Biopsia en carcinoma escamoso de orofaringe

La biopsia en carcinoma escamoso de orofaringe es un paso fundamental para su diagnóstico, por lo que es relevante conocer los diferentes tipos de ésta. Actualmente, se reconocen 4 tipos de biopsia en este tipo de carcinoma, cada uno de las cuales presentan indicaciones específicas: Biopsia incisional, excisional, punción con aguja fina (PAF) y biopsia liquida. La más frecuente y recomendada es la biopsia incisional por su rapidez y poca morbilidad asociada. Tanto la biopsia excisional como la PAF se reservan para casos de metástasis cervical de primario desconocido dependiendo de la etapa del análisis del paciente en particular. Finalmente, existe un fuerte desarrollo de la biopsia liquida, especialmente mediante el estudio del biomarcador ctHPV-DNA, el cual al ser un marcador sensible y específico para este tipo de carcinoma puede cambiar el paradigma del diagnóstico en un futuro cercano.

Oropharyngeal squamous cell carcinoma biopsy is a fundamental step in the diagnosis; therefore, it is relevant to know its different types. Currently, four types of biopsy are recognized for this type of carcinoma, each of which has specific indications: incisional biopsy, excisional biopsy, fine needle aspiration (FNA), and liquid biopsy. The most frequent and recommended procedure is incisional biopsy, because of its speed and low associated morbidity. Both excisional biopsy and FNA are reserved for cases of cervical metastasis of unknown primary depending on the stage of analysis of the particular patient. Finally, there is a strong development in liquid biopsy, especially through the study of the ctHPV-DNA biomarker, which is a sensitive and specific marker for this type of carcinoma, and may change the diagnostic paradigm in the near future.

Comparative cephalometric study of the airways between different ethnic groups with normal occlusion

ABSTRACT Objective: This study aimed to compare the nasopharynx and oropharynx airway dimensions of Caucasians, Blacks, Japanese, Japanese Brazilians, and Black Caucasians. Methods: A sample of 216 lateral radiographs of untreated young Brazilian subjects (mean age of 12.94 years; SD 0.88) were divided into five groups: Black Caucasian, Black, Caucasian, Japanese, and Japanese Brazilian. Lateral radiographs were used to measure the oropharynx (from the midpoint on the soft palate to the closest point on the anterior pharyngeal wall) and the nasopharynx (from the intersection of the posterior border of the tongue and the inferior border of the mandible to the closest point on the posterior pharyngeal wall). Analyses of variance (ANOVA) and Tukey's test were performed (p< 0.05). Results: The linear dimension of the oropharynx was similar among the different ethnic groups. Caucasian individuals presented a significantly greater linear dimension of the nasopharynx than Black Caucasian and Black individuals. Conclusions: All the groups had similar buccopharyngeal values. However, Caucasian individuals had significantly higher values when compared to Black Caucasians and Black individuals.

RESUMO Objetivo: Este estudo teve como objetivo comparar as dimensões das vias aéreas da nasofaringe e da bucofaringe de leucodermas, melanodermas, xantodermas, feodermas e nipo-brasileiros. Material e métodos: Uma amostra de 216 telerradiografias laterais de jovens brasileiros não tratados (idade média de 12,94 anos; DP 0,88) foi dividida em cinco grupos: melanodermas, leucodermas, xantodermas, feodermas e nipo-brasileiros. As telerradiografias foram utilizadas para medir a bucofaringe (do ponto médio do palato mole até o ponto mais próximo da parede anterior da faringe) e a nasofaringe (da intersecção da borda posterior da língua e da borda inferior da mandíbula até o ponto mais próximo). Foram realizadas análises de variância (ANOVA) e teste de Tukey (p < 0,05). Resultados: A dimensão linear da bucofaringe foi semelhante entre os diferentes grupos étnicos. Indivíduos leucodermas apresentaram dimensão linear da nasofaringe significativamente maior do que indivíduos feodermas e melanodermas. Conclusões: Todos os grupos apresentaram valores da bucofaringe semelhantes. No entanto, os indivíduos leucodermas apresentaram valores significantemente maiores, quando comparados aos feodermas e melanodermas.

Oral and oropharyngeal mucosal lesions: clinical-epidemiological study of patients attended at a reference center for infectious diseases

Abstract Objective To determine the prevalence, epidemiological profile, and clinical characteristics of Oral or Oropharyngeal Mucosal Lesions (OOPML) in patients attended at the Otorhinolaryngology Service of the Evandro Chagas National Institute of Infectious Diseases (INI-FIOCRUZ) from 2005 to 2017. Methods Statistical analysis of descriptive data from medical records (gender, age, education level, skin color, origin, smoking, alcoholism, HIV co-infection, time of disease evolution, first symptom, and OOPML location) was performed. Results Of 7551 patients attended at the service, 620 (8.2%) were included in the study. OOPML were classified into developmental anomalies (n = 3), infectious diseases (non-granulomatous n = 220; granulomatous n = 155), autoimmune diseases (n = 24), neoplasms (benign n = 13; malignant, n = 103), and unclassified epithelial/soft tissue diseases (n = 102). OOPML of infectious diseases (60.5%) and neoplasms (18.7%) were the most frequent. The predominant demographics of patients with OOPML were: males (63.5%), white (53.5%), and those in the fifth to sixth decades of life (43.3%). Local pain (18.1%) and odynophagia (15%) were the most reported first symptoms, and the most frequent OOPML sites were the palatine tonsil (28.5%), hard palate (22.7%), and tongue (20.3%). The median evolution time was three months. Conclusions Infectious OOPML were the most frequent, as expected in a reference center for infectious diseases, and thus, they are likely to be less frequent in general care and/or dental services. Underreporting of OOPML is possible, as oral/oropharyngeal examination is often not included in the routine medical examination. Oral cavity/oropharynx examination should be performed by specialists, such as dentists and otorhinolaryngologists, who have the expertise in identifying OOPML, even in incipient/asymptomatic cases. Given the numerous diseases in which OOPML can present, diagnosis could be facilitated by multidisciplinary teams, potentially enabling the early treatment of diseases, and thus, reduce morbidity and improve prognosis. The use of standardized medical records for oral/oropharyngeal systematic examination could provide relevant tools for differential diagnoses and information for new clinical-epidemiological studies. Level of evidence: Level 3.

Geometria orofaríngea e parâmetros acústicos vocais de indivíduos hígidos e com doença de Parkinson / Oropharyngeal geometry and acoustic parameters of voice in healthy and Parkinson's disease subjects

RESUMO Objetivo verificar se existem diferenças nas medidas acústicas e da geometria orofaríngea entre indivíduos hígidos e pessoas com Doença de Parkinson, segundo a idade e sexo e investigar se há correlações entre as medidas geométricas orofaríngeas nessa população. Método participaram 40 indivíduos, sendo 20 com diagnóstico de Doença de Parkinson e 20 indivíduos hígidos, pareados por faixa etária, sexo e índice de massa corporal. As variáveis acústicas estudadas foram frequência fundamental, jitter, shimmer, glottal-to-noise excitation ratio, ruído e média da intensidade. As variáveis geométricas da orofaringe foram aferidas por faringometria acústica. Resultados as variáveis geométricas foram menores no grupo com Doença de Parkinson e os idosos com Doença de Parkinson apresentaram menor área da junção orofaríngea que os idosos hígidos. Com relação aos parâmetros acústicos vocais, o valor da frequência fundamental foi menor no sexo masculino, no grupo com Doença de Parkinson e os valores de jitter foram maiores no grupo não idoso dos sujeitos com Doença de Parkinson. Houve correlação positiva moderada entre o comprimento e volume da cavidade oral, comprimento da cavidade faríngea e o comprimento do trato vocal e do volume da cavidade faríngea e o volume do trato vocal. Conclusão indivíduos com Doença de Parkinson apresentaram menores valores de área glótica e área da junção orofaríngea, comparativamente aos hígidos. Quando distribuídos por faixa etária e sexo, a frequência fundamental foi menor no grupo com doença de Parkinson, na população masculina. Houve correlação positiva moderada entre as medidas de comprimento e volume da orofaringe, na amostra estudada.

ABSTRACT Purpose to verify whether there are differences in acoustic measures and oropharyngeal geometry between healthy individuals and people with Parkinson's disease, according to age and sex, and to investigate whether there are correlations between oropharyngeal geometry measures in this population. Methods 40 individuals participated, 20 with a diagnosis of Parkinson's disease and 20 healthy individuals, matched by age, sex, and body mass index. Acoustic variables included fundamental frequency, jitter, shimmer, glottal-to-noise excitation ratio, noise, and mean intensity. Oropharyngeal geometry variables were measured with acoustic pharyngometry. Results geometry variables were smaller in the group with Parkinson's disease, and older adults with Parkinson's disease had a smaller oropharyngeal junction area than healthy older adults. Regarding acoustic parameters of voice, fundamental frequency values were lower in males with Parkinson's disease, and jitter values ​​were higher in the non-elderly subjects with Parkinson's disease. There was a moderate positive correlation between oral cavity length and volume, pharyngeal cavity length and vocal tract length, and pharyngeal cavity volume and vocal tract volume. Conclusion individuals with Parkinson's disease had smaller glottal areas and oropharyngeal junction areas than healthy individuals. When distributed into sex and age groups, the fundamental frequency was lower in males with Parkinson's disease. There was a moderate positive correlation between oropharyngeal length and volume measures in the study sample.

Treatment outcome of oropharyngeal squamous cell carcinoma through propensity score analysis

Abstract According to an extensive database, the Objective is to compare surgical versus nonsurgical treatment through Propensity Score (PS) for patients with Oropharyngeal Squamous Cell Carcinoma (OPSCC). Methods: We retrospectively evaluated epidemiological data from 8075 patients with OPSCC diagnosed between 2004 and 2014 and used PS matching to analyze possible prognostic factors for its outcomes with regression analyses. Results: Cox multiple regression analysis to study survival after PS matching shows that type of treatment was associated with death with a hazard ratio of 1.753 (p < 0.05) of non-surgical treatment. However, it was not associated with recurrence (p> 0.05). In the surgical treatment group, overall survival was 79.9% at one year, 36.4% at five years, and 20.5% at ten years. Disease-free survival was 90.1%, 64.8%, and 56.0% at 1, 5, and 10-years, respectively. In the non-surgical treatment group, overall survival was 60.6% at one year, 21.8% at five years, and 12.7% at ten years. Disease-free survival was 90.8%, 67.2%, and 57.8% at 1, 5, and 10-years, respectively. Conclusion: Patients in the surgical treatment group had better outcomes related to survival. Recurrence is associated with the survival of OPSCC cancer. Recurrence-free survival is similar to both treatments. Level of evidence: 2C.

Métodos utilizados na análise morfométrica do trato vocal em cantores: revisão integrativa / Methods used in morphometric analysis of singers' vocal tracts: an integrative review

RESUMO Objetivo descrever os principais métodos quantitativos utilizados para análise morfométrica do trato vocal em cantores, suas aplicações e os principais segmentos estudados. Estratégia de pesquisa trata-se de uma revisão integrativa guiada pela pergunta condutora: "Quais os principais métodos quantitativos utilizados para análise morfométrica do trato vocal, suas aplicações e os principais segmentos estudados em cantores?". Foram utilizadas as bases eletrônicas PubMed, Scopus e BVS, por meio da chave de busca Vocal tract OR Oropharynx AND Morphology OR Geometry AND Evaluation OR Diagnosis AND voice, sem restrições de ano de publicação, sendo incluídos artigos em três idiomas: português, inglês e espanhol. Critérios de seleção: a seleção se deu de forma independente, por meio da leitura por pares e posterior aplicação dos critérios de exclusão e inclusão. Resultados dos 380 estudos, foram excluídos 30 duplicados. A partir da leitura dos resumos, aplicando-se os critérios de seleção, foram selecionados 18 estudos para leitura na íntegra, dos quais, 12 foram incluídos nesta revisão. A ressonância magnética foi o principal instrumento utilizado e os segmentos analisados incluíram desde o comprimento e volume do trato vocal, como segmentos isolados e suas particularidades morfológicas. Conclusão os métodos de quantificação morfológica do trato vocal integram instrumentos importantes para a avaliação instrumental do trato vocal e de seus segmentos, colaborando na atualização tecnológica em voz para melhor compreensão e intervenções fonoaudiológicas na voz cantada

ABSTRACT Purpose To describe the main quantitative methods used for morphometric analysis of the vocal tract in singers, their applications and the main segments studied. Research strategy This is an integrative review guided by the guiding question "What are the main quantitative methods used for morphometric analysis of the vocal tract, their applications and the main segments studied in singers?". The electronic databases PubMed, Scopus and VHL were used through the search key (Vocal tract OR Oropharynx) AND (Morphology OR Geometry) AND (Evaluation OR Diagnosis) AND (voice), without restriction of years of publication, including articles in three languages: Portuguese, English and Spanish. Selection criteria The selection took place independently through reading by pairs and subsequent application of exclusion and inclusion criteria. Results Of the 380 studies, 30 duplicates were excluded. After reading the abstracts, applying the selection criteria, 18 studies were selected for full reading, of which 12 were included in this review. Magnetic resonance imaging was the main instrument used and the analyzed segments ranged from the length and volume of the vocal tract to isolated segments and their morphological particularities. Conclusion Vocal tract morphological quantification methods are important for the instrumental evaluation of the vocal tract and its segments, a technological update leading to better understanding of singers' voice and therapeutical intervention.

Relação da infecção do papiloma vírus humano (HPV) com a apresentação de carcinomas de células escamosas de regiões da orofaringe / Relationship of human papilloma virus (HPV) infection with the presentation of squamous cell carcinomas from regions of the oropharynx

O papiloma vírus humano (HPV) é classificado como uma doença sexualmente transmissível, sendo esse vírus de DNA de fita dupla associado convencionalmente ao câncer de colo de útero, entretanto, em estudos mais recentes esse vírus também foi associado ao carcinoma de células escamosas de orofaringe (CCEO). Nesse sentido, essa re-visão sistemática tem como objetivo mostrar a relação entre o HPV e o CCEO. Dessa forma, foram utilizadas as bases de dados PubMed, The Cochrane Library, BioOne, Lilacs e Scielo com artigos publicados no período entre janeiro de 2010 e junho de 2020 com publicações nos idiomas: português, espanhol e inglês, respeitando os cri-térios de inclusão e exclusão. Foram considerados elegíveis 11 artigos que apresentaram a relação com a infecção de orofaringe e com o HPV. Apesar do alto número de artigos encontrados pela busca da relação com o HPV com neoplasias em diferentes regiões do corpo, foi possível compreender a relação presente entre o CCEO e a infecção causada pelo HPV através de um modelo de estratificação PRISMA. Assim, foi demonstrado, além da presença dessa relação, a necessidade de métodos diagnósticos mais rápidos, acessíveis e eficazes para apresentação correta entre patologia e fator etiológico. (AU)

Human papilloma virus (HPV) is classified as a sexually transmitted disease, in which this double-stranded DNA virus is often associated with cervical cancer. However, in more recent studies, this virus has also been associated with oropharyngeal squamous cell carcinoma (OSCC). Therefore, this systematic review aims to show the relationship between HPV and CCEO. Thus, Pubmed, The Cochrane Library, Bioone, Lilacs and Scielo databases were used with articles published between January 2010 and June 2020 encompassing publications in Portuguese, Spanish and English, respecting the inclusion and exclusion criteria. A total of eleven articles that presented a relationship with oropharyngeal infection and HPV were considered eligible. Despite the high number of articles found by the search for the association between HPV and neoplasms in different regions of the body, it was possible to understand the association between CCEO and the infection caused by HPV, through a PRISMA stratification model. Thus, it was demonstrated, in addition to the presence of this association, the need for faster, more accessible and effective diagnostic methods for the correct presentation of pathology and etiological factor. (AU)

Prognostic factors in oropharyngeal squamous cell carcinoma in the state of São Paulo, Brazil: 10-year follow-up

Abstract Objective: To descriptively analyze the epidemiological data, clinical stage, and outcomes of oropharyngeal squamous cell carcinoma in the state of São Paulo, Brazil, and to estimate the influence of clinical stage and treatment type on overall and disease-free survival. Methods: We retrospectively analyzed epidemiological data from the São Paulo Cancer Center Foundation database relative to patients with oropharyngeal squamous cell carcinoma diagnosed between 2004 and 2014 in the state of São Paulo. Univariate and multivariate Cox regression analyses were performed to assess factors associated with the outcomes. A forward stepwise selection procedure was used. Survival curves were estimated by the Kaplan-Meier method and compared by the Gehan-Breslow-Wilcoxon test. Results: A total of 8075 individuals with oropharyngeal squamous cell carcinoma were identified. Of these, 86.3% were diagnosed at an advanced stage and 13.7% at an early stage. Only 27.2% of patients were treated surgically, whereas 57.5% were treated medically. Patients undergoing surgery had longer overall survival than those receiving medical treatment in both early- and advanced-stage oropharyngeal squamous cell carcinoma. However, there was no significant difference in disease-free survival between surgical and medical treatment. Conclusion: No significant difference in disease-free survival between medical and surgical treatment suggests similar complete remission rates with both approaches. Patients receiving medical treatment had shorter overall survival, which may be due to complications from chemotherapy and radiotherapy. However, we cannot confirm this relationship based on the data provided by the São Paulo Cancer Center Foundation. Prospective studies are warranted to assess whether the lower overall survival rate in patients receiving medical treatment is secondary to complications from chemotherapy and radiotherapy. Level of evidence: 2C.

Extensive Giant Lipoma of Oropharynx

@#Lipoma is a benign, slow growing tumour composed of adipose tissue. In general, it is very unusual for lipoma to form in the head and neck region, let alone achieve a size of more than 10 cm with the involvement of deep neck spaces. We discussed a case of an extremely huge neck lipoma measuring 18 cm x 14 cm with extensive involvement of deep neck spaces, infratemporal fossa and pharynx, closely adherent to submandibular and parotid gland. The diagnostic and therapeutic challenges were discussed, in achieving a surgically complete excision and cosmetically acceptable outcome

Common bacteria in oropharynx of children with Mycoplasma pneumoniae pneumonia and its clinical significance / 中华实用儿科临床杂志

Objective:To investigate the common bacteria in the oropharynx of children with Mycoplasma pneumoniae pneumonia (MPP) and its clinical significance.Methods:A total of 134 children with MPP who were hospitalized in the Department of Pediatric Respiratory, Shengjing Hospital of China Medical University from December 2016 to June 2017 were selected as the research subjects, and 42 healthy children in the same hospital were selected retrospectively as the healthy control group during the same period.Fluorescent quantitative polymerase chain reaction Taqman probe was used to detect common oropharyngeal bacteria[ Streptococcus pneumoniae(SP), Moraxella catarrhalis(CTA), Haemophilus influenza(HI)] for the enrolled children.Firstly, the bacterial detection rate of MPP children and healthy children was compared.Then, according to age(<1 years old, 1-<3 years old, 3-<6 years old and 6-14 years old), bacterial detection[Mycoplasma pneumoniae(MP), MP+ bacteria]and bacterial species(MP+ SP, MP+ CTA, MP+ HI), 134 children with MPP were divided into groups to compare.Moreover, the relevant clinical datas were retrospectively analyzed by rank sum test and chi- square test. Results:Among 134 children with MPP, 79 (58.96%) children were detected bacteria, and 17 (40.48%) children were detected bacteria among 42 healthy children, with statistically significant differences( χ2=4.404, P<0.05). Compared with the MP group, the level of white blood cell (WBC)[8.5(6.7, 12.0)×10 9/L vs.7.8(5.8, 9.3)×10 9/L, Z=-2.232], C reactive protein(CRP)[19.2(7.2, 35.0) mg/L vs.8.4(3.4, 24.6) mg/L, Z=-2.810], lactate dehydrogenase(LDH)[286(244, 365) U/L vs.250(210, 302) U/L, Z=-2.474] and the incidence of lobar pneumonia[40.51%(32/79 cases) vs.18.18%(10/55 cases), χ2=7.510], pleural effusion[13.92%(11/79 cases) vs.3.64%(2/55 cases), χ2=3.917], refractory Mycoplasma pneumoniae pneumonia (RMPP)[34.18%(27/79 cases) vs.18.18%(10/55 cases), χ2=4.151] in MP+ bacteria group were higher; the course of fever[10(7, 12) d vs.8(6, 10) d, Z=-2.706] and duration of antibiotic use[16(13, 19) d vs.12(9, 16) d, Z=-3.747] in MP+ bacteria group were longer (all P<0.05). The level of WBC in MP+ SP group[12.20(7.80, 17.30)×10 9/L] was higher than that in MP+ HI group [6.75(5.37, 9.44)×10 9/L], and the differences were statistically significant( Z=11.574, P<0.05), and the incidence of lobar pneumonia in MP+ SP group [56.67%(17/30 cases)]was higher than that in MP+ CTA group [0(0/3 cases)]and MP+ HI group[18.75%(3/16 cases)], and the differences were statistically significant( χ2=9.770, P<0.05). Conclusions:Bacterial colonization or infection is more likely to occur in the oropharynx of children with MPP.When WBC, CRP, and LDH are significantly increased and the image shows a large consolidation or pleural effusion, it may indicate mixed bacterial infection, longer course of fever and higher incidence of RMPP, and the common mixed bacteria is SP.

Transoral stepped atlantoaxial release theory for irreducible atlantoaxial dislocation / 中华骨科杂志

Objective:To investigate the clinical efficacy of different grade transoral atlantoaxial release for the treatment of irreducible atlantoaxial dislocation.Methods:From January 2010 to December 2019, 297 patients with irreducible atlantoaxial dislocation treated by different grade releases were retrospectively analyzed, including 132 males and 165 females, aged 42.3±12.14 years (range, 10-63 years). All cases were treated by different grade releases, Grade I (196, 66.0%), Grade II (54, 18.2%), Grade III (28, 9.4%) and Grade IV (19, 6.4%). The American Spinal Injury Association (ASIA) grade and Japanese Orthopedic Association (JOA) score were recorded as the clinical evaluation index. The clivus-canal angle (CCA) and cervico-medullary angle (CMA) were measured to evaluate the reduction. The surgery time, blood loss, duration of bony fusion and complications were also analyzed.Results:The follow-up time was 14.8±10.2 months (range, 9-36 months). The surgery time of Grade I-IV were 2.02±0.35 min, 3.00±0.36 min, 4.07±0.96 min and 5.24±0.83 min, respectively ( F=385.43, P<0.001), blood loss was 84.08±27.21 ml, 153.61±31.36 ml, 268.93±48.94 ml and 444.21±109.51 ml, respectively ( F=582.39, P<0.001). The preoperative ASIA motor score of Grade I-IV were 83.85±6.68, 84.06±5.47, 84.07±5.99 and 85.00±4.11, respectively. The last follow-up were 98.34±2.38, 98.67±1.79, 98.86±1.58 and 98.32±2.11, respectively, with statistically significant differences from preoperative ( P<0.05). The preoperative JOA score of Grade I-IV were 11.44±1.73, 11.59±1.72, 11.61±1.47 and 11.32±1.80, respectively. The last follow-up were 16.22±1.00, 16.28±1.02, 16.14±1.04 and 16.16±1.07, respectively, with statistically significant differences from preoperative ( P<0.05). The preoperative CCA of Grade I-IV were 110.19°±8.76°, 112.48°±7.66°, 106.61°±6.54° and 109.05°±7.79°, respectively. The last follow-up were 140.22°±8.04°, 141.86°±7.04°, 142.35°±8.62° and 140.15°±6.49°, respectively, with statistically significant differences from preoperative ( P<0.05). The preoperative CMA of Grade I-IV were 113.48°±9.54°, 116.03°±8.38°, 109.55°±7.13°, and 112.46°±8.33°, respectively. The last follow-up were 144.28°±7.75°, 146.40°±6.98°, 145.81°±8.27° and 143.24°±6.36°, respectively, with statistically significant differences from preoperative ( P<0.05). Solid bony fusion was obtained except for 3 cases, the fusion time was 9.71±2.55 months (range 3-14 months). Altogether 33 complications occurred in all cases (11.1%), including 3 fusion failure, 3 cerebrospinal leak, 3 wound infection, 2 death (1 case caused by cerebrospinal leak), 11 pharyngeal discomfort, 4 postoperative pain surrounding iliac crest, and 8 malunion of iliac crest. Conclusion:Transoral stepped atlantoaxial release theory could provide guidelines for atlantoaxial dislocation treatment, and make the transoral release technique more effective and safer.

Efectividad de ejercicios para rehabilitar la disfagia orofaríngea posterior a un accidente cerebrovascular: una revisión integradora / Effectiveness of exercises to rehabilitate oropharyngeal dysphagia after stroke: an integrative review

Introducción. La selección del tratamiento para pacientes con disfagia debe ba-sarse en evidencia con la mejor calidad posible. Este tratamiento puede involucrar ejercicios de rehabilitación con el objetivo de modificar la fisiología de la deglución y promover cambios a largo plazo.Objetivo. Explorar los efectos de ejercicios y maniobras destinadas a la reactivación de la función de deglución en personas con disfagia orofaríngea posterior a un acci-dente cerebrovascular, a través de publicaciones científicas existentes en los últimos diez años.Metodología. Se realizó una revisión de la literatura en las bases de datos PubMed con los términos MeSH "Deglutition Disorders" y "Exercise Therapy", y con los términos libres "Dysphagia" y "Swallowing Therapy", combinados con el booleano de intersección "AND".Resultados. Los ejercicios con entrenamiento de resistencia de lengua al paladar, entrenamiento de la fuerza muscular espiratoria (EMST), chin tuck contra resisten-cia (CTAR), Shaker y apertura mandibular fueron los que mostraron, con mayor respaldo bibliográfico, efectos positivos en el tratamiento de la disfagia. Conclusiones. La información recopilada podría ser de utilidad clínica para guiar la selección de uno u otro procedimiento terapéutico. Se debe continuar generando evidencia relacionada con la efectividad de los ejercicios deglutorios en la disfagia orofaríngea posterior a un ACV

Introduction. The treatment selection for patients with dysphagia should be based on the best possible quality evidence. This treatment may involve rehabili-tative exercises with the aim of modifying swallowing physiology and promoting long-term changes.Objective. To explore the effects of exercises and maneuvers aimed at reactivating swallowing function in people with oropharyngeal dysphagia after a stroke, through existing scientific publications from the last ten years.Methodology. A literature review was carried out in the PubMed databases with the MeSH terms "Deglutition Disorders" and "Exercise Therapy", and with the free terms "Dysphagia" and "Swallowing Therapy", combined with the Boolean inter-section "AND".Results. The tongue-to-palate resistance training exercises, expiratory muscle strength training (EMST), chin tuck against resistance (CTAR), Shaker, and jaw opening were those that showed, with greater bibliographic support, positive effects in the treatment of dysphagia.Conclusions. The information collected could be of clinical utility to guide the selection of one or another therapeutic procedure. Evidence should continue to be generated regarding the effectiveness of swallowing exercises in oropharyngeal dys-phagia after stroke

Avaliação epidemiológica de pacientes com câncer de boca e orofaringe da liga mossoroense de estudos e combate ao câncer / Epidemiological evaluation of patients with oral and oropharyngeal cancer from the Mossoroense League of Studies and Combating Cancer / Evaluación epidemiológica de pacientes con cáncer de boca y orofaringe de la Liga Mossoroense de Estudos e Combate ao Câncer

Introdução:Os tumores de cabeça e pescoço têm expressiva incidência e mortalidade, assim comoalta letalidade, e constituem um relevante problema de saúde pública, particularmente nos países em desenvolvimento. Dentre as neoplasias malignas diagnosticadas no mundo, aproximadamente 10% estão localizadas na boca, sendo esse o sexto tipo de câncer mais incidente. Objetivo:Avaliar o perfil epidemiológico de pacientes diagnosticados com câncer de boca e faringe da Liga Mossoroense de Estudos e Combate ao Câncer do município de Mossoró, Rio Grande do Norte,Brasil,entre janeiro 2013 e junho de 2018.Metodologia:Estudo transversal, fundamentado na análise retrospectiva e descritiva de prontuários médicos.Resultados:Dos221 prontuáriosanalisados, a cor branca (56,6%) e o gênero masculino (70,6%) foram os mais prevalentes, com média de idade entre 55 e65 anos. A maioria (61,9%) apresentava ensino fundamental incompleto, sendo residentes de área urbana (59,6%) com histórico de uso de tabaco (64,6%) e/ou bebidas alcoólicas (53,9%). Osítio mais prevalente de câncer em boca foi a base da língua (12,7%).Conclusões:Conhecer o perfil dos pacientes com câncer de boca e orofaringe é um importante passo para melhor traçar e direcionar ações de saúde pública visando tanto àprevenção quanto o diagnóstico precoce (AU).

Introduction:Head and neck tumors have a significant incidence and mortality, as well as high lethality, and are a relevant public health problem, particularly in developing countries. Among the malignant neoplasms diagnosed in the world, approximately 10% are located in the mouth, this being the sixth most frequent type of cancer. Objective:To evaluate the epidemiological profile of patients diagnosed with oral and pharyngeal cancer of the Mossoroense League of Studies and Cancer Fighting in the municipality of Mossoró, Rio Grande do Norte, Brazil,between January 2013 and June 2018.Methodology:Cross-sectional study, based on retrospective and descriptive analysis of medical records.Results:Of the 221 records analyzed, white (56.6%) and male (70.6%) were the most prevalent, with a mean age between 55 and 65 years. Most (61.9%) had incomplete primary education, being residents of an urban area (59.6%) with a history of tobacco use (64.6%) and / or alcoholic beverages (53.9%).The most prevalent site of cancer in the mouth was the base of the tongue (12.7%). Conclusions:Knowing the profile of patients with oral and oropharyngeal cancer is an important step to better outline and direct public health actions aimed at both prevention and early diagnosis (AU).

Introducción: Los tumores de cabeza y cuello tienen una expresiva incidencia y mortalidad, así como alta letalidad, y constituyen un relevante problema de salud pública, especialmente en los países en desarrollo. Entre las neoplasias malignas diagnosticadas en el mundo,aproximadamente el 10% están localizadas en la boca, siendo este el sexto tipo de cáncer más común.Objetivo: Evaluar el perfil epidemiológico de pacientes diagnosticados con cáncer de boca y faringe de la Liga Mossoroense de Estudos e Combate ao Câncer del municipio de Mossoró, Rio Grande do Norte, Brasil,entre enero de 2013 y junio de 2018.Metodologia: Estudio transversal, basado en el análisis retrospectivo y descriptivo de los registros médicos.Resultados: De los 221 registros analizados, blancos (56,6%) y varones (70,6%) han sido los más prevalentes, con una media de edad entre 55 y 65 años. La mayoría (61,9%) presentaba educación primaria incompleta, siendo residentes de área urbana (59,6%) con antecedentes de uso de tabaco (64,6%) y/o bebidas alcohólicas (53,9%). El sitio más prevalente de cáncer en boca fuelabase de la lengua (12,7%). Conclusiones: Conocer el perfil de los pacientes con cáncer de boca y orofaringe es un importante paso para mejor delinear y dirigir acciones de salud pública objetivando tanto la prevención como el diagnóstico precoz (AU).

Metastasis from tongue squamous cell carcinoma to the kidney

Metastasis to the kidney from other primary sites is extremely rare. Previous studies reported the lung as the most common primary site. Distant metastasis from the tongue to the kidney is exceedingly rare. Herein, we describe a case of metastatic squamous cell carcinoma to the kidney in a 71-year-old male with a detailed discussion of differentiating it from potential mimickers. The patient underwent a total glossectomy and bilateral cervical lymph node dissection. A diagnosis of well-differentiated squamous cell carcinoma of the tongue was rendered and the tumor was staged pT3 pN3b. Within two years of initial presentation, the patient developed widely metastatic disease, including pulmonary nodules, renal masses, left adrenal mass, and pancreatic mass. Accurate diagnosis of a secondary involvement of the kidney by a metastatic tumor requires the appropriate correlation of clinical and imaging findings as well as morphologic and immunohistochemical clues.

Estudio comparativo del espacio aéreo faríngeo según deformidades dentofaciales en radiografías cefalométricas / Comparative study of pharyngeal airway space according to dentofacial deformities in cephalometric radiographs

RESUMEN Objetivo: Comparar la dimensión del espacio aéreo faríngeo superior e inferior en las deformidades esqueléticas clase I, II y III determinadas en radiografías cefalométricas. Material y métodos: Se realizó un estudio de tipo retrospectivo donde se analizó 106 radiografías cefalométricas, tomadas en el centro radiográfico del Centro Universitario de Salud de la Universidad Peruana de Ciencias Aplicadas entre los años 2011 y 2014. A través del programa Nemoceph® se marcaron los puntos y trazados cefalométricos principales para determinar la de-formidad esquelética (según Steiner) y la dimensión de las vías aéreas superior e inferior (según McNamara). Resultados: La mayor dimensión en promedio (17,68 mm), se encontró en el espacio aéreo faríngeo superior (EAFS) con en la deformidad dentofacial clase III (DDF clase III) y la menor dimensión en promedio (13,71 mm) en la DDF clase II. En el espacio aéreo faríngeo inferior (EAFI), el mayor promedio (15,98mm) se presenta en la DDF clase III y el menor promedio (13,19mm) en la DDF clase II. Al comparar la dimensión del espacio faríngeo (EAF) entre las DDF, se encontró que existe diferencias estadísticamente significativas entre el EAFS de las DDF II y III, con un valor de p = 0,001; y en el inferior entre DDF III con DDF I y DDF III con DDFII con valores de p=0,0236 y p=0,0042 respectivamente. Conclusiones: En este estudio se encontró que existe diferencias estadísticamente significativas en el espacio aéreo faríngeo superior e inferior entre las tres clases de deformidades esqueléticas.

SUMMARY Objectives: Compare the dimension of the upper and lower pharyngeal airspace between the skeletal deformities class I, II and III in cephalometric radiographs. Material and methods: A retrospective type of study was made where there were analyzed 106 side radiogra-phies, taken in the X-ray center of the University health Center of the Peruvian University of Applied Sciences UPC between the years 2011 and 2014. Through the program Nemoceph® the main cephalometrics points and tracings were marked to be able to obtain the skeletal deformity (Steiner) and the dimension of the upper and lower airspace (McNamara). Results: In the upper pharyngeal airspace it was found that the highest aver-age dimension was 17.68 mm founded in the dentofacial deformation class III, and the lowest in class II with a value of 13.71 mm. Fort the lower airspace, the highest average was 15.98mm and the lowest 13.19mm, also founded in skeletal deformation Class III and Class II respectively. While comparing the size of the pharyngeal space between classes of deformity, it was found that there is statistically significant difference between the upper airspace of skeletal deformities class II and III with a value of p = 0.001; and in the lower, between classes III - I and III - II with values of p=0.0236 and p=0.0042 respectively. Conclusions: In this study it was found that there is a statistically significant difference in the upper and lower pharingeal airspace between the three dentofacial skeletal deformities.

Comparison of the clinical effect of a facial-submental artery island flap in reconstruction after resection of oral cavity and oropharyngeal squamous cell carcinoma / 口腔疾病防治

Objective @#To compare the clinical effect of the reconstruction of defects of the surgical area with the facial-submental artery island flap (FSAIF) after resection of oral cavity squamous cell carcinoma (OC-SCC) and oropharyngeal squamous cell carcinoma (OP-SCC).@*Methods@#A total of 203 cases of oral cavity squamous cell carcinoma and 72 cases of oropharyngeal squamous cell carcinoma were treated with the FSAIFs. The complications and success rate of the two groups were observed. The swallowing and voice functions of the two groups were evaluated and compared 6 months after the operation. The survival of the two groups was followed up. @*Results@#No significant differences were found in TNM stage, the skin paddle of the flap, the rate of flap failure, or local complications between the OC-SCC and OP-SCC groups (P > 0.05). Significant differences in swallowing and speech outcomes were observed between the groups (P < 0.05). No significant differences were found in survival outcome between the groups after 9-59 months of follow-up.@*Conclusion@#FSAIF can be used for reconstructing the defect in oral cavity or oropharynx, but the swallowing function of reconstructing the defect in oropharynx is poor.

Survival trends of patients with oral and oropharyngeal cancer treated at a cancer center in São Paulo, Brazil

OBJECTIVE: We aimed to estimate the overall survival (OS) and conditional survival (CS) in patients diagnosed with oral and oropharyngeal squamous cell carcinoma (SCC) and to determine their survival trends. METHODS: The study included all consecutive patients treated at the A.C. Camargo Cancer Center for oral or oropharyngeal SCC between 2001 and 2012. Data were obtained from the Hospital Cancer Registry. OS and CS were analyzed using the Kaplan-Meier method to evaluate the probability of survival with Cox predictor models. RESULTS: Data of 505 oral and 380 oropharyngeal SCC patients obtained in 2001-2006 and 2007-2012 were analyzed. Most of the oral SCC (59%) and oropharyngeal SCC (90%) patients had stages III-IV SCC. The 5-year OS for patients with oral SCC was 51.7%, with no significant difference between the first and second periods. The CS rates in 2007-2012 were 65% after the first year and 86% up to the fifth year. For oropharyngeal SCC, the 5-year OS rate was 45.0% in the first period. The survival rate increased to 49.1% from 2007 to 2012, with a reduction in the risk of death (HR=0.69;0.52-09.2). The CS estimates from 2007 to 2012 were 59% after the first year and 75% up to the fifth year. CONCLUSION: Survival across the two time periods remained stable for oral SCC but showed a significant increase for oropharyngeal SCC, possibly because of improvements in the patients' response to radiotherapy, such as intensity-modulated radiation therapy, and the use of more accurate diagnostic imaging approaches.

Advanced carcinoma of the oropharynx: survival analysis comparing two treatment modalities

Abstract About 92,000 new cases of oropharynx carcinoma are expected to occur annually worldwide. There is no consensus about the best therapy for these advanced tumors. The objective of the present study was to evaluate overall and disease-free survival rates of patients with advanced oropharynx squamous cell carcinoma, comparing surgery + radiotherapy with chemotherapy + radiotherapy. Medical records of patients were reviewed. Previously treated tumors were excluded. Clinical, demographic and microscopic information was collected, and p16 staining was performed. Kaplan-Meier survival curves were plotted. Forty-seven cases were included, 41 men and 6 women, having a mean age of 56.3 years. Most patients were smokers (85.1%) and consumed alcohol (74.5%). Patients were stage III (21.3%) or IV (78.7%). Most lesions affected the base of the tongue (36.2%). Of the 23 cases available for p16 testing, 3 were positive (13.0%). There was no difference between the overall and the disease-free survival rates for the two treatment modalities (p>0.05), even when only resectable tumors were compared. Seventeen cases experienced recurrence (36.2%); 16 (34.0%) patients remained alive without disease; 15 (31.9%) died due to disease; 9 (19.2%) were recurrent at the last follow-up. The two treatment protocols were equally efficient in treating advanced oropharynx squamous cell carcinoma, since both promoted similar overall and disease-free survival rates. The results and interpretations related herein mostly regard "conventional" oropharyngeal squamous cell carcinomas, as opposed to HPV-associated tumors.

Deglutition manifestations in patients with oropharyngeal cancer subjected to conservative therapy: systematic review / Manifestações da deglutição em pacientes com câncer de orofaringe submetidos à terapia conservadora: revisão sistemática

ABSTRACT Objectives: To characterize scientific production and identify deglutition changes in individuals with oropharyngeal cancer subjected to conservative therapy. Methods: The search was applied to five electronic database [Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), US National Library of Medicine National Institutes of Health (PubMed), Web of Science, and Scopus], besides the search of grey literature in the databases (OpenThesis e OpenGrey), avoiding selection and publication bias. Prospective longitudinal studies concerning the theme: deglutition disorders in individuals with oropharyngeal cancer subjected to conservative therapy were considered eligible. The risk of bias and the evaluation of individual methodological quality of the selected studies were measured by "The Joanna Briggs Institute Critical Appraisal tools for use in JBI Systematic Reviews" for prospective and longitudinal studies. Results: The search resulted in 899 records and after analysis four of them fulfilled the eligibility criteria. Among the studies included, all individuals presented some type of deglutition changes, the most common were: reduced of strength and retraction of the base of the tongue, delayed deglutition trigger, reduced laryngeal elevation, presence of residues on tongue and palate, in the pharyngeal area, valleculae, and posterior pharyngeal wall, as well as in the vestibules and in pyriform sinuses. Conclusion: The evidence from this systematic review suggests that conservative therapies cause deglutition changes or amplify the pre-existing ones, regardless of the type and magnitude of radiation, as well as tumor staging. However, there is little standardization in the research methodologies, making a meta-analysis study difficult to conduct.

RESUMEN Objetivos: Caracterizar la producción científica e identificar las alteraciones de deglución en personas con cáncer de orofaringe sometidas a tratamiento conservador. Métodos: Se realizó una búsqueda en cinco bases de datos electrónicas [Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), US National Library of Medicine National Institutes of Health (PubMed), Web of Science y Scopus], además de la literatura gris en las bases de datos OpenThesis y OpenGrey, evitando sesgo de selección y publicación. Se consideraron elegibles los estudios longitudinales prospectivos sobre el tema: trastornos de deglución en pacientes con cáncer de orofaringe sometidos a tratamiento conservador. El riesgo de sesgo y la calidad metodológica individual de los estudios seleccionados se evaluaron mediante la herramienta de evaluación crítica del Instituto Joanna Briggs (JBI) para uso de sus revisiones sistemáticas, estudios prospectivos y longitudinales. Resultados: La búsqueda encontró 899 registros y, tras análisis, cuatro de ellos cumplieron los criterios de elegibilidad. Entre los estudios incluidos, todos los pacientes presentaron algún tipo de trastorno de la deglución. Los más frecuentes fueron: fuerza y retracción reducidas de la base de la lengua, retraso en el disparo de la deglución, elevación laríngea reducida, presencia de residuo en lengua y paladar, en región faríngea, valléculas y pared posterior de la faringe, así como en el interior de los vestíbulos y en los senos piriformes. Conclusión: Esta revisión sistemática sugiere que los tratamientos conservadores producen alteraciones de deglución o intensifican aquellas que ya existen, independientemente del tipo y de la intensidad de radiación, así como de la estadificación del tumor. Hay, sin embargo, poca estandarización en las metodologías de investigación, lo que hace difícil un estudio de metanálisis.

RESUMO Objetivos: Caracterizar a produção científica e identificar as alterações da deglutição em indivíduos com câncer de orofaringe submetidos à terapia conservadora. Métodos: Realizou-se uma busca em cinco base de dados eletrônicas [Scientific Electronic Library Online (Scielo), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), US National Library of Medicine National Institutes of Health (PubMed), Web of Science e Scopus], além da busca da literatura cinzenta nas bases de dados (OpenThesis e OpenGrey), evitando viés de seleção e publicação. Foram considerados elegíveis estudos longitudinais prospectivos sobre o tema: alterações de deglutição em indivíduos com câncer de orofaringe submetidos à terapia conservadora. O risco de viés e a qualidade metodológica individual dos estudos selecionados foram avaliados pela ferramenta de avaliação crítica do Joanna Briggs Institute (JBI) para uso de suas revisões sistemáticas, estudos prospectivos e longitudinais. Resultados: A busca resultou em 899 registros e, após análise, quatro deles atenderam aos critérios de elegibilidade. Entre os estudos incluídos, todos os indivíduos apresentaram algum tipo de alteração de deglutição; os mais frequentes foram: força e retração da base da língua reduzidas, atraso no disparo da deglutição, elevação laríngea reduzida, presença de resíduo em língua e palato, em região faríngea, valéculas e parede posterior da faringe, bem como no interior dos vestíbulos e em seios piriformes. Conclusão: Esta revisão sistemática sugere que as terapias conservadoras produzem distúrbios de deglutição ou intensificam os já existentes, independentemente do tipo e da intensidade de radiação, bem como do estadiamento do tumor. Há, no entanto, pouca padronização nas metodologias das pesquisas, dificultando um estudo de metanálise.

A Clinical and Demographic Study on Oropharyngeal Malignancies

Background: The aim of the study was to determine the distribution of oropharyngeal malignancies in terms of age, sex,personal habits, symptoms, site, histopathological type, and differentiation; and the modes of treatment adopted and its results.Materials and Methods: A total of 68 patients treated previously in the Department of Ear, Nose, and Throat of MNR MedicalCollege and Hospital were included in this study. Patients of all age groups and gender were included in the study. Patients withpersistent mass of the neck or throat or with symptoms suggesting oropharyngeal cancer were included in the study. Patientswith symptoms of chronic throat pain, difficulty swallowing, weight loss, earache, voice change, and blood-tinged saliva wereincluded in the study. Patients with severe cardiac, renal and pulmonary diseases were excluded from the study. Patientswith immunodeficiency diseases were excluded from the study. All the patients were initially evaluated by a detailed medicalhistory and comprehensive head and neck examination, which included flexible endoscope examination of the pharynx andlarynx in an outpatient department setting. Patients with suspicious looking lesions (tumors) of the oropharynx were biopsiedfor histopathological evaluation. All patients with a confirmed diagnosis of oropharyngeal squamous cell carcinoma weresubjected to evaluation by a multidisciplinary treatment team. Imaging was done to evaluate the primary tumor, involvementof lymph nodes in the neck, and for evidence of metastatic cancer spread beyond the head and neck. The patients weresubjected to either computed tomography scan or magnetic resonance imaging of the neck to evaluate the pharynx and lymphnodes in the neck.Observations and Results: Among the 68 patients, there were 41 males (60.29%) and 27 females (39.70%), with a male tofemale ratio of 1.51: 1. The mean age was 55.63 ± 5.70 years. Thirty-seven patients (54.41%) were in 55–65 years, 24 patients(35.29%) in 45–55 years, and 7 patients (10.29%) were aged above 65 years. Malignant tumors of the tonsil were observedin 21/68 (30.88%), posterior one-third of the tongue in 17/68 (25%), soft palate in 10/68 (14.70%), valleculae in 10 (14.70%),and suprahyoid epiglottis in 6 (8.82%), and posterior pharyngeal wall in 4 (105.88%) of the patients.Conclusions: Oropharyngeal cancers are one of the most common malignant tumors of the aero-digestive tract. Males aremore commonly affected than females and usually in the 5th–6th decade of life. The incidence is rising in females also becauseof using smokeless tobacco products. The most common site was tonsil followed by posterior one-third of the tongue; the leastcommon site was posterior pharyngeal wall. Well-differentiated carcinoma was the most common histopathological finding.