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      Carcinoma de paladar blando. Descripción de una serie de casos Translated title: Soft palate carcinoma. Description of cases

      case-report

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          Abstract

          RESUMEN Introducción y objetivo: Describir las características clínicas, anatómicas y el tratamiento quirúrgico, incluyendo las distintas opciones de reconstrucción de los tumores de paladar blando. Descripción: Estudio retrospectivo de 6 pacientes diagnosticados y tratados en el servicio de Otorrinolaringología del hospital San Pedro de Logroño entre los años 2018 y 2019. Discusión: Exponemos los resultados de nuestros pacientes y realizamos una revisión de los tumores de orofaringe localizados en el paladar blando, los detalles anatómicos y técnicas quirúrgicas reconstructivas más utilizadas en el tratamiento quirúrgico de los tumores de paladar blando. Conclusiones: La prevalencia de los tumores de orofaringe ha aumentado en los últimos años a expensas de la infección por el virus del papiloma humano (VPH). Sin embargo, los carcinomas de paladar blando son mayoritariamente P16 negativos. Estos tumores son poco sintomáticos en fases iniciales y es necesario un alto índice de sospecha para evitar diagnósticos tardíos. El desarrollo de la cirugía transoral ha impulsado el tratamiento quirúrgico de los tumores de paladar blando y puede reducir la necesidad de tratamientos complementarios hasta en un 40% de los casos. La reconstrucción se hace necesaria en resecciones mayores del 50%.

          Translated abstract

          ABSTRACT Introduction and objective: To describe clinical and anatomical features, and surgical treatment including several techniques of reconstructive surgery of soft palate carcinomas. Description: We conducted a retrospective study with 5 patients. All of them were diagnosed and treated in our department during 2018 and 2019. Discussion: We present our results and make a review on soft palate tumors pointing out anatomical details and most employed reconstructive surgical techniques for soft palate carcinoma's removal. Conclusions: The incidence of oropharyngeal carcinoma is increasing world-wide essentially due to increasing prevalence of human papillomavirus. Soft palate carcinomas are typically HPV negative. Initially, soft palate tumors are silent, and we should suspect them to avoid late diagnosis. Transoral surgery development has promoted surgical treatment in these tumors and allows better management and need for adjuvant therapy. Reconstruction is mandatory when resection is over 50% of the soft palate.

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          Most cited references29

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          Head and Neck Cancer

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            Tobacco-related carcinogenesis in head and neck cancer

            Head and neck cancer (HNSCC) is a devastating disease. Patients require intensive treatment that is often disfiguring and debilitating. Those who survive are often left with poor speech articulation, difficulties in chewing and swallowing, cosmetic disfigurement, as well as loss of taste. Furthermore, given that HNSCC survivors are frequently disabled and unable to return to work, the economic and societal costs associated with HNSCC are massive. HNSCC is one of many cancers that are strongly associated with tobacco use. The risk for HNSCC in smokers is approximately 10 times higher than that of never-smokers and 70–80% of new HNSCC diagnoses are associated with tobacco and alcohol use. Tobacco products have been used for centuries, however it is just within the last 60–70 years that we have developed an understanding of their damaging effects. This relatively recent understanding has created a pathway towards educational and regulatory efforts aimed at reducing tobacco use. Understanding the carcinogenic components of tobacco products and how they lead to HNSCC is critical to regulatory and harm reduction measures. To date, nitrosamines and other carcinogenic agents present in tobacco products have been associated with cancer development. The disruption of DNA structure through DNA adduct formation is felt to be a common mutagenic pathway of many carcinogens. Intense work pertaining to tobacco product constituents, tobacco use and tobacco regulation has resulted in decreased use in some parts of the world. Still, much work remains as tobacco continues to impart significant harm and contribute to HNSCC development worldwide.
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              Transoral robotic resection and reconstruction for head and neck cancer.

              To evaluate the patterns of failure, survival, and functional outcomes for patients treated with transoral robotic surgery (TORS) and compare these results with those from a cohort of patients treated with concurrent chemoradiation (CRT). Prospective non-randomized case control study. Between April 2007 and April 2009, 30 patients with head and neck squamous cell carcinoma were treated with primary TORS and adjuvant therapy as indicated on an institutional review board-approved protocol. Patients were evaluated before treatment, after treatment, and at subsequent 3-month intervals after completing treatment to determine their disease and head and neck-specific functional status using the Performance Status Scale for Head and Neck Cancer and the Functional Oral Intake Score (FOIS). Functional scores were compared to a matched group of head and neck patients treated with primary CRT. The TORS patient population included 73% stage III-IV and 23% nonsmokers. The median follow-up was 20.4 months (range, 12.8-39.6 months). The 18-month locoregional control, distant control, disease-free survival, and overall survival were 91%, 93%, 78%, and 90%, respectively. Compared to the primary CRT group, TORS was associated with better short-term eating ability (72 vs. 43, P = .008), diet (43 vs. 25, P = .01), and FOIS (5.5 vs. 3.3, P < .001) at 2 weeks after completion of treatment. In contrast to TORS patients who returned to baseline, the CRT group continued to have decreased diet (P = .03) and FOIS (P = .02) at 12 months. Our early experience in treating selected head and neck cancers with TORS is associated with excellent oncologic and functional outcomes that compare favorably to primary CRT. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
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                Author and article information

                Journal
                orl
                Revista ORL
                Rev. ORL
                Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )
                2444-7986
                December 2020
                : 11
                : 4
                : 473-480
                Affiliations
                [1] Logroño orgnameHospital San Pedro orgdiv1Servicio de Otorrinolaringología y Cirugía Cérvico-Facial España
                Article
                S2444-79862020000400010 S2444-7986(20)01100400010
                10.14201/orl.23565
                79e8616f-f0a2-45b0-8edd-f3c7d53e5c1b

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 01 July 2020
                : 13 July 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 8
                Product

                SciELO Spain

                Categories
                Caso clínico

                Anatomy,procedimientos quirúrgicos reconstructivos,carcinoma,Anatomía,oropharynx,soft palate,orofaringe,paladar blando,surgical reconstructive procedures

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