[Cervical hematoma after discectomy for spondylosis. An indication of urgent tracheotomy]. / Hematoma cervical tras disquectomía por espondilosis. Indicación de Traqueotomía Urgente.

We report the clinical case of a hematoma after surgery of cervical spondylosis which required an urgent tracheotomy due to failure in the orotracheal intubation. This illness in advanced degree, so called cervical spondylotic myelopathy, is the most serious consequence of cervical intervertebral disc degeneration.

[Morphology of the parathyroid glands. A study of 146 samples and review of the literature]. / Morfología de las glándulas paratiroides. Estudio de 146 muestras y revisión de la literatura.

Parathyroid hyperfunction condition has a very diverse and unspecific symptoms and signs. We have performed an anatomopathologic study of 146 parathyroid gland from patients diagnosed from hyperparathyroidism. About a 72.6% of the patients presented a parathyroid adenoma while in the rest 27.4% it was observed principal cells hyperplasia. Up to now we have not registered any cases of parathyroid carcinoma after anatomopathological exam of the removed gland. The mayority of the adenomas (85%) were found on the lower parathyroids and its size varied between 6 mm and 5 cm. In one case an double adenoma was diagnosed and in another two cases the adenoma was located in the superior mediastine.

[Diffuse large B-cells lymphoma of the parotid gland (MALT). Report of a case and review of the literature]. / Linfoma difuso de células b grandes parotídeo (MALT). A propósito de 1 caso y revisión de la literatura.

Althouh lymphomas are an illness that characteristically affects the lymph nodes they can present in other locations (extranodes). The lymphoid tissue of the salivary glands can be considered part of the called mucosa-associated lymphoid tissue (MALT). We report the case of a diffuse large B-cells parotid lymphoma. The location on the parotid gland, within its rareness, is the most common for salivary gland lymphomas whose diagnosis is always histological by examination of the removed piece since the biopsy can be nonsufficient and take to a wrong diagnosis besides the greater risk of injury on the facial nerve.

[Sudden cardiorespiratory arrest in adults with acute epiglottitis. Report of 2 cases]. / Parada cardiorrespiratoria súbita en adultos con epiglotitis aguda presentación de dos casos.

We report two adult cases of sudden cardiorespiratory arrest because an acute epiglottitis that ocurred in our hospital. Although it is an uncommon pathology nowdays with good prognosis generally, we try to call the attention about this complication which can happen of unforseeable way even in previous absence of respiratory obstruction. One of the patients required coniotomy in ICU due to impossibility of orotracheal intubation (OI) and the other died in spite of an urgent performance.

[Spontaneous cervical and pharyngolaryngeal hematoma after coughing attacks]. / Hematoma faringolaríngeo y cervical espontáneo tras crisis tusígena.

We report the case of a 86 years old male who, in the course of a coughing attack, refers spontaneous cervical and pharyngeal pain in addition to hoarness, dysphagia and some dyspnea. His exploration revealed a small right neck hematoma but with infiltration of the orohypopharynx and right hemilarynx for spreading later to posterior pharyngeal wall and left aryepiglottic fold. The patient was sent to ICU although he did not required a control of airway by intubation or tracheotomy finally.

[Pseudomonas and acute external otitis. Results of a microbiological study in patients without previous antibiotic treatment]. / Pseudomonas y otitis externa aguda. Resultados de un estudio microbiológico en pacentes sin tratamiento antibiótico previo.

We report the results of a microbiological clinic study that was performed by our ENT Department between years 2000 and 2001 whose main objective was to determine, in Badajoz Area of Health, which bacteria were involved in the acute diffuse external otitis of patients without previous antibiotic treatment (two weeks before obtaining the samples). Of 79 isolated microorganisms in 62 patients that fulfilled the requirements established Pseudomonas, mainly P. Aeruginosa, represented a 46.83% altogether followed by Staphylococcus (18.98%). In almost one fourth part of the cases strains of associated fungi were identified.

[Treatment of the benign paroxysmal positional vertigo (BPPV) by Epley maneuver]. / Tratamiento del vértigo posicional paroxístico benigno (VPPB) mediante la maniobra de epley.

Benign paroxysmal positional vertigo (BPPV) is the most common of the peripheral vertigo. We report the case of a 45 years old female with that pathology suspected by the symptoms which the patient related to head changes of positions and movements. Her diagnosis was confirmed by the maneuver of Dix-Hallpike, that was positive, and the treatment consisted in a maneuver of canalicular reposition according to Epley's technique. Such maneuver was successful and actually the patient is without symptoms after more than 2 years since the first episode. Finally we have performed a bibliographic review to verify the effectiveness of that treatment.

[Recurrent intrathyroid abscess in children. Clinical case and review of the literature]. / Absceso recurrente intratiroideo en niños. Caso clinico y revisión de la literatura.

Recurrent thyroid abscesses in children are an uncommon clinical disorder that use to be due to 3rd or 4th branchial anomalies and pyriform sinus fistula. We are reporting the clinical case ofa 6 year-girl who was diagnosed as left thyroid lobe and istmic abscess of 3 cm, drained by general anesthesia with positive culture for St. Viridans. Four months later she was re-admitted by the same cause and we performed a new drainage, by punction, and endovenous antimicrobial therapy for aerobic and anaerobic pathogens with good evolution. The imaging tests showed no anatomical alterations.

[Practical aspects regarding endoscopic treatment for epistaxis]. / Aspectos prácticos sobre el tratamiento endoscópico de la epistaxis.

INTRODUCTION: A prospective study is presented to evaluate some practical and financial aspects regarding surgical endoscopic ligation or cauterization of sphenopalatine (SP) and anterior ethmoidal (AE) arteries performed to control posterior nasal bleeding. PATIENTS AND METHODS: 35 patients admitted at the ENT ward between 2004 and 2006 were included in the study, and distributed into two groups depending on the protocol applied in each case. Until March 2005 the surgery was performed if there was failure or insecurity of the posterior packing, and since that date a substitutive surgical protocol (not including posterior packing) was applied. RESULTS: 82.9% of the patients were male, with a mean age of 55.74 years and a left bleeding in a 60% of the cases. Ligature/cauterization was performed on SP in 28 (80%) patients, on AE in 4 (11.4%), and on both arteries in 3 cases (8.6%). 38.7% of the SP approach only one sphenopalatine foramen was observed, through which an only branch of the artery passed; 42% of the cases two branches passed through an only foramen, and in 19.3% two or more branches were present, breaking into the nose through two or more independent clefts. AE was intradural in 3 cases, intranasal attached to the cranial base in other 3 and intranasal detached to the cranial base in 1 patient. Besides, highly significant differences were found between the two protocols, observing a mean reduction of hospital stay of 3.1 days, which throws up savings of 939.3 euros per patient. DISCUSSION AND CONCLUSIONS: Surgical treatment for epistaxis has proved to be effective (91.2% in our experience) and safe, determining an important reduction in hospital stay and avoiding the morbility of posterior packing. Accurate knowledge of the anatomy of the arteries implied and specific actuation upon the correct bleeding territory are essential to perform this surgery.

[Retropharyngeal phlegmon in adults. Report of a case and literature review]. / Flemón retrofaríngeo en adultos. Presentación de un caso y revisión de la literatura.

Retropharyngeal phlegmons and abscesses in the adult are uncommon nowdays. We report the case of a 48 years old male diagnosed as retropharyngeal phlegmon of idiopatic cause because no reasons were able to justify the clinical symptoms. Cervical CT was negative for purulent collection and the patient was treated by endovenous antibiotics and steroids until the resolution of his process. The final hospital stay was 12 days and after 10 years follow-up he has not been readmitted due to that pathology.

[Ramsay-Hunt syndrome associated to unilateral recurrential paralysis]. / Síndrome de Ramsay-Hunt asociado a parálisis recurrencial unilateral.

Varicella herpes zoster (VZV) virus reactivaction can produce multiple neuropathies of the cranial and cervical region being the peripheral facial paralysys the most common one. We report one case of Ramsay-Hunt syndrome with eruption of vesicles on left auricular pinna and face besides facial palsy which associated to ipsilateral laryngeal or recurrential paralysis nonexisting previously. Our patient was treated by oral aciclovir (800 mg, 5 times daily) for 1 week. 3 months later she returned to Emergencies due to another cause and the ENT exploration showed a recovery in the mobility of the left cord but it persisted the affectation of VII pair, specially the inferior branch or cervicofacial. It is advised that the larynx should be examined in all cases of herpes zoster that involve the head and neck.

[Analysis of our recent results in the surgical treatment of the hyperparathyroidism (1990-2005)]. / Análisis de nuestros resultados actuales en el tratamiento quirúrgico del hiperparatiroidismo (1990-2005).

OBJECTIVE: To report our recent experience (1990-2005) in the surgical treatment of hyperparathyroidism. MATERIAL AND METHOD: Up to now we have operated 153 patients (41 male and 112 female) with ages between 14 and 79 years old studying the clinical symptoms referred by them, preoperative imaging tests, type of hyperparathyroidism, its respective surgery, result or final anatomopathological diagnosis and postoperative complications. RESULTS: Parathyroid adenomas represented a 69.73% while the hyperplasias were about 26.31%. In 6 cases the glands removed were informed as normal. It stands out that the most rare adenomas were located in lower parathyroids with a relation > 5,5:1 respect to the upper ones. Among the complications we obtained 35 postoperative hypocalcemias (31 transient and 4 persistent), one case of recurrent nerve palsy after exposure of 233 nerves, 5 haemorrhages that required reintervention and 4 persistences of hypercalcemia. Globally we were able to reduce the calcium and PTH serum levels with clinical improvement in more than 96% of the operated patients. DISCUSSION-CONCLUSION: The surgery for hyperparathyroidism provides very good results in general as we stated in other published series.

[Malignant melanoma of the pinna. Importance of its diagnosis, treatment and prognostic factors]. / Melanoma maligno de pabellón auricular. Importancia del diagnóstico, tratamiento y factores pronósticos.

About 25%-30% of the primary malignant melanomas occur in the head and neck region and of these less than 10% arise on the external ear, mainly on helix and the lobule of the pinna. Melanoma thickness and nodal or distant metastases are advers factors for its prognosis. We report a case of a tumor that affected the right pinna and was removed by our ENT, department with good evolution, being the patient free of disease after 5 years follow-up.

[Metastases of pulmonary small cell carcinoma on cervical skin noted before the primary tumor]. / Metástasis de carcinoma de células pequeñas pulmonar sobre piel cervical descubierta antes del tumor primario.

We are reporting the case of a patient with final diagnosis of bronchopulmonar carcinoma of small cells who at first place assisted to E.N.T. Department due to a cervical node (adhered to the dermis) and hemoptysis of more than 2 months. We resected the neck mass which confirmed the presence ofa cutaneous metastases of an oat cell carcinome, being the patient after word ea sstudy by the Neumology Service, who found a righth lung tumor, of the same histological type. In spite of the treatment the patient die.

[Reoperation because of ectopic parathyroid adenoma with previous removal of lipothymoma. Importance of intraoperative PTH]. / Reintervención por adenoma ectópico de paratiroides con extirpación previa de lipotimoma. Importancia de la PTH intraoperatoria.

Sometimes the surgery of hyperparathyroidism is not easy and the surgical team find difficulties to locate the pathological gland or glands. We report a case of primary hyperparathyroidism due to an ectopic parathyroid adenoma which required two interventions. First we removed what it seems an adenoma but resulted to be a lipotimoma. In the reintervention practiced one week later, having then the rapid or turbo intraoperative PTH and previous digital scintigraphy, it was possible to remove an adenoma histologically confirmed, with 3,5 cm diameter located in depth to right thyroid lobe towards the superior mediastinal straits. The postoperative evolution of the patient was satisfactory and no complications were registered.

[Phlegmons and abscesses in the floor of mouth. Report of 10 cases and review of the literature]. / Flemones y abscesos del suelo de boca. Análisis de 10 casos y revisión de la literatura.

We report a review about 10 cases of phlegmons-abscesses in the floor of mouth (Ludwig's angina) treated by our Service analyzing the following variables: Age, sex, time of evolution, personal antecedents, E.N.T. exploration, clinical symptoms, type of treatment and clinical evolution. This pathology represents one of the most severe forms of cervicofacial diffuse cellulitis; it requires an early diagnosis and therapy which can include an urgent tracheostomy ifthe airway is compromised.

[Lobular capillary hemangioma on the floor of the mouth (pyogenic granuloma). Report of a case and literature review]. / Hemangioma lobular capilar del suelo de boca (granuloma piogénico). A propósito de un caso y revisión bibliográfica.

Lobular capillary hemangioma or pyogenic granuloma is a benign lesion with a focal reactive development of fibrovascular tissue and endotelial proliferation. It can appear to any age in different locations and usually has the aspect of a pediculate mass with or without ulceration zones on the area. Its treatment is the simple surgical removal and the control of the traumatic and infectious influential factors. We report a case of pyogenic granuloma on the floor of the mouth making a literature review at respect of that common clinical entity.