AI is rapidly evolving from a supportive tool into a core component of medical decision making and evidence synthesis, reshaping how clinicians interpret information at the point of care. Yet, while much of medical AI research emphasizes algorithmic performance and explainability, it seldom addresses the more practical question: how should physicians evaluate an AI recommendation in real-world, high-risk situations when fluent outputs can conceal critical errors. This Perspective offers a clinician-centered framework that treats AI outputs as provisional, testable hypotheses rather than definitive conclusions. By guiding users through premise verification, terminological precision, evidence appraisal, and causal analysis, it provides a structured defense against hallucinations, selective reporting, and data poisoning, using otolaryngology as a high-stakes, multimodal model. By placing clinical judgment at the center of AI use, this work shifts the field from passive automation toward safer, more accountable decision support grounded in patient safety.

On this Christmas Eve, we feature the International Microsurgery Journal’s (IMJ) year end finale, a high caliber masterpiece by Editor-in-Chief Tommy Nai-Jen Chang and a prestigious cohort of heavyweight authors. Tommy’s 3-5-7 method offers a transformative advancement in facial nerve surgery, resolving the long standing compromise between surgical exposure and aesthetic integrity. By utilizing a precise coordinate system of 3.5 cm anterior and 0.7 cm caudal to the tragus, surgeons can rapidly identify the buccal branch through a minimal 5 cm preauricular incision. This protocol bypasses the morbidity of deep proximal dissection and avoids visible scarring, providing a reproducible solution that prioritizes both functional preservation and cosmetic outcomes.

This article presents a comprehensive review of schwannomatosis affecting cranial nerves, delineating its unique characteristics distinct from other forms of neurofibromatosis. By addressing diagnostic complexities and the evolving criteria for identification, the paper emphasizes the critical need for accurate recognition of schwannomatosis to facilitate effective management and provide essential genetic counseling. Enriched with a detailed case study, this review delivers vital insights into the epidemiology, symptomatology, and therapeutic strategies for schwannomatosis, advocating for a revision in current clinical approaches. This work is indispensable for medical professionals aiming to enhance diagnostic precision, comprehend genetic underpinnings, and improve patient outcomes. Offering a thorough analysis of this rare condition, the article is pivotal not only for clinicians and researchers in the neurogenetic field but also for a broader spectrum of medical and scientific communities, bridging a notable gap in contemporary medical literature.

This article presents a groundbreaking surgical approach for treating facial paralysis, focusing on the combination of the pronator quadratus muscle (PQM) and the radial forearm flap (RFF). It addresses the challenges in restoring facial functions and skin closure in paralysis cases. The study's novelty lies in its detailed examination of the PQM's vascular anatomy when combined with the RFF, a topic previously unexplored. Through meticulous dissections, it provides crucial anatomical insights essential for enhancing facial reanimation surgeries, offering significant benefits in medical practices related to facial reconstruction and nerve transfer techniques.

This comprehensive review article presents a profound exploration of critical facets within the realm of microsurgery, challenging existing paradigms. Through meticulous examination, the authors illuminate the intricate world of microangiosomes, dissection planes, and the clinical relevance of anatomical structures. Central to this discourse is an exhaustive comparative analysis of dermal plexus flaps, meticulously dissecting the viability and potential grafting applications of subdermal versus deep-dermal plexi. Augmenting this intellectual voyage are detailed illustrations, guiding readers through the intricate microanatomy underlying skin and adjacent tissues. This synthesis of knowledge not only redefines existing microsurgical principles but also opens new frontiers. By unearthing novel perspectives on microangiosomes and dissection planes and by offering a comparative insight into dermal plexus flaps, this work reshapes the landscape of microsurgery. These elucidations, coupled with visual aids, equip practitioners with invaluable insights for practical integration, promising to propel the field of microsurgery to unprecedented heights.

This article provides an overview of the major elements of a comprehensive manuscript review. The article also illustrates some of the basic responsibilities of the reviewer and describes some of the benefits and burdens associated with this role. Scholars may find this article useful as they conduct critical reviews of research papers.

The senior author (Dr. Isao Koshima) designed a tibial osseo-periosteal (TOP) flap. TOP flap has a favorable anatomical position with a thin skin around it, hence it is a good option for an island flap. TOP flap can be used for various mild to moderately sized osteo-cutaneous defects with low morbidity. In this article, the authors describe their experience of the first reported cohort of TOP flaps in clinical practice.

The study aims to assess the predictive values of certain psychological factors on the quality of life in patients with Head and Neck Cancer after radiotherapy. The authors conclude that the identification and the understanding of the depressive symptoms of patients, their beliefs about their illness as well as their coping strategies may provide the basis for timely implementation of appropriate intervention that may improve the quality of life in patients.

The author reports a case involving a 59-year-old man with delayed presentation of a huge mastoid cholesteatoma complicated by skull base erosion and cerebrospinal fluid leakage. Delayed presentation of this disease entity can have negative health consequences for patients. Regular otologic examinations, audiologic follow-up, and imaging examinations are viewed as the most effective strategies for the prevention of this type of situation. Early recognition of cholesteatomas is essential, as appropriate and timely treatment can prevent this rare comorbid condition from becoming fatal.

The study identifies how current voice, cough, and daytime breathing problems affect mental and physical quality of life in obstructive sleep apnea patients, as well as how the combination of voice, cough, and diurnal dyspnea impacts quality of life.