Endoscopic Temporalis Tendon Extension (ETTE).

Many techniques have been proposed to restore facial symmetry in facial nerve palsies. This study presents our surgical approach called Endoscopic Temporalis Tendon Extension (ETTE). After nasotracheal intubation, a 4 cm skin incision is made at the nasolabial fold. Under endoscopic view, the medial face of the masseter muscle is detached from the mandibular ramus. The coronoid process is then sectioned by Piezosurgery®. Finally, a fascia lata graft is suspended between the temporalis tendon and the orbicularis oris. ETTE is a mixed technique, with a static suspension component and a dynamic contraction one. The preservation of the temporalis muscle insertion in temporal fossa allows for an optimal contraction. A fascia lata graft is necessary for reasons of length. The scar produced by the nasolabial incision allows to recreate the missing nasolabial fold. The endoscopic assistance provides greater precision during the procedure and entails a shorter learning curve.

Multifocal Giant Cell Tumor of the Nasal Fossa: Case Report and Literature Review.

Giant cell tumors of bone (GCT) are rare soft tissue tumors, that account for 3%-5% of primary bone tumors with <2% occurring in the head and neck. The nasal cavity is a highly unusual site of presentation. We reviewed 15 cases of GCT of nasal cavity and paranasal sinuses. We add 1 case to the literature. The case herein reported, appears to be the second nasal fossa GCT described in the literature and the first documented case with multifocal localization. A case of multifocal GCT of the nasal cavity is described. Although rare in the general population, GCT should be included among the possibilities in the differential diagnosis when evaluating tumors of the head and neck. Management of this particular tumor remains challenging; surgical removal is still the gold standard treatment, preferring a minimally invasive trans-nasal approach to reduce intra and post-operative morbidity. Laryngoscope, 2023.

"Hot" vs "Cold" endoscopic stapes surgery: a matched case-control study.

PURPOSE: To compare hearing results and complication rates between two groups of patients operated on by endoscopic stapes surgery (ESS) for otosclerosis, either with CO2 fiber laser or microdrill. METHODS: A case-control study was performed. All consecutive cases of CO2 fiber laser ESS operated at a single center during the period 2017-2020 (case group) were matched to a control group of patients operated by traditional technique, according to year of surgery, preoperative mean air-bone gap, sex and age. Audiological data from preoperative and postoperative examinations and complication rates were compared. RESULTS: 46 cases were included. Mean operative time was significantly longer in the laser cohort (65 min) than in the drill one (45 min) (p = 0.003). Similar results were found in the two groups regarding the mean postoperative BC-PTA. The high-frequency bone conduction resulted significantly higher in the laser group (p = 0.002), suggesting an overclosure effect in the laser group. Consistently, a significant improvement of the BC-PTA threshold at 2000 Hz postoperatively was found in the laser group (p = 0.034). The postoperative AC-PTA significantly improved in both groups at all frequencies (p < 0.05), except for the AC threshold at 8 kHz. Similar rates of complications were found in the two groups. CONCLUSION: This study is the first to compare hearing results and complications between CO2 fiber laser and microdrill in ESS. Our results demonstrated similar functional outcomes between the two groups, confirming ESS as safe and effective, regardless of the technique used.

Simulative Evaluation of a Joint-Cartesian Hybrid Motion Mapping for Robot Hands Based on Spatial In-Hand Information.

Two sub-problems are typically identified for the replication of human finger motions on artificial hands: the measurement of the motions on the human side and the mapping method of human hand movements (primary hand) on the robotic hand (target hand). In this study, we focus on the second sub-problem. During human to robot hand mapping, ensuring natural motions and predictability for the operator is a difficult task, since it requires the preservation of the Cartesian position of the fingertips and the finger shapes given by the joint values. Several approaches have been presented to deal with this problem, which is still unresolved in general. In this work, we exploit the spatial information available in-hand, in particular, related to the thumb-finger relative position, for combining joint and Cartesian mappings. In this way, it is possible to perform a large range of both volar grasps (where the preservation of finger shapes is more important) and precision grips (where the preservation of fingertip positions is more important) during primary-to-target hand mappings, even if kinematic dissimilarities are present. We therefore report on two specific realizations of this approach: a distance-based hybrid mapping, in which the transition between joint and Cartesian mapping is driven by the approaching of the fingers to the current thumb fingertip position, and a workspace-based hybrid mapping, in which the joint-Cartesian transition is defined on the areas of the workspace in which thumb and fingertips can get in contact. The general mapping approach is presented, and the two realizations are tested. In order to report the results of an evaluation of the proposed mappings for multiple robotic hand kinematic structures (both industrial grippers and anthropomorphic hands, with a variable number of fingers), a simulative evaluation was performed.

Revision canal-wall down surgery: comparison of surgical outcomes with three different techniques.

OBJECTIVE: This study aimed to analyze the role of the endoscope in revision canal-wall down (CWD) tympanomastoid surgery and compare its use to the more traditional microscopic approach. Moreover, we aim to investigate functional outcomes of revision surgeries in a cohort of two tertiary reference centers. METHODS: A total of 103 patients undergoing revision surgery after previous CWD tympanomastoidectomy were included in the present study and divided in three groups according to the surgical technique used: endoscope exclusive (n = 22), combined (n = 35) and microscope exclusive (n = 46). Data regarding surgical indications, pre-operative clinical and audiological assessments, intraoperative findings and surgical considerations were extracted. During follow-up, data regarding anatomic and audiologic outcomes were collected and persistence or recurrence of the disease assessed. RESULTS: The most frequent sites of cholesteatoma recurrence or persistence was the anterior epitympanum. There was a statistically significant ABG improvement of - 6.02 dB HL (95% CI - 8.87 to - 3.16, p < 0.001) between pre-operative and postoperative ABG, without significant effect of surgical technique. During follow-up, no significant differences regarding disease or otorrhea control were observed. Duration of surgery and hospitalization was shorter in the endoscopic cohort without statistical significance. Intra- and postoperative complications were lower in the endoscopic group. CONCLUSION: Revision CWD surgery can take advantage of the endoscope as a minimally invasive exclusive or adjunct tool to traditional microscopic procedures. Outcome measures of endoscopic revision CWD surgery showed anatomic and functional results comparable to those of the microscopic group. The complication rate, the duration of surgery and hospitalization were favorable in the endoscopic group.

Ex Vivo Ovine Model for Surgical and Microsurgical Training on Parotidectomy and Facial Nerve Reanimation: Proposal of Structured Training Program.

INTRODUCTION: Facial nerve palsy has a great physical and psychological impact on patients, so the avoidance of facial nerve damage during surgery and its reanimation are important for Otolaryngologists and head and neck surgeons. The acquisition of anatomical knowledge and surgical training regarding the parotid surgery and facial nerve is mandatory, but not easy to achieve. Surgical simulation is a reliable alternative to the on-the-job learning. In the study, we tested an ex vivo animal model to obtain the basic and advanced skills of parotid gland surgery and facial nerve reconstruction/reanimation. MATERIALS AND METHODS: A prospective cohort study has been conducted on ovine head and neck specimen. A junior resident, a senior resident, and an expert surgeon were involved in a step-by-step preplanned dissection, divided in macroscopic and microscopic. Each procedure was recorded and evaluated by an expert surgeon following an adapted rating scale. RESULTS: A statistically significant improvement in terms of execution times and quality of the work was show in most of the surgical steps and for many quality items by the junior and senior residents, while the expert surgeon, as expected, did not show any improvement. DISCUSSION: Our ex vivo ovine model provided the trainee with close-to-real tissues in term of elastic resistance and consistency, to learn the skills requested in a head and neck surgery, on a reproducible environment. It is mandatory to have a feedback, which focuses on the quality of the work through valid and reliable assessment of technical skills. The judgment parameters should be reproducible and focused on the specific surgical procedure. Some limitations to this study are present, such as anatomical differences between ovine and human and the limited number of study participants. CONCLUSION: This proposal of training program on the ex vivo ovine model for the acquisition of skills needed in head and neck surgery proved to be feasible, effective, repeatable, and cheap.

Feedback-aided data acquisition improves myoelectric control of a prosthetic hand.

OBJECTIVE: Pattern-recognition-based myocontrol can be unreliable, which may limit its use in the clinical practice and everyday activities. One cause for this is the poor generalization of the underlying machine learning models to untrained conditions. Acquiring the training data and building the model more interactively can reduce this problem. For example, the user could be encouraged to target the model's instabilities during the data acquisition supported by automatic feedback guidance. Interactivity is an emerging trend in myocontrol of upper-limb electric prostheses: the user should be actively involved throughout the training and usage of the device. APPROACH: In this study, 18 non-disabled participants tested two novel feedback-aided acquisition protocols against a standard one that did not provide any guidance. All the protocols acquired data dynamically in multiple arm positions to counteract the limb position effect. During feedback-aided acquisition, an acoustic signal urged the participant to hover with the arm in specific regions of her peri-personal space, de facto acquiring more data where needed. The three protocols were compared on everyday manipulation tasks performed with a prosthetic hand. MAIN RESULTS: Our results showed that feedback-aided data acquisition outperformed the acquisition routine without guidance, both objectively and subjectively. SIGNIFICANCE: This indicates that the interaction with the user during the data acquisition is fundamental to improve myocontrol.

High Human Papillomavirus DNA loads in Inflammatory Middle Ear Diseases.

Background. Previous studies reported human papillomaviruses (HPVs) in middle ear tumors, whereas these viruses have been poorly investigated in chronic inflammatory middle ear diseases. We investigated HPVs in non-tumor middle ear diseases, including chronic otitis media (COM). Methods. COM specimens (n = 52), including chronic suppurative otitis media (CSOM) (n =38) and cholesteatoma (COMC) (n = 14), as well as normal middle ear (NME) specimens (n = 56) were analyzed. HPV sequences and DNA loads were analyzed by quantitative-PCR. HPV genotyping was performed by direct sequencing. Results. HPV DNA was detected in 23% (12/52) of COM and in 30.4% (17/56) of NME (p > 0.05). Specifically, HPV DNA sequences were found in 26.3% (10/38) of CSOM and in 14.3% (2/14) of COMC (p > 0.05). Interestingly, the HPV DNA load was higher in COMC (mean 7.47 copy/cell) than in CSOM (mean 1.02 copy/cell) and NME (mean 1.18 copy/cell) (P = 0.03 and P = 0.017 versus CSOM and NME, respectively). HPV16 and HPV18 were the main genotypes detected in COMC, CSOM and NME. Conclusions. These data suggest that HPV may infect the middle ear mucosa, whereas HPV-positive COMCs are associated with higher viral DNA loads as compared to NME.

Automated Instability Detection for Interactive Myocontrol of Prosthetic Hands.

Myocontrol is control of a prosthetic device using data obtained from (residual) muscle activity. In most myocontrol prosthetic systems, such biological data also denote the subject's intent: reliably interpreting what the user wants to do, exactly and only when she wants, is paramount to avoid instability, which can potentially lead to accidents, humiliation and trauma. Indeed, instability manifests itself as a failure of the myocontrol in interpreting the subject's intent, and the automated detection of such failures can be a specific step to improve myocontrol of prostheses-e.g., enabling the possibility of self-adaptation of the system via on-demand model updates for incremental learning, i.e., the interactive myocontrol paradigm. In this work we engaged six expert myocontrol users (five able-bodied subjects and one trans-radial amputee) in a simple, clear grasp-carry-release task, in which the subject's intent was reasonably determined by the task itself. We then manually ascertained when the intent would not coincide with the behavior of the prosthetic device, i.e., we labeled the failures of the myocontrol system. Lastly, we trained and tested a classifier to automatically detect such failures. Our results show that a standard classifier is able to detect myocontrol failures with a mean balanced error rate of 18.86% over all subjects. If confirmed in the large, this approach could pave the way to self-detection and correction of myocontrol errors, a tighter man-machine co-adaptation, and in the end the improvement of the reliability of myocontrol.

A Control Architecture for Grasp Strength Regulation in Myocontrolled Robotic Hands Using Vibrotactile Feedback: Preliminary Results.

Nowadays, electric-powered hand prostheses do not provide adequate sensory instrumentation and artificial feedback to allow users voluntarily and finely modulate the grasp strength applied to the objects. In this work, the design of a control architecture for a myocontrol-based regulation of the grasp strength for a robotic hand equipped with contact force sensors is presented. The goal of the study was to provide the user with the capability of modulating the grasping force according to target required levels by exploiting a vibrotactile feedback. In particular, the whole human-robot control system is concerned (i.e. myocontrol, robotic hand controller, vibrotactile feedback.) In order to evaluate the intuitiveness and force tracking performance provided by the proposed control architecture, an experiment was carried out involving four naïve able-bodied subjects in a grasping strength regulation task with a myocontrolled robotic hand (the University of Bologna Hand), requiring for grasping different objects with specific target force levels. The reported results show that the control architecture successfully allowed all subjects to achieve all grasping strength levels exploiting the vibrotactile feedback information. This preliminary demonstrates that, potentially, the proposed control interface can be profitably exploited in upper-limb prosthetic applications, as well as for non-rehabilitation uses, e.g. in ultra-light teleoperation for grasping devices.

Experimental evaluation of a sEMG-based control for elbow wearable assistive devices during load lifting tasks.

In this work, a surface skin electromyography(sEMG)-based control solution for elbow wearable assistive devices during load lifting tasks is presented. The goal of the controller consists in limiting the user's muscle activity during the task execution, in such a way that the assistive device can partially compensate the load-related biceps muscle effort. Since sEMG-driven control strategies based on the estimation of the joint torques generally requires complex task- and subject-dependent training sessions for tuning the control algorithms, here a more direct control approach is proposed, based on a muscle activity error related proportional-integral action together with an double-threshold activation logic. The controller's parameters are easily set by means of a fast, online and automatic subject calibration procedure, ensuring a simple adjustability to different users. An experimental phase has been conducted in order to evaluate the sEMG-based control performance involving four healthy subjects, using as wearable assistive device a twisted string action module, which is particularly suitable for assistive applications because of its lightness and compactness. Results show that the control strategy is able to successfully limit the EMG activity of the subjects during the lifting tasks, providing preliminary outcomes and promising possibilities for the use of twisted string-based technologies to assist human joints and muscles.

Interconnection and Simulation Issues in Haptics.

In this paper, three results are presented concerning certain computational/control aspects, crucial for the proper behavior of haptic devices. The first one is a novel technique for a real-time simulation of virtual environments, which is able to preserve the energetic behavior of the simulated physical system and to avoid undesired effects related to unstable behaviors of the haptic device. The proposed real-time integration method is simpler, in terms of computational complexity, than similar solutions known in the literature, and provides an additional insight when "faulty conditions" are met. Second, a new method for the energy-consistent interconnection of discrete-time physical systems, implemented by algorithms running at different frequencies (i.e., multirate systems), is illustrated. Multirate systems are very common in haptics, since the frequency, at which the control law of the haptic interface is executed, is usually higher than the frequency of the simulation of the virtual environment. Finally, the third result presented in this paper concerns the problem of energy generation due to the time discretization in the acquisition of the haptic interface position. Similarly, to the previous case, a technique for an energy-consistent analog/digital conversion is proposed. All these methodologies have been validated, both by simulations and experiments.