Tumor de cuerpo carotídeo en adolescente. Reporte de un caso / Carotid body tumor in an adolescent. A case report

Introducción. Los paragangliomas del cuerpo carotídeo son neoplasias infrecuentes y representan el 0,6 % de los tumores de cabeza y cuello. La edad de presentación promedio es la quinta década de vida. El objetivo de este artículo fue describir un caso de paraganglioma del cuerpo carotídeo en una adolescente. Caso clínico. Se presenta el caso de una paciente adolescente con paraganglioma de cuerpo carotídeo derecho, de 5x3x3 cm, Shamblin III. Se analizaron la historia clínica, los exámenes diagnósticos, la técnica quirúrgica utilizada y su evolución correspondiente. La información fue obtenida a partir de la ficha clínica, previa autorización por consentimiento de los padres de la paciente. Resultados. Se hizo resección quirúrgica completa y reparo vascular con injerto de vena safena invertida, con evolución favorable y permeabilidad completa del puente vascular, sin secuelas. Conclusión. Este caso podía corresponder a un tumor de etiología familiar, dada su edad temprana de presentación. Se hizo necesario complementar su estudio con imágenes y objetivar el compromiso vascular asociado para la planificación quirúrgica. En estos pacientes, la complejidad de su localización y el compromiso vascular del tumor requiere de un equipo multidisciplinario, con cirujanos de cabeza y cuello y cirujanos vasculares para un resultado exitoso.

Introduction. Carotid body paragangliomas are rare, representing 0.6% of head and neck tumors, with average age of presentation in the fifth decade of life. The objective of this article is to describe a clinical case of carotid body paraganglioma in an adolescent. Clinical case. Review and analysis of the clinical case, reviewing its clinical history, study tests, surgical technique used and its corresponding evolution. Information obtained from the clinical record prior authorization by consent of the patient's parents. Results. Adolescent patient with paraganglioma of the right carotid body, 5x3x3 cm, Shamblin III. With complete surgical resection and inverted saphenous vein graft, favorable evolution, with complete permeability of the vascular bridge, without sequelae. Conclusion. This case could correspond to a tumor of familiar etiology, given its early age of presentation. It is necessary to complement the study with images and to objectively determine the associated vascular involvement for surgical planning. In these patients, the complexity of their location and vascular involvement of the tumor requires a multidisciplinary team with head and neck and vascular surgeons for a successful outcome.

Anatomical Diversity in Femur bones: Understanding the Morphological Variability for Surgical and Prosthetic Applications / Diversidad Anatómica en Huesos Fémur: Comprensión de la Variabilidad Morfológica para Aplicaciones Quirúrgicas y Protésicas

SUMMARY: The femur, the body's longest bone, plays a critical role in orthopaedics and radiology. Understanding its anatomy, particularly the neck-shaft angle (NSA), is vital for diagnosing bone issues and designing hip implants. While some Asian populations' femur measurements have been studied, there is a research gap concerning Sri Lankans. This study aimed to fill this gap by examining the proximal femur's anatomy in the Sri Lankan population. We analysed 45 adult human femurs (26 right, 19 left) of unknown sex, ethically sourced from the University of Sri Jayewardenepura. Femurs with fractures or pathologies were excluded. Precise measurements were recorded using digital vernier callipers, with millimetre accuracy. Parameters included mean femoral length, vertical and transverse femoral head diameters, neck axis and neck length. Each measurement was taken three times to minimize subjectivity. Right femurs had a mean length of 42.8 mm (SD±2.64), while left femurs measured 43.53 mm (SD±3.27). Mean NSA was 125.78º (SD±4.45) for left femurs and 127.59º (SD±2.06) for right. Mean femoral head diameters were 4.09mm (SD±0.30) (right) and 4.12mm (SD±0.31) (left). Mean anterior neck lengths of the right and left were 2.61 (SD±0.54) and 2.71(SD±0.50) respectively. Comparing our findings with other Asian populations highlighted significant variations in femur measurements. These discrepancies emphasize the need for population-specific data for orthopaedic interventions and raise questions about the suitability of imported prosthetics. Differences in femur length, neck length, and NSA between sides suggest potential challenges in using implants designed for one side on the other. This study underscores the necessity of population-specific data in orthopaedics, as femur measurements differ even among Asian populations. Further research and statistical analysis are essential for tailoring orthopaedic solutions to individual populations. The findings also suggest a potential need for locally manufactured prosthetics to better suit the Sri Lankan population.

El fémur, el hueso más largo del cuerpo, desempeña un papel fundamental en ortopedia y radiología. Comprender su anatomía, en particular el ángulo cuello-diáfisis (NSA), es vital para diagnosticar problemas óseos y diseñar implantes de cadera. Si bien se han estudiado las medidas del fémur de algunas poblaciones asiáticas, existe un vacío en la investigación sobre los habitantes de Sri Lanka. Este estudio tuvo como objetivo examinar la anatomía del fémur proximal en la población de Sri Lanka. Analizamos 45 fémures humanos adultos (26 derechos, 19 izquierdos) de sexo desconocido, obtenidos éticamente de la Universidad de Sri Jayewardenepura. Se excluyeron fémures con fracturas o patologías. Se registraron mediciones precisas utilizando calibradores vernier digitales, con precisión milimétrica. Los parámetros incluyeron la longitud femoral media, los diámetros vertical y transversal de la cabeza femoral, el eje del cuello y la longitud del cuello. Cada medición se tomó tres veces para minimizar la subjetividad. Los fémures derechos tuvieron una longitud media de 42,8 mm (DE ± 2,64), mientras que los fémures izquierdos midieron 43,53 mm (DE ± 3,27). La NSA media fue de 125,78º (DE±4,45) para el fémur izquierdo y de 127,59º (DE±2,06) para el derecho. Los diámetros medios de la cabeza femoral fueron 4,09 mm (DE ± 0,30) (derecha) y 4,12 mm (DE ± 0,31) (izquierda). Las longitudes medias del cuello anterior de la derecha y la izquierda fueron 2,61 (DE ± 0,54) y 2,71 (DE ± 0,50) respectivamente. La comparación de nuestros hallazgos con otras poblaciones asiáticas destacó variaciones significativas en las medidas del fémur. Estas discrepancias enfatizan la necesidad de datos específicos de la población para las intervenciones ortopédicas y plantean dudas sobre la idoneidad de las prótesis importadas. Las diferencias en la longitud del fémur, la longitud del cuello y la NSA entre lados sugieren posibles desafíos al utilizar implantes diseñados para un lado en el otro. Este estudio subraya la necesidad de datos específicos de la población en ortopedia, ya que las mediciones del fémur difieren incluso entre las poblaciones asiáticas. Es esencial realizar más investigaciones y análisis estadísticos para adaptar las soluciones ortopédicas a poblaciones individuales. Los hallazgos también sugieren una posible necesidad de prótesis fabricadas localmente para adaptarse mejor a la población de Sri Lanka.

Tratamiento quirúrgico del carcinoma de Merkel facial avanzado. Presentación de un caso / Surgical treatment of advanced facial Merkel cell carcinoma. A case report

Introducción. El carcinoma de Merkel es un tumor maligno poco frecuente, que afecta principalmente a la población caucásica y cuya etiología guarda relación con el poliomavirus de las células de Merkel. Conlleva mal pronóstico, especialmente en estadios finales. Caso clínico. Se expone el caso de una paciente que presentaba un tumor primario facial de grandes dimensiones, con avanzado grado de extensión, afectación linfática cervical y metástasis parotídea derecha. Fue tratada mediante exéresis de la lesión primaria y cobertura con injerto de piel parcial, linfadenectomía cervical y parotidectomía ipsilateral. Resultados. Se logró mejoría importante en la calidad de vida de la paciente y sobrevida de al menos seis meses. Conclusión. Aunque no está claro el manejo óptimo del carcinoma de Merkel avanzado debido a su mal pronóstico, la cirugía favorece una mejoría en la calidad de vida del paciente y puede tener un papel clave en el manejo del carcinoma de Merkel en los estadios avanzados.

Introduction. Merkel carcinoma is a rare malignant tumor that mainly affects the Caucasian population and whose etiology is related to the Merkel cell polyomavirus. It has a poor prognosis, especially in the final stages. Clinical case. The case of a patient who presented a large primary facial tumor, with an advanced degree of extension, cervical lymphatic involvement and right parotid metastasis is described. She was treated surgically by excision of the primary lesion and coverage with partial skin graft, cervical lymphadenectomy, and ipsilateral parotidectomy. Results. A significant improvement was achieved in the patient's quality of life and survival of at least six months.Conclusion. Although the optimal management of advanced Merkel carcinoma is unclear due to its poor prognosis, surgery improves the patient's quality of life and it can play a key role in the management of Merkel carcinoma in advanced stages.

Effectiveness and tolerance of electrochemotherapy as palliative therapy for patients with head and neck cancer and malignant melanoma and its relation to early skin reaction

Abstract Objectives To evaluate the efficacy and tolerance after the electrochemotherapy treatment for local therapy of cutaneous and subcutaneous metastases of head-and-neck tumors and malignant melanoma refractory to standard therapies, mainly in neck metastasis of squamous cell carcinoma. And, to evaluate the relation of this response according to the skin reaction (healing with ulcer or dry crust). Methods prospective pase II, observational clinical study of 56 patients with metastases of head-and-neck squamous cell carcinoma (n = 13), papillary thyroid carcinoma (n = 4), adenoid cystic carcinoma of parotid gland (n = 1) or malignant melanoma (n = 37, 5 in head). Patients were treated by electrochemotherapy (application of electrical pulses into the tumor) after the administration of a single intravenous dose of bleomycin. Kaplan-Meier curves were performed. The statistical significance was evaluated using log-rank test; p-value of less than 0.05 was considered as significant. Results Overall clinical response was observed in 47 patients (84%). Local side effects were mild in all the patients. Ten patients (76.9%) with neck metastasis of squamous cell carcinoma had some degree of response, but only in one was complete. Patients even with only partial response had a higher overall survival than patients without response (p = 0.02). Most of the patients with squamous cell carcinoma had diminution of pain and anxiety. Response rate and overall survival was higher in MM patients (86.5%) than in squamous cell cancer patients (76.9%) (p = 0.043). The healing process (dry crust/ulcer) was not associated with the overall survival (p = 0.86). Conclusions Electrochemotherapy is associated a higher overall survival and diminution of pain and anxiety. Therefore, it is an option as palliative treatment for patients with neck metastasis of squamous cell carcinoma refractory to other therapies or even as a concomitant treatment with newer immunotherapies. The type of healing of the surgical wound could not be associated with a higher rate of response or survival. Level of evidence III.

Malignant tumors affecting the head and neck region in ancient times: Comprehensive study of the CRAB Database

Abstract In the modern world, cancer is a growing cause of mortality, but archeological studies have shown that it is not exclusive to modern populations. The aim of this study is to examine the epidemiologic, social, and clinicopathologic features of head and neck cancers in ancient populations. To do this, we extracted all records that described malignant lesions in the head and neck region available in the Cancer Research in Ancient Bodies Database (CRAB). The estimated age, sex, physical condition of the remains (skeletonized, mummified), anatomic location of tumors, geographic location, chronology, tumor type, and methods of tumor diagnosis were collected. One hundred and sixty-seven cases were found, mostly originating from Europe (51.5%). Most records were of adults between 35 and 49 years of age (37.7%). The most involved site was the skullcap (60.4%), and the most common malignancies were metastases to the bone (65.3%) and multiple myeloma (17.4%). No primary soft tissue malignancies were registered. The results of our study indicate that head and neck cancers were present in ancient civilizations, at least since 500,000 BCE. The available data can help to improve the current understanding of the global distribution of head and neck cancer and its multidimensional impacts on populations in the contemporary world.

Caracterización de los pacientes con cáncer bucal en el Hospital Provincial Docente Oncológico María Curie de Camagüey

Introducción: El cáncer bucal continúa siendo una de las neoplasias malignas en ascenso, de acuerdo con su incidencia y el importante número de muertes cada año. En este sentido, se han desarrollado programas de salud para la población que garantizan la pesquisa, la prevención y la atención de las enfermedades. Objetivo: Caracterizar a los pacientes con cáncer bucal en el Hospital Provincial Docente Oncológico María Curie de la provincia Camagüey durante el período 2018-2022. Métodos: Se realizó un estudio descriptivo transversal en el Hospital Provincial Docente Oncológico María Curie de la provincia Camagüey en un universo de 218 pacientes, que acudieron al Servicio de Cirugía de Cabeza y Cuello del año 2018 al 2022 y tuvieron como diagnóstico cáncer bucal. La muestra se delimitó a 113 pacientes que cumplieron con los criterios de inclusión y exclusión. Resultados: El cáncer bucal predominó en el sexo masculino con 89 (78,76 %) en los años 2019 y 2021. Hubo mayor frecuencia en pacientes de piel blanca con 97 (85,84 %) y el año 2021 mostró mayor número de estos enfermos. La lengua fue la más afectada con 43 (30,05 %) pacientes, seguida por el suelo de boca en 18 (15,92 %) y las encías en 17 (15,04 %) pacientes. Según el estadio existió un predominio del IV en 61 (53,98 %) enfermos, seguido por el III con un 18,58 % de pacientes diagnosticados. Conclusiones: Prevaleció del sexo masculino en el grupo de 60 a 79 años y los pacientes de piel blanca fueron los más afectados. La localización de las lesiones se manifestó con mayor incidencia en la lengua y los estadios IV y III de la enfermedad son los más representativos en el momento del diagnóstico.

Introduction: Oral cancer continues to be one of the malignant neoplasms on the rise, according to its incidence and the significant number of deaths each year. In this sense, health programs have been developed for the population that guarantee screening, prevention and care of the diseases. Objective: To characterize patients with oral cancer at the María Curie Oncological Teaching Provincial Hospital in Camagüey province during the period 2018-2022. Methods: A cross-sectional descriptive study was carried out in the María Curie Oncological Teaching Provincial Hospital of Camagüey province in a universe of 218 patients, who attended the Head and Neck Surgery Service from 2018 to 2022 and had oral cancer as diagnosis. The sample was limited to 113 patients who met the inclusion and exclusion criteria. Results: Oral cancer predominated in the male sex with 89 (78.76%) in the years 2019 and 2021. There was a higher incidence in patients with white skin with 97 (85.84%) and the year 2021 showed a higher number of these patients. The tongue was the most affected with 43 (30.05%) patients, followed by the floor of the mouth in 18 (15.92%) and the gums in 17 (15.04%) patients. According to stage there was a predominance of stage IV in 61 (53.98%) patients, followed by stage III with 18.58% of patients diagnosed. Conclusions: Male sex prevailed in the 60 to 79 years age group and white skin patients were the most affected. The location of the lesions manifested with greater incidence on the tongue and stages IV and III of the disease are the most representative at the time of diagnosis.

Bushen Huoxue Prescription Regulates PINP and β-CTX in Treatment of Femoral Head Necrosis with Syndrome of Liver and Kidney Deficiency / 中国实验方剂学杂志

ObjectiveTo explore the therapeutic mechanism of Bushen Huoxue prescription from the perspective of bone metabolism by observing the clinical efficacy of this prescription in treating femoral head necrosis （ONFH， syndrome of liver and kidney deficiency） and its influences on bone metabolism indexes： N-terminal propeptide （PINP） and β-collagen degradation product （β-CTX）. MethodSixty-six ONFH patients with the syndrome of liver and kidney deficiency in Zhengzhou Traditional Chinese Medicine Hospital of Orthopedics from December 2021 to September 2022 were selected. The patients were randomized into an experimental group and a control group by the parallel control method， with 33 patients in each group. The experimental group received Bushen Huoxue prescription orally， while the control group received Xianlinggubao Capsules orally， with a treatment cycle of 6 months. The visual analogue scale （VAS） score， Harris score， Association Research Circulation Osseous （ARCO） staging， imaging changes， quantitative scores of TCM symptoms， and serum levels of PINP and β-CTX were determined before and after treatment. The occurrence of adverse events and reactions was recorded. ResultThe total response rate in the experimental group was 83.87% （26/31）， which was higher than that （68.75%， 22/32） in the control group （Z=-2.096， P<0.05）. After treatment， the single and total scores of TCM symptoms， VAS score， and β-CTX level decreased in the two groups （P<0.05）. Moreover， the decreases in the scores of hip pain， lower limb mobility， soreness of waist and knees， and lower limb flaccidity， total score of TCM symptoms， VAS score， and β-CTX level in the experimental were larger than those in the control group （P<0.05）. After treatment， the imaging results showed no significant improvement in the two groups. The Harris score and PINP level in both groups increased after treatment （P<0.05）， and the increases were more obvious in the experimental group than in the control group （P<0.05）. No serious adverse event or adverse reaction appeared during the observation period. ConclusionBushen Huoxue prescription can relieve pain and TCM symptoms and improve the hip joint function in treating ONFH patients with the syndrome of liver and kidney deficiency. It can inhibit the development of ONFH， increase PINP， and decrease β-CTX. No obvious side effect appears during the clinical observation period， which shows that Bushen Huoxue prescription has good safety.

Caracterización de marcadores de células madre tumorales en cáncer escamocelular de cavidad oral

Introducción: El cáncer escamocelular de cavidad oral es una patología con bajas tasas de sobrevivencia. Cuando no es tratado adecuadamente es un tumor de alta recurrencia y resistente al tratamiento. Nuevas hipótesis plantean que las células tumorales progenitoras por sus propiedades de auto renovación, iniciación tumoral, migración y metástasis pueden ser responsables de la manutención y renovación de este tumor. Sin embargo, aún no existe un consenso sobre la verdadera participación de ellas, debido a que su identificación y caracterización es aún un reto experimental. Objetivo: En este trabajo se busca detectar células con expresión de marcadores de células tumorales Progenitoras en muestras cáncer escamocelular de cavidad oral y relacionarlo con los estadios de diferenciación del tumor. Metodología: En esta investigación se tomaron 32 muestras de pacientes con carcinoma escamocelular de cavidad oral. Se logró detectar in situ, mediante la técnica de inmunofluorescencia, cuatro reconocidos marcadores de células tumorales progenitoras. Resultados: Se identificaron los marcadores OCT4, SSEA4, NANOG y TRA-1-60 en los diferentes estadios de diferenciación tumoral, lo que sugiere la participación de las células progenitoras tumorales en la evolución de esta patología. Conclusiones: El establecimiento y correcta identificación de las células tumorales progenitoras abre nuevas vías terapéuticas para el abordaje de este tumor, en busca de mejorar el pronóstico, tasa de sobrevivencia y calidad de vida del paciente.

Introduction: Squamous cell carcinoma of the oral cavity is a pathology with poor survival rates. When it is not adequately treated, it is a tumor with high recurrence and resistance to treatment. According to new hypotheses, progenitor tumor cells, due to their properties of self-renewal, tumor initiation, migration, and metastasis, could be responsible for the maintenance and renewal of this tumor. However, there is still no consensus on their true participation, subsequent to difficult in their identification and characterization. Materials and methods: In this research, 32 samples provided from patients diagnosis with squamous cell carcinoma of the oral cavity were used. To detect specific markers progenitor tumor cells were used immunofluorescence microscopy. Results: The cells markers OCT4, SSEA4, NANOG and TRA-1-60 were identified in the different stages of the tumor samples, all these findings suggest the role of tumor progenitor cells in the evolution of this pathology. Conclusions: The establishment and correct identification of the progenitor tumor cells provide new therapeutic options for the approach of this tumor seeking to improve the prognosis, survival rate and quality of life of the patient.

Signos y Síntomas en 3557 Pacientes con Trastornos Temporomandibulares

Los trastornos temporomandibulares (TTM) tienen una alta frecuencia en la población y pueden presentar síntomas en la región de la cabeza, el oído y la región cervical. Este estudio evalúa la presencia de signos y síntomas en la región de la cabeza y el cuello, incluyendo: cefalea, trastornos del oído, y de la columna vertebral, en una población de 3557 pacientes con TTM. Para este estudio los datos consistieron en los registros de 3557 pacientes consecutivos de TTM referidos a una clínica privada de trastornos temporomandibulares y dolor craneofacial, en Santiago de Chile entre 1998 y 2019. El examen y los registros fueron efectuados por uno los autores (RW), en un programa computacional previamente diseñado. Los resultados fueron analizaron utilizando la distribución de la frecuencia de los datos para evaluar la prevalencia. En esta serie 72.67 % correspondieron a pacientes de sexo femenino. Los síntomas más prevalentes reportados por los 3557 pacientes estudiados fueron rigidez en el cuello 65,25 %, cefaleas 61,01 % y dolor lumbar 57,16 %. Los síntomas relacionados con el oído fueron: mareos en el 46,70 %, dolor de oídos en 32,64 % y tinnitus en el 33,60 % de los pacientes. La asimetría facial estuvo presente en el 74.08 % de los 3557 pacientes. Se observó desviación mandibular en apertura bucal, en el 74.44 % de los 3557 pacientes. Se presentó dolor a la palpación muscular en un alto porcentaje de los pacientes, en los músculos temporales, maseteros, esternocleidomastoideo y trapecio, Este estudio nos permite describir la frecuencia de los signos y síntomas que presentan los pacientes con TTM en una amplia casuística.

Temporomandibular disorders (TMD) are frequently associated with other conditions in the head, ear and neck region, including cervical spine disorders and headache. This study evaluates the presence of signs and symptoms in the head and neck region, including headache, ear disorders, cervical and spine disorders, on a population of 3557 patients with TMD. For this study data consisted of the records of 3557 consecutive TMD patients referred to a temporomandibular disorder and craniofacial pain private clinic in Santiago, Chile between 1998 and 2019. The examination and recordings were made by all the authors. The results were analyzed using the distribution of frequency of the data to asses prevalence. The most prevalent symptoms reported by the 3557 subjects were neck stiffness 65.25 %, headaches 61.01 % and low back pain 57.16 %, the most frequent ear symptom was dizziness 46.70 %. The present study analize the frecuency of signs and symptons presented in a big casuistic of patients with TMD.

Relationship between prehospital clinical status intracranial pressure and outcomes in pediatric patients with severe head trauma

Introduction: The prehospital phase of the management of pediatric severe traumatic brain injury may have a direct influence on the results. Objective: To evaluate the influence of prehospital variables on intracranial pressure and the results in pediatric patients with severe TBI. Method: A descriptive study of 41 pediatric patients who were admitted to the medical emergency department and later admitted to the pediatric intensive care unit due to severe head trauma was carried out between January 2003 and December 2018. Results: children aged 5-17 years predominate, and the highest number of cases were received between 0-3h at the neurotrauma center. Of the 41 cases, 27 arrived with a non-expedited airway and hypoxia was verified upon arrival by pulse oximetry. A correlation was observed between arterial hypotension on admission and elevated intracranial pressure in 9 of 15 children (60%) and in the deceased (40%). Discussion: Clinical conditions, oxygenation, arterial hypotension, and treatment in the prehospital phase may influence the state of intracranial pressure and other intracranial variables in pediatric patients with severe head injury.

Introducción: La fase prehospitalaria del manejo del traumatismo craneoencefálico grave pediátrico puede tener una influencia directa en los resultados. Objetivo: Evaluar la influencia de variables prehospitalarias sobre la presión intracraneal y los resultados en pacientes pediátricos con TCE grave. Metodología: Se realizó un estudio descriptivo de 41 pacientes pediátricos que ingresaron al servicio de urgencias médicas y posteriormente ingresaron a la unidad de cuidados intensivos pediátricos por traumatismo craneoencefálico severo entre enero de 2003 y diciembre de 2018. Resultados: predominan los niños de 5 a 17 años, y el mayor número de casos se recibieron entre las 0-3h en el centro de neurotrauma. De los 41 casos, 27 llegaron con vía aérea no acelerada y se verificó hipoxia al llegar mediante oximetría de pulso. Se observó correlación entre hipotensión arterial al ingreso y presión intracraneal elevada en 9 de 15 niños (60%) y en los fallecidos (40%). Discusión: Las condiciones clínicas, la oxigenación, la hipotensión arterial y el tratamiento en la fase prehospitalaria pueden influir en el estado de la presión intracraneal y otras variables intracraneales en pacientes pediátricos con traumatismo craneoencefálico grave.

Retalho supraclavicular para reconstrução oncológica em cabeça e pescoço: Uma série de 62 casos / Supraclavicular flap for head and neck oncological reconstruction: A series of 62 cases

Introdução: A reconstrução oncológica de defeitos extensos em cabeça e pescoço impõe ao cirurgião plástico a difícil decisão entre o uso de retalhos livres e retalhos pediculados. O retalho supraclavicular é um dos principais exemplos de retalho pediculado, sendo versátil, com espessura delgada e cor semelhante à região a ser reconstruída. Método: Um estudo retrospectivo foi realizado através da coleta de dados de prontuário de pacientes internados no Instituto do Câncer do Estado de São Paulo, entre dezembro de 2010 e março de 2020. Resultados: Dentre os 62 pacientes reconstruídos com retalho supraclavicular, 37 eram do sexo masculino e 25 do sexo feminino. Cinquenta e oito pacientes (93,5%) possuíam alguma comorbidade associada. Ao todo, 27 complicações relacionadas ao retalho (43,5%) foram registradas, sendo 5 necroses totais (8%). Conclusão: O retalho supraclavicular possui importante papel nas reconstruções oncológicas de cabeça e pescoço e deve ser considerado como opção em pacientes maus candidatos a retalhos microcirúrgicos.

Introduction: The oncological reconstruction of extensive defects in the head and neck requires the plastic surgeon to make a difficult decision between the use of free flaps and pedicled flaps. The supraclavicular flap is one of the main examples of a pedicled flap, being versatile, with a thin thickness and similar color to the region to be reconstructed. Method: A retrospective study was carried out by collecting data from medical records of patients admitted to the Cancer Institute of the State of São Paulo between December 2010 and March 2020. Results: Among the 62 patients reconstructed with a supraclavicular flap, 37 were male and 25 female. Fifty-eight patients (93.5%) had some associated comorbidity. In total, 27 complications related to the flap (43.5%) were recorded, 5 of which were total necrosis (8%). Conclusion: The supraclavicular flap plays an important role in head and neck oncological reconstructions and should be considered as an option in patients who are poor candidates for microsurgical flaps.

Tratamento cirúrgico do cisto epidermóide situado anteriormente ao osso hióide: relato de caso / The surgery treatament of epidermoid cyst situated anteriorly to the hyoid bone: case report / Tratamiento quirúrgico del quiste epidermoide situado anterior al hueso hioides: reporte de um caso

O cisto epidermóide (CE) é uma má formação cística de desenvolvimento incomum. Ocorre mais comumente na linha média do assoalho da boca, ocasionalmente localiza-se lateralmente ou em outros sítios. A etiologia do CE ainda é incerta, mas acredita-se que esteja associado a remanentes do ectoderma durante a fusão do primeiro e segundo arcos branquiais. A lesão cresce lentamente sem provocar dor, apresentando-se como massa de consistência semelhante à de borracha ou à massa de pão. Seu diagnóstico se dá por meio de exame clínico e exames complementares de imagem como tomografia computadorizada, ressonância magnética e/ou ultrassonografia, entretanto somente com o exame histopatológico é possível um diagnóstico definitivo. A excisão cirúrgica do cisto é o tratamento de escolha. Quando o diagnóstico é precoce e a intervenção correta, o índice de recidiva torna-se raro. Diante da raridade de casos na região maxilo facial e a dificuldade relacionada ao diagnóstico, o presente trabalho tem como objetivos descrever a ocorrência do cisto epidermóide bem como seu diagnóstico através de exame histopatológico/exames de imagem, tratamento cirúrgico e contribuir com a literatura já existente por meio de um relato de caso que foi diagnosticado no Serviço de Patologia Bucal da Universidade de Gurupi, campus Gurupi/TO.

Epidermoid cysts (EC) is an unusually developing cystic malformation that occurs most frequently in the midline of the floor of the mouth, occasionally located laterally or elsewhere. The etiology of the (EC) still uncertain, but it is believed to be associated with remnants of the ectoderm during the fusion of the first and second branchial arches. The lesion grows slowly without causing pain, presenting itself as a mass with a consistency like of rubber or bread dough. Diagnosis of (EC) is made through complementary imaging tests such as computed tomography, magnetic resonance imaging and/or ultrasound, only histopathological examination it is possible to obtain a definitive diagnosis. Surgical excision of cyst is the treatment of choice. When the diagnosis is made early and the intervention is correct, the recurrence rate is rare. Given the rarity of cases in the maxillofacial region and the difficulty related to diagnosis, this study aims to describe epidermoid cysts occurrence and your diagnostic through of histopathologic/imagine exams, surgical treatment and contribute to the existing literature, through a review and description of a clinical case that was diagnosed at the Oral Pathology Outpatient Clinic at the Faculty of Dentistry - University of Gurupi - UNIRG. Gurupi -Tocantins. Brazil.

El quiste epidermoide (CE) es una malformación quística de desarrollo infrecuente. Ocurre más comúnmente en la línea media del piso de la boca, ocasionalmente se localiza lateralmente o en otra parte. La etiología de la FB aún es incierta, pero se cree que está asociada con restos del ectodermo durante la fusión del primer y segundo arcos branquiales. La lesión crece lentamente sin causar dolor, apareciendo como una masa con una consistencia similar a la de la goma o la masa de pan. Su diagnóstico se realiza a través del examen clínico y pruebas de imagen complementarias como tomografía computarizada, resonancia magnética y/o ultrasonografía, sin embargo, solo con el examen histopatológico es posible un diagnóstico defi nitivo. La escisión quirúrgica del quiste es el tratamiento de elección. Cuando el diagnóstico es temprano y la intervención es correcta, la tasa de recurrencia se vuelve rara. Dada la rareza de los casos en la región maxilofacial y la difi cultad relacionada con el diagnóstico, el presente trabajo tiene como objetivo describir la ocurrencia del quiste epidermoide así como su diagnóstico a través del examen histopatológico/pruebas de imagen, tratamiento quirúrgico y contribuir a la literatura existente a través de un reporte de caso que fue diagnosticado en el Servicio de Patología Oral de la Universidad de Gurupi, campus Gurupi/TO.

Análisis Morfológico y Biométrico de la Fóvea de la Cabeza del Fémur / Morphological and Biometric Analysis of the Fovea for Ligament of Head of Femur

En la literatura actual se encuentra escasa información referente a la fóvea de la cabeza del fémur (fóvea de la cabeza del hueso fémur). Este estudio tuvo como propósito recolectar datos morfológicos y biométricos respecto a la fóvea de la cabeza del fémur y reconocer variaciones que podrían ser de utilidad en las diversas patologías de la región. Se utilizaron 46 huesos fémures humanos pertenecientes al Departamento de Ciencias Básicas de la Universidad de La Frontera, Chile. Para la medición de datos se utilizó material ad hoc y los datos fueron analizados el programa Excel y los softwares ImageJ e Image Pro Plus. La longitud promedio de los huesos fémures fue de 43,8 ± 2,9 cm; el ángulo de torsión del cuello fue de 23,0 ± 2,0°. En el 100 % de las muestras se observó una fóvea en el cuadrante posteroinferior de la cabeza del fémur. El área promedio de la fóvea de la cabeza del fémur fue de 1,51 ± 0,7 cm2. El perímetro fue de 4,72 ± 1,0 cm; la forma de la fóvea fue: 60,9% ovalada, 23,9% triangular y 15,2 % circular, teniendo como base la fórmula derivada del índice craneal, dejando la fórmula como feret mínimo/feret máximo, con el cual los valores mayores a 0,8 se clasificaban como circulares y los menores como ovalados. Conocer la ubicación de la fóvea de la cabeza del fémur adquiere implicancia médica, ya que una fóvea en posición anormalmente alta, en imágenes radiológicas, es un indicador de displasia pélvica. La importancia de las variaciones de la fóvea de la cabeza del fémur debe ser más investigadas para una correcta comprensión de las patologías que afectan a la cabeza femoral.

SUMMARY: In the current literature there is little information regarding the fovea for ligament of head of femur. The aim of this study was to collect morphological and biometric data regarding the fovea for ligament of head of femur and recognize variations that could be useful in the various pathologies of the region. Forty six human femur bones belonging to the Department of Basic Sciences of the University of La Frontera, Chile were used. For data measurement, ad hoc material was used and the data were analyzed with the Excel program and the ImageJ and Image Pro Plus software. The average length of the femur bones was 43.8 ± 2.9 cm; the neck torsion angle was 23.0 ± 2.0°. In 100% of the samples, a fovea was observed in the posteroinferior quadrant of the head of femur. The average area of the fovea for ligament of head of femur was 1.51 ± 0.7 cm3. The perimeter was 4.72 ± 1.0 cm; The shape of the fovea was: 60.9% oval, 23.9% triangular and 15.2% circular, based on the formula derived from the cranial index, leaving the formula as minimum feret/maximum feret, with which the values greater than 0.8 were classified as circular and those less as oval. Knowing the location of the fovea for ligament of head of femur acquires medical implications, since a fovea in an abnormally high position, in radiological images, is an indicator of pelvic dysplasia. The importance of variations in the fovea for ligament of head of femur must be further investigated for a correct understanding of the pathologies that affect the femoral head.

Evaluación de guías prácticas y preservación de la glándula submandibular en la disección del cuello

Introducción: Las guías prácticas de atención al cáncer de cabeza y cuello abordan actualmente la preservación funcional de algunos órganos dentro del tratamiento oncoespecífico. Objetivos: Evaluar guías de práctica clínica y cómo abordan la preservación de la glándula submandibular en la disección del cuello. Métodos: Se realizó una investigación cuantitativa, descriptiva y transversal, donde se evaluaron seis guías de atención al cáncer de cabeza y cuello, en cuanto a su calidad metodológica y la preservación de la glándula submandibular en la disección del cuello. Se utilizó el instrumento Appraisal of Guidelines Research and Evaluation y se conformó un equipo compuesto por cuatro evaluadores que dieron su consentimiento y fueron capacitados en su uso. Para el análisis de la información se empleó el Statistical Package for Social Sciences versión 21 y se calculó la puntuación de calidad para cada dominio y el coeficiente de correlación intraclase. Resultados: La mayor puntuación de calidad correspondió a los dominios 1, 4 y 6. La guía con mayor puntuación de calidad fue la de la Sociedad Europea de Oncología Médica, con una media de 94,3 %, mientras que la de la Sociedad China de Oncología Clínica obtuvo el menor valor para un 71,5 %. Tres guías obtuvieron la máxima puntuación de calidad (7) en la evaluación global. La mayor fuerza de concordancia entre los evaluadores correspondió a la guía de la Sociedad Americana de Oncología Clínica (1) y la menor a la del Instituto Nacional de Oncología y Radiobiología (0,93). Conclusiones: Las guías de práctica clínica del cáncer de cabeza y cuello evaluadas presentaron una alta calidad metodológica y la preservación de la glándula submandibular en la disección del cuello no fue abordada en ninguna.

Introduction: Practical guidelines for head and neck cancer care currently address the functional preservation of some organs within oncospecific treatment. Objectives: To evaluate clinical practice guidelines and how they address the preservation of the submandibular gland in neck dissection. Methods: A quantitative, descriptive and cross-sectional research was carried out to evaluate six guidelines for head and neck cancer care, in terms of their methodological quality and the preservation of the submandibular gland in neck dissection. The Appraisal of Guidelines Research and Evaluation instrument was used, a team was composed by four evaluators who gave their consent and were trained to use such instrument. For the analysis of the information, the Statistical Package for Social Sciences version 21 was used and the quality score for each domain and the intraclass correlation coefficient were calculated. Results: The highest quality score corresponded to domains 1, 4 and 6. The guide with the highest quality score was that of the European Society of Medical Oncology reporting an average of 94.3%, while that of the Chinese Society of Clinical Oncology obtained the lowest value (71.5%). Three guidelines had the highest quality score (7) in the global evaluation. The highest strength of agreement between the evaluators corresponded to the guideline of the American Society of Clinical Oncology (1) and the lowest to that of the National Institute of Oncology and Radiobiology (0.93). Conclusions: The head and neck cancer clinical practice guidelines evaluated presented high methodological quality and the preservation of the submandibular gland in neck dissection was not addressed in any of them.

Eugene Nicholas Myers' Lecture on Head and Neck Cancer, 2020: The Surgeon as a Prognostic Factor in Head and Neck Cancer Patients Undergoing Surgery

Abstract This paper is a transcript of the 29th Eugene N. Myers, MD International Lecture on Head and Neck Cancer presented at the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 2020. By the end of the 19th century, the survival rate in treated patients was 10%. With the improvements in surgical techniques, currently, about two thirds of patients survive for > 5 years. Teamwork and progress in surgical reconstruction have led to advancements in ablative surgery; the associated adjuvant treatments have further improved the prognosis in the last 30 years. However, prospective trials are lacking; most of the accumulated knowledge is based on retrospective series and some real-world data analyses. Current knowledge on prognostic factors plays a central role in an efficient treatment decision-making process. Although the influence of most tumor- and patient-related prognostic factors in head and neck cancer cannot be changed by medical interventions, some environmental factors—including treatment, decision-making, and quality—can be modified. Ideally, treatment strategy decisions should be taken in dedicated multidisciplinary team meetings. However, evidence suggests that surgeons and hospital volume and specialization play major roles in patient survival after initial or salvage head and neck cancer treatment. The metrics of surgical quality assurance (surgical margins and nodal yield) in neck dissection have a significant impact on survival in head and neck cancer patients and can be influenced by the surgeon's expertise. Strategies proposed to improve surgical quality include continuous performance measurement, feedback, and dissemination of best practice measures.

Analysis of muscle mass by computed tomography in patients with head and neck cancer: a prospective study / Análise da massa muscular por tomografia computadorizada em pacientes com câncer de cabeça e pescoço: um estudo prospectivo

Abstract Objective: To evaluate the preoperative muscle mass of patients with head and neck cancer (HNC) with computed tomography (CT), comparing the results obtained through analysis of cross-sectional areas at the level of the third lumbar vertebra (L3) with those obtained through analysis of cross-sectional areas at the levels of the third cervical and fourth thoracic vertebrae (C3 and T4, respectively). Materials and Methods: A total of 63 patients with HNC were evaluated preoperatively. Using CT, we assessed muscle mass at L3, as well as at C3 and T4. Results: Most (73.0%) of the patients had low muscle mass at L3, whereas 50.8% had a normal body mass index. The cross-sectional area at L3 correlated strongly with those at C3 and T4 (r = 0.831 and r = 0.763, respectively; p < 0.001 for both). In addition, the muscle mass index at L3 correlated strongly with those at C3 and T4 (r = 0.781 and r = 0.715, respectively; p < 0.001 for both). Conclusion: Low muscle mass appears to be highly prevalent in patients with HNC. Measurements at C3 and T4 could represent alternative means of assessing muscle mass in such patients.

Resumo Objetivo: Avaliar e comparar a massa muscular de pacientes com câncer de cabeça e pescoço (CCP) durante o período pré-operatório com tomografia computadorizada (TC), por meio da análise das áreas transversais no nível da terceira vértebra lombar (L3) em comparação com níveis cervical (C3) e torácico (T4). Materiais e Métodos: Sessenta e três pacientes com CCP foram avaliados no pré-operatório. A TC foi utilizada para avaliar a massa muscular de L3, assim como as secções transversais de C3 e T4. Resultados: A maioria dos pacientes (73,0%) tinha baixa massa muscular analisada pela TC de L3, mas índice de massa corpórea normal (50,8%). Também foi observada forte correlação entre as áreas e o índice de massa muscular (IMM) de L3 com C3 (área: r = 0,831, p < 0,001; IMM: r = 0,781, p < 0,001) e T4 (área: r = 0,763, p < 0,001; IMM: r = 0,715, p < 0,001). Conclusão: A baixa massa muscular é altamente prevalente em pacientes com CCP. As análises de TC em C3 e T4 podem representar opção para avaliar a massa muscular em pacientes com CCP.

Current Insights on Neoplasms and Adequate Dental Care for Patients with Oral Cancer / Actualización sobre Neoplasmas y su Correcta Atención Odontológica en Pacientes con Cancer Oral

The present study aimed to review the literature on the main complications of antineoplastic therapies and the degree of knowledge of dental surgeons about these complications. A bibliographic search was conducted in the main health databases PUBMED (www.pubmed.gov) and Scholar Google (www.scholar.google.com.br), in which studies published from 1987 to 2023 were collected. Laboratory studies, case reports, systematic and literature reviews, which were developed in living individuals, about the main neoplastic genes and their relationship with the cells of individuals affected by neoplasms in the head and neck region, and studies on the care with this group of patients, were included. Therefore, articles that did not deal with neoplasm and the main complications of antineoplastic therapies were excluded. Neoplasm is a clonal disorder, caused by mutations, resulting from changes in the genetic structure of cells. Each healthy cell has instructions on how to grow and divi de. In the presence of any error in these instructions (mutation), it can result in a diseased cell that, when proliferating, may cause a tumor. Countless knowledge has been accumulated over the years on the main characteristics of neoplasms, whether they are cancer cell biology, carcinogenesis mechanism, neoplasms of the maxillofacial system and sequels of antineoplastic treatments. In this context, methods have been developed that offer a better quality of life for patients diagnosed with this pathology, as well as preventive vaccine models that may, in the not too distant future, contribute to this goal to be successfully achieved.

El presente estudio tuvo como objetivo revisar la literatura sobre las principales complicaciones de las terapias antineoplásicas y el grado de conocimiento de los odontólogos sobre este abordaje. Se realizó una búsqueda bibliográfica en las principales bases de datos de salud PUBMED (www.pubmed.gov) y Scholar Google (www.scholar.google.com.br), en la que se recopilaron estudios publicados entre 1987 y 2023. Fueron incluidos estudios de laboratorio, relatos de casos, revisiones de la literatura y revisiones sistemáticas, desarrolladas en individuos vivos, que incluyeran los principales genes neoplásicos y su relación con las células de individuos afectados por neoplasias en la cabeza y el cuello. También, se tuvieron en cuenta estudios relacionados con la atención a este grupo de pacientes. La neoplasia es un trastorno clonal, causado por mutaciones, como resultado de cambios en la estructura genética de las células. Cada célula sana tiene instrucciones sobre cómo crecer y dividirse. En presencia de cualquier error en estas instrucciones (mutación), puede provocar una célula alterada que, al proliferar, puede causar un tumor. Se han acumulado innumerables conocimientos a lo largo de los años sobre las principales características de las neoplasias, ya sea sobre biología de células cancerosas, el mecanismo de la carcinogénesis, la neoplasias del sistema maxilofacial y las diferentes secuelas de tratamientos antineoplásicos. En este contexto, se han desarrollado métodos que ofrecen una mejor calidad de vida para los pacientes diagnosticados con esta patología, así como modelos de vacunas preventivas que, en un futuro no muy lejano, pueden contribuir a alcanzar este objetivo con éxito.

Dermatofibrossarcoma na glabela: Uma localização incomum / Dermatofibrosarcoma in glabella: An uncommon location

O dermatofibrossarcoma é um câncer raro que apresenta padrão de crescimento lento e invasão tecidual agressiva. O tratamento para esta condição envolve intervenção cirúrgica com o objetivo de obter margens livres. Neste caso particular, temos um homem de 60 anos que apresentava uma massa na região da glabela que foi extirpada duas vezes sob anestesia local em outro serviço. Os resultados de ambas as biópsias indicaram dermatofibroma. No entanto, o paciente apresentou nova recidiva, que durante a análise imuno-histoquímica da excisão inicial revelou tratar-se de dermatofibrossarcoma. Como resultado, uma ampla excisão foi realizada até que margens negativas fossem obtidas ao exame de congelação. Além disso, um retalho frontal foi empregado no procedimento para reconstrução do defeito cirúrgico. O resultado do tratamento foi considerado bem-sucedido, sem complicações.

Dermatofibrosarcoma is a rare cancer with a slow growth pattern and aggressive tissue invasion. The treatment for this condition involves surgical intervention to achieve clear margins. In this particular case, we have a 60-year-old man who had a mass in the glabella area that was excised twice under local anesthesia at a different facility. The results of both biopsies indicated dermatofibroma. However, the patient experienced a new recurrence, and during the immunohistochemistry analysis of the initial excision, it was revealed to be dermatofibrosarcoma. As a result, a broad excision was performed until negative margins were obtained based on frozen sections. Additionally, a frontal flap was employed to reconstruct the surgical defect. The outcome of the treatment was deemed successful, without complications.

Animal Model Standardization for Studying Avascular Necrosis of the Femoral Head in Legg-Calvé-Perthes Disease / Padronização de modelo animal para o estudo da necrose isquêmica da cabeça femoral na doença de Legg-Calvé-Perthes

Abstract Objective Testing an experimental model for ischemic necrosis of the femoral head in Legg-Calvé-Perthes disease by evaluating gait, imaging and morphohistology. Methods The operation was done in 11 piglets. Necrosis by cerclage in the right femoral neck was induced. Piglets were divided into group A, with 8 animals, euthanizing two in the 2nd, 4th, 6th, and 8th weeks, respectively; and group B, with 2 animals (sham), submitted to the surgical procedure without cerclage of the right femoral neck. The gait classification used was that of Etterlin. The frozen femurs were submitted to digital radiography and computed tomography. The height and width of the epiphysis and epiphysary coefficient were measured at study times. Light microscopy and immunohistochemistry with TGF-β1 were performed. Results One animal died of sepsis in Group A. In this group, claudication was observed in all animals. On digital radiography and computed tomography, bone sclerosis, enlargement of the right femoral neck, flattening, collapse, and fragmentation of the right femoral head were observed. All epiphysis height and epiphysary coefficient values of the right femoral head were lower than the contralateral ones, in which were observed chondrocytes disordered and separated by gaps. A reduction in TGF-β1 expression was observed at 2 and 6 weeks in the right femoral head and at eight in the left. In group B, there were no signs of necrosis and gait was normal. Conclusions The model presented reproduced macroscopic necrosis on digital radiography, computed tomography, and microscopy. Gait evaluation showed a good correlation with other ischemia findings. Level of EvidenceV. Diagnostic studies.

Resumo Objetivo Testar um modelo experimental para necrose isquêmica da cabeça femoral na doença de Legg-Calvé-Perthes avaliando a marcha, exames de imagens e morfohistologia. Métodos Operaram-se 11 leitões. Induziu-se a necrose por cerclagem no colo femoral direito. Dividiram-se os leitões em grupo A com 8 animais, sacrificando-se dois na 2ª, 4ª, 6ª e 8ª semanas, respectivamente; e grupo B, com 2 animais (sham), submetidos ao procedimento cirúrgico sem a cerclagem do colo femoral direito. A classificação da marcha utilizada foi a de Etterlin. Os fêmures congelados foram submetidos à radiografia digital e tomografia computadorizada. Mediram-se a altura e largura da epífise e o coeficiente epifisário nos tempos de estudo. Realizou-se, microscopia de luz e imunohistoquímica com TGF-β1. Resultados Um animal morreu por sepse no grupo A. Neste grupo, observou-se claudicação em todos os animais. Na radiografia digital e tomografia computadorizada observaram-se: esclerose óssea, alargamento do colo femoral direito, achatamento, colapso e fragmentação da cabeça femoral direita. Todos os valores da altura da epífise e coeficiente epifisário da cabeça femoral direita foram menores que os contralaterais, nos quais observaram-se condrócitos desordenados e separados por lacunas. Observou-se redução da expressão do TGF-β1 com 2 e 6 semanas nas cabeças femorais direitas e nas esquerdas com oito. No grupo B, não ocorreram sinais de necrose e a marcha foi normal. Conclusões O modelo apresentado reproduziu a necrose macroscopicamente, na radiografia digital, tomografia computadorizada e microscopia. A avaliação da marcha demonstrou boa correlação com os demais achados de isquemia. Nível de EvidênciaV. Estudos diagnósticos.

Epidermoid cysts of the orofacial region: A clinico-pathological study of 13 cases with review of literature

Background: Epidermoid cysts (ECs) are uncommon benign cystic lesions derived from the germinative epithelium. Head and neck ECs constitute only 7% of all ECs whereas only 1.6% are seen intraorally. The floor of the mouth is the commonest intraoral site whereas tongue, lips, buccal mucosa, and jaws are less commonly involved intraoral sites. To date, very few large case series of ECs of head and neck have been published. To the best of our knowledge, this is the third-largest case series of 11 intraoral ECs along with 2 extra-oral cases in the pre-auricular region. Aims: To highlight the typical and atypical features of ECs in the common as well as rare sites and draw attention to its consideration as a differential diagnosis for head and neck masses. Settings and Design: Archival data of 13 histopathological cases identified as ECs were analyzed from the Department of Oral Pathology at a tertiary dental hospital and college in New Delhi from 2007 to 2020. Materials and Methods: The demographic, clinical, radiographic, histopathological features, and treatment modalities were recorded and analyzed. Statistical Analysis Used: Appropriate statistical tests were used. Results: The study found strong male predilection in the ratio of 10:3 with an average age of presentation as 28 years. The pre-auricular region and floor of the mouth were the common sites involved followed by buccal mucosa, lips, and jaws. All patients presented with slowly growing swelling with dysphagia, dyspnea, and dysphonia seen in larger cysts on the floor of the mouth. Microscopically, all cases were lined with stratified squamous epithelium filled with laminated layers of keratin. Two cases showed the presence of melanin. One case showed recurrence even after complete surgical excision. Conclusion: ECs, though a rare entity, should be considered in differential diagnosis for head and neck masses and require close follow-up due to their potential for malignant transformation.