Tatiana Ferreira Foscaldo

BACKGROUND AND OBJECTIVE: Trigeminal neuralgia (TN) and postherpetic neuralgia (PHN) are severe peripheral neuropathic pain conditions associated with substantial functional impairment. Although pharmacological treatments are available, many patients experience insufficient efficacy or poor tolerability. Botulinum toxin type A (BoNT-A) has emerged as a potential treatment, but uncertainties remain regarding its efficacy, safety, and clinical positioning. This umbrella review aimed to synthesise evidence from systematic reviews evaluating BoNT-A in TN and PHN. A systematic search was conducted in MEDLINE, Embase, Cochrane Library, Web of Science, and CINAHL from inception to November 2025. Systematic reviews with or without meta-analysis evaluating BoNT-A in adults with TN or PHN were included. Methodological quality was assessed using AMSTAR-2, and only moderate- or high-quality reviews were included. Primary outcomes were pain intensity reduction and responder rates (≥ 50% pain reduction). Secondary outcomes included quality of life and adverse events. Ten systematic reviews (2015-2024) met the inclusion criteria. Botulinum toxin type A was consistently associated with reductions in pain intensity and higher responder rates than placebo, particularly in TN. In PHN, evidence was more limited but supported short-term (1-3 months) improvements in pain intensity. Evidence on quality of life was scarce and inconclusive. Botulinum toxin type A was well tolerated, with mostly mild and transient adverse events. Botulinum toxin type A appears to provide short-term pain relief in selected patients with TN and PHN and is generally well tolerated. Current evidence supports its role as an adjunctive third-line option for focal peripheral neuropathic pain, although heterogeneity and limited long-term data warrant cautious interpretation.

Chondrolipoma is a rare benign soft tissue neoplasm, being more common in adulthood, approximately 20% occur in the head and neck region and only 1 to 5% in the oral cavity. We present the case of a 62-year-old female patient who presented with an increase in volume in the floor of the mouth, with a five-year evolution. On clinical examination, the patient presented a painless sessile lesion with well-defined borders, located on the right side of the floor of the mouth, measuring approximately 3 cm in diameter. An excisional biopsy was performed, which revealed variable amounts of cartilaginous tissue surrounded by adipocytes arranged in lobules, confirming the diagnosis of chondrolipoma. A literature review was carried out, indicating that the most common location of chondrolipomas in the head and neck region was the tongue (46.4%), followed by the lower lip (14.3%), oropharynx (14.3%), floor of the mouth (10.7%), nasopharynx (7.1%), masseter muscle (3.6%) and sternocleidomastoid muscle (3.6%). Chondrolipomas have an undefined etiology and histogenesis, are more frequently observed in adult patients, and predominantly affect the head and neck region. The most affected areas are the tongue and lower lip, which together account for 60.7% of cases.

Solitary Fibrous Tumor (SFT) is a rare mesenchymal neoplasm, account approximately 3% of mesenchymal tumors in the oral cavity. We present the case of a 65-year-old female patient with a painless swelling in the left upper lip. Clinical examination revealed a firm, smooth-surfaced submucosal lesion without ulceration, non-tender on palpation, and exhibiting a slightly yellowish hue. Computed tomography demonstrated a well-defined, isodense mass measuring 25 mm in diameter, with no evidence of bone invasion. The lesion was surgically excised, and histopathological analysis confirmed the diagnosis of SFT, supported by positive immunohistochemical staining for CD34 and STAT6. The tumor was classified as low risk for metastasis, and the patient demonstrated favorable postoperative recovery. The patient remains under follow-up with the medical team and has been recurrence-free for 07 months. This case underscores the rarity of oral cavity SFT and emphasizes the importance of comprehensive differential diagnosis to guide effective management and reduce recurrence risk.