Prevalencia de alteraciones en el complejo estilohioideo y tonsilolitos en la tomografía computarizada de haz cónico realizada en individuos con fisura labiopalatina / Cleft lip and palate subjects prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography

Introducción y objetivos: Los tonsilolitos y alteraciones en el complejo estilohioideo pueden presentar similar sintomatología a otras de diferente etiología. Los individuos con fisura labiopalatina describen similares síntomas en razón de las repercusiones anatómicas propias de esta anomalía. El objetivo de este estudio fue determinar la prevalencia de alteraciones del complejo estilohioideo y tonsilolitos en exámenes de tomografía computarizada de haz cónico en individuos con fisura labiopalatina. Métodos: Según criterios de inclusión y exclusión fueron analizadas 66 tomografías de 2.794 tomografías, en el software i- Cat visión ® con índice Kappa 0,8 intraexaminador. Resultados: La prevalencia total de osificación del complejo estilohioideo incompleto en individuos con fisura labiopalatina fue de 66,6%, la prevalencia de estos hallazgos en el género femenino fue de 75% y 61,9% en el género masculino. La prevalencia total de tonsilolitos fue de 7,5%. Conclusión: Es de relevancia constatar en el informe radiológico la presencia de la calcificación del complejo estilo-hioideo y tonsilolitos. Debido a la proximidad anatómica y similar sintomatología clínica con otras alteraciones orofaciales presentes en los individuos con fisura labiopalatina, haciendo énfasis en individuos con fisura labiopalatina del género femenino, pacientes con fisura tipo transformen incisivo y posforamen incisivo por presentar mayor prevalencia. Conocer más sobre la morfometría anatómica de individuos con fisura labiopalatina coadyuva relevantemente en la elección de conductas clínicas y calidad de vida de estos pacientes, teniendo presente que la fisura labiopalatina es una de las anomalías más comunes (AU)

Introduction and objectives: Tonsilloliths and abnormal stylohyoid complex may have similar symptoms to others of different aetiology. Individuals with cleft lip and palate describe similar symptoms because of the anatomical implications that are peculiar to this anomaly. The aim of this study was to determine the prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography in individuals with cleft lip and palate. Methods: According to the inclusion and exclusion criteria, 66 CT scans out of of 2,794 were analysed, on i- Cat ® vision software with 0.8 index Kappa intra-examiner. Results: The total prevalence of ossification of the incomplete stylohyoid complex in individuals with cleft lip and palate was 66.6%; the prevalence of these findings in females was 75% and 61.9% in males. The total prevalence of tonsilloliths was 7.5%. Conclusion: It is important to ascertain calcification of the stylohyoid complex and tonsilloliths in the radiological report, due to the anatomical proximity and similarsymptomatology to other orofacial impairments inindividuals with cleft lip and palate, focusing on females with oral cleft formation, patients with incisive trans foramen cleft and incisive post foramen cleft because they are more prevalent. Greater knowledge of the anatomical morphometry of individuals with cleft lip and palate greatly contributes towards the selection of clinical behaviours and the quality of life of these patients, since cleft lip and palateis one of the most common anomalies (AU)

Review of videolaryngoscopy pharyngeal wall injuries.

OBJECTIVES: Reports of patient injuries associated with videolaryngoscopy are increasing in the literature. There are a wide variety of opinions regarding both safe use of the device and patient care following aerodigestive tract injury. We have seen an increase in videolaryngoscopy-associated injuries in recent years at our institution. Because of this, we wanted to determine if video-assisted laryngoscopy presents a greater risk of injury compared with direct laryngoscopy. Furthermore, we wanted to determine if there were patient and/or surgical factors that could contribute to patient injuries following videolaryngoscopy. DATA SOURCES: MAMC anesthesia records, PubMed, Ovid. REVIEW METHODS: We compared rates of injury between videolaryngoscopy to direct laryngoscopy at our institution by searching anesthesia records to identify laryngoscopy procedures that resulted in injury to the soft palate or oropharynx. We also identified 19 published cases in the literature, in addition to our cases, that we reviewed for patient characteristics (e.g., body mass index, age and sex, Mallampati grade), type of videolaryngoscope, location of injury, and type of repair (if any) required. RESULTS: At our institution, we have a statistically higher rate of injury using videolaryngoscopy compared to direct laryngoscopy. Our data also indicate that women are more commonly injured during videolaryngoscope intubation than men. The right tonsillar pillars and soft palate are the most frequently injured, with through-and-through perforation of the soft tissues being the most common type of injury. The most common repair of injuries required simple closures, and long-term harm was very rare. CONCLUSION: Our data suggests that using video-assisted laryngoscopy for intubation puts a patient at significantly greater risk for injury compared to direct laryngoscopy. Laryngoscope, 2016 127:349-353, 2017.

STRAIGHT TO VIDEO: TONSILLAR INJURY DURING ELECTIVE GLIDESCOPE(ò)-ASSISTED PEDIATRIC INTUBATION.

Airway management in pediatric patients presenting for tonsillectomy and adenoidectomy may prove challenging given the enlarged upper airway structures. Video Laryngoscopy (VL) can be very helpful but it does not come without risks. In this case report, we report an unfavorable outcome of VL in a pediatric patient with adenotonsillar hypertrophy.

Vaporización láser CO2 de amígdalas en niños: una técnica segura y eficaz / CO2 laser vaporization of tonsils in children: a safe and effective technique

Introducción: La hipertrofia amigdalina es una de las principales causas de ronquido infantil, tiene una prevalencia que oscila entre el 9 y el 10% y alcanza hasta el 30% en niños de 3-6 años. Se debe nombrar que solo el 3% de ese 30% tienen OSA, pues esa es la verdadera indicación de la cirugía. El objetivo fue evaluar la seguridad y eficacia de la vaporización de amígdalas con láser CO2 en pacientes pediátricos con OSA, del Servicio de Otorrinolaringología de la Clínica Carlos Ardila Lülle - Bucaramanga. Métodos: Estudio descriptivo de 47 niños entre 3 y 11 años, sometidos al procedimiento entre enero del 2011 y febrero del 2012, por obstrucción ventilatoria alta con pausas respiratorias mayores de 10 segundos durante el sueño, secundaria a hipertrofia del tejido amigdalino. Resultados: 97,8% de los niños estudiados tenían amígdalas grado IV y 2,1% grado III. Se debe exponer por qué existe tan alto porcentaje en el grado IV, pues la diferencia es muy grande, y eso puede ser objeto de censura. El tiempo quirúrgico fue, en promedio, de 25 minutos. En el 100% el procedimiento fue ambulatorio. Hay que tener cuidado con esto, porque los niños que van a cirugía por OSA como indicación deben someterse a hospitalización posterior en la UCI, pues corren el riesgo de presentar apneas, puesto que sus receptores de CO2 disminuyen la sensibilidad de hipoxia, pues al quitar el tejido no hay obstrucción; entonces, sus niveles de CO2 se reducen mucho, y esto es lo único que estimula en los centros respiratorios de ellos, y así se produce la apnea. 24 niños no registraron dolor (51%), y dos presentaron emesis (0,94%). La evolución postintervención fue satisfactoria en la mayoría, y ninguno de los pacientes presentó cuadros de sangrado o infección. Un mes después del procedimiento, 98% de los padres referían una notable mejoría de la respiración oral (ronquido), del sueño y los síntomas diurnos, o episodios de apnea. De lo contrario, sería una cirugía sin criterios adecuados, según lo relatado en la literatura. En ninguno de los pacientes que cumplieron un año de evolución se evidenció hipertrofia del tejido residual...

Introduction: Tonsillar hypertrophy is one of main causes of child snoring, having a prevalence ranging between 9 and 10% and reaching until 30% in children between 3 to 6 years old. The aim of our study was to determinate the efficacy and safety of tonsil laser vaporization with CO2 in the Otorrinolaryngology Service at the Clínica Carlos Ardila Lülle, Bucaramanga, Colombia. Methods: Descriptive study on 47 children between 3 and 11 years old, who underwent tonsil laser vaporization with CO2 in the last year by presented high ventilatory obstruction secondary to tonsillar hypertrophy tissue. Results: 97.8% had Grade IV tonsils and 2.1% were grade III. The operating time averaged 25 minutes. The 100% of the procedures were ambulatory. 24 children no reported pain (51%), 2 patients experienced emesis (0.94%). The evolution was satisfactory in more of them and not body presented bleeding or infection. After one month, 98% of parents reported a significant improvement in mouth breathing, snoring, sleep, and daily symptoms. Between children with one year evolution nobody of them presented residual tissue hypertrophy...

An unusual complication of an attempt to open the airway in a choking child.

The use of a blind finger sweep to clear the upper airway can cause subsequent problems when used in paediatric practice. This case report adds support to recommendations that this procedure should not be used, while simultaneously describing a complication the authors have not come across in the published literature.

[The "invisible" foreign body]. / Der "unsichtbare" Fremdkörper.

A 58-year-old female patient fell down a stairs carrying a plant pot. The bamboo stem penetrated the left lower lip and remained stuck in the throat. The patient pulled the bamboo stem out immediately. The lower lip was sutured and a tear in the mucous membrane in the tonsils was explored and cleansed. A foreign body could not be detected either clinically or by computed tomography (CT) of the neck. After 1 week a control CT of the neck was carried out because the patient complained of odynophagy and a putrid taste. An initially overlooked foreign body was now detected in the "lung window" and lay in an abscess cavity on the prevertebral surface. The foreign body was surgically removed with the patient under narcosis and there were no aftereffects.

Histologic assessment of thermal injury to tonsillectomy specimens: a comparison of electrocautery, coblation, harmonic scalpel, and tonsillotome.

OBJECTIVES/HYPOTHESIS: To determine the extent of thermal injury to the tonsillar tissue following the use of various types of instrumentation. To determine if tonsillectomy specimens routinely contain tissue other than lymphoid tissue. STUDY DESIGN: Retrospective histologic analysis. METHODS: A histologic analysis performed on 228 tonsillectomy specimens removed by use of an electrocautery in 132 specimens, harmonic scalpel in 46, coblation device in 24, and a tonsillotome in 26. The specimens were evaluated for presence and percentage of skeletal muscle and depth of thermal tissue injury. RESULTS: The mean percentage of skeletal muscle present in the specimens was 0.79% for electrocautery, 1.74% for harmonic scalpel, 0.97% for coblation device, and 1.66% for the tonsillotome. Skeletal muscle was absent in only 8 of 228 specimens (3.5%). Electrocautery has a statistically significant (P < .05) lower percentage of muscle tissue compared to harmonic scalpel and the tonsillotome. There was no statistically significant difference in the mean depth of thermal injury among the harmonic scalpel (0.68 mm), electrocautery (0.58 mm), and coblation device (0.71 mm) specimens. The tonsillotome specimens had no thermal injury. CONCLUSIONS: Attempts to remove the entire tonsil results in a similar depth of thermal injury to tonsillectomy specimens when using the harmonic scalpel, electrocautery, and coblation device. Skeletal muscle is a nearly ubiquitous finding in routine tonsillectomy specimens. The use of an electrocautery with a needle point may allow for a more precise dissection as it results in tonsillectomy specimens with a smaller percentage of muscle present.

[Carotid dissection with cerebri media thrombosis due to a tonsillar lesion]. / Karotisdissektion mit Cerebri-media-Thrombose nach Tonsillenverletzung.

A 7-year-old boy suffered a tonsillar lesion due to trauma and presented to hospital with a GCS of 15. Some hours later he developed hemiparesis with loss of consciousness. Angiography displayed a left-sided carotid dissection associated with thrombosis of the arteria cerebri media. After initial treatment by heparinization, the increase of intracranial pressure was treated by craniectomy. The neurological deficits diminished partially after days and reimplantation of the skull cap was possible. The initial hemiparesis decreased slightly during rehabilitation after 5 weeks.

Management of oropharyngeal trauma in children.

OBJECTIVE: To determine the indications for admission, requisite imaging studies, and urgent medical or surgical intervention. DESIGN: We retrospectively reviewed the charts of 26 children (age range, 5 months to 14 years) who were seen by the otolaryngology service in the emergency department at the Children's National Medical Center, Washington, DC, from 1985 to 1993 and who were diagnosed as having oropharyngeal trauma. We specifically looked for common findings in the history and physical examination on initial presentation to predict the necessary steps in evaluation and management. SETTING: Tertiary care pediatric referral center. RESULTS: Indications for admission were (1) concern about neurologic injury, (2) concern about vascular injury, (3) radiographic evidence of retropharyngeal free air or abscess, (4) pneumomediastinum, and (5) unreliable adult supervision at home. Six patients required surgery; 3 underwent retropharyngeal aspiration or incision and drainage procedures; 2 required neck explorations; and 1, who had an impaled foreign body in the parapharyngeal space, underwent surgical extraction. There were no vascular, neurologic, or other permanent injuries. CONCLUSIONS: Oropharyngeal trauma may result in palatal and posterior pharyngeal wall injury requiring closure of lacerations and management of retropharyngeal free air. Rarely does an injury lead to retropharyngeal abscess or significant pneumomediastinum. Lateral oropharyngeal injuries require increased concern about potential neurovascular impairment. However, neither the mechanism of injury nor the degree of injury correlates with the potential for neurovascular sequelae. Since neurovascular involvement may not become clinically apparent until days or weeks after the incident, admission for observation alone should be based on the distance from the patient's home to the hospital and on the level of reliable adult supervision. Indications for medical and surgical treatment of internal carotid artery thrombosis remain controversial.

Penetrating trauma of the oropharynx in children.

Penetrating trauma of the oropharynx is not an uncommon problem in the pediatric population. Innocuous injuries with minor soft-tissue trauma have been associated with severe neurologic sequelae. A review of 77 oral trauma cases that occurred from 1981 to 1990 at Boston Children's Hospital was undertaken to see if constant factors could be identified so that a treatment protocol might be outlined for these patients. Twenty-three (30%) patients sustained injury to the soft palate and peritonsillar area. Fifty percent of these cases required surgical debridement and repair. None of the 23 patients developed neurological sequelae. Physical examination may not correlate with the development of symptoms nor the mechanism of injury. Care should be taken during the examination to identify any neurological problems that may not relate to the degree of injury. Conservative management can be entertained if no abnormal neurologic findings are noted.

[Cerebral infarct secondary to an intraoral injury from a spoon. A case report]. / Infarto cerebral secundario a traumatismo intrabucal con una cuchara. Informe de un caso.

We report the case of a 4-year-old female who developed an extensive cerebral infarction after trauma to the right peritonsillar area with a spoon. Blunt injury to the intima of the interna carotid artery promotes thrombus formation or clot embolization which results in an ischemic cerebrovascular event. We emphasize the need to prevent this rare complication of intraoral trauma in childhood.

Management strategy for penetrating oropharyngeal injury.

Direct force applied to an object held in the mouth may cause either superficial or penetrating injury within the oropharynx. The natural course for a majority of these injuries is spontaneous healing. Penetrating trauma in the parapharyngeal space may cause life-threatening vascular injuries. Violation of the retropharyngeal space may lead to dissecting emphysema or mediastinitis. Knowledge of these infrequent but serious sequelae complicates emergency department management decisions.