Percorrer por autor "Salvado, Francisco"
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- Analysis of cervical node metastasis in oral cavity squamous cell carcinoma patientsPublication . Silva, Leonor Cruz e; Coutinho, José Cunha; Coutinho, Gonçalo Cunha; São João, Ricardo; Domingues, Tiago; Caldas, Cecília; Palmela, Paulo; Nobre, Miguel Araújo; Salvado, FranciscoAnalysis of cervical node metastasis in oral cavity squamous cell carcinoma patients
- Analysis of cervical node metastasis in oral cavity squamous cell carcinoma patients retrospective study and literature comparisonPublication . Silva, Leonor Cruz; Coutinho, José Cunha; São João, Ricardo; Domingues, Tiago Dias; Coutinho, Gonçalo Cunha; Caldas, Cecília; Palmela, Paulo; Nobre, Miguel; Salvado, FranciscoBackground/Objective: Oral Cavity Cancer is a frequent type of Head and Neck Cancer, associated with high mortality rates worldwide. One of the main prognostic factors for the disease is regional lymph node metastasis that is associated with survival rate reduction by 50%. Reported tumour sites more frequently associated with regional node metastasis vary throughout literature. Therefore, we aimed to conduct a retrospective study that would allow us to identify the relationship between patient and SCC tumour factors with the rate of neck metastasis and compare our data with the conclusions from similar studies. Methods: A retrospective study was conducted in the Oral Medicine and Oncology Consultation of the Stomatology Department from Centro Hospitalar Universitário Lisboa Norte, comprehending patients diagnosed with Squamous Cell Carcinoma between January 2015 and April 2021. As eligibility criteria we considered patients which had clinical charts with complete information including sociodemographic variables, tumour site and disease staging at diagnosis. We excluded tumour sites with only two diagnosed cases, considering bias risk. Three groups were defined according to a clinical/pathological reason. The current research was approved by an independent ethics committee. Results: The sample includes 151 cases, the majority of which were males (≈59%) and with average age at diagnosis (± standard deviation) of 65 ± 13 years-old. Oral tumour sites with highest percentage of cases with clinical positive lymph nodes (cN+) by the time of diagnosis were inferior gingiva (72.7%, n=16), mouth floor (66.7%, n=22), oropharynx (64.7%, n=11), retromolar trigone (58%, n=11) and ventral tongue (57%, n=16). Sites with fewer cases of cN+ were inferior lip (31%, n=4) and superior lip (n=0). Similar results were found in our sample when operated tumors (pN+) were considered: floor of the mouth (65%, n=13), retromolar trigone (63.6%, n=7), inferior gingiva (46.2%, n=6) and ventral tongue (45%, n=9). Tumour sites with fewer pN+ cases were hard palate (25%, n=1), superior gingiva (16.7%, n=1) and inferior lip (0 out of 7 cases). According to Fisher’s exact test there is no statistically significant association (p-value=0.1506) between primary tumour site and cervical node disease (either cN+ or, whenever available, pN+). Conclusions: Our data seem to indicate an association between primary tumour site and N+, being cervical metastasis more frequent when tumour site was posterior and caudally located. Lower lip had the fewer positive lymph nodes, probably correlated with the inclusion in the same group of oral mucosa and skin cancers. Despite these findings, the association was not statistically significant.
- A predictive model for arthrogenous temporomandibular disorders based on clinical signs and symptomsPublication . Angelo, David Faustino; Cardoso, Henrique José; Geraldes, Carlos; São João, Ricardo; Maffia, Francesco; Sanz, David; Salvado, FranciscoThis study aimed to develop and internally evaluate a multivariable statistical model to identify arthrogenous temporomandibular disorders (TMD) using routinely collected clinical data. The model's performance was compared with the Fonseca Anamnestic Index (FAI) alone, using an imaging-based classification as the reference standard. This cross-sectional observational study included 1170 consecutive patients attending their first consultation at a tertiary TMD center between August 2019 and August 2024. Arthrogenous TMD was deter mined using combined clinical and imaging assessment according to the Dimitroulis classification. Clinical variables, including age, maximum mouth opening (MMO), individual FAI items, and joint-related complaints, were extracted from the EUROTMJ database. Generalized additive models (GAMs) were used to develop pre dictive models. Performance was assessed using receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, and specificity in training (60%) and test (40%) datasets. The final Fonseca–Dimitroulis (FD-Class) model incorporated age, MMO, selected FAI items (Q2, Q6, Q7), crepitus, and temporomandibular joint (TMJ) locking. The model achieved an AUC of 0.761 in the training dataset and 0.742 in the test dataset, outperforming the FAI alone (AUC = 0.662). This model may support the early identification of arthrogenous TMJ disease and improve decision-making regarding referral for advanced imaging in maxillofacial practice.This study aimed to develop and internally evaluate a multivariable statistical model to identify arthrogenous temporomandibular disorders (TMD) using routinely collected clinical data. The model's performance was compared with the Fonseca Anamnestic Index (FAI) alone, using an imaging-based classification as the reference standard. This cross-sectional observational study included 1170 consecutive patients attending their first consultation at a tertiary TMD center between August 2019 and August 2024. Arthrogenous TMD was deter mined using combined clinical and imaging assessment according to the Dimitroulis classification. Clinical variables, including age, maximum mouth opening (MMO), individual FAI items, and joint-related complaints, were extracted from the EUROTMJ database. Generalized additive models (GAMs) were used to develop pre dictive models. Performance was assessed using receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, and specificity in training (60%) and test (40%) datasets. The final Fonseca–Dimitroulis (FD-Class) model incorporated age, MMO, selected FAI items (Q2, Q6, Q7), crepitus, and temporomandibular joint (TMJ) locking. The model achieved an AUC of 0.761 in the training dataset and 0.742 in the test dataset, outperforming the FAI alone (AUC = 0.662). This model may support the early identification of arthrogenous TMJ disease and improve decision-making regarding referral for advanced imaging in maxillofacial practice.
- Retrospective comparative study of bone loss in implants with and without immediate loading in the Egas Moniz university clinicPublication . São João, Ricardo; Galrinho, Bárbara; Salvado, Francisco
- Retrospective comparative study of bone loss in implants with and without immediate loading in the Egas Moniz university clinicPublication . Galrinho, Bárbara; São João, Ricardo; Salvado, FranciscoTo evaluate bone loss after three years in implants placed at the implantology consult at the Egas Moniz University Clinic, relating bone loss to the type of loading (conventional or immediate load). A comparative and retrospective study, performed on a sample of 65 implants, placed in 24 of 327 patients, who attended the implantology consult at the Egas Moniz University Clinic in 2015, representing 7.3% of the study population through the measurement of distance between implant platform and bone using radiographs. Three years after implant placement with and without immediate loading there is statistically significant bone loss mesially and distally. It was found that when compared bone loss in loaded vs unloaded mesially and distally implants, there were no statistically significant differences. The bone loss of the unloaded implants was compared three years after being placed, with the bone level of the loaded implants also three years later. No significant difference was found. Although no statistically significant differences were found between bone loss in loaded implants vs unloaded mesially and distally, as it is supported by the literature, it was possible to conclude that there was, in fact, a statistically significant bone loss, mesially and distally, three years after implant placement with and without immediate loading. This may be due to poor oral hygiene, a history of periodontitis, smoking and peri-implantitis.
- Tumor Location and Referral Sources as Determinants of Late-Stage Oral Cancer Diagnosis in a Portuguese CohortPublication . Coutinho, José Cunha; Silva, Leonor Cruz e; São João, Ricardo; Coutinho, Gonçalo Cunha; Domingues, Tiago; Nobre, Miguel Araújo; Caldas, Cecília; Salvado, FranciscoBackground: Most cases of oral cancer at the time of diagnosis are already locally advanced, which is associated with a worse prognosis. This study aimed (1) to identify tumor characteristics and risk factors associated with late-stage oral cancer diagnosis in the Portuguese population and (2) to develop population- and provider-oriented early detection strategies, particularly focused on recognizing potentially malignant disorders, to enhance timely diagnosis and improve patient outcomes. Methods: A retrospective study of 151 patients with oral cancer treated in a Portuguese tertiary hospital between January 2015 and April 2023 was conducted. Information regarding sociodemographic variables, habits, tumor location and form of presentation, referral sources, and stage of the disease at initial diagnosis was analyzed. Results: The majority of patients were male, and the mean age at diagnosis was 65 years. Most were diagnosed at stage IV (51.7%, n = 75), and most of these were referred by the emergency department (46.7%, n = 35). Family physicians made the earliest referrals. Patients referred by dentists were diagnosed at more advanced stages of disease by comparison. The anatomical sites with the highest percentage of locally advanced disease were the lower gingiva, retromolar trigone, and upper gingiva. Conclusions: Late-stage oral squamous cell carcinoma was the most common diagnosis, particularly for lesions in the gingiva and retromolar trigone, and was more frequent among cases referred through emergency departments, reflecting gaps in early detection. Targeted surveillance, improved professional training, and public awareness are essential to promote earlier diagnosis.