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: The purpose of this retrospective chart review was to determine whether and how the submandibular gland is involved in metastases of squamous cell carcinoma of the head and neck.
Abstract: Background. The purpose of this retrospective chart review was to determine whether and how the subman- dibular gland is involved in metastases of squamous cell car- cinoma of the head and neck. Methods. We reviewed the records of all patients for whom pathology specimens were available after neck dissection for primary head and neck cancers at two institutions. Results. One hundred sixty-nine patients were included in the study, 27 underwent bilateral neck dissections, and 196 submandibular glands were resected and sent for pathology. One hundred forty-four glands had normal histologic findings. Normal or benign histologic changes were present in 187 glands. Three submandibular glands showed invasion from a locally in- volved lymph node, and six had direct extension from a primary lesion. The primary lesions were all ipsilateral to the involved gland and originated from cancers of the floor of the mouth, al- veolar ridge, and tongue. No submandibular glands showed pathologic evidence of metastases. Conclusions. Because the submandibular gland has no in- traparenchymal lymph nodes, its involvement in upper aerodi- gestive tract carcinomas must be through extension from a locally involved lymph node or the primary tumor. Previous work has demonstrated that the submandibular gland can undergo transplantation out of the neck with subsequent reimplantation, as a possible means of protection from the effects of radiation. We demonstrated the submandibular gland to be involved only in cases of ipsilateral oral cavity tumors or metastasis to ip- silateral level I lymph nodes. We conclude that it is oncologically sound to consider transplantation and replantation of the con- tralateral submandibular gland for patients with head and neck squamous cell carcinoma when level I lymph nodes are unlikely to be involved. A 2004 Wiley Periodicals, Inc. Head Neck 26: 1064-1068, 2004
61 citations
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TL;DR: The available evidence suggests the UW-QOL is the most appropriate screening tool to assess appearance issues in clinical practice and the DAS24 shows promise as a research tool for improving understanding of how appearance affects QOL in HNC patients.
Abstract: Summary Background Facial disfigurement is often experienced by head and neck cancer (HNC) patients following surgery and has a significant impact on their quality of life (QOL). The aim of the current review is to assess patient-reported outcome (PRO) measures for use in HNC patients, appraise the psychometric properties of QOL instruments that include an appearance domain and determine which instrument/s might be the most appropriate for use in HNC patients in clinical practice and research. Method A systematic search of the English-language literature was performed using the Medline and PsycINFO electronic databases. PRO measures designed to assess QOL and the impact of disfigurement on QOL were identified. Instruments were evaluated based on their development and validation criteria, appearance domain content and use in assessing QOL outcomes in HNC patients. Results From 530 articles, 18 QOL questionnaires were identified. Only five PRO instruments were considered suitable for review: University of Washington QOL questionnaire (UWQOLQ); Head and Neck Survey (HNS); European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck 35 (EORTC QLQ-HN Derriford Appearance Scale 59 (DAS59) and the Derriford Appearance Scale 24 (DAS24). The UW-QOL has better coverage of appearance issues than the EORTC QLQ-H&N35 and the HNS, is well validated and demonstrates promising psychometric properties. The DAS24 and DAS59 which are devoted solely to appearance issues and are not specific to HNC, have had psychometric properties tested in large scale studies, but have only been used in clinical practice in a limited number of studies. Conclusion The available evidence suggests the UW-QOL is the most appropriate screening tool to assess appearance issues in clinical practice. The DAS24 shows promise as a research tool for improving understanding of how appearance affects QOL in HNC patients.
60 citations
TL;DR: This work aimed to study the incidence of metastasis to the submandibular gland (SMG) and to establish the oncologic basis of SMG preservation in early‐stage cancer of the oral cavity (OSCC).
Abstract: Background. We aimed to study the incidence of metastasis to the submandibular gland (SMG) and to establish the oncologic basis of SMG preservation in early-stage cancer of the oral cavity (OSCC). Methods. This was a retrospective study of 261 patients with OSCC treated primarily with surgery at a tertiary medical center. One hundred thirty-two early-stage (T1-2, N0) OSCCs were further analyzed. Results. The mean age was 59 years with male-to-female sex ratio of 1.4:1. Two hundred sixty-one neck dissections were performed with SMG removal in 253 patients. One patient with an advanced floor of mouth cancer had obvious infiltration of the SMG. Only 2.5% (3 of 116) patients with early-stage OSCC had level I metastasis; none had SMG metastases. Conclusion. SMG preservation in early cancers (T1-2, N0) of the oral cavity should be feasible unless there is evidence of direct invasion of the gland or close proximity of the cancer to it. V C 2009 Wiley Periodicals, Inc. Head Neck 31: 1619- 1623, 2009
55 citations
TL;DR: Lip cancer is a frequent disease of the oral cavity and general agreement has been reached concerning stage T and N+ surgical treatment, unresolved questions remain with regard to N0 treatment.
50 citations
TL;DR: The marginal mandibular nerve may be injured during neck dissection, particularly of level 1, and the rate of injury is underreported in the literature and its impact on patients is not well defined.
Abstract: Background. Neck dissection to remove cervical lymph nodes is common practice in head and neck cancer management. The marginal mandibular nerve may be injured during neck dissection, particularly of level 1. The rate of injury to this nerve is underreported in the literature and its impact on patients is not well defined.Methods. An observational study was undertaken on patients who had undergone neck dissection over a 5-year period. The patients were examined for weakness and given a questionnaire related their perception of their appearance and their function.Results. Sixty-six patients were identified who had undergone 85 neck dissections. The rate of House Brackmann injury was 18% when analyzed by patient and 23% by neck. There were moderate correlations between observed injury and subjective responses to questions relating to ability to smile and weakness of the lower lip.Discussion. The rate of smile asymmetry following neck dissection is relatively high; however, severe injuries to the marginal mandibular nerve are uncommon. (C) 2009 Wiley Periodicals, Inc. Head Neck 31: 673-678, 2009
49 citations