Short-term survival in extensive craniofacial resections

OBJECTIVES: Craniofacial resection (CFR) procedures for craniofacial tumors with cranial extension are often extensive. Although CFRs may yield good oncological results, there are concerns about high perioperative morbidity and mortality. This study aimed to determine risk factors for perioperative mortality after open CFR in terms of deaths occurring during index hospitalizations. METHODS: We conducted a retrospective analysis of CFRs conducted at a tertiary oncology hospital from May 2009 through December 2018. RESULTS: Our analysis included data from the medical records of 102 patients, the majority of whom were male (n=74, 72.5%). The mean age was 61 years (±18.3 years). Skin malignancies (n=64, 63.4%) accounted for nearly two-thirds of the treated tumors, and most of these were squamous cell carcinoma. Postoperative medical complications occurred in 33 patients (33%), and surgical complications occurred in 48 (47%). Multivariate analysis revealed the only independent risk factors for perioperative deaths to be the presence of intracranial tumor extension on preoperative imaging (hazard ratio [HR]=4.56; 95% confidence interval [CI]: 1.74-11.97; p=0.002) and the unexpected emergence of postoperative neurological dysfunction (HR=10.9; 95% CI: 2.21-54.3; p=0.003). CONCLUSIONS: In our study, factors related to tumor extension were associated with a higher risk of perioperative death.

Abscesso laríngeo de prega vestibular / Laryngeal abscess in the vestibular fold

Introdução: Os abscessos laríngeos podem ser considerados uma raridade clínica atualmente, devido principalmente ao aumento do uso de antibióticos, bem como seus espectros de ação. Na era pré-antibiótica era um problema relativamente comum, com uma taxa de mortalidade próxima a 100%. A localização mais frequente dos abscessos na laringe é a região supraglótica periepiglótica, sendo extremamente incomuns em outras regiões. Em ampla revisão literária, não foi encontrado nenhum caso de abscesso laríngeo na prega vestibular. Relato de caso: Paciente do sexo masculino, 31 anos, cantor, procurou nosso serviço com quadro de um dia de odinofagia, disfagia e disfonia. Refere tabagismo e etilismo social. Na laringoscopia direta, observou-se edema e hiperemia importantes da prega vestibular direita, com abaulamento local. A tomografia computadorizada mostrou área hipoatenuante em prega vestibular direita, estabelecendo o diagnóstico. O paciente foi submetido à drenagem cirúrgica e recebeu antibioticoterapia. Apresentou boa evolução, com resolução dos sintomas em três dias. Discussão: O abscesso laríngeo deve ser um diagnóstico diferencial em casos de maior severidade de uma laringite comum. Na maioria dos casos, o tratamento clínico resolve o caso, mas uma abordagem cirúrgica pode ser necessária, especialmente para descartar neoplasias ou outras alterações anatômicas da laringe. A perviedade da via aérea deve estar garantida. A evolução é boa, se o tratamento é prontamente estabelecido.

Introduction: Laryngeal abscesses can be considered clinical rarities nowadays, mainly due to the increase of the use of antibiotics and their spectrum of action. In the pre-antibiotic era, this problem was relatively usual, with a mortality rate close to 100%. The most frequent site where the abscesses occur in the larynx is the supraglotic (periepiglotic) region, and they are extremely rare in other regions. In the literary revision, no report of laryngeal abscess in vestibular fold was found. Case report: Male, 31 years old, singer, presenting at our institution with odynophagia, dysphagia and aphonia for one day. Consumption of alcohol and tobacco is related as frequent. Direct laryngoscopy revealed significant edema and hyperemia of right vestibular fold and bulging in the region. Computadorized tomography showed hypoattenuation of the vestibular fold, establishing the diagnosis. The patient was submitted to surgical approach, with drainage of the abscess, and antibiotics were prescribed. The outcome was good, with resolution of the symptoms in three days. Discussion: The laryngeal abscesses must be a differential diagnosis in cases of major severity of a single laryngitis. In the majority of patients, the clinical treatment may solve the case, but the surgical approach is sometimes necessary, specially to discharge neoplasms, or other anatomic alterations of the larynx. The upper airway must be assured. The outcome is good, if the treatment is promptly established.