Thiago Bittencourt Ottoni de Carvalho

Seis anos de atendimento em trauma facial: análise epidemiológica de 355 casos

Facial traumas are frequent in emergencies, and they require the diagnosis of fractures and associated lesions. AIM: To analyze epidemiological data concerning facial trauma care. MATERIALS AND METHODS: Three hundred and fifty-five charts from patients with facial trauma treated by the Service of Otorhinolaryngology, from January 2002 to December 2008, were revised. The following data was collected: age, gender, etiology, anatomical localization of the fracture, associated injuries, alcohol consumption, treatment, and hospitalization. STUDY DESIGN: A retrospective historical longitudinal study. RESULTS: Most of the patients are young adult men (p<0.05) with a male:female ratio of 4:1(p<0.05). Interpersonal violence is the most prevalent cause of facial trauma (27.9%), followed by motor vehicle accidents (16.6%) (p<0.05). The mandible is the most prevalent facial bone fractured (44.2%), followed by nasal fracture (18.9%) (p<0.05). 41.1% of the patients consumed alcohol with a male:female ratio of 11.2:1 (p<0.05). Seventy-seven percent of the patients required surgical intervention (p<0.05) and 84.5% were hospitalized (p<0.05). CONCLUSION: Young male adults are the most prevalent victims of facial trauma, and interpersonal violence is responsible for the majority of the facial injuries. Most of the cases of facial trauma are associated with the consumption of alcohol. Further studies will be necessary to provide a clear understanding of the trends in the etiology of facial trauma.

Relationship of obstructive sleep apnea syndrome with the 5-HT2A receptor gene in Brazilian patients.

BackgroundSerotonin (5-HT) regulates a variety of visceral and physiological functions, including sleep. Polymorphisms in the 5-HT2A receptor gene can alter its transcription, affecting the number of receptors in the serotoninergic system, contributing to obstructive sleep apnea syndrome (OSAS).ObjectiveThe aim of this study was to determine the prevalence of the 102T-C and -1438G-A polymorphisms in the 5-HTR2A gene in Brazilian patients with and without OSAS.Subjects and methodsA cross-sectional study performed at the Otorhinolaryngology and Sleep Disorder Out Clinics, São José do Rio Preto Medical School, FAMERP. One hundred patients were examined as index cases and 100 persons as controls, of both genders to both groups. DNA was extracted from peripheral blood leukocytes, and the sites that encompassed both polymorphisms were amplified by PCR-RFLP.ResultsThere was a significant prevalence of the male gender in index cases compared with the control group gender (p < 0.0001). There was no significant genotypic difference in the 102T-C polymorphism between the case and control groups (p = 1.000). The AA genotype of the -1438G-A polymorphism was more prevalent in the patients with OSAS compared with the controls (OR, 2.3; CI 95% 1.20–4.38; p = 0.01).ConclusionsThere was no difference in the prevalence of the 102T-C polymorphism between patients with OSAS and the control group. Serotoninergic system dysfunction appeared to be related to OSAS. The -1438G-A polymorphism and OSAS are related in this studied Brazilian population.

Avaliação dos níveis séricos de testosterona em pacientes com síndrome da apneia obstrutiva do sono

UNLABELLED Males with obstructive sleep apnea syndrome (OSAS) may present decreased testosterone serum levels because of hypoxemia. AIM To correlate testosterone levels in OSAS patients with laboratory parameters. MATERIAL AND METHODS 103 registries of OSAS patients were reviewed from 2002 to 2009. The following data collected: age when polysomnography was done, hematocrit and hemoglobin levels, total testosterone serum levels, BMI, apnea/hypopnea index (AHI), and O2 saturation. STUDY DESIGN A cross-sectional retrospective case study. RESULTS 79 patients (77%) had no hormonal changes, and 24 patients (23%) had decreased serum levels. In patients with normal testosterone levels, 70% were overweight; 63% with altered testosterone levels had obesity grade I (p<0.05). Patients with altered testosterone levels had significantly lower average doses of Ht, Hb and androgen compared to patients without altered androgen levels. The average BMI of patients with altered hormone levels was significantly higher compared to patients with normal hormone levels. CONCLUSIONS The relationship between morning testosterone levels and obesity, and to a lesser degree age, AHI and hypoxemia may be the cause of central suppression of testosterone in these patients. Decreased blood HT and HB levels may be related to lower levels of circulating testosterone.

Molecular pathogenesis of juvenile nasopharyngeal angiofibroma in brazilian patients.

Juvenile nasopharyngeal angiofibroma (JNA) is a vascular tumor of the nasopharynx that accounts for 0.5% of all cancers of the head and neck. It primarily affects males aged 14–25 years. Of the many genes that mediate the development of JNA, GSTM1 has been most frequently associated with this vascular tumor. The loss of expression of GSTM1 (null genotype) is linked to the development of these tumors. The aim of this cross-sectional case study was to examine the prevalence of the GSTM1-null genotype in Brazilian patients with JNA. DNA was extracted from the leukocytes of blood samples from 10 patients. GSTM1 genotypes were analyzed using a PCR-based assay that was designed to identify the wild-type allele of GSTM1. All 10 patients (100%) were males, with a mean age of 17.8 years. The null genotype for GSTM1 was noted in 4 patients (40%)—1 (10%) at Fisch stage I, 1 (10%) at stage III, and 2 (20%) at stage II. No patient with this genotype had stage IV disease. There was no correlation between Fisch classification and GSTM1 genotype (P = .5695). The correlation between age at diagnosis and GSTM1 genotype was not significant (P = .728). The present findings indicate that there is evidence of an association between the GSTM1-null genotype and JNA in this studied Brazilian population.

Polymorphisms in the 5-HTR2A gene related to obstructive sleep apnea syndrome

UNLABELLED Obstructive sleep apnea syndrome (OSAS) is one of the most complex disorders of sleep; it involves several genetic factors that contribute to the phenotype. Serotonin (5-HT) regulates a variety of visceral and physiological functions, including sleep. Gene 5-HTR2A polymorphisms may change the transcription of several receptors in the serotoninergic system, thereby contributing to OSAS. AIM To investigate the prevalence of T102C and -1438G/A polymorphisms in the 5-HTR2A gene of patients with and without OSAS. MATERIAL AND METHOD A molecular study of 100 index-cases and 100 controls of both genders. DNA was extracted from blood leukocytes samples and the regions that enclose both polymorphisms were amplified with PCR-RFLP. STUDY DESIGN A cross-sectional case study. RESULTS There was a significant prevalence of males in index cases compared to controls (p<0.0001). No significant genotypic differences between cases and controls were found in T102C polymorphisms (p=1.000).There were significant differences between the AA genotype of -1438G/A polymorphisms and patients with OSAS (OR:2.3; CI95%:1.20-4.38, p=0.01). CONCLUSION Serotonergic mechanisms may be related to OSAS. There were no differences in the prevalence of T102C polymorphisms in patients with OSAS and the control group. There is evidence of an association between the -1438G /A polymorphism and OSAS.

Gradual approach to refinement of the nasal tip: surgical results

INTRODUCTION The complexity of the nasal tip structures and the impact of surgical maneuvers make the prediction of the final outcome very difficult. Therefore, no single technique is enough to correct the several anatomical presentations, and adequate preoperative planning represents the basis of rhinoplasty. OBJECTIVE To present results of rhinoplasty, through the gradual surgical approach to nasal tip definition based on anatomical features, and to evaluate the degree of patient satisfaction after the surgical procedure. METHODS Longitudinal retrospective cohort study of the medical charts of 533 patients of both genders who underwent rhinoplasty from January of 2005 to January of 2012 was performed. Cases were allocated into seven groups: (1) no surgery on nasal tip; (2) interdomal breakup; (3) cephalic trim; (4) domal suture; (5) shield-shaped graft; (6) vertical dome division; (7) replacement of lower lateral cartilages. RESULTS Group 4 was the most prevalent. The satisfaction rate was 96% and revision surgery occurred in 4% of cases. CONCLUSION The protocol used allowed the implementation of a gradual surgical approach to nasal tip definition with the nasal anatomical characteristics, high rate of patient satisfaction with the surgical outcome, and low rate of revision.

Abscesso de língua: relato de caso

INTRODUCAO: Os abscessos na lingua sao raros mesmo estando frequentemente em contato com traumas, mordeduras, e corpos estranhos. Isto decorre devido as caracteristicas imunologicas da saliva e algumas caracteristicas histologicas e anatomicas da lingua. Este trabalho tem como objetivo relatar um caso de abscesso de lingua ocorrido em nosso servico, e fazer uma revisao da literatura. RELATO DO CASO: Paciente 76 anos, sexo masculino, atendido com queixa de dor a degluticao de evolucao progressiva ha uma semana, com piora importante ha 3 dias. Relata historia de cirurgia para implante dentario no inicio do periodo. Na admissao durante o exame da cavidade oral foi evidenciado abaulamento de aproximadamente 2X2 cm no terco medio posterior de lingua a direita, doloroso a palpacao. Optou-se pela internacao do paciente. Solicitou-se uma ressonância nuclear magnetica que evidenciou lesao sugestiva de abscesso na base da lingua a direita. Foi submetido a tratamento clinico com antibioticoterapia drenagem cirurgica. O paciente evoluiu satisfatoriamente. DISCUSSAO: A manifestacao clinica do abscesso de lingua pode ser variada. O diagnostico deve ser feito pela historia clinica, correlacionando os fatores de risco associados, exame fisico e aos exames de imagem confirmatorios. A etiologia e os diagnosticos diferenciais devem ser considerados dependendo do local da manifestacao clinica. A abordagem deve incluir a permeabilidade da via aerea, suporte clinico, antibioticoterapia sistemica e drenagem do abscesso. CONSIDERACOES FINAIS: O abscesso de lingua deve entrar no diagnostico diferencial dos abaulamentos de lingua devendo ser conduzido com antibioticoterapia e drenagem cirurgica de maneira rotineira.Introduction: The tongue abscesses are rare even being frequently in touch with trauma, bites, and foreign bodies. It occurs because of the immunological features of the saliva and some histological and anatomical characteristics of the tongue. This work has as objective report a case of tongue abscess occurred in our job, and do a literature review. Case Report: Patient of 76 years, male, assisted with complaint of pain when swallowing with progressive evolution for a week, with a significant deterioration over three days. Report history of the surgery, for dental implant in the beginning of the period. In the admission during the oral cavity examination was evident bulging of nearly 2 × 2 cm in the middle third posterior of the right tongue, painful to palpation. Was opted the hospitalization of the patient. Was required a MRI that showed suggestive lesions of abscess in the base of the tongue in the right side. Was submitted to a clinical treatment with antibiotic therapy and surgical drainage. The patient recovered uneventfully. Discussion: The clinical manifestation from the tongue abscess can be varied. The diagnosis must be done by clinic history, correlating risk factors associated, physical exam and the confirmatory imaging exams. The etiology and the differential diagnosis must be considered depending of the place of the clinical manifestation. The approach must include the permeability of airway, clinical support, and systemic antibiotic therapy and abscess drainage. Final Considerations: The abscess of the tongue must go in the differential diagnosis of bulging of the tongue being conducted with the antibiotic therapy and surgical drainage in a daily basis.

Gradual Approach to Refinement of the Nasal Tip: Surgical Results

Objectives: The complexity of the nasal tip structure and the impact of surgical holder maneuvers makes prediction of the final outcome very difficult. Therefore, no technique alone is enough to correct the numerous anatomic presentations adequately being the preoperative planning, the basis of rhinoplasty. This study’s aim is to present results of rhinoplasty, by gradual surgical approach to nasal tip definition based on anatomic features, and evaluate the degree of satisfaction of patients after the surgical procedure. Methods: A retrospective historical cohort study of the medical charts of 533 patients of both sexes who underwent rhinoplasty from January 2005 to January 2012. Cases were allocated into 7 groups: (1) no surgery on nasal tip, (2) interdomal breakup, (3) cephalic trim, (4) domal suture, (5) shield-shaped graft, (6) vertical dome division, and (7) replacement of lower lateral cartilages. Results: Group 4 was the most prevalent. The satisfaction rate was 96%, and revision surgery occurred in 4% of cases. Conclusions: The protocol used allowed the association of the gradual surgical approach to nasal tip definition with the nasal anatomic characteristics, high rate of satisfaction with the surgical outcome, and low rate of revision.

Tongue Abscess: Case Report

INTRODUCAO: Os abscessos na lingua sao raros mesmo estando frequentemente em contato com traumas, mordeduras, e corpos estranhos. Isto decorre devido as caracteristicas imunologicas da saliva e algumas caracteristicas histologicas e anatomicas da lingua. Este trabalho tem como objetivo relatar um caso de abscesso de lingua ocorrido em nosso servico, e fazer uma revisao da literatura. RELATO DO CASO: Paciente 76 anos, sexo masculino, atendido com queixa de dor a degluticao de evolucao progressiva ha uma semana, com piora importante ha 3 dias. Relata historia de cirurgia para implante dentario no inicio do periodo. Na admissao durante o exame da cavidade oral foi evidenciado abaulamento de aproximadamente 2X2 cm no terco medio posterior de lingua a direita, doloroso a palpacao. Optou-se pela internacao do paciente. Solicitou-se uma ressonância nuclear magnetica que evidenciou lesao sugestiva de abscesso na base da lingua a direita. Foi submetido a tratamento clinico com antibioticoterapia drenagem cirurgica. O paciente evoluiu satisfatoriamente. DISCUSSAO: A manifestacao clinica do abscesso de lingua pode ser variada. O diagnostico deve ser feito pela historia clinica, correlacionando os fatores de risco associados, exame fisico e aos exames de imagem confirmatorios. A etiologia e os diagnosticos diferenciais devem ser considerados dependendo do local da manifestacao clinica. A abordagem deve incluir a permeabilidade da via aerea, suporte clinico, antibioticoterapia sistemica e drenagem do abscesso. CONSIDERACOES FINAIS: O abscesso de lingua deve entrar no diagnostico diferencial dos abaulamentos de lingua devendo ser conduzido com antibioticoterapia e drenagem cirurgica de maneira rotineira.Introduction: The tongue abscesses are rare even being frequently in touch with trauma, bites, and foreign bodies. It occurs because of the immunological features of the saliva and some histological and anatomical characteristics of the tongue. This work has as objective report a case of tongue abscess occurred in our job, and do a literature review. Case Report: Patient of 76 years, male, assisted with complaint of pain when swallowing with progressive evolution for a week, with a significant deterioration over three days. Report history of the surgery, for dental implant in the beginning of the period. In the admission during the oral cavity examination was evident bulging of nearly 2 × 2 cm in the middle third posterior of the right tongue, painful to palpation. Was opted the hospitalization of the patient. Was required a MRI that showed suggestive lesions of abscess in the base of the tongue in the right side. Was submitted to a clinical treatment with antibiotic therapy and surgical drainage. The patient recovered uneventfully. Discussion: The clinical manifestation from the tongue abscess can be varied. The diagnosis must be done by clinic history, correlating risk factors associated, physical exam and the confirmatory imaging exams. The etiology and the differential diagnosis must be considered depending of the place of the clinical manifestation. The approach must include the permeability of airway, clinical support, and systemic antibiotic therapy and abscess drainage. Final Considerations: The abscess of the tongue must go in the differential diagnosis of bulging of the tongue being conducted with the antibiotic therapy and surgical drainage in a daily basis.

Análise retrospectiva de cirurgias rinossinusais em um hospital escola

INTRODUCTION: The ENT is a medical specialty that covers 4.4% of all doctors in Sao Paulo, with a variety of surgical procedures distributed between pharynx, nose, ear and larynx. Knowing the profile of a reference service in otolaryngology allows for a better organization, scaling the volume of care and surgeries, providing better training to the student and resident physician. OBJECTIVE: To describe the profile of sinonasal surgery and patients to them in the department of otolaryngology and head and neck surgery at a teaching hospital. METHOD: We conducted a cohort study of cross-sectional retrospective study with review of 872 charts of patients undergoing surgery Sinus between January 2006 and December 2008. Used questionnaires, seeking sex, age, surgical diagnosis and surgery. RESULTS: Of 872 patients studied, 45.4% were female and 54.6% male, ranging in an age group 40-80 years (mean 29.8 years). The main surgical diagnoses were: nasal septum deviation (n=457), nasal deformity after trauma (n=287), enlarged turbinates (n=153), rhinosinusal polyposis (n=73), chronic sinusitis (n=32). Among the most frequently performed surgical procedures include: septoplasty (n=388), rhinoplasty (n=215), FESS (n=131), intra-turbinal cauterization (n=114), reconstructive rhinoplasty (n=73), turbinectomy (n=43), turbinoplasty (n=55). It is emphasized that patients may have received more than one surgical diagnosis and realized more than one surgery, depending on the alert. CONCLUSION: We present the volume and diversity of Sinus surgeries performed in our department, contributing to the scarce scientific literature on this type of case.