Mónica Hernando

Complicaciones quirúrgicas de la cirugía submaxilar

INTRODUCTION AND OBJECTIVES Submandibular gland excision is the treatment of choice in chronic pathology resistant to medical treatments or in oncological cases. The aim of this study was to analyse its current postoperative complications. MATERIAL & METHODS Retrospective study on submandibular gland excisions performed at our University Hospital between 2004 and 2010. RESULTS A total of 29 submandibular gland excisions were performed: 44.8% (13) for chronic sialadenitis, 37.9% (11) for salivary gland neoplasm and 17.2% (5) for adjacent tumours. Median length of hospital stay was 2 days. Complications were more common after gland excision due to inflammatory causes. There were only 2 cases of paralysis of the marginal facial nerve branch (6.8%); 1 was due to neoplastic pathology and 1, from inflammatory pathology. CONCLUSION Despite marginal facial nerve paresis being one of the most relevant issues after submandibular gland excision, this type of surgery is a safe technique in our experience.

The role of partial parotidectomy for benign parotid tumors: A case-control study

Abstract Objective: To evaluate the results and complications after partial parotidectomy vs superficial parotidectomy, as primary treatment of benign parotid tumors. Study design: Case-control study. Setting: University hospital. Subjects and methods: A case-control study is presented on parotidectomy, comparing a group of 25 patients treated by partial parotidectomy vs a similar group of 25 patients treated by superficial parotidectomy. All patients had primary benign parotid tumors, were matched by sex and age, and had a minimum follow-up of 4 years. Independent variables included sex, age, medical history, intra-operative variables (surgical time, estimated blood loss, type of drainage, use of collagen), fine-needle aspiration cytology, computed tomography findings, and final histopathological diagnosis. Outcome measures were early and late complications, such as facial nerve paralysis, seroma, sialocele, Frey syndrome, and recurrence. Results: Partial parotidectomy resulted in less early and late complications than superficial parotidectomy, with similar recurrence rates. Temporal facial paresis was found in 4% of partial surgeries, vs 12% of superficial parotidectomies, a significant difference. Three months after surgery, only one patient has a persistent marginal nerve paresis. In contrast, sialocele was more common after partial parotidectomy (28% vs 16%), a significant difference. Conclusions: Partial parotidectomy achieves less early and late complications than superficial parotidectomy, with similar recurrence rates.

Cirugía endoscópica nasosinusal como cirugía mayor ambulatoria

Introduccion La cirugia endoscopica nasosinusal (CENS) es una tecnica quirurgica muy extendida que permite el tratamiento de multiples enfermedades del area nasosinusal. Por otro lado, aunque muchas intervenciones otorrinolaringologicas se realizan ambulatoriamente, la CENS todavia se aplica con al menos un dia de ingreso en la mayoria de los hospitales. Objetivos Evaluar nuestra experiencia en CENS como cirugia mayor ambulatoria, analizar las causas que causaron el ingreso inesperado e identificar algun factor de riesgo para no cumplir con el alta precoz. Material y metodo Se estudia a 145 pacientes intervenidos ambulatoriamente mediante CENS por rinosinusitis cronica, polipos antrocoanales y dacriocistorrinostomias desde agosto de 2004 a junio de 2007. Se analizaron las variables: sexo, edad, antecedentes personales (hipertension arterial, asma, sindrome de Widal), enfermedad intervenida, septoplastia asociada, extension de la cirugia y cirugia de revision. Resultados El indice de sustitucion fue del 13,1 %; las causas mas frecuentes fueron las hemorragias (31,6 %), de las que mas de la mitad solo precisaron observacion sin recambio de taponamiento, y mareo/debilidad tras cirugia (36,8 %). De todas las variables estudiadas, solo la cirugia de revision se asocio a un incremento en la tasa de reingreso ( odds ratio =3,5; intervalo de confianza del 95 %, 1,2-10,1). Conclusiones Nuestra experiencia en CENS como cirugia mayor ambulatoria muestra un indice de sustitucion del 13,1 %, si bien la mayoria de los casos correspondieron a pacientes con complicaciones leves. La cirugia de revision supuso en nuestra serie un factor que aumento la tasa de ingreso.

Wildervanck's syndrome with severe inner ear dysplasia and agenesis of the right internal carotid artery

We describe a case with Wildervanck syndrome (cervico-oculo-acoustic syndrome) comprising Klippel-Feil anomaly, retractio bulbi (Duane syndrome), and congenital sensorineural deafness. An 18-month male baby had a severe inner ear dysplasia, and MRI also showed a complex vascular carotid malformation associated.

Surgical management of salivary gland tumours

Abstract Introduction and objectives Salivary gland tumours account for 3% of head and neck tumours. The aim of this study is to analyze our series of tumours of the salivary glands requiring surgical treatment at our centre from 2004 to 2007. Material and methods This study is a retrospective review of 49 patients diagnosed as having tumours of the major and minor salivary glands or ectopic salivary tumours, and surgically treated at our hospital between 2004 and 2007. We reviewed their clinical characteristics, imaging findings, fine-needle cytology results, surgical charts (sub-maxillectomies, parotidectomies, palatal tumour excisions, and cervicotomies), final pathology findings, and course with at least 1 year follow-up. Results Forty-nine salivary tumours were treated, including 43 parotid tumours (87%), 3 submandibular tumours (6%), 1 palatal tumour (2%), and 2 ectopic tumours (4%). Sixteen percent of the tumours were malignant. Fine-needle cytology sensitivity was 40%, whereas specificity was 100%. Out of 43 parotidectomies, 40 (93%) were primary parotidectomies, and 3 were review parotidectomies. Most parotidectomies (81%) were superficial or partial and 8 (19%) were total. Parotidectomies complications are similar to those described previously in the literature: permanent facial palsy in superficial or partial parotidectomy (5%), wound dehiscence or necrosis (13%), post-operative bleeding (4%), fever or wound infection (7%), sialoceles (44%) and Freys syndrome (2%). Conclusions Parotid tumours are the most common salivary gland tumours. Most of them are benign, but Warthins tumour is more frequent than usual in our series. Early and late complications from parotidectomy are uncommon, although sialocele is a common transitory complication in our series.

S166 – Partial Parotidectomy for Benign Parotid Tumors

Objectives 1) To evaluate our results and complications after partial parotidectomy vs. superficial parotidectomy, as primary treatment of benign parotid tumors. 2) To present an evidence-based review on partial parotidectomy as the method of choice of treatment of benign parotid tumors. Methods A case-control study is presented on parotidec-tomy, comparing a group of 25 patients treated by partial parotidectomy vs. a similar group of 25 patients treated by superficial parotidectomy. All patients had primary benign parotid tumors, were matched by sex and age, and had a minimum follow-up of 12 months in a university hospital. Independent variables included sex, age, medical history, intraoperative variables (surgical time, estimated blood loss, type of drainage, use of collagen), fine-needle aspiration, CT findings, and final histopathological diagnosis. Outcome measures were early and late complications, such as facial nerve paralysis, seroma, sialocele, Frey syndrome, and recurrence. Comparison of both groups was done by Chi-squared and non-parametric analysis, after a .05 significance level, and multivariate regression analysis. Results Partial parotidectomy resulted in less early and late complications than superficial parotidectomy, with similar recurrence rates. Facial paresis was found in 24% of partial surgeries, vs. 36% of superficial ones (a significant difference); 3 months after surgery, only 1 patient has a persistent marginal nerve paresis. By contrast, only seroma was more common after partial parotidectomy (28% vs 16%). Conclusions Partial parotidectomy achieves less early and late complications than superficial parotidectomy, with similar recurrence rates.

Nasosinusal Endoscopic Surgery as Major Out-Patient Surgery

INTRODUCTION Functional endoscopic sinus surgery (FESS) is a useful and widespread technique that allows the treatment of a large number of nasal pathologies. Nevertheless, although many ENT operations are carried out on an out-patient basis, FESS procedures commonly require at least 1 day of hospital admission in many centres. OBJECTIVES To evaluate our experience in FESS as day-case, to study causes of unexpected overnight admission, and to identify any risk factors for failing to comply with early discharge. MATERIAL AND METHOD We studied 145 patients consecutively subjected to out-patient FESS procedures for chronic rhinosinusitis, antrochoanal polyps, and dacryocystorhinostomy from August 2004 to June 2007. We analyzed sex, age, medical history (arterial hypertension, asthma, Widal syndrome), pathology, associated septoplasty, extent of the surgery, and revision surgery. RESULTS The re-admission rate was 13.1% with the following as the most frequent causes: bleeding (31.6%), requiring only observation in over half the cases (ie, without changing the nasal packing), and dizziness/weakness (36.8%). Only revision surgery was associated with an increase in the re-admission rate (odds ratio, 3.5; 95% CI, 1.2-10.1). CONCLUSIONS Our experience in FESS for out-patient surgery shows a readmission rate of 13.1 %, although most cases were related to minor complications. The revision surgery was the only variable that could be associated with an increase in re-admission rate.

Eficacia del corticoide intratimpánico como tratamiento de rescate en sordera súbita neurosensorial idiopática

INTRODUCTION Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as an abrupt hearing loss of at least 30dB of unknown cause. The hearing response obtained after intratympanic steroid injection as a salvage treatment after a prior failure of initial systemic steroid treatment was analysed. MATERIAL AND METHOD An observational study was performed on 125 cases of ISSHL who were diagnosed from 2006 to 2014. Sixteen achieved complete recovery after one week according to Siegels criteria. The remaining 109 cases were analysed in two groups: one that received intratympanic corticosteroid salvage therapy (treatment group) and one that did not (control group). The recovery was analysed after 6 months and 2 years of follow-up. RESULTS The difference between each group at baseline were not statistically significant. After systemic treatment for 7 days, PTA in the control group was 53.13dB and 66.11dB in the treatment group (P<.01). After 6 months, the mean PTA improvement was 10.84dB in the treatment group, and 1.13dB in the control group, a significant difference (P<.0001). Only 10 cases achieved full hearing recovery after intratympanic corticosteroid salvage therapy, none of the patients did so in the control group. CONCLUSION Intratympanic corticosteroid rescue for ISSHL acheived hearing improvement for the cases with failure of initial systemic corticosteroid treatment. However, this treatment did not provide complete hearing recovery according to Siegels criteria in most cases.

Anterior Versus Posterior Approach to Otoplasty

Prominent ear (lop ear) occurs in 5 % of the white population. This malformation is inherited in an autosomal dominant pattern with variable penetrance. In most patients, two deformities usually coexist, determining the greatest separation of the auricles: an inadequate development of the antihelix fold and an overdevelopment of the concha. The authors discuss the techniques of anterior and posterior approach to otoplasty, the authors’ approach, and possible complications. The authors concluded that the retroauricular approach to create a new antihelix without cartilage section allows achieving good results with fewer complications.