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Mucoepidermoid carcinoma is a type of salivary gland cancer that can develop in the context of a parotid gland cyst. This type of tumor is composed of mucous, epidermoid, and intercalated cells, and usually presents as a slow-growing and painless mass. A parotid gland cyst is a condition in which a fluid-filled sac forms in the parotid gland. The tumor can be masked as it develops within the parotid cyst. A 45-year-old female patient presented with a suspect of benign neoplasm of the major salivary gland. She underwent partial right parotidectomy, which upon pathological analysis confirmed the diagnosis of mucoepidermoid microcarcinoma associated with parotid gland cysts. The patient did well and continues under regular follow-up with no further treatment.
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Importance: Postoperative radiation therapy for close surgical margins in low- to intermediate-grade salivary carcinomas lacks multi-institutional supportive evidence. Objective: To evaluate the oncologic outcomes for low- and intermediate-grade salivary carcinomas with close and positive margins. Design, Setting, and Participants: The American Head and Neck Society Salivary Gland Section conducted a retrospective cohort study from 2010 to 2019 at 41 centers. Margins were classified as R0 (negative), R1 (microscopically positive), or R2 (macroscopically positive). R0 margins were subclassified into clear (>1 mm) or close (≤1 mm). Data analysis was performed from June to October 2023. Main Outcomes and Measures: Main outcomes were risk factors for local recurrence. Results: A total of 865 patients (median [IQR] age at surgery, 56 [43-66] years; 553 female individuals [64%] and 312 male individuals [36%]) were included. Of these, 801 (93%) had parotid carcinoma and 64 (7%) had submandibular gland carcinoma, and 748 (86%) had low-grade tumors and 117 (14%) had intermediate-grade tumors, with the following surgical margins: R0 in 673 (78%), R1 in 168 (19%), and R2 in 24 (3%). Close margins were found in 395 of 499 patients with R0 margins (79%), for whom margin distances were measured. A total of 305 patients (35%) underwent postoperative radiation therapy. Of all 865 patients, 35 (4%) had local recurrence with a median (IQR) follow-up of 35.3 (13.9-59.1) months. In patients with close margins as the sole risk factor for recurrence, the local recurrence rates were similar between those who underwent postoperative radiation therapy (0 of 46) or observation (4 of 165 [2%]). Patients with clear margins (n = 104) had no recurrences. The local recurrence rate in patients with R1 or R2 margins was better in those irradiated (2 of 128 [2%]) compared to observed (13 of 64 [20%]) (hazard ratio [HR], 0.05; 95% CI, 0.01-0.24). Multivariable analysis for local recurrence found the following independent factors: age at diagnosis (HR for a 10-year increase in age, 1.33; 95% CI, 1.06-1.67), R1 vs R0 (HR, 5.21; 95% CI, 2.58-10.54), lymphovascular invasion (HR, 4.47; 95% CI, 1.43-13.99), and postoperative radiation therapy (HR, 0.10; 95% CI, 0.04-0.29). The 3-year local recurrence-free survivals for the study population were 96% vs 97% in the close margin group. Conclusions and Relevance: In this cohort study of patients with low- and intermediate-grade major salivary gland carcinoma, postoperative radiation therapy for positive margins was associated with decreased risk of local recurrence. In isolation from other risk factors for local recurrence, select patients with close surgical margins (≤1 mm) may safely be considered for observation.
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Carcinoma , Neoplasias de las Glándulas Salivales , Humanos , Masculino , Femenino , Lactante , Adulto , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Estudios de Cohortes , Márgenes de Escisión , Carcinoma/cirugía , Neoplasias de las Glándulas Salivales/radioterapia , Neoplasias de las Glándulas Salivales/cirugía , Neoplasias de las Glándulas Salivales/patologíaRESUMEN
INTRODUCTION: The aim of this study is to assess the impact of lymph node ratio (LNR) and number of positive lymph nodes (NPLN) on mortality and recurrence rates in patients with laryngeal squamous cell carcinoma. MATERIALS AND METHODS: We conducted a retrospective multicenter international study involving 24 Otorhinolaryngology-Head and Neck Surgery divisions. Disease-specific survival (DSS) and disease-free survival (DFS) were evaluated as the main outcomes. The curves for DSS and DFS according to NPLN and LNR were analyzed to identify significant variations and establish specific cut-off values. RESULTS: 2507 patients met the inclusion criteria. DSS and DFS were significantly different in the groups of patients stratified according to LNR and NPLN. The 5-year DSS and DFS based on LNR and NPLN demonstrated an improved ability to stratify patients when compared to pN staging. CONCLUSION: Our data demonstrate the potential prognostic value of NPLN and LNR in laryngeal squamous cell carcinoma.
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Neoplasias de Cabeza y Cuello , Ganglios Linfáticos , Humanos , Ganglios Linfáticos/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Estadificación de Neoplasias , Metástasis Linfática/patología , Índice Ganglionar , Pronóstico , Estudios Retrospectivos , Neoplasias de Cabeza y Cuello/patología , Escisión del Ganglio LinfáticoRESUMEN
[This corrects the article DOI: 10.3389/fimmu.2021.709861.].
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BACKGROUND: Immune hyperactivity is an important contributing factor to the morbidity and mortality of COVID-19 infection. Nasal administration of anti-CD3 monoclonal antibody downregulates hyperactive immune responses in animal models of autoimmunity through its immunomodulatory properties. We performed a randomized pilot study of fully-human nasal anti-CD3 (Foralumab) in patients with mild to moderate COVID-19 to determine if its immunomodulatory properties had ameliorating effects on disease. METHODS: Thirty-nine outpatients with mild to moderate COVID-19 were recruited at Santa Casa de Misericordia de Santos in Sao Paulo State, Brazil. Patients were randomized to three cohorts: 1) Control, no Foralumab (n=16); 2) Nasal Foralumab (100ug/day) given for 10 consecutive days with 6 mg dexamethasone given on days 1-3 (n=11); and 3) Nasal Foralumab alone (100ug/day) given for 10 consecutive days (n=12). Patients continued standard of care medication. RESULTS: We observed reduction of serum IL-6 and C-reactive protein in Foralumab alone vs. untreated or Foralumab/Dexa treated patients. More rapid clearance of lung infiltrates as measured by chest CT was observed in Foralumab and Foralumab/Dexa treated subjects vs. those that did not receive Foralumab. Foralumab treatment was well-tolerated with no severe adverse events. CONCLUSIONS: This pilot study suggests that nasal Foralumab is well tolerated and may be of benefit in treatment of immune hyperactivity and lung involvement in COVID-19 disease and that further studies are warranted.
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Anticuerpos Monoclonales/uso terapéutico , COVID-19/inmunología , COVID-19/prevención & control , Neumonía/terapia , Administración Intranasal , Adolescente , Adulto , Anticuerpos Monoclonales/administración & dosificación , Biomarcadores , Proteína C-Reactiva/análisis , COVID-19/fisiopatología , COVID-19/terapia , Estudios de Cohortes , Femenino , Humanos , Inmunidad/efectos de los fármacos , Interleucina-6/sangre , Pulmón/efectos de los fármacos , Pulmón/inmunología , Pulmón/patología , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Proyectos Piloto , Neumonía/prevención & control , Adulto JovenRESUMEN
The most significant prognostic factor is the presence of regional metastasis in patients with oral squamous cell carcinoma (SCC). The radical neck dissection has been the preferred therapeutic modality to neck metastasis for one century. The objective of this study was to analyze the feasibility of selective neck dissection for SCC of the lower sites of the mouth. The charts of a series of 460 cases of SCCs of the inferior floor of the mouth treated in Hospital Heliópolis, Brazil, between 1978 and 2002, were retrospectively reviewed. The pattern of metastatic spread was analyzed in the radical neck dissection according to N stage. In the radical neck dissections, the metastatic spread index for levels IV and V were 5.8% and 4.6%, respectively, for cN0 patients and 9.9% and 5.9%, respectively, for cN+ patients. When level I was the only site of metastasis, this index was 11% and 5.5%, respectively. The indication of a selective neck dissection including levels I-IV is oncologically safe for SCCs of the inferior mouth when level I is clinically compromised.
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Carcinoma de Células Escamosas/cirugía , Neoplasias de la Boca/cirugía , Disección del Cuello/métodos , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/patología , Distribución de Chi-Cuadrado , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/epidemiología , Neoplasias de la Boca/patología , Metástasis de la Neoplasia , Selección de Paciente , Pronóstico , Resultado del TratamientoRESUMEN
INTRODUCTION: The post-laryngectomy state is characterized by several alterations in lung function. A reliable estimation of lung function can be very useful in laryngectomees to prevent postoperative complications and to evaluate the results of the treatment. OBJECTIVE: Characterize the presence of respiratory functional disorders and the functional pattern of laryngectomees through the use of an extratracheal device. METHODS: This transversal study included 50 patients submitted to total laryngectomy at least 6 months prior to this investigation, as the treatment of choice for laryngeal cancer. RESULTS: 56% percent of the participants had altered breathing pattern, distributed as follows: 14 with obstructive pattern with no air trapping, 11 with obstructive pattern with air trapping and only 3 with restrictive pattern. On average, the diffusion decreased (74.3%) and airway resistance increased (121.7%) when compared to the expected average values for the Brazilian individuals. CONCLUSION: Most patients submitted to total laryngectomy present altered lung function, usually the obstructive type, frequently associated to a history of smoking.
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Neoplasias Laríngeas/cirugía , Laringectomía , Pulmón/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fenómenos Fisiológicos Respiratorios , EspirometríaRESUMEN
The aim of this study is to evaluate the efficacy of the application of allogenous bone at the maxillomandibular reconstructions for future rehabilitation with dental implants. The patients were submitted to reconstruction of maxilla, using allogeneic bone grafts, in 3 different techniques: onlay grafts for lateral ridge augmentation, onlay and particulate bone for sinus lift grafting, and particulate alone for sinus lift grafts. Clinical and radiographic control was done at the postoperative phase for at least 8 months, until the patient could be submitted to the installation of dental implants. The results showed success in the majority of the cases, and dental implants could be installed. This can be considered an excellent alternative when compared with the use of autogenous grafts; because handling is easier, there is a great amount of material available and a possibility of using local anesthesia, and consequently there is a reduction of patient morbidity.
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Trasplante Óseo/métodos , Implantación Dental Endoósea , Maxilar/cirugía , Procedimientos Quirúrgicos Preprotésicos Orales , Procedimientos de Cirugía Plástica , Aumento de la Cresta Alveolar/métodos , Femenino , Humanos , Masculino , Seno Maxilar/cirugía , Procedimientos Quirúrgicos Preprotésicos Orales/métodos , Procedimientos de Cirugía Plástica/métodos , Trasplante HomólogoRESUMEN
Introduction Supracricoid laryngectomy still has selected indications; there are few studies in the literature, and the case series are limited, a fact that stimulates the development of new studies to further elucidate the structural and functional aspects of the procedure. Objective To assess voice and deglutition parameters according to the number of preserved arytenoids. Methods Eleven patients who underwent subtotal laryngectomy with cricohyoidoepiglottopexy were evaluated by laryngeal nasofibroscopy, videofluoroscopy, and auditory-perceptual, acoustic, and voice pleasantness analyses, after resuming oral feeding. Results Functional abnormalities were detected in two out of the three patients who underwent arytenoidectomy, and in six patients from the remainder of the sample. Almost half of the sample presented silent laryngeal penetration and/or vallecular/hypopharyngeal stasis on the videofluoroscopy. The mean voice analysis scores indicated moderate vocal deviation, roughness and breathiness; severe strain and loudness deviation; shorter maximum phonation time; the presence of noise; and high third and fourth formant values. The voices were rated as unpleasant. There was no difference in the number and functionality of the remaining arytenoids as prognostic factors for deglutition; however, in the qualitative analysis, favorable voice and deglutition outcomes were more common among patients who did not undergo arytenoidectomy and had normal functional conditions. Conclusion The number and functionality of the preserved arytenoids were not found to be prognostic factors for favorable deglutition efficiency outcomes. However, the qualitative analysis showed that the preservation of both arytenoids and the absence of functional abnormalities were associated with more satisfactory voice and deglutition patterns.
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PURPOSE OF REVIEW: Permanent hypoparathyroidism is the most common long-term complication after total thyroidectomy and it can cause significant morbidity and increased costs. Its incidence varies from 30% to 60%. RECENT FINDINGS: The surgical technique and the extent of thyroidectomy are related to parathyroid injury and hypoparathyroidism. The glands should be identified in situ, carefully manipulated and preserved, as well as their vascularization. In case of incidental removal, routine autotransplantation is advocated. Low calcium levels, identification of fewer than two parathyroid glands at surgery, reoperation for bleeding, Graves disease and heavier thyroid specimens were considered independent predictors of permanent hypocalcemia. Intraoperative parathyroid hormone (PTH) measurements allows the early detection of hypocalcemia. Treatment is recommended for patients with symptoms of hypocalcemia or corrected serum calciumâ<â7.5âmg/dL. Acute hypocalcemia is treated with either oral calcium or an intravenous infusion. The goal is to preserve serum calcium in the low normal or mildly subnormal levels. Hypocalcemia symptoms should be considered a medical emergency. Treatment with PTH has been recently performed for the management of cases not adequately controlled with conventional therapy. SUMMARY: Hypoparathyroidism is the most common long-term complication after total thyroidectomy. Adequate recognition and management decrease its morbidity and costs.
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Hipoparatiroidismo/etiología , Glándulas Paratiroides/lesiones , Complicaciones Posoperatorias/etiología , Tiroidectomía/efectos adversos , Calcio/administración & dosificación , Calcio/sangre , Humanos , Hipocalcemia/diagnóstico , Hipocalcemia/etiología , Hipocalcemia/terapia , Hipoparatiroidismo/prevención & control , Glándulas Paratiroides/cirugía , Glándulas Paratiroides/trasplante , Hormona Paratiroidea/análisis , Complicaciones Posoperatorias/prevención & control , Tiroidectomía/métodos , Trasplante AutólogoRESUMEN
Several oncogenes and tumor-suppressor genes are involved either as early or late event in thyroid gland carcinogenesis. Human FHIT (fragile histidine triad) gene is highly conserved gene whose loss of function may be important in the development and/or progression of various types of cancer. We undertook this study to analyze FHIT and p53 gene status in different benignant and malignant thyroid tumors. Status of these genes as well as intensity of apoptosis was analyzed in tumor tissues by molecular genetic methods, immunohistochemistry, and FACS-scan analysis. The majority of the malignant thyroid cancers displayed aberrant expression of FHIT gene, concominant with p53 gene inactivation. This is followed by low rate of apoptosis, which may be important in the development and/or progression of thyroid cancer. We found higher incidence of p53 mutation and aberrant processing of FHIT mRNA in malignant tumors (papillary, follicular, medullary and anaplastic carcinomas) and in those tumors with distant metastasis. The growth of p53(-)/FHIT(-) follicular carcinoma of human origin was much faster in nude mice than p53(+)/FHIT(+) follicular carcinoma, and mice had shorter survival rate. Our results show a correlation between aberrant FHIT and p53 expression, low rate of apoptosis, and malignancy. Concomitant aberration of FHIT gene and p53 could be responsible for development of highly malignant types of thyroid cancer and may be considered as a prognostic marker for these tumors.
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Ácido Anhídrido Hidrolasas/genética , Genes p53 , Mutación , Proteínas de Neoplasias/genética , Enfermedades de la Tiroides/genética , Neoplasias de la Tiroides/genética , Ácido Anhídrido Hidrolasas/metabolismo , Adolescente , Adulto , Anciano , Animales , Apoptosis , Femenino , Citometría de Flujo , Expresión Génica , Humanos , Inmunohistoquímica , Pérdida de Heterocigocidad , Masculino , Ratones , Ratones Desnudos , Persona de Mediana Edad , Biología Molecular , Proteínas de Neoplasias/metabolismo , Trasplante de Neoplasias , Enfermedades de la Tiroides/metabolismo , Enfermedades de la Tiroides/patología , Neoplasias de la Tiroides/metabolismo , Neoplasias de la Tiroides/patología , Trasplante HeterólogoRESUMEN
The purpose of this study was to determine the recurrence rate and the long-term survival of patients treated with frontolateral laryngectomy for early glottic cancer. The study is a retrospective analysis of a cohort of patients who underwent frontolateral laryngectomy from 1995 to 2002 with a median follow-up of 48 months. This was a consecutive series of 30 patients with T1bN0 and T2N0 vocal fold carcinoma. Previously treated patients were excluded. Surgical treatment consisted of frontolateral partial vertical laryngectomy and reconstruction with bipedicle sternohyoid muscle flap. Twenty-five patients have been alive with no evidence of the disease. The median follow-up was 48 months (range, 6-85 months). Five patients experienced local recurrence. One of them underwent salvage partial hemilaryngectomy, and 4 underwent wide-field total laryngectomy with adjuvant postoperative radiation therapy. Four of five patients with retreatment were ultimately salvaged, with a median follow-up of 30 months. We had one death caused by the disease. Frontolateral laryngectomy is an efficient treatment for selected cases of early glottic carcinoma.
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Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Recurrencia Local de Neoplasia/cirugía , Femenino , Humanos , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/patología , Laringectomía/mortalidad , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
UNLABELLED: The minimally invasive video-assisted thyroidectomy (MIVAT) without gas infusion is considered safe and has advantages in terms of cosmetic results compared to the conventional approach. AIM: to present our findings regarding the identification of the external branch of the superior laryngeal nerve (EBSLN) during MIVAT. STUDY DESIGN: Transversal cohort study. MATERIAL AND METHOD: twelve patients underwent hemithyroidectomy for thyroid nodular disease through MIVAT method. The upper pedicle of the thyroid was dissected under the magnified view at 0-degree five-millimeter endoscope in order to achieve the identification of EBSLN in all cases. RESULTS: We identified 10 (83.3%) EBSLN out of 12 cases. The nerve ran medially to the branches of the superior thyroid artery in 8 cases (80%) and crossed anteriorly in 2 (20%). CONCLUSIONS: We identified the EBSLN in 83.3% of the cases, whose course was medial to the branches of the superior thyroid artery in 80% and crossing anteriorly in 20%. The ligation of the upper pedicle of the thyroid can be performed under direct view of the EBSLN.
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Nervios Laríngeos/anatomía & histología , Neoplasias de la Tiroides/cirugía , Tiroidectomía/métodos , Cirugía Asistida por Video/métodos , Estudios Transversales , Humanos , Procedimientos Quirúrgicos Mínimamente InvasivosRESUMEN
Introduction Radiotherapy or chemoradiotherapy can result in severe swallowing disorders with potential risk for aspiration and can negatively impact the patient's quality of life (QOL). Objective To assess swallowing-related QOL in patients who underwent radiotherapy/chemoradiotherapy for head and neck cancer. Methods We interviewed 110 patients (85 men and 25 women) who had undergone exclusive radiotherapy (25.5%) or concomitant chemoradiotherapy (74.5%) from 6 to 12 months before the study. The Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire was employed to evaluate dysphagia-related QOL. Results The QOL was reduced in all domains for all patients. The scores were worse among men. There was a relationship between oral cavity as the primary cancer site and the fatigue domain and also between advanced cancer stage and the impact of food selection, communication, and social function domains. Chemoradiotherapy association, the presence of nasogastric tube and tracheotomy, and the persistence of alcoholism and smoking had also a negative effect on the QOL. Conclusions According to the SWAL-QOL questionnaire, the dysphagia-related impact on QOL was observed 6 to 12 months after the treatment ended.
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BACKGROUND: Thyroglossal duct remnants are the most common midline neck masses in childhood but can be found in adults and the elderly. Sistrunk's procedure, with dissection of the tract and removal of the hyoid bone, is accepted as the main operation of choice. STUDY DESIGN: Fifty-five patients were treated from January 1994 to November 2000, and these were studied. There were 29 men and 26 women, with a median age of 17 years. Diagnosis was clinical, with 13 cases of fistula and 42 of cyst. Size varied from 1.0 to 4.0 cm, with an average of 2.5 cm. Six patients presented with local abscess. RESULTS: All the patients underwent Sistrunk's procedure. Serum collection occurred in three patients as complication. In one patient papillary carcinoma was identified in the cyst. Total thyroidectomy was not performed. There was only one recurrence, managed with a second operation. CONCLUSIONS: We concluded that the diagnosis of thyroglossal duct is clinical. Sistrunk's procedure carries low rates of complications (9.08%) and recurrence (1.82%). Antibiotic therapy is avoidable as a rule and hospital stay is short.
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Quiste Tirogloso , Adolescente , Adulto , Profilaxis Antibiótica , Carcinoma Papilar/complicaciones , Carcinoma Papilar/cirugía , Drenaje , Femenino , Humanos , Masculino , Quiste Tirogloso/diagnóstico por imagen , Quiste Tirogloso/epidemiología , Quiste Tirogloso/cirugía , Neoplasias de la Tiroides/complicaciones , Neoplasias de la Tiroides/cirugía , UltrasonografíaRESUMEN
Experienced thyroid surgeons are often able to identify the parathyroid glands, but sometimes it is difficult to differentiate them from other contiguous tissues. Contact endoscopy was introduced in otolaryngology for the characterization of normal and pathological epithelia. Our objective was to analyze contact endoscopy as an auxiliary method for identification of the parathyroid glands during thyroid surgery. Five total thyroidectomies and 5 hemithyroidectomies were performed in September 2001. After surgical exposure, contact endoscopy was performed. A total of 15 peritracheal regions were studied. Superior and inferior parathyroid tissues were identified on the basis of color, size, and probable location. Contact endoscopy was performed before and after use of methylene blue stain. Contact endoscopy was also used in neighboring areas. We compared the visual impression to the contact endoscopy findings. Two structures were visually supposed to be the superior and inferior parathyroid glands in each case. From 30 visually supposed glands, 25 were confirmed by telescope. Of the other 5 structures initially supposed to be parathyroid tissue, 3 were adipose tissue and 2 were thyroid parenchyma. In the 5 cases in which the identification of one of the glands was not confirmed, an additional contact examination enabled us to further identify parathyroid glands in 3 cases in which structures were initially identified as adipose tissue. Contact endoscopy is an efficient auxiliary method for the identification of the parathyroid glands during thyroid surgery that poses little risk of morbidity to the patient.
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Endoscopía/métodos , Cuidados Intraoperatorios/métodos , Glándulas Paratiroides/anatomía & histología , Glándula Tiroides/cirugía , Tejido Adiposo/anatomía & histología , Adulto , Femenino , Humanos , MasculinoRESUMEN
Oncocytic tumors of the endocrine system are a group of rare entities described in several organs, including the thyroid gland. Medullary carcinoma can seldom show the predominance of cells with oncocytic changes but the positive immunostaining for calcitonin should be helpful for the correct diagnosis. We describe the case of a 71 year-old female Caucasian patient, with a hard 5 cm thyroid nodule for 2 months. There was no significant cervical adenopathy. Thyroid hormone levels were normal. The US-Doppler examination showed a centrally vascularized nodule. Cytopathology analyses was suspicious for follicular neoplasm with predominance of oncocytic cells, and a hemithyroidectomy was performed. Frozen section examination confirmed a follicular neoplasm and the definitive histopathological and immunohistochemical analyses was conclusive for a medullary carcinoma, oncytic variant. A total thyroidectomy was then performed, followed by adjuvant 131Iodine therapy. After a 40-month follow-up the patient is alive with no evidence of disease. Medullary carcinoma should be considered in the differential diagnosis of unusual thyroid carcinomas with predominance of cells with oncocytic changes.
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Carcinoma Medular/patología , Neoplasias de la Tiroides/patología , Anciano , Femenino , HumanosRESUMEN
Abstract Introduction: The post-laryngectomy state is characterized by several alterations in lung function. A reliable estimation of lung function can be very useful in laryngectomees to prevent postoperative complications and to evaluate the results of the treatment. Objective: Characterize the presence of respiratory functional disorders and the functional pattern of laryngectomees through the use of an extratracheal device. Methods: This transversal study included 50 patients submitted to total laryngectomy at least 6 months prior to this investigation, as the treatment of choice for laryngeal cancer. Results: 56% percent of the participants had altered breathing pattern, distributed as follows: 14 with obstructive pattern with no air trapping, 11 with obstructive pattern with air trapping and only 3 with restrictive pattern. On average, the diffusion decreased (74.3%) and airway resistance increased (121.7%) when compared to the expected average values for the Brazilian individuals. Conclusion: Most patients submitted to total laryngectomy present altered lung function, usually the obstructive type, frequently associated to a history of smoking.
Resumo Introdução: A condição pós-laringectomia é caracterizada por várias alterações na função pulmonar. Uma estimativa confiável da função pulmonar pode ser muito útil em pacientes laringectomizados para prevenir complicações após as intervenções cirúrgicas e avaliar os resultados do tratamento. Objetivo: Caracterizar a presença de distúrbios funcionais respiratórios e o padrão funcional de pacientes laringectomizados através do uso de um dispositivo extratraqueal. Método: Estudo transversal que incluiu 50 pacientes submetidos à laringectomia total pelo menos seis meses antes desta investigação, como tratamento de escolha para o câncer de laringe. Resultados: Dos participantes, 56% apresentavam padrão respiratório alterado, assim distribuídos: 14 com padrão obstrutivo sem aprisionamento aéreo, 11 com padrão obstrutivo e aprisionamento aéreo e apenas três com padrão restritivo. Em média, verificou-se que a difusão encontrava-se diminuída (74,3%) e a resistência das vias aéreas aumentada (121,7%) em relação aos resultados esperados em brasileiros. Conclusão: A maioria dos pacientes submetidos à laringectomia total apresenta função pulmonar alterada, do tipo obstrutiva, quase sempre associada a história de tabagismo.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Neoplasias Laríngeas/cirugía , Laringectomía , Pulmón/fisiopatología , Fenómenos Fisiológicos Respiratorios , EspirometríaRESUMEN
BACKGROUND: Some primary studies compare manual and mechanical pharyngeal closures after total laryngectomy. The purpose of this study was to evaluate the advantages of the mechanical suture in pharyngeal closure. METHODS: The literature survey included research in MEDLINE, EMBASE, and LILACS. The intervention analyzed was stapler-assisted pharyngeal closure, whereas the control group was manual suture pharyngeal closure. RESULTS: The survey resulted in 319 studies. However, 4 studies were selected (417 patients). In the group of patients in whom the stapler was used, the incidence of pharyngocutaneous fistula was 8.7%, whereas in the other, it was 22.9%, with an absolute risk reduction of 15% (95% confidence interval [CI], 0.02-0.28; p = .02; I(2) = 66%). Regarding the surgical time, the average difference was 80 minutes in favor of the stapler group (95% CI, 23.16-136.58 minutes; p < .006). CONCLUSION: The difference for starting oral feeding was 8 days in favor of the mechanical suture (95% CI, 4.01-11.73 days; p < .001). Patients who underwent mechanical suture had a shorter hospitalization period.
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Fístula Cutánea/cirugía , Neoplasias Laríngeas/cirugía , Laringectomía/métodos , Engrapadoras Quirúrgicas , Técnicas de Sutura/instrumentación , Fístula Cutánea/prevención & control , Medicina Basada en la Evidencia , Femenino , Humanos , Neoplasias Laríngeas/patología , Laringectomía/efectos adversos , Tiempo de Internación , Masculino , Pronóstico , Cicatrización de Heridas/fisiologíaRESUMEN
Abstract Introduction Supracricoid laryngectomy still has selected indications; there are few studies in the literature, and the case series are limited, a fact that stimulates the development of new studies to further elucidate the structural and functional aspects of the procedure. Objective To assess voice and deglutition parameters according to the number of preserved arytenoids. Methods Eleven patients who underwent subtotal laryngectomy with cricohyoidoepiglottopexy were evaluated by laryngeal nasofibroscopy, videofluoroscopy, and auditory-perceptual, acoustic, and voice pleasantness analyses, after resuming oral feeding. Results Functional abnormalities were detected in two out of the three patients who underwent arytenoidectomy, and in six patients from the remainder of the sample. Almost half of the sample presented silent laryngeal penetration and/or vallecular/ hypopharyngeal stasis on the videofluoroscopy. The mean voice analysis scores indicated moderate vocal deviation, roughness and breathiness; severe strain and loudness deviation; shorter maximum phonation time; the presence of noise; and high third and fourth formant values. The voices were rated as unpleasant. There was no difference in the number and functionality of the remaining arytenoids as prognostic factors for deglutition; however, in the qualitative analysis, favorable voice and deglutition outcomes were more common among patients who did not undergo arytenoidectomy and had normal functional conditions. Conclusion The number and functionality of the preserved arytenoidswere not found to be prognostic factors for favorable deglutition efficiency outcomes. However, the qualitative analysis showed that the preservation of both arytenoids and the absence of functional abnormalities were associated with more satisfactory voice and deglutition patterns.