[Exchanging and maintaining the airway in hyoid surgery: using a flexible exchanger during new surgical treatments for obstructive sleep apnea syndrome]. / Modificación y mantenimiento de la vía aérea en la cirugía del hioides. Empleo de un intercambiador flexible en las nuevas técnicas quirúrgicas del síndrome de apnea obstructiva del sueño.

OBJECTIVE: To assess the level of intubation difficulty and anatomical changes after hyoid surgery. To evaluate the difficulty of switching from nasotracheal to orotracheal intubation after hyoid and palatopharyngeal surgery using an exchanger. MATERIAL AND METHODS: Prospective study enrolling 30 patients undergoing surgery for obstructive sleep apnea syndrome (OSAS) in 2 consecutive phases. Anatomical features suggesting risk of difficult intubation, anatomical changes caused by surgery, the incidence of failure to intubate upon first attempt during the first surgical session, and upon switching from nasal to oral intubation, and the time required to intubate were recorded. The rate of complications during and after surgery was also noted. RESULTS: The incidence of difficult intubation was 15% and no complications developed in the switch from nasotracheal to orotracheal intubation (100% success rate). CONCLUSION: New surgical treatments for the OSAS patient require new anesthetic maneuvers such as nasotracheal-orotracheal intubation exchange after hyoid surgery. The exchanger used in the present study offers a valid way to achieve airway management in this situation.

Modificación y mantenimiento de la vía aérea en la cirugía del hioides. Empleo de un intercambiador flexible en las nuevas técnicas quirúrgicas del síndrome de apnea obstructiva del sueño / Exchanging and maintaining the airway in hyoid surgery: using a flexible exchanger during new surgical treatments for obstructive sleep apnea syndrome

OBJETIVO: Establecer el grado de dificultad de intubación así como las alteraciones anatómicas tras la cirugía hioidea. Valorar la dificultad que plantea el cambio de intubación nasotraqueal a orotraqueal tras la cirugía hioidea y palatofaríngea empleando un intercambiador. MATERIALES Y MÉTODOS: Estudio prospectivo en el que se incluyeron 30 pacientes intervenidos de cirugía del Síndrome de Apnea Obstructiva del Sueño (SAOS) en dos tiempos quirúrgicos consecutivos. Se recogieron variables anatómicas predictivas de intubación difícil, los cambios anatómicos producidos por la cirugía, la incidencia de intubaciones fallidas en el primer tiempo quirúrgico y en el cambio de intubación nasal a oral, recogiéndose el tiempo empleado en dicho cambio. También se recogieron las complicaciones intra y postoperatorias. RESULTADOS: La incidencia de intubación difícil fue de un 15%, ninguno de los cambios de intubación nasotraqueal a orotraqueal presentó complicaciones, obteniéndose un 100% de intubaciones exitosas. CONCLUSIÓN: Las nuevas técnicas quirúrgicas en el paciente con SAOS, implican nuevas actuaciones anestésicas, como el cambio de intubación nasotraqueal a orotraqueal necesario tras la cirugía hioidea. El intercambiador empleado en el presente trabajo plantea una alternativa valida para el manejo de la vía aérea en esa situación

OBJECTIVE: To assess the level of intubation difficulty and anatomical changes after hyoid surgery. To evaluate the difficulty of switching from nasotracheal to orotracheal intubation after hyoid and palatopharyngeal surgery using an exchanger. MATERIAL AND METHODS: Prospective study enrolling 30 patients undergoing surgery for obstructive sleep apnea syndrome (OSAS) in 2 consecutive phases. Anatomical features suggesting risk of difficult intubation, anatomical changes caused by surgery, the incidence of failure to intubate upon first attempt during the first surgical session, and upon switching from nasal to oral intubation, and the time required to intubate were recorded. The rate of complications during and after surgery was also noted. RESULTS: The incidence of difficult intubation was 15% and no complications developed in the switch from nasotracheal to orotracheal intubation (100% success rate). CONCLUSION: New surgical treatments for the OSAS patient require new anesthetic maneuvers such as nasotracheal- orotracheal intubation exchange after hyoid surgery. The exchanger used in the present study offers a valid way to achieve airway management in this situation

[Histologic changes in soft palate in patients with obstructive sleep apnea]. / Cambios histológicos en el paladar blando en pacientes con apnea obstructiva del sueño.

In patients suffering from obstructive sleep apnea syndrome (OSAS) the reiterate injuries against the soft structures of the pharyngeal wall causes macro- and microscopic damages, which differ basically from the alterations verified in subjects without OSAS. We present a comparative histological study of 45 patients with OSAS operated on uvulopalatopharyngoplasties to face up 10 palates coming from normal post-mortem human among which a comparative anatomopathological study of 8 parameters was realized and the differences between the two groups signaled.

[Lateral cervical tumor of neural etiology: cervical schwannoma]. / Tumoración laterocervical de etiología nerviosa: schwannoma cervical.

Schwannoma are benign tumors of the nerve sheath arising from Schwann cells of cranial and spinal nerves. The most frequent sites are the peripheral nerves of the head and neck and the flexor surfaces of the upper extremities. Cervical schwannoma are rare, which makes them interesting to ENT-specialists. A new case of cervical schwannoma is reported, the literature is reviewed and the pathogenic, criteria and therapy are discussed.

[Management of chronic cough in high volume medical offices: efficacy of a sequential protocol]. / Manejo de la tos crónica en consultas de alta demanda: eficacia de un protocolo secuencial.

INTRODUCTION: Chronic cough is one of the main causes of medical consultation. There is not however an homogeneous attitude regarding its management. A prospective evaluation was performed of a simple therapeutic protocol based on the anatomical approach of the cough reflex. METHODS: A total of 110 patients with chronic cough for longer than four weeks were studied. The exclusion criteria were: non-smoking during the last year, not to have diseases compromising the immune system and not to have received inhibitors of the angiotensing converting enzyme. A three-visit stepwise approach was performed with specific diagnostic tests ordered and a specific therapy instituted according to the clinical suspicion. RESULTS: At the third visit, 97% of patients were free from cough or had improved markedly. Cough causes were identified in 105 cases (95%) and the most common were: asthma (33%), postnasal dripping (29%), gastroesophageal reflux (10%), and asthma with associated gastroesophageal reflux (16%). Patients with asthma had a longer duration of tos compared with those who had postnasal dripping (p < 0.05) as the only differential feature. CONCLUSIONS: The diagnostic-therapeutic diagram based on the anatomic reflex of cough is useful for the management of chronic cough in a highly demanded medical office. With this protocol, the cause of cough can be identified and treated successfully in almost every patient with a small number of diagnostic tests and medical visits.

Manejo de la tos crónica en consultas de alta demanda: eficacia de un protocolo secuencial / Management of chronic cough in highly demanded medical offices: efficacy of a sequential protocol

Introducción. La tos crónica es una de las principales causas de consulta médica; no existe, sin embargo, una actitud homogénea respecto a su manejo. Evaluamos de forma prospectiva un sencillo protocolo de tratamiento basado en la aproximación anatómica del reflejo de la tos. Métodos. Se estudiaron 110 pacientes que padecían tos crónica por más de cuatro semanas y los siguientes criterios de exclusión: no fumar en el último año, no padecer enfermedades que comprometen la inmunidad y no recibir inhibidores de la enzima de conversión de la angiotensina. Se realizó una aproximación 'paso a paso' consistente en tres visitas en las que se solicitaron pruebas diagnósticas y se instituyó un tratamiento específico de acuerdo con la sospecha clínica. Resultados. A la tercera visita el 97 por ciento de los pacientes estaba sin tos o había mejorado de forma notable. Las causas de la tos se identificaron en 105 casos (95 por ciento), siendo las más comunes: asma (33 por ciento), síndrome de goteo postnasal (29 por ciento), reflujo gastroesofágico (10 por ciento) y asma con reflujo gastroesofágico asociado (16 por ciento). Los pacientes con asma presentaron una mayor duración de la tos en comparación con los que presentaron goteo postnasal (p < 0,05) como única característica diferencial. Conclusiones. El diagrama diagnóstico-terapéutico basado en la anatomía del reflejo de la tos es útil para el manejo de la tos crónica en una consulta de alta demanda. Con este protocolo la causa de la tos puede ser identificada y tratada con éxito en casi todos los pacientes con un reducido número de pruebas diagnósticas y visitas médicas (AU)

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[Dilated vestibular aqueduct syndrome in children. Report of a case]. / Síndrome del acueducto vestibular dilatado en la infancia. A propósito de un caso.

Enlarged vestibular aqueduct syndrome is a clinical condition characterized for a progressive perceptive deafness linked to a broadening of vestibular aqueduct greater than 1.5 mm without other otic abnormal structures. We report the case of a 2-year-old child with such congenital malformation. We have reviewed the actual literature and point out its clinical and physiopathologic features as well treatment possibilities of these cases.

[Tonsillectomy in adults. Our experience]. / Amigdalectomía en adultos. Nuestra experiencia.

Tosillectomy or palatine tonsils removal was by far as the very middle of the twenty century the commonest surgery in childhood, but owing to the abstinence behavior in past decades this operation has dropped considerabily and in consequence numerous grown up presents frequently tonsillar pathology requiring its removal in middle adult life.

[ENT emergencies due to foreign bodies at a tertiary hospital]. / Urgencias Otorrinolaringológicas por cuerpos extraños en un hospital terciario.

A study of the patients who, through a year, came to the Emergencies Department showing foreign bodies in ENT-area has been accomplished. Among ENT urgencies foreign bodies constitute the most frequent cases. Age, sex, date, time of admission, sitting, kind of body and treatment are taken in consideration. The intruders were most commonly found in the pharyngeal area. A striking correspondence between age and location is underlined.

[Mucoepidermoid carcinoma of the larynx. A case report]. / Carcinoma mucoepidermoide de laringe. A propósito de un caso.

We report a case of laryngeal mucoepidermoid carcinoma that was diagnosed in the Hospital Miguel Servet of Zaragoza. The unusual tumor site and difficult diagnosis were notable and, above all the fatal outcome after local recurrence and metastasis in spite of good overall prognosis.

[Inflammatory pseudotumor of the paranasal sinuses]. / Pseudotumor inflamatorio de senos paranasales.

The inflammatory pseudotumor of the head and of the neck is a lesion of unknown etiology which affects the orbita more frequently but cases have also been described in the paranasal sinuses, larynx, mouth, cervical column and by direct extension from the orbita in the Central Nervous System. In the majority of cases, it behaves as a limited benignant inflammation within the osseous walls of the area where it is to be found; other times it destroys the osseous limits and invades the surrounding areas, behaving as a neoplasia. It must be distinguished from sinusitis, granulomatous inflammations, vasculitis, diseases of the collagen, sarcoidosis, neoplasias and benignant tumours. We present a case of inflammatory pseudotumour, occupying the right maxillary sinus, nasal fossa and rhinopharynx. Surgical extirpation has been the treatment used.

[Intracranial invasion of a tumor of the ear]. / Invasión intracraneal de un tumor ótico.

A 55 years old woman with a neoplasm originating in ceruminous glands of the external auditory canal, with temporal bone and intracranial invasion, mimicking a glomus jugulare tumor. This group of neoplasms, rare in man, are best treated by and aggressive wide "en bloc" temporal bone and contiguos structures resection. In our review few similar cases are found.

[Malignant tumor of the external auditory canal]. / Tumoración maligna de conducto auditivo externo.

The neoplasms from the modified apocrine glands of the external auditory canal are usually included under the term ceruminoma without any reference to their histology, clinical course or prognosis. It seems better to classify them according to their histologic pattern in the following types: 1.--Ceruminous adenoma, 2.--Adenoid-cystic carcinoma, 3.--Adenocarcinoma, and 4.--Pleomorphic adenoma (mixed tumour). We describe a case of adenoid-cystic carcinoma originated at postero-superior wall of the external auditory canal which presented as an otitis of long duration, and was treated surgically and received post-operative radiotherapy. The patient is at present free of disease. We review the literature on this group of tumours of the EAC.