Fístula traumática de líquido cefalorraquídeo tras realización de test PCR mediante hisopo nasal para el diagnóstico de COVID-19. Revisión sistemática / Traumatic cerebrospinal fluid leak after performing PCR test using a nasal swab for the detection of COVID-19 disease. A Systematic review

Introducción y objetivo: Las fístulas de líquido cefalorraquídeo (LCR) pueden producirse tras un traumatismo, esto conlleva una disrupción entre la aracnoides y la duramadre, frecuentemente asociado a un defecto óseo. La epidemia mundial producida por la COVID-19 ha generado la necesidad de disponer de test rápidos para la detección del virus en mucosa nasal y orofaríngea. Los hisopos nasales (HN) han demostrado ser útiles a la hora de recoger muestras nasofaríngeas y por lo tanto se ha generalizado su uso. Este método diagnostico se considera seguro, pero existen una serie de posibles complicaciones entre las que se encuentra una de las más temidas; la fístula de LCR. El objetivo de este artículo es realizar una revisión bibliográfica exhaustiva de artículos disponibles que describan esta complicación, investigando los factores predisponentes y a su vez describir una técnica segura para evitarla.Método: Se realizaron búsquedas en las bases de datos de PubMed, Web of Science y Scopus de acuerdo con las pautas de PRISMA desde marzo de 2020 hasta noviembre de 2021. Se revisaron los estudios que informaron datos clínicos de pacientes con fistulas de LCR tras ser sometidos a frotis nasales mediante hisopos. Nos centramos en los síntomas de alarma presentados, las estrategias diagnosticas y el manejo terapéutico. Resultados: Hasta la fecha se han reportado once casos publicados de pacientes con diagnostico de fistula de LCR segundaria a la realización de test PCR mediante HN. En esta revisión sistemática se incluyen estos artículos. (AU)

Introduction and objective: Cerebrospinal fluid leaks (CSF) can occur after trauma, this leads to a disruption between the arachnoid and the dura, frequently associated with a bone defect. The global epidemic produced by COVID-19 has generated the need for rapid tests to detect the virus in the nasal and oropharyngeal mucosa. Nasal swabs (NS) have proven to be useful in collecting nasopharyngeal specimens and therefore their use has become widespread. This diagnostic method is considered safe, but there are a number of possible complications, including one of the most feared; CSF leak. The objective of this article is to carry out an exhaustive bibliographic review of available articles that describe this compli-cation, investigating the predisposing factors and describe a safe technique to avoid it. Method: PubMed, Web of Science and Scopus databases were searched according to PRISMA guidelines, from March 2020 to November 2021. Studies reporting clinical data of patients with CSF leak after being subjected to NS were reviewed. We focus on the alarm symptoms presented, diagnostic strategies and therapeutic management. Results: To date, eleven published cases have been reported of patients with a diagnosis of CSF leaks caused by performig a PCR test using a nasal swab. All the articles were included in this systematic review. Each article described this complication in one patient, so we have a total of eleven patients. The average age at diagnosis was 45 years, with 8 women and 3 men. The cribriform plate is the most frequently affected anatomical location. In five patients, 45,5%, the preexistance of malformation at the level of the skull base was known, which corresponds to a risk factor when suffering a CSF leaks after NS. (AU)

Laryngeal Electromyography for Prognosis of Vocal Fold Paralysis.

OBJECTIVE: This study aimed to determine the value of laryngeal electromyography in the prognosis of vocal fold paralysis. STUDY DESIGN: This is a retrospective descriptive study. MATERIALS AND METHODS: This study included 80 patients diagnosed with unilateral or bilateral vocal fold paralysis on flexible laryngoscopy between 2002 and 2014 in a tertiary medical center. Laryngeal electromyography using a standardized protocol was performed; the outcome measures were classified and analyzed into two groups according to the degree of injury. Group 1 included patients with mild to moderate injury, and group 2 included patients with severe to complete injury. Prognosis was correlated with vocal fold motion recovery status with a minimum of 6 months of follow-up since the symptoms onset using positive and negative predictive values. RESULTS: Sixty patients showed acute or chronic recurrent laryngeal neuropathy in laryngeal electromyography. Twelve of 41 patients included in group 1 recovered motion, and 30 of 35 patients included in group 2 did not recover, resulting in 88.2% of positive predictive value and 35.7% of negative predictive value. CONCLUSIONS: Our data confirm that laryngeal electromyography is a useful clinical tool in predicting poor recovery in patients with vocal fold paralysis. It allows identification of candidates for early intervention.

Evolution of Patients With Immediate Complete Facial Paralysis Secondary to Acoustic Neuroma Surgery.

OBJECTIVE: To study the evolution of patients with immediate complete facial paralysis after acoustic neuroma surgery in different scenarios and assess different facial reanimations techniques. METHODS: This study included 50 patients with complete facial paralysis immediately after acoustic neuroma surgery. Data were analyzed into 4 groups according to the need and type of reconstruction of the facial nerve, either none, immediate, or on a deferred basis. All patients had intraoperative facial nerve monitoring, and facial nerve function was evaluated according the House-Brackmann (HB) scale. RESULTS: Of all patients with immediate total paralysis, no patients achieved totally normal facial function (grade I), and only 5 (10%) recovered to a grade II. For all groups included, the majority of patients (82%) achieved an acceptable final facial function (grade III HB). In this series, only 2 patients remained with a grade VI facial function. CONCLUSIONS: The possibility of recovering near normal facial function after a grade VI facial paralysis is very low. Procedures like the immediate repair of the facial nerve with an interposed donor graft may provide better facial function in patients with partially injured facial nerve. Even in cases of total section, there are other procedures that can improve the results.

Fibrous dysplasia of the temporal bone secondary to ear surgery: a case report.

INTRODUCTION: In this report, we describe the clinical course, diagnostic features and management of a patient with fibrous dysplasia of the temporal bone 7 years after middle ear surgery on the same side. CASE PRESENTATION: A 16-year-old Caucasian girl presented to our hospital with a growing bone lesion in the roof of the left temporal bone. She had undergone a previous tympanoplasty at 7 years of age because of a cholesteatoma. At the time of that first surgery, no radiological or histological signs indicated a bone disorder. A computed tomographic scan of the temporal bone showed a lesion with rarefaction areas and lytic images inside that affected the roof of the cavity to the tegmen tympani without alterations in the inner ear. A surgical revision of the ear cavity was performed by resecting the lesion and regularizing the cavity. The histopathologic study confirmed fibrous dysplasia. The patient progressed satisfactorily after surgery with no evidence of recurrence. CONCLUSION: To the best of our knowledge, this is the first report of fibrous dysplasia of the temporal bone secondary to ear surgery.