In-office Laryngeal Procedures: a Modern Perspective for Vocal Fold Interventions

Introduction: The purpose of this article is to discuss in-office laryngeal procedures as an alternative to surgical intervention under general anesthesia. In-office procedures have become more common due to technological advancements. As a result, these approaches are less invasive and more patient-friendly, with increased pain tolerance and reduced procedure time and cost. Methods: We conducted a thematic analysis of published reports regarding the best known and performed in-office laryngeal interventions. Three questions guided our analysis: What laryngological procedures can be performed in the office setting? What are the advantages of in-office laryngology procedures compared to operating room surgical procedures? Why aren't more in-office procedures performed in some Latin American countries? Discussion: Despite being performed more frequently, there is still controversy whether in-office procedures should be performed as often due to the risk of complications. Furthermore, procedures that are done in the office setting are more popular in some countries than in others, even though their benefit has been well demonstrated. This article describes various in-office procedures, including biopsy, vocal fold injections, and laser surgery. We also discuss what factors might contribute to having office-procedures being performed more frequently in some countries than others. Conclusion: Awake interventions offer numerous benefits, including shorter procedure time, reduced costs, and lower patient morbidity. These advantages have significantly transformed the treatment of laryngeal diseases in modern laryngology practice in a global manner.

Introducción: El propósito de este artículo es discutir los procedimientos laríngeos en el consultorio como una alternativa a la intervención quirúrgica bajo anestesia general. Los procedimientos en consultorio se han vuelto más comunes debido a los avances tecnológicos. Como resultado, estos enfoques son menos invasivos y más amigables para el paciente, con mayor tolerancia al dolor y reducción del tiempo y costo del procedimiento. Métodos: Realizamos un análisis temático de los informes publicados sobre las intervenciones laríngeas más conocidas y realizadas. Tres preguntas guiaron nuestro análisis: ¿Qué procedimientos laringológicos se pueden realizar en el consultorio y cuales sin los más frecuentes?, ¿cuáles son las ventajas de los procedimientos laringológicos fuera del quirófano frente a los que se realizan bajo anestesia general?, ¿por qué no se realizan más procedimientos laringológicos en el consultorio en la mayoría de los países en Latinoamérica? Discusión: A pesar de que se realizan con mayor frecuencia, aún existe controversia sobre si los procedimientos en consultorio deben realizarse con tanta frecuencia debido al riesgo de complicaciones. Además, los procedimientos que se realizan en el consultorio son más populares en algunos países que en otros, aunque sus beneficios han sido bien demostrados. Este artículo describe varios procedimientos en el consultorio, incluida la biopsia, las inyecciones de cuerdas vocales y la cirugía con láser. También se discutieron los factores que podrían contribuir a que los procedimientos en el consultorio se realicen con más frecuencia en algunos países que en otros. Conclusión: Las intervenciones con pacientes despiertos ofrecen numerosos beneficios, incluido un tiempo de procedimiento más corto, costos reducidos y una menor morbilidad para el paciente. Estas ventajas han transformado significativamente el tratamiento de las enfermedades laríngeas en la práctica de la laringología moderna a nivel mundial.

Development of a Medical Complexity Score for Pediatric Aerodigestive Patients.

OBJECTIVE: To develop a complexity scoring system to characterize the diverse population served in pediatric aerodigestive clinics and help predict their treatment outcomes. STUDY DESIGN: A 7-point medical complexity score was developed through an iterative group consensus of relative stakeholders to capture the spectrum of comorbidities among the aerodigestive population. One point was assigned for each comorbid diagnosis in the following categories: airway anomaly, neurologic, cardiac, respiratory, gastrointestinal, genetic diagnoses, and prematurity. A retrospective chart review was conducted of patients seen in the aerodigestive clinic who had ≥2 visits between 2017 and 2021. The predictive value of the complexity score for the selected outcome of feeding progression among children with dysphagia was analyzed with univariate and multivariable logistic regression. RESULTS: We analyzed 234 patients with complexity scores assigned, showing a normal distribution (Shapiro Wilk P = .406) of the scores 1-7 (median, 4; mean, 3.50 ± 1.47). In children with dysphagia, there was waning success in the improvement of oral feeding with increasing complexity scores (OR, 0.66; 95% CI, 0.51-0.84; P = .001). Tube-fed children with higher complexity scores were incrementally less likely to achieve full oral diet (OR, 0.60; 95% CI, 0.40-0.89; P = .01). On multivariable analysis, neurologic comorbidity (OR, 0.26; P < .001) and airway malformation (OR, 0.35; P = .01) were associated with a decreased likelihood to improve in oral feeding. CONCLUSIONS: We propose a novel complexity score for the pediatric aerodigestive population that is easy to use, successfully stratifies diverse presentations, and shows promise as a predictive tool to assist in counseling and resource use.

Aldehyde Accumulation in Aged Alcoholic Beer: Addressing Acetaldehyde Impacts on Upper Aerodigestive Tract Cancer Risks.

Aldehydes, particularly acetaldehyde, are carcinogenic molecules and their concentrations in foodstuffs should be controlled to avoid upper aerodigestive tract (UADT) and liver cancers. Highly reactive, acetaldehyde forms DNA and protein adducts, impairing physiological functions and leading to the development of pathological conditions. The consumption of aged beer, outside of the ethanol metabolism, exposes habitual drinkers to this carcinogen, whose concentrations can be over-increased due to post-brewing chemical and biochemical reactions. Storage-related changes are a challenge faced by the brewing industry, impacting volatile compound formation and triggering flavor instability. Aldehydes are among the volatile compounds formed during beer aging, recognized as off-flavor compounds. To track and understand aldehyde formation through multiple pathways during beer storage, consequent changes in flavor but particularly quality losses and harmful compound formation, this systematic review reunited data on volatile compound profiles through gas chromatography analyses from 2011 to 2021. Conditions to avoid flavor instability and successful methods for reducing beer staling, and consequent acetaldehyde accumulation, were raised by exploring the dynamic conversion between free and bound-state aldehydes. Future research should focus on implementing sensory analyses to investigate whether adding aldehyde-binding agents, e.g., cysteine and bisulfite, would contribute to consumer acceptance, restore beer flavor, and minimize acetaldehyde-related health damage.

Impact of Coronavirus Disease 2019 on the Pediatric Population with Aerodigestive Disease.

OBJECTIVE: To determine the impact of the coronavirus disease 2019 (COVID-19) quarantine on baseline health, medication use, health anxiety, and healthcare use in pediatric patients with aerodigestive disease and to evaluate for associations of commonly prescribed medications with the risk of COVID-19 illness. STUDY DESIGN: Prospective study of patients presenting in person to pediatric neurogastroenterology clinics between July 2020 and March 2021. RESULTS: Of 202 recruited patients, 71.3% were seen in the aerodigestive diseases center and 28.7% in the functional abdominal pain (FAP)/motility clinic. Of all patients, 25.1% reported improved overall health during quarantine; patients with aerodigestive disease (35.3%) reported higher rates of improved overall health compared with patients with FAP/motility disorders (3.6%, P = .0001). Patients with aerodigestive disease had fewer airway symptoms (P < .05) and less medication use during quarantine (inhaled steroids, P < .05 and albuterol, P < .05). Despite objective improvement, there was significant health-related anxiety, with greater anxiety scores reported during and at the end of quarantine (P < .05), with no difference between patient groups (P > .11). Patients continued to access healthcare during quarantine. In total, 28.7% of patients were seen in the emergency department (patients with FAP more than patients with aerodigestive disease, P = .02), and 19.8% were hospitalized. COVID-19 testing was performed in 58.4% of patients and 2.0% (n = 4) of the entire cohort tested positive. CONCLUSIONS: Patients with aerodigestive disease show improvement of airway symptoms and decreased use of medications during the pandemic, despite increased health-related anxiety. Despite complexities of accessing care due to the widespread lockdown, all patient groups continued to access healthcare.

Anaplastic extraosseous (extramedullary) plasmacytoma in the right nostril.

Extraosseous (extramedullary) plasmacytomas are rare plasma cell neoplasms that can result in an erroneous and/or delayed diagnosis as often they are not considered in the differential diagnosis due to their rarity. Furthermore, the anaplastic type is one of the most difficult to recognize in biopsies. We report the case of a patient with an extraosseous plasmacytoma occluded in the right nostril. Its prompt and accurate diagnosis resulted in early treatment and a good outcome, despite the tumour being anaplastic with the risk of progressing into a plasma cell myeloma. The patient shows no recurrence or disease progression after 10 years of follow-up. Our case highlights the clinical and pathological characteristics of this rare disorder that should be considered in order to improve diagnostic criteria and thus early treatment. We also reviewed the pertinent literature.

Experiencia de una unidad aerodigestiva pediátrica en Latinoamérica / Case management experience in a pediatric aerodigestive unit in Latin-America

Introducción: las unidades aerodigestivas proveen un cuidado complejo coordinado a pacientes pediátricos con condiciones congé-nitas o adquiridas de grados variables que afectan la vía respiratoria, el tracto gastrointestinal, la deglución y el crecimiento. La primera unidad aerodigestiva de Guatemala fue fundada en el año 2018 en un hospital privado, y por ser la única de su tipo en el país, no se tenían datos locales al respecto. Pacientes y métodos: se llevó a cabo un estudio retrospectivo cuantitativo; se analizó el total de casos reportados en la unidad aerodigestiva pediátrica desde el 1 de enero de 2018 hasta el 31 de mayo de 2019, se contó con un total de 69 casos. Resultados: el 79% de los pacientes presentaron más de una patología de diferente etiología. La indicación principal para realizar la triple endoscopia fue tos crónica. Los diagnósticos encontrados como comorbilidades con mayor frecuencia fueron bronquitis bacteriana recurrente y enfermedad por reflujo gastroesofágico. Conclusión: la triple endoscopia es útil tanto en el diagnóstico como en la toma de decisiones en el manejo de las patologías aerodigestivas pediátricas de alta complejidad. Es una herramienta útil que pone en evidencia que múltiples etiologías pueden contribuir a síntomas crónicos de la vía aérea, y que estas pueden pasarse por alto si se realiza un solo procedimiento.

Introduction: Aerodigestive programs provide coordinated interdisciplinary care to pediatric patients with complex congenital or ac-quired conditions affecting breathing, the gastrointestinal tract, swallowing, and growth. The first aerodigestive program in Guatemala was founded in the year 2018 in a private hospital and, since it's one of its kind in the country, there was no local data reported. Patients and methods: A total of 69 cases of children who were evaluated at the aerodigestive program from January 1st, 2018 to May 31st, 2019, were retrospectively analyzed in a quantitative study. Results:79% of patients presented more than one pathology from different etio-logy. Overall the main indication for the triple scope was chronic cough. The findings reported that recurrent bacterial bronchitis and gastroesophageal reflux were the most common comorbidities present in the same patient. Conclusion:The triple scope procedure is a useful investigative tool for patients with recalcitrant aero-digestive complaints. In particular, the triple scope can yield more than one specialty-specific diagnosis normally missed by one procedure.

Prevention of upper aerodigestive tract cancer through active search strategies and use of equipped propaedeutics / Prevenção ao câncer do trato aerodigestivo superior através das estratégias de buscaativa e uso da propedêutica armada

Abstract Introduction Upper aerodigestive tract cancer is among the most frequent malignancies and has epidemiological importance worldwide. Most cases are already advanced at the diagnosis, with a strong negative impact on survival and high cost to the government. Campaigns directed against these cancers have often failed in Brazil. Objective To evaluate the effectiveness of screening for upper aerodigestive tract cancers, using active search strategies and the use of equipped propaedeutics. Methods A cross-sectional, prospective, descriptive, analytical and exploratory study, since its objectives are based on the visualization of cancerous lesions in a sample consisting of individuals with risk factors, aiming to expand the necessary knowledge for cancer detection, aiming at secondary prevention of the oral cavity, oropharynx, larynx and hypopharynx cancer. Results A total of 16.7% of precancerous lesions and 0.5% of cancer lesions located in the upper aerodigestive tract were clinically visualized. Conclusion The method was effective in the identification of precancerous lesions for the purpose of secondary prevention, but equally important against upper aerodigestive tract cancer, since in the present study the chance of finding the latter was increased by 22.7, showing it is an alternative for future campaigns against the disease.

Resumo Introdução O câncer do trato aerodigestivo superior configura-se entre os mais frequentes e apresenta-se com importância epidemiológica no mundo. A maior parte apresenta-se avançada ao diagnóstico, com forte impacto negativo na sobrevida e elevado custo ao erário. As campanhas feitas contra esses cânceres têm frequentemente falhado no Brasil. Objetivo Avaliar a efetividade do rastreamento para lesões cancerizáveis do trato aerodigestivo superior com estratégias de busca ativa e uso da propedêutica armada. Método Estudo transversal, prospectivo, descritivo, analítico e exploratório, uma vez que os seus objetivos se alicerçam na visualização das lesões cancerizáveis numa amostra composta por indivíduos com fatores de risco, de forma a aprofundar o conhecimento necessário para a sua detecção, visando à prevenção secundária do câncer da cavidade oral, orofaringe, laringe e hipofaringe. Resultado Foram visualizadas clinicamente 16,7% lesões cancerizáveis e 0,5% cânceres de localização no trato aerodigestivo superior. Conclusão O método mostrou-se efetivo na identificação de lesões cancerizáveis com intuito de prevenção secundária, mas igualmente importante contra o câncer do trato aerodigestivo superior, uma vez que neste presente estudo multiplicou-se a chance do encontro desse por 22,7; apresenta-se como opção para futuras campanhas contra a doença.

Prevention of upper aerodigestive tract cancer through active search strategies and use of equipped propaedeutics.

INTRODUCTION: Upper aerodigestive tract cancer is among the most frequent malignancies and has epidemiological importance worldwide. Most cases are already advanced at the diagnosis, with a strong negative impact on survival and high cost to the government. Campaigns directed against these cancers have often failed in Brazil. OBJECTIVE: To evaluate the effectiveness of screening for upper aerodigestive tract cancers, using active search strategies and the use of equipped propaedeutics. METHODS: A cross-sectional, prospective, descriptive, analytical and exploratory study, since its objectives are based on the visualization of cancerous lesions in a sample consisting of individuals with risk factors, aiming to expand the necessary knowledge for cancer detection, aiming at secondary prevention of the oral cavity, oropharynx, larynx and hypopharynx cancer. RESULTS: A total of 16.7% of precancerous lesions and 0.5% of cancer lesions located in the upper aerodigestive tract were clinically visualized. CONCLUSION: The method was effective in the identification of precancerous lesions for the purpose of secondary prevention, but equally important against upper aerodigestive tract cancer, since in the present study the chance of finding the latter was increased by 22.7, showing it is an alternative for future campaigns against the disease.

Caracterización clinicoterapéutica de niños y adolescentes con cuerpos extraños aerodigestivos / Clinical therapeutical characterization of children and adolescents with aerodigestive foreign bodies

Se realizó una investigación descriptiva, observacional y longitudinal en el Servicio de Otorrinolaringología del Hospital Infantil Sur Dr. Antonio María Béguez César de Santiago de Cuba, que abarcó desde enero de 2015 hasta diciembre de 2017, con el objetivo de caracterizar a los 341 niños y adolescentes atendidos en el cuerpo de guardia por presentar cuerpos extraños aerodigestivos. En la casuística primaron el grupo etario de menores de 5 años (62,5 por ciento), el sexo masculino (52,8 por ciento), la procedencia urbana (65,1 por ciento), los cuerpos extraños orgánicos (67,4 por ciento), la fosa nasal como localización anatómica, la obstrucción nasal como síntoma principal y la extracción manual a través de rinoscopia anterior. En 11,1 por ciento de los exámenes radiográficos se observó el cuerpo extraño. Solo falleció un paciente durante el estudio

A descriptive, observational and longitudinal investigation in the Otolaryngology Service of Dr. Antonio María Béguez César Southern Children Hospital was carried out in Santiago de Cuba from January, 2015 to December, 2017, aimed at characterizing the 341 children and adolescents assisted in the emergency room because they presented aerodigestive foreign bodies. In the case material There was a prevalence of under 5 age group (62.5 percent), male sex (52.8 percent), urban origin (65.1 percent), organic foreign bodies (67.4 percent), the nasal cavity as anatomical localization, nasal obstruction as main symptom and the manual extraction through previous rhinoscopy. In 11.1 percent of the radiographic exams the foreign body was observed. Just a patient died during the study

Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation.

OBJECTIVE: To test the hypothesis that oral feeding at first neonatal intensive care unit discharge is associated with less neurodevelopmental impairment and better feeding milestones compared with discharge with a gastrostomy tube (G-tube). STUDY DESIGN: We studied outcomes for a retrospective cohort of 194 neonates <37 weeks' gestation referred for evaluation and management of feeding difficulties between July 2006 and July 2012. Discharge milestones, length of hospitalization, and Bayley Scales of Infant Development-Third Edition scores at 18-24 months were examined. χ2, Mann-Whitney U, or t tests and multivariable logistic regression models were used. RESULTS: A total of 60% (n = 117) of infants were discharged on oral feedings; of these, 96% remained oral-fed at 1 year. The remaining 40% (n = 77) were discharged on G-tube feedings; of these, 31 (40%) remained G-tube dependent, 17 (22%) became oral-fed, and 29 (38%) were on oral and G-tube feedings at 1 year. Infants discharged on a G-tube had lower cognitive (P <.01), communication (P = .03), and motor (P <.01) composite scores. The presence of a G-tube, younger gestation, bronchopulmonary dysplasia, or intraventricular hemorrhage was associated significantly with neurodevelopmental delay. CONCLUSIONS: For infants referred for feeding concerns, G-tube evaluations, and feeding management, the majority did not require a G-tube. Full oral feeding at first neonatal intensive care unit discharge was associated with superior feeding milestones and less long-term neurodevelopmental impairment, relative to full or partial G-tube feeding. Evaluation and feeding management before and after G-tube placement may improve long-term feeding and neurodevelopmental outcomes.

Effect of Severity of Esophageal Acidification on Sleep vs Wake Periods in Infants Presenting with Brief Resolved Unexplained Events.

OBJECTIVES: To describe the pattern of gastroesophageal reflux (GER) events in wake and sleep states with increasing acid reflux index (ARI) in neonates and to test the hypothesis that GER-related symptoms are frequent in ARI >7% in wake state. STUDY DESIGN: Infants underwent 24-hour pH-impedance studies with 6-hour concurrent video-polysomnography studies. Data were stratified based on the 24-hour ARI (% duration that esophageal pH is <4) into ARI < 3% (normal), ARI 3 ≥ to ≤7% (intermediate), and ARI >7% (abnormal). GER frequency, clearance mechanisms, and symptoms were distinguished during wake state and sleep state. RESULTS: Total wake and sleep duration was similar (P ≥ .2) in all ARI groups. Acidic events were frequent with increasing ARI in wake state vs sleep state (P ≤ .03). The symptom index increased with increasing ARI (P ≤ .02) in both wake state and sleep state. Acid clearance time increased with increasing ARI in wake state (P ≤ .02). In ARI > 7% vs ARI ≤ 7%, frequency of acidic GER events was higher (P ≤ .02) in wake state and sleep state; proximal migration of acid (P = .03) and acid clearance time were higher in wake state (P = .0005) only. Symptom index was higher in ARI >7% vs ARI ≤ 7% in wake state (P < .0001), comparable in normal vs intermediate (P = .4), and higher in abnormal vs intermediate (P = .0004) groups. CONCLUSIONS: Severe esophageal acid exposure (ARI >7%) is associated with increased reflux-associated symptoms in wake state. Sleep state appears to be protective regardless of ARI, likely because of greater chemosensory thresholds. Attention to posture and movements during wake state can be helpful. Scrutiny for non-GER etiologies should occur for infants presenting with life-threatening symptoms.

Oropharyngeal cancer: an emergent disease? / Cáncer de orofaringe: ¿una enfermedad emergente?

Abstract Oropharyngeal cancer incidence has recently increased, thereby attracting public attention. Akin to other malignancies of the upper aerodigestive tract, it has been attributed to the carcinogenic effects of tobacco and alcohol use. However, recent evidence shows that a substantial increase in the disease is attributable to the effects of human papillomavirus (HPV). Marked progress has been made in relation to the knowledge of molecular and genetic mechanisms involved in the genesis and progression of these cancers. This has led to the development of new and promising therapies of a more specific and less toxic nature that have prolonged life and improved its quality. However, these therapies have failed to significantly increase the proportion of patients who are cured. To decrease the mortality associated with these neoplasms, it is necessary to adopt public health measures aimed at prevention and early diagnosis.

Resumen El cáncer de orofarínge recientemente ha incrementado su incidencia, por lo que ha atraído la atención pública. Como en otras neoplasias malignas de las vías aerodigestivas superiores se atribuye a los efectos carcinogénicos del tabaco y alcohol, sin embargo evidencia reciente señala un incremento substancial atribuible a los efectos del virus del papiloma humano. Mucho se ha avanzado en relación a los conocimientos de los mecanismos moleculares y genéticos implicados en la génesis y progresión de estas neoplasias, lo que ha conducido al desarrollo de nuevas y prometedoras terapias, mas especificas y menos tóxicas, que han prolongado la vida y mejorado su calidad, pero no han logrado incrementar significativamente la proporción de pacientes curados. Si se desea abatir la mortalidad por estas neoplasias es necesario emprender medidas de salud publica dirigidas a su prevención y diagnóstico temprano.

Neuroblastoma congénito cervical en recién nacido: presentación de un caso / Cervical congenital neuroblastome in a newborn: presentation of a case

Los neuroblastomas congénitos cervicales son muy raros. Esta forma de cáncer infantil se forma en el tejido nervioso y por lo general suele presentarse con mayor frecuencia en las glándulas suprarrenales. Aunque puede aparecer prenatalmente, es más frecuente que se diagnostique en el primer año de vida. Son tumores agresivos con una alta mortalidad. En casi todos los casos (50-60 por ciento de los mismos), para cuando se detecta un neuroblastoma, ya se ha diseminado a otras partes del cuerpo. Se presenta un caso de recién nacido que las primeras 24 horas, muestra una historia de compromiso de vías respiratorias y digestivas asociado a una masa cervical sólida y parálisis de XII par craneal.

Cervical congenital neuroblastomes are very rare. This form of infantile cancer forms in the nervous tissue and generally it uses to appear more frequently in the suprarenal glands. Although they may appear prenatally, they are more frequent in the first year after birth. They are aggressive tumors with a high mortality. In almost all the cases (50/60 percent of them), when a neuroblastome is detected, it is already disseminated to other parts of the body. We present the case of a newborn who shows a history of respiratory and digestive tracts compromise associated to a solid cervical mass and XII cranial par paralysis during the first 24 hours after birth.

Upper aerodigesiive tract neoplasm (uatn): an update / Neoplasia dl traacto aerodigestivo superior (uatn): una actualización

Introduction: according to the review carried out, while the majority of head and neck cancerous lesions are cutaneous and thyroid are associated with low lethality, there are others that are developed in the upper aerodigestive tract and are usually squamous cell carcinomas, which are usually diagnosed in advanced stages and are associated with very poor survival and functional prognosis. In Colombia, squamous cell carcinoma is the neoplasm of greatest occurrence in head and neck; it becomes evident as a detectable premalignant lesion and it registers between 100 and 120 new cases by year according to the Colombian National Cancer Institute in 1998. This update is important because of the new findings on the disease natural history and the characteristics of each location in the upper aerodigestive tract. Methodology: the relevant biomedical literature was searched in several databases such as Medline, Proquest, Science Direct, Ovid and Cochrane, as well as available information in web sites of national scientific journals and Organizations.

Introducción: De acuerdo a la revisión llevada a cabo, mientras que la mayoría de las lesiones cancerosas de cabeza y cuello son cutáneas y asociadas con la tiroides y de baja letalidad, hay otras que se desarrollan en el tracto aerodigestivo superior y usualmente son carcinomas de células escamosas, las cuales son usualmente diagnosticadas en estados avanzados y asociadas con una muy pobre supervivencia y pronóstico funcional. En Colombia, el carcinoma de células escamosas es la neoplasia de mayor ocurrencia en la cabeza y el cuello, esta se manifiesta como una lesión premaligna detectable y registra entre 100 a 120 casos nuevos al año en Colombia de accauerdo al Instituto Nacional de Cancerología en 1998. Esta actualización es importante debido a los nuevos hallazgos en la historia natural de la enfermedad y a las características de cada localización en el tracto aerodigestivo superior. Metodología: Fue buscada la literatura biomédica relevante en algunas bases de datos tales como Medline, Proquest, Science Direct, Ovid y Cochrane, así como también la información disponible en sitios Web de organizaciones y revistas científicas nacionales.

Penfigóide cicatricial no trato aerodigestivo superior: relato de dois casos / Cicatricial pemphygoid in the upper aerodigestive tract: report of two cases

Penfigóide Cicatricial (Penfigóide Cicatricial de Membrana Mucosa) é uma doença auto-imune inflamatória crônica caracterizada pela presença de bolhas subepiteliais em membranas mucosas e, ocasionalmente na pele. Pode haver acometimento oral, nasal, faríngeo, laríngeo, ocular, esofágico, anogenital e de pele, predominantemente em pacientes na quinta e sexta décadas de vida. O tratamento preconizado inclui corticóides sistêmicos e agentes imunossupressores. Descrevemos neste trabalho dois casos com a doença em atividade, sendo que um evoluiu com complicação séptica pelo uso de imunossupressor e outro que apresentou estenose supraglótica exigindo traqueotomia.

Cicatricial pemphygoid (mucous membrane cicatricial pemphygoid) is a chronic autoimmune inflammatory disease characterized by subepithelial bubbles in mucous membranes and, occasionally on the skin. It may affect the mouth, the nose, pharynx, larynx, the eyes, esophagus, anus, genitals and skin; especially affecting patients between fifty and sixty years of life. Treatment includes systemic steroids and immunosuppressive agents. In the present paper we describe two cases with the active disease, and one of them had sepsis because of using immunosuppressive agents and another that presented supraglottic stenosis requiring tracheostomy.