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Crecimiento posterior del hematoma.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alejandro Pelaz, Jeremías Bayón, Lorena Gallego, Luis Junquera" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Alejandro" "apellidos" => "Pelaz" ] 1 => array:2 [ "nombre" => "Jeremías" "apellidos" => "Bayón" ] 2 => array:2 [ "nombre" => "Lorena" "apellidos" => "Gallego" ] 3 => array:2 [ "nombre" => "Luis" "apellidos" => "Junquera" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173573511000846" "doi" => "10.1016/j.otoeng.2010.07.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573511000846?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651910001573?idApp=UINPBA00004N" "url" => "/00016519/0000006200000006/v1_201304231440/S0001651910001573/v1_201304231440/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173573511000858" "issn" => "21735735" "doi" => "10.1016/j.otoeng.2010.09.001" "estado" => "S300" "fechaPublicacion" => "2011-11-01" "aid" => "208" "copyright" => "Elsevier España, S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "sco" "cita" => "Acta Otorrinolaringol Esp. 2011;62:465-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2135 "formatos" => array:3 [ "EPUB" => 40 "HTML" => 1457 "PDF" => 638 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case study</span>" "titulo" => "Sensorineural Hearing Loss Evolution in Vogt–Koyanagi–Harada Syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "465" "paginaFinal" => "468" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evolución de la hipoacusia neurosensorial bilateral en el síndrome de Vogt Koyanagi Harada" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2424 "Ancho" => 3285 "Tamanyo" => 359069 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Changes in macular width and hearing over time. <span class="elsevierStyleItalic">X</span>-axis: time in months, from April 2008 until November 2009, with the treatments applied. <span class="elsevierStyleItalic">Y</span>-axis: macular width in microns. <span class="elsevierStyleItalic">Z</span>-axis: hearing in dB. Solid lines express the variation of macular width over time: marked with squares for the right eye and with diamonds for the left eye. Dotted lines correspond to the variation of mean hearing (125–8000<span class="elsevierStyleHsp" style=""></span>Hz) over time, marked with circles for the right ear and with crosses for the left ear.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Verónica Rodríguez Rivera, Herminio Pérez Garrigues, Roberto Gallego Pinazo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Verónica" "apellidos" => "Rodríguez Rivera" ] 1 => array:2 [ "nombre" => "Herminio" "apellidos" => "Pérez Garrigues" ] 2 => array:2 [ "nombre" => "Roberto" "apellidos" => "Gallego Pinazo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001651910001615" "doi" => "10.1016/j.otorri.2010.09.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651910001615?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573511000858?idApp=UINPBA00004N" "url" => "/21735735/0000006200000006/v1_201304231505/S2173573511000858/v1_201304231505/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173573511000901" "issn" => "21735735" "doi" => "10.1016/j.otoeng.2010.07.003" "estado" => "S300" "fechaPublicacion" => "2011-11-01" "aid" => "205" "documento" => "article" "crossmark" => 0 "subdocumento" => "ssu" "cita" => "Acta Otorrinolaringol Esp. 2011;62:454-61" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2568 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 2124 "PDF" => 396 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Procedures for Integrating a Voice Unit 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elsevierViewall">Distribution of diagnostic agreement and disagreement.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Carlos Casado-Morente, Rafael Casanova-Castillo, Antonio Hernández-Rubiño, Carlos Gómez-Velasco, Encarnación Fernández-Ruiz, David Piédrola-Maroto, Rafael Urquiza-de la Rosa" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Juan Carlos" "apellidos" => "Casado-Morente" ] 1 => array:2 [ "nombre" => "Rafael" "apellidos" => "Casanova-Castillo" ] 2 => array:2 [ "nombre" => "Antonio" "apellidos" => "Hernández-Rubiño" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "Gómez-Velasco" ] 4 => array:2 [ "nombre" => "Encarnación" "apellidos" => "Fernández-Ruiz" ] 5 => array:2 [ "nombre" => "David" "apellidos" => "Piédrola-Maroto" ] 6 => array:2 [ "nombre" => "Rafael" "apellidos" => "Urquiza-de la Rosa" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001651910001585" "doi" => "10.1016/j.otorri.2010.07.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001651910001585?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173573511000901?idApp=UINPBA00004N" "url" => "/21735735/0000006200000006/v1_201304231505/S2173573511000901/v1_201304231505/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case study</span>" "titulo" => "Haematoma of the Floor of the Mouth Associated to Acute Myocardial Infarction" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "462" "paginaFinal" => "464" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Alejandro Pelaz, Jeremías Bayón, Lorena Gallego, Luis Junquera" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Alejandro" "apellidos" => "Pelaz" "email" => array:1 [ 0 => "alejandropelazgarcia@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Jeremías" "apellidos" => "Bayón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Lorena" "apellidos" => "Gallego" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Luis" "apellidos" => "Junquera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Maxilofacial, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Universitario Central de Asturias, Oviedo, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cirugía Maxilofacial, Hospital de Cabueñes, Gijón, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hematoma de suelo oral asociado al síndrome coronario agudo" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1300 "Ancho" => 975 "Tamanyo" => 196551 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Left view. Subsequent growth of the haematoma.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The oral floor and tongue are both generously irrigated by branches arising from the external carotid artery, among which are the lingual, facial and submental arteries.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Haemorrhage and haematoma at this level are usually associated with soft tissue or bone trauma of this territory or with certain surgeries on it. Haematomas in the oral floor have also been described in haemophilic patients<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and in relation to the use of acenocoumarol,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> streptokinase<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> or heparin.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Bleeding complications associated with the use of tissue plasminogen activator have been well documented. However, we have registered only 3 cases of oral floor haematomas related to using alteplase.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Clinical Case</span><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of an 80-year-old male patient admitted to our hospital due to an acute coronary syndrome with posterior inferior ST elevation myocardial infarction (STEMI). Four hours after the onset of chest pain and having established the diagnosis of STEMI, we began conventional therapy (aspirin, clopidogrel, heparin sodium and thrombolysis with 9000<span class="elsevierStyleHsp" style=""></span>units of alteplase). After 90<span class="elsevierStyleHsp" style=""></span>min, not fulfilling reperfusion criteria, we proceeded to perform a rescue percutaneous coronary intervention (PCI) of the right coronary artery.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Immediately after completing the thrombolysis, a haematoma appeared in the oral floor, with progressive growth (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). After 4<span class="elsevierStyleHsp" style=""></span>h, the patient began to show obvious signs of airway involvement. Being unable to carry out conventional intubation, we proceeded to perform an emergency tracheostomy under local anaesthesia. Once the surgery was completed, we explored the oral area thoroughly, finding no traumatic lesions that explained the haematoma. Nevertheless, we did confirm the synchronous presence of other smaller haematomas located in the abdomen, right forearm and left hand. We also observed epistaxis and haematuria.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">Any unrecognised oropharyngeal trauma can lead to haematomas in the oral floor or upper airways, especially severe in patients with coagulation disorders. The genesis of these haematomas is often related to lesions secondary to bites in the context of an episode of syncope or convulsive crisis.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> In this context, it is crucial to conduct a thorough exploration of the oral mucosa to rule out an aetiopathogenic cause of the haematoma. In our patient, we could not identify any suspicious area, so we must accept that it originated spontaneously.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The indexed literature contains 3 similar cases.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a> Two of them occurred in the context of acute coronary syndrome<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> and another during a transient ischemic attack.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> On two occasions, no traumatic injury was identified to justify their apppearance.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">At any rate, it is important to consider that, in critically ill patients with coagulation disorders, any manoeuvre aimed at maintaining airway patency, including both the placement of a Guedel airway and naso- or endotracheal intubation, may become an involuntary aetiopathogenic agent of the haematoma.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Another point to consider is the type of measures to be applied after the onset of this complication and their adequate timing. Surgical drainage is not usually indicated in the initial moments of the haematoma, due to the diffuse and widespread nature of the bleeding.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> At this stage, a close control of size and growth rate together with an evaluation of the position and size of the tongue are considered as appropriate measures. For some authors, the administration of corticosteroids, antibiotics and oxygen therapy is recommendable.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> If the haematoma is self-limited, its reabsorption usually occurs around the tenth day.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,7</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Uncontrolled progression of the episode generally leads to a clinical situation similar to Ludwig angina,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> characterised by oral floor elevation, increased tongue volume with superior and posterior displacement and loss of mobility. The presence of dysarthria, dysphagia, drooling and dyspnoea require the adoption of an urgent therapeutic attitude to preserve airway patency. Treatment can range from intubation (orotracheal or nasotracheal) to cricothyroidotomy or tracheostomy.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">According to the latest protocols, an active major haemorrhage would require performing a primary percutaneous coronary intervention at the expense of thrombolysis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Consequently, it seems advisable to carry out an oropharyngeal examination before performing thrombolysis, especially in patients who have suffered a loss of consciousness, trauma or manipulation of the airway in the context of cardiopulmonary resuscitation.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:2 [ "identificador" => "xres94853" "titulo" => "Abstract" ] 1 => array:2 [ "identificador" => "xpalclavsec82004" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres94852" "titulo" => "Resumen" ] 3 => array:2 [ "identificador" => "xpalclavsec82005" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical Case" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interests" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-06-14" "fechaAceptado" => "2010-07-05" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec82004" "palabras" => array:3 [ 0 => "Haematoma of the floor of the mouth" 1 => "Alteplase" 2 => "Acute myocardial infarction" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec82005" "palabras" => array:3 [ 0 => "Hematoma de suelo oral" 1 => "Alteplasa" 2 => "Síndrome coronario agudo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We report the case of an 80-year-old man who developed a haematoma in the floor of the mouth after receiving alteplase in the treatment of an acute myocardial infarction. Both the treatment received and appropriate preventive measures to avoid such haematomas are described.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de un paciente varón de 80 años de edad, ingresado en nuestro hospital por un síndrome coronario agudo tratado con alteplasa, tras lo cual desarrolló un hematoma de suelo oral espontáneo. Describimos tanto el tratamiento recibido como las medidas preventivas para evitar su aparición.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Pelaz A, et al. Hematoma de suelo oral asociado al síndrome coronario agudo. Acta Otorrinolaringol Esp. 2011;62:462–4.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 731 "Ancho" => 975 "Tamanyo" => 147617 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Anterolateral view of the haematoma affecting the oral floor that compromises the volume in the oral cavity.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1300 "Ancho" => 975 "Tamanyo" => 196551 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Left view. 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