Abstract Background Sinonasal inverted papilloma (SNIP) is histologically benign but locally aggressive, with high recurrence rates and a relevant risk of malignant transformation. Tumor involvement of the nasal root and overlying skin may result in a full-thickness craniofacial defect with direct intracranial–external communication. Reconstruction is particularly challenging after failure of conventional skull base techniques (e.g., titanium mesh and pericranial flaps), which may lead to pneumocephalus, cerebrospinal fluid (CSF) leakage, and infection. Objective To describe a multidisciplinary staged salvage strategy combining bifrontal craniotomy with a vascularized anterolateral thigh (ALT) free flap for definitive reconstruction of complex anterior skull base and nasion defects after failed conventional reconstruction. Methods We report a recurrent SNIP case with failed initial skull base reconstruction. After infection control and resolution of pneumocephalus, an ALT free flap was used. The pedicle was routed transcranially through an enlarged skull base defect to temporal recipient vessels, enabling three-layer reconstruction from dura to skin and restoration of nasal dorsum contour. Results Definitive reconstruction was completed in 7 h. The flap survived without vascular compromise. During the postoperative course and early follow-up, no CSF leak, infection, or recurrent pneumocephalus was observed. Stable intracranial–extracranial separation and satisfactory functional/aesthetic outcomes were achieved. Conclusion Bifrontal re-exploration followed by staged ALT free-flap reconstruction represents a viable salvage option for complex anterior skull base defects after failed primary repair. In our experience, transcranial pedicle routing and a three-layer reconstruction approach can facilitate effective intracranial-extracranial separation.

Abstract Introduction and objectives Head and neck cancer remains a major global health challenge, with radiotherapy representing a central component of curative and palliative treatment. Despite advances in precision techniques, high-dose irradiation unavoidably affects adjacent oral structures, leading to a broad spectrum of side effects. These include dental caries, periodontitis, xerostomia, mucositis, candidiasis, trismus, dysphagia, and osteoradionecrosis—each with potential for chronic morbidity and diminished quality of life. This scoping review aims to summarize current evidence on oral side effects associated with head and neck radiotherapy, raise interdisciplinary awareness and propose a dental care model ensuring individualized therapies while focusing on prevention. Data Radiation-induced oral effects are common, multifactorial, and often long-lasting. Caries and periodontitis are largely driven by hyposalivation and mucosal compromise, while trismus reflects dose-dependent impairment of the masticatory apparatus. Osteoradionecrosis, though less frequent, carries severe clinical consequences. Sources A systematic literature search was conducted using PubMed for articles published between 1999 and November 2025. The search strategy combined the terms “head and neck cancer”, “radiotherapy” with the side effects mentioned above. Study selection Studies were considered eligible if they examined oral side effects resulting from radiotherapy in patients with head and neck cancer, in total, 151 studies were included into the review. Results We describe the epidemiology, underlying mechanisms, and clinical manifestations of common sequelae and provide a structured overview of preventive and therapeutic strategies. Clinical significance The understanding, early identification and management of radiation-induced oral complications are essential to preserve function, maintain quality of life, and improve long-term outcomes for head and neck cancer patients.

The aim of this study was to analyze self-reported pain symptoms on the side of the vestibular schwannoma (VS) and their impact on health-related quality of life (HRQoL) in conservatively managed VS- patients. Prospective clinical study. Department of Otorhinolaryngology, Department of Neurosurgery, Single-center University Hospital, Certified skull base center, Germany. A total of 163 conservatively managed patients at the time of initial diagnosis or during wait-and-scan strategy with radiologically confirmed unilateral VS. Exclusion criteria: prior surgery, radiotherapy, or bilateral tumors, as well as neurofibromatosis type II (NFII). Assessment using the Penn Acoustic Neuroma Quality-of-Life Scale (PANQOL), and for a subset of patients (n = 80/163), the Short-Form McGill Pain Questionnaire (SF-MPQ). Prevalence of pain; differences in HRQoL scores; correlations between pain and age, tumor size, and psychosocial factors via t-test and ANOVA; assessment of clinical relevance using the Minimal Clinically Important Difference (MCID). Overall, 48.75

Background Skull base osteomyelitis (SBO) is a severe disease not only because of its rapid progression and its high mortality: diagnosis and treatment are often protracted and in more than 30% of cases no causative pathogen can be detected. SBO is usually preceded by immunodeficiency, which is why opportunistic infections caused by atypical pathogens must also be taken into consideration. In consideration of the different possible entities, an interdisciplinary approach with surgical debridement, pathological sampling, microbiological testing and antimicrobiological therapy is indispensable. Case presentation We report on a 58-year-old female patient who presented to our clinic for the first time in 2014 with a bilateral skull base osteomyelitis. The patient had a history of several comorbidities, including hypogammaglobulinemia following the successful treatment of a relapsed B-CLL. Different surgical treatments had already been attempted at the time of initial presentation. Several rheumatological, orthopedic, haemato-oncological and divergent microbiological differential diagnoses could be ruled out. Despite various interdisciplinary treatment attempts (including surgery, antibiotic therapies and hyperbaric oxygen therapy) the progress led to a palsy of the caudal cranial nerve group in 2022. With all preceded microbiological sampling being negative, we initiated species specific PCRs covering atypical organisms. An atypical infection of Mycoplasma pneumoniae was detected. After starting antibiotic therapy with azithromycin and doxycycline the progress could be halted and the palsies were regredient. The following MRI scans confirmed a decline in findings. Conclusions To the authors' knowledge, this case report is the first description of SBO as an extrapulmonary M. pneumoniae infection. It shows the diagnostic and therapeutic complexity of a multifaceted clinical picture in which immunological, microbial and ENT-surgical diagnostic and therapeutic concepts must be regularly coordinated. Against the background of the high proportion of missing pathogens up to 30%, interdisciplinary cooperation within the framework of the ABS concept is emphasized. Structured and interdisciplinary diagnostics by a skull base center specializing in this field was ultimately decisive for treatment in this case.

Skull base osteomyelitis (SBO) is a potentially life-threatening condition requiring multimodal treatment, including antibiotic therapy, surgery, and hyperbaric oxygen therapy. This study aimed to evaluate the role and the effectiveness of antibiotic therapy in the management of SBO. A retrospective analysis was conducted on 52 adult patients treated for SBO at the Department of Otolaryngology between 2006 to 2025. The study focused on the selection, duration, and mode of antibiotic administration, guided by microbiological findings. Antibiotic regimes were tailored based on pathogen sensitivity, surgical intervention and hyperbaric oxygen therapy provided as indicated. Of the 52 patients, 75.0

Introduction Skull base osteomyelitis (SBO) is a rare but potentially life-threatening disease. It usually occurs as a complication of severe otitis externa or infection in the nasopharynx, often in immunocompromised patients. The therapeutic strategy is complex, patient-specific and requires interdisciplinary cooperation.

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 24 h 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

Introduction Due to rapid progression and high mortality rates - especially in immunodeficient patients - osteomyelitis (OM) of the skull base is a severe disease. The different origins show similar radiological findings, therefore interdisciplinary approaches including surgical debridement, pathological sampling, structured microbiological diagnostics and counselling by antibiotic stewardship teams are the key to successful therapy.

Einleitung Die Schädelbasisosteomyelitis (SBO) ist aufgrund des potentiell rasanten Progresses und der hohen Mortalität – insbesondere bei Immundefizienz – ein schwerwiegendes Krankheitsbild. Verschiedene Ätiologien lassen sich radiologisch häufig nicht differenzieren, weshalb zur erfolgreichen Behandlung ein interdisziplinärer Ansatz mit chirurgischem Debridement, pathologischer Sicherung, strukturierter mikrobiologischer Diagnostik und antibiotischer Therapie im Rahmen eines Antibiotic-Stewartships (ABS) notwendig ist.

Skull base osteomyelitis is a rare but potentially life-threatening disease. It usually occurs as a complication of severe otitis externa or infection in the nasopharynx, often in immunocompromised patients. The therapeutic strategy is complex, patient-specific and requires interdisciplinary cooperation. A retrospective evaluation of all patients with skull base osteomyelitis at the Department of Otorhinolaryngology of the University Hospital Duesseldorf from 2006 to 2023 was carried out. It was investigated which factors, in addition to treatment regimens (antibiotic therapy with i.v./oral antibiotics, surgical debridement and HBO therapy) have an influence on the clinical, laboratory and morphological outcome of the patients. A total of 42 patients who received interdisciplinary treatment in our clinic were included in the study, of whom 71.4

Introduction Deep drilling at the lateral skull base with a linear drill holds great potential to reduce invasiveness but poses challenges due to the proximity of the drill channel to critical structures, such as the facial nerve, which can be mechanically or thermally damaged. The development of a drill system capable of real-time temperature monitoring and prediction is crucial to minimize the risk of thermal damage and enhance the safety of procedures, like implantation, taking samples or drug delivery.

Einleitung Die Schädelbasisosteomyelitis (SBO) ist eine seltene aber potenziell lebensbedrohliche Erkrankung. Sie tritt meist als Komplikation einer ausgeprägten Otitis externa oder Infektion im Bereich des Nasenrachens, oft bei immungeschwächten Patienten, auf. Die therapeutische Strategie ist komplex, patientenspezifisch und bedarf der interdisziplinären Zusammenarbeit.

Introduction Dizziness is one of the most common symptoms in medicine, but the diagnosis is very complex and depends on the examiner"s expertise. In addition, this experience and expensive, equipment-based, error-prone diagnostics are not available across the country.

Bei vestibulären Schwannomen (VS) wird der einseitige Hörverlust häufig als gravierendes Symptom empfunden. Beim retrosigmoidalen Zugang als auch unter Strahlentherapie kann der Erhalt des Hörvermögens nicht garantiert werden, beim translabyrinthären Zugang ist der Verlust unvermeidlich. Im klinischen Kontext ist es jedoch schwierig, eine ausreichend prädiktive Aussage in Bezug auf einen zu erwartenden Erfolg mittels einer Cochlea Implantation (CI) zu tätigen. Retrospektiv wurden 29 Patienten ausgewertet, die nach Operation eines intra- u./o. extralabyrinthären VS mit einem CI ipsilateral versorgt wurden. Evaluationsparameter waren u.a. die Bewertung des persönlichen Nutzens, das postop. Sprachverstehen, die Auswertung des Promontorialtests (PT), die Tumorlokalisation u. -größe oder Hinweise auf cochleäre Veränderungsprozesse. Insgesamt gaben ca. 86% der Patienten einen Nutzen durch das CI an. Innerhalb des ersten Jahres konnte bei über 50% der Patienten ein Sprachverstehen>50%/65dB im Einsilbertest (ET) gezeigt werden. Bei 7 Patienten liegen Langzeitergebnisse (>5 Jahre) vor, hier erreichten 6 Patienten ein Ergebnis von>50% im ET. Bei positivem PT zeigten postop. 9 von 14 Patienten ein ausreichendes Sprachverstehen. Wenn weitere Risikofaktoren wie Tumorgröße (>Koos 2) oder Hinweise auf cochleäre Veränderungen berücksichtigt werden, ergibt sich ein Sprachverstehen von über 50% im ET bei 73% der Patienten. Eine erfolgreiche Hörrehabilitation nach VS-Resektion ist mittels CI möglich. Die Option sollte bereits in die präop. Beratung aufgenommen werden. Mögliche Risikofaktoren (Tumorgröße/-lage; neg. PT, cochleäre Obliterationszeichen), die für eine stärkere neurale Schädigung sprechen können, sollten im Vorfeld im Rahmen der Entscheidungsfindung bedacht werden.

Purpose Postoperative wound infections after cochlear implantation are rare but sometimes serious and can lead to explantation. Therefore, perioperative antibiotic administration is often recommended. However, in clinical practice, the type and duration of antibiotic prophylaxis varies between different centers. The aim of this study was to investigate the role of perioperative antibiotic prophylaxis in preventing postoperative complications. Methods 700 patients who underwent cochlear implantation between 2007 and 2019 were retrospectively evaluated with regard to wound infections within the first 28 postoperative days. These were classified into major and minor complications. Data were analyzed using the IBM statistical program SPSS. Results In 670 out of 700 patients the type and duration of perioperative antibiotic administration could be reconstructed from the records. Of these 67 patients (10%) received antibiotics as a single shot, 158 patients (23.6%) were treated with antibiotics for a period of 48 h, and 445 patients (66.4%) received prolonged antibiotic therapy for more than 72 h. In total 64 patients (9.5%) showed abnormalities in wound assessment within the first 28 postoperative days after implantation. Major infections (1.6%) were detected in 11 patients. Overall, there was no statistically significant difference in wound infection rates between the group receiving single-shot antibiosis and the group receiving 48 h prophylaxis or antibiotic treatment > 72 h ( p = 0.46). Conclusion Patients receiving an antibiotic single shot do not appear to be at significantly increased risk for postoperative wound infections compared with patients with prolonged antibiotic treatment. Continuation of data collection across centers seems reasonable.

An atraumatic approach to the inner ear is an important goal in the future development of cochlear implant surgery, as the current surgical procedure for electrode insertion is highly invasive. To reduce invasiveness, minimally invasive surgical options are being explored, such as the insertion of one or more drill channels. Due to the proximity to critical structures, a temperature sensor is incorporated into the medical drill for process parallel temperature monitoring to prevent thermal damage. The temperature data is sent to the analysis hardware via Bluetooth BLE. This requires a power supply for the electronics on the drill. There are a number of limitations to the design of such a power supply. For one, the drill is rotating. Therefore, the energy generation must be contactless. Secondly, the energy generation should not depend on the rotation of the drill, so that the temperature can be measured even without the drill rotating and the rotational speed of the drill is not limited. In this paper, we propose a solution for a contactless energy transmission system (ETS) based on inductive coupling. Considering the dimensional limitations of attaching the electronics to the drill shaft, a multilayer PCB coil with multiple contacts for different number of turns is developed. The electrical circuit is simulated and the best settings are identified. The power supply is validated according to the predefined requirements. In the future, the medical drill will be built with the newly developed ETS. Sterilization and wear tests are performed to confirm the suitability of the drill with integrated temperature sensor for the operating room.

Einleitung Schwindel gehört zu den häufigsten Symptomen der Medizin, jedoch ist die Diagnostik sehr komplex und von der Expertise des Untersuchers abhängig. Zudem ist diese Erfahrung sowie teure, apparative, störanfällige Diagnostik nicht flächendeckend vorhanden.

Other Supporting Colleagues from Clinical Predictors for Germline Mutations in Head and Neck Paraganglioma Patients: Cost Reduction Strategy in Genetic Diagnostic Process as Fall-Out