Clinic and epidemiologic characteristics in the with squamous cell carcinoma of the mouth and oropharynxResumo / Summary O câncer de boca e orofaringe é de comportamento agressivo e, no Brasil, a incidência é considerada uma das mais altas do mundo, sendo o mais comum da região de cabeça e pescoço. Objetivo: O objetivo deste trabalho é analisar os aspectos clínico-epidemiológicos dos pacientes e a evolução da doença. Costa. This was analyzed with emphasis on age, gender, profession, ethnic aspects, tobacco and alcohol use, dental prosthesis, referement origin, site of the lesion, clinical staging, histologic grade, treatment methods, survival and second cancer presence in the study group. The data were analysed by Exact Test of Fischer. Results: In the oral cavity cancer patients, a male female ratio of 3.35:1 was observed, the median age was 62 years (ranging 46 to 91 years), 90.7% were Caucasian, 81% were referred from medical professionals, tobacco use was identified in 76.8%, alcohol intake in 74%, 79% were not dental prosthesis users, tongue was the commonest site identified (51.1%), 53% were staged as III and IV clinical stages, 72.1% were moderately differentiated SCC, combined modality of treatment (surgery and adjuvant radiation therapy) was employed in 47% and 9.3% presented a second primary tumor. For the oropharynx, the male female ratio was 11.5:1, the median age was 58 years (ranging 40 to 81 years), 92% were Caucasian, 92% were referred from medical professionals, exposure to tobacco and alcohol was respectively noted in 84% and 80%, 52% did not use dental prosthesis, the tonsils were the commonest site (76%), 96% were staged as III and IV, 84% had moderately differentiated SCC, 75% underwent combined treatment (surgery and adjuvant radiation therapy) and 8% presented a second tumor elsewhere. There was not significant relationship between the clinical staging and tobacco, alcohol and dental prosthesis exposure. These factors, the age and the histologic grade had no relationship with the tumor site. For the oral cavity, 69,7% were alive with no evidence of disease and for the oropharynx, 22% were under this condition. Conclusion: The professional who performs the first evaluation is important in recognizing the lesions in order to achieve early detection.Palavras-chave: carcinoma espinocelular, câncer bucal, boca, orofaringe, epidemiologia.

BRAZ DAS et al. Quality of life and depression in patients undergoing total and partial laryngectomy. CLINICS 60(2):135-142, 2005. PURPOSE: The surgical treatment of head and neck cancer, primarily laryngeal cancer, causes sequelae and can change the patient´s quality of life. The purpose of this study was to investigate the impact of laryngectomy on the quality of life regarding the functional, physical, psychological, and social aspects. METHODS: Fourteen patients underwent total laryngectomy and 16 underwent vertical partial laryngectomy. The Quality of Life Core Questionnaire (QLQ-C30) and Head and Neck (H&N35) questionnaire from the European Organization for Research and Treatment of Cancer (EORTC) were used for quality of life evaluation, while the Beck Depression Inventory questionnaire was used for the depression screen. RESULTS: In the total laryngectomy group, reported adverse effects were worsened, social and emotional function (21.3%), olfaction and taste changes (85.6%), cough (71.3%), speech difficulty (100%), and dysphagia (64.3%). Most of the patients (85.5%) judged their quality of life to be reasonable. In the partial laryngectomy group, reported adverse effects were worsened, emotional function (71.4%), speech difficulty (100%), and dysphagia (31.3%). However, most of the patients judged their quality of life to be above the general average. CONCLUSION: Despite being different surgeries, both groups experienced similar difficulties but at different levels. The quality of life was judged worse in the patients who underwent total laryngectomy.

A therapeutic decision in the treatment of Tis/T1a glottic carcinoma with radiotherapy (RT) or transoral laser surgery (TOS) is still an open issue. Oncologic outcome and voice quality may support the choice for the latter To conduct a systematic review and meta-analysis to compare oncologic and functional outcomes of TOS and RT as treatment options for Tis/T1a glottic cancer. Literature research on online databases was carried out. Potentially eligible articles were reviewed. Relevant articles were selected and evaluated. There was statistical significance favoring patients initially treated with TOS when it comes to overall survival, disease-specific survival and larynx preservation. No difference in local control was found. TMF, Jitter and Shimmmer measurements presented statistically significant results in favor of RT. Self-assessment of voice quality (VHI) and f0 showed no statistically significant differences. Maximum Phonation Time (MPT) had a better response to RT. There is a trend in favor of RT. Tis/T1a glottic cancer patients submitted to TOS had significant overall and disease specific survival and had fewer risks of having a total laryngectomy, when compared to the radiotherapy group. The self-assessment of voice quality and f0 did not show any difference; however, Jitter, Shimmer and MPT measurements favored radiotherapy.

Dysphagi a can be a consequence of total laryngectomy even in the absence of symptoms and it could indeed directly or indirectly compromise quality of life. Aim: To evaluate the characteristics of swallowing after total laryngectomy and pharyngolaryngectomy with pharyngeal T closure, correlating them with the Quality of Life in Swallowing Disorders questionnaire. Methods: A prospective evaluation was performed in 28 patients; fifteen undergoing total laryngectomy and thirteen undergoing total pharyngolaryngectomy. Swallowing was evaluated through videofluoroscopy regarding the preparatory, oral and pharyngeal phases of swallowing, and the quality of life related to swallowing questionnaire was employed to measure quality of life. Results: Anatomical and functional changes were observed under videofluoroscopic evaluation. Dysphagia was diagnosed in 18 patients (64.3%), being mild in 66.6% and moderate/severe in 33.3%. The questionnaire indicated good quality of life in almost all scales. Complaints of dysphagia were associated to the burden (p=0.036) and mental health scale (p=0.031). The questionnaire indicated impact on the mental health scale for patients with severe dysphagia (p=0.012). Conclusions: High incidence of dysphagia was observed in some quality of life assessments, especially of mild degree.

Os grandes avanços na compreensão da fisiologia vocal e o desenvolvimento científico e tecnológico na área de voz permitiram transpor o limite terapêutico através dos meios para a detecção precoce de alterações vocais. Objetivo: Avaliar indivíduos sem queixa vocal e correlacionar possíveis achados telelaringo-estroboscópicos, perceptivo-auditivos e acústicos. Forma de Estudo: Observacional coorte com corte transversal. Casuística e Méto-do: Foram avaliados 21 indivíduos do sexo masculino, com idade variando de 20 a 50 e mediana de 33 anos, sem queixas vocais, que não faziam uso de tabaco nem de destilados. Os sujeitos foram submetidos às avaliações telelaringo-estroboscópica, perceptivoauditiva e acústica da voz. Resultados: Do total de sujeitos avaliados, 57,15% apresentaram alteração em uma ou mais das avaliações realizadas. À telelaringo-estroboscopia, observou-se fenda vocal triangular posterior em 4 sujeitos. Dez apresentaram alteração na análise perceptivo-auditiva, observando-se os seguintes parâmetros: instabilidade, rouquidão e soprosidade, todos em grau discreto. Na avaliação da ressonância, três apresentaram cada foco hipernasal, cul de sac e laringo-faríngea. A avaliação acústica apresentou as seguintes médias: f0 -125,69 Hz; jitter -0,22%; shimmer -3,06%; NNE -12,29 dB; HNR -20,75 dB; freqüência do tremor -2,09 Hz; amplitude do tremor -1,16 Hz. Alguns sujeitos apresentaram valores de shimmer% e freqüência do tremor maiores do que a média. Conclusão: Foram detectadas alterações em 57,15% das avaliações realizadas em indivíduos sem queixas vocais. Esses achados podem ser indicativos de uma variação da normalidade ou representar uma predisposição a alterações glóticas e vocais que, com o passar do tempo, podem desenvolver-se. Em todas as avaliações alteradas houve alteração de parâmetro acústico. The great progress in understanding the vocal physiology and the scientific and technological development in the voice area allow transposing the therapeutic limit through the means for the precocious detection of vocal changes. Objective: to evaluate subjects without vocal complaint, and to correlate possible videostroboscopic, perceptual and acoustic analysis finding. Study Design: Observacional cohort with transversal cut. Patients and Methods: 21 men without vocal complaints were studied. Their ages ranged from 20 to 50 with median of 33. They were neither alcohol nor smoke users. The subjects underwent the videostroboscopic, perceptual and acoustic evaluations. Results: 57.15% of the subjects presented any alteration in one or more of the evaluated aspects. In the videostroboscopy it was observed posterior triangular gap in 4 subjects. Ten subjects presented a mild grade alteration in the perceptual analysis, in instability, hoarseness and breathiness parameters. Three subjects presented respectively hipernasal, cul de sac and pharyngolaryngeal resonance focus. The acoustic evaluation presented the following averages: f0 -125.69 Hz; jitter -0.22%; shimmer -3.06%; NNE --12.29 dB; HNR -20.75 dB; tremor freq...

Introduction Radiotherapy or chemoradiotherapy can result in severe swallowing disorders with potential risk for aspiration and can negatively impact the patient's quality of life (QOL). Objective To assess swallowing-related QOL in patients who underwent radiotherapy/chemoradiotherapy for head and neck cancer. Methods We interviewed 110 patients (85 men and 25 women) who had undergone exclusive radiotherapy (25.5%) or concomitant chemoradiotherapy (74.5%) from 6 to 12 months before the study. The Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire was employed to evaluate dysphagia-related QOL. Results The QOL was reduced in all domains for all patients. The scores were worse among men. There was a relationship between oral cavity as the primary cancer site and the fatigue domain and also between advanced cancer stage and the impact of food selection, communication, and social function domains. Chemoradiotherapy association, the presence of nasogastric tube and tracheotomy, and the persistence of alcoholism and smoking had also a negative effect on the QOL. Conclusions According to the SWAL-QOL questionnaire, the dysphagia-related impact on QOL was observed 6 to 12 months after the treatment ended.

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