Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2008. Vol. 13, no. 6

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    Merkel cell carcinoma of the head and neck : report of seven cases
    (2008) Luaces Rey, Ramón; Fernández Alba, Javier; Martín, Roberto; García-Rozado González, Alvaro; Paradela de la Morena, Sabela; Robles Veiga, Olga; López-Cedrún Cembranos, José Luis
    Merkel cell carcinoma is a rare and aggressive primary cutaneous neoplasm. Clinically it is characterized by innocuous appearance, as a fast growing asymptomatic nodule or plaque. Head and neck are the most common sites of presentation (50%). The treatment is based on local surgery completed with cervical lymph node dissection, radiotherapy, chemotherapy and other treatments depending on the staging. Sentinel lymph biopsy seems to be useful for its treatment. Tumour staging is the only prognostic factor related to overall survival. Prognosis is very poor due to the high incidence of loco-regional recurrence and metastases. Seven cases of Merkel cell carcinoma of the head and neck are reported. These were treated in our Department over the last two and a half years. A literature review was made.
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    Macroglossia caused by adenoid cystic carcinoma : case report
    (2008) Luna Ortiz, Kuauhyama; Carmona-Luna, Tania; Herrera Gómez, Angel; Cano Valdez, Ana María
    A 33-year-old woman sought medical care at our institution for macroglossia. She had been treated before with tracheostomy and gastrostomy due to an adenoid cystic carcinoma (ACC) of the mobile tongue, in clinical stage IVC. She was subjected to total glossectomy with larynx preservation, modified radical dissection of the right neck and of the left supraomohyoid muscle, as well as reconstruction using a free flap from the rectus abdominus. The histological report described a 15x11 cm solid type ACC of the mobile tongue (grade III), with infiltration to adjacent soft tissues, vascular and lymphatic vessels, as well as two metastatic lymph nodes in the right neck dissection. One month after surgery, bone and bilateral pulmonary tumor activity became evident. In advanced-stage tumors, treatment must be individualized, and when accompanied by severe deterioration of the quality of life, surgery is recommended independently from the extension, provided that a good reconstruction is accomplished.
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    Reliability of an infrared auditory thermometer in the measurement of oral temperature
    (2008) Moya Villaescusa, María José; Sánchez Pérez, Arturo J.; Bermejo Fenoll, Ambrosio
    Aim: To evaluate the reliability of the measurements obtained from different parts of the oral cavity using an infrared auditory thermometer, and to contrast these results with those obtained from the axilla and auditory canal. Study design: A comparative descriptive design was used to establish differences between the temperature recordings made in 66 healthy volunteers with an infrared auditory thermometer applied to different parts of the body (oral cavity and left ear) versus the recordings obtained with a glass mercury thermometer in the axillary zone. The study sample was balanced with respect to gender, and the mean age was 21.15 (± 1.61) years. Results: The largest standard deviation of all the locations corresponded to the left ear. This variable did not present a normal distribution. However, there were no statistically significant differences among the consecutive measurements made in the different anatomical (oral or axillary) regions. Conclusions: The thermal device used in this study seems to fulfill most of the requirements of an ideal clinical thermometer for yielding objective information on body temperature. It is easy to use, noninvasive, inexpensive and rapid. The temperature in the oral cavity is very representative of body temperature.
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    Impact of the systematic use of the informed consent form at public dental care units in Galicia (Spain)
    (2008) Rubiños López, Emilio; Rodríguez Vázquez, Luis Miguel; Varela Centelles, Almudena; Varela Otero, Flor; Blanco Otero, María Isabel; Fernández Fraga, Carlos; Varela Centelles, Pablo Ignacio
    Aim: To ascertain the impact of routine application of the informed consent form at the primary dental care units of the Galician Health Service. Study design: Non random selection of consecutive patients seeking tooth extraction between 9 January and 7 March 2007 at the dental care units of Burela, Praza do Ferrol and Viveiro (Lugo). The study included sociodemographic, clinical, utilization, behavioural and IC-related variables. Main results: A total of 462 patients, mainly males (n=249; 53.9%) entered the study. The mean age of the participants was 57.87±17.54 years. 93.7% of the patients gave their consent for tooth extraction, whereas 47.3% did not want to be informed. The average time employed for obtaining the informed consent was 3.40±1.87 minutes, with a median of 4 and the same mode. The referred stress values did not differ before and after reading the informed consent form 3.28±2.52 vs 3.41±2.45 (p=0.661). Conclusion: Routine application of the informed consent form before tooth extraction under local anaesthesia did not impair clinical practice nor is it a barrier to dental care. The use of this form does not require changes beyond the allocation of the time necessary for its completion.
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    Calcium sulfate and PTFE nonporous barrier for regeneration of experimental bone defects
    (2008) Macedo, Nelson Luiz; Macedo, Luís Guilherme Scavone; Monteiro, Adriana Socorro Ferreira
    The aim of the study was to evaluate the possibility to obtain guided bone regeneration with two types of physical barriers (calcium sulfate and PTFE nonporous barrier) in surgical defects created in rat parietal bones. In the right parietal bone the calcium sulfate barrier filled out the whole defect and in the left parietal bone the barrier of PTFE was positioned in the floor and externally to the surgical defect. After 7, 14, 30 and 45 days four animals were sacrificed in each period and the bone containing the defects were submitted to the microscopic analysis. The results of the study revealed that the PTFE barrier was more effective for bone regeneration in shallow transcortical defects compared to the calcium sulfate. However, additional experiments are necessary to determine if calcium sulfate would be successful in other bone defects types or the use of the material under another consistence could complement the results obtained in this work.
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    Bacteremia originating in the oral cavity. A review
    (2008) Poveda Roda, Rafael; Jiménez Soriano, Yolanda; Carbonell Pastor, Enrique; Gavaldá Esteve, Carmen; Margaix Muñoz, María; Sarrión Pérez, María Gracia
    In patients at risk because of heart disease, bacteremias induced by invasive dental treatments have been reported as a cause of bacterial endocarditis (BE) - a serious disorder that continues to involve a high mortality. As a result, different scientific societies have supported recommendations for the administration of antibiotics prior to invasive dental treatments, in order to neutralize bacteremia. In this context, the recommendations of the American Heart Association (AHA) are the most widely used in our setting. Advances in our knowledge of the etiopathogenesis of bacterial endocarditis have placed increasingly less importance on invasive dental treatments as a causal factor (the AHA again reduced the number of cases in which antibiotic prophylaxis is recommended, on occasion of its latest guidelines update in 2007) - with increasingly greater importance being placed on factors associated with hygiene and oral health. The present study offers a critical review of the relationship between dental treatment, bacteremia and bacterial endocarditis.
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    Rehabilitation of atrophic maxilla : a review of 101 zygomatic implants
    (2008) Pi Urgell, Joan; Revilla Gutiérrez, V.; Gay Escoda, Cosme
    Introduction: Zygomatic implants are a good rehabilitation alternative for upper maxilla with severe bone reabsorption. These implants reduce the need for onlay-type bone grafting in the posterior sectors and for maxillary sinus lift procedures - limiting the use of bone grafts to the anterior zone of the upper jaw in those cases where grafting is considered necessary. Objective: To evaluate the survival of 101 zygomatic implants placed in upper maxilla presenting important bone reabsorption, with a follow-up of 1-72 months. Patients and methods: A retrospective study was made of 101 Zygoma® implants (Nobel Biocare, Göteborg, Sweden) placed in 54 patients with totally edentulous and atrophic upper maxilla, in the period between 1998-2004. There were 35 women and 19 men, subjected to rehabilitation in the form of fixed prostheses and overdentures using 1-2 zygomatic implants and 2-7 implants in the anterior maxillary zone. The principal study variables were smoking, a history of sinusitis, the degree of bone reabsorption, and peri-implant bone loss, among others. Results: The descriptive analysis of the 101 zygomatic implants placed in 54 patients with a mean age of 56 years (range 38-75) yielded a percentage survival of 96.04%, with four failed implants that were removed (two before and two after prosthetic loading). Nine patients were smokers, and none of the 54 subjects reported a history of sinus disorders. Discussion and conclusions: Zygomatic implants are designed for use in compromised upper maxilla. They allow the clinician to shorten the treatment time, affording an interesting alternative for fixed prosthetic rehabilitation. This study confirms that zygomatic bone offers predictable anchorage and acceptable support function for prostheses in atrophic jaws. However, these implants are not without complications. Longer-term evaluations are needed of zygomatic implant survival in order to establish a correct clinical prognosis.
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    Frequency of positive aspirations in anesthesia of the inferior alveolar nerve by the direct technique
    (2008) Vasconcelos, Belmiro Cavalcanti; Freitas, Karla Coelho de Miranda; Canuto, Marta Rejane
    Objectives: Evaluate the frequency of positive aspirations and complications resulting from anesthesia of the inferior alveolar nerve by the direct technique. Study design: The sample was composed of 138 anesthetic injections applied with Duflex syringes with reflux. The anesthesia was applied in patients of both sexes of various ages for procedures in which such anesthesia would be necessary. Results: The results showed 4.3% of positive aspirations in vivo. When the percentages of positive aspiration on the right and left sides were compared, no significant association was found. A greater number of positive aspirations was observed in the 15-30-year-old age group. It is emphasized that the only type of complication associated with positive aspirations was hematoma. Conclusions: The percentage of positive aspirations from inferior alveolar nerve block by the direct technique is significant, and for the most part they do not appear in the form of a thin thread, requiring great care on the part of the person applying the anesthesia.
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    Malacoplakia : case report in tongue and review of the literature
    (2008) Álvarez Gómez, Gloria Jeanethe; Marín Botero, ML.; Henao Calle, Cecilia Amparo; Duque Serna, Francisco Levy
    Malakoplakia is a relatively uncommon chronic inflammatory reaction of unknown etiology. It usually affects the genitourinary tract but may rarely involve the tongue. There are many theories that explain this reaction but it seems to be the answer to an infectious agent in a patient with immunologic deficiency. Microscopically, malakoplakia is characterized by the presence of foamy histiocytes with distinctive basophilic inclusions, which are known as MichaelisGutmann bodies due to a partially ingested bacteria and their posterior calcification. There are many alternatives to treat this entity. We report the only case diagnosed in the tongue, in a 15 years-old male in the Maxillofacial Surgery and Stomatology Service of the Hospital San Vicente de Paúl in Medellín, Antioquia, Colombia.
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    Correlation of CD4 cell count with gingival bleeding index in HIV positive individuals
    (2008) Doshi, Dolar; Ramapuram, John; Anup, Nagaraj; Sharma, Gaurav
    Objectives: To correlate CD4 cell count with gingival bleeding index in HIV positive individuals. Methods: Fifty-one serologically confirmed HIV positive individuals were included in the study. Plaque index and bleeding index was recorded by a single examiner. CD4 cell count was obtained within 30 days from the day of examination. CD4 cell counts and gingival bleeding index was correlated using Spearman?s correlation test. p < 0.01 was considered as statistically significant. Results: Mean plaque score, mean gingival bleeding index score and mean CD4 cell count was 1.40, 0.96 and 249.86 cells/mm3 respectively. It was noticed that gingival bleeding was enhanced in individuals with increased immunosuppression. However, no significant positive correlation was seen between mean CD4 cell count and gingival bleeding (p = 0.14). Conclusion: Though CD4 cells are an important indicator for clinical aggravation of HIV infection, periodontal disease as measured by bleeding index is not directly associated to the cell count.
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    Prognostic significance of the anatomical location and TNM clinical classification in oral squamous cell carcinoma
    (2008) Araújo Júnior, Raimundo Fernandes de; Barboza, Carlos Augusto Galvão; Clebis, Naianne Kelly; Moura, Sergio Adrianne Bezerra de; Costa, Antônio de Lisboa Lopes
    Objetives: The aim of this study was to investigate the existence of correlation between the TNM clinical classification, anatomical location and prognosis of oral squamous cell carcinoma. Study design: A total of 130 oral squamous cell carcinomas were selected from the files of the Dr. Luiz Antonio Hospital (Natal, Rio Grande do Norte, Brazil). Data concerning TNM clinical classification, anatomical location and prognosis were obtained. Pearsons correlation test was applied for the statistical analysis of data. Results: It revealed a statistically significant correlation (p = 0.01) between TNM clinical classification and prognosis. It also revealed correlation between TNM classification and the anatomical location of oral squamous cell carcinomas (p = 0.01). Conclusions: We concluded that TNM classification presented correlation with prognosis and with the different anatomical locations of oral squamous cell carcinomas.
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    Gorlin-Goltz syndrome : Clinicopathologic aspects
    (2008) Ortega García de Amezaga, Aitziber; García Arregui, Olatz; Zepeda Nuño, Sergio; Acha Sagredo, Amelia; Aguirre Urízar, José Manuel
    Gorlin-Goltz syndrome, also known as nevoid basal cell carcicoma syndrome, comes into being due to a genetic alteration produced by a mutation in the ?Patched? tumour suppressor gene, and it is inherited in a dominant autosomal way, though sporadic cases have been found. This syndrome shows a high penetrance and variable expressiveness. It is about a multisystemic process that is characterised by the presence of multiple pigmented basocellular carcinomas, keratocysts in the jaws, palmar and/or plantar pits and calcification of the falxcerebri. Together with these major features a great number of processes considered as minor features have also been described. The latter include numerous skeletical, dermatology related and neurological anomalies among others. In some occasions, the presence of very aggressive basocellular carcinomas has been described as well as other malignant neoplasias. Due to the importance of oral maxillofacial manifestations of this syndrome, it is fundamental to know its characteristic in order to make a diagnosis, an early preventive treatment and establish right genetic advice. In this work the main clinicopathologic and the therapeutic aspects related to the syndrome under consideration have been revised and updated.
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    Letter to the editor : starch artifacts in oral biopsy specimen
    (2008) Pinto, Lucielma Salmito Soares; Silva, Andréia Aparecida da; León, Jorge Esquiche; Jorge, Jacks