Cervical necrotizing fasciitis: report of 6 cases and review of literature.

OBJECTIVE: Necrotizing fasciitis in the cervical region is a rare entity, characterized by a fulminant infection that causes extensive necrosis of the subcutaneous tissue and fascial planes, with high mortality and morbidity rates. The origin is generally odontogenic or pharyngeal, involving a mixed flora of microorganisms. Descending infection and mediastinal involvement are usually associated and are the main complications. The aim of the present study was to review the cases treated in our department and analyze diagnosis and treatment, supplementing the understanding of the disease. METHODS: A retrospective study was performed on the clinical records of patients admitted to our center between January 2005 and June 2010 with diagnosis of necrotizing cervical fasciitis. RESULTS: Six clinical records were reviewed. The origin of the infection was mainly oropharyngeal and odontogenic, with a mixed flora of Prevotella, Peptostreptococcus and coagulase-negative Staphylococcus. All patients presented mediastinal involvement: superior mediastinitis in 4 patients and superior and postero-inferior mediastinitis in 2 cases. All patients underwent early drainage by bilateral cervicotomy with mediastinal drainage by a cervical approach in those with superior mediastinal affection, and associated thoracotomy, in a single surgical step, for postero-inferior mediastinitis. Temporary tracheotomy was performed in all cases. All received broad spectrum antibiotics, with a medium hospital stay of 37 days. There were no deaths reported. CONCLUSION: Concerning cervical necrotizing fasciitis, early diagnosis and surgical treatment associated to antibiotics and intensive medical care are essential to obtain a favorable outcome.

[Monostotic fibrous dysplasia. Three cases and literature review]. / Displasia fibrosa monostótica. A propósito de tres casos y revisión de la literatura.

The fibrous dysplagia is a rare benign osseous pathology of unknown aetiology. It presents an incidence of craniofacial affectation of a 10% in its monostotic variety and a 100% in the poliostotic. The temporal bone implication is very rare, being usually referred in the monostotic variety. The diagnosis is based on radiology (CT) and histology. The majority of the authors agree in a conservative treatment. We present three clinical cases of monostotic fibrous dysplagia with craniofacial affectation, two of them in the temporal bone and another one in the frontal bone.

[Current aspects of laryngeal tuberculosis]. / Aspectos actuales de latuberculosis laríngea.

In the preantibiotic era laryngeal tuberculosis was the most frequent pathology of the larynx. In the last decades some changes in the presentation and evolution of the pathology have occurred due to the new chemiotherapy and the improvement of the nutrition. Actually it presents less incidence and infectivity and less evidence of pulmonary disease. In this article we analyse, on occasion of a clinical case and with a revision of the literature, the actual patterns of the laryngeal tuberculosis.

Displasia fibrosa monostótica. A propósito de tres casos y revisión de la literatura / Monostotic fibrous displasia. Three cases and litterature revision

La displasia fibrosa es una enfermedad benigna ósea infrecuente, de etiología desconocida. Presenta una incidencia de afectación craneofacial del 10 por ciento en su variedad monostótica y del 100 por ciento en la poliostótica. La implicación del hueso temporal resulta poco frecuente, siendo principalmente documentada en la forma monostótica. El diagnóstico se basa en la radiología (TC) y la histología. La mayoría de autores están de acuerdo en seguir un tratamiento conservador. Nosotros presentamos tres casos clínicos de displasia fibrosa monostótica con afectación craneofacial, dos de ellos a nivel del hueso temporal y otro a nivel frontal (AU)

No disponible

Aspectos actuales de la tuberculosis laringea. A propósito de un caso / Actuel aspects of laryngeal tuberculosis

En la era preantibiótica la tuberculosis laríngea fue considerada la enfermedad más frecuente de la laringe. En las últimas décadas se han dado una serie de cambios en la forma de presentación y evolución de la enfermedad debido a la aparicición de quimioterápicos y a la mejoría del estado nutricional. Actualmente presenta menor incidencia e inefectividad y menor evidencia de enfermedad pulmonar. En este artículo analizamos, a partir de un caso clínico y de una revisión en la literatura, los patrones actuales de la tuberculosis laríngea (AU)

No disponible

Síndrome de Melkersson-Rosenthal: consideraciones diagnósticas

No disponible

[Treatment of laryngeal stenosis with laser]. / Tratamiento de las estenosis laríngeas con láser.

Laryngo-tracheal stenosis are conditions in which the treatment remain under discussion and sometimes is far from disappointing. Our results are commented and literature perusal of the subject as well.

[Otorhinolaryngological manifestations of varicella-zoster virus]. / Manifestaciones otorrinolaringológicas del virus varicela-zoster.

Otological complications of varicella-zoster syndrome (Ramsay Hunt syndrome) include facial paralysis, tinnitus, hearing loss, vertigo, dysgeusia, and skin rash. The lower cranial nerves sometimes are affected by this neuritis. A case is reported of a woman without immune-system impairment who had cranial multineuritis with unilateral involvement of the VII, VIII, IX and X cranial nerves after infection with varicella-zoster virus without herpetic lesions.

[Cricoid calcification in the study of esophageal foreign bodies]. / La calcificación cricoidea en el estudio de los cuerpos extraños esofágicos.

Lateral radiography of the neck is performed for the study of radio-opaque esophageal foreign bodies that are not visualized by indirect laryngoscopy. This projection may reveal a calcified linear image behind the cricoid cartilage due to calcification of the posterior lamina. In such cases, esophagoscopy and/or computed tomography must be performed to determine whether the image is due to an anatomic variant or a true foreign body.

Oncogenic osteomalacia: case report and review of head and neck associated tumours.

Oncogenic osteomalacia is an uncommon syndrome characterized by mineral metabolism abnormalities that disappear after the resection of an associated tumour. Head and neck is the second most frequent location of these tumours. We describe a case with an ethmoido-frontal phosphaturic mesenchymal tumour and review oncogenic osteomalacia-associated tumours. Among 21 cases found, 57 per cent affected the sinonasal area and 20 per cent the mandible. The diagnosis of the tumour lasted a mean of 4.7 years from the onset of osteomalacia, and most of them showed a significant vascular component. An aggressive surgical approach is recommended.

[An auricular pseudocyst. A report of 4 cases]. / Pseudoquiste auricular. A propósito de cuatro casos.

The words pseudocyst of the pinna was suggested in 1966 by Engel for those intracartilaginous swellings of the auricula, presenting in young healthy males without traumatic precedents or previous manipulation. The AA. report 4 cases diagnosed and treated in their Hospital Department. A woman, 85, was one of them. Review of the subject's literature.

[Dysphagia in Forestier's disease (vertebral ankylosing hyperostosis)]. / La disfagia en la enfermedad de Forestier o hiperostosis anquilosante vertebral.

Forestier's disease is characterized by the formation of vertebral bridges which joint the ventral aspect of the vertebral bodies by ossification of the anterior vertebral longitudinal ligament. A 58-year-old man with idiopathic ankylotic hyperostosis had pronounced osteophytosis of the neck that produced the unusual symptom of dysphagia. The literature is reviewed and the pathogenic criteria, diagnosis, and therapy are discussed.

Anastomosis between both hypoglossal nerves in a 30 mm human embryo.

In this paper we present the first description of an anastomosis between both hypoglossal nerves during the embryonic period, a very uncommon anatomical variation. This was observed in a 30 mm crown-rump (C-R) length human embryo (Carnegie stage 23) from the Bellaterra Collection (Prof. Doménech Mateu), stained for nerve fibers. The anastomosis consisted of a large diameter trunk (36.7 microns) situated in front of and slightly below the hyoid cartilage, and clearly distinguishable from the anastomosis found in adults, which has a very fine diameter and is located in the suprahyoid region.

[Retropharyngeal abscess]. / Absceso retrofaríngeo.

We present 2 cases of retropharyngeal abscess in adults as complication of acute tonsillitis and cervical pyogenic osteomyelitis, respectively. These cases confirm that retropharyngeal abscess has a significant morbi-mortality despite of new antibiotic drugs introduced. A review of the present characteristics of the complaint is treated in this paper.

[Pseudocyst of the auricle]. / Pseudoquiste de pabellón auricular.

Reporting one case of pseudocyst of the auricle in a young male, 18, white and wealthy, diagnosed and treated. Bibliographical review of this condition and explanation of its etiopathogenetic, clinic and therapeutical characteristics, as well. This deformity seems to be more prevalent as the number of published cases may suggest.

[Does branchiogenic carcinoma exist or not?]. / Carcinoma branquiogénico. Realidad o ficción?

A 43 year-old man with a cystic mass on the side of the neck was admitted to the hospital for possible branchial cyst. The histopathological analysis showed a carcinoma developed on a branchial cyst. After reviewing the literature, we conclude that carcinoma developing on a branchial cyst is uncommon, if, indeed, it exists at all. The diagnostic criteria should be adhered to strictly. When confronted with this histopathologic diagnosis, the possibility of cystic metastasis to the neck of a squamous carcinoma of unknown origin should be considered.

[Tonsillolithiasis]. / Tonsilolitiasis.

A 43-year-old female patient complaining with odynophagy since a month and a half without response to the medical treatment is presented. The pharynx exam showed an asymmetric swelling in the right tonsillar surface and the radiology provided evidence of calcareous concretions as responsible cause of the picture.

[Peripheral facial palsy associated with rhinopharyngeal tumor]. / Parálisis facial periférica asociada a neoplasia de rinofaringe

Peripheral facial paralysis from tumoral origin is scarce in number, in spite of possible manifold causative growths. One case in which the palsy was associated to a rhinopharyngeal neoplasm is reported and possible ways of nerve involvement discussed. Although progression seems to be the most probable hypothesis in this instance, only the anatomo-pathological exam has affirmative value.

[Malformations induced by vitamin A administered in the young chick blastoderm]. / Malformations occasionnées par la vitamine A admnistrée chez le jeune blastoderme de poulet.

The administration of 2250 IU of retinyl palmitate in young chick blastoderm at 4-5 HH stage brings 28% of surviving embryos and 84.5% malformed. The most frequent induced anomalies affect neural tube and/or neural crest which are the most sensible structures to vitamin A teratogenic action. The teratogenic mechanism would be produced by direct effect upon neuroblast and neural crest cells, and thus, this would cause the usual association of neural tube closure defects with facial malformations.