Facial Nerve Research Articles

Pleomorphic adenoma in an adolescent, about a clinical case

Introduction: salivary gland tumors in children represent a low percentage of pediatric head and neck tumors; most of them are diagnosed in association with the Parotid salivary gland and present a higher proportion of malignancy than in adults. Objective: to present a case with a diagnosis of Pleomorphic Adenoma: clinical symptoms, complementary examinations, treatment and evolution. Case presentation: female patient, 13 years old, from a rural background and white race, attended the Maxillofacial Surgery consultation, in good general condition, accompanied by her parents, due to an increase in volume of a hard consistency, not fixed to deep planes ( mobile), asymptomatic, of 7 months of evolution and 3 cm in length located in the left parotid region. Ultrasound of soft tissues and neck was indicated, as well as contrast-enhanced facial mass tomography, which showed a mass in relation to the left parotid gland that captured contrast. In addition, complementary examinations and a fine needle aspiration biopsy (FNAB) were performed, resulting in a benign parotid gland tumor (Pleomorphic Adenoma). Superficial parotidectomy was performed with preservation of the facial nerve. The patient progressed satisfactorily and continues to be followed up by consultation. Conclusions: pleomorphic adenomas are discovered in practice as slowly growing asymptomatic masses; the size is variable and will always depend on the stage at which it is detected.

Clinical and electrophysiological prognostic factors in predicting poor outcomes in patients with idiopathic facial nerve paralysis

ObjectiveThis study was designed to verify whether one or more clinical and neurophysiological parameters could predict a poor prognosis in idiopathic facial paralysis. MethodsSeventy-three outpatients with unilateral idiopathic facial nerve paralysis who visited our hospital within 7 days of onset. All patients received treatment according to a standard therapy protocol and ocular care. Patients’ baseline characteristics were assessed before initiating treatment, including demographic characteristics, facial nerve function assessment and previous medical history. House-Brackmann (H-B) grading system was performed at baseline and six months after the onset. Electroneurography (ENoG) and blink reflex tests were conducted 7–10 days after the onset of paralysis. Sunnybrook Facial Grading System (SFGS) was conducted at baseline, days 7–10 post-onset when the electrophysiological tests were performed, and one month after the onset. ResultsAccording to the H-B grade at 6 months following the onset, 58 patients (79.5 %) had a good prognosis, while 15 patients (20.5 %) had a poor prognosis. The CMAP amplitudes in three facial muscles (frontalis, orbicularis oculi, and orbicularis oris) were decreased, and ENoG values were increased in the poor prognosis group compared with the good prognosis group (all p < 0.01). The results of the blink reflex study showed that the group with a poor prognosis had a longer R1 latency compared to the group with a good prognosis. Additionally, the group with a poor prognosis exhibited a higher rate of R1 absence on the affected side (both p < 0.01). The findings of conditional logistic regression indicated that the absence of R1 on the affected side, frontalis ENoG, orbicularis oculi ENoG, and orbicularis oris ENoG were predictive factors of a poor prognosis for facial nerve palsy. The receiver operating characteristic (ROC) curves showed that the SFGS at 1 month after onset of 55 is considered a critical cutoff value for poor prognosis, with a sensitivity of 86.7 % and specificity of 91.4 %. ConclusionElectroneurography (ENoG) and blink reflex tests acquired within 7–10 days after the onset of paralysis are significant and highly valuable for predicting the prognosis of idiopathic facial nerve paralysis. Higher ENoG values of the muscles innervated by the facial nerve and the absence of R1 on the affected side of the blink reflex are predictive factors for a poor prognosis. The SFGS is a clinical tool that plays an important role in evaluating the prognosis of idiopathic facial paralysis, particularly one month after onset.

Clinical observation on acupuncture at infusion points of "four seas" on refractory peripheral facial paralysis

To observe the clinical effect of acupuncture at the infusion points of "four seas" for refractory peripheral facial paralysis on the basis of conventional acupuncture. A total of 52 patients with refractory peripheral facial paralysis were randomized into an observation group (26 cases, 2 cases dropped out) and a control group (26 cases, 1 case dropped out). On the basis of conventional acupuncture (Yintang [GV 24+] and Yangbai [GB 14], Dicang [ST 4] at affected side, etc.), acupuncture at the infusion points of "four seas", i.e. Baihui (GV 20), Dazhui (GV 14) and bilateral Shangjuxu (ST 37), Xiajuxu (ST 39), Zusanli (ST 36), was delivered in the observation group. On the basis of conventional acupuncture, shallow acupuncture was applied at corresponding non-meridian and non-acupoint points of the infusion points of "four seas" in the control group. The needles were maintained for 30 min, the treatment was given once every other day, 3 times a week for 4 weeks in the two groups. Before and after treatment, the House-Brackmann (H-B) facial nerve grading and the dynamic view score of the facial nerve function scoring system were observed, and the clinical efficacy was evaluated after treatment in the two groups. After treatment, the H-B facial nerve grading was improved compared with that before treatment in the two groups (P<0.05), and the grading in the observation group was superior to that in the control group (P<0.05); the dynamic view scores of the facial nerve function scoring system were increased compared with those before treatment in the two groups (P<0.05), and the score in the observation group was higher than that in the control group (P<0.05). The total effective rate was 91.7% (22/24) in the observation group, and that in the control group was 84.0% (21/25), there was no significant difference in the total effective rate between the two groups (P>0.05). The cure rate was 62.5% (15/24) in the observation group, which was higher than 20.0% (5/25) in the control group (P<0.05). On the basis of conventional acupuncture, acupuncture at infusion points of "four seas" can effectively treat refractory peripheral facial paralysis, improve the facial nerve function and increase the cure rate.

The Retromandibular Vein and Its Relation With Facial Nerve Branches: Practical Implications of an Anatomic Variation.

The Retromandibular Vein and Its Relation With Facial Nerve Branches: Practical Implications of an Anatomic Variation.

Translation and Reliability of Urdu Version of House-Brackmann Facial Grading System (HBFGS) in Patients with Bell's Palsy

Background: Bell's palsy is characterized by the sudden onset of facial paralysis due to facial nerve inflammation. Accurate assessment tools, such as the House-Brackmann Facial Grading System (HBFGS), are essential for evaluating the severity of facial nerve dysfunction. This study aimed to translate and validate the Urdu version of HBFGS for Urdu-speaking patients, enhancing its reliability and applicability. Objective: To translate the HBFGS into Urdu and evaluate its reliability and validity in assessing facial nerve function among Urdu-speaking patients with Bell's palsy. Methods: A cross-sectional study was conducted with 245 participants diagnosed with Bell's palsy. The UHBFGS was developed through forward-backward translation and cultural adaptation. Participants' facial motor function was assessed using the UHBFGS by trained physiotherapists. Reliability was evaluated using Cronbach’s alpha and intraclass correlation coefficient (ICC), while SPSS version 25 was used for data analysis. Results: The UHBFGS demonstrated high internal consistency (Cronbach’s alpha = 0.951) and excellent test-retest reliability (Pearson’s r = 0.907). Inter-rater reliability was confirmed with an ICC of 0.888. Grade 3 severity was most common, affecting 43% of participants. Conclusion: The Urdu version of the HBFGS is a reliable and valid tool for assessing facial nerve function in Urdu-speaking patients, facilitating improved clinical evaluation and patient management.

Systematic Review On Effectiveness Of Low-Level Laser Therapy In The Treatment Of Bell’s Palsy

Background: Bell's palsy is a condition characterized by the sudden onset of facial paralysis or weakness, often linked to viral infections such as herpes simplex. Low-level laser therapy (LLLT) has emerged as a potential treatment due to its anti-inflammatory and nerve-regenerative properties. This systematic review evaluates the effectiveness of LLLT in improving outcomes for patients with Bell's palsy. Objective: The objective of this systematic review was to assess the efficacy of LLLT in treating Bell's palsy by comparing its outcomes with control treatments in randomized controlled trials (RCTs). Methods: A comprehensive literature search was conducted across databases such as PubMed, Google Scholar, ScienceDirect, and PEDro, using keywords like "Bell’s Palsy," "Low-Level Laser Therapy," and "randomized controlled trial." Five RCTs were included, comprising a total of 349 participants, with 155 in the LLLT groups and 194 in control groups. Data were extracted using a modified Cochrane template and analyzed using SPSS version 25, focusing on outcome measures such as the House-Brackmann Scale and Sunnybrook Facial Grading System. Results: LLLT showed significant improvements in facial function compared to control treatments, with effect sizes favoring LLLT (Effect size: 0.65, 95% CI: 0.35-0.95, p&lt;0.001). The review identified moderate heterogeneity (I² = 48%). Conclusion: LLLT appears to be a promising non-invasive treatment for Bell's palsy, enhancing facial nerve function and recovery. Further high-quality RCTs are needed to standardize treatment protocols and confirm these findings.

Recurrent Facial Palsy in an Adolescent - Case Report

Introduction: Recurrent facial nerve paralysis is an unusual occurrence. Main Symptoms: Recurrent facial palsy, oro-facial swelling, and a fissured tongue. Main Diagnosis: Lower Motor Neuron Palsy. No definitive therapy is available, and frequent recurrences are common. Conclusion: Idiopathic recurrent Lower Motor Neuron facial palsy with atypical presentations can be indicative of Melkerson-Rosenthal syndrome.

Translation and Reliability of the Facial Disability Index (FDI) in Bell’s Palsy

Background: Bell's palsy, a sudden-onset facial paralysis linked to the facial nerve, is often poorly assessed in non-English-speaking populations due to culturally insensitive tools. The Facial Disability Index (FDI) is traditionally used but lacks adaptations for Urdu-speaking patients, leading to potential disparities in care. Objective: This study aimed to translate and evaluate the reliability and validity of the Urdu Facial Disability Index (UFDI) for assessing facial impairment in Bell's palsy patients. Methods: A cross-sectional study design was employed over four months, recruiting 203 Urdu-speaking patients with Bell's palsy from rehabilitation clinics. The UFDI underwent rigorous translation and cultural adaptation processes, including forward and backward translation and expert committee reviews. Participants completed the UFDI and the House-Brackmann Facial Grading Scale (HBFGS) for validity assessment. Descriptive statistics and reliability analyses were conducted using SPSS version 25, with Cronbach's alpha for internal consistency and intraclass correlation coefficient (ICC) for test-retest reliability. Results: The UFDI showed a Cronbach’s alpha of 0.77 and an ICC of 0.99, indicating good internal consistency and excellent test-retest reliability. Spearman’s rho showed significant correlation with HBFGS (r = 0.508, p &lt; 0.05), confirming convergent validity. Conclusion: The UFDI is a reliable and valid tool for assessing facial disability in Urdu-speaking patients with Bell’s palsy, enhancing culturally sensitive clinical care.

Delayed facial nerve palsy after vestibular schwannoma resection: risk factors, extent and prognosis.

Facial nerve palsies may develop during the postoperative period of microsurgical removal of vestibular schwannomas (VSs), even after normal facial function for days or weeks after surgery. The aim of this study was to identify the pathomechanism and predictive factors of delayed palsy. The clinical data of 193 patients who underwent vestibular schwannoma surgery between 2012 and 2021 were retrospectively analyzed. A total of 134 patients were included. The patients showed intact facial nerve function up to 24h after surgery. All patients (n = 20) with palsy from postoperative day 4 were included and collectively referred to as delayed facial nerve palsy (DFNP). Various factors were checked using a binomial regression analysis. The mean age of patients with DFNP was 57.8 years (55% female, 45% male). 70% had VS with KOOS ≥ 3, and 60% underwent surgery via a translabyrinthine approach Among the 16 patients with DFNP-related neurotropic pathogens, 25% were seropositive for herpes simplex virus. Most patients (n = 9/20) experienced onset of palsy between postoperative days 6 and 10. Of the four variables included in the significance test, three were significant: KOOS ≥ 3 (p < .04), ipsilateral vestibular organ failure (p < .05), and age group (p < .03). After therapy, 100% of patients recovered almost complete facial nerve function. The parameters mentioned above (KOOS classification and ipsilateral vestibular dysfunction) could be proven risk factors for the occurrence of DFNP.

Hemifacial microsomia – a review of the literature of current hypotheses of pathogenesis, and possible therapeutic methods

&lt;b&gt;Introduction:&lt;/b&gt; Hemifacial microsomia (HFM) is the second most common congenital craniofacial anomaly.&lt;b&gt;Aim:&lt;/b&gt; The aim of this study is to review data related to HFM.&lt;b&gt;Materials and methods:&lt;/b&gt; Materials for the review were selected based on an analysis of publications published in the last 10 years.&lt;b&gt;Results:&lt;/b&gt; There are three possible models of pathogenesis – vascular abnormalities, Meckel’s cartilage damage, and abnormal development of cranial neural crest cells – caused by genetic, maternal, and external factors. Symptoms results from disorders of structures originating from the first, and second branchial arches, most commonly resulting in mandibular hypoplasia, microtia or anotia, hypoplasia of the auditory ossicles, facial nerve paralysis, and soft tissue deficiency. The severity of the disorder varies greatly, depending on the number of structures involved, and the degree of penetration. The most common classification system (Orbit, Mandible, Ear, Nerve, Soft tissue; OMENS) has recently been proposed to assess the temporomandibular joint disc, and to assess disturbances originating from another structures. Other classifications such as FACIAL or ICHOM criteria have also been developed. The approach to treating each case should be individualized, primarily focusing on reconstructing the underdeveloped mandible, orthodontic treatment, creating the external ear, and filling soft tissue deficiencies.&lt;b&gt;Discussion:&lt;/b&gt; The complexity of the condition is noted, as well as the need for interdisciplinary patient care.&lt;b&gt;Conclusions:&lt;/b&gt; Through analysis of existing research, and clinical data, significant information regarding etiology, symptoms, possible classification systems, and therapeutic options has been gathered.

Vestibular schwannoma microneurosurgery in patients over 70: a single institution experience and proposal of a treatment algorithm.

Elderly patients with vestibular schwannoma (VS) are commonly observed. Retrospective analysis of 25 patients aging ≥ 70 operated on in our neurosurgical department for unilateral VS. The purpose of our study is to propose an algorithm for the treatment of VS in elderly patients. American Society of Anesthesiology (ASA) Grade I-II patients and Grade III with life-threatening tumors were enrolled. Karnofsky Performance Status Scale (KPS) was used for evalutation of the quality of life. The House-Brackmann (HB) scale for facial nerve (FN) outcome was used. Tumor size was categorized according to Koos' classification. A retrosigmoid approach was used in all cases, except one in which a translabyrinthine approach was performed. Surgical removal graduation: total (GTR), near total (NTR > 95%), subtotal (STR > 90%). The clinical and radiological follow-up period was set first at six months and then at one year after surgery. FN results evaluation was performed at one year, categorized according to House-Brackmann grades I-VI. Mean age: 74,4years (70-83); 28% ASA I, 56% ASA II, 16% ASA III. Mean tumor size: 2,7cm (1,5-4,2cm). 68%, STR 32%. Mortality was zero. At last follow-up (one year after surgery) FN results were: HBI 81%, HBII 9.5%, HBIII 9.5%; HB IV 0%. Only 4 patients had preoperative HB IV, of whom one improved from HB IV to HB III. Transient complications occurred only in large VS. Re-growth of residue after STR was observed in 3 cases, treated with SRS in 2 cases and observed in 1. An algorithm of treatment of vestibular schwannoma in the elderly is proposed. In particular, in patients in general good conditions, age does not appear to be a major contraindication for microsurgery of VS. FN results at last follow-up are satisfactory and the complication rates are acceptable.

Simplified medial canthoplasty: Technique and early postoperative complications in 601 dogs (1180 eyes).

To present a novel modified medial canthoplasty (MCP) technique, the application in 601 dogs (1180 eyes), and a review of the early postoperative complications related to the technique. Macroblepharon and nasal entropion is a common presentation in many brachycephalic dog breeds promoting chronic keratitis. The previously described MCP techniques limit the medial shortening of the eyelids to the location of the lacrimal puncta. A novel technique was developed allowing for a more extensive eyelid shortening nasally. The modification of the here described technique includes the longitudinal splitting of the lacrimal canaliculi allowing for an extensive shortening of the lids beyond the lacrimal puncta. Records of 601 dogs which underwent the modified MCP were reviewed regarding breed, indications for surgery, follow-up, and early postoperative surgical complications. Descriptive statistics were applied. Six hundred one dogs (1180 eyes) were included in this study. Twenty-four different breeds underwent the simplified MCP with the Pug (n = 403) being the most represented breed. Indications were macropalpebral fissure, medial entropion, pigmentary keratitis, trichiasis by haired caruncle, strabismus after globe prolapse, and facial nerve paralysis. The overall complication rate was 1.01% (12/1180) and consisted of wound dehiscence 0.59% (7/1180), corneal ulceration caused by suture material 0.25% (3/1180), and wound infection (2/1180). None of the 601 operated dogs developed serious complications related to the surgical technique. The simplified MCP is a novel technique with a very low complication rate.

The Clinical and Surgical Characteristics of Parotid Tumors with Parapharyngeal Space Involvement-A Multicenter Experience of the Polish Salivary Network.

Backgrounds/Objectives: Parotid gland tumors (PGTs) with parapharyngeal space (PPS) involvement have a specific clinical course and they can be a great challenge for surgeons, especially due to more difficult approaches and the risk of serious complications. The aim of this study is to present the characteristics of PGTs with PPS involvement. Methods: Retrospective, multicenter analysis of 1954 primary PGTs from 5 years (2017-2021) was performed. Comparative analysis was performed between groups with and without PPS involvement and included the following clinical and histopathological data: age, sex, place of residence, tumor size, FNAC result, percentage of malignant tumors, histological diagnosis, radicality of resection, and postoperative facial nerve (FN) dysfunction. Results: PPS involvement was found in 114 patients (5.83%). Secondary tumors affecting the deep lobe or the entire gland were predominant (46 and 60 cases, respectively). In a univariate analysis of tumors with and without PPS involvement, statistically significant differences were found in their size > 4 cm (12.97% vs. 37.72%), percentage of malignant tumors (7.12% vs. 17.55%), incidence of Warthin Tumors (WTs) (43.58% vs. 24.56%), percentage of R1 resection (5.53% vs. 12.50%), and rate of FN paresis (17.15% vs. 53.34%). Multivariate analysis showed that tumors with PPS involvement were statistically significantly characterized by larger size (tumors > 4 cm were 2.9 times more frequent), 2 times less frequent occurrence of WTs, and 1.6 times higher risk of FN paresis. Conclusion: PGTs with PPS involvement show certain clinical and histological differences and require more complex surgical accesses. Therefore, they cannot be treated as "ordinary" tumors occupying the deep lobe.

Comparing the Differences in Adverse Events among Chimeric Antigen Receptor T-Cell Therapies: A Real-World Pharmacovigilance Study.

In this study, we compared the similarities and differences in adverse events (AEs) among CAR T-cell products through signal mining via the FDA Adverse Event Reporting System (FAERS) and identified unknown AEs to provide a reference for safe clinical medication. Data from the FAERS database spanning from the fourth quarter of 2017 to the first quarter of 2024 were extracted. Signals were identified using the reporting odds ratio (ROR) method and the Medicines and Healthcare Products Regulatory Agency (MHRA) method. A total of 11,386 AE reports related to six CAR T-cell products were selected. The top three categories of AEs reported were nervous system disorders, immune system disorders, and general disorders and administration site conditions. However, there were variations in the AE spectra among the different CAR T-cell products. The BCMA-targeting drugs idecabtagene vicleucel (Ide-cel) and ciltacabtagene autoleucel (Cilta-cel) were found to be associated with parkinsonism, which were not observed in CD19-targeting drugs. Tisagenlecleucel (Tisa-cel) and axicabtagene ciloleucel (Axi-cel) exhibited cerebrovascular accident-related AEs, graft versus host disease, and abnormal coagulation indices. Cilta-cel was associated with cerebral hemorrhage, intracranial hemorrhage, cranial nerve disorder, and facial nerve disorder. Cardiopulmonary toxicity, including hypoxia, tachypnoea, cardiorenal syndrome, and hypotension, exhibited strong signal intensities and considerable overlap with CRS. The number of positive signals for cardiopulmonary toxicity associated with drugs targeting CD-19 is greater. Clinicians should assess patients prior to medication and closely monitor their vital signs, mental status, and laboratory parameters during treatment.

Non-motor symptoms in primary hemifacial spasm: A case-control study

Abstract BACKGROUND: Primary hemifacial spasm (HFS) is caused by neurovascular conflict (NVC) at the root entry zone of the facial nerve. The literature on non-motor symptoms (NMS) in HFS is limited. OBJECTIVE: Study aimed to assess NMS in patients with primary HFS. METHODS: A cross-sectional, hospital-based, case-control study recruited 50 patients with primary HFS and 50 age- and sex-matched controls. Depression, anxiety, sleep quality, and fatigue were assessed using Beck’s depression inventory (BDI), Hamilton anxiety rating scale (HAM-A), Pittsburgh sleep quality index (PSQI), and fatigue assessment scale (FAS), respectively. RESULTS: A total of 30 female patients and 28 female controls were included in the study. The mean age of patients was 50.7 ± 10.7 years and that of controls was 52.4 ± 8.7 years. Seventeen patients (34%) and five controls (10%) had depression. The mean BDI score was significantly higher in patients (8.2 ± 5.6 vs. 4.0 ± 3.8; p = 0.01). Anxiety occurred in 40 patients (80%) and 4 controls (8%) (p = 0.01). The mean HAM-A score was significantly higher in patients (14.1 ± 7.0 vs. 4.8 ± 3.9; p = 0.02). The frequency of poor sleepers was significantly higher in patients (26% vs. 4%; p = 0.01); however, there was no significant difference in the mean PSQI scores (3.7 ± 4.2 vs. 1.3 ± 1.7; p = 0.08). The mean FAS score did not differ significantly between the groups (16.3 ± 3.3 vs. 14.1 ± 3.2; p = 0.24), and the fatigue frequency was similar in both groups. CONCLUSION: Primary HFS is associated with depression, anxiety, and poor sleep. This finding emphasizes the necessity for a psychiatric evaluation of depression and anxiety in patients with primary HFS.

Topographic anatomy of the endolymphatic sac: a pilot cadaveric dissection study.

The precise location of the endolymphatic sac (ES) may be difficult during surgical approaches. This morphometric study aimed to determine the exact location of ES in adult human cadavers for the management of pathologies such as Meniere's disease. Twenty temporal bones of 10 adult cadavers (mean age: 70 ± 13.40 years, range: 45-92 years; sex: 4 males and 6 females) fixed with 10% formalin were bilaterally dissected to obtain numeric data about the location of ES. Distances of ES to the posterior semicircular canal (PSC), Donaldson line (DL), sigmoid sinus (SS) and sinodural angle (SA) were found as 2.76 ± 1.18 (0.96-5.58) mm, 1.74 ± 1.13 (0.58-5.07) mm, 2.30 ± 1.09 (0.54-4.91) mm and 16.04 ± 3.15 (9.82-22.18) mm, respectively. In addition, the angle between the tangents passing through the cortical bone (CB) and SS was determined as 35.37°±11.32° (21.30°-60.58°). No statistical difference was found between right-left or male-female measurements (p > 0.05). DL, SS, and PSC are essential anatomical landmarks for determining the location of ES. The spatial location of SS, including its depth to the cortical bone and the distance to anteriorly located anatomical structures of the mastoid cavity consisting of the facial nerve and PSC, is believed to be underlined for ES surgery. Our data may be used as a database to further define the relationship between ES and adjacent anatomical structures (SS, PSC, etc.) during the application of surgical approaches.

Clinical Analysis and Treatment Strategies About Cartilage Scaffold Exposure After Auricular Reconstruction With the Expanded Two-Flap Method.

Objectives: Soft tissue expansion is one of the main methods for autologous cartilage auricular reconstruction. The aim of this study was to analyze the risk factors for cartilage exposure after this method and to describe a surgical method for this complication. Methods: From January 2018 to December 2020, 853 patients (908 sides) underwent auricular reconstruction with an expanded two-flap method at our center. Thirty-two patients experienced cartilage exposure postoperatively. These patients were set as the case group, and 1:1 matched sampling was performed among patients who did not have cartilage exposure. The matched sample of 32 cases was set as the control group. All 64 patients were evaluated according to the Orbit, Mandible, Ear, Nerve, and Soft tissue (OMENS) classification system to analyze the correlation between cartilage exposure and hemifacial microsomia (HFM) and OMENS subtypes. The complication was repaired with superficial temporal fascial flap combined with skin graft. Results: HFM might be a risk factor for scaffold cartilage exposure, and there was a significant correlation between cartilage exposure and orbital malformation, facial nerve dysplasia, and soft tissue developmental malformation. The use of a superficial temporal fascial flap combined with a split-thickness skin graft to repair the complication achieved satisfactory outcomes. Conclusions: There is a correlation between cartilage scaffold exposure and the severity of HFM. Temporoparietal fascial flap transfer combined with skin grafting proved to be an effective method for cartilage exposure.

Objective evaluation, using computed tomography, of round window access for cochlear implantation.

The aim of this study was to determine optimal radiological parameters for assessment of the round window approach in cochlear implantation surgery. Patients undergoing cochlear implantation at the Department of Otolaryngology in Szczecin, between 2015 and 2022 inclusive, were eligible for the study. Radiological assessments were performed according to eight parameters (seven proposed in the literature) and visibility clinical assessments were made intra-operatively on a scale of 1 to 5 (1 - not visible, 5 - fully visible). Visibility assessments of the round window niche (RWN) and round window membrane (RWM) allowed the difference (RWN minus RWM) to be used as a clinical assessment of the size of the overhang over the round window. Computed tomography images of 57 ears from 52 patients were analyzed in terms of round window access. The study group included 26 females and 26 males, ranging in age from 1 year to 80 years, with a median age of 41 years. In clinical assessment, round window visibility was rated as 5, after removal of the bone overhang, in 69% of patients. Cochlear access through the round window was achieved in 39 (68%) cases, extended access through the round window in 13 (23%) cases and cochleostomy was performed in 5 (9%) cases. Statistically significant ordinal correlations with round-window access were found using one parameter from the literature (Chen_Angle) and from our proposal (RWM_prediction). From parameters describing the bone overhang of the round window, positive correlations (using Kendall rank tests) were found using parameters from the literature (Sarafraz_OH and Mehanna_OH). Radiological measurements describing access to the round window which determine the angle based on the anatomy of the posterior wall of the auditory canal and the position of the facial nerve were found to be of the highest value. In the future, the use of algorithms for computed tomography evaluation and robot-assisted surgery will require parameters for assessing round window access, for surgery planning and choice of electrode. The parameters proposed by various authors are summarized, allowing researchers to assess their usefulness in further clinical practice.

Surgical and radiosurgical outcomes for Koos grade 3 vestibular schwannomas.

This study aimed to reveal the preferred initial treatment for Koos grade 3 vestibular schwannomas (VS). We performed a two-institutional retrospective study on 21 patients with Koos grade 3 VS undergoing resection at Yokohama Medical Center and 37 patients undergoing radiosurgery at Yokohama Rosai Hospital from 2010 to 2021. Tumor control, complications, and functional preservation were compared. The median pre-treatment volume and follow-up duration were 2845 mm3 and 57.0 months, respectively, in the resection group and 2127 mm3 and 81.7 months, respectively, in the radiosurgery group. In the resection group, 16 (76.2%) underwent gross total resection, and three patients (14.3%) experienced regrowth; however, no one required additional treatment. In the radiosurgery group, the tumor control rate was 86.5%, and three cases (8.1%) required surgical resection because of symptomatic brainstem compression. Kaplan-Meier analyses revealed that tumors with delayed continuous enlargement and large thin-walled cysts were significantly associated with poor prognostic factors (p = 0.0027, p < 0.001). The pre-radiosurgery growth rate was also associated with the volume increase (p = 0.013). Two cases (9.5%) required additional operation due to complications such as post-operative hematoma and cerebrospinal fluid leaks in the resection group, whereas temporary cranial neuropathies were observed in the radiosurgery group. Two patients (9.5%) had poor facial nerve function (House-Brackmann grading grade 3) in the resection group, while no one developed facial paresis in the radiosurgery group. Trigeminal neuropathy improved only in the resection group.Radiosurgery can be considered for the treatment of Koos grade 3 VS for functional preservation. However, resection may also be considered for patients with severe trigeminal neuropathy or a high risk of volume increments, such as large thin-walled cysts and rapid pre-treatment growth.

3D 4K Exo-Endoscopic Temporal Bone Dissection: A Novel Approach for Sharing the Anatomy.

Temporal bone dissection is overwide recognized as an ideal training method for otologic surgeons. The knowledge of temporal bone anatomy and especially of the course of infratemporal facial nerve is pivotal in practice. The 3D exoscope is an innovative and promising tool, that was recently introduced in ear surgery. A high-definition 3D exoscope (3D VITOM®) mounted on the VERSACRANETM holding system (Karl Storz) was used to perform two temporal bone dissection, with the aim to study the anatomy of infratemporal facial nerve. The 3D endoscope (TIPCAM®1 S 3D ORL, Karl Storz) was used in combination to provide a close-up high-quality view and to provide a different angle of view on fine anatomical relationships. The high-definition 3D exoscope allowed to conduct the dissection with high quality visualization and to share the same surgical field with trainees. Moreover, it showed a high interchangeability with the 3D endoscope. 3D 4K Exo-endoscopic temporal bone dissection seems to have benefits in terms of educational purpose, especially concerning anatomy understanding. The superiority in teaching value of this tool should be further investigated in cohort studies.