Feasibility and perioperative safety of transoral robotic surgery with da Vinci Xi platform / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the feasibility and perioperative safety of transoral robotic surgery with da Vinci Xi platform for pharyngolaryngeal tumors. Methods: A retrospective analysis was performed on 55 consecutive cases with resection of pharyngolaryngeal tumors by transoral robotic surgery with da Vinci Xi platform from July 27, 2020 to October 31, 2021 in the Department of Head and Neck Surgery, Fudan University Eye, Ear, Nose and Throat Hospital, including 44 males and 11 females, aged 25-79 years. There were 41 cases of oropharyngeal tumors, 9 cases of parapharyngeal space tumors, 2 cases of laryngeal tumors, 2 cases of hypopharyngeal tumors and 1 case of retropharyngeal space tumor. Operative time, intraoperative blood loss, postoperative hospital stay, perioperative tracheotomy, nasal feeding, hemorrhage and other complications were analyzed. Results: Of the 55 patients, 54 received resection of pharyngolaryngeal tumors by da Vinci robot through oral approach, and only 1 case of pyriform sinus carcinoma underwent a conversion to open surgery due to poor exposure of lower margin. The average surgical time for the patients with transoral robotic surgeries was 64.4 min, the average blood loss was 24.8 ml, the average postoperative hospital stay was 6.9 d, and the average oral feeding time was 11.1 d. Seventeen patients (30.9%) underwent preventive tracheotomy during surgery. Among 38 cases of laryngeal cancer, 28 underwent simultaneously neck dissection. No serious complications occurred in all patients during and after operation. The follow-up time was 1-15 months. Aside from 1 patient had a relapse 10 months after surgery, other patients had no recurrence or metastasis. Conclusion: Transoral robotic surgery with da Vinci Xi is safe, effective and minimally invasive for resection of pharyngolaryngeal tumors under reasonable indications.

Transoral endoscopic resection of benign tumors in parapharyngeal space via medial pterygomandibular raphe approach / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the surgical methods and effects of transoral endoscopic resection of benign tumors in parapharyngeal space via medial pterygomandibular raphe approach. Methods: The clinical data of 23 patients who underwent resection of benign tumors in parapharyngeal space by endoscopic medial pterygomandibular raphe approach from January 2016 to July 2020 in the Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University were analyzed retrospectively. There were 14 males and 9 females with a median age of 43 years. The tumors were located in the anterior space of the styloid process in 13 cases and in the posterior space in 10 cases. The smallest tumor volume was 7.3 ml and the largest was 80.2 ml. The preoperative imaging features, the characteristics and risks of this approach in the operation were analyzed, and the feasible mode of operation was explored. Results: All patients completed the operation successfully. The intraoperative blood loss was 20 to 50 ml, with an average of 28.3 ml. The operation time was 40 to 110 min, with an average of 75.4 min. The incision length was 2 to 4 cm, with an average of 3.0 cm. The postoperative pain score was 2 to 4, with an average of 3.2. The postoperative hospital stay was 4 to 9 d, with an average of 6.7 d. Postoperative pathological diagnosis included pleomorphic adenoma (n=12), neurilemmoma (n=10) and basal cell adenoma (n=1). The patients were followed up for 6 to 60 months. There was no postoperative complication such as infection or serious bleeding, and there was no tumor recurrence after operation. Conclusion: Endoscopic resection of benign tumor in parapharyngeal space via medial pterygomandibular raphe approach is a safe, effective, and minimally invasive surgical method for the treatment of tumors in parapharyngeal space.

Spicy food consumption and risk of lip, oral cavity and pharynx cancers: a prospective cohort study of Chinese adults / 中华流行病学杂志

Objective: To explore the association of spicy food consumption and risk of lip, oral cavity, and pharynx cancers (LOCPs) in Chinese adults. Methods: Based on the baseline survey and long-term follow-up of the China Kadoorie Biobank (CKB) study, Cox proportional hazard regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for associations between spicy food consumption and LOCPs incidence. Results: Of the 510 145 participants included at baseline, 30.1% reported daily spicy food consumption. During a mean follow-up of 10.8 (2.0) years, we documented 767 LOCPs cases. Multivariate adjusted analyses showed that the risk of LOCPs incidence decreased with the frequency of spicy food intake (trend P=0.003), with HR of 0.69 (95%CI:0.54-0.88) for daily spicy food consumers, compared with never or occasional consumers. Participants who preferred moderate pungency degrees had the lowest risk of LOCPs, with a 33%[0.67(95%CI:0.52-0.87)] reduced risk compared to those who consumed spicy food less than once per week. The later the starting age, the lower the risk (trend P=0.004). Those who started eating spicy food after 18 years old had the lowest risk of LOCPs incidence, with adjusted HR (95%CI) of 0.70(0.54-0.92). Conclusions: Spicy food intake might be associated with a decreased risk of LOCPs incidence. Such association was independent of healthy lifestyles. Advocating moderate-pungency spicy food consumption and healthy lifestyles might help prevent LOCPs.

Transoral robotic surgery for parapharyngeal space neoplasm: a report of 7 cases / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the safety, efficacy and feasibility of transoral robotic surgery (TORS) for parapharyngeal space (PPS) neoplasms. Methods: We collected data from 7 patients with PPS neoplasm who received TORS in Sun Yat-sen University Cancer Center between May 2017 and November 2020, and patients' clinical and pathological characteristics were analysed. There were 2 men and 5 women with age ranged from 35 to 76 years. Among them, 2 patients underwent secondary surgery, 2 patients required combined transcervical approach to complete surgery, and 1 patient was suspected of ipsilateral cervical lymph node metastasis and scheduled for diagnostic TORS. The preoperative tumor size, operation time, intraoperative blood loss, postoperative bleeding, dyspnea, neurological impairment, feeding time and postoperative hospital stay were analyzed. SPSS 24.0 was used to analyze the data. Results: TORS was performed successfully with complete removal of tumors in all 7 cases. Among 6 patients with curative TORS, 5 patients received TORS with postoperative diagnoses of neurogenic tumors and 1 patient underwent TORS combined transcervical approach with postoperative disgnosis of recurrent pleomorphic adenoma; no intraoperative tumor rupture occurred; the intraoperative blood loss was 20-200 ml with a median of 40 ml; the operation time was 65.0-238.0 min with a median of 77.5 min; the oral feeding time was 3-6 days with a median of 3 days; and the postoperative hospital stay was 4.2±1.6 days. One patient presented with neck swelling 3 days after surgery, but this symptom relieved 3 days later after treatments with antibiotic, hemostasis and detumescence. One patient received diagnostic TORS, as intraoperative pathology indicating a recurrent pleomorphic adenoma, then the neoplasm got completely resected through transcervical-transparotid approach. None of 7 patients manifested with airway obstruction, bleeding or nerve injury symptoms after operation. All patients were followed for 2 to 44 months, no local recurrence or distant metastasis was found. Conclusions: TORS is a safe, effective and feasible treatment for selected PPS neoplasms, with less cosmetic impact, less trauma and blood loss, few postoperative complications, enhanced postoperative recovery and short hospital stay.

Adenoma pleomórfico del espacio parafaríngeo: una entidad escondida / Pleomorphic adenoma of the parapharyngeal space: a hidden entity

Resumen Los tumores del espacio parafaríngeo son poco frecuentes. Dentro de ellos, las neoplasias benignas son las más frecuentes, destacando principalmente los adenomas pleomorfos. Estos tumores suelen permanecer asintomáticos hasta alcanzar el tamaño suficiente para producir alteraciones debido al efecto de masa. A pesar de su naturaleza benigna, es necesario realizar resección completa dada su alta tasa de recurrencia y potencial de transformación maligna. Presentamos el caso de un paciente de 52 años que en estudio de vértigo se detecta incidentalmente una masa tumoral del espacio parafaríngeo de 45 mm × 32 mm de diámetro, de etiología incierta. Se realizó una biopsia incisional endoscópica que evidenció un adenoma pleomórfico, que actualmente se encuentra en etapa de evaluación y planificación de escisión completa. En conclusión, dado que los hallazgos clínicos y radiológicos no siempre son suficientes para determinar la naturaleza de las lesiones del espacio parafaríngeo, es importante contar con un diagnóstico histológico. Los avances en las técnicas de cirugía endoscópica sinusal han permitido acceder a esta zona con una mínima morbilidad y estadía hospitalaria. Debido a la posibilidad de transformación maligna los adenomas pleomórficos requieren un manejo activo.

Abstract Tumors of the parapharyngeal space are rare. Benign neoplasms are the most frequent and, among them, pleomorphic adenomas stand out. These tumors are usually asymptomatic until they reach a size large enough to produce symptoms due to mass effect. Despite its benign nature, it is necessary to perform a complete resection given its high recurrence rate and its potential for malignant transformation. We present the case of a 52-year-old man in whom a study of vertigo incidentally detected a mass in the parapharyngeal space measuring 45 mm × 32 mm in diameter, of unknown etiology. An endoscopic incisional biopsy was performed, showing a pleomorphic adenoma, which is currently under assessment to plan complete removal. In conclusion, as clinical and radiological findings are not always sufficient to determine the nature of parapharyngeal space lesions, it is important to obtain a histological diagnosis. Advances in endoscopic sinus surgery techniques have allowed access to this area with minimal morbidity and hospital stay. Due to the possibility of malignant transformation pleomorphic adenomas require active management.

Ultrasonography guided fine needle aspiration cytology in patients with laryngo-hypopharyngeal lesions / Punção aspirativa por agulha fina guiada por ultrassonografia em pacientes com lesões laríngeo-hipofaríngeas

Abstract Introduction: Laryngeal lesions are usually evaluated by microlaryngoscopy/direct laryngoscopy under anaesthesia for disease mapping and tissue diagnosis. However patients with anticipated airway compromise due to laryngeal mass may require either a protective tracheotomy or emergency tracheotomy to secure the airway. To minimise risk of unplanned tracheotomy and expedite the diagnosis we performed ultrasound-guided transcutaneous fine needle aspiration cytology. Objective: To evaluate the feasibility and performance of ultrasound-guided transcutaneous fine needle aspiration cytology of suspicious/recurrent laryngo-hypopharyngeal masses. Methods: Fine needle aspiration cytology was performed under ultrasound guidance. Twenty- four patients were recruited, of which 17 had a pure laryngeal lesion; 6 patients had laryngo-pharyngeal, and one patient had a base tongue lesion with supra-glottis extension. Results: Out of 24 patients, 21 had positive cytology for squamous cell carcinoma, 2 patients had non-diagnostic cytology (atypical cells) and the other had inadequate tissue for definitive diagnosis. Patients with negative and inconclusive cytology underwent direct laryngoscopy biopsy, which was positive for squamous malignancy. All patients tolerated the procedure well and no adverse events were noted. Conclusion: Although direct laryngoscopy remains the standard of care in evaluation of laryngo-hypopharyngeal lesions, this pilot study has shown that ultrasound-guided transcutaneous fine needle aspiration cytology was feasible as an out-patient procedure, employing safe and sensitive technique enabling rapid diagnosis and avoiding the need for direct laryngoscopy under GA for tissue diagnosis.

Resumo Introdução: As lesões laríngeas são geralmente avaliadas por microlaringoscopia/laringoscopia direta sob anestesia para mapeamento da doença e diagnóstico tecidual. No entanto, em pacientes com comprometimento prévio das vias aéreas devido à lesão laríngea, pode ser necessária uma traqueostomia protetora ou traqueostomia de emergência para assegurar as vias aéreas. Para minimizar o risco de uma traqueostomia não planejada e facilitar o diagnóstico, realizamos punção aspirativa por agulha fina guiada por ultrassonografia transcutânea. Objetivo: Avaliar a viabilidade e o desempenho da punção aspirativa por agulha fina guiada por ultrassonografia transcutânea em lesões laríngeo-hipofaríngeas suspeitas/recorrentes. Método: A punção aspirativa por agulha fina foi realizada sob orientação ultrassonográfica. Foram recrutados 24 pacientes, 17 com lesão laríngea apenas, 6 com lesão laríngeo-faríngea e um com lesão na base da língua com extensão supraglótica. Resultados: Dos 24 pacientes, 21 apresentaram citologia positiva para carcinoma espinocelular, 2 citologia não diagnóstica (células atípicas) e o outro tecido inadequado para o diagnóstico definitivo. Os pacientes com citologia negativa e inconclusiva foram submetidos à biópsia através de laringoscopia direta, que foi positiva para lesão maligna espinocelular. Todos os pacientes toleraram bem o procedimento e nenhum evento adverso foi observado. Conclusão: Embora a laringoscopia direta continue a ser o padrão de cuidado na avaliação das lesões laríngeo-hipofaríngeas, este estudo piloto demonstrou que a punção aspirativa por agulha fina guiada por ultrassonografia transcutânea é uma técnica viável, ambulatorial, segura e sensível, permite rápido diagnóstico e evita a necessidade de laringoscopia direta sob anestesia geral para diagnóstico tecidual.

Beta-adrenergic pathway activation in head and neck cancer: a comprehensive analysis of the clinical and genomic features using integrated bioinformatics / Ativação da via beta-adrenérgica no câncer de cabeça e pescoço: uma análise abrangente das características clínicas e gênomicas utilizando a bioinformática

O estresse crônico leva à ativação da via de sinalização beta-adrenérgica. Sua ativação tem sido implicada na progressão de diferentes tipos de câncer, mas seu papel nos carcinomas espinocelulares de cabeça e pescoço (CECPs) permanece indefinido. O objetivo deste estudo foi investigar o papel da ativação da via betaadrenérgica na progressão dos CECPs, avaliar seu impacto na sobrevida dos pacientes e buscar possíveis terapias para pacientes que encontravam-se com a via beta-adrenérgica ativa. Quinhentos e vinte pacientes do The Cancer Genome Atlas com CECPs primários foram divididos em dois grupos: ADRB2baixa / SLC6A2baixa e ADRB2alta / SLC6A2alta. A associação de características clinicopatológicas e genômicas entre os grupos foram analisadas utilizando bioinformática. Os genes diferencialmente expressos (DEGs) foram identificados através da análise da expressão diferencial. A análise de sobrevida também foi realizada com base nas expressões ADRB2 e SLC6A2. Foram identificados medicamentos em potencial para tratamento de CECPs com base nos DEGs. Houve associação entre as expressões ADRB2 e SLC6A2 com idade, raça, localização do tumor, grau histológico, invasão perineural e status do HPV p16. Foram identificados 898 DEGs entre os grupos. Foi demonstrado que a expressão ADRB2alta / SLC6A2alta influenciou a proliferação, adesão e invasão de células CECPs além da angiogênese. Pacientes com carcinomas espinocelular de laringe e faringe apresentando expressão ADRB2alta / SLC6A2alta tiveram menor sobrevida. Por fim, 56 drogas antineoplásicas e imunoterápicas aprovadas pelo Food Drugs Administration foram identificadas como potenciais alvos para o tratamento personalizado. Significância: Estes achados sugerem fortemente um papel proeminente da sinalização beta-adrenérgica no CECPs ao estimular um fenótipo tumoral mais agressivo. Estas alterações tiveram um impacto negativo no prognóstico dos pacientes com CECP em região de faringe e laringe(AU)

Chronic stress leads to the activation of the beta-adrenergic pathway. Its activation has been implicated in the progression of different types of cancer but its role on head and neck squamous cell carcinomas (HNSCCs) remains undefined. The aim of this study was to investigate the influence of the beta-adrenergic pathway activation in the progression of HNSCCs, assess its impact in the survival of the patients, and explore the potential targets. Five hundred and twenty The Cancer Genome Altas patients with primary HNSCCs were divided in two groups: ADRB2low / SLC6A2low and ADRB2high / SLC6A2high. The association of clinicopathological and genomic features between the groups was analyzed using a bioinformatic approach. Differentially expressed genes (DEGs) were identified through differential expression analysis. Survival analysis was also performed based on ADRB2 and SLC6A2 expressions. Potential drugs for treatment of HNSCC were identified based on the DEGs. There was association between ADRB2 and SLC6A2 expressions with age, race, tumor site, histologic grade, perineural invasion, and HPV p16 status. It was identified 898 DEGs between the groups. It was demonstrated that ADRB2high / SLC6A2high expression influenced HNSCC cells proliferation, adhesion, invasion, and angiogenesis. Patients with larynx and pharynx squamous cell carcinomas presenting ADRB2high / SLC6A2high expression showed had lower survival rates. Finally, 56 Food Drugs Administration-approved antineoplastic and immunotherapeutic drugs were identified as potential targets for the personalized treatment. Significance: These findings strongly suggest a prominent role of beta-adrenergic pathway in HNSCC by stimulating a more aggressive tumoral phenotype. These alterations were shown to negatively impact the prognosis of patients with larynx and pharynx squamous cell carcinomas(AU)

Hospitalização para casos de câncer de boca e faringe no Brasil e Mundo / Hospitalization for cases of oral and pharyngeal cancer in Brazil and World

Objetivo: Avaliar a internação hospitalar por câncer de boca e faringe no Brasil no período de 2008 a 2017. Métodos: Estudo das internações por estas neoplasias registradas no Sistema de Informação Hospitalar disponíveis no DATASUS/MS entre 2008 e 2017. Resultados: Foram registradas 263.556 mil internações por câncer de boca e faringe. O Sudeste apresentou a maior frequência de casos (44,3%). A maior taxa de internação ocorreu no Sul (19,6/100 mil habitantes). As maiores taxas de letalidade encontradas foram no Norte (12,7%) e Sudeste (12,3%). Houve um predomínio de internações em regime privado (53,5%) e em caráter de urgência no Brasil (53,5%). A média de permanência hospitalar foi de 6,4 dias. A taxa de letalidade em caráter de urgência foi maior do que em caráter eletivo. A taxa de internação apresentou tendência decrescente e a taxa de letalidade hospitalar, tendência de incremento de 0,2% a cada ano. A análise de índice de desenvolvimento humano médio e taxa de internação mostrou correlação moderada positiva entre essas variáveis e as regiões do país. Houve maior custo médio em reais por internação hospitalar em caráter eletivo e a região Centro-Oeste obteve maior média de custo financeiro (por guia autorizada) nesta modalidade. Conclusão: Observa-se um elevado número de internações por estes tipos de câncer no Brasil, além de um acentuado custo e alta média de permanência hospitalar, sendo variável entre as regiões do país.

Aim: To analyze hospital admission for oral and pharyngeal cancer in Brazil and regions from 2008 to 2017. Methods: This study analyzed the hospitalizations for this neoplasm registered in the Hospital Information System available in DATASUS/MS between 2008 and 2017. Results: A total of 263,556 hospitalizations were registered. The Southeast presented the highest frequency of cases (44.3%). The highest hospitalization rate occurred in the South (19.6/100 thousand). The highest rates of lethality were found in the North (12.7%) and Southeast (12.3%). There was a predominance of hospitalizations in the private care (53.5%) and emergency care (53.5%) sectors in Brazil. The mean hospital stay was 6.4 days. The case fatality rate was higher than the elective rate. The hospitalization rate declined, and the hospital lethality rate showed a tendency toward an increase of 0.2% per year. The correlation analysis of the average human development index and the hospitalization rates were moderately positive between the variables and the regions of the country. There was a higher average cost in reais for hospital admission on an elective basis, and the Mid-West region obtained a higher average financial cost (per authorized guide) in this modality. Conclusion: It was possible to verify a high number of hospitalizations for these types of cancer in Brazil, in addition to a high cost and average hospital stay, which tend to vary throughout the country.

Resultados funcionales de pacientes tratados con faringolaringectomía y reconstrucción faríngea con colgajo pediculado / Functional Outcomes using pedicle flap reconstruction approach after pharyngolaryngectomy in laryngeal carcinoma patients

INTRODUCCIÓN: La laringectomía total es el tratamiento de elección del cáncer de laringe avanzado, requiriendo en ocasiones asociar una resección parcial o total de la faringe para su manejo. El defecto faríngeo, puede repararse con colgajos libres o pediculados, teniendo estos últimos la ventaja de ser simples, confiables y resistentes a la radioterapia. OBJETIVO: Presentar los resultados funcionales de una serie de pacientes tratados con faringolaringectomía y reconstrucción faríngea con colgajo pediculado. MATERIAL Y MÉTODO: Se revisaron registros de pacientes con laringectomía total más faringectomía parcial y reconstrucción con colgajo pediculado en el Hospital Regional de Talca entre 2009 y 2017, encontrando 6 casos de los cuales 4 se encontraron vivos al momento de iniciar el estudio. Se realizó videofluoroscopía para evaluar deglución, presencia de estenosis y/o fístulas, además, de evaluación nutricional y encuesta de calidad de vida. RESULTADOS: En el estudio de la deglución por fluoroscopía, todos los pacientes presentaron escasa retención del material de contraste en la hipofaringe y esófago cervical, lo cual está en relación con cambios morfológicos posquirúrgicos, sin afectar significativamente el mecanismo deglutorio. Todos los pacientes se encontraron eutróficos en su evaluación nutricional y sin evidencias de alteración de su calidad de vida secundaria a la deglución. CONCLUSIONES: La reconstrucción faríngea parcial con colgajo pediculado en pacientes con laringectomías totales asociadas a faringectomía parcial permite una deglución adecuada y sin disfagia, con un estado nutricional eutrófico.

INTRODUCTION: Total laryngectomy is the treatment of choice for advanced laryngeal cancer and after radiotherapy failure. In patients with pharyngeal invasion, it is associated with total or partial pharyngectomy, wich defect can be repaired with free or pedicle flaps. AIM: To present a brief series of pedicle flap reconstruction approach after pharyngolaryngectomy in laryngeal carcinoma patients and functional outcomes MATERIALS AND METHOD: We looked at laryngeal cancer patient records who were treated with total laryngectomy with partial pharyngectomy and pharyngeal reconstruction with pedicle flap at "Hospital Regional de Talca" between the years 2009 and 2017, finding 6 cases, 4 of which were alive at the beginning of the study. We analized videoflourocopy swallow studies to assess mechanisms of deglutition, and presence of stenosis or fistulas. We also performed a nutritional state assessment and a quality of life questionnaire. RESULTS: During videodeglutition study, the 4 patients showed minimal contrast swallow delay at hypopharynx and cervical esophagus. All the patients were found eutrophic in their nutritional assessment and with no significant evidence of quality of life disturbances secondary to deglutition state. CONCLUSIONS: Partial pharyngeal reconstruction using pedicle flaps in patients who underwent total laryngectomy with partial pharyngectomy allows to maintain an adequate deglutition without dysphagia, as well as a good nutritional state.

Potential years of life lost due to oropharyngeal cancer in Brazil: 1979 to 2013 / Anos potenciais de vida perdidos por câncer de boca e faringe no Brasil: 1979 a 2013

ABSTRACT OBJECTIVE To estimate the years of life lost by the Brazilian population due to mouth and pharynx cancer from 1979 to 2013, and analyze the temporal trends in the studied period, according to the country's region, sex and anatomical site. METHODS The death records were obtained from the Mortality Information System and the data referring to the population, from the censuses of the Brazilian Institute of Geography and Statistics of 1980, 1991, 2000, 2010, and from intercensal estimates for the other years. The rates of potential years of life lost were calculated by applying the method suggested by Romeder and McWhinnie, and their trends were calculated using the Prais-Winsten method with first-order autocorrelation. The historical series were smoothed with the centered moving average technique of third order for white noise reduction. RESULTS In the period from 1979 to 2013 in Brazil, there were a total of 107,506 premature deaths due to mouth and pharynx cancer, which generated a total of 1,589,501 potential years of life lost, the equivalent to a rate of 3.6 per 10,000 inhabitants. Males, whose rate was six times higher than for females, contributed with 85% of the years lost. The trends in the rates of years of life lost showed an annual 0.72% increase for men, 1.13% for women and 1.05% for pharynx cancer. CONCLUSIONS The rate of potential years of life lost due to mouth and pharynx cancer in the country showed an upward trend within the studied period for both sexes, as well as for pharynx cancer and for the North, Northeast and Midwest regions.

RESUMO OBJETIVO Estimar os anos de vida perdidos pela população brasileira devido ao câncer de boca e faringe de 1979 a 2013 e analisar a tendências temporais no período estudado, segundo região do país, sexo e sítio anatômico. MÉTODOS Os registros de óbitos foram obtidos do Sistema de Informações sobre Mortalidade e os dados referentes à população, dos censos do Instituto Brasileiro de Geografia e Estatística de 1980, 1991, 2000, 2010 e de estimativas intercensitárias para os demais anos. Foram calculadas as taxas de anos de vida potencialmente perdidos aplicando o método sugerido por Romeder e McWhinnie, e suas tendências foram calculadas usando o método de Prais-Winsten com correção para autocorrelação de primeira ordem. As séries históricas foram alisadas com técnica de média móvel central de ordem 3 para redução de ruído branco. RESULTADOS No período de 1979 a 2013 no Brasil, houve um total de 107.506 mortes prematuras devido ao câncer de boca e faringe, o que gerou um total de 1.589.501 anos potenciais de vida perdidos, equivalendo a uma taxa de 3,6 por 10.000 habitantes. O sexo masculino, com uma taxa seis vezes maior que a do sexo feminino, contribuiu com 85% dos anos perdidos. As tendências das taxas de anos de vida perdidos mostraram aumento anual de 0,72% nos homens, 1,13% nas mulheres e 1,05% para o câncer de faringe. CONCLUSÕES A taxa de anos potenciais de vida perdidos por câncer de boca e faringe no país mostrou tendência de aumento dentro do período estudado em ambos os sexos, assim como para o câncer de faringe e para as regiões Norte, Nordeste e Centro-Oeste.

Plenitud ótica como primer síntoma en patología del espacio parafaríngeo / Otic fullness as a first symptom in parapharyngeal space pathology

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.

Potential Years of Lost Life of the Lip, Oral Cavity and Pharynx Neoplasms in Slovak Population - 2010-2015

Objective: To analyse Potential Years of Life Lost (PYLL) rates trends of lip, oral cavity and pharynx neoplasms in the Slovak population by age and gender. Material and Methods: The study analyses PYLL rates (age-standardized) of lip, oral cavity and pharynx neoplasms (C00-C14) per 100,000 in the period of six years (2010-2015). The study sample was divided into two age sub-categories (all ages: 0-69y. and working group: 20-69y.) National mortality data (C00-C14) (3,138 mortality causes) were analysed from the Statistical Office of the Slovak Republic. Results: The highest PYLL rate was found in sub-category 20-69 years in males (378 per 100,000) in 2012 and in females (64 per 100,000) in 2013. The highest PYLL rate was observed in sub-category all age groups in males (296 per 100,000) in 2012 and in females (50 per 100,000) in 2013. The PYLL rates of lip, oral cavity and pharynx neoplasms had in the period 2011- 2015 upward trend in both sexes, however, in the 2014 was found the opposite trend. In 2015 the highest PYLL rates (non-standardized) in both sexes was found in age subcategory 55-59y. Conclusion: Our study should contribute to the development of oral cancer intervention programs.

Condroma del espacio parafaríngeo, reporte de un caso / Chondroma of the parapharyngeal space, report of one case

Introducción. El condroma es una neoplasia benigna de origen mesenquimal y de etiología desconocida, muy infrecuente en los tejidos blandos debido a su constitución de células de cartílago maduro sin hueso; sin embargo, son frecuentes las calcificaciones focales. Al presentarse en cabeza y cuello, suele hacerlo en el maxilar o el paladar duro, y son pocos los reportes de este tumor en el espacio parafaríngeo. Se reporta el caso de una paciente de 68 años de edad, que acudió a consulta por dolor en el paladar blando, cefalea y dolor paratiroideo izquierdo asociado a disfagia de cuatro años de evolución. Se practicaron los estudios pertinentes y, finalmente, se confirmó el diagnóstico de condroma mediante biopsia. Discusión. Los condromas muy rara vez se encuentran en los tejidos blandos, por lo cual se sugiere que el diagnóstico sea cuidadosamente orientado para descartar una posible malignidad de la lesión y que los controles posquirúrgicos sean frecuentes

Introduction: Chondroma is a benign neoplasm of mesenchymal origin and of unknown etiology, very infrequently appearing in the soft tissues due to its constitution of mature cartilage cells without bone; however, they usually present focal calcifications. When occurring in the head and neck, they usually appear in the jaw or hard palate. Just a few cases of this pathology are reported in the pharynx. Materials and Methods: We present a case of a female 68 years old, who came to the clinic due to pain in the soft palate, headache and left parathyroid pain associated with dysphagia, of four years of evolution. Corresponding studies were carried out and finally the diagnosis of chondroma was confirmed by biopsy. Discusion: Chondromas are rarely found in the soft tissues, suggesting that the diagnosis should be carefully oriented to rule out possible malignancy of the lesion and that post-surgical controls should be frequent

Trend of oral and pharyngeal cancer mortality in Brazil in the period of 2002 to 2013 / Tendência de mortalidade por câncer de boca e faringe no Brasil no período 2002-2013

ABSTRACT OBJECTIVE To analyze the trend of oral and pharyngeal cancer mortality rates in the period of 2002 to 2013 in Brazil according to sex, anatomical site, and macroregion of the country. METHODS The mortality data were obtained from the Mortality Information System and the population data were obtained from the Brazilian Institute of Geography and Statistics. The trend of the rates standardized by sex and age was calculated using the Prais-Winsten estimation, and we obtained the annual percentage change and the respective 95% confidence intervals, analyzed according to sex, macroregion, and anatomical site. RESULTS The average coefficient of oral cancer mortality was 1.87 per 100,000 inhabitants and it remained stable during the study period. The coefficient of pharyngeal cancer mortality was 2.04 per 100,000 inhabitants and it presented an annual percentage change of -2.6%. Approximately eight in every 10 deaths occurred among men. There was an increase in the rates of oral cancer in the Northeast region (annual percentage change of 6.9%) and a decrease in the Southeast region (annual percentage change of -2.9%). Pharyngeal cancer mortality decreased in the Southeast and South regions with annual percentage change of -4.8% and -5.1% respectively. Cancer mortality for tonsil, other major salivary glands, hypopharynx, and other and unspecified parts of mouth and pharynx showed a decreasing trend while the other sites presented stability. CONCLUSIONS Pharyngeal cancer mortality decreased in the period of 2002 to 2013. Oral cancer increased only in the Northeast region. Mortality for tonsil cancer, other major salivary glands, hypopharynx, and other and ill-defined sites in the lip, oral cavity, and pharynx decreased.

RESUMO OBJETIVO Analisar a tendência das taxas de mortalidade por câncer de boca e de faringe no período de 2002-2013 no Brasil segundo sexo, sítio anatômico e macrorregião do país. MÉTODOS Os dados sobre mortalidade foram obtidos junto ao Sistema de Informações sobre Mortalidade e os dados das populações foram obtidos junto ao Instituto Brasileiro de Geografia e Estatística. A tendência das taxas padronizadas por sexo e faixa etária foi calculada por regressão de Prais-Winstein, obtendo a sua variação percentual anual e os respectivos intervalos de confiança de 95%, analisados segundo sexo, macrorregião e sítio anatômico. RESULTADOS O coeficiente médio de mortalidade por câncer de boca foi de 1,87/100.000 habitantes e permaneceu estável durante o período estudado. O coeficiente de mortalidade por câncer de faringe foi de 2,04/100.000 habitantes e apresentou variação percentual anual de -2,6%. Aproximadamente oito em cada 10 óbitos ocorreram entre homens. Observou-se aumento nas taxas por câncer de boca na região Nordeste (variação percentual anual de 6,9%) e diminuição na região Sudeste (variação percentual anual -2,9%). Mortalidade por câncer de faringe diminuiu nas regiões Sudeste e Sul com variação percentual anual de -4,8% e -5,1% respectivamente. Mortalidade por câncer de amígdala, outras glândulas salivares maiores, hipofaringe e outras partes não especificas de boca e faringe, apresentaram tendência de declínio enquanto os demais sítios apresentaram estabilidade. CONCLUSÕES A mortalidade por câncer de faringe apresentou diminuição no período 2002-2013. O câncer de boca apresentou aumento só na região Nordeste. Mortalidade por câncer de amígdala, outras glândulas maiores, hipofaringe e outras localizações mal definidas de lábio, cavidade oral e faringe mostraram declínio.

Retrospective analysis of 188 cases of parapharyngeal space tumors / 临床耳鼻咽喉头颈外科杂志

To explore the diagnosis,treatment,surgical approach and prognosis of parapharyngeal space tumors.The clinical data of 188 patients with parapharyngeal space tumor who were treated from January 2007 to December 2016 were analyzed retrospectively.All patients underwent imaging examination before operation.Surgical approach was as follows:transcervical approach applied in 159 cases,endoscopic-assisted transnasal approach in 9 cases,transcervical-transmandibular approach in 8 cases,transcervical-transparotid approach in 8 cases,transoral approach in 7 cases,and infratemporal fossa approach in 4 case.Of the 188 cases,the tumor was benign in nature in 168 cases(89%)and malignant in 20 cases(11%).Complications occurred in 28(15%)patients,with the most common symptom being hoarseness.168 cases of benign tumors were followed up for 10 months to 10 years,and 3 cases were lost and 4 cases had recurrence.All cases underwent re-operation.Patients with malignant tumors received combined treatment after surgery,and 3 cases were lost to follow-up,1 case died of recurrence 9 months after surgery,the rest survived.Surgery is the preferred method for treating parapharyngeal space tumors and postoperative recurrence rate is pretty low.Endoscopy provides a new surgical management method,helping to reduce postoperative complications and recurrence rate.

Health-related quality of life of patients with squamous cell carcinoma: a comparison according to tumor location

Abstract: The aim of this study was to evaluate the health-related quality of life (QOL) of patients with squamous cell carcinoma (SCC) according to tumor location. The sample consisted of 27 patients with primary SCC in the oral cavity (n = 15), pharynx (n = 7), and larynx (n = 5) who were undergoing cancer treatment at the Cancer Hospital of Londrina, regardless of age, sex, clinical stage, and type of antineoplastic treatment. Health-related QOL was evaluated using the 30-item Cancer-Quality of Life Questionnaire (QLQ-C30), the 35-item Head and Neck Cancer-Quality of Life Questionnaire (QLQ-HN35), and the University of Washington Quality of Life Questionnaire (UW-QOL). These questionnaires were administered individually to each patient before ambulatory care. Sociodemographic data (age and sex) and clinical data (T stage, tumor location, and type of antineoplastic treatment) were collected from the patients' medical records. Scores were compared according to tumor location using the chi-squared test and one-way analysis of variance (p < 0.05). No score differed significantly according to tumor location. It can be concluded that the health-related QOL of patients with SCC was not influenced by tumor location.

Actinomicosis amigdalina imitando una recaída de un linfoma no Hodgkin / Tonsillar actinomycosis mimicking relapse of diffuse large B-cell non-Hodgkin lymphoma

La actinomicosis es una infección poco frecuente, lentamente progresiva y de difícil diagnóstico. Se presenta el caso clínico de una mujer de 63 años en remisión total de un linfoma no Hodgkin difuso de células B grandes de amígdala. Durante su seguimiento se observó un ligero aumento de la lactato deshidrogenasa (LDH). Por la posibilidad de una recaída de su linfoma se realizó una tomografía por emisión de positrones (TEP-TC) que detectó mayor densidad y actividad en la orofaringe izquierda. Se realizó la extirpación de la lesión, cuyo diagnóstico histopatológico fue de una actinomicosis amigdalina. El género Actinomyces es comensal de la orofaringe y de la vía respiratoria y digestiva. La forma cérvico-facial es la más frecuente. La extirpación quirúrgica es a menudo esencial para un diagnóstico definitivo. Es importante incluir esta enfermedad en el diagnóstico diferencial de las lesiones tumorales de la región cérvico-facial.

Single transverse extended incision for radical neck dissection / Esvaziamento cervical radical por incisão transversa única estendida

ABSTRACT Objective: to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. Method: we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden. There were 29 neck dissections, eight bilateral and 10 unilateral (26 radical and three selective). Staging revealed nine patients with T4 tumor, one T3, six T2, one T1 and one Tx. Five patients were N0, nine N2b, one N2c and three N3. The average number of dissected lymph nodes was 34.25. We performed the neck dissection through a single incision located in the middle neck, coincident with the skinfold, with a length of about 2 to 3 cm behind the anterior edge of the trapezius muscle and 3 to 4 cm from the midline for the unilateral neck dissections. Results: as complications, there were myocutaneous flap necrosis in one patient with prior radiation therapy, one lymphatic fistula, one dehiscence of the tracheostomy, one cervical abscess, one salivary fistula and one suture dehiscence. Conclusions: the single extended incision provides adequate exposure of the neck structures, without compromising surgical time, even in bilateral dissections. It does not compromise the resection of all cervical lymph nodes; it has excellent aesthetic and functional results and is easily associated with other approaches to resection of the primary tumor.

RESUMO Objetivo: verificar a eficácia da incisão cervical única, transversa e estendida, para o esvaziamento cervical radical. Método: estudo prospectivo, de janeiro de 2008 a janeiro de 2009, de 18 pacientes submetidos a tratamento cirúrgico de tumores malignos da via aero-digestiva superior. A lesão primária se situava na cavidade oral em oito casos, na orofaringe em três, no seio piriforme em três, na laringe em dois, no seio maxilar em um e em um caso a lesão primária era oculta. Houve 29 esvaziamentos, sendo oito bilaterais e 10 unilaterais (26 radicais e três seletivos). O estadiamento revelou nove pacientes com tumor T4, um T3, seis T2, um T1 e um Tx. Cinco pacientes eram N0, nove N2b, um N2c e três N3. A média de linfonodos dissecados foi de 34,25. O esvaziamento cervical foi realizado por meio de uma única incisão localizada no terço médio do pescoço, coincidente com dobra cutânea, com extensão de cerca de 2 a 3 cm para trás da borda anterior do músculo trapézio e 3 a 4 cm da linha média para os esvaziamentos cervicais unilaterais. Resultados: como complicações houve necrose de retalho miocutâneo em um paciente com radioterapia prévia, uma fistula linfática, uma deiscência do traqueostoma, um abscesso cervical, uma fístula salivar e uma deiscência de sutura. Conclusões: a incisão única e estendida proporciona exposição adequada das estruturas do pescoço, sem comprometer o tempo cirúrgico, mesmo em esvaziamentos bilaterais. Não compromete a ressecção de todos os linfonodos cervicais, apresenta excelentes resultados estéticos e funcionais e é facilmente associada com outras abordagens para ressecção do tumor primário.

Resección transoral-transnasal de tumores del espacio parafaríngeo / Transoral-transnasal approach to parapharyngeal space tumors

Objetivos: Determinar la tasa de resección quirúrgica completa en tumores seleccionados del Espacio parafaríngeo tratados por vía transoral o transnasal o por ambas. Diseño: descriptivo, retrospectivo. Materiales y métodos: Se incluyeron en este estudio los pacientes que tuvieron neoplasias localizadas en el espacio parafaríngeo y que fueron tratados con cirugía por vía transoral o transnasal. El abordaje transoral consistió en realizar una incisión con cauterio en la zona de mayor protrusión del tumor (pilar amigdalino y paladar), disección de la mucosa y del tumor de los planos profundos, traccionándolo hacia la cavidad oral. Para disecar el límite superior (rinofaringe) y lateral se utilizaron endoscopios que fueron introducidos por la incisión y por la cavidad nasal. El abordaje transnasal consistió en realizar una incisión en la pared lateral de la rinofaringe y disecar el tumor del plano profundo traccionándolo hacia el cavum. Resultados: Fueron tratados 3 pacientes por vía transoral y uno por vía endonasal por padecer tumores del espacio parafaríngeo. Tres tumores se originaron en glándulas salivales menores localizadas una en el espacio. Preestiloideo (1/3), otra en el espacio masticador (1/3) y otra en el sector superior del espacio preestiloideo (1/3). La histología dio como resultado dos adenoma pleomorfo y un carcinoma mucoepidermoide de bajo grado (1/3). (Está bien así? Qué es 1/3?). Una neoplasia se originó en el lóbulo profundo de la parótida y se extendió al espacio preestiloideo, su histología fue carcinoma mucoepidermoide de grado moderado. Conclusiones: La tasa de resección completa en pacientes con tumores del espacio parafaríngeo seleccionados tratados por vía transoral y endonasal fue del 100%. (AU)

Objectives: To determine the rate of complete surgical resection in parapharyngeal space selected tumors treated with transoral and / or transnasal approach. Design: Descriptive, retrospective. Materials and methods: Patients who had tumors localized in parapharyngealspace and who were treated with transoral or transnasal surgery. were included in this study. The transoral approach consisted in performing an incision with cautery in the area of greates tumor protrusion (tonsillar pillar and palate), dissection of the mucosa and tumor of the deep planes, pulling it into the oral cavity. To dissect the upper limit (nasopharynx) and lateral we used endoscopes that were inserted by the incision and the nasal cavity. The transnasal approach consisted in making an incision in the side wall of the nasopharynx and dissect the tumor of the deep plane pulling it towards the cavum. Results: Three patients were treated with transoral and one byendonasalapproacheswho had parapharyngeal space tumors. Three tumors originated in minor salivary glands located in prestyloidspace (1/3), masticator space (1/3) and upper sector of pree-styloid space (1/3). Histology was in two pleomorphic adenoma, and another onelow degree mucoepidermoid carcinoma (1/3). A neoplasm was originated in the deep lobe of the parotid gland and was extended to the prestyloid space, was a moderate degree of mucoepidermoid carcinoma. Conclusions: Complete resection rate in patients with selected parapharyngeal space tumors, treated by transorally and endonasal approach was 100%. (AU)

Short-term complications in reconstruction of the postoperative defects with free jejunum graft in patients with pharyngeal, laryngeal or cervical esophageal cancers / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To explore the clinical effects and short-term complications of using free jejunum graft (FJG) to reconstruct the defects by resections of pharyngeal, laryngeal or cervical esophageal cancers.@*METHOD@#Fifty-eight cases of pharyngeal, laryngeal or cervical esophageal cancers were reconstructed with FJG. All cases were analyzed retrospectively.@*RESULT@#The success rate of FJG transplantations was 91.4% (53/58). The incidence of post-operative short-term complication was 43.1% (25/58), which was not related to age or BMI. The most common complication was anastomotic leakage (18.9%), which was not related to per-operative radiation therapy. However, BMI > 25 cases had significantly higher incidence of anastomotic leakage than BMI ≤ 25 cases (P = 0.009). The second and third most common complications were respiratory system complications (10. 3%) and FJG necrosis (8. 6%). Para-operative death rate was 3.4% (2/58). Two-year overall survival rates of hypopharyngeal cancer and cervical esophageal cancer were 49% and 67% respectively. The group with no short-term complications had a slightly better survival rate than the group with short-term complications from the Kaplan-Meier curve, but there was no significant difference (P = 0.103).@*CONCLUSION@#FJG is ideal to reconstruct cervical digestive tract circumferential defects with a high success rate and a low mortality. However, the post-operative complication rate is high. Intensive observation, early detection and timely treatment of complications are crucial.