Facial nerve palsy following parotid gland surgery: A machine learning prediction outcome approach.

Introduction: Machine learning (ML)-based facial nerve injury (FNI) forecasting grounded on multicentric data has not been released up to now. Three distinct ML models, random forest (RF), K-nearest neighbor, and artificial neural network (ANN), for the prediction of FNI were evaluated in this mode. Methods: A retrospective, longitudinal, multicentric study was performed, including patients who went through parotid gland surgery for benign tumors at three different university hospitals. Results: Seven hundred and thirty-six patients were included. The most compelling aspects related to risk escalation of FNI were as follows: (1) location, in the mid-portion of the gland, near to or above the main trunk of the facial nerve and at the top part, over the frontal or the orbital branch of the facial nerve; (2) tumor volume in the anteroposterior axis; (3) the necessity to simultaneously dissect more than one level; and (4) the requirement of an extended resection compared to a lesser extended resection. By contrast, in accordance with the ML analysis, the size of the tumor (>3 cm), as well as gender and age did not result in a determining favor in relation to the risk of FNI. Discussion: The findings of this research conclude that ML models such as RF and ANN may serve evidence-based predictions from multicentric data regarding the risk of FNI. Conclusion: Along with the advent of ML technology, an improvement of the information regarding the potential risks of FNI associated with patients before each procedure may be achieved with the implementation of clinical, radiological, histological, and/or cytological data.

[Hypopharyngeal cancer: analysis of the evolution and treatment results]. / Cáncer de hipofaringe: análisis de la evolución y los resultados del tratamiento en nuestro medio.

OBJECTIVE: Hypopharyngeal carcinoma is an aggressive malignancy usually diagnosed at a late state, thereby resulting in overall poor prognosis and low survival rates for these patients. The purpose of this study is to present the progress and outcomes of patients treated for hypopharyngeal carcinoma at our department. MATERIAL AND METHOD: We retrospectively reviewed 89 patients who had been diagnosed with hypopharygeal carcinoma between 1980 and 2005. Most of the tumours were advanced (T3 and T4) and 73 % showed palpable regional metastases at presentation. RESULTS: The five-year survival rate was 40.7 %. The overall incidence of distant metastases and subsequent primary neoplasms was 7.5 % and 23.5 %, respectively. CONCLUSIONS: Hypopharyngeal cancer is still the one with the worst prognosis in the head and neck area. The poor survival rate seems to be related primarily to advanced stage disease at presentation and particularly to the status of cervical lymph-node metastases.

[Malignant multiple neoplasms in head and neck squamous cell carcinoma]. / Neoplasias malignas múltiples en el cáncer escamoso de cabeza y cuello.

INTRODUCTION: The incidence of multiple malignant neoplasms in the upper aerodigestive tract is high and ranges from 7% to 20%. We make a retrospective study to evaluate the incidence of multiple malignant neoplasms in head and neck squamous cell carcinomas, their main characteristics and survival. MATERIAL AND METHOD: We studied 103 multiple malignant neoplasms from an oncological database of 1330 patients with head and neck squamous cell carcinomas. We use the SPSS v15 for analysis of the results. RESULTS: The incidence of multiple malignant neoplasms in our series is 7.73 %. Tumours of the hypopharynx are the primary tumours most often associated with multiple malignant neoplasms (21.34 %), followed by tumours of the oropharynx (15.38 %). Lung tumours are the multiple malignant neoplasms most often associated (29.03 %). The 5-year global survival is 33 % from diagnosis of the second primary tumour, 78.02 % of which are metachronous with an average of 40 months between the diagnosis of the primary tumour and the presentation of the second tumour. CONCLUSIONS: Multiple malignant neoplasms are very frequent in the head and neck area which shows the importance of thorough regular check-ups of these patients as the presence of multiple malignant neoplasms considerably worsens the prognosis.

[Hemithyroidectomy: when it is necessary an intraoperative frozen-section biopsy?]. / Hemitiroidectomías: Ecuándo es necesaria la biopsia intraoperatoria?

INTRODUCTION: Many surgeons use intraoperative frozen section biopsy of the thyroid nodules to confirm malignant disease, but it continues to generate considerable controversy. We reviewed our recent experience to determinate de clinical utility of frozen section in our surgical management and intraoperative decision-making. PATIENTS AND METHOD: All patients who had operations for the thyroid nodular disease between 2000 and 2006 were included in this retrospective study. We compared the results of frozen section diagnosis and definitive histologic results in a population of 212 patients. RESULTS: Frozen section was false negative in 3 patients (1.66 %) and false positive in 1 (0.47 %) and avoided 12 reoperations (5.6 %). When there was not suspicious malignant disease had a sensitivity of 0.75 %. In the group of follicular disease the sensitivity was 3.7 %, and in the group with suspicious malignant disease was 37.5 %. CONCLUSIONS: Frozen section was more helpful in the group of suspicious for malignant disease. It does not seem to be necessary when fine-needle biopsy indicates bening or follicular disease.

[Revision stapedectomy]. / Cirugía de revisión de las estapedectomías.

OBJECTIVE: The aim of the study was to determine the causes of failure in otosclerosis surgery. MATERIAL AND METHOD: We performed 23 revisions of stapedectomy during the period between January 2000 and April 2005. The time between the primary surgery and the revision surgery ranged from 3 months to 25 years. The most frequent reasons for revision surgery were first of all patients with closed initial gap and progressive hearing loss in 56.52 % of cases and secondly patients without any initial hearing improvement in 39.12 % of cases. RESULTS: The main surgical findings were: short prosthesis in correct position (13.04 %), displaced prosthesis (60.87 %), bridles over the oval window (65.22 %), necrosis of the long process of the incus (26.2 %), and obliterative footplate (26.09 %). As for the audiometric results, we got a complete closure of gap in 60.8 % of patients (n = 14), partial closure of gap in 13.2 % (n = 3), persistence of the initial gap in 21.7 % (n = 5), and cophosis in 4.3 % (n = 1). CONCLUSIONS: The migration of the prosthesis is the main cause of failure after stapedectomy. Good closure of the gap was achieved in two thirds of the patients.