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A 55-year-old female patient, previously diagnosed with breast carcinoma and having undergone surgery, chemotherapy, and radiotherapy, presented with two foci of bone metastasis. She was referred for evaluation due to numbness on her lower lip and chin. A panoramic X-ray revealed a discreet, poorly delimited radiolucent area in the right mandibular ramus region. Cone-beam computed tomography confirmed a hypodense image in the mandibular medullary bone with indistinct borders and signs of cortical bone resorption. Given the patient's clinical symptom of paresthesia, her history of metastatic breast cancer, and the imaging findings, the primary diagnosis hypothesis was another bone metastasis. The patient was subsequently referred to her oncologist. During follow-up, the patient developed extraoral asymmetry with an increased volume in the right mandibular ramus region. There was also an evolution of radiolucent and hypodense areas, along with severe disruption of the distal cortex of the right mandibular ramus. Unfortunately, the patient passed away 3 years after the initial evaluation. [ABSTRACT FROM AUTHOR]

Objective: We performed a systematic review dedicated to pooling evidence for the associations of clinical features with malignant transformation (MT) and recurrence of 3 oral potentially malignant disorders (OPMDs) (actinic cheilitis [AC], oral leukoplakia [OL], and proliferative verrucous leukoplakia [PVL]).Study Design: We selected studies that included clinical features and risk factors (age, sex, site, size, appearance, alcohol intake, tobacco use, and sun exposure) of OL, PVL, and AC associated with recurrence and/or MT.Results: Based on the meta-analysis results, non-homogeneous OL appears to have a 4.53 times higher chance of recurrence after treatment. We also found 6.52 higher chances of MT of non-homogeneous OL. Another clinical feature related to higher MT chances is the location (floor of the mouth and tongue has 4.48 higher chances) and the size (OL with >200 mm2 in size has 4.10 higher chances of MT). Regarding habits, nonsmoking patients with OL have a 3.20 higher chance of MT. The only clinical feature related to higher chances of MT in patients with PVL was sex (females have a 2.50 higher chance of MT).Conclusions: Our study showed that some clinical features may indicate greater chances of recurrence after treatment and MT of OPMD. [ABSTRACT FROM AUTHOR]

Syphilis, a sexually transmitted disease caused by Treponema pallidum, manifests in distinct stages, each characterized by different oral lesions. A 38-year-old male presented with ulcerated lesions on the lateral border of the tongue and anterior vestibule fornix, evolving over 40 days. The patient reported additional symptoms such as weight loss, fever, and fatigue. An incisional biopsy of the anterior vestibule lesion revealed non-specific chronic ulceration. Following referral to the infectious and contagious diseases center, the patient received diagnoses of syphilis and HIV/AIDS, leading to a 6-month hospitalization. Treatment was administered, resulting in the patient's current well-being with an undetectable viral count. Timely and accurate diagnosis, along with proper referral, is crucial for determining an appropriate treatment strategy. [ABSTRACT FROM AUTHOR]

Oral soft tissue necrosis is a rare complication of head and neck radiotherapy, often underreported in the literature, yet associated with significant morbidity in cancer survivors. In this case series, four patients with a mean age of 60 years were diagnosed. Their medical histories included squamous cell carcinoma in the posterior regions of the oral cavity, diabetes mellitus, hypertension, intracranial aneurysms, and a risk of thrombosis. Clinical diagnosis of soft tissue necrosis occurred between 2 and 5 months after radiotherapy, presenting as extensive chronic ulcers and painful necrotic masses. Patients received treatment involving oral hygiene protocols, photobiomodulation, and PENTO. The response to treatment, as reported in the literature, is gradual, and patients are continuously monitored and supported. The case series emphasizes the diagnostic and therapeutic challenges associated with this oral toxicity resulting from radiation therapy. [ABSTRACT FROM AUTHOR]

Oral verruciform xanthoma (OVX) is an uncommon lesion of uncertain origin, allegedly related to trauma, inflammation, or altered immune response. Two cases of OVX are reported. The first patient, a 31-year-old man, with a history of graft-versus-host disease (GVHD) after allogeneic transplantation for acute myelocytic leukemia, presented painful nodular lesions on the lingual dorsum and hard palate, and diffuse lichenoid lesions. The provisional clinical diagnosis was verruciform xanthoma and lichenoid lesions in a patient with GVHD. The patient is currently taking Apixaban for six months due to a pulmonary thromboembolism, what postponed the biopsy. The second patient, also a 31-year-old man, smoker, presented an asymptomatic wart on the lower lip and a plaque on the right buccal mucosa with 1 year of evolution. Clinical appearance suggested verrucous leukoplakia or hyperkeratosis, however, histopathological and immunohistochemical examinations were compatible with OVX. Eight months after excisional biopsy, the patient remains well without recurrence. [ABSTRACT FROM AUTHOR]

A 51-year-old female patient, who is HIV-positive, was referred for the assessment of a white lesion on the buccal mucosa on the left side, near the labial commissure. The lesion measured approximately 2 cm and had well-defined, verrucous surfaces, encircled by a brownish halo, indicative of melanin pigmentation. An incisional biopsy was conducted, and the histopathological examination revealed squamous epithelium with hyperkeratosis, acanthosis, and severe epithelial dysplasia. Furthermore, superficial cells displayed koilocytosis, indicating a viral infection. Immunohistochemistry for p16 demonstrated widespread nuclear and cytoplasmic positivity in the surface epithelium. In situ hybridization for broad-spectrum HPV detected viral DNA within the nucleus of epithelial cells. These findings led to the diagnosis of HPV-associated severe epithelial dysplasia. The patient was referred to a head and neck surgeon, and a complete resection of the lesion was performed. The patient is currently under observation and shows no clinical signs of recurrence. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the presence of enamel craze lines (ECLs), part of the spectrum of the so-called cracked tooth syndrome, on the surface of teeth irradiated in vivo.Study Design: Forty teeth extracted from patients with head and neck cancer were paired, matched, and equally divided into 4 groups: noncarious irradiated (G1); noncarious control (G2); radiation-related caries (RRC) (G3), and carious control (G4). Samples were examined for ECL detection with a fiberoptic transillumination device and photographed, and ECL mean size, number, and patterns of topographic distribution in tooth crown were determined. Groups were compared accordingly: G1 versus G2; G3 versus G4.Results: We analyzed 538 ECLs, of which 30.1% were found in noncarious irradiated teeth, 19.3% in noncarious controls, 27.6% in RRC, and 23% in carious controls. Non-carious irradiated teeth presented higher quantities of ECL than non-carious control (P < 0.05). Higher incidences of ECLs were identified in specific enamel topographies of anterior G1 and G3 samples (P <.05). There was no correlation between ECL size/numbers and radiation isodose delivery to teeth.Conclusions: Increased incidence of ECLs may indicate weakened enamel structure in irradiated teeth, and this may play a role in the onset and progression of RRC. [ABSTRACT FROM AUTHOR]