[Lateral crural "J" flap repair to correct nasal valve collapse]. / El colgajo en "J" de la crus lateral del cartílago alar en el tratamiento del colapso de la válvula nasal.

INTRODUCTION: Nasal valve collapse is a common cause of nasal airway obstruction. Although many techniques have been devised to treat this problem, the outcomes of most of them have been disappointing. The aim of this study is to report our experience using the lateral crural J-flap repair to correct the nasal valve collapse. This technique is based on a new view of the structural etiology of nasal valve collapse and it offers excellent functional and aesthetic outcomes. MATERIAL AND METHODS: We present a retrospective study of 19 patients diagnosed of nasal valve collapse that underwent lateral crural J-flap repair from 2003 to 2005. RESULTS: 28 lateral crural J-flap repairs were made. Six patients underwent concomitant nasal surgery. Mean follow-up was 428 days All the patients have reported improvement of the subjective sensation of inspiratory collapse and there has been no noticeable decrement in benefit over time. No complications due to the procedure were observed. CONCLUSION: The lateral crural J-flap repair is an efective treatment for nasal valve collapse with minimal morbidity and a high success rate.

[Montgomery salivary bypass tube: a simple solution for pharyngocutaneous fistulas]. / El tubo de derivación salival de montgomery: una solución sencilla para las fístulas faringocutáneas.

INTRODUCTION: The pharyngocutaneous fistulas (PCF) are among the complications surgeons and nursing personnel fear the most due to their complexity to prevent and/or cure them. Montgomery salivary bypass tube is an effective therapeutic option in the treatment of the PCF following laryngectomy. The aim of our study was to describe our experience with salivary bypass in the treatment of the PCF. METHODS: This was a retrospective analysis of pharyngocutaneous fistulas in 21 patients in whom total laryngectomy was performed for squamous cell carcinoma of the larynx or hypopharynx (January 1999-December 2005). We determinate the overall efficacy of the Montgomery salivary bypass tube in the treatment of the PCF. RESULTS: A pharyngocutaneous fistula developed within a mean time of 7 days from surgery (from 2nd to 20th day). Montgomery salivary bypass tube was the therapeutic option in all these PCF.12 patients required local anesthesia to introduce the tube and in 9 patients the insertion method was with general anesthesia with direct vision of the hypopharynx. The mean healing time was 26 days, except in one case. This PCF achieved spontaneous closure with local wound care after the bypass was removed. CONCLUSIONS: The observed results corroborated the relevance of Montgomery salivary bypass tube as an important therapeutic option in the treatment of the PCF. There was no need of surgical treatment.

[The relationship between human papillomavirus and cyclin D1 gene amplification in squamous cell carcinomas of the head and neck]. / Relación entre el virus del papiloma humano y la amplificación del gen de la ciclina D1 en los carcinomas epidermoides de cabeza y cuello.

INTRODUCTION: infection by oncogenic subtypes of human papillomavirus (HPV) and cyclin D1 gene (CCND1) amplification are frequent events in head and neck squamous cell carcinomas. The objective of this paper is to establish the relationship between the presence of human papillomavirus (HPV) gene sequences and the development of CCND1 gene amplification in these tumours. MATERIALS AND METHODS: 59 squamous cell carcinomas of the head and neck were studied for HPV types 6b and 16 and CCND1 gene amplification by polymerase chain reaction. RESULTS: HPV DNA was detected in 14 tumors (24%). Ten of them were positive for the HPV type 6b and 4 for the HPV type 16. CCND1 gene amplification was found in 15 cases (25%). Although we have found a higher frequency of CCND1 amplification in the HPV-positive cases (36%, versus 22% in the HPV-negative cases), these differences were not statistically significant (P= 0,32). CONCLUSIONS: The presence of HPV gene sequences does not seem to be related to a significative higher incidence of CCND1 gene amplification in the squamous cell carcinomas of the head and neck.

[Prognostic factors in adenoid cystic carcinoma of salivary glands]. / Factores pronósticos en el carcinoma adenoide quístico de glándulas salivares.

OBJECTIVE: Adenoid cystic carcinoma (ACC) is a relatively rare tumor which is characterized by its long clinical history, with multiple recurrences and late distant metastasis. The aim of the present study is to show our experience in the management of this tumor and the relationship of different clinico-pathological parameters with its prognosis. MATERIAL AND METHODS: A retrospective study was carried out between 1984 and 2004 in 28 patients with ACC of the salivary glands, analyzing the most outstanding clinico-pathological variables in this tumor related to the prognosis of the tumor and the survival. RESULTS: The overall survival rates at 5, 10 and 15 years were 88%, 69% and 52% respectively. Ten (36%) patients presented local recurrence and 10 (36%) presented distant metastasis (four of which also have local recurrence). Although the differences were not statistically significant, the patients with solid histological subtype (p=0.17), with positive margins status (p=0.2), with perineural invasion (p=0.59), and those treated with surgery alone (p=0.19), presented a worse survival. DISCUSSION/CONCLUSION: Our study confirms that the ACC is a tumor with a high tendency to local recurrence and development of distant metastasis, even long term, which means a close follow-up for life. Nevertheless, it also demonstrates that acceptable survival rates can be obtained with aggressive treatment.

[Endoscopic nasal surgery for pterigopalatine fossa schwannoma]. / Abordaje de un schwannoma de la fosa pterigo-palatina por cirugía endoscópica nasal.

Schwannomas are tumors of nerve sheath origin, the lesion being derived from the Schwann cells surrounding neural tissue in most of the peripheral, cranial and autonomic nerves. Schwannomas occurring in the head and neck represent 25-35% of all reported schwannomas, and most commonly arise from the acoustic or the neumogastric nerves. In the nose and paranasal sinuses these tumors are very uncommon (fewer than 4% of all schwannomas). In the pterygopalatine fossa they are very rare, and arise in this case from the ophthalmic and maxillary branches of the trigeminal nerve. In this exceptional site, the tumor is classically approached through a Caldwell-Luc incision. In this case, we report the removal of a schwannoma of the pterygopalatine fossa by endoscopic sinus surgery.

[Anaplastic thyroid carcinoma. Our experience]. / Carcinoma anaplásico de tiroides. Nuestra experiencia.

UNLABELLED: Anaplastic thyroid cancer ranks among the most lethal of all known human malignancies, and remains almost uniformly fatal. It represents approximately 1% of all thyroid carcinomas. MATERIALS AND METHODS: A retrospective study was performed including all anaplastic thyroid carcinoma cases diagnosed in our institution between 1989 and 2000. RESULTS: We collected 15 cases previously biopsied as anaplastic thyroid carcinoma. Three of them were treated with a curative intention; different palliative modalities were carried out for the remaining cases. None of the cases survived more than 1 year, and the median survival time was 3.5 months. DISCUSSION/CONCLUSION: This study confirms the previously known aggressiveness of this neoplasm, in which the prognosis and evolution remain to be fatal.

[Expression of annexins Al and A2 in the mucosa of the upper airdigestive tract]. / Expresión de las anexinas Al y A2 en la mucosa del tracto aerodigestivo superior.

INTRODUCTION: Annexins A1 and A2 have been related with the maintenance of tissue integrity. They have been identified in a wide variety of tissues, but little is known regarding their expression in upper the aerodigestive tract. The aim of this work is to describe the expression of these proteins in the mucosa of the upper aerodigestive tract. MATERIAL AND METHODS: Tissue samples from respiratory (nasal and laryngeal) and digestive (oral and pharyngeal) mucosa from non-oncological patients were studied. Annexin A1 and A2 expression was determined by immunohistochemistry. RESULTS: Both annexins were expressed in the ciliated and in the stratified non-keratinized epithelia, but with a different pattern; ANXA1 was expressed in the more differentiated cells whereas ANXA2 was expressed in the less differentiated ones (with the exception of the cilia of ciliated cells). CONCLUSION: Although annexins A1 and A2 are structurally and philogenetically related its expression pattern in the upper aerodigestive tract suggests that they have different functions.

[Insertion of Montgomery salivary bypass tube under local anesthesia in patients with pharyngocutaneous fistula following total laryngectomy]. / Inserción del tubo de derivación salival de Montgomery con anestesia local en pacientes con fístula faringocutánea tras laringectomía total.

Montgomery salivary bypass tube is an effective therapeutic option in the treatment of the pharyngocutaneous fistulas following laryngectomy. The original insertion technique requires general anesthesia to introduce the tube with direct vision of the hypopharynx. In this paper we present an insertion method based in the Seldinger technique that allows the placement of the tube under local anesthesia in a rapid fashion and well tolerated by the patients.

[DNA extraction using Chelex resin for oncogenic amplification analysis in head and neck tumours]. / Extracción de ADN con resina Chelex en el análisis de la amplificación oncogénica en carcinomas de cabeza y cuello.

DNA extraction from tissues can be the most laborious and complex step in amplifying DNA by PCR when phenol-choroform procedure is used. We compare this lengthy, slow and expensive extraction method with other two based in the use of Chelex-100 resin. This chelating resin has been applied for extracting DNA from different tissues to use with the PCR. These procedures are simple, rapid and do not require multiple steps. In this study we compared DNA extraction from 30 head and neck squamous cell carcinomas (HNSCC) using organic solvent precipitation, Chelex 100 resin with and without proteinase K pretreatment. The results show that proteinase K-Chelex 100 procedure is as efficient as the phenol-chloroform one.

[CCND1 gene amplification in the adenoid cystic carcinoma of the minor salivary glands]. / Amplificación del gen de la ciclina D1 en los carcinomas adenoides quísticos de glándulas salivares menores.

OBJECTIVE: Adenoid cystic carcinoma (ACC) is a tumour of epithelial origin that represents the most common malignant neoplasm of the minor salivary glands. However, little is known about the genes involved in the development and progression of this tumour. Cyclin D1 gene (CCND1) plays a key role in the control of the cell cycle, and its amplification is described in numerous cancers. The aim of this study is to determine the amplification of the CCND1 gene in the ACC of the minor salivary glands. MATERIALS AND METHODS: A retrospective study was performed on 12 patients with ACC of the head and neck. The amplification of the CCND1 was determined using multiple PCR. RESULTS: Amplification of the CCND1 was found in 4 patients (33.3%). No correlation was found between CCND1 amplification and clinicopathological parameters, although disease-free survival was diminished in patients with amplification. DISCUSSION/CONCLUSIONS: Our study demonstrates for the first time the amplification of the CCND1 gene in ACC. We have found an amplification rate similar to others neoplasms. CCND1 amplification seems to be associated with a poorer prognosis in these tumours, although this needs to be confirmed in larger studies.

[Epidermal growth factor receptor gene amplification and E-cadherin expression in head and neck carcinomas]. / Amplificación del gen del receptor del factor de crecimiento epidérmico y expresión de la E-cadherina en los carcinomas de cabeza y cuello.

INTRODUCTION: The E-cadherin adhesion molecule is fundamentally involved in the maintenance of normal epithelial morphology and differentiation. The scattering and invasion of cancer cells induced by epidermal growth factor receptor (EGFR) activation has been suggested to be probably by affecting E-cadherin function. The aim of this study is to confirm whether EGFR amplification is related to E-cadherin expression in head and neck squamous cell carcinomas. MATERIAL AND METHODS: Fifty patients with head and neck squamous cell carcinoma were studied. EGFR amplification was analyzed by semiquantitative PCR. E-cadherin expressión was determined by immunohistochemistry. RESULTS: EGFR amplification was found in 9 cases (18%). E-cadherin expression was generally weaker in tumors than in adjacent normal epithelium. No relationship was found between EGFR amplification and E-cadherin expression. CONCLUSION: EGFR amplification did not affect the level of E-cadherin expression, suggesting a complementary role of both of these molecules in reduction of cellular adhesion in head and neck squamous cell carcinomas.

[Angiomyoma of the retropharyngeal space]. / Angiomioma del espacio retrofaríngeo.

We report the case of a 65-year-old male patient with an angiomyoma of the retropharyngeal space. Angiomyoma is a tumour that arises from the smooth muscle in the wall of blood vessels. It is a relatively rare tumour of the head and neck, mostly in deep locations. This one is the second reported angiomyoma of the retropharyngeal space. Although image examinations and fine needle aspiration (FNA) did point to a vascular tumour, the diagnosis of this lesion is made by on excisional biopsy and histological staining with vimentin, desmin, actin or myosin. The treatment is excision of the tumour and recurrence is exceptional.

[Inactivation of p53 and amplification of cyclin D1 in squamous cell carcinomas of the head and neck]. / Inactivación de P53 y amplificación de la ciclina D1 en los carcinomas epidermoides de cabeza y cuello.

P53 and CCND1 (cyclin D1) genes play a critical role in the cell cycle regulation. Abnormalities of these genes are frequent in different types of cancers, including those of the head and neck. The aim of this work is to investigate whether P53 inactivation (determined by loss of heterozygosity analysis) is related to CCND1 gene amplification (determined by differential PCR analysis), and if these alterations are correlated with clinical outcome in a series of 56 patients with squamous cell carcinoma of the head and neck. Loss of heterozygosity of the P53 gene was found in 39 cases (70%) and CCND1 amplification in 17 cases (30%). Both abnormalities together were found in 11 cases (20%), without a significant association between them (P = 0.83). No relationship was found between P53 inactivation, the clinico-pathological parameters analyzed and the clinical outcome. CCND1 amplification was associated with advanced T-stages (P = 0.02), nodal metastases (P = 0.01) and a decreased survival (P = 0.002). The combination of both abnormalities shows a pattern that seems to be additive, since it was associated with an increase in tumor recurrences and a decrease in survival that was higher than for either of them individually. In conclusion, P53 and CCND1 abnormalities are frequent in squamous cell carcinomas of the head and neck. The combined analysis of these abnormalities seems to be more informative than either of them individually and may have a prognostic value in these carcinomas.

[Prognostic significance of the expression of adhesion molecules E-cadherin, Cd44s and CD44V6 in supraglottic squamous carcinoma]. / Significado pronóstico de la expresión de las moléculas de adhesión E-cadherina, CD44s y CD44V6 en los carcinomas epidermoides supraglóticos.

OBJECTIVE: To establish the prognostic significance of the expression of adhesion molecules E-cadherin, CD44s and CD44v6 in squamous cell carcinomas of the supraglottic larynx. MATERIAL AND METHODS: The expression of the studied molecules was determined by immunohistochemistry in paraffin-embedded tissue specimens from 101 patients. RESULTS: The expression of the three molecules was reduced in carcinomas compared to normal epithelium. The cases with recurrence showed an E-cadherin and CD44s expression significantly lower than those cases without recurrence. Reduced expression of any of the three molecules correlated with a decrease in survival, although the differences were not significant. In multivariate analysis only nodal stage (N) was an independent prognostic factor. CONCLUSIONS: Although reduced expression of E-cadherin, CD44s and CD44v6 seems to be related to a poor prognosis in supraglottic squamous cell carcinomas, these changes do not offer a useful adjunct to current prognostic indicators.

[CCND1 oncogene amplification and cellular DNA content in squamous cell carcinomas of the head and neck]. / Amplificación del oncogén CCND1 y contenido celular de ADN en los carcinomas epidermoides de cabeza y cuello.

Cyclin D1 protein (encoded by the CCND1 gene) contributes to the progression of the cell cycle in the G1/S checkpoint. Cyclin D1 overexpression (for instance as a consequence of CCND1 amplification) might result in loss of control over genetic damage at this point and in an accumulation of chromosomal aberrations. In this work we analyze whether CCND1 amplification is associated with a higher incidence of alterations in cellular DNA content. 31 squamous cell carcinomas of the head and neck were studied. CCND1 amplification was determined by polymerase chain reaction. Cellular DNA content was determined by flow cytometry. CCND1 amplification was found in 6 (19%) cases. Thirteen (42%) cases were diploid and 18 (58%) were aneuploid. Two (33%) of the 6 cases with CCND1 amplification were aneuploid compared with 16 (64%) of the cases without CCND1 amplification (P = 0.36). We conclude that CCND1 amplification is not associated to a higher incidence of chromosomal aberrations in squamous cell carcinomas of the head and neck.

[Relationship between the integration of human papillomavirus and loss of heterozygosity of the P53 gene in squamous cell carcinomas of the head and neck]. / Asociación entre la integración del virus del papiloma humano y la pérdida de heterozigosidad del gen p53 en los carcinomas epidermoides de cabeza y cuello.

Human papillomavirus integration in cellular DNA and loss of heterozygosity of P53 gene are both related with tumour formation process by promoting genomic instability that leads to DNA abnormalities accumulation. In order to analyze the relationship between both events, 26 squamous cell carcinomas of the head and neck were studied. HPV 16 and 6b DNA was detected by PCR in 8 cases (31%), whereas P53 loss of heterozygosity was present in 16 cases (61%). No correlation was found between both events and they were not related to clinical factors neither the prognosis. Consequently, HPV integration and loss of heterozygosity of P53 seem to act independently in the genesis of these tumours.

[Molecular changes in epidermoid carcinoma of the oropharynx]. / Alteraciones moleculares en los carcinomas epidermoides de la orofaringe.

In most of the studies about molecular alterations in squamous cell carcinomas of the head and neck there is not distinction between the different subsites of this area. The objective of this study is to describe the molecular alterations in squamous cell carcinomas of the oropharynx. Twenty-nine oropharyngeal carcinomas, with a minimum follow-up of 36 months, were studied. The molecular alterations analyzed were: the amplification of 11q13 region (in the 29 cases), and the MYC and ERBB1 oncogenes (in 22 cases); the integration of Human Papillomavirus (HPV) types 6b and 16 (in 22 cases); the loss of heterozygosity (LOH) of p53 and N-acetyltransferase-2 (NAT2) gene (in 12 and 13 informative cases, respectively); and the cellular DNA content (in 13 cases). The most frequent alterations found were the LOH at p53 (67%), and NAT2 (54%) locus, followed by 11q13 amplification (49%). ERBB1 amplification was found in 14% of the cases, and MYC amplification only in one (5%). Integration of the HPV was found in 23% of the cases. Nine (69%) of the 13 analyzed cases were aneuploid. The only alteration with a prognostic significance was 11q13 amplification that showed a tendency to be associated with a higher frequency of nodal metastases and tumor recurrence.

[Preoperative evaluation in thyroplasty: the laryngeal lateral compression]. / Valoración preoperatoria de la tiroplastia: el test de compresión lateral de la laringe.

Thyroplasty type I has provided significant improvement to the treatment of patients with glottal incompetence. It is essential that patients be preoperatively evaluated using objective criteria. Laryngeal manual compression test are manipulations of the thyroid and cricoid cartilages that result in modifications of the position of the vocal folds. The most valuable laryngeal manual compression test for patients with glottal insufficiency is the lateral compression test. When this test results in a preoperative improvement in voice suggest that surgery will be successful. In this paper we present the objective evaluation of the effects of lateral compression test upon glottic incompetence by means of narrow band power spectrum analysis.

[A giant bilateral concha bullosa causing nasal obstruction]. / Concha bullosa bilateral gigante causante de obstrucción nasal.

Pneumatization of the middle turbinate or concha bullosa is the most common anatomical variant of this structure. Although usually small and asymptomatic, a large concha bullosa may obstruct sinus drainage. We present an uncommon case of massive bilateral concha bullosa that produced complete obstruction of the left nasal cavity and partial obstruction of the right nasal cavity.