Evaluation of Intima-Media Thickness and Arterial Stiffness as Early Ultrasound Biomarkers of Carotid Artery Atherosclerosis.

Carotid atherosclerosis is a major and potentially preventable cause of ischemic stroke. It begins early in life and progresses silently over the years. Identification of individuals with subclinical atherosclerosis is needed to initiate early aggressive vascular prevention. Although carotid plaque appears to be a powerful predictor of cardiovascular risk, carotid intima-media thickness (CIMT) and arterial stiffness can be detected at the initial phases and, therefore, they are considered important new biomarkers of carotid atherosclerosis. There is a well-documented association between CIMT and cerebrovascular events. CIMT provides a reliable marker in young people, in whom plaque formation or calcification is not established. However, the usefulness of CIMT measurement in the improvement of risk cardiovascular models is still controversial. Carotid stiffness is also significantly associated with ischemic stroke. Carotid stiffness adds value to the existing risk prediction based on Framingham risk factors, particularly individuals at intermediate cardiovascular risk. Carotid ultrasound is used to assess carotid atherosclerosis. During the last decade, automated techniques for sophisticated analysis of vascular mechanics have evolved, such as speckle tracking, and new methods based on deep learning have been proposed with promising outcomes. Additional research is needed to investigate the imaging-based cardiovascular risk prediction of CIMT and stiffness.

Valoración de la calidad vocal tras el tratamiento del carcinoma faringolaríngeo avanzado en un protocolo de preservación de órgano / Assessment of vocal quality following treatment of advanced pharyngo-laryngeal carcinoma with a protocol of organ preservation

Introducción y objetivos: Los carcinomas avanzados de faringe y laringe y los distintos métodos que se emplean para su tratamiento tienen un impacto directo en la función vocal, la comunicación oral y la deglución, alteraciones que pueden influir en la capacidad laboral y en la calidad de vida general. Pacientes y métodos: Con el fin de conocer la salud vocal de los pacientes tratados mediante un protocolo de preservación de órgano presentamos los resultados vocales de 17 pacientes tras ser tratados mediante una combinación de radioterapia y quimioterapia, y que han sido seguidos un mínimo de 6 meses, encontrándose vivos sin evidencia de enfermedad en el momento del estudio. Se realiza una valoración objetiva de la voz mediante espectrografía, análisis perceptual por el sistema GRABS y el Voice Handicap Index como metodología aconsejada, que puede ser empleada en el futuro en estudios más extensos. Resultados: Se observaron voces normales o levemente disfónicas en 5 pacientes (29,4%), y moderadas/severas en 12 (70,6%). Espectrográficamente, las 17 muestras se clasificaron como normales en 4 casos (23,4%), Grado I en 3 casos (17, 6%), Grado II en 3 (17,6%), Grado III en 4 (23,5%) y Grado IV en 2 (11,7%). Las puntuaciones en el cuestionario Voice Handicap Index se encontraron dentro de los rangos normales en todos los casos, excepto en 4 (23,5%). Conclusiones: El análisis acústico de la voz de los pacientes de esta serie demuestra que el daño que se produce tras un tratamiento de preservación de órgano causa un amplio rango de resultados vocales. No obstante, la sensación de incapacidad de estos pacientes es mínima. En este estudio se propone el uso de instrumentos homogéneos (espectrografía, GRABS, Tiempo Máximo de Fonación y Voice Handicap Index) para ser usados en futuros metaanálisis (AU)

Introduction and objectives: Advanced laryngeal and pharyngeal cancer, as well as methods to treat them, have a direct impact on voice function, speech communication and deglutition. Such alterations in function can influence employability and general quality of life. Patients and methods: To characterise the vocal status of the patients treated with an organ-preservation protocol, we report the voice outcomes of 17 patients who were alive and disease free at the time of the survey, with a minimum follow-up of 6 months, after a combination of radiotherapy and chemotherapy to treat advanced cancer. Objective voice assessment by means of spectrographic analysis, the GRBAS perceptual analysis system and the Voice Handicap Index was the methodology followed, which we suggest could be used in future large-scale investigations. Results: Normal or slightly dysphonic voices were observed in 5 patients (29.4%) and moderate/severe in 12 (70.6%). Spectrographically, the 17 samples were classified as normal in 4 cases (23.4%), Grade I in 3 cases (17.6%), Grade II in 3 (17.6%), Grade III in 4 (23.5%) and Grade IV in 2 (11.7%). The Voice Handicap Index questionnaire, which was completed by the patients themselves, gave normal results in all the patients except for 4 (23.5%). Conclusions: The voice acoustic analysis of this series shows that the damage related to the organ-preservation protocol displays a relatively wide range of voice function outcomes. To characterise the vocal status of these patients reliably, we propose using homogeneous instruments (spectrography, GRBAS scale, Maximum Phonation Time and Voice Handicap Index) in future meta-analyses (AU)

Piomiositis del esternocleidomastoideo en un paciente inmunocompetente / Sternocleidomastoid pyomyositis in an immunocompetent patient

No disponible

Assessment of vocal quality following treatment of advanced pharyngo-laryngeal carcinoma with a protocol of organ preservation.

INTRODUCTION AND OBJECTIVES: Advanced laryngeal and pharyngeal cancer, as well as methods to treat them, have a direct impact on voice function, speech communication and deglutition. Such alterations in function can influence employability and general quality of life. PATIENTS AND METHODS: To characterise the vocal status of the patients treated with an organ-preservation protocol, we report the voice outcomes of 17 patients who were alive and disease free at the time of the survey, with a minimum follow-up of 6 months, after a combination of radiotherapy and chemotherapy to treat advanced cancer. Objective voice assessment by means of spectrographic analysis, the GRBAS perceptual analysis system and the Voice Handicap Index was the methodology followed, which we suggest could be used in future large-scale investigations. RESULTS: Normal or slightly dysphonic voices were observed in 5 patients (29.4%) and moderate/severe in 12 (70.6%). Spectrographically, the 17 samples were classified as normal in 4 cases (23.4%), Grade I in 3 cases (17.6%), Grade II in 3 (17.6%), Grade III in 4 (23.5%) and Grade IV in 2 (11.7%). The Voice Handicap Index questionnaire, which was completed by the patients themselves, gave normal results in all the patients except for 4 (23.5%). CONCLUSIONS: The voice acoustic analysis of this series shows that the damage related to the organ-preservation protocol displays a relatively wide range of voice function outcomes. To characterise the vocal status of these patients reliably, we propose using homogeneous instruments (spectrography, GRBAS scale, Maximum Phonation Time and Voice Handicap Index) in future meta-analyses.

Schwannoma laríngeo. Un tumor de laringe poco común / Schwannoma of the larynx. An infrequent laryngeal tumour

Los schwannomas laríngeos son tumores benignos infrecuentes, localizados generalmente en la región supraglótica. Suelen originarse a partir de la rama interna del nervio laríngeo superior. La mayoría de los pacientes presentan sensación de globo faríngeo, disfagia o disfonía. La cirugía conservadora es el tratamiento de elección. Se presenta un caso de un schwannoma de laringe asintomático, el cual es diagnosticado incidentalmente en una prueba de imagen. La extirpación completa de la lesión se realizó a través de un abordaje endoscópico transoral con láser CO2 sin requerir la realización de una traqueotomía. Revisamos los procedimientos diagnósticos, el diagnóstico diferencial y las opciones terapéuticas de esta infrecuente entidad (AU)

Schwannomas are benign tumours, rare among tumours of the larynx. They normally present as supraglottic masses (because they may arise from the internal branch of the superior laryngeal nerve), most commonly involving aryepiglottic folds or false vocal folds. Most patients present with a globus sensation, dysphagia or hoarseness. Conservative surgery is the treatment of choice. We report a case of a laryngeal asymptomatic neuroma that was diagnosed accidentally in an imaging test. Complete excision of the tumour was performed through a transoral CO2 laser microsurgery without resorting to a tracheotomy. We discuss the clinical, pathologic and imaging findings and the management of this neoplasm. We also try to update the knowledge on the management of these tumours (AU)

Schwannoma of the larynx. An infrequent laryngeal tumour.

Schwannomas are benign tumours, rare among tumours of the larynx. They normally present as supraglottic masses (because they may arise from the internal branch of the superior laryngeal nerve), most commonly involving aryepiglottic folds or false vocal folds. Most patients present with a globus sensation, dysphagia or hoarseness. Conservative surgery is the treatment of choice. We report a case of a laryngeal asymptomatic neuroma that was diagnosed accidentally in an imaging test. Complete excision of the tumour was performed through a transoral CO2 laser microsurgery without resorting to a tracheotomy. We discuss the clinical, pathologic and imaging findings and the management of this neoplasm. We also try to update the knowledge on the management of these tumours.

Análisis de la inestabilidad de microsatélites en el carcinoma escamoso de laringe / Analysis of microsatellite instability in laryngeal squamous cell carcinoma

Introducción y objetivos: La literatura sobre la participación de la inestabilidad de microsatélites en el carcinoma de células escamosas de cabeza y cuello muestra una gran variabilidad, probablemente debido a las diferencias en la metodología de las pruebas. Utilizando un sistema de detección consensuado, nos planteamos como objetivo llegar a una estimación fiable de la prevalencia de la inestabilidad de microsatélites en un subconjunto de carcinomas de células escamosas de cabeza y cuello. Métodos: Se analizó el estado de inestabilidad de microsatélites en 43 pacientes no tratados previamente y diagnosticados de un carcinoma primario de células escamosas de laringe mediante una prueba de PCR múltiple, incluyendo 5 marcadores repetidos de mononucleótidos. Resultados: En 36 casos se observó un fenotipo estable o microsatélites estables (83,7%), y en 7 casos (16,3%) se mostró un fenotipo positivo de inestabilidad de microsatélites. Uno de los casos mostró inestabilidad en 3 de los 5 marcadores, otro mostró inestabilidad en 2 marcadores y 5 casos en un marcador. Entre los casos de inestabilidad de microsatélites positiva y los casos estables no hubo diferencias con respecto a la edad, el estadio del tumor, la afectación de los ganglios linfáticos o las metástasis a distancia. Conclusiones: Nuestros datos muestran que una parte de los carcinomas de células escamosas de laringe presentan inestabilidad de microsatélites. El conocimiento sobre el estado de inestabilidad de microsatélites de los pacientes permitirá el ajuste de la terapia anti-cancerígena a nivel individual(AU)

Introduction and objectives: The literature on the involvement of microsatellite instability in head and neck squamous cell carcinoma shows great variability, probably due to differences in the testing methods. Using a consensus detection system, we aimed to reach a reliable estimate of microsatellite instability prevalence in a subset of head and neck squamous cell carcinoma cases. Methods: The microsatellite instabilityI status of 43 patients with previously untreated primary laryngeal squamous cell carcinomas was analyzed by a multiplex polymerase chain reaction assay including 5 mononucleotide repeat markers. Results: Thirty-six cases showed a stable phenotype or a microsatellite stable phenotype (83.7%) and 7 cases (16.3%) showed an microsatellite instability-positive phenotype. One case showed instability in 3 of 5 markers, 1 case in 2 markers and 5 cases in 1 marker. The microsatellite instability-positive and stable cases did not differ with respect to age, tumour stage, lymph node or distant metastases. Conclusions: Our data showed that a proportion of laryngeal squamous cell carcinomas are microsatellite instability positive. Knowledge of microsatellite instability patient status will allow adjusting anticancer therapy at an individual level(AU)

Neurolaringología / Neurolaryngology

La neuroanatomía de la voz y el habla es compleja. Una intrincada red neural se responsabiliza de que se ejecuten las principales funciones de la laringe: la protección de la vía aérea, la producción de la tos y el Valsalva y la fonación. La coordinación de esos roles es muy susceptible de verse afectada por enfermedades neurológicas, tales como la enfermedad de Parkinson, los accidentes cerebrovasculares, la esclerosis lateral amiotrófica, la esclerosis múltiple, la distonía y el temblor. Una cuidadosa evaluación neurológica debe ser llevada a cabo en todo paciente que presente síntomas vocales que orienten a una causa neurológica. La visualización endoscópica mediante fibrolaringoscopio, que permita una evaluación dinámica de la voz, es una parte esencial de la valoración y en algunas ocasiones se emplean otras pruebas complementarias. La evaluación otorrinolaringológica es importante en el diagnóstico y el tratamiento de las enfermedades neurológicas con expresión al nivel laríngeo(AU)

The neuroanatomy of voice and speech is complex. An intricate neural network is responsible for ensuring the main functions of the larynx: airway protection, cough and Valsalva production, and providing voice. Coordination of these roles is very susceptible to disruption by neurological disorders. Neurological disorders that affect laryngeal function include Parkinson's disease, stroke, amyotrophic lateral sclerosis, multiple sclerosis, dystonia and essential tremor. A thorough neurological evaluation should be routine for any patient presenting with voice complaints suggestive of neurogenic cause. Endoscopic visualisation of the larynx using a dynamic voice assessment with a flexible laryngoscope is a crucial part of the evaluation and ancillary tests are sometimes performed. Otolaryngologic evaluation is important in the diagnosis and treatment of neurological disorders that affect laryngeal function(AU)

Agenesia unilateral de arteria carótida interna / Unilateral agenesis of the internal carotid artery

La agenesia de la arteria carótida interna (ACI) es una entidad infrecuente. Suele ser diagnosticada de forma casual en pacientes sometidos a una exploración radiológica por otro motivo. El diagnóstico de esta anomalía es importante ya que puede asociarse a otras malformaciones potencialmente graves, y debe ser tenido en cuenta si se va a realizar una cirugía sobre el eje carotídeo del lado sano. Presentamos el caso de un varón de 64 años en el que se objetivó incidentalmente una agenesia de ACI izquierda (AU)

Unilateral agenesis of the internal carotid artery (ICA) is an extremely rare anomaly. Diagnosis is often incidental in a radiological examination. Recognition of this anomaly has important clinical implications because other life-threatening conditions can be associated and it must be taken into account when planning carotid surgery. We report a case of 64-year-old man with agenesis of the ICA (AU)

[Analysis of microsatellite instability in laryngeal squamous cell carcinoma]. / Análisis de la inestabilidad de microsatélites en el carcinoma escamoso de laringe.

INTRODUCTION AND OBJECTIVES: The literature on the involvement of microsatellite instability in head and neck squamous cell carcinoma shows great variability, probably due to differences in the testing methods. Using a consensus detection system, we aimed to reach a reliable estimate of microsatellite instability prevalence in a subset of head and neck squamous cell carcinoma cases. METHODS: The microsatellite instabilityI status of 43 patients with previously untreated primary laryngeal squamous cell carcinomas was analyzed by a multiplex polymerase chain reaction assay including 5 mononucleotide repeat markers. RESULTS: Thirty-six cases showed a stable phenotype or a microsatellite stable phenotype (83.7%) and 7 cases (16.3%) showed an microsatellite instability-positive phenotype. One case showed instability in 3 of 5 markers, 1 case in 2 markers and 5 cases in 1 marker. The microsatellite instability-positive and stable cases did not differ with respect to age, tumour stage, lymph node or distant metastases. CONCLUSIONS: Our data showed that a proportion of laryngeal squamous cell carcinomas are microsatellite instability positive. Knowledge of microsatellite instability patient status will allow adjusting anticancer therapy at an individual level.

[Neurolaryngology]. / Neurolaringología.

The neuroanatomy of voice and speech is complex. An intricate neural network is responsible for ensuring the main functions of the larynx: airway protection, cough and Valsalva production, and providing voice. Coordination of these roles is very susceptible to disruption by neurological disorders. Neurological disorders that affect laryngeal function include Parkinson's disease, stroke, amyotrophic lateral sclerosis, multiple sclerosis, dystonia and essential tremor. A thorough neurological evaluation should be routine for any patient presenting with voice complaints suggestive of neurogenic cause. Endoscopic visualisation of the larynx using a dynamic voice assessment with a flexible laryngoscope is a crucial part of the evaluation and ancillary tests are sometimes performed. Otolaryngologic evaluation is important in the diagnosis and treatment of neurological disorders that affect laryngeal function.

Unilateral agenesis of the internal carotid artery.

Unilateral agenesis of the internal carotid artery (ICA) is an extremely rare anomaly. Diagnosis is often incidental in a radiological examination. Recognition of this anomaly has important clinical implications because other life-threatening conditions can be associated and it must be taken into account when planning carotid surgery. We report a case of 64-year-old man with agenesis of the ICA.

Prognostic significance of postoperative wound infections after total laryngectomy.

BACKGROUND: In oncologic surgery, the relationship between postoperative wound infections and prognosis remains unclear. The purpose of this study was to establish the prognostic significance of surgical wound infections in laryngectomized patients. METHOD: We studied 129 consecutive patients with previously untreated laryngeal or hypopharyngeal squamous cell carcinoma who underwent a total laryngectomy. Minimum follow-up was 24 months. RESULTS: Fifty-seven patients (44%) developed a wound infection. Infections were more frequent in hypopharyngeal tumors (p < .001). Surgical wound infection was associated with a worse disease-specific survival (p = .046), but this association was due to the hypopharyngeal subgroup of cases (p = .024). In multivariate analysis, the only parameters significantly associated with a worse disease-specific survival in these cases were nodal extracapsular invasion (p < .001) and surgical wound infection (p = .02). CONCLUSION: Our results suggest that the development of a postoperative wound infection is a poor prognostic sign in patients with advanced hypopharyngeal cancers surgically treated.

Multifocal papillary thyroid carcinoma associated with primary amyloid goiter.

Amyloid goiter is a rare condition characterized by a diffuse enlargement of the thyroid gland due to amyloid deposition. Extremely uncommon is the development of differentiated carcinomas within this type of lesion. We describe to our knowledge the sixth case of a papillary thyroid carcinoma within an amyloid goiter, arising in a 45-year old woman with chronic renal failure due to primary amyloidosis. This is the first case of a multifocal papillary carcinoma within an amyloid goiter which produces compressive symptoms. The patient suffered a total thyroidectomy with the histological diagnosis of amyloid goiter with a multifocal papillary carcinoma of follicular variant. The Congo red stain confirmed the diagnosis of amyloid goiter. Two years and a half after the surgery the patient is free of recurrence. Amyloid goiter can hide a differentiated carcinoma. To diagnose and early treat this pathology, the knowledge of the possible association between an amyloid goiter and a differentiated carcinoma is needed.

Solitary fibrous tumor of the petrous bone: a successful treatment option.

The patient was a 48-year-old man complaining about right hemicranial pain and deafness of 1 year's duration. MRI showed a solid well-vascularized mass destroying the mastoid and petrous bone, and with an epidural component that pulled the right cerebellar hemisphere. The patient underwent a right modified type A infratemporal approach, which allowed complete resection of the tumor, with a low morbidity. The pathological diagnosis was solitary fibrous tumor. The patient received complementary treatment with radiotherapy. At 24 months after the initial treatment the patient is free of disease. We conclude that solitary fibrous tumor of the petrous bone can be satisfactorily treated with surgical excision followed by radiotherapy, with low morbidity and excellent facial function. To our knowledge this is the first description of a solitary fibrous tumor of the petrous bone. Due to the lack of consensus in treating rare tumors, we want to offer this management approach for treating this kind of tumor.

Cirugía transoral LASER CO2 en tumores avanzados de faringe y laringe / Transoral laser microsurgery in advanced carcinomas of larynx and pharynx

Introducción y objetivos: Existen diversas modalidades terapéuticas de los carcinomas epidermoides avanzados de faringe y laringe. Se han propuesto nuevas estrategias que, sin empeorar los resultados oncológicos, disminuyan la morbilidad generada por los tratamientos agresivos. Entre estos tratamientos se encuentra la microcirugía transoral LASER CO2 (MTL). El objetivo de este estudio es describir los resultados de los pacientes con carcinomas avanzados de laringe y faringe tratados mediante este método en nuestro departamento. Material y método: Realizamos un estudio retrospectivo en 63 pacientes con tumores de faringe y laringe en estadios avanzados (estadios III y IV) intervenidos mediante MTL entre los años 2000 y 2008. Catorce pacientes tenían un tumor de base de lengua, 16 un tumor de seno piriforme, 29 un tumor supraglótico y 4 un tumor glótico. El tiempo medio de seguimiento fue de 51 meses. Resultados: El 28% de tumores de base de lengua, el 50% de tumores de hipofaringe, el 27% de tumores de supraglotis y el 75% de los tumores glóticos recidivaron. La supervivencia específica fue del 73,3% para todas las localizaciones con un rango que va desde el 90% para los tumores de supraglotis hasta el 50% para los tumores glóticos. El 34% de los pacientes presentaron algún tipo de complicación tras la cirugía, siendo la hemorragia local la más frecuente (17%). Conclusiones: La MTL es una alternativa válida para el tratamiento de los carcinomas de faringe y laringe en estadios avanzados. Sus resultados oncológicos son similares a los obtenidos otras modalidades terapéuticas y la morbilidad generada es menor (AU)

Introduction and objectives: There are several types of treatment for advanced squamous cell carcinomas of the pharynx and larynx. However, both open surgery and chemoradiation protocols have failed to improve control and survival. There is a tendency toward conservative treatment without worsening oncological outcomes. The objective of this study was to describe the effectiveness of organ-preserving CO2 laser microsurgery for treating advanced carcinomas of the larynx and pharynx. Material and method: A retrospective review of 63 patients undergoing CO2 laser microsurgery for the treatment of squamous cell carcinomas of the pharynx and larynx in advanced stages (stages III and IV) was performed. Tumour distribution was 14 patients with a tumour at the base of the tongue, 16 with a pyriform sinus tumour, 29 with a supraglottic tumour and 4 with a glottic tumour. Mean follow-up was 51 months. Results: Thirty-five percent of patients (23) had recurrences. The recurrence rate was 28% for base of tongue tumours, 50% for hypopharyngeal tumours, 27% for supraglottic tumours and 75% for glottic tumours. The 5-year disease-specific survival rate was 73.3% for all locations, with a range from 90% for supraglottic tumours up to 50% for glottic tumours. Thirty-four percent of patients had some type of complication after surgery. The most frequent complication was local bleeding (17%). Conclusion: Transoral CO2 laser microsurgery is an alternative for the treatment of carcinomas of the pharynx and larynx in advanced stages. Its oncological results are equivalent to other treatment modalities and its morbidity is lower (AU)

Masa cervical de origen infrecuente / Neck mass with infrequent origin

Varón de 67 años de edad diagnosticado de adenocarcinoma de próstata que refiere disfagia, disfonía y la aparición de una masa laterocervical. En una tomografía computarizada se aprecia una lesión cervical de partes blandas, osteolítica, la cual es resecada y cuyo estudio anatomopatológico fue compatible con metástasis de adenocarcinoma de próstata(AU)

We report the case of a 67-year-old male diagnosed with prostate adenocarcinoma, who referred dysphagia, dysphonia and noticed the appearance of a laterocervical mass. A CT scan revealed an osteolytic soft tissue neck lesion, which was resected. Its anatomical-pathological study was compatible with metastasis of prostate adenocarcinoma(AU)

[Neck mass with infrequent origin]. / Masa cervical de origen infrecuente.

We report the case of a 67-year-old male diagnosed with prostate adenocarcinoma, who referred dysphagia, dysphonia and noticed the appearance of a laterocervical mass. A CT scan revealed an osteolytic soft tissue neck lesion, which was resected. Its anatomical-pathological study was compatible with metastasis of prostate adenocarcinoma.

[Transoral laser microsurgery in advanced carcinomas of larynx and pharynx]. / Cirugía transoral LASER CO2 en tumores avanzados de faringe y laringe.

INTRODUCTION AND OBJECTIVES: There are several types of treatment for advanced squamous cell carcinomas of the pharynx and larynx. However, both open surgery and chemoradiation protocols have failed to improve control and survival. There is a tendency toward conservative treatment without worsening oncological outcomes. The objective of this study was to describe the effectiveness of organ-preserving CO2 laser microsurgery for treating advanced carcinomas of the larynx and pharynx. MATERIAL AND METHOD: A retrospective review of 63 patients undergoing CO2 laser microsurgery for the treatment of squamous cell carcinomas of the pharynx and larynx in advanced stages (stages III and IV) was performed. Tumour distribution was 14 patients with a tumour at the base of the tongue, 16 with a pyriform sinus tumour, 29 with a supraglottic tumour and 4 with a glottic tumour. Mean follow-up was 51 months. RESULTS: Thirty-five percent of patients (23) had recurrences. The recurrence rate was 28% for base of tongue tumours, 50% for hypopharyngeal tumours, 27% for supraglottic tumours and 75% for glottic tumours. The 5-year disease-specific survival rate was 73.3% for all locations, with a range from 90% for supraglottic tumours up to 50% for glottic tumours. Thirty-four percent of patients had some type of complication after surgery. The most frequent complication was local bleeding (17%). CONCLUSION: Transoral CO2 laser microsurgery is an alternative for the treatment of carcinomas of the pharynx and larynx in advanced stages. Its oncological results are equivalent to other treatment modalities and its morbidity is lower.