26 research outputs found
Foreign Body In Jugal Mucosa.
Introduction Foreign body in the oral cavity may be asymptomatic for long time and only sometimes it can lead to a typical granulomatous foreign body reaction. Some patients may complain of oral pain and present signs of inflammation with purulent discharge. A granuloma is a distinct, compact microscopic structure composed of epithelioid-shaped macrophages typically surrounded by a rim of lymphocytes and filled with fibroblasts and collagen. Nowadays, the increase of cosmetic invasive procedures such as injection of prosthetic materials in lips and cheeks may lead to unusual forms of inflammatory granulomas. Objectives Describe an unusual presentation of a foreign body reaction in the buccal mucosa due to previous injection of cosmetic agent. Resumed Report A 74-year-old woman was referred to the Department of Otorhinolaryngology, Head and Neck Surgery to investigate the presence of multiple painless, bilateral nodules in the buccal mucosa, with progressive growth observed during the previous 2 months. The histologic results showed a foreign body inflammatory reaction. Conclusion Oral granulomatosis lesions represent a challenging diagnosis for clinicians and a biopsy may be necessary. Patients may feel ashamed to report previous aesthetic procedures, and the clinicians must have a proactive approach.19364-36
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
Correlation between residual cochlear volume after labyrinthitis ossificans and impedance measurements of intracochlear electrodes in patients undergoing cochlear implant surgery
Introdução: A meningite bacteriana é uma das causas mais comuns de perda auditiva neurossensorial profunda adquirida, com obstrução coclear secundária à labirintite ossificante. A inserção de um implante coclear no cenário de labirintite ossificante é um desafio até para os cirurgiões mais experientes. Recomenda-se o implante coclear precoce nesse cenário para aumentar a probabilidade de alcançar uma inserção completa do conjunto de eletrodos. A impedância do eletrodo é a primeira avaliação objetiva realizada durante o procedimento cirúrgico e durante o acompanhamento dos pacientes implantados e fornece informações sobre a integridade dos eletrodos e o ambiente intracoclear. Objetivos: Determinar os valores de impedância após o implante coclear em pacientes surdos pós-meningite, correlacionando com o volume coclear residual e obliteração coclear e comparando diferenças entre os segmentos cocleares. Material e Métodos: Pacientes surdos pós-meningite e aqueles com perda auditiva idiopática (controle) submetidos à cirurgia do implante coclear (dispositivo Cochlear®) foram incluídos no estudo. Os valores de impedância no modo \"terra comum\" (CG) e no modo monopolar (MP1+2) nos segmentos basal, médio e apical foram calculados para cada grupo (no período intraoperatório e após um ano da cirurgia). O grau de ossificação da cóclea foi avaliado a partir de uma tomografia computadorizada, enquanto o grau de obliteração foi determinado no intraoperatório pelo cirurgião. Foi realizada reconstrução tridimensional do lúmen coclear residual por meio do exame de ressonância nuclear magnética, pré-operatório, para correlação com os valores de impedância. Resultados: Foram incluídos 14 pacientes no grupo com histórico de meningite e 34 no grupo com perda auditiva idiopática. Sinais de calcificação coclear foram identificados nos exames de tomografia computadorizada de oito pacientes com histórico de meningite e em apenas um paciente no grupo idiopático. O volume coclear residual foi maior no grupo com perda auditiva idiopática (p=0,0145). No entanto, não houve correlação com o tempo de perda auditiva e tampouco com os limiares auditivos pré-operatórios. Verificou-se correlação fraca entre volume coclear residual e limiares auditivos pós-operatórios somente no grupo com perda auditiva idiopática (r=0,39; p=0,0222). Foram observadas alterações significativas nas impedâncias dos eletrodos mediais e apicais em ambos os grupos após um ano da cirurgia, embora sem diferenças entre o grupo de pacientes com antecedente de meningite e o grupo idiopático. Discussão: Pacientes com implante coclear exibem impedâncias mais altas nos eletrodos do giro basal, independentemente do grau de ossificação coclear. Altas impedâncias no grupo da meningite podem ser explicadas por alterações na superfície do eletrodo. Esse comportamento ressalta a importância da persistência de fatores intracocleares na influência de parâmetros de ajuste no segmento basal. Conclusões: Os pacientes com implante coclear por surdez relacionada à meningite mostraram impedâncias com comportamento semelhante àquelas do grupo com perda auditiva idiopática, mesmo na região do giro basal, independentemente do grau de ossificação coclear. Para otimizar o resultado do implante coclear nos casos pós-meningite, é aconselhável a cirurgia antes do início da ossificação coclear.Introduction: Bacterial meningitis is one of the most common causes of profound sensorineural hearing loss acquired with cochlear obstruction secondary to ossifying labyrinthitis. The insertion of a cochlear implant in the ossifying labyrinthitis scenario is a challenge for even the most experienced surgeons. Early cochlear implantation is recommended in this scenario to increase the likelihood of achieving a complete insertion of the set of electrodes. Electrode impedance is the first objective assessment performed during the surgical procedure and during the follow-up of implanted patients and provides information on the integrity of the electrodes and the intracochlear environment. Objectives: To determine the impedance values after cochlear implantation of deaf patients after meningitis, correlating with residual cochlear volume and cochlear obliteration and comparing differences between cochlear segments. Material and Method: Post-meningitis deaf patients and idiopathic deaf patients (control) who underwent cochlear implant surgery (Cochlear® device) were included in the study. The impedance values calculated in \"common ground\" (CG) and monopolar (MP1+2) modes in the basal, middle and apical segments were calculated for each group (during the intraoperative period and after one year of surgery). The degree of ossification of the cochlea was assessed using a computed tomography scan while the degree of obliteration was determined intraoperatively by the surgeon. Three-dimensional reconstruction of the residual cochlear lumen was performed with preoperative nuclear magnetic resonance exams, for correlation with the impedance values. Results: Fourteen patients were included in the group with a history of meningitis and 34 patients in the group with idiopathic deafness. Signs of cochlear calcification were identified in computed tomography exams in 8 patients with a history of meningitis and in only one patient in the idiopathic group. Residual cochlear volume was higher in the group with idiopathic deafness (p=0.0145). However, there was no correlation with time of deafness and there was no correlation with preoperative hearing thresholds. We found a weak correlation between residual cochlear volume and postoperative hearing thresholds in the idiopathic deafness group only (r=0.39; p=0.0222). We observed significant changes in the impedances of the medial and apical electrodes in both groups after one year of surgery, although there were no differences between the group of patients with a history of meningitis and patients in the idiopathic group. Discussion: Patients with cochlear implants exhibit higher impedances in the electrodes of the basal turn, however, not correlatedwith the degree of cochlear ossification. High impedances in the meningitis group can be explained by changes on the electrode surface. This behavior highlights the importance of the persistence of intra-cochlear factors in the influence of adjustment parameters in the basal segment. Conclusions: Patients with cochlear implants due to deafness related to meningitis exhibit impedances with similar behavior to those with idiopathic deafness, even in the basal turn, regardless of the degree of cochlear ossification. In order to optimize the result of the cochlear implant in post-meningitis cases, surgery at an early stage before the start of cochlear ossification is advisable
Schwannoma de septo nasal: avaliação de massa nasal unilateral Schwannoma of the nasal septum: evaluation of unilateral nasal mass
Tonsillar Lymphoma in Children According to Age Group: A Systematic Review
Introduction: Lymphoma is a common malignant tumor of the head and neck occurring during childhood. Early diagnosis is very important in terms of prognosis in patients with tonsillar lymphoma.Our objective was to evaluate the clinical manifestations of pediatric tonsillar lymphoma according to different age groups. Materials and Methods: A systematic review of available English, Spanish, or Portuguese literature from January 1996 to June 2012 was performedin the BIREME, Cochrane, IBECS, Lilacs, PubMed/Medline, SCIELO, and Scopus databases, using “tonsillar lymphoma” and “children” as keywords. Inclusion criteria were pediatric case reports, patients aged up to 18 years, and information on clinical features at the time of diagnosis. Results: Out of 87 identified publications, 13 articles were selected describing 53 patients. Tonsillar asymmetry was the most common sign. Snoring is a common sign in patients aged under 5 years; clinical lymphadenopathy is frequent among patients aged between 6 and 10 years; and dysphagia is a common sign in patients between 11 and 18 years of age. Burkitt’s lymphoma is the most common form among all ages studied, followed by B-cell lymphoma. Conclusion: Clinical manifestations differ according to age group. However, tonsillar asymmetry is the most frequent sign regardless of age group
Epitympanum volume and tympanic isthmus area in temporal bones with retraction pockets
Objectives/HypothesisTo compare the volume of the epitympanic space, as well as the area of the tympanic isthmus, in human temporal bones with retraction pockets to those with chronic otitis media without retraction pockets and to those with neither condition. Study DesignComparative human temporal bone study. MethodsWe generated a three-dimensional model of the bony epitympanum and measured the epitympanic space. We also compared the area of the tympanic isthmus. ResultsThe mean total volume of the epitympanum was 40.55 7.14 mm(3) in the retraction pocket group, 50.03 8.49 mm(3) in the chronic otitis media group, and 48.03 +/- 9.16 mm(3) in the neither condition group. The mean volume of the anterior, lateral, and medial compartments in temporal bones in the retraction pocket group was significantly smaller than in the two control groups (P < 0.05). Total epitympanic volume was also significantly smaller in the retraction pocket group than in both control groups (P < 0.05). The mean area of the tympanic isthmus was significantly smaller in the retraction pocket group (8.11 +/- 2.44 mm(2)) than in the chronic otitis media group (9.82 +/- 2.06 mm(2)) or the neither condition group (10.66 +/- 1.78 mm(2)) (P < 0.05). Conclusion Our data indicate that temporal bones with retraction pockets have a smaller volume bony epitympanum and a smaller tympanic isthmus area as compared with temporal bones from both control groups. The smaller volume tympanic isthmus in the retraction pocket group may suggest that a blockage in the aeration pathways to the epitympanum could create dysventilation, resulting in negative pressure and ultimately in retraction pockets and cholesteatomas12611E369E374sem informaçã
Achados otorrinolaringológicos em um grupo de pacientes com doenças reumatológicas
Introdução: As manifestações otorrinolaringológicas de doenças reumáticas representam um grande desafio não só ao médico generalista, mas também ao otorrinolaringologista e ao reumatologista. Frequentemente representam manifestações iniciais de uma desordem autoimune que exige um tratamento imunossupressor imediato e agressivo. Sintomas auditivos, nasais, laríngeos e oculares podem ser a primeira manifestação de doenças reumáticas, e sua correta avaliação auxilia o médico a identificar sinais de atividade da doença. O objetivo deste trabalho foi identificar as manifestações otorrinolaringológicas em pacientes com doenças reumáticas em um hospital de alta complexidade, no que se refere a facilitar diagnóstico e tratamento precoces. Métodos: Foram realizadas avaliações clínicas e otorrinolaringológicas completas em pacientes selecionados no ambulatório de reumatologia, no segundo semestre do ano de 2010, de forma padronizada e com utilização de um formulário de preenchimento normatizado. Resultados: No grupo estudado, pacientes com LES apresentaram predominantemente manifestações laríngeas, enquanto pacientes com síndrome de Sjögren apresentaram predomínio das manifestações otológicas (100% dos casos). As alterações de exames audiométricos são encontradas em 53% dos casos portadores de GW, 80% de PR, 33% de LES e 50% de SCS. Quanto às alterações nasais, estas foram encontradas de forma prevalente em todas as patologias, principalmente a síndrome de Churg-Strauss. Discussão e conclusão: Este estudo demonstrou que a maioria dos pacientes em seguimento em nosso serviço apresenta os sinais e sintomas otorrinolaringológicos comumente relacionados em trabalhos prévios sobre doenças reumáticas, porém novos estudos com um número maior de pacientes devem ser feitos para comprovar tais relações