The prevalence of the Onodi cell - Most suitable method of CT evaluation in its detection.

BACKGROUND: The Onodi cell (sphenoethmoidal air cell) is an anatomic variant of the most posterior ethmoid cell that pneumatised superiorly and laterally to the sphenoid sinus, and is in close relation to the optic nerve. The proper identification of the Onodi cell is essential during a pre-operative computer tomography (CT) examination, as the presence of that ethmoid cell variant makes sphenoid sinus surgery more risky. The bulging of the optic nerve to the ethmoid cell wall is well visualized during endoscopic examination, but there are no clearly defined criteria for a potentially dangerous Onodi cell type in CT examinations. OBJECTIVE: To determine the prevalence and types of Onodi cell in CT examination and find the most suitable CT scanning planes to identify it. MATERIAL AND METHODS: Three plane (axial, coronal and sagittal) reconstructions of 196 paranasal sinuses were analyzed. The most posterior ethmoid cell was classified into four types, according to its position in relation to the sphenoid sinus and the optic nerve canal bulging into the lumen of the sphenoethmoid cell. RESULTS: The Onodi cell was detected in 39.8% of cases, although in 55.6% of cases a direct contact between the most posterior ethmoid cell and the optic nerve was present. Bulging of the optic nerve canal was seen in 25% of cases. In two cases two posterior ethmoid cells were in direct contact with the optic nerve canal. CONCLUSION: The prevalence of the Onodi cell was higher than previously reported. Pre-operative paranasal sinuses CT examination should be evaluated in all three planes (axial, coronal and sagittal) to avoid missing or over-detection of the Onodi cell. Axial and sagittal planes are preferable for the detection of the Onodi cell.

Neck tumour - lung hernia in a 10-year-old girl - diagnostic difficulties.

Spontaneous hernias of the pleural cupola are extremely rare tumours in the neck area. The most common tumours in children are lymph node abnormalities, and cysts that are remnants of the branchial arches. Due to diagnostic and therapeutic difficulties, we would like to present the case of a 10-year-old girl, with a neck tumour that was observed during coughing and was accompanied by dyspnea. The girl was admitted to the Paediatric Hospital of Warsaw Medical University. Finally, the neck tumour was diagnosed as a hernia of the pleural cupola, which was subsequently treated surgically. In a review of the literature we found two case reports of similar disorders that appeared spontaneously. All cases of neck tumours in children require very precise radiological diagnostic investigation. Spontaneous lung hernia is an extremely rare cause of neck tumours, which is treated surgically if it becomes symptomatic.

[Variability of magnitude of the human jugular foramen in relation to conditions of the venous outflow after ligation of the internal jugular vein]. / Zmiennosc wielkosci otworu szyjnego czaszki czlowieka w aspekcie warunków odplywu zylnego po operacjach podwiazania zyly szyjnej wewnetrznej.

The jugular foramina of the human skull, which are the main route of the venous outflow from the skull, are characterized by laterality. It is based upon predominance of one of the sides. This event presents considerable variability in human population. These differences are probably responsible for various results of ligation of the internal jugular vein, which is performed in some clinical situations in various patients. In order to appreciate the degree of this predominance much more precisely than it is presented in the available literature, a morphological study was carried out on 78 adult human cadavers. With an aid of digital image analysing system we measured a cross-section areas of the jugular foramina of non-macerated skull. We stated that parameters of the jugular foramina didn't differ significantly in respect to age, sex and body side. Predominance of one of the jugular foramina appeared in 83% of cases, and in remaining 17% was absent (it wasn't greater than an error of measurement). If it is present, the predominance of the left and the right side are equally probable. Laterality coefficient was also calculated. It was a ratio between cross-section area of the two jugular foramina: the greater one and the smaller one. Its amount was 1.62 in men and 1.59 in women, however this difference wasn't statistically significant. The range of the laterality was rather considerable because the coefficient differed from 1.02 to 3.6. When the degree of the laterality is high, ligation of the jugular vein on the greater side could by risky. We stated that in our material here were about 2.5% of such cases.

Body build--is it a factor in acute subglottic laryngitis?

Acute subglottic laryngitis (pseudocroup) is caused by viral infection and usually occurs in children from 6 months to 4 years of age. Obese children are considered to be more susceptible to the disease. In order to evaluate the influence of nutritional status on acute subglottic laryngitis occurrence, an analysis of 193 patients was performed. A group of 70 age-matched healthy children served as the control subjects. The nutritional status of children (body weight and height) was assessed and their percentile positions on the weight and weight-height charts were determined. The recurrence of pseudocroup coexistence of allergy and breast-feeding history were considered in the study. Results of statistical analysis indicate no significant difference in weight and weight-height percentile distribution between patients group and controls. The recent changes in child nutrition might be the explanation of decreased susceptibility to pseudocroup among overfed children.