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Glioma Nasal é uma malformação congênita rara, benigna e diagnosticada habitualmente logo após o nascimento, que requer tratamento precoce para evitar deformidades faciais. São relatados três casos de pacientes com diagnóstico de Glioma Nasal em acompanhamento no Departamento de Otorrinolaringologia do Hospital das Clínicas da Faculdade de Medicina da USP, com descrição, para cada caso, dos exames subsidiários, do tratamento empregado e de sua evolução. O primeiro caso é do sexo feminino, que apresentava uma massa sólida que se exteriorizava pela fossa nasal esquerda. O segundo paciente era do sexo masculino e apresentava uma fenda palatina por onde se exteriorizava uma massa ocupando a cavidade oral. O terceiro paciente era do sexo masculino e apresentava uma tumoração em dorso nasal. Após a ressecção cirúrgica, todas as peças mostravam glioma nasal. Massas congênitas de Linha Média Nasal podem representar uma lesão de difícil diagnóstico antes do estudo histopatológico, porém não se deve poupar esforços para fazer o diagnóstico correto, proporcionando assim um prognóstico acurado e uma programação cirúrgica apropriada.Nasal glioma is a rare and benign congenital defect. This condition is diagnosed usually at birth time and requires early treatment to prevent facial deformations. We report three patients with nasal glioma that were diagnosed and treated at Otorhinolaryngology Department of Clinics Hospital of São Paulo University, and discuss clinical aspects, complementary exams, treatment and follow-up for each case. The first case was female, who presented a solid mass getting off left nasal fossae. The second case was male and presented cleft palate with a solid mass occupying the oral cavity. The third patient was male and had a solid mass over nasal pyramid. After surgical resection, all cases showed nasal glioma. Nasal congenital midline mass may be difficult to diagnose before histopathology, but is necessary to make an effort to do the correct diagnosis, letting an accuracy prognosis and appropriate surgical treatment.

Objetivo: O objetivo deste trabalho foi o de estudar o diagnóstico, etiologia, evolução e tratamento de pacientes com cistos ductais e saculares de laringe na Divisão de Clínica Otorrinolaringológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Forma de estudo: Clínico randomizado. Material e método: Procurou-se enfatizar a população em que são mais prevalentes, o quadro clínico, a terapêutica e seus resultados. Foram analisados 19 pacientes, mostrando que a apresentação inicial dos cistos pode consistir desde sintomas comuns ao otorrinolaringologista até obstrução respiratória grave. Conclusão: É necessário, portanto, o conhecimento do especialista acerca dessa patologia, no sentido de realizar o diagnóstico adequado e adotar a conduta que proporcione o melhor prognóstico ao seu paciente.Aim: In this study, the authors describe their experience on diagnosis, etiology, treatment and follow-up of patients with laryngeal cysts from the otolaryngology department of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Study design: Clinical randomized. Material and method: Trying to emphasize the incidence, the clinical presentation, treatment and results. Nineteen patients were analyzed, showing that the initial clinical presentation of these cysts can represent since a common complaint until severe respiratory obstruction. Conclusion: Therefore, it is necessary the knowledge about this pathology to diagnose properly and provide a better prognosis to the patient.

Introdução: Nas últimas décadas o índice de complicações neurológicas centrais e mortalidade após cirurgia da artéria carótida (tumor do corpo carotídeo e endarterectomia) diminuiu significativamente. A lesão de nervos cranianos continua pouco alterada e elevada, e a lesão do nervo hipoglosso é a mais freqüente. Objetivo: Estudar a relação entre o nervo hipoglosso e a bifurcação carotídea, determinando a distância entre estas estruturas, além de estudar a influência do sexo, idade, raça e comprimento do pescoço sobre esta medida. Forma de estudo: Experimental. Material e método: Foram realizadas 38 dissecções da artéria carótida em 38 cadáveres. Os cadáveres eram colocados em posição padrão (pescoço em extensão de 95º). Após identificação do nervo e da bifurcação carotídea, foi medida a distância entre as estruturas. O comprimento do pescoço foi medido do processo mastóide até a incisura jugular. Resultados: O nervo hipoglosso não foi encontrado abaixo da bifurcação, e a distância entre o nervo e a bifurcação variou de 0.5 a 4.3 cm (média = 2.1 cm, mediana = 2.0 cm, desvio padrão = 0.63 cm). Comprimento do pescoço, sexo, raça e idade não demonstraram significância estatística. Conclusão: Nesta amostra observamos grande variação anatômica entre o nervo hipoglosso e a bifurcação carotídea, e não houve correlação com comprimento do pescoço, sexo, raça e idade. Um melhor entendimento da anatomia do nervo hipoglosso e a sua variação em relação à bifurcação carotídea são importantes para prevenir lesão do nervo hipoglosso.Introduction: In the last decades the incidence of central nervous complications and death has decreased, especially in endarterectomy and carotid body tumor. Contrastingly, the incidence of cranial nerve following is a problem that remains high and little changed, and the hypoglossal nerve dysfunction is the most frequent. Aim: The aim of this study was to establish the anatomical relation between the carotid artery bifurcation and hypoglossal nerve. Study design: experimental. Material and method: Carotid artery and hypoglossal nerve dissections were carried out in 38 fresh corpses. All the individuals were placed in standard position and the dissections were performed with surgical technique. The measurements were done in centimeters and millimeters from the dissected carotid bifurcation to the XII nerve in the cervical area. Results: Twenty-six individuals were male and 12 female. The majority were whites, 30, and 8 were non-whites. The distance between hypoglossal nerve and carotid artery bifurcation ranged from 0.5 cm to 4.3 cm, with mean of 2.1 cm, median 2.0 cm and standard deviation of 0.63 cm. Neck length, age, gender and race were related with the measurements and failed to show significant statistic correlation (a > 0.05). Conclusion: In this sample there is a great anatomic variation of the distance between hypoglossal nerve and carotid artery bifurcation and there was no statistical difference concerning age, gender, race and neck length. A better understanding of the anatomic course of this nerve and its variation in relation to carotid artery bifurcation, are relevant to prevent hypoglossal nerve lesions in the carotid artery surgery.

The purpose of this article is to describe a case of an 8-month-old girl who was diagnosed with a melanotic neuroectodermal tumor and was submitted to a right hemimandibulectomy and immediate reconstruction with a fibular osteocutaneous free flap. At 12-year follow-up, the longest reported in a patient this young, the transferred bone had grown much like the native mandible, and the patient had adequate mandibular contour and function. No revisions were needed, although orthopedic surgery was performed to correct an ankle valgus deviation on the donor leg. It is the opinion of the authors that microsurgical mandible reconstruction in very young patients is efficient and that the surrounding structures contribute to the remodeling of the bone segment to achieve characteristics similar to those of the native mandible.

Measure the dimensions of the nasoseptal (NS) flap and the anterior skull base (ASB) defect. Verify whether the flap is sufficient to cover the defect. Study the anatomy of the septal artery (SA).Anatomical and radiological study.After endoscopic craniofacial resection, sufficiency of the flap to cover the ASB defect was assessed. The SA was dissected. The number of branches in the pedicle and the distance between the artery and the sphenoid ostium were noted. Radiologic study analyzing CT scans of 30 patients for comparison among measurements of the NS flap and the ASB defect was performed.In all cases the flap was sufficient to cover the ASB. Two branches of the SA were found in the pedicle in 71.4%. The distance between the SA and the sphenoid ostium was 9.3 mm. The reconstruction area of the flap (17.12 cm(2) ) was larger than the defect area (8.64 cm(2) ) (P.001). The difference between the superior length of the flap and the anterior-posterior distance of the defect was ≤ 5 mm in 26.7%. Comparison between the anterior flap width and the anterior defect width revealed that in 33% the difference was ≤ 5 mm.The dimensions of NS flap are sufficient to cover completely the ASB defect. The anterior edge of the defect presents increased risk for failure in coverage. Additional width adding the nasal floor mucosa to the flap is important to decrease the risk of gap in the anterior orbit-orbit defect. It is more common to find two branches of the SA in the pedicle.

The juvenile nasopharyngeal angiofibroma has a characteristic growth in all directions from its origin. However, the extensions of the tumor seem to be independent, each one with distinct behavior. The aim of this study is to analyze the preferential direction and routes of JNA growth, as well as its correlation with the patient's age. We analyzed 33 patients without any previous treatment, attempting to the extension and routes of tumor's growth (CT scan), and its correlation with the patient's age. The sphenopalatine foramen region was affected in all cases. From this point, a growth towards several routes with a different rhythm was noted, determining variable configurations to the tumor. The lateral and superior growths were the most frequent. The expansion into the pterygopalatine fossa was very frequent and could involve important anatomical structures, determining higher morbidity. Three sites were invaded through more than one route: pterygoid fossa, middle cranial fossa and maxillary sinus. There was no significant correlation between invasion route and patient's age. However, considering the age, there was a concomitance between tumor development and facial growth by "displacement". We discuss this condition, suggesting an explanation to the tumor invasion and expansion inside the pterygopalatine fossa.

A voz aguda em excesso pode constituir verdadeiro problema social e profissional, principalmente quando peculiar a indivíduos do sexo masculino. Suas causas, em geral, são orgânicas e/ou funcionais. A causa funcional mais freqüentemente encontrada é o distúrbio conhecido como falsete mutacional, cuja terapia de primeira escolha é a vocal. Entretanto, quando seus resultados não são satisfatórios, o tratamento cirúrgico é uma opção muito conveniente e eficaz. Apresentamos dois casos de pacientes do sexo masculino, de 34 e 35 anos de idade, com voz demasiadamente aguda, resistentes à fonoterapia, que foram tratados com sucesso pela tireoplastia tipo III de Isshiki. A técnica cirúrgica, assim como a história clínica e os achados vocais pré e pós-operatórios são apresentados com detalhes neste trabalho. Expomos e discutimos, também, dados pertinentes ao tema encontrados na literatura. Concluímos que a tireoplastia tipo III de Isshiki é um procedimento eficaz, simples e com baixo índice de complicações, que pode ser utilizado para reduzir o pitch vocal em casos selecionados. Este estudo demonstrou dados que podem subsidiar educadores da área médica quando da reformulação do currículo de ORL para o curso de graduação em medicina.High-pitched voice may cause social and professional embarrassment, particularly if it occurs in men. This disorder may be organic and/or functional. Mutational falsetto (puberphonia) is the most common functional cause and is primarily treated with phonotherapy. However, when results of this therapy are limited, surgery may turn to be a convenient and effective alternative to treat these patients. In this study, we present 2 male patients (34 and 35 years old) with high-pitched voices, who failed phonotherapy and who were successfully treated with Isshiki type III thyroplasty. Medical history of the patients, surgical techniques, pre and post-operative laringostroboscopies and outcomes are presented in detail. We conclude that Isshiki type III thyroplasty is an efficient, simple to perform and low-risk procedure that may be used in selected patients with high-pitched voice.