[Cervical thymic cyst in childhood]. / Quiste tímico cervical en la infancia.

Cervical thymus cyst is a rare cause of neck mass in children. . Approximately 90 cases have been described, and just a few have been published in Spanish literature. They usually appear in early children and are diagnosed as brachial cyst. We report the case of a 6 year old boy with a swelling on the right side of the neck. The swelling had appeared a few months before. Ultrasound examination of a neck mass and MRI showed a cystic mass compatible with possible branchial cyst. Excision of the tumor was performed. Pathology showed cystic mass with remains of thymic tissue in the walls, so the final diagnosis was cervical thymic cyst.

El quiste tímico cervical es una causa infrecuente de masa cervical en la infancia. Se han descrito unos 90 casos y pocos han sido publicados en la literatura española. Normalmente aparecen en la primera infancia y se diagnostican como quiste branquial. Presentamos el caso de un niño de 6 años de edad sin antecedentes patológicos de interés, que consulta por tumoración laterocervical derecha de 3 meses de evolución. Los estudios con ecografía cervical y resonancia nuclear magnética muestran una masa de aspecto quístico compatible con posible quiste branquial. Se realiza exéresis de la tumoración. El estudio anatomopatológico evidenció que se trataba de una masa quística con restos de tejido tímico en sus paredes, por lo que el diagnóstico final fue de quiste tímico cervical.

[Results the application of mitomicyn during endonasal and endocanalicular dacryocystorhinostomy by diode laser]. / Resultados de la aplicación de mitomicina en la dacriocistorrinostomía endonasal y endocanalicular con láser diodo.

AIM OF THE STUDY: To study the effects, secondary effects and security of the intrasurgical application of mitomicyn C during endonasal and endocanalicular dacryocystorhinostomy with diode laser (TLA-ELA DCR). METHODS: We carried out a randomized, prospective, interventional and double blind study in 200 patients: intrasurgical mitomicyn C was applied in 150 of then (0.4 mgr/0.2 ml) for 5 minutes by means of a polivinil acetate dressing over the osteotomy. In other 50 patients MMC was not used we followed up at 24 hours, 10 days and 1, 3 and 6 months after surgery. Endoscopic aspects and possible complications were valued. The results were compared using the Chi-squared test with the Yates correction. We looked for the presence or abscense of secondary effects in the application of mitomicyn C. RESULTS: The average follow up was 15.25 months (range 6 to 21 months). The percentages of alterations for excesive scarring were 21.77% in patients without and MAC 8.03% in the ones MMC. The difference was statisticaly significant (p = 0.02). We did not find secondary effects due to application of mitomcyn. CONCLUSIONS: Intrasurgical application of topical MMC during TLA-ENL DCR reduces the number of pathological findings due to scarring of the surrouding area of the new drainage without secondary effects.

[Endonasal and endocanalicular dacryocystorhinostomy by diode laser. Preliminary results]. / Dacriocistorrinostomía endonasal y endocanalicular con láser diodo. Resultados preliminares.

AIM OF THE STUDY: To describe the surgical technique and to evaluate the clinical results after having performed the transcanalicular and endocanalicular dacryocystorhinostomies by diode laser, including the advantages and limits of this technique. METHODS: 34 were performed by diode laser in patients with clinical history of epiphora, with or without mucopurulent secretion, for nasolacrimal duct obstruction. The study was prospective, interventional, non randomized and non comparative. Diode laser was used to realize vaporization of lacrimal sac, osteotomy and vaporization with coagulation of nasal mucosa. The mean of surgical time was 15 minutes (range 7 to 29 minutes). Bicanalicular intubation was performed with a silicone tube and prolene filament for two months in all cases. Postsurgical follow-up was between 4 and 11 months. The degree of epiphora was evaluated by the Munk scale and lacrimal permeability was evaluated by endoscopic functional staining test in all cases. RESULTS: Out of the 34 DCR-EDN+ENC that were performed, 32 cases (94.11%) remain asymptomatic. Two of them (5.88%) required endonasal dacryocystorhinostomies by drilling, because the bony perforation was impossible to achieve by laser fiber. Two cases (5.88%) presented fibrosis and lacrimal and lower canaliculi obstruction, without epiphora because the superior canaliculi was permeable. CONCLUSION: Endonasal and endocanalicular dacryocystorhinostomy technique performed by diode laser is a valid method. It does not cause cutaneous scarring, it decreases thermic canalicular damage, it respects the lacrimal pump, it minimizes pain and bleeding, it needs less surgical time and it has turned into an out-patient procedure with a minimal surgical and postsurgical morbility.

[Transcanalicular dacryocystorhinostomy technique using diode laser]. / Dacriocistorrinostomía transcanalicular con láser diodo.

PURPOSE: To describe the surgical technique and to evaluate the clinical results of carrying out transcanalicular dacryocystorhinostomies using a diode laser (DCR-TC), including the advantages and limitations of this technique. METHODS: 43 DCR-TC were studied and they were analysed using a prospective, interventional, non randomized and non comparative study. We used local and topical anaesthesia in patients with a clinical history of epiphora or dacryocystitis for nasolacrimal obstruction. A diode laser was used to effect a vaporization of the lacrimal sac, osteotomy and vaporization with coagulation of nasal mucosa. The mean duration of surgery was 14 minutes (range 7 to 29 minutes). In all cases, and during a two-month period, bicanalicular intubation was carried out using a silicone tube and prolene filament. Follow-up was between 4 to 38 months. The degree of epiphora was evaluated using the Munk scale and lacrimal permeability was evaluated using Jones I and II tests by direct videoendoscopic control in all cases. RESULTS: 43 DCR-TC were realized, 39 cases are asymptomatic (90.7%). 2 of them (4.65%) had epiphora (degree 2 on the Munk scale) and permeable tract. One case (2.32%) presented lower canaliculi obstruction. One patient showed total osteotomy closing. CONCLUSIONS: Transcanalicular dacryocystorhinostomy carried out using a diode laser is a useful method because it does not cause cutaneous scarring, it hardly produces pain and bleeding, it respects the lacrimal pump, it needs less surgical time, it can be carried out in an out-patient surgery and it generates minimal intra and postsurgical morbility.

Dacriocistorrinostomía transcanalicular con láser diodo / Transcanalicular dacryocystorhinostomy technique using diode laser

Objetivo: Describir la técnica quirúrgica y evaluar los resultados clínicos tras la realización de Dacriocistorrinostomías transcanaliculares (DCR-TC) con láser diodo, incluyendo las ventajas y limitaciones de este procedimiento. Método: Mediante un estudio prospectivo e intervencional, no randomizado y no comparativo, se realizaron 43 DCR-TC con láser diodo bajo anestesia tópica y local en pacientes con historia clínica de epífora o dacriocistitis por obstrucción a nivel nasolagrimal. El láser diodo fue utilizado para realizar la vaporización de saco lagrimal, la osteotomía y la vaporización y coagulación de mucosa nasal. El tiempo quirúrgico medio fue de 14 minutos (rango 7-29 minutos). Se practica intubación bicanalicular con tubos de silicona e hilo de prolene durante dos meses en todos los casos. El seguimiento fue entre 4 y 38 meses. En todos los pacientes se valoró el grado de epífora mediante la escala de Munk y la permeabilidad lagrimal con el test de Jones I y II bajo control videoendoscópico directo. Resultados: De las 43 DCR-TC, permanecen asintomáticos 39 casos (90,7%). 2 pacientes (4,65%) tuvieron epifora (grado 2 en escala de Munk) y vía permeable. Un caso (2,32%) presentó obstrucción del canalículo inferior y un paciente (2,32%) mostró cierre completo de la osteotomía. Conclusiones: La Dacriocistorrinostomía transcanalicular con láser diodo es un método útil que no causa cicatriz cutánea, apenas produce dolor ni sangrado, respeta la bomba lagrimal, precisa menor tiempo quirúrgico, convirtiéndose en un procedimiento ambulatorio con morbilidad quirúrgica y postoperatoria mínima(AU)

Purpose: To describe the surgical technique and to evaluate the clinical results of carrying out transcanalicular dacryocystorhinostomies using a diode laser (DCR-TC), including the advantages and limitationss of this technique. Methods: 43 DCR-TC were studied and they were analysed using a prospective, interventional, non randomized and non comparative study. We used local and topical anaesthesia in patients with a clinical history of epiphora or dacryocystitis for nasolacrimal obstruction. A diode laser was used to effect a vaporization of the lacrimal sac, osteotomy and vaporization with coagulation of nasal mucosa. The mean duration of surgery was 14 minutes (range 7 to 29 minutes). In all cases, and during a two-month period, bicanalicular intubation was carried out using a silicone tube and prolene filament. Follow-up was between 4 to 38 months. The degree of epiphora was evaluated using the Munk scale and lacrimal permeability was evaluated using Jones I and II tests by direct videoendoscopic control in all cases. Results: 43 DCR-TC were realized, 39 cases are asymptomatic (90.7%). 2 of them (4.65%) had epiphora (degree 2 on the Munk scale) and permeable tract. One case (2.32%) presented lower canaliculi obstruction. One patient showed total osteotomy closing. Conclusions: Transcanalicular dacryocystorhinostomy carried out using a diode laser is a useful method because it does not cause cutaneous scarring, it hardly produces pain and bleeding, it respects the lacrimal pump, it needs less surgical time, it can be carried out in an out-patient surgery and it generates minimal intra and postsurgical morbility(AU)