Lesiones hemorrágicas en la mucosa oral como forma de presentación de una púrpura trombocitopénica idiopática / Haemorrhagic lesions in oral mucosa as the presentation of idiopathic thrombocytopenic purpura

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Síndrome de Horner secundario a cirugía cervical / Horner's syndrome after neck surgery

El síndrome de Horner (oculosimpatoparesis) consiste en la clásica triada de ptosis palpebral, miosis pupilar y anhidrosis facial ipsilateral. El síndrome resulta tras la interrupción de la inervación simpática del ojo y de los anexos oculares a diferentes niveles, siendo una complicación poco frecuente de la cirugía cervical. Describimos los casos de 6 pacientes que presentaron síndrome de Horner tras cirugía cervical en nuestro servicio en los últimos 5 años y una revisión de los diferentes procedimientos cervicales que producen dicha entidad(AU)

Horner's syndrome (oculosympathetic paresis) is characterised by the classic triad of ipsilateral palpebral ptosis, pupillary miosis and facial anhidrosis. The syndrome arises from the interruption of sympathetic innervation to the eye and adnexa at varying levels. It is a rare complication of neck surgery. We describe 6 patients who presented with Horner's syndrome after a neck procedure in our department during the last 5 years and review the different neck procedures that can cause it(AU)

Manifestaciones otorrinolaringológicas en pacientes con granulomatosis de Wegener (granulomatosis con poliangeitis) / Ear, nose and throat manifestations of Wegener's granulomatosis (granulomatosis with polyangiitis)

Introducción y objetivos: La granulomatosis con poliangeitis (GPA), previamente llamada granulomatosis de Wegener, es una vasculitis de pequeños vasos que con frecuencia se asocia a manifestaciones clínicas de cabeza y cuello, y en ocasiones constituyen los síntomas de presentación de la enfermedad. El objetivo de nuestro estudio fue identificar la afección otorrinolaringológica asociada a dicha enfermedad y proponer un protocolo diagnóstico de los pacientes con sospecha clínica o confirmada de la misma. Pacientes y métodos: Se realizó un estudio retrospectivo descriptivo que incluyó los pacientes diagnosticados de GPA que recibieron asistencia por el Servicio de Otorrinolaringología de un hospital público de tercer nivel de Cantabria. El período de inclusión fue de 20 años. Se recogieron de la historia clínica diferentes variables clínicas concernientes al área de cabeza y cuello. Resultados: Veinticinco pacientes con edades comprendidas entre 30 y 81 años de edad fueron incluidos en nuestro estudio. El 88% de los mismos presentaron manifestaciones otorrinolaringológicas en algún momento de la evolución de la enfermedad, y en un 28% constituyeron la forma de presentación de la misma. Los síntomas nasosinusales fueron los más frecuentes (52%), seguido de los otológicos (32%). Un paciente desarrolló un carcinoma de nasofaringe 3 años después del tratamiento con ciclofosfamida. Conclusiones: Los pacientes con GPA presentan con frecuencia manifestaciones clínicas de cabeza y cuello. Es necesario realizar una exploración sistemática otorrinolaringológica en los pacientes con sospecha o diagnóstico confirmado de GPA, tanto para contribuir al diagnóstico de la enfermedad, si esta no estuviese confirmada, como para establecer el grado de afección sistémica de pacientes con esta vasculitis(AU)

Introduction and objectives: Granulomatosis with polyangiitis (GPA), previously called Wegener's granulomatosis, is a small vessel vasculitis often associated with clinical head and neck manifestations, which are sometimes the presenting symptoms of the disease. The aim of our study was to identify ear, nose and throat (ENT) manifestations associated with GPA and propose a work-up for the management and diagnosis for patients with suspicion or confirmed diagnosis of this ENT pathology. Patients and methods: Retrospective review of the medical records of all patients diagnosed with GPA who were seen at the Department of Otolaryngology from a tertiary public hospital in Cantabria (Spain) over a 20-year period. Clinical and laboratory data, in particular those concerning ENT manifestations, were retrieved from the patients’ medical records. Results: Twenty-five patients (age range: 30-81 years) were included in the study. Of these, 88% had ENT manifestations at some point in the course of the disease. In 28% of the cases, ENT features were the presenting manifestations. The most frequent ENT manifestations were sinonasal symptoms (52%), followed by otological manifestations (32%). Conclusions: Patients with GPA often present with clinical ENT manifestations. Consequently, routine ENT physical examination must be performed in patients with suspected vasculitis to establish a diagnosis of GPA or to better determine the degree of organ system involvement in patients with GPA(AU)

Horner's syndrome after neck surgery.

Horner's syndrome (oculosympathetic paresis) is characterised by the classic triad of ipsilateral palpebral ptosis, pupillary miosis and facial anhidrosis. The syndrome arises from the interruption of sympathetic innervation to the eye and adnexa at varying levels. It is a rare complication of neck surgery.We describe 6 patients who presented with Horner's syndrome after a neck procedure in our department during the last 5 years and review the different neck procedures that can cause it.

[Ear, nose and throat manifestations of Wegener's granulomatosis (granulomatosis with polyangiitis)]. / Manifestaciones otorrinolaringológicas en pacientes con granulomatosis de Wegener (granulomatosis con poliangeitis).

INTRODUCTION AND OBJECTIVES: Granulomatosis with polyangiitis (GPA), previously called Wegener's granulomatosis, is a small vessel vasculitis often associated with clinical head and neck manifestations, which are sometimes the presenting symptoms of the disease. The aim of our study was to identify ear, nose and throat (ENT) manifestations associated with GPA and propose a work-up for the management and diagnosis for patients with suspicion or confirmed diagnosis of this ENT pathology. PATIENTS AND METHODS: Retrospective review of the medical records of all patients diagnosed with GPA who were seen at the Department of Otolaryngology from a tertiary public hospital in Cantabria (Spain) over a 20-year period. Clinical and laboratory data, in particular those concerning ENT manifestations, were retrieved from the patients' medical records. RESULTS: Twenty-five patients (age range: 30-81 years) were included in the study. Of these, 88% had ENT manifestations at some point in the course of the disease. In 28% of the cases, ENT features were the presenting manifestations. The most frequent ENT manifestations were sinonasal symptoms (52%), followed by otological manifestations (32%). CONCLUSIONS: Patients with GPA often present with clinical ENT manifestations. Consequently, routine ENT physical examination must be performed in patients with suspected vasculitis to establish a diagnosis of GPA or to better determine the degree of organ system involvement in patients with GPA.

Traumatismos cervicales / Neck injuries

Introducción y objetivo: Los traumatismos cervicales tienen un gran interés clínico dado que se asocian a una elevada morbimortalidad si no son manejados adecuadamente. El objetivo de nuestro estudio fue revisar los traumatismos cervicales externos en nuestro hospital. Material y métodos: Se realizó un estudio descriptivo retrospectivo que incluyó a pacientes que presentaron lesiones penetrantes de cuello tratadas por el Servicio de ORL en un hospital terciario durante 24 años. Resultados: Veintidós pacientes fueron incluidos en nuestro estudio. Un 45% de los casos fueron secundarios a accidentes de tráfico, un 27,3% a una agresión con arma blanca y un 23% a un intento de suicidio. En 15 casos (68%) constituían traumatismos abiertos y en 7 cerrados (31%). El síntoma más frecuente de presentación fue la hemorragia (55%), seguido de trastornos respiratorios (23%). En la exploración, en un 27% de los pacientes se detectó un enfisema subcutáneo. En un 50% de los casos se realizaron técnicas de imagen antes del tratamiento, siendo la más frecuente la tomografía computarizada de cuello (27%). Un 59,1% de los pacientes requirieron tratamiento quirúrgico, precisando una traqueotomía en 6 casos (27%), falleciendo por complicaciones hemorrágicas dos de ellos (9%). Otros 6 pacientes presentaron secuelas permanentes. Conclusiones: Los traumatismos cervicales con afectación de estructuras otorrinolaringológicos son infrecuentes en nuestro medio, siendo las más habituales las secundarias a accidentes de tráfico. Es importante tener protocolizado el manejo de estos pacientes ya que con frecuencia pueden presentar complicaciones severas o incluso la muerte, si no son tratados adecuadamente en un corto período de tiempo (AU)

Introduction and objective: Neck injuries are of great clinical interest because they can induce very significant consequences if not handled properly and can even lead to death. The aim of our study was to analyse external deep cervical trauma in our hospital. Material and methods: A retrospective study of all external deep neck injuries seen in a tertiary hospital over the course of 24 years that involved changes in structures related to otolaryngology. Results: Twenty patients were included in our study. From all the injuries, 45% were secondary to traffic accidents, 27% from assault with a knife and 23% from attempted suicide. The injuries were open in 15 (68%) cases and closed in 7 (32%). The most common symptom was bleeding (55%), followed by respiratory disorders (23%). On examination, the most frequent sign was the appearance of subcutaneous emphysema (27%). Only 50% of patients underwent imaging before treatment, most often a neck CT (27%). 59% of patients needed surgery, with 6 patients (27%) requiring a tracheotomy. Two of them died (9%) and 6 suffered permanent complications. Conclusions: Cervical injuries involving ENT structures are rare in our environment, with the most common cause being traffic accidents. It is important to have standardised guidelines for the management of these patients, because they can often developed severe complications or even die if not treated properly very rapidly (AU)

Neck injuries.

INTRODUCTION AND OBJECTIVE: Neck injuries are of great clinical interest because they can induce very significant consequences if not handled properly and can even lead to death. The aim of our study was to analyse external deep cervical trauma in our hospital. MATERIAL AND METHODS: A retrospective study of all external deep neck injuries seen in a tertiary hospital over the course of 24 years that involved changes in structures related to otolaryngology. RESULTS: Twenty patients were included in our study. From all the injuries, 45% were secondary to traffic accidents, 27% from assault with a knife and 23% from attempted suicide. The injuries were open in 15 (68%) cases and closed in 7 (32%). The most common symptom was bleeding (55%), followed by respiratory disorders (23%). On examination, the most frequent sign was the appearance of subcutaneous emphysema (27%). Only 50% of patients underwent imaging before treatment, most often a neck CT (27%). 59% of patients needed surgery, with 6 patients (27%) requiring a tracheotomy. Two of them died (9%) and 6 suffered permanent complications. CONCLUSIONS: Cervical injuries involving ENT structures are rare in our environment, with the most common cause being traffic accidents. It is important to have standardised guidelines for the management of these patients, because they can often developed severe complications or even die if not treated properly very rapidly.