Dennis Steven Moncayo Cabascango

Este libro constituye una herramienta práctica y actualizada para el abordaje integral de las patologías otorrinolaringológicas más frecuentes y complejas. A través de un enfoque claro y estructurado, presenta criterios diagnósticos precisos respaldados por la evidencia, junto con estrategias de manejo clínico y quirúrgico adaptadas a distintos niveles de atención.

Functional airway medicine has emerged as an integrative framework that redefines the understanding of upper airway disorders by linking otolaryngology, dentofacial structures, maxillofacial trauma, and sleep-related breathing conditions within a unified clinical model. This review aimed to analyze the interaction between these domains and their collective influence on airway function and systemic health. A narrative review was conducted based on recent high-impact literature published from 2020 onward, focusing on studies related to nasal obstruction, craniofacial morphology, dental occlusion, trauma-related structural changes, and obstructive sleep apnea. The findings demonstrate that airway dysfunction is a multifactorial process in which ENT pathology, mandibular positioning, dentofacial structure, and neuromuscular dynamics interact continuously. Nasal obstruction and upper airway alterations were identified as primary contributors to airflow limitation, while dentofacial factors and craniofacial morphology significantly influenced airway dimensions and collapsibility. Maxillofacial trauma was found to play an important role in long-term airway alteration, particularly through structural changes affecting nasal and mandibular alignment. Sleep-related breathing disorders, especially obstructive sleep apnea, were identified as the clinical expression of these combined factors. Additionally, the relationship between airway dysfunction and systemic conditions such as cardiovascular and metabolic disease highlights the broader health implications of airway pathology.

Minimally invasive surgery has undergone significant transformation with the emergence of next-generation laparoscopy, characterized by the integration of ergonomic optimization, advanced visualization technologies, and intelligent assistance systems. This review aims to analyze the current state and future perspectives of laparoscopic surgery through these three core domains, emphasizing their combined impact on surgical performance, intraoperative safety, and clinical outcomes. A narrative review of high-impact literature published from 2020 onward was conducted, focusing on technological advancements and their application across diverse healthcare settings. The findings indicate that ergonomics remains a critical factor influencing surgeon performance and long-term sustainability, while innovations in visualization—such as three-dimensional imaging and fluorescence guidance—enhance spatial perception and operative precision. Additionally, the incorporation of artificial intelligence is redefining surgical workflows by enabling real-time analysis, safety assessment, and decision support. Despite these advances, disparities in access and implementation persist, particularly in middle-income regions such as Mexico, Colombia, and Ecuador. The evidence suggests that a progressive and context-adapted integration of these technologies is essential to ensure both innovation and accessibility. Ultimately, next-generation laparoscopy represents a shift toward a more integrated, data-driven, and human-centered surgical paradigm.

Decision-making in general surgery frequently occurs under conditions of uncertainty, where surgeons must integrate clinical judgment, risk assessment, timing, and system-level factors to optimize patient outcomes. This review aims to analyze current evidence on decision-making processes in general surgery, focusing on risk stratification, timing of intervention, and perioperative strategies. A structured narrative review was conducted using high-impact literature indexed in international databases, including multicenter cohort studies, systematic reviews, and validated predictive models. The findings demonstrate that higher preoperative risk is consistently associated with worse postoperative outcomes, particularly in urgent and emergency surgical settings. Timing of intervention emerged as a critical determinant, with elective procedures showing significantly lower mortality and complication rates compared to non-elective surgery. Additionally, structured perioperative strategies, including enhanced recovery protocols and safety systems, were associated with reduced complications and shorter hospital stays. The results also highlight that postoperative outcomes follow an interconnected pattern, where complications contribute to prolonged hospitalization, readmission, and mortality. Furthermore, the analysis underscores the importance of system-level factors, particularly in middle-income countries such as Mexico, Colombia, and Ecuador, where variability in resources and infrastructure influences surgical outcomes. The integration of data-driven tools and multidisciplinary approaches was identified as a key component in improving decision-making under uncertainty. In conclusion, optimizing surgical decision-making requires an integrated approach that combines objective risk assessment, timely intervention, structured perioperative care, and adaptation to local healthcare contexts. This framework supports improved patient outcomes and advances the quality of surgical care in diverse clinical settings.