RESUMO
OBJECTIVE: Since the tongue is the oral structure responsible for mastication, pronunciation, and swallowing functions, patients who undergo glossectomy can be affected in various aspects of these functions. The vowel /i/ uses the tongue shape, whereas /u/ uses tongue and lip shapes. The purpose of this study is to investigate the morphological changes of the tongue and the adaptation of pronunciation using cine MRI for speech of patients who undergo glossectomy. MATERIAL AND METHODS: Twenty-three controls (11 males and 12 females) and 13 patients (eight males and five females) volunteered to participate in the experiment. The patients underwent glossectomy surgery for T1 or T2 lateral lingual tumors. The speech tasks "a souk" and "a geese" were spoken by all subjects providing data for the vowels /u/ and /i/. Cine MRI and speech acoustics were recorded and measured to compare the changes in the tongue with vowel acoustics after surgery. 2D measurements were made of the interlip distance, tongue-palate distance, tongue position (anterior-posterior and superior-inferior), tongue height on the left and right sides, and pharynx size. Vowel formants Fl, F2, and F3 were measured. RESULTS: The patients had significantly lower F2/Fl ratios (F=5.911, p=0.018), and lower F3/F1 ratios that approached significance. This was seen primarily in the /u/ data. Patients had flatter tongue shapes than controls with a greater effect seen in /u/ than /i/. CONCLUSION: The patients showed complex adaptation motion in order to preserve the acoustic integrity of the vowels, and the tongue modified cavity size relationships to maintain the value of the formant frequencies.
Assuntos
Glossectomia/reabilitação , Fala/fisiologia , Língua/patologia , Língua/fisiopatologia , Adulto , Análise de Variância , Pontos de Referência Anatômicos , Estudos de Casos e Controles , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Faringe/patologia , Faringe/fisiopatologia , Período Pós-Operatório , Valores de Referência , Estudos Retrospectivos , Acústica da Fala , Neoplasias da Língua/patologia , Neoplasias da Língua/fisiopatologia , Neoplasias da Língua/cirurgia , Resultado do TratamentoRESUMO
ABSTRACT Objective Since the tongue is the oral structure responsible for mastication, pronunciation, and swallowing functions, patients who undergo glossectomy can be affected in various aspects of these functions. The vowel /i/ uses the tongue shape, whereas /u/ uses tongue and lip shapes. The purpose of this study is to investigate the morphological changes of the tongue and the adaptation of pronunciation using cine MRI for speech of patients who undergo glossectomy. Material and Methods Twenty-three controls (11 males and 12 females) and 13 patients (eight males and five females) volunteered to participate in the experiment. The patients underwent glossectomy surgery for T1 or T2 lateral lingual tumors. The speech tasks “a souk” and “a geese” were spoken by all subjects providing data for the vowels /u/ and /i/. Cine MRI and speech acoustics were recorded and measured to compare the changes in the tongue with vowel acoustics after surgery. 2D measurements were made of the interlip distance, tongue-palate distance, tongue position (anterior-posterior and superior-inferior), tongue height on the left and right sides, and pharynx size. Vowel formants Fl, F2, and F3 were measured. Results The patients had significantly lower F2/Fl ratios (F=5.911, p=0.018), and lower F3/F1 ratios that approached significance. This was seen primarily in the /u/ data. Patients had flatter tongue shapes than controls with a greater effect seen in /u/ than /i/. Conclusion The patients showed complex adaptation motion in order to preserve the acoustic integrity of the vowels, and the tongue modified cavity size relationships to maintain the value of the formant frequencies.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Faringe/patologia , Fala/fisiologia , Língua/fisiopatologia , Língua/patologia , Glossectomia/reabilitação , Faringe/fisiopatologia , Período Pós-Operatório , Valores de Referência , Acústica da Fala , Neoplasias da Língua/cirurgia , Neoplasias da Língua/fisiopatologia , Neoplasias da Língua/patologia , Estudos de Casos e Controles , Estudos Retrospectivos , Análise de Variância , Resultado do Tratamento , Imagem Cinética por Ressonância Magnética , Pontos de Referência Anatômicos , Estadiamento de NeoplasiasRESUMO
The aim of this study was to describe the clinical features of 18 cases of metastatic tumors to the oral cavity. The files of patients seen between 1992 and 2009 with oral (soft tissue and jawbones) metastatic lesions were reviewed. Clinical features, including gender, age, site of the primary tumor, site of metastatic tumor and treatment were evaluated. Patients were 11 males and 7 females, with mean age of 64.6 years. In males, most primary tumors originated in the lungs. In females, the lung and breast were the most common sites of the primary tumors. The mandible was the main site for the development of the metastatic lesions and the most common histologic type was adenocarcinoma. Treatment modalities included radiotherapy, chemotherapy and surgical resection. Metastatic lesions should be considered in the differential diagnosis of oral lesions, particularly when a previous history of cancer is present.
Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/secundário , Boca/patologia , Adenocarcinoma/terapia , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Terapia Combinada , Diagnóstico Diferencial , Tratamento Farmacológico , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/terapia , Procedimentos Cirúrgicos Bucais , Radioterapia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
PURPOSE: The ability of oral squamous cell carcinoma to metastasize to lymph nodes does not always show a relationship with clinical staging. The aim of this study was to attempt to define a trend for predictive histopathologic and/or molecular biomarkers in the development of nodal metastasis by analyzing 2 clinically extreme groups. PATIENTS AND METHODS: Patients with small primary tumors (T1, T2) with lymph node metastasis and patients with large primary tumors (T3, T4) without metastatic disease were identified among 315 consecutive cases of primary oral squamous cell carcinoma. Group comparisons were made with use of a Mann-Whitney test, and associations among the variables were assessed with nonparametric and parametric correlational analyses. RESULTS: The degree of keratinization was significantly less in primary tumors with lymph node metastasis (P < or = .01). The degree of keratinization was significantly associated with nuclear pleomorphism (P =.02), number of mitoses (P =.02), stage of invasion (P =.002), and p53 expression (P =.04), independent of clinical stage of the tumor. Other microscopic features and immunohistochemical markers did not differ significantly between the groups (P >.05). CONCLUSION: These data indicate that there still is no single predictive parameter superior to the degree of keratinization to identify patients at risk for the development of regional metastasis.