Abstract Background With the COVID-19 pandemic, the clinical practice of physicians who work in the head and neck field in Brazil dropped dramatically. The sustained impact of the pandemic is not known. Methods An anonymous online survey was distributed to Brazilian otolaryngologists, head and neck surgeons, medical and radiation oncologists, asking about their clinical practice in the third to fourth months of the pandemic. Results The survey was completed by 446 specialists. About 40 % reported reduction of more than 75 % in outpatient care. A reduction of 90 % to 100 % in airway endoscopies was reported by 50 % of the responders, and the same rate of reduction regarding surgeries (pediatric or nasosinusal) was reported by 80 % of them. Family income decreased by 50 %, and the psychological burden on physicians was considerable. The availability of personal protective equipment and safety precautions were limited, especially in the public sector. Conclusion COVID-19 is still impacting the head and neck field, and safety concerns may hinder the prompt resumption of elective care.
Abstract Introduction: Trismus has been considered a late complication of cancer treatment. It can occur prior to treatment, mainly caused by tumor invasion or muscle spasms induced by the presence of the tumor. Objective: In this study, we evaluated the incidence of trismus and its effect on oral health in patients with malignant neoplasms of the oral cavity before performing the cancer treatment. Methods: This review was carried out via interviews, visual clinical inspection and objective measurement of maximal mouth opening in 35 consecutive patients. Trismus was defined as a maximal mouth opening <35 mm. Results: Trismus was observed in 15 patients, with a total incidence of 42%. A high rate of tooth loss was recorded, and trismus association with tooth loss was statistically verified using the Chi-square and Fisher's exact tests, the t-student test and Mann-Whitney non-parametric test. All tests were performed at p < 0.05. Conclusion: Edentulous patients are eight times more likely to have trismus compared to patients that are partially and fully dentate. Trismus was demonstrated to be correlated with tooth loss; however other oral health conditions were not shown to be a modifying factor.
Resumo Introdução: O trismo tem sido considerado uma complicação tardia do tratamento do câncer, pode ocorrer antes do tratamento, causado principalmente por invasão tumoral ou espasmos musculares induzidos pela presença do tumor. Objetivo: Avaliar a incidência do trismo e seu efeito sobre a saúde bucal em pacientes com neoplasias malignas da cavidade bucal antes de se submeterem ao tratamento do câncer. Método: Esta revisão foi realizada por meio de entrevistas, inspeção clínica visual e mensuração objetiva da abertura bucal máxima em 35 pacientes consecutivos. O trismo foi definido como abertura bucal máxima < 35 mm. Resultados: O trismo foi observado em 15 pacientes, com uma incidência de 42%. Uma alta taxa de perda dentária foi registrada e a associação do trismo com a perda dentária foi verificada estatisticamente com os testes qui-quadrado, exato de Fisher, t de Student e não paramétrico de Mann-Whitney. Todos os testes foram realizada com p < 0,05. Conclusão: Pacientes edêntulos são oito vezes mais propensos a ter trismo do que os pacientes parcial e totalmente dentados. O trismo demonstrou estar correlacionado com a perda dentária. Entretanto, as outras condições de saúde bucal não se mostraram um fator modificador.
The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread exponentially worldwide. In Brazil, the number of infected people diagnosed has been increasing and, as in other countries, it has been associated with a high risk of contamination in healthcare teams. For healthcare professionals, the full use of personal protective equipment (PPE) is mandatory, such as wearing surgical or filtering facepiece class 2 (FFP2) masks, waterproof aprons, gloves, and goggles, in addition to training in care processes. A reduction in the number of face-to-face visits and non-essential elective procedures is also recommended. However, surgery should not be postponed in the case of the most essential elective indications (mostly associated with head and neck cancers). As malignant tumors of the head and neck are clinically time sensitive, neither consultations for these tumors nor their treatment should be postponed. Postponing surgical treatment can result in a change in the disease stage and alter an individual's chance of survival. In this situation, planning of all treatments must begin with the request for, in addition to routine examinations, a nasal swab polymerase chain reaction for SARS-CoV-2 and chest computed tomography. Only if the results of these tests are positive or if fever or other symptoms suggestive of COVID-19 are present should the surgical procedure be postponed until the patient completely recovers. This is mandatory not only because of the risk of contamination of the surgical team but also because of the increased risk of postoperative complications and high risk of death. During this pandemic, the most effective safety measures are social distancing for the general public and the adequate availability and use of PPE in the healthcare field. The treatment of other chronic diseases, such as cancer, should be continued, as the damming of cases of these diseases will have a deleterious effect on the public healthcare system.
Introduction: Mucoepidermoid carcinoma (MEC) is the most common malignant salivary gland tumor, however few studies have been reported in Brazilian populations. Objective: To report clinical and pathologic data from 173 head and neck MEC treated in the Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo in São Paulo. Study design: Clinical randomized. Material and Method: From 1953 to 1997, 173 cases of MEC were found in the files of the Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo. Data were obtained from the patients' records and histological review of all cases. Results: The mean age of the patients was 44 years and 93 (53,8%) were men; parotid glands were affected in 61 cases (35,2%) and intra-oral minor salivary glands in 75 (43,4%). TNM revealed 50,3% of the cases in stages I and II, and histological grading revealed 45,2%, 18,5% and 36,3% low-grade, intermediate-grade and high-grade tumors, respectively. Surgical treatment was employed in 80,3% of the cases, with neck dissection in 52 cases (30,1%), and radiotherapy in 73 (42,2%). Local recurrence, regional and distant metastasis were found in 12,7%, 9,8% and 9,2% of the patients, respectively; 5-year and 10-year overall survival rates were 70% and 60%, respectively. Conclusions: MEC affected mainly the parotid gland and the palate of adults, without gender predilection. Half of the cases were diagnosed in initial clinical stages and 64% of the tumors were low or intermediate-grade lesions. Surgery was the treatment of choice and prognosis was good.
Introdução: Carcinoma mucoepidermóide (CME) é o tumor maligno mais comum de glândulas salivares, entretanto poucos estudos em populações brasileiras têm sido relatados na literatura. Objetivo: Reportar os dados clínico-patológicos de 173 CME de cabeça e pescoço do Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo em São Paulo. Forma de estudo: Clínico randomizado. Material e Método: Cento e setenta e três casos de CME tratados entre 1953 e 1997, obtidos dos arquivos do Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo foram utilizados no estudo. Os dados foram obtidos a partir dos prontuários e da revisão histológica de todos os casos. Resultados: A idade média dos pacientes foi de 44 anos e 93 (53,8%) eram homens. Parótida foi acometida em 61 casos (35,2%) e as glândulas salivares menores intra-orais em 75 (43,4%), TNM revelou 50,3% dos casos em estádios I e II, e a gradação histológica revelou 45,2%, 18,5% e 36,3% tumores de baixo grau, grau intermediário e alto grau de malignidade, respectivamente. Tratamento cirúrgico foi utilizado em 80,3% dos casos, complementado por esvaziamento cervical em 52 casos (30,1%) e radioterapia em 73 (42,2%). Recidiva local, recidiva regional e metástase a distância foram encontradas em 12,7%, 9,8% e 9,2% dos pacientes, respectivamente, e a sobrevida global dos pacientes em 5 e 10 anos foi de 70% e 60%, respectivamente. Conclusões: A avaliação dos 173 casos de CME de cabeça e pescoço mostrou que estes tumores ocorreram preferencialmente na glândula parótida e no palato de indivíduos adultos, sem predileção por sexo. Metade dos casos encontravam-se em estádios clínicos iniciais e 64% dos tumores eram de grau baixo ou intermediário de malignidade. O tratamento de escolha foi cirúrgico e o prognóstico dos pacientes foi bom.