Paciente con xerostomía posradioterapia por cáncer de cabeza y cuello tratado con células madre mesenquimales autólogas expandidas de tejido adiposo: una nueva oportunidad terapéutica / Radiation-induced xerostomia in a patient with head and neck cancer treated with Injection of autologous expanded adipose tissue-derived mesenchymal stem cells: A new therapeutic opportunity

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Técnicas actuales de cirugía adenoamigdalar en los trastornos respiratorios del sueño de los niños / Current techniques in tonsil surgery

En los últimos años, la consolidación de la hipertrofia amigdalar como principal indicación quirúrgica, ha originado la aparición de nuevas técnicas. La mayoría persigue una reducción de su volumen (es la llamada amigdalotomía o reducción amigdalar). Con ello, se consigue disminuir considerablemente tanto la incidencia de hemorragia intra y postoperatoria como la intensidad del dolor. Describiremos el mecanismo, las ventajas y los inconvenientes de las diferentes técnicas, incluyendo la electrodisección con bisturí eléctrico, la reducción con microdebrider, el bisturí armónico (o de ultrasonidos), la radiofrecuencia (con sus distintas variantes) y el láser CO2. Con relación a las técnicas que reducen el volumen amigdalar hay que resaltar que la posibilidad de recidiva de la hipertrofia amigdalar será alta si se elimina menos de un 85% de amígdala. Tampoco es despreciable la posibilidad de infección de los restos amigdalares, sea cual sea la técnica empleada, por lo que no serán válidas en caso de amigdalitis de repetición. Recientemente, también han aparecido alternativas a la adenoidectomía clásica con cucharilla-adenotomo. Consisten en la posibilidad de minimizar el sangrado mediante el uso del microdebrider, de la radiofrecuencia o del aspirador coagulador. También nos referiremos al concepto de adenoidectomía parcial, de preferencia en pacientes con riesgo de insuficiencia velopalatina(AU)

In recent years, consolidation of tonsillar hypertrophy as the principal surgical procedure has led to the emergence of new techniques. Most aim to reduce volume (tonsillectomy or tonsil reduction). These techniques have considerably decreased intra- and postoperative hemorrhages and pain intensity. The present article describes the mechanisms and the advantages and disadvantages of the various techniques, including electro-dissection using electrical scalpels, reduction using a microdebrider, ultrasonic scalpel, radiofrequency (with its different variations) and CO2 laser. When techniques that reduce tonsil volume are used, the possibility of recurrence of the tonsillar hypertrophy is high if less than 85% of the tonsil is removed. There is also a considerable possibility of infection of the remaining tonsils, whichever technique is used, and therefore these techniques are not valid in the case of repetitive tonsillitis. Recently, alternatives to classical adenoidectomy using adenoid curette have also appeared. Bleeding can be minimized by using a microdebrider, radiofrequency or a blood coagulator. We also discuss the concept of partial adenoidectomy, which is preferred in patients at risk of velopharyngeal insufficiency(AU)

[Current techniques in tonsil surgery]. / Técnicas actuales de cirugía adenoamigdalar en los trastornos respiratorios del sueño de los niños.

In recent years, consolidation of tonsillar hypertrophy as the principal surgical procedure has led to the emergence of new techniques. Most aim to reduce volume (tonsillectomy or tonsil reduction). These techniques have considerably decreased intra- and postoperative hemorrhages and pain intensity. The present article describes the mechanisms and the advantages and disadvantages of the various techniques, including electro-dissection using electrical scalpels, reduction using a microdebrider, ultrasonic scalpel, radiofrequency (with its different variations) and CO(2) laser. When techniques that reduce tonsil volume are used, the possibility of recurrence of the tonsillar hypertrophy is high if less than 85% of the tonsil is removed. There is also a considerable possibility of infection of the remaining tonsils, whichever technique is used, and therefore these techniques are not valid in the case of repetitive tonsillitis. Recently, alternatives to classical adenoidectomy using adenoid curette have also appeared. Bleeding can be minimized by using a microdebrider, radiofrequency or a blood coagulator. We also discuss the concept of partial adenoidectomy, which is preferred in patients at risk of velopharyngeal insufficiency.