Schwannoma laríngeo. Un tumor de laringe poco común / Schwannoma of the larynx. An infrequent laryngeal tumour

Los schwannomas laríngeos son tumores benignos infrecuentes, localizados generalmente en la región supraglótica. Suelen originarse a partir de la rama interna del nervio laríngeo superior. La mayoría de los pacientes presentan sensación de globo faríngeo, disfagia o disfonía. La cirugía conservadora es el tratamiento de elección. Se presenta un caso de un schwannoma de laringe asintomático, el cual es diagnosticado incidentalmente en una prueba de imagen. La extirpación completa de la lesión se realizó a través de un abordaje endoscópico transoral con láser CO2 sin requerir la realización de una traqueotomía. Revisamos los procedimientos diagnósticos, el diagnóstico diferencial y las opciones terapéuticas de esta infrecuente entidad (AU)

Schwannomas are benign tumours, rare among tumours of the larynx. They normally present as supraglottic masses (because they may arise from the internal branch of the superior laryngeal nerve), most commonly involving aryepiglottic folds or false vocal folds. Most patients present with a globus sensation, dysphagia or hoarseness. Conservative surgery is the treatment of choice. We report a case of a laryngeal asymptomatic neuroma that was diagnosed accidentally in an imaging test. Complete excision of the tumour was performed through a transoral CO2 laser microsurgery without resorting to a tracheotomy. We discuss the clinical, pathologic and imaging findings and the management of this neoplasm. We also try to update the knowledge on the management of these tumours (AU)

Replica a la carta «Comentario sobre las infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos» / Reply to the letter «Comments on peritonsillar infections: a prospective study of 100 consecutive cases»

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Schwannoma of the larynx. An infrequent laryngeal tumour.

Schwannomas are benign tumours, rare among tumours of the larynx. They normally present as supraglottic masses (because they may arise from the internal branch of the superior laryngeal nerve), most commonly involving aryepiglottic folds or false vocal folds. Most patients present with a globus sensation, dysphagia or hoarseness. Conservative surgery is the treatment of choice. We report a case of a laryngeal asymptomatic neuroma that was diagnosed accidentally in an imaging test. Complete excision of the tumour was performed through a transoral CO2 laser microsurgery without resorting to a tracheotomy. We discuss the clinical, pathologic and imaging findings and the management of this neoplasm. We also try to update the knowledge on the management of these tumours.

Cirugía transoral LASER CO2 en tumores avanzados de faringe y laringe / Transoral laser microsurgery in advanced carcinomas of larynx and pharynx

Introducción y objetivos: Existen diversas modalidades terapéuticas de los carcinomas epidermoides avanzados de faringe y laringe. Se han propuesto nuevas estrategias que, sin empeorar los resultados oncológicos, disminuyan la morbilidad generada por los tratamientos agresivos. Entre estos tratamientos se encuentra la microcirugía transoral LASER CO2 (MTL). El objetivo de este estudio es describir los resultados de los pacientes con carcinomas avanzados de laringe y faringe tratados mediante este método en nuestro departamento. Material y método: Realizamos un estudio retrospectivo en 63 pacientes con tumores de faringe y laringe en estadios avanzados (estadios III y IV) intervenidos mediante MTL entre los años 2000 y 2008. Catorce pacientes tenían un tumor de base de lengua, 16 un tumor de seno piriforme, 29 un tumor supraglótico y 4 un tumor glótico. El tiempo medio de seguimiento fue de 51 meses. Resultados: El 28% de tumores de base de lengua, el 50% de tumores de hipofaringe, el 27% de tumores de supraglotis y el 75% de los tumores glóticos recidivaron. La supervivencia específica fue del 73,3% para todas las localizaciones con un rango que va desde el 90% para los tumores de supraglotis hasta el 50% para los tumores glóticos. El 34% de los pacientes presentaron algún tipo de complicación tras la cirugía, siendo la hemorragia local la más frecuente (17%). Conclusiones: La MTL es una alternativa válida para el tratamiento de los carcinomas de faringe y laringe en estadios avanzados. Sus resultados oncológicos son similares a los obtenidos otras modalidades terapéuticas y la morbilidad generada es menor (AU)

Introduction and objectives: There are several types of treatment for advanced squamous cell carcinomas of the pharynx and larynx. However, both open surgery and chemoradiation protocols have failed to improve control and survival. There is a tendency toward conservative treatment without worsening oncological outcomes. The objective of this study was to describe the effectiveness of organ-preserving CO2 laser microsurgery for treating advanced carcinomas of the larynx and pharynx. Material and method: A retrospective review of 63 patients undergoing CO2 laser microsurgery for the treatment of squamous cell carcinomas of the pharynx and larynx in advanced stages (stages III and IV) was performed. Tumour distribution was 14 patients with a tumour at the base of the tongue, 16 with a pyriform sinus tumour, 29 with a supraglottic tumour and 4 with a glottic tumour. Mean follow-up was 51 months. Results: Thirty-five percent of patients (23) had recurrences. The recurrence rate was 28% for base of tongue tumours, 50% for hypopharyngeal tumours, 27% for supraglottic tumours and 75% for glottic tumours. The 5-year disease-specific survival rate was 73.3% for all locations, with a range from 90% for supraglottic tumours up to 50% for glottic tumours. Thirty-four percent of patients had some type of complication after surgery. The most frequent complication was local bleeding (17%). Conclusion: Transoral CO2 laser microsurgery is an alternative for the treatment of carcinomas of the pharynx and larynx in advanced stages. Its oncological results are equivalent to other treatment modalities and its morbidity is lower (AU)

Masa cervical de origen infrecuente / Neck mass with infrequent origin

Varón de 67 años de edad diagnosticado de adenocarcinoma de próstata que refiere disfagia, disfonía y la aparición de una masa laterocervical. En una tomografía computarizada se aprecia una lesión cervical de partes blandas, osteolítica, la cual es resecada y cuyo estudio anatomopatológico fue compatible con metástasis de adenocarcinoma de próstata(AU)

We report the case of a 67-year-old male diagnosed with prostate adenocarcinoma, who referred dysphagia, dysphonia and noticed the appearance of a laterocervical mass. A CT scan revealed an osteolytic soft tissue neck lesion, which was resected. Its anatomical-pathological study was compatible with metastasis of prostate adenocarcinoma(AU)

[Neck mass with infrequent origin]. / Masa cervical de origen infrecuente.

We report the case of a 67-year-old male diagnosed with prostate adenocarcinoma, who referred dysphagia, dysphonia and noticed the appearance of a laterocervical mass. A CT scan revealed an osteolytic soft tissue neck lesion, which was resected. Its anatomical-pathological study was compatible with metastasis of prostate adenocarcinoma.

[Transoral laser microsurgery in advanced carcinomas of larynx and pharynx]. / Cirugía transoral LASER CO2 en tumores avanzados de faringe y laringe.

INTRODUCTION AND OBJECTIVES: There are several types of treatment for advanced squamous cell carcinomas of the pharynx and larynx. However, both open surgery and chemoradiation protocols have failed to improve control and survival. There is a tendency toward conservative treatment without worsening oncological outcomes. The objective of this study was to describe the effectiveness of organ-preserving CO2 laser microsurgery for treating advanced carcinomas of the larynx and pharynx. MATERIAL AND METHOD: A retrospective review of 63 patients undergoing CO2 laser microsurgery for the treatment of squamous cell carcinomas of the pharynx and larynx in advanced stages (stages III and IV) was performed. Tumour distribution was 14 patients with a tumour at the base of the tongue, 16 with a pyriform sinus tumour, 29 with a supraglottic tumour and 4 with a glottic tumour. Mean follow-up was 51 months. RESULTS: Thirty-five percent of patients (23) had recurrences. The recurrence rate was 28% for base of tongue tumours, 50% for hypopharyngeal tumours, 27% for supraglottic tumours and 75% for glottic tumours. The 5-year disease-specific survival rate was 73.3% for all locations, with a range from 90% for supraglottic tumours up to 50% for glottic tumours. Thirty-four percent of patients had some type of complication after surgery. The most frequent complication was local bleeding (17%). CONCLUSION: Transoral CO2 laser microsurgery is an alternative for the treatment of carcinomas of the pharynx and larynx in advanced stages. Its oncological results are equivalent to other treatment modalities and its morbidity is lower.

Fallo barorreceptor tras la resección bilateral de paragangliomas carotídeos / Baroreceptor failure after bilateral resection of carotid artery parangliomas

Los paragangliomas (PGL) múltiples en la región de la cabeza y cuello son patologías raras. Presentamos el caso de una paciente de 24 años que fue intervenida en nuestro centro de PGL carotídeos bilaterales y que desarrolló un fallo barorreceptor después de la resección de éstos. Aunque resulta una complicación poco frecuente, es importante conocerla para diagnosticarla y tratarla rápidamente, evitando así mayores complicaciones postoperatorias (AU)

Multiple head and neck parangliomas are unusual pathologies. We report a case of a 24-year-old patient operated on at our centre for bilateral carotid artery parangliomas who developed baroreceptor failure after their resection. Albeit an infrequent complication, it is important to be aware of it in order to ensure is speedy diagnosis and treatment so as to avoid major post-surgical complications (AU)

Baroreceptor failure after bilateral resection of carotid artery parangliomas.

Multiple head and neck parangliomas are unusual pathologies. We report a case of a 24-year-old patient operated on at our centre for bilateral carotid artery parangliomas who developed baroreceptor failure after their resection. Albeit an infrequent complication, it is important to be aware of it in order to ensure is speedy diagnosis and treatment so as to avoid major post-surgical complications.

Ludwig's angina as an extremely unusual complication for direct microlaryngoscopy.

BACKGROUND: An extremely rare case that to our knowledge has not been reported before is described, in which a patient had a Ludwig's angina as a complication of direct microlaryngoscopy. METHODS: We report a Ludwig's angina after a direct microlaryngoscopy for a Reinke's edema, due to erosion on the internal face of the mandible produced by compression of the laryngoscope. RESULTS: The patient underwent placement of 2 drainages, intraoral and cervical, and several incisions on the floor of the mouth, with intravenous corticosteroids and antibiotics and with resolution of the illness without performing tracheostomy. CONCLUSIONS: Ludwig's angina is an extremely rare complication of microlaryngoscopy, but it is potentially life-threatening. Early diagnosis and treatment resulted in survival of the patient without complications.

Papilomas invertidos rinosinusales. Revisión de 61 casos / Inverted sinonasal papillomas. Review of 61 cases

Introducción: Los papilomas invertidos son neoplasias raras localizadas preferentemente en la pared lateral nasal, caracterizadas por la tendencia a recidivar y su potencial transformación en neoplasias malignas. El objetivo de este trabajo es analizar nuestra experiencia en el tratamiento de estas lesiones, especialmente el abordaje endoscópico. Material y métodos: Se realizó un estudio retrospectivo de 61 pacientes tratados en nuestro hospital desde 1983. Se recogieron los datos clinicopatológicos de los pacientes, el tratamiento aplicado y la evolución en el tiempo tras éste. El tiempo medio de seguimiento fue de 51 meses (rango: 6–228 meses). Resultados: Treinta y ocho de los pacientes (62%) eran hombres y 23 mujeres (38%), con una edad media de 58 años (rango: 22–80). El síntoma principal fue insuficiencia respiratoria nasal unilateral en el 91%, seguido de rinorrea en el 46%. La localización más frecuente fue el etmoides (51%), seguida del seno maxilar (28%) y la pared lateral nasal (21%). El 78% de los casos tenía sinusitis asociada y el 43%, poliposis. La clasificación por estadios de Krouse fue del 35% en estadio I, 37% en estadio II, 18% en estadio III y 8% en el IV. El 37% de los pacientes presentaba remodelación ósea en la TAC. Seis de los 42 pacientes operados por cirugía endoscópica nasal (CEN) presentaron recidiva (14%), mientras que de los pacientes a los que se operó por técnicas abiertas, presentaron recidiva 6 de 9 (67%). El tiempo medio a la recidiva fue de 41 meses. Diez de los pacientes presentaron papilomas invertidos malignizados, nueve de ellos fueron diagnosticados desde el principio como neoplasias malignizadas y uno se malignizó durante el seguimiento. Discusión y conclusiones: La CEN es el método de elección para el tratamiento de la mayor parte de los papilomas invertidos con resultados equiparables o, incluso, mejores que con las técnicas abiertas. El estrecho seguimiento de los pacientes por largos períodos de tiempo es necesario para detectar de forma precoz las recidivas y poder practicar cirugías de rescate (AU)

Introduction: Inverted papillomas are benign sinonasal lesions that arise primarily from the lateral nasal wall which are characterized by their tendency to recur and propensity to be associated with malignancy. The aim of this work is to analyze our experience in the treatment of these lesions, especially through the endoscopic approach. Material and method: We present 61 cases of sinonasal inverted papillomas that were treated at our hospital since 1983. The patients were studied by age, gender, site of presentation of the tumor, symptoms, radiologic studies, surgical treatment and evolution. The mean follow-up was 51 months (range 6–228 months). Results: Thirty eight of the patients (62%) were males and 23 females (38%). The average age was 58 years (range 22–80). The most common symptom was unilateral nasal obstruction in 91% of the cases, followed by rhinorrhea in 46%. The most frequent location was the ethmoid region in 51% of cases, followed by the maxillary sinus in 28% and the lateral nasal wall in 21% of the cases. 78% of cases had associated sinusitis and the 43% polyposis. Tumours were classified with the Krouse staging system as follows: 35% stage I, 37% stage II, 18% stage III and 8% stage IV. 37% of the patients had bony erosion in the CT scan. Six of the 42 patients treated by endoscopic procedures presented recurrence (14%), compared with 6 of the 9 patients (67%) who were treated by open approaches. The average time to the recurrence was 41 months. 17% of the patients had malignant inverted papillomas, nine of them diagnosed from the beginning as malignant neoplasies and one which became malignant during follow up. Discussion and conclusions: The endoscopic approach is the method of choice for the treatment of the majority of inverted papillomas. The close follow up of the patient for a large period of time is necessary for the early detection of recurrence and to allow for surgical salvage (AU)

[Inverted sinonasal papillomas. Review of 61 cases]. / Papilomas invertidos rinosinusales. Revisión de 61 casos.

INTRODUCTION: Inverted papillomas are benign sinonasal lesions that arise primarily from the lateral nasal wall which are characterized by their tendency to recur and propensity to be associated with malignancy. The aim of this work is to analyze our experience in the treatment of these lesions, especially through the endoscopic approach. MATERIAL AND METHOD: We present 61 cases of sinonasal inverted papillomas that were treated at our hospital since 1983. The patients were studied by age, gender, site of presentation of the tumor, symptoms, radiologic studies, surgical treatment and evolution. The mean follow-up was 51 months (range 6-228 months). RESULTS: Thirty eight of the patients (62%) were males and 23 females (38%). The average age was 58 years (range 22-80). The most common symptom was unilateral nasal obstruction in 91% of the cases, followed by rhinorrhea in 46%. The most frequent location was the ethmoid region in 51% of cases, followed by the maxillary sinus in 28% and the lateral nasal wall in 21% of the cases. 78% of cases had associated sinusitis and the 43% polyposis. Tumours were classified with the Krouse staging system as follows: 35% stage I, 37% stage II, 18% stage III and 8% stage IV. 37% of the patients had bony erosion in the CT scan. Six of the 42 patients treated by endoscopic procedures presented recurrence (14%), compared with 6 of the 9 patients (67%) who were treated by open approaches. The average time to the recurrence was 41 months. 17% of the patients had malignant inverted papillomas, nine of them diagnosed from the beginning as malignant neoplasies and one which became malignant during follow up. DISCUSSION AND CONCLUSIONS: The endoscopic approach is the method of choice for the treatment of the majority of inverted papillomas. The close follow up of the patient for a large period of time is necessary for the early detection of recurrence and to allow for surgical salvage.

Simultaneous pleomorphic adenomas of the hard palate and parapharyngeal space.

We report a very unusual presentation of simultaneous pleomorphic adenomas of 2 different locations, hard palate and parapharyngeal space. Patient age of presentation is rare because these tumors are seen in younger patients. We treated a 70-year-old woman with these 2 tumors, resecting both lesions with intraoral and cervical approaches. Pleomorphic adenomas are frequent lesions, but in the literature reviewed, we have not found articles reporting 2 simultaneous pleomorphic adenomas of these locations. Complete surgical resection is very important to avoid recurrences.

[Sinonasal mucosal melanomas. Review of 17 case]. / Melanomas mucosos rinosinusales. Revisión de 17 casos.

INTRODUCTION: Mucosal melanomas (MM) represent 1.3 % of all melanomas; 55 % of them are located in the head and neck region mainly in the sinonasal and oropharyngeal cavity. Sinonasal mucosal melanomas have a high rate of local recurrence and a high risk of developing metastases, two reasons explaining the low survival rate. MATERIAL AND METHOD: We present 17 cases of sinonasal mucosal melanomas that were diagnosed and treated in our department from 1984 to July, 2008. The patients were studied by age, gender, site of presentation of the tumour, symptoms, radiology findings, treatment and course. RESULTS: Seventeen patients with sinonasal mucosal melanomas were studied. Of these 64.7 % were females and the mean age at presentation was 74 (range 48 to 93 years). Twelve cases developed in the nasal cavity and 5 in the paranasal sinuses. The most frequent site of presentation was the septum (35 %), and the most common symptom was epistaxis (77 %). Three patients rejected any treatment, 12 of the patients were treated surgically, one received chemotherapy and another chemotherapy plus radiotherapy. The 5 year disease-specific survival rate was 35.7 %. DISCUSSION AND CONCLUSIONS: Sinonasal mucosal melanomas are rare tumours with a high mortality. The treatment of choice is still surgical resection with wide surgical margins. Even so, the main cause of treatment failure is local recurrence, followed by the development of metastases. Because of the poor prognosis with this tumour, new treatment strategies are necessary.

Melanomas mucosos rinosinusales. Revisión de 17 casos / Sinonasal mucosal melanomas. Review of 17 cases

Introducción: Los melanomas mucosos (MM) representan el 1,3 % del total de melanomas. El 55 % de ellos se encuentra en la región de la cabeza y el cuello, principalmente en el área rinosinusal y la orofaringe. Los MM rinosinusales tienen una alta tasa de recurrencias locales y una gran capacidad para desarrollar metástasis, lo que se traduce en una supervivencia muy corta. Material y método: Se presentan los MM rinosinusales diagnosticados y tratados en nuestro servicio desde 1984 a julio de 2008. Se recogieron datos clínico patológicos que incluyen edad, sexo, sitio y síntomas de presentación, hallazgos radiológicos, tratamiento y evolución. Resultados: Se realiza una revisión de 17 pacientes. El 65% eran mujeres. La media (intervalo) de la edad a la presentación fue 74 (48-93) años. Los melanomas se originaron en la cavidad nasal en 12 pacientes y en los senos paranasales en 5. El lugar de presentación más frecuente fue el septum (67 %), y el síntoma de presentación fue la epistaxis (77 %).Tres pacientes rehusaron recibir tratamiento, 12 fueron tratados quirúrgicamente, 1 con quimioterapia y 1 con quimioterapia y radioterapia. La supervivencia específica a 5 años fue del 35,7 %. Discusión y conclusiones: Los melanomas rinosinusales son tumores raros pero con una elevada mortalidad. El tratamiento de elección sigue siendo la resección quirúrgica con amplios márgenes quirúrgicos. A pesar de ello, la principal causa de fracaso del tratamiento son las recidivas locales y el desarrollo de metástasis. Dado el mal pronóstico de este tumor, parecen necesarias nuevas estrategias terapéuticas (AU)

Introduction: Mucosal melanomas (MM) represent 1.3 % of all melanomas; 55 % of them are located in the head and neck region mainly in the sinonasal and oropharyngeal cavity. Sinonasal mucosal melanomas have a high rate of local recurrence and a high risk of developing metastases, two reasons explaining the low survival rate. Material and method: We present 17 cases of sinonasal mucosal melanomas that were diagnosed and treated in our department from 1984 to July, 2008. The patients were studied by age, gender, site of presentation of the tumour, symptoms, radiology findings, treatment and course. Results: Seventeen patients with sinonasal mucosal melanomas were studied. Of these 64.7% were females and the mean age at presentation was 74 (range 48 to 93 years).Twelve cases developed in the nasal cavity and 5 in the paranasal sinuses. The most frequent site of presentation was the septum (35 %), and the most common symptom was epistaxis (77 %). Three patients rejected any treatment, 12 of the patients were treated surgically, one received chemotherapy and another chemotherapy plus radiotherapy. The 5 year disease-specific survival rate was 35.7%. Discussion and conclusions: Sinonasal mucosal melanomas are rare tumours with a high mortality. The treatment of choice is still surgical resection with wide surgical margins. Even so, the main cause of treatment failure is local recurrence, followed by the development of metastases. Because of the poor prognosis with this tumour, new treatment strategies are necessary (AU)

Giant cell tumor of the greater wing of the sphenoid: an unusual presentation.

We report a very unusual presentation of giant cell tumor probably originated on the greater wing of the sphenoid and show a review about the knowledge and the treatment of the lesion in this rare localization. We treated a 48-year-old man with a giant cell tumor of the infratemporal fossa. He presented with a right-side hearing loss and facial pain. The tumor was resected by means of a subtemporal-preauricular approach, and after 12 months of follow-up, the patient is free of recurrence. Giant cell tumors of the skull base are an extremely rare neoplasm, and there is not much information on the literature about the treatment and the prognostic. Wide resection ought to be made, and at the follow-up, the clinician must try to diagnose not only local recurrence but also the possibility of distant metastases to the lung.

[Adaptation and validation to the Spanish of the Voice Handicap Index (VHI-30) and its shortened version (VHI-10)]. / Adaptación y validación del índice de incapacidad vocal (VHI-30) y su versión abreviada (VHI-10) al español.

INTRODUCTION: The Voice Handicap Index has been shown to be a valid instrument for assessing self-perceived handicap associated with dysphonia. OBJECTIVES: To test the psychometric properties of the Spanish version of the VHI-30 (Voice Handicap Index) and its shortened version VHI-10. SUBJECTS AND METHOD: The original VHI-30 was translated into Spanish and was completed by 232 dysphonic patients and 38 non-dysphonic individuals. Prospective instrument validation was performed. RESULTS: Results showed high test-retest reliability, and high item-total correlation for both Spanish VHI-30 and VHI-10. Internal consistency demonstrated a Cronbach's alpha of 0.93 and 0.86, respectively, and a significant correlation was found between the VHI scores and the patients' self-rated dysphonic severity. CONCLUSIONS: The present study supports the use of Spanish versions of VHI-30 and VHI-10 because of their validity and reliability.

Adaptación y validación del índice de incapacidad vocal (VHI-30) y su versión abreviada (VHI-10) al español / Adaptation and Validation to the Spanish of the Voice Handicap Index (VHI-30) and its Shortened Version (VHI-10)

Introducción y objetivos: El índice de incapacidad vocal (Voice Handicap Index) es un instrumento válido para la valoración del menoscabo asociado a la disfonía que percibe el paciente. El objetivo es valorar las propiedades psicométricas de la versión castellana del VHI-30 y su versión abreviada VHI-10. Sujetos y método: El VHI-30 original se tradujo al idioma español y lo contestaron 232 pacientes con disfonía y 38 sujetos sanos. Se realizó una validación prospectiva del instrumento. Resultados: Se encuentra una alta fiabilidad test-retest y altas correlaciones ítem-total tanto para el VHI-30 como para el VHI-10. La coherencia interna demuestra valores alfa de Cronbach de 0,93 y 0,86 respectivamente, y se encontró una correlación significativa entre las puntuaciones del VHI y la valoración de los pacientes de la severidad de su disfonía. Conclusiones: El presente estudio apoya el uso de las versiones en español del VHI-30 y del VHI-10 por su validez y fiabilidad

Introduction: The Voice Handicap Index has been shown to be a valid instrument for assessing self-perceived handicap associated with dysphonia. Objectives: To test the psychometric properties of the Spanish version of the VHI-30 (Voice Handicap Index) and its shortened version VHI-10. Subjects and method: The original VHI-30 was translated into Spanish and was completed by 232 dysphonic patients and 38 non-dysphonic individuals. Prospective instrument validation was performed. Results: Results showed high test-retest reliability, and high item-total correlation for both Spanish VHI-30 and VHI-10. Internal consistency demonstrated a Cronbach’s alpha of 0.93 and 0.86, respectively, and a significant correlation was found between the VHI scores and the patients’ self-rated dysphonic severity. Conclusions: The present study supports the use of Spanish versions of VHI-30 and VHI-10 because of their validity and reliability