Paulo Antonio Monteiro Camargo

Benign masseter muscle hypertrophy

Idiopathic hypertrophy of the masseter muscle is a rare disorder of unknown cause. Some authors associate it with the habit of chewing gum, temporo-mandibular joint disorder, congenital and functional hypertrophies, and emotional disorders (stress and nervousness). Most patients complain of the cosmetic change caused by facial asymmetry, also called square face, however, symptoms such as trismus, protrusion and bruxism may also occur. The goals of the present investigation were: to report a case of idiopathic masseter hypertrophy, describe its symptoms and treatment. The patient reported bilateral bulging in the region of the mandible angle, of slow and progressive evolution. He did not complain of pain or discomfort, however there was bilateral otalgia, nighttime trismus and stress. In his physical exam we noticed bilateral masseter hypertrophy without local inflammatory alterations. We indicated surgical treatment with an extraoral approach. Complementary tests are indicated when there is diagnostic doubts. Treatment varies from conservative to surgical, and the later depends on surgeon skill and experience.

Alterações musculares e esqueléticas cervicais em mulheres disfônicas

The vocal and neck are associated with the presence of tension and cervical muscle contraction. These disorders compromise the vocal tract and musculoskeletal cervical region and, thus, can cause muscle shortening, pain and fatigue in the neck and shoulder girdle. Objective: To evaluate and identify cervical abnormalities in women with vocal disorders, and neck pains comparing them to women without vocal complaints independent of the neck. Method: This prospective study of 32 subjects studied in the dysphonic group and 18 subjects in the control group, aged between 25 and 55 year old female. The subjects underwent assessments, ENT, orthopedic, physical therapy and voice recording. Results: At Rx cervical region more patients in the control group had this normal, however, with regard to the reduction of spaces interdiscal dysphonic patients prevailed. Furthermore, postural assessment, the kyphosis of the 1st thoracic vertebra occurred in 77.0% of non-dysphonic group (p = 0.0091), while cervical rotation was present in 83% of control (p = 0.0051). Conclusion:

Avaliação videofluoroscópica da mastigação e deglutição em indivíduos com disfunção temporomandibular (DTM)

UNLABELLED To study mastication and swallowing disorders in patients with temporomandibular disorders (TMD). OBJECTIVE To investigate mastication and swallowing disorders in patients with severe TMD referred to surgery. MATERIALS AND METHODS Clinical and experimental study involving ten individuals with TMD submitted to deglutition videofluoroscopy. These patients did not have posterior teeth, mastication pain and food replacement in favor of pasty consistence food. The assessment of the oral and pharyngeal phases approached the following aspects: side of onset and preferential side for chewing, premature escape, remains of food residues in the oral cavity or in the pharyngeal recesses, number of necessary swallowing efforts, laryngeal penetration and/or tracheal aspiration. RESULTS During mastication and the oral phase we observed tongue compensatory movements upon chewing (n = 7; 70%), premature escape (n = 4; 40%), food remains in the cavity after swallowing (n = 5; 50%) and an excessive number of deglutition efforts (n = 5; 50%). On the pharyngeal phase we observed food remains in the valleculae (n = 6; 60%), in the pyriform sinuses (n = 4; 40%); laryngeal penetration (n = 1; 10%) and tracheal aspiration (n = 4; 40%). CONCLUSION TMD patients may have alterations in their chewing and swallowing patterns, with laryngeal penetration and/or tracheal aspiration. The study indicates the need for a multidisciplinary assessment because of dysphagia in TMD patients.

Topical mitomycin C effect on swine vocal folds healing.

UNLABELLED Several adjuvant therapies to surgery have been used to modulate the healing process of vocal folds, including topic mitomycin (MTC). AIM to evaluate the effect of topical MTC in the healing process of vocal folds 30 days after the exeresis of a mucosal fragment with CO2 laser in a swine model (control group without mitomycin and study group with topical MTC), with collagen deposition measurement. STUDY TYPE prospective experimental in swine. METHODS two groups of 6 swine each were subjected to exeresis of a mucosal fragment of the vocal fold with CO2 laser. Immediately after the procedure MTC was applied topically for three minutes on the study group. Thirty days later the animals were slaughtered and samples of the vocal folds were collected for histological analysis, with the purpose of quantifying collagen deposition by Picrosirius Red stain. RESULTS the average area of total collagen in the vocal folds in the control group was 2.648,03 microm2, whereas in the study group it was 2.200,30 microm2 (p=0.0043). CONCLUSION topical application of MTC after the exeresis of a mucous fragment of vocal fold with CO2 laser in swine significantly decreased total collagen deposition.

Efeito da mitomicina-C tópica sobre os depósitos de colágeno total na submucosa das pregas vocais íntegras de suínos

OBJETIVO: Estudar o efeito da aplicacao topica de Mitomicina-C em diferentes concentracoes sobre os depositos de colageno total na submucosa de pregas vocais integras de suinos. METODOS: Os animais foram divididos em tres grupos de acordo com o conteudo da solucao topica aplicada sobre as pregas vocais: solucao fisiologica 0,9 % (grupo controle); Mitomicina-C topica 4 mg/mL (grupo 1); e Mitomicina-C 8 mg/mL (Grupo 2). Apos 30 dias da aplicacao, os animais foram submetidos a eutanasia, coletado amostras das pregas vocais e coradas pela tecnica do picrosirius red com polarizacao para a quantificacao computadorizada da deposicao do colageno, atraves do programa Image Pro plus 4.5O. Compararam-se as medias de area do colageno depositado na submucosa das pregas vocais dos tres grupos atraves do teste nao parametrico de Mann-Whitney. RESULTADOS: As medias das areas de deposito colageno na submucosa das pregas vocais foram de 3.110,44 micrometros quadrados (mm2); 3.115,98 mm2 e 3.105,78 mm2 nos grupos controle, 1 e 2 respectivamente. Nao houve diferenca significativa nas areas de depositos de colageno total da submucosa das pregas vocais entre os tres grupos estudados (p>0,05). CONCLUSAO: A mitomicina-C aplicada topicamente em pregas vocais suinas integras nao alterou significativamente a deposicao de colageno na submucosa.

Pharyngeal cervical neurinoma: dysphonia and dysphagia

.Our goal was to check the results of speech, mastication and swallowing rehabilita-tion in a case of neck and pharyngeal neuroma by means of exams: laryngeal, swallowing video fluoroscopy, and electromyography of mastica-tory muscles.CASE PRESENTATIONA 38 year old patient, that after suffering a resection of a neck and pharyngeal neuroma that involved the neck region and the carotid artery, complained of dysphonia, dysphagia and chewing difficulties. In our evaluation we noticed tongue atrophy and reduction of labial mobility on the right side, associated with reduced tongue ele-vation. The videolaryngoscopy showed paralysis of the hemilarynx and also of the right vocal fold in total abduction, reduction in soft palate muscle contraction on the right side and a blowy voice pattern. After a type I thyro-plasty, she presented with a posterior midline triangular vocal fold slit with partial vocal improvement. During swallowing videofluoroscopy we noticed for all types of food material: premature food escape; food residues in the oral cavity; difficulty in transporting the food from the oral phase to the pharynx and food stasis in the piriform fossae and piriform recesses. Electromyography showed a reduction in tem-poral and masseter muscle activity on the right side. Speech therapy reha-bilitation happened in 24 sessions, with isotonic and isometric myofunctional exer-cises of the tongue and masti-catory muscles (masseter and temporalis) and the utterance of vowel /i/ sustained with hands in hook-shape asso-ciated with neck flexion to the right.DISCUSSIONTable 1 depicts the pre and post rehabilitation findings. After speech thera-py, the new tests showed: improvements in ton-gue strength, tonus and mobility; no premature food escape; increase in pharynx constriction muscles contraction, with residue reduction in the piriform fossae; increase in right side tempo-ral and masseter muscles activity and unaltered voice quality. It is important to highlight that the exercises selected for the speech therapy reha-bilitation in this patient were those that, besides indicated, presented the best results during the therapeutic tests. The vocal exercise carried out was then selected because it was the only one that caused a mild reduction in the glottal slit, and also a mild increase in voice blowing pattern during its performance. Along speech therapy, other vocal exercises were selected, associated or not to neck postural maneuvers, but also without good results as far as vocal quality is concerned. FINAL REMARKSThere was a significant improvement in mastication, swallowing, tongue muscle activity and masticatory muscles after speech therapy rehabilitation, although voice quality remained unaltered.