Comparação entre duas abordagens diferentes de tratamento cirúrgico da insuficiência velofaríngea / Comparison between two different approaches of surgical management for velopharyngeal insufficiency

RESUMO Introdução A palatoplastia secundária com veloplastia intravelar (VI) pode ser realizada previamente ao retalho faríngeo (RF), para o tratamento cirúrgico da insuficiência velofaríngea em pacientes com fissura palatina. Esta abordagem cirúrgica tem como finalidade melhorar as condições velofaríngeas, evitando, assim, a indicação de um retalho faríngeo largo e seus efeitos indesejáveis sobre a respiração. Objetivo Investigar os efeitos do retalho faríngeo realizado após a veloplastia intravelar para tratamento da insuficiência velofaríngea sobre a nasalidade e a respiração. Métodos Análise dos resultados pós-cirúrgicos da nasalidade de fala e da respiração de 50 indivíduos com fissura de palato reparada e insuficiência velofaríngea, sendo 23 submetidos ao retalho faríngeo após a veloplastia intravelar (Grupo VI+RF) e 27 submetidos unicamente ao retalho faríngeo (Grupo RF). A nasalidade foi determinada pela nasometria e o efeito da cirurgia sobre a respiração foi analisado pela medida da área de secção transversa mínima nasofaríngea, obtida pela técnica fluxo-pressão e pelo levantamento das queixas respiratórias, utilizando questionário específico. A comparação estatística entre os grupos foi realizada por meio do teste Mann-Whitney e teste t de Student, considerando significante o valor de p<0,05. Resultados Verificou-se que não houve diferença entre os grupos para os resultados de nasalidade, da medida da área nasofaríngea e do levantamento de queixas respiratórias. Conclusão Ambas as abordagens para tratamento cirúrgico da insuficiência velofaríngea mostraram resultados equivalentes, no que se refere à eliminação da hipernasalidade, bem como à condição da respiração, sugerindo que a realização do retalho faríngeo após a veloplastia intravelar não levou a melhores resultados de ressonância de fala e não favoreceu a respiração.

ABSTRACT Introduction Secondary palatoplasty with intravelar veloplasty (IV) may be performed before pharyngeal flap (PF) for surgical treatment of velopharyngeal insufficiency in individuals with cleft palate. This surgical approach aims to improve the velopharyngeal conditions, thus avoiding indication of a large pharyngeal flap and its undesirable effects on respiration. Purpose To investigate the effects of pharyngeal flap performed after intravelar veloplasty for the treatment of velopharyngeal insufficiency on nasality and respiration. Methods Analysis of postoperative outcomes of speech nasality and respiration in 50 individuals with repaired cleft palate and velopharyngeal insufficiency, being 23 submitted to pharyngeal flap after intravelar veloplasty (Group IV+PF) and 27 submitted only to pharyngeal flap (Group PF). Nasality was determined by nasometry, and the effect of surgery on respiration was assessed by measuring the minimum nasopharyngeal transverse section area, obtained by the pressure-flow technique and investigation of respiratory complaints, using a specific questionnaire. Statistical comparison between groups was performed by the Mann-Whitney test and Student t test, at a significance level of p<0.05. Results There was no difference between groups for the outcomes of nasality, measurement of nasopharyngeal area and investigation of respiratory complaints. Conclusion Both approaches for surgical treatment of velopharyngeal insufficiency demonstrated similar outcomes concerning the elimination of hypernasality, as well as for respiration, suggesting that accomplishment of pharyngeal flap after intravelar veloplasty did not provide better speech resonance outcomes nor favored respiration.

A Leech in the Nasopharynx of a Child: A Case Report.

Infestation with leeches can happen due to drinking from spring water or other unhealthy water from non-hygienic sources or swimming in infested water like Wells and swamps, and can lead to several complications in the aerodigestive tract. Epistaxis, melena, and foreign body sensation had been reported in the literature as manifestations of this condition. We described a 12-year-old child presented to our department with dry cough and spitting of blood after swimming in the water pond of a Well that led to leech entry into the nasopharynx. Removal was done, and the patient became symptom free. Infestation with a leech can lead to variable symptoms in the aerodigestive tract like spitting of blood and irritation at the site of its attachment. Hence, leech should be put in mind in dealing with patients visiting physicians with the above symptoms, especially, if they come from rural areas that drink spring or Well water.

Endoscopic sinus surgery of antrochoanal polyps: one year study of 17 patients

The aim of this prospective case series study is to assess the outcome of endoscopic sinus surgery on antrochoanal polyps in 17 patients over one year period. Seventeen patients with antrochoanal polyps were treated in the department of otorhinolaryngology in al-Jamhoree Mosul teaching Hospital from March 2006 up to February 2007. They had endoscopic transnasal surgery as the method of treatment, and all patients were followed one year postoperatively. Only one pediatric patient had recurrent polyp after 6 months and was subjected to another surgery which was complicated by temporary epiphora. Another patient had adhesions, otherwise all patients had improvement of symptoms, and frequent follow ups over one year showed no recurrence. No major complications were reported in any patient. The endoscopic transnasal surgery of antrochoanal polyp is a minimally invasive technique which is both effective and safe

Índice de complicações na translocação médio-facial para o acesso à base do crânio: análise de 12 casos

Objetivo: Propor uma alternativa cirúrgica ao acesso do terço médio da face incluindo a rinofaringe, seio esfenoidal, fossa pterigopalatina, processo odontóide e clivus. Expor como a técnica apresentada oferece exposição ampla da região e mínimas complicações que são avaliadas neste trabalho. Método: Os registros médicos de doze pacientes submetidos a translocação médio-facial no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, de 1995 a 2008, foram analisados quanto a doença tratada, localização das lesões, técnica cirúrgica e complicações. Resultados: Seis pacientes eram portadores de cordoma do clivus, neste grupo três pacientes não apresentaram complicações, um desenvolveu ectrópio, um apresentou hipoestesia do nervo infra-orbitário e um evoluiu com insuficiência velo-palatina leve. Um paciente com diagnóstico de estesioneuroblastoma apresentou granulama nasal. Os outros cinco pacientes tinham compressão vértebro-basilar e, no pós-operatório, três deles não apresentaram complicações. Dentre os que apresentaram complicações, um evoluiu com deiscência parcial do palato mole e outro apresentou pequenos granulomas em uma cavidade nasal, paresia do ramo oftálmico e leve insuficiência velo-palatina. Conclusão: A técnica de translocação médio-facial fornece uma ampla abordagem à base do crânio com poucas seqüelas e de baixa morbidade para o paciente no pós-operatório.

Gossypiboma of nose and nasopharynx: a report of two cases

Gossypiboma is an iatrogenic complication which can occur in any surgical procedure. It is an uncommon condition and is under reported in literature. Due to non-anticipation it is usually missed or misdiagnosed leading to delayed diagnosis. We present two cases of gossypiboma in the nose and nasopharynx respectively

Choanal adenoids in adults: diagnosis and treatment

Choanal adenoids, a rather rarely defined phenomenon, is the presence of adenoid tissues in the choanae, without being extension of the commonly well-known nasopharyngeal adenoids. We present a series of 22 adult patients [17-38 years; 15 males, 7females], with persistent bilaeral nasal obstruction and recurrent nasal infections, and with history e of repeated unsuccessful medical and, in many cases, repeated surgical procedures, in whom choanal adenoids was diagnosed by nasal endoscopy and/or CT scanning. Absence of adenoid tissues in the nasopharynx was confirmed in all cases. Surgical removal of choanal adenoids was undertaken in all cases endoscopically. Some other surgical. procedures like straightening of a deviated septum or reduction of a hypertrophied turbinate were undertaken in some indicated cases. Most of cases experienced complete relief of obstruction and return of a patent nasal airway and improvement of associated complaints as dry mouth and persistent cough. A thorough review of this phenomenon and its clinical relevance and methods of diagnosis and management are presented. We recommend a thorough nasal endoscopy as a routine in cases of persistent nasal obstruction even in the presence of an apparent cause of obstruction

Cirugía de angiofibroma nasofaringeo juvenil / Surgery of of juvenile nasopharyngeal angiofibroma

En el presente trabajo, analizamos los distintos tratamientos quirúrgicos que se llevaron a cabo en 6 casos de angiofibroma nasofaríngeo juvenil (ANJ). Las vías quirúrgicas que se utilizaron fueron la nasal paralateral, la transpalatina, de Rouge-Denker, y la vía natural oral. Analizamos el criterio actual sobre la preparación prequirúrgica, la utilización de las distintas técnicas actuales, haciendo mención especial del "degloving". Se hace referencia a la relación entre los diferentes estadios del tumor: tamaño y localización, y consecuentemente las distintas técnicas a emplear

Nasopharyngeal cysts

Nasopharyngeal cysts are known for over a century, but they are rarely noticed. One has to have a suspicion once a patients symptoms of nasal obstruction continues after operations to the partial inferior turbinectomy or adenoidectomy. Three cases are reproted. Surgical excision is the treatment fo choice. Marsupilization is of doubtful value