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Enfermedades Infecciosas Y... May 2024To analyze the cases of acute mastoiditis, characteristics, management and complications in children attended in the emergency department.
OBJECTIVE
To analyze the cases of acute mastoiditis, characteristics, management and complications in children attended in the emergency department.
METHODS
Retrospective study of acute mastoiditis in a Spanish tertiary hospital over a 6-year period (2018-2023).
RESULTS
One hundred two episodes of acute mastoiditis were analyzed (54% males, median age 1.8 years). Microorganisms were isolated in one third of cases, mainly Streptococcus pyogenes (64% of ear secretion cultures). Complications occurred in 27.5%, primarily subperiosteal abscess. A younger age, absence of vaccination schedule, previous history of otitis, cochlear implant carriers or white blood cell counts and C-reactive protein levels were not associated with complications. Complicated cases had longer hospitalizations. Treatment included antibiotics, corticosteroids, and surgery in 50% of cases.
CONCLUSIONS
This study shows an increase of acute mastoiditis during 2023, with a relevant role of S. pyogenes. A younger age, absence of vaccination, personal history of otitis or cochlear implant, blood cell counts and C-reactive protein levels were not associated with complications.
Topics: Humans; Mastoiditis; Retrospective Studies; Male; Female; Spain; Infant; Child, Preschool; Acute Disease; Emergency Service, Hospital; Child; Adolescent
PubMed: 38704193
DOI: 10.1016/j.eimce.2024.02.010 -
American Journal of Otolaryngology 2024To assess the audiometric outcomes following surgical repair of spontaneous temporal bone cerebrospinal fluid otorrhea and compare different surgical approaches. (Comparative Study)
Comparative Study
PURPOSE
To assess the audiometric outcomes following surgical repair of spontaneous temporal bone cerebrospinal fluid otorrhea and compare different surgical approaches.
MATERIALS AND METHODS
Retrospective review of adults (≥18 years old) who underwent repair of spontaneous CSF leak between 2011 and 2022. Audiometric outcomes were compared across the three surgical groups: transmastoid, middle cranial fossa and combined.
RESULTS
Thirty-nine patients (40 ears) met the inclusion criteria (71.8 % females; mean age 59.77 +/- 12.4). Forty-two percent underwent transmastoid, 12.5 % middle cranial fossa and 45 % transmastoid-middle cranial fossa. Four patients (10 %) had recurrence, 3 in the transmastoid group and 1 in the combined approach. The mean change in air-bone gap (ABG) for all patients (postoperative-preoperative) was -7.4 (paired t-test, p-value = 0.0003). The postoperative ABG was closed in 28 (70 %) ears (postoperative ABG ≤ 15). The mean change in pure tone average (PTA) for all patients (postoperative-preoperative) was -4.1 (paired t-test, p-value = 0.13). The mean change in word recognition scores (WRS) for all patients (postoperative-preoperative) was -3 (paired t-test, p-value = 0.35). On multivariable analysis (controlling for site and reconstruction material), there was no significant difference in ABG, PTA and WRS change between surgical groups.
CONCLUSIONS
Transmastoid, middle cranial fossa and combined approaches are all effective in treatment of spontaneous CSF leaks and all showed mean decrease in post-operative ABG. Transmastoid approach showed the greatest decrease in ABG and PTA (although middle cranial fossa approach shows the greatest decrease, when excluding profound hearing loss in a patient with superior canal dehiscence). Further studies comparing audiometric outcomes are needed.
Topics: Humans; Female; Male; Middle Aged; Retrospective Studies; Temporal Bone; Cerebrospinal Fluid Otorrhea; Treatment Outcome; Aged; Cranial Fossa, Middle; Audiometry, Pure-Tone; Adult; Cerebrospinal Fluid Leak; Mastoid; Audiometry
PubMed: 38701729
DOI: 10.1016/j.amjoto.2024.104345 -
Advances and Technical Standards in... 2024Paragangliomas are the most common tumors at jugular foramen and pose a great surgical challenge. Careful clinical history and physical examination must be performed to...
Paragangliomas are the most common tumors at jugular foramen and pose a great surgical challenge. Careful clinical history and physical examination must be performed to adequately evaluate neurological deficits and its chronologic evolution, also to delineate an overview of the patient performance status. Complete imaging evaluation including MRI and CT scans should be performed, and angiography is a must to depict tumor blood supply and sigmoid sinus/internal jugular vein patency. Screening for multifocal paragangliomas is advisable, with a whole-body imaging. Laboratory investigation of endocrine function of the tumor is necessary, and adrenergic tumors may be associated with synchronous lesions. Preoperative prepare with alpha-blockage is advisable in norepinephrine/epinephrine-secreting tumors; however, it is not advisable in exclusively dopamine-secreting neoplasms. Best surgical candidates are young otherwise healthy patients with smaller lesions; however, treatment should be individualized each case. Variations of infratemporal fossa approach are employed depending on extensions of the mass. Regarding facial nerve management, we avoid to expose or reroute it if there is preoperative function preservation and prefer to work around facial canal in way of a fallopian bridge technique. If there is preoperative facial nerve compromise, the mastoid segment of the nerve is exposed, and it may be grafted if invaded or just decompressed. A key point is to preserve the anteromedial wall of internal jugular vein if there is preoperative preservation of lower cranial nerves. Careful multilayer closure is essential to avoid at most cerebrospinal fluid leakage. Residual tumors may be reoperated if growing and presenting mass effect or be candidate for adjuvant stereotactic radiosurgery.
Topics: Humans; Jugular Foramina; Neurosurgical Procedures; Paraganglioma; Skull Base Neoplasms
PubMed: 38700686
DOI: 10.1007/978-3-031-42398-7_10 -
Anatomical Science International Jun 2024The spinal accessory nerve, considered part of the eleventh cranial nerve, provides motor innervation to sternocleidomastoid and trapezius. A comprehensive literature... (Review)
Review
The spinal accessory nerve, considered part of the eleventh cranial nerve, provides motor innervation to sternocleidomastoid and trapezius. A comprehensive literature review and two cadaveric dissections were undertaken. The spinal accessory nerve originates from the spinal accessory nucleus. Its rootlets unite and ascend between the denticulate ligament and dorsal spinal rootlets. Thereafter, it can anastomose with spinal roots, such as the McKenzie branch, and/or cranial roots. The spinal accessory nerve courses intracranially via foramen magnum and exits via jugular foramen, within which it usually lies anteriorly. Extracranially, it usually crosses anterior to the internal jugular vein and lies lateral to internal jugular vein deep to posterior belly of digastric. The spinal accessory nerve innervates sternocleidomastoid, receives numerous contributions in the posterior triangle and terminates within trapezius. Its posterior triangle course approximates a perpendicular bisection of the mastoid-mandibular angle line. The spinal accessory nerve contains sensory nociceptive fibres. Its cranial nerve classification is debated due to occasional non-fusion with the cranial root. Surgeons should familiarize themselves with the variable course of the spinal accessory nerve to minimize risk of injury. Patients with spinal accessory nerve injuries might require specialist pain management.
Topics: Humans; Accessory Nerve; Cadaver; Anatomic Variation
PubMed: 38696101
DOI: 10.1007/s12565-024-00770-w -
Case Reports in Infectious Diseases 2024() has evolved as a prominent pathogen, with nontypeable strains (NTHi) emerging as a leading cause of invasive disease, particularly among the elderly. Since the...
() has evolved as a prominent pathogen, with nontypeable strains (NTHi) emerging as a leading cause of invasive disease, particularly among the elderly. Since the introduction of B (Hib) vaccine, invasive infection has shifted from children with Hib to the elderly with NTHi. NTHi affects those primarily with predisposing factors such as an immunocompromised state, CSF leakage, or ENT infections. We present two cases that emphasize the shift of invasive infection, risk factors, and elevated intracranial pressure (ICP) as a complication. . A 75-year-old female with a sudden onset of weakness and respiratory symptoms deteriorated rapidly. Imaging revealed mastoid effusion and ventriculitis, likely originating from otomastoiditis. Lumber puncture confirmed NTHi. ICU course complicated by elevated ICP prompted repeat lumbar puncture. The patient recovered after 8 days but not near baseline. . A 50-year-old female with altered mental status, headache, and ear pain exhibited signs of pansinusitis and pseudotumor cerebri. Elevated ICP was evident upon lumbar puncture, and NTHi was isolated in CSF and blood cultures. MRI of the brain showed prominent optic nerve sheaths and transverse sinus arachnoid granulations' concern for underlying pseudotumor cerebri. Repeat lumbar puncture or ventricular drainage was deferred after discussion with neurosurgery. Diabetes was identified as a comorbidity. The patient's condition improved after 14 days of antibiotics and dexamethasone. These cases emphasize the shifting landscape of meningitis, primarily driven by NTHi, especially among the elderly. Although NTHi infections were considered less invasive, recent epidemiology review indicated it as the leading cause of meningitis. With the increasing prevalence of NTHi and its increase in invasive patterns, it is crucial to implement vaccination strategies and develop new vaccines targeting NTHi.
PubMed: 38694252
DOI: 10.1155/2024/5571104 -
International Journal of Legal Medicine Apr 2024The increased use of virtual bone images in forensic anthropology requires a comprehensive study on the observational errors between dry bones and CT reconstructions....
BACKGROUND
The increased use of virtual bone images in forensic anthropology requires a comprehensive study on the observational errors between dry bones and CT reconstructions. Here, we focus on the consistency of nonmetric sex estimation traits on the human skull.
MATERIALS AND METHODS
We scored nine nonmetric traits on dry crania and mandibles (n = 223) of archaeological origin and their CT reconstructions. Additionally, we 3D surface scanned a subsample (n = 50) and repeated our observations. Due to the intricate anatomy of the mental eminence, we split it into two separate traits: the bilateral mental tubercles and the midsagittal mental protuberance. We provide illustrations and descriptions for both these traits.
RESULTS
We obtained supreme consistency values between the CT and 3D surface modalities. The most consistent cranial traits were the glabella and the supraorbital margin, followed by the nuchal crest, zygomatic extension, mental tubercles, mental protuberance, mental eminence, mastoid process and ramus flexure, in descending order. The mental tubercles show higher consistency scores than the mental eminence and the mental protuberance.
DISCUSSION
The increased interchangeability of the virtual modalities with each other as compared to the dry bone modality could be due to the lack of tactility on both the CT and surface scans. Moreover, tactility appears less essential with experience than a precise trait description. Future studies could revolve around the most consistent cranial traits, combining them with pelvic traits from a previous study, to test for accuracy.
PubMed: 38689177
DOI: 10.1007/s00414-024-03244-w -
The Journal of Craniofacial Surgery Apr 2024Mastoid emissary foramen transmitting mastoid emissary vein connects the posterior auricular vein with the sigmoid sinus. This foramen and so the mastoid emissary vein...
Mastoid emissary foramen transmitting mastoid emissary vein connects the posterior auricular vein with the sigmoid sinus. This foramen and so the mastoid emissary vein varies in prevalence, number, size and location, knowledge of which is essential for carrying out uneventful surgeries, especially retrosigmoid, mastoidectomy, and skull base surgeries. There is a paucity of literature on this foramen in the Indian context, so the study was done. The purpose of the study is to elaborate on the prevalence, number, size, and location of mastoid foramen in dry adult skulls. The study was conducted in the Department of Anatomy using 90 dry skulls of unknown age and sex, and prevalence, number, size, and location in these skulls were noted. The mastoid foramen was detected in 27.8% of skulls, with an incidence of 31.1% and 12.2% on right and left sides of skulls, respectively. The number of foramina ranged between 1 and 4. The mean diameter of this foramen was 0.9 mm, and the most frequent location was mastoid process. The detailed morphology and morphometry of mastoid foramen are of utmost use to neurosurgeons, ENT surgeons, radiologists, and vascular surgeons as it transmits mastoid emissary vein and meningeal branch of the occipital artery, which may be injured during various surgical procedures involving mastoid region and skull base causing catastrophic hemorrhage. In addition to this, mastoid emissary vein may be the source of thrombus, causing thrombus of sigmoid sinus creating helm of neurological complications.
PubMed: 38687087
DOI: 10.1097/SCS.0000000000010142 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... May 2024To summarize the clinical characteristics and therapeutic effect of traumatic facial nerve palsy. Sixty-eight cases of traumatic facial nerve palsy were retrospectively...
To summarize the clinical characteristics and therapeutic effect of traumatic facial nerve palsy. Sixty-eight cases of traumatic facial nerve palsy were retrospectively analyzed from January 2015 to May 2023. The median course of disease was 33 days. The facial nerve function of the patients was grade HB-Ⅱin 2 cases, grade HB-Ⅲ in 4 cases, grade HB-Ⅳin 16 cases, grade HB-Ⅴ in 37 cases(38 ears), and grade HB-Ⅵ in 9 cases. 42 cases occurred immediately after injury and 26 cases were delayed. CT examination of temporal bone revealed longitudinal fractures in 51 cases(52 ears) , transverse fractures in 6 cases and mixed fractures in 4 cases. No definite temporal bone fracture was found in the remaining 7 cases. The segments of facial nerve injury in 49 cases(50 ears) were geniculate ganglion and adjacent, in 7 cases were vertical segment, in 7 cases were horizontal segment, in 2 cases were horizontal segment and vertical segment; and the other 3 cases could not be evaluated. Conservative treatment with glucocorticoids was used in 23 ears and surgery was used in 46 ears. Patients were followed up 6-24 months after treatment, including 20 cases of grade HB-Ⅰ, 19 cases of grade HB-Ⅱ, 23 cases(24 ears) of grade HB-Ⅲ, 4 cases of grade HB-Ⅳ, and 1 case of grade HB-Ⅴ.One patient was lost to follow-up. After treatment, the facial nerve function of patients was significantly improved(<0.05), and there were significant differences between conservative treatment group and surgical treatment group in the course of facial nerve palsy, the ratio of facial palsy immediately after injury, the nerve function before treatment and the nerve function after treatment(<0.05). There were no significant differences in age, sex, hearing condition, temporal bone fracture, facial nerve injury segment and rate of favorable neurologic outcomes(>0.05). The comparison of patients with neurodegeneration rate>90% and ≤90% showed that the facial nerve function of patients with neurodegeneration rate>90% before treatment was significantly worse(<0.05), but there was no significant difference between the facial nerve function after treatment(>0.05). There was no significant difference in facial nerve function between middle fossa approach group and mastoid approach group(>0.05). Patients with traumatic facial nerve palsy should be evaluated individually. Patients with mild facial nerve palsy, low neurodegeneration rate and short course of disease can be treated conservatively and followed up closely. Patients with severe facial nerve palsy, high neurodegeneration rate and more than 6 weeks of disease can be actively considered surgery. Good prognosis can be obtained by correct evaluation and treatment.
Topics: Humans; Facial Paralysis; Retrospective Studies; Male; Female; Facial Nerve Injuries; Adult; Middle Aged; Young Adult; Adolescent; Temporal Bone; Facial Nerve; Glucocorticoids; Treatment Outcome
PubMed: 38686478
DOI: 10.13201/j.issn.2096-7993.2024.05.011 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... May 2024To investigate the characteristics and prognosis of two anastomosis techniques in repairing facial nerve defects. A retrospective analysis was conducted on 30 patients...
To investigate the characteristics and prognosis of two anastomosis techniques in repairing facial nerve defects. A retrospective analysis was conducted on 30 patients who underwent facial nerve anastomosis(direct or rerouting) for facial nerve defects in our department from January 2012 to December 2021. Among them, 21 were male and 9 were female, with an average age of(37.53±11.33) years, all with unilateral onset. Preoperative House-Brackmann(H-B) facial nerve function grades were Ⅳ in 2 cases, Ⅴ in 9 cases, and Ⅵin 19 cases. The duration of facial paralysis before surgery was within 6 months in 21 cases, 6-12 months in 6 cases, and over 1 year in 3 cases. The causes of facial paralysis included 14 cases of cholesteatoma, 6 cases of facial neurioma, 6 cases of trauma, and 4 cases of middle ear surgery injury. Surgical approaches included 9 cases of the middle cranial fossa approach, 8 cases of labyrinthine-otic approach, 7 cases of mastoid-epitympanum approach, and 6 cases of retroauricular lateral neck approach. All patients were followed up for more than 2 years. The direct anastomosis was performed in 10 cases: 6 cases with defects located in the extratemporal segment and 4 cases in the tympanic segment. Rerouting anastomosis was performed in 20 cases: 11 cases with defects located in the labyrinthine-geniculate ganglion, 4 cases from the internal auditory canal to the geniculate ganglion, 3 cases in the internal auditory canal, and 2 cases in the horizontal-pyramid segment. Postoperative H-B facial nerve grades were Ⅱ in 2 cases, Ⅲ in 20 cases, and Ⅳ in 8 cases, with 73.3%(22/30) of patients achieving H-B grade Ⅲ or better. Both direct and rerouting anastomosis techniques can effectively repair facial nerve defects, with no significant difference in efficacy between the two techniques. Most patients can achieve H-B grade Ⅲ or better facial nerve function recovery. Preoperative facial nerve function and duration of facial paralysis are the main prognostic factors affecting the outcome of facial nerve anastomosis.
Topics: Humans; Male; Female; Adult; Facial Nerve; Retrospective Studies; Anastomosis, Surgical; Prognosis; Facial Paralysis; Middle Aged; Facial Nerve Injuries; Treatment Outcome
PubMed: 38686476
DOI: 10.13201/j.issn.2096-7993.2024.05.009 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... May 2024To explore the clinical manifestations and imaging characteristics, and to clarify the imaging value in the diagnosis of facial nerve schwannomas. Retrospectively...
To explore the clinical manifestations and imaging characteristics, and to clarify the imaging value in the diagnosis of facial nerve schwannomas. Retrospectively analyze the data of 23 patients with facial nerve schwannomas confirmed by surgery and pathology in the Department of Otorhinolaryngology of the First Affiliated Hospital of the Air Force Military Medical University from September 2020 to September 2022, including 8 males and 15 females, aged 18-66 years old. Summarize and analyze their clinical symptoms, specialized examinations, and imaging findings. The clinical manifestations were facial nerve paralysis in 15 cases(2 cases of HB Ⅳ, 6 cases of HB Ⅴ, 7 cases of HB Ⅵ), hearing loss in 14 cases(5 cases of conductive deafness, 2 cases of mixed deafness, and 7 cases of severe sensorineural hearing loss), 8 cases tinnitus, 7 cases ear pain, 4 cases dizziness, 4 cases headache, 2 cases ear pus, and parotid gland tumors in 6 cases presenting as local masses. Endoscopic examination revealed 8 cases of external ear canal tumors and 3 cases of intratympanic tumors. Combining temporal bone HRCT, MRI enhanced scanning, and CPR imaging techniques, 1 case involved the internal auditory canal segment, 2 cases in the tympanic segment, 6 cases in the parotid gland area. A total of 14 cases involved two or more segments of the internal auditory canal segment, the labyrinthine segment, geniculate ganglion, the tympanic segment, and the mastoid segment. When the tumors were large, adjacent structures were involved. It was found that 8 cases invaded the external auditory canal and tympanic cavity, ossicles were displaced or bony destruction; 3 cases invaded the jugular foramen area, and 1 case grew to the middle cranial fossa region with temporal lobe brain parenchymal compression. The clinical manifestations of facial nerve schwannomas are diverse. The combination of various imaging techniques will be conducive to topical and qualitative diagnosis and provide an important basis for treatment strategies.
Topics: Humans; Male; Female; Middle Aged; Adult; Neurilemmoma; Aged; Adolescent; Magnetic Resonance Imaging; Young Adult; Retrospective Studies; Facial Nerve; Tomography, X-Ray Computed; Cranial Nerve Neoplasms
PubMed: 38686473
DOI: 10.13201/j.issn.2096-7993.2024.05.006