Complete remission of stage IV sinonasal small cell neuroendocrine carcinoma: A case report.

Sinonasal small cell carcinoma (SmCC) is a rare type of neoplasm. The current case report describes the case of a 30-year-old male patient with stage IV SmCC who underwent concurrent radiotherapy (RT) plus etoposide-cisplatin treatment. Positron emission tomography (PET)/computed tomography (CT) and fibroscopy examination showed complete remission at 3 months post-treatment. However, leptomeningeal metastasis (LM) occurred at 9 months. A literature search identified no previous case reports describing LM of SmCC. The patient was treated with concurrent RT plus irinotecan-gemcitabine. During the sixth cycle of irinotecan-gemcitabine, the patient required intensive care admission due to severe acute respiratory syndrome-related coronavirus 2-associated pneumonia. Following clearance of the pneumonia, LM was assessed using PET/CT and MRI at 3 months, which revealed a complete response to irinotecan-gemcitabine. In May 2021, the patient succumbed to LM following disease recurrence. The findings of this case report should encourage other authors to publish their treatment outcomes regarding SmCC. More clinical trials are required to achieve better results in terms of patient outcome.

Modified alar batten grafts for treatment in nasal valve dysfunction: Our experience.

OBJECTIVE: Alar batten grafts are used to treat in nasal valve dysfunction (NVD). They can be placed by open or closed rhinoplasty using rib, septal, or auricular concha cartilage. Our surgical team used a modified placement of the classic alar batten.We aim to describe these changes and to the technique and demonstrate that modified alar batten grafts can improve the effects of spreader grafts and classic alar batten grafts. METHODS: A retrospective study of 91 functional rhinoplasties was performed from March 2011 to November 2019 at a public university hospital in Murcia. The patients were divided into three groups. Group A included patients operated on using spreader grafts, group B included patients operated on using spreader grafts associated with alar batten grafts fixed to the caudal edge of the lateral crura of the lower lateral cartilage (LLC), and group C included patients operated on using modified alar batten grafts. RESULTS: A total of 91 functional rhinoplasties were performed, 31 patients were operated on in group A, 27 patients were operated on in group B, and 33 patients were operated on in group C. The success rate was 67.7% in group A, 70.4% in group B and 93.9% in group C. CONCLUSION: Modified alar batten grafts achieved better results than spreader grafts and spreader grafts associated with classic alar batten grafts. The size, position and placement of the sutures of modified alar batten grafts were the key factors in improving our results.

Emergent tracheostomy during the pandemic of COVID-19: Slovenian National Recommendations.

PURPOSE: Emergent tracheostomy under local anaesthesia is a reliable method of airway management when orotracheal intubation is not possible. COVID-19 is spread through aerosol making the emergent tracheostomy a high-risk procedure for surgeons. The surgical establishment of the air conduit in emergency scenarios must be adjusted for safety reasons. METHODS: To establish the Slovenian National Guidelines for airway management in cannot intubate-cannot ventilate situations in COVID-19 positive patients. RESULTS: Good communication and coordination between surgeon and anaesthesiologist is absolutely necessary. Deep general anaesthesia, full muscle relaxation and adequate preoxygenation without intubation are initial steps. The surgical cricothyrotomy is performed quickly, the thin orotracheal tube is inserted, the cuff is inflated and ventilation begins. Following patient stabilisation, the conversion to the tracheostomy is undertaken with the following features: skin infiltration with vasoconstrictor, a vertical incision, avoidance of electrical devices in favour of classical manners of haemostasis, the advancement of the tube towards the carina, performing the tracheal window in complete apnoea following adequate oxygenation, the insertion of non-fenestrated canulla attached to a heat and moisture exchanger, the fixation of canulla with stitches and tapes, and the cricothyrotomy entrance closure. Appropriate safety equipment is equally important. CONCLUSION: The goal of the guidelines is to make the procedure safer for medical teams, without harming the patients. Further improvements of the guidelines will surely appear as COVID-19 is a new entity and there is not yet much experience in handling it.

The osteotomy diameter in the transcanalicular laser dacryocystorhinostomy. Our experience in 192 lacrimal pathways.

OBJECTIVES: We want to evaluate the influence of the size of the osteotomy on the postsurgical outcomes. METHODS: A retrospective study was performed in patients who underwent TCL-DCR from January 1, 2008, to March 1, 2019. The patients were divided into two groups: the patients in one group were subjected to LP surgery with an osteotomy diameter equal to 9 mm ± 1 mm (group A), and the patients in the other group were subjected to surgery with an osteotomy diameter equal to 14 mm ± 1 mm (group B). RESULTS: A total of 159 lacrimal pathways (LPs) were operated on in group A with a success rate (SR) of 66.6%. Thirty-three LPs were operated on in group B with an SR of 81.8%. CONCLUSION: An osteotomy diameter equal to 14 mm ± 1 mm achieved better postoperative results than an osteotomy diameter equal to 9 mm ± 1 mm.

Facial paralysis: Clinical practice guideline of the Spanish Society of Otolaryngology. / Parálisis facial: guía de práctica clínica de la Sociedad Española de ORL.

Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve.

Otoplasty Using the Combined Mustardé-Furnas Technique: Satisfaction and Objective Results.

BACKGROUND: To understand the level of satisfaction among patients undergoing otoplasty using the combined Mustardé-Furnas technique. To evaluate surgery outcomes using McDowell/Wright (MW) criteria. OBJECTIVES: The authors sought to analyze any possible correlation between satisfaction level and surgery outcome. METHODS: The authors conducted a retrospective study on patients who underwent combined Mustardé and Furnas otoplasty between 1996 and 2016. All patients were assessed 12 months after surgery employing MW goals and satisfaction surveys. RESULTS: The study includes 172 patients who underwent 343 otoplasty procedures. There were 134 patients (77.9%) who had all 6 of the criteria for surgical success as defined by MW 12 months after surgery, reporting satisfaction levels of 9 to 10. Fifteen patients (9.3%) had 5 of the 6 MW criteria, reporting satisfaction levels of 9 to 10, and 22 patients (12.79%) had only 4 MW objectives and reported satisfaction levels of 7 to 10. The Spearman rho coefficient was 0.545 and the Kendall coefficient was 0.375, with a statistically significant association (P < 0.001). CONCLUSIONS: Patient satisfaction increases as the number of MW goals are met, although the correlation is moderate to low. Patients perceive the results of the surgery as satisfactory or very satisfactory, even when ENT surgeons consider outcomes to be poor according to MW criteria.

Pseudoepitheliomatous Hyperplasia of the Larynx Requiring Total Laryngectomy.

BACKGROUND Pseudoepitheliomatous hyperplasia (PEH) is a reactive epithelial proliferation occurring secondary to infection, neoplasm, injury, and inflammation. The histopathological characteristics of PEH may lead to it being confused with well-differentiated squamous cell carcinoma (SCC). CASE REPORT We present here the case of a 57-year-old male patient, who was diabetic and a smoker, who presented with dysphonia. Although nasal endoscopy suggested SCC, morphological and immunophenotypical study of biopsy tissue ruled out malignancy. CONCLUSIONS As the prognosis worsened, the patient required several urgent surgical interventions due to bleeding abscesses and dyspnea. A total laryngectomy was performed.

Anatomical variants and bilateral lacrimal pathways surgery: avoiding unnecessary surgery.

Success rates (SR) of transcanalicular diode laser-assisted dacryocystorhinostomy (TCL DCR) may be affected by the presence of nasal anatomical variations and additionally by whether or not the pathology is bilateral. The aim is to determine whether it is necessary to perform preliminary nasal anatomical variations surgery and to determine whether bilateral cases may be operated simultaneously. We extracted the patients undergoing simultaneous bilateral TCL DCR and we compared SR across the different groups using ANOVA, Chi-square testing and logistical regression. 159 Lacrimal pathways were operated: 89 unilateral and 35 bilateral. Non-nasal anatomical variations (non-NAV) unilateral surgery returned a success of 72.72%. The mean SR for nasal anatomical variations (NAV) unilateral surgery was 70.1%. The SR for non-NAV bilateral surgery was 60.86%. The mean SR for nasal anatomical variations bilateral surgery was 58.33%. As we identified no significant differences in the SR for NAV and non-NAV patients, we can avoid simultaneous corrective surgery.

Influence of Septal Deviation on the Prognosis of Transcanalicular Diode Laser-Assisted Dacryocystorhinostomy.

Purpose. The objective of the present study is to determine whether the success rate in transcanalicular diode laser-assisted dacryocystorhinostomy (TCL DCR) is influenced by the variant septal deviation (SD). Methods. Patients were divided into two groups: one including operated lacrimal pathways (LP) with no anatomical nasosinusal variants and the other group of LP with SD. This study began on January 1, 2008, and ended on December 31, 2010, at Morales Meseguer Hospital. Variables were compared by means of ANOVA and a logistic regression model (LOGIT). Results. Out of the 159 LP operated on, 102 had no nasosinusal anatomic variant, but 39 LP were associated with SD. The first group evidenced a success rate of 67.64%, while the second group evidenced a success rate of 66.7%. Conclusion. We found no significant statistical differences between the success rates in the two groups (with SD and no anatomical variants). So we could avoid previous or concomitant septoplasty in some cases (mild and moderate SD).

Delayed diagnosis of childhood deafness: the value of false negatives in the Programme for Early Detection of Neonatal Hearing Loss. / Retraso en el diagnóstico de sordera infantil: el valor de los falsos negativos en el Programa de Detección Precoz de Hipoacusias Neonatales.

INTRODUCTION: Despite its importance, the existence of false negatives (patients who are told they hear well, but they have some degree of hipacusia) is rarely evaluated in programs for early detection of hearing loss. The aim of this study is to determine the variables that can lead to a delayed diagnosis, especially the existence of false negatives and the lack of registration of risk factors. METHODS: A retrospective study of prevalence has been carried out, in which the medical records of children diagnosed with sensorineural hearing loss born within 2005 and 2012 in the health centers of study have been analyzed. RESULTS: Of the 32 children with sensorineural hearing loss, 16 passed the OAE, 12 did not passed the OAE, and in four they were not carried out. Of the children who passed the OAE, 57% have severe hearing loss. 66% of children with hearing loss presented a risk factor for hearing loss at birth, being the most frecuent family history of hearing loss, but only 7% of those with family history of hearing loss were included in the risk group. CONCLUSIONS: The results of the study indicate that the late diagnosis of hearing loss is related to the presence of false negatives to the OAE and the non-registration of risk factors.

Hyperfunctional parathyroid carcinoma with mediastinal extension.

Parathyroid carcinoma (PC) is an extremely rare malignancy, 0.005% of all tumours and between 0.5% and 5% of all parathyroid neoplasms. Preoperative diagnosis is often difficult and is almost always obtained only after post-surgical histopathology. The prognosis is related to the local extent of disease and to complete surgical resection of the tumour. We report an uncommon case of hyperfunctional PC with mediastinal extension, emphasising the diagnostic difficulties, histopathological features and treatment strategies. The most recent data in the literature is analysed as well.

[Thirteen years' experience with superficial partial parotidectomy as treatment for benign parotid tumours]. / Trece años de experiencia en parotidectomía parcial superficial como tratamiento de neoformaciones benignas parotideas.

INTRODUCTION: Most authors agree that surgery is the treatment of choice for benign tumours of the parotid gland. However, the best surgical technique and the extent of surgery remain controversial. This study attempts to establish whether the implementation of a partial superficial parotidectomy (PSP) is appropriate for the treatment of benign parotid gland tumours. MATERIAL AND METHODS: We selected 63 patients with benign parotid gland surgery, of whom 43 had a pleomorphic adenoma and 20, a Warthin tumour. Of this group of 63 patients, 6 could not be included. We consequently studied 57 patients, 41 of them diagnosed as pleomorphic adenoma and 16, as Warthin tumours. In all of them, a PSP was performed without intraoperative monitoring of the facial nerve. RESULTS: Transient facial nerve paralysis, 14 patients (24.5%). Ten cases were resolved within the first month after surgery and 4 before the third month, after indicating facial physiotherapy. One patient (1.7%) had a permanent difficulty in keeping one side of the lower lip aligned under pressure-mobility, without altering commissure mobility. None of the patients studied had a recurrence (control, 3-13 years). CONCLUSIONS: Although PSP is a technique with a few complications, it has a recurrence rate comparable to or lower than other techniques used for the treatment of pleomorphic adenomas or Warthin parotid tumours. Intraoperative facial nerve monitoring can be helpful during surgery. The lack of monitoring would not be considered a contraindication for surgery.