Azis Arruda Chagury

Therapeutic options in idiopathic burning mouth syndrome: literature review.

Introduction Burning mouth syndrome (BMS) is characterized by a burning sensation in the tongue, palate, lips, or gums of no well-defined etiology. The diagnosis and treatment for primary BMS are controversial. No specific laboratory tests or diagnostic criteria are well established, and the diagnosis is made by excluding all other possible disorders. Objective To review the literature on the main treatment options in idiopathic BMS and compare the best results of the main studies in 15 years. Data Synthesis We conducted a literature review on PubMed/MEDLINE, SciELO, and Cochrane-BIREME of work in the past 15 years, and only selected studies comparing different therapeutic options in idiopathic BMS, with preference for randomized and double-blind controlled studies. Final Comments Topical clonazepam showed good short-term results for the relief of pain, although this was not presented as a definitive cure. Similarly, α-lipoic acid showed good results, but there are few randomized controlled studies that showed the long-term results and complete remission of symptoms. On the other hand, cognitive therapy is reported as a good and lasting therapeutic option with the advantage of not having side effects, and it can be combined with pharmacologic therapy.

Study of the association between human leukocyte antigens (HLA) and pemphigus vulgaris in Brazilian patients

Pemphigus vulgaris is a mucocutaneous blistering autoimmune disease that manifests as painful blisters or erosions on the skin and/or mucosal surfaces. IgG autoantibodies target desmoglein, playing a major role in disease pathogenesis. Genetic predisposal to pemphigus vulgaris, especially the HLA DR and DQ alleles, has been known since the 1980s. The unique constitution of the Brazilian population favors exploratory genetic studies.

Diffusion of aniline blue injected into the thyroarytenoid muscle as a proxy for botulinum toxin injection: an experimental study in cadaver larynges

Summary Introduction: Endolaryngeal injection of botulinum toxin into the thyroarytenoid (TA) muscle is one of the methods for treatment of focal laryngeal dystonia. However, after treatment, there is variation in laryngeal configuration as well as the side effects reported by patients. As a consequence of the functional variability of results, it was hypothesized that botulinum toxin diffuses beyond the limits of the muscle into which it is injected. Objectives: After injection of botulinum toxin into the TA muscle for the treatment of focal laryngeal dystonia, patients differ in terms of laryngeal configuration and side effects. We hypothesized that this toxin diffuses from the target muscle to adjacent muscles. Method: The TA muscles of 18 cadaver larynges were injected with aniline blue (0.2 mL). After fixation in formaldehyde and nitric acid decalcification, the larynges were sectioned in the coronal plane and the intrinsic muscles were analyzed. Results: We found diffusion of aniline blue to the lateral cricoarytenoid muscle, cricothyroid muscle, and posterior cricoarytenoid muscle in 94.3%, 42.9%, and 8.6% of the cases, respectively. In terms of the degree of diffusion to adjacent muscles, we found no differences related to the size (height and width) of the TA muscle or to gender. Conclusions: Our findings suggest that diffusion of botulinum toxin from its injection site in the TA muscle to the lateral cricoarytenoid muscle is likely in most cases. On the other hand, diffusion to the cricothyroid muscle occurs in approximately half of cases and diffusion to the posterior cricoarytenoid muscle occurs in very few cases.

HLA-C*17, DQB1*03:01, DQA1*01:03 and DQA1*05:05 Alleles Associated to Bullous Pemphigoid in Brazilian Population

Background Bullous pemphigoid (BP) is an autoimmune disease with bullous vesicles and an incidence of 0.2 to 1.4 per 100,000 inhabitants. Many studies have been published demonstrating the association of pemphigoid with HLA class II system alleles in different populations, however there are no data on the BP, one of the most heterogeneous in the world. Objective To typify HLA alleles in Brazilians with Bullous pemphigoid. Methods The study group included 17 Brazilian patients with a confirmed diagnosis of BP from a hospital in Sao Paulo city, southeast Brazil. DNA was extracted from peripheral blood using Qiagen kits and HLA A, B, C, DR and DQ typing was performed using polymerase chain reaction. The control group was composed of a database of 297 deceased donors from the city of Sao Paulo. The statistical significance level was adjusted using the Bonferroni correction depending on the phenotypic frequencies evaluated for HLA class I (A, B and C) and class II (DRB1, DQB1 and DQA1). Results Our findings show that alleles HLA C*17, DQB1*03:01, DQA1*01:03 and DQA1*05:05 are associated with the onset of the disease in the Brazilian population, with relative risks of 8.31 (2.46 to 28.16), 3.76 (1.81 to 7.79), 3.57 (1.53 to 8.33), and 4.02 (1.87 to 8.64), respectively (p<0.005). Conclusion Our data indicate that Brazilian patients with BP present the same genetic predisposition linked to HLA-DQB1*03:01 previously reported in Caucasian and Iranian individuals and our study introduces three new alleles (C*17, DQA1*01:03 and DQA1*05:05) involved in the pathophysiology of BP.

Hemorrhagic Bullous Angina: A Case Report and Review of the Literature

Hemorrhagic bullous angina (HBA) is described as the sudden onset of one or more bullous lesions in the oral cavity, not attributable to other vesiculobullous diseases, blood dyscrasias, or autoimmune and vascular diseases. These lesions occur almost exclusively in the oral cavity, particularly in the soft palate, and do not affect the masticatory mucosa. Here we present the case of a 57-year-old male who had a spontaneously ruptured hemorrhagic bulging in his soft palate diagnosed as HBA, along with discussion of the literature. In conclusion, HBA is a rare, benign, oral disease with low complication rates. Diagnosis is essentially clinical, and treatment consists of local hygiene and prevention of oral trauma.

Bullous Systemic Lupus Erythematosus: Case report

Summary Introduction: Bullous systemic lupus erythematosus (BSLE) is an autoantibody-mediated disease with subepidermal blisters. It is a rare form of presentation of SLE that occurs in less than 5% of cases of lupus. Case Report: A 27-year-old, female, FRS patient reported the appearance of painful bullous lesions in the left nasal wing and left buccal mucosa that displayed sudden and rapid growth. She sought advice from emergency dermatology staff 15 days after onset and was hospitalized with suspected bullous disease. Intravenous antibiotics and steroids were administered initially, but the patient showed no improvement during hospitalization. She displayed further extensive injuries to the trunk, axillae, and vulva as well as disruption of the bullous lesions, which remained as hyperemic scars. Incisional biopsy of a lesion in the left buccal mucosa was performed, and pathological results indicated mucositis with extensive erosion and the presence of a predominantly neutrophilic infiltrate with degeneration of basal cells and apoptotic keratinocytes. Under direct immunofluorescence, the skin showed anti-IgA, anti-IgM, and anti-IgG linear fluorescence on the continuous dermal side of the cleavage. Indirect immunofluorescence of the skin showed conjugated anti-IgA, was anti-IgM negative, and displayed pemphigus in conjunction with anti-IgG fluorescence in the nucleus of keratinocytes, consistent with a diagnosis of bullous lupus erythematosus. Discussion: BSLE is an acquired autoimmune bullous disease caused by autoantibodies against type VII collagen or other components of the junctional zone, epidermis, and dermis. It must be differentiated from the secondary bubbles and vacuolar degeneration of the basement membrane that may occur in acute and subacute cutaneous lupus erythematosus.

Congenital laryngeal saccular cyst

1 Professor of Otorhinolaryngology in the Medical School of the University of São Paulo. 2 Assisting Physician-PhD in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. 3 Assisting Physician-PhD in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. 4 Assisting Physician-PhD in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. 5 MD, Specialization Student on ENT in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. Divisão de Clínica Otorrinolaringológica e no Departamento de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Send correspondence to: Av. Dr. Enéas de Carvalho Aguiar, 255. Cerqueira César. Prédio Instituto Central, 6o andar, Divisão de Clínica Otorrinolaringológica. São Paulo SP, Brasil. CEP: 05403-000. Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on April 12, 2011; and accepted on August 29, 2011. cod. 7704 CASE REPORT Braz J Otorhinolaryngol. 2012;78(3):137. BJORL

Case ReportCongenital laryngeal saccular cyst

1 Professor of Otorhinolaryngology in the Medical School of the University of São Paulo. 2 Assisting Physician-PhD in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. 3 Assisting Physician-PhD in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. 4 Assisting Physician-PhD in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. 5 MD, Specialization Student on ENT in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. Divisão de Clínica Otorrinolaringológica e no Departamento de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Send correspondence to: Av. Dr. Enéas de Carvalho Aguiar, 255. Cerqueira César. Prédio Instituto Central, 6o andar, Divisão de Clínica Otorrinolaringológica. São Paulo SP, Brasil. CEP: 05403-000. Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on April 12, 2011; and accepted on August 29, 2011. cod. 7704 CASE REPORT Braz J Otorhinolaryngol. 2012;78(3):137. BJORL

Cisto sacular congênito da laringe

1 Professor of Otorhinolaryngology in the Medical School of the University of São Paulo. 2 Assisting Physician-PhD in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. 3 Assisting Physician-PhD in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. 4 Assisting Physician-PhD in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. 5 MD, Specialization Student on ENT in the Division of Clinical ENT at the Hospital das Clínicas of the Medical School of the University of São Paulo. Divisão de Clínica Otorrinolaringológica e no Departamento de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Send correspondence to: Av. Dr. Enéas de Carvalho Aguiar, 255. Cerqueira César. Prédio Instituto Central, 6o andar, Divisão de Clínica Otorrinolaringológica. São Paulo SP, Brasil. CEP: 05403-000. Paper submitted to the BJORL-SGP (Publishing Management System – Brazilian Journal of Otorhinolaryngology) on April 12, 2011; and accepted on August 29, 2011. cod. 7704 CASE REPORT Braz J Otorhinolaryngol. 2012;78(3):137. BJORL