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.

Oncological results of salvage treatment in patients with oropharynx carcinoma treated with radiotherapy.

OBJECTIVE: To evaluate the possibilities of salvage after local recurrence in patients with oropharyngeal carcinomas treated with radiotherapy, and to analyse the prognostic factors related to the final control of the disease. METHODS: Retrospective study of 596 patients with oropharyngeal carcinoma treated with radiotherapy during the period 1991-2018. RESULTS: One hundred and eighty-one patients (30.4%) had a local recurrence. Of the patients with a local recurrence, 51 (28.2%) were treated with salvage surgery. Variables that were associated with the patient not receiving salvage surgery were age greater than 75 years, tumour location in the posterior hypopharyngeal wall, an initial tumour extent cT4, and a recurrence-free interval of less than 6 months. Five-year specific survival of patients treated with salvage surgery was 19.1% (95% CI: 7.3%-30.9%). Variables that were related to specific survival were extent of recurrence and status of resection margins. Final tumour control was not achieved in any of the patients with extensive recurrence (rpT3-4, n = 25) or positive resection margins (n = 22). CONCLUSION: Patients with oropharyngeal carcinomas treated with radiotherapy with local tumour recurrence have a limited prognosis. Most patients (71.8%) were not considered candidates for salvage surgery. The 5-year specific survival of patients treated with salvage surgery was 19.1%.

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.

Anticoagulación en paciente con síndrome de Lemierre y embolias sépticas pulmonares / Anticoagulation in a patient with Lemierre syndrome and pulmonary septic embolisms

Resumen El síndrome de Lemierre, también denominado trom boflebitis séptica de la vena yugular interna, necrobaci losis o sepsis postanginal es una infección que inicia en el espacio orofaríngeo, se complica con tromboflebitis séptica de la vena yugular interna y metástasis infeccio sas. La rápida progresión a cuadros clínicos graves que comprometen la vida del paciente y su baja frecuencia justifican la divulgación de casos clínicos. Se presenta el caso de una mujer de 27 años de edad, que a las 48 horas de completar el tratamiento con fenoximetilpenicilina por una infección odontógena evolucionó con edema facial y trismus. En la angio-TC de macizo craneofacial se evidenció extenso trombo en la vena yugular interna y en la tomografía computarizada de tórax, embolias sépticas pulmonares. El tratamiento consistió en antibió ticos endovenosos de amplio espectro y anticoagulación de manera precoz.

Abstract Lemierre's syndrome, also called septic thrombo phlebitis of the internal jugular vein, necrobacillosis or postanginal sepsis, is an infection that begins in the oropharyngeal space, is complicated by septic throm bophlebitis of the internal jugular vein and infectious metastases. The rapid progression to serious clinical conditions that compromise the patient's life and its low frequency justify the disclosure of clinical cases. We present the case of a 27-year-old woman who de veloped facial edema and trismus 48 hours after com pleting treatment with phenoxymethylpenicillin for an odontogenic infection. An angio-CT of the craniofacial massif revealed an extensive thrombus in the internal jugular vein and a computed tomography of the chest showed septic pulmonary emboli. Treatment consisted of broad-spectrum intravenous antibiotics and early anticoagulation.

Association between maximum standarised uptake value (SUV) and local control in patients with oropharyngeal carcinoma treated with radiotherapy.

OBJECTIVE: To analyse the prognostic ability of the maximum standardised uptake value (SUVmax) on local disease control in patients with oropharyngeal carcinoma treated with radiotherapy. MATERIAL AND METHODS: Retrospective study of 105 patients with oropharyngeal carcinomas treated with radiotherapy, including chemo- and bio-radiotherapy, and who had a PET-CT scan prior to the start of treatment. RESULT: Patients with a SUVmax value higher than 17.2 at the primary tumour site had a significantly higher risk of local recurrence. The 5-year local recurrence-free survival for patients with SUVmax less than or equal to 17.2 (n = 71) was 86.5% (95% CI 78.2-94.7 %), and for patients with SUVmax greater than 17.2 (n = 34) it was 55.8% (95% CI 36.0-75.6 %) (P = 0.0001). This difference in local control was maintained regardless of patients' HPV status. Specific survival was similarly lower for patients with a SUV greater than 17.2. The 5-year specific survival for patients with SUVmax greater than 17.2 was 39.5% (95% CI: 20.6-58.3 %), significantly shorter than that of patients with SUVmax equal to or less than 17.2, which was 77.3% (95% CI: 66.9-87.6 %) (P = 0.0001). CONCLUSIONS: Patients with oropharyngeal carcinomas treated with radiotherapy with a SUVmax greater than 17.2 at the level of the primary tumour site had a significantly higher risk of local recurrence.

Results of radiotherapy in oropharyngeal carcinomas.

OBJECTIVE: To present the results of radiotherapy treatment in patients with oropharyngeal carcinomas. MATERIAL AND METHODS: Retrospective study of a cohort of 359 patients treated with radiotherapy, including chemo- and bio-radiotherapy, during the period 2000-2019. Information on human papillomavirus (HPV) status was available for 202 patients, of whom 26.2% were HPV-positive. RESULTS: Five-year local recurrence-free survival was 73.5% (95% CI: 68.8%-78.2%). The variables that were related to local disease control in a multivariate study were the local tumor extension category and the HPV status. Five-year local recurrence-free survival for patients with cT1 tumors was 90.0%, for cT2 88.0%, for cT3 70.6%, and for cT4 42.3%. Five-year local recurrence-free survival for HPV-negative tumors was 67.2% and for HPV-positive tumors 93.3%. Five-year specific-disease survival was 64.4% (95% CI: 59.1%-69.7%). Variables that were related to specific survival in a multivariate study were the patient's general condition, local and regional extent of the tumor, and HPV status. CONCLUSIONS: Five-year local recurrence-free survival of patients with oropharyngeal carcinomas treated with radiotherapy was 73.5%. Variables that were related to local control were local tumor extension and HPV status.

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.

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)

Neonatal oropharyngeal infection by HPV in our area.

INTRODUCTION: Although infection by human papillomavirus (HPV) is mainly considered a sexually transmitted disease, newborns exposed to the virus in the perinatal period can also be infected through mechanisms that are not yet fully understood. The aim of our study was to increase our understanding of neonatal oropharyngeal infection by HPV, trying to establish its frequency, mechanisms of infection and persistence through age 2 years. MATERIAL AND METHODS: We conducted a prospective, observational and descriptive study in a cohort of neonates born vaginally whose mothers carried HPV in the lower genital tract at the time of delivery. Tests for detection of HPV in amniotic fluid, venous cord blood and oropharyngeal secretions were performed in every neonate, and we conducted microbiological follow-up of infants colonized by HPV up to age 2 years. RESULTS: The prevalence of oropharyngeal colonization at birth was 58.24%. In the 24-month follow-up, the proportions of clearance and persistence of HPV in the oropharynx were 94.34% and 5.66%, respectively. CONCLUSIONS: The results of this case series suggest that neonatal oropharyngeal colonization by HPV, while frequent in the postpartum period, is usually a self-limited process, and the main mechanism of infection transvaginal intrapartum vertical transmission. Although colonization in most neonates is transient and asymptomatic, the clinical significance of persistent carriage remains unknown.

Oropharyngeal neuroglial choristoma with extension into the parapharyngeal space.

Oropharyngeal neuroglial choristomas are exceptionally rare head and neck tumours that contain mature neuroglial tissue. We report a case of neuroglial choristoma centred in the oropharynx and extending into the parapharyngeal space that, to the best of our knowledge, is the only case whose appearance simulated brain cortical gyri with an apparent differentiation between white and grey matter. We illustrate and detail the magnetic imaging findings of oropharyngeal choristoma that might help to establish a correct preoperative diagnosis.

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

Rol del virus papiloma humano en cabeza y cuello

Resumen El virus papiloma humano (VPH) es un virus de ADN circular doble hebra con alrededor de 200 genotipos. Este virus se relaciona a distintas lesiones tumorales que afectan cabeza y cuello, incluyendo lesiones malignas escamosas causadas por genotipos de alto riesgo como VPH-16 y VPH-18. Esta revisión tiene por objetivo determinar el rol del VPH en distintas patologías, haciendo distinción entre lesiones benignas y malignas, y con particular énfasis en aquellas en que se ha demostrado una asociación causal con el virus, tales como papilomatosis laríngea y carcinoma escamoso orofaríngeo. Además, se analizarán los mecanismos moleculares de daño, métodos de detección y de prevención como la vacunación contra el virus. Es necesario conocer la relevancia del VPH en nuestra especialidad, ya que su determinación puede tener implicancias en cuanto al manejo y pronóstico de los pacientes.

Abstract Human papillomavirus (HPV) is a double stranded circular DNA virus with around 200 genotypes. This virus is related to different tumor lesions that affect the head and neck, including malignant squamous lesions caused by high-risk genotypes such as HPV-16 and HPV-18. The objective of this review is to determine the role of HPV in different pathologies, distinguishing between benign and malignant lesions, and with particular emphasis on those in which a causal association with the virus has been demonstrated, such as laryngeal papillomatosis and oropharyngeal squamous carcinoma. In addition, molecular damage mechanisms, detection and prevention methods such as vaccination against the virus will be analyzed. It is necessary to know the relevance of HPV in our specialty, since its determination may have implications in terms of patient management and prognosis.

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).

Risk factors for survival after head and neck cancer: a cohort study in the south of Espirito Santo state

Introduction: Head and check squamous cell carcinomas (HNSCC) affects the Brazilian population with a high incidence and usually has a poor prognosis. Objective: To evaluate the risk factors for survival of patients diagnosed with HNSCC and investigate the influence of epidemiological and clinical factors on the prognostic of HNSCC in southeastern Brazil. Materials and Methods: Clinical records of 211 patients with head and neck squamous cell carcinomas diagnosed and treated between 2010 and 2018 at a reference hospital for oncology, were selected. Clinical and pathological characteristics at diagnosis and for 5 years follow up were collected. The Kaplan-Meier Curve with the Log-Rank test assessed survival, and forward stepwise multivariate logistic regression model was performed to determine the factors affecting HNSCC survival. Results: The 5-year overall survival was 30.0%. Laryngeal cancer was the most prevalent (34.1%), followed by oropharynx (33.6%) and oral cavity (24.2%). About 64% of patients had locally advanced tumors (T3 and T4) and 75.4% of the patients were diagnosed as being in the advanced clinical stages (III and IV). In the multivariate analysis, the locally advanced tumors (OR=2.748; 95%CI:1.310- 5.765), palliative chemotherapy (OR=15.757; 95%CI:5.868-42.309) and metastasis during oncological follow-up (OR=11.602; 95%CI:1.380-97.507) were associated with a poor prognosis. Conclusion: The survival rate was considered low when compared with the literature. Locally advanced tumors, palliative chemotherapy, and the appearance of metastases during follow-up were considered the most important risk factors associated with a low HNSCC survival.

Introdução: O carcinoma de células escamosas (CCE) de cabeça e pescoço possui alta incidência na população brasileira e normalmente está associado a um prognóstico desfavorável. Objetivo: Avaliar os fatores de risco para sobrevida de pacientes diagnosticados com CCE de cabeça e pescoço e investigar a influência de fatores clínicoepidemiológicos no prognóstico do CCE. Materiais e Métodos: Foram selecionados prontuários de 211 pacientes com CCE de cabeça e pescoço diagnosticados e tratados entre 2010 e 2018 em um hospital de referência em oncologia. Foram coletadas as características clínico-patológicas no momento do diagnóstico e nos 5 anos de acompanhamento. A curva de Kaplan-Meier com o teste Log-Rank avaliou a sobrevivência e o modelo de regressão logística multivariada progressiva foram realizados para determinar os fatores que afetaram a sobrevivência do CCE. Resultados: A sobrevida global em 5 anos foi de 30,0%. O câncer de laringe foi o mais prevalente (34,1%), seguido de orofaringe (33,6%) e cavidade oral (24,2%). 64% dos pacientes apresentavam tumores localmente avançados (T3 e T4) e 75,4% dos pacientes foram diagnosticados em estádios clínicos avançados (III e IV). Na análise multivariada, os tumores localmente avançados (RC = 2,748; IC 95%: 1,310-5,765), quimioterapia paliativa (RC = 15,757; IC 95%: 5,868-42,309) e metástases durante o acompanhamento oncológico (RC = 11,602; IC 95%: 1,380-97,507) foram associados a um pior prognóstico. Conclusão: A taxa de sobrevida foi considerada baixa. Tumores localmente avançados, quimioterapia paliativa e aparecimento de metástases durante o seguimento foram considerados os fatores de risco mais importantes associados a uma baixa sobrevida.

Oropharyngeal neuroglial choristoma with extension into the parapharyngeal space. / Coristoma neuroglial orofaríngeo con extensión al espacio parafaríngeo.

Oropharyngeal neuroglial choristomas are exceptionally rare head and neck tumours that contain mature neuroglial tissue. We report a case of neuroglial choristoma centred in the oropharynx and extending into the parapharyngeal space that, to the best of our knowledge, is the only case whose appearance simulated brain cortical gyri with an apparent differentiation between white and grey matter. We illustrate and detail the magnetic imaging findings of oropharyngeal choristoma that might help to establish a correct preoperative diagnosis.

Organ preservation after treatment with induction chemotherapy in patients with locally advanced carcinomas (T3-T4) of oral cavity and oropharynx. / Preservación de órgano tras un tratamiento con quimioterapia de inducción en pacientes con carcinomas localmente avanzados (T3-T4) de cavidad oral y orofaringe.

INTRODUCTION AND OBJECTIVES: With the goal of achieving functional preservation, one of the treatment strategies for patients with locally advanced squamous cell carcinomas of the head and neck is to initiate treatment with induction chemotherapy (CT) and decide the second therapeutic manoeuvre depending on the response. The objective of this study is to evaluate organ preservation capacity based on this therapeutic approach in patients with tumours of the oral cavity and oropharynx. METHODS: A retrospective study of 246 patients with locally advanced carcinomas of the oral cavity or oropharynx (cT3-T4) initially treated with induction CT. RESULTS: After induction CT 28% of patients achieved a complete response of the primary location of the tumour, 43.1% a partial response greater than 50%, and 28.9% a reduction less than 50% or persistence. After the induction CT treatment 70 patients (28.5%) underwent surgical treatment, and 176 (71.5%) radiotherapy (RT) or chemoradiotherapy (CRT). Considering the patients treated non-surgically (n=176), organ preservation for patients with a complete response (n=66) was 65.2%, for those patients with a partial response greater than 50% (n=75) it was 30.7%, and for patients with a partial response less than 50% or persistence (n=35) it was 14.3%. CONCLUSION: The response to treatment with induction CT has prognostic value in patients with locally advanced carcinomas of the oral cavity and oropharynx. Patients who are candidates for conservative treatment with RT or CRT would be those who achieve a complete response after induction treatment.

Prognostic value of nodal involvement in patients with oropharyngeal carcinoma according to the HPV status. / Valoración de la capacidad pronóstica de la afectación ganglionar de los pacientes con carcinoma de orofaringe en función del estatus HPV.

BACKGROUND AND OBJECTIVE: Different studies performed in populations with a high incidence of HPV infection have found no prognostic capacity of clinical nodal involvement (cN+) in patients with HPV-positive oropharyngeal carcinomas. The objective of this study was to assess the prognostic ability of nodal involvement in patients with oropharyngeal carcinomas according to HPV status in a cancer population with a low incidence of HPV infection. MATERIAL AND METHODS: Retrospective study of a cohort of 420 patients with oropharyngeal carcinomas treated during the period 1990-2016 for whom information on HPV status was available. RESULTS: 14.8% of the patients included in the study had HPV-positive tumours. In relation to patients without nodal involvement (cN0), nodal involvement at diagnosis (cN+) significantly decreased the specific survival of patients with HPV-negative oropharyngeal carcinomas. Conversely, no differences in survival were found for patients with HPV-positive tumours according to the presence of nodal involvement. A history of toxic consumption did not change the absence of prognostic significance of nodal involvement for patients with HPV-positive tumours. CONCLUSIONS: Regional involvement at the time of diagnosis is not a prognostic variable for patients with HPV-positive oropharyngeal carcinomas.

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.

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.