Inflammatory pseudotumour of the infratemporal fossa visualized with 18F-FDG PET/CT.

The inflammatory pseudotumour of the head and neck is a benign lesion, extremely rare outside the cranial orbits. A case is presented of an inflammatory pseudotumour not associated with the IgG4-related disease. The pseudotumour was found as a solitary mass in the infratemporal fossa of a young woman who complained of otalgia and hearing loss. A clear image of the lesion was obtained using an 18F-fluoro-deoxy-glucose (18F-FDG) PET. After the histopathological diagnosis, and treatment with corticosteroids, a second 18F-FDG PET was performed. The metabolic image had returned to normal, and the previously observed mass disappeared. A brief review is presented of the studies examining this type of lesion.

Hiposmia, rinorrea fétida y algias faciales por aspergiloma maxilar / Hyposmia, fetid rhinorrhea and facial pain caused by a maxillary aspergilloma

En los últimos años se ha observado un aumento de la incidencia de sinusitis fúngicas en sujetos inmunocompetentes. Presentamos un caso de sinusitis micótica en una paciente de 12 años, en el que concurren varios aspectos que podían dificultar su diagnóstico, produciendo un retraso en su tratamiento definitivo. Este caso ilustra cómo, para llegar a un diagnóstico correcto de esta patología, es necesario basarse en los estudios histológicos y radiológicos, pero siempre sin olvidar un aspecto clave como es la sospecha diagnóstica. El tratamiento de la sinusitis fúngica es quirúrgico, y en el momento actual la técnica de elección es la cirugía endoscópica nasal. Se exponen las características clínicas de esta patología y los métodos diagnósticos necesarios (AU)

In the last few years an increase has been observed in the incidence of fungal sinusitis in immunocompetent subjects. We present a case of mycotic sinusitis in a 12-year-old patient, in which there were several aspects that could have made the diagnosis more difficult, thus delaying her definitive treatment. This case illustrates how to arrive at a correct diagnosis of this pathology. It must be based on the histological and radiological studies, but always without forgetting a key aspect as it is a suspected diagnosis. The treatment of fungal sinusitis is surgical, and currently, endoscopic sinus surgery is the choice. We describe the clinical characteristics of this pathology and the diagnostic methods required (AU)

[Hyposmia, fetid rhinorrhea and facial pain caused by a maxillary aspergilloma]. / Hiposmia, rinorrea fétida y algias faciales por aspergiloma maxilar.

In the last few years an increase has been observed in the incidence of fungal sinusitis in immunocompetent subjects. We present a case of mycotic sinusitis in a 12-year-old patient, in which there were several aspects that could have made the diagnosis more difficult, thus delaying her definitive treatment. This case illustrates how to arrive at a correct diagnosis of this pathology. It must be based on the histological and radiological studies, but always without forgetting a key aspect as it is a suspected diagnosis. The treatment of fungal sinusitis is surgical, and currently, endoscopic sinus surgery is the choice. We describe the clinical characteristics of this pathology and the diagnostic methods required.

[Distant metastases in head and neck cancer]. / Metástasis a distancia en el cáncer de cabeza y cuello.

INTRODUCTION: The presence of distant metastasis (DM) after the initial treatment of head and neck squamous cell carcinoma (HNSCC) is not considered a common event and it is associated to a poor outcome. PURPOSE: To investigate the prevalence and risk factors associated with the diagnosis of distant metastasis in SCC. METHODS AND MATERIALS: A retrospective study of 633 patients with HNSCC to describe the clinical characteristics of the DM. RESULTS: During the follow-up period after the initial treatment, 6.2% of the patients were diagnosed of having distant metastasis. The site of primary tumor was hypopharynx in 14.4%, unknown origin in 11.8% and oropharynx in 8.5%. The most common sites of DM were the lungs (58%) and the bone (22%). Three year overall survival in patients with DM was 2.5% (versus 49,5% in the control group). CONCLUSIONS: This study confirms that DM have an adverse impact in survival. There is a need of guidelines for screening of distant metastases in patients with HNSCC in order to get an early diagnosis and a more effective treatment. Because of the poor prognosis of DM, protocols including adjuvant chemotherapy should be investigated.

[Gastric pull-up reconstruction in hypopharyngeal and cervical oesophageal cancer]. / Reconstrucción con interposición gástrica en el cáncer de hipofaringe y esófago cervical.

OBJECTIVE: To determine the results of gastric pull-up reconstruction following pharyngo-laryngo-esophagectomy. METHODS: The clinical data of 12 patients who were treated with pharyngolaryngo/esophagectomy were analysed, from 1995 to 2000. All patients had advanced disease, and required a gastric pull-up reconstruction. Clinical swallowing function and morbidity were evaluated postoperatively and the survival group was studied using a Kaplan-Meier survival curve. RESULTS: Five cases of hypopharyngeal cancer and seven cases of cervical esophageal cancer were studied. In three cases a regional flap was used. A total of 16 cervical dissections were carried out. Only in 2 patients the nodes were free of metastasis. There were four hospital deaths. At discharge, 7 patients out of the 8 had a good swallowing. The most common complications were pulmonary (58%). The five years survival was 31%. CONCLUSION: Gastric pull up transposition must be used for reconstruction following pharyngolaryngoesophagectomy. Proper selection of patients may reduce considerably the morbidity and mortality of this surgical procedure.

[Otorhinolaryngological consultation material in PDA: SEORL-PDA]. / Material de Consulta de Otorrinolaringología en PDA: SEORL-PDA.

OBJECTIVES: Occasionally, the Otolaryngologist needs to accede quickly to medical information in order to retrieve data or to solve doubts. In this way, it seems to be of interest to design a clinical guide that could be consulted as a PDA program (Pocket PC and Palm versions), in a personal computer or Internet. MATERIAL AND METHODS: Clinical contents of protocols, guides, and articles, preferably based on the evidence and the clinical experience of 102 authors. Implementation of a program that allows the guide to be used in a PDA, to update it or to add notes using tools that could be downloaded from a web page. RESULTS: A clinical practice guide SEORL-PDA version 1.1, with thirteen ENT's topics, calculation algorithms, internal links and possibility of update the content and to add notes. DISCUSSION: SEORL-PDA is a clinical guide in PDA format, with enough information and possibilities. Its downloading and installation is easily done following the instructions of the web created with these purposes.

[Second primary tumors in head and neck cancer]. / Segundos tumores primarios en el cáncer escamoso de cabeza y cuello.

INTRODUCTION: The development of second primary tumors (SPT) in patients with head and neck squamous cell carcinoma (HNSCC) has become an increasingly important factor in clinical treatment decisions. PURPOSE: To define favourable clinical characteristics for overall survival, in patients with SP head and neck cancer. MATERIAL AND METHOD: Records of 633 patients with SCC treated from 1984 to 2004 were reviewed to describe clinical characteristics of the SPT. RESULTS: The overall incidence of SPT was 11%. The incidence of the index tumors was as follows: supraglottic cancer 21% and oral cancer 16%. The most common SPT occurred in head and neck area in 47%, lung in 32% and esophagus in 11%. Second primary was associated with a poor 5 years survival in patients with HN-SCC (23 versus 53% in control group). CONCLUSION: Because of the high rate of second primary tumors, protocols including chemoprophylaxis should be investigated. Prevention and early detection are indicated.

[Montgomery salivary bypass tube: a simple solution for pharyngocutaneous fistulas]. / El tubo de derivación salival de montgomery: una solución sencilla para las fístulas faringocutáneas.

INTRODUCTION: The pharyngocutaneous fistulas (PCF) are among the complications surgeons and nursing personnel fear the most due to their complexity to prevent and/or cure them. Montgomery salivary bypass tube is an effective therapeutic option in the treatment of the PCF following laryngectomy. The aim of our study was to describe our experience with salivary bypass in the treatment of the PCF. METHODS: This was a retrospective analysis of pharyngocutaneous fistulas in 21 patients in whom total laryngectomy was performed for squamous cell carcinoma of the larynx or hypopharynx (January 1999-December 2005). We determinate the overall efficacy of the Montgomery salivary bypass tube in the treatment of the PCF. RESULTS: A pharyngocutaneous fistula developed within a mean time of 7 days from surgery (from 2nd to 20th day). Montgomery salivary bypass tube was the therapeutic option in all these PCF.12 patients required local anesthesia to introduce the tube and in 9 patients the insertion method was with general anesthesia with direct vision of the hypopharynx. The mean healing time was 26 days, except in one case. This PCF achieved spontaneous closure with local wound care after the bypass was removed. CONCLUSIONS: The observed results corroborated the relevance of Montgomery salivary bypass tube as an important therapeutic option in the treatment of the PCF. There was no need of surgical treatment.

[Prognostic factors in adenoid cystic carcinoma of salivary glands]. / Factores pronósticos en el carcinoma adenoide quístico de glándulas salivares.

OBJECTIVE: Adenoid cystic carcinoma (ACC) is a relatively rare tumor which is characterized by its long clinical history, with multiple recurrences and late distant metastasis. The aim of the present study is to show our experience in the management of this tumor and the relationship of different clinico-pathological parameters with its prognosis. MATERIAL AND METHODS: A retrospective study was carried out between 1984 and 2004 in 28 patients with ACC of the salivary glands, analyzing the most outstanding clinico-pathological variables in this tumor related to the prognosis of the tumor and the survival. RESULTS: The overall survival rates at 5, 10 and 15 years were 88%, 69% and 52% respectively. Ten (36%) patients presented local recurrence and 10 (36%) presented distant metastasis (four of which also have local recurrence). Although the differences were not statistically significant, the patients with solid histological subtype (p=0.17), with positive margins status (p=0.2), with perineural invasion (p=0.59), and those treated with surgery alone (p=0.19), presented a worse survival. DISCUSSION/CONCLUSION: Our study confirms that the ACC is a tumor with a high tendency to local recurrence and development of distant metastasis, even long term, which means a close follow-up for life. Nevertheless, it also demonstrates that acceptable survival rates can be obtained with aggressive treatment.

[Diagnostic value of head-shaking nystagmus in vestibular clinical evaluation]. / Utilidad del nistagmo de agitación cefálica en la exploración vestibular clínica básica.

OBJECTIVES: To determine the sensitivity and specificity of the head-shaking nystagmus test (HSN), the nystagmus elicited in response to a vigorous rotation of the head in the horizontal plane, in the study of patients with peripheral unilateral vestibular disease. PATIENTS AND METHODS: Retrospectively, we analyze the relationships between the HSN and the rest of the videonystagmographic tests on eighty-three patients with peripheral unilateral vestibular disease. RESULTS: Twenty-three patients showed a positive head-shaking nystagmus; twenty-one of them had unilateral caloric hypofunction and only two had a symmetric caloric test, but both of them showed some type of vestibular dysfunction on other videonystagmographic test. In our series, the HSN sensitivity for the existence of peripheral vestibular disease was 48.8%, while the specificity was 95% in relation to the caloric test, reaching 100% when the gold standard was the presence of any abnormal videonystagmographic test. CONCLUSION: HSN is a simple test that can be useful to identify patients having unilateral vestibular hypofunction.

Selección de vasos receptores en reconstrucción microquirúrgica de cabeza y cuello. Análisis en 156 colgajos libres / Recipient vessel selection in head and neck microsurgical reconstruction. Study of 156 free flaps

El éxito de una reconstrucción microquirúrgica se subordina a una adecuada planificación. Escoger adecuadamente los vasos que nutrirán nuestro colgajo libre es primordial. Para este trabajo seleccionamos 150 pacientes en los que se realizaron 156 colgajos libres en el área de cabeza y cuello. La proporción varón/mujer fue de 5:1 y la edad media de 56 años. La etiología más frecuente del defecto fue tumoral. Cincuenta colgajos se realizaron de forma inmediata al defecto (33.3%) y en 100 casos (66.6%) de forma secundaria. La arteria receptora más usada fue la tiroidea superior seguida de la facial. Se suturaron un total de 223 venas; la más frecuente fue la vena facial seguida de la yugular externa. Se realizaron, asímismo, 4 injertos venosos y 2 transposiciones de vena cefálica. La tasa global de supervivencia fue del 93%. Hubo 11 necrosis totales, 3 (1.9%) necrosis parciales y 3 (1.9%) muertes postoperatorias en el hospital (AU)

The success of a microsurgical reconstruction is subordinated to an appropriate planning. Recipient vessel selection of our free flap is primordial. For this work we select 150 patients who underwent 156 free flaps for head and neck reconstruction. The proportion male/female was of 5:1 with an average age of 56 years. Tumoral defects are the most common etiology. Fifty (33.3%) free flaps were performed inmediately and 100 (66.6%) were performed secondarily. Recipient artery selection in order of frequency included the superior thyroid artery followed by the facial artery. We performed 223 venous anastomosis; end-to-end anastomosis to the facial vein and external yugular vein was the most common method of venous revascularization. Four flaps required an interposition vein graft and we performed two cephalic vein transpositions. The overall success rate was of 93%. Eleven flaps failed and there were 3 cases (1.9%) of partial free flap necrosis. Three patients (1.9%) died postoperatively in the hospital (AU)

[Multimedia educational material. A tool of support to the Otolaryngology training]. / Material educativo multimedia. Una herramienta de apoyo a la enseñanza de la Otorrinolaringología.

Due to multimedia technologies, the medical information has taken an extraordinary growing. Nevertheless, the education at University will turn out to be a more complex pedagogic process. We present a multimedia educational material (MEM), developed as an online course to "Seminars of Otolaryngology", and available free at the University website. MEM was designed and edited by, ENT teachers, pedagogues, and image and computer experts. It has been structured as a series of modules that integrate texts, images, movie clips, video, audio and animations. The schematic presentation stands out with progressive access to the topics through internal and external links. The pedagogic resources give additional support by learning objectives, glossary, references, index and searcher. Finally, the activities and instrumental simulations complete the training in diagnosis and treatment. The MEM is an interactive useful software program for medical training in Otolaryngology, without avoiding the key figure of the teacher.

[Endoscopic nasal surgery for pterigopalatine fossa schwannoma]. / Abordaje de un schwannoma de la fosa pterigo-palatina por cirugía endoscópica nasal.

Schwannomas are tumors of nerve sheath origin, the lesion being derived from the Schwann cells surrounding neural tissue in most of the peripheral, cranial and autonomic nerves. Schwannomas occurring in the head and neck represent 25-35% of all reported schwannomas, and most commonly arise from the acoustic or the neumogastric nerves. In the nose and paranasal sinuses these tumors are very uncommon (fewer than 4% of all schwannomas). In the pterygopalatine fossa they are very rare, and arise in this case from the ophthalmic and maxillary branches of the trigeminal nerve. In this exceptional site, the tumor is classically approached through a Caldwell-Luc incision. In this case, we report the removal of a schwannoma of the pterygopalatine fossa by endoscopic sinus surgery.

[Anaplastic thyroid carcinoma. Our experience]. / Carcinoma anaplásico de tiroides. Nuestra experiencia.

UNLABELLED: Anaplastic thyroid cancer ranks among the most lethal of all known human malignancies, and remains almost uniformly fatal. It represents approximately 1% of all thyroid carcinomas. MATERIALS AND METHODS: A retrospective study was performed including all anaplastic thyroid carcinoma cases diagnosed in our institution between 1989 and 2000. RESULTS: We collected 15 cases previously biopsied as anaplastic thyroid carcinoma. Three of them were treated with a curative intention; different palliative modalities were carried out for the remaining cases. None of the cases survived more than 1 year, and the median survival time was 3.5 months. DISCUSSION/CONCLUSION: This study confirms the previously known aggressiveness of this neoplasm, in which the prognosis and evolution remain to be fatal.

[Paranasal sinus osteomas. Revision of 14 cases]. / Osteomas de senos paranasales: revisión de 14 casos.

OBJECTIVE: To present our experience in the management of paranasal sinus osteomas. MATERIAL AND METHODS: We review 14 patients with frontoethmoidal osteomas removed in our hospital between 1988-2001. The initial symptoms, site and size of the lesions, surgical approaches and short and long term complications were assesed. RESULTS: The most common symptom in our series was headache (57%); most of the tumors were located in frontal (35%) and frontoethmoidal (35%) regions with a mean size of 4.2 cm (maximum diameter) at the time of surgery. All symptomatic osteomas were resected by classic external surgical approaches but two cases were removed by endonasal surgery. DISCUSSION: Although osteomas are benign tumors, they may enlarge progressively and produce complications. Their resection is not free of risks, so there is some controversy about the management of asymptomatic patients. Endonasal surgery reduces the morbidity of the treatment but the location and size of the lesions do not allow to employ this technique in all cases.

[Insertion of Montgomery salivary bypass tube under local anesthesia in patients with pharyngocutaneous fistula following total laryngectomy]. / Inserción del tubo de derivación salival de Montgomery con anestesia local en pacientes con fístula faringocutánea tras laringectomía total.

Montgomery salivary bypass tube is an effective therapeutic option in the treatment of the pharyngocutaneous fistulas following laryngectomy. The original insertion technique requires general anesthesia to introduce the tube with direct vision of the hypopharynx. In this paper we present an insertion method based in the Seldinger technique that allows the placement of the tube under local anesthesia in a rapid fashion and well tolerated by the patients.

[Cerebellopontine angle and internal auditory canal lipomas: report of four cases and review of the literature]. / Lipomas de angulo pontocerebeloso y conducto auditivo interno: serie de 4 casos clínicos y revisión de la literatura.

AIM: Lipomas are exceptional tumors at the Cerebellopontine Angle (CPA) or the Internal Auditory Canal (IAC). We evaluate clinical, histological and radiological characteristics of the cases diagnosed in our Hospital and the results of conservative versus surgical treatment. MATERIAL AND METHODS: We report 4 cases of CPA and/or IAC and review 99 previously reported in the literature. RESULTS: Unilateral tinnitus was the most frequent symptom (100%). All lesions showed hyperintensity on T1 and hypo/isointensity on T2--weighted MNR images. Two patients underwent a retro-sigmoidal approach without complete tumoral resection and with additional neurological consequences. Another two cases were followed up by annual MNRs. During the follow-up period (4.2 years average), neither clinical nor radiological changes were detected. CONCLUSION: The surgical resection of CPA y/o IAC lipomas is associated to a significant morbidity due to the high vascularization and the dense adherence of these lesions to the surrounding tissues. The MNR is the suitable technique for differential diagnosis between lesions at this location.

[Laser cordectomy: oncologic outcome and functional results]. / Cordectomías láser: resultados oncológicos y funcionales.

OBJECTIVE: Early glottic carcinoma can be effectively treated with radiation or endoscopic laser surgery. We evaluated our experience treating early glottic cancer with laser CO2 surgery. MATERIAL AND METHODS: 64 patients with Tis, T1 and T2 carcinoma, who underwent endoscopic CO2 laser excision between January 1999 and July 2002, were retrospectively analyzed. We performed an objective and subjective evaluation of speech, and evaluation of physical, emotional and functional well being. The mean follow-up was thirty months. RESULTS: No patient died of this laryngeal neoplasm. Local control was achieved in 96% (62/64). Two patients with recurrence required total laryngectomy as savage treatment. Cause-specific survival was 100%, and overall survival was 98% (63/64). Voice quality was affected by laser surgery but impact on the quality of life was minor. CONCLUSIONS: Laser cordectomy for treatment of early glottic cancer is a valid alternative to radiation, with good outcome for voice and minimum impact on quality of life.

[Detection of herpes simplex virus and Epstein-Barr virus in squamous cell carcinoma of the upper airways and digestive system]. / Detección del virus herpes simplex y del virus de Epstein-Barr en los carcinomas de células escamosas de vías aerodigestivas superiores.

OBJECTIVE: Previous studies have investigated the role of viruses in tumor origin of head and neck cancer. Despite this, mechanis of viral carcinogenesis remain unclear. The aim of this study is to determine the prevalence of herpes simplex virus (HSV) and Epstein-Barr virus (EBV) in malignant laryngeal and oropharyngeal lesions. MATERIAL AND METHODS: Fresh frozen specimens of 28 laryngeal and oropharyngeal squamous cell carcinomas were studied. The presence or absence of HSV and EBV was determined with polymerase chain reaction (PCR) assays. RESULTS: None of the samples showed evidence for EBV DNA. One tonsilar carcinoma case (3.5%) was positive for HSV DNA detection. CONCLUSIONS: These results do not support HSV and EBV as etiological factors in head and neck cancer.

[Osteoplastic flap: our experience]. / Osteoplastia frontal: nuestra experiencia.

OBJECTIVE: Despite the advances of endoscopic surgical techniques, the frontal sinus obliteration via the osteoplastic flap (OPF) remains the treatment option for frontal sinus pathologies. The aim of this study is to evaluate indications, procedures and results of this technique. MATERIAL AND METHODS: Retrospective study of thirty one patients that underwent OPF procedure between 1986 and 1999. RESULTS: The average patient's age was 42 years. The treated pathologies were: 12 mucoceles, 8 fractures, 4 osteomas, 4 sinutisis, 1 frontal abscess, 1 frontal osteomielitis and 1 orbital celullitis. The main clinical symptoms were headache (32%) and nasal obstruction (29%). The surgical approaches es used were: brow incision in 24 patients (78%), bicoronal in 5 (16%) and through the frontal wound in 2 traumatic cases (6%). Endonasal surgical procedures were associated in 8 patients (25%). Frontal sinus obliteration was performed in 23 patients (74%). Surgical revision was necessary in two cases. The were no serious complications. The overall esthetic and functional outcome was good. CONCLUSIONS: OPF with fat obliteration is an useful technique in patients who had frontal sinus disease refractary to other methods.