Current approaches to facial nerve schwannoma surgery.

Background: Facial nerve schwannomas (FNSs) are exceedingly rare benign tumors. This study aims to report on a series of excised FNSs, providing clinical information and details on their surgical management, including novel approaches. Methods: We retrospectively reviewed patients who underwent surgical excision of FNSs in a private otology clinic and public tertiary referral center. The main outcome measures were facial nerve function, complete tumor removal, postoperative complications, tumor recurrence, and hearing. Results: Seventeen patients (10 men and 7 women) with a mean age of 44.23 years (SD, 12.21) underwent surgery during the study period. The most common symptom was facial nerve dysfunction (58.8%). Facial and otoneurologic symptoms (hearing loss, tinnitus, and vertigo) were observed in 88.8% and 77.7% of patients, respectively. The middle cranial fossa (MCF) was the most common approach (six patients, 35.2%), followed by translabyrinthine (TL), transmastoid (TM), and combined TM-MCF (three patients, 17.6% each). Exclusive endoscopic transcanal suprageniculate (ETS) and mastoid combined with cervical approaches were applied once in two patients, 5.8% each. Total tumor removal was achieved in all cases. No significant postoperative complications were observed. The mean follow-up period was 193.2 months (SD, 119.5) and no tumor recurrence was observed. Conclusion: This study provides further evidence for the safety and efficacy of various surgical approaches for FNS, and incorporates the endoscopic transcanal approach. Level of evidence: 4.

Upper airway manifestations of anti-IgLON5 disease: Otorhinolaryngological point of view.

INTRODUCTION: Anti-IgLON5 disease is a recently described neurological disorder with multisystemic features. The disease is characterized by the presence of IgLON5 antibodies in serum and cerebrospinal fluid. Our objective is to describe in detail the otorhinolaryngological manifestations of this disease, which are frequent and may include dysphagia, dysarthria, vocal cord paralysis and laryngospasm. METHODS: In this study, we present a series of 9 patients with anti-IgLON5 disease and otolaryngological manifestations. Patients were evaluated between July 2012 and March 2022 by video-polysomnography, fiber-optic laryngoscopy, and functional endoscopic evaluation of swallowing. RESULTS: The median age was 71 years, and 5 (56%) were female. Video-polysomnography showed a NREM/REM parasomnia in 6 patients (67%), obstructive sleep apnea in 8 (88%), stridor during sleep in 7 (78%) and central apneas in 1 (11%). Six out of the 9 patients (67%) presented episodes of acute respiratory failure that required mechanical ventilation, 6 had vocal fold palsy with 4 of them requiring tracheostomy (3 had to be performed on an emergency basis). Dysphagia occurred in 8 patients (89%). Prominent upper airway secretion and sialorrhea was also present in 3 cases. CONCLUSION: The anti-IgLON5 disease exhibits extensive otolaryngological symptoms, mainly affecting the upper airway. These symptoms affect the quality of life and can be life-threatening. Prompt acute management is essential for stridor, dyspnea, and dysphagia. Given the potential severity of the symptoms and rarity of the disease, it is important for otolaryngologists to be familiar with anti-IgLON5 disease. LEVEL OF EVIDENCE: Level 4.

Otorhinolaryngological manifestations in monkeypox.

BACKGROUND AND OBJECTIVE: In the current health emergency declared by the World Health Organization (WHO) for monkeypox, few data on the otorhinolaryngological (ENT) manifestations of the disease have been detailed. The purpose of this study is to describe the clinical features of the ENT manifestations in monkeypox. MATERIALS AND METHODS: Descriptive analysis of 11 consecutive patients with odynodysphagia or oral cavity lesions referred to the ENT emergency department of a tertiary hospital with epidemiological risk factors suggestive of monkeypox infection. Clinical, diagnostic and treatment findings are described. RESULTS: 90.9% of the patients had previous unsafe sexual contact. The predominant presenting features included fever over 38 °C with severe odynodysphagia. Physical examination showed ulcers and exudative lesions of variable presentation in the upper respiratory tract. Smear of the lesions confirmed polymerase chain reaction (PCR) positivity for monkeypox in all patients. CONCLUSIONS: Monkeypox virus infection can occur in the ENT area with multiple manifestations that require a high degree of epidemiological suspicion and confirmation with PCR to reach a diagnosis of certainty.

[Otorhinolaryngological manifestations in monkeypox]. / Manifestaciones otorrinolaringológicas en la viruela del mono.

Background and objective: In the current health emergency declared by the World Health Organization (WHO) for monkeypox, few data on the otorhinolaryngological (ENT) manifestations of the disease have been detailed. The purpose of this study is to describe the clinical features of the ENT manifestations in monkeypox. Material and methods: Descriptive analysis of 11 consecutive patients with odynodysphagia or oral cavity lesions referred to the ENT emergency department of a tertiary hospital with epidemiological risk factors suggestive of monkeypox infection. Clinical, diagnostic, and treatment findings are described. Results: 90.9% of the patients had previous unsafe sexual contact. The predominant presenting features included fever over 38 °C with severe odynodysphagia. Physical examination showed ulcers and exudative lesions of variable presentation in the upper respiratory tract. Smear of the lesions confirmed polymerase chain reaction (PCR) positivity for monkeypox in all patients. Conclusions: Monkeypox virus infection can occur in the ENT area with multiple manifestations that require a high degree of epidemiological suspicion and confirmation with PCR to reach a diagnosis of certainty.