Inflammatory myofibroblastic tumor of the temporal bone

UNIFESP Departamento de Otorrinolaringologia e Cabeça e PescoçoUNIFESP, Depto. de Otorrinolaringologia e Cabeça e PescoçoSciEL

Phonoaudiological findings in patients submitted to hypoglossal-facial anastomosis

The hypoglossal-facial anastomosis (HFA) have been related in patients with facial nerve lesion where proximal segment more other surgical produceres had been faited or had not been possible success. AIM: The objective of the present research is to verify the evidence of mobility in the phonoarticulate organs, speech function, chew and swallowing in patients sujected to HFA. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: Eight patients with peripheral facial paralysis (PFP) were evaluated and subjected to HFA at UNIFESP/EPM in the period from 1989 to 2000, with 6 females and 2 males, aged between 21 and 71 years with an average of 50 years. Of these, 5 after exeresis of Acoustic Neurinoma, 1 after exeresis of Fibrosarcoma, 1 after a gunshot wound and 1 after idiopathic peripheral facial paralysis of poor evolution. In the phonoaudiological evaluation, the protocol used involved identification data; classification of the facial nerve; treatments carried out; facial symmetry in repose and on voluntary movement; synhinesis of the eyes, mouth, nose and cheeks; phonoarticulate and tongue disorders; changes in chew and of the palate and a questionary concerning the appearence of the respective disturbances. RESULTS: The degree of pos anastomosis and reabilitation ranged to the eyes between II and V and to the mouth between III and V (House & Brakemann, 1985). We came to the conclusion that the recover was satisfactory and important but patients'recover expectation were inferior. There have been noted: articulatory imprecision chewing disfunction, deficit sphincteral function of oral muscles and disphage.A anastomose hipoglosso-facial (AHF) tem sido realizada em pacientes com lesão dos segmentos mais proximais do nervo facial em que outros procedimentos cirúrgicos não foram possíveis ou não obtiveram êxito. OBJETIVO: O objetivo atual da pesquisa é verificar as alterações na mobilidade dos órgãos fonoarticulatórios, quanto à função da fala, mastigação e da deglutição, em pacientes submetidos a AHF. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: Foram avaliados 8 pacientes, com paralisia facial periférica (PFP), submetidos a AHF, na UNIFESP/EPM, no período de 1998 a 2000, sendo 6 do sexo feminino e 2 do sexo masculino, idades entre 21 e 71 anos e mediana de 50 anos. Desses, 5 pós-exerése do Schwannoma do Nervo Vestibular, 1 pós-exerése de Fibrossarcoma, 1 pós-ferimento por arma de fogo e 1 pós-paralisia facial idiopática de má evolução. Na avaliação fonoaudiológica, o protocolo consta de: dados de identificação; classificação da recuperação do nervo facial; tratamentos realizados; simetria facial no repouso e no movimento voluntário; sincinesias para olho, boca, nariz e bochechas; distúrbios fonoarticulatórios e da motricidade da língua; alteração na mastigação e do paladar, e questionário referente ao parecer dos respectivos distúrbios para serem respondidos pelo paciente. RESULTADO: O grau de paralisia pós-anastomose e reabilitação variou para os olhos entre II e V e para a boca entre III e V (House & Brackemann, 1985). Concluímos que recuperação foi satisfatória e importante, mas a expectativa de melhora foi inferior ao esperado pelos pacientes. Foram observados: imprecisão articulatória, disfunção mastigatória, escape bucal de alimentos e disfagia.Universidade Federal de São Paulo (UNIFESP) Campo FonoaudiológicoUniversidade Bandeirantes de São Paulo Ciências da Reabilitação Neuro-MotoraUniversidade Federal de São Paulo (UNIFESP)Universidade Federal de São Paulo (UNIFESP) EPM Disciplina de OtorrinolaringologiaUNIFESP, Campo FonoaudiológicoUNIFESP, EPM, Disciplina de OtorrinolaringologiaSciEL

The influence of mode of delivery on neonatal and maternal short and longterm outcomes

OBJECTIVE: To evaluate the impact of mode of delivery on breastfeeding incentive practices and on neonatal and maternal short and long-term complications. METHODS: A cohort study was conducted between June 2015 and April 2016 with 768 puerperal women from 11 maternities in Sergipe, interviewed in the first 24 hours, 45–60 days and 6–8 months after delivery. Associations between breastfeeding incentive practices, neonatal and maternal, both short-term and late complications, and the exposure variables were evaluated by the relative risk (95%CI) and the Fisher exact test. RESULTS: The C-section newborns had less skin-to-skin contact immediately after delivery (intrapartum C-section: 0.18, 95%CI 0.1–0.31 and elective C-section: 0.36, 95%CI 0.27–0.47) and less breastfeeding within one hour of birth (intrapartum C-section: 0.43, 95%CI 0.29–0.63 and elective C-section: 0.44, 95%CI 0.33–0.59). Newborns from elective C-section were less frequently breastfed in the delivery room 0.42 (95%CI 0.2–0.88) and roomed-in less 0.85 (95%CI 0.77–0.95). Women submitted to intrapartum C-section had greater risk of early complications 1.3 (95%CI 1.04–1.64, p = 0.037) and sexual dysfunction 1.68 (95%CI 1.14–2.48, p = 0.027). The frequency of neonatal complications, urinary incontinence and depression according to the mode of delivery was similar. CONCLUSIONS: The C-section was negatively associated with breastfeeding incentive practices; in addition, C-section after labor increased the risk of early maternal complications and sexual dysfunction

Stillborn in Brazil: could neonatal mortality be just the tip of the iceberg? / Natimortos no Brasil: a mortalidade neonatal pode ser apenas a ponta do iceberg?

INTRODUCTION: Stillbirth has an estimation of more than 2.5 million cases across the world. A great percentage of the cause of stillbirths is reported as unknown or unexplained. The aim of this study was the identification of the causes, incidence and profile of the fetal and also the mothers in a maternity hospital in the State of Sergipe. METHODS: This was an observational and cross-sectional study in which all stillbirths of the maternal hospital in the State of Sergipe from June 2020 to May 2021 were included. Fetal death investigation forms were analyzed and some women were interviewed through telephone calls. The interview was based on the SAMPLE VA questionnaire 1 from the WHO Verbal autopsy instrument and an additional list to assess the maternal, pregnancy and labor history, and also history of signs and symptoms of COVID-19 infection. RESULTS: A total of 10375 births were delivered at the hospital and the months with highest births were May and March of 2021. We found 64 cases of stillbirth. Forty-two cases of neonatal deaths were also registered. Only 11 women with cases of stillbirth were interviewed in our study. The major participants were married or living with a partner (60%) and finished secondary education (63.63%). There were 5 cases of women with gestational age at 37 weeks or greater. Antenatal care was completed by 90.9%(n=10) of women. The majority (54.5%) had Unknown or unexplained causes of death. The remaining categories also showed relevant results. CONCLUSION: Fetal deaths were responsible for approximately 60% of perinatal deaths, in which the most reported cause in our interview were unexplained or unknown. The total number of deaths when neonatal deaths were added almost duplicated the percentage of the mortality rate at the maternity hospital. All women went into labor with less than 42 weeks of gestational age and greater or equal to 22 and most were healthy and had no diagnosed diseases

Características maternas e da assistência pré-natal associadas à peregrinação no anteparto

OBJETIVO: Analisar as características maternas e da assistência pré-natal associadas à peregrinação no anteparto entre gestantes de um estado do Nordeste brasileiro. MÉTODOS: Estudo quantitativo e transversal, com abordagens descritiva e analítica, vinculado à pesquisa Nascer em Sergipe, realizada entre junho de 2015 e abril de 2016. Foram avaliadas 768 puérperas proporcionalmente distribuídas entre todas as maternidades do estado (n = 11). Os dados foram coletados por meio de entrevistas e consultas aos cartões de pré-natal. As associações entre a peregrinação no anteparto e as variáveis de exposição foram descritas em frequências absoluta e relativa, razões de chances brutas e ajustadas e seus respectivos intervalos de confiança. RESULTADOS: A peregrinação no anteparto foi referida por 29,4% (n = 226) das entrevistadas, a maioria das quais procurou atendimento em apenas um serviço antes do atual (87,6%; n = 198). Ressalta-se que a peregrinação no anteparto foi menos frequente entre as mulheres com idade ≥ 20 anos (OR = 0,50; IC95% 0,34–0,71), com alta escolaridade (OR = 0,42; IC95% 0,31–0,59), com trabalho remunerado (OR ajustada = 0,59; IC95% 0,41–0,82), orientadas durante o pré-natal sobre a maternidade de referência para o parto (OR ajustada = 0,88; IC95% 0,42–0,92) e que utilizaram o serviço privado para realização do pré-natal (OR ajustada = 0,44; IC95% 0,18–0,86) ou do parto (OR ajustada = 0,96; IC95% 0,66–0,98). Não foi observada evidência estatística de associação entre as características gestacionais e a ocorrência da peregrinação. CONCLUSÕES: A peregrinação no anteparto sofre interferência das características socioeconômicas maternas, da assistência pré-natal e do tipo de financiamento para o parto.OBJECTIVE: To analyze the maternal characteristics and type of prenatal care associated with peregrination before childbirth among pregnant women in a northeastern Brazilian state. METHODS: Quantitative and transversal study, with descriptive and analytical approaches, part of the Nascer em Sergipe research held between June 2015 and April 2016. A total of 768 puerperal women proportionally distributed across all maternities of the state (n = 11) were evaluated. Data were collected in interviews and from prenatal records. The associations between antepartum peregrination and the exposure variables were described in absolute and relative frequencies, crude and adjusted odds ratios and their respective confidence intervals. RESULTS: Antepartum peregrination was reported by 29.4% (n = 226) of the interviewees, most of whom sought care in a single service before the current one (87.6%; n = 198). It should be noted that antepartum peregrination was less frequent among women aged ≥ 20 years old (OR = 0.50; 95%CI 0.34–0.71), with high education level (OR = 0.42; 95%CI 0.31–0.59) and a paid job (adjusted OR = 0.59; 95%CI 0.41–0.82), who had been instructed during prenatal care about the referral maternity for childbirth (adjusted OR = 0.88; 95%CI 0.42–0.92), and who used the private service to receive prenatal (adjusted OR = 0.44; 95%CI 0.18–0.86) or childbirth (adjusted OR = 0.96; 95%CI 0.66–0.98) care. No statistical evidence of associations between gestational characteristics and the occurrence of peregrination was observed. CONCLUSIONS: Antepartum peregrination suffers interference from the mother’s socioeconomic characteristics, the type of prenatal care received and the source of funding for childbirth

Anatomical study of the pigs temporal bone by microdissection

PURPOSE:Initial study of the pig`s temporal bone anatomy in order to enable a new experimental model in ear surgery.METHODS: Dissection of five temporal bones of Sus scrofa pigs obtained from UNIFESP - Surgical Skills Laboratory, removed with hole saw to avoid any injury and stored in formaldehyde 10% for better conservation. The microdissection in all five temporal bone had the following steps: inspection of the outer part, external canal and tympanic membrane microscopy, mastoidectomy, removal of external ear canal and tympanic membrane, inspection of ossicular chain and middle ear.RESULTS: Anatomically it is located at the same position than in humans. Some landmarks usually found in humans are missing. The tympanic membrane of the pig showed to be very similar to the human, separating the external and the middle ear. The middle ear`s appearance is very similar than in humans. The ossicular chain is almost exactly the same, as well as the facial nerve, showing the same relationship with the lateral semicircular canal.CONCLUSION:The temporal bone of the pigs can be used as an alternative for training in ear surgery, especially due the facility to find it and its similarity with temporal bone of the humans.Federal University of São Paulo Paulista School of MedicineFederal University of São Paulo Medical SchoolUNIFESP, EPMSciEL

Standardization of techniques used in facial nerve section and facial movement evaluation in rats

AIM: standardization of the technique to section the extratemporal facial nerve in rats and creation of a scale to evaluate facial movements in these animals before and after surgery. STUDY DESIGN: Experimental. METHOD: twenty Wistar rats were anesthetized with ketamine xylazine and submitted to sectioning of the facial nerve near its emergence through the mastoid foramen. Eye closure and blinking reflex, vibrissae movement and positioning were observed in all animals and a scale to evaluate these parameters was then created. RESULTS: The facial nerve trunk was found between the tendinous margin of the clavotrapezius muscle and the auricular cartilage. The trunk was proximally sectioned as it exits the mastoid foramen and the stumps were sutured with a 9-0-nylon thread. An evaluation and graduation scale of facial movements, independent for eye and vibrissae, was elaborated, together with a sum of the parameters, as a means to evaluate facial palsy. Absence of eye blinking and closure scored 1; the presence of orbicular muscle contraction, without blinking reflex, scored 2; 50% of eye closure through blinking reflex, scored 3, 75% of closure scored 4. The presence of complete eye closure and blinking reflex scored 5. The absence of movement and posterior position of the vibrissae scored 1; slight shivering and posterior position scored 2; greater shivering and posterior position, scored 3 and normal movement with posterior position, scored 4; symmetrical movement of he vibrissae, with anterior position, scored 5. CONCLUSION: The rat anatomy allows easy access to the extratemporal facial nerve, allowing its sectioning and standardized suture. It was also possible to establish an evaluation and graduation scale of the rat facial movements with facial palsy based on the clinical observation of these animals.OBJETIVOS: Padronização da técnica de secção do nervo facial extratemporal em ratos e elaboração de uma escala de avaliação da mímica facial desses animais antes e após essa secção. TIPO DE ESTUDO: Experimental. MÉTODO: Vinte ratos Wistar foram anestesiados com xilasina e ketamina e submetidos à secção do nervo facial próximo à sua emergência pelo forame mastóideo na pele. Todos os animais foram avaliados. Foram observados: fechamento ocular, reflexo de piscamento, movimentação e posicionamento das vibrissas, e foi elaborada uma escala de avaliação e graduação destes parâmetros. RESULTADOS: O tronco do nervo facial foi encontrado entre a margem tendinosa do músculo clavotrapézio e a cartilagem auricular. O tronco foi seccionado proximal à sua saída pelo forame mastóideo e os cotos foram suturados com nylon 9-0. Foi elaborada uma escala de avaliação e graduação da mímica facial independente para olho e vibrissa e a somatória dos parâmetros, como forma de avaliar a face paralisada. A ausência de piscamento e de fechamento ocular recebeu valor 1; a presença de contração do músculo orbicular, sem reflexo de piscamento, valor 2; fechamento ocular de 50% através de reflexo de piscamento, valor 3, o fechamento de 75%, valor 4. A presença de reflexo de piscamento com fechamento ocular completo recebeu valor 5. A ausência de movimento e posição posterior das vibrissas recebeu pontuação 1; tremor leve e posição posterior, pontuação 2; tremor maior e posição posterior, pontuação 3 e movimento normal com posição posterior, pontuação 4. A movimentação simétrica das vibrissas, com posição anterior recebeu pontuação 5. CONCLUSÃO: O rato apresenta anatomia que permite fácil acesso ao nervo facial extratemporal, possibilitando secção e sutura desse nervo de forma padronizada. Também foi possível estabelecer uma escala de avaliação e graduação da mímica facial dos ratos com paralisia facial a partir da observação clínica desses animais.UNIFESPUNIFESP-EPMUNIFESP, EPMSciEL

Hearing loss in peripheral facial palsy after decompression surgery

Facial paralysis can result from a variety of etiologies; the most common is the idiopathic type. Evaluation and treatment are particularly complex. The treatment of acute facial paralysis may require facial nerve decompression surgery. Any structure near the path of the facial nerve is at risk during transmastoid decompression surgery. AIM: This is a retrospective study, carried out in order to evaluate hearing loss after transmastoid decompression and how idiopathic cases evolved in terms of their degree of paralysis in the last 15 years. MATERIALS AND METHODS: We selected the charts from 33 patients submitted to transmastoid facial nerve decompression in the past 15 years and we assessed their hearing loss and facial paralysis. RESULTS: There was a high percentage (61%) of patients with some degree of hearing loss after the procedure and in all cases there was improvement in the paralysis. DISCUSSION: The values obtained are similar to those reported in the literature. One possible explanation for this hearing loss is the vibration transmission by drilling near the ossicular chain. CONCLUSION: The surgical procedure is not risk free; indications, risks and benefits should be explained to patients through an informed consent form.A paralisia facial pode resultar de uma variedade de etiologias, sendo a mais comum a idiopática. A avaliação e o tratamento são particularmente complexos. O tratamento da paralisia facial aguda pode envolver cirurgia de descompressão do nervo facial. Qualquer estrutura perto do trajeto do nervo facial está em risco durante a cirurgia de descompressão via transmastoidea. OBJETIVO: Estudo retrospectivo que irá avaliar a perda auditiva após descompressão via transmastoidea e a evolução do grau de paralisia nos casos idiopáticos dos últimos 15 anos. MATERIAL E MÉTODO: Foram selecionados prontuários de 33 pacientes submetidos à descompressão do nervo facial via transmastoidea nos últimos 15 anos e avaliou-se a perda auditiva e a paralisia facial. RESULTADOS: Observou-se alta porcentagem (61%) dos pacientes com algum grau de perda auditiva após o procedimento e, em todos os casos, houve melhora da paralisia. CONCLUSÃO: O procedimento cirúrgico não é isento de riscos. Indicações, riscos e benefícios devem ser esclarecidos aos pacientes por meio de consentimento informado.UNIFESP-EPMUNIFESP-EPM Setor de OtologiaUNIFESP, EPM, Setor de OtologiaSciEL

Fundus flavimaculatus and subretinal neovascularization: case report

Fundus flavimaculatus is a progressive, bilateral, hereditary retinal dystrophy characterized by ill-defined, yellowish, pisciform flecks at the level of the retinal pigment epithelium. Since the disease process is at level of the retinal pigment epithelium, it is not surprising that subretinal macular neovascularizations might occur. Nevertheless, they have been rarely reported as complications of the disease. The following report describes a case of fundus flavimaculatus that progressed with blurred vision by a subretinal macular neovascularization.Fundus flavimaculatus é distrofia retiniana hereditária, progressiva e bilateral, caracterizada por lesões amareladas, mal definidas, pisciformes no epitélio pigmentar retiniano. O aparecimento de membrana neovascular subretiniana tem sido raramente relatada como complicação da doença. Neste artigo, documentamos o caso de uma paciente com fundus flavimaculatus que evoluiu com baixa de acuidade visual por membrana neovascular subretiniana.Universidade de RegensburgUniversidade Federal do Ceará Hospital Universitário Walter CantídeoUniversidade Federal de São Paulo (UNIFESP)Universidade Federal do Ceará Hospital Universitário Walter Cantídeo Serviço de OftalmologiaUNIFESPSciEL