Temporal Flap Research Articles

Gust alleviation by spanwise load control applied on a forward and backward swept wing

The present paper investigates the feasibility of gust load alleviation at transonic speeds on a backward swept and a forward swept transport aircraft configuration. Spanwise-distributed control surfaces at the leading and trailing edges are employed to control gust-induced wing bending as well as wing torsion moments. The deflection amplitude and temporal flap actuation are determined by a novel scheme that builds on the aerodynamic strip theory. The aerodynamic effectiveness of the actuators is taken from a data base, computed from either 2D infinite swept wing simulations, or from yawed computations that take the effects of boundary-layer cross flow and the local sweep angle of the control surface into account. The present numerical flow simulations reveal that careful application of control laws at the trailing edge alleviates wing bending moments caused by strong vertical gusts by 85–90%, for both aircraft configurations. The application of leading-edge flaps introduces significant nonlinear aerodynamic interactions, that make the control of torsional moments comparably challenging. Here, the present results indicate that about 60% of wing torsion loads due to strong gusts can be removed.

Surgical Anatomy of Temporalis Muscle Transfer with Fascia Lata Augmentation for the Reanimation of the Paralyzed Face: A Cadaveric Study

Background The temporalis muscle flap transfer with fascia lata augmentation (FLA) is a promising method for smile reconstruction after facial palsy. International literature lacks a detailed anatomical analysis of the temporalis muscle (TPM) combined with fascia lata (FL) augmentation. This study aims to describe the muscle's properties and calculate the length of FL needed to perform the temporalis muscle flap transfer with FLA. Methods Twenty nonembalmed male (m) and female (f) hemifacial cadavers were dissected to investigate the temporalis muscle's anatomy. Results The calculated minimum length of FL needed is 7.03cm (f) and 5.99cm (m). The length of the harvested tendon is 3.16cm/± 1.32cm (f) and 3.18/± 0.73cm (m). The length of the anterior part of the temporalis muscle (aTPM) is 4.16/± 0.80cm (f) and 5.30/± 0.85cm (m). The length of the posterior part (pTPM) is 5.24/± 1.51cm (f) and 6.62/± 1.03cm (m). The length from the most anterior to the most posterior point (aTPMpTPM) is 8.60/± 0.98cm (f) and 10.18/± 0.79cm (m). The length from the most cranial point to the distal tendon (cTPMdT) is 7.90/± 0.43cm (f) and 9.79/± 1.11cm (m). Conclusions This study gives basic information about the temporalis muscle and its anatomy to support existing and future surgical procedures in their performance. The recommended minimum length of FL to perform a temporalis muscle transfer with FLA is 7.03cm for female and 5.99cm for male, and minimum width of 3 cm. We recommend harvesting some extra centimeters to allow adjusting afterward.

Feasibility, comparability and outcomes of three acquainted facial island flaps for periorbital defects reconstruction.

Severe coloboma of ocular malignant neoplasms post-resection poses a reconstructive challenge to surgeons. To compare the practicability, manipulability and outcomes of temporal (myocutaneous) flaps (TFs), forehead (supratrochlear artery/supraorbital artery) flaps (FFs) and buccal (facial artery) flaps (BFs) for periorbital defects reconstruction, a retrospective case series was conducted and evaluated between March 2014 and March 2021. Patient demographics and clinical parameters including age, gender, pathological diagnosis, operative methods, flap selection, operation time, aesthetic satisfaction and follow-up period were collected. The differences in complications were compared and assessed of the three flaps, including flap survival, venous congestion and donor site healing. Totally, 68 patients who underwent periorbital reconstructive operations because of common ocular malignant tumours were reviewed in this study. As for aesthetic satisfaction, a score more than "moderately dissatisfied" was obtained in 21 patients with TFs (95.5%), and of which the scores in FFs group were 12 cases (60%) and 16 cases with BFs reconstruction (61.5%) (P< .05). Severe microvascular complications underwent re-exploration operation occurred in one patient with FFs (1.5%) (P> .05). Notable flap necrosis was observed in two patients with BFs repair (2.9%) and in one case with FFs repair (1.5%), with no statistical difference between the three flap selections (P> .05). Moderate venous congestion occurred in one patient with TFs (1.5%), which was fully meliorated non-surgically. The three familiar facial island flaps are considered as minor trauma and time-saving process for reconstructing the extensive periorbital defects with comparable ranks of complications.

Analysis of clinical prognosis of endoscopic salvage surgery in patients with rT2 recurrent nasopharyngeal carcinoma

Objective: To investigate the feasibility of endoscopic salvage surgery for patients with rT2 recurrent nasopharyngeal carcinoma (rNPC) and to analyze their prognostic factors. Methods: The clinical data of 33 patients with rT2 rNPC who underwent endoscopic extended nasopharyngectomy in Eye & ENT Hospital Affiliated to Fudan University from January 2015 to July 2020 were analyzed, including 29 males (87.9%) and 4 females (12.1%), aging (51.7±10.6) years. The clinicopathological characteristics of these patients were recorded and analyzed, in terms of gender, sex, alcohol and cigarette use, interval between primary treatment to recurrence, adjuvant therapy, lymph node metastasis, internal carotid artery (ICA) invasion, necrosis, margin and reconstruction materials. Kaplan Meier analysis was used to plot the overall survival rate and progression free survival rate curve, Log-rank test was used to analyze the prognostic factors among patients, and multivariate Cox proportional hazards regression was used to determine the independent risk factors of tumor progression free survival. Results: Among 33 patients with rT2 rNPC, the recurrence interval of 24 patients with rNPC after primary radiotherapy was more than 2 years. A total of 25 patients received primary radiotherapy and adjuvant chemotherapy at the same time. There were 6 cases with cervical lymph node metastasis, 12 cases with ICA invasion, 8 cases with positive surgical margin, 7 cases underwent ICA embolization before operation. A total of 18 cases underwent pedicled tissue flap repairment after operation, including 12 pedicled nasal septal mucosa flaps and 6 temporalis muscle flaps. The median follow-up time was 15 months. Five patients died because of disease progression (in 2 cases), post surgical ICA hemorrhage (in 1 case), liver metastasis (in 1 case) and dysphagia (in 1 case). The 1-year, 2-year and 3-year overall survival rates of all patients were 93.9%, 81.8% and 81.8%, respectively. The 1-year, 2-year and 3-year progression free survival rates were 74.7%, 59.7% and 40.9%, respectively. Log-rank statistical analysis showed that the positive surgical margin (P=0.060) and recurrence interval (P=0.151) were possibly related to the prognosis of rT2 rNPC. Multivariate Cox regression analysis showed that the positive surgical margin was an independent risk factor for patients with rT2 rNPC (P=0.034). Nasopharynx hemorrhage occurred in 4 patients, skull base bone necrosis occurred in 2 patients, trismus occurred in 3 patients, and no obvious brain complications occurred in 7 patients with ICA embolization. Conclusion: Endoscopic salvage surgery for rT2 rNPC is a safe and effective surgical option, but the long-term effect still needs long-term follow-up in bulk cases.

Oral rehabilitation of oncology patients with dental implants after reconstruction surgery with autogenous flaps.

Reconstruction after radical cancer surgery in terms of function and esthetics can be quite demanding. The aim of this study was to evaluate oral rehabilitation with autogenous flaps and dental implants for maxillofacial reconstruction in oncologic patients after implant insertions. The study consisted of 19 patients diagnosed with either squamous cell carcinoma, fusocellular carcinoma, or mucoepidermoid carcinoma. The reconstruction of the maxillofacial defects was done with autogenous flaps (free fibular flap, antero-lateral thigh flap, radial forearm flap, or rotational pedicled temporal muscle flap). Implants were inserted on the average 32.03±19.51 months after reconstructive operations. A total of 82 implants were inserted. Mean follow-up after maxillo-facial surgery was 7.2 years (mean 86.56±22.04 months). Mean follow-up after implant insertions was 4.5 years (mean 54.6±21.82). Primary outcome was implant survival. Secondary outcome was evaluation of post-surgical complications. There were surgical revisions in seven patients after reconstructive surgery with flaps, mainly due to tumor relapse. Complications were seen in 11 patients. There was one implant failure. Overall implant survival rate was 98.8%. No relations were found between implant survival rate and gender, type of tumor, type of microvascular free flap, radiation therapy, chemotherapy, and prosthesis type. According to the results of this study, oral rehabilitation with dental implants inserted in free flaps for maxillofacial reconstruction after ablative oncologic surgery can be considered as a safe treatment modality with successful outcomes.

Application of temporalis muscle flap in repair and reconstruction after the resection of tumor or necrotic foci following radiotherapy of nasopharyngeal carcinoma

Objective: To summarize and popularize the application of temporalis muscle flap in repair and reconstruction after the resection of tumor or necrotic foci following radiotherapy of nasopharyngeal carcinoma (NPC). Methods: A retrospective analysis was made on the patients treated in the Department of Otorhinolaryngology Head and Neck Surgery of Xiangya Hospital between January 2019 and March 2021 who underwent surgical resection of tumor or necrosis of NPC after radiotherapy and temporalis muscle flap repair. The effect of the repair and the patients' postoperative conditions were analyzed. Results: A total 29 patients, 19 males and 10 females, aged from 33 to 65 years old, were included in the study, and were followed up for 6-35 months. Except for 2 patients who were not followed due to bleeding or special bacterial infection, the others' temporalis muscle flap healed well and no cerebrospinal fluid rhinorrhea or massive hemorrhage occurred. After the operation, all patients had no nasopharyngeal reflux or new open rhinolalia, and in some patients, the open rhinolalia even got relieved. Except for one case of depressed temporal fossa caused by infection and followed debridement and another one case of shallowed forehead wrinkles, the appearances of the other patients were basically symmetrical. Some patients had temporary mouth opening limitation after operation, and all of them recovered after rehabilitation exercises. Conclusions: The temporalis muscle flap can protect the skull base and internal carotid artery, and improve the quality of life of patients after the resection of NPC or necrotic foci. It is a reliable pedicled flap for repairing skull base defect with simple operation procedures and relatively few complications.

The application of temporalis muscle flap in the salvage nasopharyngectomy for advanced recurrent nasopharyngeal carcinoma

Objective: To summarize the application of temporalis muscle flap in the salvage nasopharyngectomy for advanced recurrent nasopharyngeal carcinoma (rNPC), and to provide guidance for the repair of extensive skull base defects in salvage rNPC. Methods: A total of 54 patients with the application of temporalis muscle flap in the salvage nasopharyngectomy for advanced rNPC were retrospectively analyzed, including 42 males and 12 females, aging from 29 to 71 years. There were 36 patients with rT3 and 18 patients with rT4. The surgical methods of temporalis muscle flap repair were summarized. The general situation, survival time and postoperative complications of patients were recorded, and the advantages and disadvantages of temporalis muscle flap were discussed. Results: The temporal muscle flap could completely cover the defect area of nasopharynx and skull base, without the need for other autologous repair materials. The follow-up period was 2 to 28 months. The survival rate of temporalis flap was 98.1% (53/54). The 1-year overall survival rate was 84.5% while 1-year progression-free survival rate was 49.0%. None of the patients had facial nerve injury. Three patients (5.6%) had necrosis of the cranial membrane required surgical intervention and four patients (7.4%) required a chonoplasty due to severe chonostril stenosis or chonostril atresia. Eleven cases (20.4%) had mouth opening restriction, chewing weakness, dysphagia and other eating difficulties. Conclusions: Temporalis muscle flap is an alternative flap for the salvage nasopharyngectomy for advanced rNPC. Temporal muscle flap shows high survival rate and wide coverage, but the surgeon should apprehend the possible complications and reduce the occurrence of them.

Salvage endoscopic surgery for skull base osteoradionecrosis in nasopharyngeal carcinoma patients: A prospective, observational, single-arm clinical study.

Postradiation skull base osteoradionecrosis (ORN) is a severe complication that occurs after radiotherapy in patients with nasopharyngeal carcinoma (NPC) that can severely affect quality of life (QOL) and be life threatening. Only 13.4% - 28.6% of patients can be cured by traditional repeated endoscopic debridement. Here, we introduced salvage endoscopic surgery for skull base ORN patients and evaluated its clinical efficacy. This was a prospective, observational, single-arm clinical study. Clinical data from 18 skull base ORN patients who underwent radical endoscopic necrectomy followed by reconstruction using a septal pedicled mucosal flap or temporal muscle flap were included in the study. The endpoint was an overall survival (OS) of 2 years. The numeric rating scale (NRS) scores for pain and foul odor were analyzed to determine the efficacy and safety of this surgery. A total of 21 patients were recruited, 18 of whom completed the study and were analyzed. All surgeries were successfully performed. During the 2-year study, the OS rate of the entire cohort was 75%. The median NRS score for pain decreased from 6.44 +- 2.62 to 0.50 +- 0.71, and the NRS score for foul odor decreased from 1.89±1.08 to 1 after surgery. Salvage endoscopic necrectomy followed by construction using a septal pedicled mucosal flap or temporal muscle flap is a novel, safe, and effective treatment for ORN in patients with NPC. This study was approved by the independent ethics committee of the Eye, Ear, Nose and Throat Hospital of Fudan University (IEC No. 2019095-1). Written informed consent was obtained from all patients. The study was registered with the Chinese Clinical Trial registry (ChiCTR2000029327).

Interpositional arthroplasty with temporal muscle flap – a surgical alternative for condylar ankylosis of the temporomandibular joint

Ankylosis of the temporomandibular joint (TMJ) is characterized by a bony or fibrous fusion between the articular fossa and the condyle. It represents one of the greatest therapeutic challenges in oral and maxillofacial surgery. Several treatments have been used for its management, such as gap arthroplasty, interpositional arthroplasty, and TMJ reconstruction with autogenous bone graft and alloplastic prostheses. A 39-year-old Black male patient developed a complex mandibular symphysis fracture associated with bilateral high condylar fractures after a motorcycle accident. In the first approach, osteosynthesis was performed to reduce and fix symphysis fractures and conservatively treat the condyles. However, the patient did not proceed with physiotherapy and adequate follow-up, evolving into bilateral ankylosis. Subsequently, he underwent interpositional arthroplasty with a temporal muscle flap. The treatment of ankylosis is imperatively surgical and aims to release the joint and reanatomize the region, restoring functionality to the stomatognathic system. The choice of technique depends on many factors, including age. In children, gap arthroplasty is the most frequent choice because it helps in the centrality of condylar growth. In adult patients, gap arthroplasty with interposition of the temporal muscle is eligible, as it restores function and reduces the recurrence of bone fusion and consequent re-ankylosis.

Orbital Exenteration: Indications and Reconstruction Methods

Orbital exenteration is a disfiguring surgery; its major indication is the treatment of extensive orbito-palpebral malignancies. The reconstruction of the residual cavity is a real challenge despite the different reconstruction techniques, especially on weakened terrain. The purpose of this study was to assess and compare the clinical indications and reconstructive methods and outcomes with previously reported data. A retrospective study was conducted on five patients who underwent orbital exenteration surgery. Those cases were collected in the department of plastic, reconstructive and burns surgery at the Al kortobi Hospital in tangier (Morocco) between mars 2021 and June 2022. The main outcome measures were demographics surgery type, clear margins histologically, surgical complications and local recurrence. Five patients were included in this study, 3 men and 2 women with an average age of 75 years old (60 to 90 years old), mean follow up was 5 months. All patients presented with a tumor in the eyelid or periocular skin, diagnosis included basal cell carcinoma in three patients and squamous cell carcinoma in the other two. Total orbital exenteration was performed in all patients, the cavity was filled with a temporalis muscle flap in four cases and with a local flap (type LLL= dufourmental flap) in one case. Clear margins tumor was obtained in all cases and no complications or recurrence were seen so far. Adjuvant radiation therapy was conducted on three cases. Reflecting the literature on the subject, exenteration aims at local control of disease invading the orbit that is potentially fatal or relentlessly progressive. We have promoted reconstruction using the temporal muscle flap thanks to its advantages such as a single operative step thus reducing operative morbidity, good skin coverage, fast healing and fewer postoperative complications. In term of our study, orbital exenteration retains its place in orbito-palpebral cancer surgery, while the temporal .......

Functional restoration of TMJ ankylosis using temporalis muscle flap with post-operative physiotherapy

Temporomandibular joint ankylosis is a highly distressing condition which involves the fusion of mandibular condyle with the base of skull causing dysphonia, dysphagia, facial deformity, impairment of upper airway and psychological stress. Because of the complex anatomy of the TMJ region, it becomes a challenging task for the surgeons to resect and restore the normal function of TMJ. Several treatment modalities have been tried to treat the ankylosis to restore the normal joint function, such as gap arthroplasty, interpositional arthroplasty, and reconstruction of TMJ, among this interpositional arthroplasty with temporalis muscle flap is most commonly used as it prevents the reankylosis. We report a series of five cases of TMJ ankylosis which has treated with resection of ankylotic mass with Interpositional arthroplasty using temporalis muscle flap.

Clinico-Pathological Characteristics, Management, and Outcome of Benign Intraosseous Maxillary Tumors in Adolescents: A Prospective Study

Benign intraosseous maxillary tumors, although uncommon among the adolescents, represent a major challenge to the maxillofacial surgeons. Treatment ranges from conservative surgery to radical resection and reconstruction. Maxillary defect reconstruction in adolescents is uncommon. it can be achieved by prosthetic obturators, local and regional flaps, and free-tissue transfer. To investigate the clinical and pathological patterns, treatment, and outcome of benign intraosseous maxillary tumors in adolescents. A 10-years prospective study included patients between 12-18 years who presented with benign intraosseous maxillary tumors and surgically treated (conservative surgery or radical resection) with immediate reconstruction. Cases were followed up to assess functional and aesthetic outcomes and detect complications. Study included 38 patients; 63.2% had non-odontogenic tumors and 36.8% had odontogenic tumors. The most common non-odontogenic tumor was central giant cell granuloma (31.6%). The most common odontogenic tumors were adenomatoid odontogenic tumor and ameloblastoma (10.5% each). Treatment included Conservative surgery (55.3%) and radical resection (44.7%). Reconstruction was performed in 17 cases by temporalis muscle flap (9.83%), obturator (2.46%), and free fibula flap (1.64%). All cases gained accepted functional and esthetic results. Non-odontogenic tumors were more common than odontogenic tumors. Central giant cell granulomas and ossifying fibromas were the most common non-odontogenic tumors. Ade-nomatoid odontogenic tumor and ameloblastoma were the most common odontogenic tumors. Maxillary reconstructions with tem-poralis muscle flap and obturator were simple and satisfactory. Microsurgical reconstruction had high success rates. Aesthetic, and functional results were satisfactory when appropriate reconstruction was performed.

Scalp reconstruction using the reverse temporalis muscle flap: a case report

The scalp is the thickest skin in the body and protects the intracranial structures. The coverage of a large scalp defect is a difficult surgical procedure, the full details of which must be considered prior to the procedure, such as defect size and depth, and various factors related to the patient’s general condition. Although a free flap is the recommended surgical procedure to cover large scalp defects, it is a high-risk operation that is not appropriate for all patients. As such, other surgical options must be explored. We present the case of a patient with an ulcer on the scalp after wide excision and split-thickness skin graft for squamous cell cancer. We successfully performed a reverse temporalis muscle flap for this patient.

Internal limiting membrane peeling in macular hole surgery.

Since the era when macular hole was considered untreatable, macular hole surgery has come a long way to being one of the most successful surgeries. Internal limiting membrane (ILM) peeling has been an essential step of macular hole surgery since the establishment of the role of ILM in the aetiopathogenesis and progression of macular hole. However, the novel technique was not all virtuous. It had some vices which were not evident immediately. With the advent of spectral domain optical coherence tomography, short- and long-term effects of ILM peeling on macular structures were known; and with microperimetry, its effect on the function of macula could be evaluated. The technique has evolved with time from total peeling to inverted flap to just temporal peeling and temporal flap in an attempt to mitigate its adverse effects and to improve its surgical outcome. ILM abrasion technique and Ocriplasmin may eliminate the need of ILM peeling in selected cases, but they have their own limitations. We here discuss the role of ILM in the pathogenesis of macular hole, the benefits and adverse effects of ILM peeling, and the various modifications of the procedure, to then explore the alternatives.

Surgical outcomes of reconstruction of soft tissue defects of the heel using various free flaps.

The goals of heel reconstruction are functional and aesthetic. Primarily due to the particular function of the heel in supporting the entire weight of the body while standing, these goals can be achieved by providing the heel with a durable and weight-bearing surface with adequate contour. Various methods such as skin graft, fasciocutaneous, and musculocutaneous local flaps have been reported for reconstructing this area. This retrospective study introduces different kinds of free flaps for heel reconstruction. Between July 2010 and September 2016, 13 patients underwent soft tissue reconstruction of the heel with anterolateral thigh flap, lateral arm flap, superficial circumflex iliac artery perforator flap, and temporalis muscle flap. Immediate and delayed postoperative results of the surgery were evaluated with satisfaction assessed subjectively among the patients. There were 8 cases of anterolateral thigh flap (61.5%), 2 cases of lateral arm flap (15.3%), 2 cases of superficial circumflex iliac artery perforator flap (15.3%), and 1 case of temporalis muscle flap (7.6%). The mean duration of surgery was 261.69 (range, 114-442) minutes and the average length of absolute immobilization was 8.38 (range, 6-11) days. All flaps survived with 3 cases of minor revision due to partial necrosis, wound dehiscence, and bulky flap. There were no morbidities among donors. Satisfactory aesthetic and functional results were observed among all the patients. This article suggests that various free flaps can be considered as reliable options in heel reconstruction, resulting in acceptable functional and aesthetic outcomes.

Patient-specific PEEK implants for immediate restoration of temporal fossa after maxillary reconstruction with temporalis muscle flap.

BackgroundTemporal hollowing is a common complication following the rotation of the temporalis muscle that leaves the patient with a cosmetic impairment. Several alloplastic materials have been used to reconstruct the donor site; however, these implants need meticulous adaptation to conform the periphery of the defect and restore the contour of the temporal area. The aim of this study was to assess the use of patient-specific polyetheretherketone (PEEK) temporal implants to prevent temporal hollowing following the use of full temporalis muscle flap for large maxillary defects reconstruction.MethodsThis was a prospective study conducted on eight patients with major maxillary defects indicating the need of reconstruction with full temporalis muscle flap or any lesion indicating major maxillary resection and immediate reconstruction with total temporalis muscle flap. For each patient, a patient-specific PEEK implant was fabricated using virtual planning and milled from PEEK blocks. In the surgical theater, the temporalis muscle was exposed, elevated, and transferred to the maxilla. After the temporalis muscle transfer, PEEK implants were fixed in place to prevent temporal hollowing.ResultsThe surgical procedures were uneventful for all patients. The esthetic result was satisfactory with no post-operative complications except in one patient where seroma occurred after 2 weeks and resolved after serial aspiration.ConclusionPatient-specific PEEK implant appears to facilitate the surgical procedures eliminate several meticulous steps that are mainly based on the surgeon’s experience.Trial registrationClinical trials registration: NCT05240963.

Full-thickness lower eyelid defect reconstruction using a pedicle rotation temporal flap and Acellular Human Dermis Graft (Alloderm)

The aim of this research was to prospectively examine the combination of a pedicled temporal rotation flap with an acellular human dermal graft technique for intermediate-sized lower eyelid defect reconstruction. Pedicled temporal rotation flaps based on the orbicularis oculi muscle were used to reconstruct the anterior lamella of lower eyelid defects in six patients (five males and one female) while the posterior lamella was reconstructed using an acellular human dermis graft (Alloderm). Flap survival at 6 months was 100%. The functionality and cosmetic results of the technique were evaluated, and corneal protection was achieved. The texture and color of the reconstructed eyelid matched the surrounding skin, and neither pain nor corneal irritation was reported. The donor site scar healed well and was inconspicuous in all cases. Furthermore, no recurrence of malignancy was observed. The combination of a temporal rotational flap with an acellular human dermal graft is the key points. This technique could be ideal for the reconstruction of intermediate-sized full-thickness lower eyelid defects.

Minimally invasive temporalis tendon transposition and upper lid lipofilling for immediate and secondary facial reanimation in patients treated for malignant tumors of the parotid gland

Treatment for facial nerve-invading parotid malignancies usually results in complete facial palsy. The authors present a novel technique to treat facial palsy following radical parotid surgery and retrospectively evaluate results in terms of soft tissue symmetry at rest and during smiling and eyelid closure using the eFACE system.9 patients with facial palsy following parotid malignancies resection or undergoing parotidectomy with planned facial nerve resection for tumor invasion were treated with the association of mini-invasive temporalis flap rotation and upper lid lipofilling to restore symmetry of the middle facial third at rest and during smiling and eyelid closure. The technique was employed during the same surgical session as the tumor removal or for secondary facial reanimation.Systematic eFACE evaluation demonstrated significant improvement in static nasolabial fold depth orientation and oral commissure position, palpebral fissure narrowing during eye closure, and oral commissure movement and nasolabial fold depth and orientation with smile (p respectively .008, .011, 0.008, 0.035, 0.011, 0.008, and 0.011, Wilcoxon's test). Furthermore, all patients described subjective improvement of corneal discomfort.The presented technique appears promising in treating facial palsy in oncological patients, representing a potential alternative to other more complex reconstructive techniques.

COVID-19-associated mucormycosis: an update of anesthetic management

BackgroundMucormycosis is uncommon, progressive fungal infection with mortality rate on higher side. The anesthetic management of surgical debridement in mucormycosis is challenging.We evaluated the anesthetic management of mucormycosis patients associated with problems of airway management, predisposing factors, and adverse effect of antifungal therapy who underwent surgical resection of necrotized tissues.ResultsFifty-six patients presented with uncontrolled diabetes mellitus. All patients had history of COVID-19 infection and received steroid during treatment. Nasal endoscopic debridement was done in 43 patients, total maxillectomy in 14 patients. Temporalis flap was needed in five patients, and orbital exenteration was required in three patients. Central venous catheter was inserted in 17 patients, and invasive arterial monitoring was done in ten patients. All patients administered lyophilized amphotericin B (deoxycholate) in combination with surgical debridement.Thirteen patients were shifted to ICU for further management and continuous hemodynamic monitoring. Fifteen patients were expired, and the mortality rate was 26.31%.ConclusionsChallenges include difficult intubation and renal function impairment due to prolonged antifungal therapy. Postoperative ICU management is important in mucormycosis patients due to comorbidities and rapid progressive infection after surgery.

Abstract WP261: Encephalomyosynangiosis Improves Angiogenesis And Recovery In Mice After Transient Ischemic Stroke

Background and Purpose: The ability of the brain to self-heal after stroke is limited by inadequate blood supply and acute inflammation. Hence, we hypothesized that improved blood supply via promoting neoangiogenesis will reduce acute inflammation and improve recovery after stroke. Encephalomyosynangiosis (EMS) is a neurosurgical procedure that achieves angiogenesis with low morbidity in patients with moyamoya disease, reducing risk of stroke. EMS has never been studied in ischemic stroke. Here, we developed a novel model of EMS after ischemic stroke induced by middle cerebral artery occlusion model (MCAo) in mice. We demonstrated that this novel EMS procedure can induce angiogenesis and improve recovery after stroke. Methods: After 60 minutes of MCAo, mice were randomized to MCAo or MCAo+EMS groups. After 3-4 hours, EMS was performed. In brief, EMS involves a craniotomy and placement of a vascular temporalis muscle flap on the pial surface of the ischemic brain. Mice were sacrificed at day 7 or 21 after MCAo. Viability of temporalis muscle was measured using a nicotinamide adenine dinucleotide reduced tetrazolium reductase assay. ARY015 Proteome Profiler Mouse Angiogenesis Array (R&amp;D Systems) was used to quantify angiogenic and neuromodulating protein expression. Immunohistochemistry was used to visualize immune infiltration by measuring F4/80 positive macrophages. Results: EMS after ischemic stroke did not increase mortality despite dual invasive surgery. Grafted temporalis muscle remained viable up to 21 days after EMS. We found a significant increase in FGF-acidic (0.677±0.007 vs. 0.585±0.014, p=0.045) and decrease in osteopontin (0.692±0.007 vs. 0.758±0.014, p=0.048) protein levels in the MCAo+EMS group 21 days after stroke, suggesting improved angiogenesis and recovery respectively. Mice in the MCAo+EMS group also showed reduced F4/80+ve macrophage accumulation in the peri-lesional territory of ischemic tissue, suggesting attenuated inflammation after stroke. Conclusions: These proof-of-concept data support that our novel EMS procedure is well-tolerated and may improve angiogenesis and recovery after stroke. EMS after MCAo is a promising new method of improving angiogenesis and recovery after stroke.