RESUMO
BACKGROUND: Prophylactic neck dissection (PND) is indicated when the chance of occult lymph node metastases from head and neck tumors is significant. There is no consensus regarding which tumor size PND would be indicated in cases of lip cancer. METHODS: A total of 139 patients with surgically treated lip cancer were selected. The size of the lesion (T) and the presence of lymph node metastases (N) were assessed by examining the medical records. For analysis purposes, the T2 group was divided into T2a (2 to 3 cm) and T2b (3 to 4 cm). RESULTS: The following distribution of incidence of neck metastases was observed in the study groups: 11.7% in T1, 9% in T2a, 43.7% in T2b, and 52.2% in T3+T4. Statistical comparison of the groups (p) revealed the following results: T2aXT2b=0.03; T2aXT3+T4=0.001. CONCLUSION: PND is indicated for tumors larger than 3 cm.
Assuntos
Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/secundário , Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Labiais/patologia , Excisão de Linfonodo , Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Metástase Linfática , Carcinoma de Células Escamosas de Cabeça e PescoçoRESUMO
OBJECTIVE: The objective of this experimental prospective study on an animal model was to determine the rate of autologous fat graft absorption in 24 paralyzed canine left vocal folds 12 weeks after introduction. METHODS: Forty mongrel dogs of both sexes weighing 15 to 20 kg were divided into three study groups (SGs) of eight dogs each whose larynges were grafted by vocal fold lipoinjection (VFL-SGA), vocal fold lipoinjection plus insulin (VFLi-SGB), and by fat graft medialization laryngoplasty (FGML-SGC) and observed for 12 weeks. Two control groups (CGs) of eight dogs each were submitted to fat graft medialization laryngoplasty (FGML-CG1) and by vocal fold lipoinjection (VFL-CG2), respectively, followed by immediate killing. All 40 dogs were submitted to left vagal and recurrent laryngeal nerve resection. All animals were confirmed to have a left vocal fold paralysis 4 weeks later when 2 mL of autologous fat graft was placed inside the left paraglottic space. The larynges were removed at preestablished times and studied for remaining fat graft volume by magnetic resonance imaging. RESULTS: The mean volume obtained by imaging were 1.9388 mL for CG1, 1.0476 mL for CG2, 0.1924 mL for VFL, 0.336 mL for VFLi, and 0.565 mL for FGML. CG1 and CG2 did not differ significantly from one another but differed from the SGs, with statistical analysis suggesting a lower absorption of the fat graft in FGML. CONCLUSION: The absorption rate was 82% in SGA, 68% in the SGB, and 71% in SGC.
Assuntos
Tecido Adiposo/transplante , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/cirurgia , Animais , Modelos Animais de Doenças , Cães , Feminino , Injeções Intralesionais , Laringe , Imageamento por Ressonância Magnética , Masculino , Transplante Autólogo , Paralisia das Pregas Vocais/terapiaRESUMO
Introdução: Desde a primeira laringectomia total, realizada em 1873, já se tem registro do interesse em se desenvolver e recuperar a comunicabilidade verbal desses pacientes. Porém grandes progressos foram observados depois de 1979, quando se pode contar com próteses traqueoesofágicas. Mesmo sendo um enorme progresso, as próteses vocais geram complicações. Objetivo: Avaliar as complicações com o emprego de próteses vocais e relaciona-las com fatores clínicos e tipo de prótese. Métodos: Dez pacientes submetidos a laringectomia total portando prótese fonatória foram acompanhados no serviço de Cirurgia de Cabeça e Pescoço do HCRP-FMRP-USP buscando-se registrar as complicações e relaciona-las com fatores clínicos e tipo de prótese. Resultados: Foram registrados: vazamento de saliva e/ou dieta da faringe para a traquéia, infecção fungica, ausência de função da prótese e esses achados foram quantificados avaliando-se os efeitos da radioterapia e do tipo de prótese usada. Conclusão: A prótese vocal apresenta dificuldades e complicações operacionais que merecem atenção e mais estudos são necessários para se ter o perfil mais completo destes aspectos.