Hipoacusia sensorineural asimétrica en el diagnóstico de schwannoma vestibular / Asymmetric sensorineural hearing loss in the diagnosis of vestibular schwannoma

Introducción: se ha descrito que los pacientes con hipoacusia asimétrica cursan en un 2% con lesiones retrococleares. La conducta de escrutinio se ha basado en la audiometría. Existen varias definiciones de asimetría audiométrica descritas en la literatura, pero sin llegar a un consenso. Aunque la prueba de oro para el diagnóstico de schwannoma vestibular es la resonancia magnética con gadolíneo, la sospecha clínica se hace en base a la asimetría audiométrica. Objetivo: hacemos una revisión de los trabajos publicados al respecto en la literatu-ra y comentamos nuestra experiencia. Reflexión: queremos enfatizar en la importancia de estudiar a los pacientes con hipoacusia asimétrica con el fin de descartar patología retrococlear. Conclusión: a pesar de que no existe un consenso claro en la definición de hi-poacusia asimétrica, la sospecha clínica de un schwannoma vestibular se basa en la audiometría

Background: It is described that 2% of patients with asymmetric hearing loss have retrocochlear lesions. The scrutiny behavior has been based on audiometry. There are several definitions of audiometric asymmetry described in the literature, but without reaching a consensus. Although the gold standard for the diagnosis of vestibular schwannoma is gadolinium magnetic resonance imaging, the clinical sus-picion is based on audiometric asymmetry. Objective: we review the results published in this regard in the literature and com-ment on our own experience. Reflection: we want to emphasize the importance of studying asymmetric hearing loss patients in order to rule out retrocochlear etiology. Conclusions: although there is no clear consensus on the definition of asym-metric hearing loss, the clinical suspicion of a vestibular schwannoma is based on the audiometry.

Acúfeno como síntoma inicial de plasmocitoma de hueso temporal

Resumen Los tumores de base de cráneo son inusuales, entre ellos el plasmocitoma surge de las células plasmáticas y puede ser el precursor del mieloma múltiple. Existen 2 tipos de plasmocitoma: el óseo solitario y el extramedular. Además, el plasmocitoma temporal es aún menos frecuente. El acúfeno puede ser la presentación inicial de estos tumores inusuales. Se presenta caso de una paciente femenina de 74 años, que inicia con acúfeno derecho, así como hipoa-cusia derecha. Acompañado de dolor cervical y limitación de la flexión cervical e inestabilidad. Como único dato a la otoscopia derecha presenta hipervascularidad del promontorio. Se realizan estudios de imagen reportando tumor con erosión ósea de ambas porciones petrosas de hueso temporal, esfenoides y columna cervical. Se realizó una biopsia transesfenoidal reportando plasmocitoma CD 138 positivo. Se inició quimioterapia y radioterapia. El acúfeno unilateral debe estudiarse ampliamente ya que puede ser síntoma de diagnósticos inusuales como neoplasias de base de cráneo.

Abstract Skull-base tumors are unusual, Plasmacytoma arises from plasma cells and could be the precursor of multiple myeloma. There are 2 types of plasmacytoma: solitary bone and extramedullary. Temporal bone plasmacytoma is even more infrequent. Tinnitus could be the initial symptom of this unusual tumors. We present the case of a 74-year-old female patient, who started with right tinnitus as well as right hearing loss. Accompanied by cervical pain and limitation of cervical flexion and instability. As the only data on right otoscopy, there was an hypervascular promontory. Imaging studies were performed reporting tumor with bone erosion of both petrous portions of temporal bone, sphenoid, and cervical spine. A transsphenoidal biopsy was performed, reporting positive CD 138 plasmacytoma. Chemotherapy and radiotherapy were indicated. Unilateral tinnitus should be fully studied because it might be a symptom of unusual diagnoses such as skull base neoplasms.

Efficacy of topical clotrimazole vs. topical tolnaftate in the treatment of otomycosis. A randomized controlled clinical trial / Eficácia do clotrimazol tópico versus tolnaftato tópico no tratamento da otomicose: um ensaio clínico controlado randomizado

Abstract Introduction: Otomycosis, an infection of the ear canal by fungi, is prevalent in hot and humid weather. Nevertheless, there is not sufficient evidence for the effectiveness of different topical antifungal treatments. Tolnaftate, is a topical antifungal agent described to be effective in the treatment of otomycosis. Currently there are not sufficient studies that prove its efficacy. Objectives: To compare the efficacy of clotrimazole and tolnaftate administration in the treatment of otomycosis. Material and methods: A controlled, randomized and open clinical trial included patients diagnosed with fungal external otitis who were treated with topical antifungals, randomized into two treatment groups: (1) clotrimazole cream; (2) tolnaftate solution. They were microscopically evaluated at one and two weeks of treatment to determine resolution of disease. Recurrence and complications were recorded. Demographic and clinical variables were collected and analyzed. Follow-up and final outcomes (absence of infection) were compared between groups. Results: Forty eight patients were included, 28 in the clotrimazole group and 20 in the tolnaftate group. Spring was the weather most commonly associated with otomycosis, while otic manipulation was the risk factor more common in both groups. Predominant symptoms were itching and otic fullness. Aspergillus niger organism was isolated most frequently. Treatment with clotrimazole resulted in 75% resolution vs 45% resolution with treatment with tolnaftate at one week of treatment (p = 0.007). The Tolnaftate treatment group demonstrated higher recurrence rates and treatment failures, 20% and 15% respectively. Conclusions: Clotrimazole cream treatment is more effective than tolnaftate for uncomplicated otomycosis. More studies are needed to corroborate our results.

Resumo Introdução: Otomicose, uma infecção fúngica do canal auditivo externo, é prevalente em climas quentes e úmidos. No entanto, a literatura não apresenta evidências suficientes sobre os diferentes tratamentos antifúngicos tópicos. O tolnaftato é um antifúngico tópico descrito como eficaz no tratamento da otomicose; entretanto, sua eficácia não está suficientemente comprovada. Objetivo: Comparar a eficácia do uso de clotrimazol e tolnaftato no tratamento da otomicose. Material e método: Ensaio clínico controlado e randomizado; incluiu pacientes diagnosticados com otite externa fúngica tratados com antifúngicos tópicos, randomizados em dois grupos de tratamento: 1) clotrimazole (creme); 2) solução de tolnaftato. Eles foram avaliados microscopicamente uma e duas semanas após o início do tratamento para avaliar a resolução da doença. Recorrência e intercorrências foram registradas; além disso, as variáveis demográficas e clínicas foram coletadas e analisadas. Os dados do acompanhamento e desfechos finais (ausência de infecção) foram comparados entre os grupos. Resultados: O estudo incluiu 48 pacientes, 28 dos quais foram alocados ao grupo clotrimazole e 20 ao grupo tolnaftato. A primavera foi a estação mais comum; a manipulação foi o fator de risco mais comum em ambos os grupos. Os sintomas mais comuns foram coceira e plenitude auricular. Aspergillus niger foi o micro-organismo mais comumente isolado. Após uma semana, o tratamento com clotrimazol apresentou uma taxa de resolução de 75% vs. 45% com o tratamento com tolnaftato (p = 0,007). O tratamento com tolnaftato apresentou maiores taxas de recidiva e falhas: 20% e 15%, respectivamente. Conclusões: Em casos de otomicose não complicada, o uso de clotrimazol (creme) é mais eficaz do que o de tolnaftato. Mais estudos são necessários para corroborar os presentes resultados.

An Emergent Entity: Indolent Mucormycosis of the Paranasal Sinuses. A Multicenter Study

Abstract Introduction Indolent or chronic mucormycosis is a rare entity that affects both immunosuppressed and immunocompetent individuals. Additionally, its clinical evolution is nonspecific and there is no standardized treatment for this condition. Objective To describe the clinical characteristics and management of patients with indolent mucormycosis. Methods In the project of study with chart review in the Interinstitutional secondary care centers, patients with evidence of indolentmucormycosis, defined as pathological confirmation of nasal/paranasal sinus mucormycosis for more than 1 month, were included. All patients underwent complete laboratory workup, imaging studies, surgical treatment and adequate follow-up. No evidence of disease status was defined when patient had subsequent biopsies with no evidence of mucormycosis. Results We included seven patients, three female and four male subjects. The mean age was 53.14 years. Four patients were immunosuppressed and three immunocompetent. Among the immunosuppressed patients three had diabetes and one had dermatomyositis. The symptomswere nonspecific: facial pain/headache, mucoid discharge and cacosmiawere the ones most frequently reported. Maxillary sinus involvement was present in all patients. Two immunosuppressed subjects received amphotericin. Posaconazole was the only treatmentinoneimmunosuppressedpatient. Allimmunocompetent patientshadsingleparanasal sinus disease and received only surgical treatment. All patients are alive and free of disease. Conclusion Indolent mucormycosis is a new and emerging clinical entity in immunosuppressed and immunocompetent patients. Single paranasal sinus disease is a frequent presentation and should not be overlooked as a differential diagnosis in these patients. Immunocompetent patients should only be treated surgically. (AU)

Refractory episodic vertigo: role of intratympanic gentamicin and vestibular evoked myogenic potentials / Vertigem refratária episódica: papel da gentamicina intratimpânica e potencial evocado miogênico vestibular

Abstract Introduction: Even today, the treatment of intractable vertigo remains a challenge. Vestibular ablation with intratympanic gentamicin stands as a good alternative in the management of refractory vertigo patients. Objective: To control intractable vertigo through complete saccular and horizontal canal vestibular ablation with intratympanic gentamicin treatment. Methods: Patients with refractory episodic vertigo were included. The inclusion criteria were: unilateral ear disease, moderate to profound sensorineural hearing loss, and failure to other treatments. Included patients underwent 0.5-0.8 mL of gentamicin intratympanic application at a 30 mg/mL concentration. Vestibular ablation was confirmed by the absence of response on cervical vestibular evoked myogenic potentials and no response on caloric tests. Audiometry, electronystagmography with iced water, and vestibular evoked myogenic potentials were performed in all patients. Results: Ten patients were included; nine patients with Meniere's disease and one patient with (late onset) delayed hydrops. Nine patients showed an absent response on vestibular evoked myogenic potentials and no response on caloric tests. The only patient with low amplitude on cervical vestibular evoked myogenic potentials had vertigo recurrence. Vertigo control was achieved in 90% of the patients. One patient developed hearing loss >30 dB. Conclusions: Cervical vestibular evoked myogenic potentials confirmed vestibular ablation in patients treated with intratympanic gentamicin. High-grade vertigo control was due to complete saccular and horizontal canal ablation (no response to iced water in electronystagmography and no response on cervical vestibular evoked myogenic potentials).

Resumo Introdução: Ainda hoje, o controle da vertigem intratável permanece um desafio. A ablação vestibular com gentamicina intratimpânica permanece como uma boa alternativa no tratamento de pacientes com vertigem refratária. Objetivo: Controlar a vertigem intratável por meio de ablação vestibular completa dos canais sacular e horizontal com gentamicina intratimpânica como tratamento. Método: Pacientes com vertigem refratária episódica foram incluídos. Os critérios de inclusão foram doença unilateral da orelha, perda auditiva neurossensorial de moderada a profunda e fracasso com outros tratamentos. Os pacientes incluídos receberam uma aplicação de 0,5-0,8 mL de gentamicina intratimpânica com concentração de 30 mg/mL. A ablação vestibular foi confirmada pela ausência de resposta no teste de potencial evocado miogênico vestibular cervical (PEMVc) e nenhuma resposta nas provas calóricas. Audiometria, eletronistagmografia com água gelada e potencial evocado miogênico vestibular foram realizados em todos os pacientes. Resultados: Ao todo, dez pacientes foram incluídos: nove com doença de Ménière e um com hidropisia tardia. Nove pacientes apresentaram ausência de resposta no teste de potencial evocado miogênico vestibular e nenhuma resposta na prova calórica. O único paciente com baixa amplitude no PEMVc apresentou recorrência da vertigem. O controle da vertigem foi obtido em 90% dos pacientes. Um paciente desenvolveu perda auditiva > 30 dB. Conclusões: O PEMVc confirmou ablação vestibular nos pacientes tratados com gentamicina intratimpânica. O alto grau de controle da vertigem foi devido à ablação completa do sáculo e canal horizontal (sem resposta à água gelada na eletronistagmografia e ausência de resposta no PEMVc).

Patrón de citocinas en hígado y bazo de perros con Leishmaniasis visceral natural

En el presente estudio se caracterizó el patrón de citocinas del bazo e hígado de perros infectados en forma natural por Leishmania infantum (chagasi) provenientes del estado Nueva Esparta, Venezuela. Los perros fueron clasificados como sintomáticos y asintomáticos considerando tres signos principales de esta patología como hepatoesplenomegalia, caquexia y onicogrifosis. Muestras de hígado y bazo fueron tomadas para evaluar carga parasitaria y la expresión de citocinas y quimiocinas por inmunohistoquímica. En los perros sintomáticos se observó una mayor carga parasitaria tanto en el hígado como en bazo. En el bazo se observó una densidad de células positivas para interferón gamma (IFN-g), interlucinas (IL-12, IL-10, IL-4, IL-8) y Proteína 1 quimioatrayente de monocito (MCP-1), similar en perros asintomáticos y sintomáticos. Mientras que en el hígado la evaluación de las citocinas IFN-g, IL-12, IL-10 IL-8 y MCP-1, mostró una tendencia al aumento en el grupo de perros sintomáticos, con incremento significativo de las células IL-4+ en los perros sintomáticos, con respecto a los asintomáticos. La densidad de células IL-4+ en el hígado se correlacionó positivamente con la hepatomegalia. Al cuantificar las concentraciones séricas de la quimiocina Proteina 1 alfa inflamatoria de macrófago (MIP-1a) se observó una alta producción en los perros asintomáticos. Estos resultados confirman laexistencia de una respuesta órgano-especifica frente a L. infantum (chagasi), del tipo T cooperador 2 (Th2) en el hígado de los perros sintomáticos, caracterizada por un marcado predominio de IL-4 sobre IFN-g e IL-12. La elevada producción de IL-4 fue directamente relacionada con la hepatomegalia.

In the present study, we characterized the cytokine pattern in the spleen and liver of naturally infected dogs with Leishmania infantum (chagasi) from the Nueva Esparta state of Venezuela. The dogs were classified as symptomatic and asymptomatic considering three main signs of this disease: hepatosplenomegalia, cachexia and onichogriphosis. Tissue samples from liver and spleen were taken to evaluate parasite load, cytokines and chemokines expression by immunohistochemistry. In symptomatic dogs, a higher parasitic load was observed in the liver and spleen as compared to asymptomatic dogs. In the spleen, the density of gamma interferón (IFN-g), interleukins (IL-12, IL-10, IL-4, IL-8) and Monocyte Chemoattractant Protein-1 (MCP-1), it was similar between asymptomatic and symptomatic dogs. Whereas, in the liver IFN-g, IL-12, IL-10 IL-8 and MCP-1 showed a tendency to increase in symptomatic dogs, with a significant increment of IL-4 + cells. In the liver, the density of IL-4+ cells was positively correlated with hepatomegaly. In addition, higher concentrations of Macrophage inflammatory protein 1 alpha (MIP-1a) were observed in the serum of asymptomatic than in symptomatic dogs. These results corroborate the existence of an organ-specific immune respose against L. infantum (chagasi), with a T helper 2 (Th2) immune response in the liver of symptomatic dogs, with prevalence of IL-4 over IFN-g and IL-12. The high production of IL-4 is directly related with hepatomegalia.

Radiocirugía psiquiátrica con Gamma Knife

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Abstract: Today, psychosurgery is a minimally invasive and highly selective treatment performed only on some patients with severe, refractory treatment, affective, anxious, or obsessive-compulsive disorders. Recent advancements in technology and functional neuroanatomy as well as economic pressures to lower the cost of caring for the chronically ill may provide an opportunity for psychosurgery to become a more attractive option in the treatment of psychiatric disease. In recent years, the rapid adoption of computer-based techniques for surgical planning and visualization and image-guided surgery have made possible a number of impressive advances in functional neurosurgery. Magnetic resonance imaging (MRI) allows for the acquisition of highly detailed structural information of soft tissues in the brain. Minute pathological alterations can be visualized even before they are detected by other means. Stereotaxic atlases based on this information are now used to achieve an extraordinary precision in the placement of electrodes and probes and to plan the operation. Functional imaging is currently possible with special metabolic markers and MRI, as well as computerized techniques for the mathematical processing and visualization of images. Thus, non-invasive evaluation of brain function can be performed with extraordinary precision and sensitivity. Bloodless stereotaxic surgery without opening the skull (even the patient's head does not need to be shaved) is possible thanks to a revolutionary technique called radiosurgery. The destruction of nervous or vascular tissue inside the brain is achieved by projecting thin and powerful beams of ionizing radiation, which come from several angles around the patient's head. These beams produced by sources of radioactive cobalt (the "gamma knife" developed in the 60's by the Swedish neurosurgeon Lars Leksell). With this modality, radiation energy concentrates in a single small point inside the brain. Gamma Knife radiosurgery was first used in our country in 1996 to treat patients diagnosed with treatment-refractory psychiatric diseases. This treatment modality requires a multidisciplinary effort on the part of psychiatrists, neuropsychologists, neurologists, neurosurgeons and medical physicists. This should also be in accordance with the psychiatric neurosurgical protocol and ethics code of Medica Sur, as well as following the guidelines established by the National Nuclear Regulatory Commission and the Radiosurgery and Stereotaxic Radiotherapy Section of the Mexican College of Neurological Surgery. Ten patients have been treated with several procedures like cingulotomy, anterior capsulotomy, subcaudate tractotomy and limbic leukotomy in order to aid them in obsessive-compulsive disorder, major depression, pathological aggression, and Asperger and Tourette Syndromes. In this paper we disclose our experience with follow-ups ranging from six months to seven years in accordance with the most usual evaluation scales for mental disease and multiaxial evaluation framework of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In our cases, the most common indications have been refractory obsessive-compulsive disorder (OCD), pathologic aggression and major depression after at least two years of treatment and with the involvement of at least two psychiatrists. According to the basal diagnosis, psychological tests are used by the neuropsychology specialist from our group and /or the neuropsychologists who have given medical treatment along with the psychiatrists. Six males and four females were treated with an age range of 13 to 52 years, and an average age of 28.2 years. The first patient had impulsive disorder and hetero-aggression, with a history of two bilateral prefrontal lobotomies with no stereotaxic planning and without a good response. The patient had gamma radiosurgery with bilateral anterior capsulotomy and continued his antipsychotic treatment. For two years, the patient had a good response and was able to go back to his wife and mother. After those two years, he developed a hypersexuality syndrome that led to a divorce from his wife and the patient was lost to clinical follow-up. The second patient was an adolescent with corpus callosum lipoma and hetero-aggression and compulsive syndrome refractory to medical treatment including carbamazepine levels above the therapeutic level. Three persons had to continuously watch him at home during 24 hours a day. He had a history of bilateral stereotaxic cingulotomy with thermocoagulation without a good response. Under general anesthesia, a gamma bilateral stereotaxic capsulotomy was performed. After 2 months of latency period and three years of follow-up, the hetero-aggression has been under control. Carbamazepine treatment is still used. The third patient had physical hetero-aggression towards his parents for more than seven years. He underwent gamma radiosurgery for bilateral capsulotomy and after a latency period of three months and a three year follow-up the patient has had no aggression episodes. The fourth patient had hetero-aggression since his teenage years, with a course of more than 6 years of this disorder and major depression with suicidal attempts. He had an electroconvulsive therapy session that led to a minor improvement lasting 2 months. Gamma radiosurgery was used for a limbic leukotomy in the cingula and the anterior arm of the internal capsules. His aggressiveness has significantly improved and his depression has been fluctuating under medical supervision. The patient has anxiety crisis that the patient's mother helps to control by giving him marijuana. The fifth patient had OCD of more than 10 years of course and a predominance of contamination fobias and bleeding hands because of frequent washing. She was treated with bilateral gamma capsulotomy and after two months of latency she stopped using gloves and after two years of follow-up the fobias have disappeared and has been able to work with no limitations in a company office. The sixth adolescent patient is the son of a neurosurgeon colleague and has symptoms of hetero and self-aggression, impulsivity and destructive behavior associated with mental retardation. The patient underwent a bilateral anterior capsulotomy under general anesthesia. The suggested treatment protocol was to combine the procedure with bilateral limbic leukotomy and hypothalamic procedure in a second surgical stage to control the self-aggression outbreaks. The patient had significant improvement of his impulsivity during the first two months and before the end of his minimum latency period of 6 to 8 months developed a zone of radionecrosis. He had an open cingulotomy after five months of radiosurgery in another hospital and his current clinical course is unknown. The seventh patient with Asperger and Tourette syndrome and impulsivity and hetero-aggression had a bilateral anterior gamma capsulotomy with significant improvement and after one year of follow-up he had a less severe clinical recurrence and underwent bilateral gamma cingulotomy to complete limbic leukotomy. He has early shown improvement but his follow-up is only two months. The eighth patient had schizophrenic disorder displayed as impulsivity crisis, obsessive ideas and hetero-aggression towards his family fluctuating with periods of depression. He had a limbic leukotomy and has good control of his aggression and is still under medical treatment as most of the patients are. The nineth patient in the series had major depression, suicidal attempts and chronic anxiety refractory to medical treatment. She was operated two years before and had a bilateral capsulotomy by thermocoagulation and because her clinical picture prevailed, she had bilateral anterior capsulotomy with gamma knife. In her six month follow-up, her anxiety has improved, and she has had no new major depression crisis and her follow-up neuropsychological tests are pending to be made in her home town.

Factores que inciden en el aparecimiento del síndrome del biberón y la atención odontológica que reciben los niños de 1 a 6 años, en el Hospital Nacional de niños Benjamín Bloom, durante el período del 1 al 30 de octubre de 1998 / Factors that influence the appearance of the bottlemouth syndrome and the dental care received by children aged 1 to 6 years old at the Benjamin Bloom National Children's Hospital, during the period from October 1 to 30, 1998

El presente trabajo de investigación es de tipo diagnóstica descriptiva realizada dentro del hospital nacional de niños Benjamín Bloom durante el período de octubre de 1998, el cual se basa en la necesidad que existe de conocer todos aquellos factores que conllevan a la población infantil de nuestro país a presentar un tipo de enfermedad dental tan destructiva como es el Síndrome del biberón el cual tiene una alto índice de presencia en la consulta odontológica diaria del Hospital Nacional de niños Benjamín Bloom, en donde asisten pacientes niños con este tipo de afección, todos ellos provenientes de diferentes lugares de la población salvadoreña. Este trabajo plasma las diferentes causas que influyen en el aparecimiento del Síndrome del biberón en el país. Se vio la necesidad de desarrollar un tema como este debido a la poca información acerca de este síndrome ya que esto afecta directamente la dentición primaria de los infantes a una edad temprana, por el inadecuado uso de la pacha así como también por un amamantamiento prolongado. Además se menciona las diferentes características clínicas que en cada etapa de la enfermedad se manifiestan, así como el alto grado de destrucción dental que puede llegar a presentar estos niños, llegando a causar daños en la salud integral del niño como un estado anímico pudiendo provocar un precario desarrollo en el niño. En este trabajo se incluyen las diferentes alternativas para poder resolver esta afección en sus diferentes etapas de desarrollo en el paciente niño así como también se agregan todas aquellas medidas preventivas y educativas para evitar el aparecimiento de dicha enfermedad. Con esta información sobre afección bucal, se pretende que el estudiante de odontología y el profesional odontólogo disponga cierta recopilación bibliográfica que ayude al adecuado manejo de este tipo de paciente y la resolución más eficaz y acertada en cuanto al tratamiento que deba elegir las necesidades de cada paciente que padece el síndrome del biberón devolviéndole así las funciones en su aparato estomatognático necesarias para su buen desarrollo.

This research work is of a descriptive diaanostic type carried out within the Benjamin Bloom National Children's Hospital during the period of October 1998, which is based on the need to know all those factors that lead to the child population of our country to present a type of dental disease as destructive as the Bottle Syndrome which has a high rate of presence in the daily dental consultation of the Benjamin Bloom National Children's Hospital, where children with this type of condition attend, all of them from from different parts of the Salvadoran population. This work reflects the different causes that influence the appearance of the Bottle Syndrome in the country. The need to develop a topic like this was seen due to the little information about this syndrome since this directly affects the primary dentition of infants at an early age, due to the inadequate use of the pacha as well as prolonged breastfeeding. In addition, the different clinical characteristics that are manifested in each stage of the disease are mentioned, as well as the high degree of dental destruction that these children can present, causing damage to the integral health of the child as a state of mind that can cause a poor development in the child. This work includes the different alternatives to be able to solve this condition in its different stages of development in the child patient, as well as all those preventive and educational measures to avoid the appearance of said disease. With this information on oral affection, it is intended that the dental student and the dental professional have a certain bibliographic compilation that helps the proper management of this type of patient and the most effective and correct resolution regarding the treatment that the needs of each should choose. patient suffering from bottle syndrome, thus restoring the functions of the stomatognathic apparatus necessary for its proper development.