Study of the relation between clinical and pathological findings of tonsillectomy specimens of patients

Most hospitals routinely examine microscopically all tonsillar and adenoid specimens from healthy pediatric patients complaining of recurrent infections or obstructive sleep apnea. Concern over missing the rare, unsuspected and significant diagnosis propagates this practice. Clinical examination for asymmetry could obviate the need for routine microscopic examination of tonsil and adenoid specimens in patients aged 16 years old and younger. A prospective controlled trial was carried out in one institution using database of 305 patients aged 16 years or younger who underwent tonsillectomy and/or adenoidectomy between 2003 and 2007 at the Shaheed Sadoughi Hospital. Patients with unilateral tonsillar enlargement were entered in this study. Patients who had risk factors for malignancy were excluded. After excision, two tonsil specimens were measured before sending for histological examination. Matched controls with symmetric tonsils underwent the same procedures. Preoperative diagnosis of tonsil asymmetry with the postoperative histological diagnosis was evaluated. Of the 305 patients undergoing tonsillectomy, 106 patients [34.75%] had asymmetric tonsils. In the control group 102 patients had symmetric tonsils. The analysis showed statistically no significant difference in the age, sex, indication of surgery and type of surgery between the two groups. Most of the specimens had reactive lymphoid hyperplasia in both the groups [58.49% and 54.9%, respectively]. Histological examination showed no malignancies or unusual pathological findings in both the groups. Tonsil asymmetry may be apparent in patients with normal physical examination, secondary to benign hyperplasia or anatomical factors. Therefore, the presence of tonsil asymmetry without risk factors like progressive enlargement of the tonsil, concomitant neck adenopathies, history of malignancy or immunocompromise may not indicate malignancy. Microscopic examination of all routine tonsils and adenoids for individuals aged 16 years or less is not indicated, but careful gross examination is still recommended

Deglutiçäo atípica: quando e porque tratá-la, um tema controverso / Atypical deglution: when and why to treat a controversial theme

Os autores apresentam uma revisäo de literatura sobre deglutiçäo com pressionamento lingual atípico, fornecendo informaçöes relacionadas com prováveis causas e métodos práticos de diagnóstico. Enfatiza-se a responsabilidade do Odontopediatra em monitorar o desenvolvimento dento-facial de seus pacientes e formular um diagnóstico precoce sobre todas as transformaçöes que estiverem ocorrendo nas estruturas orais da criança, as quais impediram um crescimento facial normal

Severe sleep apnea syndrome and tonsillar: hyperplasia in an adult / Síndrome de apnéia do sono e hiperplasia amigdaliana

Relatamos um caso de síndrome de apnéia do sono tipo obstrutivo (SASO) severa, em adulto do sexo feminino, associada a hiperplasia amigdaliana, com documentaçao de polissonografia e cefalometria, pré e pós-cirúrgica. Polissonografia pré-opeatória evidenciou índice de apnéia + hipopnéia (RDI), 109,2/h; apnéia mais longa atingindo 64 s; saturaçao de oxigênio mínimo de 40 por cento ; reduçao acentuada de estágio REM e ausência de estágios 3 e 4; intensa fragmentaçao do sono com aumento do número de despertares e movimentos corpóreos. Cefalometria mostrou aumento marcado do volume amigdaliano, com consequente reduçao do espaço aéreo posterior (2,21 mm). Os mesmos exames realizados 4 meses após amigdalectomia e uvulopalatofaringoplastia evidenciaram remissao do quadro, com índices polissonográficos nos limites da normalidade. Cefalometria mostrou dimensao adequada do espaço aéreo posterior (12,22mm)

Lymphangioma of the tonsil

A case of cavernous lymphangioma arising from the tonsil in a 45 years old man is presented along with a brief review of literature. The tumour mass was removed successfully under surface anaesthesia as an out-patient procedure without any complications

Tumores malignos de amígdala / Malignant tumors of tonsil

Se estudiaron 19 casos de neoplasias malignas de amígdala palatina, en el Hospital General Centro Médico La Raza, en el período comprendido del 1ero. de enero de 1987 al 1ero. de enero de 1991. De estos 19 casos 16 se diagnosticaron como linfoma no Hodgkin y 3 como carcinoma epidermoide. El diagnóstico inicial de estos pacientes fue amigdalitis crónica. Los pacientes se trataron con escisión biopsia seguida de quimioterapia para los linfomas y radioterapia para los carcinomas epidermoides. Se encontró que en contraste con lo reportado en la literatura hubo predominio notable de los linfomas no Hodgkin, sobre los carcinomas epidermoides.