1

Metallica
Master of Puppets

Master of Puppets

2 Iron Maiden
The Number of the Beast

Hallowed Be Thy Name

3 Judas Priest
Sad Wings of Destiny

Victim of Changes

4 Slayer
Reign In Blood

Raining Blood
5 Dio
Holy Diver

Holy Diver

6 Black Sabbath
Sabbath Bloody Sabbath

Sabbath Bloody Sabbath

7 Megadeth
Rust in Peace

Holy Wars (The Punishment Due)

8 Diamond Head
Lightning To The Nations

Am I Evil

9 Metallica
Ride The Lightning

Fade to Black
10 Motorhead
Overkill

Overkill

11 Strapping Young Lad

City

All Hail the New Flesh

12 Metallica
...And Justice for All

One

13 Iced Earth
Burnt Offerings

Dante's Inferno

14 Mercyful Fate
Don't Break the Oath

A Dangerous Meeting
15 Ozzy Osbourne
Blizzard of Ozz

Crazy Train

16 Black Sabbath
Paranoid

War Pigs

17 Pantera
Cowboys From Hell

Cemetary Gates

18 Metallica
Ride The Lightning

Creeping Death

19 Danzig
Danzig

Mother
20 Judas Priest
Painkiller

Painkiller

21 Iron Maiden
The Number of the Beast

The Number of the Beast

22 Anthrax
Among The Living

Caught In A Mosh

23 Metallica
Master of Puppets

Welcome Home (Sanitarium)

24 Slayer
Reign In Blood

Angel of Death
25 Saxon
Wheels of Steel

Wheels of Steel

26 Accept
Balls to the Wall

Balls to the Wall

27 In Flames
Colony

Coerced Coexistence

28 Iron Maiden
Piece of Mind

Revelations

29 Megadeth
Rust in Peace

Hangar 18
30 Judas Priest
Sin After Sin

Dissident Aggressor

31 Angel Witch
Angel Witch

Angel Witch

32 Testament
Souls of Black

Souls of Black

33 Down
NOLA

Lifer

34 Black Sabbath
Heaven and Hell

Heaven and Hell

35 Mastodon
Leviathan

Blood and Thunder

36 Type O Negative
October Rust

Love You To Death

37 Anthrax
Spreading the Disease

Stand Or Fall

38 Opeth
Still Life

The Moor

39 Diamond Head
Lightning To The Nations

Sucking My Love
40 Motorhead
Ace of Spades

Ace of Spades

41 Metallica
Master of Puppets

Battery

42 Black Sabbath
Black Sabbath

N.I.B.

43 Judas Priest
Stained Class

Beyond The Realms of Death

44 Iron Maiden
Powerslave

Rime of the Ancient Mariner

45 Exodus
Bonded By Blood

A Lesson in Violence

46 Tool
Aenima

Aenima

47 Death
Symbolic

Zero Tolerance

48 Black Sabbath
Paranoid

Paranoid

49 Skid Row
Slave To The Grind

Monkey Business
50 Killswitch Engage
Alive or Just Breathing

Fixation on the Darkness

51 Megadeth
Youthanasia

A tout Le Monde

52 Metallica
Ride The Lightning

For Whom the Bell Tolls

53 Machine Head
Burn My Eyes

Davidian

54 Deftones
White Pony

Digital Bath
55 Anvil
Metal on Metal

METAL ON METAL

56 Judas Priest
Defenders of the Faith

The Sentinel

57 Megadeth
Peace Sells... But Who's Buying?

Peace Sells

58 Megadeth
Peace Sells... But Who's Buying?

Wake Up Dead

59 Annihilator
Never, Neverland

Stone Wall
60 Metallica
Kill 'Em All

Seek & Destroy

61 Prong
Cleansing

Snap Your Fingers, Snap Your Neck

62 Queensryche
Queensryche

Queen of the Reich

63 Queensryche
Operation: Mindcrime

Eyes of a Stranger

64 Slayer
Seasons in the Abyss

War Ensemble
65 Slayer
South of Heaven

South of Heaven

66 System of a Down
System of a Down

Sugar

67 Testament
Practice What You Preach

Practice What You Preach

68 White Zombie
Astro Creep: 2000 -- Songs of
Love, Destruction, a

Supercharger Heaven

69 Black Sabbath
Paranoid

Iron Man
70 Pantera
Vulgar Display of Power

Mouth For War

71 Iced Earth
Something Wicked This Way
Comes

Coming Curse

72 Megadeth
Rust in Peace

Tornado of Souls

73 Budgie
Never Turn Your Back On A
Friend

Breadfan

74 Danzig
Danzig II: Lucifuge

Devil's Plaything
75 Danzig
Danzig II: Lucifuge

Long Way Back From Hell

76 Iron Maiden
Fear of the Dark

Fear of the Dark (must be a live version)

77 Annihilator
Alice in Hell

Alison Hell

78 Deftones
Around the Fur

My Own Summer (Shove It)

79 Testament
The Legacy

Alone in the Dark

80 Anthrax
Attack of the Killer B's

Startin' Up a Posse

81 Metallica
...And Justice for All

Blackened

82 Dio
The Last in Line

The Last in Line

83 Kyuss
Blues For the Red Sun

Green Machine

84 Corrosion of Conformity
Deliverance

Albatross
85 Down
NOLA

Stone the Crow

86 Metallica
Ride the Lightning

Ride the Lightning

87 Iron Maiden
Seventh Son of a Seventh Son

The Evil That Men Do

88 Fear Factory
Obsolete

Resurrection

89 Black Sabbath
Black Sabbath

Black Sabbath
90 Lamb of God
Sacrament

Redneck

91 Volbeat
Rock the Rebel/Metal the Devil

Sad Man's Tongue

92 Iron Maiden
Iron Maiden

Phantom of the Opera

93 Manowar
Kings of Metal

Hail & Kill

94 In Flames
Whoracle

Jester Script Transfigured

95 Judas Priest
Screaming For Vengeance

The Hellion/Electric Eye

96 Helloween
Keeper of the Seven Keys Pt. 1

Its Halloween

97 Faith No More
Angel Dust

Kindergarden

98 Tool
10,000 Days

Vicarious

99 Megadeth
So Far, So Good... So What!

My Last Words
100 Metallica
Kill 'Em All

Motorbreath
 Iron Maiden
1
The Number of the Beast (1982)

Scorpions
2
Love at First Sting (1984)

Europe
3
The Final Countdown (1986)

Skid Row
4
Slave to the Grind (1991)

Judas Priest
5
Defenders of the Faith (1984)
 Queensrÿche
6
Operation: Mindcrime (1988)

Bon Jovi
7
New Jersey (1988)

Whitesnake
8
Whitesnake [aka 1987] (1987)

Iron Maiden
9
Seventh Son of a Seventh Son (1988)

Ozzy Osbourne
10
Blizzard of Ozz (1980)
 Alice Cooper
11
Trash (1989)

Accept
12
Metal Heart (1985)

Kane Roberts
13
Saints and Sinners (1991)

Metallica
14
Ride the Lightning (1986)

Dio
15
Holy Diver (1983)
 Guns n' Roses
16
Appetite for Destruction (1987)

Scorpions
17
Blackout (1982)

Warlock
18
Triumph and Agony (1987)

Barón Rojo
19
Volumen brutal (1984)

Fifth Angel
20
Fifth Angel (2000)
 Black Sabbath
21
Heaven and Hell (1980)

Bon Jovi
22
Slippery When Wet (1986)

Ozzy Osbourne
23
No More Tears (1991)

Dokken
24
Under Lock and Key (1985)

AC/DC
25
Back in Black (1980)
 Metallica
26
Master of Puppets (1986)

Skid Row
27
Skid Row (1989)

Def Leppard
28
Pyromania (1983)

Shy
29
Excess All Areas (1987)

Twisted Sister
30
Stay Hungry (1984)
 Helloween
31
Keeper of the Seven Keys Part I (1987)

Judas Priest
32
Painkiller (1990)

Manowar
33
Fighting the World (1987)

Europe
34
Out of This World (1988)

Alice Cooper
35
Hey Stoopid (1991)
 Fair Warning
36
Fair Warning (1992)

Riot
37
ThunderSteel (1988)

John Norum
38
Face the Truth (1992)

Ozzy Osbourne
39
The Ultimate Sin (1986)

W.A.S.P.
40
Inside the Electric Circus (1986)
 Iron Maiden
41
Piece of Mind (1983)

Icon
42
Night of the Crime (1985)

Dokken
43
Back for the Attack (1987)

Leatherwolf
44
Street Ready (1989)

Stryper
45
To Hell With the Devil (1986)
 Saxon
46
Denim and Leather (1981)

Obús
47
El que más (1984)

Mötley Crüe
48
Shout at the Devil (1983)

Van Halen
49
5150 (1986)

Barón Rojo
50
En un lugar de la marcha (1985)
 Whitesnake
51
Slide It In (1984)

Talisman
52
Talisman (1990)

Hardline
53
Double Eclipse (1992)

Bon Jovi
54
Bon Jovi (1984)

Accept
55
Balls to the Wall (1983)
 Firehouse
56
Firehouse (1990)

KISS
57
Destroyer (1976)

Ozzy Osbourne
58
Diary of a Madman (1981)

Sangre Azul
59
El silencio de la noche (2000)

Ángeles del Infierno

60
Diabolicca (1985)
 Jupiter
61
Jupiter (1987)

Helloween
62
Keeper of the Seven Keys Part II (1988)

Y&T
63
Black Tiger (1982)

Scorpions
64
Taken by Force (1978)

Judas Priest
65
British Steel (1980)
 TNT
66
Intuition (1989)

Axel Rudi Pell

67
Oceans of Time (1998)

Edguy
68
Hellfire Club (2004)

Megadeth
69
Rust in Peace (1990)

Rata Blanca
70
Magos, espadas y rosas (1990)
 Loudness
71
Hurricane Eyes (1987)

Fifth Angel
72
Time Will Tell (1989)

Shalom
73
Shalom (1990)

Pride of Lions
74
The Destiny Stone (2004)

Pantera
75
Vulgar Display of Power (1992)
 Blind Guardian
76
Imaginations From the Other Side (1995)

Manowar
77
Hail to England (1984)

Scorpions
78
Savage Amusement (1988)

Queensrÿche
79
Empire (1990)

W.A.S.P.
80
W.A.S.P. (1984)
 Queensrÿche
81
Queensrÿche (1983) [EP]

Europe
82
Wings of Tomorrow (1984)

Running Wild
83
Death or Glory (1989)

Crashdïet
84
Rest in Sleaze (2005)

Pretty Maids
85
Red, Hot and Heavy (1984)
 Muro
86
Telón de acero (1988)

Nikolo Kotzev
87
Nostradamus (2001)

Twisted Sister
88
Come Out and Play (1999)

Jeff Scott Soto

89
Prism (2002)

King Diamond
90
Abigail (1987)
 Iced Earth
91
Something Wicked This Way Comes (1998)

Nocturnal Rites
92
Grand Illusion (2005)

Sátira
93
El mundo de los sueños (1991)

M.A.R.S.
94
Project: Driver (1986)

Tony Iommi & Glenn Hughes

95
Fused (2005)
 Jaded Heart
96
Trust (2004)

Overkill
97
Feel the Fire (1985)

Panzer
98
Al pie del cañón (1982)

Lillian Axe
99
Love + War (1989)

Stormwitch
100
The Beauty and the Beast (1987)
1. Hallowed Be Thy Name - Iron Maiden
2. War Pigs - Black Sabbath
3. Beyond the Realms of Death - Judas Priest
4. Iron Man - Black Sabbath
5. Master of Puppets - Metallica
6. Victim of Changes - Judas Priest
7. The Trooper - Iron Maiden
8. Ace of Spades - Motorhead
9. The Number of the Beast - Iron Maiden

10. N.I.B. - Black Sabbath

11. You've Got Another Thing Coming - Judas Priest
12. Stargazer - Rainbow
13. Angel of Death - Slayer
14. Black Sabbath - Black Sabbath
15. Paranoid - Black Sabbath
16. Rime of the Ancient Mariner - Iron Maiden
17. One - Metallica
18. Crazy Train - Ozzy Osbourne
19. Raining Blood - Slayer

20. Fade to Black - Metallica

21. Am I Evil? - Diamond Head
22. Painkiller - Judas Priest
23. Holy Wars... The Punishment Due - Megadeth
24. Running With the Devil - Van Halen
25. Cemetary Gates - Pantera
26. Seek and Destroy - Metallica
27. Symptom of the Universe - Black Sabbath
28. Welcome to the Jungle - Guns N Roses
29. Children of the Grave - Black Sabbath

30. 2 Minutes to Midnight - Iron Maiden

31. Mr. Crowley - Ozzy Osbourne
32. Run to the Hills - Iron Maiden
33. Breaking the Law - Judas Priest
34. Holy Diver - Dio
35. Aces High - Iron Maiden
36. Peace Sells - Megadeth
37. The Hellion/Electric Eye - Judas Priest
38. Queen of the Reich - Queensryche
39. Hangar 18 - Megadeth

40. Caught in a Mosh - Anthrax

41. Take Hold of the Flame - Queensryche
42. For Whom the Bell Tolls - Metallica
43. Souls of Black - Testament
44. Cowboys From Hell - Pantera
45. Hell Bent For Leather - Judas Priest
46. Powerslave - Iron Maiden
47. Symphony of Destruction - Megadeth
48. Sabbath Bloody Sabbath - Black Sabbath
49. Creeping Death - Metallica

50. Eyes of a Stranger - Queensryche

51. Heaven and Hell - Black Sabbath
52. Rock and Roll All Night - KISS
53. War Ensemble - Slayer
54. Revolution Calling - Queensryche
55. Into The Void - Black Sabbath
56. Tornado of Souls - Megadeth
57. Detroit Rock City - KISS
58. Panama - Van Halen
59. Fear of the Dark - Iron Maiden

60. The Four Hoursemen - Metallica

61. Diary of a Madman - Ozzy Osbourne
62. Fairies Wear Boots - Black Sabbath
63. Phantom of the Opera - Iron Maiden
64. Rock You Like A Hurricane - Scorpions
65. Sweet Leaf - Black Sabbath
66. Gates of Babylon - Rainbow
67. Rock of Ages - Def Leppard
68. Enter Sandman - Metallica
69. Halloween - Helloween

70. Flying High Again - Ozzy Osbourne

71. Indians - Anthrax
72. Battery - Metallica
73. Living After Midnight - Judas Priest
74. I Wanna Rock - Twisted Sister
75. Jesus Christ Pose - Soundgarden
76. Welcome Home - Metallica
77. The Divine Wings of Tragedy - Symphony X
78. Five Minutes Alone - Pantera
79. Rainbow in the Dark - Dio

80. Ivory Gates of Dreams - Fates Warning

81. Keeper of the Seven Keys - Helloween
82. Electric Funeral - Black Sabbath
83. We're Not Gonna Take It - Twisted Sister
84. Dante's Inferno - Iced Earth
85. Witching Hour - Venom
86. Shout at the Devil - Motley Crue
87. Wicked World - Black Sabbath
88. At War With the Devil - Venom
89. Wasted Years - Iron Maiden

90. We Are Stars - Hear 'N' Aid

91. Fast as a Shark - Accept
92. The Last in Line - Dio
93. I Am A Viking - Yngwie J. Malmsteen's Rising Force
94. Blood of My Enemy - Manowar
95. Warriors of the World United - Manowar
96. Kill the King - Rainbow
97. Metal Health - Quiet Riot
98. Black Out - Scorpions
99. A Touch of Evil - Judas Priest
100. Metropolis Part I - Dream Theater
100. Boudain – Boudain EP

Southern-fried doomy hard rock in the vein of Clutch and Kyuss. Incredibly heavy and
makes the perfect soundtrack to a day of drinking beer in a kiddie pool in the scorching
heat.

99. Kalmah – Seventh Swamphony

I’m a sucker for melodic death metal and very few bands do it as well as these guys.
98. Gigan – Multi-Dimensional Fractal Sorcery And Super Science

Completely ridiculous and mindnumbingly chaotic sci-fi death metal.

97. Weekend Nachos – Still

Weekend Nachos isn’t the kind of band that’s going to change or progress their sound
much. If you enjoy getting kicked in the teeth by seething, violent metallica hardcore, this
is right up your alley.
96. Palms – Palms

Have you ever wondered what Isis would sound like if they had Chino Moreno of Deftones
on vocals instead of Aaron Turner and maybe they got a bit less heavy? It’s this. My only
problem with this album is that I get sleepy every time I hear it.

95. Queens of the Stone Age – …Like Clockwork

Admittedly, I was a little disappointed by this album at first. I think the main reason is
because it had been so hyped up as the best album of the year and instead comes off as slow
and somber instead of dancey and catchy and incredibly awesome. However, even a
mediocre album by QOTSA is better than all of the bands that have tried to rip them off
over the last few years.

94. Mutoid Man – Helium Head

Think of this band as a mixture of newer Cave In with Every Time I Die, Converge,
whiskey and blisteringly fast rock n’ roll shredding.
93. Valdur – At War With

Albums like this that come out super late in the year are always hell on a top albums of the
year list like this one. The reason is because they are so undeniably good that upon hearing
their unyieldingly heavy style of blackened death metal, it’s difficult not to include them on
my list.

92. Living Sacrifice – The Ghost Thief

Living Sacrifice have made a name for themselves throughout the years as a legend in the
christian metal scene and they show why with Ghost Thief. Since reforming they have
taken their signature style of grooving thrash metal and added in an even heavier crunch.
91. Rob Zombie – Venomous Rat Regeneration Vendor

If you don’t like Rob Zombie, this record certainly won’t convert you. However, this record
is one of his best in years with all the catchy and groovy elements that made his early post-
White Zombie stuff awesome.

90. Finntroll – Blodsvept

I’m not sure if you’d consider this pagan metal or power metal or what, but I do know that I
love their use of non-traditional instruments in metal. The title track of this album is one of
my favorite metal songs of the year, without question.

89. Stomach Earth – Stomach Earth

Wanna know what this album sounds like? Think of the most frightening nightmare you’ve
ever had. Think about the worst day of your entire life. Picture living a day that mixes the
two together and it’s likely this hellish piece of unfaltering funeral doom would serve as the
soundtrack to it.
88. Deeds Of Flesh – Portals Of Canaan

Yet another fantastic, brutal technical death metal album from an old school legend.

87. Black Dahlia Murder – Everblack

You may hear this band referred to as metalcore still, but by no means is that the case
anymore. At this point in time, BDM have turned into a super legit death metal band with a
hell of a bite.
86. Suidakra – Eternal Defiance

A lot of people might refer to Suidakra as celtic metal, but the only description that does
them justic is amazingly catchy, melodic death metal.

85. Kadavar – Abra Kadavar

This band sounds like they’re about 40 years old. They mix psychedelic elements of early
Hawkwind with the gut-punch of Blue Cheer. This album doesn’t sound very modern, but
it does sound awesome.

84. Scorpion Child – Scorpion Child

Very retro sounding rock n’ roll. Their vocalist reminds me a lot of Robert Plant a lot of
times. Definitely one of the more interesting and unique old school rock n’ roll bands
coming up these days.
83. All Pigs Must Die – Nothing Violates This Nature

APMD has been making consistenly good albums for a long time now and his ugly,
abrasive monster is just another gem.

82. Evile – Skull

Very heavy, accessible thrash metal in the vein of Testament. A lot of cool solo’s and very
catchy choruses make this a pretty fun album even if a lot of their tricks have been used up
already.
81. Broken Hope – Omen Of Disease

In this list, I refer to a lot of music as violent, but Broken Hope have to be one of the best
examples of what classifies a metal band as violent. Their riffs are absolutely unforgiving
and don’t stop churning from the minute it the needle drops until the minute it lifts and your
entire home is covered in blood and gore.

80. Blockheads – This World Is Dead

This is simply a fantastic grind album. It’s got enough grind to make heads bang, but also
has a ton of groove to keep things interesting.
 79. Watain – The Wild Hunt

Very few bands in the modern era of black metal do it as well as Watain. They took a lot of
risks on this album, but instead of detracting from their sound, the added elements actually
gives them a more well-rounded attack that is sure to convert non-believers.

78. Amorphis – Circle

Granted, the days of Amorphis making super brutal death metal are long gone, however,
with multiple listens, their current brand of melodic death metal with extremely catchy
choruses and whatnot is still pretty awesome.
77. Inter Arma – Sky Burial

These guys are definitely one of the best bands to come from the Richmond, VA metal
scene as of late. Sky Burial is a very genuine and very heavy mix of doom, death and black
metal to create a pretty unique sound of their own.

76. Castevet – Obsian

Epic, atmospheric black metal with razor sharp riffs.

75. Age Of Taurus – Desperate Souls of Tortured Times

Bad ass, old school throwback doom.

74. Baptists – Bushcraft

If you like music fast, angry and violent, you’ll dig this album. it reminds me a lot of
Converge, honestly.

73. Grave Miasma – Odori Sepulcrorum

2013 has definitely appeared to be an amazing year for death metal. Part of the reason is
because of bands like Grave Miasma that have found unique ways to take old school death
metal and add in all sorts of interesting elements that show the future of the genre is in very
good hands.
72. Demonical – Darkness Unbound

Armed with an intense fury and an iconic Swededeath guitar tone, though this record was
released a bit late in the year to rank too high on my list, it’s hard not to be blown away by
this near perfect slab of blackened death.

71. Nolentia – May The Hand That Holds The Match That Will Set This World On Fire
Be Blessed Above All

They might have channeled their inner Fiona Apple when naming this album, but there’s
nothing hip about this obscene blast of grindcore fury. The first time I heard this album I
was blown away at how much they remind me of the glory days of Nasum.
70. Extol – Extol

This album is somewhat of a return to form for this legendary band. It kind of sounds like
this album was released in a world where their previous album The Blueprint Dives never
existed, which means it’s a massive throwback to their brutal form of technical melodic
death metal.

69. Shai Hulud – Reach Beyond The Sun

They brought back former vocalist Chad Gilbert of New Found Glory fame and the end
result is one of the best hardcore/metalcore albums I heard all year with choruses and riffs
that will stay with you long after the needles raises off the record.

68. Mammoth Grinder – Underworlds

An absolutely scathing, hate-soaked blast of hardcore powerviolence that hits with the
impact of a barbed-wire wrapped baseball bat.
67. East Of The Wall – Redaction Artifacts

I’m not 100% sure what the best genre is to define this band, whether it be “post metal” or
“progressive metal”, but to me it sounds like post progressive beautiful soundscapes with
awesome shredding and incredibly creative and catchy riffs.

66. Skeletonwitch – Serpents Unleashed

Skeletonwitch is just one of a plethora of bands on this top 100 list who I didn’t care for
much prior to hearing their new record, only to be blown away. Their brand of blackened
death thrash has definitely never sounded better than it does on Serpents Unleashed.
65. Pinkish Black – Razed To The Ground

I’ve never heard of a band creating doom metal without the use of guitars, but essentially
that’s what this Texan two-piece did. The strange thing is, it actually kind of works.

64. Noctum – Final Sacrifice

Though Noctum are just the latest in a string of Swedish occult rock bands getting signed to
major labels, they are far from a cookie cutter. Their old school riffs are catchy enough to
give anyone carpal tunnel trying to air guitar along.

63. KEN Mode – Entrench

These Canadian road dogs continue to bring forth incredibly fast, noisey post-hardcore.
Although, they did throw in a few new elements to keep it interesting.
62. Lord Dying – Summon The Faithless

Absolutely brutal old school doom metal with a heavy rock n’ roll undertone that
absolutely rules.

61. Killswitch Engage – Disarm The Descent

This is their first album in quite a few years with Jesse Leach on vocals and it absolutely
kills. Definitely better than the last 2 or 3 albums without question. Incredibly angry, which
always makes Killswitch sound more enjoyable to me.
60. Amon Amarth – Deceiver Of The Gods

If you’ve heard one Amon Amarth album, you’ve got a pretty good idea what this album
sounds like. To be fair though, Deceiver definitely features a sound that’s got a bit more
punch to it than their last few albums.

59. Arsis – Unwelcome

Though Arsis has been plagued by an insane amount of lineup changes over the years, it
has done nothing to deter their incredible style of death metal. On Unwelcome, they have
clearly made a return to the technical death metal style they first became famous for.
Though Unwelcome is heavier and more technical than their past few records, it’s also a bit
catchier, especially their cover of “Sunglasses At Night” which has to be heard to be
believed.
58. Portal – Vexovoid

Probably the scariest death metal album of the year. Their particular brand of death metal is
incredibly muddy-sounding and features horrifyingly deep guttural vocals and a pace that
moves back and forth between 1 mph and 25 mph.

57. Darkthrone – The Underground Resistance

Darkthrone isn’t the kind of band to just stick to one constant style. Though most fans are
bummed that they haven’t gone back to their black metal roots, you have to be satisified
hearing their abrasive take on old school metal that mixes Venom, Motorhead and Mercyful
Fate into one filthy cocktail.
56. Sepultura – The Mediator Between The Head And Hands Must Be The Heart

In a never-ending quest to continue churning out the most vicious thrash metal possible,
Sepultura went back to record with Ross Robinson, the producer behind their legendary
album Roots. The results feature the band’s angriest and most technically crushing sound in
at least a decade.

55. Coffins – The Fleshland

There aren’t a lot of bands that are able to mix death metal and doom as perfectly as these
Japanese monsters. Though this is just their first album from Relapse, it’s obvious that
these guys are veterans are highly skilled in the art of bringing destruction at any speed
necessary.
54. Hatebreed – Divinity Of Purpose

This record is another example of Hatebreed doing what Hatebreed does…playing fast,
thrashy metal mixed with brutal hardcore breakdowns that make me want to break
everything I own.

53. Antigama – Meteor

I honestly haven’t heard a single album from Antigama that doesn’t completely rule. Their
unique, vicious brand of grind is just as unforgivingly brutal as it is insanely catchy.

52. Hail Of Bullets – III: The Rommel Chronicles

Featuring legendary metal vocalist Martin Van Drunen, this record is based on the military
life of German field marshal Erwin Rommel and features a brutal mixture of death and
thrash metal that will leave your ears ringing for days.
51. Vista Chino – Peace

Comprised of ex members of Kyuss, this album features the desert rock sound they
basically invented, but thanks to guitarist Bruno Fevery they have a completely different
and unique style of their own.

50. Vastum – Patricidal Lust

There’s one word to perfectly describe this album…DISGUSTING. Specifically, the lyrics
are pretty graphic and disturbing, but the music is also incredibly vile as well. Vastum has
been slowly gaining more and more recognition for their incredible style of intensely brutal
death metal and Patricidal Lust sees them living up to their hype big time.
49. Aevangelist – Omen Ex Simulacra

This album is truly a modern death metal masterpiece. Their mixture of brooding, slow-
churning riffs that turn razor sharp at a moments notice, alongside brutal as hell drumming
and a creepy sci-fi atmosphere make for a formula truly fatal to the flesh.

48. Iron Reagan – Worse Than Dead

Members of Municipal Waste and Darkest Hour combined to create the perfect crossover
thrash album. It’s short enough to keep from getting boring and heavy enough to make for
the perfect soundtrack to a fistfight at a skatepark.

47. Doomriders – Grand Blood

It kind of seems like this band gets better and better with each album. More and more they
have moved away from their initial mixture of hardcore and southern rock and it’s helped
create an incredibly unique and catchy sound.
46. Cult Of Luna – Vertikal

One of my favorite post-metal bands has delivered again. Instead of sticking to their usual
tricks after a long absence, they got even more ridiculous and progressive than ever with a
sound coming straight out of George Orwell’s 1984.

45. Entrails – Raging Death

This is an absolutely perfect slab of catchy, violent Swedish death metal. I was first drawn
to this album when hearing that Dan Swano mixed/mastered it and I fell in love with it
immediately. The scary thing is that this album is their Metal Blade Records debut, which
means that the best is still yet to come.
44. Phillip H Anselmo & The Illegals – Walk Through Exits Only

Have you ever wondered what it would sound like to get beaten up by Phil Anselmo? If so,
this record is perfect for you! It showcases Phil’s classic abrasive vocal style over an
impressive array of brutal and abrasive riffs.

43. Mouth Of The Architect – Dawning

Probably the catchiest post-metal album you’ll ever hear. I’m really glad these dudes are
back, but I’m more glad to see that they’ve made one of their best albums. It’s got tons of
sludge, tons of progression, post-metal gorgeousness and sticky-sweet melodies.

42. Pestilence – Obsideo

Though Pestilence has been around since the death metal boom of the early ’90s, they are
among a handful of death metal bands that have only gotten better with age. Thanks to its
brutal, buzzing riffs and razor sharp tone and its murderous, old school pace, it’s easily one
of the best Pestilence albums in recent memory.
41. Jesu – Everyday I Get Closer To The Light From Which I Came

Though I’m more a fan of Justin Broadrick’s heavier side in Godflesh, I can’t seem to get
over how enjoyable his decidedly less aggressive music with Jesu is. The thing I like about
this album most is how it mixes a heavier guitar tone with music that’s decidedly beautiful
and emotional and genuinely enjoyable.

40. True Widow – Circumambulation

To be honest, I’m not completely sure how to describe this album. It has a pretty unique
sound, especially for being on a major metal label. Its main ingredient is an incredibly
fuzzy, doomy guitar tone, but stylistically it sounds like some kind of ’90s alternative/indie
rock. Regardless of the description, this is a great chill out record.

39. Black Star Riders – All Hell Breaks Loose

This album is more of a hard rock record than anything, but I love it. It features Scott
Gorham of Thin Lizzy and a few of the guys that toured as Thin Lizzy over the last few
years. It’s super catchy, memorable rock n’ roll done perfect.
38. Batillus – Concrete Sustain

On their last album, Batillus churned out pretty awesome slow, sludgy doom. On Concrete
Sustain, however, they shortened up the songs and made them a lot more accessible and
with a ton more groove. This could easily serve as the soundtrack to a

37. October Tide – Tunnel Of No Light

This is European doom metal done correctly. Not too melodic, not too sludgy. Thanks to
ex-members of Katatonia, these dudes know how to bring the bummer just right.
36. Nails – Abandon All Life

I feel like Nails is one of the most underrated bands in underground music. One reason is
because they are difficult to compartmentalize into one genre, due to their ability to
perfectly execute thrash, doom, death, black metal and hardcore.

35. Suffocation – Pinnacle Of Bedlam

Pinnacle Of Bedlam is a pretty simple album. It features one of the best death metal bands
in the game doing exactly what they do best. Making the most brutal, genital-smashing
death metal possible.

34. Kylesa – Ultraviolet

Kylesa is a band that never ever seems to stop tweaking their sound. On Ultraviolet,
they’ve managed to take it to a completely different level, one that’s soaked in psychedelia,
but also features tons of the bone-crushing riffs that they’ve been known for.
33. Jucifer – За Волгой для нас земли нет

If you’ve ever seen Jucifer live, then you have a pretty good idea of what they’re capable
of, even if you can barely hear anymore. On their new record that’s conceptually based on
the Russian battle of Stalingrad, they have taken their sound to incredible new and louder
than ever heights. There aren’t many bands on the planet that do doom metal quite like this
amazing husband and wife duo.

32. Church Of Misery – Thy Kingdom Scum

Jap Sabbath has done it again! I’m not sure this album will be as memorable as House Of
The Unholy in hindisght, but it’s definitely a fantastic showcase of their talent. Few bands
do the stoner metal/rock sound better than these guys.
31. Intronaut – Habitual Levitations

Musically, Intronaut have upped the ante in terms of technicality of their music, but thanks
to the newfound clean-singing throughout the album, they’ve elevated their sound to a
different plane completely.

30. Toxic Holocaust – Chemistry Of Consciousness

I’m not sure why, but for some reason I just never liked this band…until now. There was
something about their past albums that just didn’t interest me at all, so I was skeptical at
best about Chemistry of Consciousness. After giving this album a few spins, I’m very glad I
did, because it is definitely one of the best thrash albums I’ve heard all year. Something
about the way they mix in elements of black metal and crust punk/hardcore with gut-
churning thrash metal makes this the perfect soundtrack to a night of heavy drinking and
debauchery.

29. Orchid – Mouths Of Madness

The first time I heard this album, I wrote it off as Black Sabbath tribute tomfoolery. Boy
was I stupid. Though they do have a heavy dose of Sabbath influence in their sound, this
album is definitely a finely tuned, rock n’ roll killing machine. The tone from the title track
alone is said to have caused six volcanic eruptions alone on the day it was laid to tape.
28. Red Fang – Whales and Leeches

On their last album Murder The Mountains, these Portland, Or rock n’ roll warriors showed
a lot of incredible potential. On their sophomore release for Relapse, they have taken that
potential and really made it come out in spades. This record is an absolute monster. It
perfectly showcases their talented style of rock n’ roll fury, but mixed in a very steady punk
rock influence to give it a much more unique vibe that absolutely kills.

Cover of Issue #5! Get it here.

27. Lost Society – Fast Loud Death

Easily one of the best thrash albums of the year. Even though the members of Lost Society
are all in their teens, they still crank out thrash that’s incredibly reminiscent of much older
bands New York thrash bands like Nuclear Assault, Overkill and old school Anthrax.
26. Dillinger Escape Plan – One Of Us Is The Killer

This definitely seems like it’s their fastest album in a while. When it gets heavy, it gets
HEAVY and even when they try to be weird and quirky, it never loses sight of the goal.

Cover of Issue #2. Get it here.

25. Anciients – Heart Of Oak

These guys have mastered the art of manuevering through different styles of metal without
really losing focus. There are a lot of styles at play on this album, but the most obvious are
black metal and sludgey, Mastodon-esque rock n’ roll.
24. Coliseum – Sister Faith

They upped the punk-quotient on this album and gave it a gothier feel. Feels like the record
Ryan Patterson has wanted to make his entire career.

23. ASG – Blood Drive

This is a record that caught me completely off guard. They managed to make the perfect
mashup of incredibly heavy hard rock riffs, with gorgeous, catchy melodies that stay stuck
in your head all day. A lot of bands these days are trying their hand at playing old school,
bluesy rock n’ roll, but very few manage to conjure up the same passion and fury of these
North Carolina veterans.

22. Hypocrisy – End Of Disclosure

Peter Tagtgren’s voice is one of my favorite heavy metal voices of all time. On Disclosure,
they have once again released a rock solid collection of bludgeoning Swedish Death Metal
full of both impossibly heavy riffs, as well as sugary sweet choruses and melodies.
21. Iron Tongue – The Dogs Have Barked, The Birds Have Flown

These folks from Little Rock, AR clearly understand the art of slow, doomy, depressing
classic rock. They feature Rwake vocalist C.T. whose vocals aren’t screamed, but they are
just as depressing and violent. The combination of C.T’s amazing vocals with perfectly
executed, old school hard rock definitely makes for one of the more interesting hard rock
albums you’ll hear all year.

20. Autopsy – The Headless Ritual

When Autopsy’s last album Macabre Eternal came out, everybody seemed to be surprised
at how solid their first tunes after reforming were. With the release of The Headless Ritual,
everyone knew what to expect and they absolutely blew expectations away yet again. A lot
of these songs are much faster and less doomy than Macabre and the approach just seems
much more solid and focused, which is a deadly combo.

19. Obliteration – Black Death Horizon

This record is absolutely disgusting. Every time I hear it, it freaks me out a little at how
creepy and awesome it is. This band is labeled death metal, but their sound is so unique and
horrifying that they can’t really be put into a specific genre other than maybe “brutal old
school blackened death doom”.

18. Gwar – Battle Maximus

This is by far the best album Gwar has ever made. It’s got an incredibly interesting
storyline and concept lyrically and the riffs are absolutely NUTS. This is definitely an
incredibly fitting tribute to Flattus Maximus.
17. Ulcerate – Vermis

I love this band because they remind me of what it would sound like if robots decided to try
and recreate the sound of death metal. Their riffing style and their tone is very strange and
unique, especially when coupled with their amazing drumming.

16. Immolation – Kingdom Of Conspiracy

These legendary NYDM dudes just know how to do death metal right like no others. This
album is abundantly heavy, but also has enough catchy parts to stay creative and
interesting. When seeing them open for Cannibal Corpse and Napalm Death, I believe they
absolutely stole the show big time when they played songs from this record.
15. Witherscape – The Inheritance

I’m an admitted Dan Swano fanboy, so I was psyched about him creating this project. The
cool thing about this band is that it’s about as close as you’re going to come to hearing a
band perfectly capture the glory days sounds of Katatonia and Opeth.

14. The Ocean – Pelagial

This is a concept album designed to take you from the surface of the ocean to the very
bottom, one of the best concepts for an album I’ve ever heard. It’s definitely the most
gorgeous metal album of the year.

13. Clutch – Earth Rocker

Clutch is definitely one of the best hard rock bands on the planet and they stepped it up big
time with Earth Rocker. It’s got less of the blues from their last few albums and is much
more pro rock.
12. In Solitude – Sister

I wasn’t big into these guys prior to hearing this album, so it definitely caught me by
surprise to discover how insanely creative it is. This record is definitely a triumph of the
modern throwback style of rock n’ roll.

11. Exhumed – Necrocracy

Matt Harvey has once again proved that as far as death metal goes, old school is most
certainly the best school. This is their second album since reforming and in addition to
being the best album of their career, Necrocracy is a paint by numbers guide to creating a
good death metal record in 2013.
10. Vhöl – Vhöl

The most creative album I’ve heard all year. A supergroup with members of Agalloch, Yob
and Hammers of Misfortune, but it sounds like the best ’80s hardcore/thrash album never
made.

9. Evergreen Terrace – Dead Horses

I love this album because of how amazingly catch it is. I firmly believe this is the best
album Evergreen Terrace has made so far, because it’s a perfect mix of their old school
hardcore sound and the massive punch of their last two albums thanks to good production
value.

8. Cathedral – The Last Spire

This is their last album ever and it’s a doozie. The tone on this album is absolutely
mindblowing. It’s one of the heaviest, loudest straight ahead doom albums I’ve heard all
year and a great way to send off an iconic band.
7. Subrosa – More Constant Than The Gods

Though the album is incredibly doomy and heavy, the only proper word to describe it is…
gorgeous. The track “Cosey Mo” gives me goosebumps literally every time I hear it.

6. Power Trip – Manifest Decimation

Probably the best new school thrash album released in a long time. Sounds like a mix of
Budweiser, sulphur and someone who snorted a Yellow Jacket (the bee).
5. Voivod – Target Earth

Super creative, proggy, epic thrash from one of the greatest thrash metal bands to ever
exist. Definitely a return to their Sci-Fi thrash glory days.

4. Monster Magnet – Last Patrol

Like any good Monster Magnet album, Last Patrol delves into the lyrical realms of science
fiction and fantasy laid over fist-pumping psychedleic jams. Unlike their past few efforts,
however, Last Patrol has a very laid back, old school feel to it thanks to its smooth
production and it really is the perfect album for tuning in and dropping out.

3. Gorguts – Colored Sands

Gorguts have always been known for creating incredibly creative death metal, but they
stepped it up significantly on Colored Sands. Somehow Luc Lemay and co managed to take
their signature death metal style and twist and morph it into an absolutely monolithic beast
of an album.
2. Motörhead – Aftershock

Aftershock is Motörhead’s 21st album, yet somehow it very well may be one of their best.
All Motörhead albums have their own appeal and are genuinely enjoyable, however on
Aftershock, they managed to create something significantly better than they ever have
before. Whether it be the increased bluesiness, the increased punk rock influence or the
perfect production job, I sincerely believe Motörhead could retire with this as their last
album, because it showcases them at the very tip top of their game.

1. Carcass – Surgical Steel

There are a lot of reasons why I love this album enough to name it the best heavy album of
the year. The main reason though, is because no matter how many times I listen to it, I can’t
help but air guitar along wildly and marvel Bill Steer’s genius. Simply put, Carcass made
an album that mixes their signature goregrind style with Heartwork’s more melodic side,
thus creating a Death Metal Megazord.
2013 has been a great year for heavy metal, with new releases from Black Sabbath,
Tomahawk, Devildriver, Killswitch Engage, Suffocation, Amon Amarth, Rob Zombie, The
Dillinger Escape Plan, and Battlecross topping our list of the best heavy metal songs of
2013. In addition to officially released singles, we have included the best B-side non-single
tracks in this list, for a more diverse, complete page full of the 100 best songs from albums,
not just radio hits. This list was chosen on a track by track basis, so it is possible that the
rest of the album may not be good, while the track itself is excellent. We’ve linked to our
reviews of the albums after each track, if the review exists.

Which metal songs were your favorite for 2013? We’d like to hear about them in the
comments. Also make sure to check out our list of the 50 Best Metal Albums of 2013.

1. Black Sabbath – “God is Dead?” (13)

2. Battlecross – “Force Fed Lies” (War of Will)

3. Skeletonwitch – “Burned from Bone” (Serpents Unleashed)

4. Black Dahlia Murder – “Into the Everblack” (Everblack)

5. DevilDriver – “The Appetite” (Winter Kills)

6. Tomahawk – “Stone Letter” (Oddfellows)

7. The Dillinger Escape Plan – “One of Us Is the Killer” (One of Us Is the Killer)

8. Protest The Hero – “A Life Embossed” (Volition)

9. Killswitch Engage – “In Due Time” (Disarm the Descent)

10. Kylesa – “Unspoken” (Ultraviolet)

11. Amon Amarth – “Warriors of the North” (Deceiver of the Gods)

12. Children of Bodom – “Halo of Blood” (Halo of Blood)

13. Death Angel – “The Dream Calls For Blood” (The Dream Calls For Blood)

14. Vulture Industries – “The Tower” (The Tower)

15. Exhumed – “Sickened” (Necrocracy)

16. Suffocation – “Sullen Days” (Pinnacle of Bedlam)

17. Dream Theater – “Illumination Theory” (Dream Theater)

18. Soulfly – “Ayatollah of Rock N Rolla” (Savages)

19. Nine Inch Nails – “Came Back Haunted” (Hesitation Marks)

20. Rob Zombie – “Rock N’ Roll in a Black Hole”

(Venemous Rat Regeration Vendor)

21. Tomahawk – “White Hats, Black Hats” (Oddfellows)

22. Carcass – “Mount of Execution” (Surgical Steel)

23. Amon Amarth – “Deceiver of the Gods” (Deceiver of the Gods)

24. The Dillinger Escape Plan – “When I Lost My Bet” (One of Us Is the Killer)

25. Gorguts – “Forgotten Arrows” (Colored Sands)

26. Avenged Sevenfold – “Hail to the King” (Hail to the King)

27. Monster Magnet – “I Live Behind the Clouds” (Last Patrol)
28. Omnium Gatherum – “The Sonic Sign” (Beyond)
29. Death Angel – “Territorial Instinct/Bloodlust” (The Dream Calls For Blood)

30. Hatebreed – “The Language” (The Divinity

of Purpose)
31. Tomahawk – “South Paw” (Oddfellows)
32. Megadeth – “Forget to Remember” (Super Collider)
33. Toxic Holocaust – “Rat Eater” (Chemistry of Consciousness)
34. Amorphis – “Shades of Gray” (Circle)
35. Alice in Chains – “The Devil Put Dinosaurs Here” (The Devil Put Dinosaurs Here)
36. Voivod – “Kluskap O’Kom” (Target Earth)
37. Skeletonwitch – “The Evil Embrace” (Serpents Unleashed)
38. Protest The Hero – “Clarity” (Volition)
39. Caladan Brood – “Echoes of Battle” (Echoes of Battle)
40. Black Sabbath – “Age of Reason”
41. Shade Empire – “Ruins” (Omega Arcane)
42. Mors Principium Est – “The Meadows of Asphodel” (And Death Said Live)
43. Black Dahlia Murder – “Map of Scars” (Everblack)
44. Annihilator – “No Way Out” (Feast)
45. Dream Theater – “The Enemy Inside” (Dream Theater)
46. Inter Arma – “Sky Burial” (Sky Burial)
47. Leprous – “Chronic” (Coal)
48. Motorhead – “Heartbreaker” (Aftershock)
49. Soilwork – “Spectrum of Eternity” (The Living Infinite)
50. Killswitch Engage – “The New
Awakening” (Disarm the Descent)
51. The Dillinger Escape Plan – “Paranoia Shields” (One of Us Is the Killer)
52. Exhale – “Left Inside” (When Worlds Collide)
53. Battlecross – “Flesh & Blood” (War of Will)
54. Ulcerate – “Confronting Entropy” (Vermis)
55. Ihsahn – “Regen” (Das Seelenbrechen)
56. Soulfly – “Bloodshed” (Savages)
57. Alice in Chains -” Hollow” (The Devil Put Dinosaurs Here)
58. Black Sabbath – “End of the Beginning” (13)
59. Queensryche – “Spore” (Queensryche)
60. Skeletonwitch – “Unending, Everliving” (Serpents Unleashed)
61. Exhumed – “Necrocracy” (Necrocracy)
62. Death Angel – “Caster of Shame” (The Dream Calls For Blood)
63. Hatebreed – “End the Fight Before the Fight ends You” (The Divinity of Purpose)
64. Turisas – “Run Bhang-Eater, Run!” (Turisas2013)
65. Monster Magnet – “Mindless Ones” (Last Patrol)
66. Rob Zombie – “We’re An American Band” (Venemous Rat Regeneration Vendor)
67. DevilDriver – “Sail” (Winter Kills)
68. Children of Bodom – “Transference” (Halo of Blood)
69. Satyricon – “Walker Upon the Wind” (Satyricon)

70. Stratovarius -” Unbreakable” (Nemesis)

71. Witherscape – “Astrid Falls” (The Inheritance)
72. Black Dahlia Murder – “Raped in Hatred by Vines of Thorn” (Everblack)
73. Skeletonwitch – “I Am of Death (Hell Has Arrived)” (Serpents Unleashed)
74. Killswitch Engage – “The Hell in Me” (Disarm the Descent)
75. Five Finger Death Punch – “Lift Me Up” (The Wrong Side of Heaven and the
Righteous Side of Hell, Vol. 1)
76. Philip Anselmo and the Illegals – “Bedridden” (Walk Through Exits Only)
 77. Kylesa – “Quicksand” (Ultraviolet)
78. Black Sabbath – “Zeitgeist” (13)
79. Monster Magnet – “Last Patrol” (Last Patrol)
80. Exhale – “Wrath Unleashed” (When Worlds Collide)
81. Finntroll – “Blodsvept” (Blodsvept)
82. Kalmah – “Windlake Tale” (Seventh Swamphony)
83. Nine Inch Nails – “Copy of A” (Hesitation Marks)
84. Battlecross – “Beast” (War of Will)
85. Chtonic – “Defenders of Bu-Tik Palace” (Bu-Tik)
86. Carcass – “Captive Bolt Pistol” (Surgical Steel)
87. Toxic Holocaust – “Chemistry of Consciousness” (Chemistry of Consciousness)
88. Vulture Industries – “Lost Among Liars” (The Tower)
89. Megadeth – “Kingmaker” (Super Collider)
90. Omnium Gatherum – “The Unknowing” (Beyond)
91. Annihilator – “Deadlock” (Feast)
92. Five Finger Death Punch – “Battle Born” (The Wrong Side of Heaven and The
Righteous Side of Hell Vol. 2)
93. Korn – “Love & Meth” (The Paradigm Shift)

94. Dark Tranquillity – “Endtime Hearts”

(Construct)
95. Alice in Chains – “Stone” (The Devil Put Dinosaurs Here)
96. Killswitch Engage – “Beyond the Flames”
97. Tomahawk – “Oddfellows”
98. Black Sabbath – “Loner”
99. Sepultura – “Da Lama ao Caos” (The Mediator Between Head and Hands Must Be
the Heart)
100. Tarja – “Victim of Ritual” (Colours in the Dark)

http://www.sputnikmusic.com/newreleases.php?t=1
Revista Cubana de Cirugía
versión On-line ISSN 1561-2945
Rev Cubana Cir v.35 n.2 Ciudad de la Habana jul.-dic. 1996

Hospital General Provincial Docente "Carlos Manuel de Céspedes" Bayamo, Granma

Quistes y fístulas del conducto tirogloso. Nuestra experiencia

Dr. Manuel Estrada Sarmiento1

1. Especialista de II Grado en Cirugía Maxilofacial. Profesor Principal de Patología Bucal.

Secretario del Comité de Intervenciones Quirúrgicas y Presidente del Consejo Científico.
Hospital General Provincial Docente "Carlos Manuel de Céspedes", Bayamo, Granma.

RESUMEN

Se realiza una investigación observacional, retrospectiva y descriptiva de 65 pacientes con

diagnóstico clínico e histológico de quistes y/o fístula del conducto tirogloso, con el objetivo de
conocer su comportamiento en nuestro medio durante el período 1963-1993. De los 65 pacientes
43 eran masculinos (66,1 %) y 22 femeninos. El 20 % con una edad inferior a los 10 años. Nueve
pacientes (13,8 %) tenían antecedentes de cirugía previa. Se manifestaron como una tumoración
cervical en 54 pacientes y en 6 como una fístula. La técnica quirúrgica de Sistrunk se empleó en 62
pacientes (95,4 %) en los restantes la exéresis simple del quiste. La mortalidad operatoria fue nula.
Tres pacientes (4,6 %) presentaron sepsis de la herida. El seguimiento mínimo de los pacientes fue
de un año. Dos pacientes mostraron recidivas y fueron reintervenidos a los 10 meses. Esta entidad
es relativamente frecuente con predominio en las primeras décadas de la vida. Una terapéutica
adecuada conlleva a la resolución de ésta con mortalidad nula.

Palabras clave: QUISTE TIROGLOSO; FISTULA; GLANDULA TIROIDES; LENGUA.

INTRODUCCION

Los quistes y fístulas del conducto tirogloso constituyen una afección congénita desarrollada sobre
la persistencia de restos epiteliales embriológicos en el trayecto de la glándula tiroidea, que sigue
desde su aparición en el suelo faríngeo durante la tercera semana de vida hasta llegar en la sexta a
su situación anatómica definitiva. Este trayecto, denominado conducto tirogloso de His o
Bochdalek, se oblitera y se reabsorbe entre la séptima-octava semana de vida intrauterina.
Cuando esto no sucede o se realiza parcialmente, o cuando por motivos desconocidos las células
indiferenciadas de su tercio medio se diferencian e inician una actividad secretora,1 aparecen los
quistes del conducto tirogloso.1-4

Los quistes tiroglosos y su fistulación constituyen una de las afecciones congénitas más
frecuentes del cuello1,2 y representan una importante entidad en el diagnóstico diferencial
de las neoplasias del cuello.1,3 Se ha reportado el desarrollo de carcinomas en la pared del
quiste.4-8

Esta afección representa del 66 al 72 % de los procesos congénitos del cuello.1-3 Para
Anton-Pacheco9 los quistes del conducto tirogloso son la tumoración más frecuente de la
línea cervical media, aunque otros autores los sitúan en segundo lugar, tras las
linfadenopatías inflamatorias o neoplásicas.3,10,11

El tratamiento debe ser quirúrgico, mediante la técnica descrita por Sistrunk,1-16 en la cual
debido a la íntima relación embriológica del conducto tirogloso con el hueso hioides, esto
debe resecarse en su parte central, y continuar la disección por los músculos suprahioideos
hasta el foramen caecum en la base de la lengua.

El objetivo de este trabajo es presentar la experiencia de nuestro Servicio en el tratamiento

de los quistes y fístulas del conducto tirogloso.

METODO

Se utilizó como universo el total de las historias clínicas de los pacientes inscritos en el Servicio de
Cirugía Maxilofacial del Hospital General Provincial Docente "Carlos Manuel de Céspedes" de
Bayamo, diagnosticados clínica e histológicamente como afectados por quistes y/o fístulas del
conducto tirogloso. En el período comprendido desde 1963 hasta 1993 ambos inclusive, se
confeccionó el proyecto para una investigación de observación, retrospectiva y descriptiva y un
formulario para recoger de las historias clínicas las siguientes variables: edad, sexo, antecedentes,
manifestaciones clínicas, tiempo de evolución y tamaño, localización, exploración física y
complementaria, tratamiento, complicaciones posoperatorias y recidivas. Las historias clínicas que
no reunían los parámetros propuestos fueron eliminadas para quedar integrado nuestro material
de estudio por 65 pacientes, 43 masculinos y 22 femeninos con edades que oscilaron entre 5 y 36
años.

Una vez verificada la información, los datos fueron procesados y los resultados que se
obtuvieron se presentaron en tablas de números absolutos y de tanto por cientos.

RESULTADOS

La tabla 1 refleja la edad y el sexo de los estudiantes. La mayor incidencia se puso de manifiesto en
el grupo de 10 a 19 años de edad con 37 pacientes (57,0 %). El 77 % de la serie se encontró entre
los 0-19 años de edad. Las edades oscilaron entre 5 y 36 años con una media de 16,1 años y se
destaca el hecho que sólo el 20 % de los pacientes eran menores de 10 años.

TABLA 1. Quistes y fístulas tiroglosas con diagnóstico hístico confirmado según edad y sexo

Masculino Femenino Total

 Grupo No. % No. % No. %
de
edades
(años)

0-9 10 23,2 3 13,6 13 20,0

10 - 19 24 55,8 13 59,1 37 57,0

20 - 29 6 14,0 5 22,7 11 16,9

30 - 39 3 7,0 1 4,5 4 6,1

Total 43 66,1 22 65 100

El sexo masculino fue predominante con 43 pacientes (66,1 %). La relación entre uno y otro sexos
fue de 1,9:1.

En 9 pacientes (13,8 %) existían antecedentes de cirugía previa, que consistió en 3

ocasiones en el drenaje de un absceso cervical y en 6 en una exéresis presuntamente radical.

En 49 pacientes el quiste se identificó como una tumoración cervical anterior asintomática

(figura).

FIGURA 1

El síntoma predominante en los pacientes con fístula cervical (16,9 %) fue la secreción,
unas veces intermitentes y otras en forma continua (tabla 2).

TABLA 2. Manifestaciones clínicas en pacientes con quistes y fístulas tiroglosas

Manifestaciones No %

Tumoración cervical indolora 49 75,4

Tumoración cervical dolorosa 5 7,7

Fístula 11 16,9

Total 65 100,0

El tiempo de evolución de la entidad patológica fue variable, desde un mes hasta 30 meses y 6
años, y fue el promedio de 5,5 años.
El tamaño de los quistes en 41 pacientes (63,1 %) fue menor a 3 cm y en 10 mayor de 4 cm
(tabla 3).

TABLA 3. Quistes y fístulas tiroglosas según tiempo de evolución y tamaño

Tiempo - 1 cm 1 - 3 cm 4 - 6 cm Total
de
evolución No. % No. % No. % No. %
(años)

- de 1 5 35,7 7 17,1 - - 12 18,5

De 1 a 5 9 64,3 34 82,9 10 100,0 53 81,5

Total 14 100,0 41 100,0 10 100,0 65 100,0

En todos los pacientes la localización de los quistes y fístulas ocurrió en la región cervical anterior,
38 en la línea media y 27 lateralizados (21 a la izquierda y 6 a la derecha), en el 63,1 % de la serie
de afección se encontró al nivel del hioide (tabla 4).

TABLA 4. Localización topográfica de los quistes y fístulas tiroglosas

Localización Línea media Derecha Izquierda Total

No. % No. % No. % No. %

Suprahioidea 7 18,4 5 23,8 2 33,3 14 21,5

Al nivel del 26 68,4 11 52,4 4 66,7 41 63,1

hioides

Infrahioidea 5 13,2 5 23,8 - - 10 15,4

Total 38 100,0 21 100,0 6 100,0 65 100,0

En los datos recogidos en la exploración física se destacó el ascenso de la tumoración con la

deglución en 54 pacientes. La consistencia de los quistes fue dura en 49 pacientes y elástica en 11.
La piel que los recubría presentaba signos inflamatorios en 5 pacientes.

Como exploraciones complementarias se realizaron estudios ecográficos en diferentes

pacientes. En los 2 casos de recidiva se realizó fistulografía.
El tratamiento quirúrgico de elección fue en 62 pacientes (95,4 %) según técnica de
Sistrunk. En 3 pacientes se efectuó la exéresis del quiste sin resección del hioides. En todos
los casos se envió la pieza resecada para estudio anatomopatológico.

Los hallazgos de anatomía patológica fueron de quistes tiroglosos y se identificaron 3 tipos

de epitelio: escamoso, cúbico y columnar. No hubo evidencia de neoplasia ni de tejido
tiroideo.

En 3 pacientes (4,6 %) existieron complicaciones posoperatorias (infección herida

quirúrgica). Todos los pacientes tuvieron un seguimiento mínimo de un año. Se detectaron
2 recidivas a los 6 meses y fueron reintervenidos 10 meses después. Una por neoformación
del quiste y otra en forma de fístula cervical.

No se reportó mortalidad en la serie.

DISCUSION

La afección del conducto tirogloso tiene una mayor incidencia en la edad infantil, generalmente en
la primera década de la vida.1-4, 9,13,16 Esta se presenta del 60 al 80 % de los casos antes de la
segunda o tercera décadas,1-4,16 aunque su aparición en edades avanzadas no es infrecuente,17
datos que se corresponden con nuestros hallazgos.

El sexo masculino mostró una mayor incidencia, resultado que concuerda con la mayoría de
las series revisadas,2-4,9,13,17 pero discrepa de Ortiz1 pues en su investigación predominó el
femenino.

El 13,8 % de nuestra serie presentó antecedentes de algún tipo de tratamiento quirúrgico

previo. Publicaciones recientes1,2,9,13,16,17 plantean que estos antecedentes oscilan entre el
12,5 y el 33,3 %. Ello se debe a que los quistes del conducto tirogloso con frecuencia se
infectan, al ser tratados mediante incisión y drenaje, o bien a una incorrecta intervención.

Como señalan otros autores,1-17 excepto en los casos con infección, los quistes del conducto
tirogloso se manifiestan como una tumoración asintomática.

El aumento de tamaño de la tumoración tras procesos infecciosos respiratorios es un hecho

conocido,1,2,11 se atribuye a un aumento en la secreción del epitelio del quiste junto a una
dificultad en el drenaje habitual por edema de la mucosa lingual del foramen ciego.1-4

La localización típica de los quistes y fístulas del conducto tirogloso es la línea media
cervical,1-9,11,13,16,17 aunque se pueden presentar ligeramente lateralizados, más frecuentes
del lado izquierdo. En nuestra investigación pudimos corroborar lo planteado.

La exploración física aporta como datos de mayor valor diagnóstico, además de la

localización, el ascenso de la lesión con la deglución al exteriorizar la lengua debido a su
relación con el suelo de la boca. Datos que se observaron en 54 pacientes.
El diagnóstico clínico es generalmente sencillo, pero se deben realizar estudios
complementarios con el fin de descartar afecciones asociadas o comprobar que la
tumoración no sea un tiroides ectópico, con este fin siempre se debe efectuar una
gammagrafía.1-4,9,16,18

Como exploraciones complementarias se realizaron estudios ecográficos19 en diferentes

pacientes. La realización de una fistulografía en caso de recidiva, junto con la inyección de
colorante es recomendada por la mayoría de los autores1-4,9,13,20 para asegurar una exéresis
completa. En nuestra serie se realizaron 2 estudios fistulográficos.

El diagnóstico diferencial se debe realizar con las siguientes entidades: tiroides aberrante,
nódulo tiroideo, linfangiomas cervicales, quistes branquiales, dermoides, lipomas,
adenopatías inflamatorias o neoplásicas.1-17

El único tratamiento efectivo de los quistes es el quirúrgico, el cual realizamos

precozmente, al igual que otros autores,1,2,4,9,11-17 con el fin de evitar complicaciones que
dificultarían la cirugía.

La técnica quirúrgica universalmente aceptada es la descrita por Sistrunk.1-17

Al igual que otros autores 1-4,9,13,16,17 en la mayoría de las intervenciones quirúrgicas

dejamos un drenaje para evitar los hematomas y seromas.

La mortalidad en esta cirugía es mínima, nula en nuestra casuística. Nuestra cifra de

complicaciones 4,6 % es menor a la reportada por Ortiz de Solorzano,1 6 %. En general
estas complicaciones son muy discretas, y son las más comunes: la infección de la herida
quirúrgica, el edema pasajero de la glotis y la celulitis cervical. La principal causa de
recidiva la constituye la exéresis simple del quiste o fístula sin resección del hioides, que
alcanza cifras de 12,7 a 68 %.1,9,11,16

Con la técnica de Sistrunk el índice desciende ostensiblemente a valores comprendidos

entre 0 y 5 %.1,2,9,11 Las recidivas suelen ser de aparición precoz, entre 30 días y un año. En
nuestra serie se presentaron 2 recidivas a los 6 meses del tratamiento de los quistes donde
no se realizó la técnica de Sistrunk. Resultados que se corresponden con lo planteado por
los autores consultados.1-4,7-9,12-17

Es obligatorio someter el tejido extirpado a examen histopatológico con fines diagnósticos

y para descartar la existencia de neoplasias, pues se ha llegado a encontrar tejidos
neoplásicos malignos originados en estos quistes.5-8

CONCLUSION

Nos encontramos ante una afección congénita relativamente frecuente, con predominio en el sexo
masculino y en la segunda década de la vida, en la que la terapéutica quirúrgica asentada en un
adecuado conocimiento de sus bases embriológicas conlleva a la resolución de ésta con nula
mortalidad.
SUMMARY

A observational retrospective, and descriptive investigation of 65 patients with clinical and

histology-cal diagnosis of cysts and/or fistulas of the thyroglossal duct was carried out to know
their behaviour in our enviroment during the period 1983-1993. 43 of the 65 patients were males
(66,1 %) and 22 females. 20 % of them were under 10 years old. Nine patients (13,8 %) had
undergone surgery before. Cervical tumour was found in 54 patients and fistula in 6. The Sistrunk's
surgical technique was used in 62 patients (95,4 %), where as in the rest it was used the simple
exeresis of the cyst. Operative mortality was null. Three patients (4,6 %) presented incision sepsis.
The minimun follow-up lasted one year. Two patients relapsed and were operated on again 10
months later. This affection is relatively frequent with predominance in the first decades of life. An
adequate therapeutics leads to the resolution of it with no mortality.

Key words: THYROGLOSSAL CYST; FISTULA; THYROID GLAND; TONGUE.

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Recibido: 29 de mayo de 1995. Aprobado: 29 de febrero de 1996.

Dr. Manuel Estrada Sarmiento. Plaza del Himno No. 6, entre José Joaquín Palma y Padre Batista, Bayamo 85
100, Granma, Cuba.