Enfrentamiento de lesiones de cavidad oral: clasificación y diagnóstico diferencial / Assessment of oral cavity lesions: classification and differential diagnosis

Las lesiones de la cavidad oral corresponden a un hallazgo frecuente y muchas veces difíciles de diagnosticar. Su correcto reconocimiento podría ser clave en detectar patologías que podrían cambiar el pronóstico del paciente. El objetivo de esta revisión es describir una clasificación de las lesiones de la cavidad oral que permita ayudar al diagnóstico en la práctica clínica. Para esto, se detallan y se describen las lesiones, orientando al diagnóstico y a la necesidad de biopsiar. Para simplificar la orientación diagnóstica, las lesiones se clasifican en 2 grandes grupos: tumorales y no tumorales. Las lesiones no tumorales se subdividen en lesiones de la mucosa oral y lesiones de la lengua.

Lesions of the oral cavity are frequent and often difficult to diagnose. However, correct recognition could change the patient's prognosis. This review aims to describe a classification of oral mucosa lesions, to help the diagnosis in clinical practice. The lesions are described for this, guiding the diagnosis and the need for biopsy. To simplify the diagnostic orientation, the lesions are classified into two groups: tumor and non-tumor lesions. Non-tumor lesions are subdivided into lesions of the oral mucosa and lesions of the tongue.

Diagnóstico de otitis media con efusión en adultos / Diagnosis of otitis media with effusion in adults

La otitis media con efusión (OME) se define como la presencia de líquido en la cavidad del oído medio, sin signos ni síntomas de infección. Es una patología frecuente en niños, alcanzando una prevalencia del 14,8% en población de 4 a 16 años y su patogenia en este grupo se encuentra ampliamente estudiada. Sin embargo, en adultos su prevalencia es baja y, consecuentemente, su patogenia y mecanismos están menos dilucidados. El objetivo de esta revisión es describir la fisiopatología de la OME en adultos, describir sus etiologías y proponer un algoritmo de estudio diagnóstico adecuado.

Otitis media with effusion (OME), is defined as the presence of fluid in the middle ear, with no signs of acute infection. It is a frequent pathology in children, with a prevalence of 14.8% in the population between 4-16 years old, and its pathology has been widely studied in this group. However, its prevalence in adults is low; therefore, the pathology and mechanisms are less elucidated. The aim of this review is to describe the physio-pathology of the OME in adults, its etiology, and propose an algorithm for the proper diagnosis of this disease.

Voz hipernasal y regurgitación nasal aguda: reporte de un caso clínico y revisión de la literatura / Hypernasal speech and acute nasal regurgitation: a case report and a review of the literature

RESUMEN La voz hipernasal y la regurgitación nasal son síntomas de disfunción velofaríngea. Ésta puede tener múltiples causas: anatómicas, neurológicas o funcionales. Se describe el caso de una paciente de sexo femenino, de 13 años, que se presenta con voz hipernasal y regurgitación nasal aguda. Al examen físico se evidencia inmovilidad del velo del paladar derecho sin otros hallazgos neurológicos. El estudio con resonancia nuclear magnética de cerebro y punción lumbar fueron normales. Se diagnosticó una incompetencia velofaríngea aguda transitoria, de probable etiología viral. La paciente evolucionó de forma favorable con mejoría clínica progresiva. La incompetencia velofaríngea a causa de una paresia o parálisis del nervio vago y/o nervio glosofaríngeo es una causa poco frecuente de disfunción velofaríngea.

ABSTRACT Hypernasal speech and nasal regurgitation are symptoms of velopharyngeal dysfunction. This may have multiple causes, including velopharyngeal incompetence due to paresis or paralysis of the vagus nerve and/or glossopharyngeal nerve. We describe the case of a 13 year-old female patient, with hypernasal speech and acute nasal regurgitation, with a physical examination showing immobility of the right palate with no other neurological findings. Magnetic resonance imaging of the brain and lumbar puncture was normal. Transient acute velopharyngeal incompetence was diagnosed, probably of viral etiology. The patient evolved favorably with progressive clinical improvement. Velopharyngeal incompetence due to paresis or paralysis of the vagus and/or glossopharyngeal nerves is a rare cause of velopharyngeal dysfunction.

Abscesos profundos de cuello en pediatría: experiencia del Hospital Dr. Sótero del Río entre los años 2011 y 2018 / Pediatric deep neck abscesses: Dr. Sótero del Río Hospital 2011-2018 experience

RESUMEN Introducción: Los abscesos profundos de cuello son colecciones de pus alojadas en los espacios profundos cervicales. En la población pediátrica son poco frecuentes, sin embargo, pueden presentar complicaciones potencialmente mortales. Objetivo: Caracterizar a los pacientes que consultan por abscesos profundos del cuello en el Servicio de Urgencia Pediátrico del Hospital Dr. Sótero del Rio. Material y método: Estudio de tipo descriptivo retrospectivo con datos obtenidos de fichas clínicas de pacientes. Se realizó una revisión de fichas clínicas de los pacientes diagnosticados con abscesos profundos de cuello en el Servicio de Urgencia Pediátrica del Hospital Sótero del Río entre los años 2011 y 2018. Se analizaron variables clínicas (anamnesis, examen físico, exámenes de laboratorio generales y específicos y su manejo) y demográficas. Los resultados se analizaron mediante estadística descriptiva con medidas de tendencia central y rango, utilizando Statistical Package for the Social Science (SPSS). Resultados: Se incluyeron 41 pacientes entre 0 y 15 años, con un promedio de edad de 7,2 años. Sesenta y tres por ciento de los pacientes fueron de sexo masculino. Se presentaron 23 (56%) pacientes con abscesos periamigdalinos (PA), 12 (29,2%) con abscesos retrofaríngeos (RF), 5 (12,1%) con abscesos parafaríngeos (PF) y 1 (2,4%) con absceso de tipo mixto (RF- PF). El 60% de los pacientes recibió algún tratamiento médico previo. Se realizó estudio imagenológico en 83% de los pacientes. Todos los pacientes presentaron parámetros inflamatorios elevados. En el 80% de los pacientes se realizó tratamiento médico y algún tipo de drenaje. Conclusiones: Los abscesos profundos del cuello son una entidad relativamente poco frecuente en pediatría, pero potencialmente peligrosa si no se detecta a tiempo, por lo que debemos tener un alto índice de sospecha para evitar las complicaciones.

ABSTRACT Introduction: Deep neck abscesses are pus collections lodged in the deep cervical spaces. They are rare in the pediatric population, however, they can present life-threatening complications. Objective: To characterize the patients who consult for deep neck abscesses in the pediatric emergency department of Dr. Sótero del Rio Hospital. Material and method: Descriptive retrospective study. A review of clinical records of patients diagnosed with deep neck abscesses in the pediatric emergency department of Dr. Sótero del Rio Hospital between 2011 and 2018 was made. The clinical (anamnesis, physical exam, general and specific laboratory exams and management) and demographic characteristics were evaluated. The results were analyzed by descriptive statistics with measures of central tendency and range, using Statistical Package for the Social Science (SPSS). Results: Forty-one patients between 0 and 15 years of age were included, with an average age of 7.2 years. 63% of the patients were male. There were 23 (56%) patients with peritonsillar abscesses (PA), 12 (29.2%) with retropharyngeal abscesses (RF), 5 (12.1%) with parapharyngeal abscesses (PF) and 1 (2.4%) with abscess of mixed type (RF-PF). 60% of the patients received some previous medical treatment. An imaging study was performed in 83% of the patients. All the patients presented high inflammatory parameters. In 80% of patients, medical treatment and some type of drainage were performed. Conclusions: Deep abscesses of the neck are a relatively rare entity in pediatrics, but potentially dangerous if not detected in time, so we must have a high index of suspicion to avoid complications.

[Reconstruction of the mobile tongue malignant tumor excision: quality-of-life assessment in 19 patients]. / Reconstruction de la langue mobile après exérèse carcinologique. Evaluation de la qualité de vie dans 19 cas.

INTRODUCTION: Tumor tongue excision leads to anatomical and functional defects (chewing, swallowing, oral and prosthetic hygiene). The extension of the resection depends on tumor size and surgical radicality. MATERIAL AND METHOD: In our department, 72 cases of lingual tumor were treated between may 1987 and January 1997. 73% of these cases were infiltrating squamous cell carcinomas. 71% were male. Most of the tumors were located at the ventral (45%) and lateral side (36%). 25% of the tumors crossed the midline. Staging was most often pT(2) (46%) and pN(0) (62%). Reconstruction with radial free flap occurred in 37%, with pedicled pectoralis major muscle flap in 13% and with pedicled latissimus dorsi muscle flap in 25% of cases. 51% of the patients were irradiated. All the patients were asked about their quality of live by an 11 questions questionnaire. The questions concerned the different oral and lingual functions and the social, familial, affective and professional life. RESULTS: 19 patients (that means 26%) answered the questionnaire. 9 of them were reconstructed with a flap (6 free radial flaps, 2 pedicled pectoralis major flaps, 1 pedicled latissimus dorsi flap) and were irradiated. In the 10 other patients wounds were closed by simple sutures of the margins. 1 of these 10 patients was irradiated. There was no correlation between scores of the questions and neither pT nor age of patients. We observed a parallelism between scores of the questions about speech and swallowing. Scores of the questions about swallowing were higher when a flap was used for reconstruction, whatever was the type of flap. DISCUSSION: A questionnaire was drawn up from the UW QOL questionnaire. It was a simplified questionnaire with reduced number of questions and simple words. Lesser tongue immobility leads to a better swallowing. Swallowing and speech were worst when tongue resection was large. In this quality of life study, there was a few number of patients that answered the questionnaire so that it is impossible to make a difference between the different flaps.

[Auto-transplantation of an impacted or retained maxillary canine. Apropos of a case]. / Auto-transplantation de canine maxillaire incluse ou retenue. A propos d'un cas.

Transplantation of an impacted or retained maxillary canine is a common procedure. Bone width at the transplantation site may however be insufficient to accept the transplanted tooth diameter. We describe an original transplantation technique of a high and buccal impacted canine with bone support and gingival transposition. The transplanted tooth remained stable over time and the alveolar profile was normal. Ankylosis and periodontal pocket are observed after healing. Ankylosis was also present before the procedure. The periodontopathy was explained by the lack of periodontal ligament on the distal aspect of the lateral incisor root in front of the canine crown before transplantation. Pocket depth was reduced after periodontal therapy. This technique allows anatomic restoration and an acceptable periodontal environment.

[Nosologic descriptions of lesions of the oral mucosa]. / Description nosologique des lésions de la muqueuse orale.

This article describes extensively and systematically oral mucosa diseases. Macroscopical aspects are particularly described in order to give the dentist all important elements of differential diagnosis. This nosological description is based on a clinical approach: white and pigmented lesions are distinguished from ulcerated and benign so as malignant tumoral lesions. Specifically on the oral mucosa located lesions and oral mucosa lesions of systemic diseases are described.

[Semeiology, examination and diagnosis of lesions of the oral mucosa]. / Séméiologie, examen et diagnostic des lésions de la muqueuse orale.

Tracking down the oral mucosa lesions require precise interrogation and cervico-facial, buccal and general examination. Diagnosis needs more often biopsy if not contra-indicated. The opportunity of further examinations and tests is discussed.

[The role of the dentist in the diagnosis, screening and followup of lesions of the oral mucosa. / Rôle du dentiste dans les diagnostic, dépistage et suivi des lésions de la muqueuse orale.

The early detection and follow up of oral mucosa lesions are a must for every dentist. The importance of these activities is tremendous for oral cancerous and precancerous lesions, so every dentist is officially responsible for this important role in the public health. The modalities of such early detection and follow up are described.

[Principles and therapeutic elements of lesions of the oral mucosa]. / Principes et éléments thérapeutiques des lésions de la muqueuse orale.

The management of lesions of the oral mucosa requires precise knowledges and expertise in clinical care. This review article summarise the principles of the most validated therapeutical features about lesions of the oral mucosa. Global management procedures are described. Therapeutic modalities involving drugs, surgery, radiotherapy, chemotherapy, immunotherapy, electrotherapy, gene therapy and photodynamic therapy are detailed as well.