Cleto Mariosvaldo Piazzetta

Teledentistry: Distant Diagnosis of Oral Disease Using E-Mails

OBJECTIVE The purpose of this study was to evaluate the applicability of telediagnosis in oral medicine, through the transmission of clinical digital images by e-mail. SUBJECTS AND METHODS The sample included 60 consecutive patients who sought oral medicine services at the Federal University of Paraná, in the state of Paraná, located in southern Brazil. The clinical history and oral lesion images were recorded using clinical electronic charts and a digital camera, respectively, and sent by e-mail to two oral medicine consultants. The consultants provided a maximum of two clinical hypotheses for each case, which were compared with biopsy results that served as the gold standard. RESULTS In 31 of the 60 cases (51.7%), both consultants made the correct diagnosis; in 17 cases (28.3%), only one consultant made the correct diagnosis; and in 12 cases (20%), neither consultant made the correct diagnosis. Therefore, in 80% of cases, at least one consultant provided the correct diagnosis. The agreement between the first consultant and the gold standard was substantial (κ=0.669), and the agreement between the second consultant and the gold standard was fair (κ=0.574). CONCLUSIONS The use of information technology can increase the accuracy of consultations in oral medicine. As expected, the participation of two remote experts increased the possibility of correct diagnosis.

Micro-marsupialization as an alternative treatment for mucocele in pediatric dentistry.

BACKGROUND Mucocele is a common oral lesion in children and adolescents. Different techniques have been described for the treatment; however, all of them are invasive. AIM This work studied the efficacy of micro-marsupialization for the treatment for mucoceles in paediatric patients. DESIGN A retrospective review was performed using the clinical records of patients aged between 0 and 18 years with a clinical diagnosis of mucocele. The following data were obtained: age, gender, location and size of the lesion, duration of mucocele development, and type of treatment and its results. RESULTS The mean age of the patients was 11.1 ± 3.95 years. Mucoceles were found in the lower lip (83.7%), buccal mucosa (11.6%), and tongue (4.7%). From the overall cohort of 86 cases, 33 were treated by micro-marsupialization, of which five developed a recurrence that required surgical excision. The other 53 cases were treated by surgical excision, and three of these had recurrent disease. No statistically significant difference was found between the treatment methods. CONCLUSIONS Micro-marsupialization can be used to treat mucoceles in paediatric dentistry. It is simpler to perform, minimally invasive, requires no local infiltration of anaesthesia, has a lower postoperative complications rate, and is well-tolerated by patients.

[Minor salivary gland tumours: a 10-year study].

Salivary gland tumours represent between 2 % and 6.5 %, approximately, of all head and neck tumours. The aim of this paper was to identify the frequency of minor salivary gland tumours among patients in the Oral Medicine Clinic of the Federal University of Paraná during the period from 1997 to 2007. A retrospective study was conducted on 1,923 histopathological analyses of oral lesions. Fourteen cases of salivary gland tumours were found, of which 7 were benign and 7 malignant. The lesions were localized mainly in the palate (71.5 %). By histological type, 50 % of the lesions were characterized as pleomorphic adenoma, 28.6 % mucoepidermoid carcinoma, 14.3 % cystic adenoid carcinoma and 7.1 % as polymorphous adenocarcinoma. These findings suggest that salivary gland tumours have a low incidence in the population and that the pleomorphic adenoma is the most common type of tumour, followed by mucoepidermoid carcinoma.

Oral squamous cell carcinoma in two siblings with Fanconi anemia after allogeneic bone marrow transplantation

Fanconi Anemia patients are a high risk group for solid and hematologic malignancies. The risk seems to be influenced by age, chronic graft versus host disease and immunosuppressive drug regimens. Reports of oral malignant transformation in Fanconi Anemia after hematopoietic stem cell transplantation (HSCT) are increasing probably because of longer survival rates. This is the report of an 18- and her 28-year old sister who developed a post-HSCT oral squamous cell carcinoma. There were significant differences regarding time to malignant transformation, marrow donor characteristics and graft versus host disease evolution and treatment. The report reinforce the need for a routine head and neck screening for cancer in this particular syndrome and suggest that familial history should also be considered in Fanconi anemia patients at risk for oral malignancy after HSCT.

Neoplasias de glándulas salivales menores: estudio de 10 años

Resumen Las neoplasias de las glandulas salivales representan aproximadamente un 2-6,5 % de todos los tumores de la cabeza y cuello. El objetivo de este trabajo es identificar la frecuencia de neoplasias de glandulas salivales menores en pacientes de Medicina Oral de la Universidad Federal de Parana atendidos de 1997 a 2007. Se realizo un estudio retrospectivo mediante el analisis de 1.923 laudos histopatologicos, y se hallo 14 casos de neoplasias de glandulas salivales. Las lesiones encontradas fueron 7 tumores benignos y 7 malignos. Las alteraciones, en su mayoria, se encontraban en la mucosa palatina (71,5 %). En cuanto al tipo histologico, el 50 % se caracterizo como adenoma pleomorfo; el 28,6 %, como carcinoma mucoepidermoide; el 14,3 %, como carcinoma adenoide quistico, y el 7,1 %, como adenocarcinoma polimorfo. Estos resultados permiten concluir que las neoplasias de glandulas salivales tienen una baja incidencia en la poblacion y que el adenoma pleomorfo es el tipo de neoplasia mas comun, seguido del carcinoma mucoepidermoide.

Oral and Maxillofacial Complex Lesions in Adolescents: A Retrospective Study of 20 Years

Los estudios que evaluan la prevalencia de lesiones orales muestran que entre el 5,2% hasta el 12,8% de las muestras de biopsia corresponden a ninos y adolescentes. En Brasil, hay pocos estudios que hayan analizado la distribucion de las lesiones orales enesa poblacion. Por lo tanto, el objetivo de este estudio fue evaluar la distribucion de las lesiones orales y maxilofaciales de adolescentes, ingresados en el Servicio de Diagnostico Oral de la Universidad Federal de Parana (UFPR) entre 1994 a 2013. Se llevo a cabo la revision de historias clinicas y las lesiones halladas fueron clasificadas en 11 categorias: enfermedad de glandulas salivales, patologia dental, patologia gingival y periodontal, quistes odontogenicos, tumores odontogenicos, quistes no odontogenicos, patologia osea, patologia de la mucosa, patologia del tejido conectivo, tumores malignos y otras patologias. Tambien se evaluaron otras variables como edad, genero, etnia, diagnostico y localizacion de la lesion. Luego del analisis, se identificaron 376 lesiones, la mayoria en ninas (51,9%), siendo el 77,1% de los pacientes de raza blanca. La localizacion mas frecuente fue el labio inferior seguida de la encia. El mucocele fue la lesion mas comun (27,6%), seguido de hiperplasia fibroepitelial (8,2%) y granuloma piogeno (5,3%). Aunque existe una amplia serie de patologias que pueden ocurrir en la cavidad oral, las lesiones traumaticas son las mas comunes en este grupo de edad.

Gingival proliferative lesions in children and adolescents in Brazil: A 15-year-period cross-sectional study

Background: Studies assessing the prevalence of oral lesions in children and adolescents, particularly in gingiva are scarce in the literature. The aim of the study was to describe the distribution of gingival proliferative lesions based on clinical and histopathological diagnoses in children and adolescents. Materials and Methods: A review of clinical charts of children and adolescents aged between 0 and 18 years old, admitted to the Oral Medicine Outpatient Unit, of Universidade Federal do Paraná, for 15 years (1994–2009) was performed. Results: Six hundred and sixty-nine out of 5,129 patients treated during this period were aged between 0 and 18 years old, and 45 of these had gingival lesions. The largest number of lesions was observed between 11 and 16 years old. The majority of the patients were referred by Curitibas public health system. Pyogenic granuloma was the most frequent lesion (19 = 42.2%), followed by peripheral giant cell lesion (11 = 24.4%), gingival fibromatosis (10 = 22.2%), and peripheral ossifying fibroma (5 = 11.1%). Conclusion: Gingival proliferative lesions can show similar clinical characteristics. Appropriate clinical and histopathological diagnoses are necessary to guide the healthcare professional to establish the adequate treatment and to estimate the risk of recurrence.