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.
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
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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: firstname.lastname@example.org
Article received on July 19, 2010. Article accepted on September 4, 2010.