Osíris de Oliveira Camponês do Brasil

Age-Related Changes in Human Laryngeal Nerves

OBJECTIVES: We sought to perform a morphometric analysis of myelinated fibers from laryngeal nerves with the aim of verifying quantitative changes due to the aging process. METHODS: A 1-cm fragment was collected from the superior laryngeal nerves and recurrent laryngeal nerves from 12 cadavers during autopsy. The sample was divided in two groups: an adult group (aged <60 years) and an elderly group (aged ≥60 years). RESULTS: The total number of myelinated fibers from the superior laryngeal nerves was similar in both groups (adult group = 9017 ± 1692, elderly group = 7918 ± 1624; P = 0.79). The adult group had a higher total number of myelinated fibers in the recurrent laryngeal nerves than that of the elderly group (adult group = 3276 ± 383, elderly group = 2381 ± 669; P = 0.005), as well as a higher total number of fibers in the laryngeal nerves (both superior and recurrent) than the elderly group (P = 0.02). CONCLUSIONS: The adult group has a higher total number of myelinated fibers in the laryngeal nerves than the elderly group.

Análise de cantores de baile em estilo de canto popular e lírico: perceptivo-auditiva, acústica e da configuraçäo laríngea

Objetivo: deste estudo foi verificar os ajustes laringeos realizados por cantores profissionais do genero popular durante a imitacao do canto em estilo lirico uma vez que muitas vezes ao ouvirmos um cantor popular interpretar uma musica classica percebemos que o mesmo faz modificacoes em sua qualidade vocal, tentando se aproximar, por imitacao, do canto lirico. Forma de estudo: Clinico prospectivo. Material e metodo: Foram analisados 26 cantores profissionais do genero popular, 10 homens e 16 mulheres, atuantes em baile. Foi aplicado questionario sobre perfil vocal, realizada analise perceptivo-auditiva e acustica das vozes e avaliacao nasofibrolaringoscopica para analise da configuracao laringea nos estilos de canto popular e lirico. Resultado: A analise perceptivo-auditiva revelou que, ao cantar um trecho de musica em estilo lirico, o cantor popular muda a qualidade vocal, aumentando o vibrato, o volume vocal, melhorando a ressonância vocal e sobrearticulando mais as palavras. Na analise espectrografica nao foi observada a ocorrencia do formante do cantor em nenhuma das vozes. O ajuste laringeo realizado por cantores populares ao imitarem o estilo de canto lirico foi predominantemente o aumento das constricoes ântero-posterior e mediana sendo que a constricao mediana ocorreu mais no sexo masculino. Os valores de jitter e shimmer reduziram significantemente na vogal cantada em relacao a vogal falada nas vozes femininas.

Drooling: analysis and evaluation of 31 children who underwent bilateral submandibular gland excision and parotid duct ligation.

AIM To evaluate the safety of bilateral submandibular gland excision and parotid duct ligation in order to control drooling in children; to assess its long-term efficacy and complications. STUDY DESIGN longitudinal cohort. MATERIALS AND METHODS Thirty-one children aged 6 to 13 years (7.6 years old in average), with multiple neurological disabilities were submitted to a bilateral submandibular gland excision with parotid duct ligation in order to control ptyalism between December 1999 and December 2005, mean follow up of 36 months. RESULTS According to Wilkies success criteria, 87% of children had excellent or good results and insignificant morbidity was insignificant; with temporary parotid edema as the major complication. CONCLUSION Bilateral submandibular gland excision with parotid duct ligation were safe to be performed in children, with 87% of success in drooling control.

Surgery for aspiration: analysis of laryngotracheal separation in 23 children.

The aim of this study was to analyze the efficacy of laryngotracheal separation (LTS) in eliminating aspiration in children by comparing pre- and postoperative conditions. This prospective study used an internal control group. Children with neurologic impairment and a diagnosis of chronic aspiration were subjected to LTS at the Associação de Assistência à Criança Deficiente (AACD). Twenty-three children had undergone LTS with the modified Lindeman technique. All of them gained complete control of aspiration. Frequency of hospitalization, number of respiratory infections, and level of secretion were statistically reduced. After surgery only 21.7% of the children were capable of oral intake exclusively. LTS is an effective and safe technique that can be used in children resulting in aspiration control in 100% of the patients and without repercussions in the respiratory secretion and pulmonary infections.

Proposta de medição da posição vertical da laringe em repouso

AIM: The purpose of this research is to propose a procedure to measure the vertical larynx position in the neck at rest in young adults without vocal complaint. STUDY DESIGN: Transversal cohort study. MATERIAL AND METHOD: There were 68 subjects, aged between 18 to 44 years, 33 female and 35 male. The anatomical landmarks used for this research study were the right and left jaw angle (RJA and LJA), the centre of the cricoid arch cartilage (CC) and the centre of the sternal furculum (SF). In order to obtain the measures, the subjects were asked to be sitting still with their heads stretched up to the highest possible position. The devices used were a drawing compass and a 20-centimeter ruler. RESULTS: The measurement procedure proved to be easy and it did not show any discomfort to the participants. There was no statistically significant difference between genders related to the vertical larynx position in the neck; however the women presented higher larynx position than men. The vertical larynx position was easily obtained and it seems to be a very interesting parameter to intra-subject clinical follow-up.

Quantitative analysis of myelinic fibers in human laryngeal nerves according to age

INTRODUCTION AND AIM To carry out a morphometric analysis of myelinic fibers in laryngeal nerves aiming to identify quantitative changes as a result of aging. STUDY DESIGN Clinical and experimental. MATERIAL AND METHOD A 1cm fragment was collected from the superior laryngeal nerves and recurrent laryngeal nerves taken from twelve male cadavers. The sample was divided into two groups: those aged below 60 years (Adult) and those aged 60 years or more (Elderly). The material was evaluated under light microscopy coupled with an image analysis system. RESULTS The total number of myelinic fibers from the superior laryngeal nerve was similar in both age groups; there was, however, a trend for a higher number of 1 microm fibers in the adult group (p=0.0744). The adult group had a higher total number of myelinic fibers in the recurrent laryngeal nerve (p=0.0006), and this difference was seen in fibers with diameters between 1-3 microm (p<0.007). The adult group had a higher total number of myelinic fibers in the laryngeal nerves (sum of superior laryngeal nerves and recurrent laryngeal nerves fibers) compared to the elderly group (p<0.0091). CONCLUSION The total number of myelinic fibers in laryngeal nerves is higher for the group aged below 60 years.

Análise quantitativa das fibras mielínicas dos nervos laríngeos em humanos de acordo com a idade

INTRODUCAO E OBJETIVO: Realizar analise morfometrica das fibras mielinicas dos nervos laringeos com a finalidade de verificar modificacoes quantitativas decorrentes do processo de envelhecimento. FORMA DE ESTUDO: Clinico e experimental. Material e Metodo: Foi coletado fragmento de 1cm dos nervos laringeos superiores e nervos laringeos recorrentes de 12 cadaveres do sexo masculino. A amostra foi dividida em dois grupos: idade inferior a 60 anos (Adulto) e idade igual ou superior a 60 anos (Idoso). O material foi avaliado em microscopio de luz acoplado a sistema analisador de imagem. RESULTADOS: O numero total de fibras mielinicas do nervo laringeo superior foi semelhante nos dois grupos etarios, mas com tendencia para o maior numero de fibras de 1µm no grupo adulto (p=0,0744). O grupo adulto apresentou maior numero total de fibras mielinicas no nervo laringeo recorrente (p=0,0006), e esta diferenca ocorreu nas fibras com diâmetros de 1-3µm (p<0,007). O grupo adulto apresentou maior numero total de fibras mielinicas nos nervos laringeos (soma das fibras dos nervos laringeos superiores e dos nervos laringeos recorrentes) que o grupo idoso (p<0,0091). CONCLUSAO: O numero total de fibras mielinicas dos nervos laringeos e maior no grupo com idade inferior a 60 anos.

Histological analysis of autologous fascia graft implantation into the rabbit voice muscle

UNLABELLED The ideal approach for the treatment of glottal insufficiency remains a challenge for laryngologists. AIM This experimental study assessed the histological changes and fibrosis caused by autologous fascia lata grafts into the rabbit voice muscle. STUDY DESIGN A clinical and experimental study. METHODS A 0.2 × 0.2 cm fragment of autologous fascia lata was grafted into the right voice muscle of 14 adult rabbits. Animals were euthanized 30 or 60 days post-procedure and histology of the excised vocal folds was carried out. RESULTS No extensive edema, necrosis or foreign body-type reaction was observed at any time. No significant inflammatory reaction or fibrosis was seen at 30 or 60 days. CONCLUSION The presence of fascia lata in the rabbit voice muscle had no significant influence on inflammation, and does not increase fibrosis. Rabbit voice muscle shows good tolerance to fascia lata grafting.

Laryngeal schwannoma: a case report with emphasis on sonographic findings

Schwannomas are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral, cranial and autonomic nerves. Twenty-five to forty-five percent of all schwannomas occur in the head and neck region, but location of such tumors in the larynx is rarely observed. The present report is aimed at describing a clinical case of laryngeal schwannoma, with emphasis on sonographic findings.

Radiotherapy for early glottic cancer and salvage surgery after recurrence

UNLABELLED Early glottic cancer can be effectively treated with radiation or surgery, but recurrence is a possibility when using any of the treatment modalities. AIM To assess the outcome of radiotherapy as initial treatment in the control of squamous cell carcinoma of vocal cord (T1) and the effectiveness of salvage surgery (endoscopic or open) after treatment failure. MATERIALS AND METHODS A retrospective study was based on the analysis of medical records from 43 patients with T1 squamous cell carcinoma of the glottis, radiotherapy as initial treatment and follow-up period of five years. RESULTS The rate of recurrence after radiotherapy was 30.2% of the cases, mean diagnosis interval was 29.5 months. As an option for salvage treatment, patients underwent open partial laryngectomy or endoscopic surgery with control rates of 77.7% and 25% respectively. CONCLUSION Our cases showed high rates of recurrence after radiotherapy and open partial laryngectomy was more effective for the salvage surgery.