David Virós Porcuna

Colgajo de pectoral mayor: evolución de su uso en la era de los colgajos microanastomosados

Introduccion La cirugia oncologica de cabeza y cuello ha ido avanzando a medida que se ha podido ofrecer una reconstruccion adaptada al acto quirurgico. En los ultimos 30 anos se han desarrollado 2 tecnicas fundamentales: el colgajo pediculado de pectoral mayor (CMPM) y los colgajos microanastomosados. El CMPM tuvo un papel preeminente en los anos ochenta, y con posterioridad su uso disminuyo de forma progresiva a favor de los colgajos microanastomosados. Material y metodo Se realizo una revision de 351 actos reconstructivos en 317 pacientes en los que se llevo a cabo 275 CMPM y 76 colgajos libres. Analizamos la edad, el sexo, el tipo de colgajo, la indicacion y el ano de la cirugia. Resultados De los colgajos revisados: el 34 % fueron de reconstruccion de hipofaringe; el 33 %, de orofaringe; el 21 %, de reparacion de partes blandas, y el 12 %, de reparacion de fistulas faringocutaneas. La incorporacion en el uso de colgajos libres a partir del ano 2001 ha supuesto en nuestro centro el incremento en el uso de procedimientos reconstructivos, asi como la sustitucion para una serie de indicaciones del CMPM por colgajos microanastomosados. Conclusiones En la era de los colgajos libres, creemos que el CMPM sigue manteniendo un lugar privilegiado para la reconstruccion de la hipofaringe y defectos de la region cervical. Sin embargo, actualmente, en determinadas localizaciones, como la cavidad oral y la orofaringe y en defectos de las partes blandas faciales, preferimos el uso de colgajos microanastomosados para la reconstruccion.

Pólipo coanal unilateral benigno: revisión de 51 pacientes

Introduccion El polipo coanal es una lesion benigna que nace en la mucosa sinusal y se desplaza hacia la fosa nasal en direccion a la coana. Es una enfermedad unilateral que afecta principalmente a pacientes jovenes. Su tratamiento es quirurgico, y se debe extirpar tanto la lesion endonasal como la endosinusal. Material y metodo Se realizo una revision de 51 pacientes afectados de polipo coanal tratados en nuestro centro. Su diagnostico se llevo a cabo mediante exploracion clinica, endoscopia nasal, tomografia computarizada nasosinusal y, eventualmente, un estudio histologico de la masa polipoide. Resultados La localizacion lesional endosinusal fue en 46 casos maxilar; en 5 casos, etmoidal, y un caso, esfenoidal. Un paciente presento 2 polipos coanales de forma simultanea, uno de tipo antrocoanal y otro etmoidocoanal. En la serie el sintoma principal de consulta fue la obstruccion nasal unilateral. Otros sintomas de presentacion fueron rinorrea, epistaxis y roncopatia. El 85 % (39/46) de los polipos antrocoanales emergian a la fosa nasal por un orificio accesorio de Giraldes, mientras que el 15 % (7/46), por el ostium natural del seno. La zona de implantacion en el seno maxilar se documento adecuadamente en 18 pacientes. El tratamiento quirurgico utilizado fue la cirugia endoscopica nasosinusal en 46 casos. Otras opciones empleadas fueron el abordaje tipo Caldwell-Luc y la via combinada antral y endonasal bajo control endoscopico, que se corresponden a los primeros casos tratados y, por tanto, a los mas antiguos. Se apreciaron dos recidivas que fueron tratadas con exito con cirugia endoscopica nasosinusal. Conclusiones El abordaje por cirugia endoscopica nasosinusal es una opcion segura y eficaz; constituye la maniobra de eleccion en su tratamiento.

Pectoralis Major Flaps. Evolution of Their Use in the Age of Microvascularized Flaps

Abstract Introduction Oncological head and neck surgery has progressed with the possibility of adapting reconstruction to the surgery effected. In the last 30 years, 2 basic techniques have been developed: the pectoralis major myocutaneous flaps (PMMF) and microvascularized flaps. PMMF had a leading role in reconstruction surgery during the 1980s, but this has subsequently diminished in favour of microvascularized flaps. Material and method A review was conducted on 351 reconstructive surgeries in 317 patients, of which 275 were PMMF and 76 free flaps. We analyzed age, gender, flap type, indication, and year of the surgery in all cases. Results 34% of the revised flaps were used for reconstruction of the hypopharynx, 33% for the oropharynx, 21% for soft tissues, and 12% for the repair of pharyngealcutaneous fistulae. At our hospital, the introduction of the free flap technique from 2001 on has led to an increase in the use of reconstructive procedures as well as the replacement of PMMF by microvascularized flaps in a number of indications. Conclusions In this age of microvascularized flaps, we believe that PMMF still has a privileged role in the repair of hypopharynx and cervical lesions. However, in such locations as the oral cavity or oropharynx and in facial soft tissue reconstruction we prefer the use of microvascularized flaps.

Tratamiento endoscópico combinado vs. abierto en el divertículo de Zenker

INTRODUCTION Zenkers diverticulum is a superior esophagus sphincter disease with a surgical management in symptomatic cases. This treatment has undergone important changes in recent years. MATERIAL AND METHOD A retrospective review was carried out of 16 patients treated in our department between 2001 and 2008. Conventional open surgery was used as well as a combined endoscopic approach with stapler and CO(2) laser. Type of treatment, diverticulum size, operating time, oral feeding time, surgical complications, hospital stay and occurrence of relapses were analyzed. RESULTS The endoscopic approach was used in 8 patients, with a conversion to conventional open surgery being necessary in 2 cases. Operating time was of 90 min for the open approach and 45 in the endoscopic. Oral feeding could be reintroduced 36 hours after open surgery and 24h after endoscopic treatment. The average discharge date was 3.8 days after the surgery in the open group and 2 days in the endoscopic group. Complications appeared in the 12.4% of the cases, all related to cervicotomy. There were 2 cases of relapse in the group treated with open surgery, one case was treated with the endoscopic approach and another with the open approach. CONCLUSIONS The combined endoscopic approach offers good results in patients with symptomatic Zenkers diverticulum who can be under general anesthesia during the surgery. A conversion to open surgery with cervicotomy should be done when a good endoscopic exposure is not possible.

Unilateral Benign Choanal Polyp: Review of 51 Patients

Introduction Choanal polyps are a benign pathology arising in the sinusal mucosa and entering the nasal fossa heading for the choana. It is a unilateral condition mainly affecting young people. It must be surgically removed, with exeresis of both the nasal and the sinusal lesions. Material and method Aretrospective review has been made of 51 patients treated for choanal polyp at our centre. They were diagnosed through physical examination, nasal endoscopy, nasosinusal CT, and histological examination of biopsy from the mass in selected cases. Results The choanal polyps originated in the maxillary sinus in 46 cases, in the ethmoidal sinus of 5 patients, and only 1 in the sphenoid sinus. Antrochoanal and ethmoidochoanal polyps were simultaneously found in 1 patient. Unilateral nasal obstruction was the main clinical presentation in our series. Nasal discharge, epistaxis, and snoring were other initial clinical findings. Eighty-five per cent (39/46) of antrochoanal polyps (ACP) emerged into the nasal fossa through Giraldess accessory orifice, and 15% (7/46) through the natural ostium of the sinus. The origin in the maxillary sinus was adequately documented in 18 cases. The endoscopic approach was used in 46 patients. Other options employed were the Caldwell-Luc approach and a combination of limited antrostomy and endoscopic nasal surgery; these were among the first cases seen and therefore the oldest. Two of them relapsed and were treated again with an endoscopic nasosinusal approach. Conclusions Endoscopic nasosinusal surgery is a safe and effective option and represents the approach of choice for the treatment of this pathology.

Miositis fulminante del compartimento muscular cervical posterior. A proposito de un caso

An atypical case of deep neck infection is presented with muscular involvement as the main feature. Streptococcus pyogenes was the causal agent and abrupt haemodynamic impairment and severe systemic failure characterized its clinical course, requiring emergency surgical examination and subsequent admission to the critical care unit. After the diagnosis of streptococcal myositis was obtained and the antibiotic treatment adjusted, the patient progressively recovered completely.

Reconstrucción de defectos orofaríngeos tras cirugía transoral robótica. Revisión y recomendaciones de la Comisión de Cirugía de Cabeza y Cuello de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello

Transoral surgery of the oropharynx has seen an important evolution in recent years, expanding the surgical options available (TORS, TOUSS, TOLS). The capacity to resect increasingly extensive lesions and the number of patients who benefit from them. This fact has led to an evolution in the reconstruction of surgical defects after transoral surgery. This article aims to review the possible reconstructive techniques, indications and factors to be taken into account prior to surgery, proposing a protocol to assess the need for transoral reconstruction based on the depth of the defect, the staging, and previous treatment.

Sudden myositis of the posterior cervical muscular compartment. Case report

Abstract An atypical case of deep neck infection is presented with muscular involvement as the main feature. Streptococcus pyogenes was the causal agent and abrupt haemodynamic impairment and severe systemic failure characterised its clinical course, requiring emergency surgical examination and subsequent admission to the critical care unit. After the diagnosis of Streptococcal Myositis was obtained and the antibiotic treatment adjusted, the patient progressively improved to complete recovery

Mucocele por herniación orbitaria postraumática

Sinusal mucoceles are expansive lesions related to ostium sinus obstruction and treatment is surgical. We present a case of frontal mucocele secondary to ostium drainage obstruction due to herniated orbital content. This entailed difficulties for intranasal surgical resolution so a combined approach was used. The different surgical options for treating such cases are discussed.

Mucocele by postraumatic orbitary herniation

Abstract Sinusal mucoceles are expansive lesions related to ostium sinus obstruction and treatment is surgical. We present a case of frontal mucocele secondary to ostium drainage obstruction due to herniated orbital content. This entailed difficulties for intranasal surgical resolution so a combined approach was used. The different surgical options for treating such cases are discussed.