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Mucoepidermoid carcinoma is one of the most prevalent malignant tumors of the salivary glands. Resection of this tumor can result in postsurgical morbidity, affecting the patient's quality of life and normal oral functioning. This study aimed to present a successful case of postsurgical rehabilitation following mucoepidermoid carcinoma resection in the palate. Following tumor ablative surgery, the 32-year-old patient experienced impairments in both speech and feeding due to the surgical wound. A protective stent that covered the entire extent of the palate and teeth was made. This esthetic device was fabricated in a single session and provided sealing and protection of the surgical site, ensuring comfort, functionality, and, consequently, a higher quality of life during the postoperative period. The simplicity and low cost of the custom palatal stent make it applicable for use in a diverse range of postsurgical oncology patients, providing protection for surgical wounds and reducing postoperative morbidity.

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The treatment of oral cancer can lead to various oral complications, including oral defects, tissue deformation, and trismus in patients who have undergone oral cancer surgery with resection of any part of the maxillary. Restoring the ability to chew, swallow, and maintain esthetics is essential and a significant challenge. The aim of this study was to report a successful clinical case of preprosthetic surgery and prosthetic rehabilitation of a 65-year-old man who had undergone marginal maxillectomy, resulting in tissue scarring and a significant reduction in maximal mouth opening. The oral rehabilitation was achieved using a conventional removable prosthesis. This case demonstrates that preprosthetic surgery combined with conventional removable prosthesis is an effective strategy for complex rehabilitations providing functional and esthetic improvement in the affected area for patients with marginal maxillectomies resulting from oral cancer.

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BACKGROUND: Cytopathologic analysis is feasible and provides detailed morphological characterisation of head and neck lesions. AIMS: To integrate the available data published on fine-needle aspiration cytology (FNAC) used for the diagnosis of plasma cell neoplasms (PCN) of the head and neck region. MATERIALS AND METHODS: Searches on PubMed, Web of Science, Embase, and Scopus were performed to compile data from case reports/case series published in English. The Joanna Briggs Institute tool was used for the critical appraisal of studies. RESULTS: A total of 82 studies comprising 102 patients were included in this review. There was a predilection for men (68.6%) (male/female ratio: 2.1:1). Individuals in their 50s (29.4%), 60s (22.5%), and 70s (22.5%) were more often affected. The thyroid gland (26.2%) was the main anatomical location, followed by scalp (15.5%), neck/cervical region (15.5%), jaws (13.6%), and major salivary glands (13.6%). For FNAC analysis, a smear was employed in 41 (40.6%) cases and a cell block was used in four (3.9%). In 56 (55.4%) reports, no cytological methods were available. Morphologically, 34 (56.7%) cases had a diagnosis of PCN with agreement between cytopathology and histopathology. The rate of wrong diagnoses when using cytology was 27.5%. Immunophenotyping was performed in 49 (48%) of the cases. The 69-month disease-free survival rate was 60.2%, while the 27-month overall survival rate was 64.1%. CONCLUSION: This study reinforces that FNAC can be an ancillary tool in the first step towards the diagnosis of PCN of the head and neck region, especially when applying a cell block for cytological analysis.

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OBJECTIVES: To assess the association between oral mucosa hyperpigmentation in patients with leukemia and imatinib mesylate use. Additionally, we compared our data to those obtained from a systematic review. MATERIALS AND METHODS: A cross-sectional study was conducted with 74 patients undergoing treatment with imatinib mesylate. Sociodemographic characteristics, oral mucosa alterations, and medical history were evaluated. Oral hyperpigmentation was scored. The use of imatinib mesylate and hydroxyurea was evaluated. Association between oral hyperpigmentation and imatinib mesylate was assessed. A systematic review was also conducted to retrieve case reports or case series of patients with oral hyperpigmentation associated with imatinib mesylate. RESULTS: Among the 74 participants, 41 were male (55.4%) and 33 were female (44.6%). Participants' mean age was 49.3 years. Sixty-six (89.2%) patients developed hyperpigmented lesions in the hard palate mucosa. In multivariate analysis, patients who had used imatinib mesylate for > 72 months had a hyperpigmentation score 1.62 times higher than those who had used this medication during a shorter period. Patients who had used hydroxyurea for > 30 days had a hyperpigmentation score 1.43 times higher than those who had used this medication during a shorter period. The systematic review retrieved 20 clinical cases of patients undergoing imatinib mesylate treatment and exhibiting oral hyperpigmentation. CONCLUSIONS: The development of oral hyperpigmentation is associated with imatinib mesylate use. Hydroxyurea seems to increment such an association. CLINICAL RELEVANCE: To assist providers in the differential diagnosis of hyperpigmented lesions associated with imatinib mesylate, as well as in the clinical management of such lesions.

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Some prospective studies have been designed specifically to investigate perioperative bleeding in dental surgery. The quantitative assessment of intraoperative blood loss can be useful for indicating the real risk of bleeding complications, especially in medically compromised individuals. The aim of this study was to evaluate the pattern of bleeding in individuals under vitamin K antagonist (VKA) therapy and non-anticoagulated individuals submitted to dental extractions. Perioperative bleeding was evaluated by using a total collected bleeding corrected by absorbance reading (dental bleeding score). 138 procedures were performed. When the perioperative dental bleeding score was correlated with the number of extracted teeth, the quantity of bleeding was found to be directly proportional to the procedure. Extractions of two or more teeth presented higher scores than single extractions (p = 0.003). In a comparative analysis between the VKA and non-anticoagulated groups, no significant difference in the scores was found. The previous history of complications in dental procedures (p = 0.001) and the use of additional hemostatic measures were higher in the VKA group (p = 0.017). VKA therapy did not impact significantly the volume of blood lost during dental extractions. Perioperative bleeding assessment might be a useful parameter for evaluating patients under antithrombotic treatment.

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Drug-induced reactions are complications associated with high mortality and significant morbidity. Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are examples of these conditions, which are characterized by skin and mucous lesions. Here, we report a case of a 9-year-old girl who presented with blisters associated with an extensive vesicular rash and multiple ulcerations on the lips and oral cavity. A drug-induced hypersensitivity reaction to antibiotics was suspected, and a diagnosis of TEN was made. The patient was managed with withdrawal of the suspected causative agent, and the oral lesions were treated with low-level laser therapy (LLLT) and oral hygiene. This case highlights that TEN requires interdisciplinary intervention with dental assistance and follow-up to improve symptoms, nutrition, systemic condition, and quality of life.

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Os objetivos deste trabalho foram 1) avaliar o impacto da terapia anticoagulante oral no sangramento associado à exodontias durante os períodos intraoperatório e pósoperatório; 2) investigar os efeitos do etexilato de dabigatrana, um inibidor direto da trombina, sobre as células ósseas. Para atender o objetivo 1, foram recrutados indivíduos em uso de anticoagulantes orais do tipo antagonista de vitamina K (AVK) e alvo-específico (DOAC, do inglês direct oral anticoagulant) e indivíduos sem terapia anticoagulante com indicação de exodontia. As exodontias foram realizadas sem a suspensão da terapia anticoagulante e parâmetros associados a desfechos hemorrágicos foram avaliados. A avaliação quantitativa do sangramento intraoperatório foi realizada por meio da mensuração do volume e análise dos fluidos aspirados durante o procedimento e normalizada por um escore. Obtivemos como resultados que as complicações hemorrágicas pós-operatórias bem como o escore de sangramento intraoperatório foi similar entre os grupos, sendo que nenhum evento hemorrágico foi observado no grupo DOAC. A história prévia de complicações hemorrágicas em procedimentos odontológicos (p=0,001) e uso de medidas hemostáticas locais (p=0,017) foram estatisticamente maiores no grupo AVK. Para atender o objetivo 2, experimentos foram conduzidos a partir de modelo in vitro, no qual o efeito da terapia anticoagulante foi avaliado diretamente sobre as células ósseas e em modelo animal ex-vivo. Neste modelo ex-vivo, células de animais previamente tratados com etexilato de dabigatrana foram diferenciadas em osteoclastos. Culturas primárias de células-tronco de camundongos e ratos foram diferenciadas em osteoclastos e osteoblastos e tratadas com o fármaco disponível comercialmente, etexilato de dabigatrana (Pradaxa® 1-6 µg/mL) bem como seu princípio ativo, dabigatrana (0,1, 0,3, 3 e 6 µg/mL). Células não expostas aos medicamentos foram utilizadas como controle. A diferenciação de osteoclastos foi inibida pelo tratamento em ambos os modelos, in vitro e ex-vivo. Paralelamente, observou-se a redução da expressão gênica e proteica do marcador Catepsina K e da atividade reabsortiva destas células. Nas culturas de osteoblastos, o tratamento inibiu a expressão gênica dos marcadores fosfatase alcalina (ALP) e osteocalcina, reduziu a atividade in situ de ALP e a deposição de matriz extracelular, indicando um efeito negativo na diferenciação dos osteoblastos. Concluiu-se que o uso de anticoagulantes orais não aumentou a ocorrência de desfechos hemorrágicos na população estudada, o que reforça a manutenção da terapia para a realização de exodontias. O tratamento sobre culturas celulares utilizando etexilato de dabigatrana impactou negativamente a diferenciação e atividade de osteoclastos e osteoblastos.(AU)

The objectives of this study were 1) to evaluate the impact of oral anticoagulant therapy on the pattern of intraoperative and postoperative bleeding in dental surgery; 2) to investigate the effects of dabigatran etexilate, a direct thrombin inhibitor, on bone cells. To fulfill objective 1, individuals undergoing oral anticoagulant therapy with vitamin K antagonists (VKA) or direct oral anticoagulants (DOAC) and individuals without anticoagulant therapy, who had indication of dental extraction were included. Dental surgery procedures were performed without interruption of anticoagulant therapy and parameters associated with hemorrhagic outcomes were evaluated. Intraoperative bleeding was evaluated by means of the measurement of the total amount of blood collected during the procedure corrected by absorbance reading and normalized by score. The results showed that the occurrence of bleeding events and the intraoperative blood loss were similar among groups and hemorrhagic episodes were not observed amongst the individuals taking DOACs. The previous history of complications in dental procedures (p=0.001) and the use of additional hemostatic measures (p=0.017) were significantly higher in the VKA group. To fulfill objective 2, experiments were conducted by means of an in vitro model in which the direct effect of anticoagulant therapy on bone cells was evaluated. An ex-vivo animal model in which cells of animals previously treated with dabigatran etexilate were differentiated was also carried out into osteoclasts. Primary cultures of mice and rats cells were differentiated into osteoclasts and osteoblasts and treated with dabigatran etexilate solution (Pradaxa® 1-6 µg/mL) and its active principle dabigatran (0.1, 0.3, 3 and 6 µg/mL). Untreated cells were used as controls and the effects of the treatment on cell viability and differentiation were evaluated. Both dabigatran etexilate and its active principle, dabigatran inhibited osteoclast differentiation and activity in vitro and in the ex-vivo model, as demonstrated by the reduction of resorption pits and cathepsin K gene and protein expression. In osteoblast cultures, dabigatran etexilate reduced the in situ alkaline phosphatase (ALP) activity, matrix mineralization and gene expression of ALP and osteocalcin. These findings indicated osteoblast inhibition. In conclusion, oral anticoagulant therapy did not result in increased bleeding outcomes in this sample, which strengthen the advocacy of the maintenance of the therapy during dental surgery. Dabigatran etexilate treatment impaired the activity and differentiation of osteoclasts and osteoblasts.(AU)

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Granulocytic sarcoma (GS) is an extramedullary tumor associated with myelodysplastic syndromes or myeloproliferative diseases. Intraoral manifestations are considered uncommon, with a reasonable number of cases, and are mostly related to leukemia. The association of oral GS and myelofibrosis is very rare and only three cases have been published. In this paper, we report the fourth case of oral lesion in a patient with a diagnosis of myelofibrosis. The aim of this study was to present a review of the literature, discussing the current and previous cases of oral GS associated with myelofibrosis or other hematological disorders and the importance of accurate diagnosis through clinical, microscopic, and immunohistochemical features.

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