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Robotics throughout orthopaedic surgical treatment: the reason why, what and how?
These findings indicate that the automated facial expression analysis can quantify differences in context-dependent facial responses in the patient recruited in this study.

This case study demonstrates the feasibility of using automated facial expression analysis to quantitatively evaluate the differences in facial expressions and their corresponding emotions in a single patient with MCS.
This case study demonstrates the feasibility of using automated facial expression analysis to quantitatively evaluate the differences in facial expressions and their corresponding emotions in a single patient with MCS.
South Africa, and the African continent, have a shortage of ear, nose and throat (ENT) specialists. The coronavirus disease 2019 (COVID-19) pandemic not only had an adverse impact on specialist training, but also impacted the ability of trainees to undertake the final examinations in order to qualify as ENT specialists.

The response to the COVID-19 pandemic resulted in the postponement of the final examination of the Fellowship of the College of Otorhinolaryngologists of South Africa (FCORL (SA)). A virtual clinical examination was held via videoconferencing to assess clinical judgement, insight, reasoning and decision making.

The virtual clinical assessment allowed trainees to undertake the final examination despite the COVID-19 pandemic, ensuring that they could be added to the limited number of specialists in South Africa and the African continent.
The virtual clinical assessment allowed trainees to undertake the final examination despite the COVID-19 pandemic, ensuring that they could be added to the limited number of specialists in South Africa and the African continent.
Videofluoroscopy (VFSS) and fibreoptic endoscopic evaluation of swallowing (FEES) are established instrumental techniques to support differential diagnosis and treatment of oropharyngeal dysphagia. Whilst their value is undisputed, each tool is not without limitations. The COVID-19 pandemic has restricted access to VFSS and FEES leading clinicians to explore alternative or augmentative tools to support swallowing assessment.Ultrasound (US) is an established tool for visualisation of head and neck anatomy, including structures implicated in swallowing. Although US has been utilised in swallowing research for many years, its application has not translated into common clinical practice. This review presents and debates the evidence for and against use of US for clinical swallowing assessment.

Evaluation of swallowing muscle morphometry and measurement of isolated swallowing kinematics are two primary uses of US in swallowing assessment that have been identified in the literature. Use of US to detect bolus flow, aspiration and residues is in its early stages and needs further research.

US shows promise as an adjunctive modality to support assessment of swallowing. With standardisation, these measurements may have potential for transition into clinical care. Reliability and validity testing and development of normative data are imperative to ensure its use as an evidence-based instrumentation.
US shows promise as an adjunctive modality to support assessment of swallowing. With standardisation, these measurements may have potential for transition into clinical care. Reliability and validity testing and development of normative data are imperative to ensure its use as an evidence-based instrumentation.
A transcanal endoscopic approach enables visualization of the variable course of the chorda tympani inside the middle ear.

The chorda tympani is the longest intrapetrous branch of the facial nerve. Despite having been investigated in several studies, a description of its tympanic tract from an endoscopic point of view is lacking in the literature.

We performed transcanal endoscopic dissections of 44 human cadaveric head and ear specimens. The entry point of the chorda tympani into the middle ear was classified into four categories according to its location, and as covered or dehiscent according to its appearance. The chordal eminence (CE) was defined as absent, shallow, intermediate, prominent, or fused, based on its shape and extension. The relationship of the chorda tympani to adjacent bony and ligamental structures was assessed.

The tympanic tract of the chorda tympani was divided into three portions. The periannular segment was dehiscent in 54.5% of specimens, with type II being the most frequent entry point configuration (52.3%). In the interossicular segment, the nerve consistently passed lateral to the incus and medial to the malleus. The course of the intrapetrous segment was independent from the conformation of the tensor fold and supratubal recess.

The transcanal endoscopic approach allows a detailed description of tympanic segment of the chorda tympani. Novel anatomic classifications of the chorda tympani and CE are proposed herein to highlight their possible surgical implications during otologic procedures.
The transcanal endoscopic approach allows a detailed description of tympanic segment of the chorda tympani. Novel anatomic classifications of the chorda tympani and CE are proposed herein to highlight their possible surgical implications during otologic procedures.
To evaluate the efficacy of mirror biofeedback rehabilitation for synkinesis in severe acute facial paralysis in children.

Eight pediatric patients with facial paralysis with an initial electroneurography (ENoG) value less than 10% who underwent mirror biofeedback rehabilitation (the child-rehabilitation group) were enrolled. Seven infants (under age 2 yr) who were unable to undergo rehabilitation (the infant-and-toddler control group) and adult patients (n = 13, range, 33-56 yr) who underwent rehabilitation (the adult-rehabilitation group) comprised the control groups. All the patients enrolled were baseline House-Brackmann (H-B) grade VI at onset. The patients began daily facial biofeedback rehabilitation using a mirror at the first sign of muscle contraction on the affected side and were instructed to keep their eyes symmetrically open using a mirror during mouth movements. selleck chemical The training was continued for 12 months after the onset of facial paralysis. The degree of oral-ocular synkinesis was evaluated by the degree of asymmetry in eye opening width during mouth movements. The synkinesis index was calculated as a percentage of the interpalpebral space width ([normal side - affected side]/normal side). Statistical analyses used non-parametric tests (the Kruskal-Wallis test and Steel-Dwass posthoc test).

The synkinesis index was significantly lower in the child-rehabilitation group than in the infant-and-toddler control group or the adult-rehabilitation group (p < 0.001).

Children who underwent mirror biofeedback rehabilitation had less synkinesis than the infant-and-toddler control group, suggesting that mirror biofeedback rehabilitation is more effective in preventing the exacerbation of synkinesis in children.
Children who underwent mirror biofeedback rehabilitation had less synkinesis than the infant-and-toddler control group, suggesting that mirror biofeedback rehabilitation is more effective in preventing the exacerbation of synkinesis in children.
The light emitted from the endoscope during transcanal endoscopic ear surgery (TEES) heats the intratympanic space. This heat may potentially be dangerous to nearby important structures, as documented by in vitro and by animal and cadaveric studies. The aim of our work was to monitor middle ear temperatures during TEES in vivo.

Cohort study.

Tertiary referral hospital.

Four patients (15-69 yrs old) underwent transcanal endoscopic tympanoplasties for chronic perforation or retraction.

After elevating the tympanomeatal flap, a thermocouple was placed in the middle ear to measure the heat generated by a 30° Hopkins rod telescope (11 cm long, 2.7 mm wide) and fiberoptic light emitting diode light source.

Middle ear temperature in the retrotympanum was monitored under these conditions at 50 and 100% light intensity, after removing and wiping the endoscope tip, during suctioning and following middle ear irrigation.

Maximum middle ear temperature ranged from 36.26-37.30°C. Pulling out and wiping the endoscope caused no change or minimal decrease of 0.16°C. Middle ear irrigation caused a temperature drop of 2.05°C to 5.11°C. Suctioning was associated with a drop from 0.24°C to 3.91°C that was dependent on the depth of the endoscopic tip.

Middle ear temperatures during TEES using a Hopkins rod telescope and light-emitting diode light source reach values corresponding to physiological body temperature, and do not reach dangerous levels.
Middle ear temperatures during TEES using a Hopkins rod telescope and light-emitting diode light source reach values corresponding to physiological body temperature, and do not reach dangerous levels.
Conductive hearing loss (CHL) commonly arises in patients with spontaneous dehiscence of the tegmen of the temporal bone with meningoencephalocele (SME). The aim of this study was to further investigate 1) the potential mechanisms for CHL in this setting; 2) hearing outcomes following surgery to address SME, and 3) the possible causes of persistent CHL following surgery.

Retrospective case review.

Tertiary referral center.

Seven patients (six female; nine ears) who underwent middle cranial fossa repair of SME and were found to have a tegmen tympani dehiscence from October 2010 to September 2014 were included in the study.

Pre- and postoperative pure-tone audiometry.

Eight of nine ears (89%) had audiometric hearing loss at presentation. Seven ears (78%) had an air bone gap of ≥15 dB; all of these had an encephalocele traversing the tegmen tympani defect, four had a middle ear effusion, and three had a simultaneous superior semicircular canal dehiscence (SSCCD). The CHL resolved postoperatively in four of seven ears. Two of the three ears with persistent CHL had SSCCD. Attic ossicular fixation was identified in the other patient and the CHL resolved after ossiculoplasty.

CHL associated with SME can be attributed preoperatively to ossicular chain fixation and synchronous SSCCD as well as the more commonly cited cerebrospinal fluid effusion and prolapse of meningoencephalocele onto the ossicular chain. Persistent postoperative CHL can also occur due to SSCCD and ossicular fixation by adhesions.
CHL associated with SME can be attributed preoperatively to ossicular chain fixation and synchronous SSCCD as well as the more commonly cited cerebrospinal fluid effusion and prolapse of meningoencephalocele onto the ossicular chain. Persistent postoperative CHL can also occur due to SSCCD and ossicular fixation by adhesions.
To examine the relationship between the Functional Gait Assessment (FGA) and quality of life (QOL) measurements relating to balance before and after vestibular schwannoma (VS) resection and to assess the role of preoperative FGA in predicting postoperative QOL.

A prospective clinical study of adult patients undergoing VS resection between September 2018 and December 2019. FGA was administered 1 week before and after surgery. Dizziness Handicap Inventory (DHI) and Penn Acoustic Neuroma Quality of Life (PANQOL) were administered preoperatively and at 3 months postoperatively.

Single tertiary center.

Patients (age ≥ 18 years old) with VS undergoing microsurgical resection. Excluded were patient with previous surgery or radiation.

VS resection.

Primary outcome correlation between FGA and QOL surveys. Secondary outcome correlation between preoperative measurements of balance and postoperative PANQOL.

One hundred thirty-eight patients were analyzed (mean age 48 years old, 65.9% female). The translabyrinthine approach was most commonly performed.
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