Estudio retrospectivo de 544 timpanoplastias con cartílago y pericondrio: resultados anatómicos y funcionales / A retrospective study of 544 tympanoplasty with cartilage and perichondrium: anatomical and functional results

Introducción: el cierre de las perforaciones timpánicas se realiza con diferentes materiales, entre ellos el cartílago y el pericondrio. En este estudio se compararon los resultados anatómicos y funcionales obtenidos con ambos materiales, y se evaluaron posibles factores asociados con los buenos resultados. Material y métodos: estudio retrospectivo en pacientes intervenidos de timpanoplastia sin mastoidectomía entre el 1 de enero de 2001 y el 31 de diciembre de 2018. Resultados: se incluyeron 544 timpanoplastias. En la mayoría se utilizó cartílago (78,5 %) y en el resto pericondrio. El cartílago se utilizó con mayor frecuencia en los menores de 18 años (p=0,001), perforaciones totales y subtotales (p=0,000) y timpanoplastias secundarias y terciarias (p=0,008). No hubo diferencias en el tiempo de seguimiento (15,68 ± 22,18 meses frente al 12,86 ± 14,9 meses, p=0,169). La tasa de éxito anatómico fue mayor en el grupo de cartílago, sin diferencias en los resultados auditivos (82 % con cartílago y 78,3 % con pericondrio). El éxito anatómico se relacionó con la técnica utilizada para la reconstrucción con cartílago, mientras que los resultados auditivos se asociaron significativamente con el estado de la mucosa del oído medio y la cadena de huesecillos en el momento de la cirugía y el éxito anatómico posquirúrgico. Conclusiones: con el cartílago se consiguieron mejores resultados anatómicos que con el pericondrio, sin diferencias a nivel funcional. Sin embargo, los resultados funcionales empeoraron si había patología a nivel del oído medio y en ausencia de restauración anatómica.

Introduction: Different materials are used to close tympanic perforations. This stu-dy aimed to compare anatomical results obtained with cartilage and perichondrium and evaluate factors associated with successful results. Material and method: Re-trospective study of patients who underwent tympanoplasty without mastoidectomy between January 1, 2001, and December 31, 2018. Demographic data, ear pathology, surgical intervention, and anatomical and functional results were collected. Results:544 tympanoplasty were included. Cartilage was the most used (78.5%). Cartilage was used more frequently in children under 18 years (p = 0.001), to reconstruct total and subtotal perforations (p = 0.000) and in secondary and tertiary tympanoplasty (p = 0.008). Follow-up time did not differ between the two groups (15.68 ± 22.18 months vs. 12.86 ± 14.9 months, p = 0.169). The anatomical success rate was higher in the cartilage group, with no significant differences in hearing outcomes (82% with cartilage and 78.3% with perichondrium). Anatomical success was related to the technique used for cartilage reconstruction (monoblock or palisade). Hearing re-sults were significantly associated with the state of middle ear mucosa at the time of surgery, the state and mobility of the ossicle chain, and post-surgical anatomical suc-cess. Conclusions: Cartilage achieved better anatomical results than perichondrium. Both materials were comparable on a functional level. However, the functional re-sults worsen if there is pathology of the middle ear (mucosa or chain of ossicles) and anatomical restoration is not achieved.

Coexistence of Rosai-Dorfman disease and Hodgkin's lymphoma in a patient with cervical lymphadenopathy.

A man in his 40s, with no tobacco or alcohol habit, was referred to the otorhinolaryngology department presenting with a 2-month history of enlarged left cervical lymphadenopathy with no other signs or symptoms. The ear, nose and throat examination showed no abnormalities apart from the described lymphadenopathy. An ultrasound scan suggested these nodes to be part of either an inflammatory or a malignant process. Subsequent positron emission tomography-CT proved those lymph nodes to be metabolically active, as well as others within the thorax. Cervicotomy was performed and the histopathological analysis showed dilated sinuses and histiocytes with emperipolesis. Suspecting Rosai-Dorfman disease (RDD), high-dose steroid therapy was started; but given no improvement was observed, a second cervicotomy was performed, with the histopathological diagnosis of the latter of Hodgkin's lymphoma. The present article aims to emphasise the need to exclude haematological disorders whenever RDD histology is observed, given their possible coexistence, and a worse outcome and clinical and histopathological semblance.

Odynophagia as the first manifestation of toxic epidermal necrolysis.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are infrequent mucocutaneous diseases, rapidly progressive and life-threatening. The clinical aspects and the management of TEN are exposed following a case.A man in his 40s presented to the emergency department with severe odynophagia, poor general condition and fever. His medical history was significant for HIV stage AIDS, and the treatment was discontinued 5 years before the present diagnosis. He was admitted for cerebral toxoplasmosis and discharged the previous 14 days with sulfadiazine. Erythematous-bullous lesions in the oral cavity, diffuse erythematous maculopapular rashes over his neck and chest, acute bilateral conjunctivitis and purulent urethritis was observed. The diagnostic suspicion was SJS/TEN due to sulfadiazine in immunosuppressed patients.This entity is infrequent but is a life-threatening dermatological emergency that requires immediate medical attention. Its diagnosis is mainly clinical, with a new drug history, prodromal symptoms and characteristic cutaneous-mucous lesions. Early diagnosis and rapid withdrawal of the drug improve the prognosis.

Mandibular osteoma as a cause of ankylosis and progressive trismus.

Osteomas are benign tumours of bone tissue restricted to the craniofacial skeleton. The aim of this article is to present and discuss the demographic and clinical aspects and the management of craniomaxillofacial osteomas. When the patient was submitted from primary care to our hospital, he was 68 years old, and he had ankylosis of the temporomandibular joint for the previos 4 years. A CT scan was performed, finding a giant mandibular osteoma. Conservative treatment and radiological follow-up were carried out with clinical stability. Osteomas more often are seen in the paranasal sinuses and in young adults, with no differences in gender. Most are asymptomatic, but they can cause local problems. For its diagnosis, CT is usually performed. Treatment options are conservative management and follow-up or surgery. Although rarely, they can recur. Mandibular peripheral osteoma is a rare entity. Depending on the symptoms, a conservative or surgical treatment can be chosen. A clinical and radiological follow-up is necessary to detect possible recurrences or enlargement.

Comparación de las complicaciones dermatológicas entre el dermatomo y el colgajo en «U» en la cirugía del BAHA / Comparison of skin complications between dermatome and U-graft technique in BAHA surgery

Introducción y objetivo: Las complicaciones dermatológicas son las complicaciones postoperatorias más frecuentes relacionadas con las prótesis BAHA (bone anchored hearing aid). En este estudio comparamos y evaluamos estas complicaciones con dos técnicas quirúrgicas diferentes: el dermatomo BAHA y el colgajo en «U». Material y método: Se estudió a 53 pacientes intervenidos en nuestro centro entre 2001 y 2008. La comparación de las complicaciones se realizó según la clasificación de Holgers et al. Hemos registrado, además, el número de curas que se requieren hasta la estabilización de la piel. Resultados: Hemos utilizado el dermatomo en 27 pacientes y el colgajo en «U» en 26 pacientes. En el grupo dermatomo hemos tenido el 74% de complicaciones (20 pacientes), que contrastan con el 34% (9 pacientes) con el colgajo en «U». La media de curas por paciente con el dermatomo y con el colgajo en «U» es de 4,1 y 2,7, respectivamente. Las diferencias encontradas son estadísticamente significativas para un intervalo de confianza del 95%. Conclusiones: En nuestra experiencia, el uso del dermatomo eléctrico en la cirugía del BAHA es un método que nos ofrece un mayor número de complicaciones dermatológicas que el colgajo en «U». Dado que ambas técnicas tienen una serie de ventajas y desventajas, quizás la selección de la técnica por utilizar según las características de cada paciente de forma individualizada permita obtener mejores resultados en el futuro (AU)

Introduction and objective: The most common postoperative complications related to BAHA prosthetic surgery are skin complications. In this study we compare and evaluate these reactions with two different surgical techniques, the BAHA dermatome and the U-graft technique. Material and method: Fifty-three patients who underwent implantation of a BAHA at our hospital between 2001 and 2008 were studied. The comparison of the skin reactions was carried out according to Holgers' classification. We also recorded the number of cures required until the skin was stabilized. Results: We used the dermatome in 27 patients and the U-graft in 26 patients. In the dermatome group we have reported a total of 74% of skin reactions (20 patients), in contrast with the 34% (9 patients) observed in the U-graft group. The average number of cures for patients in the dermatome group and those in the U-graft group was 4.1 and 2.7, respectively. The differences found were statistically significant and had a 95% confidence interval. Conclusions: In our experience, the use of the electric dermatome in BAHA surgery offers a higher incidence of skin complications in comparison with the U-graft technique. Since both techniques have a number of advantages and disadvantages, it may be that the selection of the technique to be employed according the individual characteristics of each patient may offer better results in the future (AU)

[Comparison of skin complications between dermatome and U-graft technique in BAHA surgery]. / Comparación de las complicaciones dermatológicas entre el dermatomo y el colgajo en "U" en la cirugía del BAHA.

INTRODUCTION AND OBJECTIVE: The most common postoperative complications related to BAHA prosthetic surgery are skin complications. In this study we compare and evaluate these reactions with two different surgical techniques, the BAHA dermatome and the U-graft technique. MATERIAL AND METHOD: Fifty-three patients who underwent implantation of a BAHA at our hospital between 2001 and 2008 were studied. The comparison of the skin reactions was carried out according to Holgers' classification. We also recorded the number of cures required until the skin was stabilized. RESULTS: We used the dermatome in 27 patients and the U-graft in 26 patients. In the dermatome group we have reported a total of 74% of skin reactions (20 patients), in contrast with the 34% (9 patients) observed in the U-graft group. The average number of cures for patients in the dermatome group and those in the U-graft group was 4.1 and 2.7, respectively. The differences found were statistically significant and had a 95% confidence interval. CONCLUSIONS: In our experience, the use of the electric dermatome in BAHA surgery offers a higher incidence of skin complications in comparison with the U-graft technique. Since both techniques have a number of advantages and disadvantages, it may be that the selection of the technique to be employed according the individual characteristics of each patient may offer better results in the future.

[Baha: a new longitudinal incision with fixture out of the incision]. / BAHA: nueva incisión longitudinal con implante fuera de ésta.

Since the introduction of bone-anchored hearing aids (BAHA) a few decades ago, their effectiveness has made the use of these devices a well-established method. The most common complications associated with BAHA are dermatological, so a lot of changes were introduced in the surgical technique to reduce the frequency of skin reactions. We have analyzed our experience in the management of the skin and soft tissues over 8 years' experience with BAHA. We present a new longitudinal incision with the fixture out of the incision.

BAHA: nueva incisión longitudinal con implante fuera de ésta / Baha: a new longitudinal incision with fixture out of the incision

Desde la introducción de las prótesis osteointegradas tipo BAHA (bone anchored hearing aid) hace unas décadas, su uso se ha generalizado por ser un método efectivo. Las complicaciones más frecuentes relacionadas con el BAHA son las dermatológicas, por lo que se han producido múltiples cambios en la técnica quirúrgica con el objetivo de disminuir su frecuencia. Hemos analizado el manejo de la piel y los tejidos blandos durante 8 años de experiencia con el BAHA. Presentamos una nueva incisión longitudinal con el implante situado fuera de ésta (AU)

Since the introduction of bone-anchored hearing aids (BAHA) a few decades ago, their effectiveness has made the use of these devices a well-established method. The most common complications associated with BAHA are dermatological, so a lot of changes were introduced in the surgical technique to reduce the frequency of skin reactions. We have analyzed our experience in the management of the skin and soft tissues over 8 years experience with BAHA. We present a new longitudinal incision with the fixture out of the incision (AU)

[Revision stapedectomy]. / Cirugía de revisión de las estapedectomías.

OBJECTIVE: The aim of the study was to determine the causes of failure in otosclerosis surgery. MATERIAL AND METHOD: We performed 23 revisions of stapedectomy during the period between January 2000 and April 2005. The time between the primary surgery and the revision surgery ranged from 3 months to 25 years. The most frequent reasons for revision surgery were first of all patients with closed initial gap and progressive hearing loss in 56.52 % of cases and secondly patients without any initial hearing improvement in 39.12 % of cases. RESULTS: The main surgical findings were: short prosthesis in correct position (13.04 %), displaced prosthesis (60.87 %), bridles over the oval window (65.22 %), necrosis of the long process of the incus (26.2 %), and obliterative footplate (26.09 %). As for the audiometric results, we got a complete closure of gap in 60.8 % of patients (n = 14), partial closure of gap in 13.2 % (n = 3), persistence of the initial gap in 21.7 % (n = 5), and cophosis in 4.3 % (n = 1). CONCLUSIONS: The migration of the prosthesis is the main cause of failure after stapedectomy. Good closure of the gap was achieved in two thirds of the patients.

Cirugía de revisión de las estapedectomías / Revision stapedectomy

Objetivo: Determinar las causas del fracaso en la cirugía de revisión de la estapedectomía. Material y método: Se realizaron 23 cirugías de revisión de estapedectomías en el período comprendido entre enero de 2000 y abril de 2005. El tiempo transcurrido desde la primera cirugía varió desde un mínimo de 3 meses a un máximo de 25 años, con una media de 5,2 años. Los motivos más frecuentes de la revisión quirúrgica fueron, en primer lugar, los pacientes con cierre de umbral diferencial auditivo (UDA) inicial y pérdida auditiva posterior en el 56,52 %, y en segundo lugar, los pacientes sin ganancia auditiva inicial en el 39,12 %. Resultados: Los principales hallazgos quirúrgicos son los siguientes: prótesis corta en posición correcta (13,04 %), prótesis desplazada (60,87 %), bridas sobre la ventana oval (65,22 %), necrosis de rama larga del yunque (26,2 %) y platina reobliterada (26,09 %). En cuanto a los resultados audiométricos, obtuvimos un cierre completo del UDA en el 60,8 % (n = 14), cierre parcial del UDA del 13,2 % (n = 3), persistencia del UDA inicial en el 21,7 % (n = 5) y cofosis en el 4,3 % (n = 1). Conclusiones: La migración de la prótesis es la causa más frecuente de fracaso de la estapedectomía. Obtuvimos un cierre completo del UDA en dos tercios de los pacientes

Objective: The aim of the study was to determine the causes of failure in otosclerosis surgery. Material and method: We performed 23 revisions of stapedectomy during the period between January 2000 and April 2005. The time between the primary surgery and the revision surgery ranged from 3 months to 25 years. The most frequent reasons for revision surgery were first of all patients with closed initial gap and progressive hearing loss in 56.52 % of cases and secondly patients without any initial hearing improvement in 39.12 % of cases. Results: The main surgical findings were: short prosthesis in correct position (13.04 %), displaced prosthesis (60.87 %), bridles over the oval window (65.22 %), necrosis of the long process of the incus (26.2 %), and obliterative footplate (26.09 %). As for the audiometric results, we got a complete closure of gap in 60.8 % of patients (n = 14), partial closure of gap in 13.2 % (n = 3), persistence of the initial gap in 21.7 % (n = 5), and cophosis in 4.3 % (n = 1). Conclusions: The migration of the prosthesis is the main cause of failure after stapedectomy. Good closure of the gap was achieved in two thirds of the patients