Surgery of frontal sinus fractures. Epidemiologic study and evaluation of techniques

SummaryThe frontal sinus trauma is not rare and it is 8% of the facial fractures. It can affect the anterior and/or posterior plates, with or without hitting the nasofrontal duct. It has a large potential of complications and its management still being a controversy. Objective: To present the casuistic of fractures frontal sinus, the epidemiology and clinical and surgical management of frontal sinus fractures. Materials and Methods: Not randomized retrospective study of 24 patients with frontal sinus fractures Hospital of Clinics, School of Medicine Botucatu, São Paulo, Brazil. Results: From the 24 patients, we had 16 (66,6%) fractures of the extern plate and 8 (33,4%) of both. In 2 patients the nasofrontal duct was involved. Others facial fractures were associated in 20 (83,4%) cases and major lesions of the cerebral segment were found in 13 (54,2%). Subpalpebral incision was performed in the majority with satisfactory aesthetic results. The basis of the surgical treatment was reduction and fixation with different materials (steel wire, mononylon, titanium miniplates) and if necessary we used alogen implants or parietal bone to reconstruct the anterior plate. Conclusion: The principal cause of frontal sinus fractures is crashed car. The management depends of the complexity, because commonly there are cranioencephalic lesions associated. The surgical thecniques used are the incisions, bicoronal flap or browglabella, infra-orbital rim (“butterfly”), associated a endoscopy sinus surgery in cases of infection, cerobrospinal fluid leak and orbital complications

Hyperactivity and attention deficit syndrome in obstructive sleep apnea syndrome: is there improvement with surgical management?

SummaryNeuropsychological disorders are frequently associated with obstructive ventilatory disorders (OVD).AimTo analyze the incidence of neuropsychological disorders in Brazilian children with OVD, using a screening questionnaire and to compare the answers given before and after surgery.Patients and MethodsWe studied 30 children with clinical diagnosis of OVD. The children were divided into 3 groups: group I, children aged 4 to 7; group II, from 8 to 10; and group III, children over 11. The applied questionnaires were answered by the parents or tutors, and comprised 30 questions, 10 for each disorder: attention deficit, hyperactivity and impulsivity. The children were diagnosed with one of the disorders when presented 3 or more positive answers. The follow up interview occurred 6 months after adenotonsillectomy.ResultsThere was a predominance of male gender (60.6%) over female gender (39.4%). Group II presented the highest number of significant changes, with reductions raging from 87.5% to 33.3% of patients with attention deficit, 75% to 50% of the hyperactive patients, and 50% to 33% of the impulsive patients.ConclusionThere was neuropsychological improvement after the surgery, which occurred mainly in the children from group II. More interaction among health professionals is necessary when diagnosing and following up similar cases

Magnetic resonance angiography and transcranial Doppler ultrasound findings in patients with a clinical diagnosis of vertebrobasilar insufficiency

OBJECTIVE: To evaluate the findings of magnetic resonance angiography (MRA) and transcranial Doppler ultrasound (TCD) in patients with a clinical diagnosis of vertebrobasilar insufficiency (VBI). METHOD: From our outpatient neurotology clinic, we selected patients (using the criteria proposed by Grad and Baloh) with a clinical diagnosis of VBI. We excluded patients with any definite cause for vestibular symptoms, a noncontrolled metabolic disease or any contraindication to MRA or TCD. The patients in the study group were sex- and age-matched with subjects who did not have vestibular symptoms (control group). Our final group of patients included 24 patients (study, n=12; control, n=12). RESULTS: The MRA results did not demonstrate significant differences in the findings between our study and control groups. TCD demonstrated that the systolic pulse velocity of the right middle cerebral artery, end diastolic velocity of the basilar artery, pulsatility index (PI) of the left middle cerebral artery, PI of the right middle cerebral artery, and PI of the basilar artery were significantly higher in the study group than in the control group, suggesting abnormalities affecting the microcirculation of patients with a clinical diagnosis of VBI compared with controls. CONCLUSION: MRA failed to reveal abnormalities in patients with a clinical diagnosis of VBI compared with controls. The PI of the basilar artery, measured using TCD, demonstrated high sensitivity (91%) and specificity (91%) for detecting clinically diagnosed VBI

Sensitivity and specificity of the vertebro-basilar deprivation nystagmus, magnetic resonance angiography, and transcranial Doppler ultrasound in the diagnosis of the dizziness secondary to vertebro-basilar insufficiency

Objetivo: Determinar a sensibilidade e a especificidade da pesquisa do nistagmo de privação vertebrobasilar (PNPVB), Angiorressonância magnética (AngioRM), investigação ultrassonográfica cervical e Doppler transcraniano (DTC) em pacientes com diagnóstico clínico de insuficiência vertebrobasilar (IVB). Método: o estudo foi aprovado pela comissão de ética local. Os participantes deram consentimento formal. Foi formado grupo de estudo (GE) e grupo controle (GC) com 12 sujeitos em cada, pareados por sexo e idade, sendo 4 masculinos e 8 femininos, com média de idade de 72,66 (±8.35 anos). Os doentes foram selecionados do Ambulatório de Otoneurologia do HC-FMUSP com idade acima de 55 anos, sem outra provável causa de tonturas. Voluntários assintomáticos do Grupo de Apoio Multidisciplinar ao Idoso Ambulatorial (GAMIA) formaram o GC. Todos os participantes realizaram avaliação cardiogeriátrica para excluir qualquer doença de base que pudesse ser a causa da tontura, que não a IVB. Assim, os dois grupos realizaram a PNPVB, a AngioRM, a avaliação ultrassonográfica cervical e DTC. Resultados: PNPVB, AngioRM e avaliação ultrassonográfica cervical não mostraram diferenças entre os grupos. No DTC, foram detectadas diferenças significantes em cinco variáveis: velocidade do pico sistólico da artéria cerebral média direita (ponto de corte em 76,00; sensibilidade de 0,83; especificidade de 0,75; p=0,012), velocidade diastólica final da artéria basilar (ponto de corte em 24,00; sensibilidade de 0,66; especificidade de 0,66; p=0,028), índice de pulsatilidade (IP) da artéria cerebral média esquerda (ponto de corte em 0,85; sensibilidade de 0,83; especificidade de 0,75; p=0,005), IP da artéria cerebral média direita (ponto de corte em 0,88; sensibilidade de 0,75; especificidade de 0,75; p=0,010), IP da artéria basilar (ponto de corte em 1,01; sensibilidade de 0,91; especificidade de 0,91; p 95%. Conclusão: a PNPVB e a AngioRM não mostraram diferenças entre os grupos. O DTC mostrou sensibilidade de 91% e especificidade de 91% para o diagnóstico da IVB relacionada à tontura, quando o IP da artéria basilar for maior que 1,01Objective: To determine the sensitivity and specificity of the vertebro-basilar deprivation nystagmus (VBDN), magnetic resonance angiography (MRA), cervical ultrasonographic investigation and Transcranial Doppler Ultrasound (TDU) in patients with clinical diagnosis of vertebro-basilar insufficiency (VBI). Methods: The study was approved by the Ethics in Research Committee. The patients gave formal consent for participating in this study. We composed 2 groups: a study group (SG) and a control group (CG), comprised of 12 patients each, with sex- and age-matched patients (4 men and 8 women). Their mean age was 72.66 (±8.35) years. The study group included patients from the neurotology outpatient clinic of the HC-FMUSP who were over 55 years old, without any other possible cause for dizziness than VBI. Asymptomatic volunteers from the geriatrics outpatient clinic were included in the CG. All participants were subjected to evaluation of a cardio-geriatric professional, to exclude any subjacent disease that could cause dizziness other than VBI. Then, both groups were subjected to VBDN, MRA, cervical ultrasonographic investigation and TDU. Results: The VBDN, MRA and cervical ultrasonographic investigation did not demonstrate differences between the groups. The TDU demonstrated that the systolic pulse velocity of the right middle cerebral artery (sensitivity=0.83, specificity=0.75; p=0.028), final diastolic velocity of the basilar artery (sensitivity=0.66; specificity=0.66; p=0.028), pulsatility index (PI) of the left middle cerebral artery (sensitivity=0.83; specificity=0.75; p=0,005), PI of the right middle cerebral artery (sensitivity=0.75; specificity=0.75; p=0.010), and the PI of the basilar artery (sensitivity=0.91; specificity=0.91; p < 0.001) were significantly higher in the diseased group compared to controls. Considering the PI of the basilar artery, we observed that the statistic power of the test was higher than 95%. Conclusion: The VBDN, MRA and cervical ultrasonographic investigation did not demonstrate significant changes in patients with VBI compared to controls. The PI of the basilar artery, measured using the TDU, demonstrated high sensitivity (91%) and specificity (91%) levels in the diagnosis of VBI when the PI was higher than 1.0