Mucormycosis is a life-threatening disease, were rhinocerebral infection is most commonly seen in the clinical setting. Chronic mucormycosis is a rare presentation that exhibits a challenging diagnosis. We describe the case of a 47 year old diabetic man with complains of left zygomatic arch swelling of 3 months evolution. He had received previous antibiotic treatment without improvement. Biopsy of maxillary sinus revealed the presence of non-septated, 90° angle branched hyphae compatible with zygomicetes. The patient was treated with surgical debridement and amphotericin B until there was no evidence of fungi in the tissue by biopsy. We reviewed chronic rhino-orbito-cerebral mucormycosis from 1964–2014 and 22 cases were found, being this the second case of chronic mucormycosis reported in Mexico. A quarter of the cases were seen in immunocompetent hosts. As only 20% of the causal agent can be isolated by culture, the diagnosis is mainly made by biopsy. Besides treatment with amphotericin B, posaconazole as alternative, and control of the underlying comorbidities, surgical debridement represents the corner stone therapy. We recommend at least 36 month follow-up, due to the 13% risk of recurrence. A chronic presentation has a general survival rate of approximately 83%.

We demonstrate the morphological variability that exists in this region. Gender differences that must be considered by the surgeon to avoid complications. Further studies are needed to evaluate the value of these findings when predicting surgical complications. A CT before PNS surgery is already widely accepted.

Introduction:A high riding jugular bulb is the most common anatomical variation of the petrous section of the temporal bone. The objective of our study was to determine the prevalence of dehiscence and high riding jugular bulb (HRJB) in a Mexican population. Material and methods: This is an observational retrospective, cross-sectional, and descriptive study. The presence of High Riding Jugular Bulb was analyzed, taking as reference the basal turn of the cochlea in axial sections and then reformatted in coronal sections to observe the presence or absence of dehiscence. Patients between 0 to 95 years of age were included and classified by age groups for analysis. Infants included patients ≤ 2 years old, children from 3 to 12, teenagers from 13 to 18, and adults included patients >18 years of age. Results: A total of 229 CT (458 ears) were included. The prevalence of HRJB was 38.4%, higher in women (44.6%), and present bilaterally in 7.9% of patients. It is the highest prevalence reported in the literature. Dehiscence was present in 1.3% of the population. Conclusion: High Riding Jugular Bulb and its dehiscence are important anatomical variations associated with several symptoms like unexplained headache and tinnitus. Due to unawareness of these variations in surgery, the lesion to a vessel could be fatal. It is otorhinolaryngologists be aware of the high prevalence for patient safety.

<b><i>Introduction:</i></b> Pneumatization of the sphenoid sinus (SS) varies widely among different ethnic groups. Information regarding the prevalence and significance of SS variants among Hispanic groups is limited. This study aims to describe and analyze pneumatization and septation patterns of the SS in a Hispanic population. <b><i>Methods:</i></b> A total of 160 paranasal sinus computed tomographies were reviewed by a head and neck-specialized radiologist and 2 otolaryngologists. <b><i>Results:</i></b> The postsellar and sellar types were the most frequent patterns of pneumatization observed, with a prevalence of 52.5 and 40%, respectively. Accessory septations were present in 59.4% of the patients. Septa were inserting over the internal carotid artery (ICA) in 43.8% and over the optic nerve in 17.5% of the population. No significant association (<i>p</i> &#x3e; 0.05) was observed when comparing the different accessory septation patterns among the types of the SS. The frequency of septa inserting on the ICA was significantly higher in postsellar types (<i>p</i> &#x3c; 0.001). Pneumatization of the anterior clinoid process, pterygoid processes, and greater wing was present in 20, 17.5, and 45.9% of the sinuses, respectively. Onodi cells were encountered in 40% of the sinuses. There were no significant differences in any of the pneumatization and septation variables when compared by gender and age (<i>p</i> &#x3e; 0.05). <b><i>Discussion/Conclusion:</i></b> Differences regarding anatomical variants and septations of the SS were observed in our study when compared with findings reported in other ethnic groups. Preoperative assessment of the anatomical variants of the SS in Mexican patients is imperative to select the most optimal surgical approach and prevent iatrogenic injuries to related neurovascular structures.

Angiosarcomas are malignant neoplasias of rapid growth that develop from endothelial cells. They represent 2% of all sarcomas and only 1–4% are located in the aerodigestive tract. Since 1977, only 16 cases have been reported.We present a 33-year-old male with spontaneous epistaxis that was refractory to cauterization. During physical examination, a smooth purplish tumor of 1.5 cm × 1.5 cm was identified. A CT scan showed a nonenhanced tumor in the left nostril on the uncinate process. A biopsy revealed an intermediate-grade angiosarcoma. Surgical removal followed by radiation therapy was performed with good result. Aerodigestive angiosarcomas have a better prognosis than angiosarcomas of other locations due to better cell differentiation and the presence of early symptoms. Recurrence can occur because of tumor tissue left during resection. Our patient continues tumor free after three years.

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<b><i>Introduction:</i></b> Deep neck infections (DNIs) are abscesses located in the profound spaces of the neck and constitute one of the most common otolaryngological life-threatening emergencies. The aim of this study is to review the clinical and demographic data of patients with DNI and identify factors associated with prolonged hospitalization, reoperation, and mortality. <b><i>Methods:</i></b> Retrospective review and analysis of 75 patients with DNI admitted from January 2015 to December 2019 in a tertiary referral hospital. <b><i>Results:</i></b> Of 75 patients, 50 (66.6%) were males and 25 (33.3%) females. Age ranged from 18 to 91 years with a mean of 41.79 (±15.48). DNIs were odontogenic in 49 patients (65.3%). History of diabetes mellitus (DM) was positive in 26 patients (34.6%). The submandibular space was involved in 57 patients (76%). <i>Streptococcus</i> spp. were isolated in 35 patients (46%). Intubation for airway preservation was needed in 21 patients (28%) and tracheostomy in 6 (8%). Mediastinitis presented in 8 patients (10.67%), with a mortality rate of 62.5% (<i>n</i> = 5). Mean hospital stay was 9.13 days (±7.2). DM (<i>p</i> = 0.016), age (<i>p</i> = 0.001), BMI classification 3, 4, and 6 (<i>p</i> = 0.041), and intensive care unit (ICU) admission (<i>p</i> = 0.009) were associated with a longer stay. Surgical drainage was performed after 1.71 days (±1.65). Surgical reintervention was needed in 6 cases (8%) and was associated with temporal (<i>p</i> = 0.001) and masticator (<i>p</i> = 0.002) space involvement and DM (<i>p</i> = 0.009). Overall mortality was 8% and decreased to 1.5% when mediastinitis was excluded. Mediastinitis (<i>p</i> = 0.001), ICU admission (<i>p</i> &#x3c; 0.0001), <i>Streptococcus</i> spp. (<i>p</i> = 0.019), and low hemoglobin levels (<i>p</i> = 0.004) were associated with mortality. <b><i>Discussion/Conclusion:</i></b> DNIs are entities associated with high morbimortality. Mediastinitis and airway obstruction are life-threatening possible complications and should be promptly evaluated. Low HB could be used as a predicting factor for mortality.