Epidemiological profile and clinical implications of oral squamous cell carcinoma adjacent to dental implant

Orientador: Márcio Ajudarte LopesDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: Os implantes dentários (ID) tiveram grande avanço nas últimas décadas e promoveram grande impacto clínico à reabilitação oral. No entanto, apesar dos benefícios, algumas alterações relacionadas ao ID podem ocorrer como doenças inflamatórias, incluindo mucosite peri-implantar (MPI) e peri-implantite (PI). Tem sido também observados casos de carcinoma espinocelular (CEC) adjacente aos ID. Compreender o perfil clínico e epidemiológico dos pacientes com CEC adjacente aos ID é importante para o manejo clínico adequado. Assim, inicialmente realizamos uma revisão sistemática (RS) da literatura, a fim de avaliar o perfil epidemiológico e clínico desses pacientes. Após um processo de seleção, 33 artigos atenderam aos critérios de elegibilidade. No total, 63 pacientes foram incluídos e as mulheres foram maioria (55,5%). A idade média dos pacientes foi de 66,7 anos. Desordens orais potencialmente malignas (DOPM) foram relatadas em 46% dos pacientes. A DOPM mais comum encontrada nas mulheres foi o líquen plano oral (LPO) (52,6%). A PI foi o diagnóstico clínico inicial em 25,3% dos casos. O segundo estudo analisou retrospectivamente pacientes tratados com CEC adjacente ao ID no AC Camargo Cancer Center entre 2009 e 2020. Trinta e um pacientes preencheram os critérios de elegibilidade e foram incluídos nesta análise. Mulheres foram as mais frequentes (58,1%), a idade média dos pacientes foi de 68,8 anos e 46,9% e 54,9% eram não tabagistas e não etilistas, respectivamente. DOPM foi relatada em 45,2% dos pacientes, afetando principalmente mulheres (78,5%). Leucoplasia (63,7%) seguida de LPO (36,3%) foram as DOPM mais comuns encontradas em mulheres. PI foi o diagnóstico clínico inicial em 16,1% dos CEC adjacentes ao ID. O terceiro estudo foi um relato de uma série de treze pacientes diagnosticados com CEC em torno de ID, 10 mulheres e 3 homens. Em apenas 3 pacientes foi considerada inicialmente a possibilidade de ser uma lesão maligna ou pré-maligna. PI foi o diagnóstico preliminar mais comum, seguido por infecções fúngicas, infecções virais e úlceras traumáticas. O quarto e último capítulo, trata-se de uma carta ao editor alertando sobre dificuldade na diferenciação do LPO da leucoplasia verrucosa proliferativa em fases iniciais em pacientes com CEC adjacente ao ID. De um modo geral, a maioria dos pacientes com CEC adjacente ao ID são mulheres que não tem hábitos de tabagismo e / ou etilismo. É importante enfatizar que esses CECs podem ter características clínicas e radiográficas semelhantes as lesões inflamatórias principalmente MPI e PI, podendo atrasar o diagnóstico e comprometer o prognósticoAbstract: Dental implants (DI) have made great progress in recent decades and promoted a clinical impact on oral rehabilitation. However, despite the benefits, some changes related to DI can occur such as inflammatory diseases, including peri-implant mucositis (PIM) and peri-implantitis (PI). Cases of squamous cell carcinoma (SCC) adjacent to DIs have also been observed. Understanding the epidemiological and clinical profile of these patients with OSCC adjacent to DI is important for adequate clinical management. Thus, we initially performed a systematic review of the literature in order to assess the epidemiological and clinical profile of patients. After a selection process, 33 articles met the eligibility criteria. In total, 63 patients were included, and women were the majority of cases (55.5%). The mean age of the patients was 66.7 years. Oral potentially malignant disorders (OPMD) were reported in 46% of patients. The most common OPMD found in women was oral lichen planus (OLP) (52.6%). Peri-implantitis was the initial clinical diagnosis in 25.3% of cases. The second study retrospectively analyzed patients treated with OSCC adjacent to the DI at A.C. Camargo Cancer Center between 2009 and 2020. Thirty-one patients met the eligibility criteria and were included for this analysis. Women were the most prevalent (58.1%), the mean age of patients overall was 68.8 years, and 46.9% and 54.9% were non-smokers and non-drinkers, respectively. OPMD was reported in 45.2% of the patients, affecting mainly women (78.5%). Leukoplakia (63.7%) followed by OLP (36.3%) were the most common OPMD found in women. Peri-implantitis was the initial clinical diagnosis in 16.1% of OSCC adjacent to DI. The third study was a report of a series of thirteen patients diagnosed with OSCC around DI, 10 women and 3 men. In only 3 patients, the possibility of being a malignant or premalignant lesion was initially considered. PI was the most common preliminary diagnosis, followed by fungal infection, viral infections and traumatic ulcers. The fourth and last chapter is a letter to the editor warning about a difficulty in differentiating OLP and proliferative verrucous leukoplakia in early stages in patients with SCC adjacent to DI. In general, the majority of patients with SCC adjacent to ID are women who do not have smoking and / or alcohol habits. It is important to emphasize that these SCCs may have clinical and radiographic characteristics similar to inflammatory lesions, mainly PIM and PI, and may delay the diagnosis and compromise the prognosisMestradoPatologiaMestre em Estomatopatologia88887.476010/2020-0134696/2018-2CAPESCNP

Prognostic value of the immunohistochemical expression of vascular endothelial growth factors in malignant salivary gland neoplasms:a systematic review and meta-analysis

The immunohistochemical expression of vascular endothelial growth factor is a prognostic marker in several cancer types. In salivary gland tumors, the association between vascular endothelial growth factor and prognosis remains unclear. The purpose of this study was to perform a systematic review and meta-analysis to assess whether the immunohistochemical expression of vascular endothelial growth factor in patients with salivary gland neoplasms presents prognostic value. Immunohistochemical studies assessing the predictive value of vascular endothelial growth factor in salivary gland neoplasms were systematically reviewed using PubMed, Scopus, Embase, Cochrane Library, and Web of Science databases. It was assessed any survival rates. The fixed-effect model with an adjusted hazard ratio (HR) and 95% confidence intervals (95% CI) as effect measures were performed in the meta-analysis. The Quality in Prognosis Studies (QUIPS) tool was used to assess the quality of the included studies, and the evidence quality was assessed by the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) system. The immunohistochemical overexpression of vascular endothelial growth factor in patients with salivary gland neoplasms was associated with shortened survival (HR=5.37, 95% CI: 2.67-10.83, P = 0.00001). In addition, the presence of vascular endothelial growth factor was tightly associated with tumor size, lymph node metastasis, clinical stage, perineural invasion, vascular invasion, poor local control of the disease, and recurrence. The immunohistochemical overexpression of vascular endothelial growth factor in patients with salivary gland neoplasms has prognostic value and was associated with decreased survival time. However, more primary well-designed studies are necessary to increase the level of evidence

Estudo epidemiológico do trauma bucomaxilofacial em um hospital de referência da Paraíba.

RESUMO Objetivo: estudar os dados epidemiológicos de pacientes vítimas de traumas bucomaxilofaciais atendidos em um hospital de referência da Paraíba. Métodos: estudo transversal de abordagem indutiva com procedimento estatístico comparativo e técnica de pesquisa por documentação direta em campo. O universo foi constituído dos prontuários hospitalares obtidos de janeiro de 2016 a dezembro de 2017 de pacientes atendidos pelo Serviço de Cirurgia e Traumatologia Bucomaxilofacial desse hospital. A amostra foi composta por 332 pacientes de acordo com os critérios de elegibilidade do estudo. A coleta de dados foi realizada por dois examinadores previamente calibrados e os dados foram analisados descritiva e inferencialmente. Resultados: os pacientes do sexo masculino foram mais acometidos por trauma facial (83,1%), principalmente na terceira década de vida (32,2%). Acidentes motociclísticos foram a etiologia mais comum de trauma para ambos os sexos. Em relação à estatística inferencial com margem de erro fixada em 5%, não foi observada associação significativa (p>0,05) entre os sexos e os fatores etiológicos do trauma. Os ossos do nariz (38,2%) foram os ossos mais afetados e a lesão mais frequente de partes moles foi o edema, em 50,9% dos casos. Apenas 20,8% dos pacientes com fraturas ósseas foram politraumatizados. Conclusão: as vítimas de traumatismo bucomaxilofacial atendidas em nosso hospital são predominantemente homens na terceira década de vida, envolvidos em acidentes motociclísticos e com lesões em ossos do nariz

A Rare Case of Mandibular Aspergillus Osteomyelitis in an Immunocompetent Patient

Aspergillosis is a fungal infection caused by Aspergillus species, which is contracted through spores that colonize the respiratory tract, causing rhinosinusitis and pulmonary infections. Oral aspergillosis is rare and, when present, may cause soft tissue and bone destruction, generally in immunodeficient patients. Mandibular Aspergillus osteomyelitis is even rarer, with few cases reported in the literature. A 57-year-old Caucasian woman was referred for the evaluation of painful recurrent swelling in the anterior mandibular alveolar ridge, with purulent drainage, previously treated with multiple surgical debridement procedures and antibiotics without success. The patient was otherwise systemically healthy. Surgical debridement was performed and histopathological examination showed osteomyelitis associated with Aspergillus species. Therapy with oral itraconazole (400 mg per day) was administered for 3 months, resulting in complete resolution. No recurrence was detected after 15 years of follow-up. The patient was rehabilitated with dental implants. In conclusion, non-bacterial microorganisms, such as Aspergillus, should be considered in cases of mandibular osteomyelitis that do not heal after surgical debridement and antibiotic therapy