Jorge Basterra

Cis-Diaminedichloro Platinum Ototoxicity: An Experimental Study

Four groups of guinea pigs received different doses of cis-platinum. SEM and TEM showed a direct relation between the dose and the damage. The first row of OHC is the first one to be damaged. The IHC are more resistant than the OHC. The pattern of destruction is similar to the one produced by the aminoglucoside antibiotics.

Effect of total nasal obstruction on nocturnal oxygen saturation.

Background Nasal obstruction is considered a risk factor for sleep-disordered breathing (SDB), although the relationship has not been established clearly. This study explores the repercussion of total nasal packing on arterial oxygen saturation during the nocturnal resting hours and its implication in SDB. Methods Forty patients were subjected to total nasal packing after nasal surgery or epistaxis. In all cases the oxygen desaturation index (ODI) was monitored with and without nasal packs, and the results were compared. Results Thirty-seven patients (92.5%) showed poorer oxygen saturation after nasal occlusion. Of these, 19 patients (47.5%) reached pathological desaturation (ODI ≥ 12). Desaturation was greater among obese subjects. Conclusion Total nasal packing causes significant nocturnal oxygen desaturation. This must be taken into account in the postoperative nasal packing of patients with respiratory failure, obesity, or SDB.

Concha bullosa mucocele with invasion of the orbit.

We describe the case of a patient with a large concha bullosa mucocele invading the orbit. The wall of the mucocele was lined by a well-preserved ciliary epithelium with a ciliary density similar to that of the healthy sinus mucosa. Ciliary ultrastructure was normal. Endonasal microsurgery yielded good results, and no recurrence has been observed after 18 months. The thickness of the middle turbinate is variable and often exhibits vacuolar structures. When pneumatized, this gives origin to a so-called concha bullosa.1 This lesion was first described by Zuckerlandl in 1893.2 For a number of years concha bullosa has been related to the pathogenesis of inflammatory disorders of the paranasal sinuses. Few cases have been reported dealing with concha bullosa as a cause of disease. In the past, a case of aspergilloma was reported within a concha bullosa3; however, a triple-index bibliographic search of the past 3 years yielded only a single case of a concha bullosa mucopyocele.4 This study reports a patient with a giant mucocele within a concha bullosa that destroyed the anterior ethmoid bone and invaded the orbit. CASE REPORT

Comparative study of acute tissue damage induced by the CO2 laser versus microelectrodes in cordectomies

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.

Oropharyngectomy without mandibulotomy in advanced stage (T3–T4) oropharyngeal cancer

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.

A New Device for Treating Laryngeal Carcinoma Using Microdissection Electrodes

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.

Comparative study on chronic tissue damage after cordectomies using either CO2 laser or microdissection electrodes

This study compared the chronic damage to laryngeal soft tissues produced by microdissection electrodes and a CO2 laser after cordectomies.

[Transphenoidal endoscopic approaches for pituitary adenomas: a critical review of our experience].

Abstract Background The surgical approach to the pituitary fossae has evolved from transcranial to sublabial and transseptal microscopic ones, up to the current transsphenoidal endoscopic approach. Objectives To present our experience in the transnasal transsphenoidal approach for pituitary adenomas and the modifications introduced to improve tumoral resection and to lower iatrogenia. Material and methods Over nine years, we operated on 37 patients with pituitary adenomas using the transsphenoidal endoscopic approach. We utilised optical lens of 0° (approach) and 30° (adenoma resection), optic navigator, surgical instruments for nasal endoscopic and pituitary surgery. During the neurosurgical step, the endoscope was fixed by an articulated arm. We acceded to the pituitary fossae by a bilateral sphenoidotomy. Results Sphenoid pneumatisation was sufficient in all the patients. The more common postoperative complications were diabetes insipidus and endocrinology deficiencies. Postoperative rhinoliquorrhea affected only one patient. No alterations of nasal fossae were observed. Mean patient hospitalisation was five days. Conclusions Transsphenoidal endoscopic approach guided by navigator gives significant advantages: Shorter operating time and fewer complications, greater safety and preservation of the nasal passages. Resecting the sphenoidal rostrum and a fragment of adjacent nasal septum improves surgical instrument management into the pituitary fossae and therefore adenoma resection. Endoscope fixation stabilises the vision and allows the second surgeon to help more effectively.

A new device to improve the location of a montgomery thyroplasty prosthesis

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.

Endoscopic resection of supraglottic (T1-T2-T3) and glottic (T2-T3) carcinomas using microdissection electrodes.

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.