"The Accessory Ethmoidal Canal Does Not Necessarily Contain an Arterial Structure".

Introduction: The aim of our study is to describe the prevalence of the accessory ethmoidal artery in endonasal endoscopic cadaver dissections and to identify its intraorbital origin. Material and Methods: From 2018 to 2020, thirty-four nasal dissections were performed in seventeen adult cadaveric heads. We performed a complete ethmoidectomy to identify the ethmoidal canals. Then, we removed the bony canal and the lamina papiracea to verify the injected vessel and to confirm the vascular structure inside the canal. Results: We found the anterior ethmoidal canal (AEC) and the posterior ethmoidal canal (PEC) in 100% of nasal cavities (34/34). We identified 4 accessory ethmoidal canals (AcEC) in the 34 nasal fossae dissected (12%). All AEC contained an arterial vessel. The AcEC contained an arterial vascular structure in 2 cases, a neural structure in other specimen, and in the fourth case no structure could be verified. In 32 of 34 nasal cavities, the PEC contained an artery and only in 2 cases the PEC did not contain any vascular structure. In these specimens, we observed that the AcEC with an arterial vessel inside (6%) was closer to the posterior canal than the anterior canal. Conclusion: According to our findings, we can suggest that the presence of a canal does not necessarily imply the presence of an arterial vessel, and that presence of the accessory ethmoidal artery could be associated with the absence of posterior ethmoidal artery.

Description and relationships of the parotid gland levels proposed by the European Salivary Gland Society staging system: an anatomical study.

OBJECTIVES: To perform an anatomical study to analyze the size, weight, and the relationships of the parotid levels proposed by the European Salivary Gland Society (ESGS). MATERIALS AND METHODS: Anatomical dissections of the parotid region in 19 human specimens were performed. All dissections were systematically carried out to study the dimensions and weight of each level. We also studied the facial nerve distribution between the different levels and the relative position of the facial nerve main trunk and parotid duct in regard to the Frankfort line plane. RESULTS: The facial nerve trunk and the parotid duct were identified in all the 19 specimens, which made it feasible to define the 4 principal levels of the parotid gland body (levels I-IV). Level V was identified in 9 out of 19 dissections (47.5%). For the whole gland, the mean for the height and width dimensions were 66.37 mm and 46.84 mm, respectively, and it weighted 18.13 g. In terms of relative weight regarding the whole gland, level II was always the heaviest, representing from 41 to 47% of the gland's weight, depending on the presence of level V. Levels I and III represent almost the same amount of relative weight as they range from 20 to 22% for each one. Level IV was the lightest body level representing 8-10% of the whole, and when present, level V represented less than 5% of the whole parotid weight. The temporal and zygomatic terminal branches were always found between the cranial levels, whereas the cervical and marginal nerves lie in all cases between the caudal levels. The buccal branches had multiple ramifications that lie between both cranial and caudal levels in 47% of the cases, being found exclusively between cranial levels in 21% and between the caudal levels in the remaining 32%. CONCLUSION: As traditionally reported, the caudal superficial portion of the gland represents the most voluminous portion of the gland, being labeled in our classification as level II. Levels I and III represent similar amounts of gland, though presenting a significantly different morphological disposition. Level IV is the smallest portion of the body gland and level V, when present represents a scarce 5% of the whole body gland weight. The ESGS levels have a clear anatomical basis and the basic references needed to define them are always present.

Endoscopic medial maxillectomy with preservation of inferior turbinate: how do we do it?

The aim of this study was to describe the endoscopic medial maxillectomy technique with preservation of the inferior turbinate in patients affected by maxillary sinonasal inverted papilloma. We retrospectively reviewed the clinical charts and surgical technique in six patients with paranasal sinus inverted papilloma. There were five males and one female, whose mean age at diagnosis was 60 years ranging between 57 and 65 years. No recurrences were diagnosed, and no nasal crusting was evidenced postoperatively. Nasal breathing was satisfying in all cases. Postoperative epistaxis was not observed, and none of the patients refereed to have epiphora after the surgery. This technique has been successfully performed, showing no recurrence to the present and allowing the preservation of a functional inferior turbinate.

Miositis fulminante del compartimento muscular cervical posterior. A propósito de un caso / Sudden myositis of the posterior cervical muscular compartment. Case report

Presentamos un caso de infección cervical profunda atípica con afectación principalmente muscular, cuyo agente causal fue Streptococcus pyogenes, y cuya clínica y evolución se caracterizaron por un brusco deterioro hemodinámico y fallo sistémico severo que hizo necesaria una exploración quirúrgica urgente y su posterior ingreso en la UCI. Tras el diagnóstico de miositis estreptocócica y el pertinente cambio de pauta antibiótica, el paciente presentó una mejoría progresiva hasta su restitución completa (AU)

An atypical case of deep neck infection is presented with muscular involvement as the main feature. Streptococcus pyogenes was the causal agent and abrupt haemodynamic impairment and severe systemic failure characterized its clinical course, requiring emergency surgical examination and subsequent admission to the critical care unit. After the diagnosis of Streptococcal Myositis was obtained and the antibiotic treatment adjusted, the patient progressively recovered completely (AU)

Sudden myositis of the posterior cervical muscular compartment. Case report.

An atypical case of deep neck infection is presented with muscular involvement as the main feature. Streptococcus pyogenes was the causal agent and abrupt haemodynamic impairment and severe systemic failure characterized its clinical course, requiring emergency surgical examination and subsequent admission to the critical care unit. After the diagnosis of streptococcal myositis was obtained and the antibiotic treatment adjusted, the patient progressively recovered completely.

Tratamiento endoscópico combinado vs. abierto en el divertículo de Zenker / Combined endoscopic treatment for Zenker's diverticulum versus open approach; review of our experience

Introducción: El divertículo de Zenker es una patología del esfínter esofágico superior susceptible de tratamiento quirúrgico en aquellos casos sintomáticos. Este tratamiento ha sufrido importantes cambios en los últimos años. Material y métodos: Se realizó un estudio retrospectivo de 16 pacientes tratados en nuestro servicio entre 2001 y 2008. Se utilizó el abordaje quirúrgico abierto y el abordaje endoscópico combinado mediante grapadora endoscópica y láser. Se analizó el tipo de tratamiento llevado a cabo, tamaño del divertículo, tiempo quirúrgico, tiempo hasta la ingesta oral, complicaciones quirúrgicas, estancia hospitalaria y la presencia de recidiva. Resultados: Se inició tratamiento endoscópico en 8 casos, siendo necesaria reconversión a técnica abierta en 2 casos. El tiempo operatorio fue de 90 min para el abordaje abierto y de 45 min en el endoscópico. La ingesta oral se reinició a las 36 horas en la abierta y a las 24h en la endoscópica, siendo el alta hospitalaria a los 3,8 días en la abierta y a los 2 días en la endoscópica. Aparecieron un 12,4% de complicaciones en relación con la cervicotomía. Se presentó recidiva de la patología en 2 pacientes que se habían sometido a tratamiento abierto, un caso fue tratado con abordaje endoscópico y otro con abierto. Conclusiones: El tratamiento endoscópico combinado parece ofrecer unos buenos resultados en aquellos enfermos con divertículo de Zenker sintomático que pueden ser sometidos a anestesia general. Si no es posible una buena exposición mediante el abordaje endoscópico se debe pasar a un abordaje mediante cervicotomía (AU)

Introduction: Zenker's diverticulum is a superior esophagus sphincter disease with a surgical management in symptomatic cases. This treatment has undergone important changes in recent years. Material and method: A retrospective review was carried out of 16 patients treated in our department between 2001 and 2008. Conventional open surgery was used as well as a combined endoscopic approach with stapler and CO2 laser. Type of treatment, diverticulum size, operating time, oral feeding time, surgical complications, hospital stay and occurrence of relapses were analyzed. Results: The endoscopic approach was used in 8 patients, with a conversion to conventional open surgery being necessary in 2 cases. Operating time was of 90min for the open approach and 45 in the endoscopic. Oral feeding could be reintroduced 36hours after open surgery and 24h after endoscopic treatment. The average discharge date was 3.8 days after the surgery in the open group and 2 days in the endoscopic group. Complications appeared in the 12.4% of the cases, all related to cervicotomy. There were 2 cases of relapse in the group treated with open surgery, one case was treated with the endoscopic approach and another with the open approach. Conclusions: The combined endoscopic approach offers good results in patients with symptomatic Zenker's diverticulum who can be under general anesthesia during the surgery. A conversion to open surgery with cervicotomy should be done when a good endoscopic exposure is not possible (AU)

[Combined endoscopic treatment for Zenker's diverticulum versus open approach; review of our experience]. / Tratamiento endoscópico combinado vs. abierto en el divertículo de Zenker.

INTRODUCTION: Zenker's diverticulum is a superior esophagus sphincter disease with a surgical management in symptomatic cases. This treatment has undergone important changes in recent years. MATERIAL AND METHOD: A retrospective review was carried out of 16 patients treated in our department between 2001 and 2008. Conventional open surgery was used as well as a combined endoscopic approach with stapler and CO(2) laser. Type of treatment, diverticulum size, operating time, oral feeding time, surgical complications, hospital stay and occurrence of relapses were analyzed. RESULTS: The endoscopic approach was used in 8 patients, with a conversion to conventional open surgery being necessary in 2 cases. Operating time was of 90 min for the open approach and 45 in the endoscopic. Oral feeding could be reintroduced 36 hours after open surgery and 24h after endoscopic treatment. The average discharge date was 3.8 days after the surgery in the open group and 2 days in the endoscopic group. Complications appeared in the 12.4% of the cases, all related to cervicotomy. There were 2 cases of relapse in the group treated with open surgery, one case was treated with the endoscopic approach and another with the open approach. CONCLUSIONS: The combined endoscopic approach offers good results in patients with symptomatic Zenker's diverticulum who can be under general anesthesia during the surgery. A conversion to open surgery with cervicotomy should be done when a good endoscopic exposure is not possible.

[Neurocognitive and behavioural abnormalities in paediatric sleep-related breathing disorders]. / Alteraciones neurocognitivas y conductuales en los trastornos respiratorios del sueño infantil.

INTRODUCTION: Behavioural and neurocognitive abnormalities in children may be a consequence of sleep-related breathing disorders. The effectiveness of assessments based on questioning parents is dubious and objective assessment tools are therefore required. AIM: To ascertain the impact of these abnormalities in children with sleep-related breathing disorders and compare the reliability of questioning parents in relation to validated psychological tests. METHOD: A prospective study was performed on 20 children with sleep-related breathing disorders and 20 healthy control children between 3 and 12 years of age. Both groups were subjected to a battery of validated psychological tests. The results of both groups were compared with each other and with the response to clinical questionnaires given to parents in the problem group. RESULTS: More than 75% of the cases in the problem group presented abnormalities with regard to attention, anxiety, memory and spatial structuring. The percentage involvement in all concepts was higher in the problem group. Comparisons of attention (40% of children affected in the control group and 80% in the problem group), memory (50% and 84.2%), and spatial structuring (45% and 75%) were statistically significant. More abnormality was observed in the parameters assessed with psychological tests than the equivalent concept obtained from interviewing the parents. Comparison of abnormal concentration assessed from the questionnaires (40% of children affected) with attention during the psychological test (80%), memory (15% and 84.21%), and delayed language development (10%) compared to spatial structuring (75%) was statistically significant. CONCLUSIONS: A high prevalence of behavioural and neurocognitive abnormalities was observed in children with sleep-related breathing disorders compared to a control group of healthy children. The use of objective assessment such as psychological tests revealed more abnormalities than were expressed by parents in response to clinical interviews.

Alteraciones neurocognitivas y conductuales en los trastornos respiratorios del sueño infantil / Neurocognitive and behavioural abnormalities in paediatric sleep-related breathing disorders

Introducción: Las alteraciones de conducta y neurocognitivas en los niños pueden ser consecuencia del trastorno respiratorio del sueño. Los medios de evaluación basados en el interrogatorio a los padres tienen una eficacia dudosa y por ello se requieren herramientas objetivas de valoración. Objetivo: Averiguar el impacto de estas alteraciones en niños con trastornos respiratorios del sueño y comparar la fiabilidad del interrogatorio a los padres respecto a los tests psicológicos validados. Método: Estudio prospectivo de 20 niños con trastornos respiratorios del sueño y 20 controles sanos entre 3 y 12 años de edad. Se sometió a ambos grupos a una batería de tests psicológicos validados. Se comparan los resultados entre ambos grupos y los resultados de estos tests con la respuesta a los cuestionarios aplicados a los padres en el grupo de casos. Resultados: En el grupo de casos, más del 75% presentaba alteraciones de atención, ansiedad, memoria y estructuración espacial. Los porcentajes de afección en todos los conceptos fueron superiores en el grupo de casos. Resultan estadísticamente significativas las comparaciones de la atención (el 40% de niños afectados en el grupo control y el 80% en el grupo de casos), la memoria (el 50 y el 84,2%) y la estructuración espacial (el 45 y el 75%). Se observa mayor alteración de los parámetros valorados con los tests psicológicos que en los conceptos equivalentes obtenidos del interrogatorio de los padres. Resultaron estadísticamente significativas las comparaciones entre alteración de concentración valorada en el interrogatorio (el 40% de niños afectados) con la atención en el test psicológico (80%), la memoria (el 15 y el 84,21%) y retraso en el lenguaje (10%) comparado con la estructuración espacial (75%). Conclusiones: Se observa una alta prevalencia de alteraciones de conducta y neurocognitivas en los niños con trastornos respiratorios del sueño comparados con un grupo equivalente de niños sanos. Con la utilización de tests psicológicos se observa mayor afección por estas alteraciones respecto a lo expresado por los padres en los interrogatorios clínicos (AU)

Introduction: Behavioural and neurocognitive abnormalities in children may be a consequence of sleep-related breathing disorders. The effectiveness of assessments based on questioning parents is dubious and objective assessment tools are therefore required. Aim: To ascertain the impact of these abnormalities in children with sleep-related breathing disorders and compare the reliability of questioning parents in relation to validated psychological tests. Method: A prospective study was performed on 20 children with sleep-related breathing disorders and 20 healthy control children between 3 and 12 years of age. Both groups were subjected to a battery of validated psychological tests. The results of both groups were compared with each other and with the response to clinical questionnaires given to parents in the problem group. Results: More than 75% of the cases in the problem group presented abnormalities with regard to attention, anxiety, memory and spatial structuring. The percentage involvement in all concepts was higher in the problem group. Comparisons of attention (40% of children affected in the control group and 80% in the problem group), memory (50% and 84.2%), and spatial structuring (45% and 75%) were statistically significant. More abnormality was observed in the parameters assessed with psychological tests than the equivalent concept obtained from interviewing the parents. Comparison of abnormal concentration assessed from the questionnaires (40% of children affected) with attention during the psychological test (80%), memory (15% and 84.21%), and delayed language development (10%) compared to spatial structuring (75%) was statistically significant. Conclusions: A high prevalence of behavioural and neurocognitive abnormalities was observed in children with sleep-related breathing disorders compared to a control group of healthy children. The use of objective assessment such as psychological tests revealed more abnormalities than were expressed by parents in response to clinical interviews (AU)

[Pectoralis major flaps. Evolution of their use in the age of microvascularized flaps]. / Colgajo de pectoral mayor: evolución de su uso en la era de los colgajos microanastomosados.

INTRODUCTION: Oncological head and neck surgery has progressed with the possibility of adapting reconstruction to the surgery effected. In the last 30 years, two basic techniques have been developed: the pectoralis major myocutaneous flaps (PMMF) and microvascularized flaps. PMMF had a leading role in reconstruction surgery during the 1980s, but this has subsequently diminished in favour of microvascularized flaps. MATERIAL AND METHOD: A review was conducted on 351 reconstructive surgeries in 317 patients, of which 275 were PMMF and 76 free flaps. We analyzed age, gender, flap type, indication, and year of the surgery in all cases. RESULTS: 34 % of the revised flaps were used for reconstruction of the hypopharynx, 33 % for the oropharynx, 21 % for soft tissues, and 12 % for the repair of pharyngocutaneous fistulae. At our hospital, the introduction of the free flap technique from 2001 on has led to an increase in the use of reconstructive procedures as well as the replacement of PMMF by microvascularized flaps in a number of indications. CONCLUSIONS: In this age of microvascularized flaps, we believe that PMMF still has a privileged role in the repair of hypopharynx and cervical lesions. However, in such locations as the oral cavity or oropharynx and in facial soft- tissue reconstruction we prefer the use of microvascularized flaps.

Colgajo de pectoral mayor: evolución de su uso en la era de los colgajos microanastomosados / Pectoralis major flaps. Evolution of their use in the age of microvascularized flaps

Introducción: La cirugía oncológica de cabeza y cuello ha ido avanzando a medida que se ha podido ofrecer una reconstrucción adaptada al acto quirúrgico. En los últimos 30 años se han desarrollado 2 técnicas fundamentales: el colgajo pediculado de pectoral mayor (CMPM) y los colgajos microanastomosados. El CMPM tuvo un papel preeminente en los años ochenta, y con posterioridad su uso disminuyó de forma progresiva a favor de los colgajos microanastomosados. Material y método: Se realizó una revisión de 351 actos reconstructivos en 317 pacientes en los que se llevó a cabo 275 CMPM y 76 colgajos libres. Analizamos la edad, el sexo, el tipo de colgajo, la indicación y el año de la cirugía. Resultados: De los colgajos revisados: el 34 % fueron de reconstrucción de hipofaringe; el 33 %, de orofaringe; el 21 %, de reparación de partes blandas, y el 12 %, de reparación de fístulas faringocutáneas. La incorporación en el uso de colgajos libres a partir del año 2001 ha supuesto en nuestro centro el incremento en el uso de procedimientos reconstructivos, así como la sustitución para una serie de indicaciones del CMPM por colgajos microanastomosados. Conclusiones: En la era de los colgajos libres, creemos que el CMPM sigue manteniendo un lugar privilegiado para la reconstrucción de la hipofaringe y defectos de la región cervical. Sin embargo, actualmente, en determinadas localizaciones, como la cavidad oral y la orofaringe y en defectos de las partes blandas faciales, preferimos el uso de colgajos microanastomosados para la reconstrucción

Introduction: Oncological head and neck surgery has progressed with the possibility of adapting reconstruction to the surgery effected. In the last 30 years, two basic techniques have been developed: the pectoralis major myocutaneous flaps (PMMF) and microvascularized flaps. PMMF had a leading role in reconstruction surgery during the 1980s, but this has subsequently diminished in favour of microvascularized flaps. Material and method: A review was conducted on 351 reconstructive surgeries in 317 patients, of which 275 were PMMF and 76 free flaps. We analyzed age, gender, flap type, indication, and year of the surgery in all cases. Results: 34 % of the revised flaps were used for reconstruction of the hypopharynx, 33 % for the oropharynx, 21 % for soft tissues, and 12 % for the repair of pharyngocutaneous fistulae. At our hospital, the introduction of the free flap technique from 2001 on has led to an increase in the use of reconstructive procedures as well as the replacement of PMMF by microvascularized flaps in a number of indications. Conclusions: In this age of microvascularized flaps, we believe that PMMF still has a privileged role in the repair of hypopharynx and cervical lesions. However, in such locations as the oral cavity or oropharynx and in facial soft- tissue reconstruction we prefer the use of microvascularized flaps

[Unilateral benign choanal polyp: review of 51 patients]. / Pólipo coanal unilateral benigno: revisión de 51 pacientes.

INTRODUCTION: Choanal polyps are a benign pathology arising in the sinusal mucosa and entering the nasal fossa heading for the choana. It is a unilateral condition mainly affecting young people. It must be surgically removed, with exeresis of both the nasal and the sinusal lesions. MATERIAL AND METHOD: A retrospective review has been made of 51 patients treated for choanal polyp at our centre. They were diagnosed through physical examination, nasal endoscopy, nasosinusal CT, and histological examination of biopsy from the mass in selected cases. RESULTS: The choanal polyps originated in the maxillary sinus in 46 cases, in the ethmoidal sinus of 5 patients, and only 1 in the sphenoid sinus. Antrochoanal and ethmoidochoanal polyps were simultaneously found in 1 patient. Unilateral nasal obstruction was the main clinical presentation in our series. Nasal discharge, epistaxis, and snoring were other initial clinical findings. Eighty-five per cent (39/46) of antrochoanal polyps (ACP) emerged into the nasal fossa through Giraldés's accessory orifice, and 15% (7/46) through the natural ostium of the sinus. The origin in the maxillary sinus was adequately documented in 18 cases. The endoscopic approach was used in 46 patients. Other options employed were the Caldwell-Luc approach and a combination of limited antrostomy and endoscopic nasal surgery; these were among the first cases seen and therefore the oldest. Two of them relapsed and were treated again with an endoscopic nasosinusal approach. CONCLUSIONS: Endoscopic nasosinusal surgery is a safe and effective option and represents the approach of choice for the treatment of this pathology.

Pólipo coanal unilateral benigno: revisión de 51 pacientes / Unilateral benign choanal polyp: review of 51 patients

Introducción: El pólipo coanal es una lesión benigna que nace en la mucosa sinusal y se desplaza hacia la fosa nasal en dirección a la coana. Es una enfermedad unilateral que afecta principalmente a pacientes jóvenes. Su tratamiento es quirúrgico, y se debe extirpar tanto la lesión endonasal como la endosinusal. Material y método: Se realizó una revisión de 51 pacientes afectados de pólipo coanal tratados en nuestro centro. Su diagnóstico se llevó a cabo mediante exploración clínica, endoscopia nasal, tomografía computarizada nasosinusal y, eventualmente, un estudio histológico de la masa polipoide. Resultados: La localización lesional endosinusal fue en 46 casos maxilar; en 5 casos, etmoidal, y un caso, esfenoidal. Un paciente presentó 2 pólipos coanales de forma simultánea, uno de tipo antrocoanal y otro etmoidocoanal. En la serie el síntoma principal de consulta fue la obstrucción nasal unilateral. Otros síntomas de presentación fueron rinorrea, epistaxis y roncopatía. El 85 % (39/46) de los pólipos antrocoanales emergían a la fosa nasal por un orificio accesorio de Giraldés, mientras que el 15 % (7/46), por el ostium natural del seno. La zona de implantación en el seno maxilar se documentó adecuadamente en 18 pacientes. El tratamiento quirúrgico utilizado fue la cirugía endoscópica nasosinusal en 46 casos. Otras opciones empleadas fueron el abordaje tipo Caldwell-Luc y la vía combinada antral y endonasal bajo control endoscópico, que se corresponden a los primeros casos tratados y, por tanto, a los más antiguos. Se apreciaron dos recidivas que fueron tratadas con éxito con cirugía endoscópica nasosinusal. Conclusiones: El abordaje por cirugía endoscópica nasosinusal es una opción segura y eficaz; constituye la maniobra de elección en su tratamiento (AU)

Introduction: Choanal polyps are a benign pathology arising in the sinusal mucosa and entering the nasal fossa heading for the choana. It is a unilateral condition mainly affecting young people. It must be surgically removed, with exeresis of both the nasal and the sinusal lesions. Material and method: A retrospective review has been made of 51 patients treated for choanal polyp at our centre. They were diagnosed through physical examination, nasal endoscopy, nasosinusal CT, and histological examination of biopsy from the mass in selected cases. Results: The choanal polyps originated in the maxillary sinus in 46 cases, in the ethmoidal sinus of 5 patients, and only 1 in the sphenoid sinus. Antrochoanal and ethmoidochoanal polyps were simultaneously found in 1 patient. Unilateral nasal obstruction was the main clinical presentation in our series. Nasal discharge, epistaxis, and snoring were other initial clinical findings. Eighty-five per cent (39/46) of antrochoanal polyps (ACP) emerged into the nasal fossa through Giraldés's accessory orifice, and 15 % (7/46) through the natural ostium of the sinus. The origin in the maxillary sinus was adequately documented in 18 cases. The endoscopic approach was used in 46 patients. Other options employed were the Caldwell-Luc approach and a combination of limited antrostomy and endoscopic nasal surgery; these were among the first cases seen and therefore the oldest. Two of them relapsed and were treated again with an endoscopic nasosinusal approach. Conclusions: Endoscopic nasosinusal surgery is a safe and effective option and represents the approach of choice for the treatment of this pathology (AU)