RETROPHARYNGEAL ABSCESS: A HIDDEN COMPLICATION OF PERFORATED THORACIC ESOPHAGEAL CANCER

BACKGROUND. Deep neck infections have significant morbidity and mortality. The most common complications are mediastinitis and sepsis. Acute mediastinitis continues to be a serious condition with a high mortality rate. The common primary sources of infection are of odontogenic etiology, pharyngo-laryngeal infections, cancers and iatrogenic. Most esophageal perforations are iatrogenic (50-75%) and most occur during endoscopic procedures. MATERIAL AND METHODS. We present the case of a 60-year-old patient who developed a deep neck infection two weeks after undergoing a biopsy for a mass located in the thoracic segment of the esophagus. RESULTS. The therapeutic management consisted of placing a tracheostomy tube, performing a lateral cervical incision to permit drainage of the abscess, lavage, and drainage of the superior mediastinum along with aggressive antibiotherapy. The postoperative evolution was favorable, with the CT scan showing no remaining colections and blood samples almost returning to normal values. CONCLUSIONS. Clinical evaluation, appropriate imaging, and aggressive active management are vital to successful outcomes for deep neck infections (DNIs). The origins of DNIs are usually evident from clinical and radiological examination. However, efforts should be made to identify the source of infection and this should be treated at the same time or electively

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