Justo R. Gómez

Comparison of three prophylactic antibiotic regimens in clean-contaminated head and neck surgery

Although appropriate perioperative antibiotic prophylaxis has significantly reduced wound infection rates in clean‐contaminated head and neck surgical procedures, controversy still remains regarding the optimal antibiotic regimen.

Neck dissection with or without postoperative radiotherapy in supraglottic carcinomas.

A retrospective review of 302 previously untreated patients with primary supraglottic carcinoma was undertaken to ascertain the efficacy of postoperative radiotherapy. The 302 patients underwent a total of 383 functional neck dissections and 45 classic radical neck dissections. Pathological examination revealed nodal involvement in 117 patients (39%). In the histologically N0 group, the incidence of contralateral neck recurrence when a unilateral neck dissection and postoperative radiotherapy were carried out was 8%, rising 21% when no postoperative radiation was given. There was no difference in the ipsilateral recurrence rate in the N0 group, radiated patients (3%) and nonradiated patients (2%). Similar figures were found in the N1 group. Bilateral functional neck dissection in histologically N0, N1, and N2 necks had similar recurrence rates with or without radiotherapy. Distant metastasis appeared in 10% of N0 patients and in 35% of N3 patients. Patients who received postoperative radiotherapy showed a significantly higher rate of distant metastasis (21%) than patients who did not (8%). The number of involved lymph nodes had no relevance both in neck recurrence and distant metastasis.

Functional Significance of Peripheral Head-Shaking Nystagmus†

Objectives/Hypothesis: The objective was to determine the characteristics of horizontal head‐shaking nystagmus of peripheral origin and its relationship to vestibular dysfunction.

Morphometric analysis of the vestibular complex in the rat

The characteristics of the four major vestibular nuclei and accessory cell groups in the rat have been studied in serially cut horizontal sections. Camera lucida drawings of the vestibular nuclei and their neurons were made in these sections and subjected to a computerized image analysis. The dimensions (volume and length) and the number of cells of each vestibular nucleus were obtained, as well as morphometric parameters of their neurons (cross-sectional area, maximum and minimum diameter, and shape). These parameters were statistically analyzed by comparing the cell population from different nuclei and different parts of each nucleus. Of the major nuclei, the medial, which is the largest, has the greatest number of cells, its neurons being the smallest of all the nuclei, with the size of cells decreasing in a rostrocaudal direction. In contrast, the lateral nucleus contains the fewest cells but also the largest ones. Neurons of the superior and descending nuclei are of an intermediate size and number, with a rostrocaudal decrease in the size of the descending nucleus cells. In addition, minor nuclei are identified and described in their relationship to the other structures in the brain stem. The relevant aspects of the anatomical information in regard to functional roles are reviewed.

Malignant fibrous histiocytoma of the nasal cavity and paranasal sinuses.

Malignant fibrous histiocytomas are uncommon in the head and neck, the sinonasal tract being the most common location. This report describes 5 cases in this area: two in the nasal cavity, two in the maxillary sinus, and one in the frontal sinus. Four were primary cases and one was secondary to previous irradiation. All patients received surgical treatment, one of them with postoperative irradiation. All five patients experienced local recurrences and three also experienced distant metastases. Only one of these recurrences was successfully salvaged and the patient is alive and free of disease 3 years after resection. A summary of knowledge about the entity is reviewed.

Complications and sequelae in acoustic neuroma surgery

OBJECTIVE To evaluate the complications and sequelae of acoustic neuroma surgery, according to tumour size. PATIENTS AND METHOD A retrospective analysis of 120 patients who underwent microsurgical resection of vestibular schwannomas between November 1994 and September 2006 was undertaken. Tumour size, extent of removal, preservation of facial and cochlear nerves, complications, and sequelae were considered. The degree of hearing preservation after surgery was determined by the Gardner-Robertson classification. RESULTS There were 39 small (<1.5 cm), 59 medium (1.5-3 cm), and 22 large tumours (>3 cm). Gross total resection was accomplished in 106 cases (88.3 %). The facial nerve was anatomically and functionally preserved in 103 cases on long-term follow-up (85.4 %). The cochlear nerve was functionally preserved (Gardner-Robertson class 1 and 2) in 54.4 % of the small tumours with useful preoperative hearing. Two patients died due to postoperative complications (mortality rate, 1.6 %), and 15 (12.5 %) developed a CSF leak. CONCLUSIONS Despite the progress in the surgical treatment of acoustic neuromas, a considerable rate of complications and sequelae still remains. Therefore, there is a need to balance pros and cons of surgery in each patient according to the concurrent circumstances, as well as to consider other therapeutic strategies such as radiosurgery or a wait-and-see policy.

Parálisis facial completa tras cirugía de neurinoma del acústico: evolución y complicaciones oftalmológicas asociadas

Objetivo Averiguar la fraccion de pacientes intervenidos de un neurinoma del acustico que recuperan la funcion normal del nervio facial tras una paralisis facial completa postoperatoria, atendiendo a las complicaciones oftalmologicas asociadas a la falta de recuperacion y sus opciones terapeuticas. Material y metodo Se realiza un estudio retrospectivo de 30 pacientes intervenidos de neurinomas del acustico en nuestro servicio que, con preservacion anatomica del nervio facial, presentaron una paralisis facial completa (grado VI de House-Brackmann [HB]) postoperatoria. Se analiza la evolucion de la paralisis en funcion del tamano tumoral, la edad del paciente, el abordaje quirurgico y la localizacion del neurinoma. Tambien se estudian las complicaciones oftalmologicas surgidas y su tratamiento. Resultados De los 30 pacientes estudiados, solo 5 (16,6%) recuperaron la funcion normal facial (grado I de HB). Se observo una tendencia a una peor recuperacion en los casos con tamano tumoral mayor de 2 cm, de sexo masculino, edad mayor de 65 anos y abordados por via translaberintica. Solo un paciente presento complicaciones oftalmologicas graves. Conclusiones Nuestro analisis revela que un escaso porcentaje de pacientes recupera de forma completa su funcion facial, y que es necesario estar alerta ante posibles complicaciones oculares en este espectro de pacientes.

[Complete facial palsy following surgery for acoustic nerve neurinoma: evolution and associated ophthalmological complications].

OBJECTIVE To evaluate the fraction of patients recovering to normal function after complete facial nerve paralysis secondary to acoustic neuroma surgery, and also to address the ophthalmologic complications associated with it and the therapeutic options. MATERIAL AND METHOD We performed a retrospective review of 30 cases operated on in our department for acoustic neuroma and who, despite anatomical preservation of the facial nerve, developed a complete post-operative facial nerve paralysis (grade VI of House-Brackmann [HB]). We analyzed the evolution of the facial paralysis in relation to the tumour size, patient age, surgical approach and localization of the tumour. In addition, we studied the ophthalmologic complications and their treatment. RESULTS Only 5 of the 30 cases studied (16.6 %) recovered to normal facial nerve function (HB grade I). We observed a tendency for a poor recovery of the cases with tumour size bigger than 2 cm, males, those older than 65 years and lesions resected by the translabyrinthine approach. Only 1 patient presented serious ophthalmologic complications. CONCLUSIONS Our study reveals that only a small percentage of patients achieve total recovery of facial function. We have to be on the alert to ocular complications in this kind of patient.

Complicaciones cutáneas en los implantes oseointegrados: comparación entre la técnica clásica y la de preservación de tejido

INTRODUCTION AND OBJECTIVES The standard surgical technique for osseointegrated hearing aids involves removing a large area of subcutaneous tissue down to the periosteum. Recently, the industry has designed a new range of abutment lengths for less invasive surgery with soft tissue preservation. This study compared and evaluated the complications in the standard and the tissue preservation techniques. MATERIAL AND METHODS This was a prospective study including 29 adult patients that underwent single-stage osseointegrated hearing aids insertion between February 2009 and February 2013. We performed the standard technique in 14 patients, and the tissue preservation technique in 15. Soft tissue complications were graded according to the Holgers classification. RESULTS No patient required removal of implant or revision surgery. Although the Holgers grade was always worse in the standard technique (reaction score of 3 or higher was 28% versus 7% at a month), the complication rate was not statistically significant between the 2 groups at any postoperative time a week (p=0.233), a month (p=0.470) and a year (p=0.401). CONCLUSION In our experience the tissue preservation technique, without soft tissue reduction, is the procedure of choice for bone anchored implant surgery. The preservation technique is easier, faster and possible with local anaesthesia and has similar postoperative outcomes.

Tratamiento con toxina botulínica del síndrome del primer mordisco

First bite syndrome is a potential complication of surgery involving the infratemporal fossa, deep lobe of the parotid gland and parapharyngeal space. It is described as an acute and intense pain in the parotid region caused with the first bite of each meal. It is related to damage to sympathetic innervation of the parotid gland. Parasympathetic hyperactivation is believed to stimulate an exaggerated myoepithelial cell contraction causing pain. Usual analgesic treatments have poor results. Botulinum toxin type A causes parasympathetic nerve paralysis of the parotid gland and this fact would minimize salivation and decrease first bite syndrome. The aim of this study is to show the details of the technique and our outcomes in 5 patients treated with botulinum toxin type A.