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Agosti E, Alexander AY, Plou P, Leonel LCPC, De Bonis A, Bauman MMJ, García-Lliberós A, Piazza A, Torregrossa F, Pinheiro Neto CD, Peris Celda M. 360° around the orbit: key surgical anatomy of the microsurgical and endoscopic cranio-orbital and orbitocranial approaches. Neurosurg Focus 2024; 56:E2. [PMID: 38560949 DOI: 10.3171/2024.1.focus23866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Several pathologies either invade or arise within the orbit. These include meningiomas, schwannomas, and cavernous hemangiomas among others. Although several studies describing various approaches to the orbit are available, no study describes all cranio-orbital and orbitocranial approaches with clear, surgically oriented anatomical descriptions. As such, this study aimed to provide a comprehensive guide to the microsurgical and endoscopic approaches to and through the orbit. METHODS Six formalin-fixed, latex-injected cadaveric head specimens were dissected in the surgical anatomy laboratory at the authors' institution. In each specimen, the following approaches were modularly performed: endoscopic transorbital approaches (ETOAs), including a lateral transorbital approach and a superior eyelid crease approach; endoscopic endonasal approaches (EEAs), including those to the medial orbit and optic canal; and transcranial approaches, including a supraorbital approach, a fronto-orbital approach, and a 3-piece orbito-zygomatic approach. Each pertinent step was 3D photograph-documented with macroscopic and endoscopic techniques as previously described. RESULTS Endoscopic endonasal approaches to the orbit afforded excellent access to the medial orbit and medial optic canal. Regarding ETOAs, the lateral transorbital approach afforded excellent access to the floor of the middle fossa and, once the lateral orbital rim was removed, the cavernous sinus could be dissected and the petrous apex drilled. The superior eyelid approach provides excellent access to the anterior cranial fossa just superior to the orbit, as well as the dura of the lesser wing of the sphenoid. Craniotomy-based approaches provided excellent access to the anterior and middle cranial fossa and the cavernous sinus, except the supraorbital approach had limited access to the middle fossa. CONCLUSIONS This study outlines the essential surgical steps for major cranio-orbital and orbitocranial approaches. Endoscopic endonasal approaches offer direct medial access, potentially providing bilateral exposure to optic canals. ETOAs serve as both orbital access and as a corridor to surrounding regions. Cranio-orbital approaches follow a lateral-to-medial, superior-to-inferior trajectory, progressively allowing removal of protective bony structures for proportional orbit access.
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Affiliation(s)
- Edoardo Agosti
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 3Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy
| | - A Yohan Alexander
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 4Medical School, University of Minnesota, Minneapolis, Minnesota
| | - Pedro Plou
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 5Department of Neurosurgery, Hospital Italiano de Buenos Aires, Argentina
| | - Luciano C P C Leonel
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Alessandro De Bonis
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 6Department of Neurosurgery and Gamma Knife Radiosurgery, I.R.C.C.S. San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Megan M J Bauman
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ainhoa García-Lliberós
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 7Department of Otolaryngology, Valencia University General Hospital, Valencia, Spain
| | - Amedeo Piazza
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 8Department of Neuroscience, "Sapienza" University, Rome, Italy
| | - Fabio Torregrossa
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 9Neurosurgical Unit, Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Italy; and
| | - Carlos D Pinheiro Neto
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 10Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Maria Peris Celda
- 1Rhoton Neurosurgery and Otolaryngology Surgical Anatomy Program, Mayo Clinic, Rochester, Minnesota
- 2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
- 10Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
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Calvo-Henriquez C, García-Lliberós A, Sánchez-Gómez S, Alobid I. Assessing the effect of absorbable steroid sinus implant: a state-of-the-art systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08531-1. [PMID: 38459984 DOI: 10.1007/s00405-024-08531-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/05/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES Endoscopic sinus surgery is not a definitive treatment for chronic rhinosinusitis (CRS). The use of sinus stents after surgery to maintain sinus patency and deliver local steroids has gained popularity. The first steroid-eluting bioabsorbable implant (SEBI) approved for this indication, later Propel, was developed in 2011. This state-of-the-art review aims to summarize the available evidence, as well as to point out potential pitfalls and lack of specific analyses to guide future research on this new therapeutic option. DATA SOURCES Pubmed (Medline), the Cochrane Library, EMBASE, SciELO. REVIEW METHODS Nine research questions were defined: Are steroid-eluting Sinus implants useful for the control of CRS symptoms after surgery? Do they improve surgical field healing after CRS surgery? Do they decrease polyp regrowth after ESS? Do they decrease the need for ESS? Are they useful in symptom control as in-office procedure? Are they better than other steroid-impregnated resorbable materials? Do they have a positive impact on olfaction? Are they safe? Are they cost-effective? Retrieved articles were reviewed by two authors. RESULTS Twenty nine studies were included: 3 metanalysis, 1 systematic review, 10 randomized clinical trials, 4 quasi-experimental studies, 1 retrospective cohort study, 4 cost studies, 3 case series and 2 expert consensus. The review encompassed a population of 3,012 patients treated with SEBI and 2826 controls. CONCLUSIONS This is the first state-of-the-art review assessing steroid eluting bioabsorbable stent evidence. Despite the effort in recent years, still several questions remain unanswered. This review will hopefully guide future research efforts to better define the role of SEBI in the otolaryngology practice.
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Affiliation(s)
- Christian Calvo-Henriquez
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France
- ENT Department, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ainhoa García-Lliberós
- Rhinology Study Group of the Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies (YO-IFOS), Paris, France.
- ENT Department, Valencia University General Hospital, Valencia, Spain.
| | | | - Isam Alobid
- ENT Department, Rhinology and Skull Base Unit, Hospital Clinic, Barcelona University, IDIBAPS, CIPERES, Barcelona, Spain
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García-Lliberós A, Martin-Jimenez DI, Mondesir RJ, Agosti E, Alexander AY, Leonel LCPC, Choby G, Peris-Celda M, Pinheiro-Neto CD. Endoscopic-assisted en-bloc pterygomaxillectomy: Identifying an efficient and safe location for the pterygoid osteotomy. Head Neck 2023; 45:2718-2729. [PMID: 37458605 DOI: 10.1002/hed.27465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/10/2023] [Accepted: 07/05/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND For aggressive maxillary sinus and pterygopalatine fossa (PPF) tumors, an en-bloc pterygomaxillectomy may be indicated. METHODS Five head specimens were used to study the feasibility of an en-bloc pterygomaxillectomy. Eighty-five non-pathological CT scans were used to compare the superior edge of the inferior turbinate (IT) and the middle turbinate tail (MT) as landmarks for the pterygoid osteotomy. RESULTS Through a combined sublabial-subperiosteal incision and transoral route, a mid-sagittal osteotomy through the hard palate and an axial osteotomy below the infraorbital foramen were performed. For the endoscopic pterygoid osteotomy, an infra-vidian transpterygoid approach was performed, subsequently removing the pterygomaxillectomy en-bloc. As landmarks, the osteotomies at the level of the MT tail and IT resected the pterygoid plates completely, but the IT osteotomy was further away from the vidian canal (7.5 vs. 6 mm). CONCLUSIONS The endoscopic-assisted en-bloc pterygomaxillectomy is feasible. The IT landmark is safe and ensures complete resection of the pterygoid plates.
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Affiliation(s)
- Ainhoa García-Lliberós
- Department of Otolaryngology, Valencia University General Hospital, Valencia, Spain
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel I Martin-Jimenez
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, University Hospital Virgen Macarena, Seville, Spain
| | - Ronsard J Mondesir
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Edoardo Agosti
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
- Division of Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - A Yohan Alexander
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
- Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Luciano C P C Leonel
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Garret Choby
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria Peris-Celda
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Carlos D Pinheiro-Neto
- Rhoton Neurosurgery and Otolaryngology Anatomy Program, Mayo Clinic, Rochester, Minnesota, USA
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
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Zapater E, Basterra J, López I, Oishi N, García-Lliberós A. Use of individual anatomical variations to customise window location in montgomery implant thyroplasty: A case series study. Clin Otolaryngol 2019; 44:1162-1165. [PMID: 31514258 DOI: 10.1111/coa.13429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/04/2019] [Accepted: 09/08/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Enrique Zapater
- ENT Department, Valencia Medical School, Valencia University General Hospital, Valencia, Spain
| | - Jorge Basterra
- ENT Department, Valencia Medical School, Valencia University General Hospital, Valencia, Spain
| | - Isabel López
- ENT Department, Valencia University General Hospital, Valencia, Spain
| | - Natsuki Oishi
- ENT Department, Valencia University General Hospital, Valencia, Spain
| | - Ainhoa García-Lliberós
- ENT Department, Valencia University General Hospital and Manises Hospital, Valencia, Spain
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Valero A, Navarro AM, Del Cuvillo A, Alobid I, Benito JR, Colás C, de Los Santos G, Fernández Liesa R, García-Lliberós A, González-Pérez R, Izquierdo-Domínguez A, Jurado-Ramos A, Lluch-Bernal MM, Montserrat Gili JR, Mullol J, Puiggròs Casas A, Sánchez-Hernández MC, Vega F, Villacampa JM, Armengot-Carceller M, Dordal MT. Position paper on nasal obstruction: evaluation and treatment. J Investig Allergol Clin Immunol 2018; 28:67-90. [PMID: 29345622 DOI: 10.18176/jiaci.0232] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.
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Affiliation(s)
- A Valero
- Servicio de Neumología y Alergia, Hospital Clínic; Immunoal·lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); CIBERES Barcelona, Spain
| | - A M Navarro
- UGC Alergología, Hospital El Tomillar AGS Sur Sevilla, Spain
| | - A Del Cuvillo
- Unidad de Rinología y Asma, UGC Otorrinolaringología, Hospital de Jerez, Cádiz, Spain
| | - I Alobid
- Unitat de Rinologia i Clínica de l'Olfacte, Hospital Clínic, Barcelona, Spain
| | - J R Benito
- Unidad de Rinología, UGC ORL, Hospital Universitario Puerto Real, Cádiz, Spain
| | - C Colás
- Hospital Clínico-Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - G de Los Santos
- Unidad de Rinología y Base del cráneo anterior, Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - A García-Lliberós
- Servicio de Otorrinolaringología, Sección de Rinología, Hospital de Manises, Valencia, Spain
| | - R González-Pérez
- Unidad de Alergia, Hospital del Tórax, Complejo Hospital Universitario Nuestra S. de Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | | | - J R Montserrat Gili
- Sección de Rinología del Servicio de ORL, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - J Mullol
- Unitat de Rinologia i Clínica de l'Olfacte, Servei d' ORL, Hospital Clínic i Universitari; Immunoal•lèrgia Respiratòria Clínica i Experimental, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); CIBERES, GA2LEN, EUFOREA, Barcelona, Spain
| | | | | | - F Vega
- Servicio de Alergia, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria - Hospital Universitario de La Princesa (IP), Madrid, Spain
| | - J M Villacampa
- Servicio de Otorrinolaringología y Patología Cérvico-facial, Hospital Universitario Fundación Jiménez Díaz IDC, Madrid, Spain
| | - M Armengot-Carceller
- Servicio de Otorrinolaringología, Hospital Universitari i Politècnic la Fe, Universitat de València, Valencia, Spain
| | - M T Dordal
- Unitat d'Al·lèrgia, Badalona Serveis Assistencials, Badalona, Spain.,Servei d'Al·lèrgia, Sant Pere Claver Fundació Sanitària, Barcelona, Spain
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Zapater E, García-Lliberós A, López I, Moreno R, Basterra J. A new device to improve the location of a montgomery thyroplasty prosthesis. Laryngoscope 2014; 124:1659-62. [DOI: 10.1002/lary.24545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/16/2013] [Accepted: 12/03/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Isabel López
- ENT Department; University General Hospital; Valencia Spain
| | - Rosa Moreno
- Rehabilitation Department; University General Hospital; Valencia Spain
| | - Jorge Basterra
- ENT Department; University General Hospital; Valencia Spain
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Armengot M, García-Lliberós A, Gómez MJ, Navarro A, Martorell A. Sinonasal involvement in systemic vasculitides and cocaine-induced midline destructive lesions: Diagnostic controversies. Allergy Rhinol (Providence) 2013; 4:e94-9. [PMID: 24124643 PMCID: PMC3793120 DOI: 10.2500/ar.2013.4.0051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Multiple systemic diseases produce various clinical manifestations in the sinonasal area. They usually appear as difficult-to-diagnose disease processes with slow, atypical clinical courses. The aim of this study was to evaluate the sinonasal manifestations of systemic vasculitides, highlighting key points for diagnosis and differential diagnosis with other pathological entities, especially cocaine-induced midline destructive lesions (CIMDL). A retrospective study was performed of 10 patients treated in our hospital during the last 5 years with an initial diagnosis of systemic vasculitides with sinonasal involvement: eight patients with granulomatosis with polyangiitis (GPA; new nomenclature for Wegener granulomatosis) and two patients with Churg-Strauss syndrome (CSS). The study variables were clinical presentation, nasal endoscopy results, maxillofacial scan results, nasal biopsy results, erythrocyte sedimentation rate, and autoimmune antibody levels. The definitive diagnosis was GPA in six (60%) patients, CSS in two (20%) patients, and CIMDL in two (20%) patients. Nasal symptoms were similar in all patients, but nasal polyps were present in only one patient with CSS. Systemic manifestations were absent in patients with CIMDL. Likewise, peripheral eosinophilia was observed only in the two patients with CSS. Specific positive biopsy specimens were obtained in six patients (all six patients with GPA, one with CSS, and one with CIMDL). Antineutrophil cytoplasmic antibodies (ANCA) were positive in all patients with GPA (proteinase 3 antigen in five patients and myeloperoxidase in one patient), and perinuclear ANCA was positive in one patient with CIMDL; however, this patient showed an undefined pattern. Finally, the response to treatment was adequate in all patients excluding those with CIMDL. GPA and CIMDL syndromes pose a difficult differential diagnosis because they have common clinical, serological, and histological presentations. Negative histological results do not exclude the diagnosis of sinonasal vasculitides. The absence of systemic manifestations and the lack of response to treatment will lead to the confirmation of CIMDL syndrome in a cocaine user. Otolaryngologists play an important role in the early and differential diagnosis of these diseases.
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Affiliation(s)
- M Armengot
- Department of Pathology, General and University Hospital, Ear, Nose, and Throat and Medical School, and Departments of Surgery and Pathology, Valencia University, Valencia, Spain
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García-Lliberós A, Armengot M, Calabuig C. Tuberculous pseudotumor of the rhinopharynx. Arch Bronconeumol 2011; 47:537-8. [PMID: 21831497 DOI: 10.1016/j.arbres.2011.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 06/07/2011] [Accepted: 06/11/2011] [Indexed: 11/28/2022]
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