Introduction: Graft-versus-host disease (GVHD) is a systemic complication that can affect patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) and the mouth is one of the places affected by the disease (oGVHD). Topical corticosteroids are used to control the painful symptoms, causing a local immunosuppression and increasing the risk for opportunistic infections.Objective: This study aims to report a case of a 42-year-old woman, diagnosed with Chronic Myeloid Leukemia, who developed oGVHD and herpes simplex virus (HSV) infection after HSCT. Case Report: oGVHD was confirmed by incisional biopsy and viral infection by HSV types 1 and 2 was confirmed by PCR. Topical and systemic corticotherapy and antiviral therapies were instituted. The immunosuppression intensified viral infection and antimicrobial photodynamic therapy (aPDT) was instituted as an adjuvant treatment. aPDT application, along with the patient's immune recovery, antivirals and corticosteroids resulted in clinical improvement of oral lesions. Final Considerations: This study highlights aPDT as an effective adjunct therapy in the local treatment of opportunistic infections in onco-hematological patients.
Chronic maxillary atelectasis (CMA) is a progressive alteration in the volume of the maxillary sinuses that may result in facial asymmetry. CMA in asymptomatic patients is known as silent sinus syndrome (SSS) and is a rare entity, especially in pediatric patients. This study reports a case of SSS in a pediatric patient who received an early diagnosis through cone-beam computed tomography (CBCT). An asymptomatic 12-year-old female patient in orthodontic treatment presented with opacification of the left maxillary sinus on a panoramic radiograph. Clinically, the patient had discrete hypoglobus and enophthalmos. CBCT and nasal video-endoscopy revealed ostiomeatal obstruction with bone deformity, leading to diagnosis of SSS. Endonasal endoscopic maxillary sinusotomy was performed. Two years later, the patient remained asymptomatic, and a second CBCT exam confirmed a stable condition. This case highlights the role of optimal radiographic interpretation for early diagnosis of maxillofacial alterations in pediatric patients.
Por apresentarem maior risco de sangramento durante a realização de procedimentos odontológicos, pacientes diagnosticados com coagulopatias ou trombopatias hereditárias apresentam, frequentemente, dificuldade de acesso à assistência odontológica na Atenção Primária em Saúde. Alguns centros especializados no tratamento dessas doenças contam com o cirurgião-dentista como parte da equipe multiprofissional, permitindo que a maioria dos pacientes realizem o acompanhamento odontológico em tais serviços. Este estudo tem como objetivo relatar a experiência dos discentes de graduação e pós-graduação em Odontologia da Universidade Federal do Paraná na reabertura do ambulatório odontológico de assistência à pacientes com coagulopatias e trombopatias hereditárias do estado. Com a aposentadoria da profissional responsável pelos atendimentos odontológicos deste serviço, os pacientes ficaram desassistidos. Para suprir a demanda reprimida, o ambulatório foi reaberto como atividade extramuros da graduação e pós-graduação em Odontologia. Este fato possibilitou, além da retomada ao cuidado odontológico de pacientes com predisposição a hemorragias, o aprimoramento dos alunos no atendimento de pacientes com comprometimento sistêmico. A reabertura de um ambulatório de alta complexidade em saúde como campo de prática acadêmico é atípico, uma vez que comumente o processo se dá de forma inversa: o discente ingressando em um serviço bem estabelecido. Na presente experiência, os discentes tiveram atuação fundamental no restabelecimento da assistência à saúde pelo ambulatório de Odontologia do hemocentro.
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