Eficacia del tratamiento quirúrgico del papiloma invertido nasosinusal / Efficacy of surgical treatment of nasosinusal inverted papilloma

Introducción y objetivo: El papiloma invertido nasosinusal tiene un comportamiento localmente agresivo con riesgo de recidiva, por lo que requiere un tratamiento quirúrgico adecuado y un seguimiento prolongado en consulta. Nuestro objetivo es determinar la eficacia del tratamiento quirúrgico de los papilomas invertidos mediante cirugía endoscópica nasosinusal (CENS), evaluando la incidencia de recurrencia y la persistencia de enfermedad tras la cirugía.Método: Se realiza un estudio retrospectivo de 39 pacientes tratados de papiloma invertido entre 2006 y 2020 en un hospital universitario, registrando datos demográficos y características tumorales. Se analiza la persistencia (antes de 6 meses) o recidiva (después de 6 meses) tras tratamiento quirúrgico.Resultados: El 82% (32/39) de los casos fueron varones y la edad media fue de 54 años. La localización más frecuente fue la pared lateral nasal (38,5%). El 89,7% (35/39) de los casos fue tratado quirúrgicamente mediante CENS, obteniendo un porcentaje de persistencia y recidiva del 2,6%. Un 7,7% (3/39), al ser lesiones del vestíbulo nasal, se resecaron de forma simple. En un caso concreto (2,6%), se necesitó realizar osteoplastia frontal por extensión del papiloma. No se encontró atipia ni malignización en ninguno de los casos.Discusión y conclusiones: El tratamiento quirúrgico de elección del papiloma invertido es la CENS, considerando realizar maxilectomía medial en todos los casos. El tratamiento quirúrgico del PI mediante esta técnica presenta una baja tasa de persistencia y de recurrencia. (AU)

Autologous Adipose Tissue Injection of Vocal Cords in Presbyphonia.

OBJECTIVE: This series evaluates the long-term results of autologous adipose injection (AAI) in patients older than 65 years with presbyphonia. STUDY DESIGN: Retrospective cohort study. SETTING: Academic secondary medical center. METHODS: This was a retrospective study with a minimum follow-up of 12 months. All patients underwent AAI for atrophy of both vocal folds due to presbyphonia. We measured subjective parameters as Voice Handicap Index-10 (VHI-10) or GRBAS scale (grade, roughness, breathiness, asthenia, strain) and objective measures such as maximum phonation time (MPT) or square pixel closure defect. We reviewed the medical records of patients undergoing AAI during the 2011-2018 period. An analysis of the demographic variables of the group was performed, as well as the values of VHI-10, GRBAS, and MPT, and the minimum closure defect measured in square pixels and the number of closed frames in the glottal cycle before and after the intervention. RESULTS: At 12 months, 17 of 18 patients reported subjective and VHI-10 improvement. The mean preoperative VHI-10 (26.7) was significantly higher than the postoperative value (14.4), and the GRBAS scale had a preoperative mean of 8.7 and a postoperative mean of 4.3, both with statistical significance. MPT increased from 7.7 to 12.4 seconds (P < .0001). The minimum closure defect measurements obtained in square pixels changed from 305 to 124, achieving complete closure in 3 patients. The closed phase of the glottal cycle change from 14.3% to 38.2% after the AAI. CONCLUSIONS: AAI improves long-term vocal fold closure, demonstrating utility in patients with presbyphonia.

Open Tracheostomy for Critically Ill Patients with COVID-19.

BACKGROUND: COVID-19 is a worldwide pandemic, with many patients requiring prolonged mechanical ventilation. Tracheostomy can shorten ICU length of stay and help weaning. Aims/Objectives. To describe the long-term evolution of the critically patient with COVID-19 and the need for invasive mechanical ventilation and orotracheal intubation (OTI), with or without tracheostomy. Material and Methods. A prospective study was performed including all patients admitted to the ICU due to COVID-19 from 10th March to 30th April 2020. Epidemiological data, performing a tracheostomy or not, mean time of invasive mechanical ventilation until tracheotomy, mean time from tracheotomy to weaning, and final outcome after one month of minimum follow-up were recorded. The Otolaryngology team was tested for COVID-19 before and after the procedures. RESULTS: Out of a total of 1612 hospital admissions for COVID-19, only 5.8% (93 patients) required ICU admission and IOT. Twenty-seven patients (29%) underwent a tracheostomy. After three months, within the group of tracheotomized patients, 29.6% died and 48.15% were extubated in a mean time of 28.53 days. In the nontracheostomized patients, the mortality was 42.4%. CONCLUSIONS: Tracheostomy is a safe procedure for COVID-19 and helps weaning of prolonged OTI. Mortality after tracheostomy was less common than in nontracheostomized patients.