Frontal osteomas: standardising therapeutic indications.

BACKGROUND: We believe the currently accepted indications for frontal osteoma surgery are inappropriate. We propose a new osteoma classification system, below, in order to standardise surgical decisions. METHOD: Osteomas were classified based on: relationship of tumour mass to sinus size; tumour proximity to the infundibulum, destruction of sinus walls, and complications. Forty-five osteoma cases were thus classified (1971-2007), 29 of which underwent surgery (64.44 per cent). RESULTS: Three stages were thus derived: I, tumour/air fraction less than one-third, tumour distant from the infundibulum, no sinusitis, and no complications (18 patients (40 per cent)); II, tumour/air fraction one-third to one-half, no infundibular obstruction, no bone destruction, no sinusitis, and no complications (six (13.33 per cent)); and III, tumour/air fraction more than one-half, partial or total infundibular obstruction, sinusitis, bone destruction, and/or complications (21 (46.67 per cent)). CONCLUSION: Study findings suggest the following surgical indications: stage I, no surgery required, implement monitoring protocol; stage II, implement monitoring protocol, surgery may be required depending on tumour severity and general patient condition; and stage III, surgery always required. This system provides a method of standardising osteoma surgical decisions.

[Diagnosis and treatment of carotid body paragangliomas. Presentation of 9 cases and review of the literature]. / Diagnóstico y tratamiento de los paragangliomas carotídeos. Presentación de nueve casos y revisión de la literatura.

Carotid body paragangliomas (CBP) are relatively rare tumors arising from the carotid body paraganglion. Clinical signs and images are necessary to establish the diagnosis. Surgery is the preferred method of treatment, paying special attention to the carotid artery. Nine patients with carotid body tumors were identified, three of them with complicated diagnosis. One patient is treated with radiotherapy. Out of the eight surgical patients, three preserved the whole arterial structure, the external carotid artery is resected in two patients, the carotid artery is replaced (safen graft, gore tex prosthesis) in other two patients, and the common carotid was tied in the remaining patient. Our objective is to show the decisions taken in the patients from our casuistic, comparing them to the literature data. We conclude that the diagnosis may be deceptive, and that the attitude forward the carotid is variable, always being prepared to do arterial replacement techniques.

[Modelling of the geometry of the external auditory canal by the finite elements method]. / Modelado de la geometría del conducto auditivo externo mediante el método de los elementos finitos.

The aim of this work is to design a computerized 3-D model of the human external ear, based on the finite elements method. The method consists to splitting a specific special area in a simple element net connected between themselves by nodes. The elements are associated to equations that define their physical characteristics. We realize a coupling with the middle ear model to know the behaviour of both systems with an acoustic excitation without the use of real measures or biological models. The model simulates the acoustic and biomechanic characteristics of the human external auditory canal. The development of a computerized model allows a better knowledge of the external ear mechanic-acoustic behaviour, this makes easier understand the physiology of the human external ear.

[Esthesioneuroblastoma treatment]. / Tratamiento del estesioneuroblastoma. Revisión de la literatura.

INTRODUCTION: Esthesioneuroblastoma is an uncommon malignancy of the olfactory neuroepithelium. The best treatment has yet to be defined. The purpose of this study is to analyze the tumors's behaviour to choose the ideal treatment, the therapeutic strategy and the patterns of failure. MATERIALS AND METHODS: We carry out a revision of the series published between 1994 to 2004. In these series, we found 39 papers with 713 patients. CONCLUSIONS: In this review the 5-years survival rate is 51.2%. Through the analysis of 583 partients found in 34 publications, surgery (alone or combined) is the treatment most used (78%). The commonly management is surgical in combination with radiotherapy (47%).

[Stapedotomy, stapedectomy and revision surgery performed with laser techniques. Revision of literature]. / Estapedotomía, estapedectomía y cirugía de revisión realizados con técnica láser. Análisis de la evolución de los sistemas.

The usefulness of laser in otologic surgery, and specifically the suitability of its use in stapes surgery, is still under discussion. We intend to support the use of this method in the surgical treatment of otosclerosis, as well as to elucidate which type of laser is the most advisable one, establishing also in which stages of surgery it should be used. For this, we carry out a revision of the main opinions published in this regard in the international literature, commenting on the results and observations gathered in it. We end by setting out a number of conclusions which are the result of the analysis of the criteria put forward in the bibliography.

[Bilateral thrombosis of the internal jugular vein due to laryngeal surgery]. / Trombosis bilateral de la vena yugular interna tras cirugía laríngea.

Reporting one case of bilateral thrombosis of internal jugular vein in absence of neck's space handling or other systemic elements justifying the pathology. Clinical description, evolutive course and treatment performed. Review of corresponding literature what allowed us to classify the case between the idiopathic thrombosis jugularis after neck's surgery, surely brought about for the forced position of the neck for long time.

[Computerized 3-D model to study biomechanics of the middle ear using the finite element method]. / Modelo computadorizado 3-D para el estudio de la biomecánica del oído medio con el método de los elementos finitos (MEF).

Based on known data about the behavior of the sound transmission mechanism, we generate a model that reproduces the real mechanics of the middle ear by the finite elements method in the most exact manner possible. We designed a computerized model to simulate the biomechanic behavior of the ear drum/ossicular chain. The investigation focused on a possible clinical application, given that the variables necessary for simulation of several conditions can be introduced in our model: tympanic perforation, fixation of the ossicular chain, chain interruption, etc. Introducing the characteristics of the lesion virtually in a simulator program market is possible to reach conclusions about the conductive hypoacusis created and about therapeutic possibilities. The 3-D modelling of the tympanic membrane, malleus, incus and stapes is presented, considering form, weight, density, Young's module (N/m2) and Poisson coefficient for the different parts of each ossicle. The modeling of the union of the different tympanic-ossicular elements, including muscles and ligaments, is also shown.

[Otosclerosis and Van der Hoeven's syndrome: a contribution]. / Aportación al estudio de la otosclerosis y del síndrome de Van der Hoeve.

Morphological and microchemical changes that effect to the otosclerotic stape in the Van der Hoeve's syndrome were examined with a scanning electron microscope equipped with an energy dispersive X-ray fluorescence. Using the Ca/P ratio as criterion--measured by the characteristic x-ray fluorescence--it was shown that the Van der Hoeve stape had a higher Ca/P ratio (2.6:1) as compared to the normal stape (2:1). The Van der Hoeve's syndrome lesions as poorly mineralized, with low calcium salt and apparent increase of phosphates. This finding indicates a possible change from hydroxyapatite (or apatite) to brushite, which imply an acidification of bone.

Scanning electron microscopy images and energy-dispersive X-ray microanalysis of the stapes in otosclerosis and Van der Hoeve syndrome.

OBJECTIVE/HYPOTHESIS: The objective of this study was to evaluate the morphological and microchemical changes that affect sclerotic stapes in otospongiosis and van der Hoeve syndrome. METHODS: A scanning electron microscope equipped with an energy-dispersive x-ray analyzer was used in the experiments. RESULTS: In otosclerosis, focal lesions are poorly mineralized, with low calcium salt and reduced calcium-to-phosphorus (Ca/P) ratio (1.9:1). This finding correlates with a spongiotic type of lesion and indicates unstable mineralization with possible change from hydroxyapatite to calcium triphosphate. In van der Hoeve syndrome the presence of magnesium in stapes suggests osteoclastic function stimulation. The osteoclasts secrete many protons, causing an acidified microenvironment. Brushite is formed, and Ca/P ratio decreases in comparison with that of control patients (2.0:1 vs. 2.6:1).

Structure of the principal olfactory tract.

Although the purpose and importance of the sense of smell in human beings has not been totally clarified, it is one of the principal information channels in macrosmatic animals. It was the first long-distance information system to have appeared in phylogenetic evolution. The objective of this article is to deepen the knowledge of the pathways that join the olfactory epithelium with the cortical olfaction areas, to better understand olfactory dysfunction in human beings. Differential staining and marking techniques were applied to histologic sections obtained from 155 animals of different species, to study the different connections existing among olfactory tract components. Our study of the connections between the olfactory mucosa and the principal olfactory bulb deserves special mention. The distribution of second neuron connections of the olfactory tract with the central nervous system is quite complex and diffuse. This indicates an interrelation between the sense of smell and a multitude of functions. These connections seem to be of different quantitative importance according to species, but qualitatively they exist in both human beings and other macrosmatic animals.

Proposed classification scheme for quantitative olfactory function alterations.

Given the need for a clinical classification for daily patient examinations to refer to each type of quantitative alteration in the sense of smell, we have created a topographic classification of such alterations, establishing groups to distinguish among patients with decreased or total loss of olfaction. Because the classification is based on the diagnosis of the different causes of anosmia, it implicitly includes etiologic and topographic considerations. We have established 3 main groups on the basis of the site of the causal lesion: conduction, sensorineural, and mixed anosmias. In addition, within the sensorineural anosmias, we distinguish between the epithelial, retroepithelial, and central anosmias.

[Carcinoma of the nasopharynx, radiotherapy, otitis, labyrinthitis, inflammation of the petrous bone, meningitis]. / Cáncer de cávum, radioterapia, otitis, laberintitis, petrositis, meningitis.

Endocranial complications of otitis show new etiopathogenic possibilities. We have accomplished an analysis of this issue after one of these cases. A female patient with a nasopharyngeal carcinoma developed an otogenous meningitis. Radiotherapeutic management was followed by osteoradionecrosis of cranial basis, local hypoimmunity favorized the reported course: middle otitis, labyrinthitis, petrositis and meningitis. Comments on pathogenetic, clinic and therapeutical peculiarities of this case.

[Microsurgical approach and graft anastomosis to the trunk of the facial nerve in the Wistar rat]. / Abordaje microquirúrgico y anastomosis de injertos en el tronco del nervio facial de la rata Wistar.

An experimental model was developed for the purpose of investigating neural regeneration of the facial nerve in Wistar rats. The anatomic references used to locate the facial nerve at its exit from the skull base are described. A detailed description of the microsurgical anastomosis of cryopreserved nerve allografts is given. The major advantages and disadvantages of rat models compared with other animal models for experimental studies of the facial nerve are discussed.

[Morphological and morphometric study of sphenoidal sinus]. / Estudio morfológico y morfométrico del seno esfenoidal.

Thanks to the help of anatomical dissections and imaging techniques we way present this paper in which are described the morphologic characteristics of the sinus, its pneumatization types more frequently encountered, the traits more noteworthy related to the intersinusal partition and bone crests inside the sinus as well the distances detaching the sinus from the anterior wall of the sella turcica and clivus, through which wall the sinus cavity keeps in touch with noble cranial structures as the hypophysis and the brain stem. Ultimately our outcomes are compared with those given by other researchers.

[Chronological development of the sphenoidal sinus]. / Desarrollo cronológico del seno esfenoidal.

In this paper are exposed the main characteristics of the sphenoidal sinus rise, through a follow-up of its growth during the life-span of the first 20 years of life. For so doing the AA. studied the antero-posterior diameters, the vertical greatest diameter and the several distances detaching this sinus from other important anatomical references, as well the various degrees of pneumatization that the cavity may reach according as the years go over.

[Upper aerodigestive infections and their effect on sphenoidal sinus development]. / Influencia de las infecciones de las vías aerodigestivas altas sobre el desarrollo del seno esfenoidal.

Paranasal sinuses development and its ultimate mode of happening as well, has been the purpose of numerous hypotheses, that can be synthetized in this two: One which sees the pneumatization as mechanical event resulting from muscular tractions exerted on the sphenoidal sinus walls and another one supposing the pneumatization as an active phenomenon due to the osteoclastic potential of the same respiratory mucous membrane. In this work were employed 200 radiogramms belonging both to patients suffering chronic ENT infections and subjects without antecedents. The conclusion drawn out are that chronic infections do not modify the percentage of pneumatization types, but reduce the anteroposterior maximal diameter.

[The dorsal flap in laboratory animals]. / El colgajo dorsal en el animal de experimentación.

A total of 108 flaps were fashioned in the dorsal area of laboratory animals (47 pedicle and 7 free) and 54 myocutaneous (32 pedicle and 22 free). The anatomical characteristics of the dorsal flap in the rabbit are presented and the microsurgical technique utilized in elaborating free flaps are described. In comparing survival of the different flap types, a greater survival rate (p < 0.05) was found for myocutaneous than cutaneous; and for pedicle than free flaps. In addition it was verified than arterial flow is indispensable for flap survival.

[Dorsal flap in laboratory animals. Prediction of its viability]. / El colgajo dorsal en el animal de experimentación: predicción de la viabilidad.

Various types of flaps were fashioned in the dorsal area of laboratory animals (rabbits). Subjective and objective methods were evaluated as means of prediction of flap viability: superficial cutaneous temperature and cutaneous fluorescence test. It was verified that subjective methods served to help prognosticate flap viability, while superficial cutaneous temperature annotations were unreliable as indicators. Finally, the cutaneous fluorescence test was revealed to be an ideal method of predicting the viability of transferred tissue.