Abrão Rapoport

End results of a prospective trial on elective lateral neck dissection vs type III modified radical neck dissection in the management of supraglottic and transglottic carcinomas

Either modified type III radical neck dissection (MRND) or lateral neck dissections (LNDs) are considered valid treatments for patients with laryngeal carcinoma with clinically negative neck findings (N0). The object of this prospective study was to compare complications, neck recurrences, and survival results of elective MRND and LND on the management of laryngeal cancer patients.

Photodynamic Therapy for Root Canals Infected with Enterococcus faecalis

OBJECTIVE The aim of this study was to investigate the effects of photodynamic therapy (PDT) on endodontic pathogens by evaluating the decrease in numbers of Enterococcus faecalis colonies in the canals of extracted human teeth. BACKGROUND DATA Failure in endodontics is usually related to inadequate cleaning and disinfection of the root canal system. This is due to the establishment of microorganisms in areas where the instruments and chemical agents used during root canal preparation cannot eliminate them. PDT is a complementary therapeutic method that could be used to eliminate these remaining bacteria. PDT is a process in which radiation acts on a dye that is applied to the target organism, resulting in bacterial death. MATERIALS AND METHODS Forty-six uniradicular teeth had their canals contaminated with bacteria and were incubated for 48 h at 35 degrees C. After that, the teeth were divided into a control group (CG) and a test group (TG). The 23 CG teeth did not undergo any intervention, whereas in the TG the teeth received a solution of 0.0125% toluidine blue for 5 min followed by irradiation using a 50-mW diode laser (Ga-Al-As) at a wavelength of 660 nm. Bacterial samples were taken before and after irradiation. In each of the samples, the number of colony-forming units (CFU) was counted. RESULTS The mean decrease in CFU was 99.9% in the TG, whereas in the CG an increase of 2.6% was observed. CONCLUSION PDT was effective as a bactericidal agent in Enterococcus faecalis-contaminated root canals.

Epidemiologia do traumatismo da coluna vertebral

OBJETIVO: Avaliacao epidemiologica retrospectiva de 100 casos de traumatismo da coluna vertebral. METODO: Estudo transversal de dados colhidos por levantamento de prontuario, segundo protocolo de decodificacao local. RESULTADOS: Predominio etario de 20 a 40 anos em 64% dos casos; sexo masculino em 86%; segmento toracolombar mais comumente atingido 64% e 36% para o segmento cervical; principais causas foram as quedas em 40%, seguidas de acidentes automobilisticos em 25% e quedas da laje 23%. A prevalencia dos ferimentos por arma de fogo foi de 7%, mergulho em aguas rasas 3% e agressoes 2%. Houve analise complementar com cruzamentos entre idade, sexo, causa e segmento da coluna vertebral acometido, observando que o segmento cervical teve grande predominio nas mulheres em relacao aos homens em 85,7% X 14,3%. CONCLUSAO: O traumatismo da coluna vertebral ocorreu predominantemente em homens entre 20 e 40 anos e o segmento cervical foi o mais acometido nas mulheres em relacao aos homens na proporcao de 6:1.

Use of Allogeneic Bone Graft in Maxillary Reconstruction for Installation of Dental Implants

The aim of this study is to evaluate the efficacy of the application of allogenous bone at the maxillomandibular reconstructions for future rehabilitation with dental implants. The patients were submitted to reconstruction of maxilla, using allogeneic bone grafts, in 3 different techniques: onlay grafts for lateral ridge augmentation, onlay and particulate bone for sinus lift grafting, and particulate alone for sinus lift grafts. Clinical and radiographic control was done at the postoperative phase for at least 8 months, until the patient could be submitted to the installation of dental implants. The results showed success in the majority of the cases, and dental implants could be installed. This can be considered an excellent alternative when compared with the use of autogenous grafts; because handling is easier, there is a great amount of material available and a possibility of using local anesthesia, and consequently there is a reduction of patient morbidity.

Sternocleidomastoid Muscle Flap Preventing Frey Syndrome following Parotidectomy

Frey syndrome is one of the potential sequelae of parotidectomy. Various medical and surgical treatments have been used in an attempt to avoid this embarrassing condition. Recently, interposing barriers between the overlying skin flap and the parotid bed, such as the sternocleidomastoid muscle (SCM) flap, have been used to prevent this condition. The purpose of this study was to evaluate the impact of using this flap on Frey syndrome. A series of 138 patients who underwent subtotal or total parotidectomy from January 1995 to December 2001 were divided into two groups. One group had an SCM flap reconstruction (n = 24), and the other group did not (n = 19). A subjective clinical questionnaire and the objective Minor’s starch iodine test were used to evaluate the incidence of this syndrome. The postoperative period varied from 12 to 90 months. The frequency exact test of Fisher and the nonparametric test of Mann-Whitney were applied. The association with the absence of sweating and the presence of the SCM flap was significant (p = 0.0002). There was no association with flushing or pain and the flap. There was a significant association with the starch iodine test and the presence of the flap (p = 0.0016). The only significant association of the epidemiologic and clinical characterization of the patients with a negative or positive Minor’s test was between sweating and a positive Minor’s test (p = 0.0001). The only significant aspect in the diagnosis of Frey syndrome is gustatory sweating. There is a significant association with a negative Minor’s test and the presence of the SCM flap and with sweating and a positive Minor’s test. The SCM flap is an efficient method for preventing Frey syndrome following parotidectomy.

Prevalência dos sintomas otológicos na desordem temperomandibular: estudo de 126 casos

Introducao: A presenca de sintomas otologicos associados a desordem temporomandibular (DTM) e discutida ha seis decadas; entretanto, sua etiologia ainda permanece obscura. Forma de estudo: Prospectivo clinico randomizado. Objetivo: Neste estudo foram avaliadas a prevalencia de sintomas otologicos na DTM, sua correlacao com a dor muscular e a ausencia de dentes posteriores. Material e Metodo: Foram avaliados 126 pacientes portadores de DTM, atraves de questionario subjetivo dos sintomas, palpacao dos musculos de mastigacao, temporal, masseter, pterigoideo lateral, pterigoideo medial, digastrico, tendao do musculo temporal e dos musculos esternocleidomastoideo e trapezio. Foram feitas radiografias panorâmica e transcraniana e modelos de gesso das arcadas superior e inferior dos pacientes. Os dados obtidos foram analisados atraves do Teste Exato de Fisher, com percentil de significância menor que 0,05. Resultados: Houve presenca de sintomas otologicos em 80% dos pacientes, sendo que 50% apresentavam dor referida em ouvido; 52%, plenitude auricular; 50%, tinitus; 34%, tontura; 9%, sensacao de vertigem; e 10% relataram hipoacusia. O musculo pterigoideo lateral foi o musculo mais sensivel em 94% dos pacientes, seguido do musculo temporal em 69%, masseter em 62%, digastrico em 60%, pterigoideo medial em 50%, tendao do musculo temporal e esternocleidomastoideo em 49% e trapezio em 42% dos pacientes. Houve significância para dor muscular, e a presenca de sintomas otologicos, nos musculos masseter e esternocleidomastoideo. Os sintomas tinitus, plenitude auricular e dor referida em ouvido apresentaram alta correlacao de significância entre si. Nao houve significância para a ausencia de denticao e sintomas otologicos. Conclusao: 1) Dor referida em ouvido, tinitus, plenitude auricular e tontura foram prevalentes; 2) os sintomas otologicos presentes na DTM podem estar relacionados com a dor muscular em masseter e esternocleidomastoideo; 3) nao houve correlacao entre os sintomas otologicos e a ausencia de dentes posteriores.

Perioperative frozen section examination in parotid gland tumors

CONTEXT The minimal recommended surgical approach to parotid tumors is partial parotidectomy with resection of the superficial lobe of the gland. Histologic diagnosis prior to surgery is not possible, as incisional biopsies are contraindicated due to the possibility of facial nerve injury or incomplete tumor resection. Thus, the biopsies tend to be perioperative. OBJECTIVE To compare the results of frozen section examination with the definitive pathological diagnosis. DESIGN Accuracy study by retrospective analysis. SETTING Head and Neck Surgery Service of Heliópolis Hospital, São Paulo, Brazil. SAMPLE 153 cases of parotid gland tumors treated between 1977 and 1994. DIAGNOSTIC TEST Frozen section and pathological diagnosis. MAIN MEASUREMENTS Sensibility and specificity of the frozen section examination. RESULTS Frozen section study diagnosed 19 (12.4%) malignant and 127 (83.7%) benign tumors. Sensitivity of the frozen sections for malignancy was 61.5% (95% CI 54 to 69%) and specificity was 98% (95% CI 94 to 100%), and this result is comparable to the literature. CONCLUSIONS We consider that frozen section examination for salivary gland tumors is not sufficient on its own for deciding on the best management. Their interpretation must be correlated with clinical and intraoperative findings, in association with the surgeons experience.

Head and neck squamous cell carcinoma in childhood

BACKGROUND Squamous cell carcinoma (SCC) of the head and neck region is rare in young patients and even less frequent in children 15 years or younger children. The patients reported in the literature are isolated cases and their management is always difficult because there is no large experience or a convincing theory to support treatment decisions for every child. PROCEDURES AND RESULTS Four patients aged 15 years or younger were treated for SCC of head and neck between 1977 and 1995 at the Head and Neck Service of Heliópolis Hospital, São Paulo, Brazil, and with this paper we are reporting our experience with their treatment, including a genetic investigation in two cases (immunohistochemical analysis using monoclonal antibodies against p53 and c-erbB-2 oncogenes). These patients had no history of tobacco or ethanol abuse and no history of cancer in their families. Many authors attribute an unusual aggressiveness to SCC in childhood, with propensity to locoregional recurrence and high death rates and therefore, propose aggressive multidisciplinary therapy. Our cases, with the exception of one, had an early diagnosis and were treated using the same method we use for adults; the results were very good. CONCLUSIONS We recommend for these cases the same protocol as for older patients. In these cases, however, the primary lesion is resected with a safety margin which is usually 2 to 3 mm larger than usual safety margins and selective neck dissection is routinely indicated. This management is adopted in an attempt to avoid postoperative irradiation which may prove to be dangerous in the future for young patients. On the other hand, we recognize that due to a small number de patients, definitive treatment recommendations cannot be made at this time.

A ação do polímero de mamona durante a neoformação óssea

OBJETIVO: Devido a importância da cicatrizacao dos defeitos que venham a acometer os tecidos osseos, este estudo tem o objetivo de avaliar a acao do polimero de mamona durante a neoformacao ossea. METODOS: Para isto, um grupo de 45 ratos foi utilizado. Realizou-se a criacao de um defeito osseo na regiao do arco zigomatico de todos os animais, sendo que todos estes defeitos foram preenchidos com o polimero de mamona. Decorridos periodos de 15, 30, 60, 90 e 120 dias, os animais foram sacrificados e seguiram-se as tramitacoes laboratoriais de rotina para analise histologica. RESULTADOS: Os resultados mostraram que o polimero de mamona auxiliou no processo cicatricial. CONCLUSAO: Concluiu-se que o polimero de mamona auxiliou no processo regenerativo do defeito osseo criado experimentalmente, atuando como um agente osteocondutor.

Manifestações estomatológicas da paracoccidioidomicose

Study design: Clinical retrospective. Material and method: develop this research it had been realized a retrospective in reference book of 187 patients proceeding from the Infectology Service at the Deep Mycosis Ambulatory at Federal University of Parana, in Curitiba, between may 1985 and march 1998. The purpose of this paper was to delineate the epidemic outline describing the stomatologicals manifestations found in the sample, to discuss about the data found and to establish comparison with the pertinent literature, to observe possible changes and if they were significant as well as to notice the dyes sensibility that were used in the histopathology (HE, PAS and GROCOTT), in 20 microscopic slides. It had been settled a previous protocol to get the data concerning to the desease epidemiology such as oral manifestations, describing the kind and localization of the lesions. In the results that were found, references like sex, age, naturalness, origien and profession of the patients were determinant factors in the epidemiologic and demographic outline of the sample studied (187 cases) compared with the pertinent literature. Results: The evaluation of the results showed changes that were not to much significant in relation to the desease epidemiology. On the other hand, it was evidenced the exuberance in oral manifestations of the desease that is very commom and frequently leads the patient to a worse condition or even to a maintenance of the desease by the difficulty of nutrition that increases the immunesuppression. In the sample of these 187 patients studied, 167 (89,3%) were male and 20 (10,7%) female. In relation to the age, 75 (40,1 %) were between 40 and 50 years, with some relevant aspects:81 patients (43,3 %) were agricultural workers, 93 (49,7 %) were from inland areas of Parana. The loss of weight was related in 72 (17,22%) of the 187 complaints, followed dyspnea. In relation to the shape of the lesions, 85 (41,46%) of the patients did not show visible, the most commom were the ulcerated ones, the granulomatuos ones, followed by moriform one. The place with major incidence of lesions were lips, followed by oropharynx and hard palate, it was also noticed more than one kind of lesion in the same patient, between these 187 patients, five (2,65%) showed also tuberculosis, 140 (72,54%) did not palpable lymphonodes, 127 (67,91%) of the patients denied to use alcoholic drinks, 117 (62,57%) were smokers. The pulmonary envelopment was predominant in 166 (51,78%) of the analized cases. In the histopathology, the technique of dyeing by silver (GROCOTT) showed it self more sensitive than HE and PAS for visualization in demonstration of the etiologic agent P. brasiliensis.