The authors present variations of the inferiorly-hinged transnasal advancement flap, augmented with an inferior back-cut, as a versatile option for medial canthal defect reconstruction. A retrospective case series of seven patients with medial canthal basal cell carcinoma, all of whom underwent frozen section-controlled excision followed by immediate reconstruction using this flap technique. Surgical modifications included tailored flap sizing and use of back-cuts to enhance flap mobility. Outcomes included Strasser grading, using post-operative photographs, and complications. All defects were reconstructed successfully, with scars concealed and no major complications. Five tumours were T1a and two were staged T2b, producing defects ranging from 12 × 12 mm to 30 × 18 mm in diameter. These cases demonstrate the flap's suitability for moderate to large defects that are not amenable to simple techniques such as primary closure. Strasser grading across six patients showed good aesthetic outcomes (scores 0-2) with no cases rated 'obvious' or 'deforming'. This report highlights the versatility of the inferiorly-hinged transnasal advancement flap as a first-line option for medial canthal defects. It provides excellent cosmesis particularly for moderate to large defects in patients with adequate nasal bridge laxity, a natural skin crease inferior to the glabella, and those who wear spectacles.

Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis that commonly involves the upper respiratory tract and kidneys. The development of new-onset urinary abnormalities, microscopic hematuria, and declining renal function in a patient on treatment with methotrexate and avacopan warrants a prompt renal biopsy to lead management decisions. We describe a case of localized sinonasal GPA in a patient receiving methotrexate and avacopan who presented with new renal symptoms. Laboratory evaluation revealed a serum creatinine of 1.4 mg/dL and a urine protein-creatinine ratio (UPCR) of 0.96 g/g with moderate hematuria and red blood cell casts on urine microscopy. Renal biopsy revealed no evidence of pauci-immune crescentic glomerulonephritis, highlighting the importance of histopathologic confirmation before escalation of immunosuppressive therapy. These findings prevented escalation to stronger immunosuppressive therapy and allowed continuation of the existing regimen. Moreover, the combined use of methotrexate and avacopan in nasal-limited GPA is not well documented, and this case adds more clinical understanding to this therapeutic strategy.

Transfusion dependent thalassemia (TDT) is widely prevalent in India. Significant proportion of TDT patients show craniofacial deformity and also suffer from complications related to iron overload. There is dearth of data on quantitative dimensions of the craniofacial anatomy, more so from the eastern part of the country. We have attempted to obtain quantitative measurements of the craniofacial anatomy by digital method in TDT patients and compare with control. In addition, to also determine relationship of craniofacial defects with increasing serum ferritin (SF) in this group of patients. Sixty two TDT patients (28 males and 34 females), between age 15 and 35 years were studied over a period of four months along with 32 age and sex matched controls. Using a standard protocol, digital photographs were taken and measurements done using photoshop software. Analysis of 15 craniofacial parameters of upper, middle and lower parts of face was done and compared with control. Relationship of the SF level with each of these parameters was also studied. Compared to controls, both male and female TDT patients showed statistically significant difference ( p < 0.05) in bitragion width (BW), nose width (NW), sellion-subnasale length (SSL), lip length (LL), crest angle of nose (CNA)and angle of philtrum protrusion (APP), thus displaying defects in all of upper, middle and lower parts of face. In 44 patients, SF level > 2000 µg/Lwas found to be statistically related to BW and nasal root width (NRW). No such relationship was noted with the other 18 patients with lower SF levels. Measurement of craniofacial parameters by digital method is a convenient method to acquire a comprehensive idea about the anatomical defects of TDT patients. We have also shown that some of these defects may be related to iron overload.

A 12-year-old pony mare was presented for evaluation of dental disease and nasal discharge. At presentation, clinical signs included bilateral nasal discharge, cutaneous masses, and numerous hard enlargements involving the bones of the skull, maxilla, mandible, and cervical vertebrae. Oral exam revealed advanced dental disease with hard enlargements adjacent to and between numerous cheek teeth. Radiographs and computed tomography confirmed the presence of severe dental disease and proliferative bone lesions disseminated along the skull, hyoid apparatus, and cranial cervical vertebrae. The bony proliferations extended into the subcutis, nasal cavity, paranasal sinuses, orbits, cranial vault, and vertebral canal. Multifocal osteomas were considered the primary differential, and this was confirmed on biopsy of a bony mass. Due to the extent of the lesions and deterioration of the patient's quality of life, euthanasia was elected. On necropsy, multiple osteomas were present on the skull and to a lesser extent the cervical vertebrae. Additional abnormalities included multiple mucosal polyps in the small intestine, epidermal inclusion cysts, and adrenocortical adenomas. These findings resemble those seen in Gardner syndrome, a hereditary disease of people characterized by gastrointestinal polyps and extraintestinal manifestations, including osteomas, epidermoid cysts, adrenal tumors, and dental abnormalities. Historically, Gardner syndrome in people has been considered a separate condition from familial adenomatous polyposis (FAP). Gardner syndrome is now considered a variant of FAP associated with mutations in the adenomatous polyposis coli (APC) gene. Whole genome sequencing and variant discovery in the pony identified multiple unique variants, including a likely pathogenic single base pair insertion leading to a frameshift in APC (ENSECAP00000007276.1:p.Glu1527ArgfsTer9). While osteomas have been infrequently reported in horses, to the authors' knowledge, there have been no cases of Gardner syndrome described in equids. This case is highly suggestive of Gardner-like syndrome in an equid.

In recent years, titles like "Direct Approach to the Anterior and Lateral Part of the Maxillary Sinus with an Endoscope (DALMA) " have become increasingly common at neurosurgery conferences. However, if DALMA is not performed correctly, external nasal deformities can occur. This section provides information to ensure that DALMA is performed safely and to help prevent complications. Next, the transcribriform approach is addressed. Since this study focuses on this approach, we describe the DRAF procedure and methods for crista galli resection. DRAF surgery, if not performed by surgeons with sufficient experience, may result in insufficient bone resection, thereby complicating surgical exposure. Furthermore, resection of the crista galli significantly improves the anterosuperior view, increases the mobility of the anterior skull base tissues, and ensures adequate working space. Here, we describe the surgical techniques developed or modified by the authors for these three approaches.

Intracochlear theranostics, particularly targeted drug delivery and microsampling, offers a promising solution to inner ear diseases. However, specialized medical devices remain limited by a fundamental design challenge imposed by anatomical constraints: balancing miniaturization, dexterity, and perceptive functionality. Here, we present a low-aspect-ratio, dual-segment continuum robot that integrates catheter, endoscopic and instrumental functions. Driven by antagonistic cables, the robot uses a transition-free backbone composed of saddle-shaped joints to achieve a minimum bending radius of 1.9 mm. Dual-segment motion decoupling yields programmable C-/S-shaped configurations, facilitating anatomical navigation. The microneedle, embedded in the central channel, serves as an end-effector with positioning accuracy of 17.9 ± 4.1 μm. Fiber Bragg grating sensors, mounted on the needle, measure axial force to estimate tool-tissue interaction. Validation is performed on cadavers and in vivo animals, demonstrating the feasibility of a transcanal, atraumatic robotic paradigm. Thus, this system provides a practical and accessible approach for early diagnosis and treatment, helping extend precision medicine to underserved areas.