Lista de verificación: tomografía computarizada de cuello en urgencias no traumáticas / Checklist: Neck computed tomography in non-traumatic emergencies

A los pacientes que acuden a urgencias con síntomas inflamatorio/infecciosos a nivel cervical o con masas que pueden comprometer el tracto aerodigestivo o las estructuras vasculares, es necesario hacerles una tomografía computarizada (TC) de cuello con contraste. Su interpretación radiológica se ve dificultada por la complejidad anatómica y la interrelación fisiopatológica entre los diferentes sistemas que lo componen, en un área de estudio relativamente pequeña. Estudios recientes proponen realizar una evaluación sistemática de las estructuras cervicales, utilizando para ello un listado de verificación de 7 elementos, para identificar correctamente la patología, y detectar los hallazgos incidentales que pueden interferir en el manejo del paciente. El objetivo de este trabajo es revisar los hallazgos de la TC en la patología no traumática del cuello en urgencias siguiendo una lectura sistemática, tras la cual se pueda realizar un informe radiológico estructurado, completo y conciso.(AU)

Patients attending the emergency department (ED) with cervical inflammatory/infectious symptoms or presenting masses that may involve the aerodigestive tract or vascular structures require a contrast-enhanced computed tomography (CT) scan of the neck. Its radiological interpretation is hampered by the anatomical complexity and pathophysiological interrelationship between the different component systems in a relatively small area. Recent studies propose a systematic evaluation of the cervical structures, using a 7-item checklist, to correctly identify the pathology and detect incidental findings that may interfere with patient management. As a conclusion, the aim of this paper is to review CT findings in non-traumatic pathology of the neck in the ED, highlighting the importance of a systematic approach in its interpretation and synthesis of a structured, complete, and concise radiological report.(AU)

Prognostic value of systemic immune-inflammation index and serological biomarkers for deep neck infections / Valor pronóstico del índice de inmunoinflamación sistémica y biomarcadores serológicos para infecciones profundas del cuello

Background: Inflammatory biomarkers, including C-reactive protein, erythrocyte sedimentation rate, neutrophil tolymphocyte ratio, platelet to lymphocyte ratio, and the systemic immune-inflammation index, have been proposedas prognostic factors diverse pathologies. However, their application for deep neck infections has yet to be clarified.Material and Methods: We performed a retrospective study of 163 adult patients with diagnosis of deep neck infec-tions with the aim to evaluate the association between serological biomarkers with complications and outcomes ofpatients with DNI. Studied variables included demographic data, complications of DNI, outcomes, complicationsand death of the included subjects. The evaluated serological biomarkers were hemoglobin, leukocytes, neutrophils,lymphocytes, platelets, glucose, creatinine, albumin, CRP, and ESR. NLR, PLR, and SIII index were estimated.Results: The patients’ mean age was 40.6 ± 15.3 years. Complications of DNI were observed in 19.6% (n=32) patients, being the need for tracheostomy due to airway obstruction (11%, n=18) and mediastinitis (8.6%, n= 14) themost common. Evaluated subjects had an increased value of serological biomarkers (SII index 2639.9 ± 2062.9,NLR 11.3 ± 8.5, PLR 184.1 ± 108.5, CRP 12.6 ± 8.9 mg/dL, ESR 20.7 ± 9.1 mm/h). Patients with complicationshad a significantly higher value of all inflammatory parameters (p < 0.05). A SII index cut-off value of 2975 wasselected from a ROC curve analysis. A sensitivity of 93.8%, specificity of 86.3%, a positive predictive value of62.5%, and a negative predictive value of 98.3% are reported. The SII index was found to have an increased positive predictive value compared to NLR, PLR, and CRP for DNI complications.Conclusions: Our analysis concluded that the SII index, NLR, and PLR are valuable biomarkers to assess the risk value of 2975.(AU)

Neck circumference as an indicator of Obesity for MetabolicSyndrome in Mexican Healthcare workers

Background: Neck circumference (NC) is a novel anthropometric indicator to assess adiposity in the cervical regionthat is rarely used in Mexico. The greatest advantage of this evaluation is the saving of time, minimal use of instruments, and no pre requisites for patients. Objective: This study aimed to determine the effective-ness of NC as an indicator of obesity for Metabolic Syndrome(MetS) in comparison with BMI and Waist Circumference(WC), and to define NC cutoff levels based on parameters established by the International Diabetes Federation in a groupof healthcare workers from a Public Health Hospital of the State of Morelos, Mexico. Methods: This was a no-randomized, cross-sectional-observational study. Instruments: Anthropometric evaluation and biochemical parameters: lipid profile, fasting glucose, and blood pressure. Statistical analysis: Descriptive, correlational, Poisson multiple regression adjusted by age/sex, and ROC curves using SPSS.23 program. Results: 200 healthcare workers were recruited (146 women and 54 men), age ẋ=42.87, σ=11.25 years. The prevalence of metS was 38% (37% in women and 40.7% in men). BMI, WC, and NC were significantly correlated: BMI and WC (r=.924),BMI and NC (r=.814), and NC and WC (r=.810) (p=.01).Like wise, they were related to hyperglycemia, hypertriglyceridemia, hypertension, and decreased in HDL-cholesterol levels. The NC best cut-off points coupled with two or more components of MetS in women was ≥35.12 cm [AUC=0.765 (95%CI, 0.688-0.843)] and in men ≥41.25 cm [AUC=0.787 (95%CI, 0.688-0.906)]. Conclusion: NC proved to be a reliable indicator that can be quickly and inexpensively evaluated for the determination of obesity for the preliminary diagnosis of MetS (AU)

An analysis of contributing factors of head and neck space infections of odontogenic origin: A long-term retrospective clinical study (including COVID-19 pandemic period)

Background: The purpose of this study is to investigate predisposing factors for the head and neck infections (HNIs), regarding to the demographic data, anatomical spaces, microbiology and antibiotic sensitivity for affected patients. Material and Methods: A 13-year of retrospective study evaluating 470 patients with HNIs, treated as inpatient management in the Department of Oral and Maxillofacial Surgery of KyungHee University school of Dentistry, Seoul, Korea, from January 2009 to February 2022. Statistical analysis of demographic, time-related, anatomic, microbiologic, and treatment variables were investigated for each patient. Results: The frequency of HNIs was significantly higher in 50’s in males, followed by 70’s in females. High Severity score (SS) were significantly associated with increased LOH (Length of hospital stay) and LOM (Length of medication), while LOH showed more intensive relationship compared with LOM. The most frequently involved space in abscess was submandibular space, though incidence and severity of HNIs shows declining tendency throughout 13-year research. Streptococcus viridans was the most predominant species isolated from pus culture growth, and a combination of ampicillin and sulbactam was the 1st choice of antibiotics intravenously. According to the comparison analysis between recommended antibiotics from resistance testing result and clinically administered antibiotics, final coincidence rate was estimated about 55%. Conclusions: Due to HNIs being multifactorial, predicting progression and management of HNIs is still a challenge for oral and maxillofacial surgeons. The present study showed several predisposing factors of SHNIs and their correlations, which could contribute to earlier diagnosis and more effective treatment planning for clinicians,thereby leading to the improvement of prognosis for patients, ultimately. (AU)

Neck circumference as a predictor of cardiometabolic risk and truncal obesity in people living with HIV / Circunferencia del cuello como predictor de riesgo cardiometabólico y obesidad del tronco superior en personas que viven con VIH

Introduction: recent studies have suggested the use of neck circumference as a parameter capable of identifying risks of cardiometabolic complications and the accumulation of truncal fat caused by both antiretroviral therapy and the lifestyle of people with the human immunodeficiency virus (HIV).Objective: to investigate the relationship between neck circumference and anthropometric indicators and to assess cardiometabolic risk and truncal obesity through proposed cut-off points. Methods: cross-sectional study including 233 people with HIV. Demographic, socioeconomic, lifestyle and clinical data were collected using astructured questionnaire. The anthropometric evaluation included: weight, height, body mass index (BMI) measurements; waist (WC), neck (NC),arm and arm muscle circumferences; triceps and subscapular skinfolds and their sum. ROC curves were constructed to determine the accuracy of NC in predicting cardiometabolic risk in people living with HIV. Results: the sample was 57.5 % male, with a mean age of 38.4 years (95 %CI: 37.2-39.7 years). NC showed a positive and significant correlation with all anthropometric variables analyzed (p < 0.05), and a higher correlation strength with WC and BMI. The NC cut-off point selected as a predictor of risk of cardiac metabolic complications and truncal obesity in women was ≥ 32.4 cm, considering both WC and BMI. For men, the NC cut-off points were different when considering WC (≥ 39.6 cm) and BMI (≥ 38.1 cm) as a reference. It is worth noting that NC performed well in ROC curve analysis for men, while in women it was a poor performance.Conclusion: NC proved to be a promising indicator in the assessment of nutrition and health of people living with HIV, especially in men. (AU)

Introducción: estudios recientes han sugerido el uso de la circunferencia del cuello como parámetro capaz de identificar los riesgos de complicaciones cardiometabólicas y la acumulación de grasa troncal causados tanto por la terapia antirretroviral como por el estilo de vida de las personas con el virus de la inmunodeficiencia humana (VIH). Objetivo: investigar la relación entre la circunferencia del cuello y los indicadores antropométricos y evaluar el riesgo cardiometabólico y la obesidad troncal a través de los puntos de corte propuestos. Métodos: estudio transversal que incluyó a 233 personas con VIH. Se recogieron datos demográficos, socioeconómicos, de estilo de vida y clínicos mediante un cuestionario estructurado. La evaluación antropométrica incluyó: medidas de peso, altura, índice de masa corporal (IMC); circunferencias de cintura (CC), cuello (CN), brazo (CA) y músculo del brazo (MCB); pliegues cutáneos del tríceps y subescapular y su suma. Se construyeron curvas ROC para determinar la precisión de la CN en la predicción del riesgo cardiometabólico en personas que viven con el VIH. Resultados: el 57,5 % de la muestra eran varones, con una edad media de 38,4 años (IC 95 %: 37,2-39,7 años). La CN mostró una correlación positiva y significativa (p < 0,05) con todas las variables antropométricas analizadas, y una mayor fuerza de correlación con la CC y el IMC. El punto de corte de la CN seleccionado como predictor de riesgo de complicaciones metabólicas cardiacas y obesidad troncular en mujeres fue ≥ 32,4 cm, considerando tanto la CC como el IMC. En el caso de los hombres, los puntos de corte de la CN fueron diferentes al considerar como referencia la CC (≥ 39,6 cm) y el IMC (≥ 38,1 cm). Cabe destacar que la CN obtuvo buenos resultados en el análisis de la curva ROC en el caso de los hombres, mientras que en el de las mujeres fue deficiente.Conclusión: ... (AU)

Validity of the neck circumference for the diagnosis of obesity in school children living at high altitude / Validez de la circunferencia del cuello para el diagnóstico de obesidad en escolares que viven en altura

Background: body mass index (BMI) is commonly used to diagnose overweight and obesity, and waist circumference (WC) is used to estimate visceral fat. The measurement of WC is demanding, therefore, different studies proposed the use of neck perimeter. Objective: exploring diagnostic validity of neck perimeter to diagnose overweight and obesity in 10-12 years old children in La Paz (Bolivia). Methods: this is a cross-sectional study with a random sample of school children in El Alto (Bolivia). Weight, height, abdominal circumference and neck perimeter were measured, classifying the nutritional status with BMI-z according to the cut-off point of the World Health Organization (WHO) classification. The sample size was calculated for 95 % confidence level, an alpha level of 0.05 and 80 % power for diagnosis test design. To evaluate neck perimeter validity for diagnosing obesity, sensibility, specificity and positive and negative ratio likelihood were calculated using BMI gold standard according to age and sex. Results: a number of 371 school children between 10-12 years old were included and 34 % of them presented malnutrition by excess. Sensibility and specificity of the neck perimeter to diagnose overweight and obesity were 87.5-100 % and 75.7-86.3 %, respectively. Conclusion: neck perimeter in 10-12-year-old school children is a valid indicator for carrying out obesity diagnosis.(AU)

Introducción: el índice de masa corporal (IMC) se usa comúnmente para diagnosticar el sobrepeso y la obesidad, y la circunferencia de la cintura (CC), para estimar la grasa visceral. La medición de la CC es exigente y, por ello, diferentes estudios propusieron el uso del perímetro del cuello. Objetivo: explorar la validez diagnóstica del perímetro del cuello para diagnosticar sobrepeso y obesidad en niños de 10-12 años en La Paz (Bolivia). Métodos: estudio transversal con una muestra aleatoria de escolares de El Alto (Bolivia). Se midieron peso, talla, circunferencia de la muñeca, perímetro de cuello, clasificando el estado nutricional con IMC-z según el punto de corte de la clasificación de la Organización Mundial de la Salud (OMS). El tamaño de la muestra se calculó para un nivel de confianza del 95 %, un nivel alfa de 0,05 y una potencia del 80 % para el diseño de la prueba de diagnóstico. Para evaluar la validez del perímetro del cuello para el diagnóstico de obesidad, se calcularon la sensibilidad, la especificidad y la razón de verosimilitud positiva y negativa utilizando el patrón oro del IMC según edad y sexo. Resultados: se incluyeron 371 escolares de 10-12 años, de los cuales el 34 % presentaba malnutrición por exceso. La sensibilidad y especificidad del perímetro del cuello para diagnosticar sobrepeso y obesidad estuvo entre 87,5-100 % y 75,7-86,3 %, respectivamente. Conclusión: el perímetro del cuello en escolares de 10-12 años es un indicador válido para realizar el diagnóstico de obesidad.(AU)

Observation on the curative effect of neck acupuncture and scalp acupuncture in improving cognitive impairment and quality of life after stroke

Objective: To explore the intervention value of needle acupuncture and scalp acupuncture in improving cognitive impairment and life in stroke patients; Methods: A total of 62 stroke patients who were healed in our hospital from August 2019 to October 2021 were retrospectively selected as the research objects, and were divided into a combined healing cluster (Combined healing cluster, CTG, n=31, The patients received conventional healing combined with acupuncture and acupuncture) and the general healing cluster (GTG, n=31). The healing effects of the two clusters were contrast, and the National Institutes of Health Stroke Scale (NIHSS), neurological deficit score before and after healing Table (NDS) and Barthel Index (BI) score changes, the follow-up outcomes of the two clusters of patients were calculated and contrast between the two clusters; Results: (1) The total effective rate of patients in CTG cluster was 96.77%, and the total effective rate of patients in GTG cluster was 80.65%, and the variation in effective rate between the two clusters was notable (P<0.05). The NIHSS and NDS marks of the CTG cluster were notably bottom than those of the GTG cluster, and the variation between the clusters was notable (P<0.05). (3) On the 7th, 15th and 30th days of healing, the BI marks of the CTG cluster were notably upper than those in the GTG cluster, and the variation between the clusters was notable (P<0.05). (4) There were a total of 3 recurrences in the CTG cluster after 6 months of follow-up, with a recurrence rate of 10.00%, and a total of 9 recurrences in the GTG cluster. The recurrence rate of patients in the CTG cluster was notably bottom than that in the GTG cluster (P<0.05) (AU)

Role of early extraction of odontogenic focus in deep neck infections

Background: Odontogenic deep neck infections remain a common condition that presents a challenging issue due to the complex involvement of the neck and adjacent structures and its potential life-threatening risk. Periapical infection of the second or third molar with spread to the submandibular and parapharyngeal spaces is the most commonly observed scenario. However, the time of dental extraction of the infection focus remains controversial. The aim of this study is to provide an overview of the epidemiology, clinical and radiological features, and management in patients diagnosed with ODNI and to identify the role of early dental extraction on patient outcomes and recovery. Material and methods: This retrospective study included patients over 18 years old with a diagnosis of ODNI who were admitted to the University Hospital "Dr Jose Eleuterio Gonzalez" from January 2017 to January 2022. ODNI diagnosis was based on clinical and radiological evidence of the disease supplemented by dental and maxillofacial evaluation for an odontogenic aetiology. Results: A total of 68 patients were included in the study. The patients' mean age was 40.96 ± 14.9. Diabetes mellitus was the most common comorbidity. The submandibular space was the most common deep neck space involved (n=59, 86.8%). Mediastinitis, marginal nerve injury and orocervical fistula were observed in 7.5% of patients, with no fatality in this series. A delay of >3 days for dental extraction of the involved tooth was associated with an increased rate of mediastinitis (n=3, 100%, p= 0.022), number of surgical interventions (1.45 ± 0.61, p= 0.006), ICU stay (n=8, 40%, p= 0.019), and ICU length of stay (0.85 ± 0.8, p= 0.001). Conclusions: Expedited management with surgical drainage and intravenous antibiotic treatment, along with early extraction of the involved tooth, is mandatory. (AU)

Rhabdomyosarcoma of the head and neck in pediatric patients: a systematic review

Background: Rhabdomyosarcoma (RMS) is a soft tissue malignant tumor of mesenchymal cell origin, which usually shows variable differentiation of muscle cells. It is the most common solid sarcoma in children. The most usual site of occurrence are the head and neck regions. RMS presents a variety of histologic features, and so differential diagnosis with other small round cell tumors is needed. Hence, it has been very useful to the field to undertake additional immunohistochemical studies to determine the diagnosis and, on occasions, to assign subtype tumors. Material and methods: A systematic review of three databases (Medline, Biological Science Collection and Health & Medical Collection) was carried out with the purpose of analyzing rhabdomyosarcoma cases reported in the literature, specifically with localization in the head and neck regions in children. This strategy allowed us to identify the main anatomical site of appearance, the subtype of RMS, average age, histologic characteristics and immunohistochemistry markers used in a usual and any additional way. Results: According to the selection criteria in this systematic review, twelve articles, and fourteen cases were identified that highlight that the histological diagnosis usually presents cellular heterogeneity. Therefore, immunohistochemistry is needed to confirm the diagnosis. Conclusions: Histologic characterization is not always sufficient for a conclusive diagnosis of RMS. Therefore, immunohistochemistry is helpful to determine the subtype and consequently, sometimes the behavior, treatment and prognosis. Additional markers may vary according to the institution and the need of particular cases. (AU)

Capacidad diagnóstica de la circunferencia de cuello para evaluar la obesidad en la población adulta joven. Análisis de datos de la segunda Encuesta Nacional de Salud 2009-2010. Chile / Diagnostic capacity of neck circumference to evaluate obesity in a young adult population. Data analysis from the second national health survey in Chile, 2009-2010

Introducción: Chile está dentro de los países con mayor tasa de malnutrición por exceso, lo que obliga a disponer de herramientas eficaces para evaluar el estado nutricional; así surge nuestro interés por explorar la posibilidad de utilizar la medición de la circunferencia del cuello (CCUE) como herramienta potencial de diagnóstico de fácil obtención y acceso, y bajo costo. Objetivo: evaluar la capacidad diagnóstica de la circunferencia del cuello como predictor de obesidad en la población de 15-26 años de edad. Materiales y métodos: dado que se encuentran disponibles, y son adecuados para nuestra investigación, se utilizarán datos extraídos de la Tercera Encuesta Nacional de Salud 2009-2010. Nuestro estudio se realizó aplicando el Método de Validación Diagnóstica por Criterio Concurrente. La muestra estuvo compuesta por 536 personas cuyas edades fluctuaban entre los 15 y 26 años, de quienes se tomaron los datos de IMC, para clasificarlas en las categorías de obesidad o normalidad (patrón oro), y la CCUE (en centímetros). Se excluyeron las personas con hipertiroidismo. Se obtuvieron indicadores de exactitud diagnóstica y valores predictivos. Se aplicó el SPSS, versión 25. Resultados: según los rangos de edad y el sexo, los puntos de corte de la CCUE para clasificar la obesidad general presentaron sensibilidades y especificidades superiores a 0,85 con una área bajo la curva superior a 0,90, todos con p < 0,001. Conclusión: existe evidencia a favor de que los puntos de corte de la CCUE presentan una adecuada capacidad de diagnosticar la obesidad en este grupo etario. (AU)

Introduction: Chile is among the countries with the highest rate of excess malnutrition, for that reason it is important to have effective tools to evaluate the nutritional status; interest in neck circumference (NC) measurement as a potential prognostic tool that is easy to access and low-cost has increased. Objective: to evaluate the diagnostic capacity of neck circumference to predict obesity in the population aged 15-16 years, using data from the third National Health Survey 2009-2010. Materials and methods: Concurrent Criteria of Diagnostic Validation were used for the study. The sample consisted of 536 people of ages from 15 to 26 years, where BMI data where taken in order to classify obesity versus normality (gold standard), as was NC (measured in centimeters). People with hyperthyroidism were excluded. Indicators of diagnostic accuracy were obtained; the SPSS, version 25 was used for calculations. Results: according to age and gender ranks, the NC cut-off points to classify general obesity showed sensitivities and specificities above 0.85, with an area under the curve over 0.90, all with p < 0.001. Conclusion: there is evidence that supports that NC cutoff points are a suitable tool for diagnosing obesity in this age group. (AU)

Análisis de las fortalezas, oportunidades, debilidades y amenazas de la tomografía computarizada de doble energía en el diagnóstico por la imagen de la cabeza y el cuello / Strengths, weaknesses, opportunities, and threat analysis of dual-energy CT in head and neck imaging

El desarrollo tecnológico de la tomografía computarizada de energía dual (TCED) en el área de la cabeza y el cuello ha supuesto un avance importante, ya que se han desarrollado múltiples aplicaciones para optimizar las imágenes y reducir los artefactos metálicos, así como para diferenciar los materiales, permitiendo una mejor delineación del tumor primario, del cartílago tiroideo y la invasión ósea. Además, los algoritmos de cuantificación permiten medir la concentración de yodo, lo que refleja el flujo de sangre que llega a una lesión de forma indirecta. Permite adquirir imágenes con menores dosis de radiación y menor cantidad de contraste yodado para obtener los mismos valores de TC. Sin embargo, utiliza radiaciones ionizantes y el posprocesamiento de las imágenes consume tiempo, y los artefactos en los mapas de yodo pueden suponer una fuente potencial de pseudolesiones. Además, los escáneres de TC con tecnología de recuento de fotones son una técnica prometedora que puede desplazar algunas de las ventajas de la TCED.Esta revisión hace un análisis de la TCED aplicada a las imágenes de cabeza y cuello desde el ámbito del análisis de las fortalezas, oportunidades, debilidades y amenazas para facilitar una visión realista, basada en datos, de esta técnica.(AU)

Technological development of dual-energy computed tomography (DECT) can play an important role in head and neck area. Multiple innovative applications have evolved, optimizing images, achieving metallic artifact reduction, differentiating materials with better primary tumor delineation, thyroid cartilage and bone invasion. Furthermore, quantification algorithms allow measuring iodine concentration, reflecting the blood supply of a lesion indirectly.DECT enables acquiring images with lower radiation doses and iodine intravenous contrast load to obtain the same CT values. However, DECT uses ionizing radiation, which does not occur with MRI, and requires long post-processing times. Artifacts on iodine maps may be a potential source of pseudolesions. Besides, photon-counting CT scanners are a promising technique that may displace some DECT advantages.A review analyzing the current status of DECT applied to head and neck imaging from the scope of strengths, weaknesses, opportunities, and threatsanalysis would be very interesting to facilitate a realistic, fact-based, data-driven look of this technique.(AU)

Predicción de variables y prevención de resultados subóptimos en rejuvenecimiento quirúrgico de cara y cuello: evaluación preoperatoria sistemática con examen físico y ultrasonido / Predicting variables and preventing suboptimal results in face and neck surgical rejuvenation: a systematic physical and ultrasound evaluation

Introducción y objetivo: La evolución de las técnicas quirúrgicas para rejuvenecimiento facial y cervical ha sido significativa en los últimos años. La elección de la técnica debe personalizarse según las características anatómicas del paciente. El presente trabajo tiene como objetivo presentar nuestra evaluación preoperatoria sistemática de pacientes que se someten a rejuvenecimiento quirúrgico de cara y cuello y nuestro diagrama de toma de decisiones. Material y método: Presentamos nuestra lista de verificación preoperatoria (subdividida en 9 pasos) para identificar variantes anatómicas y deformidades individuales. Mediante exploración física y valoración ecográfica de cara y cuello, predecimos algunas variables que pueden hacer que la cirugía sea más previsible y estandarizada. Para ello creamos 7 pasos para el Diagrama de Toma de Decisiones Preoperatorias en Cirugía de Rejuvenecimiento de Cara y Cuello. Resultados: Cincuenta y nueve pacientes se sometieron a técnicas de estiramiento profundo de cara y cuello entre enero de 2019 y junio de 2021 utilizando nuestro diagrama de toma de decisiones. Presentamos 2 casos clínicos demostrativos.Conclusiones: En este artículo explicamos por qué se deben ofrecer diferentes técnicas quirúrgicas a diferentes pacientes teniendo en cuenta sus necesidades individuales. Con esta lista de comprobación y diagrama de toma de decisiones, el cirujano plástico podrá tomar decisiones personalizadas antes de la cirugía, como la orientación de la movilización del colgajo SMAS, el tipo de tratamiento de la porción más anterior del platisma o la necesidad de abordaje y tratamiento de las estructuras cervicales subplatismales, a fin de reducir la consecución de resultados menos satisfactorios, los errores quirúrgicos y agilizar la cirugía. (AU)

Background and objective: The evolution of surgical techniques for facial and neck rejuvenation has been significant over the last years. The choice of technique must be personalized according to the patient's ana- tomical details and specificities to provide individual and personalized results. This work aims to expose our systematic preoperative evaluation of the patients that will be submitted to a face and neck surgical rejuvenation and our decision-making diagram. Methods: We present our preoperative evaluation checklist (subdivided into 9 steps) to recognize the individual anatomical variants and deformities. Using the physical exam and ultrasound evaluation of the face and neck we predict some variables that can make surgery more predictable and standardized. To do so we apply our 7 steps of pre-operative Decision Making Diagram of Face and Neck Rejuvenation Surgery. Results: Fifty-nine patients were submitted to face and neck lift between January 2019 and June 2021 using deep plane cervico-facial techniques according to our decision-making diagram. We demonstrate 2 clinical cases. Conclusions: In this paper, we explain why different surgical techniques should be offered to different patients considering their individual needs. Using this checklist and decision-making diagram the surgeon will be able to make individualized decisions before surgery, such as SMAS flap lift vector direction, the type of the platysma treatment or the need for deep platysmal structures approach and treatment. This work aims to reduce the likelihood of obtaining less satisfactory results by decreasing surgical errors and making the surgery faster. (AU)

Clinical manifestations of head and neck cancer in pediatric patients, an analysis of 253 cases in a single Brazilian center

Background: Pediatric head and neck cancer (PHNC) is rare and its nonspecific clinical manifestations may often lead to delayed diagnosis. We aimed to describe the signs, symptoms, and clinicopathological characteristics of PHNC. Material and Methods: Medical records were retrospectively reviewed for all PHNC cases diagnosed from 1986 to 2016 affecting patients aged 19-years and younger from a tertiary referral center in Brazil. Demographic variables, anatomical site of primary tumors, histopathological diagnoses, signs and symptoms, and patterns of misdiagnosis were collected and interpreted by statistical and descriptive analysis. Results: A total of 253 PHNC cases were included. The mean age was 9.3 years and male patients were more frequently affected (60.9%). Burkitt lymphoma (23.7%), nasopharyngeal carcinoma (15.8%), and rhabdomyosarcoma (15.4%) were the most common cancer types. The nasopharynx (28.9%), cervical/lymph node region (25.3%), and craniofacial bones (8.3%) were the predominant anatomical sites. Tumor/swelling (68.4%), was the clinical finding often presented. The univariable analysis showed association between tumor histology and clinical variables such as sex (p=0.022), age (p<0.0001), anatomical location (p<0.0001) tumor/swelling (p=0.034), pain (p=0.031), systemic/general manifestations (p=0.004), nasal/breathing alterations (p=0.012), orbital/ocular alterations (p<0.0001). Misdiagnosis such as tonsillitis, otitis, and abscess were frequent. Conclusions: Although the clinical findings of PHNC are often unspecific, this study provided signs and symptoms with significant correlations between tumor histology. The suspicion of malignancy should be considered when the main signs and symptoms reported here appear and persist, in order to conduct a timely diagnosis.(AU)

Complications associated with submental liposuction: a scoping review

Background: Liposuction is one of the most commonly performed cosmetic procedures worldwide. Complications associated with submental liposuction are rare. However, when they occur they are significant and can cause disFiguring consequences. The objective of this study was evaluated complications from submentual liposuction in literature and description of clinical experience of complication after submentual liposuction. Material and Methods: At first, a scoping review was carried out online search with no time restrictions for complications after submental liposuction was performed in the databases Medline / PubMed, Embase, and Web of Science. The variables analyzed were: age, sex, type of esthetic procedure, anesthesia, complications, time after Procedure, treatment, follow-up care, and sequelae. Then, a case of a patient with submental hematoma after an aesthetic procedure for submental liposuction was described. Results: Firstly, 539 articles were selected, after application of the inclusion criteria, 4 studies were included. Most cases were female (8:1), with a mean age of 55.77 years. Postoperative complications were found, such as submental depression, submental edema, hypertrophic scar formation, scar contracture, cervical necrotizing fasciitis, Cervico-facial dystonia and transient facial nerve paralysis. The follow-up period for cases ranged from 3 to 12 months. The clinical case presented there was no sequelae. Conclusions: Submental liposuction requires the surgeon's attention. Anatomical knowledge, correct clinical and surgical management, diagnosis, and immediate approach to adverse situations are points that must be respected in this type of esthetic procedure to avoid more serious complications.(AU)

Response characteristics of vestibular evoked myogenic potentials recorded over splenius capitis in young adults and adolescents

Background and objectives: Examine vestibular evoked myogenic potential (VEMP) responses recorded from surface electrodes over Splenius Capitis (SPC) in a seated position. Specific aims: (1) validate response characteristics of VEMP recordings from surface electrodes over Sternocleidomastoid (SCM) and over SCP and (2) assess age effects on responses in adolescents and young adults. Materials and methods: Simultaneous surface VEMP was recorded bilaterally from electrodes placed over the dorsal neck musculature at a location known from previous work to record from SPC in 15 healthy participants during trials with head rotation toward and away from the stimulated ear. VEMP was also recorded from electrodes over SCM, ipsilateral to the stimulus ear, in the same participants in a supine, head lift/turn position. Results: Response amplitudes significantly increased with contraction strength and decreased with age. Participants were able to maintain sufficient contraction strength (amplitude) with head rotation to reliably measure over SPC. Normalized response amplitudes measured from electrodes over contralateral SPC were largest with head rotation contralateral to the stimulus ear. Normalized amplitudes and peak latencies were comparable to the same measures from SCM obtained in supine, head lift/turn position. Conclusions: Otolith generated myogenic responses can be recorded seated from electrodes over the dorsal neck with head rotation contralateral to the stimulus ear. In this position, contralateral recordings are consistent with responses known from previous work to arise from SPC; ipsilateral recordings may include crosstalk from activated muscles nearby, including ipsilateral SCM. Overall, techniques targeting contralateral SPC during contralateral head turn may provide additional methods of recording VEMPs.(AU)

Antecedentes y objetivos: Examinamos las respuestas de los potenciales evocados miogénicos vestibulares (PEMV) recogidas de los electrodos de superficie sobre el músculo esplenio (ME) en posición sentada. Objetivos específicos: 1) validar las características de los registros de la respuesta de los PEMV recogidos de los electrodos de superficie sobre el músculo esternocleidomastoideo (SCM) y el ME, y 2) evaluar los efectos de la edad en adolescentes y adultos jóvenes. Materiales y métodos: Se registraron simultáneamente los PEMV bilaterales de los electrodos situados en la musculatura dorsal del cuello, en un sitio conocido de un estudio anterior para obtener registros del ME en 15 participantes sanos durante los ensayos, con rotación de cabeza hacia y fuera del oído estimulado. También se registraron los PEMV de los electrodos situados sobre el SCM, en posición ipsilateral al oído estimulado, en los mismos participantes, en posición supina y con elevación/giro de cabeza. Resultados: Las amplitudes de la respuesta se incrementaron significativamente con la fuerza de la contracción y disminuyeron con la edad. Los participantes fueron capaces de mantener suficiente fuerza de contracción (amplitud) con la rotación de cabeza, para realizar mediciones fiables sobre el ME. Las amplitudes de la respuesta normalizada medidas en los electrodos sobre el ME contralateral fueron mayores con la rotación de cabeza contralateral al oído estimulado. Las amplitudes normalizadas y las latencias máximas fueron comparables a las mismas medidas del SCM obtenidas en posición supina, y elevación/giro de cabeza. Conclusiones: Las respuestas miogénicas generadas por otolitos pueden registrarse en posición sentada a partir de los electrodos situados en la parte dorsal del cuello, contralateral al oído estimulado. En esta posición, los registros contralaterales son coherentes con las respuestas conocidas de un estudio previo, derivadas del ME; los registros ipsilaterales pueden incluir interferencias de los músculos activados cercanos, incluyendo el SCM ipsilateral. En general, las técnicas centradas en el ME contralateral durante el giro de cabeza contralateral pueden aportar métodos adicionales de registro de los PEMV.(AU)

Efectividad de la movilidad cervicodorsal con característica socializadora y lúdica con relación al riesgo de caídas en adultos mayores con anteposición de cabeza y cuello: un ensayo clínico aleatorizado / Effectiveness of cervicodorsal mobility testing with socialising and playful features of falls risk in older adults with forward head and neck posture: A randomised clinical trial

Objetivo: El propósito del estudio fue comprobar la efectividad de la movilidad cervicodorsal con característica socializadora y lúdica en relación con el riesgo de caídas en adultos mayores con anteposición de cabeza y cuello. Material y métodos: El presente estudio fue un ensayo clínico aleatorizado con un diseño experimental, longitudinal, basado en la evaluación del riesgo de caídas mediante el Timed Up and Go en 3 grupos de 44 participantes posterior a 16 semanas, divididos en: grupo movilidad cervicodorsal, grupo movilidad cervicodorsal con característica socializadora y lúdica y grupo control que no realizó intervención. Los 132 participantes cumplieron los criterios de inclusión y exclusión: adultos mayores>60 años, con anteposición de cabeza y cuello, índice de masa corporal con sobrepeso y obesidad tipo 1 y sin enfermedades neurológicas, reumatológicas, sistémicas, inmunodepresivas, infecciosas u osteomusculares. Resultados: Hubo cambios estadísticamente significativos en la disminución del riesgo de caídas en ambos grupos que recibieron tratamiento (p<0,05). El grupo movilidad cervicodorsal disminuyó en promedio 5,43 segundos, y el grupo movilidad cervicodorsal con característica socializadora y lúdica disminuyó en promedio 5,78 segundos. Conclusión: La movilidad cervicodorsal con característica socializadora y lúdica fue efectiva en relación con la disminución del riesgo de caídas en adultos mayores con anteposición de cabeza y cuello, no observándose diferencias estadísticamente significativas entre los 2 grupos experimentales.

Objective: The purpose of the study was to assess the effectiveness of cervicodorsal mobility testing with a socialising and playful features in relation to falls risk in older adults with forward head and neck posture. Material and methods: The present study was a randomised clinical trial with a longitudinal, experimental design, based on assessment of falls risk using the Timed Up and Go Test in three groups of 44 participants after 16 weeks, divided into: cervicodorsal mobility group, cervicodorsal mobility group with socialising and playful features and a control group that did not take part in the intervention. The 132 participants met the inclusion and exclusion criteria: older adults>60 years of age, with forward head and neck posture, overweight body mass index and type 1 obesity and with no neurological, rheumatological, systemic, immunosuppressive, infectious, or musculoskeletal diseases. Results: There were statistically significant changes in decrease in falls risk in both groups receiving treatment (p<.05). The cervicodorsal mobility group decreased in risk by an average of 5.43seconds and the cervicodorsal mobility group with socialising and playful features decreased by an average of 5.78seconds. Conclusion: Cervicodorsal mobility with socialising and playful features was effective in reducing the risk for falls in older adults with forward head and neck posture and forward neck posture, and no statistically significant differences were observed between the two experimental groups.

Validez de un programa de diagnóstico rápido del cáncer de cabeza y cuello / Validity of a rapid diagnostic programme for head and neck cancer

Introducción y objetivos: Dado el conocimiento epidemiológico del carcinoma escamoso de cabeza y cuello, pronóstico y supervivencia según el estadio al diagnóstico, y ante la ausencia de programas de cribado que hayan demostrado ser coste-efectivos, nos propusimos evaluar un programa de diagnóstico rápido. El objetivo del presente estudio fue analizar si la existencia de un circuito de diagnóstico rápido desde Atención Primaria, con base en una ponderación de síntomas y signos, supondría un cambio en la proporción de diagnósticos en estadios iniciales versus tardíos en estos tumores.MétodosSe ha realizado un estudio observacional prospectivo de pacientes remitidos con la sospecha de un tumor en el área ORL en nuestro centro durante 24 meses consecutivos. Se creó un algoritmo con síntomas y signos de sospecha para utilización por el médico de familia y un circuito de remisión rápida de los pacientes candidatos. Se registraron también los pacientes con sospecha de tumor provenientes de fuentes distintas de este circuito. Los datos obtenidos (edad, sexo, consumo de tóxicos, tiempo y clínica de presentación, localización del tumor y extensión), se han comparado con los de los pacientes recogidos en la base de datos de tumores del Servicio de ORL diagnosticados durante los 4años previos al inicio del estudio.ResultadosSe incluyó en el estudio a 199 pacientes y se diagnosticaron 82 tumores del área ORL. Los médicos de familia remitieron por el circuito de diagnóstico rápido creado un total de 136 pacientes y 35 (26,1%) presentaban una tumoración. Sin embargo, la mayoría de los tumores diagnosticados durante este periodo en el Servicio de ORL (47 pacientes, 57,3% de todos los tumores diagnosticados) no fueron sospechados por su médico de familia y no fueron remitidos al hospital utilizando el circuito de diagnóstico rápido. (AU)

Introduction and objectives: Given the epidemiological knowledge of squamous cell carcinomas of the head and neck, the prognosis in survival according to the staging at diagnosis and the absence of screening programmes that have proven cost-effective, we undertook a rapid diagnosis programme. The objective of this study was to analyse whether a rapid diagnostic programme (RDP) to be used by General Practitioners (GP) would achieve a change in the proportion of diagnoses in early versus late stages in these tumours.MethodsA prospective observational study of patients diagnosed with a tumour of ENT location in our centre, was carried out for 24 consecutive months. A “suspicion algorithm” was designed and we established a rapid remission route for these patients. The data obtained (age, sex, toxic substance consumption, initial manifestations, tumour location and extension) were compared with the data of the patients in our ENT Service database diagnosed in the 4years prior to the start of the study.Results199 patients were included, and 82 ENT tumours diagnosed. The GPs sent to the Hospital via the RDP a total of 136 patients and 35 (26.1%) had a tumour. However, most of the tumours diagnosed in this period by our ENT Department (47 patients, 57.3% of all tumours diagnosed), were not suspected by the GP and were not sent via the RDP.Of the patients, 27% were diagnosed in stages i and ii, and 73% in stages iii and iv, there were no significant differences with the control group. The most frequent initial signs and symptoms were dysphonia, cervical mass and dysphagia, the relationship between initial symptom and stage at the moment of diagnosis was analysed, and in neither case did we obtain any significant variation. (AU)