Impact of site of occlusion in proximal splenic artery embolisation for blunt splenic trauma.

BACKGROUND: Proximal splenic artery embolisation (PSAE) can be performed in stable patients with Association for the Surgery of Trauma (AAST) grade III-V splenic injury. PSAE reduces splenic perfusion but maintains viability of the spleen and pancreas via the collateral circulation. The hypothesized ideal location is between the dorsal pancreatic artery (DPA) and great pancreatic artery (GPA). This study compares the outcomes resulting from PSAE embolisation in different locations along the splenic artery. MATERIALS AND METHODS: Retrospective review was performed of PSAE for blunt splenic trauma (2015-2020). Embolisation locations were divided into: Type I, proximal to DPA; Type II, DPA-GPA; Type III, distal to GPA. Fifty-eight patients underwent 59 PSAE: Type I (7); Type II (27); Type III (25). Data was collected on technical and clinical success, post-embolisation pancreatitis and splenic perfusion. Statistical significance was assessed using a chi-squared test. RESULTS: Technical success was achieved in 100% of cases. Clinical success was 100% for Type I/II embolisation and 88% for Type III: one patient underwent reintervention and two had splenectomies for ongoing instability. Clinical success was significantly higher in Type II embolisation compared to Type III (p = 0.02). No episodes of pancreatitis occurred post-embolisation. Where post-procedural imaging was obtained, splenic perfusion remained 100% in Type I and II embolisation and 94% in Type III. Splenic perfusion was significantly higher in the theorized ideal Type II group compared to Type I and III combined (p = 0.01). CONCLUSION: The results support the proposed optimal embolisation location as being between the DPA and GPA.

Temporomandibular joint arthrocentesis guided by ultrasonography: An anatomical study.

The temporomandibular joint (TMJ) arthrocentesis is a common procedure in maxillofacial surgery departments for the treatment of TMJ dysfunction. The use of ultrasonography in this area is rare, and in the vast majority of cases only as a diagnostic, and non-therapeutic use. Through this study we propose the equipment and ultrasound parameters necessary to obtain detailed and practical images when using ultrasonography as a therapeutic guide in arthrocentesis of TMJ. In addition, we provide data regarding the placement and working angulations of both the ultrasound probe and the needle that are ideal for facilitating image-guided puncture. It is a simple technique, with a relatively short learning curve, and that can provide considerable intraoperative help to the surgeon.

Tomografía computarizada multidetector en el traumatismo facial: informe estructurado y observaciones clave para un abordaje sistemático / Multidetector computed tomography for facial trauma: structured reports and key observations for a systematic approach

Las fracturas faciales, relacionadas frecuentemente con accidentes de tráfico, agresiones, accidentes laborales o caídas, constituyen un considerable número de urgencias en nuestros hospitales y asocian, además, una elevada morbimortalidad. La tomografía computarizada multidetector es la técnica de imagen de elección por su amplia disponibilidad y rapidez, y porque permite tanto la caracterización de las fracturas faciales como de las complicaciones asociadas, incluyendo las de localización craneal. Es, por tanto, fundamental para orientar el manejo clínico y la planificación quirúrgica. En este trabajo se describe la anatomía radiológica de la región facial, destacando la importancia de los contrafuertes o arbotantes faciales, se ilustran los hallazgos característicos en las fracturas faciales, y se indican los puntos clave necesarios para su abordaje estructurado al realizar el correspondiente informe radiológico

Facial fractures, often related to traffic accidents, assault, work-related accidents, or falls, account for a considerable number of emergencies in our hospitals and are associated with high morbidity and mortality. Multidetector computed tomography (MDCT) is the imaging technique of choice in this scenario because it is widely available, fast, and useful for characterizing facial fractures and associated complications, including those located in the head. For all these reasons, MDCT is fundamental in the clinical management of these patients and in planning surgery. This paper describes the radiological anatomy of the facial region, underlining the importance of the facial buttresses, and it indicates the key points necessary for carrying out a structured approach and elaborating the corresponding radiologic report

Multidetector computed tomography for facial trauma: structured reports and key observations for a systematic approach. / Tomografía computarizada multidetector en el traumatismo facial: informe estructurado y observaciones clave para un abordaje sistemático.

Facial fractures, often related to traffic accidents, assault, work-related accidents, or falls, account for a considerable number of emergencies in our hospitals and are associated with high morbidity and mortality. Multidetector computed tomography (MDCT) is the imaging technique of choice in this scenario because it is widely available, fast, and useful for characterizing facial fractures and associated complications, including those located in the head. For all these reasons, MDCT is fundamental in the clinical management of these patients and in planning surgery. This paper describes the radiological anatomy of the facial region, underlining the importance of the facial buttresses, and it indicates the key points necessary for carrying out a structured approach and elaborating the corresponding radiologic report.