La laringoscopia indirecta mediante endoscopio rígido de 70º como valor predictivo de la dificultad de visión de la laringe / Indirect laryngoscopy with rigid 70-degree laryngoscope as a predictor of difficult direct laryngoscopy

Introducción y objetivos: Los predictores comúnmente utilizados para prever la vía aérea difícil poseen poca capacidad para pronosticarla. Nuestro objetivo es investigar la potencia de la laringoscopia indirecta con el laringoscopio rígido de 70° como predictor de dificultad de visión de la laringe con la laringoscopia directa. Métodos: Se efectuó una laringoscopia indirecta con el laringoscopio rígido en el preoperatorio a 300 pacientes. Según la visión obtenida fueron clasificados en 4 grados: 1 (cuerdas vocales visibles), 2 (comisura posterior visible), 3 (visión solo de epiglotis) y 4 (ninguna estructura glótica visible). EL 3 y el 4 eran considerados predictores de dificultad de visión de la laringe. Después, bajo anestesia general, practicamos a los pacientes la laringoscopia directa con el laringoscopio de Macintosh. Valoramos como positivo el encontrar un Cormack-Lehane III-IV. Se registraron otros predictores clínicos comunes. Se elaboró un modelo de regresión logística con fines predictivos utilizando las variables relevantes. Investigamos también los predictores de la dificultad de visión de la laringe con la laringoscopia indirecta. Resultados: El modelo encontrado y sus coeficientes para confeccionarlo fueron: f(x)=-10,097+5,145 laringoscopia indirecta (3-4)+3,489 retrognatia +2,548 apertura boca <3,5cm+1,911 distancia tiromentoniana <6,5cm+1,352 roncopatía+ (0,151*cm grosor cuello). Proporciona un resultado correcto en el 94,3% de los casos. En el caso de la laringoscopia indirecta el modelo hallado era: f(x)=-2,641+0,920 roncopatía+0,875 movilidad cervical. Conclusiones: La laringoscopia indirecta fue la variable independiente con más poder predictivo (mayor coeficiente). La roncopatía es un predictor común entre los modelos de ambas laringoscopias(AU)

Introduction and objectives: The commonly-used predictors for difficult airway management are not very accurate. We investigate the power of indirect laryngoscopy with the rigid 70-degree laryngoscope as a predictor of difficult visualisation of the larynx with direct laryngoscopy. Methods: We performed preoperative indirect laryngoscopy with the rigid laryngoscope on 300 patients. The vision obtained was classified into four grades: 1 (vocal cords visible), 2 (posterior commissure visible), 3 (epiglottis visible) and 4 (no glottic structure visible). Grades 3 and 4 were considered predictors of difficult larynx visualisation. Next, direct laryngoscopy with the Macintosh laryngoscope was carried out on the patients under general anaesthesia. Positive value was defined as a Cormack and Lehane III and IV. Other common clinical predictors were also analysed. A logistic regression model using the relevant variables was elaborated. We also investigated predictors of difficult visualisation of the larynx with indirect laryngoscopy. Results: The model found and the coefficients for preparing it were: f(x)= -10.097+5.145 indirect laryngoscopy (3-4)+3.489 retrognathia +2.548 mouth opening <3.5cm +1.911 thyromental distance <6.5cm +1.352 snorer+(0.151 * cm neck thickness). This model provided a correct result in 94.3% of cases. In the case of indirect laryngoscopy, the model found was: f (x)=-2.641+0.920 snorer+0.875 cervical mobility. Conclusions: Indirect laryngoscopy was the independent variable with the greatest predictive power. Snoring is a common predictor in both laryngoscopy models(AU)

Indirect laryngoscopy with rigid 70-degree laryngoscope as a predictor of difficult direct laryngoscopy.

INTRODUCTION AND OBJECTIVES: The commonly-used predictors for difficult airway management are not very accurate. We investigate the power of indirect laryngoscopy with the rigid 70-degree laryngoscope as a predictor of difficult visualisation of the larynx with direct laryngoscopy. METHODS: We performed preoperative indirect laryngoscopy with the rigid laryngoscope on 300 patients. The vision obtained was classified into four grades: 1 (vocal cords visible), 2 (posterior commissure visible), 3 (epiglottis visible) and 4 (no glottic structure visible). Grades 3 and 4 were considered predictors of difficult larynx visualisation. Next, direct laryngoscopy with the Macintosh laryngoscope was carried out on the patients under general anaesthesia. Positive value was defined as a Cormack and Lehane III and IV. Other common clinical predictors were also analysed. A logistic regression model using the relevant variables was elaborated. We also investigated predictors of difficult visualisation of the larynx with indirect laryngoscopy. RESULTS: The model found and the coefficients for preparing it were: f(x)= -10.097+5.145 indirect laryngoscopy (3-4)+3.489 retrognathia+2.548 mouth opening <3.5 cm+1.911 thyromental distance <6.5 cm+.352 snorer+(0.151 cm neck thickness). This model provided a correct result in 94.3% of cases. In the case of indirect laryngoscopy, the model found was: f(x)=-2.641+0.920 snorer+0.875 cervical mobility. CONCLUSIONS: Indirect laryngoscopy was the independent variable with the greatest predictive power. Snoring is a common predictor in both laryngoscopy models.

Miringoplastias. Un análisis retrospectivo de nuestros resultados / Myringoplasties. A retrospective analysis of our surgical outcomes

Objetivo: El objetivo de este trabajo es presentar, de forma detallada, nuestros resultados en la cirugía de la reconstrucción de la membrana timpánica y sobre todo los diferentes factores que influyen en los resultados con el fin de contrastar su valor pronóstico. Métodos: Hemos revisado un total de 126 miringoplastias desde 2006 hasta 2010, recopilando los datos del paciente, la descripción del defecto anatómico y los aspectos más relevantes de la propia intervención. Resultados: Las perforaciones subtotales (35,7%) fueron las más frecuentes. En el 89,7% se realizó el abordaje transcanal. La técnica medial (underlay) fue la más empleada (97,6%). Como injerto se utilizó principalmente el cartílago (82,5%). Se consiguió un cierre completo de la perforación en el 71,1% a los 6 meses de seguimiento. Las reperforaciones fueron de tipo puntiforme en el 11,9%, parcial en el 11,1% y dehiscencia de los fragmentos de cartílago en el 4,8%. El tiempo medio en el cual se registró el defecto de la cirugía fue a los 3,82 meses. La ganancia auditiva media fue de 12,8 dB a los 6 meses de la intervención. Conclusiones: La miringoplastia constituye una técnica adecuada para la restitución de la integridad timpánica y para la obtención de un beneficio funcional. Un estado de la caja seco y las perforaciones posteriores parecen relacionarse con un mejor pronóstico funcional (AU)

Objective: The aim of this study was to present, myringoplasty case results in our department. Different factors were studied to confirm their prognostic value. Materials and methods: A total of 126 myringoplasties from 2006 until 2010 were reviewed, collecting patient-related details, descriptions of the anatomical defect and the most interesting surgical aspects. Results: Subtotal perforations (35.7%) were the most frequently observed. In 89.7% of the operations, the transcanal approach was preferred. The medial technique (underlay) to the tympanic membrane was the most performed (97.6%). Cartilage was the principal graft used (82.5%). Complete closure of the perforation was obtained in 71.1% of the cases at 6 months follow-up. Recurrences of the perforations were of minimal size in 11.9% of the cases, partial in 11.1% and with a cartilage fragment gap in 4.8%. The mean time in which these defects were registered was 3.82 months. The mean post-operative auditory gain was 12.8 decibels at 6 months. Conclusions: Myringoplasty is an appropriate technique for restoring tympanic integrity and obtaining functional benefit. Dried middle ear mucosa and posterior perforations seem to be related with better functional results (AU)

[Myringoplasties. A retrospective analysis of our surgical outcomes]. / Miringoplastias. Un análisis retrospectivo de nuestros resultados.

OBJECTIVE: The aim of this study was to present, myringoplasty case results in our department. Different factors were studied to confirm their prognostic value. MATERIALS AND METHODS: A total of 126 myringoplasties from 2006 until 2010 were reviewed, collecting patient-related details, descriptions of the anatomical defect and the most interesting surgical aspects. RESULTS: Subtotal perforations (35.7%) were the most frequently observed. In 89.7% of the operations, the transcanal approach was preferred. The medial technique (underlay) to the tympanic membrane was the most performed (97.6%). Cartilage was the principal graft used (82.5%). Complete closure of the perforation was obtained in 71.1% of the cases at 6 months follow-up. Recurrences of the perforations were of minimal size in 11.9% of the cases, partial in 11.1% and with a cartilage fragment gap in 4.8%. The mean time in which these defects were registered was 3.82 months. The mean post-operative auditory gain was 12.8 decibels at 6 months. CONCLUSIONS: Myringoplasty is an appropriate technique for restoring tympanic integrity and obtaining functional benefit. Dried middle ear mucosa and posterior perforations seem to be related with better functional results.

[Baha: a new longitudinal incision with fixture out of the incision]. / BAHA: nueva incisión longitudinal con implante fuera de ésta.

Since the introduction of bone-anchored hearing aids (BAHA) a few decades ago, their effectiveness has made the use of these devices a well-established method. The most common complications associated with BAHA are dermatological, so a lot of changes were introduced in the surgical technique to reduce the frequency of skin reactions. We have analyzed our experience in the management of the skin and soft tissues over 8 years' experience with BAHA. We present a new longitudinal incision with the fixture out of the incision.

BAHA: nueva incisión longitudinal con implante fuera de ésta / Baha: a new longitudinal incision with fixture out of the incision

Desde la introducción de las prótesis osteointegradas tipo BAHA (bone anchored hearing aid) hace unas décadas, su uso se ha generalizado por ser un método efectivo. Las complicaciones más frecuentes relacionadas con el BAHA son las dermatológicas, por lo que se han producido múltiples cambios en la técnica quirúrgica con el objetivo de disminuir su frecuencia. Hemos analizado el manejo de la piel y los tejidos blandos durante 8 años de experiencia con el BAHA. Presentamos una nueva incisión longitudinal con el implante situado fuera de ésta (AU)

Since the introduction of bone-anchored hearing aids (BAHA) a few decades ago, their effectiveness has made the use of these devices a well-established method. The most common complications associated with BAHA are dermatological, so a lot of changes were introduced in the surgical technique to reduce the frequency of skin reactions. We have analyzed our experience in the management of the skin and soft tissues over 8 years experience with BAHA. We present a new longitudinal incision with the fixture out of the incision (AU)