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Ângelo DF, Nunes M, Monje F, Mota B, Salvado F. A role for total alloplastic temporomandibular joint replacement in Gardner syndrome. Int J Oral Maxillofac Surg 2024; 53:219-222. [PMID: 37985266 DOI: 10.1016/j.ijom.2023.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/12/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
Gardner syndrome (GS) is a rare autosomal dominant disorder that can present with craniomaxillofacial abnormalities. The identification of osteomas or craniomaxillofacial abnormalities can therefore serve as a marker of this condition, facilitating early referral and diagnosis. A 17-year-old female with GS was referred for the management of severe limited mouth opening, causing a major problem for routine endoscopy to monitor the gastrointestinal alterations of GS. Clinical and radiological evaluations showed multiple osteomas in the mandibular angle, condylar and coronoid regions bilaterally and maximum mouth opening of 8 mm. The patient underwent surgery for osteoma removal and bilateral customized alloplastic total temporomandibular joint replacement (TMJ-TJR). At the 2-year follow-up, the patient showed improvements in quality of life, with a maximum mouth opening of 34 mm, allowing routine upper endoscopy to be performed. This is the first report of GS, a rare and challenging craniomaxillofacial abnormality, treated with TMJ-TJR. A comprehensive overview of the patient's clinical presentation, diagnostic assessment, treatment planning, and outcomes is provided.
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Affiliation(s)
- D F Ângelo
- Instituto Português da Face, Lisbon, Portugal; Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Clinica Universitária de Estomatologia, Centro Hospitalar Universitário Lisboa Norte (CHUNL), Lisbon, Portugal.
| | - M Nunes
- Clinica Universitária de Estomatologia, Centro Hospitalar Universitário Lisboa Norte (CHUNL), Lisbon, Portugal
| | - F Monje
- Department of Oral and Maxillofacial Surgery, Hospital Universitario de Badajoz, Badajoz, Spain
| | - B Mota
- Clinica Universitária de Estomatologia, Centro Hospitalar Universitário Lisboa Norte (CHUNL), Lisbon, Portugal
| | - F Salvado
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Clinica Universitária de Estomatologia, Centro Hospitalar Universitário Lisboa Norte (CHUNL), Lisbon, Portugal
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C Romão V, Sousa Bandeira MJ, Silvério-António M, Simão R, Pinto J, Gonçalves AI, Gonçalves MJ, Martins AL, José P, Coutinho G, Morena Bueno Silva L, Brito Lança M, Esteves Marques R, Macieira C, Khmelinskii N, Rodrigues W, Salvado F, Fonseca JE. AB0501 COMPREHENSIVE ASSESSMENT OF PATIENTS WITH SUSPECTED SJÖGREN’S SYNDROME: 5-YEAR RESULTS OF A MULTIDISCIPLINARY SJÖGREN’S SYNDROME CLINIC. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundPrimary Sjögren’s syndrome (pSS) is a systemic rheumatic disease that affects several organ systems, most frequently the ocular, oral and musculoskeletal domains. Multidisciplinary care is thus crucial in the optimal management of SS patients.ObjectivesTo report the clinical impact of a Multidisciplinary SS Clinic (MSSC) over a 5-year period.MethodsWe prospectively included patients assessed in the MSSC from September 2015 to October 2020. All patients had a full clinical evaluation, including disease-related questionnaires, specialized oral/ocular assessment, salivary gland biopsy (SGB) and ultrasound (SGUS), tear and salivary flow and ocular staining scores. We compared the results of patient-reported outcomes, comprehensive clinical assessments and specialized complementary exams in patients with pSS and other diagnoses.Results445 patients (96% women, mean age 57±14 years) with sicca symptoms underwent complete multidisciplinary evaluation. Patients were most frequently referred from Rheumatology (91%), but also from Stomatology (5%), Ophthalmology (2%), Internal Medicine (1%) and other medical specialties (1%). Most patients were diagnosed with pSS (n=221; 50%), followed by non-Sjögren sicca syndrome (nSSS, n=134; 30%), secondary SS (sSS, n=60; 13%) and undifferentiated connective tissue disease (n=30; 7%). Positive sicca tests were present in 217/385 patients (56%): unstimulated whole salivary flow (UWSF) ≤0.1ml/min in 84/317 (27%); Schirmer’s test ≤5mm/5min in 163/354 (46%); van Bijsterveld score ≥4 in 42/349 (12%); Ocular Staining Score (OSS) ≥5 in 36/343 (11%). Subjective complaints assessed by the EULAR Sjögren’s Syndrome Patient Reported Index (ESSPRI), the EULAR Sicca Score (ESS), the Profile of Fatigue and Discomfort - Sicca Symptoms Inventory (PROFAD-SSI), the Xerostomia Inventory (XI), and the Ocular Surface Disease Index (OSDI) did not differ between patients with pSS and other diagnoses. However, objective dryness measures such as UWSF (31vs20%, p=0.028), Schirmer’s test (51vs40%, p=0.040) and OSS (14vs7%, p=0.048) were significantly associated with pSS. A positive SGB (focus score≥1) was seen in 48% of patients with a clinical diagnosis of pSS (p<0.001 vs. other diagnoses), with a mean focus score of 1.1±1.6. Instead, 94% of patients with nSSS had grade 0-1 biopsies. Mean SGUS scores (p=0.006) and the frequency of moderate/severe changes (p<0.001) were higher in pSS patients.ConclusionMultidisciplinary evaluation was crucial in the assessment of patients with similar sicca complaints and in the management of ocular/oral/systemic involvement. Objective measurements and specialized complementary exams greatly contribute to establishing or confirming the diagnosis of pSS.Disclosure of InterestsNone declared
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Mota B, Andrade C, Cruz L, Coelho A, Coutinho J, Coutinho G, Contente F, Nunes M, Fontes S, Salvado F. P-111 Necrotizing Sialometaplasia: Differential diagnosis and treatment of a malignant masquerade. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00398-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Martinelli-Kläy CP, Lombardi T, Mendis B, Soares EG, Salvado F, Courvoisier DS, Mauricio P. Tissue eosinophilia in oral intraepithelial neoplasia as a probable indicator of invasion. Oral Dis 2018; 24:103-108. [PMID: 29480618 DOI: 10.1111/odi.12789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the presence of eosinophils in oral intraepithelial neoplasia (OIN) and oral squamous cell carcinoma (OSCC) lesions and its relation to invasion. SUBJECTS AND METHODS Ninety-nine oral biopsies were selected and subdivided into the following: OIN-1(16 cases), OIN-2 (18 cases), OIN-3 (17 cases), microinvasive OSCC (10 cases), non-metastatic OSCC (22 cases) and metastatic OSCC (16 cases). The tissue eosinophilia was evaluated histologically in slices stained with haematoxylin and eosin. RESULTS Eosinophil distribution was associated with diagnosis severity (p < .01). A significant difference was found between OIN-3 or microinvasive OSCC and non-metastatic or metastatic OSCC. Stromal invasion threshold was 7 eos/10 high power field (hpf) (96.1% specificity and 62.5% sensitivity). Eosinophils were absent in OIN-1; in OIN-2, two cases were positive. In OIN-3, five cases showed tissue eosinophilia, four of which had ≥3 eos/hpf or ≥7 eos/10 hpf. Three cases were suspected of invasion; two had a previous history of OSCC with elevated eosinophil infiltrate. In microinvasive OSCC, the four positive cases presented ≥3 eos/hpf and ≥7 eos/10 hpf. Although not significantly different, non-metastatic invasive OSCC had a higher number of cases (68.2%) with ≥22 eos/10 hpf contrasting with 50% in metastatic OSCC. CONCLUSION Our results suggest that eosinophils can be considered an indicator of invasion in OIN, helping in cases of difficult diagnosis.
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Affiliation(s)
- C P Martinelli-Kläy
- Oral Medicine and Oral and Maxillofacial Pathology Unit, Laboratory of Oral & Maxillofacial Pathology, Division of Oral Maxillofacial Surgery, Department of Surgery, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - T Lombardi
- Oral Medicine and Oral and Maxillofacial Pathology Unit, Laboratory of Oral & Maxillofacial Pathology, Division of Oral Maxillofacial Surgery, Department of Surgery, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - Brrn Mendis
- Oral Medicine and Oral and Maxillofacial Pathology Unit, Laboratory of Oral & Maxillofacial Pathology, Division of Oral Maxillofacial Surgery, Department of Surgery, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - E G Soares
- Department of Pathology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - F Salvado
- Center for Interdisciplinary Research Egas Moniz (CiiEM), Health Sciences Institute, Monte da Caparica, Portugal
| | - D S Courvoisier
- Department of Rheumatology, University Hospitals of Geneva, University of Geneva, Geneva, Switzerland
| | - P Mauricio
- Center for Interdisciplinary Research Egas Moniz (CiiEM), Health Sciences Institute, Monte da Caparica, Portugal
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de Araújo Nobre M, Maló P, Gonçalves Y, Sabas A, Salvado F. Dental implants in diabetic patients: retrospective cohort study reporting on implant survival and risk indicators for excessive marginal bone loss at 5 years. J Oral Rehabil 2016; 43:863-870. [DOI: 10.1111/joor.12435] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2016] [Indexed: 12/01/2022]
Affiliation(s)
- M. de Araújo Nobre
- Faculty of Medicine; University of Lisbon; Lisbon Portugal
- Malo Clinic; Lisbon Portugal
| | - P. Maló
- Malo Clinic; Lisbon Portugal
| | | | | | - F. Salvado
- Faculty of Medicine; University of Lisbon; Lisbon Portugal
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Angelo DF, Morouço P, Alves N, Viana T, Santos F, González R, Monje F, Macias D, Carrapiço B, Sousa R, Cavaco-Gonçalves S, Salvado F, Peleteiro C, Pinho M. Choosing sheep (Ovis aries) as animal model for temporomandibular joint research: Morphological, histological and biomechanical characterization of the joint disc. Morphologie 2016; 100:223-233. [PMID: 27450042 DOI: 10.1016/j.morpho.2016.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 04/07/2016] [Accepted: 06/15/2016] [Indexed: 12/24/2022]
Abstract
Preclinical trials are essential to the development of scientific technologies. Remarkable molecular and cellular research has been done using small animal models. However, significant differences exist regarding the articular behavior between these models and humans. Thus, large animal models may be more appropriate to perform trials involving the temporomandibular joint (TMJ). The aim of this work was to make a morphological (anatomic dissection and white light 3D scanning system), histological (TMJ in bloc was removed for histologic analysis) and biomechanical characterization (tension and compression tests) of sheep TMJ comparing the obtained results with human data. Results showed that sheep processus condylaris and fossa mandibularis are anatomically similar to the same human structures. TMJ disc has an elliptical perimeter, thinner in the center than in periphery. Peripheral area acts as a ring structure supporting the central zone. The disc cells display both fibroblast and chondrocyte-like morphology. Marginal area is formed by loose connective tissue, with some chondrocyte-like cells and collagen fibers in diverse orientations. Discs obtained a tensile modulus of 3.97±0.73MPa and 9.39±1.67MPa, for anteroposterior and mediolateral assessment. The TMJ discs presented a compressive modulus (E) of 446.41±5.16MPa and their maximum stress value (σmax) was 18.87±1.33MPa. Obtained results suggest that these animals should be considered as a prime model for TMJ research and procedural training. Further investigations in the field of oromaxillofacial surgery involving TMJ should consider sheep as a good animal model due to its resemblance of the same joint in humans.
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Affiliation(s)
- D F Angelo
- Hospital de Santa Maria, Faculty of Medicine, Lisbon, Portugal.
| | - P Morouço
- Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Leiria, Portugal
| | - N Alves
- Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Leiria, Portugal
| | - T Viana
- Centre for Rapid and Sustainable Product Development, Polytechnic Institute of Leiria, Leiria, Portugal
| | - F Santos
- CIISA, Interdisciplinary Centre of Research in Animal Health, Faculty of Veterinary Medicine, Lisbon, Portugal
| | - R González
- Infanta Cristina Hospital, Faculty of Medicina, University of Extremadura, Badajoz, Spain
| | - F Monje
- Infanta Cristina Hospital, Faculty of Medicina, University of Extremadura, Badajoz, Spain
| | - D Macias
- Department of Anatomy, Faculty of Medicina, University of Extremadura, Badajoz, Spain
| | - B Carrapiço
- CIISA, Interdisciplinary Centre of Research in Animal Health, Faculty of Veterinary Medicine, Lisbon, Portugal
| | - R Sousa
- Hospital de Santa Maria, Faculty of Medicina, Lisbon, Portugal
| | - S Cavaco-Gonçalves
- National Institute of Agrarian and Veterinary Research, Santarém, Portugal
| | - F Salvado
- Hospital de Santa Maria, Faculty of Medicina, Lisbon, Portugal
| | - C Peleteiro
- CIISA, Interdisciplinary Centre of Research in Animal Health, Faculty of Veterinary Medicine, Lisbon, Portugal
| | - M Pinho
- Interdisciplinary Centre of Research in Animal Health, Faculty of Veterinary Medicine, Lisbon, Portugal
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Salvado F, Furtado I. [A case of erythema multiforme with only oro-genital manifestations]. Rev Port Estomatol Cir Maxilofac 1988; 29:19-24. [PMID: 3267943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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