RESUMO
BACKGROUND: Odontogenic cutaneous fistulas arise as a sequel of bacterial invasion of the dental pulp, become necrotic, and infection spreads into the periradicular area resulting in dissection and breakthrough to form sinus tracts that drain towards the skin. The objective of this study was to investigate the clinical and epidemiologic characteristics of patients diagnosed with odontogenic cutaneous fistulas. METHODS: A retrospective study was done between January 2001 and December 2011. Cases were included with a clinical and radiological diagnosis of odontogenic cutaneous fistulas. The variables investigated were frequency, gender, age, localization, morphology, time of evolution, and referral clinical diagnosis. Data were analyzed using descriptive statistical methods. RESULTS: During an 11-year period, 75 cases were found. Female gender predominated with 53% of the cases, and the mean age was 45 ± 26 years. The most frequent location was the mandible angle, in 36% of the cases, and the most common morphology was a nodule, in 52%. The mean time of evolution was 8 ± 11 months. The referral clinical diagnosis was odontogenic cutaneous fistulas in 51% of the cases. CONCLUSIONS: Our results are similar to those previously published-the diagnosis was suspected in only half of the cases. We consider it important that odontogenic cutaneous fistulas be included among the differential diagnosis of cutaneous facial lesions to avoid delaying appropriate treatment.
Assuntos
Fístula Cutânea/patologia , Fístula Dentária/patologia , Dente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Fístula Cutânea/epidemiologia , Fístula Dentária/epidemiologia , Face , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
INTRODUCTION: Interleukin (IL)-17 expression has been detected in apical periodontitis lesions, but its role in the disease process remains unclear. The present study compared the expression of IL-17 in periradicular cysts and granulomas and evaluated the association of this cytokine with clinical and radiographic findings. METHODS: Apical periodontitis lesions (18 cysts and 20 granulomas) were obtained from 38 patients subjected to periradicular surgery. Some clinical, radiographic, and cone-beam computed tomographic features were recorded. Silanized slides containing paraffin sections were used for the immunohistochemical reactions using anti-IL-17 antibody. Image analysis was performed using an optical microscope, and each sample was divided into 5 high-power fields, which were evaluated for the expression of IL-17 in the epithelium and connective tissues. Results were evaluated for correlations with the lesion size and the occurrence of symptoms and sinus tract. RESULTS: Expression of IL-17 was significantly higher in cysts than in granulomas (P = .02). Among the periradicular cysts, a thin epithelium showed significantly increased labeling for IL-17 when compared with a hyperplastic epithelium (P = .003). IL-17 expression was usually associated with focal accumulations of polymorphonuclear leukocytes. No association of IL-17 expression with symptoms, sinus tract, or lesion size was observed (P > .05). CONCLUSIONS: The present study reinforces the notion that IL-17 may take part in the pathogenesis of apical periodontitis lesions. A role in the exacerbation of chronic inflammation and cyst formation is suspected. Further studies are required to shed light on the specific functions of IL-17 in periradicular inflammatory processes.
Assuntos
Interleucina-17/análise , Periodontite Periapical/imunologia , Adulto , Tomografia Computadorizada de Feixe Cônico/métodos , Tecido Conjuntivo/imunologia , Tecido Conjuntivo/patologia , Fístula Dentária/imunologia , Fístula Dentária/patologia , Epitélio/imunologia , Epitélio/patologia , Feminino , Humanos , Hiperplasia , Processamento de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Neutrófilos/imunologia , Neutrófilos/patologia , Granuloma Periapical/diagnóstico por imagem , Granuloma Periapical/imunologia , Granuloma Periapical/patologia , Periodontite Periapical/diagnóstico por imagem , Periodontite Periapical/patologia , Cisto Radicular/diagnóstico por imagem , Cisto Radicular/imunologia , Cisto Radicular/patologiaRESUMO
INTRODUCTION: Cysts and periapical granulomas are inflammatory reactions that develop in response to periapical infection by microbial species in dental root canal. It is known that toll-like receptors (TLRs) are pathogen recognition molecules and that galectins are lectins that can be associated with the inflammatory process, stimulating or inhibiting the immune system. The objective of this study was to evaluate the in situ expression of TLRs and galectins in radicular cysts and periapical granulomas. METHODS: We analyzed 62 cases (30 radicular cysts, 27 periapical granulomas, and 5 control cases). Indirect immunohistochemistry was used to evaluate the expression of TLRs (TRL-2 and TLR-4) and galectins (Gal-3 and Gal-9). RESULTS: The expression of Gal-3 and Gal-9 was significantly higher in periapical granulomas and radicular cysts than in the control group. Similarly, both Gal-3 and Gal-9 were expressed significantly more in periapical granulomas than in radicular cysts. The expression of TLR-2 was significantly higher in periapical granulomas and radicular cysts than in the control group, and it was also significantly higher in radicular cysts with sinus tract than in the cases without sinus tract. Furthermore, the expression of TLR-4 was significantly higher in the cases of periapical granulomas with sinus tract than in the cases without sinus tract. CONCLUSIONS: Gal-3/Gal-9 and TLR-2/TLR-4 expression in the periapical granulomas and radicular cysts is associated with reactive periapical inflammation. Pathobiology of periapical disease is a very complex interplay of many bioactive molecules involved in immunoinflammatory responses. Up-regulation of these bioactive molecules might be an important modulator of inflammatory periapical lesions.
Assuntos
Galectina 3/análise , Galectinas/análise , Granuloma Periapical/metabolismo , Periodontite Periapical/metabolismo , Cisto Radicular/metabolismo , Receptor 2 Toll-Like/análise , Receptor 4 Toll-Like/análise , Biópsia/métodos , Proteínas Sanguíneas , Fístula Dentária/imunologia , Fístula Dentária/metabolismo , Fístula Dentária/patologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Granuloma Periapical/imunologia , Granuloma Periapical/patologia , Periodontite Periapical/imunologia , Periodontite Periapical/patologia , Cisto Radicular/imunologia , Cisto Radicular/patologiaRESUMO
La fístula dentoalveolar se desarrolla como una ruta de drenaje desde una lesión inflamatoria periapical, siguiendo el camino de menor resistencia, a través de hueso, periostio y mucosa. Puede salir a través de cualquier punto de la mucosa bucal o aún por la piel. Algunos profesionales están convencidos de que la presencia de una fístula indica una lesión seria que requiere cirugía apical e incluso la exodoncia. Sin embargo, su tratamiento tiene buen pronóstico, siendo la indicación correcta una adecuada terapia endodóntica no quirúrgica.
Assuntos
Humanos , Fístula Dentária/etiologia , Fístula Dentária/patologia , Periodontite Periapical/complicações , Fístula Dentária/microbiologia , Infecções Bacterianas/microbiologia , Prognóstico , Tratamento do Canal Radicular/métodosRESUMO
La fístula dentoalveolar se desarrolla como una ruta de drenaje desde una lesión inflamatoria periapical, siguiendo el camino de menor resistencia, a través de hueso, periostio y mucosa. Puede salir a través de cualquier punto de la mucosa bucal o aún por la piel. Algunos profesionales están convencidos de que la presencia de una fístula indica una lesión seria que requiere cirugía apical e incluso la exodoncia. Sin embargo, su tratamiento tiene buen pronóstico, siendo la indicación correcta una adecuada terapia endodóntica no quirúrgica.(AU)
Assuntos
Humanos , Fístula Dentária/etiologia , Fístula Dentária/patologia , Periodontite Periapical/complicações , Tratamento do Canal Radicular/métodos , Prognóstico , Infecções Bacterianas/microbiologia , Fístula Dentária/microbiologiaRESUMO
Hymenoptera order includes bees, which have a stinging apparatus at the tail capable of delivering venom to the affected tissues. Myocardial infarction, acute renal failure, Necrotizing fasciitis, fatal infection and hemifacial asymmetry, are some of the unusual reactions reported following hymenoptera stings. This paper reports a case of bee sting in the right floor of the nose that mimicked an odontogenic infection affecting the upper lip, canine space and nasal cavity such as in cases of infection secondary to pulpal or periodontal pathology of the anterior teeth. After a thorough clinical and radiographic examination, odontogenic infection was discarded and the diagnosis of floor of the nose mucosal lysis and lip abscess secondary to a bee sting was made. This case was successfully managed with adequate incision, drainage and antibiotics without any further complication. There are several reports of unusual reactions following hymenoptera stings. However, just a few of them referred to infections of local reactions and none of them related to the anatomic location affected in the patient of the present case. Early diagnosis and treatment prevented infection dissemination and the likelihood of tissue necrosis as in previously reported cases of Necrotizing fasciitis.
Assuntos
Abscesso/patologia , Fístula Dentária/patologia , Mordeduras e Picadas de Insetos/complicações , Doenças Labiais/patologia , Mucosa Nasal/patologia , Abscesso/etiologia , Abscesso/terapia , Adulto , Animais , Venenos de Abelha/efeitos adversos , Abelhas , Desbridamento , Fístula Dentária/etiologia , Fístula Dentária/terapia , Diagnóstico Diferencial , Drenagem , Humanos , Doenças Labiais/etiologia , Doenças Labiais/terapia , Masculino , Doenças Dentárias/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: The objective of this study was to identify the probable factors associated with pulpectomy failure of primary teeth through qualitative analysis by histopathology (HIST) and scanning electron microscopy (SEM). STUDY DESIGN: A longitudinal clinical investigation of the efficacy of pulpectomy in primary teeth with irreversible pulp changes was carried out with 133 teeth (66 children) evaluated up to 48 months. The overall success was 86.1% during follow-up. Of the 18 teeth extracted as a result of treatment failure, 8 presented sufficiently undamaged roots to be randomly selected for HIST (n = 4) and SEM (n = 4) analysis. RESULTS: Necrotic tissue and chronic inflammatory cells were observed in all specimens submitted to HIST as external radicular resorption associated with Howship's lacunae. SEM analysis showed apical and furcation areas heavily infected with microorganisms and Howship's lacunae. CONCLUSION: These findings suggest that the main factors responsible for pulpectomy failure were technique limitations associated with the morphological irregularities created by external/inflammatory resorption.
Assuntos
Pulpectomia/métodos , Dente Decíduo/patologia , Criança , Pré-Escolar , Fístula Dentária/etiologia , Fístula Dentária/patologia , Cavidade Pulpar/microbiologia , Cavidade Pulpar/patologia , Cavidade Pulpar/ultraestrutura , Necrose da Polpa Dentária/terapia , Seguimentos , Humanos , Incisivo/microbiologia , Incisivo/patologia , Incisivo/ultraestrutura , Estudos Longitudinais , Microscopia Eletrônica de Varredura , Dente Molar/microbiologia , Dente Molar/patologia , Dente Molar/ultraestrutura , Doenças Periapicais/etiologia , Doenças Periapicais/patologia , Pulpite/terapia , Obturação do Canal Radicular/métodos , Preparo de Canal Radicular/instrumentação , Reabsorção da Raiz/patologia , Ápice Dentário/microbiologia , Ápice Dentário/patologia , Ápice Dentário/ultraestrutura , Raiz Dentária/microbiologia , Raiz Dentária/patologia , Raiz Dentária/ultraestrutura , Dente Decíduo/ultraestrutura , Falha de TratamentoRESUMO
Hymenoptera order includes bees, which have a stinging apparatus at the tail capable of delivering venom to the affected tissues. Myocardial infarction, acute renal failure, Necrotizing fasciitis, fatal infection and hemifacial asymmetry, are some of the unusual reactions reported following hymenoptera stings. This paper reports a case of bee sting in the right floor of the nose that mimicked an odontogenic infection affecting the upper lip, canine space and nasal cavity such as in cases of infection secondary to pulpal or periodontal pathology of the anterior teeth. After a thorough clinical and radiographic examination, odontogenic infection was discarded and the diagnosis of floor of the nose mucosal lysis and lip abscess secondary to a bee sting was made. This case was successfully managed with adequate incision, drainage and antibiotics without any further complication. There are several reports of unusual reactions following hymenoptera stings. However, just a few of them referred to infections of local reactions and none of them related to the anatomic location affected in the patient of the present case. Early diagnosis and treatment prevented infection dissemination and the likelihood of tissue necrosis as in previously reported cases of Necrotizing fasciitis.
A ordem das himenópteras inclui abelhas, que possuem um ferrão na cauda capaz de de injetar veneno nos tecidos afetados. Fasciite necrosante, infecção fatal e assimetria hemifacial são algumas das reações incomuns relatadas após picada de himenópteras. Este estudo relata um caso de picada de abelha no assoalho da narina direita que simulou uma infecção odontogênica atingindo o lábio superior, o espaço canino e a cavidade nasal, como observado nos casos de infecção secundária após patologia pulpar ou periodontal dos dentes anteriores. Após completo exame clínico e radiográfico, foi descartada a hipótese de infecção odontogênica e foi estabelecido o diagnóstico de lise da mucosa do assoalho da narina e abscesso do lábio, após picada de abelha. Este caso foi tratado com sucesso com adequada incisão, drenagem e administração de antibióticos, sem outras complicações. Há vários relatos de reações incomuns resultantes de picada de himenópteras, porém poucos são relativos a infecções locais e nenhum se refere à localização anatômica afetada no paciente do caso aqui relatado. Diagnóstico e tratamento precoces preveniram a disseminação da infecção e a possibilidade de necrose tecidual, como já relatado em casos de fasciite necrosante.