Tuberculosis de la glándula parótida / Tuberculosis of parotid gland

Hoy en día la tuberculosis es una de las más importantes infecciones reemergentes en el mundo. Hasta un 20% de las formas de presentación son extratorácicas. Sin embargo, la presencia de tuberculosis a nivel parotídeo es infrecuente incluso en países subdesarrollados, donde la incidencia de esta enfermedad es mayor. Presentamos un paciente de 83 años que acude por tumoración en región parotídea de 4 semanas de evolución sin antecedentes personales. La exploración clínica revela una masa en cola de parótida izquierda de aproximadamente 3 × 2 cm, no dolorosa a la palpación y sin evidencia de adenopatías a nivel cervical. Tras el estudio radiológico y punción con aguja fina, no se obtienen datos concluyentes, por lo que se procede a realizar exéresis. Se envía muestra para estudio de PCR, se confirma diagnóstico de tuberculosis parotídea. Tras recibir quimioterapia antituberculosa complementaria, el paciente es dado de alta por remisión de la enfermedad (AU)

Tuberculosis is currently one of the most important re-emerging infections worldwide. Up to 20% of cases are extra-thoracic. However, the presence of parotid tuberculosis is uncommon even in developing countries where the incidence of this disease is higher. The case of an 83 year-old patient is presented who had a tumour in the parotid region of 4 weeks onset, and with no previous personal history. Clinical examination revealed a mass of approximately 3 × 2 cm in the left parotid. It was not painful on palpation and there was no evidence of cervical lymph node involvement. After inconclusive radiological examination and fine needle aspiration, an excision of the lesion was performed, and the specimen sent for a PCR study. This confirmed the diagnosis of parotid tuberculosis, and after receiving additional tuberculosis treatment the patient was discharged due to remission of the disease (AU)

Base of Tongue Tuberculosis: A Case Report.

INTRODUCTION: Tuberculosis is an infectious disease that has displayed increasing incidence in the last decades. It is estimated that up to 20% of tuberculosis cases affect extra-pulmonary organs. In the ENT area, soft palate and tongue are the least probable locations. CASE REPORT: A 62-year-old female with a history of rheumatoid arthritis and treatment with corticosteroids and Adalimumab, developed a foreign body sensation in the pharynx accompanied by a sore throat and halitosis. The laryngoscopy with a 70 degree rigid telescope showed an ulcerated hypertrophic lesion in the right vallecula of about 2-3 cm in the base of the tongue. Acid-alcohol resistant bacilli were found positive for M. tuberculosis, through the Ziehl Neelsen method and Löwenstein culture the patient was treated with tuberculostatic medication. CONCLUSION: TB is a possible diagnosis when in the presence of an ulcerated lesion at the base of the tongue, accompanied by sore throat, dysphagia, or foreign body sensation.

Anestesia tópica en la nasofibrolaringoscopia flexible / Topical anesthesia in flexible nasofibrolaryngoscopy

Introducción: El desarrollo de la otorrinolaringología en las últimas décadas se ha visto favorecido por la aparición de la nasofibrolaringoscopia flexible, la cual se ha convertido en una herramienta diagnóstica esencial para el otorrinolaringólogo. Sin embargo su uso no está exento de molestias para el paciente, razón por la cual diversas opciones de anestesia tópica se han propuesto durante el desarrollo de la técnica. Materiales y métodos: Estudio prospectivo, doble ciego, cruzado, realizado en pacientes sin antecedentes de patología nasal a través del cual comparamos el uso de anestésico tópico (lidocaína) + epinefrina, oximetazolina y placebo. Mediante escala visual analógica se valoró el grado de molestias durante cada exploración. Resultados: Fueron evaluados 18 pacientes, 10 mujeres (55,6%) y 8 hombres (44,4%), con una edad promedio de 28 años ± 4. El grado de molestia generado por la exploración con la aplicación de lidocaína más epinefrina fue de 1,94; oximetazolina 3,78; y placebo 4,61. Al comparar la mezcla lidocaína-epinefrina con oximetazolina obtuvimos significación estadística a favor de la lidocaína-epinefrina (p < 0,05); al comparar el uso de lidocaína-epinefrina con placebo el resultado también fue estadísticamente significativo en favor de la lidocaína-epinefrina (p < 0,05). Conclusiones: En este estudio demostramos que el uso de la asociación de lido (AU)

Introduction: The emergence of flexible nasofibrolaryngoscopy in recent decades has facilitated the development of Otolaryngology and the nasofibrolaryngoscope has become an essential diagnostic tool for the otolaryngologist. However, its use is not without discomfort for the patient, which is why various options for topical anaesthesia have been proposed during the development of the technique. Material and methods: This was a prospective, double blind, crossover study in patients with no history of nasal disease, through which we compared the use of topical anaesthetic (Lidocaine) + epinephrine, oxymetazoline and placebo. Using a visual analogue scale, the degree of discomfort was assessed during each scan. Results: We evaluated 18 patients, 10 women (55.6%) and 8 men (44.4%), with a mean age of 28±4 years. The degree of disturbance generated by the scan with the application of lidocaine-epinephrine was 1.94; with oxymetazoline it was 3.78, and with placebo, 4.61. When the lidocaine-epinephrine solution was compared with oxymetazoline, there was a statistical significance in favour of lidocaine-epinephrine (P<0.05). When we compared the use of lidocaine-epinephrine with the placebo, the result was also statistically significant in favour of lidocaine-epinephrine (P<0.05). Conclusions: In this study we demonstrated that using lidocaine associated with epinephrine as a topical anaesthetic prior to flexible nasofibrolaryngoscopy decreases pain and feeling of discomfort for the patient. Consequently, we can recommend the use of topical nasal anaesthesia when performing this exploratio (AU)

[Topical anesthesia in flexible nasofibrolaryngoscopy]. / Anestesia tópica en la nasofibrolaringoscopia flexible.

INTRODUCTION: The emergence of flexible nasofibrolaryngoscopy in recent decades has facilitated the development of Otolaryngology and the nasofibrolaryngoscope has become an essential diagnostic tool for the otolaryngologist. However, its use is not without discomfort for the patient, which is why various options for topical anaesthesia have been proposed during the development of the technique. MATERIAL AND METHODS: This was a prospective, double blind, crossover study in patients with no history of nasal disease, through which we compared the use of topical anaesthetic (Lidocaine) + epinephrine, oxymetazoline and placebo. Using a visual analogue scale, the degree of discomfort was assessed during each scan. RESULTS: We evaluated 18 patients, 10 women (55.6%) and 8 men (44.4%), with a mean age of 28±4 years. The degree of disturbance generated by the scan with the application of lidocaine-epinephrine was 1.94; with oxymetazoline it was 3.78, and with placebo, 4.61. When the lidocaine-epinephrine solution was compared with oxymetazoline, there was a statistical significance in favour of lidocaine-epinephrine (P<0.05). When we compared the use of lidocaine-epinephrine with the placebo, the result was also statistically significant in favour of lidocaine-epinephrine (P<0.05). CONCLUSIONS: In this study we demonstrated that using lidocaine associated with epinephrine as a topical anaesthetic prior to flexible nasofibrolaryngoscopy decreases pain and feeling of discomfort for the patient. Consequently, we can recommend the use of topical nasal anaesthesia when performing this exploration.

Temporal bone dissection practice using a chicken egg.

HYPOTHESIS: Temporal bone drilling practice constitutes an essential stage in training for the surgical approach to this complex anatomic structure. To facilitate adaptation and surgical skills in otologic surgery, we recall the easy cost-effective practice of drilling a chicken egg. BACKGROUND: The resident in training must master the use of the surgical microscope, the burr, and fine drilling instruments used in dissection. Animal models, plastic temporal bones, prototyped temporal bones, and virtual reality temporal bones have all been used. METHODS: This article describes a method of training residents' otologic skills by drilling a chicken egg. We used basic support materials found in a typical temporal bone dissection laboratory, with a surgical microscope, a desk, and a drilling system. Practice includes drilling and dissection of the eggshell, preserving the natural eggshell membrane. RESULTS: Learning temporal bone drilling on an egg, using basic materials, allows the surgeon to simulate surgery on a physical model using the same instrumentation that is used in surgery, obviating the need for laboratory conditions required for cadaveric dissection. CONCLUSION: Simulation is emerging as a mandatory component of surgical training. The egg is an excellent cost-effective model for drilling and dissection training and helps in improving surgical skills, enables learning of fine motor skills, and allows repeated practice. Although this method of training does help one control a drill and manual instrumentation, it does not help with temporal bone anatomy knowledge.