Long-term functional outcomes and quality of life after partial glossectomy for T2 squamous cell carcinomas

Abstract Introduction: Partial glossectomy and reconstruction strategy for malignant tongue tumors influences speech and swallowing. Objective: The aim of this retrospective study was to evaluate long-term functional outcomes after partial glossectomy for pT2 mobile tongue carcinomas with a maximum dimension between 2 and 3 cm. Different reconstruction strategies (with or without pedicled flap) were compared. Methods: Twenty-two patients with at least 12 months followup were included. Clinician-based and self-reported instruments were used to analyze tongue motility, speech intelligibility and articulation, swallowing, and quality of life. Results: Patients with a higher tongue motility had better articulation and lower dysphagia. Avoiding pedicled flap reconstruction seemed to guarantee lower impairment of speech and swallowing. Worse functional outcomes induced a lower quality of life. Conclusion: Partial glossectomy results in tongue motility impairment and consequently alterations of oral functions. Since the type of reconstruction impacts long-term outcomes, it should be adequately planned before surgery.

Prognostic role of margin status in open and CO2 laser cordectomy for T1a-T1b glottic cancer / Papel prognóstico do estado da margem cirúrgica na cordectomia aberta e com laser de CO2 em câncer glótico T1a-T1b

Abstract Introduction Cordectomy by laringofissure and transoral laser surgery has been proposed for the treatment of early glottic cancer. Objectives The aim of this retrospective study was to evaluate the prognostic value of margin status in 162 consecutive cases of early glottic carcinoma (Tis-T1) treated with CO2 laser endoscopic surgery (Group A) or laryngofissure cordectomy (Group B), and to compare the oncologic and functional results. Methods Clinical prognostic factors, local recurrence rate according to margin status, overall survival and disease-free survival were analyzed. Results Margin status is related to recurrence rate in both groups (p < 0.05) without significant differences between open and laser cordectomy (p > 0.05). The 5 years overall survival and disease-free survival were respectively 90.48% and 85.71% in Group A; 88.14% and 86.44% in Group B (p > 0.05). Lower tracheostomy rate, earlier recovery of swallowing function and shorter hospital stay were observed in Group A (p < 0.05). Conclusions Margin status has a prognostic role in T1a-T1b glottic cancer. Transoral laser surgery showed similar oncologic results of open cordectomy, with better functional outcomes.

Resumo Introdução Cordectomia por laringofissura e cirurgia transoral a laser têm sido propostas para o tratamento do câncer glótico inicial. Objetivos O objetivo desse estudo retrospectivo foi avaliar o valor prognóstico do estado da margem em 162 casos consecutivos de carcinoma glótico inicial (Tis-T1) tratado com cirurgia endoscópica a laser de CO2 (Grupo A) ou cordectomia por laringofissura (Grupo B) e comparar resultados oncológicos e funcionais. Método Foram analisados fatores prognósticos clínicos, taxa de recorrência local de acordo com o estado da margem, sobrevida global e sobrevida livre de doença. Resultados O estado de margem está relacionado à taxa de recorrência em ambos os grupos (p < 0,05) sem diferenças significativas entre cordectomia aberta e cirurgia a laser (p > 0,05). A sobrevida global de cinco anos e a sobrevida livre de doença foram, respectivamente, 90,48% e 85,71% no Grupo A; 88,14% e 86,44% no Grupo B (p > 0,05). Menor taxa de traqueostomia, recuperação mais rápida da função de deglutição e menor tempo de internação foram observados no Grupo A (p < 0,05). Conclusões O estado da margem tem papel prognóstico no câncer glótico T1a-T1b. A cirurgia a laser transoral mostrou resultados oncológicos semelhantes aos da cordectomia aberta, com melhores resultados funcionais.

Realidad virtual y psicología clínica: Estado actual y perspectiva futura / Virtual reality and clinical psychology: Current situation and future perspective

Los sistemas de realidad virtual (RV) son instrumentos tecnológicos que pueden ofrecer muchas ventajas potenciales a la investigación y a la intervención dentro del ámbito de la psicología clínica. La relevancia metodológico-experimental de la RV reside en su capacidad de crear rigurosos contextos experimentales multisensoriales, interactivos y ecológicamente representativos, de modo tal de activar los mismos procesos psicológicos y las mismas acciones que los individuos realizan en la vida cotidiana. Las aplicaciones realizadas, y la multiplicidad de las que se hayan en curso, testimonian la eficacia y la eficiencia de la RV para el tratamiento de una amplia gama de problemas y déficits psicológicos, entre los cuales se encuentran: la terapia de los trastornos fóbicos, la cura paliativa para pacientes oncológicos, el entrenamiento para niños autistas, el diagnóstico y la terapia de las distorsiones de la imagen corporal en los trastornos alimentarios...