Non-pedicled vs vascular pedicled nasal flap in repair of cerebrospinal fluid rhinorrhea.

CONCLUSIONS: In our study, pedicled nasal flap (NF) did not provide better results than free nasal graft (NG) for primary closure of cerebrospinal fluid (CSF) rhinorrhea. In the future, a multicenter randomized study would be needed to confirm this result. The choice of surgical technique will depend on the surgeon's experience, and the position and size of the defect. OBJECTIVES: To evaluate our results in repairing CSF leaks, comparing the two techniques we used: free NG and pedicled NF. METHODS: A total of 33 patients diagnosed with CSF rhinorrhea were operated on between June 2000 and May 2010; 17 were women. The mean age was 44.7 years (± 13.0). Twenty-two (66.6%) NFs of the middle and lower turbinate and septum were performed, the rest being NGs of the middle and lower turbinate only. A descriptive statistical analysis and a Kaplan-Meier survival analysis were carried out and the log-rank statistic was used to compare both techniques. RESULTS: In the present study, 78% of defects were closed in all cases; NF was used in 86% (19) and NG in 63.63% (7). The mean follow-up was 71.5 (95% confidence interval (CI), 56.9-86.1) months. There were no statistically significant differences (p > 0.05).

Minimally invasive endoscopic techniques for treating large, benign processes of the nose, paranasal sinus, and pterygomaxillary and infratemporal fossae: solitary fibrous tumour.

OBJECTIVES: We report an extremely rare case of a large solitary fibroma of the paranasal sinus, which we treated by sinonasal endoscopic surgery. We describe its clinical and histopathological features, and we report the endoscopic technique used to deal with such a large sinonasal mass (penetrating the pterygomaxillary and infratemporal fossae); we also offer a brief survey of the literature. CASE REPORT: A woman presented with an approximately one-year history of nasal obstruction. Nasal endoscopy revealed an irregularly shaped, friable, reddish mass that occupied the whole of the right nasal fossa. Magnetic resonance imaging of the paranasal sinuses revealed a large mass that occupied the anterior and posterior ethmoids and the maxillary and sphenoid sinuses, displacing the septum and penetrating the pterygomaxillary fossa, having destroyed the lateral wall of the right nasal fossa. The tumour was resected by means of sinonasal endoscopic surgery; an endoscopic medial maxillectomy with extension to the pterygomaxillary and infratemporal regions was performed. Histological analysis confirmed the diagnosis of solitary fibrous tumour. During follow up, we performed regular nasal endoscopies, as well as computed tomography scans one and six months post-operatively. CONCLUSIONS: Endoscopic techniques are currently the approach of choice for the treatment of such tumours of the sinonasal cavity and pterygomaxillary and infratemporal regions. The size of the lesion did not contraindicate endoscopic sinonasal surgery as a curative treatment.

[Objective study of the voice in a normal population and in dysphonia caused by nodules and vocal polyps]. / Estudio objetivo de la voz en población normal y en la disfonía por nódulos y pólipos vocales.

A study of the objective evaluation of voice was made of 100 voices of healthy adults and 60 with disphonia (nodules and polyps). A laryngostroboscopy and an acoustic analysis was made to everyone. A sustained vowel "a" was carried out and digitalized with Dr. Speech Science software. These parameters were estimated: fundamental frequency (Fo, according to gender), Jitter, Shimmer and glottic noise (NNE, HNR, SNR). In the healthy group Fo was 139.72 in men and 267.33 in women, jitter 0.24 and shimmer 2.10. In disphonic patients (nodules) Fo was 126.96 in men and 240.72 in women, jitter 0.35 and shimmer 3.25. In disphonic patients (polyps) Fo was 119.75 in men and 218.26 in women, jitter 0.50 and shimmer 4.34. These difference were statistically significant. Glottic Noise in healthy group was: NNE -13.62, HNR 24.07 and SNR 24.49; in disphonic patients (nodules) was: NNE -10.65, HNR 25.21 and SNR 25.55; in disphonic patients (polyps) was: NNE -8.24, HNR 29.63 and SNR 28.22. Only the difference in the NNE was statistically significant. We highlight the importance of objective evaluation of voice disorders.

Estudio objetivo de la voz en población normal y en la disfonía por nódulos y pólipos vocales / Study objetive of voice in normal poblation and disphonia for nodules and polyps

Presentamos un estudio sobre la evaluación objetiva de la voz en 100 adultos sanos y en 60 sujetos con disfonía por nódulos o pólipos vocales. A todos se les realizó una laringoestroboscopia y un análisis acústico vocal. Se registró y digitalizó la vocal "a" con el programa Dr. Speech Science. Se estimaron los parámetros: frecuencia fundamental (Fo, expresada en función del sexo), jitter, shimmer y Ruido Glótico (NNE, HNR y SNR). La Fo en el grupo normal fue de 139.72 en varones y 267.33 en mujeres, jitter 0.24 y shimmer 2.10. En pacientes disfónicos por nódulos Fo fue 126.96 en varones y 240.72 en mujeres, jitter 0.35 y shimmer 3.25. En pacientes disfónicos por pólipos Fo fue 119.75 en varones y 218.26 en mujeres, jitter 0.50 y shimmer 4.34. Todas estas diferencias fueron estadísticamente significativas. El Ruido Glótico en población normal fue de: NNE -13.62, HNR 24.07 y SNR 24.49; en pacientes con nódulos: NNE -10.65, HNR 25.21 y SNR 25.55; en pacientes con pólipo vocal: NNE -8.24, HNR 29.63 y SNR 28.22. Sólo existió diferencia estadísticamente significativa en el parámetro NNE. Destacamos la importancia de la valoración objetiva de los trastornos de la voz (AU)

A study of the objective evaluation of voice was made of 100 voices of healthy adults and 60 with disphonia (nodules and polyps). A laryngostroboscopy and an acoustic analysis was made to everyone. A sustained vowel "a" was carried out and digitalized with Dr. Speech Science software. These parameters were estimated: fundamental frequency (Fo, according to gender), Jitter, Shimmer and glottic noise (NNE, HNR, SNR). In the healthy group Fo was 139.72 in men and 267.33 in women, jitter 0.24 and shimmer 2.10. In disphonic patients (nodules) Fo was 126.96 in men and 240.72 in women, jitter 0.35 and shimmer 3.25. In disphonic patients (polyps) Fo was 119.75 in men and 218.26 in women, jitter 0.50 and shimmer 4.34. These difference were statistically significant. Glottic Noise in healthy group was: NNE -13.62, HNR 24.07 and SNR 24.49; in disphonic patients (nodules) was: NNE -10.65, HNR 25.21 and SNR 25.55; in disphonic patients (polyps) was: NNE -8.24, HNR 29.63 and SNR 28.22. Only the difference in the NNE was statistically significant. We highlight the importance of objective evaluation of voice disorders (AU)

[Osteoma and polyposis: an unusual association]. / Osteoma y poliposis: una inusual asociación.

A case of osteoma of the ethmoidal sinuses associated with nasal polyposis was treated by endoscopic nasal surgery. The pathophysiology of both diseases is reviewed. The therapeutic strategy is described and the bibliography is reviewed.

[Head and neck symptoms of gastroesophageal reflux]. / Manifestaciones en cabeza y cuello del reflujo gastroesofágico.

In otorhinolaryngology, the relationship between gastroesophageal reflux (GER) and pharyngolaryngeal disorders is well-known. In fact, many patients with GER debut with head and neck symptoms or are first seen by an otolaryngologist. We proposed to identify the ENT symptoms most frequently associated with GER, to differentiate between physiological and pathological GER, and to confirm the effectiveness of antacid treatment. Our study included 20 ambulatory patients who presented pharygolaryngeal symptoms and clinical manifestations of GER (heartburn and regurgitation). The patients underwent a complete ENT examination and were referred to a gastroenterologist for esophagoscopy, manometry, and 24-hour pH monitoring. All patients received antireflux therapy for one month (ranitidine 150 mg given twice daily). We conclude that GER produces a variety of manifestations, but the most frequent pharyngolaryngeal symptoms and physical findings were globus pharyngeus and erythema of the arytenoids, respectively. Pathological GER was found in only one third of our patients and 90% responded well to treatment.

[Our experience in the management of parapharyngeal tumors]. / Nuestra experiencia en el manejo de los tumores del espacio parafaríngeo.

The rate of occurrence of neoplasma arising from the parapharyngeal space is scarce, about 0.5 percent of neck and face tumors. In the paper is reported our 10-year experience on its clinical diagnosis and therapeutical management as well. We have found 13 percent (3/23) malignancies and 87 percent (20/30) benign growth. 35 percent were paragangliomas and 22 percent represent salivary tumors. Diagnostic procedures, ways of approach and surgical complications are considered.

[The nuclear determination of the DNA content by flow cytometry as a fixed sample of the healthy larynx]. / Contenido de ADN nuclear por citometría de flujo en muestras no fijadas de laringe sana.

We analyzed the DNA nuclear content and cellular cycle distribution of the healthy laryngeal tissues without any laryngeal disease (healthy) and that of from patients afflicted with laryngeal epidermoid carcinoma (healthy/Ca). We have carried out studies on fresh samples, unfixed samples, and analysing them immediately after their extraction in the flow cytometer, using human peripheral blood lymphocytes as control of the ploidy in each case. In the study effected, we did not find any differences in the DNA content of the healthy laryngeal tissues and those macroscopically healthy from patients with epidermoid carcinoma of the larynx. However, the laryngeal tissues show a significantly higher DNA content than the human peripheral blood lymphocytes used as check.

[Collagen diseases and their manifestations in the head and neck region]. / Enfermedades del colágeno y sus manifestaciones en la región de cabeza y cuello.

We carried out a clinical study on the manifestations of various connective tissue pathologies of the head and neck. The need to suspect the presence of these pathological entities from non-specific ENT symptoms and performing early diagnoses of cochleovestibular diseases on the basis of a clinical and examination protocol is emphasized.

The antrum exclusion technique in cholesteatoma surgery.

A new surgical technique for the treatment of cholesteatoma is reported. The technique involves auto-exclusion for exteriorization of the attic and tympanic box only. The resulting cavity is rather small. The technique allows visual post-operative control of the attic and tympanic membrane. There is no visual access to the mastoid cavity which, however, is the most unlikely site for occurrence of a residual cholesteatoma. The proposed technique was applied to 102 patients and both the anatomic and functional results obtained are reported.

[Congenital laryngeal atresia: apropos of a case]. / Atrésie laryngée congénitale: a propos d'un cas.

A case of congenital laryngeal atresia in which the laryngeal lumen was obstructed by a soft, smooth protrusion is reported. Laryngeal stenosis was located at the glottic level and appeared as a protrusion reducing the laryngeal lumen to a few millimeters. The stenotic tissue consisted of striated muscle fibres cross-linked through their midlines.

[Clinical aspects and diagnosis of expansive processes in the cerebellopontine angle]. / Clínica y diagnóstico de los procesos expansivos del ángulo pontocerebeloso.

The AA. present a review of the expansive processes of the cerebellopontine angle (CPA) diagnosed at their Department, during the six last years. Emphasis is made upon the clinic findings gained through neuro-otological explorations and imaging, both helpful for preoperative diagnosis of the nature of the tumor.

[Rhinocerebral mucormycosis. Apropos a case]. / Mucormicosis rinocerebral. A propósito de un caso.

We present a case of rhinocerebral mucormycosis in a 47 years old woman without diabetic or immunodepression past. The diagnosis was confirmed through a histological study of the material obtained after surgery. The treatment with amphotericin B and radical surgery showed ineffective. The patient died two weeks after entrance. We make an evaluation of the etiopathological, clinical and therapeutic aspects and also a revision of the relevant literature.