Implantación coclear con bisturí armónico Ultracision® / Cochlear implants using the Ultracision® harmonic scalpel

Hemos valorado la utilidad, indicaciones e inconvenientes del bisturí armónico Ultracision®, en la implantación coclear, así como sus ventajas respecto de otros sistemas de electrocoagulación. Estos aspectos se analizaron en 50 implantes cocleares realizados a lo largo de estos últimos años. Como conclusión, hay que establecer que el bisturí armónico Ultracision ® encuentra sus indicaciones más importantes en el campo de la otología, en aquellos casos en los que el implante coclear está insertado en la cóclea y es necesario utilizar un sistema de electrocoagulación o incisión, con fines diversos. En la mencionada situación, el bisturí armónico Ultracision® se mostró rápido, eficaz y seguro y con evidentes ventajas respecto del corte frío o de la electrocoagulación bipolar

We have evaluated the utility, indications and disadvantages of the Ultracision® harmonic scalpel, in the cochlear implants, and his advantages compare to other electrocoagulation´s systems. These aspects were evaluated in 50 cases of cochlear implants, made along the last years. We concluded that the Ultracision® harmonic scalpel is indicated, mainly, in the otology field, in these situations in wich the cochlear implant is in the cochlea, and is mandatory the use of an electrocoagulation system. In this situation, the Ultracision® harmonic scalpel was quick, safe and sure, and with many advantages, over the traditional scalpel and the bipolar diathermy

[Cochlear implants using the Ultracision harmonic scalpel]. / Implantación coclear con bisturí armónico Ultracision.

We have evaluated the utility, indications and disadvantages of the Ultracision harmonic scalpel, in the cochlear implants, and his advantages compare to other electrocoagulation's systems. These aspects were evaluated in 50 cases of cochlear implants, made along the last years. We concluded that the Ultracision harmonic scalpel is indicated, mainly, in the otology field, in these situations in wich the cochlear implant is in the cochlea, and is mandatory the use of an electrocoagulation system. In this situation, the Ultracision harmonic scalpel was quick, safe and sure, and with many advantages, over the traditional scalpel and the bipolar diathermy.

Pólipo antrocoanal gigante / Giant antrochoanal polyp

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[Selective therapeutic embolization in intractable epistaxis]. / Embolización selectiva terapéutica en epistaxis incoercibles.

Epistaxis is a common otolaryngologic emergency that is controlled frequently with conservative measures. On the other hand, more aggressive treatments are required in refractory or severe epistaxis, which may have systematical impact. About intractable posterior epistaxis, selective embolization of external carotid territory is an effective option for managing. Three patients with severe epistaxis successfully treated with selective embolization and a review of literature are exposed.

Embolización selectiva terapéutica en epistaxis incoercibles / Therapeutic selective embolization in intractable epistaxis

La epistaxis es una patología frecuente dentro de la urgencia otorrinolaringológica y en muchos casos aparece como un problema menor que se solventa con tratamiento conservador. En los casos recurrentes o severos puede ocasionar importantes complicaciones sistémicas, que nos hacen evaluar terapéuticas más agresivas buscando una resolución más efectiva. La embolización selectiva en el territorio de la arteria carótida externa es un método terapéutico aceptado en las epistaxis posteriores incoercibles y refractarias a los habituales tratamientos conservadores. Exponemos tres casos de epistaxis controladas mediante esta técnica, así como una completa revisión de la bibliografía actual sobre el tema (AU)

Epistaxis is a common otolaryngologic emergency that is controlled frequently with conservative measures. On the other hand, more aggressive treatments are required in refractory or severe epistaxis, which may have systematical impact. About intractable posterior epistaxis, selective embolization of external carotid territory is an effective option for managing. Three patients with severe epistaxis successfully treated with selective embolization and a review of literature are exposed (AU)

[Congenital absence of major salivary glands]. / Ausencia congénita de glándulas salivares mayores.

Congenital absence of major salivary glands is infrequent, with only a few cases in the world medical literature. We found 30 documented cases in a bibliographic search. We report a case of total agenesia of the parotid gland diagnosed in the course of a study motivated by symptoms of facial pain and the temporomandibular joint. Agenesia of a major salivary gland (specially the partial ones) usually develops with no manifestation that motivates the patient to seek treatment. Parotid aplasia can be an isolated finding or associated with the absence of other glands or with abnormalities such as aplasia of the lacrimal gland, mandibulofacial dysostosis, and ectodermic dysplasia.

[Immunohistochemical expression of P53 suppressor genes and retinoblastoma in laryngeal carcinoma]. / Expresión inmunohistoquímica de genes supresores p53 y retinoblastoma en el carcinoma de laringe.

Carcinoma of the larynx is responsible for 1% of all tumors and for 25% of oncologic disease of the head and neck. Tumor suppressor genes control cell proliferation by suppressing specific mechanisms that stimulate the proliferative response. Rb and p53, both nuclear, are the most studied tumor suppressor genes. We evaluated the immunoexpression of these markers in 72 carcinomas of the larynx and correlated it with patients' clinical parameters: age, sex, occupation, tobacco and alcohol use, marital status, etc. Biological and anatomopathological parameters (tumor stage, histological type, degree of local invasion, and lymph node metastases) also were studied. Statistically significant differences were found in mean immunostaining for the Rb gene with respect to histological grade, lymph node enlargement, and smoking. We observed no positive correlation between p53 and the classic clinical-pathological parameters, although important trends were evident, as well as relatively frequent immunostaining (about 40%) of the total neoplastic population.

Ausencia congénita de glándulas salivares mayores / Congenital absence of major salivary glands

La ausencia congénita de las glándulas salivares mayores, es un hallazgo infrecuente, con pocos casos comunicados en la literatura médica mundial: en la revisión bibliográfica realizada, hemos encontrado 30 casos documentados. Aportamos un nuevo caso de agenesia total de glándula parótida, diagnosticado mediante estudios de imagen, al estudiar un cuadro de dolor facial y de la articulación temporomandibular, pues la agenesia de una glándula salival mayor (especialmente las agenesias parciales), suele cursar sin manifestaciones propias que hagan consultar al paciente. Puede ser un hallazgo aislado o asociado a otras anormalidades, como la ausencia de la glándula lacrimal, disostosis mandibulofacial y displasias ectodérmicas (AU)

Congenital absence of major salivary glands is infrequent, with only a few cases in the world medical literature. We found 30 documented cases in a bibliographic search. We report a case of total agenesia of the parotid gland diagnosed in the course of a study motivated by symptoms of facial pain and the temporomandibular joint. Agenesia of a major salivary gland (specially the partial ones) usually develops with no manifestation that motivates the patient to seek treatment. Parotid aplasia can be an isolated finding or associated with the absence of other glands or with abnormalities such as aplasia of the lacrimal gland, mandibulofacial dysostosis, and ectodermic dysplasia (AU)

Expresión inmunohistoquímica de genes supresores p53 y retinoblastoma en el carcinoma de laringe / Immunohistochemical expression of P53 suppressor genes and retinoblastoma in laryngeal carcinoma

El carcinoma de laringe supone el 1 por ciento de los tumores del organismo, así como el 25 por ciento de la patología oncológica de cabeza y cuello. Los genes supresores tumorales controlan la proliferación celular mediante supresión de mecanismos específicos que estimulan la respuesta proliferativa, siendo el Rb y el p53, ambos nucleares, los más estudiados. Hemos valorado la inmunoexpresión individualizada de estos marcadores en 72 carcinomas de laringe, efectuando una correlación con diferentes parámetros clínicos de los pacientes, como son: edad, sexo, trabajo que desempeñan, tabaco, alcohol, estado civil, etc., así como con los parámetros pronósticos clásicos, tanto biológicos como anatomopatológicos (estadio tumoral, tipo histológico, grado de invasión local y metástasis linfáticas). Hemos advertido diferencias estadísticamente significativas en las medias de inmunotinción del gen Rb con respecto a los grupos de grado histopatológico, a la existencia de adenopatías tumorales y al tabaco. Por otra parte, no hemos observado correlación positiva del p53 con respecto a ninguno de los parámetros clínico Patológicos clásicos, si bien se perciben tendencias importantes, así como una media de inmunotinción relativamente alta (alrededor del 40 por ciento) en la población neoplásica total (AU)

Carcinoma of the larynx is responsible for 1% of all tumors and for 25% of oncologic disease of the head and neck. Tumor suppressor genes control cell proliferation by suppressing specific mechanisms that stimulate the proliferative response. Rb and p53, both nuclear, are the most studied tumor suppressor genes. We evaluated the immunoexpression of these markers in 72 carcinomas of the larynx and correlated it with patients' clinical parameters: age, sex, occupation, tobacco and alcohol use, marital status, etc. Biological and anatomopathological parameters (tumor stage, histological type, degree of local invasion, and lymph node metastases) also were studied. Statistically significant differences were found in mean immunostaining for the Rb gene with respect to histological grade, lymph node enlargement, and smoking. We observed no positive correlation between p53 and the classic clinical-pathological parameters, although important trends were evident, as well as relatively frequent immunostaining (about 40%) of the total neoplastic population (AU)

[Middle ear carcinoma]. / Carcinoma de oído medio.

Middle-ear cancer represents 5 to 10% of all ear neoplasms. Risk factors include chronic suppurative pathology of the middle ear and prior irradiation. Most malignant tumors are squamous-cell carcinomas. We report the case of a 51-year-old woman with this process. The ideal treatment is mastoidectomy or pterosectomy followed by radiotherapy. We made a bibliographic review of the clinical manifestations, diagnosis, treatment, and prognosis of middle-ear cancer. Five-year survival rates range from 25 to 50% in patients who undergo surgery and radiotherapy.

[Idiopathic associated paralysis of the Xth and XIIth cranial nerves]. / Parálisis asociadas pares craneales X Y XII de etiología idiopática.

We are putting forward a case of associated laryngeal paralysis placed among the paralyses of the lateral pharyngeal area. Due to the association of the Xth and XIIth cranial nerves we could consider it within the labelled as Tapia's syndrome. Nevertheless, the presumable viral etiology of the case makes such classification entitled to discussion, because only are accepted as etiopathogenetic noxes both the traumatisms and tumours.

[Ambulatory aerosol therapy in the treatment of chronic pathology of the O.R.L. region]. / La aerosolterapia ambulatoria en el tratamiento de la patología crónica en la esfera O.R.L.

This study considers the efficacity of the ambulatory aerosol therapy in chronic cases of the ENT area. A nebulizer, air-jet type, of 4 microns MMAD, was the device employed, and an ample spectre antibiotic (cefotaxime) a mucolytic (N-acetyl-cysteine) plus a corticoid (methyl-prednisolone) the associated drugs. The antibiotic was discarded when otitis were the problem. The results have been favourable in 75 percent of the cases whilst negative in the resting 24 percent of the treated subjects.

[Granular cell tumor of the larynx]. / Tumor de células granulosas de laringe.

Granular cell tumors are unusual tumors that can affect any site of the body, with most cases affecting the head and neck region. First described by Abrikossoff, considerable debate has surrounded the histogenesis of this neoplasm. We report a case of granular cell myoblastoma of the larynx. Histological features are described. The treatment was surgical removal, endoscopically.

[Rare benign tumors in otorhinolaryngology: plasma cell granuloma and histiocytoma]. / Tumores benignos raros en O.R.L.: granuloma de células plasmáticas e histiocitoma.

Two benign tumors in the face are reported. Plasma cell granuloma is a rare benign tumor that affects people at all ages and most frequently involves the lung. It is dominated by mature plasma cell proliferation. The AA. report a case appearing as a painless nontender mass in the right cheek, with purplish discoloration of the overlying skin. Differential diagnosis with Plasmocytoma was considered. Histiocytoma are most common seen on the lower extremities of young adults. Reporting a case localized on the skin of the root of the nose. Differential diagnosis with osteoma is made.

[Open wound of the larynx caused by the horn of a bull]. / Traumatismo abierto de laringe por asta de toro.

Open laryngeal traumas are seldom seen in E.N.T., specially those ones secondary to horn bull goring. We do a synthetized study with regard to report this original case treated in our Service. We justify the paper because of the intensity, the seriousness and the originality of the picture.

[Mixed tumor of the external auditory canal]. / Tumor mixto de conducto auditivo externo.

Ceruminoma is a collective term applied to tumors arising from the modified apocrine (ceruminous) glands of the external auditory canal. Four distinctive histopathologic patterns are recognized: adenoma, pleomorphic adenoma, adenoid cystic carcinoma, and adenocarcinoma. We report a case of pleomorphic adenoma. It manifested as a soft mass covered with epithelium, filling the right external auditory canal. Wide local excision was the treatment, but local recurrence appeared four years later.

[Peripharyngeal abscess. Apropos of 2 cases]. / Abscesos perifaríngeos. A propósito de dos casos.

Peripharyngeal abscess still occurs despite the advent of antibiotics. Mediastinitis developing from a retropharyngeal abscess is a rare complication. A patient with retropharyngeal and subsequent mediastinal abscess is reported. We explain how pathological processes in the neck, can spread into the chest by direct continuity or by dissection through the fascial planes. We also report another patient lateropharyngeal abscess and respiratory distress.

[Malignant lymphoma at the cranial base. Apropos of a case]. / Linfoma maligno de base craneal. A propósito de un caso.

A case of malignant lymphoma that manifested itself neurologically is presented. We review the frequency of apparition on the head and neck of these tumours, and comment about clinical features and treatment.