Parapharyngeal space tumors: Fifty-one cases managed in a single tertiary care center.

CONCLUSIONS: Pre-operative planning for parapharyngeal tumors must include meticulous analysis. Factors such as tumor size, distance to cranial base, and relation to neurovascular structures must guide the selection of a surgical approach. OBJECTIVE: To summarize experience in diagnosis and surgical management of parapharyngeal tumors, analyzing the frequencies of various tumoral types, clinical presentation, choice of surgical approach and outcomes. This study also compares the results with the most relevant case series in the literature. METHODS: A retrospective review was performed of the records of 51 patients treated by the team, from 1984-2012. Only primary tumors were included, excluding invasion from adjacent spaces and metastatic disease. All patients underwent imaging studies and surgical resection of the neoplasm. Cytological analysis and arteriography were used on an individualized basis. Surgical excision was performed via different approaches, predominantly through a cervicoparotid route. RESULTS: Benign neoplasms were predominant (80%), and the most frequent tumor was pleomorphic adenoma. FNAC had a 100% accuracy to differentiate benign vs malignant tumors. The most common post-operative sequel was compromise of a cranial nerve, and three patients presented local complications after surgery. After follow-up, only three of 41 patients with benign tumors had recurring disease.

Comparison and improvements of LCMV and MUSIC source localization techniques for use in real clinical environments.

The present work shows some improvements realized on practical aspects of the implementation of Singular Value Decomposition (SVD) methods to localize the sources of neural activity by means of magnetoencephalograph (MEG). Two methods have been improved and compared i.e. a spatial filter, the Linearly Constrained Minimum Variance Beamformer (LCMV) method, and a signal subspace method that is an implementation of the MUSIC (Multiple Signal Classification) method due to Mosher et al. (1992). It also shows the performance of both methods comparing three different averaging procedures. The influence of the correct selection of the noise subspace dimension has been analyzed. Using acoustic stimulus for real patient measurements, we discuss the relevant differences of both methods and propose an adequate strategy for future diagnosis based on correct source localization.

[Brain neuroplasticity in occipital areas in blind teenagers]. / Neuroplasticidad cerebral en áreas occipitales en adolescentes ciegos.

INTRODUCTION AND DEVELOPMENT: Neuroplasticity is a process by which neurons increase their connectivity with other neurons in a stable fashion as a consequence of experience, learning and both sensitive and cognitive stimulation. Different authors have shown a huge process of brain plasticity in blind subjects towards other sensorial areas, mainly auditive and visual ones. From an anatomical standpoint many data show significant differences in blind subjects brains, mainly in visual pathways and structures as a result of lack of activity on those areas. This brings a lesser neuroplasticity and, therefore, a decrease in structural volumes. They have also found differences in subcortical structures volumes related to vision, such as splenium or corpus callosum istmus. METHODOLOGY: An adolescent was administered passive tactile stimulation with an 1,500 taxels stimulator. This was carried out daily for an hour, for three months, and stimulation consisted of vertical, horizontal and oblique lines. The results obtained in an adolescent indicate a clear progression of EEG activity from tactile sensory parietal areas to visual occipital ones as stimulation progresses. CONCLUSION: Therefore one can speculate if systematic and organized repetition of tactile stimuli in blind subjects leads to a greater neuroplasticity which expands towards occipital areas, largely responsible for human vision.

Estimulación eléctrica del nervio facial con función pronóstica en la cirugía de parótida / Electrical stimulationof the facial nerve with a prognostic function in parotid surgery

Introducción. La electromiografía continua durante la parotidectomía y la estimulación directa del nervio facial como técnica de identificación intraoperatoria disminuyen la morbilidad postoperatoria significativamente. Objetivo. Determinar la utilidad de los parámetros neurofisiológicos intraoperatorios obtenidos mediante estimulación eléctrica del nervio facial como valores predictivos del tipo de lesión y pronóstico funcional. Pacientes y métodos. Serie correlativa de 20 casos de parotidectomía monitorizada. Se compara la función facial postoperatoria, tipo de lesión y su pronóstico con las variaciones de latencia/amplitud de la respuesta muscular entre dos estimulaciones del nervio facial pre y posresección, además de la ausencia o presencia de respuesta muscular a la estimulación posresección. Resultados. Todos los pacientes menos uno presentaron potencial evocado motor (PEM) a la estimulación posresección. El 55% obtuvo indemnidad facial postoperatoria y el 45% presentó algún tipo de paresia. La caída de amplitud del PEM intraoperatorio del 21% y el aumento de la latencia media del 13,5% se corresponden con las lesiones axonales y desmielinizantes, respectivamente, con un tiempo medio de recuperación de tres y seis meses. El único caso de ausencia de respuesta a la estimulación posresección presentó una paresia permanente. Conclusiones. La presencia del PEM tras resección no asegura la indemnidad funcional del nervio. Sin embargo, puede considerarse un dato que sugiere menor grado de afectación en el caso de haberlo y mejor pronóstico. Las variaciones de latencia y amplitud de los PEM tienden a ser parámetros indicadores del grado de afectación intraoperatorios y del pronóstico funcional (AU)

Introduction. Continuous electromyography during parotidectomies and direct stimulation of the facial nerve as an intraoperative identification technique significantly lower the rate of post-operative morbidity. Aim. To determine the usefulness of intra-operative neurophysiological parameters registered by means of electrical stimulation of the facial nerve as values capable of predicting the type of lesion and the functional prognosis. Patients and methods. Our sample consisted of a correlative series of 20 cases of monitored parotidectomies. Post-operative facial functioning, type of lesion and its prognosis were compared with the variations in latency/amplitude of the muscle response between two stimulations of the facial nerve before and after resection, as well as in the absence or presence of muscle response to stimulation after resection. Results. All the patients except one presented motor evoked potentials (MEP) to stimulation after resection. There was no facial damage following the operation in 55% of patients and 45% presented some kind of paresis. The 21% drop in the amplitude of the intra-operative MEP and the mean increase in latency of 13.5% correspond to axonal and demyelinating insult, respectively, with a mean recovery time of three and six months. The only case of absence of response to the post-resection stimulation presented permanent paresis. Conclusions. The presence of MEP following resection does not ensure that functioning of the nerve remains undamaged. Nevertheless, it can be considered a piece of data that suggests a lower degree of compromise, if it is present, and a better prognosis. The variations in latency and amplitude of the MEP tend to be intra-operative parameters that indicate the degree of compromise and functional prognosis (AU)

[Electrical stimulation of the facial nerve with a prognostic function in parotid surgery]. / Estimulación eléctrica del nervio facial con función pronóstica en la cirugía de parótida.

INTRODUCTION: Continuous electromyography during parotidectomies and direct stimulation of the facial nerve as an intraoperative identification technique significantly lower the rate of post-operative morbidity. AIM: To determine the usefulness of intra-operative neurophysiological parameters registered by means of electrical stimulation of the facial nerve as values capable of predicting the type of lesion and the functional prognosis. PATIENTS AND METHODS: Our sample consisted of a correlative series of 20 cases of monitored parotidectomies. Post-operative facial functioning, type of lesion and its prognosis were compared with the variations in latency/amplitude of the muscle response between two stimulations of the facial nerve before and after resection, as well as in the absence or presence of muscle response to stimulation after resection. RESULTS: All the patients except one presented motor evoked potentials (MEP) to stimulation after resection. There was no facial damage following the operation in 55% of patients and 45% presented some kind of paresis. The 21% drop in the amplitude of the intra-operative MEP and the mean increase in latency of 13.5% correspond to axonal and demyelinating insult, respectively, with a mean recovery time of three and six months. The only case of absence of response to the post-resection stimulation presented permanent paresis. CONCLUSIONS: The presence of MEP following resection does not ensure that functioning of the nerve remains undamaged. Nevertheless, it can be considered a piece of data that suggests a lower degree of compromise, if it is present, and a better prognosis. The variations in latency and amplitude of the MEP tend to be intra-operative parameters that indicate the degree of compromise and functional prognosis.

[Presbycusis: neural degeneration and aging on the auditory receptor of C57/BL6J mice]. / Presbiacusia: degeneración neuronal y envejecimiento en el receptor auditivo del ratón C57/BL6J.

Presbycusis is a progressive hearing impairment associated with aging, characterized by hearing loss and a degeneration of cochlear structures. In this paper we analyze the effects of aging on the auditory system of C57/BL6J mice, with electrophysiological and morphological studies. With this aim the auditory potentials of mice aging 1, 3, 6, 9, 12, 15, 18, 21 and 24 months were recorded, and then the morphology of the cochleal were analyzed. Auditory potentials revealed an increase in wave latencies, as well as a decrease in their amplitudes during aging. Morphological results showed a total Corti's organ degeneration, being replaced by a flat epithelial layer, and a total absence of hair cells.

Presbiacusia: degeneración neuronal y envejecimiento en el receptor auditivo del ratón C57/BL6J / Presbycusis: neural degeneration and aging on the auditory receptor of C57/BL6J mice

La presbiacusia es una pérdida auditiva progresiva, ligada al envejecimiento, que se manifiesta como una sordera asociada a cambios degenerativos cocleares. En el presente estudio se analizan los efectos del envejecimiento sobre el sistema auditivo del ratón C57/BL6J mediante técnicas electrofisiológicas y morfológicas. Con este fin se registraron los potenciales auditivos en animales de 1, 3, 6, 9, 12, 15, 18, 21 y 24 meses de edad, con posterior análisis morfológico de sus cócleas. Los potenciales auditivos mostraron un incremento de latencia y una disminución de amplitud progresivos con la edad. Los estudios morfológicos demostraron una total degeneración del órgano de Corti, que aparecía reemplazado por un epitelio plano con ausencia de células ciliadas

Presbycusis is a progressive hearing impairment associated with aging, characterized by hearing loss and a degeneration of cochlear structures. In this paper we analyze the effects of aging on the auditory system of C57/BL6J mice, with electrophysiological and morphological studies. With this aim the auditory potentials of mice aging 1, 3, 6, 9, 12, 15, 18, 21 and 24 months were recorded, and then the morphology of the cochleal were analyzed. Auditory potentials revealed an increase in wave latencies, as well as a decrease in their amplitudes during aging. Morphological results showed a total Corti´s organ degeneration, being replaced by a flat epithelial layer, and a total absence of hair cells

[Neurilemmoma of the larynx: a case report]. / Neurinoma laríngeo: a propósito de un caso.

Neuromas or Schwannomas are extremely rare among tumors of the larynx. They are Schwann cell tumors that can be difficult to distinguish from neurofibromas. They present usually as supraglottic masses, since they may arise from the internal branch of the superior laryngeal nerve. Nuclear magnetic resonance imaging is the best diagnostic technique, conferring a high degree of suspicion. We present an exceptional case of a laryngeal neuroma, with a very long evolution, a large tumor volume, dyspnea and vocal cord fixation, with complete resolution through an external approach following surgical removal. The difficulties encountered with its pathological and clinical diagnosis are discussed as well as a review of the literature.

Neurinoma laríngeo: a propósito de un caso / Neurilemmoma of the larynx: a case report

El neurinoma laríngeo es un tumor benigno extremadamente raro que deriva de las células de Schwann y se puede confundir con un neurofibroma. La forma de presentación más frecuente es una masa supraglótica que deriva de la rama interna del nervio laríngeo superior y es la RMN el método que mejor establece el diagnóstico de sospecha. Presentamos un caso tratado en nuestro servicio, cuya excepcionalidad radica en el largo tiempo de evolución, volumen elevado que conlleva disnea e inmovilidad de la hemilaringe afecta, que se recupera tras cirugía con abordaje externo. Se discuten las dificultades planteadas por su diagnóstico clínico y anátomo-patológico, al tiempo que se hace una revisión de la bibliografía pertinente (AU)

Neuromas or Schwannomas are extremely rare among tumors of the larynx. They are Schwann cell tumors that can be difficult to distinguish from neurofibromas. They present usually as supraglottic masses, since they may arise from the internal branch of the superior laryngeal nerve. Nuclear magnetic resonance imaging is the best diagnostic technique, conferring a high degree of suspicion. We present an exceptional case of a laryngeal neuroma, with a very long evolution, a large tumor volume, dyspnea and vocal cord fixation, with complete resolution through an external approach following surgical removal. The difficulties encountered with its pathological and clinical diagnosis are discussed as well as a review of the literature (AU)

Sordera en el anciano / Hearing loss in the elderly

No disponible

A propósito de un caso: linfoma no Hodgkin de hipofaringe en paciente con infección por VIH. Remisión sin tratamiento específico para el linfoma / Report of a case: non-Hodgkin's lymphoma of the hypopharynx in a patient with HIV infection. Remission without lymphoma-specific treatment

Los linfomas no Hodgkin (LNH) son comunes en pacientes con infección por Virus de la Inmunodeficiencia Humana (VIH), pero es raro que aparezcan como linfomas primarios de laringe o hipofaringe. Presentamos el caso de un paciente al que se diagnosticó un LNH de alto grado a través de una biopsia de una lesión primaria de seno piriforme, tomada por laparoscopia directa. Simultáneamente se le diagnosticó de infección por VIH. El interés de este trabajo reside en la remisión completa del linfoma al instaurar sólo la terapia específica frente al VIH (AU)

Non-Hodgkin's lymphomas (NHL) are common in HIV patients, although it is rare for primary lymphomas to develop in the larynx or hypopharynx. We present the case of a patient that was diagnosed of a high degree NHL, following a biopsy of the piriform sinus' lesion, taker by direct laryngoscopy. Simultaneously he was diagnosed as HIV. The interest of this paper is the total remission of the lymphoma seen after specific HIV treatment only (AU)

[Spread channels of anterior commissure cancer: clinico-pathological study and surgical implications]. / Vías de diseminación del cáncer de comisura anterior: estudio clínico-patológico e implicaciones quirúrgicas.

UNLABELLED: The aim of the present study is to describe the spread channels of the anterior commisure cancer, its clinical significance and its surgical implications. PATIENTS AND METHODS: A prospective study was performed at the ENT Department of the Complutense University in about 31 patients with anterior commisure carcinoma wo underwent surgery between 1994/97. Specimens were processes with Whole-Organ Serial Sections. RESULTS: Patients were differenciated into two groups: 1) Patients with glottic tumors, with a good cord mobility and no invasive tumor in commisure region (18 patients); In these patients, conservative surgery was possible; 2) Another group (13 patients) with aggressive lesions (80% with cartilage involvement), vocal cord fixation and transglottic lesions. In these group, conservative surgery was contraindicated. CONCLUSIONS: This report emphasizes the importance of laryngoscopy in surgical technique of anterior commisure cancer.

Vías de diseminación del cáncer de comisura anterior: estudio clínico-patológico e implicaciones quirúrgicas / Spread channels of the anterior commisure cancer: a clinical and pathological study with surgical implications

El objetivo del estudio será la descripción de las vías de diseminación del cáncer de la comisura anterior y su implicación quirúrgica. Material y métodos: se realizó estudio histopatológico de 31 piezas de laringuectomía intervenidas entre 1994/97 mediante técnica de secciones seriadas de órgano completo. Resulta dos: los 31 pacientes con afectación de la región comisural anterior fueron divididos en dos grupos: 1) Un primer grupo de 18 pacientes en los que el tumor no invadía en profundidad la región comisural anterior que presentaban por laringoscopia tumores estrictamente del plano glótico con movilidad cordal conservada, en los que era posible realizar cirugía funcional; 2) Un segundo grupo de peor pronóstico, formado por 13 pacientes con invasión en profundidad de la región comisural anterior (83 por ciento con invasión del esqueleto cartilaginoso), todos ellos con invasión de más de un piso laríngeo y fijación cordal, en los que estaba contraindicada cualquier tipo de cirugía conservadora. Conclusiones: la imagen laringoscópica en el cáncer de la comisura anterior resulta fundamental para plantear cualquier intento de cirugía conservadora. (AU)

The aim of the present study is to describe the spread channels of the anterior commisure cancer, its clinical significance and its surgical implications. PATIENTS AND METHODS: A prospective study was performed at the ENT Department of the Complutense University in about 31 patients with anterior commisure carcinoma wo underwent surgery between 1994/97. Specimens were processes with Whole-Organ Serial Sections. RESULTS: Patients were differenciated into two groups: 1) Patients with glottic tumors, with a good cord mobility and no invasive tumor in commisure region (18 patients); In these patients, conservative surgery was possible; 2) Another group (13 patients) with aggressive lesions (80% with cartilage involvement), vocal cord fixation and transglottic lesions. In these group, conservative surgery was contraindicated. CONCLUSIONS: This report emphasizes the importance of laryngoscopy in surgical technique of anterior commisure cancer (AU)

[Report of a case: non-Hodgkin's lymphoma of the hypopharynx in a patient with HIV infection. Remission without lymphoma-specific treatment]. / A propósito de un caso: linfoma no Hodgkin de hipofaringe en paciente con infección por VIH. Remisión sin tratamiento específico para el linfoma.

Non-Hodgkin's lymphomas (NHL) are common in HIV patients, although it is rare for primary lymphomas to develop in the larynx or hypopharynx. We present the case of a patient that was diagnosed of a high degree NHL, following a biopsy of the piriform sinus' lesion, taker by direct laryngoscopy. Simultaneously he was diagnosed as HIV. The interest of this paper is the total remission of the lymphoma seen after specific HIV treatment only.

Rotura capsular en el cáncer avanzado de laringe / Extracapsular spread in advanced laryngeal cancer

La rotura capsular del ganglio metastásico es un signo de muy mal pronóstico en los pacientes con cáncer de laringe. La identificación de esta rotura de la cápsula del ganglio por el tumor es difícil en el estudio prequirúrgico del paciente, incluso con las modernas técnicas de imagen. El objetivo de este trabajo será establecer parámetros histopatológicos predictivos de diseminación extracapsular en los ganglios metastásicos. Para ello hemos estudiado 11variables patológicas (tumorales -estadio T, localización tumoral, diámetro tumoral, invasión laríngea en profundidad, grado de diferenciación, invasión perineural, invasión cartilaginosa- y de las adenopatías cervicales- número de ganglios afectados, diámetro de los ganglios, bilateralidad de las metástasis cervicales, estadio N-) que podrían ser predictivas de rotura capsular en 47 pacientes con metástasis cervicales intervenidos quirúrgicamente en la Cátedra de ORL de la Universidad Complutense de Madrid entre los años 94/97. Todas las piezas quirúrgicas fueron estudiadas mediante Secciones Seriadas de Órgano Completo. Las variables que aumentaron el riesgo de rotura capsular en el presente estudio fueron la localización del tumor, el diámetro tumoral mayor de 2 cm, las presencia de 2-3 ganglios metastásicos y el estadio N (AU)

The aim of the present study is to evaluate histopathological features of extracapsular spread detected in patients with laryngeal cancer. PATIENTS AND METHODS: Specimens of 47 patients with laryngeal cancer were processed as Whole-Organ Serial Sections at the ENT Department of the Complutense University of Madrid between 1994/97. RESULTS: Extracapsular metastases were found in 21 patients. The risk for extracapsular spread was higher in those patients with: supraglottic or piriform sinus cancer, more than 2-3 neck metastatic nodes, tumor diameter of more than 2 cm and N2 stage (AU)

Cáncer glótico precoz: estudio clínicopatológico / Early glottic carcinoma: a clinical and pathological study

La displasia laríngea, el carcinoma in situ (Tis) y el carcinoma microinfiltrante (T1) de la cuerda vocal son parte del espectro histopatológico del cáncer glótico precoz. El objetivo del presente estudio es identificar la incidencia de malignización de las displasias de la cuerda vocal y las causas de recidiva tumoral del cáncer glótico precoz tratado con cirugía. Material y métodos: se realizó un estudio prospectivo de seguimiento desde el año 1992 sobre una cohorte de 134 pacientes con displasia-carcinoma in situ-cáncer glótico precoz de cuerda vocal. El grupo de estudio estaba formado por 68 displasias, 11 carcinomas in situ y 55 carcinomas microinfiltrantes. Resultados: Nueve pacientes de 68 displasias se malignizaron (13 per cent), mientras que seis pacientes con cáncer glótico precoz recidivaron localmente (11 per cent), todos ellos con afectación de la región comisural anterior. Se realizaron en total 8 laringectomías totales (6 per cent), falleciendo tres pacientes por enfermedad tumoral laríngea. Conclusión: El principal factor de riesgo de malignización del cáncer glótico precoz fue la afectación de la región comisural anterior (AU)

The aim of the present study is to evaluate histopathological features of malignization of laryngeal dysplasia and recurrence of early glottic carcinoma. PATIENTS AND METHODS: A prospective study was perform in a cohort of 134 patients who underwent surgery between 1992/99 at the ENT department of the Complutense University of Madrid. Tumor localization, malignization rate and recurrence rate were studied in 68 cases of laryngeal dysplasia, 11 of in situ-carcinoma and 55 of microinvasive carcinoma. RESULTS: Nine laryngeal dysplasias experienced invasive carcinoma (13%) and six patients with invasive glottic carcinoma had laryngeal recurrence (11%), all of them with anterior commisure involvement. Eight patients underwent total laryngectomy for recurrence (6%) and three patients died of laryngeal cancer. CONCLUSIONS: Anterior commisure involvement was the most important risk factor in early glottic carcinoma (AU)

[Report of a case: large tonsillolith in palatine tonsil]. / A propósito de un caso: gran tonsilolito en amígdala palatina.

A 69-year-old woman presented with a one-year history of dysphagia and a hard overgrowth of the right palatine tonsil visible in oral examination. Computerized Tomography scan showed a big calcified lesion inside the tonsil not seen in a pharyngoscopy. Tonsillectomy was performed and a giant tonsillolith was found inside the resected piece. The calculus was 3 x 2 x 2.3 cm and with an irregular-pyramidal shape. Normal tonsillar tissue with many colonies of Actionomyces inside the tonsillar crypts was the definitive pathological feature.

A propósito de un caso: gran tonsilolito en amígdala palatina / Giant tonsillolith in palatine tonsil: report of one case

Presentamos el caso de una paciente de 69 años con clínica de disfagia de un año de evolución. En la exploración se apreció crecimiento de amígdala palatina derecha, con consistencia dura. La tomografía computerizada mostró una imagen de gran calcificación ocupando el centro de la amígdala, no evidenciable por faringoscopia. Realizada la extracción quirúrgica de la amígdala, en su interior se halló un tonsilolito gigante, con forma de pirámide irregular de 3x2x2,3 cm. El análisis histopatológico de la pieza de amigdalectomía se informó como tejido amigdalar dentro de los límites normales con presencia de numerosas colonias de actinomices en las criptas (AU)

A 69-year-old woman presented with a one-year history of dysphagia and a hard overgrowth of the right palatine tonsil visible in oral examination. Computerized Tomography scan showed a big calcified lesion inside the tonsil not seen in a pharyngoscopy. Tonsillectomy was performed and a giant tonsillolith was found inside the resected piece. The calculus was 3 x 2 x 2.3 cm and with an irregular-pyramidal shape. Normal tonsillar tissue with many colonies of Actionomyces inside the tonsillar crypts was the definitive pathological feature (AU)

[Early glottic carcinoma: a clinico-pathological study]. / Cáncer glótico precoz: estudio clínico-patológico.

UNLABELLED: The aim of the present study is to evaluate histopathological features of malignization of laryngeal dysplasia and recurrence of early glottic carcinoma. PATIENTS AND METHODS: A prospective study was perform in a cohort of 134 patients who underwent surgery between 1992/99 at the ENT department of the Complutense University of Madrid. Tumor localization, malignization rate and recurrence rate were studied in 68 cases of laryngeal dysplasia, 11 of in situ-carcinoma and 55 of microinvasive carcinoma. RESULTS: Nine laryngeal dysplasias experienced invasive carcinoma (13%) and six patients with invasive glottic carcinoma had laryngeal recurrence (11%), all of them with anterior commisure involvement. Eight patients underwent total laryngectomy for recurrence (6%) and three patients died of laryngeal cancer. CONCLUSIONS: Anterior commisure involvement was the most important risk factor in early glottic carcinoma.

[Extracapsular spread in advanced laryngeal cancer]. / Rotura capsular en el cáncer avanzado de laringe.

UNLABELLED: The aim of the present study is to evaluate histopathological features of extracapsular spread detected in patients with laryngeal cancer. PATIENTS AND METHODS: Specimens of 47 patients with laryngeal cancer were processed as Whole-Organ Serial Sections at the ENT Department of the Complutense University of Madrid between 1994/97. RESULTS: Extracapsular metastases were found in 21 patients. The risk for extracapsular spread was higher in those patients with: supraglottic or piriform sinus cancer, more than 2-3 neck metastatic nodes, tumor diameter of more than 2 cm and N2 stage.