Undifferentiated Head And Neck Tumors: The Contribution Of Immunohistochemical Technique To Differential Diagnosis.

Undifferentiated head and neck and skull base tumors are not unusual. They can arise in mucosa as well as in salivary glands, soft tissues or lymph nodes. Suitable therapy and prognosis for each case depends upon precise histopathological diagnosis. To evaluate the role of immunohistochemical techniques in determining the conclusive diagnosis. The occurrence of these tumors in our service and the way in which they were distributed according to cell pattern, patient's age and tumor location was also evaluated. Cross-sectional study. Hospital das Clínicas, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. 43 biopsies performed between January 1990 and December 1997, diagnosed as undifferentiated head and neck tumors. We applied an immunohistochemical panel in accordance with the avidin-biotin-peroxidase complex method. The final diagnosis was achieved after new analysis in conjunction with biopsies stained using the hematoxylin-eosin technique. This study evaluated undifferentiated tumors in head and neck, and the way in which they were distributed, according to cell pattern, patient's age and tumor location. The most frequent locations for undifferentiated tumors were the lymph nodes, 20.9%; pharynx and neck, 16.3%; paranasal sinus, 14%; and nose, 11.6%. They were most prevalent during the seventh decade of life (34.9%), and twice as prevalent in men as in women. The immunohistochemical technique allowed conclusive diagnosis for 60.5% of the tumors and was suggestive for 20.9% of the biopsies. The most prevalent cell pattern was round cells (51.2%), followed by epithelioid cells (20.9%), spindle cells (16.3%), myxoid pattern (9.3%) and pleomorphic cells (2.3%). Our results demonstrate the fundamental role of the immunohistochemical technique for conclusive diagnosis of undifferentiated tumors.121244-

(Central) Auditory Processing: the impact of otitis media

OBJECTIVE: To analyze auditory processing test results in children suffering from otitis media in their first five years of age, considering their age. Furthermore, to classify central auditory processing test findings regarding the hearing skills evaluated. METHODS: A total of 109 students between 8 and 12 years old were divided into three groups. The control group consisted of 40 students from public school without a history of otitis media. Experimental group I consisted of 39 students from public schools and experimental group II consisted of 30 students from private schools; students in both groups suffered from secretory otitis media in their first five years of age and underwent surgery for placement of bilateral ventilation tubes. The individuals underwent complete audiological evaluation and assessment by Auditory Processing tests. RESULTS: The left ear showed significantly worse performance when compared to the right ear in the dichotic digits test and pitch pattern sequence test. The students from the experimental groups showed worse performance when compared to the control group in the dichotic digits test and gaps-in-noise. Children from experimental group I had significantly lower results on the dichotic digits and gaps-in-noise tests compared with experimental group II. The hearing skills that were altered were temporal resolution and figure-ground perception. CONCLUSION: Children who suffered from secretory otitis media in their first five years and who underwent surgery for placement of bilateral ventilation tubes showed worse performance in auditory abilities, and children from public schools had worse results on auditory processing tests compared with students from private schools

Neurophysiologic aspects of the facial musculature aiming at rehabilitation of Facial Paralysis

PURPOSE: theoretical review on the neurophysiologic aspects of the orofacial musculature, aiming at the rehabilitation of peripheral facial paralysis. METHODS: review of the literature on neuroanatomicophysiology of orofacial musculature by means of researching articles of national and international journals and in scientific books about the theme, in the period between 1995 and 2005. RESULTS: we have reviewed 50 references all along this work. Out of them, 20 on neurophysiology, and 14 on neuroanatomy. The others were on speech therapy and facial paralysis. The studied articles were divided in three groups: I. Aspects of the neuromuscular compound; II. Morphologic and histochemical characteristics of the face muscles and III. Denervation and muscular atrophy. CONCLUSION: from the findings, we managed to didactically systematize the particularities of the neuroanatomicophysiology, whose knowledge, under the author's point of view, is relevant for the success of the rehabilitation of facial paralysis.OBJETIVO: revisão teórica dos aspectos e particularidades neurofisiológicas relevantes da musculatura orofacial, visando a reabilitação na paralisia facial periférica. MÉTODOS: revisão da literatura sobre neuro-anatomofisiologia da musculatura orofacial mediante pesquisa dos artigos dos periódicos nacionais e internacionais e nos livros científicos sobre o tema, no período entre 1995 a 2005. RESULTADOS: foram revistas 50 referências neste trabalho. Destas, 20 sobre neurofisiologia, 14 sobre neuroanatomia. As demais sobre fonoaudiologia e paralisia facial. Os artigos de neurofisiologia e neuroanatomia estudados foram divididos em três grupos: I - Aspectos do complexo neuromuscular; II - Características morfológicas e histoquímicas dos músculos da face e III - Denervação e atrofia muscular. CONCLUSÃO: a partir dos achados, procurou-se sistematizar didaticamente as particularidades da neuro-anatomofisiologia, cujo conhecimento, na impressão dos autores, são relevantes para o sucesso na reabilitação da paralisia facial.687

Surgical disaster in temporomandibular joint: Case report

AbstractBackgroundTemporomandibular-ankylosis brings extensive limitations on the patient quality of life. Surgical treatment is frequently necessary associated with a continuous rehabilitation. The anatomy of this region and potential complications of this surgery must be thoroughly known to avoid iatrogenic injuries.Case presentationA young patient underwent surgical treatment of congenital bilateral ankylosis with disastrous consequences such as facial palsy, deafness and cerebrospinal leaks on the right side related to intraoperative trauma involving structures of the external, middle and inner ear.ConclusionSince there is no corrective treatment for this type of injuries, the craniomaxillofacial surgeon and other professionals who carry out interventions of this nature need perfect knowledge of the anatomy of the temporal bone and lateral skull base, taking into account the risk of surgical disasters like the one here reported

Ewing's sarcoma of the head and neck

CONTEXT: Ewing's sarcoma is a rare neoplasm, which usually arises in long bones of the limbs and in flat bones of the pelvis, with the involvement of head and neck bones being very unusual. CASE REPORT: a case of Ewing's sarcoma occurring in the mandible of a 35-year-old female. Pain and swelling of the tumor were the main complaints. The early hypothesis was an undifferentiated malignant neoplasm, possibly a sarcoma. The CT scan depicted an expansive lesion, encapsulated, with septa and characteristics of soft tissue, involving the left side of the mandible and extending to the surrounding tissues. The patient underwent surgical excision of the lesion, the definitive diagnosis of Ewing's sarcoma was established, and the patient commenced on radiotherapy.CONTEXTO: O Sarcoma de Ewing é uma doença que geralmente acomete os ossos longos e a pelve, sendo rara a ocorrência em cabeça e pescoço. RELATO DE CASO: Caso de Sarcoma de Ewing começando na mandíbula em uma paciente de 35 anos, sendo a tumoração e a dor local os principais sintomas referidos. O diagnóstico inicial foi de neoplasia maligna indiferenciada, sugestivo de sarcoma e a tomografia computadorizada mostrou lesão expansiva com características de tumor de partes moles, septada e encapsulada, acometendo a mandíbula esquerda e apresentando extensão para as partes moles adjacentes. O tratamento realizado foi a remoção cirúrgica da lesão, complementado com radioterapia pós-operatória. O diagnóstico definitivo foi de Sarcoma de Ewing.19820

Evaluation of the Digisonic® SP cochlear implant: patient outcomes and fixation system with titanium screws

Cochlear implants have revolutionized the way patients affected by severe hearing loss experience the world. Neurelec developed a fixation system with two titanium screws that requires no skull bone drilling. OBJECTIVE: To describe the outcomes and procedure-related details of a series of patients implanted with the Digisonic® SP cochlear implant. METHOD: This retrospective study analyzed patients submitted to cochlear implant placement within a period of 18 months. All patients had postlingual hearing impairment. Data was collected from patient charts and standard questionnaires answered by the surgeons in charge of carrying out the procedures. RESULTS: The six patients offered the Digisonic® SP cochlear implants were operated by experienced surgeons. The procedures took 95 to 203 minutes (mean = 135') to be completed, which is less time than what has been described for other fixation approaches. No complications were recorded and hearing improvement was satisfactory. CONCLUSION: The Digisonic® SP cochlear implant developed by Neurelec offered good audiological results for adult patients, shorter surgery time, and no surgical or postoperative complications.O implante coclear para pacientes com disacusia grave/profunda revolucionou o modo com que estes interagem com o meio ambiente. A Neurelec desenvolveu um sistema que permite fixação com uso de dois simples parafusos de titânio, sem necessidade de broqueamento do osso do crânio do paciente. Este artigo teve o objetivo de descrever uma casuística de pacientes submetidos a implante coclear com o Digisonic® SP, para mostrar os resultados cirúrgicos e detalhes do procedimento. MÉTODO: Estudo retrospectivo que avaliou os pacientes, no período de 18 meses, submetidos a implante coclear com o Digisonic® SP. Todos os pacientes eram pós-linguais. Coleta dos dados realizada por meio da análise dos prontuários dos pacientes, além de questionário padronizado aplicado nos cirurgiões que realizaram o procedimento. RESULTADOS: Os seis casos implantados com o Digisonic® SP foram realizados por cirurgiões experientes e o tempo cirúrgico variou de 95 a 203 minutos (média de 135 minutos), que é menor do que o descrito com outras formas de fixação. Não houve nenhum tipo de complicação e o ganho auditivo foi satisfatório. CONCLUSÃO: O implante Digisonic® SP desenvolvido pela Neurelec apresentou bons resultados audiológicos em adultos, tempo de cirurgia menor e não ocorreram complicações cirúrgicas ou pós-operatórias.566

Study of the relationship between the degree of tinnitus annoyance the presence of hyperacusis✩✩Please cite this article as: Guimarães AC, Carvalho GM, Voltolini MM, Zappelini CE, Mezzalira R, Stoler G, et al. Study of the relationship between the degree of tinnitus annoyance and the presence of hyperacusis. Braz J Otorhinolaryngol. 2014;80:24-8.

AbstractIntroductionHyperacusis can be defined as a manifestation of an increased of central auditory pathways gain and can be considered a pre-tinnitus state. In some cases tinnitus can be caused by such increased gain.AimTo evaluate the prevalence of hyperacusis in patients with tinnitus and its relation to the annoyance of tinnitus.Materials and methodsRetrospective study with patients from the neurotology service complaining of tinnitus in the first consultation were submitted to clinical evaluation, a questionnaire and audiological evaluation of tinnitus and hyperacusis. The degree of annoyance of tinnitus and hyperacusis was measured using a visual analog scale.ResultsWe analyzed medical records of 309 patients, 169 (54.7%) females and 140 (45.3%) males. The mean age was 53 years. The median degree of tinnitus annoyance was 7. Hyperacusis was present in 57 (18.4%) patients, with a median degree of 5. The degree of annoyance due to tinnitus patients with hyperacusis was similar to that of patients without hyperacusis.ConclusionHyperacusis was present in 18.4% of patients with tinnitus. The degree of annoyance due to tinnitus had no correlation with the presence of hyperacusis.© 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved

Facial palsy and pregnancy: management and treatment

PURPOSE: To compare the degree of peripheral facial palsy of pregnant women and puerperae at admission and at discharge and to evaluate related factors. METHODS: Retrospective, cross-sectional study, with analysis of medical records of pregnant and postpartum women with facial palsy, over a period of 12 months, with application of a standardized protocol for patient evaluation and of the House-Brackmann scale on the occasion of the first visit and at discharge. RESULTS: Six patients were identified, mean age of 22.6 years. Five cases were classified as stage IV and one as stage II on the House-Brackmann scale, being two of them puerperae and four pregnant. All showed improvement on the House-Brackmann scale. CONCLUSION: The Bell's palsy has a good prognosis even in pregnant and postpartum women, being important to perform the correct treatment to reduce the sequelae in this group identified as more susceptible to peripheral facial palsy.OBJETIVO: Comparar o grau da paralisia facial periférica de gestantes e puérperas no momento da admissão e na alta e avaliar outros fatores associados. MÉTODOS: Estudo retrospectivo, transversal, com análise dos prontuários de gestantes e puérperas atendidas no ambulatório de paralisia facial, em um período de 12 meses, com aplicação de protocolo padronizado de avaliação das pacientes e da escala de House-Brackmann na primeira consulta e na data da alta. RESULTADOS: Foram identificadas 6 pacientes, com média de idade de 22,6 anos. Cinco casos foram classificados com estadiamento IV e um com II na escala de House-Brackmann, sendo que duas eram puérperas e quatro gestantes. Todas evoluíram com melhora na escala de House-Brackmann. CONCLUSÃO: A paralisia de Bell tem bom prognóstico mesmo em gestantes e puérperas, sendo importante realizar tratamento adequado para diminuir as sequelas neste grupo apontado como mais susceptível à paralisia facial periférica.36837

Hifocus Helix™ Electrode Insertion: Surgical Approach.

Cochlear implants have been used for almost 30 years as a device for the rehabilitation of individuals with severe-to-profound hearing loss. One of the important aspects of cochlear implantation is the type of electrode selected and proper insertion of the electrode array in scala tympani to minimize cochlear damage. The HiFocus Helix™ electrode is a precurved design aimed at placing the electrode contacts close to the spiral ganglion cells in the modiolus. The prescribed insertion techniques are intended to minimize the likelihood of damage to the basilar membrane or lateral wall of the cochlea. To describe the first insertion of a HiFocus Helix™ electrode in Brazil exposing surgical particularities and device details in a patient with profound hearing loss, due to Mondini's dysplasia. No problems were encountered during the surgical procedure. The patient experienced improvement in hearing thresholds and speech perception. The HiFocus Helix™ electrode proved easy to insert and provided expected hearing benefits for the patient. This manuscript indicates that the HiResolution™ Bionic Ear System with HiFocus Helix™ electrode comprise a cochlear implant system that is practical and beneficial for the treatment of severe-to-profound hearing loss.830

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