Clinical outcomes and prognostic factors of head and neck squamous cell carcinoma: a ten-year follow-up study.

Traditional guidelines for determining the prognosis of patients with head and neck squamous cell carcinoma (HNSCC) are used to make therapeutic decisions. However, only 50% of the patients had lived for more than five years. The present study aimed to analyze the correlation of traditional prognostic factors such as tumor size, histological grading, regional metastases, and treatment with the survival of patients with HNSCC. A total of 78 patients diagnosed with HNSCC were followed up for 10 years after diagnosis and treatment. The health status of the patients was tracked at four time points, and according to the evolution of the patients and their final clinical status, we performed a prognostic analysis based on the clinical outcomes observed during the follow-up period. The final study cohort comprised 50 patients. Most patients had tumors < 4 cm in size (64%) and no regional metastases (64%); no patients had distant metastases at the time of diagnosis. Most individuals had tumors with good (48%) and moderate (46%) degrees of malignancy. At the end of the follow-up period, only 14% of the patients were discharged, 42% died of the tumor, and 44% remained under observation owing to the presence of a potentially malignant disorder, relapse, or metastases. This analysis showed that traditional prognostic factors were not accurate in detecting subclinical changes or predicting the clinical evolution of patients.

Etiopathogenesis of pathological mandibular fracture: literature review and case reports / Etiopatogenia da fratura patológica mandibular: revisão de literatura e relatos de caso

ABSTRACT Pathological mandibular fractures are fractures induced by pathologies affecting the mandible's base or those resulting from forces that would typically be tolerable if the bone were not compromised by an underlying condition. These fractures often present complex clinical scenarios owing to the compromised bone integrity caused by the pathology, which impedes resolution. Systemic changes may also diminish the capacity for bone neoformation, significantly limiting therapeutic options. Therefore, this study aimed to provide a comprehensive review of the published scientific literature and present clinical cases related to the treatment and prevention of pathological mandibular fractures. A literature review was conducted, focusing on case reports indexed in the MEDLINE and SCIELO databases using specific keywords as descriptors. The search yielded ten articles, which described the etiopathogenesis, classified as infectious, idiopathic, benign pathology, malignant pathology, and iatrogenic. The literature suggests that prioritizing surgery to address the underlying local pathology is crucial. Managing the remaining bone defect optimally may necessitate multiple surgical interventions. Furthermore, preventive measures should be implemented in potential iatrogenic cases. Notably, fractures of malignant, idiopathic, hereditary, and metabolic etiologies may indicate the initial manifestation of diseases.

RESUMO As fraturas patológicas mandibulares são aquelas provocadas por patologias que envolvem a base da mandíbula ou que ocorrem por forças de carga que seriam toleradas de forma normal caso o osso não fosse enfraquecido subjacentemente. Os pacientes com fraturas patológicas de mandíbula tendem a apresentar situações clínicas complexas, com limitação ou comprometimento ósseo causado pela patologia que dificulta a sua resolução bem como diminuição da capacidade de neoformação óssea pelas alterações de ordem sistêmica que podem restringir significativamente as alternativas terapêuticas. Desta forma, o objetivo do presente trabalho é revisar a literatura científica publicada e apresentar casos clínicos sobre tratamento e prevenção de fratura patológica mandibular. Uma revisão de literatura foi realizada a partir de relatos de caso indexados nas bases de dados MEDLINE e SCIELO com palavras-chave utilizadas de acordo com seus descritores específicos. A pesquisa resultou em dez artigos descrevendo como etiopatogenia causas classificadas como de origem infecciosa, idiopática, patologia benigna, patologia maligna e iatrogenia. A literatura preconiza que a cirurgia para o tratamento da patologia local seja a prioridade e que o defeito ósseo remanescente seja administrado da melhor maneira que o caso permitir, podendo ser corrigido em mais de um tempo cirúrgico. Os possíveis casos iatrogênicos devem ter condutas preventivas. Fraturas de etiologia maligna, idiopática, hereditária e metabólica apresentam a possibilidade de sinalização da primeira manifestação das doenças.

Clinical outcomes and prognostic factors of head and neck squamous cell carcinoma: a ten-year follow-up study

Abstract Traditional guidelines for determining the prognosis of patients with head and neck squamous cell carcinoma (HNSCC) are used to make therapeutic decisions. However, only 50% of the patients had lived for more than five years. The present study aimed to analyze the correlation of traditional prognostic factors such as tumor size, histological grading, regional metastases, and treatment with the survival of patients with HNSCC. A total of 78 patients diagnosed with HNSCC were followed up for 10 years after diagnosis and treatment. The health status of the patients was tracked at four time points, and according to the evolution of the patients and their final clinical status, we performed a prognostic analysis based on the clinical outcomes observed during the follow-up period. The final study cohort comprised 50 patients. Most patients had tumors < 4 cm in size (64%) and no regional metastases (64%); no patients had distant metastases at the time of diagnosis. Most individuals had tumors with good (48%) and moderate (46%) degrees of malignancy. At the end of the follow-up period, only 14% of the patients were discharged, 42% died of the tumor, and 44% remained under observation owing to the presence of a potentially malignant disorder, relapse, or metastases. This analysis showed that traditional prognostic factors were not accurate in detecting subclinical changes or predicting the clinical evolution of patients.