[Essential palatal myoclonus. A pediatric case report]. / Mioclonía palatina esencial. Reporte de un caso pediátrico.

Essential palatal myoclonus is a rare neurological disorder characterized by involuntary movements of the soft palate musculature causing objective-clicking tinnitus. The palatal myoclonus is classified in two forms, secondary and essential palatal myoclonus. Primary (essential) palatal myoclonus is the most common type in childhood. Normal computed tomography and magnetic resonance guide the diagnosis. Spontaneous resolution usually occurs in the essential type of palatal myoclonus. In this report, we present an 8-year-old child making rhythmic, rapid clicking noises from her throat with spontaneous resolution.

La mioclonía palatina esencial es una entidad otoneurológica rara. Se caracteriza por movimientos involuntarios de los músculos del paladar blando que causan un tinnitus objetivo. La mioclonía del paladar se clasifica en dos tipos: secundaria y primaria (mioclonía palatina esencial); esta última es más frecuente en pediatría. La tomografía computada y la resonancia magnética de cerebro normal orientan al diagnóstico. La mioclonía palatina esencial, generalmente, se resuelve en forma espontánea. Se presenta a una paciente de 8 años de edad con un "clic" rápido en forma rítmica en su boca que cedía en forma espontánea.

[Complicated cholesteatoma in a child with Down syndrome: a case report]. / Colesteatoma complicado en un niño con síndrome de Down: un caso clínico.

Acquired cholesteatoma in children is an aggressive disease due to its rapid growth and high recurrence rate. The complications are divided into intra-and extratemporal complications or intracranial complication. Subperiosteal abscess is the most common extratemporal complication. It is most frequent in young children. However, there are also other associated complications described in the literature. Down syndrome patients have anatomical and functional predisposing factors that contribute to chronic cholesteatomatous otitis media. The prevalence is greater than 80 %. In this report, we present a case of subperiosteal abscess in an 8-year-old child with Down's syndrome. This abscess presented as a complication of an extended cholesteatoma and required inmediate surgery for resolution.

El colesteatoma adquirido en niños es una enfermedad agresiva debido a su rápido crecimiento y la alta tasa de recurrencia. Las complicaciones se dividen en dos grandes grupos: las relacionadas con el hueso temporal (dentro o fuera de él) y las complicaciones intracraneales. El absceso subperióstico es la complicación extratemporal más común y es más frecuente en los niños más pequeños. Los pacientes que padecen síndrome de Down tienen una prevalencia elevada (superior al 80 %) de otitis media con efusión, que puede estar determinada anatómicamente por la hipoplasia mediofacial con una nasofaringe estrecha y adenoides hipertrófica, junto a trastornos funcionales y mecánicos de la trompa auditiva. Se presenta un niño de 8 años con síndrome de Down que desarrolló un absceso subperióstico como complicación de un colesteatoma que requirió abordaje quirúrgico inmediato para su resolución.

[Traumatic perilymphatic fistula. Report of a pediatric case]. / Fístula perilinfática de causa traumática. Reporte de un caso pediátrico.

Traumatic perilymphatic fistula is an unusual pathology. Generally caused by pencils, swabs, hair buckles, and matches. Among the most frequent symptoms, patients can present hearing loss and vertigo. Diagnosis requires a complete physical examination that includes otomicroscopy, audiometry and computed tomography of both boulders. Treatment depends on the patient's symptoms. In general, it is conservative at first, but may require surgery. We present a clinical case of a 6-year-old boy with perilymphatic fistula secondary to left ear trauma due to swab, which required surgical treatment.

La fístula perilinfática de causa traumática es una patología poco habitual. En general, es causada por lápices, hisopos, hebillas de pelo y fósforos. Dentro de los síntomas más frecuentes, los pacientes pueden presentar hipoacusia y vértigo. Su diagnóstico requiere un examen físico completo que incluya otomicroscopía, audiometría y tomografía computada de ambos peñascos. El tratamiento depende de la sintomatología del paciente. En general, en un principio, es conservador, pero puede llegar a requerir cirugía. Se presenta un caso clínico de un niño de 6 años con fístula perilinfática secundaria a un traumatismo del oído izquierdo por un hisopo, que requirió tratamiento quirúrgico.

Synchrony with distress in affective empathy and compassion.

Sensitivity to suffering of others is a core factor in social cohesion and evolutionary success. The emergence of such sensitivity may occur via two neuro-functional mechanisms. One is sharing the pain and distress of others, which relies on affective empathy. The other involves a caring concern for others' wellbeing, termed compassion. Both affective empathy and compassion are triggered by cues of pain and distress, exhibited by suffering targets. Yet, the mechanisms underlying distress processing in empathy and compassion are not clear. In the current research, we investigated synchrony with a target's distress, as a putative mechanism for continuous processing of distress cues. Participants viewed a video of a target in distress when given two different instructions: they were asked to continuously rate their distress in the affective empathy condition, or their feelings of care in the compassion condition. We used these dynamic ratings as well as participants' autonomic and facial responses to assess multi-channel synchrony with the target's self-rated distress fluctuations. Dynamic ratings and facial corrugator responses were significantly positively synchronized with the target's distress. For the corrugator responses, synchrony with the target was more pronounced than synchrony with participants' own ratings. Autonomic responses exhibited negative synchrony with the target's distress. Synchrony was higher in the affective empathy than in the compassion condition, across channels. These results point to the key role of subjective and physiological synchrony with the target's distress in empathic sharing of negative experiences. They also highlight the attenuation of embodied resonance with distress in compassionate experiences.

[Actinomycosis in temporal bone. A pediatric case report]. / Actinomicosis en el hueso temporal. Reporte de un caso pediátrico.

Actinomycosis is an infection caused by a Gram-positive, filamentous anaerobic bacillus. Mainly belonging to the human commensal flora of the oropharynx, it normally colonizes the human digestive and genital tracts and the bronchial tree. It is slightly frequent in the temporal bone. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened in patients in whom optimal surgical resection of infected tissues has been performed. A pediatric patient with actinomycosis in temporal bone who needed surgery resolution is reported.

La actinomicosis es una infección causada por un bacilo anaerobio Gram-positivo, filamentoso, ramificado, no esporulado. Integra la flora habitual de la orofaringe y coloniza transitoriamente el tracto gastrointestinal, genital femenino y el árbol bronquial. Es poco frecuente en el hueso temporal. Por su semejanza a un hongo, es difícil su reconocimiento, lo que hace necesaria la sospecha clínica para obtener los cultivos apropiados en condiciones anaeróbicas en forma prolongada. Los hallazgos microscópicos típicos incluyen necrosis con gránulos de azufre amarillento y la presencia de filamentos que se asemejan a infecciones fúngicas. El tratamiento requiere de elevadas y prolongadas dosis de antibiótico con penicilina o amoxicilina, entre 6 y 12 meses. La duración de la terapia antimicrobiana podría ser reducida en pacientes que han sido operados quirúrgicamente. Se presenta, a continuación, un caso clínico de actinomicosis en el hueso temporal en un paciente pediátrico que requirió tratamiento quirúrgico para su resolución.

Rapid weight gain in children soon after diagnosis of type 1 diabetes: is there room for concern?

OBJECTIVE: To examine weight status in children at diagnosis (Dx) of type 1 diabetes and observe weight change post-Dx. RESEARCH DESIGN AND METHODS: Data on 136 subjects (76 M/60 F) with type 1 diabetes diagnosed in 1998-2001 at Children's Hospital San Diego was obtained from Institutional Review Board (IRB)-approved database. All patients received two daily insulin injections (NPH/Regular) and were examined at least twice, up to 7 months post-Dx. RESULTS: Average age at Dx (SD) was 9.02 yr (4.46)yr; 63.9% were Caucasian, 25% Mexican American (MA), 2.9% African American, 0.7% Asian, and 7.3% mixed. Diabetic ketoacidosis rate was more common in MA (44.1%) vs. Caucasians (20.9%) at Dx (p < 0.02). Average body mass index Z-score (BMI-Z) at Dx was -0.28 (39th percentile); 13.5% had BMI > or = 85th percentile, and 7.2% were obese. By 2 wk, and 15-41 d post-Dx, mean weight gain was 9% (5.9) and 12.8% (8), respectively. Mean A1C at Dx, 42-70 and 71-139 d later, was 11.4, 7.6, and 6.9%, respectively. Coinciding with improved glycemic control, by 10 wk, mean BMI-Z reached a plateau of 0.86 (80th percentile). On average, MA were heavier than Caucasians at Dx (p = 0.006), and remained heavier. By 71-139 d, 31.7% had BMI > or = 85th percentile and 15.9% were obese; 47.8% of 2- to 5-yr olds had BMI > or = 85th percentile vs. 22.6% nationally (p < 0.005) CONCLUSIONS: Despite the initial weight loss at Dx of type 1 diabetes, by 10-20 wk post-Dx, almost one third were overweight and obese, more so in MA. In light of the obesity epidemic, closer attention to overall caloric intake in children with new onset diabetes is prudent.

Importance of leuprolide acetate variable dosing for precocious puberty: a range of acceptable suppression.

AIM: The effect of the variation in hormonal suppression on bone maturation, growth velocity, and adult height prediction was examined during treatment with leuprolide acetate for central precocious puberty (CPP). METHODS: Ten girls on variable doses of Lupron were studied for one year. Height, weight, body mass index, luteinizing hormone (LH), estradiol, and growth velocity were measured every 3 months. Bone age and predicted height were assessed every 6 months. RESULTS: LH range changed from 0.5-1.4 IU/I to 0.1-2.8 IU/I. The average Lupron dose decreased from 0.33 +/- 0.11 to 0.26 +/- 0.08 mg/kg. Predicted adult height averaged 158.33 +/- 9.5cm at the start of the study and increased to 161.45 +/- 6.26 cm (p <0.01). LH and estradiol did not correlate with the rate of bone maturation, growth velocity, predicted height, or with leuprolide dose. CONCLUSION: Variable dosing of leuprolide acetate is needed to achieve similar amounts of hormonal suppression, yet small changes in dose did not significantly change LH or estradiol levels or predicted height.

Childhood lichen planus pemphigoides: a case report and review of the literature.

Lichen planus pemphigoides is a rare autoimmune blistering disease that is characterized by evolution of vesico-bullous skin lesions in patients with active lichen planus. We describe a case of lichen planus pemphigoides in a 6-year-old boy and review the clinical and immunopathologic features of all reported cases of pediatric lichen planus pemphigoides. The mean age at onset of childhood lichen planus pemphigoides is 12 years with a male to female ratio of 3:1 and a mean lag-time between lichen planus and the development of lichen planus pemphigoides of 7.9 weeks. Vesiculo-bullous lesions were found on the extremities in all patients and there was palmoplantar involvement in about half of the cases. Direct and indirect immunofluorescence features were similar to those reported in adults. One patient had Western immunoblot data revealing antigens of 180, 230, and 200 kDa. Immunoelectron microscopy in two cases showed localization of immune deposition different from that in bullous pemphigoid. We found that topical corticosteroids or oral dapsone caused resolution of lichen planus pemphigoides without known relapse of blistering in four cases, suggesting that it might be possible to reserve oral corticosteroids as a second line of therapy in children with lichen planus pemphigoides.

Oxytocin regulates social approach.

The physical space individuals share is known as interpersonal space. As social creatures, people tend to approach others actively and explore the environment around them, opting for different space preferences with different people. In the current study, we sought to examine the role of oxytocin (OT) in regulating active social interpersonal space preferences. Contrary to previous studies that reported a preference for increased space following intranasal OT, we predicted that following OT administration individuals would exhibit increased active approach towards a protagonist. Accordingly, we measured active approach towards friends and strangers. The results indicated that OT increased social approach, particularly to strangers, suggesting that the OT system plays a major role in regulating social approach, depending on type of protagonist. The results are in line with the social salience and anxiety reduction hypotheses showing that OT increases approach to strangers.

The role of oxytocin in implicit personal space regulation: An fMRI study.

Personal space, defined as the distance individuals choose to maintain between themselves and others, is an indicator of affiliation and closeness. Most paradigms that measure personal space preferences involve explicit choice and therefore fail to examine the implicit aspects of such preferences. In the current study, we sought to investigate an implicit form of interpersonal space that is more closely related to real-life situations involving affiliation. We studied the effects of oxytocin (OT) on neural networks that involve affiliation and tested the impact on personal space preferences. In a double-blind placebo-controlled study, we asked participants to choose between two rooms that differed only in the distances between two stimuli. The stimuli were either social stimuli (two chairs) or non-social stimuli (table and plant). The behavioral results showed that OT caused participants to choose a closer space in social blocks but did not affect their choices in non-social blocks. Imaging results revealed an interaction between stimulus and treatment (OT/PL) in the dorsal striatum, an area that is related to approach motivation and is part of the reward circuitry. Specifically, OT increased activity in the dorsal striatum in the social blocks and decreased this activity in the non-social blocks. The results of the study strengthen the social salience theory regarding OT, indicating that OT does not uniformly affect all social responses and that context has a determining impact on our behavior.

Cell migration along the lateral cortical stream to the developing basal telencephalic limbic system.

During embryogenesis, the lateral cortical stream (LCS) emerges from the corticostriatal border (CSB), the boundary between the developing cerebral cortex and striatum. The LCS is comprised of a mix of pallial- and subpallial-derived neural progenitor cells that migrate to the developing structures of the basal telencephalon, most notably the piriform cortex and amygdala. Using a combination of in vitro and in vivo approaches, we analyzed the timing, composition, migratory modes, origin, and requirement of the homeodomain-containing transcription factor Gsh2 (genomic screened homeobox 2) in the development of this prominent migratory stream. We reveal that Pax6 (paired box gene 6)-positive pallial-derived and Dlx2 (distal-less homeobox 2)-positive subpallial-derived subpopulations of LCS cells are generated in distinct temporal windows during embryogenesis. Furthermore, our data indicate the CSB border not only is comprised of separate populations of pallial- and subpallial-derived progenitors that contribute to the LCS but also a subpopulation of cells coexpressing Pax6 and Dlx2. Moreover, despite migrating along a route outlined by a cascade of radial glia, the Dlx2-positive population appears to migrate primarily in an apparent chain-like manner, with LCS migratory cells being generated locally at the CSB with little contribution from other subpallial structures such as the medial, lateral, or caudal ganglionic eminences. We further demonstrate that the generation of the LCS is dependent on the homeodomain-containing gene Gsh2, revealing a novel requirement for Gsh2 in telencephalic development.

Factors influencing the decision to test young infants for herpes simplex virus infection.

In a nested case-control study of 478 infants < or =90 days of age, one-third of infants undergoing cerebrospinal fluid herpes simplex virus (HSV) testing by polymerase chain reaction were >28 days of age. Recognized factors, such as mode of delivery, were not associated with HSV testing. The factors currently used by physicians in the decision to order this test do not best reflect the likelihood of HSV infection.

[Deep neck infections: Report of three pediatric cases]. / Abcesos profundos de cuello: Reporte de tres casos pediátricos.

Retropharyngeal and parapharyngeal abscesses are rare but associated with significant morbidity and potential mortality. In recent years, there has been an increase in the incidence of these infections, mainly due to a greater availability of computed tomography scan and a greater virulence of the germs (Group A b-hemolytic Streptococcus and methicillin-resistant Staphylococcus aureus). They predominate in children younger than 5 years. Treatment of retropharyngeal and parapharyngeal abscesses consists of an intravenous antibiotic and eventually surgical drainage. Surgical treatment is indicated in patients with abscesses greater than 2 cm 3, with respiratory difficulty or poor response to initial antibiotic treatment. The aim of this study is to describe clinical features and treatment of three cases of deep neck abscesses presented at Hospital de Niños Pedro de Elizalde, Otorhinolaryngology Department in the period of one year.

Los abscesos retro y parafaríngeos son procesos infrecuentes aunque asociados con morbilidad significativa y potencial mortalidad. En los últimos años, se ha detectado un aumento de incidencia de estas infecciones, que se debe, principalmente, a una mayor disponibilidad de la tomografía computada y a mayor virulencia de los gérmenes (Streptococcus beta hemolítico del grupo A y Staphilococcus aureus meticilino resistente). Predominan en menores de 5 años. El tratamiento de los abscesos retro y parafaríngeos consiste en antibiótico endovenoso y, eventualmente, drenaje quirúrgico. Serían pasibles de tratamiento quirúrgico aquellos pacientes con abscesos mayores de 2 cm 3, con dificultad respiratoria o mala respuesta al tratamiento antibiótico inicial. El objetivo de este reporte es presentar las características clínicas y el tratamiento de tres pacientes con abscesos profundos de cuello que se presentaron en Otorrinolaringología del Hospital de Niños Pedro de Elizalde en el período de un año.

The role of oxytocin in modulating interpersonal space: A pharmacological fMRI study.

Interpersonal space is a nonverbal indicator of affiliation and closeness. In this study we investigated the effects of oxytocin (OT), a neuropeptide known for its social role in humans, on interpersonal space. In a double blind placebo controlled study we measured the effect of intranasal OT on the personal distance preferences of different familiar (friend) and unfamiliar (stranger) protagonists. Behavioral results showed that participants preferred to be closer to a friend than to a stranger. Intranasal OT was associated with an overall distancing effect, but this effect was significant for the stranger and not for the friend. The imaging results showed interactions between treatment (OT, placebo) and protagonist (friend, stranger) in regions that mediate social behavior including the dorsomedial prefrontal cortex (dmPFC), a region associated with the mentalizing system. Specifically, OT increased activity in the dmPFC when a friend approached the participants but not when a stranger approached. The results indicate that the effect of OT on interpersonal space greatly depends on the participant's relationship with the protagonist. This supports the social salience theory, according to which OT increases the salience of social cues depending on the context.

Fístula perilinfática de causa traumática. Reporte de un caso pediátrico / Traumatic perilymphatic fistula. Report of a pediatric case

La fístula perilinfática de causa traumática es una patología poco habitual. En general, es causada por lápices, hisopos, hebillas de pelo y fósforos.Dentro de los síntomas más frecuentes, los pacientes pueden presentar hipoacusia y vértigo. Su diagnóstico requiere un examen físico completo que incluya otomicroscopía, audiometría ytomografía computada de ambos peñascos. El tratamiento depende de la sintomatología del paciente. En general, en un principio, es conservador, pero puede llegar a requerir cirugía. Se presenta un caso clínico de un niño de 6 años con fístula perilinfática secundaria a un traumatismo del oído izquierdo por un hisopo, que requirió tratamiento quirúrgico

Traumatic perilymphatic fistula is an unusual pathology. Generally caused by pencils, swabs, hair buckles, and matches. Among the most frequent symptoms, patients can present hearing loss and vertigo.Diagnosis requires a complete physical examination that includes otomicroscopy, audiometry and computed tomography of both boulders. Treatment depends on the patient's symptoms. In general, it is conservative at first, but may require surgery.We present a clinical case of a 6-year-old boy with perilymphatic fistula secondary to left ear trauma due to swab, which required surgical treatment

Colesteatoma complicado en un niño con síndrome de Down: un caso clínico / Complicated cholesteatoma in a child with Down syndrome: a case report

El colesteatoma adquirido en niños es una enfermedad agresiva debido a su rápido crecimiento y la alta tasa de recurrencia. Las complicaciones se dividen en dos grandes grupos: las relacionadas con el hueso temporal (dentro o fuera de él) y las complicaciones intracraneales. El absceso subperióstico es la complicación extratemporal más común y es más frecuente en los niños más pequeños. Los pacientes que padecen síndrome de Down tienen una prevalencia elevada (superior al 80 %) de otitis media con efusión, que puede estar determinada anatómicamente por la hipoplasia mediofacial con una nasofaringe estrecha y adenoides hipertrófica, junto a trastornos funcionales y mecánicos de la trompa auditiva. Se presenta un niño de 8 años con síndrome de Down que desarrolló un absceso subperióstico como complicación de un colesteatoma que requirió abordaje quirúrgico inmediato para su resolución.

Acquired cholesteatoma in children is an aggressive disease due to its rapid growth and high recurrence rate. The complications are divided into intra-and extratemporal complications or intracranial complication. Subperiosteal abscess is the most common extratemporal complication. It is most frequent in young children. However, there are also other associated complications described in the literature. Down syndrome patients have anatomical and functional predisposing factors that contribute to chronic cholesteatomatous otitis media. The prevalence is greater than 80 %. In this report, we present a case of subperiosteal abscess in an 8-year-old child with Down's syndrome. This abscess presented as a complication of an extended cholesteatoma and required inmediate surgery for resolution.

Actinomicosis en el hueso temporal. Reporte de un caso pediátrico / Actinomycosis in temporal bone. A pediatric case report

La actinomicosis es una infección causada por un bacilo anaerobio Gram-positivo, filamentoso, ramificado, no esporulado. Integra la flora habitual de la orofaringe y coloniza transitoriamente el tracto gastrointestinal, genital femenino y el árbol bronquial. Es poco frecuente en el hueso temporal. Por su semejanza a un hongo, es difícil su reconocimiento, lo que hace necesaria la sospecha clínica para obtener los cultivos apropiados en condiciones anaeróbicas en forma prolongada. Los hallazgos microscópicos típicos incluyen necrosis con gránulos de azufre amarillento y la presencia de filamentos que se asemejan a infecciones fúngicas. El tratamiento requiere de elevadas y prolongadas dosis de antibiótico con penicilina o amoxicilina, entre 6 y 12 meses. La duración de la terapia antimicrobiana podría ser reducida en pacientes que han sido operados quirúrgicamente. Se presenta, a continuación, un caso clínico de actinomicosis en el hueso temporal en un paciente pediátrico que requirió tratamiento quirúrgico para su resolución.

Actinomycosis is an infection caused by a Gram-positive, filamentous anaerobic bacillus. Mainly belonging to the human commensal flora of the oropharynx, it normally colonizes the human digestive and genital tracts and the bronchial tree. It is slightly frequent in the temporal bone. Bacterial cultures and pathology are the cornerstone of diagnosis, but particular conditions are required in order to get the correct diagnosis. Prolonged bacterial cultures in anaerobic conditions are necessary to identify the bacterium and typical microscopic findings include necrosis with yellowish sulfur granules and filamentous Gram-positive fungal-like pathogens. Patients with actinomycosis require prolonged (6- to 12-month) high doses of penicillin G or amoxicillin, but the duration of antimicrobial therapy could probably be shortened in patients in whom optimal surgical resection of infected tissues has been performed. A pediatric patient with actinomycosis in temporal bone who needed surgery resolution is reported.

Mioclonía palatina esencial. Reporte de un caso pediátrico / Essential palatal myoclonus. A pediatric case report

La mioclonía palatina esencial es una entidad otoneurológi-ca rara. Se caracteriza por movimientos involuntarios de los músculos del paladar blando que causan un tinnitus objetivo.La mioclonía del paladar se clasifica en dos tipos: secundaria y primaria (mioclonía palatina esencial); esta última es más frecuente en pediatría. La tomografía computada y la reso-nancia magnética de cerebro normal orientan al diagnóstico. La mioclonía palatina esencial, generalmente, se resuelve en forma espontánea.Se presenta a una paciente de 8 años de edad con un "clic" rápido en forma rítmica en su boca que cedía en forma espontánea

Essential palatal myoclonus is a rare neurological disorder characterized by involuntary movements of the soft palate musculature causing objective-clicking tinnitus. The palatal myoclonus is classified in two forms, secondary and essential palatal myoclonus. Primary (essential) palatal myoclonus is the most common type in childhood. Normal computed tomography and magnetic resonance guide the diagnosis. Spontaneous resolution usually occurs in the essential type of palatal myoclonus.In this report, we present an 8-year-old child making rhythmic, rapid clicking noises from her throat with spontaneous resolution.

[Maxillary osteomyelitis secondary to rhinosinusitis in children: case report]. / Osteomielitis del maxilar secundaria a rinosinusitis en la infancia: caso clínico.

Rhinosinusitis is a very common childhood condition. Osteomyelitis is an unusual complication, which mainly occurs in toddlers and young children. The most frequent etiologic agent is Staphylococcus aureus. Iniatially, it is characterized by fever, low eyelid edema, unilateral rhinorrhea and ipsilateral palatine edema. Subsequently, abscesses develop in the maxillar yuxtanasal and/or the dental alveolar area. Secondary, it can be complicated by sequestrations, spontaneous expulsion of dental pieces and/or fistula, as well as orbital and intracranial complications. The diagnosis is based on clinical findings and is confirmed by computed tomography findings. The treatment is clinical and surgical. Here we report a five year old child, with rhinosinusitis complicated by osteomyelitis of maxillary bone, mediated by a methicillin-resistant Staphylococcus aureus infection.

La rinosinusitis es una patología muy frecuente en la infancia. Entre sus complicaciones, se encuentra la osteomielitis, rara complicación que, cuando se presenta, ocurre, principalmente, en lactantes y niños pequeños. El agente etiológico más frecuente es el Staphylococcus aureus. Clínicamente, se manifiesta con fiebre alta, edema de párpado inferior, rinorrea unilateral y edema palatino ipsilateral; luego se agrega un absceso sobre el área maxilar yuxtanasal y/o sobre los alvéolos dentarios. Secundariamente, pueden desarrollarse secuestros, expulsiones espontáneas de piezas dentarias y trayectos fistulosos, así como complicaciones orbitarias y endocraneales. El diagnóstico es, sobre todo, clínico; se confirma con tomografia computada. El tratamiento es médico quirúrgico. Se presenta un niño de 5 años de edad con rinosinusitis complicada con osteomielitis del hueso maxilar, cuyo germen responsable fue el Staphylococcus aureus meticilino resistente.