Clasificación de las resecciones transorales en la orofaringe: propuesta del grupo de trabajo de la Sociedad Catalana de Otorrinolaringología / Transoral oropharyngeal resection classification: Proposal of the SCORL working group

Introducción y objetivos: La cirugía mínimamente invasiva ha presentado una expansión muy importante en la última década. Con el objetivo de aportar un lenguaje común tras cirugía transoral de la orofaringe, se ha creado un sistema de clasificación de las resecciones en esta zona, independientemente de la instrumentalización utilizada. Métodos: Desde el Grupo de Trabajo en Oncología de la Sociedad Catalana de Otorrinolaringología, se presenta una propuesta de clasificación basada en una división topográfica de las diferentes zonas de la orofaringe, así como en la afectación de las estructuras anexas según las vías anatómicas de extensión de estos tumores. Resultados: La clasificación se inicia utilizando la letra D o I según la lateralidad sea derecha (D) o izquierda (I). A continuación se coloca el número del área resecada. Esta numeración define las zonas iniciando a nivel craneal donde el área I sería el paladar blando, el área II lateral en la zona amigdalina, el área III en la base de lengua, el área IV en los repliegues glosoepiglóticos, la epiglotis y repliegues faringoepiglóticos, el área V pared orofaríngea posterior y VI el trígono retromolar. Se añade el sufijo p si la resección afecta profundamente al plano submucoso de la zona comprometida. Las diferentes áreas propuestas tendrían, de una forma teórica, diferentes implicaciones funcionales. Conclusiones: Propuesta de sistema de clasificación por áreas que permite definir diferentes tipos de cirugía transoral de la orofaringe así como compartir los resultados y ayudar en la docencia de este tipo de técnicas (AU)

Introduction and goals: There has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used. Methods: From the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours. Results: The classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone. The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications. Conclusions: Proposal for a system of classification by area to define different types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique (AU)

Transoral oropharyngeal resection classification: Proposal of the SCORL working group. / Clasificación de las resecciones transorales en la orofaringe: propuesta del grupo de trabajo de la Sociedad Catalana de Otorrinolaringología.

INTRODUCTION AND GOALS: There has been a very significant increase in the use of minimally invasive surgery has in the last decade. In order to provide a common language after transoral surgery of the oropharynx, a system for classifying resections has been created in this area, regardless of the instrumentation used. METHODS: From the Oncology Working Group of the Catalan Society of Otorhinolaryngology, a proposal for classification based on a topographical division of the different areas of the oropharynx is presented, as also based on the invasion of the related structures according to the anatomical routes of extension of these tumours. RESULTS: The classification starts using the letter D or I according to laterality either right (D) or left (I). The number of the resected area is then placed. This numbering defines the zones beginning at the cranial level where area I would be the soft palate, lateral area II in the tonsillar area, area III in the tongue base, area IV in the glossoepiglottic folds, epiglottis and pharyngoepiglottic folds, area V posterior oropharyngeal wall and VI the retromolar trigone. The suffix p is added if the resection deeply affects the submucosal plane of the compromised area. The different proposed areas would, in theory, have different functional implications. CONCLUSIONS: Proposal for a system of classification by area to definedifferent types of transoral surgery of the oropharynx, and enable as sharing of results and helps in teaching this type of technique.

Tratamiento quirúrgico de los carcinomas escamosos de cabeza y cuello en España durante el periodo 2006-2011 / Surgical treatment of head and neck squamous cell carcinomas in Spain during the 2006-2011 period

Introducción y objetivos: La cirugía es uno de los pilares básicos en el tratamiento de los pacientes con carcinomas escamosos de cabeza y cuello (CECC). El objetivo del presente estudio es analizar el estado actual del uso de la cirugía en este tipo de pacientes en España. Métodos: Revisión retrospectiva de las altas hospitalarias de los pacientes con CECC tratados quirúrgicamente durante el periodo 2006-2011 en España a partir de los datos obtenidos del Conjunto Mínimo Básico de Datos al Alta Hospitalaria (CMBD). Resultados: Se recogió información correspondiente a 26.629 altas hospitalarias, con un total de 27.937 procedimientos. Globalmente, en nuestro país la mitad de los pacientes con un CECC reciben un tratamiento quirúrgico sobre la localización primaria del tumor. No se produjeron modificaciones significativas en el número de procedimientos a lo largo del periodo de estudio. Apareció una suave tendencia hacia la disminución en el número y porcentaje de cirugías realizadas en pacientes del sexo masculino, y un elevado incremento para las pacientes del sexo femenino a lo largo del periodo de estudio. Del total de procedimientos realizados, un 15,7% se realizaron en centros hospitalarios de nivel de complejidad bajo, un 32,2% en los de complejidad intermedia, y un 52,1% en centros de alta complejidad. Conclusiones: La cirugía constituye un pilar fundamental en el tratamiento de los pacientes con un CECC. En España, aproximadamente la mitad de los pacientes con un CECC reciben un tratamiento quirúrgico sobre la localización primaria del tumor (AU)

Introduction and objectives: Surgery is one of the basic pillars in the treatment of patients with head and neck squamous cell carcinoma (HNSCC). The objective of the present study was to analyse the current state of the use of surgery in patients with HNSCC in Spain. Methods: Retrospective review of the hospital discharge reports of the patients with HNSCC treated surgically during the 2006-2011 period in Spain. We obtained the data from the Minimum Basic Data Set during the hospital discharge. Results: We obtained information on 26,629 hospital discharges, with a total of 27,937 surgical procedures. Overall, in our country about half of the patients with HNSCC receive surgical treatment of the primary tumour location. There were no significant changes in the number of surgical procedures throughout the study period. There was a smooth downward trend in the number and percentage of surgeries carried out in male patients, and a significant increase in those carried out in female patients throughout the study period. Among the total of surgical procedures, 15.7% were carried out in hospitals with a low level of complexity, 32.2% in hospitals with an intermediate complexity and 52.1% in centres of high complexity. Conclusions: Surgery is one essential pillar in the treatment of patients with HNSCC. In Spain about half of the patients with HNSCC receive surgical treatment for the primary location of the tumour (AU)

[Surgical treatment of head and neck squamous cell carcinomas in Spain during the 2006-2011 period]. / Tratamiento quirúrgico de los carcinomas escamosos de cabeza y cuello en España durante el periodo 2006-2011.

INTRODUCTION AND OBJECTIVES: Surgery is one of the basic pillars in the treatment of patients with head and neck squamous cell carcinoma (HNSCC). The objective of the present study was to analyse the current state of the use of surgery in patients with HNSCC in Spain. METHODS: Retrospective review of the hospital discharge reports of the patients with HNSCC treated surgically during the 2006-2011 period in Spain. We obtained the data from the Minimum Basic Data Set during the hospital discharge. RESULTS: We obtained information on 26,629 hospital discharges, with a total of 27,937 surgical procedures. Overall, in our country about half of the patients with HNSCC receive surgical treatment of the primary tumour location. There were no significant changes in the number of surgical procedures throughout the study period. There was a smooth downward trend in the number and percentage of surgeries carried out in male patients, and a significant increase in those carried out in female patients throughout the study period. Among the total of surgical procedures, 15.7% were carried out in hospitals with a low level of complexity, 32.2% in hospitals with an intermediate complexity and 52.1% in centres of high complexity. CONCLUSIONS: Surgery is one essential pillar in the treatment of patients with HNSCC. In Spain about half of the patients with HNSCC receive surgical treatment for the primary location of the tumour.

Cirugía reparadora de la parálisis facial mediante colgajo libre microvascularizado de músculo gracilis / Facial reanimation surgery with micro-vascular gracilis free flap for unilateral facial palsy

Introducción/objetivos: La transferencia de colgajo libre muscular microneurovascular es actualmente el procedimiento de elección para la parálisis facial de larga evolución. Presentamos una serie de casos de pacientes tratados con colgajo libre de músculo gracilis con inervación motora por el nervio maseterino. Se analiza la técnica quirúrgica y cuantificamos el movimiento otorgado por el músculo, así como la mejoría en la calidad de vida y los resultados estéticos obtenidos. Materiales y métodos: Se analizan 10 pacientes con parálisis facial unilateral, quienes fueron intervenidos con colgajo muscular libre gracilis, durante los años 2010 y 2012 en 2 centros hospitalarios de tercer nivel. Resultados: No encontramos fallo de la microsutura con supervivencia de todos los colgajos realizados. El movimiento muscular se cuantificó mediante vectores en reposo y contracción, con un promedio de 1,7 cm, se inició aproximadamente hacia el cuarto mes después de la intervención. Se demuestra también una mejoría significativa de la simetría en reposo, así como de la competencia oral y ocular. Conclusiones: Como se presenta actualmente en la literatura los colgajos libres microvascularizados son la técnica de elección para la reanimación facial. En nuestra experiencia consideramos que el colgajo con músculo gracilis inervado por el nervio maseterino es una técnica fiable y segura, que ofrece adecuados resultados tanto funcionales como estéticos (AU)

Introduction and objectives: Micro-neurovascular free muscle flap transfer is currently the procedure of choice for long-standing facial paralysis. We present a case series of patients treated with gracilis muscle free flap with motor innervation by the masseteric nerve. We discuss the surgical technique and quantify the movement granted by the muscle, the improvement in quality of life and aesthetic results. Materials and methods: We report ten patients with unilateral facial paralysis who underwent free gracilis muscle flap, between the years 2010 and 2012 in two tertiary hospitals. Results: It is not reported any failure of the microsuture with survival of all flaps. The muscle movement was quantified by vectors at rest and contraction with an average of 1.7 cm that initiated around the fourth month after surgery. Patients also reported a significant improvement in symmetry at rest as well as oral and ocular competition. Conclusion: As currently presented in literature, microvascular free flaps are the technique of choice for facial reanimation. In our experience, we believe that gracilis muscle flap innervated by the masseteric nerve is a reliable and secure technique that provides adequate functional and aesthetic results (AU)

Colgajo antebraquial radial en cabeza y cuello: nuestra experiencia / Free radial forearm flap in head and neck: our experience

Introducción: La cirugía oncológica conlleva a importantes defectos y secuelas, así como alteraciones funcionales y cosméticas notables. En este aspecto, la cirugía reconstructiva tiene un papel esencial, permitiendo mayor radicalidad en la exéresis y disminución de las morbilidades funcionales y cosméticas asociadas. El objetivo de este estudio es presentar y evaluar la experiencia y resultados de la Unidad de Microcirugía Reconstructiva del Servicio de Otorrinolaringología de nuestro centro. Métodos: Estudio retrospectivo de procedimientos realizado entre los años 2006-2012. Resultados: Un total de 36 casos fueron revisados. El tumor primario se localizó en la mayoría de los casos en orofaringe (58%). En 5 casos se realizó el procedimiento para reconstrucción y cierre de fístulas (4 faringostomas y una fístula traqueoesofágica). El fracaso por necrosis total fue del 16% (6/39). No se produjo mortalidad asociada. Las complicaciones postoperatorias más frecuentes fueron: dehiscencia de sutura en 5 pacientes y faringostoma (fístula) en 5 casos. La radioterapia previa influyó de forma significativa en el aumento de la incidencia global de las complicaciones (p < 0,05). Conclusiones: Actualmente, la cirugía reconstructiva juega un papel fundamental en la cirugía oncológica de cabeza y cuello. El colgajo radial es un método seguro y fiable para la reconstrucción de la mayoría de defectos en la esfera otorrinolaringológica. Asumir este tipo de intervención ofrece una mayor autonomía y seguridad en la cirugía oncológica (AU)

Introduction: Oncologic surgery leads to important defects and sequelae, as well as notable cosmetic and functional alterations. In this aspect reconstructive surgery has an essential role, allowing more radical excision and lower associated functional and cosmetic morbidities. The aim of this study was to present and evaluate the experience and results of the reconstructive microsurgery unit in our centre's ENT department. Methods: Retrospective study of procedures performed between 2006 and 2012. Results: A total of 36 cases were reviewed. The primary tumour was found in the oropharynx (58%) in the majority of cases. In 5 cases the procedure was performed for reconstruction and fistula closure (4 pharyngostoma and 1 tracheoesophageal fistula). Failure from total necrosis was 16% (6/36). No associated mortality has been reported. The most common postoperative complications were wound dehiscence in 5 patients and pharyngostoma (fistula) in 5 cases. Prior radiotherapy significantly influenced the increase in the overall incidence of complications (P<0.05). Conclusions: Reconstructive surgery currently plays an important role in surgery for head and neck cancer. The radial forearm flap is a safe, reliable method for reconstruction of most defects in the ENT field. This type of intervention provides greater autonomy and safety in surgical oncology (AU)

Facial reanimation surgery with micro-vascular gracilis free flap for unilateral facial palsy.

INTRODUCTION AND OBJECTIVES: Micro-neurovascular free muscle flap transfer is currently the procedure of choice for long-standing facial paralysis. We present a case series of patients treated with gracilis muscle free flap with motor innervation by the masseteric nerve. We discuss the surgical technique and quantify the movement granted by the muscle, the improvement in quality of life and aesthetic results. MATERIALS AND METHODS: We report ten patients with unilateral facial paralysis who underwent free gracilis muscle flap, between the years 2010 and 2012 in two tertiary hospitals. RESULTS: It is not reported any failure of the microsuture with survival of all flaps. The muscle movement was quantified by vectors at rest and contraction with an average of 1.7 cm that initiated around the fourth month after surgery. Patients also reported a significant improvement in symmetry at rest as well as oral and ocular competition. CONCLUSION: As currently presented in literature, microvascular free flaps are the technique of choice for facial reanimation. In our experience, we believe that gracilis muscle flap innervated by the masseteric nerve is a reliable and secure technique that provides adequate functional and aesthetic results.

[Free radial forearm flap in head and neck: our experience]. / Colgajo antebraquial radial en cabeza y cuello: nuestra experiencia.

INTRODUCTION: Oncologic surgery leads to important defects and sequelae, as well as notable cosmetic and functional alterations. In this aspect reconstructive surgery has an essential role, allowing more radical excision and lower associated functional and cosmetic morbidities. The aim of this study was to present and evaluate the experience and results of the reconstructive microsurgery unit in our centre's ENT department. METHODS: Retrospective study of procedures performed between 2006 and 2012. RESULTS: A total of 36 cases were reviewed. The primary tumour was found in the oropharynx (58%) in the majority of cases. In 5 cases the procedure was performed for reconstruction and fistula closure (4 pharyngostoma and 1 tracheoesophageal fistula). Failure from total necrosis was 16% (6/36). No associated mortality has been reported. The most common postoperative complications were wound dehiscence in 5 patients and pharyngostoma (fistula) in 5 cases. Prior radiotherapy significantly influenced the increase in the overall incidence of complications (P<05). CONCLUSIONS: Reconstructive surgery currently plays an important role in surgery for head and neck cancer. The radial forearm flap is a safe, reliable method for reconstruction of most defects in the ENT field. This type of intervention provides greater autonomy and safety in surgical oncology.

Tumor de células basales en seno maxilar: presentación inusual / Basal cell adenoma in maxillary sinus: unusual presentation

Presentamos un caso de tumor de células basales de glándula salival menor localizado en el seno maxilar, localización extraordinariamente infrecuente. No se han hallado casos previos en la literatura médica inglesa ni española (AU)

We report a case of basal cell adenoma of a minor salivaly gland in the maxillary sinus, an extremely infrequent location. We have not found similar previous cases reported (AU)

Basal cell adenoma in maxillary sinus: unusual presentation.

We report a case of basal cell adenoma of a minor salivaly gland in the maxillary sinus, an extremely infrequent location. We have not found similar previous cases reported.