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1.
Front Surg ; 11: 1395936, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39045088

RESUMO

Objective: The local spread of oral tongue squamous cell carcinoma (OTSCC) follows pathways of dissemination along areas of lesser resistance. In more advanced scenarios, the tumor can extend beyond the hemi-tongue of origin, by passing through the lingual septum and following the fibers of the transverse muscle. This can lead to the invasion of the contralateral extrinsic muscles, the first being the genioglossus and more laterally the hyoglossus. An anatomically guided surgical resection of the tumor can be planned to ensure both oncological safety and an acceptable functional outcome. This approach aims to preserve the hyo-styloglossus unit (HSU) whenever feasible. Methods: Between January 2019 and November 2022, six patients received extended glossectomy Type B (EG Type B), with preservation of the HSU. Preliminary oncological results and functional results in terms of swallowing (FOIS score) and quality of life (MDADI) are presented. Results: Five out of the six patients are alive and disease-free, while one patient died due to other causes. All patients who were candidates for an EG Type B underwent a swallowing assessment prior to surgery and followed daily postoperative swallowing training. At discharge, the patients continued swallowing training in an outpatient clinic. Five out of the six patients reached a full oral diet within 1 year of follow-up. Conclusion: The oncological results confirm the safety of this technique. The importance of preserving the HSU, the minimal functional unit, shows very encouraging results in terms of swallowing rehabilitation.

2.
Acta Otorhinolaryngol Ital ; 44(Suppl. 1): S42-S57, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38745516

RESUMO

The oral cavity is a primary site for malignant neoplasms of the head and neck region. Surgery, with or without adjuvant therapy, offers the highest probability of cure by focusing on radical tumour removal and organ function restoration. Reconstructive options are represented by local and free flaps, while small defects can be managed without reconstruction. For medium-sized defects without bone involvement, local flaps can be a good alternative to free flaps in selected patients. The purposes of this article are to analyse the main minimally-invasive reconstructive techniques in oral cancer surgery through a systematic review of the literature and develop a reconstructive algorithm based on the site and size of the defect. We defined minimally-invasive reconstruction as any reconstructive option not involving flap dissection from the neck or other distant areas from the oral cavity. Options considered include: local myo-mucosal or mucosal flaps (based on the facial or buccal arteries, and palatal flap), Bichat's fat pad flap, and nasolabial flap. Use of biological or synthetic materials is also described. In selected patients with small to moderate-sized defects, the possibility of reconstruction with local flaps can be a viable option.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos , Boca , Procedimentos de Cirurgia Plástica , Humanos , Procedimentos de Cirurgia Plástica/métodos , Boca/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neoplasias Bucais/cirurgia
5.
Eur Arch Otorhinolaryngol ; 280(6): 3015-3022, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36897364

RESUMO

INTRODUCTION: In the last decade, compartmental surgery (CTS) has been the surgical approach of choice for advanced tumors of the tongue and oral floor. METHODS: Advanced tumors (cT3-T4) oral tongue squamous cell carcinoma (OTSCC) may extend beyond the lingual septum and involve the contralateral hemitongue, developing along the intrinsic transverse muscle. The disease may then involve the genioglossus muscle and, more laterally, the hyoglossus muscle. RESULTS: The surgical approach to the contralateral tongue must be guided by anatomic and anatomopathological principles to achieve a safe oncological resection based on the principles of CTS. CONCLUSION: We propose a schematic classification of glossectomies that extend to the contralateral hemitongue based on the anatomy and pathways of tumor spread.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias da Língua , Humanos , Glossectomia , Neoplasias da Língua/cirurgia , Neoplasias da Língua/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Língua/fisiologia , Neoplasias de Cabeça e Pescoço/cirurgia
6.
Eur Arch Otorhinolaryngol ; 279(6): 3159-3166, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34739577

RESUMO

OBJECTIVE: The aim of the study was to evaluate the impact of the COVID-19 pandemic on new diagnoses of head and neck cancer (HNC) in South Tyrol, northern Italy in terms of the number of new diagnoses and worsening disease stage due to diagnostic delay. METHODS: Patients were divided into two groups: the control group with a first diagnosis of HNC in 10 months before the national lockdown (March 9th, 2020) and the study group with a first diagnosis of HNC in 10 months after lockdown. RESULTS: A total of 124 patients were included in the study. Before the spread of COVID-19, 79 new diagnoses of HNCs were registered, while in the period after the lockdown, 45 new cancers cases were diagnosed and the difference was statistically significant (p = 0.01278). Early clinical T-stage results showed 52 cases in the control group and 21 in the study group, again with a significant difference (p = 0.03711). Advanced T-stage results showed 27 cases in the control group and 24 in the study group. CONCLUSIONS: This study highlights the impact of the COVID-19 pandemic on HNCs, showing a statistically significant difference in the number of diagnoses before and after the lockdown which was related to the spread of the SARS-CoV-2 virus, and with a relevant decrease in early cT-staged HNCs.


Assuntos
COVID-19 , Neoplasias de Cabeça e Pescoço , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Diagnóstico Tardio , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias de Cabeça e Pescoço/epidemiologia , Humanos , Itália/epidemiologia , Pandemias , Encaminhamento e Consulta , SARS-CoV-2
7.
Oral Oncol ; 117: 105269, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33827034

RESUMO

OBJECTIVES: To present an anatomical cadaver dissection study and our preliminary surgical experience with endoscopic-assisted multi-portal compartmental resection of the masticatory space (MS) in locally advanced oral squamous cell carcinoma (OSCC) of the retromolar area. MATERIALS AND METHODS: Two fresh-frozen cadaver heads were dissected in the Laboratory of Anatomy to define the surgical steps of an endoscopic-assisted multi-portal compartmental approach to the MS. After this preclinical anatomical study, patients affected by locally advanced OSCC originating from the retromolar area with extension to the MS were prospectively enrolled and operated at two Italian referral centers for head and neck cancer between October 2019 and May 2020. RESULTS: Surgical technique of endoscopic-assisted multi-portal compartmental resection of the MS was preclinically defined step by step in 3 phases: transnasal, transoral/trancervical, and multi-portal. Compartmental resection of the MS was successfully completed in all specimens (4 MSs dissected). The surgical technique was subsequently applied in 3 patients affected by primary OSCC of the retromolar area, providing satisfactory results in terms of negative resection margins and local control. CONCLUSIONS: Multi-portal compartmental resection of the MS combining the transnasal and transoral/transcervical corridors is technically feasible. Such an approach to the MS in locally advanced OSCC provides different angles of incidence to the target and full control of tumor margins.


Assuntos
Neoplasias Bucais , Carcinoma de Células Escamosas de Cabeça e Pescoço , Cadáver , Endoscopia , Humanos , Boca/anatomia & histologia , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia
8.
J Maxillofac Oral Surg ; 20(1): 154-156, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33584058

RESUMO

Although free flaps are widely recognized as a gold standard, pectoralis major muscle flap (PMMF) still remains a valuable workhorse in head and neck reconstruction. The technique we describe in the present paper allows to harvesting the PMMF with an accurate and complete isolation of the pedicle, sparing the superior sternum-acromion muscular fibers.

10.
J Clin Virol ; 60(3): 243-9, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24845262

RESUMO

BACKGROUND: HPV16 is the most prevalent genotype in oropharyngeal squamous cell carcinomas (OPSCCs), but there are few information about intratype variants prevalence and their clinical relevance in these tumors. Moreover, since HPV DNA detection alone is not sufficient to determine a favorable prognosis for OPSCCs, additional diagnostic/prognostic biomarkers are necessary. OBJECTIVES: To assess the prevalence of HPV intratype variants and evaluate the role of HPV16 DNA methylation as prognostic marker in OPSCCs. STUDY DESIGN: We analyzed 81 biopsies of OPSCCs for HPV detection and genotyping with a pyrosequencing-based HPV DNA-test. We also quantified viral DNA methylation frequency in the LCR by pyrosequencing in patients with transcriptionally-active HPV16-infection, analyzing it in function of available clinical/virological data. RESULTS: The overall HPV prevalence was 74.1% and HPV16 was confirmed the most prevalent genotype (51/60, 85.0%). Interestingly, we detected, for the first time, HPV16 African variants in 10/51 cases (19.6%), pointing out their clinical relevance also out of the anogenital district. Regarding viral DNA methylation, the E2BS1 showed a significantly higher mean methylation frequency compared to E2BS3/4, as previously observed in high-grade precancerous lesions of the uterine cervix. On the other hand, patient with a mean methylation frequency in the early promoter >10% showed only a tendency to have a worse prognosis. CONCLUSIONS: Our results highlight both the involvement of HPV16 African variants in OPSCCs development and the necessity of further studies to deepen the role of viral methylation in these tumors, in order to better define similarities/differences compared to cervical cancer.


Assuntos
Carcinoma de Células Escamosas/virologia , Metilação de DNA , DNA Viral , Variação Genética , Papillomavirus Humano 16/genética , Neoplasias Orofaríngeas/virologia , Infecções por Papillomavirus/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Linhagem Celular Tumoral , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/epidemiologia , Neoplasias Orofaríngeas/patologia , Infecções por Papillomavirus/complicações , Prevalência , Regiões Promotoras Genéticas , Fatores de Risco , Análise de Sobrevida
11.
Microsurgery ; 33(2): 90-104, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22821727

RESUMO

BACKGROUND: Microsurgical reconstruction has become the worldwide gold standard for repairing surgical defects in head and neck cancer. The aim of this article is to describe a standardized reconstructive approach to the oral cavity and oropharynx soft tissue defects. PATIENTS AND METHODS: Since 1992, the authors have treated 163 patients affected by oral cavity and oropharynx cancer, performing a total of 175 flaps. A systematic postoperative functional study prompted a surgical strategy, in terms of flap choice, shape, and insetting. A two-dimensional template was used to obtain a three-dimensional reconstruction for the best functional and aesthetic outcome. To simplify preoperative planning, surgical resections were divided into a set number of classes. The templates, flap choice, and insetting are described for each region. RESULTS: Complications consisted of seven partial necroses of the flap which easily resolved with a local toilette and 12 complete necroses of the flap due to vascular thrombosis, these patients required a secondary reconstruction with another free flap. Functional results were systematically evaluated in the first 60 patients of our series with particular attention to the swallowing function, which was analyzed by both videofluoroscopy and functional endoscopic evaluation of swallowing. Results showed a good functional recovery with the described reconstructive techniques. CONCLUSION: A standardized surgical strategy based on reproducible templates might facilitate less experienced surgeons in analyzing the problem, choosing the best technical solution and foreseeing the functional outcomes.


Assuntos
Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Microcirurgia , Boca/cirurgia , Orofaringe/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos Clínicos , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Boca/patologia , Orofaringe/patologia , Estudos Retrospectivos , Resultado do Tratamento
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