RESUMEN
Voice quality remains the issue often used to support preference for radiotherapy in treatment of early glottic cancer. We therefore conducted a perceptual voice study in 2 groups, one treated with radiotherapy for malignant disease and the other with narrow-margin laser cordectomy for either malignant or extensive benign lesions. Sequential patients, 12 treated with radiotherapy and 30 with CO(2) laser excision, were included. Voice samples were recorded before and at intervals after surgery. Ratings of validated judges were used for statistical analysis of various voice characteristics at each time point. Voice deteriorated temporarily after surgery as compared with the radiated group; however, at 6 and 24 months no significant differences were found between the groups. Preferential use of narrow-margin laser cordectomy for appropriate early glottic tumors can be supported not only for oncologic reasons but also on the basis of voice results, cost, and efficiency considerations.
Asunto(s)
Neoplasias Laríngeas/cirugía , Terapia por Láser , Microcirugia , Pliegues Vocales/cirugía , Calidad de la Voz , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/radioterapia , Laringoscopía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Resultado del Tratamiento , Pliegues Vocales/patología , Pliegues Vocales/efectos de la radiación , Calidad de la Voz/efectos de la radiaciónRESUMEN
During a 2-year period, 192 indirect surgeries on the laryngopharynx were performed in an outpatient videoendoscopy laboratory under topical anesthesia with or without intravenous sedation. These procedures included cancer staging and biopsy; vocal fold injections of Teflon, Gelfoam, botulinum toxin, or steroids; glottic web lysis; and granuloma removal. The techniques used to perform these procedures are elucidated. Careful chart review of these patients shows that indirect surgery was performed successfully in 96% of cases. Intravenous conscious sedation was utilized in 39% of patients. No significant complications were encountered. By avoiding the need for an operating room, hospitalization, or general anesthesia, this technique was clearly as safe or safer, more convenient for surgeon and patient, and more cost-effective than the same procedure would have been via the traditional direct laryngoscopy. As the authors have already done in their practices, the indirect method should therefore be reinstated as the preferred approach to the clinical circumstances described here.
Asunto(s)
Endoscopía/métodos , Laringoscopía/métodos , Laringe/cirugía , Faringe/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
Allergic fungal sinusitis is a benign noninvasive sinus disease related to a hypersensitivity reaction to fungal antigens. A wide variety of fungal agents has been implicated, with the vast majority belonging to the Dematiaceae family. Allergic fungal sinusitis should be suspected in any atopic patient with refractory nasal polyps. Sinus computed tomograms and magnetic resonance imaging findings can be quite distinctive, but not diagnostic. Diagnosis requires histopathologic examination, which shows characteristic allergic mucin. Hyphae can be demonstrated on special fungal stains or confirmed by a positive fungal culture. At surgery, the diagnosis should be considered if thick, tenacious allergic mucin is encountered in the atopic patient with nasal polyps. Fungal cultures should then be obtained, and the pathologist alerted to the possible diagnosis of allergic fungal sinusitis. Current recommendations for therapy include conservative but complete exenteration of all allergic mucin. This can often be accomplished endoscopically. Adjunctive short-term systemic steroids are often helpful, and nasal steroid sprays should be continued long term. The length and dose of steroid therapy is controversial. Persistence of allergic fungal sinusitis with recurrence of sinonasal symptoms is common, particularly when there has been incomplete eradication of allergic fungal mucin. Even when the patient is clinically disease free, recurrence can occur, presumably from reexposure to fungal antigens. Therefore close clinical, endoscopic, and radiographic follow-up is important.
Asunto(s)
Hipersensibilidad/microbiología , Micosis , Sinusitis/etiología , Humanos , Hipersensibilidad/diagnóstico , Hipersensibilidad/terapia , Micosis/diagnóstico , Micosis/fisiopatología , Micosis/terapia , Recurrencia , Sinusitis/diagnóstico , Sinusitis/microbiología , Sinusitis/terapiaRESUMEN
To better determine the role of allergy in rhinitis and nasal polyposis, we assessed the prevalence of nasal mucosal allergy in the absence of systemic allergy. After a thorough literature search we compiled and analyzed data from nine studies (287 patients) that tested for specific immunoglobulin E both intranasally and systemically. When meta-analysis was applied to the different populations, 19% of those who demonstrated specific immunoglobulin E manifested nasal mucosal allergy but no systemic allergy. We suggest that there is an important segment of rhinitis and nasal polyp patients who have nasal mucosal allergy.
Asunto(s)
Hipersensibilidad , Inmunoglobulina E/análisis , Mucosa Nasal/inmunología , Pólipos Nasales/inmunología , Rinitis/inmunología , Humanos , Prueba de RadioalergoadsorciónAsunto(s)
Esófago/cirugía , Laringe Artificial/efectos adversos , Colgajos Quirúrgicos/métodos , Dehiscencia de la Herida Operatoria/cirugía , Tráquea/cirugía , Fístula Traqueoesofágica/cirugía , Humanos , Reoperación , Dehiscencia de la Herida Operatoria/etiología , Factores de Tiempo , Fístula Traqueoesofágica/etiologíaRESUMEN
High grade malignant tumours of the parotid gland require radical resections. The surgeon is therefore confronted with the problem of a reliable and minimally deforming reconstruction. Due to different manifestations, locations and spread, one should be familiar with a variety of reconstructions. Four case histories are presented, illustrating the necessity of approaching each parotid tumour resection and the resulting defect individually. Technical aspects of different reconstructions are discussed.
Asunto(s)
Carcinoma/cirugía , Neoplasias de la Parótida/cirugía , Adulto , Anciano , Carcinoma/diagnóstico por imagen , Carcinoma/radioterapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias de la Parótida/diagnóstico por imagen , Neoplasias de la Parótida/radioterapia , Cuidados Posoperatorios , Trasplante de Piel/métodos , Colgajos Quirúrgicos , Procedimientos Quirúrgicos Operativos/métodos , Tomografía Computarizada por Rayos XRESUMEN
Hemangiopericytoma is an infrequent vascular tumor that rarely appears in the head and neck. The nasal cavity and the paranasal sinuses are most often involved. Four cases are added to the literature and some important features are stressed. The clinical presentation is aspecific. Diagnosis is made only by careful histological examination with special stainings (reticulin, immunohistochemistry with Ulex Europaeus) and gives an idea about the grading. Treatment with radical surgery, if possible, is effective while preoperative embolisation can reduce the risk of hemorrhage. The median follow-up of the present cases is only 3 years. During this period no recurrence was observed. We suggest that more radical resections can probably reduce the local recurrence rate. However lifetime clinical follow-up is warranted since late recurrences have been reported in almost half of the patients.