Luis Ubirajara Sennes

Endoscopic anatomy of the pterygopalatine fossa and the transpterygoid approach: development of a surgical instruction model.

Introduction: The pterygopalatine fossa (PPF) is a narrow space located between the posterior wall of the antrum and the pterygoid plates. Surgical access to the PPF is difficult because of its protected position and its complex neurovascular anatomy. Endonasal approaches using rod lens endoscopes, however, provide better visualization of this area and are associated with less morbidity than external approaches. Our aim was to develop a simple anatomical model using cadaveric specimens injected with intravascular colored silicone to demonstrate the endoscopic anatomy of the PPF. This model could be used for surgical instruction of the transpterygoid approach.

Steroid injection in chronic inflammatory vocal fold disorders, literature review

UNLABELLED Steroids are potent inhibitors of inflammation and wound repair. Local administration of steroids directly into the larynx has been reported in many laryngeal diseases. AIM The purpose of this study is to review related literature about the use of steroid injection in patients with benign, inflammatory and chronic vocal disease. METHODOLOGY We performed an electronic survey in Medline database and selected clinical trials regarding steroid use in benign laryngeal diseases. RESULTS Steroids are indicated in these situations: 1) acute inflammatory diseases, mainly when edema compromises the airways; 2) auto- immune disease with laryngeal involvement; 3) laryngeal stenosis; 4) benign lesions of the vocal folds, e.g., nodules, polyps and Reinkes edema, to reduce the inflammatory reactions before phonosurgery or in an attempt to avoid surgery; 5) In phonosurgery, aiming to reduce scarring. In this case, it could be used as a preventive measure in vocal fold scarring, or for scar treatment. CONCLUSION Steroids may be considered an important therapeutic option in the management of many diseases, specially the inflammatory ones, associated with vocal changes.

Paradoxical Vocal Fold Movement: A Case Report

We present a case of one patient with respiratory stridor that was resolved by speech therapy. Paradoxical vocal fold movements were observed by flexible fiberoptic videolaryngoscopy in this patient during episodes of wheezing and dyspnea. Otherwise, normal vocal fold movement was observed in normal conditions of breathing (out of the crisis) and during phonation. Many different terms have been used to describe this entity in the literature, and it is crucial that clinicians recognize the subtle signs of functional stridor. Paradoxical vocal fold motion has to be considered as an important cause of respiratory disease. Its recognition and treatment are discussed in this report.

Injeção de corticosteróide em patologias vocais inflamatórias crônicas, revisão da literatura

Os corticosteroides sao potentes inibidores da inflamacao e da cicatrizacao. Administracao local de esteroides diretamente na laringe tem sido relatada em diversas patologias laringeas. OBJETIVO: O objetivo desse estudo e realizar uma revisao da literatura sobre o uso de infiltracao de corticosteroide em pregas vocais, em pacientes com patologias vocais benignas, inflamatorias e cronicas de laringe. METODOLOGIA: Realizou-se uma busca eletronica na base de dados Medline, selecionando-se estudos clinicos que utilizavam corticosteroides em patologias benignas da laringe. RESULTADOS: Os corticosteroides sao indicados nas seguintes situacoes: 1) doencas inflamatorias agudas, principalmente naquelas relacionadas a edema que comprometa a via aerea; 2) doencas auto-imunes com alteracoes laringeas; 3) estenose laringea; 4) em lesoes benignas inflamatorias das pregas vocais, como nodulos, polipos e edema de Reinke, para diminuir o processo inflamatorio pre-cirurgico ou na tentativa de se evitar uma intervencao cirurgica; 5) em fonocirurgia, com o objetivo de reduzir a formacao de cicatriz. Seu uso pode ser profilatico, visando a prevencao da formacao de cicatriz ou terapeutico em uma cicatriz ja formada. CONCLUSAO: Os corticosteroides podem ser considerados uma opcao terapeutica importante no manejo de varias patologias, principalmente aquelas de origem inflamatoria que causam alteracoes vocais.

Cysts, Sulcus Vocalis, and Mucosal Bridges of the Vocal Fold and Their Association with Polyps

Objectives: Polyps are common lesions of vocal folds. Phonotrauma is related to physiopathology of this lesion. The objective of our study was to analyze the association with polyps and other benign vocal fold lesions (BVFLs). Methods: Sixty-eight patients underwent microlaryngeal surgery due to polyps of vocal folds. We analyzed retrospectively the presence of polyps in association with sulcus vocalis, cysts, and mucosal bridges. Results: The presence of BVFLs associated with polyps occurred in 14 (20.5%) patients. In 8 (57%) patients the polyp was associated with sulcus vocalis, in 4 (29%) with vocal fold cyst and in 2 (14%) with mucosal bridge. BVFLs was contralateral to the polyp in 9 (64%) patients (6 sulcus and 3 cysts). Conclusion: The association between polyps and others BVFLs is relatively frequent (20.5%). The polyp appears to arise from alterations in vocal fold vibration caused by the ipsilateral BVFL or as a result of repeated trauma of the contralateral BVFL.

Diffusion of Aniline Blue Injected into Thyroarytenoid Muscle

Objective: Intralaryngeal injection of botulinum toxin into the thyroarytenoid (TA) muscle is one of the methods for the treatment of laryngeal focal dystonia. The side effects and the modification of the laryngeal configuration are probably due to the diffusion of the botulin toxin to nearby structures. Aim: Analyze the diffusion of aniline blue (liquid substance) injected into the TA to the adjacent intrinsic laryngeal muscles. Method: Study Design: Experimental. Eighteen excised cadaveric larynges were analyzed after injection of aniline blue (0.2 mL) into the TA, using the intralaryngeal technique. After fixation by formaldehyde and decalcification using nitric acid, the larynges were sectioned in the coronal plane in 4 slices and the intrinsic muscles analyzed. Results: The aniline blue spread to the lateral cricoarytenoid muscle, the cricothyroid muscle and the posterior cricoarytenoid muscle 94.3%, 42.9%, and 8.6%, respectively. Gender, height, and width of the TA had no effect on the likelihood of diffusion to any of the muscles. Conclusion: The present study showed that, based on the methodology proposed, the diffusion of a solution injected into the TA occurs in almost all cases toward the CAL muscle. The CT muscle was affected in half of the cases. Although rarely, it can also achieve the PCA muscle.

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.

P080: Use of Carbon-Coated Beads to Augment the Vocal Fold

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.

Use of ultrasound in the differential diagnosis of peritonsillar infections

Abstract Objectives: The aim of this study was to evaluate the use of ultrasound as a noninvasive and inexpensive method of diagnosis, differentiating peritonsillar abscess from peritonsillar cellulitis. Methods: Thirty-nine patients with a clinical diagnosis of peritonsillar infection, 24 females and 15 males (age range, 7 to 44 years), were evaluated in the Clinical Hospital of Sao Paulo University Medical School, in the Otolaryngology Emergency Service. These patients were evaluated with intraoral and percutaneous ultrasound. Needle aspiration was used to compare and confirm the diagnosis. Results: The ultrasound showed 69.3% of the patients with peritonsillar abscess and 30.7% with peritonsillar cellulitis. The sensitivity was 96% and the specificity was 78.5%. Conclusion: The authors conclude that ultrasonography performed by a experienced radiologist proved to be a efficient method in the differential diagnosis of peritonsillar abscess and peritonsillar cellulitis.