ABSTRACT Objective: The objective of this study was to evaluate the oral health condition and dental treatments performed in patients in pre-allogeneic HCT. Method: The records of patients treated during 2018 at a Brazilian HCT service were reviewed. The following oral health data were obtained: 1. Decayed, missing and filled teeth / correlated index for primary dentition (DMFT/dmft); 2. Quality of oral hygiene and 3. Dental pathologies: 3.1 Periodontal infectious focus, 3.2 Endodontic infectious focus and 3.3 Carie incidence. All dental procedures performed were surveyed. Results: Thirty-three patients were included, with a mean age of 28.42 (±16.37), 20 male (60%) and 13 female. The average DMFT/dmft found in this study was 10.24 (± 8.37), similar to the index found in the population in southeastern Brazil. The younger study population presented a DMFT/dmft considered high, when compared to the general population. A total of 27.2% of the patients had active caries lesions, 33.3%, foci of periodontal infection, 15.1%, endodontic infectious focus and 40%, poor oral hygiene. Almost half of the patients (48.4%) had to undergo dental intervention, 24.2% needing periodontal scaling, 21.2%, fillings and 12.1%, tooth extractions. Conclusion: We conclude that the studied population had an important incidence of dental pathologies and infectious conditions that could complicate throughout HCT, especially in younger patients, therefore presenting a high demand for dental treatment in the pre-HCT. Studies that assess the impact of dental conditioning on the outcomes of HCT with an emphasis on dental infectious complications, days of hospitalization and survival are necessary.”

Abstract Introduction Epidemiological studies focused on prognostic factors associated with laryngeal cancer in the Brazilian population are poorly reported in the literature. Objective To evaluate the influence of certain risk factors on the survival rates of patients with squamous cell carcinoma (SCC) of the larynx. Methods This retrospective study was conducted on adult patients who were admitted to the outpatient clinic of the head and neck department in a tertiary care hospital. Evaluation of the influence of risk factors on the survival rates of patients registered in the hospital with laryngeal SCC was performed based on age, sex, initial stage, time of evolution, habits, educational levels and relapse and death. Overall survival (OS), disease-free survival (DFS) and clinical-demographic data were analyzed using the Kaplan-Meier method, Log-rank test and Cox regression. Results A total of 107 patients with a mean age of 59.8 years (range 19-81) were included in this study. Stages III and IV were associated with decreased DFS (p = 0.02) and OS (p = 0.02). Smoking patients had a greater period of disease evolution than non-smoking patients (p = 0.003). Alcohol consumption in smokers increased the risk of death by 2.8 (p = 0.002) compared with non-drinking smokers. Male patients presented lower DFS average when compared with female patients (p = 0.04). Conclusion Our study confirms that male gender, smoking habit combined with alcohol consumption, and advanced stages were strongly associated with poor prognosis.

Resumo Objetivo: Examinar o potencial das imagens de contraste dinâmico (DCE-MRI) e difusão (DW-MRI) em ressonância magnética na detecção de linfonodos cervicais malignos. Materiais e Métodos: Foram realizadas DCE-MRI e DW-MRI em 33 linfonodos cervicais. Os valores de realce relativo máximo, realce relativo, tempo de pico, taxa de realce e lavagem, brevidade do realce e área sob a curva foram avaliados pela análise semiquantitativa (DCE-MRI). Os coeficientes de difusão aparente na DW-MRI foram obtidos na área de interesse. Foram excluídas partes císticas ou necróticas dos nódulos. Todos os pacientes foram submetidos a dissecção cervical ou a biópsia. Os resultados de imagem foram correlacionados com os achados patológicos. Nenhum paciente foi submetido a tratamento neoadjuvante antes da dissecção do pescoço. Resultados: Realce relativo, realce relativo máximo e taxa de realce aumentaram nos nódulos malignos (p < 0,009, p < 0,05 e p < 0,03, respectivamente). O tempo de pico foi reduzido nos nódulos malignos (p < 0,02). A análise multivariada identificou tempo de pico (sensibilidade, 73,7%; especificidade, 69,2%) e realce relativo (sensibilidade, 89,2%; especificidade, 69,2%) como variáveis capazes de distinguir os nódulos benignos e malignos. Conclusão: Embora o DCE-MRI possa diferenciar os nódulos benignos e malignos, ainda não há consenso sobre a técnica de análise semiquantitativa, em razão de dificuldade de aplicação clínica. Valores baixos do coeficiente de difusão aparente podem predizer nódulo metastático, mas devem-se considerar também resultados falso-positivos, provavelmente secundários ao processo inflamatório.

Abstract Objective: To examine the potential of two magnetic resonance imaging (MRI) techniques-dynamic contrast enhancement (DCE) and diffusion-weighted imaging (DWI)-for the detection of malignant cervical lymph nodes. Materials and Methods: Using DCE and DWI, we evaluated 33 cervical lymph nodes. For the DCE technique, the maximum relative enhancement, relative enhancement, time to peak enhancement, wash-in rate, wash-out rate, brevity of enhancement, and area under the curve were calculated from a semi-quantitative analysis. For the DWI technique, apparent diffusion coefficients (ADCs) were acquired in the region of interest of each lymph node. Cystic or necrotic parts were excluded. All patients underwent neck dissection or node biopsy. Imaging results were correlated with the histopathological findings. None of the patients underwent neoadjuvant treatment before neck dissection. Results: Relative enhancement, maximum relative enhancement, and the wash-in rate were significantly higher in malignant lymph nodes than in benign lymph nodes (p < 0.009; p < 0.05; and p < 0.03, respectively). The time to peak enhancement was significantly shorter in the malignant lymph nodes (p < 0.02). In the multivariate analysis, the variables identified as being the most capable of distinguishing between benign and malignant lymph nodes were time to peak enhancement (sensitivity, 73.7%; specificity, 69.2%) and relative enhancement (sensitivity, 89.2%; specificity, 69.2%). Conclusion: Although DCE was able to differentiate between benign and malignant lymph nodes, there is still no consensus regarding the use of a semi-quantitative analysis, which is difficult to apply in a clinical setting. Low ADCs can predict metastatic disease, although inflammatory processes might lead to false-positive results.

RESUMO CONTEXTO: Disfagia é uma queixa presente em 32% dos pacientes com laringite. OBJETIVO: O objetivo desta investigação foi avaliar o trânsito oral e faríngeo de pacientes com laringite, com a hipótese de que a alteração no trânsito do bolo pela boca e faringe pode estar envolvida com a queixa de disfagia. MÉTODOS: A avaliação videofluoroscópica da deglutição de bolos líquido, pastoso e sólido foi realizada em 21 pacientes com laringite, 10 deles com disfagia e 21 voluntários normais da mesma idade e sexo. Duas deglutições de 5 mL de bolo líquido, duas deglutições de bolo pastoso e duas deglutições de bolo sólido foram avaliadas em sequência casual definida por sorteio. Bolo líquido foi sulfato de bário 100%, e o bolo pastoso foi preparado com 50 mL de bário líquido e 4 g de espessante alimentar (amido e maltodextrina). O bolo sólido foi 2,2 g de uma bolacha macia embebida em bário líquido. A duração da preparação oral, trânsito oral, trânsito faríngeo, depuração da faringe, abertura do esfíncter superior do esôfago, movimento do hióide e do trânsito oral-faríngeo foram medidas. Precedendo a videofluoroscopia todos pacientes realizaram exame de pHmetria de 24 horas. RESULTADOS: O registro do pH intraesofágico distal revelou resultado anormal em 10 pacientes. Pacientes com laringite apresentaram maior duração da preparação oral para bolo pastoso e um tempo de trânsito oral mais rápido para bolo sólido. Os pacientes com laringite e disfagia tiveram uma preparação oral mais longa para bolo pastoso e sólido e tempo de trânsito oral menor com bolos líquido, pastoso e sólido. CONCLUSÃO: Preparação oral mais longa para bolos pastoso e sólido e trânsito mais rápido através da boca são situações associadas com a presença de disfagia em pacientes com laringite.

ABSTRACT BACKGROUND: Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

OBJETIVO: Avaliar o comportamento da função fonatória e a sensação de esforço de mulheres jovens, antes e após uma prova de uso prolongado da voz, pelo período de uma hora contínua.MÉTODOS: Participaram 20 mulheres jovens, sem alterações laríngeas, submetidas à analise acústica vocal (MDVP-Advanced, CSL- Kay Pentax(r)), avaliação perceptivo-auditiva da voz, realizada por cinco juízes, e mensuração do nível de esforço fonatório utilizando uma escala visual analógica, antes e após o uso prolongado da voz, a partir da leitura de um texto padronizado por uma hora, em intensidade e frequência vocal habitual, sem pausas para hidratação ou repouso vocal. Foram realizadas a descrição e comparação entre as variáveis e aplicado o tratamento estatístico apropriado.RESULTADOS: Os parâmetros acústicos de frequência fundamental (f0) e de frequência grave da emissão (Flo) aumentaram após uma hora de uso da voz, enquanto as medidas de intensidade do tremor (Atri), da variação da amplitude (vAm), a relação harmônico-ruído (NHR) e a taxa de fonação suave (SPI) diminuíram após a prova de uso prolongado de voz. Os juízes concordaram com a diminuição do grau geral da disfonia (kappa=0,66), da rugosidade (kappa=0,59) e soprosidade vocal (kappa=0,73); o aumento da estabilidade fonatória (kappa=0,64); a projeção vocal (kappa=0,48); o pitch (kappa=0,74) e o loudness (kappa=0,65). O esforço fonatório aumentou significativamente após a prova (p=0,003).CONCLUSÃO: Uma hora de uso prolongado da voz parece favorecer uma adaptação laríngea e aumento da atividade da musculatura adutora para manter a eficiência vocal. Entretanto, a auto percepção do esforço fonatório fica evidente e pode ser compreendido como sinal de fadiga da musculatura ocasionada pelo uso contínuo.

OBJECTIVES: To evaluate the behavior of the phonatory function and the perceived strain in Brazilian young women, before and after a test of prolonged voice use test, for a period of one continuous hour.METHODS: Twenty young women without laryngeal disorders participated in the study and were submitted to vocal acoustic analysis (MDVP-Advanced, CSL-Kay Pentax(r)), perceptual voice assessment, carried out by five judges, and the measurement of speech-strain level using a visual analog scale before and after a prolonged use of the voice, from the reading of a standardized text for one hour in usual vocal intensity and frequency, without breaks for hydration or vocal rest. The description and comparison between the variables and the appropriate statistical analysis were carried out.RESULTS: The acoustic parameters of fundamental (f0) and low frequency (Flo) of the emission increased after 1 hour of voice use, while the values for the amplitude tremor intensity index (Atri), amplitude variation (vAm), noise-to-harmonic ratio (NHR), and soft phonation index (SPI) were reduced after the prolonged voice use test. The judges agreed with the decrease in the overall level of dysphonia (kappa=0.66), roughness (kappa=0.59), and vocal breathiness (kappa=0.73); increased phonatory stability (kappa=0.64); vocal projection (kappa=0.48); pitch (kappa=0.74); and loudness (kappa=0.65). The phonatory strain increased significantly after the test (p=0.003).CONCLUSION: One hour of prolonged voice use seems to favor laryngeal adaptation and increased adductor muscle activity to maintain vocal efficiency. However, the self-perception of vocal strain is evident and can be understood as a sign of muscle fatigue caused by continuous use.

Patients with bisphosphonate-related osteonecrosis of the jaws (BRONJ) who received intravenous or oral bisphosphonates (BP) were selected for determination of their bone microarchitecture as a risk predictor of BRONJ development. The diagnosis of BRONJ was made based on clinical and radiographic findings. The control group consisted of healthy patients. All patients underwent quantitative and qualitative ultrasound measurements of bone at the hand phalanges carried out using the DBM Sonic BP. Ultrasound bone profile index (UBPI), amplitude-dependent speed of sound (AD-SoS), bone biophysics profile (BBP), and bone transmission time (BTT) were measured. The BRONJ group consisted of 17 patients (62 ± 4.24; range: 45-82); 10 (58.8%) were male and seven (41.1%) were female, of whom 11 (64.7%) suffered from multiple myeloma, three (17.6%) from osteoporosis, one (5.8%) from prostate cancer, one (5.8%) from kidney cancer, and one (5.8%) from leukemia. Fourteen (82.3%) of them received intravenous BP whereas three (17.6%) received oral BP. Nine (9/17; 52.9%) patients developed bone exposure: two in the maxilla and seven in the mandible. Regarding quantitative parameters, Ad-SoS was low in the BRONJ group, but not significant. The UBPI score was significantly reduced in BRONJ patients with exposed bone when compared to controls (0.47 ± 0.12 vs. 0.70 ± 0.15; p = 0.004). The present study demonstrated that quantitative ultrasound was able to show bone microarchitecture alterations in BRONJ patients, and suggests that these analyses may be an important tool for early detection of bone degeneration associated with BRONJ.

OBJETIVOS: Determinar os índices de nasalância de laringectomizados totais usuários de prótese traqueoesofágica e correlacioná-los com os achados da avaliação perceptivo-auditiva da nasalidade. MÉTODOS: Participaram do estudo 25 laringectomizados totais, com idade média de 63 anos, sendo 20 do gênero masculino e cinco do feminino. Todos eram usuários de prótese traqueoesofágica e realizaram terapia fonoaudiológica para reabilitação da comunicação traqueoesofágica. Os laringectomizados foram submetidos à avaliação da nasalância, utilizando a nasometria e avaliação perceptivo-auditiva da nasalidade, por julgamento de fonoaudiólogos treinados. RESULTADOS: Os valores encontrados da nasalância para as frases nasais (59,92%) e para as orais (18,64%) estão dentro da normalidade para falantes laríngeos do português brasileiro. Foi possível perceber, na maioria dos falantes, presença de nasalidade nas frases nasais e ausência nas orais. O valor do teste de especificidade foi de 100% para as frases nasais e de sensibilidade, 100% para as frases orais. CONCLUSÃO: O laringectomizado total usuário de prótese traqueoesofágica apresenta nasalidade vocal adequada, compatível com índices nasométricos.

OBJECTIVES: The objective of this study was to determine the rates of nasalance for total laryngectomized users of a tracheoesophageal voice prosthesis and correlate them with the findings of auditory-perceptual assessment of nasality. METHODS: In this study, 25 total laryngectomized users, including 20 men and five women, with a mean age of 63 years old participated. All the participants had a tracheoesophageal voice prosthesis and underwent treatment for the rehabilitation of tracheoesophageal communication. These patients were submitted to nasalance assessment using nasometry and auditory-perceptual evaluation of nasality and were rated by trained speech therapists. RESULTS: The nasalance values obtained for nasal (59.92%) and oral (18.64%) sentences were within the normal limits for laryngeal speakers of Brazilian Portuguese language. It was possible to observe the presence of nasality in nasal sentences and its absence in oral sentences among most speakers. Specificity was found to be 100% for nasal sentences and sensitivity was 100% for oral sentences. It was not possible to calculate these values for the oral sentences. CONCLUSIONS: Total laryngectomized patients with tracheoesophageal voice prostheses have adequate vocal nasality compatible with nasometry rates.

PURPOSE: To evaluate and correlate the amplitude of esophageal contractions triggered by swallowing water with dynamic extension and habitual, strong and weak sound intensity in total laryngectomees wearing a tracheoesophageal prosthesis. METHODS: Thirty total laryngectomees using tracheoesophageal voice with a phonatory prosthesis were evaluated by measuring the amplitude of contractions in the proximal, middle and distal esophagus and the pressure of the pharyngoesophageal transition by manometry. In order to measure vocal intensity the subject was asked to emit phonation of the vowel /a/ at habitual, strong and weak intensity which was captured with a sound pressure meter. Dynamic extension was calculated by subtracting strong intensity from weak intensity. RESULTS: A positive correlation was observed between contraction amplitude and dynamic extension in the proximal (rho: 0.45; p=0.01) and distal (rho: 0.41; p=0.02) esophagus There was no correlation with other parameters.. Total laryngectomees wearing a phonatory prosthesis with a dynamic extension above 21 dBNPS had greater contraction amplitude than laryngectomees with a dynamic extension below this value. CONCLUSIONS: There was a positive correlation between pressure amplitude in the proximal and distal esophagus and increased dynamic extension. The individuals with normal dynamic extension had greater contraction amplitude in the proximal esophagus than individuals with dynamic extension lower than the expected values for age.

PURPOSE: To assess the effect of a program of singing training on the voice of total laryngectomees wearing tracheoesophageal voice prosthesis, considering the quality of alaryngeal phonation, vocal extension and the musical elements of tunning and legato. METHODS: Five laryngectomees wearing tracheoesophageal voice prosthesis completed the singing training program over a period of three months, with exploration of the strengthening of the respiratory muscles and vocalization and with evaluation of perceptive-auditory and singing voice being performed before and after 12 sessions of singing therapy. RESULTS: After the program of singing voice training, the quality of tracheoesophageal voice showed improvement or the persistence of the general degree of dysphonia for the emitted vowels and for the parameters of roughness and breathiness. For the vowel "a", the pitch was displaced to grave in two participants and to acute in one, and remained adequate in the others. A similar situation was observed also for the vowel "i". After the singing program, all participants presented tunning and most of them showed a greater presence of legato. The vocal extension improved in all participants. CONCLUSION: Singing training seems to have a favorable effect on the quality of tracheoesophageal phonation and on singing voice.

TEMA: reabilitação do laringectomizado total. OBJETIVO: correlacionar a proficiência de voz e de fala de laringectomizados totais usuários de prótese traqueoesofágica com a pressão intraluminal da transição faringoesofágica no repouso e durante a fonação. MÉTODO: foram estudados 12 laringectomizados totais com voz traqueoesofágica, usuários de prótese fonatória, submetidos à coleta e registro do material de voz e da fala, que foram avaliados por três expertos, utilizando-se um protocolo de julgamento geral da comunicação traqueoesofágica. Em seguida, os indivíduos foram encaminhados à manometria esofágica para avaliar a pressão intraluminal da transição faringoesofágica durante a fonação e no repouso. RESULTADOS: durante a fonação, os indivíduos caracterizados como bons falantes (16,7%) pelos expertos apresentaram valores médios de amplitude de pressão na transição faringoesofágica de 27,48mmHg. Entre os falantes moderados (52,5%), obteve-se amplitude média de 30,63mmHg e para os piores falantes (30,8%), 38,72mmHg. Durante o repouso, os melhores falantes apresentaram pressão média de 14,72mmHg, os moderados, 13,04mmHg e os piores falantes, 3,54mmHg. CONCLUSÃO: os melhores falantes apresentaram os menores valores de amplitude de pressão durante a fonação. Em contrapartida, a pressão em repouso foi maior para os bons falantes e menor para os piores, sugerindo que a elevação da pressão na transição faringoesofágica durante a fonação prejudica a qualidade da comunicação traqueoesofágica com a prótese fonatória.

BACKGROUND: rehabilitation of individuals with total laryngectomy. AIM: to correlate the voice and speech proficiency of individuals with total laryngectomy, users of tracheoesophageal, prosthesis with the intraluminal pharyngoesophageal transition pressure at rest and during phonation. METHOD: twelve individuals with total laryngectomy and with tracheoesophageal voice, users of speech prosthesis, were submitted to a voice and speech sample gathering and registration. These individuals were assessed by three experts using a specific protocol for the evaluation of tracheoesophageal communication. Individuals also underwent esophageal manometry in order to evaluate the intraluminal pharyngoesophageal transition pressure during rest and phonation. RESULTS: during phonation, individuals who had been characterized by the experts as good speakers (16.7%) presented average values of pressure amplitude during pharyngoesophageal transition of 27.48mmHg. Average amplitude of 30.63mmHg was observed for individuals classified as moderate speakers (52.5%), and of 38.72mmHg for individuals classified as poor speakers (30.8%). During rest, the good speakers presented an average pressure of 14.72mmHg, the moderate speakers of 13.04mmHg and the poor speakers of 3.54mmHg. CONCLUSION: the good speakers presented the lowest amplitude values of pharyngoesophageal transition pressure during phonation. However, the pressure observed in the rest condition was higher for the good speakers and lower for the poor speakers, suggesting that the raise in the pharyngoesophageal transition pressure during phonation damages the quality of tracheoesophageal communication when using speech prosthesis.

O uso do cidofovir para papilomatose respiratória recorrente juvenil (PRRJ) ainda não tem estudos caso-controle suficientes que comprovem sua eficácia em literatura. OBJETIVO: Avaliar fatores que influenciem o prognóstico da PRRJ, e observar a atuação do cidofovir na erradicação da PRRJ. DESENHO DO ESTUDO: Retrospectivo. MATERIAIS E MÉTODOS: 22 crianças com PRRJ foram avaliadas num centro terciário. Todas as crianças foram submetidas ao tratamento cirúrgico, seguido (Grupo 2) ou não (Grupo 1) pelo uso do cidofovir. A idade ao diagnóstico foi correlacionada ao escore de Derkay e à evolução da doença. Os Grupos 1 e 2 tiveram suas evoluções comparadas entre si. RESULTADOS: Quinze crianças foram consideradas curadas, 8 no Grupo 2 e 7 no Grupo 1. Houve uma correlação negativa entre idade e Escores Total e Clínico (P<0,05). O número médio de cirurgias necessárias para controlar a doença foi semelhante entre os Grupos, mas a duração do tratamento até remissão foi significativamente maior no Grupo 1 quando comparado ao Grupo 2 (P<0,05). CONCLUSÕES: A PRRJ é mais agressiva quanto mais nova a idade do paciente ao diagnóstico. Pacientes tratados com cidofovir apresentaram duração significativamente menor de tratamento até erradicação da PRRJ do que os submetidos apenas ao tratamento cirúrgico.

The efficacy of cidofovir in juvenile recurrent respiratory papillomatosis (JRRP) remains uncertain due to the lack of published case-control studies. AIM: To establish factors affecting the progression of JRRP prognosis, and to evaluate cidofovir for eradicating JRRP. STUDY DESIGN: Retrospective. METHODS: 22 children with JRRP were evaluated at a referral center. All children underwent surgical debulking, followed by cidofovir injection (Group 2) or not (Group 1). Age at diagnosis was correlated with the Derkay score and disease outcome. Disease progression was compared between groups 1 and 2. RESULTS: fifteen children were considered disease-free; 8 were in Group 2 and 7 in Group 1. Age and total and clinical scores (P<0.05) were negatively correlated. The mean number of surgeries required to control the disease was identical in both groups; the duration of treatment until remission was significantly higher in Group 1 (P<0,05). CONCLUSION: JRRP is more aggressive in earlier onset disease. The duration of treatment was significantly lower in patients treated with cidofovir until eradication of JRRP compared to patients treated with surgery only.

A fixação dos CE, principalmente os pontiagudos, favorece a migração pelo corpo, gerando a expressão popular: "os CEs caminham pelo corpo em direção ao coração". OBJETIVO: Descrever os mecanismos envolvidos na migração do CE e a forma de diagnosticá-los. METODOLOGIA: Numa população de 3.000 casos de corpos estranhos, em 40 anos, foram analisados quatro que tiveram deslocamento extraluminal. Foram tomados os dados clínicos, radiológicos, endoscópicos e ultrassonográficos coletadas no serviço de documentação médica. RESULTADOS: São apresentadas três histórias clínicas em que o CE era de espinha de peixe e uma de cartilagem de peixe. Em todos se analisou o deslocamento. Em dois a migração se iniciou no esôfago, um para a aorta e outro para a região cervical e nos dois outros, o deslocamento ocorreu a partir da faringe: um para a fáscia pré-vertebral e outro se exteriorizou na região submandibular. Discutem os mecanismos pelos quais ocorre a migração dos CEs pelo corpo e os riscos que tais deslocamentos promovem para o paciente e a forma de diagnosticá-los. CONCLUSÕES: Os CE podem caminhar pelo corpo, porém não para o coração. Em casos de histórias arrastadas de ingestão de CEs, o estudo por imagens se faz obrigatório, previamente ao exame endoscópico.

Fixation of foreign bodies (FB), in the mucosa, can favor its migration, giving origin to the popular saying: "FB walk to the heart". AIM: describe the mechanisms involved in FB migration and how to diagnose them. METHODOLOGY: From a sample of 3,000 foreign bodies, during 40 years, we analyzed four which had extra-lumen migration. We analyzed clinical, radiologic, endoscopic and ultrasound data collected at the medical documentation service. RESULTS: three clinical histories are presented, describing two fish bones and one piece of fish cartilage. FB shifting was analyzed in all of them. Migration started in the esophagus in two, one going to the aorta and the other to the neck area. In the other two, migration started in the pharynx, and the FB moved towards the prevertebral fascia and the other externalized in the submandibular region. The mechanisms and the risks posed to the patient, by FB migration, and the way to diagnose them are hereby discussed. CONCLUSIONS: the study allows us to determine that FB can move through the body but not towards the heart. The study also serves as a warning sign: in cases of prolonged histories of FB ingestion, imaging studies are mandatory before endoscopic examination.

Várias técnicas para a reconstrução da laringe, pós laringectomias parciais verticais, são citadas na literatura, algumas utilizando estruturas da própria laringe, como a prega vestibular, porém, poucas dão destaque à análise das funções laríngeas após estas reconstruções. Este estudo teve como objetivo avaliar as funções laríngeas em pacientes submetidos à cordectomia completa (tipo IV), reconstruídos com retalho de prega vestibular. FORMA DE ESTUDO: Estudo de coorte transversal. MATERIAL E MÉTODO: Dez pacientes, nove do sexo masculino e um do sexo feminino, com idades entre 45 e 75 anos, e média de 64,5, com carcinomas glóticos tratados por cordectomias totais ou completas (tipo IV) e reconstruídos com retalho de prega vestibular, foram submetidos a videolaringoestroboscopia, onde se avaliou a permeabilidade laríngea, o posicionamento do retalho, o fechamento laríngeo, a movimentação das aritenóides e a característica da fonte sonora: vibrátil ou friccional, e quando vibrátil, a localização e as estruturas que a compunham. A qualidade vocal foi analisada por avaliação perceptiva auditiva e objetiva computadorizada. A função de proteção das vias aéreas durante a deglutição foi realizada pela avaliação endoscópica da deglutição. RESULTADOS: Os resultados evidenciaram que não houve necessidade de manter a traqueostomia no pós-operatório tardio, pois a luz laríngea reconstruída mantinha-se pérvia. A função de proteção estava mantida em todos os casos, a coaptação completa em 30% e somente um paciente teve a movimentação da aritenóide limitada devido à imobilidade do lado operado. Evidenciaram, também, que havia fonte sonora vibrátil em 90% dos casos e que em todos a prega vestibular participava da sua composição. Em sete pacientes a fonte sonora vibrátil se localizava na região glótica. A análise computadorizada revelou freqüência fundamental média de 177,5 Hz, jitter médio de 1,11% e shimmer de 7,04%. Pela escala GRBAS, um paciente apresentou voz normal e 4 tiveram disfonia discreta. CONCLUSÕES: A reconstrução laríngea pós-cordectomia realizada com o retalho da prega vestibular tornou possível emissão de voz normal (freqüência fundamental 205 Hz, jitter 0,13%, shimmer 1,16%), proporcionando coaptação completa em 30% dos casos, fonte sonora vibrátil na região glótica em 70% e participação do retalho como estrutura vibrátil em 90%, além de preservar as funções laríngeas de respiração e proteção das vias aéreas durante a deglutição.

Several reports of techniques for larynx reconstruction after partial vertical laryngectomy are available in the literature, some of them using structures of the larynx itself such as the vestibular fold, but few have emphasized analysis of laryngeal function after reconstruction. Thus, the objective of the present study was to assess laryngeal function in patients submitted to total or complete cordectomy (type IV) followed by reconstruction with vestibular fold flap. STUDY DESIGN: Cohort transversal. MATERIAL AND METHODS: Ten patients, nine males and one female aged 45 to 75 years (mean age: 64.5 years), with glottis carcinomas treated by total or complete cordectomy (type IV) and reconstructed with vestibular fold flap were submitted to videolaryngostroboscopy for assessment of laryngeal permeability, flap positioning, laryngeal closure, arytenoid movement, characteristics of speech sound source (vibrating or frictional) and, when the source was vibrating, location and structures of the sound source. Voice quality was evaluated by perceptual acoustic assessment and by objective computer analysis. The function of lower airway protection during swallowing was analyzed by endoscopic evaluation of swallowing. RESULTS: There was no need to maintain tracheostomy during the late postoperative period since the reconstructed laryngeal lumen remained pervious. The function of airway protection during swallowing was preserved in all patients, with full coaptation of laryngeal structures in 30% of the cases and one patient presented immobility of the operated hemilarynx in midline position. Vibrating sound source was detected in 90% of the cases and was located in the glottic region in seven patients. The vestibular fold flap participated in the composition of the vibrating sound source in all cases. Computerized analysis revealed the following mean values: fundamental frequency, 177.5 Hz, jitter 1.11% and shimmer 7.04%. Using GRBAS scale we observed normal voice in one patient and four patients with discrete dysphonia. CONCLUSIONS: Laryngeal reconstruction with vestibular fold flap after cordectomy was able to maintain laryngeal function, providing normal voice according to perceptive auditory or acoustic analysis (fundamental frequency, 205 Hz, jitter 0.13% and shimmer 1.16%), with full coaptation of laryngeal structures in 30% of the cases, vibrating sound source in the glottic region in 70% and participation of the flap as a vibrating structure in 90%, as well as the maintenance of the laryngeal functions of breathing and airway protection during swallowing.