Fernando Danelon Leonhardt

Transoral robotic surgery for oropharyngeal carcinoma and its impact on patient-reported quality of life and function

The aim of this study was to assess the quality of life of patients with oropharyngeal squamous cell carcinoma after transoral robotic surgery (TORS).

Transoral Robotic Surgery for Parapharyngeal Space Tumors

Purpose: To evaluate the outcomes of patients with parapharyngeal space (PPS) tumors treated with a transoral robotic surgery (TORS) approach. Materials and Methods: We prospectively enrolled well-defined benign PPS tumors accessible from the oropharynx with no carotid encasement or bone erosion. We designated outcome measures that included technical feasibility of the approach, local tumor control and complication rates. Descriptive statistics were used to summarize the outcome data. Results: With a mean follow-up of 29.9 months (range 12–40 months), a total of 10 patients have been enrolled. TORS was completed in 9 of 10 patients with acceptable operative time and blood loss and no significant complications including hemorrhage, infection, trismus or tumor spillage. Local control has been 100% for 7 patients with pleomorphic adenomas. Conclusions: We confirm the safety and feasibility of the TORS approach for PPS tumors that achieves a high local control and low surgical complication rate. TORS is a viable approach for removing benign tumors and lesions of the PPS.

Processamento auditivo em indivíduos com epilepsia de lobo temporal

Temporal epilepsy, one of the most common presentation of this pathology, causes excessive electrical discharges in the area where we have the final station of the auditory pathway. Both the anatomical and functional integrity of the auditory pathway structures are essential for the correct processing of auditory stimuli. AIM: to check the Auditory Processing in patients with temporal lobe epilepsy regarding the auditory mechanisms of discrimination from sequential sounds and tone patterns, discrimination of the sound source direction and selective attention to verbal and nonverbal sounds. METHOD: eight individuals with temporal lobe epilepsy were assessed, after excluding those with non-confirmed diagnosis or with the focus of discharges not limited to this lobe. The evaluation was carried out through special auditory tests: Sound Localization Test, Duration Pattern Test, Digits Dichotic Test and Non-Verbal Dichotic Test. Their performances were compared to the performances of individuals without neurological diseases (case-control study). RESULTS: similar performances were observed between patients with temporal lobe epilepsy and the control group regarding the auditory mechanism of sound source direction discrimination. Comparing the other auditory mechanisms assessed, the patients with temporal lobe epilepsy presented worse results. CONCLUSION: individuals with temporal lobe epilepsy had more deficits in auditory processing than those without cortical damage.

Ocorrência de reflexo acústico alterado em desordens do processamento auditivo

Introduction: The acoustic reflex threshold is defined as the lowest sound intensity capable of starting the middle ear protection mechanism due to intense sounds (Metz, 1952; Jerger, 1970), being necessary the structural and functional integrity of the periferic and central auditory system. These structures are also responsable for the central processing of auditory information. Aim: We intend to verify whether acoustic reflex abnormalities can also appear in auditory processing (AP) disorders, resulting in symptoms related to speech and language disorders. Study design: Prospective randomized. Material and method: Data were analyzed from one hundred AP assessments, using Pereira (1997) method. Patients, male and female, with ages ranging from 07 to 18 years, had normal hearing thresholds and normal tympanograms patterns. The difference between the acoustic reflex and hearing thresholds defined the acoustic reflex level (ARL), considered normal between 70-90dB and altered when above of this range or when absent in one or more frequencies (Carvallo, 1996; 1997; Metz, 1952). Results: Disorders of AP were found in 97% of the patients. In this group, 62% showed ARL abnormalities, being statistically significant. Furthermore, patients with AP disorders showed ARL alterations, more frequently on severe degree disorders, on patients with combined auditory gnosis impairments and on patients with more than one auditory ability altered. Conclusion: Patients with acoustic reflex alterations and normal audiometry should perform the AP assessment, as these symptoms could unmask pathologies of the central nervous system.

Head and neck hemangiopericytoma in a child: case report

CONTEXT Hemangiopericytoma is a relatively rare tumor, first described in 1942, with approximately 300 cases described in the literature to date. In most cases, it affects the trunk and lower extremities. The head and neck incidence is less than 20%, mostly in adults. We describe a case of malignant head and neck hemangiopericytoma in a child. TYPE OF STUDY Case report. CASE REPORT A twelve-year-old male patient noted the presence of a firm painless right-side retroauricular lymph node of 1 cm in diameter, which at first remained unchanged for six months, but subsequently enlarged progressively. He denied having had previous trauma at that site. In November 2000, he presented nasal obstruction and voluminous epistaxis that required hospitalization and blood transfusion. During dental treatment one month later, a cranial x-ray revealed bone alterations. A subsequent computed tomography scan showed an extensive lesion of soft tissue density that had invaded the maxillary fossa, eroding the skull base and middle and nasal fossa. The child was then referred to our service, where biopsy was performed, giving a diagnosis of hemangiopericytoma. Shortly afterwards, magnetic resonance imaging revealed that this lesion had undergone significant growth, while maintaining the same invasion pattern. The patient was submitted to conservative surgery in April 2001, with only partial resection of the tumor because of its extent. Histopathological examination of the specimen confirmed the presence of malignant hemangiopericytoma. Following the surgery, the patient presented fast regrowth of the lesion, with partial response to chemotherapy and radiotherapy.

Auditory processing in patients with temporal lobe epilepsy

UNLABELLED Temporal epilepsy, one of the most common presentation of this pathology, causes excessive electrical discharges in the area where we have the final station of the auditory pathway. Both the anatomical and functional integrity of the auditory pathway structures are essential for the correct processing of auditory stimuli. AIM to check the Auditory Processing in patients with temporal lobe epilepsy regarding the auditory mechanisms of discrimination from sequential sounds and tone patterns, discrimination of the sound source direction and selective attention to verbal and nonverbal sounds. METHOD eight individuals with temporal lobe epilepsy were assessed, after excluding those with non-confirmed diagnosis or with the focus of discharges not limited to this lobe. The evaluation was carried out through special auditory tests: Sound Localization Test, Duration Pattern Test, Digits Dichotic Test and Non-Verbal Dichotic Test. Their performances were compared to the performances of individuals without neurological diseases (case-control study). RESULTS similar performances were observed between patients with temporal lobe epilepsy and the control group regarding the auditory mechanism of sound source direction discrimination. Comparing the other auditory mechanisms assessed, the patients with temporal lobe epilepsy presented worse results. CONCLUSION individuals with temporal lobe epilepsy had more deficits in auditory processing than those without cortical damage.

The value of prognostic clinical data in Bell's palsy

UNLABELLED Electroneurography (ENoG) and clinical staging are currently the methods of choice to indicate prognosis in Bells palsy, although ENoG is an electrophysiological test not universally available. AIM Identify other options of prognostic evaluation based upon clinical aspects and minimal electrical stimulation test allowing prognostic measurement in almost any circumstances. STUDY DESIGN Historic cohort. MATERIAL AND METHOD Chart review of 1,521 cases of IPFP, analyzing the following clinical aspects: gender, age, paralyzed side, installation mode, previous symptoms, associated symptoms and minimal electrical stimulation test (Hilger test) and its statistical correlation to facial palsy evolution after 6 months. RESULTS Data indicated that patients above 60 years old had worse prognosis in comparison with patients under 30 years old. A progressive mode of paralysis installation, absence of previous symptoms, concomitant vertigo and response superior to 3.5 mA at minimum electrical stimulation test were also related to worse prognosis. On the other hand, the absence of concomitant symptoms, diminished tearing and sudden onset were related to better prognosis. CONCLUSION Clinical factors and Hilgers test can accurately indicate the prognosis in cases of Bells palsy when ENoG is not available.

Valor prognóstico de dados clínicos em paralisia de Bell

Com o advento dos testes eletrofisiologicos, a avaliacao clinica parece ter perdido interesse na paralisia de Bell. A eletroneuronografia (ENoG) associada ao estadiamento clinico da doenca e o metodo mais frequentemente utilizado para mensurar o prognostico da paralisia de Bell. Entretanto, a ENoG constitui-se em um teste eletrofisiologico ainda nao universalmente disponivel, especialmente nos servicos de emergencia. OBJETIVO: Estudar a medida do prognostico da paralisia de Bell com base nos dados clinicos e no teste de estimulacao eletrica minima, teste de Hilger, permitindo assim uma previsao de prognostico segura e factivel na maioria dos servicos. FORMA DE ESTUDO: coorte historica. MATERIAL E METODO: Estudo coorte retrospectivo, analisando 1521 casos de paralisia de Bell, correlacionando-se os dados clinicos sexo, idade, lado da paralisia, modo de instalacao, sintomas previos, sintomas associados e os resultados do teste de estimulacao eletrica minima (Hilger), com a evolucao da paralisia apos 6 meses. RESULTADO: O estudo desses dados indicou que pacientes acima de 60 anos apresentaram prognostico pior em comparacao com pacientes com idade abaixo de 30 anos; o modo de instalacao progressiva, a ausencia de sintomas previos, a presenca de vertigem concomitante a paralisia e resposta acima de 3,5 mm no teste de Hilger estiveram relacionados com mau prognostico. Por outro lado, a ausencia de sintomas concomitantes, a diminuicao do lacrimejamento e o inicio subito foram relacionados com bom prognostico. CONCLUSAO: A analise de fatores clinicos, associada ao teste de Hilger, pode indicar o prognostico da paralisia facial com reduzida margem de erro, sendo uma alternativa bastante interessante especialmente quando nao ha disponibilidade da ENoG.

Vocal assessment in patients submited to CO2 laser cordectomy

AIM To evaluate voice outcomes in patients with early glottic carcinoma treated by CO2 laser cordectomy. METHOD 15 patients with glottic Tis and T1 squamous cell carcinoma treated with CO2 laser were analyzed. The assessment consisted of perceptual voice analysis, objective voice evaluation and video-laryngo-stroboscopic exam. In addition, patients rated their voices and completed the Voice related Quality of Life (VR-QOL) questionnaire. The results were compared with those obtained in a matched control group. RESULTS Most of the patients presented some degree of hoarseness on perceptual voice analysis, mainly rough and breathy voices. Their acoustic evaluation compared with the control group showed a small increase in fundamental frequency, but with no statistically significant difference, and the values of jitter, shimmer and noise to harmonic ratio were worse and statistically significant. As regards to videolaryngo-stroboscopic findings, better results were achieved in the less extensive resection group. Patients have had minimal repercussion in their life quality in respect to voice. CONCLUSIONS In spite of voice alterations in patients submitted to cordectomy by CO2 laser, functional results are acceptable, with minimal repercussion in their quality of life.

Ligadura endoscópica endonasal da artéria esfenopalatina para epistaxe severa

Introduction: Severe epistaxis, usually associated to hypertension and blood dyscrasia, may benefit from surgery when the conservative treatment fails. Aim: to evaluate the results of endoscopic endonasal ligation of the sphenopalatine artery for non-responsive severe epistaxis. Study design: Clinical prospective. Material and Method: chart review of twelve patients submitted to endoscopic endonasal ligation of the sphenopalatine artery regarding clinical aspects, predisposing factors and complications of the procedure. Results: the mean age was 50.9 years, and the male:female: ratio was 2:1. Hypertension was presented in 33% and hematologic disorders in 16.6% of the patients. One patient, 8.3%, presented a new bleeding episode after the surgery. Discussion: the endoscopic endonasal ligation of the sphenopalatine artery, proved to be a safe surgical method and presented 8.3% of bleeding after the procedure in our study. Conclusion: avoiding the complications of previous surgical treatments for severe epistaxis, the endoscopic endonasal ligation of the sphenopalatine artery is an effective technique affordable for otolaryngologists with practice in endoscopic endonasal surgery.