Student Number : 9000040F - M Dentistry research report - Faculty of Health Sciences / This study assessed the sagittal soft-tissue changes of the lower lip and chin area in 22 patients subsequent to mandibular autorotation following surgical vertical impaction of the maxilla. A subgroup of six patients in addition had undergone advancement genioplasty procedures. Lateral cephalometric radiographs were taken immediately prior to surgery and on average 15 months following surgery. Sixteen cephalometric landmarks were identified on each radiograph and these were digitized using a Kontron Videoplan Image Analysis System to enable differences reflecting changes to be assessed. The comparison between those cases that had had maxillary elevation only and the six cases that had received additional advancement genioplasty procedures revealed statistically significant differences in relation to the proportional changes in the chin area. Therefore, when studying the soft-tissue chin changes following mandibular autorotation, these six patients were excluded from the sample. It was found that there was no significant difference in the lower lip response between the two groups and therefore when studying the lower lip changes, the two groups could be pooled. The soft-tissue changes in the chin area showed statistically and clinically significant correlations. In the horizontal plane, a ratio of 0.9:1 was found for the changes between sulcus inferior and point B, between soft-tissue pogonion and hard-tissue pogonion, and between soft-tissue gnathion and hard-tissue gnathion. In the vertical dimension, soft-tissue gnathion followed hard-tissue gnathion in a ratio of 0.9:1, whereas soft-tissue menton followed hardtissue menton in a ratio of 1:1. In the study of the lower lip response, a significant correlation with a ratio of 1:1 existed for the horizontal change in the lower lip as measured at labrale inferius relative to both lower incisor tip and lower incisor anterius. In the vertical dimension, stomion inferius followed lower incisor anterius in a ratio of 1.3:1, while labrale inferius followed lower incisor anterius in a ratio of 1.5:1. Multiple regression analyses revealed that presurgical tissue thickness exerted no influence upon the strength of the correlations between changes expressed at corresponding soft- and hard-tissue landmarks located in the lower lip and soft-tissue chin area. Based on the findings of this study, it is suggested that the soft-tissue to hard-tissue ratios may be applied to prediction tracings with enhanced confidence. As a result, the tracings will reflect a more accurate prediction of the lower lip and soft-tissue chin positions following autorotation of the mandible.

Made available in DSpace on 2014-12-17T15:32:18Z (GMT). No. of bitstreams: 1 CyntiaCPC.pdf: 2470782 bytes, checksum: 4619c7ffcab85bffa54a732d30786d99 (MD5) Previous issue date: 2010-02-24 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Currently, bone morphogenetic proteins (BMPs) have effective participation in the growth of malignancies. Knowing that there are few studies involving BMPs and oral squamous cell carcinoma, this work constitutes an immunohistochemical study of BMP-2, BMPR IA and BMPR II in squamous cell carcinomas (SCC) of the lower lip relating to the clinical and pathological aspects of this lesion. The sample consisted of 40 cases of SCC of the lower lip, being 20 cases of SCC of the lower lip with regional metastasis and 20 cases without metastasis. We evaluated the intensity of expression (score 1 to mark absent / weak, score 2 for high ) and was found the percentage of labeled cells, where the score was 1 cases with 0 to 50% of positive cells, score 2 with 51 to 75% of positive cells, and score 3 more than 75% of positive cells. The sample comprised 72.5% of men with a mean age of 65.8 years, there was a predominance of stage II and 52.5% of the carcinomas were classified as low grade, being carcinoma with metastasis presenting most cases (70%) as carcinomas of high malignancy grade (p = 0.004). The largest number of cases of SCC of the lower lip that were in stages I / II (61, 9%) were classified as carcinomas of low grade malignancy and carcinomas in stages III / IV were classified as high-grade tumors (p = 0, 024). The BMP-2 showed strong intensity of immunostaining in 82.5%, BMPR-IA showed 55% of cases with an intensity of immunostaining absent / weak and BMPR-II showed 85% of cases with an intensity of immunostaining absent / weak. Only the protein BMPR-IA were significantly associated with all clinic-pathological parameters studied, metastasis (p <0.001), TNM (p <0.001) and histological grade of malignancy with (p = 0.028). The percentage of positive cells, all markers showed the highest number of cases with more than 75% of positive cells (score 3) and only BMPR-II showed statistical difference when related to the presence and absence of metastasis (p = 0.049 ). We conclude that there is disturbance in the BMP signaling pathway in EC-mediated lower lip and that high expression of BMP-2 associated with the expression of BMPR-IA and BMPR-II are associated with metastasis in carcinoma / Atualmente as prote?nas morfogen?ticas do osso (BMPs) t?m efetiva participa??o no crescimento de neoplasias malignas. Sabendo que s?o escassos os trabalhos envolvendo BMPs e o carcinoma epiderm?ide oral, este trabalho realizou um estudo imunoistoqu?mico da BMP-2, BMPR IA e BMPR II em carcinomas epiderm?ides (CE) de l?bio inferior relacionando com os aspectos clinico-patol?gicos desta les?o. A amostra constou de 40 casos de CE de l?bio inferior, sendo 20 casos de CE de l?bio inferior com met?stase linfonodal regional e 20 casos sem met?stase. A grada??o histol?gica de malignidade foi realizada no front invasivo da les?o. Foi avaliada a intensidade de express?o (escore 1 para marca??o ausente/ fraca e escore 2 para marca??o forte), bem como foi verificado a porcentagem de c?lulas positivas, onde o escore 1 era os casos com 0 a 50% das c?lulas positivas; escore 2 com 51 a 75% das c?lulas positivas; e escore 3 com mais de 75% das c?lulas positivas. A amostra foi composta por 72,5% de homens com a m?dia de idade de 65,8 anos, houve um predom?nio do est?gio II e 52,5% dos carcinomas foram classificados como de baixo grau, sendo os carcinomas com met?stase regional apresentando a maioria dos casos (70%) como carcinomas de alto grau de malignidade (p =0,004). O maior n?mero de casos de CE de l?bio inferior que estavam nos est?gios I/ II (61, 9%) foi classificado em carcinomas de baixo grau de malignidade e os carcinomas nos est?gios III/ IV foram classificados em alto grau de malignidade (p =0, 024). A BMP-2 apresentou intensidade da imunomarca??o forte em 82,5%, BMPR-IA observou-se 55% dos casos com intensidade de imunomarca??o ausente/ fraca e a BMPR-II revelou 85% dos casos com intensidade de imunomarca??o ausente/ fraca. Apenas a prote?na BMPR-IA apresentou associa??o estatisticamente significante com todos os par?metros clinico-patol?gicos estudados, met?stase (p<0,001), TNM (p<0,001) e grada??o histol?gica de malignidade com ( p=0,028). Quanto ? porcentagem de c?lulas positivas, todos os marcadores apresentaram o maior n?mero de casos com mais de 75% das c?lulas positivas (escore 3) e apenas a BMPR-II apresentou diferen?a estat?stica quando relacionada com a presen?a e aus?ncia de met?stase (p=0,049). Conclui-se que existe dist?rbio na via de sinaliza??o BMP-mediada no CE de l?bio inferior e que a alta express?o da BMP-2 associada com a express?o da BMPR-IA e BMPR-II est?o relacionadas com a met?stase neste carcinoma

Made available in DSpace on 2014-12-17T15:32:31Z (GMT). No. of bitstreams: 1 AnaRLAM_TESE.pdf: 3774507 bytes, checksum: 2b9028dcadafe1a4c66e01ba9daab791 (MD5) Previous issue date: 2012-07-19 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Squamous cell carcinoma of the lower lip is among the most common malignant tumors of the oral and maxillofacial region, with good prognosis in more than 90% of patients with 5-year survival. In these carcinomas, the development of lymph node metastasis decreases the prognosis and it has been associated with the formation of new lymphatic vessels. It has been suggested the important role of vascular endothelial growth factor-C (VEGF-C), the receptor type 3 VEGF (VEGFR-3) and hypoxia-induced factor 1 (HIF-1) in this process. The aim of this study was to evaluate the immunoexpression of VEGF-C, VEGFR-3 and HIF-1? and correlate with intra and peritumoral lymphatic density in squamous cell carcinomas of the lower lip metastatic and non-metastatic. The sample consisted of 50 cases of squamous cell carcinoma of lower lip, of which 25 had regional lymph node metastasis and 25, absence of metastasis. The percentages of cells immunostained for VEGF-C, VEGFR-3 and HIF-1? in front of tumor invasion and in the center of tumor were evaluated. Microvessel density lymphatic (MDL) was determined by the counting of lymph microvessels immunostained by the anti-D2-40 in five fields (200?), in an area of evaluation with 0.7386 mm2. The invasion of the lymph vessels by malignant cells was also evaluated. Immunostaining was correlated with the presence and absence of metastasis, TNM clinical stage, local recurrence, disease outcome (remission of injury or patient death) and histological grading. The analysis of intra and peritumoral lymphatic density showed no significant association with clinicopathological parameters and immunoexpressions of VEGF-C, VEGFR-3 and HIF-1? (p > 0,05). There was a weak positive correlation, significant, between intra and peritumoral lymphatic density (r = 0,405; p = 0,004). VEGF-C showed no significant association with clinicopathological and prognosis parameters (p > 0,05). For VEGFR-3, there was scarce membrane staining and intense and homogenous cytoplasmic staining in neoplastic cells. Percentage of positive cytoplasmic VEGFR-3 in center of tumor, exhibited a statistically significant association with metastasis (p = 0,009), patient death (p = 0,008) and histological grades of malignancy proposed by Bryne et al. (1992) (p = 0,002) and World Health Organization (p = 0,003). A low positive correlation was statistically significant between the immunoreactivity of VEGFC and VEGFR-3 cytoplasmic (r = 0,358; p = 0,011) and between the percentage of positive cytoplasmic VEGFR-3 in front of tumor invasion and in the center of the tumor (r = 0,387; p = 0,005) was also demonstrated. There was no association between HIF-1?, clinicopathological and prognosis parameters, and VEGF-C and VEGFR-3. The percentage of nuclear positivity for HIF-1? was significantly higher in cases without invasion of peritumoral lymphatic (p = 0,040). Based on the results we can conclude that most cytoplasmic expression of VEGFR-3 in center of tumor in metastatic cases, high degree of malignancy and poorly differentiated, contributes to poor outcome of squamous cell carcinoma of the lower lip, including patient death. Intra and peritumoral lymphatic density seems to be not associated with lymph node metastasis in these carcinomas / O carcinoma epiderm?ide de l?bio inferior est? entre as les?es malignas mais comuns da regi?o oral e maxilofacial, com progn?stico bom, em mais de 90% dos pacientes com sobrevida de 5 anos. Nestas les?es, o desenvolvimento de met?stase linfonodal diminui sobremaneira o progn?stico e tem sido associado ? forma??o de novos vasos linf?ticos. Tem sido sugerido o importante papel do fator de crescimento endotelial vascular-C (VEGF-C), do receptor tipo 3 do VEGF (VEGFR-3) e do fator 1 induzido por hip?xia (HIF-1) neste processo. O objetivo desta pesquisa foi avaliar as imunoexpress?es de VEGF-C, VEGFR-3, HIF-1? e a densidade linf?tica intra e peritumoral em carcinomas epiderm?ides de l?bio inferior metast?ticos e n?o-metast?ticos, correlacionando-as com par?metros clinicopatol?gicos e progn?sticos. A amostra foi constitu?da por 50 casos de carcinoma epiderm?ide de l?bio inferior, 25 com met?stase linfonodal regional e 25 sem met?stase. Foram avaliados os percentuais de c?lulas imunomarcadas para os anticorpos anti-VEGF-C, anti-VEGFR-3 e anti-HIF-1?, no front de invas?o e no centro tumoral. A densidade microvascular linf?tica (LMVD) foi estabelecida por meio da soma da contagem de microvasos linf?ticos imunomarcados pelo anticorpo anti-D2-40, em cinco campos (200?), em uma ?rea de avalia??o com 0,7386 mm2. A invas?o dos vasos linf?ticos por c?lulas neopl?sicas tamb?m foi avaliada. A imunomarca??o foi relacionada com a presen?a e aus?ncia de met?stase, estadiamento cl?nico TNM, recidiva local, desfecho da doen?a (remiss?o da les?o ou ?bito dos pacientes) e grada??o histol?gica. A an?lise das densidades linf?ticas intra e peritumorais n?o demonstrou associa??o significativa com os par?metros clinicopatol?gicos, progn?sticos e imunoexpress?es de VEGF-C, VEGFR-3 e HIF-1? (p > 0,05). Houve fraca correla??o positiva, significativa, entre as densidades linf?ticas intra e peritumorais (r = 0,405; p = 0,004). O VEGF-C n?o exibiu associa??o significativa entre os par?metros clinicopatol?gicos e progn?sticos avaliados (p > 0,05). Para o VEGFR-3, houve escassa marca??o membranar e intensa e homog?nea marca??o citoplasm?tica nas c?lulas neopl?sicas. O percentual de positividade citoplasm?tica do VEGFR-3, no centro tumoral, exibiu associa??o estatisticamente significativa com a presen?a de met?stase (p = 0,009), ?bito dos pacientes (p = 0,008) e grada??es histol?gicas de malignidade proposta por Bryne et al. (1992) (p = 0,002) e pela Organiza??o Mundial de Sa?de (p = 0,003). Uma fraca correla??o, estatisticamente significativa, entre a imunoexpress?o de VEGF-C e VEGFR-3 citoplasm?tica (r = 0,358; p = 0,011) e entre os percentuais de positividade citoplasm?tica de VEGFR-3 no front de invas?o e no centro tumoral (r = 0,387; p = 0,005) tamb?m foi demonstrada. N?o foi observada associa??o entre o HIF-1? os par?metros clinicopatol?gicos, progn?sticos e o VEGF-C e VEGFR-3. O percentual de positividade nuclear para HIF-1? foi significativamente maior nos casos sem invas?o dos linf?ticos peritumorais (p = 0,040). Com base nos resultados pode-se concluir que a maior express?o citoplasm?tica de VEGFR-3, no centro tumoral, nos casos metast?ticos, de alto grau de malignidade e pobremente diferenciados, contribui para pior evolu??o dos carcinomas epiderm?ides de l?bio inferior, incluindo o ?bito dos pacientes. As densidades linf?ticas intra e peritumorais parecem n?o estar associadas ao densenvolvimento de met?stase linfonodal nestes carcinomas

Made available in DSpace on 2014-12-17T15:32:34Z (GMT). No. of bitstreams: 1 ErickaJDS_tese.pdf: 814077 bytes, checksum: c31b79040c7db1898443078febad2a0d (MD5) Previous issue date: 2007-03-09 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / The progression of the oral squamous cells carcinomas (OSCCs) seems to suffer influence from related factors to the host, as local and systemic immunologic response, which are essential to the antineoplasic defenses. The purpose of this study was evaluate the local immunity in 30 tongue and 20 lower lip SCC by immunohistochemistry method, utilizing antibodies anti-CD3, CD4, -CD8, -CD25 e -&#950;(zeta), which immunoexpressions were compared considering the anatomical localization, the intensity of the inflammatory infiltrate into the front of invasion and metastases. The CD4/CD8+ ratio was calculated for each case and associate with the mentioned variable, being the intensity of the inflammatory infiltrated also compared with the anatomical localization and metastase and for this the cases had been grouped in two categories: (n = 10) absent/scarce inflammatory infiltrate; and (n = 40) moderate/intense infiltrate. Fisher?s exact test was performed (&#945;= 0.05) and it was not observed any significant correlation between these groups with anatomical sites and metastases. With regard to the immunoexpression, the CD3+, CD4+, CD8+ and CD25+ cells count was higher in the lower lip SCCs while the anti-&#950;immunomarcation was more evident in the non metastatic cases. Through the statistical analyses, it was verified that the CD3 exhibited positive-significant correlation with the inflammatory infiltrate (p = 0.023). Furthermore, antibodies against CD8 and CD25 cells were also significantly correlated with the inflammatory infiltrate (p = 0.002 and 0.030, respectively) and with the anatomical site (p = 0.004 and p = 0.004) mainly in the lower lip SCCs. CD4/CD8 ratio did not show significant association with metastase nor with anatomical localization. We conclude that the inflammatory infiltrated of the Bryne s (1998) system did not constitute an indicator of aggressiveness in the tongue and lower lip SCCs analyzed and that clinical behavior of the SCCs studied was related in part to the immunohistochemical profile of infiltrated the inflammatory present in tumoral invasion front / A progress?o dos carcinomas epiderm?ides orais (CEOs) parece sofrer influ?ncia de fatores relacionados ao hospedeiro, como a resposta imunol?gica local e sist?mica, as quais parecem ser essenciais para a defesa anti-neopl?sica. O presente estudo teve por objetivo analisar a imunidade local em 30 casos de CEs de l?ngua e 20 de l?bio inferior, atrav?s do m?todo da imuno-histoqu?mica, utilizando os anticorpos anti-CD3, -CD4, -CD8, -CD25 e -&#950;(zeta), comparando a imunomarca??o em ambas as localiza??es, com a intensidade de infiltrado inflamat?rio no front de invas?o e com presen?a ou n?o de met?stase. A raz?o de c?lulas CD4/CD8+ foi calculada para cada caso e associada com as vari?veis mencionadas, sendo a intensidade do infiltrado inflamat?rio comparada tamb?m com a localiza??o anat?mica e met?stase e para isso os casos foram agrupados em duas categorias (infiltrado escasso ou ausente E/A e infiltrado intenso ou moderado I/M), sendo encontrado 10 casos na categoria E/A e 40 na categoria I/M. Aplicado o teste exato de Fisher n?o verificamos associa??o significativa destes grupos com o s?tio anat?mico ou com met?stase. Em rela??o ? imunomarca??o, a contagem das c?lulas CD3+, CD4+, CD8+ e CD25+ foi maior nos CEs de l?bio inferior e sem met?stase, enquanto que o anti-&#950;foi mais expresso apenas nos casos sem met?stase. Atrav?s da an?lise estat?stica verificou-se que os anticorpos anti-CD3, anti-CD8 e anti-CD25 exibiram associa??o significativa positiva com o infiltrado inflamat?rio (p=0.023, p=0.002 e p=0.030, respectivamente); e os anticorpos anti-CD8 a anti-CD25 estiveram associados de forma positiva com a localiza??o anat?mica, ambos com valores de p=0.004, estando estes mais presentes nos CEs de l?bio inferior. A raz?o CD4/CD8 n?o exibiu associa??o significativa com met?stase nem com localiza??o anat?mica. Conclu?mos que o padr?o infiltrado inflamat?rio da grada??o histol?gica de malignidade de Bryne (1998) n?o constituiu um indicador de agressividade nos CEs de l?ngua e l?bio inferior analisados, e que o comportamento cl?nico dos CEs estudados esteve relacionado em parte ao perfil imuno-histoqu?mico do infiltrado inflamat?rio presente no front de invas?o tumoral