The mandibular defects caused by mandibulectomies can involve esthetic and functional sequelae in patients. The fibula presents positive aspects and can be used as an option for mandibular reconstruction after tumor resections or extensive traumas. Furthermore, this retrospective study of the patients who have passed through a mandibular reconstruction with a microvascular fibular flap over the last 17 years describes the experience of the Oral and Maxillofacial SurgeryService at the ErastoGaertner Hospital, Curitiba/PR. The use of this flap type has a complication rate of 32.3%, which includes the fixation material exposure, flap resorptions, fistulas, pathological fractures, tumor recurrence, infections, seromas, and thrombocytopenia. Most of them are associated with patients who have received radiotherapy and/or chemotherapy. These data suggest a high frequency of complications when a reconstruction plate fixation is used. Minor complications are usual and they should not be overlooked because they can lead to devastating consequences.
<p><strong>Objective:</strong> recently, there has been a rapid aging process of the world population. Despite of a longer permanence of natural teeth and a reduction of oral diseases caused by the improvement of life conditions and the provision of health care, the prevalence of oral diseases in the elderly is still considered significant. Therefore, the aim of this study is to evaluate the epidemiological profile of elderly patients (above 60 years old) attended in 25 years of campaigns oral cancer prevention in the Paraná state, Brazil, between 1989 and 2013. <strong>Material and Methods</strong>: Patients, volunteers, were evaluated during 25 years of oral cancer prevention by the campaign team and all patients were evaluated in a methodical way with inspection of all intra-oral areas. <strong>Results</strong>: a total of 22.909 patients were attended during the 25 years of projects. Of these, 6.134 were older than 60 years old, with appearance of 1.523 oral lesions during the examination and 4.611 patients had no oral alterations during the dentist evaluation, among those were found injuries by traumatic origin, inflammatory lesions and others types of injury. <strong>Conclusion</strong>: it is clear the necessity for specialized care and active surveillance of these patients, since it is a consensus in the literature that the best treatment is early diagnosis. It is also necessary the development of epidemiological studies of the elderly population, which are scarce and difficult to elaboration of plans for effective action to meet the specific demands of this age group.</p><p> </p><p>Key words: oral cancer, Oral Examination, Oral Health, elderly cancer.</p>
A prevenção e o diagnóstico precoces são atualmente, as medidas mais eficazes de que dispomos para melhorar o prognóstico dos tumores malignos. Os tumores de boca e orofaringe são tratados com sucesso quando descobertos precocemente. A radioterapia é quase sempre um dos tratamentos de eleição para estes tumores. Quando as neoplasias são diagnosticadas em estádios mais avançados, o tratamento muitas vezes necessita ser mais rápido para ser eficiente, e com isso os radioterapeutas lançam mão do hiperfracionamento, no qual o paciente recebe duas doses diárias de radiação, com dose diária menor por fração, mas maior ao dia, ficando em cerca de 160cGy/2x/dia. Quando as glândulas salivares maiores estão presentes no campo irradiado, a xerostomia torna-se presente já na segunda semana de tratamento (1500 a 2000 cGy), alterando a saúde geral do paciente, que fica com dificuldade para se alimentar, falar e dormir. O objetivo deste estudo foi avaliar as alterações quantitativas do fluxo salivar total não estimulado de pacientes que se submetem ao hiperfracionamento para tratamento de carcinoma espinocelular de boca e orofaringe. Foram avaliadas as amostras de saliva de doze pacientes do Hospital Erasto Gaertner, de Curitiba, Paraná, pacientes esses do sexo masculino. Foram coletadas duas amostras de saliva, a primeira antes da radioterapia e a segunda, ao término do tratamento. Como resultado, obtivemos perda salivar em 91,7% dos pacientes, com uma porcentagem de perda de fluxo salivar total de 62,9%, registrada na segunda coleta. Concluindo, o hiperfracionamento ocasiona xerostomia bastante acentuada quando as glândulas salivares maiores encontram-se presentes no campo irradiado.
Purpose: Most head and neck malignant neoplasias are diagnosed in advanced stages. Another threatening element to the patients' survival chances and quality of life is the high risk of developing a second primary tumor (SPT). SPT significantly worsens prognosis, and for that reason patients must be monitored for early diagnosis. The main objective of this study was to analyze the occurrence of SPTs in patients with oral squamous cell carcinoma (OSCC) treated in Erasto Gaertner Hospital (EGH), Curitiba, PR, Brazil, in a period of 16 years.Methods: Design: retrospective study. The sample comprised patients with OSCC who developed SPT between January 1990 and December 2005. Demographic and clinical data were recorded form the patients' medical charts and analyzed with descriptive statistics.Results: During this period, 34,637 patients were admitted at EGH. A total of 1,637 (4.4%) patients were diagnosed with OSCC, and 37 (2.7%) developed a SPT. Patients who developed SPT were 29 (78.4%) male and 8 (21.6%) female, with a median age of 58 years old. The most frequent anatomical SPT site was the mouth, oropharynx and oesophagus, with an overall survival of 27%.Conclusion: Patients treated from OSCC must be carefully monitored because of the increased risk of SPT, especially when there is a continuous history of tobacco and alcohol consumption.
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