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Osseointegrated implants inserted in the temporal bone are a vital component of bone-anchored hearing systems (BAHS). Despite low implant failure levels, early loading protocols and simplified procedures necessitate the application of implants which promote bone formation, bone bonding and biomechanical stability. Here, screw-shaped, commercially pure titanium implants were selectively laser ablated within the thread valley using an Nd:YAG laser to produce a microtopography with a superimposed nanotexture and a thickened surface oxide layer. State-of-the-art machined implants served as controls. After eight weeks' implantation in rabbit tibiae, resonance frequency analysis (RFA) values increased from insertion to retrieval for both implant types, while removal torque (RTQ) measurements showed 153% higher biomechanical anchorage of the laser-modified implants. Comparably high bone area (BA) and bone-implant contact (BIC) were recorded for both implant types but with distinctly different failure patterns following biomechanical testing. Fracture lines appeared within the bone ~30-50 μm from the laser-modified surface, while separation occurred at the bone-implant interface for the machined surface. Strong correlations were found between RTQ and BIC and between RFA at retrieval and BA. In the endosteal threads, where all the bone had formed de novo, the extracellular matrix composition, the mineralised bone area and osteocyte densities were comparable for the two types of implant. Using resin cast etching, osteocyte canaliculi were observed directly approaching the laser-modified implant surface. Transmission electron microscopy showed canaliculi in close proximity to the laser-modified surface, in addition to a highly ordered arrangement of collagen fibrils aligned parallel to the implant surface contour. It is concluded that the physico-chemical surface properties of laser-modified surfaces (thicker oxide, micro- and nanoscale texture) promote bone bonding which may be of benefit in situations where large demands are imposed on biomechanically stable interfaces, such as in early loading and in compromised conditions.

Background Segmentation of important structures in temporal bone CT is the basis of image-guided otologic surgery. Manual segmentation of temporal bone CT is time- consuming and laborious. We assessed the feasibility and generalization ability of a proposed deep learning model for automated segmentation of critical structures in temporal bone CT scans. Methods Thirty-nine temporal bone CT volumes including 58 ears were divided into normal (n = 20) and abnormal groups (n = 38). Ossicular chain disruption (n = 10), facial nerve covering vestibular window (n = 10), and Mondini dysplasia (n = 18) were included in abnormal group. All facial nerves, auditory ossicles, and labyrinths of the normal group were manually segmented. For the abnormal group, aberrant structures were manually segmented. Temporal bone CT data were imported into the network in unmarked form. The Dice coefficient (DC) and average symmetric surface distance (ASSD) were used to evaluate the accuracy of automatic segmentation. Results In the normal group, the mean values of DC and ASSD were respectively 0.703, and 0.250 mm for the facial nerve; 0.910, and 0.081 mm for the labyrinth; and 0.855, and 0.107 mm for the ossicles. In the abnormal group, the mean values of DC and ASSD were respectively 0.506, and 1.049 mm for the malformed facial nerve; 0.775, and 0.298 mm for the deformed labyrinth; and 0.698, and 1.385 mm for the aberrant ossicles. Conclusions The proposed model has good generalization ability, which highlights the promise of this approach for otologist education, disease diagnosis, and preoperative planning for image-guided otology surgery.

Purpose Otology and neuro-otology surgeries pose significant challenges due to the intricate and variable anatomy of the temporal bone (TB), requiring extensive training. In the last years 3D-printed temporal bone models for otological dissection are becoming increasingly popular. In this study, we presented a new 3D-printed temporal bone model named 'SAPIENS', tailored for educational and surgical simulation purposes. Methods The 'SAPIENS' model was a collaborative effort involving a multidisciplinary team, including radiologists, software engineers, ENT specialists, and 3D-printing experts. The development process spanned from June 2022 to October 2023 at the Department of Sense Organs, Sapienza University of Rome. Acquisition of human temporal bone images; temporal bone rendering; 3D-printing; post-printing phase; 3D-printed temporal bone model dissection and validation. Results The 'SAPIENS' 3D-printed temporal bone model demonstrated a high level of anatomical accuracy, resembling the human temporal bone in both middle and inner ear anatomy. The questionnaire-based assessment by five experienced ENT surgeons yielded an average total score of 49.4 ± 1.8 out of 61, indicating a model highly similar to the human TB for both anatomy and dissection. Specific areas of excellence included external contour, sigmoid sinus contour, cortical mastoidectomy simulation, and its utility as a surgical practice simulator. Conclusion We have designed and developed a 3D model of the temporal bone that closely resembles the human temporal bone. This model enables the surgical dissection of the middle ear and mastoid with an excellent degree of similarity to the dissection performed on cadaveric temporal bones.

•A comprehensive review of Eagle Syndrome has been presented including diagnosis, work-up, and management.•There are medical and surgical treatment options for Eagle Syndrome.•Given the non-specific symptoms, imaging is crucial in the diagnosis of this disorder. The objective of this report is to summarize the symptoms, diagnostic workup, necessary imaging, and management of Eagle syndrome. A comprehensive literature review was conducted on peer-reviewed publications of Eagle syndrome across multiple disciplines in order to gain a thorough understanding of the presentation, diagnosis, and management of this disorder. Diagnoses of Eagle Syndrome have increased, in part due to the awareness of physicians to patient symptomatology. While cervical pain and dysphagia are among the typical symptoms, patients can present with a wide spectrum of benign and dangerous symptoms. CT scan is the gold standard for diagnosis and can be aided by both 3D reconstructive imaging and Angiography. Treatment strategies include medical management (analgesics, corticosteroids, antidepressants, and anticonvulsants) and varied surgical approaches (extraoral, transoral, endoscopic assisted). Increased understanding by providers treating patients with Eagle Syndrome allows for a more comprehensive treatment plan. With a variety of medical regimens and more definitive surgical approaches, Eagle Syndrome can be treated safely and effectively.

Bell’s palsy is the most common condition involving a rapid and unilateral onset of peripheral paresis/paralysis of the seventh cranial nerve. It affects 11.5–53.3 per 100,000 individuals a year across different populations. Bell’s palsy is a health issue causing concern and has an extremely negative effect on both patients and their families. Therefore, diagnosis and prompt cause determination are key for early treatment. However, the etiology of Bell’s palsy is unclear, and this affects its treatment. Thus, it is critical to determine the causes of Bell’s palsy so that targeted treatment approaches can be developed and employed. This article reviews the literature on the diagnosis of Bell’s palsy and examines possible etiologies of the disorder. It also suggests that the diagnosis of idiopathic facial palsy is based on exclusion and is most often made based on five factors including anatomical structure, viral infection, ischemia, inflammation, and cold stimulation responsivity.

Objective Our study focused on the development and evaluation of the SAPIENS (Specific Anatomical Printed-3D-model In Education and New Surgical Simulations) as a valid tool for otologic surgical education. Methods Twenty junior otolaryngologist surgeons in training were enrolled in the study. Each participant was invited to perform dissection of three different temporal bones. 1)Transparent 3-D printed model; 2)Opaque 3-D model; 3)fresh frozen human temporal bone. Following their drilling experience, participants answered to two specific questionnaires. The first was a questionnaire developed by Mowry et al. to evaluate 3D models in its general characteristics of anatomy and dissection, while the second one was a questionnaire specifically designed to compare the 3-D printed models with the human fresh frozen temporal bone. Results The average total score of the questionnaire was calculated as 53.2/61 in transparent 3-D model and 55.4/61 in the opaque 3-D model. These values indicate that the 3D printed models closely resemble the human TB in terms of anatomy and dissection. Comparisons of the 3D model and human TB were rated as very similar in all surgical steps. The total score was 4/5 in the transparent 3-D model and 4.2/5 in the opaque 3-D model. Conclusion We have designed and developed a 3D-printed model of the temporal bone that closely resembles the human temporal bone. The SAPIENS 3-D printed temporal bone model could be considered a valuable tool for advancing oto-surgical education due to its similarity to the human temporal bone in terms of anatomy and dissection.

PurposeHigh-resolution multislice CT (HR-MSCT) and cone beam CT (CBCT) are commonly used for preoperative temporal bone imaging, with HR-MSCT often preferred due to its shorter scan duration and lower susceptibility to motion artifacts. However, recent advancements in accelerated flat panel CT (Acc-FPCT) available with the latest generation angiography systems have addressed traditional limitations of CBCT by significantly decreasing scan time. This cadaver-based study evaluates the diagnostic performance and radiation dose of Acc-FPCT compared to HR-MSCT in preoperative temporal bone imaging.MethodsSix different Acc-FPCT protocols were acquired on five whole-head cadaveric specimens (ten temporal bones). Three neuroradiologists experienced in temporal bone imaging assessed the image quality of Acc-FPCT protocols in comparison to that of HR-MSCT for the visualization of 31 landmarks of middle and inner ear using a 5-point Likert scale. We also compared radiation dose parameters (CT dose index and dose length product) among the protocols.ResultsTwo high-Resolution Acc-FPCT protocols were found to be superior to HR-MSCT by all raters (p < 0.001). There were no significant differences between the two HR-FPCT protocols (p = 0.25). The remaining Acc-FPCT protocols were rated significantly inferior to HR-MSCT. The inter-rater reliability was excellent (ICC (2,k) = 0.925; CI [0.92–0.93]). The dose length product was significantly lower in all Acc-FPCT protocols compared to HR-MSCT.ConclusionThe results of our cadaver-based study highlight the utility of certain Acc-FPCT protocols as a viable alternative to HR-MSCT in preoperative temporal bone imaging, improving the visualization of critical anatomical landmarks without increasing radiation exposure.

Bone conduction implants are used to treat hearing loss by transmitting mechanical vibrations to the inner ear via bone screws anchored in the temporal bone. Secure screw fixing is essential for an efficient signal transmission and implant stability. We hypothesized that regions of higher bone density should be prioritized for screw placement to optimize fixing. This ex-vivo study aimed to validate the Screw Implantation Safety Index (SISI), computed as the percentage of the insertion path characterized by dense bone, as a preoperative marker for safe and effective screw placement. We analyzed 24 bone samples (1cm3) extracted from the temporal bones of two Thiel-preserved cadaver heads. Each specimen underwent quantitative computed-tomography (CT) and micro-CT (μCT) imaging to determine SISI values. Self-tapping titanium screws (5mm) were inserted, and pull-out testing was conducted to assess maximum pull-out force, stiffness, and strain energy at the bone-screw interface. Linear regression models were used to evaluate associations between SISI and mechanical stability. SISI values ranged from 29% to 81% (μCT) and 39% to 93% (clinical CT). The average pull-out force was 535N (standard deviation of 151N), with weak but statistically significant correlations between CT-based SISI scores and pull-out force (R2=0.24, p=.01), as well as strain energy (R2=0.23, p=.01). Comparison with μCT data validated the clinical CT results. Our findings suggest that the SISI score could enhance preoperative planning for bone conduction implants by guiding optimal screw placement. Further research is needed to assess its clinical feasibility and impact on long-term implantation outcomes.

PurposeA distinct form of cochlear hypoplasia, characterized by the preservation of the first half of the basal turn with hypoplastic and anteriorly displaced upper turns, was historically associated with branchio-oto-renal (BOR) syndrome, but can also occur in other genetic, syndromic and non-syndromic causes of hearing loss. This study aims to describe this phenotype with relative preservation of the basal turn, particularly its first half, in a significant proportion of cochlear hypoplasia cases due to different causes.MethodsWe retrospectively reviewed temporal bone imaging from 125 patients (250 ears) with cochlear malformations from a tertiary pediatric center, focusing on cases where the basal turn was partially or completely preserved. Temporal bone CT and internal auditory meatus MRI were assessed for cochlear morphology and associated anomalies and genetic, clinical and syndromic associations described.ResultsFifty-eight patients exhibited a preserved basal turn with different degrees of hypoplasia of the upper turns. These cases were grouped into five etiological clusters: branchio-oto-renal (BOR), CHARGE, Walker-Warburg (WWS) syndromes, other genetic cases and likely non-genetic cases (including syndromic conditions without a genetic cause identified such as oculo-auriculo-vertebral spectrum - OAVS). Genetic cases may show bilateral and symmetrical appearances, aberrant facial nerve courses were observed in 30 patients.ConclusionsPreservation of the first half of the basal turn suggests developmental arrest between 50 and 54 days of gestation, and is common across genetic and non-genetic conditions of cochlear hypoplasia. Frequent facial nerve anomalies may complicate cochlear implantation. Integrating imaging with embryological insights supports the need for refined, developmentally-based classification systems.

Purpose To investigate the influence of arcuate eminence’s distance to temporal bone outer table (AE-OT) on surgical outcomes following the middle fossa repair of superior canal dehiscence (SCD). Methods We conducted a cohort study of consecutive repairs at a center between 2011 and 2022. AE-OT was measured on temporal bone CT imaging. Surgical outcomes were assessed with established metrics including Symptom Resolution Score (SRS), rate of Overall Symptom Improvement (OSI), and change in low-frequency air–bone gap (ΔLF-ABG) from pre- to post-surgery. Multivariable regression models assessing surgical outcomes were constructed with AE-OT as the primary predictor. Models adjusted for patient demographics, medical and surgical history, and follow-up duration. Results A total of 402 repairs were included. Mean AE-OT was 27.1 mm (SD 2.1, range 20.8–33.9). Every mm increase in AE-OT was independently associated with a 14% reduction in odds of OSI (aOR 0.86, 95% C.I. [0.75, 0.98]) and a 4-point decrease in SRS (adj. β − 4.0 [− 6.9, − 1.1]) among frank dehiscences. AE-OT was also not associated with operative duration and ΔLF-ABG among both frank dehiscences and near dehiscences. Conclusions Longer AE-OT predicted poorer symptomatic response but similar operative duration and audiometric improvement among frank SCD cases.