Spontaneous cerebrospinal fluid otorrhoea: case report and literature review.

Cerebrospinal fluid otorrhoea may occur through the temporal bone both in children and adults. In children it is generally associated with labyrinthine malformations and usually presents with hearing loss in a child with recurrent meningitis. In adults it is sequel to direct head injury, otologic or neurotologic surgery or infection. More rarely this pathology is described as being "spontaneous", occurring without any history of trauma, surgery or infection. Spontaneous cerebrospinal fluid otorrhoea in adults may present with dull symptoms such as a blocked ear or short term conductive hearing-loss. The anatomic site of this fistula is the tegmen tympani which may have a microscopic or macroscopic bone deficiency or sometimes even a "silent" meningoencephalic herniation. The authors describe a case of spontaneous cerebrospinal fluid otorrhoea occurring in an adult patient with bilateral absence of the tegmen tympani and review the literature regarding this specific. They suggest that its actual occurrence may be underestimated. Special attention should be given to adult patients with recurrent or persistent middle ear effusion. Any suspicion should be followed by meticulous imaging and surgical exploration since this may be a lifethreatnening situation.

Prevalence of adapted swallowing in a population of school children.

Adapted swallowing (AS) and its effects on dentofacial balance are frequently observed in children with orofacial myofunctional alterations. The preliminary objective of this research was to identify the frequency of cases of adapted swallowing in a population of school children, and targeting early treatment to prevent morphofunctional alteration of the face and its consequences on dentofacial harmony. One hundred school children between seven and nine years old attending the Children and Adolescents' Supporting Program (PRODECAD) of the State University of Campinas (UNICAMP) Brazil were selected at random and examined. Orofacial myofunctional assessments were carried out through standardized protocol. Results indicated the prevalence of adapted swallowing associated with resting posture alterations of dentofacial structures and mastication with dentofacial disharmony was 57%. Adapted swallowing without alteration of dentofacial form was observed in 19% of cases, and 24% of cases had a swallowing pattern within normal limits. The high prevalence of alterations suggests the need for early professional intervention.

Ewing's sarcoma of the head and neck.

CONTEXT: Ewing's sarcoma is a rare neoplasm, which usually arises in long bones of the limbs and in flat bones of the pelvis, with the involvement of head and neck bones being very unusual. CASE REPORT: a case of Ewing's sarcoma occurring in the mandible of a 35-year-old female. Pain and swelling of the tumor were the main complaints. The early hypothesis was an undifferentiated malignant neoplasm, possibly a sarcoma. The CT scan depicted an expansive lesion, encapsulated, with septa and characteristics of soft tissue, involving the left side of the mandible and extending to the surrounding tissues. The patient underwent surgical excision of the lesion, the definitive diagnosis of Ewing's sarcoma was established, and the patient commenced on radiotherapy.

Pressäo no ouvido médio e óxido nitroso (N2O) / Middle ear pressure and nitrous oxide

O objetivo do trabalho foi verificar a pressäo gerada no ouvido médio durante a administraçäo de N2), se há relaçäo com o tempo e se ocorre difusäo dos gases pela tuba auditiva. Dezesseis pacientes de ambos os sexos, ASA 1 e submetidos a septoplastias foram estudados. Medicaçäo pré-anestésica: midazolam (0,1 mg/kg). Induçäo com droperidol (0,1 mg/kg), alfentanil (0,02 mg/kg), propofol (1-2 mg/kg) para tubagem orotraqueal. Os pacientes foram divididos: Grupo I (n=8), mantidos com O2 + isoflurano e grupo N (n=8), com N2O: O2 + isoflurano. A hipotensäo arterial foi induzida com injeçöes de metropolol e droperidol. As PAS e PAD foram medidas a cada 5 minutos, com observaçäo contínua e FC e ECG. Para verificar a interferência do N2) sobre a pressäo no ouvido médio, foram feitas impedanciometrias e aferiçöes do reflexo estapediano antes da induçäo da anestesia e a cada dois minutos após a intubaçäo traqueal. Houve diferença sifnificativa (p>0.01) quanto a PAS, PAD e FC iniciais e os menores valores de manutençäo, nos dois grupos. No grupo I, a pressäo no ouvido médio manteve-e inalterada. No grupo N, a pressäo no ouvido médio apresentou elevaçäo gradual, pico e declínio brusco. Ao se interromper a anestesia, com a recuperaçäo do reflexo da deglutiçäo a pressäo cai próximo a zero. O reflexo estapediano foi abolido nos dois grupos. Conclusöes: O N2O näo altera a funçäo da tuba auditiva normal. Com aumento da pressäo no interior do ouvido médio até 258 mm H2O (2.54 kPa) em média, a tuba auditiva abre-se, equalizando a pressäo com a atmosfera. Em pacientes anteriormente submetidos a timpanoplastia ou mastoidectomia fechada, o N2O deve ser evitado poi pode desorgaizar os elementos anatômicos reconstruídos. Naqueles já submetidos a estapedectomia, o N2O deve ser contra-indicado em quaisquer circunstâncias, pela maior labilidade dos elementos anatômicos de ligaçäo, a nível da janela oval, às variaçöes pressóricas observadas, podendo provocar dano auditivo neurossensorial irreversível. Os resultados näo permitiram relacionar a pressäo no ouvido médio com o tempo de administraçäo do N2O. O isoflurano + oxigênio näo alteram as pressöes do ouvido médio e näo interferem com a funçäo tubária. As técnicas anestésicas empregadas abolem o reflexo estapediano

Colesteatoma de ouvido médio: revisäo cirúrgica em 104 pacientes / Cholesteatoma of the middle: surgery review in 104 pacients

A propósito de 27 revisöes cirúrgicas de pacientes operados por colesteatoma douvido médio, numa série de 104 pacientes, o autor descreve seus achados clínico-cirúrgicos e comenta os casos reoperados. O autor conclui propondo acompanhamento disciplinado para avaliar pequenas perfuraçöes residuais e/ou retraçöes geradoras de recidiva