Rogerio Borghi Buhler

Fiberoptic endoscopic swallowing disorders in chronic encephalopathy

OBJECTIVE: To evaluate the results of fiberoptic endoscopic examination of swallowing safety in children with cerebral encephalopathy in order to identify patients with oropharyngeal dysphagia. METHODS: 68 children from the Association for the Care of Disabled Children (Associação de Assistência à Criança Deficiente -AACD), São Paulo, were submitted to fiberoptic endoscopic examination of swallowing safety from March 1999 to March 2000. RESULTS: We observed premature spillage (53%), penetration in a pureed consistency (5.9%), penetration in a liquid consistency (4.4%), tracheal aspiration in a pureed consistency (14.7%), tracheal aspiration in a liquid consistency (32.3%), residue (7.4%), cough effectiveness (44.1%). CONCLUSIONS: Children showed a high incidence of pharyngeal swallowing disorders. Tracheal aspiration was the most important disorder because it is related with high morbidity in children with cerebral encephalopathy. The texture and consistency of the patientacute;s diet may be modified to decrease the risk of aspiration and improve swallowing examination.

Avaliação nasofibrolaringoscópica da deglutição em crianças

Introduction: Very little has been published about the disorders of deglutition in children with neurological impairment. The swallowing difficutties found by children with cerebral palsy are debilitating, particularly by the chronic pulmonary diseases and malnutrition. Study design: Prospective clinical no randomized. Objective: The purposes of this study were to (1) asses the use of nasoendoscopic examination of swallowing in chlidren and (2) describe the swallowing pharyngeal abnormalities. Material and method: The data reported here were extracted from a database on 134 pediatric swallow studies. All children had primary diagnosis of cerebral palsy, with swallowing abnormalities. The ages ranged from four months to 14 years. Results: The prevalence of each type of abnormality in the study group was: premature spillage (53,7%), tracheal aspiration in a liquid consistence (33,6%), tracheal aspiration in a pureed consistence (14,9%). There was regular agreement between the finds of premature spillage and tracheal aspiration. None of the children had complications during the exam. Conclusion: It was concluded that the nasoendoscopic evaluation of swallowing is a valid and valuable tool for evaluating pharyngeal dysphagia in children.

Adenoma pleomórfico de parótida: aspectos clínicos, diagnósticos e terapêuticos

The neoplasias of the parotid gland are a heterogeneous group with more than 30 histological kinds already defined, and the pleomorphic adenoma is the most common benign tumor. AIM: In this study we present our case of parotid gland pleomorphic adenoma, with the purpose of discussing the clinical presentation, the diagnosis and the more suitable surgical techniques to treat this disorder. MATERIAL AND METHOD: A retrospective clinical study was carried out on a group of 68 patients with histological diagnosis of parotid gland pleomorphic adenoma who underwent surgery at the Department of Otolaryngology of the HSPE-FMO, from January 1982 to June 2002. The data regarding their age, sex, more frequent symptoms, supplementary tests performed, location, size, surgical technique used, treatment complications and evolution were gathered. RESULTS: In our case we observed a higher incidence in female patients, being more frequent in their fifth decade of life. The most common clinical presentation was of a nodule at the parotid region, this sign being present in 100% of the cases. Superficial parotidectomy by identifying and preserving the facial nerve was the more common surgery (91.2 % of the cases). The more frequent post-surgical complications were paresis (14.7%) and paralysis (7.3%) of the facial nerve, followed by the Freys syndrome (4.4%). CONCLUSION: The pleomorphic adenoma is the most common benign neoplasia of the parotid gland, being more frequent in female patients from their fifth decade of life. It is a clinically diagnosable neoplasia, to be confirmed with a histopathological examination. The superficial parotidectomy is the basic procedure to diagnose and treat it, being low the recurrence index with this surgery.

Collagen Type I, Collagen Type III, and Versican in Vocal Fold Lamina Propria

OBJECTIVE To analyze the distributions of collagen type I, collagen type III, and versican in the lamina propria of the human vocal fold. DESIGN Cross-sectional analysis of cadaveric vocal folds of adult human larynges. SETTING Academic tertiary referral center. SUBJECTS Larynges harvested at autopsy from 10 adult men and 10 adult women. MAIN OUTCOME MEASURES Immunohistochemical reactions were performed using antihuman monoclonal antibodies to analyze the expression of collagen type I, collagen type III, and versican. RESULTS Collagen type I density was lower in the intermediate layer compared with the superficial and deep layers of vocal folds. Collagen type III density was lower in the intermediate layer compared with the deep layer. Versican density was lower in the superficial layer compared with the intermediate and deep layers. Versican density was lower in the lamina propria of women compared with men; this difference was noted in the superficial layer only. There was a positive correlation between collagen type III and versican densities within the lamina propria. CONCLUSION Collagen type I, collagen type III, and versican are distributed differently within the lamina propria layers of the adult vocal folds.