Unusual Nasal Insufficiency in an Infant: What's Behind the Nostril?

OBJECTIVES: Inflammatory myofibroblastic tumor (IMT) is a rare benign lesion, especially in the pediatric age. There are several cases described in pulmonary, digestive and renal localizations, but involvement in head and neck area is infrequent. METHODS: Case report and review of the literature. RESULTS: A 1 year and 11 months old child, during 2 months had clinical signs of nasal respiratory insufficiency and epistaxis subsequently developing a purulent rhinorrhea and a sleep apnea. His pediatrician previously requested a sinus and cavum X-ray with the finding of an image compatible with an intranasal mass. Endoscopic resection was performed of the mass with further immunohistochemical analysis showing the result of a lesion compatible with IMT. CONCLUSIONS: Even though there are very few cases in scientific literature of a tumor with these characteristics in infants, IMT must be present as a differential diagnosis of intranasal masses. The role of the pathologist is essential to reach the definitive diagnosis and the performance of an early surgical treatment decreases aesthetic consequences in this pathology.

Provox 2® and Provox Vega® device life-time: a case-crossover study with multivariate analysis of possible influential factors and duration.

INTRODUCTION: Tracheoesophageal speech is considered the gold standard for rehabilitation following total laryngectomy. Current literature is limited and contradictory about the possible causes of device failure. The aim of the study is to compare the device life-time between the Provox 2 and Provox Vega and to examine possible related factors that influence their duration. METHODS: Retrospective case-crossover study in 34 laryngectomized patients who had undergone tracheoesophageal voice rehabilitation using indwelling Provox 2 and Provox Vega voice prostheses between 2010 and 2016 in a tertiary care centre. RESULTS: A total of 440 prostheses were evaluated. The most frequent reason for replacement was due to an endoprosthesis leakage (n = 221, 64.2%) in both models. Radiotherapy increases the risk of prosthesis replacement (IRR = 1.88, p = 0.007) as well as bilateral neck dissection (IRR = 1.56, p = 0.017) in Provox 2. Age and unilateral neck dissection do not seem to influence the duration of the prosthesis. Mean life-time of Provox 2 was 106.64 days and 124.19 days for Provox Vega (p = 0.261). Complementary treatment with radiotherapy demonstrated a lower device survival (p < 0.001). DISCUSSION: Results confirmed the non-significant differences on device life between Provox Vega and Provox 2, as well as the relevant role of radiotherapy treatment in the increase of replacements and diminution of the device duration.

Réplica a «Reconstrucción de orofaringe e hipofaringe. ¿Qué hemos aprendido?» / Reply to «Reconstruction of the oropharynx and hypopharynx. What have we learned?»

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Linfoma no Hodgkin primario de la glándula parótida: revisión de 8 casos / Primary Non-Hodgkin Lymphoma of the parotid gland: Revision of 8 cases

La manifestación de un linfoma no Hodgkin como tumor primario de la parótida representa el 5% de los tumores en esta localización. Se presentan 8 pacientes diagnosticados y tratados de linfoma no Hodgkin parotídeo en nuestro hospital entre 1996–2003. El 62% eran mujeres que presentaban una masa indurada de 4 meses de evolución. En todos los casos se realizó una punción aspiración con aguja fina y una tomografía computerizada siendo el estudio inmunohistoquímico esencial en el diagnóstico definitivo. Para ello, se realizó en todos los casos una biopsia. El tratamiento fue con quimioterapia en el 75% de los casos y en el 25% quirúrgico. El objetivo es analizar los patrones clínicos y patológicos, así como las distintas modalidades terapéuticas y pronósticas, que caracterizan a este tipo de patología basándonos en el análisis de nuestros pacientes y comparándolos con los reflejados en la literatura (AU)

The manifestation of non-Hodgkin lymphoma as a primary parotid tumour account for 5% of all tumours at this location. We present 8 patients diagnosed and treated for parotid non-Hodgkin lymphoma in our hospital between 1996 and 2003. Of the cases, 62% were women who had an indurated mass for almost 4 months. A fine needle aspiration and computed tomography were performed on all patients. The immunohistochemical study provided us with the definitive diagnosis. Biopsy was done in all cases. The treatment was chemotherapy in 75% cases and surgery in 25%.The objective was to analyse the clinical and pathological patterns, plus the different treatment modalities and prognoses, which characterise this type of pathology based on the analysis of our patients and compared with those reported in the literature (AU)

[Primary non-Hodgkin lymphoma of the parotid gland: Revision of 8 cases]. / Linfoma no Hodgkin primario de la glándula parótida: revisión de 8 casos.

The manifestation of non-Hodgkin lymphoma as a primary parotid tumour account for 5% of all tumours at this location. We present 8 patients diagnosed and treated for parotid non-Hodgkin lymphoma in our hospital between 1996 and 2003. Of the cases, 62% were women who had an indurated mass for almost 4 months. A fine needle aspiration and computed tomography were performed on all patients. The immunohistochemical study provided us with the definitive diagnosis. Biopsy was done in all cases. The treatment was chemotherapy in 75% cases and surgery in 25%. The objective was to analyse the clinical and pathological patterns, plus the different treatment modalities and prognoses, which characterise this type of pathology based on the analysis of our patients and compared with those reported in the literature.

[Treatment of chin deformities]. / Tratamiento de las deformidades del mentón.

Facial beauty depends on the form, proportion and position of its various units. The chin is the most prominent element of the lower third of the face, both in the frontal view and in profile. The surgical approach to chin deformities did not start until the second half of the twentieth century. The development of silicone prostheses and the emergence of sliding genioplasty offered surgeons a whole new range of options to modify the size and position of the chin. We have performed a historical review of chin surgery, the multiple aesthetic analyses available and the advantages and disadvantages of the different alloplastic materials and osteotomies. To do so, a comprehensive search through current scientific literature on the topic has been carried out, focusing on large series, long-term follow-up studies, research in animal models and medical evidence. As happens in almost any topic in facial plastic surgery, no strong evidence useful in ENT practice for handling chin deformities can be found in today's scientific literature. Ethnicity influences the aesthetic analysis; the type and degree of deformity to be corrected will determine the allo-plastic augmentation of the chin or the suitability of osteotomy. Porous polyethylene (Medpor, Porex Surgical, Newman, Ca, USA) and solid silicone (Silastic, Michigan Medical Corporation, Santa Barbara, Ca, USA) show a clear advantage over other alloplastic materials. Moderate-to-severe retrogenia benefits from sliding genioplasty strategies rather than prosthetic enlargement.

Tratamiento de las deformidades del mentón / Treatment of chin deformities

La belleza facial se basa en la forma, la proporción y la posición adecuadas de sus distintos elementos. El mentón domina el tercio facial inferior, tanto en el plano frontal como en el sagital. El tratamiento de las deformidades del mentón no se desarrolló hasta mediados del siglo XX. La aparición de las prótesis de silicona y la descripción de la genioplastia de deslizamiento supusieron el inicio de un gran número de opciones para modificar las dimensiones y posición de esta estructura. En este artículo realizamos una revisión de la historia de la cirugía del mentón, las distintas formas de análisis estético y las ventajas y los inconvenientes de los distintos materiales aloplásticos y osteotomías. Para ello hemos llevado a cabo una exhaustiva búsqueda en la literatura científica actual sobre el tema, en que primaron las series largas, los artículos con seguimiento a largo plazo, los estudios en animales de experimentación y la evidencia médica. En el momento actual, al igual que en casi cualquier tema de cirugía plástica facial, hay escasa evidencia científica que pueda guiar la práctica del especialista en otorrinolaringología en el manejo de las deformidades del mentón. Las variaciones étnicas condicionan el análisis estético; el tipo de deformidad a corregir y su grado determinarán la colocación de una prótesis o la realización de una osteotomía. En las mentoplastias con prótesis la silicona sólida (Silastic, Michigan Medical Corporation, Santa Barbara, Ca, Estados Unidos) y el polietileno poroso (Medpor, Porex Surgical, Newman, Ga, Estados Unidos) muestran una ventaja clara sobre los otros materiales aloplásticos. En retrogenias moderadas o severas la osteotomía se muestra como la mejor opción

Facial beauty depends on the form, proportion and position of its various units. The chin is the most prominent element of the lower third of the face, both in the frontal view and in profile. The surgical approach to chin deformities did not start until the second half of the twentieth century. The development of silicone prostheses and the emergence of sliding genioplasty offered surgeons a whole new range of options to modify the size and position of the chin. We have performed a historical review of chin surgery, the multiple aesthetic analyses available and the advantages and disadvantages of the different alloplastic materials and osteotomies. To do so, a comprehensive search through current scientific literature on the topic has been carried out, focusing on large series, long-term follow-up studies, research in animal models and medical evidence. As happens in almost any topic in facial plastic surgery, no strong evidence useful in ENT practice for handling chin deformities can be found in today's scientific literature. Ethnicity influences the aesthetic analysis; the type and degree of deformity to be corrected will determine the allo-plastic augmentation of the chin or the suitability of osteotomy. Porous polyethylene (Medpor, Porex Surgical, Newman, Ca, USA) and solid silicone (Silastic, Michigan Medical Corporation, Santa Barbara, Ca, USA) show a clear advantage over other alloplastic materials. Moderate-to-severe retrogenia benefits from sliding genioplasty strategies rather than prosthetic enlargement

[Bronchoscopy in children with foreign body aspiration]. / Broncoscopia en población infantil tras aspiración de cuerpo extraño.

INTRODUCTION AND OBJECTIVES: Aspiration of foreign body presents a high incidence of mortality during the paediatric life period. Family suspect and detection of specific symptoms and signs determine the need of bronchoscopy. The objective of this study is to establish the clinical parameters that indicate foreign body in airway. METHODS: Retrospective study in 44 children with foreign body aspiration. We reviewed age, sex, family suspect, blood analysis, chest x-ray, time to consulting, location, type, complications, and time to discharge. RESULTS: Decisive clinical factors that indicate foreign body in airway are family suspect and respiratory clinic. Findings after auscultation and chest x-ray support suspect, but final diagnostic only can be made after bronchoscopy. Bronchoscopy with foreign body removal was performed during first 24 hours in 86.36 % of patients, and founded that those with delayed diagnosis had increased morbidity. CONCLUSIONS: Family's suspect is the most important parameter that indicates foreign body located in airway. Bronchoscopy performed during the first hours avoids morbidity. This is a secure technique when performed in adequate place with trained personnel.

Broncoscopia en población infantil tras aspiración de cuerpo extraño / Bronchoscopy in children with foreign body aspiration

Introducción y objetivos: La aspiración de cuerpos extraños supone en la edad pediátrica una importante causa de mortalidad. La sospecha familiar y la detección de síntomas y signos de riesgo determinan la necesidad de realizar una broncoscopia. El objetivo de este trabajo es determinar qué parámetros ofrecen más sensibilidad para detectar un cuerpo extraño obstructivo. Métodos: Estudio retrospectivo en 44 pacientes con sospecha de cuerpo extraño en la vía aérea. Se estudia la edad y el sexo, la sospecha familiar, la clínica, la analítica, la radiografía de tórax, el tiempo medio hasta la consulta hospitalaria, la localización del cuerpo extraño, el tipo de cuerpo extraño, las complicaciones y la estancia hospitalaria. Resultados: Los factores más determinantes que indican la presencia de un cuerpo extraño fueron la sospecha familiar y la clínica. Los hallazgos tras la auscultación y la radiografía de tórax dan apoyo a la sospecha, aunque el diagnóstico final sólo se establece tras la realización de la broncoscopia. Se realizó broncoscopia en las primeras 24 h, y se extrajo cuerpo extraño en el 86,36 % de los pacientes; en los casos en que se retrasó el diagnóstico hubo aumento de la morbilidad. Conclusiones: La sospecha clínica familiar inicial es el factor fundamental para llegar al diagnóstico. La realización de esta técnica en las primeras horas tras la sospecha evita morbilidad. La broncoscopia es una técnica segura siempre que sea realizada en un medio adecuado y por personal entrenado

Introduction and objectives: Aspiration of foreign body presents a high incidence of mortality during the paediatric life period. Family suspect and detection of specific symptoms and signs determine the need of bronchoscopy. The objective of this study is to establish the clinical parameters that indicate foreign body in airway. Methods: Retrospective study in 44 children with foreign body aspiration. We reviewed age, sex, family suspect, blood analysis, chest x-ray, time to consulting, location, type, complications, and time to discharge. Results: Decisive clinical factors that indicate foreign body in airway are family suspect and respiratory clinic. Findings after auscultation and chest x-ray support suspect, but final diagnostic only can be made after bronchoscopy. Bronchoscopy with foreign body removal was performed during first 24 hours in 86.36 % of patients, and founded that those with delayed diagnosis had increased morbidity. Conclusions: Family’s suspect is the most important parameter that indicates foreign body located in airway. Bronchoscopy performed during the first hours avoids morbidity. This is a secure technique when performed in adequate place with trained personnel

Traumatismo penetrante de oído interno / Penetrating trauma to the inner ear

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[Resection with end-to-end anastomosis for postintubation tracheal stenosis]. / Resección con anastomosis término-terminal en la estenosis traqueal tras intubación.

OBJECTIVE: To study results of resection and end-to-end anastomosis in tracheal stenosis (TS). PATIENTS AND METHOD: Retrospective review of 14 patients with previous long-term intubation and residual tracheal stenosis, all operated on with resection and end-to-end anastomosis. We studied the percentage of surgical success, decannulation index, use of Montgomery T tube, and complications. RESULTS: We performed a total of 42 interventions (mean, 2.93) and 19 T-Montgomery tubes were used. We achieved surgical success in 85.12 % of patients, with a decannulation index of 71.42 %. Two patients developed granulomas in the suture field that required treatment with endoscopic laser and cryotherapy. One patient died intraoperatively. CONCLUSIONS: Surgical resection with end-to-end anastomosis and insertion of a T-Montgomery tube is a useful technique in post-intubation tracheal stenosis despite involving multiple interventions in a large percentage of patients.

Resección con anastomosis término-terminal en la estenosis traqueal tras intubación / Resection with end-to-end anasthomosis for postintubation tracheal stenosis

Objetivo: Evaluar los resultados de la cirugía de resección con anastomosis término-terminal en la estenosis traqueal (ET). Pacientes y método: Estudio retrospectivo de 14 pacientes con antecedentes de intubación prolongada y ET, operados mediante resección y anastomosis término-terminal. Se estudia los porcentajes de resolución de la estenosis, decanulación, utilización del tubo en T de Montgomery y complicaciones. Resultados: Se realizó un total de 42 (media, 2,93) intervenciones y se colocaron 19 tubos en T de Montgomery. En el 85,12 % de los pacientes se resolvió la estenosis, con decanulación en el 71,42 %. Dos pacientes desarrollaron granulomas en la zona de sutura, que requirieron exéresis mediante broncoláser y crioterapia. Una paciente falleció durante la operación. Conclusiones: La cirugía resectiva con anastomosis término-terminal y colocación de tubo en T de Montgomery es una técnica útil para la resolución de la ET tras intubación, aunque en un alto porcentaje de pacientes requiera múltiples intervenciones

Objective: To study results of resection and end-to-end anastomosis in tracheal stenosis (TS). Patients and method: Retrospective review of 14 patients with previous long-term intubation and residual tracheal stenosis, all operated on with resection and end-to-end anastomosis. We studied the percentage of surgical success, decannulation index, use of Montgomery T tube, and complications. Results: We performed a total of 42 interventions (mean, 2.93) and 19 T-Montgomery tubes were used. We achieved surgical success in 85.12 % of patients, with a decannulation index of 71.42 %. Two patients developed granulomas in the suture field that required treatment with endoscopic laser and cryotherapy. One patient died intraoperatively. Conclusions: Surgical resection with end-to-end anastomosis and insertion of a T-Montgomery tube is a useful technique in post-intubation tracheal stenosis despite involving multiple interventions in a large percentage of patients