RESUMO
El síndrome de apneas e hipoapneas obstructivas del sueño se asocia con una disminución de la calidad de vida, bajo rendimiento escolar y, hasta en el 40% de los niños, trastornos de conducta como hiperactividad, enuresis, ansiedad y depresión. Varios estudios demostraron que la adenoamigdalectomía es efectiva para mejorar o resolver los trastornos respiratorios del sueño. Si bien esta cirugía tiene resultados beneficiosos, no está exenta de riesgos. El dolor y el sangrado posoperatorio son las dos causas principales de morbilidad. Otras complicaciones de la cirugía son las náuseas y los vómitos posoperatorios, el retraso en la alimentación, la deshidratación, la otalgia referida, los cambios en la voz y, raras veces, la muerte.En este artículo se realizan recomendaciones sobre el cuidado posoperatorio de los niños con adenoamigdalectomía
Obstructive sleep apnea and hypopnea syndrome is associated with decreased quality of life, poor school performance and, in up to 40% of children, behavioral problems such as hyperactivity, enuresis, anxiety and depression. Several studies have shown that adenoamygdalectomy is effective in improving or resolving sleep-disordered breathing. While this surgery has beneficial results, it is not without risks. Postoperative pain and bleeding are the two main causes of morbidity. Other complications of surgery include postoperative nausea and vomiting, delayed feeding, dehydration, referred earache, voice changes, and, rarely, death. Recommendations on postoperative care for children undergoing adenoamygdalectomy are mentioned in this article.
Assuntos
Humanos , Masculino , Feminino , Criança , Tonsilectomia , Adenoidectomia , Complicações Pós-Operatórias , Transtornos Respiratórios , Tonsila Faríngea/cirurgia , Apneia Obstrutiva do SonoRESUMO
Objective: The study aims to assess the impact of obstructive sleep apnea on quality of life in pediatric patients along with their management approaches. Methodology: The study has applied a cross-sectional design to recruit children, visiting ENT clinics with the suggestion of obstructive sleep apnea. History and OSA assessment were collected for these children from the hospital. Besides this, OSA-18 questionnaire was used to collect the data, translated into Arabic language for respondents' feasibility. Results: A total of 24 patients (40%) were able to cure with medical treatment, whereas 36 patients (60%) were provided with surgical treatment. There were significant association between medical management and parental smoking (p-value=0.011), OSA score (p-value-0.003) and the size of adenoid (p-value=0.008). A significant association was also shown between size of adenoid and severity of OSA18 (p-value=0.031). No significant difference was shown between parental smoking, allergic rhinitis and severity of OSA. Conclusion: Although the surgical management is still the main modality in treating OSA, medical treatment plays an important role especially in cases with mild OSA, small adenoids and indoor smoking.
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Qualidade de Vida , Tonsila Faríngea/cirurgia , Estudos Transversais/estatística & dados numéricos , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/terapia , Rinite Alérgica/terapia , Gerenciamento de Dados/organização & administraçãoRESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Faringe/cirurgia , Tonsilectomia/métodos , Adenoidectomia/métodos , Apneia Obstrutiva do Sono/cirurgia , Faringe/patologia , Complicações Pós-Operatórias/epidemiologia , Tonsila Faríngea/cirurgia , Tonsila Faríngea/patologia , Estudos Prospectivos , Perda Sanguínea Cirúrgica , HipertrofiaRESUMO
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.
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.
Assuntos
Adenoidectomia/métodos , Faringe/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia/métodos , Tonsila Faríngea/patologia , Tonsila Faríngea/cirurgia , Perda Sanguínea Cirúrgica , Criança , Pré-Escolar , Feminino , Humanos , Hipertrofia , Masculino , Faringe/patologia , Complicações Pós-Operatórias/epidemiologia , Estudos ProspectivosRESUMO
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)
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Adenoidectomia , Tonsila Faríngea/cirurgia , Comorbidade , Tempo de Internação , Complicações Pós-Operatórias , Tonsilectomia , Estudos Transversais , Estudo Observacional , Estudos RetrospectivosRESUMO
INTRODUCTION: Pharyngeal tonsil hyperplasia is the most frequent cause of nasal obstruction and chronic mouth breathing during childhood. Adenoidectomy is the procedure of choice for the resolution of these symptoms. It is not yet known, however, whether the conventional technique ("blind curettage") has been surpassed by more modern adenoidectomy techniques (video-assisted, with the aid of instruments). This study aimed to compare the conventional adenoidectomy technique with two other emerging techniques, performed in a reference otorhinolaryngology center. METHODS: This is a prospective and observational study of 33 children submitted to adenoidectomy using 3 different techniques that were followed up for a period of 3 months after surgery. The patients were divided into 3 different groups, according to the adenoidectomy technique: Group A (conventional technique - "blind curettage"); Group B (video-assisted adenoidectomy with microdebrider); Group C (video-assisted adenoidectomy with radiofrequency - Coblation®). The surgical time of each procedure was measured, being considered from the moment of insertion of the mouth gag until complete hemostasis was achieved. The questionnaire for quality of life OSA-18 was applied to all caregivers on the day of the surgery and 30-90 days after the procedure. Postoperative complications were also analyzed. RESULTS: For the entire patient sample, there was an improvement in quality of life after the surgery (p < 0.05). When analyzing the evolution of OSA-18 index, all groups showed statistically significant improvement, for all assessed domains. There were no statistically significant differences between the 3 techniques assessed for quality of life improvement after the surgery (p > 0.05). Regarding the duration of the procedure, the conventional technique showed the shortest surgical time when compared to the others (p < 0.05). No postoperative complications were noted, for any patient. CONCLUSIONS: The adenoidectomy resulted in improvement of quality of life, and there were no major postoperative complications, for all operated children, regardless of the technique used. The conventional technique was faster when compared to the more modern adenoidectomy techniques.
Assuntos
Adenoidectomia/métodos , Tonsila Faríngea/cirurgia , Adolescente , Criança , Pré-Escolar , Curetagem/métodos , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Qualidade de VidaRESUMO
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.
Assuntos
Técnicas de Ablação/métodos , Tonsila Palatina/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Técnicas de Ablação/instrumentação , Tonsila Faríngea/patologia , Tonsila Faríngea/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Hipertrofia/cirurgia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Tonsila Palatina/patologia , Polissonografia , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
Respiratory viruses are frequently detected in association with chronic tonsillar hypertrophy in the absence of symptoms of acute respiratory infection (ARI). The present analysis was done in follow-up to a previous clinical study done by this same group. Nasopharyngeal washes (NPWs) were obtained from 83 of 120 individuals at variable times post adenotonsillectomy, in the absence of ARI symptoms. A look back at virus detection results in NPWs from the same 83 individuals at the time of tonsillectomy revealed that 73.5% (61/83) were positive for one or more viruses. The overall frequency of respiratory virus detection in post-tonsillectomy NPWs was 58.8%. Rhinovirus (RV) was the agent most frequently detected, in 38 of 83 subjects (45.8%), followed by enterovirus in 7 (8.4%), human metapneumovirus in 6 (7.2%), human respiratory syncytial virus in 3 (3.6%) and human coronavirus in 1 (1.2%). Remarkably, there was no detection of adenovirus (HAdV) or human bocavirus (HBoV) in asymptomatic individuals in follow-up of adenotonsillectomy. In keeping with persistence of respiratory DNA viruses in human tonsils, tonsillectomy significantly reduces asymptomatic shedding of HAdV and HBoV in NPWs.
Assuntos
Tonsila Faríngea/cirurgia , Vírus de DNA/isolamento & purificação , Nasofaringe/microbiologia , Tonsilectomia , Criança , HumanosRESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Técnicas de Ablação/métodos , Tonsila Palatina/cirurgia , Apneia Obstrutiva do Sono/cirurgia , Técnicas de Ablação/instrumentação , Tonsila Faríngea/patologia , Tonsila Faríngea/cirurgia , Hipertrofia/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Tonsila Palatina/patologia , Polissonografia , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
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.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Tonsila Faríngea/cirurgia , Tonsilite/cirurgia , Tonsilite/complicações , Hemorragia/etnologia , Adenoidectomia , Tonsila Faríngea/patologiaRESUMO
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.
Assuntos
Resistência das Vias Respiratórias , Apneia Obstrutiva do Sono/fisiopatologia , Adenoidectomia , Tonsila Faríngea/cirurgia , Adolescente , Índice de Massa Corporal , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Tonsila Palatina/cirurgia , Pletismografia , Polissonografia , Respiração , Sistema Respiratório/fisiopatologia , Sono , Espirometria , Tonsilectomia , VigíliaRESUMO
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.
Assuntos
Adenoidectomia , Tonsila Faríngea/patologia , Tonsila Faríngea/cirurgia , Tonsila Palatina/patologia , Tonsila Palatina/cirurgia , Qualidade de Vida , Apneia Obstrutiva do Sono/cirurgia , Tonsilectomia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hipertrofia/complicações , Hipertrofia/cirurgia , Lactente , Masculino , Estudos Prospectivos , Apneia Obstrutiva do Sono/etiologiaRESUMO
Introducción: La incidencia de reoperación posadenoidectomía, ya sea una segunda adenoidectomía o una amigdalectomía, no es conocida en nuestro medio. Publicaciones extranjeras muestran 2% de readenoidectomías y 8% de amigdalectomías posteriores. Objetivo: Describir las adenoidectomías efectuadas en nuestro centro, evaluar la prevalencia de reoperaciones y buscar posibles factores asociados a éstas. Material y método: Estudio retrospectivo descriptivo y analítico. Se revisaron fichas de pacientes adenoidectomizados por roncopatía con pausas respiratorias entre enero de 1999 y diciembre 2010. Se registraron datos demográficos, controles y nasofaringolaringoscopías (NFL). Se consignaron las reoperaciones (readenoidectomías y amigdalectomías). Resultados: Se revisaron 106 fichas. Un 55,7% de los pacientes eran hombres. A la NFL, 42% de los pacientes tenían adenoides grado 3y 58% grado 4 de Parikh. Un 5,6% de los pacientes fueron reoperados (1 adenoidectomía y 5 adenoamigdalectomías). Se observó diferencia significativa en edad (p =0,04) y tamaño amigdalino (p =0,004) entre los reoperados y lo no reoperados. No hubo asociación por sexo (p =0,45), asma (p =0,31) ni rinitis (p =0,18). Sin embargo, a la regresión logística multivariada, ninguna variable se asoció significativamente de manera independiente con la necesidad de reoperación. Conclusión: La prevalencia de reoperaciones fue similar a la publicada, no encontrándose asociación con otros factores.
Introduction: The incidence of post-adenoidectomy reoperation, be it a second adenoidectomy or a tonsillectomy, is unknown within our environment. Foreign publications show a 2% of re-adenoidectomies and an 8% of ulterior tonsillectomies. Aim: To describe the adenoidectomies performed at our center, to assess the prevalence of reoperations, and to seek possible associated factors to the latter. Material y method: Descriptive and analytical retrospective assessment. A review was performed of records for patients that between January of 1999 and December of 2010 underwent adenoidectomy on account of snoring pathology. Demographics, controls, nasopharyngolaryngoscopies and reoperations (re-adenoidectomies and tonsillectomies) were recorded. Results: The review entailed checking 106 records. 55,7% of patients were men. 42% of patients had Parikh?s Grade III adenoids and 58% showed Grade IV ones. 5,6% of patients underwent reoperation. A significant difference could be observed in age (p=0,04) and tonsillar size (p=0,004) between those that had and had not undergone reoperation. There was no gender association (p=0,45), neither for asthma (p=0,31) or rhinitis (p=0,18). Yet, by multivariate logistic regression, no variable was significantly associated by itself to the need for reoperation. Conclusion: Reoperation prevalence was similar to that published, and no association to other factors was discovered.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Reoperação/estatística & dados numéricos , Tonsilectomia/estatística & dados numéricos , Adenoidectomia/estatística & dados numéricos , Tonsila Faríngea/cirurgia , Tonsila Faríngea/patologia , Rouquidão/etiologia , Prevalência , Estudos Retrospectivos , Fatores de Risco , Obstrução das Vias Respiratórias/etiologia , HiperplasiaRESUMO
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.
Assuntos
Humanos , Masculino , Pré-Escolar , Tonsila Palatina/cirurgia , Tonsila Palatina/patologia , Hamartoma/cirurgia , Hamartoma/patologia , Pólipos/patologia , Tonsilectomia , Adenoidectomia , Tonsila Faríngea/cirurgia , Tonsila Faríngea/patologiaRESUMO
UNLABELLED: Palatine and pharyngeal tonsils are immune reactive lymphoid organs that manifest specific antibodies and B/T-cell activity to respond to a variety of antigens. They perform humoral and cellular immune functions. The possible effects of adenotonsillectomy upon the immune system remain controversial. OBJECTIVE: To study the short and long-term impacts of tonsillectomy upon the cellular and humoral immunity of children. METHOD: This longitudinal prospective study included 29 children referred to adenotonsillectomy for adenotonsillar hypertrophy. Serum IgA, IgM, and IgG and lymphocyte counts were analyzed at three points in time: before surgery, 1-2 months after surgery (short term), and 12-14 months after surgery (long term). RESULTS: TCD4+ cell counts were significantly increased shortly after surgery. IgA and IgG values were significantly reduced in the long run, but were within normal ranges for this age group. CONCLUSION: This study indicated that adenotonsillectomy does not pose negative short or long term impacts upon the cellular and humoral immunity of children submitted to the procedure.
Assuntos
Tonsila Faríngea/cirurgia , Imunidade Humoral/imunologia , Tonsilectomia , Tonsila Faríngea/imunologia , Tonsila Faríngea/patologia , Biomarcadores/sangue , Relação CD4-CD8 , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Hipertrofia/cirurgia , Imunoglobulina A/sangue , Imunoglobulina A/imunologia , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Masculino , Estudos Prospectivos , Fatores de TempoRESUMO
As tonsilas palatinas e faríngea são órgãos linfoides imunologicamente reativos, que manifestam anticorpos específicos e atividade de células B e T em resposta a uma variedade de antígenos, desempenhando funções de imunidade humoral e celular. Os possíveis efeitos imunológicos da adenotonsilectomia ainda permanecem controversos. OBJETIVO: O propósito desse estudo foi investigar o impacto da tonsilectomia na imunidade celular e humoral em crianças a curto e longo prazo. MÉTODO: Desenho do estudo: longitudinal prospectivo. Foram incluídas 29 crianças com indicação de adenotonsilectomia por hipertrofia adenoamigdaliana. IgA, IgM e IgG séricas e contagem de linfócitos foram analisados em 3 períodos: antes, 1 a 2 meses (curto prazo) e 12 a 14 meses (longo prazo) após o procedimento cirúrgico. RESULTADOS: Houve aumento estatisticamente significante de linfócitos TCD4+ a curto prazo após adenotonsilectomia. Os valores de IgA e IgG apresentaram diminuição significante a longo prazo, mas permaneceram dentro dos parâmetros de normalidade para a faixa etária. CONCLUSÃO: Os resultados do presente estudo indicam que a adenotonsilectomia, tanto a curto como a longo prazo, não apresenta repercussão negativa sobre a imunidade celular e humoral das crianças submetidas a este procedimento.
Palatine and pharyngeal tonsils are immune reactive lymphoid organs that manifest specific antibodies and B/T-cell activity to respond to a variety of antigens. They perform humoral and cellular immune functions. The possible effects of adenotonsillectomy upon the immune system remain controversial. OBJECTIVE: To study the short and long-term impacts of tonsillectomy upon the cellular and humoral immunity of children. METHOD: This longitudinal prospective study included 29 children referred to adenotonsillectomy for adenotonsillar hypertrophy. Serum IgA, IgM, and IgG and lymphocyte counts were analyzed at three points in time: before surgery, 1-2 months after surgery (short term), and 12-14 months after surgery (long term). RESULTS: TCD4+ cell counts were significantly increased shortly after surgery. IgA and IgG values were significantly reduced in the long run, but were within normal ranges for this age group. CONCLUSION: This study indicated that adenotonsillectomy does not pose negative short or long term impacts upon the cellular and humoral immunity of children submitted to the procedure.
Assuntos
Criança , Pré-Escolar , Feminino , Humanos , Masculino , Tonsila Faríngea/cirurgia , Imunidade Humoral/imunologia , Tonsilectomia , Tonsila Faríngea/imunologia , Tonsila Faríngea/patologia , Biomarcadores/sangue , Seguimentos , Hipertrofia/cirurgia , Imunoglobulina A/sangue , Imunoglobulina A/imunologia , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Estudos Prospectivos , Fatores de TempoRESUMO
INTRODUCTION: Adenotonsillar hypertrophy is a common condition in pediatric patients with upper respiratory airways complaints, and pulmonary arterial hypertension (PAH) may be one complication of that condition. OBJECTIVES: To study the occurrence of PAH (mean pulmonary artery pressure higher than or equal to 25 mmHg) in a group of children with adenotonsillar hypertrophy and upper respiratory complaints (snoring or oral breathing), and to verify the pulmonary arterial pressure (PAP) changes after adenotonsillectomy. STUDY DESIGN: Case-control prospective study. SETTINGS: Study conducted at São Lucas Hospital, approaching both public and private sector. SUBJECT AND METHODS: Thirty-three pediatric patients with adenotonsillar hypertrophy and evidence of obstructive upper airways complaints were treated with adenotonsillectomy. All 33 patients underwent echocardiogram before and after the surgery with determination of the pulmonary arterial pressure (PAP), through either the tricuspid regurgitation or artery linear flow acceleration time estimation. Similar determinations were performed in 10 normal non operated controls. RESULTS: Pulmonary hypertension was verified 12 (36%) of the 33 patients with adenotonsillar hypertrophy. Adenoidectomy or adenotonsillectomy was associated to a significant 27% decrease in mean PAP (27 ± 2.8 to 20 ± 5.1 mmHg, p<0.001) and to a non significant 26% decrease in systolic PAP (35 ± 6.2 mmHg to 25 ± 0.5 mmHg, p=0.243). The PAP values in children with no pulmonary hypertension were not changed after the surgery. CONCLUSIONS: In children with pulmonary hypertension associated to adenotonsillar hypertrophy, the adenotonsillectomy decreased PAP to normal values in all patients.
Assuntos
Adenoidectomia , Tonsila Faríngea/patologia , Obstrução das Vias Respiratórias/etiologia , Hipertensão Pulmonar/etiologia , Tonsilectomia , Tonsila Faríngea/cirurgia , Adolescente , Obstrução das Vias Respiratórias/cirurgia , Estudos de Casos e Controles , Criança , Pré-Escolar , Ecocardiografia , Feminino , Humanos , Hipertensão Pulmonar/cirurgia , Hipertrofia , Lactente , Masculino , Estudos Prospectivos , Resultado do TratamentoRESUMO
Introdução: Poucos pacientes com amígdalas palatinas assimétricas apresentam linfoma, entretanto a maioria dos linfomas em amígdalas palatinas cursam com assimetria amigdaliana. Objetivo: Relatar o perfil dos pacientes e das alterações histopatológicas em pacientes submetidos a adenoamigdalectomia/amigdalectomia com amígdalas palatinas desproporcionais. Método: Estudo retrospectivo, baseado na análise de dados do Banco de Dados do Serviço de Anatomia Patológica e na revisão dos prontuários de pacientes submetidos a adenoamigdalectomias e amigdalectomias com assimetria de amígdalas palatinas durante o período de outubro de 1999 a outubro de 2009 no Hospital de Clínicas (HC) da Universidade Federal do Paraná (UFPR). Resultados: Foram incluídos 50 pacientes, com idade entre 3 a 53 anos, idade média de 14,05 anos. O exame anatomopatológico evidenciou 48 pacientes (96%) com hiperplasia linfoide e 2 casos de linfoma (4%). Estes eram homens de 40 e 53 anos com queixa de aumento unilateral da amígdala, um deles apresentava outros sintomas (astenia e emagrecimento). Ao exame físico: desproporção amigdaliana, sem envolvimento de outros órgãos ou linfonodos. Conclusões: Nosso estudo concorda com a literatura quanto aos linfomas serem mais comuns em homens, o paciente ser o primeiro a notificar o aumento de volume e a assimetria ser maior que 2 graus entre as amígdalas palatinas em casos de linfoma. Embora raro, mesmo na presença de disparidades, há chances da assimetria cursar com um quadro maligno. A necessidade de avaliação anatomopatológica de uma peça deve ser considerada juntamente a outros dados clínicos que sugiram um quadro maligno em vigência.
Introduction: A few patients with asymmetric palatine tonsils have lymphoma; but most lymphomas in palatine tonsils evolve with tonsillar asymmetry. Objective: To report the profile of patients and histopathological changes in patients submitted to adenotonsillectomy/tonsillectomy with disproportional palatine tonsils. Method: Retrospective study based on data analysis from the Pathologic Anatomy Service Database and in the review of reports of patients submitted to adenotonsillectomy and tonsillectomy with palatine tonsils asymmetry during the period from October 1999 through October 2009 at the Clinical Hospital (HC) of the Federal University of Paraná (UFPR). Results: 50 patients took part, aged between 3 to 53 years old, mean age of 14.05 years. The anatomopathological exam confirmed 48 patients (96%) with lymphoid hyperplasia and 2 cases of lymphoma (4%). These included men aged from 40 to 53 yeas with complaint of unilateral increase of the tonsil, one of whom had other symptoms (asthenia and weight loss). Upon physical examination: tonsils disproportion without involvement of other organs or lymph nodes. Conclusion: Our study is according to the literature as regards the fact the lymphomas are more common in men, the patient is the first one to notice the increase in volume and the asymmetry is larger than 2 degrees between palatine tonsils in cases of lymphoma. Although it is rare, even in the presence of differences, there are chances for the asymmetry to evolve to a malignant profile. The need for anatomopathological evaluation of a part must be considered along with other clinical data that suggests a malignant profile.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Neoplasias Tonsilares/cirurgia , Tonsilectomia , Tonsila Faríngea/cirurgia , Tonsila Palatina/cirurgia , Tonsilite/patologiaRESUMO
Introducción: Le recurrencia de hipertrofia adenoidea, post quirúrgica se presenta en un porcentaje de la población operada, en el mundo la recurrencia varía desde el 1 por ciento al 17 por ciento, este trabajo pretende conocer la recurrencia que se presenta en nuestro medio, además de comparar dos técnicas quirúrgicas: la adenoidectomía clásica versus la adenoidectomía clásica más radiofrecuencia complementaria. Materiales y métodos: Se realizó el estudio con niños en un rango de edad de 2 a 5 años operados de adenoidectomía en el Hospital Nacional Luis N. Sáenz-PNP en el periodo 2008-2009, obteniéndose un total de 49 niños operados, de los cuales 27 fueron operados con adenoidectomía clásica y a 22 se les operó con adenoidectomía clásica más radiofrecuencia complementaria. Resultados: se obtuvo una recurrencia de 10.20 por ciento de los cuales las recurrencias de 1er grado fueron 3 (6.12 por ciento), de 2do grado 1 (2.04 por ciento) y de 3er grado 1 (2.04 por ciento), del grupo de adenoidectomia clásica fueron 4 (8.16 por ciento) y 1 (2.04 por ciento) los de radiofrecuencia complementaria. Se obtuvo un RR de 3.29 (error estándar RR: 1.08) Chi cuadrado de 1.8 (p= 0.071 > de 0.05), además de un grado de satisfacción de los padres> del 90 por ciento. Conclusiones: La técnica clásica más radiofrecuencia presenta ventajas porcentuales y disminuyen el riesgo de manera adecuada pero no se ha encontrado diferencia significativa entre usar un técnica o la otra en este trabajo; que nos permita afirmar que su aplicación es muy superior con respecto a la técnica clásica sola, con lo que respecta recurrencia.
Assuntos
Masculino , Feminino , Humanos , Lactente , Pré-Escolar , Adenoidectomia , Hipertrofia , Obstrução Nasal , Otite , Recidiva , Tonsila Faríngea/cirurgiaRESUMO
Las indicaciones de la amigdalectomía y la adenoidectomía no han variado significativamente en las últimas décadas. En la actualidad, una gran variedad de métodos quirúrgicos están disponibles para realizar estos procedimientos, todos los cuales son esencialmente seguros y efectivos. La posibilidad de visualizar el campo operatorio rinofaríngeo a través de una cámara adosada a un endoscopio ha permitido reducir las recurrencias sintomáticas y las complicaciones post-operatorias. Respecto a la amigdalectomía, cobran cada día más importancia nuevas técnicas como son la ablación por radiofrecuencia o las resecciones intracapsulares que permiten disminuir las tasas de hemorragia y el dolor post-operatorio. La decisión de optar por una técnica en particular dependerá de una serie de factores: indicación de la cirugía (infección vs. obstrucción), disponibilidad de equipamiento en pabellón, posibilidad de asumir costos adicionales y preferencias del cirujano.
The indications for adenotonsillectomy have not been changed significlantly in the last decades. Currently, a great variety of surgical procedures are available and are all essentially safe and effective. Regarding tonsillectomy, everyday new techniques are becoming more popular, such as coblation, radiofrecuency, or intracapsular resection that allows a decrease in the incidente of post operative hemorrhage and pain. The use of an endoscope and camera to visualize the rhino pharynx has reduced the recurrence of adenoids and decreased post operative complications. The decision for one particular surgical technique will vary depending of several factors, such as infection versus obstruction, availability of equipment, the possibility of assuming extra cost, and the preference of each surgeon.