Francisco Esteban Ortega

Granulomatosis de Wegener causante de parálisis facial y cofosis bilaterales

Bilateral facial paralysis (BFP) is an uncommon condition that typically occurs as a manifestation of systemic disease. We present a female patient with Wegeners granulomatosis (WG), particularly upper respiratory and ear impairment who develops hypoacusis and BFP, resistant to immunosuppressive therapy and steroid boluses. Her imaging tests showed no involvement of the facial nerve as it passed through the ear structures. The patient finally improved the BFP; however, deafness is permanent and she has entered into a cochlear implant program. Published papers on BFP are rare and they make no reference to WG as a possible aetiology.

Tratamiento quirúrgico de los carcinomas escamosos de cabeza y cuello en España durante el periodo 2006-2011

INTRODUCTION AND OBJECTIVES Surgery is one of the basic pillars in the treatment of patients with head and neck squamous cell carcinoma (HNSCC). The objective of the present study was to analyse the current state of the use of surgery in patients with HNSCC in Spain. METHODS Retrospective review of the hospital discharge reports of the patients with HNSCC treated surgically during the 2006-2011 period in Spain. We obtained the data from the Minimum Basic Data Set during the hospital discharge. RESULTS We obtained information on 26,629 hospital discharges, with a total of 27,937 surgical procedures. Overall, in our country about half of the patients with HNSCC receive surgical treatment of the primary tumour location. There were no significant changes in the number of surgical procedures throughout the study period. There was a smooth downward trend in the number and percentage of surgeries carried out in male patients, and a significant increase in those carried out in female patients throughout the study period. Among the total of surgical procedures, 15.7% were carried out in hospitals with a low level of complexity, 32.2% in hospitals with an intermediate complexity and 52.1% in centres of high complexity. CONCLUSIONS Surgery is one essential pillar in the treatment of patients with HNSCC. In Spain about half of the patients with HNSCC receive surgical treatment for the primary location of the tumour.

Síndrome de Ramsay-Hunt causante de parálisis laríngea

The Ramsay-Hunt syndrome is the association of facial palsy and varicella-zoster virus infection with involvement of the ear canal and eardrum. It may be associated with deafness, tinnitus and dizziness. It can sometimes affect the lower cranial nerves. A case of an immunocompetent patient with affectation of the VII, VIII and X cranial nerves is presented.

Open-field treatment of hyperacusis

Abstract Objective Prospective study of the effectiveness of treatment in patients with hyperacusis by means of an open-field technique of acoustic treatment with nature sounds. Material and methods Thirty-four patients were referred to a tinnitus and hyperacusis clinic at a private Otorhinolaryngology Unit. Clinical and exploratory ENT studies were performed. Open-field nature sounds were applied by means of a compact disk for half an hour each day during a period of several weeks. Results By the end of treatment, the 34 patients studied had reached normal discomfort thresholds in a maximum of 9 weeks. Conclusions The progressive open-field application of nature sounds has been effective in eliminating hyperacusis in a short space of time.

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 patients 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.

Fístula traquecolónica en un paciente tratado con una coloplastia

Acute oesophageal entities, such as oesophageal rupture or perforation, or anastomotic dehiscence may be seriously life-threatening for patients. They may force the surgeon to carry out, initially, the disconnection of the upper digestive tract and subsequently reconstruct the transit. This is a technically complex process with considerable morbidity. Tracheo-oesophageal fistulae (TOF) are a serious problem not only for patients, who may be in a life-threatening situation, but also for surgeons, as therapeutic resolution is complex, and the percentage of cases in which the fistula recurs is high. Surgical techniques for repairing TOF vary, and the surgical attitude adopted in this case and reported in this paper is exceptional.

Miotomía del cricofaríngeo en el tratamiento de la distrofia muscular oculofaríngea

Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant myopathic disease which provokes oropharyngeal dysphagia, palpabral ptosis and proximal limb weakness. It is the abnormal expression of the GCG triplet in the PABPN1 gene on chromosome 14 that causes this disease. The study of the oropharyngeal dysphagia that these patients suffer from should include upper gastrointestinal endoscopy, barium video-radiology and oesophageal manometry. Genetic study confirms the diagnosis. We report 6 patients (3 of whom were siblings) referred to our department with a confirmed diagnosis of OPMD, who underwent cricopharyngeal myotomy to achieve normal swallowing.

Tratamiento de la hiperacusia en campo abierto

Objetivo: Estudio prospectivo de la eficacia del tratamiento de pacientes con hiperacusia mediante tecnica de tratamiento acustico con sonidos de la naturaleza en campo abierto. Material y metodos: Acudieron 34 pacientes a consulta de acufenos e hiperacusia de una unidad de otorrinolaringologia de una clinica privada. Se realizo estudio otorrinolaringologico clinico y exploratorio. Se aplican sonidos de la naturaleza mediante un disco compacto en campo abierto, media hora al dia y durante varias semanas de duracion. Resultados: Al finalizar el tratamiento, los 34 pacientes estudiados consiguieron unos umbrales de malestar normales en un plazo maximo de 9 semanas. Conclusiones: La aplicacion progresiva de sonidos de la naturaleza en campo abierto ha sido efectiva a corto plazo para eliminar la hiperacusia.

Tratamiento de dos casos de enfermedad de Forestier-Rotes Querol

A 63-year-old male was referred to our department from Primary Care with odinophagia of several years’ evolution, with episodes of fluctuating dysphonia and dyspnoea. He has a history as a smoker and moderate drinker, COPD, hiatus hernia with gastroesophageal reflux and ankylosing spondulitis. Physical exploration showed no changes to the larynx, with protrusion of the posterior wall of the hypopharynx. Nasofibroscopy revealed no suspicious lesions or signs which could attribute the odinophagia to other diseases or concomitant conditions. A cervical CT found degenerative lesions with prominent osteophytes on the anterior face of vertebral bodies C3 and C4, and of less intensity on C2 and C5, which were distorting and compressing the hypopharynx (Figs. 1--3). The lack of involvement of the intervertebral discs and the absence of ankylosis were key to a diagnosis of Forestier’s disease. As the airway was not compromised, the condition was managed using hygiene

Disnea laringea en recién nacido por quiste branquial

We present the case of a newborn girl, after controlled gestation and vaginal delivery, from a single pregnancy, without conditions or treatments of interest during pregnancy, who was admitted to the neonatal ICU within hours of birth due to respiratory distress with a laryngeal origin. A cervical computed tomography (CT) scan with contrast showed a well-defined, cystic lesion with liquid density of 17 × 14 × 11 mm, which presented no contrast enhancement. The lesion was closely linked to the larynx, which it displaced towards the right (Fig. 1). The following morning, laryngeal microsurgery revealed a lesion with cystic appearance and lined by a thickened mucosa in the pharyngeal wall of the left pyriform sinus, which ascended through the pharyngoepiglottic fold up to the lingual side of the epiglottis and narrowed the airway. The lesion was sectioned and its mucous content was removed. The histological result was a branchial cleft remnant. The evolution was favourable, and the patient was discharged after 1 week. The patient developed normally in subsequent months. Cysts and fistulas are the result of a lack of closure or resolution thereof. Those originating from the second branchial arch are more frequent, as its embryological persistence is longer. At present, complete excision is recommended. The use of imaging and cytology techniques for a diagnostic