[Treatment of early glottic carcinoma with transoral laser CO2]. / Tratamiento del cáncer glótico precoz con cirugía transoral láser CO2.

OBJECTIVE: We present our outcome in the treatment of 125 patients with malignant glottic lesions between 1992 and 2003 in a retrospective study. PATIENT AND METHODS: We analyze 125 cases of patients, with previously untreated carcinoma of the larynx with histological diagnosis, treated with Transoral Laser Microresection. We will pay special attention to those tumors involving the Anterior Commissure. We will also analyze several parameters related to the post and intraoperatory histopathological report, in order to decide adjuvant therapies. We will also analyze the technique indications, complications, hospital length of stay, oncologic and functional outcomes, survival and follow up of recurrences. OUTCOMES AND CONCLUSION: Transoral laser microresection is an effective and functional preserving procedure, and nowadays the base of the treatment of early glottic carcinoma. Anterior Commissure involvement is a prognostic factor. Sometimes complementary therapies are needed based on by the histopathological report.

[Temporal bone chondroblastoma. A clinical case and literature review]. / Condroblastoma de hueso temporal. Caso clínico y revisión de la literatura.

We report a clinical case of a 31 year old male with a left temporal painful mass of six months evolution. After radiologic diagnosis, intraoperatory biopsy and surgical removal, the anatomopathological result confirmed the histology of chondroblatoma, with a satisfactory postoperative evolution. The chondroblastoma is a benign bone tumor typically located in the epiphysis of long bones and the temporal bone is an excepcional location as we have verified through a literature review.

Tratamiento del cáncer glótico precoz con cirugía transoral láser CO2 / Treatment of early glottic carcinoma with transoral laser CO2

Objetivo: Estudio retrospectivo (1992-2003) de cánceres glóticos en estadio precoz tratados con cirugía transoral láser CO2. Material y métodos: Se estudian 125 casos de pacientes no previamente tratados, con diagnóstico histológico de carcinoma, tratados mediante Resección Transoral Láser CO2. Prestaremos especial atención a la afectación de la comisura anterior. También se analizarán aspectos referentes al informe anatómico de la pieza quirúrgica y su importancia intra y postoperatoria a la hora de realizar tratamientos complementarios. Analizamos las indicaciones de la técnica, las complicaciones, la estancia media, los resultados funcionales y oncológicos, la supervivencia y realizamos seguimiento de las recidivas. Resultados y Conclusiones: La técnica Láser es efectiva, conservadora de la función, y la base del tratamiento del carcinoma precoz de cuerda vocal. La afectación comisural influye en el pronóstico. Ocasionalmente pueden ser necesarios tratamientos complementarios en base al informe patológico postoperatorio

Objective: We present our outcome in the treatment of 125 patients with malignant glottic lesions between 1992 and 2003 in a retrospective study. Patient and methods: We analyze 125 cases of patients, with previously untreated carcinoma of the larynx with histological diagnosis, treated with Transoral Laser Microresection. We will pay special attention to those tumors involving the Anterior Commissure. We will also analyze several parameters related to the post and intraoperatory histopathological report, in order to decide adjuvant therapies. We will also analyze the technique indications, complications, hospital length of stay, oncologic and functional outcomes, survival and follow up of recurrences. Outcomes and conclusion: Transoral laser microresection is an effective and functional preserving procedure, and nowadays the base of the treatment of early glottic carcinoma. Anterior Commissure involvement is a prognostic factor. Sometimes complementary therapies are needed based on by the histopathological report

Condroblastoma de hueso temporal. Caso clínico y revisión de la literatura / Temporal bone chondroblastoma. A clinical case and literature review

Presentamos el caso clínico de un paciente de 31 años de edad que consulta por una tumoración dolorosa en región temporal izquierda de seis meses de evolución. Tras su examen radiológico, biopsia intraoperatoria y exéresis quirúrgica se confirma el diagnóstico de condroblastoma, con una evolución clínica postoperatoria satisfactoria. El condroblastoma es un tumor benigno que asienta preferentemente en las epífisis de los huesos largos de las extremidades, cuya localización en hueso temporal es excepcional como constatamos al realizar una revisión bibliográfica de esta patología

We report a clinical case of a 31 year old male with a left temporal painful mass of six months evolution. After radiologic diagnosis, intraoperatory biopsy and surgical removal, the anatomopathological result confirmed the histology of chondroblatoma, with a satisfactory postoperative evolution. The chondroblastoma is a benign bone tumor typically located in the epiphysis of long bones and the temporal bone is an excepcional location as we have verified through a literature review

[Acute mastoiditis in children. A retrospective study and literature review]. / Mastoiditis aguda infantil. Estudio retrospectivo y revisión de la literatura.

OBJECTIVE: To review our experience and results in the diagnosis and treatment of acute mastoiditis, a pathology with an increasing incidence in the recent years. METHODS: The study reviewed 49 pediatric patients diagnosed and treated of acute mastoiditis between 1994 and 2003 in our hospital. We summarize epidemiologic, laboratory and clinical features. RESULTS: The mean age was 2.5 years. Seventy-five percent of cases were in autumn and winter months and nearly twenty-five percent had been diagnosed in the last year. S. pneumoniae was the most commonly isolated pathogen (28.6%), although a sterile result was the most frequent (38.1%). Twenty-four patients (48.9%) required surgical treatment. Only five patients (10.2%) developed complications. CONCLUSIONS: Acute mastoiditis is a pathology with an important incidence and is generally the consequence of an untreated otitis or an insufficient treatment. Due to the low number of complications, we can not estimate through statistical analysis valid markers like predictors for complication.

Mastoiditis aguda infantil. Estudio retrospectivo y revisión de la literatura / Acute mastoiditis in children. A retrospective study and literature review

Objetivo: Revisar en nuestro centro la experiencia y resultados en el diagnóstico y tratamiento de la mastoiditis aguda infantil, una patología que ha experimentado un sensible incremento de su incidencia en los últimos años. Material y método: Realizamos un estudio retrospectivo de 49 pacientes menores de 16 años diagnosticados y tratados de mastoiditis aguda entre los años 1994 y 2003 en nuestro hospital. Se analizan diversas variables epidemiológicas, analíticas y clínicas. Resultados: La edad media de los pacientes fue de dos años y medio. El 75% de los casos se produjeron en los meses de otoño e invierno y casi la cuarta parte han sido diagnosticados en el último año. El microorganismo más prevalente fue el S. pneumoniae en un 28,6% de los cultivos estudiados, aunque lo más frecuente (38,1%) fue un resultado estéril de la muestra. Veinticuatro de los pacientes (48,9%) precisaron tratamiento quirúrgico ante la mala evolución clínica. Se presentaron complicaciones en tan sólo cinco pacientes (10,2%). Conclusiones: La mastoiditis aguda sigue siendo una patología con una incidencia importante en nuestro medio y en la cual debemos pensar ante una OMA de mala evolución o que recibe tratamiento antibiótico inadecuado. No ha sido posible realizar análisis estadísticos significativos de variables predictivas de una complicación debido al bajo número de estas

Objective: To review our experience and results in the diagnosis and treatment of acute mastoiditis, a pathology with an increasing incidence in the recent years. Methods: The study reviewed 49 pediatric patients diagnosed and treated of acute mastoiditis between 1994 and 2003 in our hospital. We summarize epidemiologic, laboratory and clinical features. Results: The mean age was 2.5 years. Seventy- five percent of cases were in autumn and winter months and nearly twenty-five percent had been diagnosed in the last year. S. pneumoniae was the most commonly isolated pathogen (28.6%), although a sterile result was the most frequent (38.1%). Twenty-four patients (48.9%) required surgical treatment. Only five patients (10.2%) developed complications. Conclusions: Acute mastoiditis is a pathology with an important incidence and is generally the consequence of an untreated otitis or an insufficient treatment. Due to the low number of complications, we can not estimate through statistical analysis valid markers like predictors for complication

[Cancer of the parotid gland]. / Tumores malignos de la glándula parótida.

OBJECTIVE: To review our experience and results in the diagnosis and treatment of a low incidence pathology such as the cancer of the parotid gland. METHODS: The study reviewed 40 patients with malignant tumors of the parotid gland treated between 1991 and 2002 in our hospital. It was used the staging system TNM (American Joint Committee on Cancer 1997). RESULTS: The most common histological type in our series is the squamous cell carcinoma, in general unilateral and in the superficial lobe. Rapid tumor enlargement, fixation to the skin, cervical lymphadenopathy, pain and facial palsy are malignancy clinical findings. We obtained a 56% 5-year global survival rate, with a 68% for stages I and II, and 43% for stages III and IV. CONCLUSIONS: This pathology has a low incidence but high mortality. The staging and histological type are important prognostic factors. The surgery is the election treatment, associated with neck disection or radiotherapy.

Tumores malignos de la glándula parótida / Cancer of the parotid gland

Objetivo: Revisar la experiencia y resultados de nuestro hospital en el diagnóstico y tratamiento de una patología con una baja incidencia como son los tumores malignos de la glándula parótida. Material y método: Realizamos un estudio retrospectivo de 40 pacientes tratados de tumores malignos de la glándula parotídea entre los años 1991 y 2002 en nuestro hospital. El sistema de estadiaje utilizado fue el TNM, según la clasificación de la American Joint Committee on Cancer (1997). Resultados: El tipo histológico más frecuente en nuestra serie es el carcinoma epidermoide, presentándose generalmente como una tumoración unilateral y en el 90% de los casos en el lóbulo superficial de la glándula. La presencia de un crecimiento rápido, dureza y fijación a los elementos adyacentes y la piel, adenopatías regionales, dolor o parálisis facial están íntimamente relacionados con el grado de malignidad. La supervivencia global de los tumores malignos de parótida en nuestro estudio fue del 56% a los 5 años, con un 68% para los tumores en estadio I y II y un 43% para los de estadio III y IV. Conclusiones: Esta patología tiene una incidencia baja, pero de alta mortalidad. La histología y el estadio tienen un importante valor pronóstico. La cirugía es el tratamiento de elección, con vaciamiento cervical o radioterapia complementaria

Objective: To review our experience and results in the diagnosis and treatment of a low incidence pathology such as the cancer of the parotid gland. Methods: The study reviewed 40 patients with malignant tumors of the parotid gland treated between 1991 and 2002 in our hospital. It was used the staging system TNM (American Joint Committee on Cancer 1997). Results: The most common histological type in our series is the squamous cell carcinoma, in general unilateral and in the superficial lobe. Rapid tumor enlargement, fixation to the skin, cervical lymphadenopathy, pain and facial palsy are malignancy clinical findings. We obtained a 56% 5-year global survival rate, with a 68% for stages I and II, and 43% for stages III and IV. Conclusions: This pathology has a low incidence but high mortality. The staging and histological type are important prognostic factors. The surgery is the election treatment, associated with neck disection or radiotherapy

Tumores malignos del conducto auditivo externo y oído medio / Malignant tumours of the external auditory canal and of the middle ear

Objetivos: Revisar la experiencia de nuestro Centro en el tratamiento de una patología tan poco frecuente como son los tumores del CAE y oído medio. Material y métodos: Se realiza una revisión de 36 pacientes con tumores malignos del oído medio y CAE tratados en el servicio de nuestro hospital en el período de 1977-2000, excluyendo los tumores de pabellón, tumores metastásicos y sarcomas. El sistema de estadiaje utilizado es el propuesto por el M.D. Anderson. Resultados: El tipo histológico más frecuente en nuestra serie es el carcinoma epidermoide, presentándose en el 100 por ciento de los casos con otorrea y dolor como primer síntoma en el momento de la consulta. La combinación de cirugía y radioterapia obtuvo una tasa de supervivencia a los 5 años del 41 por ciento. Conclusiones: Esta patología precisa para la realización de un diagnóstico precoz un alto índice de sospecha clínica. El correcto estadiaje clínico tiene un importante valor pronóstico (AU)

OBJECTIVES: To review our experience and results in the treatment of a low incidence pathology such as the malignant ear tumors. METHODS: The study reviewed 36 patients with malignant tumors of the EAC and middle ear treated between 1977 and 2000 in our hospital, excluding cancer of the pinna, metastatic tumours and sarcomas. It was used the staging system proposed by the M.D. Anderson. RESULTS: The most common histological type in our series is the squamous cell carcinoma, and the otorrhea and pain are the primary symptoms in 100% of patients. Surgery combined with radiotherapy obtained a 41% 5-year survival rate. CONCLUSIONS: The staging system is an important prognostic factor and it is important an early diagnosis to achieve a better therapeutical result (AU)

[Geniculate ganglion tumors. Therapeutic and reconstructive management]. / Tumores del ganglio geniculado. Manejo terapéutico y reconstructivo.

We present five cases of patients diagnosed of a facial nerve tumoral lesion localised at the Geniculate Ganglion and all of which underwent surgical resection. The initial symptoms were in four cases of peripheral facial nerve paralysis and in the fifth case facial paresis. Two trans-mastoid extralabyrinthine approaches were performed and one through a combined path (middle fossa and trans-mastoid) with reconstruction of the facial nerve through a termino-terminal graft. In the fourth case, an approach through fossa media was done, and did not include nerve reconstruction but palliative treatment with a palpebral gold plaque. In the fifth case, a modified trans-labyrinthine approach with facial-hypoglossus termino-terminal anastomosis. Histological diagnosis was 3 neurinomas and 2 hemangiomas. Of the termino-terminal grafts two managed a functional Grade III of the House-Brackmann classification. The third one sustained a Grade VI and therefore a suspension with temporal muscle was carried out. The patient with facial-hypoglossus anastomosis is in a functional Grade IV. Geniculate ganglion tumors are in their majority benign and their treatment is the total resection of the tumor. Nerve reconstruction can be primary or deferred with the aid of a nerve graft or anastomosis, being necessary palliative techniques when resection is not possible.

Tumores del ganglio geniculado. Manejo terapéutico y reconstructivo / Geniculate ganglion tumors. Therapeutic and reconstructive management

Presentamos cinco casos de pacientes diagnosticados de una lesión tumoral del nervio facial localizada en la región del ganglio geniculado a los cuales se practicó cirugía de exéresis. La clínica inicial fue en cuatro de los casos parálisis facial periférica de larga evolución y en el quinto paresia facial. Se realizaron dos abordajes transmastoideos extralaberínticos y uno por vía combinada (fosa media y transmastoidea) con reconstrucción del nervio facial mediante injerto termino-terminal. En el cuarto caso, un abordaje por fosa media, no se incluyó reconstrucción nerviosa sino tratamiento paliativo con placa de oro palpebral. En el quinto, un abordaje translaberíntico modificado, se hizo anastomosis termino-lateral hipogloso-facial. El diagnóstico histológico fue de 3 neurinomas y 2 hemangiomas. Funcionalmente 2 de los injertos termino-terminales lograron grado III de la clasificación de House-Brackmann. El tercero mantuvo grado VI por lo que se realizó suspensión con músculo temporal. El paciente con anastomosis hipoglosofacial está en grado funcional IV. Los tumores del ganglio geniculado son en su mayoría de histología benigna y su tratamiento es la exéresis completa. La reconstrucción nerviosa puede ser primaria o diferida ayudándose de injerto nervioso o anastomosis, siendo necesarias las técnicas paliativas cuando ésta no es posible (AU)

We present five cases of patients diagnosed of a facial nerve tumoral lesion localised at the Geniculate Ganglion and all of which underwent surgical resection. The initial symptoms were in four cases of peripheral facial nerve paralysis and in the fifth case facial paresis. Two trans-mastoid extralabyrinthine approaches were performed and one through a combined path (middle fossa and trans-mastoid) with reconstruction of the facial nerve through a termino-terminal graft. In the fourth case, an approach through fossa media was done, and did not include nerve reconstruction but palliative treatment with a palpebral gold plaque. In the fifth case, a modified trans-labyrinthine approach with facial-hypoglossus termino-terminal anastomosis. Histological diagnosis was 3 neurinomas and 2 hemangiomas. Of the termino-terminal grafts two managed a functional Grade III of the House-Brackmann classification. The third one sustained a Grade VI and therefore a suspension with temporal muscle was carried out. The patient with facial-hypoglossus anastomosis is in a functional Grade IV. Geniculate ganglion tumors are in their majority benign and their treatment is the total resection of the tumor. Nerve reconstruction can be primary or deferred with the aid of a nerve graft or anastomosis, being necessary palliative techniques when resection is not possible (AU)

[Malignant tumours of the external auditory canal and of the middle ear]. / Tumores malignos del conducto auditivo externo y oído medio.

OBJECTIVES: To review our experience and results in the treatment of a low incidence pathology such as the malignant ear tumors. METHODS: The study reviewed 36 patients with malignant tumors of the EAC and middle ear treated between 1977 and 2000 in our hospital, excluding cancer of the pinna, metastatic tumours and sarcomas. It was used the staging system proposed by the M.D. Anderson. RESULTS: The most common histological type in our series is the squamous cell carcinoma, and the otorrhea and pain are the primary symptoms in 100% of patients. Surgery combined with radiotherapy obtained a 41% 5-year survival rate. CONCLUSIONS: The staging system is an important prognostic factor and it is important an early diagnosis to achieve a better therapeutical result.