Bilateral inverted papilloma: case report and literature review

The inverted papilloma is an uncommon unilateral nasosinusal benign tumor. The clinical picture presents nonspecific signs and symptoms, such as unilateral nasal obstruction, anosmia and headache. The diagnosis is established by anamnesis, physical exam, computed tomography and magnetic resonance imaging. Treatment is essentially surgical. This report has the objective of presenting an uncommon bilateral inverted nasal papilloma and making a literature review.O papiloma invertido é um raro tumor nasossinusal benigno e unilateral. As manifestações clínicas são inespecíficas, como obstrução nasal unilateral, rinorréia, epistaxe, hiposmia e cefaléia. O diagnóstico é realizado por meio de anamnese detalhada, exame otorrinolaringológico e exames complementares. A tomografia computadorizada e a ressonância magnética são exames fundamentais na elucidação diagnóstica, no tratamento e no acompanhamento do paciente. O tratamento é essencialmente cirúrgico. Este trabalho tem como objetivo relatar um caso de papiloma invertido bilateral e realizar uma revisão da literatura.Hospital CEMAUNIFESP-EPMUNIFESP, EPMSciEL

Pediatric otosclerosis: Case report and literature review

SummaryOtospongiosis is an osteodystrophy of the temporal bone, characterized by disordered neoformation and deposition of bone, characterized by the presence of a progressive conductive, sensorineural or mixed hearing loss and tinnitus. Typically, otospongiosis presents as a slowly progressive conductive hearing loss in the third to fourth decade of life. Uncommonly children and adolescents may also have conductive or sensorineural hearing loss caused by otosclerosis. We describe a case of an 11-year-old patient, with progressive unilateral conductive hearing loss for 5 years. The otoscopic examination revealed a positive Schwartz's sign in the left ear. Audiometry, impedanciometry and CT scan showed characteristics that suggested otospongiosis. We reviewed clinical aspects, diagnosis and the therapeutic approach for otospongiosis in children

Regenereation of the mandibular branch of rats\' facial nerve regenereation after implanting undifferenciated mesenchymal stromal multipotent cells and differenciated Schwann-like cells in vitro

INTRODUÇÃO: O nervo facial desempenha um papel importante em diversas funções fisiológicas no organismo, no entanto, distúrbios funcionais desse nervo podem também afetar a psique do indivíduo, provocando mudanças significativas na autoimagem, interferindo no rendimento profissional e piorando a qualidade de vida. Lesões graves do nervo facial (neurotmeses) mesmo quando tratadas precocemente apresentam resultados funcionais pobres. Com a recente descoberta das células-tronco, as células multipotentes do estroma mesenquimal indiferenciadas (CMEMi) ou diferenciadas em células com fenótipo de células de Schwann (CMEMd) podem ser uma alternativa melhor para o tratamento de lesões graves do nervo facial. OBJETIVOS: Avaliar a melhora funcional e histológica do ramo mandibular do nervo facial após neurotmese e implantação das CMEMi e CMEMd. MÉTODOS: Em 48 ratos Wistar realizou-se a neurotmese do ramo mandibular direito do nervo facial com a formação de um hiato de 3mm e a tubulização (conduíte de silicone) da região do nervo lesada. Foram criados quatro grupos de acordo com o método de reparo: conduíte de silicone vazio (grupo A, grupo controle); conduíte de silicone com gel acelular (grupo B); conduíte de silicone com gel acelular e CMEMi (grupo C), e conduíte de silicone com gel acelular e CMEMd (grupo D). Um quinto grupo, grupo N, foi criado a partir de segmentos do nervo normal para a avaliação histológica. Os resultados funcionais foram avaliados com o estudo de condução nervosa e os histológicos por avaliação qualitativa e quantitativa dos segmentos proximais e distais. RESULTADOS: Na avaliação funcional, após 6 semanas, os grupos C e D apresentaram amplitudes maiores que os grupos A e B (p<0,001). O grupo C apresentou duração menor que os grupos A, B e D (p<0,001). Na avaliação qualitativa dos segmentos proximais, houve pouca diferença entre os grupos, já nos segmentos distais, as diferenças dos grupos A e B em relação aos grupos C e D foram bem evidentes, no entanto, em ambos os segmentos, o grupo C foi o que mais se aproximou do nervo normal. Na avaliação histológica quantitativa do segmento proximal, não houve diferença no número total e na densidade axonal entre os grupos (p0,169), somente nos diâmetros axonais dos grupos A e B quando comparados ao nervo normal (p<0,001). No segmento distal, o número e a densidade axonal do grupo C foram maiores que os do grupo A e B (p=0,001) e iguais as do grupo D (p=0,711), porém, em todos os grupos, número e a densidade axonal foram menores que do grupo N (p0,003). Não houve diferença na média dos diâmetros entre os grupos operados (p0,007), somente quando comparados com o grupo N (p<0,001). CONCLUSÕES: As CMEMi assim como as CMEMd beneficiaram a regeneração do ramo mandibular do nervo facial de ratos Wistar, contudo, as CMEMi apresentaram resultados funcionais e histológicos melhores que as CMEMdINTRODUCTION: Facial nerve performs an important function in different physiological activities in the organism, however, functional disturbances of such nerve may also attack a persons mind, causing expressive changes in their self-image, interfering in professional life and aggravating their quality of life. Severe lesions in the facial nerve (neurotmesis) present poor functional results even when early treated. With recent discovering of the stem cells, undifferentiated multipotent stem cell (uMSC) from mesenchymal stroma or differentiated to Schwann cell-like (dMSC) can be a better perspective to treat severe lesion of the facial nerve. OBJECTIVES: The objective of this study is to evaluate the functional and histological improvement of the mandibular branch after neurotmesis and implantation of the uMSC and dMSC. METHODS: The neurotmesis of the right mandibular branch of the facial nerve with a 3mm gap formation and tubulization (silicone tubing) of the wounded nerve area was performed in 48 Wistar rats. Four groups were divided according to the restoration method: empty silicone tubing (group A, control group); silicone tubing with non-cell gel (group B); silicone tubing with non-cell gel and uMSC (group C) and silicone tubing with non-cell gel and dMSC (group D). A fifth group (N) was created from the normal nerve segments to perform histological evaluation. The nerve conduction study evaluated the functional results; quantity and quality evaluation of the distal and proximal segment evaluated the histological results. RESULTS: After six weeks, regarding functional evaluation, groups C and D presented larger amplitude than groups A and B (p<0.001). Group C presented lesser duration than groups A, B and D (p<0.001). There was little difference among the groups in the quality evaluation of the proximal segments; on the other hand, the differences in groups A and B in relation to groups C and D were quite expressive in the distal segments. However, group C, in both segments, was the one that came closer to the normal nerve. Regarding quantity histological evaluation of the proximal segment, there was no difference in the total number and in the axonal density among the groups (p0.169); there was difference only in the axonal diameters in groups A and B when compared to normal nerve (p<0,001). Regarding distal segment, axonal density and number, in group C, were higher than in group A and B (p=0.001) and the same as in group D (p=0,711), but number and axonal density were lesser than in group N (p0,003). There was no difference in the diameter average among the operated groups (p0.007), when only compared to group N (p<0.001). CONCLUSION: Both uMSC and dMSC benefited regeneration of the mandibular branch of the facial nerve in Wistar rats, although uMSC presented better functional and histological result

Partial lesions of the intratemporal segment of the facial nerve: Graft versus partial reconstruction

Objectives: In cases of partial lesions of the intratemporal segment of the facial nerve, should the surgeon perform an intraoperative partial reconstruction, or partially remove the injured segment and place a graft? We present results from partial lesion reconstruction on the intratemporal segment of the facial nerve. Methods: A retrospective study on 42 patients who presented partial lesions on the intratemporal segment of the facial nerve was performed between 1988 and 2005. The patients were divided into 3 groups based on the procedure used: interposition of the partial graft on the injured area of the nerve (group 1; 12 patients); keeping the preserved part and performing tubulization (group 2; 8 patients); and dividing the parts of the injured nerve (proximal and distal) and placing a total graft of the sural nerve (group 3; 22 patients). Results: Fracture of the temporal bone was the most frequent cause of the lesion in all groups, followed by iatrogenic causes (p < 0.005). Those who obtained results lower than or equal to III on the House-Brackmann scale were 1 (8.3%) of the patients in group 1, none (0.0%) of the patients in group 2, and 15 (68.2%) of the patients in group 3 (p < 0.001). Conclusions: The best surgical technique for therapy of a partial lesion of the facial nerve is still questionable. Among these 42 patients, the best results were those from the total graft of the facial nerve

Electromyographic and ultrasonographic evaluation of the masseter muscle individuals with unilateral peripheral facial paralysis

Introduction: Individuals with peripheral Facial Paralysis (FP) show conditions that lead to unilateral mastication, performed by the non-affected side, mainly due to the difficulty of action of the buccinator muscle. Objectives: characterize the motor control and morphology of the masseter muscle in individuals with unilateral peripheral FP through electromyographic and ultrasonographic evaluation. Method: 16 participants, of both sexes, with ages superior to 18 years old. The study group (SG) consisted of 8 individuals who'd had idiopathic unilateral peripheral FP for more than 6 months; the control group (CG) consisted of 8 normal individuals. All the subjects were submitted to the masseter muscle evaluation through surface electromyography (sEMG) and ultrasonography (USG) during the following tasks: rest, clenching with cotton roller between the teeth (CT) and clenching with maximum intercuspation (MIC). Results: There was no statistically significant difference in comparisons within and between the groups concerning the hemifacial asymmetry, both for the sEMG and for the USG. Also there were no significant differences in the activation of the masticatory muscles (masseter and temporal) in the sEMG. Conclusions: Both the motor control and the morphology of the masseter muscles in individuals with unilateral peripheral FP were similar to those of normal individuals. Although literature suggests that the demand of functional adaptations made by FP individuals could exceed the structural and functional tolerance of the temporomandibular joints, the results indicate that the length of analyzed patient's FP was not enough to generate anatomical and physiological differences in the masticatory muscles

Quantitative histological analysis of the mandibular branch of the facial nerve in rats Análise histológica quantitativa do ramo mandibular do nervo facial em ratos

PURPOSE: To establish a model to quantitative histological analysis of the mandibular branch of the facial nerve in rats. METHODS: Eleven Wistar rats had their right and left mandibular branches of the facial nerve surgically removed and were sacrificed afterwards. Quantitative histological analysis was performed with: a) partial number of axons; b) partial area of the transversal cut of the nerve (9000&#956;m²); c) partial density. The averages of partial density were obtained. The statistical study was established by Wilcoxon test (p=0.05). RESULTS: In relation to density of axons, comparison between sides shows no statistically significant difference (p=0.248; p=0.533). Mean partial density of distal and proximal samples was, respectively, 0.18 ± 0.02 and 0.19 ± 0.02 axons/&#956;m². Comparison between proximal and distal samples shows no statistically significant difference (p=0.859; p=0.182). CONCLUSION: This study has successfully established a model to histological quantitative analysis of the mandibular branch of the facial nerve in rats.<br>OBJETIVO: Estabelecer um modelo para análise histológica quantitativa do ramo mandibular do nervo facial de ratos. MÉTODOS: Onze ratos Wistar tiveram os ramos mandibulares de seus nervos faciais direito e esquerdo removidos cirurgicamente, e submetidos à análise histológica quantitativa de suas regiões proximal e distal com: a) contagem total do número de axônios, b) medida da área parcial (9000&#956;m²) de corte transversal do nervo, c) cálculo de densidade parcial (DP). RESULTADOS: Em relação à densidade dos axônios, a comparação entre os lados não mostrou diferença estatisticamente significativa (p=0,248; p=0,533). A densidade parcial média das amostras distais e proximais foi, respectivamente, 0,18 ± 0,02 e 0,19 ± 0,02 axônios/&#956;m². A comparação entre as amostras proximais e distais não mostrou diferença estatisticamente significativa (p=0,859; p=0,182). CONCLUSÃO: Este estudo estabeleceu com sucesso um modelo de análise histológica quantitativa do ramo mandibular do nervo facial em ratos

Assessment of a Neurophysiological Model of the Mandibular Branch of the Facial Nerve in Rats by Electromyography

Objectives: Our objective was to develop an experimental model for the noninvasive and objective evaluation of facial nerve regeneration in rats using a motor nerve conduction test (electromyography). Methods: Twenty-two rats were submitted to neurophysiological evaluation using motor nerve conduction of the mandibular branch of the facial nerve to obtain the compound muscle action potentials (CMAPs). To record the CM APs, we used two needle electrodes that were inserted into the lower lip muscle of the rat. A supramaximal electrical stimulus was applied, and the values of CMAP latency, amplitude, length, area, and stimulus intensity obtained from each side were compared by use of the Wilcoxon test. Results: There was no significant difference (all p &gt; 0.05) in latency, amplitude, duration, area, or intensity of stimuli between the two sides. The amplitudes ranged between 1.61 and 8.30 mV, the latencies between 1.03 and 1.97 ms, and the stimulus intensities between 1.50 and 2.90 mA. Conclusions: This is a noninvasive, easy, and highly reproducible method that contributes to an improvement of the techniques previously described and may contribute to future studies of the degeneration and regeneration of the facial nerve.Sao Paulo FoundationSao Paulo Foundatio

Facial clinimetric evaluation scale and synkinesis assessment questionnaire translation into Brazilian Portuguese: A validation study

Introduction Facial nerve palsy results in both functional disability and psychological morbidity. There are several well-established grading scales to quantify the quality of life of these patients. Objective Translate and validate the Facial Clinimetric Evaluation (FaCE) scale and Synkinesis Assessment Questionnaire (SAQ) to Brazilian Portuguese. Methods This study adopted a forward-backward translation method and performed cross-cultural adaptation. A pilot study was conducted to correct any confusing language and to evaluate content validity. A validation study was then performed. Internal consistency of the Brazilian Portuguese version of the FaCE and SAQ items was evaluated by Cronbach's alpha coefficient. Construct validity was assessed by Spearman's Rank Correlation Coefficient between FaCE and SAQ scores to eFACE, House-Brackmann, Short Form 12 (SF-12) and Facial Disability Index (FDI) (sub)scores. Results A total of 90 patients were included. Cronbach's alpha for total domain scored 0.881 for FaCE and 0.809 for SAQ. FaCE total score correlation to eFACE total and House-Brackmann showed Spearman's r value of 0.537 and -0.538, respectively (p < 0.001). SAQ correlation to eFACE synkinesis subdomain was -0.449 (p < 0.001). No correlation was found between SAQ and HB score. FaCE total score correlations were of 0.301 and 0.547 for SF-12 PCS and MCS, respectively (p < 0.001). Correlation between FaCE total and FDI Physical and Social/well-being functions were 0.498 and 0.567 (p < 0.001). Conclusion Brazilian Portuguese FaCE scale and SAQ versions achieved high validity and reliability in the present study. These translated instruments demonstrated good psychometric properties, being proper to use in clinical practice in Brazil and with Brazilian Portuguese speakers