[Partial pharyngolaryngectomies for treatment of pharyngolaryngeal cancer]. / Faringo-laringectomías parciales para el tratamiento del cáncer faringolaríngeo.

BACKGROUND: We undertook this study to evaluate the results obtained with conservation therapy of the larynx in patients with laryngopharyngeal epidermoid carcinoma. METHODS: Patients with stages I and II epidermoid cancer of the larynx and pharynx were included. All patients were evaluated endoscopically, functionally, and with cervical tomography. Results of the procedures were evaluated on the basis of oncological control and laryngeal function (voice, swallowing and ventilation). RESULTS: There were 41 male patients with a median age of 55 years. In 32 patients, surgery was the initial treatment and in nine patients as rescue treatment after radiotherapy. In 58.5% the location was glottic, in 22% supraglottic, in 12% glotto-supraglottic and in 7% vallecular and hypopharynx. Subtotal laryngectomy was performed with cricohyoidepiglottopexy in 18 patients, frontolateral in 11, supraglottic in 5, subglottic-epiglottectomy in 3, hemipharyngolaryngectomy in 3, and in one hemiglottectomy. The time until decannulation and removal of nasogastric catheter depended on the type of surgery. One patient (2%) had to be subjected to a rescue laryngectomy due to constant aspiration. This patient demonstrated residual tumor in the sample. Nine patients had some type of complication, the most frequent being wound infection (7.3%). One patient died postoperatively due to sepsis (2.4%), and another patient died due to systemic causes 4 months after the intervention. Median follow-up time is 25 months and no patient has presented tumor recurrence. CONCLUSIONS: Voice conservation surgery is an alternative to mutilation of the larynx in patients with locally advanced neoplasms of the larynx with a high risk of recurrence if treated with radiotherapy.

Faringo-laringectomías parciales para el tratamiento del cáncer faringolaríngeo / Partial pharyngolaryngectomies for treatment of pharyngolaryngeal cancer

BACKGROUND: We undertook this study to evaluate the results obtained with conservation therapy of the larynx in patients with laryngopharyngeal epidermoid carcinoma. METHODS: Patients with stages I and II epidermoid cancer of the larynx and pharynx were included. All patients were evaluated endoscopically, functionally, and with cervical tomography. Results of the procedures were evaluated on the basis of oncological control and laryngeal function (voice, swallowing and ventilation). RESULTS: There were 41 male patients with a median age of 55 years. In 32 patients, surgery was the initial treatment and in nine patients as rescue treatment after radiotherapy. In 58.5% the location was glottic, in 22% supraglottic, in 12% glotto-supraglottic and in 7% vallecular and hypopharynx. Subtotal laryngectomy was performed with cricohyoidepiglottopexy in 18 patients, frontolateral in 11, supraglottic in 5, subglottic-epiglottectomy in 3, hemipharyngolaryngectomy in 3, and in one hemiglottectomy. The time until decannulation and removal of nasogastric catheter depended on the type of surgery. One patient (2%) had to be subjected to a rescue laryngectomy due to constant aspiration. This patient demonstrated residual tumor in the sample. Nine patients had some type of complication, the most frequent being wound infection (7.3%). One patient died postoperatively due to sepsis (2.4%), and another patient died due to systemic causes 4 months after the intervention. Median follow-up time is 25 months and no patient has presented tumor recurrence. CONCLUSIONS: Voice conservation surgery is an alternative to mutilation of the larynx in patients with locally advanced neoplasms of the larynx with a high risk of recurrence if treated with radiotherapy.

Múltiples tumores pardos maxilofaciales como manifestación de hiperparatiroidismo primario / Multiple maxillofacial brown tumors as primary hyperparathyroidism manifestation

Objetivo: Con el fin de analizar el diagnóstico diferencial de las lesiones óseas con células gigantes en los huesos faciales, presentamos un caso con hiperparatiroidismo primario no diagnosticado previamente, que presentó múltiples tumores pardos maxilofaciales como primera manifestación clínica de la enfermedad. Caso clínico: Mujer de 70 años de edad con tumor en el arco anterior de la mandíbula de un año de evolución. Una biopsia confirmó la presencia de una lesión con células gigantes. Radiológicamente se corroboró la presencia de otras dos lesiones líticas en la región maxilofacial. Durante la evaluación bioquímica previa a la cirugía se consideró la posibilidad de hiperparatiroidismo. Por tomografía computarizada se localizó tumor de paratiroides en una posición atípica. La resección quirúrgica confirmó adenoma de paratiroides. La paciente cursó con hipocalcemia sintomática, siendo manejada con suplementos de calcio y calcitriol. Al cuarto mes de la cirugía, persistía con cifras normales de calcio sérico y el tumor mandibular se había reducido parcialmente. Conclusiones: La detección de una lesión ósea con células gigantes en la región maxilofacial es un elemento diagnóstico primordial puesto que varias entidades, entre ellas el tumor pardo del hiperparatiroidismo, pueden tener una imagen histológica similar. Sólo una evaluación clínica, radiológica y bioquímica sistemática puede permitir un diagnóstico definitivo. La presencia de múltiples tumores pardos maxilofaciales simultáneos en el hiperparatiroidismo primario es poco común, y en raras ocasiones puede ser el primer signo de la enfermedad.

OBJECTIVE: In order to analyze the differential diagnosis of giant-cell lesion in facial bones, we present a case of a patient without a previously diagnosed primary hyperparathyroidism that displayed multiple maxillofacial brown tumors as the initial clinical manifestation of the disease. CASE DESCRIPTION: A 70 year-old female with amandible tumor and one year of disease progression. Tumor biopsy confirmed the presence of a giant-cell lesion. Radiologically, we confirmed the presence of another two lytic lesions in the maxillofacial region. During biochemical evaluation prior to surgery, the possibility of hyperparathyroidism was considered. Using computed tomography, we noted a parathyroid tumor in an atypical location. Surgical resection confirmed the presence of an adenoma. Postoperatively, the patient developed symptomatic hypocalcemia and was managed with calcium supplementation in addition to calcitriol. At 4 months after surgery mandibular swelling had regressed partially and serum calcium levels returned to normal levels. CONCLUSION: The detection of giant-cell bone lesions in the maxillofacial region is a strategic diagnostic finding as several entities, among these brown tumor hyperparathyroidism can display similar histologic imaging findings. Only systematic clinical, radiologic, and biochemical evaluation can allow for a definitive diagnosis. The presence of multiple simultaneous maxillofacial brown tumors in primary hyperparathyroidism is an infrequent ocurrence, and only on rare occasions can this be the first sign of the disease.

[Transverse glossectomy for tongue cancer treatment]. / Glosectomía transversa para el tratamiento del cáncer de lengua.

INTRODUCTION: Standard care of patients with oral tongue-invasive squamous cell carcinoma in early stages is local resection and neck dissection. Traditionally, tumor resection was performed with hemiglossectomy (tongue resection in lingual long axis), which implied morbidity for deglutition and speech. Although surgical margins are sufficient, they are usually larger than necessary. OBJECTIVE: To know functional results and surgical margins in patients with T1-T2 oral tongue cancer submitted to transverse glossectomy (TG). MATERIAL AND METHODS: We analyzed charts of patients with T1-T2 oral tongue squamous cell carcinoma treated by TG during a 2-year period. We studied surgical margins, deglutition, speech intangibility, performance status and patient satisfaction. RESULTS: We included 20 patients: 12 women and eight men, with mean age of 45 years. Tumor-thickness mean was 8 mm; 19 patients showed free tumor margins in definitive histology study with mean of 1.8 cm three-dimensionally. In one patient, frozen sections were free-of-tumor, but definitive study showed a microscopic area of squamous cell carcinoma in surgical margin. All patients preserved > 50% of oral tongue and all showed lingual tip deviation and short tongue. None required nasogastric tube for feeding and speech was intelligible in all patients. CONCLUSIONS: TG provided sufficient surgical margin in all patients in this series without important morbidity and with good functional result; thus, TG is an alternative to classic vertical hemiglossectomy for patients in early stages of tongue mobile cancer.

[Post total laryngectomy stomal recurrence. Case report and review of the literature]. / Recurrencia estomal posterior a laringectomía total. Reporte de un caso y revisión de la literatura.

Development of stomal recurrence following total laryngectomy is a devastating scenario with an extremely poor prognosis. Overall rate of stomal recurrence ranges from 1.7%-40%, with an average rate of 7.5%. Irrespective of the etiology of stomal recurrence, it invariably consists of diffuse infiltration of tumor into the soft tissues of the neck and mediastinum, thereby making control of the disease difficult. Despite aggresive surgery, radiotherapy, and chemotherapy, salvage rate is poor. Prevention of stomal recurrence is therefore of paramount importance and the only means of reducing incidence. Systematic use of preventive surgical measures together with postoperative radiotherapy to the stoma and superior mediastinum have led to decrease in appearance of stomal recurrence. Intensive follow-up should be performed for patients with laryngeal carcinoma who had subglottic involvement, paratracheal lymph node metastasis, or both to detect stomal recurrence at an early stage.