Faci al traumas are frequent in emergencies, and they require the diagnosis of fractures and associated lesions. Aim:To analyze epidemiological data concerning facial trauma care. Materials and Methods:Three hundred and fifty-five charts from patients with facial trauma treated by the Service of Otorhinolaryngology, from January 2002 to December 2008, were revised. The following data was collected: age, gender, etiology, anatomical localization of the fracture, associated injuries, alcohol consumption, treatment, and hospitalization.Study Design: A retrospective historical longitudinal study. Results:Most of the patients are young adult men (p<0.05) with a male:female ratio of 4:1(p<0.05). Interpersonal violence is the most prevalent cause of facial trauma (27.9%), followed by motor vehicle accidents (16.6%) (p<0.05). The mandible is the most prevalent facial bone fractured (44.2%), followed by nasal fracture (18.9%) (p<0.05). 41.1% of the patients consumed alcohol with a male:female ratio of 11.2:1 (p<0.05). Seventy-seven percent of the patients required surgical intervention (p<0.05) and 84.5% were hospitalized (p<0.05). Conclusion:Young male adults are the most prevalent victims of facial trauma, and interpersonal violence is responsible for the majority of the facial injuries. Most of the cases of facial trauma are associated with the consumption of alcohol. Further studies will be necessary to provide a clear understanding of the trends in the etiology of facial trauma. Braz J Otorhinolaryngol. 2010;76(5):565-74. ORIGINAL ARTICLE BJORL

Introdução: desvio do septo do nariz e/ou da pirâmide nasal ocorre menos freqüentemente em crianças, podendo ser causado no período pré-natal, no parto ou durante o desenvolvimento. A deformidade septal é uma das causas principais de obstrução respiratória, podendo ser responsá-vel por episódios de rinossinusites, otites, dificuldade alimentar e as graves seqüelas do respirador bucal. Podem ocorrer isoladas ou combinadas com desvios da pirâmide nasal. A correção cirúrgica deve ser realizada precocemente na vida. Forma de estudo: Clínico retrospectivo. Material e método: Em estudo retrospectivo foram analisados 80 pacientes, 54 do sexo masculino e 26 do feminino, com idades entre 4 a 14 anos, e submetidos à septoplastia 65 casos, rinoseptoplastia, 11 casos, rinoplastia, 4 casos e procedimentos associados como adenoidectomia, adenotonsilectomia e cauterização intra-turbinal das conchas. Resultado: Recidivas do desvio do septo acorreram em 4 casos, desvio da pirâmide nasal em 4, sinéquias em 3, perfuração do septo e infecção em 1. Conclusão: Os desvios de septo do nariz e ou da pirâmide nasal devem ser corrigidos precocemente e as cirurgias associadas podem ser realizadas no mesmo ato cirúrgico.

Mal es with obstructive sleep apnea syndrome (OSAS) may present decreased testosterone serum levels because of hypoxemia. Aim:To correlate testosterone levels in OSAS patients with laboratory parameters. Material and methods:103 registries of OSAS patients were reviewed from 2002 to 2009. The following data collected: age when polysomnography was done, hematocrit and hemoglobin levels, total testosterone serum levels, BMI, apnea/hypopnea index (AHI), and O2 saturation.Study Design: A cross-sectional retrospective case study.Results: 79 patients (77%) had no hormonal changes, and 24 patients (23%) had decreased serum levels. In patients with normal testosterone levels, 70% were overweight; 63% with altered testosterone levels had obesity grade I (p<0.05). Patients with altered testosterone levels had significantly lower average doses of Ht, Hb and androgen compared to patients without altered androgen levels. The average BMI of patients with altered hormone levels was significantly higher compared to patients with normal hormone levels. Conclusions:The relationship between morning testosterone levels and obesity, and to a lesser degree age, AHI and hypoxemia may be the cause of central suppression of testosterone in these patients. Decreased blood HT and HB levels may be related to lower levels of circulating testosterone. Braz J Otorhinolaryngol. 2011;77(1):88-95. BJORL ORIGINAL ARTICLE

There was no difference in the prevalence of the 102T-C polymorphism between patients with OSAS and the control group. Serotoninergic system dysfunction appeared to be related to OSAS. The -1438G-A polymorphism and OSAS are related in this studied Brazilian population.

A laringomalácia é a causa mais comum de estridor respiratório na infância, sendo a malformação congênita da laringe de maior incidência. Geralmente, associa-se a outras doenças e/ou malformações, dentre elas a doença do refluxo gastroesofágico. Sua etiologia é desconhecida e a doença normalmente é autolimitada, com resolução espontânea em cerca de 85% dos casos, no entanto, 10 a 15% dos pacientes apresentam quadro severo, com obstrução respiratória, necessitando de intervenção cirúrgica. FORMA DE ESTUDO: Clínico retrospectivo. MATERIAL E MÉTODO: Esse estudo de revisão avalia os resultados do Serviço de Otorrinolaringologia Pediátrica da Faculdade de Medicina de São José do Rio Preto, no tratamento da laringomalácia severa, onde quinze pacientes com diagnóstico clínico e nasofibroscópico foram submetidos a supraglotoplastia unilateral e avaliação de lesões sincrônicas associadas.

Obstructive sleep apnea hypopnea syndrome (SAHS) is a complex disease of the upper respiratory airways. SAHS physiopathology is multifactorial in which airway compliance is a very important component. To evaluate the tissue changes in the palatopharyngeal muscle by morphometric, histochemical, immunohistochemical, and stereological quantification, with special attention to extracellular matrix associated with this muscle at the structural and ultrastructural levels. Thirty patients with SAHS were divided into groups of 10 according to disease severity: mild, moderate, and severe SAHS. In addition, the control group consisted of 10 patients. Fragments of palatopharyngeal muscle removed from patients with SAHS and tonsillectomies from patients in the control group were histopathologically submitted to light microscopy and transmission electron microscopy. Histopathological evaluations by light and transmission electron microscopes showed differences in analyzed groups, such as reduction of the muscle fiber diameter in patients with SAHS, taking disease severity into consideration. In contrast, stereological analysis showed a gradual increase of the collagen and elastic system fibers relative frequencies, proportionally to SAHS seriousness. MMP-2 and MMP-9 immunostaining also showed an increased reaction in the muscle fiber cytoplasm and endomisium during SAHS progression. The ultrastructural analysis showed that palatopharyngeal muscle fibers presented cytoplasmic residual corpuscles, a sign of early cell aging. In conclusion, the increase of tissue compliance in individuals with SAHS can be, in addition to other factors, consequence of diminished contractile activity of the muscle fibers, which exhibited clear signs of early senescence. Moreover, extracellular matrix components changes may contribute to muscle myopathy during SAHS progression.

Juvenile nasopharyngeal angiofibroma (JNA) is a vascular tumor of the nasopharynx that accounts for 0.5% of all cancers of the head and neck. It primarily affects males aged 14-25 years. Of the many genes that mediate the development of JNA, GSTM1 has been most frequently associated with this vascular tumor. The loss of expression of GSTM1 (null genotype) is linked to the development of these tumors. The aim of this cross-sectional case study was to examine the prevalence of the GSTM1-null genotype in Brazilian patients with JNA. DNA was extracted from the leukocytes of blood samples from 10 patients. GSTM1 genotypes were analyzed using a PCR-based assay that was designed to identify the wild-type allele of GSTM1. All 10 patients (100%) were males, with a mean age of 17.8 years. The null genotype for GSTM1 was noted in 4 patients (40%)-1 (10%) at Fisch stage I, 1 (10%) at stage III, and 2 (20%) at stage II. No patient with this genotype had stage IV disease. There was no correlation between Fisch classification and GSTM1 genotype (P = .5695). The correlation between age at diagnosis and GSTM1 genotype was not significant (P = .728). The present findings indicate that there is evidence of an association between the GSTM1-null genotype and JNA in this studied Brazilian population.

Obstructive sleep apnea syndrome (OSAS) is one of the most complex disorders of sleep; it involves several genetic factors that contribute to the phenotype. Serotonin (5-HT) regulates a variety of visceral and physiological functions, including sleep. Gene 5-HTR2A polymorphisms may change the transcription of several receptors in the serotoninergic system, thereby contributing to OSAS. Aim To investigate the prevalence of T102C and -1438G/A polymorphisms in the 5-HTR2A gene of patients with and without OSAS. Material and Method A molecular study of 100 index-cases and 100 controls of both genders. DNA was extracted from blood leukocytes samples and the regions that enclose both polymorphisms were amplified with PCR-RFLP. Study design A cross-sectional case study. Results There was a significant prevalence of males in index cases compared to controls (p<0.0001). No significant genotypic differences between cases and controls were found in T102C polymorphisms ( p =1.000). There were significant differences between the AA genotype of -1438G/A polymorphisms and patients with OSAS (OR:2.3; CI95%:1.20-4.38, p =0.01). Conclusion Serotonergic mechanisms may be related to OSAS. There were no differences in the prevalence of T102C polymorphisms in patients with OSAS and the control group. There is evidence of an association between the -1438G/A polymorphism and OSAS.