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Cross-Sectional Study on Lateral Skull Radiographs to Design a New Nasopharyngeal Swab for Simplified COVID-19 and Respiratory Infections Diagnostic Testing in Children. J Clin Med 2022; 12:jcm12010213. [PMID: 36615013 PMCID: PMC9821314 DOI: 10.3390/jcm12010213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022] Open
Abstract
Nasopharyngeal swab sample collection is the first-line testing method for diagnosing COVID-19 infection and other respiratory infections. Current information on how to properly perform nasopharyngeal swabbing in children is largely defective. This study aimed at collecting nostril to nasopharynx distance measurements on lateral skull radiographs of children and adolescents to design a nasopharyngeal swab meant to standardize and facilitate the sample collection procedure. A total of 323 cephalograms of 152 male and 171 female children aged 4-14 years taken for orthodontic reasons were selected. On each cephalogram, the shortest distance between the most anterosuperior point of the nostril contour and the nasopharynx outline was measured in mm parallel to the palatal plane. Descriptive statistics of the measurements were calculated for each age group. The lower limit of the 95% confidence intervals of the measurements was taken as a reference to design a swab shaft with marks that, at each age, delimitate a safety boundary for swab progression up to the posterior nasopharyngeal wall. The simplification of the procedure enabled by the newly designed nasopharyngeal swab is valuable to help healthcare providers perform specimen collection on children in a safe and effective way, perhaps under the less-than-ideal conditions possibly occurring in 'point-of-need' contexts.
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Cassano M, De Corso E, Fiore V, Giancaspro R, Moffa A, Casale M, Trecca EMC, Mele DA, Cassano P, Gelardi M. Update of endoscopic classification system of adenoid hypertrophy based on clinical experience on 7621 children. ACTA OTORHINOLARYNGOLOGICA ITALICA 2022; 42:257-264. [PMID: 35396589 PMCID: PMC9330757 DOI: 10.14639/0392-100x-n1832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/29/2021] [Indexed: 11/23/2022]
Abstract
Introduction Nasal endoscopy is likely to be the method of choice to evaluate nasal obstruction and adenoid hypertrophy (AH) in children given its excellent diagnostic accuracy and low risk for the patient. The aim of this study was to update the previous classification of AH to guide physicians in choosing the best therapeutic option. Materials and methods This is a retrospective observational study including 7621 children (3565 females; mean age 5.92; range: 3-14 years) who were managed for adenoid hypertrophy at our institution between 2003 and 2018. All patients were initially treated with medical therapy and then with surgery if not adequately controlled. We performed a specific analysis based on the presence or absence of comorbidities. Results In 1845 (24.21%) patients, adenoid obstruction was classified as Grade I when the fiberoptic endoscopy showed adenoid tissue occupying < 25% of choanal space. In 2829 of 7621 (37.12%) patients, the adenoid tissue was scored as Grade II since it was confined to the upper half of nasopharynx, with sufficiently pervious choana and visualisation of tube ostium. In 1611 of 7621 (21.14%) cases, adenoid vegetation occupied about 75% of the nasopharynx with partial involvement of tube ostium and considerable obstruction of choanal openings, and was classified as Grade III. Finally, 1336 of 7621 (17.53%) patients were scored as Grade IV due to complete obstruction with adenoid tissue reaching the lower choanal border without allowing the visualisation of the tube ostium. Based on resolution of symptoms in Grade III obstruction after medical therapy (that was mostly seen in patients without comorbidities), we divided patients in two subclasses: Grade IIIA was not associated with comorbidities, while Grade IIIB was correlated with important comorbidities. Conclusions These results can be useful to guide medical or surgical therapeutic intervention. In patients with class IIIB AH, surgical treatment offered adequate control not only of nasal symptoms but also of associated comorbidities.
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Pisutsiri N, Vathanophas V, Boonyabut P, Tritrakarn S, Vitayaudom N, Tanphaichitr A, Ungkanont K. Adenoid measurement accuracy: A comparison of lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy (gold standard). Auris Nasus Larynx 2021; 49:222-228. [PMID: 34334217 DOI: 10.1016/j.anl.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/21/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the accuracy of lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy in assessment of adenoid size. METHODS A cross-sectional study was conducted in 43 pediatric patients undergoing ENT surgery from July 2017 to December 2018. All patients underwent preoperative lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy. RESULTS The average adenoidal-nasopharyngeal (A/N) ratio obtained from lateral skull film, flexible endoscopy, and intraoperative rigid endoscopy was 72.9, 79.5, and 81.6, respectively. There was a moderate correlation between A/N ratio from lateral skull film and intraoperative rigid endoscopy (Pearson's correlation: 0.567, p˂0.001). Whereas, the A/N ratio from flexible endoscopy compared to intraoperative rigid endoscopy showed a stronger correlation (Pearson's correlation: 0.791, p˂0.001). From linear regression analysis, the intraoperative adenoid measurement was estimated from the results of flexible endoscopy (intraoperative rigid endoscopy: 0.72 [flexible endoscopy] +24.47) and lateral skull film (intraoperative rigid endoscopy = 0.65 [lateral skull film] + 34) CONCLUSION: Flexible endoscopy yields the most accuracy in the assessment of adenoid size and nasopharynx visualization, without radiation exposure or anesthesia. Despite less accuracy, lateral skull film is more availability in every hospital. The correlation of adenoid size measurement in this study can also be applied for the actual size of adenoid.
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Affiliation(s)
| | - Vannipa Vathanophas
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Panrasee Boonyabut
- Queen Sirikit National Institute of Child Health, Ministry of Public Health, Bangkok, Thailand
| | - Sirion Tritrakarn
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nichanun Vitayaudom
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Archwin Tanphaichitr
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kitirat Ungkanont
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Choudhari SM, Shrivastav S. Comparative Evaluation of Adenoids and Airway Space in 12 to 14-Year-Old Children With Different Growth Patterns Using Cephalometric Methods Commonly Used by ENT Specialists. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2021. [DOI: 10.1177/0301574220966875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Altered airway and growth are interrelated; hence, a study was planned to develop a diagnostic protocol that may help in diagnosing difficult airway by utilizing routine radiographic assessment. Material and Methods: Lateral cephalograms of 60 children aged 12 to 14 years who were grouped based on the growth pattern into 3 groups with 20 cases each (Group 1—normodivergent cases; Group 2—hypodivergent cases; Group 3—hyperdivergent cases) were observed. The diagnostic protocol included 3 diagnostic methods (Handelman–Osborne area method, Maw et al method, and Holmberg et al method) routinely used by ENT surgeons for altered airway evaluation, and their diagnostic efficacy was correlated with McNamara’s airway analysis. Results: Highest specificity and diagnostic accuracy were found with Holmberg et al method followed by Maw et al method. Poor specificity was observed with Handelman–Osborne area method. Conclusion: The new diagnostic protocol which includes commonly used cephalometric methods by ENT surgeons can be helpful for orthodontists in early evaluation of altered airways, so that preventive and interceptive procedures can be carried out to normalize the altered craniofacial growth. Among the methods used in this diagnostic protocol, Holmberg et al and Maw et al methods had better sensitivity and specificity.
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Affiliation(s)
- Smita Mangesh Choudhari
- Department of Orthodontics, Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sunita Shrivastav
- Department of Orthodontics, Sharad Pawar Dental College and Hospital, Sawangi (Meghe), Wardha, Maharashtra, India
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Caixeta JAS, Sampaio JCS, Costa VV, Silveira IMBD, Oliveira CRFD, Caixeta LCAS, Avelino MAG. Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing. Int Arch Otorhinolaryngol 2020; 25:e123-e128. [PMID: 33542762 PMCID: PMC7851366 DOI: 10.1055/s-0040-1709195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 02/25/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction
Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear.
Objective
To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB).
Method
This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis,
p
-values lower than 0.05 were defined as statistically significant.
Results
A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores.
Conclusion
This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.
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Analgesia for adenotonsillectomy in children: a comparison between peritonsillar infiltration of tramadol, ketamine, and placebo. Eur Arch Otorhinolaryngol 2020; 277:1815-1822. [PMID: 32157434 DOI: 10.1007/s00405-020-05878-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Post-tonsillectomy pain is mediated by nociceptive C-fibers located at peritonsillar space. Peritonsillar infiltration of medication could relieve post-operative pain blocking the afferent via. PURPOSE To evaluate the effect of peritonsillar infiltration of tramadol, ketamine, and placebo on post-operative pain in cases of adenotonsillectomy. METHODS This is a double-blind randomized placebo-controlled study. Children ASA I-II aged 3-13 years scheduled for adenotonsillectomy were included in the study. Patients were randomized to receive either 2 mg/kg of peritonsillar tramadol (Group T), 0.5 mg/kg of peritonsillar ketamine hydrochloride (Group K), and 3 mL of peritonsillar saline (Group P). Post-operative pain was recorded using the modified visual analogue scale at 2 h, 6 h, 12 h, and 24 h. Side effects, analgesia requirement, and first oral intake were also recorded. RESULTS There were included 112 patients and five were excluded until final evaluation. We evaluated 36 children of Group T, 36 of Group K, and 35 of Group P. Groups were similar regarding to age, weight, height, gender, tonsil and adenoid size, hemodynamic parameters during the surgery, surgery, and anesthesia time. There were no differences between the groups in relation to pain scores, analgesia requirement, or first time of oral intake (p > 0.05). Group T presented a higher incidence of vomit between 2 and 6 h after surgery (p > 0.05). CONCLUSION This study showed that peritonsillar infiltration of tramadol or ketamine were not superior to placebo in reducing post-operative pain in children undergone adenotonsillectomy. The use of tramadol increased the risk of nausea and vomit between 2 and 6 h after surgery.
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Soldatova L, Otero HJ, Saul DA, Barrera CA, Elden L. Lateral Neck Radiography in Preoperative Evaluation of Adenoid Hypertrophy. Ann Otol Rhinol Laryngol 2019; 129:482-488. [DOI: 10.1177/0003489419895035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To assess the value of lateral neck radiographs in quantifying adenoid hypertrophy to help guide treatment decisions in patients with symptoms of nasal obstruction. Study Design: Retrospective review. Methods: Quantitative radiologic grading of adenoids was correlated with the intraoperative grading to select cases in agreement between the two methods. The percent airway obstruction was calculated as a ratio of adenoid size to the size of the nasopharyngeal airway near the level of the choanae on the lateral neck radiographs for adenoidectomy cases in which radiographic and intraoperative grading of adenoid size were in agreement. Results: A total of 426 adenoidectomy cases with preoperative lateral neck radiographs were reviewed (M:F = 254:172 for age range 9 months to 16 years), and only cases in agreement between radiographic and intraoperative adenoid grading were included in radiographic analysis (N = 234). The percent airway obstruction values were significantly different between “severely obstructive” (N = 137, mean = 94.71, SD = 6.55, range [72.00; 100.00]) and “moderately obstructive” adenoid categories (N = 97, mean = 78.53, SD = 6.91, range [63.67; 98.08]), not only within clinically relevant age groups (1-3 years, 4-7 years, 8-15 years), but also for the entire data set (95% CI [14.41; 17.95], P < .0001). “Mildly obstructive” category was omitted due to small sample size (N = 4). Conclusion: Lateral neck radiographs can provide useful supplemental information on the degree of nasopharyngeal airway obstruction when other clinical findings do not clearly point toward adenoid hypertrophy as a primary cause of nasal obstruction. In our data set, a 65% nasopharyngeal airway obstruction represents a value two standard deviations below the mean for “moderately” obstructive adenoid category, and can be viewed as a simplified cut-off to indicate that the degree of adenoid enlargement is clinically relevant. This cut-off value can assist in evaluation of patients with symptoms of nasal obstruction. Level of Evidence: 4
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Affiliation(s)
- Liuba Soldatova
- Department of Otolaryngology—Head and Neck Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Hansel J. Otero
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - David A. Saul
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christian A. Barrera
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lisa Elden
- Department of Otolaryngology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Diouf JS, Ouédraogo Y, Souaré N, Badiane A, Diop-Bâ K, Ngom PI, Zouaki A, Diagne F. Comparison of dental arch measurements according to the grade and the obstructive character of adenoids. Int Orthod 2019; 17:333-341. [PMID: 30987957 DOI: 10.1016/j.ortho.2019.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Obstructive adenoid hypertrophy is cited as one of the causes of mouth breathing and leads to disharmony in the development of orofacial structures. The objective of this study was to compare the measurements of dental arches according to the grade and the obstructive character of adenoids. MATERIALS AND METHODS A cross-sectional study was carried out with 86 children. The grade and the obstructive character of adenoids were determined from Holmberg and Cohen's radiographic methods respectively. Dental arch measurements were taken on dental casts. A t-test and a Chi2 test were performed respectively to compare the quantitative and qualitative variables of dental arches according to the obstructive character. An Anova test made it possible to compare the quantitative variables according to the grade as Holmberg defined it. For variables that showed significant differences, a Post Hoc test was used. The significance level was set at P=0.05. RESULTS Subjects with obstructive adenoids had a shorter posterior mandibular length (P=0.04) and a greater overbite (P=0.04) than those with non-obstructive adenoids. Those with grade 4 had a greater arch depth (P=0.02) and were more prone to open bite(P=0.03). CONCLUSION A prevention program involving the otorhinolaryngologist and the orthodontist for subjects with obstructive adenoids or grade 4 is necessary to minimize their influence on dental arch relationships.
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Affiliation(s)
- Joseph Samba Diouf
- Université Cheikh Anta DIOP Dakar, Faculté de Médecine, de Pharmacie et d'Odontologie, Service d'Orthodontie, Département d'Odontologie, Senegal.
| | - Youssouf Ouédraogo
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Université Ouaga I, Ouagadougou, Burkina Faso
| | - Ngoné Souaré
- Université Cheikh Anta DIOP Dakar, Faculté de Médecine, de Pharmacie et d'Odontologie, Service d'Orthodontie, Département d'Odontologie, Senegal
| | - Alpha Badiane
- Université Cheikh Anta DIOP Dakar, Faculté de Médecine, de Pharmacie et d'Odontologie, Service d'Orthodontie, Département d'Odontologie, Senegal
| | - Khady Diop-Bâ
- Université Cheikh Anta DIOP Dakar, Faculté de Médecine, de Pharmacie et d'Odontologie, Service d'Orthodontie, Département d'Odontologie, Senegal
| | - Papa Ibrahima Ngom
- Université Cheikh Anta DIOP Dakar, Faculté de Médecine, de Pharmacie et d'Odontologie, Service d'Orthodontie, Département d'Odontologie, Senegal
| | - Ayoub Zouaki
- Université Cheikh Anta DIOP Dakar, Faculté de Médecine, de Pharmacie et d'Odontologie, Service d'Orthodontie, Département d'Odontologie, Senegal
| | - Falou Diagne
- Université Cheikh Anta DIOP Dakar, Faculté de Médecine, de Pharmacie et d'Odontologie, Service d'Orthodontie, Département d'Odontologie, Senegal
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Diouf JS, Ouedraogo Y, Seck K, Badiane A, Ngom PI, Diop-Ba K, Zouaki A, Diagne F. [Relationships between the size of the adenoids and the dental arch measurements]. Orthod Fr 2018; 89:411-420. [PMID: 30565559 DOI: 10.1051/orthodfr/2018037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 11/02/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Enlarged adenoids are often associated with oral breathing. The latter can impact the dental arches. The purpose of this study was to determine the relationships between dental arch measurements and the size of adenoids. MATERIALS AND METHODS A cross-sectional study was carried out on 86 children. The dimensions of the adenoids were determined from nine radiographic evaluation methods and the dental arch measurements made on the casts. The association between the grade of adenoids and the dental arch measurements was sought by Spearman correlation. That between the quantitative variables assessing adenoids and dental arch measurements was sought by Pearson correlation. The strength of these associations was analyzed using Cohen's values in 1988. The significance was set at p = 0.05. RESULTS Palatal depth was significantly and positively correlated with adenoid grade according to the method of Holmberg and Linder-Aronson (rho = 0.55, p = 0.005) and with the adenoid measurements according to the methods of Kemaloglu, Fujioka, Johannesson, De Menezes and Maran with r respectively equal to 0.65, 0.59, 0.63, 0.47, 0.74; and p respectively equal to 0.001, 0.002, 0.001, 0.019, and < 0.001. It was also significantly but negatively correlated with the adenoids measurements according to Hibbert's method (r = -0.52, p = 0.008). Overbite was significantly and negatively correlated with adenoid dimension using the De Menezes method (r = -0.541, p = 0.006). DISCUSSION The strength of the associations shows that using respectively Maran and De Menezes methods can allow to better highlight the association between the dimensions of the adenoids and the palatal depth and the overbite.
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Affiliation(s)
- Joseph Samba Diouf
- Service d'Orthodontie, Département d'Odontologie, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta DIOP Dakar, Sénégal
| | - Youssouf Ouedraogo
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Université Ouaga I, Ouagadougou, Burkina Faso
| | - Khady Seck
- Service d'Orthodontie, Département d'Odontologie, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta DIOP Dakar, Sénégal
| | - Alpha Badiane
- Service d'Orthodontie, Département d'Odontologie, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta DIOP Dakar, Sénégal
| | - Papa Ibrahima Ngom
- Service d'Orthodontie, Département d'Odontologie, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta DIOP Dakar, Sénégal
| | - Khady Diop-Ba
- Service d'Orthodontie, Département d'Odontologie, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta DIOP Dakar, Sénégal
| | - Ayoub Zouaki
- Service d'Orthodontie, Département d'Odontologie, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta DIOP Dakar, Sénégal
| | - Falou Diagne
- Service d'Orthodontie, Département d'Odontologie, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta DIOP Dakar, Sénégal
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Koifman ACB. Normal, abnormal, and inconclusive: has the ultrasound pattern of healthy cervical lymph nodes been defined? Radiol Bras 2016; 49:IX. [PMID: 27818556 PMCID: PMC5094814 DOI: 10.1590/0100-3984.2016.49.5e3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Ana Célia Baptista Koifman
- Adjunct Professor of Radiology at the Universidade Federal do Estado do Rio de Janeiro (Unirio) and at the Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil. E-mail:
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Ribeiro BNDF, Marchiori E. Rosai-Dorfman disease affecting the nasal cavities and paranasal sinuses. Radiol Bras 2016; 49:275-276. [PMID: 27777489 PMCID: PMC5073402 DOI: 10.1590/0100-3984.2015.0167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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