Preservación de la glándula submandibular en las disecciones linfonodulares de cuello
11 May 2015-Vol. 52, Iss: 3, pp 61-77
TL;DR: Los estudios coinciden en el bajo riesgo de metastasis ocultas a the glandula por carcinomas escamosos de cabeza y cuello, xerostomia post-quirurgica y factibilidad of the tecnica quirurgica como fundamentos para preservar the submandibular.
Abstract: Introduccion: El desarrollo acelerado de la Oncologia ha condicionado recientes modificaciones terapeuticas que pudieran incluir la preservacion de la glandula submandibular en las disecciones de cuello. Objetivos : identificar los criterios para preservar quirurgicamente la glandula submandibular y exponer los fundamentos cientifico-teoricos que permitan plantear una modificacion actual a la tecnica de diseccion de cuello al conservar dicha glandula. Metodo : se realizo una busqueda exhaustiva retrospectiva de articulos publicados en las bases de datos electronicas PUBMED, MEDLINE, COCHRANE e HINARI desde Enero 2009 hasta Julio de 2014; en las revistas Head and Neck , Otolaryngology and Head and Neck Surgery y The Laryngoscope c on los terminos: “preservacion glandula submandibular”, “criterios oncologicos conservar glandula submandibular”, “modificaciones disecciones linfonodulares cervicales”, sin restricciones idiomaticas. Ademas de cumplir con estos requisitos se incluyeron solo los articulos cuyo material y metodo reflejara: estudios poblacionales, disecciones de cuello como tratamiento oncoespecifico y confirmacion anatomo-patologica para concluir el diagnostico. Fecha de publicacion: ultimos 5 anos. Resultados : de 3 estudios que conformaron una meta-poblacion de 829 pacientes, donde se preservo la glandula submandibular en un grupo de pacientes con tumores de cavidad bucal y orofaringe y disecciones de cuello simultaneas, se evidencio que no hubo diferencias en cuanto a recaida local, regional, a distancia ni sobrevida al compararlos con otro grupo de pacientes donde la diseccion de cuello no incluyo este proceder. Conclusion : los estudios coinciden en el bajo riesgo de metastasis ocultas a la glandula por carcinomas escamosos de cabeza y cuello, xerostomia post-quirurgica y factibilidad de la tecnica quirurgica como fundamentos para preservar la submandibular, de igual manera en que la ausencia de terapia oncoespecifica anterior, linfonodulos positivos en el subnivel IB y relacion entre el tumor primario y la glandula son criterios necesarios en la seleccion de candidatos para llevar a cabo este proceder.
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01 Jan 2013
TL;DR: The authors investigated and analyzed the retrospective charts of 236 patients who underwent surgery for OCSCC over a 10-year period and the pathology reports of 294 neck dissections with SMG removal to determine the frequency and the mechanism of submandibular gland involvement in oral cavity squamous cell carcinomas.
Abstract: SUMMAry The aim of this study was to determine the frequency and the mechanism of submandibular gland (SMg) involvement in oral cavity squamous cell carcinomas (oCSCC), and to discuss the necessity of extirpation of the gland. The authors investigated and analyzed the retrospective charts of 236 patients who underwent surgery for oCSCC over a 10-year period and the pathology reports of 294 neck dissections with SMg removal. SMg involvement was evident in 13 cases (4%). Eight cases were due to direct invasion, which was the most common mechanism. Four cases had infiltration from a metastatic periglandular lymphadenopathy, and in 1 case, metastatic disease was confirmed. The tongue and floor of the mouth were the most frequent primary sites associated with SMg involvement. The study found no bilateral cases, and in 135 SMg specimens benign pathologies were detected. involvement of the SMg in oCSCC is not frequent. it is appropriate to preserve the gland unless the primary tumour or metastatic regional lymphadenopathy is adherent to the gland.
27 citations
References
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TL;DR: A meta-analysis showed that elective neck dissection reduced the risk of disease-specific death, and this reduction in disease- specific death rate supports the need to perform electiveneck dissection in oral cancers with clinical N0 neck.
143 citations
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TL;DR: The aim of the present study was to investigate the available literature regarding the oral side effects or adverse events associated with targeted cancer therapy, and determine if the initial impression that targeted therapy produces milder oral toxicities than conventional cancer treatment is accurate.
125 citations
TL;DR: Postoperative complications in 206 submandibular gland excisions, excluding those resulting from benign or malignant tumours, carried out during a 15-year period were reviewed, and in those cases with a permanent neurological deficit, the facial nerve was the most often affected.
Abstract: Summary Postoperative complications in 206 submandibular gland excisions, excluding those resulting from benign or malignant tumours, carried out during a 15-year period were reviewed. Most patients (62%) had sialolithiasis. Coexistence of sialolithiasis and nephrolithiasis was documented in 5.5% of cases. Early postoperative complications (particularly infection) developed in 14.6% of the cases, whereas late complications appeared in 25.3% of the cases (residual inflammation in Wharton's duct 7.3%). Neurological complications were observed in 16% of the cases. In 7 cases (3.4%) several nerves were involved and almost always the hypoglossal nerve. In 37.4% of the cases, these lesions resolved spontaneously in a mean period of 4 months. In those cases with a permanent neurological deficit, the facial nerve was the most often affected (7.7%) followed by the hypoglossal (2.9%) and the lingual nerve (1.4%). A single case of gustatory sweating (Frey's) syndrome was observed.
115 citations
TL;DR: The shortcomings of the current TNM classification system will be discussed, along with suggestions for improvement and expansion of the TNM system based on tumor, patient, and environment‐related factors.
Abstract: Staging systems for cancer, including the most universally used TNM classification system, have been based almost exclusively on anatomic information. However, the question arises whether staging systems should be based on this information alone. Other parameters have been identified that should be considered for inclusion in classification systems like the TNM. This is all the more important, as a shift toward nonsurgical treatments for head and neck cancer has been made over the years. For these treatment modalities tumor/biologic characteristics next to anatomic information may be particularly important for treatment choice and outcome. The shortcomings of the current TNM classification system will be discussed, along with suggestions for improvement and expansion of the TNM system based on tumor, patient, and environment-related factors. Further improvement of the TNM classification is expected to result in better treatment choices, outcome and prognostication of patients with head and neck cancer.
103 citations
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TL;DR: The role of stem/progenitor cells play in the response to radiation and the factors that can influence stem/generator induced proliferation and differentiation are discussed in this article, and the mobilization and transplantation of stem cells and supportive cells and their potential to attenuate radiation-induced salivary gland damage are discussed.
Abstract: Hyposalivation underlying xerostomia after radiotherapy is still a major problem in the treatment of head and neck cancer. Stem cell therapy may provide a means to reduce radiation-induced hyposalivation and improve the quality of life of patients. This review discusses the current status in salivary gland stem cell research with respect to their potential to attenuate salivary gland dysfunction. Knowledge on the embryonic development, homeostasis and regeneration after atrophy of the salivary glands has provided important knowledge on the location of the salivary gland as well as on the factors that influence proliferation and differentiation. This knowledge has helped to locate, isolate and characterize cell populations that contain the salivary gland stem cell, although the exact tissue stem cell is still unidentified. The role that stem/progenitor cells play in the response to radiation and the factors that can influence stem/progenitor induced proliferation and differentiation are discussed. Finally, the mobilization and transplantation of stem cells and supportive cells and their potential to attenuate radiation-induced salivary gland damage are discussed. Based on the major advances made in the field of stem cell research, stem cell-based therapy has great potential to allow prevention or treatment of radiation-induced hyposalivation.
102 citations