José Francisco Salles Chagas

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.

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.

Frey syndrome prevalence after partial parotidectomy

INTRODUCTION Frey syndrome is a sequela observed after parotidectomy and the reported incidence varies enormously in the literature. Diagnosis is evaluated by presence of the classic triad of gustatory sweating, heating and flushing while feeding and documented by Minor starch-iodine test. AIM To evaluate the incidence of this syndrome in patients submitted to partial parotidectomy at Centro Otorrinolaringológico de Limeira, from 1994 to 2004, including presence of signs and symptoms and the surgical technique. MATERIAL AND METHOD Fourteen patients undergoing partial parotidectomy with sternocleidomastoid muscle flap answered a questionnaire and were classified as positive or negative by Minor starch-iodine test in a clinical retrospective study. RESULTS 21% of the patients presented symptoms and positive iodine test. CONCLUSION Only the patients presenting clinical symptoms had a positive test and the adopted surgical technique was efficient due to low incidence of the syndrome.

Prevalência da Síndrome de Frey após parotidectomia parcial

INTRODUCTION: Frey syndrome is a sequela observed after parotidectomy and the reported incidence varies enormously in the literature. Diagnosis is evaluated by presence of the classic triad of gustatory sweating, heating and flushing while feeding and documented by Minor starch-iodine test. AIM: to evaluate the incidence of this syndrome in patients submitted to partial parotidectomy at Centro Otorrinolaringologico de Limeira, from 1994 to 2004, including presence of signs and symptoms and the surgical technique. MATERIAL AND METHOD: fourteen patients undergoing partial parotidectomy with sternocleidomastoid muscle flap answered a questionnaire and were classified as positive or negative by Minor starch-iodine test in a clinical retrospective study. RESULTS: 21% of the patients presented symptoms and positive iodine test. CONCLUSION: only the patients presenting clinical symptoms had a positive test and the adopted surgical technique was efficient due to low incidence of the syndrome.

Carcinoma diferenciado da tireóide: a validade da complementação da tireoidectomia

OBJETIVO: Analisar a invasao tumoral do lobo contralateral da glândula tireoide no carcinoma diferenciado, correlacionando o risco/beneficio com as complicacoes decorrentes de uma segunda intervencao. METODO: De outubro/93 a dezembro/96 foram operados 20 pacientes com carcinomas diferenciados da glândula tireoide. Os parâmetros analisados foram sexo, idade, tipo de operacao, tipo de complicacoes, histopatologico da peca cirurgica e invasao do lobo contralateral. Eram dois pacientes do sexo masculino (10%) e 18 do feminino (90%); as idades variaram de 17 a 89 anos; o tipo histologico mais frequente foi o carcinoma papilifero (13 casos), seguido do folicular (seis casos) e carcinoma de celulas de Hurthle (um caso). Como primeiro procedimento cirurgico houve 11 lobectomias + istmectomias, quatro lobectomias subtotais e uma istmectomia. Cinco pacientes nao realizaram a totalizacao (um por fibrose, tres por perda de seguimento e um por ser microcarcinoma). RESULTADOS: Na analise do lobo contralateral realizada em 15 pacientes, 11 resultaram negativas e outras quatro positivas (26,6%). As complicacoes apresentadas foram rouquidao (dois casos revertidos com tratamento fonoterapico), hipoparatireoidismo (dois casos, um transitorio e um permanente). CONCLUSAO: A totalizacao da tireoidectomia e um procedimento importante no tratamento do tumor maligno da tireoide pela alta porcentagem de metastase contralateral (26,6%). Alem disso, e um procedimento com mortalidade nula e pequena incidencia de complicacoes.

Avaliação da abordagem palpebral subtarsal no tratamento cirúrgico das fraturas zigomático-orbitais

OBJECTIVE To evaluate the complications, advantages and disadvantages of the subtarsal approach when used to exposure the orbital rim and orbital floor in orbitozygomatic fractures. METHODS Retrospective study of the 41 subtarsal incisions that were used in 39 patients with fractures of the zygomatic complex and/or orbital floor, of blowout type, between January 2002 and December 2006. RESULTS The observed complications were conjunctivitis, epiphora and noticeable scar, in six (14,6%), five (12,2%) and two (4.9%) of the cases, respectively. There was no ectropion, entropion or scleral show in the patients reevaluated. CONCLUSIONS The main advantages of this approach are the esthetic result together with the transoperative benefits.

The value of therapeutic planning and the degree of experience of the surgical team on the results of cancer treatment of the larynx and hypopharynx

This is a prospective study supported by 170 cases of epidermoid carcinoma of the larynx or hypopharynx, treated during the period from January of 1981 to January of 1988, at the Head and Neck Surgery Service of the Heliópolis Hospital Complex, São Paulo. The objective of this project was to evaluate the importance of surgeon experience with regard to the rates of post-operative complications and the rates of relapse and survival. The results of the 8 surgical specialists who integrate the permanent staff at the institute and who different varying degrees of experience with regard to time spent exercising their specialties were compared. The results obtained did not show a significant difference among the various surgeons, and this uniformity is explained by the fact that all the therapeutic planning was elaborated through consensus of the whole group, and this could have minimized the effect of experience of a surgeon responsible for the operation. The authors emphasize the importance of pre-operative evaluation for good results and propose that it is in the direction of complete mastery of preliminary work in the area that programs for the formation of new specialists should be directed.

Early and late assessment of the surgical treatment of the pharyngoesophageal diverticulum by mechanical and manual suture

Rationale: The occurrence of the pharyngoesophageal, or Zenker diverticulum is not frequent in the national scenario, and the technique of the diverticulectomy with cricomyotomy in medium and great dimension diverticula is still the most indicated. Because the resection of the diverticulum requires the suture of the pharynx, dehiscence can occur, thereafter delaying swallowing. Hence, the idea to accomplish this surgical procedure, to compare the manual and mechanical suture in order to evaluate the actual benefit of the mechanical technique. Objectives: The objective of this study is to retrospectively evaluate the results of the pharyngoesophageal diverticulectomy with cricomyotomy using manual and mechanical suture in a series of patients with regard to local and systemic complications. Method: 57 patients with pharyngoesophageal diverticula diagnosed through high digestive endoscopy and pharyngeal esophagram were studied. The applied surgical technique was diverticulectomy with myotomy of the cricopharyngeal muscle, done in 24 patients (42.2%) the mechanical suture (Group A) with the mechanical linear suture device and in 33 (57.8%) a manual closure of the pharynx (Group B). Results: In the postoperative period, one patient of Group A (4.1%) presented fistula caused by dehiscence of the pharyngeal suture, and three of Group B (15.1%) presented the same complication, with a good outcome using a conservative treatment. In the same group, 3 patients (9.0%) presented stenosis of the suture of the pharynx, with good outcome and with endoscopic dilatations, and no patient from Group A presented such complication. Lung infection was present in five patients, being two (8.3%) of Group A and three (9.0%) of Group B, having good outcomes after specific treatment. In the late review, done with 18 patients (75.0%) of Group A and 25 (75.7%) of Group B, the patients declared to be pleased with the surgical procedure, because they were able to regain normal swallowing. Conclusion: The diverticulectomy with myotomy and pharyngeal closure using mechanical suture was proven appropriate, for having restored regular swallowing in most of the patients, and the mechanical closure of the pharynx proved to be more effective in comparison to the manual suture, because it provided a lower index of local post-surgical complications. Correspondence to: José Luis Braga de Aquino, Department of Surgery, Medical School of Pontifical Catholic University of Campinas and Chief of Thoracic Surgery Department of HMCP-FM-PUC, Brazil

ASSESSMENT OF MECHANICAL AND MANUAL SUTURE IN THE SURGICAL TREATMENT OF THE PHARYNGOESOPHAGEAL DIVERTICULUM

Background: The occurrence of the pharyngoesophageal, or Zenker diverticulum is not frequent in the national scenario, and the technique of the diverticulectomy with cricomyotomy in medium and great dimension diverticula is still the most indicated. Because the resection of the diverticulum requires the suture of the pharynx, dehiscence can occur, thereafter delaying swallowing. Hence, the idea is to accomplish this surgical procedure, comparing the manual and mechanical suture, in order to evaluate the real benefit of the mechanical technique. Aim: To evaluate the results of the pharyngoesophageal diverticulectomy with cricomyotomy using manual and mechanical suture with regard to local and systemic complications. Method: Fifty-seven patients with pharyngoesophageal diverticula diagnosed through high digestive endoscopy and pharyngeal esophagogram were studied. The applied surgical technique was diverticulectomy with myotomy of the cricopharyngeal muscle, done in 24 patients (42.2%) the mechanical suture (group A) with the mechanical linear suture device and in 33 (57.8%) a manual closure of the pharynx (group B). Results: In the postoperative period, one patient of group A (4.1%) presented fistula caused by dehiscence of the pharyngeal suture, and three of group B (15.1%) presented the same complication, with a good outcome using a conservative treatment. In the same group, three patients (9.0%) presented stenosis of the suture of the pharynx, with good outcome and with endoscopic dilatations, and no patient from group A presented such complication. Lung infection was present in five patients, being two (8.3%) of group A and three (9.0%) on B, having good outcomes after specific treatment. In the late review, done with 43 patients (94.4%) of group A and 22 (88.0%) on B, the patients declared to be pleased with the surgical procedure, because they were able to regain normal swallowing. Conclusion: The diverticulectomy with myotomy and pharyngeal closure using mechanical suture was proven appropriate, for having restored regular swallowing in most of the patients, and the mechanical closure of the pharynx proved to be more effective in comparison to the manual one, because it provided a lower index of local post-surgical complications.

Avaliação da concordância interobservadores na análise da polipose nasossinusal por meio da tomografia computadorizada

Polipose nasossinusal (PNS) e uma entidade de etiologia controversa, caracterizada por uma condicao inflamatoria da superficie mucosa das fossas nasais e seios paranasais, bilateralmente. A queixa principal do paciente consiste na obstrucao nasal e, ao exame fisico, observam-se frequentemente massas polipoides ocupando as cavidades nasais em extensoes variaveis. Alem da rinoscopia anterior e da endoscopia nasal, o uso da tomografia computadorizada (TC) torna-se necessario para avaliacao das fossas nasais e da presenca ou nao do acometimento dos seios paranasais por essas massas, bem como a sua extensao. Este trabalho tem como objetivo avaliar a concordância interobservadores, por meio da analise da tomografia computadorizada, de 32 casos de PNS. FORMA DE ESTUDO: Clinico prospectivo. CASUISTICA E METODOS: Foram avaliadas 32 TC de pacientes portadores PNS por dois observadores experientes, separadamente, em relacao a presenca ou nao de 3 sinais tomograficos sugestivos dessa doenca: (1) alargamento infundibular do complexo ostiomeatal, (2) abaulamento lateral da lâmina papiracea e (3) apagamento do trabeculado osseo etmoidal. RESULTADOS: Observou-se Qui-quadrado nao significante para o primeiro e segundo sinais (p=0,7055 e p=0,2057) e significante para o terceiro (p=0,0040). Contudo, o coeficiente de correlacao de Kendall entre os dois observadores foi significante para os tres sinais tomograficos acima citados (p<0,001; p=0,01; p=0,03 respectivamente). CONCLUSAO: A maior concordância entre os observadores esteve presente no alargamento infundibular com maior frequencia de positividade desse sinal.