Keywords children's hospitals - tonsillectomy - epistaxis - adenoidectomy - child - bronchoscopy
Palavras-chave hospitais pediátricos - tonsilectomia - epistaxe - adenoidectomia - criança - broncoscopia
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 ].
Table 1.
Surgery
Cx Number
Percent
Tonsillectomy
17
0.9277%
Adenoidectomy
280
15.2755%
Adenotonsillectomy
849
46.3175%
Tympanotomy
286
15.6028%
Ventilation Tubes
112
6.1103%
Tympanoplasty
24
1.3093%
Tympanomastoidectomy
15
0.8183%
Cochlear Implant
2
0.1091%
Otoplasty
2
0.1091%
Septoplasty
23
1.2547%
Turbinectomy
78
4.2553%
Sinusotomy
25
1.3638%
Thyroglossal Cyst
1
0.0545%
Frenotomia
14
0.7637%
Drainage of Abscess
8
0.4364%
Laryngoplasty
10
0.5455%
Microcx of Larynx
5
0.2727%
Tracheostomy
6
0.3273%
Choanal atresia
2
0.1091%
Branchial Fistula
1
0.0545%
Biopsy
6
0.3273%
Reduction fx. Nasal
1
0.0545%
Atrial appendage excision
1
0.0545%
Dacryocystorhinostomy
3
0.1636%
Botox
7
0.3818%
Review of A / Ad / A + Ad
11
0.6001%
Revision of tracheotomy
4
0.2124%
Rear Cap
1
0.0545%
Excision of tumor
4
0.2124%
Zetaplasty
1
0.0545%
Removal of Foreign Body
23
1.2547%
Tracheostomy closure of
1
0.0545%
Correction Stenosis of Larynx
7
0.3818%
Arytenoidectomy
1
0.0545%
Withdrawal of drains
2
0.1091%
Table 2.
Exam
Exam N°
Percentage
Nasofibroscopy
92
49.2%
Laryngoscopy
73
39.03%
Fiberoptic
22
11.77%
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 ].
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.
Graphic 1. Coverage of the procedures.
