Morphometric Analysis of the Sella Turcica and Sphenoid Sinus: A Retrospective Cross-Sectional Study / Análisis Morfométrico de la Silla Turca y Seno Esfenoidal: Un Estudio Transversal Retrospectivo

SUMMARY: This study evaluated the effects of ethnicity, sex, and age on the linear dimensions of the sella turcica (ST) and the pneumatization patterns of the sphenoid sinus (SS). In this cross-sectional retrospective study, we examined digitally standardized computed tomography scans of 100 Jordanians. These study participants comprised 50 men and 50 women, and their age ranged from 23 years to 77 years. We assessed linear ST dimensions and SS pneumatization patterns and correlated this data to age and sex. Furthermore, we compared the data with different ethnic groups from previous studies. The mean (standard deviation [SD]) length, diameter, width, and depth of the ST were 9.98 (1.89) mm, 12.45 (2) mm, 11.96 (1.76) mm, and 8.38 (1.63) mm, respectively. The mean (SD) interclinoid diameter was 8.84 (2.03) mm. These measurements were not significantly correlated with sex or age. With regards to pneumatization patterns of the sphenoid sinus, the conchal type was observed in 2 % of the study participants. Presellar involvement was observed in 30 % of the patients. The sellar and postsellar type was observed in 66 % and 2 % of patients, respectively. In our study, ST measurements did not differ significantly between the sexes. Pneumatization patterns of the SS differed from the patterns reported for other races. The findings of this study could assist neurosurgeons, orthodontists, and forensic medical investigators in diagnosing and planning treatment for pituitary gland pathologies.

Este estudio evaluó los efectos de la etnia, el sexo y la edad sobre las dimensiones lineales de la silla turca y los patrones de neumatización del seno esfenoidal (SE). En este estudio retrospectivo transversal, examinamos tomografías computarizadas estandarizadas digitalmente de 100 jordanos. Los participantes del estudio comprendían 50 hombres y 50 mujeres entre los 23 y los 77 años de edad. Evaluamos las dimensiones lineales del SE y los patrones de neumatización del SE y correlacionamos estos datos con la edad y el sexo. Además, comparamos los datos con diferentes grupos étnicos de estudios previos. La media (desviación estándar) de la longitud, el diámetro, el ancho y la profundidad del SE fueron 9,98 (1,89) mm, 12,45 (2) mm, 11,96 (1,76) mm y 8,38 (1,63) mm, respectivamente. El diámetro interclinoideo medio era de 8,84 (2,03) mm. Estas medidas no se correlacionaron significativamente con el sexo o la edad. Con respecto a los patrones de neumatización del seno esfenoidal, el tipo conchal se observó en el 2 % de los participantes del estudio. Se observó afectación preselar en el 30 % de los pacientes. El tipo selar y postsillar se observó en el 66 % y el 2 % de los pacientes, respectivamente. En nuestro estudio, las medidas del SE no difirieron significativamente entre los sexos. Los patrones de neumatización de la silla turca diferían de los patrones informados para otras razas. Los hallazgos de este estudio podrían ayudar a los neurocirujanos, ortodoncistas e investigadores médicos forenses en el diagnóstico y el tratamiento de las patologías de la hipófisis.

Transoral Endoscopic Resection of Oropharyngeal Pedunculated Giant Fibrolipoma Using Harmonic Scalpel: A Case Report.

Lipoma is the most common soft tissue benign tumor in the body. It can occur in the head and neck area as well. Fibrolipoma is a variant of lipoma that contains fibrous tissue. Fibrolipomas of the head and neck are relatively rare, and their presentation depends largely on their size and location; some slowly growing tumors might go unnoticed until they reach significant size and become symptomatic. Here, we report a case of 64-year-old male who presented with large pedunculated oropharyngeal fibrolipoma that originated from the posterior oropharyngeal wall and extended downward into the postcricoid area and cervical esophagus. It was excised transorally using rigid endoscope, and ACE Harmonic scalpel was utilized to excise this 16.7 cm long mass. The postoperative pain was minimal, the surgical site showed complete healing, and oral diet was resumed easily in 5 days.

The morbidity of out-of-hours surgery for Cauda Equina Syndrome.

BACKGROUND: There is no literature specifically addressing the morbidity of out of hours surgery for Cauda Equina Syndrome (CES). Our paper rectifies this omission. This will assist the surgeon with real-time decision making with regards to timing of intervention in this rare but potentially disabling disease. METHODS: A retrospective case series analysis. Individual cases were identified using local electronic theatre management systems in the four neurosurgical centres in Scotland in 2017. "Out of hours" surgery was defined as starting outside the times 0900-1700 Monday to Friday. RESULTS: 86 patients underwent out of hours surgery for CES in Scotland in 2017. One patient sustained a nerve root injury without new deficit, giving an overall risk of 1.2%. Four patients had the intra-operative complication of CSF leak, giving an overall risk of 4.7%. Five patients underwent early revision surgery, equivalent to a re-operation risk of 5.8%. CONCLUSIONS: The morbidity of out of hours surgery for CES is comparable to that of elective microdiscectomy. Operating out of hours for CES does not appear to have an increased risk of complications. Since increased surgical risk is not borne out by our study, this should not be used as a justification to delay operative treatment.

Spontaneous parapharyngeal haematoma caused by a leaking vertebral artery pseudoaneurysm.

We describe an unusual case of spontaneous parapharyngeal haematoma, in a patient with haemophilia. The cause was a leaking extracranial vertebral artery pseudoaneurysm eroding through the atlas at the level of the skull base. The leaking pseudoaneurysm was successfully controlled with embolisation of the vertebral artery. The haematoma caused a cerebral infarct and vocal cord paralysis, requiring external drainage and tracheostomy. This is the first reported case of a parapharyngeal haematoma originating from a vertebral artery pseudoaneurysm where imaging demonstrated a causal link.

An unusual air gun injury to the ethmoid sinus.

We report an air gun pellet in the ethmoid sinus. The entrance point was concealed in the conjunctiva of the medial canthus, sparing the eye and skin. The pellet traversed the ethmoid and was stopped by the cribriform plate. It was removed by an endoscopic approach without complications. The literature is reviewed. A high index of suspicion is required to identify penetrating foreign bodies in patients walking in with low-velocity gun injuries.

Patient satisfaction with the bone-anchored hearing aid: a 14-year experience.

OBJECTIVES: To evaluate the self-rated quality of life (QoL) and benefits associated with the use of bone-anchored hearing aids (BAHAs) and to identify potential improvements in comparison to the previous conventional hearing aids. STUDY DESIGN: Cross-sectional. SETTING: BAHA program in tertiary referral center. PATIENTS: One hundred fifty-two adults who underwent BAHA procedure for more than 6 months. INTERVENTION: Rehabilitative. MAIN OUTCOME MEASURE: Results of the Entific Medical Systems questionnaire. RESULTS: One hundred seventeen responses (77%) were obtained. Overall satisfaction was excellent (median = 9). BAHA was rated very good/excellent in single-person conversation (85%), but fared less well in group situation (45%). BAHA was reported as better than the previous aid by more than 50% of patients within each subcategory where applicable (handling, 64%; comfort, 56%; cosmetic, 60%; sound, 68%; infections, 75%). Of those who reported improvement of ear infections, one quarter remained unsatisfied of improvement in QoL. Patients who used BAHA for 3 years or less (n = 45) had a similar rating to sound quality and conversation as those who used it longer (n = 72). Surprisingly, a subset of patients (n = 8) with poor bone-conduction thresholds (> 45 dB) remained satisfied with the device (median = 8). CONCLUSIONS: The BAHA can improve QoL and hearing outcome with full acclimatization to the device being achievable within a reasonable amount of time. As with conventional aids, sound quality in group situations remains poor with the BAHA. Our results provide a predictive value during preoperative counseling of patients.