[Hypoglossal facial anastomosis as a solution to a total peripheral facial palsy. Our experience]. / La anastomosis hipogloso-facial como solución a una parálisis facial residual completa. Nuestra experiencia.

Hypoglossal-facial anastomosis was performed in four patients with total peripheral facial palsy after removal of cerebellopontine tumors (three patients with neurinoma) and pontine aneurysm (one patient). The anastomosis was performed after a period of 3 months to one year from surgery. The results obtained, concerning the facial activity, were clinically valued according to the tests used (questionnary, and the House-Brackmann paralysis index); the EnOG was used for its electrophysiological assessment. The follow-up period was 4 years with a good facial recovery in three patients and poor in one (class V, 27% in ENoG). We observe that the improvement in function greatly depends on the early surgical process performance.

[Lateral sinus thrombosis due to cholesteatoma. Report of a case and literature review]. / Trombosis del seno lateral secundaria a colesteatoma. A propósito de un caso y revisión de la literatura.

After introduction of antibiotics, endocranial complications in otitis media are less common. Lateral sinus thrombophlebitis (LST) incidence has markedly decreased but mortality is still high. This complication should be considered in patients with ear discharge, fever and neurological symptoms. CT-scan and MRI enables early diagnosis and have a role in detecting addition intracranial complications. Surgical intervention should be aggressive and anticoagulation should be considered. We present a case of a woman with othorrea, fever and neurological symptoms. The CT-scan shows us a cholesteatoma that grows intracranial and a LST as complication of it.

Etiology and therapy of chronic suppurative otitis.

Infectious diseases of the ear are important in adults due to their incidence and relapses. We carried out a study of aerobic microorganisms on 251 otic exudates from patients diagnosed as having chronic suppurative otitis media without cholesteatoma (119), chronic suppurative otitis media with cholesteatoma (85) and chronic external otitis (47). The microorganisms predominantly isolated were, Pseudomonas aeruginosa, Staphylococcus aureus and other Enterobacteriaceae. 86% of isolates were monomicrobial and 14% of isolates were polymicrobial. In these latter the predominantly isolated microorganisms were also P. aeruginosa, S. aureus, Corynebacterium spp. and Proteus mirabilis. P. aeruginosa was the most commonly isolated and showed the highest percentages of resistance against antimicrobial agents tested. P. aeruginosa was most susceptible to ciprofloxacin and imipenem, but much less susceptible to cefotaxime, moxalactam and trimethoprim-sulfamethoxazole. S. aureus was highly sensitive to amoxicillin/clavulanate, trimethoprim-sulfamethoxazole, rifampin and teichoplanin. 100% of the isolates were resistant to penicillin G and ampicillin.

Incidence of dehiscences in the fallopian canal.

Fifty human temporal bones from necropsies were used to study the frequency of canal dehiscences in detail along the course of the facial nerve. Specifically, the study focused on bony dehiscences in the fallopian canal and vascular communications between the facial nerve and the surrounding bone. High frequency of dehiscences at the oval window (60%) and in the pyramidal segment (54%) were found. These dehiscence rates are in agreement with published reports. A 20% rate of dehiscences at the most anterior segment of the tympanic segment was noted and a non-reported high rate (20%) of multiple dehiscences along the course of the fallopian canal in the same temporal bone in specimens of newborns and young children. The significance of these findings in terms of clinical implications is discussed.

Acyclovir in the treatment of laryngeal papillomatosis.

We report the results obtained in a study of 3 young patients with laryngeal papillomatosis, who were treated with acyclovir after tumor excision using forceps was performed under microlaryngoscopy. No recurrence of the papillomatosis occurred between 18 and 42 months post-therapy. Laryngeal papillomatosis is the most common proliferative laryngeal lesion in children. Different non-surgical therapies have been used to prevent its recurrence but with poor results. Acyclovir is a drug with proved efficacy in DNA viral diseases. Since papillomata of the larynx is most likely a viral disease which is imputed to have a DNA virus etiology, acyclovir may be effective to control it.

Degeneration and regeneration processes in experimental facial nerve paralysis.

Facial nerve paralysis was provoked by compression of its extratemporal portion in rabbits and the degeneration and regeneration of the nerve fibres was studied ultrastructurally. The compression was removed to study the regenerative process in one group of animals. Axonal and myelin degeneration were the first events seen as a collagen tissue proliferation from the endoneurium and perineurium. Ultimately all the nerve was transformed into fibrous tissue. The myelin was disintegrated by Schwann's cells without any macrophagic activity. The regeneration process begins by the axons, that are orientated towards Büngner's bands of remnants of the Schwann's cells, in which a new myelin sheath appears. Schwann's cells play an important role, in both the degeneration and the regeneration process. The final aspect of the regenerated fibres is similar to normal but they contain more collagen tissue, thinner myelin sheaths, and a greater proportion of unmyelinated fibres.

Histological structure of the vocal fold in the human larynx.

Histological analysis of the human vocal folds, focused particularly on the lamina propria of the vocal muscle of fetuses, infants, and adults in horizontal laryngeal sections, allowed us to show the differences in morphology and composition according to the laryngeal development. Our results indicate that the origin of the vocal fold is independent of the origin of the other portions of the larynx, and the influence of the zone known as macula flava in the maturation of the vocal fold is an age-related process.

Neochondrogenesis in the septal area after submucous cartilaginous resection.

The present work was carried out to study cartilaginous repair after subperichondrial resection of the septal cartilage, the fibrous layer of the perichondrium remaining "in situ". In these conditions, after granulation tissue formation, both neochondrogenesis and connective tissue differentiation were observed. Neochondrogenesis was found in defect areas next to the resection borders, and connective tissue formation in those further away. The transition zone between both types of newly-formed tissues showed cells with intermediate characteristics of chondrocytes and myofibroblasts. The findings provide safer proof that new chondrocytes and fibroblasts growing after septal cartilage removal originate largely from a common precursor cell either in the fibrous perichondrial layer or in the connective tissue surrounding it. The peculiar topographic distribution of the newly-formed tissues may be explained by the different effects during respiration of mechanical forces on the septal space, which lacks its cartilaginous support, and on the adjacent remaining cartilage, as well as on the borders of both.

Study of common aerobic flora of human cerumen.

Cerumen is the product of the secretion of the sebaceous, ceruminous or apocrine glands together with cells exfoliated from the cornified stratum of the epithelium of the external auditory canal (EAC). In the present study we identified and quantified common flora of human cerumen. The mean count obtained was 10(6) microorganisms per ml of cerumen suspension. In 24 pools of cerumen (33.3 per cent) the isolates were monomicrobial, Staphylococcus epidermidis (12), Corynebacterium spp (10), Staphylococcus aureus (1) and Streptococcus saprophyticum (1). In 48 pools (66.6 per cent) we found polymicrobial isolates. The most commonly isolated bacteria in these polymicrobial isolates were S. epidermidis (35) and Corynebacterium spp. (43). It is noteworthy that there were isolates of Candida albicans in three cases; in one case of Pseudomonas stutzeri, in one case of Pseudomonas aeruginosa, and, on seven occasions, of S. aureus. The organisms isolated as common bacterial components of human cerumen in our experience were similar to those found by other authors. However, the mean count was much higher. This could be related to climatic conditions and to the length of time the cerumen had remained in the external auditory canal.

Influence of human wet cerumen on the growth of common and pathogenic bacteria of the ear.

The available data on the effect of human wet cerumen on bacterial growth are not conclusive. Nevertheless it is widely accepted that cerumen has a bactericidal effect. In this study the activity of human wet cerumen on bacterial growth was assessed by applying cerumen suspensions to bacterial cultures. Bacterial counts were performed before and after application of cerumen suspensions. A total of 383 assays was carried out with 73 pools of cerumen that were tested against cultures of Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium spp., Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa and Serratia marcescens. An increase in growth occurred much more frequently than a decrease in growth in almost every microrganism tested, with the mean increase percentage being much higher than the mean decrease percentage, except in the case of S. aureus. The largest average growth increase was obtained with E. coli. The largest average decrease in bacterial growth was recorded with S. marcescens. Our study does not support the conception of a decrease in bacterial growth produced by humen wet cerumen. In vitro, the most observable effect was in fact an increase in microbial growth.

[The phylogenic imprinting on the morphogenesis of the middle and external ear]. / La impronta filogénica en la morfogénesis de los oídos medio y externo.

The AA. present a review of the embryologic development of both external and middle ear and its relationship with the phylogenesis. They consider the trascendence of this linkage in the shaping and in the physiology of the conductive apparatus of the sound and even admit the possibility of determine diseases like the cholesteatoma.

[The phylogenetic imprint on the embryonic development of the inner ear]. / La impronta filogénica en el desarrollo embrionario del oído interno.

The AA. present a review of the embryologic development of the internal ear linked with evolutive phylogenic events, which will determine the morphogenesis of this organ, of ancestral origin. The significance of those phenomena in order to bring about several physiological attributes as the possibility of vestibular hearing and even to set off pathologic conditions like the otosclerosis are considered.

[Reconstructive septal surgery: review of various implants in the nasal area]. / Cirugía septal reconstructora: revisión de los diversos elementos de implante en el área nasal.

In the reconstructive techniques of the nose the rhinologist must employ several materials for rebuilding unprotected septo-pyramidal areas. In spite of its partial resorption the cartilage continues to be the best element. Other objections for its use either the distortion or its weakness against infections, are overcome by an appropriate preparation of the graft.

[Influence of climate factors on the course of secretory otitis media]. / Influencia de los factores climáticos en la evolución de la otitis media secretoria.

For many years there has been admitted a close link between climatology and the course of secretory otitis media. Despite of that there are few articles in medical literature covering this subject. As a consequence of the special climate of their Island the AA. study the evolutive run of the illness under different rates of humidity.

[Morphometric study of the intrapetrous passage of the facial nerve in adult temporal bones and its application to the study of the pathogenesis of Bell facial paralysis]. / Estudio morfométrico del recorrido intrapetroso del nervio facial en temporales adultos y su aplicación en la patogenia de la parálisis facial de Bell.

After a morphometric study, done in adult temporals, of the inner diametre of the fallopian bony canal, of the thickness of both the epineural space and the nerve trunck (in petrous, tympanic and mastoid segments) and the like with the geniculate ganglion and the pyramidal bend, the AA. thrown out the conclusion that when a generalized edema of the nerve is expected the labyrinthine segment or the distal portion of the mastoidal segment are the sites to be found most precocious or heaviest compressed.

[A new case of craniofacial fibrous dysplasia and cytogenetic study]. / Un nuevo caso de displasia fibrosa craneo-facial con estudio citogenético.

Fibrous dysplasia is an uncommon condition, which most obvious expression is the disorder of the osseous tissue setting up. Craniofacial bones are preferential sitting targets. We report a new case, in a 14-year-old boy, whose cytogenetic study neither in peripheral blood nor in tumor cells showed significantly differences.

[The Toynbee's phenomenon effect on the middle ear during nasal tamponade]. / Efecto del fenómeno de toynbee en el oído medio durante el taponamiento nasal.

Is has been demonstrated by some AA. that nasal packing can cause Eustachian tube dysfunction. There are several motives, isolated or united as well, that have been offered to account for Eustachian tube dysfunction, but the exact causative mechanism still remains unclear. We have studied the Eustachian tube function in 75 patients with septal deviation that underwent septal surgery followed by anterior nasal packing. The aim of our work is to demonstrate that one of the main causes of the tubal dysfunction, after bilateral packing of nasal cavities, is the Toynbee's phenomenon.

[Influence of the necessity of transfusion in anemia on the prognosis of ENT cancer in the protocol with concurrent hyperfractionation of carboplatin and irradiation]. / Influencia de la necesidad de transfusión por anemia sobre el pronóstico del cáncer O.R.L. en un protocolo con hiperfraccionamiento concurrente de carboplatino e irradiación.

Because of the determinant role of hemoglobin level in blood to the response of treatment (viewpoint admitted whether for irradiation or chemotherapic agents) the AA. have lead an analysis of a group of 36 patients suffering an advanced head and neck cancer (18 months mid-follow up and 30 months maximum) which underwent a program of concomitant radio-chemotherapy hyperfraccionated with carboplatin (the cytostatic) as part of each therapeutic fraction. The results in patients being transfused with an erytrocyte concentrate were compared with those from patients not having had any transfusion. The purpose of this study was the assessment of which are the influence on the prognostic of ENT-cancer resulting of the compulsory necessity of transfunding erytrocyte concentrates aroused by serious anemia presenting during the development of the schedule treatment. In brief, in that kind of patients needing transfusions of red blood cells concentrates because of serious anemia during the treatment (17% of the totality treated) were recorded 50% local failures, 33% metastases and only 17% of the totality were free of neoplasma at the end of the follow-up fixed. Instead between patients not having had transfusions (for treating anemia) the differences registered were 20% failures of loco-regional control and 13% metastases, whereas 67% were free of tumor at the end of the study. The conclusion drawn out is: the important influence on the prognostic of these tumors, when in the course of the scheduled treatment, appear severe anemia making the transfusions compulsory.

[Concomitant hyperfractionation of drugs and irradiation in the treatment of advanced ENT cancers]. / Hiperfraccionamiento concomitante de drogas e irradiación en el tratamiento del cáncer avanzado del área O.R.L.

Considering the limited results achieved up to now in the treatment of advanced ENT-cancer, with the classic customary procedures, the AA. suggest a new therapeutic schedule (within the concurrent radio-chemotherapy context) in which the selected cytotoxic drug, the carboplatin, is a part of each therapeutic fraction. A group of 36 patients suffering advanced ENT-cancer (2 cases stage III and 34 stage IV) were studied between Mars 1993 and September 1995, and the outcomes assessed after a 18 months mean follow-up (30 months maximum). There were 11% surgically rescued cases, being the full dosage administered twice daily 8.050 cGy plus 700 mg carboplatin. Tolerance was very good, so 100% of the patients received a complete treatment. Initial response was also fine resulting 93% full remissions on primaries, 96% on neck adenopathies (6% surgical rescues). Regarding the actuarial control after 30 months were controlled 88% of neck adenopathies, control loco-regional amounted for 69%, control on primaries 63% and actuarial survival amounted 55%. The AA. drawn out 10 conclusions, underlining the good tolerance of the therapeutic sketch proposed, because the antineoplastic results are by far better than those experienced with whichever modality of management of tumors of these sites and staging.

[DNA papillomavirus detection in head and neck benign proliferative lesions]. / Detección de dna papilomavirus en lesiones proliferativas benignas de cabeza y cuello

In a retrospective study, human papillomavirus (HPV) (6/11, 16 and 18 types) were tested using polymerase chain reaction (PCR), in stored formalin-fixed, paraffin-embedded tissue sections, from 36 head and neck adult papillomata. The results, only 20 percent of positive cases, are non consistent with the role of the HPV infection in the etiology of head and neck papillomata in adult patients. However we detect HPV-18 positivity in papillomata with dysplasia.