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1.
Prensa méd. argent ; 107(4): 219-230, 20210000. tab, graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1359445

ABSTRACT

Antecedentes: el tratamiento del CBC con menor tasa de recurrencia es el quirúrgico. Debido a la ausencia de lesión residual en cirugía de ampliación de márgenes y la utilidad de la congelación intraoperatoria se propuso analizar la utilidad de las retomas intraoperatorias. Objetivo: analizar el impacto de las retomas intraoperatorias en los resultados oncológicos y cosméticos de los pacientes operados de CBC. Secundariamente analizar la extensión subclínica, el valor de la congelación intraoperatoria y las tácticas reconstructivas empleadas. Lugar de aplicación: Hospital de atención terciaria de tumores. Material y métodos: trabajo observacional retrospectivo. Se incluyeron 84 resecciones durante 3 años y se realizó un análisis comparativo en términos de recurrencia, defecto quirúrgico y utilización de colgajos entre tumores sin retoma vs con retoma. Resultados: no hubo diferencias significativas en cuanto a recurrencia y uso de colgajos. El promedio de defecto para los tumores retomados fue 27,8mm y para los no retomados 22,8mm, siendo la diferencia estadísticamente significativa (p=0.002). En el subgrupo de lesiones retomadas se encontró tumor residual en solo 2,9% de las mismas. Conclusiones: las retomas adicionaron en promedio 5mm de defecto por lesión sin aportar beneficios en términos de recurrencia. Un uso más conservador de las mismas podría traducirse en mejores resultados funcionales y cosméticos


Background: the lowest recurrence rates for basal cell carcinoma are achieved by surgical treatment. Low rates of residual tumour in specimens after incomplete excisions plus intraoperative frozen section accuracy are the rationale for analyzing the value of intraoperative re-excisions during basal cell carcinoma standard surgery. Objective: to analyse intraoperative oncologic and cosmetic results of re-captures in patients surgically treated of basal-cells carcinoma. Secondary to analyse subclinic extention, the value of frozen intraoperative sections and reconstructive conducts employed. Setting: tertiary care Hospital of tumours. Methods: observational retrospective study. During a 3-year period 84 tumours were resected. A comparative analysis in terms of recurrence, surgical defect and use of flaps was done between intraoperatively re-excised and not re-excised tumours. Results: there were no statistical difference regarding recurrence rate and use of flaps. Mean surgical defect for re-excised and not re-excised specimens was 27,8mm and 22,8mm respectively, being the difference statistically significant (p=0.002). Residual tumour was found in only 2,9% of re-excised specimens. Conclusions: re-excisions added on average 5mm to surgical defect per specimen and did not contribute to any benefit in terms of recurrence rates. A more conservative use of intraoperative re-excisions could improve functional and cosmetic outcomes


Subject(s)
Humans , Recurrence , Carcinoma, Basal Cell/surgery , Retrospective Studies , Cohort Studies , Reconstructive Surgical Procedures/methods , Freezing , Head and Neck Neoplasms/surgery
2.
Arch. argent. pediatr ; 119(1): e36-e40, feb. 2021. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1147255

ABSTRACT

El hemangioma fusocelular es una neoplasia vascular benigna infrecuente. Afecta la dermis y la hipodermis de la parte distal de las extremidades; la afectación de la cabeza y el cuello es muy poco frecuente y nunca se informó compromiso de los senos paranasales. Este es el caso de un lactante de 4 meses con obstrucción nasal desde las 2 semanas debido a un tumor en los senos etmoidales que obstruía las fosas nasales. Se diagnosticó hemangioma fusocelular y se extirpó parcialmente el tumor. A los seis meses de seguimiento, se observó una regresión mínima con lesiones residuales. A los 30 meses, se observó que el tumor residual había desaparecido. El hemangioma fusocelular es infrecuente en cabeza y cuello y, a veces, la presentación no es indicativa del diagnóstico. El examen histopatológico ayuda con el diagnóstico diferencial y el tratamiento. La sensibilización sobre el hemangioma fusocelular podría aumentar los casos informados.


Spindle cell hemangioma (SCH) is a benign unusual vascular neoplasm. It does not have gender predilection and can occur at all ages. The disease affects dermis and subcutis of distal extremities predominantly; head and neck involvement is very rare, paranasal sinus involvement has not been reported before. Herein we present a 4-month-old infant with nasal obstruction since two weeks of age due to a mass in ethmoid sinus obliterating the nasal passage. After the histopathological diagnosis of SCH, the tumor was partially resected. In the sixth month follow-up, there was minimal regression of residual lesions. In the imaging studies performed 30 months after the surgery, the residual mass was found to be disappeared. SCH is not frequent in the head and neck, and presentation of some patients may not suggest the diagnosis. Histopathology is important for differential diagnosis and to orientate treatment. Awareness of SCH may increase the reported cases


Subject(s)
Humans , Male , Infant , Paranasal Sinuses , Head and Neck Neoplasms/surgery , Hemangioma/diagnosis , Nasal Obstruction
3.
Rev. bras. anestesiol ; 70(6): 595-604, Nov.-Dec. 2020. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1155768

ABSTRACT

Abstract Background and objectives: In this study, we aimed to investigate the predictive value of different airway assessment tools, including parts of the Simplified Predictive Intubation Difficulty Score (SPIDS), the SPIDS itself and the Thyromental Height Test (TMHT), in intubations defined as difficult by the Intubation Difficulty Score (IDS) in a group of patients who have head and neck pathologies. Methods: One hundred fifty-three patients who underwent head and neck surgeries were included in the study. The Modified Mallampati Test (MMT) result, Thyromental Distance (TMD), Ratio of the Height/Thyromental Distance (RHTMD), TMHT, maximum range of head and neck motion and mouth opening were measured. The SPIDSs were calculated, and the IDSs were determined. Results: A total of 25.4% of the patients had difficult intubations. SPIDS scores >10 had 86.27% sensitivity, 71.57% specificity and 91.2% Negative Predictive Value (NPV). The results of the Receiver Operating Curve (ROC) analysis for the airway screening tests and SPIDS revealed that the SPIDS had the highest area under the curve; however, it was statistically similar to other tests, except for the MMT. Conclusions: The current study demonstrates the practical use of the SPIDS in predicting intubation difficulty in patients with head and neck pathologies. The performance of the SPIDS in predicting airway difficulty was found to be as efficient as those of the other tests evaluated in this study. The SPIDS may be considered a comprehensive, detailed tool for predicting airway difficulty.


Resumo Justificativa e objetivos: Neste estudo, avaliamos o valor preditivo de diferentes ferramentas de avaliação das vias aéreas, incluindo componentes do Escore Simplificado Preditivo de Intubação Difícil (ESPID), o próprio ESPID e a Medida da Altura Tireomentoniana (MATM), em intubações definidas como difícies pelo Escore de Dificuldade de Intubação (EDI) em um grupo de pacientes com patologia de cabeça e pescoço. Método: Incluímos no estudo 153 pacientes submetidos a cirurgia de cabeça e pescoço. Coletamos os resultados do Teste de Mallampati Modificado (TMM), Distância Tireomentoniana (DTM), Razão Altura/Distância Tireomentoniana (RADTM), MATM, amplitude máxima de movimentação da cabeça e pescoço e da abertura da boca. Os ESPIDs foram calculados e os EDIs, determinados. Resultados: Observamos intubação difícil em 25,4% dos pacientes. Os escores de ESPID > 10 tiveram sensibilidade de 86,27%, especificidade de 71,57% e valor preditivo negativo de 91,2% (VPN). O resultado da análise da curva de operação do receptor (curva ROC) para os testes de avaliação das vias aéreas e ESPID mostrou que o ESPID tinha a maior área sob a curva; no entanto, foi estatisticamente semelhante a outros testes, exceto para o TMM. Conclusões: O presente estudo demonstra o uso prático do ESPID na previsão da dificuldade de intubação em pacientes com patologia de cabeça e pescoço. O desempenho do ESPID na predição de via aérea difícil mostrou-se tão eficiente quanto os demais testes avaliados neste estudo. O ESPID pode ser considerado ferramenta abrangente e detalhada para prever via aérea difícil.


Subject(s)
Humans , Adult , Aged , Aged, 80 and over , Young Adult , Intubation, Intratracheal/methods , Neck/surgery , Neck Dissection/statistics & numerical data , Thyroid Gland/surgery , Tongue Neoplasms/surgery , Nasopharyngeal Neoplasms , Predictive Value of Tests , Prospective Studies , ROC Curve , Range of Motion, Articular , Sensitivity and Specificity , Outcome Assessment, Health Care , Mandibular Advancement , Head and Neck Neoplasms/surgery , Intubation, Intratracheal/instrumentation , Laryngectomy/statistics & numerical data , Maxillofacial Injuries/surgery , Middle Aged , Mouth/physiology , Neck/anatomy & histology
4.
An. bras. dermatol ; 95(5): 583-588, Sept.-Oct. 2020. tab
Article in English | ColecionaSUS, LILACS, ColecionaSUS | ID: biblio-1130933

ABSTRACT

Abstract Background: High-risk basal cell carcinoma involves a significant rate of basal cell carcinoma that requires Mohs micrographic surgery for definitive treatment. Staged excision with pathologic margin control is a simple, accessible, and curative procedure suggested for the treatment of high-risk basal cell carcinoma. Objective: To evaluate the results of staged excision of high-risk basal cell carcinoma in the head region. Methods: This interventional study was performed on patients with high-risk basal cell carcinoma, who underwent staged excision until the margins were free of tumor. Results: A total of 122 patients (47 females and 75 males) with mean age of 57.66 ± 9.13 years were recruited in this study. Nasal and nodular types were the most common of both clinical and pathologic forms, respectively. Further, 89.3 % of cases were cured by staged excision after four years of follow-up. There was a significant relationship between treatment outcomes and recurrent lesions, multiplicity of risk factors, long-standing disease, and pathologic type. There was also a significant association between the number of surgical excisions and multiplicity of risk factors, as well as recurrence, location, and size of basal cell carcinoma. Study limitations: Lack of magnetic resonance imaging assessment in cases of suspected perineural invasion. Conclusions: High-risk basal cell carcinoma had a high cure rate by staged excision. Patients with more risk factors and those with nasal and recurrent basal cell carcinoma required more staged excisions. Failure of treatment is more probable in patients with more risk factors, long-standing lesions, and high-risk pathologic and recurrent basal cell carcinomas.


Subject(s)
Humans , Male , Female , Aged , Skin Neoplasms/surgery , Carcinoma, Basal Cell , Head and Neck Neoplasms/surgery , Mohs Surgery , Treatment Outcome , Middle Aged , Neoplasm Recurrence, Local/surgery
5.
Rev. cir. (Impr.) ; 72(4): 361-368, ago. 2020. tab
Article in Spanish | LILACS | ID: biblio-1138724

ABSTRACT

Resumen Durante la pandemia COVID-19, el enfrentamiento sanitario nacional e internacional ha enfocado sus esfuerzos en disminuir los riesgos inherentes del paciente oncológico. Existe un reforzamiento del enfoque resolutivo en los casos oncológicos críticos que requieren tratamiento precoz, evitando la exposición innecesaria al SARS-CoV-2 en los casos electivos y/o diferibles. Así como también, consideraciones de seguridad según riesgo para los cirujanos de cabeza y cuello acorde con la evidencia disponible hasta la fecha. Estas medidas tienen por objetivo evitar la exposición al virus y disminuir el uso de insumos limitados, enfocando nuestros esfuerzos en el tratamiento quirúrgico crítico.


During the COVID-19 pandemic, the national and international health confrontation has focused its efforts on reducing the inherent risk of cancer patients. There is a strengthening in the resolutions of critical oncological cases that require early treatment, avoiding unnecessary exposure to SARS-CoV-2 in elective or deferrable cases. And also, risk-based safety considerations for head and neck surgeons consistent with the evidence available to date. These actions aim to avoid exposure to the virus and decrease the use of limited supplies, focusing our efforts on critical surgical treatment.


Subject(s)
Humans , Pneumonia, Viral , Coronavirus Infections , Betacoronavirus , Head and Neck Neoplasms/surgery , Surgical Procedures, Operative/methods , Practice Guidelines as Topic , Pandemics/prevention & control
6.
Rev. otorrinolaringol. cir. cabeza cuello ; 80(2): 184-192, jun. 2020.
Article in Spanish | LILACS | ID: biblio-1115834

ABSTRACT

La recurrencia de carcinoma de células escamosas orofaríngeo (CCEOF) se asocia a mal pronóstico, particularmente en recurrencias en etapa avanzada. La cirugía en el contexto de rescate es más complicada por el tratamiento oncológico del tumor primario, por lo tanto, tiene un mayor riesgo de complicaciones y estadía hospitalaria. Sin embargo, la cirugía de rescate es la mejor oportunidad del paciente como tratamiento curativo y para supervivencia a largo plazo. La población de pacientes que reciben tratamiento para CCEOF ha cambiado en la última década, se ha reconocido que la incidencia de virus papiloma humano (VPH) asociado a CCEOF ha generado el gran aumento de CCEOF y el cambio asociado en las características de la población de pacientes, ahora los pacientes son más jóvenes y tienen menos comorbilidades. Con el aumento exponencial en la incidencia de CCEOF, la necesidad de cirugía de rescate en CCEOF podría verse en aumento. En vista del aumento de la incidencia de casos con carcinoma escamoso de orofaringe y su importante relación con el VPH, esta revisión se enfoca en la supervivencia tras cirugía de rescate con intención curativa y evaluar si con los avances en su tratamiento ha mejorado su pronóstico.


Recurrence of oropharyngeal squamous cell carcinoma (OPSCC) is associated with poor prognosis, particularly in advanced stage recurrences. Salvage surgery is complicated by previous oncological treatment of the primary tumor, therefore, it has a higher risk of complications and hospital stay. However, salvage surgery is the patient's best opportunity as a curative treatment and for long-term survival. The population of patients receiving treatment for OPSCC has changed in the last decade, it has been recognized that the incidence of human papilloma virus (HPV) associated OPSCC has generated an increase of OPSCC and changes in the epidemiology of the patient population, with younger patients and with less comorbidities. With the exponential increase in the incidence of OPSCC, the need for salvage surgery in OPSCC could increase in the future. In view of the increase in the incidence of cases with squamous oropharyngeal carcinoma and its relationship with HPV, this review focuses on survival after salvage surgery with curative intent and assessing whether the progress in its treatment has improved its prognosis.


Subject(s)
Humans , Otorhinolaryngologic Surgical Procedures/methods , Carcinoma, Squamous Cell/surgery , Head and Neck Neoplasms/surgery , Neoplasm Recurrence, Local , Papillomaviridae , Postoperative Complications , Prognosis , Carcinoma, Squamous Cell/mortality , Carcinoma, Squamous Cell/virology , Survival Rate , Salvage Therapy , Patient Selection , Medical Futility , Head and Neck Neoplasms/mortality , Head and Neck Neoplasms/virology
7.
Rev. Assoc. Med. Bras. (1992) ; 66(3): 380-384, Mar. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1136199

ABSTRACT

SUMMARY INTRODUCTION Radiotherapy (RT) plays an important role in the treatment of patients with head and neck neoplasia, and is frequently used as postoperative adjuvant therapy. This study aimed to review the literature about timing factors that may influence the clinical outcomes of patients with advanced head and neck neoplasia treated with adjuvant RT. RESULTS Timing factors such as total treatment time, length of adjuvant RT, and the absence of interruptions during RT may influence the clinical outcome of these patients. CONCLUSIONS In the same way that certain tumor factors can affect the prognosis of patients with squamous cell carcinoma of the head and neck, some therapeutic timing factors are also prognostic factors and therefore, must be carefully orchestrated in order to avoid loss at therapeutic outcomes for these patients.


RESUMO INTRODUÇÃO A radioterapia (RT) tem importante papel no tratamento dos pacientes com neoplasia de cabeça e pescoço, sendo frequentemente utilizada como terapia adjuvante a fim de diminuir a probabilidade de recorrência local. O presente estudo tem o objetivo de realizar uma revisão da literatura para avaliar os fatores terapêuticos temporais que possam ter influência sobre os desfechos clínicos dos pacientes com neoplasia avançada de cabeça e pescoço tratados com RT adjuvante. RESULTADOS As variáveis terapêuticas, como o tempo total do tratamento, a duração da RT e a ausência de interrupções durante o tratamento radioterápico são capazes de impactar o resultado clínico dos pacientes. CONCLUSÕES Da mesma forma que determinados fatores tumorais podem afetar o prognóstico de pacientes com carcinoma de células escamosas de cabeça e pescoço, alguns fatores terapêuticos temporais também constituem fatores prognósticos e, portanto, devem ser rigorosamente orquestrados a fim de se evitarem prejuízos sobrepostos para esses pacientes.


Subject(s)
Humans , Squamous Cell Carcinoma of Head and Neck/radiotherapy , Head and Neck Neoplasms/radiotherapy , Time Factors , Survival Rate , Combined Modality Therapy , Radiotherapy, Adjuvant , Disease-Free Survival , Squamous Cell Carcinoma of Head and Neck/surgery , Head and Neck Neoplasms/surgery
8.
Rev. Col. Bras. Cir ; 47: e20202460, 2020. tab, graf
Article in English | LILACS | ID: biblio-1143691

ABSTRACT

ABSTRACT Objectives: to analyze the survival in juvenile melanoma. Methods: retrospective study conducted by hospital record review and cancer records of patients aged 0 to 19 years, with histologically proven melanoma and treated between 1997 and 2017 at the Erasto Gaertner Hospital in Curitiba-PR. Results: the sample comprised 24 patients, female (62.5%), mean 14.14 ± 4.72 years old, with head and neck melanoma (37.5%), chest (25%) and extremities. (20.8%). Signs and symptoms at diagnosis were increased lesion size (25%), bleeding (20.8%) and pruritus (16.6%). There was a Breslow II and IV index and Clark IV level, with a statistical tendency between Breslow IV and death (p = 0.127), and significance between Clark V and death (p = 0.067). Nine (37.5%) patients had metastases, six (25%) with distant metastases died (p = 0.001), five were girls (20.8%). Surgery was the standard treatment and chemotherapy the most used adjuvant (37.5%). The average time between diagnosis and death was 1.3 ± 1.2 years and survival were 3.7 ± 3.2 years. Conclusion: there was a delay in diagnosis, high morbidity and mortality and average survival less than five years.


RESUMO Objetivos: analisar a sobrevida no Melanoma Infantojuvenil. Métodos: estudo retrospectivo realizado mediante revisão de prontuários e registros hospitalares de câncer, de pacientes na faixa etária de 0 a 19 anos, com melanoma comprovado histologicamente e atendidos entre 1997 e 2017 no Hospital Erasto Gaertner em Curitiba-PR. Resultados: amostra composta por 24 pacientes, sexo feminino (62,5%), média de 14,12 ± 4,72 anos de idade, com melanoma em cabeça e pescoço (37,5%), tórax (25%) e extremidades (20,8%). Os sinais e sintomas ao diagnóstico foram aumento do tamanho da lesão (25%), sangramento (20,8%) e prurido (16,6%). Ocorreu Índice de Breslow II e IV e Nível de Clark IV, com tendência estatística entre Breslow IV e óbito (p=0,127) e significância entre Clark V e óbito (p=0,067). Nove (37,5%) pacientes apresentaram metástases, seis (25%) com metástases à distância morreram (p=0,001), cinco eram meninas (20,8%). A cirurgia foi o tratamento padrão e a quimioterapia o adjuvante mais utilizado (37,5%). A média de tempo entre diagnóstico e óbito foi de 1,3 ± 1,2 anos e de sobrevida foi 3,7 ± 3,2 anos. Conclusão: houve atraso no diagnóstico, alta morbimortalidade e média de sobrevida menor do que cinco anos.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Skin Neoplasms/mortality , Melanoma/mortality , Prognosis , Survival Analysis , Survival Rate , Retrospective Studies , Chemotherapy, Adjuvant/adverse effects , Sentinel Lymph Node , Head and Neck Neoplasms/surgery , Melanoma/pathology , Melanoma/therapy , Neoplasm Metastasis , Neoplasm Staging
9.
Rev. argent. cir ; 112(2): 141-156, 2020. tab
Article in English, Spanish | LILACS | ID: biblio-1125795

ABSTRACT

Antecedentes: la cirugía robótica es una alternativa a la cirugía abierta, microcirugía láser CO2, o quimiorradioterapia en vía aerodigestiva superior. El robot permite trasladar la técnica quirúrgica abierta a un abordaje mínimamente invasivo, con acceso por boca, para patología benigna y maligna. Actualmente se emplean diferentes terapéuticas con similares resultados oncológicos. Objetivo: introducir una herramienta quirúrgica para abordaje bucal. Comunicar la experiencia inicial con el uso del robot. Evaluar la preservación de respiración y deglución. Analizar variables que determinaron una disminución en la hospitalización. Material y métodos: 13 mujeres y 11 hombres. Edad entre 16 y 82 años, media de 55,08. Total 24 pacientes con enfermedad inflamatoria crónica (8), tumores benignos (4) y malignos (12). Variables consideradas en cirugía robótica: tiempo y lugar de internación, complicaciones, estado respiratorio y deglutorio, uso de técnicas reconstructivas. Se realizó videoendoscopia de deglución para objetivar la seguridad del método. Resultados: tiempo medio de internación: 1,92 días. El 83,3% internado 1 día. El 79,9% en internación general. Unidad cerrada: 20,1%. Ninguna traqueostomía. Cicatrización del lecho por segunda. Sin complicaciones. Edema de lengua: 2 pacientes. Conclusiones: la cirugía robótica favorece la exéresis con baja morbilidady máxima preservación de tejidos sanos. Disminuye: edema posoperatorio, uso colgajos para reparar el lecho, traqueotomía temporaria, tiempo de internación. La videoendoscopia de deglución demuestra utilidad para determinar la deglución segura. Limitante del presente trabajo es el tamaño de la muestra. Es importante incrementar el número de pacientes para valorizar supervivencia y calidad de vida.


Background: robotic surgery is an alternative to open surgery, CO2 laser microsurgery, or chemoradiation for the upper aero-digestive tract. This system allows surgeons to use the open surgical technique in a minimally invasive approach through the mouth to treat benign and malignant disorders. Different treatments are currently used with similar oncologic outcomes. Objective: the aim of this study was to introduce a surgical tool through transoral approach, report the initial experience with the use of the robotic system, evaluate respiratory and digestive functional preservation and analyze the variables associated with shorter hospital length of stay. Material and methods: A total of 24 patients (13 women and 11 men, mean age 55.08 years [16-82]) were included. Eight patients had chronic inflammatory disease, four had benign tumors and 12 had cancer. The variables considered in robotic surgery were hospital length of stay, place of postoperative care, complications, respiratory and swallowing function and use of reconstructive techniques. Flexible endoscopic evaluation of swallowing was performed to document safe function. Results: mean length of stay was 1.92 days; 83.3% stayed for one day; 79.9% were admitted to the general ward and 20.1% stayed in intensive or intermediate care units. None of the patients required tracheostomy. Healing of the surgical bed occurred by secondary intention. There were no complications. Tongue edema occurred in two patients. Conclusions: robotic surgery favors tumor removal with low morbidity and maximum preservation of healthy tissues while reducing postoperative edema, use of flaps for reconstruction, temporary tracheostomy and hospital length of stay. Flexible endoscopic evaluation of swallowing is useful to determine safe swallowing function. The main limitation of our study is the sample size. It is important to increase the number of patients to evaluate survival and quality of life.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Robotic Surgical Procedures/methods , Head and Neck Neoplasms/surgery , Argentina , Postoperative Period , General Surgery/methods , Deglutition , Capsule Endoscopy
10.
Clinics ; 75: e1615, 2020. tab, graf
Article in English | LILACS | ID: biblio-1133376

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effect of the delay to initiate postoperative radiation therapy (RT) on locoregional control to head and neck squamous cell carcinoma patients. METHODS: Retrospective cohort study that included patients submitted to surgery followed by adjuvant RT (with/without chemotherapy). The time interval between surgery and RT was dichotomized by the receiver operating characteristics curve method at 92 days. Other possible sources of heterogeneity with potential impact on locoregional control were explored by regressive analysis. RESULTS: A total of 168 patients were evaluated. The median time for locoregional recurrence (LRR) was 29.7 months. The relapse-free survival rates were 66.4% and 75.4% for patients who initiated RT more than and within 92 postoperative days (p=0.377), respectively. Doses lower than 60Gy were associated with worse rates of locoregional control (HR=6.523; 95%CI:2.266-18.777, p=0.001). Patients whose total treatment time (TTT) was longer than 150 days had LRR rate of 41.8%; no patient with TTT inferior to 150 days had relapses (p=0.001). CONCLUSIONS: The interval between surgery and RT did not show influence on locoregional control rates. However, doses <60Gy and the total treatment time >150 days were associated with lower locoregional control rates.


Subject(s)
Humans , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/radiotherapy , Neoplasm Recurrence, Local , Postoperative Period , Survival Rate , Retrospective Studies
11.
Rev. cuba. pediatr ; 91(4): e789, oct.-dic. 2019. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093731

ABSTRACT

Introducción: Los tumores malignos de cabeza y cuello incluyen varios subtipos histológicos y el pronóstico depende de su ubicación anatómica. Objetivo: Describir las características clínicas y el tratamiento de pacientes pediátricos con tumores malignos de cabeza y cuello. Métodos: Estudio descriptivo, longitudinal y retrospectivo realizado en el servicio de Oncopediatría del Instituto Nacional de Oncología y Radiobiología, desde el 1ro. de enero de 2005 al 31 de diciembre de 2017. Se registraron variables demográficas, clínicas y terapéuticas. Se identificaron los pacientes a partir de las bases de datos del registro hospitalario del citado instituto. Se seleccionaron todos los pacientes con tumores de cabeza y cuello que tuvieron diagnóstico histológico. Resultados: Se identificaron 73 pacientes, con ligero predominio del sexo femenino (60,3 por ciento), con una edad media de 12 años (rango entre 0 y 18 años). El tipo histológico más frecuente fue el carcinoma tiroideo (35,6 por ciento), seguido de los rabdomiosarcomas (27,3 por ciento). El tratamiento más utilizado fue la cirugía (38,3 por ciento) seguido de la combinación de cirugía más radioterapia y quimioterapia (22,0 por ciento). Conclusiones: El tumor maligno de cabeza y cuello más frecuente en pacientes pediátricos es el carcinoma tiroideo. El tratamiento de elección es la resección total, acompañado de radioterapia y quimioterapia, dependiendo del tipo histológico y la etapa clínica(AU)


Introduction: Malignant tumors of the head and neck include several histological subtypes and the prognosis depends on their anatomical location. Objective: To describe the clinical characteristics and treatment of patients diagnosed with malignant head and neck tumors. Methods: A descriptive, longitudinal and retrospective study was carried out from January 1, 2005 to December 31, 2017 at the Oncopediatrics service in the National Institute of Oncology and Radiobiology, according to demographic, clinical and therapeutic variables. Patients were identified from the databases of the hospital registry of the above mentioned institute. All patients with head and neck tumors that had a histological diagnosis were selected. Results: 73 patients were identified, with a slight predominance of females (60.3 percent), with a mean age of 12 years (range between 0 and 18 years). The most frequent histological type was thyroid carcinoma (35.6 percent), followed by rhabdomyosarcomas (27.3 percent). The most used treatment was surgery (38.3 percent) followed by the combination of surgery plus radiotherapy and chemotherapy (22 percent). Conclusions: Tumors of the head and neck are infrequent. The treatment of choice is total resection, accompanied by radiotherapy and chemotherapy, depending on the histological type and the clinical stage(AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/drug therapy , Epidemiology, Descriptive , Retrospective Studies , Longitudinal Studies , Head and Neck Neoplasms/radiotherapy
12.
Rev. méd. Chile ; 147(7): 928-931, jul. 2019. graf
Article in Spanish | LILACS | ID: biblio-1058623

ABSTRACT

Lhermitte phenomenon is a neurological symptom described as a sensation of electric shock that radiates from the back towards the extremities, which appears when a patient flexes the neck. A transient myelopathy as a late complication of radiotherapy is associated with this symptom. It appears two to four months after treatment and disappears spontaneously. We report a 45 years old female with a neck malignant melanoma treated with surgery and adjuvant radiotherapy. She experienced the Lhermitte phenomenon that was triggered by heat. This phenomenon must be differentiated from the Uhthoff phenomenon.


Subject(s)
Humans , Male , Middle Aged , Pain/etiology , Skin Neoplasms/diagnosis , Radiotherapy, Adjuvant/adverse effects , Head and Neck Neoplasms/diagnosis , Hot Temperature/adverse effects , Melanoma/diagnosis , Skin Neoplasms/surgery , Skin Neoplasms/radiotherapy , Diagnosis, Differential , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/radiotherapy , Melanoma/surgery , Melanoma/radiotherapy
13.
Rev. chil. radiol ; 25(2): 67-70, jun. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1013851

ABSTRACT

El tumor desmoides es un tumor benigno raro, de origen fibroblastico no inflamatorio, algunas veces referido como fibromatosis no agresiva. Su etiología aún no está completamente clara, sin embargo, se asocia habitualmente a trauma previo y/o procedimientos quirúrgicos. La ubicación más frecuente es abdominal, el cual posee características imagenologicas claras, al igual que su presentación musculo esquelética plantar. La presentación fuera de estos lugares es infrecuente y difícil de diagnosticar. Presentamos un caso de un tumor desmoides cervical que genero un gran desafío diagnóstico, identificando sus claves diagnósticas y realizando una revisión de la bibliografía al respecto para esta ubicación.


Desmoid tumours are a rare benign tumour of fibroblastic non inflammatory origin, sometimes referred as non aggressive fibromatosis.The etiology is not yet completely clear, however, it is usually associated with previous trauma and / or surgical procedures. The most frequent location is in the abdomen, which has typical images characteristics, as well as its skeletal muscle presentation at the plantar level. The presentation outside these places is infrequent and difficult to diagnose. We present a case of a cervical desmoid tumour that generated a great diagnostic challenge, identifying its key imaging characteristics and performing a literature review of the bibliography regarding this location.


Subject(s)
Humans , Male , Adult , Fibroma/surgery , Fibroma/diagnostic imaging , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Fibroma/pathology , Head and Neck Neoplasms/pathology
14.
Rev. otorrinolaringol. cir. cabeza cuello ; 79(1): 117-124, mar. 2019. ilus
Article in Spanish | LILACS | ID: biblio-1004392

ABSTRACT

RESUMEN El cáncer de laringe avanzado y el cáncer de hipofaringe pueden ser tratados con terapia de conservación de órganos con radioquimioterapia, sin embargo, cuando esta última fracasa, la cirugía es la última opción para esta patología. El cáncer de hipofaringe posee una pobre sobrevida en estados avanzados, y su tratamiento quirúrgico después de radioterapia siempre se transforma en un desafío quirúrgico por las condiciones del tejido irradiado. Este artículo realiza una revisión general de las opciones de reconstrucción para defectos faringolaríngeos tanto parciales como circunferenciales, ante el caso eventual de que por la extensión tumoral y su tratamiento ablativo no sea posible un cierre primario. Se revisan distintos resultados de los principales colgajos utilizados en reconstrucción en cabeza y cuello, como son los colgajos libres fasciocutáneos, colgajo pectoral mayor y colgajos viscerales como el yeyuno, comparando tasas de fistulas faringocutáneas, resultados en deglución y rehabilitación fonatoria posterior, intentando realizar una aproximación a una recomendación terapéutica. Por último cabe mencionar que todo servicio de cabeza y cuello debe conocer las opciones existentes para cada paciente en particular, ya que además de buscar resultados oncológicos, se debe intentar lograr buenos resultados funcionales que no empobrezcan la calidad de vida de nuestros pacientes.


ABSTRACT Advanced laryngeal cancer and hypopharyngeal cancer can be treated with organ preservation therapy with radiochemotherapy. However, when the latter fails, surgery is the last option for this pathology. Hypopharyngeal cancer has a poor survival in advanced stages, and its surgical treatment after radiotherapy always becomes a surgical challenge due to the conditions of the irradiated tissue. This article makes a general review of the reconstruction options for both partial and circumferential pharyngolaryngeal defects, in the case where tumor extensions and ablative treatments do not permit a primary closure. Different results of the main flaps used in head and neck reconstruction are reviewed, such as the fasciocutaneous free flaps, pectoralis major flap and visceral flaps such as the jejunum. We then compare the rates of pharyngocutaneous fistulas, swallowing results and posterior phonation rehabilitation, while trying to perform an approach to a therapeutic recommendation. Finally, it should be mentioned that all head and neck services must know the existing options for each patient in particular, since in addition to looking for oncological results, one should try to achieve good functional results that do not impoverish the quality of life of our patients.


Subject(s)
Humans , Surgical Flaps , Laryngeal Neoplasms/surgery , Reconstructive Surgical Procedures , Quality of Life , Salvage Therapy , Head and Neck Neoplasms/surgery , Laryngectomy
15.
Rev. otorrinolaringol. cir. cabeza cuello ; 78(4): 392-398, dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-985744

ABSTRACT

RESUMEN Introducción: Los tumores de la glándula submandibular son poco frecuentes. Representan menos del 1% de todos los tumores de cabeza y cuello. Corresponden al 10% de los tumores de las glándulas salivales. Aproximadamente el 50% son malignos. Objetivos: Analizar la experiencia clínica con las submandibulectomias realizadas en el Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital Guillermo Grant Benavente. Material y método: Estudio descriptivo retrospectivo. Revisión de fichas clínicas de pacientes intervenidos de submandibulectomía entre el 01 de enero de 2011 y el 31 de diciembre de 2016 en nuestro servicio. Resultados: Se realizaron 28 submandibulectomías por patología tumoral. La edad promedio fue de 54 años, siendo el 71% de sexo femenino. 21 tumores fueron benignos (75%), siendo el más frecuente el adenoma pleomorfo (14 casos), y 7 tumores malignos (25%), siendo el más frecuente el carcinoma adenoidequístico. Se reportaron dos complicaciones transitorias (7%), una paresia de la rama marginal del nervio facial y una paresia del nervio hipogloso. El 42% de los tumores malignos presentó recurrencia. Conclusión: Nuestra serie presenta resultados acordes a la literatura en cuanto a edad de presentación, distribución por sexo, tipos histológicos, tasa de complicaciones y recurrencia; sin embargo, difiere en la menor frecuencia de tumores malignos, siendo en nuestra serie de 25%. Patología poco frecuente. La presencia de una masa indolora submandibular debe ser derivada a los centros de referencia para estudio y eventual resolución quirúrgica por el riesgo de malignidad.


ABSTRACT Introduction: Submandibular gland tumors are rare. They represent less than 1% of all head and neck tumors. They correspond to 10% of the tumors of the salivary glands. Approximately 50% are malignant. Aim: To analyze the clinical experience with the submandibulectomies performed in the Otorhinolaryngology and Head and Neck Surgery Service of the Guillermo Grant Benavente Hospital. Material and Method: Retrospective descriptive study. Review of clinical records of patients treated with a submandibulectomy between January 1,2011 and December 31, 2016 in our service. Results: 28 submandibulectomies were performed due to tumor pathology. The average age was 54 years, being 71% female. 21 tumors were benign (75%), being the most frequent the pleomorphic adenoma (14 cases), and 7 malignant tumors (25%), being the most frequent the adenoidequistic carcinoma. Two transient complications (7%) were reported, a paresis of the marginal branch of the facial nerve and a paresis of the hypoglossal nerve. 42% of malignant tumors presented recurrence. Conclusion: Our series presents results according to the literature regarding age of presentation, distribution by sex, histological types, complication rate and recurrence; however, it differs in the lower frequency of malignant tumors, being in our series of 25%. Uncommon pathology. The presence of a submandibular painless mass must be referred to the reference centers for study and possible surgical resolution due to the risk of malignancy.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Submandibular Gland/surgery , Submandibular Gland/pathology , Salivary Gland Neoplasms/surgery , Chile , Epidemiology, Descriptive , Head and Neck Neoplasms/surgery
16.
Rev. otorrinolaringol. cir. cabeza cuello ; 78(4): 417-420, dic. 2018. ilus
Article in Spanish | LILACS | ID: biblio-985748

ABSTRACT

RESUMEN Los tumores del espacio parafaríngeo (EP) son poco frecuentes, representando el 0,5%-1% de las neoplasias de cabeza y cuello. La distribución de los tumores del EP constituye: 40% tumores de glándulas salivales, seguidos de tumores neurogénicos y adenopatías. Presentamos un caso de una paciente de 52 años que acude por presentar sensación de taponamiento ótico izquierdo y molestias faríngeas de 3 meses de evolución. Tras una exploración otorrinolaringológica completa se sospecha patología del espacio parafaríngeo, que se confirma con las pruebas de imagen. Se realiza exéresis quirúrgica mediante abordaje transcervical-transparotídeo, con buena evolución posoperatoria y sin recidiva tras 1 año de seguimiento. El estudio anatomopatológico informa adenoma pleomorfo de parótida. En este trabajo se ha realizado una revisión de la etiopatogenia, diagnóstico y tratamiento de estas lesiones. Consideramos crucial realizar una exploración física otorrinolaringológica completa ante la presencia de un paciente con sintomatología inespecífica ya que el EP constituye un área anatómica difícil de explorar y que a menudo pasa desapercibida, por lo que la patología del EP representa un reto diagnóstico y terapéutico.


ABSTRACT Parapharyngeal space (PPS) tumors are infrequent and account for 0.5%-1% of head and neck neoplasms. Therefore, they represent a diagnostic challenge. The distribution of PPS tumors is as follows: 40% salivary tumors, followed by neurogenic tumors and adenopathies. We report a case of a 50 year old woman that presented with a 3-month history of otic fullness and pharyngeal disturbances. The otolaryngological examination showed PPS pathology that was confirmed by radiological images. Surgical excision by transcervical-transparotid approach was performed followed by uncomplicated healing with no recurrence in one year. The histological examination reported a pleomorphic parotid adenoma. The authors provide a discussion of the etiopathogenesis, diagnosis and treatment of this type of lesions. This clinical manuscript may shed light on the importance of a complete otolaryngological examination in a patient with unspecific symptoms considering that the PPS is a complex anatomic region and its pathology can easily go unnoticed.


Subject(s)
Humans , Female , Middle Aged , Adenoma, Pleomorphic/surgery , Parapharyngeal Space/surgery , Pharyngeal Neoplasms , Tomography, X-Ray Computed , Head and Neck Neoplasms/surgery
17.
Rev. otorrinolaringol. cir. cabeza cuello ; 78(4): 439-450, dic. 2018. ilus
Article in Spanish | LILACS | ID: biblio-985752

ABSTRACT

RESUMEN Considerando los avances en las modalidades de tratamiento para el cáncer de cabeza y cuello, el manejo quirúrgico de los defectos ha cambiado significativamente en las últimas décadas. Con la mejoría del manejo previo a la cirugía en la década de los 40s-50s, la cirugía ablativa o resectiva se convirtió en el pilar del tratamiento de los tumores avanzados en esta región, lo cual rutinariamente era seguido de tratamiento con radioterapia. Desafortunadamente, la cirugía reconstructiva no avanzó de la misma forma, no existiendo previamente opciones confiables de rehabilitación de estos pacientes. Además, los cirujanos de cabeza y cuello como otorrinolaringólogos de la época no consideraban la reconstrucción como parte importante del tratamiento quirúrgico. Sin embargo, en las últimas décadas, la cirugía reconstructiva ha presentado distintos avances que han permitido complementar el manejo de estas patologías, entregando una terapia oncológica con menos morbilidad cosmética y funcional. Esta revisión pretende de forma general dar a conocer los distintos tipos de colgajo, sus indicaciones y opciones en cirugía reconstructiva de cabeza y cuello, lo cual es de suma importancia para los servicios que manejen patología oncológica de esta región anatómica.


ABSTRACT Encompassing with the advances in the preferred treatment modalities for head and neck cancer, the management of surgical defects has changed significantly over the last decades. With the advent of improved perioperative management in the 1940-50s, radical ablative surgery became the mainstay for treatment of advanced tumors in this region, which was routinely followed by radiation therapy. Unfortunately, reconstructive surgery did not advance at the same pace, and there were no reliable reconstructive options to rehabilitate these patients. Furthermore, head and neck surgeons and otolaryngologists of the time did not consider reconstruction as an important part of the surgical treatment. However, in the last decades, reconstructive surgery has presented different advances that have made it possible to complement the management of these pathologies, delivering an oncological therapy with less cosmetic and functional morbidity. This review aims in general to make known the different types of flap, its indications and options in reconstructive surgery of the head and neck, of utmost importance for the services that handle oncological pathology of this anatomical region.


Subject(s)
Humans , Surgical Flaps , Reconstructive Surgical Procedures/methods , Head and Neck Neoplasms/surgery , Radiotherapy , Mandibular Reconstruction/methods , Maxilla/surgery
18.
Braz. j. otorhinolaryngol. (Impr.) ; 84(4): 416-425, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-951860

ABSTRACT

Abstract Introduction Reconstruction with a free flap is routine in head and neck surgery because of better functional outcomes, improved esthetics, and generally higher success rates. Objective To evaluate the clinical outcomes in patients undergoing different microvascular free flap reconstructions. Methods This was a retrospective study of 93 patients undergoing reconstructions with free flaps from 2007 to 2015. Four types of free flap were performed: anterolateral thigh (76.3%), radial forearm (16.1%), fibula (4.3%) and jejunum (3.3%). Patients' demographic data were collected, and the outcomes measured included flap survival and complications. Postoperative functional and oncological outcome were also analyzed. Results The patients included 73 men and 20 women, with a mean age of 56.1 years. The most common tumor location was the tongue. Squamous cell carcinoma represented the vast majority of the diagnosed tumors (89.2%). The most common recipient vessels were the superior thyroid artery (77.4%) and the internal jugular vein (91.4%). Nine patients required emergency surgical re-exploration and the overall flap success rate was 90.3%. Venous thrombosis was the most common cause for re-exploration. Other complications included wound infection (5.4%), wound dehiscence (1.1%), partial flap necrosis (9.7%), fistula formation (10.8%), and 1 bleeding (1.1%). The majority of patients had satisfactory cosmetic and functional results of both donor site and recipient site after 46.7 months of mean follow-up. Conclusion Microsurgical free flap is shown to be a valuable and reliable method in head and neck surgery. It can be used safely and effectively with minimal morbidity in selected patients. The reconstruction can be performed by appropriately skilled surgeons with acceptable outcomes. Success rate appears to increase as clinical experience is gained.


Resumo Introdução Reconstrução com retalhos livres é um procedimento de rotina nas cirurgias de cabeça e pescoço devido aos melhores resultados funcionais e estéticos e às taxas de sucesso geralmente maiores. Objetivo Avaliar os desfechos clínicos de pacientes submetidos a diferentes reconstruções microvasculares com retalhos livres. Método Estudo retrospectivo de 93 pacientes submetidos à reconstruções com retalhos livres, de 2007 a 2015. Foram utilizados quatro tipos de retalho livre: coxa anterolateral (76,3%), antebraço radial (16,1%), fíbula (4,3%) e jejuno (3,3%). Os dados demográficos dos pacientes foram coletados e os parâmetros avaliados incluíram sobrevida e complicações. Os resultados funcionais e oncológicos pós-operatórios também foram analisados. Resultados Os pacientes incluíram 73 homens e 20 mulheres, com idade média de 56,1 anos. O local mais comum para o tumor foi a língua. O carcinoma de células escamosas representou a maioria dos tumores diagnosticados (89,2%). As artérias receptoras mais comuns foram a artéria tireóidea superior (77,4%) e a veia jugular interna (91,4%). Nove pacientes necessitaram de reexploração cirúrgica de emergência e a taxa de sucesso global do retalho foi de 90,3%. A trombose venosa foi a causa mais comum da reexploração. Outras complicações incluíram infecção da ferida cirúrgica (5,4%), deiscência da ferida (1,1%), necrose parcial do retalho (9,7%), formação de fístula (10,8%) e sangramento (1,1%). A maioria dos pacientes apresentou resultados estéticos e funcionais satisfatórios, tanto no local doador quanto no receptor, após 46,7 meses de seguimento médio. Conclusão O retalho livre microcirúrgico mostrou ser um método valioso e confiável na cirurgia de cabeça e pescoço. Pode ser usado de forma segura e eficaz, com morbidade mínima em pacientes selecionados. A reconstrução pode ser feita por cirurgiões adequadamente qualificados com resultados aceitáveis. A taxa de sucesso parece aumentar à medida que a experiência clínica é adquirida.


Subject(s)
Male , Female , Middle Aged , Carcinoma, Squamous Cell/surgery , Reconstructive Surgical Procedures/methods , Free Tissue Flaps/transplantation , Head and Neck Neoplasms/surgery , Postoperative Complications , Arteries/surgery , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Reconstructive Surgical Procedures/adverse effects , Free Tissue Flaps/adverse effects , Length of Stay
19.
Rev. otorrinolaringol. cir. cabeza cuello ; 78(2): 191-196, jun. 2018. ilus
Article in Spanish | LILACS | ID: biblio-961614

ABSTRACT

RESUMEN Los tumores de plexo braquial son poco frecuentes, representando menos del 5% de los tumores que afectan a las extremidades superiores. Suelen presentarse entre la tercera y quinta década de la vida como una masa palpable, que puede acompañarse de dolor, parestesias y déficit motor. A continuación, presentamos un caso de un schwannoma de plexo braquial tratado en nuestro servicio.


ABSTRACT Brachial plexus tumors are uncommon, accounting for less than 5% of tumors affecting the upper extremities. They usually present between the third and fifth decade of life as a palpable mass, which can be accompanied by pain, paresthesias and motor deficit. We present a case of a brachial plexus schwannoma treated in our service.


Subject(s)
Humans , Female , Aged , Brachial Plexus , Head and Neck Neoplasms/diagnostic imaging , Neurilemmoma/diagnostic imaging , Postoperative Complications , Tomography, X-Ray Computed , Head and Neck Neoplasms/surgery , Head and Neck Neoplasms/pathology , Neurilemmoma/surgery , Neurilemmoma/pathology
20.
Int. j. morphol ; 36(1): 194-200, Mar. 2018. tab, graf
Article in English | LILACS | ID: biblio-893210

ABSTRACT

SUMMARY: Neurofibromatosis type 1 (NF1) is a rare autosomal dominant neurogenetic disease with variable clinical manifestations, which are primarily manifested as neurofibromas, café-au-lait macules (CALMs) and skeletal deformities. Although generally benign, expansile neurofibromas that are characteristic of NF1 readily lead to disturbing deformities. It is often difficult to surgically extirpate a tumor that involves these important tissues or organs. We report a rare case of a patient with neurofibromatosis Type 1. The patient presented with a congenital giant scalp neurofibroma and CALMs in the occipito-cervical region, in addition to ear and occipital deformities. We performed a challenging surgical intervention (a near-total resection) to reduce the tumor burden and rehabilitate the appearance and function of the patient while preserving the intracranial tissue structure. Here, we review this case and analyze the clinical manifestations, diagnosis and management of NF1.


RESUMEN: La neurofibromatosis tipo 1 (NF1) es una rara enfermedad neurogenética autosómica dominante, con manifestaciones clínicas variables, que se manifiestan principalmente como neurofibromas, máculas café con leche (CALM) y deformidades esqueléticas. Generalmente los neurofibromas expansivos benignos que son característicos de NF1 conducen fácilmente a deformidades exageradas. A menudo es difícil extirpar quirúrgicamente un tumor que involucra estos tejidos u órganos importantes. Presentamos un caso raro de un paciente con neurofibromatosis tipo 1. La paciente presentó un neurofibroma congénito gigante del cuero cabelludo y CALM en la región occipitocervical, además de deformidades del oido y región occipital. Realizamos una intervención quirúrgica desafiante (una resección casi total) para reducir la carga tumoral y rehabilitar la apariencia y función de la paciente mientras se preservó la estructura del tejido intracraneal. Aquí, revisamos este caso y analizamos las manifestaciones clínicas, el diagnóstico y el tratamiento de NF1.


Subject(s)
Humans , Female , Adult , Neurofibromatosis 1/surgery , Head and Neck Neoplasms/surgery , Neurofibromatosis 1/diagnostic imaging , Head and Neck Neoplasms/diagnostic imaging
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