Asystole during Suspension Laryngoscopy: Case Report, Literature Review, and Prophylactic Strategies.

Transoral laryngeal procedures are considered minimally invasive but may trigger important complications such as severe bradycardia and even asystole mediated by vagal reflex. The literature on this subject is rare. This article aims to review the literature, explain associated mechanisms, establish prophylactic strategies, and highlight the importance of intraoperative safety protocols.

Pre and post-operative otorhinolaryngology surgery care in patients with glycogen storage disease type 1 / Cuidados pré e pós-operatórios em cirurgia otorrinolaringológica em pacientes com glicogenose tipo 1b

ABSTRACT Objective: To discuss aspects of pre and post-operative otorhinolaryngology surgery in patients with glycogen storage disease type 1b. Case description: Description of three clinical cases with probable glycogen storage disease type 1b who underwent otorhinolaryngology surgery, showing the importance of multidisciplinary interaction to avoid episodes of hypoglycemia. Comments: Patients with glycogen storage disease type 1b present recurrent infections, including the otorhinolaryngology affections. When there is an indication for surgical treatment, the caloric intake should be carefully followed in order to prevent hypoglycemia. The way to ensure this is to perform the pre and postoperative period in the hospital ward. In the postoperative period, it is important to make a slow transition between the intravenous and oral routes and not suspend the infusion of glucose during the surgical procedure. The cases illustrate the need for the interaction of the otorhinolaryngologic surgeon with the anesthesiologist, the pediatrician and the gastro-pediatrician in the management of these patients, avoiding hypoglycemic episodes.

RESUMO Objetivo: Discutir aspectos de pré e pós-operatório de cirurgia otorrinolaringológica em pacientes com glicogenose tipo 1b. Descrição do caso: Descrição de três casos clínicos com provável glicogenose tipo 1b, que se submeteram à cirurgia otorrinolaringológica, mostrando a importância da interação multidisciplinar para evitar os episódios de hipoglicemia. Comentários: Pacientes com glicogenose tipo 1b apresentam infecções de repetição, incluindo as otorrinolaringológicas. Quando há indicação de tratamento cirúrgico, deve-se observar a garantia de aporte calórico para evitar hipoglicemia. A maneira de fazer isso é efetuar o pré e pós-operatório em enfermaria, tomando-se o cuidado, no pós-operatório, de realizar uma transição lenta entre a via endovenosa e a via oral e de não suspender a infusão de glicose durante o procedimento cirúrgico. Os casos ilustram a necessidade da interação do otorrinolaringologista com o anestesista, o pediatra e o gastropediatra na condução desses pacientes para que não desenvolvam hipoglicemia.

PRE AND POST-OPERATIVE OTORHINOLARYNGOLOGY SURGERY CARE IN PATIENTS WITH GLYCOGEN STORAGE DISEASE TYPE 1.

OBJECTIVE: To discuss aspects of pre and post-operative otorhinolaryngology surgery in patients with glycogen storage disease type 1b. CASE DESCRIPTION: Description of three clinical cases with probable glycogen storage disease type 1b who underwent otorhinolaryngology surgery, showing the importance of multidisciplinary interaction to avoid episodes of hypoglycemia. COMMENTS: Patients with glycogen storage disease type 1b present recurrent infections, including the otorhinolaryngology affections. When there is an indication for surgical treatment, the caloric intake should be carefully followed in order to prevent hypoglycemia. The way to ensure this is to perform the pre and postoperative period in the hospital ward. In the postoperative period, it is important to make a slow transition between the intravenous and oral routes and not suspend the infusion of glucose during the surgical procedure. The cases illustrate the need for the interaction of the otorhinolaryngologic surgeon with the anesthesiologist, the pediatrician and the gastro-pediatrician in the management of these patients, avoiding hypoglycemic episodes.

Methods of Fat Tissue Processing for Human Vocal Fold Injection: A Systematic Review.

OBJECTIVES: We analyzed different methods used to process autologous fat tissues for vocal fold injection (VFI). VFI is a safe procedure that preserves the folds' original elasticity and vibration properties and rarely triggers foreign-body reactions, but is often a temporary treatment due to fat reabsorption. To avoid it, selecting a technique that provides as many viable implantable adipocytes as possible is mandatory. STUDY DESIGN: This is a systematic review. METHODS: Data were collected from PubMed, Embase, Ovid, and Cochrane Library. Authors systematically reviewed databases for papers on autologous fat tissue processing methods involving human injections in vocal folds and vocalization outcomes that evolved the acoustic analysis of the voice before and after the surgical procedure, independently of the follow-up time. RESULTS: Nine out of the 517 articles met selection criteria for analysis. No standardized technique was found. CONCLUSION: There is no standardized technique for processing fat tissue for vocal fold injection. Further research is needed to point out the best available technique.

Scanning electron microscopy of the tongue, pharynx, and larynx of rats exposed to cigarette smoke.

OBJECTIVE: To examine, by using scanning electron microscopy, the surface of the tongue, pharynx, and larynx of animals exposed to tobacco. STUDY DESIGN: Experimental study. METHODS: Twenty rats were allocated to two groups: group I, control group: 10 rats not exposed to any inhaling pollutant and group II, tobacco group: 10 rats exposed to smoke from 10 cigarettes twice a day for 260 days. Animals of both groups had no restriction of food or water. After those 260 days, their aerodigestive segment was removed, and fragments of their tongue, hypopharynx, and right vocal fold were immersed in 2.5% glutaraldehyde and prepared for scanning electron microscopy. RESULTS: The filiform tongue papillae of the tobacco group were irregularly displayed, flattened, and adhered to each other. The hypopharynx mucosa was highly irregular, thickened, rough and had increased superficial peeling. The mucosa of the vocal folds had deep furrows surrounding the cells. These alterations were not identified for the control group. CONCLUSION: Several changes were recorded for the tongue, pharynx, and larynx of tobacco group animals, confirming the harmful effects of smoking to the respiratory and digestive epithelium.

Tonsilar metastases of melanoma in an older person.

We presented a rare case of metastasis of melanoma in palatine tonsils alerting healthcare professionals to this diagnose in black oral lesions.

Histological and immunohistochemical study of the expression of p53 and ki-67 proteins in the mucosa of the tongue, pharynx and larynx of rats exposed to cigarette smoke.

INTRODUCTION: Head and neck cancers are linked to smoking. The most affected sites are the oral cavity, pharynx and larynx. Experimental studies show epithelial lesions caused by cigarette smoke. OBJECTIVES: To investigate in rats the effects of acute cigarette smoke exposure on the mucosa of the tongue, pharynx and larynx. MATERIAL AND METHOD: Wistar rats were allocated into two groups of 20 animals: CG (control) receiving food and water ad libitum and TG (Tobacco) exposed to the smoke of 40 cigarettes/day for 60 days. Biopsy of their tongues, pharynxes and larynxes were subjected to histopathological, histomorphometric and immunohistochemical studies of protein p53 and ki-67. RESULT: The histological analysis of tongue from the Tobacco group revealed epithelial hyperplasia (90%), basal cell hyperplasia (95%) and mild to moderate dysplasia (85%). In pharynx showed basal cell hyperplasia (85%), dysplasia (25%) and vascular congestion (95%). In larynx showed basal cell hyperplasia (70%), epithelial hyperplasia (55%), congestion (100%) and inflammatory infiltrate (25%). Morphometric analysis revealed that keratin layer thickness was greater in the tobacco group. P53 immunoexpression was negative in both groups. Ki-67 immunoexpression was positive in basal cell nuclei but in parabasal cell nuclei it was positive only in the Tobacco group. CONCLUSIONS: The exposure of animals to cigarette smoke for 60 days resulted in benign lesions. The duration of exposure was not enough to cause the development cancer, as confirmed by the negative expression of p53 protein in all slides examined. Analysis of ki-67 expression showed intense epithelial proliferation in response to damage.

Ambulatory blood pressure monitoring in children with obstructive sleep apnea and primary snoring.

OBJECTIVE: To evaluate the systemic blood pressure (BP) during daytime and nighttime in children with sleep breathing disorders (SBD) and compare parameters of BP in children with diagnosis of obstructive sleep apnea syndrome (OSA) to those one with primary snoring (PS). METHODS: Children, both genders, aged from 8 to 12 years, with symptoms of SBD realized an overnight polysomnography followed by a 24h recording of ambulatory BP. RESULTS: All subjects presented with a history of snoring 7 nights per week. Children who have apnea/hipoapnea index ≥ four or a apnea index ≥ one presented a mean BP of 93±7mmHg and 85±9mmHg diurnal and nocturnal respectively whereas children who have a apnea/hipoapnea < four or a apnea index < one presented 90±7mmHg and 77±2mmHg. Eight children out of fourteen, from OSA group, lost the physiologic nocturnal dipping of the blood pressure. Among OSA children 57% were considered non-dippers. Two (16%) have presented absence of nocturnal dipping among children with primary snoring. The possibility of OSA children loosing physiologic blood pressure dipping was 6.66 higher than the possibilities of patients from PS group. DISCUSSION: Our results indicate that children with sleep apnea syndrome exhibit a higher 24h blood pressure when compared with those of primary snoring in form of decreased degree of nocturnal dipping and increased levels of diastolic and mean blood pressure, according to previous studies in literature. OSA in children seems to be associated to the development of hypertension or other cardiovascular disease.

Effects to exposure of tobacco smoke and alcohol on the tongue and pharynx of rats.

AIM: To study in rats the effects of exposure to tobacco and alcohol on the mucosa of the tongue and pharynx. MATERIAL AND METHODS: Forty adult Wistar rats were allocated into four groups of 10 animals each: GI (control), food and water "ad libitum"; GII (alcohol), 30% of ethanol diluted in drinking water and food "ad libitum"; GIII (tobacco), exposure to the smoke of 10 cigarettes/day, food and water "ad libitum"; GIV (alcohol and tobacco), simultaneous exposure to both agents. After 260 days, the animals were sacrificed. Tongue and pharynx were removed for histopathological analysis. RESULTS: GI had the lowest tongue and pharynx histological scores. In GII, GIII, and GIV tongue samples revealed: apical cell hyperplasia (GII: 60%, GIII: 30%, GIV: 20%), basal cell hyperplasia (GII: 60%, GIII: 40%), hyperkeratosis (GII: 70%, GIII: 30%, GIV: 30%), dysplasia (GII: 60%, GIII: 60%, GIV: 50%), and apoptosis (GII: 60%, GIII: 40%, GIV: 60%). Pharynx samples revealed: apical cell hyperplasia (GII: 40%, GIII: 30%, GIV: 70%), basal cell hyperplasia (GII: 30%, GIII: 40%, GIV: 40%), hyperkeratosis (GII: 50%, GIII: 80%, GIV: 40%), and dysplasia (GII: 50%, GIII: 80%, GIV: 50%). Carcinoma in situ was detected in both sites. CONCLUSIONS: Alcohol and tobacco led to significant tongue and pharyngeal lesions that ranged from benign events to severe dysplasia. These findings confirm the deleterious effects of alcohol and tobacco on the airway mucosa.

Avaliação da enurese noturna em crianças com distúrbios respiratórios obstrutivos (DRO) durante o sono, antes e após adenotonsilectomia / Nocturnal enuresis in children with obstructive breathing disorders during sleep, before and after adenotonsilectomy

Introdução: Distúrbios respiratórios obstrutivos (DRO) são frequentes em crianças e têm como sua principal causa a hipertrofia das tonsilas. A enurese noturna tem sido associada aos DRO, causando assim importante impacto psicossocial. Objetivo: Avaliar a associação entre enurese e DRO em crianças e sua possível melhora após adenoidectomia e/ou tonsilectomia. Métodos: Foram estudadas 138 crianças do Ambulatório de Distúrbios do Sono, com idade entre 5 e 12 anos, com indicação de adeno e/ou tonsilectomia por DRO. Foram analisadas variáveis como: sexo, idade e presença de enurese. As crianças foram reavaliadas três a seis meses após o tratamento cirúrgico. Resultado: Dentre as 138 crianças, 31 (22,5%) apresentavam enurese noturna. Houve predomínio na faixa etária de cinco a sete anos, com distribuição igual entre os gêneros. Houve melhora da enurese em 21 (67,7%) dos pacientes após o procedimento cirúrgico, em sete (70%) das dez crianças nas quais persistiu a enurese, também houve persistência dos roncos. Conclusão: A enurese noturna é frequente em crianças com DRO e pode ter melhora após tratamento da causa da obstrução respiratória, sugerindo interação entre SAOS e enurese noturna.