Root of Helix Inter Tragus Notch Incision (RHITNI) for open temporomandibular joint surgery: A five-year retrospective cohort study on safety and complications.

Contemporary skull base surgeons must understand transcranial and endoscopic endonasal approaches to the petrous apex (PA). We provide an anatomic overview and comparison of main approaches to the PA through illustrative anatomic dissections. On 10 sides of 5 specimens, transcranial approaches to the PA including the anterior petrosal, transcochlear, and retrosigmoid with suprameatal extension were performed. For endoscopic endonasal approaches, the transclival approach was performed in the midline of 5 specimens and its contralateral transmaxillary extension was performed on 10 sides. The anterior petrosal approach offers an anterolateral view of the PA bounded by petrous ridge posteromedially, internal auditory canal posterolaterally, greater superficial petrosal nerve anterolaterally, and lateral boundary of cranial nerve V, the Gasserian ganglion, and V3 anteromedially; it exposes the middle fossa and, once the PA is removed, the superomedial cerebellopontine angle. The transcochlear approach affords a lateral view of the PA defined medially and inferiorly by inferior petrosal sinus, posteriorly by posterior fossa dura, anteriorly by the petrous internal carotid artery, and superiorly by the superior petrosal sinus and middle fossa dura. Through a retrosigmoid approach, the PA is bounded by the superior petrosal sinus superiorly, the sagittal plane of cranial nerve VI medially, and the axial and sagittal plane of the internal auditory canal porus inferiorly and laterally, respectively. It affords a panoramic view of the posterior fossa and access to Meckel's cave after PA drilling. Endoscopic endonasal approaches target the anteromedial PA, and it is demarcated by a triangle consisting of cranial nerve VI posterolaterally, the paraclival segment of the internal carotid artery anteriorly, and the petroclival synchondrosis inferiorly and medially. The addition of the contralateral transmaxillary approach enhances lateral access up to the internal auditory canal. We provide a comprehensive overview of the main approaches to the PA through illustrative anatomic dissections and representative cases.

Aims: The present study was conducted to compare therapeutic efficacy of three different treatment regimens in otitis externa caused by Pseudomonas spp. in dogs. Study Design: Clinical study involving canine otitis externa patients caused by Pseudomonas spp. in dogs were randomly divided into 3 different groups (group I, II and III) having 06 animals in each group. Dogs in each group were subjected to three different treatment protocols along with daily flushing of ear canal with TRIS EDTA and chlorhexidine solution to compare therapeutic efficacy. Place and Duration of Study: Ear swab samples from otitis externa affected dogs were collected for a period of 09 months from January to September, 2022 from Teaching Veterinary Clinical Complex, College of Veterinary Science and Animal Husbandry, Anjora, Durg (C.G.) and various Government Veterinary Hospitals and Private Pet Clinics in and around Durg district of Chhattisgarh. Methodology: Sterile ear swabs from clinical cases of otitis externa were processed for microbiological isolation and identification of Pseudomonas spp. based on the cultural, morphological and biochemical characteristics. All isolates were also subjected to antibiotic sensitivity testing as per standard protocol. Results: Antibiogram analysis of all Pseudomonas isolates demonstrated the highest susceptibility to imipenem (100%), followed by piperacillin–tazobactam (84.2%). In contrast, the lowest susceptibility rates were observed for amikacin and ceftriaxone (5.2% each). Clinical recovery was adjudged on the basis of restoration of clinical signs after treatment in affected dogs which revealed that oral marbofloxacin combined with daily Tris-EDTA and chlorhexidine flushing for two weeks achieved complete (100%) recovery in dogs with Pseudomonas otitis externa while animals treated with amoxicillin-clavulanic acid therapy resulted in an 83.33% recovery. However, enrofloxacin administered with the same flushing protocol was effective in 66.66% of Pseudomonas otitis affected dogs Conclusion: Oral marbofloxacin in combination with daily Tris-EDTA and chlorhexidine ear flushing for two weeks was found to be the most effective therapeutic protocol. Amoxicillin–clavulanic acid demonstrated moderate efficacy, whereas enrofloxacin showed comparatively lower clinical success. Overall, marbofloxacin-based therapy appears to be the most reliable treatment option for the management of Pseudomonas otitis externa in dogs. The findings of our study reveal that Pseudomonas otits externa in dogs needs to be addressed with appropriate therapeutic regimen for early recovery and prevent recurrence. The limitations of small sample size in our study needs to validated with larger population size for much stronger recommendations towards therapeutic management of Pseudomonas otitis externa in dogs.

Cerumen (earwax) is a normal secretion of the serous and sebaceous glands of the outer third of the external ear canal, consisting of glycopeptides, lipids, hyaluronic acid, sialic acid, lysosomal enzymes, and immunoglobulins. When cerumen builds up and blocks the ear, it is referred to as cerumen impaction. Factors that increase the occurrence of cerumen impaction are narrow and tortuous ear canals, the use of cotton buds to clean the ears, the use of earplugs, or other defects. The research method used was observation, combined with questionnaire data collection and ear examination using an otoscope, which was then analyzed both descriptively and analytically. Analysis through the IBM SPSS version 23 using the chi-square statistical test obtained significant results on the relationship between ear cleaning behavior and the incidence of cerumen impaction (P = 0.009; P <0.05), and there is a significant relationship between the use of earplugs and the incidence of cerumen impaction (P = 0.002; P <0.05) in factory workers at PT Wijaya Karya Beton Pasuruan.

Cerumen, a natural substance composed of glandular secretions and skin cells in the outer ear canal, can accumulate and cause blockage, known as cerumen impaction. Multiple risk factors, such as age, gender, dental health, chewing habits, ear anatomy, and ear-cleaning behavior, are known to influence its occurrence. This study aimed to determine the relationship between sociodemographic factors and the incidence of cerumen impaction among factory workers. A cross-sectional analytical study was conducted involving 27 workers at t a concrete manufacturing company in Pasuruan, East Java, Indonesia. Data were collected through structured questionnaires and direct physical examinations of the ear and oral cavity. Analysis was performed using IBM SPSS version 23, with the chi-square test applied to assess associations. Results indicated no statistically significant relationship between cerumen impaction and age (p = 0.633), gender (p = 1.000), dental caries (p = 0.633), chewing habits (p = 1.000), or anatomical variations of the external auditory canal (p = 1.000). In conclusion, within the limited sample studied, none of the sociodemographic or clinical factors examined showed a significant association with cerumen impaction.

Intracranial pressure (ICP) monitoring is a gold standard in brain injury management. While supratentorial ICP monitoring is widespread, monitoring in the posterior cranial fossa is rare and lacks a standardized location. To define and validate a novel anatomic reference point-the WON point-for minimally invasive and standardized infratentorial ICP (iICP) probe placement. The WON point was defined as the outer third toward the ear along a line connecting the center of the external auditory canal on the side of ICP probe placement to the mastoid tip on the contralateral side. Feasibility was first assessed in 11 patients undergoing neuronavigated surgery. The point was marked and validated using tip extension. Next, an ICP sensor was implanted in 14 adult body donors on both sides. Depth, distances to venous sinuses (transverse, sigmoid, occipital, jugular bulb), and damage to critical structures were assessed. Finally, the WON point was used for iICP monitoring in 3 patients with ischemic cerebellar infarction. The WON point proved safe and effective. No damage to adjacent critical structures such as the brainstem was observed. The median distances from the WON Point were to transverse sinus 2.25 cm (IQR 1.8-2.5), to occipital sinus 4.15 cm (IQR 3.3-4.5), and to sigmoid sinus 3.2 cm (IQR 2.8-3.4). The safe median distance to the nearest venous structure was 3.28 cm (IQR 3.0-3.4). The universal WON point is a novel anatomic landmark enabling safe and reliable iICP monitoring through minimally invasive sensor placement, with cadaveric and radiological analyses confirming a consistent safe zone and 3 pilot clinical cases demonstrating feasibility in real patients. Further clinical validation is warranted to standardize its use in neurosurgery.

The internal auditory canal extends from the porous acusticus medially to the fundus laterally. At the fundus, a vertical bony plate formed by the falciform crest separates the canal from the inner ear and divides it into compartments. Owing to its role as a conduit for vital neurovascular structures, the internal acoustic meatus (IAM) is clinically important in otologic and neurosurgical procedures. To evaluate the morphometry of the IAM and provide reference data for neurosurgeons and otologists. This descriptive cross-sectional study was conducted on 72 temporal bones (36 right and 36 left) obtained from the department of anatomy of a tertiary care teaching hospital. Seventy-two dried adult human temporal bones were studied. A silicone material was injected into the internal acoustic meatus to obtain the impressions for morphometric assessment. Mean values were calculated. Side comparisons were performed using the independent samples t-test, and Pearson's correlation coefficient assessed right-left relationships. The mean width of the porus acusticus was 3.60 ± 0.54 mm on the right and 3.74 ± 0.42 mm on the left. The mean height measured 4.27 ± 0.69 mm on the right and 4.53 ± 0.60 mm on the left. No statistically significant difference was found between the sides. Pearson's correlation showed a weak, negative, and statistically nonsignificant correlation. The findings indicate a relative bilateral symmetry of the porus acusticus, providing baseline morphometric data useful for surgical planning and minimizing neurovascular injury during procedures involving the IAM.

To assess the performanceofthree-dimensional T2-weighted fast field echo imaging (3D-T2-FFE) in the visualization of the intraparotid facial nerve (IFN) and localization of tumors. Magnetic resonance imaging data from sixty-four patients who underwent 3D-T2-FFE (Time of repetition 8.30ms, Time of echo 4.10ms, Voxel 0.65 × 0.65 × 1.00mm, Field of view 220 × 220 × 65mm, Matrix 340 × 339 × 130, Number of signal average 2, Flip angle 30°) were retrospectively enrolled. Finally, 64 cases of tumors were included (including 55 benign tumors and 9 malignant tumors). The identification certainty of IFN on 3D-T2-FFE was scored with an arbitrary scale of 0-3. The parotid gland was divided into superior and inferior parts, with the level of the earlobe (approximately at the level of the external auditory canal). The tumor location was categorized as deep or superficial directly on 3D-T2-FFE images and indirectly by the facial nerve line (FNL) and the retromandibular vein line (RMVL). Surgical localization was considered the reference standard. The accuracy, sensitivity, and specificity of each method for localizing parotid lesions were compared using the McNemar test. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for deep lobe lesions in the superior part of the parotid gland using the direct method were 97.8%, 92.3%, 100.0%, 100.0%, and 96.9%, respectively. The 3D-T2-FFE method showed significantly higher sensitivity and specificity than those of FNL (p < 0.05) in the superior part of the parotid gland, and there was no significant difference in sensitivity, specificity, and accuracy between 3D-T2-FFE and RMVL (p > 0.05). The relationship between the tumor and the main trunk of the IFN was correctly predicted in 93.3% and 100% of 3D-T2-FFE images in the superior and inferior parts of the parotid glands, respectively. 3D-T2-FFE can provide detailed morphological information on the nerve in relation to adjacent parotid gland structures and tumors before surgery.

Recent data from heavy weapon training environments suggest that protecting the Warfighter from impulse noise exceeding 140 dB may require mitigating alternative paths of noise propagation into the head, rather than focusing solely on the air conduction through the ear canal. We have developed finite element (FE) models of the human head and ear to simulate the biomechanical response of the ear subjected to impulse noise. We have used MRI images, detailed geometric representations, and published material models to generate the model. The head-ear FE model incorporated major ear structural components with the U.S. Naval Research Laboratory (NRL) high-fidelity head model. The loading conditions derived from notional weapons firing and/or explosive incidents were used to characterize the biomechanical effects in the ear. The simulation results showed the sound transmission differences between bone conduction and air conduction pathways. The computationally predicted pressure responses in the brain and the inner ear were validated with experimental data. Using the local ear model, we analyzed the dynamic behavior of inner ear when subjected to skull vibration stimulated by the impulse noise, and established the relationship between the impulse noise and the basilar membrane response. This work provides a novel attempt to separate multiple transmission modes of blast impulse noise, such as air conduction (through ear canal) and bone conduction, into the inner ear and examine their effects on the responses of sensitive inner ear organs.

Pressure-induced ossicular alterations in the oim mouse model of brittle bone disease do not cause hearing loss.

Objective:To analyze the magnetic resonance hydrography results of the inner ear in patients with total deafness-type sudden sensorineural hearing loss , and to explore the incidence and correlation with therapeutic efficacy in patients with internal auditory canal vascular loops. Methods:Audiological and imaging data were collected from 517 patients with sudden sensorineural hearing loss who were hospitalized in our hospital. All patients underwent T2WI rapid imaging sequence MRI examination, and the vascular loops of the patients were graded according to the Chavda grading method. The impact of different grades of vascular loops on the clinical characteristics and prognosis of the patients was analyzed. Statistical methods such as chi-square test and non parametric rank sum test to analyze the impact of internal auditory canal vascular loops on the clinical characteristics and hearing prognosis of patients with sudden total deafness. Results:From May 2009 to June 2024, a total of 517 hospitalized patients with sudden deafness were analyzed. It was found that: ①110 patients had abnormal hydrography in the internal auditory canal, including 32 patients with mastoiditis, 30 patients with sinus, ethmoid sinus, and maxillary sinus abnormalities, 15 patients with semicircular canal abnormalities, 7 patients with high jugular bulb, and 18 patients with fine or poorly displayed internal auditory canal nerves; ②276 patients with sudden sensorineural hearing loss accompanied by vascular loops, including 156 ears on the affected side and 158 ears on the healthy side with Chavda classification of grade Ⅰ; 104 ears on the affected side and 83 ears on the healthy side with type Ⅱvascular loops; There were 16 ears on the affected side of type Ⅲ and 14 ears on the healthy side. There was no significant difference in the distribution of vascular loops between the patient and the affected side（P>0.05）; ③The frequency of vascular loops in female patients is higher than that in males（P<0.05）, but no significant differences were found in the degree of hearing loss and hearing outcomes at different frequencies among patients with different grades of vascular loops（P>0.05）. ④The incidence of tinnitus in patients with vascular loop grades Ⅰ-Ⅲ was 92.9%, 83.7%, and 100.0%, respectively. There was a statistically significant difference in the incidence of tinnitus among patients with different grades of vascular loops（P<0.05）. Conclusion:For patients with sudden total deafness, more attention should be paid to their inner ear magnetic resonance imaging results. The vascular loop of the internal auditory canal is a possible cause of tinnitus in some patients with sudden total deafness.

Cochlear implantation outcomes in patients with auditory neuropathy and internal auditory canal stenosis

Wideband absorbance measurements in cochlear implant recipients: Insights into the Transcranial Veria Technique.

Purpose. To analyze the results of treatment of patients with basal cell carcinoma of the skin (BCC) of the nose and auricles by photodynamic therapy (PDT) with a photoditazine photosensitizer. Materials and methods. In the study group of patients with BCC of the nose and auricles, most of the patients had nasal lesions – 115 (71.8%) people. Of these, 95 people (82.6%) had single tumors, and 20 people (17.4%) had multiple tumors. Lesions of the auricles and the external auditory canal were detected in 45 people (28.2%). Of these, 37 people (82.2%) had single tumors, and 8 people (17.8%) had multiple tumors. PDT was performed using a photoditazine photosensitizer and Atkus and Latus laser systems. Results. The immediate and long-term results of the treatment of BCC of the nose and auricles by the PDT method are analyzed. The immediate results were evaluated 2 months after the treatment. Complete resorption (PR) was achieved in 92.7% of cases, partial resorption (CR) was noted in 7.3% of cases. Relapses were diagnosed in the period from 4 to 36 months, with an average of 13.2 months. When analyzing long-term results after PDT treatment in patients with recurrent BCC of the nose and auricles, PR was noted in 90.5% of patients, CR – in 9.5%. Conclusion. The advantage of PDT is the possibility, if necessary, of repeated treatment courses for basal cell carcinoma of the skin. The PDT method is highly effective and well tolerated by patients, and it gives excellent and good cosmetic results.

Background National studies on primary malignant tumours arising from the external auditory canal (EAC) are rare. Objectives To investigate the incidence and outcomes of squamous cell carcinoma of the external auditory canal (SCC-EAC) in Sweden. Materials and methods The retrospective study included patients diagnosed with SCC-EAC in Sweden from 2007 to 2017. Results Forty-six patients with SCC-EAC were identified. The crude annual incidence was 0.043 per 100,000 inhabitants (age-standardised rate (ASR): 0.024 WHO, 0.045 Europe). Among the 40 patients treated with curative intent, 85% achieved remission, and 23% subsequently relapsed. Uncertain or non-radical primary surgery significantly correlated with residual tumour or relapse (p = 0.01) and disease-specific mortality (p = 0.002). Clear margins were achieved in 60% of T1 tumours and 21% of T4 tumours, indicating surgical undertreatment. None of the patients who underwent radical surgery died of SCC-EAC. Conclusions and significance The incidence of SCC-EAC in Sweden was lower than international rates. Non-radical surgery drastically increased mortality, and postoperative radiotherapy (PORT) could not fully compensate for incomplete resection. Consequently, a more aggressive surgical approach is justified.

Severe cranial deformity has been thought to cause secondary ear misalignment; however, the developmental patterns of cranial and ear asymmetry have not been systematically characterized. We aimed to clarify age-related variations and the interrelationship of cranial and ear asymmetry in healthy Japanese children using head computed tomography (CT). We retrospectively analyzed CT data from children imaged for minor head trauma between 2006 and 2023. Cranial asymmetry was assessed using the cranial vault asymmetry index (CVAI), and ear asymmetry was quantified by the absolute ear shift angle (ESA) derived from the alignment of the external auditory canals. Both indices were categorized into five grades, with grade ≥ 3 considered moderate to severe. Age-related trends were evaluated using regression and random-forest models with partial dependence plots (PDPs). A total of 235 children were included (138 males and 97 females; median age, 12months). CVAI and absolute ESA showed a significant positive correlation (r = 0.58, p < 0.001). The proportion of grade ≥ 3 deformity declined with age: CVAI peaked at 50% at 4-5months and decreased to 29% after 5years, whereas ESA peaked at 56% at 1month and decreased to 24% after 5years. PDPs indicated that absolute ESA decreased mainly within the first 6months, while CVAI showed a more marked decline after 3years. Both CVAI and ESA decreased in severity with age and showed a strong positive correlation, suggesting coordinated cranial and ear morphological development. The temporal patterns of improvement differed between the two measures.

Introduction: Epidural hematoma resulting from severe traumatic brain injury demands immediate neuroanesthetic intervention. Multifocal lesions accompanied by pneumocephalus and impending brain herniation present profound perioperative challenges requiring targeted cerebral perfusion management. Case presentation: A 17-year-old male weighing 50 kg sustained severe polytrauma, presenting with a Glasgow Coma Scale of 12 and active auditory canal bleeding. Imaging revealed multifocal epidural hematomas in the right frontotemporal (66 cc) and right parietal (43 cc) regions, alongside pneumocephalus, a 1.5 cm subfalcine herniation, and downward transtentorial herniation. The patient, classified as ASA physical status 4E, required an emergent decompressive craniotomy and concurrent facial reconstruction. A neuroprotective anesthetic strategy was deployed utilizing thiopental, fentanyl, and atracurium to minimize the cerebral metabolic rate and control intracranial pressure. Anesthesia was maintained with sevoflurane. Hemodynamics were strictly titrated to ensure optimal cerebral perfusion pressure. Following successful surgical hematoma evacuation, the patient was admitted to the intensive care unit and demonstrated an excellent neurological recovery after a five-day admission. Conclusion: Thiopental serves as a highly effective neuroprotective induction agent for severe traumatic brain injury with intracranial hypertension. Meticulous hemodynamic control and targeted reduction of cerebral metabolism are critical in preventing secondary ischemic cascades and improving functional outcomes in polytrauma patients.

ABSTRACT Objective Vestibular schwannoma (VS) is a benign tumor that originates from the Schwann cells of the vestibular nerve sheath in the internal auditory canal. This retrospective study collected data from patients with VS who underwent surgical treatment to identify their demographic characteristics and audiometric features. Methods This retrospective study included 330 VS patients who underwent surgical treatment at the ENT Hospital of Fudan University between April 2017 and December 2019. The demographic information, audiograms, and tumor details of these patients were collected. Demographic and audiometric characteristics were summarized. Correlation analysis was performed to compare the basic characteristics of patients with tumor size, pure‐tone threshold average (PTA), and tumor grades. Results Among the patients, 38.8% (128/330) exhibited predominant high‐frequency hearing loss on pure‐tone audiometry. Approximately 74.5% (246/330) of patients exhibited moderately severe or worse hearing loss. Of the 211 patients who underwent speech testing, 65.4% (138/211) did not have practical hearing function (American Academy of Otolaryngology‐Head and Neck Surgery Class C&amp;D) at the time of surgery. Correlation analysis revealed that symptom duration was the most influential variable. No correlation was found between tumor size and PTA or speech discrimination score (SDS). Multivariate ordered regression analysis identified age over 45 years, symptom duration over 12 months, symmetric threshold difference greater than 15 dB, and SDS lower than 75% as high‐risk factors for higher Koos grading. Conclusion Considering the preservation of postoperative hearing, for patients with lower Koos grades (I + II)—especially for younger patients (age below 45 years) with functional hearing—if PTA increases or if SDS decreases or falls below 75% in their follow‐ups, surgery or radiation intervention may be considered after a thorough evaluation, regardless of tumor growth.

Microsurgical Outcomes of Medial Sporadic Vestibular Schwannoma: A Matched Cohort Study of 40 Cases and 120 Referents.

Major congenital tragal malformations are characterized by structural anomalies involving both the tragal and external auditory canal (EAC) cartilages, associated with the accessory auricle (AA). Despite their prevalence, previous classification systems and surgical techniques have focused primarily on the outer framework, particularly the AA cartilage. This retrospective study included 258 ears in 247 patients who underwent surgical reconstruction between 2013 and 2023. The structural components were analyzed, and a novel classification system was proposed based on the morphology and connectivity of the deformed tragal cartilage-rather than the AA cartilage. Type-specific surgical techniques were developed, focusing on reconstruction of both inner (EAC cartilage) and outer (tragal and AA cartilages) frameworks, followed by posterior skin flap coverage. Three consistent structural components were identified: a superior, large AA with its cartilage, a inferior, small AA with deformed tragal cartilage, and a conchal protrusion with a deformed EAC cartilage. Malformations were classified into type I (50.8%), type II (34.5%), and type III (14.7%). Surgical strategies were tailored using EAC cartilage repositioning combined with cartilage transposition flap or free grafting derived from the tragal or AA cartilage. At final follow-up, 95% of parents reported high satisfaction; most scars were inconspicuous. This classification system and surgical approach emphasize the critical role of the tragal cartilage in anatomic reconstruction. By addressing both outer and inner framework deformities, this method achieves natural tragal contour with minimal scarring and may offer valuable insights into the pathologic anatomy and embryologic development of the tragus.