[Spontaneous cervical and pharyngolaryngeal hematoma after coughing attacks]. / Hematoma faringolaríngeo y cervical espontáneo tras crisis tusígena.

We report the case of a 86 years old male who, in the course of a coughing attack, refers spontaneous cervical and pharyngeal pain in addition to hoarness, dysphagia and some dyspnea. His exploration revealed a small right neck hematoma but with infiltration of the orohypopharynx and right hemilarynx for spreading later to posterior pharyngeal wall and left aryepiglottic fold. The patient was sent to ICU although he did not required a control of airway by intubation or tracheotomy finally.

Hematoma faringolaríngeo y cervical espontáneo tras crisis tusígena / Spontaneous cervical and pharyngolaryngeal hematoma after coughing attacks

Presentamos el caso clínico de un varón de 86 años que en el curso de una crisis tusígena comienza con dolor cervical y faríngeo espontáneo acompañado de disfonía, disfagia y cierta diseña. La exploración reveló un discreto hematoma laterocervical derecho pero con infiltración de la orohipofaringe y hemilaringe derechas para extenderse con posterioridad a la pared faríngea posterior y repliegue aritenoepiglótico izquierdo. El paciente fue trasladado a la UCI aunque no precisó finalmente control de la vía aérea mediante intubación o traqueotomía

We report the case of a 86 years old male who, in the course of a coughing attack, refers spontaneous cervical and pharyngeal pain in addition to hoarness, dysphagia and some dyspnea. His exploration revealed a small right neck hematoma but with infiltration of the orohypopharynx and right hemilarynx for spreading later to posterior pharyngeal wall and left aryepiglottic fold. The patient was sent to ICU although he did not required a control of airway by intubation or tracheotomy finally

[Unspecific cervical cellulitis of sudden appearance. Report of an atypical case]. / Celulitis cervical inespecífica de aparición brusca. Presentación de un caso atípico.

We report an atypical case of sudden and unspecific cervical cellulitis in a 74 yaers old woman with psoriasis as the only remarkable antecedent. After the initial exploration and successive ones we did not find any etiological causes for her symptoms. CT showed an increase of soft parts on the left side of the neck with displacemnet of the upper airway without purulent collection or abscess. The patient was admitted in IUC and was treated endovenously with cloxaciline and imipenem with good response and satisfactory evolution.

[Cervical abscess by Streptococcus anginosus-milleri after foreign body ingestion and suspicion of esophageal perforation]. / Absceso cervical por Streptococcus anginosus-milleri tras ingestión de cuerpo extraño y sospecha de perforación esofágica.

We report a case of cervical abscess after the ingestion of foreign body (chicken bone) secondary to probable esophageal perforation that it was sent to us with suspicion of mediastinal complication. The girl, 17 years-old, nothing else to arrive our hospitalary center required entrance in ICU due to her severe clinical process: High fever, intense neck-thoracic pain, laterocervical diffuse and progressive left inflammation and bad general state. The CT showed the presence of a well defined abscess and abundant aerial component that dissected the cervical muscles that made necessary to perform drainage verifying intraoperatively no mediastinal involvement. The culture of the purulent collection revealed Streptococcus anginosus/milleri resistant to clindamicine but sensible to penicilina and derivatives. We exposed a serie of considerations at respect of such microorganism and its clinical signification.

[Parotid phlegmon with involvement of both lobes. Report of a case]. / Flemón parotídeo con afectación de ambos lóbulos. A propósito de un caso.

The pathologic processes involving the parotid gland include a vast group of lesions, acute and chronic inflammations, benign and malign tumors, traumas or degenerative processes. We report the case of a 55 years old male diagnosed as left parotid phlegmon with involvement of both lobes, especially the deep one, who required admission and endovenous medical treatment for 6 days up to the resolution of the symptoms.

Flemón parotídeo con afectación de ambos lóbulos. A propósito de un caso / Parotid phlegmon with involvement of both lobes. Report of a case

La patología que puede afectar a la glándula parótida comprende un amplio grupo de lesiones, manifestaciones inflamatorias agudas y crónicas, tumores benignos y malignos, traumatismos o procesos degenerativos. Presentamos el caso de un varón de 55 años diagnosticados de un flemón parotídeo izquierdo con afectación de ambos lóbulos, especialmente del profundo, que precisó ingreso y tratamiento médico intravenoso durante 6 días hasta la resolución del cuadro clínico

The pathologic processes involving the parotid gland include a vast group of lesions, acute and chronic inflammations, benign and malign tumors, traumas or degenerative processes. We report the case of a 55 years old male diagnosed as left parotid phlegmon with involvement of both lobes, especially the deep one, who required admission and endovenous medical treatment for 6 days up to the resolution ofthe symptoms

[Utility of the surgical treatment for severe epistaxis by endoscopic approach of sphenopalatine and ethmoidal arteries]. / Utilidad del tratamiento quirúrgico de la epistaxis grave mediante abordaje endoscópico de las arterias esfenopalatina y etmoidal anterior.

INTRODUCTION: To evaluate the efficacy and cost-effectiveness of the treatments used for controlling epistaxis, particularly compared with the surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoid (AE) arteries, a intervention prospective-retrospective study is presented with the aim of assessing the feasibility of these surgical techniques as an alternative to conventional treatments. PATIENTS AND METHODS: 184 consecutive patients admitted in the ENT ward between the years 1997 and 2005 were included in the study, and distributed into three groups depending on the last treatment applied to control their bleeding: AP group.- anterior packing (n=98); PP group.- posterior packing (n=66), and ES group.- endoscopic ligation and/or cauterization of SP or AE (n=20). RESULTS: Highly significant differences were found between the groups, not only regarding the efficacy (90% for surgical treatment compared with 41.3% for AP and 63.1% for PP), but also the length of postreatment hospital stay (AP.- 4.92 days; PP.- 6.3 days; ES.- 2.15 days). DISCUSSION AND CONCLUSIONS: The lack of efficacy of conventional treatment and the increasing risk factors that condition nasal bleeding, together with the advance of endoscopic and anesthesic procedures have brought along the possibility of a surgical solution for these patients. Our results demonstrate the feasibility of these techniques as alternative for nasal packing in the treatment of posterior epistaxis, and even its ethical and economical convenience as a substitutive to posterior packing.

Absceso cervical por Streptococcus angious-milleri tras ingestión de cuerpo extraño y sospecha de perforación esofágica / Cervical abscess by Streptococcus anginosus-milleri after foreign body ingestion and suspicion of esophageal perforation

Presentamos un caso de absceso cervical tras ingestión de cuerpo extraño (pollo con hueso) secundario a probable perforación esofágica que nos fue remitido con sospecha de complicación mediastínica. Se trataba de una chica de 17 años que nada más llegar a nuestro centro hospitalario requirió ingreso en UCI dada la gravedad de su proceso: Fiebre alta, dolor intenso cérvico-torácico, tumefacción láterocervical izquierda difusa de carácter progresivo y mal estado general. El TAC informó de la presencia de un absceso bien definido y de abundante componente aéreo que disecaba la musculatura cervical por lo que fue necesario realizar drenaje comprobando intraoperatoriamente la no afectación del mediastino. El cultivo de la colección purulenta reveló Streptococcus anginosus-milleri resistente a clindamicina pero sensible a penicilina y derivados. Realizamos una serie de consideraciones al respecto de este microorganismo y su significación clínica

We report a case of cervical abscess after the ingestion of foreign body (chicken bone) secondary to probable esophageal perforation that it was sent to us with suspicion of mediastinal complication. The girl, 17 years-old, nothing else to arrive our hospitalary center required entrance in ICU due to her severe clinical process: High rever, intense neck-thoracic pain, laterocervical diffuse and progressive left inflammation and bad general state. The CT showed the presence of a well defined abscess and abundant aerial component that dissected the cervical muscles that made necessary to perform drainage verifying intraoperatively no mediastinal involvement. The culture of the purulent collection revealed Streptococcus anginosus/milleri resistant to clindamicine but sensible to penicilina and derivatives. We exposed a serie of considerations at respect of such microorganism and its clinical signification

Utilidad del tratamiento quirúrgico de la epistaxis grave mediante abordaje endoscópico de las arterias esfenopalatina y etmoidal anterior / Utility of the surgical treatment for severe epistaxis by endoscopic approach of sphenopalatine and ethmoidal arteries

Introducción: Presentamos un estudio de intervención (prospectivo-retrospectivo) para valorar la eficacia y relación coste-beneficio de distintos tratamientos para el control de la epistaxis posterior grave, y en especial para determinar si la cirugía de ligadura/cauterización de las arterias esfenopalatina (SP) y etmoidal anterior (EA) puede emplearse como alternativa a los medios convencionales. Pacientes y métodos: 184 pacientes consecutivos ingresados en nuestro servicio por epistaxis posterior fueron incluidos en el estudio entre los años 1997 y 2005, y asignados a uno de los tres grupos en función del último tratamiento que recibieron para el control de su sangrado: TA.- taponamiento anterior (98 pacientes); TP.- taponamiento posterior (66 pacientes); CE.- cirugía de ligadura/cauterización de las arterias SP y EA (20 pacientes). Resultados: Se encontraron diferencias altamente significativas entre los distintos tratamientos tanto en la eficacia (90% de la cirugía comparada con un 41,3% del taponamiento anterior y un 63,1% del posterior), tanto en lo que se refiere a la estancia media postratamiento (TA.-4,92 días; TP.- 6,3 días; CE.- 2,15 días). Discusión y conclusiones: La necesidad de repetición de los tratamientos en el control de la epistaxis posterior grave y el aumento de los factores de riesgo que la condicionan, junto con el avance de las técnicas endoscópicas y anestésicas, hacen posible la aplicación de una solución quirúrgica que demuestra una mayor eficacia y un acortamiento evidente de la estancia hospitalaria de estos pacientes. Los resultados de este estudio demuestran la viabilidad de estas técnicas como alternativa a los tratamientos convencionales, e incluso su conveniencia ética y económica como sustitutivas del taponamiento posterior

Introduction: To evaluate the efficacy and cost-effectiveness of the treatments used for controlling epistaxis, particularly compared with the surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoid (AE) arteries, a intervention prospective-retrospective study is presented with the aim of assessing the feasibility of these surgical techniques as an alternative to conventional treatments. Patients and methods: 184 consecutive patients admitted in the ENT ward between the years 1997 and 2005 were included in the study, and distributed into three groups depending on the last treatment applied to control their bleeding: AP group.- anterior packing (n=98); PP group.- posterior packing (n=66), and ES group.- endoscopic ligation and/or cauterization of SP or AE (n=20). Results: Highly significant differences were found between the groups, not only regarding the efficacy (90% for surgical treatment compared with 41.3% for AP and 63.1% for PP), but also the length of postreatment hospital stay (AP.- 4.92 days; PP.- 6.3 days; ES.- 2.15 days). Discussion and conclusions: the lack of efficacy of conventional treatment and the increasing risk factors that condition nasal bleeding, together with the advance of endoscopic and anesthesic procedures have brought along the possibility of a surgical solution for these patients. Our results demonstrate the feasibility of these techniques as alternative for nasal packing in the treatment of posterior epistaxis, and even its ethical and economical convenience as a substitutive to posterior packing

[Primary hyperparathyroidism in the pediatric population. Report of a case and review of the literature]. / Hiperparatiroidismo primario en la población pediátrica. Caso clínico y revisión de la literatura.

Parathyroid adenomas presenting as primary hyperparathyroidism are uncommon in children. We report a case in a 14 years-old male diagnosed as such illness who was studied by imaging tests (scintigraphy and IRM) that detected the responsible upper-left adenoma. He was operated without complications, with good postoperative evolution and normal calcium levels. Finally review the literature of this clinical entity in the pediatric population.

[Recidived medullary thyroid carcinoma with neck metastases and tracheal invasion]. / Carcinoma medular de tiroides recidivado con metástasis ganglionares e invasión traqueal.

Medullary carcinoma represents about 5% of all malignant tumors located in thyroid gland and it can appear as sporadic or hereditary form. We report the case of a 58-year-old female who was initially operated by General Surgery Department of an infiltrating medullary carcinoma with cervical metastasic nodes having its origin on left thyroid lobe (LTL). The patient did not want any kind of control and 5 years later she suffered dyspnea due to the tumoral recurrence with invasion of the trachea and recurrential left palsy. Our ENT Service only performed a tracheostomy on fourth tracheal ring because the woman did not accept another surgical intervention. For 6 years she has been followed and reviewed in our consults beeing on alive up to now.

[Postraumatic massive epistaxis. An indication for selective arterial embolization]. / Epístaxis masiva postraumática. Una indicación de embolización arterial selectiva.

We report a 38 years old male admitted to our hospital with massive epistaxis secondary to nasal trauma which required to perform a posterior packing, transfusion and embolization of the internal maxillary artery for stopping the nosebleed. Then we made a FENS (Functional Endoscopic Nasal Surgery) by cauterization of several bleeding points on nasal septum following an anterior packing that was removed after 48 hours without new epistaxis. In a patient like this we think that an angiography with selective embolization is the main choice when other options have failed.

Epístaxis grave recidivante secundaria a traumatismo nasal. Presentación de un caso atípico en varón de 22 años / Recurrent and severe epistaxis secondary to nasal trauma. Report of an atypical case in a 22 years-old-male

Presentamos el caso de un varón de 22 años que tras traumatismo nasal presentó epístaxis diferida y persistente grave que requirió varios ingresos hospitalarios y diversos tratamientos. Concretamente se realizaron por orden cronológico taponamiento s anteriores, ligadura-cauterización endoscópica de la arteria esfenopalatina, taponamiento posterior clásico y finalmente una nueva CENS con cauterización de la arteria etmoidal anterior. Además fue necesario transfundir para remontar la anemia del paciente cuya estancia global fue de 16 días. Las epístaxis refractarias postraumáticas son muy poco comunes pero ocasionalmente pueden suponer un problema difícil de resolver

We report the case of a 22 years old male who presented a diferred, recurrent and severe epistaxis after nasal trauma which required several admissions in our hospital and different treatments. Concretely by chronological order it has been practiced anterior tamponades, endoscopic ligature-cauterization of the sphenopalatine artery, classic posterior packing and finally a new FENS with cauterization of anterior ethmoidal artery. Besides it was necessary a transfusion to go up the anemia suffered by the patient whose global stay was 16 days. Recurrent postraumatic epistaxis are very rare but can be represent a difficult problem to solve

Carcinoma medular de tiroides recidivado con metástasis ganglionares e invasión traqueal / Recodoved medullary thyroid carcinoma with neck metastases and tracheal invasion

El carcinoma medular representa alrededor del 5% de todos los tumores malignos de la glándula tiroides y puede presentarse de forma esporádica o hereditaria. Presentamos el caso de una mujer de 58 años intervenida inicialmente por el Servicio de Cirugía General de un carcinoma medular infiltrante con metástasis ganglionares cervicales que afectaba al lóbulo tiroideo izquierdo (LTI). La paciente no siguió ningún tipo de control y 5 años después presentó disnea por recidiva tumoral con invasión de la luz traqueal y parálisis recurrencial izquierda. Nuestro Servicio de ORL practicó sólo una traqueotomía a nivel del cuarto anillo ya que la enferma no aceptó ninguna otra intervención. Durante 6 años ha seguido posteriormente revisiones en nuestras consultas continuando viva tras este período de tiempo y hasta la actualidad

Medullary carcinoma represents about 5% of all malignant tumors located in thyroid gland and it can appear as sporadic or hereditary formo We report the case of a 58 year-old female who was initially operated by General Surgery Department of an infiltrating medullary carcinoma with cervical metastasic nodes having its origin on left thyroid lobe (LTL). The patient did not want any kind of control and 5 years later she suffered dyspnea due to the turnaral recurrence with invasion of the trachea and recurrentialleft palsy. Our ENT Service only performed a tracheostorny on fourth tracheal ring because the wornan did not accept another surgical intervention. For 6 years she has been followed and reviewed in our consults beeing on alive up to now

Epístaxis masiva postraumática. Una indicación de embolización arterial selectiva / Postraumatic massive epistaxis. An indication for selective arterial embolization

Se presenta el caso de un varón de 38 años ingresado en nuestro hospital con epístaxis masiva secundaria a traumatismo nasal que requirió la realización de un taponamiento posterior, transfusión y embolización de la arteria maxilar interna para lograr controlar el sangrado. Posteriormente practicamos una CENF (Cirugía Endoscópica Nasal Funcional) con cauterización de varios puntos sangrantes a nivel del tabique nasal seguido de un taponamiento anterior que se retiró a las 48 horas sin aparecer nueva epístaxis. Para un paciente como el descrito creemos que la angiografía con embolización selectiva es de elección cuando han fracasado otras medidas

We report a 38 years old mal e admitted to our hospital with massive epistaxis secondary to nasal trauma which required to perform a posterior packing, transfusion and embolization of the internal maxillary artery for stopping the nosebleed. Then we made a FENS (Functional Endoscopic Nasal Surgery) by cauterization of several bleeding points on nasal septum following an anterior packing that was removed after 48 hours without new epistaxis. In a patient like this we think that an angiography with selective embolization is the main choice when other options have failed

[Nasal osteocartilaginous necrosis caused by cocaine. Our experience with two patients]. / Necrosis osteocartilaginosa nasal por cocaína. Nuestra experiencia en dos pacientes.

Sinonasal osteocartilaginous necrosis induced by the abuse of inhaled cocaine must be considered in the differential diagnosis of those pathologies that produce facial midline destructions. We report two cases corresponding to women admitted in our Hospital because of such entity. There were analysed their respective clinical histories, exploration data, complementary tests, medical-surgical treatment and evolution. Cocaine is one of the drugs that has increased in last 10 years producing an elevated number of complications, as we could proved on the bibliographic review performed.

[Glossopharyngeal neuralgia. A propos of one clinical case]. / Neuralgia del glosofaríngeo. A propósito de un caso clínico.

Glossopharyngeal or the 9th cranial nerve neuralgia is an uncommon pathology characterized by severe paroxysmal attacks of pain in the base of the tongue, posterior pharynx and tonsillar fossa some times associated with pain irradiated to the ear. It's Carbamazepine is the first choice of medical treatment while the microvascular decompression is considered the main surgical procedure.

Necrosis osteocartilaginosa nasal por cocaína. Nuestra experiencia en dos pacientes / Nasal osteocartilaginous necrosis by cocaine. Our experience in two patients

Las necrosis osteocartilaginosas nasosinusales debidas al abuso de cocaína por vía inhalatoria deben considerarse en el diagnóstico diferencial de las patologías que ocasionan destrucción de la línea media facial. Presentamos los casos clínicos de dos mujeres que fueron ingresadas en nuestro Hospital por este motivo. Analizamos sus historias clínicas respectivas, datos de la exploración, pruebas complementarias, tratamiento médico-quirúrgico y evolución. La cocaína es una de las drogas que ha experimentado un mayor incremento consumista en los últimos 10 años lo que ha dado lugar a un mayor número de complicaciones, como se pone de manifiesto en la revisión bibliográfica realizada

Sinonasal osteocartilaginous necrosis induced by the abuse of inhaled cocaine must be considered in the differential diagnosis of those pathologies that produce facial midline destructions. We report two cases corresponding to women admitted in our Hospital because of such entity. There were analysed their respective clinical histories, exploration data, complementary tests, medical-surgical treatment and evolution. Cocaine is one of the drugs that has increased in last 10 years producing an elevated number of complications, as we could proved on the bibliographic review performed

Neuralgia del glosofaríngeo. A propósito de un caso clínico / Glossopharyngeal neuralgia. A propos of one clinical case

La neuralgia del glosofaríngeo o IX par craneal es una patología poco común que se caracteriza por ataques de dolor paroxístico severo en base de lengua, pared faríngea posterior y fosa amigdalar a menudo acompañados de otalgia refleja. Se trata de un diagnóstico clínico a realizar una vez descartadas otras posibles causas. El tratamiento médico de elección es la carbamacepina mientras que la descompresión microvascular se considera el tratamiento quirúrgico de elección

Glossopharyngeal or the 9th cranial nerve neuralgia is an uncommon pathology characterized by severe paroxysmal attacks of pain in the base of the tongue, posterior pharynx and tonsillar fossa some times associated with pain irradiated to the ear. It's Carbamazepine is the first choice of medical tretament while the microvascular decompression is considered the main surgical procedure

[Recurrent and severe epistaxis secondary to nasal trauma. Report of an atypical case in a 22-year-old male]. / Epistaxis grave recidivante secundaria a traumatismo nasal. Presentación de un caso atípico en varón de 22 años.

We report the case of a 22-year-old male who presented a diferred, recurrent and severe epistaxis after nasal trauma which required several admissions in our hospital and different treatments. Concretely by chronological order it has been practiced anterior tamponades, endoscopic ligature-cauterization of the sphenopalatine artery, classic posterior packing and finally a new FENS with cauterization of anterior ethmoidal artery. Besides it was necessary a transfusion to go up the anemia suffered by the patient whose global stay was 16 days. Recurrent postraumatic epistaxis are very rare but can be represent a difficult problem to solve.