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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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Citations
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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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Journal ArticleDOI
TL;DR: The data of the present study support the contention that submandibular gland resection causes a decrease in unstimulated salivary volume and the compensatory salivARY mechanism seems not to be a possibility.

41 citations

Journal ArticleDOI
TL;DR: The technique of submandibular SGT is reproducible in a multicenter setting and seventy-four percent of patients were prevented from XRT-induced acute xerostomia.
Abstract: Purpose We report the results of a phase II study to determine the reproducibility of a submandibular salivary gland transfer (SGT) surgical technique for prevention of radiation (XRT)-induced xerostomia in a multi-institutional setting and to assess severity of xerostomia. Methods and Materials Eligible patients had surgery for primary, neck dissection, and SGT, followed by XRT, during which the transferred salivary gland was shielded. Intensity modulated radiation therapy, amifostine, and pilocarpine were not allowed, but postoperative chemotherapy was allowed. Each operation was reviewed by 2 reviewers and radiation by 1 reviewer. If 13 or more (of 43) were "not per protocol," then the technique would be considered not reproducible as per study design. The secondary endpoint was the rate of acute xerostomia, grade 2 or higher, and a rate of ≤51% was acceptable. Results Forty-four of the total 49 patients were analyzable: male (81.8%), oropharynx (63.6%), stage IV (61.4%), median age 56.5 years. SGT was "per protocol" or within acceptable variation in 34 patients (77.3%) and XRT in 79.5%. Nine patients (20.9%) developed grade 2 acute xerostomia; 2 had grade 0-1 xerostomia (4.7%) but started on amifostine/pilocarpine. Treatment for these 11 patients (25.6%) was considered a failure for the xerostomia endpoint. Thirteen patients died; median follow-up for 31 surviving patients was 2.9 years. Two-year overall and disease-free survival rates were 76.4% and 71.7%, respectively. Conclusions The technique of submandibular SGT is reproducible in a multicenter setting. Seventy-four percent of patients were prevented from XRT-induced acute xerostomia.

41 citations

Journal ArticleDOI
TL;DR: The lateral transcervical approach is still used as standard in the authors' institution for patients who cannot be managed by gland-sparing procedures, and no patients had damage to the hypoglossal nerve.
Abstract: In transcervical resection of the submandibular gland for benign lesions, only a limited risk of damage to neural structures can be accepted and a cosmetically satisfactory result is mandatory. In this retrospective case series, we evaluated 139 patients operated over a 10-year period and completed long-term clinical follow-up of 113 of these patients after a median of 81 months. In all patients, the operation was effective. We found a 4.3 % risk of reoperation for wound infection or postoperative hematomas and an 18.7 % risk of early paresis of the marginal branch of the facial nerve, which decreased to 2.7 % on long-term follow-up. We found a 4.4 % risk of permanent lingual nerve paresis, and no patients had damage to the hypoglossal nerve. Xerostomia was found in 22.1 % of the patients and could be quantified by the easily performed biscuit test. Only 2.5 % reported an unsatisfactory cosmetic result and all scars were ≤ 6 on the Vancouver Scar Scale. Problems with scarring were more common if there had been postoperative infection. We continue to use the lateral transcervical approach as standard in our institution for patients who cannot be managed by gland-sparing procedures.

40 citations

Journal ArticleDOI
TL;DR: Over 92% of LR failures occurred “in-field” within the high dose region when using intensity-modulated radiotherapy with whole salivary gland-sparing strategy, and sparing SMG and OC in addition to PG thus appears a safe strategy.
Abstract: The objective was to analyze locoregional (LR) failure patterns in patients with head-and-neck cancer (HNC) treated using intensity-modulated radiotherapy (IMRT) with whole salivary gland-sparing: parotid (PG), submandibular (SMG), and accessory salivary glands represented by the oral cavity (OC). Seventy consecutive patients with Stage I-II (23%) or III/IV (77%) HNC treated by definitive IMRT were included. For all LR failure patients, the FDG-PET and CT scans documenting recurrence were rigidly registered to the initial treatment planning CT. Failure volumes (Vf) were delineated based on clinical, radiological, and histological data. The percentage of Vf covered by 95% of the prescription isodose (Vf-V95) was analyzed. Failures were classified as “in-field” if Vf–V95 ≥ 95%, “marginal” if 20% < Vf-V95 < 95%, and “out-of-field” if Vf-V95 ≤20%. Correlation between Vf-V95 and mean doses (Dmean) in the PG, SMG, and OC was assessed using Spearman’s rank-order correlation test. The salivary gland dose impact on the LR recurrence risk was assessed by Cox analysis. The median follow-up was 20 months (6–35). Contralateral and ipsilateral PGs were spared in 98% and 54% of patients, respectively, and contralateral and ipsilateral SMG in 26% and 7%, respectively. The OC was spared to a dose ≤40 Gy in 26 patients (37%). The 2-year LR control rate was 76.5%. One recurrence was “marginal”, and 12 were “in-field”. No recurrence was observed in vicinity of spared structures. Vf-V95 was not significantly correlated with Dmean in PG, SMG, and OC. The LR recurrence risk was not increased by lower Dmean in the salivary glands, but by T (p = 0.04) and N stages (p = 0.03). Over 92% of LR failures occurred “in-field” within the high dose region when using IMRT with a whole salivary gland-sparing strategy. Sparing SMG and OC in addition to PG thus appears a safe strategy.

39 citations

Journal ArticleDOI
TL;DR: The hypoglossal nerve provides motor innervation to the tongue, and may be affected by pathology at multiple locations along its pathway.
Abstract: The hypoglossal nerve provides motor innervation to the tongue, and may be affected by pathology at multiple locations along its pathway. Knowledge of its anatomy and careful examination of the tongue are important in the diagnosis of lesions and determination of appropriate testing. The hypoglossal nerve anatomy and physiology, clinical disorders, and the evaluation of the hypoglossal nerve are reviewed.

38 citations