A new standardized nomenclature in Otorhinolaryngology: Criteria and quantitative and qualitative evaluation indicators of medical procedures. / Nuevo nomenclátor estandarizado en Otorrinolaringología: criterios e indicadores cuantitativos y cualitativos de baremación de actos médicos.

PURPOSE: At the request of the Organización Médica Colegial, we have elaborated a new nomenclature of medical and surgical procedures in Otorhinolaryngology-Head & Neck Surgery (ENT-HNS) based on the International Classification of Diseases ICD-9-MC. We have defined new quantitative and qualitative criteria and indicators that may allow scale and remuneration to be determined in private medical practice. METHODS: Obsolete processes were eliminated from the current list of nomenclature, new ones were added or updated, procedures from other specialties that typically belong to ENT-HNS were imported, descriptions were modified accordingly, and others were transferred from one group to another for reasons of surgical complexity. In addition, it was requested that four quantitative criteria and indicators should be assigned for each procedure: unit cost per group, professional training and complexity, professional responsibility, potential complications, and health value, assigning a final value as a product of the sum of each of the indicators. RESULTS: The new scale presents a total of 395 procedures, compared to 150 in the previous list, an increase of 163%. Surgical procedures increased from 113 to 313 (177%). By subspecialty, Laryngology (213%) has the greatest number of new procedures followed by Rhinology (141%) and Otology (82%). Twenty of 150 procedures were found to be outdated and were therefore removed from the list. Eighty-seven per cent of the procedures remained on the list, 40% as they were and 47% modified, respectively, and, in all cases retaining their original Organización Médica Colegial code. CONCLUSIONS: The new ENT-HNS nomenclature proposed by the SEORL-CCC updates and improves the previous outdated scale, adapting the current procedures to the ICD-9-CM and incorporating the new techniques developed. The updated scale establishes new evaluation criteria with quantitative and qualitative indicators to optimize the calculation of the value of a medical or surgical procedure that, eventually, will allow an assessment of its monetary value in our specialty.

Cirugía virtual para pacientes con obstrucción nasal: empleo de un software basado en dinámica de fluidos (MeComLand(R), Digbody(R) & Noseland(R)) para documentar parámetros objetivos de flujo y optimizar resultados quirúrgicos / Virtual surgery for patients with nasal obstruction: Use of computational fluid dynamics (MeComLand(R), Digbody(R) & Noseland(R)) to document objective flow parameters and optimise surgical results

INTRODUCCIÓN: La dinámica de fluidos computacional (CFD) es una herramienta matemática que permite analizar el flujo aéreo. Presentamos un software innovador basado en CFD para mejorar los resultados de la cirugía nasal. MÉTODOS: Mediante colaboración de ingenieros especialistas en mecánica de fluidos y otorrinolaringólogos se ha desarrollado un software de fácil uso denominado MeComLand(R), que utilizando los cortes de tomografía computarizada de un paciente permite obtener gran cantidad de información como flujo, presiones, temperatura, velocidad o fricción sobre la pared de las fosas nasales. El programa DigBody(R) permite modificar en 3 D la anatomía del modelo y realizar cirugías virtuales para simular resultados antes de la cirugía real. Por último, NoseLand(R) permite viajar virtualmente por el interior de la fosa nasal, mostrando todo tipo de magnitudes termo-fluido mecánicas. OBJETIVO: Presentar un programa innovador para mejorar los resultados de la cirugía nasal. Emplear este software sobre cortes tomográficos de un paciente con desviación septal para planificar distintas opciones quirúrgicas (septoplastia, turbinectomía, spreader-grafts, colgajo en J y combinaciones) a fin de conseguir la mejor alternativa con la menor morbilidad. RESULTADOS: La combinación de todos los procedimientos considerados no produce los mejores resultados en cuanto a flujo nasal. Estos se consiguen asociando septoplastia y turbinectomía. La turbinectomía aislada obtuvo resultados muy similares a la septoplastia. CONCLUSIONES: La técnica computacional CFD proporciona una información complementaria valiosa en el diagnóstico del paciente con obstrucción nasal y sobre los resultados de distintas alternativas quirúrgicas respecto al flujo nasal, contribuyendo a un mejor manejo del enfermo. El software MeComLand(R) con sus respectivos módulos DigBody(R) y NoseLand(R) suponen una alternativa barata y no invasiva al estudio funcional del paciente con obstrucción nasal

INTRODUCTION: Computational fluid dynamics (CFD) is a mathematical tool to analyse airflow. We present a novel CFD software package to improve results following nasal surgery for obstruction. METHODS: A group of engineers in collaboration with otolaryngologists have developed a very intuitive CFD software package called MeComLand(R), which uses the patient's cross-sectional (tomographic) images, thus showing in detail results originated by CFD such as airflow distributions, velocity profiles, pressure, or wall shear stress. NOSELAND(R) helps medical evaluation with dynamic reports by using a 3D endoscopic view. Using this CFD-based software a patient underwent virtual surgery (septoplasty, turbinoplasty, spreader grafts, lateral crural J-flap and combinations) to choose the best improvement in nasal flow. OBJECTIVE: To present a novel software package to improve nasal surgery results. To apply the software on CT slices from a patient affected by septal deviation. To evaluate several surgical procedures (septoplasty, turbinectomy, spreader-grafts, J-flap and combination among them) to find the best alternative with less morbidity. RESULTS: The combination of all the procedures does not provide the best nasal flow improvement. Septoplasty plus turbinoplasty obtained the best results. Turbinoplasty alone rendered almost similar results to septoplasty in our simulation. CONCLUSIONS: CFD provides useful complementary information to cover diagnosis, prognosis, and follow-up of nasal pathologies based on quantitative magnitudes linked to fluid flow. MeComLand(R), DigBody(R) and NoseLand(R) represent a non-invasive, low-cost alternative for the functional study of patients with nasal obstruction

Virtual surgery for patients with nasal obstruction: Use of computational fluid dynamics (MeComLand®, Digbody® & Noseland®) to document objective flow parameters and optimise surgical results. / Cirugía virtual para pacientes con obstrucción nasal: empleo de un software basado en dinámica de fluidos (MeComLand®, Digbody® & Noseland®) para documentar parámetros objetivos de flujo y optimizar resultados quirúrgicos.

INTRODUCTION: Computational fluid dynamics (CFD) is a mathematical tool to analyse airflow. We present a novel CFD software package to improve results following nasal surgery for obstruction. METHODS: A group of engineers in collaboration with otolaryngologists have developed a very intuitive CFD software package called MeComLand®, which uses the patient's cross-sectional (tomographic) images, thus showing in detail results originated by CFD such as airflow distributions, velocity profiles, pressure, or wall shear stress. NOSELAND® helps medical evaluation with dynamic reports by using a 3D endoscopic view. Using this CFD-based software a patient underwent virtual surgery (septoplasty, turbinoplasty, spreader grafts, lateral crural J-flap and combinations) to choose the best improvement in nasal flow. OBJECTIVE: To present a novel software package to improve nasal surgery results. To apply the software on CT slices from a patient affected by septal deviation. To evaluate several surgical procedures (septoplasty, turbinectomy, spreader-grafts, J-flap and combination among them) to find the best alternative with less morbidity. RESULTS: The combination of all the procedures does not provide the best nasal flow improvement. Septoplasty plus turbinoplasty obtained the best results. Turbinoplasty alone rendered almost similar results to septoplasty in our simulation. CONCLUSIONS: CFD provides useful complementary information to cover diagnosis, prognosis, and follow-up of nasal pathologies based on quantitative magnitudes linked to fluid flow. MeComLand®, DigBody® and NoseLand® represent a non-invasive, low-cost alternative for the functional study of patients with nasal obstruction.

[The diagnostic role of direct microlaryngoscopy]. / Papel diagnóstico de la microlaringoscopia directa.

Sulcus vocalis, vergetures, mucosal bridges, and cysts as intracordal lesions constitute a group of great diagnostic difficulty. We present 6 patients in whom microlaryngoscopy was the final diagnostic step in the evaluation of a lesion not recognized in the initial evaluation. The criteria selected were as follows: Severe GRABS. Stroboscopic parameters: glottal chink without mass lesion, asymmetry of amplitude, and irregularity of vibration, or when discrepancy between examination and quality of the voice exists. Acoustic and aerodynamic measures that demonstrate severe dysphonia. High scores on the Voice Handicap Index. We recommend carrying out a diagnostic microlaryngoscopy examination where the cause of dysphonia is unclear.

Papel diagnóstico de la microlaringoscopia directa / The diagnostic role of direct microlaryngoscopy

Los sulcus vocalis, vergetures, puentes mucosos y quistes son lesiones intracordales que constituyen un grupo de lesiones de difícil diagnóstico. Presentamos a 6 pacientes en los que la microlaringoscopia fue el paso diagnóstico definitivo en la evaluación de una lesión que no había sido apreciada en la evaluación en el consultorio. Los criterios para indicar una microlaringoscopia directa diagnóstica son altas puntuaciones del índice GRABS; los defectos de cierre glótico sin lesión tipo masa y la asimetría de fase y amplitud entre las ondas mucosas de ambas cuerdas; la desproporción entre los hallazgos de la estroboscopia o la endoscopia con la intensidad percibida de la disfonía; la disfonía severa objetivada mediante análisis acústico y aerodinámico, y las puntuaciones altas en el índice de incapacidad vocal. Recomendamos la realización de una microlaringoscopia diagnóstica en los casos de disfonía de origen incierto

Sulcus vocalis, vergetures, mucosal bridges, and cysts as intracordal lesions constitute a group of great diagnostic difficulty. We present 6 patients in whom microlaryngoscopy was the final diagnostic step in the evaluation of a lesion not recognized in the initial evaluation. The criteria selected were as follows: Severe GRABS. Stroboscopic parameters: glottal chink without mass lesion, asymmetry of amplitude, and irregularity of vibration, or when discrepancy between examination and quality of the voice exists. Acoustic and aerodynamic measures that demonstrate severe dysphonia. High scores on the Voice Handicap Index. We recommend carrying out a diagnostic microlaryngoscopy examination where the cause of dysphonia is unclear

[Head and neck paragangliomas: revision of 89 cases in 73 patients]. / Paragangliomas de cabeza y cuello: revisión de 89 casos en 73 pacientes.

INTRODUCTION: Paragangliomas (PGL) are uncommon neuroectodermal tumours. PGL are usually clinically benign tumours, although metastasis has been reported and invasive growth can occur in adjacent tissues (<10 %). Mutations in SDHB, SDHC, and SDHD, which encode sub-units of mitochondrial complex II (succinate dehydrogenase), play an important role in the pathogenesis of these tumours. MATERIAL AND METHOD: Retrospective review of 73 patients with 89 paragangliomas who had undergone resection of the PGL in our hospital. There were 8 patients who displayed multiple PGL. PGL were distributed as follows: 33 were jugular, 17 tympanic, 26 carotid body tumours, and 13 vagal paragangliomas. All these patients had a follow-up time of at least a year. The surgical approach was evaluated in terms of tumour origin, sequelae, and subsequent evolution, as well as the relapses and their relation with location of the primary tumour. RESULTS: The treatment was surgical, using complementary radiosurgery in just 1 patient. The type A infratemporal fossa approach was used in jugular paragangliomas, the approach was cervical in the carotid and vagal ones and, in the tympanics, a transmeatal or transmastoid approach was performed. In the 73 patients making up our study group, there were 11 recurrences which appeared in jugular paragangliomas (two of them in multiple PGL cases). The post-operative sequelae were mainly cranial nerve paralysis (VII, IX, X, XI, and XII), along with cerebrospinal fluid fistulas in 14 of the jugular PGLs. CONCLUSIONS: With this article we try to reflect our experience in the treatment of this type of tumour. Surgical treatment achieves excellent control of the disease with an acceptable morbidity in young or middle-aged patients. In order to diminish the probabilities of facial nerve paralysis in jugular PGL we must avoid the facial nerve transposition in the infratemporal approach.

Paragangliomas de cabeza y cuello: revisión de 89 casos en 73 pacientes / Head and neck paragangliomas: revision of 89 cases in 73 patients

Introducción: Los paragangliomas son tumores poco frecuentes de origen neuroectodérmico. Se los considera tumores benignos, pero en algunas ocasiones tienen un comportamiento biológico similar a los tumores malignos (< 10 %). Las mutaciones germinales en los genes SDHB, SDHC y SDHD, que codifican las subunidades del mismo nombre en el complejo enzimático mitocondrial de la succinato deshidrogenasa, tienen un papel importante en la patogenia. Material y método: Se trata de un estudio retrospectivo en el que se revisa a 73 pacientes intervenidos en nuestro servicio con un total de 89 paragangliomas, ya que 8 pacientes presentaban paragangliomas múltiples. Los paragangliomas se distribuyeron de la siguiente forma: 33 yugulares, 17 timpánicos, 26 carotídeos y 13 vagales. Todos estos pacientes tuvieron un seguimiento mínimo de 1 año. Se evaluaron las vías de abordaje en función de la localización tumoral, las secuelas acaecidas y su ulterior evolución, así como las recurrencias y su relación con la localización del tumor primario. Resultados: El tratamiento fue quirúrgico, utilizando la radiocirugía como tratamiento complementario en un paciente. En los paragangliomas yugulares se realizó un abordaje infratemporal tipo A, en los carotídeos y vagales el abordaje fue cervical y en los timpánicos, transmeatal o transmastoideo. De los 73 pacientes con paragangliomas intervenidos que componen nuestra población en estudio, hubo 11 recurrencias, que aparecieron en los paragangliomas yugulares, que en 2 casos fueron paragangliomas múltiples. Las secuelas postoperatorias fueron sobre todo la parálisis de nervios craneales (VII, IX, X, XI y XII), junto con las fístulas de líquido cefalorraquídeo en el 14 % de los paragangliomas yugulares. Conclusiones: Con este artículo pretendemos reflejar nuestra experiencia en el tratamiento de este tipo de tumores. El tratamiento quirúrgico consigue un excelente control de la enfermedad con una morbilidad aceptable en pacientes de mediana edad o jóvenes. Para disminuir las probabilidades de parálisis facial en los paragangliomas yugulares, debe evitarse la transposición del facial en el abordaje infratemporal de la fosa yugular

Introduction: Paragangliomas (PGL) are uncommon neuroectodermal tumours. PGL are usually clinically benign tumours, although metastasis has been reported and invasive growth can occur in adjacent tissues (<10 %). Mutations in SDHB, SDHC, and SDHD, which encode sub-units of mitochondrial complex II (succinate dehydrogenase), play an important role in the pathogenesis of these tumours. Material and method: Retrospective review of 73 patients with 89 paragangliomas who had undergone resection of the PGL in our hospital. There were 8 patients who displayed multiple PGL. PGL were distributed as follows: 33 were jugular, 17 tympanic, 26 carotid body tumours, and 13 vagal paragangliomas. All these patients had a follow-up time of at least a year. The surgical approach was evaluated in terms of tumour origin, sequelae, and subsequent evolution, as well as the relapses and their relation with location of the primary tumour. Results: The treatment was surgical, using complementary radiosurgery in just 1 patient. The type A infratemporal fossa approach was used in jugular paragangliomas, the approach was cervical in the carotid and vagal ones and, in the tympanics, a transmeatal or transmastoid approach was performed. In the 73 patients making up our study group, there were 11 recurrences which appeared in jugular paragangliomas (two of them in multiple PGL cases). The post-operative sequelae were mainly cranial nerve paralysis (VII, IX, X, XI, and XII), along with cerebrospinal fluid fistulas in 14 of the jugular PGLs. Conclusions: With this article we try to reflect our experience in the treatment of this type of tumour. Surgical treatment achieves excellent control of the disease with an acceptable morbidity in young or middle-aged patients. In order to diminish the probabilities of facial nerve paralysis in jugular PGL we must avoid the facial nerve transposition in the infratemporal approach