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Un sitio común de hiperplasia linfoidea en los trastornos linfoproliferativos postrasplante (TLPT) son las amígdalas palatinas. Sin embargo, la hipertrofia amigdalina es extremadamente común en niños, lo que dificulta la sospecha de estos trastornos. Se realizó un estudio de una serie de casos de pacientes trasplantados intervenidos de amigdalectomía por sospecha de TLPT en un hospital pediátrico de alta complejidad en Argentina desde enero de 2014 hasta diciembre de 2021. El objetivo de este trabajo es exponer las características clínicas de los pacientes trasplantados a los que se les indicó amigdalectomía con fin diagnóstico de TLPT.

A common site of lymphoid hyperplasia in post-transplant lymphoproliferative disorders (PTLD) is the palatine tonsils. However, tonsillar hypertrophy is extremely common in children, which hinders the suspicion of PTLD. A case series of transplanted patients undergoing tonsillectomy for suspected PTLD was conducted at a tertiary care children's hospital in Argentina between January 2014 and December 2021. The objective of this study is to expose the clinical characteristics of transplanted patients who underwent a tonsillectomy to diagnose PTLD

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A common site of lymphoid hyperplasia in post-transplant lymphoproliferative disorders (PTLD) is the palatine tonsils. However, tonsillar hypertrophy is extremely common in children, which hinders the suspicion of PTLD. A case series of transplanted patients undergoing tonsillectomy for suspected PTLD was conducted at a tertiary care children's hospital in Argentina between January 2014 and December 2021. The objective of this study is to expose the clinical characteristics of transplanted patients who underwent a tonsillectomy to diagnose PTLD.

Un sitio común de hiperplasia linfoidea en los trastornos linfoproliferativos postrasplante (TLPT) son las amígdalas palatinas. Sin embargo, la hipertrofia amigdalina es extremadamente común en niños, lo que dificulta la sospecha de estos trastornos. Se realizó un estudio de una serie de casos de pacientes trasplantados intervenidos de amigdalectomía por sospecha de TLPT en un hospital pediátrico de alta complejidad en Argentina desde enero de 2014 hasta diciembre de 2021. El objetivo de este trabajo es exponer las características clínicas de los pacientes trasplantados a los que se les indicó amigdalectomía con fin diagnóstico de TLPT.

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OBJECTIVES: Hypertrophic palatine tonsils play a role in the blockage of the upper airway, one of the known causes of Obstructive Sleep Apnea (OSA). Therefore, it is possible that there is an association between tonsil size and the success of pharyngeal surgery during OSA treatment. The main objective of this study was to evaluate the relationship between tonsil grade and volume, as well as to establish whether a relationship exists between tonsil size and the success rate of pharyngeal surgery (tonsillectomy and pharyngoplasty with barbed sutures). METHODS: This retrospective study includes forty-four adult patients who underwent tonsillectomy and pharyngeal surgery with barbed sutures for the treatment of simple snoring and OSA between January 2016 and September 2019. Patients who had been previously tonsillectomized or those for whom tonsil volume measurement was lacking were excluded. All patients underwent a pre-operative physical exploration at the clinic exam room and a sleep study. Prior to surgery a Drug Induced Sleep Endoscopy (DISE) was performed. Tonsil volume was measured intraoperatively using the water displacement method. The same sleep study was repeated six months following surgery. RESULTS: A significant correlation was found between tonsil grade and volume and between such measurements and the blockage observed at the level of the oropharynx during the DISE. Moreover, an association was observed between tonsil volume, but not tonsil grade, and the success of tonsillectomy and pharyngoplasty with barbed sutures. A tonsil volume greater than 6.5 cm3 was linked to success during pharyngeal surgery. CONCLUSION: A correlation exists between tonsil grade and tonsil volume. A bigger tonsil volume is associated with a greater success rate of oropharyngeal surgery during treatment of OSA. LEVEL OF EVIDENCE: Level 3, non-randomized cohort study.

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Background: A relatively frequent clinical finding in children is an asymmetric tonsil, which can have multiple etiological possibilities, including a malignant disease. The clinical finding of tonsillar asymmetry is found in approximately 2% of the pediatric population. The incidence of malignancy in the tonsils is low, estimated as 2.5 cases per 10,000 tonsillectomies. Due to its low incidence, the diagnostic tonsillectomy is not justified when tonsillar asymmetry is the only clinical finding. However, it is necessary to identify the critical clinical findings of high suspicion of malignancy that justify the performance of immediate surgery in the pediatric population. Case report: We present the case of a 10-year-old male patient. Four months before admission, the patient started with pharyngodynia and dysphagia, treated as recurrent tonsillitis. Due to exacerbation of the symptoms, orthopnea, and B symptoms, the patient came to consultation; tonsillar asymmetry was observed predominantly on the left side, with exophytic lesions extending to the hypopharynx. We decided to perform an incisional biopsy and tracheostomy due to compromised airway; histopathological diagnosis came back as B-cell lymphoma. Conclusions: Given the clinical scenario of recurrent tonsillitis, unresponsive to conventional medical treatment with antibiotics, tonsillar asymmetry with suspicious tonsillar appearance accompanied by symptoms such as fever, diaphoresis, cervical lymphadenopathy, obstructive symptoms in a pediatric patient, it is necessary to refer the patient to the specialist for timely diagnosis and treatment.

Introducción: La asimetría amigdalina es un hallazgo clínico relativamente frecuente en los niños. Se ha reportado en el 2% de la población pediátrica e incluye múltiples etiologías, entre ellas enfermedad maligna. La incidencia de malignidad es baja: se estima en 2.5 casos por cada 10,000 amigdalectomías. Por tal motivo, cuando se observa asimetría amigdalina como único hallazgo en la exploración física no se justifica la amigdalectomía con fines diagnósticos. Sin embargo, la incertidumbre de malignidad en el médico y en el paciente obliga a considerar los datos clínicos que permitan sospecharla y justificar la intervención quirúrgica. Caso clínico: Se presenta el caso de un paciente de sexo masculino de 10 años. Inició su padecimiento 4 meses previos a su ingreso hospitalario con faringodinia y disfagia, que fueron diagnosticadas y tratadas como amigdalitis recurrente. Acudió al hospital por agudización de los síntomas, evolucionando con ortopnea y síntomas B. En la exploración física se apreció asimetría amigdalina con aumento de volumen en la amígala izquierda extendida hasta la hipofaringe. Se decidió realizar una biopsia incisional y traqueostomía por compromiso respiratorio. El diagnóstico histopatológico fue linfoma de células B. Conclusiones: Ante un paciente pediátrico con amigdalitis recurrente, que no cede al tratamiento médico convencional y presenta asimetría amigdalina con aspecto sospechoso, acompañada de síntomas como fiebre, diaforesis, adenopatías cervicales y síntomas obstructivos, se deberá referir con el especialista para su diagnóstico y tratamiento oportunos.

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This study aimed to investigate the efficacy of minimally invasive tonsil surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. Tonsil ablation or turbinate reduction was performed on 49 pediatric patients with OSAHS by minimally invasive tonsil surgery. In order to evaluate the efficacy of surgery, a comparison was conducted between pre-operation and post-operation data in terms of the symptoms, signs and polysomnography test. Total effectiveness rate of the surgery was 83.7%. Subgroup analysis was also performed based on the severity of their conditions: mild, moderate, and severe groups had an effectiveness rate of 90.0, 88.9, and 66.7%, respectively (Hc=6.665, P<0.05). Postoperatively, the apnea-hypopnea index, the minimum oxygen saturation (SaO2), and corresponding symptoms improved compared to pre-operation conditions (P<0.05). Minimally invasive tonsil surgery was a safe and effective method for treating OSAHS in children.

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This study aimed to investigate the efficacy of minimally invasive tonsil surgery for the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) in children. Tonsil ablation or turbinate reduction was performed on 49 pediatric patients with OSAHS by minimally invasive tonsil surgery. In order to evaluate the efficacy of surgery, a comparison was conducted between pre-operation and post-operation data in terms of the symptoms, signs and polysomnography test. Total effectiveness rate of the surgery was 83.7%. Subgroup analysis was also performed based on the severity of their conditions: mild, moderate, and severe groups had an effectiveness rate of 90.0, 88.9, and 66.7%, respectively (Hc=6.665, P<0.05). Postoperatively, the apnea-hypopnea index, the minimum oxygen saturation (SaO2), and corresponding symptoms improved compared to pre-operation conditions (P<0.05). Minimally invasive tonsil surgery was a safe and effective method for treating OSAHS in children.

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ABSTRACT INTRODUCTION: Adenotonsillectomy is the most common surgery performed by otolaryngologists in pediatric age, and one of the most frequently asked questions about the postoperative period is whether there is a potential for change in vocal pattern of these children. OBJECTIVE: To evaluate the impact of adenotonsillectomy in the voice emission pattern of children with hypertrophy of palatine and pharyngeal tonsils. METHODS: This is a prospective study in which we carried out perceptual auditory assessments and acoustic analysis of 26 children with adenotonsillar hypertrophy at three time points: before surgery, one month and three months after surgery. The following acoustic parameters were estimated using the Praat software: fundamental frequency, jitter, shimmer, and harmonic-noise ratio. RESULTS: A statistically significant change was found between shimmer and harmonic-noise ratio during vowel /u/ production between the preoperative and 1st month postoperative time points. No significant differences were detected for acoustic parameters between preoperative analysis and that of the 3rd month post-operation. CONCLUSION: Transient changes in acoustic parameters occur in children with adenotonsillar hypertrophy submitted to adenotonsillectomy, progressing to normalization in the 3rd postoperative month.

RESUMO INTRODUÇÃO: Adenotonsilectomia é o procedimento cirúrgico mais realizado pelos otorrinolaringologistas em pacientes pediátricos, e entre as dúvidas mais frequentes a respeito do pós-operatório, inclui-se a possibilidade de modificações no padrão vocal dessas crianças. OBJETIVO: Avaliar o impacto da adenotonsilectomia no padrão de emissão vocal de crianças com hipertrofia de tonsilas palatinas e faríngea. MÉTODO: Trata-se de estudo prospectivo, em que foram realizadas a avaliação perceptiva-auditiva e a análise acústica da voz de 26 crianças com hipertrofia adenotonsilar em três oportunidades: no pré-operatório e no 1° e 3° meses após o procedimento cirúrgico. Os parâmetros acústicos frequência fundamental, jitter, shimmer e proporção harmônico-ruído foram avaliados por meio do programa Praat. RESULTADOS: Houve uma alteração estatisticamente significante entre o shimmer e a proporção harmônico-ruído da emissão da vogal/u/entre o período pré-operatório e o 1° mês do pós-operatório. Não houve diferenças significantes dos parâmetros acústicos entre a análise pré-operatória e aquela realizada no 3° mês do pós-operatório. CONCLUSÃO: Crianças com hipertrofia adenotonsilar submetidas à adenotonsilectomia cursam com alterações transitórias dos parâmetros acústicos, evoluindo com a normalização dos mesmos no 3° mês do pós-operatório.

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INTRODUCTION: Adenotonsillectomy is the most common surgery performed by otolaryngologists in pediatric age, and one of the most frequently asked questions about the postoperative period is whether there is a potential for change in vocal pattern of these children. OBJECTIVE: To evaluate the impact of adenotonsillectomy in the voice emission pattern of children with hypertrophy of palatine and pharyngeal tonsils. METHODS: This is a prospective study in which we carried out perceptual auditory assessments and acoustic analysis of 26 children with adenotonsillar hypertrophy at three time points: before surgery, one month and three months after surgery. The following acoustic parameters were estimated using the Praat software: fundamental frequency, jitter, shimmer, and harmonic-noise ratio. RESULTS: A statistically significant change was found between shimmer and harmonic-noise ratio during vowel /u/ production between the preoperative and 1st month postoperative time points. No significant differences were detected for acoustic parameters between preoperative analysis and that of the 3rd month post-operation. CONCLUSION: Transient changes in acoustic parameters occur in children with adenotonsillar hypertrophy submitted to adenotonsillectomy, progressing to normalization in the 3rd postoperative month.

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STUDY OBJECTIVES: Enlarged tonsils and adenoids, the main cause of obstructive sleep apnea syndrome (OSAS) in children, results in upper airway (UA) loading. This contributes to the imbalance between structural and neuromotor factors ultimately leading to UA collapse during sleep. However, it is unknown whether this UA loading can cause elevated airway resistance (AR) during wakefulness. We hypothesized that children with OSAS have elevated AR compared to controls and that this improves after OSAS treatment. METHODS: Case control study performed at an academic hospital. Children with OSAS and nonsnoring healthy controls underwent baseline polysomnography and spirometry, and AR measurement by body plethysmography while breathing via an orofacial mask. Children with OSAS repeated the previously mentioned tests after adenotonsillectomy. RESULTS: 31 OSAS participants (mean age ± SD = 9.7 ± 3.0 y, obstructive apnea-hypopnea index (OAHI) median [range] = 14.9 [2-58.7] events/h, body mass index [BMI] z = 1.5 ± 1) and 31 controls (age = 10.5 ± 2.5 y, P = 0.24; OAHI = 0.4 [0-1.4], P < 0.001; BMI z = 0.9 ± 1, P = 0.01) were tested. OSAS AR at baseline was 3.9 [1.5-10.3] cmH2O/L/sec and controls 2.8 [1.4 - 6.2] (P = 0.027). Both groups had similar spirometry results. 20 patients with OSAS were tested 6.4 ± 6.6 mo after adenotonsillectomy. OAHI decreased from 15.2 [2.1-58.7] to 0.5 [0 - 5.1] events/h postoperatively (P < 0.001), and AR decreased from 4.3 [1.5 - 10.3] to 2.8 [1.7 - 4.7] cmH2O/L/sec (P = 0.009). CONCLUSIONS: Children with OSAS have elevated AR that decreases after treatment. This is likely because of upper airway loading secondary to adenotonsillar hypertrophy and may contribute to the increased frequency of respiratory diseases in untreated children with OSAS.

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Lymphoepithelial cysts are uncommon benign lesions that present as painless yellowish nodules arising from various sites in the oral cavity and other parts of the body. Their etiopathogenesis is controversial, but most authors have assumed that they develop from obstruction of crypts in oral lymphoid aggregates, thus they are not true cysts but pseudocysts of retention. This paper describes a case of a large lymphoepithelial cyst located in the tonsil of a 21-year-old man complaining of a lump in the throat for four months. The patient underwent excisional biopsy, and the histopathological features showed squamous epithelium surrounded by lymphoid tissue, which were characteristically consistent with a lymphoepithelial cyst. We discuss the etiopathogenesis of these lesions and treatment modalities, which can consist of conservative surgery or only follow-up examination.

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INTRODUCTION: Adenotonsillectomy is the most common surgical procedure in otolaryngology.The main indication for this procedure is upper airway obstruction associated with hypertrophic tonsils and/or adenoids. OBJECTIVES: To describe the differences in quality of life before and after an adenoidectomy and/or tonsillectomy and compare it with that of healthy children. POPULATION AND METHODS: All children aged 1 to 17 years old hospitalized for an elective surgery between July 2012 and April 2014 were enrolled.They were compared to a control group of children in the same age range. The survey used was validated in Spanish (OSA-18) and has been especially designed to establish a relationship between obstructive sleep apnea and quality of life in pediatrics. RESULTS: Eighty-five surgery patients and 100 healthy control children were assessed. The impact on quality of life was mild in 37.6% of children, moderate in 32.9%, and severe in 29.4%,while it was mild for 96% of the control group.The average±SD of the total pre-surgery score was 67.5±20.3 (95% confidence interval [CI]:63.13-71.88). The average post-surgery scores were 37.9±21.4 (95% CI: 33.24-42.48) and 37.25±23.9 (95% CI: 32.19-42.33) at 3 and 6 months,respectively (p<0.001). The average score for the control group was 31.2±13.2 (95% CI: 28.6-33.8) and was significantly different from the post-surgery groups (p=0.03). CONCLUSIONS: Quality of life was reduced in children with a surgical indication for symptomatic adenotonsillar hypertrophy, while it was significantly improved after the surgery.

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INTRODUCTION: The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients. OBJECTIVE: To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome. METHODS: A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m(2) with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4. RESULTS: The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I-V. CONCLUSION: The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III).

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Introduction: The success of pharyngeal surgery in the treatment of obstructive sleep apnea syndrome depends on the appropriate selection of patients. Objective: To propose a new staging for indication of pharyngeal surgery in obstructive sleep apnea syndrome. Methods: A total of 54 patients undergoing extended tonsillectomy were retrospectively included, divided into six stages. Stage I: patients with palatine tonsils grade 3/4 and modified Mallampati index 1/2; stage II: palatine tonsils 3/4 and modified Mallampati index 3/4; stage III: palatine tonsils 1/2 and modified Mallampati index 1/2; stage IV: palatine tonsils 1/2 and modified Mallampati index 3/4; stage V: body mass index ≥40 kg/m2 with palatine tonsils 3/4 and modified Mallampati index 1, 2, 3, or 4. Stage VI: body mass index ≥40 with palatine tonsils 1/2 and modified Mallampati index 1, 2, 3, or 4. Results: The surgical success rates were 88.9%, 75.0%, 35.7%, 38.5%, and 100.0% in stages I–V. Conclusion: The presence of hypertrophic palatine tonsils was the anatomical factor in common in the most successful stages (I, II, and V), regardless of body mass index. Although the modified Mallampati index classes 3 and 4 reduced the success rate of surgery in patients with hypertrophic tonsils (stage II), the presence of modified Mallampati index classes 1 and 2 did not favor surgical success in patients with normal tonsils (stage III). .

Introdução: O sucesso da cirurgia faríngea no tratamento da síndrome da apneia obstrutiva do sono (SAOS) depende da adequada seleção de pacientes. Objetivo: Propor um novo estadiamento para indicação de cirurgia faríngea na SAOS. Método: Estudo retrospectivo, onde foram inclusos, 54 pacientes submetidos a amigdalectomia ampliada, divididos em 6 estádios. Estádio I: pacientes com tonsilas palatinas graus 3/4 e índice de Mallampati modificado (IMM) 1/2; Estádio II: tonsilas palatinas 3/4 e IMM 3/4; Estádio III: tonsilas palatinas 1/2 e IMM 1/2; Estádio IV: tonsilas palatinas 1/2 e IMM 3/4; Estádio V: IMC (índice de massa corpórea) ≥ com tonsilas palatinas 3/4 e IMM 1, 2, 3 ou 4. Estádio VI: IMC ≥ kg/m2 com tonsilas palatinas 1 ou 2 e IMM 1, 2, 3, ou 4. Resultados: As taxas de sucesso cirúrgico foram de 88,9%; 75,0%; 35,7%; 38,5% e 100,0% nos estádios I a V. Conclusão: A presença de tonsilas palatinas hipertróficas foi o fator anatômico em comum nos estádios de maior sucesso (I, II e V), independente do IMC. Apesar do IMM classe III e IV diminuir a taxa de sucesso da cirurgia em pacientes com tonsilas hipertróficas (estádio II), a presença de IMM classe I e II não favoreceu o sucesso cirúrgico em pacientes com tonsilas normotróficas (estádio III). .

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The purpose of this study was to investigate the changes in the humoral and cellular immunity of children with obstructive sleep apnea-hypopnea syndrome and hypertrophy of tonsils before and after plasma-mediated temperature-controlled radiofrequency ablation treatment. Fifty-seven children suffering from obstructive sleep apnea-hypopnea syndrome and with hypertrophy of tonsils were enrolled in this study. Thirty-seven children were grouped in the partial tonsillectomy group and 20, in the tonsillectomy group. The levels of CD3(+), CD4(+), CD8(+), and CD4(+)/CD8(+) were measured for cellular immunity, and the levels of IgG, IgA, and IgM were measured for humoral immunity. Blood samples were collected before and 1 and 3 months after the operation. The IgG, IgA, and IgM levels in the tonsillectomy group were significantly decreased 1 month after the operation, and recovered to the normal levels within 3 months of the operation (P < 0.05). However, the levels of IgG, IgA, and IgM in the partial tonsillectomy group decreased slightly, without a significant difference (P > 0.05). The cellular immunity of the 2 groups was not statistically different pre- and post-operation (P > 0.05). The results from the present study indicate that partial tonsillectomy by plasma-mediated temperature-controlled radiofrequency ablation did not impact on the humoral and cellular immunity of children.

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Los pólipos linfangiomatosos son malformaciones congénitas de tipo hamartomatosas caracterizados histológicamente por una proliferación linfática vascular con distintos grados de componente fibroso, adiposo y linfático, cubiertos por un epitelio escamoso. Dado a que se conocen por distintos nombres en la literatura, sólo se han descrito alrededor de 30 casos de pólipos linfagiomatosos como tal. De etiopatogenia desconocida, se presentan como una masa polipoidea o papilomatosa en las amígdalas palatinas, con sintomatología variable. Su diagnóstico definitivo es histológico tras una resección completa. No se han reportado casos de malignización ni recurrencia. En el presente trabajo se reporta el caso de un paciente de 5 años con historia de crecimiento amigdalino bilateral de dos años de evolución. La biopsia definitiva demuestra una poliposis linfangiomatosa de amígdalas palatinas y adenoides.

Lymphangiomatous polyps are hamartomatous congenital malformations. They are histologically characterized by a vascular lymphatic proliferation associated with fibrous, adipose and lymphatic components covered by squamous epithelium. There are only 30 cases described in the literature by the name of lymphangiomatous polyp, since it has multiple denominations. Even though their etiopathogenesis is unknown, their clinical presentation is described as a polypoid mass in the palatine tonsils, which may have multiple manifestations. The diagnosis is made histologically after complete resection. There have not been reports of malignant transformation nor recurrence. We present a case of a five year old patient with history of bilateral palatine tonsil growth. Final biopsy described lymphangiomatous polyps of adenoids and palatine tonsils.

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UNLABELLED: Hypertrophy and recurrent tonsillitis are common indications of tonsillectomy. However, the pathological reports are similar, regardless of clinical aspects. OBJECTIVE: Search for histopathological changes that differentiate palatine tonsils operated because of hypertrophy vis-à-vis those operated because of recurrent tonsillitis. METHOD: A prospective cross-sectional descriptive study involving 46 children divided into group I - 22 with hypertrophy; and group II - 24 with recurrent tonsillitis, in the period between 2010 and 2012, in a public hospital. We evaluated clinical and histopathological features (lymph follicles, germinal centers, fibrosis, necrosis, reticulation, infiltration by plasma cells and neutrophils). RESULTS: The patients' ages ranged between 2 and 11 years (5.17 ± 2.28). In group I, half of the patients had had the latest infection at seven months or more, and all with obstruction degree greater than 3 (> 50%). In group II, all had had the latest infection at less than seven months, and most with obstruction degree below 4 (< 75%). There was a statistically significant difference in the degree of obstruction (p = 0.0021) and number of germinal centers (p = 0.002) was higher in group I. CONCLUSION: This study suggests that the number of germinal centers is the only histopathological criterion that can be used to differentiate the two groups.

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Hipertrofia e tonsilites de repetição são indicações comuns de tonsilectomia. Entretanto, os relatórios anátomo-patológicos são semelhantes, independentemente da clínica. OBJETIVO: Buscar alterações histopatológicas que diferenciem tonsilas palatinas operadas por hipertrofia de tonsilites de repetição. MÉTODO: Estudo transversal prospectivo descritivo com 46 crianças divididas em grupos I - 22 com hipertrofia e II - 24 com tonsilites de repetição, no período de 2010 a 2012, em hospital público. Avaliamos características clínicas e histopatológicas (folículos linfáticos, centros germinativos, fibrose, necrose, reticulação, infiltração por plasmócitos e neutrófilos). RESULTADOS: A idade dos pacientes variou entre 2 e 11 anos (5,17 ± 2,28). No grupo I, metade apresentou a última infecção há sete meses ou mais e todas grau de obstrução maior que 3 (≥ 50%). No grupo II, todos apresentaram a última infecção há menos de sete meses e a maioria grau de obstrução menor que 4 (≤ 75%). Houve diferença estatisticamente significativa no grau de obstrução (p = 0,0021) e número de centros germinativos (p = 0,002), maiores no grupo I. CONCLUSÃO: Este estudo sugere que o número de centros germinativos é o único critério histopatológico que pode ser utilizado para diferenciar os dois grupos. .

Hypertrophy and recurrent tonsillitis are common indications of tonsillectomy. However, the pathological reports are similar, regardless of clinical aspects. OBJECTIVE: Search for histopathological changes that differentiate palatine tonsils operated because of hypertrophy vis-à-vis those operated because of recurrent tonsillitis. METHOD: A prospective cross-sectional descriptive study involving 46 children divided into group I - 22 with hypertrophy; and group II - 24 with recurrent tonsillitis, in the period between 2010 and 2012, in a public hospital. We evaluated clinical and histopathological features (lymph follicles, germinal centers, fibrosis, necrosis, reticulation, infiltration by plasma cells and neutrophils). RESULTS: The patients' ages ranged between 2 and 11 years (5.17 ± 2.28). In group I, half of the patients had had the latest infection at seven months or more, and all with obstruction degree greater than 3 (> 50%). In group II, all had had the latest infection at less than seven months, and most with obstruction degree below 4 (< 75%). There was a statistically significant difference in the degree of obstruction (p = 0.0021) and number of germinal centers (p = 0.002) was higher in group I. CONCLUSION: This study suggests that the number of germinal centers is the only histopathological criterion that can be used to differentiate the two groups. .

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PURPOSE: To verify the speech therapy aspects of the stomatognathic system, including phonoarticulatory structures (lips, tongue, and soft palate) and swallowing, respiratory, speech, and phonation (vocal quality and resonance) functions, before and after undergoing adenotonsillectomy. METHODS: The study included 22 children, 17 males and 5 females, aged between 5 and 10 years, suffering from hypertrophy of palatine and adenoid tonsils, with surgical indication for adenotonsillectomy and with no previous speech therapy. The speech-language pathology evaluation was performed before surgery and during the period between 1 and 6 months after adenotonsillectomy. It consisted of an evaluation of structures (lips, tongue, and soft palate) and of swallowing (liquid), respiration (mode), speech, and phonation (voice quality and resonance) functions. To evaluate vocal quality and resonance, 15 participants with the postoperative evaluation carried out in a period from 1 to 2 months were considered. RESULTS: There were differences regarding nasal respiratory mode, lips closed at rest posture, changed tongue tonus, adequate mobility of the soft palate, changed tongue posture during liquid swallowing, and absence of interposition compensatory mechanism of lips in swallowing. Reduction in the frequency of distortion processes was also found. With regard to speech, little improvement in vocal quality and resonance was seen. CONCLUSION: Following adenotonsillectomy, some structures and functions can spontaneously readapt or improve. However, most children needed to be referred to speech therapy for readapting stomatognathic structures and the assessed functions.

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OBJETIVO: Verificar os aspectos fonoaudiológicos do sistema estomatognático, incluindo as estruturas fonoarticulatórias (lábios, língua e palato mole) e as funções de deglutição, respiração, fala e fonação (qualidade vocal e ressonância), pré e pós adenotonsilectomia. MÉTODOS: Participaram 22 crianças, 17 do gênero masculino e cinco do gênero feminino, na faixa etária entre 5 e 10 anos. Todas apresentavam hipertrofia de tonsilas palatina e faríngea com indicação cirúrgica de adenotonsilectomia e nenhuma delas havia passado por fonoterapia prévia. A avaliação fonoaudiológica foi realizada no período pré-operatório e entre um e seis meses após a adenotonsilectomia e constou de avaliação das estruturas (lábios, língua e palato mole), das funções de deglutição (líquido), respiração (modo), fala e fonação (qualidade vocal e ressonância). Para avaliar a qualidade vocal e a ressonância, participaram 15 sujeitos com avaliação pós-operatória realizada no período de um a dois meses. RESULTADOS: Houve diferença quanto ao modo respiratório nasal, postura de lábios ocluídos em repouso, tônus de língua alterado, mobilidade adequada de palato mole, postura de língua alterada na deglutição de líquido, e ausência do mecanismo compensatório de interposição de lábios na deglutição. Houve redução na frequência dos processos de distorção. Em relação à fonação, foi observada discreta melhora na qualidade vocal e ressonância. CONCLUSÃO: Após a adenotonsilectomia algumas estruturas e funções podem se readaptar ou apresentar melhora espontaneamente. No entanto, foi necessário encaminhar a maioria das crianças para o atendimento fonoaudiológico na busca da readaptação das estruturas estomatognáticas e funções avaliadas.

PURPOSE: To verify the speech therapy aspects of the stomatognathic system, including phonoarticulatory structures (lips, tongue, and soft palate) and swallowing, respiratory, speech, and phonation (vocal quality and resonance) functions, before and after undergoing adenotonsillectomy. METHODS: The study included 22 children, 17 males and 5 females, aged between 5 and 10 years, suffering from hypertrophy of palatine and adenoid tonsils, with surgical indication for adenotonsillectomy and with no previous speech therapy. The speech-language pathology evaluation was performed before surgery and during the period between 1 and 6 months after adenotonsillectomy. It consisted of an evaluation of structures (lips, tongue, and soft palate) and of swallowing (liquid), respiration (mode), speech, and phonation (voice quality and resonance) functions. To evaluate vocal quality and resonance, 15 participants with the postoperative evaluation carried out in a period from 1 to 2 months were considered. RESULTS: There were differences regarding nasal respiratory mode, lips closed at rest posture, changed tongue tonus, adequate mobility of the soft palate, changed tongue posture during liquid swallowing, and absence of interposition compensatory mechanism of lips in swallowing. Reduction in the frequency of distortion processes was also found. With regard to speech, little improvement in vocal quality and resonance was seen. CONCLUSION: Following adenotonsillectomy, some structures and functions can spontaneously readapt or improve. However, most children needed to be referred to speech therapy for readapting stomatognathic structures and the assessed functions.

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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...

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