A defunctioning ileostomy in all groups was only given in selected cases: in case of active inflammatory disease defined as bloody stool and high-dosage corticosteroids (>10 mg/day), in case of difficult dissection or technical difficulties during construction of the anastomosis, in case of bleeding, or in case of an incomplete donut.
It should be noted that the greatest difficulty of dissection was in the frozen cadavers, where the physiological cleavage planes were almost absent and in which a more difficult but ultimately satisfactory dissection was performed.
The second patient (a male), who had also undergone neck surgery (unilateral dissection), was intubated with difficulty using a Fasttrach (intubating laryngeal mask airway) because of anatomical abnormalities, which developed as a result of previous operations and radiotherapy.
However, the Tokyo guidelines may have a tendency to underestimate the extent of inflammation in male patients with severity grade I and over estimate the difficulty of dissection in severity grade II.
The lack of statistically significant difference in the duration of surgery amongst patients with grade I and grade II might argue that the difficulty of dissection associated with the surgical management of patients with grade II AC is over estimated by the Tokyo guidelines.
Main Outcome Measures: ΔR1 was compared with the other preoperative data (tumor volume, facial function), with the perioperative observations (difficulties with the dissection of the facial nerve), and especially with the postoperative status after 1 year.
Delayed surgery would likely be more challenging because of the difficulty of neurovascular dissection in an area with adhesive and fibrotic tissue.
Comparative QTL studies for forage grasses will present technical challenges because of their large genome size and the difficulty of molecular dissection due to their allogamous nature.
A significant problem with this approach is difficulty visualizing the dissection process in real time; the tissue block is opaque making visualization from beneath the block very difficult.
Conclusion: Statistical analysis shows that the blink reflex, through ΔR1, has an excellent prognostic value in anticipating the difficulties with facial nerve dissection and postoperative facial function after 1 year.
