Search

Medication-related osteonecrosis of the jaw (MRONJ) is a debilitating complication associated with antiresorptive agents, in which treatment can be quite challenging. This study aimed to report two cases of cancer patients with MRONJ treated in a complementary manner by antimicrobial photodynamic therapy (aPDT). Both patients were male, 84 and 82 years old, respectively, and had a diagnosis of prostate adenocarcinoma and bone metastasis, treated with intravenous injections of bisphosphonates. The dental history for both was toothache, followed by extraction of dental elements that culminated with the appearance of necrotic bone in the mandibular region, which was confirmed with imaging exams and histopathological reports. The treatment protocol for both cases consisted of performing the aPDT once a week, associated with the use of 10 volumes hydrogen peroxide and 0.12% chlorhexidine digluconate for continuous use after oral brushing and amoxicillin with clavulanate three times a day for 7 days. The patient in case 1 performed 27 sessions, responded well to treatment, however, due to complications of the underlying neoplasm, he died without complete resolution of the osteonecrosis. In case 2, 32 sessions were carried out, with a good evolution of the symptoms. The patient is being followed up for 14 months, with no need for surgical intervention to date. Based on the reported cases and the literature survey, it can be concluded that aPDT can be an effective alternative in cases of MRONJ. The patients in the study in question showed success and control of the clinical picture.

The aim of the present study was to evaluate the 5-year recurrence-free survival and prognostic factors of odontogenic keratocyst (OKC) from a single-center retrospective cohort in the northeastern region of Brazil. Forty cases of OKC comprised the study population. In the cohort analyzed, 18 (45%) cases were recurrent OKCs and 22 (55%) were non-recurrent OKCs. Recurrence-free survival was defined as the period from the release of the histopathological report to the occurrence of relapse or last visit to the service. Comparison of the clinicopathological variables between primary and recurrent OKC lesions revealed no differences in the frequency of epithelial thickness, presence of satellite cysts and cystic spaces, presence of an inflammatory infiltrate, locularity, and lesion borders. The frequency of symptoms was practically the same even after recurrence. Satellite cysts were more frequent in the group of recurrent lesions (n = 9, p = 0.002) and the presence of an inflammatory infiltrate was also significantly associated with recurrent lesions (n = 15, p = 0.006). Previous decompression or marsupialization was associated with recurrence of the lesion (p = 0.010). In conclusion, the most significant prognostic factors were previous decompression or marsupialization, as well as, morphological parameters associated with the recurrence cases were the presence of an inflammatory infiltrate and satellites cysts. The risk of recurrence is low but continues due to the particularities of epithelial proliferation in OKC.

Oropharyngeal cancer is characterized by high morbidity and mortality. Prognostic factors for this cancer are therefore useful to predict overall survival and may provide additional therapeutic targets.To evaluate the 5-year overall survival and prognostic factors for oropharyngeal squamous cell carcinoma.Retrospective cohort (2008-2018) of a cancer referral center. The population of the study was a hospital-based cohort consisting of patients diagnosed with oropharyngeal cancer who underwent surgery and/or adjuvant therapy (radio- and/or chemotherapy).A total of 253 patients with oropharyngeal squamous cell carcinoma were analyzed. The mean age was 59.8 ± 11.9 years and there was a male predominance (81.8%). Smoking and alcohol consumption were found in 88.0% and 84.2% of the sample, respectively. The combination of radiotherapy and chemotherapy was the treatment modality in 42.7% of the sample, followed by surgery combined with radio- and chemotherapy in 15.8%. There were 143 deaths (events), the mean survival was 11.55 ± 9.69 months, and the 5-year overall survival rate was 1.1%. Overall survival was lower for clinical stage III/IV (p 0.001), HPV p16-negative status (p = 0.019), and an interval 4 weeks between diagnosis and the beginning of treatment (p 0.007).Among the prognostic factors analyzed in this cohort, p16-negative status as a poor prognostic indicator and tumor stage III/IV and an interval longer than 4 weeks between diagnosis and the beginning of treatment were significantly associated with lower overall survival.

Objective To aim of this systematic review was to explore the relationship between Human papillomavirus (HPV) and epithelial-mesenchymal transition (EMT) related to the prognosis of oropharyngeal squamous cell carcinoma (OPSCC). Design For this systematic review, searches were performed in PubMed, Web of Science, Scopus, Science Direct, and Cochrane, and a random-effects model was used for meta-analysis. The presence of EMT was confirmed by the loss of E-cadherin immunoexpression and overexpression of vimentin. Results In summary, EMT-related proteins were expressed regardless of HPV status; however, overall survival was better in HPV-positive OPSCC cases, with a 5.88 times lower death risk compared to HPV-negative patients (OR = 0.17; 95%CI = 0.10–0.30). Likewise, the maintenance of E-cadherin in OPSCC was associated with an 11.11 times lower risk of death due to the disease (OR = 0.09; 95%CI = 0.01–0.88). Conclusions More advanced clinical stages (III/IV) and the presence of lymph node metastases (N1–3) were common in OPSCC but were not significantly associated with HPV status.

Fibromyxoma is an unusual collagenized variant from odontogenic myxoma neoplasm, presenting a recurrence index of 9.52%. The case report aims to describe an uncommon lesion which presents diagnostic challenges due its similarity to other lesions such as intraosseous neurofibroma and central odontogenic fibroma. An 18-year-old female patient presented a radiolucent lesion discovered on the routine panoramic radiography, which was well circumscribed and had unilocular aspect. Clinically, the patient did not report any symptoms. Then excisional biopsy was performed for histologic evaluation of the lesion, which was observed cells with fusiform or rounded pattern in an abundant fibrous dense stroma and sometimes myxoid. Immunohistochemical analysis were request and the results were S-100(-), CK19(-), SMA(-), and vimentin (+); consequently the diagnosis of odontogenic fibromyxoma was confirmed by morphologic and immunohistochemical findings. Finally, the treatment of choice was enucleation associated with curettage due to good prognosis and she is under follow-up.

The lymphoid tissue from the body plays an important role in the recognition and processing of antigens. In response to antigen-antibody reaction, lymphoid cells proliferate, increasing in number to combat the aggressor agent more effectively, resulting in hyperplasia of this tissue. A 61-year-old female patient attended a referral service in oral diagnosis because of a lesion on right jugal mucosa, fibrous consistency, smooth, painless, 1 cm in size, and lasting for 3 months. An excisional biopsy was performed, and clinical hypotheses were cyst of the salivary duct or mucocele. Histopathologic analysis revealed a well-circumscribed and encapsulated lymphoid aggregate fragment characterized by well-differentiated small lymphocyte layers and collections of reactive lymphoblasts. Macrophages were also identified by presence of phagocytic material in their cytoplasm, thus establishing the diagnosis of lymphoid hyperplasia. Currently, the patient is well undergoing preservation after 6 months.

Objective: This study aims to determine the frequency and features of odontogenic keratocyst (OKC) in children aged 0 to 14 years in an oral pathology service in Brazil. Study design: A retrospective study was performed to review cases of OKC in children diagnosed between 1986 and 2017. Clinical data were evaluated from medical records (sex, race, age, anatomic location, treatment, radiographic findings, and recurrence). Results: Ninety-seven cases of OKC were diagnosed in a 31-year period in all age groups and 10 were found in children (10.3%). Ages ranged from 2 to14 years (mean age ± standard deviation [SD], 10.5 ± 3.5), with 8 males and 2 females. The most frequent location was the anterior region of the mandible (n = 4). Patients were predominantly asymptomatic. Moreover, in 2 children, clinical findings of Gorlin-Goltz syndrome were observed. The most commonly used treatment was enucleation followed by curettage, and 2 cases recurred. Conclusion: Although uncommon in pediatric patients, OKC should be considered a differential diagnosis in cases of osteolytic lesions in gnathic bones. Thus, the periodic assessment of children by dentists and pediatricians is essential to get a correct diagnosis and early treatment to avoid greater disfigurement these patients.

A 61-year-old female patient presented a nodular lesion located in the right buccal mucosa with a 3-month evolution. Clinical hypotheses of salivary duct cyst and mucocele were proposed, and the patient underwent excisional biopsy. Microscopically, a well-circumscribed and encapsulated lymphoid aggregate fragment was observed, characterized by layers of well-differentiated small lymphocytes and collections of reactive lymphoblasts. These findings, associated with immunohistochemistry, established the diagnosis of follicular lymphoid hyperplasia. Currently, the patient is well, under follow-up after six months.

Self-induced lesions or factitious ulcer of the mouth can be manifestation of unusual or aggressive oral habits or an emotional disorder. Here, we report 2 rare cases of difficult management of factitious ulcer. The first was an 18-year-old male patient who was a former alcohol, tobacco, marijuana, and cocaine user referred to the stomatology service because of lateral tongue lesion because the lesion itched and burned. The second occurred in a 10-year-old male patient who was taken to service because of a lip injury. The patients had the lesions treated but presented recurrence; biopsy specimen revealed a chronic inflammatory process. Systemic and local alterations that justified the ulcerations were investigated but were not found. Low-level laser therapy was performed for the 2 patients. The clinical follow-up, clinical history, and histopathologic aspects for the lesions were of great importance, and diagnosis was chronic wound by self-inflicted thermal injury.