[Fistula of the first branchial arch]. / Fístula de primer arco branquial.

The complexity of the embriologic development of the neck and the possible abnomarlies in this process, with the consequent posterior manifestations make necessary the knowledge of the embriologic anatomy of the neck. In the possible manifestations that can be of the anomalies of the development of the branchial archs are the abnomarlies of the first branchial archs. They are, in the anomalies of the development of the branchial archs infrequent and are intimately related with the facial nerve. We present a clinic case of a seven years old boy affected by this pathology and revise its more important aspects.

[Arterioveinous dural malformation in ENT]. / Malformaciones arteriovenosas durales en el ambito de la ORL.

The arterioveinous dural malformation (MAVD) is a rare entity between the vascular craneal anomalies with a not well nown ethiology and variability in treatments. We present eleven cases of MAVDs, between them five presented tinnitus as symptom of aparition. The importance of this pathology makes necessary to discard it before a patient consulting because of pulsaltil tinnitus with normal otoscopy.

[Persistence of the third branchial arch]. / Persistencia de tercer arco branquial.

The third branquial arch anomalies represent less than 1% of this deformites. The clinical manifestation can be varied althouth the formation of cysts is the commonest one and may appear at any time in life. We report the clinical case of a 7 year old boy with an neck mass. This mass was diagnosed as a branquial cyst. The patologist found a "timic reminescences". We carry out a review of the literature for this pathology.

[Cochlear implants in obliterated or ossified cochleas]. / Implantes cocleares en cócleas obliteradas o semiosificadas.

Our last cases of cochlear implants in obliterated or ossified cochleas are presented, and we had described the surgical technique for double-array or compressed system. In our opinion the best surgical method is the combined approach (endoaural with aticotomy view and posterior timpanotomy) for increased promontory view. This technique provides the advantage that it always preserve the posterior wall of the external ear canal, and the array is positioned easily.

[Internal carotid artery loop: an uncommon cause of parapharyngeal tumor]. / Bucle de arteria carótida interna: una causa infrecuente de tumoración parafaríngea.

The parapharyngeal space-occupying lessions may develop from any of the structures located inside it. Uncommon although possible ethiologies for them are anatomic variations of the course of the internal carotid artery. These anatomic variants mainly arise from degenerative, mostly age-amplified, causes and lead to elongations, angulations, kinking and tortuosities in the course of the vessel that appear as impressions or protusions of the pharyngeal wall. Utherly unfrecuently lead to loops that may show as large parapharyngeal tumors. This fact should be noticed previously to any invasive procedure to be performed on the patient specially when evidenced in concommitance with an infectious process at the moment of diagnosis. A case of an impressive internal carotid artery loop that conditioned an important parapharyngeal mass in a patient with an associated pharyngeal infection is reported to warn about this rare parapharyngeal space-occupying condition and its potential danger.

[Tuberculous epiglotittis, an atypical form of laryngeal tuberculosis. Presentation of a case and revision of litterature]. / Epiglotis tuberculosa, una forma atípica de tuberculosis laríngea. Presentación de un caso y revisión de la literatura.

An important arousal of tuberculosis has been observed in the last years, together with a change in it's clinical patterns, specially the extrapulmonar form, among wich is this laryngeal tuberculosis. This two facts and the marked polymorphism and mimetism proper of this condition may suggest that the Mycobacterium tuberculosis should be included in the differential diagnosis of any atypical lesion of the larynx, in order to obtain an earlier diagnosis excluding carcinoma and instaurate a chimotherapic protocol for minimizing or even avoiding any sequelae. Tuberculous epiglotittis is one of these atypical and unusual forms. The authors report a case of a 67 year-old male and provide a discussion on the diagnostic problems of this condition.

[Idiopathic Frey's syndrome under the appearance of a recurrent otitis externa]. / Síndrome de Frey idiopático bajo la apariciencia de una otitis externa recidivante. Tratamiento con neuro-toxina botulínica tipo A.

Frey syndrome has been observed especially in patients who have undergone a parotidectomy operation, but also in zoster herpes, in parotiditis, condilea fractures, obstetric traumatisms with forceps and in surgery of the meningioma of the cerebellopontine angle. It also appears without previous surgery, like in our case. In these circumstances it is believed that a clinical neuritis, primary or secondary to a neighbouring inflammation may cause the start of this disorder. Several treatments have been suggested which highlights the difficulty of them. The most effective one is the intradermic injection of botulinum toxin type A. Its use in Frey's syndrome was initiated by Drobik and Laskawi in 1995. Since then the references to its use are numerous. Nevertheless, it is a treatment which has been introduced very few times in our country.

[Epidermoid cyst of the parapharyngeal space]. / Quiste epidermoide de espacio parafaríngeo.

Epidermal cysts of parapharyngeal location are very unusual tumors, with a benign character, though when they reach a great size, adjacent zones and vascular and nervous structures of great importance can be affected. We are going to describe the clinical aspects of this case, the instructions and the surgical approach used: the Fabre inferior and internal jaw approach of the lateropharingeal space and infrasphenotemporal fossa, which avoids the aesthetics and functional aftereffects of other more common approaches.

[Tuberculous otitis media. Report of 3 cases]. / Otitis media tuberculosa. Estudio de 3 casos.

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear. Due to that the symptoms and signs are often indistinguishable from those of nontuberculosis chronic otitis media and the fact that the index of suspicion is low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications such as facial nerve paralysis and labyrinthitis. Medical therapy with antituberculous drugs is usually effective. We report three cases with TOM diagnosticated and followed up in our Service from january 1993 to july 2001. Their charts were retrospectively reviewed for relevant historical data, physical findings, complementary studies, treatment and clinical response. We performed a review of the literature, emphasizing that TOM should be considered in the differential diagnosis of chronic otitis media.

[Clinical descriptive study of 40 patients with carcinoma of the nasopharynx in advanced stage in an area of low epidemiological risk]. / Estudio clínico descriptivo de 40 pacientes con carcinoma de nasofaringe en estadio avanzado en un área de bajo riesgo epidemiológico.

The nasopharyngeal carcinoma in Spain, low risk geographical area, is a rare tumor. This is the cause why there few papers about it in our country. We have carried out a muestral descriptive statistical study. We have selected among all the patients diagnosed of nasopharyngeal carcinoma a big group who, have been treated with induction chemotherapy followed by radiotherapy with or without surgery, they presented very complete clinical histories in the Departments of E.N.T., Oncology and Radiotherapy that allowed us to compare all the picked up data and this increased, without doubt, the reliability of them. The results obtained in the different examined variables of our patients are the same that those we found in literature. The nasopharyngeal carcinoma is a tumor that usually affects young patients, of both sexes, without previous consumption of alcohol and tobacco and they are diagnosed in advanced stages. The rhinologic symptoms are the most frequent ones but the cervical nodes are the usual cause for consulting a doctor with a long diagnostic interval. There is a prevalence in the undifferentiated tumors showed by histology.

[Morphometric and stereologic nuclear values obtained from the study of a population suffering from nasopharyngeal carcinoma]. / Valores morfométricos y estereológicos nucleares obtenidos en el estudio de una población con carcinoma de nasofaringe.

Computer nuclear morphometry and stereology are attractive methods because its objectivity and cheapness allowing histologic diagnosis when identifying minimal variations respectively the normality and also detect negligible disparities between anormal cells which could escape to the assessment of the pathologist. We present the data gained from several morphogenic and stereologic parameters resulting of measurements of tumoral cells procured from 40 patients with nasopharyngeal carcinomata. Middle values have been: nuclear area 27.70 microns 2; nuclear perimeter 20.80 microns; nuclear factor of form 0.81 microns; nuclear outline index 4.01; nuclear orientation angle 87.29 degrees; nuclear ellipsiticity 704.14; nuclear regularity 61.83; middle lineal length 4.30, middle linear distance 107.94; and nuclear volume 118.80 microns 3. Our series is the largest studied till now of all found in the literature. Comparison our data with those of previous publications.

[Survival rate in epidermoid carcinoma of the oral cavity]. / Supervivencia en el carcinoma epidermoide de cavidad oral.

The present study aims to analyse the survival of 94 patients with squamous cell carcinoma of the oral cavity. They were 86 men and 8 women with a mean age of 61. Seventy four percent were smokers and 70% consumed alcohol regularly. Eighty three percent had unhealthy teeth. A great majority of patients (76) were in the advanced stages (III-IV) and 61% showed neck nodules. The overall survival at 5 years was the following: 70% for patients in stage I, 85% in stage II, 58% stage III and only 17% for the patients in stage IV. The most significant prognostic factor that affected the survival was the N stage. For the patients in N0 and N1 we only found significant differences when the lymph nodes were histologically affected by the tumor.

[Type I Chiari malformation as a cause of inferior vertical nystagmus]. / Malformación de Chiari tipo I como causa de nistagmo vertical inferior.

Down beat nystagmus is a central nystagmus. In the literature reviewed the two most common causes that can produce it are cerebellar degenerations and Chiari malformation. The site of lesion causing this nystagmus appears to be the brainstem or the cerebellum, although the definitive etiopathogeny remains controversial. We report the case of a 73-year-old woman with sudden unsteadiness of gait and down beating nystagmus, without any other vestibular or neurologic signs. Simple radiology and MRI evidenciated a Chiari malformation type 1 associated to plastybasia.

[First year of experience in laryngectomy and pharyngolaryngectomy with Pearson type laryngotracheal myomucosal shunt]. / Primer año de experiencia en laringectomías y faringolaringectomías con shunt miomucoso laringotraqueal tipo Pearson.

In this essay we deal with different aspects of the techniques described by Pearson and cols. in 1980, carrying out an analysis of objectives, indications and contraindications, physiological fundamentals, description of the surgical technique, aftercare and exposition of the results achieved in patients operated from September 1996-97.

[Tongue tuberculosis as the first expression of the lung process]. / Tuberculosis lingual como primera manifestación de un proceso pulmonar.

Nowadays tuberculosis incidence seems to increase again after past decades fall. This event has been worsen because of the growth of resistances, basically due to patient's failure to comply with scheduled specific therapeutics. Anyway the decrease of tuberculosis leads initially to lowering of extrapulmonary forms, being the mouth cavity one of the most infrequent seat, so that location can be omitted at first glance diagnosis. We report one tongue tuberculosis case, which was the first expression of a lung tuberculosis, and discuss other manifestations within oral cavity and also the problems of some cases, as well as the best treatment.

[Goldenhar syndrome: a polymalformation syndrome with conductive hearing loss]. / Síndrome de Goldenhar. Un síndrome polimalformativo con hipoacusia de transmisión

We report the case of a 9-years-old girl showing at examination facial asymmetry, right ear with II degree dysplasy and degree III in the left ear (according Marx classification), cleft palate, renal agenesy, scoliosis and hypoplasy of the left thumb. Otoscopically both external ear canals looked very narrow and very upright positioned. The drumhead image recalling that of chronic mucoid effusion. The measurement of hearing through pure-tone audiometry, PEATC, and tympanometry resulted in a pattern of bilateral transmissive pantonal hearing impairment accounting for 50-60 dB. Scoliosis was due either to bars or hemivertebrae or even to an atlas occipitalization. Chromosoma caryotype was normal.

[Nasal leiomyosarcoma]. / Leiomiosarcoma nasal.

Leiomyosarcoma is an infrequent soft-tissue tumor that generally occurs in the myometrium and gastrointestinal tract. Primary tumors of the veins are unusual and generally occur in the inferior vena cava and only exceptionally in peripheral veins, such as the jugular or its branches. We report a case of leiomyosarcoma located in the left inferior turbinate. The 87 year-old male patient presented nasal obstruction and recurrent nosebleed. He had pulmonary and mediastinal metastases at the time of diagnosis.

[Benign necrotizing osteitis of the external ear canal. A report of a clinical case]. / Osteítis necrotizante benigna del conducto auditivo externo. Descripción de un caso clínico.

Benign necrotizing osteitis of the external ear canal is a process of unknown origin. This necrotic process with sequestration of the tympanic bone occurs in healthy, non-diabetic patients. It should be differentiated from malignant otitis externa and radionecrosis of the tympanic bone. A case is reported and the literature on this rare clinical entity is discussed.

[Labyrinth aspects of cranial Paget's disease]. / Manifestaciones laberínticas en la enfermedad de Paget craneal.

We report the case of a 44-year-old woman suffering, since 5 years, from repetitive vertigo seizures, lasting less than one hour, together with light neuro-sensorial deafness, fullness of the left ear and left ear tinnitus. After analysis of audiologic and imagery tests a Meniere's syndrome secondary to Paget disease--confirm histologically through cortical cranial biopsy--was established.