Changing paradigms in treatment of larynx cancer✩✩Please cite this article as: Chone CT. Changing paradigms in treatment of larynx cancer. Braz J Otorhinolaryngol. 2014;80:96-7.

969

Mediastinitis: Parotid Abscess Complication.

80268-

Odontogenic myxoma in children: a case report and literature review

Benign odontogenic lesions are rare entities but are very important due to their locally aggressive nature. Odontogenic myxoma is even rarer in children than in adults. There is no evidence in the literature in regard to the best treatment approach, in terms of conservative or aggressive surgery, for this type of tumor. This paper reports a case of odontogenic myxoma in a child treated with a compromised approach through bone osteotomies and a review of the literature about this disease, especially in pediatric patients.Benign odontogenic lesions are rare entities but are very important due to their locally aggressive nature. Odontogenic myxoma is even rarer in children than in adults. There is no evidence in the literature in regard to the best treatment approach, in tesem informaçãosem informaçã

Giant Keratocystic Odontogenic Tumor: Three Cases And Literature Review.

A keratocystic odontogenic tumor is a benign intra-bone mass originating from dental lamina or its residue. It represents 2-11% of jaw cysts, and has a slow but aggressive growth. The evaluation of molecular characteristics, immunohistochemistry, and genetic expression currently have no established classification regarding the evolution and pathophysiologic pattern of these lesions. This is a clinical retrospective study with a full analysis of patient history regarding physical evaluation, radiologic images, pathology results, and surgical resection. We performed a major literature review concerning current concepts relating to its biological characterization. Three cases of keratocystic odontogenic tumor were identified. Two of the cases were large, with aggressive behavior and significant bone destruction and recurrence, which had been overlooked for more than a decade. The third case had an early diagnosis, and the treatment led to full recovery and complete healing. The keratocystic odontogenic tumor is a benign lesion with slow growth, which lends itself to a more conservative treatment, even in cases of large lesions. A better understanding of these tumors, both at the biological and molecular level, could lead to guidelines for treatment and prognosis of such patients.25245-5

Brazilian tracheotomy speech valve: diaphragm pressure standardization

Tracheotomy is performed in cases of upper airway obstruction or chronic pulmonary disorders. The Tracheotomy Speech Valves (TSV) improve communication and airway hygiene and humidification of tracheotomized patients. AIM: To show the low cost Brazilian TSV and its use in speech rehabilitation of tracheotomized patients, to evaluate diaphragm opening resistance and comfort to the patient. Study Design: Experimental, contemporary cohort. MATERIALS AND METHODS: The TSV was used in 32 patients. The valve has a diaphragm within a stainless steel body with plastic fittings. We studied the level of respiratory comfort according to the degree of valve diaphragm resistance, 40, 50 and 60 shores. RESULTS: All the patients used the TSV coupled to the cannula in a regular basis, 26 of them did it for more than 12 hours daily and from these, 14 used it for 24h daily. The diaphragm pressure obtained was that of 40 shores for 13 patients and 50 shores for 19 patients. 60 shores was never used. CONCLUSION: the metal TSV helps with speech without the need for closing the cannula with one's finger, and breathing was comfortable. We achieved standard diaphragm resistance. Currently all the patients from this study use this TSV with speech and 43.75% use it full time.A traqueotomia está indicada em condições com obstrução respiratória alta ou doença pulmonar obstrutiva crônica. As Válvulas Fonatórias (VF) melhoram a comunicação, higienização e umidificação das vias aéreas dos pacientes traqueotomizados. OBJETIVO: Demonstrar a VF nacional, de menor custo, e sua utilização na reabilitação fonatória desses pacientes, avaliar resistência de abertura pelo diafragma, o que confere melhor conforto ao paciente. Forma de Estudo: Experimental, coorte contemporâneo. MATERIAL E MÉTODO: A VF foi utilizada em 32 pacientes. A válvula tem diafragma dentro de um corpo em aço inox com encaixes de plástico. Estudou-se grau de conforto respiratório de acordo com a resistência do diafragma da válvula, 40, 50 e 60 shores. RESULTADOS: Obteve-se uso regular da VF acoplada à cânula por todos os pacientes, 26 o fizeram por mais de 12h diárias e destes 14 por 24h diárias. A pressão do diafragma obtida foi de 40 shores para 13 pacientes e 50 shores para 19 pacientes, sem utilização de 60 shores. CONCLUSÃO: A VF metálica permite fonação, sem a oclusão digital da cânula, e respiração sob conforto. Obteve-se resistência padronizada do diafragma. Atualmente todos os pacientes do estudo utilizam estas VF com fonação e 43,75% período integral.10711

Endoscopic Endonasal Transsphenoidal Resection Of Pituitary Adenomas: Preliminary Evaluation Of Consecutive Cases.

Endoscopic endonasal transsphenoidal surgery has gained increasing acceptance by otolaryngologists and neurosurgeons. In many centers throughout the world, this technique is now routinely used for the same indications as conventional microsurgical technique for pituitary tumors. To present a surgical experience of consecutive endoscopic endonasal trans-sphenoidal resections of pituitary adenomas. In this study, consecutive patients with pituitary adenomas submitted to endoscopic endonasal pituitary surgery were evaluated regarding the rate of residual tumor, functional remission, symptoms relief, complications, and tumor size. Forty-seven consecutive patients were evaluated; 17 had functioning adenomas, seven had GH producing tumors, five had Cushing's disease, and five had prolactinomas. Of the functioning adenomas, 12 were macroadenomas and five were microadenomas; 30 cases were non-functioning macroadenomas. Of the patients with functioning adenomas, 87% improved. 85% of the patients with visual deficits related to optic nerve compression progressed over time. Most of the patients with complaints of headaches improved (76%). Surgical complications occurred in 10% of patients, which included with two carotid lesions, two cerebrospinal fluid leaks, and one death of a patient with a previous history of complications. Endoscopic endonasal pituitary surgery is a feasible technique, yielding good surgical and functional outcomes, and low morbidity.80146-5

Mudando os paradigmas no tratamento do câncer de laringe

sem informação8029697sem informaçã

Metastase linfatica de carcinoma espinocelular no apice do triangulo posterior : avaliação de fatores de risco clinicos e histopatologicos

Orientador: Agricio Nubiato CrespoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Esta pesquisa avaliou as condições clínicas e histopatológicas da metástase linfática no ápice do triângulo posterior. Esta região encontra-se entre o nervo espinal, a borda inferior do ventre posterior do músculo digástrico e a borda posterior do músculo esternocleidomastóideo. Avaliou-se quais níveis cervicais com metástase clínica ou histopatológica apresentaram maior associação com a presença de metástase no ápice do triângulo posterior, nos esvaziamentos cervicais eletivos(NO), terapêuticos(N+) e em ambos. Comparou-se a prevalência da metástase no ápice do triângulo posterior nos esvaziamentos cervicais NO com a dos N+. A prevalência da metástase histopatológica em cada nível cervical foi comparada com a prevalência da metástase no ápice do triângulo posterior, nos esvaziamentos cervicais NO, N+ e em ambos. Calculou-se a influência do número de níveis cervicais com metástases, clínicas ou histopatológicas, sobre a presença de metástase no ápice do triângulo posterior. Avaliou-se a prevalência da metástase no ÁPICE para cada localização de tumor primário. Foram estudados 11 esvaziamentos cervicais radicais, dois radicais modificados, 32 supraomohióideos e 17 laterais, em 51 pacientes com carcinoma espinocelular, da orofaringe (9,8 %), hipofaringe(5,9 %), cavidade oral (51%), glote(15,7%), supraglote (11,8%) e oculto(5,9 %). A prevalência da metástase no ápice do triângulo posterior nos esvaziamentos cervicais N+(16,7%) foi 7,3 vezes maior que a dos NO (2,3%). A prevalência de metástase no ápice do triângulo posterior foi de 33,3% para tumor primário oculto, 25% para hipofaringe, 16,7% para orofaringe, 3,6% para cavidade oral e 0% para glote e supraglote. Nos tumores primários da faringe(considerando também os tumores primários ocultos) esta prevalência foi de 23,1%, 6,4 vezes maior que em primários da cavidade oral e estatitisticamente maior que em tumores primários da laringe. Houve associação significativa entre metástase histopatológica no nível 11 e no ápice do triângulo posterior, nos esvaziamentos cervicais NO, e entre metástase histopatológica no nível 11 ou III e no ápice do triângulo posterior, quando estudou-se todos os esvaziamentos cervicais. Assim, nos esvaziamentos cervicais N+ com tumores localizados na faringe, seria necessário a remoção do ápice do triângulo posterior. As demais correlações estudadas não apresentaram significância estatísticaAbstract: Dissection of posterior triangle apex (APEX) is a surgical step in supraomohyoid and lateral neck dissections. The prevalence of lymphatic metastases at this site and the clinico-histopathological conditions that influence their occurrence have not been established. We have evaluated the prevalence and the risk factors for cervical metastases in lymph nodes of the APEX. Sixty-two neck dissections were performed in 51 patients with squamous cell carcinoma of the oropharynx, hypopharynx, oral cavity, glottic larynx and supraglottic larynx or with occult primary cancers. We correlated the presence of positive metastases in the APEX with the neck level involved either clinically(CLIN) or histopathologically (H/P) and with the number of CLIN or H/P positive neck levels with metastases. The prevalence of metastases in the APEX in elective(NO) and therapeutic(N+) neck dissections was also compared. This prevalence was also compared with that for each neck level. The histopathological comparison between the APEX and the neck levels were calculated for NO, N+ and all neck dissections. The primary site of tumor was correlated with the presence of HIP positive nodes in the APEX. The overall prevalence of lymphatic metastases in the APEX was 6.5%. The prevalence in NO neck dissections was 2.3% and in N+ neck dissections, 16.7%. The prevalence of lymphatic metastases in the APEX for primary of pharynx was 23.1 %, for oral cavity was 3.6% and 0% for other sites. Metastases in the APEX were not influenced by the neck level with CLIN or H/P metastases in N+ necks. The number of CLIN or H/P positive neck levels had no influence on histopathological metastases in the APEX. Factors that influenced metastases in the APEX were positive histopathological metastases at level TI for NO neck dissections and positive histopathological metastases at level II or III for all neck dissections. All the comparisons were analyzed using the Fisher's or Poisson's test . The prevalence of histopathological metastases in the APEX in N+ necks is 7.3 times greater than that of NO necks and for primary tumor of pharynx was 6.4 times than for oral cavity. The prevalence of histopathological metastases in the APEX for primary tumor of pharynx was statistically signicantly greater than for prymary tumor of Iarynx (p = 0.0478).Histopathological metastases at level II for clinically NO necks and histopathological metastases to level II or m for all neck dissections are risk factors for metastases in the APEX. The number of positive levels did not influence the prevalence of metastases in the APEX. There is no isolated metastases in the APEX of posterior triangleDoutoradoOtorrinolaringologiaDoutor em Ciências Médica