Revista ORL

Surgical treatment of obstructive sleep apnea: palate surgery

Mon, 02 Oct 2023 00:00:00 +0200

Introduction: Upper airway (UA) surgery is a therapeutic option for patients with sleepdisordered breathing (SDB), which is based on modifying the anatomy of the UA to improve airflow and reduce apneas and hypopneas.

Objective: To review the latest pharyngoplasty procedures published in the literature, which are characterized by being functional techniques without tissue resection.

Synthesis: The advances that have marked a change in UA surgery in the last two decades are described, such as the use of drug-induced sleep endoscopy (DISE) to assess the anatomy of the UA of the sleeping patient, and the interest of otolaryngologists in acquiring training in sleep medicine. The main pharyngoplasty techniques are presented, such as lateral pharyngeal expansion (LPE), soft palate suspension (SPS), hyoid muscle suspension (HMS) and genioglossus muscle suspension (GMS).

Conclusions: UA surgery has evolved towards less invasive and more personalized procedures, which adapt to the anatomical and functional characteristics of each patient. Pharyngoplasty is an effective and safe technique to improve the quality of life and sleep of patients with SDB.

Surgical treatment of Obstructive sleep apnea:

Mon, 02 Oct 2023 00:00:00 +0200

Introduction: The diagnosis and surgical management of the obstruction of the base of the tongue in OSA continues to be a challenge for most sleep surgeons. In recent years, there has been a significant improvement in knowledge and a decrease in morbidity. Synthesis: Surgical techniques aimed at treating tongue base collapse can be divided into techniques that modify the anatomy and techniques that stimulate the upper airway. Conclusions: Technological developments and the evolution of the different surgical techniques have been constant in the last decade and will probably change even more in the coming years. Upper airway stimulation surgery has opened the frontiers in the treatment of OSA.

Surgical Treatment of Obstructive Sleep Apnea:

Tue, 09 May 2023 00:00:00 +0200

Introduction and objective: Among the possible causes of OSA, although rare, are alterations of the epiglottis. The objective of this work is to highlight its importance and insist on its active diagnosis, since in well-selected cases it can be treated surgically.Synthesis: The importance of the epiglottis as a cause of OSA, its exploration and possible surgical alternatives are detailed.Conclusions: The epiglottis is an anatomical structure that generally goes unnoticed as a cause of OSA in adults and that can cause even severe OSA.It must be studied in an active way. Its involvement in OSA is likely not to be revealed during awake examination and DISE may be required to appreciate how it collapses during inspiration in the sleeping patient.Some surgical techniques are described as it is a good choice in many properly selected patients.

Myelitis and anti-Yo antibodies: a paraneoplastic syndrome associated with nasopharyngeal carcinoma detected by positron emission tomography. A case report

Fri, 04 Oct 2024 00:00:00 +0200

Introduction and objective: Paraneoplastic syndromes (PS) associated with nasopharyngeal carcinoma (NC) are very rare. We described a patient who presented with a paraneoplastic mielitis associated with anti-Yo antibodies and NC. Description: A 70 year-old previously healthy man presented with a progressive gait disorder. The diagnosis work up demonstrated both the presence of anti-Yo antibodies together with a NC, suspected by positron emission tomography (PET-CT). Despite prompt treatment with steroids, gammaglobulins and a satisfactory tumour therapy, partial neurological symptomathology persisted. Conclusions: Although rare, clinicians should consider the possibility of paraneoplastic aetiology when attending patients with NC presenting with subacute neurological symptoms.

Squamous cell carcinoma of the nasal septum secondary to cocaine use. A case report

Mon, 20 Jan 2025 00:00:00 +0100

Introduction: Carcinomas of the nasal septum are very rare. A clinical case is presented of a patient who developed a carcinoma of the nasal septum related to cocaine consumption. Description: A 47-year-old woman, addicted to intranasal cocaine use, with no other relevant history or exposure to other toxic substances, consulted for bloody rhinorrhoea and nasal pain that had been going on for several months. Nasal endoscopy revealed a partially ulcerated tumour, 2 cm in diameter, in the anterosuperior area of the nasal septum, with associated perforation. A biopsy was performed with the result of poorly differentiated squamous cell carcinoma. Surgical treatment was proposed, but the patient refused. She underwent chemoradiotherapy treatment, presenting a poor response to it. He rejected other types of treatments, dying 14 months after diagnosis, because of the local progression of the disease. Discussion/conclusions: Patients addicted to intranasal cocaine use frequently present lesions of the nasal mucosa, especially in the septum area. It is not uncommon for these injuries to progress and eventually lead to perforation. It is important to consider performing a histopathological study of the edges of a perforation in patients without a clear history such as previous surgery, since it is important to consider the possibility of malignancy in the areas of application as a consequence of the continuous irritation and possible carcinogenic effect of the substances with which it is adulterated.

Early alterations of oropharyngeal dysphagia in bulbar and spinal amyotrophic lateral sclerosis. Cases and control study

Sat, 14 Sep 2024 00:00:00 +0200

Introduction and objective: The objective of the study is to establish the early alterations of oropharyngeal dysphagia (OD) in bulbar ALS and spinal ALS, to verify possible differences between both groups and to know the percentage of patients with ALS who require dietary adaptations after their first visit to the otorhinolaryngologist (ENT). Method: Retrospective study of 10 patients with bulbar ALS and 10 patients with spinal ALS from our hospital, evaluated by ENT at the recent diagnosis of ALS. Variables collected: demographic (age, sex) and clinical, including early alterations in the swallowing test under fiberoendoscopy (FEES) and the type of diet of each patient; and comparison of the findings between both groups. Results: Of 20 patients (median age= 68 years), 50 % presented spinal ALS and 50 % presented bulbar ALS. The swallowing test demonstrated incompetence in the propulsion of the bolus (15 % of patients) and pharyngolaryngeal residue (40 % of patients). Statistically significant differences are evident between both groups in the penetrations and aspirations observed under FEES (p<0.05) and in the need for dietary adaptations after ENT evaluation, predominating in bulbar ALS. Discussion: We found significant differences in OD between bulbar and spinal ALS, describing a greater alteration in patients diagnosed with bulbar ALS. Conclusions: The fundamental role of the otorhinolaryngologist lies in the early detection of OD in patients with ALS, preventing and/or reducing potential respiratory complications derived from it.

Complications of acute sinusitis in children

Sat, 14 Sep 2024 00:00:00 +0200

Introduction and objective: Acute sinusitis is frequently diagnosed in pediatric age, usually following an upper respiratory tract infection. Although most cases respond favorably to antibiotic treatment, occasionally orbital and intracranial complications can occur. Orbital complications are the most common and are associated with ethmoid sinusitis. Intracranial complications represent a more severe condition that requires early diagnosis and treatment due to the risk of serious sequelae. Our objective is to study the incidence and characteristics of complicated sinusitis in children, their epidemiological factors, clinical presentation, treatment and evolution. Method: We performed a descriptive retrospective study including pediatric patients (0-15 years) who required admission and imaging studies that confirmed complicated sinusitis at La Fe University and Polytechnic Hospital in Valencia over a period of 9 years (2011-2019). Results: Thirty patients with a diagnosis of complicated acute sinusitis were identified. A CT scan was performed in all cases, revealing isolated cellulitis in 8 patients (26.6%), subperiosteal abscess in 16 (53.3%), and intracranial complications in 6 (20%). The average age was 9 years, with 61% of the patients being male and 39% female. The average length of hospital stay was 8.7 days for orbital complications and 26.6 days for intracranial complications. Isolated cellulitis resolved with medical treatment alone, while surgery was necessary in 68.7% of isolated subperiosteal abscesses and 83.3% of abscesses with associated intracranial complications. Discussion: Early diagnosis and initiation of appropriate treatment are essential to achieve resolution of complications from acute sinusitis. CT scan of the paranasal sinuses is the imaging test of choice for the initial assessment of these patients. In cases of suspected intracranial complications or if a second test is needed during follow-up, MRI will be the test of choice. Although there is no established protocol for managing orbital complications, medical treatment has shown good results in isolated cellulitis and small abscesses without other associated complications. For larger abscesses, associated intracranial complications or lack of improvement after initiating medical treatment, surgery will be preferred. Conclusions: Orbital complications are the most frequently diagnosed. Medical treatment shows good results in managing cellulitis and small subperiosteal abscesses. The treatment of choice in patients with lack of response to medical treatment and in those with larger abscesses or intracranial extension.

Dealing with Artificial Intelligence and the Editorial Process. The current and future influence of AI on the editorial process of biomedical journals

José Luis Pardal-Refoyo — Wed, 19 Mar 2025 00:00:00 +0100

Editorial