Manejo de la vía aérea en una paciente con síndrome de Treacher Collins en 2 tiempos quirúrgicos / Difficult airway management in a patient with Treacher Collins syndrome using two-part surgery

El síndrome de Treacher Collins (STC), Franceschetti-Zwahlen-Klein o disostosis mandibulofacial, se caracteriza por un desarrollo craneofacial anormal. Es una anomalía congénita infrecuente que presenta una incidencia de un caso por cada 50.000 nacidos vivos. El STC es importante para la planificación anestésica debido a que la mayoría de los pacientes con esta afectación nos planteará dificultades en el manejo de la vía aérea. A continuación presentamos el caso de una paciente de 24 años con STC que es remitida a nuestro centro para la realización de una cirugía de reconstrucción facial en dos tiempos. En ambos tiempos quirúrgicos el videolaringoscopio Airtraq(R) fue esencial para el manejo de la vía aérea. Con la presentación de este caso se muestra como la planificación previa, la comunicación y el trabajo en equipo son esenciales para la seguridad del paciente

Treacher Collins syndrome (TCS), Franceschetti-Zwahlen-Klein, or mandibulofacial dysostosis, is a rare disorder of craniofacial development (incidence of approximately 1:50.000 live births). TCS is relevant to the anaesthetist because it can cause difficulties in airway management. A case report is presented of a 24 year-old woman who was referred to our institution for facial reconstruction surgery in two stages. In both surgeries Airtraq(TM) was essential for airway management. By presenting this case, it is intended to show that planning, communication and teamwork are indispensable for patient safety

Difficult airway management in a patient with Treacher Collins syndrome using two-part surgery. / Manejo de la vía aérea en una paciente con síndrome de Treacher Collins en 2 tiempos quirúrgicos.

Treacher Collins syndrome (TCS), Franceschetti-Zwahlen-Klein, or mandibulofacial dysostosis, is a rare disorder of craniofacial development (incidence of approximately 1:50.000 live births). TCS is relevant to the anaesthetist because it can cause difficulties in airway management. A case report is presented of a 24 year-old woman who was referred to our institution for facial reconstruction surgery in two stages. In both surgeries Airtraq™ was essential for airway management. By presenting this case, it is intended to show that planning, communication and teamwork are indispensable for patient safety.

The development of proliferative verrucous leukoplakia in oral lichen planus. A preliminary study.

BACKGROUND: Was to describe 14 cases of a proliferative verrucous leukoplakia as a clinical evolution of oral lichen planus. MATERIAL AND METHODS: The clinical and histopathological characteristics of 14 cases of OLP that progress towards a plaque-like and verrucous form were indicated, with monitoring over a period of six to 24.3 years. RESULTS: The female/male ratio was 11/3, (78.6 and 21.4%). The mean age when the first biopsy was undertaken was 56.4 years old. None of the patients smoked during the study. As bilateral reticular was clinically diagnostic criterion, the second most frequent clinical form was the plaque form (n=10; 71.4%), followed by the atrophic (n=6; 42.8%), and erosive forms (n=4; 28.5%). Clinically it spread towards attached gingival mucosa and the hard palate. In the histopathologic study, there were a predominance of hyperkeratosis and verrucous epithelial hyperplasia. Three of the cases progressed to a squamous cell carcinoma, and one patient developed two verrucous carcinoma. CONCLUSIONS: Further research is needed to demonstrate if proliferative multifocal oral lichen planus and proliferative multifocal oral leukoplakia are the same disorder but have different behaviour of malignancy for reasons of origin.

Una complicación inusual del colgajo de Björk en la traqueotomía electiva / An unusual complication of Björk flap in elective tracheotomy

Introducción. La traqueotomía temporal electiva se emplea confrecuencia en intervenciones realizadas en el territorio cervicofacial. El colgajode pared traqueal anterior de base inferior (colgajo de Björk) facilita elcambio de cánula en el periodo postoperatorio. Caso clínico. Paciente intervenidode un cáncer oral al que tras haberse cerrado el traqueostoma se ledescubrió de forma casual un hilo de sutura en la luz traqueal. Dada la dificultadde su retirada por vía endoscópica y ausencia de sintomatología, sedecidió no retirarlo. Discusión. La traqueotomía electiva en oncología cervicofacialasegura la vía aérea, pero presenta también complicaciones. Es muyimportante un adecuado manejo del traqueostoma, independientementede que se elija un cierre primario o secundario del mismo(AU)

Introduction. Elective temporary tracheotomy in oftenperformed in head and neck oncologic surgery. An inferiorly hingedtracheal flap (Björk flap) provides a secure airway in the inmediatepostoperative period. Clinical case. This patient underwent resectionof an oral cancer and subsequent tracheotomy. After deccanulation,a piece of suture was found into the trachea as an incidentaldiscovery. There were no symptoms related to it, and it was notpossible to remove it from the anterior tracheal wall by means ofendoscopy, so it was left in place. Discussion. Elective tracheotomyin head and neck resection for malignancy safeguards the airway,but also has complications. It is very important a careful managementof the stoma, without regard if a primary or secundary closure of itis chosen(AU)

Síndrome de Melkersson-Rosenthal / Melkersson-Rosenthal syndrome

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Osteomas cráneo-faciales: presentación de 3 casos y revisión de la literatura / Cranio-facial osteomas: report of 3 cases and review of the literature

Introducción. Los osteomas son tumores óseos benignos de crecimiento lento, localizados principalmente en la región cráneo-máxilofacial. El tratamiento de las lesiones silentes suscita controversia pues no seha evidenciado su poder de malignización. Material y Método. Se presentan 3 casos poco habituales de osteomas craneofaciales localizados en los huesos frontal, etmoides y mandibula. Discusión. Se realiza una revisión de la literatura realizando una comparativa razonada de la actitud tomada en los casos presentados, discutiendo las ventajas e inconvenientes de lostratamientos realizados. Conclusiones. Se debe realizar una valoración individualizada de cada caso para decidir su manejo, teniendo en cuenta el riesgo derivado de la intervención así como el riesgo derivado de la conductaexpectante. El tipo de cirugía en estos tumores vendrá determinada por su tamaño y localización

Introduction. Osteomas are benign, slow-growing tumorsthat are located principally in the cranio-maxillo-facial region. Treatment of these silent lesions has resulted in controversy, as their potential for becoming malignant has not been demonstrated.Material and Methods. Three somewhat uncommon cases of craniofacial osteomas located in frontal, ethmoid and mandible bones are presented. Discussion. A revision of the literature is carried out, and a reasoned comparison is made of the attitude taken in the cases presented. The advantages and disadvantages of the treatmentcarried out are discussed. Conclusions. Each case should be assessed individually in order to decide how it should be dealt with,taking into account the risk derived from the surgery as well as the risk derived from a wait and watch strategy. The type of surgery for these tumors is determined by their size and location

Linfoma nasal de células T/NK / Nasal T/NK cell lymphoma

El linfoma nasal de células T/ natural killer (NK) (LNT/NK), trashaber recibido múltiples denominaciones, ha sido definido y caracterizadoen el año 2001 por la Organización Mundial de la Salud (OMS), basándoseen una clasificación previa de la Revised European-American LymphomaClassification (REAL), de la manera en que se le conoce actualmente. Suincidencia en el mundo occidental es baja, mientras que en Asia supone elsegundo grupo de linfomas más frecuente, tras los gastrointestinales. Selocaliza preferentemente en las fosas nasales y senos maxilares, mostrandoun curso clínico agresivo, definido por una destrucción de los tejidoscircundantes. Su diagnóstico definitivo se realiza por medio de técnicas dehibridación in situ, llegando a la determinación de su inmunofenotipo. Seha observado una frecuente asociación con el virus de Epstein-Barr (VEB).El pronóstico de esta enfermedad viene definido por el índice pronósticointernacional (IPI) y por el volumen alcanzado por el tumor. A pesar deser radiosensible, su pronóstico es infausto, aconteciendo la muerte delpaciente poco tiempo después del diagnóstico, generalmente como consecuenciade las complicaciones del tratamiento

Nasal T-cell and Natural Killer cell lymphoma (NT/NKL),having been given many names, was defined and described inthe year 2001 by the World Health Organization (WHO), on thebasis of a previous classification by the Revised European-AmericanLymphoma Classification (REAL) as it is known today. Its incidencein the western world is low, while in Asia it represents the secondmost frequent group of lymphomas, followed by the gastrointestinal[lymphoma]. It is typically located in the nasal cavity and maxillarysinuses. It is associated with an aggressive clinical course,characterized by the destruction of surrounding tissue. The definitivediagnosis is made by means of in situ hybridization techniques, inorder to determine the immunophenotype. Its association with theEpstein-Barr virus (EBV) has frequently been observed. The prognosisof this disease is determined by the International Prognosis Index(IPI) and by the size of the tumor. In spite of being responsive toirradiation therapy, its prognosis is gloomy, and the death of thepatient occurs shortly after the diagnosis, generally as a result oftreatment complications

Artrocentesis de la articulación temporomandibular / Arthocenthesis of the temporomandibular joint

La artrocentesis de la articulación temporomandibular fue descrita en el año 1991 por la Dra. Dorrit W. Nitzan. La técnica básicamente consiste en la realización de una doble punción articular y el lavado con suero Ringer Lactato del compartimento superior (meniscotemporal) de la cavidad articular. Sus indicaciones primarias son la existencia de un bloqueo articular agudo y el síndrome del disco articular adherido. Otras patologías en las que se utiliza la artrocentesis con fines terapéuticos son las artropatías inflamatorias o metabólicas, los cuadros de dolor asociados a osteoartrosis y las artritis traumáticas. El porcentaje de éxito varía de un 70-100 por ciento en cuanto a mejoría del dolor y aumento de la apertura oral en sus indicaciones primarias. Las principales ventajas de esta técnica radican fundamentalmente en la mayor sencillez de realización, la posibilidad de realizarla bajo anestesia local, la nula necesidad de medios técnicos sofisticados, su bajo coste y la escasez de efectos secundarios (AU)

Oncocitoma de la glándula parótida. A propósito de un caso / Oncocytoma of the parotid gland. A report of a case

El onocitoma es una neoplasia de infrecuente presentación. Habitualmente benigna, puede localizarse en cualquier parte del organismo, siendo típica su ubicación en la glándula parótida. En el presente artículo, se documenta el caso de una mujer de 83 años con una masa de 9 x 8,5 x 11,5 cm que afectaba a la totalidad de la glándula parótida izquierda. El examen microscópico mostró una oncocitosis difusa en una neoplasia bien encapsulada. Realizamos una breve revisión de la literatura, incluyendo patogenia, características histológicas y modadlidades terapéuticas de este tumor (AU)

Descending necrotizing mediastinitis caused by odontogenic infections.

Intrathoracic dissemination of an odontogenic infection is very infrequent. The resulting clinical manifestation, known as descending necrotizing mediastinitis, causes high mortality. Due to the absence of early clinical or radiological signs, diagnosis is usually made only when the process is completely established. Treatment is a combination of intravenous antibiotics and mediastinal drainage, via either a cervical or a transthoracic approach. We report the clinical and microbiological characteristics of 4 patients with descending necrotizing mediastinitis, and their clinical course over a period of 10 years.

[The selection of cervical vessels recipients in reconstructive surgery of head and neck with free flaps]. / Elección de vasos receptores cervicales en la cirugía reconstructiva de cabeza y cuello con colgajos libres.

One of the most important parameters for success in free tissue transfer to the head and neck are a proper and careful recipient vessel dissection and meticulous vascular microanastomotic technique. The principle that govern vessel positioning in the head and neck are more complex than those used in extremity free flap transfers. In this report the vascular selection as well as technical details are discussed, based on the literature data and our own experience in 20 patients.

Tongue necrosis as a complication of temporal arteritis.

Tongue necrosis is a rare complication in giant cell arteritis, an entity in which both temporal arteritis and rheumatic polymyalgia may be included as two different manifestations of the same pathologic process. The case of a 79-year-old patient who had tongue necrosis 3 hours after ingestion of 2 mg of ergotamine tartrate is presented. This complication was the basis for the diagnosis of temporal arteritis. We reviewed possible clinical manifestations of temporal arteritis and cases of tongue necrosis in the world literature. The possible existence of triggering factors that seemed to be present in 11 of the published cases was analyzed. In seven of these cases ingestion of ergotamine derivates had taken place.

Spontaneous fracture of hypertrophied genial tubercles.

A case of spontaneous fracture of hypertrophied genial tubercles is reported. This is an uncommon event with only six previously reported cases. This entity is usually associated with severe edentulous bone resorption, a condition related to the pathogenesis of this fracture. Clinical complaints include painful swelling of the floor of the mouth and impaired tongue function. If left untreated, mucosal inflammatory changes may appear and a biopsy should be performed. Total recovery is obtained after removal of the fractured fragments.