Leandro Ribeiro

Needle in the external auditory canal: an unusual complication of inferior alveolar nerve block

Inferior alveolar nerve block is used to anesthetize the ipsilateral mandible. The most commonly used technique is one in which the anesthetic is injected directly into the pterygomandibular space, by an intraoral approach. The fracture of the needle, although uncommon, can lead to potentially serious complications. The needle is usually found in the pterygomandibular space, although it can migrate and damage adjacent structures, with variable consequences. The authors report an unusual case of a fractured needle, migrating to the external auditory canal, as a result of an inferior alveolar nerve block.

Hypoparathyroidism following thyroidectomy: Predictive factors

OBJECTIVE To evaluate the incidence and predictive factors for transient and permanent hypocalcemia and hypoparathyroidism following thyroidectomy. METHOD We studied all the 162 patients that underwent thyroid surgery in the ENT department of the Centro Hospitalar Vila Nova Gaia/Espinho from January 2005 to December 2014. We reviewed pre-operative, 6h and 12h after surgery ionized calcium and PTH levels. All patients were reviewed and evaluated according to the following criteria: gender, age, thyroid function, histologic diagnosis of the specimen, surgery extension and presence or absence of hypoparathyroidism. RESULTS There were 31 (19.1%) cases of transient hypoparathyroidism and 8 (5%) of permanent hypoparathyroidism. No significant difference was found for transient hypoparathyroidism when patients were analyzed by gender. However, all cases of permanent hypoparathyroidism were observed in female individuals. Comparing hemithyroidectomy with all other surgical procedures, we found that extension of surgery was a great predictor of transient (p=0.0001) and permanent (p=0.001) hypoparathyroidism. Diagnosis of malignancy was a strong predictor of transient hypoparathyroidism (p=0.002). It was also associated with permanent hypoparathyroidism, although differences did not reach statistical significance (p=0.096). CONCLUSION Extension of surgery (total thyroidectomy) and diagnosis of malignancy are predictors of transient and permanent hypoparathyroidism.

Cochleotoxicity monitoring protocol

Introduction Cochlear damage is frequent in long-term aminoglycosides therapy or chemotherapeutic treatments with platinum-based agents. Despite its prevalence, it is currently underestimated and underdiagnosed. A monitoring protocol is vital to the early detection of cochleotoxicity and its implementation is widely encouraged in every hospital unit. Our aim was to elaborate a cochleotoxicity monitoring protocol for patients treated with platinum compounds or aminoglycosides antibiotics.INTRODUCTION Cochlear damage is frequent in long-term aminoglycosides therapy or chemotherapeutic treatments with platinum-based agents. Despite its prevalence, it is currently underestimated and underdiagnosed. A monitoring protocol is vital to the early detection of cochleotoxicity and its implementation is widely encouraged in every hospital unit. Our aim was to elaborate a cochleotoxicity monitoring protocol for patients treated with platinum compounds or aminoglycosides antibiotics. METHODS PubMed® database was searched using terms relevant to drug cochleotoxicity in order to identify the most adequate protocol. Several articles and guidelines influenced our decision. RESULTS There is no consensus on a universal monitoring protocol. Its formulation and application rely heavily on available resources and personnel. High-frequency audiometry and otoacoustic emissions play an important role on early detection of cochleotoxicity caused by aminoglycoside antibiotics and platinum compounds. CONCLUSION A cochleotoxicity monitoring protocol consisting on an initial evaluation, treatment follow-up and post-treatment evaluation is proposed.

Sarcoma de células foliculares dendríticas de la amígdala

80-year-old caucasian man presented in the otorhinolarynology emergency with a 3-week long history of sore throat. his patient reported heavy smoking in the past 20 years. e denied fever, dysphagia or weight loss. On clinical examnation a 2 cm exophytic violaceous mass involving the upper ole of the left tonsil was found. The mucous membrane covring the tonsil was normal, without ulcerations. No other asses or lymphadenopaties were noted. Computed tomography of the head and neck confirmed tumour with 1.9 × 1.8 cm in the left tonsil (Fig. 1). After onsillectomy was performed, histological examination was ompatible with a Follicular Dentritic Cell Sarcoma (FDCS), s the tumour cells expressed CD23, CD21 and Vimentine on mmunohistochemical study (Fig. 2). This tumour was clasified as T1 N0 M0 according to TNM Classification System. ositron emission tomography carried out after the tonsilectomy did not show any residual fixation in the left tonsil rea or the lymph nodes. Because the margins of resection ere positive, partial pharingectomy was performed. The ew margins were tumour free. The patient died 1 week after, at home, of cardiac arrest.

Pharyngolaryngeal Reflux Simulating Vocal Fold Paralysis Hoarseness following Total Thyroidectomy

Objectives: Systemic multifocal fibrosclerosis is a syndrome characterized by the presence of fibrosis in various locations, most often retroperitoneal, mediastinal, and thyroid (Riedel thyroiditis). The fibrosis in the thyroid tissue can extend to the laryngeal cartilages and muscles, leading to respiratory distress. A thyroidectomy is, in these cases, an intervention to consider. Recognize potential “rare” causes of hoarseness following thyroid surgery. Method: Hoarseness case study. A 69 year old man presented to the ear, nose, and throat (ENT) consultation with a history of hoarseness and aspiration following total thyroidectomy for Riedel’s thyroiditis. Physical examination revealed exuberant pharyngolaryngeal reflux with consequent edema and redundancy of arytenoid mucosa with simetric mobility of the vocal folds. Results: Worsening dysphonia after total thyroidectomy, particularly in the context of Riedel thyroiditis, leads to suspicion of iatrogenic vocal fold paresis. The vocal fold preserved mobility, associated with signs of exuberant pharyngolaryngeal reflux with extensive mucosal damage, reveals an unsuspected cause of hoarseness. The authors postulate that post-operatory changes in esophagic sphincter pressure may have triggered reflux. Conclusions: Rare causes of hoarseness following thyroid surgery should be considered in order to promptly establish a correct treatment plan.