Antonio Sérgio Fava

Acute sinusitis in children: a retrospective study of orbital complications

UNLABELLED Among the complications of sinusitis, those that involve the orbital region are the most frequent. AIM the objective of this paper is to show an incidence of orbital cellulites (OC) secondary to acute sinusitis in children. STUDY DESIGN retrospective. METHODS After board approval, the charts of all pediatric patients diagnosed with orbital complications secondary to sinusitis, seen at the Pediatric and at the ENT clinics of the HPEV, between 1985 and 2004, were evaluated. The data was analyzed considering gender, age, clinical presentation, period of hospitalization, image study, and treatment. RESULTS from 1985 to 2004, 25 patients were diagnosed with OC secondary to sinusitis, presenting an incidence of 6% . Males predominated, the median age was 6.5 years, and the maxillary was the most frequently involved sinus. Twenty-four patients presented mild peri-orbital swallowing. All 25 patients presented X-Ray alterations. One patient with proptosis had a subperiosteal abcess seen on the CT-scan. The average time of hospitalization was 4 days. All 25 patients received IV antibiotics, 2 required surgery. CONCLUSION The incidence of orbital complications secondary to sinusitis is low, and although the majority of cases are early diagnosed and respond well to medication treatment, a surgical intervention may be required.

Correlação da infecção viral pelo papilomavírus humano com as lesões papilomatosas e o carcinoma epidermóide na boca e orofaringe

O objetivo deste trabalho e estabelecer a relacao entre a infeccao pelo virus do papiloma humano (HPV) e o desenvolvimento de lesoes malignas (carcinoma epidermoide) e benignas (hiperplasia epitelial papilomatosa e papiloma) de cavidade bucal e orofaringe. METODOS: Estudo retrospectivo de 66 lâminas e blocos de parafina com tecido biopsiado e fixado com formalina. Esse material, colhido no ano de 2002, refere-se a uma casuistica de 44 homens (66,7%) e 22 mulheres (33,3%) com idades que variavam entre 11 e 100 anos. O diagnostico foi confirmado em 38 casos de carcinoma epidermoide, 20 casos de hiperplasia epitelial papilomatosa e oito casos de papilomas. Utilizamos a imunohistoquimica para analisar este material e determinar a possivel presenca do DNA viral nas amostras citadas. RESULTADOS: Detectamos a presenca do DNA viral (HPV) em 16 dos 38 casos de carcinoma (42,5%), 19 em 20 casos de hiperplasia (95%) e em todos os oito casos de papilomas (100%). CONCLUSAO: Este estudo demonstrou que as lesoes papilomatosas e hiperplasicas da boca e orofaringe estao associadas ao HPV, ao contrario do carcinoma espinocelular que nao apresentou correlacao estatistica significante com este agente infeccioso.

Adenoma pleomórfico de parótida: aspectos clínicos, diagnósticos e terapêuticos

The neoplasias of the parotid gland are a heterogeneous group with more than 30 histological kinds already defined, and the pleomorphic adenoma is the most common benign tumor. AIM: In this study we present our case of parotid gland pleomorphic adenoma, with the purpose of discussing the clinical presentation, the diagnosis and the more suitable surgical techniques to treat this disorder. MATERIAL AND METHOD: A retrospective clinical study was carried out on a group of 68 patients with histological diagnosis of parotid gland pleomorphic adenoma who underwent surgery at the Department of Otolaryngology of the HSPE-FMO, from January 1982 to June 2002. The data regarding their age, sex, more frequent symptoms, supplementary tests performed, location, size, surgical technique used, treatment complications and evolution were gathered. RESULTS: In our case we observed a higher incidence in female patients, being more frequent in their fifth decade of life. The most common clinical presentation was of a nodule at the parotid region, this sign being present in 100% of the cases. Superficial parotidectomy by identifying and preserving the facial nerve was the more common surgery (91.2 % of the cases). The more frequent post-surgical complications were paresis (14.7%) and paralysis (7.3%) of the facial nerve, followed by the Freys syndrome (4.4%). CONCLUSION: The pleomorphic adenoma is the most common benign neoplasia of the parotid gland, being more frequent in female patients from their fifth decade of life. It is a clinically diagnosable neoplasia, to be confirmed with a histopathological examination. The superficial parotidectomy is the basic procedure to diagnose and treat it, being low the recurrence index with this surgery.

Transillumination-guided study of the endoscopic anatomy of the lacrimal fossa

UNLABELLED Dacryocystorhinostomy is the treatment of choice for the obstruction of the lachrymal apparatus. At the end of last century, the development of the endoscopic instruments for nasosinusal surgery has made it possible to do it through the endoscopic pathway. Nonetheless, anatomical variations make it difficult to have reproducibility endonasaly. AIM study the endoscopic anatomy of the lachrymal fossa through transillumination of the common canaliculus. STUDY DESIGN experimental. MATERIALS AND METHODS we dissected 40 lachrymal pathways from 20 human cadavers, in three stages: 1. identification and dilation of the lachrymal canaliculus. 2 - Optic fiber beam introduction; 3 - endoscopic dissection of the lachrymal sac, describing its position. RESULTS the most frequent position of the lachrymal sac was between the free border of the middle turbinate and its insertion immediately underneath it. The maxillary line was seen in 95% of the cases. Septoplasty was needed in 12.5%, unicifectomy in 35% and middle turbinectomy in 7.5%. CONCLUSION Although the lachrymal sac has a more frequent location, its position varied considerably. The transillumination of the common canaliculus proved useful, solving the problem of the anatomical variability.

Estudo epidemiológico das alterações estruturais da cavidade nasal associadas à síndrome da apnéia e hipopnéia obstrutiva do sono (SAHOS)

AIM: The objective of this paper is to demonstrate that structural alterations of the nasal cavity, e.g. septal deviation and conchal hypertrophy have high incidence in patients with sleep apnea and hypopnea syndrome and must be addressed with associated specific procedures of the syndrome. TYPE OF STUDY: Clinical retrospective. CASUISTIC AND METHOD: A retrospective study of 200 patients was performed, with 196 male and 4 female, attended at the otorhinolaryngology ambulatory of Hospital Prof. Edmundo Vasconcelos and Unidade Paulista de Otorrinolaringologia, all of them subjected to polysomnography, otorhinolaryngological physical exam, endoscopy exam, and surgical treatment with nasal and pharyngeal procedures. RESULTS: All of them were subjected to pharyngeal procedure: uvulopalatopharyngoplasty or uvulopalatoplasty and nose procedure: 176 septoplasty with partial turbinectomy (88%) and 24 isolated turbinectomy, with satisfactory results. CONCLUSION: We can see that structural alterations of the nasal cavity have high incidence in patients with OSA.

Epidemiological analysis of structural alterations of the nasal cavity associated with obstructive sleep apnea syndrome (OSA)

AIM The objective of this paper is to demonstrate that structural alterations of the nasal cavity, e.g. septal deviation and conchal hypertrophy have high incidence in patients with sleep apnea and hypopnea syndrome and must be addressed with associated specific procedures of the syndrome. TYPE OF STUDY Clinical retrospective. CASUISTIC AND METHOD A retrospective study of 200 patients was performed, with 196 male and 4 female, attended at the otorhinolaryngology ambulatory of Hospital Prof. Edmundo Vasconcelos and Unidade Paulista de Otorrinolaringologia, all of them subjected to polysomnography, otorhinolaryngological physical exam, endoscopy exam, and surgical treatment with nasal and pharyngeal procedures. RESULTS All of them were subjected to pharyngeal procedure: uvulopalatopharyngoplasty or uvulopalatoplasty and nose procedure: 176 septoplasty with partial turbinectomy (88%) and 24 isolated turbinectomy, with satisfactory results. CONCLUSION We can see that structural alterations of the nasal cavity have high incidence in patients with OSA.

Angiofibroma nasofaríngeo: revisão de literatura

Angiofibroma of nasopharynx is a highly vascular, rare and benign tumor, with a high a incidence of recurrence and local invasity which nature always defied the researchers on the subject. The controversies start on its site of origin, till therapeutical modalities, passing by clinical and diagnostic aspects. The most serious and baffling feature, however, is the occurrence of hemorrhagic outbreaks, sometimes very intense, which may lead the patient to death. In view of this, the efforts developed towards of minimizing this problematic fact have been many, aiming adequate control of the illness. The present article presents a global review on this subject and intends to discuss the main aspects related to angiofibroma of nasopharynx in a simple and didatic form.

Paraganglioma carotídeo bilateral

Os paragangliomas do corpo carotideo sao lesoes incomuns, embora representem a maioria dos paragangliomas da cabeca e pescoco. A presenca de lesao bilateral e rara. Os autores apresentam um caso de paraganglioma bilateral, dando enfase aos aspectos clinicos, diagnosticos e tratamento.

Surgical stoma recurrence after total laringectomy

UNLABELLED Stoma recurrence after total laryngectomy is one of the most severe developments of squamous cell carcinoma of the larynx. Risk factors most strongly implicated in stoma recurrence have been subglottic invasion by the laryngeal tumor and tracheotomy prior to laryngectomy. AIM Study the clinical findings of patients who underwent total laryngectomy and evaluate the probable risk factors to the development of stoma recurrence. STUDY DESIGN Descriptive and retrospective study MATERIALS AND METHODS We studied data from 47 patients who underwent total laryngectomy for the treatment of laryngeal cancer between 1995 and 2004 and evaluated recurrences and risk factors. RESULTS Stoma recurrence developed in 10.6 per cent of them (5 cases). There was no significant correlation between stoma recurrence and subglottic invasion or prior tracheotomy. CONCLUSION Stoma recurrence still is one of the most lethal developments associated to laryngeal cancer. In the present study it was not possible to identify factors related to this recurrence. Further studies with a larger sample and a longer follow-up period are necessary to better understand this condition.

Sinusite aguda em crianças: estudo retrospectivo de complicações orbitárias

Das complicacoes da sinusite, as que envolvem a regiao orbitaria sao mais frequentes. OBJETIVO: Este trabalho tem por objetivo mostrar a incidencia de celulite orbitaria (CO) como complicacao de sinusite aguda em criancas. Forma de Estudo: Retrospectivo. METODO: Apos autorizacao especifica, foram avaliados todos os prontuarios de pacientes pediatricos, com idade ate 12 anos, com diagnostico de complicacao orbitaria por sinusite, admitidos na Clinica de ORL e Pediatrica do HPEV no periodo de 1985 a 2004. Os casos foram analisados segundo o sexo, idade, quadro clinico, seio paranasal acometido, periodo medio de internacao, exames de imagem realizados e tratamento instituido. RESULTADO: No periodo de 1985 a 2004, foram diagnosticados 25 pacientes portadores de CO, apresentando uma incidencia de 6%, predominio do sexo masculino, com media de idade de 6,5 anos. O seio paranasal mais acometido foi o maxilar. 24 pacientes apresentavam edema periorbitario. Todos os 25 pacientes apresentavam velamento sinusal ao Rx. Um paciente apresentava deslocamento do globo ocular e proptose e a TC mostrava abscesso subperiosteal. O periodo medio de internacao foi de 4 dias. 25 pacientes receberam tratamento antibiotico endovenoso e 2 foram submetidos a tratamento cirurgico associado. CONCLUSAO: A incidencia de complicacoes orbitarias pos-sinusite sao infrequentes, com diagnostico precoce evoluem bem com tratamento clinico. A cirurgia pode ser necessaria em alguns casos.