Enrique Zapater
University of Valencia
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Featured researches published by Enrique Zapater.
Otolaryngology-Head and Neck Surgery | 2006
Jorge Basterra; Soledad Frías; José R. Alba; Ana Pérez; Enrique Zapater
OBJECTIVE: This study compared the acute tissue damage produced by a CO2 laser and microelectrodes in samples of vocal cords from patients undergoing laryngeal endoscopic surgery for stage T1 squamous cell carcinoma. STUDY DESIGN AND SETTING: Based on prior surgical experience with the CO2 laser and microelectrodes, the study protocol used hematoxylin-eosin staining of vocal cords treated with a CO2 laser (n = 20) or microelectrode (n = 20). RESULTS AND CONCLUSION: The acute tissue damage produced by the CO2 laser was similar to that induced by microelectrodes in cutting mode. The tissue damage resulting from the use of the microelectrode in coagulation mode was comparatively greater.
Acta Oto-laryngologica | 2007
Jorge Basterra; J.V. Bagán; J.R. Alba; S. Frías; Enrique Zapater
Conclusions. The postoperative course was excellent for this type of surgery, and the functional recovery was comparable to that obtained with much more laborious techniques. Objectives. To compare the advantages and disadvantages of the described technique and oropharyngectomy with labial mandibulotomy. Patients and methods. A total of 46 patients underwent surgery by means of an oropharyngectomy without mandibulotomy. The pharynx was reconstructed using a plasty made of four regional flaps. Results. In addition to obvious esthetic benefits, complications of the osteotomy were absent and surgical time was reduced. Some patients undergoing pull-through oropharyngectomy also underwent a marginal mandibulectomy, markedly reducing the frequency of radionecrosis compared with other statistics of techniques using mandibulotomy.
Laryngoscope | 2006
Jorge Basterra; Soledad Frías; José R. Alba; Enrique Zapater
INTRODUCTION For the last 3 years, we have been using microelectrodes (ME) for endoscopic electrosurgery to resect T1 tumors of the vocal cords. A first report presented early results of this surgical technique.1 Our experience has been extremely satisfactory and has been widened to include a greater number of cases and more advanced tumors. This article reports our experience using ME with a new angled handpiece to treat T1 and T2 laryngeal tumors. In this series, we discuss the new device developed to exclude the surgeon’s hand from the field of vision.
Head and Neck-journal for The Sciences and Specialties of The Head and Neck | 2009
Enrique Zapater; Soledad Frías; Ana Pérez; Jorge Basterra
This study compared the chronic damage to laryngeal soft tissues produced by microdissection electrodes and a CO2 laser after cordectomies.
American Journal of Otolaryngology | 2015
Jose V. Bagan; Felix Carbonell; Maria J. Gómez; Magdalena Sanchez; Atilio Navarro; Manuel Leopoldo; Leticia Bagan; Enrique Zapater
OBJECTIVES The objectives of this study are to describe the distinctive characteristics of extra-nodal B-cell non-Hodgkins lymphomas (BNHLs) located in the head and neck in a series of patients, to discuss patient survival, and to compare the oral versus the non-oral locations of the extra-nodal BNHLs of the head and neck. MATERIAL AND METHODS We studied 68 patients with BNHL of the head and neck. We analyzed the clinical and survival characteristics. Additionally, we performed Kaplan-Meier and Cox regression analyses to determine the influence of the different factors on survival. RESULTS This study included 68 non-nodal lymphomas; 30 lymphomas (31.9%) were located intraorally, with the gingiva as the most frequent location. The oral lymphomas in stages 1 and 2 showed a prevalence of 60% (18/30). The Kaplan-Meier analysis showed that the stage of disease and the oral versus non-oral extranodal lymphomas were significant prognostic factors (p<0.05). However, the multivariate Cox analysis indicated that only complete remission and oral versus non-oral location were significant prognostic factors (p<0.01). CONCLUSIONS The gingiva was the most common location of the intraoral lymphomas. Complete remission and non-oral location were the only significant survival factors in the multivariate Cox regression analysis.
Laryngoscope | 2014
Enrique Zapater; Ainhoa García‐Lliberós; Isabel López; Rosa Moreno; Jorge Basterra
INTRODUCTION One of the most widely accepted surgical technique for improving unilateral vocal cord palsy is the medialization thyropflasty. Adequate placement of the prosthesis is essential for optimal results. Some authors have developed mathematical models to estimate the position of the vocal cord, which can provide an idea of its location, but these models are unreliable due to inter-individual differences. That is the case for the Montgomery prosthesis (Boston Medical Products, Westborough, USA), one of the most widely used models. Its location is based on gender criteria, which can lead to a slightly displaced prosthesis, thus giving suboptimal results (Fig. 1). This article presents a surgical procedure and set of measurement devices designed to achieve accurate individualized placement of the Montgomery prosthesis. The initial results of a small series are presented.
Otolaryngology-Head and Neck Surgery | 2010
Jorge Basterra; José R. Alba; Mireya Bonet; Enrique Zapater
The surgical procedure was performed on 15 patients with laryngeal carcinoma who accepted operation after being provided thorough information. See carcinoma stages in Table 1. The study design was approved by the Institutional Review Board for Clinical Research of our institution. Surgery began with a conventional direct suspension laryngoscopy, with the same set of laryngoscopes used for carbon dioxide (CO2) laser surgery and hand instruments used for conventional laryngeal microsurgery. Tissue resection was performed with ultrafine tungsten MEs of a newer design (Sutter Instruments, Friburg, Germany). These MEs consist of 21-cm-long, angled, ultrasharp, tungsten needle electrodes (Fig 1). As shown, the MEs are angled at 90° (right-left), 135°, and 180° at their very distal ends. The proximal portion of the shaft is bent and inserted into a conventional electric scalpel (ES) hand piece (SW11200; Shining World Health Care Co., Taipei, Taiwan). This type of ES has a screwing pen point in the hand piece, which permits tightening of the ME into the hand piece; achieving a tight fit between the ME and the ES hand piece is essential for correct operation. The angled ME permits direct viewing of the surgical field. A polyvinylchloride anesthetic tube was used for the anesthetic procedure (Mallinckrodt, Athlone, Ireland). Tissue resection was performed in either the cutting or the coagulating mode, depending on the extent of bleeding. The electrosurgical generator was set to an output power of 5-20 W (depending on soft tissue or cartilage resection). Cordectomy types III, IV, and V were performed according to the general principles described elsewhere. The 90°-angled ME is helpful in the performance of up-down section of the vocal cord in the anterior commissure and in its insertion into the arytenoids. For an epiglottectomy, the laryngoscope was held against the tongue base. Traction was applied with a microforceps during simple sectioning of the epiglottis at the level of the vallecula. More extended supraglottic resections were performed according to the general principles described elsewhere. The use of 180°-angled or 135°-angled ME facilitates resection. Bleeding was treated by clamping the vessels with microforceps and electrocoagulation. Tissue samples from the surgical margins were submitted for intraoperative study. Neck dissections, when indicated, were performed in the same operation. Temporary tracheostomy was always carried out when a bilateral neck dissection was performed and in two patients with severe chronic obstructive pulmonary disease. See parameters in Table 1.
Laryngoscope | 2016
Enrique Zapater; Natsuki Oishi; Rosa Hernández; Jorge Basterra
INTRODUCTION Medialization thyroplasty is performed to improve the voice and swallowing ability in patients with unilateral laryngeal palsy. Some clinicians have used the procedure to improve the voice following cordectomy. In such cases, the extent of fibrosis of the surgical bed necessitates wide dissection of the paraglottic space to introduce the prosthesis. This surgical step is uncomfortable for the patient when it is performed under local anesthesia. Sedation is required, especially if a fibrolaryngoscope is used to monitor glottal changes. We have studied voice changes associated with sedation. In our experience, voice testing during surgical procedures performed under local anesthesia is not an accurate means by which to choose the size of the prosthesis, because both sedation and pressure exerted on the larynx by the metering device can influence phonation. Therefore, we prefer to use general anesthesia when monitoring glottal changes during surgical procedures. Herein we describe our surgical method of voice restoration after cordectomy in four patients. We performed medialization thyroplasty under intubation anesthesia. A set of metering devices that we previously designed and described was used to locate the cartilage window in a location suitable for filling the glottal defect. Direct examination was performed using direct (microsuspension) laryngoscopy. To our knowledge, this is the first report of glottal restoration via thyroplasty under general anesthesia with intubation to allow observation of the larynx through a surgical microscope. MATERIALS AND METHODS We performed surgery on four patients with glottal defects caused by prior cordectomy. Patient 1 (female) had undergone type III cordectomy; patient 2 (female) had undergone type IV cordectomy, patient 3 (male) had undergone type IV cordectomy, and patient 4 (male) had undergone type V cordectomy. All patients had severe dysphonia 1 year after treatment and selfassessed their voice quality as inadequate, even after speech therapy. A fibrolaryngoscopic examination revealed glottal defects with small anterior synechiae in patients 1 and 2, a deeper anterior defect with a small anterior synechia in patient 3, and a wide glottal defect with an extended synechia in patient 4. A single speech therapist, blinded to the planned surgical procedure, scored the patients using the Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale, maximum phonation time (MPT), Voice Handicap Index (VHI), and acoustic voice analysis (AVA) (Praat software version 5.3.39, Amsterdam the Netherlands) (Table I). All surgical procedures were performed by the same surgeon (E.Z.) with the patients under intubation anesthesia. The glottis was monitored using a microscope focused through a conventional laryngoscope. The location of the thyroid cartilage window was determined using our described method and set of measurement devices. After exposing the thyroid cartilage, the four points of the standard window recommended by Montgomery were marked via electrocautery. However, rather than constructing the entire cartilage window, we drilled a 5-mm-long, 2-mm-high line between these points, which afforded sufficient space for our measuring devices (Fig. 1). We used a new set of metering devices that were narrower and thinner than the originals (Fig. 2). After drilling the line, we positioned the laryngoscope to monitor the glottis. From this time until the end of the procedure, the surgeon performed the operation in a seated position. Our measurement devices were inserted through the cartilage hole. The point at which the device pushed the endolarynx could be seen on the monitor; the microscope was focused on the glottis and afforded an excellent magnified image. The surgeon could monitor changes in the glottis produced by the metering devices, which reproduced the angulated posterior shape of the prosthesis, but were narrower and thinner than the silicone meters provided by BMP (Westborough, MA) (Fig. 2). The angulated shape of the metering device is an advantage when compared with a straight device such as a needle. It protrudes posteriorly where the definitive prosthesis would protrude. Therefore, we can predict not only the vertical location of the prosthesis, but also the horizontal one. This enables us to customize the window location by drilling as required. From the ENT Department, University General Hospital, Valencia Medical School, Valencia, Spain. Editor’s Note: This Manuscript was accepted for publication July 29, 2015. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Natsuki Oishi, MD, University General Hospital, Avda. Tres Cruces, 46014 Valencia, Spain. E-mail: [email protected]
Clinical Otolaryngology | 2011
Jorge Basterra; Rosa Reboll; Enrique Zapater
We have operated 83 patients (73 men and 10 women; median age, 62.2 years) with T1 to T3 laryngeal carcinomas between January 2003 and January 2009. Standard diagnostic procedure for laryngeal tumours was followed. The surgical procedure began with conventional direct suspension laryngoscopy. The same set of laryngoscopes used for CO2 laser surgery was used for the microelectrodes technique. The remaining hand instruments were comprised of microforceps, microscissors and a suction tube, as used for conventional laryngeal microsurgery. Tissue resection was performed with ultrafine tungsten microelectrodes. The characteristics of the microelectrodes that we used initially were described elsewhere; we are currently using microelectrodes of a newer design and the same brand of electric scalpel handpiece (Sutter Medizintechnik GMBH, Freiburg, Germany), which allows to chase firmly the microelectrode on the handpiece. It is essential to grip the two pieces (Fig. 1); if not, the microelectrode shall turn round when pressure is executed upon the tissues. In the past, we have also used a different handpiece which also allowed to chase firmly the microelectrode. A polyvinylchloride tube was used for the anaesthetic procedure (Mallinckrodt, Ireland). The tube’s balloon was protected with a small piece of swab. Tissue resection was performed in the cutting mode of the electric scalpel handpiece and in coagulation mode when bleeding. The Valleylab Force 2 electrosurgical generator (Pfizer, Germany) was set at an output power of 5–20 W; the highest intensity level was used for the resection of cartilage, while the lowest power setting was used for the sectioning of soft tissues. The authors have initial experience with radiofrequency (Curis; Sutter Medizintechnik GMBH, Freiburg, Germany) instead of electrical generators (unpublished data). Cordectomies (Fig. 1): To perform types III, IV and V cordectomies, we used an anterior commissure laryngoscope and proceeded as follows: while clamping the false vocal cord with a microforceps, traction was applied towards the midline of the larynx; the false cord was then resected with a 180o-angled microelectrode. Once the false vocal cord was resected, resection of the vocal cord was performed with the same microelectrode by an anteroposterior deep section over the lateral limit of the vocal cord; this was followed by two up-down sections of the vocal cord, one in the anterior commissure and another one in its insertion into the arytenoid using a 90o-angled microelectrode. Supraglottic resections (Fig. 2): For supraglottic resections, the laryngoscopic procedures were similar to those used with a CO2 laser. The valve laryngoscope was held against the tongue base, allowing a full view of the vallecula. The resections were carried out as follows: 1 For partial epiglottectomy, traction of the epiglottis was applied with a microforceps towards the posterior wall of the pharynx to improve the view of the epiglottic lingual surface; partial sectioning of the epiglottis was then performed with a 90o-angled microelectrode. 2 For more extended supraglottic resections, the incision along the vallecula was made using a 180o-angled microelectrode. A deep section was then made to reach the posterior rim of the hyoid bone, and further sections were made caudally in the direction of the inferior edge of the pre-epiglottic space to capture its fat content within the epiglottal specimen. Sectioning was continued towards the foot of the epiglottis until the anterior angle of the C O R R E S P O N D E N C E : H O W W E D O I T
International Archives of Otorhinolaryngology | 2017
Natsuki Oishi; Jose V. Bagan; Karla Javier; Enrique Zapater
Introduction Because of the many HIV-related malignancies, the diagnosis and treatment of lymphoma in patients infected with human immunodeficiency virus are challenging. Objective Here, we review current knowledge of the pathogenesis, epidemiology, symptomatology, diagnosis, and treatment of head and neck lymphomas in HIV patients from a clinical perspective. Data Synthesis Although Hodgkins lymphoma is not an AIDS-defining neoplasm, its prevalence is ten times higher in HIV patients than in the general population. NHL is the second most common malignancy in HIV patients, after Kaposis sarcoma. In this group of patients, NHL is characterized by rapid progression, frequent extranodal involvement, and a poor outcome. HIV-related salivary gland disease is a benign condition that shares some features with lymphomas and is considered in their differential diagnosis. Conclusion The otolaryngologist may be the first clinician to diagnose head and neck lymphomas. The increasing survival of HIV patients implies clinical and epidemiological changes in the behavior of this disease. Early diagnosis is important to improve the prognosis and avoid the propagation of HIV infection.