Linfangiomas de cavidad oral en edad pediátrica / Lymphangiomas of the oral cavity in childhood

Los linfangiomas son tumores raros y benignos producidos por el desarrollo anómalo de los vasos linfáticos. Presentamos un caso de linfangioma quístico asintomático localizado en paladar duro; se trata de una localización atípica, puesto que la mayoría de esas lesiones se localizan en la lengua a nivel de cavidad oral. Se realizó una resección con láser de CO2, sin que se evidenciase recidiva tras dos años de seguimiento. Actualmente se acepta adoptar una actitud expectante o el tratamiento con agentes esclerosantes que reduzcan su tamaño o los eliminen (AU)

Lymphangiomas are rare, benign tumors produced by the abnormal development of the lymphatic vessels. We present a case of asymptomatic cystic lymphangioma localized in the hard palate. This is an uncommon location since most of these lesions are found in the tongue at the level of the oral cavity. Resection was performed with CO laser, and there was no evidence of recurrence after two years of follow-up. At the present time, the approaches most widely accepted are expectant treatment or administration of sclerosing agents that reduce the size of the lesions or eliminate them (AU)

El absceso retrofaríngeo en la edad infantil / Childhood retropharyngeal abscess

Introducción: Las infecciones del espacio retrofaríngeo tienen una baja incidencia. Suceden entre los 2 y los 5 años de edad normalmente. Son infecciones polimicrobianas, aunque dominan los estreptococos, estafilococos y gérmenes anaerobios. Producen dolor faríngeo, fiebre y disfagia, asociada a rigidez cervical. En la exploración se observa un abombamiento de la pared posterior faríngea. Caso clínico: Presentamos el caso de un niño de 2 años que presentó un absceso de 11 cm3 de volumen, y otro de una niña de 4 años con un absceso de 8 cm3, por lo que se procede a la incisión y el drenaje del absceso por vía transoral de entrada. Discusión: La tomografía computarizada (TC) cervical es la prueba diagnóstica de elección; permite realizar el diagnóstico en estadio temprano, así como la diferenciación entre celulitis y absceso. El absceso retrofaríngeo rara vez se resuelve espontáneamente, por lo que es necesario administrar antibioterapia intravenosa y, si es mayor de 3 mL, un drenaje quirúrgico por vía transoral o externa mediante cervicotomía lateral. Conclusión: La prueba estándar es la TC. Las complicaciones pueden ser muy graves(AU)

Introduction: The incidence of retropharyngeal infection is low. The usually occur in children between the ages of 2 and 5 years. They are often polymicrobial infections, although Streptococcus, Staphylococcus, and anaerobic organisms are especially predominant. The clinical symptoms are sore throat, fever, dysphagia and stiff neck. Physical exploration reveals a bulging of the posterior pharyngeal wall. Case report: We report the cases of a two-year-old boy with and abscess of 11 cm3 and a four-year-old girl with an abscess of 8 cm3 that required transoral surgical drainage. Discussion: Computed tomography of the neck is the diagnostic technique of choice as it enables the early detection of abscesses and makes it possible to distinguish between and abscess and cellulitis. Retropharyngeal abscesses rarely resolve spontaneously and, thus, require intravenous antibiotic therapy and, when the volume is greater thar 3 cc., transoral surgical drainage or external drainage via lateral neck incision. Conclusion: Computed tomography is the gold standard for the diagnosis of this entity. Very severe complications can develop(AU)

Malformaciones arteriovenosas durales en el ámbito de la ORL / Arterioveinous dural malformation in ENT

La Malformación Arteriovenosa Dural (MAVD) es una entidad rara dentro de las anomalías vasculares intracraneales, con etiología nobien conocida y variabilidad en sus tratamientos. Presentamos once casos de MAVDs de entre los cuales 5 presentaban el acúfeno como síntoma de aparición. La importancia de esta patología hace necesario descartarla ante un paciente que consulta por un acúfeno pulsátil con otoscopia normal

The arterioveinous dural malformation (MAVD) is a rare entity between the vascular craneal anomalies with a not well nown ethiology and variability in treatments. We present eleven cases of MAVDs, between them five presented tinnitus as symptom of aparition. The importance of this pathology makes necessary to discard it before a patient consulting because of pulsaltil tinnitus with normal otoscopy

[Fistula of the first branchial arch]. / Fístula de primer arco branquial.

The complexity of the embriologic development of the neck and the possible abnomarlies in this process, with the consequent posterior manifestations make necessary the knowledge of the embriologic anatomy of the neck. In the possible manifestations that can be of the anomalies of the development of the branchial archs are the abnomarlies of the first branchial archs. They are, in the anomalies of the development of the branchial archs infrequent and are intimately related with the facial nerve. We present a clinic case of a seven years old boy affected by this pathology and revise its more important aspects.

Fístula del primer arco branquial / Fistula of the first branchial arch

La complejidad del desarrollo embriológico del cuello y las posibles del cuello y las posibles anomalías en este proceso, con las consiguientes manifestaciones posteriores hacen necesario el conocimiento de la anatomía embriológica del cuello. Dentro de las posibles manifestaciones que pueden darse de las anomlías del desarrollo de los arcos branquiales se encuentran las anomalías del primer arco branquial. Son dentro de las anomalías del desarrollo de los arcos branquiales, infrecuentes y están íntimamente relacionadas con el nervio facial. Presentamos el caso clínico correspondiente a un niño de 7 años con esta patología y repasamos los aspectos más importantes de la misma

The complexity of the embryologic development of the neck and the possible abnormalies in thi process, with the consequent posterior manifestations make necessary the knowledge of the embryologic anatomy of the neck. In the possible manifestations that can be of the abnormalies of the development of the branchial archs are the abnormalies of the first branchial archs. The are, in the anomalies of the development of the branchial archs infrequent and are intimately related with the facial nerve. We present a clinic case of a seven years old boy affected by this pathology and revise its more important aspects

[Arterioveinous dural malformation in ENT]. / Malformaciones arteriovenosas durales en el ambito de la ORL.

The arterioveinous dural malformation (MAVD) is a rare entity between the vascular craneal anomalies with a not well nown ethiology and variability in treatments. We present eleven cases of MAVDs, between them five presented tinnitus as symptom of aparition. The importance of this pathology makes necessary to discard it before a patient consulting because of pulsaltil tinnitus with normal otoscopy.

Tortícolis y vértigo paroxístico / Tortícolis and vértigo paroxístico

No disponible

[Persistence of the third branchial arch]. / Persistencia de tercer arco branquial.

The third branquial arch anomalies represent less than 1% of this deformites. The clinical manifestation can be varied althouth the formation of cysts is the commonest one and may appear at any time in life. We report the clinical case of a 7 year old boy with an neck mass. This mass was diagnosed as a branquial cyst. The patologist found a "timic reminescences". We carry out a review of the literature for this pathology.

Persistencia de tercer arco branquial / Persistence of the third branchial arch

Las anomalías derivadas del desarrollo del tercer arco y bolsa branquiales representan menos del 1% del total de estas malformaciones. Su forma de manifestación puede ser variada, aunque la más frecuente es la forma quística y pueden aparecer en cualquier etapa de la vida. Presentamos el caso clínico correspondiente a un paciente de 7 años con una tumoración laterocervical derecha de un año de evolución, diagnosticado de quiste branquial y con un estudio anatomopatológico tras la extirpación de restos tímicos. De igual modo realizamos una revisión de la literatura de estos casos

The third branquial arch anomalies represent less than 1% of this deformites. The clinical manifestation can be varied althouth the formation of cysts is the commonest one and may appear at any time in life. We report the clinical case of a 7 year old boy with an neck mass. This mass was diagnosed as a branquial cyst. The patologist found a "timic reminescences". We carry out a review of the literature for this pathology

[Cochlear implants in obliterated or ossified cochleas]. / Implantes cocleares en cócleas obliteradas o semiosificadas.

Our last cases of cochlear implants in obliterated or ossified cochleas are presented, and we had described the surgical technique for double-array or compressed system. In our opinion the best surgical method is the combined approach (endoaural with aticotomy view and posterior timpanotomy) for increased promontory view. This technique provides the advantage that it always preserve the posterior wall of the external ear canal, and the array is positioned easily.

Implantes cocleares en cócleas obliteradas o semiosificadas / Cochlear implants in obliterated or ossified cochleas

Presentamos los últimos casos de IC en cócleas obliteradas u osificadas, describiendo la técnica quirúrgica más apropiada para el empleo de los portaelectrodos bífidos o comprimidos, destacando la importancia de la vía combinada (endoaural con aticotomía y timpanotomía posterior) para lograr la mejor visualización del promontorio. Este método tiene la ventaja de respetar la pared posterior del CAE en todos los casos y lograr con facilidad la colocación del implante

Our last cases of cochlear implants in obliterated or ossified cochleas are presented, and we had described the surgical technique for double-array or compressed system. In our opinion the best surgical method is the combined approach (endoaural with aticotomy view and posterior timpanotomy) for increased promontory view. This technique provides the advantage that it always preserve the posterior wall of the external ear canal, and the array is positioned easily

[Internal carotid artery loop: an uncommon cause of parapharyngeal tumor]. / Bucle de arteria carótida interna: una causa infrecuente de tumoración parafaríngea.

The parapharyngeal space-occupying lessions may develop from any of the structures located inside it. Uncommon although possible ethiologies for them are anatomic variations of the course of the internal carotid artery. These anatomic variants mainly arise from degenerative, mostly age-amplified, causes and lead to elongations, angulations, kinking and tortuosities in the course of the vessel that appear as impressions or protusions of the pharyngeal wall. Utherly unfrecuently lead to loops that may show as large parapharyngeal tumors. This fact should be noticed previously to any invasive procedure to be performed on the patient specially when evidenced in concommitance with an infectious process at the moment of diagnosis. A case of an impressive internal carotid artery loop that conditioned an important parapharyngeal mass in a patient with an associated pharyngeal infection is reported to warn about this rare parapharyngeal space-occupying condition and its potential danger.

[Tuberculous epiglotittis, an atypical form of laryngeal tuberculosis. Presentation of a case and revision of litterature]. / Epiglotis tuberculosa, una forma atípica de tuberculosis laríngea. Presentación de un caso y revisión de la literatura.

An important arousal of tuberculosis has been observed in the last years, together with a change in it's clinical patterns, specially the extrapulmonar form, among wich is this laryngeal tuberculosis. This two facts and the marked polymorphism and mimetism proper of this condition may suggest that the Mycobacterium tuberculosis should be included in the differential diagnosis of any atypical lesion of the larynx, in order to obtain an earlier diagnosis excluding carcinoma and instaurate a chimotherapic protocol for minimizing or even avoiding any sequelae. Tuberculous epiglotittis is one of these atypical and unusual forms. The authors report a case of a 67 year-old male and provide a discussion on the diagnostic problems of this condition.

Bucle de arteria carótica interna. Una causa infrecuente de tumoración parafaríngea / Internal carotid artery loop: an uncommon ethiology for a parapharyngeal tumor

Las tumoraciones del espacio parafaríngeo pueden originarse a partir de cualquiera de las estructuras que por él discurren. Una infrecuente aunque posible etiología de las mismas son las variantes anatómicas del trayecto de la arteria carótida interna. Dichas variantes anatómicas surgen generalmente de causas degenerativas y conducen a elongamientos, tortuosidades o suaves rizos que originan improntas en la pared faríngea. Muy raramente, se producen bucles que pueden originar importantes tumoraciones faríngeas. Este hecho debería ser reconocido previamente a cualquier tipo de procedimiento invasivo en el paciente, especialmente cuando concurre en su diagnóstico un proceso infeccioso. Presentamos un caso de gran bucle de arteria carótida interna que condicionó una importante tumoración parafaríngea en un paciente con infección faríngea asociada para llamar la atención sobre esta rara entidad como causa de tumoración parafaríngea y su potencial peligro

The parapharyngeal space-occupying lessions may develop from any of the structures located inside it. Uncommon although possible ethiologies for them are anatomic variations of the course of the internal carotid artery. These anatomic variants mainly arise from degenerative, mostly age-amplified, causes and lead to elongations, angulations, kinking and tortuosities in the course of the vessel that appear as impressions or protusions of the pharyngeal wall. Utherly unfrecuently lead to loops that may show as large parapharyngeal tumors. This fact should be noticed previously to any invasive procedure to be performed on the patient specially when evidenced in concommitance with an infectious process at the moment of diagnosis .A case of an impressive internal carotid artery loop that conditioned an important parapharyngeal mass in a patient with an associated pharyngeal infection is reported to warn about this rare parapharyngeal space-occupying condition and its potential danger

[Idiopathic Frey's syndrome under the appearance of a recurrent otitis externa]. / Síndrome de Frey idiopático bajo la apariciencia de una otitis externa recidivante. Tratamiento con neuro-toxina botulínica tipo A.

Frey syndrome has been observed especially in patients who have undergone a parotidectomy operation, but also in zoster herpes, in parotiditis, condilea fractures, obstetric traumatisms with forceps and in surgery of the meningioma of the cerebellopontine angle. It also appears without previous surgery, like in our case. In these circumstances it is believed that a clinical neuritis, primary or secondary to a neighbouring inflammation may cause the start of this disorder. Several treatments have been suggested which highlights the difficulty of them. The most effective one is the intradermic injection of botulinum toxin type A. Its use in Frey's syndrome was initiated by Drobik and Laskawi in 1995. Since then the references to its use are numerous. Nevertheless, it is a treatment which has been introduced very few times in our country.

Epiglotis tuberculosa, una forma atípica de tuberculosis laríngea. Presentación de un caso y revisión de la literatura / Tuberculous epiglotittis, an atypical form of laryngeal tuberculosis. Presentation of a case and revision of literature

Estamos asistiendo en los últimos años a un resurgir de la tuberculosis, con especial mención a las formas extrapulmonares, entre las que se encuentra la tuberculosis laríngea, a la vez que a un cambio en los patrones típicos de presentación recogidos históricamente en la literatura médica. Estos dos hechos, unidos al conocido polimorfismo y mimetismo de esta enfermedad, hacen que sea importante pensar en el Mycobacterium tuberculosis como el causante de lesiones atípicas objetivadas en la laringe del paciente, para lograr realizar un diagnóstico precoz de la misma que, por un lado, descarte la existencia de carcinoma, y, por otro, permita la instauración inmediata de un protocolo quimioterápico antituberculoso que impida o minimice las posibles secuelas de la misma. La epiglotitis tuberculosa es una de estas formas atípicas e infrecuentes de presentación. Los autores presentan un caso de un varón de 67 años y realizan una discusión de los problemas diagnósticos que presenta esta entidad

An important arousal of tuberculosis has been observed in the last years, together with a change in it's clinical patterns, specially the extrapulmonar form, among wich is this laryngeal tuberculosis. This two facts and the marked polymorphism and mimetism proper of this condition may suggest that the Mycobacterium tuberculosis should be included in the differential diagnosis of any atypical lesion of the larynx, in order to obtain an earlier diagnosis excluding carcinoma and instaurate a chimotherapic protocol for minimizing or even avoiding any sequelae.Tuberculous epiglotittis is one of these atypical and unusual forms. The authors report a case of a 67 year-old male and provide a discussion on the diagnostic problems of this condition

Síndrome de Frey idiopático bajo la apariciencia de una otitis externa recidivante. Tratamiento con neuro-toxina botulínica tipo A / Idiopathic Frey’s Syndrome under the appearance of a recurrent otitis externa

El síndrome de Frey se ha observado sobre todo en pacientes sometidos a parotidectomía, pero también en el herpes zoster trigeminal, en las parotiditis, en las fracturas condíleas, en los traumatismos obstétricos con forceps y en la cirugía del meningioma del ángulo ponto-cerebeloso. También aparece sin cirugía previa, como es nuestro caso. En estas circunstancias se piensa que una neuritis subclínica, primaria o secundaria a una inflamación vecina, puede causar el inicio de este trastorno. Se han propuesto varios tratamientos, lo cual pone de manifiesto la dificultad del mismo. El más eficaz es la inyección de toxina botulínica tipo A intradérmica. Su manejo en el síndrome de Frey lo iniciaron Drobik y Laskawi en 1995. Desde entonces son numerosas las referencias sobre su manejo. Sin embargo, es un tratamiento aún poco difundido en nuestro país

Frey syndrome has been observed especially in patients who have undergone a parotidectomy operation, but also in zoster herpes, in parotiditis, condilea fractures, obstetric traumatisms with forceps and in surgery of the meningioma of the cerebellopontine angle. It also appears without previous surgery, like in our case. In these circumstances it is believed that a clinical neuritis, primary or secondary to a neighbouring inflammation may cause the start of this disorder. Several treatments have been suggested which highlights the difficulty of them. The most effective one is the intradermic injection of botulinum toxin type A. It’s use in Frey’s syndrome was initiated by Drobik and Laskawi in 1995. Since then the references to its use are numerous. Nevertheless, it is a treatment which has been introduced very few times in our country

[Epidermoid cyst of the parapharyngeal space]. / Quiste epidermoide de espacio parafaríngeo.

Epidermal cysts of parapharyngeal location are very unusual tumors, with a benign character, though when they reach a great size, adjacent zones and vascular and nervous structures of great importance can be affected. We are going to describe the clinical aspects of this case, the instructions and the surgical approach used: the Fabre inferior and internal jaw approach of the lateropharingeal space and infrasphenotemporal fossa, which avoids the aesthetics and functional aftereffects of other more common approaches.

[Tuberculous otitis media. Report of 3 cases]. / Otitis media tuberculosa. Estudio de 3 casos.

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear. Due to that the symptoms and signs are often indistinguishable from those of nontuberculosis chronic otitis media and the fact that the index of suspicion is low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications such as facial nerve paralysis and labyrinthitis. Medical therapy with antituberculous drugs is usually effective. We report three cases with TOM diagnosticated and followed up in our Service from january 1993 to july 2001. Their charts were retrospectively reviewed for relevant historical data, physical findings, complementary studies, treatment and clinical response. We performed a review of the literature, emphasizing that TOM should be considered in the differential diagnosis of chronic otitis media.