Abordagem interdisciplinar no tratamento da macroglossia na síndrome de Beckwith-Wiedemann: relato de caso / Interdisciplinary approach in the treatment of macroglossia in Beckwith-Wiedemann syndrome: case report

RESUMO O objetivo deste estudo foi relatar a abordagem interdisciplinar no manejo da macroglossia em um caso de paciente com síndrome de Beckwith-Wiedemann, no período de dez anos. O acompanhamento iniciou pela equipe de Cirurgia Bucomaxilofacial, seguido da Fonoaudiologia, em função de dificuldades alimentares. Após avaliação clínica e instrumental, aos 8 meses de idade, iniciou-se a intervenção fonoaudiológica com foco na disfagia orofaríngea e na terapia miofuncional orofacial. Foi verificado, com 1 ano e 11 meses, ausência de sinais de alteração de deglutição em fase faríngea e melhora na postura de lábios e língua. Aos 3 anos, foram iniciados estímulos para retirada dos hábitos orais e o treino da função mastigatória. O tratamento ortodôntico para correção de mordida aberta anterior e mordida cruzada posterior unilateral iniciou-se aos 6 anos. Aos 7 anos e 5 meses de idade, constatou-se estabilidade do modo respiratório nasal e adequação da postura de repouso de lábios e língua. Aos 9 anos, em função de recidiva das alterações oclusais, optou-se pela redução cirúrgica da língua seguida de terapia miofuncional orofacial, retomada aos 9 anos e 3 meses. O resultado foi a correção da postura da língua na deglutição e a adequação da fala. A associação dos tratamentos, envolvendo Fonoaudiologia, Ortodontia e Cirurgia Bucomaxilofacial foi considerada efetiva no manejo da macroglossia, resultando na adequação e equilíbrio das funções orofaciais.

ABSTRACT This study aims to report the interdisciplinary management of macroglossia in a Beckwith-Wiedemann syndrome patient during ten years. Clinical follow-up started by the Oral and Maxillofacial Surgery team, followed by Speech Therapy due to feeding difficulties. After clinical and instrumental evaluation, at 8 months old, the speech therapy intervention was indicated, focusing on oropharyngeal dysphagia and orofacial myofunctional therapy. At 1 year and 11 months, no signs of swallowing alteration in the pharyngeal phase and improvement in the posture of the lips and tongue were found. At the age of 3, stimulation to remove oral habits and train masticatory function were initiated. Orthodontic treatment to correct anterior open bite and unilateral posterior crossbite started at age 6. At 7 years and 5 months, there was stability in the nasal breathing mode and adequacy of resting posture of lips and tongue. At the age of 9, due to relapse of the occlusal alterations, surgical reduction of the tongue was indicated, followed by orofacial myofunctional therapy, restarted at the age of 9 years and 3 months. The result was the correction of the posture of the tongue during swallowing and speech adequacy. The association of treatments involving Speech Therapy, Orthodontics and Oral and Maxillofacial Surgery was considered effective in the management of the macroglossia. It resulted in the adequacy and equilibrium of orofacial functions.

Avaliação da fala pré-tratamento e pós-tratamento fonoaudiológico associado ao biofeedback ultrassonográfico de língua e de prótese bucomaxilofacial no câncer de cavidade oral / Evaluation of speech before and after speech therapy associated with ultrasound biofeedback of tongue and bucomaxillofacial prosthesis in oral cavity cancer

RESUMO As próteses bucomaxilofaciais (PBMF) têm como objetivo a reabilitação oral de pacientes com mutilações decorrentes de cirurgias de câncer de boca. Como parte dessa reabilitação oral, a terapia fonoaudiológica associada ao biofeedback ultrassonográfico da língua possibilita melhor precisão da produção de fala. O presente estudo teve por objetivo caracterizar a produção de fala de um indivíduo com histórico de múltiplas cirurgias oncológicas que levaram à glossectomia total, com auxílio de um dispositivo individualizado de acrílico, idealizado a partir da parceria Odonto-Fonoaudiologia da instituição e confeccionado por especialista em PBMF e terapia fonoaudiológica, utilizando o biofeedback visual com ultrassonografia. O indivíduo era homem, 45 anos, professor aposentado com histórico de carcinoma epidermóide de língua com episódios de recidiva. Como tratamento oncológico, foram realizadas diversas cirurgias associadas à radioterapia, ao longo de sete anos. O tratamento oncológico culminou com a glossectomia total e instalação de osteorradionecrose de mandíbula. O tratamento desta sequela da radioterapia também exigiu múltiplas abordagens cirúrgicas, com perda de grande parte da mandíbula, levando ao severo comprometimento das funções de deglutição e fala. Durante o atendimento multiprofissional da equipe Odonto-Fonoaudiologia de um hospital universitário, foi idealizada a confecção de um dispositivo individualizado de acrílico, objetivando melhorar a inteligibilidade da fala do paciente. Tal dispositivo foi confeccionado por dentista especialista em PBMF e ajustado em conjunto com a equipe de Fonoaudiologia. Com o dispositivo de acrílico adaptado, o indivíduo iniciou a terapia fonoaudiológica associada ao biofeedback, por meio da ultrassonografia de língua, com o objetivo de promover o refinamento da produção de fala dos fones fricativos [s] e [∫]. Ao comparar a avaliação pré-terapia e pós-terapia, foi possível identificar, após a análise das falas por juízes, melhora quanto à Porcentagem de Consoantes Corretas, de moderadamente severa para levemente moderada, bem como a inteligibilidade de fala, de insuficiente para regular. O dispositivo individualizado com a terapia fonoaudiológica associada ao biofeedback produziram resultados de fala satisfatórios, considerando-se a gravidade do caso e o elevado grau de mutilação do paciente.

ABSTRACT The oral maxillofacial prostheses (PBMF) aim the oral rehabilitation of patients with mutilations resulting from oral cancer surgery. The oral rehabilitation was composed of speech therapy associated with ultrasound biofeedback of the tongue, which allows better precision in speech production. The present study aims to characterize the speech production of an individual with a history of multiple oncological surgeries with total glossectomy with the aid of an individualized acrylic device, designed based on the partnership between Dentistry and Speech Therapy and made by a prosthetic dentist, undergoing therapy and speech therapy with visual biofeedback by ultrasound. The individual is a 45-year-old man, retired teacher with a history of tongue squamous cell carcinoma with episodes of recurrence. The cancer treatment was performed by several surgeries associated with radiotherapy over seven years. This treatment resulted in total glossectomy and the presence of osteoradionecrosis (ORN) of the mandible. The sequel to radiotherapy also required multiple surgical approaches with loss of a large part of the jaw, causing severe impairment of swallowing and speech functions. During the multidisciplinary care provided by the Dentistry and Speech Therapy team at a university hospital. The creation of an individualized acrylic device was conceived, aiming to improve the speech intelligibility of the patient. This device was made by a prosthetic dentist and adjusted together with the Speech Therapy team. With the adapted acrylic device, the individual started speech therapy associated with biofeedback by means of tongue ultrasound with the aim of promoting the refinement of the speech production of the fricative headphones [s] and [∫]. When comparing the pre-therapy and post-therapy assessment (after the analysis of the speeches by judges) it was possible to identify an improvement in the Percentage of Consonants Correct (PCC) from moderately-severe to slightly-moderate, as well as speech intelligibility from insufficient to regulate. The individualized device with speech therapy associated with biofeedback produced satisfactory speech results, considering the severity of the case and the high degree of mutilation of the patient.

Functional outcomes and survival of patients with oral and oropharyngeal cancer after total glossectomy / Resultados funcionais e sobrevida de pacientes com câncer de cavidade oral e orofaringe submetidos à glossectomia total

Abstract Introduction: Cancer of the oral cavity and oropharynx presents aggressive behavior and its diagnosis is, in most cases, performed in advanced stages. Total glossectomy is a therapeutic option in locally advanced cancer, and the only one in the recurrent or residual disease, after chemoradiotherapy. Objective: To evaluate the clinical-epidemiological profile, postoperative complications, survival rates and functional aspects of patients with oral cavity and oropharynx cancer after total glossectomy. Methods: It was a retrospective study where 22 patients were included with oral cavity and oropharyngeal cancer after total glossectomy at the Hospital Regional do Vale do Paraíba, em Taubaté, São Paulo. Results: All patients were male, with a median age of 57 years, most of tumors are located in the tongue and floor of the mouth and classified as stage IVa. Total glossectomy as initial treatment was performed in 18 and as salvage in four patients. The major pectoralis myocutaneous flap was used for reconstruction in all cases. The main postoperative complication was wound infection and salivary fistula. Conclusion: Overall survival was 19% and cancer-specific survival was 30.8% in five years. Eight patients were rehabilitated for exclusive oral feeding without the dependence tracheostomy and enteral tube, all with an overall survival greater than 15 months.

Resumo Introdução: O câncer da cavidade oral e da orofaringe apresenta comportamento agressivo e seu diagnóstico é, na maioria dos casos, realizado em fases avançadas. A glossectomia total é uma opção terapêutica no câncer localmente avançado e a única no resgate de pacientes com doença residual ou recorrente, após a quimiorradioterapia. Objetivo: Avaliar o perfil clínico-epidemiológico, as complicações pós-operatórias, as taxas de sobrevida e os aspectos funcionais de pacientes com câncer da cavidade oral e da orofaringe submetidos à glossectomia total. Método: Estudo retrospectivo em que foram incluídos 22 pacientes com câncer de cavidade oral e orofaringe submetidos à glossectomia total no Hospital Regional do Vale do Paraíba, em Taubaté, São Paulo. Resultados: Todos os pacientes eram do gênero masculino, com mediana de 57 anos, com tumores principalmente na língua e no assoalho da boca e classificados, em sua maioria, como estádio clínico IVa. A glossectomia total como tratamento inicial foi realizada em 18 e como resgate em quatro pacientes. O retalho miocutâneo peitoral maior foi utilizado para a reconstrução em todos os casos. A principal complicação pós-operatória foi a infecção da ferida operatória e a fístula salivar. Conclusão: A sobrevida global foi de 19% e a específica por câncer de 30,8% em cinco anos. Oito pacientes foram reabilitados para alimentação oral exclusiva sem a dependência de traqueostomia e ou de dieta enteral, todos com sobrevida global maior do que 15 meses.

Influence of mandibulotomy approaches on oral function following radical resection of tongue carcinoma / 华西口腔医学杂志

OBJECTIVE@#This study aimed to compare the influences of postoperative oral function in patients with median or paramedian mandibulotomy during the radical resection of tongue carcinoma and to provide evidence for the choice of osteotomy location for mandibulotomy.@*METHODS@#The clinical data of 126 patients who underwent combined radical neck dissection with mandibulectomy and glossectomy followed by simultaneous reconstruction were analyzed retrospectively. The patients were divided into two groups according to the position of mandibulotomy: median mandibulotomy group (median group, n=60) and paramedian mandibulotomy group (paramedian group, n=66). The fourth edition of the University of Washington Quality of Life Questionnaire (UW-QOL) was used to compare the differences in oral functions, such as swallowing, mastication, and speech, between the two groups during regular follow-up. SPSS 24.0 software package was used for statistical analysis, and P<0.05 was considered statistically significant.@*RESULTS@#Six months after the operation, no significant differences in swallowing, mastication, and speech functions were found between the median and paramedian groups. However, the swallowing and speech functions in the paramedian group were better than those in the median group 1 year after the operation (P<0.05), whereas no statistical difference in mastication function was observed between the two groups.@*CONCLUSIONS@#Evaluation of the postoperative oral function results showed that paramedian mandibulotomy was a better surgical approach than median mandibulotomy. Paramedian mandibulotomy is worth prioritizing in the radical resection of tongue carcinoma.

Deglutição e fala de pacientes submetidos à glossectomia devido ao câncer de língua: relato de casos / Swallowing and speech of patients submitted to glossectomy due to tongue cancer: cases report

RESUMO Este estudo teve como objetivo correlacionar o grau de comprometimento da deglutição e da fala de pacientes submetidos à glossectomia devido ao câncer de língua. Trata-se de um estudo de casos, de caráter transversal observacional, realizado em sete pacientes, com idade acima de 18 anos, que realizaram glossectomia como tratamento do câncer de língua. Foram excluídos da pesquisa pacientes que possuíam doenças neurológicas, ou que realizaram outras cirurgias de cabeça e pescoço, não relacionadas ao câncer de língua. Foi realizada avaliação clínica da deglutição, por meio do protocolo Avaliação de Segurança da Deglutição (ASED) e classificação da ingestão oral, conforme a Escala Funcional de Ingestão por Via Oral (Functional Oral Intake Scale - FOIS) A avaliação da fala se deu por meio do protocolo MBGR (Marchesan, Berrentin-Felix, Genaro, Rehder). Observou-se que as maiores alterações na deglutição ocorreram em fase oral da deglutição, havendo necessidade de modificações na alimentação, impactando o nível de ingestão oral. As alterações de fala mais encontradas foram distorção nos fonemas linguoalveolares /ɾ/ e /l/ e linguopalatais /s/, /z/, /ʃ/, /ʒ/ e imprecisão articulatória. Houve correlação entre as alterações de deglutição e o nível de ingestão oral e as alterações de fala, demonstrando que, quanto maiores as modificações presentes na alimentação, maiores as alterações de fala encontradas nos indivíduos do presente trabalho.

ABSTRACT The present study aimed to correlate the swallowing and speech impairment level of patients submitted to glossectomy due to tongue cancer. This is a cross-sectional observational case study carried out with seven patients, over 18 years of age, who underwent glossectomy as a treatment for tongue cancer. Patients who had neurological diseases or who had undergone other head and neck surgeries not related to tongue cancer were excluded from the study. Swallowing clinical evaluation was performed using the ASED (Avaliação de Segurança da Deglutição) protocol and classification of oral intake according to the FOIS scale. Speech assessment was performed using the MBGR (Marchesan, Berrentin-Felix, Genaro, Rehder) protocol. It was observed that the major changes in swallowing occurred in the oral phase of swallowing, requiring changes in feeding practices with an impact on the level of oral intake. The following speech changes were mostly found: distortion in lingual-alveolar phonemes /ɾ/ and /l/ and lingual-palatals /s/, /z/, / ʃ /, /ʒ / and articulatory inaccuracy. A correlation was found between swallowing changes and oral food intake level and speech changes, demonstrating that the greater the feeding changes, the greater the speech changes found in the individuals of the present investigation.

Complete denture making in a patient of partial glossectomy using polished surface impression taking and direct metal laser sintering method: A case report / 대한치과보철학회지

For the success of complete denture, three essential requirements such as retention, stability and support are needed. Moreover, due to the absorption of residual ridge and scarring due to the surgery, when making a complete denture, which is difficult to form the mandibular lingual margins, various considerations such as the arrangement of the Non-anatomical dl non-anatomical teeth, the polished surface impression, the internally weighted metal framework and the use of the denture adhesive cream are necessary. In this case report, the patient has a severely resorbed edentulous ridge from severe periodontitis and has some soft tissue problems after the glossectomy due to tongue cancer. To obtain additional retention and stability, some trials such as polished surface impression taking, internally weighted metal insertion and minimal pressure impression were done for the better result. Moreover To make a metal framework that precisely shapes the desired three-dimensional shape and reduces the complicated process, minimal pressure impression method and direct metal laser sintering technique were used.

Dysphagia in Patients with Tongue Cancer Treated with Surgery / 대한연하장애학회지

OBJECTIVE: To evaluate the swallowing problems after a primary resection in patients with tongue cancer. METHODS: Thirty-eight patients with primary tongue cancer, who underwent a glossectomy and had undergone a Video Fluoroscopic Swallowing Study (VFSS) prior to surgery in a university hospital between January 2010 and May 2015, were included retrospectively. The clinical and swallowing features, including the VFSS parameters before and after surgery, were analyzed. RESULTS: Among the 38 patients, 33 patients were T1 and T2 stage. Thirty-one, six and one patient underwent a partial glossectomy, hemiglossectomy, and total glossectomy, respectively. More than ninety percent of the patients had a selective neck dissection. All the patients were on a regular diet before surgery and showed no penetration or aspiration on the VFSS. Immediately after surgery, 33 patients (87%) had to change to non-oral feeding. At discharge, 8 patients (21%) maintained non-oral feeding, and 30 patients ate a limited diet. In a telephone survey (mean 19 months after surgery), among the 25 survey participants, 24 patients (96%) reported no problems with their regular diet. CONCLUSION: In tongue cancer patients with low Tumor-Node-Metastasis (TNM), American Joint Committee on Cancer (AJCC) stages, a primary resection of tongue cancer did not cause statistically significant dysphagia after surgery. Although many patients had to change their diet to limited or non-oral feeding immediately after surgery, almost all patients improved and could eat a regular diet after the long term follow up.

Reduction glossectomy of congenital macroglossia due to lymphangioma

Macroglossia is a rare clinical condition defined as an enlarged tongue. Macroglossia can cause structural deformities like diastema and disproportionate mandibular growth and present functional disorders such as dysarthria, dysphonia, and respiratory problems. A 7-year-old boy who had lymphangiomatous macroglossia was treated with a reduction glossectomy by anchor-shaped combination of a U-shape and modified key-hole resection. Postoperatively, the reduced tongue was contained completely within the oral cavity, but open bite remained due to prognathism. Sensory and motor nerves to the tongue appeared to be intact, and circulation was adequate. This patient will be monitored for recurrence of tongue enlargement.

Carcinoma de Lengua Móvil / Mobile Tongue Carcinoma

Introducción: El Carcinoma de lengua móvil es uno de los tumores malignos más frecuentes de la cavidad bucal. Generalmente, los pacientes son diagnosticados después de los 40 años de edad. La detección temprana de estas lesiones, evita su desarrollo hacia fases avanzadas de la enfermedad, que oscurecen su pronóstico, por medio de una atención rápida y adecuada, biopsia oportuna, y tratamiento precoz, evitando que los pacientes sean mutilados, sufran o mueran por esta causa. El objetivo del presente estudio es reportar un grupo de pacientes con esta neoplasia, su tratamiento y supervivencia. Métodos: En el presente estudio descriptivo, longitudinal y retrospectivo fueron evaluados los pacientes con diagnóstico de carcinoma de lengua móvil, tratados en el Instituto Nacional de Oncología de la Habana, entre los años 2007 y 2011. Se reporta edad, tabaquismo, alcoholismo, estadiaje, tipo de tratamiento y supervivencia. Resultados: Se registraron 68 casos, se observó un predominio del grupo de edad entre los años 55-69, con el 41.18% de los pacientes, siendo el sexo predominante el masculino, con un 79.41% del total. En la clasificación TNM, se observó que predominó de los tumores estadiados como T3 con el 35.29 %, seguidos de los T2 con el 30.88 %, la invasión ganglionar estuvo más representada por la categoría N0 con el 58.82% de los casos. El 64.71% de los pacientes estaban vivos a los 60 meses. Conclusión: El carcinoma de lengua móvil fue más frecuente en las edades entre 55-69 años y en el sexo masculino, más del 50% de los pacientes practicaban hábitos tóxicos, hubo un predominio de etapas avanzadas, la cirugía con adyuvancia postoperatoria fue la terapéutica más común.

Introduction: Carcinoma of the mobile tongue is one of the most frequent malignant tumors of the oral cavity. Generally, patients are diagnosed after 40 years of age. The early detection of these lesions prevents their development towards advanced stages of the disease, which obscure their prognosis, through rapid and adequate care, timely biopsy, and early treatment, preventing patients from being mutilated, suffering or dying from it cause. The objective of the present study is to report a group of patients with this neoplasia, its treatment and survival. Methods: In the present descriptive, longitudinal and retrospective study, patients diagnosed with mobile tongue carcinoma, treated at the National Institute of Oncology of Havana, between 2007 and 2011, were evaluated. Age, smoking, alcoholism, staging are reported, type of treatment and survival. Results: There were 68 cases, a predominance of the age group between the years 55-69 was observed, with 41.18% of the patients, being the predominant sex the masculine, with 79.41% of the total. In the TNM classification, it was observed that tumors predominated as T3 with 35.29%, followed by T2 with 30.88%, the lymph node invasion was more represented by the N0 category with 58.82% of the cases. 64.71% of the patients were alive at 60 months. Conclusion: The mobile tongue carcinoma was more frequent in the ages between 55-69 years and in the male sex, more than 50% of the patients practiced toxic habits, there was a predominance of advanced stages, the surgery with postoperative adjuvant was the therapeutic more common.

Tratamiento quirúrgico de macroglosia grave en el síndrome de Beckwith-Wiedemann: reporte de un caso / Surgical treatment of macroglossia in Beckwith-Wiedemann syndrome: case report

El síndrome de Beckwith-Wiedemann es una enfermedad congénita, poco frecuente, caracterizada por presentar macroglosia, defectos de la pared abdominal, hemihipertrofia, onfalocele, hipoglucemia neonatal, hernia umbilical, hepatomegalia, anomalías cardíacas, entre otros. La macroglosia se presenta en el 90% de los casos y genera problemas en la masticación, deglución, fonación y respiración, que ocasionan un cierre de la vía aérea superior. La opción terapéutica de elección es la glosectomía parcial. Se presenta a un paciente pediátrico de dos meses de nacido, con síndrome de Beckwith-Wiedemann y obstrucción de la vía aérea por macroglosia grave. En los antecedentes médicos, se reportaron cardiopatías congénitas, comunicación interauricular, conducto arterioso persistente, epilepsia sintomática, falla renal, hipoglicemia, traqueotomía y gastrostomía por el colapso de la vía aérea y disfagia. Se realizó la técnica quirúrgica de glosectomía de reducción anterior, con resultados favorables.

Beckwith-Wiedemann syndrome is a rare congenital condition, characterized by presenting macroglossia, defects of the abdominal wall, hemihypertrophy, omphalocele, neonatal hypoglycemia, umbilical hernia, hepatomegaly, cardiac abnormalities, among others. Macroglossia occurs in 90% of cases, causing a problem in chewing, swallowing, phonation and breathing, resulting in a closure of the upper airway. The therapeutic option of choice is partial glossectomy. We present a 2-month-old pediatric patient with Beckwith-Wiedemann syndrome and area blockage due to severe macroglossia; in the medical history, congenital heart disease, interatrial communication, persistent ductus arteriosus, symptomatic epilepsy, renal failure, hypoglycemia, tracheotomy and gastrostomy, due to airway collapse and dysphagia. It was performed an anterior tongue reduction surgery as a surgical treatment with favorable results.

Case of making maxillary palatal augmentation complete denture for patient with dysphagia after partial glossectomy

If complication arises after glossectomy which leads to trouble in forming food bolus or transfer of the food, it is possible that either food bolus may block the airway or dysphagia may occur as the food bolus goes down into the airway. To solve the issue, palatal augmentation prosthesis could be used. In this case, the patient with an oral cancer is having difficulties swallowing food after glossectomy. Through taking impressions of polishing surface of his denture referring his tongue movement, the complete denture for the upper jaw was created using the concept of palatal augmentation prosthesis. This new upper denture increases the palatal-tongue contact pressure, allowing the patient to perform better swallowing and better pronunciation.

Prosthetic rehabilitation of a patient with tongue cancer using palatal augmentation prosthesis and mandibular implant-retained overdenture: A case report / 대한치과보철학회지

The tongue, especially its lateral part, is the most common site of oral tumors. Patients who undergo glossectomy for the treatment of tongue cancer may experience difficulty in proper functioning for pronunciation, chewing, swallowing, and oral hygiene maintenance; therefore, a palatal augmentation prosthesis can be used to restore function of the tongue. In this case, an implant overdenture was used in a patient who had residual ridge resorption and obliteration of alveololingual sulcus after undergoing glossectomy for tongue cancer treatment. In addition, a palatal augmentation prosthesis with a metal framework, support, and retention part was fabricated. The palatal vault was reduced, so that even with limited tongue movement, adequate tongue-palate contact could be achieved. After placement of the definitive prostheses, the patient showed improvement in the functions of chewing, swallowing, and pronunciation.

Incorporating a continuous suction system as a preventive measure against fistula-related complications in head and neck reconstructive surgery

BACKGROUND: Although previous studies have focused on determining prognostic and causative variables associated with fistula-related complications after head and neck reconstructive surgery, only a few studies have addressed preventive measures. Noting that pooled saliva complicates wound healing and precipitates fistula-related complications, we devised a continuous suction system to remove saliva during early postoperative recovery. METHODS: A continuous suction system was implemented in 20 patients after head and neck reconstructive surgery between January 2012 and October 2017. This group was compared to a control group of 16 patients at the same institution. The system was placed orally when the lesion was on the anterior side of the retromolar trigone area, and when glossectomy or resection of the mouth floor was performed. When the orohypopharynx and/or larynx were eradicated, the irrigation system was placed in the pharyngeal area. RESULTS: The mean follow-up period was 9.2±2.4 months. The Hemovac system was applied for an average of 7.5 days. On average, 6.5 days were needed for the net drain output to fall below 10 mL. Complications were analyzed according to their causes and rates. A fistula occurred in two cases in the suction group. Compared to the control group, a significant difference was noted in the surgical site infection rate (P < 0.031). CONCLUSIONS: Clinical observations showed reduced saliva pooling and a reduction in the infection rate. This resulted in improved wound healing through the application of a continuous suction system.

Glossectomia parcial associada à cirurgia ortognática: relato de caso / Partial glossectomy associated with orthognathic surgery: case report

A macroglossia é caracterizada pelo aumento de volume da língua, a qual afeta todo o sistema estomatognático em função de sua posição e tamanho. Ela é considerada um fator etiológico para: mordida aberta, protrusão bimaxilar, espaçamento entre os arcos dentários e pode causar instabilidade pós-tratamento ortodôntico/ortodôntico-cirúrgico. Aglossectomia é uma cirurgia com prognóstico favorável, pois melhora a estabilidade oclusal, esta pode ser associada antes, simultaneamente ou após a cirurgia ortognática. Nos casos em que o tamanho da língua inviabiliza a realização da cirúrgiaortognática. Descrever um relato de caso de glossectomia associada à cirurgia ortognática, apresentando o diagnóstico, tratamento instituído, técnica cirúrgica e acompanhamento pós operatório. Paciente sexo feminino, acompanhada há 10 anos pelo preceptor do serviço foi submetida à cirurgia ortognática e glossectomia em mesmo tempo cirúrgico, com retração mandibular instituída através de osteotomia bilateral e fixação com duas placas no sistema 2.0. A técnica selecionada para a glossectomia foi de "buraco de fechadura" modificada sem avançar a incisão muito a posterior. Não houve sequelas e a paciente ficou muito satisfeita com o resultado. A macroglossia é uma condição de difícil diagnóstico que precisa ser tratada para uma melhor qualidade de vida e desenvolvimento do paciente, melhor resultado pós operatório em cirurgias ortognáticas, evitar recidivas devido a memória muscular e a influência da língua na posição alvéolo dentaria(AU)

The macroglossia is characterized by an increase in the volume of the tongue, which affect the entire stomatognathic system in function of the tongue position and size. It is considered an etiological factor for: open bite, bimaxillary protrusion, spacing between dental arches and may cause orthodontic / orthodontic-surgical post-treatment instability. Glossectomy is a surgery with favorable prognosis, because cause a improvement of occlusal stability, may be associated before, simultaneously or after an orthognathic surgery. In cases where the size of the tongue makes it impossible to perform orthognathic surgery. To describe a case report of glossectomy associated with orthognathic surgery, presenting the diagnosis, treatment instituted, surgical technique and postoperative follow-up. Female patient, followed for 10 years by the preceptor of the service. She had been submited toaorthognathic surgery and glossectomy in one surgical time, with mandibular retraction instituted through bilateral osteotomy and fixation with two plaques in the 2.0 system. The technique selected for glossectomy was a modified "keyhole" without advancing the incision much later. There were no sequels and patient was very satisfied with the result. Macroglossia is a difficult diagnosis condition that needs to be treated for a better quality of life and development of the patient, better postoperative result in orthognathic surgeries, to avoid relapses due to a Muscular memory and the influence of the tongue in the dental alveolus position(AU)

The effectiveness of elective neck dissection on early (stage I, II) squamous cell carcinoma of the oral tongue

OBJECTIVES: The purpose of this study was to evaluate and compare the treatment outcomes of partial glossectomy with or without elective neck dissection in patients with tongue squamous cell carcinoma (SCCa). MATERIALS AND METHODS: A total of 98 patients who were diagnosed with tongue SCCa and underwent partial glossectomy between 2005 and 2014 were evaluated. Only 14 patients received elective neck dissection, and 84 patients received only partial glossectomy. RESULTS: There were 56 men and 42 women with a mean age of 57 years and mean follow-up period of 33.7 months. There were 70 patients graded as T1 and 28 as T2. The total occult metastasis rate was 17.3%. The 5-year overall survival rate was 83.3% with elective neck dissection and 92.4% with observation. The 5-year disease-free survival rate was in 70.7% in the elective neck dissection group and 65.3% in the observation group. CONCLUSION: We retrospectively reviewed the records of 98 patients with tongue SCCa. These patients were divided into two groups, those who underwent elective neck dissection and those who did not. There was no statistically significant difference between the groups undergoing partial glossectomy with or without elective neck dissection.

Analysis of speech and tongue motion in normal and post-glossectomy speaker using cine MRI

ABSTRACT Objective Since the tongue is the oral structure responsible for mastication, pronunciation, and swallowing functions, patients who undergo glossectomy can be affected in various aspects of these functions. The vowel /i/ uses the tongue shape, whereas /u/ uses tongue and lip shapes. The purpose of this study is to investigate the morphological changes of the tongue and the adaptation of pronunciation using cine MRI for speech of patients who undergo glossectomy. Material and Methods Twenty-three controls (11 males and 12 females) and 13 patients (eight males and five females) volunteered to participate in the experiment. The patients underwent glossectomy surgery for T1 or T2 lateral lingual tumors. The speech tasks “a souk” and “a geese” were spoken by all subjects providing data for the vowels /u/ and /i/. Cine MRI and speech acoustics were recorded and measured to compare the changes in the tongue with vowel acoustics after surgery. 2D measurements were made of the interlip distance, tongue-palate distance, tongue position (anterior-posterior and superior-inferior), tongue height on the left and right sides, and pharynx size. Vowel formants Fl, F2, and F3 were measured. Results The patients had significantly lower F2/Fl ratios (F=5.911, p=0.018), and lower F3/F1 ratios that approached significance. This was seen primarily in the /u/ data. Patients had flatter tongue shapes than controls with a greater effect seen in /u/ than /i/. Conclusion The patients showed complex adaptation motion in order to preserve the acoustic integrity of the vowels, and the tongue modified cavity size relationships to maintain the value of the formant frequencies.

Exploratory Study on Guide Wire-Guided Tongue Resection under Ultrasonography for Adequate Safe Margins in Tongue Cancer Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The adequate safety margin in tongue cancer is the most important prognostic factor for local recurrence and survival. This study aimed to evaluate the resection margins using a new technique of tongue resection under the guidance of guide wire under ultrasonography in patients with tongue cancer. SUBJECTS AND METHOD: In this prospective study, 10 patients with presurgical, biopsy-proven, clinical T1 or T2 tongue squamous cell carcinomas underwent resection under the guidance of guide wire inserted using ultrasonography. The data of resection margins of 37 patients who underwent partial glossectomy using the conventional method of palpation were used as control data. RESULTS: The mean safety margins (mm) of the experimental group were 7.59±4.30 (anterior), 8.56±4.69 (posterior), 5.25±3.01 (superior), 5.93±3.66 (inferior), 13.00±13.29 (medial), 5.78±2.64 (deep), and 6.67±3.06 (lateral). There were no differences in the safety margins between the two groups. CONCLUSION: Using guide wire under ultrasonography was not superior to the conventional method for partial glossectomy for having adequate resection margins.

Plasticidade neural em pacientes glossectomizados / Neuroplasticity in glossectomy patients

Objetivo: Avaliar as ativações cerebrais relacionadas à função de deglutição pré e pós-cirurgia em pacientes com diagnóstico de tumor de língua. Método: Foi realizado um estudo prospectivo e descritivo transversal incluindo pacientes com diagnóstico de câncer de língua e adultos saudáveis sem queixas relacionadas à deglutição (grupo controle). Os pacientes incluídos foram avaliados através de ressonância magnética funcional (RMf) do cérebro (paradigma evento-relacionado; deglutição de saliva versus repouso), avaliação videofluoroscópica (VF) da deglutição e avaliação da qualidade de vida (QV) relacionada à deglutição em 3 momentos: pré-cirurgia, pós-cirurgia recente (média de 1 mês) e pós-cirurgia tardio (média de 3 meses). Para o grupo controle, foi realizada apenas a RMf e os sujeitos foram pareados pela idade e gênero. Os dados foram descritos e as análises foram correlacionadas entre os momentos de avaliação e o grupo controle vs. pacientes. A análise das imagens de RMf foi realizada pelo programa estatístico FMRIB Software Library (FSL) versão 6.0 (Centre for Functional MRI of Brain - FMRIB, Analysis Group, Oxford, UK, http://www.fmrib.ox.ac.uk/fsl/). As imagens estruturais foram analisadas por inspeção visual através do programa FSLview. Resultados: Foram avaliados 8 pacientes, a maioria (5 pacientes) do gênero masculino, com média de idade de 50 anos. Todos os pacientes foram avaliados no momento pré-cirurgia. Destes, 6 foram reavaliados no pós-cirúrgico 1 e 3 no pós-cirúrgico 2. O grupo controle foi composto por 6 sujeitos saudáveis. A inspeção visual das imagens funcionais demonstrou uma redução da ativação cerebral no momento pré-cirúrgico, quando comparado ao grupo controle com sujeitos saudáveis, nas seguintes áreas: córtex pré-motor, córtex motor primário, córtex somatossensorial primário, giros pré e pós-central, ínsula e cerebelo, todas bilateralmente. No momento pós-cirúrgico 1 foi observado um discreto aumento do volume de ativação, e no momento pós-cirúrgico 2 a ativação manteve praticamente o mesmo volume, porém com áreas melhor distribuídas (giro subcentral direito extendendo-se para o giro frontal inferior, giro supramarginal bilateral, lóbulo cerebelar superior esquerdo extendendo-se para o vermis superior e o lóbulo cerebelar superior direito), apesar de menores e com menos clusters quando comparadas ao grupo controle. Conclusão: Os pacientes com diagnóstico de tumor de língua apresentaram modificações na rede neural relacionada à deglutição no momento pré-cirúrgico, sendo estas mudanças caracterizadas por uma redução na extensão dos clusters nas áreas relacionadas à função de deglutição. Pacientes avaliados no pós-cirúrgico recente, apresentaram discreto aumento na extensão dos clusters nas mesmas áreas do pré-cirúrgico. Os pacientes avaliados no momento pós-cirúrgico tardio, demonstraram maior distribuição da ativação cerebral em áreas não observadas na avaliação do momento pós-cirúrgico 1 (recente).

Objective: Assess brain activations related with pre- and postoperative swallowing function in patients with tongue tumors. Method: A prospective and descriptive cross-sectional study was performed including patients diagnosed with tongue cancer and healthy adults without complaints related to swallowing (control group). Patients included in the study were assessed using functional magnetic resonance imaging (fMRI) of the brain (eventrelated paradigm; saliva swallowing versus rest), videofluoroscopy assessment (VF) of swallowing and quality of life assessment (QoL) associated with swallowing at 3 time points: preoperative, postoperative 1 (recent; mean: 1 month) and postoperative 2 (late; mean: 3 months). For the control group, only fMRI was performed and the subjects were matched for age and gender. Data were described and analyzes were correlated between time points and control group vs. patients. The analysis of fMRI images used the statistical program FMRIB Software Library (FSL) version 6.0 (Centre for Functional Magnetic Resonance Imaging of the Brain - FMRIB, Analysis Group, Oxford, UK, http://www.fmrib.ox.ac.uk/fsl/). Structural images of FLAIR and VBM sequences were analyzed by visual inspection through the FSLview software program. Results: We evaluated eight patients; the majority (five patients) was male, with a mean age of 50 years. All patients were assessed pre-surgery. Of these, six were reassessed at post-surgical 1 and three at post-surgical 2. The control group consisted of six healthy subjects. Visual inspection of functional imaging demonstrates a reduction in brain activation at preoperative period when compared to the control group of healthy subjects in the following areas: premotor cortex, primary motor cortex, primary somatosensory cortex, pre- and post-central gyrus, insula and cerebellum, all bilaterally. A discreet increase in activation volume was observed at postoperative 1, while activation was observed to remain practically at the same volume at postoperative 2, but with areas more evenly distributed (right sub-central gyrus extending to the inferior frontal gyrus, bilateral supramarginal gyrus, left superior cerebellar lobe extending to the superior vermis and the right superior cerebellar lobe), although smaller and with less clusters when compared to control group. Conclusion: Patients diagnosed with tongue cancer present changes in the neural network associated with swallowing at preoperative, with these changes characterized by a reduction in the extension of clusters in areas related to swallowing function. Patients assessed at postoperative 1 presented a slight increase in the extension of clusters when compared to the same areas at preoperative. Patients evaluated at late postoperative time demonstrated greater distribution of brain activation in areas non-observed areas in the evaluation at post-surgical 1 (recent).

Glosectomia parcial más vaciamiento de niveles cervicalesI, II, III en el manejo del cáncer de lengua móvil / Parcial glossectomy and neck dissection levels I, II, III in the management of the mobile tongue cancer

Introducción: La incidencia del cáncer escamocelular de lengua ha venido incrementándose en las últimas décadas. Su presentación más usual es en el borde lateral, en la unión entre el tercio medio y posterior. Es más frecuente en hombres y se asocia con ingesta de alcohol y tabaco, radiación ultravioleta, virus humanos (papilomavirus), entre otros. Objetivo: Presentar el caso y técnica quirúrgica realizada en una paciente con carcinoma escamocelular de borde lateral de lengua estadio III, requiriendo glosectomía parcial más vaciamiento cervical de niveles I, II y III ipsilateral y radioterapia postoperatoria. Diseño: Reporte de caso. Materiales y métodos: Se presenta el caso de una mujer de 60 años que consultó por 5 meses de presencia de masa en lengua con limitación para la protrusión lingual, dolor con la ingesta de alimentos y otalgia izquierda, con biopsia que reportó carcinoma escamocelular infiltrante moderadamente diferenciado. Resultados: El reporte de patología confirmó carcinoma escamocelular bien diferenciado queratinizante infiltrante con márgenes libres y vaciamiento ganglionar con 2 niveles ganglionares comprometidos por tumor, indicándose Radioterapia postoperatoria. Dos años después de tratamiento, paciente no ha presentado recurrencia de lesión tumoral. Conclusiones: Al igual que el manejo quirúrgico del tumor primario y las diversas formas de reconstrucción del defecto por la glosectomía, los autores apoyamos la disección electiva supraomohioidea de cuello en pacientes N0, ya que el control de la enfermedad del cuello y la supervivencia pueden mejorar significativamente, si se realiza la disección cervical antes que las metástasis se hagan clínicamente evidentes.

Introduction: The incidence of squamous cell tongue cancer has been increasing in recent decades. Its most common presentation is on the lateral edge, at the junction of the middle and posterior third. It is more common in men and is associated with intake of alcohol and snuff, ultraviolet radiation, human viruses (human papillomavirus), among others. Objective: To present the case and surgical technique performed on a patient with squamous cell carcinoma of the tongue side edge Stage III, requiring partial glossectomy's neck dissection of levels I, II and III ipsilateral and postoperative radiotherapy. Design: Case report. Materials and Methods: We present the case of a 60 year old patient with five months of presence of a mass on tongue with limitation for protrusion, pain with food intake and left otalgia, whose biopsy reported invasive squamous cell carcinoma is presented moderately differentiated. Results: The pathology confirmed invasive squamous cell carcinoma keratinizing, well differentiated with clear margins and lymph node dissection with 2 nodal levels involved by tumor, indicating postoperative radiotherapy. Two years after treatment, patient has had no recurrence of tumor lesion. Conclusions: As with the surgical management of the primary tumor and various forms of reconstruction of the defect by glossectomy, the authors support supraomohyoid elective neck dissection N0 patients as disease control and survival neck can improve significantly, if cervical dissection is performed before metastases are clinically apparent.