Disfunções orofaciais em pacientes infantojuvenis com leucemia aguda / Orofacial dysfunctions in infants and young children with acute leukemia

RESUMO Objetivo Identificar a ocorrência de disfunções orofaciais em pacientes infantojuvenis com leucemia aguda, submetidos à quimioterapia de remissão. Métodos Em um período de 16 meses, 40 pacientes com leucemias agudas, entre 3 e 18 anos de idade, foram admitidos em um hemocentro no estado do Amazonas. Destes, 23 foram incluídos neste estudo transversal e submetidos à avaliação das funções orofaciais, por meio do Nordic Orofacial Test-Screening (NOT-S), entre o trigésimo (D30) e o trigésimo terceiro dia (D33) da fase de indução da remissão. A presença de manifestações orais também foi avaliada por meio de exame clínico. Resultados Disfunção orofacial foi observada em, aproximadamente, metade dos casos avaliados (n=11). Destes pacientes, todos tiveram o domínio Secura de Boca (VI) alterado e 81,8% (n=9) apresentaram alteração no domínio Mastigação e Deglutição (IV). Mucosites em lábios, língua, soalho e orofaringe foram as lesões orais mais encontradas após a fase de indução. Houve associação entre a ocorrência de lesões orais nos pacientes avaliados e a presença de disfunção orofacial, segundo o NOT-S (IC 95%, p-valor = 0,027). Conclusão Sugere-se que a disfunção orofacial seja frequente na fase de indução da remissão em pacientes infantojuvenis com leucemias agudas. Estudos sobre as disfunções orofaciais nessa população, bem como sua relação com as lesões orais são necessários para melhor esclarecimento e compreensão dos impactos funcionais.

ABSTRACT Purpose To Identify the occurrence of orofacial dysfunctions in young children and adolescents with acute leukemia who are undergoing remission chemotherapy. Methods Over a period of 16 months, 40 three to eighteen year -old patients with acute leukemia were admitted to the Amazonas State Hemocenter. Of these, 23 were included in the cross-sectional study and submitted to the evaluation of orofacial functions using the Nordic Orofacial Test-Screening, between D30 and D33 of the remission induction phase. The presence of oral manifestations was also evaluated via clinical examination. Results Orofacial dysfunction was observed in approximately half of the evaluated cases (n=11). Of these patients, all had alterations in the Dryness of the Mouth (VI) domain and 81.8% (n=9) showed alterations in the Chewing and Swallowing (IV) domain. Mucosites on lips, tongue, floor of the mouth and the oropharynx were the most commonly found oral lesions after the remission induction phase. According to the NOT-S, there was an association between the occurrence of oral lesions in the evaluated patients and the presence of orofacial dysfunction (95% CI, p-value = 0.027). Conclusion It is suggested that orofacial dysfunction is frequent in the remission induction phase in children and adolescents with acute leukemia. Studies regarding these orofacial dysfunctions in this population, as well as their relationship with oral lesions, are needed in order to fully understand their functional impact.

Correction to: Cervicofacial and Pharyngolaryngeal Lymphedema and Deglutition After Head and Neck Cancer Treatment.

The original version of this article unfortunately contained a mistake. Figure 2 was repeated in Figure 3.

Cervicofacial and Pharyngolaryngeal Lymphedema and Deglutition After Head and Neck Cancer Treatment.

One of the sequelae of head and neck cancer treatment is secondary lymphedema, with important impact on breathing, swallowing and vocal functions. The aim of the study was to assess the presence, staging characteristics and relationship of external and internal lymphedema and dysphagia after head and neck cancer treatment. The MDACC Lymphedema Rating Scale in Head and Neck Cancer was employed for the assessment and staging of face and neck lymphedema; the Radiotherapy Edema Scale for internal lymphedema; and a fiberoptic endoscopic evaluation of swallowing (FEES) for swallowing. The sample consisted of 46 patients with a diagnosis of head and neck cancer. Lymphedema was detected in 97.8% (45) of the evaluations with predominance of the composite type (73.9%-34). A high percentage of external lymphedema of the neck (71.7%-33) and submandibular (63%-29) were detected, with predominance of the more advanced levels. Internal edema was found in almost all structures and spaces at moderate/severe level. At FEES, residue (higher percentage in valleculae and pyriform sinus), penetration and aspirations were observed. The residue was detected in higher occurrence in patients with composite lymphedema (p = 0.012). The combined treatment with radiotherapy was related to submandibular external lymphedema (p = 0.009), altered pharyngolaryngeal sensitivity (0.040), presence of residue (p = 0.001) and penetration to pasty (p = 0.007) and internal edema in almost all structures. There was also a higher percentage of residue in cases with internal altered pharyngolaryngeal sensitivity, residue, penetration and aspiration. Combined treatment with radiotherapy is an associated factor of edema. Cervicofacial and pharyngolaryngeal lymphedema is a frequent event after treatment for HNC, with important impact on swallowing performance characterised by altered pharyngolaryngeal sensitivity, residue, penetration and aspiration. Combined treatment with radiotherapy is an associated factor.

Translation and adaptation of the Radiotherapy Edema Rating Scale to Brazilian Portuguese / Tradução e adaptação para o português brasileiro da Escala de Classificação do Edema da Radioterapia

Abstract Introduction: Internal lymphedema is one of the sequelae of head and neck cancer treatment that can lead to varying degrees of swallowing, speech, and respiration alterations. The Radiotherapy Edema Rating Scale, developed by Patterson et al., is a tool used to evaluate pharyngeal and laryngeal edema. Objective: To translate into Brazilian Portuguese, to culturally adapt and test this scale in patients undergoing treatment for head and neck cancer. Methods: The process followed the international guidelines and translation steps by two head and neck surgeons and back-translation performed independently by two North-American natives. The final version of the test was evaluated based on the assessment of 18 patients by two head and neck surgeons and two speech therapists using the scales in Brazilian Portuguese. Results: The translation and cultural adaptation were satisfactorily performed by the members of the committee in charge. Conclusion: The translation and adaptation into Brazilian Portuguese of the Radiotherapy Edema Rating Scale was successfully performed and showed to be easy to apply.

Resumo Introdução: O linfedema interno é uma das sequelas do tratamento para o câncer de cabeça e pescoço, pode levar a alterações de grau variado na deglutição, voz e respiração. A Escala do Edema da Radioterapia (Radiotherapy Edema Rating Scale), elaborada por Patterson et al., é uma ferramenta de avaliação do edema de faringe e laringe. Objetivo: Traduzir, para o português brasileiro, adaptar culturalmente e testar essa escala em pacientes submetidos ao tratamento para o câncer de cabeça e pescoço. Método: O processo seguiu as diretrizes internacionais e as etapas de tradução por dois cirurgiões de cabeça e pescoço e a retrotradução de forma independente por dois nativos norte-americanos. O teste da versão final para avaliação foi realizado a partir da avaliação de 18 pacientes por dois médicos cirurgiões de cabeça e pescoço e duas fonoaudiólogas por meio da aplicação das escalas em português. Resultados: A tradução e a adaptação cultural foram executadas satisfatoriamente pelos membros do comitê responsável. Conclusão: A tradução e adaptação da Escala do Edema da Radioterapia para o português foi bem-sucedida e de fácil aplicação.

Translation and adaptation of the Radiotherapy Edema Rating Scale to Brazilian Portuguese.

INTRODUCTION: Internal lymphedema is one of the sequelae of head and neck cancer treatment that can lead to varying degrees of swallowing, speech, and respiration alterations. The Radiotherapy Edema Rating Scale, developed by Patterson et al., is a tool used to evaluate pharyngeal and laryngeal edema. OBJECTIVE: To translate into Brazilian Portuguese, to culturally adapt and test this scale in patients undergoing treatment for head and neck cancer. METHODS: The process followed the international guidelines and translation steps by two head and neck surgeons and back-translation performed independently by two North-American natives. The final version of the test was evaluated based on the assessment of 18 patients by two head and neck surgeons and two speech therapists using the scales in Brazilian Portuguese. RESULTS: The translation and cultural adaptation were satisfactorily performed by the members of the committee in charge. CONCLUSION: The translation and adaptation into Brazilian Portuguese of the Radiotherapy Edema Rating Scale was successfully performed and showed to be easy to apply.

Translation and adaptation to Brazilian Portuguese of the Lymphedema Rating Scale in Head and Neck Cancer.

OBJECTIVE: Translate to brazilian portuguese, culturally adapt and test the rating and classification scales of cervicofacial lymphedema of the MD Anderson Cancer Center Head and Neck Lymphedema Protocol (MDACC HNL) in patients undergoing treatment for head and neck cancer. METHODS: The process followed international guidelines and translation stages by two head and neck surgeons, and back translation independently by two native Americans. The test of final version was based on the evaluation of 18 patients by one speech pathologist and one physical therapist who applied the scales in Portuguese. RESULTS: The translation of the three scales was carried out independently and the translators reached a consensus for the final version. Minor modifications were made by translating two terms into the Assessment of the Face. Versions of back-translation were similar to each other. The instrument was successfully applied to patients independently. CONCLUSION: The translation and cultural adaptation of the assessment and rating scale of the cervicofacial lymphedema of the MD Anderson Cancer Center Head and Neck Lymphedema Protocol to the Brazilian Portuguese were successful.

Translation and adaptation to Brazilian Portuguese of the Lymphedema Rating Scale in Head and Neck Cancer / Tradução e adaptação para o português brasileiro da Lymphedema Rating Scale in Head and Neck Cancer

ABSTRACT Objective: Translate to brazilian portuguese, culturally adapt and test the rating and classification scales of cervicofacial lymphedema of the MD Anderson Cancer Center Head and Neck Lymphedema Protocol (MDACC HNL) in patients undergoing treatment for head and neck cancer. Methods: The process followed international guidelines and translation stages by two head and neck surgeons, and back translation independently by two native Americans. The test of final version was based on the evaluation of 18 patients by one speech pathologist and one physical therapist who applied the scales in Portuguese. Results: The translation of the three scales was carried out independently and the translators reached a consensus for the final version. Minor modifications were made by translating two terms into the Assessment of the Face. Versions of back-translation were similar to each other. The instrument was successfully applied to patients independently. Conclusion: The translation and cultural adaptation of the assessment and rating scale of the cervicofacial lymphedema of the MD Anderson Cancer Center Head and Neck Lymphedema Protocol to the Brazilian Portuguese were successful.

RESUMO Objetivo: Traduzir, para o português brasileiro, adaptar culturalmente e testar as escalas de avaliação e classificação do linfedema cérvico-facial do MD Anderson Cancer Center Head and Neck Lymphedema Protocol (MDACC HNL) em pacientes submetidos ao tratamento para o câncer de cabeça e pescoço. Métodos: O processo seguiu as diretrizes internacionais e as etapas de tradução por dois cirurgiões de cabeça e pescoço, além de retrotradução de forma independente por dois nativos norte-americanos. O teste da versão final foi realizado a partir da avaliação de 18 pacientes por um fonoaudiólogo e um fisioterapeuta, por meio da aplicação das escalas em português. Resultados: A tradução das três escalas foi realizada de forma independente, e os tradutores chegaram a um consenso para a versão final. Foram feitas pequenas modificações, ao serem traduzidos dois termos em Assessment of the Face . As versões da retrotradução foram semelhantes entre si. O instrumento foi aplicado com sucesso nos pacientes de forma independente. Conclusão: A tradução e a adaptação das escalas de avaliação e classificação do linfedema cérvico-facial do MD Anderson Cancer Center Head and Neck Lymphedema protocol para o português foram bem sucedidas.

Correlation among ocular surface disease, xerostomia, and nasal symptoms in patients with differentiated thyroid carcinoma subjected to radioiodine therapy: A prospective comparative study.

BACKGROUND: Some complications of radioiodine therapy have been reported, but the involvement of the eyes and adnexa is rarely discussed. The purpose of this study was to determine the correlation among ocular surface changes, xerostomia, and changes in the nasal mucosa associated with radioiodine therapy. METHODS: Patients subjected to radioiodine therapy (group 1) or not subjected (group 2) were prospectively evaluated by examinations of the ocular surface and tear film, saliva production, and nasal endoscopy. Ocular and nasal symptoms and xerostomia were evaluated using questionnaires. RESULTS: Evaluation of the ocular surface did not indicate significant differences between the groups. Nasal endoscopy revealed higher mucosal pallor in group 1 and worsening of the endoscopic appearance. Worsening of ocular symptoms and nasal symptoms, xerostomia, and a significant decrease in salivary production was also observed in group 1. CONCLUSION: Subjective worsening of xerostomia, xerophthalmia, nasal symptoms, and changes in the nasal mucosa in group 1 was observed.

Videoendoscopic Evaluation of Swallowing After Thyroidectomy: 7 and 60 Days.

Deglutition complaints are frequent after thyroidectomy. The purpose of this study was to follow-up on patients with thyroidectomy indication to compare the videoendoscopic evaluation of swallowing on the seventh day (early postoperative, EPO) and on the 60th day after thyroidectomy, (late postoperative, LPO) and to compare patients that evolved with normal laryngeal mobility (NLM) and abnormal laryngeal mobility (ALM). Nasofibroscopic evaluation was performed preoperatively (PRE), on the EPO and LPO. Two groups were compared: ALM and NLM. The majority of people were women, age bracket 46-65, who underwent total thyroidectomy and with high frequency of carcinoma. 30 out of the 54 patients in the study had change in swallowing (55 %). Dysphagia occurred in 87 % (13/15) of patients with ALM in the EPO and remained in 67 % of them in the LPO. In the NLM group, dysphagia occurred in 44 % (17/39) in EPO and 25 % in LPO. There was a statistical difference between PRE and EPO, and PRE and LPO (P < 0,001). In the ALM group, liquid penetration and aspiration were identified in 33 % of the cases during EPO (P = 0,014); retention of food occurred in 87 % in EPO and in 60 % in LPO (P < 0,001). Dysphagia occurs in patients after thyroid surgery (regardless of larynx mobility alteration) and characterized by stasis of food in the oro and hypopharynx, which is also noticed in LPO, though more frequently in EPO.

Análise videofluoroscópica da deglutição após laringectomia total / Videofluoroscopic evaluation of swallowing after total laryngectomy

Introdução: As queixas de deglutição dos pacientes submetidos à laringectomia total são pouco valorizadas, devido ao impacto da perda da voz laríngea. Além disso, quando se refere à disfagia, a relevância é dada à fase esofágica. Objetivo: Descrever os resultados da análise videofluoroscópica da deglutição de pacientes laringectomizados totais. Método: estudo descritivo/retrospectivo da análise dos exames de 22 laringectomizados totais e dos prontuários com informações de deglutição. O protocolo de análise da imagem videofluoroscópica envolveu dados de mobilidade da base de língua, mobilidade do véu palatino, trânsito esofágico e estases nas consistências líquida, pastosa e, quando possível, na sólida. Resultados: Dentre os disfágicos (95%), 48% apresentou movimento de posteriorização da base de língua reduzido (PBL); 24%, redução no fechamento de véu palatino (VP); 76%, estase em base de língua (BL); 71%, em topografia de valécula (TV); 81%, em transição faringo-esofágica (TFE); 71%, em segmento faringoesofágico (SFE); 52%, em área de armazenamento de ar (AA); 86%, trânsito esofágico lento (TEL); 9%, estenose esofágica (EE). Quanto às informações de deglutição, 73% apresentou queixa para sólidos. Conclusão: a ausência de queixa na deglutição não significa normalidade do exame. A disfagia não ocorre somente na fase esofágica e sim também nas fases oral e faríngea, caracterizada por trânsito lento e estase.

Introduction: The self-reported dysphagia following total laryngectomy is underestimated and the deglutition disorders have been associated with esophageal phase. Objective: To describe features of deglutition in a population of patients submitted to total laryngectomy. Methods: Retrospective study of videofluoroscopic examination with 22 patients and analysis of swallowing’s information. The protocol of videofluoroscopic examination involved: mobility of base-of-tongue; mobility of soft palate; esophageal transit and residue with liquid; pureed and, when possible, solid food. Results: 96% had dysphagia. Of these patients, 48% had reduction in base-of-tongue movement posteriorization (BTM); 24% showed reduction in soft palate movement (SPM); 76% had residue in base-of-tongue (RBT); 71% had residue in pseudovallecula (PV); 81% had residue in pharyngoesophageal transition (PT); 71% had residue in pharyngoesophageal segment (PS); 52% showed an area of air reservation (AAR); 86% had prolonged esophageal transit times (ETTP); 9% suffered esophageal stenosis (ES). Regarding selfreported deglutition, 73% had some difficulty to swallow solid food. Conclusion: The absence of self-report dysphagia following total laryngectomy was not always associated with normal findings at videofluoroscopic examination. Swallowing disorders were detected in all phases of deglutition, not only in esophageal phase.

Impacto da videoendoscopia da deglutição na fonoterapia após tratamento de tumor de cabeça e pescoço / Impact of swallowing videoendoscopy in Speech therapy after treatment of head and neck tumor

Objetivo: Investigar mudanças na conduta terapêutica fonoaudiológica após resultados da vídeoendoscopia da deglutição (VED) de pacientes após cirurgia de tumor de cabeça e pescoço ou após tratamento exclusivo ou coadjuvante com radioterapia e quimioterapia. Métodos: Estudo retrospectivo, com coleta de dados de prontuário e análise de exame funcional. A amostra constou de 20 pacientes com disfagia moderada ou grave (11 homens e nove mulheres), com média de idade de 58 anos. Do total, 17 pacientes realizaram tratamento cirúrgico e três apenas radioquimioterapia. A VED foi realizada após o mínimo de três sessões de terapia fonoaudiológica para disfagia. Para análise do pós exame foi considerado igualmente o mínimo de três sessões de fonoterapia. Os dados coletados foram relacionados à classificação de deglutição no período terapêutico baseado na Functional Communication Measures - Swallowing (ASHA-NOMs) (FCM), estratégias terapêuticas utilizadas quanto à consistência e manobras de deglutição, necessidade de outro exame funcional e encaminhamento médico. Os dados foram comparados nos momentos pré e pós VED. Resultados: Houve 25% de mudança na conduta fonoaudiológica pós VED; 50% de mudança na classificação FCM, dos quais 30% para maior grau; 70% de influência da VED nas estratégias terapêuticas - modificação em 30% quanto às consistências seguras; 30% no uso de manobras posturais, 25% em manobras de limpeza e 40% em manobras de proteção. Houve 25% de necessidade de outro exame funcional, sendo a videofluoroscopia o exame indicado; 10% foram encaminhados ao médico. Conclusão: Há impacto da VED na conduta fonoaudiológica, especialmente em relação às estratégias terapêuticas com predomínio de mudanças de consistência e manobras seguras.

Purpose: Investigate changes in speech therapy after Fiberoptic Endoscopy Evaluation of Swallowing (FEES) in patients after head and neck oncological treatment. Methods: retrospective study, based in collection and analysis of speech therapy and functional examination. The sample consisted of 20 patients (11 males and nine females), mean age 58 years. Of the total, 17 patients underwent surgical treatment and three only radiochemotherapy. The VED was performed after a minimum of three sessions of speech therapy for dysphagia. For analyzing the post test was also considered at least three speech therapy sessions. The data collected were related to the classification of swallowing during treatment based on the Functional Communication Measures - Swallowing (ASHA-NOMs) (FCM), therapeutic strategies related to consistency, swallowing maneuvers, functional test and physician evaluation. Data were compared for the pre and post FEES. Results: There was change 25% in speech behavior after FEES, 50% in the classification FCM, of which 30% to greater scale, 70% in therapeutic strategies - 30% in regard to safe consistencies, 30% the use of postural maneuvers, in 25% cleaning maneuvers and 40% protection maneuvers. There was 25% of the necessity of a functional examination, with the fluoroscopy examination indicated, 10% were referred to a doctor. Conclusion: There was impact of FEES on the speech therapy purpose, especially in relation to therapeutic strategies with predominant changes for consistency and safely operated.

Nova técnica de confecção de fístula traqueoesofágica secundária e locação de prótese fonatória em pacientes submetidos a laringectomia total / New technique for secondary tracheoesophageal fistula in patients undergoing total laryngectomy

Introdução: A laringectomia total implica em perda da voz e areabilitação vocal tem sido um desafio para a reinserção dospacientes à sociedade. Diversas formas de reabilitação como avoz esofágica, a laringe artificial e a prótese fonatória locada emuma fístula traqueoesofágica têm sido aprimoradas. Objetivo:Descrever uma nova técnica simples e segura de confecção defístula traqueoesofágica secundária com o Dispositivo Ópticode Instalação de Prótese (DOIP). Método: Um novo material foiutilizado para realização de fístula traqueoesofágica secundáriaem seis pacientes submetidos a laringectomia total por carcinomaepidermóide avançado e com falha na reabilitação com vozesofágica. Resultados: Cinco de seis pacientes obtiveramsucesso com a nova técnica, sem complicações no ato operatórioe com emissão de som através da prótese fonatória no pósoperatórioimediato. Conclusão: A nova técnica de confecçãode fístula traqueoesofágica é simples e fácil com resultadossatisfatórios para a fonação e sem prejuízos para a deglutição.

Voz e deglutição de pacientes com e sem mobilidade laríngea após tireoidectomia / Voice and deglutition in patients with or without laryngeal mobility

INTRODUÇÃO: As queixas vocais e de deglutição podem ser apresentadas após o tratamento cirúrgico da doença de tireóide em pacientes com ou sem a mobilidade laríngea preservada. O objetivo do presente estudo foi avaliar e comparar a voz e a deglutição de pacientes com e sem mobilidade laríngea alterada após a tireoidectomia. MÉTODOS: Estudo prospectivo no qual foram avaliados pacientes com doença de tireóide divididos em dois grupos: GA, com mobilidade laríngea alterada após a tireoidectomia e GB, preservada. O protocolo de avaliação vocal perceptivo-auditiva e acústica e nasofibroscopia da deglutição foi aplicado no pré, pós-operatório recente e tardio. Ambos apresentaram percentual maior de mulheres, da faixa etária entre 46 a 65 anos e de tireoidectomia total. O número reduzido de tabagistas e da indicação de esvaziamento cervical também foi comum aos dois grupos. O carcinoma papilífero foi mais freqüente no GA e o bócio, no GB; e o volume do tecido ressecado foi menor no GA em relação ao GB. RESULTADOS: A avaliação da deglutição revelou que no GA, não houve alteração no pré-operatório (PRE). No pósoperatório recente (POR) foi observada em 87% e no pós-operatório tardio (POT), em 67%. Houve diferença estatística entre os períodos PRE e POR e PRE e POT (p<0,001). A penetração e aspiração com líquido foram identificadas em 33% da amostra no POR (p=0,014). A estase de alimento ocorreu em 87% no POR e 60% no POT(p<0,001). No GB, somente os resultados entre PRE e POR tiveram significância estatística para deglutição, com aumento de 44% no número de indivíduos com disfagia, apresentando estase e escape prematuro do alimento. Os resultados de voz indicaram que a disfonia em grau discreto caracterizada pela rugosidade esteve presente em 67% da amostra do GA no PRE. Houve diferença significativa entre PRE e POR, no grau geral, tensão, instabilidade, pitch, loudness e foco ressonantal. Entre PRE e POT, a significância ocorreu apenas no pitch e loudness...

INTRODUCTION: The vocal and deglutition complaints can be presented after surgical treatment of thyroid disease in patients with or without preserved laryngeal mobility. The objective of this study was to evaluate and to compare the voice and swallowing function of patients with and without laryngeal mobility after thyroidectomy. METHODS: This prospective study evaluated patients with thyroid disease divided in two groups: GA with laryngeal mobility modified after surgery and GB, preserved. The perceptual and acoustical analysis and fiberoptic endoscope of swallowing evaluation protocol were applied at preoperatory, recent and late post operatory. Both groups had presented bigger percentage of women, with age between 46 and 65 years, and total thyroidectomy. Reduced numbers of smokers and indication of neck dissection was common to the two groups. Papillary carcinoma was more frequent in the GA, and the benign tumor in the GB; and resected tissue volume was smaller in the GA in relation to GB. RESULTS: The evaluation of the deglutition indicated that the GA did not have alteration at preoperatory (PRE). At recent postoperative (POR) it was observed in 87% and at late period (POT), in 67%. There was statistical difference between PRE and POR, and PRE and POT (p< 0,001). Penetration and aspiration with liquid had been identified in 33% of the sample at POR (p=0,014). Residue of food occurred in 87% at POR and 60% at POT (p< 0,001). In the GB, the results between PRE and POR had significance only for deglutition, with increase of 44% in the number of individuals with dysphagia, presenting residue and premature escape of the food. Voice results had indicated light degree dysphonia characterized by the roughness in 67% of the sample of the GA at PRE. There was significant difference between PRE and POR, in the global grade, strain, instability, pitch, loudness and resonance focus. Between PRE and POT, the significance it occurred only in pitch...