Injections of local anesthetics into pterygopalatine fossa gained popularity for treating acute and chronic facial pain and headaches. Injury of maxillary artery during pterygopalatine fossa ...injection can result in pseudoaneurysm formation or acute bleeding. We aimed to identify the optimal approach into pterygopalatine fossa by comparing feasibility and safety of suprazygomatic and two infrazygomatic approaches.
We analyzed 100 diagnostic CT angiographies of cerebral arteries using 3D virtual reality. Each approach was determined as a target point in pterygomaxillary fissure and an array of outermost edges trajectories leading to it. The primary outcomes were feasibility and safety for each approach. The secondary outcome was the determination of maxillary artery position for each approach to identify the safest needle entry point.
Suprazygomatic approach was feasible in 96.5% of cases, while both infrazygomatic approaches were feasible in all cases. Suprazygomatic approach proved safe in all cases, posterior infrazygomatic in 73.5%, and anterior infrazygomatic in 38%. The risk of maxillary artery puncture in anterior infrazygomatic approach was 14.7%±26.4% compared to 7.5%±17.2%. in posterior infrazygomatic with the safest needle entry point in the upper-lateral quadrant in both approaches.
The suprazygomatic approach proved to be the safest, however not always feasible. The posterior infrazygomatic approach was always feasible and predominantly safe if the needle entry point was just anterior to the condylar process. The anterior infrazygomatic approach was always feasible, however least safe even with an optimal needle entry point just anterior to the coronoid process.
Several techniques have been employed for defect reconstruction after total laryngectomy, among others sliding epiglottoplasty. As there is a paucity of data on sliding epiglottoplasty after total ...laryngectomy, this study aimed to present this reconstruction technique in detail with the retrospective analysis of the patients.
We retrospectively reviewed single-center medical records of patients who underwent pharyngeal reconstruction after total laryngectomy between 2007-2013, with a follow-up to 2020. The study included patients who had total laryngectomy performed followed by a primary closure or sliding epiglottoplasty. The patients were divided according to the pharyngeal reconstruction technique: sliding epiglottis (
= 38) and primary closure (
= 120).
The baseline characteristics of patients, TNM stages, and previous treatment strategies did not differ significantly between the sliding epiglottis and primary closure group. The postoperative complication rates, including the pharyngocutaneous fistulae formation and strictures were comparable between the analyzed groups; however, a slightly higher incidence of pharyngocutaneus fistulae was noted within the patients after sliding epiglottoplasty. Overall 3-year survival of patients who underwent the epiglottoplasty and primary closure group were 73.7%
. 57.5%, respectively.
Sliding epiglottoplasty is considered a safe reconstruction technique. Although slightly better outcomes were noted within the epiglottoplasty group, it is still considered inferior to the primary closure. This technique ought to be considered in meticulously selected patients in whom primary closure is not feasible, epiglottis with nearby structures is spared from disease, and when the distal flaps are less appropriate or contraindicated.
Juvenile recurrent parotitis is a rare inflammatory disease of the parotid gland that shares diverse therapeutic management between institutions. Sialendoscopy has been demonstrated as an efficient ...diagnostics and therapeutic method with minimal complications; however, due to the rarity of the disease and limited data, there is a lack of universal guidelines on its optimal management. Herein, we retrospectively analysed patients with juvenile recurrent parotitis who had the sialendoscopy performed at our tertiary centre. Descriptive data were retrieved along with the number of swelling episodes one year before and after the sialendoscopy intervention. In the last decade, twenty-nine sialendoscopic procedures were performed at our clinics on twenty-one patients diagnosed with juvenile recurrent parotitis. Most of them underwent the procedure under general anaesthesia (86%). In the year before and after the sialendoscopic procedure, the patients had 3.9 ± 2.7 and 0.2 ± 0.4 episodes of swelling per year, respectively. The difference proved to be statistically significant (p < 0.0001). The complete resolution was noted in sixteen patients (76%); however, the procedure was not repeated on the same side of any patient. Solely one patient had a relapse of the disease reported more than twelve months after the sialendoscopy, nonetheless, one of his exacerbation episodes was already reported in the first year after the sialendoscopy. The mean follow-up period of patients was 48.6 months (range, 13−116 months). All things considered, this study emphasises sialendoscopy as an effective minimally invasive diagnostic and therapeutic tool for the management of juvenile recurrent parotitis.
Identifying a submandibular (Wharton's) duct punctum often hinders sialendoscopy; however, there is a paucity of evidence on whether the appearance of Wharton's duct papilla impacts the ...sialendoscopic procedure. A classification of Wharton's duct papillae based on the macroscopic appearance, size of dilatation probes, and sialendoscopic approach was proposed herein. The classification describing four main types of papillae, A, B, C, and D, was prospectively evaluated on 351 Wharton's duct papillae in 315 patients. For each papillae type, the demographic/clinical data, intraoperative complications, and time required for sialendoscope introduction were analyzed. Estuary-like papilla (type A) was commonly seen after spontaneous stone extrusion, had no intraoperative complications noted, and had the shortest time required for the sialendoscope introduction. Normal papilla (type B) was the most frequently observed papilla (48.1%), reflecting diverse underlying pathology, while difficult papilla (type C) was often associated with unfavorable anatomical variations of the mandible or floor of the mouth. Substantially closed papilla (type D) had the highest rate of intraoperative complications, namely, perforation with a false passage, and required the longest time for the sialendoscope introduction. In seven patients (2.0%), the entrance into the duct was feasible only through the fistula, while the sialendoscope introduction failed in eight patients (2.3%). In conclusion, the appearance of Wharton's duct papillae may be influenced by the underlying pathology. Based on the proposed classification, papilla typology affects the duration of sialendoscope introduction and may influence the frequency of intraoperative complications.
Virtual reality is increasingly used in medicine for diagnostics, for visualisation of complex structures and for preoperative planning. In interventional radiology, minimally invasive approach could ...be described with a target point representing the desired needle tip position and an array of all possible trajectories leading to it resembling irregular “cone” or “pyramid”. We present a pilot study of planning a minimally invasive posterior infrazygomatic and suprazygomatic approaches into the pterygopalatine fossa using a solid angle as a measure of size of the approach in five virtually reconstructed heads. The minimally invasive approaches were planned by manually drawing the edges of “pyramids” that described each approach in 3D using virtual reality program Tracer. For each head, a transverse diameter was measured and for each approach a solid angle size, average edge length and estimated area on the skin from where the target point could be reached were calculated. We found that, the solid angle of posterior infrazygomatic approach was significantly larger than suprazygomatic approach (p<0.001). Furthermore, the transverse head diameter and solid angle in posterior infrazygomatic approach were negatively correlated (ρ=-0.55, p=0.0002), while transverse head diameter and the estimated area on the skin from where the target point could be reached in the suprazygomatic approach were positively correlated (ρ=0.37, p=0.0206). In conclusion, our findings provide important preliminary evidence on the feasibility of evaluating and comparing different minimally invasive approaches using virtual reality systems, and affirm the validity of solid angle as a measure of the size of the approach.
Izhodišča: Juvenilni relapsni parotitis otrok in mladostnikov se kaže s ponavljajočimi in bolečimi otekanji obušesne žleze slinavke. Težave pogosto spontano prenehajo do konca pubertete, a pogosta ...vnetja poškodujejo žlezo in Stenonovo izvodilo. V zadnjem desetletju pri diagnosticiranju in zdravljenju uporabljamo sialendoskopijo. Metode: Analizirali smo podatke bolnikov z juvenilnim relapsnim parotitisom, ki smo jih obravnavali na naši kliniki med aprilom 2011 in oktobrom 2019 in pri katerih zdravljenje z zdravili ni preprečilo ponovnih zagonov bolezni. Pri-merjali smo število akutnih epizod pred sialendoskopijo in po njej, intraoperativne najdbe, prisotnost zožitev, upora-bo anestezije ter medoperativne in pooperativne zaplete. Kot merilo uspešnosti posega smo uporabili število akutnih zagonov parotitisa pred posegom in po njem. Rezultati: V raziskavo smo vključili 14 bolnikov. Opravili smo 19 sialendoskopij, 3 v lokalni in 16 v splošni anesteziji. Pred sialendoskopijo so bolniki utrpeli v povprečju 5 akutnih zagonov letno. Pri 6 bolnikih smo med posegom ugotovili prisotnost zožitev. Pri 2 bolnikih je med posegom prišlo do poškodbe izvodila. 11 bolnikov po posegu ni doživelo več nobene epizode vnetja, pri 3 bolnikih pa so se vnetja slinavke bistveno zmanjšala. Zaključek: Sialendokopija je varen in učinkovit poseg za dia-gnostiko in zdravljenje juvenilnega relapsnega parotitisa. Poseg ima malo zapletov, hospitalizacija je kratka, predvsem pa pomembno zmanjša število ponovnih vnetij.
Introduction: Juvenile recurrent parotitis presents with recurrent and painful swelling of the parotid gland in children and adolescents. Usually, the disease resolves spontaneously by the end of ...puberty, although frequent inflammation can damage the gland and Stensen’s duct. Sialendoscopy has been used in the diagnostic work-up and treatment of juvenile recurrent parotitis in the last decade. Methods: Data of patients with juvenile recurrent parotitis not responsive to drug treatment who were treated in our clinic between April 2011 and October 2019 were analysed. The number of acute relapses before and after sialendos-copy, intraoperative findings, stenosis, the use of anaesthe-sia, and intraoperative and postoperative complications were compared. The success of procedure was measured by a decrease in the number of acute relapses after procedure. Results: 14 patients were included in the study. 19 sialendos-copies were performed, 16 under general and 3 under local anaesthesia. The patients had an average of 5 relapses per year before the initial procedure. 6 patients had ductal stenosis. During sialendoscopy, the main duct was damaged in 2 patients. 11 patients did not have any relapses after sialen-doscopy. The other 3 had a significant reduction in relapses. Conclusion: Sialendoscopy is a safe and effective proced-ure for the diagnosis and treatment of juvenile recurrent parotitis. Sialendoscopy has few complications, a short hospitalization, and a significant reduction in the number of relapses.
Introduction: Chronic rhinosinusitis (CRS) is an inflammatory condition that affects the nose and paranasal sinuses, characterised by nasal purulent discharge, nasal blockage and hyposmia, in ...combination with facial pain/pressure for at least 12 weeks. CRS can be classified as chronic rhinosinusitis with nasal polyps (CRSwNP) and chronic rhinosinusitis without nasal polyps (CRSsNP). Asthma is a complex chronic inflammatory disorder that presents a lot of different phenotypes and endotypes. Eosinophilic asthma is a specific phenotype characterised by thickening of the basement membrane and good response to corticosteroid. IL-5 is the most important interleukin responsible for eosinophilic airway inflammation.
Material and methods: Patients with severe eosinophilic asthma were enrolled into a study group for the administration of anti-IL-5 (Mepolizumab) for severe eosinophilic asthma in a single specialised pulmonary tertiary institution. All patients were evaluated of their nasal status by a rhinologist for nasal symptoms regarding EPOS criteria, comorbidities (smoking, family history of CRS, allergies, VAS scale of asthma state, gastroesophageal reflux disease) and completed the validated SNOT-22 questionnaire on the same day before the administration of the anti-IL-5. Two separate biopsies were taken from the uncinate process or middle concha or nasal polyps, one for histopathology, the other for immunology. All patients had computer tomography scan of the paranasal sinuses and blood specimens taken for eosinophilia in the peripheral blood. The histopathological disease was characterised by counting of the eosinophils in high power field (HPF). Positive results were regarded when the count was higher than 10 per HFP. The immunologic study was performed by the RNA-sequencing. Hypereosinophilia was defined by a percentage count higher than 4% with a corresponding count higher than 500 per cubic mm.
Results: The study is still in progress, currently including 9 patients, 6 with CRS and 3 without. Preliminary results show no statistically significant differences between the groups. Unfortunately, the data about the postinterventional results of our patients is not available yet.
Conclusion: Literature shows improvement in radiologic findings and quality of life markers with Mepolizumab use.
The zirconia-resin adhesion, crucial in fixed dental prostheses, may be mechanically enhanced by airborne-particle abrasion (APA) induced surface roughening. APA may substantially increase the ...strength of 3Y-TZP, which is associated with (sub)surface compressive residual stresses through t-m phase transformation. In this work, the effects of APA and regeneration firing (RF) (1000 °C, 15 min) of various zirconia dental ceramics containing 3–5 mol.% of yttria were investigated. The phase composition, (sub)surface microstructural changes, and biaxial flexural strengths coupled with Weibull statistics and fractography were analysed and compared. The results show a significant increase in strength for 3Y and 4Y specimens after APA, ascribed to the t-m transformation toughening. However, APA substantially decreased the strength of 5Y variant. After RF, the ferroelastic domain switching phenomenon was presumably the persisting mechanism to withstand the propagation of APA-induced cracks in 3Y and 4Y zirconias, not being inferior to strength values of the as-sintered counterparts.
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