Abstract Objectives To prospectively compare the results of microvascular flap reconstruction of midface and scalp advanced oncologic defects using superficial temporal versus cervical as recipient vessels. Methods This is a parallel group clinical trial with 1:1 allocation ratio of patients who underwent midface and scalp oncologic reconstruction with free tissue flap from April 2018 to April 2022 in a tertiary oncologic center. Two groups were analyzed: those in whom superficial temporal vessels were used as the recipient vessels (Group A) and those in whom cervical vessels were used as the recipient vessels (Group B). Patient gender and age, cause and localization of the defect, flap choice for reconstruction, recipient vessels, intraoperative outcome, postoperative course, and complications were recorded and analyzed. A Fisher’s exact test was used to compare outcomes between the 2 groups. Results On the basis of the different recipient vessels, 32 patients were randomized into 2 groups, and of these 27 patients completed the study: Group A with superficial temporal recipient vessels (n = 12) and Group B with cervical recipient vessels (n = 15). There were 18 male and 09 female patients with an average age of 53.92 ± 17.49 years. The overall flap survival rate was 88.89%. The overall complication rate for vascular anastomosis was 14.81%. The total flap loss rate in patients with superficial temporal recipient vessels was higher than the complication rate in those with cervical recipient vessels but with no statistical significance (16.67% vs. 6.66%, p= 0.569). Minor complications occurred in 05 patients without statistical significance between the groups (p= 0.342). Conclusion In the group with superficial temporal recipient vessels, the postoperative rate of free flap complications was similar than the cervical recipient vessel group. Therefore the use of superficial temporal recipient vessels for midface and scalp oncologic reconstruction could be a reliable option.

Abstract Introduction Supracricoid laryngectomy still has selected indications; there are few studies in the literature, and the case series are limited, a fact that stimulates the development of new studies to further elucidate the structural and functional aspects of the procedure. Objective To assess voice and deglutition parameters according to the number of preserved arytenoids. Methods Eleven patients who underwent subtotal laryngectomy with cricohyoidoepiglottopexy were evaluated by laryngeal nasofibroscopy, videofluoroscopy, and auditory-perceptual, acoustic, and voice pleasantness analyses, after resuming oral feeding. Results Functional abnormalities were detected in two out of the three patients who underwent arytenoidectomy, and in six patients from the remainder of the sample. Almost half of the sample presented silent laryngeal penetration and/or vallecular/ hypopharyngeal stasis on the videofluoroscopy. The mean voice analysis scores indicated moderate vocal deviation, roughness and breathiness; severe strain and loudness deviation; shorter maximum phonation time; the presence of noise; and high third and fourth formant values. The voices were rated as unpleasant. There was no difference in the number and functionality of the remaining arytenoids as prognostic factors for deglutition; however, in the qualitative analysis, favorable voice and deglutition outcomes were more common among patients who did not undergo arytenoidectomy and had normal functional conditions. Conclusion The number and functionality of the preserved arytenoidswere not found to be prognostic factors for favorable deglutition efficiency outcomes. However, the qualitative analysis showed that the preservation of both arytenoids and the absence of functional abnormalities were associated with more satisfactory voice and deglutition patterns.

ObjectiveThe aim of the present study was to identify a fast, efficient and low-cost method to diagnose hypoparathyroidism after total thyroidectomy.Materials and methodsOne hundred and forty medical records, which contained patients’ clinical and laboratory data, were retrospectively analyzed. Patient parathyroid hormone values, which were obtained immediately following operation, were compared with their ionized calcium levels the morning after surgery. This comparison was used to examine the correlation between the two variables in predicting hypoparathyroidism because measuring calcium levels is low-cost and more available in the hospitals compared to measuring parathormone (PTH) levels.ResultsThere was a positive and statistically significant correlation between PTH and ionized calcium values (Pearson correlation coefficient, r = 0.456; p < 0.0001). The values of first postoperative day ionized calcium levels (stratified by the 1.10 mmol/l cut-off value) were tested as a diagnostic measure for hypoparathyroidism, and a PTH < 15 pg/mL obtained immediately following operation served as a reference. This analysis showed that ionized calcium levels measured on the first postoperative day had a sensitivity of 45.6% (95% CI 30.9-61.0%), a specificity of 88.9% (95% CI 80.5-94.5%) and an accuracy of 76.7% (95% CI 68.7-83.5%) as a diagnostic measure for hypoparathyroidism.ConclusionIn conclusion, we demonstrated that patients who had high ionized calcium levels on the first postoperative day also had high PTH levels immediately following operation and, therefore, they had lower rates of hypoparathyroidism.

INTRODUÇÃO: O esvaziamento cervical eletivo é realizado de maneira sistemática nos casos de carcinoma espinocelular da cavidade oral sem linfonodos clinicamente comprometidos devido à alta incidência de metástases ocultas. OBJETIVO: Avaliar pacientes com carcinoma espinocelular de cavidade oral tratados com esvaziamento cervical eletivo quanto a fatores preditivos para ocorrência de metástases ocultas e o impacto das mesmas na sobrevivência global e livre de progressão destes pacientes. MÉTODO: Quarenta pacientes cirurgicamente tratados foram avaliados em estudo retrospectivo. RESULTADOS: Dez casos (25%) apresentaram metástases ocultas. Das variáveis analisadas, invasão perineural e angiolinfática e também a espessura tumoral foram estatisticamente significantes à análise univariada. Apenas a invasão angiolinfática foi fator independente de risco de metástases ocultas pela regressão logística (OR = 39,3; p = 0,002). A presença de metástase oculta não apresentou diferença estatisticamente significante em relação às taxas de sobrevivência global e livre de progressão. CONCLUSÃO: A incidência de metástase oculta foi semelhante à literatura. A invasão perineural, angiolinfática e a espessura tumoral foram fatores associados à presença de metástase oculta, porém apenas a invasão angiolinfática apresentou-se como um fator de risco independente para ocorrência do fenômeno.

INTRODUCTION: Elective neck dissection is recommended in cases of oral cavity squamous cell carcinoma without lymph node metastasis because of the risk of occult metastasis. OBJECTIVE: The present study aimed to evaluate predictive factors for occult lymph node metastasis in patients with oral cavity squamous cell carcinoma treated with elective neck dissection and their impact on overall and disease-free survival. METHODS: Forty surgically treated patients were retrospectively included. RESULTS: Ten cases (25%) had lymphatic metastasis. Of the studied variables, perineural and angiolymphatic invasion in addition to tumor thickness were statistically associated with lymph node metastasis. Only angiolymphatic invasion was identified as an independent risk factor for occult metastasis in the logistic regression (OR = 39.3; p = 0.002). There was no association between overall and disease-free survival with the presence of occult lymph node metastasis. CONCLUSION: Metastatic disease rate was similar to that found in the literature. Perineural and angiolymphatic invasion and tumor thickness were associated with occult metastasis, but only angiolymphatic invasion showed to be an independent risk factor

A pesquisa médico-farmacológica clínica corresponde à aplicação experimental de determinada droga em seres humanos. Seu controle visa proteger os sujeitos de efeitos adversos inaceitáveis e de ineficiência do medicamento testado diante de outras possibilidades mais eficientes. Parcerias entre a indústria farmacêutica e pesquisadores externos estabelecem potenciais conflitos de interesses. Consulta bibliográfica realizada neste estudo indica que pesquisas com financiamento da indústria farmacêutica têm proporção mais alta de resultados favoráveis e que os conflitos de interesses representam vieses, podendo alterar resultados. Há estudos que comparam a eficácia de diferentes drogas e outros que comparam seus custos. Mesmo resultados negativos devem ser publicados. Conclui que o setor privado deve financiar a ciência para beneficiar o ser humano, especialmente no combate à doença; no entanto, deve manter empenho em financiar as pesquisas sem influenciar seus desenhos, resultados e destinações, caminhando em direção ao respeito à dignidade da pessoa.

The clinical medical pharmacological research corresponds to the experimental application of specific drug in human beings. Such application aims to protect them from unacceptable adverse effects and its inefficiency when comparing with other possibilities, more efficient. Partnerships between the pharmaceutical industry and external researchers establish potential conflict of interest. Literature use for this work indicates that researches performed under the sponsorship of pharmaceutical industry have a high rate of favorable results, and the conflicts of interest represent gaps which may interfere the result. There are studies that compare the efficiency of different drugs, whereas others compare their costs. All results should be published, even when negative. The present work concludes that the private sector must sponsor the science in order to improve human beings, especially to avoid diseases. However, it must keep its engagement in sponsoring the research with any influence on its methods, results and application, for a respectful understanding of the dignity of a person.

La investigación médico-farmacológica clínica corresponde a la aplicación experimental de determinado fármaco en seres humanos. Su control tiene como objetivo proteger los sujetos de efectos adversos inaceptables e ineficaces del fármaco probado. Relaciones entre la industria farmacéutica e investigadores externos establecen potenciales conflictos de intereses. En una consulta bibliográfica llevada a cabo en este estudio indica que investigaciones con financiación de la industria farmacéutica tienen proporción más elevada de resultados favorables y que los conflictos de intereses representan sesgos que pueden cambiar los resultados. Hay estudios que la eficiencia de distintos fármacos, mientras otros comparan sus costos. Todos los resultados obtenidos deben ser publicados, incluyendo cuando se los obtienen negativos. Se concluye que el sector privado deberá financiar la ciencia para beneficio del hombre, especialmente en el combate a la enfermedad. Sin embargo, La industria debería mantener su empeño en financiar las investigaciones sin influenciar su diseño, resultados y destinación caminando hacia a la comprensión de la persona en su dignidad.

O estudo imunoistoquímico tem sido empregado para a avaliação do diagnóstico diferencial de neoplasia. OBJETIVO: Avaliar o uso do método nos casos de câncer de cabeça e pescoço. MÉTODO: Estudo retrospectivo de casos do Registro Hospitalar de Câncer da instituição. RESULTADOS: De 704 resultados anatomopatológicos, a imunoistoquímica foi realizada em 76 (11%). A maioria correspondeu a carcinomas - 85,80% e, destes, 83,66% eram epidermoides. Todos os exames foram para fins diagnósticos. Houve maior frequência para o uso de 34BE12 (37,18%), AE1/AE3 (35,90%), 35BH11 (28,21%), CD45 (25,64%), CD20 (24,36%), CD30 (24,36%), CK7 (23,08%) e CD3 (23,08%). CONCLUSÃO: A imunoistoquímica foi usada em 10,67% dos casos de câncer de cabeça e pescoço submetidos a exame anatomopatológico, sendo maior para os carcinomas -- 5,26%. Na determinação do carcinoma epidermoide, seu uso foi de 18,42% do total de neoplasias.

Immunohistochemistry (IHC) has been employed in the differential diagnosis of tumors. OBJECTIVE: To assess the use of IHC in cases of head and neck tumor. METHOD: This is a retrospective study of the cases included in the Cancer Registry of the institution. RESULTS: IHC was used in 76 (11%) of 704 pathology tests. Most cases were carcinomas (85.80%), and 83.66% of them were squamous cell carcinomas. All tests were done with diagnostic purposes. The most frequently used antibodies were 34BE12 (37.18%), AE1/AE3 (35.9%), 35BH11 (28.21%), CD45 (25.64%), CD20 (24.36%), CD30 (24.36%), CK7 (23.08%) and CD3 (23.08%). CONCLUSIONS: IHC was used in 10.67% of the head and neck tumor cases submitted to pathology testing, mostly for carcinoma (5.26%). In the determination of squamous cell carcinoma, IHC accounted for 18.42% of all tumors.

A presença de linfonodos metastáticos é aspecto relevante no prognóstico do câncer bucal. OBJETIVO: Avaliar a densidade do linfonodo metastático (pN+) em pacientes com carcinoma espinocelular (CEC) de língua e soalho bucal e sua relação com a sobrevida livre de doença (SLD). MÉTODOS: De 1985 a 2007, 182 pacientes foram avaliados, dos quais 169 eram homens, sendo cinco estádio I, 35 estádio II, 56 estádio III e 85 estádio IV. A densidade do linfonodo foi mensurada por meio de sua mediana e a SLD pelo método de Kaplan-Meier e a diferença de grupo pelo teste log-rank. RESULTADOS:Após média de dissecção de 3,2 linfonodos metastáticos com pacientes, a densidade variou de 0,009 a 0,4, com média 0,09. A SLD a 5 anos foi de 44% e 28% para grupos com densidade linfonodal abaixo e acima da mediana (p = 0,006). O controle loco-regional a 2 anos foi de 71% e 49% para os casos com densidade abaixo e acima da mediana (p = 0,01). Quanto ao estádio pN, o controle loco-regional foi de 70% e 54% para os casos pN1 e pN2, sem significância estatística (0,20%). CONCLUSÃO: A densidade linfonodal pode ser utilizada como indicador prognóstico no CEC de língua e soalho bucal.

The presence of metastatic lymph nodes is a relevant prognostic factor in oral cancer. OBJECTIVE: This paper aims to assess metastatic lymph node density (pN+) in patients with tongue and floor-of-mouth squamous cell carcinoma (SCC) and the association of this parameter with disease-free survival (DFS). MATERIALS AND METHODS: A group of 182 patients seen between 1985 and 2007 was included, 169 of which were males. Five were on stage I, 35 on stage II, 56 on stage III, and 85 on stage IV. Median values were considered in lymph node density assessment, and the Kaplan-Meier curve was used to evaluate DFS; survival differences within the group were elicited through the log-rank test. RESULTS: An average 3.2 metastatic lymph nodes were excised from the patients in the group. Density ranged from 0.009 to 0.4, with a mean value of 0.09. Five-year DFS rates were of 44% and 28% for the groups with lymph node densities below and above the median respectively (p = 0.006). Two-year local/regional control was achieved for 71% and 49% for the patients below and above the median density respectively (p = 0.01). In terms of pN staging, local/regional control was achieved in 70% and 54% of pN1 and pN2 patients respectively, albeit without statistical significance (0.20%). CONCLUSION: Lymph node density may be used as a prognostic indicator for tongue and floor-of-mouth SCC.

Entre os pacientes portadores de carcinoma espinocelular do lábio inferior, atendidos no período de janeiro de 1980 a dezembro de 1989, no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, analisamos, retrospectivamente, 58 prontuários. além dos dados demográficos, as informações relativas aos pacientes foram completadas com anotações sobre o uso de álcool, fumo e exposição solar. O estadio clínico na época da cirurgia, bem como as características macroscópicas dos tumores, o tipo de tratamento instituído e as observações do seguimento pós-operatório também foram anotados. Foi, então, realizada uma minuciosa revisão anatomopatológica dos espécimes cirúrgicos, analisando o grau de diferenciação histológica, espessura, máxima tumoral, elastose solar, invasão perineural, invasão vascular, invasão muscular, margens cirúrgicas, infiltrado inflamatório peritumoral e acometimento ganglionar, com ou sem rotura capsular. a análise da sobrevida global a 5 anos demonstrou diferenças estatisticamente significativas para as variávies espessura tumoral, tamanho do tumor (T) e acometimento ganglionar.

The charts of 58 patients with squamous-cell carcinomas of the lower lip, treated at the General Hospital of the University of São Paulo Medical School from January 1980 to December 1989, were retrospectively analyzed. In addition to regular demographic data, all available information was collected regarding: smoking and drinking habits; sun exposure; clinical stage; macroscopic features of the primary lesions; type of treatment; and follow-up. A meticulous pathological analysis, comprising the histologic differentiation grade, maximal tumor thickness, sun elastosis, perineural spread, vascular and muscular invasion, surgical margins, peritumoral inflammatory infiltrate, and positive lymph nodes, with or without extracapsular spread, was undertaken as well. The evaluation of the overall 5-year survival showed significant statistical differences, with prognostic implications, for the following variables: maximal tumor thickness, T-stage and positive nodes.