Results of a Novel Technique for Increasing Bone Contact and Stability in Mandibular Reconstruction with Micro-vascularized Fibula Flap.

Background: Reconstruction of large mandibular defects requires reestablishment of mandibular continuity with bone and soft tissue. The microvascularized fibula flap (MFF) has the advantage of providing both, with adequate length, low resorption rate, low infection risk and possibility of dental implant insertion. It can be adapted to mandibular defects in many different ways. Purpose: This retrospective study will present and evaluate the results of the male-female joint technique for flap positioning and fixation. Methods: The technique consists of designing osteotomies on the binding edge of the MFF and recipient jaw, increasing bone contact from one to five faces. Patients submitted to mandibular reconstruction through this technique were included and evaluated regarding systemic compromise, complication occurrence as well as primary and long-term stability. Results: Ten patients underwent mandibular reconstruction with the male-female joint technique. Sixteen joints were applied, and excluding an early loss due to vascular failure, all remaining 14 joints healed uneventfully. None showed signs of early or late mobility. Conclusion: Fitting the MFF through a male-female joint that provides greater bone contact may improve stability and reduce screw loosening and mini-plate removal rates.

Sarcopenia as an early complication of patients with head and neck cancer with dysphagia.

OBJECTIVE: To evaluate the relationship between dysphagia and sarcopenia in patients with head and neck cancer (HNC). METHODS: A cross-sectional, prospective study, sample by convenience, including men with HNC during their initial oncologic evaluation. Patients answered questionnaires (demographic data, lifestyle habits, disease characteristics and the Short International Physical Activity Questionnaire). Swallowing capacity, bioelectrical impedance (BIA), handgrip strength (HGS) and physical performance test (Timed Up and Go test) were evaluated. Sarcopenia was diagnosed following the European Working Group on Sarcopenia and Foundation for the National Institute of Health criterion. RESULTS: 71 men, elderly (66.9 ± 6.25 years) and adults (53.17 ± 3.66 years), were divided into the dysphagic group (DG, 44) and the non-dysphagic group (NDG, 27). The DG presented lower body mass index (BMI), lower skeletal muscle mass and a higher number of sarcopenic individuals than the NDG (p < 0.05). The degree of dysphagia was associated with weight loss (p = 0.006) but not with sarcopenia (p = 0.084) in the DG. The multivariate analysis showed that age, percentage of weight loss and BMI interfered with pre-sarcopenia, and only age influenced sarcopenia (p < 0.005). CONCLUSION: Patients with dysphagia had a high prevalence of sarcopenia in the pre-treatment phase, related to age.

The interval since first symptoms until diagnosis of squamous cell carcinoma in the head and neck region is still a problem in southern Brazil

BACKGROUND: The aim was to examine the interval since first symptoms until final diagnosis of squamous cell carcinoma (SCC) in the head and neck region in southern Brazil. MATERIAL AND METHODS: The individuals were prospectively selected and underwent anamnesis, physical examination and interview in the first medical consultation at a Cancer Hospital from south of Brazil. RESULTS: From 488 patients who underwent clinical examination, 105 were included in the study with diagnosis of SCC. Patients average interval from first symptoms to final diagnosis was 152 days (median 86; max: 1105; min: 1), the average professional interval was 108 days (median: 97; max: 525; min: 1), and the average total period interval was 258 days (median: 186; max: 1177; min: 45). Factors statistically associated with patient and diagnosis itinerary intervals were smoking and poorly adapted dentures and distance from home to hospital, respectively. CONCLUSIONS: The identification of the itinerary characteristics of this specific population may reflect in more effective public policies, such as primary and secondary prevention programs, aiming to increase the survival of oncological patient. Furthermore, the knowledge of the variables that influence the late diagnosis minimizes patient's journey in search of care to cancer centers through health programs

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Evaluation of complications and flap losses in mandibular reconstruction with microvascularized fibula flap.

The mandibular defects caused by mandibulectomies can involve esthetic and functional sequelae in patients. The fibula presents positive aspects and can be used as an option for mandibular reconstruction after tumor resections or extensive traumas. Furthermore, this retrospective study of the patients who have passed through a mandibular reconstruction with a microvascular fibular flap over the last 17 years describes the experience of the Oral and Maxillofacial SurgeryService at the ErastoGaertner Hospital, Curitiba/PR. The use of this flap type has a complication rate of 32.3%, which includes the fixation material exposure, flap resorptions, fistulas, pathological fractures, tumor recurrence, infections, seromas, and thrombocytopenia. Most of them are associated with patients who have received radiotherapy and/or chemotherapy. These data suggest a high frequency of complications when a reconstruction plate fixation is used. Minor complications are usual and they should not be overlooked because they can lead to devastating consequences.

Core needle biopsy in the diagnosis of head and neck lesions: a retrospective study of 3 years.

The management of head and neck tumors is guided by its nature, location and extension. Despite CNB accuracy and efficiency being widely described in the literature, there are few studies that evaluate the diagnostic utility of the technique performed in an outpatient setting, in the diagnosis of head and neck tumors. The aim of this study is to present the experience, sensitivity, specificity and accuracy of the CNB performed in an outpatient setting, free handed, in an important oncology school-hospital. A total of 2007 patients with tumors in the head and neck treated for a period of 3 years were evaluated. A retrospective chart review was performed in 36 of these patients, who underwent core needle biopsy for diagnosis. All samples collected were subjected to histopathological analysis. Values of accuracy, sensitivity and specificity were 94, 92 and 100 %, respectively. In our service, held in an outpatient setting and without the aid of imaging tests, the core needle biopsy proved to be a test with high accuracy values, sensitivity and specificity, easy of application, low morbidity and high predictability, with great use in diagnosing tumors in head and neck.

Prevalence of oral lesions in 25 years of Oral Cancer Prevention campaigns in Paraná State, Brazil, 1988 to 2013

Introduction: Epidemiological studies add up as a large area of scientific research and play an important role revealing the prevalence of the several diseases in the place where they applied. Public and health professionals have become more aware of the importance of oral mucosal lesions. Objective: To determine the frequency of the oral lesions and determinate the epidemiological profile of patients attending the prevention of oral cancer campaigns in the state of Paraná, Brazil, between 1988 and 2013. Material and methods: A prospective study was conducted evaluating 25 years of oral cancer prevention campaigns in the state of Paraná, Brazil, between 1988 and 2013. All patients were evaluated in a systematic way and were older than 30 years, answering one questionnaire with data relating to harmful health habits, family history of cancer, family income, frequency of visits to dentists and knowledge on the subject. Results: A total of 22,300 patients were evaluated during the 25 years of projects and 3,731 had oral lesions, while 18,569 patients had no oral alterations during the evaluation. Among those patients, 13779 (61.78%) were female and 8521 (38.78%) were male, 843 (22.59%) were smokers, 578 (15.49%) used alcohol and in 1386 (37.14%) had the habit of using yerba mate. The prevalence of lesions occurred as follows: 533 (14.28%) cases of lesions with aspect of leukoplakia, 1095 (29.34%) inflammatory lesions, 1934 (51.83%) of traumatic origin and 169 (4 5%) classified as other. Conclusion: The campaigns have brought benefits to the health of the elderly population but it is still not enough to make up for low levels of oral lesions appearance. Education of the population should in this way be approached more seriously and effectively.

Diagnóstico nutricional de pacientes do serviço de cabeça e pescoço e sua relação com a disfagia em um hospital oncológico do Paraná / Nutritional status of patients from the head and neck service and its relationship with dysphagia in a cancer hospital of Paraná

Introdução: Pacientes com câncer de cabeça e pescoço apresentam comprometimento do estado nutricional que pode estar associado à disfagia. Objetivo: Avaliar o estado nutricional de pacientes casos novos admitidos pelo serviço de cabeça e pescoço e sua relação com a disfagia em um hospital oncológico do Paraná. Metodologia: Estudo transversal, quantitativo e prospectivo. Foram coletados dados como: sexo, idade, tabagismo, etilismo, diagnóstico médico, estadiamento tumoral, consistência alimentar consumida atualmente, presença de trismo, odinofagia e xerostomia, sinais clínicos sugestivos de disfagia, peso, altura, circunferência do braço (CB), circunferência muscular do braço (CMB) e prega cutânea triciptal (PCT). A disfagia foi classificada conforme capacidade de deglutição relatada pelo paciente. Resultados: Participaram do estudo 54 pacientes, 79,6% eram do sexo masculino. Dos pacientes que apresentaram perda de peso moderada e grave 86,8% encontravam-se com doença avançada (III e IV), (p< 0,01). A perda de peso esteve presente em 90,7% (49) dos pacientes, destes 77,5% alteraram a consistência da dieta e 79,5% citaram disfagia. Dentre os pacientes eutróficos, sobrepesos e obesos pelo IMC, 89,7% apresentaram perda ponderal leve à grave. A desnutrição conforme CB, PCT e CMB esteve associada à disfagia (p < 0,01). O diagnóstico de desnutrição pelo IMC não apresentou relação com a disfagia. Conclusão: A desnutrição está relacionada com a disfagia quando avaliado pelos métodos de CB, PCT e CMB. O IMC subestimou pacientes que estavam desnutridos e já apresentavam sinais de disfagia, não podendo ser utilizado como método isolado de avaliação nutricional destes pacientes.

Introduction: Patients with head and neck cancer have impairment nutritional status that may be associated with dysphagia. Objective: To evaluate the nutritional status of patients admitted being new cases of head and neck service and its relationship with dysphagia in a cancer hospital of Paraná. Methods: Cross-sectional study, quantitative and prospective. Data were collected as sex, age, smoking, alcohol consumption, medical diagnosis, tumor staging, currently consumed food consistency, presence of trismus, odynophagia and xerostomia, clinical signs of dysphagia, weight, height, arm circumference (AC), arm muscle circumference (AMC) and triceps skinfold thickness (TSF). Dysphagia was classified as swallowing capacity reported by the patient. Results: The study included 54 patients, 79.6% were male. Among patients with moderate weight loss and severe 86.8% had advanced disease (III and IV), (p <.01). The weight loss was present in 90.7% (49) patients and 77.5% of these changed the consistency of the diet and 79.5% reported dysphagia. Among eutrophic patients, overweight and obese by BMI, 89.7% presented severe weight loss. Malnutrition as CB, PCT and WBC was associated with dysphagia (p <.01). The diagnosis of malnutrition by BMI was not associated with dysphagia. Conclusion: Malnutrition is related to dysphagia when evaluated by CB, PCT and CMB methods. BMI underestimated patients who were malnourished and already presented signs of dysphagia, cannot being used as an isolated nutritional evaluation method of these patients.

Prevalence of oral lesions in elderly patients on oral cancer prevention campaigns in Paraná state Brazil 1989-2013 / Prevalência de lesões orais em pacientes idosos atendidos em campanhas de prevenção de câncer bucal no estado do Paraná, Brasil entre 1989 - 2013

Objective: recently, there has been a rapid aging process of the world population. Despite of a longer permanence of natural teeth and a reduction of oral diseases caused by the improvement of life conditions and the provision of health care, the prevalence of oral diseases in the elderly is still considered significant. Therefore, the aim of this study is to evaluate the epidemiological profile of elderly patients (above 60 years old) attended in 25 years of campaigns oral cancer prevention in the Paraná state, Brazil, between 1989 and 2013. Material and Methods: Patients, volunteers, were evaluated during 25 years of oral cancer prevention by the campaign team and all patients were evaluated in a methodical way with inspection of all intra-oral areas. Results: a total of 22,909 patients were attended during the 25 years of projects. Of these, 6,134 were older than 60 years old, with appearance of 1,523 oral lesions during the examination and 4,611 patients had no oral alterations during the dentist evaluation, among those were found injuries by traumatic origin, inflammatory lesions and others types of injury. Conclusion: it is clear the necessity for specialized care and active surveillance of these patients, since it is a consensus in the literature that the best treatment is early diagnosis. It is also necessary the development of epidemiological studies of the elderly population, which are scarce and difficult to elaboration of plans for effective action to meet the specific demands of this age group.

Objetivo: a população mundial atualmente sofre com um rápido processo de envelhecimento. Apesar de uma maior permanência dos dentes naturais e da redução de doenças bucais causadas pela melhoria das condições de vida e da prestação de cuidados de saúde, a prevalência de doenças bucais em idosos ainda é considerado significativa. Portanto, o objetivo deste estudo é avaliar o perfil epidemiológico dos pacientes idosos (acima de 60 anos) que foram atendidos em 25 anos de campanhas de prevenção do câncer de boca no estado do Paraná, Brasil, entre 1989 e 2013. Material e Métodos: Os pacientes foram selecionados voluntariamente e avaliados durante 25 anos de prevenção de câncer bucal pela equipe participante, os quais foram avaliados de forma metódica com a inspeção de todas as áreas intra-orais. Resultados: um total de 22.909 pacientes foram atendidos durante os 25 anos de projetos. Destes, 6.134 tinham mais de 60 anos, com presença de 1.523 pacientes com lesões orais durante o exame e 4.611 pacientes sem alterações orais durante a avaliação do dentista. As lesões encontradas tinham origem traumática, inflamatórias e outras. Conclusão: é evidente a necessidade de atendimento especializado e da busca ativa desses pacientes, uma vez que é um consenso na literatura de que o melhor tratamento de lesões orais é o diagnóstico precoce. Também é necessário o desenvolvimento de estudos epidemiológicos da população idosa, que são escassos e difíceis de elaboração assim como a realização de planos de ação eficazes para atender às demandas específicas desta faixa etária.

Unilateral Gingival Fibromatosis: a case report / Fibromatose Gengival Unilateral: um relato de caso

The gingival fibromatosis is a slow and progressive benign proliferation, which affects the gingival tissues. It may present a genetic inheritance and association with some syndromes. There are conservative and radical treatments, ranging from hygiene care to bloc resection of the affected bone. This case scenario is a 07 year-old child, who presented a nodular unilateral hyperplastic lesion in the right mandible, with sessile base and approximately 5 cm in its largest diameter. The patient presented difficulty of lip closure and slight swelling in the right area of the face. The tomographic image showed infiltration in buccal and lingual cortical of right mandible and tooth displacement. After lesion removal, the histopathologic diagnosis of fibromatosis was confirmed, with no relapse after 20 months of follow-up.

A Fibromatose Gengival é uma proliferação benigna, lenta e progressiva, que afeta os tecidos gengivais. Pode apresentar herança genética e associação à uma série de síndromes. Existem tratamentos conservadores e radicais, desde cuidados com higiene à ressecção em bloco do tecido ósseo afetado. Este é o caso clínico de uma criança, que apresentou lesão hiperplásica unilateral em mandíbula, com deslocamento dentário. Após remoção, o diagnóstico de hiperplasia gengival foi confirmado e não há recidiva da lesão até o momento.

Allelic variants of XRCC1 and XRCC3 repair genes and susceptibility of oral cancer in Brazilian patients.

BACKGROUND: The capacity for DNA repair is essential in maintaining cellular functions and homeostasis; however, this capacity can be altered based on DNA sequence variations in DNA repair genes, which may contribute to the onset of cancer. Many single-nucleotide polymorphisms (SNPs) in repair genes have been found to be associated with oral cancer. The aim of this study was to investigate the relationship between the presence of allelic variants Arg194Trp (rs:1799782) and Arg399Gln (rs: 25487) of XRCC1 gene and Thr241Met (rs: 861539) of XRCC3 gene and susceptibility to oral cancer. We also attempted to correlate the frequencies obtained for each of the SNPs to histopathological parameters. METHODS: A case-control study was conducted with genomic DNA from 150 patients with oral squamous cell carcinomas and 150 controls. SNPs were genotyped by RFLP-PCR. RESULTS: The presence of the polymorphic variants of the XRCC1 gene within codon 194 (OR 0.82, 95% CI: 0.44-1.51) and codon 399 (OR 0.94, 95% CI: 0.59-1.50) and within the XRCC3 gene (OR 0.72; 95% CI: 0.45-1.16) were not associated with an increased risk of oral cancer. A combinational analysis of SNPs in both genes indicated no association. The presence of the allelic variants of these two genes had no statistically significant effect on tumor differentiation, lymph node invasion or tumor size. CONCLUSIONS: These results suggest that allelic variants of XRCC1 and XRCC3 are not suitable markers for susceptibility to carcinomas of the oral cavity and are also not related to the later stages of such tumors.

Total thyroidectomy with ultrasonic scalpel: a multicenter, randomized controlled trial.

BACKGROUND: The ultrasonic scalpel is a recently introduced device in head and neck surgery. Total thyroidectomy is the most common endocrine procedure performed by surgeons. METHODS: This was an open, phase IV, multicenter, randomized controlled trial (RCT) that compared the use of an ultrasonic scalpel with a conventional technique in patients who underwent total thyroidectomy. The outcomes were surgical complication rate, operative time, drainage volume, postoperative pain, and costs. RESULTS: In all, 261 patients were included in 11 centers. There was a mean difference of 17% of operative time in favor of the ultrasonic scalpel group. There were no differences in postoperative complications. There was a difference in costs of 14% in favor of the ultrasonic scalpel group, but it was not statistically significant. CONCLUSIONS: The use of an ultrasonic scalpel was as safe as that of the conventional technique and had the advantage of a shorter operative time and lower postoperative drainage. Costs were not different between groups.

Incidence of second primary oral cancer tumors: a retrospective study / Incidência de segundos tumores primários de câncer de boca: um estudo retrospectivo

Purpose: Most head and neck malignant neoplasias are diagnosed in advanced stages. Another threatening element to the patients' survival chances and quality of life is the high risk of developing a second primary tumor (SPT). SPT significantly worsens prognosis, and for that reason patients must be monitored for early diagnosis. The main objective of this study was to analyze the occurrence of SPTs in patients with oral squamous cell carcinoma (OSCC) treated in Erasto Gaertner Hospital (EGH), Curitiba, PR, Brazil, in a period of 16 years. Methods: Design: retrospective study. The sample comprised patients with OSCC who developed SPT between January 1990 and December 2005. Demographic and clinical data were recorded form the patients' medical charts and analyzed with descriptive statistics. Results: During this period, 34,637 patients were admitted at EGH. A total of 1,637 (4.4%) patients were diagnosed with OSCC, and 37 (2.7%) developed a SPT. Patients who developed SPT were 29 (78.4%) male and 8 (21.6%) female, with a median age of 58 years old. The most frequent anatomical SPT site was the mouth, oropharynx and oesophagus, with an overall survival of 27%. Conclusion: Patients treated from OSCC must be carefully monitored because of the increased risk of SPT, especially when there is a continuous history of tobacco and alcohol consumption.

Objetivo: A maioria das neoplasias malignas de cabeça e pescoço é diagnosticada em estágios avançados. O alto risco de desenvolver um segundo tumor primário (STP) diminui a taxa de sobrevida dos pacientes. STP piora significativamente o prognóstico e estudos sobre ele devem ser realizados para se descobrir seus fatores de risco e melhor forma de tratamento. O principal objetivo deste estudo foi analisar a ocorrência de STP em pacientes com carcinoma epidermóide bucal (CEB) tratados no Hospital Erasto Gaertner (HEG), Curitiba, PRP, Brasil, num período de 16 anos. Metodologia: Um estudo retrospectivo foi realizado a fim de revisar os pacientes com CEB que desenvolveram STP entre Janeiro de 1990 e Dezembro de 2005. Os dados demográficos e clínicos foram coletados através dos prontuários médicos dos pacientes e foram analisados por estatística descritiva. Resultados: Neste período, 34.637 pacientes foram admitidos no HEG. Um total de 1637 (4,4%) pacientes recebeu diagnóstico de CEB, dos quais 37 (2,7%) desenvolveram STP. Os pacientes que desenvolveram STP eram 29 (78,4%) homens e 8 (21,6%) mulheres, com média de idade de 58 anos. Os sítios anatômicos mais frequentes para o STP foram a boca, orofaringe e esôfago; a taxa de sobrevivência foi de 27%. Conclusão: Pacientes tratados de CEB devem ser examinados cuidadosamente e monitorados regularmente por causa do alto risco de desenvolver um STP, especialmente aqueles que mantêm os hábitos de tabagismo e etilismo.

Prevenção em câncer bucal: 20 anos de campanha anti-tabaco no estado do Paraná, Brasil / Oral cancer prevention: 20 years of anti-tabagism campaign in Paraná, Brazil

Introdução: O câncer de boca é o 6º tipo mais frequente deneoplasia maligna no mundo. Sabe-se que o maior fator de riscoassociado a essa doença é o tabagismo. Objetivo: Relatar aexperiência de 19 anos de campanhas de prevenção de câncerde boca e tabagismo. Método: No período de 1989 a 2007 foramrealizadas campanhas de prevenção ao câncer de boca naregião central da cidade de Curitiba / PR - Brasil. Adicionalmenteao exame clínico intra-oral, os pacientes responderam a umquestionário com informações sócio-econômicas e hábitos derisco, como tabagismo e etilismo. Resultados: Foram examinadasum total de 4.405 pessoas. Foram detectadas 687 lesões oraisclassificadas como traumáticas, inflamatórias, leucoplasias,eritroplasias e malignas. Pudemos observar que porcentagem depacientes fumantes diminuiu de 22,5% em 1989 para 16,7% em2007, seguindo a tendência nacional divulgada pelo Ministério daSaúde. Os pacientes foram encaminhados para o Hospital ErastoGaertner para atendimento e conduta. Conclusão: Em 18 anosde campanha de prevenção pudemos diagnosticar precocementelesões potencialmente malignas, bem como orientar a populaçãosobre os fatores de risco em especial o tabaco. As campanhasde prevenção são um importante instrumento de diagnósticoprecoce para melhorar os indices de morbidade e mortalidade docâncer de boca.

Introduction: Oral cancer is the 6º most frequent type of cancerin the world, and one of the main causes is smoking habits.Objective: Report our 18 years experience on oral cancerprevention and tabagism. Method: We examinated people inthe streets of Curitiba / PR-Brazil, between 1989 and 2007, fororal lesions. In addition to the clinical exam, patients filled outa thorough form with social and economic information and alsoharmful habits, such as smoking and alcohol drinking. Results:4.405 people were examinated. We diagnosed 687 oral lesions(traumatic, inflammatory, leukopakia, erythroplakia, malignancysuggestivelesions). Total average of smoking patients was22.5% on 1989 and 16.7% on 2007, following the national trend,as reported by the Ministry of Health. All patients presentingoral lesions were sent to Hospital Erasto Gaertner in Curitiba.Conclusion: During 18 years of prevention campaigns we wereable to early diagnose potencially malignant lesion and to orientgeneral population about risk factors for oral cancer, speciallytobacco. Oral campaigns and screening are an important tool forprevention and to improve oral cancer morbidity and mortality.

[Oral cancer surgery and oral cutaneous fistulas: risk factors]. / Fístulas orocutâneas após cirurgia de câncer da cavidade oral: fatores de risco.

OBJECTIVE: To quantify the oral cutaneous fistulae after surgery and to identify possible risk factors. METHODS: A retrospective study, interesting patients that were submitted to surgery, with a two years minimum post-operative follow up. The considered variables were: sex, concomitant diseases, tabacco and alcohol use, the anesthesic and pulmonary risks, clinical stage, cervical linphadenectomy, pre or postoperative radiotherapy, accidents during the surgery, wound infection and or hematoma, pulmonary infection, surgery and reconstruction extension. RESULTS: In 159 patients, oral cutaneous fistulae occurred in 48 patients (30,3%): Patients stage T1 in 26,6 %,T2 in 1,8 %,T3 in 16%, and T4 in 40,3% (p=0,0138). The cases N+ developed fistulae in 22.9%, (N2c with 42,8%, (p=0,0136), those with preoperative radiotherapy in 63,6% (p=0,0346) Those with wound infection in 47,3% (p=0,0146), and those with wound deiscense in 53,7 % (p=0,0030). The fistulae rate was of 60% in the regional mucocutaneous flaps reconstruction cases, 39,2% in the myocutaneous ones and 12,5% of microsurgery ones (p=0,0286). CONCLUSION: The general rate of oral cutaneous fistulae was 30,3%. The significant factors were: T stage, cervical linphadenectomy, pre or postoperative radiotherapy, wound infection and deiscense, and the use of flaps.

Fístulas orocutâneas após cirurgia de câncer da cavidade oral: fatores de risco / Oral cancer surgery and oral cutaneous fistulas: risk factors

OBJETIVO: Quantificar as fístulas após cirurgia de câncer da cavidade oral e identificar fatores de risco. MÉTODOS: Estudo retrospectivo, interessando pacientes submetidos à cirurgia. Seguimento pós-operatório mínimo de dois anos. Variáveis estudadas: sexo, comorbidades, tabagismo, etilismo, risco anestésico e pulmonar, estadiamento clínico, linfadenectomia cervical, tratamento radioterápico, acidentes cirúrgicos, infecção ou deiscência de ferida operatória, seroma ou hematoma de sítio cirúrgico, infecção respiratória no pós-operatório, tipo de cirurgia e reconstrução realizadas. RESULTADOS: Estudados 159 pacientes. Ocorreu fístula orocutânea em 30,3 por cento (48 pacientes). Pacientes T3 tiveram fístula em 16 por cento dos casos, T4 em 40,3 por cento e naqueles estádio T1 ou T2, 26,6 por cento e 1,8 por cento respectivamente (p=0,0138). Os casos N+ evoluíram com fístula em 22.9 por cento (N2c com 42,8 por cento, p=0,0136), os com radioterapia pré-operatória em 63,6 por cento (p=0,0346). Aqueles com infecção de sítio cirúrgico em 47,3 por cento (p=0,0146) e aqueles com deiscência de ferida operatória em 53,7 por cento (p=0,0030). O índice de fístula foi de 60 por cento nos retalhos regionais mucocutâneos, de 39,2 por cento nos miocutâneos e de 12,5 por cento com retalho microcirúrgico (p=0,0286). CONCLUSÃO: O índice de fístulas foi de 30,3 por cento. Foram estatisticamente significativos para ocorrência de fístulas: estádio T, linfadenectomia cervical bilateral, radioterapia pré ou pós-operatória, infecção e deiscência de ferida operatória, e o uso de retalhos para reconstrução.

OBJECTIVE: To quantify the oral cutaneous fistulae after surgery and to identify possible risk factors. METHODS:A retrospective study, interesting patients that were submitted to surgery, with a two years minimum post-operative follow up. The considered variables were: sex, concomitant diseases, tabacco and alcohol use, the anesthesic and pulmonary risks, clinical stage, cervical linphadenectomy, pre or postoperative radiotherapy, accidents during the surgery, wound infection and or hematoma, pulmonary infection, surgery and reconstruction extension. RESULTS: In 159 patients, oral cutaneous fistulae occurred in 48 patients (30,3 percent): Patients stage T1 in 26,6 percent,T2 in 1,8 percent,T3 in 16 percent, and T4 in 40,3 percent (p=0,0138). The cases N+ developed fistulae in 22.9 percent, (N2c with 42,8 percent, (p=0,0136), those with preoperative radiotherapy in 63,6 percent (p=0,0346) Those with wound infection in 47,3 percent (p=0,0146), and those with wound deiscense in 53,7 percent (p=0,0030). The fistulae rate was of 60 percent in the regional mucocutaneous flaps reconstruction cases, 39,2 percent in the myocutaneous ones and 12,5 percent of microsurgery ones (p=0,0286). CONCLUSION: The general rate of oral cutaneous fistulae was 30,3 percent. The significant factors were: T stage, cervical linphadenectomy, pre or postoperative radiotherapy, wound infection and deiscense, and the use of flaps.

Contact endoscopy (Stomatoscopy) versus histological diagnosis of lesions of the lower lip vermilion area

In Brazil, the incidence of oral cavity cancer is estimated at 14,160 new cases in 2008. Contact endoscopy (stomatoscopy) applied to the oral cavity may favor early diagnosis. The aim of this study is to compare the contact endoscopy diagnosis to histological diagnosis of lesions of the lower lip vermilion area. Fifty-three prospective, ex vivo, non-consecutive lesions of the lip vermilion area were stained with toluidine blue solution, examined with stomatoscopy and directly biopsied. False-negatives did not occur and false-positives represented 9.4 percent. Sensitivity to diagnosis of malignancy was 100 percent, specificity was 88 percent, positive predicted value was 70.5 percent, negative predictive value was 100 percent and accuracy was 90.3 percent. Sensitivity and specificity of the contact endoscopy were high and the positive predictive value in relation to diagnosis of malignant lesions was good. Thus, stomatoscopy may be useful to diagnose lesions of the lower lip vermilion area.

Accuracy, sensitivity and specificity of fine needle aspiration biopsyin salivary gland tumours: A retrospective study

Objective: The aim of this study was to evaluate the diagnostic accuracy, sensitivity and specificity of fine needleaspiration biopsies (FNAB) of salivary gland tumours performed at the Erasto Gaertner Hospital over the courseof a four year period. Study design: A retrospective study was carried out between 2001-2005 to review thecases of patients with salivary gland tumours who had undergone pre-operative FNAB and had been diagnosedduring post-operative histopathology examination. Results: A total of 106 cases of salivary gland tumours wereconsidered for this study, but 27 cases (25.5%) of the samples were considered unsatisfactory for analysis. Thesensitivity, specificity and accuracy were calculated considering only the 79 benign and malignant cases in whichFNAB provided sufficient samples for analysis. Based on these data, the value of sensitivity was 68.2% (15/22),specificity was 87.7% (50/57), accuracy was 82.3% (65/79), positive predictive value was 68.2% (15/22) and negativepredictive value was 87.7% (50/57). Conclusions: Despite the high rate of inadequate samples obtained in theFNAB in this study, the technique offers high specificity, accuracy and acceptable sensitivity (AU)

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Accuracy, sensitivity and specificity of fine needle aspiration biopsy in salivary gland tumours: a retrospective study.

OBJECTIVE: The aim of this study was to evaluate the diagnostic accuracy, sensitivity and specificity of fine needle aspiration biopsies (FNAB) of salivary gland tumours performed at the Erasto Gaertner Hospital over the course of a four year period. STUDY DESIGN: A retrospective study was carried out between 2001-2005 to review the cases of patients with salivary gland tumours who had undergone pre-operative FNAB and had been diagnosed during post-operative histopathology examination. RESULTS: A total of 106 cases of salivary gland tumours were considered for this study, but 27 cases (25.5%) of the samples were considered unsatisfactory for analysis. The sensitivity, specificity and accuracy were calculated considering only the 79 benign and malignant cases in which FNAB provided sufficient samples for analysis. Based on these data, the value of sensitivity was 68.2% (15/22), specificity was 87.7% (50/57), accuracy was 82.3% (65/79), positive predictive value was 68.2% (15/22) and negative predictive value was 87.7% (50/57). CONCLUSIONS: Despite the high rate of inadequate samples obtained in the FNAB in this study, the technique offers high specificity, accuracy and acceptable sensitivity.

Carcinoma anaplásico de tireóde: experiência do Hospital Erasto Gaertner / Anaplastic carcinoma of the thyroid: experience of Hospital Erasto Gaertner

Introdução: O carcinoma anaplásico de tireóide é uma neoplasia maligna agressiva com alta taxa de mortalidade apesar das terapêuticas instituídas. Objetivos: Identificar fatores que possam estar relacionados ao aumento da sobrevida. Métodos: Foram analisados 67 pacientes com carcinoma anaplásico da tireóide tratados entre 1973 e 2006. O tratamento incluiu cirurgia, radioterapia, quimioterapia ou formas associadas de tratamento. A análise da sobrevida foi calculada através do método de Kaplan-Maier. A análise dos fatores e comparação das taxas de sobrevida foi feita pelo teste de log rank. Resultados: A maioria dos pacientes (85%) apresentou massa cervical ao diagnóstico; 32 pacientes (48%) apresentaram linfadenopatia cervical. Metástases à distância estiveram clinicamente presentes em 25 (37%) pacientes. A sobrevida média foi de 5,3 meses e todos (98,5%), exceto uma paciente, foram a óbito em dois anos do diagnóstico. A ausência de linfadenopatia cervical (0,045) e a abordagem com ressecção cirúrgica (p = 0,001) estiveram associadas a melhor sobrevida.Conclusão: O carcinoma anaplásico da tireóide é uma doença de alta mortalidade apesar das estratégias de tratamento. Parece que alguns pacientes se beneficiam com uma abordagem agressiva.

Introduction: Anaplastic thyroid carcinoma is an aggressive malignancy associated with a highly lethal clinical course despite therapeutic intervention. Objective: To identify factors that could potentially improve survival. Methods: The outcome was assessed in 67 patients with anaplastic thyroid carcinoma treated between 1973 and 2006. Treatment included surgery, radiotherapy, chemotherapy and combined treatment. Survival was calculated by the Kaplan-Meier method. Potential factors affecting survival were compared by the log rank test. Results: Most patients (85%) presented with a neck mass; 32 patients (48%) also had cervical lymphadenopathy. Distant metastases were clinically present in 25 (37%). Median survival was 5.3 months and all (98.5%) but one patient died within 2 year of diagnosis. The absence of cervical lymphadenopathy (p= 0,045) and the adoption of surgery (p = 0.001) were associated with best survival. Conclusion: Anaplastic thyroid carcinoma remains a deadly disease despite treatment strategies. It seems that some patients might benefit from an aggressive approach.

Reconstrução da mandíbula utilizando o retalho microvascularizado de fíbula: 11 anos de experiência do Hospital Erasto Gaertner / Mandibular reconstruction with microvascularized fibula free flap: 11-year experience of Hospital Erasto Gaertner

Introdução: Os defeitos da mandíbula causados por mandibulectomias podem trazer seqüelas estéticas e funcionais aos pacientes. Objetivo: Avaliar os pacientes submetidos reconstrução da mandíbula utilizando o retalho microvascularizado da fíbula no período de janeiro de 1997 a dezembro 2007. Métodos: Foram analisados retrospectivamente os prontuários médicos, com tempo de seguimento variando de 12 a 120 meses. Resultados: 26 pacientes foram submetidos à cirurgia, com idade média de 39 anos. Os tipos histológicos mais comuns foram o carcinoma espinocelular em 10 (38,5%) pacientes e o ameloblastoma em sete (26,9%) pacientes. Foi observada alguma complicação em 12 (46,1%) pacientes, incluindo complicações precoces em oito (30,8%) pacientes e tardias em sete (26,9%) pacientes. Dois pacientes apresentaram perda total do retalho e um paciente evoluiu a óbito por complicações clínicas no pós-operatório. Conclusões: O retalho microvascularizado de fíbula mostrou-se eficaz nas reconstruções da mandíbula, porém, com taxas de morbidade consideráveis.

Introduction: Mandibular defects caused by mandibulectomy can result in esthetic and functional sequel for patients. Objective: To investigate the mandibular reconstructions using a composite microvascular free fibula flap from January, 1997 to December, 2007. Methods: A retrospective analysis of the medical records was carried out and the follow-up time varied from 12 to 120 months. Results: Twenty-six patients with an average age of 39 years-old were operated on during the study period. Squamous cell carcinoma was the commonest type of resected tumor, in 10 (38.5%) patients, followed by ameloblastomas, which were found in 7 (26.9%) patients. Other tumors, such as myxomas, fibrous dysplasia and giant cell tumors were also treated. Complications occurred in 12 (46.1%) patients, including precocious complications in 8 (30.8%) patients and late complications in 7 (26.9%) patients. Full flap loss occurred in two patients, and one died of postoperative complications. Conclusion: Mandibular reconstruction with a free fibula flap has an acceptable success rate, but the morbidity associated with this technique is substantial and cannot be ignored.