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Chang TT, Liang SY, Rosenberg J. Burden of Family Caregivers of Patients with Oral Cancer in Home Care in Taiwan. Healthcare (Basel) 2023; 11:healthcare11081107. [PMID: 37107941 PMCID: PMC10137915 DOI: 10.3390/healthcare11081107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Oral cancer is currently the fourth leading cause of cancer-related death in Taiwan. The complications and side effects of oral cancer treatment cause a tremendous burden on patients' family caregivers. This study explored the burden on primary family caregivers of patients with oral cancer and its related factors. One hundred and seven patients with oral cancer and their primary family caregivers were included through convenience sampling. The Caregiver Reaction Assessment (CRA) scale was employed as the primary research instrument. The primary factors of caregiver burden, in descending order, were disrupted schedules (M = 3.19, SD = 0.84), a lack of family support (M = 2.82, SD = 0.85), health problems (M = 2.67, SD = 0.68), and financial problems (M = 2.59, SD = 0.84). The CRA scores of the caregivers differed significantly in terms of education level (t = 2.57, p < 0.05) and household income (F = 4.62, p < 0.05), which significantly predicted caregiver burden (R2 = 0.11, F = 4.32, p = 0.007). The study results provide a reference for healthcare professionals to identify the factors for family caregiver burden, as well as the characteristics of patients and family caregivers particularly vulnerable to caregiver burden, thus improving family-centred care.
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Affiliation(s)
- Tzu-Ting Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - John Rosenberg
- School of Health, University of the Sunshine Coast, Caboolture, QLD 4059, Australia
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Cheng CH, Liang SY, Lin L, Chang TT, Wang TJ, Lin Y. Caregiving Self-Efficacy of the Caregivers of Family Members with Oral Cancer-A Descriptive Study. Healthcare (Basel) 2023; 11:healthcare11050762. [PMID: 36900767 PMCID: PMC10000709 DOI: 10.3390/healthcare11050762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
In Taiwan, oral cancer is the fourth most common cause of cancer death in men. The complications and side effects of oral cancer treatment pose a considerable challenge to family caregivers. The purpose of this study was to analyze the self-efficacy of the primary family caregivers of patients with oral cancer at home. A cross-sectional descriptive research design and convenience recruiting were adopted to facilitate sampling, and 107 patients with oral cancer and their primary family caregivers were recruited. The Caregiver Caregiving Self-Efficacy Scale-Oral Cancer was selected as the main instrument to be used. The primary family caregivers' mean overall self-efficacy score was 6.87 (SD = 1.65). Among all the dimensions, managing patient-related nutritional issues demonstrated the highest mean score (mean = 7.56, SD = 1.83), followed by exploring and making decisions about patient care (mean = 7.05, SD = 1.92), acquiring resources (mean = 6.89, SD = 1.80), and managing sudden and uncertain patient conditions (mean = 6.17, SD = 2.09). Our results may assist professional medical personnel to focus their educational strategies and caregiver self-efficacy enhancement strategies on the dimensions that scored relatively low.
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Affiliation(s)
- Ching-Hui Cheng
- Department of Nursing, Cheng Hsin General Hospital, Taipei 112, Taiwan
| | - Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
- Correspondence:
| | - Ling Lin
- Department of Nursing, Cheng Hsin General Hospital, Taipei 112, Taiwan
| | - Tzu-Ting Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Ying Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
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Nogueira RLR, de Araújo TBS, Valverde LF, Silva VAO, Cavalcante BRR, Rossi EA, Allahdadi KJ, dos Reis MG, Pereira TA, Coletta RD, Bezerra DP, de Freitas Souza BS, Dias RB, Rocha CAG. Arsenic Trioxide Triggers Apoptosis of Metastatic Oral Squamous Cells Carcinoma with Concomitant Downregulation of GLI1 in Hedgehog Signaling. Biomedicines 2022; 10:biomedicines10123293. [PMID: 36552049 PMCID: PMC9775978 DOI: 10.3390/biomedicines10123293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Given the lack of advances in Oral Squamous Cell Carcinoma (OSCC) therapy in recent years, pharmacological strategies to block OSCC-related signaling pathways have gained prominence. The present study aimed to evaluate the therapeutic potential of Arsenic Trioxide (ATO) concerning its antitumoral effects and the inhibition of the Hedgehog (HH) pathway in OSCC. Initially, ATO cytotoxicity was assessed in a panel of cell lines. Cell viability, cell cycle, death patterns, and cell morphology were analyzed, as well as the effect of ATO on the expression of HH pathway components. After the cytotoxic assay, HSC3 cells were chosen for all in vitro assays. ATO increased apoptotic cell death and nuclear fragmentation in the sub-G1 cell cycle phase and promoted changes in cell morphology. In addition, the reduced expression of GLI1 indicated that ATO inhibits HH activity. The present study provides evidence of ATO as an effective cytotoxic drug for oral cancer treatment in vitro.
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Affiliation(s)
- Raphael Luís Rocha Nogueira
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Bahia, Brazil
- Department of Pathology, School of Medicine of the Federal University of Bahia, Salvador 40110-909, Bahia, Brazil
| | - Taís Bacelar Sacramento de Araújo
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Bahia, Brazil
- Department of Propedeutics, School of Dentistry of the Federal University of Bahia, Salvador 40100-150, Bahia, Brazil
| | - Ludmila Faro Valverde
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Bahia, Brazil
- Department of Propedeutics, School of Dentistry of the Federal University of Bahia, Salvador 40100-150, Bahia, Brazil
| | - Viviane Aline Oliveira Silva
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Bahia, Brazil
- Department of Pathology, School of Medicine of the Federal University of Bahia, Salvador 40110-909, Bahia, Brazil
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos 14784-400, São Paulo, Brazil
| | - Bruno Raphael Ribeiro Cavalcante
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Bahia, Brazil
- Department of Pathology, School of Medicine of the Federal University of Bahia, Salvador 40110-909, Bahia, Brazil
| | - Erik Aranha Rossi
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Bahia, Brazil
- Department of Pathology, School of Medicine of the Federal University of Bahia, Salvador 40110-909, Bahia, Brazil
- Center for Biotechnology and Cell Therapy, D’Or Institute for Research and Education (IDOR), São Rafael Hospital, Salvador 41253-190, Bahia, Brazil
| | - Kyan James Allahdadi
- Center for Biotechnology and Cell Therapy, D’Or Institute for Research and Education (IDOR), São Rafael Hospital, Salvador 41253-190, Bahia, Brazil
| | - Mitermayer Galvão dos Reis
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Bahia, Brazil
- Department of Pathology, School of Medicine of the Federal University of Bahia, Salvador 40110-909, Bahia, Brazil
| | - Thiago Almeida Pereira
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, CA 94305, USA
| | - Ricardo D. Coletta
- Department of Oral Diagnosis, School of Dentistry University of Campinas, Piracicaba 13414-903, São Paulo, Brazil
- Graduate Program in Oral Biology, School of Dentistry University of Campinas, Piracicaba 13414-903, São Paulo, Brazil
| | - Daniel Pereira Bezerra
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Bahia, Brazil
| | - Bruno Solano de Freitas Souza
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Bahia, Brazil
- Department of Pathology, School of Medicine of the Federal University of Bahia, Salvador 40110-909, Bahia, Brazil
- Center for Biotechnology and Cell Therapy, D’Or Institute for Research and Education (IDOR), São Rafael Hospital, Salvador 41253-190, Bahia, Brazil
| | - Rosane Borges Dias
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Bahia, Brazil
- Department of Propedeutics, School of Dentistry of the Federal University of Bahia, Salvador 40100-150, Bahia, Brazil
| | - Clarissa A. Gurgel Rocha
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, Bahia, Brazil
- Department of Pathology, School of Medicine of the Federal University of Bahia, Salvador 40110-909, Bahia, Brazil
- Department of Propedeutics, School of Dentistry of the Federal University of Bahia, Salvador 40100-150, Bahia, Brazil
- Center for Biotechnology and Cell Therapy, D’Or Institute for Research and Education (IDOR), São Rafael Hospital, Salvador 41253-190, Bahia, Brazil
- Correspondence: ; Tel.: +55-71-3176-2209
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The CO 2 waveguide laser with flexible fiber in transoral resection of oral and oropharyngeal cancers: a retrospective cohort study on postoperative and quality of life outcomes. Lasers Med Sci 2021; 37:1755-1762. [PMID: 34591217 DOI: 10.1007/s10103-021-03430-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
The aim of this study was to evaluate the CO2 waveguide laser (WG CO2 laser) with flexible fiber (Lumenis Ltd., Yokneam, Israel) in the treatment of oral and oropharyngeal cancers, specifically focusing on postoperative outcomes, pain, and quality of life (QoL). Eighty-one patients, 43 women and 38 men, with oral or oropharyngeal cancer who consecutively underwent transoral resection by WG CO2 laser from August 2015 to April 2020 were retrospectively enrolled. Resections were performed in super pulsed mode with a power setting ranging between 3 and 10 W. Data about frozen sections, reconstruction, complication rate, length of hospital stay, tracheostomy rate and time to decannulation, nasogastric feeding tube rate and time to oral feeding, pain, and QoL were reviewed. Continuous variables were presented as mean and standard deviation. Concordance between intraoperative frozen section examination and definitive histology was calculated using Cohen's K test of agreement. The mean length of hospital stay was 13 days. The feeding tube rate was 81%; the tracheostomy rate was 35%; the feeding tube was left in place for 8 days on average, and the time to decannulation was 9 days. The only complication was a postoperative bleeding in 4 patients. The median postoperative pain score measured by the Numeric Pain Rating Scale on postoperative days 1, 3, and 5 was 0 and there was a constant decrease in painkiller use over the days. The overall mean composite QoL score was 77 ± 14, with excellent results in saliva, taste, pain, and speech domains. Frozen section evaluation had a specificity of 99% and a negative predictive value of 98%. WG CO2 laser is a good and safe tool for transoral tailored resection of oral and oropharyngeal cancers. It ensures a good overall QoL and guarantees fast recovery and a very low postoperative pain.
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Reis LBM, Leles CR, Freire MCM. Associations of religiosity and spiritual well-being with appearance concerns after head and neck cancer surgery. Community Dent Oral Epidemiol 2020; 49:420-426. [PMID: 33372313 DOI: 10.1111/cdoe.12615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/12/2020] [Accepted: 12/08/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate whether religiosity and spiritual well-being are associated with appearance concerns among people with visible sequelae due to cancer surgery in the head and neck region. METHODS A cross-sectional study was carried in 202 adult patients in a referral hospital for cancer treatment in Midwest Brazil. Data on sociodemographic, psychosocial and clinical aspects and cancer-related behaviours were collected through interviews, clinical examination and medical records. The outcome was the patients' appearance concerns (Derriford Appearance Scale-DAS24). The independent explanatory variables were religiosity (Duke University Religiousness Index-DUREL) and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-FACIT-Sp12). Data were analysed using Pearson's chi-square and Poisson regression. RESULTS Most of the participants were male (76.2%), and mean age was 58.6 years (SD = 11.6). The scores of appearance concerns (DAS24) ranged from 21 to 75 (median = 33.0). In the bivariate analysis, appearance concerns were associated with spiritual well-being (FACIT-Sp12), degree of disfigurement and treatment with radiotherapy/chemotherapy. Religiosity (DUREL) was not associated with the outcome. In the adjusted regression model, a lower prevalence of appearance concerns was found among patients with higher levels of spiritual well-being (PR = 0.86; CI = 0.79-0.94), males (PR = 0.87; CI = 0.79-0.95), those with lower degrees of disfigurement (PR = 0.89; CI = 0.82-0.98) and those who had no treatment with radiotherapy/chemotherapy (PR = 0.83; CI = 0.72-0.94). CONCLUSION High spiritual well-being was independently associated with lower levels of appearance concerns in people with visible sequelae due to cancer surgery in the head and neck region. Understanding the role of this psychosocial determinant may help in the coping process.
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Affiliation(s)
- Liliane B M Reis
- School of Dentistry, Centro Universitário de Anápolis-UniEVANGÉLICA, Anápolis, Brazil.,School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Cláudio R Leles
- School of Dentistry, Federal University of Goiás, Goiânia, Brazil
| | - Maria C M Freire
- School of Dentistry, Federal University of Goiás, Goiânia, Brazil
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Tirelli G, Tofanelli M, Sacchet E, Bussani R, Shafiei V, Gatto A, Boscolo-Rizzo P, Gardenal N. Extranodal extension in head and neck squamous cell cancer: is there a role for further stratification? Br J Oral Maxillofac Surg 2020; 59:567-572. [PMID: 33441284 DOI: 10.1016/j.bjoms.2020.09.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022]
Abstract
To investigate the prognostic significance of the stratification of extranodal extension (ENE) into ENE minor (ENEmi, up to 2mm) and ENE major (ENEma, over 2mm) in non-HPV-related squamous cell cancers of the head and neck, we retrospectively reviewed microscopic slides from neck dissection specimens of ENE-positive patients and subcategorised them into ENEmi and ENEma. We then compared the two groups in terms of overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Forty-four patients with pathologically positive necks had ENE in the histological report. Twenty-six had ENEmi and 18 ENEma. The three-year OS was 46% in the ENEmi group and 38.9% in the ENEma group. DSS and DFS were 80.8% and 80.8%, respectively, in the ENEmi group and 61.1% and 77.8%, respectively, in the ENEma group. None of the comparisons revealed any statistically significant difference. The results of our survival analysis seem to show a trend towards better survival rates in the ENEmi group, particularly regarding OS. Nonetheless, extension of the tumour outside the lymph node capsule by more than 2mm was not found to be significantly associated with any of the explored survival outcomes.
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Affiliation(s)
- G Tirelli
- ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - M Tofanelli
- ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - E Sacchet
- ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - R Bussani
- Department of Histopathology, Cattinara Hospital of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - V Shafiei
- Department of Histopathology, Cattinara Hospital of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - A Gatto
- ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - P Boscolo-Rizzo
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Via 8 Febbraio 1848, 2, 35122 Padova (PD), Italy
| | - N Gardenal
- ENT Clinic, Head and Neck Department, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.
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Guimarães I, Sousa AR, Gonçalves MF. Speech handicap index: cross-cultural adaptation and validation in European Portuguese speakers with oral and oropharyngeal cancer. LOGOP PHONIATR VOCO 2020; 46:11-16. [PMID: 31918604 DOI: 10.1080/14015439.2019.1711163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION To date, no valid outcome measure has been developed in European Portuguese (EP) to assess the opinion of the patients with oral and oropharyngeal cancer about the speech impact in his/her related quality of life. OBJECTIVES This study aimed to cross-culturally adapt the speech handicap index (SHI) in EP and contribute to its validation in oral and oropharyngeal cancer patients. MATERIALS AND METHODS A cross-sectional study was carried out in two phases: (i) SHI translation, back-translation, expert analysis, and pilot study; (ii) application of the EP version of the SHI (EP-SHI) to 95 patients with oral and oropharyngeal cancer and 83 gender- and age-matched healthy individuals. A total of 23 randomly chosen patients were asked to re-fill the EP-SHI questionnaire after 3 weeks. The psychometric properties (feasibility, practicability, reliability, and validity) were assessed. RESULTS The EP-SHI version brought together expert consensus and the acceptability of 75% of the participants in the pilot study. The EP-SHI questionnaire is feasible (no missing data and floor effect < 7%), practical (an average of 5.5 min to complete), possesses internal consistency reliability (Cronbach's alpha ≥ 0.90), test-retest reliability (interclass correlation coefficient, ICC ≥ 0.90), significantly strong convergent validity with EP-voice handicap index (VHI) (rô≥0.94), distinguishes patients from healthy speakers and within the patients' group according to individual speech rating and glossectomy surgery. CONCLUSIONS The EP-SHI is a culturally relevant, valid and reliable patient reported outcome measure (PROM), and therefore, it is appropriate to be recommended for used with oral and oropharyngeal cancer patients.
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Affiliation(s)
- Isabel Guimarães
- Alcoitão School of Health Sciences & Pharmacological and Therapeutic Unit, Instituto de Medicina Molecular, Faculty of Medicine, University of Lisbon, Portugal
| | - Ana Raquel Sousa
- Instituto Portugues de Oncologia de Lisboa Francisco Gentil EPE, Lisboa, Portugal
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Marcuzzo AV, Šuran-Brunelli AN, Dal Cin E, Rigo S, Piccinato A, Boscolo Nata F, Tofanelli M, Boscolo-Rizzo P, Grill V, Di Lenarda R, Tirelli G. Surgical Anatomy of the Marginal Mandibular Nerve: A Systematic Review and Meta-Analysis. Clin Anat 2019; 33:739-750. [PMID: 31591743 DOI: 10.1002/ca.23497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/20/2019] [Accepted: 09/17/2019] [Indexed: 11/07/2022]
Abstract
The high number of marginal mandibular nerve (MMN) anatomical variants have a well-known clinical significance due to the risk of nerve injury in several surgical procedures. The aim of this study was to find and systematize the available anatomical data concerning this nerve. The PubMed and Scopus databases were investigated in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. All studies reporting extractable data on the origin, course, splitting, anastomosis and relationship of the MMN with the mandible or the facial vessels were included. We included 28 studies analyzing 1861 halves. The MMN had one (PP = 35% 95% CI:18-54%), two (PP =35% 95% CI:18-54%), three (PP = 18% 95% CI:0-35%), or four branches (PP = 2% 95% CI:0-8%). Anastomosis with the great auricular nerve, transverse cervical nerve, mental nerve, and other branches of the facial nerve were defined. The origin of the MMN in relation to the parotid and the mandible was variable. The MMN nearly always crossed the anterior facial vein laterally (PP = 38% 95% CI:9-72% if single, PP = 57% 95% CI:22-90% when multiple); its relation with other vessels was less constant. At least one branch of the MMN was found below the inferior border of the mandible (IBM), with a PP of 39% (95% CI:30-50%). The MMN has high anatomical variability and it is more often represented by one or two branches; its origin is frequently described at the parotid apex and above the IBM, although in its course at least one branch often runs below the IBM. Its most frequent anastomosis is with the buccal branch of the facial nerve. Clin. Anat., 33:739-750, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Alberto Vito Marcuzzo
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | | | - Elisa Dal Cin
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Stefania Rigo
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Alice Piccinato
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Francesca Boscolo Nata
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Margherita Tofanelli
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Paolo Boscolo-Rizzo
- Department of Neurosciences, ENT Clinic and Regional Center for Head and Neck Cancer, University of Padua, Treviso Regional Hospital, Treviso, Italy
| | - Vittorio Grill
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Roberto Di Lenarda
- Maxillofacial and Dental Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
| | - Giancarlo Tirelli
- ENT and Head and Neck surgery Clinic, Department of Medical, Surgical and Health Sciences, ASUITS, Trieste, Italy
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How we improve the transoral resection for oral and oropharyngeal cancer: the CO 2 waveguide laser. Eur Arch Otorhinolaryngol 2019; 276:2301-2310. [PMID: 31115687 DOI: 10.1007/s00405-019-05473-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/10/2019] [Indexed: 01/07/2023]
Abstract
PURPOSE The main aim of this study was to evaluate the CO2 waveguide laser (CO2 WGL) with flexible fiber (Lumenis, Santa Clara, CA) in the treatment of oral and oropharyngeal cancers specifically focusing on the lateral thermal damage (LTD) induced by this instrument and therefore on the reliability of the analysis of frozen sections collected during margin mapping. METHODS A total of 48 patients with oral and oropharyngeal cancers from T1 to T4a were prospectively enrolled in the study. We collected data about LTD, pathologic tumor and node stage (pTNM), surgical intervention, kind of reconstruction (no flap, local vs free flap), need for tracheotomy and time of removal, postoperative complications (such as bleeding, mucosal dehiscence, and fistula), need for feeding tube and time of removal. RESULTS Mean LTD was 164.7 ± 92.4 μm. Comparing frozen section histology before and after formalin embedding we found 5 true positives, 170 true negatives, 4 false positives and 4 false negatives, with a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 55.6%, 98%, 55.6%, 98%, and 96.1%, respectively. CONCLUSION CO2 WGL is a very manageable tool, which allows a precise cut. However, its high costs, the inability to re-use the fibers and its low coagulation capability must be considered.
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Tirelli G, Boscolo Nata F, Gatto A, Bussani R, Spinato G, Zacchigna S, Piovesana M. Intraoperative Margin Control in Transoral Approach for Oral and Oropharyngeal Cancer. Laryngoscope 2018; 129:1810-1815. [PMID: 30284261 DOI: 10.1002/lary.27567] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/06/2018] [Accepted: 08/17/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Piecemeal resection provides an innovative conceptual tool for margins surveillance because it entails the intraoperative evaluation of the whole resection margins and not just sample points, which should result in a better control of deep margins compared to en bloc resection. Although it is recognized that the intraoperative use of narrow band imaging (NBI) results in a better control of superficial margins, in this exploratory study we investigated whether NBI and piecemeal resection could be used in combination to improve margin control at both superficial and deep levels. Because piecemeal resection is based on frozen section analysis, we wanted to verify its reliability compared to definitive histological examination. METHODS The status of resection margins in a group of patients with oral and oropharyngeal cancers treated with NBI and laser CO2 piecemeal resection (group 1) was compared with that of an historical group of patients (group 2) treated with NBI and conventional en bloc resection. In group 1, sensitivity, specificity, and positive and negative predictive values were used to verify the rate of concordance between frozen section and definitive histology. RESULTS The difference between deep positive margins in the two groups was statistically significant (P = 0.042). The high sensitivity and specificity (94.6% and 94.7%, respectively) of frozen section analysis also demonstrated its reliability in the examination of larger samples corresponding to the whole margin. CONCLUSION Even if our findings are limited by the small number of patients, we are confident that the combined use of NBI and piecemeal resection could represent an attractive surgical strategy to improve margin control. LEVEL OF EVIDENCE 2b Laryngoscope, 129:1810-1815, 2019.
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Affiliation(s)
- Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
| | | | - Annalisa Gatto
- Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
| | - Rossana Bussani
- Department of Pathological Anatomy and Histopathology, University of Trieste, Cattinara Hospital, Trieste
| | - Giacomo Spinato
- Ear, Nose and Throat Department, Rovigo Provincial Hospital, Rovigo, Italy
| | - Serena Zacchigna
- Department of Medical Sciences University of Trieste and Cardiovascular Biology, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste
| | - Marco Piovesana
- Department of Otorhinolaryngology and Head and Neck Surgery, Trieste
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Tirelli G, Gatto A, Bonini P, Tofanelli M, Arnež ZM, Piccinato A. Prognostic indicators of improved survival and quality of life in surgically treated oral cancer. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:S2212-4403(18)30052-X. [PMID: 29506918 DOI: 10.1016/j.oooo.2018.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/10/2018] [Accepted: 01/23/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE No published study has analyzed the prognostic factors of surgically treated oral squamous cell carcinoma (OSCC) in relation to both survival and quality of life (QoL). The aim of this study was to analyze postoperative QoL in relation to survival to identify which parameters can predict the long-term outcome allowing the best QoL. STUDY DESIGN This retrospective cohort study considered 167 patients affected by OSCC treated surgically at the Otolaryngology Department of Cattinara Hospital (Trieste, Italy) by a single surgeon. We collected data about the main prognostic factors and the postoperative QoL 12 month after surgery. RESULTS The 5-year overall survival rate was equal to 68.1%, and the 5-year disease-specific survival was 77.8%. In this sample, 32% of patients also underwent adjuvant chemoradiotherapy. On stepwise Cox regression, the best predictors of disease-specific survival were the N stage (P < .001) and tumor depth of invasion (P < .001). QoL was affected by N stage, depth of invasion, invasive surgical approach, radiotherapy, and neck dissection (P < .05). CONCLUSION The prognostic factors that affect both survival rates and residual QoL are the surgical approach, the neck stage, and the depth of invasion, all of which can be minimized by early diagnosis.
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Affiliation(s)
- Giancarlo Tirelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Annalisa Gatto
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Pierluigi Bonini
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Margherita Tofanelli
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
| | - Zoran M Arnež
- Department of Plastic and Reconstructive Surgery, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Alice Piccinato
- ENT Clinic, Head and Neck Department, Azienda Sanitaria Universitaria Integrata di Trieste, Italy.
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