Objective: To investigate the clinical classification and surgical outcomes of congenital middle ear malformations accompanied by facial nerve anomalies. Methods: A retrospective cohort study was conducted to analyze clinical data of patients with congenital middle ear malformations and concomitant facial nerve anomalies who received treatment in the Department of Otolaryngology, Zhujiang Hospital, Southern Medical University, between January 2021 and December 2024. Facial nerve anomalies were categorized into four distinct types: partial obstruction of the oval window, complete obstruction of the oval window, aberrant course over the promontory, and branching anomalies. Ossicular chain malformations were classified in accordance with the Teunissen classification system. Individualized hearing reconstruction strategies were implemented based on the specific anatomical characteristics of the anomalies. All patients were followed up for 3 to 24 months. Postoperative therapeutic efficacy was evaluated by comparing preoperative and postoperative mean air conduction thresholds and air-bone gaps (ABG), while monitoring surgical complications. Results: Thirteen patients (17 ears) aged [M (Q1, Q3)] 15.0 (11.5, 21.0) years were included, with eight males and five females. Facial nerve anomalies were categorized as follows: partial obstruction of the oval window in six ears (three cases of Type Ⅰ, three cases of Type Ⅲ), complete obstruction of the oval window in three ears (one case of Type Ⅰ, two cases of Type Ⅲ), aberrant course over the promontory in six ears (all Type Ⅳ), and branching anomalies in two ears (both Type Ⅳ). Hearing reconstruction modalities employed included: incus-stapedial piston placement following vestibular fenestration in nine ears, malleus-stapedial piston placement following vestibular fenestration in two ears, partial ossicular replacement prosthesis (PORP) implantation in three ears, total ossicular replacement prosthesis (TORP) implantation in one ear, stapes mobilization in one ear, and laser-assisted ossicular chain release in one ear.Statistical analysis revealed that postoperative mean air conduction thresholds [(33.8±15.2) dB HL vs (60.1±13.8) dB HL, P<0.001] and mean ABG [(14.6±6.9) dB vs (37.2±9.2) dB, P<0.001] were significantly reduced compared with preoperative values. Postoperative ABG≤20 dB was achieved in 15 ears (88.2%). Postoperative complications were limited to transient vertigo in five cases and taste disturbance in two cases. No cases of facial paralysis, sensorineural hearing loss, tympanic membrane perforation, or tinnitus were observed. The median follow-up duration was 6.0 (5.5, 20.0) months. Conclusion: Individualized hearing reconstruction strategies based on the classification of facial nerve and ossicular chain anomalies can effectively protect the facial nerve and achieve significant hearing improvement, demonstrating favorable clinical outcomes.

Background/Objectives: Hypoglossal nerve palsy is a rare but disabling complication of general anesthesia, typically associated with tracheal intubation and head and neck surgery. This study evaluated the incidence, clinical characteristics, and potential mechanisms of postoperative tongue deviation after breast reconstruction and other surgeries performed under general anesthesia with orotracheal intubation. Methods: We retrospectively reviewed 240,646 consecutive general anesthetic procedures with orotracheal intubation performed at two tertiary hospitals between September 2011 and October 2025. Eighteen patients who developed new-onset postoperative tongue deviation were identified, and demographic features, surgical department, breast reconstruction status, anesthetic details, patient positioning, laterality of deviation, symptom duration, and recovery outcomes were analyzed. Results: Postoperative tongue deviation was documented in 18 patients, corresponding to an overall incidence of approximately 0.01%, most frequently after breast reconstruction (7/18, 38.9%), followed by vascular (27.8%), head and neck tumor (16.7%), neurosurgical (11.1%), and hepatobiliary-pancreatic surgery (5.6%). All seven breast-reconstruction cases occurred at the breast-cancer center hospital, corresponding to 0.31% of 2256 breast reconstructions. The median age was 58.0 years; 66.7% patients were female. Most patients (77.8%) achieved complete recovery, whereas 16.7% had residual deviation. Conclusions: Postoperative hypoglossal nerve palsy with tongue deviation is an exceptionally rare event after general anesthesia. In our two-center cohort, it was observed most frequently among patients undergoing breast reconstruction at one participating center; this pattern is confounded by institution-specific anesthetic and positioning practices and should not be interpreted as evidence that the procedure itself carries inherent risk. The findings are hypothesis-generating and suggest that prolonged operating time, repeated intraoperative position changes, and specific head-fixation and tube-fixation practices warrant prospective investigation. Meticulous head-neck alignment, careful tube fixation, and a structured postoperative cranial-nerve check (tongue-protrusion and voice-quality assessment in the recovery room and on postoperative day 1) may aid the early detection of this complication.

B-cell maturation antigen-targeting chimeric antigen receptor (CAR) T-cell therapies have demonstrated remarkable efficacy in relapsed/refractory multiple myeloma (RRMM). However, emerging non-immune effector cell-associated neurotoxicity syndrome (non-ICANS) neurologic events-including cranial nerve palsy (CNP) and immune effector cell (IEC)-parkinsonism (also called movement and neurocognitive toxicity)-warrant vigilance. This review summarizes clinical findings from the CARTITUDE trials, which evaluated ciltacabtagene autoleucel in > 300 patients with RRMM. CNP occurred in 6.3% of patients, with a lower incidence in more heavily pretreated patients (≥ 3 prior lines of treatment [pLOT]: 3% vs. 1-3 pLOT: 9%). Median CNP onset was day 22 postinfusion; most cases were low grade, and 90% recovered completely. IEC-parkinsonism involves motor, cognitive, and personality changes; lower incidence was observed in less heavily pretreated patients (1% vs. 6%). Median time to onset was 56 days postinfusion; however, with greater awareness, IEC-parkinsonism may be recognized earlier. Emerging data suggest that early, aggressive intervention may result in better outcomes. High CAR-T cell expansion is associated with increased risk of CNP and IEC-parkinsonism. In the early postinfusion period (days 10-28), absolute lymphocyte count (ALC) strongly correlates with circulating CAR-T cell levels and could help identify patients at increased risk of neurologic events. Prophylactic interventions, including a short course of steroids, triggered by elevated ALC before symptom onset, are under investigation. Education of patients, caregivers (including family), local oncologists, and neurologists seeing patients outside CAR-T infusion centers is essential to facilitate timely recognition, referral to the CAR-T center, and management.

Recurrent painful ophthalmoplegic neuropathy (RPON) is characterized by recurrent unilateral headache associated with ipsilateral ophthalmoplegia due to palsy of one or more ocular cranial nerves, including the oculomotor, trochlear, and abducens nerves. Herein, we report a case of RPON with frequent recurrence over a short period, wherein further recurrence was prevented using high-dose riboflavin. The patient was a 6-year-old boy who presented with a 3-day history of headache, right eye pain, vomiting, and right oculomotor nerve palsy. He had a similar episode 3 years earlier, which resolved spontaneously after 1 month. Initial treatment with intravenous methylprednisolone alleviated eye pain, ocular motility disorder, and ptosis, but not the dilated pupil. Despite steroid treatment, the patient experienced frequent relapses triggered by infectious diseases, resulting in side effects such as moon face and weight gain. High-dose riboflavin (200 mg/day) was initiated as prophylaxis after other treatments, including lower doses of riboflavin and sodium valproate, failed to prevent relapses. The patient remained relapse-free for 9 months after increasing the riboflavin dose. Although it remains unclear whether high-dose riboflavin alone or in combination with valproic acid was effective, this case suggests that high-dose riboflavin might be an effective prophylactic treatment for RPON.