Pneumomediastino espontâneo (síndrome de Hamman) relato de dois casos

Objective: Describe two cases of spontaneous pneumomediastinum in the same service unit in young patients of different sex and that showed good progress with conservative treatment. Methods: The first case is a male patient, 18, with neck pain on the right side complaints and dysphonia for 2 days. Denied injuries or ingestion of strange bodies, heavy physical exertion, coughing and vomiting or drug use. CT of the chest and neck revealed the presence of bilateral anterior cervical subcutaneous emphysema, pneumomediastinum presence and absence of pneumothorax. The second case to be analyzed it is a female patient, 16 years old, complaining of sudden dyspnea and standard voice change (nasal). It was identified to fine crackling suggestive cervical palpation of subcutaneous emphysema. He denied any probable cause of secondary pneumomedistino. CT of the chest and neck revealed sharp pneumomediastinum extending to the deep neck spaces. Result: Both cases share of signs and symptoms previously described in the literature and had their diagnoses obtained by computed tomography. Symptomatic treatment associated with home was effective in both situations. Conclusions: Spontaneous pneumomediastinum may be underdiagnosed because of its nonspecific signs and symptoms, contributing to their unique character. It is important to establish the differential diagnoses and events to which patients were exposed. Accompanied a detailed history of radiological devices allow precise diagnosis and correct treatment.Objetivo: Descrever dois casos de pneumomediastino espontâneo na mesma unidade de serviço, em pacientes jovens de sexo diferentes e que apresentaram boa evolução com tratamento conservador. Métodos: O primeiro caso é de um paciente do sexo masculino, 18 anos, com queixa de cervicalgia à direita e disfonia há 2 dias. Negou traumatismos ou ingesta de corpos estranhos, esforços físicos intensos, acessos de tosse e vômitos ou uso de drogas. TC de tórax e pescoço revelou presença de enfisema subcutâneo cervical anterior bilateral, presença de pneumomediastino e ausência de pneumotórax. O segundo caso a ser analisado trata-se de uma paciente do sexo feminino, 16 anos, com queixa de dispneia súbita e mudança do padrão de voz (nasalada). Identificou-se crepitação fina à palpação cervical sugestiva de enfisema subcutâneo. Negou qualquer causa provável de pneumomedisatino secundário. TC de tórax e pescoço revelou pneumomediastino acentuado com extensão para os espaços cervicais profundos. Resultado: Ambos os casos partilham de sinais e sintomas previamente descritos na literatura e tiveram seus diagnósticos obtidos por meio de tomografia computadorizada de tórax. O tratamento sintomático associado a repouso foi eficaz em ambas situações. Conclusões: Pneumomediastino espontâneo pode ser subdiagnosticado devido aos seus sinais e sintomas inespecíficos, contribuindo para seu caráter raro. É importante estabelecer-se os diagnósticos diferenciais e eventos a que os pacientes estiveram expostos. Uma anamnese detalhada acompanhada de aparatos radiológicos permitem o diagnóstico preciso e tratamento correto

Correction of bifid nose with tongue-in-groove technique in patient with Tessier fissure 0-14

Madelung’s disease (MD) or Multiple Symmetric Lipomatosis is a condition characterized by the accumulation of unencapsulated adipose tissue deposited symmetrically around the neck and upper trunk (type I - most common form). Its etiology is still unclear, but it is clearly associated with chronic excessive consumption of alcoholic beverages. Physical deformities lead the patient to seek medical care, along with possible symptoms of cervical involvement such as reduced mobility and respiratory disorders. Multiple Symmetric Lipomatosis diagnosis is clinical and can be complemented with imaging to rule out other diagnostic hypotheses and assess the extent of involvement. Treatment can be performed in two ways: clinical or surgical (lipectomy or liposuction). We report the case of a patient with Multiple Symmetric Lipomatosis type I surgically treated with both techniques: cervical lipectomy and abdominal liposuction. The patient evolved satisfactorily, with a reduction in complaints and no recurrences so far