[Temporalis myofascial flap: technique description and results in our patients]. / Colgajo miofascial del músculo temporal: descripción de la técnica y resultados en nuestros pacientes.

INTRODUCTION: Surgical treatment of intraoral and maxillary sinus carcinomas requires a reconstructution of the defect. It is better to do it in one time in order to decrease the morbidity for the patient and the sanitary cost. The temporalis myofascial flap is used for reconstruction of oral cavity, skull base, periorbital region and maxilla because of its feasibility. MATERIAL AND METHODS: We describe the surgical technique and present our results of the reconstructions after total or partial maxillectomy using the temporalis muscle flap in 22 patients. RESULTS: No total necrosis of the flap was seen in any case, a partial necrosis was seen in four cases. CONCLUSION: The temporalis myofascial flap is an excellent choice for oral and maxillary reconstruction.

[Sentinel node in tumours of the lip and the oral cavity]. / Estudio del ganglio centinela en tumores de labio y cavidad oral.

OBJECTIVES: This study shows the results obtained by the application of the sentinel node (SN) in oral and lip cancer and performs a lymphatic map of these tumours. PATIENTS AND METHOD: We prospectively studied 14 patients with lip and oral tumours, all of them N0. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study. RESULTS: Sentinel node was identified in all of the patients. In 11 of them the sentinel node was negative for metastases and correctly predicted the status of the neck. In 3 patients the sentinel node was the only node that contained metastases. There were no false negatives. The sensibility of the technique was 100%. CONCLUSIONS: The results showed that this technique is a feasible method for tumours in these locations and can avoid neck dissections in N0 patients.

[Changes in immunoglobulin levels following adenoidectomy and tonsillectomy]. / Alteraciones de la inmunidad tras adenoidectomía y amigdalectomía.

INTRODUCTION: Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. MATERIAL AND METHODS: We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. RESULTS: Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. DISCUSSION/CONCLUSIONS: Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency.

[Benign tumors of the parotid gland]. / Tumores benignos de la glándula parótida.

We review patients operated of parotidectomy in our ENT department of Dr. Peset Hospital from Valencia during the period 1975-2001. We shelted an amount of 145 cases. The pathologic distribution between benign and malign tumors was as following: 119 benign tumors (83%) and 26 malign tumors (17%). Here we study benign parotid tumors, which represent 83% of total parotid tumors. We performed suprafacial parotidectomies in 72% and total parotidectomy in 19% of cases. Nodulectomy was realized in 9% of patients in those tumors that arise in the lower part of the parotid gland and usualy they were Warthin tumors. The main complications of surgery were facial nerve dysfunction and Frey syndrome. We didn't have any case of permanent facial nerve dysfunction but transitory facial nerve disfunction occurred in 26% of patients. Frey syndrome appeared in 10% of patients operated of parotidectomy. Benign mixed tumor was the only one benign tumor in recurring and the frequency was 5% of patients.

Tumores benignos de la glándula parótida

Realizamos un estudio de los pacientes operados de parotidectomía en el Servicio de Otorrinolaringología del Hospital Dr. Peset de Valencia durante los años 1975-2001. Se recogieron un total de 145 casos. La distribución según patologías fue: 119 tumores benignos (83 por ciento) y 26 tumores malignos (17 por ciento). En el presente trabajo estudiamos los tumores benignos, que representan el 83 por ciento de los tumores parotídeos en nuestra casuística. Las técnicas quirúrgicas practicadas fueron la parotidectomía suprafacial (72 por ciento) y la parotidectomía total (19 por ciento). La nodulectomía está indicada en aquellos casos en los que el tumor está localizado en la cola de la parótida por debajo del ángulo de la mandíbula, la realizamos en el 9 por ciento de los casos y generalmente se trataba de cistadenoma papilar linfomatoso (tumor de Warthin). En cuanto a las complicaciones de la cirugía, en las lesiones del nervio facial, no tuvimos ningún caso de parálisis facial permanente en los tumores beningnos, en cambio las lesiones transitorias ocurrieron en el 26 por ciento de los casos. La aparición del síndrome de Frey fue del 10 por ciento en el total de pacientes operados de parotidectomía. El adenoma pleomorfo es el único tumor beningno que recidivó y la frecuencia de aparición de recidivas fue del 5 por ciento (AU)

[Incompetent tracheoesophageal fistula following phonatory puncture. Surgical resolution]. / Fístula traqueoesofágica incompetente tras punción fonatoria. Solución quirúrgica.

Large tracheoesophageal fistulas (TEF) following a total laryngectomy are rare. Most often are associated with the creation of a surgical speech fistula or puncture. We describe the surgical technique used in 3 patients with large TEF after a total laryngectomy and the creation of a speech fistula with a voice prosthesis, followed by radiation therapy. Pertinent literature is reviewed.

[Hypopharyngeal cancer: analysis of the evolution and surgical results]. / Cáncer de hipofaringe. Análisis de la evolución y resultados del tratamiento quirúrgico.

OBJECTIVE: Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer. METHODS: We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation. RESULTS: The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%. CONCLUSIONS: Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases.

[Value of the intraoperative determination of parathyroid hormone (PTH) in hyperparathyroidism surgery]. / Valor de la determinación intraoperatoria de hormona paratiroidea en la cirugía del hiperparatiroidismo.

INTRODUCTION: The success in the surgical management of hyperparathyroidism has conventionally required a bilateral neck exploration. The intraoperative monitoring of intact parathyroid hormone (PTHi), allows a less extensive procedure by confirming the complete removal of hypersecreting tissue. METHODS: Plasma samples were obtained from 32 consecutive patients before and 10 minutes after removal of abnormal parathyroid tissue. PTH was measured with a modifie immunochemiluminometric assay with a short incubation time and the results made available in 15 minutes. RESULTS: PTHi decreased by at least 60% in 30 of 32 cases. A single adenoma was removed in 26 cases, and multiple hyperplastic glands in 4 cases. The two cases in which PTHi fell < 60% were diagnosed as hyperplasia. PTHi decreased > 60% after the removal of the remnant hyperplastic glands. CONCLUSIONS: The rapid PTHi assay had excellent analytical performance and predicted the success of parathyroid surgery.

[Preliminary results of the relevance the sentinel node in head and neck tumors]. / Resultados preliminares de la utilidad del ganglio centinela en tumores de cabeza y cuello.

OBJECTIVES: The objective of this study is to assess the value of the sentinel node (SN) in head and neck tumours and to create a lymphatic mapping of these tumors. PATIENTS AND METHODS: We prospectively studied 13 patients with head and neck tumours N0. We divided these patients in two groups depending on the location of the primary tumour. We injected colloidal particles of serum albumin labeled with Tc-99 peritumoraly and we located the SN intraoperatively. The SN was then sent for anatomopathological study. RESULTS: In the oropharynx and oral cavity group, with 5 patients, the SN correctly predicted the pathological status of the neck in all of them. In the group of larynx and hypopharynx, with 8 patients, in 6, the SN correctly predicted the pathological status of the neck. In 2 patients, the SN was negative for metastases but there were metastases in the neck dissection. CONCLUSIONS: This technique represents an advance over selective dissection as an accurate method of neck staging, but its value in this field remains unclear.

[Diagnostic value of parathyroid localization techniques in surgery for primary hyperparathyroidism]. / Valor diagnóstico de las técnicas de localización paratiroidea en la cirugía del hiperparatiroidismo primario.

OBJECTIVES: To determine the accuracy of imaging techniques for localization of nodular lesions of parathyroid glands. MATERIAL AND METHODS: Seventy one patients were prospectively enrolled and underwent surgical examination for primary hyperparathyroidism. Ultrasonography (US), 201Tl/99mTc parathyroid subtraction scintigraphy and 99mTc MIBI scintigraphy were evaluated. RESULTS: The sensitivity and specificity for combined 201Tl/99mTc parathyroid subtraction scintigraphy and US for parathyroid adenomas were 72.27% and 89.22% respectively. The combination of 99mTc MIBI scintigraphy and US resulted in improved specificity (93.67%) and positive predictive value (80.39%). The accuracy of the localizing studies was lower for patients with hyperplasia. CONCLUSIONS: The combination of scintigraphy and US is the best approach for localization of nodules. In most cases, the two techniques are complementary.

Transient rise in intact parathyroid hormone concentration after surgery for parathyroid adenoma.

OBJECTIVE: Our goal was to describe the course of parathyroid hormone (PTH) after surgery for primary hyperparathyroidism (PHPT). PTH levels drop to low values after parathyroidectomy for PHPT. However, in some patients, a rebound transient increase in PTH concentrations can occur. Study design and setting A prospective study included 72 patients who underwent surgical exploration for PHPT. A single adenoma was found in 57 patients (79.1%), 2 adenomas were found in 2 (2.7%), and parathyroid hyperplasia was found in 13 (18.05%). The postoperative PTH secretion was studied in those patients who had an adenoma excised. RESULTS: This phenomenon was noted in 18 (31.6%) patients between 4 and 12 weeks, although total calcium concentrations were normal (9.3 +/- 0.6 mg/dL). Before surgery these patients had a more remarkable hyperparathyroidism (clinical and biochemical) than the others, but differences were not significant. CONCLUSION: Postoperative increases in PTH concentration can occur after successful parathyroidectomy. These increases are transient and do not indicate persistent or recurrent disease.

[Benign surgical thyroid pathology in our milieu. Correlation between exploratory tests and anatomopathology]. / Patología quirúrgica tiroidea benigna en nuestro medio. Correlación entre las pruebas exploratorias y la anatomía patológica.

In our milieu, Dr. Peset Hospital, Valencia, we have collected between 1979 and 1998, a total amount of 683 thyroidectomies. Between them 101 carcinomata and 582 bening thyroid pathology. In this work are studied the bening pathology treated surgically. 86.4 percent were women and 13.6% men. Middle age 45 years. By complementary explorations, echography the solid single node by 41.9 percent of cases and solid numerous nodes by 34.7% were the more important findings found. By gammagraphy with greater frequency discovered a cold single node by 44.2% of cases. Anatomopathological types more frequently found were single hyperplastic node (13.3%), multiple hyperplastic nodes (27.6%), spreading hyperplasy (9.1%) and follicular adenoma (37.4%). The aim of this work is the comparative study of findings of complementary explorations with the anatomopathological results gained through the surgical pieces.

Patología quirúrgica tiroidea benigna en nuestro medio. Correlación entre las pruebas exploratorias y la anatomía patológica / Benin surgical thyroid pathology in our milieu. Correlation between exploratory tests and anatomopathology

En nuestro medio del Hospital Dr. PEset de Valencia hemos recogido, en el período comprendido entre 1979-1998 un total de 683 tiroidectomías. En ellas se detectaron 101 carcinomas y 582 patologías benignas de tiroides. En el presente trabajo vamos a estudiar la patología benigna tratada quirurgicamente en nuestro Servicio. De los pacientes con patología benigna el 86,4 por ciento fueron mujeres y el 13,6 por ciento varones, con una edad media de 45 años. En las exploraciones complementarias en la ecografía los principales hallazgos encontrados fue el nódulo sólido único en el 41,9 por ciento y nódulos sólidos múltiples en el 31,7 por ciento. En la gammagrafía el hallazgo observado con mayor frecuencia fue el nódulo frío único en el 44,2 por ciento de los casos. Los tipos anatomopatológicos hallados con mayor frecuencia fueron los siguientes: hiperplasia nodular única (13,3 por ciento), hiperplasia nodular múltiple (27,6 por ciento), hiperplasia difusa (9,1 por ciento) y adenoma folicular (37,4 por ciento). El objetivo del presente trabajo es realizar un estudio estadístico comparando los hallazgos de las exploraciones complementarias (ecografía y gammagrafía) con los resultados anatomopatológicos definitivos de las piezas quirúrgicas (AU)

[Treatment of the NO neck in supraglottic cancer]. / Tratamiento del cuello NO en el cáncer supraglótico.

INTRODUCTION: Occult regional metastases in supraglottic cancer NO are the object of classical controversies. The aim of our study is to provide our experience in order to determine how neck treatment affects on regional recurrence of NO supraglottic cancer. METHODS: A retrospective study of 246 patients with NO supraglottic cancer treated in our service between 1977 to 1999 is presented. RESULTS: 11.4% of patients did not have any cervical treatment, with a 23% of neck recurrence amongst the evolution. 66.7% of patients were treated with a modified radical neck dissection, 24% of these presented occult metastases in the histopathological study. Global regional recurrence was 2.9% in early stages (T1/T2) and 13.1% in advanced stages (T3/T4). In pN+ patients, 85% underwent postoperative radiotherapy, with a regional recurrence of 8.8%. Postoperative clinical control without any other treatment in pN0 patients showed a neck recurrence of 6.1%. We performed a unilateral neck dissection in those patients with clear-lateral tumours. In these cases the clinical control of the contralateral neck gave a 5.5% recurrencies on that side. Patients treated with elective primary radiotherapy suffered a 5.5% of regional recurrence. DISCUSSION/CONCLUSIONS: Neck treatment of the NO supraglottic cancer is recommended. We treat neck in the same way of primary tumour (surgery or radiotherapy) with good control of regional recurrencies, less than 10%. In case of a negative pathological study of the neck careful, watching is the elective attitude. In the positive pathological study of the neck (pN+), radiotherapy is the elective treatment in those with three or more affected nodes or capsular breakdown in any of them.

[Unilateral polyposis: evaluation of preoperative tests]. / Poliposis unilaterales: evaluación de las pruebas preoperatorias.

UNLABELLED: The aim of this paper is to study a group of patients with occupancy of a nasal fossal, apparently by polyps, and being the other side of the nose normal. Evaluating on the one hand the true incidence of unspecific polyposis and, of other diagnosis, and on the other hand to compare the preoperative radiological findings with those seen during surgery. MATERIAL AND METHODS: A prospective study of 23 consecutive patients was carried out over a period of 30 months at the ENT Department of the Dr. Peset Hospital, in Valencia. A CT scan and preoperative biopsy was performed in all cases, the results of these being later compared with the surgical findings and the final histopathologic diagnosis. RESULTS AND CONCLUSIONS: A discrepancy between the preoperative biopsy and final diagnosis was found in 26% of the patients. The incidence of polyposis was 52%, inverted papilloma 26%, malignant tumours 13% and other diagnosis 8.6%. There is a good correlation between preoperative CT scans and surgical findings in those cases of polyposis and inverted papilloma, but not in those of malignant tumours as CT scans often underestimated these lesions.

[Why does a mastoidectomy cavity become suppurative? Our experience and revision of the literature]. / Por qué supura una cavidad de mastoidectomía? Nuestra experiencia y revisión de la literatura.

The main goal for performing surgery for chronic otitis media is to eliminate the disease and improve hearing whenever possible. Persistent drainage of a mastoid cavity means failure of surgery and of achieving the goal. In this study, we present our department's attitude for suppurative mastoid cavities as well as the reasons that do not allow adequate control of them.

[Descriptive analysis and surgical outcome of primary hyperparathyroidism]. / Análisis descriptivo y resultados quirúrgicos del hiperparatiroidismo primario.

Primary hyperparathyroidism (PHPT) was a rare but serious disease with massive biochemical, renal and skeletal signs at the time of diagnosis. In the last decades it has become a more common disorder often diagnosed by chance. The disease usually shows minimal symptoms. These clinical changes are due to advances in biochemical screening procedures, which have led to a remarkable increase in the incidence of PHPT. The aim of this study is to describe the clinical profiles, biochemical data, operative findings and postoperative results. Seventy one consecutive patients were prospectively enrolled and underwent surgical examination. Most of them showed symptoms: 6 patients were asymptomatic and 11 had a normocalcemic hyperparathyroidism. After surgery 5 patients showed persistent primary hyperparathyroidism. Parathyroid hormone concentration returned to normal levels in 95.77% of the patients studied. Parathyroidectomy is a safe and effective approach to the treatment of primary hyperparathyroidism.

Recurrent infection of a complex odontoma following eruption in the mouth.

Odontomas are the most common odontogenic tumors, and are classified as either compound or complex lesions. Although its underlying etiology remains unclear, a number of factors appear to be involved (e.g., prior trauma). The lesions are generally diagnosed in the second decade of life, often in the context of routine dental X-ray examinations. A complex odontoma is described in a 22-year-old woman referring discomfort due to overinfection following its aperture into the oral cavity in the distal alveolar region of 2.6. Initial treatment consisted of antibiotics and antiinflammatory drugs. Computed axial tomography revealed a solid, irregular mass in the distal zone of the left maxilla, imprinting upon the region of the maxillary sinus on the same side. Surgical resection was performed, raising the alveolar mucosa and upper left vestibular fundus. The surgical piece contained the amorphous adenoma mass and the tooth 2.7.

[Epley's reposition maneuver in the treatment of benign paroxysmal positional vertigo]. / Maniobra de reposición de epley para tratamiento del vértigo posicional paroxístico benigno.

We performed a prospective study over 19 patients to evaluate the efficacy of the Epley's particle repositioning maneuver for treatment of the benign paroxysmal positional vertigo (BPPV), 78.9% were cured through this procedure, so we find this method as very useful for improving the BPPV.