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Introducción y objetivo: Dado el número creciente de cirugía de tiroides, la incidencia de hipoparatiroidismo postquirúrgico está en aumento. La frecuencia de la hipocalcemia por hipoparatiroidismo tras tiroidectomía total es muy variable según la literatura (0,3-68%). El objetivo principal del presente estudio es analizar los factores bioquímicos, quirúrgicos y demográficos relacionados con un mayor riesgo de hipocalcemia. Metodología: Se trata de un estudio retrospectivo, sobre un total de 297 pacientes intervenidos de tiroidectomía total en un periodo de 8 años en un hospital terciario. Se analizan datos demográficos, clínicos y bioquímicos, tanto preoperatorios, intraoperatorios como postoperatorios y su relación con la hipocalcemia postquirúrgica. Resultados: La tasa de hipocalcemia total fue de 40,2%, siendo transitoria en el 26,1%. Fueron variables estadísticamente significativas la edad (p=0,04), la enfermedad de Graves (p=0,04), el carcinoma confirmado por anatomía patológica (p=0,04), la tiroidectomía en dos tiempos (p=0,00), el número de paratiroides trasplantadas (p=0,00) y la PTH pre y post –operatorias (p=0,03 y p=0,00) y el gradiente de PTH (p=0,00). Conclusiones: Este estudio demuestra que hay una serie de factores de riesgo intrínsecos al paciente y al acto quirúrgico capaces de predecir el riesgo de hipocalcemia tras la tiroidectomía total. Posiblemente, la optimización de la técnica quirúrgica podría evitar la aparición de hipocalcemia tras la tiroidectomía total en algunos casos, mientras que en otros, la identificación de dichos factores en el postoperatorio podría permitir la detección temprana y el tratamiento eficaz de estos pacientes. En el presente estudio, la edad, la enfermedad de Graves y el autotrasplante de paratiroides se asociaron con hipocalcemia postquirúrgica; mientras que el carcinoma de tiroides y la tiroidectomía en dos tiempos fueron factores protectores.

Objective To study about the tumoral factors in the oropharyngeal carcinoma and see how they affect the prognosis. Methods We made a retrospective study of 35 patients with carcinoma of the orophartynx since 1998 until 2003. We gathered information like tumor stage, tumor location, degree of differentiation and saw how they influence in the survival, recurrences, metastases and incidence of second tumors. Results we observed a decrease in survival, an increase of the second tumors and recurrences in the advanced tumors and in the tumors of the posterior wall of the oropharynx. We observed a decrease in survival in patients with well -differentiated tumors. Conclusion The diagnosis of the oropharyngeal tumors generally is made in advanced stages. Tumor stage and tumor location are the most important prognostic factors. [ABSTRACT FROM AUTHOR]

Objectives: To determine if there are clinical or anatomical differences between patients with grade II-IV obesity without obstructive sleep apnea (OSA) or mild OSA and patients with moderate or severe OSA and to assess whether any of these factors are predictive of moderate/severe OSA. Methods: Observational case-control study with consecutive sampling including patients between 18 and 65 years of age with grade II-IV obesity who were candidates for bariatric surgery. An anamnesis regarding OSA symptoms, a physical examination of the upper airway and a cardiorespiratory polygraphy were performed. Results: A total of 124 patients were included in the study, of whom 61.3% did not have OSA or had mild OSA and 38.7% had moderate or severe OSA. Age over 48 years was the only independent factor associated with moderate or severe OSA. Other factors showed a relation with moderate/severe OSA after multivariate analysis: male sex, STOP-BANG questionnaire ≥ 3, weight ≥ 105 kg, thick neck, neck circumference ≥ 41.25 cm, flaccid palate, Mallampati III-IV index, Friedman tongue position III-IV and retropalatal narrowing. Conclusions: The only independent predictive factor related to moderate or severe OSA in patients with morbid obesity was age over 48 years, therefore a sleep study remains essential for its diagnosis., Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-024-04908-0., Competing Interests: Conflict of InterestThe authors have no conflicts of interest to declare., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction and Objectives: Obstructive sleep apnea (OSA) is a prevalent condition among electable to bariatric surgery obese patients, often remaining underdiagnosed, thereby increasing surgical risk. The main purpose was to determine prevalence of OSA among candidates for bariatric surgery and to assess the rate of underdiagnosis of this condition. Additionally, the study aimed to evaluate the specific performance of three sleep questionnaires and scales (Excessive Daytime Sleepiness Scale (EDSS), Epworth Sleepiness Scale (ESS), and STOP-Bang) in these patients., Methods: A longitudinal, prospective, single-cohort study, with consecutive sampling including patients aged 18-65 years with obesity grade II (body mass index (BMI) ≥ 35 kg/m 2 ) and hypertension, type 2 diabetes, metabolic syndrome or OSA or obesity grade III or IV (BMI ≥ 40 kg/m 2 ) elective for bariatric surgery. Patients were evaluated at the Otorhinolaryngology department with an anamnesis regarding OSA including the administration of three sleep questionnaires (EDSS, ESS, and STOP-Bang), followed by cardiorespiratory polygraphy (CRP) for sleep evaluation., Results: 124 patients were included in this study. While 74.2% of the sample exhibited OSA on CRP, only 28.2% had a prior diagnosis. The STOP-Bang questionnaire demonstrated the highest sensitivity (93.3%) for detecting moderate to severe OSA, although with low specificity (33.8%). EDSS and ESS did not show a significant association with the presence of OSA., Conclusions: OSA screening is crucial in candidates for bariatric surgery due to its high prevalence and low diagnosis rate. The STOP-Bang questionnaire may serve as a useful tool for identifying patients at risk of moderate to severe OSA and optimizing sleep assessments. However, further research is necessary to validate its utility in this specific population., (Copyright © 2024 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Methodology: Unilateral vocal cord paralysis without laryngeal lesions is a relatively frequent entity. It can be the manifestation of numerous diseases of the thorax, neck, skull, or systemic disease. The objective is to study the extralaryngeal aetiology of unilateral vocal cord paralysis, its prognosis, and the relationship of both with different clinical variables. Retrospective study of 116 patients with complete unilateral vocal cord paralysis without laryngeal lesions. The patients underwent cervical-thoracic CT ± evaluation by Neurology with brain MRI to establish the aetiology and were followed-up for at least 1 year., Results: The most common extralaryngeal cause of vocal cord paralysis was cervical surgery (46.5%), followed by tumour (24.1%). Idiopathic paralysis was the cause in 15.5%. An association was obtained between sex and aetiology (P < .01), men in relation to malignant pathology and women to iatrogenic disease. Cardiovascular, cerebrovascular, tumour and idiopathic aetiology predominated in elderly patients; while surgical aetiology predominated in younger patients (P < .01). A total of 18.1% recovered vocal cord mobility. The female sex was related to recovery (P < .01). Tobacco and malignant aetiology were related to persistence (P < .01)., Conclusions: The first extralaryngeal cause of unilateral CV paralysis is surgical followed by lung and thyroid neoplasms. There is a great diversity of lesions that can cause the condition, in many cases involving a diagnosis of malignant tumours. Recovery is more frequent in female patients, non-smokers and with benign pathology., (Copyright © 2022 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Tumour stage is an important prognostic factor in head and neck tumours. Many tumours are diagnosed in advanced stages despite almost universal healthcare and their being symptomatic. This paper seeks to determine the diagnostic delay in head and neck tumours in our health department, to analyse factors associated with delay and if it is associated with diagnosis in advanced stages., Methods: Retrospective study of 137 patients with head and neck cancer diagnosed from 2016-2018. Patient delay, delay in primary health care, delay in secondary health care, diagnostic delay and possible associated factors (smoking, location, stage, …) were evaluated., Results: Many patients (44.5%) were diagnosed in advanced stages. The median patient delay was 30 days. The median referral to otorhinolaryngology was 3.5 days. If the referral was made by another specialist (p = .008), the patients were under previous treatment (P=.000) and the tumours were in initial stages (P=.038) this delay was greater. The median from the first visit to otorhinolaryngology was 15 days, higher in regular referrals (43%) (P=.000). The median diagnostic delay was 12 days, higher in surgical biopsies (P=.000). The median professional delay was 58.5 days and total delay was 118.5 days., Conclusions: Many head and neck tumours are diagnosed in advanced stages. A relationship was not found between diagnosis in advanced stages and diagnostic delay. However, steps must be taken to reduce these excessive delays., (Copyright © 2020 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: Although upper airway surgery in selected patients with obstructive sleep apnea (OSA) has been shown to be beneficial, its long-term effects have been questioned. The main objective was to evaluate whether results following surgery remain stable over time, both in objective and subjective terms. As a secondary aim, such stability was also measured in relation with the type of surgery performed., Methods: This work constitutes a retrospective study of OSA adult patients subjected to the following surgical procedures: different types of pharyngoplasties, tongue-base surgery, partial epiglottectomy or hyoid suspension. Those who exclusively underwent tonsillectomy or nasal surgery were excluded. Before surgery, a sleep study, and an assessment of the patients' sleepiness and quality of life were performed, which were repeated at 8, 34, and 48 months after surgery. A total of 153 patients was included., Results: Following surgery, the apnea-hypopnea index decreased from 34.84/h to 14.54/h and did not vary more than one point in subsequent controls (p = 0.01). The oxygen desaturation index changed from 31.02/h to 14.0/h and remained stable in the second (15.34/h) and third (11.43/h) controls (p = 0.01). Parameters measuring sleepiness and well-being demonstrated the maintenance of long-term benefits. New pharyngoplasties were observed to be more stable than classic pharyngoplasties in the long term (p = 0.04). Single-level surgeries were found to be more stable than multilevel surgeries, although a statistically significant difference was not observed (p = 0.07)., Conclusion: The benefits obtained remained stable in the long term. In our sample, modern pharyngoplasty techniques showed superiority over the classic ones regarding long-term stability., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction and Purposes: The relevance of the lateral pharyngeal walls in the collapse of the upper airway in obstructive sleep apnea patients has been revealed in the last 20years. New surgical techniques that address this collapse have been published. The aim of this study is to show the technique that we are currently using to treat the collapse and its results., Materials and Methods: This is a retrospective study of surgically treated OSAS patients who did not tolerate conventional positive airway pressure (CPAP) or for whom it was not indicated. After a complete physical examination either awake or under drug-induced sleep endoscopy, tonsillectomy with reposition pharyngoplasty was performed using barbed bidirectional suture and removing the supratonsillar fat. Three to 6months after surgery the subjective parameters were evaluated and a sleep study was performed., Results: Twenty-six patients were enrolled with a significative decrease in the AHI and also significative improvement in all the rest parameters studied. In 65.4% of the patients the AHI decreased 50% and was lower than 20/h, in 42.3% postoperative AHI was lower than 10/h. The most frequent complication was the partial extrusion of the suture., Conclusions: This surgical procedure obtains statistically significant results in objective and subjective parameters of sleep apnoea without major associated complications., (Copyright © 2020 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Tumour stage is an important prognostic factor in head and neck tumours. Many tumours are diagnosed in advanced stages despite almost universal healthcare and their being symptomatic. This paper seeks to determine the diagnostic delay in head and neck tumours in our health department, to analyse factors associated with delay and if it is associated with diagnosis in advanced stages., Methods: Retrospective study of 137 patients with head and neck cancer diagnosed from 2016-2018. Patient delay, delay in primary health care, delay in secondary health care, diagnostic delay and possible associated factors (smoking, location, stage, …) were evaluated., Results: Many patients (44.5%) were diagnosed in advanced stages. The median patient delay was 30 days. The median referral to otorhinolaryngology was 3.5 days. If the referral was made by another specialist (p=.008), the patients were under previous treatment (P=.000) and the tumours were in initial stages (P=.038) this delay was greater. The median from the first visit to otorhinolaryngology was 15 days, higher in regular referrals (43%) (P=.000). The median diagnostic delay was 12 days, higher in surgical biopsies (P=.000). The median professional delay was 58.5 days and total delay was 118.5 days., Conclusions: Many head and neck tumours are diagnosed in advanced stages. A relationship was not found between diagnosis in advanced stages and diagnostic delay. However, steps must be taken to reduce these excessive delays., (Copyright © 2020 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: Positional therapy (PT) has become more reliable for obstructive sleep apnea (OSA) patients with the use of new devices. The objectives of this study were to determine the preoperative prevalence of positional OSA (POSA) in our population of surgically treated patients and the proportion of patients who developed POSA after surgery and might improve with additional positional therapy., Methods: This was a retrospective study of surgically treated OSA patients from 1999 to 2017. The Cartwright definition was used to define POSA. All patients completed a sleep study before and 6 months after surgery and a complete upper airway (UA) exploration (awake ± DISE). A total of 125 patients were included., Results: The global prevalence of POSA before surgery was 31.2%. In those who were cured by surgery, the preoperative prevalence of POSA was 38.3%. Having POSA was not related with surgical success outcome. For patients not cured by surgery, the proportion of POSA significantly increased from 25.64 to 53.85% after surgery. Eighteen patients of them (23.1%) achieved AHI < 5/h in a lateral position. In those patients, PT with Night-Shift™ was suggested, 50% of them accepted it and 88.9% of them experienced excellent satisfaction. Lateral velum collapse and the absence of concentric collapse at the tongue base had statistical relationships with the development of POSA., Conclusions: The prevalence of POSA is increased after surgery in patients with persistent OSA after surgery. In these patients, the development of POSA gives an extra therapeutic chance as 23.1% of these cases can be successfully treated by using PT.

Background and Purpose: The surgical techniques used to treat velopharyngeal collapse in obstructive sleep apnoea patients have evolved over recent years. Our aim was to determine whether these new techniques have better surgical results., Materials and Methods: This is a retrospective study of moderate to severe obstructive sleep apnoea patients surgically treated from 2006 to 2018. Only adult patients with no compliance to positive airway pressure and without simultaneous multilevel surgery were included. During this period, 4 different techniques were performed: uvulopalatopharyngoplasty, lateral pharyngoplasty, expansion pharyngoplasty and barbed reposition pharyngoplasty. Success rates as defined by Sher, as well as postoperative AHI<10/h and mean relative AHI reduction (MRR) were compared., Results: 82 patients were included. AHI was significantly reduced from 43.4±24/h to 15.6±18.6/h. No significant changes in body mass index were observed. Hypoxaemia time, oxygen desaturation index, and Epworth sleepiness scale values improved after surgery. The best success rates were obtained performing barbed reposition pharyngoplasty (78.26% measured by Sher's criteria, 65.22% by AHI<10/h criteria and 74.1% by the MRR). The differences observed were statistically significant., Conclusions: Barbed reposition pharyngoplasty is a recently introduced technique that showed superiority over the other palatal surgery techniques in this cohort., (Copyright © 2019 Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: Several studies have demonstrated the validity, reliability, and safety of drug-induced sedation endoscopy (DISE) in assessing the collapse of the upper airway (UA) in patients with obstructive sleep apnea hypoapnea syndrome (OSAHS). The aim of this study was to assess the interobserver agreement on DISE and on therapeutic decision between an expert observer and an observer in training., Methods: This was a cross-sectional study. Thirty-one DISE videos performed in our service were randomly selected. Videos belonged to patients with OSAHS who wanted alternative treatments to CPAP. The videos were reviewed by an ENT experienced on DISE and a second observer in formation. Each observer independently assessed the presence of collapse of the UA according to a modified VOTE classification and proposed an alternative treatment to CPAP. Interobserver agreement kappa values were calculated., Results: In assessing the presence of collapse at different levels of the upper airway, the percentage of agreement was 80 % at the level of the soft palate (kappa = 0.1667), 89.29 % in the oropharynx (k = 0.7742), 80.65 % at the tongue base (k = 0.5571), and 74.17 % at the epiglottis (k = 0.4768). When degree and configuration of the collapse was evaluated, the interrater agreement was moderate to good, except at the level of the tongue base where the agreement was weak for both degree and configuration of collapse (k = 0.34 and 0.38, respectively). Interobserver agreement was moderate when the indication of alternative treatments to CPAP is valued based on the findings of DISE., Conclusions: Overall, DISE is a reliable technique even when assessing interobserver agreement between an experienced observer and one in training; however, tongue base is the level of the upper airway that presents the greatest difficulties when assessing the collapse with DISE. Therefore, it is important to develop learning curves for this technique in order to obtain more reliable results.

Background: Identifying the sites of obstruction of the upper airway in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) is paramount for surgical planning. The aim of this study is to compare wake physical exam findings to the ones obtained during drug-induced sedation endoscopy (DISE) in the diagnosis of severe collapse of the upper airway in OSAHS patients., Methods: A retrospective chart review of OSAHS patients who underwent DISE at our institution during the 2006-2010 period was conducted. All the patients had previously undergone a physical examination that included modified Mallampati index (MMI), the Müller maneuver (MM), and the Friedman staging system. Level and severity of airway collapse were evaluated. A severe collapse was attributed to obstructions equal or greater than 75 % of the airway., Results: A total of 138 patients were included in the study. The incidence of severe airway collapse was compared between DISE and MM; at retropalatal level, no significant difference was found. At retrolingual level, 69 % of patients had severe collapse with DISE in comparison to a 28 % with the MM (p < 0.05). No relationship was found either with the MMI or with the Friedman staging system when compared to the incidence of severe retrolingual collapse diagnosed by DISE. Concordance was low between awake and DISE exploration in both retropalatal and retroglossal level., Conclusion: The Müller maneuver underestimates tongue base severe obstruction diagnosis when compared to that obtained after DISE in OSAHS patients. The wake patient exploration does not accurately correlate to DISE exploration.

The aim of this study was to assess the surgical success rate of patients undergoing oropharyngeal surgery, selected through drug-induced sleep endoscopy. Secondly, to compare outcomes of the different oropharyngeal surgery techniques applied. The study design was retrospective case series of surgically treated patients from 2006 to 2013. All patients were diagnosed with either moderate or severe obstructive sleep apnea and did not tolerate conventional positive airway pressure. We performed five different surgical techniques to treat oropharyngeal collapse: partial palate resection, uvulopalatopharyngoplasty, Z-palatoplasty, lateral pharyngoplasty and expansion pharyngoplasty. Patients in whom multilevel surgery was performed were excluded. 53 patients were included in our study, 52.8 % were severe obstructive sleep apnea patients, mean age was 43.9 years, mean body mass index 27.5. The surgical success rate according to Sher's criteria was 71.7 %. 47.2 % had a postoperative apnea hypopnea index lower than 10. The highest success rate was measured in patients who underwent expansion pharyngoplasty (90 % according to Sher's criteria, 80 % with a postoperative apnea hypopnea index lower than 10) although it did not reach statistical significance. Our conclusion is that drug-induced sleep endoscopy is a good tool to select surgical candidates in patients with moderate-to-severe obstructive sleep apnea who are not compliant with the optimal therapy. Expansion pharyngoplasty was the surgical technique with the highest success rates.

Introduction and Objectives: Fine needle aspiration cytology (FNAC) is a globally accepted technique in the preoperative evaluations of head and neck tumours; however, the effectiveness in the interpretation of salivary glands neoplastic lesions is still controversial. The objective of this study consisted of assessing the efficacy of FNAC in preoperative diagnosis of parotid tumours., Methods: This retrospective study was conducted using 93 patient samples with parotid gland tumoral pathology, treated at the Otorhinolaryngology Department in our institution during the 2007-2011 period. Preoperative FNAC was employed and the patients subsequently submitted to surgical excision with histopathological diagnosis of the specimen. Cytology results were classified as negative for malignancy, positive for malignancy or insufficient sample, and later compared with the definitive histological diagnosis., Results: The mean age of the studied sample was 52.9 years (range: 11 to 88 years); 55.9% were men. The FNAC showed significant sensitivity of 57.1%, with a specificity of 95.1%, for detecting malignancy in parotid gland tumours. The positive and negative predictive values for malignancy were 50 and 96.3%, respectively., Conclusions: FNAC is considered a simple test but of limited use for diagnostic guidance in tumour pathology of the parotid gland in our environment, mainly because of its low sensitivity. However, the high specificity and high negative predictive value of FNAC makes it a more accurate test in benign or negative result cases., (Copyright © 2013 Elsevier España, S.L. All rights reserved.)

Fiberoptic examination of the pharynx under drug-induced sleep is a test that helps to detect the areas of vibration and collapse in patients with sleep-disordered breathing. This article is a review of the available literature on the subject, aimed at helping otolaryngologists to understand the procedure and to resolve some controversies surrounding it., (Copyright © 2013 Elsevier España, S.L. All rights reserved.)

The purpose of the present study was to compare pharyngeal and polysomnographical findings during drug-induced sleep endoscopy (DISE) performed with either propofol or midazolam as a single sedative agent. It is prospective, non-randomized, double-blinded case series study. Sixteen patients with sleep disordered breathing were sedated first with propofol and after full wake up with midazolam. Simultaneous polysomnography (PSG) was performed. We compared the zones of obstruction and vibration found with both drugs using the VOTE classification. Simultaneous PSG findings are also compared. There were 15 men and one woman; the mean age was 42.7 years old, mean body mass index 26.9 kg/m(2). Average DISE duration was 20 min with Propofol and 14.3 min with Midazolam. The induced sleep stage obtained was N2 with both drugs. Outpatient physical exam did not correlate with drug-induced sleep findings. There was a good correlation between DISE results with both drugs in all the areas of collapse except the velum (p < 0.005). Using a continuous perfusion, there is a good agreement in the findings observed in DISE performed with propofol and midazolam and PSG.

We report the case of a patient with autophony diagnosed with a patulous Eustachian tube. The patient was treated according to the technique described by Bluestone and Cantekin, inserting an indwelling catheter into the tube. Good results were obtained after one year of monitoring., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Objective: The aim of this study was to present, myringoplasty case results in our department. Different factors were studied to confirm their prognostic value., Materials and Methods: A total of 126 myringoplasties from 2006 until 2010 were reviewed, collecting patient-related details, descriptions of the anatomical defect and the most interesting surgical aspects., Results: Subtotal perforations (35.7%) were the most frequently observed. In 89.7% of the operations, the transcanal approach was preferred. The medial technique (underlay) to the tympanic membrane was the most performed (97.6%). Cartilage was the principal graft used (82.5%). Complete closure of the perforation was obtained in 71.1% of the cases at 6 months follow-up. Recurrences of the perforations were of minimal size in 11.9% of the cases, partial in 11.1% and with a cartilage fragment gap in 4.8%. The mean time in which these defects were registered was 3.82 months. The mean post-operative auditory gain was 12.8 decibels at 6 months., Conclusions: Myringoplasty is an appropriate technique for restoring tympanic integrity and obtaining functional benefit. Dried middle ear mucosa and posterior perforations seem to be related with better functional results., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Synovial sarcoma is the fourth most common type of sarcoma. It is usually found in the knee or ankle joints, and is exceptional in the head and neck. Most cases are diagnosed in men between 20 and 40 years of age. Diagnosis is often casual due to the infrequent nature of this tumour and its non-specific clinical and radiological characteristics. Confirmation is therefore based on immunohistochemistry and electron microscopy techniques. We report a case of biphasic sinovial sarcoma located in the infratemporal fossa treated at our hospital and we make a review of the literature., (Copyright © 2009 Elsevier España, S.L. All rights reserved.)

The management of voice disorders requires a close collaboration between the throat surgeon and the speech therapy team. The diagnosis of cordal lesions is essential to an accurate therapy. Stroboscopy contributes functional information which is useful to decide between microsurgery, vocal reeducation or a combined treatment. We have reviewed our phonomicrosurgery cases for the past five years and analyzed the correlation between preoperative diagnosis obtained by stroboscopy and intraoperative findings. In 90% of cases there exists a relation between both diagnoses. We consider stroboscopy as an essential means of evaluation to establish an adequate management and guidance for surgical treatment., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

Introduction and Objectives: The purpose of this work is to study the functional sequelae after peripheral facial palsy (PFP) to analyze its impact and relationship with the degree of facial nerve dysfunction, from the neurophysiological point of view., Methods: We present a retrospective study which includes a total of 150 cases of peripheral facial palsy. All patients underwent electroneurography and electromyography to see the degree of axonal damage and to evaluate the existence of signs of reinervation in the muscles explored or possible innervation errors., Results: Of the patients studied, 31.9% (46) had sequelae; 67.4% (31) were women, a statistically significant result (P=.031). Of all the sequelae, the most frequent was miochymia which appeared in 24% of cases (36). Patients with left side involvement presented a higher number of sequelae (40.3%, 27 cases) with a statistically significant difference (P=.05). The average rate of axonal injury on first visit by patients who subsequently developed sequelae was 75.26%; worse results on electroneurography were statistically associated with the onset of sequelae (P=.007). Electromyography of patients with sequelae shows that a greater degree of denervation could be considered a risk factor for the occurrence of sequelae (P=.039)., Discussion/conclusions: In our study we found that sequelae are more frequent after facial palsy when there is significant axonal loss. This work shows other risk factors so far not mentioned in the literature, such as female gender and left-side involvement., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

Introduction and Objective: The most common postoperative complications related to BAHA prosthetic surgery are skin complications. In this study we compare and evaluate these reactions with two different surgical techniques, the BAHA dermatome and the U-graft technique., Material and Method: Fifty-three patients who underwent implantation of a BAHA at our hospital between 2001 and 2008 were studied. The comparison of the skin reactions was carried out according to Holgers' classification. We also recorded the number of cures required until the skin was stabilized., Results: We used the dermatome in 27 patients and the U-graft in 26 patients. In the dermatome group we have reported a total of 74% of skin reactions (20 patients), in contrast with the 34% (9 patients) observed in the U-graft group. The average number of cures for patients in the dermatome group and those in the U-graft group was 4.1 and 2.7, respectively. The differences found were statistically significant and had a 95% confidence interval., Conclusions: In our experience, the use of the electric dermatome in BAHA surgery offers a higher incidence of skin complications in comparison with the U-graft technique. Since both techniques have a number of advantages and disadvantages, it may be that the selection of the technique to be employed according the individual characteristics of each patient may offer better results in the future.

Introduction and Objectives: This is a retrospective study on patients who underwent septoplasty and septorhinoplasty at Dr. Peset Hospital in Valencia. Surgical procedures are described and results evaluated., Material and Methods: 49 septorhinoplasties and 6 rhinoplasties were aesthetic and functionally evaluated after surgery. Variables such as type of deformity, age, gender, previous surgery and surgical results where described and compared. Fisher exact test was used to find statistic significance between variables., Results: Septum remained centred after 91% (45) of septoplasties. There was no statistical significance between type of septal deviation and results. Straight nasal pyramid was obtained after 76% (42) of septorhinoplasties and also in this procedure we did not find statistic significances between deformity and final result. Feminine gender and secondary surgery where predictive factors for worse surgical results., Conclusion: Septopyramidal surgery tries to obtain a good nasal function and aesthetic result. Starting with Cottle's principles, more specific techniques have been developed to resolve the different deformities.

Since the introduction of bone-anchored hearing aids (BAHA) a few decades ago, their effectiveness has made the use of these devices a well-established method. The most common complications associated with BAHA are dermatological, so a lot of changes were introduced in the surgical technique to reduce the frequency of skin reactions. We have analyzed our experience in the management of the skin and soft tissues over 8 years' experience with BAHA. We present a new longitudinal incision with the fixture out of the incision.

Objective: Hypopharyngeal carcinoma is an aggressive malignancy usually diagnosed at a late state, thereby resulting in overall poor prognosis and low survival rates for these patients. The purpose of this study is to present the progress and outcomes of patients treated for hypopharyngeal carcinoma at our department., Material and Method: We retrospectively reviewed 89 patients who had been diagnosed with hypopharygeal carcinoma between 1980 and 2005. Most of the tumours were advanced (T3 and T4) and 73 % showed palpable regional metastases at presentation., Results: The five-year survival rate was 40.7 %. The overall incidence of distant metastases and subsequent primary neoplasms was 7.5 % and 23.5 %, respectively., Conclusions: Hypopharyngeal cancer is still the one with the worst prognosis in the head and neck area. The poor survival rate seems to be related primarily to advanced stage disease at presentation and particularly to the status of cervical lymph-node metastases.

Introduction: The incidence of multiple malignant neoplasms in the upper aerodigestive tract is high and ranges from 7% to 20%. We make a retrospective study to evaluate the incidence of multiple malignant neoplasms in head and neck squamous cell carcinomas, their main characteristics and survival., Material and Method: We studied 103 multiple malignant neoplasms from an oncological database of 1330 patients with head and neck squamous cell carcinomas. We use the SPSS v15 for analysis of the results., Results: The incidence of multiple malignant neoplasms in our series is 7.73 %. Tumours of the hypopharynx are the primary tumours most often associated with multiple malignant neoplasms (21.34 %), followed by tumours of the oropharynx (15.38 %). Lung tumours are the multiple malignant neoplasms most often associated (29.03 %). The 5-year global survival is 33 % from diagnosis of the second primary tumour, 78.02 % of which are metachronous with an average of 40 months between the diagnosis of the primary tumour and the presentation of the second tumour., Conclusions: Multiple malignant neoplasms are very frequent in the head and neck area which shows the importance of thorough regular check-ups of these patients as the presence of multiple malignant neoplasms considerably worsens the prognosis.

Introduction: Many surgeons use intraoperative frozen section biopsy of the thyroid nodules to confirm malignant disease, but it continues to generate considerable controversy. We reviewed our recent experience to determinate de clinical utility of frozen section in our surgical management and intraoperative decision-making., Patients and Method: All patients who had operations for the thyroid nodular disease between 2000 and 2006 were included in this retrospective study. We compared the results of frozen section diagnosis and definitive histologic results in a population of 212 patients., Results: Frozen section was false negative in 3 patients (1.66 %) and false positive in 1 (0.47 %) and avoided 12 reoperations (5.6 %). When there was not suspicious malignant disease had a sensitivity of 0.75 %. In the group of follicular disease the sensitivity was 3.7 %, and in the group with suspicious malignant disease was 37.5 %., Conclusions: Frozen section was more helpful in the group of suspicious for malignant disease. It does not seem to be necessary when fine-needle biopsy indicates bening or follicular disease.

Introduction: Laryngeal carcinoma is a common neoplasia in our country. It is well-known that the supraglottis is more frequently involved in Mediterranean countries. We present our results on the incidence of neoplasias affecting supraglottis and glottis and we find a change in the normal trend., Objective: To study the incidence of glottic and supraglottic tumours in our hospital over the last 31 years. We also analyze risk factors such as smoking and alcohol in the population of the Valencian Region., Patients and Method: We performed a retrospective review of 991 patients diagnosed as having carcinomas of the glottis and supraglottis between 1974 and 2005. The epidemiological data about the consumption of tobacco and alcohol in the population of the Valencian Region, Spain, are obtained from descriptive epidemiological studies (Health Statistics and the 2003 National Health Survey)., Conclusions: With a total of 548 carcinomas of the glottis and 443 of the supraglottis, we find a change in the incidence maintained since 1990, with statistically significant differences (P=.0056). Thus, we can state that the glottis is more frequently affected than the supraglottis. Changes in the consumption of tobacco and alcohol cannot explain this current change.