[Early corticoid treatment of idiopathic facial palsy (Bell)]. / Tratamiento precoz con corticoides en la parálisis facial idiopática (Bell).

Idiopathic facial palsy (IFP) (Bell's palsy) is the commonest cause of acute facial paralysis. Perhaps because of its unknown origin, a wide range of treatments are used. Controversy exists as to whether the disorder should be left to run its natural course or treated with steroids. The effect of early steroid treatment on the evolution of IFP was evaluated in the Ear, Nose, and Throat Service of the University Hospital of Alicante (Spain) with a prospective protocol from September 1991 to January 1992. The therapeutic protocol for all patients (47 patients) was an intramuscular injection of 60 mg prednisone in the Emergency Room followed by a course of oral steroids (deflazacort) that was gradually tape-red-off. The average duration of IFP before presentation in the Emergency Department was 1.30.9 days. Clinical improvement was observed on day 149 and a complete cure by day 3026. Full recovery of facial motor function without sequelae occurred in 95.6% of patients. Age, the intensity of paralysis, and a history of hypertension and diabetes had a negative influence on the course of IFP. These results support early steroid treatment for IFP.

[Functional surgery versus radical surgery in carcinoma of the hypopharynx]. / Cirugía funcional versus cirugía radical en el carcinoma de hipofaringe.

A retrospective study was made of the clinical features and effectiveness of different surgical techniques in 66 patients with carcinoma of the hypopharynx treated at our hospital between 1985 and 1990. Thirty-seven patients were treated surgically and 29 were not. In the early stages, surgical treatment was functional: 15 patients had hemipharyngolaryngectomy or partial pharyngectomy. In advanced, but operable, stages, radical surgery was performed: 22 patients underwent total laryngectomy with partial pharyngectomy or total pharyngolaryngectomy. In 15 cases, reconstruction was needed; a muscle flap of pectoralis major yielded good results. Survival after a 5-year follow-up was 60% in cases treated with functional surgery and 37% in those treated with radical surgery. Functional surgery enabled decannulation of 65% of patients.

[Trans-septo-sphenoidal transnasal approach for microsurgery of hypophyseal tumors]. / Abordaje trans-septo-esfenoidal transnasal para el tratamiento microquirúrgico de tumores de hipófisis.

The surgical treatment of hypophyseal tumors has improved from external approach (transcranial-subtemporal) to the trans-septo-transphenoidal approach. Since the last thirty years this way to access has been increasingly used, because it provides an excellent exposure, little bleeding, is rapidly and easily performed with less morbi-morality and has smoother postoperative period. A retrospective study of 16 patients whose hypophyseal tumors were treated surgically using the trans-septo-sphenoidal transnasal (maxillary-premaxillary) approach is presented. All these patients were seen in the E.N.T. Department of Alicante's General University Hospital, between January 1990 and June 1993. The trans-septo-sphenoidal transnasal via avoids some of the problems of the sublabial trans-sphenoidal procedure; namely longer operating time, oral contamination of the surgical field, subsequence difficulties due to the lack of sensibility and discomfort of the upper jax area and postoperative alterations in the projection of the septal-columelar tip.

[Our experience in the surgery of otosclerosis]. / Nuestra experiencia en la cirugía de la otosclerosis.

A retrospective study of 613 operations on 495 patients with otosclerosis was made in the Department of Otorhinolaryngology of Hospital General Universitario of Alicante between 1974 to 1992. The clinical-pathological characteristics of this series were studied. Statistical analysis of the results was made. The improvement in air-bone gap for conversational frequencies was 27 dB. Closure of the postoperative air-bone gap for conversational frequencies was 7.6 dB and the overall percentage of closure of this gap was 80.5%. Better auditory results were obtained with partial platinectomy than with stapedectomy. Nothing was inserted between the prosthesis and the vestibule, permitting a shorter, easier operation with no occurrence of perilympathic fistule.

[Obliterative otosclerosis]. / Otosclerosis obliterativa.

In true (grade IV) obliterative otosclerosis, the limits of the oval windows are lost. The insertion of a prosthesis requires drilling and surgical ability. Thirty eight cases of the true obliterative otosclerosis operated in our Department between 1974 and 1992 have been reviewed. Only 6.2% of all the patients operated by us with the diagnosis of otosclerosis had true obliterative otosclerosis. The average preoperative gap in conversational frequencies was 39 dB. In general, the gap closure obtained (13 dB) was slightly lesser than that for otosclerosis. Reobliteration of the oval window may occur in this type of otosclerosis.

[Open rhinoplasty: outcomes of 100 cases]. / Rinoplastia abierta: resultados de 100 casos.

Open rhinoplasty is a technique that allows a sharper evaluation of nasal deformities since a visual diagnosis may be done. We present a review of the cases in which an open rhinoplasty was performed in our department in the last five years. Preoperative and postoperative data are recorded in a standardized form in order to facilitate their analysis. The techniques used for each type of nasal deformity (dorsal and basal) are described and the results discussed.

[Botryoid rhabdomyosarcoma of the nasopharynx treated with chemotherapy only. Survival lasting more than ten years]. / Rabdomiosarcoma botrioide de nasofaringe. Supervivencia mayor de diez años tratado sólo con quimioterapia.

The progress of Rahbdomyosarcoma (RMS) of the nasopharynx succeed frequently as infiltrative and destructive form to the base of the skull, in which case its prognostic is worse as when localized somewhere else. We report the case of a RMS in a 4-year-old child. The tumour infiltrating the base of the skull (stage III), was treated with chemotherapy only because the neighbourhood of the sella turcica and the pituitary gland strongly forbids the appeal to radiotherapy, in order to avoid untoward side-effects on this gland and also upon the growth of the child. At present, 10 years after, he remains asymptomatic and free of the tumour. Computered tomography has probe to be the best way to study the site and the extent of this growth and even the control of course of treatment.

[Glottic liposarcoma: a first case in the national literature]. / Liposarcoma glótico. Primer caso en la literatura nacional.

Liposarcoma is a tumour of mesenchymal origin. Only between 3-8 percent of the total amount of cases are localized in the head and neck. Laryngeal sitting is an extremely rare occurrence. The AA. inform about the case princeps published in the national literature. It deals with an 83-years-old woman presenting a polypoid tumor on the left vocal cord. The diagnosis could be confirmed through immunochemistry which verified the positivity of the proliferative cellularity for vimentine and protein S-100, immunophenotype consistent with liposarcoma. 36 months later the patient, alive, remains tumor-free.

Projections from the primary auditory cortex onto the dorsal cortex of the inferior colliculus in albino rats.

The topography of connections from the primary auditory cortex (Te1) onto the dorsal cortex (DC) of the inferior colliculus (IC) was studied using the anterograde neural tracers Phaseolus vulgaris (PHA-L) and Biotinylated dextran amine (BDA). Injections in different restricted portions of the ventral Te1 showed labelled axonal sheets in the ipsilateral DC with extensions in the central nucleus and the external cortex. Also contralateral labelled axons were found with a patchy appearance. The pattern of labelled axonal laminae is arranged in an orderly fashion, so that a correlation exists between the injection field (antero-to caudoventral injections) and the pattern of labelled axonal sheets (from a ventromedial to a dorsolateral arrangement) in the IC. However, variations from this pattern were observed. Also only the injections made in rostral and middle parts of Te1 V are orderly arranged in the territory of the DC, while the Te1 V caudoventral projection partially overlaps those from antero and mid-central regions. A topographical arrangement in the fibre projection from the medial and dorsal zones of Te1 (Te1 D) exists in the neuropil of the IC. The bands from Te1 D overlapped with the bands from Te1 V but in different order. This indicates that the projection of the mid-dorsal zone of Te1 is not topographically arranged in the DC like Te1 V. Based on the results we have obtained, there is strong evidence that the projection from Te1 V to the DC is topographically organized in a rostrocaudal sequence which gives definite terminal fields. However, each of these fields (medial, central and external) receives a principal bulk of primary auditory cortical fibres and a supplementary one. This implies that territories of the DC which contain neurons responsive to low frequencies receive a projection from Te1 fields with neurons which are responsive to high or to low frequencies.

[Extracanalicular osteomas of the temporal bone: three cases]. / Osteomas extracanaliculares del hueso temporal. Tres casos.

Osteoma is a slow-growing tumor formed by mature bone tissue. In the temporal bone, intracanalicular osteomas are more frequent than extracanalicular osteomas. In Spain, only twelve cases of extracanalicular tumors of the temporal bone have been described in the literature. We present three new cases of extracanalicular osteoma (mastoids). The clinical and radiological features of each case are described and the relevant literature is reviewed.

[Zenker's diverticulum. Four cases]. / Divertículo de Zenker. Cuatro casos.

The pharyngoesophageal diverticulum (Zenker's diverticulum) is a pathology not often found, but it is responsive of dysphagia and other unpleasant ailments experienced for the patients, who generally must be submitted to surgery. The AA. describe the surgical procedure followed at their ENT-Department at Hospital General de Alicante and also some clinic-pathological features verified. Review about the literature on the subject. The conclusion drawn out remark the feasibility and the effectiveness of this method of diverticulectomy associated to the cricopharyngeal myotomy. The dissection is easied introducing strips of gauze into the diverticular sack and retaining the oesophagoscope inside the organ during the procedure.