How employees' lean construction competence affects construction safety performance.

This study empirically tested the relationship between sub-dimensions of employees' lean construction (LC) competence and construction safety performance (SP), while incorporating organizational LC competence as a mediator. Data were collected from 710 employees on 300 construction projects. The hypothesis model was validated using multiple regression analysis. The results show that employees' cognitive competence can positively influence construction SP both directly and indirectly via organizational LC competence. However, employees' social competence had a direct negative effect on construction SP, but it can have an indirect positive effect on construction SP via organizational LC competence. Coincidentally, employees' continuous improvement competence had no direct effect on construction SP, but it can have an indirect positive impact via organizational LC competence. This article clarifies the definition of LC competence and empirically validates its influence on construction SP, enriching LC management theory and guiding managers on how to improve construction SP in LC practice.

Do CT values change over time and correlate with hearing in the non-surgical ears of otosclerosis patients?

BACKGROUND: High-resolution computed tomography (HRCT) is often used to diagnose otosclerosis. AIMS/OBJECTIVES: To investigate whether CT values change over time and correlate with hearing in the non-surgical ears of otosclerosis patients. MATERIALS AND METHODS: 32 patients with bilateral otosclerosis who had undergone unilateral stapedectomy were enrolled in the study. HRCT examination and pure tone audiometry were performed before and after the surgery. CT values of different regions of interest (ROIs) were measured manually and the data were collected for analysis. RESULTS: The CT value of anterior to the inner auditory meatus (AIAM) decreased by 88.5 HU (p < .05), and the changes in CT values in other ROIs showed no statistical difference. Regarding hearing, the value of air bone gap (ABG) increased by 3.6 dB (p = .020), and the average hearing deterioration rate of ABG was 3.1 dB/year. The CT value of the mid-point of the stapes footplate (MPSF) showed a certain correlation with the change of ABG (p < .05). CONCLUSIONS AND SIGNIFICANCE: The CT value of AIAM may change over time. The overall hearing of non-surgical ears in otosclerosis patients shows a deteriorating trend. Moreover, the changes in the CT value of MPSF may be related to the hearing, which needs further research.

Study on Spacing Regulation and Separation Performance of Nanofiltration Membranes of GO.

Graphene oxide (GO) membranes have attracted significant attention in the field of water processing in recent years due to their unique characteristics. However, few reports focus on both membrane stability and the "trade-off" effect. In this study, a series of aliphatic diamines (1, 2-ethylenediamine, 1, 4-butanediamine, and 1, 6-hexamethylenediamine) of covalent crosslinked GO were used to prepare diamine-modified nanofiltration membranes, BPPO/AX-GO, with adjustable layer spacing using the vacuum extraction−filtration method. Moreover, Ax-GO-modified nanofiltration membranes modified with adipose diamine had higher layer spacing, lower mass-transfer resistance, and better stability. When the number of carbon atoms was 5, the best layer spacing was reached, and when the number of carbon atoms was greater than 4, the modified membrane nanosheets more easily accumulated. With the increase in layer spacing, the water flux of the composite film increased to 26.27 L/m2·h·bar. Meanwhile, adipose diamine crosslinking significantly improved the stability of GO films. The interception sequence of different valence salts in the composite membrane was NaCl > Na2SO4 > MgSO4, and the rejection rate of bivalent salts was higher than that of monovalent salts. The results can provide some experimental basis and research ideas for overcoming the "trade-off" effect of a lamellar GO membrane.

Unexpected Branch Malformation of the Facial Nerve during Stapes Surgery: Comparison between Intraoperative and Radiographic Findings.

The aim of this study was to determine the prevalence of facial nerve (FN) bifurcation in patients who undergo stapes surgery, and to ascertain the correlation between the intraoperative and radiographic findings in cases where an unexpected branch malformation for patients undergoing stapes surgery. Patients who underwent stapes surgery were retroactively examined for confirmed FN bifurcation. Among the 887 patients, 10 had a bifurcated FN confirmed during surgery and had a preoperative high-resolution computed tomography (HRCT) scan. The HRCT scans were examined by two radiologists who were blinded to the operational findings. The diagnostic accuracy of HRCT imaging was examined along with their preoperative audiometry. In total, 887 patients underwent stapes surgery and among them the prevalence of FN bifurcation was 1.13%. These 10 patients had a 1:1 male-female ratio with a mean age of 17.9 ± 7.0 years. From a surgical review, all cases had bifurcation at the horizontal segment of FN, including 1 case of FN trifurcation. The diagnostic difference between HRCT imaging and intraoperation observations for malformations in the middle ear varies widely depending on the location, ranging from 0% to 90%. The prevalence of incus and stapes malformations was high in both imaging and operation findings (≥60%). The detection rate of abnormal positioning and bifurcation of the FN during HRCT imaging was 30% and 0%, respectively. The mean air-bone gap hearing threshold for patients was significantly improved from 42.3 dB preoperatively to 15.6 dB postoperatively without any complications. These results showed that it is extremely difficult to predict the FN bifurcation prior to surgery with a detection rate of 0%. The diagnostic difference between HRCT imaging and intraoperation observations for malformations of different parts of the middle ear varies widely. These results highlight the importance of being vigilant in regard to FN anatomical variation during stapes surgery for any unexpected malformations that are not detected during HRCT evaluation. In addition, the surgical outcomes for these patients were optimal when treatment was performed by senior surgeons.

Stability of computed tomography densitometry in patients with otosclerosis:a two-year follow-up.

OBJECTIVES: To quantify the progression of otosclerosis in the unoperated ear between two stapedotomy procedures for patients with bilateral otosclerosis which can help to determine whether a HRCT scan should be re-performed before the second surgery for patients who already received HRCT imaging before the initial surgery. METHODS: 35 patients who underwent bilateral stapedotomy were included. Two rounds of HRCT examination and audiometry were performed at the time of the first surgery and second surgery on the ear that was not operated on during the initial surgery. The relationship between the changes in HRCT densitometry and audiometry over time was analyzed. RESULTS: The second round of HRCT did not add significant information about the changes to the otosclerosis lesions in either the imaging diagnosis or the HRCT density values except for small changes in the HRCT densitometry readings at the area anterior to the inner auditory (P = 0.01). While the changes in HRCT manifestation are small, changes near the fissula ante fenestram (FAF) were still positively correlated with the air bone gap (ABG) of patients (p = 0.031, r = 0.388). CONCLUSIONS: The progression of lesions in otosclerosis is slow resulting in small and insignificant changes to the HRCT features. Therefore, a repeat HRCT evaluations prior to surgery is not necessary for patients who have had a previous HRCT evaluation within 2 years of the operation. The small changes in HRCT manifestation near the FAF were still correlated with negative effects on the ABG which could cause worsened hearing thresholds over this timeframe.

Atypical manifestations of acute coronary syndrome - throat discomfort: a multi-center observational study.

To present the clinical characteristics and the misdiagnosis rate of acute coronary syndrome manifested primarily as throat discomfort, we conducted a multicentric and retrospective study in the cardiology and otorhinolaryngology departments. Records of patients with primary complaint of throat discomfort, absence of chest pain at onset, and an ultimate diagnosis of acute coronary syndrome, as well as patients with pharyngitis (as controls) were collected from May 2015 to April 2016. The patients' main manifestations were compared. Logistic regression results showed that chest tightness, dyspnea, perspiring, and exertional throat symptoms were significantly associated with acute coronary syndrome, with odds ratios of 8.3 (95% CI 2.2-31.5), 10.9 (95% CI 1.8-66.9), 25.4 (95% CI 3.6-179.9), and 81.2 (95% CI 13.0-506.7). A total of 25 (56.82%) out of 44 acute coronary syndrome patients, who were first admitted to the otorhinolaryngology department, were misdiagnosed, with a 12% (3/25) mortality rate. Throat discomfort can be the principal manifestation of acute coronary syndrome. Such patients exhibit high misdiagnosis and mortality rates. Exertional throat symptoms, chest tightness, perspiring, and dyspnea were important indicators of acute coronary syndrome in patients whose main complaint was throat discomfort. The awareness of this condition will result in prompt diagnosis and reduce morbidity and mortality.

Whether cochlea involvement on CT in otosclerosis patients impacts the effect of stapedotomy.

BACKGROUND: The success rate of stapedotomy in otosclerosis patients with cochlea involvement was unknown. AIMS/OBJECTIVES: To determine the difference of surgical outcomes and symptomatology in otosclerosis patients with or without cochlea involvement on CT. MATERIAL AND METHODS: 79 otosclerosis patients were included and grouped by HRCT, including cochlear-involved otosclerosis (C-group) or non-cochlear-involved otosclerosis (NC-group, control group). Patients were defined as NC-group in the presence of normal or solely fenestral involvement, or C-group if the hypodensities involve other parts of the labyrinthine bone Patients in the control group were collected at a 2:1 ratio to the C-group with similar follow-up times. Detailed complaints and surgical outcomes were compared between these groups. RESULTS: Chief complaints were similar in the C-group and NC-group. Although postoperative AC, BC, and ABG decreased significantly in both groups, the success rate was significantly higher in C-group regarding the postoperative ABG ≤10 dB. Furthermore, diffuse lesions may indicate a more severe disease and a poorer prognosis. CONCLUSIONS AND SIGNIFICANCE: Stapedotomy was effective for clinical otosclerosis. The surgical outcome was inferior favorable for cochlea involvement patients, especially for cases with widely involvement. There was no difference in chief complaints among patients with different CT degree of otosclerosis.

The Impact of the Frequency-Specific Preoperative Sensorineural Hearing Loss to Postoperative Overclosure of Bone Conduction in Stapedotomy.

OBJECTIVE: To evaluate the frequency-specific relationships between the preoperative sensorineural hearing loss and postoperative overclosure of bone conduction (BC) threshold after stapedotomy. METHODS: We conducted a retrospective analysis of 207 otosclerosis patients who underwent stapedotomy in our hospital. Pre- and postoperative audiometry were collected between patients with or without preoperative sensorineural hearing loss (SNHL) component (i.e., SNHL group and non-SNHL group, respectively). Overclosure rate (OR), deterioration rate (DR), and their significant values (i.e., SOR or SDR) were compared between the sub-groups at each frequency to access the frequency-specific outcomes. RESULTS: There were 69 patients in non-SNHL group and 138 patients in SNHL group. Postoperative success rate was similar in non-SNHL group and SNHL group. For frequency-specific outcomes, both the OR and SOR were significantly obvious in all SNHL subgroups than those in non-SNHL subgroups (p < 0.001), except at 4 kHz for SOR. Extent of overclosure and significant overclosure were more obvious in SNHL subgroups than those in non-SNHL subgroups (p < 0.01). The DR and SDR of BC were significantly obvious at 1k to 4 kHz in non-SNHL subgroups than those in SNHL subgroups (p < 0.01), however, not so for the extent of deterioration (p > 0.05). Frequency-specific success rate was similar at each frequency. CONCLUSION: Stapedotomy was efficient and safe in patients with or without SNHL component preoperatively. Frequency-specific overclosure effect was more obvious in all tone frequencies in SNHL subgroups than those in non-SNHL subgroups. For frequency-specific outcomes, about 50% BC with preoperative SNHL component at tone frequency meet postoperative significant overclosure effect, which was most obvious at low frequencies.

Activation of the Melanocortin-4 receptor signaling by α-MSH stimulates nerve-dependent mouse digit regeneration.

BACKGROUND: Expression of Mc4r in peripheral organs indicates it has broader roles in organ homeostasis and regeneration. However, the expression and function of Mc4r in the mouse limb and digit has not been fully investigated. Our previous work showed that Mc4r-/- mice fail to regenerate the digit, but whether activation of MC4R signaling could rescue digit regeneration, or stimulate proximal digit regeneration is not clear. RESULTS: We analyzed the expression dynamics of Mc4r in the embryonic and postnatal mouse limb and digit using the Mc4r-gfp mice. We found that Mc4r-GFP is mainly expressed in the limb nerves, and in the limb muscles that are undergoing secondary myogenesis. Expression of Mc4r-GFP in the adult mouse digit is restricted to the nail matrix. We also examined the effect of α-MSH on mouse digit regeneration. We found that administration of α-MSH in the Mc4r+/- mice rescue the delayed regeneration of distal digit tip. α-MSH could rescue distal digit regeneration in denervated hindlimbs. In addition, α-MSH could stimulate regeneration of the proximally amputated digit, which is non-regenerative. CONCLUSIONS: Mc4r expression in the mouse limb and digit is closely related to nerve tissues, and α-MSH/MC4R signaling has a neurotrophic role in mouse digit tip regeneration.

Relationship between short-term and mid-term hearing outcomes after stapedotomy in patients with otosclerosis: an investigation.

BACKGROUND: Although stapedotomy is effective for patients with clinical otosclerosis, the time of hearing stabilization has not yet been consistent. OBJECTIVE: To investigate the relationships between post-operative follow-up times, hearing outcomes, and threshold shift after stapedotomy. MATERIALS AND METHODS: Fifty-five patients with clinical otosclerosis that underwent stapedotomy were retrospectively studied. Pure tone audiometry tests were conducted within the first month (short-term) and within 1 year (mid-term) postoperatively. Data were analyzed for two rounds of audiometry tests at different postoperative follow-up times. RESULTS: Air conduction (AC) and bone conduction (BC) were significantly correlated with preoperative hearing levels (p<.01). AC, BC, and air bone gap (ABG) significantly improved at the short-term (p<.001) and continued to improve at the mid-term (p<.01). The success rate of surgery increased from 87% at short-term to 98% at mid-term. Less than 1/3 of cases encountered BC deterioration at short-term, whereas most improved at mid-term. CONCLUSIONS: Hearing results showed a trend of improvement between short-term and mid-term follow-ups after stapedotomy. AC, ABG, and success rate displayed significant improvement several months postoperatively. BC deterioration occurred in less than 30% of patients at short-term. The recovery of BC at 4 kHz was later than that of low frequencies.

Finite element simulation of cochlear traveling wave under air and bone conduction hearing.

Besides the normal hearing pathway known as air conduction (AC), sound can also transmit to the cochlea through the skull, known as bone conduction (BC). During BC stimulation, the cochlear walls demonstrate rigid body motion (RBM) and compressional motion (CPM), both inducing the basilar membrane traveling wave (TW). Despite numerous measuring and modeling efforts for the TW phenomenon, the mechanism remains unclear, especially in the case of BC. This paper proposes a 3D finite element cochlea model mimicking the TW under BC. The model uses a traditional "box model" form, but in a spiral shape, with two fluid chambers separated by the long and flexible BM. The cochlear fluid was enclosed by bony walls, the oval and round window membranes. Contingent boundary conditions and stimulations are introduced according to the physical basis of AC and BC. Particularly for BC, both RBM and CPM of the cochlea walls are simulated. Harmonic numerical solutions are obtained at multiple frequencies among the hearing range. The BM vibration amplitude ([Formula: see text]) and its relation with volume displacement difference between the oval and round windows [Formula: see text], as well as the pressure difference at the base of the cochlea ([Formula: see text]), are analyzed. The simulated BM response at 12 mm from the base is peaked at about 3 k Hz, which is consistent with published experimental data. The TW properties under AC and BC are the same and have a common mechanism. (1) [Formula: see text] is proportional to [Formula: see text] at low frequencies. (2) [Formula: see text] is also proportional to [Formula: see text], within 5 dB error at high frequencies such as 16 k Hz. This study partly reveals the common quantitative relations between the TW and related factors under AC and BC hearing.

Changes of incudostapedial joint angle in stapedotomy: does it impact hearing outcomes?

PURPOSE: The aims of this article are: (1) is there an ideal incudostapedial joint (ISJ) angle after stapedotomy? (2) is there any difference between pre- and postoperative ISJ angle? and (3) what is the significance of the ISJ angle in postoperative hearing outcomes? METHODS: Forty six ears from 39 different adult patients (28 women and 11 men; 21 left and 25 right ears) with a mean age of 39 years with clinical otosclerosis who underwent stapedotomy between May 2017 and May 2019 were retrospectively registered, including seven bilateral surgery cases. ISJ angle and intravestibular depth of the stapes prosthesis were measured from multiple planar reconstruction-computed tomography images and the length of the prosthesis was measured during surgery. Relationships between the ISJ angle parameters and postoperative hearing outcomes and parameters of the prosthesis were analyzed. RESULTS: The mean ISJ angle was 93.3° ± 8.8° preoperatively and 101.9° ± 6.3° postoperatively, increasing by 8.6° during stapedotomy (p < 0.01). There were weak and negative correlations between ISJ angle changes and postoperative air conduction gains at frequencies ≤1 kHz and bone conduction gains at 0.5 kHz. When the postoperative ISJ angle changed more than 20°, the success rate of the procedure decreased to 0%. CONCLUSION: The stapedotomy operation increased the ISJ angle. The success of postoperative auditory outcomes had more to do with the ISJ angle change than the value of the angle itself, indicating there is no universal ideal ISJ angle that surgeons should aim for during stapedotomy.

Frequency-specific hearing results after stapes surgery for Chinese population otosclerosis with different degrees of hearing loss.

Background: Frequency-specific hearing studies are important for predicting hearing results and the prognosis after stapes surgery, to prepare for the rehabilitation of frequency-specific hearing in patients with otosclerosis.Objectives: To evaluate outcomes of stapes surgery of Chinese otosclerosis patients with different degrees of hearing loss.Methods: We conducted a retrospective analysis of 213 otosclerosis patients who underwent stapes surgery in our hospital. Pre- and post-operative audiometric evaluation using conventional audiometry.Results: The post-op ABG was less than 20 dB in 94.52% of all cases after surgery. There was no statistical significance of the post-op ABG among different groups at all frequencies except extremely severe group (p < .05). There was a significant improvement of both AC and BC thresholds in post-op period and the most significant improvement was found in severe group. There were no serious post-op complications and no re-operations during the follow-up period.Conclusion: Stapes surgery is a suitable treatment option for otosclerosis with mild to extremely severe HL. The mild to moderate hearing loss groups had the most significant improvement of AC thresholds in the low frequency region, and the severe to extremely severe groups appeared in the high frequency region.

Effect of esterified hyaluronic acid as middle ear packing in tympanoplasty for adhesive otitis media.

OBJECTIVES: The goal of this study was to evaluate the effects of middle ear packing agents (MEPA) on post-operative hearing improvement and complications after tympanoplasty in patients with adhesive otitis media (OM). MATERIALS AND METHODS: Patients with adhesive OM who underwent tympanoplasty surgery were enrolled in the study between January 2012 and January 2015. A total of 205 patients who received canal wall-down tympanoplasty with ossicular chain reconstruction were randomized into one of the three groups with different MEPA. Group 1 (n = 72) received MeroGel as the MEPA, Group 2 (n = 64) cartilage, and Group 3 (n = 69) both. Air conduction (AC) and bone conduction (BC) thresholds at 0.5, 1, 2, and 4 kHz were measured, and air-bone gaps (ABG) were analyzed before and after the surgery for each patient. RESULTS: Mean pre- and post-operative ABG was 30.9 dB and 17.6 dB in Group 1, 31.4 dB and 21.9 dB in Group 2, and 32.2 dB and 19.1 dB in Group 3. The ABG closure was 13.3 ± 7.5 in Group 1, 9.5 ± 5.9 in Group 2, and 13.1 ± 9.3 in Group 3. The improvement of ABG after surgery was statistically significant in all three groups (p < .05). The ABG closure was statistically significantly smaller in Group 2 than in other two groups (p < .05). CONCLUSIONS: Tympanoplasty using esterified hyaluronic acid (i.e. MeroGel) or cartilage as the MEPA resulted in improved hearing for patients with conductive hearing loss due to adhesive OM. Using MeroGel as the MEPA appeared to achieve a better post-operative outcome than using cartilage.

MPR-CT Imaging for Stapes Prosthesis: Accuracy and Clinical Significance.

OBJECTIVES: The aims of this article are: 1) to re-evaluate the accuracy of multiple planar reconstruction computed tomography (MPR-CT) imaging on stapes-prosthesis parameters, and 2) to clarify possible relationships between prosthesis intravestibular depth and postoperative hearing outcomes. PATIENTS: Seventy patients (46 women and 24 men; 32 right and 38 left sides) with the mean age of 40 years (range, 19-62 yr) with clinical otosclerosis. INTERVENTION(S): All patients underwent stapedotomy and were implanted with the same type of titanium piston prosthesis by the same surgeon. MAIN OUTCOME MEASURE(S): Postoperative MPR-CTs were obtained at patients' follow-up visits. The length and intravestibular depth of the stapes prosthesis (including absolute and relative depth) were calculated from the MPR-CT imaging. Relationships between the intravestibular depth of the prosthesis and hearing outcomes (pre- and postoperative audiograms) were analyzed using Spearman correlation analyses. RESULTS: The length of the prosthesis was overestimated by 1.8% (0.1 mm) by the MPR-CT imaging. Axial and coronal measurements were significantly correlated (p < 0.05). There was great intersubject variability in hearing outcomes differed insignificantly, regardless of intravestibular depth within the security range. No relationships were found between the intravestibular depth of the stapes prosthesis, as measured with MPR-CT, and postoperative hearing results. CONCLUSIONS: MPR-CT can provide an accurate estimation of stapes prosthesis parameters. However, the prosthesis intravestibular depth did not seem to affect postoperative hearing outcomes.

Is it necessary to retain the tensor tympani tendon in tympanoplasty?

OBJECTIVES/HYPOTHESIS: To evaluate the acoustic effect after canal wall-down tympanoplasty with sectioning of the tensor tympani muscle (TTM) tendon in patients with chronic otitis media. STUDY DESIGN: Prospective, controlled clinical trial. METHODS: From January 2010 to April 2014, 212 patients underwent canal wall-down tympanoplasty with ossicular chain reconstruction in one-stage surgery. For this study, the patients were assigned to two groups. In group 1 (107 patients), the TTM tensor would be removed during the surgery, whereas it would be retained in group 2 (105 patients). Pre- and postoperative air conduction and bone conduction thresholds at 0.5, 1, 2, and 4 kHz were reported, and the air-bone gaps (ABGs) were measured. RESULTS: Mean postoperative ABG was 16.0 dB in group 1 and 17.0 dB in group 2 and the ABG closure was 11.9 ± 8.5 in group 1 and 11.8 ± 9.7 in group 2. Both were not statistically different (P = .2381 and P = .9625). Overall, 84.1% of patients in group 1 and 75.2% of patients in group 2 attained a postoperative ABG of 20 dB or less. Success rate in group 1 is slightly higher than group 2, but not significant (P = .1255). CONCLUSIONS: The section of the tensor tympani muscle tendon in canal wall-down tympanoplasty with ossiculoplasty had no statistically significant influence on sound transmission and can be a safe maneuver in middle ear surgery. LEVEL OF EVIDENCE: 4

Characterization of Haemaphysalis flava (Acari: Ixodidae) from Qingling subspecies of giant panda (Ailuropoda melanoleuca qinlingensis) in Qinling Mountains (Central China) by morphology and molecular markers.

Tick is one of important ectoparasites capable of causing direct damage to their hosts and also acts as vectors of relevant infectious agents. In the present study, the taxa of 10 ticks, collected from Qinling giant pandas (Ailuropoda melanoleuca qinlingensis) in Qinling Mountains of China in April 2010, were determined using morphology and molecular markers (nucleotide ITS2 rDNA and mitochondrial 16S). Microscopic observation demonstrated that the morphological features of these ticks were similar to Haemaphysalis flava. Compared with other Haemaphysalis species, genetic variations between Haemaphysalis collected from A. m. qinlingensis and H. flava were the lowest in ITS2 rDNA and mitochondrial 16S, with sequence differences of 2.06%-2.40% and 1.30%-4.70%, respectively. Phylogenetic relationships showed that all the Haemaphysalis collected from A. m. qinlingensis were grouped with H. flava, further confirmed that the Haemaphysalis sp. is H. flava. This is the first report of ticks in giant panda by combining with morphology and molecular markers. This study also provided evidence that combining morphology and molecular tools provide a valuable and efficient tool for tick identification.

High-resolution computed tomographic features of the stapedius muscle and facial nerve in chronic otitis media.

OBJECTIVE: To improve preoperative recognition of the morphologic features of stapedius muscle and facial nerve in cases of chronic otitis media by providing a systemized description using temporal bone high-resolution computed tomography (HRCT). STUDY DESIGN: Retrospective review of HRCT scans from 212 patients. SETTING: Tertiary hospital affiliated to Fudan University. PATIENTS: Men and women undergoing surgery for chronic otitis media. No preference for demographics or side presenting otitis media. INTERVENTION: Therapeutic surgery. MAIN OUTCOME MEASURE: Location and morphology of stapedius muscle and facial nerve. RESULTS: The stapedius muscle was encountered in 90.5% of axial (n = 181) and 87% of coronal sections (n = 174), and differences between sides and genders were not significant (p > 0.05). Five categories of anomalies or pathologic features were identified in axial layers, and 3 categories were identified in coronal layers. Two axial and 2 coronal CT planes were found to be especially significant in imaging the facial nerve and its morphology (p < 0.001), whereas axial planes were more apt to show stapedius muscle features. Other pathologic features were also observed significantly more from specific CT imaging planes. CONCLUSION: The presence the stapedius muscle and the morphology between the stapedius muscle and the facial nerve vary between different observation areas, and some CT planes provide more useful information than others. The imaging planes outlined in this study can be used to systematically and correctly identify certain facial nerve and stapedius muscle features and clarify unfamiliar pathologic anatomy in preoperative planning.

The suprapyramidal fossa: a 3-dimensional reconstructive and surgical study.

OBJECTIVE: To clarify the position, occurrence rate, and configuration of the suprapyramidal fossa (SF) through surgical observation and 3-dimensional reconstruction. METHODS: SF of 300 ears with chronic otitis media were observed during surgery. The air cell and its abutting structures, including the facial nerve (FN), were reconstructed using high-resolution computed tomography (HRCT) data. RESULTS: In 68.3% (n = 205) of patients, the SF was observed in surgery. It is situated at the posterior wall of the facial recess of the retrotympanum. This air cell, usually the only one present on the surface of the pyramidal segment of the FN canal (FNC), is usually the largest if small air cells are found nearby. Its delineated location is as follows: pyramidal eminence and the pyramidal segment of the FNC medially, the deeper external acoustic meatus laterally, the aditus ad antrum superiorly, the posterior part of the tympanic annulus, and the chordal ridge anterior-inferiorly. Its configuration varies between rounded (11.7%, n = 35), curved-rod (52.7%, n = 158), and irregular (4%, n = 12). Additionally, the sensitivity and specificity of HRCT in detecting the SF were 79.0% and 88.4%, respectively. CONCLUSION: Occurrence and configuration of the SF is not a rule; however, the positive positional relationship between the SF and the second genu of the FNC is a rule, if the SF is detected. Considering this, the SF may be an important anatomic landmark to identify the FN during otosurgery. However, HRCT has a limited diagnostic value when the SF is atypical.