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Analysis of skull base reconstruction methods in huge cranial-nasal communication defect: Bilateral reverse temporalis muscle flap and free flap

Fri, 01 May 2026 00:00:00 GMT

Title: Analysis of skull base reconstruction methods in huge cranial-nasal communication defect: Bilateral reverse temporalis muscle flap and free flap Authors: Nuch, Kong Srey; Hong, Jong Won; Lee, Won Jai; Chang, Jong Hee; Kim, Chang Hoon Abstract: Background: Effective skull base reconstruction for huge cranial-nasal defects is critical to restoring function and esthetics and preventing complications, such as cerebrospinal fluid (CSF) leakage and ascending infection. We introduced and evaluated two advanced surgical methods of reconstruction: bilateral reverse temporalis muscle flaps and free flaps. Methods: A retrospective review of 16 patients (11 males and 5 females) who underwent skull base reconstruction from January 2017 to December 2024 was conducted. Bilateral reverse temporalis muscle flaps or free flaps, predominantly anterolateral thigh flaps and one rectus myocutaneous flap, were used. Data included patient demographics, defect origins, pathological lesions, reconstruction methods, and postoperative outcomes. Results: Huge cranial-nasal defects resulted from benign tumors (n=3), malignant tumors (n=10), or mucocele/infection (n=3). The defect originated from the nasal cavity (n=12), and the cranium (n=4), with an average defect size of 23.8 +/- 9.3 cm2. Reconstruction was performed using bilateral reverse temporalis muscle flaps (n=6) or free flaps (n=10). Both reconstruction methods effectively prevented CSF leakage and ensured primary healing. Complication rates were comparable, with free flap reconstructions associated with fewer postoperative issues. There were no significant differences in operation times or hospital stays between the two techniques. Conclusion: Bilateral reverse temporalis muscle and free flaps were both effective for skull base reconstruction in patients with huge cranial-nasal communication defects. Bilateral reverse temporalis flaps provide reliable vascularization without microsurgery, and free flaps offer customizable volume. The reconstruction approach should be tailored to the defect size, donor site condition, and surgeon's expertise. (c) 2026 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.

Application of Patient-operated Otoscope in Diagnosing Patulous Eustachian Tube Dysfunction

Wed, 01 Apr 2026 00:00:00 GMT

Title: Application of Patient-operated Otoscope in Diagnosing Patulous Eustachian Tube Dysfunction Authors: Yun, Ji Min; Cheon, Tae Uk; Park, Soobin; Bae, Seong Hoon Abstract: Objective: A patulous Eustachian tube (PET) is characterized by persistent Eustachian tube patency, leading to symptoms, such as aural fullness, autophony, and audible breathing. The diagnostic criteria include both characteristic symptoms and objective findings; however, intermittent symptom presentation often prevents confirmation during clinic visits, leading to underdiagnosis. We aimed to evaluate the clinical utility of a patient-operated portable digital otoscope for confirming the diagnosis of PET. Study design: Prospective observational study. Setting: The study was conducted between January 2024 and July 2025 in a tertiary referral center. Patients: Patients with possible PET, defined by characteristic symptoms and positional improvement, but without observed tympanic membrane (TM) fluctuations during in-clinic evaluation. Intervention: Patient-operated portable digital otoscope for confirming the diagnosis of PET. Main outcome measure: Clinical utility of a patient-operated portable digital otoscope for confirming the diagnosis of PET. Results: Among 62 ears from 48 patients with possible or definite PET, 31 (50%) were initially diagnosed with definite PET. Of 24 patients (31 ears) with possible PET findings, 15 (18 ears) participated in the study. TM fluttering was detected in 8 ears in patient-operated recordings, increasing the definite PET rate from 50.0% to 62.9% (P <0.001). Conclusion: Patient-operated portable digital otoscopy significantly increased the objective confirmation of PET and addressed the diagnostic gap due to intermittent symptoms. This approach enables timely symptom-triggered TM visualization beyond clinical settings, potentially reducing diagnostic delays and unnecessary repeat visits.

Rare missense variants in MYO7A and OTOP2 genes in a South Korean Meniere's disease cohort

Wed, 01 Apr 2026 00:00:00 GMT

Title: Rare missense variants in MYO7A and OTOP2 genes in a South Korean Meniere's disease cohort Authors: Pham, Mai T.; Cruz-Granados, Pablo; Nadar-Ponniah, Prathamesh T.; Chua, Han Chow; Jang, Seung Hyun; Gee, Heon Yung; Jung, Jinsei; Choi, Jae Young; Kim, Sung Huhn; Lopez-Escamez, Jose A. Abstract: Background Meniere's disease (MD) is a polygenic condition defined by episodes of vertigo associated with sensorineural hearing loss and tinnitus. Genetic studies in familial MD in East Asian populations are limited, and the potential MD genes remain to be established in non-Finnish European populations.Methods By exome sequencing and rare variant analysis, we have searched for existing and novel genes associated with MD in a South Korean cohort of 16 MD individuals with bilateral sensorineural hearing loss.Results We have found one individual with two rare missense variants in the OTOP2 gene, a new candidate gene for MD and three heterozygous variants in the MYO7A gene, supporting the hypothesis of biallelic inheritance. Wild-type and mutated protein models were compared, and currents were measured in the human proton channel OTOP2 expressed in Xenopus laevis oocytes to further elucidate functional consequences. Structural changes in the T364M or H435Q OTOP2 variants were not associated with changes in measured currents, regardless of pH or Ca2+ concentrations.Conclusion The OTOP2 gene is a novel candidate for the audiovestibular dysfunction observed in MD. Furthermore, rare variants in the MYO7A gene, previously associated with European MD, have been found in the South Korean cohort. The OTOP2 protein was found in the basal cells of the stria vascularis, spiral ganglion neurons and inner hair cells in the organ of Corti, suggesting a dual role in endolymphatic homeostasis and neural signal transmission.

A 62-aa core of the cochlin LCCL domain induces macrophage M1 polarization in vitro

Sun, 01 Mar 2026 00:00:00 GMT

Title: A 62-aa core of the cochlin LCCL domain induces macrophage M1 polarization in vitro Authors: Kim, Hyoyeol; Bae, Seong Hoon; Jang, Seung Hyun; Yoon, Soljee; Kim, Kyeonghwan; Jang, Seung Hyeon; Gee, Heon Yung; Kim, Youngsoo; Jung, Jinsei; 장승현 Abstract: BackgroundCochlin, encoded by the COCH gene, mediates innate immunity against bacterial infections by segregating pathogens and recruiting immune cells through its N-terminal LCCL domain. This domain is cleaved and secreted to attract macrophages and neutrophils, but its core motif has remained unclear.MethodsWe designed and synthesized a shortened core peptide of the LCCL domain (cLCCL; 62 amino acids) preserving the conserved structural motif. Structural stability was predicted by in silico modeling. The immunomodulatory effects of LCCL and cLCCL were evaluated in RAW264.7 macrophage cells using bulk RNA sequencing, quantitative PCR, Western blotting, flow cytometry, and immunocytochemistry.ResultsRNA sequencing in RAW264.7 cells showed that both LCCL and synthetic cLCCL peptides induced M1 polarization, with upregulation of TICAM2, CD40, and CD86. Flow cytometry demonstrated a significant increase in CD40(+)/CD86(+) M1-polarized macrophages following LCCL or cLCCL treatment, with comparable effects between the full-length and core peptides.ConclusionThe identified cLCCL appears to promote pro-inflammatory macrophage polarization, activate pro-inflammatory innate immune pathways, and warrants further evaluation in mechanistic and in vivo studies.