Absceso periamigdalino bilateral. Reporte de un caso y revisión de las controversias en el diagnóstico y tratamiento / Bilateral peritonsillar abscess. A case report and review of controversies surrounding diagnosis and management

La presentación bilateral del absceso periamigdalino es poco frecuente. Su abordaje es controversial y se discute si realizar amigdalectomía en caliente versus diferida. Se presenta el caso de un paciente de sexo masculino, de 14 años, con odinofagia, trismo y fiebre. Presentaba hipertrofia amigdalina bilateral, pilares abombados y edema de paladar blando. Tomografía computada: hipertrofia amigdalina bilateral, con realce poscontraste, ambas con colección, edema con moderada estenosis faríngea. Se decidió internación para tratamiento endovenoso y amigdalectomía con drenaje bilateral. Resolución completa del cuadro con alta a las 48 horas. Ante la presencia de un absceso periamigdalino, debe considerarse la posibilidad de un absceso contralateral oculto. Debe ser diagnosticado y tratado adecuadamente para prevenir complicaciones. La amigdalectomía en caliente podría ser un tratamiento seguro y debería ser considerado en pacientes que serán sometidos a anestesia para drenaje. La decisión final debe ser determinada para cada caso en particular.

The bilateral presentation of peritonsillar abscess is uncommon. Its management is controversial and it has been argued whether a quinsy tonsillectomy or an interval tonsillectomy should be performed. Here we describe the case of a 14-year-old boy with sore throat, trismus, and fever. He had bilateral tonsillar hypertrophy, convex arches, and soft palate edema. Computed tomography: bilateral tonsillar hypertrophy, with post-contrast enhancement, both with collection, edema with moderate pharyngeal stenosis. The patient was hospitalized for intravenous therapy and tonsillectomy with bilateral drainage resulting in a complete resolution of his condition and discharge at 48 hours. In the presence of a peritonsillar abscess, an unsuspected contralateral abscess should be considered. It should be diagnosed and managed adequately to prevent complications. Quinsy tonsillectomy could be safe and should be considered in patients who will undergo anesthesia for abscess drainage. The final decision should be made for each patient on an individual basis.

Transoral endoscopic ultrasonic surgery (TOUSS) in head & neck unknown primary carcinoma investigation.

Metastatic carcinoma of unknown primary (CUP) to cervical lymph nodes represents less than 5% of all head and neck malignancies. Recent publications support the use of transoral surgery during the diagnosis work-up, and transoral endoscopic ultrasonic surgery represent a recently described alternative technique in transoral surgery. A pilot study to assess the feasibility of trans-oral ultrasonic base of tongue (BOT) mucosectomy and bilateral tonsillectomy approach in CUP diagnosis work-up was conducted. Ten patients were included consecutively. In 2 cases (20%) the primary was found, in one case in the right tonsil, and another one in the left BOT. According to our results, the use of trans-oral ultrasonic surgery to perform the base of tongue mucosectomy and bilateral tonsillectomy in CUP patient's during the diagnosis work-up represents an effective option in patients with good anatomical exposure.

Dependent factors in the adult patient and their relationship with post-tonsillectomy bleeding and pain in an outpatient setting.

INTRODUCTION AND OBJECTIVE: Tonsillectomy performed on an outpatient basis in adult patients presents bleeding and pain as main postoperative complications. Following rules such as cold surgical technique, analgesic protocols, preoperative interview, and postoperative follow-up help to better control the process. However, there are patient-dependent factors such as sex, age, indication for tonsillectomy and the time elapsed between the last tonsil infection and surgical intervention that can influence postoperative complications and should be considered. The objective of this work is to evaluate the influence of age, sex, the indication for tonsillectomy and the period elapsed between the last tonsil infection and surgery on bleeding and pain control. METHODS: A prospective, descriptive, and observational study was carried out in 96 adult patients who underwent outpatient surgery under general anaesthesia, using cold surgical technique, evaluating these complications based on age, sex, indication for tonsillectomy and time elapsed after the last tonsillitis. RESULTS: The patients operated on during the 4 weeks after an episode of tonsillitis presented more postoperative pain. No relationship was found between this period and postoperative bleeding. CONCLUSIONS: Male patients had a higher incidence of bleeding than women. The period elapsed between the last tonsil infection and the surgical procedure was associated with greater postoperative pain, but not with greater postoperative bleeding.

Manejo de hemorragia posamigdalectomía en Chile / Treatment of post tonsillectomy bleeding in Chile

Resumen Introducción: La amigdalectomía es una de las cirugías más frecuentes en la población pediátrica. Aunque se considera una cirugía sencilla y segura, no está exenta de riesgos, siendo el principal la hemorragia posoperatoria. Objetivo: Evaluar el manejo de la hemorragia posamigdalectomía en otorrinolaringólogos en Chile. Material y Método: Se realizó un estudio transversal descriptivo sobre la experiencia y manejo de hemorragias posamigdalectomía mediante una encuesta difundida a socios activos de la Sociedad Chilena de Otorrinolaringología, Medicina y Cirugía de Cabeza y Cuello (SOCHIORL). Resultados: Se recopilaron respuestas de 102 de los 348 socios. El 97% ha presentado esta complicación. La medida inicial ante una hemorragia tardía fuera de una unidad de otorrinolaringología es derivar al servicio de urgencias en el 88% de los casos. En urgencia, la indicación más frecuente es administrar ácido tranexámico endovenoso en un 80%. En el caso de hemorragia sin estigmas de sangrado actual, un 68% indica alta con control precoz. Si se evidencian coágulos en la fosa amigdalina, el 72% indica hospitalización para observación. Si se evidencia sangrado activo, el 94% indica hospitalización y revisión de hemostasia en pabellón. Conclusión: Los resultados a nivel nacional, según este estudio, son concordantes con la literatura mundial. El manejo en el servicio de urgencia se basa en la experiencia del tratante. Respecto a los distintos escenarios clínicos, se recomienda hospitalización en caso de evidenciar coágulos y manejo en pabellón en la presencia de sangrado activo. El manejo es variable en pacientes sin hallazgos al examen físico.

Abstract Introduction: Tonsillectomy is one of the most frequent surgeries in the pediatric population. Although it is considered a simple and safe surgery, it has associated risks, the main one being postoperative bleeding. Aim: Evaluate the management of post-tonsillectomy hemorrhage in otorhinolaryngologists practicing in Chile. Material and Method: A descriptive cross-sectional study was carried out on the experience and management of post-tonsillectomy hemorrhage through a survey distributed to active members of the Sociedad Chilena de Otorrinolaringología, Medicina y Cirugía de Cabeza y Cuello (SOCHIORL). Results: Responses were collected from 102 out of 348 active members, of which 97% have presented this complication. The initial measure in a late hemorrhage occurring outside of an otolaryngology unit is referral to the emergency department in 88% of cases. In the emergency room, the most frequent management is to administer intravenous tranexamic acid in 80%. In the case of hemorrhage without trace of current bleeding, 68% discharge with early control. If clots are evident in the tonsillar fossa, 72% admit for observation. If there is evidence of active bleeding, 94% admit and perform revision surgery. Conclusion: Results of this study are consistent with international literature. Management in the emergency department is based on the experience of the treating physician and different clinical scenarios. Hospitalization is recommended when clots are observed, revision surgery when evidence of active bleeding and, in patients with no findings at the moment of the evaluation, management is variable.

Single dose of intraoperative intravenous morphine for analgesia in children undergoing tonsillectomy: Randomized, double-blind clinical trial / Dose única de morfina endovenosa intraoperatória para analgesia de crianças submetidas à amigdalectomia: ensaio clínico randomizado duplo cego

Abstract Introduction Children undergoing tonsillectomy have severe pain in the postoperative period. One of the pharmacological options for analgesia is opioids, such as morphine. However, the risks of adverse effects, such as increased recovery time from anesthesia and respiratory depression, can limit its use. Objectives To evaluate the use of intraoperative intravenous morphine to reduce immediate postoperative pain in children undergoing tonsillectomy. Methods In this double-blind randomized study, children aged 3-10 years were submitted to tonsillectomy, with or without adenoidectomy, and divided into two groups. Children in group M received 0.1 mg/kg of intravenous morphine during anesthetic induction, while those in the control group received conventional anesthesia without morphine. Postoperative pain perceptions were assessed at 30, 60, 120, 180 and 240 min after recovery from anesthesia, by the children themselves and also by their parents or guardians, using a facial pain scale. Results A total of 57 children were included, 30 in the group with morphine and 27 in the group without morphine. According to the children themselves, the postoperative pain was less at the evaluations performed at 30 min after awakening from anesthesia (p= 0.023), while according to their parents/guardians, the pain was less intense in the evaluations performed at 30 (p= 0.002), 60 (p= 0.006) and 180 min (p= 0.007) after awakening. Moreover, postoperative analgesics were less requested by children in the morphine group. No observed side effects were associated with the use of morphine. Conclusion A single dose of intravenous morphine during anesthetic induction reduced the intensity of immediate postoperative pain in children undergoing tonsillectomy, without increasing the time of awakening from anesthesia and with lower consumption of rescue analgesics.

Resumo Introdução Crianças submetidas a amigdalectomias apresentam dor intensa no pós-operatório. Uma das opções farmacológicas de analgesia são os opioides, como a morfina. No entanto, os riscos de efeitos adversos, como aumento do tempo de recuperação da anestesia e depressão respiratória, podem limitar o seu uso. Objetivos Avaliar o uso de morfina endovenosa intraoperatória na redução da dor pós-operatória imediata de crianças submetidas a amigdalectomia. Método Neste estudo cego randomizado, crianças de 3 a 10 anos foram submetidas a amigdalectomia, com ou sem adenoidectomia, e divididas em dois grupos. As crianças do grupo M receberam 0,1 mg.kg-1 de morfina endovenosa na indução anestésica, enquanto as do grupo controle receberam anestesia convencional sem morfina. As percepções de dor no pós-operatório foram avaliadas aos 30, 60, 120, 180 e 240 min após a recuperação da anestesia, pelas próprias crianças e também pelos seus pais ou responsáveis, com uma escala de dor pela face. Resultados Foram incluídas 57 crianças, 30 no grupo com morfina e 27 no grupo sem morfina. De acordo com as próprias crianças, a dor pós-operatória foi menor durante as avaliações feitas aos 30 minutos após o despertar da anestesia (p = 0,023), enquanto segundo seus pais/responsáveis a dor foi menos intensa nas avaliações feitas aos 30 (p = 0,002), 60 (p = 0,006) e 180 minutos (p = 0,007) após o despertar. Além disto, analgésicos no pós-operatório foram menos solicitados pelas crianças do grupo da morfina. Não foram observados efeitos colaterais associados ao uso da morfina. Conclusão Uma dose única de morfina endovenosa durante a indução anestésica reduziu a intensidade da dor pós-operatória imediata de crianças submetidas a amigdalectomia, sem aumento do tempo de despertar da anestesia e com menor consumo de analgésicos de resgate.

Complicaciones en amigdalectomía con electrodisección y técnica clásica: servicio desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga / Electrodissection and classical tonsillectomy complications: servicio desconcentrado Hospital Pediatrico Dr. Agustin Zubillaga

La amigdalectomía es uno de los procedimientos quirúrgicos más frecuentes en la actualidad especialmente en edad pediátrica. Con el objetivo de determinar las complicaciones en amigdalectomía con electrodisección y técnica clásica en pacientes pediátricos que ingresaron al Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga en el año 2017, se realizó un estudio de recolección retrospectiva de datos seleccionando 119 historias clínicas, obteniendo que 73,95% de los casos fueron intervenidos por técnica de electrodisección y 26,05% por técnica clásica. Las principales indicaciones para cirugía fueron amigdalitis a repetición e hipertrofia amigdalina. Para ambas técnicas, el tiempo quirúrgico promedio fue entre 21-40 minutos (44,32% y 48,39%, respectivamente) y la estancia hospitalaria menor de un día en 54,55% y 61,29% de los casos, respectivamente. La principal complicación intraoperatoria reportada fue la hemorragia (29,03% para la técnica clásica y 15,91% para la técnica de electrodisección). Entre las complicaciones postoperatorias, el dolor (63,64%) y la fiebre (60,23%) prevaleció en pacientes operados con electrodisección mientras que en los pacientes con técnica clásica la más frecuente fue la fiebre (61,29%). Con estos resultados, se demuestra que ambas técnicas tienen similar tiempo quirúrgico y estancia hospitalaria, pero difieren en en tipo de complicaciones(AU)

Tonsillectomy is one of the most frequent surgical procedures in our times especially in pediatric age. In order to determine the complications of electrodissection and classical tonsillectomy in pediatric patients who were admitted at the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga in 2017, a review of 119 medical charts was performed. The results show that 73.95% of the cases had electrodissection tonsillectomy and 26.05% had classical tonsillectomy. The main indications for surgery were recurrent tonsillitis (electrodissection: 86.09% and classical: 80.65%) and tonsillar hypertrophy (electrodissection: 60.23% and classical: 35.48%). For both techniques, the mean surgical time was between 21-40 minutes (44.32% and 48.39%, respectively) and the hospital stay was less than one day (54.55% and 61.29%, each). The main intraoperative complication reported was hemorrhage (29.03% for classical versus 15.91% for electrodissection). Among the postoperative complications, pain (63.64%) and fever (60.23%) prevailed in patients with electrodissection tonsillectomy while fever was most frequent in patients with classical tonsillectomy (61.29%). These results show that both techniques have similar surgical time and hospital stay but differ in type of complications(AU)

Amigdalitis hemorrágica espontánea abscedada: revisión bibliográfica y reporte de un caso / Spontaneous tonsillar hemorrhage and abscess: bibliographic review and case report

En este artículo se presenta un paciente que en contexto de un cuadro amigdalino agudo bilateral con un absceso periamigdalino unilateral concomitante presenta sangrado espontáneo proveniente de la amígdala abscedada. Los signos y síntomas observados en este paciente, así como los estudios complementarios son compatibles con la entidad clínica definida como amigdalitis hemorrágica espontánea, una complicación altamente infrecuente de la amigdalitis aguda y/o crónica en nuestra época, la que solía tener una gran tasa de mortalidad y gravedad en la era preantibiótica. A continuación, se reúnen y analizan los antecedentes descritos en la literatura referidos a este cuadro, al igual que su estudio complementario requerido para definir conducta, la cual es fundamentalmente de resorte quirúrgico.

In this article we report a patient who, in the context of a bilateral acute tonsillar condition with a concomitant unilateral peritonsillar abscess presents spontaneous bleeding from the abscessed tonsil. The clinical features observed in our patient, as well as the complementary studies are all compatible with the clinical entity known as spontaneous tonsil hemorrhage, a highly rare complication of acute and/or chronic tonsillitis in our time, which used to have major severity and mortality rate in the pre-antibiotic era. Following next, we gather and analyze the information described in literature referred to this affliction, as well as the complementary tests required to define its fundamentally surgical management.

[Oral trans-mucosal dexmedetomidine for controlling of emergence agitation in children undergoing tonsillectomy: a randomized controlled trial]. / Dexmedetomidina transmucosa oral para controle da agitação ao despertar em crianças submetidas a amigdalectomia: ensaio clínico randomizado.

OBJECTIVES: Emergence agitation is a negative behavior commonly recorded after pediatric tonsillectomy. We investigated the efficacy of preoperative premedication with oral transmucosal buccal dexmedetomidine on the incidence and severity of emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia. METHODS: Ninety patients aged (3-6 years), ASA I-II were enrolled into three groups (n = 30) to receive oral transmucosal dexmedetomidine 0.5 µg.kg-1 (Group DEX I), 1 µg.kg-1 (Group DEX II) or saline placebo (Group C). Our primary endpoint was the Watcha agitation score at emergence in PACU. Secondary outcomes were preoperative sedation score, intraoperative hemodynamics, postoperative Objective Pain Scale (OPS) and adverse effects. RESULTS: The patients' demographics, preoperative sedation scores and extubation time showed no difference between groups. Significant differences between groups in incidence and frequency distribution of each grade of Watcha score were evident at 5 minutes (p = 0.007), 10 minutes (p = 0.034), 30 minutes (p = 0.022), 45 minutes (p = 0.034) and 60 minutes (p = 0.026), postoperatively with significant differences between DEX I and II groups. DEX groups showed lower OPS scores at 5 minutes (p = 0.011), 10 minutes (p = 0.037) and 30 minutes (p = 0.044) after arrival at PACU, with no difference between DEX I and II groups. Patients in DEX II group exhibited lower intraoperative mean heart rate at 15 minutes (p = 0.020), and lower mean arterial pressure at 30 minutes, (p = 0.040), 45 minutes (p = 0.002) and 60 minutes (p = 0.006) with no significant differences between groups in other time points. CONCLUSION: This study demonstrates the clinical advantage and the simple technique of oral transmucosal DEX premedication for emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia compared with saline placebo. TRIAL REGISTRATION: Clinical Trials.gov trial registry: NCT02720705.

Oral trans-mucosal dexmedetomidine for controlling of emergence agitation in children undergoing tonsillectomy: a randomized controlled trial / Dexmedetomidina transmucosa oral para controle da agitação ao despertar em crianças submetidas a amigdalectomia: ensaio clínico randomizado

Abstract Objectives: Emergence agitation is a negative behavior commonly recorded after pediatric tonsillectomy. We investigated the efficacy of preoperative premedication with oral transmucosal buccal dexmedetomidine on the incidence and severity of emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia. Methods: Ninety patients aged (3-6 years), ASA I‒II were enrolled into three groups (n = 30) to receive oral transmucosal dexmedetomidine 0.5 µg.kg-1 (Group DEX I), 1 µg.kg-1 (Group DEX II) or saline placebo (Group C). Our primary endpoint was the Watcha agitation score at emergence in PACU. Secondary outcomes were preoperative sedation score, intraoperative hemodynamics, postoperative Objective Pain Scale (OPS) and adverse effects. Results: The patients' demographics, preoperative sedation scores and extubation time showed no difference between groups. Significant differences between groups in incidence and frequency distribution of each grade of Watcha score were evident at 5 minutes (p= 0.007), 10 minutes (p= 0.034), 30 minutes (p= 0.022), 45 minutes (p= 0.034) and 60 minutes (p= 0.026), postoperatively with significant differences between DEX I and II groups. DEX groups showed lower OPS scores at 5 minutes (p= 0.011), 10 minutes (p= 0.037) and 30 minutes (p= 0.044) after arrival at PACU, with no difference between DEX I and II groups. Patients in DEX II group exhibited lower intraoperative mean heart rate at 15 min (p= 0.020), and lower mean arterial pressure at 30 minutes, (p= 0.040), 45 minutes (p= 0.002) and 60 minutes (p= 0.006) with no significant differences between groups in other time points. Conclusion: This study demonstrates the clinical advantage and the simple technique of oral transmucosal DEX premedication for emergence agitation in preschool children undergoing tonsillectomy under sevoflurane anesthesia compared with saline placebo. Trial registration Clinical Trials.gov trial registry: NCT02720705.

Resumo Objetivos: A agitação ao despertar da anestesia é um comportamento negativo comumente registrado após amigdalectomia pediátrica. Avaliamos a eficácia da pré-medicação com dexmedetomidina via transmucosa oral no pré-operatório sobre a incidência e gravidade da agitação ao despertar em crianças pré-escolares submetidas à amigdalectomia sob anestesia com sevoflurano. Métodos: Noventa pacientes entre três e seis anos e estado físico ASA I-II foram incluídos em três grupos (n = 30) para receber 0,5 µg.kg-1 ou 1 µg.kg-1 de dexmedetomidina via transmucosa oral (Grupo DEX I e Grupo DEX II, respectivamente) ou solução salina (Grupo C). O desfecho primário foi o escore de agitação ao despertar medido com a escala de Watcha na SRPA. Os desfechos secundários foram escore de sedação pré-operatória, hemodinâmica intraoperatória, escore OPS (Objective Pain Scale) e efeitos adversos no pós-operatório. Resultados: A demografia dos pacientes, os escores de sedação pré-operatória e o tempo de extubação não apresentaram diferença entre os grupos. Diferenças significativas entre os grupos na distribuição da incidência e frequência de cada grau do escore de Watcha foram evidentes aos 5 minutos (p = 0,007), 10 minutos (p = 0,034), 30 minutos (p = 0,022), 45 minutos (p = 0,034) e 60 minutos (p = 0,026) no pós-operatório, com diferenças significativas entre os grupos DEX I e II. Os grupos DEX apresentaram escores OPS mais baixos aos 5 minutos (p = 0,011), 10 minutos (p = 0,037) e 30 minutos (p = 0,044) após a chegada à SRPA, sem diferença entre os grupos DEX I e II. Os pacientes do grupo DEX II apresentaram menor frequência cardíaca média aos 15 minutos de intraoperatório (p = 0,020) e menor pressão arterial média aos 30 minutos, (p = 0,040), 45 minutos (p = 0,002) e 60 minutos (p = 0,006), sem diferenças significativas entre os grupos em outros momentos. Conclusão: Este estudo demonstra a vantagem clínica e a técnica simples da pré-medicação com DEX por via transmucosa oral para agitação ao despertar em crianças pré-escolares submetidas à amigdalectomia sob anestesia com sevoflurano, comparado à solução salina. Registro do estudo: Clinical Trials.gov trial registry: NCT02720705.

[Preemptive nebulized ketamine for pain control after tonsillectomy in children: randomized controlled trial]. / Uso preventivo de cetamina nebulizada para controle da dor após amigdalectomia em crianças: estudo randômico e controlado.

OBJECTIVES: The administration of ketamine as nebulized inhalation is relatively new and studies on nebulized ketamine are scarce. We aimed to investigate the analgesic efficacy of nebulized ketamine (1 and 2mg.kg-1) administered 30min before general anesthesia in children undergoing elective tonsillectomy in comparison with intravenous ketamine (0.5mg.kg-1) and saline placebo. METHODS: One hundred children aged (7-12) years were randomly allocated in four groups (n=25) receive; Saline Placebo (Group C), Intravenous Ketamine 0.5mg.kg-1 (Group K-IV), Nebulized Ketamine 1mg.kg-1 (Group K-N1) or 2mg.kg-1 (Group K-N2). The primary endpoint was the total consumption of rescue analgesics in the first 24h postoperative. RESULTS: The mean time to first request for rescue analgesics was prolonged in K-N1 (400.9±60.5min, 95% CI 375.9-425.87) and K-N2 (455.5±44.6min, 95% CI 437.1-473.9) groups compared with Group K-IV (318.5±86.1min, 95% CI 282.9-354.1) and Group C (68.3±21.9min, 95% CI 59.5-77.1; p<0.001), with a significant difference between K-N1 and K-N2 Groups (p<0.001). The total consumption of IV paracetamol in the first 24h postoperative was reduced in Group K-IV (672.6±272.8mg, 95% CI 559.9-785.2), Group K-N1 (715.6±103.2mg, 95% CI 590.4-840.8) and Group K-N2 (696.6±133.3mg, 95% CI 558.8-834.4) compared with Control Group (1153.8±312.4mg, 95% CI 1024.8-1282.8; p<0.001). With no difference between intravenous and Nebulized Ketamine Groups (p=0.312). Patients in intravenous and Nebulized Ketamine Groups showed lower postoperative VRS scores compared with Group C (p<0.001), no differences between K-IV, K-N1 or K-N2 group and without significant adverse effects. CONCLUSION: Preemptive nebulized ketamine was effective for post-tonsillectomy pain relief. It can be considered as an effective alternative route to IV ketamine.

Preemptive nebulized ketamine for pain control after tonsillectomy in children: randomized controlled trial / Uso preventivo de cetamina nebulizada para controle da dor após amigdalectomia em crianças: estudo randômico e controlado

Abstract Objectives The administration of ketamine as nebulized inhalation is relatively new and studies on nebulized ketamine are scarce. We aimed to investigate the analgesic efficacy of nebulized ketamine (1 and 2 mg.kg-1) administered 30 min before general anesthesia in children undergoing elective tonsillectomy in comparison with intravenous ketamine (0.5 mg.kg-1) and saline placebo. Methods One hundred children aged (7-12) years were randomly allocated in four groups (n = 25) receive; Saline Placebo (Group C), Intravenous Ketamine 0.5 mg.kg-1 (Group K-IV), Nebulized Ketamine 1 mg.kg-1 (Group K-N1) or 2 mg.kg-1 (Group K-N2). The primary endpoint was the total consumption of rescue analgesics in the first 24 h postoperative. Results The mean time to first request for rescue analgesics was prolonged in K-N1 (400.9 ± 60.5 min, 95% CI 375.9-425.87) and K-N2 (455.5 ± 44.6 min, 95% CI 437.1-473.9) groups compared with Group K-IV (318.5 ± 86.1 min, 95% CI 282.9-354.1) and Group C (68.3 ± 21.9 min, 95% CI 59.5-77.1; p < 0.001), with a significant difference between K-N1 and K-N2 Groups (p < 0.001). The total consumption of IV paracetamol in the first 24 h postoperative was reduced in Group K-IV (672.6 ± 272.8 mg, 95% CI 559.9-785.2), Group K-N1 (715.6 ± 103.2 mg, 95% CI 590.4-840.8) and Group K-N2 (696.6 ± 133.3 mg, 95% CI 558.8-834.4) compared with Control Group (1153.8 ± 312.4 mg, 95% CI 1024.8-1282.8; p < 0.001). With no difference between intravenous and Nebulized Ketamine Groups (p = 0.312). Patients in intravenous and Nebulized Ketamine Groups showed lower postoperative VRS scores compared with Group C (p < 0.001), no differences between K-IV, K-N1 or K-N2 group and without significant adverse effects. Conclusion Preemptive nebulized ketamine was effective for post-tonsillectomy pain relief. It can be considered as an effective alternative route to IV ketamine.

Resumo Objetivos A administração de cetamina por via inalatória através de nebulizador é relativamente nova e os estudos sobre este assunto são escassos. Nosso objetivo foi investigar a eficácia analgésica da cetamina nebulizada (1 e 2 mg.kg-1) administrada 30 minutos antes da anestesia geral em crianças submetidas à amigdalectomia eletiva, em comparação com cetamina intravenosa (0,5 mg.kg-1) e placebo (soro fisiológico). Métodos Cem crianças entre 7-12 anos foram randomicamente alocadas em quatro grupos (n = 25) e receberam: soro fisiológico para controle (Grupo C); 0,5 mg.kg-1 de cetamina intravenosa (Grupo C-IV); 1 mg.kg-1 de cetamina nebulizada (Grupo C-N1); 2 mg.kg-1 de cetamina nebulizada (Grupo C-N2). O desfecho primário foi o consumo total de analgésicos de resgate nas primeiras 24 horas de pós-operatório. Resultados O tempo médio para a primeira solicitação de analgésicos de resgate foi prolongado nos grupos C-N1 (400,9 ± 60,5 min, IC 95% 375,9-425,87) e C-N2 (455,5 ± 44,6 min, IC 95% 437,1-473,9) em comparação com o Grupo C-IV (318,5 ± 86,1 min, IC 95% 282,9-354,1) e o Grupo C (68,3 ± 21,9 min, IC 95% 59,5-77,1; p < 0,001), com uma diferença significativa entre os grupos C-N1 e C-N2 (p < 0,001). O consumo total de paracetamol IV nas primeiras 24 horas de pós-operatório foi reduzido no Grupo C-IV (672,6 ± 272,8 mg, IC 95% 559,9-785,2), Grupo C-N1 (715,6 ± 103,2 mg, IC 95% 590,4-840,8) e Grupo C-N2 (696,6 ± 133,3 mg, IC 95% 558,8-834,4) em comparação com o Grupo C (1153,8 ± 312,4 mg, IC 95% 1024,8-1282,8; p < 0,001). Não houve diferença entre os grupos de cetamina intravenosa e nebulizada (p = 0,312). Os pacientes dos grupos de cetamina intravenosa e nebulizada apresentaram escores VRS pós-operatórios menores, em comparação com o Grupo C (p < 0,001), sem diferenças entre os grupos C-IV, C-N1 ou C-N2 e sem efeitos adversos significativos. Conclusão A administração preventiva de cetamina nebulizada foi eficaz no alívio da dor pós-amigdalectomia. Cetamina nebulizada pode ser considerada como uma via alternativa eficaz à cetamina IV.

Características posoperatorias de la faringoplastia combinada con amigdalectomía en comparación con la amigdalectomía en niños con síndrome obstructivo de apnea del sueño / Postoperative characteristics of combined pharyngoplasty and tonsillectomy versus tonsillectomy in children with obstructive sleep apnea syndrome

Objetivo. Identificar las ventajas posoperatorias de la amigdalectomía en conjunto con la faringoplastia en comparación con la amigdalectomía sola en niños con apnea obstructiva del sueño. Métodos. En un estudio prospectivo observacional, los pacientes que cumplían con los criterios del estudio fueron asignados aleatoriamente a dos grupos: el grupo de amigdalectomía y faringoplastia, y el grupo de solo amigdalectomía. En ambos grupos, también se practicó adenoidectomía a los pacientes con vegetaciones. Se compararon los procesos de cicatrización en la herida faríngea y las proporciones hemorrágicas. Además, se evaluó la función velofaríngea posoperatoria. Resultados. La faringoplastia junto con la amigdalectomía se practicó en 328 niños con apnea obstructiva del sueño debido a hipertrofia amigdalina, y la amigdalectomía sola, en 275 niños. Estas cohortes no mostraban diferencias demográficas significativas. Por otro lado, se encontró que la pérdida de sangre fue significativamente menor en el grupo que recibió amigdalectomía y faringoplastia (p < 0,01), y el proceso de cicatrización fue notablemente más breve. La función velofaríngea posoperatoria no resultó afectada. Conclusiones. En comparación con la amigdalectomía, la amigdalectomía junto con la faringoplastia redujeron la duración del proceso de cicatrización y la pérdida de sangre; no obstante, las complicaciones posoperatorias no aumentaron. En nuestra opinión, la combinación de faringoplastia y amigdalectomía reúne un gran potencial en el tratamiento de los niños con apnea obstructiva del sueño.

Purpose. The study aims to identify the postoperative advantages of tonsillectomy in conjunction with pharyngoplasty and tonsillectomy alone in children with obstructive sleep apneas. Methods. In a prospective observational study, patients who met the study criteria were randomly divided into two groups: tonsillectomy and pharyngoplasty group, and tonsillectomy alone group. In both groups, adenoidectomy was also performed in patients with adenoid hypertrophy. Differences in their healing processes in the pharyngeal wound and their hemorrhage proportions were compared. Furthermore, postoperative velopharyngeal function was also assessed. Results. Pharyngoplasty together with tonsillectomy was performed in 328 children with obstructive sleep apnea from tonsillar hypertrophy, and tonsillectomy was performed in 275 children. These cohorts did not reveal any significant demographic differences between groups. Furthermore, blood loss was found to be significantly decreased in the tonsillectomy and pharyngoplasty group (P <0.01), and the healing process was markedly shorter. Postoperative velopharyngeal function was not affected. Conclusions. Tonsillectomy in conjunction with pharyngoplasty reduced the duration of the healing process and blood loss, compared with tonsillectomy alone; however, postoperative complications did not increase. We consider pharyngoplasty in conjunction with tonsillectomy has great potential in the treatment of children with obstructive sleep apnea.

Amigdalo adenoidectomía en pacientes con comobilidades / Adenotonsillectomy in patients with comorbidities

La adenoamigdalectomía es una de las cirugías más frecuentemente realizadas en los pacientes menores de 15 años. Es considerada una cirugía de mediana complejidad. No está exenta de riesgos y sus indicaciones deben ser muy bien evaluadas: la obstrucción de la vía aérea superior causada por hiperplasia y las infecciones bacterianas recurrentes son las indicaciones más frecuentes de amigdalectomía, y adenoidectomía. Objetivo: Describir las características clínico-epidemiológicas de la población a quien se le practica adeno-amigdalectomía portadores de hipertrofia amigdalina y vegetaciones adenoideas (HAVA) en el Hospital J.P Garrahan, sus complicaciones y el tiempo de estadía hospitalaria. Materiales y métodos: estudio descriptivo, observacional, retrospectivo y transversal, con revisión de Historias clínicas de los pacientes adeno-amigdalectomizados entre Enero 2015 a Marzo 2016. Resultados: Se realizó amigdalectomía y/o adenoidectomía en 68 pacientes. 36 masculinos, 32 femeninos. 93% (63/68) presentaban comorbilidades. El 7% (5/68) eran niños previamente sanos. Promedio de edad: 12,5 años (rango 1-16 años), mediana de edad 6 años. Tipos de comorbilidades: síndromes genéticos 18/63, antecedente de transplantes sólidos o alogénicos de médula ósea 12/63, obesidad 6/68, patología de base con compromiso muscular 4/63, patologías hematológicas 2/63, pacientes neurológicos 12/63, otros 9/63. Presentó sangrado en el postoperatorio inmediato 1/68. El tiempo de internación promedio fue de 3 días (AU)

Adenotonsillectomy is one of the most frequently performed surgeries in patients under 15 years of age. It is considered an intermediate surgery that is not devoid of risks and its indications should be well evaluated. Upper airway obstruction caused by hyperplasia and recurrent bacterial infections are the most common indications for tonsillectomy and adenoidectomy. Objective: To describe the clinical and epidemiological features of a series of patients who underwent adenotonsillectomy at Hospital J. P. Garrahan because of tonsillar hypertrophy and adenoid vegetation (THAV) assessing complications and the time of hospital stay. Material and methods: A descriptive, observational, retrospective and cross-sectional study was conducted consisting of a review of the clinical charts of patients who underwent adenotonsillectomy between January 2015 and March 2016. Results: Tonsillectomy and/or adenoidectomy was performed in 68 patients. 36 male, 32 female. Overall, 93% (63/68) presented with comorbidities; 7% (5/68) were previously healthy children. Mean age: 12.5 years (range, 1-16 years), median age: 6 years. Type of comorbidity: genetic syndromes 18/63, history of solid organ or allogeneic bone marrow transplantation 12/63, obesity 6/68, underlying muscular disorder 4/63, hematological disorders 2/63, neurological disorders 12/63, others 9/63. One patient had a hemorrhage in the immediate postoperative period 1/68. Mean hospital stay was 3 days (AU)

[Obstructive sleep apnoea syndrome]. / Síndrome de apneas-hipopneas durante el sueño.

INTRODUCTION: Obstructive sleep apnoea (OSA) is highly prevalent in children and a major public health problem. An attempt is made to determine the clinical and polysomnographic presentation of paediatric OSA in our area. PATIENTS AND METHODS: Retrospective descriptive study of sleep tests conducted on children up to 14 years-old from 1999 to 2012 in the Sleep Unit of the University Hospital of Albacete. Age, gender, anthropometric, clinical data, indication and variables of sleep study, treatment, and outcomes were collected. RESULTS: The study included 234 children. OSA was found in 71.8%, with 42.3% moderate and 44.6% severe. The majority were male (60.7%) and the mean age 5 was years, of whom 78% were pre-school or school age. There was overweight/obesity in 44%, with 93.4% snoring, apnoea 84.5%, and 5.4% daytime sleepiness. There were 23 polysomnographies and 145 polygraphies, with a median apnoea/hypopnoea index (AHI) of 10, Sat.O2 minimum 84%, desaturation index 8, and mean sleep supine 53.65% and supine events 57.61%. Treatment was lifestyle modifications 29.2%, CPAP 6%, and surgery 42.9%. Improved snoring and/or apnoea 69.4%, and weight 32.4% of overweight/obesity children. CONCLUSIONS: Most of the studied children had a pathological AHI. Almost half were overweight/obese, and a high percentage had moderate-severe OSA. Most frequent treatment was surgery. The clinical outcome was favourable in almost 70%. Less than a third with OSA and overweight/obesity improved weight.

Puntos de aproximación de pilares en amigdalectomía pediátrica / Pillars´ approach suture points in pediatric tonsillectomy / Pontos de abordagem dos pilares na tonsilectomia pediátrica

INTRODUCCIÓN: A lo largo de los años, varias técnicas de amigdalectomía han sido desarrolladas y modificadas con el fin de reducir su morbimortalidad. Diversos estudios han comparado estas técnicas, no habiendo consenso en cuanto al método con mejores resultados. El objetivo de nuestro trabajo es describir la técnica personal de amigdalectomía y analizar la frecuencia de sangrado y el desarrollo de insuficiencia velopalatina post-quirúrgica en la cirugía con aproximación de pilares. MATERIAL Y MÉTODO: Estudio descriptivo, prospectivo. Se incluyeron pacientes operados de amigdalectomía con amigdalotomo de Daniels, de 3 a 15 años, en el período comprendido desde febrero de 2017 a febrero de 2018, en el sistema de salud Malvinas Argentinas. Se interrogó por sintomatología de sangrado e insuficiencia velopalatina mediante una encuesta de elaboración propia a la semana y al mes post-quirúrgico...

INTRODUCTION: Throughout the years, several tonsillectomy techniques have been developed and modified in order to reduce their morbidity and mortality. Several studies have compared these techniques, and there is no consensus regarding the method with better results. The objective of our study is to describe the personal technique of tonsillectomy and analyze the frequency of bleeding and development of post-surgical velopalatine insufficiency in surgery with abutment approach. MATERIAL AND METHOD: Descriptive, prospective study. We included patients undergoing tonsillectomy with Daniels, from between 3 and 15 years old, from February 2017 to February 2018, in the Malvinas Argentinas hospital. They were interrogated for symptomatology of bleeding and velopalatine insufficiency by through of a self-developed questionnaire one week and one month after surgery…

INTRODUÇÃO: Ao longo dos anos, várias técnicas de amigdalectomia foram desenvolvidas e modificadas para reduzir sua morbidade e mortalidade. Diversos estudos compararam essas técnicas, não havendo consenso em relação ao método com melhores resultados. O objetivo do nosso trabalho é descrever a técnica pessoal de amigdalectomia e analisar a frequência de sangramento e o desenvolvimento de insuficiência velopalatina pós-cirúrgica em cirurgia com abordagem de abutment. MATERIAL E MÉTODO: Estudo descritivo, prospectivo. Foram incluídos pacientes submetidos à tonsilotomia com tonsilectomia de Daniels, de 3 a 15 anos, no período de fevereiro de 2017 a fevereiro de 2018, no sistema de saúde Malvinas Argentinas. Foi interrogado por sintomatologia de hemorragia e insuficiência velopalatine por meio de um questionário autodevelado durante a semana e o mês pós-cirúrgico...

Perfil orofacial de crianças respiradoras orais pré adenoidectomia e/ou amidalectomia / Orofacial profile of mouth breathing children previous to adenoidectomy and/or tonsillectomy / Perfil orofacial en niños con respiración oral antes de una adenoidectomía y/o amigdalectomía

As obstruções das vias aéreas superiores, como tonsilas hipertrofiadas, são causas da respiração oral. Objetivo: traçar o perfil miofuncional orofacial de crianças respiradoras orais pré-adenoidectomia e/ou amidalectomia. Trata-se de um estudo descritivo de caráter quantitativo de levantamento de dados. As avaliações de motricidade orofacial basearam-se no protocolo MBGR. Resultados: foram avaliadas 32 crianças, com média de idade de 8,9 anos. Destas, 34,4% eram do sexo feminino e 65,6%, do sexo masculino; prevaleceram o aleitamento natural e o hábito oral. As principais queixas foram de respiração oral e ronco. A maioria foi encaminhada para a realização de adenoamigdalectomia. A postura corporal esteve normal. Prevaleceram lábios entreabertos e língua no assoalho bucal, má oclusão Classe II de Angle, presença de tonsilas hipertrofiadas. O ronco foi descrito em 100% da amostra. A deglutição atípica prevaleceu em 77,4%. A articulação apresentou-se predominantemente normal, as alterações articulatórias presentes foram observadas no sexo masculino. A postura de lábios entreabertos apresentou relação com a deglutição atípica. Conclusão: os dados levantados não diferem da literatura com relação à respiração oral obstrutiva. Abre-se espaço para pesquisas que abranjam o pré e pós-operatório, e que propiciem um acompanhamento longitudinal das crianças.

The obstruction of the upper airways, such as hypertrophic tonsils, is the main cause of mouth breathing. Objective: to trace the orofacial myofunctional profile of mouth-breathing children previous to adenoidectomy and/or tonsillectomy. This is a descriptive quantitative study for data collection. Evaluations of orofacial motor function were based on the MBGR protocol. Results: 32 children with an age average of 8.9 years were evaluated; 34.4% of them were female and 65.6% male; breastfeeding and oral habits prevailed. The main complaints were oral breathing and snoring. Most were referred for adenotonsillectomy. The body posture was normal in 68.8% of the cases. There was a prevalence of parted lips and tongue in the mouth floor, Angle Class II malocclusion, besides hypertrophic tonsils. Snoring was described in 100% of the sample. Atypical swallowing was present in 77.4% of the sample. The articulation was predominantly normal, and articular changes were observed in males. Parted lips were related to atypical swallowing. Conclusion: the collected data did not differ from the literature regarding obstructive oral breathing. There is an open space for new research that embraces both pre- and postoperatory moments, providing a longitudinal monitoring of children.

Las obstrucciones de las vías respiratorias superiores, tales como las amígdalas hipertrofiadas, son la causa de la respiración oral. Objetivo: Trazar el perfil miofuncional orofacial de niños antes de la adenoidectomía y/o amigdalectomía. Se trata de un estudio descriptivo y cuantitativo para la recopilación de datos. Las evaluaciones de la función motora orofacial se basaran en el protocolo MBGR. Resultados: Se evaluaron 32 niños con un pormedio de edad de 8,9 años. De estos, el 34,4% eran mujeres y 65,6%, hombres; han prevalecido la lactancia materna y el hábito oral. Las principales quejas eran la respiración oral y ronquidos. La mayoría fue remitida para la realización de adenoamigdalectomía. La postura del cuerpo ha prevalecido normal. Hubo prevalencia de labios entreabiertos y de lengua en el piso de la boca, maloclusión Clase II de Angle y la presencia de amígdalas hipertrofiadas. El ronquido fue descrito en el 100% de los casos. La función masticatoria era normal. La deglución atípica estaba presente en 77,4%. La articulación se presentó predominantemente normal, las alteraciones articulatorias presentes fueron observadas en el sexo masculino. Los labios entreabiertos presentaran relación con la deglución atípica. Conclusión: los datos levantados no difieren de la literatura acerca de la respiración oral de etiología obstructiva. Se abre espacio para investigaciones que cubran los períodos pre y postoperatorio y propicien un seguimiento longitudinal de los niños.

Dolor cervical atípico: síndrome de Eagle / Atypical neck pain: Eagle syndrome

Presentamos el caso de un varón de 45 años con dolor cervical derecho muy localizado, característico y persistente. El estudio radiológico nos permitió diagnosticar claramente un síndrome de Eagle. Por lo anterior el paciente fue sometido a cirugía de extirpación de apófisis estiloides derecha. El paciente evolucionó sin mayores complicaciones ni incidencias, y obteniendo la resolución del cuadro.

Here we introduce a 45-year-old man suffering from an intense, unique and permanent pain, located in his right neck. Radiology showed us signs leading to the diagnosis of Eagle Syndrome. Surgery of right Styloid apophysis removal, with no complications, letting the patient free of symptoms.

Síndrome de PFAPA: diagnóstico y evolución post-agmidalectomía. Stadística propia / PFAPA syndrome: diagnosis and post-tonsillectomy evolution. Our own statistics / PFAPA síndrome: diagnóstico e evolução pós-amigdalectomia. Estatística própria

Introducción: el síndrome de PFAPA (fiebre periódica, estomatitis aftosa, faringitis y adenopatías), se diagnostica mediante la exclusión de otras patologías pediátricas. El score diagnóstico de Gaslini resulta útil al momento de evaluar el riesgo del paciente de padecer una de estas enfermedades inflamatorias, orientando según el resultado al diagnóstico o la exclusión de una de ellas con una sensibilidad del 95% y una especificidad del 82%. No se comprende aún su etiología ni la causa de su respuesta frente a los corticoides y a la amigdalectomía. Marco referencial: En el Servicio de Otorrinolaringología de la Clínica Universitaria Reina Fabiola se sugiere amigdalectomía terapéutica frente a la falta de respuesta de la terapia corticoidea en los niños diagnosticados con síndrome de PFAPA. Materiales y métodos: Se realizó un estudio retrospectivo- descriptivo, mediante revisión de historias clínicas y control telefónico posquirúrgico a los 90 días, de todos los pacientes amigdalectomizados por padecer de síndrome de PFAPA para caracterizar la muestra, evaluar la remisión o no de las crisis febriles y correlacionar este resultado con el score de Gaslini. Resultados: n= 5. Promedio de edad = 3,8 años. Promedio de edad de inicio de las crisis = 3 años. Se observó abundancia de crisis con síntomas floridos y sólo un paciente con historia familiar positiva. El score de Gaslini arrojó pacientes de bajo riesgo. El control telefónico encontró remisión completa de las crisis en todos los pacientes. Conclusiones: Resultados alentadores post-amigdalectomía. Respaldo del score de Gaslini.

Introduction: PFAPA syndrome (periodic fever, aphthous stomatitis, pharingytis, and adenopaty), is a periodic fever syndrome which is diagnosed by excluding other diseases. It usually begins between 2 and 5 years old. It is known that Gaslini Score is useful to evaluate the patient’s risk of developing one of these inflammatory diseases, having a sensitivity of 95% and a specificity of 82%. Neither its etiology, nor their response to corticosteroids and tonsillectomy is still clear. Framework: In the Department of Otolaryngology at the Clínica Universitaria Reina Fabiola, therapeutic tonsillectomy is suggested when PFAPA syndrome is diagnosed and response against corticosteroids fails to curb the incidence of this disease in the daily life of the child. Materials and methods: A retrospective descriptive study was conducted by reviewing medical records and telephone control at 90 days after surgery, in all patients undergoing tonsillectomy that suffer syndrome PFAPA, in order to characterize the patients included, evaluate remission and correlate this results with gaslini score. Results: n= 5. Average age = 3.8 years. Average age of onset of the crisis = 3 years. Many patients had generalized symptoms as companions of the crisis, but only one had a positive family history. Gaslini’s score dropped as a result all low-risk patients. The telephone control found a complete remission of crises in all patients. Conclusions: Post-tonsillectomy results, in our patients that have PFAPA syndrome, are encouraging as definitive therapy, as well as the correlation with the score of Gaslini.

Introdução: o PFAPA síndrome (febre periódica, estomatite aftosa, faringite e linfadenopatia), é diagnosticada pela exclusão de outras patologias pediátricas. A pontuação de Gaslini é útil quando se avalia risco de desenvolver uma dessas doenças inflamatórias do paciente, orientando-o com o resultado de diagnóstico ou exclusão com uma sensibilidade de 95% e uma especificidade de 82%. Ainda não se compreende a sua etiologia ou causa da sua resposta aos corticoides e amigdalectomia. Quadro de referência: No Departamento de Otorrinolaringologia da Clínica Universitaria Reina Fabiola se sugere amigdalectomia terapêutica frente a falta de resposta da terapia com corticosteróides em crianças com diagnóstico de síndrome de PFAPA. Materiais e métodos: Um estudo descritivo retrospectivo foi realizado pela revisão dos prontuários e de controle telefonico pós-cirúrgico após 90 dias, de todos os pacientes pós-amigdalectomia por sofrer síndrome PFAPA para caracterizar a amostra, avaliar a remissão ou não as convulsões febris e correlacionar este resultado com score de Gaslini. Resultados: n = 5. Edade média = 3,8 anos. Edade média de início das crises = 3 anos. Observou-se abundância de crise com sintomas floridas e sómente uma história familiar positiva. A pontuação de Gaslini indicou pacientes de baixo risco. O controle telefonico deu como resultado uma remissão completa das crises em todos os pacientes. Conclusões: Resultados encorajadores pós-amigdalectomia. Respaldo do score de Gaslini.

Disminución de hemorragia post adenoamigdalectomía mediante la utilzación de subgalato de bismuto / Decrease of post adenoamigdalectomy hemorrhage through the use of bismutal subgalate / Diminuição da hemorragem pós adenotonsilectomia através do uso do subgalato de bismuto

Introducción: la cirugía de amígdalas y adenoides es la más frecuentemente realizada en otorrinolaringología. La incidencia de complicaciones es baja, siendo la hemorragia la más frecuente y seria. Se estima que la incidencia de hemorragia post adenoamigdalectomia es entre 0,1 y 8,1%. Dentro de las técnicas hemostáticas se utilizan suturas, electrocauterio, radiofrecuencia, presión con packs, vasoconstrictores u otras sustancias hemostáticas. Entre estas últimas el subgalato de bismuto (activa el factor XII de la coagulación) ha sido empleado durante décadas para hemostasia de diferentes sitios quirúrgicos. El objetivo de este trabajo es determinar la eficacia de la pasta de subgalato de bismuto en la disminución de hemorragias post adenoamigdalectomías. Material y método: Trabajo retrospectivo con pacientes adultos y pediátricos intervenidos quirúrgicamente de amigdalectomía/ adenoidectomía mediante técnica de Daniels y cureta de Beckmann, a los que se dividió en dos grupos: Uno, sin la utilización de subgalato de bismuto y otro utilizando la pasta hemostática intraoperatoria. Posteriormente se comparó la incidencia de hemorragia postquirúrgica entre ambos grupos. Resultados: El primer grupo incluyó a 2.125 pacientes operados y el porcentaje de hemorragias post quirúrgicas sin la utilización del subgalato de bismuto fue de 4,56% (N=97). El otro grupo se conformó con 1.647 pacientes a los que se les aplicó la pasta de subgalato de bismuto en el lecho sangrante y el porcentaje de hemorragias post quirúrgicas descendió a 1,33% (N=22). La diferencia entre ambos grupos fue estadísticamente significativa p=0,001. Conclusiones: La pasta de subgalato de bismuto disminuye la incidencia de hemorragia post amigdalectomía.

Backgruond: tonsils and adenoid surgery are the most frequently performed in otorhinolaryngology. The incidence of complications is low, being the hemorrhage the most frequent and serious one (estimated between 0.1% and 8.1%). The hemostatic techniques used during surgery are sutures, electrocautery, radio frequency, pressure with packs, vasoconstrictors and other haemostatic substances. Between these last substances, Bismuth Subgalate (activates factor XII of coagulation) has been used during decades for hemostasis in different surgical sites. The objective is to determine the efficacy of Bismuth Subgalate paste in the reduction of postadenotonsillectomy hemorrhage. Material and method: Retrospective study including adult and pediatric patients who underwent tonsilectomy / adenoidectomy using the Daniels technique and Beckmann’s curette, which were divided into two groups: one without the use of bismuth subgalate and another using the intraoperative hemostatic paste. Subsequently, the incidence of postoperative hemorrhage between the two groups was compared. Results: The first group included 2,125 patients operated. The percentage of postoperative hemorrhages without the use of the bismuth subgalate was 4.56% (N = 97). The other group consisted of 1,647 patients in whom the Bismuth Subgalate paste was used as a hemostatic agent during surgery. The percentage of postoperative hemorrhage fell to 1.33% (N = 22). The difference between both groups was statistically significant p = 0.001. Conclutions: Bismuth subgalate paste decreases the incidence of post adenotonsillectomy hemorrhage.

Introdução: amígdalas e adenóides cirurgia é a mais realizada na otorrinolaringologia. A incidência de complicações é baixa, sendo o sangramento mais frequentes e graves. Estima-se que a incidência de hemorragia pós-adenotonsilectomia é entre 0,1 e 8,1%. Entre as técnicas hemostáticos, electrocauterização, suturas, radiofrecuecia, pacotes de pressão vasoconstritores ou outras substâncias hemostáticos são utilizados. O subgalato de bismuto ( ativa o fator de coagulação XII) tem sido usada há décadas para hemostasia de diferentes locais cirúrgicos. O objectivo é determinar a eficiência de pasta de subgalato de bismuto na redução de hemorragias pós-adenoamigdalectomia. Material e método: Estudo retrospectivo com pacientes adultos e pediátricos submetidos á cirurgia de adenoidectomia/ amigdalectomia pela técnica Daniels e cureta Beckmann, que foi dividido em dois grupos: um sem o uso de subgalato de bismuto e a outra usando pasta hemostática intraoperatória subsequentemente na incidência de hemorragia pós-cirúrgica entre os dois grupos foi comparado. Resultados: O primeiro grupo incluiu 2125 pacientes operados e a porcentagem de hemorragias pós-cirúrgico, sem o uso de subgalato de bismuto foi 4,56% (97n) o outro grupo foi formada com 1647 pacientes o qual foi aplicada uma pasta de subgalato de bismuto e a percentagem de hemorragia pós-cirurgia caiu para 1,33% (22n), a diferença entre ambos grupos foi estatisticamente significativa (p:0,001). Conclusões: a pasta de subgalato de bismuto diminui a incidencia de hemorragia pós-adenoamigdalectomia.

Adenoamigdalitis hemorrágica espontánea, revisión de la literatura y presentación de tres casos / Spontaneous hemorrhagic adenotonsillitis, literature revision and presentation of three cases

La amigdalitis hemorrágica espontánea define al sangrado no iatrogénico de las amígdalas. Es una patología generalmente secundaria a infecciones locales comunes como la amigdalitis, siendo una consecuencia de una erosión de vasos de pequeño calibre localizados en el órgano sangrante y que ha logrado su control en la actualidad gracias al advenimiento de la antibioticoterapia precoz. Se presenta constantemente dentro de las indicaciones de amigdalectomía, pero, en su mayoría, se asume como entidad teórica dada esta baja incidencia y prevalencia. Es importante para su manejo adecuado, mantener la indicación y procurar que ésta no sea olvidada por parte de los especialistas. En esta revisión, presentamos tres casos clínicos de adenoamigdalitis hemorrágica espontánea, revisión de la literatura, destacando un paciente con sangrado exclusivo del adenoides, entidad no descrita previamente en la literatura.

Spontaneous hemorrhagic tonsillitis defines non iatrogenic bleeding of the tonsils. It is a clinical entity generally secondary to common local infections like tonsillitis, being a consequence of an erosion of the small peripheral vessels, and that has been controlled in present time thanks to the advent of early antibiotic therapy. It is constantly presented amongst the indications for tonsillectomy, but, it is mostly assumed as a theoretic entity given its low incidence and prevalence. It is important, for its correct management, to maintain the indication and to seek for it not to be forgotten by the area s specialists. In this article, we present three clinical cases of hemorrhagic adenotonsillitis, detailing one where exclusive bleeding of the adenoids, an entity not yet described in the literature, is present.