Desafios terapêuticos da mucosite oral em oncopediatria: um relato de caso

Abstract

Neuroblastoma (NB) is a neoplasm of the sympathetic nervous system, and the second most common extracranial malignant solid tumor in childhood. In antineoplastic therapy, oral complications can be observed, including oral mucositis (OM). It is an acute inflammation of the mucosa, resulting from the toxicity of chemotherapeutic drugs. This case report emphasizes the management of OM, as well as its influence on the systemic condition and quality of life. A 9-year-old female L.M.M.F, diagnosed two months ago with metastatic neuroblastoma with local recurrence, was admitted to the hospital unit, complaining of severe pain in the oral cavity and oropharynx. On physical examination, he had dysphagia and severe weight deficit, which weakened the swallowing of his own saliva. The intraoral examination revealed grade 3 OM lesions, according to the World Health Organization (WHO), on the lips, anterior gingiva and oropharynx. The treatment consisted of removal of local debris, hygiene of the oral cavity with 0.12% chlorhexidine and swab, aiming at local microbial control, daily. In addition, photobiomodulation (Photon Lase III - PL7336, DMC) was applied to the erythematous and hemorrhagic bed at a 90 degree angle to a lip contact surface (660 nm, 50 mW, 2 J / cm 2, 90 seconds) punctually in the areas of the lesion bed and in sweeping in the oropharynx region (interspersed sessions). Racealfatocopherol acetate (vitamin E) was prescribed for antioxidant action and hydration of the lips. Knowing the possibility of bacteremia, it was decided that all treatment would be accompanied by antibiotic therapy with cefepime 1 mg / day. After 7 days, there was complete remission of the lesion. It is concluded that the dental intervention in interdisciplinarity, allowed the physical and emotional restoration, allowing a better quality of life of the patient.