Miringoplastia con cartílago en alas de mariposa. Nuestra experiencia / Inlay butterfly miringoplasty. Our experience

Introducción: Se han propuesto múltiples técnicas quirúrgicas para cerrar perforaciones timpánicas. Eavey, hace dos décadas, describió una técnica destinada a cerrar perforaciones centrales en niños. Para ello diseñó un injerto de cartílago con forma de alas de mariposa que se colocaba entre la membrana timpánica. Dicha técnica demostró gran efectividad para el cierre de perforaciones así como baja morbilidad, rapidez y gran diferencia económica. Métodos: Se realiza un estudio descriptivo de serie de casos analizando 32 intervenciones en niños y adultos con la técnica de Eavey modificada, durante el periodo de enero de 2012 a noviembre de 2016. Se evaluaron los resultados quirúrgicos y los resultados funcionales audiométricos. Resultados: El éxito quirúrgico se logró en el 93% de los casos, incluyendo los cierres completos en 27 pacientes (84%) y 3 casos en los que se presentaron dehiscencias mínimas asintomáticas. Se presentó un rechazo del injerto y persistencia de la perforación y en un caso una perforación residual. No se describen complicaciones quirúrgicas o posquirúrgicas mayores asociadas al procedimiento. La mejoría de la media del gap audiométrico fue de 17 dB preoperatorio a 7dB posterior a la intervención. Conclusiones: La técnica de Eavey modificada es un procedimiento con baja morbilidad, costo-efectiva, con facilidad técnica que demuestra ser eficaz para el cierre de perforaciones timpánicas en adultos y niños (AU)

Introduction: Multiple surgical techniques have been proposed to close tympanic perforations. Eavey, two decades ago, described a technique aimed at closing central perforations in children. For this, he designed a butterfly-shaped cartilage graft that was placed between the tympanic membrane in an inlay manner. This technique showed great effectiveness for the closure of perforations as well as low morbidity, rapidity and great economic difference. Methods: We performed a descriptive study of a series of cases analysing 32 interventions in children and adults with the modified Eavey technique, during the period from January 2012 to November 2016. We evaluated the surgical and audiometric functional results. Results: Surgical success was achieved in 93% of cases, including complete closures in 27 patients (84%) and 3 cases in which minimal asymptomatic dehiscences occurred. There was rejection of the graft and persistence of the perforation in only one case. No major surgical or postoperative complications associated with the procedure were described. The mean improvement in the audiometric gap was from 17 dB preoperatively to 7 dB after the intervention. Conclusions: The modified Eavey technique is a low morbidity, cost-effective procedure with a technical facility that proves effective for the closure of tympanic perforations in adults and children (AU)

Inlay butterfly miringoplasty. Our experience. / Miringoplastia con cartílago en alas de mariposa. Nuestra experiencia.

INTRODUCTION: Multiple surgical techniques have been proposed to close tympanic perforations. Eavey, two decades ago, described a technique aimed at closing central perforations in children. For this, he designed a butterfly-shaped cartilage graft that was placed between the tympanic membrane in an inlay manner. This technique showed great effectiveness for the closure of perforations as well as low morbidity, rapidity and great economic difference. METHODS: We performed a descriptive study of a series of cases analysing 32 interventions in children and adults with the modified Eavey technique, during the period from January 2012 to November 2016. We evaluated the surgical and audiometric functional results. RESULTS: Surgical success was achieved in 93% of cases, including complete closures in 27 patients (84%) and 3 cases in which minimal asymptomatic dehiscences occurred. There was rejection of the graft and persistence of the perforation in only one case. No major surgical or postoperative complications associated with the procedure were described. The mean improvement in the audiometric gap was from 17dB preoperatively to 7dB after the intervention. CONCLUSIONS: The modified Eavey technique is a low morbidity, cost-effective procedure with a technical facility that proves effective for the closure of tympanic perforations in adults and children.

Abordaje por fosa media, aplicaciones en lesiones del hueso temporal / Middle fossa approach: Applications in temporal bone lesions

El abordaje por fosa media es una técnica quirúrgica de gran utilidad en la cirugía de base de cráneo lateral. Si bien es cierto, que por sus restringidas indicaciones así como por su complejidad técnica ha tenido una implantación limitada. Presentamos nuestra experiencia en 10 pacientes en los cuales por gran complejidad del proceso, la situación o la extensión de la lesión, el abordaje por fosa media fue el tratamiento de elección. A pesar de la gran complejidad de los casos no hubo ningún caso de mortalidad asociada a la cirugía. De la morbilidad registrada destacar un hematoma epidural y un hematoma córtico-subcortical. La función auditiva se preservó en 5 pacientes de los 7 pacientes que presentan audición en el momento de la cirugía. En 8 pacientes se logró una función facial House/Brackmann I-II y en los 2 restantes no hubo empeoramiento de la misma función. En 9 de los 10 pacientes se realizó una cirugía resolutiva de la patología. El abordaje por fosa media es una técnica quirúrgica segura y fiable. Nos proporciona un gran control y exposición de los diferentes procesos patológicos de la base de cráneo. Consideramos de gran importancia su conocimiento, pues en determinados pacientes puede ser la única alternativa viable y resolutiva, de ahí la importancia de difundir este abordaje en nuestra especialidad (AU)

The middle fossa approach is a surgical technique that is very useful for lateral skull base surgery. However, it is true that it has limited surgical indications and implementation due to its technical complexity. We present our experience in 10 patients in whom the middle fossa approach was the treatment of choice because of the extent of the injury and complexity of the lesion or process. Despite the complexity of the cases, there was no mortality associated with surgery. Postoperative complications were found in 2 patients who presented an epidural hematoma and a cortico-subcortical hematoma. Hearing function was preserved in 5 patients out of the 7 who had adequate hearing at the time of surgery. House/Brackmann I-II facial nerve function was achieved in 8 patients; the remaining 2 had no deterioration of the nerve function. In 9 out of 10 patients, the surgery achieved complete solution of the lesion. The middle fossa approach is a safe and reliable surgical technique. It gives us great control and exposure of different skull base processes. We consider its knowledge of great importance, because it may be the only viable surgical alternative in some specific patients. That is the reason why it is important to learn this approach and know about it in our specialty (AU)

Middle fossa approach: Applications in temporal bone lesions. / Abordaje por fosa media, aplicaciones en lesiones del hueso temporal.

The middle fossa approach is a surgical technique that is very useful for lateral skull base surgery. However, it is true that it has limited surgical indications and implementation due to its technical complexity. We present our experience in 10 patients in whom the middle fossa approach was the treatment of choice because of the extent of the injury and complexity of the lesion or process. Despite the complexity of the cases, there was no mortality associated with surgery. Postoperative complications were found in 2 patients who presented an epidural hematoma and a cortico-subcortical hematoma. Hearing function was preserved in 5 patients out of the 7 who had adequate hearing at the time of surgery. House/Brackmann I-II facial nerve function was achieved in 8 patients; the remaining 2 had no deterioration of the nerve function. In 9 out of 10 patients, the surgery achieved complete solution of the lesion. The middle fossa approach is a safe and reliable surgical technique. It gives us great control and exposure of different skull base processes. We consider its knowledge of great importance, because it may be the only viable surgical alternative in some specific patients. That is the reason why it is important to learn this approach and know about it in our specialty.

Tumor de células basales en seno maxilar: presentación inusual / Basal cell adenoma in maxillary sinus: unusual presentation

Presentamos un caso de tumor de células basales de glándula salival menor localizado en el seno maxilar, localización extraordinariamente infrecuente. No se han hallado casos previos en la literatura médica inglesa ni española (AU)

We report a case of basal cell adenoma of a minor salivaly gland in the maxillary sinus, an extremely infrequent location. We have not found similar previous cases reported (AU)

Basal cell adenoma in maxillary sinus: unusual presentation.

We report a case of basal cell adenoma of a minor salivaly gland in the maxillary sinus, an extremely infrequent location. We have not found similar previous cases reported.