Abstract Objectives: This study aims to investigate the pattern of immunoexpression of proteins p16, p53 and Ki-67 in RRP, as well as to evaluate its influence on the number of surgeries that patients have undergone to date and to analyze the benefit of immunohistochemistry in this disease. Methods: Clinical-demographic data and tumor samples were obtained from 33 patients with RRP. The expression of proteins p16, p53 and Ki-67 was analyzed by immunohistochemical method. Results: Most patients had already undergone more than one surgery. The p16 marker was negative in 24.2% of the cases, with little positivity in 27.3% of the cases, moderate in 36.4% and intense in 12.1%. The p53 marker was positive in all cases, with little immunoexpression in 39.4% of cases, moderate in 36.4% and intense in 24.2%. The Ki-67 marker showed nuclear positivity in all lesions, although in varying degrees, with a mean proliferative index ±SD (standard deviation) of 51.7±26. Conclusions: The papillomatous lesions had varying degrees of immunoexpression of proteins p16, p53 and Ki-67, but no specific immunohistochemical pattern was observed. It was found, with statistical difference, that the number of surgeries was higher in cases with greater intensity of p53 expression, without correlation with the other markers. The benefit of immunohistochemistry in recurrent respiratory papillomatosis may lie in the prognostic assessment. However, further studies are needed to evaluate the use of this technique for this purpose. Level of evidence:: 4.

Abstract Introduction The study of larynx lesions is of great importance. More than 50% of people with vocal complaints have benign vocal fold alterations and some require surgery. Objective To determine which factors are related to surgical recurrence of benign laryngeal lesions and to determine which videolaryngoscopic diagnoses are related to the risk or protection of surgical relapses over time. Methods Observational, analytical, cross-sectional study with retrospective data collection of 1,383 surgeries in 1,301 patients. Results The mean age at the first surgery was 39.2 years old. The predominant gender was female (65.6%). There were 396 cases of polyps (25.34%), 349 cases of cysts (22.33%), 261 cases of Reinke edema (16.7%), 175 cases of nodules (11.2%), 153 cases of minor structural alterations (MSAs) (9.79%), 94 cases of leukoplakia (6.01%), 77 cases of granulomas (4.93%) and 58 cases of pseudocysts (3.71%). The age presented statistical significance with the risk of surgical relapses (p = 0.016). Male gender was associated with the greatest chance of relapse. Diagnosis of granuloma (p < 0.001) and of leukoplakia (p < 0.001) were associated with a higher risk of surgical recurrence. Cyst diagnosis was associated with protection (p = 0.015) in relation to the chance of further surgeries. Patients with associated lesions, bilaterals or voice professionals did not present a statistically significant association with surgical recurrence. Conclusion Age and gender are statistically related to the increase of surgical relapses. Leukoplakia and granuloma are associated with increased surgical relapses. Patients submitted to cyst microsurgery appear to be protected against surgical recurrence.

INTRODUCTION: Dysphonia is the main symptom of lesions that affect the vocal tract. Many of those lesions may require surgical treatment. Polyps are one of the most common forms of vocal cord lesions and the most prevalent indication for laryngeal microsurgery. There are different types of polyps, and their different characteristics can indicate different prognosis and treatments. AIM: To conduct a comparative study of polypoid lesions (angiomatous and gelatinous) in patients undergoing laryngeal microsurgery via an electronic protocol. METHOD: We prospectively evaluated 93 patients diagnosed with vocal fold polyps; the polyps were classified as angiomatous or gelatinous. RESULTS: In total, 93 patients undergoing laryngeal microsurgery were diagnosed with vocal fold polyps. Of these, 63 (64.74%) had angiomatous and 30 (32.26%) gelatinous polyps. Most patients with angiomatous polyps were men; their polyps were frequently of medium size, positioned in the middle third of the vocal fold, and accompanied by minimal structural alterations (MSA). In contrast, the majority of patients with gelatinous polyps were women; their polyps were smaller, positioned in the middle and posterior third of the vocal fold, and were not accompanied by MSA. Both types of polyps were more frequently located on the right vocal fold. CONCLUSION: Angiomatous polyps were more frequently encountered than gelatinous polyps. In addition, correlations between polyp type and sex, polyp size, position, location, and the presence of MSA were observed. Different surgical techniques were used, but the postoperative results were similar and satisfactory after speech therapy.

INTRODUÇÃO: A fusão da medicina com a informática facilita a recuperação de dados armazenados, favorecendo a realização de pesquisas com maior rigor científico. Estudos na área da Otorrinolaringologia, mais especificamente na área de Laringologia e Voz são de fundamental importância, pois 70% da população economicamente ativa necessitam da voz para trabalhar. OBJETIVO: Criar protocolo informatizado das doenças da laringe, aplicá-lo e validá-lo, avaliar as alterações laringoscópicas em pacientes submetidos à microcirurgia de laringe. MÉTODO: Criou-se uma base de dados de doenças otorrinolaringológicas através da revisão bibliográfica de livros-texto e de artigos científicos. Após, realizou-se a informatização destes dados e a sua incorporação ao SINPE© formando o protocolo mestre (doenças otorrinolaringológicas) e o protocolo específico (doenças laríngeas). Foi realizada coleta de dados prospectivos de pacientes submetidos à microcirurgia de laringe no Hospital Paranaense de Otorrinolaringologia. Os dados coletados foram analisados por meio de gráficos através do módulo SINPE© Analisador. RESULTADOS: Foram avaliados 245 pacientes, de 9 a 79anos, sendo que 36,61% (93 pacientes) foram submetidos à cirurgia por presença de pólipo nas pregas vocais, 12,6% (32) por papilomatose e 11,83% (29) por cisto intracordal. CONCLUSÕES: A criação de uma base eletrônica de dados clínicos das doenças otorrinolaringológicas foi factível. A implantação e a validação do protocolo foram possíveis. Sua disponibilização pode ser efetuada a médicos envolvidos na coleta de dados clínicos e resgate de informações para realização de trabalhos científicos de forma organizada. As alterações laríngeas mais encontradas foram pólipo, papiloma e cisto intra-cordal.

INTRODUCTION: The merging of medicine with information technology facilitates the retrieval of stored data, aiding the conduct of research with greater scientific rigor. Studies in the field of otorhinolaryngology, specifically in the area of laryngology and voice, are of fundamental importance, since 70% of the economically active need their voice to work. OBJECTIVE: To create a computerized protocol of the diseases of the larynx, apply and validate it, and use it to evaluate patients undergoing laryngoscopic microsurgery of the larynx. METHOD: We created a database of ENT diseases through a literature review of textbooks and scientific articles. Next, we computerized the data and incorporated it into the SINPE©, creating a master protocol (ENT diseases) and a specific protocol (laryngeal diseases). Data were collected prospectively from patients undergoing laryngeal microsurgery in the ENT Hospital of Paraná. The collected data were analyzed with graphs through the SINPE© Analyzer module. RESULTS: We evaluated 245 patients aged 9-79 years, and determined that 36.61% (93 patients) underwent surgery for the presence of polyps on the vocal folds, 12.6% (32) underwent surgery for papillomatosis, and 11.83% (29) underwent surgery for intracordal cysts. CONCLUSIONS: The creation of an electronic database of clinical ENT diseases was feasible. We were also able to implement and validate the protocol. The database may be released to physicians involved in clinical data collection and retrieval of information to conduct scientific research in an organized manner. The most common laryngeal disorders identified were polyps, papilloma, and intracordal cysts.

INTRODUÇÃO: Diversos estudos abordam fatores pré-operatórios que predizem dificuldade de intubação endotraqueal, graduada pelos anestesistas pela escala de Cormack-Lehane. Estes parâmetros foram pouco avaliados para a dificuldade de locação do laringoscópio nas microcirurgias da laringe. Não há uma escala padrão de dificuldade direcionada aos cirurgiões de laringe. OBJETIVO: Criar uma escala padrão de dificuldade de locação do laringoscópio durante microcirurgia da laringe, com foco na exposição das pregas vocais (PPVV); avaliar quais parâmetros clínicos predizem dificuldade de exposição das PPVV; verificar a melhora da exposição laríngea com o suspensor do laringoscópio. MÉTODO: Estudo prospectivo, randomizado, de 57 pacientes submetidos à microcirurgia de laringe. No pré-operatório foram avaliados: 3 dados epidemiológicos, 2 de anamnese e 13 de exame físico. No intra-operatório: o anestesista avaliava o escore de Cormack-Lehane e o cirurgião avaliava conforme a escala proposta, antes e após a colocação do suspensor. RESULTADOS E CONCLUSÃO:Vários parâmetros apresentaram sensibilidade, especificidade, valor preditivo positivo altos para exposição inadequada da laringe. Porém, apenas distância hiomentual <6,05cm (p=0,003) e classe 2 de Cormack-Lehane (p=0,04) com significância estatística e alta sensibilidade, 100% e 81% respectivamente. O uso do suspensor do laringoscópio melhorou a exposição laríngea de forma significativa (p=0,04). A escala proposta padroniza a vizualização e gradua a dificuldade de exposição das PPVV, facilitando comparações entre estudos e comunicação entre otorrinolaringologistas.

INTRODUCTION: Several studies addressing preoperative factors that predict difficulty of endotracheal intubation graduated by anesthesiologists, for the scale of the Cormack-Lehane. These parameters were evaluated for the difficulty of location of the laryngoscope in microsurgery of the larynx. There is not a standard scale of difficulty targeted to surgeons of the larynx. OBJECTIVE: Create a standard scale of difficulty leasing the laryngoscope during microsurgery of the larynx, with a focus on exposure of the vocal folds (vocal cords) to evaluate which clinical parameters predict difficulty of exposure of their vocal folds and verify the improvement of laryngeal exposure with the hanger of the laryngoscope. METHOD: A prospective randomized study, 57 patients undergoing laryngeal microsurgery. The preoperative parameters were evaluated: three epidemiological data, two of history and 13 physical examination. Intraoperatively: the anesthesiologist evaluated the Cormack-Lehane score and the surgeon evaluated according to the proposed scale, before and after placement of the hanger. RESULTS AND CONCLUSION: Several parameters showed sensitivity, specificity, positive predictive value for high inadequate exposure of the larynx. But only distance hiomentual <6.05 cm (p = 0.003) and 2 classes of Cormack-Lehane (p = 0.04) with statistical significance and high sensitivity of 100% and 81% respectively. The use of the hanger of laryngoscope laryngeal exposure improved significantly (p = 0.04). The proposed scale standardizes the visualization and grades the difficulty of exposure of their vocal folds, facilitating comparisons between studies and communication between otolaryngologists.