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Chinese Journal of Oncology ; (12): 450-454, 2022.
Article in Chinese | WPRIM | ID: wpr-935236


Objective: Local recurrence is the main cause of treatment failure in patients with oral squamous cell carcinoma (OSCC). This study was proposed to investigate the feasibility of near infrared fluorescence (NIF) via indocyanine green (ICG) for monitoring surgical marginal in operation for OSCC patients. Methods: In 35 patients with OSCC treated surgically in the Department of Oral and Maxillofacial Surgery, Nanjing University School of Medicine, from January 2019 to June 2020, ICG (0.75 mg/kg) was administered intravenously via elbow vein at (12±1) hours before surgery, and NIF was performed intraoperatively on the surgical field and the cut edge of the surgically excised specimen, and fluorescence intensity was measured for OSCC tissue and normal oral mucosa, abnormal fluorescence signals were taken and subjected to rapid cryopathological examination. Correlation between NIF tumor boundary grading and pathological tumor boundary grading was analyzed by Spearman correlation analysis. Results: Clear ICG NIF was obtained for tumor lesions in all 35 patients, with a positive rate of 100%. The fluorescence intensity of OSCC tissue was (412.73±146.56) au, which was higher than that of normal oral mucosa tissue [(279.38±82.56) au, P<0.01]. Abnormal fluorescence signals were detected at the tumor bed and the cut edge of the surgical resection specimen in 4 patients, of which 2 cases were pathologically confirmed as cancer cell residue and 2 cases as inflammatory cell infiltration. The rate of positive detection of cut margins using ICG NIF technique in OSCC was 5.7% (2/35). Twenty of the 35 OSCC patients had grade 1, 11 of grade 2, and 4 of grade 3 tumor borders revealed by NIF of surgical resection specimens, which was positively correlated with pathological tumor border (r=0.809, P<0.001). Conclusions: ICG NIF technique can effectively detect the residual cancer cells at the incision margin, which is of great clinical value in reducing local recurrence of OSCC after surgery due to intraoperative cancer residue.

Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms , Humans , Indocyanine Green , Margins of Excision , Mouth Neoplasms/surgery , Neoplasm, Residual , Optical Imaging/methods , Squamous Cell Carcinoma of Head and Neck/surgery
Odontoestomatol ; 24(39): 1-9, 2022.
Article in English | LILACS, BNUY, BNUY-Odon | ID: biblio-1370334


Los tumores metastásicos en cavidad oral son pocos frecuentes, representan el 1% de las neoplasias malignas orales, son relativamente más frecuentes en los maxilares, respecto a aquellos localizados en los tejidos blandos orales. Se describe el caso de una paciente de 75 años de edad, con antecedentes de carcinoma renal de células claras, que consulta por la aparición repentina de una lesión tumoral en reborde alveolar superior izquierdo. Se realizó la biopsia exéresis con diagnóstico presuntivo de tumor metastásico o posible lesión reactiva. El informe anátomo - patológico confirma el diagnóstico de metástasis de un carcinoma renal. Las metástasis orales tienen un pronóstico generalmente malo, compromete la sobrevida, por lo que es importante realizar un exhaustivo estudio del paciente y considerar sus antecedentes, ya que en ocasiones son diagnosticadas tardíamentete.

Metastatic tumors to the oral cavity are rare, representing only 1% of malignant oral neoplasms. These metastatic tumors occur more frequently in the jaws than in soft oral tissues. This article describes the case of a 75-year-old patient with a history of clear cell renal carcinoma who seeks care because of the sudden appearance of a tumor lesion in the upper left alveolar ridge. An excision biopsy was performed with a presumptive diagnosis of a metastatic tumor or potential reactive lesion. The pathology report confirmed the diagnosis of renal cell carcinoma metastasis. Oral metastatic tumors usually present a bad prognosis with a low survival rate. It is important to examine patients thoroughly and consider their medical records, as they are sometimes diagnosed late.

Os tumores metastásicos na cavidade oral são raros, representam 1% das neoplasias malignas orais, sendo relativamente mais frequentes nos ossos maxilares enquanto aos localizados nos tecidos moles orais. Descreve-se o caso de uma mulher de 75 anos com história de carcinoma renal de células claras, que consultou com queixa de lesão tumoral localizada na crista alveolar superior esquerda. Uma biópsia foi feita com diagnóstico clínico presuntivo de tumor metastático ou possível lesão reativa. O laudo anátomopatológico confirmou o diagnóstico de metástase de carcinoma renal. As metástases orais geralmente têm um prognóstico ruim, com baixa sobrevivência, portanto é importante fazer um estudo exaustivo do paciente e tomar em conta sua história, já que às vezes o diagnóstico é tardio.

Humans , Female , Aged , Mouth Neoplasms/secondary , Carcinoma, Renal Cell/pathology , Kidney Neoplasms/pathology , Mouth Neoplasms/surgery , Mouth Neoplasms/diagnosis , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/diagnosis
Article in Chinese | WPRIM | ID: wpr-936114


OBJECTIVE@#To investigate the characteristics of pathogen infection and to establish a prediction model of infections in oral squamous cell carcinoma patients undergoing surgery with free flap reconstruction.@*METHODS@#The retrospective cohort study consisted of 1 596 patients undergoing tumor resection and free flap reconstruction for oral squamous cell carcinoma from January 2018 to December 2020. According to the postoperative infection, the patients were divided into the infected group (n=154) and non-infected group (n=1 442). The characteristics of pathogens were analyzed in the infected patients. The primary outcome variable was postoperative infection, and Logistic regression was used to determine risk factors of the infection. The prediction model was established and the discriminatory accuracy of the model was evaluated using receiver operating characteristic (ROC) curve.@*RESULTS@#Totally 154 cases were infected in the 1 596 cases undergoing surgery with free flap reconstruction, and the infection rate was 9.65%. The most frequent sites of infection were the surgical wound and respiratory tract. A total of 268 pathogens were isolated and cultured, including 240 strains of Gram-negative bacteria, accounting for 89.55%, mainly Pseudomonas aeruginosa and Klebsiella pneumoniae; 23 strains of Gram-positive bacteria, accounting for 8.58%, mainly Enterococcus faecalis and Staphylococcus aureus; and 5 strains of fungi, accounting for 1.87%. The isolated Pseudomonas aeruginosa had high resistant rate to imipenem and meropenem, and was sensitive to antibiotics, such as ciprofloxacin. The isolated Staphylococcus aureus had high resistant rate to erythromycin and clindamycin, and was sensitive to vancomycin. According to the multivariate Logistic analysis, four independent variables were significantly associated with an increased risk of postoperative infection (P < 0.05): clinical N category≥1, the American Society of Anesthesiologists (ASA) grade ≥2, tracheotomy and length of hospital stay >13 d. The prediction model was established based on these factors and the expression of the risk prediction model was as follows: predicted probability value P=1/(1+e-a), a=-0.803+0.674×(clinical N category ≥1)+0.518×(the ASA grade ≥2)+0.918×(tracheotomy)+1.581×(length of hospital stay >13 d), Hosmer-Lemeshow χ2=10.647, P=0.223, the degree of fitting of the model was good. The area under the ROC curve was 0.818 and 95%CI of the model for predicting infection was 0.789-0.846.@*CONCLUSION@#Oral squamous cell carcinoma patients undergoing surgery with free flap reconstruction are prone to have a high incidence of postoperative infection and Gram-negative bacteria are the main pathogens causing an infection. The established prediction model is of good predictive effect. Rational antimicrobial use coupled with awareness of infection control measures is paramount to reduce the incidence of postoperative infection in the oral squamous cell carcinoma patients undergoing surgery with free flap reconstruction.

Anti-Bacterial Agents/therapeutic use , Carcinoma, Squamous Cell/surgery , Drug Resistance, Bacterial , Free Tissue Flaps , Head and Neck Neoplasms , Humans , Microbial Sensitivity Tests , Mouth Neoplasms/surgery , Retrospective Studies , Squamous Cell Carcinoma of Head and Neck/drug therapy
Braz. j. otorhinolaryngol. (Impr.) ; 87(6): 678-682, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1350353


Abstract Introduction: After surgery for oral cavity cancer, superficial surgical defects are usually covered with a skin graft that can be harvested with different thicknesses depending on the reconstructive need. Despite its popularity and efficacy, this solution has the disadvantage of excessive harvesting times and scarring of the donor site. Other surgeons have proposed the use of bovine pericardium as a reconstructive solution. Its use in otorhinolaryngology especially after oral cavity surgery has never been reported. Objective: The aim of this manuscript is to present our preliminary experience with the use of a collagen membrane obtained from bovine pericardium in the reconstruction of small and superficial defects after transoral resection of oral cavity tumors. Methods: A bovine collagen membrane was used to cover surgical defects in 19 consecutive patients undergoing transoral resection of small/superficial oral cancers. Photographs were obtained in the postoperative period to follow the healing process. We analyzed the pro and cons of this tool, recorded data on postoperative chewing-, speechand taste-related quality of life, and tested the most appropriate settings providing the best reconstructive result. Results: The bovine collagen membrane allowed us to cover surgical defects of varying size in different oral sites. Shaping and placement proved to be simple. The membrane facilitated physiologic tissue repair: after one month it was completely absorbed and replaced by the patient's own mucosa. No adverse features were observed in the cohort. Conclusion: A bovine collagen membrane can represent a fast and easy solution in cases of split-thickness defect. Unlike a skin graft, it is not associated with donor site morbidity and allows the patient's own mucosa to be restored with a more physiological result.

Resumo Introdução: Os defeitos cirúrgicos superficiais pós-cirurgia para câncer de cavidade oral geralmente são cobertos com um enxerto de pele que pode ser colhido com diferentes espessuras, depende das necessidades de reconstrução. Apesar de sua popularidade e eficácia, essa solução tem a desvantagem dos tempos excessivos de colheita e cicatrização do local doador. Outros cirurgiões propuseram o uso do pericárdio bovino como solução reconstrutiva, enquanto seu uso em otorrinolaringologia, especialmente após cirurgia de cavidade oral, nunca foi relatado. Objetivo: Apresentar nossa experiência preliminar com o uso de uma membrana de colágeno obtida do pericárdio bovino, na reconstrução de defeitos pequenos e superficiais após resseçcão transoral de tumores da cavidade oral. Método: Uma membrana de colágeno bovino foi usada para cobrir defeitos cirúrgicos em 19 pacientes consecutivos submetidos à resseçcão transoral de câncer oral pequeno/superficial. As fotografias foram obtidas no pós-operatório para acompanhar o processo de cicatrização. Analisamos os prós e contras desse enxerto, registramos dados sobre a qualidade de vida relacionada à mastigação, fala e paladar no pós-operatório e testamos as configurações mais apropriadas, para proporcionar o melhor resultado reconstrutor. Resultados: A membrana de colágeno bovino nos permitiu cobrir defeitos cirúrgicos de tamanhos variados nos diferentes sítios orais. A modelagem e a colocação demonstraram ser simples. A membrana guiou o reparo fisiológico do tecido e após um mês foi completamente absorvida e substituída pela mucosa do próprio paciente. Não foram observadas características adversas na coorte. Conclusão: Uma membrana de colágeno bovino pode representar uma solução rápida e fácil em casos de defeitos de espessura dividida. Ao contrário de um enxerto de pele, ele não está associado à morbidade do local doador e permite que a mucosa do próprio paciente seja restaurada com um resultado mais fisiológico.

Humans , Animals , Cattle , Oral Surgical Procedures , Reconstructive Surgical Procedures , Quality of Life , Surgical Flaps , Mouth Neoplasms/surgery , Skin Transplantation
Article in English | WPRIM | ID: wpr-880867


Neck dissection for oral squamous-cell carcinoma (OSCC) is a clinically controversial issue and has therefore been the subject of abundant research. However, no one has performed a bibliometric study on this topic to date. The aim of this study was to assess the development of research on neck dissection for OSCC in terms of the historical evolution, current hotspots and future directions, particularly including research trends and frontiers from 2010 to 2019. Literature records related to research on neck dissection for OSCC were retrieved from the Web of Science Core Collection (WoSCC). CiteSpace was used as a tool to perform a bibliometric analysis of this topic. The survey included 2 096 papers. "Otorhinolaryngology" was the most popular research area. The most active institutions and countries were Memorial Sloan Kettering Cancer Center and the USA, respectively. Shah J.P. was the most cited author. Among the six identified "core journals", Head & Neck ranked first. The top three trending keywords were 'invasion', 'upper aerodigestive' and 'negative neck'. 'D'Cruz AK (2015)' was the most cited and the strongest burst reference in the last decade. The study evaluated the effect on survival of elective versus therapeutic neck dissection in patients with lateralized early-stage OSCC. The depth of invasion and the management of N0 OSCC were research frontiers in this field. The present study provides a comprehensive bibliometric analysis of research on neck dissection for OSCC, which will assist investigators in exploring potential research directions.

Bibliometrics , Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms , Humans , Mouth Neoplasms/surgery , Neck Dissection
CoDAS ; 33(4): e20190236, 2021. tab
Article in Portuguese | LILACS | ID: biblio-1286110


RESUMO Objetivo caracterizar o tempo de decanulação e liberação de dieta por via oral dos pacientes submetidos à cirurgia do câncer de boca no Hospital Alberto Cavalcante, e verificar quais fatores estão associados ao atraso no tempo de decanulação e de liberação de dieta por via oral. Método estudo observacional de análise do banco de dados de 33 pacientes adultos tratados cirurgicamente do câncer de boca e atendidos no período de 2012 a 2017. As variáveis sociodemográficas (idade e sexo) e clínicas (tipo de cirurgia, extensão operatória, tipo de reconstrução, condições clínicas e tempos de decanulação e reintrodução da via oral) foram coletadas por meio de análise de prontuários eletrônicos. Foi realizada análise estatística descritiva com medidas de tendência central, dispersão e proporções. Para análise de associação foi utilizado o teste não paramétrico Mann-Whitney para amostras independentes. Resultados Dos 33 participantes, predominou o sexo masculino e idosos, 69,8% realizaram ressecção de mais de uma estrutura. A mediana do tempo de decanulação entre os pacientes com câncer de boca foi de 8 dias, e da liberação da via oral foi de 9,5 dias. As ressecções com mais de uma estrutura, a presença de fístula e de deiscência interferiram no tempo de liberação de via oral. Conclusão a mediana de tempo de decanulação foi de oito dias e de liberação de via oral de 9,5 dias. As ressecções com mais de uma estrutura, a presença de fístula, e de deiscência de sutura, estão associadas com o aumento do tempo de liberação de via oral.

ABSTRACT Purpose to analyze the time of decannulation and oral diet release of patients undergoing oral cancer surgery at the Hospital Alberto Cavalcante and to verify which factors are associated with the time of decannulation and oral diet release. Methods an observational study of the database of 33 adult patients surgically treated with oral cancer and served between 2012 and 2017. The socio-demographic variables (age and gender) and clinical variables (type of surgery, surgical extension, type of reconstruction, clinical conditions and times of decannulation and reintroduction of the oral route) were collected through electronic medical records analysis. Descriptive statistical analysis was performed with measures of central tendency, dispersion and proportions. For the association analysis, the non-parametric Mann-Whitney U test was used for independent samples. Results of the 33 participants, male and elderly predominated, 69.8% underwent resection of more than one structure. The median time of decannulation among patients with oral cancer was 8 days, and oral clearance of 9.5 days. Resections with more than one structure, the presence of fistula and dehiscence interfered in the oral release time. Conclusion the median time of decannulation was eight days and oral release time of 9.5 days. Resections with more than one structure, the presence of fistula, and suture dehiscence are associated with increased oral release time.

Humans , Male , Adult , Aged , Mouth Neoplasms/surgery , Tracheostomy , Retrospective Studies
Rev. Fac. Odontol. (B.Aires) ; 36(84): 33-38, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1366750


El objetivo del presente trabajo es describir la técnica de mandibulotomía para resección de una lesión oncológica. Se describe el caso de una paciente de sexo femenino de 79 años con una formación vegetante que se extiende desde el polo inferior amigdalino izquierdo hasta surco glosoepiglótico homolateral y pared lateral de hipofaringe, con diagnóstico de carcinoma epidermoide poco diferenciado invasor. Se realizó la resección del tumor bajo anestesia general en el Hospital Sirio Libanés en mayo de 2019. La técnica de mandibulotomía utilizada en este caso clínico permitió acceder a la cavidad oral y orofaringe para la resección de un tumor no accesible a través de la boca abierta (AU)

Humans , Female , Aged , Mouth Neoplasms/surgery , Carcinoma, Squamous Cell , Mandibular Osteotomy , Hypopharynx , Argentina , Biopsy/methods , Oral Surgical Procedures , Dental Service, Hospital , Head and Neck Neoplasms
Autops. Case Rep ; 11: e2021299, 2021. graf
Article in English | LILACS | ID: biblio-1285404


Primary malignant melanoma of the oral cavity is a rare tumor in clinical practice. Extensive malignant melanomas are still very rare in the literature. Patients with malignant melanoma of oral cavity are often diagnosed at the advanced stage of the disease due to their painless and nonspecific radiological findings. Histopathology is the gold standard for the final diagnosis and staging of the tumor. Surgery followed by radiotherapy is the standard treatment offered to patients with malignant melanoma. Here we present a rare case of extensive malignant melanoma of oral cavity which was successfully managed by surgical excision followed by adjuvant radiotherapy.

Humans , Male , Adult , Mouth Neoplasms/pathology , Melanoma/pathology , Mouth Neoplasms/surgery , Mouth Neoplasms/therapy , Radiotherapy, Adjuvant
Rev. bras. anestesiol ; 70(4): 434-439, July-Aug. 2020. graf
Article in English, Portuguese | LILACS | ID: biblio-1137195


Abstract Background and objectives When planning the management of a predicted difficult airway, it is important to determine which strategy will be followed. Video laryngoscopy is a major option in scenarios with factors suggesting difficult airway access. It is also indicated in rescue situations, when there is tracheal intubation failure with direct laryngoscopy. The objective of the present report was to show the efficacy of using the video laryngoscope as the first device for a patient with a large tumor that occupied almost the entire anterior portion of the oral cavity. Case report An 85 year-old male patient, 162 cm, 70 kg, ASA Physical Status II, Mallampati IV classification, was scheduled for resection of an angiosarcoma located in the right maxillary sinus that invaded much of the hard palate and the upper portion of the oropharynx. He was conscious and oriented, with normal blood pressure, heart and respiratory rates and, despite the large tumor in the oral cavity, he showed no signs of respiratory failure or airway obstruction. After intravenous cannulation and monitoring, sedation was performed with 1 mg of intravenous midazolam, and a nasal cannula was placed to provide oxygen, with a flow of 2 L min−1. Then, the target-controlled infusion of remifentanil with an effect site concentration of 2 ng mL−1 was initiated, according to Minto's pharmacokinetic model. Ventilation was maintained spontaneously during airway handling. A trans-cricothyroid block was performed, with 8 mL of 1% lidocaine solution injected into the tracheal lumen. Slight bleeding did not prevent the use of an optical method for performing tracheal intubation. The entire oral cavity was sprayed with 1% lidocaine. The McGraph video laryngoscope with the difficult intubation blade was used, and an armored tube with a guide wire inside was used for tracheal intubation, performed on the first attempt with appropriate glottis visualization. Conclusion The video laryngoscope occupies a prominent position in cases in which access to the airway is difficult. In the present case it was useful. It can be used as first choice or as a rescue technique. The video laryngoscope is an appropriate alternative and should be available for facing the ever-challenging difficult airway patient.

Resumo Justificativa e objetivos No planejamento da abordagem a uma via aérea difícil prevista, é importante determinar qual será a estratégia a ser seguida. A videolaringoscopia é uma ótima opção em situações em que existam fatores indicadores de dificuldade de acesso à via aérea. Também é indicada em situações de resgate, quando houve insucesso na tentativa de intubação com a laringoscopia direta. O objetivo deste relato é mostrar a eficácia da utilização do videolaringoscópio como primeiro dispositivo diante de paciente com grande tumor que ocupava quase a totalidade da porção anterior da cavidade oral. Relato do caso Paciente com 85 anos, sexo masculino, 162 cm, 70 kg, estado físico ASA II, classificação de Mallampati IV, foi escalado para a ressecção de um angiossarcoma localizado no seio maxilar direito que invadia grande parte do palato duro e da porção superior da orofaringe. Apresentava-se lúcido, consciente e orientado, com valores de pressão arterial, frequência cardíaca e respiratória normais e, apesar do grande tumor na cavidade oral, não apresentava qualquer sinal de insuficiência respiratória ou de obstrução das vias aéreas. Após venóclise, foi feita monitorização e sedação com 1 mg de midazolam, por via venosa, e colocado cateter nasal para administração de oxigênio, com fluxo de 2 L.min-1. Em seguida, foi iniciada a infusão alvo-controlada de remifentanil com concentração efeito de 2 ng.mL-1 segundo o modelo farmacocinético de Minto. A ventilação foi mantida em espontânea durante a manipulação da via aérea. Foi realizado bloqueio transcricotireóideo, sendo injetados 8 mL de solução de lidocaína a 1% na luz traqueal. Um pequeno sangramento não impediu que um método óptico fosse utilizado para realizar a intubação traqueal. Toda a cavidade oral recebeu o spray de lidocaína tópica a 1%. Foi utilizado o videolaringoscópio McGraph com a lâmina de intubação difícil, e um tubo aramado com fio guia no seu interior, foi utilizado para a intubação traqueal, que foi realizada na primeira tentativa, com boa visualização da glote. Conclusão O videolaringoscópio ocupa uma posição de destaque nos casos em que o acesso à via aérea é difícil. No presente caso, a sua utilização foi útil. Ele pode ser utilizado como primeira opção ou como técnica de resgate. Nas condições sempre preocupantes diante de um paciente com via aérea difícil, o videolaringoscópio deve estar disponível, constituindo-se uma boa opção.

Humans , Male , Aged, 80 and over , Mouth Neoplasms/surgery , Intubation, Intratracheal/methods , Laryngoscopy/methods , Hemangiosarcoma/surgery , Video Recording , Laryngoscopes , Remifentanil/administration & dosage , Anesthetics, Local/administration & dosage , Laryngoscopy/instrumentation , Lidocaine/administration & dosage
J. appl. oral sci ; 28: e20190198, 2020. tab, graf
Article in English | LILACS, BBO | ID: biblio-1056596


Abstract Pathological parameters have been indicated as tumor prognostic factors in oral carcinoma. Objective: The objective of this study was to investigate the impact of pathological parameters on prognosis of patients affected only by tongue and/or floor of the mouth squamous cell carcinoma (SCC). Methodology: In total, 380 patients treated in the Brazilian National Cancer Institute (INCA) from 1999 to 2006 were included. These patients underwent radical resection followed by neck dissection. The clinical and pathological characteristics were recorded. The Kaplan-Meier method and Cox proportional hazards model were used in survival analysis. Overall survival (OS), cancer-specific survival (CSS) and disease-free interval (DFI) were estimated. Cox residuals were evaluated using the R software version 3.5.2. Worst OS, CSS and DFI were observed in patients with tumors in advanced pathological stages (p<0.001), with the presence of perineural invasion (p<0.001) and vascular invasion (p=0.005). Results: Advanced pathological stage and the presence of a poorly differentiated tumor were independent prognostic factors for OS and CSS. However, advanced pathological stage and perineural invasion were independent predictors of a shorter OS, DFI and CSS. Conclusion: Pathological stage and perineural invasion were the most significant pathological variables in survival analysis in tongue and/or floor of the mouth SCC.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Mouth Neoplasms/pathology , Tongue Neoplasms/pathology , Carcinoma, Squamous Cell/pathology , Mouth Floor/pathology , Neck Dissection/methods , Time Factors , Mouth Neoplasms/surgery , Mouth Neoplasms/mortality , Tongue Neoplasms/surgery , Tongue Neoplasms/mortality , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/mortality , Regression Analysis , Disease-Free Survival , Kaplan-Meier Estimate , Neoplasm Grading/methods , Neoplasm Staging
Rev. argent. cir ; 111(3): 129-141, set. 2019. graf, tab
Article in Spanish | LILACS | ID: biblio-1057355


Antecedentes: sobre la base de la bibliografía revisada y los resultados de supervivencia global y libre de enfermedad con diferentes márgenes de resección, se plantea la hipótesis de que márgenes < 5mm son suficientes para lograr una tasa de supervivencia global y comparables a las obtenidas con márgenes mayores. Objetivo: evaluar la supervivencia global y la supervivencia específica a 3 y 5 años de los pacientes con carcinomas escamosos de cavidad oral, en función de los márgenes quirúrgicos obtenidos. Material y métodos: se reclutaron entre enero de 2010 y diciembre de 2017 81 pacientes operados, 57,1%hombres, con una edad media de 60,49 años. Resultados: en el análisis multivariado en función de la supervivencia global y libre de enfermedad, resultaron variables pronósticas significativas el grado de diferenciación tumoral (p = 0,033), la invasión ganglionar extracapsular (p = 0,001) y la infiltración perineural (p = 0,000). Se pudo observar que no hay diferencias en la supervivencia libre de enfermedad de los diferentes grupos evaluados sobre la base de los márgenes quirúrgicos, pero se cree que la radioterapia posoperatoria estaría confundiendo la importancia real de los márgenes, debido a que la mayoría de los pacientes que presentaban márgenes cercanos fueron sometidos a radioterapia posoperatoria. Conclusiones: las variables analizadas concuerdan con la bibliografía en el sentido de que los únicos factores pronósticos resultan las características histológicas. Si bien existen muchos trabajos que analizan los márgenes en el carcinoma escamoso de cavidad oral, todavía no hay consenso en cuanto al valor pronóstico de los márgenes cercanos (1-5 mm).

Background: Based on the literature reviewed and the results of overall and disease-free survival with different surgical margins, we hypothesized that margins < 5mm are sufficient to achieve and overall survival rate and are comparable to those obtained with larger margins. Objective: The primary outcome of the present study was to evaluate overall survival and specific survival at 3 and 5 years of patients with squamous cell carcinoma of the oral cavity according to the surgical margins obtained. Material and methods: Between January 2010 and December 2017, 81 patients underwent surgery; 57.1% were men and mean age was 60.49 years. Results: At multivariate analysis, tumor differentiation (p = 0.033), extracapsular lymph node invasion (p = 0.001) and perineural invasion (p = 0.000) were identified as significant predictors of overall survival and disease-free survival. There were no differences in disease-free survival in the different groups evaluated based on the surgical margins. Yet, postoperative radiotherapy may actually obscure the importance of margins since most patients with close margins underwent postoperative radiotherapy. Conclusions: The variables analyzed in this paper are consistent with the literature in that only histological characteristics are prognostic factors. Although there are many studies analyzing the surgical margins in squamous carcinoma of the oral cavity, there is still no consensus regarding the prognostic value of close margins (1-5 mm).

Humans , Male , Middle Aged , Aged , Mouth Neoplasms/surgery , Carcinoma , Carcinoma, Squamous Cell/therapy , General Surgery , Methods , Mouth , Neoplasms
Rev. argent. cir ; 111(2): 61-70, jun. 2019.
Article in English, Spanish | LILACS | ID: biblio-1013347


Antecedentes: la cirugía reconstructiva del tercio medio de la cara es compleja y variada. La vecindad anatómica con la órbita, la base del cráneo y el seno maxilar favorece la extensión tumoral del paladar a dichas estructuras, desafiando al cirujano que debe realizar una resección con intención curativa. Objetivo: obtener conclusiones sobre la supervivencia y el intervalo libre de enfermedad en cánceres palatosinusales T4a/b, sucesivamente operados durante un período de 30 años. Material y métodos: la cirugía se extendió a la órbita en el 85,2%, al cráneo en el 8,3%, al cuello en el 18,7% y a la glándula parótida en el 7,3%. La reconstrucción de partes blandas se realizó con colgajos libres en el 32,5%, musculares en el 21,6%, de vecindad en el 20,2%, musculocutáneos en el 14,2% y con piel en el 11,3%. Resultados: se produjeron complicaciones locales y generales. Estas últimas llevaron a la muerte de 4/203 ‒2%‒ pacientes. La supervivencia global a 5 años fue del 62,5% y la libre de enfermedad, del 53%, El análisis multivariado para recurrencia fue significativo en los vírgenes de tratamiento previo y para supervivencia a favor de los escamosos frente a otras estirpes histológicas. Conclusiones: en presencia de oftalmoplejía o compromiso del contenido orbitario o de ambos, la exenteración tiene indicación absoluta. La supervivencia a 5 años resulta aceptable si se tiene en cuenta que fueron solo estadios avanzados de la enfermedad. Los tratamientos previos con que concurrieron algunos pacientes fueron negativos para su evolución. La cirugía primaria desempeñó un papel esencial en la supervivencia libre de enfermedad.

Background: the problems of reconstructive surgery for the midface are variable and can be very complex. The anatomical proximity of the midface to the orbit, base of the skull and maxillary sinuses is a challenge for the surgeon who must perform a curative resection. Objective: The aim of this presentation is to report the survival rate and disease-free interval in T4a and T4b neoplasms of the palate and paranasal sinuses consecutively resected over a 30-year period. Material and methods: Surgery was extended to the orbit in 85.2%, the skull in 8.3%, the neck in 18.7% and the parotid gland in 7.3%. Soft tissue reconstruction was performed using free flaps in 32.5%, muscle flaps in 21.6%, local flaps in 20.2%, musculocutaneous flaps in 14.7% and skin flaps in 11.3%. Results: Local and general complications were reported, and 4/203 patients (2%) died. At 5 years, overall survival was 62.5% and disease-free survival was 53%. Univariate analysis revealed that lack of previous treatment was significantly associated with recurrence and squamous cell carcinoma was a predictor of survival. Conclusions: The indication of exenteration is mandatory in the presence of ophthalmoplegia or involvement of the orbital content. Survival at 5 years is acceptable, considering the advanced stages of the disease. In some patients, previous treatments were associated with adverse outcome. Primary surgery plays an essential role for disease-free survival.

Mouth Neoplasms/surgery , Reconstructive Surgical Procedures/methods , Palate/surgery , Palate, Soft/surgery , Parotid Gland/surgery , Argentina , Mouth Neoplasms/mortality , Survival Rate , Reconstructive Surgical Procedures/adverse effects
Rev. cuba. estomatol ; 56(2): e1985, abr.-jun. 2019. graf
Article in English | LILACS | ID: biblio-1093223


ABSTRACT Introduction: The cemento-ossifying fibroma is a benign bone neoplasm that affects mainly the female sex during the third or fourth decades of life. This lesion has a slow growth and the treatment is the surgical removal of the tumor, because radiotherapy is not indicated. Objective: to describe and discuss a case of central cemento-ossifying fibroma. Case report: A 41-year-old female patient sought dental treatment due to tooth mobility in the anterior region of the mandible. In this region of the mandible, an increase in volume was noted with a firm consistency on palpation, covered by normal mucosa, and displacement of teeth. Radiographically, the presence of an extensive lesion in this region was observed. An incisional biopsy was performed which led to the final diagnosis of central cemento-ossifying fibroma. Subsequently the tumor was completely removed. An autogenous bone graft was performed and four osseointegrated implants were installed to rehabilitate the patient. Implant-supported prostheses (lower arch) and a complete denture (upper arch) were installed to restore esthetics and function of the patient's oral cavity. Conclusion: Despite being a benign tumor, the central cemento-ossifying fibroma caused functional and aesthetic damage to the patient and required a complex rehabilitation treatment. After approximately 5 years of tumor removal, there was no recurrence of the lesion or signs of peri-implant or periodontal diseases, evidencing the success of the treatments(AU)

RESUMEN Introducción: El fibroma cemento-osificante es una neoplasia ósea benigna que afecta principalmente al sexo femenino durante la tercera o cuarta décadas de la vida. Esta lesión tiene un crecimiento lento y el tratamiento es la extirpación quirúrgica del tumor, porque la radioterapia no está indicada. Objetivo: Describir y analizar un caso de un fibroma cemento-osificante central. Presentación caso: Paciente de 41 años de edad buscó tratamiento dental debido a la movilidad dental en la región anterior de la mandíbula. En esta región de la mandíbula se observó un aumento de volumen con una consistencia firme a la palpación, cubierta por la mucosa normal y desplazamiento de los dientes. Radiográficamente, se observó la presencia de una lesión extensa en esta región. Se realizó una biopsia incisional, que indicó el diagnóstico final del fibroma cemento-osificante central. Después el tumor fue completamente extirpado. Se realizó un injerto óseo autógeno y, posteriormente, se instalaron cuatro implantes osteointegrados para rehabilitar al paciente. Se instalaron prótesis soportadas por implantes (arco inferior) y una dentadura (arco superior) para restablecer la estética y la función de la cavidad bucal de la paciente. Conclusiones: A pesar de ser un tumor benigno, el fibroma cemento-osificante central causó daños funcionales y estéticos al paciente y requirió un complejo tratamiento de rehabilitación. Después de 5 años de la extirpación del tumor, no hubo recurrencia de la lesión. Además, no hubo signos de enfermedades periimplantarias y/o periodontales, lo que demuestra el éxito del tratamiento(AU)

Humans , Female , Adult , Prostheses and Implants/adverse effects , Mouth Neoplasms/surgery , Cementoma/diagnostic imaging , Mouth Rehabilitation/methods
An. bras. dermatol ; 94(1): 79-81, Jan.-Feb. 2019. tab, graf
Article in English | LILACS | ID: biblio-983755


Abstract: We report the case of a 47-year-old male patient with S100 negative granular cell tumor of the oral cavity, focusing on dermoscopic features as well as surgical approach, not previously reported in the literature. The study contributes to the literature on dermoscopy and surgical treatment for this tumor and provides a practical approach to differentiating non-neural granular cell tumors and granular cell tumors.

Humans , Male , Middle Aged , Mouth Neoplasms/surgery , Mouth Neoplasms/pathology , Mouth Neoplasms/chemistry , Mouth Neoplasms/diagnostic imaging , S100 Proteins , Granular Cell Tumor/surgery , Granular Cell Tumor/pathology , Granular Cell Tumor/chemistry , Granular Cell Tumor/diagnostic imaging , Dermoscopy/methods , Treatment Outcome
Rev. Assoc. Med. Bras. (1992) ; 64(8): 710-716, Aug. 2018. tab
Article in English | LILACS | ID: biblio-976847


INTRODUCTION Malignant neoplasms of the head and neck, due to its anatomical location, can cause significant alterations in vital functions related to feeding, communication and social interaction of the affected patients. Objective To analyze the quality of life of patients with advanced malignant neoplasms of the oral cavity and submitted to radical operations with curative intent. Material and methods 47 patients with oral cavity squamous cell carcinoma (SCC), in stages III and IV, underwent surgical treatment with segmental mandibulectomy and complementary radiotherapy. The patients were submitted to the quality of life questionnaires after a minimum time of six months after the surgical treatment. Results Of the 183 patients, only 47 (25.7%) were able to answer the questionnaire and were included as the sample of the study. The majority of patients selected were male (39; 82.9%). The mean age was 64.4 years. The majority of the patients presented clinical stage IV (83%) and were submitted to adjuvant radiotherapy (95.4%). The mean score obtained after the questionnaires were applied was 64.6. The worst scores were found in swallowing and chewing. Conclusion There were no statistically significant differences in the domains of quality of life between the two groups studied (with bone reconstruction versus no bone reconstruction). Patients interviewed 2 years or more after treatment presented higher scores (p = 0.02).

RESUMO INTRODUÇÃO As neoplasias malignas de cabeça e pescoço, pela própria localização anatômica, podem acarretar alterações significativas em funções vitais relacionadas à alimentação, comunicação e interação social dos indivíduos afetados. OBJETIVO Analisar a qualidade de vida dos pacientes com neoplasias malignas avançadas de cavidade oral, submetidos a operações radicais com intenção curativa. MATERIAL E MÉTODOS 47 pacientes portadores de carcinoma espinocelular de cavidade oral, em estádios III e IV, foram submetidos ao tratamento cirúrgico com mandibulectomia segmentar e radioterapia complementar. Os pacientes foram submetidos ao teste de qualidade de vida após o tempo mínimo de seis meses do tratamento cirúrgico. RESULTADOS Dos 183 pacientes, com apenas 47 (25,7%) foi possível a realização da entrevista, compondo estes a amostra para o estudo. A maioria dos pacientes do grupo selecionado era do sexo masculino, total de 39 homens (82,9%). A idade média foi de 64,4 anos. A maioria dos pacientes apresentava estadiamento clínico IV (83%), sendo submetidos à radioterapia adjuvante (95,4%). A média do escore obtido após a avaliação dos questionários foi de 64,6. Os piores escores foram encontrados nos quesitos deglutição e mastigação. CONCLUSÃO Não houve diferenças estatisticamente significativas nos domínios de qualidade de vida entre os dois grupos estudados (com reconstrução óssea versus sem reconstrução óssea). Pacientes entrevistados dois anos ou mais após o tratamento apresentaram escores superiores (p=0,02).

Humans , Male , Female , Adult , Aged , Quality of Life , Mouth Neoplasms/surgery , Carcinoma, Squamous Cell/surgery , Mandibular Osteotomy/methods , Mandibular Reconstruction/methods , Socioeconomic Factors , Time Factors , Mouth Neoplasms/physiopathology , Mouth Neoplasms/pathology , Carcinoma, Squamous Cell/physiopathology , Carcinoma, Squamous Cell/pathology , Linear Models , Cross-Sectional Studies , Surveys and Questionnaires , Analysis of Variance , Treatment Outcome , Sex Distribution , Age Distribution , Middle Aged , Neoplasm Staging
Rev. chil. cir ; 70(1): 59-65, 2018. tab, ilus
Article in Spanish | LILACS | ID: biblio-899657


Resumen Introducción La rehabilitación oral con implantes es en la actualidad la mejor opción para el tratamiento de pacientes parcial o totalmente edéntulos. Sin embargo, no es un procedimiento exento de complicaciones. La aparición de carcinoma epidermoide en la encía circundante de los implantes, aunque infrecuente puede ser una de ellas y aunque no hay muchos casos descritos en la literatura, sería conveniente establecer qué relación, si es que existiera, pueden tener los implantes en el desarrollo de esta enfermedad. Caso clínico Presentamos el caso de una mujer de 85 años de edad con antecedentes personales de liquen plano oral, exfumadora y portadora de implantes osteointegrados colocados en las áreas correspondientes a 34, 45 y 46, que desarrolló un carcinoma epidermoide en la encía periimplantaria.

Introduction Currently, dental implants is considered as the best choice for edentulism partial or complete treatment. However, this treatment has some associated medical complications such as surrounding gum squamous cell carcinoma. Even though there are not that many cases described in medical literature, it could be appropriated to determine whether there is any relation between this neoplasic disease and the dental implants. Clinical case Presenting a 85-year-old women with PMH of lichen planus, ex-smoker and osseointegrated dental implant in areas 34, 45 and 46, with surrounding implant gum area Squamous cell carcinoma.

Humans , Female , Aged, 80 and over , Mouth Neoplasms/diagnosis , Carcinoma, Squamous Cell/diagnosis , Dental Implantation/adverse effects , Mouth Neoplasms/surgery , Mouth Neoplasms/etiology , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/etiology
Rev. cir. traumatol. buco-maxilo-fac ; 17(1): 31-34, jan.-mar. 2017. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1281743


O cementoblastoma benigno é uma lesão patológica rara, de origem odontogênica, caracterizada pela proliferação anormal de cementoblastos, o que forma, consequentemente, uma massa de tecido semelhante a cemento. Na maioria dos casos, é encontrado em associação com primeiros molares inferiores. Ocorre mais frequentemente em caucasianos, entre as 2ª e 3ª décadas de vida, afetando, assim, raramente dentes decíduos. Geralmente, apresenta sintomatologia dolorosa e expansão de corticais ósseas. Seu tratamento vai desde a remoção completa da lesão com extração do dente envolvido até o tratamento endodôntico com preservação do elemento dentário. No presente artigo, relata-se um caso de cementoblastoma benigno em uma paciente de 23 anos sem sintomatologia dolorosa e ao exame clínico nada de anormal foi observado, sendo tratada através da remoção da lesão e extração do dente... (AU)

The benign cementoblastoma is a rare pathologic wound, of odontogenic origin feature of the abnormal cementoblast proliferation, resulting hence a coat mass like to cement. Usually is found in association with the first bottom molars. This happen more frequently on Caucasian, between the 2ª and 3ª decade of life, affecting rarely the primary dentition . Generally show a painful symptomatic and expansion of the cortical bone. The treatment starts with the removal wound full of with the tooth extraction involved in the endodontico treatment , with preservations of the dental element. This article descrambles a cementobastoma benign case in a patient with 23 years old, asymptomatic and the clinic exam nothing abnormal was found. Was treated through the wound removal and the tooth extraction... (AU)

Humans , Female , Young Adult , Mouth Neoplasms/surgery , Cementoma/surgery , Mouth Neoplasms/diagnostic imaging , Cementoma/diagnostic imaging
J. appl. oral sci ; 25(3): 341-345, May-June 2017. graf
Article in English | LILACS, BBO | ID: biblio-893626


Abstract Lesions in the floor of the mouth can be a challenging diagnosis due to the variety of pathological conditions that might be found in this area. Within a broad range of lesions, attention has to be addressed to those that require specific management, such as a dermoid cyst (DC) and a ranula. Especially in pediatric patients, in whom the failure of diagnosis can postpone the correct treatment and cause sequelae later in life. DC, a developmental anomaly, is managed primarily by surgical resection. On the other hand, ranula is a pseudocyst that may be treated by marsupialization. This article reports a large and painful lesion in the floor of the mouth in a pediatric patient. With a diagnostic hypothesis of ranula, two surgical interventions were performed, but there were recurrences of the lesion. Subsequently, the patient was referred to the Oral and Maxillofacial Surgery Unit for re-evaluation. Computed tomography showed a semi-transparent image suggesting a cystic formation. Another surgical procedure was performed where the lesion was completely removed. Anatomopathological analysis confirmed the diagnosis of DC. The five-year follow-up showed no signs of recurrence. This article indicates that although DC in the floor of the mouth is rare, it should be considered in the differential diagnosis of other diseases in this area. This precaution may be particularly important in the following circumstances: 1) Similar lesions that have different therapeutic approaches and, 2) To prevent future sequelae in pediatric patients.

Humans , Female , Adolescent , Mouth Neoplasms/surgery , Mouth Neoplasms/pathology , Dermoid Cyst/surgery , Dermoid Cyst/pathology , Mouth Floor/surgery , Mouth Floor/pathology , Ranula/pathology , Mouth Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Treatment Outcome , Dermoid Cyst/diagnostic imaging , Diagnosis, Differential , Mouth Floor/diagnostic imaging
Braz. dent. j ; 27(6): 781-786, Nov.-Dec. 2016. tab, graf
Article in English | LILACS | ID: biblio-828061


Abstract Adenosquamous carcinoma is an aggressive variant of squamous cell carcinoma. This report describes a case of adenosquamous carcinoma with clinical features of a benign lesion and discusses the differential diagnoses, especially regarding histopathological and immunohistochemical analyses. A 45-year-old male was referred to our outpatient clinic complaining about a rapid-growing enlargement in hard palate. Clinical examination revealed an erythematous and pedunculated nodule with lobulated non-ulcerated surface. Excisional biopsy was performed following clinical diagnosis of pyogenic granuloma. Histologically, the specimen consisted of areas characterizing both well-differentiated squamous cell carcinoma and true adenocarcinoma. After a broad list of immunohistochemical markers was evaluated (AE1/AE3, CEA, CK5, CK7, CK8/18, p53, p63 and Ki67), the diagnosis of adenosquamous carcinoma was rendered and the patient referred to complementary surgery. Adenosquamous carcinoma represents a challenge in diagnostic routine due to its rarity, diverse range of clinical presentations and histological features. Furthermore, classical clinical benign features may be present in malignant lesions; hence the submission of every surgical specimen to histological analysis is mandatory to provide the patient the adequate treatment.

Resumo O carcinoma adenoescamoso é uma variante agressiva do carcinoma de células escamosas. Este relato descreve um caso de carcinoma adenoescamoso que apresenta características clínicas de uma lesão benigna e discute o diagnóstico diferencial, especialmente em relação à análise histopatológica e imuno-histoquímica. Um homem de 45 anos foi encaminhado ao nosso serviço queixando-se um aumento de volume de rápido crescimento no palato duro. O exame clínico revelou um nódulo eritematoso e pedunculado com superfície lobulada não ulcerada. Foi realizada biópsia excisional seguindo a hipótese clínica de granuloma piogênico. Histologicamente o fragmento consistia em áreas de carcinoma de células escamosas bem diferenciado e áreas de adenocarcinoma verdadeiro. Após a avaliação de uma ampla lista de marcadores imuno-histoquímicos (AE1/AE3, CEA, CK5, CK7, CK8/18, p53, p63 e Ki67), o diagnóstico de carcinoma adenoescamoso foi atribuído e o paciente foi encaminhado à cirurgia complementar. O carcinoma adenoescamoso representa um desafio na rotina de diagnóstico, devido à sua raridade, diversificada gama de apresentações clínicas e características histológicas. Além disso, características clínicas benignas podem estar presentes em lesões malignas, por isto a submissão de todas as peças cirúrgicas à análise histológica é obrigatória para fornecer ao paciente o tratamento adequado.

Humans , Male , Middle Aged , Carcinoma, Adenosquamous/diagnosis , Granuloma, Pyogenic/diagnosis , Mouth Neoplasms/diagnosis , Carcinoma, Adenosquamous/surgery , Diagnosis, Differential , Mouth Neoplasms/surgery
An. bras. dermatol ; 91(5,supl.1): 84-86, Sept.-Oct. 2016. graf
Article in English | LILACS | ID: biblio-837924


Abstract Lipomas are very common benign slow-growing soft tissue neoplasms composed of mature adipose tissue mostly diagnosed in the fifth decade of life. These tumors rarely present in the oral cavity, representing less than approximately 5% of all benign mouth tumors. They are usually less than 2cm in size and etiology remains unclear. We report a young male patient presenting with a giant lipoma in the buccal mucosa. Histopathology revealed a large area of mature fat cells consistent with conventional lipoma and an area of the mucosal lining of the lesion suggestive of morsicatio buccarum. In the present article, we emphasize the clinicopathological features and differential diagnosis of the disease.

Humans , Male , Adult , Mouth Neoplasms/pathology , Lipoma/pathology , Mouth Mucosa/pathology , Mouth Neoplasms/surgery , Salivary Gland Neoplasms/pathology , Rare Diseases , Diagnosis, Differential , Lipoma/surgery , Mouth Mucosa/surgery