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Abstract Introduction Oral cavity squamous cell carcinoma (OCSCC) is the most common malignancy in the oral cavity. Two types of mandibular resections have been described: the segmental mandibulectomy and the marginal mandibulectomy. Both may have a different impact over the quality of life, oncological prognosis, and functional or aesthetic result. Objectives The aim of this study was to systematically explore the literature to determine the survival outcomes and disease control rates in patients who underwent segmental or marginal mandibulectomy for OCSCC with histological evidence of cortical and medullary bone invasion. Data Synthesis This review involved a systematic search of the electronic databases MEDLINE/PUBMED, Google Scholar, Ovid Medline, Embase, and Scopus including articles from 1985 to 2019. Fifteen articles were included for qualitative analysis and 11 articles were considered for meta-analysis calculations. All of them correspond to retrospective cohort studies. Conclusion This systematic review reveals the low-level evidence regarding the impact over local control or survival according to the type of mandibulectomy. Our results need to be considered with precaution according to the limited evidence available. We just found difference regarding the 5-year disease-free survival, and a tendency in favor of segmental mandibulectomy was confirmed when medullary invasion was evident.
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Abstract Introduction Head and neck surgery remains a complex field; the patients can suffer important functional or life-threating complications after treatment that need unplanned readmissions, increasing the cost related to the treatment. Objective To evaluate the incidence risk factors and causes associated with 30-day unplanned hospital readmission and visit to the emergency room (ER) after surgery for head and neck cancer. Methods Prospective, longitudinal, nonrandomized study. Results A total of 834 patients were included, 726 in the major surgery group and 108 in the minor surgery group. The 30-day readmission rate for all causes was of 7,9% for the patients treated by a major surgery and of 0% for the patients treated in the outpatient clinic for minor procedures, to a total readmission rate of 6,8%. The rate of visit to the emergency room for all causes in the first 30 days was of 14% for the patients treated by a major surgery and of 2,7% for the patients treated in the outpatient clinic. Conclusion Major surgery, the American Society of Anesthesiologists (ASA) status and type of wound are conditions related to unplanned readmission or visit to the ER in the first 30 day after discharge. The most commonly associated causes are infections or wound complications. An evidence-based risk stratification of the patients can be important to improve decision-making and resource utilization. An educational strategy can provide possible ways to improve the rate of readmission and reduce the amount of money expended by healthcare systems.
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Abstract Introduction The submental flap provides an alternative technique in orofacial reconstruction, especially in situations in which free flaps are not available, or the patients are unfit. Objective To demonstrate the oncological safety and benefits of this flap in oral cavity reconstruction. Methods A total of 14 patients with oral cavity cancers, who underwent submental flap reconstruction from January 2016 to January 2018, were included in the study. Results There were 11 male and 3 female patients with a mean age of 66.7 ± 14 (Min: 52/Max: 91) years old. The most common primary tumor site was the mobile tongue in 12 (85.7 %) patients. All of the patients underwent ipsilateral selective neck dissection after the flap was harvested. Flap partial necrosis was observed in one patient, and total necrosis in another one. The mean follow-up was of one year. Nonlocal or regional recurrences were observed. Conclusion Submental island flap represents a good option in oral cavity reconstruction in a restricted setting or in patients considered not fit for free flap reconstruction. Preoperative selection of clinically neck node-negative patients is essential due to the potential risk of occult metastasis.
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Abstract Introduction Multiple incisions have been described for the surgical approach of cervical neck nodes. All of these descriptions are associated with better or worse exposure of the surgical field as well as with different functional and aesthetic results, which are not always satisfactory. Objective Compare the transverse cervical incision with the classic incision in J or U. Methods This is a retrospective study of 47 patients who required cervical neck dissection between June 15, 2016 and June 15, 2017.A transversal incision was made in these surgeries, and their results were then compared with those of a group of 57 patients treated between January 1, 2010 and January 1, 2012, in whose cases an incision in J or U was made. Results Regarding the incision type, complications were present in 4 (8.5 %) cases in the transversal incision group, and in 7 (12.2 %) patients of the group of traditional incisions in J or U, without statistical differences (p = 0.078). The only variables associated with complications of healing in the two groups was body mass index (BMI) < 18.5. The patients showed subjective satisfaction with the aesthetic result of the transverse incision, with an average of 7.51 vs 6.20 in the J or U incision. Conclusion The transverse incision represents a safe, aesthetic, and oncologically adequate option, associated with a lower cicatricial retraction rate, without significant complication rate and allowing adequate exposure of the surgical field, similar to the obtained with the classic incision in J or U.
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Antecedentes: la población mundial envejece de manera acelerada. Una tercera parte de los mayores de 65 años se cae por lo menos una vez al año, y esta prevalencia se incrementan a la mitad cuando se superan los 69 años. Objetivo: establecer la sensibilidad del uso de sensores inerciales para determinar la marcha y las rotaciones del tronco en un grupo de individuos sanos. Materiales: utilizamos tres sensores inerciales de nueve ejes, junto a un mismo número de microcontroladores, los cuales enviaron la información vía bluetooth al ordenador, el procesamiento de los datos fue realizado mediante un programa de análisis desarrollado en MATLAB. Para analizar la sensibilidad de los sensores utilizamos el protocolo de Akram et al.,5 modificado, el cual consta de cinco actividades. Resultados: en nuestro estudio participaron seis voluntarios, con una media de edad de 29 años, con un rango de edad de 25 a 33 años. Los sensores fueron capaces de detectar múltiples variables, entre ellas la elevación máxima y mínima de las piernas, número de pasos, el grado de inclinación del tronco, giro, velocidad y cadencia. Conclusión: los resultados hasta ahora obtenidos son prometedores y consideramos que el uso de múltiples sensores inerciales para valorar la marcha y el equilibrio podrían resultar en una nueva herramienta para el diagnóstico y seguimiento de personas con trastorno de la marcha y equilibrio
Introduction: The world population is aging rapidly. A third of those over 65 years of age falls at least once a year, and this prevalence increases by half when they exceed 69 years. Objective: To determine the sensitivity of the use of inertial sensors to determine the gait and rotations of the trunk in a group of healthy individuals. Materials: We use 3 inertial sensors of 9-axis together with the same number of microcontrollers, that sent the information via bluetooth to the computer, the data processing was carried out through an analysis program developed in MATLAB. To analyze the sensitivity of the sensors we use the protocol of Akram et al,5 modified, which consists of 5 activities. Results: In our study 6 volunteers participated, with an average age of 29 years, with an age range 25 to 33 years. The sensors were able to detect multiple variables, including the maximum and minimum elevation of the legs, number of steps, the degree of inclination of the trunk, rotation, speed and cadence. Conclusion: The results obtained are promising and we believe that the use of multiple inertial sensors to assess gait and balance could result in a new tool for the diagnosis and monitoring of people with gait and balance disorder.