Profile of Laryngeal Microsurgeries in Patients Over 60 Years Old

Abstract Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associ- ated with laryngeal lesions and determine prevention and treatment approaches.

Papilomatose laríngea / Laryngia papillomatosis

A papilomatose laríngea é uma doença com etiologia relacionada ao papilomavírus humano. Afeta adultos e crianças nas formas única e múltipla. São tumores benignos com potencial morbimortalidade em função do envolvimento da via aérea e de possível malignização. Seu tratamento é controverso, mas, atualmente, realiza-se exérese cirúrgica e é possível usar cidofovir.

Laryngeal papillomatosis is a disease associated with human papilloma vírus. It occurs in adults and children as single or multiple tumors. It has a benign behavior, but its morbimortality is due to the airway involvement and potencial malignization. Its treatment is controversial, surgery is indicated and cidofovir can be used.

Proposed computerized protocol for epidemiological study of patients undergoing microsurgery of the larynx

Introduction: The merging of medicine with information technology facilitates the retrieval of stored data, aiding the conduct of research with greater scientific rigor. Studies in the field of otorhinolaryngology, specifically in the area of laryngology and voice, are of fundamental importance, since 70% of the economically active need their voice to work. Objective: To create a computerized protocol of the diseases of the larynx, apply and validate it, and use it to evaluate patients undergoing laryngoscopic microsurgery of the larynx. Method: We created a database of ENT diseases through a literature review of textbooks and scientific articles. Next, we computerized the data and incorporated it into the SINPE©, creating a master protocol (ENT diseases) and a specific protocol (laryngeal diseases). Data were collected prospectively from patients undergoing laryngeal microsurgery in the ENT Hospital of Paraná. The collected data were analyzed with graphs through the SINPE© Analyzer module. Results: We evaluated 245 patients aged 9-79 years, and determined that 36.61% (93 patients) underwent surgery for the presence of polyps on the vocal folds, 12.6% (32) underwent surgery for papillomatosis, and 11.83% (29) underwent surgery for intracordal cysts. Conclusions: The creation of an electronic database of clinical ENT diseases was feasible. We were also able to implement and validate the protocol. The database may be released to physicians involved in clinical data collection and retrieval of information to conduct scientific research in an organized manner. The most common laryngeal disorders identified were polyps, papilloma, and intracordal cysts...

Gingival fibromatosis with hemi-osseous hyperplasia of jaws, focal maxillary viral papillomatosis of gingiva, fissured tongue and congenitally missing anterior teeth: A case report and surgical management of a new syndrome.

Gingival fibromatosis is characterized by fibrotic enlargement of the gingiva that can occur as inherited or sporadic form. Inherited form can be an isolated trait or as a component of a syndrome. This article reports a 35 year old male patient affected by gingival fibromatosis associated with hemiosseous hyperplasia of mandible, maxilla, and zygoma on the right side, viral papillomatosis of maxillary anterior gingiva, fissured tongue and congenitally missing anterior teeth. The patient was subjected to phase I and phase II periodontal therapy. There was no evidence of recurrence of the enlargement after one year but the papillomatosis recurred. Gingival fibromatosis has been reported to be associated with various other abnormalities but not with those described in our case. This observation raises the possibility that the coexistence of these entities in our case may represent a new syndrome.

Laryngeal papilomatosis presenting with acute upper airway obstruction.

A six year old boy who presented with sudden onset of difficulty in breathing following a week’s history of cough and a sensation of foreign body in the throat. On clinical examination he was in severe respiratory distress with markedly diminished breath sounds bilaterally. Respiratory distress was positional with some relief observed with change in position. A CT scan done showed normal thoracic inlet and a chest X-ray showed hyperinflation of the lungs bilaterally. Direct laryngoscopy under general anesthesia revealed an extensive mass of papilomatous growth occluding the glottis; this was excised and processed in the histopathology Laboratory. Patient recovered fully and was discharged from the hospital two days after surgery in excellent condition. A monthly follow up for six months after discharge was uneventful, with no recurrence.

Aplicação local de cidofovir como tratamento adjuvante na papilomatose laríngea recorrente em crianças / Local application of cidofovir as adjuvant therapy in recurrent laryngeal papillomatosis in children

OBJETIVO: Avaliar a eficácia da aplicação local de cidofovir em associação com o tratamento cirúrgico na papilomatose laríngea recorrente (PLR) em crianças. Desenho do estudo: Prospectivo. MÉTODOS: Quatorze pacientes, com idade média de 4.7 anos e com duas ou mais recidivas após tratamento cirúrgico, foram submetidos à ressecção dos papilomas e injeção de 22.5 mg de cidofovir (7,5 mg/ml) no tecido de onde as lesões foram removidas. Após intervalos de 2-3 semanas, a mesma dose de cidofovir foi repetida duas ou três vezes. Em caso de recidiva, um novo ciclo de cirurgia seguido de aplicações locais de cidofovir era reiniciado. Cinco crianças apresentavam HPV-6 e cinco HPV-11; em quatro casos a tipagem não foi realizada. RESULTADOS: Antes do início do estudo, os pacientes eram submetidos, em média, a duas cirurgias por ano para o controle das recidivas; após o tratamento com cidofovir, a taxa anual de cirurgia diminuiu para 1,1 (p = 0,013). O intervalo médio entre as recidivas antes do início do estudo era de 1.6 meses; ao final do estudo, o intervalo aumentou para 4,4 meses (p = 0,014). Os pacientes com HPV-6 não apresentaram alteração significante nos intervalos entre as recidivas após o tratamento com cidofovir, enquanto 60 por cento das crianças com HPV-11 encontravam-se livres de doença ao final do estudo. CONCLUSÃO: O cidofovir é um adjuvante eficaz no tratamento da PLR em crianças, quando utilizado sob a forma de aplicações locais em associação com a ressecção cirúrgica das lesões. O HPV-11 pode ser mais susceptível aos efeitos benéficos do cidofovir.

OBJECTIVE: Evaluate the efficacy of local application of cidofovir in association with surgical treatment of recurrent laryngeal papillomatosis in children. Study design: Prospective. METHODS: Fourteen patients, with an average age of 4.7 years and with two or more relapses after surgical treatment, were submitted to resection of the papillomas and injection of 22.5 mg of cidofovir (7.5 mg/ml) in the tissue where the lesions had been removed. After 2 to 3 week intervals, the same dose of cidofovir was repeated two or three times. In the case of relapse, a new cycle of surgery followed by local applications of cidofovir was repeated. Five children presented HPV-6 and five HPV-11, while in four, the type was not determined. RESULTS: Before beginning of the study, patients were submitted, on the average, to 2 operations a year for control of relapses. After treatment with cidofovir, the annual rate for surgery dropped to 1.1 (p = 0.013). The average interval between relapses before beginning of the study was 1.4 months; at the end of the study, the interval reached 4.4 months (p = 0.014). Patients with HPV-6 did not show a significant change in the intervals between relapses after treatment with cidofovir, while 60 percent of the children with HPV-11 were disease free at the study end. CONCLUSION: Cidofovir was found to be an effective adjuvant in the treatment of recurrent laryngeal papillomatosis in children, when used in the form of local applications in association with surgical resection of the lesions. HPV-11 may be more susceptible to the beneficial effects of cidofovir.

Frenulectomía peneana con láser CO2 en hombres con lesiones por virus papiloma humano / Dioxide laser penis frenulectomy in men with human papiloma virus infection

El dióxido de carbono (CO2) presenta ventajas sobre la cirugía convencional. No se hanencontrado estudios de frenulectomía en pacientes con virus papiloma humano (HPV) con láser u otras técnicasquirúrgicas. Objetivos: Dar a conocer la técnica de la frenulectomía, valorar la eficacia del láser de CO2, evaluarposibles complicaciones, apreciar sus ventajas. Materiales y Métodos: Estudio cuantitativo descriptivo transver-sal. Variables de estudio: Tiempo operatorio, sangrado intraoperatorio, tiempo de internación post operatoria, com-plicaciones post operatorias, tiempo de cicatrización. Universo de estudio: 55 hombres de 17 a 63 años con lesionespor HPV en pene, entre octubre de 2006 a julio de 2008. Muestra: 53 pacientes. Resultados: En el estudio 19%tenían 24 años, 18% 19 años, 17% 21 años (Media: 24,62). En 61% de los pacientes la intervención duró 1,5 minutos(media 1,8). Solo el 2% experimentó sangrado intraoperatorio. Complicaciones post operatorias: sangrado en el 2%y dolor a la erección en el 4%. 38% de los pacientes tardó 15 días en cicatrizar (media: 13,62). Conclusiones:Frenulectomía láser con CO2 es eficaz por su reducido tiempo operatorio, escasas complicaciones y por serambulatoria.

Carbon dioxide (CO2) has advantages over conventional surgery. No studies were found aboutfrenulectomy with laser or other surgical techniques in patients with human papillomavirus (HPV). Objectives: toshow the frenulectomy technique, to determine the effectiveness of CO2 laser surgery, evaluate complications,appreciate its advantages. Material and Methods: A descriptive cross-sectional quantitative study. Study variables:operative time, intraoperative bleeding, postoperative hospitalization time, postoperative complications, healing time.Universe study: 55 men from 17 to 63 years with HPV lesions in penis, from October 2006 to July 2008. Results: In thestudy 19% were 24 years, 18% 19 years, 17% 21 years (mean: 24.62). In 61% of patients the operation lasted 1.5minutes (mean 1.8). Only 2% experienced intraoperative bleeding. Postoperative complications: bleeding in 2% andpain on erection in 4%. 38% of patients took 15 days to heal, (mean: 13.62). Conclusions: Frenulectomy with CO2laser is effective, because it reduced operating time, few complications and it ́s ambulatory.

Papilomatosis laríngea / Laryngeal papillomatosis

La papilomatosis respiratoria recidivante es una enfermedad de la vía aérea que afecta a las personas de todas las edades y que se caracteriza por la aparición de masas epiteliales recidivantes y benignas. Su evolución es multiforme y va desde su desaparición luego de un período de tratamiento relativamente corto y sencillo hasta su progresión por toda la vía aérea, llegando a sitios inaccesibles para el cirujano, obstruyéndola y a veces transformándose en un carcinoma pavimentosos que puede llevar al paciente a la muerte.

Pseudopapiloma irritativo o por succión / Irritation or suction papilloma

El propósito de este trabajo es presentar un caso clínico de pseudopapiloma por irritación o de succión en un niño de siete años de edad, diagnosticado y tratado en la Asignatura de Odontología Integral Niños de la F.O.L.P. El pseudopapiloma irritativo es una lesión gingival exofítica común en la cavidad bucal, desarrollándose como respuesta a la estimulación constante a la que está sometida la mucosa bucal. En nuestro caso clínico, el niño presentaba un espacio producido por la falta de erupción del incisivo lateral inferior permanente, convirtiéndose en el motivo desencadenante del tumor, ya que el paciente realizaba una succión constante a través del espacio interdental. Luego de la motivación se realizó la exéresis de la masa tumoral sin margen de seguridad, obteniendo buenos resultados a corto y a largo plazo

Recurrent respiratory papillomatosis: a study of 24 cases.

24 cases of recurrent respiratory papillomatosis (RRP) in children were treated by surgical removal with cup forceps and followed up for variable periods between 1990-95. Most of the patients required multiple operations due to recurrence. No anaesthetic death or complication was recorded. Voice changes of different degrees were noted. Four patients has glottic web formation. The findings suggest that recurrence of RRP is very common & needs multiple session of surgery. For children with persistent and progressive voice change/cry, the necessity of precise & comprehensive endoscopic examination of the upper aerodigestive tract under general anesthesia (GA) is emphasized.

Una innovación terapéutica en papilomatosis laríngea / A therapeutic innovation in laringeal papillomatosis

El autor ha tratado diez casos de Papilomatosis Laríngea, asociando la técnica del Prof. O. Kleinssaser, de una meticulosa resección con microcirugía laríngea, con los conceptos de terapia neural segmentaria de acuerdo a la técnica de Huneke. Los resultados han sido sorprendentemente satisfactorios. El primer caso tratado, lleva diez años sin presentar recurrencias. Por ser un procedimiento agregado tan inocuo, de fácil aplicación en Latinoamérica, no solo por las obvias razones económicas, sino fundamentalmente, por las razones humanas de proporcionar bienestar a los pacientes que adolecen de una enfermedad, que en muchos casos, es rebelde a los tratamientos clásicos

Criocirugía en el tratamiento de verrugas periungueales / Criosurgery in the treatment of periungueal warts

Las verrugas son neoformaciones epidérmicas benignas muy frecuentes, transmisibles y producidas por un papilomavirus humano. Las de localización periungueal pueden ocasionar distrofia ungueal local. Son las más resistentes al tratamiento y las que recidivan más frecuentes. Se efectuó un estudio piloto para determinar la eficacia de la criocirugía con rasurado de las lesiones en el manejo de las verrugas periungueales, método que demostró una respuesta efectiva en 75 por ciento de los casos

Tratamiento combinado en papilomatosis laríngea recidivante con resección microlaringoscópica láser CO2 e Ifn Ó 2b / Surgical remove with laser CO2 and combination with interferon in the treatment of laringeal papillomatosis

La papilomatosis laríngea de origen viral, de mal pronóstico, se caracteriza por múltiples recurrencias que ocasionan obstruccion de las vías aéreas. El tratamiento de elección en la cirugía con láser CO2, y la combinación con interferón ha mejorado su pronóstico. Presentamos un estudio preliminar con este esquema terapéutico. En 12 pacientes diagnosticados con papilomatosis laríngea: 6 mujeres y 6 hombres de 32 a 72 años de edad recibieron dos esquemas de tratamiento; el grupo A) quirúrgico: 6 pacientes (3 hombre y 3 mujeres) a quienes se les realizó resección de las lesiones y el grupo B) una mujer y cinco hombres en quienes se combinó el tratamiento quirúrgico con dosis inicial local de 3 x 106 UI de IFN Ó 2b (Intron A), continuando con la misma administración de 10 x 10 UI intramuscular cada 8 días. Esta dosis se aplicó semanalmente durante 15 meses. Por medio de la prueba exacta de Fisher se encontró que los pacientes del grupo B mejoraron en forma significativa (p<0.0001) al compararse con el grupo A. En los pacientes del grupo B se encontró una incidencia de efectos colaterales como: cefalea, fiebre, artralgias, depresión, anorexia

Lesiones premalignas de la mama / Breast premaling lesions

Se analiza en forma retrospectiva una serie de 127 pacientes con 136 lesiones premalignas de la mama (LPM) sobre 1.421 operaciones por enfermedades mamarias benignas (9,5 por ciento) en un lapso de 15 años. Entre las LPM se reconocieron 72 (52,9 por ciento) hiperplasias atípicas, 40 (29,4 por ciento) adenosis esclerosantes, 13 (9,6 por ciento) hipreplasias radiales, 5 (3,7 por ciento) papilomatosis múltiple, 3 (2,2 por ciento) displasias proliferativas juveniles focalizadas y 3 (2,2 por ciento) adenomas de pezón. La edad promedio fue de 47,1 años; 80 (63 por ciento) fueron premenospáusicas y 49 (37 por ciento) postmenospáusicas. La clínica diagnosticó 54 casos (39,7 por ciento) y la mamografía a través de lesiones no palpables 82 (60,3 por ciento). De estas últimas 54 (65,8 por ciento) fueron por microcalcificaciones y 28 (34,1 por ciento) por opacidades no cálcicas. La simultaneidad de lesiones se observó en 13 casos (9,5 por ciento), predominando en ese aspecto la adenosis esclerosante. Seis de las 127 pacientes (4,7 por ciento) tuvieron en su evolución una segunda LPM. Doce pacientes (8,8 por ciento) tenían cáncer de mama previo a la LPM, mientras que con una media de seguimiento de 78 meses, 5 pacientes (3,7 por ciento) desarrollaron un cáncer de mama, 4 en la misma mama, 3 de ellos un año después. Destacamos la mayor eficacia de la mamografía en el diagnóstico de las LPM, el predominio numérico y cualitativo de las hiperplasias atípicas como una enfermedad de riesgo dentro de las LPM, y una alta relación de las LPM con el cáncer de mama previo o posterior: 17 pacientes (13,3 por ciento)

Uso da técnica de ventilaçäo a jatos em crianças submetidas à microcirurgia de laringe com laser de CO2 / Use of jet ventilation technique in children submetted to larynx microsurgery with CO2-Laser

O laser de CO2 tem sido adequado na remoçäo de lesöes em cordas vocais e de laringe. Porém, a combustäo do material de tubaçäo traqueal é uma grave complicaçäo da técnica. Com objetivo de avaliar a técnica do Jet-Venturi, 5 crianças de 0 a 10 anos, de ambos os sexos e com papilomatose de laringe submeteram-se ao laser, sendo ventiladas com cânula metálica cilíndrica adaptada ao laringoscópio de suspensäo. Na anestesia utilizou-se propofol ou etomidato associados ao atracúrio e alfentanil; ou induçäo inalatória com halotano. Períodos de apnéia coincidiram com a aplicaçäo do laser, näo havendo variaçäo significativa dos parâmetros hemodinâmicos ou da SatO2. Os tempos médios de cirurgia e de despertar foram 36,6/3,1 e 13,3/1,45 minutos, respectivamente. A bradicardia foi a única complicaçäo observada. Concluiu-se que o método ventilatório foi adequado para manter a ventilaçäo, diminuir o risco de igniçäo e melhorar a atuaçäo do cirurgiäo