Bionic Lid Implant for Natural Closure (BLINC)

Facial nerve palsy (FNP) leads to an inability to blink. The exposed eye is at risk of developing corneal keratopathy and currently there is a lack of solution to active eye closure that is immediate and reliable. Bionic Lid Implant for Natural Closure (BLINC) proposes the use of an implantable actuator combined with the effects of an eyelid sling for dynamic eye closure. The aims of this thesis are to 1) explore the clinical need for BLINC, 2) describe the BLINC technology, and 3) present the results of its application in cadaveric and live models. Methods The aims of this project are addressed in three parts. In part one, the current therapies addressing key clinical end points in FNP from an ocular perspective and the setting where BLINC may first be used are explored. In part two the science behind BLINC is outlined. Finally in part three application of BLINC in cadaveric and live models are studied followed by a discussion on future steps preceding a pilot study in humans. Results Patients with FNP consistently identify issues related to the eye a primary concern. Current reanimation strategies offer the possibility of dynamic eye closure but the results are delayed and often unpredictable. BLINC reliably achieves active eye closure in cadaveric models by means of a wireless-powered, implantable electromagnetic actuator in conjunction with an eyelid sling. BLINC closes the eye in a similar fashion to natural closure for a symmetrical blink in FNP. Successful application of an inactive device in its complete form is achieved in a live animal without significant morbidity. Conclusion BLINC offers the possibility of restoring active eye closure with use of an implantable actuator. The concept has been successfully demonstrated in cadaveric models with successful device implantation in a live model. Future live trials are needed to address the remaining biocompatibility issues in preparation for human application

Exploring patient values and perceptions with facial nerve palsy to help guide management: An Australian perspective

**Background**: Facial nerve palsy (FNP) leads to a combination of aesthetic and functional deficits with profound psychosocial consequences. Significant advances have been made in restoring dynamic function through a range of facial reanimation solutions. Patient-reported severity scales are predetermined metrics that provide limited insight into patient values and perceptions. A qualitative study was conducted to elicit the experiences of patients with FNP and explore their views and motivations for seeking therapy. **Methods**: Participants were sourced from the Sydney Head and Neck Cancer Institute Database, Australia. Eligibility for the study included age over 18 years and a diagnosis of complete FNP. Semi-structured interviews were conducted and the transcripts were subjected to thematic text analysis. **Results**: Nineteen patients consented to participate in the study. One was excluded due to an isolated marginal mandibular nerve palsy. Five main themes emerged: eye symptoms, fear of judgement and social withdrawal, aversion to further invasive surgeries, the need for multidisciplinary streamlined care and lack of public awareness. **Conclusion**: Eye symptoms and the social consequences of FNP carry significant impact on both patients’ personal and professional lives. There is a paucity of services that can support patients across the complex spectrum of problems seen in FNP

Adjunct retrograde cerebral perfusion provides superior outcomes compared with hypothermic circulatory arrest alone : a meta-analysis

Objective: Retrograde cerebral perfusion is becoming less frequently used as a method of neuroprotection during aortic surgery. The present meta-analysis aims to compare outcomes after arch surgery with hypothermic circulatory arrest versus hypothermic circulatory arrest + retrograde cerebral perfusion. Methods: Electronic searches were performed using 7 databases from their inception to September 2016. Relevant comparative studies that included patient groups who underwent aortic arch surgery using hypothermic circulatory arrest with continuous retrograde cerebral perfusion or hypothermic circulatory arrest alone were identified, and data were extracted by 2 independent researchers. Data were aggregated using a random-effects model per predefined clinical end points. Results: Twenty-eight comparative studies were identified, with 2705 hypothermic circulatory arrest cases and 2817 hypothermic circulatory arrest + retrograde cerebral perfusion cases. No significant differences were seen between both groups in terms of age, gender, proportion of dissections and aneurysms, and hemiarch/total arch repair. The hypothermic circulatory arrest + retrograde cerebral perfusion group had slightly longer cardiopulmonary bypass time and lower body arrest time. Mortality was significantly increased for the hypothermic circulatory arrest cohort compared with the hypothermic circulatory arrest + retrograde cerebral perfusion cohort (odds ratio, 1.75; 95% confidence interval, 1.16-2.63; P =.007; I2 = 54%), but not on pooling of adjusted estimates. Stroke was also increased for the hypothermic circulatory arrest cohort (odds ratio, 1.50; 95% confidence interval, 1.07-2.10; P =.02; I2 = 29%). No difference in temporary neurologic deficit was identified (P =.66). Meta-regression found the treatment effect for mortality and stroke to be less pronounced in more contemporary series. Conclusions: These results suggest that the addition of retrograde cerebral perfusion during aortic arch surgery may provide better outcomes than using hypothermic circulatory arrest alone, although significant confounders exist. Further robust studies are required to confirm the utility of retrograde cerebral perfusion in arch surgery

Chimeric Vastus Lateralis and Anterolateral Thigh Flap for Restoring Facial Defects and Dynamic Function following Radical Parotidectomy

BACKGROUND: Extirpation of malignant tumors of the parotid results in creation of a complex facial defect often in combination with facial nerve palsy. This study presents the authors\u27 experience using vastus lateralis muscle as a chimeric flap with anterolateral thigh flap to allow both soft-tissue reconstruction and dynamic reanimation in radical parotidectomy. METHODS: A retrospective review of the medical records of cancer patients who had undergone radical parotidectomy and reconstruction using a chimeric vastus lateralis and anterolateral thigh flap between March of 2013 and May of 2017 was performed using the Sydney Head and Neck Cancer Institute database. The return of dynamic midface movement was the primary outcome investigated. Electronic, clinician-graded facial function scale grades were used to formally assess postoperative outcomes. RESULTS: A total of 27 patients were included in the study with an average age of 72 years (range, 31 to 88 years). Thirteen patients (48 percent) had developed dynamic function by the end of the study period. Young age predicted a more rapid return to dynamic function (p = 0.018). Both being a woman and having an intact facial nerve before surgery improved dynamic midface movement (p = 0.005 and p = 0.036, respectively). On multivariable analysis, superior midface dynamic function was associated with neurotization using midface facial nerve branches as opposed to using nerve-to-masseter alone (p = 0.05). CONCLUSION: The chimeric vastus lateralis and anterolateral thigh flap is a suitable option for restoring defects and dynamic function following radical parotidectomy

Characterization of temporal soft tissue space to aid the design of implants aimed at restoring function in facial paralysis

Aim: Facial paralysis inflicts devastating functional and aesthetic deficits. Several solutions are being developed, including implantable bionics to correct paralytic lagophthalmos. The temporal fossa has been postulated to be a suitable location for such devices. Anatomical studies of this fossa have limited application in the design of implants with complex internal components that are constrained by specific functional requirements. In this study, we assess the variation in temporal fossa volumes that could be utilized by a functional implantable device.Methods: CT scans of 18 hemifaces were used to create a 10-point template for measuring tissue thickness in the temporal fossa. Using this data, linear models were used to perform a volumetric analysis of the temporalis muscle and temporal fat pad concerning key anatomical landmarks.Results: The estimated temporalis muscle, temporal fat, and total combined volumes were 19.2 mL (95%CI: 10.4-32.9), 10.3 mL (95%CI: 6.1-16.1), and 29.5 mL (95%CI: 16.7-48.9) respectively, consistent with other publications. The temporalis muscle volume increases rapidly and then plateaus moving posteriorly along the zygomatic arch and superiorly along the lateral orbital rim. Whereas the temporal fat increases similarly along the lateral orbital rim, it increases at a uniform rate along the zygomatic arch.Conclusion: Simple geometric modelling of the functional soft tissue space in the temporal fossa is feasible and can be readily applied to aid in the development of implantable devices