Bulletproof Temporal Bone: A Case of Self-Inflicted Ballistic Injury.

Temporal bone injuries due to gunshot wounds are uncommon but devastating, with a high risk of damage to critical neurovascular structures. The high resistance of the temporal bone, the densest bone in the human body, can sometimes avoid a fatal outcome. However, the complications are in many cases devastating and include hearing loss, facial paralysis, cerebrospinal fluid leakage, intracranial damage, and vascular injuries. Our goal was to report a case of ballistic injury to the temporal bone and describe the surgical approach taken for treatment. A 74-year-old man was transferred to the emergency room of our tertiary hospital, intubated and sedated, after an attempted suicide with a firearm. The CT scan showed the metal projectile lodged within the temporal bone on the right side, with the destruction of the ossicular chain and bony labyrinth. After stabilization, sedation was reversed, and the otolaryngology team was called. On examination, the entry wound was located in the cavum concha, with no active bleeding but presenting active otorrhea of cerebrospinal fluid. The patient had complete peripheral facial paralysis on the right side and spontaneous horizontal nystagmus toward the left side. Empirical antibiotic therapy was initiated. A subtotal petrosectomy was performed, with the removal of the foreign body, repair of the cerebrospinal fluid fistula, obliteration of the cavity with abdominal fat, and closure of the external auditory canal. He was discharged on the 11th-day post-surgery, maintaining complete facial paralysis and right-side anacusis, but was able to walk with assistance. In conclusion, penetrating trauma of the temporal bone is a potentially life-threatening situation, and patients that survive have a guarded prognosis, as it often leads to permanent sequelae even when managed promptly.

Laryngectomy: Phonation Alternatives and Their Impact on the Quality of Life.

Background The decision to consent to surgery is a life-changing moment. This study addresses the impact of total laryngectomy (TL) on phonation and its effect on the quality of life (QoL) of patients. The primary objective of this cohort study is to compare the alternatives in phonation rehabilitation, and the secondary objective is to identify concurrent predictors of vocal outcomes. Methodology To perform a comprehensive analysis, we reviewed data from patients who underwent TL with bilateral radical neck dissection in the Department of Otolaryngology, Head and Neck Surgery at Centro Hospitalar Universitário de Santo António between January 2010 and October 2022. Adult patients who consented to participate in the study and underwent subjective evaluation were included in this study. Data regarding clinical history was primarily collected. Statistical analysis was performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Different types of vocal rehabilitation formed the subgroups to be compared. An additional analysis was performed for baseline variables collected in the clinical records, and vocal outcomes were measured using the Self-Evaluation of Communication Experiences After Laryngectomy (SECEL) questionnaire. Furthermore, linear models taking SECEL scores as the outcome were developed. Results The first search identified a total of 124 patients operated during the study period. In total, 63 patients were alive at the time of the current follow-up, with 61 deaths (49%). Overall, 26 of the 63 alive patients completed the SECEL questionnaire. All patients were male. The mean age at diagnosis was 62.2 ± 10.6 years. The mean age at the time of subjective vocal assessment with the SECEL questionnaire was 66.3 ± 10.4 years. The mean time of follow-up after the initial diagnosis was 4 ± 3.8 years. A statistically significant difference was observed in esophageal speech (ES), which was inferior to other modalities (mean SECEL total score for ES: 46.6 ± 12.2 vs. mean SECEL total score for all other modalities: 33 ± 15.1; p = 0.03). The follow-up time correlated significantly with vocal function, as measured by the SECEL questionnaire (p = 0.013). Conclusions The SECEL questionnaire can be a valuable tool to evaluate QoL in laryngectomy patients, given its usefulness in assessing the psychological impact derived from vocal functionality in this group. ES appears inferior to other modalities regarding voice-related QoL.

Labyrinthine Fistula in Chronic Otitis Media Surgery: Management and Outcomes.

The objective of this retrospective study was to present the experience on the management of labyrinthine fistula secondary to chronic otitis media in a tertiary center. 263 patients, who underwent tympanomastoidecomy, in Centro Hospitalar Universitário do Porto, between 2015 and 2020 were reviewed, to select only those with labyrinthine fistulas. 26 patients (9.89%) had cholesteatoma complicated by fistula of the lateral semicircular canal. Most frequent symptoms were unspecific, such as otorrhea, hearing loss and dizziness. Preoperative high-resolution computed tomography predicted fistula in 54%. Using the Dornhoffer and Milewski classification, 10 cases (38.46%) were identified as stage I, 15 (57.69%) at stage II, and 1 (3.85%) as stage III. The choice between open or closed surgical procedure was independent of the type of fistulae. The cholesteatoma matrix was completely removed from the fistula and immediately covered by autogenous material. In one patient matrix was left over the fistula. After surgery, hearing (bone conduction) was preserved or improved in 73% of the patients. There was no statistically significant relationship between the extent of the labyrinthine fistula, type of material used in fistula repair and the hearing outcome. Also, we didn't find a statistically significant relationship between extent of the labyrinthine fistula and the presence of facial nerve canal dehiscence, tegmen timpani erosion, sigmoid sinus exposure or ossicular bone erosions. In conclusion, a complete and nontraumatic removal of cholesteatoma matrix over the fistula in a single-staged procedure, is a safe and effective procedure, which achieves a hearing preservation or improvement in most cases.

Geriatric otorhinolaryngology: reasons for outpatient referrals from generalists to ENT specialists.

PURPOSE: To determine the main symptoms leading to referral of geriatric patients from primary care to otorhinolaryngology. METHODS:  Retrospective, observational study performed on patients aged 65 and older, referred from Primary Care to the Otorhinolaryngology and Head and Neck Surgery department of a tertiary centre during 2019 and 2020. Symptoms leading to otorhinolaryngological referral were categorized as "Oto-neurological symptoms", "Nasal symptoms", "Pharyngolaryngeal symptoms", "Other Head and Neck symptoms" and "Other Reasons". Data regarding age, gender and whether patients maintain follow-up or have been discharged was also collected. RESULTS:  The study population included a total of 1304 patients (697 female; 607 male). Oto-neurological symptoms were found to be the most prevalent symptoms, with 65% of patients reporting oto-neurological symptoms as at least one of the reasons for referral. Hearing loss was the most commonly reported symptom, with an association found between this symptom and age (p < 0.001). Results also showed an association between the female gender and vertigo/dizziness (p < 0.001) and tinnitus (p = 0.007). An association between the male gender and nasal symptoms was also found (p = 0.018), particularly nasal obstruction (p = 0.003) and epistaxis (p = 0.028). No statistically significant associations were found among the pharyngolaryngeal group. CONCLUSIONS:  This retrospective observational study allowed for a better understanding of the type of otorhinolaryngological symptoms affecting elderly patients and driving otorhinolaryngology evaluation, cementing hearing loss as one of the major complaints among older adults and allowing for a better preparation by otorhinolaryngologists for the changing needs of this subset of the population.

Clues for facial canal dehiscence in chronic otitis media.

INTRODUCTION AND OBJECTIVES: The goal of this study was to determine the impact of external and middle ear findings in the incidence of facial canal dehiscence (FCD) during mastoidectomy for chronic otitis media. MATERIAL AND METHODS: We examined the operative details of 186 patients who underwent primary tympanomastoidectomy for chronic otitis media between January 2015 and January 2020 retrospectively. In this study we only evaluated the second portion of the facial nerve canal. RESULTS: The global prevalence of FCD was 22.6% (42/186 patients) with a higher incidence, of 38.7% (36/93), in patients with chronic otitis media with cholesteatoma (C-COM). Associations were found between facial canal dehiscence, labyrinthine fistula (p˂ .001) and facial nerve paralysis (p˂ .001). Ossicular erosions were observed at a significant level in patients with facial canal dehiscence, the incidence of FCD was significantly higher (p=.005, Odds ratio 5.489) when malleus and incus were eroded, incus plus stapes were eroded (p=.014; OR 4.059) and malleus, incus, and stapes together were eroded (p=.002; OR 4.929). CONCLUSIONS: This study revealed an incidence of facial canal dehiscence of 22.6%. It also revealed that the presence of lateral semicircular canal fistula is associated with a higher prevalence of facial canal dehiscence. The same was noted in the case of some ossicular erosions, especially the combinations of eroded malleus and incus, incus and stapes, and all 3 ossicles. These findings raise awareness about the usefulness of middle ear findings in predicting FCD, thus providing valuable information for the otological surgeon to avoid iatrogenic injuries.

Clues for facial canal dehiscence in chronic otitis media

Introduction and objectives: The goal of this study was to determine the impact of external and middle ear findings in the incidence of facial canal dehiscence (FCD) during mastoidectomy for chronic otitis media.Material and methodsWe examined the operative details of 186 patients who underwent primary tympanomastoidectomy for chronic otitis media between January 2015 and January 2020 retrospectively.In this study we only evaluated the second portion of the facial nerve canal.ResultsThe global prevalence of FCD was 22.6% (42/186 patients) with a higher incidence, of 38.7% (36/93), in patients with chronic otitis media with cholesteatoma (C-COM).Associations were found between facial canal dehiscence, labyrinthine fistula (p˂ .001) and facial nerve paralysis (p˂ .001).Ossicular erosions were observed at a significant level in patients with facial canal dehiscence, the incidence of FCD was significantly higher (p=.005, Odds ratio 5.489) when malleus and incus were eroded, incus plus stapes were eroded (p=.014; OR 4.059) and malleus, incus, and stapes together were eroded (p=.002; OR 4.929).ConclusionsThis study revealed an incidence of facial canal dehiscence of 22.6%. It also revealed that the presence of lateral semicircular canal fistula is associated with a higher prevalence of facial canal dehiscence.The same was noted in the case of some ossicular erosions, especially the combinations of eroded malleus and incus, incus and stapes, and all 3 ossicles. (AU)

Introducción y objetivos: El objetivo de este estudio fue determinar el impacto de los hallazgos del oído externo y medio en la incidencia de dehiscencia del canal facial (DCF) durante la mastoidectomía por otitis media crónica.Material y métodosExaminamos los detalles quirúrgicos de 186 pacientes intervenidos de timpanomastoidectomía primaria por otitis media crónica entre enero de 2015 y enero de 2020 de forma retrospectiva.En este estudio solo evaluamos la segunda porción del canal del nervio facial.ResultadosLa prevalencia global de DCF fue del 22,6% (42/186 pacientes) con una incidencia mayor, del 38,7% (36/93), en pacientes con otitis media crónica con colesteatoma (C-COM).Se encontraron asociaciones entre DCF, fístula laberíntica (p ˂ 0,001) y parálisis del nervio facial (p ˂ 0,001).Se observaron erosiones osiculares significativas en pacientes con DCF. La incidencia de DCF fue significativamente mayor (p=0,005; odds ratio 5.489) cuando el martillo y el yunque estaban erosionados, el yunque y el estribo erosionados (p=0,014; OR 4,059) y erosiones del martillo, yunque y estribo juntos (p=0,002; OR 4,929).ConclusionesEste estudio reveló una incidencia de DCF del 22,6%. También reveló que la presencia de fístula del canal semicircular lateral se asocia con una mayor prevalencia de DCF.Lo mismo se observó en el caso de algunas erosiones osiculares, especialmente las combinaciones de martillo y yunque, yunque y estribo, y los 3 huesecillos erosionados. (AU)

Autoinflation compared to ventilation tubes for treating chronic otitis media with effusion.

BACKGROUND: Otitis media with effusion (OME) is the most common cause of acquired hearing loss and surgery in children. Autoinflation has been suggested as an alternative treatment for OME. OBJECTIVES: The aim of the study was to compare treatment outcome with a new autoinflation device versus ventilation tube (VT) surgery or watchful waiting in children with chronic bilateral OME from the waiting list for surgery. METHODS: Forty-five children performed autoinflation during four weeks, forty-five were submitted to VT surgery, and twenty-three were enrolled as control group. Tympanometry was performed in the autoinflation and the control groups and audiometry in all groups. RESULTS: An equivalent hearing improvement was achieved in the autoinflation and the VT group at one (p=.19), six (p=.23) and twelve (p=.31) months with no significant alteration in the control group. In the autoinflation group 80% of the children avoided surgery and no complications were reported compared to 34% complication rate in the VT group. CONCLUSION: Autoinflation achieved an equivalent improvement in hearing thresholds compared to VT surgery for treating OME. SIGNIFICANCE: Autoinflation may be a reasonable first-line treatment for children with OME to potentially avoid surgery.Article Summary: The Moniri autoinflation device is well tolerated and an effective alternative to ventilation tubes for treatment of chronic otitis media with effusion in young children.What's known on this subject: Previous studies have shown that autoinflation may reduce effusion in children with otitis media with effusion; however limited compliance to treatment, lack of adequate hearing evaluation, short follow-up time and also lack of comparative data to ventilation tube surgery have been reported.What this study adds: A new device was developed to allow for the performance of autoinflation in young children. The effect is compared to ventilation tube surgery and equivalent improvement in hearing is achieved in the short and the long-term follow-up.

Follicular lymphoma presenting as an isolated concha cymba mass / Linfoma folicular con presentación de masa aislada en la cymba de la concha

No disponible

Hyperacusis and stapes surgery: An observation in fifty patients after stapedotomy.

OBJECTIVE: To assess hyperacusis after stapedotomy and its possible influencing factors. STUDY DESIGN: Prospective, interventional, and longitudinal study. SETTING: A tertiary referral center. PATIENTS: Fifty consecutive patients (35 females, mean age = 46.8 years). INTERVENTION: All patients underwent stapedotomy. The validated Portuguese version of the "Hyperacusis Questionnaire" (HQ) was administered before and two weeks and one month after surgery. RESULTS: No hyperacusis was reported by any patient before surgery. At two weeks after surgery, all patients experienced hyperacusis, with a mean HQ at 16.88 ± 6.54 (range 4-25). One month after surgery, hyperacusis had already resolved in most patients. Gender, preoperative presentation or surgeon had no influence on HQ scores (p > 0.05). Patients with previous contralateral stapedotomy showed lower HQ scores (p = 0.001). Audiological parameters improvement measured at one month after surgery (PTA, SRT and contralateral SRT) were associated with HQ higher scores. CONCLUSION: This study confirms that hyperacusis is a common complaint after stapedotomy that usually resolves in one month after surgery. The HQ highest scores were registered among patients with the highest audiological gain after surgery. This suggests that hyperacusis may be a positive prognostic factor for audiological success after stapedotomy.

SUPERFÍCIE DE IMPLANTES DE TITÂNIO E SUA CAPACIDADE DE ESTÍMULO NA FORMAÇÃO ÓSSEA: UMA REVISÃO DE LITERATURA / Surface of Titanium Implants and your Ability to Stimulate Bone Formation: A Review of Literature

Durante anos o grande desafio da odontologia tem sido a busca por métodos que reabilitem os pacientes de forma menos traumática e eficaz do ponto de vista funcional e estético. Nessa interface, os implantes dentários surgiram e estão em pleno desenvolvimento tecnológico para garantir a satisfação dos pacientes. Dessa forma, o objetivo deste trabalho foi revisar a literatura sobre as superfícies de implantes de titânio e sua capacidade de estimulo na formação óssea, enfocando evidências científicas acerca das alterações químicas e topográficas no contexto da osseointegração.

For years the big challenge of dentistry has been the search for methods that rehabilitates patients less traumatic, and more effective functionally and aesthetically. In this interface, dental implants have emerged and are being increasingly perfected to ensure the complete satisfaction of rehabilitated patients. Thus, the aim of this study was to develop a theoretical review on the surfaces of titanium implants and their ability to stimulate bone formation focusing on scientific evidence of chemical and topographical changes in the context of osseointegration.

Revisão das Diretrizes da ABENO para a definição do Estágio Supervisionado Curricular nos cursos de Odontologia / ABENO's review of the Guidelines to define the Supervised Curricular Internship in Dental courses

O estágio curricular supervisionado é objeto de lei e de avaliação dos cursos de graduação em Odontologia pelo Ministério da Educação do país. A regulamentação deste componente curricular é amparada por diferentes segmentos de regulação da formação profissional do cirurgião dentista. A Associação Brasileira de Ensino Odontológico (ABENO) por meio da sua Comissão de Ensino divulgou as primeiras diretrizes acerca do assunto em 2002 e apresenta a revisão destas diretrizes à luz da legislação vigente e das melhores práticas educacionais para atendimento ao perfil do egresso preconizado pelas Diretrizes Curriculares Nacionais (DCN) para o curso de graduação em Odontologia. Assim, são apresentadas 12 diretrizes da ABENO para a definição do estágio curricular supervisionado nos cursos de graduação em Odontologia (AU).

The supervised traineeship is a law object in the evaluation of Dental undergraduate courses in Brazil, by the country's Ministry of Education. The regulation of this curricular component exists in several documents provided by different segments of regulating the training of dentists. The Brazilian Association of Dental Education (Associação Brasileira de Ensino Odontológico - ABENO), through its Education Commission, issued the first guidelines on this subject in 2002, and presents a review of these guidelines in the light of current legislation and best educational practices to meet the profile of the recommended egress by the Guidelines National curriculum for undergraduate Dental course. Thus, they present 12 ABENO guidelines for the definition of curricular supervised training in undergraduate courses in dentistry (AU).

Fluoroquinolone-metal complexes: a route to counteract bacterial resistance?

Microbial resistance to antibiotics is one of the biggest public health threats of the modern world. Antibiotic resistance is an area of much clinical relevance and therefore research that has the potential to identify agents that may circumvent it or treat resistant infections is paramount. Solution behavior of various fluoroquinolone (FQ) complexes with copper(II) in the presence and absence of 1,10-phenanthroline (phen) was studied in aqueous solution, by potentiometry and/or spectrophotometry, and are herein described. The results obtained showed that under physiological conditions (micromolar concentration range and pH7.4) only copper(II):FQ:phen ternary complexes are stable. Hence, these complexes were synthesised and characterised by means of UV-visible and IR spectroscopy, elemental analysis and single-crystal X-ray diffraction. In these complexes, the FQ acts as a bidentate ligand that coordinates the metal cation through the carbonyl and carboxyl oxygen atoms and phen coordinates through two N-atoms forming the equatorial plane of a distorted square-pyramidal geometry. The fifth position of the penta-coordinated Cu(II) centre is generally occupied axially by an oxygen atom from a water molecule or from a nitrate ion. Minimum inhibitory concentration (MIC) determinations of the complexes and comparison with free FQ in various E. coli strains indicate that the Cu-complexes are as efficient antimicrobials as the free antibiotic. Moreover, results strongly suggest that the cell intake route of both species is different supporting, therefore, the complexes' suitability as candidates for further biological testing in FQ-resistant microorganisms.

Evaluation of radioprotective effect of pilocarpine ingestion on salivary glands.

There is controversy concerning the effect of pilocarpine in the reversal of radio-induced xerostomia; however, the tests are usually performed at the end of radiotherapy. The present study evaluated the radioprotective effects of pilocarpine when ingested during radiation treatment. Eleven patients (recently diagnosed with head and neck cancer who were not undergoing radiotherapy) were divided into two groups: the control group (saline solution intake n=6) and the pilocarpine-treated (5 mg pilocarpine three times daily, n=5) group, in a prospective and double-blinded study. For five weeks, oral conditions, unstimulated salivary flow and stimulated saliva flow were collected weekly, with the first collection occurring prior to radiation therapy. As early as the second week, the control group exhibited oral complications and greater reduction in salivary flow rate. At the end of the study, the pilocarpine-treated group presented mean values of salivary flow greater than those of the control group. Pilocarpine intake applied simultaneously with radiotherapy demonstrated encouraging results with regard to lowering salivary flow reduction and incidence of xerostomia, as well as of oral complications.

Repercussões da radioterapia na região orofacial e seu tratamento / Impact of radiotherapy on the orofacial region and management of related conditions

A radioterapia em região de cabeça e pescoço provoca inúmeras sequelas ao paciente irradiado, afetando o sistema estomatognático e com repercussões sistêmicas importantes. As sequelas da radiação ionizante podem ser extensas e, algumas vezes, permanentes, em especial nas glândulas salivares e no tecido ósseo. É relevante que o cirurgião dentista tenha conhecimento das reações adversas e das formas adequadas de prevenção e tratamento para amenizar o desconforto e melhorar a condição de vida do paciente irradiado. Portanto, a conscientização e motivação deste paciente, com a promoção de saúde oral através da adequação do meio bucal e orientações sobre ações preventivas, são essenciais para se obter o melhor prognóstico.

Head and neck radiotherapy causes countless sequelae in irradiated patients, affecting the stomatognathic system, with significant systemic implications. Sequelae of exposure to ionizing radiation may be extensive and sometimes permanent, particularly in the salivary glands and bone tissue. It is of utmost importance that the surgeon dentist be aware of adverse reactions and appropriate forms of treatment to alleviate discomfort and improve the quality of life of the irradiated patient. Therefore, awareness and motivation of the patient, with promotion of oral health through the adaptation of the oral environment and guidance on preventive measures are essential to get a better prognosis.

Conhecimento dos alunos do curso de graduação em odontologia da Universidade Estadual da Paraíba sobre hepatites virais / Knowledge of undergraduate dental students from the state University of Paraíba about Viral Hepatites

Objeti vo: Avaliar o conhecimento de acadêmicos do curso de Odontologia sobre hepati tes virais. Método: A amostra foi constituída por 109 acadêmicos dos 157 acadêmicos do Curso de Odontologia da Universidade Estadual da Paraíba (UEPB), do terceiro ao quinto anos, selecionadosaleatoriamente, os quais estão mais expostos aos fatores de risco inerentes ao não conhecimento das hepatites virais. Os dados foram coletados através de um questionário com questões de múltipla escolha que abordavam o conhecimento sobre hepatites virais. As variáveis do estudo incluíam questõescomo: tipo de Equipamento de Proteção Individual usado durante os procedimentos, opinião sobre a exposição ao vírus da hepatite, quais seriam as vias de transmissão da hepatite, se o acadêmico já havia sofrido acidente com instrumental pérfuro-cortante. Os dados foram analisados de forma descritiva. Resultados: Todos os alunos (100%) afirmaram que usavamluvas, máscara e gorro, porém, apenas 92% deles achavam estar expostos aos vírus da hepati te. Em relação às vias de exposição, 95% dos acadêmicos afirmaram ser o sangue contaminadouma das principais vias de transmissão da hepatite, porém, 36% apenas afirmaram que as mucosas poderiam ser uma via de transmissão. De todos os acadêmicos pesquisados, 28% jáhaviam sofrido algum acidente pérfuro-cortante. Os resultados da investigação com base no questi onário mostraram que apenas 75% dos acadêmicos eram vacinados, 63% responderam que para a hepati te ti po B. Conclusão: Os estudantes de Odontologia têm consciência dos riscos de contaminação em relação às hepatites virais, mas osconhecimentos adquiridos sobre os mesmos não estão sendo aplicados na práti ca clínica.

Objective: To evaluate the knowledge of undergraduate dental students about viral hepatites. Methods: The sample was composed of 109 out of 157 3rd-5th undergraduate dental students from the State University of Para¡ba (UEPB), Brazil, selected at random, who are more exposed to the risk factors inherent to the unawareness of viral hepatites. Data were collected using a questionnaire with multiple-choice questions arguing about the knowledge of viral hepatites. The study variables included questions regarding individual protection equipment used during the procedures, opinion about exposure to hepatitis virus, which would be the transmission routes, and whether the student had already suffered any accident with perforating/cutting instruments. Data were subjected to descriptive analysis. Results: All (100%) students affirmed to use gloves, mask and cap, but only 92% of them believed to be exposed to the hepatitis virus. Regarding the forms of exposure, 95% of the undergraduate students affirmed that contaminated blood is one of the main transmission routes of hepatitis, but only 36% of them believed that the mucosas could be a transmission route. From all undergraduate students interviewed for the study, 28% had already experienced some kind of perforating/cutting accident. The results of this questionnaire-based investigation revealed that only 75% of the undergraduate students were vaccinated, 63% of them for type B hepatitis. Conclusion: The dental students are aware of the risks of contamination by viral hepatites, but the acquired knowledge about the risks are not being applied in the clinical practice.

Prevalência de dentes retidos presentes em radiografias panorâmicas / Prevalence of impacted teeth in panoramic radiographs

OBJETIVO: Avaliar quais dos grupos dentários apresentavam-se mais retidos, relacionando com gênero e idade. METODOLOGIA: Estudo transversal, retrospectivo mediante a análise de 3.500 radiografias panorâmicas. Foram incluídos neste estudo pacientes com dentição permanente completa; faixa etária de 15 a 35 anos; ambos os gêneros; radiografias panorâmicas que apresentaram, pelo menos, um dente retido. Para a coleta de dados, utilizou-se uma ficha pré-elaborada, os dados foram analisados de forma descritiva com medidas de tendência central de média, desvio-padrão, valores máximo e mínimo e inferencial com teste de Qui-Quadrado de Pearson, adotando-se em todos os casos, como nível de significância 0,05 (p=0,05). RESULTADOS: O grupo dos molares apresentou maiores médias (2,81). Encontrou-se que não houve diferença estatisticamente significante (p=0,825), quando se relacionou gênero e presença de dente retido. Observou-se associação estatisticamente significante (p=0,001) entre faixa etária e presença do dente retido, estando mais presente entre a faixa etária dos 15 aos 20 anos. CONCLUSÃO: Os molares encontraram-se mais retidos. O gênero feminino apresentou o maior número de dentes retidos, porém a diferença não foi estatisticamente significante. A faixa etária dos 15 aos 20 anos foi a mais prevalente.

AIMS: To evaluate which groups had most impacted teeth in relation to gender and age. MATERIAL AND METHODS: We conducted a retrospective, cross-sectional study, analyzing 3,500 panoramic radiographs. The patients, aged from 15 to 35 years, of both genders, all had complete permanent dentition, and the radiographs showed at least one impacted tooth. A previously prepared form was used for the collection of data, which were descriptively analyzed with measurements showing the main trends in means, standard deviation, maximum and minimum values and inferential statistics using the chi-square test, adopting a significance level of 0.05 (p=0.05) in all cases. RESULTS: The group of molars showed the highest means (2.81). No statistically significant differences (p=0.825) were found between gender and presence of the impacted tooth. There was a statistically significant difference (p=0.001) between age and presence of an impacted tooth, which was most prevalent among patients aged 15 to 20 years. CONCLUSIONS: The molars were found to be the most impacted group of teeth. Females had more impacted teeth than males, but the difference was not statistically significant. The most prevalent age group was 15 to 20 years.

Fluxo salivar e concentração do fator de crescimento epidérmico (EGF) na saliva de pacientes diabéticos tipo 2 / Salivary flow and epidermal growth factor (EGF) levels in saliva of type 2 diabetic patients

O objetivo deste trabalho foi o de avaliar o fluxo salivar e a concentração do EGF na saliva de pacientes diabéticos, comparados a um grupo controle de pacientes clinicamente sadios. A amostra foi composta de 15 indivíduos divididos em dois gruops, G0 - controle (n=9) e G1 - diabéticos (n=6). A saliva foi coletada por estimulação mecânica com o auxílio de um hiperboloide. A concentração do EGF foi verificada por meio de imunoensaio do tipo sanduíche, com a utilização de Kit ELISA (R&D Systems®) e auxílio de um leitor de microplaca. Pôde-se observar uma média do fluxo salivar de 1,27 ml/min. no G0 e 1.26 ml/min. no G1, não havendo diferença estatisticamente significativa entre os dois grupos, quando empregado o teste t-Student (p=0,972). Quando ao EGF, foram observadas as médias de 1624,08 pg/ml e 2367,66 pg/ml para o G0 e G1, respectivamente, também não sendo esta diferença significante (p=0,559). Os dados deste trabalho demonstram que não houve diferenças significativas do fluxo salivar e da concentração de EGF na saliva dos pacientes diabéticos em relação ao grupo controle.

The aim of this study was to evaluate the salivary flow and the concentration of EGF in saliva of diabetic patients not insulin-dependents compared with a non diabetic patients (control group). Stimulated saliva was collected in two groups of patients: G0 - control (n=9) and G1 - diabetics (n=6), using a hiperbolóide. Saliva was expelled in the first minute and it was despised. In the following five minutes it was collected with a funnel connected to a graduated tube. EGF concentration measurement was performed using a sandwich-type immunoassay, using an ELISA Kit (R&D Systems®) and a microplate reader. It was observed an average of salivary flow of 1.27ml/min. in G0 and 1,26ml/min. in G1 and it was not found significant differences between the two groups (p=0,972). It was also observed an average of 1624.08 pg/ml of EGF in the G0 and 2367.66 pg/ml in the G1 and as the salivary flow the difference was not statistically significant (p=0.559). The data present in this work demonstrate no differences between salivary flow and EGF concentration of diabetic patients as compared as non-diabetic patients.

O Duplo Papel da Inflamação no Surgimento das Lesões Cancerígenas / The Double Role of Inflammation in the Emergence of Cancerous Lesions

Nesta revisão, ficou demonstrado que da mesma maneiraque as células imunológicas agem para reparar os tecidosafetados, as células cancerígenas produzem desordenadamenteos fatores da inflamação para manter ocrescimento e desenvolvimento da lesão tumoral. Elasproduzem exageradamente as mesmas substânciasinflamatórias como citocinas, prostaglandinas e leucotrienos,as quais normalmente desempenham a reparação naturaldos tecidos. O câncer vai se servir dessas substânciaspara induzir sua própria proliferação e tornar permeáveis asbarreiras que o cercam. Assim, o processo que permite aosistema imunológico reparar lesões e destruir os agentesagressores em todos os recônditos do organismo é desviadoem favor das células cancerosas. E graças à inflamação,elas vão se infiltrar nos tecidos vizinhos, penetrar no fluxosanguíneo e linfático para originar as metástases. O excessodessas substâncias inflamatórias nos tecidos contíguosacarreta o bloqueio de um processo natural que se chamaapoptose, ou seja, o suicídio celular geneticamenteprogramado, contribuindo assim para a proliferação anárquicados tecidos. As células cancerosas se veem assimprotegidas da destruição celular, e o tumor vai cada vezmais, ganhando tamanho e corpo...

This review demonstrated that in the same way the immunecells act to repair the affected tissues, cancer cells producedisorderly inflammation factors to sustain growth anddevelopment of the tumor. They produce exaggeratedly thesame inflammatory substances such as cytokines,prostaglandins and leukotrienes, which usually play thenatural tissue repair. The cancer uses those substances toinduce its own proliferation and to make permeable barrierssurrounding it. Then the process that allows the immunesystem to repair damage and to destroy aggressors in allreaches of the body is skewed in favor of cancerous cells.And due to inflammation, such cells will infiltrate throughsurrounding tissues, penetrate into lymphatic and blood flowuntil give rise to metastases. The excess of these inflammatorysubstances in the surrounding tissues, leads to blockage ofa natural process called apoptosis, or genetically programmedcell suicide, thereby contributing to the uncontrolledproliferation of tissues. Cancerous cells are thus protectedfrom cell destruction, and the tumor will increasingly gainingsize and body...

Fatores relacionados ao diagnóstico tardio do câncer de boca no estado da Paraíba – Brasil: relatos de pacientes portadores / Factors related to diagnostic delay of oral cancer in the state of Paraíba – Brazil: subjects perspectives

O Carcinoma Epidermoide (CE) da cavidade bucal, no Brasil, é uma patologia com incidência elevada, apresentando altas taxas de mortalidade e morbidade. O estágio da doença, no momento do diagnóstico caracteriza o mais importante fator de prognóstico. Neste estudo foram avaliados os fatores relacionados ao diagnóstico tardio desta patologia em pacientes no estado da Paraíba – Brasil, relatos e seu significado para estes pacientes. A amostra constou de 84 pacientes,diagnosticados no ambulatório do Serviço de Cabeça e Pescoço do Hospital Napoleão Laureano, em João Pessoa/PB. Foi realizada uma entrevista semi-estruturada com os portadores da doença, obtendo-se dados sócio-demográficos e as respostas que expressaram as razões da procura tardia do serviço de saúde. Identificou-se pela análise de conteúdo das respostas os significados do diagnóstico tardio e foram agrupados de acordo com seu conteúdo em: 1. Sabia da lesão,mas só procurou, quando incomodou; 2. Sabia da lesão, procurou um serviço de saúde e foi diagnosticado e tratado inadequadamente; 3. Não sabia da existência da lesão, procurou o serviço de saúde, quando incomodou; 4. Medo enegação da doença, temor do enfrentamento da doença; 5. Indisponibilidade de tempo por trabalho e dificuldade de acesso. Pela análise de conteúdo, o medo da doença, a desinformação e as condições sociais desfavoráveis representaram um desestímulo à procura do tratamento.

Oral squamous cell carcinoma in Brazil represents a pathology with a high level of incidence, a high mortality rate andmorbidity, making the stage of the illness, at the moment of diagnosis, the most important factor in the prognosis ofthis type of tumor. Factors related to late diagnosis of oral cancer have been analyzed in the state of Paraíba throughspeeches and their significances in patients with this pathology. The sample consisted of 84 patients with squamous cell carcinoma in the oral cavity diagnosed at the Head and Neck Division at Napoleão Laureano Hospital, in Joao Pessoa- PB. A semi-structured interview has been realized from which social and demographic data and responses by patients who expressed their reasons for searching for the late medical help have been obtained.The reasons of the late diagnosis has been identified by the words of the patients, grouping them according to thematic categories: 1. The patient was unaware of the injury but looked for help only when it became unconfortable; 2. The patient was aware of the injury, looked for help but was diagnosed and treated inappropriately; 3. The patient was aware of the injury and looked for help when it became unconfortable; 4. Fear and denial towards the disease, afraid to face their condition; 5. Lack of time due to working hours and transportations difficulties. The results of the interview show that, fear of the disease, lack ofinformation and poor socio-economic conditions unmotivated patients to seek out treatment.