Adult tonsillectomy : postoperative pain depends on indications

AbstractIntroductionIntense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an acute tonsillitis. Although recurrent tonsillitis is the most frequent indication for surgery, many tonsillectomies are performed due to other indications and these patients may be unfamiliar with such pain.ObjectiveTo verify whether individuals with recurrent tonsillitis experience different post-tonsillectomy pain intensity than those with other indications for surgery, with no history of episodes of acute tonsillitis.MethodsA total of 61 tonsillectomies were performed under general anesthesia, using a potassium titanyl phosphate (KTP) laser (to eliminate the potential influence on the study results of forceful dissection of fibrotic tonsils in patients with history of recurrent tonsillitis) and multiple ligations of blood vessels within the tonsillar beds. The patients received 37.5mg Tramadoli hydrochloridum+325mg Paracetamol tablets for 10 days. Postoperative variables included the duration of hospital stay, postoperative hemorrhage and readmission rate. The patients reported pain intensity on consecutive days, pain duration, weight loss on postoperative day 10, character, intensity and duration of swallowing difficulties, and the need for additional doses of painkillers. Healing was also assessed. Capsular nerve fibers were histologically examined in the resected tonsils by immunostainings for general and sensory markers.ResultsIndications for the surgery were: recurrent acute tonsillitis (34 patients), no history of recurrent tonsillitis: focus tonsil (20) and intense malodour (7). Pain intensity on postoperative days 3–4 and incidence of readmissions due to dehydration were significantly higher in the group with no history of recurrent tonsillitis. No significant differences in relative densities of protein gene product (PGP) 9.5- and calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibers were observed.ConclusionPatients with recurrent tonsillitis qualified for tonsillectomy reported lower pain intensity than those without recurrent tonsillitis and the pain scores were unrelated to nerve fibers density

Antibiotic use in post-adenotonsillectomy morbidity: a randomized prospective study

A tonsilectomia, associada ou não à adenoidectomia, continua a ser um dos procedimentos cirúrgicos mais realizados mundialmente, incidindo principalmente sobre a população pediátrica. OBJETIVO: Investigar o impacto do uso da amoxacilina por 7 dias na recuperação pós adenoamigdalectomia, comparando os resultados com um grupo controle. Tipo de Estudo: Estudo prospectivo randomizado controlado com 120 pacientes. PACIENTES E MÉTODO: Os pacientes foram randomizados ao tempo da cirurgia para receber um curso de 7 dias de amoxacilina associada a analgésicos ou apenas analgésicos. Durante a primeira semana de pós-operatório foram avaliados o grau de dor, aceitação da via oral, náuseas e vômitos, febre e retorno às atividades. RESULTADOS: Somente no 4º pós-operatório o grupo recebendo antibiótico teve uma diferença estatística significante no grau de dor. Não houve diferença entre os dois grupos para outros dados analisados. CONCLUSÃO: Considerando os resultados do nosso estudo e revisando a literatura sobre o uso de antibióticos, nós concordamos que não há nenhuma melhora na recuperação dos pacientes submetidos à adenoamigdalectomia após o uso de amoxicilina por 7 dias.Tonsillectomy with or without adenoidectomy still is one of the most commonly performed surgical procedures in the world, mostly in the pediatric population. AIM: to study the impact of amoxicillin for 7 days in post-adenotonsillectomy recovery, comparing results with a control group. Study type: prospective, randomized, controlled study with 120 patients. PATIENTS AND METHODS: the patients were randomized according to surgery time to receive 7 days of amoxicillin associated with pain killers, or analgesic alone. During the first week of postoperative, we assessed the level of pain, oral intake acceptance, nausea and vomits, fever and return to daily activities. RESULTS: It was only in the fourth post-operative day that the group receiving antibiotic agents showed a statistically significant difference as far as pain is concerned. There was no difference between the two groups for other data analyzed. CONCLUSION: considering the results from our study and reviewing the literature on the use of antibiotic agents, we agree that there is no improvement in patient recovery after adenotonsillectomy with the use of amoxicillin for 7 days in the postoperative

Tratamento ortodôntico e a apneia obstrutiva do sono

A apneia obstrutiva do sono é um distúrbio relacionado a respiração durante o sono que atinge indivíduos de todas as idades. Seu estudo e tratamento são de extrema importância, dada a alta prevalência na população e suas consequências, como a diminuição no desempenho neurocognitivo e no crescimento e sonolência e fadiga diurna excessiva. Entre os tratamentos, destacam-se o avanço ortopédico ou cirúrgico da mandíbula, visando corrigir a retroposição mandibular e a expansão rápida da maxila, que permite um reposicionamento da língua. O avanço estimula o crescimento mandibular de forma passiva ou ativa, avançando a língua e mudando as estruturas faríngeas. A expansão separa a sutura palatina mediana, expandindo a cavidade oral e envolve a colocação do aparelho fixo (Hyrax) dento-suportado por bandas cimentadas ou com cobertura acrílica por oclusal (McNamara). Mais estudos e meta análises são necessários para substanciar ainda mais o tratamento da apneia obstrutiva do sono pela ortodontia.Obstructive sleep apnea is a sleep-related breathing disorder that affects individuals of all ages. Its study and treatment are of extreme importance, given the high prevalence in the population and its consequences, such as the decrease in neurocognitive performance and growth and drowsiness and excessive daytime fatigue. Treatments include the orthopedic or surgical advancement of the mandible, aiming to correct the mandibular retroposition and rapid expansion of the maxilla, which allows a repositioning of the tongue. The advancement stimulates mandibular growth in a passive or active way, advancing the tongue and changing the pharyngeal structures. The expansion separates the medial palatine suture, expanding the oral cavity, and involves the placement of the fixed (Hyrax) dento-supported by cemented bands or occlusal acrylic cover (McNamara). Further studies and meta-analyzes are needed to further substantiate the treatment of obstructive sleep apnea by orthodontics

Therapeutic laser for pain relief after tonsillectomy

OBJECTIVE: The postoperative period of a tonsillectomy is usually very painful, requiring the use of pain-relieving drugs. The aim of this study was to evaluate the efficacy of low-level laser therapy in post-tonsillectomy pain control. METHODS: 18 children aged 5 to 15 years undergoing adenotonsillectomy between June 2005 and October 2006 were randomized to receive either local application of therapeutic laser immediately after surgery and 24 hours postoperatively (n=9) or routine analgesic drug therapy, if necessary. Pain was assessed by visual analog scale scores, need for analgesics, and acceptance of diet during the postoperative period. RESULTS: Patients undergoing laser applications had lower median pain scores and required less analgesic medication postoperatively than the control group. Acceptance of diet was similar in both groups. CONCLUSIONS: Preliminary results showed that low-level laser therapy is effective in the reduction of post-tonsillectomy pain, minimizing the need of analgesic medication in children and adolescents.OBJETIVO: O pós-operatório da tonsilectomia é, em geral, bastante doloroso e os pacientes necessitam de analgésicos. Este estudo visou avaliar a eficácia da aplicação do laser terapêutico no controle da dor no pós-operatório de tonsilectomia. MÉTODOS: 18 crianças de cinco a 15 anos de idade foram submetidas à adenotonsilectomia, no período de junho de 2005 a outubro de 2006, sendo randomizadas para receber aplicações de laser terapêutico na área cirúrgica imediatamente após o procedimento e 24 horas após a cirurgia (n=9) ou seguir a rotina, com analgesia farmacológica, se necessário. A avaliação da dor foi realizada por escala analógica de dor, pela necessidade de analgésicos e pela aceitação da dieta no pós-operatório. RESULTADOS: Os pacientes submetidos à aplicação do laser apresentaram medianas das notas da escala de avaliação da dor menores e utilizaram menos analgésicos no pós-operatório em comparação aos pacientes controles. A aceitação da dieta nos dois grupos não foi diferente. CONCLUSÕES: Os resultados preliminares mostraram que o laser terapêutico foi eficaz na diminuição da dor e na redução de uso de analgésicos no pós-operatório de tonsilectomias em crianças e adolescentes.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP-EPM Departamento de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP-EPMUNIFESP, EPM, Depto. de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, EPM Depto. de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, EPMSciEL

Tonsillar lymphoma in children with unilateral tonsillar enlargement

OBJECTIVE: To demonstrate the importance of a medical examination with emphasis on changes of the palatine tonsils (PT) and proper anamnesis to early identify patients with tonsillar lymphoma. CASE DESCRIPTION: Case 1 - 5-year-old girl with a muffled voice noted by her mother and a report of feeling a strange sensation in the throat for two weeks. She was previously treated in another service at the beginning of the symptoms with amoxicillin without improvement. An important increase in the right PT was noted, with smooth surface and absence of crypts. The diagnosis of non-Hodgkin lymphoma (NHL) was confirmed after surgery. On further investigation, positive mesenteric lymph nodes were noted. Case 2 - 11-year-old girl came to the emergency service to investigate a painless nodule in the left palatine tonsil with progressive growth for one year, without other complaints. She had previously undergone other medical consultations, but no importance was given to the patient's complaint. Oroscopy showed that the left PT was increased crossing the midline and with a nodule in the upper pole. Patient also had NHL. COMMENTS: A detailed examination of the oral cavity and neck is essential to identify suspicious tonsillar lymphoma. Patients with unilateral tonsillar enlargement and other findings suggestive of malignancy should undergo tonsillectomy.OBJETIVO: Demonstrar a importância do exame físico com ênfase nas alterações das tonsilas palatinas (TP) e na anamnese direcionada para a identificação precoce de pacientes com linfoma de TP. DESCRIÇÃO DO CASO: Caso 1 - Menina de cinco anos com voz abafada, observada pela mãe, e sensação de algo estranho na garganta há duas semanas. Foi atendida em outro serviço no início do quadro, sendo medicada com amoxicilina, sem melhora. Apresentava aumento importante da TP direita com superfície lisa e ausência de criptas. Após cirurgia, foi confirmado o diagnóstico de linfoma não Hodgkin (LNH). Na investigação também foi identificado acometimento dos linfonodos mesentéricos pelo linfoma. Caso 2 - Menina de 11 anos procurou o pronto-socorro para investigar nódulo em TP esquerda, indolor, de crescimento progressivo há um ano, sem outras queixas. Já havia passado por consultas médicas anteriores, não tendo sido valorizada a queixa da paciente. A TP esquerda encontrava-se aumentada, ultrapassando a linha média e com nódulo no polo superior. Também foi diagnosticado LNH após exame anatomopatológico. COMENTÁRIOS: Um exame minucioso da cavidade oral e do pescoço é essencial para identificar alterações suspeitas de linfoma tonsilar. Pacientes com assimetria tonsilar e outros achados sugestivos de malignidade devem ser submetidos à tonsilectomia.OBJETIVO: Demostrar la importancia de un examen físico con énfasis en las alteraciones de las tonsilas palatinas (TP) y en la anamnesis dirigida a la identificación temprana de pacientes con linfoma de TP. DESCRIPCIÓN DEL CASO: Caso 1 - Niña de cinco años, con voz velada, observada por la madre, y «sensación de algo extraño en la garganta» hace dos semanas. Fue atendida en otro servicio en el inicio del cuadro, siendo medicada con amoxicilina, sin mejora. Presentaba aumento importante de la TP derecha con superficie lisa y ausencia de criptas. Después de la cirugía, se confirmó el diagnóstico de linfoma no Hodgkin (LNH). En la investigación también se identificó acometimiento de los nodos linfáticos mesentéricos por el linfoma. Caso 2 - Muchacha de 11 años buscó al servicio de urgencia para investigar nódulo en TP izquierda, indolora, de crecimiento progresivo hace un año, sin otras quejas. Ya había pasado por consultas médicas anteriores, no habiendo sido valorizada la queja de la paciente. La TP izquierda se encontraba aumentada, sobrepasando la línea media y con nódulo en el polo superior de esa. También se diagnosticó LNH después de examen anatomopatológico. COMENTARIOS: Un examen minucioso de la cavidad oral y del cuello es esencial para identificar alteraciones sospechosas de linfoma tonsilar. Pacientes con asimetría tonsilar y otros hallazgos sugestivos de malignidad deben ser sometidos a tonsilectomía.28829

Management of Difficult Airway in a Cat with Tonsillitis

Background: Tracheal intubation is performed in an anesthetized patient in order to optimize oxygenation and to allow the administration of volatile anesthetics. Some patients have characteristics that make intubation a challenge. Therefore, an adequate pre-anesthetic evaluation enables the anesthesiologist to define the best management. There are reports of the impossibility of performing conventional intubation attributed to the lack of pre-anesthetic consultation in Medicine, which motivates and justifies the discussion of these aspects in Veterinary Medicine. Therefore, this study aims to report a case of difficult airway management in a feline with tonsillitis. Case: A 3-year-old male NDB cat weighing 3.5 kg was admitted to the Veterinary Hospital, Federal University of Pampa (UNIPAMPA) - Uruguaiana, for consultation. After physical examination, total tooth extraction and tonsillectomy was recommended. On the day of the procedure, a physical evaluation of the patient was performed, and he was classified as ASA II. Zolazepam and tiletamine [Zoletil®️ - 5 mg/kg, i.m] associated with morphine [Dimorf®️ - 0.3 mg/kg, i.m] was given as premedication. Given the difficulty of intubation in a previous procedure reported by the tutor, a thoughtful conduct was planned for the intubation of the patient, considering the possibility of tracheostomy. The patient was pre-oxygenated, and subsequently, propofol [Propovan®️ - 4 mg/kg, i.v] was administered to promote anesthetic induction. The first attempt at intubation was done by laryngoscopy, but despite the use of a 6 cm blade, it was too large in relation to the hyperplastic tissue; then swabs and a flashlight were subsequently used. With the help of two people, the experienced anesthesiologist was able to position the endotracheal tube correctly approximately 25 min after the first attempt, requiring supplemental doses of propofol [Propovan®️ to the effect, i.v] and oxygenation between the attempts. Anesthetic maintenance was achieved with isoflurane [Isoforine®️ vaporized in 100% oxygen] in a system without gas rebreathing. Locoregional block of the maxillary nerve and inferior branch of the mandibular nerve was performed with lidocaine 2% [0.1 mL/kg]. During the transoperative, the vital parameters remained stable and there was no need for analgesic rescue. After the end of the procedure and extubation, the patient received oxygen therapy via facemask until he regained consciousness and had no complications.Discussion: The mortality of dogs and cats related to anesthetic procedures is substantially higher when compared to humans. Studies have shown that most anesthetic-related complications in humans are predictable. The lack of adequate pre-anesthetic evaluation or anesthetic consultation are factors that can cause losses in the transoperative period. Therefore, sharing information that can mitigate these situations is critical. The scarcity of reports on pre-anesthetic evaluation in veterinary medicine allows the identification of a gap on the role of the anesthesiologist in this important stage of anesthesia, and how it is performed in the hospital routine or in veterinary clinics. The success in managing the difficult airway in the case reported here can be attributed to the procedures adopted in all stages of the procedure, especially the planning based on information obtained during the pre-anesthetic period. It is worth mentioning that the owner was a veterinarian and we believe this also contributed to the outcome, since he informed the anesthesiologist about the difficulties encountered during the previous procedure. This case motivated the implementation of a pre-anesthetic consultation service in the hospital in question. In addition to the physical examination, a complete anamnesis carried out with the owner may reveal relevant details for determining the most appropriate and safe anesthetic conduct for the patient.Keywords: preanesthetic evaluation, endotracheal intubation, veterinary anesthesia.Título: Manejo da via aérea difícil em um gato com tonsiliteDescritores: avaliação pré-anestésica, intubação endotraqueal, anestesiologia veterinária.

Evaluation of the relationship between tonsilar asymmetry and tonsilar lymphoma in children

Orientador: Reinaldo Jordão GusmãoTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: O linfoma é a terceira neoplasia mais frequente da infância correspondendo a cerca de 12% de todas neoplasias em indivíduos com menos de 15 anos, e é a neoplasia maligna mais frequente em cabeça e pescoço. Aproximadamente 15% dos linfomas de cabeça e pescoço em crianças acometem o anel de Waldeyer. O diagnóstico e o tratamento precoce têm grande importância no prognóstico dos pacientes com linfoma de tonsilas palatinas. Os objetivos deste trabalho são avaliar a prevalência das manifestações clínicas de crianças com linfoma de tonsila palatina e identificar a associação entre a assimetria tonsilar e o linfoma de tonsila palatina em crianças. Foram realizadas revisões sistemáticas da literatura com artigos que incluíam crianças até os 18 anos com linfoma de tonsila palatina ou assimetria tonsilar. Foram encontrados 66 casos de crianças com linfoma; a assimetria tonsilar foi a manifestação clinica mais frequente, presente em 72,7% dos casos, seguida pela alteração na aparência da tonsila palatina em 45,4% e linfonodomegalia cervical em 30,3% dos casos. O linfoma de Burkitt foi o tipo mais frequente. A principal causa de assimetria tonsilar foi a hiperplasia linfóide seguida pelo linfoma e por alterações benignas inespecíficas. Foi encontrada associação entre a assimetria tonsilar e o linfoma de tonsilas palatina, sendo a razão de verossimilhança de 43,5 para crianças com assimetria de tonsilas e de 8938,4 para crianças com assimetria de tonsilas e outros sinais de suspeição para malignidadeAbstract: Lymphoma is the third most common malignancy of childhood, accounting for approximately 12% of all cancers in individuals under 15 years of age and is the most common malignancy in the head and neck. About 15% of head and neck lymphomas in children affect the Waldeyer's ring. The early diagnosis and early treatment are very important in the prognosis of patients with palatine tonsils lymphoma. The objectives of this thesis are to evaluate the prevalence of the clinical manifestations of children with tonsillar lymphoma and identify the association between the tonsillar asymmetry and the tonsillar lymphoma in children. Systematic reviews of the literature were conducted with articles that included children up to 18 years with tonsillar lymphoma or tonsillar asymmetry. 66 cases of children with lymphoma were included; the tonsillar asymmetry was the most common clinical manifestation, present in 72.7% of cases, followed by the change in appearance of the palatine tonsil in 45.4% and cervical lymphadenopathy in 30.3% of cases. Burkitt's lymphoma was the most common type. The most frequent cause of tonsillar asymmetry was lymphoid hyperplasia followed by lymphoma and nonspecific benign changes. There was an association between the tonsillar asymmetry and tonsillar lymphoma with the likelihood ratio of 43.5 for children with tonsillar asymmetry and 8938.4 for children with asymmetry of tonsils and other signs of suspicion for malignancyDoutoradoOtorrinolaringologiaDoutor em Ciências Médica

Complicaţiile postoperatorii ale tonsilectomiei după datele centrului republican de chirurgie funcţională, fonoaudiologie şi recuperare în ORL în perioada 1996 – 2005

A fost efectuată o analiză retrospectivă a complicaţiilor postoperatorii la pacienţii supuşi tonsilectomiei în CRCFFR ORL în perioada anilor 1996-2005 cu stabilirea incidenţei complicaţiilor postoperatorii după materialele clinicii ORL a SCR şi din literatura de specialitate