Revisión sistemática del schwannoma localizado en el suelo oral. A propósito de un caso / Oral floor schwannoma. Systematic review and case report

Objetivos. Revisar de manera sistemática el schwannoma localizado en el suelo oral. Presentar un caso tratado en nuestro departamento. Material y método. Mediante la utilización de motores de búsqueda se identificaron artículos sobre schwannoma localizado en el suelo oral. Los criterios de inclusión fueron: a) diagnóstico definitivo de schwannoma localizado en el suelo oral; b) casos publicados en inglés, español o alemán. Se analizaron variables relacionadas con las características clínicas, diagnósticas y de tratamiento. Resultados. Se identificaron 19 artículos que cumplían los criterios de inclusión. Edad media: 44,3 años (rango 17-77); 42,1% mujeres y 57,8% hombres; tiempo de evolución de 8,7 meses (rango 1-60); tumoración localizada en el lado izquierdo del suelo oral 52,6%, en el lado derecho 42,1%; diámetro mayor medio 38,3 mm (rango 10-70); afectación del nervio hipogloso 15,7%, nervio lingual 15,7%, nervio milohioideo 5,2%, no se identificó nervio de origen en el 21,1% de los casos; punción aspiración con aguja fina no diagnóstica en el 31,5% e identificación de tumoración benigna en el 21%. La exéresis quirúrgica se realizó en el 100% de los casos con un tiempo de seguimiento de 34,3 meses (rango 1-120). No se documentaron recurrencias. Conclusiones. Los schwannomas localizados en el suelo de la boca son infrecuentes. Se presentan en torno a los 40 años, con leve predominancia por el sexo masculino y del lado izquierdo del suelo oral. El tiempo de evolución se encuentra próximo a los 9 meses. Usualmente asintomático. Los nervios hipogloso y lingual se afectan por igual. En proporción similar, el nervio de origen no puede ser identificado. La punción aspiración con aguja fina no es efectiva. El tratamiento de elección consiste en la enucleación del tumor una vez diagnosticado. No se documentaron recidivas (AU)

Objective. Systematically review the oral floor schwannoma. Report of a case treated in our department. Material and method. Published articles about oral floor schwannoma were identified. The inclusion criteria were: a) Final diagnosis of schwannoma located in the oral floor. b) Articles published in English, Spanish or German. The variables were analysed regarding clinical features, diagnosis and treatment. Results. Nineteen articles that met the inclusion criteria. Average age: 44.3 years (range 17-77); 42.1% were females and 57.8% males; time of lesion development was 8.7 months (range 1-60); side of the oral floor location: left side 52.6%, right side 42.1%; average diameter: 38.3 mm (range 10-70); hypoglossal nerve involvement: 15.7%, lingual nerve: 15.7%, mylohyoid nerve: 5.2%, nerve not identified in 21.1% of cases; fine needle aspiration biopsy: non diagnostic in 31.5%, benign tumor identified 21%. Surgical excision was performed in 100% of the cases with a follow up of 34.3 months (rank 1-120). No recurrences were reported. Conclusions. Schwannomas located on the floor of the mouth are uncommon. Environment are presented at age 40 with a slight predominance for males and mainly the left. The time evolution is close to 9 months. The hypoglossal and lingual nerves are affected equally. In similar proportion the nerve of origin cannot be identified. Fine needle aspiration biopsy is not efficient. The treatment of choice is enucleation of the tumor 11 diagnosed. No recurrences were observed (AU)

Treatment of oral and oropharyngeal epidermoid carcinomas by means of CO2 laser.

INTRODUCTION: The effect of the wide long-wave CO2 laser is the thermal vaporization of the tissues, getting a maximum energy concentration with a minimum of tissue penetration. In oral surgery, it is generally used for the treatment of oral and oropharyngeal small mucous tumors, due to the scarce morbidity that takes place and the absence of reconstructive necessity. OBJECTIVE: To analyze the postoperative evolution, in the patients treated by oral and oropharyngeal epidermoid carcinomas, after CO2 laser resection. To compare it with that of the patients treated by means of conventional surgical methods, achieving the reconstruction through direct suture or the employment of local, regional or distance flaps. METHODS: A prospective study was designed including 70 patients treated by oral and oropharyngeal epidermoid carcinomas. Thirty-five patients were treated by means of CO2 laser, in 10 cases direct wound-closure was realized, and in the remaining 25 patients some local, regional or distance flap were used. There were analysed the presence of postoperative pain, the degree of cicatricial retraction, and the speech and swallowing functional results. RESULTS: We obtained a smaller painful degree and postoperative cicatricial retraction by the employment of CO2 laser. It permits minimizing the functional speech sequels (better words articulation) and swallowing (effective and precocious functional recovery). CONCLUSION: CO2 laser resection has become the elective treatment for small oral and oropharyngeal epidermoid carcinomas. The reasons are the absence of reconstructive surgery necessity, the scarce cicatricial retraction, and the excellent postoperative evolution.

Small cell undifferentiated carcinoma of the submandibular gland with neuroendocrine features.

This article reports the clinical, histopathologic, and immunohistochemical findings in a case of small cell undifferentiated carcinoma of the submandibular gland. The tumor was composed of anaplastic cells slightly larger than lymphocytes without ductal differentiation. On immunohistochemical analysis, the tumor contained cells that reacted positively with antibodies to cytokeratin, neuron-specific enolase, synaptophysin, and chromogranin. The present case supports the hypothesis that small cell undifferentiated carcinomas of the salivary glands arise from presumed multipotential ductal stem cells. When this tumor entity is located on the salivary glands, it appears to behave less aggressively than when it is a primary tumor of the bronchial tree.