Miguel Magalhães

Tumores del espacio parafaríngeo. Nuestra experiencia-i.p.o. francisco gentil-lisboa

Primary parapharyngeal space tumours are rare, representing only a 0.5% of head and neck neoplasms. the authors report a case series review of 38 patients with parapharyngeal tumours who underwent surgical excision between 1975 and 1998. twenty-six of them were female (68%) and twelve male (32%). thirty-three tumours (87%) were benign and five (13%) were malignant being the pleomorphic adenoma the most common neoplasm (39%). all patients were treated surgically: the trans-cervical approach was used in 19 cases, cervical-parotid in 5, the trans-parotid approach in 7 patients, transoral in 5, the cervical-parotid approach with mandibulectomy in 2 and the combined transoral-cervical approach in 1 case. out of the 33 patients with benign neoplasms, 1 (a pleomorphic adenoma treated through a transoral approach) had a recurrence. amongst the 5 with malignant disease, recurrence or persistent local tumour was seen in 4 cases; and of these, 3 with persistent local tumour after incomplete excision died

Immediate Reconstruction of Large Full-Thickness Segmental Anterior Maxillary Defect with Bone Transport

Maxillary segmental defects are a reconstructive challenge particularly when the anterior arch is involved. Missing bone, mucosa, and teeth should be replaced; fistulae closure should be guaranteed by bone and mucosa continuity; stable functional occlusion should be achieved; and facial aesthetics restored. These defects resulting from tumor excisions, if left untreated, will cause additional problems related to interposed scar and collapse of lip and nose. Immediate reconstruction should avoid these problems and should be considered when safe tumor-free margins are obtained. This study describes the treatment of such a defect resulting from a myxoma excision, with trifocal distraction requiring only one additional surgery. Internal distractors were fixed bilaterally for transport of two segmental discs created by inverted L osteotomies at the same surgical time of tumor excision. A second surgery was performed after central contact between transport discs was achieved, for device removal and creation of a dynamic system to regenerate molding and compression-focus development. This was accomplished by internal fixation of one side and central fixation of a full-open distractor to act as compression device when reversely activated. Central perfect adaptation between transported segments and good-quality attached mucosa lining the alveolar crest were determinant to obtain a stable functional and aesthetic result.

Surgery vs. primary radiotherapy in early-stage oropharyngeal cancer

Background Early-stage oropharyngeal squamous cell carcinoma (OPSCC) can currently be treated by surgical resection or definitive radiotherapy (RT). The aim of this study is to review the outcomes of early-stage OPSCC submitted to surgery or primary RT. Preliminary results have shown similar overall survival (OS) and locoregional recurrence-free survival (LRFS). Material/Methods Retrospective study of patients with cT1-T2 cN0-N1 OPSCC, diagnosed between January 2009 and December 2014, treated with surgery or primary RT. Results 61 patients with cT1-T2 cN0-N1 OPSCC were included. Forty-two (69%) were submitted to surgical resection, of which 37 (88%) had adjuvant treatment (24 received RT and 13 chemoradiotherapy). Nineteen (31%) were treated with primary RT, and 3 of them had concurrent chemotherapy. RT was given with intensity-modulated radiation therapy (IMRT) (71%) or three-dimensional conformal radiation therapy (3D-CRT) (29%). At a median follow-up of 5.4 years, there were 3 tumor persistences, 5 local failures, 2 regional failures and no distant metastasis. The 3-year and 5-year OS were 77% and 71% in the RT group vs. 71% and 59% in the surgery group, respectively (HR 0.60, 95% CI 0.22–1.61; p = 0.30). The 3-year and 5-year LRFS were 71% and 64% in the RT group vs. 66% and 50% in the surgery group, respectively (HR 0.59, 95% CI 0.24–1.45; p = 0.24). Up to 34% had acute grade 3 toxicity and 11% had grade 4 osteoradionecrosis of the jaw. Conclusions Longer follow-up still does not show a significant difference in OS and LRFS between both treatments. Because most patients submitted to surgery required adjuvant RT and since its side-effects were not negligible, further studies are warranted to better suit the first treatment for each patient and to prevent the need for adjuvant treatment and the risk of toxicity.

Outcomes for Patients at Head and Neck Cancer Consultation

Objective: Head and neck cancer outpatient departments have to deal with challenging, impairing, and highly lethal diseases. As the search for better treatments continues, we aimed to analyze the clinical outcomes of our patients and to identify factors that may affect short-term survival. Method: We performed a retrospective cohort study concerning all patients referred to the head and neck consultation of a Portuguese cancer center (Lisbon’s Instituto Português Oncologia) during 2008. Clinical and demographic data were obtained from medical records of those patients, from their first appointment until December 2011. Results: Four hundred forty-four patients were referred to our consultation over the study period. Most of them were men (87%) and the mean age was 60.4 years (range, 14-86 years). The most common cancers were laryngeal (37%) and oropharyngeal (23%), and the majority (58%) were advanced (stage IVa or higher). Sixty percent of our patients were treated with surgery and adjuvant radiotherapy. The average time elapsed between treatment and first appointment was 80 days (range, 2-275 days). The overall 2-year survival rate was 58% and the 2-year disease-specific survival rate was 64%. The overall recurrence rate was 25%, mostly at the primary site. Conclusion: Most of our patients had advanced tumors at the time of referral. Despite the early beginning of treatment at our center, survival, locoregional control, and treatment options are compromised. Public health policies should be developed to improve public health education regarding head and neck cancer prevention and early referral.