Síndrome de Eagle, apófisis estiloides con prolongación hasta el hioides / Eagle syndrome, styloid process with prolongation to the hyoid

Se presenta un caso de un paciente de 48 años que fue tratado inicialmente por síndrome de articulación temporomandibular; posteriormente se diagnosticó apófisis estiloides mayor a 8 cm que se prolongaba hasta el hioides bilateralmente. Refería intenso dolor a predominio izquierdo en cabeza y cuello. La radiografía panorámica y la tomografía computada 3 D permitieron evaluar la dimensión de las apófisis. Se intervino quirúrgicamente el lado izquierdo que resultaba ser el más sintomático, por vía externa con buena evolución sin morbilidad..(AU)

It is presented a case of a 48 year male who was treated initially by temporomandibular malfunction; lately was diagnosed a styloid process longer than 8 cm that extended up to hyoids bilaterally. He referred an intense pain especially in the left side of head and neck. The panoramic radiography and the tomography scan with 3 dimension reconstruction allowed us to evaluate the process dimension. We underwent an external access surgery on the more symptomatic side. The evolution was good without complications..(AU)

Malignant Peripheral Nerve Sheath Tumor of the Infraorbital Nerve.

The objective of this study is to report a large, rare, and ulcerative infiltrated skin lesion. Its diagnosis, therapeutic management, and progress are described. The patient is a 78-year-old white man, who presented with a 12-month ulcerative perforated lesion that had affected and infiltrated the skin, with easy bleeding. He had a history of hypertension, although controlled, was a 40-year smoker, had chronic atrial fibrillation, diabetes, and microangiopathy. During the consultation, the patient also presented with ocular obstruction due to an inability to open the eye. He mentioned having reduced vision. The computed tomography scan showed upper maxilla osteolysis without eye involvement. We underwent a radical resection in which upper maxilla and the anterior orbital margin were included. We used a Becker-type flap that allowed us to rebuild the cheek and to complete a modified neck dissection. Progress was favorable; the patient recovered ocular motility and his vision improved to 20/200. The final biopsy result was "malignant peripheral nerve sheath tumor, malignant schwannoma." Malignant schwannoma of the peripheral nerve is extremely rare. The total resection and reconstruction being completed in one surgery represented a challenge due to the difficulty in obtaining tissues in addition to the necessity of an oncological resection.

El paciente virtual como método de enseñanza en el pregrado / The virtual patient as a teaching method in undergraduate

OBJETIVOS: Presentar un programa de trabajo práctico virtual para cirugía utilizando el correo electrónico y a través del aprendizaje basado en problemas, y evaluar la respuesta del alumnado. SUJETOS Y MÉTODOS: Análisis retrospectivo y lineal. Se consideran los alumnos de los últimos cinco años, con un promedio de 18 alumnos por año. Total: 90 alumnos. Con cada uno de los tutores intervinientes en el proyecto se establecieron pautas de manejo y seguimiento de cada caso clínico quirúrgico que se daba a cada alumno. Todos los alumnos tenían un caso diferente entre sí que se repitió anualmente en cada curso. Algunos tutores seguían un solo caso y otros, dos. Cada alumno estableció con su tutor la manera más fácil y práctica para comunicarse, sea por teléfono, correo electrónico o personalmente. El tutor debía incentivar la búsqueda de información y hacer que el alumno se sintiera responsable del paciente. Cada caso, previamente establecido, debía ser operado, sufrir complicaciones, algunos fueron dados de alta y otros fallecieron. En base al número de alumnos cursantes, se determinaron los casos, siempre buscando que cada tutor desarrollara casos afines a las clases que daba o a su subespecialidad. RESULTADOS: El trabajo práctico virtual usando Internet fue muy útil para los estudiantes y benefició la relación docentealumno. La encuesta realizada a los alumnos mostró un 100% de satisfacción con el proyecto, lo mismo que la encuesta a los tutores. CONCLUSIÓN: La iniciativa de realizar un práctico con un paciente virtual fue sumamente satisfactoria para alumnos y tutores

AIMS: To present a virtual program about a practical work in Surgery using the web through problem based learning and to evaluate the student opinion. SUBJECTS AND METHODS: Retrospective and lineal analysis. We included all the students in the last five years, with average of 18 students each one. Total: 90 pupils. Were established with each of the tutors, management guidelines and monitoring of each surgical case report that was given every student. All the students had a different case, repeated annually in each course. Some tutors had only one case and others two. Each pupil agrees with the tutor the easiest way to have a communication between them, such as phone, e-mail o in person. The tutor had to encourage the information research and make the student responsible of the patient. Every one of the cases, previously set, should have complications, some were extern and others died. Based on the number of students in each course, we decided the cases, always trying to find out cases according with the classes taught by the tutor and his specialization. RESULTS: The virtual program about a practical work in surgery has been very useful for the pupils and improved the relation between them and tutors. The search with students showed a 100% of satisfaction with this project, the same as with the tutors search. CONCLUSION: The initiative of a working with a virtual patient has been extremely successful for both students and tutors