RESUMO
BACKGROUND: Partial glossectomy is the most common procedure for early-stage tongue cancer. Although late postoperative bleeding occasionally occurs, the associated risk factors have not been adequately identified. AIMS/OBJECTIVES: We aimed to investigate the rate and risk factors for late postoperative bleeding after transoral partial glossectomy with or without neck dissection for tongue cancer at our institution. MATERIAL AND METHODS: We analysed 211 patients who had undergone transoral partial glossectomy between January 2016 and January 2023. The potential risk factors associated with late postoperative bleeding were investigated using univariate and multivariate logistic regression analyses. RESULTS: Of the 211 patients, 40 (19%) showed late postoperative bleeding, with 19 (9%) classified as grade IIIa (Clavien-Dindo classification). Regarding all grades, late postoperative bleeding was significantly higher in patients aged <70 years and in those with polyglycolic acid (PGA) sheets (p = .046 and .030, respectively). For grade ≥ IIIa, late postoperative bleeding was significantly higher in patients with a history of anticoagulant/platelet administration, a mucosal defect covered with fibrin glue and a PGA sheet (p = .045 and .026, respectively). CONCLUSIONS AND SIGNIFICANCE: The findings of this study suggest that primary closure decreases the frequency of late postoperative bleeding.
Assuntos
Glossectomia , Neoplasias da Língua , Humanos , Glossectomia/efeitos adversos , Glossectomia/métodos , Neoplasias da Língua/cirurgia , Adesivo Tecidual de Fibrina , Língua , Hemorragia Pós-Operatória/epidemiologia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/cirurgia , Fatores de RiscoRESUMO
BACKGROUND: There exists a lacuna in the structured reporting of swallowing dysfunction and quality of life (QoL) outcome following major glossectomy. METHODS: Prospective cohort study to assess the swallowing dysfunction and QoL following STG (subtotal glossectomy) or NTG (near total glossectomy) over a 6-month period using FEES and PAS scale, MDADI, and FACT-HN. RESULTS: Twenty-four patients were available for analysis. The pre- and post-adjuvant evaluation revealed a statistically significant improvement in the composite MDADI and FACT-HN scores. Subscale analysis of FACT-HN scores revealed maximum deficit in the head and neck cancer-specific score domain followed by functional domain and social well-being domain, with serial improvement noted in the post-adjuvant setting. CONCLUSION: This study showed serial improvement in terms of swallowing dysfunction although social and functional well-being domains related to QoL continued to reveal major deficits. Better outcomes were seen with preservation of bilateral base of tongue and mandible.
Assuntos
Transtornos de Deglutição , Deglutição , Humanos , Glossectomia/efeitos adversos , Estudos Prospectivos , Qualidade de Vida , Transtornos de Deglutição/etiologiaRESUMO
OBJECTIVE: To analyze the functional outcomes and complications of total glossectomy with laryngeal preservation and reconstruction with free or pedicled flaps. METHODS: A search was conducted using Pubmed/MEDLINE, Cochrane Library, Scopus, and Google Scholar databases. A single arm meta-analysis was performed for feeding tube dependence (FTD), tracheostomy dependence (TD), and speech intelligibility (SI) rates. Peri-operative sequels and complications were evaluated as secondary outcomes. RESULTS: A total number of 642 patients (median age: 54.2 years; 95% CI 52.1-58) were included. Functional assessment was performed after a median of 12 months (n = 623/642; 95% CI 10.6-12). Overall, the cumulative FTD rate was 22.9% (n = 188/627; 95% CI 10.2-38.7), the TD rate was 7.3% (n = 95/549; 95% CI 1.9-15.8), and the SI was 91.1% (n = 314/409; 95% CI 80.7%-97.8). The cumulative complication rate was 33.1% (n = 592/642). Eighteen patients (n = 18/592; 3.0%) experienced a major fistula, while aspiration pneumonia occurred in 17 cases (n = 17/592; 2.8%). CONCLUSIONS: Total glossectomy with laryngeal preservation and pedicled/free flaps reconstruction may guarantee good functional results and an acceptable quality of life. Further prospective studies are advised to define clinical guidelines about proper patients' and flaps' selection.
Assuntos
Retalhos de Tecido Biológico , Demência Frontotemporal , Neoplasias da Língua , Humanos , Pessoa de Meia-Idade , Glossectomia/efeitos adversos , Glossectomia/métodos , Estudos Prospectivos , Qualidade de Vida , Demência Frontotemporal/cirurgia , Neoplasias da Língua/cirurgia , Retalhos Cirúrgicos , Estudos RetrospectivosRESUMO
BACKGROUND: There is no consensus on the postoperative outcomes of tongue reconstruction. Therefore, the authors developed a novel risk model for predicting dysphagia after tongue reconstruction. METHODS: This retrospective study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical, or OPERA, group across 31 cancer centers and university hospitals in Japan. A total of 532 patients [390 (73.3%) men and 142 (26.7%) women; median age at surgery, 60 years (range, 15 to 88 years)] who were diagnosed with oral tongue squamous cell carcinoma and underwent tongue reconstruction following glossectomy between 2009 and 2013 were included. Independent risk factors were identified using univariate regression analysis and converted to a binary format for multivariate analysis. An integer value was assigned to each risk factor to calculate a total score capable of quantifying the risk of feeding tube dependence. RESULTS: Overall, 54 patients (10.2%) required a feeding tube at the time of evaluation. Predictive factors for feeding tube dependence were advanced age, lower American Society of Anesthesiologists physical status, low body mass index, lower serum albumin, comorbid hypertension and diabetes, extended tongue defect, resection beyond the tongue, laryngeal suspension, postoperative radiation therapy, and no functional teeth. In multivariate logistic regression analysis, age greater than or equal to 58.5 years, postoperative radiation therapy, wider tongue defect, and body mass index less than 21.27 kg/m 2 earned 6, 4, 3, and 2 points, respectively, for a maximum total score of 15. CONCLUSION: The authors' risk model provides a mathematical tool for estimating the individual risk of postoperative feeding tube dependence before tongue reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
Assuntos
Carcinoma de Células Escamosas , Transtornos de Deglutição , Neoplasias de Cabeça e Pescoço , Neoplasias da Língua , Masculino , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Estudos Retrospectivos , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Japão/epidemiologia , Neoplasias da Língua/cirurgia , Neoplasias da Língua/complicações , Neoplasias da Língua/patologia , Língua/cirurgia , Glossectomia/efeitos adversos , Neoplasias de Cabeça e Pescoço/cirurgiaRESUMO
BACKGROUND: Numerous options to manage local reconstruction following transoral partial glossectomy are possible. In this work, we present our experience using a matrix for mucosal regeneration, Integra®, after transoral resections of squamous cell carcinoma of the oral tongue. METHODS: A retrospective analysis of patients treated for tongue carcinoma and reconstruction with Integra®, from September 2017 to September 2022. Functional outcomes were evaluated by measuring swallowing and speech abilities, tongue motility, and subjective quality of life. RESULTS: The series accounts for 13 consecutive patients, staged from Tis to T3, no positive resection margins were found, average defect size was 17.8 cm2. The average histologically measured depth of invasion was 4.1 mm (range 2-12 mm), and no recurrences were observed during follow-up. All patients maintained excellent swallowing function, the average number of recognized words by an external listener during a phone call was 70.5 out of 75, the lingual motility test was good (a mean score of 4.5 out of 6 movements correctly executed) and subjective questionnaires results were optimal. Less satisfying functional results were recorded in elderly patients receiving a wider surgical resection. CONCLUSIONS: This reconstructive technique for allows obtaining optimal healing and functional outcomes in patients with tumors suitable for transoral glossectomy.
Assuntos
Carcinoma de Células Escamosas , Glossectomia , Humanos , Idoso , Glossectomia/efeitos adversos , Glossectomia/métodos , Estudos Retrospectivos , Qualidade de Vida , Carcinoma de Células Escamosas/patologia , RegeneraçãoRESUMO
INTRODUCTION: Macroglossia occurs in 80% to 99% of patients with Beckwith-Wiedemann syndrome (BWS) and a variety of surgical techniques for tongue reduction are offered by surgeons. The purpose of this study is to evaluate the postoperative outcomes of the anterior "W" tongue reduction technique in patients with BWS. METHODS: A retrospective review was conducted of all patients diagnosed with BWS that underwent an anterior "W" tongue reduction for macroglossia in the past 7 years, performed by 2 surgeons. Demographics, procedural characteristics, perioperative outcomes, and complications were assessed. RESULTS: A total of 19 patients met inclusion criteria consisting of 8 male and 11 female patients. The mean age at the time of surgery was 405 days, mean surgeon operating time was 1.06â h, and mean length of follow-up was 467 days. Postoperative oral competence was observed in 100% of patients. There was no reported history of sleep apnea or airway compromise. Speech delay was seen in 4 patients pre- and postoperatively. Feeding issues decreased from 7 patients preoperatively to 1 patient postoperatively. Preoperative prevalence of class III malocclusion (53%) and isolated anterior open bite (26%) decreased postoperatively to 37% and 16%, respectively. The only reported complications were superficial tip wound dehiscence in 3 patients treated with nystatin antifungal therapy. None of the patients required revisional surgery. CONCLUSION: Patients treated with the anterior "W" tongue reduction technique had low rates of perioperative complications and significant improvements in oral competence. Anterior "W" tongue reduction is safe and effective for the correction of macroglossia in patients with BWS.
Assuntos
Síndrome de Beckwith-Wiedemann , Macroglossia , Síndrome de Beckwith-Wiedemann/complicações , Síndrome de Beckwith-Wiedemann/cirurgia , Feminino , Glossectomia/efeitos adversos , Glossectomia/métodos , Humanos , Macroglossia/congênito , Macroglossia/cirurgia , Masculino , Língua/cirurgiaRESUMO
OBJECTIVE: Treatment of tongue cancer caused oral morbidities such as oral dryness, and dysphagia. The purpose of this study is to examine the time course of oral function and QOL based on resected area for patients after tongue cancer resection. METHODS: 31 patients who underwent tongue cancer resection at the Showa University Head and Neck Oncology Center. The participants were divided into two groups; 24 participants in partial/hemi glossectomy group (PG), and seven in subtotal/total glossectomy group (TG). Participants were evaluated swallowing function (FOIS and MASA-C), tongue pressure (TP: kPa), BMI, whole body muscle mass (kg), and QOL evaluation (EORTC QLQ-C30, H & N35). Participants were measured at baseline (before surgical treatment), 1, 3, and 6 months after surgical treatment (1M, 3M, and 6M). RESULTS: At baseline, tongue pressure and FOIS score of PG were significant higher than that of TG. At 1M, TP, MASA-C, and FOIS score of PG were significant higher than that of TG. At 3M, TP, MASA-C, and FOIS score of PG were significant higher than that of TG. At 6M, TP and MASA-C were significantly higher than that of TG. QOL measurements did not noted any significant difference between groups before 6M. At 6M, Some QOL measurements of TG related tongue function (Swallowing, Senses, Speech, Social contact) were significantly lower than PG. CONCLUSIONS: The resected area had significant effects on oral morbidities and feeding function. It is necessary to develop more effective rehabilitation methods to improve patients QOL who had functional impairment remained.
.
Assuntos
Transtornos de Deglutição/fisiopatologia , Deglutição , Glossectomia/efeitos adversos , Procedimentos de Cirurgia Plástica/efeitos adversos , Pressão , Qualidade de Vida , Neoplasias da Língua/cirurgia , Transtornos de Deglutição/etiologia , Feminino , Seguimentos , Glossectomia/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Procedimentos de Cirurgia Plástica/reabilitação , Neoplasias da Língua/patologiaRESUMO
Head and neck surgeons must have a thorough knowledge of head and neck vascular anatomy and its variations. This case report documents a variation in the superior thyroid artery encountered during a neck dissection and discusses the surrounding literature. A 55-year-old female with squamous cell carcinoma of the tongue underwent a partial glossectomy, right level I-IV neck dissection and reconstruction with a radial forearm free flap. During the procedure, an arterial branch was encountered arising 2-3cm caudal to the common carotid bifurcation. This variant branch was shown to represent the superior thyroid artery. On review of the literature, various classification systems of the superior thyroid artery origin have been described. Awareness of such anatomical variation is vital for the head and neck surgeon to avoid unexpected complication.
Assuntos
Variação Anatômica , Lesões das Artérias Carótidas/prevenção & controle , Artéria Carótida Externa/anormalidades , Complicações Intraoperatórias/prevenção & controle , Esvaziamento Cervical/efeitos adversos , Lesões das Artérias Carótidas/etiologia , Feminino , Glossectomia/efeitos adversos , Glossectomia/métodos , Humanos , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Esvaziamento Cervical/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Glândula Tireoide/irrigação sanguínea , Neoplasias da Língua/cirurgiaRESUMO
BACKGROUND: The medial sural artery perforator free flap (MSAP) has gained increasing popularity in head and neck reconstruction. Its slightly bulkier nature than the radial forearm flap, combined with negligible donor site morbidity, makes it an ideal candidate for the reconstruction of partial glossectomy defects. The ability to harvest the MSAP as a chimeric flap with a portion of the medial gastrocnemius muscle gives it greater flexibility in soft tissue reconstruction. METHODS: A retrospective study of patients with partial glossectomy defects reconstructed using the MSAP by a single surgeon was performed. Perioperative data, donor and recipient site characteristics, complications, and outcomes were analyzed. A video is included to show technical points for the harvest of the flap. RESULTS: A total of 10 patients were included. The average age was 59.1 years, with a mean of 43.5% of the tongue resected. All flaps survived, with no major complications. At follow-up, the patients had regained an average of 86.5% of original speech, with none requiring NG feeding. The average MSAP skin flap thickness was 7.8â¯mm, with 6 flaps being harvested as chimeric fasciocutaneous muscle flaps. Five flaps incorporated 2 perforators. Two case examples are presented. CONCLUSION: The chimeric MSAP perforator allows for more robust partial glossectomy reconstruction with improved postoperative functional outcomes. It should be considered as the workhorse flap for partial tongue reconstruction.
Assuntos
Carcinoma de Células Escamosas , Glossectomia/efeitos adversos , Músculo Esquelético , Procedimentos de Cirurgia Plástica , Artérias da Tíbia/cirurgia , Neoplasias da Língua , Língua , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Feminino , Glossectomia/métodos , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/transplante , Retalho Perfurante/irrigação sanguínea , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Língua/lesões , Língua/cirurgia , Neoplasias da Língua/patologia , Neoplasias da Língua/cirurgia , Resultado do TratamentoRESUMO
BACKGROUND: Macroglossia, a cardinal feature of the (epi)genetic disorder Beckwith-Wiedemann syndrome, is associated with obstructive sleep apnea, speech and/or feeding difficulties, and dental or jaw malalignment. These sequelae may be treated and/or prevented with tongue reduction surgery; the authors sought to determine whether certain Beckwith-Wiedemann syndrome patients may benefit from early surgical intervention before age 12 months. METHODS: The authors conducted a retrospective review of patients with Beckwith-Wiedemann syndrome who underwent tongue reduction from 2014 to 2019. The authors assessed primary outcomes of change in obstructive sleep apnea by polysomnography, respiratory support required, and feeding route before and after tongue reduction, and reviewed postoperative complications and the need for repeated tongue reduction. RESULTS: Of the 36 patients included, the median age at tongue reduction was 9.5 months (interquartile range, 3.8 to 22.8 months). For those with severe obstructive sleep apnea, there was a significant reduction in the obstructive apnea hypopnea index from 30.9 ± 21.8 per hour to 10.0 ± 18.3 per hour (p =0.019) and improvement in nadir oxyhemoglobin saturation from 72 ± 10 percent to 83 ± 6 percent (p =0.008). Although there was no significant change in overall supplemental feeding tube or respiratory support, there were specific patients who experienced clinically meaningful improvement. Of note, these positive outcomes applied equally to those who underwent surgery at a younger age (<12 months). To date, only one patient required a repeated tongue reduction. CONCLUSION: Based on improved polysomnographic findings and rarity of surgical complications or repeated surgery, the authors' data support the safety and efficacy of this early intervention when clinical indications are present and an experienced multidisciplinary team is available for consultation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Assuntos
Síndrome de Beckwith-Wiedemann/cirurgia , Glossectomia/métodos , Macroglossia/congênito , Complicações Pós-Operatórias/epidemiologia , Apneia Obstrutiva do Sono/cirurgia , Síndrome de Beckwith-Wiedemann/complicações , Síndrome de Beckwith-Wiedemann/genética , Pré-Escolar , Estudos de Viabilidade , Métodos de Alimentação/estatística & dados numéricos , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/prevenção & controle , Feminino , Seguimentos , Glossectomia/efeitos adversos , Humanos , Lactente , Macroglossia/complicações , Macroglossia/genética , Macroglossia/cirurgia , Masculino , Polissonografia/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Sistema de Registros/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/etiologia , Distúrbios da Fala/etiologia , Distúrbios da Fala/prevenção & controle , Tempo para o Tratamento , Língua/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: The objective of this study was to determine the effectiveness and morbidities of two different tongue base surgical approaches in patients with obstructive sleep apnoea (OSA). DESIGN AND SETTING: We carried out a prospective analysis in order to understand in detail the relative impact on apnoeas of the two different tongue base procedures. Seventy cases in 85 patients with OSA were divided into two operating groups and randomized. Altogether, 37 transoral robotic surgeries (TORS) and 33 coblations were performed. The patency of retrolingual passage was investigated by Muller's manoeuvere, polysomnography. Apnoea-hypopnea index (AHI) was the primary outcome measure with the Epworth Sleepiness Score (ESS). The final follow-up visit was at 6 months. RESULTS: The AHI index improved from 29.7 ± 9 to 10.7 ± 3.9 (P < .005) following TORS and from 27.2 ± 6.4 to 10.3 ± 4 in the coblation group. Selecting a threshold of a 50% reduction in AHI and AHI less than 20 events/h, the overall success rate was 75.6% in TORS compared with 78.7% in coblation (P = .785). Similar results were seen in AHI reduction rates (36%, 37.8%, respectively). ESS showed a significant improvement 6 months following surgery in both groups. CONCLUSION: Transoral robotic surgery technique showed higher complication rates than coblation. TORS and coblation of the tongue base represent a promising treatment option with a similar AHI improvement. However, coblation promises lower complication rates unlike TORS.
Assuntos
Técnicas de Ablação/métodos , Endoscopia/métodos , Glossectomia/métodos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos , Apneia Obstrutiva do Sono/cirurgia , Técnicas de Ablação/efeitos adversos , Adulto , Endoscopia/efeitos adversos , Feminino , Glossectomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/patologiaRESUMO
We explored the effects of various parameters on taste impairments (TIs) in head-and-neck (H&N) cancer patients receiving intensity-modulated radiotherapy (IMRT). From January 2014 to September 2017, 88 H&N cancer patients subjected to curative or postoperative IMRT were enrolled in this prospective study. All patients underwent at least 1 year of follow-up after IMRT. Quality-of-life assessments in terms of patient-reported gustatory function were measured using the taste-related questions of the European Organization for Research and Treatment of Cancer H&N35 questionnaires. At a median follow-up time of 27 months, 27 of 88 patients (30.7%) reported long-term TIs. In multivariate analyses, glossectomy most significantly predicted TIs (P = 0.04). The percentage of TIs (61.5%) was significantly (P = 0.03) higher in patients who underwent partial or total glossectomy than in patients who did not undergo surgery (28.0%) and those who underwent radical surgery without glossectomy (20.0%). When we excluded surgical patients from analyses, the mean radiation dose to the oral cavity was of borderline significance in terms of TI prediction (P = 0.05). Only 10.5% of patients suffered from TIs when the mean radiation dose was <5000 cGy compared with 38.7% when the mean dose was ≥5000 cGy. In conclusion, glossectomy is the major cause of long-term TIs in H&N cancer patients receiving IMRT. In patients who do not undergo glossectomy, reduction of the mean radiation dose to the oral cavity may reduce TIs after IMRT.
Assuntos
Glossectomia/efeitos adversos , Neoplasias de Cabeça e Pescoço/radioterapia , Neoplasias de Cabeça e Pescoço/cirurgia , Boca/cirurgia , Radioterapia de Intensidade Modulada/efeitos adversos , Distúrbios do Paladar/radioterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Qualidade de Vida , Doses de Radiação , Adulto JovemRESUMO
OBJECTIVES: The purpose of the retrospective study was to compare the differences of quality of life (QOL) outcomes 2 or more years postoperatively between the free radial forearm flap (FRFF) and anterolateral thigh flap (ALTF) in reconstruction of defects of a hemiglossectomy. METHODS: Ninety patients who had a lapse ≥2 years since the reconstructive flap surgery were evaluated by the University of Washington quality of life scale (UW-QOL), and Performance Status Scale for Head and Neck (PSS-HN). RESULTS: Patients in the FRFF group reported statistically and clinically significantly better scores in the recreation, swallowing, chewing and speech domains of the UW-QOL compared with those in the ALTF group (P < .05). Similarly, FRFF provided better results in the understandability of speech and normalcy of diet of the PSS-HN, than the ALTF (P < .05). CONCLUSIONS: FRFF had the advantage of oral functions, such as chewing, speech and swallowing, over the ALTF for reconstruction of defect of half of the tongue. These results may provide useful information for surgeons to select a suitable free flap for tongue reconstruction.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Glossectomia/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Qualidade de Vida , Neoplasias da Língua/cirurgia , Adulto , Idoso , Feminino , Antebraço/irrigação sanguínea , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Coxa da Perna/irrigação sanguíneaAssuntos
Boca/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Glândula Sublingual/cirurgia , Retalhos Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Carcinoma Verrucoso/cirurgia , Feminino , Glossectomia/efeitos adversos , Humanos , Masculino , Neoplasias Mandibulares/cirurgia , Osteotomia Mandibular/efeitos adversos , Mucosa Bucal/cirurgia , Complicações Pós-Operatórias/cirurgia , Glândula Sublingual/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Neoplasias da Língua/cirurgiaRESUMO
OBJECTIVE: Surgery for locally advanced oral cancer often requires wide resections of multiple subsites of the oral cavity, including the oral tongue, floor of the mouth, and lower gingiva, and it causes chewing and swallowing disorders. The aim of this prospective, observational study was to determine which subsites have a greater impact on chewing and swallowing disorders after surgery. METHODS: A prospective, observational study was conducted involving 52 patients who underwent surgery for locally advanced oral cancer with free flap reconstruction. The patients' Functional Oral Intake Scale scores were measured before surgery and 1 and 3 months after surgery. Possible predictors of chewing and swallowing disorders were subjected to univariate analysis and multivariate logistic regression analysis. Age, sex, preoperative body mass index, clinical stage, extent of mandibular bone resection, floor of the mouth resection, total or subtotal glossectomy, laryngeal suspension, bilateral neck dissection, and postoperative radiation therapy were the variables evaluated. RESULTS: Multivariate logistic regression analysis showed that both anterior or extensive mandibular bone resection and postoperative radiation therapy were independently associated with poor oral intake after surgery. CONCLUSIONS: The identified predictors will be helpful for better management of patients identified as being at high risk of chewing and swallowing disorders.
Assuntos
Transtornos de Deglutição/diagnóstico , Retalhos de Tecido Biológico/efeitos adversos , Glossectomia/efeitos adversos , Mastigação , Neoplasias Bucais/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Idoso , Transtornos de Deglutição/etiologia , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos ProspectivosRESUMO
BACKGROUND: Venous coupling devices are widely used during reconstructive surgery involving microvascular anastomosis but have not served as foreign bodies in head and neck surgical site infections. METHODS: We conducted a case report. RESULTS: A patient underwent resection and free flap reconstruction for recurrent tongue squamous cell carcinoma. She developed a neck abscess due to Streptococcus intermedius 7 weeks postoperatively, days after starting chemoradiotherapy. The surgical site infection healed with drainage and antibiotics. Two surgical site infection relapses due to S. intermedius occurred 3 and 8 weeks after completing radiation, the second relapse after a prolonged course of i.v. antibiotics. Surgical exploration revealed a venous coupler within granulation tissue. The device was removed and no further surgical site infection relapses occurred. CONCLUSION: To the best of our knowledge, this is the first report of a delayed-onset head and neck surgical site infection in which a venous coupler served as a foreign body. An infected foreign body should be suspected in relapsing surgical site infections due to a single organism.
Assuntos
Retalhos de Tecido Biológico/efeitos adversos , Microcirurgia/instrumentação , Procedimentos de Cirurgia Plástica/efeitos adversos , Infecção da Ferida Cirúrgica/patologia , Infecção da Ferida Cirúrgica/cirurgia , Idoso , Biópsia por Agulha , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Remoção de Dispositivo/métodos , Feminino , Seguimentos , Glossectomia/efeitos adversos , Glossectomia/métodos , Humanos , Imuno-Histoquímica , Microcirurgia/métodos , Procedimentos de Cirurgia Plástica/métodos , Reoperação/métodos , Infecção da Ferida Cirúrgica/fisiopatologia , Neoplasias da Língua/patologia , Neoplasias da Língua/cirurgia , Resultado do Tratamento , CicatrizaçãoRESUMO
Beckwith-Wiedemann syndrome (BWS) is a rare paediatric overgrowth disorder. Associated macroglossia is a feature of many children with BWS and is felt to be a risk factor for obstructive sleep apnoea (OSA). Sleep-disordered breathing is highly variable in this population. The relationship between degree of macroglossia or other genotypic or phenotypic factors and OSA severity has not been established. The natural history of OSA in this population is unknown; a variety of conservative and surgical therapies have been used to treat OSA in children with BWS but none have been studied systematically. Tongue reduction is the mainstay of surgical therapy for macroglossia associated with BWS, but limited data are available regarding its efficacy in treating OSA or its effect on speech and swallowing. More research is needed to better identify which children with BWS are at risk for OSA and the most effective treatment for these patients.
Assuntos
Síndrome de Beckwith-Wiedemann/complicações , Glossectomia/efeitos adversos , Macroglossia/cirurgia , Apneia Obstrutiva do Sono , Criança , Gerenciamento Clínico , Glossectomia/métodos , Humanos , Macroglossia/etiologia , Medição de Risco , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Apneia Obstrutiva do Sono/terapiaRESUMO
Purpose: The aims of this article were to determine the effects of hard palate morphology and glossectomy surgery on tongue position and shape during /s/ for patients with small tumors. The first expectation was that laminal /s/ would be more prevalent in patients, than apical, due to reduced tongue tip control after surgery. The second was that patients would hold the tongue more anteriorly than controls to compensate for reduced tongue mass. Method: Three-dimensional tongue volumes were calculated from magnetic resonance imaging for the whole tongue and the portion anterior to the first molar during the /s/ in /Ésuk/ for 21 controls and 14 patients. These volumes were used to calculate tongue anteriority and cross-sectional shape. Dental casts were used to measure palate perimeter, height, and width of the hard palate. Results: Palate height correlated with tongue height in controls (p < .05), but not patients. In patients, tongue anteriority correlated negatively with canine width and cross-sectional tongue shape (p < .05). Controls with a high palate favored laminal /s/. Patients preferred laminal /s/ regardless of palate height (p < .01). Conclusions: For controls, hard palate height affected tongue height; a higher palate yielded a higher tongue. For patients, hard palate width affected tongue width; a narrower palate yielded a more anterior tongue. Tongue shape was unaffected by any palate features. Preference for /s/ showed an interaction effect between subject and palate height. Controls with high palates preferred a laminal /s/. All patients preferred a laminal /s/; glossectomy surgery may reduce tongue tip control.
Assuntos
Glossectomia/efeitos adversos , Fonética , Complicações Pós-Operatórias/fisiopatologia , Transtorno Fonológico/fisiopatologia , Neoplasias da Língua/fisiopatologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dente Molar/diagnóstico por imagem , Palato Duro/diagnóstico por imagem , Palato Duro/fisiopatologia , Complicações Pós-Operatórias/etiologia , Transtorno Fonológico/etiologia , Neoplasias da Língua/cirurgia , Adulto JovemRESUMO
BACKGROUND: While aggressive treatment for oral cancer may optimize survival, decrements in speech and swallowing function and quality of life often result. This exploratory study investigated how patients recover their communicative function, swallowing ability, and quality of life after primary surgery [with or without adjuvant (chemo)radiation therapy] for tongue cancer over the course of the first year post-operation. METHODS: Patients treated for oral cancer at three institutions (University of Alberta Hospital, Mount Sinai Beth Israel Medical Center, and Turku University Hospital) were administered patient-reported outcomes assessing speech [Speech Handicap Index (SHI)], swallowing [(M.D. Anderson Dysphagia Inventory (MDADI)] and quality of life [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module (EORTC-H&N35)]. Outcome measures were completed pre-operatively and at 1-, 6-, and 12-months post-operatively. RESULTS: One hundred and seventeen patients undergoing partial glossectomy with reconstruction participated in this study. Results indicated no significant differences in swallowing function (MDADI and EORTC-H&N35 subscales) between baseline and 6 months post-surgery and no significant differences in speech function (SHI subscales) between baseline and 1 year post-surgery. Most quality of life domains (EORTC-H&N35 subscales) returned to baseline levels by 1 year post-operation, while difficulties with dry mouth and sticky saliva persisted. A clear time trend of adjuvant (chemo)radiation therapy negatively affecting dry mouth scores over time was identified in this study, while negative independent effects of chemoradiation on MDADI swallowing, and EORTC-H&N35 swallowing, eating, and opening mouth subscales were found. CONCLUSIONS: Assessment time influenced patient-reported speech, swallowing, and quality of life outcomes, while treatment (by time) effects were found for only swallowing and quality of life outcomes. Results of the present study will help guide clinical care and will be useful for patient counseling on expected short and long-term functional and quality of life outcomes of surgical and adjuvant treatment for oral cavity cancer.
Assuntos
Atividades Cotidianas , Glossectomia/métodos , Medidas de Resultados Relatados pelo Paciente , Neoplasias da Língua/patologia , Neoplasias da Língua/cirurgia , Adulto , Idoso , Canadá , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Avaliação da Deficiência , Glossectomia/efeitos adversos , Glossectomia/psicologia , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Estudos Prospectivos , Qualidade de Vida , Procedimentos de Cirurgia Plástica/métodos , Medição de Risco , Distúrbios da Fala/etiologia , Distúrbios da Fala/fisiopatologia , Xerostomia/etiologia , Xerostomia/fisiopatologiaRESUMO
The appropriate tongue reconstruction method is critical for better functional outcomes. The aim of this study was to determine the optimal reconstructive method for restoring postoperative function based on the extent of resection. We retrospectively reviewed 43 patients with lateral oral tongue cancer who underwent glossectomy between January 2010 and October 2014. Tongue mobility, articulation, verbal diadochokinesis, speech intelligibility and swallowing outcomes were assessed 2-3 years postoperative and were analyzed according to resected tongue volume and the method of reconstruction. In partial glossectomy cases, the secondary intention group had better function in tongue mobility, articulation, and speech intelligibility (p < 0.001 for all) than the free flap reconstruction group. In contrast, in hemi-glossectomy cases, the free flap reconstruction group had better tongue mobility, articulation, verbal diadochokinesis and speech intelligibility (p < 0.05 for all) than the secondary intention group. There was no significant difference in swallowing outcome between the secondary intention and flap reconstruction groups in both partial glossectomy and hemi-glossectomy cases. In conclusion, secondary intention appears to be the most appropriate option after partial glossectomy. However, flap reconstruction is necessary to restore tongue volume and function in patients who undergo a resection of more than half of the tongue volume.