Abordaje laparoscópico de la neoplasia mucinosa apendicular de bajo grado / Laparoscopic approach of low-grade appendiceal mucinous neoplasm

RESUMEN Las neoplasias mucinosas apendiculares son infrecuentes y se clasifican en neoplasias mucinosas de bajo grado, de alto grado y adenocarcinoma mucinoso. Se consideran precursoras del pseudomixoma peritoneal, caracterizado por la acumulación de mucina dentro de la cavidad abdominal. Informamos tres casos de neoplasia mucinosa apendicular de bajo grado, dos varones y una mujer, que presentaron dolor abdominal agudo, diagnosticados preoperatoriamente mediante tomografía y que fueron manejados con un abordaje laparoscópico (apendicectomía, resección parcial de ciego y colectomía derecha, respectivamente). Los tres casos tuvieron una buena evolución posoperatoria y no hubo complicaciones. Se concluye que las neoplasias mucinosas apendiculares son raras y no tienen una presentación clínica específica. El abordaje laparoscópico es una opción segura y factible. La frecuencia y la duración del seguimiento de estos pacientes es motivo de controversia.

ABSTRACT Appendiceal mucinous neoplasms are rare and are classified in low-grade mucinous neoplasm, high-grade mucinous neoplasm and mucinous adenocarcinoma. They are considered precursors of pseudomyxoma peritonei, characterized by the accumulation of mucin within the abdominal cavity. We report three cases of low-grade appendiceal mucinous neoplasm, two men and one woman, who presented with acute abdominal pain. The diagnoses were made preoperatively by computed tomography scan and the tumors were managed through laparoscopic approach (appendectomy, partial resection of the cecum and right colectomy, respectively). The three patients evolved with favorable postoperative outcome without complications. Appendiceal mucinous neoplasms are rare without specific clinical presentation. The laparoscopic approach is a safe and feasible option. The frequency and duration of surveillance in these patients are still controversial.

Atresia bronquial / Bronchial atresia

Introducción: La atresia bronquial es una patología poco frecuente, generalmente asintomática e incidental en las imágenes del tórax. La aproximación diagnóstica de esta entidad se puede hacer por radiografía y broncoscopia, donde se identifican algunos aspectos claves en el diagnóstico diferencial. De acuerdo las manifestaciones clínicas y posibles complicaciones el tratamiento puede ser desde conservador hasta quirúrgico con resección lobar o segmentaria. Objetivo: Presentar las características de un caso con atresia bronquial. Presentación de caso: Se presenta un caso de atresia bronquial en una paciente de 19 años de edad cuyo tratamiento definitivo fue bilobectomía media-inferior derecha. Conclusiones: La atresia bronquial es una entidad infrecuente que puede cursar de manera asintomática y ser detectada por un hallazgo radiológico en pacientes adultos de manera incidental. El diagnóstico se puede confirmar por broncoscopia y el tratamiento casi siempre es quirúrgico(AU)

Introduction: Bronchial atresia is a rare disease, generally asymptomatic and incidental in chest images. The diagnostic approach of this entity can be done by radiography and bronchoscopy, some key aspects are identified in the differential diagnosis. According to the clinical manifestations and possible complications, the treatment can range from conservative to surgical with lobar or segmental resection. Objective: To describe a case of bronchial atresia. Case report: A case of bronchial atresia is reported in a 19-year-old patient whose definitive treatment was a right-lower-middle bilobectomy. Conclusions: Bronchial atresia is a rare entity that can occur asymptomatically and be detected incidentally by a radiological finding in adult patients. The diagnosis can be confirmed by bronchoscopy, and treatment is almost always surgical(AU)

Mucocele de cavidades paranasales / Sinus mucocele

Los mucoceles son quistes expansivos e indolentes de las cavidades paranasales. A pesar de ser lesiones benignas, tienen potencial destructivo local por su expansión crónica y cambios óseos. Su ubicación más frecuente es frontoetmoidal. Se postula que su origen es por alteración de la vía de drenaje de los senos. La clínica es dependiente de su ubicación: los mucoceles frontoetmoidales presentan aumento de volumen, cefalea o proptosis. Las imágenes juegan un rol importante en el diagnóstico, siendo la tomografía computarizada y la resonancia magnética los exámenes que detectan patrones sugerentes de mucoceles. El tratamiento es quirúrgico, donde el abordaje endoscópico ha desplazado al abierto por ser mínimamente invasivo, presentar menos comorbilidades y tener menor tasa de recurrencia.

Mucoceles are expansive and indolent cyst of the paranasal cavities. Despite being benign lesions, they have local destructive potential because of its chronic expansion and bony changes. Its most common location is frontoethmoidal. Alterations in the drainage pathway of sinus is thought to be the origin of mucoceles. The clinical features depend on the location. Frontoethmoidal often presents frontal swelling, headache or proptosis. Imaging plays an important part of diagnosis. Tomography and magnetic resonance have patterns that can suggest the presence of a mucocele. Paranasal sinus mucoceles are primarily treated surgically. The endoscopic surgical management has replaced the open resection because of its minimally invasive treatment, less morbidity and low recurrence rates.

Complete enucleation surgical treatment and histological analysis of a mucocele in lower lip in a child: case report / Tratamiento quirúrgico de enucleación completa y análisis histológico de un mucocele en el labio inferior en un niño: reporte de caso

Objective: The aim of this case report is to describe the surgical removal of a mucocele and its histological analysis, in a child. Case Report: An 11-year-old female patient attended the Pediatric Dentistry clinic complaining of a lower lip lesion. During the anamnesis, the mother reported that the child had a habit of biting and sucking the spot frequently. Clinical examination showed the lesion was compatible with a mucocele. The proposed treatment was a complete enucleation of the lesion under local anesthesia. The incision and tissue divulsion were performed for maximum preservation of the mucosa, avoiding a possible recurrence. Total adjacent glands removal was also performed. The lesion was placed in 10% formaldehyde for histopathological analysis (H&E Staining), which showed dense connective tissue presenting chronic inflammatory infiltrate and extravasated mucin, presence of granulation tissue delimiting the area of extravasated mucin and presence of minor salivary glands. The patient was advised to quit the habit, and after seven days the sutures were removed. At the one-year follow-up there was no recurrence of the lesion. Conclusion: The proposed treatment proved to be effective without recurrence of the lesion.

Objetivo: El objetivo de este reporte de caso es describir la extirpación quirúrgica de un mucocele y su análisis histológico en un niño. Informe del caso: una paciente de 11 años de edad asistió a la clínica de Odontopediatria quejándose de una lesión en el labio inferior. Durante la anamnesis, la madre informó que el niño tenía la costumbre de morder y chupar el lugar con frecuencia. En el examen clínico, la lesión fue compatible con un mucocele. El tratamiento propuesto fue una enucleación completa de la lesión bajo anestesia local. La incisión y la divulgación del tejido se realizaron para la máxima preservación de la mucosa, evitando una posible recurrencia. También se realizó la extracción total de las glándulas adyacentes. La lesión se colocó en formaldehído al 10% para el análisis histopatológico (tinción H&E), que mostró tejido conectivo denso que presenta infiltrado inflamatorio crónico y mucina extravasada, presencia de tejido de granulación que delimita el área de mucina extravasada y presencia de glándulas salivales menores. Se aconsejó al paciente que abandonara el hábito, y después de siete días se retiraron las suturas. En el seguimiento de un año no hubo recurrencia de la lesión. Conclusión: El tratamiento propuesto demostró ser efectivo sin recurrencia de la lesión.

Tratamento de mucocele com a técnica de shira: relato de caso / Treatment of mucocele with shira's technique: case report

O termo mucocele pode ser definido como ''cavidade patológica contendo muco'', sendo este conteúdo proveniente das glândulas salivares menores. Enquadrando-se como um processo patológico destas glândulas. A mucocele pode ser caracterizada pelo fenômeno de extravasamento ou de retenção de muco, dando-se o diagnóstico somente através da análise microscópica. Clinicamente apresenta-se como um nódulo indolor, circunscrito, normocrômico ou azulado e flutuante à palpação, localiza-se predominantemente no lábio inferior. A escolha do tratamento partirá da análise de alguns fatores, como o tamanho da lesão, a sua localização, profundidade e a idade do paciente, sendo a excisão cirúrgica juntamente com as glândulas acessórias da lesão a mais indicada. Há várias técnicas para realização de tal procedimento e a técnica de Shira foi a opção para o referido relato de caso. Esta técnica se dá a partir da injeção cuidadosa de material hidrocolóide irreversível (alginato) dentro da lesão previamente esvaziada de seu conteúdo com o objetivo de delimitar a mesma e facilitar a remoção cirúrgica. Utilizar esta técnica reduz as chances de recidiva da lesão, pois com a utilização do alginato a lesão fica bem delimitada facilitando a excisão cirúrgica, mas mesmo com esta técnica deve-se orientar o paciente para a remoção dos fatores etiológicos envolvidos, pois sua permanência acarretará na recidiva da lesão(AU)

The term mucocele can be defined as a 'pathological cavity containing mucus', and this content comes from the minor salivary glands, fitting in as a pathological process of these glands. Mucocele can be characterized by the mucous extravasation or retention phenomena, giving the diagnosis only through microscopic analysis. Clinically it is presented as a painless, circumscribed, normochromic or bluish nodule floating on palpation. It is predominantly located on the lower lip. The choice of treatment will depend on the analysis of some factors, such as the size of the lesion, its location, depth and the age of the patient. Surgical excision together with the accessory glands of the lesion is the most indicated. There are several techniques for performing such a procedure and the Shira technique was the option for this case report. This technique is based on the careful injection of irreversible hydrocolloid material (alginate) into the lesion previously emptied of its mucoid content in order to delimit it and facilitate surgical removal. Using this technique reduces the chances of recurrence of the lesion, because with the use of alginate the lesion is well delimited facilitating surgical excision, but even with this technique the patient should be guided to remove the etiological factors involved, since its permanence will lead to recurrence of the lesion(AU)

Mucocele: Clinical Characteristics and Outcomes in 46 Operated Patients

Abstract Introduction Paranasal sinus mucocele is a benign, expansive lesion associated with paranasal sinus obstruction. It affectsmostly adults, and ismost common in the frontal and ethmoidal sinuses. Objective To evaluate outcomes in patients undergoing surgical treatment for paranasal sinus mucocele. Methods Retrospective review of medical records of patients treated for paranasal sinus mucocele at the ENT department of a tertiary care hospital between 2005 and 2016. Results Forty-six patients underwent surgical treatment of paranasal sinusmucocele. Themean age was 50.1 years, and 56.5% were male. The most prevalent symptom was pain, and the frontal sinus was most commonly affected. The vast majority of patients (89.1%) underwent endoscopic sinusmarsupialization; 10.9% required combined open and endoscopic access. Seven recurrences occurred. Conclusion Sinus mucocele is an expansive disease that primarily affects the frontal sinus of adult patients. In most cases, endoscopic surgery is an effective treatment modality. (AU)

Cirugía de elevación del seno asociada con pseudoquiste antral y mucocele / Sinus lifting surgery associated with antral pseudocyst and mucocele

Introducción: pseudoquistes y quistes verdaderos de los maxilares son contraindicaciones para cirugías de aumento de volumen óseo en la región posterior de la maxila. Objetivo: describir dos casos de pacientes con transtornos en los senos maxilares (pseudoquiste y quiste verdadero del maxilar) en senos maxilares neumatizados que necesitaban reconstrucción ósea, para posterior rehabilitacion con implantes oseointegrados. Presentación de casos: se presentan dos casos clínicos en que la planificación quirúrgica consistió en la remoción de la lesión y simultánea elevación del suelo del seno maxilar. En el primer caso, pseudoquiste antral, se procedió a la aspiración del contenido quístico previamente a la elevación de la membrana de Schneider. En el segundo caso, quiste verdadero del seno maxilar, se realizó la remoción completa de la lesión quística. En ambos casos no hubo perforación de la membrana, y el hueso bovino inorgánico fue utilizado como material de relleno. La instalación de los implantes fueron después de 7 meses de la cirugía de elevación de seno. Los controles clínicos y tomográficos mostraron adecuada oseointegración de los implantes y ausencia de recidiva y/o restos de la lesión. Conclusiones: el quiste verdadero del seno maxilar causa la destrucción de las paredes óseas y debe ser removido previamente a las cirugías de elevación sinusal. Ningún tratamiento es indicado para el pseudoquiste antral, teniendo claro que la lesión no representa necesariamente una contraindicación para la elevación de la membrana sinusal y colocación de injerto óseo para implantes. Mientras tanto, la aspiración previa de contenido líquido del pseudoquiste evita posibles complicaciones infecciosas posoperatorias(AU)

Introduction: maxillary pseudocysts and true cysts are contraindications for bone volume augmentation surgery in the posterior maxillary region. Objective: describe two cases of patients with maxillary sinus disorders (pseudocyst and true cyst) in pneumatized maxillary sinuses requiring bone reconstruction with a view to eventual rehabilitation with osseointegrated implants. Case presentation: two clinical cases are presented in which surgical planning consisted in lesion removal and simultaneous maxillary sinus floor elevation. In the first case, antral pseudocyst, aspiration was performed of the cystic content before elevation of the Schneiderian membrane. In the second case, true cyst of the maxillary sinus, total removal of the cystic lesion was performed. Membrane perforation did not occur in either case. Inorganic bovine bone was used as filler in both. Implantation was performed 7 months after sinus lifting surgery. Clinical and tomographic examination showed adequate implant osseointegration and absence of recurrence and/or lesion remnants. Conclusions: true maxillary sinus cysts cause bone wall destruction, and should be removed before performing sinus lifting surgery. No treatment is indicated for antral pseudocyst, for the lesion does not necessarily constitute a contraindication for sinus membrane lifting and bone graft placement for implantation. On the other hand, previous aspiration of the liquid content of the pseudocyst prevents possible postoperative infectious complications(AU)

Paciente com proptose ocular associado a mucocele etmoidal: apresentação clínica e tratamento / Patient with ocular properties associated with ethmoidal mucocele: clinical presentation and treatment

Resumo Relato de um caso clínico de proptose ocular relacionado com mucocele etmoidal, o caso é raro e seu acometimento ocular não é comumente relacionado na literatura. Ressaltamos ainda sua apresentação clínica e o tratamento instituído. W.L.S, Paciente do sexo masculino, 27 anos procedente de Fortaleza-CE. Comparece ao ambulatório HUWC com queixa de baixa da acuidade visual percebida há 10 dias em olho direito (OD). Ao exame oftalmológico melhor acuidade visual corrigida de 20/200 OD e 20/20 olho esquerdo (OE), ausência de abdução e elevação do OD com ptose leve (distância margem reflexo 1-2 mm) e diplopia ao olhar para direita. Proptose OD de aspecto axial de grau moderado (24mm). Biomicroscopia lâmpada de fenda sem alterações. Pressão intraocular: 18mmHg OD 12 mmHg OE. Fundo de olho: OD aspecto palidez discreta de disco, sem outras alterações e OE dentro da normalidade. Solicitada tomografia de crânio (TC) que demonstrou presença de lesão arredondada em área do seio etmoidal penetrando parede óssea da órbita do OD sugestiva de mucocele etmoidal. Encaminhado para serviço de otorrinolaringologia do HUWC, sendo submetido a procedimento cirúrgico endoscópico etmoidectomia. Um mês após o procedimento cirúrgico a acuidade visual OD 20/25, movimentos oculares presentes e simétricos, ausência de diplopia e persistência de leve palidez em OD. Expansão da mucocele pode ocorrer ao longo de muitos anos ou rapidamente. Acometimento ocular com baixa da acuidade visual é incomum como primeiro sintoma, quando ocorre merece tratamento imediato. O tratamento cirúrgico é geralmente indicado no caso e deve ser instituído assim que possível para adequada recuperação visual.

Abstract Report of a clinical case of ocular proptosis related to ethmoidal mucocele, the case is rare and ocular involvement is not commonly related in the literature. We also emphasize its clinical presentation and the treatment instituted. W.L.S., male, 27 years old from Fortaleza-CE. He presents to the HUWC outpatient clinic complaining of low visual acuity perceived for 10 days in the right eye (OD). The ophthalmologic exam showed a best corrected visual acuity of 20/200 OD and 20/20 left eye (OS), absence of abduction and elevation of OD with light ptosis (distance margin 1 - 2 mm) and diplopia when looking to the right. Proptose OD of moderate aspect axial aspect (24mm). Biomicroscopy slit lamp without changes. Intraocular pressure: 18mmHg OD 12 mmHg OS. Background of eye: OD discrete pallor disk appearance, no other changes and OS within normality. A CT scan was performed that showed presence of a rounded lesion in the ethmoidal sinus area penetrating the bone wall of the OD orbit suggestive of ethmoidal mucocele. Forwarded to the otorhinolaryngology service of the HUWC, being submitted to endoscopic surgical procedure etmoidectomy. One month after the surgical procedure visual acuity of OD 20/25, present and symmetrical ocular movements, absence of diplopia and persistence of mild pallor in OD. Expansion of mucocele may occur over many years or rapidly. Ocular involvement with low visual acuity is uncommon as the first symptom, when it occurs it deserves immediate treatment. Surgical treatment is generally indicated in the case and should be instituted as soon as possible for adequate visual recovery.

Giant appendiceal mucinous cystadenoma treated by laparoscopy: a case report and review of the literature / Cistadenoma mucinoso apendicular gigante tratado por laparoscopia: relato de caso e revisão de literatura

ABSTRACT Appendiceal mucinous cystadenoma is a rare entity, which causes appendicular mucocele. It is more frequent in women over 50 years old. In half of the cases it is asymptomatic. Tomography of the abdomen is the gold standard in its preoperative diagnosis. The treatment is surgical, with good prognosis, the complete resection evolves without appendicular rupture and extravasation. We report a case of a 64-year-old man with appendiceal mucinous cystadenoma. A laparoscopic right hemicolectomy was performed. This therapy that can be safely used to treat appendiceal mucocele, as long as it is cautious.

RESUMO O cistadenoma mucinoso apendicular é entidade rara que causa mucocele apendicular, sendo mais frequente em mulheres acima dos 50 anos. Em metade dos casos, o cistadenoma mucinoso apendicular é assintomático. A tomografia do abdome é o padrão-ouro para um diagnóstico pré-operatório. O tratamento é cirúrgico e tem bom prognóstico; a ressecção completa evolui sem ruptura apendicular e sem extravasamento. Relatamos um caso de paciente homem de 64 anos com cistadenoma mucinoso apendicular. Foi realizada hemicolectomia laparoscópica direita. Esse é um procedimento que pode ser usado com segurança no tratamento de mucocele apendicular, desde que seja executado com cautela.

Mucocele maxilar secundario a cirugía ortognática: reporte de un caso / Maxillary mucocele after an orthognathic surgery: case report

El mucocele es un tumor pseudoquístico poco frecuente en el seno maxilar y una rara complicación de la cirugía ortognática. El caso reportado describe la presentación de un mucocele que afecta parcialmente el seno maxilar y se presenta clínicamente como un tumor nasal. Se trata de una mujer de 44 años que, luego de 12 años de realizarse cirugías ortognáticas, presenta dolor facial y obstrucción de la fosa nasal derecha. La tomografía axial computarizada de senos paranasales revela una masa de contenido líquido que ocupa la mitad inferior del seno maxilar derecho, extendiéndose a la fosa nasal ipsilateral. La paciente es intervenida por vía endoscópica realizándose una marsupialización intranasal y meatotomía media, evolucionando satisfactoriamente en un seguimiento de dos años.

Mucoceles are not often found in the maxillary sinus, and is a rare surgery complication, in this case, orthognathic. This review describes a mucocele that partially occupies the right maxillary sinus, causing a chronic nasal obstruction. This is the case of a 44 year-old female patient, which after 12 years of several orthognathic surgeries, presents facial pain and right nasal obstruction. The paranasal sinus computed tomography reveals a mass with liquid content that occupies the lower part of the right maxillary sinus and compromises the right nasal cavity. The patient was treated with an intranasal marsupialization and a middle meatotomy with endoscopic nasal approach. Evolution was satisfactory two years after the intervention.

Presencia de la celdilla supra-órbito-etmoidal: revisión de la literatura a partir de un caso / Presence of supraorbital ethmoid cell: literature review from a case

La celdilla supra-órbito-etmoidal es una variación anatómica que se presenta con diferente frecuencia para las distintas poblaciones. Representa un desafío al realizar cirugía endoscópica funcional del seno frontal debido a que su presencia dificulta el drenaje adecuado del receso del frontal mismo y puede ser confundida con el seno. La celdilla supra-órbito-etmoidal presenta relaciones espaciales constantes con la arteria etmoidal anterior, sirviendo como marcador anatómico confiable para el abordaje quirúrgico. Se destaca la importancia de considerar la presencia de tabiques óseos en el seno frontal en el estudio imagenológico que puedan sugerir la presencia de la celdilla supra-órbito-etmoidal. Se presenta el caso clínico de un paciente que consulta por proptosis del ojo derecho debido a un proceso expansivo por mucocele localizado en dicha variante anatómica.

The supraorbital ethmoid cell its an anatomical variation with different frecuency for diverse populations. It represents a challenge for the endoscopical functional :surgery of the frontal sinus. The supraorbital ethmoid cell presents an estable anatomical relationship with the anterior ethmoidal artery, serving as a dependable anatomical marker for the surgical approach. We stand out the importance to consider the presence of bony septations in the frontal sinus that might suggest the presence of the supraorbital ethmoid cell. We introduce a clinical case from a patient who had an expansive process from a mucocele in the supraorbital ethmoid cell.

Sospecha clínica y tratamiento quirúrgico de los mucoceles esfenoidales / Diagnosis and surgical treatment of sphenoid mucoceles

Introducción: Los mucoceles son formaciones benignas de lento crecimiento que pueden aparecer en cualquier seno paranasal, representando el seno esfenoidal menos del 10%. Objetivo: Presentamos nuestra experiencia de mucoceles en el seno esfenoidal. Material y método: Se obtuvieron los datos a partir de nuestra base de datos que recoge prospectivamente los casos de tumores de cabeza y cuello. Entre enero 1989 y enero 2013 se registraron 58 mucoceles en 54 pacientes, de los cuales 4 (7%) eran de seno esfenoidal. Tres pacientes eran mujeres y uno varón, con edades comprendidas entre 42 y 61 años. Todas las lesiones fueron estudiadas con endoscopia nasal, tomo-grafía computarizada y resonancia magnética. Resultados: Tres pacientes presentaron un antecedente quirúrgico de seno paranasal. El síntoma más frecuente fue la cefalea (3 pacientes de 4). Dos pacientes presentaron diplopia y uno pérdida progresiva de agudeza visual, requiriendo manejo quirúrgico urgente. Todos fueron tratados con esfenoidotomía por abordaje endoscópico endonasal. Fueron dados de alta a las 48 h posteriores con antibioticoterapia. Ninguno presentó recidiva. Conclusión: Los mucoceles esfenoidales representan menos del 10% de los mucoceles nasosinusales. La pérdida de agudeza visual requiere un rápido diagnóstico y manejo terapéutico quirúrgico urgente. El tratamiento de elección es la marsupialización.

Introduction: Sinus mucoceles are benign cysts that may appear in any sinus, but only 1%-10% occur in the sphenoid sinus. Aim: We describe the cases of sphenoid sinus mucoceles seen at our centre over the last 25 years. Material and method: In a prospective review of all mucoceles diagnosed between 1989 and 2013, we identified 58 mucocels in 54 patients. Four of the 58 (7%) were sphenoid mucoceles. There were three female patients and one male, and ages ranged from 42 to 61 years. We performed an endoscopy, CT and MR in all patients to confirm diagnosis. Results: Three patients had had endoscopic endonasal surgery in the past. The presenting symptoms were headache in 3 patients, diplopia in two, and visual loss, causing blindness, in one. The patient with amaurosis requiered urgent surgery. All four patients underwent sphenoidotomy with marsupialisation by the endonasal endoscopic approach. They were discharged 48 hours later on oral antibiotics. No recurrences have been observed to date. Conclusions: Sphenoid mucocele is a rare disease, requiring prompt treatment in cases of amaurosis. Good results can be achieved with endonasal endoscopic marsupialisation.

Herniación de quiste de seno maxilar a través de fístula oroantral: reporte de un caso / Hermiation of a maxillary sinus cyst through an oroantral fistula: report of a case

Los quistes de retención mucosa y los mucoceles son las lesiones máscomunes de los senos paranasales. Éstos comparten características muysimilares y su diferencia estará determinada por su etiología. A diferencia del quiste de retención mucosa, cuyo comportamiento es mucho más sutil, el mucocele causa fenómenos infl amatorios locales, y algunas veces,reabsorción ósea de las estructuras adyacentes. El tratamiento será laenucleación quirúrgica. En el caso clínico que presentamos a continuación,se evidencia una lesión quística que se expone a través del alvéolo no cicatrizal de extracción traumática realizada semanas atrás, además se presenta la técnica que utilizamos para el cierre de fístula oroantral.

Mucus retention cysts and mucoceles are the most common lesions of the paranasal sinuses. They share very similar characteristics and the difference between them depends on their etiology. Unlike mucous reten-tion cysts, whose behavior is much more subtle, mucoceles cause local infl ammatory phenomena and sometimes bone resorption of adjacent structures. The treatment called for is surgical enucleation. The clinical case presented deals with a cystic lesion protruding through the non-cicatricial alveolus following a traumatic extraction performed weeks earlier. We also present the technique used to close the oroantral fi stula.

Mucoceles de cavidades paranasales: experiencia en el Hospital Barros Luco-Trudeau / Paranasal sinus mucoceles: the Barros Luco-Trudeau experience

Introducción: Los mucoceles son pseudotumores expansivos de las cavidades paranasales, cuyos síntomas están dados por su crecimiento expansivo. El tratamiento tradicional ha sido la extracción quirúrgica por vía externa, siendo desplazado en las últimas décadas por la resección endoscópica. Objetivo: Evaluar la experiencia en nuestro servicio sobre el diagnóstico y tratamiento de los mucoceles. Material y método: Revisión retrospectiva de pacientes tratados por mucocele en el Servicio de Otorrinolaringología, entre 2002y 2013. Se describen características clínico-demográficas, métodos diagnósticos, tratamiento y aparición de recidivas. Resultados: Se analizaron 45pacientes con seguimiento promedio de 24,93 meses. El 51,11% correspondió al sexo masculino. La edad promedio fue 49,68 años. El 46,6% fueron mucoceles fronto-etmoidales (6 frontales, 6 etmoidales y 9 fronto-etmoidales), el resto en seno maxilar, con un periodo de latencia de 7,33 meses. Los síntomas más frecuentes fueron oftalmológicos (55,5%) como proptosis y diplopía, mientras que el 51,1% de los pacientes tenía antecedentes de rinosinusitis crónica. El tratamiento fue mediante resección endoscópica en el 66,22%, por vía abierta 31,1% y manejo combinado en 6,66%. Hubo 8 casos recidivados, que representan el 17,7% de la serie. Discusión: Nuestra casuística resultó semejante a otras series publicadas. En los últimos años se ha preferido el abordaje endoscópico, sin embargo, el abordaje externo o combinado siguen siendo claves en el manejo de mucoceles extensos o para tratar recidivas. La aparición potencialmente tardía de recidivas requiere un tiempo de seguimiento largo para estos pacientes. Conclusiones: Los mucoceles representan un desafío diagnóstico y terapéutico y el manejo endoscópico parece una alternativa segura en el manejo de mucoceles que no comprometan órbita o tengan extensión craneal.

Introduction: Mucoceles are expansive pseudotumors of the paranasal sinuses and clinical presentations of symptoms are given by expansive growth. Traditional treatment has been open surgical extraction, being shifted in recent decades by endoscopic resection. Aim: To evaluate our experience in diagnosis and treatment of mucoceles. Material and methods: Retrospective chart review of patients treated for mucocele in the Department of Otolaryngology, between 2002 and 2013. Clinical and demographic characteristics, diagnostic methods, treatment and recurrence are described. Results: 45 patients with average follow-up of 24.93 months were analyzed. 51.11% were male. The mean age was 49.68years. 46.6% were fronto-ethmoidal mucoceles (6 in frontal sinus, 6 in ethmoidal sinus and 9 fronto-ethmoidal), the rest in the maxillary sinus, with a latency period of 7.33 months. Most frequent symptoms were ophtalmologic (55.5%) as proptosis and diplopia, while 51.1% of patients had a history of chronic rhinosinusitis. Treatment was by endoscopic resection in 66.22%, 31.1% by open surgery and 6.66% in combined approach. There were 8 recurrent cases, accounting for 17.7% of the series. Discussion: Our series was similar to other published earlier. In recent years, endoscopic approach is preferred, however, combined external approach or keys remain in handling large mucoceles or to treat recurrences. The late onset of recurrences potentially requires a long follow-up time for these patients. Conclusions: Mucoceles represent a diagnostic and therapeutic challenge and endoscopic management seems a safe alternative in the management of orbital involvement or cranial extension mucoceles.

Mucocele and Fibroma: Treatment and Clinical Features for Differential Diagnosis

Mucocele is a benign lesion occurring in the buccal mucosa as a result of the rupture of a salivary gland duct and consequent outpouring of mucin into soft tissue. It is usually caused by a local trauma, although in many cases the etiology is uncertain. Mucocele is more commonly found in children and young adults, and the most frequent site is the lower inner portion of the lips. Fibroma, on the other hand, is a benign tumor of fibrous connective tissue that can be considered a reactionary connective tissue hyperplasia in response to trauma and irritation. They usually present hard consistency, are nodular and asymptomatic, with a similar color to the mucosa, sessile base, smooth surface, located in the buccal mucosa along the line of occlusion, tongue and lip mucosa. Conventional treatment for both lesions is conservative surgical excision. Recurrence rate is low for fibroma and high for oral mucoceles. This report presents a series of cases of mucocele and fibroma treated by surgical excision or enucleation and the respective follow-up routine in the dental clinic and discusses the features to be considered in order to distinguish these lesions from each other.

Mucocele é uma lesão comum na mucosa bucal, que resulta da ruptura de um ducto de glândula salivar e consequente derramamento de mucina para o interior dos tecidos moles circunjacentes. Frequentemente este derrame resulta de trauma local, embora em muitos casos a etiologia seja indefinida. É uma lesão não infecciosa benigna, que frequentemente afeta a cavidade bucal de crianças e adultos jovens, localizando-se geralmente na porção interna dos lábios inferiores. Por outro lado, o fibroma é um tipo de tumor benigno do tecido conjuntivo fibroso que pode ser considerado uma hiperplasia reacional do tecido conjuntivo em resposta a traumas e irritação. Geralmente são nodulares, com consistência firme, assintomáticos, coloração semelhante à da mucosa, base séssil, superfície lisa, localizados na mucosa jugal ao longo da linha de oclusão, língua e mucosa labial. O tratamento convencional para ambas as lesões é a excisão cirúrgica conservadora, sendo que sua recorrência é rara para fibromas e alta para as mucoceles. Este trabalho relata casos clínicos de mucocele e fibroma, tratados pela técnica de excisão cirúrgica ou enucleação, bem como descreve a proservação no consultório odontológico. As características importantes para o diagnóstico diferencial dessas lesões são discutidas.

Appendiceal mucocele: a case report and review of literature

Appendiceal mucocele is an uncommon disease caused by a progressive dilatation of the ileocecal appendix by a mucus filled lumen. We report the case of a 72-year-old woman who underwent surgery for an appendiceal mucocele. This case highlights the importance of both a correct preoperative diagnosis and a targeted surgical strategy, to reduce the risk of complications like the rupture of the mucocele and consequent pseudomyxoma peritonei [PP]