Lingual amyloidosis associated to long-term hemodialysis: Two case reports.

The ß2-microglobulin amyloidosis is a newly recognized type of systemic amyloidosis, which occurs in patients with chronic renal failure undergoing long-term hemodialysis. The dialysis-related amyloidosis (DRA) of the tongue is an uncommon and late complication, which occurs in patients undergoing chronic hemodialysis for more than 20 years. The aim of this paper is to report two cases of lingual amyloidosis associated with long-term hemodialysis. Two patients were referred to the Oral Medicine Clinic due to the presence of multiple nodules on the tongue and macroglossia. The patients had history of chronic renal failure and had been dialysed for more 20 years with bio-incompatible cellulose membrane. Biopsies of the lesions were performed and the histopathological features and Congo red stain revealed oral amyloidosis. Both patients remain in clinical follow-up after 12 and 6 months, respectively. Recognition of the amyloidosis tongue lesions can minimize the complications caused by this condition such as obstruction of the upper airways, making it imperative to carry out early treatment. Furthermore, in patients with oral amyloidosis, lesions in areas of trauma may ulcerate and cause pain and dysphagia becoming necessary periodic surgical removal and regular follow-up of these patients.

Análise cefalométrica das vias aéreas superiores de pacientes Classe III submetidos a tratamento ortocirúrgico / Cephalometric analysis of the upper airways of Class III patients subjected to orthosurgical treatment

OBJETIVO: o objetivo deste estudo foi avaliar as alterações causadas por cirurgia ortognática de recuo mandibular associada ou não à cirurgia maxilar combinada nas vias aéreas superiores (VAS). MÉTODOS: foram avaliadas radiografias cefalométricas de perfil pré-cirúrgicas e pós-cirúrgicas imediatas de 17 pacientes com Classe III. Foram realizadas medições do diâmetro do espaço aéreo (EA) no plano sagital, nas regiões correspondentes à hipofaringe e à orofaringe; também foram registradas as alterações na posição do osso hioide. Utilizou-se o teste t pareado e o coeficiente Pearson, buscando possíveis associações entre as alterações esqueléticas e as ocorridas no EA. RESULTADOS: observou-se redução significativa do EA na região da hipofaringe (média de 3,10mm, p=0,024). O osso hioide sofreu deslocamento inferior e posterior, além de diminuição da distância entre o mesmo e a região anterior da mandíbula. Não foi possível correlacionar, quantitativamente, a redução anteroposterior do EA com o recuo mandibular. Entretanto, observou-se correlação forte entre o diâmetro inicial do EA e a quantidade de redução observada ao nível da hipofaringe, e moderada em relação à orofaringe. CONCLUSÕES: o recuo mandibular pode causar estreitamento significativo das VAS, principalmente na porção mais inferior (hipofaringe). Portanto, deve-se atentar para sua avaliação durante o plano de tratamento ortocirúrgico, já que não foram descartados possíveis efeitos deletérios dessas alterações nas funções do indivíduo.

OBJECTIVE: The aim of this study was to evaluate the effects of orthognathic surgery for mandibular setback - with and without combined maxillary surgery - on the upper airways (UA).METHODS: Immediate lateral preoperative and postoperative cephalometric radiographs of 17 Class III patients were evaluated. Measurements of airway space (AS) diameter were taken in the sagittal plane in the hypopharyngeal and oropharyngeal regions, and changes in hyoid bone position were also recorded. Paired t-test and Pearson's coefficient were applied seeking for potential associations between skeletal and AS changes.RESULTS: Significant AS reduction was noted in the hypopharyngeal region (mean= 3.10 mm, p= 0.024). The hyoid bone was displaced inferiorly and posteriorly, thereby reducing its distance to the anterior mandibular region. No quantitative correlation could be established between anteroposterior AS reduction and mandibular setback. However, there was a strong correlation between initial AS diameter and the amount of reduction observed in the hypopharynx, but only moderate correlation with the oropharynx.CONCLUSIONS: Mandibular setback can cause significant UA narrowing, especially in the inferior-most portion (hypopharynx). Therefore, special attention should be given to UA evaluation when formulating an orthosurgical treatment plan since the potential deleterious effects of these changes on functions of the patients should not be overlooked.

Detection of Dialister pneumosintes in the subgingival biofilm of subjects with periodontal disease.

Dialister pneumosintes has been indicated as a potentially new periodontopathic species. This study evaluated the prevalence of this microorganism in saliva and subgingival biofilm from subjects with different periodontal conditions. Subgingival biofilm and saliva samples from 48 subjects with periodontal health (PH) and 116 patients with chronic periodontitis (CP) were obtained. DNA was extracted from the samples and the presence of D. pneumosintes was determined by PCR. Differences in clinical parameters and frequency of D. pneumosintes between groups were sought by Mann-Whitney, Chi-square and Fisher's exact tests. Overall, D. pneumosintes was detected in 47.8% of the biofilm samples, but only in 3% of saliva samples. CP patients presented a significantly greater mean prevalence of this species in sites with periodontal health and periodontal infection (43.5+/-7.4% and 62.1+/-6.4%, respectively) than PH subjects (29.4+/-7.9%) (Mann-Whitney; p<0.01). Moreover, significant associations between the prevalence of D. pneumosintes and pocket depth (p=0.001), attachment loss (p=0.001) and bleeding on probing (GLM, p=0.014) were observed after adjusting for age and gender. These findings corroborate the association of D. pneumosintes with periodontitis.