RESUMO
BACKGROUND: Chagas disease is a systemic illness with widespread microvascular involvement. Experimental and clinical studies suggest that functional and structural microcirculatory abnormalities might be relevant to the disease progression. OBJECTIVES: To show the presence of sublingual microcirculatory alterations in patients with chronic Chagas disease. METHODS: This was a cross-sectional study including adult patients with serologic diagnosis of Chagas disease (n = 41) and control volunteers with negative serology (n = 38), from an endemic rural population. Study participants underwent clinical, electrocardiographic, echocardiographic, and sublingual videomicroscopic assessment. Videos were acquired by a sidestream-dark-field (SDF) imaging device and evaluated by a software-assisted analysis (AVA 3.2 software). FINDINGS: Most of Chagas disease patients were in the indeterminate phase (n = 34) and had lower heart rate and more echocardiographic abnormalities than control group (50 vs. 26%, p = 0.03). They also exhibited higher small microvessels total and perfused vascular density (20.12 ± 2.33 vs. 19.05 ± 2.25 and 20.03 ± 2.28 vs. 19.01 ± 2.25 mm/mm2, p < 0.05 for both). Other microvascular variables did not differ between groups. MAIN CONCLUSIONS: Patients with chronic Chagas disease exhibited increases in sublingual total and perfused microvascular density. Angiogenesis might be the underlying mechanism. The videomicroscopic assessment of mucosal sublingual microcirculation might be an additional tool in the monitoring of Chagas disease.
Assuntos
Doença de Chagas , Microcirculação , Soalho Bucal , População Rural , Humanos , Microcirculação/fisiologia , Estudos Transversais , Masculino , Feminino , Doença de Chagas/fisiopatologia , Adulto , Pessoa de Meia-Idade , Soalho Bucal/irrigação sanguínea , Estudos de Casos e Controles , Doença Crônica , Doenças EndêmicasRESUMO
BACKGROUND: Microvascular dysfunction plays a central role in organ dysfunction during septic shock. Endothelial glycocalyx (eGC) damage could contribute to impaired microcirculation. The aim was to assess whether several eGC-damaged biomarkers are associated with microvascular dysfunction in resuscitated septic shock patients. METHODS: This cross-sectional study included resuscitated septic shock patients (N = 31), and a group of healthy individuals (N = 20). The eGC damage biomarkers measured were syndecan-1 (SDC-1), soluble CD44 (CD44s), hyaluronic acid (HYAL) in blood sample; sulfated glycosaminoglycans (GAGs) in urine sample; and thrombomodulin (TBML) in blood sample as biomarker of endothelial cell damage. Microcirculation was assessed through sublingual videocapillaroscopy using the GlycoCheck™, which estimated the perfused vascular density (PVD); the perfused boundary region (PBR), an inverse parameter of the eGC thickness; and the microvascular health score (MVHS). We defined a low MVHS (<50th percentile in septic patients) as a surrogate for more impaired microvascular function. RESULTS: The SDC-1, CD44s, TBML and GAGs levels were correlated with impaired microvascular parameters (PVD of vessels with diameter < 10 µm, MVHS and flow-adjusted PBR); p < 0.05 for all comparisons, except for GAGs and flow-adjusted PBR. The SDC-1 [78 ng/mL (interquartile range (IQR) 45-336) vs. 48 ng/mL (IQR 9-85); p = 0.052], CD44s [796ρg/mL (IQR 512-1995) vs. 526ρg/mL (IQR 287-750); p = 0.036], TBML [734ρg/mL (IQR 237-2396) vs. 95ρg/mL (IQR 63-475); p = 0.012] and GAGs levels [0.42 ρg/mg (IQR 0.04-1.40) vs. 0.07 ρg/mg (IQR 0.02-0.20); p = 0.024]; were higher in septic patients with more impaired sublingual microvascular function (low MVHS vs. high MVHS). CONCLUSION: SDC-1, CD44s, TBML and GAGs levels were associated with impaired microvascular function in resuscitated septic shock patients.
Assuntos
Biomarcadores , Glicocálix , Receptores de Hialuronatos , Ácido Hialurônico , Microcirculação , Choque Séptico , Sindecana-1 , Trombomodulina , Humanos , Glicocálix/metabolismo , Choque Séptico/fisiopatologia , Choque Séptico/sangue , Masculino , Feminino , Pessoa de Meia-Idade , Biomarcadores/sangue , Sindecana-1/sangue , Estudos Transversais , Receptores de Hialuronatos/metabolismo , Idoso , Trombomodulina/sangue , Ácido Hialurônico/sangue , Estudos de Casos e Controles , Ressuscitação , Glicosaminoglicanos , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Angioscopia Microscópica , Microvasos/fisiopatologia , Microvasos/patologia , Adulto , Densidade Microvascular , Soalho Bucal/irrigação sanguíneaRESUMO
Significance: The study of sublingual microcirculation offers valuable insights into vascular changes and overcomes some limitations of peripheral microcirculation assessment. Videomicroscopy and pulse oximetry have been used to assess microcirculation, providing insights into organ perfusion beyond macrohemodynamics parameters. However, both techniques have important limitations that preclude their use in clinical practice. Aim: To address this, we propose a non-invasive approach using photoplethysmography (PPG) to assess microcirculation. Approach: Two experiments were performed on different samples of 31 subjects. First, multi-wavelength, finger PPG signals were compared before and while applying pressure on the sensor to determine if PPG signals could detect changes in peripheral microcirculation. For the second experiment, PPG signals were acquired from the ventral region of the tongue, aiming to assess the microcirculation through features calculated from the PPG signal and its first derivative. Results: In experiment 1, 13 out of 15 features extracted from green PPG signals showed significant differences (p<0.05) before and while pressure was applied to the sensor, suggesting that green light could detect flow distortion in superficial capillaries. In experiment 2, 15 features showed potential application of PPG signal for sublingual microcirculation assessment. Conclusions: The PPG signal and its first derivative have the potential to effectively assess microcirculation when measured from the fingertip and the tongue. The assessment of sublingual microcirculation was done through the extraction of 15 features from the green PPG signal and its first derivative. Future studies are needed to standardize and gain a deeper understanding of the evaluated features.
Assuntos
Luz Verde , Soalho Bucal , Humanos , Valores de Referência , Microcirculação , FotopletismografiaRESUMO
PURPOSE: Sublingual varicose veins are a common vascular lesion with different names, such as caviar tongue or vascular malformations. This study aimed to investigate whether there is an association between sublingual varicose veins and cardiovascular diseases by observing arterial hypertension, diabetes, thrombosis, and infarction. In addition, to evaluate a series of thrombi that affected the oral cavity and to analyze their clinical aspects and relate them to possible systemic alterations. METHODS: This is a cross-sectional study consisting of a sample of 134 varicosities, 23 vascular malformations, and 4 thrombosis. RESULTS: Lingual varicosities are more frequently observed in women aged 57.4 ± 16.4 years. Hypertension was present in lingual varicosities (n = 73), as well as diabetes (n = 107), reports of thrombosis (n = 41), and infarction (n = 45). Arterial hypertension was decompensated (n = 12). The most frequent underlying diseases were diabetes (p < 0.001), infarction (p = 0.012), and thrombosis (p = 0.004), and the most commonly used drug was losartan. CONCLUSION: It can be inferred from the present study that lingual varicosities are related to cardiovascular diseases and can serve as a parameter to measure their decompensation.
Assuntos
Hipertensão , Varizes , Humanos , Estudos Transversais , Feminino , Pessoa de Meia-Idade , Masculino , Hipertensão/complicações , Idoso , Adulto , Trombose , Soalho Bucal/irrigação sanguínea , Língua/irrigação sanguínea , Idoso de 80 Anos ou maisRESUMO
Solitary fibrous tumor (SFT) is a neoplasm of fibroblastic/myofibroblastic origin with intermediate biological behavior. We report here two cases of SFT affecting an unusual anatomical site in 58-year-old and 40-year-old female patients and discuss the differential diagnosis of this lesion. In case 01, the lesion showed the clinical appearance of an asymptomatic "blister" with normal color, rubbery consistency, measuring 0.3 cm, and affected the lower lip; while in case 02, a symptomatic red nodular lesion with a soft consistency and measuring 0.5 cm affected the floor of the mouth. Excisional biopsies were performed. Microscopically, two well-delimited benign neoplasms were observed, exhibiting the proliferation of ovoid to spindle-shaped mesenchymal cells, vascular spaces with staghorn arrangement, and the absence of mitosis figures. Immunohistochemistry was performed in case 01 to assist in the diagnosis. Weak and diffuse immunostaining was observed for α-SMA and intense and diffuse immunopositivity for Bcl-2 and CD34. Based on histopathological and immunohistochemical features, a diagnosis of SFT was rendered in both cases. The low occurrence and nonspecific clinical features of oral SFT may make its clinical diagnosis difficult. Also, morphological and immunohistochemical are essential for differential diagnosis with other mesenchymal neoplasms.(AU)
O tumor fibroso solitário (TFS) é uma neoplasia de origem fibroblástica/miofibroblastica com comportamento biológico intermediário. Nesse artigo relatamos dois casos de TFS afetando sítios anatômicos incomuns em pacientes do sexo feminino de 58 anos e 40 anos e discutir os seus diagnósticos. No caso 01 clinicamente a lesão apresentou um aspecto de "bolha" assintomática, coloração normal da mucosa, consistência borrachoide medindo 0,3 cm, em região de lábio inferior, enquanto que no caso 02, como uma lesão sintomática, vermelha, nodular com consistência mole e medindo 0,5 cm afetando o assoalho bucal. As biópsias excecionais foram realizadas. Microscopicamente, observamos duas lesões neoplásicas bem delimitadas exibindo uma proliferação de células mesenquimais variando de ovoides a fusiformes, vasos sanguíneos em formato de "chifre de veado", com ausência de figuras de mitoses. No caso 01 foi realizado análise imuno-histoquímica para auxiliar no diagnóstico. Foi observado uma marcação fraca e difusa de α-SMA e uma intensa e difusa imunopositividade para o Bcl-2 e CD34.Baseado nos achados histopatológicos e imuno-histoquímicos o diagnóstico de TFS foi estabelecido em ambos os casos. A baixa ocorrência e os achados clínicos inespecíficos do TFS oral podem dificultar o diagnóstico clínico. Além disso, as análises morfológicas e imuno-histoquimicas são essenciais para realização do diagnóstico diferencial com outras neoplasias mesenquimais.(AU)_
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/patologia , Tumores Fibrosos Solitários/diagnóstico , Tumores Fibrosos Solitários/patologia , Imuno-Histoquímica , Diagnóstico Diferencial , Lábio/patologia , Soalho Bucal/patologiaRESUMO
Introdução: Rânula é um fenômeno de extravasamento de muco, também chamado cisto de retenção de muco, que ocorre especificamente no soalho bucal. A origem da mucina extravasada é usualmente da glândula sublingual, podendo, porém, se originar do ducto da glândula submandibular ou, ainda, das glândulas salivares menores presentes no soalho de boca. Rânulas de dimensões maiores usualmente originam se do corpo da glândula sublingual. Relato de caso: Este trabalho descreve um caso em uma criança de 5 anos de idade com uma rânula em região lateral esquerda de língua, e discutir questões sobre o tratamento desta patologia. Considerações finais: Há várias formas de tratamento, sendo as mais usadas a marsupialização, concomitante ou não com a excisão cirúrgica da lesão e da glândula salivar envolvida... (AU)
Introduction: Ranula is a phenomenon of mucus leakage, also called mucus retention cyst, which occurs specifically in the mouth floor. The origin of the extravasated mucin is usually from the sublingual gland, but it can originate from the duct of the submandibular gland or even from the minor salivary glands it presents on the floor of the mouth. Larger sized ranulas usually arise from the body of the sublingual gland. Case report: This work is a case in a 5-year-old child with a ranula in the left tongue region, and discuss about the treatment of this pathology. Final considerations: There are several forms of treatment, the most used being marsupialization, concomitant or not with a surgical excision of the lesion and the involved salivary gland... (AU)
Introducción: Ránula es un fenómeno de fuga de moco, también llamado quiste de retención de moco, que ocurre específicamente en el piso de la boca. El origen de la mucina extravasada suele ser de la glándula sublingual, pero puede originarse en el conducto de la glándula submandibular o incluso en las glándulas salivales menores presentes en el suelo de la boca. Las ranulas de mayor tamaño generalmente surgen del cuerpo de la glándula sublingual. Reporte de caso: Este artículo describe un caso en un niño de 5 años con una ránula en la región lateral izquierda de la lengua y analiza cuestiones sobre el tratamiento de esta patología. Consideraciones finales: Existen varias formas de tratamiento, siendo las más utilizadas la marsupialización, concomitante o no con la exéresis quirúrgica de la lesión y de la glándula salival afectada... (AU)
Assuntos
Humanos , Feminino , Pré-Escolar , Doenças das Glândulas Salivares , Glândulas Salivares Menores , Glândula Sublingual , Cistos , Boca , Soalho Bucal/patologiaRESUMO
Introduction: Body piercings consist of small holes made with a needle in different parts of the skin or body to introduce a jewel or decorative element. In the oral cavity, most piercings are placed in the tongue. However, some complications may occur, and surgical techniques must be used for their removal. These complications present a certain degree of difficulty due to their position and may challenge the ability of the clinician to access the specific anatomical location. The different imaging techniques, from simple radiography to intraoperative techniques such as image intensifiers, have become an extremely useful tool for locating an object in the three dimensions of space, allowing safe location and extraction. Objective: The aim of this study is to report the case of a complication of a body piercing in the oral cavity and how the use of imaging was decisive for surgical planning and for the quick and effective resolution of the case. Material and Methods: A 14-year-old female patient came looking for treatment. Her mother reported the onset of the condition after the insertion of a needle-like metallic object while performing an artistic perforation in the lingual region. Since the girl was unable to extract the object, she sought medical advice at the Carlos Arvelo Military Hospital in Caracas, Venezuela. Subsequently, an imaging study was performed by means of a Computed Tomography to locate the metallic object. It was observed that the foreign body had migrated to the floor of the mouth/sublingual region, requiring the area to be surgically approached. It was also decided to use an intraoperative image intensifier. The removal of the object was performed satisfactorily. Conclusion: The extraction of foreign bodies placed in the lingual and sublingual region represents a challenge for the clinician due to the number of important anatomical structures that pass through that area. This makes clinicians plan their surgical removal using pre- and intraoperative imaging, to find a less traumatic location, reduce surgical time as well as the risk of damaging adjacent anatomical structures.
Introducción: Los body piercings consisten en producir perforaciones con una aguja en diferentes localizaciones de la piel con el fin de introducir una joya o elemento decorativo a través del agujero producido previamente. En la cavidad oral, la lengua es el sitio de mayor elección; sin embargo, en ciertas ocasiones suelen presentarse ciertas complicaciones, por lo cual se debe recurrir a técnicas quirúrgicas para su remoción presentando cierto grado de dificultad para su localización y la capacidad del clínico para acceder al espacio anatómico. Las diferentes técnicas imagenológicas desde una radiografía simple hasta técnicas intraoperatorias como los intensificadores de imágenes se han convertido en una herramienta sumamente útil para la ubicación de un objeto en las tres dimensiones del espacio, permitiendo una localización y extracción segura para el clínico y el paciente. Objetivo: El propósito de este trabajo es reportar un caso de una complicación de esta práctica en la región bucal y cómo el uso de la imagenología fue determinante para la planificación quirúrgica y la resolución del caso de manera rápida y efectiva. Material y Métodos: Se presenta a consulta una paciente femenina de 14 años de edad, quien madre refiere inicio de enfermedad actual posterior a introducirse objeto metálico tipo aguja de compás con la finalidad de realizar perforación artística en región lingual, al no poder extraer dicho objeto, acude a evaluación en el Hospital Militar Carlos arvelo de Caracas; posterior se realiza estudio imagenológico tipo Tomografía Computarizada para la ubicación del objeto metálico donde se observa que el cuerpo extraño habría migrado hacia el piso de boca/región sublingual, teniendo la necesidad de abordar quirúrgicamente la zona y elegir el uso de intensificador de imagen transoperatorio para retiro del mismo el cual se dio de manera satisfactoria. Conclusión: Los cuerpos extraños desplazados a la región lingual y sublingual representan un desafío para el clínico al momento de extraerlos, esto se debe a la cantidad de estructuras anatómicas importantes que pasan por dicha zona, lo que hace que el clínico opte en su planificación quirúrgica por el uso de imagenología pre y transoperatoria obteniendo así una localización menos traumática, menor tiempo operatorio y menor riesgo de lesión de estructuras anatómicas adyacentes.
Assuntos
Humanos , Feminino , Adolescente , Língua/cirurgia , Tomografia Computadorizada por Raios X , Corpos Estranhos/diagnóstico por imagem , Soalho Bucal/diagnóstico por imagem , Radiografia , Piercing Corporal , Soalho Bucal/cirurgiaRESUMO
Se describe el caso clínico de un paciente de 56 años edad, quien acudió al Servicio de Cirugía Oral y Maxilofacial del Hospital Central de Maputo, capital de Mozambique, por presentar aumento de volumen debajo de la lengua, del lado derecho, lo cual le causaba dolor al ingerir alimentos. Durante la exploración clínica se corroboró el aumento de volumen en el piso de la boca, conformado por una zona amarillenta, rodeada de un halo eritematoso que dolía a la palpación. Se diagnosticó una sialolitiasis de la glándula submandibular derecha y se indicó enucleación quirúrgica con anestesia local. El paciente evolucionó favorablemente y no presentó recidivas.
The case report of a 56 years patient is described. He went to the Oral and Maxillofacial Surgery Service of Maputo Central Hospital, capital of Mozambique, due to an increase of volume under the tongue, on the right side, which caused him pain when ingesting foods. During the clinical exploration the increase of volume was corroborated in the bottom of the mouth, conformed by a yellowish area, surrounded by an erythematosus halo that hurted at palpation. A sialolithiasis of the right submandibular gland was diagnosed and a surgical enucleation with local anesthesia was indicated. The patient had a favorable clinical course and he did not present relapses.
Assuntos
Glândula Submandibular , Cirurgia Bucal , Cálculos das Glândulas Salivares , Soalho BucalRESUMO
SUMMARY: The mylohyoid muscle, one of the suprahyoid group, forms the floor of the mouth. Its main function is swallowing. It is a margin between the sublingual and the submandibular spaces and is important in the pathway of oral and maxillofacial infection. In prosthodontics, it is one of anatomic landmarks that limits the lingual margin of the mandibular denture. Currently, the muscle receives much interest in the fields of maxillofacial reconstruction and rejuvenation. The hemorrhagic issue around the mandibular lingual region is usually involved with the mylohyoid especially in the dental implant installation. This review covers anatomic features of the mylohyoid muscle with diverse clinical implications.
RESUMEN: El músculo milohioideo es un músculo del grupo suprahioideo que forma el piso de la cavidad oral. Su función principal es la deglución. Es conocido como un límite entre los espacios sublingual y submandibular y es importante en la vía de infección oral y maxilofacial. En la prostodoncia, es uno de los hitos anatómicos que limita el margen lingual de la dentadura mandibular. Actualmente, el músculo recibe mucho interés en los campos de la reconstrucción y el rejuvenecimiento maxilofacial. El problema hemorrágico alrededor de la región lingual mandibular generalmente está relacionado con el músculo milohioideo, especialmente en la instalación de implantes dentales. Esta revisión cubre las características anatómicas del músculo milohioideo con diversas implicaciones clínicas.
Assuntos
Humanos , Dentição , Músculos/anatomia & histologia , Soalho BucalRESUMO
Metastases derived from primary tumours distant to the oral and maxillofacial region account for only 1% of all malignancies at that location, usually with a poor prognosis. In women, the primary tumours that most frequently metastasise to the oral cavity are breast adenocarcinomas affecting the jawbones and soft tissues (41% and 24%, respectively), followed by adrenal glands and female genital organs to the jawbones (8%), and female genital organs to the soft tissues (15%). Metastatic tumours of the mouth are a challenging diagnosis because of their exceptional occurrence. We report on the case of an 83-year-old woman who consulted for a bleeding ulcerated tumour on the floor of the mouth. A biopsy-confirmed metastasis of an adenocarcinoma of Müllerian origin. The oral lesion was the first sign of undetected cancer. The patient agreed to surgical resection and was further referred to palliative care for her symptoms.