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 marginal mandibular nerve courses superficial to the facial artery at approximately one-fourth of the distance from the masseteric tuberosity to the mental midline, a reliable and safe approach to surgery of the lower face.
36 citations
TL;DR: A moderate risk of injury to the marginal mandibular branch of the facial nerve (MMN) after neck dissection in level I B whereas the corresponding risk after level II A dissection was negligible.
Abstract: The immediate and permanent frequency of injury to the marginal mandibular branch of the facial nerve (MMN) after neck dissection has only scarcely been addressed in the medical literature. We investigated the risk of injury in 159 consecutive patients after neck dissection for various reasons in level I B and level II A, respectively. In 95 patients with oral cancer 13 (14%) of the cases had malfunction of the lower lip domain 2 weeks after neck dissection in level I B indicating paresis to the MMN. Follow-up analyses 1-2 years after the operation showed permanent paralysis in 4 to 7% of the cases in whom two of them had the nerve sacrificed for oncologic reasons during the operation. In 18 patients with parotic cancer the corresponding permanent frequency of MMN paralysis was 11.1%. In 46 patients with neck dissection in level II A but not in level I B, no paresis of the MMN was registered. Recognition of the MMN during the operation, pre- or postoperative radiation therapy, re-operation for deep hemorrhage, age, gender or postoperative infection did not have any statistically significant influence on the frequency of MMN injury. In conclusion we found a moderate risk of injury to the MMN after neck dissection in level I B whereas the corresponding risk after level II A dissection was negligible.
35 citations
TL;DR: Preservation of the ipsilateral submandibular gland during neck dissection is oncologically safe, except in patients with prior surgery or radiotherapy, or a primary tumour in close relation to the gland.
Abstract: Aim To investigate the incidence of metastasis to the submandibular gland in patients with head and neck squamous cell carcinoma. Methods We retrospectively evaluated histological reports of neck dissections for upper respiratory tract carcinoma (performed 2002-2009), recording: primary tumour site, tumour-node-metastasis stage, level Ib involvement, previous radiotherapy, perineural invasion, lymphovascular invasion, extracapsular spread, and the presence of malignant disease in the submandibular gland. Results We evaluated 107 cases. The most common primary site was the oral cavity (49 per cent) followed by the supraglottis (21 per cent), glottis (14 per cent), oropharynx (9 per cent) and hypopharynx (6 per cent). Forty-eight per cent of patients had advanced local disease, with 21 per cent at tumour stage 3 and 27 per cent at tumour stage 4. Fifty-six per cent had cervical lymph node metastasis, and 8 per cent received pre-operative radiotherapy. Forty-eight per cent had perineural invasion, 46 per cent lymphovascular spread, 27 per cent extracapsular spread and 8 per cent level Ib metastasis. Only one patient had submandibular gland involvement, due to direct spread (a case with prior radiotherapy and macroscopic submandibular gland involvement evident peri-operatively). Conclusion Submandibular gland metastasis from head and neck primary squamous cell carcinoma is extremely rare. Preservation of the ipsilateral submandibular gland during neck dissection is oncologically safe, except in patients with prior surgery or radiotherapy, or a primary tumour in close relation to the gland.
34 citations
TL;DR: This study was carried out for the purpose of evaluating the efficacy of submandibular gland transfer to prevent radiation‐induced xerostomia.
Abstract: Background. This study was carried out for the purpose of evaluating the efficacy of submandibular gland transfer to prevent radiation-induced xerostomia. Methods. Thirty-eight patients with oropharyngeal carcinoma were recruited. Twenty-six submandibular glands were transferred into the submental space to elude radiotherapy in 24 patients (transfer group); the submandibular gland was not disturbed in the control group (n ¼ 14). The salivary flow rate, xerostomia, and quality of life (QOL) were assessed preoperatively, postoperatively, and after radiotherapy. The swallowing function was then evaluated after radiotherapy. Results. All the transferred glands survived and functioned after radiotherapy. The submandibular salivary flow rate recovered by 6 months after radiotherapy in the transfer group, whereas the flow rate declined drastically after radiotherapy and remained at a low level in the longer term in the control group. Two years after radiotherapy, 92.3% of patients in the transfer group had no or minimal xerostomia. QOL in the transfer group was better than that in the control group from 3 months after radiotherapy. Histologically, the majority of the transferred glands had normal glandular acini and ducts. There was no significant difference in dysphagia between the groups. Conclusions. The submandibular gland can be successfully transferred to the submental space, thus preserving salivary function and preventing radiation-induced xerostomia. The transfer of the submandibular gland can improve the QOL by alleviating xerostomia, although it did not relieve dysphagia in this study. V C 2011 Wiley Periodicals, Inc. Head Neck 34: 937-942, 2012 Radiation is a primary or secondary therapeutic modality in most patients with head and neck cancer, resulting in salivary gland dysfunction in almost all patients. Xerosto- mia is the most common side effect of radiotherapy (RT) for head and neck cancer, occurring in up to 90% of patients who undergo this conventional treatment. 1 Xero- stomia is a significant problem that causes impairment of mastication, deglutition, gustation, and phonation, increas- ing the risk of dental caries and oropharyngeal candidia- sis. Ultimately, this can lead to decreased nutritional intake and weight loss. These all have a negative impact on the quality of life (QOL) of the patients. Several preventative strategies are being explored to address the problem of radiation-induced xerostomia. Novel strategies, including the transfer of the submandib- ular gland, 2 the use of amifostine, 3 and intensity-modu- lated radiation treatment (IMRT) to spare the parotid and/ or submandibular gland 4,5 have met with varying degrees of success. Because the submandibular glands contribute 2 thirds of the resting production of saliva (approximately 200-300 mL/day/1 gland), it is feasible that xerostomia would be alleviated if the function of the submandibular gland was preserved by being surgically transferred to the submental space before RT. The purpose of this study was to evaluate the efficacy of submandibular gland transfer to prevent radiation-induced xerostomia.
34 citations
TL;DR: This study examined functional outcomes related to 2 saliva‐sparing treatments: (1) oral pilocarpine during radiotherapy; or the submandibular salivary gland transfer (SGT) before radiotherapy.
Abstract: Background
Xerostomia has a devastating impact on oral function and quality of life in patients who receive radiation treatment for head and neck cancer. The purpose of this study was to examine functional outcomes related to 2 saliva-sparing treatments: (1) oral pilocarpine during radiotherapy; or (2) the submandibular salivary gland transfer (SGT) before radiotherapy.
Methods
Sixty-nine patients were recruited (SGT = 36; pilocarpine = 33). Speech intelligibility, swallowing outcomes, and quality of life were assessed at 4 points in time (pretreatment, and 1 month, 6 months, and 12 months after the pretreatment assessment).
Results
There were no differences between groups in speech outcomes; however, significant between-group differences existed in swallowing and quality of life outcomes. In all cases, patients who received the SGT procedure had better swallowing outcomes and quality of life scores than the patients who received oral pilocarpine.
Conclusion
The SGT should be the treatment of choice between the 2 treatments offered to prevent xerostomia in the present study. © 2011 Wiley Periodicals, Inc. Head Neck, 2012
34 citations