Late bilateral vocal cord palsy following endotracheal intubation due to COVID-19 pneumonia.

Vocal cord paralysis is a rare but severe complication after orotracheal intubation. The most common cause is traumatic, due to compression of the recurrent laryngeal nerve between the orotracheal tube cuff and the thyroid cartilage. Other possible causes are direct damage to the vocal cords during intubation, dislocation of the arytenoid cartilages, or infections, especially viral infections. It is usually due to a recurrent laryngeal nerve neuropraxia, and the course is benign in most patients. We present the case of a man who developed late bilateral vocal cord paralysis after pneumonia complicated with respiratory distress due to SARS-CoV-2 that required orotracheal intubation for 11 days. He presented symptoms of dyspnea 20 days after discharge from hospital with subsequent development of stridor, requiring a tracheostomy. Due to the temporal evolution, a possible contribution of the SARS-CoV-2 infection to the picture is pointed out.

Parálisis bilateral tardía de cuerdas vocales trasintubación endotraqueal por neumonía COVID-19 / Late bilateral vocal cord palsy following endotracheal intubation due to COVID-19 pneumonia

La parálisis de cuerdas vocales es una complicación poco frecuente, aunque severa, tras una intubación orotraqueal. La causa más frecuente es la traumática, debido a la compresión del nervio laríngeo recurrente entre el maguito del tubo orotraqueal y el cartílago tiroides. Otras posibles causas son lesión directa de las cuerdas vocales durante la intubación, luxación de los cartílagos aritenoides e infecciones, sobre todo víricas. Suele deberse a una neuroapraxia del nervio laríngeo recurrente, y el curso es benigno en la mayoría de los pacientes. Presentamos el caso de un varón que desarrolló una parálisis de cuerdas vocales bilateral tras una neumonía complicada con distrés respiratorio por SARS-CoV-2 que requirió intubación orotraqueal durante 11 días. Presentó clínica de disnea a los 20 días del alta hospitalaria con desarrollo posterior de estridor, siendo necesaria la realización de una traqueostomía. Debido a la evoución temporal, se apunta una posible contribución de la infección por SARS-CoV-2 al cuadro.(AU)

Vocal cord paralysis is a rare but severe complication after orotracheal intubation. The most common cause is traumatic, due to compression of the recurrent laryngeal nerve between the orotracheal tube cuff and the thyroid cartilage. Other possible causes are direct damage to the vocal cords during intubation, dislocation of the arytenoid cartilages, or infections, especially viral infections. It is usually due to a recurrent laryngeal nerve neuropraxia, and the course is benign in most patients. We present the case of a man who developed late bilateral vocal cord paralysis after pneumonia complicated with respiratory distress due to SARS-CoV-2 that required orotracheal intubation for 11 days. He presented symptoms of dyspnea 20 days after discharge from hospital with subsequent development of stridor, requiring a tracheostomy. Due to the temporal evolution, a possible contribution of the SARS-CoV- 2 infection to the picture is pointed out.(AU)

Late bilateral vocal cord palsy following endotracheal intubation due to COVID-19 pneumonia. / Parálisis bilateral tardía de cuerdas vocales trasintubación endotraqueal por neumonía COVID-19.

Vocal cord paralysis is a rare but severe complication after orotracheal intubation. The most common cause is traumatic, due to compression of the recurrent laryngeal nerve between the orotracheal tube cuff and the thyroid cartilage. Other possible causes are direct damage to the vocal cords during intubation, dislocation of the arytenoid cartilages, or infections, especially viral infections. It is usually due to a recurrent laryngeal nerve neuropraxia, and the course is benign in most patients. We present the case of a man who developed late bilateral vocal cord paralysis after pneumonia complicated with respiratory distress due to SARS-CoV-2 that required orotracheal intubation for 11 days. He presented symptoms of dyspnea 20 days after discharge from hospital with subsequent development of stridor, requiring a tracheostomy. Due to the temporal evolution, a possible contribution of the SARS-CoV- 2 infection to the picture is pointed out.

[Supraglottic laryngectomy. Still on-going]. / Laringuectomía supraglótica. Todavía en la brecha.

INTRODUCTION: Horizontal supraglottic laryngectomy (HSL) allows the preservation of a functioning larynx and avoids a permanent tracheostoma. Its use and training have been conditioned by the employment of organ preservation programs and endoscopic laser surgery. OBJECTIVE: To show functional and oncological long-term results of HSL. MATERIAL AND METHOD: 110 patients treated with HSL with a minimum of 5 years follow-up. RESULTS: Local control, 89% for T1, 91% for T2, 80% for T3 and 91% for T4. Regional control 80.9%. Cause specific survival, 77.6%, 72.6% and 67% at 3, 5 and 10 years, significantly influenced by N-stage. Functional larynx preservation, 87%, with a 8.5% of non-decanulated patients. CONCLUSION: HSL is a safe surgical procedure, with similar functional and oncological results to other therapeutic options. Its indications should be considered according to own experience and results.

Laringuectomía supraglótica. Todavía en la brecha / Supraglottic laryngectomy. Still on-going

Introducción: La laringuectomía horizontal supraglótica (LHS) permite conservar la función laríngea evitando un traqueostoma permanente. Su empleo ha decrecido en favor de técnicas endoscópicas y protocolos de preservación de órgano, condicionando su aprendizaje. Objetivo: Presentar los resultados funcionales y oncológicos a largo plazo. Material y método: Se revisan 110 pacientes, tratados con LHS, con seguimiento mínimo de 5 años. Resultados: Control local de 89% en T1, 91% en T2, 80% en T3 y 91% en T4. Control regional del 80,9%. Supervivencia causa específica de 77,6%, 72,6% y 67% a 3, 5 y 10 años, influida significativamente por el estadio N. El 87% conserva una laringe funcional, de los que no se ha decanulado el 8,5%. Conclusión: La LHS es una técnica útil y oncológicamente segura, con resultados funcionales y oncológicos similares a otras opciones terapéuticas. Su indicación debe valorarse en función de los resultados y la experiencia propia

Introduction: Horizontal supraglottic laryngectomy (HSL) allows the preservation of a functioning larynx and avoids a permanent tracheostoma. Its use and training have been conditioned by the employment of organ preservation programs and endoscopic laser surgery. Objective: To show functional and oncological long-term results of HSL. Material and method: 110 patients treated with HSL with a minimum of 5 years follow-up. Results: Local control, 89% for T1, 91% for T2, 80% for T3 and 91% for T4. Regional control 80.9%. Cause specific survival, 77.6%, 72.6% and 67% at 3, 5 and 10 years, significantly influenced by N-stage. Functional larynx preservation, 87%, with a 8.5% of non-decanulated patients. Conclusion: HSL is a safe surgical procedure, with similar functional and oncological results to other therapeutic options. Its indications should be considered according to own experience and results

[Factors affecting local and regional control and survival of carcinomas of the tongue and floor of mouth]. / Factores que afectan el control local, regional y supervivencia en carcinomas de lengua móvil y suelo de boca.

A retrospective study of 142 patients that had previous surgery for carcinoma of the tongue or floor of mouth looking into the factors that affect significantly the evolution of our patients and in which circumstances we could benefit from new therapeutic techniques. Cause specific survival at 3 and 5 years was 63.4% and 56.9% respectively. Recurrences were found locally in 32 patients (22.5%), regional in 32 (22.5%) and metastasis in 11 (7.4%). T staging had no did impact on local recurrence, but the presence of positive margins (p = 0.0323). Regional control for N0/N1 was 85% (90/106) versus 55.5% (20/36) for N2/N3 (p = 0.001). Regional control by N staging was 84.5% (73/86) for N0, 85% (17/20) for N1, 57% (30/35) for N2 and 0% for N3 (0/1). Both, N staging and number of positive nodes had a significant impact in specific survival. Positive margins and the presence of positive nodes have the greatest impact on survival and regional control. Adjuvant postoperative radiotherapy did not increase survival, but not prospective random selection was performed. To evaluate this.

Factores que afectan el control local, regional y supervivencia en carcinomas de lengua móvil y suelo de boca / Factors affecting local and regional control and survival of carcinomas of the tongue and floor of mouth

Hemos realizado un estudio retrospectivo de 142 pacientes intervenidos de carcinoma de lengua móvil o suelo de boca buscando qué factores afectan de forma significativa la evolución de nuestros pacientes y en qué circunstancias podríamos beneficiarnos de nuevas modalidades terapéuticas. La supervivencia causa específica a 3 y 5 años fue de 63,4 por ciento y 56,9 por ciento respectivamente. Se detectó una recidiva local en 32 pacientes (22,5 por ciento), regional en 32 (22,5 por ciento) y a distancia en 11 (7,4 por ciento). No se ha encontrado influencia del T en la incidencia de recidiva local pero sí lo tiene la presencia de márgenes positivos (p=0,0323). El control regional en N0/N1 fue de un 85 por ciento (90/106) frente a un 55,5 por ciento (20/36) en los N2/N3 (p=0,001). El control regional, especificado por estadio N fue de 84,5 por ciento (73/86) en los N0, 85 por ciento (17/20) en los N1, 57 por ciento (30/35) para los N2 y 0 por ciento para los N3 (0/1). Tanto el estadio N como el número de ganglios mostró una significativa repercusión en la supervivencia específica. En nuestra experiencia los factores que mayor impacto tienen en el control del cáncer de cavidad oral y suelo de boca son la presencia de bordes quirúrgicos infiltrados y el estado del cuello. El empleo de radioterapia adyuvante no implicó un incremento en la supervivencia, si bien no se hicieron grupos aleatorios para su valoración (AU)

A retrospective study of 142 patients that had previous surgery for carcinoma of the tongue or floor of mouth looking into the factors that affect significantly the evolution of our patients and in which circumstances we could benefit from new therapeutic techniques. Cause specific survival at 3 and 5 years was 63.4% and 56.9% respectively. Recurrences were found locally in 32 patients (22.5%), regional in 32 (22.5%) and metastasis in 11 (7.4%). T staging had no did impact on local recurrence, but the presence of positive margins (p = 0.0323). Regional control for N0/N1 was 85% (90/106) versus 55.5% (20/36) for N2/N3 (p = 0.001). Regional control by N staging was 84.5% (73/86) for N0, 85% (17/20) for N1, 57% (30/35) for N2 and 0% for N3 (0/1). Both, N staging and number of positive nodes had a significant impact in specific survival. Positive margins and the presence of positive nodes have the greatest impact on survival and regional control. Adjuvant postoperative radiotherapy did not increase survival, but not prospective random selection was performed. To evaluate this (AU)

[Experience with the HME-Provox Stomafilter in laryngectomized patients]. / Experiencia con el uso del HME-Provox Stomafilter en pacientes laringuectomizados.

Respiratory symptoms after total laryngectomy are both frequent and troublesome. Previous studies have demonstrated the positive effect of a heat and moisture exchanger (MHE) on the respiratory system in patients after total laryngectomy. In the present study we analyze the opinion of 40 total laryngectomized patients regarding the use of the MHE-Provox Stomafilter kit. Focus has been directed to speech function parameters and pulmonary symptoms. Benefits in phonatory parameters--intelligibility, fluency, pressure and telephone intelligibility, have been over 70%. Reduction in pulmonary symptoms--coughing, sputum production, forced expectoration, stoma cleaning--have also been significant. Our results support the use of MHE Provox Stomafilter for minimizing and preventing respiratory problems and increasing the quality of the voice through the tracheoesophageal puncture system.

Experiencia con el uso del HME-Provox® Stomafilter en pacientes laringuectomizados / Experience with the HME-Provox® Stomafilter in laryngectomised patients

Los problemas respiratorios tras una laringuectomía total son frecuentes. Estudios recientes han puesto de manifiesto la utilidad de los sistemas que permiten el intercambio de calor y humedad (HME) en los pacientes laringuectomizados. En el presente estudio analizamos la opinión de 40 pacientes laringuectomizados a los que se les ha suministrado el HME-Provox® Stomafilter. La investigación se ha centrado en parámetros vocales y de función respiratoria. Los resultados han puesto de manifiesto que los pacientes refieren beneficios fonatorios en más de un 70 por ciento de los casos. De igual modo se obtiene una reducción en los síntomas pulmonares en más de un 80 por ciento de los pacientes. Estos resultados apoyan el uso de los intercambiadores de calor y humedad para reducir y prevenir los problemas respiratorios y aumentar la eficacia de la rehabilitación vocal mendiante las fístulas traqueoesofágicas (AU)

Respiratory symptoms after total laryngectomy are both frequent and troublesome. Previous studies have demonstrated the positive effect of a heat and moisture exchanger (MHE) on the respiratory system in patients after total laryngectomy. In the present study we analyze the opinion of 40 total laryngectomized patients regarding the use of the MHE-Provox Stomafilter kit. Focus has been directed to speech function parameters and pulmonary symptoms. Benefits in phonatory parameters--intelligibility, fluency, pressure and telephone intelligibility, have been over 70%. Reduction in pulmonary symptoms--coughing, sputum production, forced expectoration, stoma cleaning--have also been significant. Our results support the use of MHE Provox Stomafilter for minimizing and preventing respiratory problems and increasing the quality of the voice through the tracheoesophageal puncture system (AU)

Cirugía septopiramidal ambulatoria: métodos, resultados y satisfacción de los pacientes / Septo-pyramidal out-patient surgery: methods, results and patients safisfaction

La cirugía mayor ambulatoria es una actividad con tendencia creciente en la otorrinolaringología. Numerosos estudios han validado la utilidad de algunas intervenciones, como la septoplastia y la cirugía endoscópica nasosinusal realizadas de forma ambulatoria, sin embargo no se han comparado los resultados de la septorrinoplastia ambulatoria frente a cirugía con ingreso, pese a ser una práctica común. Se presenta un estudio sobre los resultados estéticos y funcionales y la incidencia de complicaciones en 40 septoplastias y 40 septorrinoplastias realizadas mediante cirugía sin ingreso en un período de dos años y se las compara con el mismo número de intervenciones realizadas con ingreso. Asimismo, se realiza un cuestionario sobre la satisfacción del paciente tras la cirugía. No se han presentado complicaciones graves en ninguno de los grupos. El número de complicaciones, los resultados funcionales y estéticos y el grado de satisfacción de los pacientes no difirieron en ninguno de los dos grupos. La cirugía septopiramidal (septoplastias y septorrinoplastias) puede ser realizada con poco riesgo deforma ambulatoria, manteniendo la misma calidad en los resultados (AU)

Outpatient surgery is an activity that increases constantly in Otolaryngology. There are studies about some nasal surgery techniques, such as septoplasty or endonasal endoscopic performed as outpatient surgery, but so far nobody has reported any comparative analysis on the results of outpatient septorhinoplasty, although this is a frequent practice. We report our experience with 40 cases of outpatient septoplasty and 40 outpatient septorhinoplasty, performed by the same surgeon, and we make a comparative study with the same number of operations performed on in-patients with traditional surgical techniques. Aesthetic and functional results and satisfaction level in postoperative interviews were compared in both cases. No serious complications were present in either group. The number of complications, the functional and aesthetic results and the degree of patients satisfaction were similar in both groups. Septopyramidal surgery (septoplasty and septorhinoplasty) is suitable to be performed on outpatient with the same quality as in-patients (AU)

[Iatrogenic bladder lithiasis in the Burch technique. An infrequent complication]. / Litiasis vesical yatrogénica en la técnica de Burch. Una complicación infrecuente.

OBJECTIVE: To describe an uncommon case of iatrogenic bladder lithiasis in a female patient who underwent colposuspension according to the Burch technique. METHODS/RESULTS: A female patient who had undergone colposuspension for urinary stress incontinence presented with irritative bladder symptoms and dyspareunia two years later. Patient evaluation revealed stone formation on the nonresorbable suture. Stone removal was achieved endoscopically using local anesthesia and without compromising continence. CONCLUSION: Removal of the calculus that had formed on the suture was achieved by endoscopy without compromising continence.

[Ambulatory septopyramidal surgery: methods, results and patient satisfaction]. / Cirugía septopiramidal ambulatoria: métodos, resultados y satisfacción de los pacientes.

Outpatient surgery is an activity that increases constantly in Otolaryngology. There are studies about some nasal surgery techniques, such as septoplasty or endonasal endoscopic performed as outpatient surgery, but so far nobody has reported any comparative analysis on the results of outpatient septorhinoplasty, although this is a frequent practice. We report our experience with 40 cases of outpatient septoplasty and 40 outpatient septorhinoplasty, performed by the same surgeon, and we make a comparative study with the same number of operations performed on in-patients with traditional surgical techniques. Aesthetic and functional results and satisfaction level in postoperative interviews were compared in both cases. No serious complications were present in either group. The number of complications, the functional and aesthetic results and the degree of patients satisfaction were similar in both groups. Septopyramidal surgery (septoplasty and septorhinoplasty) is suitable to be performed on outpatient with the same quality as in-patients.

[Randomized prospective study comparing BCG and BCG plus oral tegafur in the prevention of stage T1 superficial tumors of the bladder. Results after 2.5 years]. / Estudio aleatorio prospectivo comparando BCG y BCG más Tegafur oral en la profilaxis de los tumores superficiales de vejiga estadio T1. Resultados a dos años y medio.

We present our experience in eighty patients with superficial bladder cancer stage T1. They have been randomized to receive BCG 27 mg weekly x 6 and monthly until complete one year (Group A) or the same schedule plus Tegafur 800 mg daily until complete one year. Results are similar in both groups. With a median follow up of two years and a half, 33% in Group A and 20% in Group B have had recurrence; 7.6% in group A and 3% in group B have had progression in stage. Differences are not significant in both cases. Tolerance of Tegafur is good with only 11% of secondary effects. We concluded that there are no differences in both treatments but there is a trend to better results with combinant therapy. It is necessary more patients to achieve definitive results.

[The BTA test in the diagnosis of bladder tumors. Usefulness in the hospital setting]. / Test de bta en el diagnóstico de los tumores vesicales. Utilidad en un medio hospitalario.

We show our results in the diagnostic and follow-up of the bladder tumors comparing de BTA test with Void Cytology, in order to substitute this with the former. We performed BTA test, Void Cytology (of the same sample) and abdominal ultrasound to 133 patients. They are divided in three groups: 45 with bladder tumor, 16 healthy controls, 72 in follow-up with and without prophylaxis. The sensibility and specificity in tumor's group were similar. In controls' and follow-up's groups the void cytology specificity was superior. There is a high number of false positives in the follow-up group with a large number of "white" cystoscopes. A high number of false positives was seen if the BTA test was done in he first three months of follow-up. In the subgroup in prophylaxis with cystostatic there weren't false positives. We conclude that BTA test is useful in the diagnostic of bladder tumor but not in the follow-up, especially in the first three months.