Foreign Body in Jugal Mucosa

Introduction Foreign body in the oral cavity may be asymptomatic for long time and only sometimes it can lead to a typical granulomatous foreign body reaction. Some patients may complain of oral pain and present signs of inflammation with purulent discharge. A granuloma is a distinct, compact microscopic structure composed of epithelioid-shaped macrophages typically surrounded by a rim of lymphocytes and filled with fibroblasts and collagen. Nowadays, the increase of cosmetic invasive procedures such as injection of prosthetic materials in lips and cheeks may lead to unusual forms of inflammatory granulomas. Objectives Describe an unusual presentation of a foreign body reaction in the buccal mucosa due to previous injection of cosmetic agent. Resumed Report A 74-year-old woman was referred to the Department of Otorhinolaryngology, Head and Neck Surgery to investigate the presence of multiple painless, bilateral nodules in the buccal mucosa, with progressive growth observed during the previous 2months. The histologic results showed a foreign body inflammatory reaction. Conclusion Oral granulomatosis lesions represent a challenging diagnosis for clinicians and a biopsy may be necessary. Patients may feel ashamed to report previous aesthetic procedures, and the clinicians must have a proactive approach.(AU)

Foreign Body in Jugal Mucosa.

Introduction Foreign body in the oral cavity may be asymptomatic for long time and only sometimes it can lead to a typical granulomatous foreign body reaction. Some patients may complain of oral pain and present signs of inflammation with purulent discharge. A granuloma is a distinct, compact microscopic structure composed of epithelioid-shaped macrophages typically surrounded by a rim of lymphocytes and filled with fibroblasts and collagen. Nowadays, the increase of cosmetic invasive procedures such as injection of prosthetic materials in lips and cheeks may lead to unusual forms of inflammatory granulomas. Objectives Describe an unusual presentation of a foreign body reaction in the buccal mucosa due to previous injection of cosmetic agent. Resumed Report A 74-year-old woman was referred to the Department of Otorhinolaryngology, Head and Neck Surgery to investigate the presence of multiple painless, bilateral nodules in the buccal mucosa, with progressive growth observed during the previous 2 months. The histologic results showed a foreign body inflammatory reaction. Conclusion Oral granulomatosis lesions represent a challenging diagnosis for clinicians and a biopsy may be necessary. Patients may feel ashamed to report previous aesthetic procedures, and the clinicians must have a proactive approach.

Rhinosinusitis in hematopoietic stem cell-transplanted patients: influence of nasosinus mucosal abnormalities?

INTRODUCTION: Rhinosinusitis is characterized by inflammation extending from the mucosa of the nasal cavity into the paranasal sinuses. There are some aggravating features, such as immunosuppression, that can cause the nasal mucosal inflammation to linger for a long period, resulting in chronic or recurrent episodes. Such immunosuppression is the major feature of patients undergoing a hematopoietic stem cell transplant (HSCT); rhinosinusitis prevalence is higher in this group compared to immunocompetent patients. Nasal epithelial abnormalities have been described in, and may have some influence over, recurrent sinus infections among those patients. However, it is not clear whether rhinosinusitis can trigger mucosal abnormalities or whether a preexisting vulnerability for sinusitis recurrence is more likely. The objective of the study was to verify the influence of rhinosinusitis on nasal epithelial damage in patients undergoing hematopoietic stem cell transplantation. METHOD: A total of 30 allogeneic HSCT patients were divided into two groups: 24 patients with chronic or recurrent rhinosinusitis and 6 patients without rhinosinusitis. These patients underwent a biopsy of the uncinate process that was analyzed by transmission electron microscopy and optical microscopy. RESULTS: The nasal mucosa analysis by optical microscopy showed no significant abnormalities. The ciliary orientation was obviously normal in the transplanted patients without rhinosinusitis. There was a trend toward a difference in the amount of cilia (decreased) and the primary modification of the ultrastructure of transplanted patients with rhinosinusitis. CONCLUSION: HSCT patients, with and without rhinosinusitis, showed no significant histological abnormalities, except for ciliary disorientation and a possible decrease in ciliary and ultrastructural abnormalities in HSCT patients with rhinosinusitis.

Malformações capilares: resultados preliminares do tratamento associando laser ND:Yag 1064 nm e luz intensa pulsada / Capillary malformations: preliminary results of treatment associating ND:Yag 1064 nm laser and intense pulsed light

Introdução: As malformações vasculares congênitas do tipo capilar têm seus melhores resultados até o momento com o laser de corante. Nós associamos, em um único equipamento, o laser ND:Yag 1064 nm de pulso longo e a luz intensa pulsada, para o tratamento de lesões superficiais e profundas. Método: Dezessete pacientes foram tratados com a associação descrita em regime ambulatorial, com anestesia tópica, apenas em intervalos mensais, pelo mesmo cirurgião. O equipamento utilizado foi a plataforma Synchro (DEKA), com a ponteira de 4 mm de diâmetro e fluência de 110 J/cm2 para o laser ND:Yag 1064nm. Para a luz intensa pulsada foi utilizado um filtro de corte de 550 nm, a ponteira de 46 x 10 mm e 21 J/cm2 de fluência, divididos em dois disparos. Os resultados foram avaliados clinicamente e por meio de fotografias, em conjunto com os pacientes. Resultados: Dentre os dezessete pacientes tratados, quatro resultados foram considerados excelentes, nove, bons, quatro, regulares e nenhum insuficiente. Conclusão: O tratamento pode ser realizado adequadamente com anestesia tópica em regime ambulatorial. A associação das duas tecnologias possibilitou a obtenção de resultados satisfatórios e, provavelmente, é mais uma técnica no tratamento destas lesões.

Introduction: Congenital vascular malformations up to know, have their best results with dye laser. We associate, in single equipment, long pulse Nd:Yag 1064 nm laser and intense pulsed light, for simultaneous treatment of the superficial and deep lesions. Methods: Seventeen patients were treated with the association described in an office basis with topical anesthesia only at monthly intervals by the same surgeon. The equipment utilized was the Synchro Platform (DEKA) with a 4 mm diameter spot size and fluency of 110 J/cm2 for the ND:Yag 1064 nm laser. For the intense pulsed light was utilized a 550 nm cutoff filter with a 46 x 10 mm spot size and 21 J/cm2 as fluency, divided in two shots. Results were evaluated through clinical and photographical analysis together with the patient. Results: Among the seventeen patients treated, four results were considered excellent, nine, good,four, regular and none insufficient. Conclusion: The treatment can adequately be done in an office basis with topical anesthesia. Association of the two different technologies got a satisfactory result and it is probably one more technique for treating such lesions.

Halitose: proposta de um protocolo de avaliação: [revisão] / Halitosis: an assessment protocol proposal: [review]

A Halitose é um sintoma constrangedor com significativo impacto social. Ela afeta milhões de pessoas ao redor do mundo e muitos recursos são investidos em produtos para a melhora do hálito, sem sucesso. O estudo da halitose com uma abordagem científica se justifica, uma vez que a halitose é causa de restrição social, diminui a qualidade de vida e pode ser indicativo da presença de doenças mais graves. OBJETIVO: Elaborar um protocolo de avaliação da halitose com o objetivo de minimizar custos, evitar exames desnecessários e orientar o diagnóstico causal. MÉTODO: O protocolo foi elaborado baseado na literatura e na experiência pessoal dos autores, adotando uma anamnese baseada em evidências. RESULTADO: Existem muitas causas da halitose e a maioria delas está relacionada com a cavidade oral, outras estão relacionadas com doenças otorrinolaringológicas e respiratórias. Doenças gastrointestinais, alterações das funções renais e hepáticas e outras síndromes metabólicas são causas menos freqüentes, porém importantes de halitose. CONCLUSÃO: Existem custos importantes envolvidos no diagnóstico e tratamento da halitose, incluindo consultas ambulatoriais, avaliação de especialistas e exames complementares. Estes custos poderiam ser minimizados adotando uma anamnese baseada em evidências e um organograma para uma investigação clínica racional.

Halitosis is an embarrassing symptom with a significant social impact. Halitosis affects millions of people worldwide and many resources are spent annually in products to improve halitus, unsuccessfully. The study of halitosis in a scientific basis is justified once halitosis causes social restriction, decreases life quality and may be an indication of serious diseases. AIM: To elaborate a protocol for halitosis assessment in order to minimize costs, avoid unnecessary tests and provide a guideline for diagnosis. METHODS: The protocol was created based on the literature and on the authors’ personal experiences, adopting an evidence-based anamnesis. RESULTS: There are many causes of halitosis and most of them are related to the oral cavity; others are related to otolaryngologic and respiratory diseases. Gastrointestinal diseases, liver/renal impairment and other metabolic syndromes are less frequent, but also important causes of halitosis. CONCLUSION: There are important costs involved in halitosis assessment and treatment, including medical appointments, specialist assessment, and complementary tests. Such costs would be minimized by adopting a protocol of evidence-based anamnesis and a flowchart for a rational clinical investigation.

Harderian gland of wistar rats revised as a protoporphyrin ix producer

In 1694 Johann Jacob Harder described, for the first time, the harderian gland, located near the eye in the great majority of vertebrates, and regarded it as a lacrimal gland. This gland has multiple functions that vary according to the animal species. In the present work, we review the literature on the harderian gland of rats, focusing our study on the detection of great amounts of protoporphyrin IX (PpIX) produced by rodent glands. Protoporphyrin IX is a powerful photosensitizer that is widely used for photodynamic therapy (PDT). We also discuss the anatomic and the histological evidence for the presence of PpIX in the harderian gland of Wistar rats. Protoporphyrin IX has been detected in the lumen and in acinar cells of this gland, as confirmed by fluorescence microscopy. These findings together with numerous reports in the literature suggest that the harderian gland could be useful experimental model for studying the photodynamic process.

Construction and evaluation of a non-laser optical system for photodynamic process excitation

Objetivo: Descrever a construção de uma fonte de luz não-laser, a partir de uma lâmpada de Tungstênio e filtros óticos adequados e demonstrar que sua eficiência em estudos fotodinâmicos, mediados por protoporfirina IX, é semelhante a do laser de Hélio Neônio. Métodos: As regiões Infravermelha e Azul do espectro de emissão óptica de uma lâmpada de Tungstênio foram convenientemente descartadas por processos de absorção, enquanto que a fração centrada na região do vermelho foi removida com o uso de um filtro de interferência. O efeito fotodinâmico foi estudado, em glândula Harderiana de ratos Wistar em razão da produção endógena de protoporfirina IX (PpIX) por estas glândulas. Foram utilizados 20 ratos. Cada animal teve as duas glândulas expostas cirurgicamente, sendo uma delas tratada com a fonte não-laser e a outra mantida como controle. Após tratamento por 30 minutos os animais foram sacrificados e suas glândulas removidas para estudo histológico. Os resultados foram comparados a estudos realizados com laser de Hélio Neônio, já publicados. Resultados: A luz produzida pelo equipamento está centrada em torno de (636 ± 6,5) nm, fornecendo uma densidade de potência de 11,3 mW/cm2. Os efeitos fotodinâmicos produzidos na glândula Harderiana, podem ser observados tanto por espectroscopia de fluorescência como por microscopia ótica. Conclusão: Não foram observadas diferenças significativas nos resultados do efeito fotodinâmico obtidos com a fonte de luz não-laser proposta, em comparação aos resultados conhecidos com o uso do laser de Hélio Neônio.

Histopathological evaluation in biopsies of palatine tonsils submitted to cryptolysis by coagulation with CO2 laser for treatment of chronic caseous tonsillitis.

OBJECTIVE: To perform histopathological evaluation in biopsies of palatine tonsils in a group of patients, with symptoms of chronic caseous tonsillitis, treated with an innovative and conservative method, using CO(2) laser. BACKGROUND DATA: In general, the treatment of chronic caseous tonsillitis with CO(2) laser, as described in the literature, refers to the clinical experience of the authors and, the technique used for criptolysis encourages tissue vaporization, which leads to the consequent reduction of the tonsillar parenchyma. MATERIALS AND METHODS: The individuals were submitted to cryptolysis coagulation with only 6 W of CW, CO(2) laser power, in scanned and unfocused mode, over a mean area of 2.2 mm diameter, leading to energy doses from 18 to 54.5 joules/cm(2). Biopsies were performed at the beginning and end of each treatment. A comparative analysis was performed between the initial and final biopsies taking into consideration possible alterations in the following: germinal centers, lymphoid tissue, sub-epithelial fibrosis, and parenchyma fibrosis. RESULTS: The histopathological analysis of these biopsies showed that the laser, used at a specific energy density, could relieve the symptoms of the disease causing neither increase of the fibrotic content nor decrease of the lymphoid structure. The action of the laser, following the proposed technique, is superficial, causing only epithelial coagulation, which enables a weakening of the tension forces in the crypt borders, causing them to open. This effect results in the reduction and even disappearance of caseous retention. CONCLUSION: We, therefore, conclude that the proposed method of treatment with CO(2) laser, called laser cryptolysis by coagulation (LCC) is an effective and conservative method, causing no significant morphological alterations to the tonsils.

Pesquisa de eosinófilos no muco nasal: valor no diagnóstico diferencial de rinites / Eosinophils search in the nasal mucus: value in the differential diagnosis of rhinitis

O exame citológico do muco nasal para pesquisa de eosinófilos foi avaliado criticamente em 75 pacientes portadores de sintomas e comprovadamente alérgicos e em 29 pessoas sem quadro clínico de ritine e sem qualquer síntoma sugestivo de atopia. A pesquisa dos eosinófilos foi feita avaliando-se a percentuagem dos mesmos em relaçäo aos leucócitos e fazendo-se a contagem seqüencial das células em estudo. Os autores concluem que a determinaçäo do número absoluto de eosinófilos é a forma mais objetiva e correta de se fornecer o resultado.É também uma forma prática de se examinar a lâmina, pois, ao ser atingido o número crítico indicativo de processo alérgico, o exame pode ser dado por terminado. Consideram significativo o encontro de mais de 20 eosinófilos por lâmina. É importante salientar que as lâminas devem ser examinadas minuciosamente em toda a sua extensäo,exeto nos casos em que há abundantes eosinófilos ou que logo de início é atingida a contagem de 20 eosinófilos. Os casos negativos näo têm valor diagnóstico