José Luis Llorente-Pendás

Adaptación y validación del índice de incapacidad vocal (VHI-30) y su versión abreviada (VHI-10) al español

Introduccion y objetivos El indice de incapacidad vocal (Voice Handicap Index) es un instrumento valido para la valoracion del menoscabo asociado a la disfonia que percibe el paciente. El objetivo es valorar las propiedades psicometricas de la version castellana del VHI-30 y su version abreviada VHI-10. Sujetos y metodo El VHI-30 original se tradujo al idioma espanol y lo contestaron 232 pacientes con disfonia y 38 sujetos sanos. Se realizo una validacion prospectiva del instrumento. Resultados Se encuentra una alta fiabilidad test-retest y altas correlaciones item-total tanto para el VHI-30 como para el VHI-10. La coherencia interna demuestra valores alfa de Cronbach de 0,93 y 0,86 respectivamente, y se encontro una correlacion significativa entre las puntuaciones del VHI y la valoracion de los pacientes de la severidad de su disfonia. Conclusiones El presente estudio apoya el uso de las versiones en espanol del VHI-30 y del VHI-10 por su validez y fiabilidad.

Primary tumours of the parapharyngeal space. Our experience in 51 patients

INTRODUCTION AND OBJECTIVES Tumours of the parapharyngeal space are rare, representing only 0.5 % of head and neck oncology. The aim of this study is to present our experience with the diagnosis and therapies for these tumours. PATIENTS AND METHOD This study is a retrospective review of 51 patients diagnosed as having tumours of the parapharyngeal space and treated surgically between 1984 and 2006. Tumours originating in the deep lobe of parotid gland were excluded. RESULTS Seventy percent of the parapharyngeal space neoplasms were benign and thirty percent malignant. Pleomorphic adenoma was the most common neoplasm (37 %), followed by miscellaneous benign tumours (34 %), paraganglioma (21 %), and neurogenic tumours (8 %). Surgery was chosen in all case, with the transcervical approach used in 32 cases, the cervical-transparotid approach in 13 cases, the transmandibular approach in 4 cases (with mandibulectomy in 1 patient), the transoral approach in 1 case, and the infratemporal fossa approach in 1 case. The most common complications were those deriving from damage to nerve structures. CONCLUSIONS Most parapharyngeal space tumours can be removed surgically with a low rate of complications and recurrence. The transcervical approach is the most frequently used.

Infecciones periamigdalinas, estudio prospectivo de 100 casos consecutivos

INTRODUCTION Peritonsillar infection is the most frequent complication of acute tonsillitis. Peritonsillar infections are collections of purulent material, usually located between the tonsillar capsule and the superior constrictor of the pharynx. Peritonsillar infection can be divided into abscess and cellulitis. MATERIAL AND METHODS We prospectively analysed the clinical data from 100 patients with peritonsillar infection from 2008 to 2010. The diagnosis of abscess or peritonsillar cellulitis was primarily based on obtaining pus through fine-needle aspiration. RESULTS Seventy-seven per cent of patients had no history of recurrent tonsillitis and 55% were receiving antibiotic treatment. Sixty-two cases were peritonsillar abscess and the rest were cellulitis. Trismus, uvular deviation and anterior pillar bulging were statistically associated with peritonsillar abscess (P<.005). All patients were admitted to hospital and treated with puncture-drainage, intravenous antibiotics (amoxicillin/clavulanate in 83% of cases) and a single dose of steroids. All patients were discharged on oral antibiotic therapy. The mean length of hospital stay was 3 days and the recurrence rate was 5%. CONCLUSIONS Due to the absence of clinical practice guidelines, there are different therapeutic protocols. According to our experience, puncture-aspiration and administration of intravenous antibiotics is a safe, effective way to treat these patients. To determine the efficacy and safety of outpatient management, controlled studies would be needed.

Tumores primarios del espacio parafaríngeo. Nuestra experiencia en 51 pacientes

Resumen Introduccion y objetivos Los tumores originados en el espacio parafaringeo son poco frecuentes, y representan el 0,5 % de la enfermedad oncologica de cabeza y cuello. El objetivo de este estudio es presentar nuestra experiencia en el diagnostico y el tratamiento de estos tumores. Pacientes y metodo Realizamos un estudio retrospectivo de 51 pacientes, diagnosticados y tratados quirurgicamente de una tumoracion parafaringea, durante el periodo comprendido entre 1984 y 2006. Se excluyeron los tumores originados en el lobulo profundo de la parotida. Resultados El 70 % de las neoplasias del espacio parafaringeo fueron de naturaleza benigna y el 30 %, maligna. El adenoma pleomorfo fue el tumor mas frecuente (37 %), seguido por un grupo de tumores de origen miscelaneo (34 %), los paragangliomas (21 %) y los tumores de origen neurogenico (8 %). En todos los casos el tratamiento fue quirurgico. Se realizo un tratamiento transcervical en 32 pacientes, un tratamiento cervical-transparotideo en 13 pacientes, un tratamiento transmandibular en 4 pacientes (solo se preciso de mandibulectomia en un caso), un caso de tratamiento transoral y un caso de tratamiento infratemporal tipo A. Las complicaciones mas frecuentes fueron las derivadas de lesiones de estructuras nerviosas. Conclusiones La mayoria de los tumores localizados en el espacio parafaringeo son subsidiarios de tratarse de forma quirurgica, con una tasa baja de complicaciones y recurrencias. El mas utilizado es el tratamiento transcervical.

Cirugía transoral LASER CO2 en tumores avanzados de faringe y laringe

INTRODUCTION AND OBJECTIVES There are several types of treatment for advanced squamous cell carcinomas of the pharynx and larynx. However, both open surgery and chemoradiation protocols have failed to improve control and survival. There is a tendency toward conservative treatment without worsening oncological outcomes. The objective of this study was to describe the effectiveness of organ-preserving CO₂ laser microsurgery for treating advanced carcinomas of the larynx and pharynx. MATERIAL AND METHOD A retrospective review of 63 patients undergoing CO₂ laser microsurgery for the treatment of squamous cell carcinomas of the pharynx and larynx in advanced stages (stages III and IV) was performed. Tumour distribution was 14 patients with a tumour at the base of the tongue, 16 with a pyriform sinus tumour, 29 with a supraglottic tumour and 4 with a glottic tumour. Mean follow-up was 51 months. RESULTS Thirty-five percent of patients (23) had recurrences. The recurrence rate was 28% for base of tongue tumours, 50% for hypopharyngeal tumours, 27% for supraglottic tumours and 75% for glottic tumours. The 5-year disease-specific survival rate was 73.3% for all locations, with a range from 90% for supraglottic tumours up to 50% for glottic tumours. Thirty-four percent of patients had some type of complication after surgery. The most frequent complication was local bleeding (17%). CONCLUSION Transoral CO₂ laser microsurgery is an alternative for the treatment of carcinomas of the pharynx and larynx in advanced stages. Its oncological results are equivalent to other treatment modalities and its morbidity is lower.

Transoral laser microsurgery in advanced carcinomas of larynx and pharynx

Abstract Introduction and objectives There are several types of treatment for advanced squamous cell carcinomas of the pharynx and larynx. However, both open surgery and chemoradiation protocols have failed to improve control and survival. There is a tendency toward conservative treatment without worsening oncological outcomes. The objective of this study was to describe the effectiveness of organ-preserving CO2 laser microsurgery for treating advanced carcinomas of the larynx and pharynx. Material and method A retrospective review of 63 patients undergoing CO2 laser microsurgery for the treatment of squamous cell carcinomas of the pharynx and larynx in advanced stages (stages III and IV) was performed. Tumour distribution was 14 patients with a tumour at the base of the tongue, 16 with a pyriform sinus tumour, 29 with a supraglottic tumour and 4 with a glottic tumour. Mean follow-up was 51 months. Results Thirty-five percent of patients (23) had recurrences. The recurrence rate was 28% for base of tongue tumours, 50% for hypopharyngeal tumours, 27% for supraglottic tumours and 75% for glottic tumours. The 5-year disease-specific survival rate was 73.3% for all locations, with a range from 90% for supraglottic tumours up to 50% for glottic tumours. Thirty-four percent of patients had some type of complication after surgery. The most frequent complication was local bleeding (17%). Conclusion Transoral CO2 laser microsurgery is an alternative for the treatment of carcinomas of the pharynx and larynx in advanced stages. Its oncological results are equivalent to other treatment modalities and its morbidity is lower.

Baroreceptor failure after bilateral resection of carotid artery paragangliomas

Abstract Multiple head and neck paragangliomas are unusual pathologies. We report a case of a 24-year-old patient operated on at our centre for bilateral carotid artery paragangliomas who developed baroreceptor failure after their resection. Although this is an infrequent complication, it is important to be aware of it in order to ensure speedy diagnosis and treatment so as to avoid major post-surgical complications.

Fallo barorreceptor tras la resección bilateral de paragangliomas carotídeos

Multiple head and neck parangliomas are unusual pathologies. We report a case of a 24-year-old patient operated on at our centre for bilateral carotid artery parangliomas who developed baroreceptor failure after their resection. Albeit an infrequent complication, it is important to be aware of it in order to ensure is speedy diagnosis and treatment so as to avoid major post-surgical complications.

Solitary fibrous tumor of the petrous bone: A successful treatment option

Abstract The patient was a 48-year-old man complaining about right hemicranial pain and deafness of 1 years duration. MRI showed a solid well-vascularized mass destroying the mastoid and petrous bone, and with an epidural component that pulled the right cerebellar hemisphere. The patient underwent a right modified type A infratemporal approach, which allowed complete resection of the tumor, with a low morbidity. The pathological diagnosis was solitary fibrous tumor. The patient received complementary treatment with radiotherapy. At 24 months after the initial treatment the patient is free of disease. We conclude that solitary fibrous tumor of the petrous bone can be satisfactorily treated with surgical excision followed by radiotherapy, with low morbidity and excellent facial function. To our knowledge this is the first description of a solitary fibrous tumor of the petrous bone. Due to the lack of consensus in treating rare tumors, we want to offer this management approach for treating this kind of tumor.

Schwannoma laríngeo. Un tumor de laringe poco común

Schwannomas are benign tumours, rare among tumours of the larynx. They normally present as supraglottic masses (because they may arise from the internal branch of the superior laryngeal nerve), most commonly involving aryepiglottic folds or false vocal folds. Most patients present with a globus sensation, dysphagia or hoarseness. Conservative surgery is the treatment of choice. We report a case of a laryngeal asymptomatic neuroma that was diagnosed accidentally in an imaging test. Complete excision of the tumour was performed through a transoral CO₂ laser microsurgery without resorting to a tracheotomy. We discuss the clinical, pathologic and imaging findings and the management of this neoplasm. We also try to update the knowledge on the management of these tumours.