Quality of life and functional outcomes in tongue cancer patients: a long-term, prospective, comparative study.

BACKGROUND: The tongue has an indispensable role in communication, swallowing and breathing. Tongue cancer treatment involves direct resection of the tumor and surrounding tissue, which can limit many essential functions of the tongue. There are few patient-reported quality of life studies involving tongue cancer exclusively. There is also a lack of data on the outcomes of quality of life regarding different reconstructive methods, adjuvant non-surgical therapies and other predicting factors. Our objective is to assess the quality of life, functional status, and predicting factors in patients with tongue cancer up to one year after surgical resection. MATERIAL AND METHODS: Thirty-six patients with tongue cancer were prospectively identified between October of 2017 and January 2021. Patients were examined before and one, three, six and twelve months after surgical resection with the validated University of Washington Quality of Life questionnaire (UW-QOL). Data collection included patient age, sex, TNM staging, size of resection, neck dissection, tracheostomy, reconstructive method and adjuvant therapies. Outcome scores were compared using the Friedman test. Multiple linear regression analysis was used to identify the predictors of quality of life and functional status. RESULTS: The use of UWQOL scores as dependent variables revealed the following predicting factors: age, tobacco use, radiotherapy, chemotherapy, reconstruction method and neck dissection. CONCLUSIONS: The most relevant findings in our study are that flap reconstruction becomes increasingly necessary when a glossectomy resection is over 45 mm, in order to maintain tongue function. We established that the reconstructive flap type does not influence quality of life in the long term. Also, we have found that cervical sentinel node biopsy provides better quality of life over neck dissection in the first 3 months after surgery.

Flattening of the orbital lower eyelid fat as a long-term outcome after surgical treatment of orbital floor fractures.

Our aim was to report the incidence of asymmetry of the lower eyelid (that manifests itself as flattening of the eyelid fat) as a long-term complication of the surgical approach of unilateral fractures of the orbital floor. We retrospectively reviewed the aesthetic appearance of the lower eyelid in 43 patients after repair of such fractures. Long-term asymmetry seen as asymmetrical flattening of the eyelid fat was evaluated and graded qualitatively as mild, moderate, and severe. We studied its relations to the surgical approach, patient's age and sex, and postoperative time; 20 of the 43 had flattening of the lower eyelid fat. There were significantly more patients with flattening of the fat after a transconjunctival approach than after transcutaneous ones (p=0.03). We found a statistical likelihood of the development of flattening of the fat when patients were between 40 and 60 years old at the time of operation (p=0.006). Increasing age at the time of the study was related to increased severity (p=0.0019), with the greatest significance over 55 years old (p=0.006). We found no relation to patients' sex, or duration of operation. To our knowledge this is the first time that flattening of the eyelid fat has been described as a long-term complication after a particular approach to orbital floor fractures. The transconjunctival incision was more likely to be associated with this long-term outcome. Patients over 40 years old are also at risk of developing flattening, and this is more severe when the patient is over 55. A short follow-up period is not sufficient for the evaluation of the aesthetic outcome of traditional approaches to fractures of the orbital floor in the lower eyelid.

Tratamiento y complicaciones de las fracturas de seno frontal / Frontal sinus fracture treatment and complications

Introducción. Las fracturas de seno frontal se producen comoresultado de impactos de alta energía. Un tratamiento inadecuado puedeconducir a complicaciones serias incluso muchos años después del traumatismo.Objetivos. Evaluar los datos epidemiológicos y revisar las complicacionesasociadas. Estandarizar el protocolo de tratamiento. Materialesy métodos. Se revisaron 95 pacientes diagnosticados de fracturas deseno frontal pertenecientes al servicio de Cirugía Oral y Maxilofacial delHospital Universitario 12 de Octubre de Madrid, entre enero de 1990 ydiciembre de 2004. Resultados. La edad media de los pacientes revisadoses de 34 años. La mayoría son hombres (78%) y la causa más frecuente deltraumatismo, los accidentes de tráfico. El patrón de fractura más comúnes el que afecta únicamente a la pared anterior del seno frontal. Las complicacionesdescritas son: deformidad estética frontal, sinusitis frontal, mucocelefrontal, celulitis fronto-orbitaria, intolerancia al material de osteosíntesis,complicaciones infecciosas del SNC y persistencia de fístula de líquidocefalorraquídeo. Conclusiones. El objetivo ha de estar encaminado aprevenir las complicaciones asociadas a los pacientes con fracturas de senofrontal. Hay que individualizar el protocolo de tratamiento en cada caso.Es recomendable un seguimiento a largo plazo para identificar precozmentelas posibles complicaciones(AU)

Frontal sinus fractures are caused by highvelocity impacts. Inappropriate treatment can lead to seriouscomplications, even many years after the trauma. Objectives. Toevaluate epidemiological data and associated complications. Tostandardize the treatment protocol. Materials and methods. theclinical records of 95 patients with frontal sinus fractures treatedbetween January 1990 and December 2004 at the Oral andMaxillofacial Surgery Department, “12 de Octubre” Hospital (Madrid,Spain), were reviewed. Results. The average age of patients withfrontal sinus fractures was 34 years. Most of them were male (78%)and the most frequent mode of injury was motor vehicle accident.The commonest frontal sinus fracture pattern was the outer tablefracture. The complications described were: cosmetic deformation,frontal sinusitis, frontal mucocele, orbital cellulitis, intolerance ofosteosynthesis material, meningitis and persistent CSF leak.Conclusions. Treatment of frontal sinus fractures must be tailoredfor each individual patient. Its aim should be to reduce associatedcomplications, which may need a long-term follow-up to be detected(AU)

Seguimiento radiológico en paciente con fibroma condromixoide del seno frontal. Diagnóstico diferencial, alternativas terapéuticas y revisión de la literatura / Radiological follow-up of a patient with chondromyxoid fibroma of the frontal sinus. Differential diagnosis, therapeutic alternatives and a revision of theliterature

Introducción. El fibroma condromixoide es un tumor benigno de crecimiento lento y poco frecuente. Su incidencia en la región craneofacial es rara, especialmente en el seno frontal. Objetivos. Presentamos el seguimiento a largo plazo de un paciente intervenido en relación a un fibromacondromixoide del seno frontal. Se discuten los distintos diagnósticos diferenciales y las alternativas terapéuticas. Discusión. Desde el punto de vista de anatomía patológica es necesario hacer el diagnóstico diferencialcon condrosarcoma, mixosarcoma, mixoma y cordoma. Desde el punto de vista radiológico, el diagnóstico de fibroma condromixoide ha de ser considerado en toda lesión ósea aislada con expansión u osteolisis, márgenes lobulados y septos intralesionales. El tratamiento del fibromacondromixoide incluye principalmente curetaje o resección en bloque, mientras que la radioterapia aislada no se considera de primera elección.Conclusiones. La naturaleza benigna del fibroma condromixoide implica la importancia de evitar tratamientos radicales. El abordaje subcraneal se presenta como una alternativa válida para el tratamiento de lesiones localizadas en el seno frontal. Es fundamental un seguimiento clínico-radiológicoadecuado para identificar precozmente posibles recidivas

Introduction. Chondromyxoid fibroma is a slow growingand rare benign bone tumor. Its location in the craniofacial skeleton is not common, especially in the frontal sinus. Objectives. We present a long-term follow-up of a patient with a frontal chondromyxoidfibroma who was operated four years ago. We discussthe various differential diagnoses and possible treatments. Discussion. The differential diagnosis includes chondrosarcoma, myxosarcoma, myxoma and chordoma. From the radiological point of view, chondromyxoid fibroma must be always considered as a diagnosticpossibility when a solitary bone lesion appears with expansion or cortical osteolysis, lobulated margins and intralesional septi. Treatment includes curettage or monoblock resection with immediate bone graft reconstruction. Radiation therapy alone mustnot be considered as the first therapeutic possibility. Conclusions. the benign nature of the tumor does not justify radical, unnecessary treatment. The subcranial approach is appropriate for lesions located in the frontal sinus. A clinical and radiological follow-up isneeded to identify tumor relapse