OOOO Volume 129, Number 1 KARINE CESTARO MESQUITA, SARA MARIA SILVA, KARUZA MARIA ALVES PEREIRA, FABRICIO BITU SOUSA, ANA PAULA NEGREIROS NUNES ALVES and, MARIO ROGERIO LIMA MOTA Immunosuppression consists in a risk factor for opportunistic infections or diseases, many of them with oral manifestations. A 37-year-old man who had undergone kidney transplant 4 years ago was referred to our service for evaluation of bilateral palate ulcers on suspicion of lymphoproliferative disease. Clinically, 2 shallow, symmetric, and painful ulcers in hard palate mucosa with gingival involvement were observed. The periodontal examination did not show any alteration; however, the leukocyte counts revealed neutropenia, suggesting association with the injury. Incisional biopsy was performed under antibiotic coverage, and the patient was later hospitalized because of worsening neutropenia and the oral ulceration. Histopathologic examination was compatible with neutropenic ulcer, and it presented spontaneous improvement concomitant to elevation of the number of neutrophils. The patient remains under follow-up with progressive clinical improvement. Therefore, neutropenia contributes to the development of nonspecific oral lesions, and the association between clinical and hematologic examination is important for appropriate diagnosis and treatment.
CENTRAL GIANT CELL GRANULOMA: A CASE REPORT. SAMARA ANDREOLLA LAZARO, HENRIQUE CESCA, TIAGO NASCIMENTO MILETO, FRANKLIN DAVID GORDILLO YEPEZ, CASSIAN TAPARELLO, GABRIELA CAOVILLA FELIN and, FERDINANDO DE CONTO A 35-year-old male patient had a history of increased volume and discomfort in the right mandibular region for approximately 3 years. Clinical examination revealed a facial asymmetry due to poorly defined swelling in the right body of the jaw. Intraoral examination showed a diffuse swelling in the alveolar part of the 41 to 46 region with obliteration of the buccal vestibule in the same region and tooth mobility, which was proposed on palpation of firm consistency. Computed tomography shows the bone expansion of the buccal and lingual cortices and the bone fenestration. Incisional biopsy results led to diagnosis of central giant cell granuloma. The treatment consists of the Erichs arch bar followed by resection and reconstruction of the tumor mass with rigid internal fixation material, a 2.4-mm system, and corticoid therapy. After 1 year of follow-up, the patient presented recurrence of the lesion, and curettage was instituted followed by the patient receiving clinical and radiographic follow-up.
APPROACH OF CLINICAL MANIFESTATIONS OF RAMSAY HUNT SYNDROME TYPE II IN THE MAXILLOFACIAL COMPLEX IN ONCOLOGICAL PATIENT. SAMARA ANDREOLLA LAZARO, FRANKLIN DAVID GORDILLO YEPEZ, HENRIQUE CESCA, CASSIAN TAPARELLO, TIAGO NASCIMENTO MILETO, GABRIELA CAOVILLA FELIN and, RENATO SAWAZAKI Ramsay Hunt syndrome is characterized by hemifacial paralysis of peripheral nerves, otitis, and ipsilateral redness in the auricle. A female patient in the seventh decade of life undergoing chemotherapy treatment for adenocarcinoma of the
endometrium presented ipsilateral hemifacial paralysis, referring odynophagia, dysphagia, and dysphonia. Clinical examination revealed ulcerations and blistering lesions with crust formation in the left auricular pavilion as well as surrounding erythema on the skin, such manifestations also present in the cervical and cranial regions. Intraoral examination presented numerous herpetic erosions in the palatal and lingual region only on the left side. From the clinical and imaging findings, the diagnosis of Ramsay Hunt syndrome type II was established. The treatment was performed using acyclovir, laser therapy (low-intensity laser), and oral hygiene with 0.12% chlorhexidine digluconate. After 45 days of treatment, the patient had complete remission of the herpetic lesions, but hemiparalysis did not have a complete regression.
ROOT CYST IN A DENS INVAGINATUS WITH EPITHELIAL PLAQUES SIMILAR TO SQUAMOUS ODONTOGENIC TUMOR. CAMILLA PALMEIRA ESTEVES, JULIA VIANNA NERI ANDRADE REIS, LIVIA ANDRADE VITORIA, LUCIANA MARIA PEDREIRA RAMALHO, NAIADJA DE SANTANA CERQUEIRA, VIVIANE PALMEIRA DA SILVA and, ANDRE CARLOS DE FREITAS Periapical lesions related to dens invaginatus are rare and usually involve upper lateral incisors. Its malformation is caused by the invagination of the crown or root in odontogenesis. A 37year-old female patient presented to the clinic with swelling in the anterior region of the maxilla. Radiographically, cystic lesion between teeth 1.1 and 1.2 was observed with the presence of an invaginated tooth associated with the 1.2. Pulp vitality was positive for both teeth. The lesion was enucleated, and anatomopathologic examination revealed a cystic lesion with a fibrous wall containing epithelial plaques similar to squamous odontogenic tumor and microabscesses. Ten months after surgery there was recurrence of the lesion, and a new enucleation was performed with curettage and removal of the dens invaginated. The histopathologic examination defined the diagnosis as a root cyst associated with a dens invaginated. It has been undergoing follow-up for 10 months with no signs of recurrence.
NECROTIZING SIALOMETAPLASIA OF MINOR SALIVARY GLAND: REPORT OF 2 NEW CASES. MARIA DANIELLE C. DA COSTA FONTES, MATEUS DUTRA, BEATRIZ CORDEIRO, LUANA DARC DIAFILOS TEIXEIRA, e MICHELLE AGOSTINI, MARIO JOSE ROMANACH and, BRUNO AUGUSTO BENEVENUTO DE ANDRADE Necrotizing sialometaplasia is a benign self-limiting inflammatory reaction that mainly occurs in the minor salivary glands of the hard palate, mimicking malignancy. Case 1 involved a 32year-old man with a painful ulcerated swelling in the hard palate lasting 3 weeks. Case 2 involved a 63-years-old man presenting a painless ulcer of 2-week duration located in the hard palate. Microscopically, both cases showed salivary glands with preserved lobular architecture containing acini with variable degrees of degeneration and foci of ductal squamous metaplasia. Both lesions regressed completely after incisional biopsy. Oral clinicians and pathologists should consider necrotizing sialometaplasia when evaluating oral ulcerated lesions located in the hard palate.