Leiomyoma of the palatine tonsil - report of a rare and unusual tumor at this site

A leiomyoma is a remarkably rare cause of a benign, one-side tonsillar enlargement. The diagnosis is essentially histologic and will not normally be suspected clinically. Immunohistochemistry is needed for substantiation of the morphology and confirmation. We submit this illustrative case report.

Boon that Resolves Microscopic Puzzle

Introduction: Immunohistochemistry plays a major role to confirm the accurate diagnosis of non-Hodgkin lymphoma B cell type -Tonsillar fossa. Case Presentation: A 65 year old male presented with blocking sensation in the throat, dysphagia and loss of appetite with loss of weight since 2 months. Video laryngoscopic examination revealed a growth in the right tonsil. Contrast enhanced CT neck showed well defined mass in the tonsillar fossa with multiple enlarged lymph nodes in right submandibular and para tracheal region. Biopsy showed predominantly necrotic tonsillar tissue with lymphoid cells showing angiocentric distribution along with few bizarre cells. The differential diagnosis was Lymphoma and Poorly differentiated carcinoma. Immunohistochemistry was done which showed the neoplastic cells positive for CD 20 and negative for CD 3 and cytokeratin. A diagnosis of non-Hodgkin lymphoma B cell type-Right tonsillar fossa was made. The patient was referred to medical oncology for chemotherapy. Conclusion: We present this case to highlight the role of immunohistochemistry to arrive at the accurate diagnosis and management of the patient.

Tonsilolito gigante: hallazgo inesperado. Reporte de caso / Giant tonsillolith: unexpected finding. Case report

Introducción: se presenta el caso de un tonsilolito gigante periamigdalino como hallazgo en una radiografía panorámica de rutina en odontología. Caso clínico: se presenta el caso de un paciente masculino de 26 años a quien le realizaron radiografía panorámica de control, en la que se evidenció una gran imagen radiopaca a nivel periamigdalino derecho de aproximadamente 2 cm de diámetro; el paciente fue asintomático al momento de la consulta y al recibir tratamiento quirúrgico se evidenció un tonsilolito gigante que fue retirado en bloque sin complicaciones. Discusión: se presentan diagnósticos diferenciales de imágenes radiopacas encontradas en radiografías de cabeza y cuello compatibles con tonsilolitos. Conclusiones: se recuerda esta entidad diagnóstica que, aunque rara, se debe tener presente como posible hallazgo en estudios de imagen cabeza y cuello o síntomas a nivel amigdalino.

Introduction: We present the case of a giant tonsil stone as a finding in routine pano-ramic radiography in dentistry. Clinical case: we present the case of a 26 years-old male patient who underwent a control panoramic radiography where a large radiopa-que image of approximately 2 cm in diameter was evidenced at the right peritonsillar level; the patient was asymptomatic at the time of the consultation, when recei-ving surgical treatment, a giant tonsillolith was evidenced which was removed en bloc without complications. Discussion: differential diagnosis of radiopaque ima-ges found in head and neck radiographs compatible with tonsilloliths are presented. Conclusions: Although rare, this entity should be kept in mind as a possible finding in head and neck imaging studies or symptoms at tonsillar space.

Is there a relationship between tonsil volume and the success of pharyngeal surgery among adult patients with obstructive sleep apnea?

Abstract Objectives: Hypertrophic palatine tonsils play a role in the blockage of the upper airway, one of the known causes of Obstructive Sleep Apnea (OSA). Therefore, it is possible that there is an association between tonsil size and the success of pharyngeal surgery during OSA treatment. The main objective of this study was to evaluate the relationship between tonsil grade and volume, as well as to establish whether a relationship exists between tonsil size and the success rate of pharyngeal surgery (tonsillectomy and pharyngoplasty with barbed sutures). Methods: This retrospective study includes forty-four adult patients who underwent tonsillectomy and pharyngeal surgery with barbed sutures for the treatment of simple snoring and OSA between January 2016 and September 2019. Patients who had been previously tonsillectomized or those for whom tonsil volume measurement was lacking were excluded. All patients underwent a pre-operative physical exploration at the clinic exam room and a sleep study. Prior to surgery a Drug Induced Sleep Endoscopy (DISE) was performed. Tonsil volume was measured intraoperatively using the water displacement method. The same sleep study was repeated six months following surgery. Results: A significant correlation was found between tonsil grade and volume and between such measurements and the blockage observed at the level of the oropharynx during the DISE. Moreover, an association was observed between tonsil volume, but not tonsil grade, and the success of tonsillectomy and pharyngoplasty with barbed sutures. A tonsil volume greater than 6.5 cm3 was linked to success during pharyngeal surgery. Conclusion: A correlation exists between tonsil grade and tonsil volume. A bigger tonsil volume is associated with a greater success rate of oropharyngeal surgery during treatment of OSA. Level of evidence: Level 3, non-randomized cohort study.

Lingual tonsil hypertrophy: about a case of unpredictable difficult airway / Hipertrofia de la amígdala lingual: a propósito de un caso de vía aérea difícil imprevisible

Abstract: Eleven years old children, proposed for resection of pylocitic astrocytoma of cerebellum, presented with lingual tonsil hypertrophy causing a unpredictable difficult airway approach. The presence of a lingual tonsil hypertrophied isn't diagnosed most of the times, with their occurrence being associated with previous tonsillectomy in more than half of the cases. Its occurrence, and non-identification, can originate scenarios of difficult airway approach, with a higher morbility association.

Resumen: Niño con 11 años, propuesto para exéresis de recidiva de astrocitoma pilocítico del cerebelo con hipertrofia de las amígdalas linguales a condicionar vía aérea difícil no previsible. La hipertrofia de las amígdalas linguales es subdiagnosticada y se suele asociar a amigdalectomía previa en más de la mitad de los casos. Su ocurrencia y no reconocimiento, puede originar situaciones de vía aérea difícil, con alta morbilidad asociada.

Coblation Tonsil Resection (TR): Our Experience For A Powered Instrument Feasibility With Advantages And Disadvantages

Background:Tonsillectomy is one of most commonly performed surgical procedure in otorhinolaryngology. In past, various surgical techniques for tonsillectomy have been de veloped. And coblation tonsillectomy is one of the latest techniques developed. We carried this study to check feasibility of powered instrument (coblator) in view of patient and surgeons benefit with advantages and disadvantages for tonsillectomy. Material And Methods:We carried out this study in randomly selected total 125 patients who presented to our ENT department with chief complain of recurrent tonsillitis. All patients underwent coblation techniques and were analysed for total time consumption during operation, amount of bloodloss during operation, immediate postoperative pain, postoperative haemorrhage whether primary or secondary, time needed to return back to the normal activity and diet ,total percentage of healing post operatively. Each patient had preoperative blood investigation to exclude any coagulation disorder and anemia. Postoperative analgesics and broad spectrum antibiotics were administered. Result:Mean operation time was 12±2.45 minutes in coblation group. Intraoperative blood loss turned out to be 20.00±5.0 ml for the coblation. Mean return to normal diet period was significantly shorter (5.00±1.50). Otherwise, return to normal behaviour was significantly earlier with coblation(10.50±2.00 ). Postoperative we have not seen any case of primary hemorrhage or secondary hemorrhage in our study.Conclusion:We found that coblation technique for tonsillectomy offers considerable advantages in the operation time and intra operative blood loss. Coblation is related with timely return to routine activities and normal adequate diet. To endorse its significance over conventional tonsillectomy warrants further study.

Prevalence of epstein-barr virus infection in palatine tonsils hyperplasia through the immunoexpression of the LMP-1 marker / Avaliação da prevalência de infecção por epstein-barr vírus na hiperplasia de tonsilas palatinas através da imunoexpressão do marcador LMP-1

Introduction: LMP-1 (latent membrane protein 1) is a membrane protein found in EBV and can be identified through immunohistochemistry. Objectives: To evaluate the prevalence of EBV virus in tonsillar tissue samples correlating with tonsil size, age and gender. Methods: An LMP-1 immunohistochemical study was performed in slides from patients with tonsil hyperplasia. Results: The sample consisted of 120 slides, 66 were from male. The average tonsillar size was 6.0 cm2 (1.5-14.0) and the average age was 6.5 years (2-18). Overall, 72 patients were positive for the virus, the majority being male (51%) and preschoolers (51.4%). For comparative analysis, the sample was divided: group 1 (positive immunohistochemistry) and group 2 (negative immunohistochemistry). The average age was 6.74 years (± 4.14) and 6.19 years (± 3.82) for group 1 and 2, respectively. Group 1 had 37 preschoolers, 23 school-age children and 12 adolescents. Group 2 had 28 preschoolers, 14 school-age children and 6 adolescents (p=0.71). To evaluate the presence of virus, the slides were divided according to area: G (≥6cm²) and P (<6cm²). In G group, 54 slides were positive, while in P group, 18 were positive. Group 1 presented 54 of G group slides and 18 of P group slides, with no statistical difference, but with a tendency to positivity (p=0.09). Conclusion: Most of the sample was positive for the presence of Epstein-Barr virus. There was no difference in the virus presence or absence when correlated with the tonsillar size, age or sex

Introdução: LMP-1 (proteína latente de membrana-1) é uma proteína de membrana encontrada no Epstein-Barr vírus (EBV) e que pode ser identificadaatravés da imunoistoquímica. Objetivo: Avaliar a prevalência do EBV em amostras de tecido tonsilar correlacionando com o tamanho da tonsila, idade e sexo. Método: Realizou-se um estudo imunoistoquímico de LMP-1 para EBV em lâminas de pacientes com hiperplasia de tonsilas. Resultados: A amostra foi composta por 120 lâminas, sendo 66 (55%) de pacientes do sexo masculino. O tamanho médio tonsilar foi 6,0 cm2 (1,5-14,0) e a idade média 6,5 anos (2-18). Ao todo, 72 pacientes (60%) tiveram positividade para o vírus, a maioria meninos (51%) e pré-escolares (51,4%). A amostra foi dividida em: grupo 1 (imunoistoquímica positiva) e grupo 2 (imunoistoquímica negativa). A idade média foi de 6,74 anos (±4,14) e 6,19 anos (±3,82), para o grupo 1 e 2, respectivamente. O grupo 1 apresentou 37 pré-escolares, 23 escolares e 12 adolescentes. O grupo 2 foi composto por 28 pré-escolares, 14 escolares e 6 adolescentes, sem diferença estatística (p=0,71). Para avaliar a presença do EBV, as lâminas foram divididas de acordo com a área: G (≥6 cm²) e P (<6 cm²). No grupo G, 54 lâminas foram positivas, enquanto no grupo P, 18, sem diferença estatística, mas com tendência a positividade (p=0,09). Conclusão: A maior parte da amostra foi positiva para o Epstein-Barr vírus. Não houve diferença significante na positividade ou não do vírus quando correlacionada com o tamanho tonsilar, a idade e o sexo dos pacientes.

Diagnostic methods and criteria of obstructive sleep apnea hypopnea syndrome in children / 口腔疾病防治

@#Obstructive sleep apnea hypopnea syndrome (OSAHS), which is a common childhood disease, is a trending topic in clinical multidisciplinary research due to its detriment to the growth and development of children. Due to the wide variety and specificity of pathogenesis and clinical manifestations, the clinical diagnosis of OSAHS is sophisticated and difficult and remains controversial in the field. This review summarizes the common diagnostic methods in OSAHS for children, including polysomnography,which is known as the current “gold standard”, pulse oximetry, fiberoptic nasopharyngoscopy, nasopharyngeal lateral X-ray, CT, and magnetic resonance imaging (MRI). Furthermore, it emphasizes the new diagnostic critical value from Chinese guidelines for the diagnosis and treatment of obstructive sleep apnea in children (2020) for children with OSAHS released by China in 2020: the obstructive apnea hypopnea index (OAHI) is ≥ 1 time/h; it also emphasizes the importance of history and physical examination to contribute to clinical diagnosis and treatment for children with OSAHS.

Asymmetric palatine tonsil in a pediatric patient: Is it always a malignant neoplasm? / Asimetría amigdalina en pediatría: ¿cuándo sospechar malignidad?

Abstract Background: A relatively frequent clinical finding in children is an asymmetric tonsil, which can have multiple etiological possibilities, including a malignant disease. The clinical finding of tonsillar asymmetry is found in approximately 2% of the pediatric population. The incidence of malignancy in the tonsils is low, estimated as 2.5 cases per 10,000 tonsillectomies. Due to its low incidence, the diagnostic tonsillectomy is not justified when tonsillar asymmetry is the only clinical finding. However, it is necessary to identify the critical clinical findings of high suspicion of malignancy that justify the performance of immediate surgery in the pediatric population. Case report: We present the case of a 10-year-old male patient. Four months before admission, the patient started with pharyngodynia and dysphagia, treated as recurrent tonsillitis. Due to exacerbation of the symptoms, orthopnea, and B symptoms, the patient came to consultation; tonsillar asymmetry was observed predominantly on the left side, with exophytic lesions extending to the hypopharynx. We decided to perform an incisional biopsy and tracheostomy due to compromised airway; histopathological diagnosis came back as B-cell lymphoma. Conclusions: Given the clinical scenario of recurrent tonsillitis, unresponsive to conventional medical treatment with antibiotics, tonsillar asymmetry with suspicious tonsillar appearance accompanied by symptoms such as fever, diaphoresis, cervical lymphadenopathy, obstructive symptoms in a pediatric patient, it is necessary to refer the patient to the specialist for timely diagnosis and treatment.

Resumen Introducción: La asimetría amigdalina es un hallazgo clínico relativamente frecuente en los niños. Se ha reportado en el 2% de la población pediátrica e incluye múltiples etiologías, entre ellas enfermedad maligna. La incidencia de malignidad es baja: se estima en 2.5 casos por cada 10,000 amigdalectomías. Por tal motivo, cuando se observa asimetría amigdalina como único hallazgo en la exploración física no se justifica la amigdalectomía con fines diagnósticos. Sin embargo, la incertidumbre de malignidad en el médico y en el paciente obliga a considerar los datos clínicos que permitan sospecharla y justificar la intervención quirúrgica. Caso clínico: Se presenta el caso de un paciente de sexo masculino de 10 años. Inició su padecimiento 4 meses previos a su ingreso hospitalario con faringodinia y disfagia, que fueron diagnosticadas y tratadas como amigdalitis recurrente. Acudió al hospital por agudización de los síntomas, evolucionando con ortopnea y síntomas B. En la exploración física se apreció asimetría amigdalina con aumento de volumen en la amígala izquierda extendida hasta la hipofaringe. Se decidió realizar una biopsia incisional y traqueostomía por compromiso respiratorio. El diagnóstico histopatológico fue linfoma de células B. Conclusiones: Ante un paciente pediátrico con amigdalitis recurrente, que no cede al tratamiento médico convencional y presenta asimetría amigdalina con aspecto sospechoso, acompañada de síntomas como fiebre, diaforesis, adenopatías cervicales y síntomas obstructivos, se deberá referir con el especialista para su diagnóstico y tratamiento oportunos.

Recomendaciones para el manejo clínico del niño en el posoperatorio de adenoamigdalectomía / Recommendations for the clinical management of the child in the postoperative adenoamygdalectomy

El síndrome de apneas e hipoapneas obstructivas del sueño se asocia con una disminución de la calidad de vida, bajo rendimiento escolar y, hasta en el 40% de los niños, trastornos de conducta como hiperactividad, enuresis, ansiedad y depresión. Varios estudios demostraron que la adenoamigdalectomía es efectiva para mejorar o resolver los trastornos respiratorios del sueño. Si bien esta cirugía tiene resultados beneficiosos, no está exenta de riesgos. El dolor y el sangrado posoperatorio son las dos causas principales de morbilidad. Otras complicaciones de la cirugía son las náuseas y los vómitos posoperatorios, el retraso en la alimentación, la deshidratación, la otalgia referida, los cambios en la voz y, raras veces, la muerte.En este artículo se realizan recomendaciones sobre el cuidado posoperatorio de los niños con adenoamigdalectomía

Obstructive sleep apnea and hypopnea syndrome is associated with decreased quality of life, poor school performance and, in up to 40% of children, behavioral problems such as hyperactivity, enuresis, anxiety and depression. Several studies have shown that adenoamygdalectomy is effective in improving or resolving sleep-disordered breathing. While this surgery has beneficial results, it is not without risks. Postoperative pain and bleeding are the two main causes of morbidity. Other complications of surgery include postoperative nausea and vomiting, delayed feeding, dehydration, referred earache, voice changes, and, rarely, death. Recommendations on postoperative care for children undergoing adenoamygdalectomy are mentioned in this article.

Therapeutic efficacy observation of Tuina manipulation for pediatric adenoid hypertrophy / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of Tuina (Chinese therapeutic massage) manipulation for pediatric adenoid hypertrophy (AH). Methods: A total of 60 children with AH were randomized into an observation group and a medication group, with 30 cases in each group. The observation group was treated with pediatric Tuina treatment, and the medication group was treated with 0.05％ mometasone furoate nasal spray. The changes of main clinical symptom score, quality of life (QOL) score and X-ray nasopharynx lateral film were observed, and the clinical efficacy was evaluated. Results: The total effective rate of the observation group was 90.0％, and that of the medication group was 66.7％. The difference between the two groups was statistically significant (P<0.05). After treatment, the A/N value [ratio of adenoid thickness (A) and nasopharyngeal cavity width (N)] of posterior nasopharyngeal lateral film did not show significant change in either group (P>0.05). After treatment, the clinical symptom scores in both groups decreased, and the intra-group differences were statistically significant (P<0.001), but there was no statistical difference between the two groups (P>0.05). After treatment, the QOL scores of children in both groups decreased, and the intra-group differences were statistically significant (P<0.001), and the difference between the two groups was statistically significant (P<0.001). Conclusion: Tuina manipulation is effective in treating pediatric AH, and produces a better effect in improving traditional Chinese medicine symptoms and QOL than 0.05％ mometasone furoate nasal spray.

Prevalence of soft tissue calcifications in CBCT images from the oral and maxillofacial radiology service at UNAB, Viña del Mar, Chile / Prevalencia de calcificaciones en tejidos blandos en CBCT del servicio de radiología oral y maxilofacial de la UNAB sede Viña del Mar, Chile

Soft tissue calcifications can indicate the presence of more serious, potentially life-threatening pathologies. Therefore, their study can lead to an early diagnosis of those conditions that have not yet become clinically apparent. Main objective: To determine the prevalence of calcifications in soft tissues of the head and neck in cone beam computed tomography images obtained from the Oral and Maxillofacial Radiology Service at Universidad Andrés Bello (UNAB), Viña del Mar, Chile. Material and Methods: Retrospective, cross-sectional, quantitative study. A total of 288 images of cone beam computed tomography (CBCT) were used. Images were obtained at random from the database of the Oral and Maxillofacial Radiology Service at UNAB, Viña Del Mar, between 2014 and 2019. Results: A prevalence of 59.72% of soft tissue calcifications was obtained. The most prevalent were: tonsilloliths and calcified stylohyoid ligament, accounting for 30.65% and 45.56%, respectively. Conclusion: A high prevalence of soft tissue calcifications was found in a population that has not been studied previously; therefore, it is important that the dentist perform a detailed analysis of the cone beam computed tomography.

Introducción: Las calcificaciones en tejidos blandos pueden indicar patologías más graves, que incluso pueden comprometer la vida. Por lo tanto, investigarlas puede conducir a un diagnóstico temprano de aquellas que aún no se han manifestado clínicamente. Objetivo principal: determinar la prevalencia de calcificaciones en tejidos blandos de cabeza y cuello en tomografía computarizada de haz cónico del Servicio de Radiología Oral y Maxilofacial de la UNAB, Viña del Mar, Chile. Material y Métodos: Estudio retrospectivo, transversal, cuantitativo. Se utilizaron 288 volúmenes de tomografía computarizada de haz cónico (CBCT, por las iniciales en inglés de Cone Beam Computed Tomography), obtenidas al azar, de la base de datos del Servicio de Radiología Oral y Maxilofacial de la Universidad Andrés Bello (UNAB), Viña del Mar entre 2014 y 2019. Resultados: Se obtuvo una prevalencia de 59.72% de calcificaciones en tejidos blandos. Las más prevalentes fueron: tonsilolitos, con un 30,65% y ligamento estilohioídeo calcificado, con un 45,56%. Conclusión: Se encontró una alta prevalencia de calcificaciones en tejidos blandos en una población que no ha sido estudiada previamente, por ello es importante que el odontólogo realice un análisis detallado de la tomografía computarizada de haz cónico.

A metastatic histiocytic sarcoma case with primary involvement of the tonsil

Histiocytic sarcoma (HS) is an extremely rare and aggressive hematopoietic tumor. Although it can be seen at any anatomic location, the most common primary sites are skin as extranodal region, locations including the lymph nodes and gastrointestinal tract. To the best of our knowledge, in light of PubMed search, this is the first primary tonsillar HS case presented with disseminated metastases at the time of diagnosis. A 58-year-old male patient applied with swelling on the right side of the neck, difficulty in swallowing, and weight loss. Positron emission tomography computed tomography was performed and increased pathological 18F fluorodeoxy D glucose uptake was detected in the right palatine tonsil, bilateral cervical multiple lymph nodes, liver masses, intra abdominal lymph nodes, and nodular lesion in the left adrenal gland. Tonsillectomy was performed and the pathological result was reported as HS. The patient did not respond to any treatment and had died after 5 months from the date of diagnosis. In conclusion, HS is generally diagnosed at advanced stage, it has limited chemotherapy response and high mortality rates. To understand this rare disease's pathophysiological and clinical features, further investigations are needed

Inflammatory markers in palatine tonsils of children with obstructive sleep apnea syndrome / Marcadores inflamatórios em tonsilas palatinas de crianças com síndrome da apneia obstrutiva do sono

Abstract Introduction Obstrutive sleep apnea syndrome is characterized by repeated episodes of upper airway obstruction, associated with intermittent hypoxia and hypercapnia, and the main risk factor in childhood is adenotonsillar hypertrophy. The lymphocytes in these structures are responsible for local and systemic immune responses. Objective Verify the levels of the inflammatory markers, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-15, TNF-α, CRP and α1-GP, in the tonsils of children with and without obstructive sleep apnea syndrome. Methods This cross-sectional prospective study included 34 children with complains of snoring, difficulty breathing during sleep or recurrent tonsillitis. Patients underwent to a complete otorhinolaryngological examination, nasal endoscopy and polysomnography and were divided into two groups with 17 children each: obstructive sleep apnea syndrome group and control group. All underwent an adenotonsillectomy. Cytokines were measured in the collected tonsils (ELISA and Multiplex methods). Results Statistically significant increasing were observed between IL-8 and IL-10 cytokines of patients with obstructive sleep apnea when compared to the control group; also between c-reactive protein and α1-GP of the tonsils cortical region in children with obstructive sleep apnea syndrome when compared with the medullary region. There were no statistically significant differences for the remaining inflammatory mediators. Conclusion After the analysis of the levels of pro and anti-inflammatory markers (IL-1β, IL-4, IL-6, IL-8, IL-10, Il-15, TNF-α, CRP, α1-GP) in the tonsils, we observed higher levels of markers IL-8 and IL-10 in pediatric patients with obstructive sleep apnea syndrome.

Resumo Introdução A síndrome da apneia obstrutiva do sono é caracterizada por episódios repetidos de obstrução das vias aéreas superiores, associados a hipóxia intermitente e hipercapnia, e o principal fator de risco na infância é a hipertrofia adenotonsilar. Os linfócitos nessas estruturas são responsáveis por respostas imunes locais e sistêmicas. Objetivo Dosar os marcadores inflamatórios, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-15, TNF-α, PCR e α1-GP, nas tonsilas de crianças com e sem síndrome da apneia obstrutiva do sono. Método Estudamos prospectivamente 34 crianças que se queixavam de ronco, dificuldade para respirar durante o sono ou tonsilites recorrentes. Os pacientes foram submetidos a exame otorrinolaringológico completo, endoscopia nasal e polissonografia e foram divididos em dois grupos com 17 crianças cada: síndrome de apneia obstrutiva do sono e controle. Todos foram submetidos à adenotonsilectomia. As citocinas foram medidas nas tonsilas coletadas (métodos ELISA e Multiplex). Resultados Com diferenças estatisticamente significantes, observou-se aumento das citocinas IL-8 e IL-10 em pacientes com apneia obstrutiva do sono em comparação ao grupo controle, assim como aumento dos níveis de proteína C reativa e de α1-GP na região cortical das tonsilas de crianças portadoras de síndrome da apneia obstrutiva do sono em comparação com a região medular. Não houve diferenças estatisticamente significantes para o restante dos mediadores inflamatórios. Conclusão Após a análise dos níveis de marcadores pró e anti-inflamatórios (IL-1β, IL-4, IL-6, IL-8, IL-10, Il-15, TNF-α, PCR, α1-GP) nas tonsilas, observamos níveis mais altos de marcadores IL-8 e IL-10 em pacientes pediátricos com síndrome da apneia obstrutiva do sono.

Hipertrofia de amígdalas linguales: presentación de casos revisión narrativa / Lingual tonsil hypertrophy: presentation of cases narrative review

Actualmente no es sólito tener pacientes con síntomas causados por la implicación de las amígdalas linguales y que pasemos por alto su sospecha. Los signos y síntomas que pueden presentar los pacientes son variados, desde el síndrome de apnea obstructiva del sueño (síntoma más común) y disfagia hasta tos crónica mal abordada y, por lo mismo, tratada inadecuadamente. Presentamos los casos clínicos de dos pacientes con hipertrofia de amígdalas linguales y una revisión narrativa del tema.

Currently, it is not unusual to have patients with symptoms due to the involvement of lingual tonsils and let us go unnoticed their suspicion. The signs and symptoms that patients may present are varied, from giving obstructive sleep apnea syndrome (the most common symptom) dysphagia to poorly treated and poorly treated chronic cough. We present the clinical cases of two patients with hypertrophy of the lingual tonsils and a narrative review of the subject.

Post-operative bleeding in tonsillectomy versus tonsillectomy with fossa closure in a tertiary military hospital: A cohort study

Objective@#To determine the incidence of post-operative bleeding among patients who underwent tonsillectomy alone versus tonsillectomy with fossa closure at the Victoriano Luna Medical Center from January 2015 to December 2017. @*Methods@#Design: Retrospective Cohort Study. Setting: Tertiary Military Hospital. Patients: Medical records of 83 patients that underwent tonsillectomy under the Department of Otorhinolaryngology – Head and Neck Surgery between January 2015 to December 2017 were retrospectively reviewed for data regarding sex, age, tonsillectomy with or without fossa closure and post-operative bleeding. Cases of tonsillectomy alone versus tonsillectomy with fossa closure were compared (particularly with respect to post-operative bleeding), tabulated and statistically analyzed using risk ratio and t-test.@*Results@#There were 57 cases of tonsillectomy alone versus 26 cases of tonsillectomy with fossa closure. The incidence of bleeding in all cases of tonsillectomy whether tonsillectomy alone or with fossa closure was 4.8%. The incidence of bleeding was higher in cases of tonsillectomy with fossa closure at 11.5% (versus 1.8% in tonsillectomy alone). Post-operative bleeding was 0.1 times more likely to occur in patients who underwent tonsillectomy alone than those who underwent tonsillectomy with fossa closure but there was no statistically significant difference in the risk of post-operative bleeding between the two. @*Conclusion@#Although the incidence of bleeding was higher in cases of tonsillectomy with fossa closure, our results suggest that there is no statistically significant difference in risk for postoperative bleeding between tonsillectomy alone or tonsillectomy with fossa closure.

Experiencia clínica y manejo de los abscesos periamigdalinos en el Complejo Asistencial Dr. Sótero del Río / Clinical experience and management of peritonsillar abscesses at the Dr. Sótero del Río Health Center

RESUMEN Introducción: El absceso periamigdalino es una causa importante de consulta de urgencia en los servicios de otorrinolaringología. Su manejo incluye tratamientos antibióticos y drenaje del absceso. Objetivo: Describir y analizar las características clínicas, epidemiológicas y manejo de los abscesos periamigdalinos en el Complejo Asistencial Dr. Sótero del Río. Material y método: Estudio retrospectivo, descriptivo, incluyendo a todos los pacientes con un absceso periamigdalino entre los años 2013 y 2016. Se analizaron variables epidemiológicas, clínicas, uso de antibióticos, drenajes, y persistencia del cuadro. Resultados: La serie está constituida por 122 pacientes, con una edad promedio de 29 años. Diez y nueve coma seis por ciento corresponde a pacientes pediátricos. La clínica se caracterizó principalmente por odinofagia (62,7%), voz engolada (32%), fiebre (27%) y trismus (27%). Al examen físico, se observó abombamiento del pilar (67,2%), desplazamiento de la úvula (41,8%), trismus (26,2%), y placas blanquecinas sobre la amígdala (18,9%). Este último hallazgo fue más frecuente en la población pediátrica. El 46,2% de los pacientes recibió algún tratamiento antibiótico antes de consultar en el servicio de urgencia, y el 35,7% de los pacientes recibieron corticoides durante la consulta al servicio de urgencia. En la gran mayoría (92%), se realizó un drenaje del absceso, principalmente por incisión (81,7%). Sólo en el 13,1% de los pacientes se requirió un segundo drenaje. Conclusión: El absceso periamigdalino es una causa importante de consulta en los servicios de urgencia, siendo más frecuente en el adulto joven. El drenaje del absceso asociado a un tratamiento antibiótico endovenoso y/o vía oral presenta un excelente pronóstico.

ABSTRACT Introduction: Peritonsillar abscesses are an important cause of emergency consults in the otorhinolaryngology department. Its management includes use of antibiotics and drainage of the abscess. Aim: To describe and analyze the clinical characteristics, epidemiology, and management of peritonsillar abscesses at the Dr. Sótero del Río Health Center. Material and method: Retrospective and descriptive study of all patients presenting with a peritonsillar abscess between the years 2013 and 2016. Variables analyzed include demographics, signs and symptoms, use of antibiotics, drainage, and persistence of the disease. Results: This series includes 122 patients, with a mean age of 29 years; 19.6% are pediatric patients. Clinically, patients presented mainly with odynophagia (62.7%), muffled voice (32%), fever (27%), and trismus (27%). On physical examination, swelling of the tonsillar pillar (67.2%), uvula deviation (41.8%), trismus (26.2%), and white patches on tonsil (18.9%) were observed. The latter finding was more common in children. Forty-six percent of the patients received an antibiotic treatment previous to consulting at the emergency department, and 35.7% received steroids at the emergency department. The majority (92%) had the abscess drained, mainly by incision (81.7%). Only 13.1% of the patients required a second drainage. Conclusion: Peritonsillar abscess is a common presentation at the emergency department, seen primarily in young adults. The prognosis is excellent with drainage of the abscess associated with an intravenous and/or oral antibiotic treatment.

Recubrimiento del lecho amigdalino en amigdalectomía intracapsular. Reporte de técnica quirúrgica / Coating of the tonsillar bed in intracapsular tonsillectomy. Surgical technique report

El recubrimiento del lecho amigdalino se trata de un procedimiento coadyuvante y sencillo ya descrito por varios autores con diferencias en la técnica que ocupa unos cuantos minutos más en la cirugía amigdalina tradicional, pero que representa en la experiencia de muchos un aporte para la pronta cicatrización y recuperación de los pacientes sometidos a esta cirugía que se realiza desde hace mucho tiempo, pero que implica un postoperatorio particularmente molesto por cuenta del dolor en los días siguientes. Es un reto y una responsabilidad el alivio del dolor postoperatorio y la prevención de las complicaciones relacionadas principalmente con el sangrado. La intención de este artículo es proponer en la práctica diaria, cuando se realizan amigdalectomías, una técnica complementaria que mejorará las condiciones de un período postoperatorio con menor dolor y una recuperación más rápida. Se busca el recubrimiento de la zona operada con el remanente de la mucosa de la cápsula amigdalina protegiendo la musculatura del lecho.

The covering of the tonsillar bed is a simple procedure already described by several authors with differences in the technique that occupies a few minutes more in the traditional tonsillectomy, but that represents, in the experience of many, a contribution for the early healing and recovery of patients submitted to this surgery that has been performed since long time ago, but that embodies a particularly annoying postoperative period due to pain in the following days. It is our challenge and responsibility to relieve postoperative pain and prevent complications mainly related to bleeding. The intention of this article is to propose in our daily practice, when it is performed tonsillectomies, a complementary technique that will improve the conditions of a postoperative period with less pain and quick recovery. The coating of the operated area is sought with the remaining mucosa of the tonsillar capsule protecting the musculature of the tonsillar bed.

Conditioned Medium from Tonsil-Derived Mesenchymal Stem Cells Relieves CCl₄-Induced Liver Fibrosis in Mice

BACKGROUND: The liver is an organ with remarkable regenerative capacity; however, once chronic fibrosis occurs, liver failure follows, with high mortality and morbidity rates. Continuous exposure to proinflammatory stimuli exaggerates the pathological process of liver failure; therefore, immune modulation is a potential strategy to treat liver fibrosis. Mesenchymal stem cells (MSCs) with tissue regenerative and immunomodulatory potential may support the development of therapeutics for liver fibrosis. METHODS: Here, we induced hepatic injury in mice by injecting carbon tetrachloride (CCl₄) and investigated the therapeutic potential of conditionedmedium from tonsil-derivedMSCs (T-MSCCM). In parallel, we used recombinant human IL-1Ra,which, as we have previously shown, is secreted exclusively from T-MSCs and resolves the fibrogenic activation of myoblasts. Hepatic inflammation and fibrosis were determined by histological analyses using H&E and Picro-Sirius Red staining. RESULTS: The results demonstrated that T-MSC CM treatment significantly reduced inflammation as well as fibrosis in the CCl₄-injured mouse liver. IL-1Ra injection showed effects similar to T-MSC CM treatment, suggesting that T-MSC CM may exert anti-inflammatory and anti-fibrotic effects via the endogenous production of IL-1Ra. The expression of genes involved in fibrosis was evaluated, and the results showed significant induction of alpha-1 type I collagen, transforming growth factor beta, and tissue inhibitor of metalloproteases 1 upon CCl₄ injection, whereas treatment with T-MSC CM or IL-1Ra downregulated their expression. CONCLUSION: Taken together, these data support the therapeutic potential of T-MSC CM and/or IL-1Ra for the alleviation of liver fibrosis, as well as in treating diseases involving organ fibrosis.

A Case of Adenosquamous Carcinoma Arising from the Tonsil / 대한이비인후과학회지

Adenosquamous cell carcinoma of tonsil is a rare lesion of head and neck and is often misdiagnosed as squamous cell carcinoma. It has a very aggressive clinical pattern. We encountered a patient with an adenosquamous cell carcinoma of tonsil and performed various treatment modalities including surgical resection, radiation therapy, chemotherapy but the patient expired two years after the first diagnosis. Such case has never been reported earlier in Korea. Herein, we present this rare case with a review of related literature.