Rodrigo de Paiva Tangerina

Systematic head and neck physical examination as a predictor of obstructive sleep apnea in class III obese patients

Our aim was to determine if anatomical abnormalities of the upper airway (UA) and facial skeleton of class III severely obese patients are related to the presence and severity of obstructive sleep apnea syndrome (OSAS). Forty-five patients (69% females, mean age 46.5 +/- 10.8 years) with a body mass index (BMI) over 40 kg/m(2) underwent UA and facial skeletal examinations as well as polysomnography. Mean BMI was 49 +/- 7 kg/m(2) and mean neck circumference was 43.4 +/- 5.1 cm. Polysomnographic findings showed that 22% had a normal apnea-hypopnea index (AHI) and 78% had an AHI over 5. The presence of OSAS was associated with younger age (P = 0.02), larger neck circumference (P = 0.004), presence of a voluminous lateral wall (P = 0.0002), posteriorized soft palate (P = 0.0053), thick soft palate (P = 0.0014), long uvula (P = 0.04), thick uvula (P = 0.0052), and inferior turbinate hypertrophy (P = 0.04). A larger neck circumference (P = 0.02), presence of a voluminous lateral wall (P = 0.04), posteriorized soft palate (P = 0.03), and thick soft palate (P = 0.04) were all associated with OSAS severity. The prevalence of OSAS in this group was high. A larger neck circumference and soft tissue abnormalities of the UA were markers for both the presence and severity of OSAS. Conversely, no abnormalities in the facial skeleton were associated with OSAS in patients with morbid obesity.

Rhinolithiasis as cause of oronasal fistula

Rhinolithiasis is a disease caused by deposition of organic and inorganic compounds in the nasal cavity, leading to unilateral nasal obstruction, fetid rhinorrhea, epistaxis, and it may cause complications. The authors present a case of rhinolithiasis with oronasal fistula and literature review.

Rinolitíase como causa de fístula oronasal

Rhinolithiasis is a disease caused by deposition of organic and inorganic compounds in the nasal cavity, leading to unilateral nasal obstruction, fetid rhinorrhea, epistaxis, and it may cause complications. The authors present a case of rhinolithiasis with oronasal fistula and literature review.

Clinical and polysomnographic findings in class III obese patients

UNLABELLED The Obstructive Sleep Apnea/Hipopnea Syndrome (OSAHS) is closely related to obesity; a linear relation, however, has not been established, particularly in morbid obesity patients. AIM To evaluate clinical and polysomnographic findings in a group of class III obese patients, and to relate these findings with the presence or absence of OSAHS. MATERIAL AND METHOD Forty five patients with body mass index (BMI) over 40Kg/m2 were selected consecutively. A clinical history, the anthropometric examination and polysomnography were undertaken in all patients. The results of a study group and a control group (with no OSAHS) were compared. RESULTS The sample consisted of 68.9% female and 31.1% male patients. The average age was 46.5 years (SD - 10.8 years); the average BMI was 49 (SD - 7 Kg/m2) and the average neck circumference was 43.4 cm (SD - 5.1 cm). All subjects were habitual snorers and 48.9% had daytime drowsiness. Polysomnography showed that 77.8% had an apnea/hipopnea index over 5. The findings associated with OSAHS were: younger age (p=0,02) and an increased neck circumference (p=0.004). CONCLUSION The prevalence of OSAHS was very high, which emphasizes the importance of investigating this syndrome in patients sent for bariatric surgery. The neck circumference was the best OSAHS marked in this group of patients.

Achados clínicos e polissonográficos em pacientes com obesidade classe III

A Sindrome da apneia/hipopneia obstrutiva do sono (SAHOS) apresenta estreita correlacao com a obesidade, porem nao esta estabelecida uma relacao linear de gravidade principalmente em relacao aos extremos como na obesidade morbida. OBJETIVO: Avaliar os achados clinicos e polissonograficos em pacientes com obesidade classe III e correlacionar esses achados com a presenca da SAHOS. MATERIAIS E METODOS: Foram selecionados consecutivamente 45 pacientes com indice de massa corporea superior a 40Kg/m2. Todos foram submetidos a anamnese, exame fisico antropometrico e polissonografia. Os achados foram comparados entre os pacientes com e sem SAHOS. RESULTADOS: 68,9% dos pacientes eram do sexo feminino e 31,1% do masculino. A idade media foi de 46,5 DP 10,8 anos, a media do IMC foi 49 DP 7Kg/m2 e a media da circunferencia cervical foi 43,4 DP 5,1cm. Todos os pacientes eram roncadores habituais e 48,9% tinham queixa de hipersonolencia diurna. Os achados polissonograficos mostraram que 77,8% apresentaram indice de apneia/hipopneia superior a cinco. Apresentaram correlacao com a presenca da SAHOS: idade mais jovem (p=0,02) e maior circunferencia cervical (p=0,004). CONCLUSAO: A prevalencia de SAHOS foi elevada, ressaltando a importância da sua investigacao em pacientes referenciados para cirurgia bariatrica. O principal marcador da SAHOS foi a circunferencia cervical.

Vestibular Schwannoma: spontaneous tumor involution

The natural history of Vestibular Schwannomas (VS) is yet not totally known, but most of them have the tendency to slow growth, sometimes without any kind of symptoms during the individuals entire time. About 69% of diagnosed VS do not grow at all and 16% of these can even regress. Considering tumors that grow, about 70% have grown less than 2mm an year. Advanced radiological diagnosis, especially magnetic resonance imaging with gadolinium helps us diagnose small and less symptomatic tumors. Treatment of choice still is complete tumor resection. Surgical approaches have improved considerably and have helped preserve facial nerve function and hearing. Considering VSs natural history, there is a possibility for conservative treatment for these tumors, because their growth in the first year after diagnosis predicts tumor growth behavior in the next years. Surgery should be done in cases of tumor growth, patients desire or symptoms worsening. Moreover, in terms of postoperative sequelae, there is no difference between patients who underwent surgery immediately after diagnosis and those who underwent initial conservative treatment for these tumors.

Schwannoma vestibular: involução tumoral espontânea

A historia natural dos schwannomas vestibulares ainda nao esta totalmente elucidada, mas sua maioria tende a apresentar crescimento lento, muitos permanecendo sem sintomas durante toda a vida do paciente. Cerca de 69% deste tipo de tumor diagnosticados nao apresentam crescimento e, destes, 16% chegam a apresentar regressao tumoral. Considerando os tumores que apresentam crescimento, cerca de 70% crescem menos de 2 mm ao ano. O avanco nos metodos de diagnostico por imagem, particularmente a ressonância magnetica com contraste de gadolinio, permite o diagnostico cada vez mais de lesoes com sintomas minimos e tamanhos menores. O tratamento de escolha para estes tumores ainda e a resseccao completa do tumor. As tecnicas cirurgicas apresentaram grande avanco nas ultimas decadas, o que possibilitou diminuicao da mortalidade. Assim, a cirurgia, que antes tinha como objetivo apenas a resseccao completa do tumor, agora visa tambem a preservacao da audicao e da funcao do nervo facial. Consideracoes finais: Considerando-se sua historia natural, abre-se a possibilidade de uma conduta conservadora ja que o ritmo de crescimento no primeiro ano apos o diagnostico prediz o comportamento do tumor nos proximos anos. A conduta conservadora nao implica em repudio a cirurgia, devendo ser utilizada em casos de aumento tumoral, piora dos sintomas ou desejo do paciente. Alem disso, em relatos de literatura nao ha diferenca estatisticamente significante entre os pacientes submetidos a cirurgia logo apos o diagnostico ou apos conduta conservadora inicial, no que diz respeito as sequelas pos-operatorias.

Inverted papilloma in the sphenoethmoidal recess

Inverted papilloma is a nasal benign tumor that usually arises from the lateral nasal wall, especially from the middle meatus. It has high local invasive likelihood, high recurrence rates and malignancy potential. Sphenoethmoidal recess involvement is rare and is usually due to sphenoid sinus primary disease. In the literature, no case of isolated sphenoethmoidal recess inverted papilloma has been reported yet. The present report describes an exceptional location of inverted papilloma, arising from the sphenoethmoid recess, without involving the sphenoid sinus.

Schwanoma vestibular como causa de surdez súbita

The sudden Hearing Loss (SHL) is a symptom caused by more than 60 different diseases, including Vestibular Schwannoma (VS). Shaia & Sheehy (1976) presented a study with 1,220 cases of SHL reporting 1% incidence of VS. There is no specific characteristic for the diagnosis of VS and Magnetic Resonance Imaging (MRI) is the gold standard exam to diagnose such disease. AIM: To determine the real incidence of VS presenting as SHL performing MRI in all patients with SHL. STUDY DESIGN: Transversal cohort. MATERIL AND METHOD: Prospective study in which MRI with gadolinium was performed in all patients with SHL in the Emergency Service of Sao Paulo Hospital from April 2001 through May 2003. RESULTS: MRI was performed in 49 patients with symptoms of SHL, with three cases (6.1%) of VS found. CONCLUSION: The real incidence of VS presenting as SHL may be greater than that mentioned in conventional reports probably because MRI had not been performed in all patients with SHL.

Papiloma invertido isolado em recesso esfenoetmoidal

Inverted papilloma is a nasal benign tumor that usually arises from the lateral nasal wall, especially from the middle meatus. It has high local invasive likelihood, high recurrence rates and malignancy potential. Sphenoethmoidal recess involvement is rare and is usually due to sphenoid sinus primary disease. In the literature, no case of isolated sphenoethmoidal recess inverted papilloma has been reported yet. The present report describes an exceptional location of inverted papilloma, arising from the sphenoethmoid recess, without involving the sphenoid sinus.