extrinsic), physical damage to tooth structure (enamel, dentin, and cementum), and alteration in tooth sensitivity.

[Prevalence of oral lichen planus and oral leukoplakia in 112 patients with oral squamous cell carcinoma]. / Prevalencia de liquen plano oral y leucoplasia oral en 112 pacientes con carcinoma oral de células escamosas.

OBJECTIVE: To study the association existing between precancerous conditions, like oral lichen planus and oral leukoplakia into 112 patients with oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: We applied a protocol to 112 patients with OSCC in the "Servicio de Estomatología del Hospital General Universitario de Valencia". We made two groups: 1. patients with precancerous lesions and oral carcinoma, 2. patients with OSCC and no precancerous lesions. RESULTS: The average age was 61.4 years, 85 of them being men and 27 women. The tongue and floor of the mouth were the most common locations. 33.6% of the tumours presented stage TNM I, most of them being histologically well differentiated and the 55.8% were ulcerated. We found differences between two groups of the patients regarding alcohol and tobacco habits, location, size and clinical stage and histological differentiation of the malignant lesions.

Retinoids: application in premalignant lesions and oral cancer.

Squamous cell carcinoma (SCC) of the oral cavity is a multistep process, progressing through a series of discrete, irreversible and complementary alterations in genes that control cell growth, death, and differentiation. In the premalignant state, the oral mucosa progresses through various grades of epithelial dysplasia, with the potential to convert to SCC. Natural and synthetic vitamin A metabolites and analogs (retinoids) were found to suppress head and neck and lung carcinogenesis in animal models, and inhibit carcinogenesis in individuals with premalignant lesions and a high risk to develop cancer of the aerodigestive tract. Likewise, retinoids prevent the development of second primary cancers in head and neck and lung cancer patients who had been treated for the first primary. These effects are thought to result from changes in the expression of genes that regulate cell growth and differentiation. Chemopreventive strategies are designed to suppress, reverse, or prevent the formation of premalignant lesions and their subsequent progression to SCC. This is a review of the application of retinoids in the chemoprevention of head and neck cancer.

Hereditary epidermolysis bullosa. Dental management of three cases.

Hereditary epidermolysis bullosa (EB) is a mucocutaneous disorder characterized by the appearance of blisters and vesicles in response to minimum friction. The digestive mucosa is one of the most frequently affected regions--including the oral mucosa. Three types of EB have been established according to the histological level of the lesion. Thus, simple EB involves intraepidermal bullae that leave no scars, while junctional EB exhibit blisters between the lamina lucida and lamina densa of the basal membrane. These lesions heal leaving atrophy and involve important hypoplastic lesions in the dental enamel. In turn, dystrophic EB presents synechiae-forming subepidermal blisters--the recessive form being the variant involving the greatest oral lesions (microstomia, ankyloglossia, milium cysts and rampant caries). Three cases of EB are presented and their clinical-dental management difficulties are described. The oral manifestations are described, along with the dental treatments provided and the evolution of the periodontal indices over a two-year period following the application of hygiene-preventive and therapeutic measures.

Alendronate-related oral mucosa ulcerations.

Alendronate is widely used in the treatment of osteoporosis and other bone diseases. Although it is considered a well-tolerated drug, there are numerous reports of adverse effects on the mucosa in the upper aerodigestive tract, with oesophagitis as the most common complication. The strict regulations for the proper administration of the drug indicate that these side effects might well be the result of a direct, irritant mechanism on the upper aerodigestive tract. We present two clinical cases of patients who developed extensive palatal ulcers as a result of taking alendronate. We discuss possible mechanisms implicated in the production of the ulcers and some clinical factors of interest.

[Oral lichen planus plaques and homogeneous leukoplasia: comparative results of treatment with CO2 laser]. / Liquen plano oral en placas y leucoplasia oral homogénea: resultados comparativos tras el tratamiento de estas lesiones con láser CO2.

OBJECTIVE: To determine the efficacy of CO2 laser therapy in plaque-like oral lichen planus and homogeneous oral leukoplakia. MATERIAL AND METHODS: We studied two groups of patients; one comprised 29 cases of plaque-like oral lichen planus (group 1) and the other one included 34 cases of homogeneous oral leukoplasia (group 2). After histological study, all the lesions were treated by CO2 laser evaporation at 10 W. We analyzed the results following one month, three months and one year after the treatment. RESULTS: In group 1, 19 lesions (65.5%) were revoluted enterally in one month. Patients reported a slight to moderate pain in 16 cases (55.2%), while 4 (13.8%) showed recurrences after three months and 12 (41.4%) at the end of the following time (one year). In group 2 we found a complete healing after one month in 28 cases (82.4%), with a slight to moderate pain in 22 cases (64.7%). Three months after the treatment we found 7 recurrences (20.6%) and 8 (25.8%) one year after. CONCLUSIONS: We found lower rate of recurrences in homogeneous oral leukoplakias than in plaque-like oral lichen planus after treatment with carbon dioxide laser therapy.

[Sinus aspergillosis after an endodontic treatment. Presentation of a clinical case]. / Aspergilosis sinusal a partir de un tratamiento odontológico. Presentación de un caso clínico.

Aspergillosis is an opportunistic deep mycosis that occurs in immunocompromised patients, often in the paranasal sinuses. However, it sometimes occurs in healthy subjects, producing symptoms similar to those of a chronic sinusitis that is unresponsive to conventional treatment. A possible entry point for Aspergillus is the oroantral communication originated by perforation of the dental root cavity during root canal of a molar with penetration of material. We report the clinical case of a patient with symptoms of chronic sinusitis who was diagnosed as sinus aspergillosis after radiological and histological study. The origin may have been a third upper molar in which a root canal was performed.

Oral manifestations associated with human immunodeficiency virus infection in a Spanish population.

A study was made of the oral manifestations in 396 patients with human immunodeficiency virus (HIV) infection. The following risk groups were established: intravenous drug users (79.5%), homosexuals (7.8%), homosexual intravenous drug users (3.3%), heterosexuals (8.1%) and hemophiliacs/transfusion patients (1.3%). The oral lesions, in decreasing order of frequency, were: periodontal disease (78.28%), candidiasis (65.65%), hairy leukoplakia (16.16%), herpes simplex virus lesions (5.30%). Kaposi's sarcoma (2.27%), recurrent aphthous ulceration (RAS) (1.01%), lichen planus (0.5%), non-Hodgkin's lymphoma (0.25%), tuberculous lesion of the tongue (0.25%) and ulcerations of uncertain etiology (0.25%). Attention is drawn to the greater predominance of these lesions in patients with CD4 values of less than 200/ mm3, compared with those who have higher lymphocyte counts.

[Oral histiocytosis X with severe upper maxillary destruction]. / Histiocitosis X oral con severa destrucción del maxilar superior.

Histiocytosis X is a group of disorders of the reticuloendothelial system that have different clinical features and common histological characteristics, including abnormal proliferation of Langerhans cells. Eosinophilic granuloma is a localized form of histiocytosis affecting one or more bones. A case report is made of a patient diagnosed as histiocytosis X whose first manifestation was the appearance of an orosinusal communication. The lesions were located in the maxillary bones and produced large osteolytic lesions. No other bones were affected. In spite of surgery and radiotherapy, the disease recurred at 12 months.

Candida biotypes in patients with oral leukoplakia and lichen planus. Candida biotypes in leukoplakia and lichen planus.

Prevalence of yeasts in 35 leukoplakia and 34 oral lichen planus patients was compared with that observed in persons without oral diseases. Serotype and morphotype were determined on Candida albicans isolates. Yeasts were isolated from the oral cavity specimens of 43.7% of the patients. C. albicans (serotype A) was the predominant species (76% in leukoplakia, 88.2% in lichen planus and 60.8% in healthy persons). Sixteen morphotypes were encountered on malt extract agar, being 732, 733, 734, 753 and 754 the most frequently found. Morphotypes SP1N and SP1Y were the most common on Sabouraud-trypheniltetrazolium agar (68.4% of the isolates from leukoplakia and 73.3% from lichen planus, but only 46.6% of the isolates from healthy oral mucosa showed SP1N morphotype). Presence of oral lesions was associated with a marked reduction in the yeast species and C. albicans biotypes, suggesting that C. albicans and particularly some of its biotypes, show a high potential of adaptation to the changes associated with the development of oral leukoplakia and lichen planus.

Comparison of a new test for the measurement of resting whole saliva with the draining and the swab techniques.

A quantification method for measuring whole saliva is described. This whole saliva test (WST) consists of a Whatman paper strip, is easily carried out, innocuous, low-cost and single use. Due to its characteristics, it could be considered as the oral equivalent of Schirmer's tear test. A sample of 159 healthy subjects (81 males and 78 females; mean age 31.62 years) participated in this comparative study of this new procedure and two other tests, the draining and the swab test. Correlation was statistically positive among the three types of tests.

Oral lichen planus. An evolutive clinical and histological study of 45 patients followed up on for five years.

A study is made of 45 patients clinically and histologically diagnosed of oral lichen planus, and followed up on for 5 years. The course of the disease was monitored after three months and one, two and five years. The patients were classified in terms of lesion evolution (healed, improved, stationary or worse). Two evolutive groups were established for statistical purposes: (a) favorable (healed or improved lesions) and unfavorable cases (stationary or worsened oral lesions); and (b) healed and non-healed cases. Statistical correlations were established between these evolutive groups and different clinical and histological parameters, in an attempt to identify parameters of predictive value in the course of the disease. No statistically significant results were obtained, with the exception of inflammatory infiltrate. Thus, the depth of this infiltrate was found to be greater in patients with an unfavorable evolution (p = 0.02) than in those with a favorable course. Likewise, the inflammatory infiltrate was greater in non-healed than in healed cases.

Orofacial manifestations of mixed connective tissue disease with an uncommon serologic evolution.

Mixed connective tissue disease is a multisystemic disorder with overlapping features of systemic lupus erythematosus, scleroderma, and polymyositis, and is differentiated from them by a high titer of antibody to ribonucleoprotein. Orofacial manifestations of mixed connective tissue disease include trigeminal neuralgia-like pain, neuropathy, features suggestive of Sjögren's syndrome, and lymphadenopathy. Our recent experience with one patient with trigeminal neuropathy, facial paralysis, Sjögren's syndrome, and aseptic meningitis as early manifestations of the disease, together with an uncommon serologic evolution, is described.