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BACKGROUND: Achieving an aesthetically pleasant tip rotation is paramount in rhinoplasty, and these results should be long-lasting. However, even powerful structural techniques such as septal extension grafts can lose rotation over time, as most support depends on the attachment of the graft to the septal cartilage. METHODS: We describe a simple suture technique to strengthen tip support in rhinoplasty, by suspending it to the cartilaginous dorsum, providing additional support to the tip against forces, such as gravity, scar contraction and muscle tension. CONCLUSIONS: Combining traditional techniques with suspension sutures can improve intraoperative results and could enhance long-term tip stability.

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PURPOSE: Congenital nasal obstruction can be a significant cause of respiratory distress in the newborn, given that they are considered to be obligate nasal breathers. Several different causes have been described, which can be broadly classified as anatomical/malformative, non-tumoral masses and cysts, benign and malignant neoplasia, inflammatory/infectious, traumatic/iatrogenic, and miscellaneous. The purpose of this review is to provide updated and useful clinical information for teams involved in neonatal care, especially in a hospital setting. METHODS: A review of the available literature was performed. Studies were sourced from PubMed with searching of relevant headings and sub-headings and cross-referencing. RESULTS: The most common etiology is inflammatory, which can have different precipitating factors or be idiopathic, a condition known as neonatal rhinitis. On the other hand, some less frequent but nonetheless relevant conditions causing severe nasal obstruction include choanal atresia, midnasal stenosis, and pyriform aperture stenosis. Some cystic lesions, such as dacryocystoceles with intranasal mucocele, can also produce significant obstruction. Diagnosis usually requires a nasal endoscopy and in some cases imaging such as computed tomography. Management includes different medical and surgical strategies and will greatly depend on the etiology and the severity of symptoms. CONCLUSION: Congenital nasal obstruction can be a significant cause of respiratory distress in the newborn. The wide spectrum of differential diagnoses requires a thorough knowledge of nasal anatomy, physiology, and pathology; as well as different management strategies.

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El estridor es un ruido respiratorio anormal generado por obstrucción o colapso de la vía aérea laringotraqueal, de manera aguda o de evolución crónica. Existen distintas causas tanto congénitas como adquiridas capaces de producir dificultad respiratoria, que puede llegar a ser grave y con potencial riesgo vital. El diagnóstico clínico del paciente con estridor persistente debe ser complementado con un estudio endoscópico de la vía aérea y en ocasiones con imágenes, para intentar determinar el o los sitios comprometidos y posibles malformaciones asociadas. La indicación de tratamiento debe ser individualizada, considerando el estado general del paciente, las etiologías responsables, el im pacto sobre la respiración y la deglución, el pronóstico y la capacidad técnica del equipo tratante, entre otras. Las alternativas pueden incluir observación, medidas no farmacológicas, medicamentos locales o sistémicos, procedimientos endoscópicos, cirugías abiertas, o bien la instalación de una traqueostomía de manera temporal o como manejo definitivo. El objetivo de esta revisión es entregar un adecuado conocimiento de la fisiopatología y la etiopatogenia del estridor pediátrico persistente, fundamental para el correcto manejo de estos pacientes complejos, que debiera realizarse idealmente en un contexto multidisciplinario.

Stridor is an abnormal respiratory sound caused by obstruction or collapse of the laryngotracheal airway, either acutely or chronically. There are different causes, both congenital and acquired, that can produce shortness of breath which may be severe and potentially life-threatening. The clini cal diagnosis must be complemented with an endoscopic airway assessment and sometimes with imaging, to try to determine the areas involved and possible associated malformations. Treatment should be individualized, considering the patient's overall condition, stridor etiology, its impact on breathing and swallowing, prognosis, and technical capacity of the managing team, among others. Alternatives may include observation, non-pharmacological measures, local or systemic medications, endoscopic and open surgeries, or a temporary or long-term tracheostomy. A thorough understan ding of the pathophysiology and etiopathogenesis of persistent pediatric stridor is essential for the correct management of these complex patients, ideally in a multidisciplinary manner.

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OBJECTIVES: To review interventions required by children admitted for intensive care management following tonsillectomy or adenotonsillectomy either as elective or unplanned admission in a tertiary children's hospital. METHODS: A retrospective chart review over a 10-year period between April 2007 and March 2017 was performed. Charts were interrogated for treatments that were administered in the paediatric intensive care unit. Respiratory support therapies such as supplemental oxygen administration, high-flow nasal oxygen, positive pressure ventilation, continuous positive airway pressure, airway interventions and tracheal intubation were reviewed. RESULTS: There were 103 children admitted to the paediatric intensive care unit following tonsillectomy or adenotonsillectomy. The average age was 6.2 years (range 7 months-17 years). The main indications for the procedure were sleep disordered breathing or obstructive sleep apnoea syndrome. In all, 53 children had syndromes with medical comorbidities, 31 were current continuous positive airway pressure users and 5 had a tracheostomy in situ. Forty children admitted to paediatric intensive care unit did not require any high-level care. Ten children who had an unplanned admission had their respiratory interventions started in the theatre or in the post-anaesthetic care unit, before paediatric intensive care unit admission, and did not require escalation of care. CONCLUSION: Children may not require admission for intensive care after tonsillectomy if they have had an incident-free period in the post-anaesthetic care unit. Some of those who required high-flow nasal oxygen could have been managed on the ward provided with adequate training and monitoring facilities. The level of care they require in post-anaesthetic care unit reflected the level of care for the immediate postoperative period in the paediatric intensive care unit.

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Stridor is an abnormal respiratory sound caused by obstruction or collapse of the laryngotracheal airway, either acutely or chronically. There are different causes, both congenital and acquired, that can produce shortness of breath which may be severe and potentially life-threatening. The clini cal diagnosis must be complemented with an endoscopic airway assessment and sometimes with imaging, to try to determine the areas involved and possible associated malformations. Treatment should be individualized, considering the patient's overall condition, stridor etiology, its impact on breathing and swallowing, prognosis, and technical capacity of the managing team, among others. Alternatives may include observation, non-pharmacological measures, local or systemic medications, endoscopic and open surgeries, or a temporary or long-term tracheostomy. A thorough understan ding of the pathophysiology and etiopathogenesis of persistent pediatric stridor is essential for the correct management of these complex patients, ideally in a multidisciplinary manner.

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BACKGROUND: Tonsillectomy is one of the most commonly performed surgical procedures in children. It is performed for sleep-disordered breathing and infective symptoms. Despite advances in instrumentation and perioperative care, posttonsillectomy haemorrhage (PTH) remains a significant complication, which should be audited regularly. METHODS: A retrospective case series of all tonsillectomies performed in patients <15 years old in the Auckland region during 2017 was performed. Demographic, clinical, and surgical data were extracted and analysed. Univariate analysis was performed to compare patients with and without PTH. RESULTS: A total of 2177 tonsillectomies were performed during the study period, 64% in a public hospital and 36% in a private hospital. The overall PTH rate was 3.6% (0.23% occurring within the first 24 hours (primary) and 3.4% after 24 hours (secondary)). Mean time to PTH was 6.6 ± 3 days (range: 1-16 days). 90% of PTH occurred within the first 10 days and 99% by 14 days. Return to theatre was required in 28% of these cases, representing 1% of all tonsillectomies. There were no deaths or major complications in this cohort. The only differences observed between patients with PTH and those without were that children with PTH had smaller tonsils (p=0.004) and were less likely to have associated OME (p<0.001). CONCLUSION: It is important to report institutional tonsillectomy outcomes and associated complications. These results show that PTH rates in Auckland remain within acceptable limits according to the literature.

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BACKGROUND: The respiratory epithelium is mainly constituted by caliciform (produces mucus, responsible of keeping moisture and trapping particles) and ciliated cells (transports mucus into the pharynx, by the movement of multiple cilia). For centuries, nasal lavages have been used for different rhinosinusal conditions. Some studies suggest not only a direct effect on the mobilisation of secretions, but also an improvement in mucociliary clearance rates. To our knowledge, the impact of temperature in nasal lavages has been scarcely studied. METHODOLOGY/PRINCIPAL: We used the saccharin test-applying it in the inferior turbinate and timing the detection of its taste-, to estimate mucociliary clearance rates before and after nasal lavages with saline solution at room (20 °C) or body (37 °C) temperatures. RESULTS: 78 healthy subjects were studied, with a mean saccharin test time of 13.88 min. Then, a nasal lavage was performed, half with 20 °C saline and the other with 37 °C. In both, times improved from baseline (from 13.66 to 11.59 and 14.06 to 9.4 min, respectively) with p values < 0.05. CONCLUSIONS: Nasal lavages with saline solution improve mucociliary clearance as measured by saccharin test. Temperature seems to matter, which should be taken into account when indicating nasal lavages to our patients.

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Introducción: Los paragangliomas son tumores neuroectodérmicos que suelen encontrarse adyacentes a estructuras ganglionares autonómicas. El paraganglioma carotídeo es un tumor parasimpático, habitualmente no secretor de hormonas y de bajo potencial maligno. Objetivo: Realizar una revisión de la literatura con conceptos actuales respecto al abordaje clínico y quirúrgico de esta patología. Diseño: Revisión narrativa de la literatura. Materiales y métodos: Se realizó una búsqueda en bases virtuales como Pubmed y Scielo utilizando los términos "paraganglioma" y "tumor del cuerpo carotídeo" con el fin de encontrar documentos actualizados sobre este tema. Resultados: De las fuentes bibliográficas halladas, se depuraron según impacto, población objeto y tiempo de publicación hasta obtener 48 documentos incluyendo artículos de revisión, reportes de caso y libros, de los cuales se sintetizó información sobre el abordaje del paraganglioma del cuerpo carotídeo. Conclusiones: Ante la presencia de una masa cervical lateral debe considerarse la posibilidad de un paraganglioma; la tomografía computada y la resonancia magnética permiten la aproximación diagnóstica y su clasificación inicial, mientras que la angiografía permite el uso de técnicas de embolización selectiva, cuyo uso en estos tumores es controvertido. La cirugía es el único tratamiento curativo y se considera el manejo de elección en la mayoría de los casos, mientras que la radioterapia se indica en aquellos casos de resecciones incompletas o cuando la cirugía está contraindicada.

Introduction: Paragangliomas are neuroectodermal tumors often found adjacent to autonomic ganglion structures. The carotid paraganglioma is a parasympathetic tumor, usually without hormone secretion function and low malignant potential. Objective: To review current concepts regarding the clinical and surgical management of this condition. Design: Narrative review of the literature. Materials and methods: A search was conducted throughout virtual bases such as Pubmed and Scielo using the terms "paraganglioma" and "carotid body tumor" in order to find updated documents on this topic. Results: From the bibliographical sources found, they were depurated by their impact, target population and publication time until 48 papers including review articles, case reports and books; from these literature, information on carotid body paraganglioma was synthesized. Conclusions: In the presence of a lateral neck mass, paraganglioma should be considered; computed tomography and magnetic resonance allows to do a diagnostic approaching and its initial classification, while angiography allows the use of selective embolization techniques, whose use on these tumors is controversial. Surgery is the only curative treatment and is considered the treatment of choice in most cases, while radiation therapy is indicated in cases of incomplete resection or when surgery is contraindicated.

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Las evaluaciones para la decanulación y los trastornos de la deglución son motivos frecuentes de interconsulta otorrinolaringológica para pacientes en cuidados intensivos. El objetivo de la traqueotomía es mantener una vía aérea permeable. No previene necesariamente los episodios de aspiración e incluso podría favorecerlos. Cuando la causa que motivó la traqueotomía se resuelve, puede plantearse la decanulación del paciente. La deglución es un acto complejo que involucra la interacción coordinada de diversas estructuras de la vía aereodigestiva. El estudio endoscópico con fibra óptica y la videofluoroscopia son herramientas útiles y complementarias en la evaluación de pacientes con trastornos de la deglución. Para el manejo de estos pacientes es necesario un conocimiento sobre la fisiología laríngea y de la deglución, y sobre las distintas alternativas terapéuticas disponibles. Aunque muchas veces coexisten trastornos de la deglución en los pacientes traqueotomizados, la evaluación para la decanulación no es sinónimo de evaluación de la deglución. Un paciente puede ser candidato a ser decanulado y tener un trastorno de la deglución asociado, o bien un paciente traqueotomizado puede lograr deglutir de manera adecuada. Conocer y comprender estos conceptos lleva a un manejo más eficiente, y ayuda a clarificar la comunicación entre el intensivista y el otorrinolaringólogo. Idealmente, debiera existir un equipo multidisciplinario especializado en la evaluación y tratamiento de estos pacientes (AU)

With intensive care patients, decannulation and deglutition disorders are frequent reasons for otorhinolaryngological assessment. The objective of a tracheostomy is to maintain a patent airway. It does not necessarily prevent episodes of aspiration and may even favour them. When the cause that led to the tracheostomy resolves, a decannulation may be proposed. Deglutition is a complex act involving the coordinated interaction of several structures of the aerodigestive tract. Fibre-optic endoscopy and videofluoroscopy are 2 useful, complementary tools for the evaluation of patients with swallowing disorders. In managing these patients, a thorough knowledge of laryngeal and swallowing physiology, as well as of the different therapeutic alternatives, is required. Although it is not uncommon for swallowing disorders to coexist in tracheostomy patients, decannulation evaluation is not synonymous with deglutition assessment. A patient could be a candidate for decannulation and have a swallowing disorder, or a tracheostomy patient could swallow adequately. Knowing and understanding these concepts will lead to more efficient management and help to clarify communication between the intensive care physician and the otorhinolaryngologist. Ideally, a multidisciplinary team should be formed to evaluate and manage these patients (AU)

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With intensive care patients, decannulation and deglutition disorders are frequent reasons for otorhinolaryngological assessment. The objective of a tracheostomy is to maintain a patent airway. It does not necessarily prevent episodes of aspiration and may even favour them. When the cause that led to the tracheostomy resolves, a decannulation may be proposed. Deglutition is a complex act involving the coordinated interaction of several structures of the aerodigestive tract. Fibre-optic endoscopy and videofluoroscopy are 2 useful, complementary tools for the evaluation of patients with swallowing disorders. In managing these patients, a thorough knowledge of laryngeal and swallowing physiology, as well as of the different therapeutic alternatives, is required. Although it is not uncommon for swallowing disorders to coexist in tracheostomy patients, decannulation evaluation is not synonymous with deglutition assessment. A patient could be a candidate for decannulation and have a swallowing disorder, or a tracheostomy patient could swallow adequately. Knowing and understanding these concepts will lead to more efficient management and help to clarify communication between the intensive care physician and the otorhinolaryngologist. Ideally, a multidisciplinary team should be formed to evaluate and manage these patients.

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El cáncer gástrico es una patología de muy alta incidencia y mortalidad en Chile, razón que motivó su incorporación al programa de garantías explícitas en salud, GES, desde el 1º de julio de 2006. El propósito de este estudio es evaluar el efecto de este programa sobre el acceso al diagnóstico y tratamiento oportuno de esta neoplasia, para lo cual se analizaron datos secundarios obtenidos a partir de fichas clínicas, informes de Endoscopía Digestiva Alta y Biopsias, realizadas a 76 pacientes tratados quirúrgicamente por diagnóstico de cáncer gástrico entre el 1º de julio 2003 hasta el 30 de junio de 2007 en un hospital del SSMS. Los resultados mostraron que en contra de lo esperado, no hubo cambios significativos en el número de pacientes operados. De hecho, en comparación a años anteriores el número de gastrectomías por cáncer gástrico fue menor, realizándose sólo 12 en el período Post-Auge en comparación a las 16,33 gastrectomías/año del período precedente, lo que representa una disminución del 26,53%; sin haber cambios significativos en la proporción por sexo y la edad de los pacientes. En cuanto a las garantías explícitas, hubo incumplimiento de plazos en, al menos, 2 de los 12 pacientes con diagnóstico de cáncer gástrico e indicación de resección quirúrgica. Las razones por la cual los resultados del Auge no se tradujeron en mayor número de cirugías y en un cumplimiento total de los plazos garantizados, son múltiples y no necesariamente excluyentes entre sí, y debieran ser objeto de análisis en estudios posteriores.

Gastric cancer is a pathology with a high prevalence and mortality rate in Chile. In view of the latter, such condition was incorporated to the explicit health guarantees program (GES) from July 1st 2006. The purpose of the present study is to assess the impact of such program on the access to a timely diagnosis and treatment for such neoplasia. This was achieved through the analysis of secondary data obtained from medical records, Upper GI Endoscopy and Biopsy reports, from 76 patients having undergone surgery for gastric cancer between July 1st 2003 and June 30th 2007 at a SSMS hospital of operated patients. In fact, compared to previous years, the number of gastrectomies for Gastric Cancer was smaller, with 12 procedures carried out during the Post-AUGE period, as compared to 16,33 gastrectomies/year during the previous period. This represents a decrease in 26,53%, without significant proportional changes per patient gender and age. As for the explicit guarantees, there was non-fulfillment of the assured deadlines in at least 2 of the 12 patients with a diagnosisof gastric cancer and an indication for surgical therapy. The reasons why the AUGE outcomes did not result in a greater number of surgeries and in a total fulfillment of the guaranteed deadlines are manifold and not necessarily mutually excluding, and should be subject of analysis in further studies.

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