Role of steroids in conservative treatment of parapharyngeal and retropharyngeal abscess in children.

PURPOSE: To characterize the clinical features and outcomes of pediatric patients with retropharyngeal (RPA) or parapharyngeal abscesses (PPA) managed only with medical treatment and showing the importance of early symptoms and imaging studies in the diagnosis of deep neck space infections (DNIs) in children. METHODS: A retrospective analysis of all patients diagnosed with RPA and PPA between 2007 and 2017 was performed in Hospital Universitario Central de Asturias. RESULTS: 30 children were identified, with 11 RPA and 19 PPA. 23 children (76.7%) were under 5 years old, and all were treated with intravenous amoxicillin/clavulanic acid and corticosteroids. Torticollis and fever were present in all patients. The mean length of hospital stay was 7.5 days. There were no complications associated. CONCLUSION: DNIs can be treated in a conservative way, reserving the surgical drainage for cases with a complication associated (airway compromise, lack of response to antibiotic therapy, immunocompromised patients). Treatment with intravenous antibiotics and corticosteroids is a safe option, reducing the duration of symptoms and the length of hospital stay.

Management options for orbital complications of acute rhinosinusitis in pediatric patients.

OBJECTIVES: Acute bacterial rhinosinusitis (ABRS) is a common pediatric condition. Despite its tendency to heal without complications, orbital complications (OC) are seen in 6% of patients and can cause vision impairment and put life at risk. Current treatment of this complications involves systemic antibiotics with or without surgical drainage, remaining controversial the use of corticosteroids. The aim of this study is to describe our results in the management of this complication both through medical and surgical treatment, with the inclusion of corticosteroids on it. METHODS: A retrospective cross-sectional study was conducted in a tertiary hospital over pediatric patients with this complication. RESULTS: 23 patients were included with a mean age of 7.4 years. Ten of them (43.5%) presented ophthalmoplegia on admission and 2 of those also impaired visual acuity. A computerized tomography was performed in all patients and all of them received intravenous antibiotics and corticosteroids achieving that 60% did not require surgical treatment. The mean length of hospital stay was 6.2 days. CONCLUSIONS: The treatment of OC of ABRS with intravenous antibiotics and corticosteroids is safe, remaining surgical treatment available when necessary. When evolution is favorable, a reduced hospital stay must be sought.

The use of pedicled buccal fat pad combined with sequestrectomy in bisphosphonate-related osteonecrosis of the maxilla.

The use of pedicled buccal fat pad flap (BFP) has proved of value for the closure of oroantral and oronasal communications and is a well-established tool in oral and maxillofacial surgery. Otherwise, the perceived limitations of surgical therapy for bisphosphonate-related osteonecrosis of the jaws (BRONJ) have been widely discussed, and recommendations have largely been made to offer aggressive surgery only to stage 3 patients refractary to conservative management. Oroantral communication may be a common complication after sequestrectomy and bone debridement in upper maxillary BRONJ. We report a case series of stage 3 recalcitrant maxillary BRONJ surgically treated with extensive sequestrectomy and first reconstruction using pedicled BFP. All the cases presented an uneventful postoperative healing was uneventful without dehiscence, infection, necrosis or oroantral communication. We postulate that managing initially the site with BFP and primary closure may ensure a sufficient blood supply and adequate protection for an effective bone-healing response to occur. This technique may represent a mechanic protection and an abundant source of adipose-derived adult stem cells after debridement in upper maxillary BRONJ. We evaluate in this work results, advantages and indications of this technique.

Helmet-delivered heliox-CPAP in severe upper airway obstruction caused by PHACES syndrome.

We present the case of a 4-month-old girl with PHACES syndrome and severe upper respiratory airway obstruction secondary to multiple subglottic and tracheal hemangiomas effectively treated with heliox-CPAP delivered by helmet (HH-CPAP).

Hiposmia, rinorrea fétida y algias faciales por aspergiloma maxilar / Hyposmia, fetid rhinorrhea and facial pain caused by a maxillary aspergilloma

En los últimos años se ha observado un aumento de la incidencia de sinusitis fúngicas en sujetos inmunocompetentes. Presentamos un caso de sinusitis micótica en una paciente de 12 años, en el que concurren varios aspectos que podían dificultar su diagnóstico, produciendo un retraso en su tratamiento definitivo. Este caso ilustra cómo, para llegar a un diagnóstico correcto de esta patología, es necesario basarse en los estudios histológicos y radiológicos, pero siempre sin olvidar un aspecto clave como es la sospecha diagnóstica. El tratamiento de la sinusitis fúngica es quirúrgico, y en el momento actual la técnica de elección es la cirugía endoscópica nasal. Se exponen las características clínicas de esta patología y los métodos diagnósticos necesarios (AU)

In the last few years an increase has been observed in the incidence of fungal sinusitis in immunocompetent subjects. We present a case of mycotic sinusitis in a 12-year-old patient, in which there were several aspects that could have made the diagnosis more difficult, thus delaying her definitive treatment. This case illustrates how to arrive at a correct diagnosis of this pathology. It must be based on the histological and radiological studies, but always without forgetting a key aspect as it is a suspected diagnosis. The treatment of fungal sinusitis is surgical, and currently, endoscopic sinus surgery is the choice. We describe the clinical characteristics of this pathology and the diagnostic methods required (AU)

[Hyposmia, fetid rhinorrhea and facial pain caused by a maxillary aspergilloma]. / Hiposmia, rinorrea fétida y algias faciales por aspergiloma maxilar.

In the last few years an increase has been observed in the incidence of fungal sinusitis in immunocompetent subjects. We present a case of mycotic sinusitis in a 12-year-old patient, in which there were several aspects that could have made the diagnosis more difficult, thus delaying her definitive treatment. This case illustrates how to arrive at a correct diagnosis of this pathology. It must be based on the histological and radiological studies, but always without forgetting a key aspect as it is a suspected diagnosis. The treatment of fungal sinusitis is surgical, and currently, endoscopic sinus surgery is the choice. We describe the clinical characteristics of this pathology and the diagnostic methods required.

I Conferencia Nacional de Consenso sobre el Injerto Óseo del Seno Maxilar / 1st National Consensus Conference on maxillar sinus bone grafts

Objetivo: El objetivo de la I Conferencia Española de Consenso sobre el Injerto Óseo Sinusal era intentar llegar a puntos de acuerdo sobre las principales controversias de esta técnica, aplicada de forma muy variada y con el empleo de materiales muy diversos, y conseguir plasmar los mismos en un documento resumen consensuado por todos los autores. Material y método: Durante los días 17 y 18 de octubre de 2008 se celebró en Oviedo la citada conferencia, auspiciada por la Sociedad Española de Cirugía Oral y Maxilofacial. En ella se dieron cita un total de 50 ponentes de reconocido prestigio nacional e internacional que repasaron en 6 mesas de trabajo las principales controversias sobre los injertos óseos sinusales. Tras las conferencias de los ponentes, los moderadores establecían las principales conclusiones de cada mesa y se abría un turno de debate donde participaban todos los asistentes. Resultado: Este documento y sus conclusiones emanan de las presentaciones realizadas por los ponentes y de las deliberaciones y acuerdos de cada mesa de trabajo. Ambos han sido aprobados tras varias correcciones por todos los autores antes de ser enviados para su publicación. Además, han obtenido el reconocimiento científico oficial de la Sociedad Española de Cirugía Oral y Maxilofacial y deben servir como base para futuros estudios y reuniones científicas. Conclusiones: El objetivo fundamental cuando se realiza un injerto óseo sinusal es la formación de hueso vital en el seno maxilar, para conseguir la supervivencia a largo plazo de los implantes tras su carga protésica. Para ello, la técnica y la secuencia de tratamiento deben orientarse a conseguir resultados predecibles y estables en el tiempo, aunque esto suponga un mayor tiempo de espera hasta la colocación de la prótesis. La estabilidad inicial del implante es el factor clave para la osteointegración y debe ser el principal criterio para indicar implantes simultáneos o diferidos en el seno maxilar(AU)

Objective: The objectives of the first Spanish Consensus Conference on Sinus Bone Graft were trying to reach agreements points on the major controversies of this technique, and translate them in a summary document. Material and method: During the 17th and 18th of October of 2008 took place in Oviedo (Spain) the Conference, sponsored by the Spanish Society of Oral and Maxillofacial Surgery. There, 50 national and international speakers reviewed in 6 workshops the major controversies of sinus bone grafts. Following the conferences, the moderators proposed the main conclusions of each workshop and opened a round of discussion where all attendees participated. Results: This document and its conclusions emanate from the presentations made by the speakers and the discussions and agreements of each workshop. Both have been approved after several corrections by all authors before being submitted for publication. They have also obtained the official scientific recognition of the Spanish Society of Oral and Maxillofacial Surgery and should serve as a basis for future scientific studies and meetings. Conclusions: The main objective when we perform a sinus bone graft is vital bone formation in the maxillary sinus, to achieve long-term survival of the implants after prosthetic loading. To do this, the technique and sequence of treatment should aim to achieve predictable and stable results over time, although this involves a longer waiting time. The initial implant stability is the key factor for osseointegration and should be the main criterion to indicate simultaneous or delayed implants in the maxillary sinus(AU)

Giant neck liposarcoma with pathological clavicular fracture.

Liposarcomas generally originate in the extremities or retroperitoneum, they are very unusual in the head and neck region, and extremely rare in the thorax. The mainstay of treatment for liposarcomas is surgical excision. We report a very unusual case, not reported before to our knowledge, of a well-differentiated liposarcoma arising from the supraclavicular fossa that produces a pathological clavicular fracture. The patient underwent complete resection of the lesion, without damage of the cervical nerves. Eight months after the surgery the patient is free of recurrence. We demonstrate that giant liposarcomas can be resected completely without morbidity.

Oral bisphosphonates-associated osteonecrosis in rheumatoid arthritis.

Adverse effects associated with the use of bisphosphonates are infrequent and consist of pyrexia, renal function impairment, and hypocalcemia. Bisphosphonates-associated osteonecrosis of the jaws is an uncommon but potentially serious complication of intravenous bisphosphonate therapy in cancer patients. The degree of risk for osteonecrosis in patients taking oral bisphosphonates, such as alendronate, is uncertain and warrants careful monitoring. Oral bisphosphonates-associated osteonecrosis can occur in patients with rheumatoid arthritis. We report a case of mandibular osteonecrosis in a patient who received alendronate for 3.8 years. The pathology improved after bisphosphonate therapy discontinuation and sequestrectomy. To our knowledge there are only three cases published in the literature relating bisphosphonates-associated osteonecrosis of the jaws in patients with rheumatoid arthritis. All the cases published, including our case, have reported association between methotrexate, prednisone and alendronate sodium (Fosamax) therapy. Corticosteroid therapy and dental surgery could increase the risk of developing bisphosphonates-associated osteonecrosis of the jaws in these patients.

Transabdominal surgical approach in the management of renal tumors involving the retrohepatic inferior vena cava.

Multiple reports over the last decade have documented the clear superiority of surgery over other alternative treatments in the management of renal cell carcinoma with extension into the inferior vena cava (IVC). Controversy persists, however, regarding the management of tumor thrombus that extends retrohepatically, but not entering the right atrium. In this report, we retrospectively review our experience with the use of a feasible transabdominal technique without any form of bypass or anticoagulation for safe removal of renal tumor involving the retrohepatic IVC. From 1988 to 1998, 132 patients with renal cell carcinoma underwent radical nephrectomies at the urology service of our hospital. Five patients (3.8%) had retrohepatic venous extension through the renal vein into the IVC. Our transabdominal approach was accomplished by complete mobilization of the liver, control of the hepatocaval connection, total vascular exclusion of the IVC without heparin administration, removal of the tumor thrombus, and primary closure of the longitudinal vena cavotomy. From our results, we found the transabdominal approach with total vascular exclusion of the IVC to be satisfactory, with no early deaths, acceptable morbidity, and a remarkable limitation of blood loss and transfusion requirements.

Grave anaphylactic-like reaction in the course of menstruation. A case report.

The case of a woman with a serious anaphylactic pattern during menstruation is described. The patient had a clinical picture of urticaria, angioedema and shock at each menstruation for a period of 2 years until hysterectomy was performed. The studies showed no hormonal or immunological change. The only relevant finding was the extraordinarily strong vasodilating action of the menstrual fluid in the patient, and not in the controls. The results of the study suggest the possibility of two mechanisms: 1) an IgE-mediated mechanism causing hypersensitivity to some metabolic substance in the menstrual fluid and 2) an excessive pharmacological vasodilatory action produced by the prostacyclin in the fluid itself.