The success rate of voice rehabilitation with VP was 94%. In primary TEP, the success rate was 97%, whereas in secondary TEP it was 78%; 2 years later, it was 96% and 75%, respectively. A tendency for a higher success rate in voice rehabilitation after TL was observed in primary TEP. The use of xRT and age of patient had no influence on the success rate.
The clinical features and severity of DCA varied according to different age groups, perhaps due to the location of the infection and a higher incidence of comorbidity in adults. Thus, DCA in adults is more facile to have multispace involvement and lead to complications and seems to be more serious than that in children.
Background Dissection of posterior triangle apex (APEX) is a surgical step in supraomohyoid and lateral neck dissections. The prevalence of lymphatic metastases at this site and the clinicohistopathologic conditions that influence their occurrence have not been established. We have evaluated the prevalence and the risk factors for cervical metastases in lymph nodes of the APEX. Methods Sixty‐two neck dissections were performed in 51 patients with squamous cell carcinoma of the oropharynx, hypopharynx, oral cavity, glottic larynx, and supraglottic larynx or with primary occult tumor. We correlated the presence of positive metastases in the APEX with the neck level involved either clinically (CLIN) or histopathologically (H/P) and with the number of CLIN‐ or H/P‐positive neck levels with metastases. The prevalence of metastases in the APEX in elective (N0) and therapeutic (N+) neck dissections was also compared. This prevalence was also compared with that for each neck level. The histopathologic comparisons between the APEX and the neck levels were calculated for N0, N+, and all neck dissections. The primary site of tumor was correlated with the presence of H/P‐positive nodes in the APEX. Results The overall prevalence of lymphatic metastases in the APEX was 6.5%. The prevalence in N0 neck dissections was 2.3% and in N+ neck dissections it was 16.7%. The prevalence of lymphatic metastases in the APEX for primary tumors of pharynx was 23.1%, for the oral cavity it was 3.6%, and it was 0% for other sites. Metastases in the APEX were not influenced by the neck level with CLIN or H/P metastases in N+ necks. The number of CLIN‐ or H/P‐positive neck levels had no influence on histopathologic metastases in the APEX. Factors that influenced metastases in the APEX were positive histopathologic metastases at level II for N0 neck dissections and positive histopathologic metastases at level II or III for all neck dissections. All the comparisons were analyzed using Fisher's or Poisson's test. Conclusions The prevalence of histopathologic metastases in the APEX in N+ necks is 7.3 times greater than that of N0 necks and for primary tumors of pharynx it was 6.4 times greater than for the oral cavity and significantly greater than for the larynx. Histopathologic metastases at level II for clinically N0 necks and histopathologic metastases to level II or III for all neck dissections are risk factors for metastases in the APEX. The number of positive levels did not influence the prevalence of metastases in the APEX. There are no isolated metastases in the APEX of the posterior triangle. © 2000 John Wiley & Sons, Inc. Head Neck 22: 564–571, 2000.
A disfonia tem recebido um enfoque ocupacional crescente e torna-se necessário, ao otorrinolaringologista, atualizar a abordagem clínica dos trabalhadores que usam a voz como instrumento de trabalho, onde novas catagorias profissionais têm surgido e, com elas, as disfunções vocais conseqüentes às condições de trabalho. Hoje, há grandes preocupações com o prejuízo econômico e produtivo que o ditúrbio vocal possa gerar. Sabe-se que a disfunção vocal tem como característica a multicausalidade e, por isso, a avaliação, conclusão e emissão de relatórios médicos tornam-se incertos. Objetivo: Para melhor avaliar estes profissionais e garantir um atendimento com respaldo científico adequado, estabeleceu-se um protocolo multidisciplinar, que consiste em anamnese dirigida, exame físico, endoscopia laríngea, análise perceptiva da voz e aplicação do Voice Handicap Index (VHI). Forma de estudo: Coorte histó-rica transversal. Material e método: Para testar o uso do méto-do, em caráter preliminar, o protocolo foi aplicado em 15 profissionais que usavam a voz para trabalhar. Então, realizou-se um estudo retrospectivo com estes pacientes. Resultado: Demonstrou-se que 13,3% dos profissionais apresentaram performance vocal normal; 33,3%, disfonia funcional e 46%, disfonia orgânico-funcional. A disfunção vocal foi relacionada ao exercício do trabalho em 40% dos pacientes e em 46,6% ela foi descartada. Conclusão: Concluiu-se que o método é suficientemente abrangente e pode ser de utilidade ao otorrinolaringologista, para a avaliação clínico-ocupacional deste grupo de pacientes. Dysphoni a has an occupational view nowadays. A shift in the voice-oriented professional's clinical approach has been required. New voice-oriented job categories have emerged and, as a result, the voice disorder in the professional enviroment has increased. The economic and productivity harm due to voice disorders are a preocupation. Dysphonia has multiple causes and its evaluation, ethiological conclusion and occupational reports aren't defined yet. Aim: In order to obtain a more accurate and comprehensive evaluation, a multidisciplinary protocol was elaborated to ensure proper medical scientific support. It consists of anamnesis, physical exam, laryngeal endoscopy, perceptive voice analysis and Voice Handicap Index application (VHI). Study design: Transversal historic cohort. Material e método: In this preliminary study, the protocol was applied on 15 voice professionals with dysphonia. Results: 13,3% with normal voice performance; 33,3% with functional dysphonia; 46% with organic dysphonia. Dysphonia was related to the voice-oriented job in 40% cases and it was ruled out in 46,6%. Conclusion: We concluded that the protocol is complete enough to help otolaryngologists evaluate this workers' category. EricaPalavras-chave: disfonia, ocupacional, multidisciplinar.
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