O objetivo deste trabalho é relatar e discutir um caso clínico de um paciente acometido por Angina de Ludwig que evoluiu gravemente para mediastinite. O paciente compareceu inicialmente ao Pronto Socorro do Hospital Universitário da Universidade Estadual de Londrina e após diagnóstico de Angina de Ludwig foi internado e tratado de forma emergencial. O tratamento foi multiprofisssional e constituiu-se em abordagem cirúrgica para descompressão dos tecidos, administração de antimicrobianos e remoção da causa da infecção. Mesmo após a primeira abordagem cirúrgica, o paciente evoluiu gravemente e houve a necessidade de reabordagem da região cervical e torácica. O paciente necessitou de um mês de internação hospitalar até que o quadro infeccioso fosse estabilizado. Após o incidente, o paciente se apresentava com baixa autoestima e com sua relação interpessoal afetada. Desta forma, foi encaminhado para a Clínica Odontológica Universitária da Universidade Estadual de Londrina onde foi reabilitado com prótese total superior e prótese parcial removível inferior a fim de devolver grande parte da função mastigatória, estética e, consequentemente, qualidade de vida.Descritores: Angina de Ludwig; Infecção; Prótese Dentária; Saúde Bucal.ReferênciasJiménez Y, Bagán JV, Murillo J, Poveda R. Odontogenic infections. Complications. Systemic manifestations. Med Oral Patol Oral Cir Bucal. 2004;9(Suppl):139-43.Lugo AFG, Ravago MGC, Martinez RAG, Peltrini RJZ. Ludwig’s angina: A report of two cases. Rev Esp Cir Oral Maxilofac. 2014;36(4):177-81.Umeda M, Minamikawa T, Komatsubara H, Shibuya Y, Yokoo S, Komori T. Necrotizing fasciitis caused by dental infection: a retrospective analysis of 9 cases and a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(3):283-90.Bakir S, Tanriverdi MH, Gün R, Yorgancilar AE, Yildirim M, Tekbas G et al. Deep neck space infections: a retrospective review of 173 cases. Am J Otolaryngol. 2012;33(1):56-63.Brook I. Microbiology and management of peritonsillar, retropharyngeal, and parapharyngeal abscesses. J Oral Maxillofac Surg. 2004;62(12):1545-50.Caccamese JF Jr, Coletti DP. Deep neck infections: Clinical considerations in aggressive disease. Oral Maxillofac Surg Clin North Am. 2008;20(3):367–80.Chen MK, Wen YS, Chang CC, Lee HS, Huang MT, Hsiao HC. Deep neck infections in diabetic patients. Am J Otolaryngol. 2000;21(3):169-73Vieira F, Allen SM, Stocks RM, Thompson JW. Deep neck infection. Otolaryngol Clin North Am. 2008;41(3):459-83.Zarb GA, Bolender CL. Tratamento protético para os pacientes edêntulos – Próteses totais convencionais e implantossuportadas. 13. ed. Santos: São Paulo; 2013.Rodrigues JC. Tabu do corpo. Rio de Janeiro: Fiocruz; 2006.Narby B, Kronström M, Söderfeldt B, Palmqvist S. Changes in attitudes toward desire for implant treatment: a longitudinal study of a middle-aged and older Swedish population. Int J Prosthodont. 2008;21(6):481-85.Walton JN, MacEntee MI. Choosing or refusing oral implants: a prospective study of edentulous volunteers for a clinical trial. Int J Prosthodont. 2005;18(6):483-8.Sakarya EU, Kulduk E, Gündoğan O, Soy FK, Dündar R, Kılavuz AE, Özbay C, Eren E, İmre A. Clinical features of deep neck infection: analysis of 77 patients. Kulak Burun Bogaz Ihtis Derg. 2015;25(2):102-8.Botha A, Jacobs F, Postma C. Retrospective analysis of etiology and comorbid diseases associated with Ludwig’s Angina. Ann Maxillofac Surg. 2015;5(2):168-73.Suehara AB, Goncalves AJ, Alcadipani FAMC, Kawabata NK, Menezes MB. Deep neck infection: analysis of 80 cases. Braz J Otorhinolaryngol. 2008;74(2):253-59.Lee JK, Kim HD, Lim SC. Predisposing factors of complicated deep neck infection: an analysis of 158 cases. Yonsei Med J. 2007;48(1):55-62.Igoumenakis D, Gkinis G, Kostakis G, Mezitis M, Rallis G. Severe odontogenic infections: causes of spread and their management. Surg Infect (Larchmt). 2014;15(1):64-8.Rao DD, Desai A, Kulkarni RD, Gopalkrishnan K, Rao CB. Comparison of maxillofacial space infection in diabetic and nondiabetic patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;110(4):e7-12.Akinbami BO, Akadiri O, Gbujie DC. Spread of odontogenic ifnfections in Port Harcourt, Nigeria. J Oral Maxillofac Surg. 2010;68(1):2472-77.Flynn TR, Shanti RM, Hayes C. Severe odontogenic infections, Part 2: Prospective outcomes study. J Oral Maxillofac Surg. 2006;64(7):1104-13.Huang TT, Liu TC, Chen PR, Tseng FY, Yeh TH, Chen YS. Deep neck infection: analysis of 185 cases. Head Neck. 2004;26(10):854-60.Hsu RF, Wu PY, Ho CK. Transcervical drainage for descending necrotizing mediastinitis may be sufficient. Otolaryngol Head Neck Surg. 2011;145(5):742-47.Varghese L, Mathews SS, Antony Jude Prakash J, Rupa V. Deep head and neck infections: outcome following empirical therapy with early generation antibiotics. Trop Doct. 2018;48(3):179-82.Liau I, Han J, Bayetto K, May B, Goss A, Sambrook P et al. Antibiotic resistance in severe odontogenic infections of the South Australian population – a 9- year retrospective audit. Aust Dent J. 2018;63(2):187-92.
O Líquen Plano Oral (LPO) é uma doença crônica imunologicamente mediada com potencial de malignização incerto. O objetivo desse artigo é relatar um caso de Carcinoma de Células Escamosas (CCE) diagnosticado em paciente com diagnóstico prévio de LPO. Paciente do sexo feminino, 69 anos, foi atendida durante uma campanha de diagnóstico precoce de câncer de boca realizada na cidade de Londrina/PR, sendo detectada uma lesão eritroplásica em língua e encaminhada para uma melhor avaliação. Na anamnese a paciente relatou que há 2 anos atrás foi diagnosticada com LPO através de biópsia em língua, não sendo proposto nenhum tratamento. Ao exame físico, observamos uma mancha eritematosa em borda lateral de língua do lado esquerdo, não apresentando nenhuma outra lesão na cavidade oral. Com a hipótese diagnóstica de eritroplasia, foi requisitada a lâmina da biópsia anterior para análise, que revelou características microscópicas incompatíveis com o diagnóstico de LPO. Optamos então por realizar uma nova biópsia e a análise histopatológica revelou ilhas de células epiteliais malignas invadindo o tecido conjuntivo, estabelecendo o diagnóstico de CCE. A paciente foi encaminhada para tratamento, sendo realizada glossectomia parcial. Em acompanhamento de 6 meses a paciente encontra-se bem e sem sinais de recidiva. A transformação maligna do LPO ainda é discutida na literatura e muitos casos relatados podem se tratar de erro no diagnóstico inicial, como no caso apresentado. O erro de diagnóstico pode levar a morbidades importantes e comprometer o prognóstico do caso.Descritores: Diagnóstico; Líquen Plano; Carcinoma de Células Escamosas.ReferênciasGiuliani M, Troiano G, Cordaro M, Corsalini M, Gioco G, Lo Muzio L et al. Rate of malignant transformation of Oral Lichen Planus: a systematic review. Oral Dis. 2019; 25(3):693-709.Bardellini E, Amadori F, Flocchini P, Bonadeo S, Majorana A. Clinicopathological features and malignant transformation of oral lichen planus: a 12-years retrospective study. Acta Odontologica Scandinavica 2013;71(3/4):834-40.Eisen D. The clinical features, malignant potential, and systemic associations of oral lichen planus: a study of 723 patients. J Am Acad Dermatol. 2002;46(2):207-14.Farhi D, Dupin N. Pathophysiology, etiologic factors, and clinical management of oral lichen planus, part I: facts and controversies. Clin Dermatol. 2010;28(1):100-8.Roopashree MR, Gondhalekar RV, Shashikanth MC, George J, Thippeswamy SH, Shukla A. Pathogenesis of oral lichen planus – a review. J Oral Pathol Med. 2010;39(10):729-34.van der Meij EH, van der Waal I. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications. J Oral Pathol Med. 2003;32(9):507-12.Kramer IR, Lucas RB, Pindborg JJ, Sobin LH. Definition of leukoplakia and related lesions: an aid to studies on oral precancer. Oral Surg Oral Med Oral Pathol. 1978;46(4):518-39.Aghbari SMH, Abushouk AI, Attia A, Elmaraezy A, Menshawy A, Ahmed MS et al. Malignant transformation of oral lichen planus and oral lichenoid lesions: a meta-analysis of 20095 patient data. Oral Oncology. 2017;68:92-102.Eisenberg E. Oral lichen planus:a benign lesion. J Oral Maxillofac Surg. 2000;58(11):1278-85. Alrashdan MS, Cirillo N, McCullough M. Oral lichen planus: a literature review and update. Arch Dermatol Res. 2016;308(8):539-51.Lodi G, Scully C, Carrozzo M, Griffiths M, Sugerman PB, Thongprasom K. Current controversies in oral lichen planus: report of an international consensus meeting. Part 2. Clinical management and malignant transformation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;100(2):164-78.Sousa FACG, Paradella TC, Brandão AAH, Rosa LEB. Líquen plano bucal versus displasia epitelial: dificuldades diagnósticas. Braz J Otorhinolaryngol. 2009;75(5):716-20.Rode M, Kogoj-Rode M. Malignant potential of the reticular form of oral lichen planus over a 25-year observation period in 55 patients from Slovenia. J Oral Sci. 2002;44(2):109-11.Van der Meij EH, Mast H, Van der Waal I. The possible premalignant character of oral lichen planus and oral lichenoid lesions: a prospective five-year followup study of 192 patients. Oral Oncol. 2007;43(8):742-48.Oliveira Alves MG, Almeida JD, Balducci I, Guimarães Cabral LA. Oral lichen planus: a retrospective study of 110 Brazilian patients. BMC Res Notes. 2010;3:157.Radochová V, Drˇízhal I, Slezák R. A retrospective study of 171 patients with oral lichen planus in the East Bohemia-Czech Republic–single center experience. J Clin Exp Dent. 2014;6(5):e556-61.Fitzpatrick S, Hirsch S, Gordon S. The malignant transformation of oral lichen planus and oral lichenoid lesions: a systematic review. J Am Dent Assoc. 2014;145(1):45-56.Bermejo-Fenoll A, Sánchez-Siles M, López-Jornet P, Camacho-Alonso F, Salazar-Sánchez N. A retrospective clinicopathological study of 550 patients with oral lichen planus in south-eastern Spain. J Oral Pathol Med. 2010;39(6):491-96.Chaiyarit P, Ma N, Hiraku Y, Pinlaor S, Yongvanit P, Jintakanon D et al. Nitrative and oxidative DNA damage in oral lichen planus in relation to human oral carcinogenesis. Cancer Sci. 2005;96:553-59.Georgakopoulou EA, Achtari MD, Achtaris M, Foukas PG, Kotsinas A. Oral lichen planus as a preneoplastic inflammatory model. J Biomed Biotechnol. 2012;2012:759626.Accurso BT, Warner BM, Knobloch TJ, Weghorst CM, Shumway BS, Allen CM et al. Allelic imbalance in oral lichen planus and assessment of its classification as a premalignant condition. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;112(3):359-66.
Simple Bone Cyst (SBC) is an uncommon jaw lesion considered a "pseudocyst" because the lack of epithelial lining. In turn, xanthomatous cells are abnormal macrophages, also called histiocytes, characterized by the abundant presence of lipid content. They are mainly related to a soft tissue injury called xanthoma, but can also be found in pre-existing intraosseous lesions or in intraosseous xanthoma variations. Thus, the objective of this study is to report a case of a 16-year-old male patient, referred with an asymptomatic radiolucent lesion in the right coronoid process. The cone-beam computed tomography confirmed the presence of an osteolytic lesion and an exploratory surgery was indicated.During the surgical procedure, an almost empty cavity was found, with small fragments of soft yellowish tissue, which was removed. The microscopic analysis revealed the presence of xanthomatous cells. After 3 months a total bone healing was noted. Clinical and radiographic follow-up of the case was performed for 1 year, without signs of recurrence.It is very important the association of clinical and histopathological characteristics for the diagnosis, mainly in cases with atypical radiographical, clinical and histopathological presentation.
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