El stent preoperatorio en la carótida externa o interna para el tratamiento de paragangliomas y tumores complejos del cuello / The pre-operative stent in the external or internal carotid for the treatment of complex paragangliomas and tumours

No disponible

Auto-injerto de arteria femoral superficial en cirugía oncológica del cuello / Superficial femoral artery autograft in neck surgical oncology

No disponible

Estudio genético del complejo enzimático succinato deshidrogenasa en los paragangliomas carotídeos. Implicaciones diagnósticas / Genetic study of the succinate dehydrogenase enzyme complex in carotid paragangliomas: diagnostic implications

Introducción: Los paragangliomas (PG) en general y los carotídeos (PGC) en particular son tumores infrecuentes, generalmente únicos y de evolución benigna, que presentan controversias en su comportamiento biológico e historia natural. Objetivo: Correlacionar la presencia de mutaciones de los genes del complejo enzimático succinato deshidrogenasa (SDH) con la aparición de presentaciones atípicas de PG (bilaterales, multicéntricos y malignos). Pacientes y método: Estudio genético en 20 pacientes, 18 con PGC esporádico y 2 con PGC familiar; 2 pacientes presentaban localizaciones múltiples y 3 fueron de evolución maligna. Después de consentimiento informado específico, se obtuvo sangre periférica de los pacientes para realizar un estudio genómico según protocolo estándar. Resultados: Se detectaron mutaciones en 6 pacientes (30 % de la serie), repartiéndose de forma homogénea (2 por subunidad B, C o D). Las mutaciones fueron del 100 % en las formas familiares (2/2) y del 22,2 % en las esporádicas (4/18). Los 2 pacientes con PG múltiples presentaron mutaciones (SDHB y SDHC). En 2 de 3 pacientes con PG de evolución maligna se presentaron mutaciones en SDHB. En los casos familiares se estudió a 3 hijos de los pacientes, resultando positivo (SDHB) un caso. Finalmente, 3 de las 6 mutaciones descritas por nosotros no han sido referidas previamente en la literatura consultada (SDHB c.472 del A, SDHC c.A377G y SDHC c.A21G). Conclusiones: La mutación de las subunidades de SDH es responsable de la tendencia a padecer un PG tanto en las formas familiares como en las esporádicas, teniendo una importante relevancia en la presencia de formas múltiples y el pronóstico evolutivo de estos tumores(AU)

Introduction: Carotid paragangliomas (CPGs) are uncommon tumours which tend to be isolated and benign. However, there are controversies over their biological behaviour and natural history. Aim: To correlate the presence of mutations of succinate dehydrogenase (SDH) complex genes with the appearance of atypical CPGs (bilateral, multicentral and malignant). Patients and methods: We carried out mutation analyses in 18 patients with sporadic CPGs and 2 patients with familial CPGs. Two patients had multiple locations and three had a malignant outcome. After obtaining informed consent, peripheral blood was obtained to perform a genomic study according to a standard protocol. Results: We identified SHD mutations in six patients (30 %), 100 % in familial CPGs (2/2) and 22.2 % in sporadic CPGs (4/18). Both patients with multiple CPGs showed mutations in SDH (SDH subunit B and SDH subunit C). Two of three patients with CPGs and malignant outcome showed mutation in the SDH subunit B gene. In familial CPGs, we studied three children and we found a positive case (SDHB). Finally, we identified three novel SHD mutations (SDHB c.472 del A, SDHC c.A377G; and SDHC c.A21G). Conclusion: SDH mutations are responsible for the trend to suffer CPGs in both familial and sporadic forms and may play an important role in multiple CPGs and malignant PGs(AU)

Malformaciones arteriovenosas durales en el ámbito de la ORL / Arterioveinous dural malformation in ENT

La Malformación Arteriovenosa Dural (MAVD) es una entidad rara dentro de las anomalías vasculares intracraneales, con etiología nobien conocida y variabilidad en sus tratamientos. Presentamos once casos de MAVDs de entre los cuales 5 presentaban el acúfeno como síntoma de aparición. La importancia de esta patología hace necesario descartarla ante un paciente que consulta por un acúfeno pulsátil con otoscopia normal

The arterioveinous dural malformation (MAVD) is a rare entity between the vascular craneal anomalies with a not well nown ethiology and variability in treatments. We present eleven cases of MAVDs, between them five presented tinnitus as symptom of aparition. The importance of this pathology makes necessary to discard it before a patient consulting because of pulsaltil tinnitus with normal otoscopy

[Fistula of the first branchial arch]. / Fístula de primer arco branquial.

The complexity of the embriologic development of the neck and the possible abnomarlies in this process, with the consequent posterior manifestations make necessary the knowledge of the embriologic anatomy of the neck. In the possible manifestations that can be of the anomalies of the development of the branchial archs are the abnomarlies of the first branchial archs. They are, in the anomalies of the development of the branchial archs infrequent and are intimately related with the facial nerve. We present a clinic case of a seven years old boy affected by this pathology and revise its more important aspects.

Fístula del primer arco branquial / Fistula of the first branchial arch

La complejidad del desarrollo embriológico del cuello y las posibles del cuello y las posibles anomalías en este proceso, con las consiguientes manifestaciones posteriores hacen necesario el conocimiento de la anatomía embriológica del cuello. Dentro de las posibles manifestaciones que pueden darse de las anomlías del desarrollo de los arcos branquiales se encuentran las anomalías del primer arco branquial. Son dentro de las anomalías del desarrollo de los arcos branquiales, infrecuentes y están íntimamente relacionadas con el nervio facial. Presentamos el caso clínico correspondiente a un niño de 7 años con esta patología y repasamos los aspectos más importantes de la misma

The complexity of the embryologic development of the neck and the possible abnormalies in thi process, with the consequent posterior manifestations make necessary the knowledge of the embryologic anatomy of the neck. In the possible manifestations that can be of the abnormalies of the development of the branchial archs are the abnormalies of the first branchial archs. The are, in the anomalies of the development of the branchial archs infrequent and are intimately related with the facial nerve. We present a clinic case of a seven years old boy affected by this pathology and revise its more important aspects

[Arterioveinous dural malformation in ENT]. / Malformaciones arteriovenosas durales en el ambito de la ORL.

The arterioveinous dural malformation (MAVD) is a rare entity between the vascular craneal anomalies with a not well nown ethiology and variability in treatments. We present eleven cases of MAVDs, between them five presented tinnitus as symptom of aparition. The importance of this pathology makes necessary to discard it before a patient consulting because of pulsaltil tinnitus with normal otoscopy.

[Persistence of the third branchial arch]. / Persistencia de tercer arco branquial.

The third branquial arch anomalies represent less than 1% of this deformites. The clinical manifestation can be varied althouth the formation of cysts is the commonest one and may appear at any time in life. We report the clinical case of a 7 year old boy with an neck mass. This mass was diagnosed as a branquial cyst. The patologist found a "timic reminescences". We carry out a review of the literature for this pathology.

Persistencia de tercer arco branquial / Persistence of the third branchial arch

Las anomalías derivadas del desarrollo del tercer arco y bolsa branquiales representan menos del 1% del total de estas malformaciones. Su forma de manifestación puede ser variada, aunque la más frecuente es la forma quística y pueden aparecer en cualquier etapa de la vida. Presentamos el caso clínico correspondiente a un paciente de 7 años con una tumoración laterocervical derecha de un año de evolución, diagnosticado de quiste branquial y con un estudio anatomopatológico tras la extirpación de restos tímicos. De igual modo realizamos una revisión de la literatura de estos casos

The third branquial arch anomalies represent less than 1% of this deformites. The clinical manifestation can be varied althouth the formation of cysts is the commonest one and may appear at any time in life. We report the clinical case of a 7 year old boy with an neck mass. This mass was diagnosed as a branquial cyst. The patologist found a "timic reminescences". We carry out a review of the literature for this pathology

[Skull base meningiomas: a predictive system to know the extent of their surgical resection and patient outcome]. / Meningiomas de la base de cráneo. Un sistema predictivo para canocer las posibilidades de su extirpación y pronóstico

OBJECTIVE: The aim of this study was to build a preoperative predictive system which could provide reliable information about: 1 degrees which skull base meningiomas can be total or partially removed, and 2 degrees their surgical outcome. METHOD: Patient histories and imaging data were reviewed retrospectively from 85 consecutive skull base meningiomas patients who underwent surgery from 1990 and 2002. From the preoperative data, nine variables were selected for conventional statistical analysis as regards their relationship with: 1 degrees total vs partial tumor resection and 2 degrees with patients outcome according to the degree of tumour removal. RESULTS: From the nine variables analysed only two had a statistical association with the type of tumour resection performed (total vs partial) and the patient outcome: 1) arteries encasement and 2) cranial nerves involvement. Upon correlating these two variables with the type of tumour resection performed (total vs partial) and with the Karnofsky'scale to evaluate patients surgical outcome, the following grading groups were identified: Grade I: skull base meningiomas which did not involve cranial nerves or artery or only encased one artery or one cranial nerve. In these cases the incidence of gross tumour resection was 98.3% (p< 0.0001) and the perspective to reach 70 points in the Karnofsky'scale was of 96.5% ( p=0.001). Grade II: skull base meningiomas which involved one cranial nerve and encased, at least, two main cerebral arteries. In these cases, the frequency of total resection, decreased to 83.3% (p<0.0001) and the probability to reach 70 points in the Karnofsky'scale was 70.6% (p=0.001). Grade III: skull base meningiomas which involved two or more cranial nerves and encased several arteries In this group, the frequency of a total resection was of 42.9% (p<0.0001) and the probability of reaching 70 points in the Karnofsky'scale was only 60% (p=0.001). CONCLUSIONS: We propose a preoperative grading system for skull base meningiomas that helps predicting both whether total or partial tumor removal will be achieved during surgery and the immediate postsurgical outcome of the patient. In applying this predictive system we will be able to reduce surgical morbidity, to advance the possibility of a radiosurgical treatment and give a more precise information to the patients and their families about our surgical decision-making process.

Meningiomas de la base de cráneo. Un sistema predictivo para conocer las posibilidades de su extirpación y pronóstico / Skull base meningiomas: a predictive system to know the extent of their surgical resection and patient outcome

Objetivo. Encontrar un sistema predictivo que basándose únicamente en datos preoperatorios nos oriente, con fiabilidad, sobre : 1° qué meningiomas dela base de cráneo pueden ser extirpados total o parcialmente y 2° cuál es su pronóstico postquirúrgico. Métodos. Se ha revisado de forma retrospectiva, las historias clínicas e iconografías de 85 pacientes, con meningiomas de la base de cráneo, intervenidos entre1990 al 2002. De ellas se han tomado nueve variables que han sido tratadas estadísticamente, mediante un test estándar, para correlacionarlas con: 1° resección total o parcial del tumor (Simpson, 5 grados) y 2° conocido el mencionado grado de resección total o parcial, éste se correlacionó con el pronóstico funcional postoperatorio del paciente (Karnofsky).Resultados. De las variables preoperatorios analizadas, solo dos demostraron tener una asociación significativa con la extirpación total o parcial del tumor, así como con el pronóstico postquirúrgico del paciente. Dichas variables fueron: a) las arterias englobadas por el tumor (p = 0.001) y b) la afectación de pares craneales(p< 0.0001). Seguidamente, se conjugaron las diversas posibilidades de cada una de ellas para conocer el grado de extirpación tumoral (total o parcial). Para predecir el pronóstico funcional postoperatorio del enfermo, se relacionó la extirpación total o parcial con la escala de Karnofsky. De ambos análisis, grado de extirpación y pronóstico, se obtuvo el siguiente sistema de gradación: Grado I: meningiomas, de la base de cráneo, que no afectan a pares craneales ni engloban arterias o bien solamente afectan a un par craneal o engloban sólo una arteria. En ellos las posibilidades de extirpación total se encuentran en un 98,3% (p<0.0001) y las perspectivas de alcanzar 70 puntos en la escala de Karnofsky son de un 96,5%.Grado II: meningiomas que afectan a un par craneal e incluyen dos o más arterias. La extirpación total en estos casos disminuye al 83,3% (p< 0.0001) y las perspectivas de alcanzar 70 puntos en la escala de Karnofsky descienden a un 70,6%.Grado III: meningiomas que afectan dos o más pares craneales e incluyen varias arterias. En este grupo, las posibilidades de una extirpación total son de un 42,9% (p<0.0001) con las perspectivas de alcanzarlos 70 puntos en la escala de Karnofsky en sólo el 60%.Conclusiones. El sistema de gradación que se propone permite, en los casos de meningiomas de la base de cráneo: 1° predecir las posibilidades de una extirpación total o parcial y 2° conocer el pronóstico quirúrgico delos pacientes en cada grupo. Aplicando este sistema podremos reducir nuestra morbilidad quirúrgica, anticiparla necesidad de una terapia con radiocirugía y dar una información, más precisa, al paciente y familiares sobre nuestras propuestas quirúrgicas

Objective. The aim of this study was to build a preoperative predictive system which could provide reliable information about: 1° which skull base meningiomas can be total or partially removed, and 2°their surgical outcome. Method. Patient histories and imaging data were reviewed retrospectively from 85 consecutive skull base meningiomas patients who underwent surgery from1990 and 2002. From the preoperative data, nine variables were selected for conventional statistical analysis as regards their relationship with: 1° total vs partial tumor resection and 2° with patients outcome according to the degree of tumour removal. Results. From the nine variables analysed only two had a statistical association with the type of tumour resection performed (total vs partial) and the patient outcome: 1) arteries encasement and 2) cranial nerves involvement. Upon correlating these two variables with the type of tumour resection performed (total vs partial)and with the Karnofsky'scale to evaluate patients surgical outcome, the following grading groups were identified: Grade I: skull base meningiomas which did not involve cranial nerves or artery or only encased one artery or one cranial nerve. In these cases the incidence of gross tumour resection was 98,3% (p<0.0001) and the perspective to reach 70 points in the Karnofsky'scale was of 96,5% ( p= 0.001).Grade II: skull base meningiomas which involved one cranial nerve and encased, at least, two main cerebral arteries. In these cases, the frequency of total resection, decreased to 83,3% (p<0.0001) and the probability to reach 70 points in the Karnofsky'scale was 70,6%(p=0.001).Grade III: skull base meningiomas which involved two or more cranial nerves and encased several arteries In this group, the frequency of a total resection was of42,9% (p<0.0001) and the probability of reaching 70points in the Karnofsky'scale was only 60% (p= 0.001).Conclusions. We propose a preoperative grading system for skull base meningiomas that helps predicting both whether total or partial tumor removal will be achieved during surgery and the immediate postsurgical outcome of the patient. In applying this predictive system we will be able to reduce surgical morbidity, to advance the possibility of a radiosurgical treatment and give a more precise information to the patients and their families about our surgical decision-making process

[Non Hodgkin's lymphoma in the ENT field]. / Linfomas no Hodgkin en patología cérvico-facial.

OBJECTIVES: Non Hodgkin's lymphoma (NHL) is a frecuent tumor in the ENT field althougt there are not too many publications with a large number of patients. PATIENTS AND METHODS: We have studied 300 patiens with NHL and analysed the head and neck affectation, the presence in Waldeyer's ring, the first symptoms and the stage of the disease. RESULTS: Over 50% had head and neck manifestation. Of them, the most frequent one were adenopathies. In the Waldeyer's ring, the tonsil was the most frecuently affected structure. CONCLUSION: There is an evident relationship between NHL and the Oto-Rhino-laringology area and it is necessary consider it in the differential diagnosis of head and neck adenopathies.

[Internal carotid artery loop: an uncommon cause of parapharyngeal tumor]. / Bucle de arteria carótida interna: una causa infrecuente de tumoración parafaríngea.

The parapharyngeal space-occupying lessions may develop from any of the structures located inside it. Uncommon although possible ethiologies for them are anatomic variations of the course of the internal carotid artery. These anatomic variants mainly arise from degenerative, mostly age-amplified, causes and lead to elongations, angulations, kinking and tortuosities in the course of the vessel that appear as impressions or protusions of the pharyngeal wall. Utherly unfrecuently lead to loops that may show as large parapharyngeal tumors. This fact should be noticed previously to any invasive procedure to be performed on the patient specially when evidenced in concommitance with an infectious process at the moment of diagnosis. A case of an impressive internal carotid artery loop that conditioned an important parapharyngeal mass in a patient with an associated pharyngeal infection is reported to warn about this rare parapharyngeal space-occupying condition and its potential danger.

[Auditory-evoked brainstem response in a schwannoma of the VIIIth cranial nerve: an anatomophysiological and functional correlation. Our experience]. / Respuesta evocada auditiva de tronco en el schwannoma del VIII par: correlación anatomofisiológica y funcional. Nuestra experiencia.

INTRODUCTION: Schwannomas are tumors charasteristically originated from the nerve sheath. They expande eccentrically from the nerve promoting a disturbance in the neural function either due to vascular compresion or to the effect of the tumor itself on the nerve, disturbance that can be evidenced with the Auditory-evoked Brainstem Response (ABR), fact that constituted the base for their diagnosis in the past. The new radiological techniques developed over the last decades have made possible an earlier diagnosis, and therefore changed their prognosis in terms of nerve function. Diagnosis is more certain today with these techniques so it could seem that ABR may not have any longer a role in the management of this condition. OBJECTIVE: To describe the most frequent ABR patterns in those patients suffering from acoustic schwannoma related to the size of the tumour and the remanent audition thresholds, and to determine the value of this test in our practice. MATERIAL AND METHODS: We describe the ABR features found in our series of 72 patients. Whose diagnosis was done between 1997 and 2003 in relation to the size of the tumour and the residual auditory function. RESULTS AND CONCLUSIONS: ABR has a good sensibility for detection of acoustic schwannoma. This sensibility decreases in small-sized tumours, specially in intracanalicular ones. ABR patterns do not relate to the size of the tumour but they do to the auditory function. The authors defend ABR to be a very valuable test due to the information and accesibility they provide.

Linfomas no Hodgkin en patología cérvico-facial / Non Hodgkin’s lymphoma in the ENT field

Objetivo: El linfoma no Hodgkin (LNH) es una tumoración frecuente que afecta con asiduidad al área ORL aunque no existen muchos trabajos con series grandes sobre el tema. Pacientes y metodología: Hemos estudiado 300 pacientes con LNH y hemos analizado su afectación cérvicofacial, del anillo de Waldeyer, sus síntomas de aparición y el estadio de la enfermedad. Resultados: Más del 50% tenían afectación cérvico-facial. De ellos, la manifestación clínica más frecuente era la presencia de adenopatías. Dentro de la afectación del anillo de Waldeyer, lo más frecuente es la afectación de la amígdala palatina. La mayoría de los paciente se encontraba en un estadio IV de su enfermedad. Conclusiones: Existe una relación clara entre el LNH y el área ORL por lo que es necesario tenerlo en cuenta en la aparición de adenopatías cérvico-faciales

Objetives: Non Hodgkin´s lymphoma (NHL) is a frecuent tumor in the ENT field althougt there are not too many publications with a large number of patiens. Patients and methods: We have studied 300 patiens with NHL and analysed the head and neck affectation, the presence in Waldeyer ´s ring, the first symptoms and the stage of the disease. Results: Over 50% had head and neck manifestation. Of them, the most frequent one were adenopathies. In the Waldeyer ´s ring, the tonsil was the most frecuently affected structure. Conclusion: There is an evident relationship between NHL and the Oto-Rhino-laringology area and it is necessary consider it in the differential diagnosis of head and neck adenopathies

Bucle de arteria carótica interna. Una causa infrecuente de tumoración parafaríngea / Internal carotid artery loop: an uncommon ethiology for a parapharyngeal tumor

Las tumoraciones del espacio parafaríngeo pueden originarse a partir de cualquiera de las estructuras que por él discurren. Una infrecuente aunque posible etiología de las mismas son las variantes anatómicas del trayecto de la arteria carótida interna. Dichas variantes anatómicas surgen generalmente de causas degenerativas y conducen a elongamientos, tortuosidades o suaves rizos que originan improntas en la pared faríngea. Muy raramente, se producen bucles que pueden originar importantes tumoraciones faríngeas. Este hecho debería ser reconocido previamente a cualquier tipo de procedimiento invasivo en el paciente, especialmente cuando concurre en su diagnóstico un proceso infeccioso. Presentamos un caso de gran bucle de arteria carótida interna que condicionó una importante tumoración parafaríngea en un paciente con infección faríngea asociada para llamar la atención sobre esta rara entidad como causa de tumoración parafaríngea y su potencial peligro

The parapharyngeal space-occupying lessions may develop from any of the structures located inside it. Uncommon although possible ethiologies for them are anatomic variations of the course of the internal carotid artery. These anatomic variants mainly arise from degenerative, mostly age-amplified, causes and lead to elongations, angulations, kinking and tortuosities in the course of the vessel that appear as impressions or protusions of the pharyngeal wall. Utherly unfrecuently lead to loops that may show as large parapharyngeal tumors. This fact should be noticed previously to any invasive procedure to be performed on the patient specially when evidenced in concommitance with an infectious process at the moment of diagnosis .A case of an impressive internal carotid artery loop that conditioned an important parapharyngeal mass in a patient with an associated pharyngeal infection is reported to warn about this rare parapharyngeal space-occupying condition and its potential danger

Respuesta evocada auditiva de tronco en el schwannoma del VIII par: correlación anatomofisiológica y funcional. Nuestra experiencia / Auditory-evoked brainstem response in a schwannoma of the VIIIth cranial nerve: an anatomophysiological and functional correlation. Our experience

Introducción: Los schwannomas son tumores que se originan a partir de las células de schwann de la vaina neural. Se extienden excéntricamente desde el nervio y producen un trastorno de la función neural, tanto por compresión vascular como por la propia acción del tumor sobre el nervio, que puede ser demostrado mediante pruebas de Potenciales Evocados Auditivos de Troncoencéfalo (PEATC), hecho que fue antaño la base para su diagnóstico. Las nuevas técnicas radiológicas desarrolladas en las últimas décadas han posibilitado un diagnóstico más precoz y, por tanto, un cambio en su pronóstico en términos de función. Hoy día, con estas técnicas, el diagnóstico es más certero y podría parecer que los PEATC ya no tienen papel alguno en el manejo de esta entidad. Objetivo: Determinar los patrones de registro de PEATC más frecuentes en pacientes afectos de schwannoma del VIII par en relación al tamaño del tumor y de la audición residual y hallar el valor que dicha prueba tiene en nuestro medio hoy día en el manejo de esta entidad. Material y métodos: Describimos los hallazgos más frecuentes en el registro de PEATC de nuestra serie de 72 pacientes afectos de schwannoma del VIII par craneal, cuyo diagnóstico fue realizado entre 1997 y 2003, en relación con el tamaño tumoral y la función auditiva residual. Resultados y conclusiones: Los PEATC tienen una alta sensibilidad para la detección del schwannoma del VIII par. Esta sensibilidad disminuye sustancialmente en tumores de pequeño tamaño, especialmente los intracanaliculares. Los patrones del registro no guardan relación con el tamaño tumoral pero sí con la función auditiva del paciente. Los autores creemos que es una prueba que todavía hoy tiene un gran valor por la información que proporciona así como por su accesibilidad

Introduction: Schwannomas are tumors charasteristically originated from the nerve sheath. They expande eccentrically from the nerve promoting a disturbance in the neural function either due to vascular compresion or to the effect of the tumor itself on the nerve, disturbance that can be evidenced with the Auditory-evoked Brainstem Response (ABR), fact that constituted the base for their diagnosis in the past. The new radiological techniques developed over the last decades have made possible an earlier diagnosis, and therefore changed their prognosis in terms of nerve function. Diagnosis is more certain today with these techniques so it could seem that ABR may not have any longer a role in the management of this condition. Objective: To describe the most frequent ABR patterns in those patients suffering from acoustic schwannoma related to the size of the tumour and the remanent audition thresholds, and to determine the value of this test in our practice. Material and methods: We describe the ABR features found in our series of 72 patients. Whose diagnosis was done between 1997 and 2003 in relation to the size of the tumour and the residual auditory function. Results and conclusions: ABR has a good sensibility for detection of acoustic schwannoma. This sensibility decreases in smallsized tumours, specially in intracanalicular ones. ABR patterns do not relate to the size of the tumour but they do to the auditory function. The authors defend ABR to be a very valuable test due to the information and accesibility they provide

[Idiopathic Frey's syndrome under the appearance of a recurrent otitis externa]. / Síndrome de Frey idiopático bajo la apariciencia de una otitis externa recidivante. Tratamiento con neuro-toxina botulínica tipo A.

Frey syndrome has been observed especially in patients who have undergone a parotidectomy operation, but also in zoster herpes, in parotiditis, condilea fractures, obstetric traumatisms with forceps and in surgery of the meningioma of the cerebellopontine angle. It also appears without previous surgery, like in our case. In these circumstances it is believed that a clinical neuritis, primary or secondary to a neighbouring inflammation may cause the start of this disorder. Several treatments have been suggested which highlights the difficulty of them. The most effective one is the intradermic injection of botulinum toxin type A. Its use in Frey's syndrome was initiated by Drobik and Laskawi in 1995. Since then the references to its use are numerous. Nevertheless, it is a treatment which has been introduced very few times in our country.

Síndrome de Frey idiopático bajo la apariciencia de una otitis externa recidivante. Tratamiento con neuro-toxina botulínica tipo A / Idiopathic Frey’s Syndrome under the appearance of a recurrent otitis externa

El síndrome de Frey se ha observado sobre todo en pacientes sometidos a parotidectomía, pero también en el herpes zoster trigeminal, en las parotiditis, en las fracturas condíleas, en los traumatismos obstétricos con forceps y en la cirugía del meningioma del ángulo ponto-cerebeloso. También aparece sin cirugía previa, como es nuestro caso. En estas circunstancias se piensa que una neuritis subclínica, primaria o secundaria a una inflamación vecina, puede causar el inicio de este trastorno. Se han propuesto varios tratamientos, lo cual pone de manifiesto la dificultad del mismo. El más eficaz es la inyección de toxina botulínica tipo A intradérmica. Su manejo en el síndrome de Frey lo iniciaron Drobik y Laskawi en 1995. Desde entonces son numerosas las referencias sobre su manejo. Sin embargo, es un tratamiento aún poco difundido en nuestro país

Frey syndrome has been observed especially in patients who have undergone a parotidectomy operation, but also in zoster herpes, in parotiditis, condilea fractures, obstetric traumatisms with forceps and in surgery of the meningioma of the cerebellopontine angle. It also appears without previous surgery, like in our case. In these circumstances it is believed that a clinical neuritis, primary or secondary to a neighbouring inflammation may cause the start of this disorder. Several treatments have been suggested which highlights the difficulty of them. The most effective one is the intradermic injection of botulinum toxin type A. It’s use in Frey’s syndrome was initiated by Drobik and Laskawi in 1995. Since then the references to its use are numerous. Nevertheless, it is a treatment which has been introduced very few times in our country

[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.