Intralabyrinthine schwannomas : Surgical management and hearing rehabilitation with cochlear implants.

Intralabyrinthine schwannomas (ILS) are a rare differential diagnosis of sudden hearing loss and vertigo. In an own case series of 12 patients, 6 tumors showed an intracochlear, 3 an intravestibular, 1 a transmodiolar including the cerebellopontine angle (CPA), 1a transotic including the CPA, and 1 a multilocular location. The tumors were removed surgically in 9 patients, whereas 3 patients decided for a "wait-and-test-and-scan" strategy. Of the surgical patients, 3 underwent labyrinthectomy and cochlear implant (CI) surgery in a single-stage procedure; 1 patient had extended cochleostomy with CI surgery; 3 underwent partial or subtotal cochleoectomy, with partial cochlear reconstruction and CI surgery (n = 1) or implantation of electrode dummies for possible later CI after repeated MRI follow-up (n = 2); and in 2 patients, the tumors of the internal auditory canal and cerebellopontine angle exhibiting transmodiolar or transmacular growth were removed by combined translabyrinthine-transotic resection. For the intracochlear tumors, vestibular function could mostly be preserved after surgery. In all cases with CI surgery, hearing rehabilitation was successful, although speech discrimination was limited for the case with subtotal cochleoectomy. Surgical removal of intracochlear schwannomas via partial or subtotal cochleoectomy is, in principle, possible with preservation of vestibular function. In the authors' opinion, radiotherapy of ILS is only indicated in isolated cases. Cochlear implantation during or after tumor resection (i. e., as synchronous or staged surgeries) is an option for hearing rehabilitation in cartain cases and represents a therapeutic approach in contrast to a "wait-and-test-and-scan" strategy.

[Intralabyrinthine schwannomas : Surgical management and hearing rehabilitation with cochlear implants. German version]. / Intralabyrinthäre Schwannome : Chirurgisches Management und Hörrehabilitation mit Cochleaimplantaten.

Intralabyrinthine schwannomas (ILS) are a rare differential diagnosis of sudden hearing loss and vertigo. In an own case series of 12 patients, 6 tumors showed an intracochlear, 3 an intravestibular, 1 a transmodiolar including the cerebello-pontine angle (CPA), 1 a transotic including the CPA and 1 a multilocular location. The tumors were removed surgically in 9 patients, whereas 3 patients opted for a "wait-and-test-and-scan" strategy. Of the surgical patients, 3 underwent labyrinthectomy and cochlear implant (CI) surgery in a single stage procedure; 1 patient received extended cochleostomy with CI surgery; 3 underwent partial or subtotal cochleoectomy, with partial cochlear reconstruction and CI surgery (n = 1) or implantation of electrode dummies for possible later CI following repeated MRI follow-up (n = 2); and in 2 patients, the tumors of the internal auditory canal and cerebellopontile angle exhibiting transmodiolar or transmacular growth were removed by combined translabyrinthine-transotic resection. For the intracochlear tumors, vestibular function could mostly be preserved after surgery. In all cases with CI surgery, hearing rehabilitation was successful, although speech discrimination was limited for the case with subtotal cochleoectomy. Surgical removal of intracochlear schwannomas via partial or subtotal cochleoectomy is, in principle, possible with preservation of vestibular function. In the authors' opinion, radiotherapy of ILS is only indicated in isolated cases. Provided performed early enough, cochlear implantation after surgical removal of ILS is an option for auditory rehabilitation, thus representing-in contrast to the "wait-and-test-and-scan" strategy-a therapeutic approach.

Use of autologous platelet derivatives for secondary alveoloplasty in patients with cleft lip and palate: a systematic review and meta-analysis.

This study aimed to evaluate the effectiveness of autologous platelet derivatives (APD), specifically platelet-rich plasma (PRP) or platelet-rich fibrin (PRF), combined with autogenous iliac crest bone grafts in secondary alveoloplasty for patients with cleft lip and palate. Electronic databases, relevant journals, and reference lists of included studies were searched until July 2022. Best-evidence synthesis was performed to draw conclusions. After the search strategies, 12 randomized controlled trials were included that provided data on six outcomes: newly formed bone, mean bone loss in height and width, bone density, functionality, and postoperative complications. Two authors independently assessed the risk of bias, and the certainty of evidence was assessed using the GRADE approach. The pooled results suggest that there is uncertainty as to whether the combination of APDs with autogenous iliac crest bone grafts improves the percentage of newly formed bone, as the certainty of the evidence was assessed as very low. It may slightly improve the functionality of patients (with low certainty of the evidence) and probably slightly reduces the incidence of postoperative complications (with moderate certainty of evidence). Further randomized clinical trials with standardized methodologies are required to validate these findings.

[Prevalence of ano-rectal pathology in HIV/AIDS patients]. / Prevalencia de patología ano-rectal en pacientes portadores de VIH/SIDA.

INTRODUCTION: The ano-rectal pathology (ARP) is the most common surgical condition in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Our aim was to determine the current prevalence and clinical characteristics of the ARP in patients with HIV/AIDS in clinical control in the infectious diseases unit of the Hernán Henríquez Aravena Hospital in Temuco. STUDY DESIGN: Cross section. Location and period: Infectious Diseases Unit of the hospital during the month of June 2010. INCLUSION CRITERIA: Patients with HIV/AIDS under control in the unit, medical records were analyzed and complete physical examination was performed. RESULTS: In the period of study 384 patients were in control in the unit. Fifty had ARP which is a prevalence of 13%. Anal condyloma disease and hemorrhoidal disease were the most common diseases. Most patients (76%) were on antiretroviral therapy with good clinical response. CONCLUSION: The prevalence of ARP in HIV/AIDS patient has increased in recent years. This study shows a change in the pattern of presentation, being anal condyloma the most common ARP.

[Metastasis to the lateral skull base]. / Metastase eines Trachealkarzinoms im Bereich der Felsenbeinspitze.

BACKGROUND: Tumours and metastases of the lateral skull base are rare findings. Clinically, the progressive involvement of ipsilateral cranial nerves is important. CASE REPORT: A 69-year-old man presented with headache and palsies of the facial nerve and nerve VI. Furthermore, he had hearing loss and hypaesthesia of the trigeminal nerve (V3). Four months previously, laser therapy for carcinoma of the trachea (cT4 cN3 cM0) had been done. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed an intrapetrosal mass with destruction of the lateral skull base. The findings suggested a metastasis of the tracheal carcinoma. We performed a mastoidectomy with specimen collection, and the pathological analysis revealed infiltration of a squamous cell carcinoma. The patient died within 3 weeks after radiotherapy with palliative intention despite malignant progression. CONCLUSION: The diagnosis and therapy of metastases to the lateral skull base is an interdisciplinary challenge. CT and MRI scans are essential for planning further procedures. In cases of headache and cranial nerve palsies, a metastasis to the lateral skull base must be considered in the differential diagnosis.

[Interferon-alpha as treatment option in severe persistent uncontrolled bronchial asthma: an open label study]. / Interferon-alpha als Therapieoption bei der Behandlung des schwergradig persistierenden, unkontrollierten Asthma bronchiale: Eine offene Studie.

BACKGROUND: The purpose of this study was to evaluate the long-term safety and therapeutic effects of IFN-alpha in patients with severe persistent uncontrolled asthma on long-term oral glucocorticoid (GC) treatment. PATIENTS AND METHODS: The study included 16 patients (2 male, 14 female; age 39 years [range: 24 - 63]) with severe persistent asthma. Diagnosis and severity classification of asthma were established according to the guidelines of the "Deutsche Atemwegsliga". Eight patients stopped the therapy within 7 months due to side effects (n = 3), costs not covered by health insurance (n = 2), non-compliance (n = 2), and change of residence (n = 1). 8 patients (8 female, age 49 years [range: 35 - 68], duration of disease 16 years [range: 5 - 24]) were treated for at least 12 months with IFN-alpha (9 microg) 3 times/week. All patients were on oral glucocorticoids (GCs) for more than 5 years (average dose 17.5 [range: 5.0 - 64.0] mg/d). Clinical signs, lung function, need for reliever medication, number of emergency visits and hospitalisations and diary were assessed prior to and after 12 months of treatment. Data are given as percent of normal or median [range]. RESULTS: IFN-alpha improved lung function after 12 months: FEV1 64 vs. 75 %; FEV1/IVC 76 vs. 89 %; RV 153 % vs. 129 %; Rtot 193 vs. 111 % and morning PEF by 50 - 190 L/min. IFN-alpha also significantly reduced the use of reliever medication (10 [2 - 20] vs. 1 [0 - 3] puffs/d), nocturnal awakening (11 [4 - 30] vs. 1 [0 - 5]/month), emergency visits (7 [2 - 15] vs. 0 [0 - 5]/month) and hospitalisations (4 [1 - 8] vs. 0 [0 - 5]/year). In 5 patients the asthma attacks and nightly disturbances disappeared completely. The improvements were achieved despite a tapering of the oral GCs in all patients from 17.5 (5.0 - 64.0) to 2 (0 - 16) mg/d. In 5 patients GC treatment could be discontinued. The number of blood eosinophils decreased from 0.46 to 0.28 Gpt/L. Adverse events were transient and usually decreased within 3 to 4 weeks. Two patients developed an autoimmune thyreoiditis. CONCLUSION: In severe persistent, uncontrolled, and GC-dependent asthma, treatment with IFN-alpha leads to sustained clinical improvement and allows the reduction or discontinuation of oral GCs. Severe side effects may occur in isolated cases.

[Secondary amaurosis after infraorbital injury with a wooden foreign body]. / Sekundäre Erblindung nach orbitaler Holzfremdkörperverletzung.

We report a 68-year-old male who had orbital trauma from a bicycle accident. His vision was initially normal but deteriorated over 8 days to complete blindness. After 13 days, when he first consulted a physician, clinical investigation revealed total ophthalmoplegia, ptosis, and chemosis. Computed tomographic scan showed fractures of the medial orbital wall, orbital floor, and posterior ethmoid with dislocation into the orbital apex near the optic nerve. The patient was sent to our department for optic nerve decompression. Clinical examination showed induration and an already healed infraorbital entry wound suggesting an orbital foreign body, which was confirmed by ultrasound. Renewed analysis of CT scans in different window settings could clearly demonstrate a wooden foreign body in the lower eyelid. Additionally, a diffuse inflammation in the orbital apex was diagnosed. The foreign body was removed and decompression of the orbita and optic nerve was performed. Antibiotics and corticosteroids were administered i.v. Unfortunately, no visual improvement could be achieved.

[Is diabetes in the elderly patient a risk factor for cataracts?]. / Sind diabetische Erkrankungen beim älteren Patienten ein Kataraktriskofaktor?

The higher prevalence of diabetes for cataracts as a component of the multifactorial genesis of age-related cataracts has been proven in several epidemiological studies. Most of these results identified diabetes as a highly significant risk factor for cataracts in older diabetic males and females. The increased cataract risk of diabetics then decreases after the age of 65 years and is related to different types of opacity. In addition to the sorbitol pathway, diabetic hyperglycaemia causes increased formation of glucose-derived advanced glycation cytotoxic end-products. In connection with these specific pathological changes, the crucial role of the lens epithelium with respect to cataractogenesis is emphasised in several studies. The results of our own prospective clinical study proved the significantly lower mean cell density in type II diabetics compared with eyes from non-diabetics. Together with the other determined morphological cell characteristics, this result seems to be due to the cataractogenic influence of diabetic metabolic disorders on the lens There are some indications for the primary cataractogenic importance of the lens epithelium in type II diabetes.

Rinoseptoplastía: experiencia de 3 años en la Pontificia Universidad Católica de Chile / Rhinoseptoplasty: three-year experience at the Pontificia Universidad Católica de Chile

RESUMEN Introducción: La rinoseptoplastía es una cirugía compleja y desafiante. Permite resolver problemas estéticos y funcionales de la nariz. Objetivo: Describir la experiencia en rinoseptoplastías realizadas en el Comité de Nariz en nuestro centro. Material y método: Estudio descriptivo de pacientes sometidos a rinoseptoplastía entre 2013 y 2015. Resultados: Se operaron 265 pacientes en 3 años, 164 (61,8%) fueron mujeres y la edad promedio fue de 29 años (rango 13-73). Las cirugías fueron principalmente primarias (secundarias: 2,6%). El abordaje más utilizado fue abierto (92,5%). Se realizó trabajo de punta nasal en 253 (95,5%) pacientes; resección del dorso osteocartilaginoso en 252 (95,1%), y aumento de éste en sólo 5 (1,9%). Las osteotomías fueron frecuentes: paramedianas en 229 (86,4%), percutánea lateral bilateral en 217 (81,9%) y percutánea lateral unilateral en 17 (6,4%). El vástago columelar fue el injerto de punta más frecuentemente utilizado, en 241 (90,9%) pacientes, seguido del escudo en 69 (26,0%). En el dorso, se utilizaron autoespaciadores en 124 (46,7%) pacientes, y espaciadores en 109 (41,1%). Conclusiones: El abordaje abierto fue el más frecuente, demostrando ser favorable en nuestro centro por la exposición y aprendizaje de nuestros residentes. Se constató 2,6% de cirugías secundarias. Se destaca el uso de vástago columelar para otorgar soporte a la punta nasal dada la alta prevalencia de nariz hispana en nuestro centro.

ABSTRACT Introduction: Rhinoseptoplasty is a complex and challenging surgery. It addresses nasal aesthetics and functionality. Aim: To describe the experience in rhinoseptoplasty performed by the Nose Committee at our medical center. Material and method: Descriptive study, of the all rhinoseptoplasties performed by the Nose Committee between 2013 and 2015. Results: 265 patients underwent surgery in the 3-year period; 164 (61.8%) were women and the mean age was 29 years (range 13-73). Most were primary surgeries (secondary: 2.6%). An external approach was most commonly used (92.5%). Nasal tip surgery was performed in 253 (95.5%) patients; osteocartilaginous dorsum reduction in 252 (95,1%), and augmentation in only 5 (1,9%). Osteotomies were frequent: paramedian in 229 (86.4%), bilateral percutaneous lateral osteotomies in 217 (81.9%) and unilateral percutaneous lateral in 17 (6.4%). Regarding nasal tip grafts, columellar strut was most often used, in 241 (90,9%) patients, followed by the shield graft in 69 (26,0%). For the dorsum, autospreaders were used in 124 (46.7%), and spreader grafts in 109 (41.1%). Conclusions: Open rhinoseptoplasty was the most commonly used approach. This has shown favorable for residents due to better exposition of nasal anatomy. Only 2.6% were secondary rhinoseptoplasties. We emphasize the use of the columellar strut for nasal tip support as we frequently encounter hispanic noses at our center.

Bola fúngica de cavidades paranasales: serie de casos / Fungus ball of the paranasal sinuses: case series

RESUMEN Introducción La bola fúngica (BF) es una sinusitis fúngica no invasiva, con acumulación extramucosa de conglomerados densos de hifas de hongos en cavidades paranasales (CPN), afectando generalmente a mujeres inmunocompetentes. Objetivo Describir la presentación cínica, diagnóstico y tratamiento de una serie de pacientes con diagnóstico de BF de CPN. Material y método Estudio descriptivo retrospectivo de pacientes con diagnóstico histopatológico de BF sometidos a cirugía endoscópica nasal (CEN) en nuestra institución entre 2010 y 2016. Resultados Se incluyeron 20 pacientes (15 mujeres, 5 hombres), con edad promedio al diagnóstico de 64 años (35-86 años), la mayoría inmunocompetente (85%). El síntoma más frecuente fue dolor facial (8/20). Todos los pacientes fueron estudiados con tomografia computarizada (TC) de CPN, presentando calcificaciones en 70%. La ubicación más frecuente fue el seno maxilar (12/20) y luego esfenoidal (6/20). Se realizó CEN en todos los pacientes, combinándolo con Caldwell Luc en 3 de ellos. Los cultivos intraoperatorios resultaron negativos en el 75% de los pacientes. Conclusión La BF tiene presentación cínica inespecifica. Se sospecha en base a hallazgos imagenológicos en la TC de CPN y se confirma histopatológicamente, dado el bajo rendimiento de los cultivos. La CEN es la herramienta diagnóstico-terapéutica de elección, con baja tasa de recidiva local.

ABSTRACT Introduction A fungus ball (FB) is a non-invasive fungal sinusitis, consisting of extramucosal accumulation of dense fungal hyphae conglomerates, located in paranasal sinuses. It generally affects immunocompetent women. Aim To describe the clinical presentation, diagnosis and treatment in a series of patients diagnosed with FB of paranasal sinuses. Material and method Retrospective descriptive study regarding all patients with a histopathologic diagnosis of FB, who underwent endoscopic sinus surgery (ESS) in our institution between 2010 and 2016. Results Twenty patients (15 women, 5 men) were included, with a mean age at diagnosis of 64 years (35-86 years). Most were immunocompetent (85%). Facial pain was the most frequent symptom (8/20). All patients were studied with a sinus CT, finding paranasal calcifications in 70%. It predominantly involved the maxillary (12/20), and sphenoid sinus (6/20). All patients were treated with ESS, with a combined Caldwell Luc approach in only 3 of them. Intraoperative cultures were negative in 75% of patients. Conclusions Sinus FB has a non-specific clinical presentation. CT findings help suspect it, and it is confirmed with a histopathological study, given the poor efficiency of cultures. ESS is the diagnostic-therapeutic procedure of choice, with a low local recurrence rate.

Tumor condroide del cartílago tiroides: reporte de un caso clínico y revisión de la literatura / Chondroid tumor of the thyroid cartilage: case report and literature review

Los tumores condroides de la laringe son poco frecuentes, y generalmente se ubican en el cartílago cricoides. El tratamiento de elección es quirúrgico, con buen pronóstico general. Se presenta el caso de un hombre de 60 años con historia de disfonía. El estudio nasofaringolaringofibroscópico revela una masa laríngea supraglótica. Las imágenes son compatibles con una lesión del cartílago tiroides. La biopsia obtenida por microlaringoscopía directa informa tumor compatible con condroma. Se realiza una resección completa de la masa por abordaje externo, la biopsia corrobora el diagnóstico de tumor condroide de bajo grado. Se describe esta patología mediante revisión bibliográfica.

Chondroid tumors of the larynx are uncommon, and usually located in the cricoid cartilage. Surgery is the treatment of choice, with good prognosis in general. We report the case of a 60-year-old man consulting for dysphonia. The nasopharyngolaryngoscopy showed a supraglottic laryngeal mass. The images were compatible with a thyroid cartilage lesion. The biopsy sample obtained by direct microlaryngoscopy was consistent with a condroma. A complete excision of the lesion was performed by external approach and the biopsy confirmed the diagnosis of a low grade chondroid tumor. We present a review of chondroid tumors of the larynx based on available literature.

Estenosis subglótica en pacientes con granulomatosis con poliangeítis / Subglottic stenosis in patients with granulomatosis with polyangiitis

Introducción: La granulomatosis con poliangeítis (GPA) es una enfermedad autoinmune con múltiples manifestaciones otorrinolaringológicas. La estenosis subglótica (ESG) se reporta entre 8%-50% de los pacientes. Objetivo: Describir la presentación clínica y tratamiento de la ESG en pacientes con GPA. Material y método: Estudio descriptivo retrospectivo de los pacientes atendidos en el Departamento de Otorrinolaringología de la Pontificia Universidad Católica de Chile entre 2011 y 2015 con diagnóstico de GPA y ESG. Resultados: Diez pacientes (90% mujeres) con edad promedio al diagnóstico de 44,6 años. Los síntomas fueron: disnea (9/10), disfonía (6/10) y estridor (5/10). En el 80%, la ESG fue la presentación inicial de la GPA. El 90% presentó GPA localizada y 10% GPA sistémica. El 60% presentó anticuerpos anticitoplasma de neutrófilos (ANCA) negativo. Todos los pacientes recibieron glucocorticoides sistémicos, asociados a inmunosupresores y/o anticuerpos monoclonales. Una paciente requirió traqueostomía y dos pacientes han requerido dilatación endoscópica con balón asociado a inyección local de metilprednisolona. Conclusiones: La ESG puede ser la única manifestación de GPA. Los síntomas inespecíficos y la alta probabilidad de presentar ANCA negativo hacen difícil el diagnóstico. El manejo debe ser individualizado y multidisciplinario. La mayoría de nuestros pacientes pudieron ser manejados adecuadamente con tratamiento médico.

Introduction: Granulomatosis with polyangiitis (GPA) is an autoimmune disease that presents with multiple ENT manifestations. Subglottic stenosis (SGS) has been reported in 8-50% of the patients. Aim: To describe the clinical presentation and treatment of SGS in patients with GPA. Material and method: Retrospective review of clinical data from all patients consulting in the Otolaryngology department at Pontificia Universidad Católica de Chile from 2011 to 2015 with SGS and GPA diagnosis. Results: Ten patients (90% female) with average age at diagnosis of44.6 years. The symptoms were: dyspnea (9/10), dysphonia (6/10) and stridor (5/10). SGS was the initial presenting manifestation of GPA in 80% of patients. GPA was localized in 90% and systemic in 10% of patients, and anti-neutrophilic cytoplasmic antibodies (ANCA) were negative in 60% of patients. Systemic glucocorticoids were used in every patient, associated with immunosuppressants and/or monoclonal antibodies. One patient required tracheostomy and 2 patients were treated with endoscopic balloon dilation associated with local methylprednisolone injection. Conclusions: SGS can be GPA’s initial or unique manifestation. Diagnosis is hindered due to the unspecificity ofsymptoms and the high probability of presenting with negative ANCA. Individualized and multidisciplinary treatment is required. Most patients were treated pharmacologically with an adequate response in our series.

Complicaciones posamigdalectomía: revisión desde la evidencia / Complications of tonsillectomy: evidence based review

La amigdalectomia corresponde a uno de los procedimientos quirúrgicos realizados con mayor frecuencia en niños. Aun cuando es considerado un procedimiento seguro, no se encuentra exento de complicaciones tanto intraoperatorias como posoperatorias precoces y tardías. El objetivo de este trabajo es revisar las potenciales complicaciones descritas en pacientes sometidos a amigdalectomia y su manejo perioperatorio considerando la evidencia y recomendaciones publicadas a la fecha con el fin de mejorar la toma de decisiones clínicas en la práctica otorrinolaringológica diaria.

Tonsillectomy is one of the most common surgical procedures performed in children. Although tonsillectomy is a safe procedure, it can be associated with intra and postoperative complications. The purpose of this article is to review the potential complications described in patients undergoing tonsillectomy considering the evidence and recommendations published in order to improve clinical decisión making and perioperative management in our daily practice.

Rinosinusitis maxilar crónica de origen dental / Chronic maxillary rhinosinusitis of dental origin

Introducción: La rinosinusitis maxilar de origen dental (RSMD) es una entidad reconocida con una incidencia cercana al 30%. Su diagnóstico puede pasar inadvertido, tanto en la clínica como en las imágenes, llevando a persistencia de sintomatología y fracaso de tratamiento. Objetivo: Describir la presentación clínica, diagnóstico y tratamiento de pacientes con rinosinusitis maxilar de origen dental. Material y método: Reporte de casos. Se revisaron historias clínicas, imágenes radiológicas, protocolos operatorios y cultivos microbiológicos de pacientes con diagnóstico de rinosinusitis de origen dental atendidos en Clínica Las Condes. Resultados: Diez pacientes, siete mujeres y tres hombres con edad promedio de 63 años. Descarga posterior y rinorrea fueron los síntomas más frecuentes. El estudio incluyó radiografía dental y tomografía computarizada de cavidades paranasales. Las complicaciones secundarias a extracciones dentales y de implantes dentales fueron las etiologías más frecuentes, siendo el primer molar la pieza dental más comprometida. Todos los casos fueron manejados en conjunto por equipo médico y odontológico. Ocho pacientes requirieron tratamiento quirúrgico y 5 de ellos además procedimientos dentales asociados. La flora responsable fue mixta aerobia y anaerobia. Conclusión: En pacientes rebeldes a tratamiento y con síntomas unilaterales, se debe tener un alto índice de sospecha y buscar dirigidamente patologías dentales que expliquen cuadros rinosinusales máxilo-etmoidales.

Introduction: Odontogenic maxillary sinusitis is a well-recognized condition and accounts for approximately 30% of maxillary sinusitis cases. The diagnosis can be missed leading to failure in medical and surgical treatments. Aim: To describe clinical features, diagnosis procedures and treatment of odontogenic maxillary sinusitis. Material and method: Case Report. We retrospectively reviewed medical records, radiologic characteristic, surgical findings and intraoperative microbial cultures of patients with diagnosis of odontogenic sinusitis at Clínica Las Condes. Results: 10 patients were identified, 7 females and 3 males with a mean age of 63 years. Posterior discharge and rhinorrhea were the most common symptoms. Dental x-rays and paranasal sinus CT-scans were performed in all patients. Iatrogenic causes, which include dental implants and dental extractions, were the most common etiology and the 1st molar was the dental piece most frequently involved. Both otolaryngologists and dentistsworked together in all cases. 8 patients had endoscopic sinus surgery and five of them received concomitant management of the dental origin. Polymicrobial cultures were obtained. Conclusions: Otolaryngologists must have a high index of suspicion and look for an odontogenic cause in individuals with unilateral maxillary and ethmoidal symptoms, resistant to conventional sinusitis therapy.

Recirculación en rinosinusitis maxilar / Mucus recirculation in maxillary rhinosinusitis

Introducción: La recirculación de moco entre el ostium natural del seno maxilar y otras aberturas en el seno, altera el transporte mucociliar normal, favorece su acumula-ción y sobreinfección, perpetuando el fenómeno inflamatorio. Objetivo: Describir nuestra experiencia en el diagnóstico y tratamiento de pacientes con rinosinusitis maxilar crónica y/o aguda recurrente cuyo estudio reveló recirculación maxilar. Material y método: Estudio retrospectivo descriptivo. Se revisaron historias clínicas, nasofibroscopías, informes radiológicos y hallazgos operatorios. Resultados: Ocho pacientes con edad promedio de 43 años. El 100%% presentó antecedente de cirugía que involucraba el seno maxilar. Todos se presentaron como rinosinusitis maxilar crónica y/o aguda con reagudizaciones frecuentes (3 episodios/ año). El diagnóstico se realizó mediante nasofibroscopía que evidenció recirculación de moco entre ostium natural y accesorio. Cinco pacientes se sometieron a cirugía endoscópica para unir el ostium accesorio (OA) al natural, disminuyendo el número de exacerbaciones. Conclusión: La recirculación maxilar se debe sospechar en pacientes con diagnóstico de rinosinusitis maxilar crónica y/o aguda recurrente con antecedente de cirugías que involucren el seno maxilar. Su diagnóstico se basa en la observación de recirculación de moco a la nasofibroscopía. El manejo es quirúrgico y dependerá de la ubicación del OA y de la permeabilidad del ostium natural.

Introduction: Recirculation of mucus between the maxillary sinus natural ostium and adjacent openings disturbs mucociliary clearence leading to secretions accumulation and persistent infection, perpetuating the inflammatory phenomenon. Aim: Describe our experience in the diagnosis and treatment ofpatients with maxillary rhinosinusitis (chronic or acute recurrent) and maxillary recirculation. Material and method: Descriptive and retrospective study. Clinical records, radiologic characteristic, nasal endoscopies and surgical findings were reviewed. Results: 8 patients, mean age of 43 years. All of them had prior history of maxillary sinus surgery. Clinical presentation was maxillary rhinosinusitis, chronic or acute, with frequent episodes ofreagudization (3 episodes/year). The diagnosis was made by endoscopic nasal examination that showed mucus recirculation between natural and accessory ostium. Endoscopic sinus surgery was done in 5patients in order to communicate the accessory to the natural ostium, leading to a decrease in the number of exacerbations. Conclusions: Maxillary recirculation must be suspected in patients with maxillary rhinosinusitis (chronic or acute recurrent) who have had prior surgical procedures that involve the maxillary sinus. The diagnosis is based on the observation of the recirculation phenomenon in the nasal endoscopy. The treatment is surgical and depends on the location of the accessory ostium and the permeability of the natural ostium.

Programa de screening auditivo neonatal universal: experiencia de más de 10 años / Universal newborn hearing screening program: experience over 10 years

Introducción: La implementación de Programas de Evaluación Auditiva Neonatal (PEAN) eficientes permite mejorar la pesquisa de recién nacidos (RN) con hipoacusia congénita (HC), facilitando una intervención temprana. Objetivo: Describir los resultados del PEAN universal llevado a cabo por el Departamento de Otorrinolaringología de Clínica Las Condes. Material y método: Estudio descriptivo, retrospectivo. Se estudiaron los resultados del programa y las variables: género, edad de diagnóstico, edad gestational al parto y factores de riesgo asociados al desarrollo de HC en RN evaluados entre mayo 2001 y junio 2012. Resultados: Fueron evaluados 18.224 RN. Reprobaron esta evaluación 809 RN (4,43%). Se diagnostican 70 HC (56% varones, 44% mujeres), con una incidencia general estimada de 3-4 cada 1.000 RN en este establecimiento. 54,3% correspondió a HC unilaterales y 45,7% a bilaterales, siendo éstas en 90% leves a moderadas. El factor de riesgo mayormente asociado fue presencia de anomalías craneofaciales en 38,5% seguido de un peso nacimiento <1.500 gr. en 10%. Discusión y conclusiones: Es imperativo la realización de PEAN universales para diagnosticar a la población general susceptible a desarrollar HC y más aún en aquellas poblaciones donde se concentran los factores de riesgo.

Introduction: Efficient universal newborn hearing screening program (UNHSP) Implementation allows the inquest improvement of newborns with congenital hearing loss (CHL), facilitating an early intervention. Aim: To describe the results of the UNHSP carried out by the Department of Otorhinolaryngology of Clinica Las Condes. Material and method: Descriptive, retrospective study. We studied the program results and variables: sex, diagnosis age, birth age in weeks and risk factors associated with development CHL in newborns evaluated between May, 2001 and June, 2012. Results: 18.224 newborns were evaluated. 809 reproved this evaluation (4.43%). We diagnosed 70 CHL (56% males, 44% women), with an incidence estimated of 3-4 cases every 1.000 newborns. 54.3% corresponded to unilateral CHL and 45.7% bilateral, 90% of this CHL were slight to moderate. The presence of craniofacial anomalies was the main associate risk factor in 38,5% followed by a weight birth <1.500 gr. in a 10%. Discussion and conclusions: Is imperative the accomplishment of UNHSP to diagnose the population at risk of developing CHL and even more in those populations where the risk factors are concentrated.

Estrategias para mejorar el seguimiento del Programa de Evaluación Auditiva Neonatal Universal / Strategies to improve follow-up of the Universal Newborn Hearing Screening Program

Introducción: El Programa de Evaluación Auditiva Neonatal (PEAN) en Clínica Las Condes se inició el 2001 y ha evaluado más de 18.000 niños. Nuestro desafío actual es lograr que aquellos cuyo examen se encuentre alterado reciban precozmente evaluación y derivación oportuna. Objetivo: Analizar el impacto de estrategias para mejorar el seguimiento del programa por medio de la reducción del porcentaje de pérdida de seguimiento. Material y método: Durante 2010 se implementaron nueve estrategias para mejorar el seguimiento del PEAN. Mediante una cohorte retrospectiva se evaluaron los resultados de PEAN 12 meses previos y posteriores a la implementación de éstas. Resultados: El 2009 se evaluaron 1.797 niños, completaron el protocolo 71,1%, perdiéndose en el seguimiento 28,9%. El 2011, posterior a la implementación de las medidas, se evaluaron 1.823 niños, completaron el protocolo 85,1%, perdiéndose en el seguimiento sólo 14,9%. La diferencia del porcentaje de pérdidas de seguimiento entre el2009y 2011 fue de 13.87% (p: 0.042). Discusión y conclusiones: Es necesario descubrir las causas de pérdida de seguimiento para establecer estrategias que ayuden a mejorar estas cifras y permitir que todo niño pesquisado sea diagnosticado a tiempo. La implementación de estrategias como las planteadas en este trabajo son una forma práctica y efectiva para mejorar el seguimiento del PEAN.

Introduction: The Newborn Hearing Screening Program (NHSP) at Clinica Las Condes began in 2001 and up to date, has evaluated over 18.000 children. Our current challenge is to achieve that children with referred screening, receive early evaluation and intervention. Aim: To analyze the Impact of strategies to Improve program's follow-up reducing the percentage of follow-up losses. Material and method: During 2010 nine NHSP strategies were implemented to improve the follow-up. By a retrospective cohort NHSP's results were evaluated 12 months previous and after the implementation of these strategies. Results: In 20091.797 children were evaluated, 71,1% completed the protocol, with 28,9% lost in the follow-up. In 2011, after strategies' implementation, 1.823 children were evaluated, 85,1 %, completed the protocol and only 14,9 % were lost in the follow-up. The difference in the percentage lost between 2009 and 2011 was 13.87 % (p: 0.042). Discussion and conclusions: It is necessary to discover the reasons of loss to follow-up, in order to establish strategies that may allow every referred child to be diagnosed in time. Implementation of strategies like the raised in this investigation is a practical and effective way to improve the follow-up of NHSP.

[Anatomy and normal variations of paranasal sinuses in radiological imaging]. / Anatomie und Normvarianten der Nasennebenhöhlen in der Schnittbildgebung.

CT and MRI are the radiological methods of choice in the diagnostics of diseases of the paranasal sinuses. Detailed anatomical knowledge is mandatory for correct image interpretation. Before endonasal surgery the individually variable anatomic situation has to be known. This article describes radiologically relevant anatomical structures and summarizes normal variations.

Prevalencia de patología ano-rectal en pacientes portadores de VIH/SIDA / Prevalence of ano-rectal pathology in HIV/AIDS patients

Introduction: The ano-rectal pathology (ARP) is the most common surgical condition in patients with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS). Our aim was to determine the current prevalence and clinical characteristics of the ARP in patients with HIV/AIDS in clinical control in the infectious diseases unit of the Hernán Henríquez Aravena Hospital in Temuco. Patients and Method: Study design: Cross section. Location and period: Infectious Diseases Unit of the hospital during the month of June 2010. Inclusion criteria: Patients with HIV/AIDS under control in the unit, medical records were analyzed and complete physical examination was performed. Results: In the period of study 384 patients were in control in the unit. Fifty had ARP which is a prevalence of 13%. Anal condyloma disease and hemorrhoidal disease were the most common diseases. Most patients (76%) were on antiretroviral therapy with good clinical response. Conclusion: The prevalence of ARP in HIV/AIDS patient has increased in recent years. This study shows a change in the pattern of presentation, being anal condyloma the most common ARP.

Introducción: La patología ano-rectal (PAR) es la afección quirúrgica más frecuente en pacientes portadores del virus de la inmunodeficiencia adquirida (VIH) y del síndrome de la inmunodeficiencia adquirida (SIDA). Nuestro objetivo fue determinar la prevalencia actual y las características clínicas de la PAR en pacientes portadores de VIH/SIDA en control clínico en la unidad de infectología del Hospital Doctor Hernán Henríquez Aravena de Temuco. Materiales y Método: Diseño de estudio: Corte transversal. Lugar y período: Unidad de Infectología del Hospital Doctor Hernán Henríquez Aravena de Temuco durante el mes de junio de 2010. Criterios de inclusión: Pacientes portadores de VIH-SIDA en control en la unidad, se analizó su historial clínico y se realizó un examen físico completo. Resultados: Durante el período 384 pacientes se encontraban en control en la unidad. Cincuenta presentaron PAR lo que constituye una prevalencia del 13%. La condilomatosis anal y la enfermedad hemorroidal fueron las patologías más frecuentes. La mayoría de los pacientes (76%) se encontraban en terapia anti-retroviral y con buena respuesta clínica. Conclusión: La prevalencia de patología ano-rectal en pacientes portadores de VIH/ SIDA se ha incrementado en los últimos años. Se aprecia un cambio en las características clínicas de presentación, siendo la condilomatosis anal la PAR más frecuente.