Tatiana de Aguiar Vidigal

Rosai-Dorfman disease in the differential diagnosis of cervical lymphadenopathy

Rosai-Dorfman Disease or Sinus Histiocytosis with Massive Lymphadenopathy (SHML) is a rare benign disease of unknown etiology, which presents with cervical lymphadenopathy. It is usually seen in younger patients. The extranodal form affect various regions of the head and neck, and is more common in patients with immune abnormalities. It is a self-limited and seldom life-threatening disease, rendering therapy unnecessary in most cases. For those who require therapy because of persistent or worsening symptoms, treatments modalities include surgery, chemotherapy, radiotherapy and steroids. The authors describe one case of a 43-year-old man with bilateral cervical masses, nasal obstruction, fever, weight loss and decreased vision with 6 months duration. As his social history was positive for tobacco and alcohol use, the initial diagnosis was a possible rhinopharyngeal malignant tumor. Medical investigation established the diagnosis of SHML. After therapy, the 6-month follow-up evidenced the patients clinical improvement, although cervical masses persisted. The clinical presentation, histological features, pathogenesis and treatment of this case are discussed.

Doença de Rosai-Dorfman como diagnóstico diferencial de linfadenopatia cervical

A Doenca de Rosai-Dorfman ou Histiocitose Sinusal com Linfadenopatia Macica (SHML) e uma entidade clinica idiopatica, rara e benigna, geralmente apresentando linfonodomegalia cervical. Usualmente acomete pacientes jovens. Manifestacoes extranodais na regiao da cabeca e pescoco sao mais comuns em pacientes com anormalidades imunologicas. E uma doenca autolimitada e, na maioria dos casos, nao ha necessidade de tratamento. Para os que requerem tratamento devido a persistencia ou piora dos sintomas tem sido tentados tratamento cirurgico, quimioterapico, radioterapico e corticoterapia. Os autores relatam um caso de um paciente do sexo masculino, 43 anos, com historia de massas cervicais bilaterais, obstrucao nasal, emagrecimento importante, febre e perda progressiva de acuidade visual ha 6 meses. Trata-se de um paciente ex-tabagista e etilista cronico, onde a suspeita inicial foi de carcinoma espinocelular de rinofaringe. Realizada propedeutica, foi feito diagnostico de doenca de Rosai-Dorfman. Instituida a terapeutica, o seguimento de 6 meses revelou melhora do estado geral do paciente onde mantem as massas cervicais em regressao lenta. A apresentacao clinica, as caracteristicas histologicas, a patogenese e o tratamento sao discutidos neste artigo.

Caudal septoplasty: efficacy of a surgical technique-preliminnary report

UNLABELLED Although not being the most frequent nasal septal deviations, those of the caudal septum account for many complaints. The correction of such defects has always been the subject of much controversy, and several different operative techniques have been described. AIM To assess the efficacy of a surgical technique for correcting caudal septal deviations. MATERIALS AND METHODS Prospective study with preliminary reports of 10 patients who answered a standardized, specific questionnaire (the Nasal Obstruction Symptom Evaluation, or NOSE), underwent acoustic rhinometry and had their noses photographed. Caudal deviations were then corrected through a surgical technique whereby the entire deviated portion is removed and a straight cartilage segment is placed between the medial crura of the alar cartilages, through a retrograde approach, to support the nasal tip. Sixty days after all patients were reassessed. RESULTS As for the NOSE questionnaire, mean pre-operative and post-operative scores were 82.39 and 7.39 respectively (p<0.001). Pre-operative acoustic rhinometry showed mean minimum cross-sectional area (MCA) values of 0.352 and 0.431 cm2, whereas mean post-operative values were 0.657 and 0.711 cm2(p<0.0001). CONCLUSIONS The study results prove, both subjectively (patient satisfaction as measured with a standardized questionnaire) and objectively (acoustic rhinometry findings), that the proposed technique for correction of caudal septal deviation is safe and effective.

The influence of nasal abnormalities in adherence to continuous positive airway pressure device therapy in obstructive sleep apnea patients. What role does the nose play

The role of the nose in obstructive sleep apnea (OSA) is a controversial topic in the literature. The comments made regarding the pathophysiology that exists between the nose and OSA are relevant and important. However, prior research shows that the treatment of nasal abnormalities can improve sleep quality but has limited impact on improvement of OSA. With regard to adherence to air pressure devices, there is a consensus in the literature that nasal surgery is able to decrease therapeutic continuous positive airway pressure (CPAP) pressure [1–4], which could make its use more comfortable and improve adherence. But in fact, only one study showed a significant mean increase of 48.6 min in use of CPAP after surgery [4]. Studies following nasal surgery that measure mediumand long-term adherence are still needed. Another relevant point is that the role of the nose on adherence to CPAP is controversial in the literature. Tarrega et al. [5] found no association between the findings of rhinomanometry and adherence to CPAP, demonstrating results similar to those found by Haddad et al. [6]. On the other hand, Morris et al. [7] and Sugiura et al. [8] found associations between nasal findings and CPAP adherence. So et al. [9] found an association when evaluating patients with a lower apnea-hyponea index, but found no association for the whole group of study subjects. There are two main factors that limit the ability to demonstrate the role of the nose on adherence to CPAP. One is the difficulty in determining an ideal method for the evaluation of nasal function [10]. A second is the fact that adherence to CPAP is multifactorial and not solely dependent upon nasal matters. Further studies that evaluate the nasal function of patients who are non-adherent to CPAP are needed. Adherence to any kind of treatment depends on the sum of the individual approaches to many small factors, and the nose is one of them.

New clinical staging for pharyngeal surgery in obstructive sleep apnea patients

INTRODUCTION The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients. OBJECTIVE To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome. METHODS A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m(2) with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4. RESULTS The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I-V. CONCLUSION The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III).