Caracterización clinicopatológica de la enfermedad liquenoide oral y sus principales subtipos

206 p.La enfermedad liquenoide oral (ELO) es el trastorno oral potencialmente maligno más frecuente en nuestro medio y incluye a diferentes procesos de base inmunológica que cursan clínicamente con la presencia de pápulas blancas en la mucosa oral. Los principales subtipos de la ELO, son el liquen plano oral (LPO) y la lesión liquenoide oral (LLO). Este trastorno presenta todavía múltiples controversias sobre su diagnóstico, clasificación y pronóstico. Por ello, hemos realizado un estudio de caracterización clínica e histopatológica, así como una valoración pronostica de la muestra analizada. Hemos incluido a 384 pacientes atendidos en las Unidades de Medicina Bucal y Patología Oral y Maxilofacial de la UPV/EHU, correspondiendo a LPO 299 (77,9%) pacientes y a LLO 85 (22,1%) pacientes. Hemos reconocido algunas diferencias clínicas entre ambos grupos, observándose una mayor presencia de lesiones erosivo-ulcerativas, afectación extraoral y síntomas en el momento del diagnóstico en el grupo LPO y un mayor porcentaje de desaparición de lesiones en el grupo LLO. La tasa de transformación maligna de la ELO fue del 2,3%, presentando una mayor incidencia el grupo LLO. Se reconocieron algunos aspectos clínicos pronósticos, como son la presencia de lesiones atróficas y en localizaciones atípicas, padecer hipertensión arterial y presentar síntomas en el momento del diagnóstico

Clinical presentation of burning mouth syndrome in patients with oral lichenoid disease

To analyze the presence of burning mouth syndrome (BMS) in a group of patients diagnosed with oral lichenoid disease (OLD). A retrospective study of 217 patients diagnosed with OLD; 158 (72,8%) women and 59 (27,2%) men, with an average age upon diagnosis of 56,4 years (SD 11,88). We carried out a detailed and complete characterization of symptoms, with special emphasis on BMS diagnostic data specified by the International Headache Society. Four patients (1.8%) presented with long-term clinical symptoms of burning mouth, indicative of BMS and they fulfilled the IHS 2018 criteria, except for criterion D, i.e.?Oral mucosa is of normal appearance?. The observed lichenoid mucosal lesions were not considered to be able to account for the reported intraoral pain in any of our patients. Thus neither diagnosis was considered to be exclusive. Patients diagnosed with OLD, and who simultaneously present clinical characteristics of BMS should be studied in detail, in order to evaluate the possibility of both diagnoses concurring

Histological assessment of a novel de-epithelialization method for connective tissue grafts harvested from the palate. An experimental study in cadavers

Objectives This study aims to compare the histological outcomes of three distinct de-epithelialization methods used in (connective tissue grafts) CTG harvested from the palate. Materials and methods An experimental study using nine cadaver head specimens was carried out to compare 3 different de-epithelialization techniques for CTG. Eighteen samples were randomly allocated to three study groups: bone scraper, diamond bur and extraoral removal with a scalpel. The main outcome variable was the graft surface percentage without epithelium remains. Additionally, the time employed, and the graft thickness were also measured. Results Sixteen CTGs were analyzed. The extraoral scalpel group presented a total surface area with no epithelium of 58.84% (22.68) and a mean de-epithelialization time of 3.7 min; the intraoral diamond bur group had 88.24% (41.3) of the surface with no epithelium and took 1.455 min, and the intraoral bone scraper showed 97.98% (5.99) of surface without epithelium and a mean time of 0.815 min (P < 0.05). Histological analysis showed significant differences between the bone scraper and the extraoral group (P = 0.009). Conclusion The de-epithelialization technique with a bone scraper seems to be the most effective and fastest de-epithelialization technique for CTG. These findings need to be confirmed in future clinical studies with larger samples. Clinical relevance The use of bone scrapers, could be a simple, effective and fast technique to de-epithelialize connective tissue grafts harvested from the palatal area for both novice and experienced surgeons

Gingival lymphatic malformation. An atypical case report

Lymphatic malformations are a rare pathology that presents a highly variable clinical expression. Intraorally, it mainly affects the dorsum of the tongue. The objective of this work is to present a case of lymphatic malformation in an atypical location. A 20-year-old male who attended the clinic for multiple vesicular lesion in attached gingiva, asymptomatic and of unknown evolution. Removal of the lesion and subsequent histological analysis were performed, which showed a microcystic lymphatic vascular lesion. Immunohistochemistry for D2-40 was performed, which corroborated the lymphatic origin of the lesion. At 6 months, no recurrence of the lesion was recognized. Clinicians should include lymphatic malformations in the differential diagnosis of multiple vesicular lesions. Knowing the oral manifestations of this entity is essential for its proper diagnosis and clinical management

Angina bullosa hemorrhagica an enigmatic oral disease

Angina bullosa hemorrhagica (ABH) is an enigmatic oral disorder described for the first time by Badham in 1967 to define blisters with a hematic content in the oral cavity and oropharynx unrelated to any hematological, dermatological or systemic disease. The ABH is an uncommon disease of the oral cavity distinctively affecting adults, with the highest incidence over the 5th decade of life. This process is considered nowadays to have a multifactorial etiopathogenesis, where mild oral traumatisms can trigger the blisters in susceptible individuals. Certain association on the onset of the lesion with the chronic use of inhaled steroids and, more controversially, with triggering systemic disorders, such as, diabetes or hypertension has been described. Characteristically, the ABH blisters are acute and are located on the lining mucosa, more frequently on the soft palate. Usually, the lesions are solitary and rupture easily, resulting in a superficial ulceration that heals quickly without scarring. The histopathological analysis shows a subepithelial blister containing blood and direct immunofluorescence on the epithelium is negative. The differential diagnosis should consider all oral vesiculobullous disorders with hematic content, including mucocutaneos, hematological or cystic pathology. The diagnosis of ABH is clearly clinical, although the biopsy might be helpful on atypical or abnormally recurrent cases. The general prognosis of ABH is good and the treatment is symptomatic. Although it is an uncommon disease, the angina bullosa hemorrhagica should be considered in the differential diagnosis of oral vesiculo-bullous processes. Acknowledging this entity will help in differentiating it from important mucocutaneous and hematological diseases such as pemphigus vulgaris, mucous membrane pemphigoid or coagulation disorders. In this review we analyze the main etiopathogenic, clinicopathological, diagnostic and therapeutic aspects of this enigmatic oral condition.peer-reviewe

Inflammatory fibro-epithelial hyperplasia related to a fixed implant-supported prosthesis : a case report

The gingival overgrowth is a common finding in the clinical practice with a diverse etiology. There are no treatment guidelines defined for this oral lesions. These can provoke discomfort to the patient and often, can alter the function of the stomatologic system. This article presents a case report of a bilateral gingival overgrowth in a 68 years old woman wearing a fixed upper-arch implant-supported prosthesis placed five years ago. The clinical exam after removing the prosthesis showed an intense accumulation of plaque around the intermediate abutments associated to a mucosal enlargement with suppuration on touching the buccal area of the implant in position 1.5 and a probing depth of 8mm. The 2.4 and 2.5 implants also showed vestibular mucosal enlargement and a probing depth of 6mm. No changes were observed in the peri-implant bone level measured in the periapical radiographs. An incisional biopsy was made on second quadrant and sent for the histopathological study. The definitive diagnosis was inflammatory fibro-epithelial hyperplasia. No recurrence has been reported after a 6 month follow-up

Peripheral giant cell granuloma associated with a dental implant : a case report

Peripheral giant cell granuloma (PGCG) is a reactive exophytic lesion classified as a benign tumor of the oral mucosa. Although its etiology is not clear, it may be a consequence of local chronic irritation or persistent trauma. The objective of this ca

Angina bullosa hemorrhagica, an uncommon oral disorder. Report of 4 cases

Angina bullosa hemorrhagica (ABH) is a rare oral disorder characterized by blood-filled bullous lesions in the oral cavity and the oropharynx in the absence of an underlying systemic, haematological or mucocutaneous condition. The presentation of the lesions is acute and located on the lining mucosa, mainly on the soft palate. Often, these lesions are single and rupture easily leaving an ulcerated area. In this study, we present 4 ABH cases in 3 women and 1 man and we discuss the main clinicopathological characteristics. The characteristics of this disorder are important to recognize in order to differentiate the lesions from other oral bullous conditions of the oral cavity such as mucocutaneous disorders or blood coagulation disorders

Therapeutic management of the odontogenic keratocyst. An energetic approach with a conservative perspective and review of the current therapeutic options

Background: Odontogenic keratocysts (OKC) are cystic lesions appearing in the jaws, usually asymptomatic with a progressive growth into the bone. Many of them are diagnosed by a routine radiological examination. Material and methods: This study reports a 12-year-old girl that presented an asymptomatic large radiolucent unilocular lesion associated to the crown of 3.8 that caused displacement of the molar and the inferior alveolar canal. Differential diagnosis included OKC, unicystic ameloblastoma, ameloblastic fibroma, dentigerous cyst and orthokeratinized odontogenic cyst. Two surgical interventions were performed; first, a marsupialization, and 10 months after, the third molar extraction plus cyst enucleation, mucosa excision and the application of Carnoy's solution. Results: The anatomopathological exam confirmed diagnosis of OKC. There was no evidence of recurrence after 2 years of follow-up. Conclusions: Marsupialization followed by surgical enucleation with mucosa excision and Carnoy's solution can help manage treatment of OKC, a lesion characterized by an aggressive behavior

Therapeutic management of the odontogenic keratocyst. An energetic approach with a conservative perspective and review of the current therapeutic options

Odontogenic keratocysts (OKC) are cystic lesions appearing in the jaws, usually asymptomatic with a progressive growth into the bone. Many of them are diagnosed by a routine radiological examination. This study reports a 12-year-old girl that presented an asymptomatic large radiolucent unilocular lesion associated to the crown of 3.8 that caused displacement of the molar and the inferior alveolar canal. Differential diagnosis included OKC, unicystic ameloblastoma, ameloblastic fibroma, dentigerous cyst and orthokeratinized odontogenic cyst. Two surgical interventions were performed; first, a marsupialization, and 10 months after, the third molar extraction plus cyst enucleation, mucosa excision and the application of Carnoy?s solution. The anatomopathological exam confirmed diagnosis of OKC. There was no evidence of recurrence after 2 years of follow-up. Marsupialization followed by surgical enucleation with mucosa excision and Carnoy?s solution can help manage treatment of OKC, a lesion characterized by an aggressive behavior