RESUMO
The purpose of this study was to investigate the average tracheal length and number of the tracheal cartilages in Turkish people, with emphasis on the relationships to body height and sex. A hundred fresh human cadaver tracheas were harvested from 75 males and 25 females. Age, sex and body height of cadavers were recorded. All the neck and intrathoracic structures were removed. The tracheal length was measured between the subcricoid level to the carina in resting and maximally stretched positions. Average tracheal length and number of the tracheal cartilages were compared in different body height groups in both sexes. We found that average body height was 160±6.4 cm and average tracheal length in resting position was 8.5±1 cm (range 6.511 cm) in females and average body height was 168.6±5.6 cm, average tracheal length was 8.7±1.1 cm (range 711.6 cm) in males, average number of tracheal cartilages was 13.6±1.7 (range 1016) in females and 13.3±1.6 (range 1019) in males and average number of the tracheal cartilages per centimeter was 1.6±0.2 in female and 1.5± 0.2 in male cadavers in resting position. Average tracheal length in male group was found to be significantly different in cadavers with body height equal or taller than 170 cm in comparison to cadavers with body height shorter than 170 cm (p <0.05). This study revealed that the average tracheal length in Turkish people is shorter than the reported length in literature. It is worth commenting that there is a considerable difference between the different races with regard to tracheal length. Tracheal length may vary with body height.
El objetivo de este estudio fue investigar la longitud traqueal promedio y el número de los cartílagos traqueales en pueblo turco, con énfasis en las relaciones a la altura del cuerpo y el sexo. Cien tráqueas frescas de cadáveres humanos fueron extraidas de 75 hombres y 25 mujeres. Se registraron la edad, sexo y altura del cuerpo en cada caso. Se disecaron el cuello y las estructuras intratorácicas. La longitud de la tráquea fue medida entre el nivel subcricoides y la carina en reposo, y en posición de máximo estiramineto. Se comparó la longitud promedio traqueal y el número de los cartílagos traqueales ente grupos con diferente de la altura del cuerpo en ambos sexos. En las mujeres, la altura del cuerpo promedio fue 160±6,4 cm y la longitud traqueal promedio en posición de reposo 8,5±1 cm (rango 6,511 cm). En hombres, la altura del cuerpo promedio fue 168,6±5,6 cm y la longitud traqueal promedio 8,7±1,1 cm (rango 711,6 cm). El número promedio de cartílagos traqueales fue 13,6±1,7 (rango 1016) en las mujeres y 13,3±1,6 (rango 1019) en los hombres, y el número promedio de cartílagos traqueales por centímetro fue 1,6±0,2 en mujeres y 1,5±0,2 en los hombres, en posición de reposo. La longitud traqueal promedio en el grupo de hombres fue significativamente diferente en cadáveres con una altura del cuerpo igual o mayor que 170 cm, en comparación con cadáveres con la altura del cuerpo menor a 170 cm (p<0,05). Este estudio reveló que la longitud traqueal promedio en pueblo turco es menor que la longitud reportada en la literatura. Por otra parte, existe una diferencia considerable entre las diferentes razas con respecto a la longitud traqueal. La longitud traqueal puede variar con la altura del cuerpo.
Assuntos
Humanos , Masculino , Feminino , Adulto , Traqueia/anatomia & histologia , Distribuição por Idade e Sexo , Estatura , Cadáver , Caracteres Sexuais , TurquiaRESUMO
There is no study based on objective measurements about the cosmetic results of myringoplasty operation in medical literature. This study aims to show the differences in the auriculomastoid angle between the operations which were done with postauricular and endaural incisions. The auriculomastoid angle of 20 patients having had postauricular myringoplasty operation were measured both preoperative and postoperative periods. The auriculomastoid angles of 17 patients having had endaural myringoplasty operation were also measured in both preoperative and postoperative periods. Also, the patients were asked whether there was a change in the shape of their ears. It was observed that the increase of the auriculomastoid angles of the patients who had myringoplasty by postauricular incision was statistically significant when compared to the ones having had the operation by endaural incision. Also, the patients who had myringoplasty operation by postauricular incision realized the change in their ears significantly when compared to the other group. In this study, esthetically better results were observed in the myringoplasty operations done by endaural incision than the ones done by postauricular incision. When deciding on the incision type, this should be considered.
Assuntos
Miringoplastia/métodos , Perfuração da Membrana Timpânica/cirurgia , Membrana Timpânica/cirurgia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miringoplastia/psicologia , Satisfação do Paciente , Resultado do TratamentoRESUMO
BACKGROUND: The aim of this prospective, single-blind study was to assess the variations in the blood levels of PaO(2), PaO(2)/FiO(2), PaCO(2), and acid-base balance of patients undergoing laryngeal microsurgery under general anesthesia using small-bore endotracheal tubes. METHODS: 25 male patients were intubated with endotracheal tubes of 5.5-mm-inner diameter and fifteen female patients were intubated with endotracheal tubes of 5-mm-inner diameter during surgery. PaO(2)/FiO(2), PaO(2), PaCO(2), percentage saturation of O(2) and HCO(3), and pH levels were monitored before surgery and at 15-min intervals during laryngeal microsurgery. Respiratory function's values (dead space, peak inspiratory pressure (PIP) and dynamic compliance) were recorded every 15 min throughout laryngeal microsurgery. RESULTS: No significant differences were observed between the pre- and intra-operative values of percentage saturation of O(2), PaO(2)/FiO(2) and HCO(3) until 120th min. There was no significant difference in respiratory function's values intraoperatively. Under anesthesia, PaO(2) levels significantly increased when compared with preoperative values. Another significant increase was observed in PaCO(2) levels after the 60th min. However, compared with preoperative values, pH levels significantly decreased under anesthesia at the 105th and 120th min. CONCLUSION: Laryngeal microsurgery under general anesthesia can be performed using small-bore endotracheal tubes. This is not likely to have any adverse effects on a patient's blood gases and acid-base balance unless the operation lasts longer than 105 min.
Assuntos
Equilíbrio Ácido-Base , Dióxido de Carbono/sangue , Laringe/cirurgia , Microcirurgia , Oxigênio/sangue , Adolescente , Adulto , Anestesia Geral , Gasometria , Feminino , Humanos , Intubação Intratraqueal/instrumentação , Laringoscopia , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Estudos Prospectivos , Respiração Artificial , Testes de Função Respiratória , Fatores de TempoRESUMO
Extraskeletal Ewing's sarcoma is rarely found arising in the head and neck region. Only six cases of extraskeletal Ewing's sarcoma invading the nasal cavity or paranasal sinuses have been reported in the literature. The first described case of that Ewing's sarcoma located in isolated maxillary sinus extending into the orbita without involving the nose is presented. A 16-year-old woman presented with swelling in her right cheek. The nasal examination was normal. A computed tomography (CT) and magnetic resonance imaging (MRI) of the sinuses revealed a large mass in the right maxillary sinus with extension to the orbita. Under general anesthesia biopsies were taken. Based on histopathological analysis, a diagnosis of extraskeletal Ewing's sarcoma was made. The patient did not accept the surgical therapy. The patient was treated with combined chemotherapy and radiotherapy. The patient has done without evidence of recurrence or metastasis for one year.
Assuntos
Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/patologia , Sarcoma de Ewing/diagnóstico por imagem , Sarcoma de Ewing/patologia , Adolescente , Feminino , Humanos , Neoplasias do Seio Maxilar/terapia , Radiografia , Sarcoma de Ewing/terapiaRESUMO
Lymphoepithelial carcinoma (LEC) of the larynx is a rare neoplasm; with a review of the literature having disclosed only 34 documented cases. This neoplasm seems to behave in a fashion reminiscent of nasopharyngeal carcinoma. In contrast to nasopharyngeal carcinoma, most cases have not been associated with Epstein-Barr virus (EBV). The diagnosis often requires immunohistochemistry or electron microscopy for confirmation. We describe a case of this tumor involving the supraglottis. The patient was treated with supraglottic laryngectomy and bilateral modified neck dissection. The histopathological study of the surgical specimen revealed an undifferentiated carcinoma with aspects of lymphoeptihelioma. The patient underwent radiotherapy and his 2-year follow-up showed no evidence of local or distant metastasis.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Glote , Neoplasias Laríngeas/diagnóstico , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Endoscopia , Humanos , Imuno-Histoquímica/métodos , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Laringectomia , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Radioterapia Adjuvante , Coloração e Rotulagem , Tomografia Computadorizada por Raios XRESUMO
HYPOTHESIS: This study was conducted to compare the effectiveness of two anti-adhesive barriers (Seprafilm and Interceed) for reducing adhesions after thyroidectomy in a rat model. The anti-adhesive barriers are suggested for use in repeated surgeries in general and the gynecologic fields in particular. STUDY DESIGN: Controlled, randomized study. METHODS: Twenty-eight male Wistar Albino rats that underwent right subtotal thyroidectomy were randomly assigned to three groups. One group received Seprafilm (n = 10), and the other received Interceed (n = 10) as anti-adhesive barriers. The third group was the control group (n = 8). At postoperative day 14, the rats were killed under general anesthesia, and the surgical fields were evaluated for the adhesion formation. The extent of the adhesion formation is scored from 0 (no adhesions) to 2 (fibrous adhesions that required sharp dissection). Histopathologically, chronic inflammation, histiocyte, fibroblast, fibrosis, collagen, vascularization, granuloma, giant cell, and fat necrosis were examined. RESULTS: All the subjects in the control group, 7 of 10 in the Interceed group, and 4 of 10 in the Seprafilm group needed to be dissected bluntly or sharply. There was significant difference between the Seprafilm and the control group (P < .05) whereas there was no significant difference between the Interceed group and the control group (P > .05). When examined histopathologically, the criteria showing adhesion, such as fibrosis, fibroblast, and collagen were higher in the control group compared with the Seprafilm and Interceed groups. There was no significant difference between the Seprafilm and Interceed groups, whereas a significant difference was found between these two groups and the control group. CONCLUSION: This study suggests that both Seprafilm and Interceed decrease the incidence of posthyroidectomy adhesions in a rat model. Both agents showed no foreign body reaction.
Assuntos
Materiais Biocompatíveis , Celulose Oxidada , Membranas Artificiais , Complicações Pós-Operatórias/prevenção & controle , Tireoidectomia , Animais , Colágeno/metabolismo , Fibroblastos/efeitos dos fármacos , Fibroblastos/patologia , Fibrose/patologia , Fibrose/prevenção & controle , Ácido Hialurônico , Masculino , Complicações Pós-Operatórias/patologia , Ratos , Ratos Wistar , Aderências Teciduais/patologia , Aderências Teciduais/prevenção & controleRESUMO
The purpose of this study was to determine changes in the hypoglossal nerve function after suspension laryngoscopy with needle electromyography of the tongue. This study also attempted to determine the possible relationship between the predictive factors of intubation difficulty by using the intubation difficulty scale, which was introduced by Adnet et al., duration of suspension laryngoscopy and changes in hypoglossal nerve function after suspension laryngoscopy. The study was performed on 39 patients who underwent suspension laryngoscopy for benign glottic pathology. Pre-operative airway assessment was evaluated by the intubation difficulty scale and the duration of suspension laryngoscopy was recorded. Needle electromyography of the tongue was performed three or four weeks after the suspension laryngoscopy. After needle electromyography of the tongue, increased polyphasia was found in 13 patients (33 per cent), bilaterally in three of them. The interference pattern was reduced in two of these 13 patients. There was no statistically significant difference in predictive factors of intubation difficulty and the duration of the operation between these 13 patients with increased polyphasia and the remaining 26 patients with completely normal electromyography findings. These findings show that, in spite of normal clinical tongue function, subclinical changes can be detected by needle electromyography of the tongue after suspension laryngoscopy.
Assuntos
Traumatismos do Nervo Hipoglosso , Laringoscopia/efeitos adversos , Língua/fisiopatologia , Adolescente , Adulto , Idoso , Eletromiografia/métodos , Feminino , Humanos , Nervo Hipoglosso/fisiopatologia , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Língua/inervaçãoRESUMO
The lacrimal drainage system (LDS) is vulnerable to surgical trauma during rhinoplasty. We aimed to investigate the possible effects of the low lateral osteotomies on the LDS during rhinoplasty using active transport dacryocystography (ATD) at the late postoperative stage. Twenty patients who underwent open rhinoplasty were evaluated by ATD between the sixth and seventh postoperative months. Presence of the LDS dehiscence and the absence of the passage of the contrast material into the inferior meatus were noted as signs of injury to the LDS in ATD. The proximity of the osteotomy site to the LDS was measured using three different measurements in ATD. The distance from the lacrimal fossa to the lateral osteotomy site, the distance from the inferior meatus to the lateral osteotomy site and the distance from the middle point of the lacrimal fossa and inferior meatus to the lateral osteotomy site were measured. The anatomic integrity of the bone structure around the LDS was preserved in all patients and free drainage of contrast media from the fossa lacrimalis to inferior meatus was observed in ATD evaluation of all patients. The average distance from the LDS to the lateral osteotomy site was found to be between 7-8.8 mm. In conclusion, the low lateral osteotomy is a safe method in order to avoid trauma to the LDS, and ATD seems an appropriate diagnostic technique in evaluation of the LDS after rhinoplasty.
Assuntos
Aparelho Lacrimal/diagnóstico por imagem , Osso Nasal/cirurgia , Osteotomia , Rinoplastia , Adulto , Feminino , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Obstrução dos Ductos Lacrimais/etiologia , Masculino , Osso Nasal/diagnóstico por imagem , Osteotomia/efeitos adversos , Radiografia , Rinoplastia/efeitos adversosRESUMO
PURPOSE: To establish the incidence of thyroid carcinoma metastasis in adult patients presenting with apparently benign cervical cysts. The authors report their experience with four cases of papillary thyroid carcinoma who present with a lateral cervical cystic mass and no palpable disease in the thyroid gland. MATERIALS AND METHODS: A retrospective review of patients undergoing surgery for solitary cervical cysts in our clinic from 1994 to 2002 was performed. Patients with a clinically obvious primary malignancy, age less than 16 years were excluded from the study. RESULTS: Thirty-seven patients were identified. A diagnosis of benign cervical cyst was shown by histological examination of the resected specimen in 32 patients (86.4%), with a mean age of 34 years (range, 16-59 years). A diagnosis of squamous cell carcinoma metastasis arising from an occult tonsillary primary was confirmed histologically in one patient (2.7%). Papillary thyroid carcinoma metastasis was confirmed by histological examination of the resected specimen in 4 patients (10.8 %), with a mean age of 29 years (range, 18-37 years). Diagnostic studies performed included ultrasound, computed tomography scan, fine-needle aspiration (FNA), and excisional biopsy. FNA was found to be helpful in only one of the 3 cases with papillary thyroid carcinoma metastasis. Final histopathological examination exhibited primary focus in the thyroid gland in all 4 patients, with a mean size of 0.5 cm (range, 0.3-0.8 cm). CONCLUSION: Our data indicate that nearly 1 out of every 10 lateral cervical cysts in young adult patients represents lymphatic metastases from occult thyroid carcinoma. An excisional biopsy for definitive diagnosis should be undertaken without prolonged delay, even if FNA does not reveal malignancy.
Assuntos
Branquioma/secundário , Carcinoma Papilar/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/secundário , Neoplasias da Glândula Tireoide/patologia , Adolescente , Adulto , Feminino , Humanos , Incidência , Metástase Linfática , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Concha bullosa is a relatively common anatomic variant that is in fact an enlarged pneumatized middle turbinate. We report a case of giant concha bullosa in a 21-year-old woman who had a history of nasal obstruction. Anterior nasal examination of the nasal cavity revealed bilateral nasal masses which were covered with normal mucosa. Nasal endoscopy of both nasal cavities was impossible because of total occlusion. Computed tomography showed a bilateral giant concha bullosa. Under general anesthesia, resection of lateral half of the concha bullosa was performed bilaterally by a transnasal endoscopic technique to achieve nasal airway patency.
Assuntos
Obstrução Nasal/etiologia , Neoplasias Nasais/diagnóstico , Conchas Nasais/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Nasais/complicações , Neoplasias Nasais/diagnóstico por imagem , Neoplasias Nasais/patologia , Neoplasias Nasais/cirurgia , Tomografia Computadorizada por Raios X , Conchas Nasais/patologiaRESUMO
A 33-year-old male patient was admitted to our hospital with a painless ulcer on the tongue. The lesion was 2 x 3 cm in size, necrotic, and whitish in the anterior part of the ventral surface of the tongue. On further investigation, pulmonary tuberculosis was diagnosed. Cultures of the biopsy specimen and the sputum revealed acid fast bacilli. Histopathologic examination of the biopsy specimen showed tubercles consisting of epithelioid granulomas with caseous necrosis and Langhans giant cells. The lesion was thought to be an extrapulmonary manifestation of pulmonary tuberculosis. Antituberculous therapy was initiated and the ulcer regressed after two months. In the differential diagnosis of nonhealing oral ulcers, tuberculosis should also be considered, especially in patients living in a high risk country for tuberculosis.
Assuntos
Doenças da Língua/diagnóstico , Tuberculose Bucal/diagnóstico , Tuberculose Pulmonar/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Humanos , Masculino , Úlceras Orais/diagnóstico , Úlceras Orais/tratamento farmacológico , Úlceras Orais/patologia , Doenças da Língua/tratamento farmacológico , Doenças da Língua/patologia , Tuberculose Bucal/tratamento farmacológico , Tuberculose Bucal/patologia , Tuberculose Pulmonar/tratamento farmacológico , Tuberculose Pulmonar/patologiaRESUMO
Mucoceles are uncommon and the majority of cases occur in the frontoethmoidal complex. The accumulation of mucous secretion and eventual secondary infection may result in the formation of a pyocele of the middle turbinate, which is exceptionally rare. This case report presents a patient with a large pyocele of the middle turbinate invading the orbit. A 48-year-old woman presented with a three-week history of nasal obstruction, slight rhinorrhea, and headache. There was an external swelling of the nasal pyramid just near the medial canthus and right exophthalmos with bulging of the medial canthus of the ipsilateral eye. A computed tomography scan revealed a rounded, expansive lesion of soft tissue density. There was a thin compact bone at the margin. Under general anesthesia, resection of the lateral and inferior walls of the middle turbinate was performed. The large cystic mass was filled with pus. Exophthalmos and bulging of the medial canthus immediately disappeared. Histologic examination showed the mucocele wall with a ciliary respiratory epithelium.
Assuntos
Mucocele/diagnóstico , Doenças dos Seios Paranasais/diagnóstico , Conchas Nasais/patologia , Diagnóstico Diferencial , Feminino , Cefaleia/etiologia , Humanos , Pessoa de Meia-Idade , Mucocele/diagnóstico por imagem , Mucocele/patologia , Mucocele/cirurgia , Obstrução Nasal/etiologia , Doenças dos Seios Paranasais/diagnóstico por imagem , Doenças dos Seios Paranasais/patologia , Doenças dos Seios Paranasais/cirurgia , Tomografia Computadorizada por Raios XRESUMO
At present, there is still no agreement about the therapy of idiopathic sudden sensorineural hearing loss (ISSHL). Hyperbaric oxygen (HBO) is used in the therapy of ISSHL to increase the partial oxygen pressure and the oxygen concentration in the inner ear and also to improve the blood profile and the microcirculation. In our prospective randomized study, we aimed to investigate the therapeutic effects of HBO therapy in the 1st 2 weeks of the onset of ISSHL. Fifty-one hospitalized patients with confirmed ISSHL who had received therapy were grouped randomly into two groups. Twenty-one patients (group I) received steroids, plasma expander dextrans (rheomacrodex), diazepam, pentoxiphylline and salt restriction, and 30 patients (group II) received the same basic treatment with the addition of HBO therapy. Audiological assessments of the patients were performed before and after the treatment. The hearing gains at frequencies of 250, 500, 1,000, 2,000 and 4,000 Hz were calculated separately. The level of hearing loss at the five frequencies was assessed in three groups at the first visit: equal or below 60 dB, between 61-80 dB and equal or above 81 dB. The average of the mean hearing gains at the five frequencies of the patients according to the age groups in group II was compared. The mean hearing gains at the five frequencies were compared between the two groups, and statistically significant improvement was detected in all the frequencies except at 2,000 Hz in group II. The mean hearing gains in group II were found to be significantly high in patients with initial hearing levels up to 60 dB in comparison to patients with initial hearing levels below 60 dB. When age groups and mean hearing gains were compared, there was no statistically significant difference in group I. In group II, the mean hearing gains were 39.1+/-18.3 dB in patients younger than 50 years and 22.7+/-11.3 dB in patients older than 50 years ( P=0.044). In conclusion, the addition of HBO therapy to conventional treatment modalities significantly improves the outcome of ISSHL, especially at the frequencies of 250, 500, 1,000 and 4,000 Hz and in hearing loss of above 61 dB. Furthermore, HBO therapy was found to be more effective in patients younger than 50 years.
Assuntos
Perda Auditiva Neurossensorial/terapia , Perda Auditiva Súbita/terapia , Oxigenoterapia Hiperbárica , Adolescente , Adulto , Idoso , Audiometria de Tons Puros , Feminino , Perda Auditiva Neurossensorial/fisiopatologia , Perda Auditiva Súbita/fisiopatologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: We investigated the effect of topical administration of ascorbic acid on the healing process of tympanic membrane perforations in rats. DESIGN AND METHODS: Thermal myringotomy was induced in both ears of 22 albino rats. The right and left ears were assigned to topical applications of ascorbic acid and saline solution, respectively. The same procedure was performed after 48 hours. Perforations were examined daily by otomicroscopy and healing periods were determined. For histopathologic examination, a single rat in which closure of the tympanic membranes was not completed was sacrificed on days 5, 7, 10, and 12. Data were analyzed with the use of the Student's t-test. RESULTS: The mean durations of healing in the right and left ears were 7.6 and 8.3 days, respectively. No significant differences were found between the applications of ascorbic acid and saline solution with regard to the duration of closure and histopathologic healing criteria. CONCLUSION: Our data suggest that topical application of ascorbic acid have no beneficial effect on the healing of rat tympanic membrane perforations.
Assuntos
Antioxidantes/administração & dosagem , Ácido Ascórbico/administração & dosagem , Perfuração da Membrana Timpânica/tratamento farmacológico , Administração Cutânea , Animais , Modelos Animais de Doenças , Feminino , Distribuição Aleatória , Ratos , CicatrizaçãoRESUMO
Laryngotracheal foreign bodies, although less common than bronchial foreign bodies, are potentially more dangerous. We report a 10-year-old girl with Down syndrome with asthma bronchiale symptoms, which was later found to be the result of a thin bone lamella impacted in her larynx. There was no clear history of foreign body aspiration. She was treated with the initial diagnosis of asthma bronchiale. It took a month before the final diagnosis was made. The foreign body was removed via direct laryngoscopy. It was a white and thin bone lamella with sharp edges, measuring 28 x 19 x 2 mm. We thought the case was worth presenting because of its rare location, the size of the foreign body, and the long duration before the final diagnosis was made.
Assuntos
Asma/diagnóstico , Erros de Diagnóstico , Serviços Médicos de Emergência/métodos , Corpos Estranhos/diagnóstico , Laringe , Criança , Tosse/etiologia , Feminino , Corpos Estranhos/complicações , Corpos Estranhos/cirurgia , Humanos , Laringoscopia , Sons Respiratórios/etiologia , Resultado do TratamentoRESUMO
OBJECTIVE: This study aims to identify the level of the vocal folds as projected on the exterior thyroid cartilage. STUDY DESIGN: Anatomic study of human cadaver larynges. METHODS: The study includes 83 fresh larynges harvested at autopsy from 62 male and 21 female cadavers. The larynges were excised and divided in the midline posteriorly. One needle was inserted at the level of anterior commissure from endolarynx, and the other was inserted at the thyroid ala just anterior to the vocal process along the superior surface of the right vocal cord. Measurements of vocal cord projections on the thyroid ala were done with a caliper. RESULTS: The mean value of the ratio of the distances from the superior thyroid notch to anterior commissure and the midline height from thyroid notch to the inferior border of thyroid cartilage was found to be 0.41 in males and 0.38 in females. No statistical differences were observed between these two groups (P =.062). We found that the distance from the anterior commissure to the inferior thyroid border in midline "c" was longer than the distance from the posterior border of the vocal cord to the inferior border of the inferior tubercle of the thyroid ala "d" in 44 (71%) males and in 7 (33%) females. On the other hand, "d" was longer than "c" in 8 (12.9%) males and in 8 (38.1%) females. These two distances were equal in 10 (16.1%) males and in 6 (28.6%) females. CONCLUSION: In this study, we found that the anterior commissure lies approximately at the juncture of the upper two fifths and lower three fifths of the midline height of thyroid cartilage in the majority of the larynges of the male and female cadavers. The position of the posterior border of the vocal cords was found to be at a lower level than anterior commissure in two thirds of males and in one third of females. This means that the vocal cords slope downward posteriorly in the majority of the larynges of the males. This may be one of the causes of failure of some type I thyroplasties.
Assuntos
Laringe/anatomia & histologia , Cartilagem Tireóidea/anatomia & histologia , Prega Vocal/anatomia & histologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Prior to 2003, only 39 cases of oncocytic carcinoma of salivary gland origin had been reported in the English-language literature. We report a new case, which occurred in a 48-year-old woman whose disease had metastasized to regional lymph nodes. She was treated by radical parotidectomy, with sacrifice of the facial nerve, and radical neck dissection. At the 3-year follow-up, she remained free of disease. Our review of the literature suggests that patients with such tumors who undergo aggressive surgery rather than conservative treatment have the best prognosis.
Assuntos
Adenoma Oxífilo/patologia , Neoplasias Parotídeas/patologia , Adenoma Oxífilo/metabolismo , Adenoma Oxífilo/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Metástase Linfática , Pessoa de Meia-Idade , Neoplasias Parotídeas/metabolismo , Neoplasias Parotídeas/cirurgiaRESUMO
OBJECTIVES: We investigated the frequency of hypothyroidism in patients treated with total laryngectomy, hemithyroidectomy-isthmectomy, and postoperative radiotherapy for T3 or T4 larynx cancers. PATIENTS AND METHODS: Twenty-nine male patients (mean age 54 years; range 43 to 72 years) with T3 or T4 larynx cancers were prospectively included in the study. Preoperatively, thyroid function tests were normal in all the patients. Following radiotherapy, serum thyroid-stimulating hormone (sTSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels were measured every three months at least for a year. Detection of an increased level of sTSH together with decreased or normal levels of FT3 and/or FT4 indicated clinical and subclinical hypothyroidism, respectively. The relationship was assessed between hypothyroidism and both age and radiotherapy dosage. Statistical analyses were made with the use of the Student's t- test and Mann-Whitney U-test. RESULTS: Following radiotherapy, thyroid function tests remained normal in 12 patients (41%), while 12 patients (41%) and five patients (18%) developed subclinical and clinical hypothyroidism, respectively. No significant relationship was found between age and thyroid dysfunction (p>0.05), whereas radiotherapy dosage was found in significant relationship with the development of hypothyroidism (p<0.05). CONCLUSION: Due to high rates of subclinical or clinical hypothyroidism following combined therapy, thyroid functions should be closely monitored in patients undergoing laryngectomy for T3 or T4 larynx cancers.
Assuntos
Hipotireoidismo/etiologia , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/cirurgia , Adulto , Idoso , Terapia Combinada , Humanos , Laringectomia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Radioterapia Adjuvante/efeitos adversos , Testes de Função Tireóidea , Glândula Tireoide/efeitos da radiação , Tireoidectomia/efeitos adversos , Tireotropina/sangue , Tiroxina/sangue , Tri-Iodotironina/sangueRESUMO
Lymphangiomas of the larynx are quite rare and even rarer in adults. Isolated cavernous lymphangioma in the laryngeal ventricle was diagnosed in a 47-year-old woman. The patient presented with hoarseness with a history of three months. Direct laryngoscopy performed under general anesthesia showed a large, smooth, gray-reddish tumor above the right vocal fold, originating from the right ventricle. The tumor was removed through a micro-laryngoscopic procedure with cold instruments. Histopathologic diagnosis was cavernous lymphangioma. There was no local recurrence a year after the operation.
Assuntos
Neoplasias Laríngeas/diagnóstico , Linfangioma/diagnóstico , Diagnóstico Diferencial , Feminino , Rouquidão/etiologia , Humanos , Neoplasias Laríngeas/complicações , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Laringoscopia , Linfangioma/complicações , Linfangioma/patologia , Linfangioma/cirurgia , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: We investigated the effect of oropharyngeal Candida colonization on the contamination of the Blom-Singer voice prosthesis and its lifetime. PATIENTS AND METHODS: The study included 26 male laryngectomized patients (age range 45 to 76 years) in whom the Blom-Singer low-pressure prosthetic valve inserted required removal due to improper functioning. All patients had postoperative radiotherapy. Patients who had nystatin therapy were excluded. At the time of removal, cultures were obtained from the esophageal end of the prosthesis and from the oropharynx to be examined with regard to Candida growth. RESULTS: Candida colonization was recovered from the cultures obtained on 20 prostheses (77%) and from 14 oropharyngeal specimens (54%). The presence of oropharyngeal colonization was always associated with that on prostheses. The average lengths of prosthesis use were 5.7 months (range 4 to 9 months) and 6.2 months (range 3 to 10 months) in patients with and without positive oropharyngeal Candida colonization, respectively (p>0.05). CONCLUSION: The results suggest that the presence of oropharyngeal Candida colonization has no effect on the prosthesis lifetime.