RESUMO
Granulomatosis with polyangiitis (GPA) is a potentially lethal disease characterized by systemic necrotizing vasculitis, which affects small- and medium-sized blood vessels and is often associated with serum cytoplasmic antineutrophil cytoplasmic antibody. The upper and lower respiratory tract and kidney are the most involved sites, but oral lesions can be identified in 6-13% of the cases, whereas in only 2% of the cases, oral manifestations represent the first signal of the disease usually as gingival swellings or unspecific ulcerations. Without treatment, the mainstay of which is the combination of immunosuppressants and systemic corticosteroids, GPA may run a fatal course. In this report we describe an original case of GPA affecting a 75-year-old female patient referred to our service due to a gingival swelling with 3-month duration. Although the patient was correctly diagnosed and promptly treated, she died 3 months after the initial diagnosis.
Assuntos
Corticosteroides/uso terapêutico , Doenças da Gengiva/diagnóstico , Granulomatose com Poliangiite/diagnóstico , Imunossupressores/uso terapêutico , Corticosteroides/administração & dosagem , Idoso , Anticorpos Anticitoplasma de Neutrófilos/sangue , Diagnóstico Diferencial , Quimioterapia Combinada , Evolução Fatal , Feminino , Doenças da Gengiva/sangue , Doenças da Gengiva/tratamento farmacológico , Granulomatose com Poliangiite/sangue , Granulomatose com Poliangiite/diagnóstico por imagem , Granulomatose com Poliangiite/tratamento farmacológico , Humanos , Imunossupressores/administração & dosagemRESUMO
The aim of this paper is to evaluate the clinical, radiographic, and histopathological findings and treatment modalities in all cases of ameloblastomas treated at the Sao Paulo Cancer Hospital, between 1953 and 2003. 121 case reports were retrieved from the medical files. Data were reviewed and statistical analysis was performed using Kaplan-Meyer method and Cox proportional risk model. The patients' age ranged from 2 to 82 years (mean 33.2 years), with a slight female prevalence. Most cases were located in the posterior mandible (80%). Radiographically, 60% showed a multilocular pattern. 113 casees were solid ameloblastomas, and plexiforme subtype was the most common. Solid tumours were treated by wide resection, curettage and criosurgery, or curettage alone, and unicystic tumours by curettage and/or cryotherapy. The global mean recurrence rate was 22%, with a mean follow-up of 9.7 years. The ameloblastomas were predominantly solid, affecting the posterior mandible. Important factors for outcome were radiographically multilocular lesions, the presence of ruptured basal cortical bone and histologically follicular tumours.
Assuntos
Ameloblastoma/epidemiologia , Neoplasias Maxilomandibulares/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ameloblastoma/classificação , Brasil/epidemiologia , Criança , Pré-Escolar , Criocirurgia/estatística & dados numéricos , Curetagem/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Neoplasias Mandibulares/epidemiologia , Neoplasias Maxilares/epidemiologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Osteotomia/estatística & dados numéricos , Estudos Retrospectivos , Fatores Sexuais , Resultado do Tratamento , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
AIM: To report the endodontic treatment of an immature maxillary central incisor with dens invaginatus. SUMMARY: Dens invaginatus is a rare malformation of teeth, probably resulting from an infolding of the dental papilla during tooth development. The present case describes the complex endodontic treatment of a type III dens invaginatus in an immature maxillary central incisor with a necrotic pulp and abscess formation. The initial treatment goal was to achieve apexification of the pseudocanal root and conservative root canal treatment in the main canal. Following 1-year of treatment with calcium hydroxide dressings, radiography revealed a healing response, but no sign of a hard tissue barrier at the apex. Periapical surgery with the placement of a zinc oxide cement (IRM) root-end filling was considered successful at the 4-year follow-up. KEY LEARNING POINTS: The complexity of the canal system and open apex in dens invaginatus present a challenge to endodontic treatment. Correct diagnosis and treatment planning are fundamental to treatment of dens invaginatus. Periapical surgery is indicated in cases of unsuccessful apexification in immature teeth with dens invaginatus and nonvital pulp.
Assuntos
Dens in Dente/complicações , Necrose da Polpa Dentária/terapia , Incisivo/patologia , Tratamento do Canal Radicular/métodos , Apicectomia , Hidróxido de Cálcio/uso terapêutico , Criança , Cavidade Pulpar/patologia , Seguimentos , Humanos , Masculino , Metilmetacrilatos/uso terapêutico , Abscesso Periapical/terapia , Obturação Retrógrada/métodos , Materiais Restauradores do Canal Radicular/uso terapêutico , Ápice Dentário/patologia , Cimento de Óxido de Zinco e Eugenol/uso terapêuticoRESUMO
BACKGROUND: Oral avascular bone necrosis is an important adverse effect of chemotherapy and biphosphate therapy. OBJECTIVE: To report our experience in oral avascular bone necrosis in cancer patients assigned to undergo chemotherapy. PATIENTS AND METHODS: Fourteen patients presenting oral avascular bone necrosis were selected from the clinical files of five Stomatological Clinics in Brazil. Clinical data as well as treatment and prognosis information were obtained from all 14 patients. RESULTS: Twelve patients (86%) were submitted to biphosphonate therapy. The most important symptom was pain, present in all cases, and the mandible was the most common involved site. Most patients (79%) had their conditions managed by antibiotic therapy and surgical debridation; however complete response was achieved in only three cases (21%). CONCLUSION: Avascular bone necrosis is a serious oral side-effect of cancer chemotherapy, particularly in patients using biphosphonates, and antibiotic therapy and surgical debridation were not able to promote complete response in most cases.
Assuntos
Antineoplásicos/efeitos adversos , Difosfonatos/efeitos adversos , Doenças da Boca/induzido quimicamente , Osteonecrose/induzido quimicamente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Lipomas represent about 1 to 5% of all neoplasms of the oral cavity. Although relatively common, few large series of intraoral lipomas and its variants are seen in the literature. Therefore, the authors present the clinical, histological and immunohistochemical features of 46 cases of intraoral lipomas reviewed from the files of the University of Campinas Dental School from 1970 to 2001. Most of the cases affected adults, without gender predilection, and the main involved sites were the buccal mucosa (21 cases), tongue (six cases), lips (six cases) and floor of mouth (five cases). The histological analysis revealed 21 cases of lipoma, 18 fibrolipomas, four intramuscular lipomas, two minor salivary gland lipomas and one spindle cell lipoma. PCNA and ki-67 expression indexes were higher in spindle cell lipoma, intramuscular lipomas and fibrolipomas compared to common lipomas, but the differences were not statistically significant. All lesions were removed surgically and none showed recurrence, regardless of the various proliferative activities.