Craniofacial changes and symptoms of sleep-disordered breathing in healthy children

INTRODUCTION: The main cause of mouth breathing and sleep-disordered breathing (SDB) in childhood is associated with upper airway narrowing to varying degrees. OBJECTIVE: The aim of this study was to assess the prevalence of morphological and functional craniofacial changes and the main clinical symptoms of SDB in healthy children. METHODS: A cross-sectional observational study was conducted. A sample comprising 687 healthy schoolchildren, aged 7-12 years old and attending public schools, was assessed by medical history, clinical medical and dental examination, and respiratory tests. The self-perceived quality of life of mouth breathing children was obtained by a validated questionnaire. RESULTS: Out of the total sample, 520 children were nose breathers (NB) while 167 (24.3%) were mouth breathers (MB); 32.5% had severe hypertrophy of the palatine tonsils, 18% had a Mallampati score of III or IV, 26.1% had excessive overjet and 17.7% had anterior open bite malocclusion. Among the MB, 53.9% had atresic palate, 35.9% had lip incompetence, 33.5% reported sleepiness during the day, 32.2% often sneezed, 32.2% had a stuffy nose, 19.6% snored, and 9.4% reported having the feeling to stop breathing while asleep. However, the self-perception of their quality of life was considered good. CONCLUSION: High prevalence of facial changes as well as signs and symptoms of mouth breathing were found among health children, requiring early diagnosis and treatment to reduce the risk of SDB. .

INTRODUÇÃO: a principal causa da respiração bucal e dos distúrbios respiratórios do sono (DRS) está associada ao estreitamento das vias aéreas superiores, em diferentes graus. OBJETIVO: avaliar a prevalência de alterações morfológicas e funcionais da face e os principais sintomas clínicos de DRS em crianças saudáveis. MÉTODOS: estudo transversal, observacional, com amostra de 687 escolares saudáveis, provenientes de escolas públicas, com idades entre 7 e 12 anos. Foram avaliados pela história clínica, exame clínico médico e odontológico e testes respiratórios. A autopercepção da qualidade de vida dos escolares com respiração bucal foi obtida por meio de um questionário validado. RESULTADOS: na amostra total, 520 crianças eram respiradoras nasais (RN) e 167 (24,3%) eram respiradoras bucais (RB); 32,5% tinham hipertrofia das amígdalas palatinas, 18% tinham índice Mallampati obstrutivo (III e IV); 26,1% tinham overjet exagerado e 17,7%, mordida aberta anterior. Entre os RB, 53,9% tinham palato atrésico; 35,9% com ausência de selamento labial; 33,5% relataram sonolência diurna; 32,2%, espirros frequentes; 32,2%, nariz entupido; 19,6% roncavam e 9,4% relataram ter a sensação de parar de respirar durante o sono. Entretanto, a autopercepção da qualidade de vida desses escolares foi considerada boa. CONCLUSÃO: foi encontrada alta prevalência de alterações faciais, de sinais e de sintomas clínicos de respiração bucal nos escolares saudáveis examinados, necessitando diagnóstico e tratamento para reduzir o risco de DRS. .

A rare case of bilateral nasolabial cysts in a postpartum lady.

Nasolabial cyst, also known as Klestadt's cyst is an uncommon nonodontogenic cyst. Bilateral nasolabial cysts are rarer and less than 10 cases have been reported in the literature. Diagnosis is usually clinical and they present as slow-growing swellings in the nasolabial region causing cosmetic deformity and nasal obstruction. A postpartum lady presented with bilateral swelling of the cheeks. Excision was done via a sublabial approach. She is asymptomatic one year after surgery. Nasolabial cysts are developmental but usually noticed after a trauma. There is no data relating the cysts to pregnancy.

Correlación diagnóstico clínico e histopatológico en cirugía endoscópica nasosinusal / Clinical and histopathological correlation in endoscopic sinus surgery

Introducción: El estudio histopatológico de muestras obtenidas mediante cirugía endoscópica nasosinusal (CENS) es rutinaria en muchos centros hospitalarios, sin embargo, los reportes de sus resultados y el análisis de su real utilidad clínica son escasos en la literatura publicada. Objetivos: Describir y analizar el estudio de la anatomía patológica obtenida mediante CENS y conocer la correlación entre el diagnóstico clínico y la histopatología. Material y método: Se realizó un estudio descriptivo retrospectivo mediante revisión de fichas clínicas y recolección de datos anatomopatológicos, intervenciones por CENS en el Hospital Clínico Universidad de Chile. Resultados: El mayor porcentaje de los resultados histopatológicos fueron diferentes formas de rinosinusutis crónica (RSC) representando 65,67 por ciento (RSC simple, alérgica, poliposa alérgica y no alérgica). Entre los hallazgos con menor frecuencia destacan: papiloma invertido (4,9(0) por ciento), pólipo antrocoanal (9,31(0) por ciento), rinosinusitis fúngica no invasiva (2,45(0) por ciento) y 7 casos de patología maligna. Con respecto a la correlación clínica e histopatológica, se encontró para RSC una concordancia del 92,15 por ciento, para RSC poliposa del 95,94 por ciento y en pólipos antrocoanales 85,71 por ciento. Conclusiones: La mayoría de los resultados obtenidos fueron distintas formas de inflamación crónica de la mucosa nasosinusal. Se encontró una fuerte correlación entre el diagnóstico clínico y la histopatología, sin embargo, la aparición no excepcional de patología maligna inclina la conducta hacia el uso rutinario de solicitud de biopsia.

Introduction: Histopathological examination of samples obtained by endoscopic sinus surgery (ESS) is routine in many hospitals, however, results reports and effective analysis of its clinical utility are scarce in the literature. Aim: To describe and analyze the pathological study in ESS. Furthermore, recognize the correlation between histopathology and clinical diagnosis. Material and method: A cross-sectional study by reviewing medical records and collecting data from ESS interventions in the University of Chile Clinical Hospital was performed. Results: Most of the diagnoses were different forms of chronic rinosinusutis (CRS), representing 65.67 percent(simple, allergic and polypoid). Among the most common are unusual findings: inverted papilloma (4.9 percent), antrochoanal polyp (9.31 percent), fungal non-invasive rhinosinusitis (2.45 percent) and 7 cases of malignancy. Clinical and histopathologic correlation found for CRS was 92.15 percent 95.94 percent in nasal polyposis and 85.71percent in antrochoanal polyps. Conclusions: Most of the results were different forms of chronic inflammation of the sinus mucosa. A strong correlation between clinical diagnosis and histopathology was found, however, the onset of not exceptional malignant disease suggest the routine use of biopsy.

Mucormicosis: Una micosis emergente / Mucormycosis: An emergent mycosis

El objetivo de este trabajo es presentar la incidencia, frecuencia, características clínicas y evolución de los pacientes con mucormicosis atendidos en el Hospital de Clínicas José de San Martín, Universidad de Buenos Aires, entre los años 1982 y 2010. Durante ese período se diagnosticaron 10 casos de mucormicosis. Los tres primeros entre 1982 y 2004 y los últimos 7 entre 2005 y 2010. La incidencia y frecuencia de esta enfermedad, para el período 1980-2004 fue 0.13 pacientes/año y 0.1 casos/10 000 egresos (IC 95%: 0.00 a 0.3) respectivamente. En el período 2005-2010 la incidencia fue 0.86 pacientes/año y la frecuencia de 1.1 casos/10 000 egresos (IC 95%: 0.5 a 2.4). Hubo nueve casos de mucormicosis rinosinuso-orbitaria, siete en pacientes con diabetes mellitus, uno en una paciente con una hemopatía maligna y neutropenia, y el restante en un paciente con HIV/sida que además estaba neutropénico y con un síndrome hemofagocítico. En una paciente se realizó el diagnóstico post mortem de mucormicosis pulmonar. El diagnóstico se efectuó por la observación de filamentos cenocíticos en los diez casos. Hubo desarrollo de mucorales en los cultivos de 8/9 pacientes; cinco Rhizopus spp y tres Mucor spp. Todos los pacientes recibieron un tratamiento inicial con anfotericina B deoxicolato, que en tres de ellos fue continuado con anfotericina B liposomal, y cirugía. Tres enfermos recibieron además un tratamiento adyuvante con oxigeno hiperbárico. La mortalidad fue 30%.

Mucormycosis is an opportunistic infection caused by fungi of the order Mucorales. It is characterized by rapid progression and high morbidity and mortality in the absence of early diagnosis and prompt treatment. It was an infrequent disease, but in recent years, its incidence appears to have increased. The aim of this paper is to report the cases of mucormycosis diagnosed from 1982 to 2010 at the Hospital de Clinicas José de San Martín, University of Buenos Aires. We diagnosed 10 cases of mucormycosis; the first three between 1982 and 2004 and the last 7 between 2005 and 2010. The incidence from 1980 to 2004 was 0.13 patient-years and the frequency 0.1/10 000 discharges (95% CI 0.00- 0.3). In the period 2005 to 2010, the incidence was 0.86 patients per year with 1.1/10 000 discharges (95% CI 0.5-2.4). There was a pulmonary mucormycosis case (in a patient treated with corticosteroids) and nine rhinocerebral cases, two in neutropenic and seven in diabetic patients. The diagnosis was made by observation of cenocytic hyphae in 10/10 patients. Mucorales were recovered in 8/9 cultures (5 Rhizopus spp and 3 Mucor spp.). In one case diagnosis of pulmonary mucormycosis was made post-mortem. Nine patients were treated with amphotericin B deoxycholate (in 3 patients supplemented with liposomal amphotericin B) and surgery. Three patients underwent hyperbaric chamber. Seven patients had favorable outcome. In conclusion, mucormycosis is a rare disease, but its incidence has increased over the past five years. A good evolution of the patients is linked to early diagnosis and treatment.

incidence of concha bullosa and its association with chronic rhinosinusitis deviated nasal septum and osteomeatal complex obstruction

To determine the incidence of concha bullosa and its association with deviated nasal septum, obstruction of osteomeatal complex and chronic rhinosinusitis. Retrospective study. Otorhinolaryngology, head and neck surgery department. Nine hundred thirty-one consecutive paranasal sinus CTs taken between 2008 and 2010 were reviewed; 347 cases of concha bullosa [CB] were identified. Those cases were reviewed radiologically for the presence and severity of deviated nasal septum, obstruction of the osteomeatal complex and sinus disease. The significance of associations was tested using chi-square or Fischer exact tests. Patient's age ranged from 8 to 84 years with a mean age of 32.6 years. Two hundred twenty-nine [66%] were females. Three hundred forty-seven [37.3%] had CB and 224 [64.6%] had deviated nasal septum with CB. No association between a unilateral or dominant CB and ipsilateral or contralateral DNS and ipsilateral or contralateral maxillary, ethmoid and sphenoid sinus involvement was found. Similarly, there was no association with disease in the ipsilateral or contralateral osteomeatal complex. Although concha bullosa is a common occurrence in the nasal cavity, no statistically significant relationships between the presence of concha bullosa, deviated nasal septum, obstruction of osteomeatal complex and sinus disease was found

Staphylococcus aureus and MRSA nasal carriage in general population

Assessment of Staphylococcus aureus [S. aureus] and MRSA nasal carriage in our general population. Cross-sectional analytical study. A private Pathology Laboratory in Lahore city from January 2002 to December 2003. Nasal swabs were obtained from the apparently healthy persons accompanying the patients attending the laboratory. These swabs were inoculated on blood and mannitol salt agar plates and incubated at 37°C. The isolate[s] were identified as S. aureus on the basis of colony morphology, Gram staining, catalase and coagulase tests. Sensitivity to Oxacillin was determined using standard Kirby Bauer technique. Nasal swabs from 1660 subjects from the community were studied. Out of these samples, a total of 246 [14.82%] samples were positive for growth of S. aureus [nasal carriers of S. aureus]. Out of 246 S. aureus isolates, 48 [19.51%] isolates were methicillin resistant S. aureus [MRSA]. Nasal carriage was higher in males [15.47%] as compared to females [13.26%], in urban areas [16.99%] as compared to rural areas [11.32%] and in the year 2002 [16.02%] as compared to year 2003 [13.08%]. However, the difference was significant only for the urban vs. rural comparison [p<0.05]. MRSA isolates were also significantly higher among S. aureus isolates from the nasal cavities of urban subjects [22.98%] as compared to rural ones [11.11%]. Maximum nasal carriage was present in the age group upto 9 years [20.23%] with decrease in the age groups 10-19, 20-29 and 30-39 years followed by small rise in the older subjects. The nasal S. aureus carriage as well as methicillin resistance among these isolates are more common in urban community

Incidência de desvio do septo nasal em recém-nascido / Incidence of deviation of nasal septum in newborn

Foram avaliados 1202 recém-nascidos com idade entre um e três dias, no periodo de 1997 a 1998, no hospital Universitário, na Maternidade Cândido Mariano e na Santa Casa. Diagnosticou-se desvio do septo nasal em 31 crianças. O peso médio dos recém-nascidos era de 3,29g, altura média de 49,25cm, sendo 18 (58 por cento) da cor branca, 13 (42 por cento) morena, 16 (51,6 por cento) do sexo masculino e 15 (49,4 por cento) feminino, 9 (29,1 por cento) nasceram de parto normal e 22 (70,9 por cento) de parto cesariana. A ordem gestacional das mäes: 10 (32,3 por cento) eram primíparas e 21 (67,7 por cento multíparas. Os estudos estatísticos mostraram näo haver relaçäo entre peso, altura, sexo, tipo de parto e ordem gestacional com a ocorrência do desvio.

Prevalencia de enfermedades del oído, nariz y garganta en Chile: defunciones y egresos en 1985 / Prevalence in otorhinolaryngologic diseases in Chile: dealth and exit in 1985

Se trata de un estudio de prevalencia de las enfermedades del oído, nariz y garganta en el universo de las defunciones y egresos hospitalarios ocurridos en Chile durante 1985. Las defunciones por estas causas alcanzaron a 464, siendo la primera causa los cuerpos extraños faríngeo y laríngeo quienes presentaron 203 muertos con una tasa de 1.7 por 100.000 y 44%del total de defunciones por el grupo de causas en estudio. El 59%de ellas ocurrieron en menores de 15 años. La segunda causa de muerte es el tumor maligno de la laringe con 121 defunciones y una tasa de 1.0 por 100.000 y 26%del total. La tercera causa es la otitis media supurativa y no especificada con 23 defunciones, una tasa de 0,2 por 100.000 y 5%del total. Las causas que ocupan los cinco lugares siguientes son los tumores malignos, todos de predominio masculino. Con respecto a los egresos hospitalarios corresponden a 34.492, 65%de los cuales ocurren en menores de 15 años. La primera causa de egreso es la enfermedad crónica de las amigdalas con 13.030 hospitalizaciones, 85%de las cuales son en menores de 15 años. La segunda causa es la otitis media supurativa y no especificada con 3.571 egresos, 40%en menores de 15 años. Es interesante conocer los escenarios determinados por las defunciones y los egresos ya que es posible prevenir un número importante de ellos mediante programas educativos aplicados a nivel de la atención primaria, mejorando los hábitos de la población

Rhinosporidiosis in Bankura.

Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium Seeberi. Although a variety of sites may be affected, the principal site of infection is the nasal mucosa, the disease is endemic in India and Sri Lanka, smaller series are also described from East Africa and parts of America, but it is very rare in Europe. The 116 cases seen in the Medical College at Bankura during January 1983 to December 1987 are presented here. The disease is more prevalant in males and in the second decade of life. Excision by diathermy knife and electrocautery of the base proved to be helpful to prevent recurrence.

Morbidity pattern of ear, nose, and throat diseases in children in Benghazi

A study of morbidity pattern of E.N.T. disease in children in Benghazi was carried out for a period of two and a half years ending in December 1981. Children below 12 years comprised 20.2% E.N.T. out-patients, and 28.01% of E.N.T. emergencies. The common conditions encountered were tonsillitis 35.35%; otitis media 19.56%; and epistaxis 3.03%. The common emergencies were epistaxis [26.28%], foreign body nose [17.09%], trauma nose [16.32%] and foreign body in the oseophagus [10.9%]