Prone position ventilation (PPV) has been widely used in the treatment strategy of patients with acute respiratory distress syndrome (ARDS). Patients undergoing PPV may develop facial edema and are at risk for pressure injuries due to prolonged prone positioning. In clinical practice, preventive measures such as repositioning, protective dressings, and pressure-relief cushions are commonly used to prevent pressure injuries. However, factors such as improper endotracheal tube placement, self-paid dressings, and delayed clearance of oral and nasal secretions have reduced the effectiveness of preventing facial pressure injuries. To address the above issues, a device for preventing pressure injuries on the faces of patients in the prone position was designed by healthcare workers in the nursing department of Dalian Friendship Hospital, and a National Utility Model Patent of China was obtained (ZL 2024 2 0340439.8). The device consists of a support plate and a circuit control system. The support plate is equipped with two support members. Support member 1 is directly fixed to the support plate, while support member 2 is connected to the support plate via a slide and a spiral rod, serving to support the patient's face and allowing for adjustment of the appropriate width according to the size of the patient's face. Inside the two support members, there are several telescopic rods, with the upper ends designed as spherical supports. The height and position of the telescopic components can be adjusted through a circuit control system, regularly changing the pressure distribution on the patient's face, thereby achieving the purpose of changing the pressure points on the face. The inner wall of support member 2 is equipped with a camera, allowing direct observation of the patient's facial condition through a monitor, avoiding compression of the eyes and nose, and promptly removing secretions from the mouth to keep the face clean, thereby reducing the risk of facial pressure-related injuries. The center of the two support members features a hollow slot, facilitating the placement of a tracheal tube. The circuit control system includes a random module, a time setting module, a control module, and a drive module. Parameters can be set as needed. When the shortest set time is reached, the random module and time setting module send instructions to the control module. Upon receiving the instructions from the time setting module and the random number from the random module, the control module transmits information to the drive module. The drive module, upon receiving the information, controls multiple telescopic rods to adjust their height and position, thereby changing the support points on the patient's face. The device features a simple structure and convenient operation, allowing for flexible adaptation to the patient's facial shape. It can be replaced with the patient's facial pressure area, providing an intuitive view of the patient's facial pressure situation. With automation and high safety, it helps reduce the risk of pressure-related injuries and lightens the workload of medical staff.
Humans ; Pressure Ulcer/prevention & control* ; Prone Position ; Equipment Design ; Facial Injuries/prevention & control* ; Respiration, Artificial/instrumentation* ; Respiratory Distress Syndrome/therapy*

OBJECTIVE: To investigate the related parameters of temporal bone structure in the surgery of cochlear implantation through facial recess approach so as to offer a theoretical reference for the avoidance of facial nerve injury and the accurate localization. METHOD: In a surgical simulation experiment, twenty human temporal bones were studied. The correlation parameters were measured under surgical microscope. RESULT: Distance between suprameatal spine and short process of incus was (12.44 +/- 0.51) mm. Width from crotch of chorda tympani nerve to stylomastoid foramen was (2.67 +/- 0.51) mm. Distance between short process of incus and crotch of chorda tympani nerve was (15.22 +/- 0.83) mm. The location of maximal width of the facial recess into short process of incus, crotch of chorda tympani nerve were (6.28 +/- 0.41) mm, (9.81 +/- 0.71) mm, respectively. The maximal width of the facial recess was (2.73 +/- 0.20) mm. The value at level of stapes and round window were (2.48 +/- 0.20 mm) and (2.24 +/- 0.18) mm, respectively. Distance between pyramidalis eminence and anterior round window was (2.22 +/- 0.21) mm. Width from stapes to underneath round window was (2.16 +/- 0.14) mm. CONCLUSION These parameters provide a reference value to determine the position of cochlear inserting the electrode array into the scale tympani and opening facial recess firstly to avoid potential damage to facial nerve in surgery.
Anatomic Landmarks ; anatomy & histology ; Chorda Tympani Nerve ; anatomy & histology ; Cochlea ; anatomy & histology ; Cochlear Implantation ; methods ; Ear, Middle ; Facial Nerve Injuries ; prevention & control ; Humans ; Incus ; anatomy & histology ; Organ Sparing Treatments ; methods ; Round Window, Ear ; anatomy & histology ; Stapes ; anatomy & histology ; Temporal Bone ; anatomy & histology ; Tympanic Membrane ; anatomy & histology

Diplopia ; etiology ; Enophthalmos ; etiology ; Exophthalmos ; etiology ; Facial Nerve Injuries ; etiology ; Hemorrhage ; etiology ; Humans ; Intraoperative Complications ; etiology ; prevention & control ; Orbit ; blood supply ; surgery ; Orbital Fractures ; surgery ; Postoperative Complications ; etiology ; prevention & control ; Reconstructive Surgical Procedures ; adverse effects ; Reflex, Trigeminocardiac ; Vision, Low ; etiology

OBJECTIVE: To study the neuroprotective effect of facial nerve monitoring in canal wall down of mastoidectomy with tympanoplasty. METHOD: Twenty cases of chronic suppurative otitis media were performed canal wall down of mastoidectomy with tympanoplasty under general anesthesia. Facial nerve monitoring was used during surgery to locate the facial nerve. Threshold level of kinetic current and amplitude of synchronous reaction were recorded. RESULT: Seven cases with cholesteatoma were found facial nerve partial exposured in tympanic segment or mastoid segment. 13 cases had integrated facial never canal. Synchronous myopotential response of facial nerve was evoked successfully in all cases. Electroshock threshold had significant difference between facial nerve exposed group and non-exposed group (P<0.01). No facial palsy were found in all cases. CONCLUSION Facial nerve monitoring is benefit in locating facial nerve in canal wall down of mastoidectomy with tympanoplasty and could avoid facial nerve injury during surgery.
Adolescent ; Adult ; Aged ; Facial Nerve ; physiology ; Facial Nerve Injuries ; prevention & control ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Intraoperative ; Otitis Media, Suppurative ; surgery ; Treatment Outcome ; Tympanoplasty ; methods ; Young Adult

OBJECTIVETo summarize and analyse the techniques of avoiding facial nerve injury during acoustic neuroma microsurgery.

METHODSOne hundred and eighty patients with large acoustic neuroma (> or =4 cm) and 70 patients with medium acoustic neuroma (2.4-4.0 cm) were diagnosed by MRI/ CT scan before operation and confirmed by postoperative pathologic examination. All of patients were treated by sub-occipital retrosigmoid approach for tumor removal and facial nerve reservation during operation. The relationships among the bone, arachnoid, nerve and vascular anatomy were particularly observed during the operation. After decompression of the tumor, the origination and location of the facial nerve as well as the relationship between the tumor and the facial nerve should be identified. The patients were followed-up from 6 months to 1 year postoperatively and assessed by House-Brackmann facial nerve function grading system.

RESULTSTotal tumor resection was achieved in 240 of 250 cases (96%) and subtotal in 10 cases including 1 case died because of cerebellar encephalomalacia after operation. According to the House-Brackmann facial nerve function grading, recovery of normal function (grade I) was achieved in 214 cases (85.6%), grade II in 25 cases (10%), grade III in 5 cases (2.09%) and grade IV in 5 cases (2.09%).

CONCLUSIONMicroneurosurgical techniques are helpful for total resection of acoustic neuroma and keeping facial nerve anatomic intact.

Adolescent ; Adult ; Aged ; Facial Nerve Injuries ; etiology ; prevention & control ; Female ; Follow-Up Studies ; Humans ; Intraoperative Complications ; prevention & control ; Male ; Microsurgery ; methods ; Middle Aged ; Neuroma, Acoustic ; surgery ; Retrospective Studies ; Treatment Outcome ; Young Adult