Abstract Ramsay-Hunt syndrome is an infectious disease associated with the varicella-zoster virus, and peripheral facial palsy is often one of its clinical manifestations. This case report describes a patient diagnosed with Ramsay-Hunt syndrome who developed peripheral facial palsy and was treated by photobiomodulation therapy. A 26-year-old woman developed a lack of facial mobility on the right side, asymmetry, otalgia, dysgeusia, and dry eyes, leading to the diagnosis of Ramsay-Hunt syndrome. Her peripheral facial palsy was classified as moderately severe according to the House-Brackmann scale. Acyclovir, prednisone, and physiotherapy sessions were prescribed to manage peripheral facial palsy. In the absence of a clinical response to the proposed therapies, photobiomodulation therapy was employed using the parameters: 780 nm, 100 mW, 3 J/point, and 30.48 J/cm2. After five sessions of photobiomodulation therapy, complete recovery of facial movement was observed. Photobiomodulation therapy treated peripheral facial palsy effectively, allowing a fast recovery and avoiding irreversible sequelae in a patient with Ramsay-Hunt syndrome.

Resumo A síndrome de Ramsay Hunt é uma doença infeciosa associada ao vírus varicela zoster e a paralisia facial periférica é frequentemente uma das suas manifestações clínicas. Este relato de caso descreve uma paciente com diagnóstico de síndrome de Ramsay Hunt que desenvolveu paralisia facial periférica e foi tratada com fotobiomodulação. Uma mulher de 26 anos desenvolveu falta de mobilidade facial do lado direito, assimetria, otalgia, disgeusia e olhos secos, levando ao diagnóstico de síndrome de Ramsay Hunt. A paralisia facial periférica foi classificada como moderadamente grave de acordo com a escala de House Brackmann. Foram prescritos aciclovir e prednisona, além de sessões de fisioterapia para manipulação da paralisia facial periférica. Na ausência de resposta clínica às terapias propostas, foi empregada fotobiomodulação nos parâmetros: 780 nm, 100 mW, 3 J/ponto e 30,48 J/cm2. Após cinco sessões de fotobiomodulação, foi observada uma recuperação completa do movimento facial. A fotobiomodulação foi eficaz no tratamento da paralisia facial periférica, permitindo uma rápida recuperação e evitando sequelas irreversíveis numa paciente com síndrome de Ramsay Hunt.

ABSTRACT Purpose To investigate the impact of chemoradiation-induced hypopharyngeal mucositis on swallowing and its management, based on an integrative literature review. Research strategy Two researchers were responsible for the search and selection of articles, within the following databases: PubMed, Embase, Scopus, Science Direct, and Lilacs. Selection criteria The search terms used were “Pharyngeal Mucositis”, “Radiotherapy” and “Esophagitis”, with the aid of the Boolean operator (AND). The search equation used was “Pharyngeal Mucositis” AND Radiotherapy AND Esophagitis. The following central question guided the study: “What is the assessment and management of radiation-induced hypopharyngeal mucositis in the head and neck region and its impact on swallowing?” Results 75 studies were identified, of which 6 were excluded due to duplicity and 60 were excluded for not meeting the inclusion criteria; the remaining articles were read in full and 4 were selected to be part of the integrative literature review. Conclusion Despite the scarce literature and little information on methods for evaluating hypopharyngeal mucositis, the articles point out that, regardless of the radiation dose, radiotherapy in the cervical region causes hypopharyngeal mucositis. Hypopharyngeal mucositis causes a great impact on swallowing, resulting in the need to use an alternative feeding route. In addition to the lack of information regarding the assessment and grading of hypopharyngeal mucositis, the studies do not discussitsdirect treatment or prevention.

RESUMO Objetivo Investigar o impacto da mucosite hipofaríngea quimiorradioinduzida na deglutição e o seu manejo, a partir de uma revisão integrativa de literatura. Estratégia de pesquisa A busca e a seleção dos artigos foram realizadas nas seguintes bases de dados: PubMed, Embase, Scopus, ScienceDirect e LILACS. Critérios de seleção Os termos de busca utilizados foram ‘’Pharyngeal Mucositis”, ‘’Radiotherapy” e ‘’Esophagitis”, com auxílio do operador booleano (AND). A equação de busca utilizada foi: ‘’Pharyngeal Mucositis” AND “Radiotherapy” AND “Esophagitis”. A seguinte questão central orientou o estudo: “Qual a forma de avaliação e manejo da mucosite hipofaríngea induzida pela radiação na região de cabeça e pescoço e seu impacto na deglutição?”. Resultados Foram identificados 75 estudos, sendo que 6 foram excluídos devido à duplicidade e 60 foram excluídos por não se encaixarem nos critérios de inclusão; os artigos restantes foram lidos na íntegra e 4 foram selecionados para fazerem parte desta revisão integrativa da literatura. Conclusão Apesar da escassa literatura e das poucas informações sobre os métodos de avaliação da mucosite hipofaríngea, os artigos apontam que, independentemente da dose de radiação, a radioterapia na região cervical causa mucosite hipofaríngea. A mucosite hipofaríngea provoca grande impacto na deglutição, resultando na necessidade de uso de via alternativa de alimentação. Além da ausência de informações quanto à avaliação e graduação da mucosite hipofaríngea, os estudos não discutem o tratamento direto ou a prevenção desse tipo de doença.

ABSTRACT Objective: To propose the use of extraoral laser therapy to treat odynophagia associated with radioinduced hypopharyngeal mucositis. Odynophagia is characterized by swallowing pain, often requiring diet changes, which directly impacts the patient’s quality of life. Material and Methods: The investigation was an observational descriptive study with case series report. Was performed application of extraoral photobiomodulation for three oncologic patients with odynophagia associated with oral and hypopharyngeal mucositis radioinduced, with low-level laser therapy (Therapy XT DMC®) with λ808nm, 100mW power and 4J energy, 40 seconds per point. Reports of three patients who underwent treatment were collected, transcribed and reviewed qualitatively. The laser application points were proposed based on a previous anatomical study in cadavers, which sought to identify the best area of application of the extraoral laser in the cervical region to reach the hypopharynx. Results: Patients reported reduced odynophagia and greater comfort with the use of this extraoral laser therapy to the hypopharynx in the carotid trigone. Conclusion: The carotid trigone was the best extraoral region for laser application to reach the hypopharyngeal region. The laser therapy protocol applied in this region brought comfort to the patients assessed. Further studies are needed to assess the analgesic capacity of this treatment.

RESUMEN Objetivo: Proponer el uso del láser de baja potencia extraoral para el tratamiento de la odinofagia asociada a mucositis hipofaríngea radio inducida. La odinofagia se caracteriza por dolor al tragar, que a menudo requiere cambios en la dieta, lo que impacta directamente en la calidad de vida del paciente. Material y métodos: La investigación fue un estudio observacional descriptivo con reporte de series de casos clínicos. Se realizó aplicación de fotobiomodulación extraoral para tres pacientes con odinofagia asociada a mucositis oral e hipofaríngea. Se utilizó la terapia con láser de baja potencia (Therapy XT DMC®), con λ808nm, 100 mW de potencia y 4J de energía, 40 segundos por punto. Se recopilaron, transcribieron y revisaron cualitativamente los informes de tres pacientes que se sometieron a tratamiento. Los puntos de aplicación del láser se propusieron a partir de un estudio anatómico previo en cadáveres, que buscó identificar la mejor zona de aplicación del láser extraoral en la región cervical para llegar a la hipofaringe. Resultados: Los pacientes informaron una reducción de la odinofagia y una mayor comodidad con el uso de este tratamiento en el trígono carotídeo. Conclusión: El trígono carotídeo resultó ser la mejor región extraoral para la aplicación de láser para llegar a la región hipofaríngea. El uso de láser de baja potencia aplicado en esta región redujo la odinofagia de los pacientes. Se necesitan más estudios para evaluar la capacidad analgésica de este tratamiento.

Abstract Background: Osteoradionecrosis of the jaw (ORNJ) is the most severe and complex sequel of head and neck radiotherapy (RT) because of the bone involved, it may cause pain, paresthesia, foul odor, fistulae with suppuration, need for extra oral communication and pathological fracture. We treated twenty lesions of ORNJ using low-level laser therapy (LLLT) and antimicrobial photodynamic therapy (aPDT). The objective of this study was to stimulate the affected area to homeostasis and to promote the healing of the oral mucosa. Methods: We performed aPDT on the exposed bone, while LLLT was performed around the bone exposure (red spectrum) and on the affected jaw (infrared spectrum). Monitoring and clinical intervention occurred weekly or biweekly for 2 years. Results: 100% of the sample presented clinical improvement, and 80% presented complete covering of the bone exposure by intact oral mucosa. Conclusion: LLLT and aPDT showed positive results as an adjuvant therapy to treat ORNJ.