Neurological complications following functional neck dissection.

A retrospective study was done to assess the incidence and factors associated with neurological complications in patients who have undergone a functional neck dissection (FND). Four hundred forty-two epidermoid cancer patients operated on from January 1984 to December 2002 were included in the study. Clinical parameters, neurological sequelae, and other complications were evaluated in all cases. The incidence of neural damage was calculated on the nerves at risk (n =714). Paralysis of the 11th nerve occurred in 12 cases (1.68%). A lesion of the marginal branch of the 7th cranial nerve was observed in nine cases (1.26%). Bernard-Horner's syndrome and hypoglossal nerve paralysis were noted in four and three cases (0.56 and 0.42%), respectively. Thus, the incidence of neurological sequelae after FND is low. Neurological complications were not associated with either clinical parameters or non-neurological complications (P >0.05). None of the factors studied can predict the appearance of neural problems in the postoperative period.

Analysis of the causes of immediate unanticipated bleeding after pediatric adenotonsillectomy.

OBJECTIVES: To assess the incidence of unexpected postoperative bleeding in children undergoing adenoidectomy and/or tonsillectomy (T&A), and to investigate its possible undetected haematological causes. METHODS: We prospectively collected all patients under 14 years of age with a normal preoperative haematologic work-up (activated partial thromboplastic time, prothrombin time, fibrinogen, and platelet count), who underwent surgery of adenoids and/or tonsils at our institution between January 1997 and November 2000. RESULTS: There were 1516 cases that accomplished the inclusion criteria in the period of survey. Thirteen patients bled after surgery. This represents an incidence of 0.8% of immediate postoperative haemorrhage among the 1516 procedures analyzed. No statistical differences were found between bleeding and non-bleeding patients according to age, sex, and type of procedure (P>0.05). In 6 of the 13 bleeding patients (46.1%) an alteration of the coagulation system was subsequently found: 5 von Willebrand's disease, and 1 releasing thrombopathy. CONCLUSIONS: The incidence of bleeding after adeno and/or tonsillectomy at our institution is comparable with series previously reported in the current medical literature. In nearly one half of the cases, undetected coagulation diseases (mainly von Willebrand's disease) are diagnosed after surgery in the haematological study.

[Cost-benefit analysis of the anatomo-pathological study of tonsillectomy specimens in the pediatric population]. / Análisis costo-beneficio del estudio anatomopatológico de las piezas de amigdalectomía en la población pediátrica.

To study the cost-benefit of the histological examination of tonsilar samples, we evaluated 567 cases (547 routine and 20 nonroutine cases) of patients under 14 years of age, operated between 1st January 1996 and 30th November 2000. There were 2 routine cases (0.3%), and 6 nonroutine cases (30%) with a diagnosis different to follicular hyperplasia. In this way, our clinical preoperative sensitivity was 75% and specificity 97%. The average cost per case at our Centro to study the tonsilar samples was 30$. We conclude that the histological examination of tonsilar specimens is economically worth only in nonroutine cases, although additional factors (e.g. training of residents of Pathology and the quality control of the institution must be taken into consideration.

[The value of waiting in spontaneous remission of recurrent tonsillitis without associated adenoid pathology]. / Utilidad de la espera en la remisión espontánea de la amigdalitis de repetición sin patología adenoidea asociada.

In order to assess the rate of spontaneous remission in children with recurrent acute tonsillitis (RAT), we revised the pediatric patients who were seen between 1994 and 1999. For this purpose, 123 cases that were on the waiting list for tonsillectomy under the indication of RAT without associated adenoid disease were selected. Only 23 (18.7%) of the children who were included in the study were removed from the waiting list after a mean time of 9 months because of spontaneous remission of the disease. Thus, there is no justification for claiming that long waiting lists for tonsillectomy are frequently associated with spontaneous remission of RAT.

Análisis costo-beneficio del estudio anatomopatológico de las piezas de amigdalectomía en la población pediátrica / Cost-benefit analysis in the pathological exam of tonsillar samples in the pediatric population

Con el objeto de estudiar la relación costo-beneficio del examen histopatológico de las piezas quirúrgicas de amígdala palatina, se evaluaron 567 amigdalectomías (547 rutinarias y 20 no rutinarias) realizadas en menores de 14 años, entre el 1 de enero de 1996 y el 30 de noviembre de 2000. En 2 casos (0,3 por ciento) de las rutinarias y 6 (30 por ciento) de las no rutinarias se encontró un diagnóstico distinto del de hiperplasia folicular linfoide. Así, la sensibilidad de nuestra valoración clínica preoperatoria resultó ser del 75 por ciento, y la especificidad fue del 97 por ciento. El costo medio por caso en nuestra Institución para el estudio histológico de los especímenes de amígdala resultó ser de 5.955 pesetas. Como conclusión, el análisis sistemático de las amígdalas sólo es económicamente beneficioso en los casos no rutinarios, aunque han de tenerse en cuenta factores adicionales como son la docencia de los residentes de Anatomía Patológica y el control de calidad de la Institución (AU)

To study the cost-benefit of the histological examination of tonsilar samples, we evaluated 567 cases (547 routine and 20 nonroutine cases) of patients under 14 years of age, operated between 1st January 1996 and 30th November 2000. There were 2 routine cases (0.3%), and 6 nonroutine cases (30%) with a diagnosis different to follicular hyperplasia. In this way, our clinical preoperative sensitivity was 75% and specificity 97%. The average cost per case at our Centro to study the tonsilar samples was 30$. We conclude that the histological examination of tonsilar specimens is economically worth only in nonroutine cases, although additional factors (e.g. training of residents of Pathology and the quality control of the institution must be taken into consideration (AU)

Utilidad de la espera en la remisión espontánea de la amigdalitis de repetición sin patología adenoidea asociada / Benefits of waiting for the spontaneous remission of recurrent acute tonsillitis (RAT) with out associated adenoid disease

Con el objeto de determinar el porcentaje de remisiones espontáneas en los casos de amigdalitis de repetición se realizó un estudio que incluía a pacientes pediátricos vistos entre 1994 y 1999. Para ello revisamos los 123 casos puestos en lista de espera quirúrgica por amigdalitis de repetición (AR) durante este período, sin patología adenoidea asociada. En sólo 23 niños (18,7 por ciento), se resolvieron los episodios de AR espontáneamente tras un tiempo medio de 9 meses y, por tanto, fueron retirados de la lista de espera. En conclusión, consideramos que no existe justificación para pensar que períodos largos de espera resuelven de forma espontánea muchos casos de AR (AU)

In order to assess the rate of spontaneous remission in children with recurrent acute tonsillitis (RAT), we revised the pediatric patients who were seen between 1994 and 1999. For this purpose, 123 cases that were on the waiting list for tonsillectomy under the indication of RAT without associated adenoid disease were selected. Only 23 (18.7%) of the children who were included in the study were removed from the waiting list after a mean time of 9 months because of spontaneous remission of the disease. Thus, there is no justification for claiming that long waiting lists for tonsillectomy are frequently associated with spontaneous remission of RAT (AU)

Graft-vs-host disease as a cause of enlargement of the epiglottis in an immunocompromised child.

We report a rare case of dyspnea due to enlargement of the epiglottis in a severely immunocompromised patient. The child underwent a previous tracheostomy at another hospital because of respiratory distress under the diagnosis of acute epiglottitis. The patient was subsequently decannulated without incident. One year later, the child developed a new episode of dyspnea with inspiratory stridor. A new tracheostomy was neccessary, and a biopsy specimen of the enlarged epiglottis was taken to confirm the diagnosis of graft-vs-host disease. The therapeutic measures in these situations are discussed below, and a review of the current literature concerning the etiology and management of epiglottic enlargement is performed.

Comparison of amoxicillin and azithromycin in the prevention of recurrent acute otitis media.

OBJECTIVE: To compare the outcome of patients with recurrent acute otitis media (AOM) treated either with amoxicillin or with azithromycin. METHODS: This prospective, controlled, and randomized study, compares the outcome of 71 patients with recurrent AOM treated with azithromycin (31 patients) or amoxicillin (40 patients) for the prevention of AOM. azithromycin was given at a dose of 10 mg/kg once a week, whereas amoxicillin was administered daily as a single intake of one third of the therapeutic dosage (20 mg/kg per day). All treatments were prescribed for 3 months. Both groups were homogeneous with regard to the currently accepted predisposing factors of recurrent AOM. Mean age of children was 35.3 months, and average follow-up was 11.5 months. The treatment was considered effective when the number of episodes of AOM dropped to less than 50% after the prophylaxis. RESULTS: Patients in the azithromycin group had a clinical response to prophylaxis (80.6%) comparable to those treated with amoxicillin (89.5%) (P=0.300). The incidence of adverse effects was similar in both groups. CONCLUSION: According to these results, a prophylaxis with azithromycin is as useful as amoxicillin to prevent recurrent AOM.

Speech results and complications of near-total laryngectomy.

Near-total laryngectomy provides a functional alternative to total laryngectomy in selected cases of laryngeal and hypopharyngeal cancer. We report our experience with the first 49 patients treated with near-total laryngectomy over a 3-year period. Successful speech rehabilitation was obtained in 79.5% of the patients in a median time of 40 days. Speech was acquired in 89.6% of the patients with follow-up longer than 6 months. Hands-free conversation was possible in 51.4% of the speaking patients. Five patients had symptomatic aspiration and 23 developed postoperative pharyngocutaneous fistula. Four local recurrences occurred in the laryngeal remnant. These results confirm that near-total laryngectomy provides a relatively safe, simple, and reproducible speech rehabilitation method for patients in whom total laryngectomy otherwise would be required.