[Fistula of the first branchial arch]. / Fístula de primer arco branquial.

The complexity of the embriologic development of the neck and the possible abnomarlies in this process, with the consequent posterior manifestations make necessary the knowledge of the embriologic anatomy of the neck. In the possible manifestations that can be of the anomalies of the development of the branchial archs are the abnomarlies of the first branchial archs. They are, in the anomalies of the development of the branchial archs infrequent and are intimately related with the facial nerve. We present a clinic case of a seven years old boy affected by this pathology and revise its more important aspects.

[Arterioveinous dural malformation in ENT]. / Malformaciones arteriovenosas durales en el ambito de la ORL.

The arterioveinous dural malformation (MAVD) is a rare entity between the vascular craneal anomalies with a not well nown ethiology and variability in treatments. We present eleven cases of MAVDs, between them five presented tinnitus as symptom of aparition. The importance of this pathology makes necessary to discard it before a patient consulting because of pulsaltil tinnitus with normal otoscopy.

[Persistence of the third branchial arch]. / Persistencia de tercer arco branquial.

The third branquial arch anomalies represent less than 1% of this deformites. The clinical manifestation can be varied althouth the formation of cysts is the commonest one and may appear at any time in life. We report the clinical case of a 7 year old boy with an neck mass. This mass was diagnosed as a branquial cyst. The patologist found a "timic reminescences". We carry out a review of the literature for this pathology.

[Skull base meningiomas: a predictive system to know the extent of their surgical resection and patient outcome]. / Meningiomas de la base de cráneo. Un sistema predictivo para canocer las posibilidades de su extirpación y pronóstico

OBJECTIVE: The aim of this study was to build a preoperative predictive system which could provide reliable information about: 1 degrees which skull base meningiomas can be total or partially removed, and 2 degrees their surgical outcome. METHOD: Patient histories and imaging data were reviewed retrospectively from 85 consecutive skull base meningiomas patients who underwent surgery from 1990 and 2002. From the preoperative data, nine variables were selected for conventional statistical analysis as regards their relationship with: 1 degrees total vs partial tumor resection and 2 degrees with patients outcome according to the degree of tumour removal. RESULTS: From the nine variables analysed only two had a statistical association with the type of tumour resection performed (total vs partial) and the patient outcome: 1) arteries encasement and 2) cranial nerves involvement. Upon correlating these two variables with the type of tumour resection performed (total vs partial) and with the Karnofsky'scale to evaluate patients surgical outcome, the following grading groups were identified: Grade I: skull base meningiomas which did not involve cranial nerves or artery or only encased one artery or one cranial nerve. In these cases the incidence of gross tumour resection was 98.3% (p< 0.0001) and the perspective to reach 70 points in the Karnofsky'scale was of 96.5% ( p=0.001). Grade II: skull base meningiomas which involved one cranial nerve and encased, at least, two main cerebral arteries. In these cases, the frequency of total resection, decreased to 83.3% (p<0.0001) and the probability to reach 70 points in the Karnofsky'scale was 70.6% (p=0.001). Grade III: skull base meningiomas which involved two or more cranial nerves and encased several arteries In this group, the frequency of a total resection was of 42.9% (p<0.0001) and the probability of reaching 70 points in the Karnofsky'scale was only 60% (p=0.001). CONCLUSIONS: We propose a preoperative grading system for skull base meningiomas that helps predicting both whether total or partial tumor removal will be achieved during surgery and the immediate postsurgical outcome of the patient. In applying this predictive system we will be able to reduce surgical morbidity, to advance the possibility of a radiosurgical treatment and give a more precise information to the patients and their families about our surgical decision-making process.

[Internal carotid artery loop: an uncommon cause of parapharyngeal tumor]. / Bucle de arteria carótida interna: una causa infrecuente de tumoración parafaríngea.

The parapharyngeal space-occupying lessions may develop from any of the structures located inside it. Uncommon although possible ethiologies for them are anatomic variations of the course of the internal carotid artery. These anatomic variants mainly arise from degenerative, mostly age-amplified, causes and lead to elongations, angulations, kinking and tortuosities in the course of the vessel that appear as impressions or protusions of the pharyngeal wall. Utherly unfrecuently lead to loops that may show as large parapharyngeal tumors. This fact should be noticed previously to any invasive procedure to be performed on the patient specially when evidenced in concommitance with an infectious process at the moment of diagnosis. A case of an impressive internal carotid artery loop that conditioned an important parapharyngeal mass in a patient with an associated pharyngeal infection is reported to warn about this rare parapharyngeal space-occupying condition and its potential danger.

[Non Hodgkin's lymphoma in the ENT field]. / Linfomas no Hodgkin en patología cérvico-facial.

OBJECTIVES: Non Hodgkin's lymphoma (NHL) is a frecuent tumor in the ENT field althougt there are not too many publications with a large number of patients. PATIENTS AND METHODS: We have studied 300 patiens with NHL and analysed the head and neck affectation, the presence in Waldeyer's ring, the first symptoms and the stage of the disease. RESULTS: Over 50% had head and neck manifestation. Of them, the most frequent one were adenopathies. In the Waldeyer's ring, the tonsil was the most frecuently affected structure. CONCLUSION: There is an evident relationship between NHL and the Oto-Rhino-laringology area and it is necessary consider it in the differential diagnosis of head and neck adenopathies.

[Auditory-evoked brainstem response in a schwannoma of the VIIIth cranial nerve: an anatomophysiological and functional correlation. Our experience]. / Respuesta evocada auditiva de tronco en el schwannoma del VIII par: correlación anatomofisiológica y funcional. Nuestra experiencia.

INTRODUCTION: Schwannomas are tumors charasteristically originated from the nerve sheath. They expande eccentrically from the nerve promoting a disturbance in the neural function either due to vascular compresion or to the effect of the tumor itself on the nerve, disturbance that can be evidenced with the Auditory-evoked Brainstem Response (ABR), fact that constituted the base for their diagnosis in the past. The new radiological techniques developed over the last decades have made possible an earlier diagnosis, and therefore changed their prognosis in terms of nerve function. Diagnosis is more certain today with these techniques so it could seem that ABR may not have any longer a role in the management of this condition. OBJECTIVE: To describe the most frequent ABR patterns in those patients suffering from acoustic schwannoma related to the size of the tumour and the remanent audition thresholds, and to determine the value of this test in our practice. MATERIAL AND METHODS: We describe the ABR features found in our series of 72 patients. Whose diagnosis was done between 1997 and 2003 in relation to the size of the tumour and the residual auditory function. RESULTS AND CONCLUSIONS: ABR has a good sensibility for detection of acoustic schwannoma. This sensibility decreases in small-sized tumours, specially in intracanalicular ones. ABR patterns do not relate to the size of the tumour but they do to the auditory function. The authors defend ABR to be a very valuable test due to the information and accesibility they provide.

[Idiopathic Frey's syndrome under the appearance of a recurrent otitis externa]. / Síndrome de Frey idiopático bajo la apariciencia de una otitis externa recidivante. Tratamiento con neuro-toxina botulínica tipo A.

Frey syndrome has been observed especially in patients who have undergone a parotidectomy operation, but also in zoster herpes, in parotiditis, condilea fractures, obstetric traumatisms with forceps and in surgery of the meningioma of the cerebellopontine angle. It also appears without previous surgery, like in our case. In these circumstances it is believed that a clinical neuritis, primary or secondary to a neighbouring inflammation may cause the start of this disorder. Several treatments have been suggested which highlights the difficulty of them. The most effective one is the intradermic injection of botulinum toxin type A. Its use in Frey's syndrome was initiated by Drobik and Laskawi in 1995. Since then the references to its use are numerous. Nevertheless, it is a treatment which has been introduced very few times in our country.

[Extramedullary plasmacytoma of the head and neck. Report of 3 clinical cases]. / Plasmocitoma extramedular de cabeza y cuello. Presentación de 3 casos clínicos.

Plasmocytomas are neoplasic disorders arising from plasma cells that include Multiple Myeloma (MM) Solitary Plasmocytoma of the bone and Extramedullary Plasmacytoma (EMP). EMP are solitary tumours consisting of plasma cell proliferation that occurs in locations other than bone. A variable percentage may be associated at a later date with the development of MM. EMP represent up to 4% of nonepithelial tumours of the upper respiratory tract. They generally occur in the submucosal tissue of the upper airways (80% of cases), with a predilection for nasopharynx, nasal cavity, paranasal sinuses and tonsils. We report 3 cases of Extramedullary Plasmocytoma located one in the upper respiratory tract. All the patients underwent surgical resection or biopsy of the lesion that allowed the histological study, which showed a plasma cell proliferation. Serum and bone marrow studies conclude the diagnosis of Extramedullary Plasmocytoma. The treatment was radiotherapy, with or without previously surgery. Three patients are currently under close follow-up and no evidence of recurrence has been found. We review the clinic, diagnostic, therapeutic and prognostic aspects of this kind of tumours.

[Epidermoid cyst of the parapharyngeal space]. / Quiste epidermoide de espacio parafaríngeo.

Epidermal cysts of parapharyngeal location are very unusual tumors, with a benign character, though when they reach a great size, adjacent zones and vascular and nervous structures of great importance can be affected. We are going to describe the clinical aspects of this case, the instructions and the surgical approach used: the Fabre inferior and internal jaw approach of the lateropharingeal space and infrasphenotemporal fossa, which avoids the aesthetics and functional aftereffects of other more common approaches.

[Clinical descriptive study of 40 patients with carcinoma of the nasopharynx in advanced stage in an area of low epidemiological risk]. / Estudio clínico descriptivo de 40 pacientes con carcinoma de nasofaringe en estadio avanzado en un área de bajo riesgo epidemiológico.

The nasopharyngeal carcinoma in Spain, low risk geographical area, is a rare tumor. This is the cause why there few papers about it in our country. We have carried out a muestral descriptive statistical study. We have selected among all the patients diagnosed of nasopharyngeal carcinoma a big group who, have been treated with induction chemotherapy followed by radiotherapy with or without surgery, they presented very complete clinical histories in the Departments of E.N.T., Oncology and Radiotherapy that allowed us to compare all the picked up data and this increased, without doubt, the reliability of them. The results obtained in the different examined variables of our patients are the same that those we found in literature. The nasopharyngeal carcinoma is a tumor that usually affects young patients, of both sexes, without previous consumption of alcohol and tobacco and they are diagnosed in advanced stages. The rhinologic symptoms are the most frequent ones but the cervical nodes are the usual cause for consulting a doctor with a long diagnostic interval. There is a prevalence in the undifferentiated tumors showed by histology.

[High jugular bulb and its relationship with acoustic neurinoma surgery]. / Golfo yugular prominente y su repercusión en la cirugía de los neurinomas del acústico.

The jugular bulb is formed by the junction of the sigmoid sinus, inferior petrous sinus and the jugular vein. It is housed in the jugular fossa of the petrous pyramid. Variations in its size, location and relationship to the internal acoustic canal (IAC) have been reported. When the jugular bulb is located medial and less than 2 mm from the posterior wall of the internal acoustic canal, it is named as high jugular bulb. If the surgeon is not aware of this variation, damage to this structure can result in profuse haemorrhage and air embolism. This anatomical change also makes difficult the access to the intracanalicular portion of acoustic neurinomas when these tumours are excised by a retrosigmoid approach. We present the case of a patient with an acoustic schwannoma in whom a preoperative axial cranial CT revealed a high jugular bulb. To control this venous structure, we opened the IAC in a longitudinal manner achieving a total excision of the lesion preserving the function of the facial nerve. We conclude that preoperative radiological investigations in acoustic schwannomas surgery should include cranial MR and TC, to rule out the presence of a high jugular bulb. Cranial axial CT including bony windows and slices of 1.5 mm thick, should be carried out to exclude a high jugular bulb.

[Survival rate in epidermoid carcinoma of the oral cavity]. / Supervivencia en el carcinoma epidermoide de cavidad oral.

The present study aims to analyse the survival of 94 patients with squamous cell carcinoma of the oral cavity. They were 86 men and 8 women with a mean age of 61. Seventy four percent were smokers and 70% consumed alcohol regularly. Eighty three percent had unhealthy teeth. A great majority of patients (76) were in the advanced stages (III-IV) and 61% showed neck nodules. The overall survival at 5 years was the following: 70% for patients in stage I, 85% in stage II, 58% stage III and only 17% for the patients in stage IV. The most significant prognostic factor that affected the survival was the N stage. For the patients in N0 and N1 we only found significant differences when the lymph nodes were histologically affected by the tumor.

[Clinical course and treatment of sphenoid mucocele. Report of a case]. / Clínica y tratamiento de los mucoceles esfenoidales. A propósito de un caso.

Endoscopic surgical technique minimaly invasives employed in the therapy of paranasal sinuses pathology are imposing up little by little to the external approach procedures, as specialists get experienced and outcomes can be assessed in middle/long term. In this paper we record the case of a woman enduring a sphenoidal mucocele non-complicated, optimal stage for the indication of endoscopic surgery minimally invasive, because in this condition the best postoperative functional results are attainable and in addition recurrence failures are reduced at minimum. The discovery of the illness in an earle stage, thanks to a greater availability of diagnostic means like TC or RMN, allow us the broadening of indications of this surgery and consequently improve the postoperative results.

[First year of experience in laryngectomy and pharyngolaryngectomy with Pearson type laryngotracheal myomucosal shunt]. / Primer año de experiencia en laringectomías y faringolaringectomías con shunt miomucoso laringotraqueal tipo Pearson.

In this essay we deal with different aspects of the techniques described by Pearson and cols. in 1980, carrying out an analysis of objectives, indications and contraindications, physiological fundamentals, description of the surgical technique, aftercare and exposition of the results achieved in patients operated from September 1996-97.

[Maxillary sinusitis caused by Aspergillus]. / TI: sinusitis maxilar por Aspergillus.

Naso-sinusal aspergillosis is an infrequent ailment which true incidence is not correctly assumed and furthermore the cases are increasing because of the progression of immunodeficiency problems. Suspicious become accentuated when repeated antibiotic treatments fail or in patients with previous dental pathology or radiologically show inside of sinus images of forcing bodies. Despite of which the diagnosis should be histological thanks to the examination of the surgical piece gained following the classic approaches through the canine fossa or endoscopic surgery. The only real treatment is surgery. We report one clinical case of an acute naso-sinusal aspergillosis with ineffectiveness of all used treatments and whose diagnose was achieved only through the anatomopathological study of the piece supplied by the Caldwell-Luc procedure.

[Acute infectious mastoid complications in infancy]. / Complicaciones infecciosas agudas mastoideas en la infancia.

The incidence of acute mastoiditis accounts for 0.004% of acute middle otitis. Nowadays there is a decrease of number of mastoiditis and its complications, but from time to time are seen outbreaks without logical explanation of facts. We report 4 clinical cases of acute mastoiditis complicated with subperiosteal abscess, in children between 8 and 23 month old, seen at our department during the last 3 years, three of them diagnosed in a 4-month term.

[Deep neck infections]. / Infecciones cervicales profundas.

Deep neck infections are charts potentially dangerous though of low incidence. Few times linked to severe complications, as mediastinitis, of high morbi-mortality. They call for emergency procedures combining neck and thorax surgery, if there is a mediastinitis, with a broad-spectrum antibiotherapy within an Intensive Care Unit, with the aim of the maintain the patients's equilibrium constant till their reestablishment. We report 3 cases seen in a term lesser than one year at the Universitary Hospital of Salamanca. The 3 presented with thoracic complication because the spread of the neck's infect. Nevertheless the pending severity all three survived. We emphasize the necessity of realizing the pressing surgery and the utilitarianism of broad-spectrum antibiotherapy as key elements in order to get the patient's reestablishment. Literature review on the subject.

Plasmocitoma extramedular nasofaringeo. reporte de caso / Extramedulary plasmocytoma in the nasopharynx. case report

Los plasmocitomas extramedulares (PEM) son tumores solitarios de células plasmáticas localizada en lugares lejanos al hueso. Un porcentaje variable puede desarrollar con posterioridad un mieloma múltiple. Los PEM representan cerca de un 4 por ciento de los tumores no epiteliales del tracto respiratorio superior. Generalmente se desarrollan en el tejido submucoso de vías aéreas superiores con predilección por la nasofaringe, las fosas nasales, los senos paranasales y las amígdalas. Los tumores rinofaríngeos son raros; una revisión en Medline encontró 10 casos en la nasofaringe, uno de ellos en España. Presentamos el caso clínico de un paciente varón de 69 años, con patología tubárica crónica, cuyo examen clínico reveló la existencia de una lesión polipoide en nasofaringe, sin adenopatías cervicales. La resección endoscópica transnasal permitió el estudio histológico de la pieza, que mostró una proliferación de células plasmáticas. Los estudios séricos y de médula ósea permitieron concluir el diagnóstico de plasmocitoma extramedular. El tratamiento fue completado con radioterapia, no existiendo evidencia de recurrencia de la enfermedad después de 18 meses

[Study of Cyfra 21-1 as a new tumor marker for the diagnosis of epidermoid carcinoma of the head and neck]. / Estudio del Cyfra 21-1 como un nuevo marcador tumoral en el diagnóstico del carcinoma epidermoide de cabeza y cuello.

Serum concentrations of Cyfra 21-1, a soluble cytokeratin fragment, were evaluated in 157 healthy patients, 66 patients with benign ear, nose or throat disease, and 102 patients with untreated epidermoid carcinoma of the head and neck. The technique had a sensitivity of 53.9% and specificity of 98.4% for a cutoff value of 1.5 ng/ml. Cyfra 21-1 levels differed significantly with tumor location (p < 0. 005) and tumor stage (p < 0.005), but not with the degree of histological differentiation.