This national survey is the largest series of nasal vestibule cancer ever published. Wang classification is more prognostic and easier to use than the Union Internationale Contre le Cancer 2002. Surgery or hypofractionated RT can be used for T1 lesions, whereas larger lesions should be treated with combined approach.

NA. Laryngoscope, 126:1883-1888, 2016.

Cochlear implantation has successfully restored the perception of hearing for nearly 200 thousand profoundly deaf adults and children. More recently, implant candidature has expanded to include those with considerable natural hearing which, when preserved, provides an improved hearing experience in noisy environments. But more than half of these patients lose this natural hearing soon after implantation. To reduce this burden, biosensing technologies are emerging that provide feedback on the quality of surgery. Here we report clinical findings on a new intra-operative measurement of electrical impedance (4-point impedance) which, when elevated, is associated with high rates of postoperative hearing loss and vestibular dysfunction. In vivo and in vitro data presented suggest that elevated 4-point impedance is likely due to the presence of blood within the cochlea rather than its geometry. Four-point impedance is a new marker for the detection of cochlear injury causing bleeding, that may be incorporated into intraoperative monitoring protocols during CI surgery. The preservation of cochlear structure and residual functional hearing has become the standard of care for cochlear implantation (CI). Hearing preservation is important to facilitate combined electrical and acoustic stimulation of the cochlea, as this improves speech recognition in noise and music appreciation 1-4. Cochlear structural preservation will ensure that the ear is ready for future, regenerative therapies 5,6. Structural and functional preservation of the cochlea depends not only upon the electrode design, but also the surgery. Electrodes must be introduced into the cochlea without causing injury. Until recently, technologies have not existed to guide the surgeon during the implant procedure; the operation has been conducted "blind" without the provision of feedback. Over recent years, we and others have begun to monitor cochlear function during cochlear implantation 7-10 , using the CI's own electrodes to monitor the electrophysiological response of the ear to acoustic stimulation. This technique, known as electrocochleography, has provided valuable information to guide surgeons during the operation; if the electrophysiological response is preserved during surgery, residual hearing is better after implantation 7-10. This paper is motivated by a desire to increase the scope of intraoperative monitoring during CI surgery. Current methods allow real-time detection of cochlear dysfunction, but these do not assess cochlear injury directly. Here we report on a method that has this potential. We have monitored "four-point" electrical impedance (4PI) from the implant's intracochlear electrodes during CI surgery. This impedance measurement is acquired by passing current between two outer electrodes whilst the voltage (from which the impedance may be inferred) is measured between two inner electrodes (Fig. 1A). The method is believed to assess the bulk impedance between the two inner electrodes, and has been used to differentiate between tissue and fluid ...

ObjectiveTo investigate a new wide bone-anchored hearing implant considering initial stability, stability over time, implant loss, and skin reaction.Study DesignConsecutive, prospective case series.SettingTertiary referral center.PatientsTwenty adult patients were enrolled. All operations were 1-stage, single-incision technique with subcutaneous reduction.Intervention(s)Measurement of implant stability.Main Outcome Measure(s)Implant stability quotient (ISQ) values were recorded using resonance frequency analysis at the time of implantation and at 10 days, 6 weeks, 6 months, and 1 year after surgery. Skin and soft tissue reactions according to Holgers grading system.ResultsImplant stability quotient measurements revealed a significant increase in ISQ during the first 10 days after operation, and the ISQ values continued to rise throughout the 1-year observation period. No implants were lost. Skin and soft tissue reactions were rare and minor, as no reaction was seen in 93% of the follow-up examinations and no grade 4 reactions occurred.ConclusionThe new wide implant showed good stability at surgery. Osseointegration was fast, and implant stability increased throughout the 1-year observation period. No implants were lost. Skin and soft tissue reactions were rare and minor.

Objective: To investigate the effect on final-product performance of a distributed, virtual reality (VR) simulation training program on cadaveric dissection performance and learning curves compared with standard VR simulation training during a temporal bone course. Study Design: Educational interventional cohort study. Setting: The national Danish temporal bone courses of 2016 and 2017. Subjects: Postgraduate year 2 to 5 residents in otorhinolaryngology. Intervention: Nine participants volunteered for additional VR simulation training (intervention) before the temporal bone course, with training blocks distributed (i.e., separated). The remaining 28 participants received standard VR simulation training during the temporal bone course (control). Main Outcome Measure: VR simulation and cadaveric dissection final-product performances were analyzed by blinded raters using a 26-item modified Welling Scale. Results: Distributed VR simulation training before the temporal bone course (intervention) significantly increased dissection final-product performance by 25% compared with standard VR simulation training during the course (control) (mean scores 12.8 points versus 10.3 points, p < 0.01). Distributed and repeated VR simulation practice markedly decreased drilling time. Guidance by the simulator-integrated tutor-function significantly increased final-product performance by 2.3 points compared with nontutored procedures but at the cost of increased drilling time. Conclusion: Skills acquired in a VR simulation environment translate to cadaveric dissection skills and repeated and distributed VR simulation can be used to further increase performance compared with standard VR simulation training during a temporal bone course. Further dissemination of inexpensive VR simulators would allow all future temporal bone course participants to train locally before attending future centralized courses.

The degree of pain and time to return to work following superficial parotidectomy has not previously been reported. Pain is measured by use of visual analogue scale and the use of analgesics is registered 14 days after superficial parotidectomy. Results showed that pain is generally weak after superficial parotidectomy and can be treated with mild analgesics. Pain is considerably lower than, e.g. after tonsillectomy. Median number of days until total recovery was 12 days (range: 3-70), and median time to return to work was 16 days (range: 3-70). We recommend 2 weeks recreation period after superficial parotidectomy.

Objective:To investigate the clinical outcome of a surgical technique with tissue preservation for a wide bone-anchored hearing implant concerning postoperative complications, skin reactions, implant loss, and implant stability.Study Design:Consecutive, prospective case series.Setting:Tertiary referral center.Patients:Twenty-four adult patients with normal skin quality were enrolled.Intervention(s):Implantation of bone-anchored implant was performed using a one-stage linear-incision technique with tissue preservation surgery.Main Outcome Measures(s):Skin and soft tissue reactions according to Holgers grading system. Pain and numbness measured according to visual analogue scale. Implant stability quotient values were recorded using resonance frequency analysis. Follow-up at 10 days, 6 weeks, 6 months, and 1 year after surgery.Results:Primary implant stability was good and a significant increase in implant stability quotient occurred during the first 10 days and continued to be stable throughout the 1-year observation period. No implants were lost. Skin and soft tissue reactions were few, no reaction (Holger grade 0) was observed in 88% of the follow-up examinations and no grade 4 reactions occurred. Pain and numbness were minimal.Conclusion:The wide implant showed good stability initially and throughout the observation period. Skin and soft tissue reactions were rare and minor. No implants were lost.

Objective Mastoidectomy is a cornerstone in the surgical management of middle and inner ear diseases. Unfortunately, training is challenged by insufficient access to human cadavers. Three-dimensional (3D) printing of temporal bones could alleviate this problem, but evidence on their educational effectiveness is lacking. It is largely unknown whether training on 3D-printed temporal bones improves mastoidectomy performance, including on cadavers, and how this training compares with virtual reality (VR) simulation. To address this knowledge gap, this study investigated whether training on 3D-printed temporal bones improves cadaveric dissection performance, and it compared this training with the already-established VR simulation. Study Design Prospective cohort study of an educational intervention. Setting Tertiary university hospital, cadaver dissection laboratory, and simulation center in Copenhagen, Denmark. Methods Eighteen otorhinolaryngology residents (intervention) attending the national temporal bone dissection course received 3 hours of mastoidectomy training on 3D-printed temporal bones. Posttraining cadaver mastoidectomy performances were rated by 3 experts using a validated assessment tool and compared with those of 66 previous course participants (control) who had received time-equivalent VR training prior to dissection. Results The intervention cohort outperformed the controls during cadaver dissection by 29% ( P < .001); their performances were largely similar across training modalities but remained at a modest level (~50% of the maximum score). Conclusion Mastoidectomy skills improved from training on 3D-printed temporal bone and seemingly more so than on time-equivalent VR simulation. Importantly, these skills transferred to cadaveric dissection. Training on 3D-printed temporal bones can effectively supplement cadaver training when learning mastoidectomy.