Paroxysmal nocturnal hemoglobinuria (PNH) is a hematological disorder that affects hematopoietic stem cells. An association with other hematological diseases, such as hemolytic anemia and neutropenia, is observed with a high occurrence of aplastic anemia. The aim of the present study is to report a case of dental infection in a patient with PNH exhibiting exuberant gingival involvement. A 45‐year‐old male patient sought the Federal University of Ceara reporting severe toothache associated with tooth 24. Clinical examination revealed that the tooth was associated with an apparent fistula and a yellowish lesion with smooth surface located in the palate. The patient had interrupted the medication to control PNH. Blood transfusion was requested due to deficient hematological parameters. Tooth extraction and excisional biopsy were performed under antibiotic coverage. In the postoperative period, low‐level laser therapy (LLLT) was performed. Histopathological examination revealed connective tissue showing extensive necrotic areas, accumulation of basophilic material, numerous cyst‐like cavities, and degenerated cells. Histopathological findings were compatible with the initial clinical diagnosis of gingival necrosis. The patient evolved with febrile neutropenia, requiring hospitalization for 1 month. Improvement in the overall health was observed after the administration of antibiotics, eculizumab, and weekly LLLT at the biopsy site.
Background
Malignant neoplasms that affect children and adolescents are predominantly embryonic and generally affect blood system cells and supporting tissues.
Aim
This study aimed to summarize the scientific evidence about the prevalence of malignant lesions in the oral cavity of children and adolescents.
Design
In this systematic review and meta‐analysis (PROSPERO CRD42020158338), data were obtained from seven databases and the gray literature. Cross‐sectional observational studies on the prevalence of biopsied oral pediatric malignancies were included. The Newcastle‐Ottawa Scale assessed the quality of the included studies, and the GRADE approach evaluated the evidence certainty. The meta‐analysis prevalence was calculated using MedCalc® software, adopting a 95% confidence level (CI; random‐effect model).
Results
Forty‐two studies were included in the meta‐analysis. Of the 64,522 biopsies, the prevalence of malignant lesions was 1.93% (n = 1,100; 95% CI = 1.21%‐2.80%). Countries with a low socioeconomic profile showed the highest prevalence. The sample size did not influence the prevalence of oral malignancies, and unspecified lymphomas (12.08%; 95% CI = 5.73%‐20.37%) and rhabdomyosarcoma (10.53%; 95% CI = 7.28%‐14.30%) were the most common lesions.
Conclusions
Oral malignant lesions biopsied in children and adolescents had a prevalence of <3%, and lymphomas and sarcomas were the most prevalent lesions.
Bone marrow transplantation (BMT) has been used to treat numerous malignant and non-malignant hematological diseases, genetic and immunological diseases with a high risk of oral mucositis (OM) due to the action of antineoplastic drugs. As photobiomodulation therapy (FBMT) with low-level laser is a proven non-invasive treatment for OM, the objective of this study was to evaluate the incidence of OM in patients on BMT undergoing FBM. 53 patients undergoing treatment received FBMT (red laser, 2J, 20s, 100mW) as a preventive protocol. If MO was observed, an infrared laser (4J, 40s, 100W) was administered. The following data were collected from patients' medical records: sex, age, chemotherapy protocol (QT) and type of BMT. An incidence of 34% was observed in the population studied (20% grade I, 11.3% grade II and 1.9% grade III). Prevention protocols using FBMT significantly reduced the incidence of oral mucositis (p = 0.004). Now, young patients with myeloid leukemia, the time between QT and BMT (p = 0.010) and time of QT (p = 0.018) were directly associated with the increased incidence of oral mucositis. It was concluded that low-intensity preventive laser therapy was associated with a reduction in the incidence of oral mucositis, showing the importance of this therapy in the management of patients undergoing BMT.
Background
Trismus is a common adverse effect in patients with head and neck cancer. Patients have a limitation of mouth opening (< 35mm), which can compromise maxillomandibular function. The cancer treatment itself can lead to its emergence, with surgery and radiotherapy being the most involved. This study aimed to evaluate the efficacy of a PBMT protocol for treating and reducing the severity of trismus in patients undergoing radiotherapy for head and neck cancer.
Material and Methods
Sixteen patients who had a mouth opening < 35mm and were undergoing RT were included. The patients were evaluated daily before and after the PBMT application, measuring mouth opening and performing pain scores for the masticatory muscles using the VAS scale. We used the infrared laser (~ 808nm) extraoral, 0.1W power, 3J energy, 30s (30.61/cm2) per point, applied to temporalis anterior, masseter, and TMJ muscles. We used one intraoral point with the same wavelength and energy density as the others for the medial pterygoid muscle.
Results
The mean mouth opening of the patients increased by more than 7 mm throughout the treatment. The pain scores on the initial days showed an immediate reduction after PBMT on the ipsilateral side in the muscles and TMJ. Throughout PBMT applications, there was a significant reduction in pain scores in all muscles and the TMJ. The radiation dose of all patients was above 40Gy, which is the threshold dose for the risk of developing trismus. PBMT in patients with mouth opening < 35mm has been responsible for long-term improvement in mouth opening limitation and pain during mouth opening.
Conclusion
It is suggested that PBMT helps in pain control by anti-inflammatory muscle pathways. Further studies are needed to evaluate the preventive capacity of this or other PBMT protocols in trismus related to RT of HNC.
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