Sclerotherapy of face and oral cavity low flow vascular malformations: our experience.

We have reviewed our experience (15 patients during the period 2008-2012) in the treatment of low flow vascular malformations (LFVMs) of the face and oral cavity with polidocanol foam sclerotherapy. They were diagnosed clinically and with the help of Doppler ultrasound and magnetic resonance imaging. The maximum dose recommended for each session was 20mg/day and the minimum interval between sessions was 4 weeks. Embolisation was repeated as many times as needed until the size of the lesions and the symptoms had been reduced sufficiently. Patients were followed up 1, 6, and 12 months after treatment had finished, and the size of the lesions was assessed objectively. The 8 men and 7 women were aged between 18 and 71 (mean 44) years. The lesions had reduced and symptoms had improved in all cases. During the follow-up period, one patient relapsed and developed further symptoms. The pain and postoperative inflammation were successfully controlled with an analgesic and an anti-inflammatory drug. There was only one complication (superficial necrosis), which healed completely by second intention. Direct puncture and sclerosis with polidocanol foam are an effective treatment for LFVM of the face and oral cavity.

Use of platelet-rich plasma in the treatment of bisphosphonate-related osteonecrosis of the jaw.

Platelet-rich plasma is a concentrate of growth factors and osteoconductive proteins, which can play a major role in bone biology by accelerating and enhancing bone repair and regeneration. This paper describes the results of using platelet-rich plasma in the management of bisphosphonate-associated necrosis of the jaw. Eight patients with a diagnosis of bisphosphonate-associated necrosis of the jaw were surgically treated for debridement and removal of necrotic bone, followed by application of autologous platelet concentrate enriched with growth factors and primary suture of the wound. Patients underwent periodic clinical and radiological follow-up examinations. All patients showed clinical improvement and oral lesions resolved 2-4 weeks after treatment. After an average 14-month follow up period, patients remained asymptomatic. Although not conclusive, the combination of necrotic-bone curettage and platelet-rich-plasma to treat refractory osteonecrosis of the jaw yielded promising results.

[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.

Plasmocitoma extramedular de cabeza y cuello. Presentación de 3 casos clínicos / 3 Cases of extramedullary plasmocytomas of the head and neck

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Plamocitoma extramedular de cabeza y cuello. Presentación de 3 casos clínicos / 3 cases of extramedullary plasmocytomas of the head and neck

Los plasmocitomas son neoplasias que derivan de las células plasmáticas, que incluyen el mieloma múltiple (MM), el plasmocitoma solitario de hueso y el plasmocitoma extramedular (PEM). Los PEM son tumores solitarios que consisten en una proliferación de células plasmáticas localizadas en lugares distintos del hueso. Un porcentaje variable puede desarrollar con posterioridad un MM. Representan más 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 (80 por ciento de los casos), con predilección por la nasofaringe, las fosas nasales, los senos paranasales y las amígdalas. Presentamos los casos clínicos de tres pacientes diagnosticados de PEM localizados en vías aerodigestivas superiores en nuestro Servicio. En los tres casos la resección o la biopsia de la tumoración permitió su estudio histológico en el que se observó una proliferación de células plasmáticas. Los estudios séricos y de médula ósea permitieron concluir el diagnóstico. El tratamiento se realizó con cirugía y radioterapia en 2 casos, y exclusivamente con radioterapia en el tercero de ellos. Los pacientes son sometidos a revisiones periódicas, no habiéndose observado recurrencia de la enfermedad. Llevamos a cabo una revisión de los aspectos clínicos, diagnósticos terapéuticos y pronósticos de este tipo de tumores (AU)

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[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.

Quiste epidermoide de espacio parafaríngeo / Epidermal cyst of the parapharyngeal space

Los quistes epidermoides de localización parafaríngea son tumores muy infrecuentes, de carácter benigno, aunque cuando alcanzan un gran tamaño, pueden afectar a zonas vecinas y comprometer a estructuras vasculares y nerviosas de gran importancia. Presentamos las características clínicas de un caso, así como las indicaciones y la técnica quirúrgica empleada: abordaje inferior y mandibular interno de Fabre de la región laterofaríngea y fosa infraesfenotemporal, que evita las secuelas estéticas y funcionales de otras vías más utilizadas (AU)

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 (AU)

[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.

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

El carcinoma de nasofaringe en España, que es considerada una zona geográfica de escasa incidencia, es un tumor raro. Ello es una de las causas de que existan muy pocos trabajos sobre este tema en nuestro país. Hemos realizado un estudio descriptivo muestral, es decir, seleccionado de entre todos los pacientes diagnosticados de carcinoma de nasofaringe a un amplio grupo que por haber sido tratado de manera multidisciplinar con poliquimioterapia de inducción seguida de radioterapia con o sin cirugía posterior presentaba historias clínicas completas en los Servicios de O.R.L., Oncología y Radioterapia, lo que nos permitió contrastar todos los datos recogidos y aumentó, sin duda, la fiabilidad de los mismos. Los resultados obtenidos son coincidentes con los recogidos en la literatura. El carcinoma de nasofaringe es un tumor que afecta a pacientes jóvenes, de ambos sexos, sin consumo previo de alcohol y tabaco, que son diagnosticados en estadios avanzados, en los que la clínica rinológica es la más frecuente pero las adenopatías cervicales son el motivo de consulta habitual, con un amplio intervalo diagnóstico. Predominan los tumores indiferenciados en el estudio histológico (AU)

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 (AU)

[Morphometric and stereologic nuclear values obtained from the study of a population suffering from nasopharyngeal carcinoma]. / Valores morfométricos y estereológicos nucleares obtenidos en el estudio de una población con carcinoma de nasofaringe.

Computer nuclear morphometry and stereology are attractive methods because its objectivity and cheapness allowing histologic diagnosis when identifying minimal variations respectively the normality and also detect negligible disparities between anormal cells which could escape to the assessment of the pathologist. We present the data gained from several morphogenic and stereologic parameters resulting of measurements of tumoral cells procured from 40 patients with nasopharyngeal carcinomata. Middle values have been: nuclear area 27.70 microns 2; nuclear perimeter 20.80 microns; nuclear factor of form 0.81 microns; nuclear outline index 4.01; nuclear orientation angle 87.29 degrees; nuclear ellipsiticity 704.14; nuclear regularity 61.83; middle lineal length 4.30, middle linear distance 107.94; and nuclear volume 118.80 microns 3. Our series is the largest studied till now of all found in the literature. Comparison our data with those of previous publications.

[Type I Chiari malformation as a cause of inferior vertical nystagmus]. / Malformación de Chiari tipo I como causa de nistagmo vertical inferior.

Down beat nystagmus is a central nystagmus. In the literature reviewed the two most common causes that can produce it are cerebellar degenerations and Chiari malformation. The site of lesion causing this nystagmus appears to be the brainstem or the cerebellum, although the definitive etiopathogeny remains controversial. We report the case of a 73-year-old woman with sudden unsteadiness of gait and down beating nystagmus, without any other vestibular or neurologic signs. Simple radiology and MRI evidenciated a Chiari malformation type 1 associated to plastybasia.

[Vagal chemodectoma with atypical cells. Case report]. / Quemodectoma vagal con atipias celulares. Presentación de un caso.

We report a clinical case of vagal chemodectoma with cell atypies, which was presented as slowly growing neck mass without any other symptoms. At the beginning and due to the histologic report of the needle biopsy, which morphologic study based on cellular atypia was misinterpreted as a malignant tumor and with the images obtained by computed tomography (CT) suggesting a malignant neoplasia, we proceeded to approach the case as a metastatic tumor of unknown origin. We made a revision of the epidemiologic factors, and diagnostic and therapeutic management of this type of growths.

[Microcytic carcinoma of the nose cavity. A case report]. / Carcinoma microcítico de fosa nasal. A propósito de un caso.

Tumors of the nasal cavity and sinuses are rather infrequent, being squamous carcinoma the predominant type, which accounts for the 80 percent of the totality of them. Maxillary sinus is the most affected, followed by nose cavity. Half of cases are originated on turbinates. We present the clinical case of a woman patient diagnosed of microcytic carcinoma of the right nasal cavity originated at the level of middle turbinate. The mass filled the width of the fossa getting in touch with the nasal septum, without encroaching it. According its extent the tumor was classified as T2, N0, M0 and treated with radiotherapy only. Microcytic carcinoma is an exceptional histological type in nasal cavity and next to its numeric meagerness in this location makes this case a very peculiar one.

[Goldenhar syndrome: a polymalformation syndrome with conductive hearing loss]. / Síndrome de Goldenhar. Un síndrome polimalformativo con hipoacusia de transmisión

We report the case of a 9-years-old girl showing at examination facial asymmetry, right ear with II degree dysplasy and degree III in the left ear (according Marx classification), cleft palate, renal agenesy, scoliosis and hypoplasy of the left thumb. Otoscopically both external ear canals looked very narrow and very upright positioned. The drumhead image recalling that of chronic mucoid effusion. The measurement of hearing through pure-tone audiometry, PEATC, and tympanometry resulted in a pattern of bilateral transmissive pantonal hearing impairment accounting for 50-60 dB. Scoliosis was due either to bars or hemivertebrae or even to an atlas occipitalization. Chromosoma caryotype was normal.

[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.

[Pendred syndrome as a cause of familial deafness]. / Síndrome de Pendred como causa de sordera familiar.

Pendred syndrome is an autosomal recessive disorder characterized by congenital deafness and goiter. The gene responsible for this syndrome is located on chromosome 7q31. The disorder is related to a defect in iodine organification, but the molecular basis of the defect remains unknown. We report two cases of Pendred syndrome, a young woman and her brother. The patients presented deafness, goiter that appeared in the prepubertal years, and a positive perchloriate discharge test. The genetic factors, clinical features, and diagnosis are reviewed.

[Benign necrotizing osteitis of the external ear canal. A report of a clinical case]. / Osteítis necrotizante benigna del conducto auditivo externo. Descripción de un caso clínico.

Benign necrotizing osteitis of the external ear canal is a process of unknown origin. This necrotic process with sequestration of the tympanic bone occurs in healthy, non-diabetic patients. It should be differentiated from malignant otitis externa and radionecrosis of the tympanic bone. A case is reported and the literature on this rare clinical entity is discussed.

[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.

[Labyrinth aspects of cranial Paget's disease]. / Manifestaciones laberínticas en la enfermedad de Paget craneal.

We report the case of a 44-year-old woman suffering, since 5 years, from repetitive vertigo seizures, lasting less than one hour, together with light neuro-sensorial deafness, fullness of the left ear and left ear tinnitus. After analysis of audiologic and imagery tests a Meniere's syndrome secondary to Paget disease--confirm histologically through cortical cranial biopsy--was established.

[Solitary extramedullary plasmocytoma of oropharynx]. / Plasmocitoma solitario extramedular orofaríngeo.

Report on a solitary extramedullary plasmacytoma case, an entity rarely diagnosed in daily practice, because of its low incidence. When the process occurs is seen fundamentally located at upper aero-digestive tract. Our patient was a 34-year-old man, who was diagnosed as oropharyngeal plasmacytoma with the peculiarity that the lesion feigned a benign one wether for the clinical features or the macroscopical aspect. The patient underwent surgery and postoperative rontgentherapy, after discarding a systemic disease. Till now the evolution proved good.