Acta otorrinolaringologica espanola最新文献

Introduction and objectives

Nasal dermoids are uncommon midline congenital lesions in the nose, usually diagnosed in the first years of life. Imaging is mandatory to evaluate local and intracranial extension and treatment consists in surgical excision. This study aims to review the experience of the department in managing pediatric nasal dermoids using a dorsal rhinotomy surgical approach.

Material and methods

Retrospective case series of pediatric nasal dermoids treated at a tertiary university teaching hospital over a period of seven years.

Results

Nine children were treated during this period. Clinical presentation was a dermoid sinus-cyst in seven cases and a cystic lesion in two. Pre-operative imaging revealed extension of the lesion to the foramen cecum in three cases. Surgery was performed via vertical dorsal rhinotomy in all patients, and associated endoscopic surgery was used in three patients. Reconstruction with autologous material was performed in three cases. No complications or recurrences were registered during the follow-up.

Conclusions

In the presented series, a vertical dorsal rhinotomy incision has provided good functional and aesthetic results. The possibility of nasal dermoid intracranial extension should be accessed with imaging but remains uncommon. In its absence, this approach may be useful and can be paired with other techniques, such as nasal endoscopy, to achieve the best outcomes.

Background and objective

Nodal metastases in the central compartment are frequent in papillary thyroid cancer (PTC). However, they are mostly micrometastases with no impact on survival and their relevance on the risk of locoregional relapse is controversial.

There is no consensus regarding optimal management of the central neck in patients with PTC cN0. In our center, we do not perform prophylactic central neck dissection (pCND). The objective of this study is to review our long-term results and compare them with the most recent literature.

Patients and methods

Retrospective review of patients with PTC who underwent total thyroidectomy (TT) without CND between 2005 and 2017. Primary result was disease-free survival in the neck (DFS).

Results

321 patients were identified, mostly T1-T2 tumors (94.1%). Median follow-up was 90 months. DFS in the central compartment was excellent (96.1% at 10 year’s follow-up). 19 patients had cervical recurrence, of which 15 underwent salvage surgery.

On their last visit, including salvage surgery when appropriate, 77% of patients had excellent response, 18.7% had indeterminate response, 3.1% had biochemically incomplete response and 1.2% had morphologically incomplete response. Recurrent laryngeal nerve (RLN) paralysis after TT was transient in 4.7% of patients and permanent in 0.9% of patients. There were no RLN paralysis after salvage surgery. Permanent hypoparathyroidism occurred in 3.4% of patients. Only one patient had hypoparathyroidism after salvage surgery and it was permanent.

Conclusions

Based on long-term results and low rate of complications associated with salvage surgery in our experience, we consider routine pCND is not justified.

Background and objectives

The surgery of osseointegrated implants has undergone different modifications over the years with the aim of achieving better results and facilitating the surgical technique. Today the most commonly used technique is the linear incision with tissue preservation and placement of the abutment and implant. The long-term success of this technique has served as the basis for the development of the so-called minimally invasive surgical approach (MIPS). This study compares the short-, medium- and long-term results between the classic linear incision technique and the MIPS technique.

Material and methods

A prospective study was conducted on patients who had an osseointegrated implant placed between February 2016 and February 2020. A total of 59 surgeries were performed, 32 surgeries according to the linear incision technique with tissue preservation and 27 with MIPS technique. Outcomes were evaluated at 1 week, 1 month and 1 year.

Results

Statistically significant differences were achieved between the two groups at 1 week after surgery. Eighty percent of the MIPS patients had Holgers grades 0–1 compared to 35% of the linear technique patients (p = 0.001). No statistically significant differences were observed at 1 month (p = 0.457) and 1 year (p = 0.228). One case with grade 4 was recorded which resulted in implant extrusion one month after surgery with the MIPS technique. A new osseointegrated implant was placed 2 months after the fall using the same MIPS technique with good results. We were also able to verify that the duration of surgery was much shorter with the MIPS technique and better tolerated in terms of postoperative discomfort by the patient.

Conclusions

In our experience, the MIPS technique is the technique of choice for surgery of osseointegrated Ponto model implants as it is simpler, faster and presents fewer problems in the immediate postoperative period, with similar long-term postoperative results.

Aim

The study aimed to define the coursing pattern of the anterior ethmoidal artery (AEA) in the orbit to minimize complications during endoscopic interventions.

Materials and methods

A total of ten formalin-fixed cadaveric halves were included in the study. Orbital regions were shown with a superior approach. The superior rectus and superior oblique muscles, as well as the connective tissue and vessels were removed to observe the path of the anterior ethmoidal artery. Measurements such as the width of the artery, the anterior-posterior length of the U formation, the length of the intraorbital part of the ophthalmic artery, and the distance of the AEA from its opthalmic origin to the anterior ethmoidal foramen were made.

Results

Ten of the AEAs originated from the ophthalmic artery. The AEA branches originated from the ophthalmic artery approximately 18.4 mm after the orbital artery entered the orbital, and the mean width of the AEAs was 0.82 mm. In seven of the total anterior ethmoidal arteries, they coursed in the intraethmoidal cavities below the cranial base. The mean distance from the origin of AEAs to the medial wall of the orbit was 4.9 mm. After leaving the ophthalmic artery, seven of the AEAs were coursing forward and turned back ('U' turn formation), which have proximately 1.5 mm in anteroposterior direction.

Conclusion

The anterior ethmoidal artery is 0.8 mm wide, originates from the distal part of the ophthalmic artery, entering the orbit after a 1.5 mm U-turn.

Introduction

Hypoparathyroidism is the most common postsurgical complication of total thyroidectomy. Furthermore, it is the main cause of prolonged hospitalization after this procedure.

Objective

To predict the probability of post-thyroidectomy hypocalcemia according to the levels of intact parathyroid hormone (iPTH), as well as to determine the needs for treatment with exogenous calcium according to the levels of serum calcium (Ca).

Materials and methods

Retrospective study was carried out on patients who underwent total thyroidectomy between January 2017 and January 2020 at Los Arcos del Mar Menor University Hospital (HULAMM). iPTH and Ca levels were measured at 4, 24 and 48 hours after the surgery. Follow-up was 6 months.

Results

Ninety-four patients were operated on. Temporary and permanent postoperative hypoparathyroidism percentages were, respectively, 51.06% and 6.38%. PTHi level 24 hours after the procedure was the most reliable predictor of post-thyroidectomy temporary hypoparathyroidism (Area Under the ROC Curve (AUC)=0.933, P<.001). iPTH levels ≥ 29 pg/ml predicted normal parathyroid metabolism.

Conclusions

The combined values of iPTH and Ca levels 24 hours after thyroidectomy seems to be a reliable, safe and efficient method to control the post-thyroidectomy hypoparathyroidism. Our protocol could reduce the hospital stay of patients at low risk of hypocalcemia, allowing them to be discharged from the hospital on the first postoperative morning and identifying patients at high risk of hypocalcemia early.

Background and objective

Septal perforation (SP) cause heterogeneous symptoms depending on the anatomical location, highlighting scabs, nasal obstruction and/or epistaxis. The use of questionnaires to determine the quality of life in different pathologies is increasing in sinonasal pathologies and in patients with SP the NOSE-Perf questionnaire was constructed, currently validated in English. The aim of this study is the translation, cross-cultural adaptation, and validation of the NOSE-Perf questionnaire into Spanish.

Material and methods

Prospective single-center study of 81 patients (38 with SP and 43 controls), visited in the Rhinology section of a tertiary hospital. Adaptation and translation NOSE-Perf into Spanish and validation using the NOSE and NOSE-Perf questionnaire in Spanish.

Results

Significant differences were found in the mean NOSE-Perf score and in the mean NOSE score (95%CI: 21.2-26.9; P<.001 and 95%CI: 53.8-70.5; P<.001) between PS group and control group. Pearson's correlation between the two questionnaires NOSE-Perf and NOSE in the SP group was 0.74 (95%CI: 0.56-0.86; P<.001). In the control group it was r = 0.85 (95%CI: 0.73-0.91; P<.001). Cronbach's alpha coefficient of the NOSE-Perf was 0,95 (95%CI: 0,93-0.96) for internal consistency. The reliability evaluation was carried out by test-retest, and a strong Pearson correlation was obtained between the questionnaires r = 0.94 (95%CI: 0.85-0.97; P<.001) and r = 0.89 (95%CI: 0.77-0.95; P<.001).

Conclusions

The Spanish version of the NOSE-Perf is as reliable and valid as the English version, which makes it possible to assess the impact on quality of life that it causes in patients with perforations in the Spanish-speaking population.

Among the symptoms presented by patients with SARS-CoV-2 infection, we can find various otorhinolaryngological alterations. Dysphonia appears in up to 79% of infected patients during the acute phase. Dysphonia can also occur as a sequelae, often underestimated, possibly due to its appearance along with other symptoms, also in patients after prolonged intubation or tracheostomy. We present a systematic review of the literature with a bibliographic search in PubMed, Cochrane and Google Scholar, with MESH terms including studies in English and Spanish. The results of the studies found and the vocal manifestations in patients during COVID-19 disease and the consequences produced are analysed. Dysphonia is an acute manifestation of COVID-19 with alterations in aerodynamic and acoustic analysis and in fibrolaryngoscopy. Post-COVID dysphonia can be a persistent symptom that is often underestimated, requiring multidisciplinary management and speech therapy intervention. Laryngeal sequelae are common in post-intubation or post-tracheostomy patients and are related to intubation time, tube number, pronation and respiratory sequelae.

Objetivos

comparar entre el índice de neutrófilos linfocitos (NLR) y el volumen plaquetario medio (VPM) en la predicción de la viscosidad del derrame en la otitis media con derrame.

Materiales y métodos

Se incluyeron en el estudio 248 niños con derrame en el oído medio. Se evaluaron los hemogramas completos (CBC) preoperatorios. Se registraron los valores de NLR y MPV. La viscosidad del derrame se evaluó durante la cirugía mientras se aspiraba el derrame después de la miringotomía. Se clasificaron 2 tipos de derrames; tipos serosos y mucoides.

Resultados

se reportaron diferencias estadísticamente significativas en NLR y MPV entre los derrames serosos y mucoides. Los valores de corte de NLR y MPV para diferenciar entre derrames serosos y mucoides fueron 1,21 y 7,95 respectivamente. Cuando se compararon NLR y MPV, NLR pareció tener mayor sensibilidad, especificidad y precisión diagnóstica que MPV.

Conclusión

NLR es superior a MPV como predictor de la viscosidad del derrame en otitis media con derrame. Ambos marcadores se consideran rentables y fiables para la evaluación de la viscosidad del derrame.