Erich Christiano Madruga de Melo

Distribution of Collagen in the Lamina Propria of the Human Vocal Fold

Objectives To describe the arrangement of collagen fibers in the lamina propria of the human vocal fold.

Length of the human vocal folds: proposal of mathematical equations as a function of gender and body height.

To obtain a mathematical equation that could estimate the length of the intermembranous part of the vocal fold as a function of body height and gender, we removed the larynges from 39 cadavers (22 men and 17 women) after recording the subjects height, age, and cause of death. The dimensions of the vocal folds were determined with a digital pachymeter. The following equations were obtained: y = 0.18x − 15.8 for men and y = 0.24x − 28.1 for women, where y is the length of the intermembranous part of the vocal folds in millimeters and x is the height of the individual in centimeters. We conclude that it is possible to estimate the normal expected length of the intermembranous portion of the male and female vocal folds on the basis of body height.

Fiberoptic endoscopic swallowing disorders in chronic encephalopathy

OBJECTIVE: To evaluate the results of fiberoptic endoscopic examination of swallowing safety in children with cerebral encephalopathy in order to identify patients with oropharyngeal dysphagia. METHODS: 68 children from the Association for the Care of Disabled Children (Associação de Assistência à Criança Deficiente -AACD), São Paulo, were submitted to fiberoptic endoscopic examination of swallowing safety from March 1999 to March 2000. RESULTS: We observed premature spillage (53%), penetration in a pureed consistency (5.9%), penetration in a liquid consistency (4.4%), tracheal aspiration in a pureed consistency (14.7%), tracheal aspiration in a liquid consistency (32.3%), residue (7.4%), cough effectiveness (44.1%). CONCLUSIONS: Children showed a high incidence of pharyngeal swallowing disorders. Tracheal aspiration was the most important disorder because it is related with high morbidity in children with cerebral encephalopathy. The texture and consistency of the patientacute;s diet may be modified to decrease the risk of aspiration and improve swallowing examination.

Avaliação nasofibrolaringoscópica da deglutição em crianças

Introduction: Very little has been published about the disorders of deglutition in children with neurological impairment. The swallowing difficutties found by children with cerebral palsy are debilitating, particularly by the chronic pulmonary diseases and malnutrition. Study design: Prospective clinical no randomized. Objective: The purposes of this study were to (1) asses the use of nasoendoscopic examination of swallowing in chlidren and (2) describe the swallowing pharyngeal abnormalities. Material and method: The data reported here were extracted from a database on 134 pediatric swallow studies. All children had primary diagnosis of cerebral palsy, with swallowing abnormalities. The ages ranged from four months to 14 years. Results: The prevalence of each type of abnormality in the study group was: premature spillage (53,7%), tracheal aspiration in a liquid consistence (33,6%), tracheal aspiration in a pureed consistence (14,9%). There was regular agreement between the finds of premature spillage and tracheal aspiration. None of the children had complications during the exam. Conclusion: It was concluded that the nasoendoscopic evaluation of swallowing is a valid and valuable tool for evaluating pharyngeal dysphagia in children.

Schwanoma de laringe: relato de caso

Schwannomas are benign, slow-growing, encapsulated tumors, which appear on the sheath of sensitive or cranial motor nerves Schwann cells, and having no nervous elements. They rarely appear on the larynx, and there are sporadic reports in the literature. This work has as purpose to report a case of laryngeal schwannoma. A 82 years-old woman, born and residing in the city of Sao Paulo, SP, went to the Hospital, suffering from slowly progressive, long-term dysphagia for solids and globus sensation. The indirect laryngoscopy with a 70o rigid telescope revealed a submucous tumor, rounded, at the interarytenoid region. A neck computed tomography was made, revealing an apparently solid lesion, with no central necrosis and no extension to deeper levels, the greatest diameter of which was of 2.5 cm. The patient underwent a larynx microsurgery with tumor full removal. The histological analysis revealed a laryngeal schwannoma. The patient recovered well with no no signs of recurrence or residual tumor until now.

Estenose subglótica como manifestação clínica da granulomatose de Wegener em adolescentes: relato de caso e revisão de literatura

Wegeners Granulomatosis is a well-characterized systemic vasculitis and necrotising granulomatous inflammation of the upper, lower respiratory tracts and the kidneys. The initial manifestations of the disease usually occur in patients over than twenty years old. The otolaryngologic symptoms like rhinorrhea, recurrent sinusitis and epistaxis are commonly present in early course of the disease. It seems that subglottic stenosis is correlated to Wegeners granumatosis in adolescents. We describe a case of a patient that developed subglottic stenosis associated with Wegeners granulomatosis in childhood during the course of the disease.

Osteomas fronto-etmoidais: aspectos clínicos e cirúrgicos

Introduction: Fronto-ethmoidal osteomas are the most frequent paranasal sinus benign tumor and they may envolve with either infectious complications and destruction of adjacent structures. Though they are relatively frequent, few of them are cases requiring surgery. Aim: To report on a group of nine patients with frontal or ethmoidal osteoma, as well as to discuss the clinical presentation and the most suitable treatment of this disease. Study design: Clinical prospective. Material and Method: A prospective clinical study of nine patients who were submitted to surgery at the HSPE-FMO (State Public Servants Hospital) of Sao Paulo, and at the Sao Luiz Hospital of the city of Sao Paulo, in the period from 1995 to 1999. The surgical treatment was the therapeutic option selected in this group. The clinical evolution was assessed during the postoperative period. Results: Of the nine patients, five were females and four a male, ages ranging from 12 to 55 years, with an average age of 39,55 years. All the patients had a resolution of the symptoms and only one of them presented sequels (hyposmia). Conclusion: Based on both the literature review and on the cases followed, the authors concluded that the lesions compromising the drainage of the frontal sinus osteos, those with destruction of the sinus limits as well as any ethmoidal tumors should be surgically treated.

P079: Distribution of Collagen in Reinke Edema

The adult group had a total number of myelin fibers at the RLN higher than the elderly group (p 0.0006), this difference happening at myelin fibers with diameters of 1-3 m (p 0.007). Superior laryngeal nerves had a higher number of myelin fibers compared to recurrent laryngeal nerves (p 0.0001). The adult group had a higher total number of fibers at laryngeal nerves (sum of superior laryngeal nerves and recurrent laryngeal nerves fibers) than the elderly group (p 0.0091). CONCLUSIONS: Total number of myelin fibers from RLN is higher for the adult group, this difference occurring at myelin fibers with a diameter 1-3 m. The adult group has a higher total number of myelin fibers at the laryngeal nerves.