Endoscopic sinus surgery in sinusitis.

In terms of functional treatment of sinonasal pathologies, endoscopic surgery represents a spectacular advance, offering excellent illumination, views of areas previously impossible to monitor, and the ability to view the main reference points in the surgical field. Over a five-year period (1988-1993), the authors have performed 278 paranasal sinus operations, using endoscopic techniques. The results obtained in 250 patients, with a minimum follow-up period of one year, have been analyzed. The criteria of assessment used include: self-assessment by the patient and the surgeon's assessment, made on basis of the endoscopic data. The best results were obtained in cases of antrochoanal polyps, polyposis not associated with asthma or acetylsalicylic acid (ASA) sensitivity, circumscribed chronic sinusitis, and aspergillomas. The worst results, with a high rate of recurrence, have been obtained with ASA sensitivity and chronic suppurative pan-sinusitis. It is essential to reach a consensus on the staging of polyposis so that treatment can be monitored adequately, even though, in itself, the pathology is difficult to classify as it can vary in a single patient for no apparent reason. On the other hand, there is a difference between the subjective and objective assessment of the condition, and this makes it even harder to explain the results obtained.

[Efficacy and safety of dotarizine vs. cinnarizine in the symptomatic treatment of acute balance disorders (common vertigo)]. / Eficacia y seguridad de dotarizina frente a cinarizina en el tratamiento sintomático de los trastornos agudos del equilibrio (vértigo común).

One hundred and ten adult patients suffering from peripheral vertigo were treated in a multifactorial double-blind randomized clinical trial with dotarizine (50 mg b.i.d.) or cinnarizine (75 mg b.i.d.). There was a 60 days clinical follow-up. Results showed that dotarizine was significantly active against the vertigo attacks and its associated symptoms (mainly neurovegetative). The global superiority of dotarizine was confirmed by statistically significant differences between treatments in the improvement of the severity of vertigo, hearing loss in audiometries, global relief of symptoms, disability produced by crises and global assessment by the investigators themselves. No clinically significant unwanted effects were seen in either group on blood pressure, heart rate or analytical parameters. No serious adverse effects to dotarizine were reported. This study confirms the value of dotarizine in the treatment of peripheral vertigo.

[The middle turbinate as the cause of sinusal pathology]. / El cornete medio como causa de patología sinusal.

The middle turbinate and its anatomical variations (concha bullosa and paradoxically bent middle turbinate) may be the site of different pathologies due to the alteration of the sinus function at the key area of the osteomeatal complex. In the present work we study 4 cases of concha bullosa and 4 cases of paradoxically bent middle turbinates, associated to recurrent sinusitis and/or headaches, which underwent endoscopic surgery. Improvement was achieved in all recurrent circumscribed sinusitis. One of the patients with bilateral paradoxically bent middle turbinate had an associated pansinusitis, and he only improved in his right side. An aspergilloma was found inside one of the conchae bullosae. Headaches improved in all the cases analyzed. Anatomic variations may be the cause of recurrent sinusal pathology or isolated headaches and it should be noted that, in correctly selected groups, a dramatic improvement can be achieved with a minor surgical procedure on the middle turbinate or ethmoidal infundibulum.

[Unusual manifestations of squamous carcinoma of the lip]. / Manifestaciones inusuales del carcinoma escamoso de labio.

We present a case of squamous cell carcinoma of the lip with metástasis to the mandible and meningeal involvement causing multiple cranial nerve palsies. Biopsy proven metástasis to the mandible was demonstrated. Studies of CT scan of the head were negative. Extension through perineural space have been speculated.

[Nasosinusal inverted papilloma]. / Papilomas invertidos nasosinusales.

Inverted papilloma is a papillar lesion of the nasal cavity and paranasal sinuses that arise from the Schneiderian membrane. This tumor has a high rate of local recurrence. We present a review of 10 cases of inverted papilloma of the nose and paranasal sinuses. A review of the literature is done.

[Review of 156 myringoplasties]. / Revisión de 156 miringoplastias.

We report the anatomical and functional results of 156 myringoplasty; 134 with onlay surgical technique and 22 with underlay technique. We comment the climatologic of our area and its relation with the surgical failures.