Endoscopic Study of Ethmoidal Canals in Cadavers, Including a Histological Analysis of Their Contents

Abstract Introduction The advent of the endoscope has enabled the use of the endonasal approach for a variety of diseases. Studying the ethmoidal canals is important for surgeries of the paranasal sinuses and the anterior base of the skull. Objective To investigate the ethmoidal canals and evaluate their structure, the presence of vessels and nerves, their location, and to perform an anatomopathological study of their contents. Methods We evaluated 20 cadavers (20 left and 20 right nasal cavities) through endoscopic dissection of the anterior base of the skull and exposure of the medial periorbita and dura mater; then, the ethmoidal canals were located and measured in relation to the anterior wall of the sphenoid sinus and between the ethmoidal canals, followed by removal of their content for histological analysis. Results Vessels were present in 75% of the left anterior ethmoidal canals, 70% of the left posterior ethmoidal canals, 75% of the left middle ethmoidal canals, 85% of the right anterior ethmoid canals, and 64.5% of the right posterior ethmoid canals; 50% of the right middle ethmoidal canals contained one vessel. Conclusion The ethmoidal canal does not necessarily contain an ethmoidal artery. Studies with a larger sample should be performed to quantify the correct proportion of arteries and ethmoidal canals.

In Vivo Computed Tomography Direct Volume Rendering of the Anterior Ethmoidal Artery: A Descriptive Anatomical Study

Abstract Introduction The clinical relevance of the anatomy and variations of the anterior ethmoidal artery (AEA) is outstanding, considering its role as a landmark in endoscopic surgery, its importance in the therapy of epistaxis, and the high risks related to iatrogenic injuries. Objective To provide an anatomical description of the course and relationships of the AEA, based on direct computed-tomography (CT)-based 3D volume rendering. Methods Direct volume rendering was performed on 18 subjects who underwent (CT) with contrast medium for suspected cerebral aneurism. Results The topographical location of 36 AEAs was assessed as shown: 10 dehiscent (27.8%), 20 intracanal (55.5%), 6 incomplete canals (16.7%). Distances from important topographic landmarks are reported. Conclusion This work demonstrates that direct 3D volume rendering is a valid imaging technique for a detailed description of the anterior ethmoidal artery thus representing a useful tool for head pre-operatory assessments.

Impact of delay in the diagnosis and treatment of head and neck cancer / Impacto da demora no diagnóstico e tratamento no câncer de cabeça e pescoço

ABSTRACT INTRODUCTION: Head and neck tumors can be easily recognized through clinical evaluation. However, they are often diagnosed at advanced stages. OBJECTIVE: To evaluate the delay from the patient's initial symptoms to the definitive treatment. METHODS: Retrospective study of patients enrolled in 2011 and 2012. A questionnaire was filled in about socioeconomic aspects, patient history, tumor data, professionals who evaluated the patients, and the respective time delays. RESULTS: The following time delay medians were observed: ten months between symptom onset and the first consultation; four weeks between the latter and the first consultation with a specialist; four weeks between the specialist consultation and diagnosis attainment; and 12 weeks between diagnosis and the start of treatment. CONCLUSIONS: Most head and neck tumors are diagnosed at advanced stages, due to patient and health care factors.

RESUMO INTRODUÇÃO: Apesar de poderem ser facilmente reconhecidos ao exame clínico, os tumores de cabeça e pescoço são, muitas vezes, diagnosticados em estadiamento avançado. OBJETIVO: Avaliar a demora entre o surgimento dos sintomas iniciais do paciente e seu encaminhamento para o tratamento definitivo. MÉTODO: Trata-se de um estudo retrospectivo de pacientes arrolados em 2011 e 2012. Foi preenchido questionário sobre fatores sócio-econômicos, antecedentes, dados do tumor, profissionais que avaliaram os pacientes e respectivos períodos de demora. RESULTADOS: Foram observadas as seguintes medianas de tempo de demora: 10 meses entre o início dos sintomas e o primeiro atendimento; 4 semanas entre este e a primeira consulta com o especialista; 4 semanas entre esta e o estabelecimento do diagnóstico; e 12 semanas entre este e o início do tratamento. CONCLUSÕES: A maior parte dos cânceres de cabeça e pescoço é diagnosticada em estádios avançados, por fatores relacionados aos pacientes e à atenção à saúde.