Clinical outcomes of functional endoscopic sinus surgery in cystic fibrosis patients - a single centre experience.

BACKGROUND: Endoscopic sinus surgery (ESS) is an established surgical option for cystic fibrosis (CF) patients with chronic rhinosinusitis that is refractory to conventional medical management. Objective and subjective evidence of benefit of ESS in this cohort of patients is currently conflicting in the literature. METHODOLOGY: A single center retrospective study was undertaken of all CF patients (transplanted and non-transplanted) over the age of 16 who underwent an ESS over a six-year period from 2015 to 2021. Patients on triple-therapy CFTR modulators were excluded. Data was collected on demographics, clinical management, and outcome measures. The objective outcome measures were lung function (%predicted FEV1), pulmonary exacerbations (total number of days of IV antibiotics- both ambulatory and in hospital). The subjective outcome measure was SNOT-22 scores preand 6 months post-operatively. A minimally clinical important difference (MCID) in SNOT-22 scores of 9 points was used. RESULTS: 55 patients were included in our study, with a median age of 31 and 53% females. Median Lund-Mackay scores for the cohort was 13 (3- 24). There was a significant improvement in lung function at 1-year post-surgery, and a significant MCID reduction in SNOT-22 scores at 6 months post-surgery across the cohort. Sub-group analysis revealed a sustained MCID reduction in SNOT-22 scores in both lung-transplanted and native lung groups, and in patients with primary ESS or previous ESS. However, there was no post-operative pulmonary function improvement in lung transplanted patients and patients with previous ESS. There was no impact on the rate of pulmonary exacerbations across the cohort. 2 patients in the cohort died secondary to pulmonary disease. CONCLUSIONS: There was a demonstrated clinical and symptomatic benefit of ESS in CF patients in this study. Stricter guidelines for indications for ESS need to be established with regards to CF patients who will undergo ESS in the future.

A feasibility study of using a high-definition intra-operative exoscope in teaching septorhinoplasty.

OBJECTIVE: This pilot study aimed to assess the feasibility of using a high-definition intra-operative exoscope in teaching septorhinoplasty. METHODS: The exoscope was used in septorhinoplasty cases with different trainers and trainees. A high-definition screen displayed real-time, magnified images. Post-procedure, a questionnaire was completed by trainer and trainees, assessing the feasibility, safety and content validity of the exoscope as a septorhinoplasty training tool. RESULTS: Trainees and trainers assigned favourable ratings to all aspects of the exoscope as a training tool, particularly with regard to teaching anatomy and improving visualisation. CONCLUSION: The exoscope is a potentially effective training tool in septorhinoplasty, and is especially useful in improving visualisation, without restricting the operator. Annotatable intra-operative photographs and videos allow trainees to study cases outside of the operating theatre environment. The use of an exoscope for septorhinoplasty in the UK may facilitate increased hands-on involvement earlier in training than is currently typical.

The European Rare Disease Network for HHT Frameworks for management of hereditary haemorrhagic telangiectasia in general and speciality care.

Hereditary haemorrhagic telangiectasia (HHT) is a complex, multisystemic vascular dysplasia affecting approximately 85,000 European Citizens. In 2016, eight founding centres operating within 6 countries, set up a working group dedicated to HHT within what became the European Reference Network on Rare Multisystemic Vascular Diseases. By launch, combined experience exceeded 10,000 HHT patients, and Chairs representing 7 separate specialties provided a median of 24 years' experience in HHT. Integrated were expert patients who focused discussions on the patient experience. Following a 2016-2017 survey to capture priorities, and underpinned by more than 40 monthly meetings, and new data acquisitions, VASCERN HHT generated position statements that distinguish expert HHT care from non-expert HHT practice. Leadership was by specialists in the relevant sub-discipline(s), and 100% consensus was required amongst all clinicians before statements were published or disseminated. One major set of outputs targeted all healthcare professionals and their HHT patients, and include the new Orphanet definition; Do's and Don'ts for common situations; Outcome Measures suitable for all consultations; COVID-19; and anticoagulation. The second output set span aspects of vascular pathophysiology where greater understanding will assist organ-specific specialist clinicians to provide more informed care to HHT patients. These cover cerebral vascular malformations and screening; mucocutaneous telangiectasia and differential diagnosis; anti-angiogenic therapies; circulatory interplays between anaemia and arteriovenous malformations; and microbiological strategies to counteract loss of normal pulmonary capillary function. Overall, the integrated outputs, and documented current practices, provide frameworks for approaches that augment the health and safety of HHT patients in diverse health-care settings.

EPOS 4 Patients.

EPOS2020 is the 4th and most recent version of the European Position Paper on Rhinosinusitis and Nasal Polyps which was first published in 2005. It aims to provide the most up to date scientifically robust information on the topic published in the literature which has been critically analysed by an international group of clinicians drawn from all disciplines dealing with these problems together with patients. The guidelines offer evidence-based recommendations and care pathways for acute and chronic rhinosinusitis in both adults and children. Management of these diseases from the patients' perspective is an important part of EPOS2020. Not only is this included in the main document but, for the first time, we have produced a separate supplement dedicated to and in collaboration with patients, EPOS4Patients, which aims to provide information in an accessible format, to answer frequently asked questions about these diseases and their treatment options as well as including useful patient resources and websites. It has never been more important for patients to be actively involved in their care. Being well informed helps you to make the best decisions together with your doctor.

Coronavirus disease 2019: changing the future of emergency epistaxis management.

BACKGROUND: Acute epistaxis can be a life-threatening airway emergency, requiring in-patient admission. The coronavirus disease 2019 pandemic placed significant strain on hospital resources, and management has shifted towards an out-patient-centred approach. METHODS: A five-month single-centre retrospective study was undertaken of all epistaxis patients managed by the ENT department. A pre-coronavirus disease 2019 pandemic group was managed with pre-existing guidelines, compared to new guidelines for the coronavirus disease 2019 pandemic group. A telephone survey was performed on out-patients with non-dissolvable packs to assess patient comfort and satisfaction. RESULTS: A total of 142 patients were seen. The coronavirus disease 2019 pandemic group had significantly more patients aged over 65 years (p = 0.004), an increased use of absorbable dressings and local haemostatic agents (Nasopore and Surgiflo), and fewer admissions (all p < 0.0005). Rates of re-presentation and morbidity, and length of hospital stay were similar. The telephone survey revealed out-patient management to be efficacious and feasible. CONCLUSION: The coronavirus disease 2019 pandemic has shifted epistaxis management towards local haemostatic agents and out-patient management; this approach is as safe and effective as previously well-established regimens.

Improving the management of suspected tonsillitis and peritonsillar abscess referred to ENT - a coronavirus disease 2019 service improvement.

BACKGROUND: The impact of coronavirus disease 2019 on healthcare has led to rapid changes in otolaryngology service provisions. As such, new standard operating procedures for the management of suspected tonsillitis or quinsy were implemented in our centre. METHODS: A retrospective audit was performed of acute referrals to ENT of patients with suspected tonsillitis, peritonsillar cellulitis or quinsy, during the 10 weeks before (group 1) and 10 weeks after (group 2) implementation of the new standard operating procedures. RESULTS: Group 2 received fewer referrals. Fewer nasendoscopies were performed and corticosteroid use was reduced. The frequency of quinsy drainage performed under local anaesthetic increased, although the difference was not statistically significant. Hospital admission rates decreased from 56.1 to 20.4 per cent, and mean length of stay increased from 1.13 to 1.5 days. Face-to-face follow up decreased from 15.0 to 8.2 per cent, whilst virtual follow up increased from 4.7 to 16.3 per cent. There were no significant differences in re-presentation or re-admission rates. CONCLUSION: Management of suspected tonsillitis or quinsy using the new standard operating procedures appears to be safe and effective. This management should now be applied to an out-patient setting in otherwise systemically well patients.

ENT training amongst general practitioners: results from a questionnaire.

OBJECTIVES: To evaluate the level of undergraduate and post-graduate ENT exposure amongst general practitioners and their perceived quality of this training. A secondary aim was to examine whether general practitioners believe ENT department based rotations should remain in the undergraduate curriculum. METHOD: An online questionnaire-based survey was sent to general practices in England. RESULTS: A total of 417 general practitioners completed the questionnaire. Sixty-seven per cent had completed an ENT rotation at medical school whereas 27 per cent had undertaken a postgraduate placement in ENT. Fifty-one per cent had received post-graduate teaching in ENT, mainly in the form of lectures. The majority of general practitioners were not satisfied with their training in ENT at undergraduate and post-graduate levels. Eighty-five per cent of general practitioners believed formal hospital-based ENT training should remain in the undergraduate curriculum. CONCLUSION: General practitioners reported insufficient exposure to ENT during both post-graduate and undergraduate training. Proposals to outsource undergraduate ENT teaching to affiliated departments such as general practice are of concern.

An anatomical study of the facial artery / Un estudio anatómico de la arteria facial

The facial artery (a branch of the external carotid artery) is the main artery of the face. It gives rise to seven branches viz. inferior labial, superior labial, inferior alar, superior alar, lateral nasal and angular arteries, which are variable. This study included a dissection of twenty embalmed adult cadaveric head and neck specimens. The parameters of origin, branching patterns, termination and variations were analysed and compared with sex and laterality. The facial artery followed the standard anatomical description of origin in 84.62 % of the sample. Variations: (i) origin as a linguofacial trunk in 12.82 % and (ii) high origin in 2.56 % was observed. Male specimens displayed a higher number of linguofacial trunk origins (7.69 %). The branching patterns of the facial artery was classified into six types, with subtypes for Types 1 and 2. Subtype 1-A (standard anatomical description with early termination) occurred in most of the sample (46.15 %). Males were found to have more variations in branching patterns than females (48.72 % and 41.03 % respectively). Termination of the facial artery was as follows: inferior labial artery (5.13 %), superior labial artery (10.26 %), inferior alar artery (10.26 %), superior alar artery (46.15 %), lateral nasal artery (5.13 %), and angular artery (20.51 %). A single case (2.56 %) of an abortive artery was noted. Statistical analysis showed that sex was independent of each parameter observed in this study. Anatomical knowledge of the facial artery is of importance to clinicians and surgeons during procedures such as musculomucosal, island flaps and aesthetic dermatology.

La arteria facial (una rama de la arteria carótida externa) es la arteria principal de la cara. Da lugar a siete ramas: labial inferior, labial superior, alar inferior, alar superior, arterias nasales y angulares laterales, además de ramas pequeñas variables. Este estudio incluyó una disección de veinte muestras de cabeza y cuello de cadáveres adultos fijados. Los parámetros de origen, patrones de ramificación, terminación y variaciones fueron analizados y comparados con el sexo y la lateralidad. La arteria facial se originó de manera normal en el 84,62 % de la muestra. Variaciones: (i) origen como tronco linguofacial en 12.82 % y (ii) se observó un origen alto en 2,56 %. Las muestras en los hombres mostraron un mayor número de orígenes del tronco linguofacial (7,69 %). Los patrones de ramificación de la arteria facial se clasificaron en seis tipos, con subtipos para los Tipos 1 y 2. El subtipo 1-A (descripción anatómica normal con terminación temprana) se observó en (46,15 %) de la muestra. Las muestras de varones tenían una mayor variación en los patrones de ramificación que las muestras de mujeres, 48,72 % y 41,03 % respectivamente. La terminación de la arteria facial fue la siguiente: arteria labial inferior (5,13 %), arteria labial superior (10,26 %), arteria alar inferior (10,26 %), arteria alar superior (46,15 %), arteria nasal lateral (5,13 %) y arteria angular (20,51 %). Se observó un solo caso (2,56 %) de una arteria abortiva. El análisis estadístico mostró que el sexo era independiente de cada parámetro observado en este estudio. El conocimiento anatómico de la arteria facial es importante para los médicos y cirujanos durante procedimientos como colgajos musculomucosal y en la dermatología estética.

Endoscopic transnasal image-guided approach to diagnosis in orbital apex and optic canal lesions.

OBJECTIVE: Prompted by a recurring skull base multidisciplinary team debate on the necessity of securing a definitive tissue diagnosis before initiating treatment for lesions of the orbital apex, a review of anterior skull base procedures over an 11-year period was undertaken. METHODS: Data collected prospectively on cases from 2006 to 2017 were analysed. Presenting symptoms, imaging and histology findings, outcomes, complications, and impact on treatment were evaluated. All surgery was carried out endoscopically with the aid of image guidance. RESULTS: Twenty-one patients undergoing endoscopic orbital apex and/or optic canal biopsy were included. The mean patient age was 49 years. Five malignant tumours were identified, five benign tumours, seven infective cases (two tuberculosis and five fungal) and two cases of immunoglobulin G4 related disease. Two patients had non-diagnostic biopsies (one lesional) and were treated successfully as Tolosa-Hunt syndrome cases. CONCLUSION: A successful diagnosis was achieved in nearly all cases without adverse impact, other than one cerebrospinal fluid leakage case. Management was directly influenced by the outcome in all cases.

The morphometry and morphology of the foramen magnum in age and sex determination within the south african black population utilizing computer tomography (CT) scans / Morfometría y morfología del foramen magnum en la determinación de edad y sexo dentro de la población negra sudafricana mediante tomografía computarizada (TC)

SUMMARY: The morphology and morphometry of the foramen magnum aid forensic studies in identifying unknown individuals according to age and sex. Moreover, these parameters of the foramen magnum have clinical relevance to surgeons in the transcondylar approach. This study aimed to analyze the morphometry and morphology in relation to the age and sex of individuals within the South African Black population, utilizing computerized tomography images. The use of computerized tomography images allowed for accurate morphometric diameters using the SLICER 3-D software version 4.7.0. Radiological images also provide a patient's clinical history. Thus, the process of exclusion in respect to patients with pathological conditions of the skull is achieved. The sample studied included 150 computerized tomography images (93 males and 57 females) arranged according to age cohorts (children aged 1-12 years, adolescents aged 13-17 years and adults aged 18-25 years). The morphometric parameters viz. antero-posterior diameter, transverse diameter and area of the foramen magnum was analyzed in relation to age and sex. The morphological variations of the foramen magnum was simultaneously observed between males and females and within the age groups. The objective of this study were to improve data on the morphological and morphometric parameters of the foramen magnum in the South African Black population. This study also attempted to associate the morphological and morphometric parameters of the foramen magnum with age and sex determination.

RESUMEN: La morfología y morfometría del foramen magnum ayuda a los estudios forenses en la identificación de individuos desconocidos según la edad y el sexo. Además, parámetros del foramen magnum tienen relevancia clínica para los cirujanos en el abordaje transcondilar. Este estudio tuvo como objetivo analizar la morfometría y la morfología del foramen magnum, en relación con la edad y el sexo, dentro de la población negra sudafricana, utilizando imágenes de tomografía computarizada. El uso de imágenes de tomografía computarizada permitió definir diámetros morfométricos precisos utilizando el software SLICER 3-D versión 4.7.0. Las imágenes radiológicas también proporcionan antecedentes de la historia clínica de un paciente. De este modo, se logra el proceso de exclusión con respecto a los pacientes con afecciones patológicas del cráneo. La muestra estudiada incluyó 150 imágenes de tomografía computarizada (93 hombres y 57 mujeres) organizadas según cohortes de edad (niños de 1 a 12 años, adolescentes de 13 a 17 años y adultos de 18 a 25 años). Los parámetros morfométricos que se consideraron fueron: diámetro antero-posterior, diámetro transversal y área del foramen magnum. Las variaciones morfológicas del foramen magnum se observaron simultáneamente entre hombres y mujeres y dentro de los grupos de edad. El objetivo de este estudio fue mejorar los datos sobre los parámetros morfológicos y morfométricos del foramen magnum en la población negra sudafricana. Este estudio también intentó asociar los parámetros morfológicos y morfométricos del foramen magnum con la determinación de la edad y el sexo.

The foramen transversarium of typical and atypical cervical vertebrae: morphology and morphometry / El foramen transverso de vértebras cervicales típicas y atípicas: morfología y morfometría

The seven cervical vertebrae found in the human body are classified into typical and atypical vertebrae. Their transverse processes contain foramen transversarium (FT) and traditionally there is one foramen present on each side, of similar size. However, variations of this foramen regarding its shape, size, number, laterality, location and osteometric characteristics have been documented in the literature. This morphological and morphometric study was conducted on 126 cervical vertebrae (82 typical and 44 atypical) obtained from the osteological bank at the University of Kwa-Zulu Natal to produce a database which may serve as a useful guideline to medical personnel. There were variations observed regarding shape, number of FT, laterality and position, which have not previously been reported. The most types of variations were evident in the typical cervical vertebrae, then secondly, the seventh cervical vertebrae. The axis vertebrae did not display any accessory FT or variations.

Las siete vértebras cervicales que se encuentran en el cuerpo humano se clasifican como vértebras típicas y atípicas. Sus procesos transversos presentan un foramen transverso (FT) y normalmente este foramen es de tamaño similar en cada lado. Sin embargo, se han reportado en la literatura variaciones de este foramen, con respecto a su forma, tamaño, número, lateralidad, ubicación y características osteométricas. Este estudio morfológico y morfométrico se realizó en 126 vértebras cervicales (82 típicas y 44 atípicas) obtenidas del banco de Osteología de la Universidad de Kwa-Zulu Natal, para producir una base de datos que pueda servir como una guía útil para el personal médico. Se observaron variaciones con respecto a la forma, el número de FT, la lateralidad y la posición, que no se habían reportado anteriormente. La mayoría de los tipos de variaciones eran evidentes en las vértebras cervicales típicas y en segundo lugar en las séptimas vértebras cervicales. Los axis no mostraron ningún FT accesorio o variaciones.

Sulfide production kinetics and model of stormwater retention ponds.

Stormwater retention ponds can play a critical role in mitigating the detrimental effects of urbanization on receiving waters that result from increases in polluted runoff. However, the benthic oxygen demand of stormwater facilities may cause significant hypoxia and trigger the production of hydrogen sulfide (H2S). This process is not well-documented and further research is needed to characterize benthic processes in stormwater retention ponds in order to improve their design and operation. In this study, sediment oxygen demand (SOD), sediment ammonia release (SAR) and sediment sulfide production (SSP) kinetics were characterized in situ and in the laboratory. In situ SOD and SSP data were utilized to develop a stormwater retention pond water sulfide concentration model which demonstrates strong correlation with sulfide concentrations observed in situ (r = 0.724, N = 91, p < 0.001) and in laboratory experiments (r = 0.691, N = 38, p < 0.001). At 4 °C, in situ rates of SOD, SAR and SSP were higher than those measured in laboratory. Sulfate-reducing bacteria (SRB) represented 4.99% of the bacteria present in the top 30 cm of the pond sediment, with Desulfobulbaceae spp., Desulfobacteraceae spp. and Desulfococcus spp. being the dominant SRB taxa identified.

Anatomy of the dorsalis pedis artery / Anatomía de la arteria dorsal del pie

The dorsalis pedis artery (DPA) is the largest blood vessel distal to the ankle joint. It is the continuation of the anterior tibial artery (ATA) and runs along the dorsum of the foot until the 1st intermetatarsal space. The DPA gives rise to five branches, viz. medial tarsal, lateral tarsal, arcuate, deep plantar and dorsal metatarsal arteries. Given the vast blood supply provided by the DPA, in the current era of microvascular surgery, the anatomy of the DPA is of increasing interest to anatomists, surgeons and angiographers. The aim of this study was to outline the course, origin, branching patterns and possible variations of the DPA. The present study included the dissection of forty (n=40) cadaveric specimens of the lower limb region (Left: 25; Right: 15). The origin, course and branching patterns of the artery were studied. These morphological parameters were further analysed with regard to laterality to determine if a correlation existed. The Pearson Chi-square test was employed and a p value of less than 0.05 was deemed statistically significant. Although the DPA was present in 97.5 % of cases, it followed the standard anatomical description in only 42.5 % of cases. The DPA originated from the peroneal artery in 5 % of cases. In 25 % of cases, DPA deviated laterally. Variation in the branching pattern of the DPA, which was recorded in 50 % of cases, was further classified according Types 1 to 6. The findings of this study correlated closely with most previous studies. However, the incidence of lateral deviation of the DPA was higher in this study as well as the incidence of Type 1 variation in branching pattern. Additionally, this study proposes a novel variation in branching pattern which has been termed Type 6, which displays a recurrent branch of the Type 5 variation. The DPA has an important role in a clinical setting since the DPA flap is employed in reconstructive surgeries and peripheral circulation may be assessed by the palpation of the DPA pulse. Therefore, a thorough understanding of the anatomy of the DPA is of prime importance to podiatrists, surgeons, anatomists and angiographers.

La arteria dorsal del pie (ADP) es el vaso sanguíneo más grande distal a la articulación del tobillo. Es la continuación de la arteria tibial anterior (ATA) y se extiende a lo largo del dorso del pie hasta el primer espacio metatarsiano. La ADP da lugar a cinco ramas: a. tarsalis medialis, a. tarsalis lateralis, a. arcuata, a. plantaris profunda y aa. metatarsales dorsales. Dado el vasto suministro de sangre proporcionado por la ADP, en la era actual de la cirugía microvascular, la anatomía de la ADP es de creciente interés para los anatomistas, cirujanos y expertos en angiografía. El objetivo de este estudio fue delinear el curso, origen, patrones de ramificación y las posibles variaciones de la ADP. El presente estudio incluyó la disección de cuarenta (n = 40) muestras cadavéricas del miembro inferior (izquierda: 25; derecha: 15). Se estudiaron los patrones de origen, curso y ramificación de la arteria. Estos parámetros morfológicos se analizaron adicionalmente con respecto a la lateralidad para determinar si existía una correlación. Se empleó la prueba Chi-cuadrado de Pearson y se consideró estadísticamente significativo un valor de p de menos de 0,05. Aunque la ADP estuvo presente en el 97,5 % de los casos, siguió la descripción anatómica estándar en solo el 42,5 % de los casos. La ADP se originó en la arteria fibular en el 5 % de los casos. En el 25 % de los casos, la ADP se desvió lateralmente. La variación en el patrón de ramificación de la ADP, que se registró en el 50 % de los casos, se clasificó según los tipos 1 a 6. Los hallazgos de este estudio se correlacionaron estrechamente con la mayoría de los estudios previos. Sin embargo, la incidencia de desviación lateral de la ADP fue mayor en este estudio, así como la incidencia de la variación del tipo 1 en el patrón de ramificación. Además, este estudio propone una nueva variación en el patrón de ramificación que se ha denominado Tipo 6, que muestra una rama recurrente de la variación Tipo 5. La ADP tiene un papel importante en la clínica, ya que el colgajo de la ADP se emplea en cirugías reconstructivas y la circulación periférica se puede evaluar mediante la palpación del pulso de la ADP. Por lo tanto, una comprensión profunda de la anatomía de la ADP es de vital importancia para los podólogos, cirujanos, anatomistas y en la angiografía.

Omalizumab treats chronic rhinosinusitis with nasal polyps and asthma together-a real life study.

INTRODUCTION: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma often coexist and thus treating both with one intervention is an attractive strategy. OBJECTIVE: To prospectively evaluate whether treatment with the monoclonal antibody against IgE Omalizumab for severe allergic asthma also effectively treats co-existent CRSwNP. METHODS: SNOT-22 and the ACQ-7 scores were recorded at 4 and 16 weeks of treatment in a cohort of patients with both CRSwNP and severe refractory allergic asthma treated with Omalizumab (n=13) according to UK guidelines for their severe asthma. SNOT-22 in a surgery only treated CRSwNP with asthma group (n=24) was compared. RESULTS: Rapid improvement was seen at 4 weeks and 16 weeks of treatment in both CRSwNP and asthma control. The improvement in CRSwNP with Omalizumab was similar to that seen in a group of patients who received upper airway surgery. CONCLUSION: Omalizumab treatment for severe allergic asthma also improves co-existent CRSwNP. Further clinical studies of current and emerging biological agents for severe asthma should include upper airway outcomes. These agents may be effective for severe CRSwNP and comparative studies with surgery are warranted.

The morphology of the sphenoid air sinus from childhood to early adulthood (1 to 25 years) utilizing 3D reconstructed images / La morfología del seno esfenoidal desde la infancia hasta la adultez temprana (1 a 25 años) utilizando imágenes reconstruídas en 3D

SUMMARY: The morphology of the sphenoid air sinuses is variable amongst populations. The variation in terms of the morphology of this air sinus is particularly important in cranial base surgery. This study aimed to illustrate the three dimensional (3D) morphology of the sphenoid air sinus across ages 1 to 25 years in a South African population. The frequency of the sphenoid sinus characteristics viz. its presence, shape and septa was observed in 3D reconstructed sphenoid sinus models. The sample (n=480 patients) consisted of 276 males and 204 females, 1-25 years and of two population groups viz. black African and white. The sphenoid air sinus was present in (442/480) 92.1 % on the right and in (441/480) 91.9 % on the left. The sphenoid air sinus was absent in 7.9 % and 8.1 % on the right and left sides respectively. Of those present, six different shapes were identified in the anterior/coronal view. Overall, the main shape identified in the anterior view, was quadrilateral on the right (n=243; 50.6 %) and left (n=238; 49.6 %). There was no association between the shape anteriorly and sex or population groups. However, three forms in the lateral view viz. sellar, presellar and conchal types were documented. The main shape identified was the sellar type on both sides (45.2 % R; 49 % L). Laterally, there was an association between shape and sex, on the left side only, and, between the population groups (p<0.05). Intersinus septa were observed in 90.2 % and located predominantly central in 55.4 %. The maximum amount of partial intrasinus septa observed was up to 7 septa. An in depth analysis and classification of the three dimensional form of the sphenoid air sinus according to age 1-25 years was documented in this study. This study proposed a classification of the air sinus utilizing its three dimensional form. The classification illustrated how the air sinus developed within the sphenoid bone and grows into its surrounding parts in both a lateral and posterior direction.

RESUMEN: La morfología de los senos esfenoides puede variar entre las poblaciones. La variación en términos de morfología de este seno es particularmente importante en la cirugía de base de cráneo. Este estudio tuvo como objetivo ilustrar la morfología tridimensional (3D) del seno esfenoidal en una población sudafricana entre las edades de 1 a 25 años. La frecuencia de las características de los senos esfenoides, su presencia, forma y septo se observó en los modelos de seno esfenoidal, reconstruido en tres dimensiones. La muestra (n = 480 pacientes) consistió en 276 varones y 204 mujeres, 1-25 años, divididos en dos grupos de población africana negra y blanca. El seno esfenoidal estaba presente en 92,1 % (442/ 480) en el lado derecho, y en 91,9 % (441/480) en el lado izquierdo. El seno esfenoidal estaba ausente en 7,9 % y 8,1 %, en los lados derecho e izquierdo, respectivamente. Se identificaron seis formas diferentes en la vista anterior / coronal. En general, la forma principal identificada en la vista anterior fue cuadrilátero: 50,6 % a la derecha (n = 243), y 49,6 % a la izquierda (n = 238). No hubo asociación entre la forma anterior y el sexo, o en grupos de población. Sin embargo, se observaron en la imagen lateral tres tipos, que fueron documentados: sellar, presellar y conchal. La forma principal identificada fue el tipo sellar en ambos lados (45,2 % derecha, 49 % izquierda). Lateralmente, se presenta una asociación entre la forma y los sexos, sólo en el lado izquierdo, y entre los grupos de población (p <0,05). Se observaron septos interinos en el 90,2 %; de éstos, un 55,4 % se presentaban de forma centralizada. La cantidad máxima de septos parciales interinos fue de hasta 7. En este estudio se documentó un análisis en profundidad y clasificación de la forma tridimensional del seno esfenoidal según la edad, de 1 a 25 años. Este estudio propuso una clasificación del seno esfenoidal utilizando su forma tridimensional. La clasificación presentó el desarrollo del seno esfenoidal dentro del hueso esfenoides y el crecimiento en sus partes circundantes, tanto en dirección lateral como posterior.

Shape, septa and scalloping of the maxillary sinus / Forma, septo y festoneado del seno maxilar

The maxillary sinus varies according to age, however there are limited studies that have illustrated its 3D form over time. This study aimed to classify the maxillary sinus by the shape, number of septa and scallops in a 1 to 25 year age group, utilising computerized tomography (CT) scans and 3D reconstruction. CT scans (n=480) were reviewed from the picture archiving and communication system (PACS) of the state and private hospitals in Pietermaritzburg and Durban KwaZulu- Natal (KZN), South Africa. The sample consisted of 276 males and 204 females, 1-25 years and of two population groups, black African and white. SLICER 3D (www.slicer.org) was utilised in order to reconstruct a 3D model of the sinus. Morphological traits such as the presence of the sinus, scalloping and septa within the sinuses were categorised. In addition, the shape of the 3D model of the sinus was analysed anteriorly (coronal) and laterally (sagittal) adapting the classifications by Kim (1962) and Kim et al. (2002). The maxillary sinus was present bilaterally in n=477 individuals (99.4 %). Five different anterior shapes viz. Type 1 (triangular), Type 2 (upside down triangle), Type 3 (square), Type 4 (irregular) and Type 5 (rectangular) were identified in the anterior view. This shape was associated with age and population groups (p<0.05). In the lateral view, the maxillary sinus appeared to be quadrilateral with differences noted along the inferior wall. Intrasinus maxillary septa were more evident in the anterior region of the maxillary sinus (27.9 % right; 28.5 % left). The maxillary septa were commoner in females (37.9 % right; 39.4 % left) than in males (28.5 % right; 30.3 % left). They were also more commonly observed in the white cohort (63.8 % right; 68.1 % left) than in the black African cohort (29.1 % right; 30.5 % left). Scalloping in the axial plane from above along its anterior margin was also observed. An in-depth classification of the morphology of the 3D form of the maxillary sinus according to age (1 to 25 years) was established. Five different shapes in both the anterior and lateral view of the 3D model were observed. Anteriorly, it was noted that the main shape was Type 2 (upside down triangle). The shape of the sinus changed in the form according to age. Laterally, the shape was related to the development of the teeth, as the inferior wall of the sinus was classified. Maxillary septa and scalloping of the sinus were reported in all age groups. Surgically, the sinus morphology is essential for dental procedures such as sinus augmentation or dental implants, and anthropologically, in forensic identification.

El seno maxilar varía según la edad, sin embargo existen pocos estudios que hayan ilustrado su forma tridimensional. El objetivo de este estudio fue clasificar el seno maxilar por su forma, número de septos y las vieiras en un grupo de 1 a 25 años, utilizando tomografías computarizadas (TC) y reconstrucción 3D. Las tomografías computarizadas (n = 480) fueron revisadas del sistema de archivo y comunicación de imágenes (PACS) de los hospitales estatales y privados de Pietermaritzburg y Durban KwaZulu- Natal (KZN), Sudáfrica. La muestra consistió en 276 hombres y 204 mujeres, de 1 a 25 años y de dos grupos de población, negro africano y blanco. Se utilizó el software SLICER 3D (www.slicer.org) para reconstruir un modelo 3D del seno aéreo. Se clasificaron rasgos morfológicos como la presencia del seno aéreo, festoneado y septos dentro de los senos. Además, se analizó la forma del modelo 3D del seno anterior (coronal) y lateral (sagital) adaptando las clasificaciones de Kim (1962) y Kim et al. (2002). El seno maxilar estaba presente bilateralmente en n = 477 individuos (99,4 %). Se encontraron cinco diferentes formas anteriores: Tipo 1 (triangular), Tipo 2 (triángulo invertido), Tipo 3 (cuadrado), Tipo 4 (irregular) y Tipo 5 (rectangular) fueron identificados en la vista anterior. Esta forma se asoció con la edad y los grupos de población (p <0,05). En la vista lateral, el seno maxilar parecía cuadrilátero con diferencias observadas a lo largo de la pared inferior. Los septos maxilares fueron más evidentes en la región anterior del seno maxilar (27,9 % derecho y 28,5 % izquierdo). Los septos maxilares eran más frecuentes en las mujeres (37,9 % derecho, 39,4 % izquierdo) que en los varones (28,5 % derecho y 30,3 % izquierdo). También se observaron más comúnmente en la cohorte blanca (63,8 % derecho, 68,1 % izquierda) que en la cohorte africana negra (29,1 % derecho y 30,5 % izquierda). También se observó la festoneación en el plano axial desde arriba a lo largo de su margen anterior. Se estableció una clasificación en profundidad de la morfología de la forma tridimension del seno maxilar según la edad (1 a 25 años). Se observaron cinco formas diferentes tanto en la vista anterior como en la lateral del modelo 3D. Anteriormente, se observó que la forma principal era el Tipo 2 (triángulo invertido). La forma del seno cambia según la edad. Lateralmente, la forma estaba relacionada con el desarrollo de los dientes, ya que se clasificó la pared inferior del seno maxilar. Los septos maxilares y la festoneación del seno maxilar se encontraron en todos los grupos de edad. Desde el punto de vista quirúrgico, el conocimiento de la morfología del seno maxilar es esencial al momento de realizar procedimientos dentales como el aumento del seno o los implantes dentales, y antropológicamente, en la identificación forense.

The plantar aponeurosis in fetuses and adults: an aponeurosis or fascia? / La aponeurosis plantar en fetos y adultos: ¿aponeurosis o fascia?

The plantar aponeurosis (PA), which is a thickened layer of deep fascia located on the plantar surface of the foot, is comprised of three parts. There are differing opinions on its nomenclature since various authors use the terms PA and plantar fascia (PF) interchangeably. In addition, the variable classifications of its parts has led to confusion. In order to assess the nature of the PA, this study documented its morphology. Furthermore, a pilot histological analysis was conducted to examine whether the structure is an aponeurosis or fascia. This study comprised of a morphological analysis of the three parts of the PA by micro- and macro-dissection of 50 fetal and 50 adult cadaveric feet, respectively (total n=100). Furthermore, a pilot histological analysis was conducted on five fetuses (n=10) and five adults (n=10) (total n=20). In each foot, the histological analysis was conducted on the three parts of the plantar aponeurosis, i.e. the central, lateral, and medial at their calcaneal origin (total n=60). Fetuses: i) Morphology: In 66 % (33/50) of the specimens, the standard anatomical pattern was observed, viz. three parts (i.e. central, lateral, medial) that originated from the medial and lateral processes of the calcaneal tuberosity and inserted onto the metatarsals. In 18 % (9/50) of the specimens, a two-part structure was observed. Variable origins of the medial part were noted in 16 % (8/50) of the specimens. In order to document these variations, the central part of the PA was divided into three segments (i.e. upper, middle, lower): a) In 63 % (5/8) of the specimens, the medial part arose from the middle segment; b) In 37 % (3/8) of the specimens, the medial part arose from the middle and upper segments. ii) Histological analysis: a) The central part contained longitudinally arranged semi-dense type I collagen fibres with fibroblasts; b) The lateral part displayed semi-dense type I collagen fibres with fibroblasts, hyaluronic acid, corpusculum sensorium fusiforme (Ruffini corpuscle) and corpusculum lamellosum (Pacinian corpuscle); c) The medial part comprised of loose connective tissue with elastic and reticular fibres. Adults: i) Morphology: In 100 % of the specimens, the standard anatomical pattern was observed. ii) Histological Analysis: a) In the central part, longitudinally arranged type I collagen fibres with fibroblasts were visible; b) The lateral part contained longitudinally arranged type I collagen fibres with fibroblasts; c) The medial part comprised of loose connective tissue, type I and type III collagen fibres, elastic and reticular fibres. In the current study, the morphology of the PA in fetuses and adults conformed to the standard anatomical description with variations in the origin of the medial part observed in fetuses. In addition, the fetal specimens displayed a two-part structure of the PA when the medial part was absent. Microscopically, the findings suggest that only the central and lateral parts may be considered as the PA, whilst the medial part may be termed the PF.

La aponeurosis plantar (AP), que es una capa engrosada de fascia profunda localizada en la superficie plantar del pie, está compuesta de tres partes. Hay diferentes opiniones sobre su nomenclatura, ya que varios autores utilizan los términos AP y fascia plantar (FP) de forma intercambiable. Además, las distintas clasificaciones de sus partes han dado lugar a confusión. Con el fin de evaluar la naturaleza de la AP, este estudio documentó su morfología. Además, se realizó un análisis histológico para examinar si la estructura es una aponeurosis o fascia. Este estudio consistió en un análisis morfológico de las tres partes de la AP de 50 pies de fetos y 50 pies de cadáveres adultos, por micro y macrodisección, respectivamente (total n = 100). Además, se realizó un análisis histológico en cinco fetos (n = 10) y cinco adultos (n = 10) (total n = 20). En cada pie, el análisis histológico se realizó sobre las tres partes de la aponeurosis plantar, es decir, la central, lateral y medial en su origen calcáneo (total n = 60). Fetos: i) Morfología: En el 66 % (33/50) de los especímenes, se observó el patrón anatómico estándar, es decir, tres partes (central, lateral y medial) que se originaron a partir de los procesos medial y lateral de la tuberosidad calcánea y se insertaban en los metatarsianos. En 18 % (9/50) de los especímenes, se observó una estructura de dos partes. Los orígenes variables de la parte mediana se visualizaron en el 16 % (8/50) de los especímenes. Para documentar estas variaciones, la parte central de la AP se dividió en tres segmentos (superior, medio, inferior): en el 63 % (5/8) de los casos, la parte mediana surgió del segmento medio; en el 37 % (3/8) de los casos, los casos la parte medial surgió de los segmentos medio y superior. ii) Análisis histológico: a) La parte central contenía fibras de colágeno tipo I semi-densas dispuestas longitudinalmente con fibroblastos; b) La parte lateral mostró fibras de colágeno tipo I semi-densas con fibroblastos, ácido hialurónico, corpúsculo sensorial fusiform (corpúsculo de Ruffini) y corpúsculo lamellosum (corpúsculo de Pacini); c) La parte medial comprende tejido conjuntivo suelto con fibras elásticas y reticulares. Adultos: i) Morfología: En el 100 % de los especímenes se observó el patrón anatómico estándar. ii) Análisis histológico: a) En la parte central, se observaron fibras de colágeno de tipo I con disposición longitudinal de fibroblastos; b) La parte lateral contenía fibras de colágeno de tipo I dispuestas longitudinalmente con fibroblastos; c) La parte medial estaba compuesta de tejido conectivo suelto, fibras de colágenos tipo I y tipo III, fibras elásticas y reticulares. En el presente estudio, la morfología de la AP en fetos y adultos se ajustó a la descripción anatómica estándar con variaciones en el origen de la parte medial observada en fetos. Además, los especímenes fetales mostraron una estructura de dos partes de la AP cuando la parte medial estaba ausente. Microscópicamente, los hallazgos sugieren que sólo las partes central y lateral pueden considerarse como AP, mientras que la parte medial puede denominarse FP.

Sex determination using morphometric and morphological dimensions of the clavicle within the KwaZulu-natal population / Determinación de sexo dentro de la población KwaZulu-natal mediante el uso de dimensiones morfométricas y morfológicas de la clavícula

Sex determination plays an essential role in forensic anthropology in the identification of an individual from skeletal remains. The aim of the study was to determine sex of an individual using the clavicle in a KwaZulu-Natal population. Various morphometric and morphological parameters were measured using 100 clavicles of known sex (66 male and 34 female) and age (range 25­95 years). The mean maximum length, mid-shaft circumference and maximum breadth of the sternal and acromial ends of the male clavicles were greater in females. However, the mean medial curve of the clavicle was greater in females than in males on both sides, and on the right side the female clavicles also had a greater mean lateral curve than the males. The maximum length and mid-shaft circumference alone could be used to predict sex with an accuracy of 89 %. Therefore, the provision of morphometric data pertaining to the clavicle may assist forensic investigators, anthropologists and anatomists to sex the clavicle.

La determinación del sexo juega un papel esencial en la antropología forense e identificación de un individuo con restos óseos. El objetivo fue determinar el sexo de un individuo mediante la clavícula en una población KwaZulu-Natal. Se midieron varios parámetros morfométricos y morfológicos utilizando 100 clavículas (66 hombres y 34 mujeres) con un rango etario entre 25­95 años. La longitud máxima media, circunferencia media del eje y la amplitud máxima de los extremos esternal y acromial de las clavículas de los hombres fueron mayores que en las mujeres. Sin embargo, la curva medial media de la clavícula fue mayor en mujeres que en hombres en ambos lados, y en el lado derecho las mujeres también tenían una curva lateral media de las clavículas mayor que en los hombres. La circunferencia máxima y la circunferencia media del eje por sí solas podrían ser utilizadas para predecir el sexo con una precisión de 89 %. Por tanto, la información de datos morfométricos relativos a la clavícula pueden ayudar a los investigadores forenses, antropólogos y anatomistas en la determinación del sexo.

A Morphological Study of the Suprascapular Notch in a Sample of Scapulae at the University of Kwazulu Natal / Estudio Morfológico de la Escotadura Supraescapular en una Muestra de Escápulas de la Universidad de KwaZulu-Natal

The suprascapular notch (SSN) is important, as it is a risk factor in the development of suprascapular nerve entrapment syndrome. The purpose of this study is to describe the morphology of the SSN of a sample of normal scapulae in the Discipline of Clinical Anatomy, University of KwaZulu Natal. Sixty scapulae were used consisting of 37 males and 23 females (mean age 51 years). The superior transverse diameter and maximal depth of the notches were measured. Comparisons were made of the notch in relation to the maximal width and length of the scapulae, laterality and sex. The Rengachary classification method was adopted to describe the shape of the SSN. Analysis of morphological variations showed Type II- wide blunted V-shaped notch to be predominant (65%). Three scapulae had absent notches (Type I). The average notch depth and transverse diameter were 6.51±2.69 mm and 13.18±5.52 mm respectively. The right SSN were significantly deeper than the left (7.54±2.51 mm) (p<0.02). The male scapulae were distinctively larger, with females having a much shallower and wider notch. Understanding the morphological variation of the SSN is important when various radiological imaging techniques are utilized such as during arthroscopic shoulder operations and anaesthesia for landmarking of the suprascapular nerve.

La incisura supraescapular (IS) es importante, ya que es un factor de riesgo en el desarrollo del síndrome de atrapamiento del nervio supraescapular. El propósito de este estudio fue describir la morfología de la IS de una muestra de escápulas normales en la disciplina de Anatomía Clínica de la Universidad de KwaZulu-Natal. Se utilizaron sesenta escápulas, 37 de hombres y 23 de mujeres (edad media 51 años). Se midieron el diámetro transversal superior y la profundidad máxima de las incisuras. Se realizaron comparaciones de la incisura en relación al ancho máximo y la longitud de la escápula, su lateralidad y el sexo. Se utilizó el método de clasificación de Rengachary para describir la forma de la IS. El análisis de las variaciones morfológicas mostró que el Tipo II, muesca amplia roma en forma de V, fue predominante (65%). Tres escápulas no presentaron incisuras (Tipo I). La Media de la profundidad y diámetro transversal fueron 6,51±2,69 mm y 13,18±5,52 mm, respectivamente. Las IS derechas fueron significativamente más profundas que las izquierdas (7,54±2,51 mm) (p<0,02). Las escápulas de los hombres fueron significativamente de mayor tamaño que las de mujeres, con una incisura más superficial y ancha. La comprensión de las variaciones morfológicas de la IS son relevantes ya que diversas técnicas de imágenes radiológicas son utilizadas durante cirugías artroscópicas y anestesia del hombro para estimar puntos anatómicos del nervio supraescapular.