Facial nerve palsy following parotid gland surgery: A machine learning prediction outcome approach.

Introduction: Machine learning (ML)-based facial nerve injury (FNI) forecasting grounded on multicentric data has not been released up to now. Three distinct ML models, random forest (RF), K-nearest neighbor, and artificial neural network (ANN), for the prediction of FNI were evaluated in this mode. Methods: A retrospective, longitudinal, multicentric study was performed, including patients who went through parotid gland surgery for benign tumors at three different university hospitals. Results: Seven hundred and thirty-six patients were included. The most compelling aspects related to risk escalation of FNI were as follows: (1) location, in the mid-portion of the gland, near to or above the main trunk of the facial nerve and at the top part, over the frontal or the orbital branch of the facial nerve; (2) tumor volume in the anteroposterior axis; (3) the necessity to simultaneously dissect more than one level; and (4) the requirement of an extended resection compared to a lesser extended resection. By contrast, in accordance with the ML analysis, the size of the tumor (>3 cm), as well as gender and age did not result in a determining favor in relation to the risk of FNI. Discussion: The findings of this research conclude that ML models such as RF and ANN may serve evidence-based predictions from multicentric data regarding the risk of FNI. Conclusion: Along with the advent of ML technology, an improvement of the information regarding the potential risks of FNI associated with patients before each procedure may be achieved with the implementation of clinical, radiological, histological, and/or cytological data.

[Hypopharyngeal cancer: analysis of the evolution and treatment results]. / Cáncer de hipofaringe: análisis de la evolución y los resultados del tratamiento en nuestro medio.

OBJECTIVE: Hypopharyngeal carcinoma is an aggressive malignancy usually diagnosed at a late state, thereby resulting in overall poor prognosis and low survival rates for these patients. The purpose of this study is to present the progress and outcomes of patients treated for hypopharyngeal carcinoma at our department. MATERIAL AND METHOD: We retrospectively reviewed 89 patients who had been diagnosed with hypopharygeal carcinoma between 1980 and 2005. Most of the tumours were advanced (T3 and T4) and 73 % showed palpable regional metastases at presentation. RESULTS: The five-year survival rate was 40.7 %. The overall incidence of distant metastases and subsequent primary neoplasms was 7.5 % and 23.5 %, respectively. CONCLUSIONS: Hypopharyngeal cancer is still the one with the worst prognosis in the head and neck area. The poor survival rate seems to be related primarily to advanced stage disease at presentation and particularly to the status of cervical lymph-node metastases.

Cáncer de hipofaringe: análisis de la evolución y los resultados del tratamiento en nuestro medio / Hypopharyngeal cancer: analysis of the evolution and treatment results

Objetivo: el cáncer de hipofaringe es un cáncer muy agresivo que generalmente se diagnostica en estadios muy avanzados, su pronóstico es desalentador y la tasa de supervivencia, muy baja. El objetivo de este estudio es presentar la evolución y los resultados de los pacientes tratados de cáncer de hipofaringe en nuestro servicio. Material y método: realizamos un estudio retrospectivo en 89 pacientes diagnosticados de cáncer de hipofaringe entre los años 1980 y 2005. En su mayoría se trataba de tumores avanzados (T3 y T4) y el 73 % presentaba adenopatías palpables en el momento del diagnóstico. Resultados: la supervivencia a los 5 años fue del 40,7 %. Encontramos una incidencia de metástasis a distancia y segundos tumores primarios de un 7,5 y un 23,5 %, respectivamente. Conclusiones: el carcinoma de hipofaringe continúa siendo el cáncer de cabeza y cuello de pronóstico peor. La tasa de supervivencia parece estar relacionada primariamente con el estadio tumoral de presentación y, de forma particular, con el estado de los ganglios linfáticos cervicales (AU)

Objective: hypopharyngeal carcinoma is an aggressive malignancy usually diagnosed at a late state, thereby resulting in overall poor prognosis and low survival rates for these patients. The purpose of this study is to present the progress and outcomes of patients treated for hypopharyngeal carcinoma at our department. Material and method: We retrospectively reviewed 89 patients who had been diagnosed with hypopharygeal carcinoma between 1980 and 2005. Most of the tumours were advanced (T3 andT4) and 73 % showed palpable regional metastases at presentation. Results: The five-year survival rate was 40.7 %. The overall incidence of distant metastases and subsequent primary neoplasms was 7.5 % and 23.5 %, respectively. Conclusions: Hypopharyngeal cancer is still the one with the worst prognosis in the head and neck area. The poor survival rate seems to be related primarily to advanced stage disease at presentation and particularly to the status of cervical lymph-node metastases (AU)

[Malignant multiple neoplasms in head and neck squamous cell carcinoma]. / Neoplasias malignas múltiples en el cáncer escamoso de cabeza y cuello.

INTRODUCTION: The incidence of multiple malignant neoplasms in the upper aerodigestive tract is high and ranges from 7% to 20%. We make a retrospective study to evaluate the incidence of multiple malignant neoplasms in head and neck squamous cell carcinomas, their main characteristics and survival. MATERIAL AND METHOD: We studied 103 multiple malignant neoplasms from an oncological database of 1330 patients with head and neck squamous cell carcinomas. We use the SPSS v15 for analysis of the results. RESULTS: The incidence of multiple malignant neoplasms in our series is 7.73 %. Tumours of the hypopharynx are the primary tumours most often associated with multiple malignant neoplasms (21.34 %), followed by tumours of the oropharynx (15.38 %). Lung tumours are the multiple malignant neoplasms most often associated (29.03 %). The 5-year global survival is 33 % from diagnosis of the second primary tumour, 78.02 % of which are metachronous with an average of 40 months between the diagnosis of the primary tumour and the presentation of the second tumour. CONCLUSIONS: Multiple malignant neoplasms are very frequent in the head and neck area which shows the importance of thorough regular check-ups of these patients as the presence of multiple malignant neoplasms considerably worsens the prognosis.

Neoplasias malignas múltiples en el cáncer escamoso de cabeza y cuello / Malignant multiple neoplasms in head and neck squamous cell carcinoma

Introducción: La frecuencia de neoplasias malignas múltiples en el tracto aerodigestivo superior es elevada y varía de un 7 a un 20 %. Valoramos la frecuencia de segundos tumores primarios en carcinomas escamosos de cabeza y cuello, y determinamos sus principales características y la supervivencia. Material y método: Realizamos un estudio retrospectivo con 103 segundos tumores primarios de una base de datos de 1.330 pacientes con carcinomas epidermoides de cabeza y cuello. Empleamos el programa SPSS v15 para el análisis de resultados. Resultados: La frecuencia de segundos tumores primarios en nuestra serie es del 7,73 %. Los tumores primarios que más frecuentemente asocian segundos tumores primarios son los de hipofaringe (21,34 %), seguidos de los de orofaringe (15,38 %). El segundo tumor primario más frecuentemente asociado es el de pulmón (29,03 %). La supervivencia general es del 33 % a los 5 años del diagnóstico del segundo tumor primario. El 78,02 % de los segundos tumores primarios son metacrónicos, con una media de 40 meses entre el diagnóstico del tumor primario y la aparición del segundo tumor primario. Conclusiones: Los segundos tumores primarios son muy frecuentes en el área de cabeza y cuello, lo cual resalta la importancia de un control periódico y exhaustivo de estos pacientes ya que su aparición conlleva un ensombrecimiento importante del pronóstico (AU)

Introduction: The incidence of multiple malignant neoplasms in the upper aerodigestive tract is high and ranges from 7% to 20%. We make a retrospective study to evaluate the incidence of multiple malignant neoplasms in head and neck squamous cell carcinomas, their main characteristics and survival. Material and method: We studied 103 multiple malignant neoplasms from an oncological database of 1330 patients with head and neck squamous cell carcinomas. We use the SPSS v15 for analysis of the results. Results: The incidence of multiple malignant neoplasms in our series is 7.73 %. Tumours of the hypopharynx are the primary tumours most often associated with multiple malignant neoplasms (21.34 %), followed by tumours of the oropharynx (15.38 %). Lung tumours are the multiple malignant neoplasms most often associated (29.03 %). The5-year global survival is 33 % from diagnosis of the second primary tumour, 78.02 % of which are metachronous with an average of 40 months between the diagnosis of the primary tumour and the presentation of the second tumour. Conclusions: Multiple malignant neoplasms are very frequent in the head and neck area which shows the importance of thorough regular check-ups of these patients as the presence of multiple malignant neoplasms considerably worsens the prognosis (AU)

[Hemithyroidectomy: when it is necessary an intraoperative frozen-section biopsy?]. / Hemitiroidectomías: Ecuándo es necesaria la biopsia intraoperatoria?

INTRODUCTION: Many surgeons use intraoperative frozen section biopsy of the thyroid nodules to confirm malignant disease, but it continues to generate considerable controversy. We reviewed our recent experience to determinate de clinical utility of frozen section in our surgical management and intraoperative decision-making. PATIENTS AND METHOD: All patients who had operations for the thyroid nodular disease between 2000 and 2006 were included in this retrospective study. We compared the results of frozen section diagnosis and definitive histologic results in a population of 212 patients. RESULTS: Frozen section was false negative in 3 patients (1.66 %) and false positive in 1 (0.47 %) and avoided 12 reoperations (5.6 %). When there was not suspicious malignant disease had a sensitivity of 0.75 %. In the group of follicular disease the sensitivity was 3.7 %, and in the group with suspicious malignant disease was 37.5 %. CONCLUSIONS: Frozen section was more helpful in the group of suspicious for malignant disease. It does not seem to be necessary when fine-needle biopsy indicates bening or follicular disease.

Hemitiroidectomías: ¿cuándo es necesaria la biopsia intraoperatoria? / Hemithyroidectomy: when it is necessary an intraoperative frozen-section biopsy?

Introducción: Muchos cirujanos utilizan la biopsia intraoperatoria de los nódulos tiroideos para confirmar malignidad, pero continúa generando bastante controversia. Hemos revisado nuestra experiencia reciente para determinar la utilidad clínica de la biopsia extemporánea en la toma de decisiones intraoperatorias. Pacientes y método: Se incluyó en este estudio retrospectivo a todos los pacientes sometidos a una cirugía tiroidea por nódulo tiroideo entre 2000 y 2006. Comparamos los resultados de la biopsia introperatoria con los de la anatomía patológica definitiva en una población de 212 pacientes. Resultados: La biopsia extemporánea tuvo un resultado falso negativo en 3 (1,67 %) pacientes y falso positivo en 1 (0,47 %). Evitó 12 (5,6 %) reintervenciones. Cuando no hubo sospecha previa de malignidad, su sensibilidad fue del 0,75 %. En el grupo de lesiones foliculares su sensibilidad fue del 3,7 % y en el sospechoso de malignidad del 37,5 %. Conclusiones: La biopsia extemporánea fue más útil en el grupo con sospecha de malignidad. No parece ser necesaria cuando la punción-aspiración con aguja fina indica que es benigna o de tipo folicular

Introduction: Many surgeons use intraoperative frozen section biopsy of the thyroid nodules to confirm malignant disease, but it continues to generate considerable controversy. We reviewed our recent experience to determinate de clinical utility of frozen section in our surgical management and intraoperative decision-making. Patients and method: All patients who had operations for the thyroid nodular disease between 2000 and 2006 were included in this retrospective study. We compared the results of frozen section diagnosis and definitive histologic results in a population of 212 patients. Results: Frozen section was false negative in 3 patients (1.66 %) and false positive in 1 (0.47 %) and avoided 12 reoperations (5.6 %). When there was not suspicious malignant disease had a sensitivity of 0.75 %. In the group of follicular disease the sensitivity was 3.7 %, and in the group with suspicious malignant disease was 37.5 %. Conclusions: Frozen section was more helpful in the group of suspicious for malignant disease. It does not seem to be necessary when fine-needle biopsy indicates bening or follicular disease

[Revision stapedectomy]. / Cirugía de revisión de las estapedectomías.

OBJECTIVE: The aim of the study was to determine the causes of failure in otosclerosis surgery. MATERIAL AND METHOD: We performed 23 revisions of stapedectomy during the period between January 2000 and April 2005. The time between the primary surgery and the revision surgery ranged from 3 months to 25 years. The most frequent reasons for revision surgery were first of all patients with closed initial gap and progressive hearing loss in 56.52 % of cases and secondly patients without any initial hearing improvement in 39.12 % of cases. RESULTS: The main surgical findings were: short prosthesis in correct position (13.04 %), displaced prosthesis (60.87 %), bridles over the oval window (65.22 %), necrosis of the long process of the incus (26.2 %), and obliterative footplate (26.09 %). As for the audiometric results, we got a complete closure of gap in 60.8 % of patients (n = 14), partial closure of gap in 13.2 % (n = 3), persistence of the initial gap in 21.7 % (n = 5), and cophosis in 4.3 % (n = 1). CONCLUSIONS: The migration of the prosthesis is the main cause of failure after stapedectomy. Good closure of the gap was achieved in two thirds of the patients.

Cirugía de revisión de las estapedectomías / Revision stapedectomy

Objetivo: Determinar las causas del fracaso en la cirugía de revisión de la estapedectomía. Material y método: Se realizaron 23 cirugías de revisión de estapedectomías en el período comprendido entre enero de 2000 y abril de 2005. El tiempo transcurrido desde la primera cirugía varió desde un mínimo de 3 meses a un máximo de 25 años, con una media de 5,2 años. Los motivos más frecuentes de la revisión quirúrgica fueron, en primer lugar, los pacientes con cierre de umbral diferencial auditivo (UDA) inicial y pérdida auditiva posterior en el 56,52 %, y en segundo lugar, los pacientes sin ganancia auditiva inicial en el 39,12 %. Resultados: Los principales hallazgos quirúrgicos son los siguientes: prótesis corta en posición correcta (13,04 %), prótesis desplazada (60,87 %), bridas sobre la ventana oval (65,22 %), necrosis de rama larga del yunque (26,2 %) y platina reobliterada (26,09 %). En cuanto a los resultados audiométricos, obtuvimos un cierre completo del UDA en el 60,8 % (n = 14), cierre parcial del UDA del 13,2 % (n = 3), persistencia del UDA inicial en el 21,7 % (n = 5) y cofosis en el 4,3 % (n = 1). Conclusiones: La migración de la prótesis es la causa más frecuente de fracaso de la estapedectomía. Obtuvimos un cierre completo del UDA en dos tercios de los pacientes

Objective: The aim of the study was to determine the causes of failure in otosclerosis surgery. Material and method: We performed 23 revisions of stapedectomy during the period between January 2000 and April 2005. The time between the primary surgery and the revision surgery ranged from 3 months to 25 years. The most frequent reasons for revision surgery were first of all patients with closed initial gap and progressive hearing loss in 56.52 % of cases and secondly patients without any initial hearing improvement in 39.12 % of cases. Results: The main surgical findings were: short prosthesis in correct position (13.04 %), displaced prosthesis (60.87 %), bridles over the oval window (65.22 %), necrosis of the long process of the incus (26.2 %), and obliterative footplate (26.09 %). As for the audiometric results, we got a complete closure of gap in 60.8 % of patients (n = 14), partial closure of gap in 13.2 % (n = 3), persistence of the initial gap in 21.7 % (n = 5), and cophosis in 4.3 % (n = 1). Conclusions: The migration of the prosthesis is the main cause of failure after stapedectomy. Good closure of the gap was achieved in two thirds of the patients

Lipoma pleomorfo de orofaringe / Oropharynx pleomorphic lipoma

El lipoma pleomorfo es una neoplasia benigna mesenquimatosa que aparece principalmente en varones entre la quinta y sexta décadas de la vida. Muestra predilección por la parte posterior del cuello, hombros, y espalda. Macroscómicamente se asemeja a un lipoma típico. Sin embargo, microscópicamente, este neoplasia se caracteriza por presentar tejido adiposo maduro, intercalado con células gigantes pleomórficas y multinucleadas. Presentamos un caso muy poco frecuente de lipoma pleomorfo de localización orofaríngea. Revisamos aspectos anatomoclínicos, clínica, diagnóstico y tratamiento y revisamos la literatura al respecto (AU)

Schwanomas extracraneales. Presentación de 5 casos / Extracranial schwannomas. Presentation of five cases

Los schwanomas son tumores raros de cabeza y cuello que aparecen de cualquier nervio periférico, craneal o autonómico. Presentamos cinco casos y discutimos sobre aspectos clínicos y de tratamiento (AU)