Myomucosal island flaps for oropharyngeal reconstruction.

The oropharynx represents one of the most challenging areas to reconstruct for the head and neck surgeon. The buccinator myomucosal island flaps pedicled on the facial artery [tunnelized facial artery myomucosal island flap (t-FAMMIF)] or the buccal artery [buccal artery myomucosal island flap (BAMMIF)] are an ideal reconstructive option for moderate size defects measuring up to 8-9cm. Two fresh specimens have been used to show the step-by-step surgical technique of both island flaps. Design and flap extension, dissection plane, identification of the vascular pedicle, flap rotation and insetting are described. Reconstructive indications and the pros and cons of each one are discussed in this article. Myomucosal island flaps represent a very useful and versatile option for the functional reconstruction of the oropharynx. A detailed knowledge of the vascular anatomy of the cheek is key to obtain a large flap while minimizing the risk of complications.

Bonebridge® bone conduction implant. Hearing outcomes and quality of life in patients with conductive/mixed hearing loss.

PURPOSE: The aim of this study was to analyze the hearing outcomes and quality of life in a series of 52 patients affected by conductive or mixed hearing loss and treated with Bonebridge®. METHODS: 52 of 71 patients implanted with Bonebridge® between October 2012 and January 2022, were included in the study. We compared the air conduction thresholds at the frequencies 500, 1000, 2000, 3000, 4000 Hz, the SRT50% and the World Recognition Score at an intensity of 50 dB with and without the implant. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was employed to assess the quality of life of patients. RESULTS: The liminal tone audiometry (free field) pure tone average for air conduction after 6 months with the implant was 35.12 dB, obtaining a mean gain of 31.83 dB. With Bonebridge®, the mean SRT was 34.17 dB, whereas before the surgery no patient achieved 50% of correct answers at a sound intensity of 50 dB. The world recognition score at 50 dB changed from 11% without the implant to 85% with it. We observed one case of implant failure and one case of implant exposure. The APHAB questionnaire showed an improvement after implantation in practically all the subscales. CONCLUSIONS: The hearing outcomes and the subjective benefits reported by patients obtained in our study are similar to those published in the literature. Bonebridge® represents an excellent method for the rehabilitation of patients with conductive and mixed hearing loss, showing a low rate of complications.

Right colonic interposition for severe pharyngoesophageal stricture in head and neck patients: A feasible rescue strategy after multiple failed reconstructive options.

Severe pharyngeal stricture is an uncommon complication that may occur afer laryngectomy especially in irradiated patients. Its management is a challenge and high risk of recurrence after reconstruction exists. We present two patients with severe end-stage pharyngoesophageal stricture after several failed attempts of reconstruction with regional and free flaps, in which a right colon transposition was performed. Twenty days after surgery both patients were able to tolerate an oral diet, and no minor or major complications were observed. Right colonic transposition may be a valid option for secondary pharyngeal reconstruction if other less invasive methods such as regional or free flaps have failed to restore the pharyngoesophageal continuity or if the inferior location of stricture makes a tension free anastomosis impossible.

Role of Intratympanic Dexamethasone for Intractable Posterior Canal Benign Paroxysmal Positional Vertigo.

BACKGROUND: Benign paroxysmal positional vertigo is a frequent diagnosed disorder, most of the patients are successfully treated with reposition maneuvers. In between 3-12.5% of these patients remain symptomatic. Recent studies support the use of intratympanic corticosteroid for intractable vertigo with promising results. MATERIAL AND METHODS: Patients diagnosed with benign paroxysmal positional vertigo between June 2017 and December 2019 in a tertiary university hospital and in two private hospitals were included in the study and analyzed prospectively. They were treated and followed with repositioning maneuvers and intratympanic dexamethasone injections if the criteria was met. RESULTS: 4 out 72 patients included in the study developed criteria for intractable vertigo after at least 6 repositioning maneuvers. The posterior semicircular canal was affected in all cases, 3 out of 4 patients experienced symptom resolution, after two, four and five intratympanic dexamethasone injections respectively. CONCLUSIONS: The use of intratympanic steroids to treat patients with refractory benign paroxysmal positional vertigo showed encouraging results. We believe a multicenter randomized clinical trial should be performed to assess the efficacy of intratympanic steroids in the treatment of this pathology.

Cervicofacial surgery and implantable hearing device extrusion: management of challenging cases.

OBJECTIVE: To describe our management of implantable hearing device extrusion in cases of previous cervicofacial surgery. METHODS: A review was conducted of a retrospectively acquired database of surgical procedures for implantable hearing devices performed at our department between January 2011 and December 2019. Cases of device extrusion and previous cervicofacial surgery are included. Medical and surgical management is discussed. RESULTS: Four cases of implant extrusion following cervicofacial surgery were identified: one involving a Bonebridge system and three involving cochlear implants. In all cases, antibiotic treatment was administered and surgical debridement performed. The same Bonebridge system was implanted in the middle fossa. The three cochlear implants were removed, and new devices were implanted in a more posterior region. CONCLUSION: Previous cervicofacial surgery is a risk factor for hearing implant extrusion. The middle fossa approach is the best option for the Bonebridge system. Regarding the cochlear implant, it is always suitable to place it in a more posterior area. An inferiorly based fascio-muscular flap may be a good option to reduce the risk of extrusion.

Pseudo mastoid obliteration with conchal cartilage may be a safe alternative technique for cochlear implantation in canal wall down mastoidectomy with large meatoplasty.

OBJECTIVE: Safe cochlear implantation is challenging in patients with canal wall down mastoid cavities, and the presence of large meatoplasties increases the risk of external canal overclosure. This paper describes our results of obliteration of the mastoid cavity with conchal cartilage as an alternative procedure in cases of canal wall down mastoidectomy with very large meatoplasty. METHODS: The cases of seven patients with a canal wall down mastoidectomy cavity who underwent cochlear implantation were retrospectively reviewed. Post-operative complications were analysed. The mean follow-up duration was 4.5 years. RESULTS: There was no hint of cholesteatoma recurrence and all patients have been free of symptoms during follow up. Only one patient showed cable extrusion six months after surgery, and implantation of the contralateral ear was needed. CONCLUSION: Pseudo-obliteration of the mastoid cavity with a cartilage multi-layered palisade reconstruction covering the electrode may be a safe alternative in selected patients with a large meatoplasty.

Endoscopic reconstruction of large anterior skull base defects with opening of the sellar diaphragm. Experience at a tertiary level university hospital.

BACKGROUND: The indications for expanded endoscopic transnasal approaches continue to increase, with more complex skull base defects needing to be repaired. This study reviews the management of large anterior skull base defects with opening of the sellar diaphragm. METHOD: A prospective analysis of endonasal endoscopic surgery carried out at Son Espases University Hospital between January 2013 and December 2018 was performed. The analysis included only the cases with a significative intra-operative cerebrospinal fluid leak. In all cases, reconstruction was performed by combining the gasket seal technique with a pedicled mucosal endonasal flap. RESULTS: Twenty-eight patients were included. The mucoperiosteal nasoseptal flap, the lateral wall flap and the middle turbinate flap were used in 13, 8 and 7 patients, respectively, combined with the gasket seal technique. One case of post-operative cerebrospinal fluid leak was observed (3.57 per cent). CONCLUSION: The combination of a gasket seal with an endonasal mucosal flap is an excellent technique for repairing large anterior skull base defects.

The Bonebridge active bone conduction system: a fast and safe technique for a middle fossa approach.

BACKGROUND: The transmastoid pre-sigmoid approach is always the preferred choice for implantation of the Bonebridge active bone conduction system in patients with a normal anatomy. When an anatomical variant exists or a previous surgery has been performed, a retrosigmoid approach or middle fossa approach can be performed. METHODS: The preferred surgical technique for a middle fossa approach is described. A 14 mm drill head (Neuro Drill) was used to create the bed at the squamous portion of the temporal bone. Surgical time and complication rate were analysed. RESULTS: The surgical time was shorter than 30 minutes in all cases, and only 14 seconds were needed to create a 14 mm bone bed. No complications were observed during the follow-up period (6-45 months). CONCLUSION: Use of the Neuro Drill for the middle fossa approach is an easy technique. It significantly decreases the surgical time, without increasing the complication rate.

Malformaciones congénitas del cuello. Diagnóstico y tratamiento / Congenital neck mass. Diagnosis and treatment

Las alteraciones congénitas del cuello constituyen un desafío para los médicos de familia y los especialistas. Aunque algunas de ellas son diagnosticadas de forma intrauterina, la mayoría permanecen silentes y se manifiestan en el contexto de infecciones a lo largo de la vida. La localización anatómica, la consistencia y la edad son determinantes en la orientación del posible diagnóstico. Una masa cervical en línea media infrahioidea hará pensar en un quiste tirogloso. Si es lateral, descartaremos un quiste braquial. Los estudios complementarios por imagen son fundamentales, sin olvidar pruebas anatomopatológicas como punción aspiración de aguja fina (PAAF) (AU)

Congenital neck masses are a challenge for general practitioners and specialists. Although some of them are diagnosed in utero, most of them remain silent until complications appear in the adult age. The anatomical location, consistency and age are determinants in guiding the possible diagnosis. A midline infrahyoid mass may be a thyroglossal cyst, however a lateral neck mass is more possible to result in a brachial cyst. Complementary imaging studies are essential such as pathological tests like needle aspiration fine needle aspiration (FNA) (AU)

[Congenital neck mass. Diagnosis and treatment]. / Malformaciones congénitas del cuello. Diagnóstico y tratamiento.

Congenital neck masses are a challenge for general practitioners and specialists. Although some of them are diagnosed in utero, most of them remain silent until complications appear in the adult age. The anatomical location, consistency and age are determinants in guiding the possible diagnosis. A midline infrahyoid mass may be a thyroglossal cyst, however a lateral neck mass is more possible to result in a brachial cyst. Complementary imaging studies are essential such as pathological tests like needle aspiration fine needle aspiration (FNA).

Manejo del vértigo posicional paroxístico benigno en atención primaria / Management of benign paroxysmal positional vertigo in first care centers

El vértigo posicional paroxístico benigno es la entidad más frecuente dentro de los vértigos de origen periférico. Se caracteriza por crisis de vértigo desencadenadas por cambios posicionales de la cabeza y de corta duración. Suele presentarse en los mayores de 40-50 años, y hasta el 50% de los casos no se deben a una causa conocida, por lo que se habla de vértigo posicional paroxístico benigno idiopático. Debido a la alta incidencia del vértigo posicional paroxístico benigno, consideramos de especial trascendencia poseer los conocimientos necesarios para poder diagnosticar y tratar con eficacia esta afección en el ámbito de la medicina de atención primaria, ya que en la mayoría de los casos se obtienen excelentes resultados a través de unas maniobras específicas y fáciles de realizar (AU)

The benign paroxysmal positional vertigo is the most common disease in the group of peripheral vertigo. It's characterized by vertiginous sensation triggered by the positional changes of the head and usually lasts less than one minute. It is most frequently seen in middle-aged patients (40-50 years old) and in up 50% of cases we do not know the cause, so we refer to them as idiopathic benign paroxysmal positional vertigo. Because of the high incidence of benign paroxysmal positional vertigo in general population, it is of utmost importance to be aware of the differential diagnosis and to be able to treat this pathology with efficacy, because in most cases we can achieve excellent results performing specific and simple maneuvers (AU)

[Management of benign paroxysmal positional vertigo in first care centers]. / Manejo del vértigo posicional paroxístico benigno en atención primaria.

The benign paroxysmal positional vertigo is the most common disease in the group of peripheral vertigo. It's characterized by vertiginous sensation triggered by the positional changes of the head and usually lasts less than one minute. It is most frequently seen in middle-aged patients (40-50 years old) and in up 50% of cases we do not know the cause, so we refer to them as idiopathic benign paroxysmal positional vertigo. Because of the high incidence of benign paroxysmal positional vertigo in general population, it is of utmost importance to be aware of the differential diagnosis and to be able to treat this pathology with efficacy, because in most cases we can achieve excellent results performing specific and simple maneuvers.

Manejo de hipoacusia neurosensorial súbita en atención primaria / Management of sudden neurosensory hearing loss in a Primary Care Centre

La hipoacusia súbita es una pérdida auditiva neurosensorial de rápida instauración (horas o días) en un individuo aparentemente sano. La etiología puede ser amplia y multifactorial. La mayoría de los pacientes no recuperan la audición en su evolución natural e incluso algunos pueden desarrollar una cofosis del oído afecto. Es una urgencia otológica, ya que la pronta instauración terapéutica logra ofrecer un mejor pronóstico auditivo. Debido al escaso conocimiento de esta enfermedad, puede ser infradiagnosticada en centros de atención primaria. En su diagnóstico no es necesario el manejo de instrumental avanzado: basta con una detallada historia clínica, una otoscopia normal y la correcta interpretación de la acumetría (diapasones). De esta forma se logra un diagnóstico certero en la mayoría de los casos, el cual se confirmará mediante audiometría (AU)

Sudden hearing loss is a rapid loss of neurosensory hearing that may occur within hours or days in an apparently healthy patient. Its origins are variable and multifactorial. Most patients do not recover hearing if not treated, and some even develop cophosis (deafness) in the affected ear. It is an otological emergency, as early therapeutic management offers a better hearing prognosis. As there is limited knowledge on this condition, it may be underdiagnosed in Primary Health Care Centers. It should be suspected in patients with abrupt hearing loss or tinnitus. Sophisticated instruments are not required for its diagnosis, just a detailed history, basic otoscopy, and proper interpretation of the hearing test. In this way, an accurate diagnosis is achieved in most cases, which is confirmed by audiometry (AU)

[Management of sudden neurosensory hearing loss in a Primary Care Centre]. / Manejo de hipoacusia neurosensorial súbita en atención primaria.

Sudden hearing loss is a rapid loss of neurosensory hearing that may occur within hours or days in an apparently healthy patient. Its origins are variable and multifactorial. Most patients do not recover hearing if not treated, and some even develop cophosis (deafness) in the affected ear. It is an otological emergency, as early therapeutic management offers a better hearing prognosis. As there is limited knowledge on this condition, it may be underdiagnosed in Primary Health Care Centers. It should be suspected in patients with abrupt hearing loss or tinnitus. Sophisticated instruments are not required for its diagnosis, just a detailed history, basic otoscopy, and proper interpretation of the hearing test. In this way, an accurate diagnosis is achieved in most cases, which is confirmed by audiometry.

Manejo de cuerpos extraños nasales y óticos en niños / Management of foreign bodies in ears and nose in children

Los cuerpos extraños en los oídos y las fosas nasales son muy frecuentes en la urgencia de otorrinolaringología. La edad de los pacientes afectos suele estar entre 2–5 años, pero pueden producirse a cualquier edad, incluso en adultos. Se puede ver todo tipo de cuerpos extraños, como pequeños juguetes, lápices, plastilinas, semillas, trozos de comida y hasta insectos. Muchas de estas situaciones se solucionan en salud primaria y solo los casos más difíciles llegan a nuestra especialidad. Debemos tener conocimiento de la anatomía de estas zonas, conocer el material ideal con el que se debe trabajar, las técnicas y las alternativas de extracción, y los cuidados postextracción para provocar el menor traumatismo posible y no provocar secuelas a corto ni a largo plazo (AU)

Foreign bodies in the ears and nose are very frequently seen in the otolaryngology emergency service. The age of the affected patients is generally between 2–5 years. However, this may occur at any age, even in adults. All kinds of foreign bodies can be seen, such as small toys, pencils, Plasticines, seeds, bits of food and even insects. Many of these situations are solved in primary health care and only the most difficult cases come to our speciality. It is important to have knowledge of the anatomy of these areas, knowing the best material to work with, the techniques and extraction alternatives and post-extraction care in order to have the least possible trauma and not cause short and long term sequels (AU)

Manejo de cuerpos extraños nasales y óticos en niños / Management of foreign bodies in ears and nose in children

Los cuerpos extraños en los oídos y las fosas nasales son muy frecuentes en la urgencia de otorrinolaringología. La edad de los pacientes afectos suele estar entre 2–5 años, pero pueden producirse a cualquier edad, incluso en adultos. Se puede ver todo tipo de cuerpos extraños, como pequeños juguetes, lápices, plastilinas, semillas, trozos de comida y hasta insectos. Muchas de estas situaciones se solucionan en salud primaria y solo los casos más difíciles llegan a nuestra especialidad. Debemos tener conocimiento de la anatomía de estas zonas, conocer el material ideal con el que se debe trabajar, las técnicas y las alternativas de extracción, y los cuidados postextracción para provocar el menor traumatismo posible y no provocar secuelas a corto ni a largo plazo (AU)

Foreign bodies in the ears and nose are very frequently seen in the otolaryngology emergency service. The age of the affected patients is generally between 2–5 years. However, this may occur at any age, even in adults. All kinds of foreign bodies can be seen, such as small toys, pencils, Plasticines, seeds, bits of food and even insects. Many of these situations are solved in primary health care and only the most difficult cases come to our speciality. It is important to have knowledge of the anatomy of these areas, knowing the best material to work with, the techniques and extraction alternatives and post-extraction care in order to have the least possible trauma and not cause short and long term sequels (AU)

[Pharmacological prophylaxis of gastroesophageal reflux. Incidence of pharyngocutaneous fistula after total laryngectomy]. / Profilaxis farmacológica del reflujo gastroesofágico. Incidencia de fístula faringocutánea tras laringuectomía total.

Pharyngocutaneous fistula is a serious complication of total laryngectomy. This problem increases morbidity, prolongs hospitalization, and occasionally causes death. Numerous contributing factors have been implicated in fistula formation (1). We propose that gastroesophageal reflux, which often is subclinical, is an important trigger and should be prevented. We evaluated the effect of associating an antireflux agent like metoclopramide hydrochloride to our usual ranitidine of our protocol after total laryngectomy on reducing the incidence (p<0.05) of pharyngocutaneous fistula.