Jaw metastasis as first presentation of lung adenocarcinoma. A case report

Publisher Copyright: © 2021 Elsevier Espana S.L.. All rights reserved.Metastatic disease of the oral cavity is rare and constitutes 1 % of all oral cavity malignancies. Lung cancer is the most common primary site metastasizing to the jaws, especially in man, and the mandible is more affected than the maxilla. We present the case of a 64 year-old-female patient who was admitted to hospital complaining of pain and swelling located to the left mandibular ascending ramus and angle, with 7 month duration. The first differential diagnosis was between primary malignances of the oral cavity, but the biopsy revealed a carcinoma of unknown origin. Further investigation revealed an advanced stage primary adenocarcinoma of the lung. Oral metastasis are usually evidence of a widespread disease and indicate a poor prognosis. As consequence, the treatment modalities for these patients are palliative in most cases. The clinical case of a 41-year-old male evaluated for a tumor in the attached gingiva with previous periodontal treatment and a history of kidney transplantation is described. Excisional biopsy was performed with a diagnosis of KS, which after completing the study confirmed disseminated iatrogenic-type KS requiring a change in immunosuppressive medication and 6 cycles of chemotherapy treatment with complete response.publishersversionpublishe

Changes in the epidemiology of maxillofacial trauma

Objectives: Due to COVID-19 pandemic, social distancing policies were enacted worldwide, including by the Portuguese official authorities. However, the impact of these measures on maxillofacial trauma and fracture surgical repair remains poorly understood. The aim of this study was to evaluate and compare the incidence and aetiology of facial fractures submitted to surgical repair during 1-year of COVID-19 pandemic versus the previous 4 years, in a level III Trauma Centre located in Lisbon, Portugal. Materials and methods: All emergency episodes registered in our hospital between March 2016 and February 2021 that resulted in patient admittance for surgical treatment of facial fracture were included. Comparative analysis was performed for variables such as fracture type and aetiology. Results: Analysis showed that surgeries performed during the 1st year of COVID-19 were reduced by 37.5 %. Considering only the 75-day lockdown period at the beginning of the pandemic, reduction was even more pronounced and reached-66.7 %. Significant differences in the aetiology were also found, with physical assault and sport accidents relative frequency decreasing. Moreover, despite being systematically the second most common cause of fracture, during lockdown, fall ranked first, over physical assault. The relative frequency of nasal fractures, the most common facial fracture treated in our hospital, decreased during both the 1st year of COVID-19 and the lockdown period, while mandible fractures ranked first during lockdown. Conclusions: Our study shows that COVID-19 pandemic and enacted policies have significantly changed the epidemiology of maxillofacial trauma.publishersversionpublishe

A Metastização Cervical dos Cancros Cutâneos de Cabeça e Pescoço

Skin cancer is the most frequent cancer, with higher incidence in head and neck, due to chronic sun exposure. The risk of neck metastasis depends on their histology and staging. Melanoma and Merkel carcinoma with N0 neck stage, have a probability of locorregional micrometastases around 20% and from 20-50% respectively. Squamous cell carcinoma has a risk from 5 up to 20%. However, there are several factors, including staging model limitations, that turn assessment of squamous cell carcinoma metastasis cumbersome. The use of sentinel lymph node biopsy and follow-up protocols are also debatable.O cancro cutâneo é a neoplasia mais frequente de todas, com maior incidência na área de cabeça e pescoço, pela fotoexposição crónica. A estratificação do risco metastático linfático regional cervical tende a ser sistematizada de acordo com modelos de estadiamento tumoral, que são tendencialmente aceites no melanoma e carcinoma de células de Merkel, mas pouco consensuais no carcinoma espinocelular. Um dos focos de investigação é o risco de micrometástases em casos de tumores de estádio clínico e imagiológico N0, de que um modo geral varia entre 5% a 20% nos carcinomas espinocelulares, cerca de 20% nos melanomas e de 20 a 50% nos carcinomas de células de Merkel, dependendo de vários fatores de risco. A utilidade do gânglio sentinela e os protocolos de acompanhamento são também matéria de discussão