Microbial leakage through the implant-abutment interface of Morse taper implants in vitro.

OBJECTIVES: The aim of this study was to determine and compare the frequency of bacterial leakage of Streptococcus sanguinis biotype II along the implant-abutment interface between two systems of morse taper dental implants. Different methods of activation of the taper abutments were used: tapped-in (Bicon) and screwed-in (Ankylos). MATERIALS AND METHODS: Twenty sterile assemblies were used and attached, 10 Bicon and 10 Ankylos implants, according to manufacturers' specifications. They were then totally immersed within 20 test tubes containing a sterile nutrient solution brain-heart infusion (BHI). The internal part of the 20 implants was previously inoculated with 0.1 microl of S. sanguinis II (ATCC 10557) and then connected to the respective abutments. The assemblies were incubated under anaerobic conditions for 14 days in an autoclave at 37 degrees C. They were monitored daily for solution cloudiness resultant from microbial leakage on the interface of the assemblies. For statistical analysis, the Fisher test was applied and significance was assigned at the 5% level. RESULTS: There was solution cloudiness, indicating the finding of bacterial growth inside two Bicon assemblies and two Ankylos assemblies 48 h after incubation. Microbial leakage was further substantiated by testing the suspension for the presence of Streptococcus sp. None of the sterility controls were contaminated. The frequency of bacterial leakage along the implant-abutment interface, with the two different morse taper implant systems, was 20% of the assemblies of each system. There were no statistical differences between them. CONCLUSION: Irrespective of which of the two morse taper implant connection systems of activation was analyzed, tapped-in (Bicon) or screwed-in (Ankylos), this in vitro experiment showed bacterial leakage along the implant-abutment interface.

Comparative study of the changes in partial pressure of plasma carbon dioxide during carbon dioxide insufflation into the intraperitoneal and preperitoneal spaces.

BACKGROUND: We aimed to compare plasma concentrations of carbon dioxide (CO(2)) in dogs that underwent intra- and preperitoneal CO(2) insufflation. MATERIALS AND METHODS: Thirty dogs were studied. Ten formed a control group, 10 underwent intraperitoneal CO(2) insufflation, and 10 underwent preperitoneal CO(2) insufflation. General anesthesia with controlled ventilation was standardized for all dogs. After stabilizing the anesthesia, blood samples were collected at predetermined times and were sent for immediate gasometric analysis. Analysis of variance was used for comparing variables. RESULTS: The plasma CO(2) concentration in the intraperitoneal insufflation group increased significantly more than in the preperitoneal insufflation group and was significantly greater than in the control group (P < 0.05). The pH values in the intraperitoneal group were lower than in the preperitoneal group (P < 0.05). CONCLUSION: The data from this study suggest that a greater plasma concentration of CO(2) is achieved by insufflation at constant pressure into the intraperitoneal space than into the preperitoneal space.

Rationale for selective neck dissection in N+ oral cancer.

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.

Use of allogeneic bone graft in maxillary reconstruction for installation of dental implants.

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.

Photodynamic therapy for root canals infected with Enterococcus faecalis.

OBJECTIVE: The aim of this study was to investigate the effects of photodynamic therapy (PDT) on endodontic pathogens by evaluating the decrease in numbers of Enterococcus faecalis colonies in the canals of extracted human teeth. BACKGROUND DATA: Failure in endodontics is usually related to inadequate cleaning and disinfection of the root canal system. This is due to the establishment of microorganisms in areas where the instruments and chemical agents used during root canal preparation cannot eliminate them. PDT is a complementary therapeutic method that could be used to eliminate these remaining bacteria. PDT is a process in which radiation acts on a dye that is applied to the target organism, resulting in bacterial death. MATERIALS AND METHODS: Forty-six uniradicular teeth had their canals contaminated with bacteria and were incubated for 48 h at 35 degrees C. After that, the teeth were divided into a control group (CG) and a test group (TG). The 23 CG teeth did not undergo any intervention, whereas in the TG the teeth received a solution of 0.0125% toluidine blue for 5 min followed by irradiation using a 50-mW diode laser (Ga-Al-As) at a wavelength of 660 nm. Bacterial samples were taken before and after irradiation. In each of the samples, the number of colony-forming units (CFU) was counted. RESULTS: The mean decrease in CFU was 99.9% in the TG, whereas in the CG an increase of 2.6% was observed. CONCLUSION: PDT was effective as a bactericidal agent in Enterococcus faecalis-contaminated root canals.

Assessment of carotid artery invasion by lymph node metastasis from squamous cell carcinoma of aero-digestive tract.

UNLABELLED: Carotid involvement by metastatic lymph nodes changes the approach in head and neck tumors. AIM: To evaluate interobserver agreement by CT scan analysis regarding the involvement of the carotid artery by metastatic lymph nodes from squamous cell carcinoma of the upper aerodigestive tract and its relation to resection criteria. MATERIALS AND METHODS: retrospective study of 99 CT images of patients with SCC were evaluated. Eighty-six were males and 13 females, with ages ranging from 32 to 76 years. Four radiologists, without any previous knowledge of the clinical stage, analyzed imaging results. No patients had received previous treatment and histological diagnoses were obtained through biopsy. The carotid artery invasion was classified as simple (0 to 50% and from to 100%), and complex (0 to 25%; 26 to 50%; 51 to 75% and 76 to 100%). The level of interobserver agreement was obtained through Kappa Index (p < 0,05) and the concordance power varied from despicable to excellent. RESULTS: The Kappa Index were moderate (0, 53%) for simple classification and minimum (0, 36%) for complex classification. CONCLUSIONS: The computed tomography showed low effectiveness in the evaluation of lymph node metastasis resection concerning carotid artery invasion.

Oral health changes in with oral and oropharyngeal cancer.

UNLABELLED: Inflammatory disease and oral trauma are relevant factors for patients with oral cancer. AIM: This paper aims to assess the association between oral hygiene, periodontal disease, oropharyngeal and oral cancer. MATERIAL AND METHOD: In this cross-sectional prospective study, fifty subjects with untreated oral and oropharyngeal squamous cell carcinoma were compared to fifty cancer-free subjects, paired by age and gender. They answered an oral health questionnaire and underwent oral examination to assess periodontal disease and dental health, as per the CPITN. Periodontal disease classification and CPITN assignment were done according to WHO guidelines. RESULTS: Periodontal examination and the CPITN elicited the differences between the two groups, with evidences of advanced disease among the subjects with oral or oropharyngeal cancer, confirmed by the presence of periodontal pockets with depths of 6mm or greater in 76% of the subjects evaluated, while only 10% of the subjects in the control group showed the same level of disease. No relevant differences were observed in the DMF index and oral hygiene between both groups. CONCLUSION: The findings indicate that there is an association between cancer and more severe periodontal disease regardless of oral hygiene and dental health status.

The importance of pre-epiglottis space invasion in the treatment planning of larynx and hypopharynx cancer.

UNLABELLED: The involvement of pre-epiglottis space can change the indication for partial laryngeal resection. AIM: The aim of this study was to evaluate inter-observer and intra-observer agreement by means of computed tomography analysis regarding the involvement of the pre-epiglottis space (PES) from carcinoma of the upper aerodigestive tract and its relation with therapeutic planning. MATERIALS AND METHODS: Retrospective study of ninety-five computed tomography exams of patients with squamous cell carcinoma, from 1990 to 2004, were selected and evaluated; 87 were males and eight females, with ages ranging from 32 to 73 years. Imaging results were analyzed twice by three radiologists, individually, without any previous knowledge of the clinical stage. No patient had received any previous treatment up to the moment of imaging examination, such as surgery, chemotherapy or radiotherapy. All the cases were confirmed by biopsy. Information was obtained from the medical charts. RESULTS: Kappa Index was calculated by assessing agreement between the three observers. We obtained substantial to almost perfect levels of agreement. CONCLUSIONS: After a general Kappa Index of 0.72, the results suggest a substantial agreement in the involvement of the PES by means of computed tomography analysis.

Value of computed tomography for evaluating the subglottis in laryngeal and hypopharyngeal squamous cell carcinoma.

CONTEXT AND OBJECTIVE: Subglottic involvement in squamous cell carcinoma is a determining factor for contraindicating conservative partial surgery. The subglottis is easily identified by axial computed tomography sections. The present study aimed to evaluate the occurrence of false-negative and false-positive results, and the overall accuracy of staging by computed tomography, in order to detect the involvement of the subglottic laryngeal compartment, in cases of laryngeal and hypopharyngeal squamous cell carcinoma. DESIGN AND SETTING: Retrospective, non-randomized study of patients treated at Hospital Heliópolis, São Paulo, Brazil. METHODS: Computed tomography scans were performed on third-generation equipment with 5-mm slice thickness. Afterwards, all patients underwent surgical and anatomopathological examinations as the gold standard procedures. RESULTS: Among 60 patients, 14 were diagnosed with subglottic extension by surgical and histopathological examination. There were three false-negative and no false-positive results from computed tomography scans. The sensitivity and negative predictive value were 100.0%. Accuracy was 95.0%, specificity was 93.5% and positive predictive value was 82.4%. CONCLUSIONS: Computed tomography could serve as a powerful auxiliary method for staging laryngeal and hypopharyngeal cancer. However, precautions should be taken in analyzing computed tomography scan data, because vegetating lesions may also be projected into the subglottic compartment, without real involvement of the subglottis, which may cause a false-positive result.

Radical versus supraomohyoid neck dissection in the treatment of squamous cell carcinoma of the inferior level of the mouth.

UNLABELLED: The therapeutic paradigm for neck metastasis of squamous cell carcinoma (SCC) in the lower level of the mouth has changed due to survival. AIM: A comparative study between radical (RND) versus selective neck dissection (SND). MATERIAL AND METHOD: An analysis of mouth SCC in the lower level of the mouth in 460 files from the Head & Neck and ORL Department of the Heliopolis Hospital, from 1978 to 2002. In the RND the metastathic rate in levels IV and V was assessed; in the SND the presence and site of recurrence was identified. The chi square test with the Yates correction was the chosen statistical method. RESULTS: In the RND the metastatic rates were 5.8% (level IV) and 4.6% (level V) for cNO cases, and 9.9% (level IV) and 5.9% (level V) for cN+ cases; for level I only the rates were 11.0% for cNO cases and 5.5% for cN+ cases. In the SND the number of recurrences was 4 (4.1%) in 97 neck dissections (pNO) and 2 (10%) in 20 neck dissections (pN+). There was no advantage in using radiation compared to non-irradiated cases (5.6% and 5.7%). CONCLUSION: The SND may be used for SCC of the lower level of the mouth.

Functional study of the voice and swallowing following supracricoid laryngectomy.

UNLABELLED: To identify the grade and evolution of dysphagia and dysphonia in patients undergoing supracricoid laringectomy, and to study the association of these findings with clinical and surgical variables. METHOD: The study included 22 cases undergoing supracricoid laringectomy at the Head and Neck Surgery and Otolaryngology Department of the Heliopolis Hospital - Brasil, and referred to speech therapy. Dysphagia and dysphonia were correlated with gender, age, stage T (T1, T2, T3, T4), primary site (supraglottis, glottis or subglottis), preservation of one or two arytenoids, reconstructive procedures (cricohyoidopexy or cricohyoidoepiglotopexy), time to withdraw the naso-enteral tube, and time to close the tracheostomy. Statistical tests included the Chi-square and/or Fischers exact test. RESULT: We observed an association between moderate grade dysphagia and the glottis as the primary site, cricohyoidoepiglotopexy as the type of reconstruction and naso-enteral tube removal within one month after the surgery. There was also an association between severe dysphagia and the supraglottis as the primary site. Dysphagia and dysphonia were associated in the degree of severity; however a larger number of patients had better progression of dysphagia compared to the progression of dysphonia. There was no statistical significance between other associations. CONCLUSION: Improvement of swallowing is more frequent than improvement of dysphagia. There is an association between moderate dysphagia and the glotttis as primary site, cricohyoidoepiglotopexy and naso-enteral tube removal within one month after surgery.

Single transverse extended incision for radical neck dissection.

OBJECTIVE: to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. METHOD: we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective). Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. RESULTS: as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. CONCLUSIONS: the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor. OBJETIVO: verificar a eficácia da incisão cervical única, transversa e estendida, para o esvaziamento cervical radical. MÉTODO: estudo prospectivo, de janeiro de 2008 a janeiro de 2009, de 18 pacientes submetidos a tratamento cirúrgico de tumores malignos da via aero-digestiva superior. A lesão primária se situava na cavidade oral em oito casos, na orofaringe em três, no seio piriforme em três, na laringe em dois, no seio maxilar em um e em um caso a lesão primária era oculta. Houve 29 esvaziamentos, sendo oito bilaterais e 10 unilaterais (26 radicais e três seletivos). O estadiamento revelou nove pacientes com tumor T4, um T3, seis T2, um T1 e um Tx. Cinco pacientes eram N0, nove N2b, um N2c e três N3. A média de linfonodos dissecados foi de 34,25. O esvaziamento cervical foi realizado por meio de uma única incisão localizada no terço médio do pescoço, coincidente com dobra cutânea, com extensão de cerca de 2 a 3 cm para trás da borda anterior do músculo trapézio e 3 a 4 cm da linha média para os esvaziamentos cervicais unilaterais. RESULTADOS: como complicações houve necrose de retalho miocutâneo em um paciente com radioterapia prévia, uma fistula linfática, uma deiscência do traqueostoma, um abscesso cervical, uma fístula salivar e uma deiscência de sutura. CONCLUSÕES: a incisão única e estendida proporciona exposição adequada das estruturas do pescoço, sem comprometer o tempo cirúrgico, mesmo em esvaziamentos bilaterais. Não compromete a ressecção de todos os linfonodos cervicais, apresenta excelentes resultados estéticos e funcionais e é facilmente associada com outras abordagens para ressecção do tumor primário.

[Cyclosporine induced gingival hyperplasia in kidney transplants]. / Hipertrofia gengival em transplantados renais.

OBJECTIVE: Assess the influence of cyclosporine on the gingival growth of 60 patients with kidney transplant through a research carried out at the Hospital Cajuru in Curitiba, (April to October of 2002). METHODS: Regardless of age, gender, ethnic or social condition, all patients received cyclosporine daily and had, at least, one dental segment. They monthly returned to the Hospital for medical control and for several laboratory exams, among them the cyclosporine serum level. This permitted observation of these cases, especially with respect to the reaction of gingival growth. Clinical dental exams of the patients comprised filling out a form on their personal data, height and weight and number of dental segments. Also an observation of the degree of the gingival and bacterial plaque index was recorded. These data were treated statistically. RESULTS: Of the patients treated only with cyclosporine, 47.2% showed no alterations of the gingival structure while 52.8% presented gingival growth, of them 33.3% with a > 2 degree. Of the patients treated with both cyclosporine and nifedipine, 33.3% had a normal gingiva and 66.7% presented gingival growth. In 45.8% of them, the alteration was of > 2 degree, with no significant difference between results of the male and female patients. A positive correlation between excess fat and the corrected cyclosporine dose and serum concentration per unit of Body Mass Index was found, also between excess fat and the bacterial plaque index. A significant association between the extent of increased gingival growth and the bacterial plaque index was also observed. CONCLUSION: Use of cyclosporine when associated with nifedipine brings about an increase of gingival growth.

Neck dissection in squamous cell carcinoma of the tongue.

AIM: The purpose of this study was to assess the prognosis of patients with tonsillar squamous cell carcinoma with different stages of lymph node involvement and to determine the best elective neck dissection for those cases. STUDY DESIGN: Case series. MATERIAL AND METHOD: 51 patients with tonsillar tumors were treated between 1992 and 2001. The incidence of different tumor-node-metastasis stages was evaluated according to primary tumor extension. RESULTS: cN0 patients had metastases in stages I and II only. Among pN+ subjects with stage I metastases, 6/7 had primary tumor extending to oral cavity. CONCLUSION: Supraomohyoid neck dissection (stages I, II and III) is the elective treatment of choice when tonsillar primary tumor extends to oral cavity. When primary tumors are limited to the oropharynx, selective neck dissection of stages II and III proved to be more adequate.

Review of survival rates 20-years after conservative surgery for papillary thyroid carcinoma.

INTRODUCTION: A less extensive thyroidectomy could be used for patients in the low risk group. OBJECTIVE: To perform a critical follow-up after lobectomy with isthmusectomy for the treatment of papillary thyroid carcinoma in patients with a single nodule limited to the periphery of the lobe. METHODS: Thirty-one patients with thyroid papillary carcinoma operated on till 1993 were selected. They had undergone lobectomy with isthmusectomy. This is a retrospective cohort study in which the oncological outcome (contralateral and regional recurrence) and the reoperation complications (recurrent nerve paralysis/paresis and hypoparathyroidism) were evaluated. Descriptive analysis was employed. RESULTS: In the last decade (2003-2013), 6 (20%) contralateral recurrences were observed in the remaining lobe and in 1 of these cases (3%), contralateral lymph node metastases were noted. A completion thyroidectomy plus lymphadenectomy was performed, without modification of global survival. CONCLUSION: Because of the rate of 20% of contralateral recurrence after a 20-year follow-up, we suggest modification of the surgical paradigm for total thyroidectomy as an initial therapy.

Extracranial neurogenic tumors of the head and neck.

INTRODUCTION: Peripheric nerve tumors typically derive from Schwann cells of the peripheral nerve sheet. Since these tumors are uncommon, they should be considered in preoperative differential diagnosis. OBJECTIVE: To report the experience of a tertiary care department. METHODS: Forty-two patients with head and neck peripheral neurogenic tumors were retrospectively analyzed and evaluated from 1977 to 2013. The preoperative diagnosis was confirmed by biopsy or imaging study. RESULTS: The mean age was 41.7 and 15 patients (36%) were male. The mean size was 5.5cm and 26 (61%) were located laterally in the neck. Most tumors (39.9%) presented as an asymptomatic neck mass. Most (39.9%) were resected through a neck approach. Cranial nerves were the commonest site of origin. CONCLUSIONS: Extracranial neurogenic tumors presented with a mean size of 5.5cm, were located laterally in the neck, normally had their origin from cranial nerves, and their resection approach is cervical.

Prevalence of alterations in chest computerized tomography in patients with head and neck cancer.

OBJECTIVE: to assess the prevalence of abnormalities found by computed tomography (CT) of the chest in patients with squamous cell carcinoma of the head and neck. METHODS: we retrospectively analyzed chest CT exams of 209 patients with squamous cell carcinoma of the head and neck. The CT findings were stratified as inflammatory / infectious, parenchymal, nodular uncharacteristic and nodular metastatic/tumoral. RESULTS: alterations were diagnosed in 66.6% of patients. Of these, 25.3% represented emphysema; 18.8%, uncharacteristic micronodules; 12.9%, metastases; 11.9%, thoracic lymph node enlargements; and in 6.6% we detected active pulmonary tuberculosis or its sequelae, pneumonia or inflammatory / infectious signs and pleural thickening or effusion. CONCLUSION: the prevalence of exams with alterations and the considerable rate of detected metastases indicate that chest CT should be required for diagnostic and / or staging in cases of head and neck cancer.

Videolaryngostroboscopy following frontolateral laryngectomy with sternohyoid flap.

We conducted a retrospective study to analyze the videostroboscopic findings in a group of 21 patients who underwent vertical frontolateral laryngectomy with reconstruction by use of the sternohyoid muscle flap. They had T1b and T2 glottic tumors and a follow-up of more than 1 year. Three observers analyzed the recorded videostroboscopic data. The cases in which the stroboscopic evaluation of the vocal folds was incomplete were studied in regard to the clinical staging, the supraglottic hyperfunction, and the vibratory site; the Fisher exact test was applied. The glottic closure was complete in 15 individuals, and 6 had irregular vocal gaps. The site of vibration was glottic in 10 cases, supraglottic in 7, and mixed in 4. The amplitude was normal on 4 and slightly diminished on 9 preserved sides, whereas it was moderately or severely diminished on 16 and absent on 5 reconstructed sides. The mucosal wave vibratory pattern was always totally present on 15 preserved and 5 reconstructed sides: normal or slightly diminished in the preserved vocal folds, and moderately or severely diminished in the reconstructed ones. The reconstructed vocal folds had a nonvibrating portion in 5 cases. The movement extent of the preserved side was larger than that of the other side in 8 cases, and the sides were similar in 13 cases. The symmetry was regular in 18 cases. The periodicity was always or generally regular in 9 cases. There was supraglottic hyperadduction in 16 cases, with a lateral constriction predominance. The mucosal appearance was normal in 15 patients and wet in 6 patients. The epiglottis was straight in 14 cases and crescent in 7. Mucus formation was observed in 1 patient in the posterior vibratory portion. Videolaryngostroboscopy allowed thorough evaluation of the vibratory pattern of the vocal folds in 52.4% of the patients. The supraglottic hyperadduction component and the supraglottic vocal source presented difficulty for this evaluation. The site of vibration was glottic in 47.6%, supraglottic in 33.3%, and mixed in 19.1% of the cases. The vibratory pattern was diminished on both sides, but mainly on the reconstructed one.

Evolution of patients with squamous cell carcinoma of upper aerodigestive tract.

CONTEXT: Local and regional recurrences are frequent in patients with squamous cell carcinoma of the upper aerodigestive tract and early diagnosis is important for salvage treatment. OBJECTIVE: To identify the period of highest risk for the development of recurrences after surgical treatment of squamous cell carcinoma of the upper aerodigestive tract, in spite of radical therapy, in order to plan the follow-up for these patients. TYPE OF STUDY: Cross-sectional, descriptive. SETTING: Department of Head and Neck Surgery/Otorhinolaryngology, Heliópolis Hospital (Hosphel), São Paulo, Brazil. PARTICIPANTS: A review was made of the hospital records of 889 patients with squamous cell carcinoma of the upper aerodigestive tract surgically treated between October 1977 and December 1996: 364 had oral cavity tumors, 107 had tumors of the oropharynx, 152 of the hypopharynx and 266, larynx tumors. The disease was stage I in 14 patients, stage II in 117, stage III in 352, stage IV in 397 and 9 patients were not staged. MAIN MEASUREMENTS: The interval between treatment and recurrence of disease was evaluated. The results were expressed as medians, quartiles (25% to 75%) and percentiles (10% to 90%). The annual incidence of recurrences and second tumors was calculated. RESULTS: Seventy-four percent of the recurrences were diagnosed within 18 months post-treatment. The local and regional recurrences and distant metastases showed medians of 270, 210 and 435 postoperative days respectively. The incidence of a second primary tumor varied from 2 to 3.1% a year. CONCLUSION: The majority of recurrences occurred within 18 months after the initial surgical treatment. The incidence of a second tumor remained stable after the first post-treatment year.