Neoadjuvant Immunotherapy for Head and Neck Squamous Cell Carcinoma:Expecting Its Application in Temporal Bone Squamous Cell Carcinoma

Temporal bone malignant tumors are characterized by atypical clinical symptoms,and easy recurrence and metastasis.They account for 0.2%of head and neck tumors,and the most common pathological type is squamous cell carcinoma.Patients with squamous cell carcinoma of the temporal bone are often at advanced stages when diagnosed,and lose the chance for surgery.Neoadjuvant immunotherapy has recently been approved as the first-line treatment for refractory recurrent/metastatic squamous cell carcinoma of the head and neck.However,it remains to be determined whether neoadjuvant immunotherapy can be used as the first-line treatment for temporal bone squamous cell carcinoma to reduce the tumor stage before surgery,or as a palliative treatment for patients with unresectable advanced stage carcinoma.The present study reviews the development of immunotherapy and its clinical application in head and neck squamous cell carcinoma,summarizes the treatment of temporal bone squamous cell carcinoma,and prospects the neoadjuvant immunotherapy as the first-line treatment for temporal bone squamous cell carcinoma.

Standardization of experimental animals temporal bone sections

Preparation of the temporal bone for light microscopy is an important step in histological studies of the inner ear. Due to the complexity of structures of the inner ear, it is difficult to measure or compare structures of interest without a commonly accepted standardized measure of temporal bone sections. Therefore, standardization of temporal bone sections is very important for histological assessment of sensory hair cells and peripheral ganglion neurons in the cochlear and vestibular systems. The standardized temporal bone sectioning is oriented to a plane parallel to the outer and internal auditory canals. Sections are collected from the epitympanum to the hypotympanum to reveal layers in the order of the crista ampullaris of the superior and lateral semicircular canals, macula utriculi and macula sacculi, superior vestibular ganglion neurons, macula of saccule and inferior vestibular ganglion neurons, cochlear modiolus, endolymphatic duct and endolymphatic sac, and finally the crista ampullaris of the posterior semicircular canal. Moreover, technical details of preparing for temporal bone sectioning including fixation, decalcification, whole temporal bone staining, embedding penetration, and embedding orientation are also discussed.

SUBJECTIVE TINNITUS AS FIRST PRESENTATION IN A PATIENT WITH METASTATIC LUNG CANCER IN TEMPORAL BONE-A CASE REPORT

Metastasis of lung cancer to the temporal bone is a very rare disease and subjective tinnitus as the present-ing symptom in these patients is even rarer. Here we report a case in which a 42-year-old male presented with subjective tinnitus of three months, with no pulmonary disease symptoms. Pure tone audiometry indi-cated moderate conductive deafness in left ear with an air-bone gap of 21.3 dB. HRCT temporal bone scan-ning indicated high-density shadows in the left epitympanic cavity, sinus tympani and mastoid cavity. Chron-ic otitis media with cholesteatoma was suspected and surgical treatment recommended. However, preopera-tive chest x-ray revealed high-density millet lesions scattered widely in both lungs. HRCT lung scanning confirmed the lungs lesions and indicated lung cancer. In order to determine correlations between the tempo-ral bone and pulmonary lesions, a CT-guided trans-mastoid aspiration biopsy and immunohistochemical study were conducted, which confirmed that the temporal bone lesion was metastatic from the lungs. The pa-tient was given a series of chemotherapy immediately and his tinnitus significantly improved after three months of treatment, with full recovery of his hearing and complete resolution of shadows in the mastoid cavity. Unfortunately, he subsequently developed multiple bone metastases in the 9th month and cerebral metastasis in the 18th month. Multiple organ failure resulted in death in 2.5 years.

Combined Subtemporal-Supralabyrinthine Approach to Geniculate Ganglion for Management of Facial Paralysis in Temporal Bone Fracture

Objective To investigate the clinical outcomes of facial never decompression via a combined subtemporal-su- pralabyrinthine approach to geniculate ganglion for management of facial paralysis in temporal bone fracture. Methods Eighteen patients with unilateral facial paresis due to temporal bone fracture were treated between March 2003 and March 2011. Facial function was House-Braekmann（HB） grade m in 6 patients, HB grade V in 9 patients and HB grade VI in 3 patients. The preoperative mean air conduction threshold was 52 dB HL for the 15 cases with longitudinal temporal bone fracture and showed severe sensorineural heating loss in the 3 cases with transverse temporal bone fracture. Fracture lines were detected in 15 cases on temporal bone axial CT scans and ossicular disruption was determined in 11 cases by virtual CT endoscopy. The geniculate ganglion or the tympanic mastoid segment of the facial nerve showed an irregular morphology on curved planar reformation images of the facial nerve canal. After an intact canal wall mastoi- do-epitympanectomy, the ossicular chain recess was opened by drilling through the was disrupted, the incus was removed to damage was evaluated. If the ossicular chain was intact, the supralabyrinthine cells between the tegmen tympani and ossicular chain. If the ossicular chain access the supralabyrinthine recess. The geniculate ganglion and the distal labyrinthine segment of the facial nerve were exposed. After completing facial nerve decompression, the dislocated incus was replaced, or a fractured incus was reshaped to bridge the space between the malleus and the stapes. Results Pronounced ganglion geniculatum swelling was found in 15 cases of longitudinal temporal bone fracture, with greater petrosus nerves damage in 3 cases and bleeding in 5 cases. Disrupted ossicular chains were seen in 11 cases, including dislocated incus resulting in crushing of the horizontal portion of the facial nerve in 3 cases and fracture of the incus long process in 1 case. In 3 cases of transverse fractures, dehiscence on the promontory, semicircular canal or oval window was found. All cases had primary healing with no complication. At follow-ups ranging from 0.5 to 3 years （average 1.2 years）, facial nerve function recovered to HB grade I in 11 cases, 11 in 5 cases and m in 2 cases. Overall hearing recovery was 33 dB. Conclusion The clinical outcomes concerning facial nerve function and hearing recovery are satisfactory via a combined subtemporal-supralabyrinthine approach to the geniculate ganglion for facial nerve decompression in temporal bone fracture patients with facial paralysis.

Characteristic anatomical structures of rat temporal bone

As most gene sequences and functional structures of internal organs in rats have been well studied,rat models arc widely used in experimental medical studies.A large number of descriptions and atlas of the rat temporal bone have been published,but some detailed anatomy of its surface and inside structures remains to be studied.By focusing on some unique characteristics of the rat temporal bone,the current paper aims to provide more accurate and detailed information on rat temporal bone anatomy in an attempt to complete missing or unclear areas in the existed knowledge.We also hope this paper can lay a solid foundation for experimental rat temporal bone surgeries,and promote information exchange among colleagues,as well as providing useful guidance for novice researchers in the field of hearing research involving rats.

CT VIRTUAL ENDOSCOPY IN ASSESSING OSSICULAR CHAIN DISRUPTION CSUSED BY TEMPORAL BONE FRACTURE AND EAR TRAUMA

Objective To explore the value of computed tomography virtual endoscopy(VE) in assessing ossicular chain disruption in temporal bone fracture and ear trauma with intact tympanum. Methods High resolution spiral computerized tomography(CT) was completed in 35 cases of temporal bone fracture and 5 cases of tympanum trauma, all with intact or healed tympanum. Three-dimensional reconstruction was completed using a virtual endoscopy software. Audiological tests were conducted in all patients and evaluation of facial nerve injury in patients with facial paralysis. Patients with mild conductive deafness, ossicular chain subluxation on VE, and no facial paralysis were treated conservatively for 4-12 weeks with repeated hearing evaluation; those with facial paralysis underwent surgery if no recovery after 4- 8 weeks of conservative treatment. Patients with moderate to severe conductive hearing loss or mixed hearing loss, incus long process fracture or dislocation on VE and facial paralysis, underwent ossicular chain reconstruction and facial nerve decompression after conservative treatment for 4-8 weeks, or exploratory tympanotomy only if no facial paralysis. VE, audiological tests and facial nerve function tests were repeated in 3-6 months after surgery. Results Of the 6 cases with mild conductive hearing loss, ossicular chain subluxation and no facial paralysis, 3recovered to normal hearing spontaneously and 3 showed no significant improvement, after 4-12 weeks of conservative treatment. After conservative treatment for 4-8 weeks, 3 of the 12 cases with mild conductive deafness, ossicular chain dislocation on VE and facial paralysis recovered to normal hearing and HouseBrackmann(HB) grade I facial function from HB grade II,4 showed facial function recovery to HB grade I(n=2) or II(n=2) from HB grade III but no hearing recovery, and 5 gained no recovery and went on to receive exploratory tympanotomy and facial nerve decompression. The 11 cases with moderate to severe conductive deafness, incus long process fracture or dislocation on VE and facial paralysis all received ossicular chain reconstruction and facial nerve decompression after 4-8 weeks of conservative treatment. The 7 cases with moderate to severe conductive deafness, dislocated or fallen incus on VE but no facial paralysis received ossicular chain reconstruction after conservative treatment. The 4 cases with mixed hearing loss, dislocated or fallen incus on VE and no facial paralysis received ossicular chain repair via the intact canal wall epitympanum approach after conservative treatment. Pharmacological therapies continued postoperatively in these patients to treat sensorineural deafness. Although temporal bone CT scans displayed the fracture line and malleus/incus abnormalities, VE provided additional detailed information on dislocation of incudomalleal and incudostapedial joints, incus dislocation or fracture, separation between crus longum incudis and stapes, and incus shifting. These were all confirmed during surgery. VE results and surgery findings were 100% consistent in patients with ossicular chain disruption. Conclusion VE can provide reliable visual evidence for accurate assessment of traumatic ossicular chain disruption, timing of surgery and individualizing surgical strategies and postoperative follow-up.

Langerhans' Cell Histiocytosis (Histiocytosis X) of the Temporal Bone

Objectives Langerhans’ Cell histiocytosis (LCH) is a rare disease, which remains poorly understood and whose cellular origin remains unknown. To increase understanding of temporal bone LCH, it is necessary to study recent advances in the diagnosis and treatment of this disease. Methods The long term(5 to 30 years) results of 21 temporal bone LCH cases treated between 1973 and 2003 were reviewed. Surgery, radiotherapy, pharmacologic therapy or a combination of these treatments were employed in these cases. Results Eighteen patients were cured(18/21, 85%). Six patients developed residual diabetes insipidus (DI) and dwarfism (28%). Three patients died(14%). Conclusions The Alessi classification system for LCH based on the extent of disease accurately predicts prognosis and is a useful guide in selecting treatment methodologies. X-ray, computed tomography and magnetic resonance imaging have proved useful in defining the extent of osseous and soft tissue diseases. Diagnosis of LCH is based on clinical presentations, radiographic findings and histopathological results. Surgery and radiotherapy are the main treatment modalities. Pharmacologic therapy should be used in patients with aggressive, disseminate, and refractory lesions. LCH has a predilection for children and prognosis depends on age and extent of vital organ involvement.

Virtual Temporal Bone Anatomy

Background The Visible Human Project(VHP) initiated by the U.S. National Library of Medicine has drawn much attention and interests from around the world. The Visible Chinese Human(VCH) project has started in China. The current study aims at acquiring a feasible virtual methodology for reconstructing the temporal bone of the Chinese population, which may provide an accurate 3-D model of important temporal bone structures that can be used in teaching and patient care for medical scientists and clinicians. Methods A series of sectional images of the temporal bone were generated from section slices of a female cadaver head. On each sectional image, SOIs (structures of interest) were segmented by carefully defining their contours and filling their areas with certain gray scale values. The processed volume data were then inducted into the 3D Slicer software(developed by the Surgical Planning Lab at Brigham and Women’s Hospital and the MIT AI Lab) for resegmentation and generation of a set of tagged images of the SOIs. 3D surface models of SOIs were then reconstructed from these images. Results The temporal bone and structures in the temporal bone, including the tympanic cavity, mastoid cells, sigmoid sinus and internal carotid artery, were successfully reconstructed. The orientation of and spatial relationship among these structures were easily visualized in the reconstructed surface models. Conclusion The 3D Slicer software can be used for 3- dimensional visualization of anatomic structures in the temporal bone, which will greatly facilitate the advance of knowledge and techniques critical for studying and treating disorders involving the temporal bone.

Embryonal Rhabdomyosarcoma of Middle Ear and Temporal Bone: A Rare Case Report

Introduction: Rhabdomyosarcoma accounts for up to 60% of childhood soft tissue sarcoma, occurring mostly in the head and neck region but rarely in the ear and temporal areas. Case Report: A 4-year-old boy came to our hospital due to a purulent discharge, bleeding from his left ear. Also seen mass in the left ear along with facial weakness and diplopia. After histopathologic evaluation, it was diagnosed as embryonal rhabdomyosarcoma. Conclusion: Rhabdomyosarcoma should be kept in mind as a differential diagnosis in all children presenting with otitis media with mastoiditis. Biopsy should be considered who are not responding to medications and those worsening condition.

Validation of a 3D-printed human temporal bone model for otology surgical skill training

Hypothesis:Three-dimensional(3D)printed temporal bones are comparable to cadaveric temporal bones as a training tool for otologic surgery.Background:Cadaveric temporal bone dissection is an integral part of otology surgical training.Unfortunately,availability of cadaveric temporal bones is becoming much more limited and concern regarding chemical and biological risks persist.In this study,we examine the validity of 3D-printed temporal bone model as an alternative training tool for otologic surgery.Methods:Seventeen otolaryngology trainees participated in the study.They were asked to complete a series of otologic procedures using 3D-printed temporal bones.A semi-structured questionnaire was used to evaluate their dissection experience on the 3D-printed temporal bones.Results:Participants found that the 3D-printed temporal bones were anatomically realistic compared to cadaveric temporal bones.They found that the 3D-printed temporal bones were useful as a surgical training tool in general and also for specific otologic procedures.Overall,participants were enthusiastic about incorporation of 3D-printed temporal bones in temporal bone dissection training courses and would recommend them to other trainees.Conclusion:3D-printed temporal bone model is a viable alternative to human cadaveric temporal bones as a teaching tool for otologic surgery.

Evaluation and significance of Eustachian tube angles and pretympanic diameter in HRCT temporal bone of patients with chronic otitis media

Objective:To evaluate the significance of Eustachian tube(ET)angles and ET pretympanic diameter on high resolution computed tomography(HRCT)Temporal bone in patients with chronic otitis media(COM).Methods:A retrospective study was carried out at Tertiary care centre.Group A included 92 ears with COM(38 patients with bilateral COM and 16 with unilateral COM);and Group B included 108 normal ears(54 patients with bilateral normal ears).Reid plane-ET angle,Tubotympanic angle and the ET pretympanic diameter was evaluated by HRCT temporal bone,and compared in the two groups.Patients with chronic otitis media(Group A)were subdivided into Group A1(Blocked ET)and Group A2(Patent ET).The parameters were evaluated and compared in the subgroups too.Results:The mean Reid plane-ET angle and Tubotympanic angle in Group A was 25.41
2.57 and 148.12
3.43 respectively;whereas in Group B it was 27.56
3.62 and 145.14
4.34 respectively.Reid plane-ET angle was significantly less in patients with COM and Tubotympanic angle was significantly more obtuse in COM patients.ET pretympanic diameter was(5.37
2.10)mm in Group A and(6.47
2.40)mm in Group B.It was significantly less in patients with COM.A significant correlation was found between the ET patency and the two ET parameters(Reid plane-ET angle and pretympanic diameter).Conclusions:Eustachian tube angles in adults may play a significant role in the etiology of chronic otitis media.Decrease in Reid plane-ET angle and pretympanic diameter on HRCT temporal bone can be used to predict ET dysfunction and to plan the surgical management of chronic otitis media.

Stereo morphology of temporal bone and ear

Background The temporal bone has the most complicated anatomic feature among the whole human body, which always challenges otolaryngologists. This study was to study three-dimensional (3D) morphology of the temporal bone and the ear by means of a computer image processing technique, for the purpose of providing a 3D image to help in pathological, diagnostic and surgical procedures Methods Forty sets of temporal bone celloidin serial sections with reference points were prepared and the contours of selected structures and reference points were entered into a graphics programme The technique of computer-aided 3D reconstruction was applied to obtain 3D images and parameters of the temporal bones and the ears Stereo views of the ossicles (n=5), the facial nerves (n=11), the posterior tympanic sinuses (n=11), the posterior ampullary nerves (n=4), the endolymphatic ducts and sacs (n=5), and the bony and membranous labyrinth (n=1) were reconstructed Results Three-dimensional images, including the cochlea, the ossicles, the nerves, the tendons and the endolymphatic fluid system in the temporal bone, were obtained Stereo picture pairs and 3D parameters of spatial dimensions, angle and volume for these reconstructed structures were calculated The arrangement of the ossicles, spatial relationship of the bony and membranous labyrinth, the whole course of the facial nerves, the endolymphatic sac and posterior tympanic cavity were clearly observable Stereo picture pairs made the spatial relationships among the above-mentioned structures much clearer The operation of the posterior ampullary nerve transection was designed and simulated on the graphic computer based on 3D anatomic investigations Conclusion The technique of computer-aided 3D reconstruction provides a new tool to observe the morphology of the temporal bone and thus may allow design and study of new surgical approaches

17例耳硬化症患者的临床与影像学分析

目的分析17例耳硬化症患者的临床特征、影像学表现及手术治疗效果。方法收集2020年5月~2023年5月在湖州市中心医院接受手术治疗的17例(17耳)耳硬化症患者临床、影像学资料,分析其临床表现、颞骨CT影像学表现及手术前后纯音测听结果变化。结果17例(17耳)患者中,11耳(64.71%)为前庭窗型,表现为进行性传导性听力损失,其中9耳有耳鸣,3耳有轻微平衡问题;混合型6耳(35.29%)显示混合性听力损失,5耳有耳鸣,3耳有偶发性平衡障碍。影像学上,前庭窗型显示镫骨底板区域骨质增厚、前庭窗密度增加;混合型则显示镫骨底板增厚及耳蜗周围密度减低,1耳可见“双环征”,两种类型耳硬化症患者骨密度差异无统计学意义(P>0.05)。术后均未见耳鸣加重或其他严重并发症,仅2例(11.76%)出现暂时性头晕,术后随访显示术区恢复良好,无感染或其他迟发性并发症;术后听力测试显示气导阈值、气骨导差较术前显著改善(P均<0.05)。结论前庭窗型和混合型耳硬化症的影像学和临床表现各有特点,镫骨成形术可显著改善听力,降低气导阈值和气骨导差,且手术安全、并发症少。

以面瘫为首要表现的颞骨占位病变2例

1 临床资料例1,患者,男,35岁,因发现右耳后肿物,反复破溃伴感染1年有余,不伴局部疼痛、耳痛及耳道内流脓,于2017-09-04入院。22年前患者右耳听力逐渐下降,无耳痛、流脓,未行系统治疗。20年前自述"受凉"后出现右侧面瘫,当地医院考虑为"吊线风"、"面神经炎",未行影像学检查,采用针灸、贴膏药等治疗无好转。

儿童颞骨乳突B淋巴母细胞淋巴瘤1例

1临床资料患儿,男,9岁,主因间断右侧口角歪斜1月余,加重伴耳痛3天于2019-05-28入院。患儿入院前1月余无明显诱因间断出现右侧口角歪斜,伴右眼偏斜,偶伴右耳疼痛,每次持续约20~100 min,可自行恢复正常,病情间断反复发作,无发热、头痛、头晕及眩晕,无张口受限,无耳溢液及听力下降,曾就诊于神经内科,诊断不详,予营养神经等治疗后病情无缓解。入院前3天患儿无明显诱因口角歪斜呈持续性,伴右侧耳痛,门诊考虑“右侧周围性面神经麻痹待查;右侧中耳乳突炎”收治入院。患儿既往体健,家族中无遗传性疾病史。专科查体:右侧额纹消失,右眼闭合不全,无溢泪,右侧鼻唇沟变浅,口角对称,张口时口角左偏,伸舌无偏斜;双侧耳廓无畸形,右侧外耳道变窄、后壁肿胀,鼓膜不能窥及;右侧乳突区压痛;鼓腮漏气;左耳(-)。面神经检测未见异常。颞骨CT示右侧中耳鼓室及乳突小房渗出性病变,未见骨质破坏(图1A)。

Understanding the effects of structured self-assessment in directed,self-regulated simulation-based training of mastoidectomy:A mixed methods study

Objective:Self-directed training represents a challenge in simulation-based training as low cognitive effort can occur when learners overrate their own level of performance.This study aims to explore the mechanisms underlying the positive effects of a structured self-assessment intervention during simulation-based training of mastoidectomy.Methods:A prospective,educational cohort study of a novice training program consisting of directed,self-regulated learning with distributed practice(5x3 procedures)in a virtual reality temporal bone simulator.The intervention consisted of structured self-assessment after each procedure using a rating form supported by small videos.Semi-structured telephone interviews upon completion of training were conducted with 13 out of 15 participants.Interviews were analysed using directed content analysis and triangulated with quantitative data on secondary task reaction time for cognitive load estimation and participants’self-assessment scores.Results:Six major themes were identified in the interviews:goal-directed behaviour,use of learning supports for scaffolding of the training,cognitive engagement,motivation from self-assessment,selfassessment bias,and feedback on self-assessment(validation).Participants seemed to self-regulate their learning by forming individual sub-goals and strategies within the overall goal of the procedure.They scaffolded their learning through the available learning supports.Finally,structured self-assessment was reported to increase the participants’cognitive engagement,which was further supported by a quantitative increase in cognitive load.Conclusions:Structured self-assessment in simulation-based surgical training of mastoidectomy seems to promote cognitive engagement and motivation in the learning task and to facilitate self-regulated learning.

Middle ear osteoma causing Eustachian tube obstruction:A case report and literature review

Middle ear osteoma is an extremely rare benign tumor of the middle ear.Due to its very slow growth rate and benign nature,osteoma of the middle ear can be found incidentally without causing any symptoms.The most common clinical signs are conductive hearing loss,the sense of fullness in the ear,tinnitus,and otorrhea.Small-sized osteomas can be misdiagnosed as otosclerosis without showing any signs other than conductive hearing loss.When the mass becomes very large,and symptoms caused by the tumor increase,treatment also becomes difficult.In this paper,we report a case of middle ear osteoma causing conductive hearing loss and effusion due to the effect of pressure on the middle ear ossicles and the Eustachian tube.We also present a review of the pertinent literature.

Surgical Management of Traumatic Facial Paralysis:A Case Review Study

Objective To evaluate efficacy of surgical treatment in traumatic facial paralysis.Methods:Thirty-three cases were reviewed,including temporal bone fracture and iatrogenic facial nerve injury.All the patients were treated with various surgical methods according to their pathogeny.Results The mean percentage facial function improvement (House-Brackmann GradeⅠ-Ⅱ) was 86% in temporal bone fracture and function was improved after proper operation to iatrogenic facial nerve injury.Conclusions Patients with traumatic facial paralysis receive proved outcomes itreaed with proper surgical methods according to their particular condition of nerve injury.

The diagnostic conundrum in necrotizing otitis externa

Necrotizing otitis externa(NOE)is an aggressive and fast‐evolving infection of the external auditory canal.Late diagnoses and untreated cases can lead to severe,even fatal consequences and so early diagnosis and treatment are paramount.NOE is a notoriously challenging diagnosis to make.It is therefore important to understand what diagnostic modalities are available and how otolaryngologists can use them to accurately treat such an aggressive disease.This review aims to evaluate the different diagnostic options available in NOE and discuss their advantages and limitations,thus,providing an up‐to‐date picture of the multimodal approach required in the diagnosis of this disease.

Endolymphatic sac papillary tumor： a case report

Endolymphatic sac papillary tumor （ELST） is an extremely rare and aggressive tumor characterized by hearing loss and temporal bone destruction. A case with clinical, imaging, pathologic and treatment data is reported and relevant literature is reviewed. A 25-year-old woman, with ELST underwent craniotomy for tumor subtotal resection, and the diagnosis was confirmed by pathologic examination. Postoperative radiotherapy consisted of 50.4 Gy/28 f was given accordingly. The patient is currently alive with no signs of tumor recurrence locally and no radiation side-effects observed after one year follow-up. Complete resection is impossible in most cases, local resection, adjuvant radiotherapy may provide favored local control. A long-term follow-up is highly advocated in consideration of its slow development course.