[Facial nerve tumours]. / Tumores del nervio facial.

INTRODUCTION: Tumours originating in the facial nerve are extremely rare and their therapeutic approach requires the aid of specialists from a number of disciplines. AIMS: Our aim was to analyse the cases treated in our centre over a five-year period. PATIENTS AND METHODS: All the subjects submitted to surgical interventions to treat facial nerve tumours between January 1992 and December 1996 were evaluated retrospectively. Data recorded from all patients included age, sex, side affected, time prior to diagnosis, presenting symptom and symptoms observed at the time of diagnosis, previous history of disorders affecting the facial nerve and associated neurological symptoms. We also noted the location of the lesion, the surgical technique used, pathology findings, post-operative complications, length of post-operative stay in hospital, facial sequelae and surgical repair procedures used on the facial nerves involved in the intervention. RESULTS: Six cases, with a mean age of 29 years (range: 16-46 years), were treated. Three of the patients were males (50%). Symptoms of the disease included facial palsy (4), neurosensory hypoacusis (1) and tinnitus (1). All six individuals (100%) had alterations affecting facial functioning in the course of the disease. The pathological diagnosis was schwannoma in four cases and hemangioma in the other two. Neural grafts were carried out in three patients and some kind of deficit was observed at the end of the follow-up in all the cases. CONCLUSIONS: Facial nerve tumours are very infrequent. An early diagnosis is needed to diminish the facial sequelae following surgery performed to treat this clinical entity.

Tumores del nervio facial / Facial Nerve Tumours

Introducción. Los tumores originados a partir del nervio facial son sumamente raros y su enfoque terapéutico afecta a especialistas en diversas disciplinas. Objetivo. Analizar los casos tratados en un período de cinco años en nuestra institución. Pacientes y métodos. Se evaluaron retrospectivamente todos los sujetos operados de tumores del nervio facial entre enero de 1992 y diciembre de 1996. A todos ellos se les registró la edad, el sexo, el lado, el tiempo hasta el diagnóstico, el síntoma de inicio y los síntomas presentes en el momento del diagnóstico, la historia previa de alteraciones del nervio facial y la clínica neurológica asociada. Igualmente se anotaron localización de la lesión, la técnica quirúrgica, la anatomía patológica, las complicaciones posoperatorias, la estancia posquirúrgica, las secuelas faciales y los procedimientos quirúrgicos reparadores sobre los nervios faciales operados. Resultados. Se trataron seis casos, con una media de edad de 29 años (rango: 16-46 años). Tres pacientes eran varones (50%). El síntoma inicial de la enfermedad fue parálisis facial (4), hipoacusia neurosensorial (1) y acúfeno (1). Los seis individuos (100%) presentaron alteraciones de la función facial en el curso de la enfermedad. El diagnóstico anatomopatológico fue schwannoma en cuatro casos y hemangioma en los dos restantes. Se realizaron injertos neurales en tres pacientes y se objetivó algún tipo de déficit al final del seguimiento en todos los casos. Conclusiones. Los tumores del nervio facial son muy raros. Se necesita un diagnóstico precoz con el objetivo de disminuir las secuelas faciales tras la cirugía en esta entidad (AU)

Introduction. Tumours originating in the facial nerve are extremely rare and their therapeutic approach requires the aid of specialists from a number of disciplines. Aims. Our aim was to analyse the cases treated in our centre over a fiveyear period. Patients and methods. All the subjects submitted to surgical interventions to treat facial nerve tumours between January 1992 and December 1996 were evaluated retrospectively. Data recorded from all patients included age, sex, side affected, time prior to diagnosis, presenting symptom and symptoms observed at the time of diagnosis, previous history of disorders affecting the facial nerve and associated neurological symptoms. We also noted the location of the lesion, the surgical technique used, pathology findings, post-operative complications, length of post-operative stay in hospital, facial sequelae and surgical repair procedures used on the facial nerves involved in the intervention. Results. Six cases, with a mean age of 29 years (range: 16-46 years), were treated. Three of the patients were males (50%). Symptoms of the disease included facial palsy (4), neurosensory hypoacusis (1) and tinnitus (1). All six individuals (100%) had alterations affecting facial functioning in the course of the disease. The pathological diagnosis was schwannoma in four cases and hemangioma in the other two. Neural grafts were carried out in three patients and some kind of deficit was observed at the end of the follow-up in all the cases. Conclusions. Facial nerve tumours are very infrequent. An early diagnosis is needed to diminish the facial sequelae following surgery performed to treat this clinical entity (AU)

El uso del teléfono en pacientes con implante coclear / Telephone use in cochlear implanted patients

El uso del teléfono supone un reto importante para los pacientes con implante coclear ya que pueden aparecer distintas limitaciones que deberán superar: falta de apoyo visual, la eliminación de las frecuencias agudas en la señal telefónica, ruido ambiental, interferencias de los teléfonos móviles con el procesador externo del implante, la ansiedad producida ante un interlocutor que muchas veces es desconocido, etc. El propósito de este estudio es analizar el uso que los pacientes implantados en el Hospital Universitario La Paz hacen del teléfono y averiguar cuáles son los aspectos que presentan una mayor dificultad, así como su posible solución para mejorar su percepción de las conversaciones telefónicas. También realizamos una comparativa de las interferencias que los pacientes sufren con diferentes modelos de móvil, con el fin de descubrir cuáles son los terminales mas recomendados para minimizar dichas interferencias. Con este fin se envió un cuestionario a 21 pacientes implantados con un COMBI 40+ de MED-EL. Todos los pacientes del estudio utilizaban el teléfono fijo en alguna medida y, un porcentaje de ellos (66,7 por ciento), también el móvil. Los modelos de telefonía móvil más modernos parecen ser los más recomendables para estos pacientes, ya que producen menos interferencias con el implante (AU)

Factores clínicos predictivos de la extensión extracapsular en los ganglios linfáticos cervicales / Predictif clinical factors of the extracapsular extension of the cervical lymphatic nodes

No disponible

[Predictive clinical factors of extracapsular extension in lymph nodes of the neck]. / Factores clínicos predictivos de la extensión extracapsular en los gánglios linfáticos cervicales.

In order to assess the main clinical factors predicting extracapsular spread (ECS) in neck lymph nodes of patients with laryngeal cancer, step-wise logistic regression (LR) was applied to data retrospectively obtained from 141 patients surgically treated. Thirty six variables were evaluated in each patient. One hundred twenty eight out of the 141 patients had complete information on the 36 variables studied. With data from these 128 patients a linear discriminant function was obtained with an overall accuracy of 65.4%. The rate of correct prediction was 60.8% for presence of ECS and 71.7% for absence of ECS. Only 3 secondary variables created out of the 36 employed for the analysis were necessary to obtain these results.

[Electrooculographic findings in patients with neurofibromatosis]. / Alteraciones electro-oculográficas en pacientes con neurofibromatosis.

Neurofibromatosis are frequent genetic syndromes, with the electrooculographic examination (EOG) as an useful tool in their evaluation. We present the EOG findings of 16 patients with this entity which were seen at our Department between 1969 and 1991. Mean of age was 31 years. Nine patients were female (56%). The most frequent pathologic findings were: spontaneous nystagmus (37.5%) and abnormalities in the pursuit tracking test (31.2%). These results are discussed and the main literature concerning this matter is reviewed.

Alteraciones electro-oculográficas en pacientes con neurofibromatosis / Electrooculographic findings in patients with neurofibromatosis

Las neurofibromatosis (NF) son un grupo frecuente de síndromes genéticos, siendo el electro-óculograma (EOG) una prueba útil en su evaluación. Presentamos los hallazgos EOG de 16 pacientes vistos en nuestro Servicio entre los años 1969 y 1991. La media de edad fue de 31 años. De todos los enfermos, 9 eran mujeres (56 por ciento). Las alteraciones encontradas con mayor frecuencia fueron: el nistagmoespontáneo (37,5 por ciento) y anomalías en el seguimiento (31,2 por ciento). Estos resultados son discutidos presentándose una revisión de la literatura sobre el tema (AU)

Neurofibromatosis are frequent genetic syndromes, with the electrooculographic examination (EOG) as an useful tool in their evaluation. We present the EOG findings of 16 patients with this entity which were seen at our Department between 1969 and 1991. Mean of age was 31 years. Nine patients were female (56%). The most frequent pathologic findings were: spontaneous nystagmus (37.5%) and abnormalities in the pursuit tracking test (31.2%). These results are discussed and the main literature concerning this matter is reviewed (AU)

Clinical features of pharyngeal cancer: a retrospective study of 258 consecutive patients.

Pharyngeal cancer still presents an unsatisfactory mortality (30-40 per cent in most series, with a slightly better prognosis for nasopharyngeal cancer relative to both oropharyngeal and hypopharyngeal cancers) despite advances in treatment. Therefore, it is critical to know the clinical features of pharyngeal cancer. The purpose of this study was to investigate the most relevant clinical features of pharyngeal cancer (oropharyngeal, hypopharyngeal, and nasopharyngeal) in order to improve knowledge of this malignancy with the aim of ameliorating diagnosis and treatment. The retrospective study was based on a review of medical records from 258 consecutive patients with pharyngeal cancer (oropharyngeal, hypopharyngeal and nasopharyngeal) diagnosed at La Paz University Hospital, Madrid, Spain, between January 1 1991 and and December 31 1995. Medical records were provided by the Departments of Otorhinolaryngology, Head and Neck Surgery, Radiation Oncology, and Medical Oncology. All medical records were analysed for the following clinical variables: 1) incidence, 2) sociodemographics, 3) sites (oropharynx, hypopharynx, nasopharynx) and subsites, 4) clinical and histological staging, 5) pathology, 6) presenting symptoms, 7) time to diagnosis, 8) patients' general performance status at diagnosis, 9) personal cancer history and synchronous head and neck tumours, 10) premalignant lesions, and 11) paediatric cases. Our most outstanding finding was the excessively long time that elapsed between first clinical manifestation appearance and conclusive diagnosis of pharyngeal cancer (4.7 months for pharynx, 4.5 for oropharynx, 4.4 for hypopharynx and 6.5 for nasopharynx cancers). It was found that nasopharyngeal cancer was quite different from both oropharyngeal and hypopharyngeal cancers with respect to its potential aetiology, risk factors and clinical presentation. In addition it has a better prognosis.

Hematoma y absceso septal tras traumatismos nasales menores en pacientes pediátricos / Hematoma and septal abscess following minor nasal trauma in children

Con el objetivo de estudiar las complicacio-nes de los traumatismos nasales menores, evaluamos retrospectivamente 9 casos vistos entre 1990 y 1997. La media de edad de los pacientes fue de 5 años (rango: 2-14 años). Siete enfermos fueron varones (77,8 por ciento). El tratamiento consistió en drenaje quirúrgico y antibióticos postoperatorios. Todos los en-fermos desarrollaron algún tipo de secuelas, menores en 4 casos (44,4 por ciento) y mayores en los restantes 5 casos (55,6 por ciento). En resumen, los traumatismos nasales menores no están exentos de secuelas. Su tratamiento incluye el drenaje quirúrgico y los antibióticos en un intento de minimizar la aparición de secuelas (AU)

[The impact of extracapsular spread and desmoplasia on local recurrence in patients with malignant tumors of the larynx and hypopharynx]. / Impacto de la extensión extracapsular y la desmoplasia en la recidiva local de pacientes con tumores malignos de laringe e hipofaringe.

A study was made of the impact of the presence of extracapsular spread (ECS) and desmoplastic pattern (DP) in cervical lymph nodes on local recurrence in 119 patients with laryngeal and hypopharyngeal cancer. All patients underwent surgery between 1984 and 1992 for squamous-cell carcinoma and had histologically confirmed lymph node metastasis. The tumor recurred locally in 15.7% of patients without ECS and in 36.1% of patients with ECS (p < 0.03). The frequency of local recurrence did not differ significantly between patients without DP (20.0%) and patients with DP (29.0%) (p > 0.05). Therefore ECS in cervical lymph nodes of patients with laryngeal cancer was related with an increased rate of local recurrence, but DP did not modify the probability of local recurrence.

[Thromboembolic prophylaxis in patients with head and neck carcinomas: a risk-benefit study]. / Profilaxis tromboembólica en pacientes con carcinomas de cabeza y cuello: un estudio riesgo-beneficio.

Thromboembolism is a risk in major surgical procedures on the head and neck for cancer in predisposed patients. This study was designed to determine if preoperative administration of low-molecular-weight heparin is safe or if it increases the risk of postoperative complications. Preoperative administration of low-molecular-weight heparin was the most important factor in complications such as pharyngo-cutaneous fistula, wound infection, suture dehiscence, or seroma. The second most important factor was surgical technique, and the third factor was neck dissection. Low-molecular-weight heparin did not reduce the risk of thromboembolism. In fact, one patient died suddenly from thromboembolism after surgery.

[Supraglottic laryngectomy: 3-year and 5-year results]. / Laringectomía supraglótica: resultados a tres y cinco años.

A series of 84 patients who underwent horizontal supraglottic laryngectomy between 1980 and 1995 were analyzed. All patients were men, mean age 56 years. Neck metastases were found in 37 patients; 17 patients had stage I disease, 22 stage II, 13 stage III and 32 stage IV. One patient died in the postoperative period. Pharyngocutaneous fistula was the most frequent complication, being present in 10.7% of patients. The 3-year and 5-year survival rates were 78.9 and 74.2%, respectively. Local control was 91.6% at 3-years and 90.4% at 5-years. Local recurrences occurred in 6 patients, all of whom were salvaged by total laryngectomy and radiotherapy. Neck failure occurred in 15 patients, 2 of who were salvaged with further treatment. Second primary tumors appeared in 10 patients, 30% in the head and neck, after a mean interval of 77 months.

[Quality of life and cancer of the larynx]. / Calidad de vida y cáncer de laringe.

The quality of life of patients who underwent surgery for cancer of the larynx was analyzed. Two groups of patients were separated by the type of surgical intervention: functional surgery (supraglottic, 19 patients, and cordectomy, 11 patients) and radical surgery (total laryngectomy, 69 patients, and near-total laryngectomy, 12 patients). The Psychosocial Adjustment to Illness Scale- Self Report (PAIS-SR) was used for evaluation. No statistically significant differences in overall adjustment were found between groups. Patients did not consider the permanent stoma and voice loss to be the most important determinant of quality of life. Lack of social and family support was the most important negative factor affecting patients. The need for support groups and additional studies of quality of life to identify potential problems areas for the postoperative adjustment of patients to normal life should be addressed.

[Effect of extracapsular extension on cervical recurrence and the survival of patients with laryngeal tumors]. / Influencia de la extensión extracapsular en la recidiva cervical y la supervivencia de pacientes con tumores laríngeos.

The influence of the extracapsular spread (ECS) of metastatic cervical lymph nodes in patients with laryngeal cancer is discussed. The study included 119 patients who underwent surgery between 1984 and 1992 for squamous cell carcinoma of the larynx and lymph node metastasis confirmed by histology. Results were studied from two main aspects: survival and cervical recurrence. The 3-year survival rate was 73.4% in patients without ECS and 28.9% in patients with ECS (p < 0.001). The 3-year local recurrence rate differed significantly: 23.5% in patients without ECS and 58.3% in patients with ECS (p < 0.001). These results showed that ECS had an unfavorable prognostic significance for lymph node metastasis of laryngeal cancer.

["Near-total" laryngectomy: functional results]. / Laringuectomía "casi total": resultados funcionales.

"Near total" laryngectomy is an alternative to total laryngectomy in some advanced laryngeal tumors. A prospective study was made of the results obtained in 40 patients treated with near total laryngectomy. Speech was achieved in 74.3% of patients within a mean time interval of 63 days. Of the subjects who had more than 5 months of follow-up, 84.6% could speak. Half of the patients who achieved speech used the Barton-Mayo button and did not need to use their hand for phonation. Major swallowing problems were found in 13.9%. The most common complication was pharyngo-cutaneous fistula (58.9%).

[Postoperative complications in patients with functional neck dissection]. / Evolución postoperatoria de los pacientes con vaciamiento cervical funcional.

The aim of this study was to assess the complications of surgical treatment of patients with laryngeal cancer undergoing functional neck dissection (FND). Local and medical complications, post-operative sequelae, post-operative stay and fatality rate were recorded in 195 patients. Overall complication rate was 43.07%, with 45 wound infections; 35 wound dehiscences; 39 serohematomas; 4 chylous fistulae; and 11 hemorrhages (2 cases of internal jugular vein rupture). Medical complications were seen in 11 patients. The significant association of pharyngocutaneous fistula with wound infection and dehiscence raises a reasonable doubt about the relative participation of FND in the reported complication rate. Overall incidence of surgical fatality as a result of complications was 2.56% (5/195). Permanent sequelae were found in 4.24% of FNDs (11/259). The average hospitalization was 25.17 +/- 19.88 days. Although an accurate evaluation of intrinsic complications of FND is difficult to perform in patients with combined single-state surgery for the tumor and the neck, most complications of FND are local and easy to manage.

[How to make slides]. / Cómo hacer diapositivas.

Quality of oral presentation slides is based on content and design. The most common fault is presentation of slides with too much writing, or with type to small to be seen by the audience. With a few design rules and a minimum of photographic equipment, high quality slides are to be obtain. Slides are projected to be read and communicate an idea, make them nice, simple and readable; there is no need for fancy art works. Format and color are important but not the main point, and they will depend on available material, time and money.

[How to write and present a scientific work]. / Cómo escribir y presentar un trabajo científico.

The goal of a scientific work is to give to the reader clear information in the shortest time. To achieve this goal depends on the writer's technique and experience. In this article we will review the essential ingredients of a scientific paper, and which is the role of each one. We will also make some comments on lecture presentation and on paper preparation for journal submission.