Laryngofissure and cordectomy.

Laryngofissure and cordectomy is one of the first of the successful surgical procedures for the cure of cancer limited to the vocal cord. When the lesion is confined to the membranous cord and the motion of the cord is not impaired, cure rates ranging from 85 to 98 percent have been reported. Decline in the use of the procedure is due to the success of radiation therapy in achieving comparable cure rates while preserving normal voice quality. Hemilaryngectomy procedures are now done where laryngofissure and cordectomy had previously been indicated. The more extensive procedure gives greater security due to wider margins of resection and increase applicability, particularly when the lesion involves the anterior commissure. Although the indications for laryngofissure have diminished, the surgeon may use it when a simple, less extensive procedure is called for.     

Tonsillectomy in adults. Our experience

Tosillectomy or palatine tonsils removal was by far as the very middle of the twenty century the commonest surgery in childhood, but owing to the abstinence behavior in past decades this operation has dropped considerabily and in consequence numerous grown up presents frequently tonsillar pathology requiring its removal in middle adult life.     

Laryngeal fibroendoscopic surgery. Our experience

Since 1992, when our department acquired a flexible fiberscope with a working channel, we have used it in surgery on the upper respiratory and digestive tract. We call our technique laryngeal fiberscopic surgery. We report the results of four years of experience in this field. A total of 368 surgical interventions were performed, almost half to remove benign lesions of the vocal cords (polyps, nodules, etc). This technique is a major advance in our field of study. Its main advantages are avoidance of general anesthesia and hospitalization, reduction of surgical risk, and savings of time and money. We consider it to be a useful alternative to traditional direct laryngoscopy (Kleinsasser technique) for many applications.     

Stapedectomy versus stapedotomy. Our experience

Otosclerosis surgery has seen three well-differentiated stages of development: a) SHC fenestration; b) stapes mobilization, and c) platinectomy, a procedure introduced in 1960 by Shea. Since then, only one variation has been proposed: platinotomy. After a comparative study of platinectomy versus platinotomy, we, like other authors, concluded that platinotomy was a better technique because of the ease of execution and good functional results.     

Head and neck sarcomas. Our experience

IntroductionHead and neck sarcomas are a heterogeneous group of malignant tumours that vary greatly in clinical presentation, with different histopathological and biological characteristics.Material and methodsThis was a retrospective study of patients with sarcoma located in the head and neck treated in our centre over a period of 25 years.ResultsDuring the study period, a total of 25 patients were diagnosed with sarcomas in the head and neck, accounting for 0.5% of all malignancies at this level. The most common treatments included surgical resection of the tumour, often supplemented with radiotherapy and/or adjuvant chemotherapy. The final local control, including the salvage, was 52%, with an adjusted survival of 51% at 5 years and 32% at 12 years.ConclusionsSurgical treatment of patients with head and neck sarcomas achieves acceptable results of local control and survival.     

Obstructive sleep apnea in children. Our experience

We expose our experience in obstructive sleep apnea syndrome (OSAS) in the pediatric population and review the literature. Forty-six nocturnal respiratory polygraphies were performed using a portable device (Eden Trace II Plus) that measures heart rate, chest wall impedance, nasal/oral airflow and oxygen saturation. Seven children have been studied before and six weeks after Adenotonsillectomy. All this children experienced an immediate and important improvement of their obstructive symptoms. After Adenotonsillectomy the number of obstructive sleep apneas disminished up to 87.25% and the number of hypoapneas disminished up to 73.3. The arterial oxygen saturation during the night normalized in the seven patients. The initial treatment of OSAS in children should be the Adenotonsillectomy, although the diagnostic criteria of OSAS in children have to be defined more precisely in the future.     

Second hemithyroidectomy for thyroid carcinoma. Our experience

Carcinomas as casual findings can be found in thyroid surgery. After the definitive AP result of malignant pathology, if a partial technique was performed, we can face problem of completing or not to a total thyroidectomy. We are reporting our 12 years experience about reinterventions because a diagnosis of thyroid carcinoma (hemithyroidectomies on previous one) was made after an anatomopathologic (AP) study on a sample from the first surgery for a supossed benign pathology. 18 patients have been studied, all of them were women, 45 year-old average and we have analysed the initial symptoms, results of basical complementary tests, diagnosis AP for first surgery and final result for second one. The incidence of malignancy showed in our series after the second intervention was 40% so we feel that a total thyroidectomy must be performed after a casual finding of thyroid carcinoma, because this allows oncological safety and a better control of the patient.     

Frontolateral laryngectomy. Our experience in La Rioja

It has been carried out a retrospective study on 16 patients who have suffered from glotic tumorus in T1b stage and have been treated by frontolateral laryngectomy from 1989 to 1998. Data related to age, sex, toxic habits, anatomopathological diagnosis, surgery, recurrence and survival were analysed. The disease affects more in males, in the 5th and 6th decade of life, with a medium to a high consumption of alcohol. The anatomopathological diagnosis in 96.75% of the cases was epidermoid carcinoma. The survival analysis showed that 87.5% of the patients survived free of recurrence for the first five years and only 6.25% had a local recurrence.     

Intranasal approaches for pituitary area tumors. Our experience

Transsphenoidal approach is the most commonly employed surgical technique for the resection of pituitary tumors. We present our experience in the transnasal-transsphenoidal approach in 30 patients undergoing pituitary surgery from 1998 to 2002. Ten patients underwent surgery via a sublabial-transeptal-transsphenoidal approach, 15 patients via a transeptal-transsphenoidal approach and 5 patients via a pure endoscopic transnasal-transsphenoidal. The pathological study showed 29 pituitary adenomas and 1 Rathe's cleft cyst. We conclude that the pure endoscopic transnasal-transsphenoidal approach guided by a navigator-system is safest and more effective approach. We reserved the transeptal-transsphenoidal approach for cases with obstructive septal deflection and poor pneumatized sphenoid sinuses. We do not recommend the use of the sublabial-trans-sphenoidal approach.     

Recurrent respiratory papillomatosis. Our experience and literature review

The recurrent respiratory papillomatosis is a benign lesion induced by virus, with predisposal factors not yet clear out. Several treatment have been used, being the endoscopic surgery with laser CO2 the most used technique. We present our experience with laryngeal papillomatosis patients operated with laser CO2 in the last 15 years. The high rate of recidive in the youth pattern and the possibility of malignant degeneration in the adults charactherises this patients. Meanwhile without not other concluyent works surgery will be the first therapeutic alternative, avoiding mutilant operations, and paying attention in detecting lesions suggesting malignancy.     

Voice prosthesis — Our experience

Malignancy of the larynx is a large group of malignancies in our country. The advanced stage of laryngeal carcinoma requires total laryngectomy which results in loss of speech along with other psychological and functional damages. Following total laryngectomy, tracheo-oesophageal voice prosthesis offers the most reliable form of voice rehabilitation. At S.M.S. Medical College and Hospital, Jaipur 25 patient underwent speech rehabilitation with voice prosthesis between Dec. 2001 to Dec. 2003. Speech rehabilitation was successful in all patients with few problem associated with indwelling prosthesis.     

Nasopharyngeal fibroma. Our own experience with 12 cases]

Our study is devoted to 12 cases of NPF collated in the ENT department of the Ibn Sina University Hospital in Rabat from 1983 to 1990. All our patients were male, aged from 11 to 24, with late consultation for nasal obstruction and recurring epistaxis. The diagnosis suspected clinically was confirmed by angiography and a CT scan. Surgery of the tumour was the only therapy employed for all our patients. Surgery was preceded by embolization in 5 cases, which considerably reduced per-operative bleeding.     

Nasopharyngeal angiofibroma. Our experience (1990-2001)

We present our experience in the treatment of nasopharyngeal angiofibromas, tumours not very common, with a benign histology but with the risk of severe epistaxis or possible involvement of vital structures. In a period of 12 years (1990-2001) we have treated 6 males with this pathology, operating 5 of them. We describe the clinical manifestations, the tumour stages following the Fisch classification, the diagnostic and surgical techniques used, the evolution of the patients and their postoperatory. We review also the literature about this subject.     

Submucosal cordectomy for laryngeal stenosis

Submucosal cordectomy, an old procedure first described for the treatment of bilateral abductor vocal cord paralysis, was used to relieve glottic or minimal subglottic stenosis in four patients. Three attained adequate airways with no further procedures; one required subsequent dilations for granulation tissue after which decannulation was successfully effected. Although airway restoration has been successful, the resultant voice has been poor, poorer than that usually achieved with arytenoidectomy. When cricoarytenoid scarring precludes arytenoidectomy and lateral vocal cord fixation, an adequate laryngeal lumen can be restored with submucosal cordectomy if sufficient laryngeal cartilage support remains.