Juvenile nasal angiofibroma significant locoregional involvement / [Angiofibroma nasal juvenil con importante afectación locorregional]

Juvenile nasal angiofibroma is a benign tumor characterized by abundant vascularization and a tendency to hemorrhage. Despite its benign histology, it can present locally expensive growth that usually presents bone remodeling and the mass effect of adjacent stuctures. We present the case of a 15-year-old patient who came to the emergency department of our center for recurrent epistaxis. After physical examination, it was decided to carry out imaging tests (CT an MRI) that reveal the presence of a large hypervascular mass in the right nostril and maxillary sinus. The patient undergoes surgery after embolization of the tumor.

El angiofibroma nasal juvenil es un tumor de carácter benigno, caracterizado por la vascularización abundante y tendencia a la hemorragia. A pesar de su histología benigna, puede presentar un crecimiento localmente expansivo que suele presentar una remodelación ósea y efecto masa de estructuras adyacentes. Se presenta el caso de un paciente de 15 años de edad, que acude al servicio de urgencias de nuestro centro por epistaxis de repetición. Tras la exploración física se deciden realizar pruebas de imagen (TC y RM) que ponen de manifiesto la presencia de una gran masa hipervascular en la fosa nasal derecha y seno maxilar. El paciente es intervenido quirurgícamente previa embolización del tumor.

Tratamiento del divertículo de Zenker: comparación de diferentes técnicas / Treatment of Zenker’s diverticulum: Comparison of different techniques

Introducción y objetivos: Los divertículos de Zenker se han abordado quirúrgicamente con diferentes técnicas a lo largo de los últimos años, evolucionando desde la vía abierta hasta la endoscópica. En la cirugía endoscópica, se puede utilizar el láser CO2 o la grapadora. Se analizó la recidiva o persistencia del divertículo tras el tipo de cirugía realizado. Método: Es un estudio descriptivo retrospectivo de 22 pacientes tratados de divertículo de Zenker en el servicio de otorrinolaringología de nuestro hospital entre los años 2001 y 2011. Resultados: Se realizó tratamiento con cirugía endoscópica mediante láser CO2 en 13 pacientes, mediante grapadora en 6 pacientes, y en 3 pacientes se realizó abordaje abierto. El tiempo operatorio, de ingesta oral y de ingreso fueron menores en la cirugía con grapadora (52 min, 3 días, 5 días), que en la técnica con láser (58 min, 5 días, 8 días) y mayores en el abordaje abierto (107 min, 8 días, 11 días). El 68% de nuestros pacientes mejoró con la primera intervención, porcentaje que ascendió al 95%, teniendo en cuenta la segunda intervención en los pacientes que recidivaron tras la primera cirugía. Las complicaciones aparecieron en el 13,6% de los pacientes. Conclusiones: El tratamiento de elección en la actualidad del divertículo de Zenker es la cirugía por vía endoscópica. El abordaje endoscópico con grapadora parece presentar menos morbilidad y un tiempo de hospitalización más corto en comparación con el láser CO2 (AU)

Introduction and objectives: Zenker's diverticulum has been approached surgically with different techniques over the years, evolving from open to endoscopic surgery. The CO2 laser or the stapler can be used in endoscopic surgery. Our objective was to ascertain the recurrence or persistence of the diverticulum based on the type of surgery performed. Method: A retrospective descriptive study of 22 patients treated for Zenker's diverticulum in our hospital service between 2001 and 2011. Results: Endoscopic surgery using laser CO2 was performed in 13 patients, using stapler in 6 patients and with open approach in 3 patients. Surgery time, oral intake and hospital stay were greater in the open approach (107 minutes, 8 days and 11 days respectively) and less in surgery with stapler (52 minutes, 3 days and 5 days) than the technique with laser (58 minutes, 5 days and 8 days). With the first intervention, 68% of our patients improved, a percentage that increased to 95% taking into account the second intervention in patients that relapsed after the first surgery. Complications appeared in 13.6% of the patients. Conclusions: The treatment of choice nowadays for Zenker's diverticulum is endoscopic surgery. The endoscopic approach with stapler seems to present lower morbidity and a shorter hospital stay in comparison with the CO2 laser (AU)

[Treatment of Zenker's diverticulum: comparison of different techniques]. / Tratamiento del divertículo de Zenker: comparación de diferentes técnicas.

INTRODUCTION AND OBJECTIVES: Zenker's diverticulum has been approached surgically with different techniques over the years, evolving from open to endoscopic surgery. The CO(2) laser or the stapler can be used in endoscopic surgery. Our objective was to ascertain the recurrence or persistence of the diverticulum based on the type of surgery performed. METHOD: A retrospective descriptive study of 22 patients treated for Zenker's diverticulum in our hospital service between 2001 and 2011. RESULTS: Endoscopic surgery using laser CO(2) was performed in 13 patients, using stapler in 6 patients and with open approach in 3 patients. Surgery time, oral intake and hospital stay were greater in the open approach (107 minutes, 8 days and 11 days respectively) and less in surgery with stapler (52 minutes, 3 days and 5 days) than the technique with laser (58 minutes, 5 days and 8 days). With the first intervention, 68% of our patients improved, a percentage that increased to 95% taking into account the second intervention in patients that relapsed after the first surgery. Complications appeared in 13.6% of the patients. CONCLUSIONS: The treatment of choice nowadays for Zenker's diverticulum is endoscopic surgery. The endoscopic approach with stapler seems to present lower morbidity and a shorter hospital stay in comparison with the CO(2) laser.

Estudio anatómico del orificio esfenopalatino / Sphenopalatinum foramen: an anatomical study

Introducción: La localización de la arteria esfenopalatina es fundamental en el tratamiento endoscópico de la epistaxis posterior severa. El orificio esfenopalatino, que le da salida, es variable en ubicación y relaciones anatómicas. Objetivo: Realizar un estudio descriptivo osteológico de la región del orificio esfenopalatino, describiendo la anatomía de dicha región, tamaño, localización, relaciones con cornetes y coanas, así como la existencia de orificios accesorios. Material y métodos: La exploración y el estudio anatómico de la zona se llevó a cabo en 32 hemicráneos humanos. Resultados: La localización más frecuente del orificio esfenopalatino resultó la transición entre el meato medio y superior en el 56,25%, 18 especímenes, seguido del meato superior, 37,5% (12 hemicráneos) y solamente en 2 casos el orificio se abría exclusivamente en meato medio. En el 50% de los casos encontramos la existencia de orificios accesorios, cuya localización más frecuente fue inferior al orificio en el meato medio. La cresta etmoidal se encontraba presente en todos los cráneos estudiados, produciendo un resalte anterior en el orificio esfenopalatino. Conclusión: Existen variaciones anatómicas en el orificio esfenopalatino en cuanto a localización, número y relaciones anatómicas que modificarán la entrada de la arteria esfenopalatina y sus ramas en la fosa nasal. Habiendo encontrado una marca constante localizadora del orificio esfenopalatino, la cresta etmoidal, situada en el borde anterior del orificio (AU)

Introduction: The position of the sphenopalatine artery is essential for the endoscopic treatment of severe posterior epistaxis. This artery passes through its own foramen, which has awide range of locations and anatomic relations. Objective: To carry out a descriptive osteological study on the sphenopalatine foramen area. Its anatomy, size, position and relations with turbinates and choanae are described, as well as the existence of accessory foramina. Material and methods: Exploration and anatomical study was carried out in 32 human hemicrania. Results: The area between middle and superior meatus was considered the most common location of the sphenopalatine foramen in 56.24% of the cases (18 specimens), followed by the superior meatus, with 37.5% (12 hemi-skulls). The foramen was located in middle meatus injust two cases. We found accessory foramina in 50% of the cases, most commonly positioned below the middle meatus. The ethmoidal crest appeared in every skull, producing an anteriorosseous projection on the sphenopalatine foramen. Conclusion: There are variations in position, number and anatomic relations that may cause changes in the sphenopalatine artery orifice and its branches into the nasal fossa. The ethmoidal crest, located on the anterior side of the sphenopalatine foramen, can be considered a permanent landmark to find the foramen (AU)

[Sphenopalatinum foramen: an anatomical study]. / Estudio anatómico del orificio esfenopalatino.

INTRODUCTION: The position of the sphenopalatine artery is essential for the endoscopic treatment of severe posterior epistaxis. This artery passes through its own foramen, which has a wide range of locations and anatomic relations. OBJECTIVE: To carry out a descriptive osteological study on the sphenopalatine foramen area. Its anatomy, size, position and relations with turbinates and choanae are described, as well as the existence of accessory foramina. MATERIAL AND METHODS: Exploration and anatomical study was carried out in 32 human hemi-crania. RESULTS: The area between middle and superior meatus was considered the most common location of the sphenopalatine foramen in 56.24% of the cases (18 specimens), followed by the superior meatus, with 37.5% (12 hemi-skulls). The foramen was located in middle meatus in just two cases. We found accessory foramina in 50% of the cases, most commonly positioned below the middle meatus. The ethmoidal crest appeared in every skull, producing an anterior osseous projection on the sphenopalatine foramen. CONCLUSION: There are variations in position, number and anatomic relations that may cause changes in the sphenopalatine artery orifice and its branches into the nasal fossa. The ethmoidal crest, located on the anterior side of the sphenopalatine foramen, can be considered a permanent landmark to find the foramen.

La arteria etmoidal anterior en el laberinto etmoidal: Revisión bibliográfica sobre variantes anatómicas y referencias para la cirugía endoscópica / Anterior ethmoidal artery at ethmoidal labyrinth: Bibliographical review of anatomical variants and references for endoscopic surgery

Introducción: La arteria etmoidal anterior presenta muchas variaciones anatómicas en su trayecto. Tampoco existen referencias claras para localizarla, por esto, es fácil producir una lesión iatrógena. El objetivo de este trabajo es realizar una búsqueda bibliográfica para analizar las variantes y referencias endoscópicas reseñadas en la literatura científica para localizarla. Material y métodos: Se ha realizado una revisión en la base de datos Medline y Embase, buscando tanto trabajos anatómicos como radiológicos. Tras la revisión se recogen los resultados de los principales estudios. Resultados: Se recogen 13 estudios que analizan en total 1.388 arterias etmoidales anteriores. Se encuentra ausente entre un 2–14%. Es identificable entre un 95–100% en una TC. Se sitúa entre la 2ª y la 3ª lamela etmoidal en un 74,2% y a nivel basicraneal en un 66,6%. La neumatización etmoidal se relaciona con la situación de la arteria etmoidal anterior a nivel de la base de cráneo. Entre el 83–85,3% se localiza a nivel del receso suprabullar. Se exponen varias distancias y ángulos medidas para poder localizarla. Conclusiones: La TC es útil para una planificación prequirúrgica. Se localiza más frecuentemente entre la 2.a y 3.a lamela etmoidal y a nivel basicraneal. Factores como la neumatización etmoidal o el grado de Keros pueden predecir su relación con el nivel basicraneal. La arteria etmoidal anterior, la axila del cornete medio y el borde superomedial de la nariz forman una línea recta, siendo una referencia sencilla y útil en la cirugía endoscópica (AU)

Introduction: The anterior ethmoidal artery (AEA) has a trajectory with multiple anatomical variations. In addition, there are no clear references to locate it, so it is easy to produce an iatrogenic lesion. The goal of this study was to carry out a bibliographical review to analyse variants and endoscopic reference reports in the scientific literature. Material and methods: A review in Medline and Embase data bases was carried out, looking for AEA-related anatomical and radiological studies. After the revision, the principal study results, together with several distances and angles useful for locating the AEA, are presented in this study. Results: There were 13 main articles that analysed a total of 1388 AEA. It was absent from 2 to 14%. It was identifiable in computed tomography (CT) between 95 and 100%. It was located between the second and third ethmoidal lamella in 74.2% and at the skull base level in 66.6%. Ethmoidal sinuses pneumatisation was related to AEA location at the skull base. Between 83 and 85.3%, it was found at the suprabullar recess. Conclusions: CT is useful for presurgery planning. AEA are more frequent between the second and third lamella and at skull level. Ethmoidal pneumatisation and Keros grades could be predictive factors for AEA relationship with the skull base level. The AEA, the axilla of the middle turbinate and the superomedial edge of the nose are in a straight line, being a simple and useful reference in endoscopic sinus surgery (AU)

[Anterior ethmoidal artery at ethmoidal labyrinth: Bibliographical review of anatomical variants and references for endoscopic surgery]. / La arteria etmoidal anterior en el laberinto etmoidal: Revisión bibliográfica sobre variantes anatómicas y referencias para la cirugía endoscópica.

INTRODUCTION: The anterior ethmoidal artery (AEA) has a trajectory with multiple anatomical variations. In addition, there are no clear references to locate it, so it is easy to produce an iatrogenic lesion. The goal of this study was to carry out a bibliographical review to analyse variants and endoscopic reference reports in the scientific literature. MATERIAL AND METHODS: A review in Medline and Embase data bases was carried out, looking for AEA-related anatomical and radiological studies. After the revision, the principal study results, together with several distances and angles useful for locating the AEA, are presented in this study. RESULTS: There were 13 main articles that analysed a total of 1388 AEA. It was absent from 2 to 14%. It was identifiable in computed tomography (CT) between 95 and 100%. It was located between the second and third ethmoidal lamella in 74.2% and at the skull base level in 66.6%. Ethmoidal sinuses pneumatisation was related to AEA location at the skull base. Between 83 and 85.3%, it was found at the suprabullar recess. CONCLUSIONS: CT is useful for presurgery planning. AEA are more frequent between the second and third lamella and at skull level. Ethmoidal pneumatisation and Keros grades could be predictive factors for AEA relationship with the skull base level. The AEA, the axilla of the middle turbinate and the superomedial edge of the nose are in a straight line, being a simple and useful reference in endoscopic sinus surgery.

Laringectomía horizontal supraglótica láser CO2: nuestra experiencia en seis años / CO2 laser surgery of supraglottic carcinoma: Our experience over 6 years

Introducción y objetivos: El objetivo del estudio es analizar los resultados oncológicos y funcionales de la microcirugía láser en el tratamiento del carcinoma supraglótico de laringe. Material y métodos: Cincuenta y tres pacientes fueron incluidos en este estudio retrospectivo entre el año 2000 y 2006. El periodo de seguimiento fue superior a 2 años y la media fue de 49 meses. Resultados: La extensión tumoral fue T1 en 12 pacientes (22,6%), T2 en 37 (69,8%) y T3 en 4 pacientes (7,5%). En 47 pacientes (88,7%) se realizaron vaciamientos cervicales ganglionares. Diecinueve pacientes (35,8%) recibieron radioterapia (RT) postoperatoria. Las estimaciones de la supervivencia causa-específica con el método de Kaplan-Meier fueron de 80%, 74,11% y 65% a los 2, 3 y 5 años, respectivamente. La preservación de la función laríngea fue posible en el 90,56% (48 de 53) y el control local fue del 81,13%. Durante el periodo de seguimiento 13,2% de los pacientes desarrollaron recidiva local, 11,3% recidiva regional y 5,7% recidiva locorregional. Los pacientes comenzaron a deglutir de forma temprana tras la cirugía con un tiempo medio de 5,83 días y la estancia media hospitalaria fue de 14,69 días. El 20,75% sufrieron neumonía y el 11,32% hemorragia. Únicamente un paciente (1,88%) precisó una laringectomía total por imposibilidad para la deglución. Conclusiones: Con una selección cuidadosa de pacientes, la laringectomia supraglótica con láser es un tratamiento seguro y efectivo para el cáncer supraglótico de laringe (AU)

Introduction and objetives: The study goal was to analyze the oncologic and functional outcomes of transoral laser microsurgery in the treatment of carcinoma of the supraglottic larynx. Material and methods: A total of 53 patients were included in this retrospective review between 2000 and 2006. The follow-up period was more than 2 years and the mean follow-up for all patients was 49 months. Results: Tumour extension was as follows: T1 in 12 (22.6%), T2 in 37 (69.8%) and T3 in 4 (7.5%). Forty-seven patients (88.7%) had neck dissections. Nineteen patients (35.8%) received adjuvant radiotherapy. Kaplan-Meier estimates for disease-specific survival were 80%, 74.11% and 65%, at 2, 3 and 5 years, respectively. The overall functional laryngeal preservation rate was 90.56%. (48 of 53), and local control 81.13%. During follow up, 13.2% of patients developed local recurrence, 11.3% regional recurrence and 5.7% loco-regional recurrence. Patients started swallowing early after surgery, with a mean time of 5.83 days, and the mean hospital stay was 14.69 days. Complications included 20.75% who suffered pneumonia and 11.32% with bleeding. Only one patient (1.88%) received total laryngectomy due to the impossibility of swallowing. Conclusions: With careful selection of patients, laser supraglottic laryngectomy is a safe and effective treatment for cancer of the supraglottic larynx (AU)

CO2 laser surgery of supraglottic carcinoma: our experience over 6 years.

INTRODUCTION AND OBJECTIVES: The study goal was to analyze the oncologic and functional outcomes of transoral laser microsurgery in the treatment of carcinoma of the supraglottic larynx. MATERIAL AND METHODS: A total of 53 patients were included in this retrospective review between 2000 and 2006. The follow-up period was more than 2 years and the mean follow-up for all patients was 49 months. RESULTS: Tumour extension was as follows: T1 in 12 (22.6%), T2 in 37 (69.8%) and T3 in 4 (7.5%). Forty-seven patients (88.7%) had neck dissections. Nineteen patients (35.8%) received adjuvant radiotherapy. Kaplan-Meier estimates for disease-specific survival were 80%, 74.11% and 65%, at 2, 3 and 5 years, respectively. The overall functional laryngeal preservation rate was 90.56%. (48 of 53), and local control 81.13%. During follow up, 13.2% of patients developed local recurrence, 11.3% regional recurrence and 5.7% loco-regional recurrence. Patients started swallowing early after surgery, with a mean time of 5.83 days, and the mean hospital stay was 14.69 days. Complications included 20.75% who suffered pneumonia and 11.32% with bleeding. Only one patient (1.88%) received total laryngectomy due to the impossibility of swallowing. CONCLUSIONS: With careful selection of patients, laser supraglottic laryngectomy is a safe and effective treatment for cancer of the supraglottic larynx.