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- ItemSomente MetadadadosAlterações de laringe em crianças com cardiopatias congênitas(Universidade Federal de São Paulo (UNIFESP), 2015-09-30) Torres, Ana Amelia Soares [UNIFESP]; Pignatari, Shirley Shizue Nagata Pignatari [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Congenital heart diseases (CHD) occurs in about 8-10 children per 1,000 live births, accounting for a large number of surgeries in the pediatric population. It is believed that these surgical procedures can cause laryngeal disorders, particularly vocal cord paralysis, and consequently postoperative complications; ventilation and extubation difficulties, and respiratory and subsequent phonation disorders. Several studies have shown that many children with CHD also present with associated laryngeal disturbs, which could contribute to postoperative complications. Due to the high frequency of surgeries for congenital heart diseases, it becomes important to find effective ways that help to prevent, minimize or treat such complications as early as possible. Objectives: Assess the occurrence of laryngeal diseases in patients with congenital heart disease and to determine whether the presence of these diseases is a critical postoperative complication outcome factor. Methods: A total of 52 pediatric patients undergoing cardiothoracic surgery at the Little Prince Hospital in Curitiba were evaluated. Patients underwent laryngoscopy with flexible laryngoscope (LF) to evaluate the characteristics of the upper airway before and after surgery. Information regarding demographic and clinical characteristics of the patients, as well as the outcome during hospitalization were collected. Data were statistically analyzed using Chi-square test or Fisher's exact test. Two-tailed t test was used to compare numeric variables. Results: Of 52 patients, Twenty-eight (53.8%) were female and 24 (46.2%) male (Figure 3). The median (percentil25-75%) age was 12 (5-60) months, a minimum of 0.4 months and a maximum of 264 months. Twenty-five percent of patients had some type of laryngeal affection. The diseases found were subglottic stenosis (n = 1) vallecula cyst (n = 1), intubation granuloma (n = 1), epidermoid cyst (n=1), laryngomalacia (n = 9). The occorrence of laryngeal diseases in our study were significantly higher (p <0.001), compared to the general population. No new laryngeal disorders were detected postoperatively, in addition to those initially observed preoperatively. There was no relationship between extubation difficulties and the laryngoscopy findings. Conclusions: The prevalence of laryngeal disorders in children with congenital heart disease is higher than in the general population. The surgical procedure may not be related to the increased frequency of laryngeal disorders, and laryngeal disorders do not seem to be a determinant factor for postoperative complications in these patients.
- ItemAcesso aberto (Open Access)Análise comparativa entre avaliação fonoaudiológica perceptivo-auditiva, análise acústica e laringoscopias indiretas para avaliação vocal em população com queixa vocal(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-02-01) Nemr, Kátia; Amar, Ali [UNIFESP]; Abrahão, Márcio [UNIFESP]; Leite, Grazielle Capatto De Almeida; Köhle, Juliana; Santos, Alexandra de O.; Correa, Luiz Artur Costa; Hospital Heliópolis Serviço de Fonoaudiologia; Hospital Heliópolis; Universidade Federal de São Paulo (UNIFESP); PUC/SP; CEFACAs a result of technology evolution and development, methods of voice evaluation have changed both in medical and speech and language pathology practice. AIM: To relate the results of perceptual evaluation, acoustic analysis and medical evaluation in the diagnosis of vocal and/or laryngeal affections of the population with vocal complaint. STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD: 29 people that attended vocal health protection campaign were evaluated. They were submitted to perceptual evaluation (AFPA), acoustic analysis (AA), indirect laryngoscopy (LI) and telelaryngoscopy (TL). RESULTS: Correlations between medical and speech language pathology evaluation methods were established, verifying possible statistical signification with the application of Fischer Exact Test. There were statistically significant results in the correlation between AFPA and LI, AFPA and TL, LI and TL. CONCLUSION: This research study conducted in a vocal health protection campaign presented correlations between speech language pathology evaluation and perceptual evaluation and clinical evaluation, as well as between vocal affection and/or laryngeal medical exams.
- ItemAcesso aberto (Open Access)Configuração das pregas vestibulares à fonação em adultos com e sem disfonia(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2005-02-01) Nemetz, Marcos Antônio [UNIFESP]; Pontes, Paulo Augusto de Lima [UNIFESP]; Vieira, Vanessa Pedrosa [UNIFESP]; Yazaki, Reinaldo Kazuo [UNIFESP]; Universidade Regional de Blumenau; Universidade Federal de São Paulo (UNIFESP)The real participation of the vestibular folds during phonation mechanism is unknown. How vestibular folds change their configuration during phonation is still unclear. Learning about these changes in the functional mechanism of vestibular fold would be helpful for the evaluation of pathological conditions. AIM: The objective of the present study was to analyze the configuration of laryngeal vestibular folds during phonation (sustained emission of vowel /µ/) by comparing exams of individuals without vocal complaints (the normal voice group) with those with vocal complaints. STUDY DESIGN: Transversal simple study. MATERIAL AND METHOD: 120 images of larynges were analyzed, 60 of normal voice individuals and 60 of dysphonic subjects, with equal gender distribution. The position of the free margin of the vestibular fold was identified in relation to a straight line that brought together the anterior and posterior insertions. Regarding this position, three types of configurations were described: concave, when it was in a lateral position, convex when it was in a medial position, and linear when it overlapped. RESULTS: Out of the 240 vestibular folds, 158 were concave, 41 convex and 31 linear. The concave form was predominant in both groups in relation to the other two forms, although the number of convex and linear forms increased in the dysphonic group. Analyzing the behavior of these forms in each gender we noticed that among women, the linear form was significantly increased in the dysphonic group, whereas among men there was significant increase in convex form. CONCLUSION: We concluded that there were differences in behavior of vestibular folds in the dysphonic group in relation to the normal voice group, and that the differences occurred differently in both gender groups.
- ItemAcesso aberto (Open Access)Desenvolvimento de protótipo para aplicação do laser de CO2 na laringe humana a curtas distâncias(ABORL-CCF Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, 2002-03-01) Morgado, Plínio F. [UNIFESP]; Wagner, Paulo [UNIFESP]; Neves, Luciano R. [UNIFESP]; Pontes, Paulo A. De L. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Laser endolaryngeal surgery has been performed with 350 and 400mm focal length (f ) lenses which converge the laser beam to a minimum spot size, called beam waist. The beam waist size can be described as: 2omega0 =lambdaf /pw², where lambda is the CO2 wavelength and 2omega is the beam diameter. We developed an optical system which produces a very small beam waist. This small shaft of laser is delivered precisely on the target resulting in a reduced impact spot size enhancing precision and lessening surrounding tissue trauma on laryngeal surgery. Aim: To present an optical system which delivers the laser beam at a small distance from the human glottis. Study design: Clinical trial. Material and Methods: The manufactured prototype has two metallic cylindrical shafts joined in a 135º angle from the horizontal. A coated mirror positioned in its joint change the ray path in the same angle. Two coated lenses converge the laser to a calculated beam waist. The hand piece was coupled to the laser articulated arm and the system was set to 0.5 - 2.0 W at 0.05 sec. exposure time. Laryngeal exposure was achieved with the angled videolaryngoscopy. Three patients with vocal fold polyp underwent laser surgery with the technique above described. Results: A beam waist ranging from 200 to 250 mum was obtained (lambdaCO2 = 10,6 mum). The technique offered adequate laryngeal exposure and satisfactory image quality for a proper laser application. No technical difficulties nor major bleeding or mucosal charring was observed during the treatment. No excessive scarring was observed in a two-month follow-up laryngoscopy. Conclusion: The developed prototype produced very small laser shafts which are useful in the treatment of vocal fold polyps.