The density of metastatic lymph node as prognostic factor in squamous cell carcinoma of the tongue and floor of the mouth

The presence of metastatic lymph nodes is a relevant prognostic factor in oral cancer. Objective: This paper aims to assess metastatic lymph node density (pN+) in patients with tongue and floor-of-mouth squamous cell carcinoma (SCC) and the association of this parameter with disease-free survival (DFS). Materials and Methods: A group of 182 patients seen between 1985 and 2007 was included, 169 of which were males. Five were on stage I, 35 on stage II, 56 on stage III, and 85 on stage IV. Median values were considered in lymph node density assessment, and the Kaplan-Meier curve was used to evaluate DFS; survival differences within the group were elicited through the log-rank test. Results: An average 3.2 metastatic lymph nodes were excised from the patients in the group. Density ranged from 0.009 to 0.4, with a mean value of 0.09. Five-year DFS rates were of 44% and 28% for the groups with lymph node densities below and above the median respectively (p = 0.006). Two-year local/regional control was achieved for 71% and 49% for the patients below and above the median density respectively (p = 0.01). In terms of pN staging, local/regional control was achieved in 70% and 54% of pN1 and pN2 patients respectively, albeit without statistical significance (0.20%). Conclusion: Lymph node density may be used as a prognostic indicator for tongue and floor-ofmouth SCC

Videolaryngostroboscopy and voice evaluation in patients with rheumatoid arthritis

Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. Objective: This paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. Methods: This is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. Results: Nineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). Conclusion: Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered

Valor prognóstico da metástase regional no carcinoma epidermoide de língua e soalho bucal

The presence of metastatic nodes is a survival-limiting factor for patients with mouth tumors.Objective: To evaluate the causes of treatment failure in carcinomas of the tongue and floor of the mouth due to staging.Method: This study included 365 patients with squamous cell carcinoma of the mouth treated from 1978 to 2007; 48 were staged as T1, 156 as T2, 98 as T3, and 63 as T4, of which 193 were pNo and 172 pN+.Results: Among the pN+ cases, 17/46 (36.9%) of the patients not treated with radiation therapy had relapsing tumors, against 46/126 (36.5 %) of the patients who underwent radiation therapy. Success rates in the group of subjects submitted to salvage procedures were 16/51 (31.3%) for pN0 patients and 3/77 (3.9%) for pN+ patients.Conclusion: Salvage procedure success and survival rates are lower for pN+ patients; pN+ individuals also have more relapsing local disease.Universidade Federal de São Paulo, São Paulo, BrazilHeliopolis Hosp, Dept Head & Neck Surg & Otorhinolaryngol, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Surg, BR-05508 São Paulo, BrazilHeliopolis Hosp, Dept Hlth, São Paulo, BrazilSao Jose Hosp, São Paulo, BrazilUNILUS, Sch Med Sci Santos, Santos, BrazilUniv São Paulo, Univ Hosp, Sch Med, Dept Head & Neck Surg & Otorhinolaryngol,Superbvi, BR-05508 São Paulo, BrazilUniv São Paulo, Sch Med, Dept Head & Neck Surg, BR-05508 São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc

Ameloblastoma demographic, clinical and treatment study - analysis of 40 cases

Dental lesions represent about 1% of oral cavity tumors being ameloblastoma the most common one. It is a tumor of epithelial origin that mainly affects the jaw, and less commonly the maxilla. Its clinical presentation is that of an asymptomatic slow-growing tumor. Despite being a benign tumor, it has an invasive behavior with a high rate of recurrence if not treated properly. Objective: To describe the cases of ameloblastoma in a reference department. Methods: Retrospective analysis of 40 cases. The variables analyzed were: age, gender, ethnicity, tumor location, type of treatment, complications and recurrence. Results: The most affected gender was male - 21 cases (52.5%); with a predominance of Caucasians - 24 cases (60%). The mean age was 35.45 years; the most common location was in.the jaw - 37 cases (92.5%). Facial asymmetry was the most frequent complaint. Of the 40 cases, 33 were submitted to surgery. Of those submitted to surgery, 24 (72.72%) underwent segmental resection, with recurrence in 4 (12.12%) cases. Conclusion: Ameloblastoma may relapse when treatment is not performed with broad surgical resection of the lesion with wide safety margins

Avaliação epidemiológica e da resposta terapêutica no câncer da hipofaringe

Despite the low incidence, diagnostic and therapeutic advances, hypopharyngeal cancer still has high mortality.Objective: To evaluate retrospectively the epidemiological profile and response to surgery and radiation/chemotherapy of patients with hypopharyngeal cancer.Method: We reviewed the medical records of 114 patients treated between 2002 and 2009 in a tertiary hospital with histopathological diagnosis of squamous cell carcinoma.Results: the mean age of the patients was 57 years, 94.7% were males and 5.3% females, 98.2% were smokers and 92% consumed alcohol; 72% are illiterate or did not complete first grade schooling. the main complaints were: neck node (28%), pain and dysphagia (22%), odynophagia (12.2%), dysphonia (7.8%). the clinical staging was: I (1.7%), II (3.5%), III (18.4%), IV (76.3%). the treatment was carried out with radiotherapy and chemotherapy alone in 35%, with mean 2-year survival of 20% and 5-year survival of 18%; surgery followed by radiotherapy and chemotherapy in 22.8% with 2-year survival of 60.0% and 5 years of 55.0%; chemotherapy alone in 2.6%, and 39.4% without treatment.Conclusion: Most patients already had advanced clinical stages and independent of the treatment option, had a low survival rate, confirming the poor prognosis of this neoplasm.Fed Univ São Paulo UNIFESP, São Paulo, BrazilHeliopolis Hosp, Dept Head & Neck Surg & Otorhinolaryngol, São Paulo, BrazilLusiada Fdn, Dept Surg, Sch Med Sci, Santos, SP, BrazilSao Jose Hosp RBBP, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Surg, BR-05508 São Paulo, BrazilHeliopolis Hosp, Dept Hlth, São Paulo, BrazilSao Jose Hosp, RBBP, São Paulo, BrazilUniv São Paulo, Sch Med, Dept Head & Neck Surg, Larynx Grp, BR-05508 São Paulo, BrazilUniv São Paulo, Sch Med, Dept Head & Neck Surg, BR-05508 São Paulo, BrazilFed Univ São Paulo UNIFESP, São Paulo, BrazilWeb of Scienc

Deglutição após tratamento não cirúrgico (radioterápico/ radioquimioterápico) do câncer de laringe

Radiation therapy and radiochemotherapy protocols can cause swallowing difficulties.Aim: To evaluate swallowing in patients undergoing radiation therapy and radiochemotherapy protocol only for the treatment of laryngeal tumors.Methods: A prospective study of 20 patients, with a mean age of 62 years, at the end of oncological therapy. Six patients (30%) underwent radiation therapy, and 14 patients (70%) underwent combined therapy. The mean time between treatment and an evaluation of swallowing was 8.5 months. Videofluoroscopy was done to assess the preparatory, oral and pharyngeal phases of swallowing.Results: All patients had only an oral diet. Normal swallowing was present in only 25% of patients. The swallowing videofluoroscopic examination identified the following changes: bolus formation (85%), bolus ejection (60%), oral cavity stasis (55%), changes in the onset of the pharyngeal phase (100%), decreased laryngeal elevation (65%), and hypopharyngeal stasis (80%). Laryngeal penetration was observed in 25% of the cases; 40% presented tracheal aspiration. The grade of penetration/aspiration was mild in 60% of cases. Aspiration was silent in 35% of patients. Although 75% of patients had dysphagia, only 25% complained of swallowing difficulties.Conclusion: Patients with laryngeal cancer that underwent radiation therapy/combined treatment can present changes in all swallowing phases, or may be asymptomatic.FAP, Grad Course, Sao Paulo, BrazilUNIFESP EPM, Sao Paulo, BrazilUniv Sao Paulo, BR-09500900 Sao Paulo, BrazilHOSPHEL, Voice Rehabil & Swallowing Unit, Sao Paulo, BrazilFundacao Lusiada, Unilus, Santos, BrazilHOSPHEL, Inst Grad Vourse Hlth Sci, Sao Paulo, BrazilUNIFESP EPM, Sao Paulo, BrazilWeb of Scienc

Fatores de risco de paratireoidectomia acidental em tireoidectomia

Incidental parathyroidectomy is a common event in thyroid surgery. The literature shows a finding of parathyroid glands ranging from 6.4% to 31% in pathological specimens of the thyroid gland.Objective: To collect the amount of parathyroid glands found in surgical specimens of thyroidectomy and correlate with the histopathological and demographic variables.Methods: Retrospective study based on pathological reports of thyroidectomy from January 2007 to December 2008.Results: 442 patients were submitted to total thyroidectomy, and 2.93% had parathyroid glands, which corresponded to 13 of this total. The presence of papillary thyroid carcinoma associated with incidental parathyroidectomy was 10.11%, compared to the benign lesion: 1.4%.Conclusion: Papillary thyroid carcinoma was the variable associated with increased number of incidental parathyroidectomy.Metropolitan Univ Santos UNIMES, Sch Med, Santos, SP, BrazilUniv Metropolitana Santos, Santos, SP, BrazilFed Univ Sao Paulo UNIFESP, Sao Paulo, BrazilMetropolitan Univ Santos UNIMES, Dept Otorhinolaryngol & Head & Neck Surg, Santos, SP, BrazilMetropolitan Univ Santos UNIMES, Dept Sci Initiat, Santos, SP, BrazilFed Univ Sao Paulo UNIFESP, Sao Paulo, BrazilWeb of Scienc