Accessory submaxillary gland: Two new case reports and a literature review.

BACKGROUND: The accessory submaxillary gland is a very uncommon anatomical variant, and incidence in the general population has not yet been quantified. The presence of pathology in these glands is rarer still, thus often going unnoticed. MATERIAL AND METHODS: We describe two accessory submaxillary gland cases, one asymptomatic and the other with chronic sialadenitis in the main and accessory gland caused by sialolithiasis. Although our diagnosis was by computerized tomography, magnetic resonance sialography is helpful to understand and describe this entity with greater precision. RESULTS: The first case report is an incidental finding and no intervention was required. However, case report number two had clinical symptoms and required a first intervention in which the main submaxillary gland was resected, and a second intervention in which the accessory submaxillary gland was removed. Both patients are asymptomatic to date. CONCLUSIONS: Awareness of the possible presence of accessory submaxillary glands and of potential variations of the excretory ducts is useful in diagnosis, as well as leading to more precise treatment for salivary pathology, and allowing surgeons to avoid complications or injuries during surgery. Key words:Accesory, submaxillary gland, submandibular gland, salivary gland, sialolithiasis, head and neck pathology.

Necrotizing fasciitis: an urgent diagnosis.

Necrotizing fasciitis (NF) is a rare, life-threatening soft-tissue infection and a medical and surgical emergency, with increasing incidence in the last few years. It is characterized by a rapidly spreading, progressive necrosis of the deep fascia and subcutaneous tissue. Necrotizing fasciitis is often underestimated because of the lack of specific clinical findings in the initial stages of the disease. Many adjuncts such as laboratory findings, bedside tests--e.g., the "finger test" or biopsy--and imaging tests have been described as being helpful in the early recognition of the disease. Imaging is very useful to confirm the diagnosis, but also to assess the extent of the disorder, the potential surgical planning, and the detection of underlying etiologies. The presence of gas within the necrotized fasciae is characteristic, but may be lacking. The main finding is thickening of the deep fasciae due to fluid accumulation and reactive hyperemia, best seen on magnetic resonance imaging.

Evolución de la otosclerosis hacia la implantación coclear / Evolution of otosclerosis to cochlear implantation

Introducción: La otosclerosis es una osteodistrofia de la cápsula laberíntica que produce hipoacusia de conducción. Si el proceso invade la cóclea, aparece una hipoacusia neurosensorial, siendo el implante coclear una buena alternativa en estos pacientes. Objetivo: Conocer el comportamiento de la otosclerosis en la implantación coclear. Material y métodos: Se revisó una base de datos de 250 pacientes intervenidos de implante coclear realizando un estudio retrospectivo sobre 13 pacientes con criterios clínicos, audiológicos y/o de imagen de otosclerosis bilateral. Se estudian los 26 oídos analizando la historia natural, cirugías previas, evolución hacia hipoacusia profunda, hallazgos en imagen mediante tomografía computarizada, complicaciones y resultados funcionales. Resultados: El 46% fueron mujeres y el 54% hombres con una edad media de 26 años al inicio de la hipoacusia conductiva. La cirugía del estribo fue llevada a cabo en 19 oídos (73%) a una edad media de 29 años y de estos en el 53% se realizó posteriormente un implante coclear. Los resultados de la tomografía computarizada muestran que en el 54% de los oídos existen signos de afectación radiológica en diferente grado. Se registraron un total de 3 complicaciones (23%): un fallo de implante coclear, una estimulación del nervio facial y un acúfeno bilateral. Al año de la implantación obtenemos un porcentaje promedio de aciertos en bisílabos del 80% y del 85% en frases en contexto abierto. Conclusiones: Pacientes que presentan una hipoacusia neurosensorial profunda bilateral secundaria a una otosclerosis se benefician extraordinariamente de la implantación coclear(AU)

Introduction: Otosclerosis is an osteodystrophy of the labyrinthine capsule producing conductive hearing loss. If the process invades the cochlea, a sensorineural hearing loss usually takes place. The cochlear implant is a good alternative in these patients. Objective: To ascertain the behaviour of cochlear implantation in otosclerosis. Material and methods: We reviewed a database of 250 patients that underwent cochlear implantation, performing a retrospective study of 13 patients with clinical, audiological and/or imaging findings of bilateral otosclerosis. The 26 ears were studied as to their natural history, previous surgeries, evolution to profound hearing loss, computed tomography images, complications and functional results. Results: Of the cases studied, 46% were female and 54% were men, with a mean age of 26 years at the onset of conductive hearing loss. Stapes surgery was performed in 19 ears (73%), with a mean patient age of 29 years, and 53% of them underwent cochlear implantation. Computed tomography results showed that there were signs of different degrees of radiological affectation in 54% of the ears. A total of 3 complications took place (23%): implant failure, overstimulation of the facial nerve and bilateral tinnitus were found. One year after implantation, the average percentages of correct 2-syllable words were 80% and 85% in open sentences. Conclusions: Patients having profound bilateral sensorineural hearing loss secondary to otosclerosis obtain great benefit from cochlear implantation(AU)

Evolution of otosclerosis to cochlear implantation.

INTRODUCTION: Otosclerosis is an osteodystrophy of the labyrinthine capsule producing conductive hearing loss. If the process invades the cochlea, a sensorineural hearing loss usually takes place. The cochlear implant is a good alternative in these patients. OBJECTIVE: To ascertain the behaviour of cochlear implantation in otosclerosis. MATERIAL AND METHODS: We reviewed a database of 250 patients that underwent cochlear implantation, performing a retrospective study of 13 patients with clinical, audiological and/or imaging findings of bilateral otosclerosis. The 26 ears were studied as to their natural history, previous surgeries, evolution to profound hearing loss, computed tomography images, complications and functional results. RESULTS: Of the cases studied, 46% were female and 54% were men, with a mean age of 26 years at the onset of conductive hearing loss. Stapes surgery was performed in 19 ears (73%), with a mean patient age of 29 years, and 53% of them underwent cochlear implantation. Computed tomography results showed that there were signs of different degrees of radiological affectation in 54% of the ears. A total of 3 complications took place (23%): implant failure, overstimulation of the facial nerve and bilateral tinnitus were found. One year after implantation, the average percentages of correct 2-syllable words were 80% and 85% in open sentences. CONCLUSIONS: Patients having profound bilateral sensorineural hearing loss secondary to otosclerosis obtain great benefit from cochlear implantation.

[Use of imaging criteria to identify cervical metastases using CT scans in head and neck tumours]. / Empleo de patrones de imagen en la identificación de metástasis cervical mediante tomografía computarizada en tumores de cabeza y cuello.

OBJECTIVE: To assess the diagnostic certainty of CT images to identify regional spread of head and neck tumours. PATIENTS AND METHOD: A CT study was performed on 86 patients with neoplasms in the larynx and/or pharynx. After this, surgical dissection was performed for 142 neck sides. In the imaging study the following parameters were considered for all patients before suspecting malignant nodes: size of adenopathy bigger than 10-11 mm, irregular borders, central necrosis, spherical shape, capsular enhancement and presence of groups with three or more lymphadenopathies. RESULTS: 48.5 % of dissections were N+. Sensitivity and specificity for physical examination were 59 % and 82 %, respectively, against 73 % and 86 % for CT. Lymph node necrosis was the pattern with the greatest sensitivity and specificity (35.8 % and 100 %, respectively) and its accuracy was 69.7 %. Accuracy was 60.5 % for spherical shape, 59.8 % for node size, and between 54 % and 58 % for the other three criteria. In the histopathological findings, 25 % of neck dissections were N+ when only one pattern had been detected on CT, whereas those neck sides in which four patterns were identified simultaneously showed regional spread in 100 %. CONCLUSIONS: The presence of specific morphological imaging criteria for head and neck tumours in cervical lymph nodes and their concomitance increase the accuracy of imaging to predict regional spread.

Empleo de patrones de imagen en la identificación de metástasis cervical mediante tomografía computarizada en tumores de cabeza y cuello / Use of imaging criteria to identify cervical metastases using CT scans in head and neck tumours

Objetivo: Evaluar la seguridad diagnóstica que proporcionan las imágenes de tomografía computarizada (TC) para identificar la extensión regional de tumores de cabeza y cuello (CC). Pacientes y método: Se efectuó TC a 86 pacientes diagnosticados de neoplasia de faringe y/o laringe que después fueron intervenidos, con un total de 142 vaciamientos ganglionares. En el estudio de imagen se consideraron los siguientes parámetros radiológicos para sospechar afección ganglionar: tamaño de la adenopatía > 10-11 mm, márgenes mal definidos, necrosis central, forma esférica, realce capsular y agrupación de tres o más adenopatías. Resultados: El 48,5 % de los vaciamientos resultaron N+. La sensibilidad y la especificidad de la palpación fueron del 59 y el 82 %, respectivamente, y para la TC, del 73 y el 86 %. La necrosis central fue el patrón de imagen con mayor sensibilidad y especificidad, el 35,8 y el 100 % respectivamente, con una eficiencia diagnóstica del 69,7 %. Esta eficiencia fue del 60,5 % para la forma esférica, del 59,8 % para el tamaño, y entre el 54 y el 58 % para los otros tres criterios de imagen. El 25 % de los vaciamientos resultó N+ en el estudio histopatológico cuando en la TC se había hallado sólamente uno de los patrones radiológicos descritos, pero las vertientes cervicales con cuatro patrones identificados simultáneamente presentaron extensión regional en el 100 %. Conclusiones: La presencia de patrones morfológicos específicos en los ganglios cervicales en la TC de tumores de CC y su concomitancia optimizan la eficiencia diagnóstica en esta prueba para predecir la extensión regional

Objective: To assess the diagnostic certainty of CT images to identify regional spread of head and neck tumours. Patients and method: A CT study was performed on 86 patients with neoplasms in the larynx and/or pharynx. After this, surgical dissection was performed for 142 neck sides. In the imaging study the following parameters were considered for all patients before suspecting malignant nodes: size of adenopathy bigger than 10-11 mm, irregular borders, central necrosis, spherical shape, capsular enhancement and presence of groups with three or more lymphadenopathies. Results: 48.5 % of dissections were N+. Sensitivity and specificity for physical examination were 59 % and 82 %, respectively, against 73 % and 86 % for CT. Lymph node necrosis was the pattern with the greatest sensitivity and specificity (35.8 % and 100 %, respectively) and its accuracy was 69.7 %. Accuracy was 60.5 % for spherical shape, 59.8 % for node size, and between 54 % and 58 % for the other three criteria. In the histopathological findings, 25 % of neck dissections were N+ when only one pattern had been detected on CT, whereas those neck sides in which four patterns were identified simultaneously showed regional spread in 100 %. Conclusions: The presence of specific morphological imaging criteria for head and neck tumours in cervical lymph nodes and their concomitance increase the accuracy of imaging to predict regional spread