Traumatismo penetrante de cráneo y muerte diferida: a propósito de un caso / Skull penetrating trauma and delayed death: presentation of a case

Presentamos un caso de traumatismo penetrante en el cráneo por arma blanca de morfología desconocida con muerte diferida. El estudio necrópsico puso de manifiesto herida cutánea cicatrizada y lesión encefálica modificada por hemorragias y edema secundarios a la lesión. Las pruebas de imagen (TC y reconstrucción 3D) efectuadas durante el proceso asistencial fueron útiles para localizar el orificio óseo en el cráneo, necesario para valorar las características del arma homicida. Hubo que modificar la técnica de autopsia ampliando la retirada del cuero cabelludo y del músculo temporal derecho, puesto que la lesión ósea quedaba por debajo del plano de apertura habitual, y de otra forma hubiera pasado desapercibido. Esto pone de manifiesto que las pruebas de imagen son útiles tanto para la toma de decisiones clínicas como para facilitar la valoración médico-forense posterior, por lo que es importante la colaboración entre los servicios clínicos en general, y de radiología en particular, con los servicios de patología forense(AU)

A case is presented involving a skull penetrating trauma with an unknown sharp weapon with a delayed death. The autopsy showed skin injury as a scar and brain injury modified by haemorrhage and swelling. Imaging techniques such as CT scan and 3D reconstruction performed during the healthcare process were useful to find the skull orifice, and needed to assess the characteristics of the homicide weapon. We had to modify the autopsy technique by removing a larger area of anterior scalp and right temporal muscle, because the injured bone was lower than the usual level, and otherwise it would not have been noticed. This shows that imaging techniques are useful for making clinical decisions and for medico-legal investigations, so once again we would like to emphasise the importance of collaboration between clinical services in general, and Radiology Service in particular, with the Forensic Pathology Service(AU)

Estudio comparativo mediante tomografía computarizada de la morfología de la sutura timpanoescamosa entre colesteatoma atical y oídos sanos / Comparative study through TC of the tympanosquamous suture in cases of attical cholesteatoma vs healthy ears

Introducción y objetivos: Habíamos observado, al intervenir oídos con colesteatoma, una mayor procidencia del extremo anterior de la sutura timpanoescamosa (STE). Queríamos averiguar si estos hallazgos correspondían a una especial morfología de la STE en los colesteatomas. Material y métodos: Realizamos un estudio retrospectivo, mediante tomografía computarizada (TC) preoperatoria, de la STE de pacientes intervenidos por colesteatoma entre enero de 2006 y diciembre de 2008. Se incluyó a pacientes mayores de 18 años, no intervenidos anteriormente, con TC realizada en el propio hospital e histología demostrativa de colesteatoma (n=31). Comparamos los hallazgos de la STE de estos 31 casos con los de 30 oídos sanos. El grupo sano incluyó 20 casos con colesteatoma unilateral (20 sanos/31 colesteatomas) y un grupo sano control estudiado con motivo de implante coclear (n=10). Se realizaron mediciones de la distancia en mm considerando dos puntos A y B de la STE (A era el más distal y B, el más proximal al extremo de la sutura). Seleccionamos los cortes de TC correspondientes a la máxima y la mínima separación de la STE. Resultados: Comparando las distancias máxima y mínima de la STE en los puntos A y B de todos los oídos, según estado patológico (sanos frente a colesteatoma), detectamos una menor distancia mínima A (p=0,036) y mínima B (p=0,014) en los oídos sanos respecto a los patológicos; no encontramos diferencias estadísticamente significativas de las distancias máximas A y B (p>0,05). Conclusiones: Este estudio aporta datos objetivos sobre un menor cierre de la STE en los casos de colesteatoma frente a oídos sanos. Relacionamos este hallazgo con la etiopatogenia del colesteatoma atical (AU)

Introduction and objectives: When performing surgery on ears with cholesteatoma we observed a higher prominence of the anterior edge of the tympanosquamous suture (TSS). The aim was to find out whether these surgical findings corresponded to a particular morphology of the tympanosquamous suture (TSS) in cholesteatomas. Material and methods: A retrospective analysis was carried out using preoperative computed tomography (CT) of the TSS in patients undergoing surgery for cholesteatoma in the period between January 2006 and December 2008. Patients older than 18 years were included, who had not been previously operated, with a CT performed at the hospital and with a histology which proved cholesteatoma (n=31). The findings of the TSS from these 31 cases were compared with those of 30 healthy ears. The healthy group included 20 cases of unilateral cholesteatoma (20 healthy/31 cholesteatomas) and a control group of 10 healthy patients studied for cochlear implants (n=10). Measurements of the distance in mm. were made selecting two points A and B of the TSS (A being the furthest point and B the nearest to the edge of the suture). The CT cuts were selected according to the greatest and smallest separation of the TSS. Results: Comparing the maximum and minimum distance of the TSS in points A and B of all the ears, according to pathological state (heathly ears vs cholesteatoma ears), we detected a reduced minimal distance in A (p=0.036) and B (p=0.014) in the healthy ears with respect to the cholesteatoma ears. No statistically significant differences were found in maximum distances A and B (p>0.05). Conclusions: This study provides objective data on a lesser closure of the TSS in cases of cholesteatoma vs healthy ears. We correlate this finding with the aetiopathogenesis of attical cholesteatoma (AU)

Comparative study through TC of the tympanosquamous suture in cases of attical cholesteatoma vs healthy ears.

INTRODUCTION AND OBJECTIVES: When performing surgery on ears with cholesteatoma we observed a higher prominence of the anterior edge of the tympanosquamous suture (TSS). The aim was to find out whether these surgical findings corresponded to a particular morphology of the tympanosquamous suture (TSS) in cholesteatomas. MATERIAL AND METHODS: A retrospective analysis was carried out using preoperative computed tomography (CT) of the TSS in patients undergoing surgery for cholesteatoma in the period between January 2006 and December 2008. Patients older than 18 years were included, who had not been previously operated, with a CT performed at the hospital and with a histology which proved cholesteatoma (n=31). The findings of the TSS from these 31 cases were compared with those of 30 healthy ears. The healthy group included 20 cases of unilateral cholesteatoma (20 healthy/31 cholesteatomas) and a control group of 10 healthy patients studied for cochlear implants (n=10). Measurements of the distance in mm. were made selecting two points A and B of the TSS (A being the furthest point and B the nearest to the edge of the suture). The CT cuts were selected according to the greatest and smallest separation of the TSS. RESULTS: Comparing the maximum and minimum distance of the TSS in points A and B of all the ears, according to pathological state (heathly ears vs cholesteatoma ears), we detected a reduced minimal distance in A (p=0.036) and B (p=0.014) in the healthy ears with respect to the cholesteatoma ears. No statistically significant differences were found in maximum distances A and B (p>0.05). CONCLUSIONS: This study provides objective data on a lesser closure of the TSS in cases of cholesteatoma vs healthy ears. We correlate this finding with the aetiopathogenesis of attic cholesteatoma.