Important Anatomical Structures Research Articles

Functional and Aesthetic Lower Lip Reconstruction With Depressor Anguli Oris Muscle Flap and Reverse Superior Labial Artery Flap.

The lower lip is an important anatomical structure involved in daily activities such as eating, drinking, and speaking, as well as in facial expressions. Lower lip defects should be repaired to preserve lip function without disrupting the aesthetic harmony of the lips within the face. This goal is difficult for plastic surgeons because, for functional and aesthetic repair, it is necessary to replace the mucosa, muscle (especially contractile), and skin tissues present in the lip. Subtotal lower lip repair was performed using an innervated depressor anguli oris muscle flap and a desepithelialized reverse superior labial artery flap in seven male patients with a mean age of 63 years. A depressor anguli oris muscle flap was used to repair the orbicularis oris muscle defect. The desepithelialized part of the reverse superior labial artery flap was used for mucosal defect repair, whereas the remaining part was used for skin defect repair. Patients were followed up for an average of 15 months. Patient lips, epithelialization, sensation, and sphincter function were clinically evaluated. Electromyography (EMG) was performed at 6 and 12 months to evaluate the function of the depressor anguli oris muscle flap. All the reverse superior labial artery flaps survived without any loss. Trapdoor deformity developed in the flaps of two patients. The desepithelialized parts of the flaps were completely epithelialized (covered with mucosa) by approximately 6th week. In the EMG controls of the patients at 6 months, the depressor anguli oris muscle was contractible. Sensation regained in the operated lip during the follow-up period. The combination of an innervated depressor anguli oris muscle flap and a desepithelialized reverse superior labial artery flap is an important surgical option for the functional and aesthetic repair of subtotal lower lip defects.

N6-methyladenosine-modified circCDK14 promotes ossification of the ligamentum flavum via epigenetic modulation by targeting AFF4

BackgroundThe ligamentum flavum (LF) is an important anatomical structure of the spine. Ossification of the LF (OLF) has become the leading cause of thoracic spinal stenosis. Circular RNAs (circRNAs) and N6-methyladenosine (m6A) modification are reported to be associated with several human diseases. However, the role of circRNAs and m6A modification in the pathogenesis of OLF has not been fully investigated. Here, we aimed to explore the vital function of circRNAs and m6A modification in OLF.Materials and methodsWe analysed the circRNA expression of 4 OLF tissues and 4 normal LF tissues using bioinformatic analysis and identified circCDK14 for further analysis. We investigated the effects of circCDK14 on the osteogenic differentiation of LF cells. We observed that circCDK14 regulated its target genes by binding to miRNAs as a miRNA sponge. Moreover, the circRNA pull-down assay indicated that RNA-binding proteins might regulate the expression of circCDK14 via m6A modification.ResultsCircCDK14 was significantly upregulated in OLF tissues compared to normal LF tissues. Overexpression of circCDK14 promoted the osteogenic differentiation of LF cells. Mechanistically, CircCDK14 promoted the expression of ALF transcription elongation Factor 4 (AFF4) by serving as a sponge for miR-93-5p. Moreover, Wilms tumour 1-associated protein (WTAP) increased the stability of circCDK14 via N6-methyladenosine modification.ConclusionThe m6A-modified CircCDK14 binding to miR-93-5p played an important role in the osteogenesis of LF cells by targeting AFF4, providing a promising therapeutic target for OLF.

Strategies for prevention and treatment of vascular and nerve injuries in mandibular anterior implant surgery

Important anatomical structures such as mandibular incisive canal, tongue foramen, and mouth floor vessels may be damaged during implant surgery in the mandibular anterior region, which may lead to mouth floor hematoma, asphyxia, pain, paresthesia and other symptoms. In severe cases, this can be life-threatening. The insufficient alveolar bone space and the anatomical variation of blood vessels and nerves in the mandibular anterior region increase the risk of blood vessel and nerve injury during implant surgery. In case of vascular injury, airway control and hemostasis should be performed, and in case of nerve injury, implant removal and early medical treatment should be performed. To avoid vascular and nerve injury during implant surgery in the mandibular anterior region, it is necessary to be familiar with the anatomical structure, take cone-beam computed tomography, design properly before surgery, and use digital technology during surgery to achieve accurate implant placement. This article summarizes the anatomical structure of the mandibular anterior region, discusses the prevention strategies of vascular and nerve injuries in this region, and discusses the treatment methods after the occurrence of vascular and nerve injuries, to provide clinical reference.

Ear concha carcinoma: excision and repair with an innovative revision of Masson’s post-auricular revolving-door flap (flip-flop flap)

Carcinomas of the concha are difficult to treat due to the difficulty in accessing the site and the surrounding important anatomical structures. In this article, we describe the reparative procedure of an auricular concha defect using the Masson1 revolving door island flap revisited according to Mauro Giordani, MD.

The Application of Mask Region-Based Convolutional Neural Networks in the Detection of Nasal Septal Deviation Using Cone Beam Computed Tomography Images: Proof-of-Concept Study.

Artificial intelligence (AI) models are being increasingly studied for the detection of variations and pathologies in different imaging modalities. Nasal septal deviation (NSD) is an important anatomical structure with clinical implications. However, AI-based radiographic detection of NSD has not yet been studied. This research aimed to develop and evaluate a real-time model that can detect probable NSD using cone beam computed tomography (CBCT) images. Coronal section images were obtained from 204 full-volume CBCT scans. The scans were classified as normal and deviated by 2 maxillofacial radiologists. The images were then used to train and test the AI model. Mask region-based convolutional neural networks (Mask R-CNNs) comprising 3 different backbones-ResNet50, ResNet101, and MobileNet-were used to detect deviated nasal septum in 204 CBCT images. To further improve the detection, an image preprocessing technique (contrast enhancement [CEH]) was added. The best-performing model-CEH-ResNet101-achieved a mean average precision of 0.911, with an area under the curve of 0.921. The performance of the model shows that the model is capable of detecting nasal septal deviation. Future research in this field should focus on additional preprocessing of images and detection of NSD based on multiple planes using 3D images.

RARE ANATOMIC VARIATIONS: AGENESIS OF LEFT MENTAL FORAMEN COEXISTING WITH TWO RIGHT MENTAL FORAMINA

Knowledge about the proximity of important anatomical structures is crucial for all surgical interventions, including those in the lower jaw region. One of these important structures is the mental foramen, which transmits the mental nerve, whose branches provide sensory innervation to the chin, lower lip, and gingiva. The mental foramen variations can influence the effectiveness of the mental nerve anesthesia and can also be related to complications during surgical procedures such as implant placement, apicoectomy, vestibuloplasty, etc. We present a very rare case of agenesis of left mental foramen coexisting with two right mental foramina incidentally found in a patient examined by cone-beam computed tomography.

Evaluation of the benefit of indocyanine green as an educational and practical tool for ureteral identification in laparoscopic pelvic surgery: a cross-sectional study

Background Indocyanine green (ICG) is a visible near-infrared fluorescent dye. Several studies have reported its benefit in identifying important anatomical structures, tissue vascularization, and sentinel lymph nodes in the case of tumors. Studies have shown that ICG is critical and safe in gynecologic surgeries. However, research on how ICG dye can help surgeons in laparoscopic surgeries correctly identify the course of the ureter has yet to be further investigated. Method This cross-sectional study enrolled 62 gynecology attending and resident surgeons who were asked to identify the course of the ureter on images of laparoscopic surgeries. The results were then compared with images in which ICG dye highlighted the course of the ureter. The purpose of this study was to detect the ability of surgical assistants and residents to adequately identify the course of the ureter in laparoscopic pelvic surgeries. Results No statistically significant differences were found in terms of year of residency, years of experience, number of laparoscopic procedures attended, and correct identification of ureter course. ICG proved useful in identifying the correct ureteral trajectory. Conclusions ICG can be a valuable tool to improve the correct identification of ureters and improve surgical outcomes.

Delayed Diagnosis of a Ligamentous Lisfranc Injury on a Bomber Task Force Member.

The tarsometatarsal joint, or Lisfranc joint, is an extremely important anatomical structure and injury to it has been shown to cause long-term disabling ramifications. With a wide spectrum of injury involvement, from fracture dislocations to sprains, it is important to establish a diagnosis early to guide management. Although the more extreme higher energy fracture dislocations are more widely studied, there remains a paucity of literature on lower energy purely ligamentous injuries, especially among military service members.1 The deployed setting provides an extra layer of complexity in determining a musculoskeletal injury etiology for the provider, especially in resource-limited areas. When a high level of suspicion for Lisfranc injury exists based upon clinical presentation and in the setting of negative X-rays, more prudence should be placed on additional workup. This will guide decision-making for possible expedited stateside return for the patient and better odds of follow-up care. The following case demonstrates a unique scenario of an undiagnosed, purely ligamentous Lisfranc tear in a 23-year-old woman in a deployed environment with late presentation to an orthopedic surgeon stateside. Furthermore, emphasis is placed on factors that led to her delayed diagnosis and how advocating for advanced imaging modalities up-front can expedite care.

Examination of 3D sella turcica models in three species of ruminants.

Sella turcica is an important anatomical structure that contains the pituitary gland. Changes observed on the sella turcica facilitate the identification of diseases such as Down syndrome, Seckel syndrome and tuberculum sellae meningioma in humans. Therefore, studies in this region are critical for a better understanding of sella turcica. The crania of six adult male tuj sheep, five adult male hair goats and five adult male gazelles were used in the study. Cross-sectional images of the cranium were captured using computed tomography. Cross-sectional images were used to model the sella turcica region in 3D, and the region was analysed morphologically and morphometrically. It was observed in the study that fossa hypophysialis, dorsum sella and processus clinoideus caudalis were clearly observed on the sella turcica. The processus clinoideus caudalis in some animals was not split into two. In morphometric analysis, the sella turcica length and sella turcica height (rostral border) parameters were statistically significant between the groups (p < 0.05). Consequently, this study morphological and morphometric examinations were carried out on the sella turcica of different ruminant species, and the differences between the groups were discussed. This study is expected to contribute to the very limited number of related studies, taxonomy and clinical studies in this field.

Placement of ilio-sacral screws in fusionless technique for pediatric neuromuscular scoliosis utilizing planning software, in conjunction with intraoperative navigation, results in a safer optimal screw: a CT-based study.

The insertion of ilio-sacral (IS) screws for distal anchoring in the instrumentation of pediatric neuromuscular scoliosis (NS) presents a significant challenge, often leading to elevated rates of complications. Utilizing computed tomography (CT) navigation and preoperative planning technology is proposed as a potential solution to mitigate these challenges. This study aims to assess the precision of IS screw placement through CT-graphic measurements, both with and without preoperative planning, followed by navigated IS screw insertion, in pediatric neuromuscular scoliosis. Thirty-two treated patients were grouped based on surgical procedure: planned (P): 19 patients (n=38 screws) and non-planned (NP): 13 patients (n=26 screws). All screw placements (P and NP) took place under CT navigation. IS screw trajectories of P-group were drawn preoperatively on CT images with the cranial trajectory planning program and fused with the intraoperative CT images. There are several important anatomical structures that should be avoided when placing the IS screw (L5 root, spinal canal, L5S1 facet, SI joint, neurovascular structures anteriorly to the sacrum, S1 root in the S1 foramen and the intestines). Each trajectory was evaluated based on seven radiographical parameters whom we have enlisted partially based on the essentials of a good trajectory described by Miladi et al. (1: Ilium; 2: SI joint; 3: Promontorium; 4: Sacral plate; 5: Anterior sacral cortex; 6: S1 foramen; 7: Spinal canal). An independent sample T test was executed to compare both groups. The trajectories in the P group showed a significantly (P<0.05) higher overall similarity and optimality (12.1±2.1 vs 9.1±2.2 points) compared to the non-planned trajectory. Preoperative planning and navigated placement of IS screws on fusion images with intraoperative CT, results in a better trajectory of the ilio-sacral screws.

Retrospective evaluation and descriptive analysis of the prevalence of anatomical structures and variations in CBCT images before dental implant planning in a group Turkish population, part I.

The aim of this study is to emphasize the importance of using cone-beam computed-tomography in order to determine the anatomical structures and their variations before the treatment in patients who apply to the dentist clinic for implant treatment. In the study, CBCT images of 500 adult patients (240 female and 260 male), aged between 21 and 82 years, who applied for implant treatment due to missing teeth, were retrospectively analyzed. Anatomical structures and variations such as nasopalatine canal(NPC), canalis sinuosus(CS), antral alveolar artery(AAA), were evaluated in multiplanar reformation(MPR) sections which are axial, sagittal and coronal can be viewed in consistence with each other. The incidence of anatomical variation of CS in the right region was similar according to gender. The "Funnel" appearance of the NPC shape was found most common shape in both female and male patients (n = 89; 37.1% for females and n = 71; 27.3% for males). CBCT has become the most popular 3D imaging method in dental practice especially for planning dental implants. Understanding the relationship with important anatomical structures before implant applications is crucial in dealing with potential complications that may arise afterward. Assessing significant anatomical structures by CBCT and taking precautions against possible risks facilitate the work of dentists during and after procedures.

Feasibility study of a novel digital template-guided flapless extraction for maxillary palatal impacted teeth.

With the increasing maturity of 3D printing technology, the application of digital guide template in the extraction of impacted teeth has become more sophisticated. However, for maxillary palatal deeply impacted teeth, there still exist significant clinical challenges. This experiment introduces a novel digital guide template and innovatively employs a flapless technique to explore a minimally invasive approach for the extraction of palatal deeply impacted teeth. This experiment included 40 patients diagnosed with palatal completely impacted teeth, randomly divided into an experimental group and a control group. The experimental group used the new digital guide template for flapless extraction, while the control group employed the traditional freehand flap technique. The experimental group can significantly reduce the localization time of palatally impacted teeth (P < 0.001), with total surgery times of 18.15 ± 4.88min and 22.00 ± 7.71min for the experimental and control groups, respectively (P = 0.067). Although there were no significant statistical differences between the two groups in terms of intraoperative bleeding, adjacent tooth damage, infection, or damage to nearby important anatomical structures, the experimental group showed significant improvements in postoperative pain (P < 0.05), swelling (P < 0.001), and patient satisfaction (P < 0.001) compared to the control group. Compared to traditional freehand flap surgery, flapless extraction of palatally impacted teeth guided by digital templates significantly reduces the localization time of impacted teeth and demonstrates notable advantages in some postoperative complications. Future studies with larger sample sizes are needed to substantiate the feasibility of this technique.

Reconstruction of a Wrist Defect with a Distally-Based Radial Artery Perforator Flap: A Case Report

Introduction: Because of the important anatomical structures situated superficially, reconstruction of wrist soft tissue defects is challenging for the plastic surgeon. Depending on the characteristics of the defect, various reconstruction methods are commonly performed. A pedicled perforator flap stands as a valuable option providing reliable coverage of the defect while preserving the vascularity. Case report: A 35-year-old male presented with a post traumatic wrist soft tissue defect with exposure of underlying structures. Surgical debridement was performed, and the resulting defect was reconstructed with a distally-based radial artery pedicled perforator flap. Postoperative recovery was uncomplicated. Conclusion: Radial artery perforator flap proved to be a workhorse flap for soft tissue reconstruction of the wrist. It has many of the benefits of the radial forearm flap but minimizes the disadvantages.

3d printing of skull models in horse, ox and pig

In this study, it was aimed to physically create skull models of large-sized animal sample horse, cattle and pig species used in veterinary anatomy education with three-dimensional printing technology and to determine the suitability of these models anatomically. The anatomical structures on the skull models obtained for this purpose were examined comparatively and the advantages and disadvantages of the models in terms of their usability in education were revealed. For the study, 3D reconstruction and segmentation processes were performed digitally on the cross-sectional images of horse, cattle and pig skulls obtained by computed tomography scanning and printed. Anatomical structures were comparatively analyzed on the produced 3d plastic replicas and organic skulls. Anatomical accuracy of the 3d models, printing quality, printing errors, advantages and disadvantages were evaluated. Plastic models were found to be approximately 45% lighter than organic models in horses, 55% lighter in cattle and 60% lighter in pigs. The weight (g)/printing time (s) ratio was calculated as 11.8 for equine skull models, 12.7 for bovine models and 7.4 for porcine models. It was determined that the anatomical accuracy of the models was at a high level, important anatomical structures could be printed in accordance with the original skulls, and only some sutures between the skull bones and holes with a diameter of less than 2 mm could not be clearly visualized due to scanning and printing quality. As a result, it was determined that the plastic replicas obtained can be used in veterinary anatomy education in terms of anatomical accuracy, as well as important advantages such as being lighter, more resistant to effects such as falling, impact, cleaning, easy storage, low cost, reprinting when necessary and making corrections on the model.

Pituitary adenoma. Clinical case

The article describes a clinical case of pituitary adenoma. It is known, that a pituitary adenoma is a benign tumor formation emanating from the glandular tissue of the anterior pituitary gland. Its growth is accompanied by endocrine, neurological and neuro-ophthalmological complications, which is a serious problem in modern neurosurgery due to the involvement of the most important anatomical structures in the pathological process and makes radical tumor resection difficult with a minimum number of complications.

The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options: A Scientific Statement From the American Heart Association.

Tricuspid valve disease is an often underrecognized clinical problem that is associated with significant morbidity and mortality. Unfortunately, patients will often present late in their disease course with severe right-sided heart failure, pulmonary hypertension, and life-limiting symptoms that have few durable treatment options. Traditionally, the only treatment for tricuspid valve disease has been medical therapy or surgery; however, there have been increasing interest and success with the use of transcatheter tricuspid valve therapies over the past several years to treat patients with previously limited therapeutic options. The tricuspid valve is complex anatomically, lying adjacent to important anatomic structures such as the right coronary artery and the atrioventricular node, and is the passageway for permanent pacemaker leads into the right ventricle. In addition, the mechanism of tricuspid pathology varies widely between patients, which can be due to primary, secondary, or a combination of causes, meaning that it is not possible for 1 type of device to be suitable for treatment of all cases of tricuspid valve disease. To best visualize the pathology, several modalities of advanced cardiac imaging are often required, including transthoracic echocardiography, transesophageal echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, to best visualize the pathology. This detailed imaging provides important information for choosing the ideal transcatheter treatment options for patients with tricuspid valve disease, taking into account the need for the lifetime management of the patient. This review highlights the important background, anatomic considerations, therapeutic options, and future directions with regard to treatment of tricuspid valve disease.

Safety of cholecystectomy performed by surgeons who prefer fundus first versus surgeons who prefer a standard laparoscopic approach

BackgroundAn alternative method to standard laparoscopic cholecystectomy (SLC) is the “fundus first” method (FFLC). Concerns have been raised that FFLC can lead to misinterpretation of important anatomical structures, thus causing complications of a more serious kind than SLC. Comparisons between the methods are complicated by the fact that FFLC is often used as a rescue procedure in complicated cases. To avoid confounding related to this we conducted a population-based study with comparisons on the surgeon level. MethodIn GallRiks, the Swedish registry for Gallbladder surgery, we stratified all cholecystectomies performed 2006–2020 in three groups: surgeries carried out by surgeons that uses FFLC in <20 % of the cases (N = 150,119), in 20–79 % of the cases (N = 10,212) and in 80 % or more of the cases (N = 3176). We compared the groups with logistic regression, adjusting for sex, age, surgical experience, year of surgery and history of acute cholecystitis. All surgical complications (bleeding, gallbladder perforation, visceral perforation, infection, and bile duct injury) were included as outcome. A separate analysis was done with regards to operation time. ResultsNo difference in incidence of all surgical complications or bile duct injury were seen between groups. The rates of bleeding (OR 0.34 [0.14–0.86]) and gallbladder perforation (OR 0.61 [0.45–0.82]) were significantly lower in the “fundus first > 80% group” and the operative time was shorter (OR 0.76 [0.69–0.83]). ConclusionIn this study including >160,000 cholecystectomies, both methods was found to be equally safe. Key messageDuring laparoscopic cholecystectomy, the standard method of dissection and fundus first dissection are equally safe surgical techniques. Surgeons need to learn both methods to be able to use the one most appropriate for each individual case.

Single-Center Experience of Resection of 120 Cases of Intradural Spinal Tumors

Our study presents a single-center experience of resection of intradural spinal tumors either with or without using intraoperative computed tomography-based registration and microscope-based augmented reality (AR). Microscope-based AR was recently described for improved orientation in the operative field in spine surgery, using superimposed images of segmented structures of interest in a two-dimensional or three-dimensional mode. All patients who underwent surgery for resection of intradural spinal tumors at our department were retrospectively included in the study. Clinical outcomes in terms of postoperative neurologic deficits and complications were evaluated, as well as neuroradiologic outcomes for tumor remnants and recurrence. 112 patients (57 female, 55 male; median age 55.8 ± 17.8 years) who underwent 120 surgeries for resection of intradural spinal tumors with the use of intraoperative neuromonitoring were included in the study, with a median follow-up of 39 ± 34.4 months. Nine patients died during the follow-up for reasons unrelated to surgery. The most common tumors were meningioma (n= 41), schwannoma (n= 37), myopapillary ependymomas (n= 12), ependymomas (n= 10), and others (20). Tumors were in the thoracic spine (n= 46), lumbar spine (n= 39), cervical spine (n= 32), lumbosacral spine (n= 1), thoracic and lumbar spine (n= 1), and 1 tumor in the cervical, thoracic, and lumbar spine. Four biopsies were performed, 10 partial resections, 13 subtotal resections, and 93 gross total resections. Laminectomy was the common approach. In 79 cases, patients experienced neurologic deficits before surgery, with ataxia and paraparesis as the most common ones. After surgery, 67 patients were unchanged, 49 improved and 4 worsened. Operative time, extent of resection, clinical outcome, and complication rate did not differ between the AR and non-AR groups. However, the use of AR improved orientation in the operative field by identification of important neurovascular structures. High rates of gross total resection with favorable neurologic outcomes in most patients as well as low recurrence rates with comparable complication rates were noted in our single-center experience. AR improved intraoperative orientation and increased surgeons' comfort by enabling early identification of important anatomic structures; however, clinical and radiologic outcomes did not differ, when AR was not used.

ASSESSMENT OF NUMBER AND LEVEL OF ATTACHMENT OF BUCCAL FRENUM IN THE EDENTULOUS OLD AGE PEOPLE IN A TERTIARY CARE CENTER OF NEPAL

Background: Frenum is a fold of mucous membrane that encase muscle fibers. Frenum are important anatomical structure during complete denture fabrication. There is paucity of data related to buccal frenum. This study aimed to assess the number and level of buccal frenal attachment among the edentulous age groups and genders in both the maxillary and mandibular arches. Methods: A descriptive cross-sectional study was conducted in the Department of Prosthodontics &amp; Maxillofacial Prosthetics of Chitwan Medical College. In total 97 patients of within the age of 55-85 years’ old participated in the study. In this study demographic details of participants followed by level and number of buccal mucosa in the oral cavity were noted in a predesigned proforma. The collected data was then transferred into SPSS and was analyzed for descriptive statistics using SPSS version 26. Results: In this study, in total 97 complete edentulous patients participated in which 59 (60.8%) were males and rest were females. Single buccal frenum was mostly observed in the maxillary arch. About 49(50.5%) of the participants showed single buccal frenum on right side of maxillary arch, while on the left side 40 (41.2%) of the participants had single buccal frenum. In the mandibular arch, 62 (63.9 %) on the right side and 68 (70.1%) on the left side had no frenum at all. Conclusions: From this study it can be concluded that there is variation in the buccal frenum too. In order to provide proper retention, stability, and support with the least amount of post-placement corrections, a solid understanding of the morphological variation of frenum is thus necessary.

Intravenous tranexamic acid significantly improved visualization and shortened the operation time in microscopic middle ear surgery: a randomized controlled trial.

The microscopic middle ear surgery involves a limited operating space and numerous important anatomical structures in which good visualization is crucial, as even a small amount of bleeding can greatly affect the clarity of surgical field. This study aims to investigate whether intravenous 1g of tranexamic acid can improve surgical visualization and further shorten the operation time in microscopic middle ear surgery. This study is a prospective, randomized, double-blind, controlled trial conducted from December 2021 to December 2022, enrolling patients who were scheduled for microscopic modified radical mastoidectomy due to chronic otitis media. In addition to standard techniques to optimize the surgical field, participants were randomized into the TXA (tranexamic acid) group (1g diluted to 20ml normal saline) and the control group (20ml normal saline). The primary outcome was assessed based on the clarity of the surgical field using the Modena Bleeding Score. Secondary outcomes included operation time, the surgeon satisfaction with the visual clarity, postoperative 24h coagulation parameters, and the incidence of adverse events. Student's t -test, χ2 test, and ANOVA of repeated measures were used for statistical analyses. A total of 28 patients were enrolled in each group using a 1:1 randomized allocation with similar demographic characteristics, including 24 male and 32 female individuals, and the mean age is 45.6±11.9 years. The surgical visualization in the TXA group was significantly better than that of the control group (2.29±0.46 vs. 2.89±0.31, P <0.001) as assessed by the Modena Bleeding Score. Furthermore, the TXA group demonstrated a shorter operation time compared to the control group (88.61±10.9 vs. 105.2±15.9, P <0.001) and higher surgeon satisfaction with surgical field (7.82±0.55 vs. 6.50±0.64, P <0.001). No statistically significant differences were found in postoperative coagulation parameters in the two groups. No TXA-related adverse events or complications occurred during the 12-month follow-up. Intravenous 1g of TXA can further significantly improve the visual clarity in the microscopic middle ear surgery and shorten the operation time based on other standard measures implemented.