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.

Diagnóstico y tratamiento de los paragangliomas carotídeos. Presentación de nueve casos y revisión de la literatura / Diagnosis and treatment of carotid body paragangliomas

Los paragangliomas carotídeos (PC) son tumores infrecuentes derivados de los paraganglios del cuerpo carotídeo. Al diagnóstico se llega por la clínica y las imágenes. El tratamiento es quirúrgico, siendo fundamental la actitud ante la arteria carótida. Presentamos nueve pacientes, en tres de ellos el diagnóstico es complejo. Un caso se trata con radioterapia. De los ocho pacientes operados: en tres se conserva la totalidad de la estructura arterial, en dos casos se reseca la carótida externa, en dos enfermos se sustituye la carótida (un injerto de safena, una prótesis de gore tex), en una paciente se liga la carótida común. Nuestro objetivo es referir las decisiones tomadas en los pacientes de nuestra casuística, comparándolas con los datos de la literatura. Concluimos que el diagnóstico puede ser engañoso y que la actitud ante la carótida es variable, debiéndose tener siempre prevista la realización de técnicas de sustitución arterial

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.

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

El objetivo del trabajo es diseñar un modelo computadorizado tridimensional del conducto auditivo externo humano. Nos basamos en el método de los elementos finitos, que consiste en dividir un determinado recinto espacial en una malla de elementos simples conectados entre sí por nodos, asociando después a cada elemento ecuaciones que definen sus características físicas. Al resolver las ecuaciones resultantes se logra reproducir la realidad mediante una ejecución numérica computadorizada. El modelo reproduce las características acústicas y mecánicas del conducto auditivo externo humano, lo que nos permitirá, tras acoplarlo a un modelo del oído medio, conocer la respuesta de ambos sistemas ante una excitación sonora, sin necesidad de acudir a mediciones reales o modelos biológicos. El desarrollo de este modelo computadorizado permite conocer las características mecanoacústicas del conducto, lo que facilita la comprensión de la fisiología de esta porción externa del órgano de la audición

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%).

Tratamiento del estesioneuroblastoma. Revisión de la literatura / Esthesioneuroblastoma treatment

Introducción: El estesioneuroblastoma es un tumor maligno infrecuente originado en el epitelio olfatorio. No existe acuerdo sobre el mejor sistema de tratamiento. Son objetivos principales de este trabajo analizar qué características de estaneoplasia pueden influir en la elección de su tratamiento, cuáles la estrategia terapéutica más utilizada y qué tasas de supervivencia se alcanzan. Material y Métodos: Se realiza una revisión de las publicaciones aparecidas entre 1990 y 2004 útiles al fin de esta investigación. Resultados y conclusiones: El dato con más base de información estudia la tasa de supervivencia a 5años, que es de 51,2%; esta cifra se obtiene por la constatación de 39 trabajos que incluyen 713 casos clínicos. Por el análisis de 583 pacientes extraídos de 34 publicaciones conocemos quela cirugía, sola o combinada, es el medio terapéutico más utilizado (78%) y que la estrategia más habitual es la combinación de cirugía y radioterapia (47% de los casos) (AU)

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 with713 patients. Discussion. Conclusions: In this review the 5-yearssurvival rate is 51.2%. Through the analysis of 583 patients found in 34 publications, surgery (alone or combined) is the treatment most used (78%). The commonly management is surgical in combination with radiotherapy (47%) (AU)

[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.

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

Se sigue discutiendo la utilidad del láser en la cirugía otológica y concretamente la adecuación de su empleo a la cirugía del estribo. Pretendemos apoyar el uso de este medio en el tratamiento quirúrgico de la otosclerosis y además dilucidar qué tipo de láser es el más aconsejable, definiendo también en qué tiempos de la cirugía puede emplearse. Para ello efectuamos una revisión de las principales opiniones que al respecto han aparecido en la literatura internacional, comentando los resultados y observaciones que en ella se reúnen. Finalizamos exponiendo unas conclusiones que son fruto del análisis de los criterios expuestos en la bibliografía. (AU)

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 (AU)

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

Basándonos en los datos ya conocidos sobre el comportamiento de los mecanismos de transmisión del sonido, creamos un modelo que reproduce la actividad mecánica del oído medio, utilizando el método de los elementos finitos. Diseñamos un modelo computadorizado que simula el comportamiento biomecánico de la membrana timpánica y la cadena osicular. Centramos el interés de la investigación en sus posibles aplicaciones clínicas, pudiendo introducir en el modelo las variables necesarias para la simulación de distintas situaciones: perforaciones timpánicas, fijaciones osiculares, interrupciones de la cadena, etc. Suministrando al programa simulador las características de la lesión creamos un modelo virtual sobre el que podemos valorar la hipoacusia existente y las posibilidades terapéuticas. Realizamos este modelo 3-D de membrana timpánica, martillo, yunque y estribo considerando su forma, peso, densidad, módulo de Young (N/m2) y coeficiente de Poisson, para las diferentes partes del sistema. Mostramos también la modelización de los elementos de unión entre los diferentes elementos tímpano-osiculares, incluidos músculos y ligamentos (AU)

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 (AU)

[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.

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.