Paulo Henrique de Souza Castro

Use of 660-nm Diode Laser in the Prevention and Treatment of Human Oral Mucositis Induced by Radiotherapy and Chemotherapy

OBJECTIVE The aim of this multidisciplinary study was to evaluate quantitatively and qualitatively the effect of a 660-nm diode laser in the prevention and treatment of human oral mucositis (OM) in patients suffering from head and neck cancer who had undergone radiotherapy and chemotherapy. BACKGROUND DATA OM is a severe oral lesion resulting from the toxic effects of treatment for cancer in the head and neck region. Low-level laser therapy is indicated to prevent and treat this oral complication and may be used alone or in association with conventional drug treatment, producing pain relief and wound repair. METHODS This study included 72 patients with head and neck cancer treated at the Cancer Hospital of Mato-Grosso, Brazil, and divided into a control group (C; n = 36) and a laser group (L; n = 36). Laser therapy was performed in combination with radiotherapy and chemotherapy twice a week using a diode laser (lambda = 660 nm, power = 30 mW, spot size = 2 mm, energy = 2 J per point). RESULTS Statistically significant differences were observed between the two groups. Patients in group L usually did not present with OM or pain, but all patients in group C presented with OM ranging from Level I to III associated with pain. This difference was significant from week 1 on, increased until week 4 and remained stable up to week 7. CONCLUSION Laser therapy was effective in preventing and treating oral effects induced by radiotherapy and chemotherapy, thus improving the patients quality of life.

Mesenchymal Chondrosarcoma Mimicking Apical Periodontitis

This report describes the case of a patient with mesenchymal chondrosarcoma in the region of tooth #18 that mimicked apical periodontitis. Forty-five days after endodontic treatment, gingival swelling and intense pain were observed. The endodontist suspected a furcation lesion, and the treatment option that the patient chose was extraction of the tooth. Seven days after suture removal, a rapidly growing swelling was seen in the region. The patient was referred to an oral and maxillofacial surgeon, who recommended an incisional biopsy after evaluating imaging and clinical findings. Microscopic examination confirmed the diagnosis of mesenchymal chondrosarcoma. The patient underwent hemimandibulectomy with wide surgical margins. This clinical case draws attention to the fact that endodontic lesions should be carefully evaluated because malignant tumors such as mesenchymal chondrosarcoma might mimic apical periodontitis.

Epidemiologia do câncer de boca em laboratório público do Estado de Mato Grosso, Brasil

This study analyzed oral cancer epidemiology based on histopathology reports from a public laboratory in Mato Grosso, Brazil, after a specific policy was implemented for treating oral and facial diseases in the State. This was a cross-sectional epidemiological study, based on 1,324 histopathology reports issued from January 2005 to December 2006. The study identified 44 cases of oral cancer, or 3% of all oral lesions, and analyzed them in relation to the following variables: histological type, gender, age, and patients place of residence (capital versus rest of State). The most common histological type was squamous cell carcinoma. Most of the diagnoses occurred in men in their 50s and 60s living in the interior of the State. During two years in operation, this public oral pathology service had recorded a considerable number of oral cancer cases.

Removal of multiple keratocystic odontogenic tumors in a nonsyndromic patient

Multiple keratocystic odontogenic tumors are one of the key features of Gorlin–Goltz syndrome. A 15-year-old nonsyndromic female child presented with multiple keratocystic odontogenic tumors. The presence of the tumors was observed in immunological examinations. The images led to the suspicion of Gorlin–Goltz syndrome which was discarded after analyzing the patients medical history and complementary examinations. Le Fort I osteotomy was opted to access the maxillary tumors favoring visibility and allowing simultaneous bilateral accesses. A sagittal vestibular incision in the lower rim was performed to access the mandibular lesions. After 3 months, the patient underwent a bilateral myotomy to reduce the volume of the masseter muscles. The occurrence of nonsyndromic multiple keratocystic odontogenic tumors is rare. Clinicians facing this situation shall seek for other known features of the Gorlin–Goltz syndrome and follow up closely these patients for the possibility of occurrence of basal cell carcinoma.

Lipoma of the Palate: An Uncommon Finding

Background: Lipoma is a benign neoplasm originated from adipose cells circumscribed by connective tissue. This neoplasm represents about 1% to 4.4% of all oral benign tumors and it is rarely located in the palate area. Objective: This case reports the occurrence of an oral lipoma in the hard palate of a 57-year-old woman and discusses its etiology and treatment. Case Report: The treatment consisted in the total resection of the lesion and laser therapy. The patient is being followed up for forty three months with no signs of recurrence. Conclusion: Lipoma in hard palate is a rare entity that may be associated with endocrine factors and local inflammation.

Limitation of mouth opening after radiotherapy for head and neck

Objective: To evaluate the ability to open the mouth in patients undergoing radiotherapy for head and neck and the variables related to this limitation. Methods: 32 patients were evaluated six months after completion of radiotherapy sessions to treat cancer in the head and neck. The maximum mouth opening was measured using digital calipers and its association with gender, age, smoking, alcohol consumption, tumor location, chemotherapy and surgery were analyzed using the Mann-Whitney and Kruskal-Wallis tests at a level of significance of 95%. Results: The mean age of patients was 60.44 years; 87.5% were male; 81.2% were smokers; 65.6% regularly consumed alcohol. The average mouth opening was 43.17 mm and seven (21.9%) patients had trismus. The most common locations of the tumors were the tongue (31.3%) followed by the larynx and vocal folds with five (15.6%) each. No association was found between limited mouth opening and the other variables. Conclusion: In this sample, 21.9% of patients had trismus six months after completing radiotherapy. The variables gender, age, smoking habits and alcohol consumption, tumor location, previous surgery and adjunctive chemotherapy were not associated with limited mouth opening.

Epidemiology and georeferencing of squamous cell carcinoma cases and their relationship with pesticides

Objective To assess the prevalence of epidermoid carcinoma cases, georeference their locations, and seek to correlate them to areas with higher agricultural production and use of pesticides. Methods This was a cross-sectional, descriptive and retrospective study conducted by searching the histopathological reports with confirmed diagnosis of epidermoid carcinoma of the mouth issued from August 2005 to December 2011 by the public oral pathology laboratory of the State of Mato Grosso, Brazil. Data were plotted with the IBM SPSS Statistics software and spatial analysis used the ArcGIS 10.1 software. Results There were a higher number of diagnoses in 2007 (26.6%); 99 cases (75%) of patients were male; 96 cases (72.8%) were patients aged between 41 and 70 years; and the cities of Cuiaba, Varzea Grande and Rondonopolis respectively showed the highest number of occurrences. Conclusion No relationship was found between the occurrence of cases of epidermoid carcinoma and the municipalities with high agricultural production and pesticide use.

Agressive osteoblastoma in a seven-year-old girl's mandible: Treatment and six-year monitoring

Highlights • A case of osteoblastoma in a seven-year-old patient’s mandible is presented.• Marsupialization of the lesion reduced its volume and allowed a more conservative surgical procedure.• Patient is in a good general state with no recurrence after six years.

Ectopic Thyroid at the Base of the Tongue of a Young Patient

Lingual thyroid is defined as an ectopic thyroid gland tissue located in the midline of the tongue base and it is uncommonly observed in clinical practice and is rare in children. This paper describes the surgical treatment of ectopic thyroid at the base of the tongue in a child. The chief complaint of the 12-year-old, melanodermic female patient was the difficulty to swallow for 15 days. The intraoral physical examination barely showed a nodular lesion at tongue base. The CT scan showed a round, well defined hyperdense lesion of approximately 25.8 mm at its largest diameter, with infiltrative growth in the posterior region of the base of the tongue. The proposed treatment was complete resection of the lesion. The histopathological diagnosis was lingual thyroid. After the diagnosis was established, the patient was referred to an endocrinologist for exams and medical follow-up. Lingual thyroid is a rare condition and its diagnosis in children is even rarer. Its approach should be transdisciplinary and should take into consideration the hormonal aspects of the patient in addition to the clinical condition of the lesion. In the presented case, the removal of the alteration was performed via conservative surgical procedure followed by immediate referral of the patient to the endocrinologist for a follow-up.

Rehabilitation of an Advanced Case of Adenoid Cystic Carcinoma

Adenoid cystic carcinoma is a cancer of the salivary gland that primarily affects the parotid, submandibular, and accessory salivary glands. Its growth is slow and it has infiltrative nature. A 46-year-old female patient coming from the rural area presented a lesion on the palate and reported pain in the region for three years. After incisional biopsy, and histopathological diagnosis of adenoid cystic carcinoma of the cribriform type of minor salivary gland, superior hemimaxillectomy and adjuvant treatment with radiotherapy and maxillofacial prosthetic rehabilitation were performed.