RESUMEN

Premalignant conditions affect the larynx. Dysplasia can progress in severity resulting in cancer depending on many clinical, pathological and molecular factors. The purpose of this study was to examine the expression of the p21 and p27 cyclin-dependent kinase inhibitors and p53 tumour suppressor gene in dysplasia of the larynx. A total of 114 cases of untreated dysplasia were selected from the archives of the University of Newcastle. p21, p27 and p53 immunohistochemistry was performed and the cases followed up. Twenty-eight dysplasias (24%) subsequently developed into cancers. Expression of the molecular factors studied was not associated with cancer progression. p53 expression was associated with smoking (P = 0.005). In contrast, grade of dysplasia was significantly associated with cancer risk (odds ratio 6.7; P = 0.0001). The majority (75%) of cancers were detected within 12 months of dysplasia being diagnosed.

Asunto(s)

Carcinoma de Células Escamosas/genética , Proteínas de Ciclo Celular/genética , Neoplasias Laríngeas/genética , Lesiones Precancerosas/genética , Proteína p53 Supresora de Tumor/genética , Proteínas Supresoras de Tumor/genética , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/patología , Inhibidor p21 de las Quinasas Dependientes de la Ciclina , Inhibidor p27 de las Quinasas Dependientes de la Ciclina , Progresión de la Enfermedad , Femenino , Predisposición Genética a la Enfermedad , Humanos , Incidencia , Neoplasias Laríngeas/epidemiología , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Lesiones Precancerosas/epidemiología , Lesiones Precancerosas/patología , Fumar/epidemiología

RESUMEN

The UK incidence of malignant disease of the minor salivary glands is only 0.6 per million per year. The tumours have a varied histology, can present in any age group and are frequently advanced if located in the sinonasal cavities. In a 20-year review of 21 patients treated for minor salivary gland malignancy in a single institution, it was found that mucoepidermoid tumours were more common in the oral cavity and adenoid cystic carcinomas in the sinonasal tract (p = 0.002). Outcome was variable with sinonasal and adenoid cystic carcinoma having a poorer outcome. Kaplan-Meier curves showed that oral tumours had a higher probability of long term survival. Radical surgery with reconstruction and post-operative adjuvant radiotherapy was effective in achieving loco-regional control. There were no local recurrences within 5 years and three after 5 years. Five patients developed metastatic disease within 10 years and a further two after 10 years. Late recurrences occurred and survival was mainly determined by the presence of systemic disease.

Asunto(s)

Neoplasias de las Glándulas Salivales/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Neoplasias de las Glándulas Salivales/patología , Neoplasias de las Glándulas Salivales/radioterapia , Glándulas Salivales Menores , Tomografía Computarizada por Rayos X/métodos

RESUMEN

Two rare cases of metastases from malignant peripheral nerve sheath tumours (MPNST) of the head and neck are described. The initial lesions were superficial, but despite early diagnosis and complete excision, they metastasised to the ipsilateral parotid gland. Both underwent further complete excision and neither metastatic lesion showed progression in grade. One patient is alive, however, the other died of widespread metastases. There are no other reported cases of these sarcomas in the head and neck metastasising to the parotid gland.

Asunto(s)

Neoplasias de Cabeza y Cuello , Neoplasias de la Vaina del Nervio/secundario , Neoplasias de la Parótida/secundario , Adulto , Resultado Fatal , Humanos , Masculino , Tomografía Computarizada por Rayos X/métodos

RESUMEN

A histological study of both recipient and flap vessels was performed in 30 patients with head and neck cancer, and relevant preoperative risk factors were assessed. A total of 35 free flaps were transferred in 30 patients; 16 patients had preoperative radiotherapy, 13 were smokers, eight had hypertension and six had peripheral vascular disease. No significant venous pathology was found in either the flap or the neck veins. However, over two-thirds of the neck arteries and one-half of the flap arteries were found to have microscopic arterial pathology. The only pre-existing factor significantly influencing vessel pathology was hypertension (P=0.007). All flaps survived, although in two there was some loss of the skin paddle. This study reveals that the majority of patients undergoing microsurgery in the head and neck region have pre-existing arterial damage in both the flap and the recipient arteries, but this does not have a significant effect on the overall patency of the microvascular anastomoses.

Asunto(s)

Neoplasias de Cabeza y Cuello/patología , Adulto , Anciano , Anciano de 80 o más Años , Anastomosis Quirúrgica/métodos , Femenino , Neoplasias de Cabeza y Cuello/irrigación sanguínea , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Microcirculación , Persona de Mediana Edad , Recurrencia Local de Neoplasia/irrigación sanguínea , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Complicaciones Posoperatorias/etiología , Cuidados Preoperatorios/métodos , Estudios Prospectivos , Procedimientos de Cirugía Plástica/métodos , Factores de Riesgo , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/patología , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

The purpose of this study was to assess the incidence of abnormal vascular histology and to determine whether or not this was correlated with the incidence of postoperative microvascular problems. The microvascular histology of both donor and recipient vessels was studied in 38 patients (40 flaps) undergoing breast reconstruction with free TRAM flaps. Preoperative risk factors were assessed and correlated with histological changes in vessels, and both were tested against anastomotic complications. Thrombosis of either the artery or the vein of the flap was seen in 6 cases (15%), and of these, two flaps failed completely and one suffered partial necrosis. The occlusion affected the arterial anastomosis in 3 patients, and the venous anastomosis in 2 patients, while both the artery and the vein were thrombosed in one case. Preoperative risk factors such as smoking, obesity, radiotherapy, and chemotherapy were not associated with a significantly higher incidence of thrombosis or with significant histological abnormalities in vessels (P value varied between 0.3-0.06). Microvascular histology showed variable degrees of pathological changes in six flaps (15%); nevertheless, in this group, only one flap suffered a venous thrombosis, which ended in total flap loss. Among those with one or more risk factors (24 patients), only 2 had some evidence of histological abnormality of the blood vessels used for the microvascular anastomosis (P = 0.2).

Asunto(s)

Mamoplastia/métodos , Microcirculación/patología , Colgajos Quirúrgicos/irrigación sanguínea , Trombosis/epidemiología , Adulto , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/cirugía , Distribución de Chi-Cuadrado , Estudios de Cohortes , Femenino , Supervivencia de Injerto , Humanos , Incidencia , Mamoplastia/efectos adversos , Microcirculación/fisiología , Microcirugia/efectos adversos , Microcirugia/métodos , Persona de Mediana Edad , Análisis Multivariante , Complicaciones Posoperatorias/epidemiología , Pronóstico , Flujo Sanguíneo Regional , Medición de Riesgo , Factores de Riesgo , Trombosis/etiología

RESUMEN

BACKGROUND: This case report describes a rare benign tumour, which presented as discrete areas of gingival hyperplasia affecting both the mandible and the maxilla. METHOD: Surgical excision of the lesions was carried out under local anaesthetic. Histopathological examination confirmed the diagnosis of oral myofibromatosis. RESULTS: The condition responded to surgical excision and appears to have limited growth potential. It affects a wide spectrum of ages and can be alarming due to rapid enlargement and ulceration, so careful diagnosis is important to avoid unnecessary aggressive treatment.

Asunto(s)

Hiperplasia Gingival/etiología , Neoplasias Gingivales/complicaciones , Miofibromatosis/complicaciones , Actinas/análisis , Adolescente , Diagnóstico Diferencial , Fibroblastos/patología , Neoplasias Gingivales/patología , Humanos , Masculino , Músculo Liso/patología , Miofibromatosis/patología

RESUMEN

Accurate, predictive assessment of the behaviour and progression of oral cancers and precancers remains elusive in clinical practice. Archival tissue specimens from 10 previously treated patients with oral lesions of known clinical outcome (3 years post-treatment) were re-examined histopathologically, and proliferative cell labelling indices (LIs) determined for Ki67, cyclin A and histone mRNA cell cycle markers. While histone mRNA labelling ultimately proved unreliable, both Ki67 and cyclin A LIs demonstrated a clear trend for enhanced labelling to occur in increasingly dysplastic and neoplastic tissue, with particular emphasis on suprabasal labelling in abnormal tissue. Perhaps of greatest significance was the observation of increased LIs and suprabasal labelling in lesions with poor clinical outcome, such as patients developing recurrent disease or cervical lymph node metastasis. Measurement of cell proliferative activity in individual oral epithelial dysplastic lesions or invasive squamous cell carcinomas may thus provide unique, predictive information on clinical outcome.

Asunto(s)

Carcinoma de Células Escamosas/patología , Células Epiteliales/patología , Neoplasias de la Boca/patología , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/química , División Celular , Ciclina A/genética , Femenino , Regulación Neoplásica de la Expresión Génica , Histonas/genética , Humanos , Antígeno Ki-67/genética , Leucoplasia/química , Leucoplasia/patología , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/química , ARN Mensajero/análisis

RESUMEN

Adenoid cystic carcinoma (ACC) is a rare malignant tumour believed to arise from the epithelial cells of mucous-secreting glands. It is a slow-growing but aggressive tumour with a propensity for perineural invasion. A 10 year review of 45 patients (19 males and 26 females with a median age of 56 years) treated for ACC at a single institution between 1989 and 1999 was performed to analyse factors involved in treatment failure, local control, treatment-related morbidity and mortality. The data collected were treated for survival curves according to the Kaplan-Meier method and the log-rank test was used to assess the statistical significance of the various groups. The overall survivals at 3 years and 5 years were 71% and 65%, respectively, while the disease-free survivals at 3 years and 5 years were 73% and 63% respectively. Out of the 45 patients, only six had local recurrences, yielding an 87% locoregional freedom from relapse; 16 patients (35.6%) developed distant metastases, with the lung (8/16) being the commonest site. Patients treated for tumours of the nose and paranasal sinuses experienced more morbidity than those with tumours at other sites. Positive margins, perineural invasion and solid histology of ACC were associated with increased morbidity and treatment failure. Patients treated with combined therapy did better than those who underwent a single treatment modality.

Asunto(s)

Carcinoma Adenoide Quístico/terapia , Neoplasias de Cabeza y Cuello/terapia , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma Adenoide Quístico/secundario , Terapia Combinada , Supervivencia sin Enfermedad , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Factores Sexuales , Análisis de Supervivencia , Insuficiencia del Tratamiento

RESUMEN

Eleven patients, with a mean age of 57 years, who had undergone radial forearm flap reconstruction following the excision of intraoral carcinoma, underwent flap biopsy at a mean of 45 months postoperatively. Seven of the patients had received postoperative radiotherapy. In eight patients the clinical appearance of the flap was similar in colour to that of adjacent normal oral mucosa; the remaining flaps retained the appearance of normal volar forearm skin. Histological examination of the flaps showed varying degrees of telangiectasia and mild chronic inflammation. In only two patients was superficial infection by candida hyphae identified. Intraoral free flaps, although clinically resembling oral mucosa, retain histological features of skin, at least within the period under study. The erythematous clinical appearance was not correlated with the presence of chronic fungal infection, but reflected the presence of vascular repair tissue, telangiectasia and mild residual chronic inflammation.

Asunto(s)

Candidiasis Bucal/complicaciones , Neoplasias de la Boca/patología , Colgajos Quirúrgicos/patología , Adulto , Anciano , Biopsia/métodos , Candidiasis Bucal/patología , Estudios de Casos y Controles , Enfermedad Crónica , Eritema/etiología , Eritema/patología , Femenino , Humanos , Leucoplasia Bucal/etiología , Leucoplasia Bucal/patología , Masculino , Persona de Mediana Edad , Mucosa Bucal , Neoplasias de la Boca/radioterapia , Neoplasias de la Boca/cirugía , Radioterapia Adyuvante/métodos , Estudios Retrospectivos , Telangiectasia/etiología , Telangiectasia/patología

RESUMEN

The aim of this study was to examine the expression of MUC1 and MUC2 glycoproteins in laryngeal cancer and to determine if mucin expression is related to prognosis. The study included laryngeal specimens from 57 patients comprising of 36 laryngeal carcinomas and 21 normal controls. High MUC1 expression was found in both carcinomas and normal control groups (P = 0.689, Fisher's exact test). High levels of MUC2 expression were only detected in carcinomas versus controls (P = 0.009, Fisher's exact test). Using multivariate analysis neither MUC1 nor MUC2 expression significantly related to survival. MUC1 expression however, did correlate with T stage. Advanced T stage was associated with prognosis (P = 0.001).

Asunto(s)

Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/metabolismo , Neoplasias Laríngeas/genética , Neoplasias Laríngeas/metabolismo , Mucina-1/genética , Mucina-1/metabolismo , Mucinas/genética , Mucinas/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Monoclonales/metabolismo , Biomarcadores de Tumor , Carcinoma de Células Escamosas/mortalidad , Supervivencia sin Enfermedad , Femenino , Expresión Génica , Humanos , Inmunohistoquímica , Neoplasias Laríngeas/mortalidad , Masculino , Persona de Mediana Edad , Mucina 2 , Estadificación de Neoplasias , Pronóstico , Mucosa Respiratoria/metabolismo , Mucosa Respiratoria/patología , Estudios Retrospectivos

RESUMEN

The purpose of this study was to determine whether mucin expression is altered in laryngeal cancer. MUC1 and MUC2 mucin expression was examined in biopsy specimens from 80 patients that comprised 23 laryngeal dysplasias, 36 laryngeal carcinomas, and 21 normal larynx control specimens. High MUC1 expression was found in all 3 groups (P = 0.689, Fisher exact test). However, significantly higher levels of MUC2 expression were detected in carcinomas compared with dysplasias and control specimens (P = 0.009, Fisher exact test). Altered MUC2 expression may be an important step in carcinogenesis in laryngeal cancer.

Asunto(s)

Biomarcadores de Tumor/metabolismo , Carcinoma de Células Escamosas/metabolismo , Neoplasias Laríngeas/metabolismo , Mucina-1/metabolismo , Mucinas/metabolismo , Lesiones Precancerosas/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Femenino , Expresión Génica , Humanos , Inmunohistoquímica , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Mucina-1/genética , Mucina 2 , Mucinas/genética , Lesiones Precancerosas/patología , Mucosa Respiratoria/metabolismo , Mucosa Respiratoria/patología

RESUMEN

INTRODUCTION: Patients with skin involvement from head and neck cancer have a poor prognosis, with a median survival time of 2 months. METHOD AND RESULTS: During a 9 year period, 31 patients with skin involvement above the clavicle by non-cutaneous malignant tumours of the head and neck were treated. In 19 males and 12 females with a mean age of 62 years, the parotid gland (32%) and the oral cavity (29%) were the commonest sites of primary disease and 77% of the cases were squamous cell carcinomas. Twenty-six had recurrent disease, 20 had received previous radiotherapy and all underwent surgical resection with free flap reconstruction, the commonest being the radial forearm (78%). Complete histological clearance was achieved in 53% of the cases, and adjuvant post-operative irradiation was given to 60%. With this form of management, palliation was extended to a mean survival of 23 months. Six patients are currently alive and disease free at a mean follow up of 4.5 years. CONCLUSIONS: Patients with head and neck skin involvement by non-cutaneous head and neck malignancies have a very poor prognosis, but surgical resection combined with free microvascular flap reconstruction and planned post-operative radiotherapy, can offer good long-term palliation.

Asunto(s)

Neoplasias de Cabeza y Cuello/cirugía , Colgajos Quirúrgicos , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/secundario , Carcinoma de Células Escamosas/cirugía , Femenino , Neoplasias de Cabeza y Cuello/radioterapia , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Neoplasias Cutáneas/secundario , Neoplasias Cutáneas/cirugía

RESUMEN

OBJECTIVES: Qualitative comparison of the clinical, radiographic and histological outcomes in a small sample of cariously exposed primary molars, extracted after unsuccessful pulp treatment by two vital pulpotomy methods. SUBJECTS AND METHODS: The primary molars were extracted, because of treatment failure, during a longitudinal clinical investigation of the relative efficacy of 20% Buckley's Formocresol versus calcium hydroxide powder as pulp dressings in vital pulp therapy (in press). Fifty-two child patients were sequentially enrolled in the longitudinal clinical investigation, 26 boys and 26 girls. Primary molar teeth requiring vital pulp therapy were randomly allocated to either the formocresol group (F) or the calcium hydroxide group (C). Coronal pulp amputation was prescribed only in teeth with vital, cariously-exposed pulp tissue. All cases were reviewed using predefined clinical and radiological criteria. Seventy-nine cariously-exposed primary molars required vital pulp therapy. Forty-four teeth were included in group F and 35 in group C. Five per cent (n = 2) of teeth in group F and 11 per cent of teeth (n = 4) in group C were terminated from the trial due to clinical and/or radiographic failure. Of the six teeth extracted, five were sufficiently intact to be retained for histological evaluation. RESULTS: Post-extraction radiographs taken before specimen preparation showed reactionary dentine barrier (bridge) formation in teeth treated with calcium hydroxide. However, the narrowing of root canals, indicative of appositional reactionary dentine deposition, was seen in both groups (F and C). Histological examination confirmed these findings and revealed that pus cells were evident in all specimens examined. There was also histological evidence of resorption of reactionary dentine within the root canal and that forming the calcified barrier (dentine bridge). CONCLUSION: The clinical and radiographic outcomes for the five teeth correlate well with the reported findings from decalcified histological section. Although numbers are small, the histological findings may indicate possible reasons for treatment failure. There are few reports of this sort in the literature of this under-researched treatment modality.

Asunto(s)

Caries Dental/terapia , Diente Molar/patología , Pulpotomía/métodos , Diente Primario/patología , Hidróxido de Calcio/uso terapéutico , Niño , Preescolar , Caries Dental/diagnóstico por imagen , Caries Dental/patología , Calcificaciones de la Pulpa Dental/diagnóstico por imagen , Calcificaciones de la Pulpa Dental/patología , Recubrimiento de la Pulpa Dental , Exposición de la Pulpa Dental/diagnóstico por imagen , Exposición de la Pulpa Dental/patología , Exposición de la Pulpa Dental/terapia , Dentina Secundaria/diagnóstico por imagen , Dentina Secundaria/patología , Femenino , Formocresoles/uso terapéutico , Humanos , Estudios Longitudinales , Masculino , Diente Molar/diagnóstico por imagen , Radiografía , Irrigantes del Conducto Radicular/uso terapéutico , Supuración , Diente Primario/diagnóstico por imagen , Insuficiencia del Tratamiento , Cemento de Óxido de Zinc-Eugenol

RESUMEN

The occurrence of multiple tumours in the salivary glands is an unusual phenomenon and the simultaneous development of tumours different types is extremely rare. Two cases are presented with synchronous tumours of the parotid gland of different histological types. The first was a Warthin tumour in combination with a metastatic lung carcinoma and the second was a pleomorphic adenoma in combination with non-Hodgkin's malignant lymphoma.

Asunto(s)

Neoplasias Primarias Múltiples/patología , Neoplasias de la Parótida/patología , Adenolinfoma/patología , Adenoma Pleomórfico/patología , Anciano , Femenino , Humanos , Neoplasias Pulmonares/patología , Linfoma Folicular/patología , Masculino , Neoplasias Primarias Múltiples/cirugía , Neoplasias de la Parótida/cirugía

RESUMEN

The purpose of this study was to determine the oestrogen and progesterone receptor status of a selection of salivary tumours. Using immunohistochemistry, we detected nine oestrogen receptor and six progesterone receptor positive tumours from a sample of 36. One acinic cell carcinoma and two mucoepidermoid carcinomas demonstrated positivity for both receptors. We suggest that there may be role for oestrogen manipulation in the management of some salivary tumours.

Asunto(s)

Receptores de Estrógenos/análisis , Receptores de Progesterona/análisis , Neoplasias de las Glándulas Salivales/química , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad

RESUMEN

Twenty patients (12 men and 8 women, median age 69 years) with metastatic tumours in the parotid gland who presented over a 12-year period were evaluated retrospectively. Preoperative investigations included fine needle aspiration cytology (n = 11) and computed tomography or magnetic resonance imaging (MRI) (n = 14). Most tumours originated from the head and neck region, the two main types being squamous cell carcinoma (n = 10) and malignant melanoma (n = 7). All 20 presented with a parotid mass and 11/20 (55%) had associated lymphadenopathy. Eleven patients (55%) underwent superficial, five total, and four radical, parotidectomy. Neck dissection was required in 16 patients (80%), and all 11 patients with clinically palpable lymph nodes had evidence of tumour in the neck dissection specimens. Half of all patients (n = 10) received adjuvant postoperative radiotherapy. Three-quarters of the patients (n = 15) were alive after a mean follow-up of 31 months and only one developed a marginal recurrence. The cumulative 5-year survival rate was 51%, and there was no significant difference (P = 0.48) in the 3-year survival rates of patients who had radical compared with those who had modified neck dissections. Patients who had superficial parotidectomy had a longer overall survival compared with those who had total or radical parotidectomy (P = 0.04) perhaps reflecting the advanced nature of tumours that required total or radical excision of the gland. We conclude that superficial parotidectomy is usually an adequate treatment for secondary parotid tumours (when disease is clinically limited to the superficial lobe), and we suggest that patients in whom metastatic disease of the parotid gland is suspected do not require neck dissection if they have no palpable lymph nodes and MRI shows no evidence of spread. There seems to be no survival advantage in radical over modified neck dissection.

Asunto(s)

Neoplasias de la Parótida/secundario , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/secundario , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Neoplasias de Cabeza y Cuello/patología , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática/patología , Imagen por Resonancia Magnética , Masculino , Melanoma/patología , Melanoma/secundario , Persona de Mediana Edad , Disección del Cuello , Estadificación de Neoplasias , Glándula Parótida/cirugía , Neoplasias de la Parótida/diagnóstico , Neoplasias de la Parótida/terapia , Radioterapia Adyuvante , Estudios Retrospectivos , Tasa de Supervivencia , Tomografía Computarizada por Rayos X

RESUMEN

Chronic non-specific sialadenitis of the parotid gland is an insidious inflammatory disorder which is characterised by intermittent, often painful, swelling of the gland. The disease tends to progress and may lead to the formation of a fibrous mass. The purpose of this paper is to review our experience in the surgical management of patients with chronic non-specific parotid sialadenitis. In a consecutive series of 100 patients treated for benign parotid disease, 19 were found to have chronic non-specific sialadenitis; 10 were male and 9 female. Mean age was 46 years and the mean duration of symptoms was 4.6 years. Sialography was performed in two-thirds of the patients and 17 patients were treated by superficial parotidectomy. Thirteen patients developed temporary facial nerve weakness and three Frey's syndrome. Three patients complained of temporary paraesthesia of the cheek, and two developed painful neuroma of the greater auricular nerve. Although there were two cases of infection of the parotid duct remnant, no recurrence of deep lobe sialadenitis or fistula formation was noted. Histologically, 3 lesions showed mild chronic sialadenitis, the rest had widespread involvement of the gland, and prolonged duration of symptoms was associated with extensive and severe involvement of the gland. Superficial parotidectomy has a very high success rate, with minimal long-term complications, and should be offered early in established cases, to reduce unnecessary morbidity.

Asunto(s)

Parotiditis/cirugía , Adulto , Enfermedad Crónica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Parotiditis/diagnóstico por imagen , Parotiditis/patología , Complicaciones Posoperatorias , Radiografía , Resultado del Tratamiento

RESUMEN

Over an 18-year period, 147 patients with malignant tumours involving the maxillary complex were treated in a combined head and neck clinic, of whom 50 underwent surgery. There were 33 males and 17 females, the mean age was 57 years (range 11-87 years). The most common clinical presentations were either painful facial swelling, infraorbital anaesthesia, palatal ulceration or nasal obstruction. Preoperative investigations included EUA, biopsy and either CT or MRI scans. Of the 50 tumours, 62% were squamous cell carcinomas. Surgery consisted of either partial or total maxillectomy including craniofacial resection in nine patients. Reconstruction was by either split skin grafting or by free tissue transfer when the cranial contents had been exposed. Adjuvant radiotherapy was given in 82% of the patients. The mean follow-up was 5 years and 59% of patients are alive and disease free. The 5-year local control rate was 67%; it was greatly influenced by histological evidence of nerve invasion, local recurrence being the major cause of death. It was concluded that adequate surgical clearance, followed by planned postoperative radiotherapy, is the most effective treatment for malignant disease of the maxillary complex.

Asunto(s)

Neoplasias del Seno Maxilar/cirugía , Procedimientos de Cirugía Plástica/métodos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Neoplasias del Seno Maxilar/patología , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Trasplante de Piel , Colgajos Quirúrgicos , Resultado del Tratamiento

RESUMEN

Malignant parotid tumours are uncommon and present a significant management challenge. Fifty-one such patients (25 male, 26 female, median age 64 years) operated on in the Newcastle Plastic Surgery Unit between 1983 and 1994 were retrospectively evaluated. Preoperative investigations included FNA cytology (n = 20), and for staging CT and/or MRI scans (n = 21). Of the 35 primary tumours 32 were epithelial and three lymphomatous. Metastatic tumours were squamous cell carcinoma (7), melanoma (6), renal cell carcinoma (2) and sebaceous carcinoma (1). FNA cytology correctly diagnosed malignancy with an 88% sensitivity (false negatives = 2). A total or radical parotidectomy was required in 60% of patients, the rest undergoing superficial parotidectomy. In continuity neck dissection was undertaken in 23 (45%) cases. Postparotidectomy reconstruction included 10 free, 3 myocutaneous, and 4 local transposition/rotation flaps. Thirty-seven patients (73%) received postoperative radiotherapy. Seventy-two per cent of patients are alive after a mean follow-up of 42 months. The crude 5- and 10-year survival rates were 68% and 49% respectively while the loco-regional control rate (Kaplan-Meier method) at 10 years was 79%. Fifteen patients (30%) have permanent facial palsy. It is concluded that radical surgery with appropriate reconstruction followed by planned postoperative adjuvant radiotherapy gives effective control of malignant parotid tumours.

Asunto(s)

Neoplasias de la Parótida/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Biopsia con Aguja/métodos , Niño , Terapia Combinada , Enfermedades del Nervio Facial/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Paratiroidectomía , Neoplasias de la Parótida/patología , Neoplasias de la Parótida/radioterapia , Neoplasias de la Parótida/secundario , Cuidados Preoperatorios , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento

RESUMEN

A case of poorly differentiated adenocarcinoma of adnexal origin in the upper lip of a man aged 75 is reported which on presentation and initial biopsy was thought to be a salivary neoplasm. He had been aware of the lesion for 10 years but had sought treatment because of recent increase in size of the tumour. He subsequently developed bilateral metastases in cervical nodes. The histopathologic features and relationship of the tumour to the orbicularis oris muscle were consistent with a poorly differentiated adnexal adenocarcinoma of sweat-gland origin. Although carcinomas of skin adnexae are rare they should be considered in the differential diagnosis of tumours in the orofacial region.

Asunto(s)

Adenocarcinoma/patología , Neoplasias de los Labios/patología , Adenocarcinoma/secundario , Anciano , Biopsia , Diagnóstico Diferencial , Estudios de Seguimiento , Humanos , Metástasis Linfática/patología , Masculino , Neoplasias de las Glándulas Salivales/patología , Neoplasias de las Glándulas Sudoríparas/patología