Cuerpos extraños en seno maxilar

IntroductionForeign bodies in maxillary sinus (FBMS), whatever their origin or nature, are an unusual clinical condition. Diagnosis is based on the radiological findings in a clinical context of unilateral chronic rhinosinusitis. Treatment is the surgical removal of the intrasinusal foreign body.Patients and methodsTo identify FBMS, the records of 68 patients with unilateral chronic rhinosinusitis operated on from 2000 to 2007 were reviewed.ResultsFrom 68 records reviewed, we found 11 (16 %) FBMS. Ten (91 %) of these 11 foreign bodies were thought to come from the teeth and the last 1 (9 %) had a non odontogenic origin. Eight of the 11 (73 %) patients with FBMS presented with chronic maxillary sinusitis symptoms and all patients showed radiological findings. Treatment was the surgical removal of the foreign body, in 9 (82 %) patients through endonasal approach by functional endoscopic sinus surgery (FEES) and in the other 2 (18 %) patients a mixed surgical procedure by endonasal meatotomy and oral antrotomy was required.ConclusionsChronic maxillary sinusitis showing FBMS is rare and it must be suspected with a prior history of dental procedures. The most frequent source of FBMS is material of odontogenic origin, and non-odontogenic origin secondary to an external injury in an accident or assault is much more unusual. We also review the nature of these foreign bodies, their clinical implications and treatment options.     

Prevalencia de alteraciones en el complejo estilohioideo y tonsilolitos en la tomografía computarizada de haz cónico realizada en individuos con fisura labiopalatina

Introduction and objectives

Tonsilloliths and abnormal stylohyoid complex may have similar symptoms to others of different aetiology. Individuals with cleft lip and palate describe similar symptoms because of the anatomical implications that are peculiar to this anomaly. The aim of this study was to determine the prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography in individuals with cleft lip and palate.

Linfoma angiocéntrico localizado en paladar

Angiocentric lymphomas are very infrequent neoplasms in our geographical setting. They tend to develop in the oronasal region in the form of necrotic lesions —specifically in the midfacial zone— with a rapid course and poor prognosis. Immunohistochemically, the malignant cells have been shown to correspond to T lymphocytes. In addition, recent research supports the posible role of Epstein- Barr virus as a possible etiological factor. We present the case of a 67 year old man with an ulcerated palatinal lesion of recent appearance that was diagnosed as angiocentric lymphoma by histopathological and immunohistochemical study. Following diagnosis, treatment was provided in the form of 3 cycles of CHOP type chemotherapy and radiotherapy.     

Implicación ORL en infecciones por Leishmania

IntroductionLeishmaniasis comprises a group of diseases caused by protozoan parasites of the genus Leishmania that are transmitted by the bite of infected phlebotomine mosquitoes from animal reservoirs. Three different clinical forms are generated: cutaneous, mucocutaneous and visceral. We present the findings in the head and neck of this disease observed in our health area.Patients and methodsA review of the last 26 years in our hospital, noting the clinical, diagnostic and therapeutic characteristics of the cases detected.ResultsThirteen cases were identified, 7 cutaneous, 4 mucocutaneous and 2 visceral or kala-azar. The mean age was 53.7 ± 10.8 years. Immunodeficiency was identified in 61% of the cases. The incidence of the disease was 1.5:100,000 inhabitants/year, with a prevalence of 2%. Of those infected, 69% had involvement of the ear-nose-throat area. In 12 cases the diagnosis was established by biopsy of the lesions. The time from clinical debut to diagnosis ranged from 3 to 10 months. Antimony compounds were used as treatment in 11 patients and amphotericin B in 3, alone or combined with the former. One cutaneous form resolved with excision of the lesion. Ninety-two percent healed clinically and parasitologically.ConclusionsLeishmaniasis in Spain frequently entails cutaneous and mucocutaneous involvement, often of the skin of the head, face and neck or upper-airway mucosa. Its clinical presentation varies greatly, and it should be suspected if there is no response to conventional therapies and in conditions of immunodeficiency.     

Utilidad y versatilidad del colgajo en isla de la arteria supraclavicular en reconstrucción de cabeza y cuello

Introduction

The supraclavicular island flap is a rotational pedicled flap and may have some advantages in head and neck reconstruction compared with free-tissue transfer when this kind of reconstruction is not affordable or recommended.

Screening auditivo en niños con factores de riesgo de hipoacusia en el área 3 de madrid

The early identification of the hearing loss is very important to begin a early rehabilitation and to get a normal development of the language. Because of reason, the newborn hearing screening started, mainly in cases with risk factors. The objective of this report is to study the incidence of hearing loss in children with risk factors in the area 3 of Madrid. We realyzed hearing screening in 138 children in a period of 3.5 years, by otoacoustic emissions in younger 1 year and auditory brain stem evoked response in older 1 year. The results show that the incidence of sensorineural hearing loss is 4.34% of cases in children with risk factors, and more specifically 2.8% of bilateral profound hearing loss, and too, we detected 6.5% of transmisive hearing loss. The age of identification of hearing loss decreased to 6 months with the hearing screening programms. These results support the need of realization of hearing scrrening programms with obligatory character, though we advocate for the universal screening to include all cases of hearing loss without risk factors     

Videoendoskopie der gro?en Kopfspeicheldrüsen

Videoendoscopy is a minimally invasive procedure for the diagnosis and therapy of sialopathies of the major salivary glands. The main indication is sialolithiasis of the submandibular and parotid glands. Sialoendoscopy offers, on the one hand, a diagnostic method for radiolucent calculi in particular and, on the other, can be used to simultaneously remove calculi. Furthermore, endoscopy is of high value for the diagnosis and treatment of other salivary gland diseases in which there are pathological changes of the ductal system. For example, regeneration of the gland is now possible in cases of chronic sialadenitis, due to the removal of a sialostenosis. Sialadenectomy can thereby be avoided.     

Manifestaciones audiovestibulares en las vasculitis sistémicas

Systemic vasculitides constitute a heterogeneous group of diseases with frequent overlapping in their clinical findings and the size of the vessels involved. They may be primary or secondary to other diseases. Their common characteristic is the inflammation of blood vessels, giving rise to ischaemia. In the present article, we have reviewed the most common audiovestibular features that may be observed in patients with systemic vasculitides. Audiovestibular manifestations may be the first symptom of a systemic vasculitis. Audiological manifestations include sudden hearing loss and progressive sensorineural hearing loss. Vertigo and nystagmus are vestibular symptoms that may be observed in several systemic vasculitides. Vestibular loss in caloric test, abnormal head-shaking nystagmus, head thrust test and positioning test (benign paroxysmal positioning vertigo) may also be found. Improvement of audiovestibular function is frequently observed in patients with giant cell arteritis following corticosteroid therapy.     

Miringoplastias en niños: nuestros resultados

Introduction and objectivesMyringoplasty, one of the most frequent surgical techniques in otology, is the repair of tympanic membrane when the ear has only a perforation without any ossicular damage. The main objective of our work was to study the outcome of myringoplasty in patients less than 15 years of age. We also reviewed the existence of prognostic factors, such as Eustachian tube functionality, surgical technique and the hearing outcome after surgery.MethodWe present a retrospective study (1994-2010) with a total of 81 children (under 15 years of age) who had undergone myringoplasty during that period of time. For these children, we analysed age, sex, technique, approach, type of graft, type of perforation, anaesthesia, hearing gain and perforation closure. We correlated these variables with the success of the surgery.ResultsThe percentage of closure was 84% (n = 68). The techniques used were underlay in 79.01% (n = 64), overlay in 11.11% (n = 9) and sandwich in 9.87% (n = 8). The percentage of patients with hearing improvement was 88.40% (n = 61).ConclusionMyringoplasty is a surgical technique that offers good anatomical and functional results in children. We did not find prognostic factors in our study. We found postoperative improvement of hearing but it was not statistically significant.     

Influencia de la existencia de una dehiscencia en un canal semicircular en el espesor óseo de los canales contralaterales

ObjectivesOur objective was to determine if the existence of dehiscence in the superior or posterior semicircular canal was associated with the thinning of the bone roof in the rest of the vertical canals (superior or posterior).MethodsThe thickness of the superior and posterior semicircular canals contralateral to a dehiscence was studied using computerized tomography and compared statistically.ResultsWhen a superior semicircular canal had a dehiscence, the contralateral canal showed a significant mean decrease in its thickness of 0.5 mm (SD: 0.3 mm). This was not the case if the dehiscence was in the posterior semicircular canal, where the thickness of 2.1 mm remained unchanged (SD: 1.2 mm; P=.49).When a posterior semicircular canal showed dehiscence, no significant thinning was shown in the superior semicircular (1 mm; SD: 0.4) or in the posterior contralateral (1.3 mm; SD: 0.3) canals.ConclusionThe existence of a dehiscence in the superior semicircular canal is associated with bone thinning in the canal on the opposite side, but not with the posterior semicircular canal. In contrast, if the dehiscence is in the posterior semicircular canal, contralateral and superior canal thickness is not modified.     

Factores perinatales que influyen en la detección de otoemisiones acústicas en recién nacidos sanos,por parto vaginal,en las primeras 48 horas de vida

Introduction and objectivesMost hospitals perform neonatal hearing screening because it is a very useful procedure. Otoacoustic emissions are an ideal technique for this screening. We analyse the possible influence on screening results of some perinatal factors.Materials and methodsWe collected retrospective data from 8,239 healthy newborns delivered vaginally at the maternity ward of our hospital. We compared multiple perinatal factors vs the results of otoacoustic emissions performed within the first 48 h of life, before discharge.ResultsA total of 6.4% of newborns had an abnormal response and failed the screening. Univariate and multivariate analysis showed a significant (P<.0001) positive relationship between breastfeeding and normal otoacoustic emissions (OR: 0.65). Another, less significant factor was female gender. The remaining variables, including origin, education or employment status of the mother, maternal smoking, dystocic delivery, presentation, need for resuscitation, preterm labour (34-36 weeks), weight, length and frequent maternal pathology, such as streptococcus detection, hypothyroidism, hypertension or diabetes, were not significant.ConclusionsBreastfeeding was the most important factor related to a normal response in otoacoustic emissions. It may improve final results and reduce the number of neonates who need to be rescheduled for a repeated test, as well as the associated anxiety and the possibility of losing patients during follow-up. These are major problems in neonatal hearing screening.     

Comparación de 2 protocolos analgésicos en el control del dolor postamigdalectomía en pacientes adultos ambulatorios

Introduction and objectivesTonsillectomy causes a moderate to severe postoperative pain, and its treatment is an unsolved problem.The objective of this study was to compare the effectiveness of 2 analgesic protocols and their related complications.MethodsTwo groups of adult patients submitted to ambulatory tonsillectomy were studied. In group 1, 52 patients received a combination of tramadol and NSAIDs postoperatively; in group 2, 60 patients were treated with prednisone and NSAIDs. Two surgical techniques were used: cold dissection or dissection with electrocautery. Pain was recorded on days 4, 7 and 15, using a numerical scale from 0 to 10.ResultsBoth groups showed similar pain at postoperative day 4. At day 7, pain was higher in group 2 (P=.049), while at day 15 both groups showed only some discomfort. Sickness and vomiting was more frequent in group 1, and haemorrhage and hospitalisation in group 2. Cold dissection patients showed lower levels of pain at days 4 and 7, independently of analgesic protocol, and had lower haemorrhage and emergency visit rates.ConclusionsThe efficacy of both protocols was similar in terms of control of pain, with the exception of day 7; however, the protocol with prednisone showed fewer secondary effects. Patients operated using cold dissection had less pain and fewer complications.     

Bakterielle Infektionen der großen Kopfspeicheldrüsen

The parotid gland is most commonly involved in bacterial sialadenitis. Predisposing factors for the ductally ascending infection, are dehydration, xerogenic drugs and salivary gland diseases associated with ductal obstructions or reduced saliva secretion. In the majority of cases the infection is caused by Staphylococcus aureus. However, a variety of other aerobic and anaerobic pathogens may be involved. Besides hydration, elimination of ductal obstruction and stimulation of saliva flow antibiotic treatment according to antibiogram is essential. In selected cases, for instance if a salivary gland abscess develops, surgical treatment may become necessary. Actinomycosis, tuberculosis and atypical mycobacteriosis are rare variations of bacterial sialadenitis which clinically may resemble a salivary gland tumor     

Management eines großen bilateralen Glomus jugulare Tumors

Bilateral glomus jugulare tumors are rare. However, their treatment should preserve not only the function of the facial nerve but also the caudal cranial nerves and the middle ears in order to avoid bilateral hearing losses. Further, venous cerebral drainage has to be ensured in order to avoid cerebral hypertension and hemorrhagic infarction after bilateral jugular ligations. In the case presented bilateral glomus jugulare tumors required super-selective angiography and embolization. Complete tumor removal on both sides was then possible by a transmastoid-transcervical approach without any further functional deteriorations. Middle ear function was preserved on both sides by temporary ventral translocation of the posterior wall of the auditory meatus. As the sigmoid sinus and internal jugular vein had been ligated during initial previous surgery, venous drainage was tested one year later by angiography and compression of the remaining internal jugular vein. A sufficient collateral circulation was found and permitted surgery on the second side.     

Comentarios sobre minusvalía en patología vestibular

Handicap of the patient with vestibular disease can be measured by means of scales and questionnaires. The utility of a questionnaire developed and validated in Spanish language is commented (CEMPV). The CEMPV consists of 46 questions distributed in three scales (emotional, functional and organic) whose obtained scores are related to diverse degrees of handicap (global, emotional, functional and organic). The CEMPV is self-employed and evaluates the evolution of the patient and allows to accredit the results obtained between different investigators.     

Encuesta sobre el conocimiento en la indicación de implantes cocleares para el tratamiento de la hipoacusia en España

Introduction

This study aims to analyse the knowledge of cochlear implant (CI) candidacy criteria of otorhinolaryngology specialists in Spain, and from the results, consider whether it is necessary to implement training measures aimed at improving knowledge in this area.

Embolización selectiva terapéutica en epistaxis incoercibles

Epistaxis is a common otolaryngologic emergency that is controlled frequently with conservative measures. on the other hand, more aggresive treatments are requiered in refractory or severe epistaxis, which may have systemical impact. about intractable posterior epistaxis, selective embolization of external carotid territory is an effective option for managing. three patients with severe epistaxis successfully treated with selective embolization and a review of literature are exposed