Modalidades de radioterapia empregadas para o câncer de cabeça e pescoço / Radiotherapy modalities used for head and neck cancer

O câncer de cabeça e pescoço (CCP) refere-se ao grupo de tumores que atingem a laringe, cavidade nasal, nasofaringe, orofaringe, cavidade oral e glândulas salivares. A radioterapia no paciente com CCP representa uma terapia para manutenção do órgão, através da destruição das células neoplásicas malignas. O objetivo do presente estudo foi identificar estratégias radioterápicas aplicadas ao paciente com CCP e seus respectivos efeitos colaterais em cavidade oral, além de investigar as principais modalidades utilizadas nos sistemas de saúde do Brasil. Tratou-se de uma revisão narrativa da literatura com busca ativa das bases eletrônicas PUBMED, LILACS e SCIELO. Após todas as etapas de refinamento, um total de 58 artigos foram incluídos na presente revisão. A radioterapia possui papel de destaque no tratamento do CCP. No entanto, por não ser um método terapêutico com alta especificidade, resulta em efeitos adversos ao tratamento como mucosite oral, trismo e disfunção salivar, que findam por reduzir a qualidade de vida do paciente. Dentre as principais técnicas radioterapêuticas utilizadas no Brasil, a IMRT e VMAT caracterizam-se como as formas mais avançadas da terapia em 3D, proporcionando doses equivalentes para cada área da lesão tumoral, poupando áreas teciduais circunvizinhas que não necessitam de irradiação. Além da toxicidade reduzida, uma maior sobrevida pode ser observada em pacientes tratados com essas técnicas. Um dos maiores desafios atuais na radioterapia contra o CCP é a proteção de tecidos saudáveis. Nesse sentido, a IMRT e VMAT apresentam superioridade em relação às demais técnicas.

Head and neck cancer (CCP) refers to the group of tumors that affect the larynx, nasal cavity, nasopharynx, oropharynx, oral cavity and salivary glands. Radiotherapy in patients with CCP represents a therapy for organ maintenance, through the destruction of malignant neoplastic cells. The aim of this study was to identify radiotherapy strategies applied to patients with CCP and their respective side effects in the oral cavity, and to investigate the main modalities used in health systems in Brazil. It was a narrative review of the literature with active search of electronic databases PUBMED, LILACS and SCIELO. After all stages of refinement, a total of 58 articles were included in this review. Radiotherapy has a prominent role in the treatment of CCP. However, because it is not a therapeutic method with high specificity, it results in adverse effects to treatment such as oral mucositis, trismus and salivary dysfunction, which end up reducing the quality of life of the patient. Among the main radiotherapeutic techniques used in Brazil, IMRT and VMAT are characterized as the most advanced forms of 3D therapy, providing equivalent doses for each area of the tumor sparing surrounding tissue areas that do not require irradiation. In addition to reduced toxicity, greater survival can be observed in patients treated with these techniques. One of the biggest current challenges in radiation therapy against CCP is the protection of healthy tissues. In this sense, the IMRT and VMAT present superiority in relation to the other techniques.

Evaluación de la experiencia de telemedicina en consulta de Cirugía de cabeza y cuello en un centro de referencia en Manizales / Evaluation of telemedicine experience in head and neck surgery consultation in a referral center in Manizales

Introducción. La infección por COVID-19 afectó drásticamente la atención en salud a nivel mundial, generando retos para la atención primaria. En orden de mitigar y manejar el contagio, la telemedicina se convirtió en una modalidad emergente y efectiva en varias especialidades médicas, incluida la cirugía de cabeza y cuello. Métodos. Estudio de corte transversal con análisis retrospectivo de pacientes atendidos en la consulta virtual durante 18 meses. Se estimaron frecuencias absolutas y relativas, y bivariado con regresión logística binaria. Se incluyeron las variables de diagnóstico primario, poder resolutivo de la consulta, necesidad de cita presencial, plataforma y dificultades de la misma. Resultados. Se incluyeron 2485 pacientes provenientes de 11 departamentos. La patología tiroidea fue la más frecuente (62,9 %), seguida de la aerodigestiva (10,9 %). La consulta fue eficiente en el 99 % de los casos, con una capacidad resolutiva del 96,4 %. El 1,4 % tuvo dificultades en la plataforma y el 8,3 % de los pacientes requirió cita presencial. Cuando hubo dificultad para la revisión de exámenes o una inadecuada inspección funcional, fue 30 veces más probable no poder resolver eficientemente la consulta. Conclusión. La telemedicina provee una alternativa eficiente de atención en cirugía de cabeza y cuello, especialmente en los controles de patología tiroidea, evitando desplazamientos innecesarios. En el tracto aerodigestivo, donde el examen físico es primordial, su utilidad está limitada a la posibilidad de realizar un examen endoscópico posterior que permita una adecuada estadificación y facilite la valoración presencial.

Introduction. The COVID-19 infection drastically affected health care worldwide, creating challenges for primary care. In order to mitigate and manage infection, telemedicine has become an emerging and effective modality in several medical specialties, including head and neck surgery. Methods. Retrospective cross-sectional analysis of patients seen in virtual consultation over 18 months. Absolute and relative frequencies were estimated, univariate analysis was done with chi-square, and bivariate analysis with binary logistic regression. Variables such as primary diagnosis, the resolution power of the consultation, the need for an in-person appointment, the platform, and its difficulties were included. Results. 2485 patients from 11 departments were included. Thyroid pathology was the most frequent (62.9%), followed by aerodigestive tract pathology (10.8%). The consultation was efficient in 99% of cases, with a resolution capacity of 96.4%. 1.4% had difficulties on the platform and 8.3% of patients required an in-person. When there was difficulty in reviewing exams or an inadequate functional inspection, it was 30 times more likely to not be able to efficiently be resolved. Conclusion. Telemedicine provides an efficient alternative for care in head and neck surgery, especially in thyroid pathology controls, avoiding unnecessary travel. In the aerodigestive tract, where the physical examination is essential, its usefulness is limited to the possibility of performing a subsequent endoscopic examination that allows adequate staging and facilitates in-person assessment.

Análisis de los tiempos críticos en diagnóstico y tratamiento de Cáncer de Cabeza y Cuello en Complejo Asistencial Sótero del Río / Analysis of critical times in diagnosis and treatment of Head and Neck Cancer at Hospital Sótero del Río

Introducción: El cáncer de cabeza y cuello (CaCyC) representa una alta carga de enfermedad. El retraso del inicio de tratamiento es un factor predictor independiente de mortalidad. Objetivo: Describir los tiempos entre hitos claves diagnósticos y terapéuticos de pacientes con CaCyC atendidos en Hospital Sótero del Río (CASR) y comparar la experiencia local con guías internacionales. Material y Método: Estudio descriptivo-retrospectivo de pacientes presentados en Comité Oncológico de cabeza y cuello (COCYC) del CASR desde septiembre 2020 hasta julio 2022. Se analizan los tiempos críticos del proceso diagnóstico y terapéutico. Resultados: 78 pacientes se seleccionan, 75,5% con carcinoma escamoso. La mediana de tiempos entre derivación desde atención primaria (APS) y evaluación CASR es 2 días, entre evaluación y biopsia es 9 días, y entre diagnóstico histológico e inicio de tratamiento en cualquier modalidad de 27 días. Se comparan los tiempos críticos según los plazos definidos por el Cancer Council Australia. Las tasas de cumplimiento entre derivación APS y evaluación CASR es 67%. Según el tratamiento recibido, la tasa de cumplimiento desde el ingreso al inicio de tratamiento es 70% para cirugía exclusiva, 0% para inicio de radioterapia, y 20% para radioquimioterapia. Para cirugía y radioterapia adyuvante, la tasa es 67% entre evaluación y cirugía, y 6% entre cirugía y radioterapia. Conclusión: Se describen los tiempos entre hitos claves diagnósticos y terapéuticos. Los tiempos de derivación desde APS e inicio de terapias quirúrgicas son comparables a la literatura internacional, pero los tiempos en inicio de radioterapia son mejorables.

Introduction: Head and neck cancer (H&NCa) represents a high burden of disease. Delay in starting treatment is an independent predictor of mortality. Objective: To describe the times between the key diagnostic and therapeutic milestones of patients with H&NCa treated at the Hospital Sótero del Río (CASR) and compare the local experience with international guidelines. Material and Method: descriptive-retrospective study of patients presented to the Head and Neck Oncology Committee (H&NOCO) of the CASR from September 2020 to July 2022. The critical times of the diagnostic and therapeutic process are analyzed. Results: 78 patients are selected, 75.5% with squamous cell carcinoma. The median time between referral from primary care (PC) and CASR evaluation is 2 days, between evaluation and biopsy is 9 days, and between histological diagnosis and initiation of treatment in any modality is 27 days. Critical times are compared according to the deadlines defined by Cancer Council Australia. Compliance rates between PC referral and CASR admission is 67%. Depending on the treatment received, the compliance rate from admission to the start of treatment is 70% for exclusive surgery, 0% for the start of radiotherapy, and 20% for radiochemotherapy. For surgery and adjuvant radiotherapy, the rate is 67% between evaluation and surgery, and 6% between surgery and radiotherapy. Conclusion: Waiting times between key diagnostic and therapeutic process are described. The times of referral from PC and start of surgical therapies are comparable to the international literature. However, times regarding the start radiotherapy can be improved.

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.

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.

Osteorradionecrose dos maxilares em pacientes portadores de câncer de cabeça e pescoço - Overview de revisões sistemáticas / Osteoradionecrosis and its treatment protocols in patients with head and neck cancer - overview of systematic reviews

Os pacientes portadores de câncer de cabeça e pescoço realizam tratamento, de radioterapia podendo ou não estar associados à quimioterapia e/ou cirurgias. A qualidade de vida dos mesmos é afetada em função dos efeitos colaterais causados pelos tratamentos. Mucosite, hiposalivação, perda do paladar, trismo e osteorradionecrose são os efeitos colaterais que mais acomentem os pacientes em tratamento para câncer de cabeça e pescoço. A osteorradionecrose é considerada um evento tardio e a maior complicação pós tratamento de radioterapia. Foi realizada uma busca sistemática nas bases de dados eletrônicas MEDLINE / PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Open Gray e busca manual, sem restrição de idioma e tempo. Os critérios de elegibilidade foram os seguintes: 1) ser revisão sistemática; 2) abordar sobre os efeitos orais e complicações após quimioterapia e/ou radioterapia em pacientes adultos portadores de câncer de cabeça e pescoço e 3) RS baseadas em estudos clínicos prospectivos/ retrospectivos e ECR (estudo clínico randomizado). A elegibilidade foi determinada de acordo com os critérios de exclusão para:1) RS que descrevessem a o tratamento para as sequelas da ORN; 2) as RS baseadas em relatos de casos ou estudos in vitro sobre ORN; 3) ORN em ossos não gnáticos (temporal); 4) não abordarem sobre incidência, tratamento ou prevenção da ORN e 5) revisão da classificação da ORN. Foram identificados 1321 artigos, mas apenas 13 foram considerados elegíveis. A fase de elegibilidade, qualidade metodológica (AMSTAR 2) foi conduzida por dois examinadores independentes e calibrados (RMS e GS), e um terceiro examinador (MSANM) foi consultado para a resolução de incongruências. O número de pacientes avaliados para o desenvolvimento de ORN ao longo do tratamento foi 33.762 sendo que desses, 2.094 desenvolveram a lesão, representando uma incidência de 6,2%. Quanto a localização a mandíbula é o local de maior acometimento. A exodontia após a radioterapia foi apontada como o maior fator causal para o desenvolvimento de ORN. A abordagem de tratamento para a ORN com pentoxifilina e tocoferol demonstrou eficácia superior em relação ao uso de antibioticoterapia e câmera hiperbárica. Baseado no risco de viés, é baixo o nível atual de evidência para as abordagens preventivas e curativas da ORN.

RNPS1 stabilizes NAT10 protein to facilitate translation in cancer via tRNA ac4C modification / 国际口腔科学杂志·英文版

Existing studies have underscored the pivotal role of N-acetyltransferase 10 (NAT10) in various cancers. However, the outcomes of protein-protein interactions between NAT10 and its protein partners in head and neck squamous cell carcinoma (HNSCC) remain unexplored. In this study, we identified a significant upregulation of RNA-binding protein with serine-rich domain 1 (RNPS1) in HNSCC, where RNPS1 inhibits the ubiquitination degradation of NAT10 by E3 ubiquitin ligase, zinc finger SWIM domain-containing protein 6 (ZSWIM6), through direct protein interaction, thereby promoting high NAT10 expression in HNSCC. This upregulated NAT10 stability mediates the enhancement of specific tRNA ac4C modifications, subsequently boosting the translation process of genes involved in pathways such as IL-6 signaling, IL-8 signaling, and PTEN signaling that play roles in regulating HNSCC malignant progression, ultimately influencing the survival and prognosis of HNSCC patients. Additionally, we pioneered the development of TRMC-seq, leading to the discovery of novel tRNA-ac4C modification sites, thereby providing a potent sequencing tool for tRNA-ac4C research. Our findings expand the repertoire of tRNA ac4C modifications and identify a role of tRNA ac4C in the regulation of mRNA translation in HNSCC.

WNT7A promotes tumorigenesis of head and neck squamous cell carcinoma via activating FZD7/JAK1/STAT3 signaling / 国际口腔科学杂志·英文版

Wnt signaling are critical pathway involved in organ development, tumorigenesis, and cancer progression. WNT7A, a member of the Wnt family, remains poorly understood in terms of its role and the underlying molecular mechanisms it entails in head and neck squamous cell carcinoma (HNSCC). According to the Cancer Genome Atlas (TCGA), transcriptome sequencing data of HNSCC, the expression level of WNT7A in tumors was found to be higher than in adjacent normal tissues, which was validated using Real-time RT-PCR and immunohistochemistry. Unexpectedly, overexpression of WNT7A did not activate the canonical Wnt-β-catenin pathway in HNSCC. Instead, our findings suggested that WNT7A potentially activated the FZD7/JAK1/STAT3 signaling pathway, leading to enhanced cell proliferation, self-renewal, and resistance to apoptosis. Furthermore, in a patient-derived xenograft (PDX) tumor model, high expression of WNT7A and phosphorylated STAT3 was observed, which positively correlated with tumor progression. These findings underscore the significance of WNT7A in HNSCC progression and propose the targeting of key molecules within the FZD7/JAK1/STAT3 pathway as a promising strategy for precise treatment of HNSCC.

Spatial transcriptomics reveals that metabolic characteristics define the tumor immunosuppression microenvironment via iCAF transformation in oral squamous cell carcinoma / 国际口腔科学杂志·英文版

Tumor progression is closely related to tumor tissue metabolism and reshaping of the microenvironment. Oral squamous cell carcinoma (OSCC), a representative hypoxic tumor, has a heterogeneous internal metabolic environment. To clarify the relationship between different metabolic regions and the tumor immune microenvironment (TME) in OSCC, Single cell (SC) and spatial transcriptomics (ST) sequencing of OSCC tissues were performed. The proportion of TME in the ST data was obtained through SPOTlight deconvolution using SC and GSE103322 data. The metabolic activity of each spot was calculated using scMetabolism, and k-means clustering was used to classify all spots into hyper-, normal-, or hypometabolic regions. CD4T cell infiltration and TGF-β expression is higher in the hypermetabolic regions than in the others. Through CellPhoneDB and NicheNet cell-cell communication analysis, it was found that in the hypermetabolic region, fibroblasts can utilize the lactate produced by glycolysis of epithelial cells to transform into inflammatory cancer-associated fibroblasts (iCAFs), and the increased expression of HIF1A in iCAFs promotes the transcriptional expression of CXCL12. The secretion of CXCL12 recruits regulatory T cells (Tregs), leading to Treg infiltration and increased TGF-β secretion in the microenvironment and promotes the formation of a tumor immunosuppressive microenvironment. This study delineates the coordinate work axis of epithelial cells-iCAFs-Tregs in OSCC using SC, ST and TCGA bulk data, and highlights potential targets for therapy.

Clinical care pathway time intervals and tumor progression among head and neck cancer patients at East Avenue Medical Center before and during the COVID-19 pandemic

Objective@#To investigate the association between the time intervals of key clinical time points and tumor progression (increase in clinical staging) in head and neck cancer patients before and during the pandemic.@*Methods@#Design: Retrospective Cohort Study. Setting: Tertiary Government Training Hospital. Participants: A total of 81 head and neck cancer patients who consulted at the OPD and underwent elective surgery between January 1, 2018, and December 31, 2022, under the Department of Otorhinolaryngology – Head and Neck Surgery of East Avenue Medical Center were included in the study; 40 patients comprised the pre-pandemic group and 41 patients-the pandemic group.@*Results@#Majority of patients were men (61.73%), and the mean age was 54 years. The most prevalent tumor site was the oral cavity (37.04%). Most patients were Clinical Stage IV at the time of diagnosis (32.10%) and at the time of surgery (58.02%). In the pre-pandemic period, median time-to-consult was 180 days, time-to-diagnosis was 14 days, and time-to-treatment was 57 days. During the pandemic, median time-to-consult significantly increased to 365 days (Mann-Whitney test, U = 589, p = .028), but time-to-diagnosis decreased to 10 days, and time to-treatment decreased to 43 days, although these were not significant (U = 775, p = .667; U = 809, p = .917). Among the 81 patients in the study, 14 (17.28%) showed tumor progression (pre-pandemic: 6; 15%; pandemic: 8; 19.51%), but there was no significant association between time-to-consult and increase in clinical staging for both pre-pandemic (χ2(38) = 34.2, p = .646) and pandemic groups (χ2(16) = 23.1, p = .110) or between time-to-diagnosis and increase in clinical staging for pre-pandemic (χ2(56) = 36.8, p = .978) and pandemic groups (χ2(23) = 28.3, p = .267). Overall, there was no significant association between time-to-treatment and increase in clinical staging for both pre-pandemic (χ2(62) = 80.00, p = .062) and pandemic groups (χ2(32) = 30.4, p = .548), but a subset of patients with larynx primary tumor site had a statistically significant association between time-to-treatment and tumor progression (χ2(5) = 12.00, p = .035).@*Conclusion@#This study revealed that there was an increase in time to-consult for head and neck cancer patients during the pandemic. However, there was no significant difference in time-to-diagnosis and time-to-treatment. This shows that the Department of ORL-HNS, East Avenue Medical Center has provided pandemic head and neck cancer care similar to before the pandemic. No significant associations were found between tumor progression and time intervals of the key clinical time points but patients who had an increase in clinical stage were noted with longer time-to treatment. It was also observed that more patients were in advanced clinical stages during the pandemic.

3D radiotherapy in the parotid gland and its dosimetric relationship with salivary flow and quality of life in patients with head and neck cancer

Aim: Hyposalivation and dry mouth affect the quality of life in patients with Head and Neck Cancer, who did the treatment with radiotherapy. Thus this study has the objective to evaluate the dosimetric relationship between 3D radiotherapy and changes in salivary flow, xerostomia and quality of life in patients with head and neck cancer according to the volume of the irradiated parotid gland. Methods: 23 patients with cancer in the head and neck area and in need of 3D radiotherapy were followed up during radiotherapy treatment, and the parotid gland (PG) design was also performed in radiotherapy planning. Questionnaires were carried out to determine xerostomia and quality of life, while the salivary flow was determined through calculations regarding the collection and weighing of saliva. Such data were collected in three moments: before the beginning of the radiotherapy treatment (D0), in the middle of the treatment (D1) and at the end of it (D2). The numerical variables are represented by measures of central tendency and measures of dispersion. Results: when associating the salivary flow, the xerostomia questionnaire and the OHIP-14, a statistically significant difference was found (p-value <0.001), as well as when comparing some volumes of irradiated PG with the OHIP-14. However, no relationship was found between dosimetric data, xerostomia and hyposalivation. Conclusion: patients undergoing 3D radiotherapy for malignant neoplasms in the head and neck region had decreased salivary flow, increased complaints of dry mouth and decreased quality of life. However, it was not possible to establish a statistically significant correlation between these findings and the volumes of irradiated parotids

Consumo de laticínios e risco de câncer de cabeça e pescoço: análise do consórcio internacional de epidemiologia do câncer de cabeça e pescoço / Dairy consumption and risk of head and neck cancer: analysis of the international consortium of head and neck cancer epidemiology

Introdução. Estudos têm explorado as possíveis conexões entre o consumo de laticínios e câncer de cabeça e pescoço (CCP), mas os resultados têm sido inconsistentes. Objetivos 1. Avaliar a associação entre consumo de leite e câncer de cabeça e pescoço; 2º. Avaliar a modificação no efeito do consumo de leite de acordo com consumo de álcool e tabagismo; 3º. Avaliar a associação entre consumo de queijo, manteiga, iogurte, sorvete e o câncer de cabeça e pescoço. Metodologia foram utilizados dados individuais de um total de 15 estudos caso-controle (12.998 casos e 9.510 controles) do consórcio Internacional Head and Neck Cancer Epidemiology (INHANCE). 1. A análise do leite incluiu 8.925 casos e 12.339 controles. As ORs e os intervalos de confiança de 95% foram calculados por meio de análise de regressão logística multinível aplicados às categorias do quartil de laticínios e ajustados para uso de cigarro e álcool. Modelos ajustados incluíram idade, sexo, nível de escolaridade, raça/etnia e centro de estudo. 2. Para avaliar heterogeneidades na associação entre o leite e o CCP, de acordo com o consumo de tabaco e de álcool, foram realizadas análises estratificadas por esses dois fatores 3. Para avaliar a associação entre o consumo de derivados do leite e CCP, realizamos análises de regressão logística multinível de efeitos aleatórios para queijo, manteiga, iogurte e sorvetes. Resultados 1. Foram encontradas ORs maiores do que a unidade para o quarto quartil de frequência de consumo de leite (em comparação com o primeiro quartil) para CCP em geral (OR=1,27 (IC 95%; 1,10-1,47) e para câncer da cavidade oral (OR= 1,25 1,07-1,47). 2. Não foi verificada alteração significativa das OR para o quartil IV versus o quartil I na análise estratificada por tabaco e álcool. 3º. O iogurte mostrou uma relação dose-resposta para todas as localizações anatômicas do estudo. Por outro lado, o consumo elevado de sorvete foi associado a uma maior chance de CCP, com p de tendência menor do que 0,05 para CEC de orofaringe (p=0,029) e CCP geral (p<0,001). Conclusão 1. O alto consumo de leite se associou ao CCP após ajuste por outras variáveis e essa relação parece apresentar dose-resposta. 2. Os resultados da presente investigação mostram que os comportamentos de beber e de fumar parecem não modificar o efeito do leite sobre o câncer de cabeça e pescoço. 3. Foram encontradas associações de magnitude e direção diferentes de acordo com o tipo de derivado do leite estudado. Iogurte e queijo apresentaram efeito protetor, enquanto o consumo aumentado de sorvete associou-se à maior chance de CCP.

Introduction. Studies have explored the possible connections between dairy consumption and head and neck cancer, but the results have been inconsistent. Objectives 1. To assess the association between milk consumption and head and neck cancer; 2. To evaluate the modification in the effect of milk consumption according to alcohol and smoking consumption; 3. To evaluate the association between cheese, butter, yogurt, ice cream consumption and head and neck cancer. Methodology individual data from a total of 15 case-control studies (12,998 cases and 9,510 controls) from the International Head and Neck Cancer Epidemiology Consortium (INHANCE) were used. 1. Milk analysis included 8,925 cases and 12,339 controls. ORs and 95% confidence intervals were calculated through multilevel logistic regression analysis applied to quartile categories of dairy and adjusted for cigarette and alcohol use; adjusted models included age, sex, education level, race/ethnicity, and study center. 2. Stratified analyses by tobacco and alcohol consumption were conducted to assess heterogeneity in the association between milk and HNC. 3. Multilevel random-effects logistic regression analyses were conducted for cheese, butter, yogurt, and ice cream consumption. Results 1. ORs greater than unity was found for the fourth quartile of milk consumption frequency (compared to the first quartile) for overall HNC (OR=1.27 (95% CI; 1.10-1.47)) and for oral cavity cancer (OR=1.25 (1.07-1.47)). 2. No significant alteration of ORs for quartile IV versus quartile I was observed in the analysis stratified by tobacco and alcohol. 3. Yogurt showed dose-response for all anatomical locations of the study. On the other hand, high ice cream consumption was associated with increased odds of HNC, with a trend p-value less than 0.05 for oropharyngeal HNC (p=0.029) And overall HNC (p <0.001). Conclusion: 1. High milk consumption was associated with HNC after adjustment for other variables, and this relationship seems to exhibit a dose-response. 2. The results of this investigation show that drinking and smoking behaviors appear not to modify the effect of milk on head and neck cancer. 3. Different magnitude and direction associations were found according to the type of milk derivative studied. Yogurt and cheese showed a protective effect, while increased ice cream consumption was associated with a higher chance of HNC.

Treatment of osteoradionecrosis of the jaw with injectable platelet-rich fibrin (i-PRF): case series / Tratamento de osteorradionecrose dos maxilares com fibrina rica em plaquetas injetável (i-PRF): série de casos

Objective: This study evaluated the use of autogenous blood concentrate (injectable platelet-rich fibrin) [i-PRF] for promoting soft tissue healing in osteoradionecrosis (ORN) lesions in patients who underwent head and neck radiotherapy. Material and Methods: This study included five ORN lesions in four patients who were treated with i-PRF (applied weekly for 4 weeks to the lesions). Soft tissue features were evaluated through clinical analysis at baseline and at 7, 15, 30, 60, and 90 days after the first session of i-PRF. Extension of the bone lesions was evaluated radiographically. Patient-centered related outcomes were evaluated using quality-of-life questionnaires at baseline and 90 days after the first treatment session. Quality of life data were analyzed using descriptive and frequency statistics and the Wilcoxon test. Results: Of the 5 treated lesions, 1 was completely closed and 3 remained open. The open lesions showed increased necrotic tissue exposure. No changes were observed in the radiographic appearance of the lesions. There was also no impact on the patient's quality of life. Conclusion: The results suggest that the majority of ORN lesions remained stable after the application of i-PRF, with a slight improvement in the quality of the mucosa around the lesions. Furthermore, it was observed that i-PRF did not compromise the quality of life of patients during treatment.(AU)

Objetivo: Este estudo avaliou o uso de concentrado de sangue autógeno (fibrina rica em plaquetas injetável) [i-PRF] para promover a cicatrização de tecidos moles em lesões de osteorradionecrose (ORN) em pacientes submetidos a radioterapia de cabeça e pescoço. Material e Métodos: Este estudo incluiu cinco lesões de ORN em quatro pacientes tratados com i-PRF (aplicado semanalmente por 4 semanas nas lesões). As características do tecido mole foram avaliadas por meio de análises clínicas no início e aos 7, 15, 30, 60 e 90 dias após a primeira sessão de i-PRF. A extensão das lesões ósseas foi avaliada radiograficamente. Os resultados centrados no paciente foram avaliados usando questionários de qualidade de vida no início e 90 dias após a primeira sessão de tratamento. Os dados de qualidade de vida foram analisados usando estatísticas descritivas e de frequência, além do teste de Wilcoxon. Resultados: Das 5 lesões tratadas, 1 foi completamente fechada e 3 permaneceram abertas. As lesões abertas mostraram aumento na exposição de tecido necrótico. Não foram observadas mudanças na aparência radiográfica das lesões. Também não houve impacto na qualidade de vida do paciente. Conclusão: Os resultados sugerem que a maioria das lesões de ORN permaneceu estável após a aplicação de i-PRF, com uma discreta melhora na qualidade da mucosa ao redor das lesões. Além disso, observou-se que a i-PRF não comprometeu a qualidade de vida dos pacientes durante o tratamento.(AU)

Pseudotumor fibroso calcificante de cuello en una paciente adolescente: reporte de caso / Calcifying fibrous pseudotumor of the neck in an teenager female patient: case report

RESUMEN: Introducción: El pseudotumor fibroso calcificante es un tumor benigno de tejidos blandos que aparece principalmente en niños y adultos jóvenes entre 20 y 30 años de edad, aún sin una etiología clara y definida. De distribución corporal variable, siendo relativamente poco común en el cuello. Caso clínico: Se presenta el caso de una paciente adolescente de 17 años con tumor en el cuello de rápido crecimiento que se manifestó con dolor moderado localizado, ronquido excesivo y dificultad respiratoria progresiva. Tratamiento: Se realiza resección completa del tumor localizado en hipofaringe, la cual confirma el diagnóstico histopatológico e inmunohistoquímico de pseudotumor fibroso calcificante. Conclusión: El pseudotumor fibroso calcificante de cuello es una patología benigna rara, con síntomas inespecíficos y muy probablemente, inducida porque el tumor comprime los tejidos circundantes. La resolución quirúrgica sigue siendo el Gold estándar (GS) en cuanto al tratamiento. El pronóstico postresección es bueno a largo plazo, con tasas bajas de recurrencias. Se discute la aproximación diagnóstica y terapéutica en un paciente adolescente comparado con lo descrito en la literatura.

ABSTRACT Introduction: Calcifying fibrous pseudotumor is a benign soft tissue tumor, appearing mainly in children and young adults between 20 and 30 years of age, still without a clear and defined etiology. It has a variable body distribution, being relatively uncommon in the neck. Case report: We present the case of a 17-year-old teenager female patient with a rapidly growing neck tumor, which manifested with moderate localized pain, excessive snoring and progressive respiratory distress. Treatment: Complete resection of the tumor located in the hypopharynx was performed, which confirmed the histopathological and immunohistochemical diagnosis of calcifying fibrous pseudotumor. Conclusion: Calcifying fibrous pseudotumor of the neck is a benign pathology, rare with non-specific symptoms and most probably induced by the tumor compressing the surrounding tissues. Surgical resolution remains the gold standard for treatment. The prognosis after resection is good in the long term, with low recurrence rates. The diagnostic and therapeutic approach in this teenager patient is discussed compared to that described in the literature

A experiência de pacientes com câncer de cabeça e pescoço quanto ao autocuidado com a radiodermite / The experience of patients with head and neck cancer regarding self-care for radiodermatitis / Experiencia de pacientes con cáncer de cabeza y cuello sobre el autocuidado de la radiodermitis

RESUMO Objetivo: Analisar a experiência de pacientes com câncer de cabeça e pescoço quanto ao autocuidado com a radiodermite associado aos fatores sociodemográficos e clínico-patológicos. Método: Estudo descritivo com abordagem qualitativa, desenvolvido em um Centro de Referência de Alta Complexidade em Oncologia em Belém - Pará - Brasil. Realizado com entrevistas e análise de prontuário. Os dados foram coletados de fevereiro a abril de 2022, e tratados por análise de conteúdo de Bardin subsidiada pelo software IRAMUTEQ. Resultados: Emergiram três subcategorias: importância do conhecimento do paciente quanto a radioterapia; identificação dos efeitos adversos relacionados ao tratamento; e, orientação do enfermeiro quanto ao autocuidado. Considerações Finais: O conhecimento dos pacientes foi incipiente sobre o tratamento, efeitos adversos foram identificados pelo impacto negativo em sua autoestima e autoimagem e a orientação do autocuidado foi efetiva com a reprodução do cuidado. O estudo oportuniza a elaboração de estratégia de ensino adequada em pesquisas futuras.

ABSTRACT Objective: To analyze the experience of patients with head and neck cancer regarding self-care for radiodermatitis associated with sociodemographic and clinical-pathological factors. Method: A descriptive study with a qualitative approach, carried out at a High Complexity Oncology Reference Center in Belém - Pará - Brazil. It was conducted through interviews and analysis of medical records. The data were collected from February to April 2022 and processed using Bardin's content analysis supported by the IRAMUTEQ software. Results: Three subcategories emerged: The importance of the patient's knowledge about radiotherapy; Identification of adverse effects related to the treatment; and Nurses' guidance on self-care. Final Considerations: The patients' knowledge about the treatment was incipient, adverse effects were identified by the negative impact on their self-esteem and self-image, and self-care guidance was effective in reproducing care. The study provides an opportunity to develop an appropriate teaching strategy in future research.

RESUMEN Objetivo: Analizar la experiencia de pacientes con cáncer de cabeza y cuello sobre el autocuidado de la radiodermatitis asociado a factores sociodemográficos y clínico-patológicos. Método: Estudio descriptivo con enfoque cualitativo, desarrollado en un Centro de Referencia de Alta Complejidad en Oncología en Belém, Pará, Brasil. Realizado por medio de entrevistas y análisis de historias clínicas. Los datos se recopilaron de febrero a abril de 2022 y se procesaron mediante análisis de contenido de Bardin con ayuda del software IRAMUTEQ. Resultados: Surgieron tres subcategorías: importancia del conocimiento del paciente sobre radioterapia; identificación de los efectos adversos relacionados con el tratamiento; y orientación del enfermero sobre el autocuidado. Consideraciones finales: El conocimiento de los pacientes sobre el tratamiento era incipiente, ellos identificaron los efectos adversos debido al impacto negativo en su autoestima y autoimagen y la orientación de autocuidado fue efectiva dado que lograron reproducir el cuidado. El estudio contribuye a que se desarrollen estrategias de enseñanza adecuada en futuras investigaciones.

Determinantes Sociais na Sobrevida dos Pacientes com Câncer de Cabeça e Pescoço / Social determinants in the survival of patients with head and neck cancer / Determinantes Sociales en la Supervivencia de Pacientes con Cáncer de Cabeza y Cuello

dos pacientes com câncer de cabeça e pescoço. Métodos: Trata-se de uma revisão integrativa de literatura, realizada em janeiro de 2023 nas bases de dados Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde e PubMed e com a string de busca ((determinantes sociais de saúde OR condição de vida OR condição sócio-demográfica OR condição socioeconômica OR fatores sociais) AND (análise de sobrevida)). Resultados: Dos 315 artigos encontrados e, após os critérios de elegibilidade e etapas de seleção, apenas 12 correspondiam aos critérios escolhidos. Tais estudos indicam que dentre as pessoas com câncer de cabeça e pescoço o homem, negro, com idade superior a 50 anos, solteiro e/ou divorciado e com baixo nível socioeconômico está propenso a ter uma pior sobrevida. Conclusão: Com base nos artigos selecionados, compreendeu-se que os determinantes sociais em saúde influenciam na melhora ou piora da sobrevida do paciente com câncer de cabeça e pescoço

Objective: Understand how Social Determinants of Health impact the survival of patients with head and neck cancer. Methods: This is an integrative literature review, carried out in January 2023 in the Scientific Electronic Library Online, Latin American and Caribbean Literature in Health Sciences and PubMed databases and with the search string ((social determinants of health OR living condition OR socio-demographic condition OR socioeconomic condition OR social factors) AND (survival analysis)). Results: Of the 315 articles found and, after the eligibility criteria and selection steps, only 12 corresponded to the chosen criteria. Such studies indicate that among people with head and neck cancer, black men, over the age of 50, single and/or divorced and with low socioeconomic status are likely to have a worse survival rate. Conclusion: Based on the selected articles, it was understood that social determinants of health influence the improvement or worsening of survival of patients with head and neck cancer.

Objetivo: Comprender cómo los Determinantes Sociales en Salud impactan en la supervivencia de los pacientes con cáncer de cabeza y cuello. Método: Se trata de una revisión integrativa de la literatura, realizada en enero de 2023 en las bases de datos Scientific Electronic Library Online, Literatura Latinoamericana y del Caribe en Ciencias de la Salud y PubMed, utilizando la cadena de búsqueda ((determinantes sociales de salud OR condición de vida OR condición socio-demográfica OR condición socioeconómica OR factores sociales) AND (análisis de supervivencia)). Resultados:De los 315 artículos encontrados y, después de aplicar los criterios de elegibilidad y etapas de selección, solo 12 cumplían con los criterios elegidos. Estos estudios indican que entre las personas con cáncer de cabeza y cuello, los hombres negros, mayores de 50 años, solteros y/o divorciados y con bajo nivel socioeconómico, tienen una peor supervivencia. Conclusión:Con base en los artículos seleccionados, se comprendió que los determinantes sociales en salud influyen en la mejora o empeoramiento de la supervivencia del paciente con cáncer de cabeza y cuello.

Riesgo de osteorradionecrosis de los maxilares según el tipo de radioterapia / Risk of Osteoradionecrosis of the Jaws according to Type of Radiotherapy

Introducción: El cáncer de cabeza y cuello es el séptimo más común a nivel mundial. Las opciones terapéuticas para su manejo incluyen la radioterapia, la cual debe procurar un equilibrio entre la eliminación del tumor y la preservación del tejido sano porque su aplicación implica el riesgo de desarrollar una osteorradionecrosis de los maxilares. Objetivo: Valorar si el riesgo de que se produzca osteorradionecrosis de los maxilares varía en función del tipo de radioterapia. Métodos: Diseño documental, retrospectivo basado en los principios de las revisiones sistemáticas exploratorias según lo establece la lista de chequeo PRISMA Extension for Scoping Reviews (PRISMA-ScR). Se realizaron búsquedas en inglés y español en PubMed, LILACS, ScienceDirect, Tripdatabase y Epistemonikos. Resultados: En total se incluyeron 12 estudios publicados entre 2016 y 2022 con diversos diseños de investigación; el estudio de cohorte retrospectivo fue el que tuvo mayor representación. Se analizaron distintas opciones de radioterapia y sus protocolos, entre ellos, la radioterapia de intensidad modulada, la terapia de protones de intensidad modulada, la radioterapia corporal estereotáctica y la radioterapia tridimensional. La literatura refiere que los protocolos que implican dosis totales más bajas representan un menor riesgo de osteorradionecrosis. Conclusiones: El riesgo de osteorradionecrosis de los maxilares debe atribuirse, en mayor medida, a la dosis total de radiación recibida por el paciente y a la dosis por fracción que al tipo de radioterapia(AU)

Introduction: Head and neck cancer is the seventh most common cancer worldwide. Therapeutic options for its management include radiotherapy, which should seek a balance between tumor elimination and preservation of healthy tissue because its application implies the risk of developing osteoradionecrosis of the jaws. Objective: To assess whether the risk of developing osteoradionecrosis of the jaws varies according to the type of radiotherapy. Methods : Documentary, retrospective design based on the principles of exploratory systematic reviews as established by the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist. PubMed, LILACS, ScienceDirect, Tripdatabase and Epistemonikos were searched in English and Spanish. Results: In total, 12 studies published between 2016 and 2022 with various research designs were included; the retrospective cohort study had the highest representation. Different radiotherapy options and their protocols were analyzed, including intensity-modulated radiotherapy, intensity-modulated proton therapy, stereotactic body radiotherapy, and three-dimensional radiotherapy. The literature refers that protocols involving lower total doses represent a lower risk of osteoradionecrosis. Conclusions: The risk of osteoradionecrosis of the jaws should be attributed, to a greater extent, to the total radiation dose received by the patient and the dose per fraction than to the type of radiotherapy(AU)

A Cocktail of Natural Compounds Holds Promise for New Immunotherapeutic Potential in Head and Neck Cancer / 中国结合医学杂志

OBJECTIVE@#To obtain detailed understanding on the gene regulation of natural compounds in altering prognosis of head and neck squamous cell carcinomas (HNSC).@*METHODS@#Gene expression data of HNSC samples and peripheral blood mononuclear cells (PBMCs) of HNSC patients were collected from Gene Expression Omnibus (GEO). Differential gene expression analysis of GEO datasets were achieved by the GEO2R tool. Common differentially expressed gerres (DEGs) were screened by comparing DEGs of HNSC with those of PBMCs. The combination was further analyzed for regulating pathways and biological processes that were affected.@*RESULTS@#Totally 110 DEGs were retrieved and identified to be involved in biological processes related to tumor regulation. Then 102 natural compounds were screened for a combination such that the expression of all 110 commonly DEGs was altered. A combination of salidroside, ginsenoside Rd, oridonin, britanin, and scutellarein was chosen. A multifaceted, multi-dimensional tumor regression was showed by altering autophagy, apoptosis, inhibiting cell proliferation, angiogenesis, metastasis and inflammatory cytokines production.@*CONCLUSIONS@#This study has helped develop a unique combination of natural compounds that will markedly reduce the propensity of development of drug resistance in tumors and immune evasion by tumors. The result is crucial to developing a combinatorial natural therapeutic cocktail with accentuated immunotherapeutic potential.

Reabilitação protética bucomaxilofacial: um estudo retrospectivo de base universitária / Maxillofacial prosthetic rehabilitation: an university-based retrospective study

A Prótese bucomaxilofacial (PBMF) é a especialidade da Odontologia que reabilita proteticamente pacientes com perda de estrutura na região da face. Entende-se por PBMFs aquelas utilizadas na reabilitação de pacientes que apresentam deformidades por etiologia congênita, traumática ou patológica. Objetivo: Avaliar retrospectivamente o perfil dos pacientes bem como as características das reabilitações protéticas realizadas em um Projeto de Extensão em Prótese Bucomaxilofacial de uma Universidade no sul do Brasil.Materiais e métodos:Foram analisados 90 prontuários de pacientes atendidos no período de agosto de 2017 a dezembro de 2018, e coletados os seguintes dados: gênero, cor/etnia, idade, etiologia da deformidade, tipo de prótese reabilitadora realizada e referenciamento do paciente ao Projeto. Resultados:Observou-se que pacientes do gênero masculino e cor branca foram os mais frequentemente reabilitados com a maioria dos tipos de prótese, com exceção da prótese nasal. A idade dos pacientes variou de 5 a 81 anos. A prótese ocular foi a mais confeccionada. A etiologia patológica foi a que mais exigiu tratamento reabilitador. Médicos e equipes hospitalares foram os que mais referenciaram pacientes para o Projeto de Extensão.Discussão: A maior prevalência de atendidos foi de pacientes do gênero masculino, etiologia patológica, com idade 60 anos ou mais, o que reforça a sobrevida das pessoas que são diagnosticadas com câncer e necessitam reabilitação bucomaxilofacial. Conclusão: A grande procura por atendimento no Projeto de Extensão em PBMF mostra uma carência desse serviço e poucas pesquisas para esclarecer o perfil do paciente que mais procura atendimento PBMF.

Bucomaxillofacial Prosthesis (BMFP) is a specialty of Dentistry that rehabilitates patients with loss of structure in the face region. BMFP are known to be used in the rehabilitation of patients who present deformities due to congenital, traumatic or pathological etiology. Aim:In retrospect, to assess the profile of patients, as well as the features of clinical cases of rehabilitations performed at the Buccomaxillofacial Prosthesis Extension Project, at the Faculty of Dentistry of the Universidade Federal do Rio Grande do Sul, UFRGS. Materials and methods:from August 2017 to December 2018, 90 charts were cataloged with the following data: gender, ethnicity, age, etiology of the deformity, type of rehabilitation prosthesis, how the patient came to the Project. Results:It was concluded that white male patients were the predominant group to be benefited with prosthesis. The age gap was from 5 to 81 years. Ocular prosthesis was the most prevalent one. The pathological etiology was the one that most required rehabilitation treatment. Doctors and hospital staff were the ones who most referred patients to the Project.Discussion:The prevalence of patients attended was male, pathological etiology, aged 60 years or more, which reinforces the survival of people who are diagnosed with cancer and need oral and maxillofacial rehabilitation. Conclusion:The great demand for care in the BMFP Extension Project shows a lack of this service and little research to clarify the profile of the patient who most seeks BMFP care.

Mucormicosis de cabeza y cuello: actualización en el diagnóstico y manejo médico-quirúrgico. Una revisión narrativa / Mucormycosis of the head and neck: update on diagnosis and medical-surgical management. A narrative review

La mucormicosis, es una patología de baja preva- lencia, rápidamente progresiva y de alta mortalidad que engloba un amplio espectro de infecciones del tipo opor- tunistas, causada por hongos de la familia Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunninghamellaceae, Syncephalastraceae y Radiomycetaeae. Actualmente es la tercera causa de infección fúngica invasiva, posterior a la candidiasis y aspergilosos, siendo su presentación clínica más frecuente la rinocerebral de origen paranasal, cuyo síntoma característico es la rinosinusitis aguda bacteriana con proyección a los dientes antrales, de rápido avance y fatalidad. En esta revisión se emplearon resultados extraídos ma- nualmente de artículos indexados en las bases de datos MED- LINE y EBSCO a raíz de la búsqueda de los términos mu- cormycosis, oral surgery y patient care management con el objetivo de entregar una visión actualizada de la literatura, respecto al diagnóstico y tratamiento de la mucormicosis de cabeza y cuello (AU)

Mucormycosis is a low-prevalence, rapidly progres- sive and high-mortality pathology that encompasses a wide spectrum of opportunistic infections caused by fungi of the Mucoraceae, Lichtheimiaceae, Thamnidiaceae, Cunningha- mellaceae, Syncephalastraceae, and Radiomycetaeae. It is currently the third cause of invasive fungal infection, after candidiasis and aspergillosis, with its most frequent clinical presentation being rhinocerebral of paranasal origin, whose characteristic symptom is acute bacterial rhinosinusitis with projection to the antral teeth, with rapid progression and fatality. In this review, manually extracted results from articles indexed in the MEDLINE and EBSCO databases were used following the search for the terms mucormycosis, oral sur- gery and patient care management with the aim of providing an updated view of the literature regarding the diagnosis and treatment of mucormycosis of the head and neck