The physiopathology of obstructive sleep apnea syndrome is multifactorial. Gender and obesity status, as well as genetic, anatomic, and hormonal factors, together with ventilatory drive, interact in a diverse manner in the physiopathology and clinical expression of the disease. Obesity is the main risk factor, since increases in body mass index, visceral fat, and neck circumference are strong predictors of the disease. Progesterone increases the activity of the upper airway dilator muscles and therefore plays a protective role in premenopausal women. This explains the fact that the prevalence of the disease is higher in postmenopausal patients, in patients with polycystic ovary syndrome, as well as in males. Evidence supports the fact that, as individuals grow older, there is a decrease in muscle tonus, with a consequent reduction in the dimensions of the upper airway lumen. Craniofacial anomalies, such as in retrognathia or micrognathia, are accompanied by posterior positioning of the tongue and can result in narrowing of the upper airway lumen. Finally, decreased ventilatory drive has been detected in patients with obstructive sleep apnea syndrome and hypercapnia.

Nontuberculous Mycobacteria (NTM), especially Mycobacterium avium-intracellulare complex (MAC), has been considered responsible for human disease, especially in HIV patients. Nevertheless, it has been diagnosed in immunocompetent elderly men, frequently with previous pulmonary disease: chronic obstructive lung disease (COPD), complications of tuberculosis, pulmonary fibrosis and bronchiectasis. We relate the case of a female patient, 51 years old, with continuously acid fast bacilli (AFB) smears and with three previous treatments, which were conducted at the multiresistant tuberculosis (MRTB) service. MAC was identified in the sputum culture, and she received treatment for one year. The posterior sputum exams were negative. The cavity lesions observed in the high-resolution computed tomography (HRCT) were reduced, and some of the nodule lesions became bronchiectasis, even after the end of treatment. We agree with the literature reports that indicate that MAC is the cause of bronchiectasis. It is necessary to identify the type of mycobacteria in immunocompetent individuals with positive AFB smears that do not become negative with tuberculosis treatment.

Presentación de casos clínicos RESUMENLos quistes del maxilar constituyen un conjunto muy variado de entidades, entre las que se incluyen los tumores benignos y malignos de origen odontogénico. Existe poca información sobre la prevalencia de esta patología. Afecta con mayor frecuencia al sexo masculino, entre la segunda y la tercera década de la vida. La proporción de pacientes de 6 a 7 años con quistes dentígeros es de solo 9,1%. El quiste dentígero engloba la corona de un diente permanente normal, impactado, no erupcionado. Suele presentar una sintomatología insidiosa y no se descubre hasta que la tumoración afecta a los órganos vecinos. El objetivo es exponer un caso de quiste dentígero. Si bien es de aparición muy poco frecuente, la presentación de este caso sirve para poner al médico pediatra en conocimiento sobre cómo debe actuar ante una tumoración maxilar unilateral en un niño sano. Se remarca la importancia del manejo multidisciplinario de la entidad. Palabras clave: quiste odontogénico, quiste dentígero, maxilar, tumores odontogénicos, odontología pediátrica. ABSTRACTMaxillary cysts are a diverse group of entities that include benign and malignant odontogenic tumors. Information on the prevalence of this disease is limited. It is more common among males, and usually occurs in the second and third decade of life. The proportion of 6 to 7 year old patients with dentigerous cysts is only 9.1%. Dentigerous cysts encompass the crown of a permanent and unerupted impacted teeth. They are usually slow growing asymptomatic lesions that are not discovered until they affect surrounding organs. The aim of this study is to present an unusual case of dentigerous cyst and to inform the pediatrician about the management of a unilateral maxillary tumor in a healthy child, underlining the importance of a multidisciplinary approach of this disease.

Arch Argent Pediatr 2016;114(2):e87-e90 / e87Presentación de casos clínicos RESUMEN La rinosinusitis es una patología muy frecuente en la infancia. Entre sus complicaciones, se encuentra la osteomielitis, rara complicación que, cuando se presenta, ocurre, principalmente, en lactantes y niños pequeños. El agente etiológico más frecuente es el Staphylococcus aureus. Clínicamente, se manifiesta con fiebre alta, edema de párpado inferior, rinorrea unilateral y edema palatino ipsilateral; luego se agrega un absceso sobre el área maxilar yuxtanasal y/o sobre los alvéolos dentarios. Secundariamente, pueden desarrollarse secuestros, expulsiones espontáneas de piezas dentarias y trayectos fistulosos, así como complicaciones orbitarias y endocraneales. El diagnóstico es, sobre todo, clínico; se confirma con tomografia computada. El tratamiento es médico quirúrgico. Se presenta un niño de 5 años de edad con rinosinusitis complicada con osteomielitis del hueso maxilar, cuyo germen responsable fue el Staphylococcus aureus meticilino resistente. Palabras clave: sinusitis, osteomielitis, maxilar, niños. ABSTRACT Rhinosinusitis is a very common childhood condition.Osteomyelitis is an unusual complication, which mainly occurs in toddlers and young children. The most frequent etiologic agent is Staphylococcus aureus. Iniatially, it is characterized by fever, low eyelid edema, unilateral rhinorrhea and ipsilateral palatine edema. Subsequently, abscesses develop in the maxillar yuxtanasal and/or the dental alveolar area. Secondary, it can be complicated by sequestrations, spontaneous expulsion of dental pieces and/or fistula, as well as orbital and intracranial complications. The diagnosis is based on clinical findings and is confirmed by computed tomography findings. The treatment is clinical and surgical. Here we report a five year old child, with rhinosinusitis complicated by osteomyelitis of maxillary bone, mediated by a methicillin-resistant Staphylococcus aureus infection. INTRODUCCIÓNLa rinosinusitis representa un cuadro frecuente en la infancia; sin embargo, solo un pequeño porcentaje puede presentar complicaciones que pongan en riesgo la vida, como la osteomielitis. La incidencia de las complicaciones óseas se encuentra entre el 5% y el 10%.

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