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1.
Jpn J Clin Oncol ; 54(3): 248-253, 2024 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-38061912

RESUMO

Transoral robotic surgery (TORS), introduced by Weinstein et al. in 2005, has been widely adopted as a minimally invasive procedure, particularly for the treatment of patients with early stage oropharyngeal cancer. TORS is typically performed using the da Vinci Surgical System, similar to robot-assisted surgeries for other malignancies. The main difference between TORS and these other robot-assisted surgeries is that it is performed through the natural orifice of the mouth, which limits the surgical working space, and that it progresses from the lumen of the pharynx to the deeper tissues. The advantages of TORS are mainly due to the benefits of using the da Vinci Surgical System, such as three-dimensional high-definition images, magnification, multiple forceps articulation, tremor-stabilization function and motion scale function. To date, many big data and meta-analyses have shown that TORS is superior to conventional surgeries, such as open surgery, in terms of oncological outcomes, post-operative functionality and quality of life. In Japan, TORS is expected to spread across the country, as it has been covered by health insurance since April 2022. This review highlights the procedures of TORS, its unique aspects, its unparalleled advantages as a minimally invasive surgery for treating laryngeal and pharyngeal cancers, and its current status in Japan.


Assuntos
Neoplasias Faríngeas , Procedimentos Cirúrgicos Robóticos , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Japão , Qualidade de Vida , Boca/cirurgia
2.
Langenbecks Arch Surg ; 409(1): 158, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38748236

RESUMO

BACKGROUND: This paper reports on the first experience after implementation of a transoral endoscopic thyroidectomy via vestibular approach (TOETVA) as an alternative to (partial) thyroidectomy or isthmusectomy in a single center. Feasibility, implementation and specific complications are addressed. METHODS: All patients who underwent a TOETVA procedure in our center between November 2019 and March 2023 were included. The surgical technique was performed as described by Anuwong et al. All procedures were performed by two dedicated head- and neck surgeons. RESULTS: A total of 20 patients were included. All patients underwent TOETVA surgery as planned and no conversions were needed. Observed complications were post-operative wound infections (POWI) (2/20; 10%), clinically significant seroma (1/20, 5%) and unilateral hemiparesis of the larynx (3/20; 15%). Permanent mental nerve damage was seen in 3/20 patients (15%), and 4 other patients (20%) experienced transient neuropraxia. CONCLUSIONS: TOETVA is a feasible alternative to (partial) thyroidectomy or isthmusectomy in selected patients. Special care should be taken when placing the trocars in the oral vestibulum to prevent mental nerve damage. Experience and training are essential for implementing the TOETVA procedure. TRIAL REGISTRATION: This study was registered to ClinicalTrials.gov. TRIAL REGISTRATION NUMBER: NCT05396703.


Assuntos
Estudos de Viabilidade , Cirurgia Endoscópica por Orifício Natural , Complicações Pós-Operatórias , Tireoidectomia , Humanos , Tireoidectomia/efeitos adversos , Tireoidectomia/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/métodos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/cirurgia , Boca/cirurgia , Resultado do Tratamento
3.
Lasers Surg Med ; 56(2): 165-174, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38247042

RESUMO

OBJECTIVES: Hyperspectral imaging (HSI) provides spectral information about hemoglobin, water and oxygen supply and has thus great potential in perfusion monitoring. The aim of the present study was to investigate the feasibility of HSI in the postoperative monitoring of intraoral free flaps. METHODS: The 14 patients receiving reconstructive head and neck surgery with a radial forearm free flap were included. HSI was performed intraoperatively (t0), on Day 1 (t1), 2 (t2), 3-6 (t3), 7-9 (t4), 10-11 (t5) and 12-15 (t6) postoperatively. Flap tissue perfusion was assessed on defined regions of interest by calculating the perfusion indices Tissue Hemoglobin Index (THI), hemoglobin oxygenation (StO2 ), Near Infrared Perfusion Index (NIR Perfusion Index) and Tissue Water Index (TWI). RESULTS: Image quality varied depending on location of the flap and time of measurement. StO2 was >50 intraoperatively and >40 on t1 for all patients. A significant difference was found solely for TWI between t0 and t2 and t0 and t4. No flap loss occurred. CONCLUSIONS: The use of HSI in the monitoring of intraoral flaps is feasible and might become a valuable addition to the current clinical examination of free flaps.


Assuntos
Retalhos de Tecido Biológico , Humanos , Estudos de Viabilidade , Imageamento Hiperespectral , Boca/diagnóstico por imagem , Boca/cirurgia , Hemoglobinas , Água
4.
Eur Arch Otorhinolaryngol ; 281(5): 2667-2678, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38530463

RESUMO

PURPOSE: Transoral robotic surgery is well established in the treatment paradigm of oropharyngeal pathology. The Versius Surgical System (CMR Surgical) is a robotic platform in clinical use in multiple specialities but is currently untested in the head and neck. This study utilises the IDEAL framework of surgical innovation to prospectively evaluate and report a first in human clinical experience and single centre case series of transoral robotic surgery (TORS) with Versius. METHODS: Following IDEAL framework stages 1 and 2a, the study evaluated Versius to perform first in human TORS before transitioning from benign to malignant cases. Iterative adjustments were made to system setup, instrumentation, and technique, recorded in accordance with IDEAL recommendations. Evaluation criteria included successful procedure completion, setup time, operative time, complications, and subjective impressions. Further evaluation of the system to perform four-arm surgery was conducted. RESULTS: 30 TORS procedures were successfully completed (15 benign, 15 malignant) without intraoperative complication or conversion to open surgery. Setup time significantly decreased over the study period. Instrumentation challenges were identified, urging the need for TORS-specific instruments. The study introduced four-arm surgery, showcasing Versius' unique capabilities, although limitations in distal access were observed. CONCLUSIONS: TORS is feasible with the Versius Surgical System. The development of TORS-specific instruments would benefit performance and wider adoption of the system. 4-arm surgery is possible however further evaluation is required. Multicentre evaluation (IDEAL stage 2b) is recommended.


Assuntos
Neoplasias de Cabeça e Pescoço , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias de Cabeça e Pescoço/cirurgia , Estudos Prospectivos , Boca/cirurgia
5.
Clin Oral Investig ; 28(5): 269, 2024 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-38656417

RESUMO

OBJECTIVE: Radial Forearm Free flap (RFFF) is widely used in head and neck reconstruction, yet its donor site defect remains a significant drawback. The Medial Sural Artery Perforator Free Flap (MSAPFF) is considered an alternative flap to RFFF. This study aims to comprehensively analyze their characteristics, outcomes, and their impact on patient quality of life. METHODS: All patients who underwent oral cavity reconstruction using RFFF and MSAPFF between February 2017 and April 2023 were included in this study. Flap characteristics, outcomes and post-operative complications were recorded and compared. Subjective donor site morbidity, aesthetic and functional results, and quality of life were also analyzed. RESULTS: The study included 76 patients: 37 underwent reconstruction with RFFF, and 39 with MSAPFF. There was no significance difference between the RFFF and MSAPFF regarding the success rate (97.2% vs 97.4%), flap size (4.8 × 8.8 cm2 vs 5 × 9.8 cm2), hospital of stay (15.5 days vs 13.5 days) and recipient site complications (P > 0.05). However, MSAPFF showed larger flap thickness (P = 0.001), smaller arterial caliber (P = 0.008), shorter pedicle length (P = 0.001), and longer harvesting time (P < 0.001). No significant difference was observed between the pre-and postoperative ranges of wrist and ankle movements or in recipient site complications. MSAPFF showed a significant difference in donor site morbidity (P < 0.05). CONCLUSION: The MSAPFF is an excellent alternative to the RFFF for repairing oral cavity defects, with additional advantage of a well-hidden scar on the posterior calf, a larger flap thickness, accepted pedicle length and arterial caliber. However, one should consider the harvesting time and surgical skills required in comparison to the RFFF. CLINICAL RELEVANCE: The study highlights the importance of the MSAPFF as an alternative option for RFFF with less donor site morbidity and high success rate in oral cavity reconstruction and improved patient Quality of life after ablative surgery.


Assuntos
Antebraço , Retalhos de Tecido Biológico , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Complicações Pós-Operatórias , Qualidade de Vida , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Retalho Perfurante/irrigação sanguínea , Antebraço/cirurgia , Sítio Doador de Transplante/cirurgia , Adulto , Idoso , Estudos Retrospectivos , Neoplasias Bucais/cirurgia , Boca/cirurgia
6.
Aesthetic Plast Surg ; 48(4): 680-688, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37735260

RESUMO

BACKGROUND: During reduction malarplasty, cheek bulging could be found immediately after zygomatic complex is moved inwards, backwards and upwards. As patient is in the supine position during surgery, the effect of gravity is eliminated, so the only reason for the bulge is the redistribution of the soft tissue in the deep facial spaces. The buccal fat pad, with its main body behind the zygomatic arch and buccal extension in the cheek area, is most likely to be responsible for the bulge. METHODS: 3D buccal extension models were reconstructed from preoperative and long-term follow-up CT images and the volume measured. By comparing the pre- and postoperative 3D models, the shape deviation of the buccal extension and facial soft tissue can be identified. RESULTS: Eleven patients (22 buccal extensions) met the inclusion criteria. Compared with the preoperative buccal extension volume, the postoperative volume increased significantly. By comparing the reconstructed models, the buccal extension volume increase with anteroinferior protrusion can be visually detected, and cheek bulging was clearly identified on the lower face. The bulging area coincided with the projection of the buccal extension on the skin surface. CONCLUSIONS: Reduction malarplasty may cause volume redistribution of the buccal fat pad. Therefore, preoperative assessment of the size of the buccal fat pad based on CT images is recommended. The buccal extension volume increase with anteroinferior protrusion is an important cause of postoperative cheek bulging and should be considered during treatment. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .


Assuntos
Procedimentos de Cirurgia Plástica , Zigoma , Humanos , Bochecha/diagnóstico por imagem , Bochecha/cirurgia , Zigoma/diagnóstico por imagem , Zigoma/cirurgia , Tecido Adiposo/transplante , Boca/cirurgia
7.
Ann Surg Oncol ; 30(9): 5728-5732, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37410312

RESUMO

BACKGROUND: Transoral robotic surgery (TORS) has renovated the surgical management of oropharyngeal squamous cell carcinoma (OPSCC), allowing a minimally invasive surgical approach with optimal oncological outcomes. The recent introduction of the da Vinci Single Port (SP) system resulted in a considerable improvement of TORS technique. METHODS: In this video, we illustrate the transoral robotic lateral oropharyngectomy performed with the da Vinci SP system in a 50-year-old male patient suffering from a p16+ oropharyngeal squamous cell carcinoma cT4N1M0. RESULTS: The transoral robotic lateral oropharyngectomy is illustrated step by step. The structures encountered during the resection are described, and the surgical margins are defined based on anatomical landmarks. The most critical regions encountered during resection are pointed out, and the tip and tricks of this surgery are reported. CONCLUSIONS: A step-by-step transoral lateral oropharyngectomy is described to increase its reproducibility. The da Vinci SP system owns various benefits for performing transoral lateral oropharyngectomy due to the increased maneuverability in the narrower oral cavity working spaces.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Orofaríngeas , Procedimentos Cirúrgicos Robóticos , Masculino , Humanos , Pessoa de Meia-Idade , Carcinoma de Células Escamosas de Cabeça e Pescoço , Procedimentos Cirúrgicos Robóticos/métodos , Reprodutibilidade dos Testes , Boca/cirurgia , Boca/patologia , Neoplasias Orofaríngeas/cirurgia , Neoplasias Orofaríngeas/patologia
8.
Stomatologiia (Mosk) ; 102(6): 9-15, 2023.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-37997307

RESUMO

OBJECTIVE: To correlate the magnitude of the amount of translation of prosthesis and the native joint, and the postoperative change in the volume of the contralateral condylar process after unilateral total joint replacement. MATERIAL AND METHODS: The study examined 16 patients with post-traumatic jaw deformation treated with unilateral TMJ replacement using total endoprosthesis. The mandible kinematics was recorded using the Cadiax Diagnostic system and correlated with the remodeling of the native joint. RESULT: On average, the group showed an 8.5% decrease in the volume of the native condylar process. In 13 patients, the amplitude of the native joint movement in the mouth opening and the mandible pro- and laterotrusion markedly deviated quantitatively that combined with the translational movement of the TMJ endoprosthesis in all types of mandibular abduction in all the patients. Correlation analysis showed a moderate negative relationship (r= -0.43) in opening the mouth between the amplitude of movement of the native joint and of the endoprosthesis, as well as a noticeable negative strength of relationship. Also, the correlation analysis showed a moderate positive relationship between the change in the native condylar process volume and movement amplitude when opening the mouth, and an inverse correlation of the high strength of relationship between the change in the native condylar process volume and movement amplitude of the TMJ endoprosthesis. CONCLUSION: Electronic axiography found that patients in the postoperative period could restore some of the translational movements even with the attachment of the lateral pterygoid muscle cut off. The main factor influencing the magnitude of the endoprosthesis translational movement is the design of the fossa component: the ratio of the circumferential surface of the fossa to the diameter of the head of the endoprosthesis, as well as the presence of lateral stoppers. The study showed that unilateral TMJ reconstruction provides changes in the volume of the native joint directly related to the amplitude of the movement of the joint itself and inversely correlated with the amplitude of the movement of the endoprosthesis.


Assuntos
Artroplastia de Substituição , Implantes Dentários , Humanos , Articulação Temporomandibular/cirurgia , Mandíbula/cirurgia , Boca/cirurgia , Côndilo Mandibular/diagnóstico por imagem , Côndilo Mandibular/cirurgia
9.
Stomatologiia (Mosk) ; 102(6): 68-75, 2023.
Artigo em Russo | MEDLINE | ID: mdl-37997316

RESUMO

Most of the articles on the groin flap were published in the period from 1975 to 2010, from 2015 to 2022, the SCIP flap surpassed the groin flap in the number of publications. According to the results of a literature search in PubMed and RINC, 30 articles were found and selected, including 288 flaps from the iliac region. The length of the vascular pedicle, the diameter of the vessels, the complications, the prevalence of the flap in the reconstruction of the head and neck, the thickness and the size of the flap were evaluated. Both of these flaps have the same nutrition, but different levels of dissection. In comparison with the groin flap, the SCIP flap has a longer vascular pedicle, which can be enlarged due to new techniques, which also allows it to be used as an ultra-thin flap, and it reduces the need for secondary procedures for defatting and reduces the risks of the complications in the donor area. The thickness of the SCIP flap is less than the groin one, which, according to the author, increases the aesthetic level of operations in the facial area in the case of the texture and color of the flap. Vascular anatomy of the SCIP flap is variable, therefore, the use of preoperative planning is necessary. Despite this, complications in the donor or recipient area during reconstruction with a SCIP flap are minimal. It has been proved that the SCIP flap is versatile and safe in all aspects of reconstruction. It can be concluded that the SCIP flap should be considered as a «workhorse¼ in reconstructive microsurgery of soft tissues of the throat and oral cavity.


Assuntos
Retalho Perfurante , Procedimentos de Cirurgia Plástica , Humanos , Virilha/cirurgia , Microcirurgia/métodos , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/cirurgia , Artéria Ilíaca/cirurgia , Boca/cirurgia
10.
HPB (Oxford) ; 24(5): 727-736, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34774412

RESUMO

BACKGROUND: A novel procedure called shark mouth pancreaticojejunostomy (SMP) was developed, for the reconstruction of the pancreatic stump which has a theoretical advantage for anastomosis healing and wide applicability. METHODS: A comparative study of the patients who underwent SMP (SMP cohort) and those who underwent end-to-end dunking pancreaticojejunostomy (historic cohort) at Peking University Third Hospital was conducted. Each group was analyzed for the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) and morbidities. RESULTS: The clinicopathological data of 151 patients from the SMP cohort and 82 patients from the historic cohort were analyzed. In the SMP group, the rate of CR-POPF was 7.3% (11/151), which was significantly lower than the rate of CR-POPF in the historic group as 19.5% (16/82) (P = 0.005). The primary results were unaffected by sensitivity analyses based on several risk factors for CR-POPF. The rates of morbidities besides CR-POPF were 15.9% (24/151) in the SMP group and 17.1% (14/82) in the historic cohort (P = 0.194). The principal results were not changed by the propensity score matched (PSM) analysis. CONCLUSION: SMP is a safe and simple surgical procedure for the reconstruction of the pancreatic stump compared with end-to-end dunking pancreticojejunostomy.


Assuntos
Pancreaticojejunostomia , Tubarões , Animais , Humanos , Boca/cirurgia , Fístula Pancreática/etiologia , Fístula Pancreática/prevenção & controle , Pancreaticoduodenectomia/efeitos adversos , Pancreaticojejunostomia/efeitos adversos , Pancreaticojejunostomia/métodos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
11.
Klin Lab Diagn ; 67(10): 588-593, 2022 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-36315174

RESUMO

The widespread use of traditional removable prosthetics is explained by the relative simplicity of the technological stages of manufacture and determines its availability. The development of prosthetic stomatitis of the oral cavity is facilitated by poor fixation and stabilization of removable orthopedic structures. Microbiome biofilms formed on the surface of dental orthopedic structures can help reduce their service life and cause an inflammatory process of the oral cavity of microbial etiology during dental prosthetics in the process of orthopedic rehabilitation. The purpose of the study: to assess the level of adaptation of patients during orthopedic rehabilitation based on the study of the microbiome and the assessment of the degree of fixation of removable lamellar dentures. Qualitative and quantitative characteristics of the microbiome of prostheses at the stages of orthopedic pealitation were assessed; facultative anaerobic species belonging to the genera Staphylococcus, Micrococcus, Enterococcus, Streptococcus, Klebsiella prevailed;noted the elimination of microorganisms of the genera Bifidobacterium and Lactobacterium, yeast-like fungi of the species Candida albicans were isolated. An analysis of the index of fixation of prostheses showed an increase depending on the duration of use; a good level of fixation of prostheses was established in groups of patients.


Assuntos
Prótese Parcial Removível , Microbiota , Humanos , Prótese Parcial Removível/microbiologia , Boca/cirurgia , Boca/microbiologia , Candida albicans , Biofilmes
12.
BMC Cancer ; 21(1): 663, 2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34078311

RESUMO

BACKGROUND: Patients with locally advanced oral cavity cancer sometimes stopped treatment after neoadjuvant chemotherapy. There are no guidelines of the management for these patients. Before designing clinical trials, we conducted this study to investigate their characteristics, reasons of dropout, and the follow-up information. METHODS: Medical records were consecutively reviewed of patients with locally advanced oral cavity cancer who underwent neoadjuvant chemotherapy from Jan 2017 to Dec 2019.Variables were compared between patients stopped treating after chemotherapy and completed treatments by student t-test and Chi-square test. Logistic regression model was used to calculate the odd rations of potential predictors of dropout. The dropout patients were followed up for reasons and results of their decision. RESULTS: A total of 171 patients were included with 23 not undergoing surgery after chemotherapy. The odd ratios of age over 65 and single marital status were 3.11 (95%CI: 1.1, 8.7) and 4.935 (95%CI: 1.5, 16.1), respectively, for the dropout. The median survival of patients without surgery was 7.4 months. Believing that chemotherapy would be effective and being afraid of the consequence of surgery were the main reasons of refusing surgery. CONCLUSIONS: The prognosis was poor of these dropout patients. Symptom relief and fear of surgery were the reasons of dropout. Age and marital status affected their decision. Clinical trials are needed to be designed for these patients.


Assuntos
Medo/psicologia , Neoplasias Bucais/terapia , Terapia Neoadjuvante/estatística & dados numéricos , Procedimentos Cirúrgicos Bucais/psicologia , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Boca/patologia , Boca/cirurgia , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/mortalidade , Neoplasias Bucais/patologia , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Pacientes Desistentes do Tratamento/psicologia , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
13.
AJR Am J Roentgenol ; 217(1): 198-206, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-32876497

RESUMO

BACKGROUND. Imaging surveillance is important for the early diagnosis of recurrence after definitive treatment of oral squamous cell carcinoma (OSCC). The Neck Imaging Reporting and Data System (NI-RADS) includes a standardized template for surveillance imaging and categorizes probability of recurrence at the primary site and in the neck (cervical lymph nodes) by assigning categories of 1 (no evidence of recurrence), 2 (low suspicion, subdivided into 2a and 2b for the primary site), 3 (high suspicion), and 4 (definite recurrence). OBJECTIVE. The aim of this study was to determine the rate of locoregional and nodal OSCC recurrence stratified by NI-RADS category among patients undergoing surveillance CT or MRI. METHODS. This retrospective study included 158 patients enrolled in an institutional surveillance program after resection of OSCC with curative intent. A total of 503 contrast-enhanced CT or MRI examinations performed during surveillance were evaluated. Each examination was randomly assigned to one of four radiologists with expertise in head and neck imaging, who provided NI-RADS categories for the primary site and the neck (1006 assigned NI-RADS categories). NI-RADS performance in identifying recurrence was assessed by ROC curve analysis. All four readers evaluated 50 randomly assigned cases to determine interreader agreement by use of the Kendall W statistic. RESULTS. Cancer recurrence was confirmed in 7.6% (38/503) of cases for the primary site and in 6.2% (31/503) for the neck. For the primary site, recurrence rates were 1.0% in NI-RADS category 1, 7.1% in category 2a, 5.6% in category 2b, 66.7% in category 3, and 100.0% in category 4. For the neck, recurrence rates were 0.5% in category 1, 7.0% in category 2, 80.0% in category 3, and 100.0% in category 4. NI-RADS had AUC values of 0.934 for the primary site and 0.959 for the neck. Interreader agreement was 0.67 for the primary site and 0.81 for the neck. CONCLUSION. NI-RADS offers excellent discriminatory power in detection of OSCC recurrence, both for the primary site and the neck. CLINICAL IMPACT. Radiologists and maxillofacial surgeons should implement NI-RADS in surveillance regimens for postoperative OSCC to help detect recurrences in an effective and standardized manner using imaging.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neoplasias Bucais/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Sistemas de Informação em Radiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Boca/diagnóstico por imagem , Boca/cirurgia , Neoplasias Bucais/cirurgia , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia
14.
Dermatol Surg ; 47(6): 780-784, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33867466

RESUMO

BACKGROUND: Most patients with scleroderma suffer from microstomia, which can have debilitating consequences on their quality of life. Unfortunately, treatment options remain limited. No specific guidelines exist; hence, microstomia remains a challenge to treat in this patient population. OBJECTIVE: This review aims to evaluate the different medical and surgical treatment modalities currently available for microstomia in patients with scleroderma and make recommendations for future research. MATERIALS AND METHODS: A search of PubMed, Ovid MEDLINE, and Ovid Embase was conducted to identify articles discussing the treatment of microstomia in scleroderma. Twenty articles discussing surgical therapy and one article discussing medical therapy were reviewed. RESULTS: Mostly because of a scarcity of high-level evidence, no individual therapy has documented long-term efficacy. Some treatments demonstrate positive results and warrant further research. CONCLUSION: Given the variability of results, specific recommendations for the treatment of microstomia in patients with scleroderma are difficult to establish. A multifaceted approach that includes surgical and medical therapy is likely the best option to improve oral aperture in this patient population. Surgical treatments such as neurotoxins, autologous fat grafting, and ultraviolet A1 phototherapy may hold the most potential for improvement.


Assuntos
Microstomia/terapia , Qualidade de Vida , Escleroderma Sistêmico/complicações , Tecido Adiposo/transplante , Músculos Faciais/efeitos dos fármacos , Músculos Faciais/inervação , Músculos Faciais/efeitos da radiação , Músculos Faciais/cirurgia , Humanos , Microstomia/etiologia , Microstomia/psicologia , Boca/efeitos dos fármacos , Boca/efeitos da radiação , Boca/cirurgia , Neurotoxinas/administração & dosagem , Escleroderma Sistêmico/terapia , Transplante Autólogo , Resultado do Tratamento , Terapia Ultravioleta/métodos
15.
Am J Otolaryngol ; 42(5): 103012, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33857781

RESUMO

PURPOSE: Planned flap reconstruction, allowing aggressive resections of oral cavity squamous cell carcinoma (OCSCC), may decrease positive surgical margins. The purpose of this study was to determine if length of stay (LOS), as a proxy measure for flap reconstruction, is associated with positive margin rates in OCSCC. MATERIALS AND METHODS: Data from the National Cancer Database was retrospectively collected for patients undergoing surgery for previously untreated clinical T1-3 OCSCC. Post-operative LOS was dichotomized between ≤4 and >4 days as a proxy measure for whether patients may have received flap reconstruction. Patients with LOS >4 days represent a diverse group, but those with a LOS ≤4 days are less likely to have undergone an oral cavity flap reconstruction. RESULTS: 10,107 patients were included, of which 5290 (52%) were clinical T1 and 4852 (48%) were clinical T2-3. 771 (8%) patients had a positive surgical margin. On multivariable logistic regression analysis, LOS ≤4 days was significantly associated with a positive margin resection in patients with clinical T2-3 tumors (OR 1.68, 95%CI 1.37-2.06) compared to patients with LOS >4 days. LOS was not associated with surgical margin status in patients with clinical T1 disease (OR 0.76, 95%CI 0.55-1.06). Patients with positive margin resections demonstrated worse overall survival (cT1: OR 1.35, 95%CI 1.06-1.72; cT2-3: OR 1.52, 95%CI 1.33-1.74). CONCLUSIONS: LOS >4 days after oral cavity cancer resection was significantly associated with negative surgical margins in clinical T2-3 oral cavity cancer, suggesting the possibility that patients undergoing flap reconstruction after resection have fewer positive surgical margins.


Assuntos
Bases de Dados como Assunto , Neoplasias de Cabeça e Pescoço/cirurgia , Tempo de Internação , Margens de Excisão , Boca/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Procedimentos de Cirurgia Plástica/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Fatores de Tempo
16.
Am J Otolaryngol ; 42(6): 103133, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34252712

RESUMO

INTRODUCTION: The infrahyoid myocutaneous flap (IHMCF) is an often-overlooked flap of the anterior neck used for reconstruction of oral cavity and laryngopharyngeal defects. The primary goal of this systematic review is to evaluate the postoperative outcomes and efficacy of this flap. METHODS: A comprehensive search of PubMed, Biological Abstracts, CINAHL Plus, and Web of Science was conducted. Two researchers independently scrutinized the studies to determine inclusions based on relevance, sample size, and English language publications. RESULTS: Twenty-eight studies containing 1027 IHMCF cases met the inclusion criteria. Primary outcomes included flap necrosis and postoperative functional outcomes. The rate of flap survival was 99%. Total skin necrosis and partial skin necrosis were minor complications that occurred in 2.5% and 5.8% of cases respectively. Poor speech and swallowing outcomes were reported in 6.4% and 6.5% of cases respectively. The included studies were predominantly retrospective. An average MINORS score of 9.6 suggests moderate bias among the studies. CONCLUSIONS: The IHMCF is both safe and effective for repairing medium sized mucosal lesions of the head and neck region in carefully selected patients. IHMCF use in oral cavity reconstruction is particularly appealing although functional outcomes remain difficult to statistically assess. Complications of IHMCFs are rare and often minor. To ensure the best outcome, pre-surgical planning needs to be conducted and all contraindications should be respected. Further large prospective multi-centered trials are needed for more accurate analysis.


Assuntos
Laringe/cirurgia , Boca/cirurgia , Retalho Miocutâneo , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Faringe/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retalho Miocutâneo/efeitos adversos , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Planejamento de Assistência ao Paciente , Faringe/imunologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Procedimentos de Cirurgia Plástica/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
17.
Am J Otolaryngol ; 42(6): 103166, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34333218

RESUMO

PURPOSE: High-risk oropharyngeal squamous cell carcinoma (OPSCC) associated with tobacco exposure remains difficult to treat due to high rates of locoregional recurrence similar to oral cavity squamous cell carcinoma (OCSCC). Current NCCN guidelines allow for surgical management of this disease, but oncologic and functional data in the modern era remain scarce. We sought to compare and contrast oncologic and functional considerations for surgical management of OPSCC and OCSCC in a cohort of Veterans. MATERIALS AND METHODS: We conducted a retrospective review of patients treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2017 and 2020, treated using a homogenous, multi-modality algorithm. RESULTS: OPSCC tumors presented with a higher rate of perineural invasion (p < 0.05) and extranodal extension (p = 0.02) compared to OCSCC tumors. Compliance with NCCN guidelines for adjuvant treatment were lower for OPSCC patients primarily due to a higher rate of previous irradiation; re-irradiation could be delivered in 75% of patients when recommended by NCCN guidelines. Total glossectomy was accompanied by concomitant total laryngectomy in 100% of OPSCC patients and 0% of OCSCC. CONCLUSION: Surgical resection and free flap reconstruction of high-risk OPSCC generates oncologic outcomes comparable to OCSCC with comparable complication rates but a lower overall functional status. Reconstruction focused on rapid healing allows for high-rates of re-irradiation and minimal treatment delays. LEVEL OF EVIDENCE: level 4.


Assuntos
Boca/cirurgia , Neoplasias Orofaríngeas/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Saúde dos Veteranos , Veteranos , Idoso , Terapia Combinada , Feminino , Retalhos de Tecido Biológico , Glossectomia , Humanos , Laringectomia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Orofaríngeas/patologia , Neoplasias Orofaríngeas/radioterapia , Guias de Prática Clínica como Assunto , Radioterapia Adjuvante , Estudos Retrospectivos , Risco , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/radioterapia , Resultado do Tratamento
18.
Clin Anat ; 34(7): 1087-1094, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33905588

RESUMO

There is little anatomical evidence about the venous plexus in the floor of the oral cavity, although venous injury can elicit late postoperative bleeding after oral surgery and it is difficult to identify the exact location of such an injury. The aim of this study was to assess the relative risk for venous injury during surgery. We investigated the course patterns of the venous plexus in the floor of the oral cavity and analyzed their relationships to those of the arteries using 23 human cadavers (41 halves) in the anatomy course at Niigata University during 2016-2018. The venous plexus in the floor of the oral cavity comprised the perforating submental vein, the vena comitans of the hypoglossal nerve, the vena comitans of the submandibular duct, the vena comitans of the lingual nerve, the sublingual vein, and the deep lingual vein. Individual variations of this plexus include duplications or absences of some veins. There is a high incidence of a submental branch running above the mylohyoid or perforating submental artery in the sublingual fossa among individuals with the perforating submental vein piercing the mylohyoid muscle, whereas the sublingual artery has a high incidence there when there is no perforating submental vein. The course patterns of arteries in the floor of the oral cavity can be predicted by estimating the course patterns of the submental veins. The course patterns of the submental veins or veins associated with the nerves and submandibular duct need to be carefully considered during surgery.


Assuntos
Variação Anatômica , Boca/irrigação sanguínea , Boca/cirurgia , Veias/anatomia & histologia , Cadáver , Feminino , Hemorragia/prevenção & controle , Humanos , Masculino , Procedimentos Cirúrgicos Bucais
19.
BMC Gastroenterol ; 20(1): 132, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370759

RESUMO

BACKGROUND: Third-space endoscopy is a novel, safe, and effective method for treating different gastrointestinal conditions. However, several failed endoscopic procedures are attributed to incomplete myotomy. Lighting devices are used to prevent organic injuries. We aimed to investigate the feasibility of using a hand-made LED-probe (LP) in third-space procedures. METHODS: This prospective study was conducted in a tertiary-care center in Mexico between December 2016 and January 2019. We included peroral endoscopic myotomy (POEM) and gastric peroral endoscopic myotomy(G-POEM) procedures. Pseudoachalasia, peptic ulcer, normal gastric emptying scintigraphy (GES) and prepyloric tumors were excluded. LP was used to guide or confirm procedures. Clinical and procedural characteristics were recorded and analyzed. RESULTS: Seventy third-space procedures were included (42POEM,28G-POEM), with an average patient age of 46.7 ± 14.3 and 43.7 ± 10.1 years, respectively. For the POEM and G-POEM groups, respectively, 18/42(42.9%) and 13/28(46.7%) patients were males; median procedure times were 50 (interquartile range [IQR]: 38-71) and 60(IQR: 48-77) min, median LP placement times were 5(IQR: 4-6) and 6(IQR: 5-7) min, mild adverse events occurred in 4(9.4%) and 4(14.2%) of cases, and clinical success at 6 months occurred in 100 and 85.7% of cases. Integrated relaxation pressure (IRP) improved from 27.3 ± 10.8 to 9.5 ± 4.1 mmHg (p < 0.001); retention percentage at 4 h also improved. LP was successfully placed and adequate myotomy confirmed including 14.2 and 17.8% of POEM and G-POEM difficult patients. CONCLUSIONS: Using an LP is promising and allows guiding during third-space procedures either for submucosal tunnel creation or myotomy confirmation, with excellent safety and efficacy in clinical practice.


Assuntos
Endoscopia do Sistema Digestório/instrumentação , Acalasia Esofágica/cirurgia , Iluminação/instrumentação , Miotomia/instrumentação , Piloromiotomia/instrumentação , Adulto , Endoscopia do Sistema Digestório/métodos , Estudos de Viabilidade , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Boca/cirurgia , Miotomia/métodos , Estudos Prospectivos , Piloromiotomia/métodos , Centros de Atenção Terciária , Resultado do Tratamento
20.
Jpn J Clin Oncol ; 50(4): 387-391, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-31829423

RESUMO

BACKGROUND: Remote access and endoscopic thyroid surgery has been gaining popularity because it allows patients to avoid a visible scar in the neck. There is limited data on transoral endoscopic thyroidectomy when it relates to patients with papillary thyroid carcinoma. We aim to evaluate the safety of ipsilateral central compartment dissection for patients who undergo transoral thyroidectomy (thyroidectomy vestibular approach-compartment lymph node dissection). PATIENTS AND METHODS: A total of 80 patients who underwent thyroidectomy vestibular approach-compartment lymph node dissection for papillary thyroid carcinoma from June 2015 to September 2016 were identified. Over the same period, a matched cohort of 80 patients who underwent open thyroidectomy with routine ipsilateral central compartment dissection was also identified (Open-compartment lymph node dissection). The two groups were analyzed in terms of patient characteristics, perioperative clinical results and post-operative outcomes. RESULTS: All patients were female with a mean age of 32-year. There was no difference in mean maximum tumor size and number of lymph nodes dissected. Moreover, there was no difference in average positive lymph nodes between thyroidectomy vestibular approach-compartment lymph node dissection and Open-compartment lymph node dissection (1.48 vs 1.08, P = 0.647). Operative time was longer in the thyroidectomy vestibular approach-compartment lymph node dissection group (193 vs 102 min, P < 0.001). Thyroidectomy specific complications were similar with rates of temporary recurrent laryngeal nerve palsy of 6.3 vs 8.8% and temporary hypocalcemia rates of 2.5 vs 5% in the thyroidectomy vestibular approach-compartment lymph node dissection and Open-compartment lymph node dissection groups, respectively. CONCLUSIONS: Thyroidectomy vestibular approach-compartment lymph node dissection is a feasible and safe option for select patients with papillary thyroid carcinoma who require central node dissection compared with Open-compartment lymph node dissection, and can be a viable alternative for patients wishing to avoid a visible scar.


Assuntos
Carcinoma Papilar/cirurgia , Endoscopia , Boca/cirurgia , Esvaziamento Cervical/efeitos adversos , Neoplasias da Glândula Tireoide/cirurgia , Adulto , Carcinoma Papilar/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/patologia , Adulto Jovem
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