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Resumen La esclerodermia pertenece a un grupo de enfermedades autoinmunes del tejido conectivo que produce inflamación, disfunción vascular y fibrosis excesiva del tejido de soporte de la piel y los órganos viscerales. A nivel bucal se presentan afecciones como la xerostomía y la microstomía, así como caries y enfermedad periodontal por dificultades en el control de la placa bacteriana. Su tratamiento odontológico requiere un manejo integral, que comprenda las patologías bucales presentes y los síntomas permanentes característicos de la enfermedad. Si bien es una patología muy infrecuente en la práctica general, es necesario enfatizar la importancia de que el odontólogo cumpla un rol multidisciplinario en el tratamiento de estos pacientes. Esta revisión narrativa tiene por objetivo describir las manifestaciones bucomaxilofaciales y el manejo odontológico del paciente con esclerodermia.
Abstract Scleroderma belongs to a group of autoimmune connective tissue diseases that causes inflammation, vascular dysfunction and excessive fibrosis of the supporting skin tissue and visceral organs. In the mouth, conditions such as xerostomia and microstomy are evident, as well as caries and periodontal disease due to difficulty in bacterial plaque control. Its dental treatment requires an integral management, which includes the oral pathologies present and the characteristic permanent symptoms of the disease. Although this pathology is not very common in the general practice, it is necessary to emphasize the importance of the dentist playing a multidisciplinary role in the treatment of these patients. This narrative review aims to describe the oral and maxillofacial manifestations and the dental management of patients with scleroderma.
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INTRODUCTION: Epidermolysis bullosa (EB) is a group of genetic disorders characterized by fragility of the skin and mucosal membranes. Dystrophic EB (DEB) is caused by mutations in the gene coding for type VII collagen. Among the most frequent oral manifestations in Recessive DEB (RDEB) are oral ulcers and blisters, absence of tongue papillae and palatal rugae, ankyloglossia, oral vestibule obliteration, and microstomia. The following report describes a modified impression technique used in a patient with severe RDEB and severe microstomia to obtain models for orthodontic treatment with aligners. CASE REPORT: A 25-year-old female patient with severe RDEB was referred for orthodontic treatment. Severe microstomia (8 mm), hindered the use of conventional trays or intraoral scanners to design the aligners. Therefore, a contracture release surgery in combination with a modified impression technique was performed to obtain an optimal impression and subsequent aligners for orthodontic treatment. DISCUSSION: This case presents an alternative strategy to provide orthodontic treatment with aligners in patients with severe microstomia due to severe RDEB. Reports of orthodontic treatment in people living with EB, especially in RDEB, are still rare, with few publications about fixed braces, early teeth extraction and removable devices, and none using aligners. Most of the impression techniques reported are aimed at oral rehabilitation. The multidisciplinary approach and impression technique reported should broaden the alternatives of orthodontic techniques provided to patients with EB and severe microstomia. CONCLUSIONS: This article describes an oral contracture release surgery and modified impression technique for obtaining good quality impression for the design of orthodontic aligners in patients with severe microstomia due to severe RDEB.
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Introdução: a Epidermólise Bolhosa hereditária (EB) é uma doença rara, caracterizada por formações de bolhas na pele e nas mucosas que sofrem mínimos traumas ou aparecem espontaneamente. As principais divisões de EB são Epidermólise Bolhosa Simples, Epidermólise Bolhosa Juncional, Epidermólise Bolhosa Distrófica e a Síndrome de Kindler. As manifestações bucais geralmente encontradas nos pacientes com EB são as bolhas no epitélio oral, microstomia, anquiloglossia, doença periondontal, hipoplasia do esmalte, cárie dentária, atrofia da maxila e prognatismo mandibular, variando para cada tipo da doença. Objetivo: relatar as manifestações bucais dos portadores de Epidermólise Bolhosa residentes no município de Barra da Estiva. Metodologia: trata-se de um estudo transversal, quantitativo e descritivo que foi desenvolvido no município de Barra da Estiva BA com a população de portadores de Epidermólise Bolhosa, através da realização de anamnese e exame clínico. Estatística descritiva foi utilizada para tabular os dados coletados. Resultados: foram analisados 5 portadores de Epidermólise Bolhosa, a maioria do sexo masculino (60%), com média de idade de 5,6 anos. As manifestações bucais encontradas foram bolhas orais (100%), anquiloglossia (100%), língua despapilada (100%), hipoplasia de esmalte (80%), cárie (40%) e abertura de boca limitada em média de 28,6 mm. Conclusão: os portadores de Epidermólise Bolhosa apresentaram manifestações orais características da doença, tendo como consequências maiores dificuldades para realizar higienização bucal e tratamento odontológico, sendo necessário conhecimento prévio dos cirurgiões-dentistas para o atendimento desses pacientes.
Introduction: inherited Epidermolysis Bullosa (EB) is a rare disease, characterized by blistering of the skin and mucous membranes that suffer minimal trauma or appear spontaneously. The main divisions of EB are Simple Epidermolysis Bullosa, Junctional Epidermolysis Bullosa, Dystrophic Epidermolysis Bullosa and Kindler Syndrome. The oral manifestations usually found in patients with EB are blisters in the oral epithelium, microstomy, ankyloglossia, periodontal disease, enamel hypoplasia, dental caries, atrophy of the jaw and mandibular prognathism, varying for each type of disease. Objective: to report the oral manifestations of Epidermolysis Bullosa patients living in the municipality of Barra da Estiva. Methods: cross-sectional study, quantitative and descriptive that was developed in the municipality of Barra da Estiva-BA with the population of people with Epidermolysis Bullosa, through anamnesis and clinical examination. Descriptive statistics was used to tabulate the data collected. Results: 5 children with Epidermolysis Bullosa were analyzed, most male (60%), with an average age of 5,6 years. Oral manifestations found were oral blisters (100%), anquiloglossia (100%), loss of papillae of the tongue (100%), enamel hypoplasia (80%), tooth decay (40%) and mouth opening limited to the average of 28.6 mm. Conclusion: epidermolysis Bullosa children presented oral manifestations common to the disease, leading to difficulties in performing oral hygiene and dental treatment, requiring prior knowledge of dental surgeons for the care of these patients.
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Humanos , Masculino , Feminino , Pré-Escolar , Criança , Manifestações Bucais , Vesícula , Epidermólise Bolhosa , Hipoplasia do Esmalte Dentário , Microstomia , Demografia , Epidemiologia Descritiva , Estudos de Avaliação como AssuntoRESUMO
A microstomia ocorre em 70% dos pacientes com esclerose sistêmica e há poucas opções terapêuticas. Descrevemos caso de mulher de 39 anos com diagnóstico de esclerose sistêmica em 2010, em uso de micofenolato de mofetil e rituximabe, apresentando microstomia. Foram realizadas duas sessões de luz intensa pulsada e sete sessões de laser fracionado ablativo Erbium:YAG de 2940nm, com resposta clínica importante. A formação e reorganização de fibras colágenas e elásticas foram responsáveis pela melhora da microstomia. Há poucos estudos com o uso de tecnologias para a abordagem da microstomia. Este é o primeiro com Er:YAG 2940nm para esta finalidade
Facial surgeries are often challenging for surgeons due to their complex anatomy, aesthetic and functional importance. Interventions in the cosmetic subunit that comprises the eyebrows can be particularly difficult. This case report aims to demonstrate the use of island flap in this region. We performed the excision of melanocytic nevus, with a good outcome and absence of postoperative complications. This technique is commonly used for facial reconstruction; however, the literature describes only a few cases using this method for eyebrow reconstruction.
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OBJETIVO: Esse estudo teve como propósito verificar, por meio da fotogrametria computadorizada, a eficácia do uso da órtese oral como auxiliar na terapia fonoaudiológica. MÉTODO: Após a documentação fotográfica, cada paciente foi submetido a terapia fonoaudiológica, por meio da terapia miofuncional orofacial, associada ao uso da órtese oral, confeccionada segundo Borges et al. (2011). Ao término do tratamento, foi realizado novo registro fotográfico, em seguida, a mensuração da dimensão vertical (distância entre lábio superior/inferior) e horizontal (distância entre comissuras direita/esquerda), com o uso do programa Corel Draw X3. RESULTADOS: As médias da abertura bucal aumentaram da avaliação inicial para a avaliação final, tendo aumentado 5,1 mm no sentido horizontal (67,3 mm para 72,4 mm) e 13,9 mm no sentido vertical (de 32,7 mm para 46,6 mm). Essas diferenças se revelam significativas para as avaliações (p <0,05). CONCLUSÃO: O uso da órtese oral associado a terapia fonoaudiológica demonstrou ser eficaz como mais um instrumento na prevenção da microstomia.
OBJECTIVES: The aim of this study was to through computerized photogrammetry, the efficacy of oral orthosis as an aid in speech therapy. METHODS: After the photographic documentation, each patient underwent speech therapy, through orofacial myofunctional therapy, associated with the use of an oral orthosis, made according to Borges et al. (2011). At the end of the treatment, a new photographic record was taken, then the vertical dimension measurement (distance between upper lip) and horizontal (distance between corners right/left), using the program Corel Draw X3. RESULTS: The mean mouth opening increased from the initial evaluation to the final evaluation, increasing 5.1 mm in the horizontal direction (67.3 mm to 72.4 mm) and 13.9 mm in the vertical direction (from 32.7 mm to 46.6 mm). These differences are significant for the evaluations (p<0.05). CONCLUSION: The use of oral orthosis associated with speech therapy proved to be effective as another tool in the prevention of microstomia.
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Humanos , Queimaduras/reabilitação , Fotogrametria/instrumentação , Fonoaudiologia/métodos , Microstomia/terapia , Reabilitação Bucal/métodos , Aparelhos Ortopédicos/provisão & distribuição , Estudos Longitudinais , Terapia Miofuncional/instrumentaçãoRESUMO
AIM: To report the rehabilitation of a female patient, 40 years old, with a microstomia. CASE REPORT: The Z-plasty surgery was performed in the region of the labial commissure to increase the mouth opening. In the mandible, two implants were installed in the interforaminal region and an overdenture with bar/clip attachment system was made. The maxilla was atrophic, with the presence of two bone sites in the intermaxillary suture region: the first one anterior to the incisive foramen and the second one in the middle of the hard palate. Two implants were placed without a graft in those sites. The conventional maxillary denture was converted into an overdenture with ball attachments system. CONCLUSION: Based on the presented case, with a 2-year follow-up, it can be concluded the validity of the use of the techniques of surgeries to increase the mouth opening, implants in intermaxillary suture and overdentures as rehabilitation therapy for patients with microstomia.
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Arcada Edêntula , Microstomia , Adulto , Prótese Ancorada no Osso , Prótese Dentária Fixada por Implante , Retenção de Dentadura , Revestimento de Dentadura , Feminino , Seguimentos , Humanos , Mandíbula , SuturasRESUMO
La esclerodermia pertenece a un grupo de enfermedades autoinmunes del tejido conectivo, que produce: inflamación, disfunción vascular y fibrosis excesiva del tejido conectivo de soporte de la piel y los órganos viscerales. A nivel bucal se evidencian afecciones como xerostomía, microstomía, caries y enfermedad periodontal. El tratamiento odontológico requiere un manejo integral por parte de los profesionales, que comprenda las patologías orales presentes y los síntomas permanentes característicos de la enfermedad sistémica de base. El objetivo de este artículo es presentar dos casos de esclerodermia resaltando sus manifestaciones orales presentes.
Scleroderma belongs to a group of autoimmune connective tissue diseases that causes inflammation, vascular dysfunction and excessive fibrosis of the connective tissue supporting the skin and visceral organs. A level oral conditions such as xerostomia, microstomia, caries and periodontal disease are evident. Dental treatment requires a comprehensive management by professionals who understand oral pathologies and permanent characteristic symptoms of systemic disease. The aim of this paper is to present two cases of scleroderma highlighting present oral manifestations.
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Difficulty in dental management is one of the factors that characterize the patient that requires special care in dentistry. One of the clinical conditions that make dental treatment particularly complex is microstomia. Microstomia is defined as a small and insufficient oral aperture that will hinder diagnosis and dental treatment. Although there have been reports of patients with diseases and syndromes that cause microstomia, the available literature offers only a limited number of reviews on this topic. The aim of this paper is to present a review of the etiology, clinical characteristics, diagnosis and treatment of microstomia. In addition, to describe the therapeutic adaptations to be applied in dental procedures in patients with microstomia, emphasizing the importance of a preventive approach in this group of patients...
La dificultad en el manejo odontológico es uno de los factores que definen al paciente que requiere cuidados especiales en odontología. Una de las situaciones clínicas que más dificulta el tratamiento dental es la microstomia. La microstomia se define como una apertura bucal pequeña e insuficiente que va a dificultar el diagnóstico y el tratamiento bucodental. Aunque se han descrito casos clínicos de pacientes con enfermedades y síndromes que cursan con microstomia, no hay muchas revisiones del tema en la literatura. El objetivo de este artículo es presentar una revisión sobre la etiología, la clínica, el diagnóstico y el tratamiento de la microstomia. Así como, describir las adaptaciones terapéuticas que se deben aplicar en los procedimientos dentales en el paciente con microstomia, recalcando la importancia de un enfoque preventivo en este grupo de pacientes...
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Humanos , Microstomia/diagnóstico , Microstomia/etiologia , Microstomia/terapiaRESUMO
Las cicatrices post-quemaduras de labio superior, originadas en quemaduras de espesor parcial profundo suelen provocar importantes secuelas estéticas y funcionales al perder la elasticidad y complacencia de la piel sana por placas cicatrizales rígidas e hipertróficas. Estas secuelas, de por si, suelen provocar la limitación de la apertura bucal. La condición fundamental para la reparación de esta secuela consiste en devolver la elasticidad normal al área cicatrizal. Por eso para la cobertura de áreas funcionales y móviles es ideal el aporte de piel sana mediante la realización de colgajos que permitan lograr un buen resultado funcional y aceptable aspecto lo estético. En el caso del labio superior la presencia de pelo, en el varón permite un rudimentario bigote, que permitiría ocultar al paciente otras cicatrices y/o asimetrías del área. Las posibilidades existentes para reemplazar la unidad completa de labio superior aportando pelo para el bigote no son tantas especialmente en el paciente com secuelas de quemadura peribucal. El colgajo de cuero cabelludo resulta muy grueso con alta densidad pilosa y rígido para la movilidad fina que requiere el labio superior, resultando en un pobre resultado estético y funcional. Se presenta el caso de un paciente con una microstomía severa cuya reparación, además de la comisuroplastía, se realizó con un colgajo interóseo posterior a distancia, como novedad, aportando buena elasticidad y naturalidad en la densidad pilosa.
The post-burn scars upper lip, originated in deep partial thickness burns usually cause significant aesthetic and functional sequelae to lose elasticity and healthy skin complacency by rigid plates and hypertrophic scarring. These consequences, in itself, often cause the limitation of mouth opening. The fundamental condition for the repair of this sequel is to restore normal elasticity scar area. So for functional area coverage and mobile is ideal healthy skin input by conducting flaps to achieve an acceptable good functional and aesthetic aspect. In case the presence of the upper lip hair in the male enables a crude mustache, which would hide the patient other scars and / or asymmetries in the area. The options available to replace the complete unit providing upper lip hair for the mustache are not many especially in patients with perioral burn sequelae. The scalp flap is very thick and densely hairy mobility rigid for the thin upper lip required, resulting in a poor aesthetic and functional result. We report the case of a patient with a severe microstomia whose repair work and the commissuroplasty, was performed with a posterior interosseous flap remote, as new, providing good elasticity and natural in hair density.
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Humanos , Queimaduras , Lábio , MicrostomiaRESUMO
O tratamento da microstomia é frequentemente um desafio no dia-a-dia do tratamento das sequelas de queimaduras. De maneira geral, as técnicas utilizadas são complexas, com resultados muitas vezes insatisfatórios e com alta taxa de recidiva. O presente trabalho teve como objetivo apresentar um caso grave de microstomia em uma criança de 2 anos, que teve sua resolução alcançada de forma simples, prática e econômica em contrapartida aos métodos tradicionais que muitas vezes são caros, complexos e pouco práticos.
The microstomia treatment is still a challenge in the day by day of the burn sequelae treatment. Usually, the techniques are complex, with poor results and high incidence of recurrence. This study presents a severe case of microstomia in a 2 years old child. The solution was simple, and cheap, in comparison to the traditional surgical methods, usually expensive, complex and low acessibility in a small Center.
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Humanos , Feminino , Pré-Escolar , Aparelhos Ortopédicos/provisão & distribuição , Queimaduras/complicações , Microstomia/etiologia , Microstomia/terapiaRESUMO
Se describe el caso de una mujer de 63 años con microstomía ocasionada por la ingesta accidental en la infancia de una sustancia química. La poca apertura oral que le imposibilitaba sonreír además de impedirle el acceso a los procedimientos odontológicos, alteraba su calidad de vida. Es remitida al Servicio de Cirugía Plástica donde se le reseca la brida cicatrizal con ®W¼-plastia, comisuroplastia bilateral y como se logra ampliar su orificio oral de 2.5 a 4.8 cm, se resuelven los síntomas principales con mejoría del factor social y de la calidad de vida.
A case of a 63 year old woman with microstomia caused by accidental swallowing of a chemical substance when she was a child is presented. The small mouth opening didn´t let her smile or receive dental services and decreased her life quality. She is remitted to Plastic Surgery Service, where an excision of scar contracture with W-plasty and bilateral commisuroplasty were made, improving oral opening from 2.5 to 4.8 cm and providing a better social environment and life quality.