Silvio K. Hirota

Systemic Treatment in Severe Cases of Recurrent Aphthous Stomatitis: An Open Trial

PURPOSE This study aimed to evaluate the efficacy of the systemic drugs thalidomide, dapsone, colchicine, and pentoxifylline in the treatment of severe manifestations of RAS. METHODS An open, 4-year clinical trial was carried out for 21 consecutive patients with severe RAS. Initially, patients were given a 2-week course of prednisone to bring them to a baseline status. Simultaneously, one of the four test drugs was assigned to each patient to be taken for a period of 6 months. During the course of the trial, patients were switched to one of the other three drugs whenever side effects or a lack of satisfactory results occurred, and the 6-month limit of the treatment was then reset. RESULTS The most efficient and best-tolerated drug was thalidomide, which was administered to a total of eight patients and resulted in complete remission in seven (87.5%). Dapsone was prescribed for a total of nine patients, of whom eight (89%) showed improvement in their symptoms, while five showed complete remission. Colchicine was administered to a total of ten patients, with benefits observed in nine (90%), of whom four showed complete remission. Pentoxyfilline was administered to a total of five patients, with benefits observed in three (60%), of whom one patient showed complete remission. CONCLUSION The therapeutic methods used in this trial provided significant symptom relief. Patients experienced relapses of the lesions; however, this occurred after withdrawal of their medication during the follow-up period.

Carcinoma epidermóide oral em paciente jovem: relato de caso e revisão da literatura

Squamous cell carcinoma is the most common malignant neoplasm of the oral cavity, usually affecting individuals over 50 years of age. It rarely occurs in patients who are less than 40 years old (1 to 6%). This report describes a case of squamous cell carcinoma, staged T2N1M0 (stage III), involving the lateral border and dorsal surface of the tongue of a 25-year-old white female patient, with no smoking or drinking habits. Initial tumor presentation was of deep ulceration and intense pain. This report focuses on the etiological factors, differential diagnosis and prognosis related to the case. Additionally, a brief literature review regarding squamous cell carcinoma in young patients is also included.

Treatment of painful and recurrent oral mucoceles with a high-potency topical corticosteroid: a case report.

Single mucoceles are a relatively common disorder of the oral mucosa, but the occurrence of multiple mucoceles is considered an uncommon event. There are only a few reports in the literature. 1-6 Although no etiologic factor has been associated with multiple mucoceles, some authors reported on this condition in patients with oral lichen planus and in association with graft-versus-host disease. 1,6,7 There is a hypothesis that an inflammatory process may play a role in the pathogenesis of recurrent mucoceles, 6,7 although it was also argued that changes in minor salivary-gland function may contribute to the development of these lesions. 2

Psoriasiform mucositis on the gingival and palatal mucosae treated with retinoic-acid mouthwash.

mucosae treated with retinoic-acid mouthwash A 35-year-old African-American female sought our clinic for evaluation of a burning sensation on the palate and gingival bleeding of one-year duration. Oral examination showed diffuse erythema on the upper gingival mucosa, resembling a desquamative gingivitis (Fig. 1a), and erythematous patches on the hard and soft palatal mucosa (Fig. 1b,c). No other lesion was reported either on the skin or on other mucosal surfaces. The patient was neither a smoker nor an alcohol abuser; otherwise she was in good health. Her family history presented nothing noteworthy. The diagnostic procedure began with microscopic examination of biopsies taken from the palatal and gingival mucosae, which were consistent with psoriasiform lesion (Fig. 2a–d). Periodic acid-Schiff staining of the histopathological slide sections was negative for Candida infection. A serological test for syphilis was non-reagent, and a complete blood cell count was within normal limits.

Reação liquenoide à carbamazepina em mucosa bucal: relato de caso

Lichenoid drug reactions are more common in skin, but they may also occur in the oral mucosa. It is difficult to diagnose these lesions due to their clinical similarity to the idiopathic oral lichen planus lesions. The present article reports a case of lichenoid reaction in oral mucosa associated to the use of carbamazepine, emphasizing the diagnostic process.

Quality of life in patients submitted to surgical treatment for minor salivary gland neoplasms

This study was aimed at assessing the quality of life in patients submitted to surgical treatment for minor salivary gland neoplasms (MSGN). Twelve patients (10 women and 2 men, mean age: 49.4 years) with histopathologic diagnosis of pleomorphic adenoma (PA, 3 cases), polymorphous low-grade adenocarcinoma (PLGA, 2 cases), cystic adenoid carcinoma (CAC, 4 cases), and muco-epidermoid carcinoma (MEC, 3 cases) were evaluated. All of them were treated by surgical excision; patients with CAC received radiotherapy as well. The patients quality of life was evaluated through a self-administered questionnaire concerning their physical well-being, emotional status, normal daily activities, and family relationships. The results showed that patients with MEC--the youngest among all patients--reported a significantly greater worsening of their physical well-being and emotional status after treatment as compared with patients treated for PA (P<0.05), and also of their functional activities as compared with those treated for PA and PLGA (P<0.05). In conclusion, age of development of the neoplasm and type of disease produce more impact on patients quality of life than does the therapys degree of aggression.

Candidose hiperplásica em palato desenvolvida por contato à glossite romboide mediana

A male white patient aged 41 years was referred to the Stomatology Unit with a histopathological diagnosis of hyperplastic candidosis with modera-te dysplasia on the palate. The clinical examination showed a white plaque measuring about 2 cm in diameter, with an erythematous halo, not removable by scraping (Fig. 1a). Also there was an erythematous atrophic area over which was a white plaque shaped similarly to the palatal lesion, on the dorsum of the tongue, which suggested candidosis as-sociated with median rhomboid glossitis (Fig. 1b). Cytology and PAS staining con-firmed the presence of Candida hyphae.The patient had no history of systemic diseases and reported not using systemic or local medication. Laboratory exams did not reveal anemia, diabetes, or HIV infection. The patient used a partial removable dental appliance that did not make contact with the palatal lesion. The patient smoked but did not consume alcohol chronically.Treatment with oral miconazole 20 mg gel, TID, during four weeks, resol-ved significantly both lesions. Cytology of both areas after treatment showed that Candida was absent; a biopsy of the residual lesion revealed hyperkeratosis without dysplasia.