Evolution of endoscopic surgery in the treatment of inverted papilloma

Inverted papilloma (IP) has several treatment avenues. The endoscopic approach in the last decade has proven to be a good option over the traditional approach. OBJECTIVE: Describe the epidemiological profile of patients with inverted Papilloma, describe our experience on managing this tumor and compare our data with the literature. Study Design: Cross-sectional, historical cohort. METHOD: Retrospective study of medical records of 17 patients treated for histopathologicallyconfirmed inverted papilloma between 2005 and 2011. We assessed patients age, gender, tumor side, symptoms, diagnosis, comorbidities and habits, Krouse staging, surgical approach, intraoperative and postoperative, and malignant postoperative recurrence and also the correlation between recurrence with preoperative staging, the surgical approach used, and the presence of malignancy. RESULTS: Five (29.41%) patients were classified as Krouse stage T2, 9 (52.94%) as T3 and 3 (17.65%) as T4. Three (17.65%) patients had malignancy and the recurrence rate was 23.5% (4 pacients). Eleven patients (64.70%) underwent endoscopic approach, 3 (17.6%) the combined aprroach (endoscopic assisted) and 3 (17.6%) external approach. CONCLUSION: The endoscopic approach is currently becoming a method not only effective but also safe for the treatment of more advanced stages of IP.O papiloma invertido (PI) apresenta diversos tipos de tratamento cirúrgico. A abordagem endoscópica exclusiva tem se mostrado na última década como boa opção em relação à abordagem externa. OBJETIVO: Descrever a amostra dos pacientes com diagnóstico de papiloma invertido, mostrar a experiência do serviço no manejo do tumor e comparar os dados com os da literatura. Forma do Estudo: Estudo de coorte histórica com corte transversal. MÉTODO: Estudo retrospectivo dos prontuários de 17 pacientes operados em um serviço de Rinologia entre 2005 e 2011. Foram avaliados perfil epidemiológico, estadiamento de Krouse, via de acesso cirúrgico, malignização e recorrência pós-operatória e a correlação entre recidivas e estadiamento pré-operatório, via de acesso cirúrgico e malignização. RESULTADOS: Cinco (29,41%) dos pacientes foram classificados como estádio T2 de Krouse, nove (52,94%) como T3 e três (17,65%) como T4. Três (17,65%) pacientes apresentaram malignização e quatro (23,5%) recidiva. Onze pacientes (64,70%) foram submetidos à via endoscópica exclusiva, três (17,6%)à via combinada e três (17,6%) à via aberta. CONCLUSÃO: O acesso endoscópico exclusivo atualmente é um método não só eficaz como também seguro para o tratamento dos estádios mais avançados do PI.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, EPM, Depto. de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoSciEL

A evolução da cirurgia endoscópica no tratamento do papiloma invertido Evolution of endoscopic surgery in the treatment of inverted papilloma

O papiloma invertido (PI) apresenta diversos tipos de tratamento cirúrgico. A abordagem endoscópica exclusiva tem se mostrado na última década como boa opção em relação à abordagem externa. OBJETIVO: Descrever a amostra dos pacientes com diagnóstico de papiloma invertido, mostrar a experiência do serviço no manejo do tumor e comparar os dados com os da literatura. Forma do Estudo: Estudo de coorte histórica com corte transversal. MÉTODO: Estudo retrospectivo dos prontuários de 17 pacientes operados em um serviço de Rinologia entre 2005 e 2011. Foram avaliados perfil epidemiológico, estadiamento de Krouse, via de acesso cirúrgico, malignização e recorrência pós-operatória e a correlação entre recidivas e estadiamento pré-operatório, via de acesso cirúrgico e malignização. RESULTADOS: Cinco (29,41%) dos pacientes foram classificados como estádio T2 de Krouse, nove (52,94%) como T3 e três (17,65%) como T4. Três (17,65%) pacientes apresentaram malignização e quatro (23,5%) recidiva. Onze pacientes (64,70%) foram submetidos à via endoscópica exclusiva, três (17,6%)à via combinada e três (17,6%) à via aberta. CONCLUSÃO: O acesso endoscópico exclusivo atualmente é um método não só eficaz como também seguro para o tratamento dos estádios mais avançados do PI.Inverted papilloma (IP) has several treatment avenues. The endoscopic approach in the last decade has proven to be a good option over the traditional approach. OBJECTIVE: Describe the epidemiological profile of patients with inverted Papilloma, describe our experience on managing this tumor and compare our data with the literature. Study Design: Cross-sectional, historical cohort. METHOD: Retrospective study of medical records of 17 patients treated for histopathologicallyconfirmed inverted papilloma between 2005 and 2011. We assessed patients age, gender, tumor side, symptoms, diagnosis, comorbidities and habits, Krouse staging, surgical approach, intraoperative and postoperative, and malignant postoperative recurrence and also the correlation between recurrence with preoperative staging, the surgical approach used, and the presence of malignancy. RESULTS: Five (29.41%) patients were classified as Krouse stage T2, 9 (52.94%) as T3 and 3 (17.65%) as T4. Three (17.65%) patients had malignancy and the recurrence rate was 23.5% (4 pacients). Eleven patients (64.70%) underwent endoscopic approach, 3 (17.6%) the combined aprroach (endoscopic assisted) and 3 (17.6%) external approach. CONCLUSION: The endoscopic approach is currently becoming a method not only effective but also safe for the treatment of more advanced stages of IP

Orofacial-cervical alterations in individuals with upper airway resistance syndrome

ABSTRACT INTRODUCTION: Studies that assess the upper airways in sleep-related breathing disorders have been performed only in patients with obstructive sleep apnea syndrome who seek medical attention. Therefore, in addition to the need for population studies, there are no data on the orofacial-cervical physical examination in subjects with upper airway resistance syndrome. OBJECTIVES: To compare the orofacial-cervical examination between volunteers with upper airway resistance syndrome and without sleep-related breathing disorders. METHODS: Through questionnaires, physical measurements, polysomnography, and otorhinolaryngological evaluation, this study compared the orofacial-cervical physical examination, through a systematic analysis of the facial skeleton, mouth, throat, and nose, between volunteers with upper airway resistance syndrome and volunteers without sleep-related breathing disorders in a representative sample of the adult population of the city of São Paulo. RESULTS: There were 1042 volunteers evaluated; 49 subjects (5%) were excluded as they did not undergo otorhinolaryngological evaluation, 381 (36%) had apnea-hypopnea index > 5 events/hour, and 131 (13%) had oxyhemoglobin saturation < 90%. Among the remaining 481 subjects (46%), 30 (3%) met the criteria for the upper airway resistance syndrome definition and 53 (5%) met the control group criteria. At the clinical evaluation of nasal symptoms, the upper airway resistance syndrome group had more oropharyngeal dryness (17% vs. 29.6%; p = 0.025) and septal deviation grades 1-3 (49.1% vs. 57.7%; p = 0.025) when compared to controls. In the logistic regression model, it was found that individuals from the upper airway resistance syndrome group had 15.6-fold higher chance of having nose alterations, 11.2-fold higher chance of being hypertensive, and 7.6-fold higher chance of complaining of oropharyngeal dryness when compared to the control group. CONCLUSION: Systematic evaluation of the facial skeleton, mouth, throat, and nose, between volunteers with upper airway resistance syndrome and volunteers without sleep-related breathing disorders, showed that the presence of upper airway resistance syndrome is mainly associated with nasal alterations and oropharyngeal dryness, in addition to the risk of hypertension, regardless of gender and obesity