Resección transoral de la apófisis estiloides por síndrome de Eagle: caso clínico / Transoral resection of the stiloyd process for Eagle síndrome: case report

El síndrome de Eagle está caracterizado por una elongación o una curvatura medial excesiva de la apófisis estiloides o por una calcificación del ligamento estilohioideo que puede provocar dolor cervicofacial o síntomas neurológicos por la compresión de los vasos o nervios del cuello. El tratamiento más eficaz es el quirúrgico y consiste en la resección de la apófisis estiloides; puede ser realizado por vía externa o mediante un abordaje transoral. Se describe el caso clínico de un paciente con síndrome de Eagle que fue tratado con éxito mediante un abordaje transoral, sin amigdalectomía y con asistencia de endoscopios. (AU)

Eagle syndrome is characterized by an elongation or excessive medial curvature of the styloid process or calcification of the stylohyoid ligament that can cause cervicofacial pain or neurological symptoms due to compression of the vessels or nerves of the neck. The most effective treatment is surgical and consists of resection of the styloid process, it can be performed by externally or through a transoral approach.The clinical case of a patient with Eagle syndrome who was successfully treated by a transoral approach, without tonsillectomy and with the assistance of endoscopes, is described. (AU)

Osteonevus of Nanta: a case report in a combined melanocytic nevus

Abstract Secondary osteoma cutis is a phenomenon that may occur in several conditions. When it occurs in a melanocytic nevus it is named osteonevus of Nanta, an event considered uncommon and characterized by the presence of bone formation adjacent or interposed with melanocytic cells. There are reports of its occurrence in various melanocytic lesions, being more frequently associated with intradermal nevus. We report a case of osteonevus of Nanta in combined nevus, possibly the first description of this association.

Osificación heterotópica mesentérica precoz posabdomen abierto y su manejo quirúrgico: presentación de un caso / Mesenteric heterotopic ossification after open abdomen and its surgical management: presentation of a case

OBJETIVO: Reportar el caso de un paciente con antecedente de múltiples cirugías por peritonitis y abdomen abierto, con hallazgo intraoperatorio de osificación heterotópica en el mesenterio. CASO CLÍNICO: Paciente masculino de 59 años, con antecedente de apendicectomía complicada hace 12 meses, que en esa oportunidad requirió manejo de abdomen abierto, colectomía derecha e ileostomía terminal. Un año posapendicectomía reingresa para reconstitución de tránsito con hallazgo intraoperatorio de masa calcificada en mesenterio, de 15 x 10 x 6 cm, cuyo estudio histológico informa osificación heterotópica mesentérica. Esta entidad es de baja frecuencia, asociada al antecedente de trauma y cirugía abdominal, y se ha descrito como causa de morbimortalidad. El manejo quirúrgico resectivo es factible por equipos con experiencia. CONCLUSIÓN: Se describe un caso con antecedente de abdomen abierto, con posterior hallazgo de osificación heterotópica mesentérica. Este caso clínico es representativo por sus factores de riesgos clásicos y manejo empleado para su resolución.

OBJECTIVE: Report the case of a patient with a history of multiple surgeries due to peritonitis and open abdomen, with intraoperative finding of mesenetrioc heterotopic ossification. CLINICAL CASE: A 59-year-old male patient with a history of complicated appendectomy 12 months ago, which requires the management of an open abdomen, right colectomy and terminal ileostomy. One year after appendectomy, is readmitted for transit reconstitution. Intraoperative finding were calcified mass in mesentery, of 15 x 10 x 6 cm, whose histological study reports mesenteric heterotopic ossification. This entity has low frequency, and is associated with a history of trauma and abdominal surgery, is described as a cause of morbidity and mortality. Resective surgical management is feasible for experienced teams. CONCLUSION: A case with antecedent of open abdomen is described, with later finding of mesenteric heterotopic ossification. This clinical case is representative for its classic risk factors and management used for its resolution.

Osificación heterotópica de cadera asociada a pancreatitis aguda severa: reporte de un caso / Hip heterotopic ossification associated with severe acute pancreatitis: a case report

La osificación heterotópica (OH), es la formación anormal de hueso maduro dentro de tejidos blandos extra esqueléticos donde normalmente no existe tejido óseo. Varias formas de OH han sido descritas de acuerdo a su presentación clínica, localización y ocurrencia progresiva o aislada. Su presentación en pacientes sometidos a inmovilización prolongada en el contexto de coma farmacológicamente inducido, en ausencia de lesiones del sistema nervioso central, es poco habitual. Presentamos el caso de una paciente de 40 años, sexo femenino, sin antecedentes mórbidos, que presenta episodio de pancreatitis aguda grave, manejada en UCI. Producto de lo anterior, requiere coma farmacológicamente inducido por 3 meses y hospitalizaciones reiteradas y prolongadas durante los 10 meses siguientes. Durante 3 años desde la resolución de su cuadro inicial evoluciona con alteración progresiva de la marcha y rigidez de la extremidad inferior derecha, sin eventos traumáticos durante ese período. Se objetiva mediante radiografía y TAC foco de OH coxofemoral derecha. Se resuelve de forma quirúrgica y biopsia de pieza operatoria confirma el diagnóstico. La paciente logra buena recuperación posterior. NIVEL DE EVIDENCIA: IV

Heterotopic ossification (HO) is the abnormal formation of mature bone within extraskeletal soft tissues where bone does not exist. Various presentation of HO have been described according to the clinical settings and location of the lesions, and progressive or isolated occurrence. A rare form of presentation occurs in induced coma patients with long-term immobilization and without central nervous system injuries. We present the case of a 40 years old female patient, without previous morbidity, who develop a severe acute pancreatitis. The patient requires an intensive care unit management (ICU) and a 3-month pharmacology induced coma and reiterative and prolonged hospitalizations during the next 8 months. During 3 years after resolution of her base disease, patient develops a progressive step claudication and a hip rigidity in adduction and external rotation. A coxofemoral HO focus is confirmed by radiology and CT. A surgical treatment of HO was performed, and the initial diagnose confirmed by anatomic pathology after biopsy of the injury. Patient had a favorable outcome.

Dolor cervical atípico: síndrome de Eagle / Atypical neck pain: Eagle syndrome

Presentamos el caso de un varón de 45 años con dolor cervical derecho muy localizado, característico y persistente. El estudio radiológico nos permitió diagnosticar claramente un síndrome de Eagle. Por lo anterior el paciente fue sometido a cirugía de extirpación de apófisis estiloides derecha. El paciente evolucionó sin mayores complicaciones ni incidencias, y obteniendo la resolución del cuadro.

Here we introduce a 45-year-old man suffering from an intense, unique and permanent pain, located in his right neck. Radiology showed us signs leading to the diagnosis of Eagle Syndrome. Surgery of right Styloid apophysis removal, with no complications, letting the patient free of symptoms.

Cuadro sincopal en el contexto del síndrome de Eagle / Episode of syncope in Eagles syndrome

El síndrome de Eagle es una patología infrecuente, caracterizada por la presencia de dolor cervicofacial, cefalea y calambres que se proyectan en la garganta, en el cuello y en el oído. Describimos el caso de una mujer de 36 años, con historia de tumefacción cervical, sensación de irritación faríngea y síncope, en la que en los estudios radiológicos se encontró una osificación total de ambos ligamentos estilohioideo, causante de su cuadro sincopal por compresión carotídea.

Eagle's syndrome is an infrequent pathology characterized by the presence of cervicofacial pain, headache and cramps that are projected in the throat, neck and ear. We reported a case of a 36 year-old woman with a history of cervical swelling, sore throat and syncope, which on imaging studies was found ossification both stylohyoid ligaments, causing carotid compression and syncope.

Osificación hetertópica neurogénica bilateral de cadera / Bilateral neurogenic heterotopic ossification of hip

La osificación heterotópica es una verdadera actividad osteoblástica con formación anormal de hueso lamelar maduro en tejidos blandos extraesqueléticos donde el hueso no existe normalmente. Se presenta un paciente con afección de ambas caderas, pretendiendo realizar una breve revisión sobre diagnóstico, seguimiento y tratamiento de esta patología.

Oropharyngeal styloids: An unusual presentation.

The close proximity of the styloid process to many of the vital neurovascular structures in the neck makes it clinically significant. The styloid process is said to be elongated if it is longer than 3.0 cm in length. Anatomical variations are very common and clinical symptoms arising from such variations have to be recognized. Elongated styloid processes may cause chronic throat pain along with foreign body sensation, dysphagia, vague facial pain, and otalgia. Surgical excision of an elongated styloid is considered as a satisfactory treatment for such cases. Here, we present a unique case of bilaterally elongated styloids that could be visualized just by depressing the tongue, when they appeared like the tusks of an elephant in the oropharyngeal region.

Extensa metaplasia ósea endometrial y exitoso embarazo espontáneo post tratamiento / Bony metaplasia of the endometrium. Report of two cases

We report a 28 year old female consulting for infertility and a 26-year-old woman consulting for severe dysmenorrhea. In both patients a osseous metaplasia of the endometrium was found. Both patients were subjected to a hysteroscopic resection of the osseous material and both achieved spontaneous pregnancies and term deliveries following the procedures. If the bony material is removed, normal pregnancies and deliveries are feasible afterwards, no matter how extensive is the the osseus metaplasia.

Metaplasia óssea endometrial: quadro clínico e seguimento após tratamento / Endometrial osseous metaplasia: clinical presentation and follow-up

OBJETIVO: apresentar o quadro clínico das pacientes com metaplasia óssea e avaliar os fatores de risco, as mudanças dos sinais e sintomas após a retirada do fragmento ósseo. MÉTODOS: foi realizado um estudo transversal com 16 pacientes diagnosticadas com fragmentos ósseos na cavidade uterina no período de julho de 2006 a janeiro de 2009. O critério de inclusão foi o achado de fragmento ósseo retirado da cavidade uterina. Todas as pacientes tiveram confirmação histológica de presença de tecido ósseo na cavidade endometrial. Obtivemos os dados de todas as pacientes antes e depois da retirada por meio de um questionário para avaliar o efeito da retirada sobre a sintomatologia das pacientes, além da pesquisa de possíveis fatores relacionados ao aparecimento da doença. RESULTADOS: metade das pacientes (8/16) tinha sintomas hemorrágicos e um terço (6/16) apresentava infertilidade. A retirada dos fragmentos foi efetiva na melhora das queixas, havendo desaparecimento dos sintomas em todos os casos de menorragia e dor pélvica. CONCLUSÃO: A retirada do fragmento ósseo pode restaurar a fertilidade em pacientes selecionadas e que tenham como causa a metaplasia óssea, além de ser bastante efetiva em proporcionar melhora nos casos que cursam com dor pélvica e menorragia.

PURPOSE: to describe the clinical signs and symptoms of patients with bone metaplasia and to assess the risk factors for changes in these symptoms after removal of the bone fragment. METHODS: a cross-sectional study was conducted on 16 patients with a diagnosis of bone fragments in the uterine cavity during the period comprising July 2006 to January 2009. The inclusion criterion was the detection of a bone fragment removed from the uterine cavity. The presence of bone tissue in the endometrial cavity was histologically confirmed in all patients. The data of all patients were obtained before and after removal by means of a questionnaire for the evaluation of the effect of removal on the symptoms and for the search of possible factors related to the onset of the disease. RESULTS: half the patients (8/16) had hemorrhagic symptoms and one third (6/16) were infertile. Removal of the fragments was quite effective in improving the complaints, with the disappearance of symptoms in all cases of hemorrhage and of pelvic pain. CONCLUSION: removal of bone fragments can restore the fertility of selected patients whose infertility is caused by bone metaplasia and is quite effective in leading to improvement in patients with pelvic pain and menorrhage.

Estudo anatômico da cóclea para confecção de instrumental para a cirurgia de implante coclear com 2 feixes de eletrodos em cócleas ossificadas / Cochlear anatomy study used to design surgical instruments for cochlear implants with two bundles of electrodes in ossified cochleas

A ossificação da cóclea, decorrente principalmente de meningite, impede a inserção completa do implante coclear convencional. Os implantes com 2 feixes de eletrodos mais curtos do que o convencional foram desenvolvidos especialmente para cócleas ossificadas. Porém, durante essa cirurgia há um grande risco de lesão da artéria carótida interna (ACI). Portanto, a medida da profundidade das cocleostomias para inserir os dois feixes de eletrodos aumentaria a segurança desse procedimento. OBJETIVOS: 1) Obter as distâncias entre as cocleostomias e a ACI em ossos temporais de cadáver; 2) Confeccionar instrumento que possa ser usado na cirurgia de implante coclear com 2 feixes de eletrodos. FORMA DE ESTUDO: Experimental prospectivo. MATERIAL E MÉTODO: Em 21 ossos de cadáveres foi realizada: 1) mastoidectomia cavidade aberta; 2) cocleostomias nos giros basal e médio da cóclea; 3) identificação da ACI; 4) medida da distância entre as cocleostomias e a artéria. RESULTADOS: A medida média ± desvio padrão obtida para o túnel superior foi 8,2 ± 1,1mm e para o túnel inferior foi 8,1± 1,3mm. A menor distância encontrada foi 6,5mm para o túnel superior e 6,0mm para o túnel inferior. CONCLUSÃO: Apesar dos parâmetros calculados concluímos que a melhor medida para ser considerada na confecção do instrumento cirúrgico serão as mínimas medidas obtidas em cada um dos giros cocleares, pois é a maneira mais segura para evitar a lesão da ACI, que pode ser fatal.

Cochlear ossification, mainly secondary to meningitis, prevents the complete conventional cochlear implant insertion. Implants with two electrode bundles shorter than the conventional ones were specifically developed for ossified cochleas. However, during surgery there is a high risk of damaging the internal carotid artery (ICA). Therefore, measuring cochleostomy depth in order to insert the two electrode bundles would greatly increase the procedure's safety. AIMS: 1) Find the distances between cochleostomies and ICA in cadaver temporal bones. 2) Design an instrument that can be used in cochlear implant surgery to introduce an implant with two bundles of electrodes. STUDY DESIGN: Experimental prospective. MATERIALS AND METHODS: In 21 temporal bones from cadavers we performed: 1) canal wall down mastoidectomy; 2) cochleostomy in the cochlear basal and middle turns; 3) ICA identification; 4) Length determination between the cochleostomies and the artery. RESULTS: the average distance ± standard deviation obtained for the upper tunnel was of 8.2 ± 1.1 mm and for the lower tunnel it was of 8.1± 1.3 mm. The shortest distance found was of 6.5 mm for the upper tunnel and 6.0 mm for the lower tunnel. CONCLUSION: Despite the values calculated, we concluded that the best value to be considered in creating a surgical instrument are the minimum lengths obtained for each one of the cochlear turns, because this is the safest way to avoid damaging the ICA, that can be fatal.

Síndrome de eagle: relato de três casos / Eagle's syndrome; report of three cases

O processo estilóide do osso emporal é uma projeção óssea que corresponde ao local de origem dos músculos estilofaríngeo, estilo-jióideo e estiloglosso. A síndrome de eagle se caracteriza pela presença de sintomas como otalgia, disfagia, odinofagia e dor facial...

The styloid processo of temporal bone is a bone projection that come form stylopharyngeal and styloglossal muscles. The eagle's syndrome is characterized by presence of symptoms such cervical pain, dysphagia, odynophagia, otalgia...

Human penile ossification: case report

CONTEXT: Ossification in the human penis is such a rare condition that only 34 histologically evident cases have previously been reported. Among several conditions that have been correlated with this problem the most frequent is Peyronie disease. In all these conditions, human penile ossification appears to be a metaplastic bone formation process. CASE REPORT: A 59-year-old white man presented with a one-year history of slight pain upon erection and during intercourse. He also complained of hard plaque near the base of the penis. One year earlier, he had sustained blunt trauma during intercourse. Examination of the penis revealed a fixed firm mass extending over the proximal third of the penile shaft, measuring 3.0 x 3.0 x 2.0 cm and involving the corporal sponge, without surface extension. There was no impotence or other relevant clinical finding. Radiography on the penis revealed irregular calcification in the same position as the palpable mass and in the septum of the proximal inner third of the penis. The importance of this report lies in the extent of the human penile ossification, as demonstrated by the radiological and histological confirmation.

CONTEXTO: Ossificação do pênis humano é uma condição rara e apenas 34 casos histologicamente evidentes foram relatados. Várias condições foram relacionadas com o problema e o mais freqüente foi a Doença de Peyronie. Em todas, as ossificações parecem ser resultado de um processo de metaplasia com formação óssea. RELATO DO CASO: Um homem de 59 anos branco apresentou-se com história de leve dor no pênis durante as ereções há um ano. Ele também referia a presença de uma placa dura na base do pênis, que começou a crescer após um trauma na relação sexual. O exame do pênis revelou tratar-se de uma massa fixa, firme, no terço proximal do pênis de aproximadamente 3.0 x 3.0 x 2.0 cm, sem extensão para a superfície. Não havia impotência ou outra alteração clínica relevante. A radiografia do pênis identificou extensa área calcificada no corpo esponjoso e região do septo, em correspondência à massa palpada. A importância deste relato é a extensão da ossificação de acordo com a radiologia e confirmação histológica.

Multisegmental cervical ossification of the posterior longitudinal ligament: anterior vs posterior approach.

AIMS: To determine the surgical approach in patients with multisegmental (four or more segments) OPLL of the cervical spine. METHODS AND MATERIALS: Data of 27 patients who had undergone either an anterior (corpectomy with excision of OPLL and interbody fusion = 14 patients) or posterior approach (laminectomy = 12, laminoplasty = 1 patient) for the multisegmental cervical OPLL was analyzed retrospectively. The patients in each group were statistically similar in respect to preoperative factors such as age, duration of symptoms, preoperative modified Japanese orthopedic association score, OPLL thickness, effective canal diameter, and antero-posterior cord compression ratio. The clinical outcome was assessed by the Harsh grading system and recovery rate was assessed by Hirabayashi method. RESULTS: There was no statistical difference in the outcome, and recovery rate. Nine patients developed complications after anterior approach in contrast to one after posterior approach. CONCLUSIONS: In patients with multisegmental cervical OPLL, there was no significant difference in the short-term recovery rate and outcome between two groups. The immediate postoperative complications were less in patients who had undergone posterior approach. From our analysis, it appears that the posterior approach is probably the preferred method of treatment in a multisegmental OPLL in absence of preoperative kyphosis.

Metaplasia ósea del endometrio como causa de infertilidad / Bone metaplasia of the endometrium as a cause of infertility

Se presentan dos casos de Metaplasia ósea del endometrio en pacientes infértiles que son sometidas a Resección histeroscópica de fragmentos óseos con embarazo posterior.

Two cases of endometrial osseous metaplasia of the endometrium in infertile patients with ressection of bony tissue by histeroscopy, followed by pregnancy.

Osificación endometrial: diagnóstico ultrasonográfico y su correlación histopatológica / Endometrial ossification: ultrasound diagnosis and histopathological confirmation

La osificación endometrial es una rara condición que puede ser explicada en ocasiones por un fenómeno de metaplasia. Puede existir una historia previa de abortos (principalmente en aquellos mayores a 12 semanas). Su presentación clínica puede incluir problemas de fertilidad primaria o secundaria, alteraciones menstruales, dolor pelviano y dismenorrea. Reportamos una revisión de la casuística de nuestro servicio, de aquellas pacientes en las que se hizo este diagnóstico por ultrasonografía y su correlación histopatológica posterior (n=13). La edad vario entre los 19 y los 62 años (mediana de 38), donde 5 eran mayores de 40 años. Del total de pacientes, 7 consultaron por infertilidad primaria o secundaria, de las cuales tres tenían antecedentes de aborto previo (uno provocado) y una el de aborto posterior. Del total de pacientes, solo 4 tenían el antecedente de uso de anticonceptivos orales, el resto no uso ningún método; 3 tenían alteraciones menstruales (amenorrea, oligomenorrea e irregularidad menstrual). Al ultrasonido, el grosor endometrial vario entre 2 y 8 mm (mediana de 4mm). Se realizó historoscopía en pacientes como método diagnóstico y terapéutico. En el resto de ellas, se realizó legrado biópsico

Ossificaçäo ectópica de pavilhäo auricular: relato de caso com formaçäo de massa tumoral / Ectopic ossification of the auricular cartilage: case report with tumor formation

Os autores relatam o caso raro de um paciente com ossificaçäo ectópica de cartilagem da orelha, com formaçäo de grande massa tumoral que alterava totalmente a morfologia do pavilhäo auricular. Foi submetido a exérese cirúrgica da massa tumoral e o estudo anatomo-patológico revelou proliferaçäo de tecido ósseo, de modo a formar nódulo em meio a cartilagem hialina e fibrose