Pathological Mechanisms and Additional Factors Involved in Complex Neck Traumatology

Background. Cervical trauma can be closed or open, have different degrees of severity, incidence rates, prevalence, or mortality, with variations in the presence of demographic factors. The different types of traumatic injuries have a certain pattern of occurrence depending on criteria related to sex, age, alcohol consumption, and socio-demographic factors. Increasing the rate of trauma is becoming a public health problem and it is necessary to study their epidemiology and implement control strategies. Aims. The objectives of the study are to establish the particularities of epidemiological, morphopathological, and pathophysiological factors involved in complex neck traumatology. Methods. The study group consisted of 384 patients, representative for the population of Moldova, who presented at the ENT Clinic, Hospital “St. Spiridon” Iași and the Institute of Forensic Medicine, Iași during 2012–2016, with complex cervical trauma pathology, produced by various mechanisms, such as car accidents, domestic accidents, aggressions, ballistic trauma, self-inflicted attempts, hanging or strangulation. Data were collected from autopsy reports and medical records. Results. Complex cervical trauma occurs with a predisposition in males, with an average age of 43 years, from rural areas. The mechanism of cervical trauma is predominantly self-inflicted—hanging in 78.4% of the total number of cases, followed by 14.8% of stabbing aggression. The majority of neck injuries, both open and closed, are located in anatomical zone II (73.6%), vascular and pharyngeal are produced by stabbing. Psychiatric disorders and blood alcohol levels are correlated with complex cervical trauma caused by self-inflicted mechanism—hanging and can be considered a predictive factor of suicide attempts. Conclusions. Overall, the vast majority of closed neck injuries were caused by the self-inflicted mechanism, attempted suicide by hanging, followed by the accidental mechanism. Regarding the penetrating complex aero-digestive cervical traumas, they were mostly produced by stabbing both in aggression and self-inflicted circumstances. Aggravating addictive factors such as alcoholism and mental disorders require a competent assessment in terms of the indication of institutionalized treatment, prevention of repeated self-inflicted attempts, or social reintegration

Pathological Mechanisms and Additional Factors Involved in Complex Neck Traumatology

Background. Cervical trauma can be closed or open, have different degrees of severity, incidence rates, prevalence, or mortality, with variations in the presence of demographic factors. The different types of traumatic injuries have a certain pattern of occurrence depending on criteria related to sex, age, alcohol consumption, and socio-demographic factors. Increasing the rate of trauma is becoming a public health problem and it is necessary to study their epidemiology and implement control strategies. Aims. The objectives of the study are to establish the particularities of epidemiological, morphopathological, and pathophysiological factors involved in complex neck traumatology. Methods. The study group consisted of 384 patients, representative for the population of Moldova, who presented at the ENT Clinic, Hospital “St. Spiridon” Iași and the Institute of Forensic Medicine, Iași during 2012–2016, with complex cervical trauma pathology, produced by various mechanisms, such as car accidents, domestic accidents, aggressions, ballistic trauma, self-inflicted attempts, hanging or strangulation. Data were collected from autopsy reports and medical records. Results. Complex cervical trauma occurs with a predisposition in males, with an average age of 43 years, from rural areas. The mechanism of cervical trauma is predominantly self-inflicted—hanging in 78.4% of the total number of cases, followed by 14.8% of stabbing aggression. The majority of neck injuries, both open and closed, are located in anatomical zone II (73.6%), vascular and pharyngeal are produced by stabbing. Psychiatric disorders and blood alcohol levels are correlated with complex cervical trauma caused by self-inflicted mechanism—hanging and can be considered a predictive factor of suicide attempts. Conclusions. Overall, the vast majority of closed neck injuries were caused by the self-inflicted mechanism, attempted suicide by hanging, followed by the accidental mechanism. Regarding the penetrating complex aero-digestive cervical traumas, they were mostly produced by stabbing both in aggression and self-inflicted circumstances. Aggravating addictive factors such as alcoholism and mental disorders require a competent assessment in terms of the indication of institutionalized treatment, prevention of repeated self-inflicted attempts, or social reintegration

Laryngeal Paraganglioma—A Case Report

Background and Objectives: Paragangliomas of the head and neck are rare neuroendocrine tumors originating from the paraganglia, which might be sympathetic or parasympathetic. Laryngeal paragangliomas are the rarest subtype of these tumors, with only 1.41% of all paragangliomas, arising from the supraglottic or subglottic paraganglia of the larynx. The vast majority of them are benign, but there are some cases in which they turn out to be malignant, and the only way to know with certainty the difference between them is when we identify distant metastases. The aim of this article is to share our experience with a rare case of laryngeal paraganglioma and review the clinical characteristics, methods of diagnostic, necessary investigation prior to the operation, and surgical management of this type of tumor. Materials and Methods: We present the case of a 68-year-old female patient, a non-smoker, who accused dysphagia, dysphonia, foreign body sensation, chronic cough, and hoarseness for six months. We performed a tracheostomy prior to biopsy to secure the airways in case of bleeding and then took a few biopsy samples. The histopathological exam revealed the presence of a laryngeal paraganglioma. An enhanced CT scan was performed in order to describe the localization, size, and invasion of the tumor. We also measured the vanillylmandelic acid from the urine to determine if the tumor produced catecholamines alongside a full cardiology and endocrinology examinations. In order to prevent massive bleeding during the operation, chemoembolization was attempted before surgery, but it was unsuccessful due to an anatomical variation of the left superior thyroid artery. She underwent surgery, first through transoral endoscopic microsurgery; however, we decided to undertake an external approach because of poor bleeding control, even though we had ligated both the superior thyroid artery and the external carotid artery, with a thyrotomy and laryngofissure achieving the complete resection of the tumor. Results: The patient was discharged 10 postoperative days later, with the recommendation of introducing food step-by-step from liquids to solids. She was decannulated after 30 days, with no complications regarding breathing, phonation, or deglutition. Twelve months after the surgery, we did not identify any local relapses of distant metastases. Conclusions: Laryngeal paragangliomas are rare neuroendocrine tumors that arise from the laryngeal paraganglia. Surgery is the best treatment option available, and it can be done by either an external approach or by transoral endoscopy. Enhanced CT or MRI, as well as full cardiological and endocrinological evaluation are mandatory prior to the operation. Measuring the catecholamines levels show the if the tumor is secretory. Controlling the bleeding poses the biggest challenge in performing the resection of the tumor, especially when a transoral endoscopic approach is chosen. Further standardized follow-up guidelines are required in the future

Stress and Burnout among Medical Specialists in Romania: A Comparative Study of Clinical and Surgical Physicians

This study, which focuses on 227 participants (196 females and 31 males) comprising 187 clinical specialists and 40 surgical physicians, examines the prevalence of burnout in medical specialists. We investigate the effects of the emotional exhaustion (EE), Depersonalization (D), and personal accomplishment (PA) dimensions on professional satisfaction and plans to change careers using the modified licensed Maslach Burnout Inventory—Human Services Survey (MBI-HSS (MP)). High emotional exhaustion is reported by 52.63% of men and 71.28% of women in the clinical medicine group (n = 188). In the surgical specialties (n = 39), scores are significantly higher, with 75% of men and 77.77% of women reporting EE. In our sample group, 71.36% express high levels of emotional exhaustion, with similar patterns across specialization and gender. Clinical medicine respondents report high degrees of depersonalization in 33.13% of females and 21.05% of males, while surgical specialty respondents report high levels in 33.33% of females and 50% of males. Across genders and specializations, 33.03% of all respondents show high levels of depersonalization. Clinical medicine participants report high levels of personal accomplishment (42.60% of females and 42.10% of males), whereas surgical specialties report 44.44% of females and 66.66% of male on the PA dimension. Of the total number of respondents, 44.05% report having a high level of personal accomplishment; differences exist depending on specialty and gender. In addition, questions regarding professional fulfilment and intention to change careers were presented to the participants. A total of 53.40% (16 male and 105 female) of the clinical medicine respondents said they intended to change careers, while 33 participants (9 male, 34 female) doubted if they would remain in the same specialization. Furthermore, 86 individuals (9 male and 77 female) in the surgical specialties said they would never choose to work in healthcare again. Regression analysis suggests that being male, higher in age, and working in surgical specialties with lower job satisfaction and a higher intention to change profession are associated with higher levels of EE. Age and work satisfaction are significant predictors of depersonalization, and higher career satisfaction is associated with increased levels of PA

Prognostic Significance of Multifactorial Analysis in Complex Cervical Aero-Digestive Trauma Cases

Background and Objectives: In the context of complex aerodigestive cervical traumas, the prognosis and outcome heavily depend on risk factors, particularly injuries to the larynx, trachea, major digestive tissues, cervical vertebrae, and vascular structures. With the increasing prevalence of trauma as a public health concern, there is a pressing need for epidemiological research and the implementation of preventative measures. The purpose of this research is to establish the profile of the predictable impact factors that determine the prognosis of patients with complex cervical trauma. Methods and Methods: The study group consisted of 106 patients with complex cervical trauma pathology developed by various mechanisms such as car accidents, home-related accidents, aggression, gunshot wounds, and self-inflicted attempts, resulting in hospitalization in the E.N.T. Clinic at “St. Spiridon” Iași Hospital, from 2012 to 2016; medical records were the source of the collected data. Results: Hemodynamic instability upon admission associated with age, muscle and laryngeal injuries, and anemia were identified as negative prognostic factors. Additionally, the utilization of imaging-based paraclinical investigations for diagnosing traumatic lesions emerged as a positive prognostic factor in managing this pathology. The management of penetrating cervical trauma remains a subject of debate, with some advocating for surgical exploration beyond the platysma layer in all cases, while others argue for a more selective conservative approach due to a high rate of negative explorations. Conclusions: The statistical evaluation of epidemiological, clinical, lesion, paraclinical, and therapeutic parameters is needed to establish predictable risk factors in the prognosis of complex aerodigestive cervical trauma

Improving the Treatment Outcome of Naso-Orbito-Ethmoido-Maxillary Fractures Using Virtual Three-Dimensional Anthropometric Data

Background: Naso-orbito-ethmoido-maxillary (NOEM) fractures are usually the result of a high or moderate intensity impact to the upper midface. These types of fractures are difficult to treat and are frequently misdiagnosed. Craniometric analysis can be of real aid in the treatment of NOEM complex fractures by establishing midfacial proportions. Aim: This study aims to establish the distances between selected anthropometric points and midfacial proportions found in the adult Caucasian population and to determine if any differences exist between genders. Methodology: Measurements between anthropometric points, nasion (N), dacryon (D), infraorbital foramen (IOF), frontomalare orbitale (FMO), rhinion (Rhi) and porion (Po), were made on 3D models obtained using patients’ CT exams. Results: Significant differences were found between genders for the orbital dimensions represented by N–FMO (p = 0.000), N–IOF (p = 0.000), Rhi–FMO (p = 0.000), Rhi–IOF (p = 0.000), nose bridge width N–D (p = 0.001), Rhi–D (p = 0.016), D–D (p = 0.038) and the projection of the nose evaluated by Rhi–Po (p = 0.000), N–Po (p = 0.000), while a t-test showed that there are no significant differences between males and females for the N–Rhi (p = 0.254). Conclusions: The values of these measurements can be utilized during skeletal reconstruction after NOEM fractures, especially for bilateral comminuted fractures where no points of comparison are available

Anatomical Variants of Internal Carotid Artery—Results from a Retrospective Study

Background and Objectives: The internal carotid artery (ICA) is a vascular structure that can be easily injured during sinus endoscopic procedures, and surgeons should be familiar with its anatomic variants. The aim of this study was to describe the anatomical variations in the internal carotid artery in relationship to sphenoidal sinuses, using computed tomography (CT). Materials and Methods: In this retrospective study, we evaluated the variations of the ICA in relationship to sphenoidal sinuses in a cohort of 600 patients who were assessed between January 2020 and December 2022 in ‘Saint Spiridon’ Emergency Hospital, Iasi, Romania. Descriptive statistics were used to characterize our data. Results: The most prevalent anatomical variant was represented by intrasinusal septa with posterior insertion on the ICA (58.6%), followed by procident ICA (58%) and dehiscent ICA (52%). We could not find any statistical significance regarding demographic characteristics among groups. Conclusions: A thorough CT examination should be performed before functional endoscopic sinus surgery, with the identification of anatomical variants of the ICA, in order to prevent its injury with potentially fatal consequences