Arytenoid asymmetry in opera singers.

INTRODUCTION: Otolaryngologists commonly observe asymmetrical movements of the arytenoid cartilages, but few authors have described the clinical implications of this asymmetry, especially in singers. OBJECTIVES: The aim of this study was to determine the epidemiological and clinical characteristics of arytenoid asymmetry in adduction in a group of healthy opera singers and to evaluate the impact of this asymmetry on the voice. PATIENTS AND METHODS: The medical charts and laryngeal video recordings of 245 healthy opera singers were retrospectively reviewed. Arytenoid asymmetry was defined in relation to the position of the corniculate cartilages, cuneiform cartilages and aryepiglottic angle. RESULTS: The subjects had a mean age of 38.54years (range: 18 to 85 years) and presented a male-to-female sex ratio of 1.02. About 5% of subjects had a history of smoking. The most common vocal symptoms were occasional dysphonia (4%), followed by vocal fatigue (2%) and pharyngeal dryness (2%). Arytenoid asymmetry was slightly more common in males (50.6%) and predominantly affected the right side (64.5%). The most common form of asymmetry was cuneiform asymmetry (37.5%), followed by aryepiglottic angle asymmetry in 33.1% of cases and corniculate asymmetry in 29.4% of cases. Mild asymmetry was observed in the majority of cases. No correlation was observed between arytenoid asymmetry and vocal symptoms. CONCLUSION: Almost one out of two singers was likely to present arytenoid asymmetry in adduction. The presence of this asymmetry does not appear to be correlated with any vocal symptoms.

Post-traumatic Pott's puffy tumour: A case report.

INTRODUCTION: Osteomyelitis of the frontal sinus is a rare clinical entity and generally occurs as a complication of trauma to the forehead or frontal sinusitis. It can be responsible for life-threatening complications, as the first symptoms may appear to be minor. Early diagnosis and appropriate management to prevent central nervous system complications significantly reduce the morbidity and mortality. CASE REPORT: The authors report the case of a 34-year-old man with Pott's puffy tumour following trauma to the frontal sinus. DISCUSSION: The diagnosis was suggested clinically and confirmed radiologically. Treatment was surgical with craniotomy and external drainage.

[The silent sinus syndrome: A reconstruction of the orbital floor with Medpor implant]. / Le silent sinus syndrome: reconstruction orbitaire par implant Medpor.

INTRODUCTION: The silent sinus syndrome (SSS) is a rare clinical entity in both ENT and ophthalmology. It is characterized by enophthalmos and ptosis associated with a reduction in pressure in the maxillary sinus caused by chronic hypoventilation. The objective of this study was to demonstrate the importance of maxillary hypoplasia whether congenital or acquired in this disease, and the use of Medpor implant for reconstruction of the orbital floor. MATERIAL AND METHODS: We report 3 cases of silent sinus syndrome proved clinically and radiologically. The first is a 45 year old male patient complaining of enophthalmos which occurred gradually, without any medical history; the second case is that of a woman of 39 years with a gradual onset enophthalmos, with a history of sinusitis; the third case, a man of 25 years who had a history of nasal trauma and consults for enophthalmos and diplopia. RESULTS: Endoscopic surgery is performed quickly allowing a disappearance of enophthalmos and diplopia. All patients underwent a reconstruction of the orbital floor with a Medpor implant fixed by miniplates without complications.

[Dermatofibrosarcoma protuberans of the face: Long term patient of a follow up].

We report the case of a patient 40 years old affected by a facial tumour diagnosed as a dermatofibrosarcoma protu­berans. He has been followed in our clinic for the last 22 years. He got a recurrency after 11 years and after an other surgery he his actually free of disease. The purpose of this article is to evaluate the tumoral recurrency and the long term follow up.

[Post operative Caldwell-Luc procedure maxillary cyst: Report of a case]. / Syndrome post Caldwell Luc: à propos d'un cas.

Rare complication of radical surgery (Caldwell Luc procedure) of the maxillary sinus, maxillary cyst can occurred several years after. We describe the case of a patient 56 years old, who came to our consultationfor repeated pain in the right maxillary region with moderate facial asymmetry. In her history we noted a previous sinus surgery (Caldwell Luc) more than 10 years before. The imaging showed an expansive process filled with proteinic tissue of the posterior wall of the maxillary. With the history of the former surgery, we suspected the existence of a mucocele. She underwent an endonasal surgery and the pathological examination of the specimen revealed an intra osseous cyst lined with ciliated respiratory type mucosa post surgery of the maxillary sinus. The diagnosis of a maxillary cyst complicating a Caldwell Luc was established based on the results obtained with the clinico-radiological and pathological results.

[Oncocytoma of the parotid gland: a case report]. / Oncocytome de la glande parotide: a propos d'un cas.

Oncocytoma is a rare benign salivary gland tumour with an incidence rate about 1-2%. It is located in the parotid gland in 82% of cases. The aging mitochondrial hypothesis could explain the predilection between 70 and 90 years. Clinical and radiological features of the parotid oncocytoma are not different from those of the others parotid benign tumors. We report a case of oncocytoma of the left parotid gland in a 69 years woman in whom fine needle aspiration cytology (FNAC) was for a pleomorphic adenoma. Through this case we highlight the importance of histopathology in the positive diagnosis of parotid oncocytoma as well as in it's differential diagnosis and also the place of FNAC.

[Setting up a "Bonebridge"]. / Mise en place d'un "Bonebridge".

Hearing rehabilitation after bilateral radical mastoidectomy has different options. The Bonebridge is a new type of middle ear implant bone conduction. It leaves the external ear canal opened and offers acoustic and aesthetic advantages that make it a new alternative of choice. We report our first case of Bonebridge implanted on a 17 years old patient. He had bilateral conductive hearing loss secondary to a bilateral radical mastoidectomy with open technique and meatoplasty for a bilateral cholesteatoma. The surgical technique is described. After 8 months of use the hearing gain is stable without cutaneous adverse effect.

Infección por Helicobacter pylori: Asociación a Patologías gástricas y Métodos de diagnóstico / Infection by Helicobacter pylori: Association to `gastric` Pathologies and Methods of diagnosis

La infección por helicobacter pylori está distribuida a nivel mundial, la prevalencia es del 50%. Esta infección está asociada a enfermedades como las gastritis, úlceras, cancer gástrico y linfoma de MALT. El objetivo es describir la relación existente entre enfermedad e infección por helicobacter pylori.

Actividad anti-helicobacter pylori de Plantago major, Clinopodium bolivianum, Caléndula officinalis y Piper angustifolium por el método de difusión de disco / Activity anti-Helicobacter pylori of Plantago major, Clinopodium bolivianum, Calendula officinalis and Piper angustifolium by the method of dissemination of disk

Helicobacter pylori es una bacteria asociada a patologías gástricas como gastritis, ulceras, cancer y linfoma de MALT. De acuerdo a estudios realizados en la ciudad de La Paz-Bolivia aproximadamente el 50% de la población esta infectada por esta bacteria.

[Cochlear implant in a patient with dilatation of the endolymphatic sac and vestibular aqueduct]. / Implante coclear en paciente con dilatación del saco endolinfático y del acueducto del vestíbulo.

We present an 8 years patient old with a giant dilatation of the vestibular aqueduct associated with profound and progressive bilateral sensorineural hearing loss. The patient received a cochlear implant and during the surgery a pulsatile clear fluid via the cochleostomy was observed, without gusher. We present all the problems, and offer some advices for this kind of surgery.

[Obstructive sleep apnea in children. Our experience]. / Síndrome de la apnea obstructiva del sueño en el niño. Nuestra experiencia.

We expose our experience in obstructive sleep apnea syndrome (OSAS) in the pediatric population and review the literature. Forty-six nocturnal respiratory polygraphies were performed using a portable device (Eden Trace II Plus) that measures heart rate, chest wall impedance, nasal/oral airflow and oxygen saturation. Seven children have been studied before and six weeks after Adenotonsillectomy. All this children experienced an immediate and important improvement of their obstructive symptoms. After Adenotonsillectomy the number of obstructive sleep apneas disminished up to 87.25% and the number of hypoapneas disminished up to 73.3. The arterial oxygen saturation during the night normalized in the seven patients. The initial treatment of OSAS in children should be the Adenotonsillectomy, although the diagnostic criteria of OSAS in children have to be defined more precisely in the future.

[Pansinusitis secondary to inflammatory myofibroblastic tumor]. / Pansinusitis secundaria a tumor miofibroblástico inflamatorio.

Inflammatory myofibroblastic tumors are aetiologically enigmatic and biologically unpredictable lesions. The lungs are the organs of apparent predilection. These tumors have also been documented in a number of extrapulmonary sites including head and neck. Paranasal location is rare. We report a case of a maxillary location in a 10 years and 10 months old girl initiated as an acute pansinusitis.

[Pleomorphic adenoma in ectopic salivary tissue in a child]]. / Adenoma pleomorfo en tejido salivar ectópico en el niño.

Benign tumors appearing in cervical ectopic salivary tissue are rare. Most of these tumors are pleomorphic adenomas and many occur in adults. We report two cases of pleomorphic adenoma developing in cervical ectopic salivary tissue in children and review the pathogenesis of salivary heterotopia and these benign tumors.

[Labyrinth involvement in Langerhan's cell histiocytosis]. / Afectación laberíntica en la histiocitosis de células Langerhans.

Langerhans' cell histiocytosis is a rare pathology that implies an abnormal proliferation of these kind of cells associated with granular infiltration that affects different structures of the human body, including the temporal bone. The middle ear and the mastoid are mostly involved (61%). The inner ear is more resistant to the destruction caused by the granulation tissue, but when occurs, an irreversible neurosensorial hearing loss appears. The early diagnose and the choice of the therapeutical sequences are essential to avoid these lesions.

Estudio de la cóclea: previo al implante coclear / Study the cochlea: previous to cochlear implant

En el protocolo de estudio de los posibles candidatos al Implante Coclear se debe realizar un estudio de la configuración y de la permeabilidad de la cóclea. Por ello, además de las proyecciones estandar coronar y axial del peñasco, hemos incluido sistemáticamente una proyección de Stenvers modificada para poder obtener en un sólo plano del espacio la práctica totalidad de las espiras cocleares. Esta proyección sirve también para el control postoperatorio del electrodo en el interior de la cóclea, ante las dudas de una correcta colocación intracoclear

Nasal gliomas: main features, management and report of five cases.

Nasal gliomas are neurologic malformations that should be considered in the presence of a congenital nasal mass. Appropriate pre-operative examination must be performed to identify a possible connection with CNS, which is present in 15-20% of the cases. This examination should determine whether initial craniotomy is necessary. Here, we report five cases and review the main characteristics and management of this pathology.

Middle-ear adenoma (MEA): a report of two cases, one with predominant "plasmacytoid' features.

Middle-ear adenomas (MEAs) are rare neoplasms which can display several histological patterns and represent a diagnostic challenge. We present two cases of MEA which share some histopathological features such as medium to small cells forming solid infiltrating tumour nests as well as scattered glandular structures with Alcian blue and PAS positive material within. The second case also displayed a distinct and predominant "plasmacytoid' appearance which, in a small biopsy, might have been misleading. Both cases expressed an admixture of epithelial and neuroendocrine immunohistochemical markers, whereas ultrastructural study demonstrated electron dense granules. Taken together, these observations support a mixed epithelial and neuroendocrine nature for these neoplasms, the differential diagnosis of which includes paragangliomas and other tumours or tumour-like lesions involving less frequently the middle ear, such as meningiomas, plasmacytomas and inflammatory polyps. The existence of MEAs with plasmacytoid features should be remembered to avoid confusion with plasmacytomas, plasmacytoid myoepithelioma and plasma cell inflammatory infiltrates.

Primary localized nasopharyngeal amyloidosis. A case report.

Primary localized amyloidosis of the nasopharynx is a rare disease. We present the case of a 13-year-old girl, to our knowledge only the second pediatric case reported in the literature. Symptoms were nasal obstruction and bleeding from the oral cavity. Physical examination revealed a mass in the nasopharynx and left side of the soft palate. The diagnosis was made by biopsy and histopathologic study of the surgical specimen. Immunohistochemical study revealed amyloid light chains (AL). The main treatment was surgical. At follow-up 9 months later, no recurrence had developed. While rare, localized amyloidosis should be considered in the differential diagnosis of nasal obstruction, epistaxis and glue ear, and must be recognized and understood by the otolaryngologist to allow appropriate diagnostic and therapeutic planning.