Planificación quirúrgica de colgajo faríngeo a medida para insuficiencia velofaríngea secundaria a fisura de paladar: reporte de caso y revisión de literatura / Surgical planning of a tailor-made pharyngeal flap for velopharyngeal insufficiency secondary to a cleft palate: case report and literature review

Resumen La insuficiencia velofaríngea (IVF) es una de las principales secuelas estructurales tras la palatoplastía primaria en casos de fisura de paladar. La IVF se caracteriza por la ausencia de tejido suficiente para lograr un cierre adecuado del mecanismo velofaríngeo durante el habla, lo que conlleva a una resonancia hipernasal y la emisión nasal de aire durante la producción de sonidos orales. Al respecto, el tratamiento ideal para corregir la IVF es quirúrgico, dentro de los cuales el colgajo faríngeo de pedículo superior es uno de los procedimientos más utilizados en nuestro país. Para su realización es fundamental determinar el ancho necesario, lo cual puede ser determinado mediante una videofluoroscopía multiplano (VFMP). Por esto, con el objetivo de potenciar el trabajo multidisciplinario en la corrección quirúrgica de la IVF, a continuación, se presentan los procedimientos de evaluación fonoaudiológica, videonasofaríngoscopía flexible y videofluoroscopía multiplano utilizados para la planificación quirúrgica de un colgajo faríngeo en un adolescente chileno diagnosticado con IVF secundaria a fisura palatina operada. Además, se describe el uso de la VFMP en la planificación quirúrgica del colgajo faríngeo mediante una revisión de literatura.

Abstract Velopharyngeal insufficiency (VPI) is one of the main structural sequelae after primary palatoplasty in cases of cleft palate. VPI is characterized by the absence of sufficient tissue to achieve adequate closure of the velopharyngeal mechanism (VFM) generating hyper-nasal resonance and nasal emission during the production of oral sounds. In cases of cleft palate, the ideal treatment to correct VPI is surgery. The upper pedicle pharyngeal flap is one of the most widely used procedures. To plan it, is essential to determine the appropriate width, which can be determined by means of multiplane videofluoroscopy (MPVF). For this reason, and with the aim of promoting multidisciplinary approach in the surgical correction of VPI, the following procedures such as speech and language evaluation, flexible videonasopharyngoscopy and multiplane videofluoroscopy used for the surgical planning of a pharyngeal flap, in a Chilean adolescent diagnosed with VPI secondary to operated cleft palate, will be presented. In addition, the use of MPVF in pharyngeal flap surgical planning is described through a literature review.

Correlação entre ausculta cervical e eletromiografia de superfície na fase faríngea da deglutição / Correlation between cervical auscultation and electromyography in the pharyngeal phase of swallowing / Correlación entre auscultación cervical y electromiografía de superficie en la fase faríngea de la deglución

Objetivo: Correlacionar os dados acústicos da ausculta cervical com a atividade elétrica dos músculos envolvidos na fase faríngea da deglutição. Métodos: Trata-se de um estudo observacional, transversal, de abordagem quantitativa, aprovado em janeiro pelo CEP/UFSCPA (número 1.389.050). Todos os participantes do estudo assinaram o termo de consentimento livre e esclarecido. A fase faríngea da deglutição foi avaliada por meio de ausculta cervical e eletromiografia de superfície. Os indivíduos ingeriram 90 ml de água. Os dados da ausculta foram transferidos para o DeglutiSom® software, a duração e amplitude da atividade eletromiográfica foram mensuradas durante a deglutição com aparelho de eletromiografia de superfície Miotec®. O nível de significância adotado foi de 5%. Resultados:Cinquenta e sete mulheres participaram deste estudo. A média de idade foi de 23,4 anos. Ressalta-se que quanto maior a frequência média do pico da ausculta, menor é a média do pico do músculo supra-hióideo e quanto maior a intensidade, maior é o pico, assim como a média dos picos supra-hióideos. Foi possível demonstrar que o pico de atividade do músculo supra-hióideo foi significativamente maior do que o pico de atividade do músculo infra-hióideo para a deglutição de 90 ml de água. Conclusão:Os parâmetros acústicos da deglutição em indivíduos saudáveis estão correlacionados com a atividade elétrica dos músculos envolvidos na fase faríngea da deglutição.

Objective: Correlate the acoustic data of cervical auscultation to the electrical activity of the muscles involved in the pharyngeal phase of swallowing. Methods: This is an observational, cross-sectional study involving a quantitative approach and was approved on January by CEP/UFSCPA (number 1.389.050). All participants of the study signed an informed consent form. The pharyngeal phase of swallowing was assessed by employing auscultation and surface electromyography. Individuals ingested 90 ml of water. The auscultation data were transferred to DeglutiSom® software, the duration and amplitude of electromyographic activity was measured during swallowing using a Miotec® surface electromyography device. The level of significance adopted was 5%. Results: Fifty-seven women participated in this study. The average age was 23.4 years on average. It must be highlighted that the greater the average peak frequency of auscultation, lower was the average peak of the suprahyoid muscle and the greater the intensity, the greater was the peak, as well as the average of the suprahyoid peaks. It was possible to demonstrate that the peak of suprahyoid muscle activity was significantly higher than the peak of infra hyoid muscle activity for swallowing 90 ml of water. Conclusion: The acoustic swallowing parameters in healthy individuals are correlated with the electrical activity of muscles involved in the pharyngeal phase of swallowing.

Objetivo: Correlacionar los datos acústicos de la auscultación cervical con la actividad eléctrica de los músculos involucrados en la fase faríngea de la deglución. Métodos: Se trata de un estudio observacional, transversal, de abordaje cuantitativo y aprobado en enero por CEP/UFSCPA (número 1.389.050). Todos los participantes del estudio firmaron un formulario de consentimiento informado. La fase faríngea de la deglución se evaluó mediante auscultación y electromiografía de superficie. Los individuos ingirieron 90 ml de agua. Los datos de auscultación fueron cargados em el software DeglutiSom®, la duración y la amplitud de la actividad electromiográfica se midió durante la deglución utilizando un dispositivo de electromiografía de superficie Miotec®. El nivel de significancia adoptado fue del 5%. Resultados: Cincuenta y siete mujeres participaron en este estudio. La edad promedio fue 23,4 años. Cabe destacar que a mayor frecuencia de pico promedio de auscultación, menor fue el pico promedio del músculo suprahioideo y a mayor intensidad, mayor fue el pico, así como el promedio de los picos suprahioideos. Fue posible demostrar que el pico de actividad del músculo suprahioideo era significativamente más alto que el pico de actividad del músculo infrahioideo para tragar 90 ml de agua. Conclusión: Los parámetros de deglución acústica en individuos sanos se correlacionan con la actividad eléctrica de los músculos involucrados en la fase faríngea de la deglución.

Transoral endoscopic resection of benign tumors in parapharyngeal space via medial pterygomandibular raphe approach / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the surgical methods and effects of transoral endoscopic resection of benign tumors in parapharyngeal space via medial pterygomandibular raphe approach. Methods: The clinical data of 23 patients who underwent resection of benign tumors in parapharyngeal space by endoscopic medial pterygomandibular raphe approach from January 2016 to July 2020 in the Department of Otorhinolaryngology Head and Neck Surgery, the Affiliated Hospital of Qingdao University were analyzed retrospectively. There were 14 males and 9 females with a median age of 43 years. The tumors were located in the anterior space of the styloid process in 13 cases and in the posterior space in 10 cases. The smallest tumor volume was 7.3 ml and the largest was 80.2 ml. The preoperative imaging features, the characteristics and risks of this approach in the operation were analyzed, and the feasible mode of operation was explored. Results: All patients completed the operation successfully. The intraoperative blood loss was 20 to 50 ml, with an average of 28.3 ml. The operation time was 40 to 110 min, with an average of 75.4 min. The incision length was 2 to 4 cm, with an average of 3.0 cm. The postoperative pain score was 2 to 4, with an average of 3.2. The postoperative hospital stay was 4 to 9 d, with an average of 6.7 d. Postoperative pathological diagnosis included pleomorphic adenoma (n=12), neurilemmoma (n=10) and basal cell adenoma (n=1). The patients were followed up for 6 to 60 months. There was no postoperative complication such as infection or serious bleeding, and there was no tumor recurrence after operation. Conclusion: Endoscopic resection of benign tumor in parapharyngeal space via medial pterygomandibular raphe approach is a safe, effective, and minimally invasive surgical method for the treatment of tumors in parapharyngeal space.

Clinical characteristics and outcomes of 111 neonates with upper airway obstruction admitted via transportation / 中华儿科杂志

Objectives: To analyze the clinical characteristics and outcomes of neonates with upper airway obstruction (UAO) who were admitted via transportation, hence to provide more evidence-based information for the clinical management of UAO. Methods: This was a single center retrospective study. Patients were hospitalized in Beijing Children's Hospital from January 1, 2016 to May 31, 2021 with age <28 days or postmenstrual age (PMA) ≤44 weeks, and UAO as the first diagnosis. The general information of patients, obstructed sites in the upper airway, treatment, complications and prognosis were analyzed. The outcomes of surgical UAO vs. non-surgical UAO were analyzed by 2 by 2 χ2 test. Results: A total of 111 cases were analyzed (2.3% of the total NICU hospitalized 4 826 infants in the same period), in which 62 (55.9%) were boys and 101 (91.0%) were term infants, and their gestational age was (38.7±2.0) weeks, birth weight (3 207±585) g, PMA on admission (40.8±2.5) weeks and weight on admission was (3 221±478) g. There were 92 cases (82.9%) with symptoms of UAO presenting on postnatal day 1, and 35 cases (31.5%) had extra-uterine growth retardation on admission. The diagnosis of UAO and the obstructive site was confirmed in 25 cases (22.5%) before transportation. There were 24 cases (21.6%), 71 cases (64.0%), and 16 cases (14.4%) who had UAO due to nasal, throat, and neck problems, respectively. The top 5 diagnosis of UAO were vocal cord paralysis (28 cases), bilateral choanal atresia (20 cases), laryngomalacia (15 cases), pharynx and larynx cysts (7 cases), and subglottic hemangioma (6 cases). The diagnosis and treatment of all the patients followed a multidisciplinary approach consisted of neonatal intensive care unit, ear-nose-throat department and medical image departments. A total of 102 cases (91.9%) underwent both bronchofiberscope and fiber nasopharyngoscope investigation. Seventy cases (63.1%) required ventilation. Among the 58 cases (52.3%) who required surgical intervention, 16 had tracheotomy. For cases with vs. without surgical intervention, the rate of cure and (or) improvement were 94.8% (55/58) vs. 54.7% (29/53), and the rate of being discharged against medical arrangement were 1.7% (1/58) vs. 45.3% (24/53) (χ²=24.21 and 30.11, both P<0.01). Conclusions: Neonatal UAO may locate at various sites of the upper airway. The overall prognosis of neonatal UAO is favorable. A multidisciplinary approach is necessary for efficient evaluation and appropriate surgical intervention.

Changes in the airway after mentoplasty (genioplasty): systematic review / Cambios en la vía aérea después de una mentoplastia (genioplastia): una revisión sistemática

SUMMARY: The aim of this research was to evaluate the changes obtained with the mentoplasty technique in the increase of the airway imaging. A systemic review was performed using the parameters of the prism matrix, in the PubMed, Science Direct, Redalyc database, covering the years 1984 to 2019 with the use of defined inclusion criteria. The authors independently applied the selected parameter of data extraction, study selection and risk-to-bias assessment. A total of 1,251 articles were obtained among the 3 databases, of which 10 met the inclusion criteria. The variables studied were: type of research, sample size, sex, age, dento-skeletal diagnosis, airway classification, diagnosis of obstructive sleep apnea syndrome (OSAS), type of imaging evaluation, variables evaluated in the image, pre and post-operative values, surgical technique and type of fixation used, other surgical procedures applied, and complications. In the cases of linear evaluation with cephalometric analysis (9 articles) they used PAS (posterior airspace), MP-H (mandibular plane to the hyoid) and SNB (saddle-nasion-point B), and SCSA (section area as the most relevant points, smallest cross section) and VT (total volume) in the volumetric evaluations (2 articles). The average change in posterior airspace achieved by the cited authors is 4.2 mm with standard deviation of 1.4 mm with the use of advancement mentoplasty. The most widely used technique was mentoplasty with a horizontal osteotomy by 5 authors. Based on the research there is a positive relationship between the increase in the airway and the advancement mentoplasty procedure, however, more standardized studies associated with the way of measuring and evaluating the relationship between advancement and the airway are necessary.

RESUMEN: El objetivo de esta investigación fue evaluar los cambios obtenidos con la técnica de mentoplastia en el incremento de la via aérea. Una revisión sistemática fue realizada utilizando parámetros de la matriz prisma, en PubMed, Science Direct, Redalyc database, cubriendo los años 1984 a 2019 con criterios de inclusión definidos. Los autores aplicaron de forma independiente los parámetros de selección y extracción de datos, selección de estudios y riesgos de sesgo. Un total de 1251 artículos fueron obtenidos de las 3 bases de dato, donde 10 artículos cumplieron los criterios de inclusión. Las variables estudiadas fueron: tipo de investigación, tamaño de la muestra, genero, edad, diagnóstico dento esqueletal, clasificación de la vía aérea, diagnostico de síndrome de apnea del sueño (SAOS), tipo de evaluación de la imagen, variables evaluadas en la imagen en pre y postoperatorio, técnica quirúrgica y tipo de fijación utilizada, otros procedimientos quirúrgicos y complicaciones. En el caso de la evaluación linear con cefalometria (9 artículos), usaron PAS (posterior airspace), MP-H (plano mandibular hacia el hueso hioide) y SNB (silla turca-nasion- punto B) y SCSA (sección de puntos mas relevantes, menores transfversales) y el VT (volumen total) en las evaluaciones volumétricas (2 artículos). El promedio de cambio posterior de la vía aérea citado por autores fue de 4,2 mm con una desviación estándar de 1,4 mm con el uso de la mentoplastia de avance. La técnica mas habitual fue la mentoplastia con osteotomía horizontal (5 autores). Basados en esta investigación existe una relación positiva entre el incremento de la vía aérea y el avance con genioplastia; sin embargo, mas estudios estandarizados junto con medidas definidas y la evaluación correcta del avance y la vía área son necesarios.

Preescolar con divertículo de Zenker y hallazgo intraoperatorio de cuerpo extraño esofágico / Preschool-age child with Zenker's diverticulum and intraoperative finding of an esophageal foreign body

Introducción. El divertículo de Zenker es una evaginación sacular ciega que puede presentarse a nivel faringoesofágico. No se conoce exactamente su incidencia en la edad pediátrica, constituyendo una patología muy infrecuente. La sintomatología es inespecífica, lo que dificulta el diagnóstico precoz y determina un mayor riesgo de complicaciones asociadas. Caso clínico. Paciente preescolar femenina con cuadro recurrente de emesis con deshidratación, posteriormente asociado a disfagia, a quien se le diagnosticó un divertículo de Zenker. Se realizó tratamiento quirúrgico con hallazgo intraoperatorio de dilatación esofágica, un área de estenosis secundaria al hallazgo incidental de un cuerpo extraño y divertículo de Zenker en la región lateral del esófago dilatado. Discusión. Esta patología es extremadamente rara, pero se debe tener en cuenta dentro de los diagnósticos diferenciales en pacientes con sintomatología faringo-esofágica. Conclusión. Se presenta una preescolar sin antecedente de procedimientos esofágicos o malformaciones congénitas asociadas con diagnóstico de un divertículo de Zenker y dilatación esofágica por un cuerpo extraño, tratada quirúrgicamente de forma exitosa.

Introduction. Zenker's diverticulum is a blind saccular evagination that can present at the pharyngoesophageal level. Its incidence in pediatric age is not exactly known, constituting a very infrequent pathology. The symptoms are nonspecific, which makes early diagnosis difficult and determines a higher risk of associated complications.Clinical case. Female preschool patient with recurrent dehydration due to emesis, later associated with dysphagia, who was diagnosed with Zenker's diverticulum. Surgical treatment was performed with intraoperative finding of esophageal dilation, an area of stenosis secondary to the incidental finding of a foreign body, and a Zenker's diverticulum in the lateral region of the dilated esophagus. Discussion. This pathology is extremely rare, but it should be taken into account within the differential diagnoses in patients with pharyngo-esophageal symptoms. Conclusion: We present a preschool female patient with no history of esophageal procedures or congenital malformations associated with a diagnosis of Zenker's diverticulum and esophageal dilation due to a foreign body, successfully treated surgically.

Association between voice symptoms and college professors' home working conditions during online classes in times of COVID-19 pandemic / Asociación entre síntomas vocales y condiciones de trabajo en casa durante las clases online en tiempos de COVID-19 de docentes universitarios

Introduction. Due to the COVID-19 pandemic, teaching conditions changed around the world from in-person classes to online classes, which also determined changes on teachers' working conditions. Method: Exploratory cross-sectional study with the aim of determining the association between two voice symptoms (vocal fatigue and throat pain) with home working conditions during online classes in times of COVID-19 pandemic. Professors answered an online survey including 27 questions about four components: sociodemographic factors, characteristics of home working, quarantine characteristics, and health conditions (including voice functioning). Results: 177 college professors from Argentina, Colombia, and Chile participated in this study. First, incidence of vocal fatigue, during online classes in times of COVID-19 pandemic, represented around 50%. Although throat pain had a smaller incidence, it was also important (35%). Second, days in quarantine, number of classes per week, people living with during quarantine, and history of vocal fatigue before quarantine were important associated factors of vocal fatigue. Third, important associated factors of throat pain were number of classes per week, level of stress, years of experience, and history of throat pain before quarantine. Conclusion: Similar to pre-COVID-19, vocal fatigue and throat pain were frequently reported voice symptoms among college professors. Associated factors of these symptoms included years of experience, number of classes per week, stress, people living with during quarantine due to COVID-19, and history of voice symptoms. Workplace Health Promotion programs should include activities that facilitate a healthy occupational voice use during and post-COVID-19 pandemic, considering the implications of online teaching on teachers' health and safety

Introducción: Debido a la pandemia del COVID-19, las condiciones de ense-ñanza-aprendizaje cambiaron alrededor del mundo, pasando de clases presen-ciales a clases virtuales, lo que también determinó cambios en las condiciones de trabajo docente. Métodos: Estudio transversal exploratorio que tuvo como propósito determinar la asociación entre dos síntomas de voz (fatiga vocal y dolor de garganta) con las con-diciones de trabajo docente durante las clases virtuales en tiempos de COVID-19. Los profesores diligenciaron una encuesta virtual que incluyó 27 preguntas sobre los siguientes cuatro componentes: factores sociodemográficos, características del tra-bajo en casa, características de la cuarentena, y condiciones de salud (incluyendo funcionamiento vocal). Resultados: 177 profesores universitarios de Argentina, Colombia y Chile parti-ciparon en este estudio. Primero, la incidencia de la fatiga vocal durante las clases virtuales en tiempos de COVID-19 representó alrededor del 50%. Aunque el dolor de garganta tuvo una menor incidencia, también fue importante (35%). Segundo, los días en cuarentena, número de clases por semana, personas con las que vivió durante la cuarentena, y los antecedentes de fatiga vocal antes de la cuarentena estuvieron estadísticamente asociados a la fatiga vocal. Tercero, los factores asociados al dolor de garganta fueron el número de clases semanales, los niveles de estrés, los años de experiencia y los antecedentes de dolor de garganta antes de la cuarentena.Conclusión: Similar a hallazgos previos al COVID-19, la fatiga vocal y el dolor de garganta son síntomas vocales frecuentemente reportados en docentes universitarios. Factores asociados de estos síntomas incluyen años de experiencia, número de clases semanales, estrés, personas con las que vivió durante la cuarentena y antecedentes de estos síntomas vocales antes del trabajo en casa. Los Programas de Promoción de la Salud en los Lugares de Trabajo deben incluir actividades que faciliten el uso ocupacional saludable de la voz durante y después del COVID-19, considerando las implicaciones de la enseñanza virtual en la salud y seguridad de los profesores.

Caractéristiques de l'automédication en ORL à l'Hôpital d'Instruction des Armées-Cotonou au Bénin / Characteristics of self-medication in ENT at Military Teaching Hospital Cotonou in Benin

Etudier l'ampleur et les caractéristiques de l'automédication en consultation ORL. Méthode: Etude descriptive du 1er juin 2020 au 1er février 2021 dans le service d'ORL-CCF/ Hôpital d'Instruction des Armées. Ont été inclus tous les patients reçus en consultation ORL ayant déclaré avoir utilisé des substances actives sans prescription médicale pour soulager leur plainte actuelle. 6 Résultats: L'automédication a été retrouvée chez 373 patients soit une prévalence de 47,88%. La moyenne d'âge était 32,26 ans (02 mois et 80 ans). Les sujets âgés 0 à 20 étaient plus représenté (68,4%). La sex-ratio était de 0,86. Les professions libérales étaient plus représentées (30%). La quasi-totalité des patients (98%) a pu énumérer au moins deux effets nocifs de l'automédication. Les médicaments en cause étaient les médicament en vente libre OTC (80%). Les principales raisons ayant motivé l'automédication ont été le coût élevé des prestations médicales (41,3%) et le manque de temps (33,2%). Conclusion: L'automédication a été retrouvée chez des patients volontiers jeunes, de sexe féminin, porteurs d'affections rhinologiques. Les OTC étaient en cause dans huit cas sur dix. Les principales motivations à l'automédication ont été le coût élevé des prestations médicales et le manque de temps.

Respostas pressóricas faringeana, esofágica e do esfíncter esofagiano a tarefas vocais à luz da manometria de alta resolução / Pharyngeal, upper esophageal sphincteric and esophageal pressures responses related to vocal tasks at the light of high resolution manometry

ABSTRACT BACKGROUND: High-resolution manometry (HRM) represents a potential tool for measuring pharyngoesophageal phonation pressures. OBJECTIVE: This study aims to evaluate pharyngeal, esophageal upper sphincteric and esophageal pressures during different phonation tasks. METHODS: 12 (six males, mean age 27 years) professional singers underwent HRM and produced four different vocal tasks at low, medium and high vocal loudness: vowel /ae/, ascending five note scale, word /hey/ and word /go/. Pressures were measured at pharynx, upper esophageal sphincter (UES) and esophagus. Visual analysis of the HRM topographic plots were performed. RESULTS: Esophageal pressures are higher during vocalization than at rest. Pharyngeal and UES phonation pressures does not differ significantly from rest pressures. Visual analysis of the topographic plots showed an important UES pressure increasement during phonation. CONCLUSION: HRM is a valuable tool for measuring pharyngoesophageal pressures during phonation. Esophageal pressures are higher during phonation than at rest and tend to increase with vocal loudness increment. The topographic plot provides additional data about phonatory mechanism physiology, especially at the UES region.

RESUMO CONTEXTO: A manometria de alta resolução (MAR) é uma ferramenta de grande potencial para mensuração das pressões faringoesofágicas durante a fonação. OBJETIVO: O estudo visa avaliar pressões faringianas, do esfíncter esofagiano superior e do esôfago durante manobras fonatórias. MÉTODOS: Doze (seis homens, idade média 27 anos) cantores profissionais foram submetidos à MAR e produziram quatro tarefas vocais em intensidade baixa, média e alta: vogal / ae /, escala ascendente de cinco notas, palavras /hey/ e /go/. Pressões aos níveis da faringe, esfíncter esofagiano superior e esôfago foram aferidas além de análise visual dos traçados. RESULTADOS: Pressões esofágicas foram maiores na vocalização que no repouso. Pressões da faringe e esfíncter esofagiano superior durante a fonação não foram diferentes que no repouso. Análise visual dos traçados mostrou importante incremento da pressão do esfíncter durante a fonação. CONCLUSÃO: MAR é uma ferramenta valiosa para mensurar as pressões faringoesofágicas durante a fonação. Pressões esofágicas são maiores durante a fonação que no repouso e tendem a aumentar com maior intensidade sonora. Análise visual dos traçados mostram dados adicionais sobre a fisiologia do mecanismo da fonação, especialmente na região do esfíncter esofagiano superior.

Comparison between nasopharyngeal swabs and saliva as reliable specimens for the diagnosis of SARS-CoV-2 / Comparación de la confiabilidad del diagnóstico del SARS-CoV-2 entre muestras de hisopado y saliva

Introduction: The SARS-CoV-2 virus is a positive-strand RNA virus. The virus can also be detected in many different specimens as throat swabs, nasal swabs, sputum, saliva, blood, etc. Objective: The aim of this paper is to compare the reliability of different types of specimen collection, saliva and swabs samples for the detection of SARS-CoV-2. Material and Methods: A sample of 22 COVID-19 positive patients was selected. Paired samples from saliva, nasopharyngeal, oropharyngeal and nasopharyngeal + oropharyngeal swabs were collected on the 7th day after diagnosis. The hyssops and medium employed was IMPROSWAB and IMPROVIRAL NAT Medium, Germany. The sample evaluation was conducted through RT-PCR. The results were compared using Fisher's exact test and ROC curve. The gold standard proposed in this paper was the nasopharyngeal + oropharyngeal swabs specimen. Results: The gold standard method detected 10 true positive cases, of which oropharyngeal swabs, nasopharyngeal swabs and saliva only detected three positive cases. Significant differences (Fisher's exact test p = 0.003) were detected in the comparison between saliva and the gold standart proposed. The ROC curve analysis showed that saliva had an area under the curve of 0.650, with a 30 percent of sensibility. However, the nasopharyngeal and nasopharyngeal + oropharyngeal samples had an area under curve of 0.950 and 1.000, respectively, with a sensibility of 90 percent and 100 percent, respectively. Conclusion: Saliva samples are not a reliable specimen for SARS-CoV-2 RNA detection. In turn, the most reliable specimens are nasopharyngeal and nasopharyngeal + oropharyngeal samples collected by swabbing(AU)

Introducción: El SARS-CoV-2 es un virus ARN positivo. Este virus puede ser detectado en diferentes tipos de secreción como hisopada bucal, nasal, esputo, saliva, sangre, etc. Objetivo: El objetivo de este estudio es comparar la confiabilidad de diferentes tipos de muestras, saliva y exudado, en la detección de SARS-CoV-2. Material y Métodos: Una muestra de 22 pacientes con diagnóstico de Covid-19 fue estudiada. Se tomaron muestras pareadas de saliva y exudado nasofaríngeo y orofaríngeo en cada paciente. Se emplearon los hisopos y medios de la firma alemana IMPROVE®. Los resultados de las determinaciones por RT-PCR se compararon mediante test de Fisher (test de la probabilidad exacta de Fisher) y cada sets de muestras fue evaluada individualmente y luego comparadas por curvas ROC. El estándar de oro propuesto fue el doble hisopado nasofaríngeo/orofaríngeo. Resultados: El método de oro propuesto detectó 10 casos positivos. La coincidencia de detección entre todos los sets de muestras fue de 3 casos (30 por ciento). Se obtuvieron diferencias significativas (Fisher p = 0.003) en la comparación de los casos detectados en saliva vs el estándar de oro. El análisis de curvas ROC mostró un área bajo la curva de 0.650 (30 por ciento de sensibilidad) para la saliva. En el caso del hisopado nasofaríngeo y el estándar de oro mostraron un área bajo la curva de 0.95 y 1.00, respectivamente, con una sensibilidad del 90 (AU) por ciento y 100 por ciento, respectivamente. Conclusiones: La saliva no es una muestra confiable para la detección de SARS-CoV-2. La muestra más confiable para el diagnóstico fue el hisopado nasofaríngeo y el doble hisopado(AU)

Características do padrão de refluxo na posição ortostática versus posição supina em pacientes com refluxo laringofaríngeo

Resumo Introdução: Muitos problemas relacionados à laringe têm sido atribuídos ao refluxo laringofaríngeo, inclusive disfonia, pigarro frequente, tosse crônica e sensação de "globus" faríngeo. No entanto, ainda há controvérsias quanto ao diagnóstico e à apresentação clínica dessa condição clínica. Objetivo: Descrever as características do refluxo laringofaríngeo de diferentes posições, em pacientes diagnosticados por meio de pHmetria orofaríngea. Método: Foi feita uma revisão retrospectiva de prontuários de 161 pacientes com refluxo laringofaríngeo diagnosticado por pHmetria orofaríngea de 24 horas. Os indivíduos do estudo foram categorizados em grupos com refluxo laringofaríngeo na posição ortostática e refluxo laringofaríngeo na posição supina com base nos resultados do pH. Os dois grupos foram comparados quanto à apresentação clínica e às características do pH. Resultados: Foram encontradas taxas significativamente mais altas de refluxo laringofaríngeo na posição ortostática em comparação à posição supina (p < 0,0001). Os resultados do índice de sintomas de refluxo foram significativamente maiores no grupo com refluxo laringofaríngeo na posição ortostática em comparação com o grupo com refluxo laringofaríngeo na posição supina. O uso do escore de Ryan composto (composite Ryan score) para a pHmetria orofaríngea de 24 horas foi significantemente maior no grupo com refluxo laringofaríngeo ortostático em relação ao grupo supino (p < 0,0001). Nenhuma diferença significante foi encontrada entre os grupos refluxo laringofaríngeo na posição ortostática e posição supina em relação à frequência da apresentação clínica ou classificações do índice de desvantagem vocal. Conclusão: O refluxo laringofaríngeo foi mais prevalente na posição ortostática entre os grupos de estudo. As características relacionadas ao refluxo, inclusive parâmetros de pH, foram mais evidentes no refluxo laringofaríngeo na posição ortostática.

Funciones bucofaríngeas en el segundo y tercer año de vida / Oropharyngeal functions in the second and third year of life

RESUMEN Introducción: durante los tres primeros años de vida, las funciones bucofaríngeas se atribuyen a factores genéticos y ambientales. Objetivo: caracterizar las funciones bucofaríngeas en el segundo y tercer año de vida, en niños del municipio de Santa Clara, provincia Villa Clara. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo, en el período de octubre de 2014 a junio de 2017. El universo de estudio estuvo constituido por todos los niños nacidos en el Hospital Universitario Ginecobstétrico «Mariana Grajales¼ de Santa Clara, en abril y mayo de 2013, pertenecientes a cualquier área de salud de dicho municipio. La muestra estuvo integrada por 64 niños que fueron examinados a los 18, 24, 30 y 36 meses de edad. Para la recolección de los datos se aplicó el método de observación; la información obtenida se procesó y se sometió a pruebas estadísticas. Resultados: las funciones bucofaríngeas, excepto la fonatoria, sufrieron un deterioro progresivo según aumentó la edad de los niños observados; así mismo, aparecieron hábitos de respiración bucal y deglución con protracción exagerada. Conclusiones: se produjeron importantes cambios en las funciones bucofaríngeas en el segundo y tercer año de vida, en los niños integrantes de la cohorte estudiada.

ABSTRACT Introduction: oropharyngeal functions are attributed to genetic and environmental factors during the first three years of life. Objective: to characterize oropharyngeal functions in the second and third year of life, in children from Santa Clara municipality, Villa Clara province. Methods: a prospective, longitudinal and descriptive study was carried out from October 2014 to June 2017. The study universe consisted of all the children born at "Mariana Grajales" Gynecology and Obstetrics University Hospital in Santa Clara, in April and May 2013, belonging to the health areas of the mentioned municipality. The sample consisted of 64 children who were examined at 18, 24, 30 and 36 months of age. Observation method was applied for data collection; the obtained information was processed and subjected to statistical tests. Results: oropharyngeal functions, with the exception of phonatory, suffered a progressive deterioration as the age of the observed children increased; likewise, mouth breathing and swallowing habits with exaggerated protraction appeared. Conclusions: important changes in oropharyngeal functions during the second and third year of life were observed in children belonging to the studied cohort.

Clinical study on obstructive sleep apnea following pharyngeal flap surgery / 华西口腔医学杂志

OBJECTIVES@#This study aims to investigate the incidence and severity of obstructive sleep apnea (OSA) in cleft patients with velopharyngeal insufficiency (VPI) after pharyngeal flap surgery (PFS) and explore the influence of operation age.@*METHODS@#A retrospective study was conducted in 82 cleft patients after PFS. The patients were divided into two groups according to their age at the time of surgery. The incidence and severity of OSA were assessed at least 1.2 years (mean 6.0 years) postoperatively by polysomnography (PSG).@*RESULTS@#The incidence rates of OSA were 20% in the adult group and 31% in the child group. No significant difference was found between the two groups (@*CONCLUSIONS@#Some patients still have OSA average of 6.0 years after PFS, and operation ageis unrelated to the incidence and severity of OSA.

Efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of OSAHS with soft palate oropharyngeal obstruction / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the efficacy of relocation and expansion pharyngoplasty by suspension sutures in the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). Methods: Seventy-three patients(including 60 males and 13 females) with OSAHS admitted to the department of otorhinolaryngology of our hospital in recent two years were retrospectively analyzed. All the patients had velopharyngeal obstructionevaluated by electronic endoscopic Müller test and were divided into control group (34 cases) and observation group (39 cases). The patients in the control group were performed modified uvulopalatopharyngoplasty, while those in the observation group were performed relocation and expansion pharyngoplasty by suspension sutures.The scores of ESS, AHI and LSaO2 before and after treatment were collected and compared. Results: The total effective rate of the observation group was 94.87%, which was significantly higher than 79.41% of the control group. The AHI was lower and LSaO2 value was higher (χ2=-1. 896,-1. 968,P<0.05)in the observation group. The sleeping symptoms and quality of life of the two groups were significantly improved. The ESS score of the observation group was decreased more significantly than that of the control group after treatment, and the difference was statistically significant (χ2=-1.451,P<0.05). The incidence of foreign body sensation in pharynx of the observation group (89.74%) was higher than that of the control group (55.88%), and the postoperative bleeding and postoperative recurrence rate (0.00%, 2.56%) was lower than that of the control group (8.82%, 14.70%)with statistical significance (χ2=4.738,4.249,4.119,P<0.05).The incidence of transient nasopharyngeal reflux in both groups was low and statistically insignificant (χ2=0.629,P>0.05). Conclusions: Preoperative strict screening of indications plays an important role in the selection of palatopharyngeal surgery methods and curative effect. Relocation and expansion pharyngoplasty by suspension sutures can improve the clinical efficacy of OSAHS with better safety and less recurrence.

Detection of oropharyngeal sensory function in normal population / 中华耳鼻咽喉头颈外科杂志

Objective: To study the oropharyngeal sensory function by Current Perception Threshold(CPT) detection, to explore the detection method of oropharyngeal sensory function in normal population, and to analyze the possible influencing factors. Methods: Fifty-eight normal subjects were included prospectively in this study. Age, gender, body mass index (BMI) were collected. The age of the subjects ranged from 20 to 76 (43.27±13.52) years old. There were 34 females with 17 in childbearing period and 17 in menopause; and 24 males were included.In all the cases, 6 cases were in low BMI, 39 cases were in normal BMI, 10 cases were overweight and 3 cases were suffering from obesity. The CPT system of Neurometer was used to stimulate bilateral palatoglossal arch and tongue base.The current used was 2000 Hz, 250 Hz and 5 Hz respectively.The function of type Aβ, Aδ and C sensory nerve fibers were tested and the CPT values were recorded.The values were inversely proportional to pharyngeal sensation function.To evaluate the oropharyngeal sensory function of the subjects, the CPT values of each frequency at each testing point were compared. SPSS 25.0 software was used for statistical analysis. Results: The CPT value of palatoglossal arch was significantly lower than that of tongue base (t=-2.58,-2.65,-2.54,-2.47,-2.37,-2.77,P<0.05), 2 000 Hz>250 Hz>5 Hz, and there was no significant difference between left and right sides(t=-0.03,-0.51,-0.49,0.06,-0.16,0.13,P>0.05). The CPT value of male was slightly higher than that of female (t=0.92,1.55,0.27,0.78,1.44,1.26,0.35,0.77,1.27,0.24,0.78,0.96,P>0.05). The CPT values of women in childbearing period were significantly less than those in menopausal women (t=-3.90,-3.64,-2.14,-4.20,-4.28,-4.28,-3.52,-4.46,-3.41,-3.63,-4.66,-2.86,P<0.05). The CPT value increased with age, and the values of all frequency of 20 to 30 years old group was significantly lower than those of subjects over 40 years old at each point (The t values of bilateral palatoglossal arch at 2 000 Hz were -5.57,-6.22,-10.18,-11.00;the t values of bilateral palatoglossal arch at 250 Hz were -6.39,-8.79,-6.39,-15.61;the t values of bilateral palatoglossal arch at 5 Hz were -7.09, -5.57, -9.26, -15.23;the t values of tongue base at 2 000 Hz were -3.11,-3.88,-7.60,-8.55;the t values of tongue base at 250 Hz were -6.31,-10.59,-8.52,-10.60;the t values of tongue baseat 5 Hz were -6.69,-5.09,-8.70,-7.07,P<0.05).The values at all frequencies and testing points of 30-40 years old group were significantly lower than those of all subjects over 60 years old (The t values of bilateral palatoglossal arch at 2 000 Hz were -10.91,-12.42;the t values of bilateral palatoglossal arch at 250 Hz were -6.25,-10.87;the t values of bilateral palatoglossal arch at 5 Hz were -5.53,-11.01;the t values of tongue base at 2 000 Hz were -8.62,-10.12;the t values of tongue base at 250 Hz were -6.89,-7.82;the t values of tongue base at 5 Hz were -6.13,-6.48,P<0.05). Conclusions: CPT can be used to evaluate oropharyngeal sensory function. The sensitivity of tongue base is lower than that of palatoglossal arch, there is no significant difference in oropharyngeal sensory function between male and female,between left and right sides. There are many factors influencing oropharyngeal sensory function. Age, hormone level changes may affect the sensitivity of oropharyngeal sensory function.

Knockout fth1b affects early mineralization of zebrafish pharyngeal teeth / 华西口腔医学杂志

OBJECTIVES@#A study was conducted to explore the expression pattern and function of ferritin heavy polypeptide gene (fth1b) in zebrafish pharyngeal teeth development and lay the foundation for subsequent research on teeth development and mineralization.@*METHODS@#The zebrafish embryos were harvested at 56, 72, 96, and 120 h after fertilization. The expression of fth1b in zebrafish pharyngeal teeth development was detected by whole embryo @*RESULTS@#The expression pattern of fth1b gene was very similar to that of the known zebrafish pharyngeal teeth marker dlx2b and was specifically expressed in the zebrafish pharyngeal teeth during development. After the specific knockout of the gene fth1b, the earliest gene that can be detect in zebrafish pharyngeal teeth-pitx2 was expressed normally during early development. The dlx2b expression was not significantly different from that of wild type zebrafish, but the mineralization of pharyngeal teeth in the mutant was weaker than that of wild type zebrafish.@*CONCLUSIONS@#The gene fth1b is specifically expressed in zebrafish pharyngeal teeth and acts on their early mineralization.

Apport de la tomodensitométrie dans la pathologie ORL non traumatique au centre hospitalier universitaire de Brazzaville / NA

Objectif: décrire l'apport de la tomodensitométrie dans la pathologie ORL non traumatique. Méthodologie : Il s'agissait d'une étude transversale et descriptive allant de mai 2003 à janvier 2017 soit 13 ans et 8 mois, au CHU de Brazzaville. Nous avons inclus dans notre étude tous les patients ayant présentés une pathologie ORL, pour laquelle le bilan diagnostique nécessitait la réalisation d'une tomodensitométrie. Résultats : la fréquence de prescription de la TDM en ORL représentait 3,5%. L'âge moyen 38,2 ± 18,2 ans. Le sexe masculin représentait 59%. La TDM était utile dans le diagnostic devant 51,90% des signes fonctionnels, 48,10% du syndrome tumoral. L'atteinte rhinosinusienne représentait 59,5% suivie du pharynx 17,8%. La pathologie infectieuse représentait 63% (sinusite 51%) et la pathologie tumorale 37% (tumeur du cavum 18%). Conclusion: La prescription de la tomodensitométrie dans les pathologies ORL reste faible. Les indications et les lésions observées sont multiples. La TDM reste un moyen d'exploration complémentaire utile dans la pathologie tumorale qu'infectieuse.

Objective: To describe the contribution of CT scans in non-traumatic ENT pathology. Methodology: This was a cross-sectional and descriptive study from May 2003 to January 2017 (13 years and 8 months), at the University Hospital of Brazzaville. We included in our study all patients who presented an ENT pathology for which the diagnostic work-up required a CT scan. Results: The frequency of prescription of CT in ENT represented 3.5%. The average age of the patients was 38.2 ± 18.2 years. Males accounted for 59%. CT was useful in the diagnosis of 51.90% of the functional signs and 48.10% of the tumour syndrom. Rhinosinus involvement accounted for 59.5%, followed by the pharynx for 17.8%. Infectious pathology represented 63% (sinusitis 51%) and tumour pathology 37% (cavum tumour 18%). Conclusion: The prescription of CT scans in ENT pathologies remains low. The indications and lesions observed are multiple. CT remains a useful complementary means of exploration in tumour and infectious pathology.

Three-dimensional pharyngeal airway space changes after bimaxillary advancement

ABSTRACT Introduction: The probability of improvement in the upper airway space (UAS) with orthognathic surgery should be considered during the surgical-orthodontic treatment decision, providing not only an esthetic, but also a functional benefit for the patient. Objective: The purpose of this study was to evaluate the 3D changes in the upper airway space after maxillomandibular advancement surgery (MMA). Methods: A retrospective analysis of 56 patients, 21 male and 35 female, with a mean age of 35.8 ± 10.7 years, who underwent MMA was performed. Pre- and postoperative cone-beam computed tomography scans (CBCT) were obtained for each patient, and the changes in the UAS were compared using Dolphin Imaging 11.7 software. Two parameters of the pharyngeal airway space (PAS) were measured: airway volume (AV) and minimum axial area (MAA). Paired t-test was used to compare the data between T0 and T1, at 5% significance level. Results: There was a statistically significant increase in the UAS. Bimaxillary advancement surgery increased the AV and the MAA, on average, by 73.6 ± 74.75% and 113.5 ± 123.87%, respectively. Conclusion: MMA surgery tends to cause significant increase in the UAS; however, this increase is largely variable.

RESUMO Introdução: A probabilidade de melhoria do espaço aéreo superior (EAS) com cirurgia ortognática deve ser considerada durante a decisão do tratamento ortodôntico-cirúrgico, proporcionando não somente um benefício estético, mas também funcional, para o paciente. Objetivo: O objetivo do presente estudo foi avaliar as alterações 3D no espaço das vias aéreas superiores após a cirurgia de avanço maxilomandibular (AMM). Métodos: Foi realizada uma análise retrospectiva de 56 pacientes, 21 homens e 35 mulheres, com média de idade de 35,8 ± 10,7 anos, submetidos a AMM. Foram obtidas tomografias computadorizadas de feixe cônico (TCFC) pré- e pós-operatórias para cada paciente, e as alterações no EAS foram comparadas usando o software Dolphin Imaging v. 11.7. Foram medidos dois parâmetros do espaço aéreo faríngeo (EAF): volume das vias aéreas (VVA) e área axial mínima (AAM). Foi utilizado o teste t pareado para comparar os dados entre T0 e T1, com nível de significância de 5%. Resultados: Houve um aumento estatisticamente significativo no EAS. A cirurgia de avanço bimaxilar aumentou o volume das vias aéreas (VVA) e a área axial mínima (AAM) em média 73,6 ± 74,75% e 113,5 ± 123,87%, respectivamente. Conclusão: A cirurgia de AMM tende a causar o aumento significativo do EAS; no entanto, esse aumento é altamente variável.

Pharyngeal tuberculosis. Concerning a case in Peru / Tuberculosis faríngea. A propósito de un caso en Perú

Abstract Pharyngeal tuberculosis is an extrapulmonary form of this disease which makes up less than 1% of cases, most of which are secondary. In Peru, there are no case reports of this form of extra-pulmonary tuberculosis. We present the case of a 42-year-old man who consulted due to a two-month history of sore throat and a pharyngeal lump, with no epidemiological or medical history. A biopsy of the lesion and Ziehl-Neelsen staining yielded results compatible with pharyngeal tuberculosis. A chest x-ray showed bilateral miliary lesions, confirming a secondary form of disseminated tuberculosis. This highlights the importance of ruling out tuberculosis in all cases of chronic pharyngitis which are unresponsive to conventional treatment.

Resumen La tuberculosis faríngea es una forma extrapulmonar de esta enfermedad que corresponde a menos de 1% de casos, mayormente de carácter secundario. En Perú, no hay datos de reportes de casos en esta forma de tuberculosis extrapulmonar. Presentamos el caso de un varón de cuarenta y dos años que consultó por dolor de garganta y tumoración en faringe de dos meses de evolución, sin antecedentes epidemiológico o patológico. Se realiza biopsia de la lesión y coloración Ziehl Neelsen dando compatible a tuberculosis faríngea. En la radiografía de tórax se encontró lesiones pulmonares diseminadas bilaterales de tipo miliar, confirmando forma secundaria a tuberculosis diseminada. Por ello, se resalta la importancia de descartar tuberculosis ante toda faringitis crónica sin respuesta al tratamiento convencional.

Trânsitos oral e faríngeo na pirose funcional / Oral and pharyngeal transit in functional heartburn

ABSTRACT BACKGROUND: Gastroesophageal reflux disease is associated with slower transit of the bolus through the pharynx and upper esophageal sphincter. Functional heartburn has similar symptoms to gastroesophageal reflux disease, however, the symptoms are not caused by reflux. OBJECTIVE: The aim of this investigation was to evaluate oral and pharyngeal transit in patients with functional heartburn, with the hypothesis that, similar to patients with gastroesophageal reflux disease, they have changes in pharyngeal and upper esophageal sphincter transit time. METHODS: Oral and pharyngeal transit was evaluated by videofluoroscopy in eight women with functional heartburn, five with mild dysphagia for solid foods, and 12 female controls. Controls and patients swallowed in duplicate 5 mL and 10 mL of liquid and paste boluses. RESULTS: No difference in the oral or pharyngeal transit time was found between patients and controls. No aspiration of bolus into the airways was detected in any individual. Pharyngeal residues were detected in the same proportion of swallows, in patients (12.5%) and controls (15.0%), after swallows of 10 mL paste bolus. CONCLUSION: Oral, pharyngeal and upper esophageal sphincter transit time are similar in patients with functional heartburn to healthy controls.

RESUMO CONTEXTO: A doença do refluxo gastroesofágico está associada ao trânsito mais lento do bolo deglutido pela faringe e esfíncter superior do esôfago. Pirose funcional tem sintomas similares aos de doença do refluxo gastroesofágico, entretanto eles não são consequência de refluxo. OBJETIVO: Como na pirose funcional os sintomas são semelhantes aos da doença do refluxo gastroesofágico, o objetivo desta investigação foi avaliar a duração do trânsito do bolo deglutido pela boca, faringe e esfíncter superior do esôfago em pacientes com pirose funcional, com a hipótese de que esses pacientes também apresentem alteração no trânsito. MÉTODOS: Pelo método videofluoroscópico foi avaliado o trânsito oral e faríngeo de oito pacientes do sexo feminino com pirose funcional, cinco com disfagia leve para alimentos sólidos, e 12 indivíduos controles do sexo feminino. Controles e pacientes deglutiram em duplicata 5 mL e 10 mL de bolos com a consistências líquida e pastosa. RESULTADOS: Com bolo líquido e pastoso não houve diferença na duração do trânsito oral, faríngeo e pelo esfíncter superior do esôfago entre controles e pacientes. Não houve aspiração do bolo para as vias aéreas em nenhum indivíduo. Os resíduos faríngeos foram observados na mesma proporção das deglutições em pacientes (12,5%) e controles (15%), com a deglutição de 10 mL de bolo pastoso. CONCLUSÃO: A duração do trânsito oral, faríngeo e pelo esfíncter superior do esôfago foi semelhante nos pacientes com pirose funcional e controles.