Neurofibromatosis laríngea pediátrica: reporte de localización atípica / Pediatric neurofibromatosis of the larynx: report of atypical location

Los neurofibromas laríngeos (NFL) son tumores benignos poco frecuentes de localización principalmente supraglótica. Se manifiestan con síntomas obstructivos de la vía aérea. El tratamiento es la resección completa del tumor mediante abordaje endoscópico; se reserva la cirugía abierta para tumores de gran extensión. Se presenta el caso de un paciente pediátrico con localización atípica de NFL asociado a neurofibromatosis tipo 1 (NF1). Se realizó resección endoscópica del tumor y la anatomía patológica informó neurofibroma plexiforme. Es importante sospechar de esta patología en todo niño con estridor inspiratorio atípico progresivo. Se sugiere seguimiento a largo plazo por la alta probabilidad de recidiva.

Laryngeal neurofibromas (LNFs) are rare benign tumors mainly located in the supraglottis. LNFs occur with airway obstruction symptoms. The treatment is complete resection via an endoscopic technique; the open approach is reserved for large tumors. Here we describe the case of a pediatric patient with LNF of atypical location associated with neurofibromatosis type 1 (NF-1). The tumor was resected with an endoscopic technique, and the pathological study reported a plexiform neurofibroma. It is important to suspect this condition in any child with atypical, progressive inspiratory stridor. Long-term follow-up is recommended due to the high rate of recurrence

Clinical features and management analysis of 11 cases of laryngocele / 中华耳鼻咽喉头颈外科杂志

Objective: To summarize clinical features and our experience of the diagnosis and treatment of laryngocele. Methods: Clinical data of 11 laryngocele patients in department of Otorhinolaryngology Head and Neck Surgery of the Second Affiliated Hospital of Shanxi Medical University from January 2012 to December 2021 were retrospectively reviewed, including 9 men and 2 women, aged from 12 to 75 years, with median age of 56 years. Electronic laryngoscope was performed in 10 of all patients, laryngeal CT in 10 and cervical color ultrasound in 5 before operation.All the operations were performed under general anesthesia, and the external cervical approach was used for external and combined laryngocele. The internal laryngocele was resected by low temperature plasma through transoral endoscopy. Patients were followed up regularly after operation to evaluate the effect. Clinical feature, types of lesions, imaging findings, surgical approaches and follow-up results were analyzed through descriptive statistical method. Results: Eleven laryngocele patients were divided into mixed type (n=6), internal type (n=4) and external type (n=1).Nine patients presented with hoarseness or dysphonia, 7 with cervical mass and 1 with airway obstruction. Surgical resections were done through external cervical approach (n=7)or transoral endoscopic approach (n=4). All the operations were successful and no complication occurred. All cases were followed up from 17 to 110 months. No recurrence was encountered. Conclusions: Laryngocele is a rare lesion with atypical clinical presentation. Preoperative imaging including CT scan and electronic laryngoscope is essential to evaluate the location, and extent of the lesion, and to make the surgical plan.Complete surgical excision is required. Surgical resection is the only effective method for the treatment of laryngocele.

Poorly differentiated neuroendocrine carcinoma of the tongue base: a case report / 临床耳鼻咽喉头颈外科杂志

Neuroendocrine carcinoma(NEC) is a malignant tumor derived from neuroendocrine cells, with distinct clinical, morphological and immunohistochemical characteristics. Neuroendocrine carcinoma of the head and neck is very rare in clinic. Larynx is the most common affected site, and the root of the tongue is extremely rare. The clinical manifestations are mainly eating pain, cauliflower like mass in the mouth, and ulcerative lesions that have not healed for a long time. Maxillofacial MRI and contrastenhanced CT are the most commonly used examination tools for such diseases, which can detect the spaceoccupying lesions of tumors. Neuroendocrine granules found in the cytoplasm under pathological light microscope can be diagnosed as neuroendocrine carcinoma. However, for most cases, it is difficult to make a diagnosis only under light microscope, and it is often necessary to make a diagnosis by means of immunohistochemistry and other technical means. This paper reports a case of neuroendocrine carcinoma of the root of the tongue, introduces its characteristics, diagnosis and treatment, and reviews the relevant literature of this case.

Aspectos clínicos asociados al diagnóstico y tratamiento de la aspergilosis laríngea en pacientes inmunocompetentes / Clinical aspects associated with the diagnosis and treatment of laryngeal aspergillosis in immunocompetent patients

INTRODUCCIÓN. La aspergilosis laríngea en individuos inmunocompetentes, aunque rara, se reporta cada vez con más frecuencia; por lo cual, es necesario comprender mejor los aspectos clínicos y terapéuticos más adecuados para abordar su atención. OBJETIVO. Documentar los aspectos clínicos asociados al diagnóstico y el tratamiento de la aspergilosis laríngea en sujetos inmunocompetentes. METODOLOGÍA. Se realizó un estudio Bibliográfico Narrativo de carácter retrospectivo, donde se evaluaron los casos clínicos reportados de personas inmunocompetentes con aspergilosis laríngea desde el año 1983 hasta el 2022. Se hizo una revisión bibliográfica en las bases de datos PubMed/Medline y ScienceDirect, y se incluyeron todos los casos reportados en sujetos inmunocompetentes. RESULTADOS. Se identificaron 30 casos clínicos que cumplieron con los criterios de inclusión dentro de un grupo de 586 artículos revisados. El patógeno más reportado fue Aspergillus fumigatus y la evaluación histopatológica la principal herramienta para diagnosticar la aspergilosis. Se reportaron más casos en mujeres con un 58%. La mayor incidencia se observó en sujetos entre 20 y 49 años de edad. Los síntomas más comunes fueron disfonía, disnea y tos. El tratamiento farmacológico empleado actualmente es el Itraconazol seguido por el Voriconazol. CONCLUSIONES. La evidencia reportada mostró que la aspergilosis laríngea en pacientes inmunocompetentes podría estar dejando de ser un evento "poco común" por lo que debe prestarse más atención a su diagnóstico y tratamiento.

INTRODUCTION. Laryngeal aspergillosis in immunocompetent individuals, although rare, is reported with increasing frequency; therefore, it is necessary to better understand the most appropriate clinical and therapeutic aspects to address its care. OBJECTIVE. To document the clinical aspects associated with the diagnosis and treatment of laryngeal aspergillosis in immunocompetent subjects. METHODOLOGY. A retrospective Narrative Bibliographic study was performed, where clinical case reports of immunocompetent subjects with laryngeal aspergillosis from 1983 to 2022 were evaluated. A literature review was performed in PubMed/Medline and ScienceDirect databases, and all reported cases in immunocompetent subjects were included. RESULTS. Thirty clinical cases that met the inclusion criteria were identified from a pool of 586 articles reviewed. The most reported pathogen was Aspergillus fumigatus and histopathologic evaluation the main tool for diagnosing aspergillosis. More cases were reported in women with 58%. The highest incidence was observed in subjects between 20 and 49 years of age. The most common symptoms were dysphonia, dyspnea and cough. The pharmacological treatment currently used is Itraconazole followed by Voriconazole. CONCLUSIONS. The evidence reported showed that laryngeal aspergillosis in immunocompetent patients may no longer be a "rare" event and more attention should be paid to its diagnosis and treatment.

Algoritmo para el manejo de la obstrucción laríngea en pediatría / Algorithm for the management of laryngeal obstruction in pediatrics

La laringe se localiza en la encrucijada aerodigestiva; cualquier patología que la comprometa tendrá repercusión en la respiración, la deglución y/o la voz. Se divide en tres regiones: la supraglotis (comprende la epiglotis, las bandas ventriculares y los ventrículos laríngeos), la glotis (espacio limitado por las cuerdas vocales) y la subglotis (zona más estrecha de la vía aérea pediátrica y único punto rodeado en su totalidad por cartílago: el anillo cricoides). La obstrucción laríngea se puede presentar como una condición aguda potencialmente fatal o como un proceso crónico. El síntoma principal es el estridor inspiratorio o bifásico. La etiología varía mucho según la edad y puede ser de origen congénito, inflamatorio, infeccioso, traumático, neoplásico o iatrogénico. Se describen las patologías que ocasionan obstrucción laríngea con más frecuencia o que revisten importancia por su gravedad, sus síntomas orientadores para el diagnóstico presuntivo, los estudios complementarios y el tratamiento.

The larynx is at the aerodigestive crossroads; any pathology that involves it will have an impact on breathing, swallowing and/or the voice. It`s divided into three regions: supraglottis (includes epiglottis, ventricular bands and laryngeal ventricles), glottis (space limited by the vocal cords) and subglottis (narrowest area of pediatric airway and the only point of larynx completely surrounded by cartilage: the cricoid ring). Laryngeal obstruction can present as a potentially fatal acute condition or as a chronic process. The main symptom is inspiratory or biphasic stridor. The etiology varies widely according to age and it may be of congenital, inflammatory, infectious, traumatic, neoplastic or iatrogenic origin. We describe the pathologies that cause laryngeal obstruction, either those that occur very often or those which are important for their severity, their guiding symptoms to the presumptive diagnosis, additional studies and treatment.

Carcinoma of the posterior wall of the hypopharynx: surgical treatment with larynx preservation / Carcinoma da parede posterior da hipofaringe: tratamento cirúrgico com preservação da laringe

Abstract Introduction: Posterior pharyngeal wall is the most rare subsite for hypopharyngeal carcinomas. Because of its rarity, there are few studies published in the literature specifically concerning posterior pharyngeal wall carcinoma. Objectives: To report our functional results in patients with the carcinoma of the posterior wall of the hypopharynx after surgical treatment by resection via a lateral or infrahyoid pharyngotomy approach, with the preservation of the larynx and reconstruction with a radial forearm free flap. Methods: The study included 10 patients who underwent surgery for a carcinoma of the posterior wall of the hypopharynx over a 6 year period. The associated postoperative morbidity was investigated and functional results were analyzed. Results: Nine patients had T3 lesions and one patient had a T2 lesion. The preferred approach to access the hypopharynx was a lateral pharyngotomy in 5 patients and lateral pharyngotomy combined with infrahyoid pharyngotomy in 5 patients with superior extension to oropharynx. The pharyngeal defects were reconstructed successfully with radial forearm free flaps. Four patients received adjuvant radiotherapy only, and 4 patients with N2b and N2c neck diseases received adjuvant chemoradiotherapy. The mean duration of hospitalization was 15.6 days (range, 10-21 days). All patients achieved oral intake in a median time of 74 days (range, 15-180). Decannulation was achieved in all patients and the median time fordecannulation was 90 (range, 21-300 days). The mean followup duration was 38.3 months (range, 10-71 months) and 8 patients survived. One patient died due to regional recurrence in the retropharyngeal lymph nodes and 1 patient died due to systemic metastasis. Conclusion: Primary surgery is still a very effective treatment modality for the carcinoma of the posterior wall of the hypopharynx and does not permanently compromise the swallowing and laryngeal functions if pharyngeal reconstruction is performed with a free flap.

Resumo Introdução: A parede posterior da faringe é o subsítio mais raro para carcinomas hipofaríngeos. Devido à sua raridade, há poucos estudos publicados na literatura especificamente sobre o carcinoma da parede posterior da faringe. Objetivo: Relatar nossos resultados funcionais em pacientes com carcinoma da parede posterior da hipofaringe após tratamento cirúrgico por ressecção via faringotomia lateral ou infra-hióidea, com preservação da laringe e reconstrução com retalho livre radial do antebraço. Método: O estudo incluiu 10 pacientes submetidos à cirurgia para carcinoma da parede posterior da hipofaringe por 6 anos. A morbidade pós-operatória associada foi investigada e os resultados funcionais foram analisados. Resultados: Nove pacientes apresentaram lesões T3 e um paciente apresentou lesão T2. Avia preferida para acessar a hipofaringe foi a faringotomia lateral em 5 pacientes e a faringotomia lateral combinada com a faringotomia infra-hióidea em 5 pacientes com extensão superior até a orofaringe. Os defeitos faríngeos foram reconstruídos com sucesso com retalhos livres radiais do antebraço. Quatro pacientes receberam apenas radioterapia adjuvante e 4 pacientes com doença cervical N2b e N2c receberam quimiorradioterapia adjuvante. A duração média da hospitalização foi de 15,6 dias (variação de 10 a 21 dias). Todos os pacientes retornaram à ingestão oral em um tempo médio de 74 dias (variação de 15 a 180). A decanulação foi possível para todos os pacientes e o tempo médio foi de 90 dias (variação de 21 a 300 dias). A duração média do seguimento foi de 38,3 meses (10 a 71 meses) e 8 pacientes sobreviveram. Um paciente foi a óbito devido a recorrência regional nos linfonodos retrofaríngeos e outro devido a metástase sistêmica. Conclusão: A cirurgia primária ainda é uma modalidade de tratamento muito eficaz para o carcinoma da parede posterior da hipofaringe e não compromete de forma permanente as funções de deglutição e da laringe se a reconstrução faríngea for feita com retalho livre.

Caracterización de pacientes con papiloma laríngeo / Characteristics of patients with lagyngeal papillomatosis

La papilomatosis laríngea es la neoplasia laríngea benigna más común y está causada por el virus de papiloma humano. Se considera que la papilomatosis laríngea tiene un papel independiente como factor de riesgo de cáncer; se clasifica dentro de tres grupos de acuerdo con sus características clínicas: juvenil, adulto y recurrente. Su incidencia asociada a neoplasia maligna es del 4%. Objetivos: Determinar si existen factores de riesgo asociados al tipo de papilomatosis laríngea; y si existe relación con el tipo de papilomatosis y neoplasias asociadas. Metodología: Estudio observacional descriptivo de pacientes que acuden al servicio de Otorrinolaringología del Hospital General San juan de Dios y su caracterización. Resultados: De los 33 pacientes evaluados con papilomatosis laríngea, 51 % fueron del género masculino, la edad promedio sin incluir pacientes pediátricos fue de 23 años. La mediana de reintervenciones es de 4 veces, y la mayoría tiene pérdida del seguimiento. La papilomatosis tipo infantil es la más común con pacientes de 7 a 14 años de edad. Los pacientes con papilomatosis adulta presentaron más factores de riesgo que los pacientes con papilomatosis infantil y recurrente, p=0.01. Los pacientes presentan ronquera, disfonía y dificultad respiratoria. El diagnóstico se realiza por clínica con laringoscopía sin biopsia en la mitad de los pacientes. El 9% de los pacientes estudiados presentaron neoplasia asociada. El número de reintervenciones está asociado a un mayor riesgo de progresión a neoplasia. Conclusión: Los pacientes con papilomatosis adulta presentaron más factores de riesgo que los pacientes con papilomatosis infantil, y el 9% de los pacientes presentan una neoplasia asociada, más alta de la reportada en la literatura.(AU)

Laryngeal papillomatosis is the most common benign neoplasm and is caused by the human papilloma virus. Laryngeal papillomatosis is considered to have an independent role as risk factor. Laryngeal papillomas are classified into three groups, according to their clinical characteristics: juvenile, adult and recurrent. 4% is associated with neoplasia. Objectives: Determine if there are risk factors associated with the type of laryngeal papillomatosis and if there is a relationship with the type of papillomatosis and associated neoplasms. Methodology: Descriptive observational study of patients attending the Otolaryngology service of the General Hospital San Juan de Dios de Guatemala and their characterization. Results: Of the 33 patients evaluated with laryngeal papillomatosis, 51% were male, with an average age of 23 years. The median number of reoperations is 4, and most do not return to follow-up. Infantile type papillomatosis is the most common, with patients 7 to 14 years of age. Patients with adult papillomatosis had more risk factors than patients with infantile and recurrent papillomatosis, p= 0.01. Patients present hoarseness, dysphonia and respiratory distress upon admission. Diagnosis is made clinically with laryngoscopy without biopsy in half of the patients. 9% of the patients studied had associated neoplasia. The number of reoperations is associated with an increased risk of developing a neoplasm. Conclusion: Patients with adult papillomatosis presented more risk factors than patients with infantile papillomatosis. And 9% of the patients present associated neoplasia, higher than reported in the literature

Laryngeal and vocal alterations after thyroidectomy / Alterações laríngeas e vocais após tireoidectomia

Abstract Introduction: Dysphonia is a common symptom after thyroidectomy. Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy + isthmectomy n = 40, total thyroidectomy n = 88, thyroidectomy + lymph node dissection n = 23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy + isthmectomy n = 6; total thyroidectomy n = 17; thyroidectomy + lymph node dissection n = 9) and 2 superior laryngeal nerve (lobectomy + isthmectomy n = 1; Total thyroidectomy + lymph node dissection n = 1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n = 76; palsy n = 13), thyroiditis (n = 8; palsy n = 0), and carcinoma (n = 67; palsy n = 21). Conclusion: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.

Resumo Introdução: A disfonia é um sintoma comum após a tireoidectomia. Objetivo: Analisar os sintomas vocais, auditivo-perceptivos e acústica vocal, videolaringoscopia, procedimento cirúrgico e achados histopatológicos em pacientes submetidos à tireoidectomia. Método: Estudo prospectivo. Pacientes submetidos à tireoidectomia foram avaliados da seguinte forma: anamnese, laringoscopia e avaliações vocais acústicas. Momentos: pré-operatório, 1ª avaliação pós (15 dias), 2ª avaliação pós (1 mês), 3ª avaliação pós (3 meses) e 4ª avaliação pós-operatória (6 meses). Resultados: Dos 151 pacientes, 130 eram mulheres e 21, homens. Tipos de cirurgia: lobectomia + istmectomia n = 40, tireoidectomia total n = 88, tireoidectomia + dissecção de linfonodo n = 23. Sintomas vocais foram relatados por 42 pacientes na 1ª avaliação pós-operatória (27,8%), reduzidos para 7,2% após 6 meses. Na análise acústica, f0 e APQ estavam diminuídos nas mulheres. As videolaringoscopias mostraram que 144 pacientes (95,3%) tiveram exames normais no momento pré-operatório. Paralisia das cordas vocais foi diagnosticada em 34 pacientes na 1ª avaliação pós-operatória, 32 do nervo laríngeo recorrente (lobectomia + istmectomia - n = 6; tireoidectomia total - n = 17; tireoidectomia total + dissecção de linfonodos - n = 9) e 2 do nervo laríngeo superior (lobectomia + istmectomia - n = 1; tireoidectomia total + dissecção de linfonodos - n = 1). Após 6 meses, 10 pacientes persistiram com paralisia do nervo laríngeo recorrente (6,6%). Histopatologia e correlação com paralisia das cordas vocais: bócio coloide nodular (n = 76; paralisia n = 13), tireoidite (n = 8; paralisia n = 0) e carcinoma (n = 67; paralisia n = 21). Conclusão: Os sintomas vocais, relatados por 27,8% dos pacientes na 1ª avaliação pós-operatória, diminuíram para 7% em 6 meses. Na análise acústica, f0 e APQ diminuíram. A paralisia transitória de cordas vocais secundária à lesão do nervo laríngeo recorrente e nervo laríngeo superior ocorreu, respectivamente, em 21% e 1,3% dos pacientes, reduziu-se para 6,6% e 0% após 6 meses.

Oncological results of surgical treatment versus organ-function preservation in larynx and hypopharynx câncer / Resultado oncológico de tratamento cirúrgico versus protocolo de preservação de órgão em câncer de laringe e hipofaringe

Summary Introduction: Since the beginning of the 1990s, non-surgical radiochemotherapy treatment has become popular with the prospect of maintaining oncological results and preserving the organ in patients with advanced squamous cell carcinoma of the larynx and hypopharynx. However, subsequent studies demonstrated increased recurrence and mortality after the non-surgical treatment became popular. Objective: To compare the oncological results of surgical and non-surgical treatments of patients with larynx and hypopharynx cancer and to evaluate the variables associated with disease recurrence. Method: This is a retrospective cohort study of 134 patients undergoing surgical (total or partial laryngectomy) or non-surgical (isolated radiotherapy, chemotherapy or induction chemotherapy followed by radiotherapy and chemotherapy) treatment, with 62 patients in the surgical group and 72 in the non-surgical group. Results: Disease-free survival rates were higher in the surgical group (81.7% vs. 62.2%; p=0.028), especially in III/IV stages (p=0.018), locally advanced tumors T3 and T4a (p=0.021) and N0/N1 cases (p=0.005). The presence of cervical lymph nodes, especially N2/N3, was considered a risk factor for disease recurrence in both groups (HR=11.82; 95CI 3.42-40.88; p<0.0001). Patients not undergoing surgical treatment were 3.8 times more likely to develop recurrence (HR=3.76; 95CI 1.27-11.14; p=0.039). Conclusion: Patients with larynx or hypopharynx cancer non-surgically treated had a poorer disease-free survival, especially in cases with locally advanced tumors (T3 and T4a) and in which the neck was only slightly affected (N0/N1).

Resumo Introdução: A partir de estudos do início dos anos 1990, popularizou-se o tratamento não cirúrgico com radioquimioterapia, com a perspectiva de manutenção do resultado oncológico e preservação do órgão em pacientes com carcinoma espinocelular avançado de laringe e hipofaringe. Entretanto, estudos posteriores demonstraram aumento da recorrência e da mortalidade com a difusão do tratamento não cirúrgico. Objetivo: Comparar o resultado oncológico dos tratamentos cirúrgico e não cirúrgico de pacientes com câncer de laringe e hipofaringe e avaliar as variáveis associadas à recidiva de doença. Método: Estudo de coorte retrospectiva de pacientes submetidos ao tratamento cirúrgico (laringectomia total ou parcial) e não cirúrgico (radioterapia isolada, radioterapia concomitante a quimioterapia ou quimioterapia de indução seguida de radioterapia e quimioterapia) de 134 pacientes, sendo 62 no grupo cirúrgico e 72 no não cirúrgico. Resultados: As taxas de sobrevivência livre de doença foram maiores no grupo cirúrgico (81,7% vs. 62,2%; p=0,028), principalmente em estádios III/IV (p=0,018), tumores localmente avançados T3 e T4a (p=0,021) e casos N0/N1 (p=0,005). A presença de linfonodos cervicais, principalmente N2/N3, foi considerada fator de risco para recidiva de doença nos dois grupos (HR=11,82; IC95% 3,42-40,88; p<0,0001). Pacientes não submetidos ao tratamento cirúrgico apresentaram 3,8 vezes mais chance de desenvolvimento de recidiva (HR=3,76; IC95% 1,27-11,14; p=0,017). Conclusão: Pacientes com câncer de laringe ou hipofaringe tratados de forma não cirúrgica tiveram menor sobrevivência livre de doença, especialmente nos tumores localmente avançados (T3 e T4a) e com pescoço pouco comprometido (N0/N1).

Incidence and endoscopic characteristics of acute laryngeal lesions in children undergoing endotracheal intubation / Incidência e características endoscópicas de lesões agudas laríngeas em crianças submetidas à intubação endotraqueal

ABSTRACT INTRODUCTION: Acute laryngeal lesions after intubation appear to be precursors of chronic lesions. OBJECTIVE: To describe the incidence and type of acute laryngeal lesions after extubation in a pediatric intensive care unit (PICU). METHODS: A cohort study involving children from birth to <5 years, submitted to intubation for more than 24 h in the PICU of an university hospital. In the first eight hours after extubation, a flexible fiberoptic laryngoscopy (FFL) was performed at the bedside. Those with moderate to severe abnormalities underwent a second examination seven to ten days later. RESULTS: 177 patients were included, with a median age of 2.46 months. The mean intubation time was 8.19 days. Seventy-three (41.2%) patients had moderate or severe alterations at the FFL, with the remaining showing only minor alterations or normal results. During follow-up, 16 children from the group with moderate to severe lesions developed subglottic stenosis. One patient from the normal FFL group had subglottic stenosis, resulting in an incidence of 9.6% of chronic lesions. CONCLUSION: Most children in the study developed mild acute laryngeal lesions caused by endotracheal intubation, which improved in a few days after extubation.

Resumo Introdução: As lesões laríngeas agudas após a intubação parecem ser precursoras das lesões crônicas. Objetivo: Descrever a incidência e o tipo de lesões laríngeas agudas após extubação em Unidade de Terapia Intensiva Pediátrica (UTIP). Método: Estudo de coorte envolvendo crianças de 0 a 5 anos incompletos, com intubação por mais de 24 horas na UTIP de um hospital universitário. Nas primeiras 8 horas após extubação, uma nasofibrolaringoscopia à beira do leito foi realizada. Aqueles com anormalidades moderadas a graves foram submetidos a novo exame entre 7-10 dias após. Resultados: 177 pacientes foram incluídos, com idade mediana de 2,46 meses. O tempo médio de intubação foi de 8,19 dias. Setenta e três (41,2%) pacientes apresentaram alterações moderadas ou graves à laringoscopia, o restante mostrando apenas alterações leves ou exame normal. Durante o acompanhamento, 16 crianças do grupo lesões moderada a grave desenvolveram estenose subglótica. Um paciente do grupo laringoscopia normal teve estenose subglótica, somando-se uma incidência de 9,6% de lesões crônicas. Conclusão: A maioria das crianças do estudo desenvolveu lesões laríngeas agudas leves decorrentes da intubação endotraqueal, com melhora em alguns dias após a extubação.

Incisão em abordagem única por meio de técnica de retalho deltopeitoral para reconstrução de traqueostomia em paciente submetido à radioterapia após laringectomia / One stage "slit" deltopectoral flap technique for end tracheostomy reconstruction in irradiated postlaryngectomy patient

Reconstruir lesão do estoma traqueal em pacientes submetidos a laringectómica total é um desafio, especialmente, quando a pele do perístoma está lesionada devido à radioterapia. A reconstrução é complexa e geralmente requer mais de uma abordagem. Apresenta-se técnica simples utilizada com sucesso em paciente de 80 anos com deiscência de lesão do estoma traqueal e retração da traqueia.

Reconstruction of tracheal stoma wound in patients who undergone total laryngectomy is challenging especially when the peristomal skin is unhealthy due to radi therapy. The reconstruction is complex and usually requires more than one stage. We present a simple techniqued successfully used in an 80-year-old patient with dehisced tracheal stoma wound and retraction of trachea.

Comparação de via aérea por máscara laríngea Supreme e via aérea por máscara laríngea ProSeal para trauma laringofaríngeo e morbidade pós-operatória em crianças / Comparison of laryngeal mask airway supreme and laryngeal mask airway proseal for laryngopharyngeal trauma and postoperative morbidity in children / Comparación de vía aérea por mascarilla laríngea Supreme y vía aírea por mascarilla laríngea ProSeal para el trauma laringofaríngeo y la morbilidad postoperatoria en niños

EXPERIÊNCIA E OBJETIVOS: A via aérea por máscara laríngea (LMA), que tem sido utilizada frequentemente no tratamento das vias aéreas, pode causar lesão e morbidade na área laringofaríngea. Nesse estudo, comparamos as alterações macroscópicas nas estruturas laringofaríngeas e a morbidade laringofaríngea pós-operatória pelo uso da LMA Supreme® versus LMA ProSeal® em crianças. MÉTODOS: Dividimos os pacientes em dois grupos. Inserimos LMA ProSeal #3 no primeiro grupo e LMA Supreme #3 no segundo grupo. Antes da inserção da LMA e em seguida à sua remoção, fizemos laringoscopia direta nos pacientes. Comparamos entre os dois grupos: hiperemia, lesão de mucosa e as manchas de sangue por ocasião da remoção da LMA, e também o tempo de inserção, percentual de sucesso na inserção do tubo gástrico na primeira tentativa, náusea, vômito e dor de garganta. RESULTADOS: Não foram observadas diferenças significativas entre os dois grupos para tempo médio de operação, gênero, idade, peso, percentual de sucesso na inserção do tubo gástrico na primeira tentativa, náusea, vômito, dor de garganta e lesão de mucosa. O tempo médio de inserção para o grupo LMA ProSeal foi significativamente maior versus grupo LMA Supreme (p = 0,0001). O índice de manchas de sangue na remoção da LMA foi significativamente mais alto no grupo LMA ProSeal versus LMA Supreme (p = 0,034). Os pacientes que apresentaram manchas de sangue por ocasião da remoção da LMA exibiram hiperemia e lesão de mucosa significativamente mais expressivas versus pacientes com LMA limpa (p = 0,0001, p = 0,020). CONCLUSÃO: Em crianças, a inserção da LMA Supreme é mais rápida e fácil do que a inserção da LMA ProSeal; e, em comparação com LMA ProSeal, causa menos lesão laringofaríngea.

BACKGROUND AND OBJECTIVES: Laryngeal mask airway (LMA), which has been used frequently in airway management, can cause laryngopharyngeal injury and morbidity. In this trial, we compare the macroscopic changes on laryngopharyngeal structures and the postoperative laryngopharyngeal morbidity by using LMA supreme with LMA proseal in children. METHODS: We divided patients into two groups. We inserted size three LMA proseal into the first group and size three LMA supreme into the second group. Before LMA insertion and after LMA removal, we performed direct laryngoscopy on the patients. We compared hyperemia, mucosal injury and blood staining on LMA removal, as well as insertion time, rate of success in gastric tube insertion on the first attempt, nausea, vomiting, and sore throat between the two groups. RESULTS: We recorded no significant differences between the two groups for mean operation time, sex, age, weight, rate of success in gastric tube insertion on first attempt, nausea, vomiting, sore throat and mucosal injury. Mean insertion time for the LMA proseal group was significantly longer than the LMA supreme group (p = 0.0001). The ratio of blood staining on LMA removal was significantly higher in the LMA proseal group than the LMA supreme group (p = 0.034). The patients with blood staining on LMA removal exhibited significantly more mucosal hyperemia and injury than the patients with clear LMA (p = 0.0001, p = 0.020). CONCLUSION: LMA supreme insertion is faster and easier than LMA proseal and causes less laryngopharyngeal injury than LMA proseal in children.

EXPERIENCIA Y OBJETIVOS: La vía aérea por mascarilla laríngea (LMA), que ha sido utilizada a menudo en el tratamiento de las vías aéreas, puede causar lesión y morbilidad en el área laringofaríngea. En ese estudio, comparamos las alteraciones macroscópicas en las estructuras laringofaríngeas y la morbilidad laringofaríngea postoperatoria por el uso de la LMA Supreme® versus LMA ProSeal® en niños. MÉTODOS: Dividimos los pacientes en dos grupos. Insertamos LMA ProSeal #3 en el primer grupo y LMA Supreme #3 en el segundo grupo. Antes de la inserción de la LMA e inmediatamente después de su retirada, hicimos una laringoscopia directa en los pacientes. Comparamos entre los dos grupos: hiperemia, lesión de mucosa y las manchas de sangre en razón de la retirada de la LMA, y también el tiempo de inserción, porcentaje de éxito en la inserción del tubo gástrico en el primer intento, náusea, vómito y dolor de garganta. RESULTADOS: No fueron observadas diferencias significativas entre los dos grupos para tiempo promedio de operación, sexo, edad, peso, porcentaje de éxito en la inserción del tubo gástrico en el primer intento, náusea, vómito, dolor de garganta y lesión de mucosa. El tiempo promedio de inserción para el grupo LMA ProSeal fue significativamente mayor versus grupo LMA Supreme (p = 0,0001). El índice de manchas de sangre en la retirada de la LMA fue significativamente más alto en el grupo LMA ProSeal versus LMA Supreme (p = 0,034). Los pacientes que tenían manchas de sangre en razón de la retirada de la LMA tenían hiperemia y una lesión de la mucosa significativamente más expresivas versus pacientes con LMA limpia (p = 0,0001, p = 0,020). CONCLUSIONES: En los niños, la inserción de la LMA Supreme es más rápida y fácil que la inserción de la LMA ProSeal; y en comparación con LMA ProSeal, causa menos lesión laringofaríngea.

Manejo de carcinoma glótico temprano: experiencia en el Hospital Universitario San Ignacio / Management of Early Glottic Cancer: Hospital Universitario San Ignacio Experience

Objetivos: Exponer la experiencia de la Unidad de Otorrinolaringología del Hospital Universitario San Ignacio en el manejo del cáncer glótico en estadios tempranos. Establecer la tasa de recurrencias y la calidad de la voz postratamiento. Diseño: Estudio descriptivo. Pacientes y métodos: Pacientes con cáncer glótico en estadios I y II, manejados con cirugía y/o radioterapia. Revisión de historias clínicas, 2004- 2012. Resultados: 63 pacientes con cáncer de laringe en estadios tempranos, 53 hombres y 10 mujeres, con edad promedio de 66,5 años; 48 recibieron manejo quirúrgico y 60 se trataron con radioterapia. 90% presentaron mejoría en el VHI y solo 10% sufrieron empeoramiento del mismo; la mejoría promedio fue de 19 puntos. En cuatro pacientes hubo recurrencia local y en dos a distancia. Conclusiones: Con el enfoque diagnóstico y terapéutico que realizamos en el Hospital San Ignacio, para el manejo del carcinoma glótico en estadios tempranos, hemos obtenido una adecuada tasa de curación de la enfermedad y mantenido una apropiada calidad de la voz postratamiento...

Objectives: To describe the experience of the ENT unit of the Hospital Universitario San Ignacio, in the management of glottic cancer in early stages with surgery and/ or radiotherapy. Establish the rate of recurrence and speech quality after treatment. Type of study: Descriptive study. Patients and Methods: Patients with glottic cancer at early stages managed with conservative surgery and/or radiotherapy. Medical charts of 2004 to 2012. Results: 63 patients with laryngeal cancer in the early stages (stages I and II), mean age 66.5 years. 48 patients underwent surgical treatment and 60 radiotherapy. Of the 31 patients, 28 showed improvement (90%) of de VHI and only 3 (10%) worsed, with an average improvement of 19 points. 4 patients developed local recurrence and 2 recurred in distance. Conclusions: The therapeutic approach in San Ignacio Hospital of glottic carcinoma stages I-II, obtained adequate cure rate with good voice quality after treatment...

Laryngeal Leishmaniasis

Introduction: Leishmaniasis is classified into three clinical presentations: visceral, coetaneous and mucocutaneous. The latter is usually secondary to hematogenous spread after months or years of skin infection and can manifest as infiltrative lesions, ulcerated or vegetating in nose, pharynx, larynx and mouth, associated or not with ganglionics infarction. Laryngeal involvement is part of the differential diagnosis of lesions in this topography as nonspecific chronic laryngitis, granulomatosis and even tumors of the upper aerodigestive tract presenting atypical evolution. Sometimes it is difficult for the correct diagnosis of Leishmaniasis, with description of cases in the literature were conducted improperly. Objective: The objective of this study is to report a case of laryngeal Leishmaniasis addressing the difficulty of diagnosis, complications and treatment applied. Case Report: A patient with pain throat, dysphagia, odynophagia, dysphonia and weight loss, with no improvement with symptomatic medication. At telelaringoscopy, infiltrative lesion showed nodular supraglottis. He underwent a tracheotomy for airway obstruction and biopsy with immunohistochemical study for a definitive diagnosis of laryngeal Leishmaniasis. The patient was referred to the infectious diseases that initiated treatment with N-methylglucamine antimoniate with satisfactory response to therapy. Final Comments: Faced with a clinical suspicion of granulomatous diseases, it is essential to follow protocol laboratory evaluation associated with histological injury, to get a precise definition etiological without prolonging the time of diagnosis. Medical treatment for mucosal Leishmaniasis, recommended by the World Health Organization, was adequate in the case of laryngeal disorders, with complete resolution of symptoms...

Urbach-Wiethe disease (lipoid proteinosis).

Lipoid proteinosis is a rare autosomal recessive disorder of variable severity that may involve the skin, mucous membranes of the upper respiratory tract and internal organs that may display different clinical manifestations based on the site of involvement. A 34-year-old male patient was admitted to our hospital with a complaint of hoarseness present since childhood but had worsened in recent years. A dermatological examination revealed light brown papillomatous skin lesions on the dorsum of both hands and elbows present for a long duration. Endoscopic examination of the larynx revealed widespread mucosal thickening and irregularity. Microscopic examination revealed acid Schiff (PAS) positive, Congo red negative eosinophilic hyaline material deposits in the dermis and submucosal regions. The final diagnosis was lipoid proteinosis with skin and larynx involvement. This typical case has been reported to draw attention to the fact that lipoid proteinosis should be included in the differential diagnosis of patients presenting with hoarseness in childhood.

Pseudosarcoma laríngeo / Laryngeal pseudosarcoma

El pseudosarcoma de laringe es un tumor poco frecuente, sobre el cual hay gran controversia a causa de su histogénesis y comportamiento biológico, de ahí la variada nomenclatura que ha recibido. Es un tumor maligno, considerado de buen pronóstico por su evolución favorable tras tratamiento, su alta supervivencia y buena calidad de vida. Se expone un caso, en el que aparece la radioterapia como factor de riesgo …

The pseudosarcoma of larynx is an infrequent tumor, who presents a great controversy in its histogenesis and biological behaviour, which explains the varied nomenclature that it has received. It is a malignant tumor, considered of good prognosis because of its favourable evolution after treatment, its high survival and good life quality. We expose a case in which the radiotherapy seems to be risk factor…

The improvement of mixed human serum-induced anaphylactic reaction death model in guinea pigs / 法医学杂志

OBJECTIVE@#To increase the death rate of fatal anaphylaxis in guinea pigs and the detectahie level of the tryptase of mast cell in hlood serum.@*METHODS@#Seventy-four guinea pigs were randomly divided into five groups: original model group, original model control group, improved model group, improved model control group, improved model with non-anaphylaxis group. Using mixed human serum as the allergen, the way of injection, sensitization and induction were improved. ELISA was used to detect the serum mast cell tryptase and total IgE in guinea pigs of each group.@*RESULTS@#The death rate of fatal anaphylaxis in original model group was 54.2% with the different degree of hemopericardium. The severe pericardial tamponade appeared in 9 guinea pigs in original model group and original model control group. The death rate of fatal anaphylaxis in improved model group was 75% without pericardial tamponade. The concentration of the serum total IgE showed no statistically difference hetween original model group and original model control group (P > 0.05), hut the serum mast cell tryptase level was higher in the original model group than that in the original model control group (P > 0.05). The concentration of the serum total IgE and the serum mast cell tryptase level were significantly higher in improved model group than that in the improved model control group (P < 0.05).@*CONCLUSION@#The death rate of the improved model significantly increases, which can provide effective animal model for the study of serum total IgE and mast cell tryptase.

Laryngeal granuloma in a thorougbread horse: a multidisciplinary study / Granuloma laríngeo en un caballo pura sangre: un estudio multidisciplinario / Granuloma de laringe em um cavalo puro-sangue: um estudo multidisciplinar

A two year-old racing thoroughbred mare presented with loud respiratory stertor, that was auscultated in thetracheal and laryngeal regions. Upon palpitation of the larynx, no changes were noted. The upper respiratory tractwas examined via a fiberoptic endoscopy where the nasal passages were observed to be unchanged and the scope passed with normal resistance. The guttural pouches and their openings were normal. The right arytenoid cartilage appeared thickened throughout its length and failed to retract during inspiration. In the right, dorsal cricoarytenoidcartilage a gross mass was observed projecting from the right wall. The mass was surgically removed from thelarynx and samples were collected for histopathologic and bacterial study. Histopathologic study of the cricoidcartilage revealed extensive proliferation of fibrous connective tissue, well vascularized granulation tissue with diffuse infiltration of lymphocytes, plasma cells and a few giant cells. Bacterial cultures provided isolation of Pseudomonas aeruginosa, whose antibiogram demonstrated sensitivities to ampicillin, ceftazidime, ciprofloxacin, cefepime, gentamicin, imipinem, meropenem, piperacillin, piperacillin/tazobactam and resistance to trimethoprim. In conclusion, a laryngeal granuloma was detected in a racing thoroughbred mare by a multidisciplinary, clinical study involving endoscopy, as well as histopathologic and microbiologic studies.

Una yegua de dos años de edad Pura Sangre de Carreras presentó estertor respiratorio fuerte que se auscultaen las regiones de la tráquea y la laringe. En la palpación de la laringe no se detectaron cambios. Las víasrespiratorias superiores fueron examinadas con un endoscopio de fibra óptica en los pasajes nasales no seobservaron cambios la resistencia fue normal. Las bolsas guturales y sus aberturas fueron normales, el cartílagoaritenoideo derecho apareció engrosado en toda su longitud y no se retrae durante la inspiración. En el cartílagocricoaritenoideo dorsal derecho se observó una masa que sobresale de la pared derecha. La masa fue removidamediante cirugía de la laringe y las muestras fueron colectadas para un estudio histopatológico y bacteriano. Elestudio histopatológico del cartílago cricoides evidenció una gran proliferación de tejido conectivo fibroso, tejido de granulación bien vascularizado con infiltrado difuso de linfocitos, células plasmáticas y células gigantes. Elcultivo bacteriano permitió el aislamiento de Pseudomonas aeruginosa, el antibiograma mostró una sensibilidadde la ampicilina, ceftazidima, ciprofloxacina, cefepima, gentamicina, imipenem, meropenem, piperacilina,piperacilina / tazobactam y la resistencia a el trimetoprim. En conclusión, se detecto un granuloma laríngeo en un Pura Sangre de Carrera mediante un estudio multidisciplinario clínico, endoscopio, histopatológico ymicrobiológico.

Uma égua de corrida puro-sangue de dois anos apresentou estertor respiratório forte que foi auscultado nasregiões da traquéia e da laringe. Na palpação da laringe não foram detectadas alterações. As vias respiratórias foram examinados com um endoscópio de fibra ótica onde nas fossas nasais não foram observados trocas e a resistência era normal. As bolsas guturais e as suas aberturas foram normais. A cartilagem aritenóide direita apareceu espessada em todo seu comprimento e não se retrai durante a inspiração. Na cartilagem cricoaritenóidedorsal direita mostrou uma massa que se projeta da parede direita. A massa foi removida através de cirurgia dalaringe e as amostras foram coletadas para um estudo histopatológico e bacteriano. O estudo histopatológico dacartilagem cricóide evidenciou uma proliferação grande de tecido conector fibroso, tecido de granulação bemvascularizado com infiltrado difuso de linfócitos, células plasmáticas e células gigantes. A cultura bacterianapermitiu o isolamento de Pseudomonas aeruginosa e o antibiograma mostrou sensibilidade de ampicilina,ceftazidima, ciprofloxacina, cefepima, gentamicina, imipenem, meropeném, piperacilina/tazobactama, eresistência a trimetoprim. Em conclusão, um granuloma de laringe foi detectado em uma égua de corridapuro-sangue através de um estudo clínico multidisciplinar, envolvendo endoscopia, avaliação histopatológicae microbiológica.