Schwannomas are benign tumors of the peripheral nerve sheath originating from Schwann cells, which can manifest in head and neck regions and are rare in the oral cavity, especially their involvement in the maxillary alveolar ridge, which is even more atypical. Among all its variants, plexiform schwannoma is characterized by an intraneural multinodular growth.Its differential diagnosis of plexiform neurofibroma is justified by the fact that the latter is pathognomonic for neurofibromatosis and carries great risks of malignancy. In this paper, we present a rare clinical case report of a plexiform schwannoma in a gingival alveolar ridge in a 33-year-old male patient, in which we describe his clinical, histopathological, immunohistochemical aspects and his due approach which, after incisional biopsy diagnosed with plexiform schwannoma, was approached for excision of the lesion by the maxillofacial surgery of Hospital das Cínicas, University of São Paulo Medical School, as well as their respective 7, 14 and 30 day postoperative periods, no signs of recurrence so far. Therefore, in these cases, we emphasize the importance of a thorough clinical examination and the need for additional tests, such as histopathological and immunohistochemical analyzes to determine the correct diagnosis and promote the appropriate treatment.
Desde o início da pandemia da COVID-19, em dezembro de 2019, muitos pacientes infectados relataram alterações de paladar e olfato como primeiros sintomas. O cirurgião-dentista deve estar capacitado para diagnosticar esta sintomatologia e encaminhar o paciente para serviços de saúde especializados. O presente estudo se propôs a realizar uma revisão narrativa sobre a possível patogênese da disgeusia e ageusia em pacientes infectados pelo SARS-CoV-2. Os dados foram coletados a partir de estudos identificados nos bancos de dados BVS, Google Acadêmico, LILACS, PubMed, SciELO e Web of Science, utilizando-se como descritores: disgeusia, ageusia, fisiopatologia e coronavírus. Dentre os possíveis mecanismos para a disgeusia, destacam-se a invasão viral em tecido nervoso, acometimento secundário às alterações de olfato, relação com comorbidades e medicamentos, associação à grande presença do vírus na saliva e sua alta afinidade pelos diversos receptores da enzima conversora de angiotensina-2 presentes na cavidade bucal. Portanto, alterações de paladar são sintomas típicos em pacientes infectados pelo SARS-CoV-2 e que tendem a regredir com o tempo. Entretanto, sua fisiopatologia, mecanismo de ação e prognóstico ainda não são bem estabelecidos, exigindo mais estudos experimentais.
Surgical dental treatment for cancer patients requires more alertness in propaedeutics when in comparison to normoreactive subjects. Therapy must always be appropriate to the individual's clinical and systemic condition. Under those circumstances, we report a female patient, 51 years old, leucoderma, with a previous history of breast carcinoma. She underwent surgical excision, radiotherapy, and reconstruction of the right breast. The patient described experiencing pain around the 14 tooth area. Clinical and radiographical observations revealed the presence of a protuberance in the vestibule-distal region and in the alveolar ridge of the tooth. The protuberance is related to the local anatomy and previous exodontia, which occurred due to extensive coronary loss, deflection of the remaining cusps, presence of gingival hyperplasia covering the crown, endodontic treatment with the absence of gutta-percha in the region of the pulp chamber, and ankylosis. In her medication history, there was no use of anti-resorptive drugs, which would represent a surgical contraindication. The surgical planning for the region of the 14 tooth included flap making and vestibular and bone spike osteoplasty, with beveling of the osteotomy margins. An antibiotic was prescribed for 7 days and the patient should start taking it 2 days before the surgery. The subject had good post-surgical tissue repair and probable posterior prosthetic rehabilitation. Therefore, it is fair to conclude that careful anamnesis sets up an adequate surgical propaedeutics with a good prognosis, which may improve the quality of life of cancer patients.
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