Schwannoma of the larynx. An infrequent laryngeal tumour.

Schwannomas are benign tumours, rare among tumours of the larynx. They normally present as supraglottic masses (because they may arise from the internal branch of the superior laryngeal nerve), most commonly involving aryepiglottic folds or false vocal folds. Most patients present with a globus sensation, dysphagia or hoarseness. Conservative surgery is the treatment of choice. We report a case of a laryngeal asymptomatic neuroma that was diagnosed accidentally in an imaging test. Complete excision of the tumour was performed through a transoral CO2 laser microsurgery without resorting to a tracheotomy. We discuss the clinical, pathologic and imaging findings and the management of this neoplasm. We also try to update the knowledge on the management of these tumours.

[Neck mass with infrequent origin]. / Masa cervical de origen infrecuente.

We report the case of a 67-year-old male diagnosed with prostate adenocarcinoma, who referred dysphagia, dysphonia and noticed the appearance of a laterocervical mass. A CT scan revealed an osteolytic soft tissue neck lesion, which was resected. Its anatomical-pathological study was compatible with metastasis of prostate adenocarcinoma.

[Transoral laser microsurgery in advanced carcinomas of larynx and pharynx]. / Cirugía transoral LASER CO2 en tumores avanzados de faringe y laringe.

INTRODUCTION AND OBJECTIVES: There are several types of treatment for advanced squamous cell carcinomas of the pharynx and larynx. However, both open surgery and chemoradiation protocols have failed to improve control and survival. There is a tendency toward conservative treatment without worsening oncological outcomes. The objective of this study was to describe the effectiveness of organ-preserving CO2 laser microsurgery for treating advanced carcinomas of the larynx and pharynx. MATERIAL AND METHOD: A retrospective review of 63 patients undergoing CO2 laser microsurgery for the treatment of squamous cell carcinomas of the pharynx and larynx in advanced stages (stages III and IV) was performed. Tumour distribution was 14 patients with a tumour at the base of the tongue, 16 with a pyriform sinus tumour, 29 with a supraglottic tumour and 4 with a glottic tumour. Mean follow-up was 51 months. RESULTS: Thirty-five percent of patients (23) had recurrences. The recurrence rate was 28% for base of tongue tumours, 50% for hypopharyngeal tumours, 27% for supraglottic tumours and 75% for glottic tumours. The 5-year disease-specific survival rate was 73.3% for all locations, with a range from 90% for supraglottic tumours up to 50% for glottic tumours. Thirty-four percent of patients had some type of complication after surgery. The most frequent complication was local bleeding (17%). CONCLUSION: Transoral CO2 laser microsurgery is an alternative for the treatment of carcinomas of the pharynx and larynx in advanced stages. Its oncological results are equivalent to other treatment modalities and its morbidity is lower.

Baroreceptor failure after bilateral resection of carotid artery parangliomas.

Multiple head and neck parangliomas are unusual pathologies. We report a case of a 24-year-old patient operated on at our centre for bilateral carotid artery parangliomas who developed baroreceptor failure after their resection. Albeit an infrequent complication, it is important to be aware of it in order to ensure is speedy diagnosis and treatment so as to avoid major post-surgical complications.

Ludwig's angina as an extremely unusual complication for direct microlaryngoscopy.

BACKGROUND: An extremely rare case that to our knowledge has not been reported before is described, in which a patient had a Ludwig's angina as a complication of direct microlaryngoscopy. METHODS: We report a Ludwig's angina after a direct microlaryngoscopy for a Reinke's edema, due to erosion on the internal face of the mandible produced by compression of the laryngoscope. RESULTS: The patient underwent placement of 2 drainages, intraoral and cervical, and several incisions on the floor of the mouth, with intravenous corticosteroids and antibiotics and with resolution of the illness without performing tracheostomy. CONCLUSIONS: Ludwig's angina is an extremely rare complication of microlaryngoscopy, but it is potentially life-threatening. Early diagnosis and treatment resulted in survival of the patient without complications.

[Inverted sinonasal papillomas. Review of 61 cases]. / Papilomas invertidos rinosinusales. Revisión de 61 casos.

INTRODUCTION: Inverted papillomas are benign sinonasal lesions that arise primarily from the lateral nasal wall which are characterized by their tendency to recur and propensity to be associated with malignancy. The aim of this work is to analyze our experience in the treatment of these lesions, especially through the endoscopic approach. MATERIAL AND METHOD: We present 61 cases of sinonasal inverted papillomas that were treated at our hospital since 1983. The patients were studied by age, gender, site of presentation of the tumor, symptoms, radiologic studies, surgical treatment and evolution. The mean follow-up was 51 months (range 6-228 months). RESULTS: Thirty eight of the patients (62%) were males and 23 females (38%). The average age was 58 years (range 22-80). The most common symptom was unilateral nasal obstruction in 91% of the cases, followed by rhinorrhea in 46%. The most frequent location was the ethmoid region in 51% of cases, followed by the maxillary sinus in 28% and the lateral nasal wall in 21% of the cases. 78% of cases had associated sinusitis and the 43% polyposis. Tumours were classified with the Krouse staging system as follows: 35% stage I, 37% stage II, 18% stage III and 8% stage IV. 37% of the patients had bony erosion in the CT scan. Six of the 42 patients treated by endoscopic procedures presented recurrence (14%), compared with 6 of the 9 patients (67%) who were treated by open approaches. The average time to the recurrence was 41 months. 17% of the patients had malignant inverted papillomas, nine of them diagnosed from the beginning as malignant neoplasies and one which became malignant during follow up. DISCUSSION AND CONCLUSIONS: The endoscopic approach is the method of choice for the treatment of the majority of inverted papillomas. The close follow up of the patient for a large period of time is necessary for the early detection of recurrence and to allow for surgical salvage.

Simultaneous pleomorphic adenomas of the hard palate and parapharyngeal space.

We report a very unusual presentation of simultaneous pleomorphic adenomas of 2 different locations, hard palate and parapharyngeal space. Patient age of presentation is rare because these tumors are seen in younger patients. We treated a 70-year-old woman with these 2 tumors, resecting both lesions with intraoral and cervical approaches. Pleomorphic adenomas are frequent lesions, but in the literature reviewed, we have not found articles reporting 2 simultaneous pleomorphic adenomas of these locations. Complete surgical resection is very important to avoid recurrences.

[Sinonasal mucosal melanomas. Review of 17 case]. / Melanomas mucosos rinosinusales. Revisión de 17 casos.

INTRODUCTION: Mucosal melanomas (MM) represent 1.3 % of all melanomas; 55 % of them are located in the head and neck region mainly in the sinonasal and oropharyngeal cavity. Sinonasal mucosal melanomas have a high rate of local recurrence and a high risk of developing metastases, two reasons explaining the low survival rate. MATERIAL AND METHOD: We present 17 cases of sinonasal mucosal melanomas that were diagnosed and treated in our department from 1984 to July, 2008. The patients were studied by age, gender, site of presentation of the tumour, symptoms, radiology findings, treatment and course. RESULTS: Seventeen patients with sinonasal mucosal melanomas were studied. Of these 64.7 % were females and the mean age at presentation was 74 (range 48 to 93 years). Twelve cases developed in the nasal cavity and 5 in the paranasal sinuses. The most frequent site of presentation was the septum (35 %), and the most common symptom was epistaxis (77 %). Three patients rejected any treatment, 12 of the patients were treated surgically, one received chemotherapy and another chemotherapy plus radiotherapy. The 5 year disease-specific survival rate was 35.7 %. DISCUSSION AND CONCLUSIONS: Sinonasal mucosal melanomas are rare tumours with a high mortality. The treatment of choice is still surgical resection with wide surgical margins. Even so, the main cause of treatment failure is local recurrence, followed by the development of metastases. Because of the poor prognosis with this tumour, new treatment strategies are necessary.

Giant cell tumor of the greater wing of the sphenoid: an unusual presentation.

We report a very unusual presentation of giant cell tumor probably originated on the greater wing of the sphenoid and show a review about the knowledge and the treatment of the lesion in this rare localization. We treated a 48-year-old man with a giant cell tumor of the infratemporal fossa. He presented with a right-side hearing loss and facial pain. The tumor was resected by means of a subtemporal-preauricular approach, and after 12 months of follow-up, the patient is free of recurrence. Giant cell tumors of the skull base are an extremely rare neoplasm, and there is not much information on the literature about the treatment and the prognostic. Wide resection ought to be made, and at the follow-up, the clinician must try to diagnose not only local recurrence but also the possibility of distant metastases to the lung.

[Adaptation and validation to the Spanish of the Voice Handicap Index (VHI-30) and its shortened version (VHI-10)]. / Adaptación y validación del índice de incapacidad vocal (VHI-30) y su versión abreviada (VHI-10) al español.

INTRODUCTION: The Voice Handicap Index has been shown to be a valid instrument for assessing self-perceived handicap associated with dysphonia. OBJECTIVES: To test the psychometric properties of the Spanish version of the VHI-30 (Voice Handicap Index) and its shortened version VHI-10. SUBJECTS AND METHOD: The original VHI-30 was translated into Spanish and was completed by 232 dysphonic patients and 38 non-dysphonic individuals. Prospective instrument validation was performed. RESULTS: Results showed high test-retest reliability, and high item-total correlation for both Spanish VHI-30 and VHI-10. Internal consistency demonstrated a Cronbach's alpha of 0.93 and 0.86, respectively, and a significant correlation was found between the VHI scores and the patients' self-rated dysphonic severity. CONCLUSIONS: The present study supports the use of Spanish versions of VHI-30 and VHI-10 because of their validity and reliability.