OBJETIVO: Comparar a reinervação muscular com enxerto de nervo em um e dois tempos operatórios, utilizando a neurorrafia término-lateral (NTL) sem lesão do nervo doador. MÉTODOS: Vinte ratos foram distribuídos em quatro grupos. O grupo 1 (G1), um estágio, recebeu o enxerto que foi suturado ao nervo tibial (NT), por meio de NTL, e seu coto livre foi suturado por NTL ao coto distal do nervo peroneal (NP), seccionado a um centímetro do NT, na mesma cirurgia. O grupo 2 (G2), dois estágios, recebeu o enxerto de nervo na primeira cirurgia, como já descrito. Dois meses depois, na segunda cirurgia, o NP foi seccionado e seu coto distal ligado ao coto distal do enxerto como em G1. O grupo controle de normalidade (Gn) recebeu o enxerto da mesma forma, apenas. E o grupo controle de denervação (Gd), além de receber o enxerto, teve o NP seccionado e seus cotos sepultados na musculatura adjacente, com a finalidade de denervar o músculo tibial cranial (MTC), alvo deste estudo. Os parâmetros utilizados para avaliar a reinervação do MTC foram massa muscular, diâmetro mínimo da fibra muscular e área. RESULTADOS: O grupo G2 apresentou superioridade (p<0,0001) em relação ao G1 na massa do MTC, no diâmetro mínimo e na área das fibras musculares. Na comparação entre os quatro grupos, estes mesmos parâmetros tiveram sua expressão máxima em Gn e mínima em Gd, como era esperado. CONCLUSÃO: A reinervação muscular em dois estágios apresenta melhor resultado quando comparada à técnica em um tempo.

PURPOSE: To compare muscle reinnervation in one and two surgical stages using end-to-side neurorrhaphy (ESN) without donor nerve injury. METHODS: The experiment was performed on four groups of 20 rats. Group 1 (G1), one stage, received the graft which was sutured to the tibial nerve, with ESN, and its free stump was sutured end-to-end to the distal stump of the sectioned peroneal nerve (PN), all in the same operation. In Group 2 (G2), two stages, the nerve graft was sutured to the tibial nerve, with ESN. Two months later the PN was sectioned and its distal stump connected to the distal stump of the graft as in G1. Normal control group (Gn) received the graft only sutured to the tibial nerve, with ESN. Denervated control group (Gd), as well received the graft and had the PN sectioned and its two stumps buried in adjacent musculature, with the aim of denervating the cranial tibial muscle (CTM), the target of this study. The parameters used to evaluate CTM reinnervation were muscle mass, muscle fiber's minimum diameter and area. RESULTS: The mean CTM mass, the average of the muscular fibers areas and the average of the muscular fiber minimum diameters was higher (all p<0.0001) in G2 than in G1. Comparing the four groups, these parameters had their maximum expression in Gn and the minimum in Gd, as expected. CONCLUSION: The two stages showed better muscle reinnervation than one stage.

Apesar dos benefícios da radioterapia no tratamento de tumores malignos, vários são os seus efeitos colaterais na região de cabeça e pescoço. Sendo assim, a avaliação das condições bucais pelo cirurgião dentista é fundamental para prevenir e/ou minimizar estes danos. Este estudo retrospectivo teve como objetivo verificar as condições dentárias e as necessidades de tratamento odontológico dos 357 pacientes que receberam radioterapia na região de cabeça e pescoço, atendidos pelo Orocentro/ FOP/UNICAMP, no período de janeiro de 1990 a dezembro de 2004. Em 148 (41,5%) do total dos pacientes a avaliação odontológica não foi realizada previamente à radioterapia. A avaliação odontológica pré-radioterápica foi realizada em 209 pacientes (58,5%) dos quais 94 (45%) não tinham necessidades de tratamento odontológico no momento da avaliação, enquanto 115 (55%) apresentavam algum tipo de necessidade odontológica. O grupo de pacientes avaliados antes da radioterapia apresentou menores necessidades de restaurações, endodontias e exodontias que os pacientes não avaliados. Conclui-se que a avaliação das condições bucais previamente à radioterapia é essencial para diminuir as necessidades de tratamento odontológico enfatizando a importância da participação do cirurgião-dentista na equipe multidisciplinar que trata pacientes com câncer.

In spite of its recognized benefits in the treatment of malignant tumors, radiation therapy have several side effects in the head and neck region. The evaluation of oral conditions by a dentist is important to prevent or minimize these problems. The aim of this retrospective review was to analyze the dental needs in 357 patients who received radiotherapy in the head and neck region and were treated at Orocentro/FOP/UNICAMP, between January 1990 and December 2004. Review of patient files showed that dental examination before radiotherapy was not performed in 148 patients (41.5%) and was done in 209 patients (58.5%). From the total of examined patients, 94 (45%) did not require dental procedures at the moment of examination, while 115 (55%) presented some sort of dental need. Following the patients after the radiotherapy, it was observed that the group of patients that was evaluated before radiation presented less need of restorations, root canal filling and dental extractions than those who were not evaluated. The results of this study confirm that the evaluation of oral conditions prior to radiotherapy is essential to minimize the dental needs, emphasizing the importance of the dentist in the multidisciplinary team that treats cancer patients.

Plasma cell neoplasia is a lymphoid neoplastic proliferation of B cells. This denomination encloses multiple myeloma (MM), solitary bone plasmacytoma and extramedullary plasmacytoma. MM consists of a clonal proliferation of plasma cells based in the bone marrow, with various degrees of differentiation. Neoplastic cells usually produce great amounts of monoclonal light or heavy chains of immunoglobulin that can be detected in serum or urine. The disease is more frequently in men and the average age at diagnosis is about 60 years. The diagnosis is established by blood and urine exams and medullary biopsy. Patients may present renal failure, bone pain, fatigue, recurrent infections and nervous system dysfunction. Oral manifestations may be the first sign of MM, highlighting the importance of the dentist in the early diagnosis of the disease. Treatment involves mainly irradiation and chemotherapy and the prognosis is generally poor. This paper reports a case of a 65 years old black female who had a complaint of a painful mass in the maxilla that prompted a MM diagnosis.

Oral melanoacanthoma (MA) is a rare, benign pigmented lesion, similar to cutaneous MA, characterized by hyperplasia of spinous keratinocytes and dendritic melanocytes. The pathogenesis of oral MA remains uncertain, although its clinical behavior is suggestive of a reactive origin. The most common intraoral sites are the buccal mucosa, lip, palate and gingiva. The average age of presentation is 28 years, mainly in blacks, with a strong female predilection. The oral melanotic macule (MM) is a small, well-circumscribed brown-to-black macule that occurs on the lips and mucous membranes. The etiology is not clear and it may represent a physiologic or reactive process. The average age of presentation is 43 years, with a female predilection. A biopsy is recommended to distinguish these lesions from each other and from other oral melanocytic lesions. We depict four cases each of oral MA and MM, affecting Caucasian and Latin American mestizo patients. The clinicopathological features of these cases reflect its ample spectrum, and to the best of our knowledge, it is the first example of oral MA affecting a Caucasian boy reported in the English literature. Therefore oral MA and MM should be considered in the differential diagnosis of pigmented lesions in the oral mucosa in these populations.