Vinicius Antunes Freitas

Surgical treatment of otosclerosis in medical residency training

UNLABELLED The number of patients with stapes otosclerosis compared to the number of otorhinolaryngologists has declined over the past several years. As a result a controversy has arisen in the literature, whether or not stapes surgery should be included in residency programs. AIM the objective of the present study is to evaluate the results and complications of estapedotomies performed by residents between January, 1997 and January, 2000, and consequently study the feasibility of including estapedotomies in residency programs. STUD DESIGN: retrospective review of prospectively collected audiometric data. MATERIALS AND METHODS fifty charts of patients that were submitted to a total of 51 primary stapedotomies were reviewed mainly for complications and audiological results. RESULTS there was closure of the air-bone gap within 10 dB HL in 70.5% of ears and closure to within 20 dB HL in 86.3% of ears. There was one ear with total hearing loss (2%). CONCLUSION From the results and complications seen in the present study, and analyzing papers from the literature, it is possible to conclude that stapedotomy is a procedure that can be included in residency programs, if there are surgical cases for the residents.

Cicatricial pemphygoid in the upper aerodigestive tract: report of two cases

Cicatricial pemphygoid (mucous membrane cicatricial pemphygoid) is a chronic autoimmune inflammatory disease characterized by subepithelial bubbles in mucous membranes and, occasionally on the skin. It may affect the mouth, the nose, pharynx, larynx, the eyes, esophagus, anus, genitals and skin; especially affecting patients between fifty and sixty years of life. Treatment includes systemic steroids and immunosuppressive agents. In the present paper we describe two cases with the active disease, and one of them had sepsis because of using immunosuppressive agents and another that presented supraglottic stenosis requiring tracheostomy.

Tratamento cirúrgico da otosclerose na residência médica

The number of patients with stapes otosclerosis compared to the number of otorhinolaryngologists has declined over the past several years. As a result a controversy has arisen in the literature, whether or not stapes surgery should be included in residency programs. AIM: the objective of the present study is to evaluate the results and complications of estapedotomies performed by residents between January, 1997 and January, 2000, and consequently study the feasibility of including estapedotomies in residency programs. STUD DESIGN: retrospective review of prospectively collected audiometric data. MATERIALS AND METHODS: fifty charts of patients that were submitted to a total of 51 primary stapedotomies were reviewed mainly for complications and audiological results. RESULTS: there was closure of the air-bone gap within 10 dB HL in 70.5% of ears and closure to within 20 dB HL in 86.3% of ears. There was one ear with total hearing loss (2%). CONCLUSION: From the results and complications seen in the present study, and analyzing papers from the literature, it is possible to conclude that stapedotomy is a procedure that can be included in residency programs, if there are surgical cases for the residents.

Sphenoid Sinus Inverted Papilloma: A Case Report and Literature Review

Introduction Inverted papilloma is a rare benign tumor of the nasal fossa, which usually originates from its lateral wall. Only 5% of cases demonstrate exclusive sinus involvement. Primary sphenoid sinus involvement is even rarer. Although considered a benign lesion, the tumor has a potentially invasive nature and has also been found to have an associated malignancy rate of 7 to 15%. Objectives To report a case of inverted nasal papilloma originating in a rare location: the sphenoid sinus. Resumed Report a 56-year-old woman, presented to our outpatient clinic complaining of frontal headache, occasional otalgia and recent forgetfulness. She was initially evaluated by a neurologist and then submitted to a head magnetic resonance imaging. A lesion was found to be filling both sphenoid sinuses. Sinus computed tomography showed an opacified sphenoid sinus with apparent bony integrity. The patient underwent sphenoidotomy through a transnasal endoscopic approach. A bleeding papillomatous lesion was identified. A biopsy was performed and histopathologic study suggested inverted papilloma. The lesion was then completely resected. The patient has been followed for 60 days after surgery; no signs of recurrence were found upon flexible nasofibroscope examination. Conclusion Inverted Papilloma exclusively involving the sphenoid sinus is a rare entity. Non specific symptomatology and Clinical presentation make this kind of tumor a diagnostic and therapeutic challenge. The Endoscopic Sphenoidotomy has been the treatment of choice. Close follow-up is required in order to detect possible recurrences and malignant transformation.

Penfigóide cicatricial no trato aerodigestivo superior: relato de dois casos

Penfigoide Cicatricial (Penfigoide Cicatricial de Membrana Mucosa) e uma doenca auto-imune inflamatoria cronica caracterizada pela presenca de bolhas subepiteliais em membranas mucosas e, ocasionalmente na pele. Pode haver acometimento oral, nasal, faringeo, laringeo, ocular, esofagico, anogenital e de pele, predominantemente em pacientes na quinta e sexta decadas de vida. O tratamento preconizado inclui corticoides sistemicos e agentes imunossupressores. Descrevemos neste trabalho dois casos com a doenca em atividade, sendo que um evoluiu com complicacao septica pelo uso de imunossupressor e outro que apresentou estenose supraglotica exigindo traqueotomia.

Malignant Schwannoma in patients with von Recklinghausen disease: report of two cases

Von Recklinghausen’s disease is characterized by the presence of cafe-au-lait spots, multiple neurofibromas and hamartomas. It is a dominant autosomal disease with high penetrance and variable expression, involving the head and neck in 22 to 47% of the patients. It is known as type I neurofibromatosis, in order to differentiate it from central involvement, especially that of the eight cranial nerve (acoustic neuroma type 2 neurofibromatosis) . Malignant transformation varies between 2% and 40%, and these patients are more prone to having malignant tumors of the nervous tissues and other secondary neoplasias. They tend to appear in young patients in the middle of their bodies, and these patients run a high risk of having the tumors turn malignant of worse prognoses and happening earlier on when compared to neurofibromas alone. Malignancy must be suspected when there is a fast growing and painful mass, investigated by image exams (CT, MRI, Bone Scintigraphy and Angiography) for staging, resection evaluation and lesion biopsy purposes. Benign lesions can also show fast growth. Clinical development is characterized by local recurrences, and has poor prognosis in patients with multiple neurofibromatosis, and the lungs are frequently the seat of distant metastasis. Treatment is based on radiotherapy, chemotherapy and surgery; it bears a low 3-year survival rate. CASE REPORTS