Variant of the Technique for Laryngeal Microsurgery in Cases of Difficult Laryngoscopy

Abstract Introduction Low exposure of the larynx can make laryngeal microsurgery difficult or even impossible. The application of rigid and contact endoscopy enabled oblique and retrograde angled visualization, allowing transoperative staging with greater reach of the anatomical areas. However, there is difficulty or even impossibility of performing the surgical act, due to the incompatibility of the angled path with the straight surgical tools. Objective To demonstrate the efficiency of the variant of the technique for laryngeal microsurgery in cases of difficult laryngoscopy and to analyze the new surgical instruments specific to the endoscopic procedure. Methods This is a cross-sectional retrospective study, based on the analysis of 30 medical records of patients treated surgically at a philanthropic hospital in the state of Sergipe, Brazil, between the years of 2014 and 2015. Results The technical variant used 30- and 70-degree endoscopes that provided complete oblique view of the endolarynx. The association of angled instruments (forceps, suction pumps, retractors and scissors) enabled the execution of the surgical procedures. Conclusion The association of rigid endoscopy with angled instruments promoted full visualization of the surgical lesion and operative resolution. (AU)

Variant of the Technique for Laryngeal Microsurgery in Cases of Difficult Laryngoscopy.

Introduction Low exposure of the larynx can make laryngeal microsurgery difficult or even impossible. The application of rigid and contact endoscopy enabled oblique and retrograde angled visualization, allowing transoperative staging with greater reach of the anatomical areas. However, there is difficulty or even impossibility of performing the surgical act, due to the incompatibility of the angled path with the straight surgical tools. Objective To demonstrate the efficiency of the variant of the technique for laryngeal microsurgery in cases of difficult laryngoscopy and to analyze the new surgical instruments specific to the endoscopic procedure. Methods This is a cross-sectional retrospective study, based on the analysis of 30 medical records of patients treated surgically at a philanthropic hospital in the state of Sergipe, Brazil, between the years of 2014 and 2015. Results The technical variant used 30- and 70-degree endoscopes that provided complete oblique view of the endolarynx. The association of angled instruments (forceps, suction pumps, retractors and scissors) enabled the execution of the surgical procedures. Conclusion The association of rigid endoscopy with angled instruments promoted full visualization of the surgical lesion and operative resolution.

Adenotonsillar Hypertrophy in Pre-School Children with Sickle Cell Disease and Diagnostic Accuracy of the Sleep Disturbance Scale for Children.

Introduction Adenotonsillar hypertrophy is more common in children with sickle cell disease, and can lead to sleep-disordered breathing. Objectives To determine the frequency of adenotonsillar hypertrophy in pre-school children with sickle cell disease and assess the diagnostic accuracy of the sleep-disordered breathing subscale in the Sleep Disturbance Scale for Children. Method Observational study with a group of 48 children with sickle cell disease and a control group of 35 children without the disease. The children underwent oropharingoscopy and video nasal endoscopy. The parents and/or guardians answered the questions of the subscale. Results Adenotonsillar hypertrophy was observed in 25% of the children in the study group, and in 20% of the children in the control group, with no statistical difference between the groups. The subscale score ranged from 3 to 11 in both groups. There was a statistical significance in the study group. The average was 4.79 (standard deviation [SD] ± 2.50), with 4.19 (SD ± 1.72) among the children without adenotonsillar hypertrophy, and 6.5 (SD ± 3.40) among the children with adenotonsillar hypertrophy. There was also a statistical significance in the control group. The average was 5.23 (SD ± 2.81), with 4.44 (SD ± 2.2) among the children without adenotonsillar hypertrophy, and 7.87 (SD ± 2.89) among the children with adenotonsillar hypertrophy. Conclusion Adenotonsillar hypertrophy was not associated with sickle cell disease in pre-school children. The subscale of sleep-disordered breathing in the Sleep Disturbance Scale for Children was a useful tool for the diagnostic suspicion of adenotonsillar hypertrophy in children in this age group.

Adenotonsillar Hypertrophy in Pre-School Children with Sickle Cell Disease and Diagnostic Accuracy of the Sleep Disturbance Scale for Children

Abstract Introduction Adenotonsillar hypertrophy is more common in children with sickle cell disease, and can lead to sleep-disordered breathing. Objectives To determine the frequency of adenotonsillar hypertrophy in pre-school children with sickle cell disease and assess the diagnostic accuracy of the sleepdisordered breathing subscale in the Sleep Disturbance Scale for Children. Method Observational study with a group of 48 children with sickle cell disease and a control group of 35 children without the disease. The children underwent oropharingoscopy and video nasal endoscopy. The parents and/or guardians answered the questions of the subscale. Results Adenotonsillar hypertrophy was observed in 25% of the children in the study group, and in 20% of the children in the control group, with no statistical difference between the groups. The subscale score ranged from 3 to 11 in both groups. There was a statistical significance in the study group. The average was 4.79 (standard deviation [SD] ± 2.50), with 4.19 (SD ± 1.72) among the children without adenotonsillar hypertrophy, and 6.5 (SD ± 3.40) among the children with adenotonsillar hypertrophy. There was also a statistical significance in the control group. The average was 5.23 (SD ± 2.81), with 4.44 (SD ± 2.2) among the children without adenotonsillar hypertrophy, and 7.87 (SD ± 2.89) among the children with adenotonsillar hypertrophy. Conclusion Adenotonsillar hypertrophy was not associated with sickle cell disease in pre-school children. The subscale of sleep-disordered breathing in the Sleep Disturbance Scale for Children was a useful tool for the diagnostic suspicion of adenotonsillar hypertrophy in children in this age group.

Comparison of two otologic suspensions of ciprofloxacin 2 mg/mL and hydrocortisone 10 mg/mL in the treatment of otitis externa: a multicenter, double-blind, randomized study / Comparação de duas suspensões otológicas de ciprofloxacino 2 mg/mL e hidrocortisona 10 mg/mL no tratamento da otite externa: um estudo multicêntrico, duplo-cego e randomizado

This was Phase III multicenter, double-blind, randomized, comparative safety and efficacy study in parallel groups of subjects, assessing non-inferiority between two commercially available otologic suspensions containing ciprofloxacin 2mg/mL and hydrocortisone 10mg/mL (Otociriax and Cipro HC®) in the treatment of acute diffuse otitis externa. Following screening and informed consent, subjects were randomly allocated into two treatment groups: Group A (treated with Otociriax) and Group B (treated with Cipro HC®). Treatment regimen in both groups was three drops, twice daily for seven days. The primary study endpoint was otitis cure, defined as elimination of pain, edema, and otorrhea. The secondary study endpoint was presence of side effects. Efficacy assessments included presence and intensity of otitis externa manifestations. Safety assessments included vital signs and physical examination, as well as adverse event monitoring. Study data analysis was performed using GraphPad Prism 5.0...

Premalignant laryngeal lesions: twenty-year experience in specialized service.

Introduction Premalignant lesions are considered both a hyperplastic and dysplastic stage of epithelial lesions in the glottic larynx that may or may not progress into an invasive carcinoma. The evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies. Objective The goal of this study was to determine the accuracy of the preoperative exam for diagnosis of premalignant laryngeal lesions and their connection with benign diseases of the vocal folds, as well as to assess their epidemiologic characteristics. Methods This is a retrospective and longitudinal cohort study performed through the review of surgical records of patients who underwent laryngeal microsurgery performed by a single surgeon from 1990 to 2009. Results Preoperative assessment of outpatients was 64.4% accurate. Vocal fold cysts were the most frequently associated benign lesions. The patients who apparently had premalignant lesions represented 10.57% of those who underwent laryngeal microsurgery. Premalignant lesions prevailed in men (69.49%) age from 41 to 50 years (32.20%). Conclusion Although the evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies, about one-third of premalignant lesions are diagnosed just during the laryngeal microsurgery. Cysts were the most prevalent concomitant benign lesion of the vocal folds. Males were more prevalent than females and the predominant age bracket was between 41 and 50 years.

Premalignant Laryngeal Lesions: Twenty-Year Experience in Specialized Service

Introduction Premalignant lesions are considered both a hyperplastic and dysplastic stage of epithelial lesions in the glottic larynx that may or may not progress into an invasive carcinoma. The evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies. Objective The goal of this study was to determine the accuracy of the preoperative exam for diagnosis of premalignant laryngeal lesions and their connection with benign diseases of the vocal folds, as well as to assess their epidemiologic characteristics. Methods This is a retrospective and longitudinal cohort study performed through the review of surgical records of patients who underwent laryngeal microsurgery performed by a single surgeon from 1990 to 2009. Results Preoperative assessment of outpatients was 64.4% accurate. Vocal fold cysts were the most frequently associated benign lesions. The patients who apparently had premalignant lesions represented 10.57% of those who underwent laryngeal microsurgery. Premalignant lesions prevailed in men (69.49%) age from 41 to 50 years (32.20%). Conclusion Although the evolution of laryngoscopic procedures in outpatients has provided better access to important information for safe and easy diagnosis of laryngeal pathologies, about one-third of premalignant lesions are diagnosed just during the laryngeal microsurgery. Cysts were the most prevalent concomitant benign lesion of the vocal folds. Males were more prevalent than females and the predominant age bracket was between 41 and 50 years...

Complicações intracranianas decorrentes de infecções otorrinolaringológicas / Intracranial complications of otorhinological infections

Apesar da redução na incidência de complicações intracranianas decorrentes de infecções otorrinolaringológicas após o advento de antibioticoterapia, estas permanecem como afecções extremamente graves. Os autores fazem uma revisão das complicãções intracranianas, com efeito expansivo, decorrentes de infecções nasossinusais e otológicas. Conclui-se que as complicações intracranianas originárias de infecções otorrinolaringológicas são graves, com alta taxa de mortalidade e sequelas.

Associaçöes técnicas conjugadas para correçäo cirúrgica do ronco e SAOS (periférica) / Technical associations joined to snoring and SAOS (peripheral) surgical corrections

OBJETIVO: Com esta proposta de associaçäo conjunta de técnicas cirúrgicas clássicas objetivamos oferecer de forma mais segura aquilo que cada uma especificamente apresenta de melhor, com a introduçäo da Microscopia Optica em todos os procedimentos. MATERIAL E MÉTODO: Realizamos com critérios bem definidos o topodiagnóstico prático periférico, isolando apenas os classificados como Nível I de Fujita. Associamos três grupos específicos de técnica. Grupo A: LAUP (Kamami) + U.P.F.P. Parcial (Fujita Modificado-FM). Grupo B: LAUP + Criptólise (Krespi) + U.P.F.P. Parcial (Fujita Modificado). Grupo C: LAUP + Microcirurgia Tonsilas (Andréa/Dias) + U.P.F.P. (FM). As indicaçöes cirúrgicas de cada grupo säo para: Grupo A: hipertrofia de úvula + rebaixamento de palato + ausência ou atrofia de tonsilas palatinas (TP). Grupo B: quadro anatômico semelhante ao Grupo A + hipertrofia de TP (grau I e II). Grupo C: hipertrofia de úvula e de TP (grau III)+ redundância faríngea. No período de 38 meses, estamos com 60 casos operados, na proporçäo de: Grupo A: 20, Grupo B: 12 e Grupo C: 28. RESULTADOS: Houve melhora clínica em 46 pacientes (76,67 por cento). Os melhores resultados foram detectados nos Grupos A e C. CONCLUSÄO: A seleçäo em grupos dos pacientes portadores de ronco e SAOS (periférica) do nível I de Fujita, considerando-se parâmetros anátomo-clínicos, oferece-nos mais segurança na escolha adequada dos métodos de abordagem cirúrgica. Portanto, com esta proposta de associaçäo de técnicas, estamos conseguindo melhorar nossos resultados e sugerimos que este esquema seja efetivado em outros serviços

Ameloblastoma de fossa nasal: revisão bibliográfica e relato de dois casos / Nasal ameloblastoma: literature review and report of two cases

O ameloblastoma é um tumor bastante incomum na cavidade nasal. Surge a partir do epitélio odontogênico, podendo estender-se ao seio maxilar, órbitas e base de crânio. Apresentamos dois casos de ameloblastoma em fossa nasal direita, associados a sintomas nasossinusais e seus principais achados, clínicos e cirúrgicos

Pré e pós-operatório em pacientes submetidos a microcirurgias das principais lesões benignas da laringe / Pre and Post-Operative Conditions of Patients Who Underwent Laryngeal Microsurgery for the Main Benign Lesions

As lesões benignas da laringe, embora não sejam consideradas patologias graves, requerem um diagnóstico e tratamento adequados graças ao seu impacto na voz. O objetivo deste estudo foi analisar estatisticamente as principais patologias benignas da laringe e o resultado funcional dos pacientes submetidos ao tratamento cirúrgico. Material e método: O estudo foi realizado com um grupo de 40 pacientes, entre três e 62 anos de idade, com quadro de disfonia crônica. Submeteram-se ao exame ORL de rotina e a videolaringoestroboscopia complementar no pré e pós-operatório. Resultados: Houve um predomínio de pacientes do sexo feminino, sendo os da faixa etária dos 31 aos 40 anos a mais acometida. A rouquidão foi o sintoma mais freqüente; e os cistos, as lesões mais incidentes. Em 15% dos casos, a microcirurgia da laringe serviu para elucidar ou mudar o diagnóstico.

Benign lesions of larynx, although they are not considered serious pathologies, require proper diagnosis and treatment due to their impact on the voice. This study aims at analysing statistically main benign pathologies of larynx and the functional result of pacients submitted to surgical treatment. Material and method: this study was carried out with a group of 40 pacients, aged between three and 62, with record of chronical disphony. They were submitted to routine ORL test and to complementary videolaringoestroboscopy in pre-and post-operating phases. Result: Female sex predominated, being age group 31 to 40 most affected. Hoarseness was the most frequent symptom and cyst the lesion which happened most. In 15% of the cases, larynx microsurgery helped explain or change diagnosis