Surgical management of mastoiditis with intratemporal and intracranial complications in children. Outcome, complications, and predictive factors.

INTRODUCTION: Intratemporal or intracranial complications of acute mastoiditis are often of significant severity, can be life-threatening, and require prompt and usually aggressive treatment. This study focused on analyzing the outcomes and complications of different surgical techniques used in intracranial and intratemporal complications of acute mastoiditis, the most common complication of acute otitis media. METHODS: A retrospective study of pediatric patients with mastoiditis with intratemporal and intracranial complications was designed at the Niño Jesús University Children's Hospital in Madrid, Spain, from 2005 to 2021. RESULTS: Of 417 patients with mastoiditis, 112 patients developed intratemporal and intracranial complications, with subperiosteal abscess being the most frequent complication. The most frequently isolated pathogens were Streptococcus pneumoniae, Streptococcus pyogenes, and Fusobacterium necrophorum. The most used surgical technique was myringotomy with placement of transtympanic drainage, in 86.6% of all cases. In patients with intracranial complications, neurosurgical procedures were necessary for 19.2%, with craniotomy with mastoidectomy being the most frequent. Most of the cases evolved favorably, and only 5.4% of the patients required surgical reintervention, being more frequent in intratemporal complications. In terms of complications, we found cases of neutropenia in 3.6%, neurological sequelae in 5.4%, and permanent hearing loss in 2.7%. CONCLUSIONS: There was a favorable evolution with a low incidence of reoperation and sequelae within our series. The surgical technique of choice correlated with the severity of the complication. If the mean size of the abscess exceeds 20 mm, incision and drainage, along with myringotomy and tube placement, should be considered as the initial treatment. Closed mastoidectomy should be reserved for deteriorating of clinical evolution or acute mastoiditis with intracranial complications. Intracranial and multiple concomitant complications were associated with a more extended hospital stay, ICU occupancy, neurosurgical intervention, and risk of neurological sequelae and neutropenia. Conversely, intratemporal complications may result in permanent hearing loss.

[Fracture of thyroid cartilage after a sneezing episode]. / Fractura tiroidea tras estornudo: a propósito de un caso.

We present a case report of a thyroid fracture after a sneezing episode, with odynophagia, dysphonia, and neck pain. The examination showed oedema at the right vocal cord and haematoma at the right false vocal cord. An anterior thyroid fracture without displacement, and a subcutaneous emphysema could be seen on the CT. Thyroid fracture because of this aetiology is most exceptional; only 1 similar case report has been described in the literature.

[Sclerosing polycystic adenosis of the submandibular gland]. / Adenosis poliquística esclerosante de la glándula submaxilar.

Sclerosing polycystic adenosis (SPA) is a rare, newly-reported lesion of the salivary glands. Most cases occurred within mayor salivary glands and were frequently confused with other salivary gland carcinomas such as acinar cell carcinoma. We report a case of SPA within the submandibular gland in a 63-year-old woman.

Adenosis poliquística esclerosante de la glándula submaxilar / Sclerosing polycystic adenosis of the submandibular gland

La adenosis poliquística esclerosante (APE) es una entidad poco frecuente descrita hace poco tiempo, que afecta a las glándulas salivales, principalmente mayores, y que frecuentemente se ha confundido con otros carcinomas de glándula salival como el carcinoma de células acinares. Presentamos un caso de APE en la glándula submaxilar de una mujer de 63 años (AU)

Sclerosing polycystic adenosis (SPA) is a rare, newly-reported lesion of the salivary glands. Most cases occurred within mayor salivary glands and were frequently confused with other salivary gland carcinomas such as acinar cell carcinoma. We report a case of SPA within the submandibular gland in a 63-year-old woman (AU)

Fractura tiroidea tras estornudo: a propósito de un caso / Fracture of thyroid cartilage after a sneezing episode

Presentamos un caso de fractura del cartílago tiroides tras estornudo, con clínica de disfonía, odinofagia y molestias cervicales. En la exploración presentaba edema de cuerda vocal derecha con hematoma de banda derecha y enfisema subcutáneo cervical. En el estudio con tomografía computarizada (TC) se apreciaba una fractura en línea media del cartílago tiroides sin desplazamiento y enfisema subcutáneo. La fractura del cartílago tiroides debida a esta etiología es casi excepcional, y sólo se ha descrito un caso más en la literatura científica

We present a case report of a thyroid fracture after a sneezing episode, with odynophagia, dysphonia, and neck pain. The examination showed oedema at the right vocal cord and haematoma at the right false vocal cord. An anterior thyroid fracture without displacement, and a subcutaneous emphysema could be seen on the CT. Thyroid fracture because of this aetiology is most exceptional; only 1 similar case report has been described in the literature