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Rev. argent. cir. plást ; 29(1): 32-37, 20230000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1428587


Los procedimientos reconstructivos en cabeza y cuello son todo un desafío debido a que son áreas expuestas, con gran movimiento, y desempeñan funciones esenciales de la vida como el habla, la alimentación y la respiración. El colgajo supraclavicular es un colgajo locorregional, fasciocutáneo, fino, axial a la arteria supraclavicular, versátil, con baja morbilidad, que se usa ampliamente para cubrir defectos en cuello y sector inferior de la cara ya que proporciona tejido similar al de estas regiones, y técnicamente rápido y sencillo.Se puede usar en asociación con otros colgajos para reconstrucciones complejas. Es un colgajo infrautilizado que es una buena alternativa frente a los colgajos tradicionales musculares regionales y libres. Las principales indicaciones son secuelas de quemaduras como las contracturas esternomentonianas, defectos oncológicos ya sea piel o mucosa oral, faringostomas y fístulas traqueocutáneas. Se mencionan 3 casos clínicos en los cuales se llevó a cabo un colgajo supraclavicular en el Hospital Pasteur, Montevideo, Uruguay.

Reconstructive head and neck procedures are challenging because they are exposed areas, are highly mobile, and perform essential life functions such as speaking, eating, and breathing. The supraclavicular flap is a locoregional, fasciocutaneous, thin flap, axial to the supraclavicular artery, versatile, with low morbidity, which is widely used to cover defects in the neck and lower face since it provides tissue similar to that of these regions, and Technically fast and simple. It can be used in association with other flaps for complex reconstructions. It is an underutilized flap that is a good alternative to traditional regional and free muscle flaps. The main indications are sequelae of burns such as sternomental contractures, oncological defects in the skin or oral mucosa, pharyngostomies and tracheocutaneous fistulas. Three clinical cases are mentioned in which a supraclavicular flap was performed at the Pasteur Hospital, Montevideo, Uruguay

Humans , Male , Middle Aged , Perforator Flap/transplantation , Head and Neck Neoplasms/surgery
Rev. Flum. Odontol. (Online) ; 1(60): 75-87, jan.-abr. 2023. tab, graf
Article in Portuguese | LILACS, BBO | ID: biblio-1411343


Objetivos: Descrever o perfil das solicitações de vaga para tratamento do câncer de boca e analisar o tempo entre a solicitação e o agendamento. Métodos. Pesquisa com dados secundários do Sistema Estadual de Regulação do Estado do Rio de Janeiro, entre setembro de 2015 e junho de 2018. Incluiu-se as solicitações para "Oncologia Ambulatório de 1ª vez- Cirurgia de Cabeça e Pescoço" classificadas como câncer de boca e excluiu-se as com status "cancelada". Resultados. Foram exportados 5802 registros, sendo 1663 elegíveis. A idade média foi de 61 anos, com um desvio padrão de 12,3 anos. O tempo médio de espera foi de 19 dias com um desvio padrão de 16,6 dias. 19% dos agravos referiram-se as "Neoplasia maligna de outras partes e partes não especificadas da língua". Conclusão. O perfil dos pacientes corrobora o encontrado na literatura e o tempo de espera para o atendimento é considerado aceitável.

Objectives: To describe the profile of vacancy requests for treatment of oral cancer and to analyze the time between the request and the schedule. Methods. Research with secondary data from the State Regulation System of the State of Rio de Janeiro, between September 2015 and June 2018. Included were requests for "First-time Ambulatory Oncology - Head and Neck Surgery" classified as oral cancer and those with "canceled" status were excluded. Results. 5,802 records were exported, of which 1663 were eligible. The average age was 61 years, with a standard deviation of 12.3 years. The average waiting time was 19 days with a standard deviation of 16.6 days. 19% of the complaints referred to "Malignant neoplasm from other parts and unspecified parts of the tongue". Conclusion. The profile of patients corroborates that found in the literature and the waiting time for care is considered acceptable.

Humans , Male , Female , Middle Aged , Aged , Appointments and Schedules , Mouth Neoplasms , Delivery of Health Care , Health Services Accessibility/legislation & jurisprudence , Head and Neck Neoplasms
Braz. j. biol ; 83: e249424, 2023. graf
Article in English | LILACS, VETINDEX | ID: biblio-1345538


Abstract Hypoxia is a prominent feature of head and neck cancer. However, the oxygen element characteristics of proteins and how they adapt to hypoxia microenvironments of head and neck cancer are still unknown. Human genome sequences and proteins expressed data of head and neck cancer were retrieved from pathology atlas of Human Protein Atlas project. Then compared the oxygen and carbon element contents between proteomes of head and neck cancer and normal oral mucosa-squamous epithelial cells, genome locations, pathways, and functional dissection associated with head and neck cancer were also studied. A total of 902 differentially expressed proteins were observed where the average oxygen content is higher than that of the lowly expressed proteins in head and neck cancer proteins. Further, the average oxygen content of the up regulated proteins was 2.54% higher than other. None of their coding genes were distributed on the Y chromosome. The up regulated proteins were enriched in endocytosis, apoptosis and regulation of actin cytoskeleton. The increased oxygen contents of the highly expressed and the up regulated proteins might be caused by frequent activity of cytoskeleton and adapted to the rapid growth and fast division of the head and neck cancer cells. The oxygen usage bias and key proteins may help us to understand the mechanisms behind head and neck cancer in targeted therapy, which lays a foundation for the application of stoichioproteomics in targeted therapy and provides promise for potential treatments for head and neck cancer.

Resumo A hipóxia é uma característica proeminente do câncer de cabeça e pescoço. No entanto, as características do elemento oxigênio das proteínas e como elas se adaptam aos microambientes de hipóxia do câncer de cabeça e pescoço ainda são desconhecidas. Sequências do genoma humano e dados expressos de proteínas de câncer de cabeça e pescoço foram recuperados do atlas de patologia do projeto Human Protein Atlas. Em seguida, comparou o conteúdo do elemento de oxigênio e carbono entre proteomas de câncer de cabeça e pescoço, e células epiteliais escamosas da mucosa oral normal, localizações do genoma, vias e dissecção funcional associada ao câncer de cabeça e pescoço também foram estudadas. Um total de 902 proteínas expressas diferencialmente foi observado onde o conteúdo médio de oxigênio é maior do que as proteínas expressas de forma humilde em proteínas de câncer de cabeça e pescoço. Além disso, o conteúdo médio de oxigênio das proteínas reguladas positivamente foi 2,54% maior do que das outras. Nenhum de seus genes codificadores foi distribuído no cromossomo Y. As proteínas reguladas positivamente foram enriquecidas em endocitose, apoptose e regulação do citoesqueleto de actina. O conteúdo aumentado de oxigênio das proteínas altamente expressas e reguladas pode ser causado pela atividade frequente do citoesqueleto e adaptado ao rápido crescimento e divisão das células cancerosas de cabeça e pescoço. O viés do uso de oxigênio e as proteínas-chave podem nos ajudar a entender os mecanismos por trás do câncer de cabeça e pescoço na terapia direcionada, o que estabelece uma base para a aplicação da estequioproteômica na terapia direcionada e oferece uma promessa para potenciais tratamentos para o câncer de cabeça e pescoço.

Humans , Head and Neck Neoplasms/genetics , Oxygen , Carbon , Proteome/genetics , Tumor Microenvironment
Odovtos (En línea) ; 24(3)dic. 2022.
Article in English | LILACS-Express | LILACS, SaludCR | ID: biblio-1406165


Abstract This study investigated the shear bond strength (SBS) of a universal adhesive to enamel/dentin; 1) that had undergone radiotherapy (RT) and 2) that were readily restored and had undergone RT. Enamel and dentin surfaces were obtained from 90 intact human molars. They were randomly divided into six groups according to the presence and timing of irradiation (RT0:no radiotherapy/control, RT1:RT before restoration, RT2:RT after restoration groups) and adhesive application modes (etch&rinse/ER, self-etch/SE)(n=15). A universal adhesive and resin composites were applied. The radiotherapy protocol was conducted with 60 Gy. The SBS test was subjected (1mm/min) and failure type analysis was performed. The resin-enamel/dentin interfaces were examined. Data were statistically analyzed. For enamel and dentin, the presence and timing of irradiation did not significantly influence the SBS values (p>0.05). For enamel, significantly higher SBS values were obtained using etch&rinse mode than self-etch mode (p<0.05). The predominant failure was mixed type. Loss of enamel prisms and obliterated irregular dentinal tubules were found for the radiotherapy-treated specimens. Resin tags were clearer in the irradiated enamel treated with ER than SE. Irradiation with different timings did not influence the bond strength to enamel and dentin, negatively. Irrespective of radiotherapy, the etch&rinse mode caused higher bond strength to enamel than self-etch mode.

Resumen Este estudio investigó la fuerza de unión al cizallamiento (SBS) de un adhesivo universal al esmalte/dentina en piezas que se habían sometido a radioterapia (RT). Se obtuvieron superficies de esmalte y dentina de 90 molares humanos intactos. Se dividieron aleatoriamente en seis grupos según la presencia y el momento de la irradiación (RT0: sin radioterapia/control, RT1: RT antes de la restauración, RT2: RT después de la restauración considerando los modos de aplicación del adhesivo (n=15). Se aplicó un adhesivo universal y resinas compuestas. El protocolo de radioterapia se realizó con 60 Gy. Se sometió a la prueba adhesiva (1mm/min) y se realizó análisis del tipo de falla. Se examinaron las interfases resina-esmalte/dentina. Los datos fueron analizados estadísticamente. Para el esmalte y la dentina, la presencia y el momento de la irradiación no influyeron significativamente en los valores adhesivos (p>0,05). Para el esmalte, se obtuvieron valores adhesivos significativamente más altos utilizando el modo de grabado y enjuague que el modo de autograbado (p<0,05). La falla predominante fue de tipo mixto. Se encontró pérdida de prismas de esmalte y túbulos dentinarios irregulares obliterados en las muestras tratadas con radioterapia. La irradiación con diferentes tiempos no influyó negativamente en la fuerza de unión al esmalte ni a la dentina. Independientemente de la radioterapia, el modo de grabado ácido y enjuague provocó una mayor fuerza de adhesión al esmalte que el modo de autograbado.

Humans , Radiotherapy/adverse effects , Turkey , Dental Cementum/drug effects , Head and Neck Neoplasms
Revista Naval de Odontologia ; 49(2): 39-45, 21 out. 2022. tab
Article in Portuguese | LILACS, BBO | ID: biblio-1410682


Pacientes com câncer de cabeça e pescoço (CCP) apresentam limitações e comprometimentos funcionais. A dor orofacial acomete grande parte desses pacientes e pode ser causada por inúmeros fatores, tanto nos tecidos moles quanto nos duros. Pacientes com CCP em estágio avançado, necessitam receber assistência que possibilite melhor qualidade de vida para ele e seus familiares, como forma de cuidado paliativo, principalmente quando a doença não tem mais chance de ser controlada. A analgesia farmacológica é o principal pilar no tratamento da dor oncológica, mas também pode ser realizada por meio de terapias não farmacológicas. Este estudo teve como objetivo revisar a literatura buscando as diferentes formas de controle da dor orofacial de pacientes com CCP em cuidados paliativos. Foram realizadas buscas nas bases de dados PubMed e SciELO com as palavras "(pain control) AND (palliative care) AND (head and neck cancer)", buscando artigos dos dez últimos anos (2011-2021) e restringindo para ensaios clínicos e ensaios clínicos randomizados. Encontramos dez artigos na base PubMed e nenhum na SciELO. Após a leitura do título e resumo, excluímos cinco por não avaliarem pacientes com CCP ou não terem a abordagem analgésica como objetivo do estudo, sendo incluídosfinalmente 5 artigos em nossa revisão. A maioria dos estudos mostrou que a analgesia realizada nos pacientes em cuidados paliativos acometidos por lesões malignas de cabeça e pescoço acontece com opioides. Nesta revisão observamos poucos estudos clínicos, sendo importante a realização de trabalhos que busquem novas formas de diminuir os sintomas e melhorar a qualidade de vida desses pacientes.

Humans , Palliative Care , Pain Management , Head and Neck Neoplasms , Mouth Neoplasms
Rev. colomb. cir ; 37(4): 580-587, 20220906. tab, fig
Article in Spanish | LILACS | ID: biblio-1396342


Introducción. Los colgajos del territorio de la arteria submentoniana pueden ser utilizados como un colgajo cutáneo, musculofacial y osteocutáneo, realizando cierres primarios del defecto del sitio donante, sin generar defectos funcionales ni estéticos mayores. Métodos. Describir la experiencia de nuestro equipo quirúrgico, las complicaciones relacionadas con el uso del colgajo y los resultados oncológicos, así como los desenlaces tardíos durante el seguimiento de los pacientes incluidos en el estudio. Resultados. Se incluyeron veintiún pacientes, con una edad media de 66 años (rango 52 - 86), con patología oncológica de lengua, labio inferior, paladar blando, nariz, órbita y orofaringe. Todos los pacientes fueron sometidos a disección selectiva ipsilateral del cuello, tras la extracción del colgajo y en todos los casos se preservó el nervio mandibular marginal. Se registraron complicaciones como la necrosis parcial. La estancia hospitalaria media fue de 8 días.Conclusiones. El colgajo de la arteria submentoniana ha mostrado resultados favorables debido a su uso versátil, amplio arco de rotación, color y baja morbilidad del sitio donante. Se recomienda realizar estudios más robustos, que incluyan la experiencia de diversos especialistas en países que compartan las mismas limitaciones técnicas y características sociodemográficas.

Introduction. Flaps from the territory of the submental artery can be used as a cutaneous, musculofacial and osteocutaneous flap, performing primary closure of the donor site defect, without generating major functional or aesthetic defects. Methods. To describe the experience of the same surgical team, the complications related to the use of the flap and the oncological results, as well as the late outcomes during the follow-up of the patients included in the study. Results. Twenty-one patients with a mean age of 66 years (range: 52-86), with oncological pathology of the tongue, lower lip, soft palate, nose, orbit, and oropharynx were included. All patients underwent ipsilateral selective neck dissection after flap removal, and in all cases the marginal mandibular nerve was preserved. Complications such as partial necrosis were recorded. The mean hospital stay was 8 days. Conclusions. The submental artery flap has shown favorable results due to its versatile use, wide arc of rotation, color, and low donor site morbidity. More robust studies are recommended, including the experience of various specialists in countries sharing the same technical limitations and sociodemographic characteristics.

Humans , Transplantation, Autologous , Myocutaneous Flap , Head and Neck Neoplasms , Postoperative Period , Tissue Transplantation
Rev. otorrinolaringol. cir. cabeza cuello ; 82(3): 391-397, sept. 2022.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1409951


Resumen En la terapia con oxígeno hiperbárico (HBO) se utiliza oxígeno al 100% de concentración en una cámara presurizada con presiones supraatmosféricas, que corresponden de 2 a 3 atmósferas. Los mecanismos por los cuales funciona esta terapia se relacionan con propiedades físicas de los gases y su comportamiento fisiológico en el organismo, lo que lleva finalmente a la hiperoxia, evento fisiológico que permite la obtención de diversos efectos beneficiosos. La evidencia en medicina ha demostrado su utilidad mayormente en la enfermedad por descompresión, infecciones cutáneas graves e intoxicación por monóxido de carbono. En el ámbito de la otorrinolaringología ha probado ser útil en algunas enfermedades como la hipoacusia súbita idiopática, tanto como terapia única como asociada al uso de corticosteroides, como en la osteomielitis refractaria del oído externo, la que en conjunto con antibioticoterapia y manejo quirúrgico presenta un evidente aumento en la tasa de mejoría. Cabe mencionar que la terapia con HBO ha demostrado también beneficios en los tratamientos y complicaciones posteriores a la radiación en pacientes con cáncer de cabeza y cuello. Es importante mencionar que la terapia con HBO no está exenta de riesgos y requiere que los pacientes cumplan con características específicas para su utilización, por lo que su indicación debe ser juiciosa y en casos seleccionados.

Abstract In hyperbaric oxygen therapy, 100% pure oxygen is used in a pressurized chamber with super atmospheric pressures which correspond to 2-3 atmospheres. The mechanism by which this treatment works is related to the physical properties of gases and their physiological behavior in the body, which leads to hyperoxia, the physiological event which allows for diverse beneficial health effects. The evidence in medicine has proven its utility mainly in decompression sickness, severe skin infections and carbon monoxide poisoning. In the otolaryngology field it has been proven useful in diseases like idiopathic sudden sensorineural hearing loss, both as the only treatment and as a concurrent treatment along with corticosteroids, in malignant otitis externa which in conjunction with antibiotic treatment and a surgical approach presents a clear increase in improvement rates. It must be mentioned that hyperbaric chamber treatment has also shown benefits in radiation treatment and post radiation complications in head and neck cancer patients. It is important to note that hyperbaric oxygen therapy is not without risks and patients must meet specific criteria for it to be applied, therefore it must be indicated using careful judgement and only in necessary cases.

Humans , Deafness/therapy , Hyperbaric Oxygenation/instrumentation , Osteomyelitis/therapy , Otolaryngology , Head and Neck Neoplasms/therapy , Hearing Loss, Sensorineural/therapy
Rev. otorrinolaringol. cir. cabeza cuello ; 82(3): 355-359, sept. 2022. tab, ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1409946


Resumen El paraganglioma carotideo es un tumor infrecuente, originado de las células de la cresta neural. Raramente son secretores y tienen un bajo potencial maligno. El diagnóstico es difícil y requiere una alta sospecha clínica, combinada con estudios imagenológicos. Su tratamiento está basado en la cirugía, con especial cuidado de las estructuras vasculonerviosas que se encuentran en intimo contacto. Se describe la casuística de paragangliomas de cuerpo carotídeo en Clínica Las Condes y compararla con una revisión de la literatura actualizada del tema.

Abstract Carotid paraganglioma is a rare tumor, originated from neural crest cells. Usually they lack hormone secretion function, and have a low malignant potential. Diagnosis is difficult, and requires high clinical suspicious, combined with image and pathologic findings. Its treatment is based on surgery, with special care of close anatomic relation with important vascular-nervous structures. Here, we present cases of carotid paragangliomas evaluated at Clinica Las Condes comparing them with an updated literature review.

Humans , Female , Adult , Middle Aged , Carotid Body Tumor/diagnosis , Head and Neck Neoplasms/diagnosis , Immunohistochemistry , Carotid Body Tumor/surgery , Carotid Body Tumor/pathology , Diagnosis, Differential , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/pathology
Rev. otorrinolaringol. cir. cabeza cuello ; 82(3): 324-327, sept. 2022. ilus
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1409940


Resumen La adenopatía dermatopática es una entidad histopatológica que consiste en un aumento del tamaño ganglionar en respuesta a enfermedades cutáneas crónicas. En el análisis histopatológico se observa una hiperplasia paracortical con presencia de células dendríticas, células de Langerhans e histiocitos. La presentación clínica más habitual es la aparición de adenopatías de características benignas con o sin prurito en pacientes con antecedentes de enfermedad cutánea. La aparición de masas laterocervicales es un motivo de consulta frecuente en otorrinolaringología. Presentamos el caso de un paciente exfumador de 41 años que consultó por aparición brusca de una masa cervical quística, sugestiva de quiste braquial o de una adenopatía quística. Una vez descartada malignidad, se procedió a realizar exéresis de la lesión mediante cervicotomía para diagnóstico patológico. El estudio de la muestra confirmó el diagnóstico de adenopatía dermatopática en un paciente sin antecedente de enfermedad cutánea previa.

Abstract Dermatopathic lymphadenopathy is a histopathologic entity which consists on reactive lymphadenopathy in the setting of chronic cutaneous diseases. The histologic examination is characterized by paracortical hyperplasia with presence of dendritic cells, Langerhans cells and histiocytes. The most common clinical presentation is the presence of lymphadenopathy with benign characteristics with or without pruritus in patients with prior history of cutaneous disease. The appearance of laterocervical masses is a frequent reason for consultation in otorhinolaryngology. We present the case of a 41-year-old ex-smoker who consulted due to the sudden appearance of a cystic cervical mass, suggestive of a brachial cyst or cystic adenopathy. Once malignancy had been ruled out, excision of the lesion within cervicotomy was performed in order to reach a pathological diagnosis. The histologic study confirmed the diagnosis of dermatopathic adenopathy in a patient with no history of previous skin disease.

Humans , Male , Adult , Branchioma/diagnosis , Lymphadenopathy/diagnosis , Head and Neck Neoplasms/diagnosis , Skin Diseases/complications , Diagnosis, Differential , Lymphadenopathy/pathology
Rev. Odontol. Araçatuba (Impr.) ; 43(2): 12-15, maio-ago. 2022. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1361784


O papilomavírus humano (HPV) é a doença sexualmente transmissível mais comum em todo o mundo, mais de 150 tipos de HPV já foram identificados, sendo que 25 tipos estão associados a lesões em cavidade oral e genital. O diagnóstico e tratamento precoce das lesões por HPV são importantes para um melhor prognóstico do paciente. O presente estudo objetiva relatar o caso clínico de uma paciente com papiloma de células escamosas. Trata-se portanto de um tumor benigno, onde o tratamento consiste na remoção completa da lesão com a devida margem de segurança. Recidivas são incomuns, contudo o paciente deve manter acompanhamento odontológico periódico, e encaminhado para acompanhamento médico(AU)

Human papillomavirus (HPV) is the most common sexually transmitted disease worldwide, with more than 150 types of HPV identified. Among types, 25 of which are associated with lesions in the oral and genital cavity. Early diagnosis and treatment of HPV lesions are important for a better patient prognosis. The study aim to report the clinical case of a patient with squamous cell papilloma. It is, therefore, a benign tumor, where treatment consists of complete removal of the lesion with the necessary safety margin. Relapses are uncommon, but the patient must maintain periodic dental care and be referred for medical follow-up(AU)

Humans , Female , Middle Aged , Papilloma , Papillomaviridae , Head and Neck Neoplasms , Palate, Soft/injuries , Sexually Transmitted Diseases , Dental Care
Rev. APS ; 25(1): 174-186, 25/07/2022.
Article in Portuguese | LILACS | ID: biblio-1393380


Introdução: As massas cervicais são causas frequentes de encaminhamentos aos ambulatórios de otorrinolaringologia, muitas vezes com pouca abordagem na atenção primária à saúde. Sendo assim, a falta de uma rotina de manejo pode deixar o médico assistente inseguro e por vezes confuso quanto ao caminho de investigação a ser seguido, tornando-se necessário elaborar e aplicar uma rotina propedêutica que facilite e direcione o raciocínio clínico para diagnóstico de massas cervicais. Desenvolvimento: Através de revisão da literatura de artigos científicos coletados nos portais Medline, Lilacse PubMed,utilizando descritores específicos como: necklump; head and neck cancer; epidemiology of head and neck cancere consulta à literatura médica específica, foi elaborado um fluxograma para diagnóstico inicial das massas cervicais. Conclusão: Os autores elaboraram um fluxograma para a investigação e diagnóstico das massas cervicais de fácil memorização e aplicabilidade, adequado às condições estruturais de instituições públicas, e visando melhor atendimento, minimização de riscos, bem como qualificação dos profissionais. O fluxograma proposto visa ao diagnóstico diferencial entre doenças malignas e benignas, focando o que pode ser feito em nível de atenção primária à saúde.

Introduction: Neck masses are frequent causes of referrals to otorhinolaryngology clinics, often with a little approach in primary health care. Therefore, the lack of a usual approach can make the attending physician unsafe and prone to error, thus, it is necessary toelaborate a propaedeutic routine for the diagnosis of neck masses. Development: From a literature review of scientific articles collected on Medline, Lilacsand PubMedportals using specific descriptors such as: neck lump; head and neck cancer; epidemiology of head and neck cancer and using specific medical literature, a flowchart had been prepared for initial diagnosis of neck masses. Conclusion: The authors sought a practical form, easy to remember and applicable, appropriate to public institutions, aiming for better care, minimizing risks as well as the qualifications of professionals, targeting on the differential diagnosis between malignant and benign diseases, and what can be done at primary level of health care.

Primary Health Care , Diagnosis , Head and Neck Neoplasms
Säo Paulo med. j ; 140(3): 454-462, May-June 2022. tab, graf
Article in English | LILACS | ID: biblio-1377387


ABSTRACT BACKGROUND: Clinical assessment of head and neck cancers is highly challenging owing to the complexity of regional anatomy and wide range of lesions. The diagnostic evaluation includes detailed physical examination, biopsy and imaging modalities for disease extent and staging. Appropriate imaging is done to enable determination of precise tumor extent and involvement of lymph nodes, and detection of distant metastases and second primary tumors. OBJECTIVE: To evaluate the initial staging discrepancy between conventional contrasted computed tomography (CT) and 18F-fluorodeoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) and its impact on management plans for head and neck malignancies. DESIGN AND SETTING: Prospective cross-sectional study in two tertiary-level hospitals. METHODS: This study included 30 patients with primary head and neck malignant tumors who underwent contrasted computed tomography and whole-body 18F-FDG PET/CT assessments. The staging and treatment plans were compared with the incremental information obtained after 18F-FDG PET/CT. RESULTS: 18F-FDG PET/CT was found to raise the stage in 33.3% of the cases and the treatment intent was altered in 43.3% of them, while there was no management change in the remaining 56.7%. 18F-FDG PET/CT had higher sensitivity (96% versus 89.2%) and accuracy (93% versus 86.7%) than conventional contrast-enhanced computed tomography. CONCLUSION: Our study demonstrated that 18F-FDG PET/CT had higher sensitivity and accuracy for detecting head and neck malignancy, in comparison with conventional contrast-enhanced computed tomography. 18F-FDG PET/CT improved the initial staging and substantially impacted the management strategy for head and neck malignancies.

Humans , Positron Emission Tomography Computed Tomography/methods , Head and Neck Neoplasms/therapy , Head and Neck Neoplasms/diagnostic imaging , Cross-Sectional Studies , Prospective Studies , Sensitivity and Specificity , Radiopharmaceuticals , Fluorodeoxyglucose F18 , Positron-Emission Tomography , Neoplasm Staging
Rev. otorrinolaringol. cir. cabeza cuello ; 82(2): 244-257, jun. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1389845


La inteligencia artificial posee una larga historia, llena de innovaciones que han dado como resultado diferentes recursos diagnósticos de alto rendimiento, que se encuentran disponibles actualmente. En este artículo se presenta una revisión sobre la inteligencia artificial y sus aplicaciones en medicina. El trabajo se centra en la especialidad de otorrinolaringología con el objetivo de informar a la comunidad médica la importancia y las aplicaciones más destacadas en los diferentes procesos diagnósticos dentro de la especialidad. Incluimos una sección para el análisis del estado actual de la inteligencia artificial en otorrinolaringología en Chile, así como los desafíos a enfrentar a futuro para utilizar la inteligencia artificial en la práctica médica diaria.

Artificial intelligence has a long history full of innovations that have resulted in different high-performance diagnostic resources currently available. This work has reviewed the artificial intelligence definition and its applications to medicine. We focused our review on otolaryngology's specialty to inform the medical community of the importance and the most relevant applications in the different diagnostic processes. We include an analysis of the current state of artificial intelligence in otolaryngology in Chile, and the challenges to be faced in the future to use artificial intelligence into daily medical practice.

Humans , Otolaryngology , Otorhinolaryngologic Diseases/diagnosis , Otorhinolaryngologic Diseases/therapy , Artificial Intelligence , Chile , Machine Learning , Head and Neck Neoplasms/diagnosis
Distúrb. comun ; 34(2): e54582, jun. 2022. tab
Article in Portuguese | LILACS | ID: biblio-1396836


Introdução: No câncer de cabeça e pescoço (CCP), as sequelas relacionadas aos tratamentos e à própria localização do tumor podem trazer alterações físicas e funcionais, com impacto na qualidade de vida (QV) destes pacientes. Objetivo: mensurar o impacto do câncer de boca sobre a qualidade de vida relacionada à deglutição e saúde bucal em pacientes com câncer de cabeça e pescoço, após tratamento médico com radioterapia e/ou cirurgia. Métodos: participaram do estudo dez pacientes em pós-tratamento médico para o CCP e que foram submetidos aos questionários de qualidade de vida M.D. Anderson Dysphagia Inventory (MDAD),Oral Health Impact Profile (OHIP-14) e Questionário de Qualidade de Vida da Universidade de Washington(UW-QOL). Resultados: Os resultados dos domínios emocional e funcional do protocolo MDADI demonstraram médias positivas, enquanto o domínio físico apresentou médias que demonstraram baixo funcionamento do dia-a-dia e qualidade de vida. A partir do questionário OHIP-14, verificou-se que 40% dos participantes foram classificados com alto índice de impacto na saúde bucal. As dimensões ''desconforto psicológico'' e ''deficiência'' impactam negativamente na QV dos pacientes. "Atividade'' e "saliva" foram os problemas mais relatados, mostrando que, ''saliva'', ''humor'' e ''mastigação'' foram os três domínios mais importantes na visão dos pacientes, verificado a partir do protocolo UW-QOL. Conclusão: Apesar do número reduzido de pacientes e da heterogeneidade de localização dos tumores, os resultados demonstram que o CCP e as sequelas de seu tratamento podem impactar de maneira significativa a QV dos pacientes em diversos domínios.

Introducción: En el cáncer de cabeza y cuello (CCC), las secuelas relacionadas con el tratamiento y la propia localización del tumor pueden traer cambios físicos y funcionales, con impacto en la calidad de vida (CV) de estos pacientes. Objetivo: medir el impacto del cáncer bucal en la calidad de vida relacionada con la deglución y la salud bucal en pacientes con cáncer de cabeza y cuello después del radioterapia y/o cirurgía. Metodos: participaron del estudio diez pacientes en postratamiento médico por cáncer de cabeza y cuello y fueron sometidos a cuestionarios de calidad de vida M.D. Anderson Dysphagia Inventory (MDADI), Oral Health Impact Profile (OHIP-14) y cuestionario de calidad de vida de la Universidad de Washington (UW-QOL). Resultados: Los resultados de los dominios emocional y funcional del protocolo MDADI mostraron medias positivas, mientras que el dominio físico mostró medias que evidenciaron bajo funcionamiento cotidiano y calidad de vida. Del cuestionario OHIP-14 se encontró que 40% de los participantes fueron clasificados como de alto impacto en la salud bucal. Las dimensiones "malestar psicológico" y "discapacidad" tienen un impacto negativo en la calidad de vida de los pacientes. "Actividad" y "saliva" fueron los problemas más reportados, mostrando que "saliva", "estado de ánimo" y "masticar" eran los tres dominios más importantes en la opinión de los pacientes verificado a partir del protocolo UW-QOL. Conclusión: A pesar del pequeño número de pacientes y la heterogeneidad de la localización del tumor, los resultados demuestran que el CCP y las secuelas de su tratamiento pueden impactar significativamente la calidad de vida de los pacientes en varios dominios.

Introduction: In head and neck cancer (HNC), the sequelae related to the treatment and the location of the tumor itself can bring physical and functional changes, with an impact on the quality of life (QoL) of these patients. Objective: measure the impact of oral cancer on quality of life related to swallowing and oral health in patients with head and neck cancer after radiotherapy and/or surgery. Methods: 10 patients participated on study in medical post-treatment for head and neck cancer and they were submitted the quality of life questions M.D. Anderson Dysphagia Inventory, Oral Health Impact Profile (OHIP-14) and University of Washington quality of life questionnaire (UW-QOL). Results: The results of the emotional and functional domains of the MDADI protocol showed positive means, while the physical domain showed low day-to-day functioning and quality of life means. From the OHIP-14 questionnaire, it was found that 40% of participants were hated with a high index of impact on oral health. The dimensions "psychological discomfort" and "deficiency" negatively impact on patients QOL. "Activity" and "spittle" were the problems most reported, showing that, "spittle", "humor" and "chewing" were the three most important domains on patient's view verified from the UW-QOL protocol. Conclusion: Despite the small number of patients and the heterogeneity of tumor location, the results demonstrate that the CCP and the sequelae of its treatment can significantly impact the QoL of patients in several domains.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Quality of Life , Deglutition , Head and Neck Neoplasms , Mouth Neoplasms/psychology , Oral Health , Cross-Sectional Studies , Surveys and Questionnaires
Revista Digital de Postgrado ; 11(1): 335, abr. 2022. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1417138


Objetivo: Correlacionar la clasificación clínica ganglionar con el estudio de anatomía patológica de las disecciones cervicales realizadas a los pacientes con cáncer de cabeza y cuello en la Cátedra Servicio de Otorrinolaringología del Hospital Universitario de Caracas desde el 2011 al 2016.Método: Estudio descriptivo y cuantitativo que evaluó 27pacientes, a quienes se les practicó disección cervical tipo radical clásica, radical modificada y selectiva. Resultados: edad promedio 56 años, el 77,8% sexo masculino. El tipo histológico más frecuente fue carcinoma escamoso 81,5%. El tipo de disección más practicada fue la selectiva 53,3%, seguida dela radical clásica 26,7% y de la radical modificada 20,0%. Se constató 36% de recidiva local o cervical. Dieciséis pacientes con ganglios clínicamente positivos, 13 fueron confirmados histológicamente. Todos aquellos clínicamente sin ganglios, fueron confirmados histológicamente como negativos. La sensibilidad de la clasificación clínica para ganglios positivos fue 81,3% y la especificidad 100%. Las siete recidivas cervicales presentaban ganglios positivos. No hubo recidivas en los 11pacientes ganglios negativos. El 22,7% y 71,6% de pacientes con estado ganglionar positivo y negativo sobrevivieron a los 5 años, respectivamente; fue una diferencia estadística significativa (p=0,024). Conclusión: La relación entre la clasificación patológica y la clínica, así como la presencia de ganglios positivos en las recidivas cervicales son estadísticamente significativas y se relacionan con la disminución en la sobrevida. La palpación de cuello continúa siendo una herramienta útil en la toma de decisiones terapéuticas, que demostró una sensibilidad y especificidad superior al promedio(AU)

Objective: To correlate the clinical lymph node classification with the pathological result of neck dissections performed in patients with head and neck cancer at the Otorhinolaryngology Department of the Hospital Universitario de Caracas from January 1, 2011 to December 31, 2016. Method: Descriptive, quantitative and retrospective study, which evaluated 27 patients, who under went classical radical, modified radical and selective neck dissection. Results: averageage 56 years, 77.8% male. the most frequent histological type was squamous carcinoma 81.5%. The most used type of dissectio was selective 53.3%, followed by the classical radical 26.7% and the modified radical 20.0%, of these 36% presented local or cervical recurrence. Of the 16 patients with positive lymph nodes, 13 had patology confirmation, and all the negative nodes also had negative patology confirmation; regarding cervical recurrence, of the 7 cases where it was present, all positive nodes, and in the 11 patients negative nodes, all negative cervical recurrence. Conclusion: thee relationship between the pathological and clinical classification, as well as the presence of positive lymph nodes in cervical recurrences are statisticall ysignificant and are related to the decrease in survival. Neck palpation continues to be a useful tool in therapeutic decision making, which has shown higher than average sensitivity andspecificity(AU)

Humans , Male , Female , Middle Aged , Neck Dissection , Head and Neck Neoplasms , Lymph Nodes , Recurrence , Carcinoma, Squamous Cell , Neck
ABCS health sci ; 47: e022232, 06 abr. 2022. tab
Article in English | LILACS | ID: biblio-1402555


INTRODUCTION: The prevalence of malnutrition is high among head and neck cancer (HNC) patients and negatively impacts their quality of life, treatment, and survival rates. OBJECTIVE: To identify preoperative nutritional variables capable of predicting postoperative complications in surgically treated HNC patients. METHODS: This was a prospective cohort study of HNC patients referred for surgery as initial treatment. RESULTS: Sixty patients were included in the study; they had a median age of 65.5 years, were mostly me n (85%), and most had low education levels (90%) and low household income (78.3%). The incidence rate of severe postoperative complications (grades II, III, IV, and V according to the Clavien-Dindo grading system) was found to be 50%. The nutritional variables under investigation, namely calf circumference (CC), triceps skinfold, body mass index, and adductor pollicis muscle thickness were shown to predict postoperative complications in HNC patients, especially CC, which was found to be an independent predictor of complications (OR=0.8; 95%CI: 0.65­0.96). Each 1-cm increase in calf circumference was associated with a 20% decrease in the risk of postoperative complications. CONCLUSION: Our findings show the nutritional variables studied are useful in the prognostic assessment of HNC surgery.

Humans , Male , Female , Adult , Young Adult , Anthropometry , Nutritional Status , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/complications , Prospective Studies , Malnutrition
Braz. j. otorhinolaryngol. (Impr.) ; 88(2): 204-211, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1374713


Abstract Introduction: General anesthesia causes pulmonary atelectasis within few minutes of induction. This can have significant impact on postoperative outcome of cancer patients undergoing prolonged reconstructive surgeries. Objective: The purpose of this study was to evaluate the impact of sonographically detected perioperative atelectasis on the need for postoperative oxygen supplementation, bronchodilator therapy and assisted chest physiotherapy in patients undergoing free flap surgeries for head and neck carcinoma. Methods: Twenty eight head and neck cancer patients underwent bilateral pulmonary ultrasonographic assessments before and after lung surgery. Lung ultrasound scores, serum lactate, and PaO2/FiO2 ratio were measured both at the beginning and at end of the surgery. Patients were scanned in the supine position and the number of single and confluent B lines was noted. These values were correlated with the need for oxygen therapy, requirement of bronchodilators and total weaning time to predict the postoperative outcome. Other factors affecting weaning were also studied. Results: Among twenty eight patients, seven had mean lung ultrasound score of ≥10.5 which correlated with prolonged weaning time (144.56±33.5min vs. 66.7±15.7min; p = 0.005). The change in lung ultrasound score significantly correlated with change in PaO2/FiO2 ratio (r = −0.56, p = 0.03). Elevated total leukocyte count >8200 ΜL and serum lactate >2.1 mmoL/L also predicted prolonged postoperative mechanical ventilation. Conclusion: This preliminary study detected significant levels of perioperative atelectasis using point of care lung ultrasonography in head and neck cancer patients undergoing long duration surgical reconstructions. Higher lung ultrasound scores highlighted the need for frequent bronchodilator nebulizations as well as assisted chest physiotherapy and were associated with delayed weaning. We propose more frequent point of care lung ultrasonographic evaluations and use of recruitment maneuvers to reduce the impact of perioperative pulmonary atelectasis.

Resumo Introdução: A anestesia geral causa atelectasia pulmonar poucos minutos após sua indução. Isso pode ter um impacto significativo no resultado pós-operatório de pacientes com câncer submetidos a cirurgias reconstrutivas prolongadas. Objetivo: Avaliar o impacto das atelectasias perioperatórias detectadas por ultrassonografia na necessidade de suplementação pós-operatória de oxigênio, terapia broncodilatadora e fisioterapia respiratória assistida em pacientes com carcinoma de cabeça e pescoço submetidos a cirurgias com uso de retalho livre. Método: Foram submetidos a avaliações ultrassonográficas pulmonares bilaterais antes e após a cirurgia 28 pacientes com câncer de cabeça e pescoço. Os escores de ultrassonografia pulmonar, lactato sérico, razão PaO2/FiO2 foram medidos no início e no fim da cirurgia. Os pacientes foram avaliados na posição supina e o número de linhas B confluentes e únicas foi observado. Esses valores foram correlacionados com a necessidade de oxigenoterapia, necessidade de broncodilatadores e tempo total de desmame para predizer o resultado pós-operatório. Outros fatores que afetam o desmame também foram estudados. Resultados: Entre os 28 pacientes, sete apresentaram escore médio de ultrassonografia pulmonar ≥ 10,5, que se correlacionou com o tempo de desmame prolongado (144,56 ± 33,5 minutos vs. 66,7 ± 15,7 minutos; p = 0,005). A mudança no escore de ultrassonografia pulmonar correlacionou-se significantemente com a mudança na razão PaO2/FiO2 (r = −0,56, p = 0,03). A contagem total elevada de leucócitos > 8200 uLe o nível de lactato sérico >2,1 mmoL/L também previram ventilação mecânica pós-operatória prolongada. Conclusão: Este estudo preliminar detectou um nível significante de atelectasia perioperatória com ultrassonografia pulmonar no local de atendimento em pacientes com câncer de cabeça e pescoço submetidos a reconstruções cirúrgicas de longa duração. Escores mais altos de ultrassonografia pulmonar enfatizaram a necessidade de nebulizações broncodilatadoras frequentes e fisioterapia respiratória assistida e foram associados a desmame tardio. Propomos avaliações ultrassonográficas pulmonares mais frequentes no local de atendimento e o uso de manobras de recrutamento para reduzir o impacto das atelectasias pulmonares perioperatórias.

Humans , Pulmonary Atelectasis/etiology , Pulmonary Atelectasis/therapy , Pulmonary Atelectasis/diagnostic imaging , Plastic Surgery Procedures/adverse effects , Free Tissue Flaps , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/diagnostic imaging , Postoperative Complications , Bronchodilator Agents , Ultrasonography/adverse effects , Lactates , Lung
São Paulo; s.n; s.n; 2022. 98 p. tab, graf.
Thesis in Portuguese | LILACS | ID: biblio-1397191


Nos últimos anos, houve um aumento na frequência dos casos de tumores de cabeça e pescoço apesar da diminuição do consumo do tabaco e álcool, e isso tem sido atribuído, em parte, à infecção pelo Papilomavírus Humano HPV. Por apresentar baixa sobrevida em 5 anos e ter alta morbidade, tem se buscado novos alvos moleculares para terapias combinadas. Nesse contexto nosso grupo identificou, através da tecnologia de Phage Display, uma sequência peptídica com interação preferencial por células tumorais com relação à células não transformadas, e ensaios adicionais identificaram seu alvo como sendo a proteína Stratifin. Stratifin tem sido reportado como um oncogene em diversos modelos tumorais, entretanto seu papel em carcinoma de células escamosas de cabeça e pescoço (CCECP) permanece desconhecido e poucos trabalhos na literatura reportam sua atividade em CCECP e/ou outro tumores relacionados ao HPV. Dessa forma, o objetivo desse trabalho foi explorar o potencial valor clínico e o papel biológico da Stratifin em CCECP. Dados do perfil de expressão e de metilação assim como dados clínicos foram extraídos em base de dados do The Cancer Genoma Atlas TCGA. Paralelamente, o perfil de expressão de Stratifin foi verificado através de ensaios de RT/qPCR e Western Blot em um painel de linhagens celulares de CCECP que contempla as principais características moleculares para esses tipos tumorais. A partir da observação de que todas as linhagens expressam Stratifin, utilizou-se a tecnologia de CRISPR/Cas9 para modular sua expressão (nocauteando ou superexpressando o gene) de modo a se observar parâmetros relacionados ao processo tumorigênico. Dessa forma, foi possivel verificar os efeitos da Stratifin em ensaios de proliferação, viabilidade após tratamentos com quimioterápicos, irradiação, crescimento livre de ancoragem e clonogenicidade. Como resultados, observamos que expressão aumentada de Stratifin no tecido tumoral quando comparado ao tecido normal, foi positivamente relacionada com o grau histológico, negatividade para HPV, mutação em TP53 e CDKN2A. Biologicamente, o nocaute de Stratifin foi relacionado com maior sensibilidade à quimioterápicos, menor capacidade de formação de colônias, e reduzida capacidade de crescimento livre de ancoragem. Esses resultados sugerem que Stratifin atue como um oncogene em CCECP, entretanto ensaios adicionais devem ser realizados para corroborar esse achados

Over recent years, there has been an increase of head and neck tumors frequency despite the decrease in tobacco and alcohol consumption, and this has been attributed, in part, to Human Papillomavirus infection. Due to its low 5-year survival and high morbidity, new molecular targets for combined therapies have been sought. In this context, our group identified, through Phage Display technology, a peptide sequence with preferential interaction by tumor cells in relation to non-transformed cells, and further assays identified its target as the Stratifin protein. Stratifin has been reported as an oncogene in several tumor models, however its role in head and neck squamous cell carcinoma (HNSCC) remains unknown and few works in the literature report its activity in HNSCC and/or other HPV-related tumors. Therefore, the aim of this study was to explore the potential clinical value and biological role of Stratifin in HNSCC. Expression profile data as well as clinical data were extracted from The Cancer Genome Atlas - TCGA database. In parallel, the expression profile of Stratifin was verified through RT/qPCR and Western Blot assays in a panel of HNSCC cell lines that address the main molecular characteristics for these tumor types. Since all cell lines express Stratifin, CRISPR/Cas9 technology was used to modulate its expression (gene knocking out or overexpressing) in order to check parameters related to the tumorigenic process. Thus, it was possible to verify the Stratifin effects in proliferation assays, viability after chemotherapy treatments, irradiation, anchorage-free growth and clonogenicity. As a result, we observed an increased expression of Stratifin in tumor tissue when compared to normal tissue, which was positively related to histological grade, HPV negativity, mutation in TP53 and CDKN2A. Biologically, knockout of Stratifin was associated with greater sensitivity to chemotherapy, less colony-forming capacity, and reduced anchorage-free growth capacity. These results suggest that Stratifin acts as an oncogene in HNSCC, however additional assays should be performed to corroborate these findings

Alphapapillomavirus/chemistry , Cell Surface Display Techniques , Head and Neck Neoplasms/pathology , Bacteriophages/classification , Pharmaceutical Preparations , Blotting, Western/instrumentation , Drug Therapy , Research Report