RESUMO
OBJECTIVE: To determine the prevalence, epidemiological profile, and clinical characteristics of Oral or Oropharyngeal Mucosal Lesions (OOPML) in patients attended at the Otorhinolaryngology Service of the Evandro Chagas National Institute of Infectious Diseases (INI-FIOCRUZ) from 2005 to 2017. METHODS: Statistical analysis of descriptive data from medical records (gender, age, education level, skin color, origin, smoking, alcoholism, HIV co-infection, time of disease evolution, first symptom, and OOPML location) was performed. RESULTS: Of 7551 patients attended at the service, 620 (8.2%) were included in the study. OOPML were classified into developmental anomalies (nâ¯=â¯3), infectious diseases (non-granulomatous nâ¯=â¯220; granulomatous nâ¯=â¯155), autoimmune diseases (nâ¯=â¯24), neoplasms (benign nâ¯=â¯13; malignant, nâ¯=â¯103), and unclassified epithelial/soft tissue diseases (nâ¯=â¯102). OOPML of infectious diseases (60.5%) and neoplasms (18.7%) were the most frequent. The predominant demographics of patients with OOPML were: males (63.5%), white (53.5%), and those in the fifth to sixth decades of life (43.3%). Local pain (18.1%) and odynophagia (15%) were the most reported first symptoms, and the most frequent OOPML sites were the palatine tonsil (28.5%), hard palate (22.7%), and tongue (20.3%). The median evolution time was three months. CONCLUSIONS: Infectious OOPML were the most frequent, as expected in a reference center for infectious diseases, and thus, they are likely to be less frequent in general care and/or dental services. Underreporting of OOPML is possible, as oral/oropharyngeal examination is often not included in the routine medical examination. Oral cavity/oropharynx examination should be performed by specialists, such as dentists and otorhinolaryngologists, who have the expertise in identifying OOPML, even in incipient/asymptomatic cases. Given the numerous diseases in which OOPML can present, diagnosis could be facilitated by multidisciplinary teams, potentially enabling the early treatment of diseases, and thus, reduce morbidity and improve prognosis. The use of standardized medical records for oral/oropharyngeal systematic examination could provide relevant tools for differential diagnoses and information for new clinical-epidemiological studies. LEVEL OF EVIDENCE: Level 3.
Assuntos
Doenças da Boca , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Doenças da Boca/epidemiologia , Adulto Jovem , Adolescente , Criança , Idoso , Prevalência , Pré-Escolar , Mucosa Bucal/patologia , Brasil/epidemiologia , Lactente , Idoso de 80 Anos ou mais , Doenças Faríngeas/epidemiologia , Estudos RetrospectivosRESUMO
BACKGROUND: The orthopantomography is a diagnostic tool with a relevant role in the precocious detection of pathologies and anomalies of the head and neck, such as calcifications of the soft tissues. The digital orthopantomography is the most used image diagnostic tool in dentistry. It is a low cost easily taken radiography that allows the visualization of the mandible, maxillae, and other craniofacial structures without exposing the patient to high doses of radiation. Given the exposed, the aim of this study has a great relevance since it aims to evaluate the prevalence of atheroma plaques and tonsilloliths with digital panoramic radiography in Northeast Brazilian population. METHODS: A total of 500 digital orthopantomography were evaluated, but only 365 were eligible to be included in this study. The soft tissue calcification was classified in tonsilolith and atherosclerosis. Sex and age were correlated with calcification using Fisher´s test. Following an interexaminer analysis was perfomed using the kappa test. RESULTS: Calcifications were diagnosed in 6 radiographics, being 3 tonsiloliths and 3 Atherosclerosis. Atherosclerosis was found only in patients over 40 years old. This finding was statistically significant P≤0.05. CONCLUSIONS: Although, the prevalence of calcifications in soft tissues is low, the detection of these pathologies through the digital panoramic radiography becomes relevant once vascular diseases could be diagnosed at early stages, enabling thus an adequate management of the underlying clinical condition.
Assuntos
Calcinose/diagnóstico por imagem , Calcinose/epidemiologia , Cálculos/diagnóstico por imagem , Cálculos/epidemiologia , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/epidemiologia , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/epidemiologia , Radiografia Panorâmica , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Feminino , Cabeça/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Prevalência , Estudos Retrospectivos , Adulto JovemRESUMO
Abstract: Objective: To determine the prevalence and risk factors for oral high-risk human papillomavirus (HR-HPV) infection in human immunodeficiency virus(HIV)-infected men. Materials and methods: Consecutive male outpatients with HIV-infection were enrolled. Demographic and behavioral risk data were obtained. Anal swabs and oral rinses were tested for HR-HPV DNA. Oral, pharyngeal and video laryngoscopy examinations were performed for detection of lesions. Results: The prevalence of HR-HPV oral infection was 9.3% (subtypes other than HR HPV 16/18 predominated). The prevalence of anal HR-HPV infection was 75.7%. The risk factors for oral infection with HR-HPV were tonsillectomy (OR=13.12) and years from HIV diagnosis (OR=1.17). Conclusions: Tonsillectomy and years from HIV diagnosis were associated with oral HPV infection. No association was found between oral and anal HR-HPV infections. This is the first study reporting the prevalence and risk factors for oral HR-HPV infection in Mexican HIV-infected population.
Resumen: Objetivo: Determinar la prevalencia y los factores de riesgo para infección oral por virus de papiloma humano de alto riesgo (VPH-AR) en individuos con VIH. Material y métodos: Se incluyeron pacientes ambulatorios consecutivos con VIH. Se recabó información demográfica y sobre factores de riesgo conductuales. Se detectó DNA de VPH-AR en hisopado rectal y enjuague bucal. Se efectuó exploración de boca, faringe y videolaringoscopía para detectar lesiones. Resultados: La prevalencia de VPH-AR oral fue 9.3% (predominaron subtipos diferentes de VPH-AR 16/18). La prevalencia de VPH-AR anal fue 75.7%. Los factores de riesgo para VPH-AR oral fueron la tonsilectomía (OR=13.12) y los años de diagnóstico del VIH (OR=1.17). Conclusiones: La tonsilectomía y los años de diagnóstico del VIH se asociaron con VPH-AR oral. No hubo asociación entre VPH-AR oral y anal. Este es el primer reporte sobre prevalencia y factores de riesgo para VPH-AR oral en población mexicana con VIH.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Doenças Faríngeas/epidemiologia , Infecções por HIV/epidemiologia , Infecções por Papillomavirus/epidemiologia , Doenças da Boca/epidemiologia , Doenças do Ânus/epidemiologia , Papiloma/virologia , Comportamento Sexual , Consumo de Bebidas Alcoólicas/epidemiologia , Neoplasias Bucais/epidemiologia , Fumar/epidemiologia , Comorbidade , Infecções por HIV/sangue , Estudos Transversais , Estudos Prospectivos , Inquéritos e Questionários , Contagem de Linfócito CD4 , México/epidemiologiaRESUMO
SUMMARY: The role of systemic inflammatory response as a prognostic factor has been proposed in a variety of cancers. The purpose of this study was to investigate the prognostic value of the pretreatment neutrophil-to-lymphocyte ratio (NLR) in the incidence of pharyngocutaneous fistula (PCF) in patients who underwent total laryngectomy. We conducted a retrospective cohort analysis of 141 patients with squamous cell carcinoma of larynx who underwent total laryngectomy from 2009 to 2015. The incidence of PCF was 49.6%. A higher risk of 23% was observed among patients with NLR > 2.5 for the occurrence of PCF (p = 0.007). Patients with laryngeal squamous cell carcinoma who present elevated values in the ration > LR> (> 2.5) presented a higher risk of developing pharyngocutaneous fistula in the postoperative setting of total laryngectomy.
Assuntos
Fístula Cutânea/sangue , Fístula/sangue , Laringectomia , Linfócitos , Neutrófilos , Doenças Faríngeas/sangue , Complicações Pós-Operatórias/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Estudos de Coortes , Fístula Cutânea/epidemiologia , Feminino , Fístula/epidemiologia , Humanos , Incidência , Neoplasias Laríngeas/cirurgia , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Estudos RetrospectivosRESUMO
OBJECTIVE: To determine the prevalence and risk factors for oral high-risk human papillomavirus (HR-HPV) infec- tion in human immunodeficiency virus(HIV)-infected men. MATERIALS AND METHODS: Consecutive male outpatients with HIV-infection were enrolled. Demographic and behav- ioral risk data were obtained. Anal swabs and oral rinses were tested for HR-HPV DNA. Oral, pharyngeal and video laryngoscopy examinations were performed for detection of lesions. RESULTS: The prevalence of HR-HPV oral infection was 9.3% (subtypes other than HR HPV 16/18 predominated). The prevalence of anal HR-HPV infection was 75.7%. The risk factors for oral infection with HR-HPV were tonsillectomy (OR=13.12) and years from HIV diagnosis (OR=1.17). CONCLUSIONS: Tonsillectomy and years from HIV diagnosis were associated with oral HPV infection. No association was found between oral and anal HR-HPV infections. This is the first study reporting the prevalence and risk factors for oral HR-HPV infection in Mexican HIV-infected population.
OBJETIVO: Determinar la prevalencia y los factores de riesgo para infección oral por virus de papiloma humano de alto ries- go (VPH-AR) en individuos con VIH. MATERIAL Y MÉTODOS: Se incluyeron pacientes ambulatorios consecutivos con VIH. Se recabó información demográfica y sobre factores de riesgo conductuales. Se detectó DNA de VPH-AR en hisopado rectal y enjuague bucal. Se efectuó exploración de boca, faringe y videolaringoscopía para detectar lesiones. RESULTADOS: La prevalencia de VPH-AR oral fue 9.3% (predominaron subtipos diferentes de VPH-AR 16/18). La prevalencia de VPH-AR anal fue 75.7%. Los factores de riesgo para VPH-AR oral fueron la tonsilectomía (OR=13.12) y los años de diagnóstico del VIH (OR=1.17). CONCLUSIONES: La tonsilectomía y los años de diagnóstico del VIH se asociaron con VPH-AR oral. No hubo asociación entre VPH-AR oral y anal. Este es el primer reporte sobre prevalencia y factores de riesgo para VPH-AR oral en población mexicana con VIH.
Assuntos
Infecções por HIV/epidemiologia , Doenças da Boca/epidemiologia , Infecções por Papillomavirus/epidemiologia , Doenças Faríngeas/epidemiologia , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Doenças do Ânus/epidemiologia , Doenças do Ânus/virologia , Contagem de Linfócito CD4 , Comorbidade , Estudos Transversais , Infecções por HIV/sangue , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Doenças da Boca/virologia , Neoplasias Bucais/epidemiologia , Neoplasias Bucais/virologia , Papiloma/epidemiologia , Papiloma/virologia , Doenças Faríngeas/virologia , Prevalência , Estudos Prospectivos , Fatores de Risco , Assunção de Riscos , Comportamento Sexual , Fumar/epidemiologia , Inquéritos e Questionários , Tonsilectomia/estatística & dados numéricos , Carga Viral , Adulto JovemRESUMO
OBJECTIVE: To evaluate the incidence of pharyngocutaneous fistula after total laryngectomy and try to identify its predictors. METHODS: From May 2005 to April 2010, 93 patients underwent total laryngectomy. We evaluated complications during and after surgery and compared them with the following variables: gender, nutritional status, previous tracheotomy, tumor location, type of surgery, TNM staging, prior treatment with chemotherapy and/or radiotherapy, use of flaps for reconstruction and surgical margin. All patients presented with advanced neoplastic disease according to TNM. RESULTS: 14 (15.1%) patients developed postoperative salivary fistula. The mean time to onset of salivary fistula was 3.5 days, with a standard deviation of 13.7 days. Comparing salivary fistula with TNM variables, type of operation and neck dissection, prior tracheotomy, use of flap, preoperative radio and chemotherapy and surgical margin, there was no statistically significant difference (p> 0,05). CONCLUSION: The incidence of salivary fistula was 15.1% and no predictive factor for its formation was found.
Assuntos
Fístula Cutânea/epidemiologia , Fístula Cutânea/etiologia , Fístula/epidemiologia , Fístula/etiologia , Laringectomia/efeitos adversos , Doenças Faríngeas/epidemiologia , Doenças Faríngeas/etiologia , Fístula das Glândulas Salivares/epidemiologia , Fístula das Glândulas Salivares/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Incidência , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Retalhos CirúrgicosRESUMO
OBJETIVO: Avaliar a incidência de fístula faringocutânea após laringectomia total e tentar identificar os fatores preditores. MÉTODOS: No período de maio de 2005 a abril de 2010, 93 pacientes foram submetidos à laringectomia total. Foram avaliadas as complicações per e pós-operatórias e comparadas com as seguintes variáveis: sexo, estado nutricional, traqueostomia prévia, localização do tumor primário, tipo de operação realizada, estadiamento de acordo com o TNM, tratamento prévio com quimioterapia e/ou radioterapia, utilização de retalhos para reconstrução e margem cirúrgica. Todos os pacientes apresentavam a neoplasia em estádio avançado segundo o TNM. RESULTADOS: 14 (15,1%) pacientes evoluíram com fístula salivar no pós-operatório. O tempo médio de aparecimento da fístula salivar foi 3,5 dias, com desvio padrão de 13,7 dias. Comparando a fístula salivar com as variáveis TNM, tipo de operação e esvaziamento cervical, traqueostomia prévia, utilização de retalho miocutâneo, rádio e quimioterapia pré-operatória e margem cirúrgica, não foi observado diferença estatisticamente significativa (p>0,05). CONCLUSÃO: A incidência de fístula salivar foi 15,1% e não foi encontrado fator preditor para sua formação.
OBJECTIVE: To evaluate the incidence of pharyngocutaneous fistula after total laryngectomy and try to identify its predictors. METHODS: From May 2005 to April 2010, 93 patients underwent total laryngectomy. We evaluated complications during and after surgery and compared them with the following variables: gender, nutritional status, previous tracheotomy, tumor location, type of surgery, TNM staging, prior treatment with chemotherapy and/or radiotherapy, use of flaps for reconstruction and surgical margin. All patients presented with advanced neoplastic disease according to TNM. RESULTS: 14 (15.1%) patients developed postoperative salivary fistula. The mean time to onset of salivary fistula was 3.5 days, with a standard deviation of 13.7 days. Comparing salivary fistula with TNM variables, type of operation and neck dissection, prior tracheotomy, use of flap, preoperative radio and chemotherapy and surgical margin, there was no statistically significant difference (p> 0,05). CONCLUSION: The incidence of salivary fistula was 15.1% and no predictive factor for its formation was found.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Cutânea/epidemiologia , Fístula Cutânea/etiologia , Fístula/epidemiologia , Fístula/etiologia , Laringectomia/efeitos adversos , Doenças Faríngeas/epidemiologia , Doenças Faríngeas/etiologia , Fístula das Glândulas Salivares/epidemiologia , Fístula das Glândulas Salivares/etiologia , Carcinoma de Células Escamosas/cirurgia , Incidência , Neoplasias Laríngeas/cirurgia , Estudos Retrospectivos , Retalhos CirúrgicosRESUMO
BACKGROUND: The pharyngocutaneous fistulae is troublesome and the most common complication following total laryngectomy. Our objective was to determine the incidence of pharingocutaneous fistulae after the total laryngectomy in our serie and to make review of the medical literature. METHODS: We made a retrospective study of a serie of 81 consecutive cases of laryngeal carcinoma treated between 1995 and 2008 in our section. Total laryngectomy was performed in 29 cases and 52 patients treated with organ preservation approach, were excluded. In 14 cases, the procedure was combined with radical neck dissection, pharyngeal resection or myocutanenous flaps. Nasogastric tube for feeding in the postoperative period was used in all patients and surgical gastrostomy was performed in 5 cases. RESULTS: Our incidence of fistulas when total laryngectomy was the alone procedure is 20 % and 34.5 % when simultaneous surgical proceedings were associated. Spontaneous closure was noted in 80 % of the cases and the mean hospitalization time was 23 days. CONCLUSIONS: Most of the fistulas can be managed with conservative treatment. Pectoralis major myocutanenous flap is appropriate when conservative treatment has failed. In small fistulas, nasogastric or gastrostomy tube for feeding can be successfully managed in the ambulatory follow up. The cost-benefit relation must be better analyzed.
Assuntos
Fístula/etiologia , Fístula Intestinal/etiologia , Laringectomia/efeitos adversos , Doenças Faríngeas/etiologia , Adulto , Idoso , Feminino , Fístula/epidemiologia , Fístula/terapia , Humanos , Fístula Intestinal/epidemiologia , Fístula Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/epidemiologia , Doenças Faríngeas/terapia , Estudos RetrospectivosRESUMO
The extension of the surgery and closure type of the pharynx can be the determinants in the pharyngocutaneous fistula development. The objective of the study is to evaluate the incidence of pharingocutaneous salivary fistulae after total laryngectomies comparing manual and mechanical sutures. The study is designed as non-randomized, prospective clinical study. Sixty patients with squamous cell carcinoma were submitted to total laryngectomies. In 30 cases, the linear stapler (75 mm) closure (surgical technique described in details) and in other 30 cases manual suture was used. The cases of mechanical suture were prospective and consecutive and the cases of manual suture were a review series of patients who underwent a manual suture of pharynx, in the same period of time. The statistical analysis between the two groups concluded that both were comparable. Fistulae incidence was 6.7% (2/30) in the group with the mechanical suture and 36.7% (11/30) in the group with manual suture closure, presenting a significant difference (p = 0.0047). The total laryngectomy with mechanical closure is an easy and fast learning technique, allowing watertight closure of the pharynx with a low risk of contamination of the surgical field. It is an assured method, even in previously irradiated patients, since we respect the limits of its indication regarding the extension of primary tumor that must be confirmed by previous suspension laryngectomy performed in the operating room.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Fístula Cutânea/epidemiologia , Neoplasias Laríngeas/cirurgia , Laringectomia , Doenças Faríngeas/epidemiologia , Suturas , Adulto , Idoso , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/patologia , Estudos de Coortes , Fístula Cutânea/patologia , Feminino , Humanos , Incidência , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/patologia , Masculino , Pessoa de Meia-Idade , Doenças Faríngeas/patologia , Fatores de Risco , Resultado do TratamentoRESUMO
OBJECTIVE: Histoplasmosis is a granulomatous fungal disease caused by Histoplasma capsulatum. The objective of the present paper was to describe the prevalence of oral histoplasmosis (OH) in two services from an endemic area in Argentina between 1991 and 2002 and to compare the clinicopathological profile of OH between HIV-positive and HIV-negative patients. METHODS: About 733 HIV+ (group A) and 14 260 patients (group B) were examined. Clinical diagnosis was confirmed by cytology, biopsy or culture. RESULTS: About 21 (3%) and 10 (0.07%) cases of OH were diagnosed in group A and B respectively. Most patients were male. A total of 90% of patients in group A were <45 years old whereas 70% of group B were more than 45 years old. Palate, gingiva and oropharynx were the most frequent locations. The importance of including histoplasmosis in the differential diagnosis of ulcerated oral lesions in immunocompromised patients was discussed.