[Usefulness of facial nerve monitoring during parotidectomy]. / Utilidad de la monitorización del nervio facial en la cirugía de la glándula parótida.

OBJECTIVE: To analyse the usefulness of facial nerve monitoring by continuous electromyography during parotidectomy. PATIENTS AND METHODS: Fifty-two consecutive patients who underwent parotidectomy (27 unmonitored and 25 monitored) between 1987 and 1998. Both groups had a similar distribution of superficial and total parotidectomy. RESULTS: Facial nerve monitoring reduced the incidence and severity of facial nerve paralysis independently of the kind of surgery performed. The incidence of temporary facial paralysis was significantly lower in the monitored group (36%) than in the unmonitored group (70%) (p = 0.013). The rates of permanent deficit were 4% for the monitored group and 30% for the unmonitored group (p = 0.025). CONCLUSIONS: The results suggest that intraoperative facial nerve monitoring reduces the incidence of postoperative facial deficit. The routine use of facial nerve monitoring is controversial. However, it is considered useful in surgery where there is a higher risk of injury to the facial nerve such as total parotidectomy, re-interventions or chronic inflammatory conditions.

[Analysis of 2,500 squamous cell carcinoma of the head and neck]. / Análisis de 2.500 carcinomas escamosos de cabeza y cuello.

The purpose of this paper is to define the prevalence of squamous cell carcinoma of the head and neck as seen at the ENT Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain in the last years, studying 2500 cases. Relative frequencies at the various sites, age distribution, male to female ratios, TNM stage are reported. From the results we point out that laryngeal squamous cell carcinomas (1297 cases) were more than 50% of all tumors, followed by oropharygeal carcinomas, oral cavity carcinomas and hypopharyngeal carcinomas. The mean age was 61 years, and patients with nasopharyngeal carcinomas were the youngest. 92% of the patients were males, and the highest rate of males was seen in the larynx and hypopharynx (97% males). Only 9% of the patients were non-smokers and 18% were not alcohol drinkers. Hypopharyngeal squamous cell carcinomas concentrated the highest rate of patients with severe toxic consumption. A significant proportion of earlier tumors was only seen in the larynx and oral cavity (54% and 41% Stages I-II, respectively). On the other hand, hypopharyngeal carcinoma, oropharyngeal carcinoma and nasopharyngeal carcinomas were mainly diagnosed in advanced stages.

Utilidad de la monitorización del nervio facial en la cirugía de la glándula parótida / Usefulness of facial nerve monitoring during parotidectomy

Objetivo: analizar la utilidad de la monitorización del nervio facial por electromiografía continua en la cirugía de la glándula parótida. Pacientes y métodos: 52 parotidectomías realizadas consecutivamente entre 1987 y 1998. Diferenciamos dos grupos: uno constituido por 25 pacientes en que se monitorizó el nervio facial durante la cirugía y el otro de 27 pacientes sin monitorización. La distribución según el tipo de cirugía (parotidectomía suprafacial o total) era similar en ambos grupos. Resultados: la monitorización del nervio facial disminuyó la frecuencia y severidad de la parálisis facial postoperatoria independientemente del tipo de cirugía realizado. El 36 por ciento de los pacientes del grupo monitorizado presentó algún grado de parálisis facial inmediata, frente al 70 por ciento del grupo no monitorizado (p=0,013). Al año, el porcentaje de pacientes con alteración de la función facial fue del 4 y del 30 por ciento para cada grupo, respectivamente (p= 0,025).Discusión: la monitorización del nervio facial durante la parotidectomía ha disminuido la incidencia de la parálisis facial postoperatoria. Su uso rutinario en la cirugía de la parótida es discutible, pero se considera útil en intervenciones donde el riesgo de lesión del nervio facial está aumentado (parotidectomía total, reintervención y parotiditis crónica) (AU)

OBJECTIVE: To analyse the usefulness of facial nerve monitoring by continuous electromyography during parotidectomy. PATIENTS AND METHODS: Fifty-two consecutive patients who underwent parotidectomy (27 unmonitored and 25 monitored) between 1987 and 1998. Both groups had a similar distribution of superficial and total parotidectomy. RESULTS: Facial nerve monitoring reduced the incidence and severity of facial nerve paralysis independently of the kind of surgery performed. The incidence of temporary facial paralysis was significantly lower in the monitored group (36%) than in the unmonitored group (70%) (p = 0.013). The rates of permanent deficit were 4% for the monitored group and 30% for the unmonitored group (p = 0.025). CONCLUSIONS: The results suggest that intraoperative facial nerve monitoring reduces the incidence of postoperative facial deficit. The routine use of facial nerve monitoring is controversial. However, it is considered useful in surgery where there is a higher risk of injury to the facial nerve such as total parotidectomy, re-interventions or chronic inflammatory conditions (AU)

Análisis de 2.500 carcinomas escamosos de cabeza y cuello / Head and neck carcinoma: analysis of 2.500 cases

El objetivo de este trabajo es definir la prevalencia de los carcinomas escamosos de cabeza y cuello diagnosticados en el Servicio de Otorrinolaringología del Hospital de la Santa Creu y Sant Pau de Barcelona en los últimos años, estudiando 2.500 casos diagnosticados consecutivamente. Se analizan las distintas localizaciones, la distribución por edades, sexos y la clasificación TNM. En los resultados destaca cómo los carcinomas de la laringe (1.297 casos) suponen algo más de la mitad de los tumores diagnosticados, seguidos de la orofaringe, la cavidad oral y la hipofaringe. La edad media fue de 61años, siendo los pacientes con carcinomas de nasofaringe los más jóvenes. El 92 por ciento de los pacientes fueron varones, siendo el predominio masculino más acusado en las localizaciones laringe e hipofaringe (97 por ciento varones). Sólo 9 por ciento eran no fumadores y 18 por ciento no bebedores de alcohol. La hipofaringe fue la localización donde se concentraron los pacientes con mayores hábitos tóxicos. La laringe y la cavidad oral fueron las dos únicas localizaciones donde los tumores se diagnosticaron de forma importante en estadios precoces (54 por ciento y 41 por ciento de estadios I-II, respectivamente). Por el contrario en la hipofaringe, la orofaringe y nasofaringe los tumores se diagnosticaron, mayoritariamente, en estadios avanzados (AU)

The purpose of this paper is to define the prevalence of squamous cell carcinoma of the head and neck as seen at the ENT Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain in the last years, studying 2500 cases. Relative frequencies at the various sites, age distribution, male to female ratios, TNM stage are reported. From the results we point out that laryngeal squamous cell carcinomas (1297 cases) were more than 50% of all tumors, followed by oropharygeal carcinomas, oral cavity carcinomas and hypopharyngeal carcinomas. The mean age was 61 years, and patients with nasopharyngeal carcinomas were the youngest. 92% of the patients were males, and the highest rate of males was seen in the larynx and hypopharynx (97% males). Only 9% of the patients were non-smokers and 18% were not alcohol drinkers. Hypopharyngeal squamous cell carcinomas concentrated the highest rate of patients with severe toxic consumption. A significant proportion of earlier tumors was only seen in the larynx and oral cavity (54% and 41% Stages I-II, respectively). On the other hand, hypopharyngeal carcinoma, oropharyngeal carcinoma and nasopharyngeal carcinomas were mainly diagnosed in advanced stages (AU)

Treatment of neck nodes after induction chemotherapy in patients with primary advanced tumours.

Responsiveness of neck nodes to induction chemotherapy often differs from that of the primary tumour. We have conducted a retrospective study to evaluate the results of treating the neck in a cohort of 350 patients with locally advanced (T3-4) head and neck carcinomas treated with radiation therapy at the primary location of the tumour after induction chemotherapy. One hundred and thirty-nine patients (40%) did not have neck nodes on diagnosis (N0). The treatment of the neck included surgery in 65 patients. Neck dissections were carried out before radiotherapy in 37 patients and after radiotherapy in 28 patients. The frequency of neck treatment failure was 24%. There was a tendency to better neck control when treatment included neck dissection, independently of the neck stage or response to chemotherapy. This tendency was statistically significant in patients with an advanced regional tumour (N2-3) who did not achieve a complete regional response after chemotherapy. In a multivariate analysis the variables that were related to the regional failure were the relapse of the tumour at the primary site, the neck stage (N), the type of treatment used in the neck, and the grade of regional response after induction chemotherapy. Our results lead us to suggest that after induction chemotherapy neck surgery is advisable in all cases with advanced regional disease (N2-3), independently of the grade of response achieved after induction chemotherapy, and is also advisable in N1 patients in whom induction chemotherapy does not achieve a complete response.