ABSTRACT
INTRODUCTION: Pediatric subglottic pathology still represents a challenge when it comes to choosing the right treatment. We present the management of patients followed in our center for this reason during the last 5 years. MATERIAL AND METHODS: Retrospective study of patients followed by glotosubglottic pathology (stenosis, cysts or granulomas) between 2011 and 2016 in a third level hospital. RESULTS: Twenty-seven patients were included in the review. Treatment options varied according to the nature, location and severity of the subglottic stenosis. Two patients with congenital subglottic stenosis were treated by laryngotracheoplasty. Seventeen patients with acquired subglottic stenosis were included: in one (5.9%) laryngotracheoplasty was performed, one (5.9%) received cricotracheal split, two of them (11.8%) underwent partial cricotracheal resection (PCTR) , seven patients (41.2%) underwent microsurgery, three (17.6%) received tracheal dilatation, and the last three (17.6%) were submitted to observation without needing further treatment. Five patients with post-intubation subglottic cysts received microsurgery. Of three patients diagnosed with post-intubation subglottic granuloma, two (66%) resolved spontaneously and one (33%) required microsurgery. CONCLUSIONS: Management of pediatric subglottic pathology remains a major challenge. Since the creation of the Airway Committee in our center, the improvement in the management of these patients has led to a multidisciplinary management, with the consequent impact on the clinical results.
OBJETIVOS: La patología del espacio subglótico en pacientes pediátricos sigue representando un reto a la hora de elegir el tratamiento idóneo. Presentamos el manejo de los pacientes seguidos en nuestro centro por este motivo durante los últimos 5 años. MATERIAL Y METODOS: Estudio retrospectivo de los pacientes seguidos por patología glotosubglótica (estenosis, quistes o granulomas) entre 2011 y 2016 en un centro de tercer nivel. RESULTADOS: Veintisiete pacientes fueron incluidos en la revisión. Las opciones de tratamiento variaron en función de la naturaleza, la localización y la gravedad de la afectación subglótica. Dos pacientes con estenosis subglótica congénita fueron tratados mediante laringotraqueoplastia. Se incluyeron 17 pacientes con estenosis subglótica adquirida: en uno (5,9%) se realizó laringotraqueoplastia, en uno (5,9%) split cricotiroideo, dos de ellos (11,8%) se intervinieron mediante resección cricotraqueal parcial (PCTR), siete pacientes (41,2%) se sometieron a microcirugía, tres (17,6%) recibieron dilatación traqueal y los tres últimos (17,6%) se sometieron a observación sin necesitar finalmente tratamiento. Cinco pacientes con quistes subglóticos postintubación recibieron microcirugía. De tres pacientes diagnosticados de granuloma subglótico postintubación, dos (66%) se resolvieron espontáneamente y uno (33%) requirió microcirugía. CONCLUSIONES: El manejo de la patología subglótica pediátrica sigue representando un gran desafío. Desde la creación del Comité de Vía Aérea en nuestro centro, la mejoría en la gestión de estos pacientes ha conducido a un manejo multidisciplinar de los mismos, con el consiguiente impacto en los resultados clínicos.
Subject(s)
Laryngoplasty/methods , Laryngostenosis/surgery , Microsurgery/methods , Plastic Surgery Procedures/methods , Child , Child, Preschool , Female , Granuloma/etiology , Humans , Intubation, Intratracheal/adverse effects , Laryngostenosis/pathology , Male , Retrospective Studies , Severity of Illness Index , Treatment OutcomeABSTRACT
Objetivos. La patología del espacio subglótico en pacientes pediátricos sigue representando un reto a la hora de elegir el tratamiento idóneo. Presentamos el manejo de los pacientes seguidos en nuestro centro por este motivo durante los últimos 5 años. Material y métodos. Estudio retrospectivo de los pacientes seguidos por patología glotosubglótica (estenosis, quistes o granulomas) entre 2011 y 2016 en un centro de tercer nivel. Resultados. Veintisiete pacientes fueron incluidos en la revisión. Las opciones de tratamiento variaron en función de la naturaleza, la localización y la gravedad de la afectación subglótica. Dos pacientes con estenosis subglótica congénita fueron tratados mediante laringotraqueoplastia. Se incluyeron 17 pacientes con estenosis subglótica adquirida: en uno (5,9%) se realizó laringotraqueoplastia, en uno (5,9%) split cricotiroideo, dos de ellos (11,8%) se intervinieron mediante resección cricotraqueal parcial (PCTR), siete pacientes (41,2%) se sometieron a microcirugía, tres (17,6%) recibieron dilatación traqueal y los tres últimos (17,6%) se sometieron a observación sin necesitar finalmente tratamiento. Cinco pacientes con quistes subglóticos postintubación recibieron microcirugía. De tres pacientes diagnosticados de granuloma subglótico postintubación, dos (66%) se resolvieron espontáneamente y uno (33%) requirió microcirugía. Conclusiones. El manejo de la patología subglótica pediátrica sigue representando un gran desafío. Desde la creación del Comité de Vía Aérea en nuestro centro, la mejoría en la gestión de estos pacientes ha conducido a un manejo multidisciplinar de los mismos, con el consiguiente impacto en los resultados clínicos
Introduction. Pediatric subglottic pathology still represents a challenge when it comes to choosing the right treatment. We present the management of patients followed in our center for this reason during the last 5 years. Material and methods. Retrospective study of patients followed by glotosubglottic pathology (stenosis, cysts or granulomas) between 2011 and 2016 in a third level hospital. Results. Twenty-seven patients were included in the review. Treatment options varied according to the nature, location and severity of the subglottic stenosis. Two patients with congenital subglottic stenosis were treated by laryngotracheoplasty. Seventeen patients with acquired subglottic stenosis were included: in one (5.9%) laryngotracheoplasty was performed, one (5.9%) received cricotracheal split, two of them (11.8%) underwent partial cricotracheal resection (PCTR) , seven patients (41.2%) underwent microsurgery, three (17.6%) received tracheal dilatation, and the last three (17.6%) were submitted to observation without needing further treatment. Five patients with post-intubation subglottic cysts received microsurgery. Of three patients diagnosed with post-intubation subglottic granuloma, two (66%) resolved spontaneously and one (33%) required microsurgery. Conclusions. Management of pediatric subglottic pathology remains a major challenge. Since the creation of the Airway Committee in our center, the improvement in the management of these patients has led to a multidisciplinary management, with the consequent impact on the clinical results
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Laryngostenosis/surgery , Laryngeal Neoplasms/surgery , Laryngoplasty/methods , Tracheal Stenosis/surgery , Tracheal Neoplasms/surgery , Pharyngeal Muscles/surgery , Treatment Outcome , Recovery of Function , Retrospective StudiesABSTRACT
CASO CLÍNICO: La anestesia peribulbar es una técnica habitual durante la cirugía de cataratas. Es una técnica segura pero no exenta de complicaciones. Se presenta el caso de un varón que desarrolló un absceso orbitario tras una anestesia peribulbar que produjo la perforación de un mucocele frontoetmoidal no conocido. Discusión: El absceso orbitario secundario a la perforación iatrogénica de un mucocele tras una anestesia peribulbar es una complicación hasta ahora no descrita. El diagnóstico precoz del proceso orbitario, el tratamiento médico intensivo y la monitorización de los signos de deterioro son vitales para la prevención de complicaciones serias
CLINIC CASE: Peribulbar anesthesia is used in daily practice during cataract surgery. It is a safe technique, but not without complications. We present the case of a man who had an orbital abscess secondary to peribulbar anesthesia that led to the perforation of an unknown frontoethmoidal mucocele. DISCUSSION: Orbital abscess secondary to an iatrogenic mucocele perforation after anesthesia is a periorbital complication not described. The detection of the orbital process, intensive medical treatment and monitoring for signs of deterioration are vital in preventing serious complications
Subject(s)
Humans , Male , Aged, 80 and over , Orbital Diseases/etiology , Abscess/etiology , Cataract Extraction , Mucocele/complications , Anesthesia/adverse effects , ConjunctivaABSTRACT
CASO CLÍNICO: Mujer de 25 años con sinusitis subaguda derecha acudió por molestias en ojo derecho. Ante clínica y tomografía urgente sugestiva de absceso subperióstico orbitario etmoidal, se realizó un drenaje urgente, hallándose una tumoración sólida con biopsia positiva para rabdomiosarcoma alveolar. Se inició tratamiento con quimioterapia y radioterapia con remisión completa y resolución del cuadro clínico. DISCUSIÓN: El rabdomiosarcoma orbitario alveolar en adultos es infrecuente. Presenta un alto riesgo de diseminación y puede debutar simulando una sinusitis, como en este caso, por lo que un diagnóstico y tratamiento precoces son de especial importancia en estos pacientes
CASE REPORT: A 25-year-old woman with right subacute sinusitis, complained about discomfort in her right eye. Clinical manifestations and computed tomography were suggestive of sub-periosteal orbital ethmoid wall abscess, for which the patient underwent urgent drainage. A solid tumor was found, with a positive biopsy for alveolar rhabdomyosarcoma. Complete remission and resolution of orbital symptoms were achieved with chemotherapy and radiation therapy. DISCUSSION: Alveolar orbital rhabdomyosarcoma in adults is uncommon. Rhabdomyosarcoma has a high risk of spreading. It can simulate a sinusitis, as in our patient, early diagnosis and early treatment being especially important in these patients
Subject(s)
Humans , Female , Adult , Rhabdomyosarcoma, Embryonal/diagnosis , Rhabdomyosarcoma, Alveolar/diagnosis , Ethmoid Sinusitis/complications , Orbital Diseases/diagnosisABSTRACT
CASE REPORT: A 25-year-old woman with right subacute sinusitis, complained about discomfort in her right eye. Clinical manifestations and computed tomography were suggestive of sub-periosteal orbital ethmoid wall abscess, for which the patient underwent urgent drainage. A solid tumor was found, with a positive biopsy for alveolar rhabdomyosarcoma. Complete remission and resolution of orbital symptoms were achieved with chemotherapy and radiation therapy. DISCUSSION: Alveolar orbital rhabdomyosarcoma in adults is uncommon. Rhabdomyosarcoma has a high risk of spreading. It can simulate a sinusitis, as in our patient, early diagnosis and early treatment being especially important in these patients.
Subject(s)
Ethmoid Sinusitis/diagnosis , Orbital Neoplasms/diagnosis , Rhabdomyosarcoma, Alveolar/diagnosis , Adult , Female , HumansABSTRACT
CLINIC CASE: Peribulbar anesthesia is used in daily practice during cataract surgery. It is a safe technique, but not without complications. We present the case of a man who had an orbital abscess secondary to peribulbar anesthesia that led to the perforation of an unknown frontoethmoidal mucocele. DISCUSSION: Orbital abscess secondary to an iatrogenic mucocele perforation after anesthesia is a periorbital complication not described. The detection of the orbital process, intensive medical treatment and monitoring for signs of deterioration are vital in preventing serious complications.
Subject(s)
Abscess/etiology , Anesthesia, Local/adverse effects , Mucocele/surgery , Orbital Diseases/etiology , Paranasal Sinus Diseases/surgery , Streptococcal Infections/etiology , Surgical Wound Infection/therapy , Abscess/drug therapy , Abscess/surgery , Aged, 80 and over , Cataract Extraction , Edema/etiology , Humans , Iatrogenic Disease , Lens Implantation, Intraocular , Male , Mucocele/complications , Mucocele/diagnosis , Orbital Diseases/therapy , Paranasal Sinus Diseases/complications , Paranasal Sinus Diseases/diagnosis , Streptococcal Infections/therapyABSTRACT
There are many causes of tympanic perforation but usually only one treatment, surgical. However, many patients cannot or will not undergo surgery. In such cases, treatment with sodium hyaluronidate may be satisfactory. In our group of 20 patients with 21 tympanic perforations who underwent this treatment, 15 evolved favorably. The drawbacks and patient selection are discussed.
Subject(s)
Glycoside Hydrolases/therapeutic use , Hyaluronoglucosaminidase/therapeutic use , Tympanic Membrane Perforation/drug therapy , Adolescent , Adult , Child , Female , Humans , Male , Middle AgedABSTRACT
Osteomas of the middle ear are extremely rare. Those of the mastoid process being most frequent encountered als the tympanic sitting. Extracanalicular osteomas of the temporal bone are scarce. Bibliography about this particular subject account for 60 communications, only 9 with reference to the middle ear. The AA. report the case of an osteoma of the left incus in an 17-years-old boy, suffering a progressive deafness dating from 3 years term. The otoscopy showed a reddish mass protruding in the tympanum. TC and MNR provided evidence of a mass involving de auditory ossicula. Through an exploratory tympanotomy could be removed the anomaly. Histopathology make sure the diagnosis of osteoma. The AA. remark some clinical and surgical features of the piece compared with the other 10 cases reported in the literature reviewed.
Subject(s)
Ear Ossicles/pathology , Ear, Middle/pathology , Osteoma/diagnosis , Osteoma/pathology , Adolescent , Deafness/etiology , Humans , Magnetic Resonance Imaging , Male , Osteoma/complications , Tomography, X-Ray ComputedABSTRACT
The paper deals with 5 adults carriers of this syndrome diagnosed by means of nuclear magnetic resonance (NMR). Neither the conventional radiography nor the plain computerized tomography showed indicative clues of the deformity. However electronystagmography prove in all cases a vertical down beating nystagmus. In one instance the nystagmus become rotatory at lateral glance. In all cases appeared an altered smooth pursuit and a lack of suppression fixation of the vestibular nystagmus. The AA. emphasize the diagnostic value of the electronystagmography (which tracings could spare several other, sometimes expensive, examinations) and suggest a prompt MRI.
Subject(s)
Arnold-Chiari Malformation/physiopathology , Electronystagmography , Nystagmus, Pathologic/etiology , Adult , Arnold-Chiari Malformation/complications , Arnold-Chiari Malformation/diagnosis , Cough/complications , Diplopia/etiology , Female , Headache/etiology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Sneezing , Vertigo/etiologyABSTRACT
Report of the results of radiotherapy in 12 patients suffering from chemodectomas of the temporal bone. Complete or partial remissions under both clinical and radiological aspects are argued. Discussion on radiotherapy versus surgery of these growths.
