Title
Search
All Issues
7
Year: 2010  Vol. 14   Num. 4  - Oct/Dec Print:
Original Article
Versão em PDF PDF in Portuguese Versão em PDFPDF in English Texto Text in Portuguese
Profile ENT Surgery in a Pediatric Hospital in Curitiba
Perfil Cirúrgico Otorrinolaringológico em um Hospital Pediátrico de Curitiba
Author(s):
Juliana Benthien Cavichiolo1, Bettina Carvalho2, Lauro João Lobo Alcântara2, Elise Zimmermann3, Saulo Carvalho Filho4, Marcos Mocellin5.
Key words:
Children's hospitals, Tonsillectomy, Epistaxis, Adenoidectomy, Child, Bronchoscopy.
Abstract:

Introduction: ENT procedures are very common in the pediatric surgery and otolaryngologists have a wide range of surgical procedures, and adenotonsillectomy most performed procedure, followed by otological. The most common complication is bleeding from tonsillectomies. Despite being the most feared complication, only a minority of patients need surgical intervention to stop the bleed. Objective: To evaluate the surgical profile in hospital pediatric otolaryngology Curitiba. Method: Retrospective Study of registered surgeries. Results: A total 2020 procedures performed in the operating room in 2009, 9.26% (187) and tests were 90.74% (1833) surgeries, being 65.14% (1316) performed by the SUS,% 32.47 (656) by covenant and 2.39% (48) individuals. The gender distribution was 1106 boys and 914 girls. Adenoidectomy with or without tonsillectomy corresponded to 62.5% (1146). Of these, only 0.96% (11) underwent revision surgery center. In second place comes the otological surgery, with results of tympanostomy, with or without ventilation tube, the most prevalent. Conclusion: The otolaryngologists are able to perform various types of ENT surgical. A procedure most frequently performed in pediatric hospital in Little Prince is adenotonsillectomy, with revision rate similar to that reported in the literature. Boys are more subjected to procedures than girls. Most ENT procedures performed in this hospital in 2009 were performed by the SUS. This shows the importance of adenotonsillectomy in the daily practice of pediatric ENT, and the weight of this problem among users of SUS is great.

INTRODUCTION

The ENT surgery are very common in the pediatric surgery, adenotonsillectomy is the procedure most often performed by otolaryngologists, followed by otologic procedures. The most common complication is bleeding from tonsillectomies. Despite being the most feared complication, only a small proportion of patients need surgical intervention to stop the bleeding.

The aim of this study is to evaluate the profile of ENT surgery in a tertiary Children's Hospital of Curitiba, Parana, Brazil.


METHOD

We performed a retrospective Table review of patients undergoing surgical procedures in ENT Hospital Infantil Pequeno Príncipe, Curitiba / PR, from 1 January 2009 until December 31, 2009.We analyzed the sex of the patients and there were what surgeries were performed by SUS, by health plans or private. The surgeries were divided into: tonsillectomy, adenoidectomy, adenotonsillectomy, tympanostomy with or without ventilation tube tympanoplasty tympanomastoidectomy, cochlear implant, otoplasty, septoplasty, turbinectomy, sinusotomy, excision of a thyroglossal cyst, excision of branchial fistula, drainage of abscsesso, laryngoplasty , laryngeal surgery, a stenosis of the larynx, arytenoidectomy, tracheostomy, tracheostomy closure, correction of choanal atresia, nasal fracture reduction, biopsies, excision of tumor, Zplasty, excision of atrial appendage, dacryocystorhinostomy, a botox, cap posterior nasal, and data were computed on the need for reintervention after the initial surgical procedure.


RESULTS

Of the total of 2020 procedures performed in the operating room in 2009, 9.26% (187) and tests were 90.74% (1833) surgeries, being 65.14% (1316) performed by SUS, 32.47% ( 656) by covenant and 2.39% (48) individuals. The gender distribution was 1106 boys and 914 girls. Adenoidectomy with or without tonsillectomy was the most performed surgery, accounting for 62.5% (1146) of the surgeries. Of these, only 0.96% (11) underwent revision surgery center. In second place come the otologic surgery, and the tympanostomy, with or without ventilation tube, the most prevalent. Nasal surgery, laryngeal and cervicofacial were also performed, but in smaller numbers.









DISCUSSION

Surgery and ENT procedures are performed much in the pediatric population. The surgeries range from a simple foreign body removal to major cancer surgery. A tonsillectomy is the most common surgery performed by ENT and most frequently performed in pediatric patients. Its most common indications are recurrent tonsillitis, recurrent infection of the upper airways, obstructive sleep apnea (OSA), poor nutrition, and cardiopulmonary changes due to respiratory obstruction.

Among the possible complications of tonsillectomies is the most feared bleeding. This complication is infrequent, with incidence ranging from 0.1 to 1.4% in adenoidectomy and 0.23% to 1.6% in tonsillectomy. The need for surgical intervention is low, only major bleeding sayings that are considered a minority of cases.

There are two types of postoperative bleeding: primary (<24 hours) and secondary (> 24 hours). Both should be observed carefully because of the risk of bleeding exists even be delayed.

In our study we found a wide range of ENT surgical procedures. The surgeries performed in the service, its absolute value and percentage relative to total ENT is in Table 1. The values and percentage of procedures are shown in Table 2.

Our rate of Tonsillectomy with or without adenoidectomy was 62.5% of all surgeries performed by specialists without regard to tests performed in the operating room.

We found a reintervention rate in this type of surgery was 0.96%, being consistent with the literature.

Bleeding after tonsillectomy is often unpredictable, and preventing the most effective way to avoid it. Anamnesis of possible coagulation disorders, surgical technique, and immediate postoperative evaluation are important to avoid unwanted outcomes.

The coverage of the procedures took place, according to Table 1.



Graphic 1. Coverage of the procedures.




CONCLUSION

Hearing experts are able to make various types of surgical procedures, intervening in the oral cavity, hearing aid, phonatory, respiratory beyond the cervical-facial surgery.

ENT surgery most commonly performed in pediatric patients at the Hospital Infantil is adenotonsillectomy, with revision rate similar to that reported in the literature. Boys are undergoing more than girls. Most ENT surgery performed at Children's Hospital in 2009 was performed by the SUS.

This shows the importance of tonsillectomy in ORL practice daily, and the weight of this problem among users of SUS is great.


BIBLIOGRAPHIC REFERENCES

1. Waldeyer W. Uber denlymphatischen apparat dês Pharynx. Dtsch Med Wochenschr. 1884, 10:313.

2. Paradise JL. Tonsillectomy and Adenoidectomy. In Bluestone C. Pediatric Otolaryngology. Philadelphia: W. B. Saunders; 1996.

3. Windfuhr JP. Lethal post-tonsillectomy hemorrhage. Auris Nasus Larynx - Int J ORL. 2003, 30:391-/396.

4. Derkay C, Darrow D, Welch C, Sinacori J. Post-Tonsillectomy Morbidity and Quality of Life in Pediatric Patients with Obstructive Tonsils and Adenoid: Microdebrider vs Eletrocautery. Otolaryngology - Head and Neck Surgery. 2006, 134:114-120.

5. Vieira FMJ, Diniz FL, Figueiredo CR, Weckx LL. Hemorragia na adenoidectomia e/ou amigdalectomia: estudo de 359 casos. Rev Bras Otorrinolaringol. 2003, 69(3):338-41.

6. Silva BSR, Garcia LB, Ortiz LR. Monteiro LS, Maeda NA. Hemorragia no pós-operatório imediato de Adenoidectomia e/ou Tonsilectomia. Arq Int Otorrinolaringol. 2009, 13(2):155-160.

7. Coelho RG, Brandão FH, Carvalho MRMS, Aquino JEP, Pereira SH, Eiras B. Perfil de Pacientes Submetidos à Adenoidectomia,Amigdalectomia e Adenoamigdalectomia pela Disciplina de Otorrinolaringologia da UNISA. Arq Int Otorrinolaringol. 2008, 12(2):189-193.

8. Deutsch ES, Reilly JS. Amigdalectomia e Adenoidectomia - Mudanças nas Indicações. Em: manual de Otorrinolaringologia Pediátrica da International Association of Pediatric Otorhinolaryngology (IAPO). São Paulo: LIS Gráfica e Editora Ltda. 1997,145-59.

9. Alcântara LJL, Pereira RG, Mira JGS, Soccol AT, Tholken R, Koerner HN, Mocellin M. Impacto na Qualidade de Vida nos Pacientes Adenoamigdalectomizados. Arq Int Otorrinolaringol. 2008, 12(2):172-178.

10. Fonseca VR, Marcelino TF, Medeiros AIL, Zimmermann E, Möller LG. Perfil dos pacientes submetidos à Adenoamidalectomia no Hospital Angelina Caron no ano de 2006. Rev Assoc Paranaense de Otorrinolaringol. 2007, 1(2):04-07.

11. Siebert DR. Complicações Pós-Operatórias de Adenoamigdalectomia - Em: Tratado de Otorrinolaringologia. 1ª Ed. São Paulo: Editora Roca 2003, 253-261.

12. Balbani APS, Montovani JC, Carvalho RC. Faringotonsilites em crianças: visão de uma amostra de pediatras e otorrinolaringologistas. Rev Bras Otorrinolaring. 2009, 75(1):139-146.









1 Resident in Otorhinolaryngology at the Federal University of Parana.
2 Head of the Department of Otolaryngology, Hospital Pequeno Príncipe. Attending Physician in the Department of Otolaryngology, School of Medicine, UFPR.
3 Otorhinolaryngologist SBORL. Fellow in the Department of Otolaryngology, Hospital Pequeno Príncipe.
4 Professor of Pediatrics Department of Federal University of Parana. Pediatrician Assistant Professor in Otolaryngology, School of Medicine, UFPR.
5 Professor in the Department of Otolaryngology, UFPR. Head of the Department of Otorhinolaryngology, Clinical Hospital, Faculty of Medicine, Federal University of Parana.

Institution: Clinical Hospital, Federal University of Parana, Hospital Pequeno Príncipe. Curitiba / PR - Brazil. Mail Adress: Juliana Benthien Cavichioli - Captain Clementino Paraná, 130 - Curitiba / PR - Brazil - Zip code: 80620-180 - Telephone: (+55 41) 3310-1010 - E-mail: jucavs@hotmail.com

Article received on July 19, 2010. Article accepted on September 4, 2010.

  Print:

 

All right reserved. Prohibited the reproduction of papers
without previous authorization of FORL © 1997- 2019