Tumor de células gigantes tenosinovial condroide de articulación temporomandibular. Presentación de un caso / Chondroid tenosynovial giant cell tumour of the temporomandibular joint: A case report

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Adenoma pleomorfo de epiglotis / Pleomorphic adenoma of the epiglottis

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Resultados funcionales y estéticos tras rinoplastia de aumento / Functional and aesthetic results after augmentation rhinoplasty

Introducción y objetivos: La septorrinoplastia de aumento (SRA) podría definirse como aquella técnica cuya finalidad es conseguir un aumento de las dimensiones de la pirámide nasal, tanto del dorso como de la punta. A lo largo de los años, para conseguir este aumento se han utilizado múltiples materiales que han sido objeto de controversia. El objetivo del presente estudio es mostrar nuestra experiencia con la septorrinoplastia de aumento, resaltando el tipo y la naturaleza de los injertos utilizados y las complicaciones acaecidas. Material y método: Se ha realizado un estudio retrospectivo descriptivo mediante la revisión de historiales clínicos de 188 pacientes intervenidos de septorrinoplastia en nuestro servicio en un período de 12 años comprendido entre enero de 1998 y abril de 2009.Resultados: En 42 pacientes se realizó una septorrinoplastia de aumento, la cual constituye el objeto de nuestro estudio. En un 66% de casos (28/42) se utilizó un injerto onlay de cartílago cuadrangular, en 22 pacientes (85,7%) una lámina única de cartílago y en 6 pacientes (21%) un injerto doble de cartílago cuadrangular. En 14 pacientes fue necesario recurrir a los injertos de material sintético: en todos los casos se empleó el Gore-Tex®, en 12 (28,5%) pacientes como único material del injerto y en 2 (4,7%) pacientes conjuntamente con cartílago septal. Conclusiones: La reconstrucción del dorso nasal exige el conocimiento de diferentes técnicas y recursos quirúrgicos, así como la utilización de diferentes tipos de injertos en función de las necesidades de cada paciente. El injerto ideal, que existe sólo como concepto, sería aquel que aúna biocompatibilidad, baja tasa de complicaciones y resultados estables a largo plazo. En la actualidad, el cartílago autólogo, y más concretamente el cartílago septal, permanece como primera opción en la SRA. En caso de no disponer de cartílago septal, recurrimos siempre a los injertos de cartílago de concha, de uno o de ambos lados según la necesidad de material (AU)

Introduction: Augmentation rhinoplasty could be defined as the method whose goal is to increase the dimensions of the nasal pyramid, both the dorsum and the tip. For a long time, surgeons have used different kinds of materials that have often been the object of discussion. The aim of this study is to report our experience with augmentation septorhinoplasty, emphasizing the type and nature of the grafts employed and the ensuing complications. Material and method: This is a retrospective study describing the medical history of 188patients who underwent septorhinoplasty surgery in our Department over a period of 12 years, from January 1998 to April 2009. Of these patients, 42 underwent augmentation septorhinoplasty, which is the object of our study. Results: In 66% of the cases (28/42), quadrangular autologous cartilage was the ‘‘onlay’’ graft most widely employed; we used a single graft in 22 (85.7%) cases and a double one in the other6 (21%). In 14 patients, it was necessary to use grafts of synthetic material: in all the cases Gore-Tex® was chosen, in 12 (28.5%) patients as the only graft material and in 2 (4.7%) used together with septal cartilage. Conclusions: Nasal dorsum reconstruction requires the knowledge of different methods and surgical procedures, as well as the use of different types of grafts according to the needs of each patient. The ideal graft, which exists only as a concept, would be the one combining biocompatibility, a low complication rate and results that remained stable for a long time. At present, autologous cartilage, and more precisely septal cartilage, is still the first option for augmentation rhinoplasty. If septal cartilage is not available, we always turn to conchalcartilage grafts, from one or both sides depending on the amount of cartilage required (AU)

[Functional and aesthetic results after augmentation rhinoplasty]. / Resultados funcionales y estéticos tras rinoplastia de aumento.

INTRODUCTION: Augmentation rhinoplasty could be defined as the method whose goal is to increase the dimensions of the nasal pyramid, both the dorsum and the tip. For a long time, surgeons have used different kinds of materials that have often been the object of discussion. The aim of this study is to report our experience with augmentation septorhinoplasty, emphasising the type and nature of the grafts employed and the ensuing complications. MATERIAL AND METHOD: This is a retrospective study describing the medical history of 188 patients who underwent septorhinoplasty surgery in our Department over a period of 12 years, from January 1998 to April 2009. Of these patients, 42 underwent augmentation septorhinoplasty, which is the object of our study. RESULTS: In 66% of the cases (28/42), quadrangular autologous cartilage was the "onlay" graft most widely employed; we used a single graft in 22 (85.7%) cases and a double one in the other 6 (21%). In 14 patients, it was necessary to use grafts of synthetic material: in all the cases Gore-Tex was chosen, in 12 (28.5%) patients as the only graft material and in 2 (4.7%) used together with septal cartilage. CONCLUSIONS: Nasal dorsum reconstruction requires the knowledge of different methods and surgical procedures, as well as the use of different types of grafts according to the needs of each patient. The ideal graft, which exists only as a concept, would be the one combining biocompatibility, a low complication rate and results that remained stable for a long time. At present, autologous cartilage, and more precisely septal cartilage, is still the first option for augmentation rhinoplasty. If septal cartilage is not available, we always turn to conchal cartilage grafts, from one or both sides depending on the amount of cartilage required.

Evolución de la calidad de vida en pacientes intervenidos de carcinomas de orofaringe, laringe o hipofaringe / Quality of life evolution in patients after surgical treatment of laryngeal, hypopharyngeal or oropharyngeal carcinoma

Introducción y objetivos: La calidad de vida (CV) es un parámetro que se utiliza de forma habitual a la hora de elegir el tratamiento de un paciente con cáncer. En pacientes con cáncer de cabeza y cuello, la eliminación de estructuras anatómicas directamente relacionadas con funciones básicas (comer, hablar, respirar) hace que las secuelas del tratamiento quirúrgico se consideren como determinantes en la calidad de vida de los pacientes. El objetivo del presente estudio es evaluar si la calidad de vida de pacientes tratados quirúrgicamente por un carcinoma de laringe, hipofaringe u orofaringe cambia a lo largo del tiempo, comparando su calidad de vida previa al tratamiento, a los 3 y 6 meses post tratamiento. Material y método: Estudio prospectivo realizado entre los meses de noviembre de 2008 y junio de 2009, con 53 pacientes diagnosticados y tratados de carcinoma de cabeza y cuello sometidos a: cirugía parcial (n=32) y radical (n=21). Análisis de calidad de vida mediante el cuestionario general de la European Organization of Research and Treatment of Cancer (EORTC) EORTC QLQ-C30 y el específico de cabeza y cuello EORTC QLQ-H&N35 antes del tratamiento, a los tres y seis meses después. Resultados: No existen diferencias significativas en el estado de salud general de ambos grupos. Los mayores cambios se producen en la escala funcional. No se encontraron diferencias en los problemas de deglución o sentimiento de enfermedad, reflejándose problemas evidentes de fonación en ambos grupos. Conclusiones: La aplicación rutinaria de cuestionarios de calidad de vida en pacientes oncológicos ofrece la posibilidad de conocer en que esferas y medida los pacientes se ven afectados por el tratamiento y las secuelas, permitiendo adecuar la información y los tratamientos de apoyo y rehabilitación a las verdaderas necesidades de los pacientes (AU)

Introduction: The assessment of quality of life in patients with head and neck cancer is dependent on many variables. Objective: The aim of this study was to evaluate the differences in quality of life among patients treated with conservative or radical surgery for laryngeal, oropharyngeal or hypopharyngeal cancer, evaluated before and at 3 and 6 months after definitive therapy. Material and method: Prospective study between November 2008 and June 2009 on 53 patients diagnosed and treated for head and neck carcinoma with surgery: partial (n=32) and radical (n=21). Quality of life was evaluated using the European Organization of Research and Treatment of Cancer (EORTC) general questionnaire EORTC QLQ-C30 and its specific head and neck EORTC QLQ-H&N35 before treatment, and at 3 and 6 months afterwards. Results: No significant differences were found in overall health. Patients experienced the greatest changes in functional scale. There were no changes in swallowing problems or feeling of disease, while evident phonation problems were present in both groups. Discussion and conclusions: The routine application of quality of life questionnaires in cancer patients improves information regarding how and to what extent patients feel that treatment and its sequelae modify it, making it possible to adapt rehabilitation and support programs to their real needs. This data helps in choosing between different options depending on the results, delivering improved care to patients (AU)

Hemangioma capilar de oído medio / Capillary hemangioma of the middle ear: a case report

Los hemangiomas capilares se consideran tumores vasculares benignos. Aproximadamente dos tercios de los mismos se localizan en cabeza y cuello. Su origen en oído medio procede del aporte vascular del ganglio geniculado. Se encuentran infradiagnosticados debido a la gran variedad de patologías con similares manifestaciones clínicas y radiológicas, siendo definitivo, el examen histológico para su diagnóstico(AU)

Capillary hemangiomas are considered benign vascular tumours. Two-thirds of hemangiomas occur in the head and neck region. They commonly originate from the vascular networks around the geniculate ganglion. They are underdiagnosed because there are a great many diseases with similar clinical and radiologic signs. Therefore, the histological exam is definitive for diagnosis(AU)

[Quality of life evolution in patients after surgical treatment of laryngeal, hypopharyngeal or oropharyngeal carcinoma]. / Evolución de la calidad de vida en pacientes intervenidos de carcinomas de orofaringe, laringe o hipofaringe.

INTRODUCTION: The assessment of quality of life in patients with head and neck cancer is dependent on many variables. OBJECTIVE: The aim of this study was to evaluate the differences in quality of life among patients treated with conservative or radical surgery for laryngeal, oropharyngeal or hypopharyngeal cancer, evaluated before and at 3 and 6 months after definitive therapy. MATERIAL AND METHOD: Prospective study between November 2008 and June 2009 on 53 patients diagnosed and treated for head and neck carcinoma with surgery: partial (n=32) and radical (n=21). Quality of life was evaluated using the European Organization of Research and Treatment of Cancer (EORTC) general questionnaire EORTC QLQ-C30 and its specific head and neck EORTC QLQ-H&N35 before treatment, and at 3 and 6 months afterwards. RESULTS: No significant differences were found in overall health. Patients experienced the greatest changes in functional scale. There were no changes in swallowing problems or feeling of disease, while evident phonation problems were present in both groups. DISCUSSION AND CONCLUSIONS: The routine application of quality of life questionnaires in cancer patients improves information regarding how and to what extent patients feel that treatment and its sequelae modify it, making it possible to adapt rehabilitation and support programs to their real needs. This data helps in choosing between different options depending on the results, delivering improved care to patients.

[Capillary hemangioma of the middle ear: a case report]. / Hemangioma capilar de oído medio.

Capillary hemangiomas are considered benign vascular tumours. Two-thirds of hemangiomas occur in the head and neck region. They commonly originate from the vascular networks around the geniculate ganglion. They are underdiagnosed because there are a great many diseases with similar clinical and radiologic signs. Therefore, the histological exam is definitive for diagnosis.

Linfoma no Hodgkin primario de la glándula parótida: revisión de 8 casos / Primary Non-Hodgkin Lymphoma of the parotid gland: Revision of 8 cases

La manifestación de un linfoma no Hodgkin como tumor primario de la parótida representa el 5% de los tumores en esta localización. Se presentan 8 pacientes diagnosticados y tratados de linfoma no Hodgkin parotídeo en nuestro hospital entre 1996–2003. El 62% eran mujeres que presentaban una masa indurada de 4 meses de evolución. En todos los casos se realizó una punción aspiración con aguja fina y una tomografía computerizada siendo el estudio inmunohistoquímico esencial en el diagnóstico definitivo. Para ello, se realizó en todos los casos una biopsia. El tratamiento fue con quimioterapia en el 75% de los casos y en el 25% quirúrgico. El objetivo es analizar los patrones clínicos y patológicos, así como las distintas modalidades terapéuticas y pronósticas, que caracterizan a este tipo de patología basándonos en el análisis de nuestros pacientes y comparándolos con los reflejados en la literatura (AU)

The manifestation of non-Hodgkin lymphoma as a primary parotid tumour account for 5% of all tumours at this location. We present 8 patients diagnosed and treated for parotid non-Hodgkin lymphoma in our hospital between 1996 and 2003. Of the cases, 62% were women who had an indurated mass for almost 4 months. A fine needle aspiration and computed tomography were performed on all patients. The immunohistochemical study provided us with the definitive diagnosis. Biopsy was done in all cases. The treatment was chemotherapy in 75% cases and surgery in 25%.The objective was to analyse the clinical and pathological patterns, plus the different treatment modalities and prognoses, which characterise this type of pathology based on the analysis of our patients and compared with those reported in the literature (AU)

Tratamiento quirúrgico de las estenosis subglóticas / Surgical treatment of subglottic stenosis

Introducción: Las estenosis de localización subglótica son poco frecuentes, siendo su principal mecanismo etiopatogénico la intubación orotraqueal. El objetivo es analizar la experiencia en el tratamiento, revisando el tipo de terapéutica, porcentaje de decanulación, evolución sintomática postratamiento y número de procedimientos por paciente. Material y método: Dieciséis pacientes diagnosticados y tratados de estenosis subglótica entre 1995–2007. Se recogieron datos clinicopatológicos que incluyen: edad, sexo, etiología, clínica, grado de severidad (clasificación de Cotton), métodos diagnósticos, tipo de tratamiento, evolución sintomática, decanulación y número de procedimientos. Analizamos nuestros resultados comparándolos con otros estudios para conocer la evolución, morbilidad y porcentaje de éxitos con las terapéuticas propuestas. Resultados: El 75% eran mujeres con edad media de 60 años. El 75% presentaban antecedente de intubación prolongada. El síntoma de presentación fue disnea (94%) y el 69% precisó traqueotomía de urgencia. Se trataron quirúrgicamente 10 pacientes: 7/10 láser CO2, 2/10 dilataciones y 1/10 cirugía abierta. La decanulación tras la cirugía fue posible en el 60% del total. El número de procedimientos por paciente fue 1,37. Discusión: El tratamiento de las estenosis subglóticas debe individualizarse según las características del paciente, el tipo de estenosis y la severidad de la misma. El uso de técnicas láser proporciona buenos resultados en grados leves-moderados, asociando baja morbilidad. La cirugía abierta estaría reservada para los grados más severos de estenosis y tras el fracaso del láser CO2 (AU)

Introduction: Subglottic stenosis is rare, its primary pathogenic mechanism being tracheal intubation. Its incidence has declined in recent decades due to improved material and reduced intubation time. The objective of this study was to analyse the experience in treating this disease, emphasising the type of treatment used, the rate of decannulation obtained, symptomatic changes after treatment, and the total number of procedures performed per patient. Materials and methods: The study included 16 patients diagnosed and treated for subglottic stenosis in our department from 1995 to 2007. Clinicopathologic data were collected including: age, sex, etiology and severity (the Cotton classification), diagnostic methods used, type of treatment, progression of symptoms, decannulation and number of procedures performed per patient. To identify changes, morbidity and success rate with the proposed treatment, we analysed our results, comparing them with those collected in other studies. Results: Of the cases analysed, 75% were women, with a mean age of 60 years; 75% of the total cases had a history of prolonged intubation. The presenting symptom was dyspnea (94%), and 69% required an emergency tracheotomy. Ten patients were treated surgically: 7/10 CO2 laser, 2/10 dilation and 1/10 open surgery. Decannulation after surgery was possible in 60% of the total. The number of procedures per patient was 1.37. Conclusions: Subglottic stenosis treatment must be individualised based on patient characteristics, type of stenosis and severity. The use of endoscopic laser provides the best results in mild to moderate degrees with low morbidity. Open surgery was reserved for severe degrees, and after the failure of the CO2 laser (AU)

[Surgical treatment of subglottic stenosis]. / Tratamiento quirúrgico de las estenosis subglóticas.

INTRODUCTION: Subglottic stenosis is rare, its primary pathogenic mechanism being tracheal intubation. Its incidence has declined in recent decades due to improved material and reduced intubation time. The objective of this study was to analyse the experience in treating this disease, emphasising the type of treatment used, the rate of decannulation obtained, symptomatic changes after treatment, and the total number of procedures performed per patient. MATERIALS AND METHODS: The study included 16 patients diagnosed and treated for subglottic stenosis in our department from 1995 to 2007. Clinicopathologic data were collected including: age, sex, etiology and severity (the Cotton classification), diagnostic methods used, type of treatment, progression of symptoms, decannulation and number of procedures performed per patient. To identify changes, morbidity and success rate with the proposed treatment, we analysed our results, comparing them with those collected in other studies. RESULTS: Of the cases analysed, 75% were women, with a mean age of 60 years; 75% of the total cases had a history of prolonged intubation. The presenting symptom was dyspnea (94%), and 69% required an emergency tracheotomy. Ten patients were treated surgically: 7/10 CO(2) laser, 2/10 dilation and 1/10 open surgery. Decannulation after surgery was possible in 60% of the total. The number of procedures per patient was 1.37. CONCLUSIONS: Subglottic stenosis treatment must be individualised based on patient characteristics, type of stenosis and severity. The use of endoscopic laser provides the best results in mild to moderate degrees with low morbidity. Open surgery was reserved for severe degrees, and after the failure of the CO(2) laser.

[Primary non-Hodgkin lymphoma of the parotid gland: Revision of 8 cases]. / Linfoma no Hodgkin primario de la glándula parótida: revisión de 8 casos.

The manifestation of non-Hodgkin lymphoma as a primary parotid tumour account for 5% of all tumours at this location. We present 8 patients diagnosed and treated for parotid non-Hodgkin lymphoma in our hospital between 1996 and 2003. Of the cases, 62% were women who had an indurated mass for almost 4 months. A fine needle aspiration and computed tomography were performed on all patients. The immunohistochemical study provided us with the definitive diagnosis. Biopsy was done in all cases. The treatment was chemotherapy in 75% cases and surgery in 25%. The objective was to analyse the clinical and pathological patterns, plus the different treatment modalities and prognoses, which characterise this type of pathology based on the analysis of our patients and compared with those reported in the literature.

[Bronchoscopy in children with foreign body aspiration]. / Broncoscopia en población infantil tras aspiración de cuerpo extraño.

INTRODUCTION AND OBJECTIVES: Aspiration of foreign body presents a high incidence of mortality during the paediatric life period. Family suspect and detection of specific symptoms and signs determine the need of bronchoscopy. The objective of this study is to establish the clinical parameters that indicate foreign body in airway. METHODS: Retrospective study in 44 children with foreign body aspiration. We reviewed age, sex, family suspect, blood analysis, chest x-ray, time to consulting, location, type, complications, and time to discharge. RESULTS: Decisive clinical factors that indicate foreign body in airway are family suspect and respiratory clinic. Findings after auscultation and chest x-ray support suspect, but final diagnostic only can be made after bronchoscopy. Bronchoscopy with foreign body removal was performed during first 24 hours in 86.36 % of patients, and founded that those with delayed diagnosis had increased morbidity. CONCLUSIONS: Family's suspect is the most important parameter that indicates foreign body located in airway. Bronchoscopy performed during the first hours avoids morbidity. This is a secure technique when performed in adequate place with trained personnel.

Broncoscopia en población infantil tras aspiración de cuerpo extraño / Bronchoscopy in children with foreign body aspiration

Introducción y objetivos: La aspiración de cuerpos extraños supone en la edad pediátrica una importante causa de mortalidad. La sospecha familiar y la detección de síntomas y signos de riesgo determinan la necesidad de realizar una broncoscopia. El objetivo de este trabajo es determinar qué parámetros ofrecen más sensibilidad para detectar un cuerpo extraño obstructivo. Métodos: Estudio retrospectivo en 44 pacientes con sospecha de cuerpo extraño en la vía aérea. Se estudia la edad y el sexo, la sospecha familiar, la clínica, la analítica, la radiografía de tórax, el tiempo medio hasta la consulta hospitalaria, la localización del cuerpo extraño, el tipo de cuerpo extraño, las complicaciones y la estancia hospitalaria. Resultados: Los factores más determinantes que indican la presencia de un cuerpo extraño fueron la sospecha familiar y la clínica. Los hallazgos tras la auscultación y la radiografía de tórax dan apoyo a la sospecha, aunque el diagnóstico final sólo se establece tras la realización de la broncoscopia. Se realizó broncoscopia en las primeras 24 h, y se extrajo cuerpo extraño en el 86,36 % de los pacientes; en los casos en que se retrasó el diagnóstico hubo aumento de la morbilidad. Conclusiones: La sospecha clínica familiar inicial es el factor fundamental para llegar al diagnóstico. La realización de esta técnica en las primeras horas tras la sospecha evita morbilidad. La broncoscopia es una técnica segura siempre que sea realizada en un medio adecuado y por personal entrenado

Introduction and objectives: Aspiration of foreign body presents a high incidence of mortality during the paediatric life period. Family suspect and detection of specific symptoms and signs determine the need of bronchoscopy. The objective of this study is to establish the clinical parameters that indicate foreign body in airway. Methods: Retrospective study in 44 children with foreign body aspiration. We reviewed age, sex, family suspect, blood analysis, chest x-ray, time to consulting, location, type, complications, and time to discharge. Results: Decisive clinical factors that indicate foreign body in airway are family suspect and respiratory clinic. Findings after auscultation and chest x-ray support suspect, but final diagnostic only can be made after bronchoscopy. Bronchoscopy with foreign body removal was performed during first 24 hours in 86.36 % of patients, and founded that those with delayed diagnosis had increased morbidity. Conclusions: Family’s suspect is the most important parameter that indicates foreign body located in airway. Bronchoscopy performed during the first hours avoids morbidity. This is a secure technique when performed in adequate place with trained personnel