Antônio Fernando Pereira Falcão

Orofacial manifestations of the Levy-Hollister syndrome

The Levy–Hollister syndrome, also known as the lacrimo-auriculo-dento-digital (LADD) syndrome, shows different phenotypes, resulting in a variety of local and systemic signs and symptoms. It is a rare hereditary disorder that mainly causes lacrimal, auricular, and auditory apparatus disturbances and dental and digital anomalies. Here, we describe a case of the Levy–Hollister syndrome in a 24-year-old woman and focus on its orofacial manifestations. The patient had chronic lacrimation, low-set ears, thumb agenesis, elbows with limited pronation and supination movements, pronounced hallux on the left foot, concave facial profile, and tooth roots with atypical morphology. The case emphasizes the importance of a multidisciplinary approach for early diagnosis of the Levy–Hollister syndrome.

Primary Biliary Cirrhosis and Primary Sjögren's Syndrome: Insights for the Stomatologist

Primary biliary cirrhosis (PBC) is a chronic progressive autoimmune disease characterized by portal inflammation and immune-mediated destruction of the intrahepatic bile ducts. Primary Sjögrens syndrome is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands, mainly the lachrymal and salivary glands, in the absence of other definitively diagnosed rheumatologic disease. We report a diagnosed case of primary Sjögrens syndrome associated with PBC. A 59-year-old Caucasian woman went to oral evaluation reporting dry mouth, difficulty in eating associated with burning mouth syndrome, dysgeusia and dysphagia. Intraoral examination revealed extensive cervical caries, gingivitis, gingival retraction, angular cheilitis and atrophic tongue. Hyposalivation was detected by salivary flow and Schirmers test was positive. Antinuclear and antimitochondrial antibodies were both positive. Anti-Ro/SSA and anti-La/SSB antibodies were negative. A minor salivary gland biopsy of the lower lip was performed. Histopathologic analysis revealed lymphocytic infiltrate with destruction of salivary gland architecture in some areas and replacement of glandular tissues by mononuclear cells. Optimal management of PBC associated with Sjögrens syndrome requires a multidisciplinary approach as the key to optimal patient care. Dental practitioners should be able to recognize the clinical features of this associated condition. Appropriate dental care may prevent tooth decay, periodontal disease and oral infections as well as improve the patients quality of life.