André Vicente Guimarães

Características clínico- epidemiológicas no carcinoma espinocelular de boca e orofaringe

Cancer of the oral cavity and oropharynx is aggressive. It is one of the commonest cancers in Brazil and may be considered as the commonest in the head and neck. AIM: The objective of this paper is to evaluate clinical and epidemiological factors and the outcome. STUDY DESIGN: Clinical retrospective. MATERIAL AND METHODS: In a descriptive retrospective study, the charts of 43 cases of oral and 25 of oropharyngeal squamous cell carcinoma (SCC) in the period 1997-2000 have been reviewed from the Departments of Head and Neck Surgery of Santa Casa de Misericordia de Santos and Hospital Ana Costa. This was analyzed with emphasis on age, gender, profession, ethnic aspects, tobacco and alcohol use, dental prosthesis, referement origin, site of the lesion, clinical staging, histologic grade, treatment methods, survival and second cancer presence in the study group. The data were analysed by Exact Test of Fischer. RESULTS: In the oral cavity cancer patients, a male female ratio of 3.35:1 was observed, the median age was 62 years (ranging 46 to 91 years), 90.7% were Caucasian, 81% were referred from medical professionals, tobacco use was identified in 76.8%, alcohol intake in 74%, 79% were not dental prosthesis users, tongue was the commonest site identified (51.1%), 53% were staged as III and IV clinical stages, 72.1% were moderately differentiated SCC, combined modality of treatment (surgery and adjuvant radiation therapy) was employed in 47% and 9.3% presented a second primary tumor. For the oropharynx, the male female ratio was 11.5:1, the median age was 58 years (ranging 40 to 81 years), 92% were Caucasian, 92% were referred from medical professionals, exposure to tobacco and alcohol was respectively noted in 84% and 80%, 52% did not use dental prosthesis, the tonsils were the commonest site (76%), 96% were staged as III and IV, 84% had moderately differentiated SCC, 75% underwent combined treatment (surgery and adjuvant radiation therapy) and 8% presented a second tumor elsewhere. There was not significant relationship between the clinical staging and tobacco, alcohol and dental prosthesis exposure. These factors, the age and the histologic grade had no relationship with the tumor site. For the oral cavity, 69,7% were alive with no evidence of disease and for the oropharynx, 22% were under this condition. CONCLUSION: The professional who performs the first evaluation is important in recognizing the lesions in order to achieve early detection.

Thyroglossal duct: a review of 55 cases.

BACKGROUND Thyroglossal duct remnants are the most common midline neck masses in childhood but can be found in adults and the elderly. Sistrunks procedure, with dissection of the tract and removal of the hyoid bone, is accepted as the main operation of choice. STUDY DESIGN Fifty-five patients were treated from January 1994 to November 2000, and these were studied. There were 29 men and 26 women, with a median age of 17 years. Diagnosis was clinical, with 13 cases of fistula and 42 of cyst. Size varied from 1.0 to 4.0 cm, with an average of 2.5 cm. Six patients presented with local abscess. RESULTS All the patients underwent Sistrunks procedure. Serum collection occurred in three patients as complication. In one patient papillary carcinoma was identified in the cyst. Total thyroidectomy was not performed. There was only one recurrence, managed with a second operation. CONCLUSIONS We concluded that the diagnosis of thyroglossal duct is clinical. Sistrunks procedure carries low rates of complications (9.08%) and recurrence (1.82%). Antibiotic therapy is avoidable as a rule and hospital stay is short.

Sternocleidomastoid Muscle Flap Preventing Frey Syndrome following Parotidectomy

Frey syndrome is one of the potential sequelae of parotidectomy. Various medical and surgical treatments have been used in an attempt to avoid this embarrassing condition. Recently, interposing barriers between the overlying skin flap and the parotid bed, such as the sternocleidomastoid muscle (SCM) flap, have been used to prevent this condition. The purpose of this study was to evaluate the impact of using this flap on Frey syndrome. A series of 138 patients who underwent subtotal or total parotidectomy from January 1995 to December 2001 were divided into two groups. One group had an SCM flap reconstruction (n = 24), and the other group did not (n = 19). A subjective clinical questionnaire and the objective Minor’s starch iodine test were used to evaluate the incidence of this syndrome. The postoperative period varied from 12 to 90 months. The frequency exact test of Fisher and the nonparametric test of Mann-Whitney were applied. The association with the absence of sweating and the presence of the SCM flap was significant (p = 0.0002). There was no association with flushing or pain and the flap. There was a significant association with the starch iodine test and the presence of the flap (p = 0.0016). The only significant association of the epidemiologic and clinical characterization of the patients with a negative or positive Minor’s test was between sweating and a positive Minor’s test (p = 0.0001). The only significant aspect in the diagnosis of Frey syndrome is gustatory sweating. There is a significant association with a negative Minor’s test and the presence of the SCM flap and with sweating and a positive Minor’s test. The SCM flap is an efficient method for preventing Frey syndrome following parotidectomy.

Carcinoma papilífero de tireóide localmente invasivo

Introduction: Well-differentiated thyroid carcinoma invades adjacent structures of the neck in a minority of patients. However, when it occurs there are significant morbidity and mortality. Aim: Retrospective analysis of the surgical results. Study design: Clinical retrospective. Material and method: The records of 509 patients underwent thyroidectomy in our department from 1994 to 2000 were reviewed. There were 71 cases of papillary carcinoma with 13 cases of extrathyroidal extension (18.3%). There were five men and eight women whose age median was 57. The most commonly invaded structures were: strap muscles - 10; trachea in 9 cases; recurrent laryngeal nerve - 6; larynx - 4; and esophagus - 1. In all the cases, we performed total thyroidectomy, with radical neck dissection in five and level VI dissection in six. An end-to-end anastomosis of the trachea was performed in five patients, an anastomosis between the cricoid cartilage and the trachea was performed in two patients. One patient underwent total laryngectomy. Results: One patient died due to cardiac failure in the 10th postoperative day. A curative dose of 131I has been given to all the remaining patients. All of them have received thyroid hormone replacement. Another patient died due to clinical cause in the 14th postoperative month. One patient has refused total laryngectomy and is alive with disease. Eight patients have been doing well from 10 to 49 months postoperatively. One of them have had local recurrence which was surgically salvaged.

Complicações dos esvaziamentos cervicais

UNLABELLED Because of the proximity of vital structures, certain complications are inherent to neck dissection (ND) for the treatment of patients with squamous cell carcinoma of the upper aerodigestive tract. AIM To establish the incidence of complications of ND. METHODS A cross-sectional retrospective study of patient registries. ND with curative intention was evaluated in 480 patients with squamous cell carcinoma of the upper aerodigestive tract from January 1995 to December 2008 to identify perioperative complications. RESULTS Considering the total quantity of dissected neck sides, 413 radical ND and 295 selective ND were studied, of which 220 were supraomohyoid ND and 75 were jugular ND, totaling 708 sides. There were no deaths. The most frequent complication was marginal mandibular nerve injury (5.5%), followed by accessory nerve injury (5.1%). However, in 18 out of 21 cases this nerve was sacrificed for oncological completeness. CONCLUSIONS There were no perioperative deaths. Nerves were the most commonly injured structures; the marginal mandibular branch is injured most (5.5%).

Efficacy of pectoralis major muscle flap for pharyngocutaneous fistula prevention in salvage total laryngectomy: A systematic review.

The role of pectoralis major muscle flap (PMMF) in reducing the rate of pharyngocutaneous fistula after salvage total laryngectomy has not been clearly established. The purpose of this study was to evaluate the impact of PMMF in reducing pharyngocutaneous fistula rates after total laryngectomy.

Contact Endoscopy for Intraoperative Parathyroid Identification

Experienced thyroid surgeons are often able to identify the parathyroid glands, but sometimes it is difficult to differentiate them from other contiguous tissues. Contact endoscopy was introduced in otolaryngology for the characterization of normal and pathological epithelia. Our objective was to analyze contact endoscopy as an auxiliary method for identification of the parathyroid glands during thyroid surgery. Five total thyroidectomies and 5 hemithyroidectomies were performed in September 2001. After surgical exposure, contact endoscopy was performed. A total of 15 peritracheal regions were studied. Superior and inferior parathyroid tissues were identified on the basis of color, size, and probable location. Contact endoscopy was performed before and after use of methylene blue stain. Contact endoscopy was also used in neighboring areas. We compared the visual impression to the contact endoscopy findings. Two structures were visually supposed to be the superior and inferior parathyroid glands in each case. From 30 visually supposed glands, 25 were confirmed by telescope. Of the other 5 structures initially supposed to be parathyroid tissue, 3 were adipose tissue and 2 were thyroid parenchyma. In the 5 cases in which the identification of one of the glands was not confirmed, an additional contact examination enabled us to further identify parathyroid glands in 3 cases in which structures were initially identified as adipose tissue. Contact endoscopy is an efficient auxiliary method for the identification of the parathyroid glands during thyroid surgery that poses little risk of morbidity to the patient.

TOTAL THYROIDECTOMY WITH ULTRASONIC SCALPEL: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL

The ultrasonic scalpel is a recently introduced device in head and neck surgery. Total thyroidectomy is the most common endocrine procedure performed by surgeons.

Thyroid papillary carcinoma associated to Hashimoto's thyroiditis

UNLABELLED There is controversy in the literature regarding the association between papillary thyroid carcinoma (PTC) and Hashimotos thyroiditis (HT) and as to what would be the etiological relationship between them. OBJECTIVE To establish the proportion of cases among patients with TH and CPT, correlating it with histomorphological aspects. METHOD A retrospective study of patients undergoing partial or total thyroidectomy for PTC between 2007 and 2009, a total of 41 cases. RESULTS Regarding the association of HT and CPT, we found 11 cases (26.8%), all females, but without statistical significance. The mean age was 44.9 years among the patients with coexistent TH and CPT, whereas it was 49.1 years without that association. The average size of tumors in those without TH was 20.53 mm and for those with TH it was 12.72 mm (p = 0.4). Regarding pathology staging, the ratios between those with and those without TH were kept in T1a, T1b and T3. In T2, there were no cases of coexistence of HT and PTC. CONCLUSION There is a rate of 26.8% of patients with association between TH and CPT, but without differences in relation to tumor size.

Variante oncocítica do carcinoma medular: relato de caso

Oncocytic tumors of the endocrine system are a group of rare entities described in several organs, including the thyroid gland. Medullary carcinoma can seldom show the predominance of cells with oncocytic changes but the positive immunostaining for calcitonin should be helpful for the correct diagnosis. We describe the case of a 71 year-old female Caucasian patient, with a hard 5 cm thyroid nodule for 2 months. There was no significant cervical adenopathy. Thyroid hormone levels were normal. The US-Doppler examination showed a centrally vascularized nodule. Cytopathology analyses was suspicious for follicular neoplasm with predominance of oncocytic cells, and a hemithyroidectomy was performed. Frozen section examination confirmed a follicular neoplasm and the definitive histopathological and immunohistochemical analyses was conclusive for a medullary carcinoma, oncytic variant. A total thyroidectomy was then performed, followed by adjuvant 131Iodine therapy. After a 40-month follow-up the patient is alive with no evidence of disease. Medullary carcinoma should be considered in the differential diagnosis of unusual thyroid carcinomas with predominance of cells with oncocytic changes.