Congenital Midline Cervical Cleft and Thyroglossal Duct Fibrous Cord-Like, is There a Mixed Presentation?

INTRODUCTION: Congenital midline cervical cleft is a rare condition and is frequently misdiagnosed as thyroglossal duct cyst. Otherwise, the combination of congenital midline cervical cleft and thyroglossal duct fibrosis in the same patient is as rare as important to be registered with the intention to inform and offer specific managements details for the literature. CASE PRESENTATION: Eight-year-old boy with simultaneous congenital midline cervical cleft and a thyroglossal duct fibrosis. The anatomic, clinical, radiologic, and pathologic characteristics of the congenital midline cervical cleft are described as well as surgical technique for removal and repair with Z-plasty. CONCLUSION: Congenital midline cervical cleft is a rare condition and when diagnosed must be surgically treated as early as possible. Its differential diagnosis is a clinical challenge.

Management of neck metastases in T2N0 lip squamous cell carcinoma.

BACKGROUND: Prophylactic neck dissection (PND) is indicated when the chance of occult lymph node metastases from head and neck tumors is significant. There is no consensus regarding which tumor size PND would be indicated in cases of lip cancer. METHODS: A total of 139 patients with surgically treated lip cancer were selected. The size of the lesion (T) and the presence of lymph node metastases (N) were assessed by examining the medical records. For analysis purposes, the T2 group was divided into T2a (2 to 3 cm) and T2b (3 to 4 cm). RESULTS: The following distribution of incidence of neck metastases was observed in the study groups: 11.7% in T1, 9% in T2a, 43.7% in T2b, and 52.2% in T3+T4. Statistical comparison of the groups (p) revealed the following results: T2aXT2b=0.03; T2aXT3+T4=0.001. CONCLUSION: PND is indicated for tumors larger than 3 cm.

Fractured orbital wall reconstruction with an auricular cartilage graft or absorbable polyacid copolymer.

OBJECTIVE: The objective of the study was to compare the functional and aesthetic results of fractured orbital wall reconstruction with an auricular cartilage graft or absorbable polyacid copolymer. MATERIALS AND METHODS: Twenty patients with blow-out orbital fracture/orbital floor associated or not with the medial wall were assessed by the same craniofacial surgical group. All were evaluated preoperatively and postoperatively by an ophthalmologist for diplopia, enophthalmos, exophthalmos, sensitivity, ophthalmic reflexes, intraocular pressure, and visual field.The patients were subjected to a preoperative facial multislice computed tomographic scan, repeated 6 months after surgery. Eight patients underwent reconstruction with an auricular cartilage graft, and 12 patients, with blade absorbable polyacid copolymer. Subtarsal access was used for all patients. RESULTS: Two patients showed temporary ectropion, 1 in each group. All patients presented satisfactory ocular function, and all tests revealed good orbital delineation, orbital symmetry, periorbital sinus individualization, and reduction of blow-out. CONCLUSIONS: The blow-out orbital wall reconstruction can be performed with the use of an auricular cartilage or with a blade absorbable copolymer without differences regarding functional or aesthetic complications and sequelae.

Autologous fat graft absorption in unilateral paralyzed canine vocal folds.

OBJECTIVE: The objective of this experimental prospective study on an animal model was to determine the rate of autologous fat graft absorption in 24 paralyzed canine left vocal folds 12 weeks after introduction. METHODS: Forty mongrel dogs of both sexes weighing 15 to 20 kg were divided into three study groups (SGs) of eight dogs each whose larynges were grafted by vocal fold lipoinjection (VFL-SGA), vocal fold lipoinjection plus insulin (VFLi-SGB), and by fat graft medialization laryngoplasty (FGML-SGC) and observed for 12 weeks. Two control groups (CGs) of eight dogs each were submitted to fat graft medialization laryngoplasty (FGML-CG1) and by vocal fold lipoinjection (VFL-CG2), respectively, followed by immediate killing. All 40 dogs were submitted to left vagal and recurrent laryngeal nerve resection. All animals were confirmed to have a left vocal fold paralysis 4 weeks later when 2 mL of autologous fat graft was placed inside the left paraglottic space. The larynges were removed at preestablished times and studied for remaining fat graft volume by magnetic resonance imaging. RESULTS: The mean volume obtained by imaging were 1.9388 mL for CG1, 1.0476 mL for CG2, 0.1924 mL for VFL, 0.336 mL for VFLi, and 0.565 mL for FGML. CG1 and CG2 did not differ significantly from one another but differed from the SGs, with statistical analysis suggesting a lower absorption of the fat graft in FGML. CONCLUSION: The absorption rate was 82% in SGA, 68% in the SGB, and 71% in SGC.

Complicações decorrentes do uso de prótese vocal / Complications in consequence of the vocal prosthesis use

Introdução: Desde a primeira laringectomia total, realizada em 1873, já se tem registro do interesse em se desenvolver e recuperar a comunicabilidade verbal desses pacientes. Porém grandes progressos foram observados depois de 1979, quando se pode contar com próteses traqueoesofágicas. Mesmo sendo um enorme progresso, as próteses vocais geram complicações. Objetivo: Avaliar as complicações com o emprego de próteses vocais e relaciona-las com fatores clínicos e tipo de prótese. Métodos: Dez pacientes submetidos a laringectomia total portando prótese fonatória foram acompanhados no serviço de Cirurgia de Cabeça e Pescoço do HCRP-FMRP-USP buscando-se registrar as complicações e relaciona-las com fatores clínicos e tipo de prótese. Resultados: Foram registrados: vazamento de saliva e/ou dieta da faringe para a traquéia, infecção fungica, ausência de função da prótese e esses achados foram quantificados avaliando-se os efeitos da radioterapia e do tipo de prótese usada. Conclusão: A prótese vocal apresenta dificuldades e complicações operacionais que merecem atenção e mais estudos são necessários para se ter o perfil mais completo destes aspectos.