Coblator adenoidectomy in pediatric patients: a state-of-the-art review.

INTRODUCTION: Adenoid hypertrophy is one of the main causes of nasal obstruction in 'children. Adenoid hypertrophy can be approached either with nasal corticosteroids, or surgically when medical treatment fails. Different adenoidectomy techniques have been proposed to reduce morbidity and surgical risks, with a consequent marked increase in the use of new surgical procedures in recent years, with a progressive increase in the use of coblation. This state-of-the-art review aims to systematically review the current literature on the role of coblation in adenoidectomy. METHODS: The selection criteria included children submitted to adenoidectomy with coblator vs other techniques. 11 research questions were defined. 4 databases were explored by four authors: PubMed (Medline), the Cochrane Library, EMBASE and SciELO. The level of evidence and quality of the selected articles were assessed according to assessed according to the Quality Assessment Checklist of the National Institute for Health and Clinical Excellence. RESULTS: 20 studies met the inclusion criteria: 2 metanalysis, 12 randomized clinical trial, 2 non-randomized clinical trial, 1 prospective cohort study, and 3 retrospective cohort study. It encompassed a total population of 8375 participants. Regarding the different surgical techniques, 18 studies (excluding metanalysis) performed coblation (n = 1550), 6 microdebridement (n = 883), 15 curettage (n = 4016), and 1 suction coagulation (n = 1926). CONCLUSION: Coblator adenoidectomy appears to offer better adenoid control compared to curettage, with a possible, although not confirmed lower rate of revision surgery. Similarly, this greater resection of adenoid tissue seems to be related to a greater reduction of nasal obstruction. The advantages of this technique are mainly less surgical bleeding-although it is not clear this is a clinically relevant difference, and less postoperative pain compared to cold curettage. The difference in pain is small, as adenoidectomy is not a painful surgery in general. There is little evidence on the control of OME and comparison with other techniques such as microdebrider adenoidectomy.

Relationship between short lingual frenulum and malocclusion. A multicentre study

Objective: Ankyloglossia is characterized by an abnormally short lingual frenulum, which impairs tongue movement. Ankyloglossia has been related to craniofacial growth disturbances and dental malocclusion. But even though there is a clear biological plausibility for this hypothesis, available evidence is scarce. Methods: A case–control design was followed. Patients between 4 and 14 years old were routinely screened for short lingual frenulum and recruited from the pediatric Otolaryngology consultation of 3 Spanish tertiary referral hospitals. Lingual frenulum was assessed with the Marchesan system. A cohort of cases with short lingual frenulum and a cohort of healthy controls matched for sex and age were included. Both cases and controls had pictures of occlusion. Occlusion was evaluated by an expert in orthodontics, blinded for the frenulum assessment. Results: A total of 100 participants were included, 70 males and 30 females. The proportion of malocclusion in the short lingual frenulum group was 48%, while it was 24% in the normal frenulum group. The odds ratio of malocclusion for the short lingual frenulum patients was 2.92 (CI 95% 1.15–7.56). The difference was statistically significant (p=.012). This difference was significant for patients with class III occlusion (p=.029). There was no difference for patients with class II (p=.317). Conclusions: This work supports the hypothesis that relates class III malocclusion with a short lingual frenulum.(AU)

Objetivo: La anquiloglosia se caracteriza por un frenillo lingual anormalmente corto que dificulta la movilidad de la lengua. La anquiloglosia ha sido relacionada con alteraciones del desarrollo facial y maloclusión dentaria. Sin embargo, a pesar de una clara plausibilidad biológica para esta hipótesis, la evidencia disponible es escasa. Métodos: Siguiendo un diseño de casos y controles se incluyeron pacientes entre 4-14 años atendidos en las consultas de otorrinolaringología pediátrica de 3 hospitales de tercer nivel en España. El frenillo lingual se evaluó mediante el sistema de Marchesan. Se incluyó una cohorte de casos con frenillo lingual corto, y una cohorte de controles sanos apareados por sexo y edad. A todos los participantes se les tomó fotografía dentaria en oclusión. La oclusión se evaluó mediante un odontólogo experto en ortodoncia, ciego a la evaluación del frenillo lingual. Resultados: Se incluyeron un total de 100 participantes, 70 hombres y 30 mujeres. La proporción de maloclusión en la cohorte con frenillo lingual corto fue del 48% y del 24% en la cohorte de controles. La odds ratio de maloclusión fue 2,92 (IC 95%: 1,15-7,56). La diferencia entre grupos fue estadísticamente significativa (p=0,012). Por subgrupos, la diferencia fue estadísticamente significativa para los pacientes con maloclusión clase iii (p=0,029), pero no para aquellos con maloclusión clase ii (p=0,317). Conclusiones: Este trabajo apoya la hipótesis que relaciona la maloclusión de clase iii con el frenillo lingual corto.(AU)

Multiple oral granulomatous nodules to hyaluronic acid filler.

A 74-year-old Caucasian woman presented with a 2-week history of multiple nodules in both lips and perioral region that caused her mild discomfort while eating. The patient reported hyaluronic acid infiltration on both lips 5 months prior to presentation. The examination revealed multiple, well-defined, millimetric, and firm nodules on both lips and oral mucosa. An excisional biopsy of one of the nodules was performed under local anesthesia. Histopathological analysis demonstrated acute eosinophilic inflammation, fibrosis, and granulomas on mucoid material, positive for colloidal iron stain and Alcian blue stain, alongside a minor salivary gland showed mild atrophy, fibrosis, and fat infiltration. Enhancement of the aged lip using hyaluronic acid, to restore the bulkiness and elasticity that have been lost with age, is very common. Nevertheless, soft tissue fillers are used in a wide age range. Hyaluronic acid represents 78% of the dermal filler injections in the United States, been the second most popular nonsurgical cosmetic procedure after botulinum toxin injection. Foreign body granulomatous reaction is a rare delayed complication that has been well documented elsewhere and it has been associated with poor injection technique. Although it also has been related to hypersensitivity reactions that may be caused by impurities developed during the bacterial fermentation process, treatment of granulomatous reactions with hyaluronidase is recommended.

Methods to assess olfaction in pediatric patients: a systematic review from the international YO-IFOS study group.

OBJECTIVE: Olfaction is an important sense in children, but its measurement is usually disregarded or neglected. There has been increasing interest in olfaction in recent years, and many olfaction assessment tests have been developed to assess pediatric patients. In this systematic review, we identify and compare different olfaction assessment tests used in the pediatric population DATA SOURCES: Pubmed (Medline), the Cochrane Library, EMBASE and Trip Database. REVIEW METHODS: The main outcome was review of the tests used to assess olfaction. The secondary outcomes were review of differences between tests regarding sex, age, exercises and odorants. RESULTS: A total of 18 articles fulfilled the established inclusion criteria. CONCLUSIONS: Olfaction assessment in children should combine different methods of evaluation, and not rely only on identification tasks. There are still many questions to answer. There is a great need for a specific test for children under 5 years old. Also, there is not a real cutoff value to define hyposmia yet; real cutoff values and values adapted to children's development are keenly needed.

Concha bullosa. A radiological study and a new classification / Cornete medio bulloso. Un estudio radiológico y una nueva clasificación

Objective: A pneumatised middle turbinate is called concha bullosa. It has been classified according to its extension in the coronal plane. We propose the first classification according to the axial extension of pneumatisation of the middle turbinate. Material and methods: Bulbous concha bullosa was classified in six categories according to the degree of pneumatisation of the body of the middle turbinate in the axial plane. Results: 196 CT sinonasal scans were included. 28.06% of patients had concha bullosa, unilateral in 13.26% and bilateral in 14.79%. The most common concha bullosa found was type I, followed by type III, II, IV and V. There were no statistically significant differences by side, between the patients with or without chronic rhinosinusitis without polyps. Conclusion: Our results support the hypothesis that concha bullosa is not related to chronic rhinosinusitis. Furthermore, type IV and V cells mean posterior aeration of the middle turbinate. Those variations are rare and posterior, so they can easily pass unnoticed during endoscopic sinus surgery. Our classification is also important as a surgical reference, and it can be easily studied on the preoperative CT scan

Objetivos: El cornete medio bulloso se define como una neumatización del cornete medio. Ha sido clasificado de acuerdo a la extensión de la neumatización en el plano coronal. En este trabajo proponemos la primera clasificación de acuerdo a la extensión de la neumatización en el plano axial. Material y métodos: La concha bullosa bulbar se clasificó en 6 variantes de acuerdo al grado de neumatización del cuerpo del cornete medio en el plano axial. Resultados: Se incluyeron 196 TC nasosinusales. Se encontró una concha bullosa bulbar en el 28,06% de los pacientes, unilateral en el 13,26% y bilateral en el 14,79%. La variante más frecuente fue la tipo i, seguida de las tipo iii, ii, iv y v. No se encontraron diferencias estadísticamente significativas por lado. Tampoco se encontraron diferencias estadísticamente significativas al comparar subgrupos de pacientes con y sin rinosinusitis crónica sin pólipos. Conclusión: Nuestros resultados sustentan la hipótesis de que el cornete medio bulloso no es causa de rinosinusitis crónica. Por otra parte, las celda tipo iv y v implican una neumatización posterior del cornete medio. Estas variantes son raras, y posteriores, de modo que pueden pasar fácilmente desapercibidas durante la cirugía endoscópica. Asimismo, esta clasificación es importante como referencia quirúrgica que puede estudiarse con facilidad en el estudio preoperatorio de la TC nasosinusal

Concha bullosa. A radiological study and a new classification.

OBJECTIVE: A pneumatised middle turbinate is called concha bullosa. It has been classified according to its extension in the coronal plane. We propose the first classification according to the axial extension of pneumatisation of the middle turbinate. MATERIAL AND METHODS: Bulbous concha bullosa was classified in six categories according to the degree of pneumatisation of the body of the middle turbinate in the axial plane. RESULTS: 196 CT sinonasal scans were included. 28.06% of patients had concha bullosa, unilateral in 13.26% and bilateral in 14.79%. The most common concha bullosa found was type I, followed by type III, II, IV and V. There were no statistically significant differences by side, between the patients with or without chronic rhinosinusitis without polyps. CONCLUSION: Our results support the hypothesis that concha bullosa is not related to chronic rhinosinusitis. Furthermore, type IV and V cells mean posterior aeration of the middle turbinate. Those variations are rare and posterior, so they can easily pass unnoticed during endoscopic sinus surgery. Our classification is also important as a surgical reference, and it can be easily studied on the preoperative CT scan.

Sorpresa diagnóstica en síndrome menièriforme: Bulbo yugular dehiscente / Diagnostic surprise in a Menière-like syndrome: Jugular bulb diverticulum

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