A utilização de canabinoides no tratamento da nevralgia trigeminal: scope revisão

A nevralgia trigeminal (NT) é uma patologia caracteriza por dor intensa, do tipo paroxística, ou seja, que se manifesta como ataques súbitos e de forma intermitente, na região orofacial inervada pelos ramos do nervo trigémio. Os episódios de dor em geral ocorrem de forma espontânea, porém podem ser desencadeados por estímulos que inócuos para a maioria dos indivíduos, como por exemplo o toque de um dedo em uma área específica da face ou mesmo tarefas habituais, como maquiar, escovar os dentes, mastigar e até falar. O conhecimento limitado sobre a etiologia e patofisiologia da nevralgia do trigémio faz com que o seu tratamento continue sendo um grande desafio para os profissionais de saúde. O diagnóstico precoce e preciso da NT é fundamental para o sucesso das intervenções terapêuticas e pode reduzir ou eliminar os episódios de dor. A terapia farmacológica normalmente é a primeira opção, porém deve ser individualizada e de acordo com as particularidades e condições gerais do paciente. Alguns estudos evidenciaram a efetividade dos canabinoides, seja na promoção da analgesia em dores crónicas de diversas etiologias, principalmente para as de origem neuropáticas associadas a diabetes, vírus da imunodeficiência humana, esclerose múltipla, artrite reumatoide grave e fibromialgia. Eles também apresentaram resultados satisfatórios para controle das dores de origem oncológica, pós-traumáticas, pós-cirúrgicas, dor neuropáticas e neuropatias periféricas. Durante a última década, o interesse pela canábis na medicina e medicina dentária tem aumentado, e vários países, incluindo os Estados Unidos e o Canadá, produziram sua própria legislação sobre a mesma e os medicamentos à base de canabis. Este estudo teve como objetivo fazer uma revisão de scopo da literatura disponível, levando em consideração a eficácia, indicações e doses empregadas dos canabinoides na NT. As bases de dados utilizadas foram Pubmed, ScienceDirect e LILACS. Foram incluídos artigos nas línguas Inglesa, Portuguesa e Espanhola, sem restrição de ano. Um total de 70 artigos relevantes foram identificados, no entanto após a exclusão de duplicatas, 49 artigos foram selecionados para avaliação do título e foram submetidos à leitura. Após triagem, 5 artigos de texto completo foram avaliados. Um artigo foi excluído por ser uma revisão da literatura e quarto estudos preencheram os critérios de elegibilidade e foram incluídos na revisão para extração de dados e avaliação. Os estudos analisados evidenciam o potencial terapêutico dos no manejo da NT e de outras formas de dor neuropática. Eles enfatizam a eficácia dos canabinoides cannabinoides tanto sintéticos, como o natural, na mitigação da sensibilidade à dor em pacientes diagnosticados com esclerose múltipla e síndrome da dor pós-acidente vascular cerebral com NT associada. Embora sugiram que os canabinoides possam representar uma alternativa para casos de dor neuropática refratária, dentre outras a NT, aos tratamentos convencionais. Evidências científica sobre esse agente terapêutico ainda é insuficiente, apesar de alguns estudos apontarem benefícios. Contudo, são necessários mais ensaios clínicos para elevar o nível de evidência acerca dos benefícios desse tratamento, para compreender completamente seus efeitos a longo prazo e estabelecer as melhores práticas de dosagem e segurança.Trigeminal neuralgia (TN) is a condition characterised by intense, paroxysmal pain, i.e. sudden, intermittent attacks in the orofacial region innervated by the branches of the trigeminal nerve. Episodes of pain generally occur spontaneously, but can be triggered by stimuli that are innocuous to most individuals, such as the touch of a finger on a specific area of the face or even habitual tasks such as putting on make-up, brushing teeth, chewing and even talking. The limited knowledge about the aetiology and pathophysiology of trigeminal neuralgia means that its treatment remains a major challenge for health professionals. Early and accurate diagnosis of TN is fundamental to the success of therapeutic interventions and can reduce or eliminate pain episodes. Pharmacological therapy is usually the first option, but it must be individualised and tailored to the patient's particularities and general condition. Some studies have shown the effectiveness of cannabinoids in promoting analgesia in chronic pain of various etiologies, especially neuropathic pain associated with diabetes, human immunodeficiency virus, multiple sclerosis, severe rheumatoid arthritis and fibromyalgia. They have also shown satisfactory results for controlling pain of oncological origin, post-traumatic pain, post-surgical pain, neuropathic pain and peripheral neuropathies. Over the last decade, interest in cannabis in medicine and dentistry has increased, and several countries, including the United States and Canada, have produced their own legislation on it and cannabis-based medicines. This study aimed to carry out a scoping review of the available literature, taking into account the efficacy, indications and doses used of cannabinoids in the NT. The databases used were Pubmed, ScienceDirect and LILACS. Articles were included in English, Portuguese and Spanish, with no year restriction. A total of 70 relevant articles were identified, however after excluding duplicates, 49 articles were selected for title evaluation and were submitted for reading. After screening, 5 full-text articles were evaluated. One article was excluded because it was a literature review and three studies met the eligibility criteria and were included in the review for data extraction and evaluation. The studies analysed highlight the therapeutic potential of cannabinoids in the management of TN and other forms of neuropathic pain. They emphasise the efficacy of both synthetic and natural cannabinoids in mitigating pain sensitivity in patients diagnosed with multiple sclerosis and post-stroke pain syndrome with associated TN. Although they suggest that cannabinoids may represent an alternative for cases of neuropathic pain that are refractory to conventional treatments, among others NT. Scientific evidence on this therapeutic agent is still insufficient, although some studies have shown benefits. However, more clinical trials are needed to raise the level of evidence about the benefits of this treatment, to fully understand its long-term effects and to establish the best dosage and safety practices

Conservative treatment of large unicystic ameloblastoma in a young patient: a 7-year follow-up

The unicystic ameloblastoma is an odontogenic tumor that is frequently found in young patients and usually affects the posterior region of the mandible. This paper aimed to describe a case report and 7-year follow-up of a young patient. The 12-year-old patient presented with increased volume in the lower third of the right hemiface with a duration of 6 months. Radiographic examination showed a unilocular radiolucent lesion extending along the body, angle and right mandibular ramus. An incisional biopsy was performed and a histological diagnosis of luminal unicystic ameloblastoma was obtained, opting for a conservative treatment with decompression and subsequent complete enucleation of the lesion. The patient has been under follow-up for 7 years, with a good evolution of the condition and without clinical and radiographic signs of recurrence of the lesion. Thus, it is ratified that timely conservative intervention and conservative surgical treatment should be the first choice for ameloblastoma management in young patients

Approach and Treatment of Giant Luminal Unicystic Ameloblastoma

Unicystic ameloblastoma is an odontogenic tumor that affects mainly young patients and usually involves the posterior region of the mandible. In this article, we report on the case a 12-year-old girl presenting with an 8-month history of facial swelling in her lower right quadrant. Radiographic examination revealed a unilocular radiolucent lesion extending from the body of the mandible through to the angle and ascending ramus. An incisional biopsy was performed, and a diagnosis of luminal unicystic ameloblastoma was made based on clinicopathological features. The lesion was treated in two stages, namely, an initial conservative approach via decompression and subsequent excision. The patient has been followed up for 6 months without clinical and radiographic evidence of recurrence. In conclusion, conservative timely intervention combined with a conservative surgical approach has proven efficacious in the treatment of ameloblastoma in this young patient

Approach and Treatment of Giant Luminal Unicystic Ameloblastoma

Unicystic ameloblastoma is an odontogenic tumor that affects mainly young patients and usually involves the posterior region of the mandible. In this article, we report on the case a 12-year-old girl presenting with an 8-month history of facial swelling in her lower right quadrant. Radiographic examination revealed a unilocular radiolucent lesion extending from the body of the mandible through to the angle and ascending ramus. An incisional biopsy was performed, and a diagnosis of luminal unicystic ameloblastoma was made based on clinicopathological features. The lesion was treated in two stages, namely, an initial conservative approach via decompression and subsequent excision. The patient has been followed up for 6 months without clinical and radiographic evidence of recurrence. In conclusion, conservative timely intervention combined with a conservative surgical approach has proven efficacious in the treatment of ameloblastoma in this young patient

Intraosseous Mucoepidermoid Carcinoma in the Mandible

Although it is a rare neoplasm, intraosseous mucoepidermoid carcinoma is the most common and well-recognized intraosseous salivary gland tumor. Usually, it presents as an asymptomatic volume increase and most patients perceive the presence of the lesion within a year or less of evolution. They are more common in middle-aged adults and have a slight female predilection. They are three times more common in the mandible than in the maxilla and are most often found in the area of the molars and mandibular ramus. The most frequently present symptom is cortical bulging, although some lesions may be discovered as an accidental finding on radiographs. The main modality of treatment for patients with this neoplasm is radical surgical resection, offering a greater chance of cure than the more conservative procedures, such as enucleation or curettage, due to the great possibility of recurrence and tumor metastasis. This paper reports a rare case of intraosseous mucoepidermoid carcinoma occasionally discovered after panoramic radiography of the jaws, which was treated with segmental resection through hemimandibulectomy