Schwannomas are benign, encapsulated tumors arising from Schwann cells. Extracranial hypoglossal nerve schwannomas located in the submandibular region are exceptionally rare and may clinically and radiologically mimic primary submandibular gland tumors. A 44-year-old woman presented with a painless left submandibular mass of three months' duration. Ultrasonography and contrast-enhanced computed tomography demonstrated a well-circumscribed heterogeneous lesion closely associated with the left submandibular gland, and a pleomorphic adenoma was suspected preoperatively. Preoperative needle biopsy was not performed because of concern regarding sampling error and a potentially nondiagnostic result. Magnetic resonance imaging was not performed because of financial considerations and the patient's reluctance to undergo further examination. During surgery, the encapsulated tumor was found to arise from the hypoglossal nerve and was carefully dissected from the nerve sheath while preserving the anatomical continuity of the main nerve trunk. Histopathological and immunohistochemical examinations confirmed schwannoma. At the one-year follow-up, the patient showed normal tongue movement without recurrence or neurological deficit. A review of published reports indicates that extracranial hypoglossal nerve schwannomas have been reported to present as painless submandibular masses and may be misdiagnosed before surgery. This case emphasizes that preoperative recognition of hypoglossal nerve origin may facilitate appropriate surgical planning and may allow preservation of both the functional nerve and the uninvolved submandibular gland.
This review examines the current status of artificial intelligence (AI) applications in the perioperative management of emergency trauma. Published studies suggest performance advantages of AI over traditional methods in prehospital triage, radiographic injury detection, massive transfusion prediction, and early warning of postoperative complications, although findings vary across study designs and validation settings. However, actual adoption in trauma care remains limited due to data heterogeneity, performance degradation in external validation, workflow integration challenges, lack of interpretability, and a scarcity of prospective interventional evidence. This review further argues that methodologically inflated benchmark performance constitutes an underrecognized barrier to adoption in its own right, and that bridging the implementation gap will likely require a shift from area under the receiver operating characteristic curve (AUC)-centered reporting toward reporting sensitivity at prespecified clinical thresholds and evaluating patient outcomes in prospective interventional trials.
BackgroundRobot-assisted laparoscopic fundoplication (RALF) has been proposed as a promising alternative to conventional laparoscopic fundoplication (CLF). Because comparative data are still sparse, we compared RALF and CLF in a cohort study. At our centre, RALF was introduced in late 2022.MethodsRALF was performed on a DaVinci robot. Clinical data were abstracted from clinical records of all patients who underwent surgery for gastroesophageal reflux disease (GERD) between January 2020 and June 2025. Statistical analysis was used to compare RALF and CLF and to analyse the learning curve of RALF over time.ResultsMore patients in the RALF group (total n=107) than in the CLF group (n=126), had an upside-down stomach (55% vs. 19%) and hiatal defect sizes were larger. In 6 RALF patients, the procedure had to be converted or abandoned. Operating room (OR) time was longer with RALF (mean 251 min) than with CLF (177 min, p 0.001). Adverse events during surgery and during hospitalization were similar between the groups, but hospital stay was slightly longer in RALF than in CLF patients (median 7 vs. 6 days, p=0.12). Readmissions for recurrent symptoms (20% vs. 20%) or incisional hernia (10% vs. 14%) were similar between RALF and CLF. An uneventful clinical course (i.e., “textbook outcome”) was seen in 57 (53%) RALF and 66 (52%) CLF patients. In logistic regression, only anaesthesiologic risk was associated with a non-textbook outcome. A learning curve for RALF was not found, as mean OR time was longest in the second half of 2024 and the first half of 2025 (p=0.005).ConclusionsFor patients requiring anti-reflux surgery, RALF prolongs surgery times but fails to offer clear advantages over CLF. As in the present study RALF was applied in more complicated cases and still gave grossly similar results as CLF, the possibility remains that RALF is a minor improvement as compared to CLF.
Purulent–necrotic infections of the surgical wound following instrumented correction of thoracolumbar scoliosis remain among the most serious complications in spinal surgery, because they often require implant removal, prolonged disability, and recurrence. In adult patients undergoing surgery at a mature age for scoliosis deformity (traditionally corrected in childhood or adolescence), such complications occur less frequently and have specific clinical features. The presented clinical case of a 46-year-old patient with a postoperative wound infection in the form of purulent–necrotic phlegmon after correction of the thoracic spine illustrates successful preservation of spinal instrumentation after six revision and debridement procedures, followed by installation of a vacuum-assisted closure (VAC) system and two VAC system replacements with complete wound closure. This case suggests the potential value of repeated surgical debridement combined with vacuum-assisted therapy as an effective approach to implant salvage even in severe purulent-necrotic processes, which is of significant importance for clinical practice.
