Three-dimensional reconstruction of the temporal bone: Comparison of in situ, CT, and CBCT measurements.

OBJECTIVE: To evaluate the accuracy of three-dimensional (3D) Cone Beam Computed Tomography (CBCT) and Computed Tomography (CT) reconstructions of human temporal bones compared with in situ measurements. MATERIAL AND METHODS: Experimental anatomical study of 10 human temporal bones. Wilcoxon's test was used to compare 8 distances on each temporal bone measured in situ and then on 3D CT and CBCT reconstructions. Six landmarks were used: external auditory canal (EAC), tip of the mastoid process, tip of the occiput, zygoma, a point situated 1cm above the tip of the mastoid process (T0) (open technique: lower limit of the mastoidectomy), head of stapes. RESULTS: No significant difference was observed between the 3 measuring techniques for any of the distances studied (P>0.05). DISCUSSION: This study demonstrates the equivalence of CBCT and CT for temporal bone measurements. CONCLUSION: CBCT is a new imaging modality providing 3D reconstructions of the temporal bone that are as reliable as those obtained by CT. As a result of better spatial resolution compared to CT, CBCT is associated with a significantly lower radiation dose. This technique constitutes a morphological progress, as CBCT is comparable to CT, allowing investigation of pathological ears with a lower radiation dose.

Interpretation of suspect head and neck fixations seen on PET/CT in lung cancer.

OBJECTIVES: Smoking is the major risk factor for lung and head and neck cancer. The purpose of the present study was to determine the clinical impact of serendipitously revealed head and neck fixation on PET/CT in patients undergoing investigation for lung cancer. MATERIAL AND METHODS: The reports from PET/CT studies for patients with lung cancer from September 2005 and April 2012 were retrospectively reviewed. Head and neck incidentaloma was interpreted as suggestive of second primary malignancy. These incidental findings were compared with the final diagnosis obtained from clinical and histological investigation. RESULTS: Five hundred and ninety-two patients were investigated on PET/CT for lung cancer in the study period. PET/CT-positive head and neck lesions suggestive of second primary malignancy were found in 65 (11%) patients. Nasoendoscopy was performed in 23 patients and biopsy in 10. In 4 patients (17.4% of those explored), a second primary malignant lesion was proved on histology: 2 squamous cell carcinomas (larynx and oral cavity), 1 undifferentiated carcinoma (parotid), and 1 osteosarcoma (mandible). At a median 13 months' follow-up, 3 of the 4 patients with a second primary had died from disease-related causes and 1 was free of recurrence. Metastases from lung adenocarcinoma were found in 2 patients (0.34%). CONCLUSIONS: PET/CT detected incidental head and neck malignant tumors in at least 0.68% of lung cancer patients, but in 6.4% of those with suspect head and neck fixation.

Outpatient hemithyroidectomy.

UNLABELLED: Outpatient surgery consists of performing an elective surgical procedure in the context of a day-only admission. This type of management is the result of sociological changes and allows a reduction of the cost. Hemithyroidectomy is a well-defined surgical procedure with known complications. The authors assessed the feasibility, patient satisfaction and cost of outpatient hemithyroidectomy. MATERIAL AND METHODS: One hundred and forty-six hemithyroidectomies were performed between August 2011 and September 2012. Inclusion criteria for outpatient surgery were surgical, anaesthetic and patient-dependent. Exclusion criteria were related to the bleeding risk, socio-economic conditions and the patient's understanding of the procedure. Preoperative information and the modalities of anaesthesia, surgery, postoperative surveillance and follow-up were standardized. Patient satisfaction was evaluated by questionnaire and cost was evaluated on the basis of medical information department data. RESULTS: Forty patients were eligible and 34 patients agreed to outpatient surgery (M/F sex ratio: 1/4; mean age: 46 ± 6.3 years), but only 32 operations were performed on an outpatient basis. Two conversions to conventional hospitalisation were required, one because of preoperative initiation of platelet anti-aggregants and the other because of nausea. One patient remained in hospital on the day after the operation because of severe asthenia and nausea. CONCLUSION: Patients were satisfied with this type of management and 100% of them reported that they would repeat the experience. The economy for our establishment was €711 per patient. This procedure improves patient comfort without increasing the risks and allows a reduction of management costs.