[Risk factors for postoperative complications in major head and neck surgery]. / Factores de riesgo para las complicaciones postoperatorias en cirugía mayor de cabeza y cuello.

BACKGROUND AND OBJECTIVE: Tumor extension is the factor that usually determines the choice of radiotherapy or surgery for head and neck cancers. The choice of surgery carries with it certain specific risks that must be assessed jointly by the maxillofacial surgeon and the anesthetist so that they can agree on the best course of action to choose. We aimed to identify risk factors for complications after major head and neck surgery. PATIENTS AND METHODS: Retrospective descriptive analysis of data for patients who underwent oncologic head and neck surgery with graft reconstruction. The main candidate predictors gathered from records were age, sex, ASA physical status classification, time under anesthesia, and intra- and postoperative events. The main dependent variables were records of early and delayed complications, time until extubation, and related mortality. RESULTS: We identified 61 interventions in 56 patients (mean duration of surgery, 9 hours). Early complications developed in 57.4% while they were in the critical care area. Age > or =60 years was associated with longer hospital stays. Short-term mortality was higher in current smokers (P= .01). Survival was significantly higher in patients classified ASA 1 or 2 in comparison with those classified as ASA 3 or 4, in whom long-term mortality was higher (P < .05). CONCLUSIONS: The incidence of postoperative complications was associated with comorbidity and risk behaviors found in this type of patient. We feel that a multidisciplinary medical team should assess the surgical and postoperative care of these patients.

Factores de riesgo para las complicaciones postoperatorias en cirugía mayor de cabeza y cuello / Risk factors for postoperative complications in major head and neck surgery

Objetivo: En los cánceres de cabeza y cuello la extensión del tumor es el parámetro que generalmente determina la elección de la radioterapia o la cirugía como alternativa terapéutica. Esta última opción conlleva unos riesgos específicos que deben ser evaluados conjuntamente por el cirujano maxilofacial y el anestesiólogo para optimizar dicha elección. El objetivo de esta trabajo fue identificar la existencia de factores de riesgo en las complicaciones postoperatorias en cirugía mayor de cabeza y cuello. Pacientes y métodos: Estudio observacional descriptivo retrospectivo en pacientes sometidos a cirugía oncológica maxilofacial más reconstrucción con injertos. Como variables principales predictoras se emplearon: edad, sexo, ASA, tiempo de anestesia e incidencias intra y postoperatorias y como variables principales dependientes: indicadores de complicaciones precoces, tardías y tiempo hasta extubación, así como la mortalidad asociada. Resultados: Sesenta y un intervenciones en 56 pacientes con un tiempo promedio de 9 horas de cirugía. Un 57,4% presentaron complicaciones precoces en la unidad de reanimación y 39% complicaciones tardías. Una edad >= 60 años se asoció a mayor duración de estancia hospitalaria. Los fumadores activos presentaron una mayor mortalidad a corto plazo (p = 0,01). Los pacientes con estado físico ASA I-II tuvieron una supervivencia significativamente mayor que los pacientes ASA III-IV, teniendo estos últimos una mayor mortalidad a largo plazo (p < 0,05). Conclusiones: La variabilidad en la incidencia de complicaciones postquirúrgicas asociadas a la comorbilidad y conductas de riesgo que presentan este tipo de pacientes, hace necesaria, a nuestro juicio, una evaluación por el equipo médico multidisciplinar involucrado en la cirugía y posteriores cuidados(AU)

Background and objective: Tumor extension is the factor that usually determines the choice of radiotherapy or surgery for head and neck cancers. The choice of surgery carries with it certain specific risks that must be assessed jointly by the maxillofacial surgeon and the anesthetist so that they can agree on the best course of action to choose. We aimed to identify risk factors for complications after major head and neck surgery. Patients and methods: Retrospective descriptive analysis of data for patients who underwent oncologic head and neck surgery with graft reconstruction. The main candidate predictors gathered from records were age, sex, ASA physical status classification, time under anesthesia, and intra- and postoperative events. The main dependent variables were records of early and delayed complications, time until extubation, and related mortality. Results: We identified 61 interventions in 56 patients (mean duration of surgery, 9 hours). Early complications developed in 57.4% while they were in the critical care area. Age >=60 years was associated with longer hospital stays. Short-term mortality was higher in current smokers (P = .01). Survival was significantly higher in patients classified ASA 1 or 2 in comparison with those classified as ASA 3 or 4, in whom long-term mortality was higher (P < .05). Conclusions: The incidence of postoperative complications was associated with comorbidity and risk behaviors found in this type of patient. We feel that a multidisciplinary medical team should assess the surgical and postoperative care of these patients(AU)

Rehabilitación integral en pacientes con disfunción de la articulación temporomandibular. Resultados preliminares / Integral rehabilitation in patients with dysfunction of the temporomandibular joint. Preliminary results

La eficacia de las diversas estrategias terapéuticas dirigidas al tratamiento de las alteraciones funcionales de la articulación temporomandibular (ATM) sigue siendo hoy un tema muy controvertido. Esta articulación, cuya estructura básica es el disco o menisco articular, se emplea de forma permanente, es móvil, resistente, y su alteración más frecuente es la disfunción unilateral o bilateral de etiología multifactorial. El objetivo de este estudio es valorar la eficacia del método de tratamiento de la disfunción de la ATM mediante técnicas de rehabilitación. En este artículo presentamos los resultados de un estudio prospectivo donde se ha seguido durante un período de tres años a 90 pacientes tratados con una técnica de rehabilitación integral compuesta por técnicas de relajación y concienciación, cinesiterapia y electrotermoterapia específica, como tratamiento inicial o secundario al fracaso de otro tratamiento conservador basado en medios farmacológicos o férulas de descarga. Los pacientes se valoran mediante un protocolo que mide como resultado principal el restablecimiento de la funcionalidad en la ATM y el grado en que este objetivo se consigue. Los resultados muestran que tras el alta se recupera la funcionalidad de la ATM en más del 90 por ciento de los casos. El estudio apunta hacia la eficacia del tratamiento rehabilitador integral en las diversas disfunciones de la ATM. (AU)

Valor pronóstico del parámetro inmunohistoquímico p53 en los estadios I y II del carcinoma epidermoide de lengua móvil

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Alterations in levels of different protein kinase C isotypes and their influence on behavior of squamous cell carcinoma of the oral cavity: epsilon PKC, a novel prognostic factor for relapse and survival.

BACKGROUND: Recent results suggest that some PKC isotypes, when overexposed, confer to cultured fibroblasts certain proliferative advantages, and enhanced tumorigenicity in nude mice, suggesting their participation in carcinogenic process. These findings need to be validated through the investigation of potential alterations of these kinases in common forms of human cancers. MATERIAL AND METHODS: In this prospective study we determined levels of different PKC isozymes by Western blot in tissue extracts from 29 human primary squamous cell carcinomas of the oral cavity, and their respective controls. These expressions were correlated with behavior of tumor and histologic characteristics. RESULTS: Dramatic alterations in different PKC isotypes were found. Thus, increased levels of isotypes alpha, beta, or gamma, and zeta were found in most of the patients, as well as significant correlations between levels of the isotype epsilon and survival-relapse rate and classical PKC isotypes with irregular morphology of tumoral interphase. CONCLUSIONS: These results suggest participation of some PKC isotypes (alpha, beta, gamma, and zeta) in the genesis and behavior (epsilon) of oral cancers. Levels of epsilon PKC could be used as prognostic marker.

Squamous cell carcinoma of the oral cavity: a clinicopathologic scoring system for evaluating risk of cervical lymph node metastasis.

A series of 126 cases of squamous cell carcinoma of the oral cavity with neck dissection was studied. Several clinicohistologic parameters and statistical correlation with lymph node metastasis were evaluated. Statistical association with metastasis was found in the following factors: microvascular invasion (P < 6 x 10(-7)), grade of differentiation (P < .0001), T category (P = .003), tumor thickness (P = .005), inflammatory infiltration (P = .011), tumoral interphase (P = .02), and perineural spread (P = .04). We designed a scoring system based on statistical results that eliminates the need for complex mathematical formulas. We tested this scoring system; cases with scores ranging form 7 to 12, 13 to 16, 17 to 20, and 21 to 30 points showed metastasis in 0%, 20%, 63.6%, and 86.3% of cases, respectively. The differences between these four groups in relation to rate of metastasis were very significant (P = 8 x 10(-9)). In conclusion, this scoring system is a reliable method of predicting risk of metastasis.

Maxillofacial trauma: influence of HIV infection.

Between 1986 and 1990, 171 patients with mandibular and 129 with mid-face fractures were treated in our service. Both groups were separated into patients with HIV infection and patients without HIV infection. We carried out a retrospective review of these cases. The incidence of HIV+ve patients was higher in the mandibular fracture group (19.8%) than the group with mid-face fractures (7.75%). The most important aetiology of fractures was violence and the HIV infection was acquired through intravenous drug use (heroin). HIV infection was an independent associated factor where there was concomitant infection of mandibular fractures but not in mid-face fractures. In mandibular fractures, preoperative infections were significantly higher in HIV+ve patients (26.4%) than HIV-ve patients (6.5%) (p < 0.0001). Postoperative infections were higher in HIV+ve cases than HIV-ve cases, but this difference was not statistically significant (p > 0.05). Miniplates were a good osteosynthesis medium in HIV+ve patients and intermaxillary fixation seems to increase the infection rate in the HIV+ve group. The infections were treated with antibiotics with excellent results in preoperative infections and in the majority of postoperative cases, in both HIV+ve and HIV-ve patients.