BACKGROUND:Although randomized clinical trials have demonstrated the efficacy of mepolizumab in severe CRSwNP, treatment response in routine clinical practice extends beyond sinonasal outcomes alone and often requires simultaneous assessment of symptom burden, asthma control, and eosinophilic inflammation. Real-world multidimensional evaluations remain limited. AIMS/OBJECTIVES:To evaluate the 12-month clinical response to mepolizumab in patients with severe, uncontrolled CRSwNP using a structured multidimensional assessment framework. MATERIALS AND METHODS:This retrospective single-centre real-world study included adult patients with severe, uncontrolled CRSwNP treated with mepolizumab. All patients had ≥2 prior endoscopic sinus surgeries and evidence of type 2 inflammation. Response at 12 months was evaluated across five domains: endoscopic findings, quality of life, nasal symptoms, olfactory symptoms, and asthma control and absence of systemic corticosteroid use. Overall response was classified as excellent response, partial response, or no response. Changes in Nasal Polyp Score (NPS), SNOT-22, visual analogue scale (VAS) scores, Asthma Control Test (ACT), and blood eosinophils were analysed. RESULTS:Ten patients were included. Improvements were observed in NPS (5.3 to 2.7; p=0.008), SNOT-22 (63.9 to 34.6; p=0.004), nasal VAS (7.0 to 4.3; p=0.047), olfactory VAS (9.0 to 5.9; p=0.008), ACT (16.2 to 21.2; p=0.047), and eosinophils (502.2 to 77.0 cells/µL; p=0.004). According to the revised multidimensional assessment framework, 5 patients (50%) achieved an excellent response and 5 patients (50%) achieved a partial response. One patient required rescue systemic corticosteroids during follow-up. No patients fulfilled the predefined criteria for non-response. CONCLUSIONS:In this small real-world cohort, mepolizumab was associated with improvement across multiple clinically relevant domains in patients with severe CRSwNP. These findings should be considered exploratory and require confirmation in larger prospective studies.
INTRODUCTION:Smell loss severely impacts quality of life, and current treatment options remain limited. Emerging concepts such as olfactory implants, combining an external electronic nose and an intracranial neurostimulator, raise important questions regarding patient perceptions, expectations, and acceptability. METHODS:The French patient organization Anosmie.org conducted an online survey among members experiencing smell loss. The study aimed to explore patient perceptions and expectations regarding a hypothetical olfactory implant. Questions addressed demographics, cause and duration of smell loss, perceived impact on quality of life, expectations and concerns related to such a device, its acceptability, and willingness to engage in future research. RESULTS:A total of 226 patients completed the survey. The majority were women (71.7%), aged between 51 and 70 years (69%). Most participants reported anosmia (72.1%), lasting more than 4 years in 74.5% of cases. Causes were classified as idiopathic (39%), post-viral (32.3%), post-traumatic (25.2%), and toxic (3.5%). The perceived impact on quality of life and mental well-being was strong in 80.1% and 60.6% of cases, respectively. Openness toward an olfactory implant was high: 94.2% would consider it as a potential option, and 66.4% expressed willingness to engage in future research. Expected benefits were mainly related to food enjoyment and safety. Main concerns included fear of surgery, potential side effects, device visibility, and uncertain efficacy. CONCLUSION:This survey highlights a substantial unmet need among patients with smell loss and provides insight into their perceptions and expectations regarding a potential neuroprosthetic solution. The findings suggest a high level of interest, conditioned by safety, efficacy, discretion, and clear information.
OBJECTIVE:Many studies investigated olfactory function following head trauma, but surprisingly few studies looked at smell loss following fractures of the nose. The aim of this study was to examine whether isolated fractures of the nose are associated with olfactory dysfunction. METHODS:A total of 97 participants (49 patients in the fracture group, 48 participants in the control group) were included in this cross-sectional study. The fracture and control groups were matched in terms of gender and age. Time since fracture varied, starting from 28 days to a maximum of 2 years. Olfaction was tested using the "Sniffin Sticks" test battery (odour threshold, discrimination and identification) and further data was collected using a basic questionnaire as well as via ENT examination with nasal endoscopy. RESULTS:Compared to controls the scores for odour discrimination and odour identification were lower in the fracture group (mean odour identification: 11.5 vs. 12.8; mean odour discrimination: 11.2 vs. 12.6; p<0.05). Odour thresholds were also decreased in the trauma group (mean odour thresholds: 6.8 vs. 8.1; p=0.06). General olfactory function scores (TDI score) correlated negatively with the time since fracture (p < 0.001) possibly indicating further decrease of function following trauma. CONCLUSION:Fractures of the nose are associated with a decrease in olfactory function, which is found especially for odour discrimination and odour identification.
INTRODUCTION:Endoscopic and microscopic tympanoplasty yield comparable anatomic and audiologic results, but the influence of incision choice on patient-reported cosmetic outcomes is less clear. MATERIAL AND METHODS:In this retrospective, non-randomized study, records of 197 patients who underwent type I tympanoplasty between January 2022 and January 2025 were reviewed; 91 patients completed at least 12 months of follow-up and the patient-reported outcome questionnaires (endoscopic n = 30, endaural n = 31, postauricular n = 30). Outcomes included graft success, Δair-bone gap (ABG) closure, Glasgow Benefit Inventory (GBI), and EAR-Q domains. RESULTS:Graft success was similar across groups (93.3-93.5%; p = 0.999), and ABG closure did not differ (7.23 ± 3.90, 7.26 ± 3.44, 6.30 ± 3.44 dB; p = 0.502). GBI and EAR-Q Psychological/Social scores were comparable (all p > 0.05). In contrast, cosmetic EAR-Q scores differed significantly, with less favorable scores in the postauricular group and the highest satisfaction in the endoscopic group (all p ≤ 0.01). CONCLUSION:While functional outcomes were similar, endoscopic tympanoplasty - and, among microscopic techniques, the endaural approach - may provide favorable patient-reported cosmetic outcomes, informing approach selection in suitable patients.
Introduction: Posterior nasal neurectomy (PNN) is a relatively safer modification of the Vidian neurectomy procedure. It can be recommended for patients with moderate to severe chronic (allergic and non-allergic) rhinitis that is resistant to conservative treatment. The procedure aims to transect the neural network that is responsible for excessive secretion. Here, we present our experience with PNN, evaluating its efficacy and safety. Methods: Patients who underwent PNN between 2020 and 2024 at Sheba Medical Center were included in this study. The severity of nasal discharge was evaluated using a visual analogue score (VAS) before the surgery and at least 3 months afterward. Surgical success was defined as a VAS reduction of at least 50%. Data regarding demographic and clinical characteristics, as well as VAS scores, were collected and compared between the groups. Results: A total of 37 patients who underwent the PNN procedure were eligible for analysis. The mean follow-up was 59.3 ± 28.5 months. Surgical success was achieved in 30 of 37 (81.1%) patients, with a reduction in VAS from 8.5 ± 1.1 to 2.1 ± 1.0. In the failure group (n = 7, 18.9%), the VAS decreased from 9.0 ± 1.4 to 7.3 ± 2.0. Comparing the two groups revealed that patients in the failure group were significantly older (51.6 ± 25.2 vs. 28.5 ± 15.8 years; p = 0.05). Atopy patients showed greater VAS improvement compared to non-allergic patients (6.3 ± 1.6 vs. 4.8 ± 2.5; p = 0.032). No significant impact on success rates was observed for concurrent inferior submucosal conchotomy. No major postoperative complications were noted; however, 2 of 37 patients (5.4%) reported transient nasal itching. Conclusion: PNN is an effective and safe treatment for intractable chronic rhinitis. PNN could be considered mainly in young atopic patients with allergic rhinitis resistant to conservative treatment. It should be considered as an alternative option for patients who are unwilling or contraindicated to allergen immunotherapy.
INTRODUCTION:Olfactory impairment has been associated with cognitive decline in older adults. However, investigations into the association between cognitive function and olfactory performance remain scarce, particularly within Southeast Asian populations. This study aimed to investigate the association between cognitive function and olfactory ability in the elderly, as well as its impact on olfactory-specific quality of life, using a culturally adapted smell test. METHODS:A cross-sectional study was conducted among 99 community-dwelling older adults aged ≥60 years. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA), and olfactory ability was assessed using the Malaysian-adapted Sniffin' Sticks test. The total threshold-discrimination-identification (TDI) score was used to categorize olfactory function. Olfactory-specific quality of life was measured using the validated Malay version of the short Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS). RESULTS:Among the participants, 74 demonstrated cognitive impairment and 63 were classified as hyposmic. A significant positive correlation was observed between cognitive scores and overall olfactory performances, particularly in the discrimination subtest. Cognitive impairment was also associated with poor olfactory related quality of life. CONCLUSION:This cross-sectional study highlights a significant association between cognitive performance and specific domains of olfactory function, particularly odor discrimination. These findings support the potential utility of olfactory testing in cognitive screening strategies, although causal relationships cannot be inferred from this cross-sectional design.
INTRODUCTION:This study aimed to determine the frequency of intubation-related laryngeal granulomas (ILGs) after surgery under general anesthesia and identify risk factors, with a focus on tube type and duration. METHODS:A single-center prospective cohort (November 2012-September 2013) of adults undergoing elective surgery expected to last at least 5 h with intubation was conducted. Fiberoptic laryngoscopy was performed on the day after extubation and at 1 week, 1 month, and 3 months. Candidate variables included tube type (single lumen vs. double lumen [DLT]), intubation duration, Cormack-Lehane grade, intraoperative transesophageal echocardiography (TEE), gastroesophageal reflux disease, body mass index, sex, and age. Associations were evaluated using univariate tests and multivariable logistic regression. RESULTS:Forty patients were analyzed (median age, 73 years; 19 men). Cardiovascular surgery accounted for 25 of 40 cases (62.5%); DLTs were used in 6 of 40 (15.0%) and TEE in 22 of 40 (55.0%). Mucosal changes (erythema/white plaque) were observed on day 1 in 18 of 40 patients (45.0%). ILG was detected at 1 week in 10 of 40 patients (25.0%), including nine after cardiovascular surgery. Eight of 10 cases (80%) resolved spontaneously by 1 month, whereas 2 of 10 (20%) enlarged and required 2 months of inhaled steroid therapy, with complete resolution by 3 months. Univariate analysis revealed that both intubation duration ≥13 h (p = 0.014) and DLT use (p = 0.026) were significantly associated with ILG. In multivariable analysis, intubation duration ≥13 h (adjusted odds ratio [aOR]: 10.697, 95% confidence interval [CI]: 1.639-69.828; p = 0.013) and DLT use (aOR: 14.521, 95% CI: 1.531-137.680; p = 0.020) were independent risk factors. CONCLUSION:In this cohort, ILG was detected in 25% of patients at 1 week post-extubation and typically resolved within 1 month. Prolonged intubation and DLT use were independently associated with increased ILG risk. High-risk patients - particularly those with prolonged intubation or DLT exposure - may benefit from selection of the smallest appropriate DLT when required and targeted laryngoscopy within 1 month. These findings should be interpreted cautiously, given the small sample and single-center design.
INTRODUCTION:The aim of this study was to assess the relationship between texture and the correct identification of gustatory stimuli (sweet, salty, bitter, and sour) in both healthy participants and patients with taste disorders. METHODS:This cross-sectional study included 51 participants: 32 healthy individuals and 19 patients with taste disorders. Taste testing was conducted using filter paper strips with two different surface textures (smooth and rough). Three concentrations of each tastant (sweet, sour, salty, and bitter) were applied to the strips. Each strip was placed on the anterior part of the tongue, and participants were asked to identify the taste stimulus from a list of four options using a multiple forced-choice technique. RESULTS:A significant difference between smooth and rough filter paper textures in the overall cohort of all participants was observed for the identification of bitter taste (mean identification scores: 2.25 ± 0.91 vs. 2.45 ± 0.96; mean difference: -0.22; 95% CI: -0.37 to -0.02; p = 0.035). No significant differences between smooth and rough textures were found for any tastant concentration in the overall cohort. Among participants with taste disorders, rough texture improved the correct identification of bitter taste at low concentration, but the effect did not reach statistical significance. CONCLUSION:Our results provide preliminary evidence that surface texture may affect taste quality identification and should be further explored in future research. The rough texture can enhance the correct identification of bitter taste quality.
INTRODUCTION:The aim of this study to investigate the characteristics of laryngopharyngeal reflux (LPR)-related mucosal vascular dysplasia under narrow band imaging (NBI) laryngoscopy, and to assess the function of medical intervention on abnormal vascular proliferation of LPR patients. METHODS:Based on the Symptom Index (RSI) and the Reflux Finding Score (RFS) scoring system, 150 patients diagnosed with suspicious LPR were enrolled in the study (RSI score > 13 and RFS score > 7), 50 normal people were enrolled in the control group (RSI score ≤ 13 and RFS score ≤ 7). According to the characteristics of abnormal vascular proliferation and our previous studies, the laryngopharyngeal mucosa of the suspicious LPR patients were divided into 4 grades, and the consistency between the NBI grades and RSI/RFS scores were compared. Patients who belong to II to IV grades according to NBI grading system and agreed to accept anti-acid intervention treatment were prescribed to take proton pump inhibitor (PPI) orally. Differences of the NBI grading results before and after the treatment were compared. RESULTS:There was a statistic correlation between the NBI grading the RSI/RFS scores. Significant difference existed between the NBI grading results before and after the PPI treatment. Part of the laryngeal abnormal vascular proliferation could be reversed. CONCLUSION:Vascular changes might be one of the main changes in the laryngopharyngeal mucosa of the suspicious LPR patients, and NBI could potentially become a reliable method in diagnosing LPR disease.
INTRODUCTION:We report a case of a 7 y/o female sustaining an injury from a metallic blowdart that penetrated the inferior clivus and dura at the craniovertebral junction (CVJ) and was removed with an endoscopic trans-clival approach. CASE PRESENTATION:A 7 year-old female presents to the emergency room after sustaining a penetrating injury from a metallic blowdart to the nose. Patient remained hemodynamically stable with no obvious cerebrovascular injury. Computed tomography (CT) including CT-angiography (CTA) was obtained to confirm the location and proximal structures to the injury, after which patient was taken to the operating room for removal. The blowdart was removed successfully with an endoscopic trans-clival approach without complication. A high flow cerebrospinal fluid (CSF) leak was controlled and repaired with bone wax, abdominal fat graft, and a free mucosal graft. The patient did well postoperatively, with no clinical or radiographic evidence of pneumocephalus, vascular injury, or recurrent CSF leak. She was discharged to home on postoperative day 5 and is now 14 months post-injury with no lasting sequela. CONCLUSION:This case highlights the utilization of expanded endonasal skull base techniques (i.e., trans-clival and trans-odontoid approaches) for a unique traumatic injury and approach to management in a pediatric patient. Although successful, without acute neurovascular complication and limited patient morbidity, it is difficult to generalize this endonasal approach to all cases of clival trauma with more extensive injuries and/or deficits. Further study is needed to understand the benefits and limitations of an endoscopic endonasal approach to penetrating trauma of the inferior clivus and CVJ.
INTRODUCTION:Bell's palsy is the most common acute unilateral facial paralysis. House-Brackmann (HB) grading may mask region-specific involvement; therefore, we evaluated upper and lower facial regions separately and examined factors associated with recovery. METHODS:Adults presenting within 3 days of symptom onset (January 2024-January 2025) were followed at day 15, day 30, and month 6. Standardized photographs were graded using upper and lower HB grades by three blinded otolaryngologists (median score used). Treatment patterns (no treatment, steroid only, and steroid + physiotherapy) and comorbidities (diabetes mellitus [DM] and hypertension [HT]) were recorded. RESULTS:The final cohort included 213 patients. Upper-lower HB grades were discordant at presentation in 89 patients (41.8%). HB improved significantly over time in both regions (p < 0.001). Lower-face HB grades were consistently higher at early time points, indicating greater initial severity in the lower facial region. Steroid exposure was associated with different early recovery trajectories from day 1 to day 30 (upper: p = 0.001; lower: p = 0.026). DM and HT were linked to less favorable recovery patterns, without a significant synergistic effect. CONCLUSION:Separate upper and lower HB grading reveals clinically meaningful heterogeneity in Bell's palsy. Region-specific assessment may improve prognostic stratification at presentation. Corticosteroid therapy was associated with accelerated early recovery, whereas DM and HT adversely influence outcomes. Future studies incorporating region-specific assessment are needed to clarify its role in prognostic stratification and its potential contribution to individualized patient management.
INTRODUCTION:Facial paralysis is associated with social isolation, depression, anxiety, and impaired daily functioning. Affect display, defined as the outward facial expression of internal emotional states, is a key component of nonverbal communication and plays a central role in how individuals are perceived by others. Prior observer-based research on social perception has largely treated facial paralysis as a single entity or has focused primarily on complete facial paralysis (CFP) despite meaningful clinical differences between CFP and facial synkinesis (FS). METHODS:We performed a narrative review of key studies examining affect display and social perception of patients with facial paralysis. We then conducted a prospective survey study of 557 adult casual observers who viewed 24 dynamic facial videos (8 CFP, 8 FS, 8 controls). After each video (repose to attempted smile), observers characterized the affect display of each face by selecting all applicable affects from the Derogatis Affects Balance Scale (DABS) plus a neutral affect. Mixed-effects linear models were used to analyze the data. RESULTS:Most prior literature on social perception focuses on CFP and demonstrates that individuals with facial paralysis are perceived as less attractive, as having worse quality of life and as displaying more negative emotional states compared with controls. There remains limited literature specifically addressing FS. In the present study, observers (n = 557; mean age 36.5 years; 58.9% female) rated affect display after watching videos of patients with CFP, FS, and controls smiling. Relative to controls, FS faces were less likely to be labeled content, joyful, or vigorous and more likely to be labeled anxious and depressed. CFP faces showed more profound affective distortion: odds of being labeled joyful were ∼98% lower (OR 0.02, 95% CI: 0.01-0.04) and odds of being labeled depressed were >50-fold higher (OR 58.3, 95% CI: 24.5-149.8) compared with controls. CONCLUSIONS:Both FS and CFP impair observer perception of positive affect display when attempting to smile and increase neutral or negative interpretations. This affect display penalty with attempted smiling is greater in CFP than in FS. These findings highlight distinct patterns of emotional misattribution across facial movement disorders and reinforce the importance of considering these conditions as separate entities in research and clinical care.
BACKGROUND:Facial synkinesis describes a sequela of transient facial nerve injury that can occur following viral reactivation syndromes such as Bell's palsy or following traumatic facial nerve injury. Facial synkinesis is frequently characterized by muscle hypertonicity, involuntary co-contraction of facial muscles, and spasm and can have severe functional and esthetic consequences. Although this condition is not curable, several treatment options exist; however, there is currently a lack of consensus regarding the appropriate timeline and sequence of synkinesis treatment strategies. SUMMARY:Treatment for facial synkinesis is nuanced and constantly evolving. A range of both noninvasive and invasive treatment options exist, including physical therapy, chemodenervation with botulinum toxin, and various surgical interventions such as selective facial myectomy and selective facial neurectomy. The optimal treatment strategy is often dependent on patient preference, clinical presentation, and provider comfort and can be further complicated by confusion regarding the appropriate timeline for escalation of care. This review summarizes the current treatment trends and proposes a nuanced algorithm that integrates current practice and individualized decision-making to provide a flexible framework to care for this patient population. KEY MESSAGES:Management of facial synkinesis is complicated by the wide range of treatment options in addition to the lack of clear consensus on how to integrate these modalities into a cohesive treatment plan. The algorithmic approach outlined here represents one of several possible frameworks for evaluating and managing patients with this challenging condition.
INTRODUCTION:Paralytic lagophthalmos in the setting of facial paralysis results in exposure keratopathy and places patients at risk for corneal injury and long-term sequelae. Upper eyelid weight implantation restores passive eyelid closure and increases protection of the cornea. While effective, some patients ultimately require secondary surgery. The factors associated with eyelid weight revision remain incompletely characterized. This study identifies clinical and surgical factors associated with secondary eyelid weight surgery (replacement or removal) among patients with facial paralysis at a tertiary academic medical center. METHODS:A retrospective chart review was conducted of patients who underwent eyelid weight placement for incomplete eye closure secondary to unilateral facial paralysis between January 1, 2014, and December 31, 2023. Data collected included demographics, etiology of paralysis, history of radiation therapy, paralysis severity and recovery, implant characteristics, and adjunctive facial reanimation procedures. Statistical analyses compared patient and procedural factors associated with receiving secondary surgery, and among secondary cases, between those who underwent replacement versus removal. RESULTS:Ninety-four patients met inclusion criteria, and 21 (22.3%) underwent secondary surgery. The most common indication for revision was recovery of facial nerve function (7, 33.3%), followed by bothersome symptoms (6, 28.6%), extrusion (5, 23.8%), and incomplete eye closure (3, 14.3%). Patients with partial or complete recovery of paralysis were significantly more likely to undergo secondary surgery compared with those without recovery (61.8% vs. 22%; p < 0.001). A history of radiation therapy before or after eyelid weight implantation to the head and neck was not significantly associated with revision (p = 0.4). There were no significant differences with respect to age, gender, severity of paralysis, etiology, implant material, or procedural setting. CONCLUSION:Secondary eyelid weight surgery was primarily associated with recovery of facial function followed by persistent ocular symptoms and extrusion.
INTRODUCTION:Eagle syndrome is an underrecognized condition caused by the elongation of the styloid process or calcification of the stylohyoid ligament, with an unknown true incidence. It is diagnosed clinically through symptoms related to compression of the surrounding neurovascular and musculoskeletal structures, along with radiographic confirmation of styloid elongation. Symptoms are variable and may include neck pain, dysphagia, tinnitus, dizziness, headaches, otalgia, and cognitive complaints. Surgical management via intraoral or transcervical approaches is the current standard of care. We propose a novel minimally invasive skull base approach designed to allow complete styloid removal with reduced tissue dissection. METHODS:A retrospective review was conducted in patients who underwent this minimally invasive skull base approach for Eagle syndrome between November 2020 and June 2024. Of 102 identified patients, 90 met the inclusion criteria. Demographics, operative time, intraoperative and postoperative complications, narcotic use, and symptom improvement were extracted from the electronic medical record. Data were analyzed using Excel. RESULTS:Patients were predominantly female (73.3%) and white (90%). The mean operative time for unilateral styloid removal was 53 min (±21.2). The most common postoperative complication was temporary numbness (42.2%), with resolution reported in 63.2% of affected patients. Overall, 86.7% (n = 78) of patients reported complete or partial symptom improvement by or before the 3-month follow-up. CONCLUSION:The minimally invasive skull base approach for Eagle syndrome demonstrates symptom improvement rates comparable to traditional intraoral and transcervical techniques while offering shorter operative times and limited tissue dissection. This approach appears to be an effective alternative surgical option with an acceptable complication profile.
INTRODUCTION:This study aimed to investigate the impact of conductive hearing loss (CHL) on speech perception in noisy environments, with a particular focus on the role of low-frequency air-bone gaps. While CHL is traditionally considered a peripheral auditory disorder, emerging evidence suggests that it may also affect central auditory processing, especially under complex acoustic conditions. METHODS:Thirty individuals diagnosed with CHL and thirty age-matched participants with normal hearing were recruited from the Audiology Unit of Gazi University. All participants underwent comprehensive audiological evaluations, including the Turkish Hearing in Noise Test (T-HINT). Speech recognition thresholds (SRTs) were measured adaptively in four listening conditions: quiet and noise presented from the front, right, and left. Speech-spectrum noise was delivered at 65 dB SPL. RESULTS:Participants with CHL demonstrated significantly elevated SRTs across all noise conditions compared to the control group, indicating reduced speech-in-noise intelligibility. However, speech discrimination scores in quiet did not differ significantly between groups. Notably, larger air-bone gaps at low frequencies were strongly correlated with poorer SRTs, suggesting a frequency-specific vulnerability in noisy environments. CONCLUSION:CHL substantially impairs speech perception in noise, primarily due to the detrimental effects of low-frequency air-bone gaps. These findings underscore the crucial role of low-frequency auditory input in the temporal and spectral processing of speech, underscoring the need for frequency-specific diagnostic and rehabilitative strategies in clinical audiology.
Introduction: Approximately one-third of patients with olfactory dysfunction would consider the option of an olfactory implant, a device that would sample odorants and translate this information into an electrical stimulation of the brain to produce an olfactory percept. However, the brain location for placement of such a device is to date still debated. Case Presentation: We describe the single-case of a patient with left-sided frontotemporal astrocytoma who reported perceiving a lemon smell after electrical stimulation in the olfactory bulb. Conclusion: The awake-brain surgery provides a unique opportunity to test how smell percepts are formed at the central level in humans. This information is critical in the emerging field of olfactory implants. The present case emphasizes the significant role of the olfactory bulb as a target structure for the placement of an olfactory prosthesis.
Introduction: Successful salvage facial reanimation procedures involving transfer of nerve to masseter (NTM) to an existing gracilis free muscle transfer (GFMT) have been reported when performed within 6 months. Methods: Medical records were reviewed for patients who had undergone a salvage or secondary facial reanimation surgery after an initial suboptimal GFMT by cross-face nerve graft (CFNG). Case Presentations: Between 2019 and 2024, three patients underwent salvage or secondary facial reanimation surgery after an initial procedure failed to produce movement by 11, 17, and 14 months respectively. Intraoperatively, the existing gracilis of patients 1 and 3 stimulated at 2 mA, and so a salvage procedure involving NTM transfer to the obturator nerve of the existing GFMT was performed. Successful smile was noted at 5 months for patient 1 and no facial movement after 12 months for patient 3. For patient 2, a secondary facial reanimation surgery (GFMT from the contralateral leg with innervation by the NTM) was performed due to lack of existing gracilis electrical stimulation and produced a successful smile noted at 7 months. Conclusion: This study demonstrates that successful salvage of a failed GFMT by CFNG is possible through transfer of the NTM to the obturator nerve even after 11 months.
Introduction: External neck trauma represents a potentially life-threatening clinical scenario. Blunt and penetrating injuries are the primary etiologies and may result in laryngeal injuries with concurrent tracheal involvement. High-impact or high-energy laryngotracheal trauma arises from diverse mechanisms; therefore, injury reporting must account for varied patterns and incorporate any synchronous tracheal injury, thereby establishing a more effective framework for managing complex external airway trauma. METHODS:Data from 7 patients experiencing high-intensity extreme laryngotracheal trauma were retrospectively analyzed, focusing on injury mechanisms, clinical presentations, site and grade of injury, imaging findings, management approaches and outcomes. In parallel, a PRISMA-guided search of PubMed, Embase, Scopus, and Web of Science (January 1980-April 2025) identified English language case series reporting ≥5 patients. Data on injury mechanisms, Schaefer-Fuhrman grade, management, and outcomes were extracted. RESULTS:Seven cases of severe laryngotracheal trauma with varying mechanisms are presented, including closed glottis barotrauma, penetrating and blunt neck injury, accidental strangulation, prolonged labor and rough manipulation of a vertex presentation, clothesline injury, and post-intubation injury. The obstetric patient did not survive, while other patients underwent prompt airway stabilization with favorable functional outcomes. The systematic review incorporated 11 studies: blunt trauma predominated (65-75%), severe injuries (Schaefer grades III-V) accounted for one-half of cases, and overall mortality was 2%. Tracheal extension, including cricotracheal separation, was predominantly reported after high-impact blunt trauma in several studies. CONCLUSION:The current classification system for external laryngeal trauma does not adequately capture the severity or anatomical complexities of high-impact laryngotracheal injuries. Our experience, supported by pooled literature data, underscores the limitations of laryngeal-only grading. Incorporating both the mechanism and extent of injury is essential to improve clinical decision-making, guide treatment strategies, and ultimately, enhance patient outcomes and prognosis. .
INTRODUCTION:Frontal sinus fractures are complex injuries that require individualized management based on the extent of fracture, involvement of the nasofrontal duct (NFD), and the presence of cerebrospinal fluid (CSF) leakage. Optimal treatment remains controversial, with evolving trends toward selective conservative approaches. This study aimed to evaluate treatment outcomes over a 13-year period using a standardized management algorithm. METHODS:A retrospective review was conducted of 201 patients treated for frontal sinus fractures at a tertiary academic center between 2007 and 2020. Fractures were classified according to anterior or posterior wall involvement, and management strategies included conservative observation, open reduction and internal fixation (ORIF), and cranialization. Surgical intervention was indicated based on NFD obstruction, posterior wall involvement, or CSF leakage. Clinical and demographic data, surgical techniques, and complications were analyzed. RESULTS:Out of 201 patients, 189 underwent surgical treatment. ORIF was performed in 76.2% of cases, and cranialization was required in 17%. The complication rate among surgically treated patients was 10.6%, primarily due to infection and delayed healing, compared to 25% in the conservatively managed group. The majority of fractures resulted from high-energy trauma, particularly traffic accidents, and predominantly affected young male patients. CONCLUSION:An individualized, algorithm-guided approach to frontal sinus fracture management leads to favorable outcomes and lower complication rates. Surgical intervention is particularly beneficial in cases with NFD obstruction or CSF leakage. These findings support the role of structured, multidisciplinary decision-making in optimizing treatment strategies for complex craniofacial trauma.
