Sentinel Lymph Node Biopsy in Oral and Oropharyngeal Squamous Cell Carcinoma: Statistical Validation and Impact of Micrometastasis Involvement on the Neck Dissection Decision.

PURPOSE: To evaluate the effectiveness of sentinel lymph node biopsy (SLNB) as an optimal staging method in oral and oropharyngeal squamous cell carcinoma (OOSCC) and the impact of the extent of SLN involvement on the decision for neck dissection (ND). MATERIALS AND METHODS: A prospective cohort study was performed in 96 consecutive patients with stage T1 to T4N0M0 OOSCC (mean follow-up, 62.9 months). SLN localization was determined using cervical lymphoscintigraphy and single-photon emission computed tomography. Patients underwent SLNB examination and ND. The ND specimen was investigated by hematoxylin and eosin (H&E) staining and the SLNs were investigated using H&E staining and step-serial sectioning and cytokeratin antibodies AE1 and AE3. The statistical study calculated the sensitivity and negative predictive value (NPV). The sample size of 96 patients was calculated for a 95% confidence interval with an accuracy of ±2% and an estimated a priori sensitivity of 99% compared with the benchmark. The impact of extent of SLN involvement on the decision for ND was analyzed by χ(2) test. A logistic regression model was used to assess the association of predictor variables with SLN involvement and neck disease. RESULTS: The diagnostic accuracy, sensitivity, NPV, and negative likelihood ratio were 95%, 88%, 94%, and 0.06. The statistical comparison between the extent of metastatic involvement of the SLN and neck disease was important for SLN macrometastasis (odds ratio = 11.9), but not for SLN micrometastasis (odds ratio = 0.93). CONCLUSIONS: SLNB examination is an excellent staging method in OOSCC. The present data indicate a very small risk of additional lymph node metastasis with SLN micrometastasis.

Modelo y cumplimentacion de alta hospitalaria de la unidad de gestión clínica de cirugía oral y maxilofacial. Cómo mejorarlo / Filling in the hospital discharge report in an oral and maxillofacial surgery clinical management unit. how to improve it

Objetivos. Conocer la calidad y grado de cumplimentación de la información recogida en las altas hospitalarias (IAH) del Servicio de Cirugía Oral y Maxilofacial de nuestro hospital. Material y métodos. Estudio descriptivo transversal de 152 altas hospitalarias. Incluye un total de 35 ítems agrupados. Para la evaluación del IAH valoramos la ausencia y el déficit de información. El criterio de adecuación se fijó por consenso en la cumplimentación del 90% de los ítems de forma correcta. Con el fin de conocer la fiabilidad de los resultados obtenidos se realizó la evaluación por dos revisores de forma independiente y en caso de discordancia se tomó la decisión por consenso tras revisar la historia clínica. Resultados. El 53,94% de los IAH disponen del 90% de los ítems completos y correctos del modelo de alta de nuestro Servicio. El 10,74% presentan alguna ausencia y el 65,79% de IAH presentan algún déficit de información. Se observa una variabilidad importante en la cumplimentación según el tipo de ítem analizado. Conclusiones. Nuestro trabajo valora la calidad de un modelo específico de IAH con ítems previamente seleccionados, considerados útiles y adecuados para reflejar de forma completa, exacta y precisa el proceso asistencial que recibe el paciente y detecta que los ítems: teléfono, residente, fechas de consulta, biopsia y de informe de biopsia, cirugía mayor ambulatoria e intervención urgente deben mejorarse(AU)

Objectives. To determine the quality and compliance to the information contained in the hospital discharge registry (HDR) issued by the Department of Oral and Maxillofacial Surgery in our hospital. Materials and Methods. A cross-sectional descriptive study was conducted to evaluate 152 HDR reports. These reports included a total of 35 items. We observed that there was a lack of information and some mistakes when filling the HDR boxes. Suitability criteria were set up by consensus as the completion of 90% of the items examined. To evaluate the reliability of the results, an assessment was performed by two reviewers independently, and in case of disagreement the decision was made by consensus after reviewing the medical record. Results. Only 53.94% of the HDR had 90% of the items completed appropriately; 10.74% had some items missing when filling in the form, and 65.79% lacked some information. Depending on the type of item there was a significant variation in the completion of the form. Conclusions. In the present work, we assess the quality of a specific hospital discharge form in our hospital, with items previously selected as useful and appropriate to reflect a complete, accurate and precise view of the care process of the patient, and improvements were needed in items such as, telephone, home address, date of consultation, biopsy report and the date it was performed, ambulatory surgery and emergency response(AU)

Telemedicine as an effective tool for the management of temporomandibular joint disorders.

PURPOSE: To evaluate the effectiveness of a store-and-forward telemedicine system (SFTMS) as an optimal method for the selection, diagnosis and treatment of patients with TMJ disorders (TMJD) referred from primary care sites to the Maxillofacial Surgery Unit (hospital-based). MATERIALS AND METHODS: A multicenter, analytical, quasi-experimental, non-randomized clinical study of a SFTMS aimed towards the management of patients with TMJD was conducted at the Oral and Maxillofacial Surgery Unit of the Virgen Macarena University Hospital (Seville, Spain) and 10 primary care areas of the North area of Seville located between 15 and 180 km from the hospital. The study was carried out between January 2008 and February 2010 including a non-random sample consisting of all patients with TMJD treated at primary care sites during the study period. We describe the development and effectiveness of this method based on the rates of diagnosis of myofascial syndrome and/or internal deragement Wilkes Stages I-II-III, internal deragement Wilkes Stages IV-V, other arthropathies, resolved teleconsultations, second teleconsultations, referrals to hospital, mean treatment delay, lost hours working/patient and complaints. The same variables were also described for the TMJD conventional consultation system at hospital (standard system). Descriptive statistics (frequency tables, means and medians, and dispersion measures), T-Student test was used to compare the differences in the average quantitative variables (time) and Chi2 test was used to compare the differences in the average qualitative variables. RESULTS: Over a 24-month period, 710 patients with TMJD were assisted at hospital by conventional consultation from 1-1-2008 to 2-25-2010, of which 587 (82.7%) were women and 123 (17.3%) were men with a mean age of 41.08 years. The mean time elapsed until treatment onset was 78.6 days, with a mean cost of 32 lost working hours per patient. In this period, 342 patients with TMJD were assisted by teleconsultation, of which 276 (80.7%) were women and 66 (19.2%) were men with a mean age of 38.3 years. Only 35 (10%) patients presented some other TMJ pathology that required maxillofacial surgery. The remaining 307 (89.7%) received non-surgical treatment in the primary care center (high resolutive consultations) in a mean time of 2.3 days (p<0.05), and a mean cost of 16 lost working hours/patient (p<0.05). CONCLUSIONS: Telemedicine allows a correct diagnosis and an adequate treatment for the majority of TMJD from primary care sites and shortens the delay in treatment onset, preventing displacement and unnecessary costs for these patients.

Quality of life in long-term oral cancer survivors: a comparison with Spanish general population norms.

PURPOSE: Health-related quality-of-life (HRQOL) data are becoming an important supplement to information pertaining to treatment outcomes for cancer patients. The purpose of this study was to evaluate the HRQOL of patients undergoing primary surgery for oral squamous cell carcinoma > or =5 years after treatment compared with the Spanish general population norms. MATERIALS AND METHODS: A total of 50 oral cancer patients (mean age 55.78 years, 80% male) with cancer-free survival of > or =5 years after surgery were enrolled. HRQOL was assessed with a standardized questionnaire: the Medical Outcomes Study Short Form 36-Item Health Survey. RESULTS: The Medical Outcomes Study Short Form 36-Item Health Survey scores of the oral cancer patients did not differ significantly from those of an age- and gender-matched sample from the Spanish normative population, except for the pain and social functioning domains. The patients had significantly better results compared with the population norms (Wilcoxon test, P < .05) in the physical function, general health, and vitality domains. CONCLUSIONS: These results provide patient-reported evidence that oral cancer survivors have a similar HRQOL compared with the general Spanish population. We also believe that it would be necessary to analyze the quality of life > or =5 years after treatment or from the moment the patient was discharged.

Synchronous unilateral parotid neoplasms. A case report

The parotid gland is the most usual location of benign neoplasms affecting major salivary glands and quite oftenthe recurrence of these tumours is noticed, specially in the case of pleomorphic adenoma. The occurrence of multipletumours in the parotid glands is rare and the majority of these are multifocal Warthin`s tumors (papillary cystadenomalymphomatosum). The simultaneous development of tumours with different histological types is unusualand when it occurs, the most common combination is a pleomorphic adenoma and a Warthin`s tumor. There aremany articles about Multiple Parotid Tumors (MPT) but only a few of them are focused on unilateral synchronousbenings tumors, being pleomorphic adenoma and Warthin´s these tumors.The report describes a 55 year old female with a pleomorphic adenoma occurring synchronously with a Warthin`stumor within the superficial lobe of her left parotid gland (AU)

Synchronous unilateral parotid neoplasms. A case report.

The parotid gland is the most usual location of benign neoplasms affecting major salivary glands and quite often the recurrence of these tumours is noticed, specially in the case of pleomorphic adenoma. The occurrence of multiple tumours in the parotid glands is rare and the majority of these are multifocal Warthin's tumors (papillary cystadenoma lymphomatosum). The simultaneous development of tumours with different histological types is unusual and when it occurs, the most common combination is a pleomorphic adenoma and a Warthin's tumor. There are many articles about Multiple Parotid Tumors (MPT) but only a few of them are focused on unilateral synchronous benings tumors, being pleomorphic adenoma and Warthin's these tumors. The report describes a 55 year old female with a pleomorphic adenoma occurring synchronously with a Warthin's tumor within the superficial lobe of her left parotid gland.

Quiste odontogénico calcificante asociado con odontoma complejo: Presentación de un caso y revisión bibliográfica / Calcifying odontogenic cyst associated with complex odontoma: Case report and review of the literature

Se presenta un caso de quiste odontogénico calcificante asociadocon odontoma (QOCaO) y con un canino permanente incluidoen maxilar superior, en un paciente varón de 19 años.El Quiste Odontogénico Calcificante (QOC) fue descrito porprimera vez cómo una entidad patológica por Gorlin y col. en1962.Se trata de un tumor benigno odontogénico mixto,y aunquela mayoria de estas lesiones presentan características quísticasen algunos casos se presenta como una masa sólida (15 %), ysu transformación maligna está bien documentada. El QOC sepresenta en ocasiones asociado a otros tumores odontogénicos,el más común es el odontoma al que aparece relacionado en el24% de los casos. Para esta asociación se ha sugerido el términode „Quiste Odontogénico Odontocalcificante‰.Radiológicamente es una lesión mixta, bien definida y quehistológicamente consiste en un gran quiste en cuya parte centralexiste un área sólida con acúmulos de esmalte y dentinadistribuidos irregularmente en algunas zonas y en otros lugaresadopta un aspecto organoide bien definido.Se efectúa una revisión de la literatura y se discute su patogénesis

We report a calcifying odontogenic cyst associated with odontoma(COCaO) and an included permanent canine in the superiormaxilla, in a 19 year-old-man.The calcifying odontogenic cyst (COC) was first described asa distinct entity by Gorlin et al in 1962.The lesion is a mixed odontogenic benign tumor, and althoughmost of the cases present cystic characteristics, a few are of thesolid type (15%), and its rare malignant transformation is welldocumented.The COC may occur in association with other odontogenictumors, the most common is the odontoma, occurring in about24% of the cases. For this association the term Odontocalcifyingodontogenic cyst has been suggested.Radiographically is a well defined mixed lesion and histologicallyconsists of a large cyst. In the central area of the cyst enameland dentin deposits can be found, irregularly distributed in areasand in other parts it takes on a well defined organoid aspect.A thorough review of literature takes place and the pathogenesisis discussed

Calcifying odontogenic cyst associated with complex odontoma: case report and review of the literature.

We report a calcifying odontogenic cyst associated with odontoma (COCaO) and an included permanent canine in the superior maxilla, in a 19 year-old-man. The calcifying odontogenic cyst (COC) was first described as a distinct entity by Gorlin et al in 1962. The lesion is a mixed odontogenic benign tumor, and although most of the cases present cystic characteristics, a few are of the solid type (15%), and its rare malignant transformation is well documented. The COC may occur in association with other odontogenic tumors, the most common is the odontoma, occurring in about 24% of the cases. For this association the term Odontocalcifying odontogenic cyst has been suggested. Radiographically is a well defined mixed lesion and histologically consists of a large cyst. In the central area of the cyst enamel and dentin deposits can be found, irregularly distributed in areas and in other parts it takes on a well defined organoid aspect. A thorough review of literature takes place and the pathogenesis is discussed.