Brazilian Journal of Otorhinolaryngology最新文献_第10页

Comparative analysis between the gold standard titration method and a mathematical formula to predict CPAP pressure 金标准滴定法与数学公式预测CPAP压力的比较分析

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-05-29 DOI: 10.1016/j.bjorl.2025.101656

Cíntia Felicio Adriano Rosa, Adriane Iurck Zonato, Ordival Augusto Rosa

Objective

One lower-cost alternative to either manual or APAP titration is predicting therapeutic pressure by using mathematical formulas. This study aimed to determine whether the Miljeteig and Hoffstein predictor formula was equivalent to the pressure established by manual titration in a sleep laboratory in patients using nasal or pillow masks.

Methods

The authors analyzed all CPAP titration polysomnography studies in adult patients for three consecutive months (May 20th to August 19th, 2018) in a sleep-disorders clinic. CPAP pressures were manually titrated over the night. Anthropometric data (age, sex, Body Mass Index [BMI], Neck [NC] and waist circumference) and polysomnographic data were documented. We tested Miljeteig and Hoffstein model formula-predicted CPAP (Hpred) accuracy in our patients, comparing formula results to our manual titration; Hpred = (0.16 BMI) + (0.13 NC) + (0.04 AHI) - 5.12.

Results

Nasal masks were used in 55% of our patients (n = 86) and pillow masks in 45% (n = 71). There was no difference between groups for age, body mass index, neck circumference, waist circumference, gender, baseline apnea-hypopnea index, CPAP pressure and residual AHI during titration polysomnography. The mean difference obtained between CPAP pressure and Hpred formula was 2.4 cm H₂O. The CPAP pressure means during titration was 2.4 cm H₂O higher than pressure obtained by a formula for pillow group and 2.3 for the nasal group.

Conclusions

In most patients, formula underestimated the CPAP pressure obtained during titration for both nasal and pillow masks. Even though the pressure is underestimated, this approach could help to define minimum and maximum titration pressure using APAP in patients with OSA until the optimal pressure can be determined in the sleep laboratory if necessary.

Level of evidence

Level 3.

目的利用数学公式预测治疗压力是人工或APAP滴定的一种低成本替代方法。本研究旨在确定Miljeteig和Hoffstein预测公式是否等同于在睡眠实验室中使用鼻罩或枕罩的患者通过手动滴定确定的压力。方法分析某睡眠障碍门诊连续3个月（2018年5月20日至8月19日）成人患者的所有CPAP滴定多导睡眠图研究。夜间手动滴定CPAP压力。记录了人体测量数据（年龄、性别、身体质量指数（BMI）、颈部（NC）和腰围）和多导睡眠图数据。我们在患者中测试了Miljeteig和Hoffstein模型公式预测CPAP （Hpred）的准确性，并将公式结果与我们的手动滴定进行比较；Hpred = (0.16 BMI) + (0.13 NC) + (0.04 AHI) - 5.12。结果86例（55%）患者使用鼻口罩，71例（45%）患者使用枕头口罩。各组间年龄、体重指数、颈围、腰围、性别、基线呼吸暂停低通气指数、CPAP压和滴定多导睡眠图时残留AHI均无差异。CPAP压力与Hpred公式的平均差值为2.4 cm H2O。滴定时CPAP压力均值比按公式计算的压力高2.4 cm H2O，枕头组高2.3 cm H2O。结论在大多数患者中，处方均低估了鼻罩和枕罩滴定时获得的CPAP压力。尽管压力被低估了，但这种方法可以帮助确定OSA患者使用APAP滴定的最小和最大压力，直到必要时在睡眠实验室确定最佳压力。证据等级：3级。

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引用次数: 0

Time heals. A study of thyroidectomy scars 时间会治愈。甲状腺切除术后瘢痕的研究

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-05-29 DOI: 10.1016/j.bjorl.2025.101641

Vergilius José Furtado de Araujo Filho, Vergilius José Furtado de Araujo-Neto, Leandro Luongo de Matos

Objective

To evaluate the quality of the thyroidectomy scars over a long period of time.

Methods

Over a period of two years the quality of the thyroidectomy scars among 283 consecutive patients was registered during their follow-up for malignancies. On a scale of 0 (excellent) to 3 (bad) thyroidectomy scars were classified according to the time after surgery.

Results

After 5 years or more 95% of the scars were classified as excellent or very good; 55% of them were excellent, which indicates that the scar was virtually invisible at a distance of 1.5 meters. Only 5% of the cases had a regular or bad scar after 5-years or more, and only one patient (0.5%) had a bad scar.

Conclusion

The scars remaining after thyroid surgery had an improved appearance with time, and the vast majority of patients had an excellent or very good scar after a period of five years or more.

Level of evidence

Level III.

目的评价甲状腺切除术后长期瘢痕的质量。方法对283例恶性肿瘤患者进行为期2年的随访，记录其甲状腺切除术瘢痕质量。根据术后时间将甲状腺切除术瘢痕分为0（优）~ 3（坏）级。结果术后5年及以上95%的瘢痕评分为优或极好；其中55%是优秀的，这表明在1.5米的距离上疤痕几乎是看不见的。只有5%的病例在5年或更长时间后有常规或严重的疤痕，只有1例（0.5%）有严重的疤痕。结论甲状腺术后瘢痕外观随时间的推移而改善，绝大多数患者术后5年及以上瘢痕为优或极好。证据等级：III级。

引用次数: 0

Does the diameter of the thoracic inlet influence the formation of retrosternal goiter? 胸椎入口的直径是否影响胸骨后甲状腺肿的形成？

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-05-29 DOI: 10.1016/j.bjorl.2025.101597

Leonardo Daniel Manzano Pasquel , Daniel Abreu Rocha , Yasmin Laryssa Moura Guimaraes , Gustavo Fernandes de Alvarenga , Mauricio Kase , Júlia Scomparin Magalhãnes , Regina Lúcia Elia Gomes , Ledo Mazzei Massoni Neto , Renata Lorencetti Mahmoud , Leandro Luongo de Matos , Vergilius José Furtado de Araujo Filho , Claudio Roberto Cernea

Objective

Find an association between diameter of the Thoracic Inlet (TI) and RSG to determine whether the TI would function as a natural anatomical barrier to prevent the passage of the goiters to the thoracic cavity.

Methods

A retrospective study was conducted with patients submitted to total thyroidectomy, with goiter greater than 50 cm³, who underwent Computed Tomography (CT) preoperatively to measure the TI volume. The values obtained from each continuous variable of parametric distribution were organized and described as mean and standard deviation. The distributions were defined as non-parametric by the Kolmogorov-Smirnov test. The Mann-Whitney test was used to compare two sample populations.

Results

A total of 173 patients submitted to total thyroidectomy were evaluated, and 54 patients met the inclusion criteria of the study. 85.2% were female, with a mean age of 57-years. The mean diameter of the TI was 5679 mm². 42% of the patients presented some degree of RSG. The distance below the TI ranged from 0.2 to 5 cm.

Conclusion

No significant association was found between diameter of the thoracic inlet and retrosternal goiter, demonstrating that RSG can be present regardless of the TI diameter. Statistically significant association was observed between patients with larger thyroid volume and the likelihood of this tissue to extend to the thoracic cavity.

Level of evidence

Level IV.

目的探讨胸入口（TI）直径与RSG之间的关系，以确定TI是否能作为天然的解剖屏障，阻止甲状腺肿物进入胸腔。方法回顾性研究行甲状腺全切除术且甲状腺肿大大于50 cm3的患者，术前行CT测量TI体积。从参数分布的每个连续变量得到的值被组织并描述为平均值和标准差。通过Kolmogorov-Smirnov检验将分布定义为非参数分布。曼-惠特尼检验用于比较两个样本群体。结果173例患者接受甲状腺全切除术，54例患者符合纳入标准。85.2%为女性，平均年龄57岁。TI的平均直径为5679 mm2。42%的患者出现不同程度的RSG。TI下方的距离为0.2 ~ 5cm。结论胸廓入口直径与胸廓后甲状腺肿无显著相关性，提示胸廓入口直径与胸廓后甲状腺肿无关。在甲状腺体积较大的患者与该组织延伸到胸腔的可能性之间观察到统计学上显著的关联。证据等级：四级。

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引用次数: 0

Epithelial-myoepithelial carcinoma: Retrospective analysis of the case series from a reference center in São Paulo, Brazil 上皮-肌上皮癌：来自巴西圣保罗一家参考中心的病例系列回顾性分析

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-05-29 DOI: 10.1016/j.bjorl.2025.101615

Gabriela Miglioranza Gonçalves Luccas , Kim Soares Marinho , Lara Caroline Cardoso , Maria Paula Spegiorin de Oliveira , Renato Nobutaka Gotoda , Dorival de Carlucci Junior , Luiz Paulo Kowalski

Objective

Given the recent increase in diagnoses in our service, a referral center in São Paulo, this study aims to analyze the case series at this center and compare it with the existing literature. The objective is to comprehend the characteristics and prognosis of this disease and provide insights to enhance its treatment.

Methods

Confirmed cases of EMC were selected at the Hospital das Clínicas da FMUSP between 2011 and 2021. Fourteen cases were screened and subjected to retrospective analysis of medical records for data collection.

Results

The analysis covered patient and disease characteristics. Of the total, 64.3% were female, with an average age of 71.33 years. The parotid gland was the predominant primary site (92.8%). Concerning staging, there was a significant prevalence in stages III and IVa. Among the cases, 12 underwent surgery, and eight patients received adjuvant therapy.

Conclusion

Despite EMC being a low-grade neoplasm, our case series, while aligning with much of the existing literature, revealed a more advanced presentation. This raises questions about whether this aggressiveness is due to late diagnosis or whether the neoplasm is less indolent than presumed.

Level of evidence

Level IV.

目的考虑到最近在我们圣保罗转诊中心的诊断增加，本研究旨在分析该中心的病例系列，并与现有文献进行比较。目的是了解这种疾病的特点和预后，并提供见解，以加强其治疗。方法选择2011 - 2021年在医院（Clínicas da FMUSP）确诊的EMC病例。筛选了14例病例，并对病历进行回顾性分析以收集数据。结果分析涵盖了患者和疾病特征。其中女性占64.3%，平均年龄为71.33岁。腮腺为主要原发部位（92.8%）。关于分期，在III期和IVa期有显著的流行。其中12例接受手术治疗，8例接受辅助治疗。结论：尽管EMC是一种低级别肿瘤，但我们的病例系列与大多数现有文献一致，揭示了一种更高级的表现。这就提出了这样的问题：这种侵袭性是由于晚期诊断还是肿瘤不像想象的那么惰性。证据等级：四级。

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引用次数: 0

Bedside conventional tracheostomy 床边常规气管切开术

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-05-29 DOI: 10.1016/j.bjorl.2025.101602

Giancarlo Artese Araujo, Antonio Augusto Tupinambá Bertelli, Helvécio de Resende Urbano Neto, Marianne Yumi Nakai , Caroline Schmiele Namur, Marcelo Benedito Menezes, Antonio José Gonçalves

Objective

To describe the open experience of Head and Neck Surgery division of Santa Casa in São Paulo with bedside tracheostomy.

Methods

A retrospective study of database tracheostomies was performed between 2013 and 2016. Then, age, gender, and main complications were analyzed.

Results

Analysis of 598 patients shows 9 cases (1.50%) of complications, bleeding was the cause in 6 cases (1.0%), 1 postoperative death (0.16%), 1 accidental decannulation case (0.16%) and 1 lesion in the posterior wall of the trachea (0.16%). It is possible to accomplish bedside open tracheostomy with safety.

Level of evidence

Level IV.

目的总结圣保罗市圣卡萨医院头颈外科床边气管切开术的开放性经验。方法回顾性分析2013 - 2016年数据库气管切开术病例。分析患者的年龄、性别及主要并发症。结果分析598例患者，并发症9例（1.50%），出血6例（1.0%），术后死亡1例（0.16%），意外脱管1例（0.16%），气管后壁病变1例（0.16%）。床边开放气管切开术是可以安全完成的。证据等级：四级。

引用次数: 0

Ansa cervicalis or ansa hypoglossi? A systematic review 颈袢还是舌下袢？系统回顾

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-05-29 DOI: 10.1016/j.bjorl.2025.101604

Gustavo Henrique Pereira Boog , Flávio Carneiro Hojaij , Matheus Mychael Mazzaro Conchy , Renan da Silva Bentes , Flávia Emi Akamatsu , Alfredo Luiz Jácomo

Objective

To conduct a literature review on the relationship between the ansa cervicalis (or ansa hypoglossi) and the hypoglossal nerve, discussing this disparity in terminology, and determine which of these terms is the most suitable to identify this important nerve structure.

Methods

This is a systematic review of the literature based on studies found through a standardized search performed at the LILACS and MEDLINE/PUBMED databases; classic anatomy textbooks were also consulted.

Results

Forty-five of the 3731 articles found in the scientific research databases were selected and six classic anatomy textbooks were included in the study. Controversies involving the ansa cervicalis were analyzed and the results clearly showed that most textbooks describe its relationship with the hypoglossal nerve as a temporal junction, with no exchange of nerve fibers. The ansa cervicalis contains fibers arising from the cervical cord, and not from the hypoglossal nerve.

Conclusion

The term ansa cervicalis should be chosen to name this loop of nerves. The term ansa hypoglossi is not structurally correct, and should be abandoned in medical practice, the teaching of anatomy, and in scientific publications.

Level of evidence

Level II.

目的对颈袢（或舌下袢）与舌下神经之间的关系进行文献综述，讨论这种术语上的差异，并确定哪些术语最适合用于识别这一重要的神经结构。方法：这是一个系统的文献综述，基于在LILACS和MEDLINE/PUBMED数据库中进行的标准化搜索中发现的研究；他们还查阅了经典的解剖学教科书。结果从科研数据库中检索到的3731篇文献中筛选出45篇，并纳入6本经典解剖学教材。对有关颈ansa的争议进行了分析，结果清楚地表明，大多数教科书将其与舌下神经的关系描述为颞连接，而没有神经纤维的交换。颈袢包含来自颈髓的纤维，而不是来自舌下神经。结论应选用“颈袢”一词来命名该神经袢。“舌下ansa”一词在结构上是不正确的，应该在医学实践、解剖学教学和科学出版物中放弃使用。证据等级：II级。

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引用次数: 0

Metastatic basal cell carcinoma: Case series and literature review 转移性基底细胞癌：病例系列及文献回顾

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-05-28 DOI: 10.1016/j.bjorl.2025.101619

Mariana Gonçalves Rodrigues , Aline Vieira de Lucena , Gabriela Alves Domingues , Caroline Marques de Aquino , Deborah Yukiko Otto , André Bandiera de Oliveira Santos , Luiz Paulo Kowalski

Objective

To present a metastatic head and neck basal cell carcinoma (BCC) series treated by a university teaching service between 1993 and 2021.

Methods

A review of medical records of 500 patients with high-risk BCC in the head and neck was performed. Tumors with a diameter greater than or equal to 6 mm in the “H” area of the face or greater than 10 mm in other head and neck areas; recurrences; sclerodermiform, micronodular and metatypical subtypes; and perineural invasion were considered factors indicating high-risk.

Results

Seven cases of metastatic head and neck BCC were diagnosed. The mean age at diagnosis of the primary tumor was 49.8 years, and the median time between the diagnosis of the primary tumor and that of metastases was 3 years (ranging from 1 to 20 years). The main site of metastasis was the lymph nodes. The main modalities of metastases treatment were surgery and radiotherapy.

Conclusion

BCC metastasis is a rare manifestation of a frequent disease. Post-treatment follow-up should include routine clinical examination of the neck for all patients and imaging for the diagnosis of metastases in symptomatic patients.

Level of evidence

Level IV.

目的介绍1993年至2021年间某大学教学部门治疗的一例转移性头颈部基底细胞癌（BCC）。方法回顾性分析500例头颈部高危基底细胞癌患者的临床资料。面部“H”区直径大于或等于6mm或头颈部其他区域直径大于10mm的肿瘤；复发;硬皮型、微结节型和超非典型亚型；神经周围侵犯被认为是高危因素。结果本组共确诊头颈部转移性基底细胞癌7例。原发肿瘤诊断的平均年龄为49.8岁，从原发肿瘤诊断到转移的中位时间为3年（1 ~ 20岁）。转移部位以淋巴结为主。转移治疗的主要方式是手术和放疗。结论乳腺癌转移是一种罕见的常见病。治疗后随访应包括对所有患者进行颈部常规临床检查，对有症状的患者进行影像学检查以诊断转移。证据等级：四级。

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引用次数: 0

Accuracy of ultrasound performed by medical residents in operating rooms in identifying parathyroid glands in patients with hyperparathyroidism 住院医师在手术室超声诊断甲状旁腺功能亢进患者甲状旁腺的准确性

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-05-28 DOI: 10.1016/j.bjorl.2025.101607

Regison Rafael Dias Silva , Giovanni Simões de Medeiros , Murilo Catafesta das Neves

Objective

To describe the findings of US examinations performed by Head and Neck Surgery (HNS) resident physicians in patients in the preoperative period immediately before parathyroidectomy, and to compare these results with those of examinations performed preoperatively (ultrasonography and/ or scintigraphy) and with the findings of surgical procedures.

Methods

Patients in the preoperative period of parathyroidectomy underwent US examinations performed by HNS resident physicians after induction of anesthesia. The findings were registered and later compared with those of preoperative and intraoperative examinations using descriptive statistical analysis and calculation of sensitivity, specificity, and accuracy.

Results

At least one gland was identified in 81% of the patients, most commonly the left inferior parathyroid. There was 63% agreement between the examinations performed in the operating room and the preoperative examinations. Sensitivity of 76%, specificity of 100%, and accuracy of 81.25% were evidenced in identifying parathyroids > 5 mm in patients with hyperparathyroidism associated with Chronic Kidney Disease (CKD), and sensitivity of 33% was found in patients with primary hyperparathyroidism.

Conclusion

US examinations performed by HNS resident physicians in patients preoperatively to parathyroidectomy are accurate (81.25%) in identifying parathyroids compared with intraoperative findings in patients with hyperparathyroidism associated with CKD.

Level of evidence

Level III.

目的描述头颈外科（HNS）住院医师在甲状旁腺切除术前对患者进行的术前超声检查的结果，并将这些结果与术前检查（超声和/或显像）和手术结果进行比较。方法术前甲状旁腺切除术患者在麻醉诱导后由HNS住院医师进行US检查。将结果记录下来，然后与术前和术中检查的结果进行描述性统计分析和敏感性、特异性和准确性的计算。结果81%的患者至少检出一个腺体，最常见的是左下甲状旁腺。手术室检查与术前检查的一致性为63%。诊断甲状旁腺的敏感性为76%，特异性为100%，准确性为81.25%；慢性肾脏疾病（CKD）相关甲状旁腺功能亢进症患者的5 mm，原发性甲状旁腺功能亢进症患者的敏感性为33%。结论与CKD相关甲状旁腺功能亢患者术中发现相比，HNS住院医师术前对甲状旁腺进行的us检查准确（81.25%）。证据等级：III级。

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引用次数: 0

Thyroid cancer surgical indication during pregnancy: Systematic literature review and series of illustrative cases 妊娠期甲状腺癌手术指征：系统的文献回顾和一系列说明性病例

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-05-28 DOI: 10.1016/j.bjorl.2025.101643

Lucas Albuquerque Chinelatto, Flávio Carneiro Hojaij , Dorival de Carlucci Jr., Claudio Roberto Cernea

Objective

To evaluate and discuss timing possibilities for surgical treatment in thyroid cancer in pregnant women.

Methods

Systematic literature review based on online search at the Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and National Center for Biotechnology Information (NCBI) databases. Retrospective analysis of thyroidectomies performed in the second trimester of pregnancy by the authors between 1999 and 2019.

Results

The systematic review included nine articles. Their conclusions diverge with respect to the optimal timing of thyroid surgery. The medical literature considers thyroidectomy after safe delivery. The most recent studies are more flexible regarding carrying out this surgery during the second trimester of pregnancy. In the authors’ experience (n = 5), surgical treatment during the second trimester of pregnancy is a good option for more aggressive tumors.

Conclusion

More aggressive cases of thyroid papillary carcinoma can be treated with surgery during the second trimester of pregnancy. Performing the surgery after delivery is safer in the case of less aggressive cancer cases. The decision should consider hospital costs, surgery risks, and patient anxiety in relation to cancer.

Level of evidence

Level II.

目的探讨孕妇甲状腺癌手术治疗时机的可行性。方法基于联机检索拉丁美洲和加勒比文献Ciências da Saúde （LILACS）和美国国家生物技术信息中心（NCBI）数据库进行系统文献综述。回顾性分析1999年至2019年作者在妊娠中期进行的甲状腺切除术。结果系统评价纳入9篇文献。关于甲状腺手术的最佳时机，他们的结论存在分歧。医学文献认为安全分娩后应行甲状腺切除术。最近的研究对于在妊娠中期进行这种手术更为灵活。根据作者的经验（n = 5），对于更具侵袭性的肿瘤，在妊娠中期进行手术治疗是一个很好的选择。结论侵袭性甲状腺乳头状癌在妊娠中期可行手术治疗。在癌症侵袭性较弱的情况下，分娩后进行手术更安全。该决定应考虑到医院费用、手术风险以及与癌症相关的患者焦虑。证据等级：II级。

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引用次数: 0

Laryngostroboscopy and voice evaluation in adult patients with Parkinson’s disease 成年帕金森病患者的频闪喉镜检查和声音评价

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Brazilian Journal of Otorhinolaryngology

Pub Date : 2025-05-27 DOI: 10.1016/j.bjorl.2025.101620

Andréa de Carvalho Anacleto Ferrari Castro, Rogério Aparecido Dedivitis, Débora dos Santos Queija, Mario Augusto Ferrari de Castro, Juliana Godoy Portas, Alessandra Sampaio Ferreira

Objective

To evaluate the laryngeal manifestations of PD.

Methods

Evaluation of 18 PD patients conducted between January 2011 and December 2012. Patients were evaluated through videolaryngostroboscopy, auditory perceptual analysis of the voice using the GIRBAS scale, acoustic voice analysis, and application of the Vocal Handicap Index (VHI) questionnaire.

Results

Dysphonia and vocal fatigue were referred by 72.22% and 33.3% of the patients, respectively, whereas changes during laryngoscopy were verified in 94.44%. The medians of the acoustic voice analysis and the VHI self-assessment questionnaire were unchanged. The median of the VHI emotional domain was higher among patients who presented open phase closure, with statistically significant difference (p = 0.029).

Conclusion

Patients with PD present laryngeal and voice changes.

Level of evidence

Level IV.

目的探讨PD的喉部表现。方法对2011年1月至2012年12月18例PD患者进行评估。通过视频喉频检查、使用GIRBAS量表对声音进行听觉感知分析、声学声音分析和使用语音障碍指数（VHI）问卷对患者进行评估。结果72.22%和33.3%的患者报诊为发声困难和声带疲劳，94.44%的患者报诊为喉镜检查。声学语音分析和VHI自我评估问卷的中位数不变。开放期闭合患者的VHI情绪域中位数较高，差异有统计学意义（p = 0.029）。结论PD患者存在喉部和声音的改变。证据等级：四级。

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引用次数: 0