Apport de la tomodensitométrie dans la pathologie ORL non traumatique au centre hospitalier universitaire de Brazzaville / NA

Objectif: décrire l'apport de la tomodensitométrie dans la pathologie ORL non traumatique. Méthodologie : Il s'agissait d'une étude transversale et descriptive allant de mai 2003 à janvier 2017 soit 13 ans et 8 mois, au CHU de Brazzaville. Nous avons inclus dans notre étude tous les patients ayant présentés une pathologie ORL, pour laquelle le bilan diagnostique nécessitait la réalisation d'une tomodensitométrie. Résultats : la fréquence de prescription de la TDM en ORL représentait 3,5%. L'âge moyen 38,2 ± 18,2 ans. Le sexe masculin représentait 59%. La TDM était utile dans le diagnostic devant 51,90% des signes fonctionnels, 48,10% du syndrome tumoral. L'atteinte rhinosinusienne représentait 59,5% suivie du pharynx 17,8%. La pathologie infectieuse représentait 63% (sinusite 51%) et la pathologie tumorale 37% (tumeur du cavum 18%). Conclusion: La prescription de la tomodensitométrie dans les pathologies ORL reste faible. Les indications et les lésions observées sont multiples. La TDM reste un moyen d'exploration complémentaire utile dans la pathologie tumorale qu'infectieuse.

Objective: To describe the contribution of CT scans in non-traumatic ENT pathology. Methodology: This was a cross-sectional and descriptive study from May 2003 to January 2017 (13 years and 8 months), at the University Hospital of Brazzaville. We included in our study all patients who presented an ENT pathology for which the diagnostic work-up required a CT scan. Results: The frequency of prescription of CT in ENT represented 3.5%. The average age of the patients was 38.2 ± 18.2 years. Males accounted for 59%. CT was useful in the diagnosis of 51.90% of the functional signs and 48.10% of the tumour syndrom. Rhinosinus involvement accounted for 59.5%, followed by the pharynx for 17.8%. Infectious pathology represented 63% (sinusitis 51%) and tumour pathology 37% (cavum tumour 18%). Conclusion: The prescription of CT scans in ENT pathologies remains low. The indications and lesions observed are multiple. CT remains a useful complementary means of exploration in tumour and infectious pathology.

Carcinoma de Lengua Móvil / Mobile Tongue Carcinoma

Introducción: El Carcinoma de lengua móvil es uno de los tumores malignos más frecuentes de la cavidad bucal. Generalmente, los pacientes son diagnosticados después de los 40 años de edad. La detección temprana de estas lesiones, evita su desarrollo hacia fases avanzadas de la enfermedad, que oscurecen su pronóstico, por medio de una atención rápida y adecuada, biopsia oportuna, y tratamiento precoz, evitando que los pacientes sean mutilados, sufran o mueran por esta causa. El objetivo del presente estudio es reportar un grupo de pacientes con esta neoplasia, su tratamiento y supervivencia. Métodos: En el presente estudio descriptivo, longitudinal y retrospectivo fueron evaluados los pacientes con diagnóstico de carcinoma de lengua móvil, tratados en el Instituto Nacional de Oncología de la Habana, entre los años 2007 y 2011. Se reporta edad, tabaquismo, alcoholismo, estadiaje, tipo de tratamiento y supervivencia. Resultados: Se registraron 68 casos, se observó un predominio del grupo de edad entre los años 55-69, con el 41.18% de los pacientes, siendo el sexo predominante el masculino, con un 79.41% del total. En la clasificación TNM, se observó que predominó de los tumores estadiados como T3 con el 35.29 %, seguidos de los T2 con el 30.88 %, la invasión ganglionar estuvo más representada por la categoría N0 con el 58.82% de los casos. El 64.71% de los pacientes estaban vivos a los 60 meses. Conclusión: El carcinoma de lengua móvil fue más frecuente en las edades entre 55-69 años y en el sexo masculino, más del 50% de los pacientes practicaban hábitos tóxicos, hubo un predominio de etapas avanzadas, la cirugía con adyuvancia postoperatoria fue la terapéutica más común.

Introduction: Carcinoma of the mobile tongue is one of the most frequent malignant tumors of the oral cavity. Generally, patients are diagnosed after 40 years of age. The early detection of these lesions prevents their development towards advanced stages of the disease, which obscure their prognosis, through rapid and adequate care, timely biopsy, and early treatment, preventing patients from being mutilated, suffering or dying from it cause. The objective of the present study is to report a group of patients with this neoplasia, its treatment and survival. Methods: In the present descriptive, longitudinal and retrospective study, patients diagnosed with mobile tongue carcinoma, treated at the National Institute of Oncology of Havana, between 2007 and 2011, were evaluated. Age, smoking, alcoholism, staging are reported, type of treatment and survival. Results: There were 68 cases, a predominance of the age group between the years 55-69 was observed, with 41.18% of the patients, being the predominant sex the masculine, with 79.41% of the total. In the TNM classification, it was observed that tumors predominated as T3 with 35.29%, followed by T2 with 30.88%, the lymph node invasion was more represented by the N0 category with 58.82% of the cases. 64.71% of the patients were alive at 60 months. Conclusion: The mobile tongue carcinoma was more frequent in the ages between 55-69 years and in the male sex, more than 50% of the patients practiced toxic habits, there was a predominance of advanced stages, the surgery with postoperative adjuvant was the therapeutic more common.

Conceptos básicos para el uso racional de antibióticos en otorrinolaringología / Basic concepts for the rational use of antibiotics in otorhinolaryngology

El uso racional de antibióticos es un tema de la mayor importancia en la práctica médica actual. Es fundamental que los médicos conozcan tanto las manifestaciones clínicas de cada proceso infeccioso y sus diagnósticos diferenciales, como también sus características epidemiológicas, prevalencia bacteriana local y patrones de resistencia, así como también la farmacología de los antibióticos disponibles, con el fin de tomar la mejor decisión terapéutica. Al enfrentarnos a un paciente, siempre debemos tener en mente que no todas las enfermedades inflamatorias son infecciosas, no todas las infecciones son bacterianas, y no siempre éstas últimas deben ser tratadas con antibióticos. Las infecciones de la vía aerodigestiva superior están dentro de las patologías infecciosas más frecuentes e involucran a una gran cantidad de especialidades médicas. El objetivo de esta revisión es entregar los conceptos farmacológicos y microbiológicos básicos para una utilización adecuada de los distintos antimicrobianos, y aplicar estos conceptos en el tratamiento de infecciones otorrinolaringológicas frecuentes y relevantes.

Rational use of antibiotics is of major importance in current clinical practice. It is fundamental that physicians know the clinical manifestations of each infectious disease and its differential diagnoses, their epidemiologic characteristics, local bacterial prevalence and resistance patterns, as well as the pharmacology of the different antibiotics, to make the best therapeutic decision. When faced to a patient, we always have to keep in mind that not every inflammatory disease is infectious, not every infectious disease is bacterial, and that the latter not always has to be treated with antibiotics. Upper aerodigestive infections are among the most frequent infectious diseases and involve several different medical specialties. The objective of this review is to give the basic pharmacologic and microbiologic concepts for an appropriate use of the different antimicrobials, and to apply these concepts in the treatment of frequent and relevant otorhinolaryngological infections.

Application of carbon nanoparticles as lymph node tracers in patients with cN0 lingual squamous cell carcinoma un-dergoing neck dissection / 华西口腔医学杂志

<p><b>OBJECTIVE</b>This study aimed to investigate the value of carbon nanoparticles as lymph node tracers in neck dissection for cN0 lingual squamous cell carcinoma patients.</p><p><b>METHODS</b>Ninety-six patients with cN0 lingual squamous cell carcinoma were recruited to undergo surgical treatment were randomly divided into two groups, namely, the carbon nanoparticle-labeled group (the experimental group, 50 cases) and the control group (46 cases). Carbon nanoparticle suspension was injected into the submucosal layer around the site of the primary tumor at three or four points (0.1 mL for each point) 12 h before surgery. Supraomohyoid neck dissection (SOHND, Levels Ⅰ to Ⅲ) or comprehensive neck dissection (CND, Levels Ⅰto Ⅴ) were performed based on the size and location of the primary tumor. All the lymph nodes were dissected and separated from the ex vivo surgical specimens for histopathological evaluation. The number, size, location, and pathological result of all the lymph nodes were compared between the two groups. Statistical analyses were conducted by SPSS 19.0 software.</p><p><b>RESULTS</b>A total of 1 137 lymph nodes were detected in 31 SOHND patients. The average number of lymph nodes detected in the experimental group was (43.79±19.23) /case, which was significantly higher than that in the control group [(30.82±8.77) /case] (P=0.019). Level Ⅲ covered the largest number of lymph nodes in the two groups. However, the number and proportion of lymph nodes found in Level Ⅱ of the experimental group were significantly higher than those of the control group (P=0.000). A total of 3 938 lymph nodes were detected in 65 CND patients. The average number of lymph nodes detected in the experimental group [(66.67±20.02) /case] was larger than that in the control group [(53.03±20.98) /case] (P=0.026). The difference in the lymph node location between the two groups was not statistically significant (P=0.354). In the two neck dissection methods, both the proportion of minute lymph nodes and the accuracy of the detected lymph nodes in the experimental group were significantly larger than those in the control groups (P=0.000). Compared with the control group, more metastases were proven by the carbon nanoparticle-labeled lymph nodes (P=0.000) in the experimental group.</p><p><b>CONCLUSIONS</b>Carbon nanoparticles as lymph node tracers in patients with cN0 lingual squamous cell carcinoma undergoing neck dissection can increase the number of detected lymph nodes, especially the minute nodes. Such nanoparticles can further ensure the thoroughness of neck dissection and the accuracy of clinicopathological stage.</p>

Expression of C-X-C chemokine receptor type 7 in otorhinolaryngologic neoplasms

<p><b>INTRODUCTION</b>C-X-C chemokine receptor type 7 (CXCR7) has recently been characterised as a novel receptor for the C-X-C motif chemokine 12 (CXCL12)/stromal cell-derived factor 1-alpha. CXCR7 has been thought to play an important role in the pathogenesis of chronic rhinosinusitis, angiogenesis and tumour metastasis. The present study aimed to examine the expression of CXCR7 in tissue samples of laryngeal cancer and maxillary sinus carcinoma to determine its role in the development of otorhinolaryngologic neoplasms.</p><p><b>METHODS</b>Samples of otorhinolaryngologic neoplasms were obtained from 17 patients with either nasal polyps (n = 7), laryngeal cancer (n = 5) or maxillary sinus carcinoma (n = 5), and who underwent surgical resection at West China Hospital of Sichuan University. Total RNA was isolated and CXCR7 mRNA expression was examined and quantified by relative real-time reverse transcription polymerase chain reaction. A one-way analysis of variance was performed using SPSS Statistics version 11.0 (SPSS Inc, Chicago, IL, USA) to compare the CXCR7 mRNA levels among the three groups of patients.</p><p><b>RESULTS</b>All samples tested positive for CXCR7 mRNA. The quantitative results showed that the CXCR7 mRNA levels were highest in laryngeal cancer and lowest in maxillary sinus carcinoma neoplasms, although there was no significant difference among the three samples.</p><p><b>CONCLUSION</b>CXCL12 and its receptor CXCR7 may contribute to eosinophilic inflammation in patients with chronic sinusitis and nasal polyps. Our results also suggest that CXCR7 may play a role in the progression, metastasis and angiogenesis of otorhinolaryngologic tumours.</p>

Teleaudiometry as a screening method in school children

OBJECTIVE: To compare the efficacy and feasibility of teleaudiometry with that of sweep audiometry in elementary school children, using pure-tone audiometry as the gold standard. METHODS: A total of 243 students with a mean age of 8.3 years participated in the study. Of these, 118 were boys, and 125 were girls. The following procedures were performed: teleaudiometry screening with software that evaluates hearing at frequencies of 1,000, 2000 and 4000 Hz at 25 dBHL; sweep audiometry screening in an acoustic booth (20 dBHL at the same frequencies); pure-tone audiometry thresholds in an acoustic booth (frequencies of 500, 1000, 2000 and 4000 Hz); and acoustic immittance measurements. RESULTS: The diagnostic capacities of the teleaudiometry/sweep audiometry screening methods were as follows: sensitivity  ϝ  58%/65%; specificity  ϝ  86%/99%; positive predictive value  ϝ  51%/91%; negative predictive value  ϝ  89%/92%; and accuracy  ϝ  81%/92%. Teleaudiometry and sweep audiometry showed moderate agreement. Furthermore, the use of these methods in series with immittance testing improved the specificity, whereas parallel testing improved the sensitivity. CONCLUSION: Teleaudiometry was found to be reliable and feasible for screening hearing in school children. Moreover, teleaudiometry is the preferred method for remote areas where specialized personnel and specific equipment are not available, and its use may reduce the costs of hearing screening programs. .

Linfoma de células T/Natural Killer extranodal, tipo nasal / Extranodal Natural Killer /T-cell lymphoma, nasal type

Introducción: El linfoma de células T/Natural Killer (T/NK) extranodal, tipo nasal, es un linfoma extra-ganglionar poco frecuente, con extensión a lo largo de la línea media facial, rápidamente progresivo, catastrófico y de mal pronóstico, por lo que también se le conoce como "granuloma letal de la línea media". Objetivo: El propósito de este artículo es revisar la literatura disponible y actualizada sobre el linfoma de células T/NK extranodal, tipo nasal: manifestaciones clínicas, estándares de enfoque, diagnóstico, pronóstico y tratamiento. Diseño: Revisión Narrativa de la literatura. Metodología: Revisión de la literatura mediante búsqueda selectiva por términos MeSH: Extranodal Natural Killer /T cell lymphoma, nasal type, lethal midline granuloma, de las bases de datos: MEDLINE, Current Contents, Cochrane, Pubmed y Scielo, entre los años 2000 y 2014. Resultados: Se revisaron 36 artículos según los requerimientos de los objetivos. El linfoma de células T/NK es una neoplasia rápidamente progresiva, destructiva y de mal pronóstico excepto en los casos donde el diagnóstico ha sido oportuno. Conclusiones: El diagnóstico y tratamiento tempranos del linfoma de células T/NK extranodal, tipo nasal, son las únicas herramientas para mejorar el mal pronóstico y gran afectación en la calidad de vida de los pacientes con esta enfermedad.

"Introduction: Extranodal nasal Natural Killer (NK) /T-cell lymphoma, nasal type, is an extranodal lymphoma, infrequent, with extension along facial midline, rapidly progressive, catastrophic and with poor prognosis, also known as "lethal midline granuloma". Objectives: The purpose of this article is to review the current literature available about Extranodal nasal NK/T-cell lymphoma, nasal type: Clinical manifestations, approach standards, diagnosis, prognosis and treatment. Methodology: Literature review by selective MeSH search terms: Extranodal Natural Killer / T cell lymphoma, nasal type, lethal midline granuloma of databases: MEDLINE, Current Contents, Cochrane, PubMed and SciELO, between 2000 and 2014. Results: 36 articles were reviewed according to the requirements of the objectives. Extranodal NK/T cell lymphoma, nasal type, is a rapidly progressive neoplasia, destructive and with poor prognosis except in cases where diagnosis has been timely. Conclusions: Early diagnosis and treatment of Extranodal NK/T cell lymphoma, nasal type, are the only tools to improve the poor prognosis and high impairment in quality of life of patients with this disease.

Citodiagnóstico en otorrinolaringología: diez años de experiencia en el Hospital Barros Luco Trudeau 2001 a 2010 / Citodiagnostic in otorhinolaryngology: ten years of experience in Barros Luco Hospital 2001 to 2010

Introducción: Dentro del estudio diagnóstico de pacientes con masa cervical la punción por aspiración con aguja fina (PAAF) es una herramienta útil debido a su facilidad y seguridad. Objetivo: Evaluar el rendimiento de las PAAF realizadas en nuestro servicio en los últimos diez años. Material y método: Estudio retrospectivo y descriptivo. Se obtuvieron los datos de pacientes sometidos a PAAF en el Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau entre los años 2001 a 2010 y se correlacionaron con las biopsias definitivas atingentes. Resultados: Se realizaron 197 PAAF, de las cuales 140 (71%) fueron aptas para estudio citológico y 77 tenían biopsias concomitantes. Se obtuvo una sensibilidad de 46°%, especificidad de 85°%, valor predictivo positivo de 74°% y valorpredictivo negativo de 62°%. La localización para la cual se obtuvo un mejor rendimiento de la técnica fue para glándulas salivales y los diagnósticos con mejor rendimiento fueron carcinoma escamoso y tumor mixto. Discusión: La PAAFes una herramienta subutilizada. Obtuvimos una alta tasa de muestras insuficientes para estudio diagnóstico y, en nuestro medio, es útil para descartar neo-plasia maligna en masas de glándulas salivales y metástasis de carcinoma escamoso.

Introduction: Fine needle aspiration (FNA) is an useful tool for the diagnostic evaluation of patients with a cervical mass, because of its feasibility and safety. Aim: To determine the accuracy of FNA cytology in our hospital over the last ten years. Material and method: A retrospective and descriptive study. Data were obtained from patients undergoing FNA in the Department of Otolaryngology, Hospital Barros Luco Trudeau from 2001 to 2010 and compared with the corresponding histology report of the original surgical specimen. Results: A total of 197 FNA procedures were performed in 143 patients. A definite cytological diagnosis was made in 140 patients (71%%). 77 patients had corresponding histology samples. The sensitivity was 46%%, specificity 85%%, positive predictive value 74% and negative predictive value 62%. The location for which we obtained a better performance of the technique was in salivary glands and the best performing diagnosis was squamous cell carcinoma. Discussion: FNA is an underused diagnostic tool with a high rate of non diagnostic samples. It is useful to rule out malignancy in salivary gland masses and metastatic squamous cell carcinoma in lymph nodes.

Schwannoma cervical de la cadena del simpático / Cervical schwannoma of the sympathetic chain

Los schwannomas de la cadena cervical del simpático (SC) son tumores benignos e infrecuentes, que se presentan como una masa cervical unilateral de lento crecimiento, y cuyo diagnóstico preoperatorio definitivo suele ser difícil. A pesar de las pruebas disponibles (TAC, RM, eco y angiografía), solo se obtiene en el momento de la cirugía. El tratamiento de elección es la cirugía, y rara vez se produce recidiva o malignización, aunque sí puede variar hastapresentarse el síndrome de Horner…

Schwannomas of the sympatic cervical chain are infrequent and benign tumors, presented as unilateral cervical mass of slow growth, and whose definitive preoperative diagnosis usually is difficult, in spite of the available tests (CAT, MR, ecography and angiography), obtaining it at the moment of the surgery. Surgical extirpation constitutes the election treatment, being rare the tumor recidive and the malignization, not so the Horner syndrome…

Masa nasal congénita: quiste epidermoide / Congenital nasal mass: epidermoid and dermoid cyst

Las masas nasales congénitas de la línea media son poco frecuentes, pero ante la sospecha clínica debe realizarse una valoración completa que incluya imágenes diagnósticas para descartar origen intracraneal. Se presenta un caso clínico con la presencia de dos entidades clínicas de diferentes características histológicas junto con una revisión de la literatura.

Segundo tumor primário em pacientes com câncer de vias aerodigestivas superiores / Second primary tumor in patients with upper aerodigestive tract cancer

Nos primeiros três anos após o tratamento dos pacientes com carcinomas epidermoides de vias aerodigestivas superiores (VADS), observa-se elevada incidência de recidivas. Depois do terceiro ano, o aparecimento de um segundo tumor primário (STP) torna-se importante causa de morbi-mortalidade. OBJETIVO: Avaliar a incidência e o perfil dos STP em pacientes com carcinoma epidermoide de VADS tratados com intenção curativa. MATERIAL E MÉTODO: Estudo retrospectivo em que foram analisadas a incidência, localização e tratamento dos STP e calculada sobrevida. RESULTADOS: Dos 624 casos analisados, 59 (9,4 por cento) tiveram STP durante o seguimento (4 sincrônicos e 55 metacrônicos). A sobrevida livre de STP variou de 2 a 191,3 meses (mediana, 42,5 meses). Em 20 casos (33,9 por cento) o STP foi diagnosticado após o quinto ano de seguimento. O local mais acometido por STP foi a mucosa das VADS (49,1 por cento), seguida pelo pulmão (22,0 por cento) e pelo esôfago (11,9 por cento). A melhor sobrevida pós-STP foi dos casos de STP nas VADS (32,2 por cento em 5 anos, mediana 16,2 meses). CONCLUSÃO: Nos pacientes avaliados a incidência de STP foi de 9,4 por cento. Em 33,9 por cento dos casos o STP foi diagnosticado após o quinto ano de seguimento. A localização mais frequente dos STP foi a mucosa das VADS.

In the first three years after treatment of patients with squamous cell carcinoma of upper aerodigestive tract (UADT), there is a high incidence of recurrences. After the third year, the occurrence of second primary tumor (SPT) is an important cause of morbimortality. AIM: To evaluate the incidence and the characteristics of the SPT in patients with squamous cell carcinoma of UADT, treated with curative intention. METHODS: Retrospective study where the incidence, localization and treatment of SPT had been analyzed and survival rates were calculated. RESULTS: Of the 624 analyzed cases, 59 (9.4 percent) had SPT during follow-up (4 synchronous and 55 metachronous). The SPT free survival rate ranged from 2 to 191.3 months (median of 42.5 months). In 20 cases (33.9 percent) the SPT was diagnosed after the fifth year of follow-up. The most frequent site of STP was the UADT mucosa (49.1 percent), followed by the lungs (22.0 percent) and the esophagus (11.9 percent). The best survival after-SPT occurred in cases of UADT STP (32.2 percent in 5 years, median 16.2 months). CONCLUSION: The STP incidence was 9.4 percent. In 33.9 percent of the cases, the SPT was diagnosed after the fifth year of follow-up. The most frequent localization of STP was the UADT mucosa.

Plasmocitoma extramedular nasal: presentacíon de un caso y revisión de literatura / Extramedullary plasmocytoma: case report and literature review

Extramedullary plasmocytoma is a rare plasmatic cell neoplasia which mostly compromises the head and neck (80-90%). On initial presentation they must be differentiated from multiple myeloma This may prove to be difficult because a varying percentage may be associated at a later date with the development of multiple myeloma. We describe a case of extramedullary plasmacytoma in the nose and we discussed and review the literature.

[Ear nose sarcoma. Reprt of 3 cases]

Head and neck sarcoma are very rare malignant tumors which can occur on any different ENT localization. The authors report tree different variety of ENT sarcoma diagnosed and treated at the oto-rhino-laryngological department of military hospital of Tunis. We intend to remind of clinical and histological particularities, therapeutic modalities and finally to evaluate the follow-up. From 2001 to 2007, three cases of head and neck sarcomas were diagnosted in ENT department of military hospital of Tunis. the study concerned a women [22 years old] and two men 36 and 76 years old. It deals with an orbital rhabdomyosarcoma, a carcinosarcoma of submandibular gland and a maxillary chondrosarcoma. In each case, diagnosis was validated by the immunohistochemistry. All patients had surgical removal of their tumor. External irradiation or/and chemotherapy was also indicated for all cases. ENT sarcomas are aggressive neoplasm. Long-term survival is bad with high potentialities of local recurrence and distant metastases

Selective neck dissection for treating node-positive necks in cases of squamous cell carcinoma of the upper aerodigestive tract / Esvaziamento cervical seletivo para o tratamento do pescoço positivo em carcinomas epidermóides do trato aerodigestório alto

CONTEXT AND OBJECTIVE: Modified radical neck dissection (MRND) is the classical treatment for neck metastases of squamous cell carcinoma (SCC) of the upper aerodigestive tract. However, it may still be accompanied by significant sequelae. One alternative for this treatment would be selective neck dissection (SND), which has a lower incidence of sequelae. The aim of this study was to define which neck metastasis cases would really be suitable candidates for SND. DESIGN AND SETTING: Retrospective clinical-surgical trial at the Division of Head and Neck Surgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP). METHODS: We retrospectively studied 67 patients with SCC of the upper aerodigestive tract, divided into two groups: 1) 47 patients treated by means of SND (node-negative or node-positive), 2) 20 patients treated by means of MRND (all node-positive). RESULTS: Our results demonstrated that there was no difference between the patients treated with SND or MRND in relation to disease evolution, and that the main prognostic factor was lymph node involvement. We observed that patients with pharyngeal SCC and older patients presented worse evolution and would probably not be suitable candidates for SND. CONCLUSIONS: SND may be a good option for treating node-positive necks in selected cases.

CONTEXTO E OBJETIVO: O esvaziamento cervical radical modificado (ECRM) é o tratamento clássico para as metástases cervicais do carcinoma espinocelular (CEC) do trato aerodigestório alto (TADA). Este procedimento é considerado oncologicamente satisfatório, porém pode ser acompanhado de seqüelas significativas devido à extensão do procedimento e a grande manipulação de estruturas nobres, especialmente as nervosas. Assim, tem sido proposto o esvaziamento cervical seletivo (ECS) para o tratamento de casos selecionados, pN1, pN2 sem ruptura capsular, minimizando, ou mesmo evitando, deste modo, as seqüelas do ECRM. O grande questionamento atual é a definição de quais casos seriam eleitos para este procedimento, sem alterar o resultado oncológico de médio e longo prazo. TIPO DE ESTUDO E LOCAL: Estudo clínico retrospectivo realizado na Disciplina de Cirurgia de Cabeça e Pescoço do Departamento de Cirurgia da Faculdade de Ciências Médicas da Santa Casa de São Paulo. MÉTODOS: Estudamos 67 doentes portadores de CEC do TADA de 1990 a 2001 dividindo-os em dois grupos: 1) 47 doentes tratados com ECS e 2) 20 doentes tratados com ECRM (todos N+). Os casos do grupo 1 eram clinicamente N0 e, 11 tornaram-se pN+, após o exame histopatológico. Assim, no grupo 1 obtivemos doentes pN+ tratados com ECS e seguimos estes grupos por, no mínimo, 2 anos. O grupo 2 serviu como controle da evolução dos doentes pN+. RESULTADOS: Nossos resultados mostraram que na comparação do ECS com o ECRM, não houve diferença significativa quanto à evolução (sobrevivência ou recidiva), no entanto, foi possível evidenciar uma pior evolução nos doentes N+ quando comparados aos N0, demonstrando que o principal fator prognóstico é o comprometimento linfonodal. Além disso, apesar do pequeno número de doentes, observamos que os doentes mais idosos e com CEC de faringe tiveram pior evolução e, por isto, talvez não sejam candidatos ao ECS. CONCLUSÕES: Concluímos, portanto, que o ECS pode...

Tratamiento combinado de nasoangiofibromas mediante embolización y cirugía / Juvenile nasopharyngeal angiofibromas

Se revisaron los aspectos clínicos, imagenólógicos y terapéuticos de 19 pacientes con nasoangiofribroma juvenil, quienes fueron tratados entre 1997 y 2002 en el Hospital San Vicente de Paúl, Medellín, Colombia. Ellos tuvieron embolización prequirúrgica con micropartículas de alcohol polivinílico. Todos los pacientes fueron hombres con una edad promedio de 16,4 años. Seis estuvieron en categoría Chandier I; cuatro, en categoría Chandier II; cinco, en categoría Chandier III, y cuatro, en categoría Chandier IV de nasoangiofibromas juveniles. La pérdida de sangre durante la cirugía en los casos reportados tuvo un promedio de 1.600 cc. Se presentó recidiva en cinco pacientes que pertenecían a las categorías III y IV. No hubo complicaciones derivadas de la embolización

Sarcoma de Ewing de fosas nasales / Nasal fossa Ewingïs sarcoma

Se presenta un caso de sarcoma de Ewing localizado en fosas nasales, en un paciente de 21 años, cuya manifestación inicial fue epistaxis y obstrucción nasal, haciéndose evidente, posteriormente, una masa a nivel de fosa nasal izquierda. La tomografía computada y la resonancia nuclear magnética mostraron un extenso proceso expansivo de fosa nasal izquierda y techo de fosa nasal derecha, descartando compromiso de tejido encefálico. El diagnóstico de sarcoma de Ewing se hizo basado en los hallazgos histológicos y confirmado por el estudio inmunohistoquímico. El tratamiento consistió en una poliquimioterapia neoadyuvante agresiva asociada a radioterapia. Se realiza una revisión bibliográfica del tema, enfatizando la rara localización de este tumor a nivel de cabeza y cuello. Se analizan los métodos de diagnóstico, resaltando la importancia del estudio inmunohistoquímico. Se destaca que en la actualidad hay consenso en que la mejor terapia es la poliquimioterapia neoadyuvante agresiva seguida de radioterapia y/o cirugía para el control local de la enfermedad

Quistes dermoides nasoetmoidales: manejo quirúrgico / Nasoethmoidal dermoid cysts: surgical management

Los quistes dermoides nasoetmoidales son malformaciones congénitas infercuentes, de origen ectodérmico. clínicamente pueden presentarse como un nódulo subcutáneo y/o como un orificio fictuloso cutáneo con pelos, a cualquier nivel de la línea media nasal. A diferencia de los dermides de otras localizaciones, existe la posibilidad de compromiso de estructuras profundas y extensión intracraneal, pudiendo asociarse a graves complicaciones, como meningitis y abscesos cerebrales. Por esta motivo, los dermoides nasoetmoidales, demandan una adecuada evaluación imaginológica para planificar el abordaje quirúrgico, que permita la extirpación completa de la lesión. Por las características singulares de los quistes dermoides nasoetmoidales se consideró de interés presentar 3 casos clínicos de esta poco frecuente e interesante patología, tratados en la Unidad de Cirugía Plástica del Hospital Roberto del Río, entre los años 1999 y 2001. Se discuten posteriormente algunos aspectos relacionados con su epidemiología, etiopatogenia, evaluación y manejo quirúrgico

Resección creaneofacial en tumores rinosinusales / Craneofacial resection of rinosinusal tumors

Es la resección en monobloque de un sector del macizo facial realizada a traves de un abordaje combinado transcraneal y transfacial. La filosofía del método esta basada en que la resección transfacial pura es insuficiente para asegurar la radicalidad del tratamiento. El procedimiento fue usado por diversos autores desde Dandy en 1941 ampliandose sus indicaciones y poniendose a punto su técnica hasta la decada del 80. Sus indicaciones son: carcinomas T3 y T4 de etmoides, tumores con invasión endocraniana o de la lamina cribosa, tumores con invasión de las paredes superior y/o posterior de la órbita, tumores con invasión de la base de la pterigoides o el techo de la fosa intratemporal. Sus limitaciones son: invasión masiva del parenquima cerebral o del seno cavernoso. Se reconocen tres tipos de resección, de acuedo con su topografía, la que se basa en el aspecto topobolumétrico del tumor a tratar: 1) resección anterior craneoetmoidal, 2) resección anterior craneoorbitaria ...