Malignant salivary gland tumors: agreement between fine needle aspiration biopsy, incisional biopsy and final histopathological diagnostic / Tumores malignos de glándulas salivales: concordancia entre biopsia por aspiración con aguja fina, biopsia incisional y diagnóstico histopatológico final

Background: Incisional biopsy is indicated for intraoral tumors, but it is a contraindicated surgical procedure formajor salivary glands. To avoid complications and facilitate diagnosis, fine needle aspiration biopsy (FNAB) is atype of biopsy widely used for preoperative diagnosis in these glands.Material and Methods: The aim of this study was to analyze the agreement between the diagnosis by FNAB (ma-jor glands), incisional biopsy (minor glands) and histopathological analysis of the surgical specimen in salivarygland tumors from a database (medical records) of patients treated in a cancer treatment reference center in theNortheast region of Brazil.Results: The sample consisted of 110 cases, being 86 of them malignant tumors in major salivary glands (parotidgland=73; submandibular gland=13) and 24 cases in minor salivary glands (palate). The female gender was themost affected (57.3%), especially in patients over 60 years (42.7%). In the TNM classification, 41.8% of the caseswere in T2 at the time of diagnosis, with most of the regional lymph nodes in N0 (85.5%) and 87.3% of the casesin M0. FNAB was able to identify malignant neoplasms in 68.6% of the cases (n=59), while incisional biopsy inpalatal tumors obtained agreement of 75% of the cases (n=18). The analysis revealed that tumors classified as T3-T4 (p=0.012) showed greater agreement between pre- and post-surgical diagnosis.(AU)

EGFR, VEGF, and angiogenesis promote the development of lipoma in the oral cavity.

This study aimed to detect, quantify and compare the immunohistochemical expression of EGFR and VEGF and microvessel count (MVC) in oral lipomas, and to correlate the findings with clinical and morphological characteristics of the cases studied. The sample consisted of 54 oral lipomas (33 classic and 21 non-classic) and 23 normal adipose tissue specimens. Cytoplasmic and/or nuclear immunohistochemical staining of EGFR and VEGF was analyzed. The angiogenic index was determined by MVC. Cells were counted using the Image J® software. The Statistical Package for the Social Sciences was used for data analysis, adopting a level of significance of 5% for all statistical tests. A statistically significant difference in EGFR immunoexpression (p=0.047), especially, between classic lipomas and normal adipose tissue. There was a significant difference in MVC between non-classic lipomas and normal adipose tissue (p=0.022). In non-classic lipomas, only VEGF immunoexpression showed a significant moderate positive correlation (r=0.607, p=0.01) with MVC. In classic lipomas, the number of EGFR-immunostained adipocytes was directly proportional to the number of VEGF-positive cells, demonstrating a significant moderate positive correlation (r=0.566, p=0.005). The results suggest that EGFR, VEGF, and angiogenesis participate in the development of oral lipomas but are not primarily involved in the growth of these tumors.

EGFR, VEGF, and angiogenesis promote the development of lipoma in the oral cavity

Abstract This study aimed to detect, quantify and compare the immunohistochemical expression of EGFR and VEGF and microvessel count (MVC) in oral lipomas, and to correlate the findings with clinical and morphological characteristics of the cases studied. The sample consisted of 54 oral lipomas (33 classic and 21 non-classic) and 23 normal adipose tissue specimens. Cytoplasmic and/or nuclear immunohistochemical staining of EGFR and VEGF was analyzed. The angiogenic index was determined by MVC. Cells were counted using the Image J® software. The Statistical Package for the Social Sciences was used for data analysis, adopting a level of significance of 5% for all statistical tests. A statistically significant difference in EGFR immunoexpression (p=0.047), especially, between classic lipomas and normal adipose tissue. There was a significant difference in MVC between non-classic lipomas and normal adipose tissue (p=0.022). In non-classic lipomas, only VEGF immunoexpression showed a significant moderate positive correlation (r=0.607, p=0.01) with MVC. In classic lipomas, the number of EGFR-immunostained adipocytes was directly proportional to the number of VEGF-positive cells, demonstrating a significant moderate positive correlation (r=0.566, p=0.005). The results suggest that EGFR, VEGF, and angiogenesis participate in the development of oral lipomas but are not primarily involved in the growth of these tumors.

Resumo Lipomas são as neoplasias mesenquimais benignas mais comuns, no entanto sua etiopatogenia ainda permanece desconhecida. Dessa forma, essa pesquisa teve como objetivo detectar, quantificar e comparar a expressão imunoistoquímica do EGFR, VEGF e contagem microvascular (MVC) dos lipomas orais, relacionando-os com as características clínicas e morfológicas dos casos estudados. A amostra foi composta por 54 lipomas orais (33 clássicos e 21 não clássicos) e 23 casos de tecido adiposo normal. A análise da expressão imunoistoquímica de EGFR e VEGF foi fundamentada na marcação citoplasmática e/ou nuclear. O índice angiogênico foi avaliado por meio da MVC. A contagem de células foi realizada utilizando software IMAGE J®. Os dados obtidos foram analisados no software Statistical Package for Social Science. O nível se significância de 5% foi adotado para os testes estatístico. A análise da imunoexpressão das proteínas revelou para o EGFR diferença estatisticamente significativa (p=0,041) entre o lipoma clássico e o tecido adiposo normal. Houve diferença significativa na MVC entre lipomas não clássicos e tecido adiposo normal (p=0,022). Nos lipomas não clássicos, apenas a imunoexpressão de VEGF apresentou correlação do tipo moderada, positiva e significativa (r=0,607; p=0,010) em relação a MVC. Ademais, nos lipomas clássicos foi percebido que os adipócitos imunomarcados para EGFR estiveram diretamente proporcionais a imunoexpressão de VEGF, apresentando correlação do tipo moderada, positiva e estatisticamente significativa (r=0,566; p = 0,005). Com base nos resultados, pode-se sugerir que o EGFR, VEGFR e MCV participam do desenvolvimento nos lipomas orais, contudo, não estão primariamente envolvidos no crescimento tumoral dessas neoplasias.

Mucocutaneous diseases with manifestations in the head and neck region: 24 years of experience in a Dermatology service

Background: This study aimed to evaluate the clinicopathological features of mucocutaneous diseases with manifestation in the head and neck region. Material and methods: A retrospective analysis of a dermatology reference center database was carried out. Over 24 years. Clinicopathological data were collected from medical records and the data was analyzed by descriptive statistics. Results: A total of 11.538 medical records were analyzed, being 152 cases of mucocutaneous diseases with manifestations in the head and neck region. Cutaneous lupus erythematosus was the most prevalent diagnosis (66.4%). Face (44.1%), females (79.6%), and patients with 45 years mean age were the most common features. In the oral cavity, the most affected region was the buccal mucosa (37.5%). Conclusions: Mucocutaneous diseases with head and neck manifestation were rare in the sample analyzed (1.3%), with cutaneous lupus erythematosus and lichen planus being the most common lesions in this region. (AU)

Pindborg tumor associated with a supernumerary tooth: a case report

The calcifying epithelial odontogenic tumor is a rare benign neoplasm that accounts for approximately 1% of all odontogenic tumors. Most of the cases occur in the posterior mandible, and a few involve the maxilla. Despite their relatively indolent biological behavior, tumors in the maxilla tend to grow fast. We report the case of a 33-year-old female patient exhibiting swelling in the right maxilla. An isodense area associated with an impacted supernumerary tooth was found on imaging examination. The histopathologic diagnosis was a calcifying epithelial odontogenic tumor. The treatment of choice was surgical removal of the lesion and associated dental elements. The patient has been followed up for 11 months and shows no signs of recurrence. Besides describing this case, we reviewed the literature on the association of calcifying epithelial odontogenic tumors with supernumerary teeth and found two case reports addressing this subject.

Verruciform xanthoma associated with lichen planus

Verruciform xanthoma (VX) is a rare benign lesion of unknown etiology, with a rough or papillary aspect, painless, sessile, well-defined, most lesions do not exceed 2 cm in their largest diameter, the degree of keratinization of the surface influences color, varying white to red, affecting mainly the gingiva and alveolar mucosa, and can also be seen in skin and genital. Herein, we present a report a clinical case of oral verruciform xanthoma in the buccal mucosa associated with the lichen planus lesion, as well as the morphological and immunohistochemical characteristics of the lesion. The clinical diagnostic hypothesis of oral lichen planus of the white reticular lesions on the buccal mucosa and on the tongue was confirmed by histopathology before a subepithelial connective tissue exhibiting intense inflammatory infiltrate in a predominantly lymphocytic band. In contrast, the hypothesis of the verrucous lesion in the left buccal mucosa was leukoplakia, with histopathological evidence showing exophytic and digitiform proliferations with parakeratin plugs between the papillary projections. Subepithelial connective tissue was characterized by macrophages with foamy cytoplasm (xanthoma cells). An immunohistochemical examination was performed, showing positivity for CD68, a macrophage marker, in addition to testing by Schiff's periodic acid (PAS) with diastasis, which was detected the presence of lipids inside these macrophages. The patient is free of recurrences of verruciform xanthoma and is being monitored due to the presence of lesions of oral lichen planus.

Approach and conservative surgical treatment of jaw ameloblastoma: case report / Abordagem e tratamento cirúrgico conservador do ameloblastoma da mandíbula: relato de caso / Abordaje y tratamiento quirúrgico conservador del ameloblastoma de mandíbula: reporte de caso

Abstract Ameloblastoma is a benign neoplasm, originated from the odontogenic epithelium. It preferentially affects the mandible and due to its infiltrative growth pattern, it has a tendency to local recurrence. Treatment varies based on clinical, histological and radiographic characteristics. The aggressive treatment, such as marginal resection, has shown good results, however, it also has greater morbidity. Conservative treatments, such as decompression, enucleation and curettage, can also be used, with specific indications, and when carefully performed, it has a good prognosis. Thus, the objective of this work is to describe a case of mandibular ameloblastoma, treated in a more conservative way. Male patient, 53 years old, presented an increase in volume in the anterior region of the mandible. The clinical and radiographic characteristics suggested that it was a cystic lesion, so decompression and incisional biopsy were performed, the diagnosis of which was cystic ameloblastoma. The decompression device was maintained until bone neoformation was no longer observed, with conservative marginal resection being performed, followed by peripheral ostectomy.

Resumo O ameloblastoma é uma neoplasia benigna, originada no epitélio odontogênico. Afeta preferencialmente a mandíbula e, devido ao seu padrão de crescimento infiltrativo, tem tendência à recorrência local. O tratamento varia com base nas características clínicas, histológicas e radiográficas. O tratamento agressivo, como a ressecção marginal, tem mostrado bons resultados, porém também apresenta maior morbidade. Tratamentos conservadores, como descompressão, enucleação e curetagem, também podem ser utilizados, com indicações específicas e, quando realizados com cuidado, apresentam bom prognóstico. Assim, o objetivo deste trabalho é descrever um caso de ameloblastoma mandibular, tratado de maneira mais conservadora. Paciente do sexo masculino, 53 anos, apresentou aumento de volume na região anterior da mandíbula. As características clínicas e radiográficas sugeriram que se tratava de uma lesão cística, pelo que foram realizadas descompressão e biópsia incisional, cujo diagnóstico era ameloblastoma cístico. O dispositivo de descompressão foi mantido até que a neoformação óssea não fosse mais observada, com ressecção marginal conservadora sendo realizada, seguida de ostectomia periférica.

Resumen El ameloblastoma es una neoplasia benigna, originada del epitelio odontogénico. Afecta preferentemente a la mandíbula y, debido a su patrón de crecimiento infiltrativo, tiene tendencia a la recurrencia local. El tratamiento varía según las características clínicas, histológicas y radiográficas. El tratamiento agresivo, como la resección marginal, ha mostrado buenos resultados, sin embargo, también tiene una mayor morbilidad. Los tratamientos conservadores, como la descompresión, la enucleación y el legrado, también se pueden utilizar, con indicaciones específicas, y cuando se realiza con cuidado, tiene un buen pronóstico. Por lo tanto, el objetivo de este trabajo es describir un caso de ameloblastoma mandibular, tratado de una manera más conservadora. Paciente masculino, de 53 años, presentó un aumento de volumen en la región anterior de la mandíbula. Las características clínicas y radiográficas sugirieron que se trataba de una lesión quística, por lo que se realizó descompresión y biopsia incisional, cuyo diagnóstico fue ameloblastoma quístico. El dispositivo de descompresión se mantuvo hasta que ya no se observó neoformación ósea, realizándose una resección marginal conservadora, seguida de ostectomía periférica.

Imunoexpressão das proteínas EGFR e VEGF em lipomas de cavidade oral / Immunoexpression of EGFR and VEGF proteins in oral cavity lipomas

Lipomas são as neoplasias mesênquimais benignas mais comuns. Apresentam predileção pelo tronco, ombros, pescoço e axila, sendo raro nas mãos, parte inferior das pernas e pés. A região de cabeça e pescoço é responsável por 20% dos casos. A cavidade oral é responsável por 1-4% de todos os tumores, afeta de maneira semelhante o sexo feminino e masculino, acometendo ampla faixa etária. A etiopatogênia desse tumor ainda permanece desconhecida, dessa forma, essa pesquisa teve como objetivo detectar, quantificar e comparar a expressão imunoistoquímica do EGFR, VEGF e contagem microvascular (MVC) dos lipomas orais, relacionando-os com as características clínicas e morfológicas dos casos estudados. A amostra foi composta por 54 lipomas orais (33 clássicos e 21 não clássicos) e 23 casos de tecido adiposo normal. A análise da expressão imunoistoquímica de EGFR e VEGF foi fundamentada na marcação da membrana citoplasmática e/ou núcleo. O índice angiogênico foi avaliado por meio da contagem microvascular (MVC). A contagem de células foi realizada utilizando software IMAGE J®. Os dados obtidos foram analisados no software Statistical Package for Social Science. O nível se significância de 5% foi adotado para os testes estatísticos (p ≤ 0,05). A Análise da imunoexpressão das proteínas revelou para o EGFR diferença estatisticamente significativa (p=0,041) entre o lipoma clássico e o tecido adiposo normal. Com relação a contagem de microvasos, o CMV dos lipomas não clássico apresentou diferença estatisticamente significativa (p=0,018) em relação ao tecido adiposo normal. Nos lipomas não clássicos, apenas a imunoexpressão de VEGF esteve diretamente proporcional a CMV encontrado na neoplasia, com correlação do tipo moderada, positiva e significativa (p=0,010). Ademais, nos lipomas clássicos foi percebido que os adipócitos imunomarcados para EGFR estiveram diretamente proporcionais a imunoexpressão de VEGF, isso deve-se a correlação do tipo moderada, positiva e estatisticamente significativa (p = 0,005). Com base nos resultados, pode-se concluir que apesar do EGFR, VEGFR e CMV participarem do desenvolvimento neoplásico, é possível sugerir que nos lipomas, essas proteínas e o CMV não estejam primariamente envolvidos no crescimento tumoral (AU).

Lipomas are the most common benign mesenchymal neoplasms. They have a predilection for the trunk, shoulders, neck and armpit, being rare in the hands, lower legs and feet. The head and neck region accounts for 20% of cases. The oral cavity is responsible for 1-4% of all tumors, affecting females and males in a similar way, affecting a wide age range. The etiopathogenesis of this tumor remains unknown, therefore, this research aimed to detect, quantify and compare the immunohistochemical expression of EGFR, VEGF and microvascular count (MVC) of oral lipomas, relating them to the clinical and morphological characteristics of the cases studied . The sample consisted of 54 oral lipomas (33 classic and 21 non-classical) and 23 cases of normal adipose tissue. The analysis of the immunohistochemical expression of EGFR and VEGF was based on cytoplasmic membrane and/or nucleus labeling. The angiogenic index was assessed using microvascular count (MVC). Cell counting was performed using IMAGE J® software. The data obtained were analyzed using the Statistical Package for Social Science software. A significance level of 5% was adopted for statistical tests (p ≤ 0.05). Analysis of protein immunoexpression revealed a statistically significant difference (p=0.041) for EGFR between classic lipoma and normal adipose tissue. Regarding microvessel count, the CMV of non-classic lipomas showed a statistically significant difference (p=0.018) in relation to normal adipose tissue. In non-classical lipomas, only VEGF immunoexpression was directly proportional to the CMV found in the neoplasm, with a moderate, positive and significant correlation (p=0.010). Furthermore, in classical lipomas it was noticed that adipocytes immunolabeled for EGFR were directly proportional to VEGF immunoexpression, this is due to the moderate, positive and statistically significant correlation (p = 0.005). Based on the results, it can be concluded that although EGFR, VEGFR and CMV participate in neoplastic development, it is possible to suggest that in lipomas, these proteins and CMV are not primarily involved in tumor growth (AU).

BIOSAFETY KNOWLEDGE, ACTIONS AND MEASURES OF BRAZILIAN DENTISTS DURING THE COVID-19 PANDEMIC / CONHECIMENTOS, ATITUDES E PRÁTICAS DE BIOSSEGURANÇA POR CIRURGIÕES-DENTISTAS BRASILEIROS DURANTE A PANDEMIA DA COVID-19

Objective: To identify the level of knowledge, attitudes and practices related to biosafety measures, prevention and control by DCs during the pandemic. Methods: An online questionnaire consisting of 42 questions was disseminated to the CDs operating in Brazil through social networks and also to the 27 Regional Councils of Dentistry in the country via e-mail. The collection period was from June 26 to July 2, 2020. Results: 751 CDs answered the questionnaire, of these, 54.9% undertook training in preventing and controlling the spread of the virus and the scientific article was the main means of information (44.5%). Regarding biosafety in dental care, 95.9% reported having knowledge of ANVISA's rules on the subject, however, regarding attitudes and practices, there was a failure to comply with the recommendations. Link between professional performance and training or not, were factors associated with greater knowledge and correct biosafety attitudes and practices. Conclusion: Although the Brazilian CDs have good levels of knowledge about biosafety measures for the prevention of COVID-19, they still fail to comply with basic attitudes and recommended practices.

Objetivo: Identificar o nível de conhecimento, atitudes e práticas relacionadas às medidas de biossegurança, prevenção e controle por parte dos CDs durante a pandemia. Métodos: Um questionário online composto por 42 perguntas foi divulgado aos CDs atuantes no Brasil pelas redes sociais e também aos 27 Conselhos Regionais de Odontologia do país via e-mail. O período de coleta foi do dia 26 de junho a 2 de julho de 2020. Resultados: 751 CDs responderam ao questionário, destes, 54,9% realizaram capacitação para prevenção e controle de disseminação do vírus e artigo científico foi o principal meio de informação (44,5%).  Com relação à biossegurança nos atendimentos odontológicos, 95,9% relataram ter conhecimento das normas da ANVISA sobre o assunto, porém, com relação às atitudes e práticas, observou-se descumprimento das recomendações. Vínculo de atuação profissional e realização ou não de capacitação foram fatores associados a maior conhecimento e a atitudes e práticas corretas de biossegurança. Conclusão: Os CDs brasileiros embora apresentem bons níveis de conhecimento acerca das medidas de biossegurança para prevenção da COVID-19 ainda descumprem atitudes e práticas básicas recomendadas.

Saúde bucal no brasil: uma revisão integrativa do período de 1950 a 2019 / Oral health in brazil: an integrative review from 1950 to 2019 / Salud oral en brasil: una revisión integradora en el período de 1950 a 2019

A trajetória das políticas públicas de saúde bucal no Brasil foi historicamente caracterizada como um longo processo de rupturas e continuidades. Este estudo teve como objetivo realizar uma revisão integrativa da literatura sobre os modelos assistenciais e políticas públicas de saúde bucal no Brasil desenvolvidas ao longo do período de 1950 a 2019. Desenvolveu-se mediante o método qualitativo, consistindo em uma revisão integrativa da literatura. O tema abordado baseou-se em evidências bibliográficas e documentos públicos produzidos por setores estratégicos do governo. Os primeiros modelos assistenciais em saúde bucal implementados no Brasil se configuravam como excludentes, elitistas, mutiladores e pouco resolutivos. Apenas em 1994 o Ministério da Saúde criou o Programa Saúde da Família (PSF), incluindo, em 2001, as Equipes de Saúde Bucal (ESB) na Estratégia Saúde da Família (ESF). Diante da falta de uma política nacional efetiva para a saúde bucal, a Política Nacional de Saúde Bucal (PNSB), conhecida como Brasil Sorridente, foi criada em 2004, e em 2011, a Política Nacional de Atenção Básica (PNAB) foi aprovada. Ao ser revisada em 2017, a equipe de saúde bucal foi excluída da equipe multiprofissional mínima. O cenário histórico da saúde bucal no Brasil é caraterizado por dois momentos distintos, em que inicialmente houve evolução dos modelos assistenciais em saúde bucal, seguido pela exclusão da saúde bucal no contexto de saúde da família.

The trajectory of public oral health policies in Brazil has historically been characterized as a long rupture and continuities process. This study aimed at conducting an integrative literature review on care models and public oral health policies in Brazil from 1950 to 2019. It was developed through the qualitative method, consisting of an integrative literature review. The theme approached was based on bibliographic evidence and public documents produced by strategic sectors government. The first models of oral health care implemented in Brazil represented exclusionary, elitist, mutilating, and poorly resolving models. Only in 1994, the Brazilian Ministry of Health created the Family Health Program (FHP), including in 2001 the Oral Health Teams (OHT) in Family Health Strategy (FHS). In the absence of an effective national oral health policy, National Oral Health Policy (NOHP), known as Brasil Sorridente (Smiling Brazil), was created in 2004. In 2011, the National Primary Care Policy (NPCP) was approved. When revised in 2017, the oral health team was excluded from the minimum multi-professional team. The historical scenario of oral health in Brazil is characterized by two distinct moments. Initially, there was an evolution of care models in oral health, followed by exclusion of oral health in the context of family health.

La trayectoria de las políticas públicas de salud oral en Brasil se ha caracterizado históricamente como un largo proceso de rupturas y continuidades. Este estudio tuvo como objetivo realizar una revisión integradora de la literatura sobre modelos de atención y políticas públicas de salud oral desarrolladas en Brasil desde 1950 hasta 2019. Se utilizó el método cualitativo, que consiste en una revisión integradora de la literatura. El tema abordado se basó en evidencia bibliográfica y documentos públicos producidos por sectores estratégicos del gobierno. Los primeros modelos de atención de salud oral implementados en Brasil representaban modelos excluyentes, elitistas, mutiladores y de baja resolución. Solo en 1994 el Ministerio de Salud creó el Programa de Salud Familiar (PSF), que incluyó en 2001 los Equipos de Salud Oral (ESO) en la Estrategia de Salud Familiar (ESF). En ausencia de una política nacional efectiva de salud oral, la Política Nacional de Salud Oral (PNSB), conocida como Brasil Sorridente, se creó en 2004; y en 2011 se aprobó la Política Nacional de Atención Primaria (PNAB). Cuando se revisó en 2017, el equipo de salud oral fue excluido del equipo mínimo multiprofesional. El escenario histórico de la salud oral en Brasil se caracteriza por dos momentos distintos, inicialmente hubo una evolución de los modelos de atención en salud oral, seguido de la exclusión de la salud oral en el contexto de la salud familiar.

Tratamento cirúrgico do lábio duplo: relato de caso / Surgical treatment of the double lip: case report

Introdução: O lábio duplo é caracterizado por excesso de tecido na mucosa labial, de aspecto normal, podendo acometer o lábio superior, inferior ou ambos. Ocorre com maior incidência no lábio superior, de forma uni ou bilateral, podendo ser congênito ou adquirido. A alteração geralmente é perceptível em repouso, durante a fala ou sorriso. O tratamento cirúrgico pode ser necessário, caso o paciente apresente comprometimento estético e/ou funcional. Relato de caso: Neste trabalho, é descrito um caso clínico de lábio duplo, adquirido em paciente do sexo masculino de 40 anos de idade cujas queixas eram estéticas e funcionais. Considerações Finais: Foi realizada cirurgia para remoção do excesso tecidual com incisão por planos em forma de elipse, solucionando, assim, a deformidade... (AU)

Introduction: The double lip is characterized by excess of tissue in the labial mucosa, of normal aspect, being able to affect the upper lip, inferior or both. Occurring with greater incidence in the upper lip of uni or bilateral form, being able to be congenital or acquired. The change is usually noticeable at rest, during speech or smile. Surgical treatment may be necessary if the patient presents with aesthetic and/ or functional impairment. Case report: This paper describes a clinical case of double lip acquired in a 40-year-old male patient, whose complaints were aesthetic and functional. Final considerations: Surgery was performed to remove tissue excess with incision through ellipse-shaped planes, thus solving the deformity... (AU)