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Resumen Introduccion La reconstruccion de base de craneo constituye uno de los mayores retos de la cirugia endoscopica endonasal expandida. Existen multitud de injertos y colgajos de origen endonasal que han demostrado su utilidad en el control de complicaciones como las fistulas de LCR, entre otras. Se hace necesaria la revision y el analisis de los recursos endonasales y su uso en cirugia endoscopica endonasal expandida. Objetivos Documento de consenso sobre el uso de los distintos injertos y colgajos de origen endonasal y su uso en cirugia endoscopica endonasal expandida. Material y metodos Revision bibliografica sobre los injertos libres y colgajos vascularizados de origen endonasal mas relevantes. Analisis mediante el metodo Delphi, sobre el uso de los distintos recursos endonasales para la reparacion endoscopica de defectos de base de craneo. Resultados Se obtuvieron dos resultados. 1) Una seleccion de los colgajos e injertos de origen endonasal mas representativos, describiendo origen, superficie e indicaciones, a partir de una revision bibliografica. 2) Un documento de consenso, utilizando la metodologia Delphi, con las consideraciones generales (2), recomendaciones (10) y limitaciones (6) sobre el uso de los distintos colgajos e injertos de origen endonasal. Conclusiones Presentamos el primer documento de consenso en el campo de la cirugia endoscopica endonasal utilizando el metodo Delphi como herramienta de trabajo. Se destaca la utilidad del colgajo nasoseptal junto con el resto de colgajos e injertos de origen endonasal para la cirugia reconstructiva de base de craneo.

Resumen La rinosinusitis cronica con polipos nasales (RSCcPN) es una enfermedad con gran impacto sobre la salud. La opcion quirurgica mediante cirugia endoscopica nasosinusal es la alternativa terapeutica cuando no se alcanza el control de la enfermedad con el tratamiento medico. Los abordajes endoscopicos extensos se estan postulando como posible mejor opcion de tratamiento quirurgico en ciertos fenotipos de RSCcPN. La mucoplastia endonasal asociada a estos abordajes ha demostrado ser una tecnica complementaria que mejora tanto la cicatrizacion como el edema mucoso a corto plazo en pacientes con RSCcPN. El objetivo de nuestro estudio ha consistido en analizar los resultados de las mucoplastia endonasal asociada a una etmoidoesfenoidotomia completa mas sinusotomia frontal de grado III en el tratamiento de RSCcPN a medio plazo. Para ello se realizo un estudio prospectivo de casos y controles (10/10) en pacientes con RSCcPN. En el grupo de casos se asocio a la cirugia una mucoplastia endonasal en la fosa nasal izquierda y en el grupo control no. La evaluacion de la calidad de vida al ano de la intervencion quirurgica, medida mediante la diferencia de medias de SNOT-22 (media [DE]), en el grupo de casos fue significativamente mejor que en el grupo control (45,9 [19,6]-26,6 [16,05]; p = 0,027). La mejoria endoscopica de la cicatrizacion y del edema mucoso, medida mediante la escala de Lund-Kennedy modificada, mostro mejorias relevantes al comparar ambas fosas, pero sin alcanzar la significacion (p = 0,29). La mucoplastia endonasal favorece la cicatrizacion a corto plazo, lo que mejora la calidad de vida a medio plazo (un ano) de los pacientes tratados con resecciones extensas endoscopicas de los senos.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with great impact on health. The surgical option using endoscopic sinus surgery is the therapeutic alternative when control of the disease is not achieved with medical treatment. Extensive endoscopic approaches are being postulated as a possible best surgical treatment option in certain phenotypes of CRSwNP. Endonasal mucoplasty associated with these approaches has been shown to be a complementary technique that improves both healing and mucosal edema in patients with CRSwNP in the short term. The aim of our study was to analyse the results of endonasal mucoplasty associated with a complete ethmoid-sphenoidotomy plus grade III frontal sinusotomy in the treatment of CRSwNP in the medium term. For this purpose, a prospective case-control study (10/10) was carried out on patients with CRSwNP. In the case group, endonasal mucoplasty in the left nostril was associated with surgery, and the control group was not. The assessment of quality of life at one year after surgery, as measured by the mean difference in SNOT-22 (mean [SD]), was significantly better in the case group than in the control group (45.9 [19.6]-26.6 [16.05] P=0.027). The endoscopic improvement in healing and mucosal edema, measured by the Modified Lund-Kennedy scale, showed relevant improvements, when comparing both nostrils, but without reaching significance (P=0.29). Endonasal mucoplasty promotes short-term healing, improving the quality of life in the medium term (one year) of patients treated with extensive endoscopic mucosal resections.

Objectives To perform a radio‐anatomical evaluation of the nasal cavity floor free mucosal graft (endonasal extended mucoplasty, EEM) to repair mucosal defects after an extended ethmoid‐sphenoidotomy. Methods A human cadaveric study (radiological and anatomical dissection) and an in vivo study in surgical patients with CRSwNP were performed. The EEM areas were compared between 3D reconstruction from CT scans and anatomical/surgical dissections, both in cadaver specimens and in patients. Feasibility was assessed by correlation between the EEM area on CT scans and when harvested in cadavers and when grafted in patients. Usefulness was assessed by the degree of coverage of the EEM in the surface exposed after an extended ethmoid‐sphenoidotomy. Both feasibility and usefulness were assessed in cadaveric specimens (n = 15) and patients (n = 4). Results Fifteen cadaveric specimens and 4 patients with bilateral CRSwNP were included. The mean (SD) areas obtained in the cadaveric radiological and anatomical studies were 9.44 (2.07) cm2 and 8.03 (1.36) cm2, respectively (intraclass correlation coefficient 0.59, moderate correlation), and in 3D reconstruction for operated patients were 10.32 (0.98) cm2 and 11.27 (2.44) cm2, respectively. The coverage of the ethmoidal roof in the cadaveric dissection study was 100%, from the anterior ethmoidal artery to the posterior ethmoidal artery, covering the planun sphenoidale up to 75% in the case series. In 87.5% of the cases, up to 50% of the papiracea lamina was covered. Conclusion The EEM have shown to be a feasible and useful grafting technique to repair skull base defects after performing an extended ethmoid‐sphenoidotomy during surgery for CRSwNP. Level of Evidence NA.

Previous investigations have established the ergogenic effect of caffeine on maximal muscle strength, power output and strength-endurance. However, these investigations used testing protocols that do not replicate the structure of a regular strength training session. Thus, the aim of this study was to investigate the effect of acute caffeine ingestion on muscle performance during a simulated velocity-based training workout. In a double-blind, randomized and counterbalanced experiment, 12 participants performed two experimental trials after ingesting 3 mg/kg/b.m. of caffeine or a placebo. The trials consisted of 4 sets of 8 repetitions of the bench press exercise at 70% of their one-repetition maximum performed at maximal velocity. Bar velocity was recorded with a rotatory encoder and force, power output and work were calculated. Regarding the whole workout, caffeine increased mean bar velocity (+7.8%; p=0.002), peak bar velocity (+8.7%; p=0.006), mean force (+1.5%; p=0.002), mean power output (+10.1%; p=0.003) and peak power output (+8.2%; p=0.004) when compared to the placebo. The total work performed in the caffeine trial was superior to the placebo trial (7.01±2.36 vs 6.55±2.20 kJ, p=0.001). These results suggest that the acute intake of 3 mg/kg/b.m. of caffeine before a velocity-based strength workout increased muscle performance and the total work performed across the whole training session. Thus, caffeine can be considered as an effective strategy to enhance muscle performance during the bench press training sessions.

Caffeine increases vertical jump, although its effects on kinetics and kinematics during different phases of bilateral and unilateral jumps remain unclear. The aim of this study was to identify the effects of 3 mg/kg on kinetic, kinematic and temporal variables in the concentric and eccentric phases of bilateral and unilateral countermovement jumps. A total of 16 Spanish national team traditional Jiu-Jitsu athletes took part in two experimental trials (3 mg/kg caffeine or placebo) in a randomized, double-blind crossover study. Sixty minutes after ingestion, bilateral and unilateral jumps were performed on a force platform. Compared to the placebo, caffeine increased bilateral jump height (p = 0.008, Δ% = 4.40), flight time (p = 0.008, Δ% = 2.20), flight time:contraction time (p = 0.029, Δ% = 8.90), concentric impulse (p = 0.018, Δ% = 1.80), peak power (p = 0.049, Δ% = 2.50), RSI-modified (p = 0.011, Δ% = 11.50) and eccentric mean braking force (p = 0.045, Δ% = 4.00). Additionally, caffeine increased unilateral RSI-mod in both legs (Left: p = 0.034, Δ% = 7.65, Right: p = 0.004, Δ% = 11.83), left leg flight time (p = 0.044, Δ% = 1.91), left leg jump height (p = 0.039, Δ% = 3.75) and right leg FT:CT (p = 0.040, Δ% = 9.72). Caffeine in a dose of 3 mg/kg BM in elite Jiu-Jitsu athletes is a recommended ergogenic aid as it increased performance of bilateral and unilateral vertical jumps. These increases were also accompanied by modified jump execution during the different phases of the countermovement prior to take-off.

The COVID-19 outbreak has spread extensively around the world. Loss of smell and taste have emerged as main predictors for COVID-19. The objective of our study is to develop a comprehensive machine learning (ML) modelling framework to assess the predictive value of smell and taste disorders, along with other symptoms, in COVID-19 infection. A multicenter case-control study was performed, in which suspected cases for COVID-19, who were tested by real-time reverse-transcription polymerase chain reaction (RT-PCR), informed about the presence and severity of their symptoms using visual analog scales (VAS). ML algorithms were applied to the collected data to predict a COVID-19 diagnosis using a 50-fold cross-validation scheme by randomly splitting the patients in training (75%) and testing datasets (25%). A total of 777 patients were included. Loss of smell and taste were found to be the symptoms with higher odds ratios of 6.21 and 2.42 for COVID-19 positivity. The ML algorithms applied reached an average accuracy of 80%, a sensitivity of 82%, and a specificity of 78% when using VAS to predict a COVID-19 diagnosis. This study concludes that smell and taste disorders are accurate predictors, with ML algorithms constituting helpful tools for COVID-19 diagnostic prediction.

Previous research has identified acute caffeine intake as an effective ergogenic aid to enhance velocity and power during bench press exercise. However, no previous investigation has analyzed the effects of chronic intake of caffeine on training adaptations induced by bench press strength training. Thus, the aim of this investigation was to determine the effects of pre-exercise caffeine intake on training adaptations induced by a bench press training protocol. Using a double-blind, randomized experimental design, 16 healthy participants underwent a bench press training protocol for 4 weeks (12 sessions). Seven participants ingested a placebo and nine participants ingested 3 mg/kg/BM of caffeine before each training session. Three days before, and 3 days after the completion of the training protocol, participants performed a one-repetition maximum (1RM) bench press and force-velocity test (from 10 to 100% 1RM). From comparable pre-training values, the strength training similarly increased 1RM in the caffeine and placebo groups (+13.5 ± 7.8% vs. +11.3 ± 5.3%, respectively; p = 0.53). In the caffeine group, the strength training induced a higher mean velocity at 40%, (0.81 ± 0.08 vs. 0.90 ± 0.14 m/s), 60% (0.60 ± 0.06 vs. 0.65 ± 0.06 m/s), 70% (0.47 ± 0.05 vs. 0.55 ± 0.06 m/s), 80% (0.37 ± 0.06 vs. 0.45 ± 0.05 m/s), 90% (0.26 ± 0.07 vs. 0.34 ± 0.06 m/s), and 100% 1RM (0.14 ± 0.04 vs. 0.25 ± 0.05 m/s; p < 0.05) while the increases in the placebo group were evident only at 30 (0.95 ± 0.06 vs. 1.03 ± 0.07 m/s), 70% (0.51 ± 0.03 vs. 0.57 ± 0.05 m/s) and 80% 1RM (0.37 ± 0.06 vs. 0.45 ± 0.05 m/s) (p < 0.05). The placebo group only increased peak velocity at 60 and 70% 1RM (p < 0.05) while peak velocity increased at 10%, and from 30 to 100% 1RM in the caffeine group (p < 0.05). The use of 3 mg/kg/BM of caffeine before exercise did not modify improvements in 1RM obtained during a 4 week bench press strength training program but induced more muscle performance adaptations over a wider range of load.

The p-synephrine is the principal phytochemical found in bitter orange (Citrus aurantium). This substance is widely included in dietary supplements for weight loss/body fat reduction due to its potential benefits of increasing fat oxidation. For years, p-synephrine-containing dietary supplements have been marketed without proper knowledge of their true effectiveness to enhance fat utilization, especially when combined with exercise. However, the effects of p-synephrine on fat oxidation during exercise have been investigated in the last few years. The aim of the current discussion is to summarize the evidence on the effects of p-synephrine intake on fat oxidation and performance during exercise. Previous investigations have demonstrated that the acute intake of p-synephrine does not modify running sprint performance, jumping capacity, or aerobic capacity. However, the acute intake of p-synephrine, in a dose of 2–3 mg/kg of body mass, has been effective to enhance the rate of fat oxidation during incremental and continuous exercise. This effect has been observed in a range of exercise workloads between 30% and 80% of peak oxygen uptake (VO2peak). The p-synephrine has the ability to increase the maximal rate of fat oxidation during exercise of increasing intensity without affecting the workload at which maximal fat oxidation is obtained (Fatmax). The effect of p-synephrine on fat oxidation is normally accompanied by a concomitant reduction of carbohydrate utilization during exercise, without modifying the energy expended during exercise. The shifting in substrate oxidation is obtained without any effect on heart rate during exercise and the prevalence of adverse effects is negligible. Thus, the acute use of p-synephrine, or p-synephrine-containing products, might offer some benefits for those individuals seeking higher fat utilization during exercise at low to moderate intensities. However, more research is still necessary to determine if the effect of p-synephrine on fat oxidation during exercise is maintained with chronic ingestion, in order to ascertain the utility of this substance in conjunction with exercise programs to produce an effective body fat/weight loss reduction.

Aim: (i) to compare the effects of two different low-volume resistance priming sessions, where the external load is modified on neuromuscular performance after 6 h of rest; and (ii) to identify the effects on psychological readiness in participants with resistance training experience. Methods: Eleven participants (Body mass: 77.0 ± 8.9 kg; Body height: 1.76 ± 0.08 m; Half squat repetition maximum: 139.8 ± 22.4 kg) performed the priming session under three experimental conditions in a randomized and cross-over design during the morning. The control (CON) condition: no resistance training, “optimal load” (OL) condition: two half-squat sets with a velocity loss of around 20% were performed with the “optimal load”, and 80% of repetition maximum (80% RM) condition: 2 half-squat sets with a velocity loss of around 20% were performed with the 80% RM. Countermovement jump (CMJ), mean power with OL (MPOL) and 80% RM (MP80RM), and mean velocity with OL (MVOL) and 80% RM (MV80RM) were assessed six hours after the intervention. Subjective readiness was also recorded prior to resistance training and evaluation. Significance was set at p

Pre-exercise caffeine ingestion has been shown to increase the workload at ventilatory threshold, suggesting an ergogenic effect of this stimulant on submaximal aerobic exercise. However, the time course of tolerance to the effect of caffeine on ventilatory threshold is unknown. This study aimed to determine the evolution of tolerance to the ergogenic effect of caffeine on the ventilatory threshold. Methods: Eleven participants (age 32.3 &plusmn, 4.9 yrs, height 171 &plusmn, 8 cm, body mass 66.6 &plusmn, 13.6 kg, VO2max = 48.0 &plusmn, 3.8 mL/kg/min) took part in a longitudinal, double-blind, placebo-controlled, randomized, crossover experimental design. Each participant took part in two identical treatments: in one treatment, participants ingested a capsule containing 3 mg of caffeine per kg of body mass per day (mg/kg/day) for twenty consecutive days, in the other treatment, participants ingested a capsule filled with a placebo for the same duration and frequency. During these treatments, participants performed a maximal ramp test on a cycle ergometer three times per week and the second ventilatory threshold (VT2) was assessed by using the ventilatory equivalents for oxygen and carbon dioxide. Results: A two-way ANOVA with repeated measures (substance x time) revealed statistically significant main effects of caffeine (p &lt, 0.01) and time (p = 0.04) on the wattage obtained at VT2, although there was no interaction (p = 0.09). In comparison to the placebo, caffeine increased the workload at VT2 on days 1, 4, 6 and 15 of ingestion (p &lt, 0.05). The size of the ergogenic effect of caffeine over the placebo on the workload at VT2 was progressively reduced with the duration of the treatment. In addition, there were main effects of caffeine (p = 0.03) and time (p = 0.16) on VO2 obtained at VT2, with no interaction (p = 0.49). Specifically, caffeine increased oxygen uptake at VT2 on days 1 and 4 (p &lt, 0.05), with no other caffeine&ndash, placebo differences afterwards. For heart rate obtained at VT2, there was a main effect of substance (p &lt, 0.01), while the overall effect of time (p = 0.13) and the interaction (p = 0.22) did not reach statistical significance. Heart rate at VT2 was higher with caffeine than with the placebo on days 1 and 4 (p &lt, 0.05). The size of the effect of caffeine on VO2 and heart at VT2 tended to decline over time. Conclusion: Pre-exercise intake of 3 mg/kg/day of caffeine for twenty days enhanced the wattage obtained at VT2 during cycling ramp tests for ~15 days of ingestion, while there was a progressive attenuation of the size of the ergogenic effect of caffeine on this performance variable. Therefore, habituation to caffeine through daily ingestion may reduce the ergogenic effect of this stimulant on aerobic exercise of submaximal intensity.

Background: Endoscopic sinus surgery (ESS) is performed on endonasal landmarks that have great anatomical variability, therefore a detailed preoperative study of these structures is necessary. Objective: To develop a checklist for the systematic identification of the paranasal sinuses and the skull base, based on 3D images that guide the planning and implementation of ESS to minimize complications and improve surgical outcomes. Methods: This study evaluates the usefulness of the “ABCDEF Checklist”, in a randomized study involving 30 otolaryngologists with more than 2 years of practical experience in ESS evaluating preoperative radiological examination and subsequent surgical performance in the sinus of 30 cadavers. Results: Differences between groups in identifying the essential anatomical references were significant in 9 of the 11 essential anatomical references for the Checklist Group Surgical procedures and surgical mistakes were performed systematically less often in the Checklist group but the differences did not reach significance after Bonferroni correction. Conclusions: The use of "ABCDEF Checklist" prior to ESS facilitates the identification of the essential anatomical references for the preoperative and systematized planning of the surgical procedures. However, in this small sample of 15 participants per group the differences found in the performance of the surgical procedures did not reach significance.

Purpose The ergogenic effect of caffeine on exercise of maximum intensity has been well established. However, there is controversy regarding the effect of caffeine on shifting substrate oxidation at submaximal exercise. The aim of this study was to investigate the effect of acute caffeine ingestion on whole-body substrate oxidation during 1 h of cycling at the intensity that elicits maximal fat oxidation (Fatmax). Methods In a double-blind, randomized, and counterbalanced experiment, 12 healthy participants (VO2max = 50.7 ± 12.1 mL/ kg/min) performed two acute experimental trials after ingesting either caffeine (3 mg/kg) or a placebo (cellulose). The trials consisted of 1 h of continuous cycling at Fatmax. Energy expenditure, fat oxidation rate, and carbohydrate oxidation rate were continuously measured by indirect calorimetry. Results In comparison to the placebo, caffeine increased the amount of fat oxidized during the trial (19.4 ± 7.7 vs 24.7 ± 9.6 g, respectively; P = 0.04) and decreased the amount of carbohydrate oxidized (94.6 ± 30.9 vs 73.8 ± 32.4 g; P = 0.01) and the mean self-perception of fatigue (Borg scale= 11 ± 2 vs 10 ± 2 arbitrary units; P = 0.05). In contrast, caffeine did not modify total energy expenditure (placebo = 543 ± 175; caffeine = 559 ± 170 kcal; P = 0.60) or mean heart rate (125 ± 13 and 127 ± 9 beats/min; P = 0.30) during exercise. Before exercise, caffeine increased systolic and diastolic blood pressure whilst it increased the feelings of nervousness and vigour after exercise (P < 0.05). Conclusion These results suggest that a moderate dose of caffeine (3 mg/kg) increases the amount of fat oxidized during 1 h of cycling at Fatmax. Thus, caffeine might be used as an effective strategy to enhance body fat utilization during submaxi- mal exercise. The occurrence of several side effects should be taken into account when using caffeine to reduce body fat in populations with hypertension or high sensitivity to caffeine. pre-print 332 KB

Hip thrust (HT) is a loaded bridging exercise that requires more hip extension than a back squat (SQ) does, while in a back squat, triple flex extension occurs. Due to the specificity of each exercise, it is claimed that HT gains can be better transferred to actions where hip extension occurs. In addition, strength improvements during squatting can be transferred in a greater way to vertical plane movement, such as vertical jumping. However, its effects on the performance of female soccer players are unclear. For this reason, the purpose of this study was to analyze a 7-week training program on performance variables using either HT or SQ exercises in female adolescent soccer players without lifting experience (N = 24, age = 16.82 &plusmn, 1.56 years, height = 1.64 &plusmn, 0.55 cm, body mass = 58.35 &plusmn, 6.28 kg). Players were randomized into three groups: A back squat group (SQG, N = 8), hip thrust group (HTG, N = 8), and control group (CG, N = 8). Participants in the HTG and SQG joined a progressive resistance training program twice per week for 7 weeks with either HT or SQ exercises. A countermovement jump, 10&ndash, 20 m sprint, T-test, and barbell velocity during HTs and SQs (with the load that represents ~60 and ~80% RM) were measured before and after the intervention. The HTG showed greater improvements in the 10-m sprint (d = 0.7), 20-m sprint (d = 0.46), T-test (d = 0.36), and barbell velocity at 80% repetition maximal (RM) (d = 0.53) and 60% RM (d = 1.02) during hip thrusts, while the SQG showed higher barbell velocity at 80% RM (d = &minus, 0.7) during back squats. These results may be useful for strength and conditioning coaches working with adolescent female soccer athletes, since both strengthening exercises improved performance in different ways due to the nature of the exercise.

[Background] We report a novel surgical technique based on an endonasal free mucosal graft (mucoplasty) for improving clinical results and local healing in chronic rhinosinusitis with nasal polyps (CRSwNP)., [Methods] Patients diagnosed with bilateral CRSwNP scheduled for endoscopic sinus surgery were included. They underwent complete removal of anterior and posterior ethmoid cells, in addition to bilateral type III frontal sinusotomy. An endoscopic mucoplasty was performed in the left nasal cavity, whereas the right nasal cavity served as control. Patients were evaluated before surgery and 6 months after operation, including Sino-Nasal Outcome Test (SNOT-22), Visual Analogue Scale (VAS) for olfaction, endoscopic evaluation using the Modified und-Kennedy (MLK) scoring system and healing evaluation., [Results] Ten patients (mean age 53.6 years) were included. A significa t decrease of SNOT-22 score from 57.0 (21.1) to 20.3 (20.6) (P = 0.024) and a non-significa t decrease of VAS for olfaction score from 9.3 (0.5) to 4.6 (3.9) were found. Preoperative mean MLK score was 4.9 (0.7) in the right nostril and 4.8 (1.0) in the left one. After operation, there was a greater decrease of MLK score in the left nostril than in the right (1.9 [1.0] vs. 1.3 [0.8], P = 0.034). Better healing was proved in the nostril with the mucoplasty., [Conclusion] Endonasal mucoplasty could be an effective, safe and feasible complementary surgical procedure in the treatment of CRSwNP. The reduced local edema associated with lower amount of secretions may confer a better control in the frontal recess, orbital wall and nasal roof.

Resumen Introduccion y objetivos La elevada variabilidad anatomica de los senos paranasales requiere disponer del mejor conocimiento de su conformacion tridimensional para afrontar la cirugia con mayor seguridad y eficiencia. El objetivo del estudio fue validar la utilidad de Osirix ® y la estereolitografia en la mejora de la planificacion de las cirugias endoscopicas nasosinusales. Metodos Se utilizo Osirix ® como visor y gestor de imagenes DICOM en 3 dimensiones (3D) en la planificacion de 114 cirugias endoscopicas nasosinusales por poliposis (86) y rinosinusitis cronica (28) junto con prototipos rapidos estereolitograficos en 7 mucoceles frontoetmoidales. Resultados Se identificaron mayor numero de estructuras anatomicas, mas rapidamente y con una correlacion clinico-radiologica estadisticamente significativa (p Conclusiones La utilizacion sistematica de Osirix ® para visualizacion y tratamiento autonomo de imagenes nasosinusales en 3D desde archivos DICOM permite a los cirujanos efectuar las cirugias endoscopicas nasosinusales con mayor confianza y seguridad y en menos tiempo que utilizando imagenes en 2D. Los residentes tambien alcanzan la competencia quirurgica mas rapidamente, con mayor seguridad y con menos complicaciones. La mejora en la planificacion se incrementa cuando el equipo quirurgico dispone de prototipos rapidos estereolitograficos en los casos de mayor complejidad.

Objectives: Accidental displacement of endosseous implants into the maxillary sinus is an unusual but potential complication in implantology procedures due to the special features of the posterior aspect of the maxillary bone; there is also a possibility of migration throughout the upper paranasal sinuses and adjacent structures. The aim of this paper is to review the published literature about accidental displacement and migration of dental implants into the maxillary sinus and other adjacent structures. Study Design: A review has been done based on a search in the main on-line medical databases looking for papers about migration of dental implants published in major oral surgery, periodontal, dental implant and ear-nose-throat journals, using the keywords “implant,” “migration,” “complication,” “foreign body” and “sinus.” Results: 24 articles showing displacement or migration to maxillary, ethmoid and sphenoid sinuses, orbit and cranial fossae, with different degrees of associated symptoms, were identified. Techniques found to solve these clinical issues include Cadwell-Luc approach, transoral endoscopy approach via canine fossae and transnasal functional endoscopy surgery. Conclusion: Before removing the foreign body, a correct diagnosis should be done in order to evaluate the functional status of the ostiomeatal complex and the degree of affectation of paranasal sinuses and other involved structures, determining the size and the exact location of the foreign body. After a complete diagnosis, an indicated procedure for every case would be decided. Key words:Implant, oral surgery, foreign body, paranasal sinuses, displacement, migration.

The high variability of sinonasal anatomy requires the best knowledge of its three-dimensional (3D) conformation to perform surgery more safely and efficiently. The aim of the study was to validate the utility of Osirix® and stereolithography in improving endoscopic sinonasal surgery planning.Osirix® was used as a viewer and Digital Imaging and Communications in Medicine (DICOM) 3D imaging manager to improve planning for 114 sinonasal endoscopic operations with polyposis (86) and chronic rhinosinusitis (CRS) (28). Stereolithography rapid prototyping was used for 7 frontoethmoidal mucoceles.Using Osirix® and stereolithography, a greater number of anatomical structures were identified and this was done faster, with a statistically-significant clinical-radiological correlation (P.01) compared with 2D CT plates. With a share of more than 75% of surgery performed by residents, surgical time was reduced by 38±12.3min in CRS and 42±27.9 in sinonasal polyposis. The fourth-year residents reached 100% surgical competence in critical surgical milestones with 16 surgeries (CI 12-19).The systematic use of Osirix® for visualisation and treatment of 3D sinonasal images from DICOM data files, along with the surgical team's ability to manipulate them as virtual reality, allows surgeons to perform endoscopic sinonasal surgery with greater confidence and in less time than using 2D images. Residents also achieve surgical competence faster, more safely and with fewer complications. This beneficial impact is increased when the surgical team has stereolithography rapid prototyping in more complex cases.