Anatomy and Aging of the Perioral Region.

Perioral region, although severely impacted by facial aging, is often overlooked in texts on facial rejuvenation. Sun exposure, bone resorption, dynamic contraction of the sphincteric and nonsphincteric oral musculature, gravitational pull, histological changes of the skin, and unhealthy habits all take their toll in this area. Fine wrinkling on the lips, deep nasolabial and mentolabial folds, elongation and flattening of the upper lip, downturned corners of the mouth, marionette lines, diminished vermillion and upper teeth show and chin irregularities are the main signs of this process, raising great concern amongst patients and making the perioral region the most demanded area for facial rejuvenation treatment. A huge armamentarium of surgical and nonsurgical techniques, with or without complex technology, are available to tailor patient's specific needs, from chemodenervation and mild chemical peels to operations designed to restore the size and shape of the lips. In this article we perform a comprehensive review of the contemporary treatment of the aging perioral area, detailing the most common techniques and their nuances.

Recidiva de carcinoma nasosinusal relacionado con el virus del papiloma humano con características similares al adenoide quístico / Recurrence of human papillomavirus-related carcinoma with adenoid cystic-like features

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Tiempo de respuesta terapéutica al propranolol sistémico en el manejo de hemangiomas subglóticos pediátricos: serie de casos y revisión de la literatura / Therapeutic time of response of systemic propranolol in the management of pediatric subglottic hemangiomas: case series and review of the literature

Resumen: Introducción: Los hemangiomas de la vía aérea son neoplasias congénitas de baja incidencia. Su presentación clínica consiste en una obstrucción de la vía aérea superior con disnea progresiva y estridor, ocasionando una obstrucción grave, aguda y grave de la vía aérea. Los hemangiomas infantiles tienen una incidencia al nacimiento del 2%, incrementándose al 9% a los 12 meses de vida. Casi el 60% de los hemangiomas infantiles afectan la región de la cabeza y el cuello. Sin embargo, la localización en la vía aérea superior no es tan frecuente y solo se informa en el 1.8% de los pacientes con hemangiomas cutáneos. El tratamiento tradicional de los hemangiomas laríngeos ha sido la administración de corticoides sistémicos por periodos largos, la cirugía endolaríngea con láser de CO2, la cirugía abierta, la traqueostomía y, recientemente, el propranolol oral. Casos clínicos: Se presentan cinco casos de hemangiomas subglóticos tratados con propranolol sistémico y la evaluación del tiempo de respuesta terapéutica, definido como el control satisfactorio de los síntomas obstructivos y aseguramiento de la vía aérea. En estos casos, el propranolol mostró ser una opción efectiva y segura para el tratamiento de hemangiomas laríngeos, con un tiempo de respuesta terapéutica de 48 a 72 horas. Conclusiones: El tratamiento con propranolol oral se ha convertido en los últimos años en la primera opción terapéutica debido a su alta eficacia y su buen perfil de seguridad.

Abstract: Background: Airway hemangiomas are congenital neoplasms of low incidence. Its clinical presentation consists of obstruction of the upper airway with progressive dyspnea and stridor and the life of the patient at risk. Infantile hemangiomas have an incidence at birth of 2%, increasing to 9% at 12 months of life. Almost 60% of childhood hemangiomas affect the head and neck region. However, localization in the upper airway is not as frequent and it is only reported in 1.8% of patients with cutaneous hemangiomas. The traditional treatment of laryngeal hemangiomas has been the administration of systemic corticosteroids for long periods, endolaryngeal surgery with CO2 laser, open surgery, tracheostomy or, recently, oral propranolol. Case report: Five cases of subglottic hemangioma treated with systemic propranolol are presented. The therapeutic time of response with the satisfactory control of obstructive symptoms and assurance of the airway was evaluated. In these cases, propranolol was shown to be an effective and safe option for the treatment of laryngeal hemangiomas with a therapeutic response time of 48 to 72 hours. Conclusions: In recent years, the treatment with oral propranolol has become the first therapeutic option due to its high efficacy and safety profile.

[Tiempo de respuesta terapéutica al propranolol sistémico en el manejo de hemangiomas subglóticos pediátricos: serie de casos y revisión de la literatura]. / Therapeutic time of response of systemic propranolol in the management of pediatric subglottic hemangiomas: case series and review of the literature.

Background: Airway hemangiomas are congenital neoplasms of low incidence. Its clinical presentation consists of obstruction of the upper airway with progressive dyspnea and stridor and the life of the patient at risk. Infantile hemangiomas have an incidence at birth of 2%, increasing to 9% at 12 months of life. Almost 60% of childhood hemangiomas affect the head and neck region. However, localization in the upper airway is not as frequent and it is only reported in 1.8% of patients with cutaneous hemangiomas. The traditional treatment of laryngeal hemangiomas has been the administration of systemic corticosteroids for long periods, endolaryngeal surgery with CO2 laser, open surgery, tracheostomy or, recently, oral propranolol. Case report: Five cases of subglottic hemangioma treated with systemic propranolol are presented. The therapeutic time of response with the satisfactory control of obstructive symptoms and assurance of the airway was evaluated. In these cases, propranolol was shown to be an effective and safe option for the treatment of laryngeal hemangiomas with a therapeutic response time of 48 to 72 hours. Conclusions: In recent years, the treatment with oral propranolol has become the first therapeutic option due to its high efficacy and safety profile.

Introducción: Los hemangiomas de la vía aérea son neoplasias congénitas de baja incidencia. Su presentación clínica consiste en una obstrucción de la vía aérea superior con disnea progresiva y estridor, ocasionando una obstrucción grave, aguda y grave de la vía aérea. Los hemangiomas infantiles tienen una incidencia al nacimiento del 2%, incrementándose al 9% a los 12 meses de vida. Casi el 60% de los hemangiomas infantiles afectan la región de la cabeza y el cuello. Sin embargo, la localización en la vía aérea superior no es tan frecuente y solo se informa en el 1.8% de los pacientes con hemangiomas cutáneos. El tratamiento tradicional de los hemangiomas laríngeos ha sido la administración de corticoides sistémicos por periodos largos, la cirugía endolaríngea con láser de CO2, la cirugía abierta, la traqueostomía y, recientemente, el propranolol oral. Casos clínicos: Se presentan cinco casos de hemangiomas subglóticos tratados con propranolol sistémico y la evaluación del tiempo de respuesta terapéutica, definido como el control satisfactorio de los síntomas obstructivos y aseguramiento de la vía aérea. En estos casos, el propranolol mostró ser una opción efectiva y segura para el tratamiento de hemangiomas laríngeos, con un tiempo de respuesta terapéutica de 48 a 72 horas. Conclusiones: El tratamiento con propranolol oral se ha convertido en los últimos años en la primera opción terapéutica debido a su alta eficacia y su buen perfil de seguridad.

Medical humanities in a rapidly changing world. Is there any worth in it?

This article was migrated. The article was marked as recommended. Humanism has shaped mankind during the last centuries, but technology and recent social changes have shifted the paradigm towards a data driven society where humans are no longer at the center of the world. Medicine is not alien to this new situation; clinical practice is rapidly changing, and medical curricula must adapt to it. Is there any place for humanities in medical training? In this paper we analyze the present situation of humanism in a technology flooded health environment, the roll of humanities in contemporary medical curricula and we propose a series of measures to be taken with the purpose of educating the next generation of doctors.

Endoscopic closure of large septal perforations with bilateral Hadad-Bassagasteguy flaps.

Surgical closure of nasal septal perforations is one of the most challenging procedures in nasal surgery. Defects greater than 2 cm are especially difficult to repair with the traditional approaches due to the challenges of mobilizing enough mucosa to close big gaps, and avoiding airway stenosis in the process. We present a new technique to endoscopically close major septal perforations using bilateral Hadad-Bassagasteguy flaps. Four consecutive patients with septal perforations greater than 2 cm were operated at our institution. Bilateral Hadad-Bassagasteguy flaps were endoscopically raised, one of them above the defect and the other one below it, and rotated to partially cover the defect on each side. A deep temporalis fascia graft was sandwiched between the two flaps to provide a scaffold for schneiderian mucosa growth. Both flaps were covered with a silicone sheet for 3 weeks. A complete closure of the defect was accomplished in three of the four patients; partial closure was achieved in the other. Nasal crusting, epistaxis, and nasal breathing improved in all patients. Large defects of the nasal septum may be closed in selected cases by rotation of bilateral pedicled septal mucosal flaps partially covering the defect area, followed by secondary healing of the nasal mucosa over an autologous graft acting as an epithelial scaffold. LEVEL OF EVIDENCE: 4.

Tratamiento quirúrgico de los quistes subglóticos adquiridos / Surgical management of acquired subglottic cysts

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[Long-term changes on nasal tip in rhinoplasty patients operated with the new domes technique and the banner technique]. / Cambios a largo plazo en la punta nasal en pacientes intervenidos de rinoplastia primaria mediante las técnicas de los nuevos domos y del estandarte.

INTRODUCTION: Anatomy, surgical manoeuvres, scarring and physiologic nasal aging determine the final outcome of nasal tip on rhinoplasty patients. PATIENTS AND METHOD: Post-operative nasal tip changes in 182 rhinoplasty patients operated on by the same surgeon and with a minimum one year of follow-up were studied. A personal interview was arranged with all patients and facial photographs were taken. Nasal tip rotation, projection and definition were measured. RESULTS: After multivariate analysis, surgical manoeuvres with a statistical impact on the long-term outcome of the nasal tip were dome lateralization greater than 3 mm, columellar strut and shield graft. DISCUSSION AND CONCLUSIONS: Cartilage reshaping and tip grafting provide consistent long-lasting results in nasal tip surgery.

Cambios a largo plazo en la punta nasal en pacientes intervenidos de rinoplastia primaria mediante las técnicas de los nuevos domos y del estandarte / Long-term changes on nasal tip in rhinoplasty patients operated with the new domes technique and the banner technique

Introducción: Los factores anatómicos, las maniobras quirúrgicas y el proceso de cicatrización, así como los efectos del envejecimiento nasal en la nariz, van a determinar el resultado definitivo de la punta nasal en los pacientes intervenidos de rinoplastia. Pacientes y método: Se estudiaron los cambios postoperatorios en la punta nasal de 182 pacientes intervenidos de rinoplastia primaria por un mismo cirujano con un mínimo de 1 año de seguimiento. Se citó a los pacientes para un control en el que se tomaron fotografías y se midieron las variaciones en rotación, proyección y definición de la punta. Resultados: Las maniobras quirúrgicas con impacto estadísticamente significativo en el resultado de la punta nasal a largo plazo, tras el análisis multivariable, fueron la lateralización de los domos > 3 mm, la colocación de un poste intercrural y la utilización del injerto de escudo. Discusión y conclusiones: El reposicionamiento del esqueleto cartilaginoso y la utilización de injertos permiten obtener resultados consistentes y duraderos en la cirugía de la punta nasal (AU)

Introduction: Anatomy, surgical manoeuvres, scarring and physiologic nasal aging determine the final outcome of nasal tip on rhinoplasty patients. Patients and method: Post-operative nasal tip changes in 182 rhinoplasty patients operated on by the same surgeon and with a minimum one year of follow-up were studied. A personal interview was arranged with all patients and facial photographs were taken. Nasal tip rotation, projection and definition were measured. Results: After multivariate analysis, surgical manoeuvres with a statistical impact on the long-term outcome of the nasal tip were dome lateralization greater than 3 mm, columellar strut and shield graft. Discussion and conclusions: Cartilage reshaping and tip grafting provide consistent long-lasting results in nasal tip surgery (AU)

[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

[Laryngeal leiomyosarcoma]. / Leiomiosarcoma laríngeo.

Laryngeal leiomyosarcoma is a highly infrequent malignancy, with less than fifty reports in the scientific literature world-wide. Diagnosis is based on immunohistochemistry and, occasionally, on electron microscopy techniques, making it difficult to be done preoperatively. We report a new case of laryngeal leiomyosarcoma, with an up-to-date review of the differential diagnosis and the treatment strategy.

Leiomiosarcoma laríngeo / Laryngeal leiomyosarcoma

El leiomiosarcoma laríngeo es un tumor extraordinariamente infrecuente, con menos de 50 casos descritos en la literatura mundial. Su diagnóstico implica la necesidad de técnicas de inmunohistoquímica y ocasionalmente de microscopia elestrónica, que se practica casi siempre postoperatoriamente. Presentamos un nuevo caso de leiomiosarcoma laríngeo, haciendo una revisión actualizada de su diagnóstico diferencial y de la estrategia terapéutica

Laryngeal leiomyosarcoma is a highly infrequent malignancy, with less than fifty reports in the scientific literature world-wide. Diagnosis is based on immunohistochemistry and, occasionally, on electron microscopy techniques, making it difficult to be done preoperatively. We report a new case of laryngeal leiomyosarcoma, with an up-to-date review of the differential diagnosis and the treatment strategy