ABSTRACT Hemangiomas are benign congenital vascular tumors that commonly arise in the head and neck regions. Although they present with indolent growth and involution in most cases, they can cause facial deformities. Hemangiomas have three subtypes: capillary, cavernous, and mixed. The cavernous type is most commonly observed on the lateral wall of the nose or the inferior turbinate. This report describes a case of cavernous hemangioma diagnosed in a rare location in the left retromaxillary masticatory space in a 67-year-old woman. Total excision of the lesion was performed with surgical treatment through the Caldwell-Luc access. Anatomopathological and immunohistochemical examinations suggested a malformative vascular lesion with a cavernous hemangioma pattern and without signs of malignancy. regions cases deformities subtypes capillary mixed turbinate 67yearold yearold 67 year old woman CaldwellLuc Caldwell Luc access malignancy 6

Abstract Objectives: Identifying voice handicap and voice-related quality of life in patients presenting pulmonary impairment associated with COVID-19 infection, comparing pulmonary parameters between these patients and individuals in the control group, as well as correlating pulmonary parameters to self-assessment questionnaires (IDV-10 and QVV). Methods: Thirty-five (35) patients presenting pulmonary impairment with COVID-19 infection were herein selected and compared to 35 individuals who were not affected by COVID-19 infection. Two self-assessment questionnaires were applied (vocal handicap index and voice quality of life protocol). Maximum phonation time Forced Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) were measured and videolaryngoscopy was performed. Results: There was statistically significant difference in scores recorded in voice self-assessment questionnaires (IDV-10 and QVV), Expiratory Pressure (PEF) and Forced Inspiratory Pressure (PIF) between patients with pulmonary impairment associated with COVID-19 infection and those in the control group. Correlation between PEF/PIF and scores recorded in voice self-assessment questionnaires was also observed. Conclusion: Pulmonary impairment associated with COVID-19 infection has worsened voice handicap and voice-related quality of life in the assessed patients, as well as reduced their forced expiratory and inspiratory pressure in comparison to the control group. Level of evidence: 4. Objectives voicerelated related COVID19 COVID 19 COVID-1 group selfassessment self assessment IDV10 IDV 10 (IDV-1 QVV. QVV . QVV) Methods Thirtyfive Thirty five (35 3 vocal protocol. protocol protocol) PEF (PEF PIF (PIF performed Results QVV, , PEFPIF observed Conclusion evidence 4 COVID1 1 COVID- IDV1 (IDV- (3 (IDV (

Resumo Introdução A esclerose lateral amiotrófica é a doença do neurônio motor mais comum nos adultos, a despeito da baixa incidência e da raridade. É uma doença neurodegenerativa na qual a disfagia é um sintoma comum e debilitante. A disfagia pode ser avaliada por exames complementares como a videoendoscopia da deglutição e testes de força de língua, uma vez que se trata de um dos principais músculos envolvidos na deglutição. Objetivo Comparar os resultados da força e resistência da língua aferidos pelo Iowa Oral Performance Instrument com os achados do exame à videoendoscopia da deglutição, em pacientes acometidos por esclerose lateral amiotrófica. Método Estudo transversal, feito em um hospital terciário especializado em tratamento e reabilitação. Vinte e cinco pacientes com diagnóstico de esclerose lateral amiotrófica foram submetidos a questionários de disfagia, exame de videoendoscopia da deglutição e teste de força e resistência de língua com o Iowa Oral Performance Instrument para avaliar a presença de disfagia. Resultado Quarenta e oito por cento da amostra apresentavam disfagia à videoendoscopia da deglutição e 76% apresentavam teste de força de língua alterado. Noventa por cento dos pacientes com disfagia apresentaram pressão de língua média inferior a 34,2 KPa. O teste de força de língua apresentou sensibilidade de 91,67% e especificidade de 38,46% e acurácia de 64%. Houve relação estatisticamente significante entre força da língua e disfagia e entre resistência da língua e disfagia. Conclusão Testes de força de língua, como o Iowa Oral Performance Instrument, mostrou‐se eficaz para avaliar disfagia, mostrou sua associação com a força e resistência da língua. Esse resultado deve fomentar a feitura de novas pesquisas para facilitar o diagnóstico precoce da disfagia.

Abstract Introduction Amyotrophic lateral sclerosis is the most common motor neuron disease in adults despite it being rare. It is a neurodegenerative disease in which dysphagia is a common and debilitating symptom. Dysphagia can be assessed by complementary exams, such as fiberoptic endoscopic evaluation of swallowing and the tongue strength test, as this is one of the main muscles involved in swallowing. Objective To compare the results of tongue strength and endurance measured by the Iowa oral performance instrument with the findings of the fiberoptic endoscopic evaluation of swallowing examination in patients affected by amyotrophic lateral sclerosis. Methods Cross-sectional study, carried out in a tertiary hospital specialized in treatment and rehabilitation. Twenty-five patients diagnosed with amyotrophic lateral sclerosis underwent dysphagia questionnaires, fiberoptic endoscopic evaluation of swallowing examination and tongue strength and resistance test with the Iowa oral performance instrument to assess the presence of dysphagia. Results Forty-eight percent of the sample had dysphagia at the fiberoptic endoscopic evaluation of swallowing and 76% had an altered tongue strength test. Ninety percent of patients with dysphagia had an average tongue pressure lower than 34.2 KPa. The tongue strength test showed sensitivity of 91.67% and specificity of 38.46% and accuracy of 64%. There was a statistically significant relationship between tongue strength and dysphagia and between tongue resistance and dysphagia. Conclusion Tongue strength tests, such as the Iowa oral performance instrument, proved to be effective in assessing dysphagia. This result should encourage further research to facilitate the early diagnosis of dysphagia.

Abstract Introduction Palatine and pharyngeal tonsils are the first line of defense against pathogens. Clinically, two alterations may require surgical removal of the tonsils: hypertrophy and recurrent tonsillitis. The two conditions probably result from a dysfunction of the immune system. Objective To evaluate possible differences in the plasma levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-10 (IL-10) in patients submitted to adenotonsillectomy. Methods Prospective, longitudinal study with 25 children undergoing adenotonsillectomy separated into 3 different groups: recurrent tonsillitis (RT), composed of 7 patients; recurrent hypertrophy tonsillitis (RTTH), with 8 patients; and the tonsillar hypertrophy (TH) group, with 10 patients. Ten healthy control children (SD) were also included in the study. Peripheral blood was collected, and plasma was separated to measure the levels of TNF-α, IL-6, and IL-10. The Mann-Whitney test was used for statistical analysis. Results The plasma level of IL-6 was higher in the RT (p= 0.0394) and TH (p= 0.0009) groups, compared with the control group. The TH group also had higher levels of IL-6 than the RT group (p= 0.039). The IL-6/IL-10 ratio was higher in the RT (p= 0.029) and TH (p= 0.0005) groups compared with the control group. Between the RT and RTTH groups, the IL-6/IL-10 ratio was higher in the RT group, with a statistically significant difference (p= 0.0091). Conclusion Patients with a history of chronic tonsillitis had higher levels of IL-6, compared with the control group.

ABSTRACT Nasopharyngeal carcinoma is rare and affect mainly men between the fourth and sixth decades of life. The clinic is characterized to be nonspecific and the main complaints or findings related to this disease are: cervical mass, aural dysfunction, and headache. The basis of treatment is radiotherapy that involves a wide field of irradiation of normal tissues, which usually generates sequelae with direct implications for quality of life. We report a case of a nasopharyngeal carcinoma treated with radiotherapy and chemotherapy that evolved, after 8 years, into supraglottic stenosis. We emphasize the relevance of clinical follow-up after radiotherapy, particularly due to the late sequelae and the relevance of using radiotherapy devices with a more focal cancer field, in order to minimize complications.

A vibração das pregas vocais é um importante fator envolvido na produção vocal e o envelhecimento pode alterar a quantidade de ácido hialurônico da prega vocal levando a disfonia. OBJETIVO: Este estudo compara a concentração de ácido hialurônico nas pregas vocais de ratas fêmeas idosas e jovens. Desenho do estudo: estudo experimental. MATERIAL E MÉTODO: Foram utilizadas pregas vocais de 13 ratas fêmeas divididas em dois grupos: cinco ratas idosas e oito ratas jovens. A concentração tecidual do ácido hialurônico foi determinada por meio de método fluorimétrico utilizando a proteína de ligação ao ácido hialurônico imobilizada em placas de enzyme-linked immunosorbent assay (ELISA) e também conjugada à biotina. Estreptavidina marcada com európio foi adicionada e, depois de európio ter sido liberado com o uso de solução de enhancement; a fluorescência final foi medida em um fluorímetro. RESULTADOS: Foram encontradas as seguintes concentrações de ácido hialurônico nas pregas vocais de acordo com os grupos: 581,7 ng/mg em ratas idosas e 1275,6 ng/mg em ratas jovens. A análise estatística mostrou diferença entre os grupos. CONCLUSÃO: A prega vocal de ratas idosas tem uma menor concentração de ácido hialurônico do que a concentração da prega vocal de ratas jovens.

The vibration of the vocal fold lamina propria is an important factor involved in vocal production and aging may change the amount of hyaluronic acid in the vocal fold leading to dysphonia. AIMS: This study compares the concentration of hyaluronic acid in vocal folds of aged and young female rats. Study design: experimental. MATERIALS AND METHODS: We used the vocal cords of 13 female rats divided into two groups: five aged rats and eight young ones. The tissue concentration of hyaluronic acid was determined using the fluorimetric method with the hyaluronic acid binding-protein coated on plates of enzyme-linked immunosorbent assay (ELISA), conjugated with biotin. Europium-labeled streptavidin was added and, after europium release with the use of enhancement solution, the final fluorescence was measured in a fluorometer. RESULTS: We found the following concentrations of hyaluronic acid in vocal fold according to the group: 581.7 ng/mg in old female rats and 1275.6 ng/mg in young female rats. Statistical analysis showed differences between groups. CONCLUSIONS: The vocal folds of old female rats have a lower concentration of hyaluronic acid when compared to such concentration on the vocal folds of young female rats.

O receptor do ácido Hialurônico é uma glicoproteína da membrana plasmática, sendo o principal o CD44, e está expresso em vários tipos de células onde possui a função de adesão celular. OBJETIVO: Estudar a possibilidade de empregar o método imunohistoquímico para identificar a distribuição dos receptores de ácido hialurônico ao longo da prega vocal humana. MATERIAL E MÉTODOS: Foram ressecadas as pregas vocais normais de um indivíduo de 23 anos, sexo masculino, cor negra. As lâminas foram analisadas por meio de estudo histomorfométrico, comparando-se a intensidade das cores nas camadas superficial, média e profunda da lâmina própria. Nas lâminas silanizadas foi utilizado método imunohistoquímico, sendo avaliadas através de microscopia óptica com aumento 40 vezes, obtendo coloração marrom onde houve a reação com receptor para ácido hialurônico. RESULTADOS: Os achados imunohistoquímicos mostraram presença de receptores para ácido hialurônico no epitélio de cobertura da prega vocal tendo maior concentração na região central da prega vocal. CONCLUSÃO: A técnica de imunohistoquímica, utilizada para avaliar a distribuição dos receptores para ácido hialurônico na pregas vocais humanas, mostrou sua disposição em epitélio da prega vocal e predomínio no terço médio, em relação às demais regiões na prega vocal estudada.

Hyaluronic acid receptor is a glycoprotein of the plasmatic membrane, and the CD44 is its representative, expressed in many cell types where it has the task of cell adhesion. AIM: the goal of the present experimental study is to investigate the possibility of using immunohistochemistry to identify the distribution of hyaluronic acid along the vocal fold. MATERIALS AND METHODS: We resected the normal vocal folds from a normal 23 year-old male black individual. The slides were analyzed by means of a histomorphometric study, comparing the color intensity in the superficial, middle and deep layers of the lamina propria. In the silanized slides we used immunohistochemistry, and evaluated the slides under light microscopy with 40x magnification, and the color changed to brown when there was a reaction with the receptor for hyaluronic acid. RESULTS: Immunohistochemical findings showed the presence of hyaluronic acid receptors in the epithelium covering the vocal fold, being more concentrated in the central region of the vocal fold. CONCLUSION: immunohistochemistry, used to assess the distribution of hyaluronic acid receptors in the central portion of the vocal fold, proved it to be present in the vocal fold epithelium and it prevailed in its middle third.

Existem várias terapias preconizadas para o tratamento da surdez súbita, algumas apresentam riscos significativos necessitando inclusive de internação hospitalar. OBJETIVO: Este estudo prospectivo analisa aspectos clínicos, etiológicos e evolutivos nos casos de surdez súbita (SS) em pacientes tratados ambulatorialmente com medicação oral. FORMA DE ESTUDO: clínico com coorte transversal. MATERIAL E MÉTODO: 40 pacientes com perda súbita da audição submeteram inicialmente a avaliação clínica otorrinolaringológica, testes audiométricos, análise hematológica e ressonância magnética. Confirmado o diagnóstico de SS, todos os pacientes receberam inicialmente prednisona e pentoxifilina sendo acompanhados por pelo menos um ano. RESULTADO: 45% (n=18) apresentaram normalização dos limiares auditivos, 40% (n=16) apresentaram melhoras auditivas, 15% (n=6) mantiveram os mesmos limiares iniciais. Nove casos (22,5%) apresentaram manifestações clínicas que justificaram a perda auditiva (infecção viral, fatores imunomediados, alterações vasculares e outros), três (7,5%) apresentaram tumores na região do ângulo ponto-cerebelar. A evolução auditiva nestes 12 casos com etiologia presumida não apresentou diferença estatística significante em relação aos 28 casos sem etiologia definida. O tratamento clínico instituído nos primeiros sete dias de instalação da perda auditiva, nos pacientes que obtiveram melhora, foi o único parâmetro estatisticamente significante dos fatores prognóstico avaliado. CONCLUSÃO: A pesquisa exaustiva etiológica deve ser realizada em qualquer caso de perda auditiva neurossensorial aguda. A presença de 7,5% de tumores localizados na região do ângulo ponto-cerebelar nos casos de SS juntamente com outras causas tratáveis justifica a investigação clínica nestes pacientes. Nossos pacientes apresentaram uma boa melhora auditiva em 67,5% dos casos, independentemente da etiologia. O início da terapia nos primeiros sete dias de instalação da perda auditiva foi o único fator de melhora significante dos limiares auditivos.

Out of the many forms of therapy for sudden deafness, some require hospitalization and present significant risks. AIM: This prospective study analyzes etiology and evolution in cases of sudden deafness (SD) where outpatient oral treatment was used. STUDY DESIGN: clinical with transversal cohort. MATERIAL AND METHOD: Forty cases of sudden hearing loss were followed for at least one year. All were submitted to initial clinical evaluation, auditory tests, routine blood analysis, and magnetic resonance imaging. All received initial treatment with pentoxifylline and prednisone. RESULTS: 45% (n=18) presented normal auditory thresholds, 40% (n=16) showed some improvement in hearing, 15% (n=6) maintained initial hearing level. Nine cases (22.5%) presented clinical conditions possibly implicated in hearing loss (viral infection, immunomediated hearing loss, vascular disorders, and so on); three (7.5%) had cerebellopontine tumors. Evolution of hearing in these 12 cases with presumed etiology presented no differences from hearing in the 28 cases without any known etiological factor. Clinical treatment within the first seven days was the only statistically significantly different condition in patients who improved hearing. CONCLUSIONS: An objective search for etiological bases should be conducted in any case of acute sensorineural hearing loss. The presence of cerebellopontine tumors in 7.5% of cases of SD, among other treated causes, justifies a thorough clinical investigation in these patients. Overall good evolution of hearing was observed in 67.5% of cases of SD, regardless of its etiology. Therapy within the first seven days of SD was significantly related to better outcomes in hearing.

As doenças reumáticas produzem alterações sistêmicas e podem, por isso, comprometer os vasos sangüíneos, as serosas e as mucosas de todo o trato aerodigestivo. Casos esporádicos de acometimento laríngeo por doenças reumáticas têm sido descritos. Esse estudo tem por objetivo avaliar e descrever as alterações laríngeas encontradas em pacientes reumatológicos. FORMA DE ESTUDO: coorte transversal. MATERIAL E MÉTODO: Estudo transversal com pacientes portadores de lúpus eritematoso sistêmico, esclerodermia e doença mista do tecido conjuntivo. Os pacientes submeteram-se a exame clínico otorrinolaringológico e à videolaringoestroboscopia. RESULTADOS: Foram incluídos no estudo 27 pacientes sendo que 26 conseguiram realizar a videolaringoestroboscopia. Alterações laríngeas foram observadas em 11 dos 12 pacientes portadores de lúpus, nos 11 pacientes portadores de esclerodermia e nos 3 pacientes portadores de doença mista do tecido conjuntivo. Lesões sugestivas de nódulo em bambu foram identificados em 5 pacientes e 92,3% dos pacientes apresentaram sinais laríngeos de síndrome faringolaríngea do refluxo. CONCLUSÃO: Neste estudo identificamos 5 lesões sugestivas de nódulos em bambu e sinais laríngeos de refluxo em quase todos os pacientes.

Rheumatic diseases usually promote several systemic disorders, which can affect blood vessels, mucosa and serosa of the aerodigestive tract. Scarce laryngeal involvement has been described in these patients and this study aims at investigating laryngeal alterations found in patients with rheumatic diseases. STUDY DESIGN: transversal cohort. MATERIAL AND METHOD: A transversal study was developed with systemic lupus erythematous, systemic sclerosis and mixed connective tissue disease's patients. They were evaluated by means of clinical examinations and videolaryngoestroboscopy. RESULTS: Twenty-seven patients were included in the study, 26 succeeded in completing the videolaryngoestroboscopy. Laryngeal abnormalities were seen in 11 of 12 patients with lupus, in all 11 patients with sclerodermia and in 3 patients with mixed connective tissue disease. Vocal fold bamboo node was observed in 5 patients and 92.3% of all patients presented laryngeal signs of gastroesophageal reflux disease. CONCLUSION: We noticed 5 vocal fold bamboo nodes and gastroesophageal reflux disease in almost all patients.

A surdez súbita é um sintoma cuja etiologia nem sempre é elucidada mesmo dispondo-se de toda propedêutica atual. Neste estudo avaliaremos as alterações encontradas em ressonância magnética de pacientes portadores de surdez súbita. FORMA DE ESTUDO: coorte transversal. MATERIAL E MÉTODO: Estudo prospectivo com realização de RM em 49 dos 61 pacientes com surdez súbita atendidos no pronto socorro de Otorrinolaringologia do Hospital São Paulo, no período de abril de 2001 a maio de 2003. Doze pacientes abandonaram ou não foram submetidos à ressonância magnética por outros motivos. RESULTADOS: 23 (46,9%) pacientes apresentaram alterações à ressonância magnética. Foram encontrados dois tumores sugestivos de meningioma e três schwannomas do oitavo par craniano. Lesões subcorticais e periventriculares esparsas e hiperintensas em FLAIR foram encontradas em 13 pacientes. Cinco (21,7%) pacientes apresentaram alterações periféricas. CONCLUSÃO: A surdez súbita deve ser abordada como um sintoma comum a diferentes doenças. A presença de tumores do ângulo pontocerebelar em 10,2% dos nossos casos, entre outras causas tratáveis, justifica o uso da ressonância magnética com contraste tanto para o estudo do sistema auditivo periférico quanto para o estudo das vias auditivas centrais, incluindo o cérebro.

The etiology of sudden deafness can remain undetermined despite extensive investigation. This study addresses the value of magnetic resonance imaging in the analysis of sudden deafness patients. STUDY DESIGN: transversal cohort. MATERIAL AND METHOD: In a prospective study, 49 patients attended at otolaryngology emergency room of Federal University of Sao Paulo - Escola Paulista de Medicina, from April 2001 to May 2003, were submitted to magnetic resonance imaging. RESULTS: Magnetic Resonance abnormalities were seen in 23 (46.9%) patients and revealed two tumors suggestive of meningioma, three vestibular schwannomas, thirteen microangiopathic changes of the brain and five (21.7%) pathological conditions of the labyrinth. CONCLUSION: Sudden deafness should be approached as a symptom common to different diseases. The presence of cerebellopontine angle tumors in 10.2% of our cases, among other treatable causes, justifies the recommendation of gadolinium-enhanced magnetic resonance use, not only to study the auditory peripheral pathway, but to study the whole auditory pathway including the brain.

OBJETIVO: O objetivo deste trabalho é o de verificar a aplicabilidade do método imunohistoquímico na quantificação das diferentes formas das fibras elásticas em prega vocal humana. FORMA DE ESTUDO: coorte transversal. MATERIAL E MÉTODO: Foram seguidos os seguintes critérios de inclusão: idade entre 25 e 40 anos, gênero masculino, cor branca, morte causada por ferimento de arma de fogo, menos de doze horas de morte, ausência de intubação traqueal e de trauma na região cervical e que, por análise microscópica, não apresentassem qualquer alteração da mucosa das pregas vocais. Por estes critérios dez pregas vocais foram obtidas e selecionou-se, aleatoriamente, uma prega vocal que pertencia a um indivíduo de 28 anos. A prega vocal foi transversalmente seccionada em nove regiões e três cortes de cada fragmento foram utilizados para a realização das colorações Verhoeff e resorcina-fuchsina de Weighert e para a realização do estudo imunohistoquímico. Realizou-se quantificação colorimétrica das fibras elásticas. RESULTADO: As camadas intermediária e profunda da prega vocal apresentam valores muito superiores aos da camada superficial, nas colorações histológicas. A quantidade de tropoelastina identificada pelos anticorpos não apresentou grandes diferenças entre os valores da camada superficial e os da camada intermediária e profunda. CONCLUSÃO: A imunohistoquímica é uma técnica que identifica, em prega vocal humana, todas as formas de fibras elásticas e que também possibilita a realização de medidas objetivas.

AIM: Verify the use of immunohistochemistry as a method to measure all forms of elastic fibers at human vocal folds. STUDY DESIGN: transversal cohort. MATERIAL AND METHOD: We collected vocal folds following these criterion: age between 25 and 40, Caucasian men, dead by gun shot, within 12 hours of death, without instrumentation of the larynx or suspicion of neck injury and without mucosal lesions noted by microscopy. Ten vocal folds were collected and one, of a man aged 28 years, was selected to study. The vocal fold was transversely cut in 9 regions and in each segment three slides were made. These slides were stained by Verhoeff and Weighert's resorcin-fuchsin and used for immunohistochemistry. The elastic compound was measured by colorimetric software analysis. RESULTS: In Verhoeff and Weighert's resorcin-fuchsin, the intermediate and deep layer showed values higher than those of the superficial layer. The amount of tropoelastin identified by the antibody at the superficial layer was close to those of intermediate and deep layer. CONCLUSION: Immunohistochemistry is a method that can identify and measure all forms of elastic fibers at human vocal fold.