Michelle Manzini

Glandular odontogenic cyst: an uncommon entity

The glandular odontogenic cyst is a cyst that arises in development sites of the teeth; it is usually found in the mandible and maxilla,1 and is characterized by cuboi-dal or columnar epithelium on the surface and in crypts within the epithelium.This cyst generally is encountered in the anterior areas of the mandible; it is more common in adults aged over 40 years, and tends to recur. The recorded prevalen-ce ranges from 0.012 to 1.3%.

Vertical Dome Division: A Quality-of-Life Outcome Study

Objective To assess quality-of-life outcomes in patients undergoing nasal tip surgery with the vertical dome division technique using validated instruments (Rhinoplasty Outcome Evaluation [ROE] and Nasal Obstruction Symptom Evaluation [NOSE]). Study Design Case series with planned data collection. Setting Tertiary university center. Subject and Methods Patients undergoing primary cosmetic and functional rhinoseptoplasty using vertical dome division were consecutively evaluated. The ROE, NOSE, and 100-mm visual analog scale (VAS) were administered pre- and postoperatively. Results Forty-four patients were included and completed pre- and postoperative questionnaires. Their median age was 28 years, 27 (61%) were female, and the median duration of follow-up was 5 months (range, 3-9 months). Median postoperative ROE, NOSE, and VAS scores (79 [66; 87], 20 [15; 23], and 88 [61; 97], respectively) showed significant improvement compared with preoperative scores (29 [16; 41], 75 [60; 95], and 65 [46; 82], respectively; P < .001). The change in median ROE score was significantly greater in normal- and thin-skinned patients than in thick-skinned patients (54 vs 33; P = .033). Median changes in NOSE-p (−48.5 vs −68.0; P = .10) and VAS (69.0 vs 48.0; P =.083) scores did not differ between normal-/thin- and thick-skinned patients. Conclusion Vertical dome division is a versatile technique for nasal tip refinement that resulted in significant improvement in quality-of-life outcomes related to rhinoplasty and nasal obstruction, as well as satisfaction with nasal appearance in a short-term follow-up period. The vertical dome division technique does not seem to be indicated only in patients with thick skin.

Nasal histoplasmosis without lung involvement in an immunocompromised patient

1 Second-year Resident Physician at the ENT Service of the Porto Alegre University Hospital (Resident Physician). 2 PhD in Epidemiology Federal University of Rio Grande do Sul. Hospital de Clínicas de Porto Alegre. Send corresponce to: Michelle Lavinsky-Wolff. Rua Ramiro Barcelos, no 2350, zona 19, Santa Cecília. Porto Alegre RS. CEP: 90035-903. Paper submitted to the BJORL-SGP (Publishing Management System Brazilian Journal of Otorhinolaryngology) on June 26, 2011; and accepted on November 24, 2011. cod. 8653. CASE REPORT Braz J Otorhinolaryngol. 2012;78(5):136. BJORL

Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil.

INTRODUCTION Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. OBJECTIVE To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. METHODS Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. RESULTS 123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77±0.84 vs. 1.7±1.00 comorbidities; p<0.001). CONCLUSION Tracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities.

Mandible giant-cell reparative granuloma

A 30 year old brown woman came to our ENT outpatient ward because of a recurrence of a left mandible tumor, with a progressive, painless growth, associated with facial deformity after a surgical remo-val of a giant cell reparative granuloma in the previous year.She reported a prior dental removal, 11 years before in the left mandible region. She denied past diseases.The physical exam showed a hard and painless tumor, a bone notch in the left mandibular region associated with facial deformity.Routine workup, serum calcium, phosphorus and alkaline phosphatase were normal.The panoramic radiograph showed a radiolucent area in the left mandible body, a recent post-surgical area, with mild radiologic signs of bone regeneration.The mandible CT scan showed a morphostructural alteration with bone re-modeling and a large irregular lithic area in the mandible body and left mandible alveolar processes which could correspond to post-surgical alteration or tumor recur-rence (Figure 1).The tumor was surgically excised without complications.The pathology exam confirmed central giant cell granuloma.

Preparo de cólon para colonoscopia com polietilenoglicol versus sulfato de magnésio em pacientes acima de 70 anos de idade

OBJECTIVES: To compare efficacy and safety of magnesium sulphate in relation to polyethylene glycol in bowel preparation for colonoscopy. METHODS: Sixty patients older than 70 years old, of both genders, were selected for the study, and were randomly divided into two groups: the control group, using polyethylene glycol and the in study group with magnesium sulphate. Quality of preparation, patient tolerance, and side effects produced by each substance were evaluated. Colonoscopist was blinded in relation to the information of bowel preparation. RESULTS: Patients present a homogeneus distribution in groups, in factors as age, past pathologies, side effects, cleansing quality and time taken to reach cecum during colonoscopy. There were differences in gender distribution, being higher the number of female individuals in the group which used magnesium sulphate, however with no statistical significance. CONCLUSION: Magnesium sulphate presented no statistical difference in relation to safety and efficacy levels in patients older than 70 years old, for bowel preparation, when it is compared with polyethylene glycol.

Sinonasal computed tomography in pediatric cystic fibrosis: do we know the indications?

OBJECTIVES To investigated the correlation between sinonasal computed tomography (SNCT) findings and sinonasal symptoms, genotype, chronic colonization by Pseudomonas aeruginosa, forced expiratory volume in the first second (FEV1), body mass index (BMI), Shwachman-Kulczycki (SK) score, and Bhalla score in patients with cystic fibrosis. METHODS We retrospectively reviewed the medical records of 61 patients aged 2-16 years who received care at the Pediatric Cystic Fibrosis Center of our institution over a 10-year period. SNCT findings were graded using the Lund-Mackay scoring system. For patients who had SNCT scans performed at two different time points, the findings from both examinations were compared. RESULTS Patients with chronic P. aeruginosa colonization and patients with atelectasis had higher Lund-Mackay scores (p = 0.04 and p = 0.01, respectively). There was no difference in Lund-Mackay scores between sinonasal symptomatic and asymptomatic patients (p = 0.45). Among patients who had two SNCT scans available (n = 11), those with no evidence of bronchiectasis on chest CT had decreased Lund-Mackay scores compared to those with evidence of bronchiectasis, who had an increase in their scores (p = 0.03). Variations in the Bhalla score were positively and variations in the SK score were negatively correlated with variations in the Lund-Mackay score (r = 0.74, p = 0.01; and r = -0.85, p < 0.01). CONCLUSIONS Associations between SNCT findings, chronic P. aeruginosa colonization, SK score, and chest CT findings were demonstrated. Further studies with larger sample sizes are needed to evaluate patient follow-up and assess the benefits of the sinonasal treatment strategy adopted for patients who exhibit pulmonary deterioration despite controlling for other factors associated with exacerbation.

Maxillary Hypoplasia: Differential Diagnosis of Nasal Obstruction in Infants

Abstract Maxillary hypoplasia (MH) is a rare cause of respiratory dysfunction in infants and may occur in association with genetic abnormalities or as an isolated condition. It is included in the differential diagnosis of congenital nasal obstruction. This paper seeks to report a case series of infants with MH, discuss methods for its diagnosis, and compare computed tomography (CT) measurements of nasal cavities of infants with MH and without craniomaxillofacial abnormalities. The therapeutic approach in each patient is also described. All infants with MH admitted to a tertiary hospital between 2012 and 2015 were included. Baseline nasal endoscopy was performed at bedside. The width of the infants’ nasal cavities was measured by a radiologist with experience in CT scanning of facial bones. Control patients were infants of matched sex and similar age who underwent head CT scanning for various reasons. Overall, 8 infants with MH and 8 controls were assessed. All nasal cavity dimensions of infants with MH were significantly smaller than those of control subjects. The authors conclude that the diagnosis of MH should be considered in infants with nasal obstruction and nasal cavity narrowing at nasal endoscopy.

Response to OK-432 sclerotherapy in the treatment of cervical lymphangioma with submucosal extension to the airway☆

Linfangioma é uma malformação linfática localizada, que ocorre com mais frequência na região da cabeça e do pescoço. Sua etiologia permanece desconhecida; alguns autores acreditam que se trate de malformação congênita dos vasos linfáticos, já outros creem que alguns fatores adquiridos levem a obstrução linfática, retenção de linfa, linfangiectasia e proliferação. Sua incidência é de um caso para 6.000 a 16.000 nascidos vivos.