Background and Objectives: Lower extremity amputations (LEAs) represent a significant health problem. The aim of our study was to analyse the type and trends of diabetes-related LEAs in patients hospitalized in one surgical centre in Bucharest between 2018 and 2021. The second aim was to assess the impact of the COVID-19 pandemic on the trends of LEAs. Materials and Methods: We performed a retrospective analysis of all lower limb amputations performed between 01 January 2018 and 31 December 2021 in the Department of Surgery, Dr. I. Cantacuzino Clinical Hospital, Bucharest, Romania. We evaluated demographic parameters, type of LEA, the level, the laterality and trends of the amputations, the main aetiologies leading to amputation, and the length of hospitalization. Results: During the study period, 1711 patients underwent an LEA. The mean age was 64.53 ± 9.93 years, 71.6% (n = 1481) being over 60. Men outnumbered women by a ratio of 3.62:1. The most frequent interventions were ray amputations in 41.2% (n = 705) of patients; then, there were amputations of the toe (20.4%, n = 349), transtibial amputations (18.9%, n = 323), transfemoral amputations (10.6%, n = 181), and midfoot amputations (9%, n = 154). Wet gangrene was the most frequent aetiology (40.9%, n = 699). The total number of LEAs decreased constantly throughout the analysed period, such that 616 LEAs were performed in 2018 and 323 LEAs in 2021 (p < 0.001). There was a statistically significant increase in the rate of major LEAs in the pandemic vs. pre-pandemic period (37% vs. 24.4%, p < 0.001). Conclusions: In our study, the total number of LEAs decreased throughout the analysed period, but there was an increase in the rate of major LEAs in the pandemic vs. pre-pandemic period. Being over 65 years of age, leucocytosis, sepsis at presentation, and diabetic polyneuropathy were important risk factors for the necessity of LEA in complicated diabetes-related foot disease.

The internal branch of the superior laryngeal nerve (IbSLN) plays a critical role in the sensory innervation of the supraglottic larynx. It is essential for protective reflexes such as coughing and swallowing. This nerve is frequently at risk during surgeries involving the cervical region, including thyroidectomy, carotid endarterectomy, and anterior cervical spine procedures. Injury to the IbSLN may lead to postoperative complications. A comprehensive review of the morphological and topographic characteristics of the IbSLN is presented, focusing on its anatomical course, relationships with key vascular structures, branching patterns, and clinically significant variations.

Background/Objectives: The suprasternal notch (SN) is the conventional landmark for front-of-neck airway access and anterior cervical surgery, yet the great vessels may extend to or above it. To our knowledge, no previous study has jointly classified the aortic arch (AA), brachiocephalic trunk (BCT), left brachiocephalic vein (LBCV), and sternoclavicular joint (SCJ) configuration relative to the SN in a single adult cohort. Methods: In this single-centre retrospective study, 100 consecutive adult computed tomography angiography (CTA) studies were reviewed. Using a horizontal SN reference plane, the AA, BCT, and LBCV were each graded as mediastinal, cervicomediastinal, or cervical/high-riding; the bilateral SCJ manubrial joining grade was scored on four levels and integrated into three categories (mild, clear, marked). Two observers independently classified all cases (weighted Cohen kappa = 0.89). Associations were assessed with Spearman correlation and chi-square tests. Results: The BCT was the most variable structure, cervical/high-riding in 49% and reaching or crossing the SN in 64%; the AA and LBCV were cervical/high-riding in 3% and 5%, respectively. Complete SCJ manubrial joining was absent in all cases, and the integrated SN space was marked in 15% of cases. Cervical/high-riding BCT was more frequent in women (63.5% vs. 33.3%; p = 0.005). Five of six pairwise correlations remained significant after Benjamini–Hochberg adjustment, with the strongest association for AA–BCT (rho = 0.406). Conclusions: The BCT was the principal great vessel extending to or above the SN in this cohort, whereas cervical/high-riding AA and LBCV were uncommon. The SN-referenced classification provides a reproducible descriptive framework for this topography. These findings represent cohort frequencies rather than population-based prevalence estimates, and their potential procedural relevance requires prospective validation.

Background/Objectives: Compression syndromes of the stylohyoid complex (SHC) encompass neural, arterial, and venous presentations extending beyond classic Eagle syndrome. Symptomatic disease is increasingly recognised as a dynamic neurovascular conflict determined not by styloid process (SP) length alone, but by three-dimensional orientation, vessel and nerve proximity, and positional musculoskeletal interactions. This review synthesises that literature and proposes a phenotype-based framework integrating neural, arterial, venous, and mixed presentations. Methods: This is a narrative, pathophysiologically organised review rather than a systematic or scoping review. Landmark anatomical, clinical, and cohort studies were synthesised alongside systematic reviews, meta-analyses, osteological data, and selected case reports illustrating mechanisms not captured at cohort level. Evidence strength was interpreted by study design, distinguishing pooled estimates from retrospective series and proposed mechanisms. Results: The SHC and adjacent C1 transverse process form a narrow corridor containing the internal jugular vein, carotid arteries, and lower cranial nerves. SP elongation is common, but symptomatic compression depends more on orientation, SP-to-C1 distance, vessel proximity, and dynamic positional factors than on length. Three-dimensional CT angiography/venography is the anatomical cornerstone for defining morphology and vessel relationships, whereas catheter venography with manometry remains the haemodynamic reference standard in selected venous cases. Jugular narrowing is frequent in asymptomatic individuals and is not diagnostic without clinical and haemodynamic correlation. Surgical decompression appears favourable in selected patients, whereas primary endovascular stenting, evaluated only in single-centre observational series, carries a substantial complication profile and should generally be reserved for refractory or combined presentations. Conclusions: SHC compression syndromes are best understood as overlapping neural, arterial, venous, and mixed phenotypes within a dynamic neurovascular corridor. A phenotype-based classification and a cautious “styloidectomy-first” strategy for osseous venous compression are proposed as practical frameworks, but require prospective validation.

Background/Objectives: To establish normative CTA (computed tomography angiography) morphometry of the maxillary artery (MA) relative to the lateral pterygoid muscle (LPM) and mandibular landmarks in a European population. Methods: Bilateral CTA datasets from 164 patients (328 sides; mean age 67.2 ± 13.0 years) were analysed retrospectively. The MA course was classified relative to the inferior head of the LPM as superficial (S) or deep (D); patients were assigned to three bilateral types (Type 1: S + S; Type 2: D + D; Type 3: S + D), and MA–gonial angle, MA–mandibular notch, and MA–lingula distances were measured. Results: The MA was superficial in 61.0% of sides, with no transpterygoid course; Type 1 predominated (48.8%). The MA–gonial angle distance was 34.53 ± 5.31 mm, with marked sex dimorphism (males: 36.74 mm vs. females: 31.35 mm; p < 0.0001). Looping occurred on at least one side in 34.8% of patients, and the MA lay superior to the mandibular notch in 83.4% of superficial sides. The MA–lingula distance was 8.03 ± 2.54 mm; non-retrotuberosity looping was strongly associated with proximity below 5 mm (OR = 9.95). Conclusions: A three-type bilateral classification of the MA course, the first normative MA–gonial angle dataset, and the looping–proximity association provide actionable data for surgical risk stratification in infratemporal and mandibular ramus procedures.