Localization of the Vertical Part of the Facial Nerve in the High-Resolution Computed Tomography During Pediatric Cochlear Implantation

BACKGROUND

This study proposed a classification of the vertical portion of the facial nerve (VPFN) location, incorporating the previous classifications regarding the posterior-to-anterior and medial-to-lateral dimensions. We also evaluated the implication of this proposed classification on the round window visibility during pediatric cochlear implantation (CI).

METHODS

It was a retrospective multicenter observational cohort study. This study included 334 cases that underwent CI between 2015 and 2022 at multiple referral institutes. Two physicians evaluated the preoperative computed tomography images of 334 patients and determined the radiological type of the VPFN. These types were matched with intraoperative round window accessibility.

RESULTS

The Spearman's correlation coefficient showed a strong correlation between the proposed VPFN type and the intraoperative round window visibility, as the P-value was <.001.

CONCLUSION

This classification could provide the surgeon preoperatively with the precise location of the VPFN in the lateral-to-medial and posterior-to-anterior dimensions. Furthermore, this location classification of the VPFN was significantly correlated with intraoperative round window accessibility, with an accuracy of 90.42%. Therefore, types C and D were expected to have difficult accessibility into the round window, and more surgical interventions were needed to modify the posterior tympanotomy or use other approaches.

Intra-operative ultrasound versus wire-guided localization in the surgical management of non-palpable breast cancer

BACKGROUND

Non-palpable breast lesions require some method of localization when performing breast conserving surgery (BCS). Despite the advent of newer techniques, ultrasound (US) and wire-guided localization (WGL) remain the most popular approaches.

OBJECTIVE

We aim to compare the positive margin rate of US versus WGL in the excision of breast lesions.

METHODS

Data were collected from the Clinical Access Portal. All patients who underwent US or WGL BCS were identified and consecutive data collected. Positive margins were evaluated using histopathology reports. Baseline demographics and specimen size data were also collected.

RESULTS

A total of 198 patients were included in total over a three-year period. There was some evidence of an association of type of surgery with positive margin (OR=2.11, p=0.075) where a 2.11 fold increase in the odds of a positive margin was estimated for the US method relative to WGL, but this was not statistically significant at the 5% level. This effect decreased after adjusting for potential confounders (OR=1.81, p=0.34).

CONCLUSIONS

This retrospective study of US versus WGL in BCS demonstrated no significant difference in the positive margin rate, although a trend was observed in favor of the WGL group. We have provided further evidence for the debate on the accuracy of US and WGL for non-palpable breast lesions. Available data remains sparse, and our results contradict the findings of other comparative studies.