Estenosis congénita de la apertura piriforme: forma inusual de obstrucción nasal / Congenital nasal pyriform aperture stenosis: unusual form of nasal airway obstruction

La estenosis congénita de la apertura piriforme con megaincisivo central (ECAP) es una causa poco frecuente de obstrucción de la vía aérea en neonatos. Dada su baja frecuencia y por la similitud de la clínica se confunde inicialmente con la atresia coanal, trastorno más prevalente (1:5.000 nacidos vivos). Puede tratarse de una forma menor de holoprosencefalia, por lo que el diagnóstico incluye el screening de malformaciones cardíacas y cerebrales asociadas. Presentamos un caso de una recién nacida con ECAP (AU)

Congenital nasal pyriform aperture stenosis (CNPAE) with a single mega-incisor is an uncommon form of nasal airway obstruction in the neonate. Its low frequency and its similar clinical presentation may lead us to a wrong initial diagnosis of choanal atresia, which is more frequent (1:5000 live births). CNPAE may be a minor form of holoprosencephaly, so diagnosis should include screening for heart and central nervous system abnormalities. A case of a newborn with CNPAE is reported (AU)

Carcinoma neuroendocrino primario de la piel, carcinoma de células de Merkel. Casuística 1991-2012 / Primary cutaneous neuroendocrine carcinoma, Merkel cell carcinoma. Case series 1991-2012

Introducción y objetivos: El llamado clásicamente carcinoma de células de Merkel fue descrito por Toker en 1972, se trata de un carcinoma neuroendocrino primario de la piel. Aparece en la unión dermoepidérmica, es poco frecuente, de crecimiento rápido, agresivo y de mal pronóstico. El objetivo de este trabajo es dar a conocer este carcinoma que se implanta preferentemente en la piel de la cabeza y del cuello, y que aumenta su prevalencia en los últimos años. Material y método: Recogemos 16 pacientes afectados por el carcinoma neuroendocrino primario de la piel, tratados en nuestro centro entre 12/09/91 y 13/07/12. Se precisa la edad y el sexo. Se describe la zona de implantación del tumor. Su tamaño lo expresamos en milímetros según el eje mayor de la lesión. Resultados: Nuestros pacientes son mayores de 70 años, excepto la última incluida que contaba 55, la mayor frecuencia es en mayores de 80. Los casos recogidos, cuando asientan en la piel de cabeza y cuello (10/16) tienen localización: nasal-lateronasal, mejilla-malar, párpado superior, frontal, mandibular. El eje mayor de la lesión oscila entre 7 y 35 mm. A diferencia de lo que ocurre en los carcinomas espinocelulares o basocelulares son frecuentes las recurrencias y las metástasis. Para el diagnóstico es imprescindible la inmunohistoquímica con citoqueratina 20. El tratamiento es quirúrgico, ocasionalmente seguido de radioterapia y quimioterapia. Conclusión: Se trata de un carcinoma poco frecuente de la piel, aparece en la edad avanzada, asienta en cabeza y cuello en más del 50% de los casos y conduce con frecuencia al exitus (AU)

Introduction and objectives: Merkel cell carcinoma was first described by Toker in 1972. It is an uncommon, primary neuroendocrine skin carcinoma which appears in the dermoepidermic area, grows fast, is very aggressive and has a poor prognosis. The aim of this work is to highlight the importance of this tumour, which develops mainly in the skin of the head and neck area, and whose prevalence has increased in recent years. Material and method: We gathered data on 16 patients suffering cutaneous neuroendocrine carcinoma treated at our hospital between September 12, 1991 and July 13, 2012. We indicated the age and gender of patients. We described the area where the tumour was located, indicating the size in millimetres, according to the major axis of the lesion. Results: Most of the patients studied were over 70 years old, except for one who was 55. The highest frequency of cases appeared among patients aged over 80 years. In the cases studied, when the tumour appeared in the head and neck region (10/16), its location could be nasal-lateronasal, cheek-malar, upper eyelid, frontal or mandibular. The major axis of the lesion ranged between 7 and 35 mm. Unlike with epidermoid or basocellular carcinomas, recurrence and ganglionar metastases were common. Immunohistochemical (CK20) tests are essential for a correct diagnosis. Treatment is usually surgical and occasionally followed by radiotherapy and chemotherapy. Conclusion: This carcinoma is not a very common skin tumour. It appears in old age, in the head and neck region in 50% of cases and often leads to exitus (AU)

Primary cutaneous neuroendocrine carcinoma, Merkel cell carcinoma. Case series 1991-2012.

INTRODUCTION AND OBJECTIVES: Merkel cell carcinoma was first described by Toker in 1972. It is an uncommon, primary neuroendocrine skin carcinoma which appears in the dermoepidermic area, grows fast, is very aggressive and has a poor prognosis. The aim of this work is to highlight the importance of this tumour, which develops mainly in the skin of the head and neck area, and whose prevalence has increased in recent years. MATERIAL AND METHOD: We gathered data on 16 patients suffering cutaneous neuroendocrine carcinoma treated at our hospital between September 12, 1991 and July 13, 2012. We indicated the age and gender of patients. We described the area where the tumour was located, indicating the size in millimetres, according to the major axis of the lesion. RESULTS: Most of the patients studied were over 70 years old, except for one who was 55. The highest frequency of cases appeared among patients aged over 80 years. In the cases studied, when the tumour appeared in the head and neck region (10/16), its location could be nasal-lateronasal, cheek-malar, upper eyelid, frontal or mandibular. The major axis of the lesion ranged between 7 and 35 mm. Unlike with epidermoid or basocellular carcinomas, recurrence and ganglionar metastases were common. Immunohistochemical (CK20) tests are essential for a correct diagnosis. Treatment is usually surgical and occasionally followed by radiotherapy and chemotherapy. CONCLUSION: This carcinoma is not a very common skin tumour. It appears in old age, in the head and neck region in 50% of cases and often leads to exitus.

The Zuckerkandl tubercle: problematic or helpful in thyroid surgery?

The Zuckerkandl tubercle is a residue from the embryological development of the thyroid gland. Although it is undeniably well known in surgery, this is not so among otolaryngologists. Our objective is to highlight the importance of the Zuckerkandl tubercle, as it has proven to be a reliable point of reference to locate the upper parathyroid, the lower thyroid artery and the recurrent nerve. In order to study the Zuckerkandl tubercle, we made a prospective analysis of the posterolateral border of the thyroid lobes in 107 thyroidectomies (88 total thyroidectomies and 19 hemithyroidectomies) carried out by the same surgeon; in total, 195 thyroid lobes were analysed. The Zuckerkandl tubercle was certainly detected in 155 thyroid lobes (79.48%). The Zuckerkandl tubercle was most frequent in the right thyroid lobe (P = 0.06). When the Zuckerkandl tubercle was present, we localised the upper parathyroid due to its relationship with the tubercle in 80 right thyroid lobes (95.23%) and in 65 left (91.54%). On 147 occasions (94.83%), the recurrent nerve was directed towards the cricothyroid membrane beneath the Zuckerkandl tubercle, laterally to the tracheal surface in relation with the Berry ligament. The lower thyroid artery and some of the distal branches, such as the recurrent nerve, also ran under the Zuckerkandl tubercle. The areolar tissue underlying the Zuckerkandl tubercle is difficult to dissect, and so this protuberance constitutes a surgical difficulty but it is fundamentally helpful to find those important structures that must be preserved in thyroid surgery.

Arteria innominada aberrante alta en cirugía cervical / High-riding innominate artery in neck surgery

Presentamos 2 casos de posición cervical de la arteria innominada (AI). En el primer caso no se efectúa cirugía por no existir indicación, el segundo permite obtener imágenes quirúrgicas de la AI y sus ramas, situadas delante del eje laringotraqueal. Se alerta del grave riesgo de la cirugía cervical en estos casos (AU)

We present two cases of innominate artery (IA) in a cervical position. In the first case, surgery was not performed because there was no indication. In the second, it was possible to obtain surgical images of the AI and its branches located in front of the laryngotracheal axis. A warning about the serious risk involved in cervical surgery in these cases is indicated (AU)

High-riding innominate artery in neck surgery.

We present two cases of innominate artery (IA) in a cervical position. In the first case, surgery was not performed because there was no indication. In the second, it was possible to obtain surgical images of the AI and its branches located in front of the laryngotracheal axis. A warning about the serious risk involved in cervical surgery in these cases is indicated.

¿Es el oído medio el primer filtro de selección frecuencial? / Is the middle ear the first filter of frequency selectivity?

Introducción y objetivos: La cóclea es considerada el primer filtro de selección frecuencial en la vía auditiva debido a la acción contráctil de las células ciliadas externas. Sin embargo numerosas evidencias en animales de experimentación, algunas anatómicas (conexiones entre la vía auditiva y los núcleos motores de los músculos del oído medio) y otras fisiológicas, apuntan a que el oído medio pudiera ser el primer filtro gracias al cual comienza a discriminarse un determinado sonido de un entorno ruidoso. Métodos: En colaboración con el Departamento de Ingeniería Mecánica de la Escuela Técnica Superior (ETS) de Ingenieros Industriales de la Universidad de Valladolid (UVa) hemos desarrollado y puesto a punto un nuevo admitancímetro capaz de analizar los cambios de impedancia que ocurren en el oído medio humano en función de la frecuencia. Con él hemos cuantificado la variación de la impedancia del oído en 7 voluntarios otológicamente sanos sometidos a diferentes entornos sonoros. Resultados: Hemos hallado que la impedancia del oído no es constante sino que la atención que los sujetos explorados ofrecen para discriminar una conversación en un ambiente ruidoso hace que la impedancia del oído varíe en las frecuencias agudas. Conclusiones: A la vista de los resultados consideramos que el oído medio no es un mero actor pasivo durante la audición sino que la contracción de los músculos endotimpánicos hacen posible variaciones de la impedancia de forma que la frecuencia de resonancia del oído se desplace hacia frecuencias agudas mejorando la discriminación de la palabra en ambientes ruidosos (AU)

Introduction and objectives: The cochlea has traditionally been considered as the first frequency selection filter in the auditory pathway due to the contraction of its external ciliated cells. Yet, much evidence has emerged from work carried out during experiments with animals, some of which is anatomical (connections between the auditory pathway and motor nuclei of the middle ear muscles) and other physiological, which indicates that the middle ear might be the first filter through which specific sounds from noisy environments may initially be isolated. Methods: In cooperation with the Department of Mechanical Engineering of the Technical School of Industrial Engineering at the University of Valladolid (UVa) we have developed and refined a new admittance meter capable of evaluating changes in impedance that occur in the human middle ear depending on frequency. Using this device we have measured variation in impedance in 7 otologically healthy volunteers submitted to a varied range of sound environments. Results: We have found that hearing impedance is not constant but rather that the attention offered by the examined subjects when following a conversation in a noisy environment leads to variations in hearing impedance at high frequencies. Conclusions: In the light of these findings we feel that the middle ear does not play a merely passive role in hearing but rather that the contraction of the endotympanic muscles makes possible variations in impedance such that the resonance frequency of the ear shifts towards higher frequencies, thus enhancing sound discrimination in noisy environments (AU)

[Is the middle ear the first filter of frequency selectivity?]. / Es el oído medio el primer filtro de selección frecuencial?

INTRODUCTION AND OBJECTIVES: The cochlea has traditionally been considered as the first frequency selection filter in the auditory pathway due to the contraction of its external ciliated cells. Yet, much evidence has emerged from work carried out during experiments with animals, some of which is anatomical (connections between the auditory pathway and motor nuclei of the middle ear muscles) and other physiological, which indicates that the middle ear might be the first filter through which specific sounds from noisy environments may initially be isolated. METHODS: In cooperation with the Department of Mechanical Engineering of the Technical School of Industrial Engineering at the University of Valladolid (UVa) we have developed and refined a new admittance meter capable of evaluating changes in impedance that occur in the human middle ear depending on frequency. Using this device we have measured variation in impedance in 7 otologically healthy volunteers submitted to a varied range of sound environments. RESULTS: We have found that hearing impedance is not constant but rather that the attention offered by the examined subjects when following a conversation in a noisy environment leads to variations in hearing impedance at high frequencies. CONCLUSIONS: In the light of these findings we feel that the middle ear does not play a merely passive role in hearing but rather that the contraction of the endotympanic muscles makes possible variations in impedance such that the resonance frequency of the ear shifts towards higher frequencies, thus enhancing sound discrimination in noisy environments.

[Inverted acoustic reflex: an analysis of its morphological characteristics in different physiological and pathological situations]. / Reflejo acústico invertido: análisis de sus características morfológicas en distintas situaciones fisiológicas y patológicas.

INTRODUCTION AND OBJECTIVES: Inverted acoustic reflex (IAR) or inverted acoustic effect is the name given to the positive deflexion observed during the carrying out of an admittancemetry when the ear is subjected to a high intensity sound, rather than the typical negative deflexion due to the contraction of the middle ear musculature. The objective of the paper is to analyze the morphology of the IAR by relating it to the situations (physiological or pathological) in which this effect appears with the aim of establishing a pathogenic hypothesis. METHODS: We study the admittance traces obtained in 50 patients on stimulating the ear with high sound intensities (between 100 and 110 dBs HL) in different situations (ageing, death, otosclerosis, facial palsy, perception hypoacusia and normoacusia). We analyse the morphologies of the resulting traces as well as the on-set and off-set latencies of the reflexes. RESULTS: The morphology and latency parameters are similar in all cases in which IAR appears, regardless of the physical conditions of the ear but always with the prior condition of the absence of any contraction of the stapes bone muscle. The inverted acoustic effect does not disappear after deep muscular relaxation induced by anaesthesia and is present in corpses at a time when neural activity can no longer take place. CONCLUSIONS: Although some of the characteristics of IAR cannot be explained by purely mechanical hypotheses, the appearance of this effect in a corpse and its non-disappearance with muscular relaxation means that we consider its origin to be a purely mechanical effect not mediated by any muscular reflex contraction in the human middle ear.

Reflejo acústico invertido: análisis de sus características morfológicas en distintas situaciones fisiológicas y patológicas / Inverted acoustic reflex: An analysis of its morphological characteristics in different physiological and pathological situations

Introducción y objetivos: Se denomina reflejo o efecto acústico invertido (RAI) a la deflexión positiva observada durante la realización de una admitanciometría al someter al oído a un sonido de intensidad elevada, en vez de la típica deflexión negativa debida a la contracción de la musculatura del oído medio. El objetivo del trabajo es analizar la morfología del RAI relacionándola con las situaciones (fisiológicas o patológicas), en las que este efecto aparece con el fin de establecer una hipótesis patogénica. Métodos: Estudiamos los trazados admitanciométricos obtenidos en 50 pacientes al estimular el oído con elevadas intensidades sonoras (entre 100 y 110dB HL) en distintas situaciones (envejecimiento, muerte, otosclerosis, parálisis facial, hipoacusia de percepción y normoacusia). Analizamos las morfologías de los trazados resultantes así como las latencias de aparición y de cese (on-set y off-set) de los reflejos. Resultados: La morfología y los parámetros de latencia son similares en todos los casos en los que el RAI aparece, independientemente de las condiciones físicas del oído, pero siempre con el condicionante previo de ausencia de contracción del músculo del estribo. El RAI no desaparece tras la relajación muscular profunda inducida por la anestesia y está presente en el cadáver cuando ya no puede aparecer actividad neural alguna. Conclusiones: Aunque algunas de las características del RAI no se pueden explicar sirviéndonos de forma exclusiva de hipótesis mecánicas, la aparición de ese efecto en el cadáver y la no desaparición con la relajación muscular hace que consideremos su origen como un efecto puramente mecánico no mediado por contracción refleja muscular alguna en el oído medio humano (AU)

Introduction and objectives: Inverted acoustic reflex (IAR) or inverted acoustic effect is the name given to the positive deflexion observed during the carrying out of an admittancemetry when the ear is subjected to a high intensity sound, rather than the typical negative deflexion due to the contraction of the middle ear musculature. The objective of the paper is to analyze the morphology of the IAR by relating it to the situations (physiological or pathological) in which this effect appears with the aim of establishing a pathogenic hypothesis. Methods: We study the admittance traces obtained in 50 patients on stimulating the ear with high sound intensities (between 100 and 110dBs HL) in different situations (ageing, death, otosclerosis, facial palsy, perception hypoacusia and normoacusia). We analyse the morphologies of the resulting traces as well as the on-set and off-set latencies of the reflexes. Results: The morphology and latency parameters are similar in all cases in which IAR appears, regardless of the physical conditions of the ear but always with the prior condition of the absence of any contraction of the stapes bone muscle. The inverted acoustic effect does not disappear after deep muscular relaxation induced by anaesthesia and is present in corpses at a time when neural activity can no longer take place. Conclusions: Although some of the characteristics of IAR cannot be explained by purely mechanical hypotheses, the appearance of this effect in a corpse and its non-disappearance with muscular relaxation means that we consider its origin to be a purely mechanical effect not mediated by any muscular reflex contraction in the human middle ear (AU)

[No-malignant lessions involving the paranasal sinuses and anterior skull base]. / Lesiones no malignas que implican a senos paranasales y fosa craneal anterior.

BACKGROUND AND OBJECTIVES: The lesions that involve the paranasal sinuses and the anterior cranial base at the same time are not unusual. These diseases have different features. The aim of this study is to set out the particularities of the non-malignant lesions involving both zones. MATERIAL AND METHODS: Retrospective study of 32 patients between 1986 and 2007 diagnosed with: non-malignant tumours (31.2 %), tumorlike lesions (3.1 %), fibrous-osseous lesions (12.5 %), congenital or acquired malformations (18.7 %) and infection disease (34.3 %). We analyse the diagnostic imaging, the treatment and pathogen mechanism. RESULTS: Only 6 of 43 osteomas involved the paranasal sinuses and anterior cranial fossa (13.04 %): 3 cases have developed meningitis and 1 developed a pneumocephalus. 2 cases are meningiomas: 1 was asymptomatic and the other one caused destruction at subtotal frontal bone. 1 giant hemangioma associated with Klippel-Trenaunay syndrome is treated by combined craniofacial approach. The fibrous-osseous lesions were specifically fibrous dysplasia and affected the ethmoides. The encephalocele were predominating in the malformations group, 2 were diagnosed after repeated meningitis. 11 cases are included by infection: 10 cases caused osteomielitis and the eleventh is a patient with a mucormycosis. Surgery has been used in 84.3 % of the cases: frontal craniotomy 37 %, combined craniofacial approach 18.5 %, subfrontal approach 18.5 %, osteoplastic technique 18.5 %, lateronasal approach 3.7 %, endonasal microscopic resection 3.7 %. CONCLUSIONS: In this study the diagnosis, extension and surgical management were supported in the imaging. A closed separation between the anterior cranial fossa ant the sinus is necessary after the resection. The reconstruction was performed using a pedicled pericranial flap and titanium mesh in most of the cases.

Lesiones no malignas que implican a senos paranasales / y fosa craneal anterior / No-malignant lessions involving the paranasal sinuses and anterior skull base

Introducción y objetivos. No son raras las lesiones que implican conjuntamente el territorio nasoparanasal y la fosa craneal anterior. Son enfermedades de distinta naturaleza. El objetivo de este trabajo es exponer las peculiaridades con las que alteraciones no malignas afectan a ambas regiones. Métodos. Definimos los criterios de inclusión y exclusión. Se incluyen 32 casos (1986-2007): tumores benignos (31,2 %), seudotumores (3,1 %), trastornos fibroóseos (12,5 %), malformaciones congénitas o adquiridas (18,7 %) y enfermedades infecciosas (34,3 %). Se analizan los medios de diagnóstico por imagen, el mecanismo patogénico evolutivo y el tratamiento. Resultados. De 43 osteomas considerados, 6 afectaban a la fosa craneal anterior (13,04 %); 3 desarrollaron paquimeningitis y uno, neumoencéfalo. De 2 meningiomas, uno era asintomático y el otro producía destrucción subtotal del hueso frontal. Un hemangioma gigante, dentro de un síndrome de Klippel Trenaunay, se trata por tratamiento combinado craneofacial. Los trastornos fibroóseos son específicamente displasias fibrosas, afectan al techo del etmoides. En malformaciones, predominan los meningoencefaloceles, de los que 2 se diagnosticaron tras meningitis recidivantes. De 11 pacientes incluidos por infecciones, 10 tenían en común el desarrollo de osteomielitis frontal, el undécimo es una paciente con mucormicosis. Realizamos tratamiento quirúrgico en el 84,3 %: craneotomía frontal (37 %), tratamiento combinado craneofacial (18,5 %), tratamiento subfrontal (18,5 %), técnica osteoplástica (18,5 %), tratamiento paralateronasal (3,7 %) y cirugía microscópica endonasal (3,7 %). Conclusiones. El diagnóstico, la extensión lesional y la planificación del tratamiento se apoyan principalmente en estudios de imagen. El objetivo principal del tratamiento, tras la resolución de las lesiones, es la separación estanca de FCA y senos. El colgajo pediculado de pericráneo y la osteosíntesis con miniplacas son de elección en el tiempo de reconstrucción (AU)

Background and objectives. The lesions that involve the paranasal sinuses and the anterior cranial base at the same time are not unusual. These diseases have different features. The aim of this study is to set out the particularities of the non-malignant lesions involving both zones. Material and methods. Retrospective study of 32 patients between 1986 and 2007 diagnosed with: non-malignant tumours (31.2 %), tumor like lesions (3.1 %), fibrous-osseous lesions (12.5 %), congenital or acquired malformations (18.7 %) and infection disease (34.3 %). We analyse the diagnostic imaging, the treatment and pathogen mechanism. Results. Only 6 of 43 osteomas involved the paranasal sinuses and anterior cranial fossa (13.04 %): 3 cases have developed meningitis and 1 developed a pneumocephalus. 2 cases are meningiomas: 1 was asymptomatic and the other one caused destruction at subtotal frontal bone. 1 giant hemangioma associated with Klippel-Trenaunay syndrome is treated by combined craniofacial approach. The fibrous-osseous lesions were specifically fibrous dysplasia and affected the ethmoides. The encephalocele were predominating in the malformations group, 2 were diagnosed after repeated meningitis. 11 cases are included by infection: 10 cases caused osteomielitis and the eleventh is a patient with a mucormycosis. Surgery has been used in 84.3 % of the cases: frontal craniotomy 37 %, combined craniofacial approach 18.5 %, subfrontal approach 18.5 %, osteoplastic technique 18.5 %, lateronasal approach 3.7 %, endonasal microscopic resection 3.7 %. Conclusions. In this study the diagnosis, extension and surgical management were supported in the imaging. A closed separation between the anterior cranial fossa ant the sinus is necessary after the resection. The reconstruction was performed using a pedicled pericranial flap and titanium mesh in most of the cases (AU)

Estudio de las características mecanoacústicas del oído medio sometido a cirugía estapedial con y sin conservación del tendón del estribo / Analysis of the mechanical-acoustic features of the middle ear after stapedial surgery both with and without stapes muscle preservation

Introducción y objetivos: La cirugía de sustitución estapedial realizada en casos de otosclerosis altera diversos elementos anatómicos del oído medio (osiculares, ligamentosos y tendinosos), lo que modifica sus propiedades físicas. El objetivo del trabajo es determinar qué técnicas de las practicadas durante la cirugía de la otosclerosis respetan más las características mecanoacústicas del oído medio. Pacientes y método: Estudiamos los resultados audiológicos y admitanciométricos de 100 pacientes sometidos a diversas técnicas de sustitución estapedial y los comparamos con los de 20 sujetos otológicamente sanos. Resultados: Los resultados audiológicos obtenidos son similares en los diversos tipos de técnicas quirúrgicas comparadas; sin embargo, las que respetan el tendón del músculo estapedial presentan, tras la intervención, frecuencias de resonancia del oído similares a los oídos sanos, lo que no ocurre con las demás técnicas evaluadas. Conclusiones: A la luz de los resultados, consideramos que debe conservarse el tendón estapedial durante la cirugía de la otosclerosis, ya que de este modo se preservan mejor las características mecanoacústicas del oído, lo que repercute en una mejor discriminación del lenguaje en ambientes ruidosos

Introduction and objective: Stapes replacement surgery performed in cases of otosclerosis alters various anatomical (ossicular, ligament, and tendon) elements of the middle ear affecting their physical properties. The goal of our work is to determine which of the surgical techniques applied during otosclerosis most respects the mechanical-acoustic features of the middle ear. Patients and method: We analyzed the audiological and admittance results of 100 patients who underwent various stapedial replacement techniques and compared them to 20 otologically healthy subjects. Results: The audiological results obtained are similar in the different surgical techniques compared. However, those techniques in which the stapedial muscle tendon is preserved offer similar hearing resonance frequencies post intervention as healthy ears, which was not found to be the case in the remaining techniques evaluated. Conclusions: We feel that the stapedial tendon should be preserved during otosclerosis surgery as the mechanical-acoustic features of the ear are thus better conserved, leading to enhanced language recognition in noisy environments

[Analysis of the mechanical-acoustic features of the middle ear after stapedial surgery both with and without stapes muscle preservation]. / Estudio de las características mecanoacústicas del oído medio sometido a cirugía estapedial con y sin conservación del tendón del estribo.

INTRODUCTION AND OBJECTIVE: Stapes replacement surgery performed in cases of otosclerosis alters various anatomical (ossicular, ligament, and tendon) elements of the middle ear affecting their physical properties. The goal of our work is to determine which of the surgical techniques applied during otosclerosis most respects the mechanical-acoustic features of the middle ear. PATIENTS AND METHOD: We analyzed the audiological and admittance results of 100 patients who underwent various stapedial replacement techniques and compared them to 20 otologically healthy subjects. RESULTS: The audiological results obtained are similar in the different surgical techniques compared. However, those techniques in which the stapedial muscle tendon is preserved offer similar hearing resonance frequencies post intervention as healthy ears, which was not found to be the case in the remaining techniques evaluated. CONCLUSIONS: We feel that the stapedial tendon should be preserved during otosclerosis surgery as the mechanical-acoustic features of the ear are thus better conserved, leading to enhanced language recognition in noisy environments.

[Total idiopathic laryngotracheal stenosis. Treatment with mitomycin C]. / Obstrucción laringotraqueal completa idiopática. Tratamiento con mitomicina C.

This case report involves a 69-year-old woman who presented idiopathic laryngotracheal stenosis with total obstruction of the airway. Seven surgical procedures involving open field and endoscopy techniques had to be performed due to repeated re-obstructions. The novelty in this case is that success was finally obtained with the use of mitomycin C. The drug action is well known, but is interesting to report a case in which success was only obtained when we used mitomycin C.

Obstrucción laringotraqueal completa idiopática. Tratamiento con mitomicina C / Total idiopathic laryngotracheal stenosis. Treatment with mitomycin C

Exponemos el caso de una paciente de 69 años en la que se desarrolló una estenosis laringotraqueal idiopática con obstrucción completa. Se tuvo que intervenir a la paciente 7 veces, con distintas técnicas endoscópicas o abiertas, por reobstrucciones postoperatorias. Lo novedoso del caso es que el éxito final se obtuvo tras la aplicación de mitomicina C. Es conocida la acción de este fármaco, pero tiene interés mostrar un caso complejo en el que sólo se obtiene éxito cuando se aplica mitomicina C

This case report involves a 69-year-old woman who presented idiopathic laryngotracheal stenosis with total obstruction of the airway. Seven surgical procedures involving open field and endoscopy techniques had to be performed due to repeated re-obstructions. The novelty in this case is that success was finally obtained with the use of mitomycin C. The drug action is well known, but is interesting to report a case in which success was only obtained when we used mitomycin C

Characterization of nasal paraffinoma following septorhinoplasty by attenuated total reflection--fourier transform infrared spectroscopy (ATR-FTIR).

Vaseline and paraffin have been injected into various parts of the body. Vaselinoma and paraffinoma are well-described complications, despite which nasal packing with Vaseline gauze is still common in the management of epistaxis, after rhinoplasty, endonasal surgery, to control bleeding and prevent synechiae or restenosis. Our aim is to highlight this complication, propose a safe method for its diagnosis and establish guidelines for its prevention. We report two cases of paraffinoma occurring after rhinoplasty and discuss prevention of this rare but serious complication, and suggest an alternative dressing. Attenuated total reflection (ATR) FI7R spectra have proven to be a definitive characterising tool for surgical extracts, guaranteeing detection of mineral products that histology does not offer. For these lesions we propose the name "petroleum oilomas" which we feel to be more appropriate than the more commonly used paraffinomas. Relevance of the work: a description of an innovative and safe method of diagnosis, and proposal of a procedure for postrhinoplasty packing (without mineral oils) to avoid this complication.

El papel de la cirugía en algunas patologíasinfecciosas del oído externo / The role of surgery in some infectous diseases of the outer ear

Existe una clara división, por lo que se refiere al tratamiento médico o quirúrgico, de las distintas patologías que pueden afectar a la cabeza y el cuello, consideración dicotómica que también puede extrapolarse a la patología del oído. No obstante algunas enfermedades de asiento ORL cuyo tratamiento se considera exclusivamente médico (como las infecciones localizadas y no complicadas) pueden precisar del tratamiento quirúrgico en determinadas situaciones. Mostramos dos historias clínicas de sendos pacientes que acudieron a nuestro Servicio presentando patologías infecciosas del oído externo tratadas con múltiples terapéuticas y que, finalmente, fueron sometidos a tratamiento quirúrgico para conseguir la total resolución de la enfermedad debido a la ausencia de respuesta al tratamiento médico instaurado. El objetivo del presente trabajo es mostrar que el padecimiento de una patología cuyo tratamiento es esencialmente médico no supone una contraindicación para que, ante determinadas situaciones de la propia enfermedad o del paciente, se opte por tratar quirúrgicamente las lesiones (AU)

Carcinoma epidermoide en persistenciadel conducto tirogloso / Epidermoid carcinoma in persistence of the thyroglossal duct

La malignización de un conducto tirogloso persistente es un hecho excepcional pero puede presentarse, ocurre aproximadamente en un 1 por ciento de estas disontogenias. En la mayoría de la ocasiones, estas malignizaciones se muestran con histología papilar, siendo la evolución a carcinoma epidermoide mucho más rara aún. Describimos el caso de un paciente de 46 años, fumador, que presenta carcinoma epidermoide en una persistencia del conducto tiro-gloso, se exponen los criterios diagnósticos, el tratamiento realizado y la mala evolución del paciente (AU)

Puntos clave en la cirugía de los tumoresde la glándula parótida / Key issues in parotid gland tumors surgery

Se comentan distintos puntos controvertidos y de actualidad en relación con el tratamiento quirúrgico de los tumores de la parótida. Se insiste en que desde el comienzo del manejo de un tumor parotídeo, antes de establecer la estrategia terapéutica a seguir, debemos plantearnos tres cuestiones esenciales: naturaleza de la lesión a tratar, extensión y límites de la intervención quirúrgica, actuación sobre el nervio facial. Considerando las distintas posibilidades técnicas se comenta: no debe realizarse la enucleación simple de la lesión, la parotidectomía suprafacial parcial es una posibilidad poco recomendable, la parotidectomía suprafacial es la técnica más habitual, la resección específica del lóbulo profundo es un refinamiento utilizable y las indicaciones de las parotidectomías total conservadora, radical y radical ampliada. Se tratan los puntos principales del manejo del nervio facial en la cirugía parotídea: las técnicas de cirugía parotídea respecto al nervio facial con sus detalles técnicos, cuándo debe ser resecado el nervio y las peculiaridades de la monitorización. Se concluye tratando de responer a la cuestión ¿cuando debe ser reparado el nervio mediante injerto? (AU)