Alberto Santos

Contact endoscopy during microlaryngeal surgery : a new technique for endoscopic examination of the larynx

By means of a microcolpohysteroscope during microlaryngoscopy, the cells of superficial layers of the vocal cord epithelium, previously stained with methylene blue, were observed in vivo and in situ. Several parameters were evaluated: regularity of the epithelium, dimensions and color of the nucleus, nucleus-cytoplasm ratio, nucleus and cytoplasm contours, and presence of the nucleolus, mitosis, cytoplasmic inclusions, keratosis, and koilocytes, among others. The normal squamous epithelium of the vocal cord has a homogeneous cell arrangement, with a spheroid and isochromic nucleus, and a uniform nucleus-cytoplasm ratio. Specific cellular epithelial patterns in different disorders were observed, namely, chronic laryngitis, keratosis, dysplasia, papilloma, and malignant tumor. The present study on contact endoscopy during microlaryngeal surgery reports our first results with this original technique, performed in 68 patients.

Contact Endoscopy of the Vocal Cord: Normal and Pathological Patterns

Contact endoscopy allows an in vivo and in situ study of the superficial layers of the vocal cord epithelium. This technique offers access to some characteristics of the epithelium cells: dimension and shape of the nuclei, nucleus/cytoplasm ratio, keratosis, presence of nucleolus, mitosis and koylocites. Contact endoscopy was performed during microlaryngoscopies in 92 patients with benign, pre-malign and malign pathology of the vocal cords. Systematic confrontation with pathological examination and laryngectomy specimens studied by histology and electron microscopy were used to improve the interpretation of contact endoscopy findings. Based on this correlation it has been possible to analyse the transition of the squamous and ciliated epithelium of the vocal cord as well as to delineate some pathological patterns, e.g. chronic laryngitis, keratosis, dysplasia, tumor and papilloma.

Contact Endoscopy of the Nasal Mucosa

The possibility of contact endoscopy in the nasal mucosa, using a contact microlaryngoscope is examined. With contact endoscopy it has been possible to visualize in vivo and in situ (60x, 150x) the superficial cell layers of the nasal epithelium, previously stained with methylene blue. Normal mucosa and cases with pathology (chronic rhinitis, nasal polyposis, inverted papilloma, mucormicosis and carcinoma) were assessed with contact endoscopy (50 patients). Squamous epithelium, ciliated epithelium, glandular ostia, mucus secretions, microvascular networks, inflammatory cell infiltrates, tissue inclusions, nuclear abnormalities, and fungal hyphae have been made visible. The potential of contact endoscopy in the nose, the alterations required in the contact endoscope and the intense interdisciplinary work needed are discussed. Evaluation and differentiation of stages of chronic mucosal diseases, nasal polyposis, environmental pathology, allergy, mucocilliary diseases, pharmacotherapy, are some of the entities that will benefit from this technique.

Adenoid bacterial colonization in a paediatric population

Adenoids play a key role in both respiratory and ear infection in children. It has also been shown that adenoidectomy improves these symptoms in this population. The main goal of the present study was to evaluate adenoid bacterial colonization and document a possible relation with infectious respiratory disease. A prospective observational study was designed to evaluate the proposed hypothesis in a paediatric population submitted to adenoidectomy by either infectious or non-infectious indications and compare these two cohorts. A total of 62 patients with ages ranging from 1 to 12 years old were enrolled in the study. Adenoid surface, adenoid core and middle meatus microbiota were compared. A close association between adenoid colonization and nasal infection was found, supporting that adenoids may function as bacterial reservoir for upper airway infection. The obtained results also contribute to explain the success of adenoidectomy in patients with infectious indications.

Pediatric Periorbital Infections: 5-Year Retrospective Study

Objective: Periorbital infections in the pediatric population are a common situation in hospital emergency care that can lead to visual loss, intracranial infection, or even death. We evaluated presentations and outcomes of pediatric periorbital cellulitis in order to understand different etiologies and stratifying risk populations that need different diagnostic and treatment approaches. Method: We retrospectively reviewed the pediatric patients admitted at our institution with the diagnosis of periorbital cellulitis over a period of 5 years. They were classified in subgroups according to Chandler and cross-referenced in demographics, clinical features, co-morbidities, days of in-hospital staying, CT findings, and treatment modalities. Results: We identified 112 children with periorbital cellulitis, 63 pre-septal and 49 post-septal. There were statistically significant differences between the two groups in regard to age (P < .001) and history of trauma or skin infection (P < .001). Proptosis (P < .001), diplopia (P < .01) and ophthalmoplegia (P < .001) were more frequent in post-septal infections and surgical intervention was exclusive of this group. Subperiosteal abscess patients were significantly older (P < .05), and all of them had diagnosis of acute sinusitis (P < .05). Proptosis (P < .05), ophtalmoplegia (P < .05) and diplopia (P < .05) were also differentiating features of subperiosteal abscess. Conclusion: Pre-septal infections are more common in younger children. Older children with subperiosteal abscesses need surgical intervention more often. Proptosis, diplopia, and opfthamoplegia are significant identifying features of post-septal infections, particularly in surgical patients. Trauma or skin infections are relevant findings of pre-septal infections. Post-septal infections are mostly a complication of acute sinusitis.

P057: Extramedular Solitary Plasmacytoma: Treatment & Follow-Up

OBJECTIVES: Understand presentation, etiologies, role of associated co-morbidities and beneficial management strategies, including hyperbaric oxygen therapy, in patients with infections (DNSI) and necrotizing fasciitis (NF) of the deep neck spaces. METHODS: Retrospective chart review of patients diagnosed with deep neck space infections (DNSI) or NF. Patient demographics, microbiology, antimicrobial therapy, co-morbidities, treatment modalities, duration of hospital stay and morbidity and mortality were reviewed. T-test analysis was performed. RESULTS: The study evaluated 100 patients with a predominance of adults aged 21-50 (62%). Common presenting symptoms included neck swelling (54%) and pain (27%). The most common etiologies were unknown (46%) or odontogenic (41%); 88 patients underwent prompt surgical drainage, three abscesses were drained or aspirated at the bedside, and seven were medically managed. Patients with co-morbid systemic illness had longer hospital stays (4.8 /-5.5 days) compared to those without (3.2 /2.0 days, P 0.059). There were seven patients with NF who required multiple debridements and had longer clinical courses (15.7 /9.6 days) compared to the rest of the population (P 0.001). Four patients with NF received HBO therapy with excellent outcomes. There were six inpatient complications and no deaths. CONCLUSIONS: Early surgical drainage should be considered routine care if there is strong clinical suspicion of DNSI or NF. Diagnosis is aided by specific history and physical exam findings as well as radiologic studies. Aggressive management has improved survival outcomes.