Frecuencia de Ponticulus posticus en Telerradiografías Laterales de Cráneo / Frequency of Ponticulus posticus in Digital Lateral Cephalograms

En el arco posterior del atlas se describe una variación de tejido óseo denominada Ponticulus posticus (PP), la cual se ha relacionado con el desarrollo de dolor cervical. El objetivo de este estudio fue determinar la frecuencia de PP en telerradiografías laterales digitales. Este estudio correspondió a un estudio observacional descriptivo, donde se analizaron 450 telerradiografías laterales digitales obtenidas de la base de datos del Servicio de Imagenología Oral y Maxilofacial de la Facultad de Odontología de la Universidad Andrés Bello, Viña del Mar, Chile. Se analizó la presencia de PP en cada cefalograma, y se utilizó la clasificación de Cederberg y Stubbs para determinar los grados de osificación. Se aplicó la prueba de Chi-cuadrado para establecer una asociación entre la presencia de PP con el sexo y la edad. De las 450 telerradiografías laterales el 42,4 % presenta PP, con una mayor prevalencia entre el rango de 21-40 años. En cuanto al grado de osificación, el grado 2 fue el tipo más prevalente (25 %), seguido del grado 4 (9,5 %), el grado 3 (8 %). No se encontró asociación entre la presencia de PP con edad y género (P > 0,05). La PP es frecuente en la población y se observa a diferentes edades sin predilección por sexo.

SUMMARY: A bony tissue variation called Ponticulus posticus (PP) is described in the posterior arch of the atlas, which has been associated with the development of cervical pain. The aim of this study was to determine the frequency of PP in digital lateral cephalograms. This study was an observational descriptive study, in which 450 digital lateral cephalograms obtained from the database of the Oral and Maxillofacial Imaging Service of the Faculty of Dentistry of the Andrés Bello University, Viña del Mar, Chile, were analyzed. The presence of PP was analyzed in each cephalogram, and the Cederberg and Stubbs classification was used to determine the degrees of ossification. The Chi-square test was applied to establish an association between the presence of PP with gender and age. Of the 450 lateral cephalograms, 42.4 % presented PP, with a higher prevalence in the 21-40 year range. In terms of the degree of ossification, grade 2 was the most prevalent type (25 %), followed by grade 4 (9.5 %), and grade 3 (8 %). No association was found between the presence of PP with age and gender (P > 0.05). PP is common in the population and is observed at different ages without a sex preference.

Evaluation of sinonasal-related quality of life of 49 patients undergoing endoscopic skull base surgery

Abstract Objective This study aimed to evaluate the sinonasal-related Quality of Life (QoL) in patients undergoing endoscopic skull base surgery. Methods A retrospective study was performed, including patients with benign and malignant tumors at a single institution. Each patient completed the 22-Item Sino-Nasal Outcome Test (SNOT-22) and the Empty Nose Syndrome 6 Item Questionnaires (ENS6Q) to assess their perceived QoL at least 2-months after treatment. Results Forty-nine patients were enrolled in this study. The average score was 25.1 (Stander Deviation [SD] 14.99) for SNOT-22 and 6.51 (SD = 5.58) for ENS6Q. Analysis of the overall results for the SNOT-22 showed that olfactory damage was the most serious syndrome. The most frequently reported high-severity sub-domains in SNOT-22 were nasal symptoms and sleep symptoms. Nasal crusting was the most severe item in ENS6Q according to the report. Nine patients (18.4%) had a score higher than 10.5 which indicates the high risk of Empty Nose Syndrome (ENS). SNOT-22 score was related to the history of radiotherapy (p < 0.05), while the ENS6Q score was not. Conclusions The possibility of patients suffering from ENS after nasal endoscopic skull base surgery is at a low level, although the nasal cavity structure is damaged to varying degrees. Meanwhile, patients undergoing endoscopic skull base surgery were likely to suffer nasal problems and sleep disorders. Patients who had received radiotherapy have a worse QoL than those without a history of radiotherapy. Level of evidence Level 3.

Nasal Crust-Related Morbidity and Debridement After Endoscopic Skull Base Surgery

Abstract Introduction: Nasal crust after endoscopic skull base surgery can cause nasal congestion, obstruction, and pain, which can affect quality of life. The use of debridement aims to provide symptomatic relief and improve quality of life. Generally, most adult patients tolerate office-based debridement, except in a few select patients that require further sedation in the operating room for a debridement. The study sought to determine the rate of symptomatic crust-related morbidity and the rate of debridement in both the office and the operating room. Methods: Premorbid, operative, and postoperative data of adult patients who had endoscopic skull base surgery in our institution from 2014 to 2018 were reviewed retrospectively. The characteristics of nasal symptoms in the postoperative period were determined and the numberofdebridementsin theoffice and the operatingroomwere analyzed. Results: Two hundred and thirty-four (234) patients with 244 surgeries were included in the study. The majority, 68.9%, had a sellar lesion and a free mucosa graft (FMG) was the most common skull base reconstruction at 53.5%. One hundred and twenty (49.0%) had crust-related symptoms during the postoperative period and 11 patients (4.5%) required the operating room for debridement. The use of a pedicled flap, anxiety, and preoperative radiotherapy were significantly associated with intolerance to in-office debridement (p-value=0.05). Conclusions: The use of a pedicled flap or anxiety may predispose patients to require an OR debridement. Previous radiotherapy also influenced the tolerance to the in-office debridement.

Osteological Study of the Parietal Foramen in the Adult Human Skull Bones and its Clinical and Surgical Correlations / Estudio Osteológico del Foramen Parietal en los Huesos del Cráneo Humano Adulto y sus Correlaciones Clínicas y Quirúrgicas

SUMMARY: Parietal emissary foramina (PEF) are small holes, which are localized between the middle and posterior thirds of the parietal bone posterior surface close to the sagittal suture. PEF are important structures that protect the parietal emissary vein, which passes through it. During neurosurgery procedures, parietal foramina (PF) knowledge is crucial. This work aimed to evaluate presence and location of the PF in the skull of an adult human. Moreover, measure the distance amidst PF and the sagittal suture's midline to ascertain its clinical repercussions. 74 adult human skulls, without gross pathology, were observed for the PF's existence. The PF's and sagittal suture's midline distance were measured. According to the PF patterns of presence, five groups were distributed. Finally, specimens were photographed and subjected to statistical analysis. The PF was absent in 7 skulls (9.5 %). There were 9 skulls (12.2 %) exhibited central parietal foramen where the parietal foramen lies on the sagittal suture. 17 skulls (23 %) showed right unilateral parietal foramen, whereas 15 skulls (20.3 %) demonstrated left unilateral parietal foramen. The final 26 skulls (35.1 %) exhibited bilateral parietal foramen. This descriptive study supplies valuable information of PF variations, which is crucial for neurosurgeons in modifying surgical techniques and procedures to alleviate injury to PF-emerging structures such as emissary veins.

Los forámenes emisarios parietales (FEP) son pequeños orificios que se localizan entre los tercios medio y posterior de la superficie posterior del hueso parietal, cerca de la sutura sagital. Los FEP son estructuras importantes que protegen la vena emisaria parietal, que lo atraviesa. Durante los procedimientos de neurocirugía, el conocimiento de los forámenes parietales (FP) es crucial. Este trabajo tuvo como objetivo evaluar la presencia y ubicación del FP en el cráneo de hombres adultos, además, medir la distancia entre el FP y la línea mediana de la sutura sagital para conocer su repercusión clínica. Se examinaron 74 cráneos humanos adultos, sin patología grave, para determinar la existencia del FP. Se midió la distancia de la línea mediana de la sutura sagital y del FP. De acuerdo con los patrones de presencia del FP, se distribuyeron en cinco grupos. Finalmente, los especímenes fueron fotografiados y sometidos a análisis estadístico. El PF estaba ausente en 7 cráneos (9,5 %). Hubo 9 cráneos (12,2 %) que presentaban un PF central localizándose en la sutura sagital. 17 cráneos (23 %) presentaban un FP unilateral derecho, mientras que 15 cráneos (20,3 %) se observó un FP unilateral izquierdo. Los 26 cráneos restantes (35,1 %) exhibieron FP bilaterales. Este estudio descriptivo proporciona información valiosa sobre las variaciones del FP, que es fundamental para los neurocirujanos en el momento de modificar las técnicas y los procedimientos quirúrgicos para aliviar las lesiones de las estructuras emergentes del FP, como las venas emisarias.

The Discovery of a Bone in the Anterior Fontanelle of the Skull of the Sheep (Ovis aries) / Descubrimiento de un Hueso en la Fontanela Anterior del Cráneo de la Oveja (Ovis aries)

SUMMARY: A comparative study of the skull morphology was conducted using 270 prenatal and 750 postnatal skull samples from three breeds of sheep in Nigeria namely, Balami, Uda and Yankasa. A unique bone peculiar to the Yankasa breeds of sheep was found consistently at the centre of the anterior fontanelle in the young (day-old to 1 year). At two years of age and above, the bone was fused and disappeared completely. This brings the total numbers of the neurocranium bones of the skull in the Yankasa breeds to 8, as against the 7 bones documented in the ovine species. Due to the fact that this bone has not been described in the literature, we venture to name it the anterio-fontanelle bone (of Atabo).

Se realizó un estudio comparativo de la morfología del cráneo utilizando 270 muestras de cráneos prenatales y 750 postnatales de tres razas de ovejas en Nigeria, Balami, Uda y Yankasa. Un hueso único peculiar de las razas de ovejas Yankasa se encontró consistentemente en el centro de la fontanela anterior en las crías (de un día a 1 año). A los dos años de edad o más, el hueso se fusionó y desapareció por completo. Esto eleva el número total de huesos del neurocráneo en el cráneo en las razas Yankasa a 8, frente a los 7 huesos documentados en la especie ovina. Debido a que este hueso no ha sido descrito en la literatura, nos aventuramos a denominarlo hueso antero-fontanela (de Atabo).

Sex estimation based on foramen magnum: a three-dimensional geometric morphometrics approach / Estimación del sexo basado en el foramen magno: un enfoque de morfometría geométrica tridimensional

SUMMARY: The foramen magnum is an important topographic opening which connects cranial cavity and spinal canal. The analysis of the bone material established that there are differences in the shape of the foramen magnum between individuals. The aim of this study was to determine sex based on shape and size of foramen magnum using geometric morphometrics method. A study was performed on three-dimensional models (3D models) of 214 human skulls of known sex and known age (141 male skulls and 73 female skulls). The skulls are located at the museum of Medical Faculty, University of Sarajevo. Skulls belong to Bosnian population from the mid-twentieth century. All examined skulls were scanned with a laser scanner to obtain their 3D models. On 3D models of the examined skulls, four landmarks were marked on foramen magnum. Analysis of sex determination was performed using the MorphoJ program. Results of this study showed that there are sex differences in the shape and size of the foramen magnum. Sex determination based on the shape and size of the foramen magnum was showed 65.25 % accuracy for male and 63.01 % accuracy for female using geometric morphometrics method. Examination of the effect of size of foramen magnum on sexual dimorphism of shape of foramen magnum showed a statistically significant effect. Sex determination based just on the shape of foramen magnum using geometric morphometrics method was possible with 62.41 % accuracy for male and 58.90 % accuracy for female on examined sample. Sex differences on shape and size of foramen magnum were found using geometric morphometrics method on three-dimensional models of the examined skulls. The percentage of accuracy was higher for male based on the shape and size of the foramen magnum than for female.

El foramen magno es una importante abertura topográfica que conecta la cavidad craneal y el canal espinal. El análisis del material óseo estableció que existen diferencias en la forma del foramen magno entre individuos. El objetivo de este estudio fue determinar el sexo en función de la forma y el tamaño del foramen magno utilizando morfometría geométrica. El estudio se realizó en modelos tridimensionales (modelos 3D) de 214 cráneos humanos de sexo y edad conocidos (141 cráneos masculinos y 73 cráneos femeninos). Los cráneos se encuentran en el museo de la Facultad de Medicina de la Universidad de Sarajevo. Los cráneos pertenecen a población bosnia de mediados del siglo XX. Todos los cráneos examinados fueron escaneados con un escáner láser para obtener sus modelos 3D. En los modelos 3D de los cráneos examinados, se marcaron cuatro puntos de referencia en el foramen magno. El análisis de determinación de sexo se realizó utilizando el programa MorphoJ. Los resultados de este estudio mostraron que existen diferencias de sexo en la forma y el tamaño del foramen magno. La determinación del sexo basada en la forma y el tamaño del foramen magno mostró una precisión del 65,25 % para los hombres y del 63,01 % para las mujeres utilizando morfometría geométrica. El examen del efecto del tamaño del foramen magno sobre el dimorfismo sexual de la forma del foramen magno mostró un efecto estadísticamente significativo. La determinación del sexo basada solo en la forma del foramen magno utilizando morfometría geométrica fue posible con una precisión del 62,41 % para los hombres y del 58,90 % para las mujeres en la muestra examinada. Se encontraron diferencias de sexo en la forma y el tamaño del foramen magno utilizando morfometría geométrica en modelos tridimensionales de los cráneos examinados. El porcentaje de precisión fue mayor para los hombres en función de la forma y el tamaño del foramen magno que para las mujeres.

Perfusion-weighted imaging in vestibular schwannoma: the influence that cystic status and tumor size have on perfusion profiles / Perfusão por ressonância magnética em schwannoma vestibular: influência do tamanho e estádio cístico no perfil da perfusão

Abstract Objective: The perfusion profile of vestibular schwannomas (VSs) and the factors that influence it have yet to be determined. Materials and Methods: Twenty patients with sporadic VS were analyzed by calculating parameters related to the extravascular extracellular space (EES)—the volume transfer constant between a vessel and the EES (Ktrans); the EES volume per unit of tissue volume (Ve); and the rate transfer constant between EES and blood plasma (Kep)—as well as the relative cerebral blood volume (rCBV), and by correlating those parameters with the size of the tumor and its structure (solid, cystic, or heterogeneous). Results: Although Ktrans, Ve, and Kep were measurable in all tumors, rCBV was measurable only in large tumors. We detected a positive correlation between Ktrans and rCBV (r = 0.62, p = 0.031), a negative correlation between Ve and Kep (r = -0.51, p = 0.021), and a positive correlation between Ktrans and Ve only in solid VSs (r = 0.64, p = 0.048). Comparing the means for small and large VSs, we found that the former showed lower Ktrans (0.13 vs. 0.029, p < 0.001), higher Kep (0.68 vs. 0.46, p = 0.037), and lower Ve (0.45 vs. 0.83, p < 0.001). The mean Ktrans was lower in the cystic portions of cystic VSs than in their solid portions (0.14 vs. 0.32, p < 0.001), as was the mean Ve (0.37 vs. 0.78, p < 0.001). There were positive correlations between the solid and cystic portions for Ktrans (r = 0.71, p = 0.048) and Kep (r = 0.74, p = 0.037). Conclusion: In VS, tumor size appears to be consistently associated with perfusion values. In cystic VS, the cystic portions seem to have lower Ktrans and Ve than do the solid portions.

Resumo Objetivo: O perfil de perfusão do schwannoma vestibular (SV) não tem sido estudado, nem os fatores que o influenciam. Materiais e Métodos: Vinte pacientes com SV esporádico foram analisados usando Ktrans, Ve, Kep e rCBV e correlacionados com tamanho e estádio cístico. Resultados: Ktrans, Ve e Kep foram medidos em todos os casos. rCBV só foi possível em tumores grandes. Ktrans e rCBV estavam correlacionados positivamente (r = 0,62, p = 0, 0 31 ) . Ve e Kep estavam negativamente correlacionados (r = -0,51, p = 0,021). Ktrans estava correlacionado positivamente com Ve em SVs sólidos (r = 0,64, p = 0,048). Em SVs pequenos, Ktrans foi menor (0,13 vs 0,029, p < 0,001), Kep foi maior (0,68 vs 0,46, p = 0,037) e Ve foi menor (0,45 vs 0,83, p < 0,001) que nos SVs grandes. Ktrans e Ve foram menores dentro dos cistos que nas porções solidas dos SVs císticos (0,14 vs 0,32, p < 0,001; 0,37 vs 0,78, p < 0.001, respectivamente). Foi encontrada correlação positiva em Ktrans (r = 0,71, p = 0,048) e Kep (r = 0,74, p = 0,037) entre as áreas sólidas e císticas. Conclusão: Nos SVs, o tamanho está consistentemente associado com os valores da perfusão. Nos SVs císticos, as porções císticas parecem ter valores menores de Ktrans e Ve do que nas porções sólidas.

Acute and chronic changes in porcine rete mirabile after embolization with the Menox system: angiographic and histopathological analyses / Alterações angiográficas e histopatológicas agudas e crônicas da rete mirabile no modelo suíno com sistema embólico líquido Menox

Abstract Objective: To evaluate acute and chronic changes seen on angiographic and histopathological studies of porcine rete mirabile, comparing those treated with the Menox liquid embolic system (LES) and those treated with the Onyx LES. Materials and Methods: Five pigs, each weighing approximately 35 kg, were submitted to rete mirabile embolization under general anesthesia and fluoroscopic guidance, with the Menox LES or Onyx LES. Four animals were treated with the Menox LES and underwent cerebral angiography, followed by euthanasia, at 1, 30, 60, and 90 days after embolization. One animal was treated with the Onyx LES underwent the same procedures at 30 days after embolization. In a subsequent histopathological analysis, we compared the Menox LES and Onyx LES in terms of the acute and chronic changes observed. Results: We observed no significant changes in blood pressure, heart rate, or electrocardiographic parameters that could be attributed to the super-selective infusion of dimethyl sulfoxide or the Menox embolic agent. Fluoroscopy showed adequate material opacity, appropriate progression to the center of the rete mirabile and complete unilateral embolization. Microcatheters were uneventfully detached from the embolized nidus. We observed mild to moderate intravascular and extravascular inflammatory responses, without histological evidence of necrotizing arteritis. There were no adverse neurovascular events. Conclusion: The Menox LES appears to be safe and effective, as well as being apparently equivalent to the Onyx LES in terms of the postprocedure angiographic and histopathological findings.

Resumo Objetivo: Avaliar as alterações angiográficas e histopatológicas agudas e crônicas em rete mirabile suína tratadas com o Menox liquid embolic system (LES) e comparar essas alterações com a embolização com Onyx LES. Materiais e Métodos: A embolização da rete mirabile com Menox LES e Onyx LES foi realizada em cinco suínos pesando cerca de 35 kg sob anestesia geral e orientação fluoroscópica. Quatro animais tratados com Menox LES foram submetidos a angiografia cerebral seguida de eutanásia após 1, 30, 60 e 90 dias e um animal tratado com Onix LES foi submetido ao mesmo procedimento após 30 dias. A análise histopatológica subsequente para alterações agudas e crônicas avaliou o desempenho do Menox LES comparado ao Onyx LES. Resultados: Não foram observadas alterações significativas atribuíveis à infusão superseletiva de dimetilsulfóxido ou Menox nos parâmetros de pressão arterial, frequência cardíaca ou eletrocardiograma. A fluoroscopia mostrou opacidade adequada do material, progressão adequada para o centro da rete mirabile e embolização unilateral completa. Os microcateteres foram retirados do nidus embolizado sem complicações. Observou-se resposta inflamatória intravascular e extravascular leve a moderada, sem indício histológico de arterite necrosante. Nenhum dos casos apresentou eventos neurovasculares adversos. Conclusão: A injeção de Menox LES mostrou-se segura e eficaz, além de ser equivalente ao Onyx LES em relação aos achados angiográficos e histopatológicos pós-procedimento.

Influencia de la malnutrición fetal en el crecimiento y desarrollo craneofacial

Introducción: La malnutrición fetal incide de forma negativa en el crecimiento y la maduración, afectando las estructuras craneofaciales en el feto. Objetivo: Determinar los efectos de la malnutrición fetal por defecto en el crecimiento y desarrollo craneofacial en niños. Métodos: Se realizó un estudio analítico de casos y controles, en el área de salud José Martí del municipio Camagüey, desde enero de 2018 hasta diciembre de 2020. El universo estuvo constituido por niños de 6-11 años de edad, pertenecientes al área salud y la muestra quedó conformada por 40 niños, 20 en el grupo de estudio y 20 controles. El grupo de estudio se conformó por niños que presentaron bajo peso al nacer por defecto y tuvieron alteraciones en el crecimiento del complejo craneofacial y el grupo control por niños que no presentaron alteraciones en el crecimiento del complejo craneofacial y que al nacimiento se encontraban normopeso. A todos los niños se les efectuaron mediciones antropométricas craneofaciales. Resultados: La medida de la circunferencia cefálica al nacer en los controles masculinos superó en 0,78 cm al sexo femenino y entre los malnutridos por defecto, los masculinos lograron 1,57 cm más que los femeninos. En el diámetro bicigomático hubo una fuerte asociación estadística y el riesgo relativo indicó que la incidencia del bajo peso al nacer fue mayor que en los controles (p <0,05). Conclusiones: Los niños con bajo peso al nacer presentan menor crecimiento y desarrollo craneofacial según las variables antropométricas.

Introduction: Fetal malnutrition impacts in a negative way the growth and development, thus affecting the craniofacial structures of the fetus. Objective: To determine the effects of fetal malnutrition by defect on craniofacial growth and development in children. Methods: An analytical case and control study was carried out in Jose Martí health area of Camagüey, from January 2018 to December 2020. A sample of 40 was selected from the totality of the children between 6 and 11 years old who belong to the referred health area, to be divided into 20 cases and the same number in the control group. The study group was composed of those low birth weight who present craniofacial abnormalities while control group included the children without craniofacial abnormalities and normal weight at birth. Anthropometric craniofacial measurements were performed on all the sample. Results: The head circumference at birth in male children of control group was 0.78 cm higher than that on female sex. Among those low birth weight, male children exhibited 1.57 cm higher than females. Regarding the bizygomatic diameter there was a strong statistic association and the relative risk indicated a higher incidence on the study group compared to the control group (p <0.05). Conclusions: Low birth weight children show lower craniofacial growth and development, with higher impact on females according to anthropometric variables.

Infección por bartonella henselae en pacientes pediátricos. Lesión pseudotumoral de calota. Reporte de caso

Los tumores de calota en pacientes pediátricos poseen múltiples etiologías. Dentro de las causas pseudotumorales, las infecciones juegan un rol importante, siendo la osteomielitis por Bartonella henselae (Enfermedad por Arañazo de Gato) una posibilidad diagnóstica rara, pero que debe ser estudiada y descartada. Se presenta el caso de una lactante de 1 año, con lesión expansiva de calota, a nivel frontal derecho, hipervascularizada e infiltrativa. Se realizó estudio con ultrasonido, tomografía cerebral y cintigrama óseo. Se realizó resección quirúrgica completa de la lesión, con preservación de la duramadre y zona fontanelar, además de un cuidadoso trato con el seno sagital superior. Evolucionó sin complicaciones perioperatorias. El resultado de la biopsia fue compatible con proceso inflamatorio crónico, osteomielitis supurada. Tinción de Warthin Starry positiva sugerente de Bartonella henselae. Se descartó etiología tuberculosa y fúngica. Serología positiva para Bartonella henselae. La paciente completó antibioticoterapia, azitromicina y cotrimoxazol, con evolución clínica favorable.

Calvarial tumors in pediatric patients have multiple etiologies. Among the pseudotumoral causes, infections play an important role, being Bartonella henselae osteomyelitis (Cat Scratch Disease) a rare diagnostic possibility, but it should be studied and ruled out. We present the case of a 1 year old infant, with an expansive lesion of the calvaria, at right frontal level, hypervascularized and infiltrative. Ultrasound, brain tomography and bone scintigram were performed. Complete surgical resection of the lesion was performed, with preservation of the dura mater and fontanel area, in addition to a careful treatment with the superior sagittal sinus. The patient evolved without perioperative complications. The biopsy result was compatible with a chronic inflammatory process, suppurative osteomyelitis. Positive Warthin Starry stain suggestive of Bartonella henselae. Tuberculous and fungal etiology was ruled out. Positive serology for Bartonella henselae. The patient completed antibiotic therapy, azithromycin and cotrimoxazole, with favorable clinical evolution.

Necrotizing Otitis Externa: A Proposal for Diagnostic and Therapeutic Approach

Abstract Introduction Necrotizing otitis externa has a high impact on the quality of life of patients and has shown a significant increase in its incidence in recent years. There has been a change in the profile of affected patients and a lack of consensus on the management of these patients. Objective To develop a practical and effective care protocol to standardize the diagnostic and therapeutic management of necrotizing otitis externa. Methods A retrospective cohort study of necrotizing otitis externa patients between January 2015 and December 2020. Results There were 34 patients with two bilateral cases, totaling 36 ears. The mean age was 68.5, with a higher prevalence of males (76%). Diabetes was present in 97% of the samples. The involvement of cranial pairs was identified in 35% of the sample. Pseudomonas aeruginosa was the most frequent pathogen isolated, found in 50% of the cases. Among the cultures with bacterial agents isolated, 35% showed resistance to ciprofloxacin. The most frequent exam was computed tomography (94%). Hospital admission was indicated for 31 patients (91%), and ceftazidime was the most prescribed drug (35.5%). There were 11 recurrences (32%), and 12 patients (35%) had complications during treatment. Among the unfavorable outcomes, 12% persisted with some degree of peripheral facial paralysis, 6% maintained dysphagia, and 9% died of the disease. Conclusions The present study developed a diagnostic and therapeutic protocol for the effective management of necrotizing otitis externa. This protocol is a dynamic tool and should be revised and updated as new demands emerge during its implementation.

Evaluation of The Three-Dimensional Endoscopy in Basic and Extended Nasal Procedures: A Clinical and Cadaveric Study

Abstract Introduction The three-dimensional (3D) endoscope is considered a new surgical tool used in different approaches in intranasal and anterior skull base surgical procedures. There are many advantages of 3D over two-dimensional (2D) endoscopy that have been demonstrated in clinical applications, surgical training, and different experimental studies. Objective To show the difference between using the 3D and 2D endoscopes during endonasal and anterior skull base surgery and its importance. Methods Our study is divided into two phases (clinical and cadaveric phases). In the clinical study we, have performed 52 endonasal and anterior skull base surgical procedures (26 study cases and 26 control cases). We recorded accuracy, duration, and intraoperative complication for each case. The cadaveric study was performed on three cadavers. Differences in accuracy and dissection time were recorded using 3D and 2D endoscopy for each side chosen by randomization. Results In the clinical study, the cases done by 3D endoscope were significantly faster and more accurate with less intraoperative complications compared with cases done using 2D endoscope. In cadaveric dissection, while using 3D endoscope, there was better depth of perception regarding the anatomical landmarks compared with 2D endoscope. Conclusion Three-dimensional endoscopy is an advanced instrument that allows better training for the coming generation of ear, nose, and throat surgeons. Both clinical and cadaveric studies offer a promising outcome in both endonasal and anterior skull base surgery.

Tumor de células gigantes de tejidos blandos del seno esfenoidal / Giant soft tissue tumor of the sphenoid sinus

Introducción: el tumor primario de células gigantes de tejido blando de bajo potencial maligno es un tumor raro. Se han reportado en varios sitios, incluyendo mama, glándulas salivales, pulmón, entre otros. En el cráneo representan el 1 % y afectan preferentemente al esfenoides y los huesos temporales con bajo potencial de transformación maligna. Caso: se presenta el caso de un paciente masculino de 27 años con disminución de agudeza visual izquierda rápidamente progresiva, con evidencia de defecto pupilar aferente izquierdo. La tomografía computarizada (TC) y resonancia magnética nuclear (RMN) muestran una lesión tumoral en topografía esfenoidal izquierda con extensión hacia el seno cavernoso del mismo lado que desplaza la hipófisis. Discusión: el objetivo es describir la frecuencia de la enfermedad y las características en su presentación, definir pautas para el abordaje, tratamiento y seguimiento; asimismo, establecer los factores pronósticos. Conclusiones: tumor de ubicación y presentación inusual.

Introduction: Primary tumor of giant soft tissue cells with low malignant potential is a rare tumor. They have been reported in several sites, including breast, salivary glands, lung, etc. Giant cell tumors of the skull represent 1%, preferably affects the sphenoid and temporal bones. With low potential for malignant transformation. Methods: The case of a 27-year-old male patient is presented, with decrease in left visual acuity, rapidly progressive; with evidence of left afferent pupillary defect. CT and NMR are requested finding tumor lesion in left sphenoid topography with extension to the cavernous sinus of the same side displacing the pituitary gland. Discussion: The objective of the case report is to describe the frequency of the di-sease and the characteristics in its presentation, define guidelines for the approach, treatment and follow-up; also establish the prognostic factors. Conclusions: Tumor of unusual location and presentation.

Systemic and local inflammatory response after implantation of biomaterial in critical bone injuries

ABSTRACT Purpose: To evaluate inflammatory response in critical bone injuries after implantation of the biomaterial composed of hydroxyapatite (HA)/poly (lactic-coglycolic acid) (PLGA)/BLEED. Methods: Forty-eight male Wistar rats (280 ± 20 grams) were divided into two groups: control group (CG), in which the animals do not receive any type of treatment; and biomaterial group (BG), in which the animals received the HA/PLGA/BLEED scaffold. Critical bone injury was induced in the medial region of the skull calotte with the aid of a trephine drill 8 mm in diameter. The biomaterial was implanted in the form of 1.5-mm thick scaffolds. Serum and calotte were collected at one, three and seven days. Results: Biomaterial had a significant effect on the morphological structure of the bone, accelerating osteoblast activation within three days, without causing exacerbated systemic inflammation. In addition, quantitative real-time polymerase chain reaction (qRT-PCR) analysis showed that BG induced upregulation of osteogenic genes such as runt-related transcription factor 2, and stimulated genes of inflammatory pathways such as tumor necrosis factor-α, on the first day without overexpressing genes related to bone matrix degradation, such as tissue inhibitor of metalloproteinases-1 and matrix metalloproteinase-9. Conclusions: The HA/PLGA/BLEED® association can be used as a bone graft to aid bone repair, as it is capable of modulating expression of important genes at this stage of the repair process.

Ultrasound fusion navigation-guided core needle biopsy for lesions involved the parapharyngeal space, infratemporal fossa, and skull base: a pilot study / 中华超声影像学杂志

Objective:To explore the value of ultrasound fusion navigation technology in the biopsy of parapharyngeal-infratemporal fossa-skull base (PIS) lesions.Methods:This study was conducted at the First Affiliated Hospital of Sun Yat-Sen University from March 2021 to March 2022 and included 8 patients [3 females and 5 males; age, (50±20) years; range, 16-76 years] with PIS lesions who needed to clarify the pathological diagnosis. The ultrasound fusion navigation with CT or MRI was used to guide lesion biopsy, and the technical feasibility, pathological diagnostic results and complications were evaluated.Results:The biopsy procedures were successful in all 8 patients, and the lesion size ranged from 2.2 to 6.5 cm. The exact pathological diagnosis was obtained in 7 patients, and the diagnostic rate was 87.5% (7/8). No major complication was observed after the biopsy. Mild complications occurred in 1 case, with a incidence of 12.5% (1/8).Conclusions:Ultrasound fusion navigation-guided biopsy is feasible, effective, and safe in the biopsy of deep head and neck lesions.

Multi-factor analysis of sellar floor dural suture, bone reconstruction and pedicled nasoseptal flap in skull base reconstruction / 西安交通大学学报(医学版)

【Objective】 To evaluate the efficacy and weight of sellar floor repair techniques such as different dura suture, bone reconstruction, and pedicled nasoseptal flap (PNSF) on the skull base reconstruction of medium and high flow cerebrospinal fluid leakage during endonasal endoscopic pituitary adenoma surgery. 【Methods】 We collected the data of Grade 2-3 cerebrospinal fluid leakage (Kelly grade) during endonasal endoscopic pituitary adenoma resection in our hospital from January 2015 to April 2021. Multiple reconstruction techniques such as dura suture, bone reconstruction and PNSF, and related factors such as age, sex, body mass index (BMI), diabetes, tumor size and diameter of diaphragmatic defect were recorded and introduced to multivariate regression to analyze the effects of the above factors on the duration of postoperative cerebrospinal fluid rhinorrhea and bed rest time, with a special focus on the weight priority of dura suture, bone reconstruction, and PNSF. 【Results】 A total of 281 patients were included, with the average age of (47±12.6) years, males accounting for 52.6%. There were 93 cases of PNSF, 268 cases of bone reconstruction, 109 cases of dura anchor suture, 50 cases of patch suture, and 122 cases without suture. The results of multivariate analysis indicated that the application of PNSF, bone reconstruction, and dura suture significantly reduced postoperative rhinorrhea time [reduced by 18.524, 35.876, and 16.983/19.791 (anchor suture/patch suture) hours, respectively; all PPNSF>bone reconstruction [Standard β=0.211/0.207 (anchor suture/patch suture)>0.200>0.165]. The weight of reducing bed time was bone reconstruction >dura suture > PNSF [Standard β=0.239>0.206/0.210 (anchor suture/patch suture) >0.164]. After stabilizing the learning curve in 25-30 cases, the average time for bone reconstruction was (3.9±0.4) minutes. After stabilizing learning curve in 30-40 cases, the dura suture technique took an average of (3.7±0.3) minutes per stitch, (3.7±1.0) stitches per case, and (13.6±2.7) minutes of total time consumption per case. 【Conclusion】 Dural anchoring and patching suture can both effectively shorten the duration of cerebrospinal fluid rhinorrhea and bed rest time. Bone reconstruction significantly improves the stability of reconstruction, especially in prompting patients’ early disengagement of bed rest. Moreover, the learning curves of the above two methods are economical and reasonable, and their weight is close to or even exceeds that of PNSF. Therefore, they can be an effective supplement or even substitute for PNSF.

Assessment of americium retention in bone by measuring 241Am in the skull with a whole-body counter / 中国辐射卫生

Objective To assess the retention of 241Am in the whole-body bone of worker by measuring the retention of 241Am in the skull. Methods A whole-body counter with high-purity germanium detector was used to measure the 59.5 keV full-energy peak count of 241Am in the skull. The efficiency of the measurement was calibrated by the digital skull phantom combined with the geometric model of the detector. The retention of 241Am in the worker’s skull was calculated. Results The proportion of skull dry weight relative to the whole-body bone dry weight was used as the coefficient to calculate the 241Am deposition in the whole-body bone from the measured activity of skull 241Am. Conclusion With the retention of 241Am in the skull and the proportion of skull dry weight, the retention of 241Am in the whole-body bone of the worker was calculated to be about 806 Bq.

Effect of the multidisciplinary diagnosis and treatment nursing on postoperative psychological state and quality of life in patients with lateral skull base tumor / 中国实用护理杂志

Objective:To explore the application effect of the multidisciplinary diagnosis and treatment nursing in improving postoperative anxiety and depression and quality of life in patients with lateral skull base tumor, so as to provide a constructive template for the multidisciplinary diagnosis and treatment nursing.Methods:This was a prospective cohort study design. A total of 100 patients who underwent lateral skull base tumor surgery in Shandong Second Provincial General Hospital from January 2021 to April 2022 were selected as the research objects. The patients were divided into observation group and control group by random digits table method with 50 cases in each group. The control group was given routine nursing care after operation of lateral skull base tumor and routine follow-up management. The observation group received the multidisciplinary diagnosis and treatment nursing on the basis of the control group. The intervention time was 3 months. The psychological state and quality of life of the two groups before and after intervention were evaluated by Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Short Form Health Questionnaire (SF-36).Results:There was no significant difference in SAS, SDS, and SF-36 scores before intervention between the two groups ( P>0.05). The scores of SAS, SDS and SF-36 after the intervention were (44.58 ± 5.61), (41.66 ± 8.48), (75.66 ± 13.65) points in the observation group, and (50.86 ± 4.91), (45.80 ± 9.32), (68.43 ± 14.34) points in the control group, there were statistically significant differences between the two groups( t values were -5.95, -2.32, 2.58, all P<0.05). Conclusions:The multidisciplinary diagnosis and treatment nursing can significantly improve anxiety, depression and quality of life of patients with lateral skull base tumor after surgery.

Occurrence of hypopituitarism after severe craniocerebral trauma and its predictors / 中华内分泌外科杂志

Objective:To investigate the occurrence and predictors of hypopituitarism after traumatic brain injury (TBI) .Methods:A prospective study was conducted on 185 patients with severe TBI in the Emergency Department of the First Hospital of Shanxi Medical University from Jan. 2020 to May. 2022, of whom 108 were male and 77 were female; age ranged from 18 to 79 years, mean (51.32±9.34) years. Pituitary function was assessed within 3-7 d after the onset of TBI, and the occurrence of hypopituitarism after severe TBI was counted. 41 cases in the hypopituitarism group, 26 males and 15 females, aged (52.76±9.83) years, were divided into the hypopituitarism group (hypopituitarism occurred) and the non-hypopituitarism group (hypopituitarism did not occur) according to whether hypopituitarism occurred. In the non-decompensated group, there were 144 cases, 82 males and 62 females, aged (50.91±9.27) years. The clinical data of the decompensated and non-decompensated groups were compared, and the factors influencing the occurrence of hypopituitarism were analysed, and a logistic prediction model was constructed based on the relevant influencing factors. The value of this model in predicting the occurrence of hypopituitarism after severe TBI was evaluated by using the receiver operating characteristic (ROC) curve.Results:The prevalence of hypopituitarism in the 185 patients with severe TBI in this study was 22.16%; the Glasgow coma scale (GCS) score on admission was lower in the decompensated group than in the non-decompensated group [ (6.36±1.04) vs (7.48±0.59) ], the percentage of hyperbaric oxygen therapy was lower than in the non-decompensated group (21.95% vs 49.31%) , the percentage of intracranial pressure (82.93% vs 49.31%) , midline displacement ≥5 mm (78.05% vs 29.86%) , skull base fracture (34.15% vs. 17.36%) , diffuse cerebral edema (19.51% vs 4.17%) , and serum brain derived neurophic factor (BDNF) . Brain derived neurophic factor (BDNF) was higher than that in the non-reduced group [ (6.35±1.29) ng/ml vs (4.51±1.06) ng/ml], and neuronal-specific enolase (NSE) was higher than that in the non-reduced group [ (33.06±5.42) μg/L vs (23.15±4.97) μg/L]. (4.97) μg/L]. Vascular epithelial growth factor (VEGF) was higher than that in the non-reduced group [ (312.07±24.35) pg/ml vs (226.80±20.96) pg/ml], tumor necrosis factor-α (TNF-α) was higher than that in the non-reduced group [ (281.24±38.91) ng/L vs (186.91) pg/ml], and tumor necrosis factor-α (TNF-α) was higher than that in the non-reduced group (186.55±35.72) ng/L (all P<0.05) . Increased intracranial pressure, midline displacement ≥5 mm, diffuse cerebral edema, serum BDNF, NSE, VEGF, and TNF-α levels were all independent risk factors for the development of hypopituitarism after severe TBI, with admission GCS score and hyperbaric oxygen therapy as protective factors ( P<0.05) ; a logistic prediction model was constructed based on the influencing factors as: Logit ( P) = 5.264-0.880×admission GCS score + 1.618×increased intracranial pressure + 1.941×midline displacement ≥5 mm + 1.289×diffuse cerebral edema+1.306×BDNF+1.426×NSE+1.781×VEGF+1.615×TNF-α-0.758×hyperbaric oxygen therapy; the model predicted the occurrence of severe TBI after the area under the curve (AUC) of hypopituitarism was 0.930 (95% CI 0.883-0.962) , with a predictive sensitivity and specificity of 90.24% and 89.19%, respectively. Conclusions:The incidence of hypopituitarism is higher after severe TBI. Increased intracranial pressure, midline displacement ≥5 mm, diffuse cerebral edema, serum BDNF, NSE, VEGF and TNF-α levels are all used as predictors of hypopituitarism.

Increasing Source-Object Distance: A Computed Radiographybased Strategy to Reducing Radiation Dose in Occipital-Frontal Skull X-Ray

@#Introduction: Exploring potential optimization strategies and developing evident practices is critical. Previous studies show that radiation dose can be reduced by increasing the source-image distance (SID). Although most studies use digital radiography, many hospitals in underdeveloped countries still use computed radiography (CR). Therefore, research will investigate the relationship between SID and Entrance surface dose (ESD) using the CR. Methods: This study involved the measurement of radiation dose and image quality of a radiological procedure performed at a reference SID; 100cm and the tested SIDs; 110cm, 120cm, and 130cm, using constant technical factors (70kVp, 25mAs, grid). A LiF; Mg Ti thermoluminescence dosimeter (TLD-100) chip was placed in the center of the radiation field of the OF10° skull radiography examination to measure ESD. Image quality was assessed using the European Commission guidelines and graded using relative visual assessment analysis (VGA). Results: Significant ESD reduction from 21% and 45% when SID was increased from 100cm to 130cm (p <0.001), where SID was negatively correlated with ESD (r= - 0.98). The VGA scores showed no statistical difference in the image quality of the OF10° skull radiography examination for the tested and reference images (p=0.21). VGA scores for 120cm images showed the highest image quality among the SIDs tested with a dose reduction of 37%. Conclusion: ESD was statically reduced when SID was increased from 100cm to 130cm, while image quality was diagnostically acceptable. The study suggests that 120cm is the optimal SID when both dose and image quality are considered.