Reginaldo Raimundo Fujita

Results of a prospective trial on elective modified radical classical versus supraomohyoid neck dissection in the management of oral squamous carcinoma

BACKGROUND Elective treatment of the neck in oral squamous cell carcinoma has changed over the last 20 years. The main object of this report is to present the results of a multi-institutional prospective study designed to compare standard treatment with modified radical classical neck dissection (MRND) to supraomohyoid neck dissection (SOH) in the management of the clinically negative neck in oral cancer patients. PATIENTS AND METHODS A total of 148 patients were included in the trial. All patients had previously untreated T2 to T4 N0 squamous cell carcinoma of the oral tongue (62 cases), floor of the mouth (49 cases), inferior gingiva (12 cases), or retromolar trigone (25 cases). Tumor stages were T2, 91; T3, 27; and T4, 30. There were no significant imbalances between groups. RESULTS The false-negative rate was 28%, and most positive nodes were sited at level II and III. Complications were seen in 41% of MRND patients and in 25% of SOH patients (P = 0.043). Median total duration of hospitalization was 9 days in MRND patients and 7 days in the SOH group. To date, 19 and 16 patients presented with local and neck recurrences, respectively. The 60-month actuarial survival rates were 63% in the MRND group and 67% in the SOH group (P = 0.7150). CONCLUSIONS This study demonstrates that the recurrence and survival rates were similar in both groups. SOH neck dissection can be recommended as standard elective treatment for patients with T2-T4 oral squamous cell carcinomas.

End results of a prospective trial on elective lateral neck dissection vs type III modified radical neck dissection in the management of supraglottic and transglottic carcinomas

Either modified type III radical neck dissection (MRND) or lateral neck dissections (LNDs) are considered valid treatments for patients with laryngeal carcinoma with clinically negative neck findings (N0). The object of this prospective study was to compare complications, neck recurrences, and survival results of elective MRND and LND on the management of laryngeal cancer patients.

Ocorrência da síndrome da apneia obstrutiva do sono (SAOS) em crianças respiradoras orais

UNLABELLED It is well known that mouth breathing is associated with adenotonsillar hypertrophy - which is the main cause of obstructive sleep apnea among children. Despite the importance of this matter, there are only a handful of studies showing the relationship between OSAS and mouth breathing. AIM to determine the prevalence of obstructive sleep disorders in mouth breathing children and study its correlation with otorhinolaryngological findings. STUDY DESIGN Retrospective cohort study. METHOD Data analysis from 248 medical charts of mouth breathing children seen at the Pediatric Otolaryngologic Division of a large medical institution between the years of 2000 and 2006. All patients had nasofibroscopy and or Cavum radiographs and polysomnographic exams. According to the Apnea index, patients were classified as primary snorers (AI<1); and as OSAS (>1). RESULTS From 248 patients included in the study, 144 (58%) were primary snorers and 104 (42%) had OSAS. The most prevalent otorhinolaryngological findings were adenotonsillar hypertrophy (n=152; 61.2%), tonsilar hypertrophy (n=17; 6.8%), adenoid hypertrophy (n=37; 14.9%), rhinitis (n=155; 62.5%) and secretory otitis (n=36; 14.5%). CONCLUSIONS primary snoring and OSAS are frequent findings in mouth breathing children. The most frequent otorhinolaryngological disorder in children with OSAS is adenotonsillar hypertrophy with or without rhinitis.

Endoscopic transeptal surgery for choanal atresia with a stentless folded-over-flap technique

OBJECTIVE: To analyze long-term results of a new stentless surgical technique for choanal atresia that also used no packing. STUDY DESIGN: Prospective study. METHODS: Ten patients (3 bilateral and 7 unilateral), with ages ranging from 4 days to 30 years, were operated on. The follow-up was 6 months to 36 months. This approach allowed resection of the posterior portion of the vomer, atretic plate, and part of the medial pterygoid process. Flaps were fashioned from septal, nasal, and pharyngeal mucosa from the atretic plates and fixed with fibrin glue. Postoperative control included nasal endoscopy and computerized tomography (CT). RESULTS: Adequate functional nasal breathing was maintained during follow-up. CONCLUSIONS: This technique was satisfactory and safe, allowing fast recovery in a one-step surgery, using neither stents nor nasal packing. Long-term patency with no reduction in functional quality was also observed.

OSAS in children: correlation between endoscopic and polysomnographic findings.

OBJECTIVES: To correlate polysomnographic findings with clinical history of apnea, the degree of obstruction caused by tonsillar hypertrophy, and to age group. STUDY DESIGN AND SETTING: 267 children with a clinical diagnosis of obstructive sleep apnea (OSAS) were evaluated. Patients were divided into preschool- and school-age categories, and subdivided in 3 additional groups, according to tonsillar hypertrophy. Polysomnographic findings were compared within groups. RESULTS: 34% of children had history of OSAS and normal polysomnographic findings. Tonsillar hypertrophy was correlated to more severe apnea among preschool-age children, but not among school-age children. Among children with tonsillar hypertrophy, more severe apnea was observed in preschool-age children than in school-age children. CONCLUSIONS: There is little correlation between polysomnographic and clinical findings in children with OSAS. SIGNIFICANCE: Adenotonsillar hypertrophy leads to more severe polysomnographic patterns in preschool-age children. More severe apnea is observed in younger children with adenotonsillar hypertrophy than in older ones.

Assessment of cognitive learning function in children with obstructive sleep breathing disorders

UNLABELLED Sleep obstructive breathing disorders are frequent in children but the impact of sleep deprivation on the cognitive learning function is unclear. AIM To establish whether patients with sleep obstructive breathing disorders show any functional change in learning, memory and attention. MATERIAL AND METHODS Eighty-one children aged from 6 to 12 years were divided into 3 groups: obstructive sleep apnea syndrome (OSAS), n=24; primary snoring (PS), n=37; and control, n=20. The groups were assessed using learning (Rey) and psychological (Digit, Code, Letter Concealing, and Symbol) tests. RESULTS OSAS and PS children showed statistically significant worse performance on the variable A1 in Rey test (learning and memory) when compared with controls (p=0.011). PS children had an even worse performance on the variables A2, A4, AT and A6 compared to OSAS participants and controls (p=0.020;p=0.050;p=0.004,p=0.05). CONCLUSION Children with obstructive sleep breathing disorders, in particular PS, show worse Rey test scores. PS and OSAS children performed similarly in attention tests.

Avaliação da função cognitiva da aprendizagem em crianças com distúrbios obstrutivos do sono

Sleep obstructive breathing disorders are frequent in children but the impact of sleep deprivation on the cognitive learning function is unclear. AIM: To establish whether patients with sleep obstructive breathing disorders show any functional change in learning, memory and attention. MATERIAL AND METHODS: Eighty-one children aged from 6 to 12 years were divided into 3 groups: obstructive sleep apnea syndrome (OSAS), n=24; primary snoring (PS), n=37; and control, n=20. The groups were assessed using learning (Rey) and psychological (Digit, Code, Letter Concealing, and Symbol) tests. RESULTS: OSAS and PS children showed statistically significant worse performance on the variable A1 in Rey test (learning and memory) when compared with controls (p=0.011). PS children had an even worse performance on the variables A2, A4, AT and A6 compared to OSAS participants and controls (p=0.020;p=0.050;p=0.004,p=0.05). Conclusion: Children with obstructive sleep breathing disorders, in particular PS, show worse Rey test scores. PS and OSAS children performed similarly in attention tests.

Auditory processing assessment in children with obstructive sleep apnea syndrome

INTRODUCTION The obstructive sleep apnea syndrome (OSAS) is a respiratory disorder that occurs during sleep and it is relatively common in children. AIM The goal of this paper is to verify if there is a relationship between the obstructive sleep apnea syndrome (OSAS) and auditory processing. METHODS In order to do that, three groups of children ranging in age from 5 to 11 were studied, including a normal group. Twenty subjects who made up the study group were submitted to ear, nose and throat (ENT) exams and to polysomnography (PSG), and were divided in two groups: GROUP I (RO) comprised of 10 children who presented oral breathing and displayed normal PSG, and GROUP II (SAS) comprised of 10 children who presented oral breathing and displayed abnormal PSG. Their performance was compared to the performance of the third group--GROUP III (REN) comprised of 10 children who did not refer ENT difficulties. All the subjects completed a basic audiometric assessment as well as an auditory processing diagnosis. RESULTS The analyses of the results revealed a statistically significant difference in ENT exams related to the turbinate and the palatine tonsils. Group II presented a higher incidence of turbinate hypertrophy levels II and III (p<0.001) and palatine tonsils hypertrophy grades III and IV (p 0.007). Regarding the auditory processing assessment, a statistically significant difference (p<0.001) was obtained in the dichotic digits test. Group II performed worse than group III. Also, for the non-verbal sequence memory test, Group II obtained a worse result (p<0.022) than Group I. CONCLUSION Subjects with OSAS obtained worse results in auditory processing tests.

Avaliação videoquimográfica da vibração de pregas vocais no pré e pós hidratação

Keeping the body hydrated is one of the factors that contribute to organic and functional laryngeal health, especially for professional voice users. Hydration is considered an important factor for the prevention and treatment of dysphonias. There is no objective evaluation that quantifies water present in the vocal fold tissue. AIM: To evaluate changes in vocal folds investigated through videokymography after internal and external hydration of voice professionals. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: We assessed six male professional voice users after leaving the workplace (six hours) and without having drunk water for the past four hours. We conducted ENT evaluation, comprising the first laryngeal assessment with laryngoscopy with and without stroboscopic and videokymography. These people were submitted to external and internal laryngeal hydration. They drank two glasses of hydrating solution with electrolytes, Passion Fruit Flavor (total of 300 ml), at room temperature, and external hydration with inhalation of saline solution at 0.9% during 10 minutes. Using videokymography we evaluated the time of open and closed phases during phonation, defining a quotient between these two parameters. RESULTS: We found five subjects with reduced or increased quotient. CONCLUSION: Videokymography was able to detect differences at the vibrating characteristics of vocal folds before and after hydration.

Gastroesophageal Reflux in patients with Recurrent Laryngeal Papillomatosis

UNLABELLED Evidence of a relation between gastroesophaeal reflux and pediatric respiratory disorders increases every year. Many respiratory symptoms and clinical conditions such as stridor, chronic cough, and recurrent pneumonia and bronchitis appear to be related to gastroesophageal reflux. Some studies have also suggested that gastroesophageal reflux may be associated with recurrent laryngeal papillomatosis, contributing to its recurrence and severity. AIM the aim of this study was to verify the frequency and intensity of gastroesophageal reflux in children with recurrent laryngeal papillomatosis. MATERIAL AND METHODS ten children of both genders, aged between 3 and 12 years, presenting laryngeal papillomatosis, were included in this study. The children underwent 24-hour double-probe pH-metry. RESULTS fifty percent of the patients had evidence of gastroesophageal reflux at the distal sphincter; 90% presented reflux at the proximal sphincter. CONCLUSION the frequency of proximal gastroesophageal reflux is significantly increased in patients with recurrent laryngeal papillomatosis.