Outcome of different facial nerve reconstruction techniques.

PubMed

Mohamed, Aboshanif; Omi, Eigo; Honda, Kohei; Suzuki, Shinsuke; Ishikawa, Kazuo

There is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III. To evaluate the efficacy and safety of different facial nerve reconstruction techniques. Facial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years. For facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit. Among various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Improved Facial Nerve Identification During Parotidectomy With Fluorescently Labeled Peptide

PubMed Central

Hussain, Timon; Nguyen, Linda T.; Whitney, Michael; Hasselmann, Jonathan; Nguyen, Quyen T.

2016-01-01

Objectives/Hypothesis Additional intraoperative guidance could reduce the risk of iatrogenic injury during parotid gland cancer surgery. We evaluated the intraoperative use of fluorescently labeled nerve binding peptide NP41 to aid facial nerve identification and preservation during parotidectomy in an orthotopic model of murine parotid gland cancer. We also quantified the accuracy of intraoperative nerve detection for surface and buried nerves in the head and neck with NP41 versus white light (WL) alone. Study Design Twenty-eight mice underwent parotid gland cancer surgeries with additional fluorescence (FL) guidance versus WL reflectance (WLR) alone. Eight mice were used for additional nerve-imaging experiments. Methods Twenty-eight parotid tumor-bearing mice underwent parotidectomy. Eight mice underwent imaging of both sides of the face after skin removal. Postoperative assessment of facial nerve function measured by automated whisker tracking were compared between FL guidance (n = 13) versus WL alone (n = 15). In eight mice, nerve to surrounding tissue contrast was measured under FL versus WLR for all nerve branches detectable in the field of view. Results Postoperative facial nerve function after parotid gland cancer surgery tended to be better with additional FL guidance. Fluorescent labeling significantly improved nerve to surrounding tissue contrast for both large and smaller buried nerve branches compared to WLR visualization and improved detection sensitivity and specificity. Conclusions NP41 FL imaging significantly aids the intraoperative identification of nerve braches otherwise nearly invisible to the naked eye. Its application in a murine model of parotid gland cancer surgery tended to improve functional preservation of the facial nerve. PMID:27171862

The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery.

PubMed

Lu, I-Cheng; Chang, Pi-Ying; Su, Miao-Pei; Chen, Po-Nien; Chen, Hsiu-Ya; Chiang, Feng-Yu; Wu, Che-Wei

2017-08-01

The use of neuromuscular blocking agent (NMBA) during anesthesia may interfere with facial nerve monitoring (FNM) during parotid surgery. Sugammadex has been reported to be an effective and safe reversal of rocuronium-induced neuromuscular block (NMB) during surgery. This study investigated the feasibility and clinical effectiveness of sugammadex for NMB reversal during FNM in Parotid surgery. Fifty patients undergoing parotid surgery were randomized allocated into conventional anesthesia group (Group C, n = 25) and sugammadex group (Group S, n = 25). Group C did not receive any NMBA. Group S received rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at skin incision. The intubating condition and influence on FNM evoked EMG results were compared between groups. The intubation condition showed significantly better in group S patients than C group patients (excellent in 96% v.s. 24%). In group S, rapid reverse of NMB was found and the twitch (%) recovered from 0 to >90% within 10 min. Positive and high EMG signals were obtained in all patients at the time point of initial facial nerve stimulation in both groups. There was no significant difference as comparing the EMG amplitudes detected at the time point of initial and final facial nerve stimulation in both groups. Implementation of sugammadex in anesthesia protocol is feasible and reliable for successful FNM during parotid surgery. Copyright © 2017. Published by Elsevier Taiwan.

Improved facial nerve identification during parotidectomy with fluorescently labeled peptide.

PubMed

Hussain, Timon; Nguyen, Linda T; Whitney, Michael; Hasselmann, Jonathan; Nguyen, Quyen T

2016-12-01

Additional intraoperative guidance could reduce the risk of iatrogenic injury during parotid gland cancer surgery. We evaluated the intraoperative use of fluorescently labeled nerve binding peptide NP41 to aid facial nerve identification and preservation during parotidectomy in an orthotopic model of murine parotid gland cancer. We also quantified the accuracy of intraoperative nerve detection for surface and buried nerves in the head and neck with NP41 versus white light (WL) alone. Twenty-eight mice underwent parotid gland cancer surgeries with additional fluorescence (FL) guidance versus WL reflectance (WLR) alone. Eight mice were used for additional nerve-imaging experiments. Twenty-eight parotid tumor-bearing mice underwent parotidectomy. Eight mice underwent imaging of both sides of the face after skin removal. Postoperative assessment of facial nerve function measured by automated whisker tracking were compared between FL guidance (n = 13) versus WL alone (n=15). In eight mice, nerve to surrounding tissue contrast was measured under FL versus WLR for all nerve branches detectable in the field of view. Postoperative facial nerve function after parotid gland cancer surgery tended to be better with additional FL guidance. Fluorescent labeling significantly improved nerve to surrounding tissue contrast for both large and smaller buried nerve branches compared to WLR visualization and improved detection sensitivity and specificity. NP41 FL imaging significantly aids the intraoperative identification of nerve braches otherwise nearly invisible to the naked eye. Its application in a murine model of parotid gland cancer surgery tended to improve functional preservation of the facial nerve. NA Laryngoscope, 126:2711-2717, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Nerve growth factor reduces apoptotic cell death in rat facial motor neurons after facial nerve injury.

PubMed

Hui, Lian; Yuan, Jing; Ren, Zhong; Jiang, Xuejun

2015-01-01

To assess the effects of nerve growth factor (NGF) on motor neurons after induction of a facial nerve lesion, and to compare the effects of different routes of NGF injection on motor neuron survival. This study was carried out in the Department of Otolaryngology Head & Neck Surgery, China Medical University, Liaoning, China from October 2012 to March 2013. Male Wistar rats (n = 65) were randomly assigned into 4 groups: A) healthy controls; B) facial nerve lesion model + normal saline injection; C) facial nerve lesion model + NGF injection through the stylomastoid foramen; D) facial nerve lesion model + intraperitoneal injection of NGF. Apoptotic cell death was detected using the terminal deoxynucleotidyl transferase dUTP nick end-labeling assay. Expression of caspase-3 and p53 up-regulated modulator of apoptosis (PUMA) was determined by immunohistochemistry. Injection of NGF significantly reduced cell apoptosis, and also greatly decreased caspase-3 and PUMA expression in injured motor neurons. Group C exhibited better efficacy for preventing cellular apoptosis and decreasing caspase-3 and PUMA expression compared with group D (p<0.05). Our findings suggest that injections of NGF may prevent apoptosis of motor neurons by decreasing caspase-3 and PUMA expression after facial nerve injury in rats. The NGF injected through the stylomastoid foramen demonstrated better protective efficacy than when injected intraperitoneally.

Clinical outcome of continuous facial nerve monitoring during primary parotidectomy.

PubMed

Terrell, J E; Kileny, P R; Yian, C; Esclamado, R M; Bradford, C R; Pillsbury, M S; Wolf, G T

1997-10-01

To assess whether continuous facial nerve monitoring during parotidectomy is associated with a lower incidence of facial nerve paresis or paralysis compared with parotidectomy without monitoring and to assess the cost of such monitoring. A retrospective analysis of outcomes for patients who underwent parotidectomy with or without continuous facial nerve monitoring. University medical center. Fifty-six patients undergoing parotidectomy in whom continuous electromyographic monitoring was used and 61 patients in whom it was not used. (1) The incidence of early and persistent facial nerve paresis or paralysis and (2) the cost associated with facial nerve monitoring. Early, unintentional facial weakness was significantly lower in the group monitored by electromyograpy (43.6%) than in the unmonitored group (62.3%) (P=.04). In the subgroup of patients without comorbid conditions or surgeries, early weakness in the monitored group (33.3%) remained statistically lower than the rate of early weakness in the unmonitored group (57.5%) (P=.03). There was no statistical difference in the final facial nerve function or incidence of permanent nerve injury between the groups or subgroups. After multivariate analysis, nonmonitored status (odds ratio [OR], 3.22), advancing age (OR, 1.47 per 10 years), and longer operative times (OR, 1.3 per hour) were the only significant independent predictive variables significantly associated with early postoperative facial weakness. The incremental cost of facial nerve monitoring was $379. The results suggest that continuous electromyographic monitoring of facial muscle during primary parotidectomy reduces the incidence of short-term postoperative facial paresis. Advantages and disadvantages of this technique need to be considered together with the additional costs in deciding whether routine use of continuous monitoring is a useful, cost-effective adjunct to parotid surgery.

Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicentre retrospective study.

PubMed

Linder, T; Mulazimoglu, S; El Hadi, T; Darrouzet, V; Ayache, D; Somers, T; Schmerber, S; Vincent, C; Mondain, M; Lescanne, E; Bonnard, D

2017-06-01

To give an insight into why, when and where iatrogenic facial nerve (FN) injuries may occur and to explain how to deal with them in an emergency setting. Multicentre retrospective study in eight tertiary referral hospitals over 17 years. Twenty patients with partial or total FN injury during surgery for chronic otitis media (COM) were revised. Indication and type of surgery, experience of the surgeon, intra- and postoperative findings, value of CT scanning, patient management and final FN outcome were recorded. In 12 cases, the nerve was completely transected, but the surgeon was unaware in 11 cases. A minority of cases occurred in academic teaching hospitals. Tympanic segment, second genu and proximal mastoid segments were the sites involved during injury. The FN was not deliberately identified in 18 patients at the time of injury, and nerve monitoring was only applied in one patient. Before revision surgery, CT scanning correctly identified the lesion site in 11 of 12 cases and depicted additional lesions such as damage to the lateral semicircular canal. A greater auricular nerve graft was interposed in 10 cases of total transection and in one partially lesioned nerve: seven of them resulted in an HB III functional outcome. In two of the transected nerves, rerouting and direct end-to-end anastomosis was applied. A simple FN decompression was used in four cases of superficially traumatised nerves. We suggest checklists for preoperative, intraoperative and postoperative management to prevent and treat iatrogenic FN injury during COM surgery. © 2016 John Wiley & Sons Ltd.

Hypoglossal-facial-jump-anastomosis without an interposition nerve graft.

PubMed

Beutner, Dirk; Luers, Jan C; Grosheva, Maria

2013-10-01

The hypoglossal-facial-anastomosis is the most often applied procedure for the reanimation of a long lasting peripheral facial nerve paralysis. The use of an interposition graft and its end-to-side anastomosis to the hypoglossal nerve allows the preservation of the tongue function and also requires two anastomosis sites and a free second donor nerve. We describe the modified technique of the hypoglossal-facial-jump-anastomosis without an interposition and present the first results. Retrospective case study. We performed the facial nerve reconstruction in five patients. The indication for the surgery was a long-standing facial paralysis with preserved portion distal to geniculate ganglion, absent voluntary activity in the needle facial electromyography, and an intact bilateral hypoglossal nerve. Following mastoidectomy, the facial nerve was mobilized in the fallopian canal down to its bifurcation in the parotid gland and cut in its tympanic portion distal to the lesion. Then, a tensionless end-to-side suture to the hypoglossal nerve was performed. The facial function was monitored up to 16 months postoperatively. The reconstruction technique succeeded in all patients: The facial function improved within the average time period of 10 months to the House-Brackmann score 3. This modified technique of the hypoglossal-facial reanimation is a valid method with good clinical results, especially in cases of a preserved intramastoidal facial nerve. Level 4. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Surgical management of internal auditory canal and cerebellopontine angle facial nerve schwannoma

PubMed Central

Mowry, Sarah; Hansen, Marlan; Gantz, Bruce

2013-01-01

Objective To investigate the long-term patient outcomes following tumor debulking for internal auditory canal facial schwannoma (FNS). Study Design retrospective case review Setting Tertiary referral center Patients Patients operated on between 1998–2010 for a preoperative diagnosis of vestibular schwannoma with the intraoperative identification FNS instead. Intervention diagnostic and therapeutic Main Outcome Measures House-Brackmann facial nerve score immediately and at long term follow up (>1 yr); recurrence of tumor. Results 16 patients were identified who were presumed to have vestibular schwannoma but intraoperatively were diagnosed with facial nerve schwannoma. Eleven underwent debulking surgery (67%–99% tumor removal), 2 underwent decompression only, 2 were diagnosed with nervus intermedius tumors and had total tumor removal with preservation of the motor branch of CN VII, 1 had complete tumor removal with facial nerve grafting. Five of 11 debulking patients underwent the MCF approach for tumor removal; the remainder had translabyrinthine resections. One debulking patient was lost to follow-up. Nine of 10 patients with long term follow up had H/B grade I or II facial function. One patient had recurrence of the tumor that required revision surgery with total removal and facial nerve grafting. Conclusions Tumor debulking for FNS provides an opportunity for tumor removal and excellent facial nerve function. Continuous facial nerve monitoring is vital for successful debulking surgery. FNS debulking is feasible via the MCF approach. Serial postoperative imaging is warranted to monitor for recurrence. PMID:22772011

Correlations between the clinical, histological and neurophysiological examinations in patients before and after parotid gland tumor surgery: verification of facial nerve transmission.

PubMed

Wiertel-Krawczuk, Agnieszka; Huber, Juliusz; Wojtysiak, Magdalena; Golusiński, Wojciech; Pieńkowski, Piotr; Golusiński, Paweł

2015-05-01

Parotid gland tumor surgery sometimes leads to facial nerve paralysis. Malignant more than benign tumors determine nerve function preoperatively, while postoperative observations based on clinical, histological and neurophysiological studies have not been reported in detail. The aims of this pilot study were evaluation and correlations of histological properties of tumor (its size and location) and clinical and neurophysiological assessment of facial nerve function pre- and post-operatively (1 and 6 months). Comparative studies included 17 patients with benign (n = 13) and malignant (n = 4) tumors. Clinical assessment was based on House-Brackmann scale (H-B), neurophysiological diagnostics included facial electroneurography [ENG, compound muscle action potential (CMAP)], mimetic muscle electromyography (EMG) and blink-reflex examinations (BR). Mainly grade I of H-B was recorded both pre- (n = 13) and post-operatively (n = 12) in patients with small (1.5-2.4 cm) benign tumors located in superficial lobes. Patients with medium size (2.5-3.4 cm) malignant tumors in both lobes were scored at grade I (n = 2) and III (n = 2) pre- and mainly VI (n = 4) post-operatively. CMAP amplitudes after stimulation of mandibular marginal branch were reduced at about 25 % in patients with benign tumors after surgery. In the cases of malignant tumors CMAPs were not recorded following stimulation of any branch. A similar trend was found for BR results. H-B and ENG results revealed positive correlations between the type of tumor and surgery with facial nerve function. Neurophysiological studies detected clinically silent facial nerve neuropathy of mandibular marginal branch in postoperative period. Needle EMG, ENG and BR examinations allow for the evaluation of face muscles reinnervation and facial nerve regeneration.

Effects of ozone therapy on facial nerve regeneration.

PubMed

Ozbay, Isa; Ital, Ilker; Kucur, Cuneyt; Akcılar, Raziye; Deger, Aysenur; Aktas, Savas; Oghan, Fatih

Ozone may promote moderate oxidative stress, which increases antioxidant endogenous systems. There are a number of antioxidants that have been investigated therapeutically for improving peripheral nerve regeneration. However, no previous studies have reported the effect of ozone therapy on facial nerve regeneration. We aimed to evaluate the effect of ozone therapy on facial nerve regeneration. Fourteen Wistar albino rats were randomly divided into two groups with experimental nerve crush injuries: a control group, which received saline treatment post-crush, and an experimental group, which received ozone treatment. All animals underwent surgery in which the left facial nerve was exposed and crushed. Treatment with saline or ozone began on the day of the nerve crush. Left facial nerve stimulation thresholds were measured before crush, immediately after crush, and after 30 days. After measuring nerve stimulation thresholds at 30 days post-injury, the crushed facial nerve was excised. All specimens were studied using light and electron microscopy. Post-crushing, the ozone-treated group had lower stimulation thresholds than the saline group. Although this did not achieve statistical significance, it is indicative of greater functional improvement in the ozone group. Significant differences were found in vascular congestion, macrovacuolization, and myelin thickness between the ozone and control groups. Significant differences were also found in axonal degeneration and myelin ultrastructure between the two groups. We found that ozone therapy exerted beneficial effect on the regeneration of crushed facial nerves in rats. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Quantitative facial electromyography monitoring after hypoglossal‐facial jump nerve suture

PubMed Central

Flasar, Jan; Volk, Gerd Fabian; Granitzka, Thordis; Geißler, Katharina; Irintchev, Andrey; Lehmann, Thomas

2017-01-01

Objectives/Hypothesis The time course of the reinnervation of the paralyzed face after hypoglossal‐facial jump nerve suture using electromyography (EMG) was assessed. The relation to the clinical outcome was analyzed. Study Design Retrospective single‐center cohort study Methods Reestablishment of motor units was studied by quantitative EMG and motor unit potential (MUP) analysis in 11 patients after hypoglossal‐facial jump nerve suture. Functional recovery was evaluated using the Stennert index (0 = normal; 10 = maximal palsy). Results Clinically, first movements were seen between 6 and >10 months after surgery in individual patients. Maximal improvement was achieved at 18 months. The Stennert index decreased from 7.9 ± 2.0 preoperatively to a final postoperative score of 5.8 ± 2.4. EMG monitoring performed for 2.8 to 60 months after surgery revealed that pathological spontaneous activity disappeared within 2 weeks. MUPs were first recorded after the 2nd month and present in all 11 patients 8–10 months post‐surgery. Polyphasic regeneration potentials first appeared at 4–10 months post‐surgery. The MUP amplitudes increased between the 3rd and 15th months after surgery to values of control muscles. The MUP duration was significantly increased above normal values between the 3rd and 24th months after surgery. Conclusion Reinnervation can be detected at least 2 months earlier by EMG than by clinical evaluation. Changes should be followed for at least 18 months to assess outcome. EMG changes reflected the remodeling of motor units due to axonal regeneration and collateral sprouting by hypoglossal nerve fibers into the reinnervated facial muscle fibers. Level of Evidence 3b. PMID:29094077

Facial Nerve Paralysis due to Chronic Otitis Media: Prognosis in Restoration of Facial Function after Surgical Intervention

PubMed Central

Kim, Jin; Jung, Gu-Hyun; Park, See-Young

2012-01-01

Purpose Facial paralysis is an uncommon but significant complication of chronic otitis media (COM). Surgical eradication of the disease is the most viable way to overcome facial paralysis therefrom. In an effort to guide treatment of this rare complication, we analyzed the prognosis of facial function after surgical treatment. Materials and Methods A total of 3435 patients with COM, who underwent various otologic surgeries throughout a period of 20 years, were analyzed retrospectively. Forty six patients (1.33%) had facial nerve paralysis caused by COM. We analyzed prognostic factors including delay of surgery, the extent of disease, presence or absence of cholesteatoma and the type of surgery affecting surgical outcomes. Results Surgical intervention had a good effect on the restoration of facial function in cases of shorter duration of onset of facial paralysis to surgery and cases of sudden onset, without cholesteatoma. No previous ear surgery and healthy bony labyrinth indicated a good postoperative prognosis. Conclusion COM causing facial paralysis is most frequently due to cholesteatoma and the presence of cholesteatoma decreased the effectiveness of surgical treatment and indicated a poor prognosis after surgery. In our experience, early surgical intervention can be crucial to recovery of facial function. To prevent recurrent cholesteatoma, which leads to local destruction of the facial nerve, complete eradication of the disease in one procedure cannot be overemphasized for the treatment of patients with COM. PMID:22477011

Facial reanimation by muscle-nerve neurotization after facial nerve sacrifice. Case report.

PubMed

Taupin, A; Labbé, D; Babin, E; Fromager, G

2016-12-01

Recovering a certain degree of mimicry after sacrifice of the facial nerve is a clinically recognized finding. The authors report a case of hemifacial reanimation suggesting a phenomenon of neurotization from muscle-to-nerve. A woman benefited from a parotidectomy with sacrifice of the left facial nerve indicated for recurrent tumor in the gland. The distal branches of the facial nerve, isolated at the time of resection, were buried in the masseter muscle underneath. The patient recovered a voluntary hémifacial motricity. The electromyographic analysis of the motor activity of the zygomaticus major before and after block of the masseter nerve showed a dependence between mimic muscles and the masseter muscle. Several hypotheses have been advanced to explain the spontaneous reanimation of facial paralysis. The clinical case makes it possible to argue in favor of muscle-to-nerve neurotization from masseter muscle to distal branches of the facial nerve. It illustrates the quality of motricity that can be obtained thanks to this procedure. The authors describe a simple implantation technique of distal branches of the facial nerve in the masseter muscle during a radical parotidectomy with facial nerve sacrifice and recovery of resting tone but also a quality voluntary mimicry. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Intraparotid Neurofibroma of the Facial Nerve: A Case Report.

PubMed

Nofal, Ahmed-Abdel-Fattah; El-Anwar, Mohammad-Waheed

2016-07-01

Intraparotid neurofibromas of the facial nerve are extremely rare and mostly associated with neurofibromatosis type 1 (NF1). This is a case of a healthy 40-year-old man, which underwent surgery for a preoperatively diagnosed benign parotid gland lesion. After identification of the facial nerve main trunk, a single large mass (6 x 3 cm) incorporating the upper nerve division was observed. The nerve portion involved in the mass could not be dissected and was inevitably sacrificed with immediate neuroraphy of the upper division of the facial nerve with 6/0 prolene. The final histopathology revealed the presence of a neurofibroma. Complete left side facial nerve paralysis was observed immediately postoperatively but the function of the lower half was returned within 4 months and the upper half was returned after 1 year. Currently, after 3 years of follow up, there are no signs of recurrence and normal facial nerve function is observed. Neurofibroma should be considered as the diagnosis in a patient demonstrating a parotid mass. In cases where it is diagnosed intraoperatively, excision of part of the nerve with the mass will be inevitable though it can be successfully repaired by end to end anastomosis.

Chronic, burning facial pain following cosmetic facial surgery.

PubMed

Eisenberg, E; Yaari, A; Har-Shai, Y

1996-01-01

Chronic, burning facial pain as a result of cosmetic facial surgery has rarely been reported. During the year of 1994, two female patients presented themselves at our Pain Relief Clinic with chronic facial pain that developed following aesthetic facial surgery. One patient underwent bilateral transpalpebral surgery for removal of intraorbital fat for the correction of the exophthalmus, and the other had classical face and anterior hairline forehead lifts. Pain in both patients was similar in that it was bilateral, symmetric, burning in quality, and aggravated by external stimuli, mainly light touch. It was resistant to multiple analgesic medications, and was associated with significant depression and disability. Diagnostic local (lidocaine) and systemic (lidocaine and phentolamine) nerve blocks failed to provide relief. Psychological evaluation revealed that the two patients had clear psychosocial factors that seemed to have further compounded their pain complaints. Tricyclic antidepressants (and biofeedback training in one patient) were modestly effective and produced only partial pain relief.

Intraoperative identification of the facial nerve by needle electromyography stimulation with a burr

PubMed Central

KHAMGUSHKEEVA, N.N.; ANIKIN, I.A.; KORNEYENKOV, A.A.

2016-01-01

The purpose of this research is to improve the safety of surgery for patients with a pathology of the middle and inner ear by preventing damage to the facial nerve by conducting intraoperative monitoring of the facial nerve by needle electromyography with continuous stimulation with a burr. Patients and Methods The clinical part of the prospective study was carried out on 48 patients that were diagnosed with suppurative otitis media. After the surgery with intraoperative monitoring, the facial nerve with an intact bone wall was stimulated electrically in the potentially dangerous places of damage. Minimum (threshold) stimulation (mA) of the facial nerve with a threshold event of 100 μV was used to register EMG events. The anatomical part of the study was carried out on 30 unformalinized cadaver temporal bones from adult bodies. The statistical analysis of obtained data was carried out with parametric methods (Student’s t-test), non-parametric correlation (Spearman’s method) and regression analysis. Results It was found that 1 mA of threshold amperage corresponded to 0.8 mm thickness of the bone wall of the facial canal. Values of transosseous threshold stimulation in potentially dangerous sections of the injury to the facial nerve were obtained. Conclusion These data lower the risk of paresis (paralysis) of the facial muscles during otologic surgery. PMID:27142821

[Changes in facial nerve function, morphology and neurotrophic factor III expression following three types of facial nerve injury].

PubMed

Zhang, Lili; Wang, Haibo; Fan, Zhaomin; Han, Yuechen; Xu, Lei; Zhang, Haiyan

2011-01-01

To study the changes in facial nerve function, morphology and neurotrophic factor III (NT-3) expression following three types of facial nerve injury. Changes in facial nerve function (in terms of blink reflex (BF), vibrissae movement (VM) and position of nasal tip) were assessed in 45 rats in response to three types of facial nerve injury: partial section of the extratemporal segment (group one), partial section of the facial canal segment (group two) and complete transection of the facial canal segment lesion (group three). All facial nerves specimen were then cut into two parts at the site of the lesion after being taken from the lesion site on 1st, 7th, 21st post-surgery-days (PSD). Changes of morphology and NT-3 expression were evaluated using the improved trichrome stain and immunohistochemistry techniques ,respectively. Changes in facial nerve function: In group 1, all animals had no blink reflex (BF) and weak vibrissae movement (VM) at the 1st PSD; The blink reflex in 80% of the rats recovered partly and the vibrissae movement in 40% of the rats returned to normal at the 7th PSD; The facial nerve function in 600 of the rats was almost normal at the 21st PSD. In group 2, all left facial nerve paralyzed at the 1st PSD; The blink reflex partly recovered in 40% of the rats and the vibrissae movement was weak in 80% of the rats at the 7th PSD; 8000 of the rats'BF were almost normal and 40% of the rats' VM completely recovered at the 21st PSD. In group 3, The recovery couldn't happen at anytime. Changes in morphology: In group 1, the size of nerve fiber differed in facial canal segment and some of myelin sheath and axons degenerated at the 7th PSD; The fibres' degeneration turned into regeneration at the 21st PSD; In group 2, the morphologic changes in this group were familiar with the group 1 while the degenerated fibers were more and dispersed in transection at the 7th PSD; Regeneration of nerve fibers happened at the 21st PSD. In group 3, most of the fibers

Brief electrical stimulation after facial nerve transection and neurorrhaphy: a randomized prospective animal study.

PubMed

Mendez, Adrian; Seikaly, Hadi; Biron, Vincent L; Zhu, Lin Fu; Côté, David W J

2016-02-01

Recent studies have examined the effects of brief electrical stimulation (BES) on nerve regeneration, with some suggesting that BES accelerates facial nerve recovery. However, the facial nerve outcome measurement in these studies has not been precise or accurate. The objective of this study is to assess the effect of BES on accelerating facial nerve functional recovery from a transection injury in the rat model. A prospective randomized animal study using a rat model was performed. Two groups of 9 rats underwent facial nerve surgery. Both group 1 and 2 underwent facial nerve transection and repair at the main trunk of the nerve, with group 2 additionally receiving BES on post-operative day 0 for 1 h using an implantable stimulation device. Primary outcome was measured using a laser curtain model, which measured amplitude of whisking at 2, 4, and 6 weeks post-operatively. At week 2, the average amplitude observed for group 1 was 4.4°. Showing a statistically significant improvement over group 1, the group 2 mean was 14.0° at 2 weeks post-operatively (p = 0.0004). At week 4, group 1 showed improvement having an average of 9.7°, while group 2 remained relatively unchanged with an average of 12.8°. Group 1 had an average amplitude of 13.63° at 6-weeks from surgery. Group 2 had a similar increase in amplitude with an average of 15.8°. There was no statistically significant difference between the two groups at 4 and 6 weeks after facial nerve surgery. This is the first study to use an implantable stimulator for serial BES following neurorrhaphy in a validated animal model. Results suggest performing BES after facial nerve transection and neurorrhaphy at the main trunk of the facial nerve is associated with accelerated whisker movement in a rat model compared with a control group.

Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Intraoperative Cranial Nerve Monitoring in Vestibular Schwannoma Surgery.

PubMed

Vivas, Esther X; Carlson, Matthew L; Neff, Brian A; Shepard, Neil T; McCracken, D Jay; Sweeney, Alex D; Olson, Jeffrey J

2018-02-01

Does intraoperative facial nerve monitoring during vestibular schwannoma surgery lead to better long-term facial nerve function? This recommendation applies to adult patients undergoing vestibular schwannoma surgery regardless of tumor characteristics. Level 3: It is recommended that intraoperative facial nerve monitoring be routinely utilized during vestibular schwannoma surgery to improve long-term facial nerve function. Can intraoperative facial nerve monitoring be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery? This recommendation applies to adult patients undergoing vestibular schwannoma surgery. Level 3: Intraoperative facial nerve can be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery. Specifically, the presence of favorable testing reliably portends a good long-term facial nerve outcome. However, the absence of favorable testing in the setting of an anatomically intact facial nerve does not reliably predict poor long-term function and therefore cannot be used to direct decision-making regarding the need for early reinnervation procedures. Does an anatomically intact facial nerve with poor electromyogram (EMG) electrical responses during intraoperative testing reliably predict poor long-term facial nerve function? This recommendation applies to adult patients undergoing vestibular schwannoma surgery. Level 3: Poor intraoperative EMG electrical response of the facial nerve should not be used as a reliable predictor of poor long-term facial nerve function. Should intraoperative eighth cranial nerve monitoring be used during vestibular schwannoma surgery? This recommendation applies to adult patients undergoing vestibular schwannoma surgery with measurable preoperative hearing levels and tumors smaller than 1.5 cm. Level 3: Intraoperative eighth cranial nerve monitoring should be used during vestibular schwannoma surgery when hearing preservation

Intratemporal facial nerve ultrastructure in patients with idiopathic facial paralysis: viral infection evidence study.

PubMed

Florez, Rosangela Aló Maluza; Lang, Raquel; Veridiano, Adriano Mora; Zanini, Renato de Oliveira; Calió, Pedro Luiz; Simões, Ricardo Dos Santos; Testa, José Ricardo Gurgel

2010-01-01

The etiology of idiopathic peripheral facial palsy (IPFP) is still uncertain; however, some authors suggest the possibility of a viral infection. to analyze the ultrastructure of the facial nerve seeking viral evidences that might provide etiological data. We studied 20 patients with peripheral facial palsy (PFP), with moderate to severe FP, of both genders, between 18-60 years of age, from the Clinic of Facial Nerve Disorders. The patients were broken down into two groups - Study: eleven patients with IPFP and Control: nine patients with trauma or tumor-related PFP. The fragments were obtained from the facial nerve sheath or from fragments of its stumps - which would be discarded or sent to pathology exam during the facial nerve repair surgery. The removed tissue was fixed in 2% glutaraldehyde, and studied under Electronic Transmission Microscopy. In the study group we observed an intense repair cellular activity by increased collagen fibers, fibroblasts containing developed organelles, free of viral particles. In the control group this repair activity was not evident, but no viral particles were observed. There were no viral particles, and there were evidences of intense activity of repair or viral infection.

Chitosan conduits combined with nerve growth factor microspheres repair facial nerve defects

PubMed Central

Liu, Huawei; Wen, Weisheng; Hu, Min; Bi, Wenting; Chen, Lijie; Liu, Sanxia; Chen, Peng; Tan, Xinying

2013-01-01

Microspheres containing nerve growth factor for sustained release were prepared by a compound method, and implanted into chitosan conduits to repair 10-mm defects on the right buccal branches of the facial nerve in rabbits. In addition, chitosan conduits combined with nerve growth factor or normal saline, as well as autologous nerve, were used as controls. At 90 days post-surgery, the muscular atrophy on the right upper lip was more evident in the nerve growth factor and normal sa-line groups than in the nerve growth factor-microspheres and autologous nerve groups. physiological analysis revealed that the nerve conduction velocity and amplitude were significantly higher in the nerve growth factor-microspheres and autologous nerve groups than in the nerve growth factor and normal saline groups. Moreover, histological observation illustrated that the di-ameter, number, alignment and myelin sheath thickness of myelinated nerves derived from rabbits were higher in the nerve growth factor-microspheres and autologous nerve groups than in the nerve growth factor and normal saline groups. These findings indicate that chitosan nerve conduits bined with microspheres for sustained release of nerve growth factor can significantly improve facial nerve defect repair in rabbits. PMID:25206635

Sound-induced facial synkinesis following facial nerve paralysis.

PubMed

Ma, Ming-San; van der Hoeven, Johannes H; Nicolai, Jean-Philippe A; Meek, Marcel F

2009-08-01

Facial synkinesis (or synkinesia) (FS) occurs frequently after paresis or paralysis of the facial nerve and is in most cases due to aberrant regeneration of (branches of) the facial nerve. Patients suffer from inappropriate and involuntary synchronous facial muscle contractions. Here we describe two cases of sound-induced facial synkinesis (SFS) after facial nerve injury. As far as we know, this phenomenon has not been described in the English literature before. Patient A presented with right hemifacial palsy after lesion of the facial nerve due to skull base fracture. He reported involuntary muscle activity at the right corner of the mouth, specifically on hearing ringing keys. Patient B suffered from left hemifacial palsy following otitis media and developed involuntary muscle contraction in the facial musculature specifically on hearing clapping hands or a trumpet sound. Both patients were evaluated by means of video, audio and EMG analysis. Possible mechanisms in the pathophysiology of SFS are postulated and therapeutic options are discussed.

Long-term recurrence rate of pleomorphic adenoma and postoperative facial nerve paresis (in parotid surgery).

PubMed

Zernial, Oliver; Springer, Ingo N; Warnke, Patrick; Härle, Franz; Risick, Christian; Wiltfang, Jörg

2007-04-01

The purpose of this study was to evaluate recurrence rates and comorbidity in patients with pleomorphic adenomas of patients after superficial and total conservative parotidectomy. Localization of pleomorphic adenomas, age, sex distribution and facial nerve function of 73 patients were examined in this retrospective study. The recurrence rate could be determined in 43 of these patients. The interval between surgery and last recall varied between 2 and 20 years (median: 8.1 years). Most of the patients were female (67%) with a parotid pleomorphic adenoma. No recurrence was found regard less of whether a superficial or total conservative parotidectomy had been performed. Our data did show that the total conservative parotidectomy is associated with a higher incidence of temporary impaired facial nerve function, which was seen in 42% of this group. Temporary decreased nerve function after superficial parotidectomy was rare being apparent in only 16% of this group. A more radical procedure does not significantly lower the recurrence rate. We suggest that the indication for a total conservative parotidectomy in cases of superficial adenomas should be considered carefully.

Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma

PubMed Central

Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M.; Ginsberg, Lawrence E.; Gidley, Paul W.

2014-01-01

Background Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy. PMID:25083397

Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma.

PubMed

Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M; Ginsberg, Lawrence E; Gidley, Paul W

2014-08-01

Background Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy.

Overview of pediatric peripheral facial nerve paralysis: analysis of 40 patients.

PubMed

Özkale, Yasemin; Erol, İlknur; Saygı, Semra; Yılmaz, İsmail

2015-02-01

Peripheral facial nerve paralysis in children might be an alarming sign of serious disease such as malignancy, systemic disease, congenital anomalies, trauma, infection, middle ear surgery, and hypertension. The cases of 40 consecutive children and adolescents who were diagnosed with peripheral facial nerve paralysis at Baskent University Adana Hospital Pediatrics and Pediatric Neurology Unit between January 2010 and January 2013 were retrospectively evaluated. We determined that the most common cause was Bell palsy, followed by infection, tumor lesion, and suspected chemotherapy toxicity. We noted that younger patients had generally poorer outcome than older patients regardless of disease etiology. Peripheral facial nerve paralysis has been reported in many countries in America and Europe; however, knowledge about its clinical features, microbiology, neuroimaging, and treatment in Turkey is incomplete. The present study demonstrated that Bell palsy and infection were the most common etiologies of peripheral facial nerve paralysis. © The Author(s) 2014.

Cross-face nerve grafting for reanimation of incomplete facial paralysis: quantitative outcomes using the FACIAL CLIMA system and patient satisfaction.

PubMed

Hontanilla, Bernardo; Marre, Diego; Cabello, Alvaro

2014-01-01

Although in most cases Bell palsy resolves spontaneously, approximately one-third of patients will present sequela including facial synkinesis and paresis. Currently, the techniques available for reanimation of these patients include hypoglossal nerve transposition, free muscle transfer, and cross-face nerve grafting (CFNG). Between December 2008 and March 2012, eight patients with incomplete unilateral facial paralysis were reanimated with two-stage CFNG. Gender, age at surgery, etiology of paralysis denervation time, donor and recipient nerves, presence of facial synkinesis, and follow-up were registered. Commissural excursion and velocity and patient satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. Mean age at surgery was 33.8 ± 11.5 years; mean time of denervation was 96.6 ± 109.8 months. No complications requiring surgery were registered. Follow-up period ranged from 7 to 33 months with a mean of 19 ± 9.7 months. FACIAL CLIMA showed improvement of both commissural excursion and velocity greater than 75% in 4 patients, greater than 50% in 2 patients, and less than 50% in the remaining two patients. Qualitative evaluation revealed a high grade of satisfaction in six patients (75%). Two-stage CFNG is a reliable technique for reanimation of incomplete facial paralysis with a high grade of patient satisfaction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Clinical predictors of facial nerve outcome after translabyrinthine resection of acoustic neuromas.

PubMed

Shamji, Mohammed F; Schramm, David R; Benoit, Brien G

2007-01-01

The translabyrinthine approach to acoustic neuroma resection offers excellent exposure for facial nerve dissection with 95% preservation of anatomic continuity. Acceptable outcome in facial asymptomatic patients is reported at 64-90%, but transient postoperative deterioration often occurs. The objective of this study was to identify preoperative clinical presentation and intraoperative surgical findings that predispose patients to facial nerve dysfunction after acoustic neuroma surgery. The charts of 128 consecutive translabyrinthine patients were examined retrospectively to identify new clinical and intraoperative predictors of facial nerve outcome. Postoperative evaluation of patients to normal function or mild asymmetry upon close inspection (House-Brackmann grades of I or II) was defined as an acceptable outcome, with obvious asymmetry to no movement (grades III to VI) defined as unacceptable. Intraoperative nerve stimulation was performed in all cases, and clinical grading was performed by a single neurosurgeon in all cases. Among patients with no preoperative facial nerve deficit, 87% had an acceptable result. Small size (P < 0.01) and low intraoperative nerve stimulation of < 0.10 mA (P< 0.01) were reaffirmed as predictive of functional nerve preservation. Additionally, preoperative tinnitus (P = 0.03), short duration of hearing loss (P< 0. 01), and lack of subjective tumour adherence to the facial nerve (P = 0.02) were independently correlated with positive outcome. Our experience with the translabyrinthine approach reveals the previously unestablished associations of facial nerve outcome to include presence of tinnitus and duration of hypoacusis. Independent predictors of tumour size and nerve stimulation thresholds were reaffirmed, and the subjective description of tumour adherence to the facial nerve making dissection more difficult appears to be important.

Imaging the Facial Nerve: A Contemporary Review

PubMed Central

Gupta, Sachin; Mends, Francine; Hagiwara, Mari; Fatterpekar, Girish; Roehm, Pamela C.

2013-01-01

Imaging plays a critical role in the evaluation of a number of facial nerve disorders. The facial nerve has a complex anatomical course; thus, a thorough understanding of the course of the facial nerve is essential to localize the sites of pathology. Facial nerve dysfunction can occur from a variety of causes, which can often be identified on imaging. Computed tomography and magnetic resonance imaging are helpful for identifying bony facial canal and soft tissue abnormalities, respectively. Ultrasound of the facial nerve has been used to predict functional outcomes in patients with Bell's palsy. More recently, diffusion tensor tractography has appeared as a new modality which allows three-dimensional display of facial nerve fibers. PMID:23766904

Reconstruction of facial nerve injuries in children.

PubMed

Fattah, Adel; Borschel, Gregory H; Zuker, Ron M

2011-05-01

Facial nerve trauma is uncommon in children, and many spontaneously recover some function; nonetheless, loss of facial nerve activity leads to functional impairment of ocular and oral sphincters and nasal orifice. In many cases, the impediment posed by facial asymmetry and reduced mimetic function more significantly affects the child's psychosocial interactions. As such, reconstruction of the facial nerve affords great benefits in quality of life. The therapeutic strategy is dependent on numerous factors, including the cause of facial nerve injury, the deficit, the prognosis for recovery, and the time elapsed since the injury. The options for treatment include a diverse range of surgical techniques including static lifts and slings, nerve repairs, nerve grafts and nerve transfers, regional, and microvascular free muscle transfer. We review our strategies for addressing facial nerve injuries in children.

IncobotulinumtoxinA treatment of facial nerve palsy after neurosurgery.

PubMed

Akulov, Mihail A; Orlova, Ol'ga R; Orlova, Aleksandra S; Usachev, Dmitrij J; Shimansky, Vadim N; Tanjashin, Sergey V; Khatkova, Svetlana E; Yunosha-Shanyavskaya, Anna V

2017-10-15

This study evaluates the effect of incobotulinumtoxinA in the acute and chronic phases of facial nerve palsy after neurosurgical interventions. Patients received incobotulinumtoxinA injections (active treatment group) or standard rehabilitation treatment (control group). Functional efficacy was assessed using House-Brackmann, Yanagihara System and Sunnybrook Facial Grading scales, and Facial Disability Index self-assessment. Significant improvements on all scales were seen after 1month of incobotulinumtoxinA treatment (active treatment group, р<0.05), but only after 3months of rehabilitation treatment (control group, р<0.05). At 1 and 2years post-surgery, the prevalence of synkinesis was significantly higher in patients in the control group compared with those receiving incobotulinumtoxinA treatment (р<0.05 and р<0.001, respectively). IncobotulinumtoxinA treatment resulted in significant improvements in facial symmetry in patients with facial nerve injury following neurosurgical interventions. Treatment was effective for the correction of the compensatory hyperactivity of mimic muscles on the unaffected side that develops in the acute period of facial nerve palsy, and for the correction of synkinesis in the affected side that develops in the long-term period. Appropriate dosing and patient education to perform exercises to restore mimic muscle function should be considered in multimodal treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

Facial nerve palsy due to birth trauma

MedlinePlus

Seventh cranial nerve palsy due to birth trauma; Facial palsy - birth trauma; Facial palsy - neonate; Facial palsy - infant ... An infant's facial nerve is also called the seventh cranial nerve. It can be damaged just before or at the time of delivery. ...

Macroscopic in vivo imaging of facial nerve regeneration in Thy1-GFP rats.

PubMed

Placheta, Eva; Wood, Matthew D; Lafontaine, Christine; Frey, Manfred; Gordon, Tessa; Borschel, Gregory H

2015-01-01

number of experimental animals, as they were subsequently imaged at multiple time points. The Thy1-GFP rat model will help improve clinical outcomes of facial reanimation surgery through improving the knowledge of facial nerve regeneration after surgical procedures. NA.

Surgical Approaches to Facial Nerve Deficits

PubMed Central

Birgfeld, Craig; Neligan, Peter

2011-01-01

The facial nerve is one of the most commonly injured cranial nerves. Once injured, the effects on form, function, and psyche are profound. We review the anatomy of the facial nerve from the brain stem to its terminal branches. We also discuss the physical exam findings of facial nerve injury at various levels. Finally, we describe various reconstructive options for reanimating the face and restoring both form and function. PMID:22451822

Evoked electromyography to rocuronium in orbicularis oris and gastrocnemius in facial nerve injury in rabbits.

PubMed

Xing, Yian; Chen, Lianhua; Li, Shitong

2013-11-01

Muscles innervated by the facial nerve show different sensitivities to muscle relaxants than muscles innervated by somatic nerves, especially in the presence of facial nerve injury. We compared the evoked electromyography (EEMG) response of orbicularis oris and gastrocnemius in with and without a non-depolarizing muscle relaxant in a rabbit model of graded facial nerve injury. Differences in EEMG response and inhibition by rocuronium were measured in the orbicularis oris and gastrocnemius muscles 7 to 42 d after different levels of facial nerve crush injuries in adult rabbits. Baseline EEMG of orbicularis oris was significantly smaller than those of the gastrocnemius. Gastrocnemius was more sensitive to rocuronium than the facial muscles (P < 0.05). Baseline EEMG and EEMG amplitude of orbicularis oris in the presence of rocuronium was negatively correlated with the magnitude of facial nerve injury but the sensitivity to rocuronium was not. No significant difference was found in the onset time and the recovery time of rocuronium among gastrocnemius and normal or damaged facial muscles. Muscles innervated by somatic nerves are more sensitive to rocuronium than those innervated by the facial nerve, but while facial nerve injury reduced EEMG responses, the sensitivity to rocuronium is not altered. Partial neuromuscular blockade may be a suitable technique for conducting anesthesia and surgery safely when EEMG monitoring is needed to preserve and protect the facial nerve. Additional caution should be used if there is a risk of preexisting facial nerve injury. Copyright © 2013 Elsevier Inc. All rights reserved.

Characteristics and pathogenesis of facial nerve stimulation after cochlear implant surgeries: A single-center retrospective analysis from 1,151 patients.

PubMed

Kim, Y R; Yoo, M H; Lee, J Y; Yang, C J; Park, J W; Kang, B C; Kang, W S; Ahn, J H; Chung, J W; Park, H J

2018-05-29

Incidence of facial nerve stimulation (FNS) was 2.8% (32 out of 1151) and higher in ears with cochlear anomaly (6.4%, 25 out of 391) than without cochlear anomaly (0.9%, 7 out of 760). FNS occurred at various current levels and locations of electrodes by different mechanisms related to incomplete insertion of electrodes, cochleo-facial dehiscence, and types of cochlear anomalies. FNS at apical electrodes related to cochleo-facial dehiscence with low current levels, and FNS at basal electrodes with high current levels and partial insertion of electrodes. FNS at most electrodes with high current levels was the most common type in patients with a common cavity or narrowing of the bony cochlear nerve canal. Understanding the mechanisms of FNS might provide insight for preventing FNS when performing CI surgeries. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Management of the Facial Nerve in Lateral Skull Base Surgery Analytic Retrospective Study

PubMed Central

El Shazly, Mohamed A.; Mokbel, Mahmoud A.M.; Elbadry, Amr A.; Badran, Hatem S.

2011-01-01

Background: Surgical approaches to the jugular foramen are often complex and lengthy procedures associated with significant morbidity based on the anatomic and tumor characteristics. In addition to the risk of intra-operative hemorrhage from vascular tumors, lower cranial nerves deficits are frequently increased after intra-operative manipulation. Accordingly, modifications in the surgical techniques have been developed to minimize these risks. Preoperative embolization and intra-operative ligation of the external carotid artery have decreased the intraoperative blood loss. Accurate identification and exposure of the cranial nerves extracranially allows for their preservation during tumor resection. The modification of facial nerve mobilization provides widened infratemporal exposure with less postoperative facial weakness. The ideal approach should enable complete, one stage tumor resection with excellent infratemporal and posterior fossa exposure and would not aggravate or cause neurologic deficit. The aim of this study is to present our experience in handling jugular foramen lesions (mainly glomus jugulare) without the need for anterior facial nerve transposition. Methods: In this series we present our experience in Kasr ElEini University hospital (Cairo—Egypt) in handling 36 patients with jugular foramen lesions over a period of 20 years where the previously mentioned preoperative and operative rules were followed. The clinical status, operative technique and postoperative care and outcome are detailed and analyzed in relation to the outcome. Results: Complete cure without complications was achieved in four cases of congenital cholesteatoma and four cases with class B glomus. In advanced cases of glomus jugulare (28 patients) (C and D stages) complete cure was achieved in 21 of them (75%). The operative complications were also related to this group of 28 patients, in the form of facial paralysis in 20 of them (55.6%) and symptomatic vagal paralysis in 18 of

Management of the facial nerve in lateral skull base surgery analytic retrospective study.

PubMed

El Shazly, Mohamed A; Mokbel, Mahmoud A M; Elbadry, Amr A; Badran, Hatem S

2011-01-01

Surgical approaches to the jugular foramen are often complex and lengthy procedures associated with significant morbidity based on the anatomic and tumor characteristics. In addition to the risk of intra-operative hemorrhage from vascular tumors, lower cranial nerves deficits are frequently increased after intra-operative manipulation. Accordingly, modifications in the surgical techniques have been developed to minimize these risks. Preoperative embolization and intra-operative ligation of the external carotid artery have decreased the intraoperative blood loss. Accurate identification and exposure of the cranial nerves extracranially allows for their preservation during tumor resection. The modification of facial nerve mobilization provides widened infratemporal exposure with less postoperative facial weakness. The ideal approach should enable complete, one stage tumor resection with excellent infratemporal and posterior fossa exposure and would not aggravate or cause neurologic deficit. The aim of this study is to present our experience in handling jugular foramen lesions (mainly glomus jugulare) without the need for anterior facial nerve transposition. In this series we present our experience in Kasr ElEini University hospital (Cairo-Egypt) in handling 36 patients with jugular foramen lesions over a period of 20 years where the previously mentioned preoperative and operative rules were followed. The clinical status, operative technique and postoperative care and outcome are detailed and analyzed in relation to the outcome. Complete cure without complications was achieved in four cases of congenital cholesteatoma and four cases with class B glomus. In advanced cases of glomus jugulare (28 patients) (C and D stages) complete cure was achieved in 21 of them (75%). The operative complications were also related to this group of 28 patients, in the form of facial paralysis in 20 of them (55.6%) and symptomatic vagal paralysis in 18 of them (50%). Total anterior

Reconstruction of facial nerve after radical parotidectomy.

PubMed

Renkonen, Suvi; Sayed, Farid; Keski-Säntti, Harri; Ylä-Kotola, Tuija; Bäck, Leif; Suominen, Sinikka; Kanerva, Mervi; Mäkitie, Antti A

2015-01-01

Most patients benefitted from immediate facial nerve grafting after radical parotidectomy. Even weak movement is valuable and can be augmented with secondary static operations. Post-operative radiotherapy does not seem to affect the final outcome of facial function. During radical parotidectomy, the sacrifice of the facial nerve results in severe disfigurement of the face. Data on the principles and outcome of facial nerve reconstruction and reanimation after radical parotidectomy are limited and no consensus exists on the best practice. This study retrospectively reviewed all patients having undergone radical parotidectomy and immediate facial nerve reconstruction with a free, non-vascularized nerve graft at the Helsinki University Hospital, Helsinki, Finland during the years 1990-2010. There were 31 patients (18 male; mean age = 54.7 years; range = 30-82) and 23 of them had a sufficient follow-up time. Facial nerve function recovery was seen in 18 (78%) of the 23 patients with a minimum of 2-year follow-up and adequate reporting available. Only slight facial movement was observed in five (22%), moderate or good movement in nine (39%), and excellent movement in four (17%) patients. Twenty-two (74%) patients received post-operative radiotherapy and 16 (70%) of them had some recovery of facial nerve function. Nineteen (61%) patients needed secondary static reanimation of the face.

Influencing Factors Analysis of Facial Nerve Function after the Microsurgical Resection of Acoustic Neuroma

PubMed Central

Hong, WenMing; Cheng, HongWei; Wang, XiaoJie; Feng, ChunGuo

2017-01-01

Objective To explore and analyze the influencing factors of facial nerve function retainment after microsurgery resection of acoustic neurinoma. Methods Retrospective analysis of our hospital 105 acoustic neuroma cases from October, 2006 to January 2012, in the group all patients were treated with suboccipital sigmoid sinus approach to acoustic neuroma microsurgery resection. We adopted researching individual patient data, outpatient review and telephone followed up and the House-Brackmann grading system to evaluate and analyze the facial nerve function. Results Among 105 patients in this study group, complete surgical resection rate was 80.9% (85/105), subtotal resection rate was 14.3% (15/105), and partial resection rate 4.8% (5/105). The rate of facial nerve retainment on neuroanatomy was 95.3% (100/105) and the mortality rate was 2.1% (2/105). Facial nerve function when the patient is discharged from the hospital, also known as immediate facial nerve function which was graded in House-Brackmann: excellent facial nerve function (House-Brackmann I–II level) cases accounted for 75.2% (79/105), facial nerve function III–IV level cases accounted for 22.9% (24/105), and V–VI cases accounted for 1.9% (2/105). Patients were followed up for more than one year, with excellent facial nerve function retention rate (H-B I–II level) was 74.4% (58/78). Conclusion Acoustic neuroma patients after surgery, the long-term (≥1 year) facial nerve function excellent retaining rate was closely related with surgical proficiency, post-operative immediate facial nerve function, diameter of tumor and whether to use electrophysiological monitoring techniques; while there was no significant correlation with the patient’s age, surgical approach, whether to stripping the internal auditory canal, whether there was cystic degeneration, tumor recurrence, whether to merge with obstructive hydrocephalus and the length of the duration of symptoms. PMID:28264236

Facial neuropathy with imaging enhancement of the facial nerve: a case report

PubMed Central

Mumtaz, Sehreen; Jensen, Matthew B

2014-01-01

A young women developed unilateral facial neuropathy 2 weeks after a motor vehicle collision involving fractures of the skull and mandible. MRI showed contrast enhancement of the facial nerve. We review the literature describing facial neuropathy after trauma and facial nerve enhancement patterns with different causes of facial neuropathy. PMID:25574155

Cyclin D1 expression and facial function outcome after vestibular schwannoma surgery.

PubMed

Lassaletta, Luis; Del Rio, Laura; Torres-Martin, Miguel; Rey, Juan A; Patrón, Mercedes; Madero, Rosario; Roda, Jose Maria; Gavilan, Javier

2011-01-01

The proto-oncogen cyclin D1 has been implicated in the development and behavior of vestibular schwannoma. This study evaluates the association between cyclin D1 expression and other known prognostic factors in facial function outcome 1 year after vestibular schwannoma surgery. Sixty-four patients undergoing surgery for vestibular schwannoma were studied. Immunohistochemistry analysis was performed with anticyclin D1 in all cases. Cyclin D1 expression, as well as other demographic, clinical, radiologic, and intraoperative data, was correlated with 1-year postoperative facial function. Good 1-year facial function (Grades 1-2) was achieved in 73% of cases. Cyclin D1 expression was found in 67% of the tumors. Positive cyclin D1 staining was more frequent in patients with Grades 1 to 2 (75%) than in those with Grades 3 to 6 (25%). Other significant variables were tumor volume and facial nerve stimulation after tumor resection. The area under the receiver operating characteristics curve increased when adding cyclin D1 expression to the multivariate model. Cyclin D1 expression is associated to facial outcome after vestibular schwannoma surgery. The prognostic value of cyclin D1 expression is independent of tumor size and facial nerve stimulation at the end of surgery.

[Electrical stimulation of the facial nerve with a prognostic function in parotid surgery].

PubMed

García-Losarcos, N; González-Hidalgo, M; Franco-Carcedo, C; Poch-Broto, J

Continuous electromyography during parotidectomies and direct stimulation of the facial nerve as an intraoperative identification technique significantly lower the rate of post-operative morbidity. To determine the usefulness of intra-operative neurophysiological parameters registered by means of electrical stimulation of the facial nerve as values capable of predicting the type of lesion and the functional prognosis. Our sample consisted of a correlative series of 20 cases of monitored parotidectomies. Post-operative facial functioning, type of lesion and its prognosis were compared with the variations in latency/amplitude of the muscle response between two stimulations of the facial nerve before and after resection, as well as in the absence or presence of muscle response to stimulation after resection. All the patients except one presented motor evoked potentials (MEP) to stimulation after resection. There was no facial damage following the operation in 55% of patients and 45% presented some kind of paresis. The 21% drop in the amplitude of the intra-operative MEP and the mean increase in latency of 13.5% correspond to axonal and demyelinating insult, respectively, with a mean recovery time of three and six months. The only case of absence of response to the post-resection stimulation presented permanent paresis. The presence of MEP following resection does not ensure that functioning of the nerve remains undamaged. Nevertheless, it can be considered a piece of data that suggests a lower degree of compromise, if it is present, and a better prognosis. The variations in latency and amplitude of the MEP tend to be intra-operative parameters that indicate the degree of compromise and functional prognosis.

Facial nerve paralysis secondary to occult malignant neoplasms.

PubMed

Boahene, Derek O; Olsen, Kerry D; Driscoll, Colin; Lewis, Jean E; McDonald, Thomas J

2004-04-01

This study reviewed patients with unilateral facial paralysis and normal clinical and imaging findings who underwent diagnostic facial nerve exploration. Study design and setting Fifteen patients with facial paralysis and normal findings were seen in the Mayo Clinic Department of Otorhinolaryngology. Eleven patients were misdiagnosed as having Bell palsy or idiopathic paralysis. Progressive facial paralysis with sequential involvement of adjacent facial nerve branches occurred in all 15 patients. Seven patients had a history of regional skin squamous cell carcinoma, 13 patients had surgical exploration to rule out a neoplastic process, and 2 patients had negative exploration. At last follow-up, 5 patients were alive. Patients with facial paralysis and normal clinical and imaging findings should be considered for facial nerve exploration when the patient has a history of pain or regional skin cancer, involvement of other cranial nerves, and prolonged facial paralysis. Occult malignancy of the facial nerve may cause unilateral facial paralysis in patients with normal clinical and imaging findings.

Collagen scaffolds combined with collagen-binding ciliary neurotrophic factor facilitate facial nerve repair in mini-pigs.

PubMed

Lu, Chao; Meng, Danqing; Cao, Jiani; Xiao, Zhifeng; Cui, Yi; Fan, Jingya; Cui, Xiaolong; Chen, Bing; Yao, Yao; Zhang, Zhen; Ma, Jinling; Pan, Juli; Dai, Jianwu

2015-05-01

The preclinical studies using animal models play a very important role in the evaluation of facial nerve regeneration. Good models need to recapitulate the distance and time for axons to regenerate in humans. Compared with the most used rodent animals, the structure of facial nerve in mini-pigs shares more similarities with humans in microanatomy. To evaluate the feasibility of repairing facial nerve defects by collagen scaffolds combined with ciliary neurotrophic factor (CNTF), 10-mm-long gaps were made in the buccal branch of mini-pigs' facial nerve. Three months after surgery, electrophysiological assessment and histological examination were performed to evaluate facial nerve regeneration. Immunohistochemistry and transmission electron microscope observation showed that collagen scaffolds with collagen binding (CBD)-CNTF could promote better axon regeneration, Schwann cell migration, and remyelination at the site of implant device than using scaffolds alone. Electrophysiological assessment also showed higher recovery rate in the CNTF group. In summary, combination of collagen scaffolds and CBD-CNTF showed promising effects on facial nerve regeneration in mini-pig models. © 2014 Wiley Periodicals, Inc.

The relationship between the fistula tract and the facial nerve in type II first branchial cleft anomalies.

PubMed

Ertas, Burak; Gunaydin, Rıza Onder; Unal, Omer Faruk

2015-04-01

To share our experience involving seven patients with type II first branchial cleft anomalies (hereafter, type II anomalies), to determine whether the location of the external fistula openings of the anomalies are associated with the location of the facial nerve tract, and elucidate the relationship between the location of the fistula opening and the facial nerve. The medical records of seven patients who underwent surgery from 2005 to 2013 for type II anomalies were retrospectively examined. The relationship between the fistula opening and the facial nerve was evaluated in each patient with respect to whether the fistula opening was superior or inferior to the mandibular angle. All patients underwent partial parotidectomy, facial nerve exposure, and total excision of the mass together with connection of a small cuff of the external auditory canal skin to the fistula tract. The fistula tracts were located medially to the facial nerve in two patients, and both fistulae had openings inferior to the mandibular angle. The fistula tracts were located laterally to the facial nerve in the remaining five patients: one patient had no external opening, one had an opening inferior to the mandibular angle, and the remaining three had openings superior to the mandibular angle. Because type II anomalies are rare, their diagnosis is difficult. Surgery of such lesions is challenging and associated with a high risk due to their proximity to the facial nerve. We believe that the location of the fistula opening may help to identify the relationship between the anomalous lesion and facial nerve. Studies involving larger series of cases are needed to confirm our hypothesis; however, because of the rarity of this specific anomaly, it will not be easy to compile a large number of cases. We believe that our study will encourage further investigation on this subject. Copyright © 2014. Published by Elsevier Ireland Ltd.

Facial nerve paralysis in children

PubMed Central

Ciorba, Andrea; Corazzi, Virginia; Conz, Veronica; Bianchini, Chiara; Aimoni, Claudia

2015-01-01

Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology. PMID:26677445

Diagnosis and surgical outcomes of intraparotid facial nerve schwannoma showing normal facial nerve function.

PubMed

Lee, D W; Byeon, H K; Chung, H P; Choi, E C; Kim, S-H; Park, Y M

2013-07-01

The findings of intraparotid facial nerve schwannoma (FNS) using preoperative diagnostic tools, including ultrasonography (US)-guided fine needle aspiration biopsy, computed tomography (CT) scan, and magnetic resonance imaging (MRI), were analyzed to determine if there are any useful findings that might suggest the presence of a lesion. Treatment guidelines are suggested. The medical records of 15 patients who were diagnosed with an intraparotid FNS were retrospectively analyzed. US and CT scans provide clinicians with only limited information; gadolinium enhanced T1-weighted images from MRI provide more specific findings. Tumors could be removed successfully with surgical exploration, preserving facial nerve function at the same time. Gadolinium-enhanced T1-weighted MRI showed more characteristic findings for the diagnosis of intraparotid FNS. Intraparotid FNS without facial palsy can be diagnosed with MRI preoperatively, and surgical exploration is a suitable treatment modality which can remove the tumor and preserve facial nerve function. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Management of peripheral facial nerve palsy

PubMed Central

2008-01-01

Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell’s palsy). Three quarters of peripheral FNP are primary and one quarter secondary. The most prevalent causes of secondary FNP are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. The diagnosis of FNP relies upon the presence of typical symptoms and signs, blood chemical investigations, cerebro-spinal-fluid-investigations, X-ray of the scull and mastoid, cerebral MRI, or nerve conduction studies. Bell’s palsy may be diagnosed after exclusion of all secondary causes, but causes of secondary FNP and Bell’s palsy may coexist. Treatment of secondary FNP is based on the therapy of the underlying disorder. Treatment of Bell’s palsy is controversial due to the lack of large, randomized, controlled, prospective studies. There are indications that steroids or antiviral agents are beneficial but also studies, which show no beneficial effect. Additional measures include eye protection, physiotherapy, acupuncture, botulinum toxin, or possibly surgery. Prognosis of Bell’s palsy is fair with complete recovery in about 80% of the cases, 15% experience some kind of permanent nerve damage and 5% remain with severe sequelae. PMID:18368417

Extensive actinomycosis of the face requiring radical resection and facial nerve reconstruction.

PubMed

Iida, Takuya; Takushima, Akihiko; Asato, Hirotaka; Harii, Kiyonori

2006-01-01

We present a case of extensive actinomycosis of the face, which appeared after dental surgery. Since antibiotic therapy was ineffective, the lesion was radically resected, and the skin, soft tissue and facial nerve were reconstructed using a free rectus abdominis musculocutaneous flap and simultaneously harvested intercostal nerves. Successful reanimation of the face was achieved 14 months postoperatively.

Infantile inflammatory pseudotumor of the facial nerve as a complication of epidermal nevus syndrome with cholesteatoma.

PubMed

Hato, Naohito; Tsujimura, Mika; Takagi, Taro; Okada, Masahiro; Gyo, Kiyofumi; Tohyama, Mikiko; Tauchi, Hisamichi

2013-12-01

The first reported case of facial paralysis due to an inflammatory pseudotumor (IPT) of the facial nerve as a complication of epidermal nevus syndrome (ENS) is herein presented. A 10-month-old female patient was diagnosed with ENS at 3 months of age. She was referred to us because of moderate left facial paralysis. Epidermal nevi of her left auricle extended deep into the external ear canal. Otoscopy revealed polypous nevi and cholesteatoma debris filling the left ear. Computed tomography showed a soft mass filling the ear canal, including the middle ear, and an enormously enlarged facial nerve. Surgical exploration revealed numerous polypous nevi, external ear cholesteatoma, and tumorous swelling of the facial nerve. The middle ear ossicles were completely lost. The facial paralysis was improved after decompression surgery, but recurred 5 months later. A second operation was conducted 10 months after the first. During this operation, facial nerve decompression was completed from the geniculate ganglion to near the stylomastoid foramen. Histological diagnosis of the facial nerve tumor was IPT probably caused by chronic external ear inflammation induced by epidermal nevi. The facial paralysis gradually improved to House-Blackmann grade III 5 years after the second operation. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Long-Term Facial Nerve Outcomes after Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy.

PubMed

Mooney, Michael A; Hendricks, Benjamin; Sarris, Christina E; Spetzler, Robert F; Almefty, Kaith K; Porter, Randall W

2018-06-01

Objectives  This study aimed at evaluating facial nerve outcomes in vestibular schwannoma patients presenting with preoperative facial nerve palsy. Design  A retrospective review. Setting  Single-institution cohort. Participants  Overall, 368 consecutive patients underwent vestibular schwannoma resection. Patients with prior microsurgery or radiosurgery were excluded. Main Outcome Measures  Incidence, House-Brackmann grade. Results  Of 368 patients, 9 had confirmed preoperative facial nerve dysfunction not caused by prior treatment, for an estimated incidence of 2.4%. Seven of these nine patients had Koos grade 4 tumors. Mean tumor diameter was 3.0 cm (range: 2.1-4.4 cm), and seven of nine tumors were subtotally resected. All nine patients were followed up clinically for ≥ 6 months. Of the six patients with a preoperative House-Brackmann grade of II, two improved to grade I, three were stable, and one patient worsened to grade III. Of the three patients with grade III or worse, all remained stable at last follow-up. Conclusions  Preoperative facial nerve palsy is rare in patients with vestibular schwannoma; it tends to occur in patients with relatively large lesions. Detailed long-term outcomes of facial nerve function after microsurgical resection for these patients have not been reported previously. We followed nine patients and found that eight (89%) of the nine patients had either stable or improved facial nerve outcomes after treatment. Management strategies varied for these patients, including rates of subtotal versus gross-total resection and the use of stereotactic radiosurgery in patients with residual tumor. These results can be used to help counsel patients preoperatively on expected outcomes of facial nerve function after treatment.

[Relationship between Work Ⅱ type of congenital first branchial cleft anomaly and facial nerve and surgical strategies].

PubMed

Zhang, B; Chen, L S; Huang, S L; Liang, L; Gong, X X; Wu, P N; Zhang, S Y; Luo, X N; Zhan, J D; Sheng, X L; Lu, Z M

2017-10-07

Objective: To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies. Methods: Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases. Results: Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web. Conclusions: CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.

[Anatomicopathological relation between facial nerve and large vestibular Schwannoma].

PubMed

Jiang, T; Yu, C; Guo, E; Guan, S; Yan, C

2001-05-10

To study the anatomicopathological relation between facial nerve and large vestibular schwannoma. Operation by suboccipital retrosigmoid sinus approach was performed on 40 cases with large vestibular schwannoma, During the operation, the anatomicopathological relation between the facial nerve and the vestibular schwannoma was observed directly. The facial nerve was found to be located ventrally (deep under the tumor), dorsally (over the tumor), at the upper pole of the tumor (near the tentorium cerebelli), at the lower pole of the tumor (near the rear group cranial nerves), or aberrant (unable to be identified because of infiltration of tumor). In 31 cases, mainly with parenchymatous tumor, the facial nerve was flat in shape. In 9 cases, mainly with cystic tumor, the facial nerve was bandlike. The facial nerve varies greatly in neuroanatomy among patients with large vestibular schwannoma. Strengthening of operative monitoring can increase the safety of operation.

Surgery for traumatic facial nerve paralysis: does intraoperative monitoring have a role?

PubMed

Ashram, Yasmine A; Badr-El-Dine, Mohamed M K

2014-09-01

The use of intraoperative facial nerve (FN) monitoring during surgical decompression of the FN is underscored because surgery is indicated when the FN shows more than 90 % axonal degeneration. The present study proposes including intraoperative monitoring to facilitate decision taking and provide prognostication with more accuracy. This prospective study was conducted on ten patients presenting with complete FN paralysis due to temporal bone fracture. They were referred after variable time intervals for FN exploration and decompression. Intraoperative supramaximal electric stimulation (2-3 mA) of the FN was attempted in all patients both proximal and distal to the site of injury. Postoperative FN function was assessed using House-Brackmann (HB) scale. All patients had follow-up period ranging from 7 to 42 months. Three different patterns of neurophysiological responses were characterized. Responses were recorded proximal and distal to the lesion in five patients (pattern 1); only distal to the lesion in two patients (pattern 2); and neither proximal nor distal to the lesion in three patients (pattern 3). Sporadic, mechanically elicited EMG activity was recorded in eight out of ten patients. Patients with pattern 1 had favorable prognosis with postoperative function ranging between grade I and III. Pattern 3 patients showing no mechanically elicited activity had poor prognosis. Intraoperative monitoring affects decision taking during surgery for traumatic FN paralysis and provides prognostication with sufficient accuracy. The detection of mechanically elicited EMG activity is an additional sign predicting favorable outcome. However, absence of responses did not alter surgeon decision when the nerve was found evidently intact.

Monitoring of recurrent and superior laryngeal nerve function using an Airwayscope™ during thyroid surgery.

PubMed

Ijichi, Kei; Sasano, Hiroshi; Harima, Megumi; Murakami, Shingo

2017-10-01

In thyroid surgery, intraoperative identification and preservation of the recurrent laryngeal nerve (RLN) and superior laryngeal nerve external branch (SLNEB) are crucial. Several reports have proposed that electromyography (EMG) monitoring is an acceptable adjunct for identification and preservation of the RLN. However, a limited number of hospitals have access to an EMG monitoring system. Therefore, the development of another viable monitoring method is required. The aim of the present study was to design a new RLN and SLNEB monitoring method combining an Airwayscope™ (AWS) and a facial nerve stimulator. The facial nerve-stimulating electrode stimulates the RLN or SLNEB, so that the movement of the vocal cord may be observed with an AWS. This monitoring method was performed on 10 patients with a thyroid tumor. In all the cases, RLN and SLNEB were identified and vocal cord function was preserved. All the patients exhibited normal vocal cord function following surgery. Thus, the new RLN and SLNEB monitoring method using an AWS and a facial nerve stimulator is useful in thyroid surgery, and this method may be used as a reliable and available alternative to EMG monitoring to ensure the normal function of the vocal cord.

Magnetic resonance imaging of facial nerve schwannoma.

PubMed

Thompson, Andrew L; Aviv, Richard I; Chen, Joseph M; Nedzelski, Julian M; Yuen, Heng-Wai; Fox, Allan J; Bharatha, Aditya; Bartlett, Eric S; Symons, Sean P

2009-12-01

This study characterizes the magnetic resonance (MR) appearances of facial nerve schwannoma (FNS). We hypothesize that the extent of FNS demonstrated on MR will be greater compared to prior computed tomography studies, that geniculate involvement will be most common, and that cerebellar pontine angle (CPA) and internal auditory canal (IAC) involvement will more frequently result in sensorineural hearing loss (SNHL). Retrospective study. Clinical, pathologic, and enhanced MR imaging records of 30 patients with FNS were analyzed. Morphologic characteristics and extent of segmental facial nerve involvement were documented. Median age at initial imaging was 51 years (range, 28-76 years). Pathologic confirmation was obtained in 14 patients (47%), and the diagnosis reached in the remainder by identification of a mass, thickening, and enhancement along the course of the facial nerve. All 30 lesions involved two or more contiguous segments of the facial nerve, with 28 (93%) involving three or more segments. The median segments involved per lesion was 4, mean of 3.83. Geniculate involvement was most common, in 29 patients (97%). CPA (P = .001) and IAC (P = .02) involvement was significantly related to SNHL. Seventeen patients (57%) presented with facial nerve dysfunction, manifesting in 12 patients as facial nerve weakness or paralysis, and/or in eight with involuntary movements of the facial musculature. This study highlights the morphologic heterogeneity and typical multisegment involvement of FNS. Enhanced MR is the imaging modality of choice for FNS. The neuroradiologist must accurately diagnose and characterize this lesion, and thus facilitate optimal preoperative planning and counseling.

Large Intratemporal Facial Nerve Schwannoma without Facial Palsy: Surgical Strategy of Tumor Removal and Functional Reconstruction.

PubMed

Yetiser, Sertac

2018-06-08

 Three patients with large intratemporal facial schwannomas underwent tumor removal and facial nerve reconstruction with hypoglossal anastomosis. The surgical strategy for the cases was tailored to the location of the mass and its extension along the facial nerve.  To provide data on the different clinical aspects of facial nerve schwannoma, the appropriate planning for management, and the predictive outcomes of facial function.  Three patients with facial schwannomas (two men and one woman, ages 45, 36, and 52 years, respectively) who presented to the clinic between 2009 and 2015 were reviewed. They all had hearing loss but normal facial function. All patients were operated on with radical tumor removal via mastoidectomy and subtotal petrosectomy and simultaneous cranial nerve (CN) 7- CN 12 anastomosis.  Multiple segments of the facial nerve were involved ranging in size from 3 to 7 cm. In the follow-up period of 9 to 24 months, there was no tumor recurrence. Facial function was scored House-Brackmann grades II and III, but two patients are still in the process of functional recovery.  Conservative treatment with sparing of the nerve is considered in patients with small tumors. Excision of a large facial schwannoma with immediate hypoglossal nerve grafting as a primary procedure can provide satisfactory facial nerve function. One of the disadvantages of performing anastomosis is that there is not enough neural tissue just before the bifurcation of the main stump to provide neural suturing without tension because middle fossa extension of the facial schwannoma frequently involves the main facial nerve at the stylomastoid foramen. Reanimation should be processed with extensive backward mobilization of the hypoglossal nerve. Georg Thieme Verlag KG Stuttgart · New York.

Comparison of Direct Side-to-End and End-to-End Hypoglossal-Facial Anastomosis for Facial Nerve Repair.

PubMed

Samii, Madjid; Alimohamadi, Maysam; Khouzani, Reza Karimi; Rashid, Masoud Rafizadeh; Gerganov, Venelin

2015-08-01

The hypoglossal facial anastomosis (HFA) is the gold standard for facial reanimation in patients with severe facial nerve palsy. The major drawbacks of the classic HFA technique are lingual morbidities due to hypoglossal nerve transection. The side-to-end HFA is a modification of the classic technique with fewer tongue-related morbidities. In this study we compared the outcome of the classic end-to-end and the direct side-to-end HFA surgeries performed at our center in regards to the facial reanimation success rate and tongue-related morbidities. Twenty-six successive cases of HFA were enrolled. In 9 of them end-to-end anastomoses were performed, and 17 had direct side-to-end anastomoses. The House-Brackmann (HB) and Pitty and Tator (PT) scales were used to document surgical outcome. The hemiglossal atrophy, swallowing, and hypoglossal nerve function were assessed at follow-up. The original pathology was vestibular schwannoma in 15, meningioma in 4, brain stem glioma in 4, and other pathologies in 3. The mean interval between facial palsy and HFA was 18 months (range: 0-60). The median follow-up period was 20 months. The PT grade at follow-up was worse in patients with a longer interval from facial palsy and HFA (P value: 0.041). The lesion type was the only other factor that affected PT grade (the best results in vestibular schwannoma and the worst in the other pathologies group, P value: 0.038). The recovery period for facial tonicity was longer in patients with radiation therapy before HFA (13.5 vs. 8.5 months) and those with a longer than 2-year interval from facial palsy to HFA (13.5 vs. 8.5 months). Although no significant difference between the side-to-end and the end-to-end groups was seen in terms of facial nerve functional recovery, patients from the side-to-end group had a significantly lower rate of lingual morbidities (tongue hemiatrophy: 100% vs. 5.8%, swallowing difficulty: 55% vs. 11.7%, speech disorder 33% vs. 0%). With the side-to-end HFA

Facial reanimation with gracilis muscle transfer neurotized to cross-facial nerve graft versus masseteric nerve: a comparative study using the FACIAL CLIMA evaluating system.

PubMed

Hontanilla, Bernardo; Marre, Diego; Cabello, Alvaro

2013-06-01

Longstanding unilateral facial paralysis is best addressed with microneurovascular muscle transplantation. Neurotization can be obtained from the cross-facial or the masseter nerve. The authors present a quantitative comparison of both procedures using the FACIAL CLIMA system. Forty-seven patients with complete unilateral facial paralysis underwent reanimation with a free gracilis transplant neurotized to either a cross-facial nerve graft (group I, n=20) or to the ipsilateral masseteric nerve (group II, n=27). Commissural displacement and commissural contraction velocity were measured using the FACIAL CLIMA system. Postoperative intragroup commissural displacement and commissural contraction velocity means of the reanimated versus the normal side were first compared using the independent samples t test. Mean percentage of recovery of both parameters were compared between the groups using the independent samples t test. Significant differences of mean commissural displacement and commissural contraction velocity between the reanimated side and the normal side were observed in group I (p=0.001 and p=0.014, respectively) but not in group II. Intergroup comparisons showed that both commissural displacement and commissural contraction velocity were higher in group II, with significant differences for commissural displacement (p=0.048). Mean percentage of recovery of both parameters was higher in group II, with significant differences for commissural displacement (p=0.042). Free gracilis muscle transfer neurotized by the masseteric nerve is a reliable technique for reanimation of longstanding facial paralysis. Compared with cross-facial nerve graft neurotization, this technique provides better symmetry and a higher degree of recovery. Therapeutic, III.

Neuro-ophthalmological approach to facial nerve palsy.

PubMed

Portelinha, Joana; Passarinho, Maria Picoto; Costa, João Marques

2015-01-01

Facial nerve palsy is associated with significant morbidity and can have different etiologies. The most common causes are Bell's palsy, Ramsay-Hunt syndrome and trauma, including surgical trauma. Incidence varies between 17 and 35 cases per 100,000. Initial evaluation should include accurate clinical history, followed by a comprehensive investigation of the head and neck, including ophthalmological, otological, oral and neurological examination, to exclude secondary causes. Routine laboratory testing and diagnostic imaging is not indicated in patients with new-onset Bell's palsy, but should be performed in patients with risk factors, atypical cases or in any case without resolution within 4 months. Many factors are involved in determining the appropriate treatment of these patients: the underlying cause, expected duration of nerve dysfunction, anatomical manifestations, severity of symptoms and objective clinical findings. Systemic steroids should be offered to patients with new-onset Bell's palsy to increase the chance of facial nerve recovery and reduce synkinesis. Ophthalmologists play a pivotal role in the multidisciplinary team involved in the evaluation and rehabilitation of these patients. In the acute phase, the main priority should be to ensure adequate corneal protection. Treatment depends on the degree of nerve lesion and on the risk of the corneal damage based on the amount of lagophthalmos, the quality of Bell's phenomenon, the presence or absence of corneal sensitivity and the degree of lid retraction. The main therapy is intensive lubrication. Other treatments include: taping the eyelid overnight, botulinum toxin injection, tarsorrhaphy, eyelid weight implants, scleral contact lenses and palpebral spring. Once the cornea is protected, longer term planning for eyelid and facial rehabilitation may take place. Spontaneous complete recovery of Bell's palsy occurs in up to 70% of cases. Long-term complications include aberrant regeneration with

Neuro-ophthalmological approach to facial nerve palsy

PubMed Central

Portelinha, Joana; Passarinho, Maria Picoto; Costa, João Marques

2014-01-01

Facial nerve palsy is associated with significant morbidity and can have different etiologies. The most common causes are Bell’s palsy, Ramsay–Hunt syndrome and trauma, including surgical trauma. Incidence varies between 17 and 35 cases per 100,000. Initial evaluation should include accurate clinical history, followed by a comprehensive investigation of the head and neck, including ophthalmological, otological, oral and neurological examination, to exclude secondary causes. Routine laboratory testing and diagnostic imaging is not indicated in patients with new-onset Bell’s palsy, but should be performed in patients with risk factors, atypical cases or in any case without resolution within 4 months. Many factors are involved in determining the appropriate treatment of these patients: the underlying cause, expected duration of nerve dysfunction, anatomical manifestations, severity of symptoms and objective clinical findings. Systemic steroids should be offered to patients with new-onset Bell’s palsy to increase the chance of facial nerve recovery and reduce synkinesis. Ophthalmologists play a pivotal role in the multidisciplinary team involved in the evaluation and rehabilitation of these patients. In the acute phase, the main priority should be to ensure adequate corneal protection. Treatment depends on the degree of nerve lesion and on the risk of the corneal damage based on the amount of lagophthalmos, the quality of Bell’s phenomenon, the presence or absence of corneal sensitivity and the degree of lid retraction. The main therapy is intensive lubrication. Other treatments include: taping the eyelid overnight, botulinum toxin injection, tarsorrhaphy, eyelid weight implants, scleral contact lenses and palpebral spring. Once the cornea is protected, longer term planning for eyelid and facial rehabilitation may take place. Spontaneous complete recovery of Bell’s palsy occurs in up to 70% of cases. Long-term complications include aberrant regeneration

Transtympanic Facial Nerve Paralysis: A Review of the Literature

PubMed Central

Schaefer, Nathan; O’Donohue, Peter; French, Heath; Griffin, Aaron; Gochee, Peter

2015-01-01

Summary: Facial nerve paralysis because of penetrating trauma through the external auditory canal is extremely rare, with a paucity of published literature. The objective of this study is to review the literature on transtympanic facial nerve paralysis and increase physician awareness of this uncommon injury through discussion of its clinical presentation, management and prognosis. We also aim to improve patient outcomes in those that have sustained this type of injury by suggesting an optimal management plan. In this case report, we present the case of a 46-year-old white woman who sustained a unilateral facial nerve paresis because of a garfish penetrating her tympanic membrane and causing direct damage to the tympanic portion of her facial nerve. On follow-up after 12 months, her facial nerve function has largely returned to normal. Transtympanic facial nerve paralysis is a rare injury but can have a favorable prognosis if managed effectively. PMID:26090278

The intracranial facial nerve as seen through different surgical windows: an extensive anatomosurgical study.

PubMed

Bernardo, Antonio; Evins, Alexander I; Visca, Anna; Stieg, Phillip E

2013-06-01

The facial nerve has a short intracranial course but crosses critical and frequently accessed surgical structures during cranial base surgery. When performing approaches to complex intracranial regions, it is essential to understand the nerve's conventional and topographic anatomy from different surgical perspectives as well as its relationship with surrounding structures. To describe the entire intracranial course of the facial nerve as observed via different neurosurgical approaches and to provide an analytical evaluation of the degree of nerve exposure achieved with each approach. Anterior petrosectomies (middle fossa, extended middle fossa), posterior petrosectomies (translabyrinthine, retrolabyrinthine, transcochlear), a retrosigmoid, a far lateral, and anterior transfacial (extended maxillectomy, mandibular swing) approaches were performed on 10 adult cadaveric heads (20 sides). The degree of facial nerve exposure achieved per segment for each approach was assessed and graded independently by 3 surgeons. The anterior petrosal approaches offered good visualization of the nerve in the cerebellopontine angle and intracanalicular portion superiorly, whereas the posterior petrosectomies provided more direct visualization without the need for cerebellar retraction. The far lateral approach exposed part of the posterior and the entire inferior quadrants, whereas the retrosigmoid approach exposed parts of the superior and inferior quadrants and the entire posterior quadrant. Anterior and anteroinferior exposure of the facial nerve was achieved via the transfacial approaches. The surgical route used must rely on the size, nature, and general location of the lesion, as well as on the capability of the particular approach to better expose the appropriate segment of the facial nerve.

Facial Nerve Trauma: Evaluation and Considerations in Management

PubMed Central

Gordin, Eli; Lee, Thomas S.; Ducic, Yadranko; Arnaoutakis, Demetri

2014-01-01

The management of facial paralysis continues to evolve. Understanding the facial nerve anatomy and the different methods of evaluating the degree of facial nerve injury are crucial for successful management. When the facial nerve is transected, direct coaptation leads to the best outcome, followed by interpositional nerve grafting. In cases where motor end plates are still intact but a primary repair or graft is not feasible, a nerve transfer should be employed. When complete muscle atrophy has occurred, regional muscle transfer or free flap reconstruction is an option. When dynamic reanimation cannot be undertaken, static procedures offer some benefit. Adjunctive tools such as botulinum toxin injection and biofeedback can be helpful. Several new treatment modalities lie on the horizon which hold potential to alter the current treatment algorithm. PMID:25709748

Middle ear osteoma causing progressive facial nerve weakness: a case report.

PubMed

Curtis, Kate; Bance, Manohar; Carter, Michael; Hong, Paul

2014-09-18

Facial nerve weakness is most commonly due to Bell's palsy or cerebrovascular accidents. Rarely, middle ear tumor presents with facial nerve dysfunction. We report a very unusual case of middle ear osteoma in a 49-year-old Caucasian woman causing progressive facial nerve deficit. A subtle middle ear lesion was observed on otoscopy and computed tomographic images demonstrated an osseous middle ear tumor. Complete surgical excision resulted in the partial recovery of facial nerve function. Facial nerve dysfunction is rarely caused by middle ear tumors. The weakness is typically due to a compressive effect on the middle ear portion of the facial nerve. Early recognition is crucial since removal of these lesions may lead to the recuperation of facial nerve function.

Unilateral abducens and bilateral facial nerve palsies associated with posterior fossa exploration surgery

PubMed Central

Khalil, Ayman; Clerkin, James; Mandiwanza, Tafadzwa; Green, Sandra; Javadpour, Mohsen

2016-01-01

Multiple cranial nerves palsies following a posterior fossa exploration confined to an extradural compartment is a rare clinical presentation. This case report describes a young man who developed a unilateral abducens and bilateral facial nerve palsies following a posterior fossa exploration confined to an extradural compartment. There are different theories to explain this presentation, but the exact mechanism remains unclear. We propose that this patient cranial nerve palsies developed following cerebrospinal fluid (CSF) leak, potentially as a consequence of rapid change in CSF dynamics. PMID:26951144

Hypoglossal-facial nerve "side"-to-side neurorrhaphy for facial paralysis resulting from closed temporal bone fractures.

PubMed

Su, Diya; Li, Dezhi; Wang, Shiwei; Qiao, Hui; Li, Ping; Wang, Binbin; Wan, Hong; Schumacher, Michael; Liu, Song

2018-06-06

Closed temporal bone fractures due to cranial trauma often result in facial nerve injury, frequently inducing incomplete facial paralysis. Conventional hypoglossal-facial nerve end-to-end neurorrhaphy may not be suitable for these injuries because sacrifice of the lesioned facial nerve for neurorrhaphy destroys the remnant axons and/or potential spontaneous innervation. we modified the classical method by hypoglossal-facial nerve "side"-to-side neurorrhaphy using an interpositional predegenerated nerve graft to treat these injuries. Five patients who experienced facial paralysis resulting from closed temporal bone fractures due to cranial trauma were treated with the "side"-to-side neurorrhaphy. An additional 4 patients did not receive the neurorrhaphy and served as controls. Before treatment, all patients had suffered House-Brackmann (H-B) grade V or VI facial paralysis for a mean of 5 months. During the 12-30 months of follow-up period, no further detectable deficits were observed, but an improvement in facial nerve function was evidenced over time in the 5 neurorrhaphy-treated patients. At the end of follow-up, the improved facial function reached H-B grade II in 3, grade III in 1 and grade IV in 1 of the 5 patients, consistent with the electrophysiological examinations. In the control group, two patients showed slightly spontaneous innervation with facial function improved from H-B grade VI to V, and the other patients remained unchanged at H-B grade V or VI. We concluded that the hypoglossal-facial nerve "side"-to-side neurorrhaphy can preserve the injured facial nerve and is suitable for treating significant incomplete facial paralysis resulting from closed temporal bone fractures, providing an evident beneficial effect. Moreover, this treatment may be performed earlier after the onset of facial paralysis in order to reduce the unfavorable changes to the injured facial nerve and atrophy of its target muscles due to long-term denervation and allow axonal

Delayed presentation of traumatic facial nerve (CN VII) paralysis.

PubMed

Napoli, Anthony M; Panagos, Peter

2005-11-01

Facial nerve paralysis (Cranial Nerve VII, CN VII) can be a disfiguring disorder with profound impact upon the patient. The etiology of facial nerve paralysis may be congenital, iatrogenic, or result from neoplasm, infection, trauma, or toxic exposure. In the emergency department, the most common cause of unilateral facial paralysis is Bell's palsy, also known as idiopathic facial paralysis (IFP). We report a case of delayed presentation of unilateral facial nerve paralysis 3 days after sustaining a traumatic head injury. Re-evaluation and imaging of this patient revealed a full facial paralysis and temporal bone fracture extending into the facial canal. Because cranial nerve injuries occur in approximately 5-10% of head-injured patients, a good history and physical examination is important to differentiate IFP from another etiology. Newer generation high-resolution computed tomography (CT) scans are commonly demonstrating these fractures. An understanding of this complication, appropriate patient follow-up, and early involvement of the Otolaryngologist is important in management of these patients. The mechanism as well as the timing of facial nerve paralysis will determine the proper evaluation, consultation, and management for the patient. Patients with total or immediate paralysis as well as those with poorly prognostic audiogram results are good candidates for surgical repair.

Optical stimulation of the facial nerve: a surgical tool?

NASA Astrophysics Data System (ADS)

Richter, Claus-Peter; Teudt, Ingo Ulrik; Nevel, Adam E.; Izzo, Agnella D.; Walsh, Joseph T., Jr.

2008-02-01

One sequela of skull base surgery is the iatrogenic damage to cranial nerves. Devices that stimulate nerves with electric current can assist in the nerve identification. Contemporary devices have two main limitations: (1) the physical contact of the stimulating electrode and (2) the spread of the current through the tissue. In contrast to electrical stimulation, pulsed infrared optical radiation can be used to safely and selectively stimulate neural tissue. Stimulation and screening of the nerve is possible without making physical contact. The gerbil facial nerve was irradiated with 250-μs-long pulses of 2.12 μm radiation delivered via a 600-μm-diameter optical fiber at a repetition rate of 2 Hz. Muscle action potentials were recorded with intradermal electrodes. Nerve samples were examined for possible tissue damage. Eight facial nerves were stimulated with radiant exposures between 0.71-1.77 J/cm2, resulting in compound muscle action potentials (CmAPs) that were simultaneously measured at the m. orbicularis oculi, m. levator nasolabialis, and m. orbicularis oris. Resulting CmAP amplitudes were 0.3-0.4 mV, 0.15-1.4 mV and 0.3-2.3 mV, respectively, depending on the radial location of the optical fiber and the radiant exposure. Individual nerve branches were also stimulated, resulting in CmAP amplitudes between 0.2 and 1.6 mV. Histology revealed tissue damage at radiant exposures of 2.2 J/cm2, but no apparent damage at radiant exposures of 2.0 J/cm2.

Facial nerve conduction after sclerotherapy in children with facial lymphatic malformations: report of two cases.

PubMed

Lin, Pei-Jung; Guo, Yuh-Cherng; Lin, Jan-You; Chang, Yu-Tang

2007-04-01

Surgical excision is thought to be the standard treatment of choice for lymphatic malformations. However, when the lesions are limited to the face only, surgical scar and facial nerve injury may impair cosmetics and facial expression. Sclerotherapy, an injection of a sclerosing agent directly through the skin into a lesion, is an alternative method. By evaluating facial nerve conduction, we observed the long-term effect of facial lymphatic malformations after intralesional injection of OK-432 and correlated the findings with anatomic outcomes. One 12-year-old boy with a lesion over the right-side preauricular area adjacent to the main trunk of facial nerve and the other 5-year-old boy with a lesion in the left-sided cheek involving the buccinator muscle were enrolled. The follow-up data of more than one year, including clinical appearance, computed tomography (CT) scan and facial nerve evaluation were collected. The facial nerve conduction study was normal in both cases. Blink reflex in both children revealed normal results as well. Complete resolution was noted on outward appearance and CT scan. The neurophysiologic data were compatible with good anatomic and functional outcomes. Our report suggests that the inflammatory reaction of OK-432 did not interfere with adjacent facial nerve conduction.

Microsurgical Resection of Glomus Jugulare Tumors With Facial Nerve Reconstruction: 3-Dimensional Operative Video.

PubMed

Cândido, Duarte N C; de Oliveira, Jean Gonçalves; Borba, Luis A B

2018-05-08

Paragangliomas are tumors originating from the paraganglionic system (autonomic nervous system), mostly found at the region around the jugular bulb, for which reason they are also termed glomus jugulare tumors (GJT). Although these lesions appear to be histologically benign, clinically they present with great morbidity, especially due to invasion of nearby structures such as the lower cranial nerves. These are challenging tumors, as they need complex approaches and great knowledge of the skull base. We present the case of a 31-year-old woman, operated by the senior author, with a 1-year history of tinnitus, vertigo, and progressive hearing loss, that evolved with facial nerve palsy (House-Brackmann IV) 2 months before surgery. Magnetic resonance imaging and computed tomography scans demonstrated a typical lesion with intense flow voids at the jugular foramen region with invasion of the petrous and tympanic bone, carotid canal, and middle ear, and extending to the infratemporal fossa (type C2 of Fisch's classification for GJT). During the procedure the mastoid part of the facial nerve was identified involved by tumor and needed to be resected. We also describe the technique for nerve reconstruction, using an interposition graft from the great auricular nerve, harvested at the beginning of the surgery. We achieved total tumor resection with a remarkable postoperative course. The patient also presented with facial function after 6 months. The patient consented with publication of her images.

A real-time monitoring system for the facial nerve.

PubMed

Prell, Julian; Rachinger, Jens; Scheller, Christian; Alfieri, Alex; Strauss, Christian; Rampp, Stefan

2010-06-01

Damage to the facial nerve during surgery in the cerebellopontine angle is indicated by A-trains, a specific electromyogram pattern. These A-trains can be quantified by the parameter "traintime," which is reliably correlated with postoperative functional outcome. The system presented was designed to monitor traintime in real-time. A dedicated hardware and software platform for automated continuous analysis of the intraoperative facial nerve electromyogram was specifically designed. The automatic detection of A-trains is performed by a software algorithm for real-time analysis of nonstationary biosignals. The system was evaluated in a series of 30 patients operated on for vestibular schwannoma. A-trains can be detected and measured automatically by the described method for real-time analysis. Traintime is monitored continuously via a graphic display and is shown as an absolute numeric value during the operation. It is an expression of overall, cumulated length of A-trains in a given channel; a high correlation between traintime as measured by real-time analysis and functional outcome immediately after the operation (Spearman correlation coefficient [rho] = 0.664, P < .001) and in long-term outcome (rho = 0.631, P < .001) was observed. Automated real-time analysis of the intraoperative facial nerve electromyogram is the first technique capable of reliable continuous real-time monitoring. It can critically contribute to the estimation of functional outcome during the course of the operative procedure.

Electrophysiology of Cranial Nerve Testing: Trigeminal and Facial Nerves.

PubMed

Muzyka, Iryna M; Estephan, Bachir

2018-01-01

The clinical examination of the trigeminal and facial nerves provides significant diagnostic value, especially in the localization of lesions in disorders affecting the central and/or peripheral nervous system. The electrodiagnostic evaluation of these nerves and their pathways adds further accuracy and reliability to the diagnostic investigation and the localization process, especially when different testing methods are combined based on the clinical presentation and the electrophysiological findings. The diagnostic uniqueness of the trigeminal and facial nerves is their connectivity and their coparticipation in reflexes commonly used in clinical practice, namely the blink and corneal reflexes. The other reflexes used in the diagnostic process and lesion localization are very nerve specific and add more diagnostic yield to the workup of certain disorders of the nervous system. This article provides a review of commonly used electrodiagnostic studies and techniques in the evaluation and lesion localization of cranial nerves V and VII.

Facial nerve palsy associated with a cystic lesion of the temporal bone.

PubMed

Kim, Na Hyun; Shin, Seung-Ho

2014-03-01

Facial nerve palsy results in the loss of facial expression and is most commonly caused by a benign, self-limiting inflammatory condition known as Bell palsy. However, there are other conditions that may cause facial paralysis, such as neoplastic conditions of the facial nerve, traumatic nerve injury, and temporal bone lesions. We present a case of facial nerve palsy concurrent with a benign cystic lesion of the temporal bone, adjacent to the tympanic segment of the facial nerve. The patient's symptoms subsided after facial nerve decompression via a transmastoid approach.

Contemporary solutions for the treatment of facial nerve paralysis.

PubMed

Garcia, Ryan M; Hadlock, Tessa A; Klebuc, Michael J; Simpson, Roger L; Zenn, Michael R; Marcus, Jeffrey R

2015-06-01

After reviewing this article, the participant should be able to: 1. Understand the most modern indications and technique for neurotization, including masseter-to-facial nerve transfer (fifth-to-seventh cranial nerve transfer). 2. Contrast the advantages and limitations associated with contiguous muscle transfers and free-muscle transfers for facial reanimation. 3. Understand the indications for a two-stage and one-stage free gracilis muscle transfer for facial reanimation. 4. Apply nonsurgical adjuvant treatments for acute facial nerve paralysis. Facial expression is a complex neuromotor and psychomotor process that is disrupted in patients with facial paralysis breaking the link between emotion and physical expression. Contemporary reconstructive options are being implemented in patients with facial paralysis. While static procedures provide facial symmetry at rest, true 'facial reanimation' requires restoration of facial movement. Contemporary treatment options include neurotization procedures (a new motor nerve is used to restore innervation to a viable muscle), contiguous regional muscle transfer (most commonly temporalis muscle transfer), microsurgical free muscle transfer, and nonsurgical adjuvants used to balance facial symmetry. Each approach has advantages and disadvantages along with ongoing controversies and should be individualized for each patient. Treatments for patients with facial paralysis continue to evolve in order to restore the complex psychomotor process of facial expression.

Collision tumor of the facial nerve: a synchronous seventh nerve schwannoma and neurofibroma.

PubMed

Gross, Brian C; Carlson, Matthew L; Driscoll, Colin L; Moore, Eric J

2012-10-01

To report a novel case of a collision tumor involving an intraparotid neurofibroma and a mastoid segment facial nerve schwannoma. Clinical capsule report. Tertiary academic referral center. A 29-year-old woman with a 2-year history of an asymptomatic enlarging left infraauricular mass and normal FN function presented to a tertiary care referral center. Computed tomography and magnetic resonance imaging demonstrated a cystic lesion in the deep portion of the parotid gland extending into the stylomastoid foramen. The patient underwent superficial parotidectomy, and a cystic parotid mass was found to be intrinsic to the intraparotid facial nerve. A portion of the mass was biopsied, and intraoperative frozen section pathology was consistent with a neurofibroma. A mastoidectomy with FN decompression was then performed until a normal-appearing segment was identified just proximal to the second genu. After biopsy, proximal facial nerve stimulation failed to elicit evoked motor potentials, and en bloc resection was performed. Final pathology demonstrated a schwannoma involving the mastoid segment and a neurofibroma involving the proximal intraparotid facial nerve. We report the first case of a facial nerve collision tumor involving an intraparotid neurofibroma and a mastoid segment facial nerve schwannoma. Benign FN sheath tumors of the parotid gland are rare but should be considered in the differential diagnosis of a parotid mass.

Habilitation of facial nerve dysfunction after resection of a vestibular schwannoma.

PubMed

Rudman, Kelli L; Rhee, John S

2012-04-01

Facial nerve dysfunction after resection of a vestibular schwannoma is one of the most common indications for facial nerve habilitation. This article presents an overview of common and emerging management options for facial habilitation following resection of a vestibular schwannoma. Immediate and delayed nerve repair options, as well as adjunctive surgical, medical, and physical therapies for facial nerve dysfunction, are discussed. Two algorithms are provided as guides for the assessment and treatment of facial nerve paralysis after resection of vestibular schwannoma. Copyright © 2012 Elsevier Inc. All rights reserved.

Facial Nerve Schwannoma: A Case Report, Radiological Features and Literature Review.

PubMed

Pilloni, Giulia; Mico, Barbara Massa; Altieri, Roberto; Zenga, Francesco; Ducati, Alessandro; Garbossa, Diego; Tartara, Fulvio

2017-12-22

Facial nerve schwannoma localized in the middle fossa is a rare lesion. We report a case of a facial nerve schwannoma in a 30-year-old male presenting with facial nerve palsy. Magnetic resonance imaging (MRI) showed a 3 cm diameter tumor of the right middle fossa. The tumor was removed using a sub-temporal approach. Intraoperative monitoring allowed for identification of the facial nerve, so it was not damaged during the surgical excision. Neurological clinical examination at discharge demonstrated moderate facial nerve improvement (Grade III House-Brackmann).

Hypoglossal-facial nerve reconstruction using a Y-tube-conduit reduces aberrant synkinetic movements of the orbicularis oculi and vibrissal muscles in rats.

PubMed

Kaya, Yasemin; Ozsoy, Umut; Turhan, Murat; Angelov, Doychin N; Sarikcioglu, Levent

2014-01-01

The facial nerve is the most frequently damaged nerve in head and neck trauma. Patients undergoing facial nerve reconstruction often complain about disturbing abnormal synkinetic movements of the facial muscles (mass movements, synkinesis) which are thought to result from misguided collateral branching of regenerating motor axons and reinnervation of inappropriate muscles. Here, we examined whether use of an aorta Y-tube conduit during reconstructive surgery after facial nerve injury reduces synkinesis of orbicularis oris (blink reflex) and vibrissal (whisking) musculature. The abdominal aorta plus its bifurcation was harvested (N = 12) for Y-tube conduits. Animal groups comprised intact animals (Group 1), those receiving hypoglossal-facial nerve end-to-end coaptation alone (HFA; Group 2), and those receiving hypoglossal-facial nerve reconstruction using a Y-tube (HFA-Y-tube, Group 3). Videotape motion analysis at 4 months showed that HFA-Y-tube group showed a reduced synkinesis of eyelid and whisker movements compared to HFA alone.

Hypoglossal-Facial Nerve Reconstruction Using a Y-Tube-Conduit Reduces Aberrant Synkinetic Movements of the Orbicularis Oculi and Vibrissal Muscles in Rats

PubMed Central

Kaya, Yasemin; Ozsoy, Umut; Turhan, Murat; Angelov, Doychin N.; Sarikcioglu, Levent

2014-01-01

The facial nerve is the most frequently damaged nerve in head and neck trauma. Patients undergoing facial nerve reconstruction often complain about disturbing abnormal synkinetic movements of the facial muscles (mass movements, synkinesis) which are thought to result from misguided collateral branching of regenerating motor axons and reinnervation of inappropriate muscles. Here, we examined whether use of an aorta Y-tube conduit during reconstructive surgery after facial nerve injury reduces synkinesis of orbicularis oris (blink reflex) and vibrissal (whisking) musculature. The abdominal aorta plus its bifurcation was harvested (N = 12) for Y-tube conduits. Animal groups comprised intact animals (Group 1), those receiving hypoglossal-facial nerve end-to-end coaptation alone (HFA; Group 2), and those receiving hypoglossal-facial nerve reconstruction using a Y-tube (HFA-Y-tube, Group 3). Videotape motion analysis at 4 months showed that HFA-Y-tube group showed a reduced synkinesis of eyelid and whisker movements compared to HFA alone. PMID:25574468

Unilateral abducens and bilateral facial nerve palsies associated with posterior fossa exploration surgery.

PubMed

Khalil, Ayman; Clerkin, James; Mandiwanza, Tafadzwa; Green, Sandra; Javadpour, Mohsen

2016-03-06

Multiple cranial nerves palsies following a posterior fossa exploration confined to an extradural compartment is a rare clinical presentation. This case report describes a young man who developed a unilateral abducens and bilateral facial nerve palsies following a posterior fossa exploration confined to an extradural compartment. There are different theories to explain this presentation, but the exact mechanism remains unclear. We propose that this patient cranial nerve palsies developed following cerebrospinal fluid (CSF) leak, potentially as a consequence of rapid change in CSF dynamics. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

Comparison of hemihypoglossal nerve versus masseteric nerve transpositions in the rehabilitation of short-term facial paralysis using the Facial Clima evaluating system.

PubMed

Hontanilla, Bernardo; Marré, Diego

2012-11-01

Masseteric and hypoglossal nerve transfers are reliable alternatives for reanimating short-term facial paralysis. To date, few studies exist in the literature comparing these techniques. This work presents a quantitative comparison of masseter-facial transposition versus hemihypoglossal facial transposition with a nerve graft using the Facial Clima system. Forty-six patients with complete unilateral facial paralysis underwent reanimation with either hemihypoglossal transposition with a nerve graft (group I, n = 25) or direct masseteric-facial coaptation (group II, n = 21). Commissural displacement and commissural contraction velocity were measured using the Facial Clima system. Postoperative intragroup commissural displacement and commissural contraction velocity means of the reanimated versus the normal side were first compared using a paired sample t test. Then, mean percentages of recovery of both parameters were compared between the groups using an independent sample t test. Onset of movement was also compared between the groups. Significant differences of mean commissural displacement and commissural contraction velocity between the reanimated side and the normal side were observed in group I but not in group II. Mean percentage of recovery of both parameters did not differ between the groups. Patients in group II showed a significantly faster onset of movement compared with those in group I (62 ± 4.6 days versus 136 ± 7.4 days, p = 0.013). Reanimation of short-term facial paralysis can be satisfactorily addressed by means of either hemihypoglossal transposition with a nerve graft or direct masseteric-facial coaptation. However, with the latter, better symmetry and a faster onset of movement are observed. In addition, masseteric nerve transfer avoids morbidity from nerve graft harvesting. Therapeutic, III.

The facial nerve: anatomy and associated disorders for oral health professionals.

PubMed

Takezawa, Kojiro; Townsend, Grant; Ghabriel, Mounir

2018-04-01

The facial nerve, the seventh cranial nerve, is of great clinical significance to oral health professionals. Most published literature either addresses the central connections of the nerve or its peripheral distribution but few integrate both of these components and also highlight the main disorders affecting the nerve that have clinical implications in dentistry. The aim of the current study is to provide a comprehensive description of the facial nerve. Multiple aspects of the facial nerve are discussed and integrated, including its neuroanatomy, functional anatomy, gross anatomy, clinical problems that may involve the nerve, and the use of detailed anatomical knowledge in the diagnosis of the site of facial nerve lesion in clinical neurology. Examples are provided of disorders that can affect the facial nerve during its intra-cranial, intra-temporal and extra-cranial pathways, and key aspects of clinical management are discussed. The current study is complemented by original detailed dissections and sketches that highlight key anatomical features and emphasise the extent and nature of anatomical variations displayed by the facial nerve.

Effects of agmatine sulphate on facial nerve injuries.

PubMed

Surmelioglu, O; Sencar, L; Ozdemir, S; Tarkan, O; Dagkiran, M; Surmelioglu, N; Tuncer, U; Polat, S

2017-03-01

To evaluate the effect of agmatine sulphate on facial nerve regeneration after facial nerve injury using electron and light microscopy. The study was performed on 30 male Wistar albino rats split into: a control group, a sham-treated group, a study control group, an anastomosis group, and an anastomosis plus agmatine sulphate treatment group. The mandibular branch of the facial nerve was dissected, and a piece was removed for histological and electron microscopic examination. Regeneration was better in the anastomosis group than in the study control group. However, the best regeneration findings were seen in the agmatine sulphate treatment group. There was a significant difference between the agmatine group and the others in terms of median axon numbers (p < 0.004) and diameters (p < 0.004). Agmatine sulphate treatment with anastomosis in traumatic facial paralysis may enhance nerve regeneration.

Preoperative percutaneous cranial nerve mapping in head and neck surgery.

PubMed

Park, Jung I

2003-01-01

To identify and map the course of the peripheral branches of the cranial nerve preoperatively and percutaneously. Prospective study. Preoperative percutaneous nerve mapping performed prior to the operation under deep sedation or general anesthesia without muscle paralysis. Private office surgery suite, freestanding surgery center, and regional medical centers. A total of 142 patients undergoing head and neck surgery and facial plastic surgery between August 1994 and July 1999. Monopolar probe was used for nerve stimulation. Electromyographic reading was done through intramuscular bipolar recording electrodes. The equipment used was a nerve monitor. The mandibular divisions were tested in 142 cases, the frontal division in 60 cases, the accessory nerve in 12 cases, and the hypoglossal nerve in 3 cases. Satisfactory mappings were obtained in 115 cases of the mandibular division, 49 cases of the frontal division, 8 cases of the accessory division, and 1 case of the hypoglossal nerve. Preoperative percutaneous nerve mapping is a new method of identifying the location of the peripheral branches of the cranial nerves. Identifying and mapping the course of peripheral branches of the cranial nerves safely assists the head and neck surgeon in the placement of incisions in a favorable location and in the dissection of the area involving the nerves. Mapping alerts the surgeon to an area containing a nerve and allows the surgeon to avoid just the specific area where a nerve is present, preventing large-scale abandonment of unmapped areas for fear of potential nerve damage.

Anatomical variations of the facial nerve in first branchial cleft anomalies.

PubMed

Solares, C Arturo; Chan, James; Koltai, Peter J

2003-03-01

To review our experience with branchial cleft anomalies, with special attention to their subtypes and anatomical relationship to the facial nerve. Case series. Tertiary care center. Ten patients who underwent resection for anomalies of the first branchial cleft, with at least 1 year of follow-up, were included in the study. The data from all cases were collected in a prospective fashion, including immediate postoperative diagrams. Complete resection of the branchial cleft anomaly was performed in all cases. Wide exposure of the facial nerve was achieved using a modified Blair incision and superficial parotidectomy. Facial nerve monitoring was used in every case. The primary outcome measurements were facial nerve function and incidence of recurrence after resection of the branchial cleft anomaly. Ten patients, 6 females and 4 males,with a mean age of 9 years at presentation, were treated by the senior author (P.J.K.) between 1989 and 2001. The lesions were characterized as sinus tracts (n = 5), fistulous tracts (n = 3), and cysts (n = 2). Seven lesions were medial to the facial nerve, 2 were lateral to the facial nerve, and 1 was between branches of the facial nerve. There were no complications related to facial nerve paresis or paralysis, and none of the patients has had a recurrence. The successful treatment of branchial cleft anomalies requires a complete resection. A safe complete resection requires a full exposure of the facial nerve, as the lesions can be variably associated with the nerve.

The Trigeminal (V) and Facial (VII) Cranial Nerves

PubMed Central

Sanders, Richard D.

2010-01-01

There are close functional and anatomical relationships between cranial nerves V and VII in both their sensory and motor divisions. Sensation on the face is innervated by the trigeminal nerves (V) as are the muscles of mastication, but the muscles of facial expression are innervated mainly by the facial nerve (VII) as is the sensation of taste. This article briefly reviews the anatomy of these cranial nerves, disorders of these nerves that are of particular importance to psychiatry, and some considerations for differential diagnosis. PMID:20386632

Effect of rocuronium on the level and mode of pre-synaptic acetylcholine release by facial and somatic nerves, and changes following facial nerve injury in rabbits.

PubMed

Tan, Jinghua; Xu, Jing; Xing, Yian; Chen, Lianhua; Li, Shitong

2015-01-01

Muscles innervated by the facial nerve show differential sensitivities to muscle relaxants than muscles innervated by somatic nerves. The evoked electromyography (EEMG) response is also proportionally reduced after facial nerve injury. This forms the theoretical basis for proper utilization of muscle relaxants to balance EEMG monitoring and immobility under general anesthesia. (1) To observe the relationships between the level and mode of acetylcholine (ACh) release and the duration of facial nerve injury, and the influence of rocuronium in an in vitro rabbit model. (2) To explore the pre-synaptic mechanisms of discrepant responses to a muscle relaxant. Quantal and non-quantal ACh release were measured by using intracellular microelectrode recording in the orbicularis oris 1 to 42 days after graded facial nerve injury and in the gastrocnemius with/without rocuronium. Quantal ACh release was significantly decreased by rocuronium in the orbicularis oris and gastrocnemius, but significantly more so in gastrocnemius. Quantal release was reduced after facial nerve injury, which was significantly correlated with the severity of nerve injury in the absence but not in the presence of rocuronium. Non-quantal ACh release was reduced after facial nerve injury, with many relationships observed depending on the extent of the injury. The extent of inhibition of non-quantal release by rocuronium correlated with the grade of facial nerve injury. These findings may explain why EEMG amplitude might be diminished after acute facial nerve injury but relatively preserved after chronic injury and differential responses in sensitivity to rocuronium.

Effect of rocuronium on the level and mode of pre-synaptic acetylcholine release by facial and somatic nerves, and changes following facial nerve injury in rabbits

PubMed Central

Tan, Jinghua; Xu, Jing; Xing, Yian; Chen, Lianhua; Li, Shitong

2015-01-01

Muscles innervated by the facial nerve show differential sensitivities to muscle relaxants than muscles innervated by somatic nerves. The evoked electromyography (EEMG) response is also proportionally reduced after facial nerve injury. This forms the theoretical basis for proper utilization of muscle relaxants to balance EEMG monitoring and immobility under general anesthesia. (1) To observe the relationships between the level and mode of acetylcholine (ACh) release and the duration of facial nerve injury, and the influence of rocuronium in an in vitro rabbit model. (2) To explore the pre-synaptic mechanisms of discrepant responses to a muscle relaxant. Quantal and non-quantal ACh release were measured by using intracellular microelectrode recording in the orbicularis oris 1 to 42 days after graded facial nerve injury and in the gastrocnemius with/without rocuronium. Quantal ACh release was significantly decreased by rocuronium in the orbicularis oris and gastrocnemius, but significantly more so in gastrocnemius. Quantal release was reduced after facial nerve injury, which was significantly correlated with the severity of nerve injury in the absence but not in the presence of rocuronium. Non-quantal ACh release was reduced after facial nerve injury, with many relationships observed depending on the extent of the injury. The extent of inhibition of non-quantal release by rocuronium correlated with the grade of facial nerve injury. These findings may explain why EEMG amplitude might be diminished after acute facial nerve injury but relatively preserved after chronic injury and differential responses in sensitivity to rocuronium. PMID:25973033

Hearing preservation and facial nerve function after microsurgery for intracanalicular vestibular schwannomas: comparison of middle fossa and retrosigmoid approaches.

PubMed

Noudel, R; Gomis, P; Duntze, J; Marnet, D; Bazin, A; Roche, P H

2009-08-01

Therapeutic options for vestibular schwannomas (VS) include microsurgery, stereotactic radiosurgery and conservative management. Early treatment of intracanalicular vestibular schwannomas (IVS) may be advisable because their spontaneous course will show hearing loss in most cases. Advanced microsurgical techniques and continuous intraoperative monitoring of cranial nerves may allow hearing preservation (HP) without facial nerve damage. However, there are still controversies about the definition of hearing preservation, and the best surgical approach that should be used. In this study, we reviewed the main data from the recent literature on IVS surgery and compared hearing, facial function and complication rates after the retrosigmoid (RS) and middle fossa (MF) approaches, respectively. The results showed that the average HP rate after IVS surgery ranged from 58% (RS) to 62% (MF). HP varied widely depending on the audiometric criteria that were used for definition of serviceable hearing. There was a trend to show that the MF approach offered a better quality of postoperative hearing (not statistically significant), whereas the RS approach offered a better facial nerve preservation and fewer complications (not statistically significant). We believe that the timing of treatment in the course of the disease and selection between radiosurgical versus microsurgical procedure are key issues in the management of IVS. Preservation of hearing and good facial nerve function in surgery for VS is a reasonable goal for many patients with intracanalicular tumors and serviceable hearing. Once open surgery has been decided, selection of the approach mainly depends on individual anatomical considerations and experience of the surgeon.

Combinatorial treatments enhance recovery following facial nerve crush.

PubMed

Sharma, Nijee; Moeller, Carl W; Marzo, Sam J; Jones, Kathryn J; Foecking, Eileen M

2010-08-01

To investigate the effects of various combinatorial treatments, consisting of a tapering dose of prednisone (P), a brief period of nerve electrical stimulation (ES), and systemic testosterone propionate (TP) on improving functional recovery following an intratemporal facial nerve crush injury. Prospective, controlled animal study. After a right intratemporal facial nerve crush, adult male Sprague-Dawley rats were divided into the following eight treatment groups: 1) no treatment, 2) P only, 3) ES only, 4) ES + P, 5) TP only, 6) TP + P, 7) ES + TP, and 8) ES + TP + P. For each group n = 4-8. Recovery of the eyeblink reflex and vibrissae orientation and movement were assessed. Changes in peak amplitude and latency of evoked response, in response to facial nerve stimulation, was also recorded weekly. : Brief ES of the proximal nerve stump most effectively accelerated the initiation of functional recovery. Also, ES or TP treatments enhanced recovery of some functional parameters more than P treatment. When administered alone, none of the three treatments improved recovery of complete facial function. Only the combinatorial treatment of ES + TP, regardless of the presence of P, accelerated complete functional recovery and return of normal motor nerve conduction. Our findings suggest that a combinatorial treatment strategy of using brief ES and TP together promises to be an effective therapeutic intervention for promoting regeneration following facial nerve injury. Administration of P neither augments nor hinders recovery.

Microsurgical dissection of facial nerve in parotidectomy: a discussion of techniques and long-term results

PubMed Central

Nicoli, Fabio; D’Ambrosia, Christopher; Lazzeri, Davide; Orfaniotis, Georgios; Ciudad, Pedro; Maruccia, Michele; Shiun, Li Tzong; Sacak, Bulent; Chen, Shih-Heng

2017-01-01

Background Parotidectomy has well-documented post-operative complications. Dissection of the facial nerve branches can be challenging even under loupe magnification, and partial, or complete injury of the nerve branches can occur during surgery. To reduce this risk and the associated complications, we propose a number of microsurgical best practices, which can be performed during parotidectomy. Methods A retrospective survey was conducted on 109 patients (45 males and 64 females, average age 46.2 years, range of 6 to 74 years) who underwent parotidectomy in two different institutions. Results Our data showed no permanent injury to the facial nerve, and 17% of neuroapraxia that had resolved with time. Post-operative complications have occurred in 33 cases (30% rate). In the superficial parotidectomy cohort (78 patients), the number of complications was 17 (21%). In the total parotidectomy cohort (31 patients), the number of complications was 16 (51%). Conclusions Based on our results, we believe that the use of microsurgical techniques during parotidectomy may represent a useful tool in improving accuracy and minimising local tissue trauma that can affect nerve recovery. This is particularly true in situations such as tumor recurrence, tissue fibrosis or in case of sizeable tumors around the facial nerve branches. We believe that the decreased risk of facial nerve post-operative symptoms outweigh the disadvantage of increased operative time of this procedure. PMID:28861369

Delayed facial nerve decompression for Bell's palsy.

PubMed

Kim, Sang Hoon; Jung, Junyang; Lee, Jong Ha; Byun, Jae Yong; Park, Moon Suh; Yeo, Seung Geun

2016-07-01

Incomplete recovery of facial motor function continues to be long-term sequelae in some patients with Bell's palsy. The purpose of this study was to investigate the efficacy of transmastoid facial nerve decompression after steroid and antiviral treatment in patients with late stage Bell's palsy. Twelve patients underwent surgical decompression for Bell's palsy 21-70 days after onset, whereas 22 patients were followed up after steroid and antiviral therapy without decompression. Surgical criteria included greater than 90 % degeneration on electroneuronography and no voluntary electromyography potentials. This study was a retrospective study of electrodiagnostic data and medical chart review between 2006 and 2013. Recovery from facial palsy was assessed using the House-Brackmann grading system. Final recovery rate did not differ significantly in the two groups; however, all patients in the decompression group recovered to at least House-Brackmann grade III at final follow-up. Although postoperative hearing threshold was increased in both groups, there was no significant between group difference in hearing threshold. Transmastoid decompression of the facial nerve in patients with severe late stage Bell's palsy at risk for a poor facial nerve outcome reduced severe complications of facial palsy with minimal morbidity.

Transient delayed facial nerve palsy after inferior alveolar nerve block anesthesia.

PubMed

Tzermpos, Fotios H; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

2012-01-01

Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution.

Degeneration and regeneration of motor and sensory nerves: a stereological study of crush lesions in rat facial and mental nerves.

PubMed

Barghash, Z; Larsen, J O; Al-Bishri, A; Kahnberg, K-E

2013-12-01

The aim of this study was to evaluate the degeneration and regeneration of a sensory nerve and a motor nerve at the histological level after a crush injury. Twenty-five female Wistar rats had their mental nerve and the buccal branch of their facial nerve compressed unilaterally against a glass rod for 30s. Specimens of the compressed nerves and the corresponding control nerves were dissected at 3, 7, and 19 days after surgery. Nerve cross-sections were stained with osmium tetroxide and toluidine blue and analysed using two-dimensional stereology. We found differences between the two nerves both in the normal anatomy and in the regenerative pattern. The mental nerve had a larger cross-sectional area including all tissue components. The mental nerve had a larger volume fraction of myelinated axons and a correspondingly smaller volume fraction of endoneurium. No differences were observed in the degenerative pattern; however, at day 19 the buccal branch had regenerated to the normal number of axons, whereas the mental nerve had only regained 50% of the normal number of axons. We conclude that the regenerative process is faster and/or more complete in the facial nerve (motor function) than it is in the mental nerve (somatosensory function). Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

[Clinical experience in facial nerve tumors: a review of 27 cases].

PubMed

Zhang, Fan; Wang, Yucheng; Dai, Chunfu; Chi, Fanglu; Zhou, Liang; Chen, Bing; Li, Huawei

2010-01-01

To analyze the clinical manifestations and the diagnosis of the facial nerve tumor according to the clinical information, and evaluate the different surgical approaches depending on tumor location. Twenty-seven cases of facial nerve tumors with general clinical informations available from 1999.9 to 2006.12 in the Shanghai EENT Hospital were reviewed retrospectively. Twenty (74.1%) schwannomas, 4 (14.8%) neurofibromas ,and 3 (11.1%) hemangiomas were identified with histopathology postoperatively. During the course of the disease, 23 patients (85.2%) suffered facial paralysis, both hearing loss and tinnitus affected 11 (40.7%) cases, 5 (18.5%) manifested infra-auricular mass and the others showed some of otalgia or vertigo or ear fullness or facial numbness/twitches. CT or/and MRI results in 24 cases indicated that the tumors originated from the facial nerve. Intra-operative findings showed that 24 (88.9%) cases involved no less than 2 segments of the facial nerve, of these 24 cases 87.5% (21/24) involved the mastoid portion, 70.8% (17/24) involved the tympanic portion, 62.5% (15/24) involved the geniculate ganglion, only 4.2% (1/24) involved the internal acoustic canal (IAC), and 3 cases (11.1%) had only one segments involved. In all of these 27 cases, the tumors were completely excised, of which 13 were resected followed by an immediate facial nerve reconstruction, including 11 sural nerve cable graft, 1 facial nerve end-to-end anastomosis and 1 hypoglossal-facial nerve end-to-end anastomosis. Tumors were removed with preservation of facial nerve continuity in 2 cases. Facial nerve tumor is a rare and benign lesion, and has numerous clinical manifestations. CT and MRI can help surgeons to make a right diagnosis preoperatively. When and how to give the patients an operation depends on the patients individually.

Extracranial Facial Nerve Schwannoma Treated by Hypo-fractionated CyberKnife Radiosurgery.

PubMed

Sasaki, Ayaka; Miyazaki, Shinichiro; Hori, Tomokatsu

2016-09-21

Facial nerve schwannoma is a rare intracranial tumor. Treatment for this benign tumor has been controversial. Here, we report a case of extracranial facial nerve schwannoma treated successfully by hypo-fractionated CyberKnife (Accuray, Sunnyvale, CA) radiosurgery and discuss the efficacy of this treatment. A 34-year-old female noticed a swelling in her right mastoid process. The lesion enlarged over a seven-month period, and she experienced facial spasm on the right side. She was diagnosed with a facial schwannoma via a magnetic resonance imaging (MRI) scan of the head and neck and was told to wait until the facial nerve palsy subsides. She was referred to our hospital for radiation therapy. We planned a fractionated CyberKnife radiosurgery for three consecutive days. After CyberKnife radiosurgery, the mass in the right parotid gradually decreased in size, and the facial nerve palsy disappeared. At her eight-month follow-up, her facial spasm had completely disappeared. There has been no recurrence and the facial nerve function has been normal. We successfully demonstrated the efficacy of CyberKnife radiosurgery as an alternative treatment that also preserves neurofunction for facial nerve schwannomas.

[Integration of the functional signal of intraoperative EMG of the facial nerve in to navigation model for surgery of the petrous bone].

PubMed

Strauss, G; Strauss, M; Lüders, C; Stopp, S; Shi, J; Dietz, A; Lüth, T

2008-10-01

PROBLEM DEFINITION: The goal of this work is the integration of the information of the intraoperative EMG monitoring of the facial nerve into the radiological data of the petrous bone. The following hypotheses are to be examined: (I) the N. VII can be determined intraoperatively with a high reliability by the stimulation-probe. A computer program is able to discriminate true-positive EMG signals from false-positive artifacts. (II) The course of the facial nerve can be registered in a three-dimensional area by EMG signals at a nerve model in the lab test. The individual items of the nerve can be combined into a route model. The route model can be integrated into the data of digital volume tomography (DVT). (I) Intraoperative EMG signals of the facial nerve were classified at 128 measurements by an automatic software. The results were correlated with the actual intraoperative situation. (II) The nerve phantom was designed and a DVT data set was provided. Phantom was registered with a navigation system (Karl Storz NPU, Tuttlingen, Germany). The stimulation probe of the EMG-system was tracked by the navigation system. The navigation system was extended by a processing unit (MiMed, Technische Universität München, Germany). Thus the classified EMG parameters of the facial route can be received, processed and be generated to a model of the facial nerve route. The operability was examined at 120 (10 x 12) measuring points. The evaluation of the examined algorithm for classification EMG-signals of the facial nerve resulted as correct in all measuring events. In all 10 attempts it succeeded to visualize the nerve route as three-dimensional model. The different sizes of the individual measuring points reflect the appropriate values of Istim and UEMG correctly. This work proves the feasibility of an automatic classification of an intraoperative EMG signal of the facial nerve by a processing unit. Furthermore the work shows the feasibility of tracking of the position of the

Facilitation of facial nerve regeneration using chitosan-β-glycerophosphate-nerve growth factor hydrogel.

PubMed

Chao, Xiuhua; Xu, Lei; Li, Jianfeng; Han, Yuechen; Li, Xiaofei; Mao, YanYan; Shang, Haiqiong; Fan, Zhaomin; Wang, Haibo

2016-06-01

Conclusion C/GP hydrogel was demonstrated to be an ideal drug delivery vehicle and scaffold in the vein conduit. Combined use autologous vein and NGF continuously delivered by C/GP-NGF hydrogel can improve the recovery of facial nerve defects. Objective This study investigated the effects of chitosan-β-glycerophosphate-nerve growth factor (C/GP-NGF) hydrogel combined with autologous vein conduit on the recovery of damaged facial nerve in a rat model. Methods A 5 mm gap in the buccal branch of a rat facial nerve was reconstructed with an autologous vein. Next, C/GP-NGF hydrogel was injected into the vein conduit. In negative control groups, NGF solution or phosphate-buffered saline (PBS) was injected into the vein conduits, respectively. Autologous implantation was used as a positive control group. Vibrissae movement, electrophysiological assessment, and morphological analysis of regenerated nerves were performed to assess nerve regeneration. Results NGF continuously released from C/GP-NGF hydrogel in vitro. The recovery rate of vibrissae movement and the compound muscle action potentials of regenerated facial nerve in the C/GP-NGF group were similar to those in the Auto group, and significantly better than those in the NGF group. Furthermore, larger regenerated axons and thicker myelin sheaths were obtained in the C/GP-NGF group than those in the NGF group.

Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia

PubMed Central

Tzermpos, Fotios H.; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

2012-01-01

Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution. PMID:22428971

Promising Technique for Facial Nerve Reconstruction in Extended Parotidectomy

PubMed Central

Villarreal, Ithzel Maria; Rodríguez-Valiente, Antonio; Castelló, Jose Ramon; Górriz, Carmen; Montero, Oscar Alvarez; García-Berrocal, Jose Ramon

2015-01-01

Introduction: Malignant tumors of the parotid gland account scarcely for 5% of all head and neck tumors. Most of these neoplasms have a high tendency for recurrence, local infiltration, perineural extension, and metastasis. Although uncommon, these malignant tumors require complex surgical treatment sometimes involving a total parotidectomy including a complete facial nerve resection. Severe functional and aesthetic facial defects are the result of a complete sacrifice or injury to isolated branches becoming an uncomfortable distress for patients and a major challenge for reconstructive surgeons. Case Report: A case of a 54-year-old, systemically healthy male patient with a 4 month complaint of pain and swelling on the right side of the face is presented. The patient reported a rapid increase in the size of the lesion over the past 2 months. Imaging tests and histopathological analysis reported an adenoid cystic carcinoma. A complete parotidectomy was carried out with an intraoperative notice of facial nerve infiltration requiring a second intervention for nerve and defect reconstruction. A free ALT flap with vascularized nerve grafts was the surgical choice. A 6 month follow-up showed partial facial movement recovery and the facial defect mended. Conclusion: It is of critical importance to restore function to patients with facial nerve injury. Vascularized nerve grafts, in many clinical and experimental studies, have shown to result in better nerve regeneration than conventional non-vascularized nerve grafts. Nevertheless, there are factors that may affect the degree, speed and regeneration rate regarding the free fasciocutaneous flap. In complex head and neck defects following a total parotidectomy, the extended free fasciocutaneous ALT (anterior-lateral thigh) flap with a vascularized nerve graft is ideally suited for the reconstruction of the injured site. Donor–site morbidity is low and additional surgical time is minimal compared with the time of a single

Promising Technique for Facial Nerve Reconstruction in Extended Parotidectomy.

PubMed

Villarreal, Ithzel Maria; Rodríguez-Valiente, Antonio; Castelló, Jose Ramon; Górriz, Carmen; Montero, Oscar Alvarez; García-Berrocal, Jose Ramon

2015-11-01

Malignant tumors of the parotid gland account scarcely for 5% of all head and neck tumors. Most of these neoplasms have a high tendency for recurrence, local infiltration, perineural extension, and metastasis. Although uncommon, these malignant tumors require complex surgical treatment sometimes involving a total parotidectomy including a complete facial nerve resection. Severe functional and aesthetic facial defects are the result of a complete sacrifice or injury to isolated branches becoming an uncomfortable distress for patients and a major challenge for reconstructive surgeons. A case of a 54-year-old, systemically healthy male patient with a 4 month complaint of pain and swelling on the right side of the face is presented. The patient reported a rapid increase in the size of the lesion over the past 2 months. Imaging tests and histopathological analysis reported an adenoid cystic carcinoma. A complete parotidectomy was carried out with an intraoperative notice of facial nerve infiltration requiring a second intervention for nerve and defect reconstruction. A free ALT flap with vascularized nerve grafts was the surgical choice. A 6 month follow-up showed partial facial movement recovery and the facial defect mended. It is of critical importance to restore function to patients with facial nerve injury. Vascularized nerve grafts, in many clinical and experimental studies, have shown to result in better nerve regeneration than conventional non-vascularized nerve grafts. Nevertheless, there are factors that may affect the degree, speed and regeneration rate regarding the free fasciocutaneous flap. In complex head and neck defects following a total parotidectomy, the extended free fasciocutaneous ALT (anterior-lateral thigh) flap with a vascularized nerve graft is ideally suited for the reconstruction of the injured site. Donor-site morbidity is low and additional surgical time is minimal compared with the time of a single ALT flap transfer.

Electrophysiological Assessment of a Peptide Amphiphile Nanofiber Nerve Graft for Facial Nerve Repair.

PubMed

Greene, Jacqueline J; McClendon, Mark T; Stephanopoulos, Nicholas; Álvarez, Zaida; Stupp, Samuel I; Richter, Claus-Peter

2018-04-27

Facial nerve injury can cause severe long-term physical and psychological morbidity. There are limited repair options for an acutely transected facial nerve not amenable to primary neurorrhaphy. We hypothesize that a peptide amphiphile nanofiber neurograft may provide the nanostructure necessary to guide organized neural regeneration. Five experimental groups were compared, animals with 1) an intact nerve, 2) following resection of a nerve segment, and following resection and immediate repair with either a 3) autograft (using the resected nerve segment), 4) neurograft, or 5) empty conduit. The buccal branch of the rat facial nerve was directly stimulated with charge balanced biphasic electrical current pulses at different current amplitudes while nerve compound action potentials (nCAPs) and electromygraphic (EMG) responses were recorded. After 8 weeks, the proximal buccal branch was surgically re-exposed and electrically evoked nCAPs were recorded for groups 1-5. As expected, the intact nerves required significantly lower current amplitudes to evoke an nCAP than those repaired with the neurograft and autograft nerves. For other electrophysiologic parameters such as latency and maximum nCAP, there was no significant difference between the intact, autograft and neurograft groups. The resected group had variable responses to electrical stimulation, and the empty tube group was electrically silent. Immunohistochemical analysis and TEM confirmed myelinated neural regeneration. This study demonstrates that the neuroregenerative capability of peptide amphiphile nanofiber neurografts is similar to the current clinical gold standard method of repair and holds potential as an off-the-shelf solution for facial reanimation and potentially peripheral nerve repair. This article is protected by copyright. All rights reserved.

[Experimental studies for the improvement of facial nerve regeneration].

PubMed

Guntinas-Lichius, O; Angelov, D N

2008-02-01

Using a combination of the following, it is possible to investigate procedures to improve the morphological and functional regeneration of the facial nerve in animal models: 1) retrograde fluorescence tracing to analyse collateral axonal sprouting and the selectivity of reinnervation of the mimic musculature, 2) immunohistochemistry to analyse both the terminal axonal sprouting in the muscles and the axon reaction within the nucleus of the facial nerve, the peripheral nerve, and its environment, and 3) digital motion analysis of the muscles. To obtain good functional facial nerve regeneration, a reduction of terminal sprouting in the mimic musculature seems to be more important than a reduction of collateral sprouting at the lesion site. Promising strategies include acceleration of nerve regeneration, forced induced use of the paralysed face, mechanical stimulation of the face, and transplantation of nerve-growth-promoting olfactory epithelium at the lesion site.

Effect of postoperative brachytherapy and external beam radiotherapy on functional outcomes of immediate facial nerve repair after radical parotidectomy.

PubMed

Hontanilla, Bernardo; Qiu, Shan-Shan; Marré, Diego

2014-01-01

There is much controversy regarding the effect of radiotherapy on facial nerve regeneration. However, the effect of brachytherapy has not been studied. Fifty-three patients underwent total parotidectomy of which 13 were radical with immediate facial nerve repair with sural nerve grafts. Six patients (group 1) did not receive adjuvant treatment whereas 7 patients (group 2) received postoperative brachytherapy plus radiotherapy. Functional outcomes were compared using Facial Clima. Mean percentage of blink recovery was 92.6 ± 4.2 for group 1 and 90.7 ± 5.2 for group 2 (p = .37). Mean percentage of commissural excursion restoration was 78.1 ± 3.5 for group 1 and 74.9 ± 5.9 for group 2 (p = .17). Mean time from surgery to first movement was 5.7 ± 0.9 months for group 1 and 6.3 ± 0.5 months for group 2 (p = .15). Brachytherapy plus radiotherapy does not affect the functional outcomes of immediate facial nerve repair with nerve grafts. Copyright © 2013 Wiley Periodicals, Inc.

Long-term functional recovery after facial nerve transection and repair in the rat.

PubMed

Banks, Caroline A; Knox, Christopher; Hunter, Daniel A; Mackinnon, Susan E; Hohman, Marc H; Hadlock, Tessa A

2015-03-01

The rodent model is commonly used to study facial nerve injury. Because of the exceptional regenerative capacity of the rodent facial nerve, it is essential to consider the timing when studying facial nerve regeneration and functional recovery. Short-term functional recovery data following transection and repair of the facial nerve has been documented by our laboratory. However, because of the limitations of the head fixation device, there is a lack of long-term data following facial nerve injury. The objective of this study was to elucidate the long-term time course and functional deficit following facial nerve transection and repair in a rodent model. Adult rats were divided into group 1 (controls) and group 2 (experimental). Group 1 animals underwent head fixation, followed by a facial nerve injury, and functional testing was performed from day 7 to day 70. Group 2 animals underwent facial nerve injury, followed by delayed head fixation, and then underwent functional testing from months 6 to 8. There was no statistical difference between the average whisking amplitudes in group 1 and group 2 animals. Functional whisking recovery 6 months after facial nerve injury is comparable to recovery within 1 to 4 months of transection and repair, thus the ideal window for evaluating facial nerve recovery falls within the 4 months after injury. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Peripheral facial nerve lesions induce changes in the firing properties of primary motor cortex layer 5 pyramidal cells.

PubMed

Múnera, A; Cuestas, D M; Troncoso, J

2012-10-25

Facial nerve lesions elicit long-lasting changes in vibrissal primary motor cortex (M1) muscular representation in rodents. Reorganization of cortical representation has been attributed to potentiation of preexisting horizontal connections coming from neighboring muscle representation. However, changes in layer 5 pyramidal neuron activity induced by facial nerve lesion have not yet been explored. To do so, the effect of irreversible facial nerve injury on electrophysiological properties of layer 5 pyramidal neurons was characterized. Twenty-four adult male Wistar rats were randomly subjected to two experimental treatments: either surgical transection of mandibular and buccal branches of the facial nerve (n=18) or sham surgery (n=6). Unitary and population activity of vibrissal M1 layer 5 pyramidal neurons recorded in vivo under general anesthesia was compared between sham-operated and facial nerve-injured animals. Injured animals were allowed either one (n=6), three (n=6), or five (n=6) weeks recovery before recording in order to characterize the evolution of changes in electrophysiological activity. As compared to control, facial nerve-injured animals displayed the following sustained and significant changes in spontaneous activity: increased basal firing frequency, decreased spike-associated local field oscillation amplitude, and decreased spontaneous theta burst firing frequency. Significant changes in evoked-activity with whisker pad stimulation included: increased short latency population spike amplitude, decreased long latency population oscillations amplitude and frequency, and decreased peak frequency during evoked single-unit burst firing. Taken together, such changes demonstrate that peripheral facial nerve lesions induce robust and sustained changes of layer 5 pyramidal neurons in vibrissal motor cortex. Copyright © 2012 IBRO. Published by Elsevier Ltd. All rights reserved.

Useful Method for Intraoperative Monitoring of Facial Nerve in a Scarred Bed.

PubMed

Aysal, Bilge Kagan; Yapici, Abdulkerim; Bayram, Yalcin; Zor, Fatih

2016-10-01

Facial nerve is the main cranial nerve for the innervation of facial expression muscles. Main trunk of facial nerve passes approximately 1 to 2 cm deep to tragal pointer. In some patients, where a patient has multiple operations, fibrosis due to previous operations may change the natural anatomy and direction of the branches of facial nerve. A 22-year-old male patient had 2 operations for mandibular reconstruction after gunshot wound. During the second operation, there was a possible injury to the marginal mandibular nerve and a nerve stimulator was used intraoperatively to monitor the nerve at the tragal pointer because the excitability of the distal segments remains intact for 24 to 48 hours after nerve injuries. Thus, using a nerve stimulator at the operational site may lead to false-positive muscle movements in case of injuries. Using the nerve stimulator to stimulate the main trunk at the tragal point may help to distinguish the presence of possible injuries. A reliable method for intraoperative facial nerve monitoring in a scarred operational site was introduced in this letter.

Model-based segmentation of the facial nerve and chorda tympani in pediatric CT scans

NASA Astrophysics Data System (ADS)

Reda, Fitsum A.; Noble, Jack H.; Rivas, Alejandro; Labadie, Robert F.; Dawant, Benoit M.

2011-03-01

In image-guided cochlear implant surgery an electrode array is implanted in the cochlea to treat hearing loss. Access to the cochlea is achieved by drilling from the outer skull to the cochlea through the facial recess, a region bounded by the facial nerve and the chorda tympani. To exploit existing methods for computing automatically safe drilling trajectories, the facial nerve and chorda tympani need to be segmented. The effectiveness of traditional segmentation approaches to achieve this is severely limited because the facial nerve and chorda are small structures (~1 mm and ~0.3 mm in diameter, respectively) and exhibit poor image contrast. We have recently proposed a technique to achieve this task in adult patients, which relies on statistical models of the structures. These models contain intensity and shape information along the central axes of both structures. In this work we use the same method to segment pediatric scans. We show that substantial differences exist between the anatomy of children and the anatomy of adults, which lead to poor segmentation results when an adult model is used to segment a pediatric volume. We have built a new model for pediatric cases and we have applied it to ten scans. A leave-one-out validation experiment was conducted in which manually segmented structures were compared to automatically segmented structures. The maximum segmentation error was 1 mm. This result indicates that accurate segmentation of the facial nerve and chorda in pediatric scans is achievable, thus suggesting that safe drilling trajectories can also be computed automatically.

Useful surgical techniques for facial nerve preservation in tumorous intra-temporal lesions.

PubMed

Kim, Jin; Moon, In Seok; Lee, Jong Dae; Shim, Dae Bo; Lee, Won-Sang

2010-02-01

The management of the facial nerve in tumorous temporal lesions is particularly challenging due to its complex anatomic location and potential postoperative complications, including permanent facial paralysis. The most important concern regarding surgical treatment of a tumorous temporal lesion is the inevitable facial paralysis caused by nerve injury during the tumor removal, especially in patients with minimal to no preoperative facial nerve dysfunction. We describe successful four cases in which various surgical techniques were developed for the preservation of the facial nerve in treatment of intratemporal tumorous lesions. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Electrical and transcranial magnetic stimulation of the facial nerve: diagnostic relevance in acute isolated facial nerve palsy.

PubMed

Happe, Svenja; Bunten, Sabine

2012-01-01

Unilateral facial weakness is common. Transcranial magnetic stimulation (TMS) allows identification of a conduction failure at the level of the canalicular portion of the facial nerve and may help to confirm the diagnosis. We retrospectively analyzed 216 patients with the diagnosis of peripheral facial palsy. The electrophysiological investigations included the blink reflex, preauricular electrical stimulation and the response to TMS at the labyrinthine part of the canalicular proportion of the facial nerve within 3 days after symptom onset. A similar reduction or loss of the TMS amplitude (p < 0.005) of the affected side was seen in each patient group. Of the 216 patients (107 female, mean age 49.7 ± 18.0 years), 193 were diagnosed with Bell's palsy. Test results of the remaining patients led to the diagnosis of infectious [including herpes simplex, varicella zoster infection and borreliosis (n = 13)] and noninfectious [including diabetes and neoplasma (n = 10)] etiology. A conduction block in TMS supports the diagnosis of peripheral facial palsy without being specific for Bell's palsy. These data shed light on the TMS-based diagnosis of peripheral facial palsy, an ability to localize the site of lesion within the Fallopian channel regardless of the underlying pathology. Copyright © 2012 S. Karger AG, Basel.

Electrical stimulation treatment for facial palsy after revision pleomorphic adenoma surgery

PubMed Central

Goldie, Simon; Sandeman, Jack; Cole, Richard; Dennis, Simon; Swain, Ian

2016-01-01

Surgery for pleomorphic adenoma recurrence presents a significant risk of facial nerve damage that can result in facial weakness effecting patients’ ability to communicate, mental health and self-image. We report two case studies that had marked facial weakness after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation. Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Neither subjects demonstrated adverse effects of treatment. We conclude that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. Larger studies would be difficult to pursue due to the low incidence of cases. PMID:27106613

Modern concepts in facial nerve reconstruction

PubMed Central

2010-01-01

Background Reconstructive surgery of the facial nerve is not daily routine for most head and neck surgeons. The published experience on strategies to ensure optimal functional results for the patients are based on small case series with a large variety of surgical techniques. On this background it is worthwhile to develop a standardized approach for diagnosis and treatment of patients asking for facial rehabilitation. Conclusion A standardized approach is feasible: Patients with chronic facial palsy first need an exact classification of the palsy's aetiology. A step-by-step clinical examination, if necessary MRI imaging and electromyographic examination allow a classification of the palsy's aetiology as well as the determination of the severity of the palsy and the functional deficits. Considering the patient's desire, age and life expectancy, an individual surgical concept is applicable using three main approaches: a) early extratemporal reconstruction, b) early reconstruction of proximal lesions if extratemporal reconstruction is not possible, c) late reconstruction or in cases of congenital palsy. Twelve to 24 months after the last step of surgical reconstruction a standardized evaluation of the therapeutic results is recommended to evaluate the necessity for adjuvant surgical procedures or other adjuvant procedures, e.g. botulinum toxin application. Up to now controlled trials on the value of physiotherapy and other adjuvant measures are missing to give recommendation for optimal application of adjuvant therapies. PMID:21040532

Duplicated facial nerve trunk with a first branchial cleft cyst.

PubMed

Hinson, Drew; Poteet, Perry; Bower, Charles

2014-03-01

First branchial cleft anomalies are rare and their various anatomical relationships to the facial nerve have been described. We encountered a 15-year-old female with a type II first branchial cleft cyst presenting as a right neck mass that we found during surgical excision to transverse two main facial nerve trunks. To our knowledge, this is the first reported case of a first branchial cleft anomaly in conjunction with a duplicated facial nerve trunk. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Approaches to Peripheral Nerve Repair: Generations of Biomaterial Conduits Yielding to Replacing Autologous Nerve Grafts in Craniomaxillofacial Surgery

PubMed Central

Knipfer, Christian; Hadlock, Tessa

2016-01-01

Peripheral nerve injury is a common clinical entity, which may arise due to traumatic, tumorous, or even iatrogenic injury in craniomaxillofacial surgery. Despite advances in biomaterials and techniques over the past several decades, reconstruction of nerve gaps remains a challenge. Autografts are the gold standard for nerve reconstruction. Using autografts, there is donor site morbidity, subsequent sensory deficit, and potential for neuroma development and infection. Moreover, the need for a second surgical site and limited availability of donor nerves remain a challenge. Thus, increasing efforts have been directed to develop artificial nerve guidance conduits (ANCs) as new methods to replace autografts in the future. Various synthetic conduit materials have been tested in vitro and in vivo, and several first- and second-generation conduits are FDA approved and available for purchase, while third-generation conduits still remain in experimental stages. This paper reviews the current treatment options, summarizes the published literature, and assesses future prospects for the repair of peripheral nerve injury in craniomaxillofacial surgery with a particular focus on facial nerve regeneration. PMID:27556032

Unilateral Multiple Facial Nerve Branch Reconstruction Using “End-to-side Loop Graft” Supercharged by Hypoglossal Nerve

PubMed Central

Sasaki, Ryo; Takeuchi, Yuichi; Watanabe, Yorikatsu; Niimi, Yosuke; Sakurai, Hiroyuki; Miyata, Mariko; Yamato, Masayuki

2014-01-01

Background: Extensive facial nerve defects between the facial nerve trunk and its branches can be clinically reconstructed by incorporating double innervation into an end-to-side loop graft technique. This study developed a new animal model to evaluate the technique’s ability to promote nerve regeneration. Methods: Rats were divided into the intact, nonsupercharge, and supercharge groups. Artificially created facial nerve defects were reconstructed with a nerve graft, which was end-to-end sutured from proximal facial nerve stump to the mandibular branch (nonsupercharge group), or with the graft of which other end was end-to-side sutured to the hypoglossal nerve (supercharge group). And they were evaluated after 30 weeks. Results: Axonal diameter was significantly larger in the supercharge group than in the nonsupercharge group for the buccal (3.78 ± 1.68 vs 3.16 ± 1.22; P < 0.0001) and marginal mandibular branches (3.97 ± 2.31 vs 3.46 ± 1.57; P < 0.0001), but the diameter was significantly larger in the intact group for all branches except the temporal branch. In the supercharge group, compound muscle action potential amplitude was significantly higher than in the nonsupercharge group (4.18 ± 1.49 mV vs 1.87 ± 0.37 mV; P < 0.0001) and similar to that in the intact group (4.11 ± 0.68 mV). Retrograde labeling showed that the mimetic muscles were double-innervated by facial and hypoglossal nerve nuclei in the supercharge group. Conclusions: Multiple facial nerve branch reconstruction with an end-to-side loop graft was able to achieve axonal distribution. Additionally, axonal supercharge from the hypoglossal nerve significantly improved outcomes. PMID:25426357

Masseteric-facial nerve transposition for reanimation of the smile in incomplete facial paralysis.

PubMed

Hontanilla, Bernardo; Marre, Diego

2015-12-01

Incomplete facial paralysis occurs in about a third of patients with Bell's palsy. Although their faces are symmetrical at rest, when they smile they have varying degrees of disfigurement. Currently, cross-face nerve grafting is one of the most useful techniques for reanimation. Transfer of the masseteric nerve, although widely used for complete paralysis, has not to our knowledge been reported for incomplete palsy. Between December 2008 and November 2013, we reanimated the faces of 9 patients (2 men and 7 women) with incomplete unilateral facial paralysis with transposition of the masseteric nerve. Sex, age at operation, cause of paralysis, duration of denervation, recipient nerves used, and duration of follow-up were recorded. Commissural excursion, velocity, and patients' satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. The mean (SD) age at operation was 39 (±6) years and the duration of denervation was 29 (±19) months. There were no complications that required further intervention. Duration of follow-up ranged from 6-26 months. FACIAL CLIMA showed improvement in both commissural excursion and velocity of more than two thirds in 6 patients, more than one half in 2 patients and less than one half in one. Qualitative evaluation showed a slight or pronounced improvement in 7/9 patients. The masseteric nerve is a reliable alternative for reanimation of the smile in patients with incomplete facial paralysis. Its main advantages include its consistent anatomy, a one-stage operation, and low morbidity at the donor site. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Automatic segmentation of the facial nerve and chorda tympani in pediatric CT scans.

PubMed

Reda, Fitsum A; Noble, Jack H; Rivas, Alejandro; McRackan, Theodore R; Labadie, Robert F; Dawant, Benoit M

2011-10-01

Cochlear implant surgery is used to implant an electrode array in the cochlea to treat hearing loss. The authors recently introduced a minimally invasive image-guided technique termed percutaneous cochlear implantation. This approach achieves access to the cochlea by drilling a single linear channel from the outer skull into the cochlea via the facial recess, a region bounded by the facial nerve and chorda tympani. To exploit existing methods for computing automatically safe drilling trajectories, the facial nerve and chorda tympani need to be segmented. The goal of this work is to automatically segment the facial nerve and chorda tympani in pediatric CT scans. The authors have proposed an automatic technique to achieve the segmentation task in adult patients that relies on statistical models of the structures. These models contain intensity and shape information along the central axes of both structures. In this work, the authors attempted to use the same method to segment the structures in pediatric scans. However, the authors learned that substantial differences exist between the anatomy of children and that of adults, which led to poor segmentation results when an adult model is used to segment a pediatric volume. Therefore, the authors built a new model for pediatric cases and used it to segment pediatric scans. Once this new model was built, the authors employed the same segmentation method used for adults with algorithm parameters that were optimized for pediatric anatomy. A validation experiment was conducted on 10 CT scans in which manually segmented structures were compared to automatically segmented structures. The mean, standard deviation, median, and maximum segmentation errors were 0.23, 0.17, 0.18, and 1.27 mm, respectively. The results indicate that accurate segmentation of the facial nerve and chorda tympani in pediatric scans is achievable, thus suggesting that safe drilling trajectories can also be computed automatically.

Measurement of facial movements with Photoshop software during treatment of facial nerve palsy.

PubMed

Pourmomeny, Abbas Ali; Zadmehr, Hassan; Hossaini, Mohsen

2011-10-01

Evaluating the function of facial nerve is essential in order to determine the influences of various treatment methods. The aim of this study was to evaluate and assess the agreement of Photoshop scaling system versus the facial grading system (FGS). In this semi-experimental study, thirty subjects with facial nerve paralysis were recruited. The evaluation of all patients before and after the treatment was performed by FGS and Photoshop measurements. The mean values of FGS before and after the treatment were 35 ± 25 and 67 ± 24, respectively (p < 0.001). In Photoshop assessment, mean changes of face expressions in the impaired side relative to the normal side in rest position and three main movements of the face were 3.4 ± 0.55 and 4.04 ± 0.49 millimeter before and after the treatment, respectively (p < 0.001). Spearman's correlation coefficient between different values in the two methods was 0.66 (p < 0.001). Evaluating the facial nerve palsy using Photoshop was more objective than using FGS. Therefore, it may be recommended to use this method instead.

Electrical stimulation treatment for facial palsy after revision pleomorphic adenoma surgery.

PubMed

Goldie, Simon; Sandeman, Jack; Cole, Richard; Dennis, Simon; Swain, Ian

2016-04-22

Surgery for pleomorphic adenoma recurrence presents a significant risk of facial nerve damage that can result in facial weakness effecting patients' ability to communicate, mental health and self-image. We report two case studies that had marked facial weakness after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation. Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Neither subjects demonstrated adverse effects of treatment. We conclude that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. Larger studies would be difficult to pursue due to the low incidence of cases. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

Retrospective case series of the imaging findings of facial nerve hemangioma.

PubMed

Yue, Yunlong; Jin, Yanfang; Yang, Bentao; Yuan, Hui; Li, Jiandong; Wang, Zhenchang

2015-09-01

The aim was to compare high-resolution computed tomography (HRCT) and thin-section magnetic resonance imaging (MRI) findings of facial nerve hemangioma. The HRCT and MRI characteristics of 17 facial nerve hemangiomas diagnosed between 2006 and 2013 were retrospectively analyzed. All patients included in the study suffered from a space-occupying lesion of soft tissues at the geniculate ganglion fossa. Affected nerve was compared for size and shape with the contralateral unaffected nerve. HRCT showed irregular expansion and broadening of the facial nerve canal, damage of the bone wall and destruction of adjacent bone, with "point"-like or "needle"-like calcifications in 14 cases. The average CT value was 320.9 ± 141.8 Hu. Fourteen patients had a widened labyrinthine segment; 6/17 had a tympanic segment widening; 2/17 had a greater superficial petrosal nerve canal involvement, and 2/17 had an affected internal auditory canal (IAC) segment. On MRI, all lesions were significantly enhanced due to high blood supply. Using 2D FSE T2WI, the lesion detection rate was 82.4 % (14/17). 3D fast imaging employing steady-state acquisition (3D FIESTA) revealed the lesions in all patients. HRCT showed that the average number of involved segments in the facial nerve canal was 2.41, while MRI revealed an average of 2.70 segments (P < 0.05). HRCT and MR findings of facial nerve hemangioma were typical, revealing irregular masses growing along the facial nerve canal, with calcifications and rich blood supply. Thin-section enhanced MRI was more accurate in lesion detection and assessment compared with HRCT.

Automatic segmentation of the facial nerve and chorda tympani using image registration and statistical priors

NASA Astrophysics Data System (ADS)

Noble, Jack H.; Warren, Frank M.; Labadie, Robert F.; Dawant, Benoit M.

2008-03-01

In cochlear implant surgery, an electrode array is permanently implanted in the cochlea to stimulate the auditory nerve and allow deaf people to hear. A minimally invasive surgical technique has recently been proposed--percutaneous cochlear access--in which a single hole is drilled from the skull surface to the cochlea. For the method to be feasible, a safe and effective drilling trajectory must be determined using a pre-operative CT. Segmentation of the structures of the ear would improve trajectory planning safety and efficiency and enable the possibility of automated planning. Two important structures of the ear, the facial nerve and chorda tympani, present difficulties in intensity based segmentation due to their diameter (as small as 1.0 and 0.4 mm) and adjacent inter-patient variable structures of similar intensity in CT imagery. A multipart, model-based segmentation algorithm is presented in this paper that accomplishes automatic segmentation of the facial nerve and chorda tympani. Segmentation results are presented for 14 test ears and are compared to manually segmented surfaces. The results show that mean error in structure wall localization is 0.2 and 0.3 mm for the facial nerve and chorda, proving the method we propose is robust and accurate.

Cutaneous electrical stimulation treatment in unresolved facial nerve paralysis: an exploratory study.

PubMed

Hyvärinen, Antti; Tarkka, Ina M; Mervaala, Esa; Pääkkönen, Ari; Valtonen, Hannu; Nuutinen, Juhani

2008-12-01

The purpose of this study was to assess clinical and neurophysiological changes after 6 mos of transcutaneous electrical stimulation in patients with unresolved facial nerve paralysis. A pilot case series of 10 consecutive patients with chronic facial nerve paralysis either of idiopathic origin or because of herpes zoster oticus participated in this open study. All patients received below sensory threshold transcutaneous electrical stimulation for 6 mos for their facial nerve paralysis. The intervention consisted of gradually increasing the duration of electrical stimulation of three sites on the affected area for up to 6 hrs/day. Assessments of the facial nerve function were performed using the House-Brackmann clinical scale and neurophysiological measurements of compound motor action potential distal latencies on the affected and nonaffected sides. Patients were tested before and after the intervention. A significant improvement was observed in the facial nerve upper branch compound motor action potential distal latency on the affected side in all patients. An improvement of one grade in House-Brackmann scale was observed and some patients also reported subjective improvement. Transcutaneous electrical stimulation treatment may have a positive effect on unresolved facial nerve paralysis. This study illustrates a possibly effective treatment option for patients with the chronic facial paresis with no other expectations of recovery.

Mime therapy improves facial symmetry in people with long-term facial nerve paresis: a randomised controlled trial.

PubMed

Beurskens, Carien H G; Heymans, Peter G

2006-01-01

What is the effect of mime therapy on facial symmetry and severity of paresis in people with facial nerve paresis? Randomised controlled trial. 50 people recruited from the Outpatient department of two metropolitan hospitals with facial nerve paresis for more than nine months. The experimental group received three months of mime therapy consisting of massage, relaxation, inhibition of synkinesis, and co-ordination and emotional expression exercises. The control group was placed on a waiting list. Assessments were made on admission to the trial and three months later by a measurer blinded to group allocation. Facial symmetry was measured using the Sunnybrook Facial Grading System. Severity of paresis was measured using the House-Brackmann Facial Grading System. After three months of mime therapy, the experimental group had improved their facial symmetry by 20.4 points (95% CI 10.4 to 30.4) on the Sunnybrook Facial Grading System compared with the control group. In addition, the experimental group had reduced the severity of their paresis by 0.6 grade (95% CI 0.1 to 1.1) on the House-Brackmann Facial Grading System compared with the control group. These effects were independent of age, sex, and duration of paresis. Mime therapy improves facial symmetry and reduces the severity of paresis in people with facial nerve paresis.

Measurement of facial movements with Photoshop software during treatment of facial nerve palsy*

PubMed Central

Pourmomeny, Abbas Ali; Zadmehr, Hassan; Hossaini, Mohsen

2011-01-01

BACKGROUND: Evaluating the function of facial nerve is essential in order to determine the influences of various treatment methods. The aim of this study was to evaluate and assess the agreement of Photoshop scaling system versus the facial grading system (FGS). METHODS: In this semi-experimental study, thirty subjects with facial nerve paralysis were recruited. The evaluation of all patients before and after the treatment was performed by FGS and Photoshop measurements. RESULTS: The mean values of FGS before and after the treatment were 35 ± 25 and 67 ± 24, respectively (p < 0.001). In Photoshop assessment, mean changes of face expressions in the impaired side relative to the normal side in rest position and three main movements of the face were 3.4 ± 0.55 and 4.04 ± 0.49 millimeter before and after the treatment, respectively (p < 0.001). Spearman's correlation coefficient between different values in the two methods was 0.66 (p < 0.001). CONCLUSIONS: Evaluating the facial nerve palsy using Photoshop was more objective than using FGS. Therefore, it may be recommended to use this method instead. PMID:22973325

Evidence Suggesting that the Buccal and Zygomatic Branches of the Facial Nerve May Contain Parasympathetic Secretomotor Fibers to the Parotid Gland by Means of Communications from the Auriculotemporal Nerve.

PubMed

Tansatit, Tanvaa; Apinuntrum, Prawit; Phetudom, Thavorn

2015-12-01

The auriculotemporal nerve is one of the peripheral nerves that communicates with the facial nerve. However, the function of these communications is poorly understood. Details of how these communications form and connect with each other are still unclear. In addition, a reliable anatomical landmark for locating these communications during surgery has not been sufficiently described. Microdissection was performed on 20 lateral hemifaces of 10 soft-embalmed cadavers to investigate facial-auriculotemporal nerve communications with emphasis on determining their function. The auriculotemporal nerve was identified in the retromandibular space and traced towards its terminations. The communicating branches were followed and the anatomical relationships to surrounding structures observed. The auriculotemporal nerve is suspended above the maxillary artery in the dense retromandibular fascia behind the mandibular ramus. It forms a knot and fans out, providing multiple branches in all directions in the sagittal plane. Inferiorly, it connects the maxillary periarterial plexus, while minute branches supply the temporomandibular joint anteriorly. The larger branches mainly communicate with the branches of the temporofacial division of the facial nerve, and the auricular branches enter the fascia of the auricular cartilage posteriorly. The temporal branches and occasionally the zygomatic branches arise superiorly to distribute within the temporoparietal fascia. The auriculotemporal nerve forms the parotid retromandibular plexus through two types of communication. It sends one to three branches to join the zygomatic and buccal branches of the facial nerve at the branching area of the temporofacial division. It also communicates with the periarterial plexus of the superficial temporal and maxillary arteries. This plexus continues anteriorly along the branches of the facial nerve and the periarterial plexus of the transverse facial artery as the parotid periductal autonomic plexus

[Dynamics of lagophthalmos depending on facial nerve repair and its intraoperative monitoring in neurosurgical patients].

PubMed

Tabachnikova, T V; Serova, N K; Shimansky, V N

2014-01-01

Over 200 patients with acoustic neuromas and over 100 patients with posterior cranial fossa meningiomas are annually operated on at the N.N. Burdenko Neurosurgical Institute. Intraoperative monitoring of the facial nerve function is used in most patients with tumors of the posterior cranial fossa to identify the facial nerve in the surgical wound. If the anatomical integrity of the facial nerve in the cranial cavity cannot be retained, facial nerve repair is performed to restore the facial muscle function. Intraoperative electrical stimulation of the facial nerve has a great prognostic significance to evaluate the dynamics of lagophthalmos in the late postoperative period and to select the proper method for lagophthalmos correction. When the facial nerve was reinnervated by the descending branch or trunk of the hypoglossal nerve, sufficient eyelid closure was observed only in 3 patients out of 17.

The masseteric nerve: a versatile power source in facial animation techniques.

PubMed

Bianchi, B; Ferri, A; Ferrari, S; Copelli, C; Salvagni, L; Sesenna, E

2014-03-01

The masseteric nerve has many advantages including low morbidity, its proximity to the facial nerve, the strong motor impulse, its reliability, and the fast reinnervation that is achievable in most patients. Reinnervation of a neuromuscular transplant is the main indication for its use, but it has been used for the treatment of recent facial palsies with satisfactory results. We have retrospectively evaluated 60 patients who had facial animation procedures using the masseteric nerve during the last 10 years. The patients included those with recent, and established or congenital, unilateral and bilateral palsies. The masseteric nerve was used for coaptation of the facial nerve either alone or in association with crossfacial nerve grafting, or for the reinnervation of gracilis neuromuscular transplants. Reinnervation was successful in all cases, the mean (range) time being 4 (2-5) months for facial nerve coaptation and 4 (3-7) months for neuromuscular transplants. Cosmesis was evaluated (moderate, n=10, good, n=30, and excellent, n=20) as was functional outcome (no case of impairment of masticatory function, all patients able to smile, and achievement of a smile independent from biting). The masseteric nerve has many uses, including in both recent, and established or congenital, cases. In some conditions it is the first line of treatment. The combination of combined techniques gives excellent results in unilateral palsies and should therefore be considered a valid option. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Deep Temporal Nerve Transfer for Facial Reanimation: Anatomic Dissections and Surgical Case Report.

PubMed

Mahan, Mark A; Sivakumar, Walavan; Weingarten, David; Brown, Justin M

2017-09-08

Facial nerve palsy is a disabling condition that may arise from a variety of injuries or insults and may occur at any point along the nerve or its intracerebral origin. To examine the use of the deep temporal branches of the motor division of the trigeminal nerve for neural reconstruction of the temporal branches of the facial nerve for restoration of active blink and periorbital facial expression. Formalin-fixed human cadaver hemifaces were dissected to identify landmarks for the deep temporal branches and the tension-free coaptation lengths. This technique was then utilized in 1 patient with a history of facial palsy due to a brainstem cavernoma. Sixteen hemifaces were dissected. The middle deep temporal nerve could be consistently identified on the deep side of the temporalis, within 9 to 12 mm posterior to the jugal point of the zygoma. From a lateral approach through the temporalis, the middle deep temporal nerve could be directly coapted to facial temporal branches in all specimens. Our patient has recovered active and independent upper facial muscle contraction, providing the first case report of a distinct distal nerve transfer for upper facial function. The middle deep temporal branches can be readily identified and utilized for facial reanimation. This technique provided a successful reanimation of upper facial muscles with independent activation. Utilizing multiple sources for neurotization of the facial muscles, different potions of the face can be selectively reanimated to reduce the risk of synkinesis and improved control. Copyright © 2017 by the Congress of Neurological Surgeons

A Neuromonitoring Approach to Facial Nerve Preservation During Image-guided Robotic Cochlear Implantation.

PubMed

Ansó, Juan; Dür, Cilgia; Gavaghan, Kate; Rohrbach, Helene; Gerber, Nicolas; Williamson, Tom; Calvo, Enric M; Balmer, Thomas Wyss; Precht, Christina; Ferrario, Damien; Dettmer, Matthias S; Rösler, Kai M; Caversaccio, Marco D; Bell, Brett; Weber, Stefan

2016-01-01

A multielectrode probe in combination with an optimized stimulation protocol could provide sufficient sensitivity and specificity to act as an effective safety mechanism for preservation of the facial nerve in case of an unsafe drill distance during image-guided cochlear implantation. A minimally invasive cochlear implantation is enabled by image-guided and robotic-assisted drilling of an access tunnel to the middle ear cavity. The approach requires the drill to pass at distances below 1  mm from the facial nerve and thus safety mechanisms for protecting this critical structure are required. Neuromonitoring is currently used to determine facial nerve proximity in mastoidectomy but lacks sensitivity and specificity necessaries to effectively distinguish the close distance ranges experienced in the minimally invasive approach, possibly because of current shunting of uninsulated stimulating drilling tools in the drill tunnel and because of nonoptimized stimulation parameters. To this end, we propose an advanced neuromonitoring approach using varying levels of stimulation parameters together with an integrated bipolar and monopolar stimulating probe. An in vivo study (sheep model) was conducted in which measurements at specifically planned and navigated lateral distances from the facial nerve were performed to determine if specific sets of stimulation parameters in combination with the proposed neuromonitoring system could reliably detect an imminent collision with the facial nerve. For the accurate positioning of the neuromonitoring probe, a dedicated robotic system for image-guided cochlear implantation was used and drilling accuracy was corrected on postoperative microcomputed tomographic images. From 29 trajectories analyzed in five different subjects, a correlation between stimulus threshold and drill-to-facial nerve distance was found in trajectories colliding with the facial nerve (distance <0.1  mm). The shortest pulse duration that provided the highest

[The history of facial paralysis].

PubMed

Glicenstein, J

2015-10-01

Facial paralysis has been a recognized condition since Antiquity, and was mentionned by Hippocratus. In the 17th century, in 1687, the Dutch physician Stalpart Van der Wiel rendered a detailed observation. It was, however, Charles Bell who, in 1821, provided the description that specified the role of the facial nerve. Facial nerve surgery began at the end of the 19th century. Three different techniques were used successively: nerve anastomosis, (XI-VII Balance 1895, XII-VII, Korte 1903), myoplasties (Lexer 1908), and suspensions (Stein 1913). Bunnell successfully accomplished the first direct facial nerve repair in the temporal bone, in 1927, and in 1932 Balance and Duel experimented with nerve grafts. Thanks to progress in microsurgical techniques, the first faciofacial anastomosis was realized in 1970 (Smith, Scaramella), and an account of the first microneurovascular muscle transfer published in 1976 by Harii. Treatment of the eyelid paralysis was at the origin of numerous operations beginning in the 1960s; including palpebral spring (Morel Fatio 1962) silicone sling (Arion 1972), upperlid loading with gold plate (Illig 1968), magnets (Muhlbauer 1973) and transfacial nerve grafts (Anderl 1973). By the end of the 20th century, surgeons had at their disposal a wide range of valid techniques for facial nerve surgery, including modernized versions of older techniques. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Neurophysiological mechanism of possibly confounding peripheral activation of the facial nerve during corticobulbar tract monitoring.

PubMed

Téllez, Maria J; Ulkatan, Sedat; Urriza, Javier; Arranz-Arranz, Beatriz; Deletis, Vedran

2016-02-01

To improve the recognition and possibly prevent confounding peripheral activation of the facial nerve caused by leaking transcranial electrical stimulation (TES) current during corticobulbar tract monitoring. We applied a single stimulus and a short train of electrical stimuli directly to the extracranial portion of the facial nerve. We compared the peripherally elicited compound muscle action potential (CMAP) of the facial nerve with the responses elicited by TES during intraoperative monitoring of the corticobulbar tract. A single stimulus applied directly to the facial nerve at subthreshold intensities did not evoke a CMAP, whereas short trains of subthreshold stimuli repeatedly evoked CMAPs. This is due to the phenomenon of sub- or near-threshold super excitability of the cranial nerve. Therefore, the facial responses evoked by short trains TES, when the leaked current reaches the facial nerve at sub- or near-threshold intensity, could lead to false interpretation. Our results revealed a potential pitfall in the current methodology for facial corticobulbar tract monitoring that is due to the activation of the facial nerve by subthreshold trains of stimuli. This study proposes a new criterion to exclude peripheral activation during corticobulbar tract monitoring. The failure to recognize and avoid facial nerve activation due to leaking current in the peripheral portion of the facial nerve during TES decreases the reliability of corticobulbar tract monitoring by increasing the possibility of false interpretation. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Bell's palsy and partial hypoglossal to facial nerve transfer: Case presentation and literature review

PubMed Central

Socolovsky, Mariano; Páez, Miguel Domínguez; Masi, Gilda Di; Molina, Gonzalo; Fernández, Eduardo

2012-01-01

Background: Idiopathic facial nerve palsy (Bell's palsy) is a very common condition that affects active population. Despite its generally benign course, a minority of patients can remain with permanent and severe sequelae, including facial palsy or dyskinesia. Hypoglossal to facial nerve anastomosis is rarely used to reinnervate the mimic muscle in these patients. In this paper, we present a case where a direct partial hypoglossal to facial nerve transfer was used to reinnervate the upper and lower face. We also discuss the indications of this procedure. Case Description: A 53-year-old woman presenting a spontaneous complete (House and Brackmann grade 6) facial palsy on her left side showed no improvement after 13 months of conservative treatment. Electromyography (EMG) showed complete denervation of the mimic muscles. A direct partial hypoglossal to facial nerve anastomosis was performed, including dissection of the facial nerve at the fallopian canal. One year after the procedure, the patient showed House and Brackmann grade 3 function in her affected face. Conclusions: Partial hypoglossal–facial anastomosis with intratemporal drilling of the facial nerve is a viable technique in the rare cases in which severe Bell's palsy does not recover spontaneously. Only carefully selected patients can really benefit from this technique. PMID:22574255

The new heterologous fibrin sealant in combination with low-level laser therapy (LLLT) in the repair of the buccal branch of the facial nerve.

PubMed

Buchaim, Daniela Vieira; Rodrigues, Antonio de Castro; Buchaim, Rogerio Leone; Barraviera, Benedito; Junior, Rui Seabra Ferreira; Junior, Geraldo Marco Rosa; Bueno, Cleuber Rodrigo de Souza; Roque, Domingos Donizeti; Dias, Daniel Ventura; Dare, Leticia Rossi; Andreo, Jesus Carlos

2016-07-01

This study aimed to evaluate the effects of low-level laser therapy (LLLT) in the repair of the buccal branch of the facial nerve with two surgical techniques: end-to-end epineural suture and coaptation with heterologous fibrin sealant. Forty-two male Wistar rats were randomly divided into five groups: control group (CG) in which the buccal branch of the facial nerve was collected without injury; (2) experimental group with suture (EGS) and experimental group with fibrin (EGF): The buccal branch of the facial nerve was transected on both sides of the face. End-to-end suture was performed on the right side and fibrin sealant on the left side; (3) Experimental group with suture and laser (EGSL) and experimental group with fibrin and laser (EGFL). All animals underwent the same surgical procedures in the EGS and EGF groups, in combination with the application of LLLT (wavelength of 830 nm, 30 mW optical power output of potency, and energy density of 6 J/cm(2)). The animals of the five groups were euthanized at 5 weeks post-surgery and 10 weeks post-surgery. Axonal sprouting was observed in the distal stump of the facial nerve in all experimental groups. The observed morphology was similar to the fibers of the control group, with a predominance of myelinated fibers. In the final period of the experiment, the EGSL presented the closest results to the CG, in all variables measured, except in the axon area. Both surgical techniques analyzed were effective in the treatment of peripheral nerve injuries, where the use of fibrin sealant allowed the manipulation of the nerve stumps without trauma. LLLT exhibited satisfactory results on facial nerve regeneration, being therefore a useful technique to stimulate axonal regeneration process.

Facial nerve hemangiomas: vascular tumors or malformations?

PubMed

Benoit, Margo McKenna; North, Paula E; McKenna, Michael J; Mihm, Martin C; Johnson, Matthew M; Cunningham, Michael J

2010-01-01

To reclassify facial nerve hemangiomas in the context of presently accepted vascular lesion nomenclature by examining histology and immunohistochemical markers. Cohort analysis of patients diagnosed with a facial nerve hemangioma between 1990 and 2008. Collaborative analysis at a specialty hospital and a major academic hospital. Seven subjects were identified on composite review of office charts, a pathology database spanning both institutions, and an encrypted patient registry. Clinical data were compiled, and hematoxylin-eosin-stained specimens were reviewed. For six patients, archived pathological tissue was available for immunohistochemical evaluation of markers specific for infantile hemangioma (glucose transporter protein isoform 1 [GLUT1] and Lewis Y antigen) and for lymphatic endothelial cells (podoplanin). All patients clinically presented with slowly progressive facial weakness at a mean age of 45 years without prior symptomatology. Hemotoxylin-eosin-stained histopathological slides showed irregularly shaped, dilated lesional vessels with flattened endothelial cells, scant smooth muscle, and no internal elastic lamina. Both podoplanin staining for lymphatic endothelial cells and GLUT1 and LewisY antigen staining for infantile hemangioma endothelial cells were negative in lesional vessels in all specimens for which immunohistochemical analysis was performed. Lesions of the geniculate ganglion historically referred to as "hemangiomas" do not demonstrate clinical, histopathological, or immunohistochemical features consistent with a benign vascular tumor, but instead are consistent with venous malformation. We propose that these lesions be classified as "venous vascular malformations of the facial nerve." This nomenclature should more accurately predict clinical behavior and guide therapeutic interventions.

Facial nerve paralysis associated with temporal bone masses.

PubMed

Nishijima, Hironobu; Kondo, Kenji; Kagoya, Ryoji; Iwamura, Hitoshi; Yasuhara, Kazuo; Yamasoba, Tatsuya

2017-10-01

To investigate the clinical and electrophysiological features of facial nerve paralysis (FNP) due to benign temporal bone masses (TBMs) and elucidate its differences as compared with Bell's palsy. FNP assessed by the House-Brackmann (HB) grading system and by electroneurography (ENoG) were compared retrospectively. We reviewed 914 patient records and identified 31 patients with FNP due to benign TBMs. Moderate FNP (HB Grades II-IV) was dominant for facial nerve schwannoma (FNS) (n=15), whereas severe FNP (Grades V and VI) was dominant for cholesteatomas (n=8) and hemangiomas (n=3). The average ENoG value was 19.8% for FNS, 15.6% for cholesteatoma, and 0% for hemangioma. Analysis of the correlation between HB grade and ENoG value for FNP due to TBMs and Bell's palsy revealed that given the same ENoG value, the corresponding HB grade was better for FNS, followed by cholesteatoma, and worst in Bell's palsy. Facial nerve damage caused by benign TBMs could depend on the underlying pathology. Facial movement and ENoG values did not correlate when comparing TBMs and Bell's palsy. When the HB grade is found to be unexpectedly better than the ENoG value, TBMs should be included in the differential diagnosis. Copyright © 2017 Elsevier B.V. All rights reserved.

Clinical significance of quantitative analysis of facial nerve enhancement on MRI in Bell's palsy.

PubMed

Song, Mee Hyun; Kim, Jinna; Jeon, Ju Hyun; Cho, Chang Il; Yoo, Eun Hye; Lee, Won-Sang; Lee, Ho-Ki

2008-11-01

Quantitative analysis of the facial nerve on the lesion side as well as the normal side, which allowed for more accurate measurement of facial nerve enhancement in patients with facial palsy, showed statistically significant correlation with the initial severity of facial nerve inflammation, although little prognostic significance was shown. This study investigated the clinical significance of quantitative measurement of facial nerve enhancement in patients with Bell's palsy by analyzing the enhancement pattern and correlating MRI findings with initial severity of facial palsy and clinical outcome. Facial nerve enhancement was measured quantitatively by using the region of interest on pre- and postcontrast T1-weighted images in 44 patients diagnosed with Bell's palsy. The signal intensity increase on the lesion side was first compared with that of the contralateral side and then correlated with the initial degree of facial palsy and prognosis. The lesion side showed significantly higher signal intensity increase compared with the normal side in all of the segments except for the mastoid segment. Signal intensity increase at the internal auditory canal and labyrinthine segments showed correlation with the initial degree of facial palsy but no significant difference was found between different prognostic groups.

Rat Whisker Movement after Facial Nerve Lesion: Evidence for Autonomic Contraction of Skeletal Muscle

PubMed Central

Heaton, James T.; Sheu, Shu-Hsien; Hohman, Marc H.; Knox, Christopher J.; Weinberg, Julie S.; Kleiss, Ingrid J.; Hadlock, Tessa A.

2014-01-01

Vibrissal whisking is often employed to track facial nerve regeneration in rats; however, we have observed similar degrees of whisking recovery after facial nerve transection with or without repair. We hypothesized that the source of non-facial nerve-mediated whisker movement after chronic denervation was from autonomic, cholinergic axons traveling within the infraorbital branch of the trigeminal nerve (ION). Rats underwent unilateral facial nerve transection with repair (N=7) or resection without repair (N=11). Post-operative whisking amplitude was measured weekly across 10 weeks, and during intraoperative stimulation of the ION and facial nerves at ≥18 weeks. Whisking was also measured after subsequent ION transection (N=6) or pharmacologic blocking of the autonomic ganglia using hexamethonium (N=3), and after snout cooling intended to elicit a vasodilation reflex (N=3). Whisking recovered more quickly and with greater amplitude in rats that underwent facial nerve repair compared to resection (P<0.05), but individual rats overlapped in whisking amplitude across both groups. In the resected rats, non-facial-nerve mediated whisking was elicited by electrical stimulation of the ION, temporarily diminished following hexamethonium injection, abolished by transection of the ION, and rapidly and significantly (P<0.05) increased by snout cooling. Moreover, fibrillation-related whisker movements decreased in all rats during the initial recovery period (indicative of reinnervation), but re-appeared in the resected rats after undergoing ION transection (indicative of motor denervation). Cholinergic, parasympathetic axons traveling within the ION innervate whisker pad vasculature, and immunohistochemistry for vasoactive intestinal peptide revealed these axons branching extensively over whisker pad muscles and contacting neuromuscular junctions after facial nerve resection. This study provides the first behavioral and anatomical evidence of spontaneous autonomic innervation

Rat whisker movement after facial nerve lesion: evidence for autonomic contraction of skeletal muscle.

PubMed

Heaton, James T; Sheu, Shu Hsien; Hohman, Marc H; Knox, Christopher J; Weinberg, Julie S; Kleiss, Ingrid J; Hadlock, Tessa A

2014-04-18

Vibrissal whisking is often employed to track facial nerve regeneration in rats; however, we have observed similar degrees of whisking recovery after facial nerve transection with or without repair. We hypothesized that the source of non-facial nerve-mediated whisker movement after chronic denervation was from autonomic, cholinergic axons traveling within the infraorbital branch of the trigeminal nerve (ION). Rats underwent unilateral facial nerve transection with repair (N=7) or resection without repair (N=11). Post-operative whisking amplitude was measured weekly across 10weeks, and during intraoperative stimulation of the ION and facial nerves at ⩾18weeks. Whisking was also measured after subsequent ION transection (N=6) or pharmacologic blocking of the autonomic ganglia using hexamethonium (N=3), and after snout cooling intended to elicit a vasodilation reflex (N=3). Whisking recovered more quickly and with greater amplitude in rats that underwent facial nerve repair compared to resection (P<0.05), but individual rats overlapped in whisking amplitude across both groups. In the resected rats, non-facial-nerve-mediated whisking was elicited by electrical stimulation of the ION, temporarily diminished following hexamethonium injection, abolished by transection of the ION, and rapidly and significantly (P<0.05) increased by snout cooling. Moreover, fibrillation-related whisker movements decreased in all rats during the initial recovery period (indicative of reinnervation), but re-appeared in the resected rats after undergoing ION transection (indicative of motor denervation). Cholinergic, parasympathetic axons traveling within the ION innervate whisker pad vasculature, and immunohistochemistry for vasoactive intestinal peptide revealed these axons branching extensively over whisker pad muscles and contacting neuromuscular junctions after facial nerve resection. This study provides the first behavioral and anatomical evidence of spontaneous autonomic innervation

Raman spectroscopic detection of peripheral nerves towards nerve-sparing surgery

NASA Astrophysics Data System (ADS)

Minamikawa, Takeo; Harada, Yoshinori; Takamatsu, Tetsuro

2017-02-01

The peripheral nervous system plays an important role in motility, sensory, and autonomic functions of the human body. Preservation of peripheral nerves in surgery, namely nerve-sparing surgery, is now promising technique to avoid functional deficits of the limbs and organs following surgery as an aspect of the improvement of quality of life of patients. Detection of peripheral nerves including myelinated and unmyelinated nerves is required for the nerve-sparing surgery; however, conventional nerve identification scheme is sometimes difficult to identify peripheral nerves due to similarity of shape and color to non-nerve tissues or its limited application to only motor peripheral nerves. To overcome these issues, we proposed a label-free detection technique of peripheral nerves by means of Raman spectroscopy. We found several fingerprints of peripheral myelinated and unmyelinated nerves by employing a modified principal component analysis of typical spectra including myelinated nerve, unmyelinated nerve, and adjacent tissues. We finally realized the sensitivity of 94.2% and the selectivity of 92.0% for peripheral nerves including myelinated and unmyelinated nerves against adjacent tissues. Although further development of an intraoperative Raman spectroscopy system is required for clinical use, our proposed approach will serve as a unique and powerful tool for peripheral nerve detection for nerve-sparing surgery in the future.

A 63-year-old man with peripheral facial nerve paralysis and a pulmonary lesion.

PubMed

Yserbyt, J; Wilms, G; Lievens, Y; Nackaerts, K

2009-01-01

Occasionally, malignant neoplasms may cause peripheral facial nerve paralysis as a presenting symptom. A 63-year-old man was referred to the Emergency Department because of a peripheral facial nerve paralysis, lasting for 10 days. Initial diagnostic examinations revealed no apparent cause for this facial nerve paralysis. Chest X-ray, however, showed a suspicious tumoural mass, located in the right hilar region, as confirmed by CAT scan. The diagnosis of an advanced stage lung adenocarcinoma was finally confirmed by bronchial biopsy. MRI scanning showed diffuse brain metastases and revealed a pontine lesion as the most probable underlying cause of this case of peripheral facial nerve paralysis. Platin-based palliative chemotherapy was given, after an initial pancranial irradiation. According to the MRI findings, the pontine lesion was responsible for the peripheral facial nerve paralysis, as an initial presenting symptom in this case of lung adenocarcinoma. This clinical case of a peripheral facial nerve paralysis was caused by a pontine brain metastasis and illustrates a rather rare presenting symptom of metastatic lung cancer.

Valproic Acid Promotes Survival of Facial Motor Neurons in Adult Rats After Facial Nerve Transection: a Pilot Study.

PubMed

Zhang, Lili; Fan, Zhaomin; Han, Yuechen; Xu, Lei; Liu, Wenwen; Bai, Xiaohui; Zhou, Meijuan; Li, Jianfeng; Wang, Haibo

2018-04-01

Valproic acid (VPA), a medication primarily used to treat epilepsy and bipolar disorder, has been applied to the repair of central and peripheral nervous system injury. The present study investigated the effect of VPA on functional recovery, survival of facial motor neurons (FMNs), and expression of proteins in rats after facial nerve trunk transection by functional measurement, Nissl staining, TUNEL, immunofluorescence, and Western blot. Following facial nerve injury, all rats in group VPA showed a better functional recovery, which was significant at the given time, compared with group NS. The Nissl staining results demonstrated that the number of FMNs survival in group VPA was higher than that in group normal saline (NS). TUNEL staining showed that axonal injury of facial nerve could lead to neuronal apoptosis of FMNs. But treatment of VPA significantly reduced cell apoptosis by decreasing the expression of Bax protein and increased neuronal survival by upregulating the level of brain-derived neurotrophic factor (BDNF) and growth associated protein-43 (GAP-43) expression in injured FMNs compared with group NS. Overall, our findings suggest that VPA may advance functional recovery, reduce lesion-induced apoptosis, and promote neuron survival after facial nerve transection in rats. This study provides an experimental evidence for better understanding the mechanism of injury and repair of peripheral facial paralysis.

High variability of facial muscle innervation by facial nerve branches: A prospective electrostimulation study.

PubMed

Raslan, Ashraf; Volk, Gerd Fabian; Möller, Martin; Stark, Vincent; Eckhardt, Nikolas; Guntinas-Lichius, Orlando

2017-06-01

To examine by intraoperative electric stimulation which peripheral facial nerve (FN) branches are functionally connected to which facial muscle functions. Single-center prospective clinical study. Seven patients whose peripheral FN branching was exposed during parotidectomy under FN monitoring received a systematic electrostimulation of each branch starting with 0.1 mA and stepwise increase to 2 mA with a frequency of 3 Hz. The electrostimulation and the facial and neck movements were video recorded simultaneously and evaluated independently by two investigators. A uniform functional allocation of specific peripheral FN branches to a specific mimic movement was not possible. Stimulation of the whole spectrum of branches of the temporofacial division could lead to eye closure (orbicularis oculi muscle function). Stimulation of the spectrum of nerve branches of the cervicofacial division could lead to reactions in the midface (nasal and zygomatic muscles) as well as around the mouth (orbicularis oris and depressor anguli oris muscle function). Frontal and eye region were exclusively supplied by the temporofacial division. The region of the mouth and the neck was exclusively supplied by the cervicofacial division. Nose and zygomatic region were mainly supplied by the temporofacial division, but some patients had also nerve branches of the cervicofacial division functionally supplying the nasal and zygomatic region. FN branches distal to temporofacial and cervicofacial division are not necessarily covered by common facial nerve monitoring. Future bionic devices will need a patient-specific evaluation to stimulate the correct peripheral nerve branches to trigger distinct muscle functions. 4 Laryngoscope, 127:1288-1295, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Facial reanimation with masseteric nerve: babysitter or permanent procedure? Preliminary results.

PubMed

Faria, Jose Carlos Marques; Scopel, Gean Paulo; Ferreira, Marcus Castro

2010-01-01

The authors are presenting a series of 10 cases of complete unilateral facial paralysis submitted to (I) end-to-end microsurgical coaptation of the masseteric branch of the trigeminal nerve and distal branches of the paralyzed facial nerve, and (II) cross-face sural nerve graft. The ages of the patients ranged from 5 to 63 years (mean: 44.1 years), and 8 (80%) of the patients were females. The duration of paralysis was no longer than 18 months (mean: 9.7 months). Follow-up varied from 6 to 18 months (mean: 12.6 months). Initial voluntary facial movements were observed between 3 and 6 months postoperatively (mean: 4.3 months). All patients were able to produce the appearance of a smile when asked to clench their teeth. Comparing the definition of the nasolabial fold and the degree of movement of the modiolus on both sides of the face, the voluntary smile was considered symmetrical in 8 cases. Recovery of the capacity to blink spontaneously was not observed. However, 8 patients were able to reduce or suspend the application of artificial tears. The authors suggest consideration of masseteric-facial nerve coaptation, whether temporary (baby-sitter) or permanent, as the principal alternative for reconstruction of facial paralysis due to irreversible nerve lesion with less than 18 months of duration.

Clinical features and management of facial nerve paralysis in children: analysis of 24 cases.

PubMed

Cha, H E; Baek, M K; Yoon, J H; Yoon, B K; Kim, M J; Lee, J H

2010-04-01

To evaluate the causes, treatment modalities and recovery rate of paediatric facial nerve paralysis. We analysed 24 cases of paediatric facial nerve paralysis diagnosed in the otolaryngology department of Gachon University Gil Medical Center between January 2001 and June 2006. The most common cause was idiopathic palsy (16 cases, 66.7 per cent). The most common degree of facial nerve paralysis on first presentation was House-Brackmann grade IV (15 of 24 cases). All cases were treated with steroids. One of the 24 cases was also treated surgically with facial nerve decompression. Twenty-two cases (91.6 per cent) recovered to House-Brackmann grade I or II over the six-month follow-up period. Facial nerve paralysis in children can generally be successfully treated with conservative measures. However, in cases associated with trauma, radiological investigation is required for further evaluation and treatment.

Middle Fossa Approach for Vestibular Schwannoma: Good Hearing and Facial Nerve Outcomes with Low Morbidity.

PubMed

Raheja, Amol; Bowers, Christian A; MacDonald, Joel D; Shelton, Clough; Gurgel, Richard K; Brimley, Cameron; Couldwell, William T

2016-08-01

The middle fossa approach (MFA) is not used as frequently as the traditional translabyrinthine and retrosigmoid approaches for accessing vestibular schwannomas (VSs). Here, MFA was used to remove primarily intracanalicular tumors in patients in whom hearing preservation is a goal of surgery. A retrospective chart review was performed to identify consecutive adult patients who underwent MFA for VS. Demographic profile, perioperative complications, pre- and postoperative hearing, and facial nerve outcomes were analyzed with linear regression analysis to identify factors predicting hearing outcome. Among 78 identified patients (mean age, 49 years; 53% female; mean tumor size, 7.5 mm), 78% had functional hearing preoperatively (American Academy of Otolaryngology-Head and Neck Surgery class A/B). Follow-up audiologic data were available for 60 patients overall (mean follow-up, 15.1 months). The hearing preservation rate was 75.5% (37/49) at last known follow-up for patients with functional hearing preoperatively. Other than preoperative hearing status (P < 0.001), none of the factors assessed, including demographic profile, size of tumor, and fundal fluid cap, predicted hearing preservation (P > 0.05). Good functional preservation of the facial nerve (House-Brackmann class I/II) was achieved in 90% of patients. The only operative complications were 3 wound infections (3.8%). Preliminary results from this single-center retrospective study of patients undergoing MFA for resection of VS showed that good hearing preservation and facial nerve outcomes could be achieved with few complications. These results suggest that resection via the MFA is a rational alternative to watchful waiting or stereotactic radiosurgery. Copyright © 2016 Elsevier Inc. All rights reserved.

Isolated marginal facial nerve paresis after TMJ discopexy: a case report.

PubMed

Reychler, H; Mahy, P

2011-01-01

Isolated marginal facial nerve paresis after TMJ discopexy: a case report. This is the first report of a transient, isolated marginal facial nerve paresis after temporomandibular joint arthrotomy. The paresis seems to have resulted from a crush lesion by Backhaus forceps, placed transcutaneously during the operation to distract the intra-articular space.

The split hypoglossal nerve versus the cross-face nerve graft to supply the free functional muscle transfer for facial reanimation: A comparative study.

PubMed

Amer, Tarek A; El Kholy, Mohamed S

2018-05-01

Long-standing cases of facial paralysis are currently treated with free functional muscle transfer. Several nerves are mentioned in the literature to supply the free muscle transfer. The aim of this study is to compare the split hypoglossal nerve and the cross-face nerve graft to supply the free functional muscle transfer in facial reanimation. Of 94 patients with long-standing, unilateral facial palsy, 49 were treated using the latissimus dorsi muscle supplied by the split hypoglossal nerve, and 45 patients were treated using the latissmus dorsi muscle supplied by healthy contralateral buccal branch of the facial nerve. The excursion gained by the free muscle transfer supplied by the split hypoglossal nerve (mean 19.20 ± 6.321) was significantly higher (P value 0.001) than that obtained by the contralateral buccal branch of the facial nerve (mean 14.59 ± 6.245). The split hypoglossal nerve appears to be a good possible option to supply the free vascularised muscle transfer in facial reanimation. It yields a stronger excursion in less time than the contralateral cross-face nerve graft. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Changing perception: facial reanimation surgery improves attractiveness and decreases negative facial perception.

PubMed

Dey, Jacob K; Ishii, Masaru; Boahene, Kofi D O; Byrne, Patrick J; Ishii, Lisa E

2014-01-01

Determine the effect of facial reanimation surgery on observer-graded attractiveness and negative facial perception of patients with facial paralysis. Randomized controlled experiment. Ninety observers viewed images of paralyzed faces, smiling and in repose, before and after reanimation surgery, as well as normal comparison faces. Observers rated the attractiveness of each face and characterized the paralyzed faces by rating severity, disfigured/bothersome, and importance to repair. Iterated factor analysis indicated these highly correlated variables measure a common domain, so they were combined to create the disfigured, important to repair, bothersome, severity (DIBS) factor score. Mixed effects linear regression determined the effect of facial reanimation surgery on attractiveness and DIBS score. Facial paralysis induces an attractiveness penalty of 2.51 on a 10-point scale for faces in repose and 3.38 for smiling faces. Mixed effects linear regression showed that reanimation surgery improved attractiveness for faces both in repose and smiling by 0.84 (95% confidence interval [CI]: 0.67, 1.01) and 1.24 (95% CI: 1.07, 1.42) respectively. Planned hypothesis tests confirmed statistically significant differences in attractiveness ratings between postoperative and normal faces, indicating attractiveness was not completely normalized. Regression analysis also showed that reanimation surgery decreased DIBS by 0.807 (95% CI: 0.704, 0.911) for faces in repose and 0.989 (95% CI: 0.886, 1.093), an entire standard deviation, for smiling faces. Facial reanimation surgery increases attractiveness and decreases negative facial perception of patients with facial paralysis. These data emphasize the need to optimize reanimation surgery to restore not only function, but also symmetry and cosmesis to improve facial perception and patient quality of life. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Non-invasive stimulation of the vibrissal pad improves recovery of whisking function after simultaneous lesion of the facial and infraorbital nerves in rats.

PubMed

Bendella, H; Pavlov, S P; Grosheva, M; Irintchev, A; Angelova, S K; Merkel, D; Sinis, N; Kaidoglou, K; Skouras, E; Dunlop, S A; Angelov, Doychin N

2011-07-01

We have recently shown that manual stimulation of target muscles promotes functional recovery after transection and surgical repair to pure motor nerves (facial: whisking and blink reflex; hypoglossal: tongue position). However, following facial nerve repair, manual stimulation is detrimental if sensory afferent input is eliminated by, e.g., infraorbital nerve extirpation. To further understand the interplay between sensory input and motor recovery, we performed simultaneous cut-and-suture lesions on both the facial and the infraorbital nerves and examined whether stimulation of the sensory afferents from the vibrissae by a forced use would improve motor recovery. The efficacy of 3 treatment paradigms was assessed: removal of the contralateral vibrissae to ensure a maximal use of the ipsilateral ones (vibrissal stimulation; Group 2), manual stimulation of the ipsilateral vibrissal muscles (Group 3), and vibrissal stimulation followed by manual stimulation (Group 4). Data were compared to controls which underwent surgery but did not receive any treatment (Group 1). Four months after surgery, all three treatments significantly improved the amplitude of vibrissal whisking to 30° versus 11° in the controls of Group 1. The three treatments also reduced the degree of polyneuronal innervation of target muscle fibers to 37% versus 58% in Group 1. These findings indicate that forced vibrissal use and manual stimulation, either alone or sequentially, reduce target muscle polyinnervation and improve recovery of whisking function when both the sensory and the motor components of the trigemino-facial system regenerate.

[Motor nerves of the face. Surgical and radiologic anatomy of facial paralysis and their surgical repair].

PubMed

Vacher, C; Cyna-Gorse, F

2015-10-01

Motor innervation of the face depends on the facial nerve for the mobility of the face, on the mandibular nerve, third branch of the trigeminal nerve, which gives the motor innervation of the masticator muscles, and the hypoglossal nerve for the tongue. In case of facial paralysis, the most common palliative surgical techniques are the lengthening temporalis myoplasty (the temporal is innervated by the mandibular nerve) and the hypoglossal-facial anastomosis. The aim of this work is to describe the surgical anatomy of these three nerves and the radiologic anatomy of the facial nerve inside the temporal bone. Then the facial nerve penetrates inside the parotid gland giving a plexus. Four branches of the facial nerve leave the parotid gland: they are called temporal, zygomatic, buccal and marginal which give innervation to the cutaneous muscles of the face. Mandibular nerve gives three branches to the temporal muscles: the anterior, intermediate and posterior deep temporal nerves which penetrate inside the deep aspect of the temporal muscle in front of the infratemporal line. The hypoglossal nerve is only the motor nerve to the tongue. The ansa cervicalis, which is coming from the superficial cervical plexus and joins the hypoglossal nerve in the submandibular area is giving the motor innervation to subhyoid muscles and to the geniohyoid muscle. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Comparison of hemihypoglossal-facial nerve transposition with a cross-facial nerve graft and muscle transplant for the rehabilitation of facial paralysis using the facial clima method.

PubMed

Hontanilla, Bernardo; Vila, Antonio

2012-02-01

To compare quantitatively the results obtained after hemihypoglossal nerve transposition and microvascular gracilis transfer associated with a cross facial nerve graft (CFNG) for reanimation of a paralysed face, 66 patients underwent hemihypoglossal transposition (n = 25) or microvascular gracilis transfer and CFNG (n = 41). The commissural displacement (CD) and commissural contraction velocity (CCV) in the two groups were compared using the system known as Facial clima. There was no inter-group variability between the groups (p > 0.10) in either variable. However, intra-group variability was detected between the affected and healthy side in the transposition group (p = 0.036 and p = 0.017, respectively). The transfer group had greater symmetry in displacement of the commissure (CD) and commissural contraction velocity (CCV) than the transposition group and patients were more satisfied. However, the transposition group had correct symmetry at rest but more asymmetry of CCV and CD when smiling.

Hypoglossal-facial nerve anastomosis and rehabilitation in patients with complete facial palsy: cohort study of 30 patients followed up for three years

PubMed Central

Toffola, Elena Dalla; Pavese, Chiara; Cecini, Miriam; Petrucci, Lucia; Ricotti, Susanna; Bejor, Maurizio; Salimbeni, Grazia; Biglioli, Federico; Klersy, Catherine

2014-01-01

Summary Our study evaluates the grade and timing of recovery in 30 patients with complete facial paralysis (House-Brackmann grade VI) treated with hypoglossal-facial nerve (XII-VII) anastomosis and a long-term rehabilitation program, consisting of exercises in facial muscle activation mediated by tongue movement and synkinesis control with mirror feedback. Reinnervation after XII-VII anastomosis occurred in 29 patients, on average 5.4 months after surgery. Three years after the anastomosis, 23.3% of patients had grade II, 53.3% grade III, 20% grade IV and 3.3% grade VI ratings on the House-Brackmann scale. Time to reinnervation was associated with the final House-Brackmann grade. Our study demonstrates that patients undergoing XII-VII anastomosis and a long-term rehabilitation program display a significant recovery of facial symmetry and movement. The recovery continues for at least three years after the anastomosis, meaning that prolonged follow-up of these patients is advisable. PMID:25473738

Enhancement pattern of the normal facial nerve at 3.0 T temporal MRI.

PubMed

Hong, H S; Yi, B-H; Cha, J-G; Park, S-J; Kim, D H; Lee, H K; Lee, J-D

2010-02-01

The purpose of this study was to evaluate the enhancement pattern of the normal facial nerve at 3.0 T temporal MRI. We reviewed the medical records of 20 patients and evaluated 40 clinically normal facial nerves demonstrated by 3.0 T temporal MRI. The grade of enhancement of the facial nerve was visually scaled from 0 to 3. The patients comprised 11 men and 9 women, and the mean age was 39.7 years. The reasons for the MRI were sudden hearing loss (11 patients), Méniàre's disease (6) and tinnitus (7). Temporal MR scans were obtained by fluid-attenuated inversion-recovery (FLAIR) and diffusion-weighted imaging of the brain; three-dimensional (3D) fast imaging employing steady-state acquisition (FIESTA) images of the temporal bone with a 0.77 mm thickness, and pre-contrast and contrast-enhanced 3D spoiled gradient record acquisition in the steady state (SPGR) of the temporal bone with a 1 mm thickness, were obtained with 3.0 T MR scanning. 40 nerves (100%) were visibly enhanced along at least one segment of the facial nerve. The enhanced segments included the geniculate ganglion (77.5%), tympanic segment (37.5%) and mastoid segment (100%). Even the facial nerve in the internal auditory canal (15%) and labyrinthine segments (5%) showed mild enhancement. The use of high-resolution, high signal-to-noise ratio (with 3 T MRI), thin-section contrast-enhanced 3D SPGR sequences showed enhancement of the normal facial nerve along the whole course of the nerve; however, only mild enhancement was observed in areas associated with acute neuritis, namely the canalicular and labyrinthine segment.

Facial nerve palsy: analysis of cases reported in children in a suburban hospital in Nigeria.

PubMed

Folayan, M O; Arobieke, R I; Eziyi, E; Oyetola, E O; Elusiyan, J

2014-01-01

The study describes the epidemiology, treatment, and treatment outcomes of the 10 cases of facial nerve palsy seen in children managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a 10 year period. It also compares findings with report from developed countries. This was a retrospective cohort review of pediatric cases of facial nerve palsy encountered in all the clinics run by specialists in the above named hospital. A diagnosis of facial palsy was based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Information retrieved from the case note included sex, age, number of days with lesion prior to presentation in the clinic, diagnosis, treatment, treatment outcome, and referral clinic. Only 10 cases of facial nerve palsy were diagnosed in the institution during the study period. Prevalence of facial nerve palsy in this hospital was 0.01%. The lesion more commonly affected males and the right side of the face. All cases were associated with infections: Mainly mumps (70% of cases). Case management include the use of steroids and eye pads for cases that presented within 7 days; and steroids, eye pad, and physical therapy for cases that presented later. All cases of facial nerve palsy associated with mumps and malaria infection fully recovered. The two cases of facial nerve palsy associated with otitis media only partially recovered. Facial nerve palsy in pediatric patients is more commonly associated with mumps in the study environment. Successes are recorded with steroid therapy.

Sectional anatomy aid for improvement of decompression surgery approach to vertical segment of facial nerve.

PubMed

Feng, Yan; Zhang, Yi Qun; Liu, Min; Jin, Limin; Huangfu, Mingmei; Liu, Zhenyu; Hua, Peiyan; Liu, Yulong; Hou, Ruida; Sun, Yu; Li, You Qiong; Wang, Yu Fa; Feng, Jia Chun

2012-05-01

The aim of this study was to find a surgical approach to a vertical segment of the facial nerve (VFN) with a relatively wide visual field and small lesion by studying the location and structure of VFN with cross-sectional anatomy. High-resolution spiral computed tomographic multiplane reformation was used to reform images that were parallel to the Frankfort horizontal plane. To locate the VFN, we measured the distances as follows: from the VFN to the paries posterior bony external acoustic meatus on 5 typical multiplane reformation images, to the promontorium tympani and the root of the tympanic ring on 2 typical images. The mean distances from the VFN to the paries posterior bony external acoustic meatus are as follows: 4.47 mm on images showing the top of the external acoustic meatus, 4.20 mm on images with the best view of the window niche, 3.35 mm on images that show the widest external acoustic meatus, 4.22 mm on images with the inferior margin of the sulcus tympanicus, and 5.49 mm on images that show the bottom of the external acoustic meatus. The VFN is approximately 4.20 mm lateral to the promontorium tympani on images with the best view of the window niche and 4.12 mm lateral to the root of the tympanic ring on images with the inferior margin of the sulcus tympanicus. The other results indicate that the area and depth of the surgical wound from the improved approach would be much smaller than that from the typical approach. The surgical approach to the horizontal segment of the facial nerve through the external acoustic meatus and the tympanic cavity could be improved by grinding off the external acoustic meatus to show the VFN. The VFN can be found by taking the promontorium tympani and tympanic ring as references. This improvement is of high potential to expand the visual field to the facial nerve, remarkably without significant injury to the patients compared with the typical approach through the mastoid process.

Diagnostic relevance of transcranial magnetic and electric stimulation of the facial nerve in the management of facial palsy.

PubMed

Nowak, Dennis A; Linder, Stefan; Topka, Helge

2005-09-01

Earlier investigations have suggested that isolated conduction block of the facial nerve to transcranial magnetic stimulation early in the disorder represents a very sensitive and potentially specific finding in Bell's palsy differentiating the disease from other etiologies. Stimulation of the facial nerve was performed electrically at the stylomastoid foramen and magnetically at the labyrinthine segment of the Fallopian channel within 3 days from symptom onset in 65 patients with Bell's palsy, five patients with Zoster oticus, one patient with neuroborreliosis and one patient with nuclear facial nerve palsy due to multiple sclerosis. Absence or decreased amplitudes of muscle responses to early transcranial magnetic stimulation was not specific for Bell's palsy, but also evident in all cases of Zoster oticus and in the case of neuroborreliosis. Amplitudes of electrically evoked muscle responses were more markedly reduced in Zoster oticus as compared to Bell's palsy, most likely due to a more severe degree of axonal degeneration. The degree of amplitude reduction of the muscle response to electrical stimulation reliably correlated with the severity of facial palsy. Transcranial magnetic stimulation in the early diagnosis of Bell's palsy is less specific than previously thought. While not specific with respect to the etiology of facial palsy, transcranial magnetic stimulation seems capable of localizing the site of lesion within the Fallopian channel. Combined with transcranial magnetic stimulation, early electrical stimulation of the facial nerve at the stylomastoid foramen may help to establish correct diagnosis and prognosis.

[Facial nerve injuries cause changes in central nervous system microglial cells].

PubMed

Cerón, Jeimmy; Troncoso, Julieta

2016-12-01

Our research group has described both morphological and electrophysiological changes in motor cortex pyramidal neurons associated with contralateral facial nerve injury in rats. However, little is known about those neural changes, which occur together with changes in surrounding glial cells. To characterize the effect of the unilateral facial nerve injury on microglial proliferation and activation in the primary motor cortex. We performed immunohistochemical experiments in order to detect microglial cells in brain tissue of rats with unilateral facial nerve lesion sacrificed at different times after the injury. We caused two types of lesions: reversible (by crushing, which allows functional recovery), and irreversible (by section, which produces permanent paralysis). We compared the brain tissues of control animals (without surgical intervention) and sham-operated animals with animals with lesions sacrificed at 1, 3, 7, 21 or 35 days after the injury. In primary motor cortex, the microglial cells of irreversibly injured animals showed proliferation and activation between three and seven days post-lesion. The proliferation of microglial cells in reversibly injured animals was significant only three days after the lesion. Facial nerve injury causes changes in microglial cells in the primary motor cortex. These modifications could be involved in the generation of morphological and electrophysiological changes previously described in the pyramidal neurons of primary motor cortex that command facial movements.

Effects of local application of methylprednisolone delivered by the C/GP-hydrogel on the recovery of facial nerves.

PubMed

Chao, Xiuhua; Fan, Zhaomin; Han, Yuechen; Wang, Yan; Li, Jianfeng; Chai, Renjie; Xu, Lei; Wang, Haibo

2015-01-01

Local administration of MP delivered by the C/GP-MP-hydrogel can improve the recovery of facial nerve following crush injury. The findings suggested that locally injected MP delivered by C/GP-hydrogel might be a promising treatment for facial nerve damage. In this study, the aim is to assess the effectiveness of locally administrating methylprednisolone(MP) loaded by chitosan-β-glycerophosphate hydrogel (C/GP-hydrogel) on the regeneration of facial nerve crush injury. After the crush of left facial nerves, Wistar rats were randomly divided into four different groups. Then, four different therapies were used to treat the damaged facial nerves. At the 1(st), 2(nd), 3(rd), and 4(th) week after injury, the functional recovery of facial nerves and the morphological changes of facial nerves were assessed. The expression of growth associated protein-43 (GAP-43) protein in the facial nucleus were also evaluated. Locally injected MP delivered by C/GP-hydrogel effectively accelerated the facial functional recovery. In addition, the regenerated facial nerves in the C/GP-MP group were more mature than those in the other groups. The expression of GAP-43 protein was also improved by the MP, especially in the C/GP-MP group.

Overview of Facial Plastic Surgery and Current Developments

PubMed Central

Chuang, Jessica; Barnes, Christian; Wong, Brian J. F.

2016-01-01

Facial plastic surgery is a multidisciplinary specialty largely driven by otolaryngology but includes oral maxillary surgery, dermatology, ophthalmology, and plastic surgery. It encompasses both reconstructive and cosmetic components. The scope of practice for facial plastic surgeons in the United States may include rhinoplasty, browlifts, blepharoplasty, facelifts, microvascular reconstruction of the head and neck, craniomaxillofacial trauma reconstruction, and correction of defects in the face after skin cancer resection. Facial plastic surgery also encompasses the use of injectable fillers, neural modulators (e.g., BOTOX Cosmetic, Allergan Pharmaceuticals, Westport, Ireland), lasers, and other devices aimed at rejuvenating skin. Facial plastic surgery is a constantly evolving field with continuing innovative advances in surgical techniques and cosmetic adjunctive technologies. This article aims to give an overview of the various procedures that encompass the field of facial plastic surgery and to highlight the recent advances and trends in procedures and surgical techniques. PMID:28824978

[Correlation between facial nerve functional evaluation and efficacy evaluation of acupuncture treatment for Bell's palsy].

PubMed

Zhou, Zhang-ling; Li, Cheng-xin; Jiang, Yue-bo; Zuo, Cong; Cai, Yun; Wang, Rui

2012-09-01

To assess and grade facial nerve dysfunction according to the extent of facial paralysis in the clinical course of acupuncture treatment for Bell's palsy, and to observe the interrelationship between the grade, the efficacy and the period of treatment, as well as the effect on prognosis. The authors employed the House-Brackmann scale, a commonly used evaluation scale for facial paralysis motor function, and set standards for eye fissure and lips. According to the improved scale, the authors assessed and graded the degree of facial paralysis in terms of facial nerve dysfunction both before and after treatment. The grade was divided into five levels: mild, moderate, moderately severe, severe dysfunction and complete paralysis. The authors gave acupuncture treatment according to the state of the disease without artificially setting the treatment period. The observation was focused on the efficacy and the efficacy was evaluated throughout the entire treatment process. Fifty-three cases out of 68 patients with Bell's palsy were cured and the overall rate of efficacy was 97%. Statistically significant differences (P<0.01) were perceived among the efficacy of five levels of facial nerve dysfunction. Efficacy was correlated with the damage level of the disease (correlation coefficient r=0.423, P<0.01). The course of treatment also extended with the severity of facial nerve dysfunction (P<0.01). Differences exist in patients with Bell's palsy in terms of severity of facial nerve dysfunction. Efficacy is reduced in correlation with an increase in facial nerve dysfunction, and the period of treatment varies in need of different levels of facial nerve dysfunction. It is highly necessary to assess and grade patients before observation and treatment in clinical study, and choose corresponding treatment according to severity of damage of the disease.

[CT study on the development of facial nerve canal in children].

PubMed

Li, J M; Xu, W B; Zhong, J W; Wu, H Y; Dai, W C

2016-10-07

Objective: To assess the characteristics of facial nerve canal between normal anatomy and dysplasia of children in different ages. Methods: A total of 492 health ears were divided into six groups, neonatal group (<1 m , n =42), infancy group(1 m-1 y, n =106), toddler group(1-3 y, n =102), preschool group (3-6 y, n =100), school group(6-10 y, n =60)and adolescent group (10-14 y, n =82). The length and diameter of facial nerve canal and that angles of first and second genu were measured with CT in each group. Results: ①The lengths of facial nerve canal in neonatal and infancy group were shorter than other four groups, especially in the mastoid segments of facial nerve canal. The lengths of mastoid segments in neonatal, infancy, toddler, preschool, school and adolescent groups were 5.03±0.84, 6.25±1.40, 8.34±1.38, 9.70±1.34, 10.84±1.41 and 12.17±1.83 mm, with P <0.05, respectively. After school age, the lengths of labyrinthine and tympanic segment grew slowly or developed completely ( P >0.05). ② The diameter of labyrinth and tympanic segment in neonatal group were narrower than other five groups ( P <0.05), but no significant difference among them in other groups ( P >0.05). ③The dysplasia of facial nerve canal were occurred on 978 locations. Among them, the percentage of dehiscence, aberrance, partially expanding and bifurcation were 72.9%(713/978), 5.1%(50/978), 18.9%(185/978) and 3.1%(30/978) respectively. The percentage of dehiscence in geniculate fossa segment was decreased significantly with age (neonatal group 85.7%(36/42), infancy group 59.4%(63/106), toddler group 39.2%(40/102), preschool group 33%(33/100), school group 30%(18/60)and adolescent group 26.8%(22/82), with P <0.05). Except the dehiscence of geniculate fossa and mastoid segment, there was no significant difference in the occurrence rate of the other variants ( P >O.05). Conclusions: The growth of length and dehiscence in labyrinth segment of facial nerve canal are significant in

Comparison of Facial Nerve Paralysis in Adults and Children

PubMed Central

Cha, Chang Il; Hong, Chang Kee; Park, Moon Suh

2008-01-01

Purpose Facial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults. Materials and Methods We retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005. Results The most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma. Conclusion These results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different. PMID:18972592

Cranial nerve monitoring during subpial dissection in temporomesial surgery.

PubMed

Ortler, Martin; Fiegele, Thomas; Walser, Gerald; Trinka, Eugen; Eisner, Wilhelm

2011-06-01

Cranial nerves (CNs) crossing between the brainstem and skull base at the level of the tentorial hiatus may be at risk in temporomesial surgery involving subpial dissection and/or tumorous growth leading to distorted anatomy. We aimed to identify the surgical steps most likely to result in CN damage in this type of surgery. Electromyographic responses obtained with standard neuromonitoring techniques and a continuous free-running EMG were graded as either contact activity or pathological spontaneous activity (PSA) during subpial resection of temporomesial structures in 16 selective amygdalohippocampectomy cases. Integrity of peripheral motor axons was tested by transpial/transarachnoidal electrical stimulation while recording compound muscle action potentials from distal muscle(s). Continuous EMG showed pathological activity in five (31.2%) patients. Nine events with PSA (slight activity, n = 8; strong temporary activity, n = 1) were recorded. The oculomotor nerve was involved three times, the trochlear nerve twice, the facial nerve once, and all monitored nerves on three occasions. Surgical maneuvers associated with PSA were the resection of deep parts of the hippocampus and parahippocampal gyrus (CN IV, twice; CN III, once), lining with or removing cotton patties from the resection cavity (III, twice; all channels, once) and indirect exertion of tension on the intact pia/arachnoid of the uncal region while mobilizing the hippocampus and parahippocampal gyrus en bloc (all channels, once; III, once). CMAPs were observed at 0.3 mA in two patients and at 0.6 mA in one patient, and without registering the exact amount of intensity in three patients. The most dangerous steps leading to cranial nerve damage during mesial temporal lobe surgery are the final stages of the intervention while the resection is being completed in the deep posterior part and the resection cavity is being lined with patties. Distant traction may act on nerves crossing the tentorial

Relation between a first branchial cleft anomaly and the facial nerve.

PubMed

Guo, Yu-Xing; Guo, Chuan-Bin

2012-04-01

Relations between first branchial cleft anomalies and the facial nerve vary. We reviewed 41 patients' medical records and pathological sections to clarify the relation, and found that those on the right side in young patients, which were Work type II and situated low down, were likely to be deep to the facial nerve. Copyright © 2011 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Surgical management of facial nerve paralysis in the pediatric population.

PubMed

Barr, Jason S; Katz, Karin A; Hazen, Alexes

2011-11-01

In the pediatric patient population, both the pathology and the surgical managements of seventh cranial nerve palsy are complicated by the small size of the patients. Adding to the technical difficulty is the relative infrequency of the diagnosis, thus making it harder to become proficient in the management of the condition. The magnitude of the functional and aesthetic deficits these children manifest is significantly troubling to both the patient and the parents, which makes immediate attention, treatment, and functional restoration essential. A literature search using PubMed (http://www.pubmed.org) was undertaken to identify the current state of surgical management of pediatric facial paralysis. Although a multitude of techniques have been used, the ideal reconstructive procedure that addresses all of the functional and cosmetic needs of these children has yet to be described. Certainly, future research and innovative thinking will yield progressively better techniques that may, one day, emulate the native facial musculature with remarkable precision. The necessity for surgical intervention in children with facial nerve paralysis differs depending on many factors including the acute/chronic nature of the defect as well as the extent of functional and cosmetic damage. In this article, we review the surgical procedures that have been used to treat pediatric facial nerve paralysis and provide therapeutic facial reanimation. Copyright © 2011 Elsevier Inc. All rights reserved.

Deficient functional recovery after facial nerve crush in rats is associated with restricted rearrangements of synaptic terminals in the facial nucleus.

PubMed

Hundeshagen, G; Szameit, K; Thieme, H; Finkensieper, M; Angelov, D N; Guntinas-Lichius, O; Irintchev, A

2013-09-17

Crush injuries of peripheral nerves typically lead to axonotmesis, axonal damage without disruption of connective tissue sheaths. Generally, human patients and experimental animals recover well after axonotmesis and the favorable outcome has been attributed to precise axonal reinnervation of the original peripheral targets. Here we assessed functionally and morphologically the long-term consequences of facial nerve axonotmesis in rats. Expectedly, we found that 5 months after crush or cryogenic nerve lesion, the numbers of motoneurons with regenerated axons and their projection pattern into the main branches of the facial nerve were similar to those in control animals suggesting precise target reinnervation. Unexpectedly, however, we found that functional recovery, estimated by vibrissal motion analysis, was incomplete at 2 months after injury and did not improve thereafter. The maximum amplitude of whisking remained substantially, by more than 30% lower than control values even 5 months after axonotmesis. Morphological analyses showed that the facial motoneurons ipsilateral to injury were innervated by lower numbers of glutamatergic terminals (-15%) and cholinergic perisomatic boutons (-26%) compared with the contralateral non-injured motoneurons. The structural deficits were correlated with functional performance of individual animals and associated with microgliosis in the facial nucleus but not with polyinnervation of muscle fibers. These results support the idea that restricted CNS plasticity and insufficient afferent inputs to motoneurons may substantially contribute to functional deficits after facial nerve injuries, possibly including pathologic conditions in humans like axonotmesis in idiopathic facial nerve (Bell's) palsy. Copyright © 2013 IBRO. Published by Elsevier Ltd. All rights reserved.

Partial lesions of the intratemporal segment of the facial nerve: graft versus partial reconstruction.

PubMed

Bento, Ricardo F; Salomone, Raquel; Brito, Rubens; Tsuji, Robinson K; Hausen, Mariana

2008-09-01

In cases of partial lesions of the intratemporal segment of the facial nerve, should the surgeon perform an intraoperative partial reconstruction, or partially remove the injured segment and place a graft? We present results from partial lesion reconstruction on the intratemporal segment of the facial nerve. A retrospective study on 42 patients who presented partial lesions on the intratemporal segment of the facial nerve was performed between 1988 and 2005. The patients were divided into 3 groups based on the procedure used: interposition of the partial graft on the injured area of the nerve (group 1; 12 patients); keeping the preserved part and performing tubulization (group 2; 8 patients); and dividing the parts of the injured nerve (proximal and distal) and placing a total graft of the sural nerve (group 3; 22 patients). Fracture of the temporal bone was the most frequent cause of the lesion in all groups, followed by iatrogenic causes (p < 0.005). Those who obtained results lower than or equal to III on the House-Brackmann scale were 1 (8.3%) of the patients in group 1, none (0.0%) of the patients in group 2, and 15 (68.2%) of the patients in group 3 (p <0.001). The best surgical technique for therapy of a partial lesion of the facial nerve is still questionable. Among these 42 patients, the best results were those from the total graft of the facial nerve.

Microvascular Decompression for Treatment of Trigeminal Neuralgia in Patient with Facial Nerve Schwannoma.

PubMed

Marinelli, John P; Van Gompel, Jamie J; Link, Michael J; Carlson, Matthew L

2018-05-01

Secondary trigeminal neuralgia (TN) is uncommon. When a space-occupying lesion with mass effect is identified, the associated TN is often exclusively attributed to the tumor. This report illustrates the importance of considering coexistent actionable pathology when surgically treating secondary TN. A 51-year-old woman presented with abrupt-onset TN of the V2 and V3 nerve divisions with hypesthesia. She denied changes in hearing, balance, or facial nerve dysfunction. Magnetic resonance imaging revealed a 1.6-cm contrast-enhancing cerebellopontine angle tumor that effaced the trigeminal nerve, consistent with a vestibular schwannoma. In addition, a branch of the superior cerebellar artery abutted the cisternal segment of the trigeminal nerve on T2-weighted thin-slice magnetic resonance imaging. Intraoperative electrical stimulation of the tumor elicited a response from the facial nerve at low threshold over the entire accessible tumor surface, indicating that the tumor was a facial nerve schwannoma. Considering the patient's lack of facial nerve deficit and that the tumor exhibited no safe entry point for intracapsular debulking, tumor resection was not performed. Working between the tumor and tentorium, a branch of the superior cerebellar artery was identified and decompressed with a Teflon pad. At last follow-up, the patient exhibited resolution of her TN. Her hearing and facial nerve function remained intact. Despite obstruction from a medium-sized tumor, it is still possible to achieve microvascular decompression of the fifth cranial nerve. This emphasizes the importance of considering other actionable pathology during surgical management of presumed tumor-induced TN. Further, TN is relatively uncommon with medium-sized vestibular schwannomas and coexistent causes should be considered. Copyright © 2018 Elsevier Inc. All rights reserved.

Facial Nerve Repair: Fibrin Adhesive Coaptation versus Epineurial Suture Repair in a Rodent Model

PubMed Central

Knox, Christopher J.; Hohman, Marc H.; Kleiss, Ingrid J.; Weinberg, Julie S.; Heaton, James T.; Hadlock, Tessa A.

2013-01-01

Objectives/Hypothesis Repair of the transected facial nerve has traditionally been accomplished with microsurgical neurorrhaphy; however, fibrin adhesive coaptation (FAC) of peripheral nerves has become increasingly popular over the past decade. We compared functional recovery following suture neurorrhaphy to FAC in a rodent facial nerve model. Study Design Prospective, randomized animal study. Methods Sixteen rats underwent transection and repair of the facial nerve proximal to the pes anserinus. Eight animals underwent epineurial suture (ES) neurorrhaphy, and eight underwent repair with fibrin adhesive (FA). Surgical times were documented for all procedures. Whisking function was analyzed on a weekly basis for both groups across 15 weeks of recovery. Results Rats experienced whisking recovery consistent in time course and degree with prior studies of rodent facial nerve transection and repair. There were no significant differences in whisking amplitude, velocity, or acceleration between suture and FA groups. However, the neurorrhaphy time with FA was 70% shorter than for ES (P < 0.05). Conclusion Although we found no difference in whisking recovery between suture and FA repair of the main trunk of the rat facial nerve, the significantly shorter operative time for FA repair makes this technique an attractive option. The relative advantages of both techniques are discussed. PMID:23188676

Facial nerve repair: fibrin adhesive coaptation versus epineurial suture repair in a rodent model.

PubMed

Knox, Christopher J; Hohman, Marc H; Kleiss, Ingrid J; Weinberg, Julie S; Heaton, James T; Hadlock, Tessa A

2013-07-01

Repair of the transected facial nerve has traditionally been accomplished with microsurgical neurorrhaphy; however, fibrin adhesive coaptation (FAC) of peripheral nerves has become increasingly popular over the past decade. We compared functional recovery following suture neurorrhaphy to FAC in a rodent facial nerve model. Prospective, randomized animal study. Sixteen rats underwent transection and repair of the facial nerve proximal to the pes anserinus. Eight animals underwent epineurial suture (ES) neurorrhaphy, and eight underwent repair with fibrin adhesive (FA). Surgical times were documented for all procedures. Whisking function was analyzed on a weekly basis for both groups across 15 weeks of recovery. Rats experienced whisking recovery consistent in time course and degree with prior studies of rodent facial nerve transection and repair. There were no significant differences in whisking amplitude, velocity, or acceleration between suture and FA groups. However, the neurorrhaphy time with FA was 70% shorter than for ES (P < 0.05). Although we found no difference in whisking recovery between suture and FA repair of the main trunk of the rat facial nerve, the significantly shorter operative time for FA repair makes this technique an attractive option. The relative advantages of both techniques are discussed. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Penetrating gunshot wound to the head: transotic approach to remove the bullet and masseteric-facial nerve anastomosis for early facial reanimation.

PubMed

Donnarumma, Pasquale; Tarantino, Roberto; Gennaro, Paolo; Mitro, Valeria; Valentini, Valentino; Magliulo, Giuseppe; Delfini, Roberto

2014-01-01

Gunshot wounds to the head (GSWH) account for the majority of penetrating brain injuries, and are the most lethal. Since they are rare in Europe, the number of neurosurgeons who have experienced this type of traumatic injury is decreasing, and fewer cases are reported in the literature. We describe a case of gunshot to the temporal bone in which the bullet penetrated the skull resulting in the facial nerve paralysis. It was excised with the transotic approach. Microsurgical anastomosis among the masseteric nerve and the facial nerve was performed. GSWH are often devastating. The in-hospital mortality for civilians with penetrating craniocerebral injury is very high. Survivors often have high rate of complications. When facial paralysis is present, masseteric-facial direct neurorraphy represent a good treatment.

Novel mouse model for simulating microsurgical tumor excision with facial nerve preservation.

PubMed

Lim, Jae H; Boyle, Glen M; Panizza, Benedict

2016-01-01

To determine the feasibility of using a mouse tumor model as a microsurgical training tool for otolaryngology-head and neck surgery (OHNS) trainees. Animal study. We injected athymic nude mice with human cutaneous squamous cell carcinoma (A431 cell line) deep to the parotid region overlying the masseter muscle. We sacrificed the animals 1 to 3 weeks postinjection, once a visible tumor growth was confirmed. We then asked 10 OHNS trainees to excise the tumor with preservation of the facial nerves under a high-magnification dissecting microscope. The trainees graded the tasks in several areas of specific measures using a visual analogue scale (VAS) including 1) tumor texture, 2) surgical realism, 3) usefulness, and 4) difficulty of the task. Noticeable tumor growth occurred within 5 days following A431 cell injection and reached measureable size (0.5-1.5 cm) within 1 to 3 weeks. The tumor displaced the facial nerve laterally and medially, with few demonstrating infiltration of the nerve. VAS scores (± standard deviation) were 8.1 (± 1.7), 7.7 (± 2.5), 9.0 (± 0.9) and 6.6 (± 1.9) for tumor texture, surgical realism, usefulness, and the difficulty of the task, respectively. We demonstrate a novel, reliable and cost-effective mouse model for simulating tumor extirpation microsurgery with preservation of important neural structures. OHNS trainees have found this simulation model to be realistic, useful, and appropriately challenging. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Outcome of a graduated minimally invasive facial reanimation in patients with facial paralysis.

PubMed

Holtmann, Laura C; Eckstein, Anja; Stähr, Kerstin; Xing, Minzhi; Lang, Stephan; Mattheis, Stefan

2017-08-01

Peripheral paralysis of the facial nerve is the most frequent of all cranial nerve disorders. Despite advances in facial surgery, the functional and aesthetic reconstruction of a paralyzed face remains a challenge. Graduated minimally invasive facial reanimation is based on a modular principle. According to the patients' needs, precondition, and expectations, the following modules can be performed: temporalis muscle transposition and facelift, nasal valve suspension, endoscopic brow lift, and eyelid reconstruction. Applying a concept of a graduated minimally invasive facial reanimation may help minimize surgical trauma and reduce morbidity. Twenty patients underwent a graduated minimally invasive facial reanimation. A retrospective chart review was performed with a follow-up examination between 1 and 8 months after surgery. The FACEgram software was used to calculate pre- and postoperative eyelid closure, the level of brows, nasal, and philtral symmetry as well as oral commissure position at rest and oral commissure excursion with smile. As a patient-oriented outcome parameter, the Glasgow Benefit Inventory questionnaire was applied. There was a statistically significant improvement in the postoperative score of eyelid closure, brow asymmetry, nasal asymmetry, philtral asymmetry as well as oral commissure symmetry at rest (p < 0.05). Smile evaluation revealed no significant change of oral commissure excursion. The mean Glasgow Benefit Inventory score indicated substantial improvement in patients' overall quality of life. If a primary facial nerve repair or microneurovascular tissue transfer cannot be applied, graduated minimally invasive facial reanimation is a promising option to restore facial function and symmetry at rest.

Facial nerve hemangioma: a rare case involving the vertical segment.

PubMed

Ahmadi, Neda; Newkirk, Kenneth; Kim, H Jeffrey

2013-02-01

This case report and literature review reports on a rare case of facial nerve hemangioma (FNH) involving the vertical facial nerve (FN) segment, and discusses the clinical presentation, imaging, pathogenesis, and management of these rare lesions. A 53-year-old male presented with a 10-year history of right hemifacial twitching and progressive facial paresis (House-Brackmann grading score V/VI). The computed tomography and magnetic resonance imaging studies confirmed an expansile lesion along the vertical FN segment. Excision and histopathologic examination demonstrated FNH. FNHs involving the vertical FN segment are extremely rare. Despite being rare lesions, we believe that familiarity with the presentation and management of FNHs are imperative. Laryngoscope, 2012. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

The neurosurgical treatment of neuropathic facial pain.

PubMed

Brown, Jeffrey A

2014-04-01

This article reviews the definition, etiology and evaluation, and medical and neurosurgical treatment of neuropathic facial pain. A neuropathic origin for facial pain should be considered when evaluating a patient for rhinologic surgery because of complaints of facial pain. Neuropathic facial pain is caused by vascular compression of the trigeminal nerve in the prepontine cistern and is characterized by an intermittent prickling or stabbing component or a constant burning, searing pain. Medical treatment consists of anticonvulsant medication. Neurosurgical treatment may require microvascular decompression of the trigeminal nerve. Copyright © 2014 Elsevier Inc. All rights reserved.

Regeneration of guinea PIG facial nerve: the effect of hypergravity

NASA Astrophysics Data System (ADS)

Rosenzweig, E.; Horodiceanu, E.; Ishay, J. S.

Exposure to moderate hypergravity improves the regenerative capacity of sectioned guinea-pig facial nerve. The improvement in regeneration is tri-directional as follows: a) an average 1.7 fold increase in rate of regeneration in guinea pigs subjected to hypergravity; b) a 25% enhancement of facial muscle activity following the exposure to hypergravity; and c) improvement in the quality of regeneration from an esthetic standpoint. A good correlation was recorded between the histological structure of the severed nerve at the end of the regeneration and the clinical results.

Peripheral facial weakness (Bell's palsy).

PubMed

Basić-Kes, Vanja; Dobrota, Vesna Dermanović; Cesarik, Marijan; Matovina, Lucija Zadro; Madzar, Zrinko; Zavoreo, Iris; Demarin, Vida

2013-06-01

Peripheral facial weakness is a facial nerve damage that results in muscle weakness on one side of the face. It may be idiopathic (Bell's palsy) or may have a detectable cause. Almost 80% of peripheral facial weakness cases are primary and the rest of them are secondary. The most frequent causes of secondary peripheral facial weakness are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immune disorders, drugs, degenerative diseases of the central nervous system, etc. The diagnosis relies upon the presence of typical signs and symptoms, blood chemistry tests, cerebrospinal fluid investigations, nerve conduction studies and neuroimaging methods (cerebral MRI, x-ray of the skull and mastoid). Treatment of secondary peripheral facial weakness is based on therapy for the underlying disorder, unlike the treatment of Bell's palsy that is controversial due to the lack of large, randomized, controlled, prospective studies. There are some indications that steroids or antiviral agents are beneficial but there are also studies that show no beneficial effect. Additional treatments include eye protection, physiotherapy, acupuncture, botulinum toxin, or surgery. Bell's palsy has a benign prognosis with complete recovery in about 80% of patients, 15% experience some mode of permanent nerve damage and severe consequences remain in 5% of patients.

Constriction of the buccal branch of the facial nerve produces unilateral craniofacial allodynia.

PubMed

Lewis, Susannah S; Grace, Peter M; Hutchinson, Mark R; Maier, Steven F; Watkins, Linda R

2017-08-01

Despite pain being a sensory experience, studies of spinal cord ventral root damage have demonstrated that motor neuron injury can induce neuropathic pain. Whether injury of cranial motor nerves can also produce nociceptive hypersensitivity has not been addressed. Herein, we demonstrate that chronic constriction injury (CCI) of the buccal branch of the facial nerve results in long-lasting, unilateral allodynia in the rat. An anterograde and retrograde tracer (3000MW tetramethylrhodamine-conjugated dextran) was not transported to the trigeminal ganglion when applied to the injury site, but was transported to the facial nucleus, indicating that this nerve branch is not composed of trigeminal sensory neurons. Finally, intracisterna magna injection of interleukin-1 (IL-1) receptor antagonist reversed allodynia, implicating the pro-inflammatory cytokine IL-1 in the maintenance of neuropathic pain induced by facial nerve CCI. These data extend the prior evidence that selective injury to motor axons can enhance pain to supraspinal circuits by demonstrating that injury of a facial nerve with predominantly motor axons is sufficient for neuropathic pain, and that the resultant pain has a neuroimmune component. Copyright © 2016 Elsevier Inc. All rights reserved.

Serial neurophysiological and neurophysiological examinations for delayed facial nerve palsy in a patient with Fisher syndrome.

PubMed

Umekawa, Motoyuki; Hatano, Keiko; Matsumoto, Hideyuki; Shimizu, Takahiro; Hashida, Hideji

2017-05-27

The patient was a 47-year-old man who presented with diplopia and gait instability with a gradual onset over the course of three days. Neurological examinations showed ophthalmoplegia, diminished tendon reflexes, and truncal ataxia. Tests for anti-GQ1b antibodies and several other antibodies to ganglioside complex were positive. We made a diagnosis of Fisher syndrome. After administration of intravenous immunoglobulin, the patient's symptoms gradually improved. However, bilateral facial palsy appeared during the recovery phase. Brain MRI showed intensive contrast enhancement of bilateral facial nerves. During the onset phase of facial palsy, the amplitude of the compound muscle action potential (CMAP) in the facial nerves was preserved. During the peak phase, the facial CMAP amplitude was within the lower limit of normal values, or mildly decreased. During the recovery phase, the CMAP amplitude was normalized, and the R1 and R2 responses of the blink reflex were prolonged. The delayed facial nerve palsy improved spontaneously, and the enhancement on brain MRI disappeared. Serial neurophysiological and neuroradiological examinations suggested that the main lesions existed in the proximal part of the facial nerves and the mild lesions existed in the facial nerve terminals, probably due to reversible conduction failure.

[Treatment of idiopathic peripheral facial nerve paralysis (Bell's palsy)].

PubMed

Meyer, Martin Willy; Hahn, Christoffer Holst

2013-01-28

Bell's palsy is defined as an idiopathic peripheral facial nerve paralysis of sudden onset. It affects 11-40 persons per 100,000 per annum. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement. The aim of this study was to make an overview of which pharmacological treatments have been used to improve outcomes. The available evidence from randomized controlled trials shows significant benefit from treating Bell's palsy with corticosteroids but shows no benefit from antivirals.

[Bilateral facial nerve palsy associated with Epstein-Barr virus infection in a 3-year-old boy].

PubMed

Grassin, M; Rolland, A; Leboucq, N; Roubertie, A; Rivier, F; Meyer, P

2017-06-01

Bilateral facial nerve palsy is a rare and sometimes difficult diagnosis. We describe a case of bilateral simultaneous facial nerve palsy associated with Epstein-Barr virus (EBV) infection in a 3-year-old boy. Several symptoms led to the diagnosis of EBV infection: the clinical situation (fever, stomachache, and throat infection), white blood cell count (5300/mm 3 with 70% lymphocyte count), seroconversion with EBV-specific antibodies, lymphocytic meningitis, and a positive blood EBV polymerase chain reaction (9.3×10 3 copies of EBV-DNA). An MRI brain scan showed bilateral gadolinium enhancement of the facial nerve. A treatment plan with IV antibiotics (ceftriaxone) and corticosteroids was implemented. Antibiotics were stopped after the diagnosis of Lyme disease was ruled out. The patient's facial weakness improved within a few weeks. Bilateral facial nerve palsy is rare and, unlike unilateral facial palsy, it is idiopathic in only 20% of cases. Therefore, it requires further investigation and examination to search for the underlying etiology. Lyme disease is the first infectious disease that should be considered in children, especially in endemic areas. An antibiotic treatment effective against Borrelia burgdorferi should be set up until the diagnosis is negated or confirmed. Further examination should include a blood test (such as immunologic testing, and serologic testing for viruses and bacterium with neurological tropism), a cerebrospinal fluid test, and an MRI brain scan to exclude any serious or curable underlying etiology. Facial bilateral nerve palsy associated with EBV is rarely described in children. Neurological complications have been reported in 7% of all EBV infections. The facial nerve is the most frequently affected of all cranial nerves. Facial palsy described in EBV infections is bilateral in 35% of all cases. The physiopathology is currently unknown. Prognosis is good most of the time. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Motor fiber organization in the extratemporal trunk of the facial nerve in rats: A retrograde Fluoro-Gold study

PubMed Central

CHEN, LIJIE; HU, MIN; ZHANG, LIHAI; LIU, SANXIA; LUO, JINCHAO; DENG, TIANZHENG; TAO, YE

2012-01-01

Understanding the microanatomy of the facial nerve is vital to functional restoration of facial nerve injury. This study aimed to locate the spatial orientation of five branches in the extratemporal trunk of the rat facial nerve (ETFN). Fifteen adult Sprague-Dawley albino rats were divided randomly into five groups corresponding to the five facial nerves. Fluoro-Gold™ (FG) was applied to one branch in all three rats in each group. The trunk of the facial nerve was cut at three points for fluorescence detection. Staining results showed that each branch of the facial motor nerve had a topographical orientation in the distal part of the ETFN. The temporal branch was located in the medial and acroscopic quadrant of the nerve trunk. The zygomatic branch was located in the lateral and acroscopic quadrant. The buccal branch occupied the upper half of the nerve trunk, whereas the mandibular branch occupied the lower half. The cervical branch presented a square-shaped distribution in the lateral nerve trunk. In the middle part of the ETFN, the topographical orientation remained clear, but the FG-labeled zone was extended to some extent. In the stylomastoid foramen region, all branches diffused, thereby blurring the orientation. In conclusion, each branch of the facial motor nerve had a topographical orientation and distribution in the crotch and middle part of the ETFN, but the branches diffused near the stylomastoid foramen. PMID:23226737

Facial blanching after inferior alveolar nerve block anesthesia: an unusual complication.

PubMed

Kang, Sang-Hoon; Won, Yu-Jin

2017-12-01

The present case report describes a complication involving facial blanching symptoms occurring during inferior alveolar nerve block anesthesia (IANBA). Facial blanching after IANBA can be caused by the injection of an anesthetic into the maxillary artery area, affecting the infraorbital artery.

Intraoperative nerve monitoring in laryngotracheal surgery.

PubMed

Bolufer, Sergio; Coves, María Dolores; Gálvez, Carlos; Villalona, Gustavo Adolfo

Laryngotracheal surgery has an inherent risk of injury to the recurrent laryngeal nerves (RLN). These complications go from minor dysphonia to even bilateral vocal cord paralysis. The intraoperative neuromonitoring of the RLN was developed in the field of thyroid surgery, in order to preserve nerve and vocal cord function. However, tracheal surgery requires in-field intubation of the distal trachea, which limits the use of nerve monitoring using conventional endotracheal tube with surface electrodes. Given these challenges, we present an alternative method for nerve monitoring during laryngotracheal surgery through the insertion of electrodes within the endolaryngeal musculature by bilateral puncture. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Stereotactic Radiotherapy for Intracranial Nonacoustic Schwannomas Including Facial Nerve Schwannoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nishioka, Kentaro; Abo, Daisuke; Aoyama, Hidefumi

2009-12-01

Purpose: Although the effectiveness of stereotactic radiosurgery for nonacoustic schwannomas is currently being assessed, there have been few studies on the efficacy of stereotactic radiotherapy (SRT) for these tumors. We investigated the long-term outcome of SRT for nonacoustic intracranial nerve schwannomas. Methods and Materials: Seventeen patients were treated between July 1994 and December 2006. Of these patients, 7 had schwannomas located in the jugular foramen, 5 in the trigeminal nerve, 4 in the facial nerve, and 1 in the oculomotor nerve. Radiotherapy was used as an initial treatment without surgery in 10 patients (59%) and after initial subtotal resection inmore » the remaining patients. The tumor volume ranged from 0.3 to 31.3 mL (mean, 8.2 mL). The treatment dose was 40 to 54 Gy in 20 to 26 fractions. The median follow-up period was 59.5 months (range, 7.4-122.6 months). Local control was defined as stable or decreased tumor size on follow-up magnetic resonance imaging. Results: Tumor size was decreased in 3 patients, stable in 13, and increased in 1 after SRT. Regarding neurologic symptoms, 8 patients (47%) had improvement and 9 patients were unchanged. One patient had an increase in tumor size and received microsurgical resection at 32 months after irradiation. No patient had worsening of pre-existing neurologic symptoms or development of new cranial nerve deficits at the last follow-up. Conclusions: SRT is an effective alternative to surgical resection for patients with nonacoustic intracranial nerve schwannomas with respect to not only long-term local tumor control but also neuro-functional preservation.« less

American Academy of Facial Plastic and Reconstructive Surgery

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Facial blanching after inferior alveolar nerve block anesthesia: an unusual complication

PubMed Central

2017-01-01

The present case report describes a complication involving facial blanching symptoms occurring during inferior alveolar nerve block anesthesia (IANBA). Facial blanching after IANBA can be caused by the injection of an anesthetic into the maxillary artery area, affecting the infraorbital artery. PMID:29349355

[Facial paralysis in children].

PubMed

Muler, H; Paquelin, F; Cotin, G; Luboinski, B; Henin, J M

1975-01-01

Facial paralyses in children may be grouped under headings displaying a certain amount of individuality. Chronologically, first to be described are neonatal facial paralyses. These are common and are nearly always cured within a few days. Some of these cases are due to the mastoid being crushed at birth with or without the use of forceps. The intra-osseous pathway of the facial nerve is then affected throughout its length. However, a cure is often spontaneous. When this desirable development does not take place within three months, the nerve should be freed by decompressive surgery. The special anatomy of the facial nerve in the new-born baby makes this a delicate operation. Later, in all stages of acute otitis, acute mastoiditis or chronic otitis, facial paralysis can be seen. Treatment depends on the stage reached by the otitis: paracentesis, mastoidectomy, various scraping procedures, and, of course, antibiotherapy. The other causes of facial paralysis in children are very much less common: a frigore or viral, traumatic, occur ring in the course of acute poliomyelitis, shingles or tumours of the middle ear. To these must be added exceptional causes such as vitamin D intoxication, idiopathic hypercalcaemia and certain haemopathies.

Gamma Knife radiosurgery for facial nerve schwannomas: a multicenter study.

PubMed

Sheehan, Jason P; Kano, Hideyuki; Xu, Zhiyuan; Chiang, Veronica; Mathieu, David; Chao, Samuel; Akpinar, Berkcan; Lee, John Y K; Yu, James B; Hess, Judith; Wu, Hsiu-Mei; Chung, Wen-Yuh; Pierce, John; Missios, Symeon; Kondziolka, Douglas; Alonso-Basanta, Michelle; Barnett, Gene H; Lunsford, L Dade

2015-08-01

Facial nerve schwannomas (FNSs) are rare intracranial tumors, and the optimal management of these tumors remains unclear. Resection can be undertaken, but the tumor's intimate association with the facial nerve makes resection with neurological preservation quite challenging. Stereotactic radiosurgery (SRS) has been used to treat FNSs, and this study evaluates the outcome of this approach. At 8 medical centers participating in the North American Gamma Knife Consortium (NAGKC), 42 patients undergoing SRS for an FNS were identified, and clinical and radiographic data were obtained for these cases. Males outnumbered females at a ratio of 1.2:1, and the patients' median age was 48 years (range 11-76 years). Prior resection was performed in 36% of cases. The mean tumor volume was 1.8 cm(3), and a mean margin dose of 12.5 Gy (range 11-15 Gy) was delivered to the tumor. At a median follow-up of 28 months, tumor control was achieved in 36 (90%) of the 40 patients with reliable radiographic follow-up. Actuarial tumor control was 97%, 97%, 97%, and 90% at 1, 2, 3, and 5 years postradiosurgery. Preoperative facial nerve function was preserved in 38 of 42 patients, with 60% of evaluable patients having House-Brackmann scores of 1 or 2 at last follow-up. Treated patients with a House-Brackmann score of 1 to 3 were more likely to demonstrate this level of facial nerve function at last evaluation (OR 6.09, 95% CI 1.7-22.0, p = 0.006). Avoidance of temporary or permanent neurological symptoms was more likely to be achieved in patients who received a tumor margin dose of 12.5 Gy or less (log-rank test, p = 0.024) delivered to a tumor of ≤ 1 cm(3) in volume (log-rank test, p = 0.01). Stereotactic radiosurgery resulted in tumor control and neurological preservation in most FNS patients. When the tumor is smaller and the patient exhibits favorable normal facial nerve function, SRS portends a better result. The authors believe that early, upfront SRS may be the treatment of choice for

How do I manage an acute injury to the facial nerve?

PubMed

Colbert, Serryth; Coombes, Daryl; Godden, Daryl; Cascarini, Luke; Kerawala, Cyrus; Brennan, Peter A

2014-01-01

Paralysis of the facial nerve is a cause of considerable functional and aesthetic disfigurement. Damage to the upper trunk can result in eye complications with the risk of exposure keratitis. Numerous factors influence the therapeutic strategy: the cause of the injury, the time elapsed since injury, functional impairment, and the likelihood of recovery. We discuss the management of an acute injury to the facial nerve and focus on the surgical options. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Trigeminofacial reflex: a means of detecting proximity to ophthalmic and maxillary divisions of the trigeminal nerve during surgery.

PubMed

AlMasri, Omar A; Brown, Emma E; Forster, Alan; Kamel, Mahmoud H

2014-11-01

The aim in this paper was to localize and detect incipient damage to the ophthalmic and maxillary branches of the trigeminal nerve during tumor surgery. This was an observational study of patients with skull base, retroorbital, or cavernous sinus tumors warranting dissection toward the cavernous sinus at a university hospital. Stimuli were applied as normal during approach to the cavernous sinus to localize cranial nerves (CNs) III, IV, and VI. Recordings were also obtained from the facial muscles to localize CN VII. The trigeminofacial reflex was sought simply by observing a longer time base routinely. Clear facial electromyography responses were reproduced when stimuli were applied to the region of V1, V2, and V3. Response latency was increased compared with direct CN VII stimuli seen in some cases. Responses gave early warning of approach to these sensory trigeminal branches. The authors submit this as a new technique, which may improve the chances of preserving trigeminal sensory branches during surgery in this region.

Stereotactic radiotherapy for malignancies involving the trigeminal and facial nerves.

PubMed

Cuneo, K C; Zagar, T M; Brizel, D M; Yoo, D S; Hoang, J K; Chang, Z; Wang, Z; Yin, F F; Das, S K; Green, S; Ready, N; Bhatti, M T; Kaylie, D M; Becker, A; Sampson, J H; Kirkpatrick, J P

2012-06-01

Involvement of a cranial nerve caries a poor prognosis for many malignancies. Recurrent or residual disease in the trigeminal or facial nerve after primary therapy poses a challenge due to the location of the nerve in the skull base, the proximity to the brain, brainstem, cavernous sinus, and optic apparatus and the resulting complex geometry. Surgical resection caries a high risk of morbidity and is often not an option for these patients. Stereotactic radiosurgery and radiotherapy are potential treatment options for patients with cancer involving the trigeminal or facial nerve. These techniques can deliver high doses of radiation to complex volumes while sparing adjacent critical structures. In the current study, seven cases of cancer involving the trigeminal or facial nerve are presented. These patients had unresectable recurrent or residual disease after definitive local therapy. Each patient was treated with stereotactic radiation therapy using a linear accelerator based system. A multidisciplinary approach including neuroradiology and surgical oncology was used to delineate target volumes. Treatment was well tolerated with no acute grade 3 or higher toxicity. One patient who was reirradiated experienced cerebral radionecrosis with mild symptoms. Four of the seven patients treated had no evidence of disease after a median follow up of 12 months (range 2-24 months). A dosimetric analysis was performed to compare intensity modulated fractionated stereotactic radiation therapy (IM-FSRT) to a 3D conformal technique. The dose to 90% (D90) of the brainstem was lower with the IM-FSRT plan by a mean of 13.5 Gy. The D95 to the ipsilateral optic nerve was also reduced with IM-FSRT by 12.2 Gy and the D95 for the optic chiasm was lower with FSRT by 16.3 Gy. Treatment of malignancies involving a cranial nerve requires a multidisciplinary approach. Use of an IM-FSRT technique with a micro-multileaf collimator resulted in a lower dose to the brainstem, optic nerves and chiasm

Facial nerve activity disrupts psychomotor rhythms in the forehead microvasculature.

PubMed

Drummond, Peter D; O'Brien, Geraldine

2011-10-28

Forehead blood flow was monitored in seven participants with a unilateral facial nerve lesion during relaxation, respiratory biofeedback and a sad documentary. Vascular waves at 0.1Hz strengthened during respiratory biofeedback, in tune with breathing cycles that also averaged 0.1Hz. In addition, a psychomotor rhythm at 0.15Hz was more prominent in vascular waveforms on the denervated than intact side of the forehead, both before and during relaxation and the sad documentary. These findings suggest that parasympathetic activity in the facial nerve interferes with the psychomotor rhythm in the forehead microvasculature. Copyright © 2011 Elsevier B.V. All rights reserved.

Iatrogenic facial palsy: the cost.

PubMed

Pulec, J L

1996-11-01

The cost of iatrogenic facial paralysis can be high. Ways to avoid facial nerve injury during surgery and, should it occur, ways to minimize the disability and cost are discussed. These include adequate preparation and training by the surgeon, the exercise of sound judgment, the presence of high morals by the surgeon, adequate preoperative diagnosis and surgical instrumentation and thorough preoperative oral and written informed consent. Should facial nerve injury occur, immediate consultation and reparative decompression, anastomosis or grafting should be performed to obtain the best ultimate result. The value of prompt, competent, sympathetic and continuing concern offered by the surgeon to the patient cannot be over emphasized.

After facial nerve damage, regenerating axons become aberrant throughout the length of the nerve and not only at the site of the lesion: an experimental study.

PubMed

Choi, D; Raisman, G

2004-02-01

After facial nerve trauma, aberrant regeneration is associated with synkinesis. Animal models of mechanical nerve guides or reparative cell transplants at the site of a lesion have not been shown to improve disorganized regeneration. We examined whether this is because regenerating axons become disorganized throughout the length of the nerve and not only at the site of the lesion. In rats (n = 12), retrograde fluorescent tracer techniques were used to establish that most of the temporal branch fibres were carried in the superior half of the facial nerve trunk. In two further groups of rats (n = 24) a complete proximal facial nerve lesion was made, and the nerve immediately repaired by suture. After 4 weeks, at a second operation, the superior half of the facial nerve trunk was cut, either proximal or distal to the original lesion, and retrograde tracers were applied to distal branches of the nerve. It was possible to localize the points at which regenerating fibres became aberrant in their course by studying the number of labelled motoneurons in the facial nucleus after application of the tracer to the temporal branch of the nerve: this was similar in the distal and proximal hemisection groups, suggesting that aberrant axonal development occurred throughout the length of the nerve. Future strategies aimed at improving the organization of regeneration need to provide guidance cues not only at the site of the lesion as previously thought, but also throughout the length of the nerve.

Electrophysiologic and functional evaluations of regenerated facial nerve defects with a tube containing dental pulp cells in rats.

PubMed

Sasaki, Ryo; Matsumine, Hajime; Watanabe, Yorikatsu; Takeuchi, Yuichi; Yamato, Masayuki; Okano, Teruo; Miyata, Mariko; Ando, Tomohiro

2014-11-01

Dental pulp tissue contains Schwann and neural progenitor cells. Tissue-engineered nerve conduits with dental pulp cells promote facial nerve regeneration in rats. However, no nerve functional or electrophysiologic evaluations were performed. This study investigated the compound muscle action potential recordings and facial functional analysis of dental pulp cell regenerated nerve in rats. A silicone tube containing rat dental pulp cells in type I collagen gel was transplanted into a 7-mm gap of the buccal branch of the facial nerve in Lewis rats; the same defect was created in the marginal mandibular branch, which was ligatured. Compound muscle action potential recordings of vibrissal muscles and facial functional analysis with facial palsy score of the nerve were performed. Tubulation with dental pulp cells showed significantly lower facial palsy scores than the autograft group between 3 and 10 weeks postoperatively. However, the dental pulp cell facial palsy scores showed no significant difference from those of autograft after 11 weeks. Amplitude and duration of compound muscle action potentials in the dental pulp cell group showed no significant difference from those of the intact and autograft groups, and there was no significant difference in the latency of compound muscle action potentials between the groups at 13 weeks postoperatively. However, the latency in the dental pulp cell group was prolonged more than that of the intact group. Tubulation with dental pulp cells could recover facial nerve defects functionally and electrophysiologically, and the recovery became comparable to that of nerve autografting in rats.

Iatrogenic nerve injuries during shoulder surgery.

PubMed

Carofino, Bradley C; Brogan, David M; Kircher, Michelle F; Elhassan, Bassem T; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

2013-09-18

The current literature indicates that neurologic injuries during shoulder surgery occur infrequently and result in little if any morbidity. The purpose of this study was to review one institution's experience treating patients with iatrogenic nerve injuries after shoulder surgery. A retrospective review of the records of patients evaluated in a brachial plexus specialty clinic from 2000 to 2010 identified twenty-six patients with iatrogenic nerve injury secondary to shoulder surgery. The records were reviewed to determine the operative procedure, time to presentation, findings on physical examination, treatment, and outcome. The average age was forty-three years (range, seventeen to seventy-two years), and the average delay prior to referral was 5.4 months (range, one to fifteen months). Seven nerve injuries resulted from open procedures done to treat instability; nine, from arthroscopic surgery; four, from total shoulder arthroplasty; and six, from a combined open and arthroscopic operation. The injury occurred at the level of the brachial plexus in thirteen patients and at a terminal nerve branch in thirteen. Fifteen patients (58%) did not recover nerve function after observation and required surgical management. A structural nerve injury (laceration or suture entrapment) occurred in nine patients (35%), including eight of the thirteen who presented with a terminal nerve branch injury and one of the thirteen who presented with an injury at the level of the brachial plexus. Nerve injuries occurring during shoulder surgery can produce severe morbidity and may require surgical management. Injuries at the level of a peripheral nerve are more likely to be surgically treatable than injuries of the brachial plexus. A high index of suspicion and early referral and evaluation should be considered when evaluating patients with iatrogenic neurologic deficits after shoulder surgery.

Effects of noninvasive facial nerve stimulation in the dog middle cerebral artery occlusion model of ischemic stroke.

PubMed

Borsody, Mark K; Yamada, Chisa; Bielawski, Dawn; Heaton, Tamara; Castro Prado, Fernando; Garcia, Andrea; Azpiroz, Joaquín; Sacristan, Emilio

2014-04-01

Facial nerve stimulation has been proposed as a new treatment of ischemic stroke because autonomic components of the nerve dilate cerebral arteries and increase cerebral blood flow when activated. A noninvasive facial nerve stimulator device based on pulsed magnetic stimulation was tested in a dog middle cerebral artery occlusion model. We used an ischemic stroke dog model involving injection of autologous blood clot into the internal carotid artery that reliably embolizes to the middle cerebral artery. Thirty minutes after middle cerebral artery occlusion, the geniculate ganglion region of the facial nerve was stimulated for 5 minutes. Brain perfusion was measured using gadolinium-enhanced contrast MRI, and ATP and total phosphate levels were measured using 31P spectroscopy. Separately, a dog model of brain hemorrhage involving puncture of the intracranial internal carotid artery served as an initial examination of facial nerve stimulation safety. Facial nerve stimulation caused a significant improvement in perfusion in the hemisphere affected by ischemic stroke and a reduction in ischemic core volume in comparison to sham stimulation control. The ATP/total phosphate ratio showed a large decrease poststroke in the control group versus a normal level in the stimulation group. The same stimulation administered to dogs with brain hemorrhage did not cause hematoma enlargement. These results support the development and evaluation of a noninvasive facial nerve stimulator device as a treatment of ischemic stroke.

Optogenetic probing of nerve and muscle function after facial nerve lesion in the mouse whisker system

NASA Astrophysics Data System (ADS)

Bandi, Akhil; Vajtay, Thomas J.; Upadhyay, Aman; Yiantsos, S. Olga; Lee, Christian R.; Margolis, David J.

2018-02-01

Optogenetic modulation of neural circuits has opened new avenues into neuroscience research, allowing the control of cellular activity of genetically specified cell types. Optogenetics is still underdeveloped in the peripheral nervous system, yet there are many applications related to sensorimotor function, pain and nerve injury that would be of great benefit. We recently established a method for non-invasive, transdermal optogenetic stimulation of the facial muscles that control whisker movements in mice (Park et al., 2016, eLife, e14140)1. Here we present results comparing the effects of optogenetic stimulation of whisker movements in mice that express channelrhodopsin-2 (ChR2) selectively in either the facial motor nerve (ChAT-ChR2 mice) or muscle (Emx1-ChR2 or ACTA1-ChR2 mice). We tracked changes in nerve and muscle function before and up to 14 days after nerve transection. Optogenetic 460 nm transdermal stimulation of the distal cut nerve showed that nerve degeneration progresses rapidly over 24 hours. In contrast, the whisker movements evoked by optogenetic muscle stimulation were up-regulated after denervation, including increased maximum protraction amplitude, increased sensitivity to low-intensity stimuli, and more sustained muscle contractions (reduced adaptation). Our results indicate that peripheral optogenetic stimulation is a promising technique for probing the timecourse of functional changes of both nerve and muscle, and holds potential for restoring movement after paralysis induced by nerve damage or motoneuron degeneration.

Plastic surgery and the biometric e-passport: implications for facial recognition.

PubMed

Ologunde, Rele

2015-04-01

This correspondence comments on the challenges of plastic reconstructive and aesthetic surgery on the facial recognition algorithms employed by biometric passports. The limitations of facial recognition technology in patients who have undergone facial plastic surgery are also discussed. Finally, the advice of the UK HM passport office to people who undergo facial surgery is reported.

Role of nitric oxide in the onset of facial nerve palsy by HSV-1 infection.

PubMed

Hato, Naohito; Kohno, Hisashi; Yamada, Hiroyuki; Takahashi, Hirotaka; Gyo, Kiyofumi

2013-12-01

Although herpes simplex virus type 1 (HSV-1) is a causative agent of Bell palsy, the precise mechanism of the paralysis remains unknown. It is necessary to investigate the pathogenesis and treatment of Bell palsy due to HSV-1 infection. This study elucidated the role of nitric oxide (NO) in the incidence of facial nerve paralysis caused by HSV-1 in mice and to evaluate the possible role of edaravone, a free radical scavenger, in preventing the paralysis. Sixty-two mice served as animal models of Bell palsy in this laboratory study conducted at an academic institution. Levels of NO in the facial nerve were measured using high-performance liquid chromatography and absorption photometry. The incidence of facial palsy was assessed following administration of edaravone immediately after HSV-1 inoculation and daily for 11 days thereafter. The ratio of NO (inoculated side to control side) and incidence of facial palsy. RESULTS Before the onset of facial palsy, no substantial difference in the NO level was noted between the HSV-1-inoculated side and the control side. When facial palsy occurred, usually at 7 days after inoculation, the NO level was significantly higher on the inoculated side than on the control side. Following recovery from the palsy, the high NO level of the inoculated side decreased. No increase in the NO level was observed in animals without transient facial palsy. When edaravone was administered, the incidence of facial palsy decreased significantly. These findings suggest that NO produced by inducible NO synthase in the facial nerve plays an important role in the onset of facial palsy caused by HSV-1 infection, which is considered a causative virus of Bell palsy. Hato and colleagues elucidate the role of nitric oxide in HSV-1–related facial nerve paralysis in mice and evaluate the role of edaravone, a free radical scavenger, in preventing the paralysis.

Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury.

PubMed

Shen, Chenling; Xiang, Mingliang; Wu, Hao; Ma, Yan; Chen, Li; Cheng, Lan

2013-06-15

To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, we retrospectively analyzed clinical data from 5 344 patients undergoing thyroidectomy. Among these cases, 548 underwent dissection of the recurrent laryngeal nerve, while 4 796 did not. There were 12 cases of recurrent laryngeal nerve injury following recurrent laryngeal nerve dissection (injury rate of 2.2%) and 512 cases of recurrent laryngeal nerve injury in those not undergoing nerve dissection (injury rate of 10.7%). This difference remained statistically significant between the two groups in terms of type of thyroid disease, type of surgery, and number of surgeries. Among the 548 cases undergoing recurrent laryngeal nerve dissection, 128 developed anatomical variations of the recurrent laryngeal nerve (incidence rate of 23.4%), but no recurrent laryngeal nerve injury was found. In addition, the incidence of recurrent laryngeal nerve injury was significantly lower in patients with the inferior parathyroid gland and middle thyroid veins used as landmarks for locating the recurrent laryngeal nerve compared with those with the entry of the recurrent laryngeal nerve into the larynx as a landmark. These findings indicate that anatomical variations of the recurrent laryngeal nerve are common, and that dissecting the recurrent laryngeal nerve during thyroid surgery is an effective means of preventing nerve injury.

Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury★

PubMed Central

Shen, Chenling; Xiang, Mingliang; Wu, Hao; Ma, Yan; Chen, Li; Cheng, Lan

2013-01-01

To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, we retrospectively analyzed clinical data from 5 344 patients undergoing thyroidectomy. Among these cases, 548 underwent dissection of the recurrent laryngeal nerve, while 4 796 did not. There were 12 cases of recurrent laryngeal nerve injury following recurrent laryngeal nerve dissection (injury rate of 2.2%) and 512 cases of recurrent laryngeal nerve injury in those not undergoing nerve dissection (injury rate of 10.7%). This difference remained statistically significant between the two groups in terms of type of thyroid disease, type of surgery, and number of surgeries. Among the 548 cases undergoing recurrent laryngeal nerve dissection, 128 developed anatomical variations of the recurrent laryngeal nerve (incidence rate of 23.4%), but no recurrent laryngeal nerve injury was found. In addition, the incidence of recurrent laryngeal nerve injury was significantly lower in patients with the inferior parathyroid gland and middle thyroid veins used as landmarks for locating the recurrent laryngeal nerve compared with those with the entry of the recurrent laryngeal nerve into the larynx as a landmark. These findings indicate that anatomical variations of the recurrent laryngeal nerve are common, and that dissecting the recurrent laryngeal nerve during thyroid surgery is an effective means of preventing nerve injury. PMID:25206452

Local delivery of glial cell line-derived neurotrophic factor improves facial nerve regeneration after late repair.

PubMed

Barras, Florian M; Kuntzer, Thierry; Zurn, Anne D; Pasche, Philippe

2009-05-01

Facial nerve regeneration is limited in some clinical situations: in long grafts, by aged patients, and when the delay between nerve lesion and repair is prolonged. This deficient regeneration is due to the limited number of regenerating nerve fibers, their immaturity and the unresponsiveness of Schwann cells after a long period of denervation. This study proposes to apply glial cell line-derived neurotrophic factor (GDNF) on facial nerve grafts via nerve guidance channels to improve the regeneration. Two situations were evaluated: immediate and delayed grafts (repair 7 months after the lesion). Each group contained three subgroups: a) graft without channel, b) graft with a channel without neurotrophic factor; and c) graft with a GDNF-releasing channel. A functional analysis was performed with clinical observation of facial nerve function, and nerve conduction study at 6 weeks. Histological analysis was performed with the count of number of myelinated fibers within the graft, and distally to the graft. Central evaluation was assessed with Fluoro-Ruby retrograde labeling and Nissl staining. This study showed that GDNF allowed an increase in the number and the maturation of nerve fibers, as well as the number of retrogradely labeled neurons in delayed anastomoses. On the contrary, after immediate repair, the regenerated nerves in the presence of GDNF showed inferior results compared to the other groups. GDNF is a potent neurotrophic factor to improve facial nerve regeneration in grafts performed several months after the nerve lesion. However, GDNF should not be used for immediate repair, as it possibly inhibits the nerve regeneration.

Masseteric nerve for reanimation of the smile in short-term facial paralysis.

PubMed

Hontanilla, Bernardo; Marre, Diego; Cabello, Alvaro

2014-02-01

Our aim was to describe our experience with the masseteric nerve in the reanimation of short term facial paralysis. We present our outcomes using a quantitative measurement system and discuss its advantages and disadvantages. Between 2000 and 2012, 23 patients had their facial paralysis reanimated by masseteric-facial coaptation. All patients are presented with complete unilateral paralysis. Their background, the aetiology of the paralysis, and the surgical details were recorded. A retrospective study of movement analysis was made using an automatic optical system (Facial Clima). Commissural excursion and commissural contraction velocity were also recorded. The mean age at reanimation was 43(8) years. The aetiology of the facial paralysis included acoustic neurinoma, fracture of the skull base, schwannoma of the facial nerve, resection of a cholesteatoma, and varicella zoster infection. The mean time duration of facial paralysis was 16(5) months. Follow-up was more than 2 years in all patients except 1 in whom it was 12 months. The mean duration to recovery of tone (as reported by the patient) was 67(11) days. Postoperative commissural excursion was 8(4)mm for the reanimated side and 8(3)mm for the healthy side (p=0.4). Likewise, commissural contraction velocity was 38(10)mm/s for the reanimated side and 43(12)mm/s for the healthy side (p=0.23). Mean percentage of recovery was 92(5)mm for commissural excursion and 79(15)mm/s for commissural contraction velocity. Masseteric nerve transposition is a reliable and reproducible option for the reanimation of short term facial paralysis with reduced donor site morbidity and good symmetry with the opposite healthy side. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

Anatomical study of the facial nerve canal in comparison to the site of the lesion in Bell's palsy.

PubMed

Dawidowsky, Krsto; Branica, Srećko; Batelja, Lovorka; Dawidowsky, Barbara; Kovać-Bilić, Lana; Simunić-Veselić, Anamarija

2011-03-01

The term Bell's palsy is used for the peripheral paresis of the facial nerve and is of unknown origin. Many studies have been performed to find the cause of the disease, but none has given certain evidence of the etiology. However, the majority of investigators agree that the pathophysiology of the palsy starts with the edema of the facial nerve and consequent entrapment of the nerve in the narrow facial canal in the temporal bone. In this study the authors wanted to find why the majority of the paresis are suprastapedial, i.e. why the entrapment of the nerve mainly occurs in the proximal part of the canal. For this reason they carried out anatomical measurements of the facial canal diameter in 12 temporal bones. By use of a computer program which measures the cross-sectional area from the diameter, they proved that the width of the canal is smaller at its proximal part. Since the nerve is thicker at that point because it contains more nerve fibers, the authors conclude that the discrepancy between the nerve diameter and the surrounding bony walls in the suprastapedial part of the of the canal would, in cases of a swollen nerve after inflammation, cause the facial palsy.

A forgotten facial nerve tumour: granular cell tumour of the parotid and its implications for treatment.

PubMed

Lerut, B; Vosbeck, J; Linder, T E

2011-04-01

We present a rare case of a facial nerve granular cell tumour in the right parotid gland, in a 10-year-old boy. A parotid or neurogenic tumour was suspected, based on magnetic resonance imaging. Intra-operatively, strong adhesions to surrounding structures were found, and a midfacial nerve branch had to be sacrificed for complete tumour removal. Recent reports verify that granular cell tumours arise from Schwann cells of peripheral nerve branches. The rarity of this tumour within the parotid gland, its origin from peripheral nerves, its sometimes misleading imaging characteristics, and its rare presentation with facial weakness and pain all have considerable implications on the surgical strategy and pre-operative counselling. Fine needle aspiration cytology may confirm the neurogenic origin of this lesion. When resecting the tumour, the surgeon must anticipate strong adherence to the facial nerve and be prepared to graft, or sacrifice, certain branches of this nerve.

Association Among Facial Paralysis, Depression, and Quality of Life in Facial Plastic Surgery Patients

PubMed Central

Nellis, Jason C.; Ishii, Masaru; Byrne, Patrick J.; Boahene, Kofi D. O.; Dey, Jacob K.; Ishii, Lisa E.

2017-01-01

IMPORTANCE Though anecdotally linked, few studies have investigated the impact of facial paralysis on depression and quality of life (QOL). OBJECTIVE To measure the association between depression, QOL, and facial paralysis in patients seeking treatment at a facial plastic surgery clinic. DESIGN, SETTING, PARTICIPANTS Data were prospectively collected for patients with all-cause facial paralysis and control patients initially presenting to a facial plastic surgery clinic from 2013 to 2015. The control group included a heterogeneous patient population presenting to facial plastic surgery clinic for evaluation. Patients who had prior facial reanimation surgery or missing demographic and psychometric data were excluded from analysis. MAIN OUTCOMES AND MEASURES Demographics, facial paralysis etiology, facial paralysis severity (graded on the House-Brackmann scale), Beck depression inventory, and QOL scores in both groups were examined. Potential confounders, including self-reported attractiveness and mood, were collected and analyzed. Self-reported scores were measured using a 0 to 100 visual analog scale. RESULTS There was a total of 263 patients (mean age, 48.8 years; 66.9% were female) were analyzed. There were 175 control patients and 88 patients with facial paralysis. Sex distributions were not significantly different between the facial paralysis and control groups. Patients with facial paralysis had significantly higher depression, lower self-reported attractiveness, lower mood, and lower QOL scores. Overall, 37 patients with facial paralysis (42.1%) screened positive for depression, with the greatest likelihood in patients with House-Brackmann grade 3 or greater (odds ratio, 10.8; 95% CI, 5.13–22.75) compared with 13 control patients (8.1%) (P < .001). In multivariate regression, facial paralysis and female sex were significantly associated with higher depression scores (constant, 2.08 [95% CI, 0.77–3.39]; facial paralysis effect, 5.98 [95% CI, 4.38–7

The effect of methylprednisolone on facial nerve paralysis with different etiologies.

PubMed

Yildirim, Mehmet Akif; Karlidag, Turgut; Akpolat, Nusret; Kaygusuz, Irfan; Keles, Erol; Yalcin, Sinasi; Akyigit, Abdulvahap

2015-05-01

The objective of this study was to evaluate the effectiveness of methylprednisolone (MP) in models of facial nerve paralysis obtained by nerve section, compression, or inoculation with herpes simplex virus (HSV). Experimental controlled animal study. Tertiary referral center. A total of 30 female New Zealand rabbits weighing 1200-3000 g were used for the study. They were randomly assigned to one of 6 groups of 5 animals each. A nerve section injury was realized in Groups 1a (section and MP) and 1b (section, control) rabbits. A compression-type injury was inflicted to rabbits in Groups 2a (compression and MP) and 2b (compression, control). As for animals in Groups 3a (Type 1 HSV and MP) and 3b (Type 1 HSV, controls), facial nerve paralysis resulting from viral infection was obtained. Animals in the 3 treatment groups, designated with the letter "a", were administered MP, 1 mg/kg/d, whereas those in control groups "b" received 1 mL normal saline, both during 3 weeks. All subjects were followed up for 2 months. At the end of this period, all animals had the buccal branch of the facial nerve excised on the operated side. Semi-thin sections of these specimens were evaluated under light microscopy for the following: perineural fibrosis, increase in collagen fibers, myelin degeneration, axonal degeneration, Schwann cell proliferation, and edema. No significant difference was observed (P > 0.05) between the MP treatment group and the control group with regard to perineural fibrosis, increase in collagen fibers, myelin degeneration, axonal degeneration, edema, or Schwann cell proliferation. In the group with a compressive lesion (Group 2), controls were no different from MP-treated animals as to perineural fibrosis, increase in collagen fibers, or Schwann cell proliferation, whereas axonal degeneration, myelin degeneration, and edema were significantly higher (P < 0.05) in the control group. When comparing the treatment and control groups among the animals inoculated with

Facial nerve injuries associated with the retromandibular transparotid approach for reduction and fixation of mandibular condyle fractures.

PubMed

Shi, Dan; Patil, Pavan Manohar; Gupta, Ritika

2015-04-01

To document facial nerve (FN) injuries after surgical treatment of mandibular condylar fractures using the retromandibular transparotid approach and to identify risk factors associated with these injuries. A retrospective study of patients surgically treated for mandibular condylar fractures using the retromandibular transparotid approach over seven years was conducted. The primary study variable was the postoperative change in FN function after fracture fixation. Risk factors were categorized as demographic, anatomic, experience of the operator, fracture displacement/dislocation and number of miniplates placed at the fracture site. Appropriate statistics were computed. Ninety patients with 102 fractures were analysed. Thirty two fractures (31%) were located in the condylar neck and 70 fractures (69%) were subcondylar (located below the sigmoid notch). The condylar segment was undisplaced in twelve cases (12%), displaced medially in thirty five (34%), laterally displaced in thirty (29%) and dislocated in 25 (24.5%). In 18 fractures (18%), postoperative examination revealed various degrees of damage to the FN. All nerve injuries recovered completely in 8-24 weeks. In a multivariate model, condylar neck fractures, fracture dislocation and operator inexperience were associated with a statistically significant risk of postoperative deterioration of FN function (P ≤ 0.05). The majority of facial nerve injuries after surgical treatment of condylar fractures by the retromandibular transparotid approach are transient in nature. Condylar neck fractures, fracture dislocation and operator inexperience were associated with an increased risk for FN injury. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

[Myxoma of the mastoid with destruction of the facial nerve (author's transl)].

PubMed

Neiger, M

1978-10-01

A case of Myxoma of the mastoid with initial facial spasme followed by palsy of the nerve is reported. After removing the tumor the nerve has been reconstructed from the secound knee until the stylomastoid foramen. The probable origine of the tumor is discussed.

Patterns of anomalies of structures of the middle ear and the facial nerve as revealed in newborn temporal bones.

PubMed

Tóth, Miklós; Sirirattanapan, Jarinratn; Mann, Wolf

2013-08-01

The purpose of this study is to offer new data about facial nerve malformations in the tympanic cavity. Prospective anatomic study of newborns to demonstrate the submacroscopic anatomy of the intratympanic facial nerve and its surrounding structures by malformations. Step-by-step microdissection of 12 newborn temporal bones and histologic evaluation of 4 middle ears showing multiple malformations. Four of 12 temporal bones presented malformation in the middle ear. All 4 temporal bones showed developmental failures of the stapes, and 3 of them had malposition of the tympanic portion of the facial nerve. In 3 cases, there was an oval window atresia, and in 1 case, the rim of the oval window was not ossified and was positioned medial to the stapes. Malformation or displacement of the stapes can be an indirect sign for facial nerve malformation. The most common site for facial nerve malformation is the tympanic portion. The tympanic segment of the nerve is devoid of bony covering in association with these anomalies of the stapes.

Investigating Psychosocial Causes of the Tendency for Facial Cosmetic Surgery.

PubMed

Babadi, Hadis; Fereidooni-Moghadam, Malek; Dashtbozorgi, Bahman; Cheraghian, Bahman

2018-01-22

Despite the importance of cosmetic surgery in improving body image and promoting individuals' physical and mental health, it is accompanied with some physical, mental, and economic problems, because it is an invasive procedure. Considering such extensive consequences and given the rising demand for performing such surgeries, it is essential to consider programs for reducing such requests. The present study aimed to investigate the psychosocial causes of the tendency for facial cosmetic surgery in patients referred to medical centers in Ahvaz in 2016-2017. This study was conducted on 385 facial cosmetic surgery applicants referred to medical centers in Ahvaz and were selected using a sequential non-probability sampling method. The data collection tool was a questionnaire divided into two sections namely: (1) demographic questions and (2) a questionnaire on the psychosocial causes of the tendency for facial cosmetic surgery. The mean scores of the psychological and social causes of the tendency for facial cosmetic surgery were 4.46 (SD = 1.67) and 3.44 (SD = 2.57), respectively. "Being interested in being beautiful" was the most frequent positive response of the participants regarding the cause of tending to undergo facial cosmetic surgery (88.6%) and the least frequent response was estimated to be 35.1% for the "inappropriate psychological state" cause. The results of this study showed that psychological factors affected the participants' tendency for facial cosmetic surgery more than social factors. Determining and identifying such psychological pressures and providing individual training and psychological support can prevent individuals from undergoing facial cosmetic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Facial nerve palsy after reactivation of herpes simplex virus type 1 in diabetic mice.

PubMed

Esaki, Shinichi; Yamano, Koji; Katsumi, Sachiyo; Minakata, Toshiya; Murakami, Shingo

2015-04-01

Bell's palsy is highly associated with diabetes mellitus (DM). Either the reactivation of herpes simplex virus type 1 (HSV-1) or diabetic mononeuropathy has been proposed to cause the facial paralysis observed in DM patients. However, distinguishing whether the facial palsy is caused by herpetic neuritis or diabetic mononeuropathy is difficult. We previously reported that facial paralysis was aggravated in DM mice after HSV-1 inoculation of the murine auricle. In the current study, we induced HSV-1 reactivation by an auricular scratch following DM induction with streptozotocin (STZ). Controlled animal study. Diabetes mellitus was induced with streptozotocin injection in only mice that developed transient facial nerve paralysis with HSV-1. Recurrent facial palsy was induced after HSV-1 reactivation by auricular scratch. After DM induction, the number of cluster of differentiation 3 (CD3)(+) T cells decreased by 70% in the DM mice, and facial nerve palsy recurred in 13% of the DM mice. Herpes simplex virus type 1 deoxyribonucleic acid (DNA) was detected in the facial nerve of all of the DM mice with palsy, and HSV-1 capsids were found in the geniculate ganglion using electron microscopy. Herpes simplex virus type 1 DNA was also found in some of the DM mice without palsy, which suggested the subclinical reactivation of HSV-1. These results suggested that HSV-1 reactivation in the geniculate ganglion may be the main causative factor of the increased incidence of facial paralysis in DM patients. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Assessment of the cochlear nerve to facial nerve size ratio using MR multiplanar reconstruction of the internal auditory canal in patients presenting with acquired long-standing hearing loss

PubMed Central

Hey, Constanze; Shaaban, Mohamed S; Elabd, Amr M; Hassan, Hebatallah H M; Gruber-Rouh, Tatjana; Kaltenbach, Benjamin; Harth, Marc; Ackermann, Hanns; Stöver, Timo; Vogl, Thomas J; Nour-Eldin, Nour-Eldin A

2017-01-01

Objective: To test using the facial nerve as a reference for assessment of the cochlear nerve size in patients with acquired long-standing sensorineural hearing loss (SNHL) using MRI multiplanar reconstruction. Methods: The study was retrospectively performed on 86 patients. Group 1 (study group, n = 53) with bilateral long-standing SNHL. Group 2 (control group, n = 33) without hearing loss. The nerve size was measured by drawing a region of interest around the cross-sectional circumference of the nerve in multiplanar reconstruction images. Results: No significant correlation was noted between the cochlear nerve and facial nerve size, and the patient's age, gender and weight (p > 0.05). In Group 1, the mean ratio of the cochlear to facial nerve size was 0.99 ± 0.30 (range: 0.52–1.86) and 1.12 ± 0.35 (range: 0.34–2.3) for the right and left sides, respectively. In Group 2, it was 1.18 ± 0.23 (range: 0.78–1.71) and 1.25 ± 0.25 (range: 0.85–1.94) for the right and left sides, respectively. The cochlear nerve size was statistically (p = 0.0004) smaller in Group 1 than in Group 2. Conclusion: The cochlear nerve size and the cochlear to facial nerve size ratio are significantly smaller in patients with acquired long-standing SNHL. Advances in knowledge: The facial nerve can be used as a reference for assessment of the cochlear nerve in patients with acquired long-standing SNHL. PMID:28368665

Surgical and conservative methods for restoring impaired motor function - facial nerve, spinal accessory nerve, hypoglossal nerve (not including vagal nerve or swallowing)

PubMed Central

Laskawi, R.; Rohrbach, S.

2005-01-01

The present review gives a survey of rehabilitative measures for disorders of the motor function of the mimetic muscles (facial nerve), and muscles innervated by the spinal accessory and hypoglossal nerves. The dysfunction can present either as paralysis or hyperkinesis (hyperkinesia). Conservative and surgical treatment options aimed at restoring normal motor function and correcting the movement disorders are described. Static reanimation techniques are not dealt with. The final section describes the use of botulinum toxin in the therapy of dysphagia. PMID:22073058

A System for Delivering Mechanical Stimulation and Robot-Assisted Therapy to the Rat Whisker Pad during Facial Nerve Regeneration

PubMed Central

Heaton, James T.; Knox, Christopher; Malo, Juan; Kobler, James B.; Hadlock, Tessa A.

2013-01-01

Functional recovery is typically poor after facial nerve transection and surgical repair. In rats, whisking amplitude remains greatly diminished after facial nerve regeneration, but can recover more completely if the whiskers are periodically mechanically stimulated during recovery. Here we present a robotic “whisk assist” system for mechanically driving whisker movement after facial nerve injury. Movement patterns were either pre-programmed to reflect natural amplitudes and frequencies, or movements of the contralateral (healthy) side of the face were detected and used to control real-time mirror-like motion on the denervated side. In a pilot study, twenty rats were divided into nine groups and administered one of eight different whisk assist driving patterns (or control) for 5–20 minutes, five days per week, across eight weeks of recovery after unilateral facial nerve cut and suture repair. All rats tolerated the mechanical stimulation well. Seven of the eight treatment groups recovered average whisking amplitudes that exceeded controls, although small group sizes precluded statistical confirmation of group differences. The potential to substantially improve facial nerve recovery through mechanical stimulation has important clinical implications, and we have developed a system to control the pattern and dose of stimulation in the rat facial nerve model. PMID:23475376

Necrotizing sialometaplasia of the parotid gland associated with facial nerve paralysis.

PubMed

Haen, P; Ben Slama, L; Goudot, P; Schouman, T

2017-02-01

Necrotizing sialometaplasia is a benign inflammatory lesion involving most frequently the minor salivary gland of the hard palate. Involvement of the parotid gland is rare, involvement of the parotid gland associated with facial palsy is exceptional. A 56-year-old male patient with Marfan syndrome presented with swelling and inflammation of the left parotid gland associated with progressively complete facial nerve paralysis. CT scan and MRI showed a parotid collection with hyper signal of the nearest tissues associated with erosion of the styloid process. A malignant tumor was suspected. The histological examination of a biopsy showed a lobulocentric process with necrosis, squamous metaplasia, and inflammation. The immunohistochemical examination supported a final diagnosis of necrotizing sialometaplasia. Necrotizing sialometaplasia of the parotid gland associated with facial nerve paralysis presents like a malignant neoplasm, both clinically and histologically. Only advanced immunohistochemical examination can really confirm the diagnosis. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

[Applied anatomy of facial recess and posterior tympanum related to cochlear implantation].

PubMed

Zou, Tuanming; Xie, Nanping; Guo, Menghe; Shu, Fan; Zhang, Hongzheng

2012-05-01

To investigate the related parameters of temporal bone structure in the surgery of cochlear implantation through facial recess approach so as to offer a theoretical reference for the avoidance of facial nerve injury and the accurate localization. In a surgical simulation experiment, twenty human temporal bones were studied. The correlation parameters were measured under surgical microscope. Distance between suprameatal spine and short process of incus was (12.44 +/- 0.51) mm. Width from crotch of chorda tympani nerve to stylomastoid foramen was (2.67 +/- 0.51) mm. Distance between short process of incus and crotch of chorda tympani nerve was (15.22 +/- 0.83) mm. The location of maximal width of the facial recess into short process of incus, crotch of chorda tympani nerve were (6.28 +/- 0.41) mm, (9.81 +/- 0.71) mm, respectively. The maximal width of the facial recess was (2.73 +/- 0.20) mm. The value at level of stapes and round window were (2.48 +/- 0.20 mm) and (2.24 +/- 0.18) mm, respectively. Distance between pyramidalis eminence and anterior round window was (2.22 +/- 0.21) mm. Width from stapes to underneath round window was (2.16 +/- 0.14) mm. These parameters provide a reference value to determine the position of cochlear inserting the electrode array into the scale tympani and opening facial recess firstly to avoid potential damage to facial nerve in surgery.

Parotid gland tumours: MR tractography to assess contact with the facial nerve.

PubMed

Attyé, Arnaud; Karkas, Alexandre; Troprès, Irène; Roustit, Matthieu; Kastler, Adrian; Bettega, Georges; Lamalle, Laurent; Renard, Félix; Righini, Christian; Krainik, Alexandre

2016-07-01

To assess the feasibility of intraparotid facial nerve (VIIn) tractographic reconstructions in estimating the presence of a contact between the VIIn and the tumour, in patients requiring surgical resection of parotid tumours. Patients underwent MR scans with VIIn tractography calculated with the constrained spherical deconvolution model. The parameters of the diffusion sequence were: b-value of 1000 s/mm(2); 32 directions; voxel size: 2 mm isotropic; scan time: 9'31'. The potential contacts between VIIn branches and tumours were estimated with different initial fractional anisotropy (iFA) cut-offs compared to surgical data. Surgeons were blinded to the tractography reconstructions and identified both nerves and contact with tumours using nerve stimulation and reference photographs. Twenty-six patients were included in this study and the mean patient age was 55.2 years. Surgical direct assessment of VIIn allowed identifying 0.1 as the iFA threshold with the best sensitivity to detect tumour contact. In all patients with successful VIIn identification by tractography, surgeons confirmed nerve courses as well as lesion location in parotid glands. Mean VIIn branch FA values were significantly lower in cases with tumour contact (t-test; p ≤ 0.01). This study showed the feasibility of intraparotid VIIn tractography to identify nerve contact with parotid tumours. • Diffusion imaging is an efficient method for highlighting the intraparotid VIIn. • Visualization of the VIIn may help to better manage patients before surgery. • We bring new insights to future trials for patients with VIIn dysfunction. • We aimed to provide radio-anatomical references for further studies.

[Using infrared thermal asymmetry analysis for objective assessment of the lesion of facial nerve function].

PubMed

Liu, Xu-long; Hong, Wen-xue; Song, Jia-lin; Wu, Zhen-ying

2012-03-01

The skin temperature distribution of a healthy human body exhibits a contralateral symmetry. Some lesions of facial nerve function are associated with an alteration of the thermal distribution of the human body. Since the dissipation of heat through the skin occurs for the most part in the form of infrared radiation, infrared thermography is the method of choice to capture the alteration of the infrared thermal distribution. This paper presents a new method of analysis of the thermal asymmetry named effective thermal area ratio, which is a product of two variables. The first variable is mean temperature difference between the specific facial region and its contralateral region. The second variable is a ratio, which is equal to the area of the abnormal region divided by the total area. Using this new method, we performed a controlled trial to assess the facial nerve function of the healthy subjects and the patients with Bell's palsy respectively. The results show: that the mean specificity and sensitivity of this method are 0.90 and 0.87 respectively, improved by 7% and 26% compared with conventional methods. Spearman correlation coefficient between effective thermal area ratio and the degree of facial nerve function is an average of 0.664. Hence, concerning the diagnosis and assessment of facial nerve function, infrared thermography is a powerful tool; while the effective ther mal area ratio is an efficient clinical indicator.

Reconstruction of Multiple Facial Nerve Branches Using Skeletal Muscle-Derived Multipotent Stem Cell Sheet-Pellet Transplantation.

PubMed

Saito, Kosuke; Tamaki, Tetsuro; Hirata, Maki; Hashimoto, Hiroyuki; Nakazato, Kenei; Nakajima, Nobuyuki; Kazuno, Akihito; Sakai, Akihiro; Iida, Masahiro; Okami, Kenji

2015-01-01

Head and neck cancer is often diagnosed at advanced stages, and surgical resection with wide margins is generally indicated, despite this treatment being associated with poor postoperative quality of life (QOL). We have previously reported on the therapeutic effects of skeletal muscle-derived multipotent stem cells (Sk-MSCs), which exert reconstitution capacity for muscle-nerve-blood vessel units. Recently, we further developed a 3D patch-transplantation system using Sk-MSC sheet-pellets. The aim of this study is the application of the 3D Sk-MSC transplantation system to the reconstitution of facial complex nerve-vascular networks after severe damage. Mouse experiments were performed for histological analysis and rats were used for functional examinations. The Sk-MSC sheet-pellets were prepared from GFP-Tg mice and SD rats, and were transplanted into the facial resection model (ST). Culture medium was transplanted as a control (NT). In the mouse experiment, facial-nerve-palsy (FNP) scoring was performed weekly during the recovery period, and immunohistochemistry was used for the evaluation of histological recovery after 8 weeks. In rats, contractility of facial muscles was measured via electrical stimulation of facial nerves root, as the marker of total functional recovery at 8 weeks after transplantation. The ST-group showed significantly higher FNP (about three fold) scores when compared to the NT-group after 2-8 weeks. Similarly, significant functional recovery of whisker movement muscles was confirmed in the ST-group at 8 weeks after transplantation. In addition, engrafted GFP+ cells formed complex branches of nerve-vascular networks, with differentiation into Schwann cells and perineurial/endoneurial cells, as well as vascular endothelial and smooth muscle cells. Thus, Sk-MSC sheet-pellet transplantation is potentially useful for functional reconstitution therapy of large defects in facial nerve-vascular networks.

Reconstruction of Multiple Facial Nerve Branches Using Skeletal Muscle-Derived Multipotent Stem Cell Sheet-Pellet Transplantation

PubMed Central

Saito, Kosuke; Tamaki, Tetsuro; Hirata, Maki; Hashimoto, Hiroyuki; Nakazato, Kenei; Nakajima, Nobuyuki; Kazuno, Akihito; Sakai, Akihiro; Iida, Masahiro; Okami, Kenji

2015-01-01

Head and neck cancer is often diagnosed at advanced stages, and surgical resection with wide margins is generally indicated, despite this treatment being associated with poor postoperative quality of life (QOL). We have previously reported on the therapeutic effects of skeletal muscle-derived multipotent stem cells (Sk-MSCs), which exert reconstitution capacity for muscle-nerve-blood vessel units. Recently, we further developed a 3D patch-transplantation system using Sk-MSC sheet-pellets. The aim of this study is the application of the 3D Sk-MSC transplantation system to the reconstitution of facial complex nerve-vascular networks after severe damage. Mouse experiments were performed for histological analysis and rats were used for functional examinations. The Sk-MSC sheet-pellets were prepared from GFP-Tg mice and SD rats, and were transplanted into the facial resection model (ST). Culture medium was transplanted as a control (NT). In the mouse experiment, facial-nerve-palsy (FNP) scoring was performed weekly during the recovery period, and immunohistochemistry was used for the evaluation of histological recovery after 8 weeks. In rats, contractility of facial muscles was measured via electrical stimulation of facial nerves root, as the marker of total functional recovery at 8 weeks after transplantation. The ST-group showed significantly higher FNP (about three fold) scores when compared to the NT-group after 2–8 weeks. Similarly, significant functional recovery of whisker movement muscles was confirmed in the ST-group at 8 weeks after transplantation. In addition, engrafted GFP+ cells formed complex branches of nerve-vascular networks, with differentiation into Schwann cells and perineurial/endoneurial cells, as well as vascular endothelial and smooth muscle cells. Thus, Sk-MSC sheet-pellet transplantation is potentially useful for functional reconstitution therapy of large defects in facial nerve-vascular networks. PMID:26372044

Facial paralysis for the plastic surgeon.

PubMed

Kosins, Aaron M; Hurvitz, Keith A; Evans, Gregory Rd; Wirth, Garrett A

2007-01-01

Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis.The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain.With respect to facial paralysis, surgeons tend to focus on the surgical, or 'hands-on', aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and botulinum toxin injection, but these are beyond the scope of the present paper.

Facial paralysis for the plastic surgeon

PubMed Central

Kosins, Aaron M; Hurvitz, Keith A; Evans, Gregory RD; Wirth, Garrett A

2007-01-01

Facial paralysis presents a significant and challenging reconstructive problem for plastic surgeons. An aesthetically pleasing and acceptable outcome requires not only good surgical skills and techniques, but also knowledge of facial nerve anatomy and an understanding of the causes of facial paralysis. The loss of the ability to move the face has both social and functional consequences for the patient. At the Facial Palsy Clinic in Edinburgh, Scotland, 22,954 patients were surveyed, and over 50% were found to have a considerable degree of psychological distress and social withdrawal as a consequence of their facial paralysis. Functionally, patients present with unilateral or bilateral loss of voluntary and nonvoluntary facial muscle movements. Signs and symptoms can include an asymmetric smile, synkinesis, epiphora or dry eye, abnormal blink, problems with speech articulation, drooling, hyperacusis, change in taste and facial pain. With respect to facial paralysis, surgeons tend to focus on the surgical, or ‘hands-on’, aspect. However, it is believed that an understanding of the disease process is equally (if not more) important to a successful surgical outcome. The purpose of the present review is to describe the anatomy and diagnostic patterns of the facial nerve, and the epidemiology and common causes of facial paralysis, including clinical features and diagnosis. Treatment options for paralysis are vast, and may include nerve decompression, facial reanimation surgery and botulinum toxin injection, but these are beyond the scope of the present paper. PMID:19554190

Facial-zygomatic triangle: a relationship between the extracranial portion of facial nerve and the zygomatic arch.

PubMed

Campero, A; Socolovsky, M; Martins, C; Yasuda, A; Torino, R; Rhoton, A L

2008-03-01

This study was conducted to clarify the relationships between the extracranial portion of the facial nerve (EFN) and the zygomatic arch (ZA). Four cadaveric heads (8 parotid regions), examined under 3-40x magnification, were dissected from lateral to medial to expose the EFN. In a vertical plane just anterior to the tragus, the distance from the superior edge of the ZA to the facial nerve (FN) is, on average, 26.88 mm. The FN then courses superiorly and anteriorly, crossing the ZA 18.65 mm anterior to the tragus on average. Thus, three points can be used to depict a triangle: A, at the level of the anterior border of the tragus, just above the superior edge of the ZA; B, 26 mm below A; and C, 18 mm anterior to A. This so called facial-zygomatic triangle represents the area where surgical dissection can be performed with no risk of damaging the FN. Thus, the closer one stays to the tragus, the lesser the risk of damaging the FN below the ZA. If the incision is carried out on a vertical plane closer to the tragus, the skin can be safely cut up to 2 cm below the ZA. The facial-zygomatic triangle is a very useful superficial landmark to avoid FN damage when working below the ZA.

Large intraparotid facial nerve schwannoma: case report and review of the literature.

PubMed

Salemis, N S; Karameris, A; Gourgiotis, S; Stavrinou, P; Nazos, K; Vlastarakos, P; Tsiambas, E; Tsohataridis, E

2008-07-01

Here is reported an extremely rare case of a large intraparotid facial nerve schwannoma in a 32-year-old female who presented with a parotid mass. There had been a long clinical course and sudden onset of facial weakness. Diagnostic evaluation and surgical management are discussed along with a brief review of the literature.

Repair of facial nerve defects with decellularized artery allografts containing autologous adipose-derived stem cells in a rat model.

PubMed

Sun, Fei; Zhou, Ke; Mi, Wen-Juan; Qiu, Jian-Hua

2011-07-20

The purpose of this study was to investigate the effects of a decellularized artery allograft containing autologous adipose-derived stem cells (ADSCs) on an 8-mm facial nerve branch lesion in a rat model. At 8 weeks postoperatively, functional evaluation of unilateral vibrissae movements, morphological analysis of regenerated nerve segments and retrograde labeling of facial motoneurons were all analyzed. Better regenerative outcomes associated with functional improvement, great axonal growth, and improved target reinnervation were achieved in the artery-ADSCs group (2), whereas the cut nerves sutured with artery conduits alone (group 1) achieved inferior restoration. Furthermore, transected nerves repaired with nerve autografts (group 3) resulted in significant recovery of whisking, maturation of myelinated fibers and increased number of labeled facial neurons, and the latter two parameters were significantly different from those of group 2. Collectively, though our combined use of a decellularized artery allograft with autologous ADSCs achieved regenerative outcomes inferior to a nerve autograft, it certainly showed a beneficial effect on promoting nerve regeneration and thus represents an alternative approach for the reconstruction of peripheral facial nerve defects. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Cosmetic surgery procedures as luxury goods: measuring price and demand in facial plastic surgery.

PubMed

Alsarraf, Ramsey; Alsarraf, Nicole W; Larrabee, Wayne F; Johnson, Calvin M

2002-01-01

To evaluate the relationship between cosmetic facial plastic surgery procedure price and demand, and to test the hypothesis that these procedures function as luxury goods in the marketplace, with an upward-sloping demand curve. Data were derived from a survey that was sent to every (N = 1727) active fellow, member, or associate of the American Academy of Facial Plastic and Reconstructive Surgery, assessing the costs and frequency of 4 common cosmetic facial plastic surgery procedures (face-lift, brow-lift, blepharoplasty, and rhinoplasty) for 1999 and 1989. An economic analysis was performed to assess the relationship of price and demand for these procedures. A significant association was found between increasing surgeons' fees and total charges for cosmetic facial plastic surgery procedures and increasing demand for these procedures, as measured by their annual frequency (Pfacial plastic surgery procedures do appear to function as luxury goods in the marketplace, with an upward-sloping demand curve. This stands in contrast to other, traditional, goods for which demand typically declines as price increases. It appears that economic methods can be used to evaluate cosmetic procedure trends; however, these methods must be founded on the appropriate economic theory.

Recurrent phosphaturic mesenchymal tumour of the temporal bone causing deafness and facial nerve palsy.

PubMed

Syed, M I; Chatzimichalis, M; Rössle, M; Huber, A M

2012-07-01

We describe the first reported case of a phosphaturic mesenchymal tumour, mixed connective tissue variant, invading the temporal bone. A female patient presented with increasing deafness. On examination there appeared to be a mass behind an intact tympanic membrane. Further radiological investigation showed a vascular mass occupying the middle ear, mastoid and internal auditory meatus. This was surgically resected and revealed to be a benign phosphaturic mesenchymal tumour, mixed connective tissue variant. The tumour recurred a year later, presenting as facial nerve palsy. A revision procedure was carried out; the tumour was excised with the sacrifice of a segment of the facial nerve, and a facial-hypoglossal nerve anastomosis was performed. This case report highlights the occurrence of this benign but sometimes aggressive tumour, of which both clinicians and pathologists should be aware. Early recognition of the condition remains of utmost importance to minimise the debilitating consequences of long-term osteomalacia in affected patients, and to prevent extracranial and intracranial complications caused by the tumour.

Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report.

PubMed

Casal, Diogo; Pelliccia, Giovanni; Pais, Diogo; Carrola-Gomes, Diogo; Angélica-Almeida, Maria; Videira-Castro, José; Goyri-O'Neill, João

2017-07-29

Open injuries to the face involving the external carotid artery are uncommon. These injuries are normally associated with laceration of the facial nerve because this nerve is more superficial than the external carotid artery. Hence, external carotid artery lesions are usually associated with facial nerve dysfunction. We present an unusual case report in which the patient had an injury to this artery with no facial nerve compromise. A 25-year-old Portuguese man sustained a stab wound injury to his right preauricular region with a broken glass. Immediate profuse bleeding ensued. Provisory tamponade of the wound was achieved at the place of aggression by two off-duty doctors. He was initially transferred to a district hospital, where a large arterial bleeding was observed and a temporary compressive dressing was applied. Subsequently, the patient was transferred to a tertiary hospital. At admission in the emergency room, he presented a pulsating lesion in the right preauricular region and slight weakness in the territory of the inferior buccal branch of the facial nerve. The physical examination suggested an arterial lesion superficial to the facial nerve. However, in the operating theater, a section of the posterior and lateral flanks of the external carotid artery inside the parotid gland was identified. No lesion of the facial nerve was observed, and the external carotid artery was repaired. To better understand the anatomical rationale of this uncommon clinical case, we dissected the preauricular region of six cadavers previously injected with colored latex solutions in the vascular system. A small triangular space between the two main branches of division of the facial nerve in which the external carotid artery was not covered by the facial nerve was observed bilaterally in all cases. This clinical case illustrates that, in a preauricular wound, the external carotid artery can be injured without facial nerve damage. However, no similar description was found in

Electrical response grading versus House-Brackmann scale for evaluation of facial nerve injury after Bell's palsy: a comparative study.

PubMed

Huang, Bin; Zhou, Zhang-ling; Wang, Li-li; Zuo, Cong; Lu, Yan; Chen, Yong

2014-07-01

There are no convenient techniques to evaluate the degree of facial nerve injury during a course of acupuncture treatment for Bell's palsy. Our previous studies found that observing the electrical response of specific facial muscles provided reasonable correlation with the prognosis of electroacupuncture treatment. Hence, we used the new method to evaluate the degree of facial nerve injury in patients with Bell's palsy in comparison with the House-Brackmann scale. The relationship between therapeutic effects and prognosis was analyzed to explore an objective method for evaluating Bell's palsy. The facial nerve function of 68 patients with Bell's palsy was assessed with both electrical response grading and the House-Brackmann scale before treatment. Then differences in evaluation results of the two methods were compared. All enrolled patients received electroacupuncture treatment with disperse-dense wave at 1/100 Hz for 4 weeks. After treatment, correlation analysis was conducted to find the relationship between electrical response and therapeutic effects or prognosis. Checking consistency between electrical response grading and House-Brackmann scale: Kappa value 0.028 (P = 0.578). Correlation analysis: the two methods were correlated with the prognosis, and electrical response grading (rER = 0.789) was better than the House-Brackmann scale (rHB = 0.423). Electrical response grading is superior to the House-Brackmann scale in efficacy and reliability, and can conveniently assess the degree of facial nerve injury. The House-Brackmann scale is suitable for the patients with mild facial nerve injury, but its evaluation quality for severe facial nerve injury is poor.

A System for Studying Facial Nerve Function in Rats through Simultaneous Bilateral Monitoring of Eyelid and Whisker Movements

PubMed Central

Heaton, James T.; Kowaleski, Jeffrey M.; Bermejo, Roberto; Zeigler, H. Philip; Ahlgren, David J.; Hadlock, Tessa A.

2008-01-01

The occurrence of inappropriate co-contraction of facially innervated muscles in humans (synkinesis) is a common sequela of facial nerve injury and recovery. We have developed a system for studying facial nerve function and synkinesis in restrained rats using non-contact opto-electronic techniques that enable simultaneous bilateral monitoring of eyelid and whisker movements. Whisking is monitored in high spatio-temporal resolution using laser micrometers, and eyelid movements are detected using infrared diode and phototransistor pairs that respond to the increased reflection when the eyelids cover the cornea. To validate the system, eight rats were tested with multiple five-minute sessions that included corneal air puffs to elicit blink and scented air flows to elicit robust whisking. Four rats then received unilateral facial nerve section and were tested at weeks 3–6. Whisking and eye blink behavior occurred both spontaneously and under stimulus control, with no detectable difference from published whisking data. Proximal facial nerve section caused an immediate ipsilateral loss of whisking and eye blink response, but some ocular closures emerged due to retractor bulbi muscle function. The independence observed between whisker and eyelid control indicates that this system may provide a powerful tool for identifying abnormal co-activation of facial zones resulting from aberrant axonal regeneration. PMID:18442856

Analysis of the efficacy of marketing tools in facial plastic surgery.

PubMed

Zavod, Matthew B; Adamson, Peter A

2008-06-01

To compare referral sources to a facial plastic surgery practice and to develop models correlating the referral source with the decision for surgery. Retrospective descriptive study. Well-established, metropolitan, private facial plastic surgery practice with training fellowship affiliated with an academic centre. One-thousand eighty-nine new consecutive patients presenting between January 2001 and December 2005 recorded intake data including age, gender, and chief complaint. Final data input was their decision for or against surgery. Main outcome measures included differences in referral sources based on data collected and how those sources related to decision for surgery. A 50% conversion rate was found. Women and older patients were more likely to be referred from magazines, television, and newspapers and for facial rejuvenation. Men and younger patients were more likely to be referred from the website and for rhinoplasty. For facial rejuvenation, both the number of patients interested in and the probability that they agreed to the procedure increased with age. For rhinoplasty, the converse was true. The most likely patients to schedule surgery were those who were referred from other patients, friends, or family members in our practice. The data confirm that word-of-mouth referrals are the most important source for predicting which patients will elect to proceed with surgery in this established facial cosmetic surgery practice.

Inter- and intrapatient variability of facial nerve response areas in the floor of the fourth ventricle.

PubMed

Bertalanffy, Helmut; Tissira, Nadir; Krayenbühl, Niklaus; Bozinov, Oliver; Sarnthein, Johannes

2011-03-01

Surgical exposure of intrinsic brainstem lesions through the floor of the 4th ventricle requires precise identification of facial nerve (CN VII) fibers to avoid damage. To assess the shape, size, and variability of the area where the facial nerve can be stimulated electrophysiologically on the surface of the rhomboid fossa. Over a period of 18 months, 20 patients were operated on for various brainstem and/or cerebellar lesions. Facial nerve fibers were stimulated to yield compound muscle action potentials (CMAP) in the target muscles. Using the sites of CMAP yield, a detailed functional map of the rhomboid fossa was constructed for each patient. Lesions resected included 14 gliomas, 5 cavernomas, and 1 epidermoid cyst. Of 40 response areas mapped, 19 reached the median sulcus. The distance from the obex to the caudal border of the response area ranged from 8 to 27 mm (median, 17 mm). The rostrocaudal length of the response area ranged from 2 to 15 mm (median, 5 mm). Facial nerve response areas showed large variability in size and position, even in patients with significant distance between the facial colliculus and underlying pathological lesion. Lesions located close to the facial colliculus markedly distorted the response area. This is the first documentation of variability in the CN VII response area in the rhomboid fossa. Knowledge of this remarkable variability may facilitate the assessment of safe entry zones to the brainstem and may contribute to improved outcome following neurosurgical interventions within this sensitive area of the brain.

Attempt of peripheral nerve reconstruction during lung cancer surgery.

PubMed

Li, Hanyue; Hu, Yingjie; Huang, Jia; Yang, Yunhai; Xing, Kaichen; Luo, Qingquan

2018-05-01

Vagus nerve and recurrent laryngeal nerve (RLN) injury are not rare complications of lung cancer surgery and can cause lethal consequences. Until now, no optimal method other than paying greater attention during surgery has been available. Four patients underwent lung surgery that involved RLN or vagus nerve injury. The left RLN or vagus nerve was cut off and then reconstructed immediately during surgery. Two patients underwent direct anastomosis, while the remaining two underwent phrenic nerve replacing tension-relieving anastomosis. All patients were able to speak immediately after recovery. No or minimal glottal gap was observed during laryngoscopy conducted on the second day after surgery. Most patients achieved full recovery of voice quality. Immediate reconstruction of RLN is technically feasible and can be carried out with satisfying short-term and long-term outcomes. © 2018 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

[Orthognathic surgery, master-piece of maxillo-facial surgery].

PubMed

Reychler, H

2001-01-01

Orthognathic surgery is this field of the maxillofacial surgery which aims to reposition the jaws or some segments of these jaws when masticatory dysfunctions are evident. This tridimensional repositioning in the craniofacial skeleton allows to restore the masticatory function by means of osteotomies, which must be followed either by preoperative simulated bony displacements or by callus bone distraction. Not only are the functional benefits evident on the dental, articular and neuromuscular levels, but also a facial esthetic harmony can almost be obtained.

Mastoid bone fracture presenting as unusual delayed onset of facial nerve palsy.

PubMed

Hsu, Ko-Chiang; Wang, Ann-Ching; Chen, Shyi-Jou

2008-03-01

Delayed-onset facial nerve paralysis is a rather uncommon complication of a mastoid bone fracture for children younger than 10 years. We routinely arrange a cranial computed tomography (CT) for patients encountering initial loss of consciousness, severe headache, intractable vomiting, and/or any neurologic deficit arising from trauma to the head. However, minor symptomatic cranial nerve damage may be missed and the presenting symptom diagnosed as being a peripheral nerve problem. Herein, we report a case of a young boy who presented at our emergency department (ED) 3 days subsequent to his accident, complaining of hearing loss in the right ear and paralysis of the ipsilateral face. Unpredictably, we observed his cranial CT scan revealing a linear fracture of the skull over the right temporal bone involving the right mastoid air cells. The patient was treated conservatively and recovered well without any adverse neurologic consequences. We emphasize that ED physicians should arrange a cranial CT scan for a head-injured child with symptomatic facial nerve palsy, even if there are no symptoms such as severe headache, vomiting, Battle sign, and/or initial loss of consciousness.

Case analysis of temporal bone lesions with facial paralysis as main manifestation and literature review.

PubMed

Chen, Wen-Jing; Ye, Jing-Ying; Li, Xin; Xu, Jia; Yi, Hai-Jin

2017-08-23

This study aims to discuss clinical characteristics, image manifestation and treatment methods of temporal bone lesions with facial paralysis as the main manifestation for deepening the understanding of such type of lesions and reducing erroneous and missed diagnosis. The clinical data of 16 patients with temporal bone lesions and facial paralysis as main manifestation, who were diagnosed and treated from 2009 to 2016, were retrospectively analyzed. Among these patients, six patients had congenital petrous bone cholesteatoma (PBC), nine patients had facial nerve schwannoma, and one patient had facial nerve hemangioma. All the patients had an experience of long-term erroneous diagnosis. The lesions were completely excised by surgery. PBC and primary facial nerve tumors were pathologically confirmed. Facial-hypoglossal nerve anastomosis was performed on two patients. HB grade VI was recovered to HB grade V in one patient. The anastomosis failed due to severe facial nerve fibrosis in one patient. Hence, HB remained at grade VI. Postoperative recovery was good for all patients. No lesion recurrence was observed after 1-6 years of follow-up. For the patients with progressive or complete facial paralysis, imaging examination should be perfected in a timely manner. Furthermore, PBC, primary facial nerve tumors and other temporal bone space-occupying lesions should be eliminated. Lesions should be timely detected and proper intervention should be conducted, in order to reduce operation difficulty and complications, and increase the opportunity of facial nerve function reconstruction.

Microcystic adnexal carcinoma (MAC)-like squamous cell carcinoma as a differential diagnosis to Bell´s palsy: review of guidelines for refractory facial nerve palsy.

PubMed

Mueller, S K; Iro, H; Lell, M; Seifert, F; Bohr, C; Scherl, C; Agaimy, A; Traxdorf, M

2017-01-05

Bell´s palsy is the most common cause of facial paralysis worldwide and the most common disorder of the cranial nerves. It is a diagnosis of exclusion, accounting for 60-75% of all acquired peripheral facial nerve palsies. Our case shows the first case of a microcystic adnexal carcinoma-like squamous cell carcinoma as a cause of facial nerve palsy. The patient, a 70-year-old Caucasian male, experienced subsequent functional impairment of the trigeminal and the glossopharyngeal nerve about 1½ years after refractory facial nerve palsy. An extensive clinical work-up and tissue biopsy of the surrounding parotid gland tissue was not able to determine the cause of the paralysis. Primary infiltration of the facial nerve with subsequent spreading to the trigeminal and glossopharyngeal nerve via neuroanastomoses was suspected. After discussing options with the patient, the main stem of the facial nerve was resected to ascertain the diagnosis of MAC-like squamous cell carcinoma, and radiochemotherapy was subsequently started. This case report shows that even rare neoplastic etiologies should be considered as a cause of refractory facial nerve palsy and that it is necessary to perform an extended diagnostic work-up to ascertain the diagnosis. This includes high-resolution MRI imaging and, as perilesional parotid biopsies might be inadequate for rare cases like ours, consideration of a direct nerve biopsy to establish the right diagnosis.

Physiotherapy in patients with facial nerve paresis: description of outcomes.

PubMed

Beurskens, Carien H G; Heymans, Peter G

2004-01-01

The purpose of this study was to describe changes and stabilities of long-term sequelae of facial paresis in outpatients receiving mime therapy, a form of physiotherapy. Archived data of 155 patients with peripheral facial nerve paresis were analyzed. Main outcome measures were (1) impairments: facial symmetry in rest and during movements and synkineses; (2) disabilities: eating, drinking, and speaking; and (3) quality of life. Symmetry at rest improved significantly; the average severity of the asymmetry in all movements decreased. The number of synkineses increased for 3 out of 8 movements; however, the group average severities decreased for 6 movements; substantially fewer patients reported disabilities in eating, drinking, and speaking; and quality of life improved significantly. During a period of approximately 3 months, significant changes in many aspects of facial functioning were observed, the relative position of patients remaining stable over time. Observed changes occurred while the patients participated in a program for facial rehabilitation (mime therapy), replicating the randomized controlled trial-proven benefits of mime therapy in a more varied sample of outpatients.

A new entity in the differential diagnosis of geniculate ganglion tumours: fibrous connective tissue lesion of the facial nerve.

PubMed

de Arriba, Alvaro; Lassaletta, Luis; Pérez-Mora, Rosa María; Gavilán, Javier

2013-01-01

Differential diagnosis of geniculate ganglion tumours includes chiefly schwannomas, haemangiomas and meningiomas. We report the case of a patient whose clinical and imaging findings mimicked the presentation of a facial nerve schwannoma.Pathological studies revealed a lesion with nerve bundles unstructured by intense collagenisation. Consequently, it was called fibrous connective tissue lesion of the facial nerve. Copyright © 2011 Elsevier España, S.L. All rights reserved.

[Lengthening temporalis myoplasty: A new approach to facial rehabilitation with the "mirror-effect" method].

PubMed

Blanchin, T; Martin, F; Labbe, D

2013-12-01

Peripheral facial paralysis often reveals two conditions that are hard to control: labial occlusion and palpebral closure. Today, there are efforts to go beyond the sole use of muscle stimulation techniques, and attention is being given to cerebral plasticity stimulation? This implies using the facial nerves' efferent pathway as the afferent pathway in rehabilitation. This technique could further help limit the two recalcitrant problems, above. We matched two groups of patients who underwent surgery for peripheral facial paralysis by lengthening the temporalis myoplasty (LTM). LTM is one of the best ways to examine cerebral plasticity. The trigeminal nerve is a mixed nerve and is both motor and sensory. After a LTM, patients have to use the trigeminal nerve differently, as it now has a direct role in generating the smile. The LTM approach, using the efferent pathway, therefore, creates a challenge for the brain. The two groups followed separate therapies called "classical" and "mirror-effect". The "mirror-effect" method gave a more precise orientation of the patient's cerebral plasticity than did the classical rehabilitation. The method develops two axes: voluntary movements patients need to control their temporal smile; and spontaneous movements needed for facial expressions. Work on voluntary movements is done before a "digital mirror", using an identical doubled hemiface, providing the patient with a fake copy of his face and, thus, a 7 "mirror-effect". The spontaneous movements work is based on what we call the "Therapy of Motor Emotions". The method presented here is used to treat facial paralysis (Bell's Palsies type), whether requiring surgery or not. Importantly, the facial nerve, like the trigeminal nerve above, is also a mixed nerve and is stimulated through the efferent pathway in the same manner. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Fetal facial nerve course in the ear region revisited.

PubMed

Jin, Zhe Wu; Cho, Kwang Ho; Abe, Hiroshi; Katori, Yukio; Murakami, Gen; Rodríguez-Vázquez, Jose Francisco

2017-08-01

The aim of this study was to re-examine the structures that determine course of the facial nerve (FN) in the fetal ear region. We used sagittal or horizontal sections of 28 human fetuses at 7-8, 12-16, and 25-37 weeks. The FN and the chorda tympani nerve ran almost parallel until 7 weeks. The greater petrosal nerve (GPN) ran vertical to the distal FN course due to the trigeminal nerve ganglion being medial to the geniculate ganglion at 7 weeks. Afterwards, due to the radical growth of the former ganglion, the GPN became an anterior continuation of the FN. The lesser petrosal nerve ran straight, parallel to the FN at 7 weeks, but later, it started to wind along the otic capsule, possibly due to the upward invasion of the tympanic cavity epithelium. Notably, the chorda tympanic nerve origin from the FN, and the crossing between the vagus nerve branch and the FN, was located outside of the temporal bone even at 37 weeks. The second knee of the FN was not evident, in contrast to the acute anterior turn below the chorda tympanic nerve origin. In all examined fetuses, the apex of the cochlea did not face the middle cranial fossa, but the tympanic cavity. Topographical relation among the FN and related nerves in the ear region seemed not to be established in the fetal age but after birth depending on growth of the cranial fossa.

Management of synkinesis and asymmetry in facial nerve palsy: a review article.

PubMed

Pourmomeny, Abbas Ali; Asadi, Sahar

2014-10-01

The important sequelae of facial nerve palsy are synkinesis, asymmetry, hypertension and contracture; all of which have psychosocial effects on patients. Synkinesis due to mal regeneration causes involuntary movements during a voluntary movement. Previous studies have advocated treatment using physiotherapy modalities alone or with exercise therapy, but no consensus exists on the optimal approach. Thus, this review summarizes clinical controlled studies in the management of synkinesis and asymmetry in facial nerve palsy. Case-controlled clinical studies of patients at the acute stage of injury were selected for this review article. Data were obtained from English-language databases from 1980 until mid-2013. Among 124 articles initially captured, six randomized controlled trials involving 269 patients were identified with appropriate inclusion criteria. The results of all these studies emphasized the benefit of exercise therapy. Four studies considered electromyogram (EMG) biofeedback to be effective through neuromuscular re-education. Synkinesis and inconsistency of facial muscles could be treated with educational exercise therapy. EMG biofeedback is a suitable tool for this exercise therapy.

The positional relationship between facial nerve and round window niche in patients with congenital aural atresia and stenosis.

PubMed

Chen, Keguang; Lyu, Huiying; Xie, Youzhou; Yang, Lin; Zhang, Tianyu; Dai, Peidong

2016-03-01

To investigate whether differences existing in the distance between facial nerve (FN) and round window niche opening among congenital aural atresia (CAA), congenital aural stenosis (CAS) and a normal control group and to assess its effect on the round window implantation of vibrant soundbridge, CT images of 10 normal subjects (20 ears), 27 CAS patients (30 ears) and 25 CAA patients (30 ears) were analyzed. The distances from the central point of round window niche opening to the terminal point of the horizontal segment, the salient point of pyramidal segment, the beginning point of the vertical segment, and the vertical segment of the facial nerve (abbreviate as OA, OB, OC, OE, respectively) were calculated based on three-dimensional reconstruction using mimics software. The results suggested that the pyramidal segment of the FN was positioned more closely to round window niche opening in patients with both CAA and CAS groups than that in control group, whereas there was no significant difference between CAA and CAS group (P < 0.05). The vertical portion of the FN was positioned more closely to round window niche opening in the CAA group than those in both the CAS and control groups with statistical significance (P < 0.05). Furthermore, the vertical portion of the FN was positioned more closely to round window niche opening in the CAS group than that in control group (P < 0.05). In conclusion, the dislocation between facial nerve and round window niche in patients with congenital auditory canal malformations could have significant effects on the round window implantation of vibrant soundbridge. Moreover, three-dimensional measurements and assessments before surgery might be helpful for a safer surgical approach and implantation of vibrant soundbridge.

Farris-Tang retractor in optic nerve sheath decompression surgery.

PubMed

Spiegel, Jennifer A; Sokol, Jason A; Whittaker, Thomas J; Bernard, Benjamin; Farris, Bradley K

2016-01-01

Our purpose is to introduce the use of the Farris-Tang retractor in optic nerve sheath decompression surgery. The procedure of optic nerve sheath fenestration was reviewed at our tertiary care teaching hospital, including the use of the Farris-Tang retractor. Pseudotumor cerebri is a syndrome of increased intracranial pressure without a clear cause. Surgical treatment can be effective in cases in which medical therapy has failed and disc swelling with visual field loss progresses. Optic nerve sheath decompression surgery (ONDS) involves cutting slits or windows in the optic nerve sheath to allow cerebrospinal fluid to escape, reducing the pressure around the optic nerve. We introduce the Farris-Tang retractor, a retractor that allows for excellent visualization of the optic nerve sheath during this surgery, facilitating the fenestration of the sheath and visualization of the subsequent cerebrospinal fluid egress. Utilizing a medial conjunctival approach, the Farris-Tang retractor allows for easy retraction of the medial orbital tissue and reduces the incidence of orbital fat protrusion through Tenon's capsule. The Farris-Tang retractor allows safe, easy, and effective access to the optic nerve with good visualization in optic nerve sheath decompression surgery. This, in turn, allows for greater surgical efficiency and positive patient outcomes.

Layer 5 Pyramidal Neurons' Dendritic Remodeling and Increased Microglial Density in Primary Motor Cortex in a Murine Model of Facial Paralysis

PubMed Central

Urrego, Diana; Troncoso, Julieta; Múnera, Alejandro

2015-01-01

This work was aimed at characterizing structural changes in primary motor cortex layer 5 pyramidal neurons and their relationship with microglial density induced by facial nerve lesion using a murine facial paralysis model. Adult transgenic mice, expressing green fluorescent protein in microglia and yellow fluorescent protein in projecting neurons, were submitted to either unilateral section of the facial nerve or sham surgery. Injured animals were sacrificed either 1 or 3weeks after surgery. Two-photon excitation microscopy was then used for evaluating both layer 5 pyramidal neurons and microglia in vibrissal primary motor cortex (vM1). It was found that facial nerve lesion induced long-lasting changes in the dendritic morphology of vM1 layer 5 pyramidal neurons and in their surrounding microglia. Dendritic arborization of the pyramidal cells underwent overall shrinkage. Apical dendrites suffered transient shortening while basal dendrites displayed sustained shortening. Moreover, dendrites suffered transient spine pruning. Significantly higher microglial cell density was found surrounding vM1 layer 5 pyramidal neurons after facial nerve lesion with morphological bias towards the activated phenotype. These results suggest that facial nerve lesions elicit active dendrite remodeling due to pyramidal neuron and microglia interaction, which could be the pathophysiological underpinning of some neuropathic motor sequelae in humans. PMID:26064916

Tuberculous Otitis Media Leading to Sequentialib Bilateral Facial Nerve Paralysis.

PubMed

Gupta, Nitin; Dass, Arjun; Goel, Neha; Tiwari, Sandeep

2015-05-01

Tuberculous otitis media (TOM) is an uncommon, insidious, and frequently misdiagnosed form of tuberculosis (TB). In particular, TOM is usually secondary to direct transmission from adjacent organs, while the primary form has been rarely reported. The main aim of treatment is to start the patient on an antitubercular regime and early surgical intervention to decompress the facial nerve if involved. The case report of a twenty year-old male with bilateral tuberculous otitis media, who presented himself with fever followed by sequential bilateral facial nerve paralysis, bilateral profound hearing loss, and abdominal tuberculosis leading to intestinal perforation, is presented. To the best available knowledge and after researching literature, no such case depicting the extensive otological complications of tuberculosis has been reported till date. Tuberculosis of the ear is a rare entity and in most cases the clinical features resemble that of chronic otitis media. The diagnosis is often delayed due to varied clinical presentations and this can lead to irreversible complications. Early diagnosis is essential for prompt administration of antitubercular therapy and to prevent complications.

Tuberculous Otitis Media Leading to Sequentialib Bilateral Facial Nerve Paralysis

PubMed Central

Gupta, Nitin; Dass, Arjun; Goel, Neha; Tiwari, Sandeep

2015-01-01

Introduction: Tuberculous otitis media (TOM) is an uncommon, insidious, and frequently misdiagnosed form of tuberculosis (TB). In particular, TOM is usually secondary to direct transmission from adjacent organs, while the primary form has been rarely reported. The main aim of treatment is to start the patient on an antitubercular regime and early surgical intervention to decompress the facial nerve if involved. Case Report: The case report of a twenty year-old male with bilateral tuberculous otitis media, who presented himself with fever followed by sequential bilateral facial nerve paralysis, bilateral profound hearing loss, and abdominal tuberculosis leading to intestinal perforation, is presented. To the best available knowledge and after researching literature, no such case depicting the extensive otological complications of tuberculosis has been reported till date. Conclusion: Tuberculosis of the ear is a rare entity and in most cases the clinical features resemble that of chronic otitis media. The diagnosis is often delayed due to varied clinical presentations and this can lead to irreversible complications. Early diagnosis is essential for prompt administration of antitubercular therapy and to prevent complications. PMID:26082906

Emerging perceptions of facial plastic surgery among medical students.

PubMed

Rosenthal, E; Clark, J M; Wax, M K; Cook, T A

2001-11-01

The purpose of this study was to examine the perceptions of medical students regarding facial aesthetic surgery and those specialists most likely to perform aesthetic or reconstructive facial surgery. A survey was designed based on a review of the literature to assess the desirable characteristics and the perceived role of the facial plastic and reconstructive surgeon (FPRS). The surveys were distributed to 2 populations: medical students from 4 medical schools and members of the general public. A total of 339 surveys were collected, 217 from medical students and 122 from the general public. Medical students and the public had similar responses. The results demonstrated that respondents preferred a male plastic surgeon from the ages of 41 to 50 years old and would look to their family doctor for a recommendation. Facial aesthetic and reconstructive surgery was considered the domain of maxillofacial and general plastic surgeons, not the FPRS. Integration of the FPRS into the medical school curriculum may help to improve the perceived role of the specialty within the medical community. It is important for the specialty to communicate to aspiring physicians the dedicated training of an otolaryngologist specializing in FPRS.

Aggressive fibromatosis (fibrosarcoma) of the facial nerve.

PubMed

Pulec, J L

1993-07-01

Aggressive fibromatosis of the facial nerve is a very rare tumor. Three cases have been previously reported. The tumor is locally recurrent and often has a fatal outcome. This report is of a ten-year-old boy whose tumor originally developed in the parotid area with subsequent spread to the base of the skull, the neck and the cerebellopontine angle. Treatment was by wide surgical excision, radiation therapy and chemotherapy. Despite treatment, the patient died. The clinical features of this case will be described. Only wide surgical excision early in the course of the disease may offer a chance for cure.

Diaphragm-Sparing Nerve Blocks for Shoulder Surgery.

PubMed

Tran, De Q H; Elgueta, Maria Francisca; Aliste, Julian; Finlayson, Roderick J

Shoulder surgery can result in significant postoperative pain. Interscalene brachial plexus blocks (ISBs) constitute the current criterion standard for analgesia but may be contraindicated in patients with pulmonary pathology due to the inherent risk of phrenic nerve block and symptomatic hemidiaphragmatic paralysis. Although ultrasound-guided ISB with small volumes (5 mL), dilute local anesthetic (LA) concentrations, and LA injection 4 mm lateral to the brachial plexus have been shown to reduce the risk of phrenic nerve block, no single intervention can decrease its incidence below 20%. Ultrasound-guided supraclavicular blocks with LA injection posterolateral to the brachial plexus may anesthetize the shoulder without incidental diaphragmatic dysfunction, but further confirmatory trials are required. Ultrasound-guided C7 root blocks also seem to offer an attractive, diaphragm-sparing alternative to ISB. However, additional large-scale studies are needed to confirm their efficacy and to quantify the risk of periforaminal vascular breach. Combined axillary-suprascapular nerve blocks may provide adequate postoperative analgesia for minor shoulder surgery but do not compare favorably to ISB for major surgical procedures. One intriguing solution lies in the combined use of infraclavicular brachial plexus blocks and suprascapular nerve blocks. Theoretically, the infraclavicular approach targets the posterior and lateral cords, thus anesthetizing the axillary nerve (which supplies the anterior and posterior shoulder joint), as well as the subscapular and lateral pectoral nerves (both of which supply the anterior shoulder joint), whereas the suprascapular nerve block anesthetizes the posterior shoulder. Future randomized trials are required to validate the efficacy of combined infraclavicular-suprascapular blocks for shoulder surgery.

[Prevention of laryngeal nerve lesions in thyroid surgery].

PubMed

Balanzoni, S; Altini, R; Pasi, L; Fussi, F

1994-04-01

The authors analyse problems related to laryngeal nerves in matters of thyroid surgery. As a matter of fact laryngeal nerve injury is still one of the most common complications for patients undergoing thyroid surgery. Although the sharp reduction in this drawback, due to a better anesthesiological technique and a wider surgical experience, the most representative case report show an incidence ranging from 3% to 5%. After a short introduction on surgical anatomy, attention is drawn to the "recurrent nerve risk" but also the superior laryngeal nerve too, often injured with modifications of the vocal tone and serious consequences for particular professional groups. There fore it is of basic importance, for surgeons performing thyroid surgery, to dissect the recurrent nerve for all its length, that is from the crossing with the inferior thyroid artery to the point where it enters the cricothyroid cartilage; in order not to damage the thin nervous branches and eventually anatomic variations that, when looked for, are cause of mistakes even for the most experienced surgeons.

Association between ratings of facial attractivess and patients' motivation for orthognathic surgery.

PubMed

Vargo, J K; Gladwin, M; Ngan, P

2003-02-01

To compare the judgments of facial esthetics, defects and treatment needs between laypersons and professionals (orthodontists and oral surgeons) as predictors of patient's motivation for orthognathic surgery. Two panels of expert and naïve raters were asked to evaluate photographs of orthognathic surgery patients for facial esthetics, defects and treatment needs. Results were correlated with patients' motivation for surgery. Fifty-seven patients (37 females and 20 males) with a mean age of 26.0 +/- 6.7 years were interviewed prior to orthognathic surgery treatment. Three color photographs of each patient were evaluated by a panel of 14 experts and panel of 18 laypersons. Each panel of raters were asked to evaluate the facial morphology, facial attractiveness and recommend surgical treatment (independent variables). The dependent variable was the patient's motivation for orthognathic surgery. Outcome measure--Reliability of raters were analyzed using an unweighted Kappa coefficient and a Cronbach alpha coefficient. Correlations and regression analyses were used to quantify the relationship between variables. Expert raters provided reliable ratings of certain morphological features such as excessive gingival display and classification of mandibular facial form and position. Based on the facial photographs both expert and naïve raters agreed on facial attractiveness of patients. The best predictors of patients' motivation for surgery were the naïve profile attractiveness rating and the patients' expected change in self-consciousness. Expert raters provide more reliable ratings on certain morphologic features. However, the layperson's profile attractiveness rating and the patients' expected change in self-consciousness were the best predictors for patients' motivation for surgery. These data suggest that patients' motives for treatment are not necessarily related to objectively determined need. Patients' decision to seek treatment was more correlated to laypersons

Current Concept in Adult Peripheral Nerve and Brachial Plexus Surgery.

PubMed

Rasulic, Lukas

2017-01-01

Peripheral nerve injuries and brachial plexus injuries are relatively frequent. Significance of these injuries lies in the fact that the majority of patients with these types of injuries constitute working population. Since these injuries may create disability, they present substantial socioeconomic problem nowadays. This article will present current state-of-the-art achievements of minimal invasive brachial plexus and peripheral nerve surgery. It is considered that the age of the patient, the mechanism of the injury, and the associated vascular and soft-tissue injuries are factors that primarily influence the extent of recovery of the injured nerve. The majority of patients are treated using classical open surgical approach. However, new minimally invasive open and endoscopic approaches are being developed in recent years-endoscopic carpal and cubital tunnel release, targeted minimally invasive approaches in brachial plexus surgery, endoscopic single-incision sural nerve harvesting, and there were even attempts to perform endoscopic brachial plexus surgery. The use of the commercially available nerve conduits for bridging short nerve gap has shown promising results. Multidisciplinary approach individually designed for every patient is of the utmost importance for the successful treatment of these injuries. In the future, integration of biology and nanotechnology may fabricate a new generation of nerve conduits that will allow nerve regeneration over longer nerve gaps and start new chapter in peripheral nerve surgery.

3D-Ultrasonography for evaluation of facial muscles in patients with chronic facial palsy or defective healing: a pilot study.

PubMed

Volk, Gerd Fabian; Pohlmann, Martin; Finkensieper, Mira; Chalmers, Heather J; Guntinas-Lichius, Orlando

2014-01-01

While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with facial palsy, a reliable method to evaluate the facial muscles in patients with long-term palsy for therapy planning is lacking. A 3D ultrasonographic (US) acquisition system driven by a motorized linear mover combined with conventional US probe was used to acquire 3D data sets of several facial muscles on both sides of the face in a healthy subject and seven patients with different types of unilateral degenerative facial nerve lesions. The US results were correlated to the duration of palsy and the electromyography results. Consistent 3D US based volumetry through bilateral comparison was feasible for parts of the frontalis muscle, orbicularis oculi muscle, depressor anguli oris muscle, depressor labii inferioris muscle, and mentalis muscle. With the exception of the frontal muscle, the facial muscles volumes were much smaller on the palsy side (minimum: 3% for the depressor labii inferior muscle) than on the healthy side in patients with severe facial nerve lesion. In contrast, the frontal muscles did not show a side difference. In the two patients with defective healing after spontaneous regeneration a decrease in muscle volume was not seen. Synkinesis and hyperkinesis was even more correlated to muscle hypertrophy on the palsy compared with the healthy side. 3D ultrasonography seems to be a promising tool for regional and quantitative evaluation of facial muscles in patients with facial palsy receiving a facial reconstructive surgery or conservative treatment.

3D-Ultrasonography for evaluation of facial muscles in patients with chronic facial palsy or defective healing: a pilot study

PubMed Central

2014-01-01

Background While standardized methods are established to examine the pathway from motorcortex to the peripheral nerve in patients with facial palsy, a reliable method to evaluate the facial muscles in patients with long-term palsy for therapy planning is lacking. Methods A 3D ultrasonographic (US) acquisition system driven by a motorized linear mover combined with conventional US probe was used to acquire 3D data sets of several facial muscles on both sides of the face in a healthy subject and seven patients with different types of unilateral degenerative facial nerve lesions. Results The US results were correlated to the duration of palsy and the electromyography results. Consistent 3D US based volumetry through bilateral comparison was feasible for parts of the frontalis muscle, orbicularis oculi muscle, depressor anguli oris muscle, depressor labii inferioris muscle, and mentalis muscle. With the exception of the frontal muscle, the facial muscles volumes were much smaller on the palsy side (minimum: 3% for the depressor labii inferior muscle) than on the healthy side in patients with severe facial nerve lesion. In contrast, the frontal muscles did not show a side difference. In the two patients with defective healing after spontaneous regeneration a decrease in muscle volume was not seen. Synkinesis and hyperkinesis was even more correlated to muscle hypertrophy on the palsy compared with the healthy side. Conclusion 3D ultrasonography seems to be a promising tool for regional and quantitative evaluation of facial muscles in patients with facial palsy receiving a facial reconstructive surgery or conservative treatment. PMID:24782657

Phrenic nerve reconstruction in complete video-assisted thoracic surgery.

PubMed

Kawashima, Shun; Kohno, Tadasu; Fujimori, Sakashi; Yokomakura, Naoya; Ikeda, Takeshi; Harano, Takashi; Suzuki, Souichiro; Iida, Takahiro; Sakai, Emi

2015-01-01

Primary or metastatic lung cancer or mediastinal tumours may at times involve the phrenic nerve and pericardium. To remove the pathology en bloc, the phrenic nerve must be resected. This results in phrenic nerve paralysis, which in turn reduces pulmonary function and quality of life. As a curative measure of this paralysis and thus a preventive measure against decreased pulmonary function and quality of life, we have performed immediate phrenic nerve reconstruction under complete video-assisted thoracic surgery, and with minimal additional stress to the patient. This study sought to ascertain the utility of this procedure from an evaluation of the cases experienced to date. We performed 6 cases of complete video-assisted thoracic surgery phrenic nerve reconstruction from October 2009 to December 2013 in patients who had undergone phrenic nerve resection or separation to remove tumours en bloc. In all cases, it was difficult to separate the phrenic nerve from the tumour. Reconstruction involved direct anastomosis in 3 cases and intercostal nerve interposition anastomosis in the remaining 3 cases. In the 6 patients (3 men, 3 women; mean age 50.8 years), we performed two right-sided and four left-sided procedures. The mean anastomosis time was 5.3 min for direct anastomosis and 35.3 min for intercostal nerve interposition anastomosis. Postoperative phrenic nerve function was measured on chest X-ray during inspiration and expiration. Direct anastomosis was effective in 2 of the 3 patients, and intercostal nerve interposition anastomosis was effective in all 3 patients. Diaphragm function was confirmed on X-ray to be improved in these 5 patients. Complete video-assisted thoracic surgery phrenic nerve reconstruction was effective for direct anastomosis as well as for intercostal nerve interposition anastomosis in a small sample of selected patients. The procedure shows promise for phrenic nerve reconstruction and further data should be accumulated over time. © The

Primary Nasopharyngeal Tuberculosis Combined with Tuberculous Otomastoiditis and Facial Nerve Palsy

PubMed Central

Choi, Hee Young; Jang, Ji Hye; Lee, Kyung Mi; Choi, Woo Suk; Kim, Sang Hoon; Yeo, Seung Geun; Kim, Eui Jong

2016-01-01

Primary nasopharyngeal tuberculosis (TB) without pulmonary involvement is rare, even in endemic areas. Herein, we present a rare complication of primary nasopharyngeal TB accompanied with tuberculous otomastoiditis (TOM) and ipsilateral facial nerve palsy, in a 24-year-old female patient, with computed tomography and magnetic resonance imagery findings. PMID:27127580

A pediatric case with peripheral facial nerve palsy caused by a granulomatous lesion associated with cat scratch disease.

PubMed

Nakamura, Chizuko; Inaba, Yuji; Tsukahara, Keiko; Mochizuki, Mie; Sawanobori, Emi; Nakazawa, Yozo; Aoyama, Kouki

2018-02-01

Cat scratch disease is a common infectious disorder caused by Bartonella henselae that is transmitted primarily by kittens. It typically exhibits a benign and self-limiting course of subacute regional lymphadenopathy and fever lasting two to eight weeks. The most severe complication of cat scratch disease is involvement of the nervous system, such as encephalitis, meningitis, and polyneuritis. Peripheral facial nerve palsy associated with Bartonella infection is rare; few reported pediatric and adult cases exist and the precise pathogenesis is unknown. A previously healthy 7-year-old boy presented with fever, cervical lymphadenopathy, and peripheral facial nerve palsy associated with serologically confirmed cat scratch disease. The stapedius muscle reflex was absent on the left side and brain magnetic resonance imaging revealed a mass lesion at the left internal auditory meatus. The patient's symptoms and imaging findings were gradually resolved after the antibiotics and corticosteroids treatment. The suspected granulomatous lesion was considered to have resulted from the host's immune reaction to Bartonella infection and impaired the facial nerve. This is the first case report providing direct evidence of peripheral facial nerve palsy caused by a suspected granulomatous lesion associated with cat scratch disease and its treatment course. Copyright © 2017. Published by Elsevier B.V.

[RESEARCH PROGRESS OF PERIPHERAL NERVE SURGERY ASSISTED BY Da Vinci ROBOTIC SYSTEM].

PubMed

Shen, Jie; Song, Diyu; Wang, Xiaoyu; Wang, Changjiang; Zhang, Shuming

2016-02-01

To summarize the research progress of peripheral nerve surgery assisted by Da Vinci robotic system. The recent domestic and international articles about peripheral nerve surgery assisted by Da Vinci robotic system were reviewed and summarized. Compared with conventional microsurgery, peripheral nerve surgery assisted by Da Vinci robotic system has distinctive advantages, such as elimination of physiological tremors and three-dimensional high-resolution vision. It is possible to perform robot assisted limb nerve surgery using either the traditional brachial plexus approach or the mini-invasive approach. The development of Da Vinci robotic system has revealed new perspectives in peripheral nerve surgery. But it has still been at the initial stage, more basic and clinical researches are still needed.

Facial nerve stimulation associated with cochlear implant use following temporal bone fractures.

PubMed

Espahbodi, Mana; Sweeney, Alex D; Lennon, Kristen J; Wanna, George B

2015-01-01

To describe the incidence and management of patients with facial nerve stimulation (FNS) associated with cochlear implant (CI) use in the setting of a prior temporal bone fracture. One adult CI recipient is reported who experienced implant associated FNS with a history of a temporal bone fracture. Additionally, a literature search was performed to identify similar patients from previous descriptions of CI related FNS. Presence of FNS after implantation and ability to modify implant programming to avoid FNS. The patient in the present report experienced FNS for middle and basal electrodes during intraoperative neural response telemetry (NRT) in the absence of any surgical exposure or manipulation of the facial nerve. FNS was absent during device activation, but it recurred during follow-up programming sessions. However, additional programming has prevented further FNS during regular implant use. Four other patients with FNS after temporal bone fracture were identified from the literature, and the present case represents the one of two cases in which reprogramming allowed for implant use without FNS. CI associated FNS is uncommon in patients with a history of a temporal bone fracture, but it is likely that fracture lines provide a lower impedance pathway to the adjacent facial nerve and thus reduce the threshold for FNS. The present report suggests that, in the setting of a prior temporal bone fracture, NRT is not always a reliable predictor of FNS during implant use, and programming changes can help to mitigate FNS when it occurs. Copyright © 2015 Elsevier Inc. All rights reserved.

[Application of grading evaluation on facial nerve function of Bell's palsy treated with electroacupuncture].

PubMed

Zhou, Zhang-Ling; Zuo, Cong; Cheng, Shu-Luo; Shao, Wei-Wei; Liu, Li-Ping

2013-08-01

To explore the correlation of facial nerve injury degree with facial contraction degree induced by electric stimulation in the treatment of Bell's palsy with electroacupuncture, and the significance in elec tric reaction grading evaluation. Sixty-eight cases of Bell's palsy were enrolled. The positive and negative electrodes of the acupuncture treatment apparatus were attached to the needle handles at the 3 groups of points, named Taiyang (EX-HN 5)-Yangbai(GB 14), Xiaguan (ST 7)-Quanliao (SI 18) and Heliao (LI 19)-Jiachengjiang (Extra). The disperse-dense wave was applied. According to the severity of local muscle contraction after needling, the electric reaction was divided into 4 grades, named superior, moderate, poor and no reaction. After acupuncture and electroacupuncture, the efficacy was evaluated in accordance with the different electric reaction grades. The curative rate was 100.0% (44/44) in patients with superior electric reaction, was 100.0% (7/7) in patients with moderate electric reaction, was 18.2% (2/11) in patients with poor electric reaction and was 0 (0/6) in patients with noelectric reaction. The difference was significant statistically in comparison of 4 groups (P<0.01). The superiority correlation presented between the efficacy and electric reaction grade (P< 0.001). The higher the superiority of electric reaction grade was, the better the efficacy was. The difference in the efficacy among different electric reaction grades was significant statistically (P<0.001). And the course of treatment was the shortest for those with the high superiority of electric reaction. The reaction grade of electric stimulation is conform to the facial nerve injury grading in Bell's palsy. The contraction degree of facial mimetic muscle induced by electroacupuncture stimulation is closely correlated with severity of disease. Based on the electric reaction, the facial nerve injury severity can be understood generally and the prognosis be judged.

Social perception of morbidity in facial nerve paralysis.

PubMed

Li, Matthew Ka Ki; Niles, Navin; Gore, Sinclair; Ebrahimi, Ardalan; McGuinness, John; Clark, Jonathan Robert

2016-08-01

There are many patient-based and clinician-based scales measuring the severity of facial nerve paralysis and the impact on quality of life, however, the social perception of facial palsy has received little attention. The purpose of this pilot study was to measure the consequences of facial paralysis on selected domains of social perception and compare the social impact of paralysis of the different components. Four patients with typical facial palsies (global, marginal mandibular, zygomatic/buccal, and frontal) and 1 control were photographed. These images were each shown to 100 participants who subsequently rated variables of normality, perceived distress, trustworthiness, intelligence, interaction, symmetry, and disability. Statistical analysis was performed to compare the results among each palsy. Paralyzed faces were considered less normal compared to the control on a scale of 0 to 10 (mean, 8.6; 95% confidence interval [CI] = 8.30-8.86) with global paralysis (mean, 3.4; 95% CI = 3.08-3.80) rated as the most disfiguring, followed by the zygomatic/buccal (mean, 6.0; 95% CI = 5.68-6.37), marginal (mean, 6.5; 95% CI = 6.08-6.86), and then temporal palsies (mean, 6.9; 95% CI = 6.57-7.21). Similar trends were seen when analyzing these palsies for perceived distress, intelligence, and trustworthiness, using a random effects regression model. Our sample suggests that society views paralyzed faces as less normal, less trustworthy, and more distressed. Different components of facial paralysis are worse than others and surgical correction may need to be prioritized in an evidence-based manner with social morbidity in mind. © 2016 Wiley Periodicals, Inc. Head Neck 38:1158-1163, 2016. © 2016 Wiley Periodicals, Inc.

Nerve Transfer Surgery for Penetrating Upper Extremity Injuries

PubMed Central

Karamanos, Efstathios; Rakitin, Ilya; Dream, Sophie; Siddiqui, Aamir

2018-01-01

Context Nerve transfer surgery is an option for repair of penetrating injuries of the upper extremity. In the right setting, it has advantages over tendon transfers and nerve grafting. Objective To review our experience since 2006 of nerve transfer surgery in the upper extremities. Design We included cases performed to repair penetrating trauma within three months of injury with at least three years’ follow-up. Main Outcome Measures Preoperative and postoperative muscle strength of the affected extremity. Results All 16 patients were males aged 16 to 43 years. Six patients underwent nerve transfer surgery because of elbow flexion; 5, finger extension; 3, finger flexion; and 2, wrist pronation. Nine patients (56%) had associated vascular injury, and 4 (25%) had fractures. Average follow-up was 6 years. No perioperative complications occurred. Patients had a mean of 3.7 operations after the initial trauma. All patients received physical therapy. All patients improved from 0 of 5 muscle strength preoperatively to a mean of 3.8 (range = 2/5 to 5/5) within 1 year after surgery. In all cases, strength was maintained, and 8 (50%) had continued improvement after Year 1. Ten (63%) returned to their previous employment level. Mean Disabilities of the Arm, Shoulder and Hand score improved from 68 to 83 postoperatively. Conclusion Nerve transfer is a safe, effective technique for correcting penetrating trauma-related nerve injury. In appropriate patients it offers advantages over other techniques. Outcomes can be maintained long term, and many patients can return to their previous level of function. PMID:29702048

Preoperative Visualization of Cranial Nerves in Skull Base Tumor Surgery Using Diffusion Tensor Imaging Technology.

PubMed

Ma, Jun; Su, Shaobo; Yue, Shuyuan; Zhao, Yan; Li, Yonggang; Chen, Xiaochen; Ma, Hui

2016-01-01

To visualize cranial nerves (CNs) using diffusion tensor imaging (DTI) with special parameters. This study also involved the evaluation of preoperative estimates and intraoperative confirmation of the relationship between nerves and tumor by verifying the accuracy of visualization. 3T magnetic resonance imaging scans including 3D-FSPGR, FIESTA, and DTI were used to collect information from 18 patients with skull base tumor. DTI data were integrated into the 3D slicer for fiber tracking and overlapped anatomic images to determine course of nerves. 3D reconstruction of tumors was achieved to perform neighboring, encasing, and invading relationship between lesion and nerves. Optic pathway including the optic chiasm could be traced in cases of tuberculum sellae meningioma and hypophysoma (pituitary tumor). The oculomotor nerve, from the interpeduncular fossa out of the brain stem to supraorbital fissure, was clearly visible in parasellar meningioma cases. Meanwhile, cisternal parts of trigeminal nerve and abducens nerve, facial nerve were also imaged well in vestibular schwannomas and petroclival meningioma cases. The 3D-spatial relationship between CNs and skull base tumor estimated preoperatively by tumor modeling and tractography corresponded to the results determined during surgery. Supported by DTI and 3D slicer, preoperative 3D reconstruction of most CNs related to skull base tumor is feasible in pathological circumstances. We consider DTI Technology to be a useful tool for predicting the course and location of most CNs, and syntopy between them and skull base tumor.

Advances in computer imaging/applications in facial plastic surgery.

PubMed

Papel, I D; Jiannetto, D F

1999-01-01

Rapidly progressing computer technology, ever-increasing expectations of patients, and a confusing medicolegal environment requires a clarification of the role of computer imaging/applications. Advances in computer technology and its applications are reviewed. A brief historical discussion is included for perspective. Improvements in both hardware and software with the advent of digital imaging have allowed great increases in speed and accuracy in patient imaging. This facilitates doctor-patient communication and possibly realistic patient expectations. Patients seeking cosmetic surgery now often expect preoperative imaging. Although society in general has become more litigious, a literature search up to 1998 reveals no lawsuits directly involving computer imaging. It appears that conservative utilization of computer imaging by the facial plastic surgeon may actually reduce liability and promote communication. Recent advances have significantly enhanced the value of computer imaging in the practice of facial plastic surgery. These technological advances in computer imaging appear to contribute a useful technique for the practice of facial plastic surgery. Inclusion of computer imaging should be given serious consideration as an adjunct to clinical practice.

Combined use of decellularized allogeneic artery conduits with autologous transdifferentiated adipose-derived stem cells for facial nerve regeneration in rats.

PubMed

Sun, Fei; Zhou, Ke; Mi, Wen-juan; Qiu, Jian-hua

2011-11-01

Natural biological conduits containing seed cells have been widely used as an alternative strategy for nerve gap reconstruction to replace traditional nerve autograft techniques. The purpose of this study was to investigate the effects of a decellularized allogeneic artery conduit containing autologous transdifferentiated adipose-derived stem cells (dADSCs) on an 8-mm facial nerve branch lesion in a rat model. After 8 weeks, functional evaluation of vibrissae movements and electrophysiological assessment, retrograde labeling of facial motoneurons and morphological analysis of regenerated nerves were performed to assess nerve regeneration. The transected nerves reconstructed with dADSC-seeded artery conduits achieved satisfying regenerative outcomes associated with morphological and functional improvements which approached those achieved with Schwann cell (SC)-seeded artery conduits, and superior to those achieved with artery conduits alone or ADSC-seeded artery conduits, but inferior to those achieved with nerve autografts. Besides, numerous transplanted PKH26-labeled dADSCs maintained their acquired SC-phenotype and myelin sheath-forming capacity inside decellularized artery conduits and were involved in the process of axonal regeneration and remyelination. Collectively, our combined use of decellularized allogeneic artery conduits with autologous dADSCs certainly showed beneficial effects on nerve regeneration and functional restoration, and thus represents an alternative approach for the reconstruction of peripheral facial nerve defects. Copyright © 2011 Elsevier Ltd. All rights reserved.

Restoration of Trigeminal Cutaneous Sensation with Cross-Face Sural Nerve Grafts: A Novel Approach to Facial Sensory Rehabilitation.

PubMed

Catapano, Joseph; Scholl, David; Ho, Emily; Zuker, Ronald M; Borschel, Gregory H

2015-09-01

Although treating facial palsy is considered debilitating for patients, trigeminal nerve palsy and sensory deficits of the face are overlooked components of disability. Complete anesthesia leaves patients susceptible to occult injury, and facial sensation is an important component of interaction and activities of daily living. Sensory reconstruction is well established in the restoration of hand sensation; however, only one previous report proposed a surgical strategy for sensory nerve reconstruction of the face with use of nerve transfers. Nerve transfers, when used alone, have limited application because of their restricted arc of rotation in the face; extending their arc by adding nerve grafts greatly expands their utility. The following cases demonstrate the early results after V2 and V3 reconstruction with cross-face nerve grafts in three patients with acquired trigeminal nerve palsy. Cross-face nerve grafts using the sural nerve permit more proximal reconstruction of the infraorbital and mental nerves, which allows reinnervation of their entire cutaneous distribution. All patients demonstrated improved sensation in the reconstructed dermatomes, and no patients reported donor-site abnormalities. Cross-face nerve grafts result in minimal donor-site morbidity and are promising as a surgical strategy to address sensory deficits of the face. Therapeutic, V.

Surgical management of vestibular schwannoma: attempted preservation of hearing and facial function.

PubMed

Youssef, T F; Matter, A; Ahmed, M R

2013-05-01

Vestibular schwannomas are benign tumours which usually originate from the vestibular portion of the VIIIth cranial nerve. Treatment options include observation with serial imaging, stereotactic radiation and microsurgical removal. The goal of surgery was complete eradication of tumour with preservation of hearing and facial nerve function. A retrospective review was undertaken of 24 cases of vestibular schwannoma jointly operated upon by a team of neurosurgeons and otologists at the Suez Canal University Hospital, with assessment of VIIth and VIIIth cranial nerve function, tumour size, and extent of growth. All surgery utilised a retromastoid, suboccipital approach. Complete tumour removal was achieved in 19 patients. Anatomical preservation of the facial nerve was possible in 66.6 per cent of patients. Pre-operative, useful hearing was present in four patients, and preserved in 80 per cent. Cerebrospinal fluid leakage was diagnosed in two (8.3 per cent) patients, who responded to conservative therapy. The retromastoid, suboccipital surgical approach to the skull base can be safely and successfully achieved using a microsurgical technique, with minimal or no damage to neurovascular structures, even for large tumours.

Effectiveness of fibrin adhesive in facial nerve anastomosis in dogs compared with standard microsuturing technique.

PubMed

Attar, Bijan Movahedian; Zalzali, Haidar; Razavi, Mohammad; Ghoreishian, Mehdi; Rezaei, Majid

2012-10-01

Epineural suturing is the most common technique used for peripheral nerve anastomosis. In addition to the foreign body reaction to the suture material, the surgical duration and difficulty of suturing in confined anatomic locations are major problems. We evaluated the effectiveness of fibrin glue as an acceptable alternative for nerve anastomosis in dogs. Eight adult female dogs weighing 18 to 24 kg were used in the present study. The facial nerve was transected bilaterally. On the right side, the facial nerve was subjected to epineural suturing; and on the left side, the nerve was anastomosed using fibrin adhesive. After 16 weeks, the nerve conduction velocity and proportion of the nerve fibers that crossed the anastomosis site were evaluated and compared for the epineural suture (right side) and fibrin glue (left side). The data were analyzed using the paired t test and univariate analysis of variance. The mean postoperative nerve conduction velocity was 29.87 ± 7.65 m/s and 26.75 ± 3.97 m/s on the right and left side, respectively. No statistically significant difference was found in the postoperative nerve conduction velocity between the 2 techniques (P = .444). The proportion of nerve fibers that crossed the anastomotic site was 71.25% ± 7.59% and 72.25% ± 8.31% on the right and left side, respectively. The histologic evaluation showed no statistically significant difference in the proportion of the nerve fibers that crossed the anastomotic site between the 2 techniques (P = .598). The results suggest that the efficacies of epineural suturing and fibrin gluing in peripheral nerve anastomosis are similar. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Diagnostic Value of Facial Nerve Antidromic Evoked Potential in Patients With Bell's Palsy: A Preliminary Study

PubMed Central

Lee, Ji Hoon; Kim, Sun Mi; Yang, Hea Eun; Lee, Jang Woo

2014-01-01

Objective To assess the practical diagnostic value of facial nerve antidromic evoked potential (FNAEP), we compared it with the diagnostic value of the electroneurography (ENoG) test in Bell's palsy. Methods In total, 20 patients with unilateral Bell's palsy were recruited. Between the 1st and 17th days after the onset of facial palsy, FNAEP and ENoG tests were conducted. The degeneration ratio and FNAEP latency difference between the affected and unaffected sides were calculated in all subjects. Results In all patients, FNAEP showed prolonged latencies on the affected side versus the unaffected side. The difference was statistically significant. In contrast, there was no significant difference between sides in the normal control group. In 8 of 20 patients, ENoG revealed a degeneration ratio less than 50%, but FNAEP show a difference of more than 0.295±0.599 ms, the average value of normal control group. This shows FNAEP could be a more sensitive test for Bell's palsy diagnosis than ENoG. In particular, in 10 patients tested within 7 days after onset, an abnormal ENoG finding was noted in only four of them, but FNAEP showed a significant latency difference in all patients at this early stage. Thus, FANEP was more sensitive in detecting facial nerve injury than the ENoG test (p=0.031). Conclusion FNAEP has some clinical value in the diagnosis of facial nerve degeneration. It is important that FNAEP be considered in patients with facial palsy at an early stage and integrated with other relevant tests. PMID:25024963

Outcome of patients presenting with idiopathic facial nerve paralysis (Bell's palsy) in a tertiary centre--a five year experience.

PubMed

Tang, I P; Lee, S C; Shashinder, S; Raman, R

2009-06-01

This is a retrospective study. The objective of this study is to review the factors influencing the outcome of treatment for the patients presented with idiopathic facial nerve paralysis. The demographic data, clinical presentation and management of 84 patients with idiopathic facial nerve paralysis (Bell's palsy) were collected from the medical record office, reviewed and analyzed from 2000 to 2005. Thirty-four (72.3%) out of 47 patients who were treated with oral prednisolone alone, fully recovered from Bell's palsy meanwhile 36 (97%) out of 37 patients who were treated with combination of oral prednisolone and acyclovir fully recovered. The difference was statistically significant. 42 (93.3%) out of 45 patients who presented within three days to our clinic, fully recovered while 28 (71.8%) out of 39 patients presented later then three days had full recovery from Bell's palsy. The difference was statistically significant. The outcome of full recovery is better with the patients treated with combined acyclovir and prednisolone compared with prednisolone alone. The patients who were treated after three days of clinical presentation, who were more than 50 years of age, who had concurrent chronic medical illness and facial nerve paralysis HB Grade IV to VI during initial presentation have reduced chance of full recovery of facial nerve paralysis.

Prognostic Value of Facial Nerve Antidromic Evoked Potentials in Bell Palsy: A Preliminary Study

PubMed Central

WenHao, Zhang; Minjie, Chen; Chi, Yang; Weijie, Zhang

2012-01-01

To analyze the value of facial nerve antidromic evoked potentials (FNAEPs) in predicting recovery from Bell palsy. Study Design. Retrospective study using electrodiagnostic data and medical chart review. Methods. A series of 46 patients with unilateral Bell palsy treated were included. According to taste test, 26 cases were associated with taste disorder (Group 1) and 20 cases were not (Group 2). Facial function was established clinically by the Stennert system after monthly follow-up. The result was evaluated with clinical recovery rate (CRR) and FNAEP. FNAEPs were recorded at the posterior wall of the external auditory meatus of both sides. Results. Mean CRR of Group 1 and Group 2 was 61.63% and 75.50%. We discovered a statistical difference between two groups and also in the amplitude difference (AD) of FNAEP. Mean ± SD of AD was −6.96% ± 12.66% in patients with excellent result, −27.67% ± 27.70% with good result, and −66.05% ± 31.76% with poor result. Conclusions. FNAEP should be monitored in patients with intratemporal facial palsy at the early stage. FNAEP at posterior wall of external auditory meatus was sensitive to detect signs of taste disorder. There was close relativity between FNAEPs and facial nerve recovery. PMID:22164176

Cranial nerve vascular compression syndromes of the trigeminal, facial and vago-glossopharyngeal nerves: comparative anatomical study of the central myelin portion and transitional zone; correlations with incidences of corresponding hyperactive dysfunctional syndromes.

PubMed

Guclu, Bulent; Sindou, Marc; Meyronet, David; Streichenberger, Nathalie; Simon, Emile; Mertens, Patrick

2011-12-01

The aim of this study was to evaluate the anatomy of the central myelin portion and the central myelin-peripheral myelin transitional zone of the trigeminal, facial, glossopharyngeal and vagus nerves from fresh cadavers. The aim was also to investigate the relationship between the length and volume of the central myelin portion of these nerves with the incidences of the corresponding cranial dysfunctional syndromes caused by their compression to provide some more insights for a better understanding of mechanisms. The trigeminal, facial, glossopharyngeal and vagus nerves from six fresh cadavers were examined. The length of these nerves from the brainstem to the foramen that they exit were measured. Longitudinal sections were stained and photographed to make measurements. The diameters of the nerves where they exit/enter from/to brainstem, the diameters where the transitional zone begins, the distances to the most distal part of transitional zone from brainstem and depths of the transitional zones were measured. Most importantly, the volume of the central myelin portion of the nerves was calculated. Correlation between length and volume of the central myelin portion of these nerves and the incidences of the corresponding hyperactive dysfunctional syndromes as reported in the literature were studied. The distance of the most distal part of the transitional zone from the brainstem was 4.19  ±  0.81 mm for the trigeminal nerve, 2.86  ±  1.19 mm for the facial nerve, 1.51  ±  0.39 mm for the glossopharyngeal nerve, and 1.63  ±  1.15 mm for the vagus nerve. The volume of central myelin portion was 24.54  ±  9.82 mm(3) in trigeminal nerve; 4.43  ±  2.55 mm(3) in facial nerve; 1.55  ±  1.08 mm(3) in glossopharyngeal nerve; 2.56  ±  1.32 mm(3) in vagus nerve. Correlations (p  < 0.001) have been found between the length or volume of central myelin portions of the trigeminal, facial, glossopharyngeal and vagus nerves and incidences

[Contribution of botulinum toxin to maxillo-facial surgery].

PubMed

Batifol, D; de Boutray, M; Goudot, P; Lorenzo, S

2013-04-01

Botulinum toxin has a wide range of use in maxillo-facial surgery due to its action on muscles, on the glandular system, and against pain. It already has been given several market authorizations as indicated for: blepharospasm, spasmodic stiff neck, and glabellar lines. Furthermore, several studies are ongoing to prove its effectiveness and usefulness for many other pathologies: treatment of pain following cervical spine surgery; action on salivary glands after trauma, hypertrophy, or hyper-salivation; analgesic action (acknowledged but still being experimented) on neuralgia, articular pain, and keloids scars due to its anti-inflammatory properties. Botulinum toxin injections in the cervico-facial area are more and more used and should be to be correctly assessed. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Facial palsy after dental procedures - Is viral reactivation responsible?

PubMed

Gaudin, Robert A; Remenschneider, Aaron K; Phillips, Katie; Knipfer, Christian; Smeets, Ralf; Heiland, Max; Hadlock, Tessa A

2017-01-01

Herpes labialis viral reactivation has been reported following dental procedures, but the incidence, characteristics and outcomes of delayed peripheral facial nerve palsy following dental work is poorly understood. Herein we describe the unique features of delayed facial paresis following dental procedures. An institutional retrospective review was performed to identify patients diagnosed with delayed facial nerve palsy within 30 days of dental manipulation. Demographics, prodromal signs and symptoms, initial medical treatment and outcomes were assessed. Of 2471 patients with facial palsy, 16 (0.7%) had delayed facial paresis following ipsilateral dental procedures. Average age at presentation was 44 yrs and 56% (9/16) were female. Clinical evaluation was consistent with Bell's palsy in 14 (88%) and Ramsay-Hunt syndrome in 2 patients (12%). Patients developed facial paresis an average of 3.9 days after the dental procedure, with all individuals developing a flaccid paralysis (House Brackmann (HB) grade VI) during the acute stage. 50% of patients developed persistent facial palsy in the form of non-flaccid facial paralysis (HBIII-IV). Facial palsy, like herpes labialis, can occur in the days following dental procedures and may also be related to viral reactivation. In this small cohort, long-term facial outcomes appear worse than for spontaneous Bell's palsy. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Rare encounter of unilateral facial nerve palsy in an adolescent with Guillain-Barré syndrome

PubMed Central

Iqbal, Mehtab; Sharma, Parnika; Charadva, Creana; Prasad, Manish

2016-01-01

Unilateral facial nerve palsy is rarely encountered in Guillain-Barré syndrome (GBS). We report a case of an adolescent girl who presented with peripheral ascending weakness, preceded by Campylobacter jejuni infection. After treatment with intravenous immunoglobulin, the peripheral weakness improved. Electro-diagnostic testing confirmed axonal dysfunction and the patient was positive for antiganglioside antibodies. However, the patient developed unilateral left-sided facial weakness. She was managed with further intravenous immunoglobulin and intensive physiotherapy. The outcome for facial palsy was very good, with almost complete resolution after 2 weeks. PMID:26823357

The expression of a motoneuron-specific serine protease, motopsin (PRSS12), after facial nerve axotomy in mice.

PubMed

Numajiri, Toshiaki; Mitsui, Shinichi; Hisa, Yasuo; Ishida, Toshihiro; Nishino, Kenichi; Yamaguchi, Nozomi

2006-01-01

Motopsin (PRSS12) is a mosaic serine protease that is preferentially expressed in motor neurons. To study the relationship between motopsin and motoneuron function, we investigated the expression of motopsin mRNA in facial nerve nuclei after facial nerve axotomy at the anterior margin of the parotid gland in mice. Neuronal function was monitored by assessing vibrissal motion in 3 months. Vibrissal behaviour on the injured side disappeared until the day 14 post-operation, and then recovered between the day 21 and 35. Motopsin expression decreased at the day 14, but markedly recovered by the day 21. In contrast, expression of growth-associated protein-43 (GAP-43) was induced at the day 3. These results suggest that the recovery of motopsin expression is correlated with the recovery of the facial motor neuronal function.

Restoration of orbicularis oculi muscle function in rabbits with peripheral facial paralysis via an implantable artificial facial nerve system

PubMed Central

Sun, Yajing; Jin, Cheng; Li, Keyong; Zhang, Qunfeng; Geng, Liang; Liu, Xundao; Zhang, Yi

2017-01-01

The purpose of the present study was to restore orbicularis oculi muscle function using the implantable artificial facial nerve system (IAFNS). The in vivo part of the IAFNS was implanted into 12 rabbits that were facially paralyzed on the right side of the face to restore the function of the orbicularis oculi muscle, which was indicated by closure of the paralyzed eye when the contralateral side was closed. Wireless communication links were established between the in vivo part (the processing chip and microelectrode) and the external part (System Controller program) of the system, which were used to set the working parameters and indicate the working state of the processing chip and microelectrode implanted in the body. A disturbance field strength test of the IAFNS processing chip was performed in a magnetic field dark room to test its electromagnetic radiation safety. Test distances investigated were 0, 1, 3 and 10 m, and levels of radiation intensity were evaluated in the horizontal and vertical planes. Anti-interference experiments were performed to test the stability of the processing chip under the interference of electromagnetic radiation. The fully implanted IAFNS was run for 5 h per day for 30 consecutive days to evaluate the accuracy and precision as well as the long-term stability and effectiveness of wireless communication. The stimulus intensity (range, 0–8 mA) was set every 3 days to confirm the minimum stimulation intensity which could indicate the movement of the paralyzed side was set. Effective stimulation rate was also tested by comparing the number of eye-close movements on both sides. The results of the present study indicated that the IAFNS could rebuild the reflex arc, inducing the experimental rabbits to close the eye of the paralyzed side. The System Controller program was able to reflect the in vivo part of the artificial facial nerve system in real-time and adjust the working pattern, stimulation intensity and frequency, range of wave

Retrospective study of primary reconstruction of facial traumatic events.

PubMed

Chen, Baoguo; Song, Huifeng; Gao, Quanwen; Xu, Minghuo; Chai, Jiake

2017-02-01

Facial traumatic events are commonly encountered in plastic and reconstructive surgery. Primary reconstruction is a reliable procedure with function and aesthetic considerations. We conduct a retrospective study of the experience of reconstructing facial traumatic defects in the first stage. One hundred and thirty-two cases (aged 18-65) with facial traumatic events were recruited in the study from 2008 to 2014. Facial traumatic events included injured soft tissue, maxillofacial fractures and facial nerve rupture, which were repaired primarily. After primary reconstruction, encouraging functional and aesthetic outcomes were attained. Ten cases were re-operated to reconstruct partial nasal defect. Four patients who had trouble with disabled occluding relations sought help from dentists. Inconspicuous scar and function restoration were presented. Facial wounds should be reconstructed in the first stage as far as possible. Then, satisfactory functional and aesthetic results can be achieved. However, combined injury should be carefully considered in those traumatic cases before we carry out the reconstructive surgery on the face. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Massive nerve root enlargement in chronic inflammatory demyelinating polyneuropathy.

PubMed Central

Schady, W; Goulding, P J; Lecky, B R; King, R H; Smith, C M

1996-01-01

OBJECTIVE: To report three patients with chronic inflammatory demyelinating polyneuropathy (CIDP) presenting with symptoms suggestive of cervical (one patient) and lumbar root disease. METHODS: Nerve conduction studies, EMG, and nerve biopsy were carried out, having found the nerve roots to be very enlarged on MRI, CT myelography, and at surgery. RESULTS: Clinically, peripheral nerve thickening was slight or absent. Subsequently one patient developed facial nerve hypertrophy. This was mistaken for an inner ear tumour and biopsied, with consequent facial palsy. Neurophysiological tests suggested a demyelinating polyneuropathy. Sural nerve biopsy showed in all cases some loss of myelinated fibres, inflammatory cell infiltration, and a few onion bulbs. Hypertrophic changes were much more prominent on posterior nerve root biopsy in one patient: many fibres were surrounded by several layers of Schwann cell cytoplasm. There was an excellent response to steroids in two patients but not in the third (most advanced) patient, who has benefited only marginally from intravenous immunoglobulin therapy. CONCLUSIONS: MRI of the cauda equina may be a useful adjunct in the diagnosis of CIDP. Images PMID:8971116

The effects of lipoic acid and methylprednisolone on nerve healing in rats with facial paralysis.

PubMed

Tekdemir, Emrah; Tatlipinar, Arzu; Özbeyli, Dilek; Tekdemir, Özge; Kınal, Emrah

2018-06-01

To investigate the effects of lipoic acid and methylprednisolone on nerve healing in rats with traumatic facial paralysis. The rats were randomly divided into four groups, with six rats in the control group and eight each in the remaining three groups. The buccal branch of the facial nerve in all groups except the control group was traumatized by a vascular clamp for 40 minutes. Group 1 was given lipoic acid (LA), Group 2 was given methylprednisolone (MP), and Group 3 was given lipoic acid and methylprednisolone (LA + MP) for one week. Nerve stimulus thresholds were measured before trauma, after trauma and at the end of the one week treatment period. When the groups were compared with each other, post-treatment threshold levels of LA + MP were significantly lower than LA. Although post-treatment threshold levels of LA and MP were still higher than the control group, there was no significant difference between LA + MP and control values (p > .05). Lipoic acid has a positive effect on nerve healing and can enhance the effect of methylprednisolone treatment. It is a good alternative in cases where methylprednisolone cannot be used.

Supplemental oxygen: ensuring its safe delivery during facial surgery.

PubMed

Reyes, R J; Smith, A A; Mascaro, J R; Windle, B H

1995-04-01

Electrosurgical coagulation in the presence of blow-by oxygen is a potential source of fire in facial surgery. A case report of a patient sustaining partial-thickness facial burns secondary to such a flash fire is presented. A fiberglass facial model is then used to study the variables involved in providing supplemental oxygen when an electrosurgical unit is employed. Oxygen flow, oxygen delivery systems, distance from the oxygen source, and coagulation current levels were varied. A nasal cannula and an adapted suction tubing provided the oxygen delivery systems on the model. Both the "displaced" nasal cannula and the adapted suction tubing ignited at a minimum coagulation level of 30 W, an oxygen flow of 2 liters/minute, and a linear distance of 5 cm from the oxygen source. The properly placed nasal cannula did not ignite at any combination of oxygen flow, coagulation current level, or distance from the oxygen source. Facial cutaneous surgery in patients provided supplemental oxygen should be practiced with caution when an electrosurgical unit is used for coagulation. The oxygen delivery systems adapted for use are hazardous and should not be used until their safety has been demonstrated.

[A young woman with central facial nerve palsy].

PubMed

Broere, Christiaan M; de Witte, B R René; Claes, J F H M Franka

2014-01-01

The distinction between central and peripheral facial nerve palsy can be difficult but is very important for the workup and treatment. A tumefactive demyelinating lesion (TDL) is a rare condition that can sometimes cause diagnostic difficulties due to its similarity to a brain tumour. We present a 20-year-old female patient who visited her GP with a discrete right-sided drooping corner of her mouth. The GP started treatment with oral glucorticoids because of presumed Bell's palsy and referred her to the neurology outpatient clinic. Repeated neurological examination showed central facial palsy on the right side of the face. An MRI study of the brain revealed a single large contrast-enhanced abnormality in the left hemisphere that was diagnosed as TDL after exclusion of other causes. In view of the limited number of clinical symptoms, an expectative policy was conducted. The patient recovered spontaneously and repeated MRI studies showed partial regression of TDL. TDL is often considered to be a first presentation of multiple sclerosis. Accurate analysis with MRI can help in making a diagnosis without the need for a biopsy.

Societal Value of Surgery for Facial Reanimation.

PubMed

Su, Peiyi; Ishii, Lisa E; Joseph, Andrew; Nellis, Jason; Dey, Jacob; Bater, Kristin; Byrne, Patrick J; Boahene, Kofi D O; Ishii, Masaru

2017-03-01

Patients with facial paralysis are perceived negatively by society in a number of domains. Society's perception of the health utility of varying degrees of facial paralysis and the value society places on reconstructive surgery for facial reanimation need to be quantified. To measure health state utility of varying degrees of facial paralysis, willingness to pay (WTP) for a repair, and the subsequent value of facial reanimation surgery as perceived by society. This prospective observational study conducted in an academic tertiary referral center evaluated a group of 348 casual observers who viewed images of faces with unilateral facial paralysis of 3 severity levels (low, medium, and high) categorized by House-Brackmann grade. Structural equation modeling was performed to understand associations among health utility metrics, WTP, and facial perception domains. Data were collected from July 16 to September 26, 2015. Observer-rated (1) quality of life (QOL) using established health utility metrics (standard gamble, time trade-off, and a visual analog scale) and (2) their WTP for surgical repair. Among the 348 observers (248 women [71.3%]; 100 men [28.7%]; mean [SD] age, 29.3 [11.6] years), mixed-effects linear regression showed that WTP increased nonlinearly with increasing severity of paralysis. Participants were willing to pay $3487 (95% CI, $2362-$4961) to repair low-grade paralysis, $8571 (95% CI, $6401-$11 234) for medium-grade paralysis, and $20 431 (95% CI, $16 273-$25 317) for high-grade paralysis. The dominant factor affecting the participants' WTP was perceived QOL. Modeling showed that perceived QOL decreased with paralysis severity (regression coefficient, -0.004; 95% CI, -0.005 to -0.004; P < .001) and increased with attractiveness (regression coefficient, 0.002; 95% CI, 0.002 to 0.003; P < .001). Mean (SD) health utility scores calculated by the standard gamble metric for low- and high-grade paralysis were 0.98 (0.09) and 0.77 (0

Societal Value of Surgery for Facial Reanimation

PubMed Central

Su, Peiyi; Ishii, Lisa E.; Joseph, Andrew; Nellis, Jason; Dey, Jacob; Bater, Kristin; Byrne, Patrick J.; Boahene, Kofi D. O.; Ishii, Masaru

2017-01-01

IMPORTANCE Patients with facial paralysis are perceived negatively by society in a number of domains. Society’s perception of the health utility of varying degrees of facial paralysis and the value society places on reconstructive surgery for facial reanimation need to be quantified. OBJECTIVE To measure health state utility of varying degrees of facial paralysis, willingness to pay (WTP) for a repair, and the subsequent value of facial reanimation surgery as perceived by society. DESIGN, SETTING, AND PARTICIPANTS This prospective observational study conducted in an academic tertiary referral center evaluated a group of 348 casual observers who viewed images of faces with unilateral facial paralysis of 3 severity levels (low, medium, and high) categorized by House-Brackmann grade. Structural equation modeling was performed to understand associations among health utility metrics, WTP, and facial perception domains. Data were collected from July 16 to September 26, 2015. MAIN OUTCOMES AND MEASURES Observer-rated (1) quality of life (QOL) using established health utility metrics (standard gamble, time trade-off, and a visual analog scale) and (2) their WTP for surgical repair. RESULTS Among the 348 observers (248 women [71.3%]; 100 men [28.7%]; mean [SD] age, 29.3 [11.6] years), mixed-effects linear regression showed that WTP increased nonlinearly with increasing severity of paralysis. Participants were willing to pay $3487 (95% CI, $2362–$4961) to repair low-grade paralysis, $8571 (95% CI, $6401–$11 234) for medium-grade paralysis, and $20 431 (95% CI, $16 273–$25 317) for high-grade paralysis. The dominant factor affecting the participants’ WTP was perceived QOL. Modeling showed that perceived QOL decreased with paralysis severity (regression coefficient, −0.004; 95% CI, −0.005 to −0.004; P < .001) and increased with attractiveness (regression coefficient, 0.002; 95% CI, 0.002 to 0.003; P < .001). Mean (SD) health utility scores calculated by the

Solitary Metastasis to the Facial/Vestibulocochlear Nerve Complex: Case Report and Review of the Literature.

PubMed

Ariai, M Shafie; Eggers, Scott D; Giannini, Caterina; Driscoll, Colin L W; Link, Michael J

2015-10-01

Distant metastasis of mucinous adenocarcinoma from the gastrointestinal tract, ovaries, pancreas, lungs, breast, or urogenital system is a well-described entity. Mucinous adenocarcinomas from different primary sites are histologically identical with gland cells producing a copious amount of mucin. This report describes a very rare solitary metastasis of a mucinous adenocarcinoma of unknown origin to the facial/vestibulocochlear nerve complex in the cerebellopontine angle. A 71-year-old woman presented with several month history of progressive neurological decline and a negative extensive workup performed elsewhere. She presented to our institution with complete left facial weakness, left-sided deafness, gait unsteadiness, headache and anorexia. A repeat magnetic resonance imaging scan of the head revealed a cystic, enhancing abnormality involving the left cerebellopontine angle and internal auditory canal. A left retrosigmoid craniotomy was performed and the lesion was completely resected. The final pathology was a mucinous adenocarcinoma of indeterminate origin. Postoperatively, the patient continued with her preoperative deficits and subsequently died of her systemic disease 6 weeks after discharge. The facial/vestibulocochlear nerve complex is an unusual location for metastatic disease in the central nervous system. Clinicians should consider metastatic tumor as the possible etiology of an unusual appearing mass in this location causing profound neurological deficits. The prognosis after metastatic mucinous adenocarcinoma to the cranial nerves in the cerebellopontine angle may be poor. Copyright © 2015 Elsevier Inc. All rights reserved.

Realistic prediction of individual facial emotion expressions for craniofacial surgery simulations

NASA Astrophysics Data System (ADS)

Gladilin, Evgeny; Zachow, Stefan; Deuflhard, Peter; Hege, Hans-Christian

2003-05-01

In addition to the static soft tissue prediction, the estimation of individual facial emotion expressions is an important criterion for the evaluation of the carniofacial surgery planning. In this paper, we present an approach for the estimation of individual facial emotion expressions on the basis of geometrical models of human anatomy derived from tomographic data and the finite element modeling of facial tissue biomechanics.

Comparison of trophic factors' expression between paralyzed and recovering muscles after facial nerve injury. A quantitative analysis in time course.

PubMed

Grosheva, Maria; Nohroudi, Klaus; Schwarz, Alisa; Rink, Svenja; Bendella, Habib; Sarikcioglu, Levent; Klimaschewski, Lars; Gordon, Tessa; Angelov, Doychin N

2016-05-01

After peripheral nerve injury, recovery of motor performance negatively correlates with the poly-innervation of neuromuscular junctions (NMJ) due to excessive sprouting of the terminal Schwann cells. Denervated muscles produce short-range diffusible sprouting stimuli, of which some are neurotrophic factors. Based on recent data that vibrissal whisking is restored perfectly during facial nerve regeneration in blind rats from the Sprague Dawley (SD)/RCS strain, we compared the expression of brain derived neurotrophic factor (BDNF), fibroblast growth factor-2 (FGF2), insulin growth factors 1 and 2 (IGF1, IGF2) and nerve growth factor (NGF) between SD/RCS and SD-rats with normal vision but poor recovery of whisking function after facial nerve injury. To establish which trophic factors might be responsible for proper NMJ-reinnervation, the transected facial nerve was surgically repaired (facial-facial anastomosis, FFA) for subsequent analysis of mRNA and proteins expressed in the levator labii superioris muscle. A complicated time course of expression included (1) a late rise in BDNF protein that followed earlier elevated gene expression, (2) an early increase in FGF2 and IGF2 protein after 2 days with sustained gene expression, (3) reduced IGF1 protein at 28 days coincident with decline of raised mRNA levels to baseline, and (4) reduced NGF protein between 2 and 14 days with maintained gene expression found in blind rats but not the rats with normal vision. These findings suggest that recovery of motor function after peripheral nerve injury is due, at least in part, to a complex regulation of lesion-associated neurotrophic factors and cytokines in denervated muscles. The increase of FGF-2 protein and concomittant decrease of NGF (with no significant changes in BDNF or IGF levels) during the first week following FFA in SD/RCS blind rats possibly prevents the distal branching of regenerating axons resulting in reduced poly-innervation of motor endplates. Copyright �

Validating Facial Aesthetic Surgery Results with the FACE-Q.

PubMed

Kappos, Elisabeth A; Temp, Mathias; Schaefer, Dirk J; Haug, Martin; Kalbermatten, Daniel F; Toth, Bryant A

2017-04-01

In aesthetic clinical practice, surgical outcome is best measured by patient satisfaction and quality of life. For many years, there has been a lack of validated questionnaires. Recently, the FACE-Q was introduced, and the authors present the largest series of face-lift patients evaluated by the FACE-Q with the longest follow-up to date. Two hundred consecutive patients were identified who underwent high-superficial musculoaponeurotic system face lifts, with or without additional facial rejuvenation procedures, between January of 2005 and January of 2015. Patients were sent eight FACE-Q scales and were asked to answer questions with regard to their satisfaction. Rank analysis of covariance was used to compare different subgroups. The response rate was 38 percent. Combination of face lift with other procedures resulted in higher satisfaction than face lift alone (p < 0.05). Patients who underwent lipofilling as part of their face lift showed higher satisfaction than patients without lipofilling in three subscales (p < 0.05). Facial rejuvenation surgery, combining a high-superficial musculoaponeurotic system face lift with lipofilling and/or other facial rejuvenation procedures, resulted in a high level of patient satisfaction. The authors recommend the implementation of the FACE-Q by physicians involved in aesthetic facial surgery, to validate their clinical outcomes from a patient's perspective.

Ophthalmic profile and systemic features of pediatric facial nerve palsy.

PubMed

Patil-Chhablani, Preeti; Murthy, Sowmya; Swaminathan, Meenakshi

2015-12-01

Facial nerve palsy (FNP) occurs less frequently in children as compared to adults but most cases are secondary to an identifiable cause. These children may have a variety of ocular and systemic features associated with the palsy and need detailed ophthalmic and systemic evaluation. This was a retrospective chart review of all the cases of FNP below the age of 16 years, presenting to a tertiary ophthalmic hospital over the period of 9 years, from January 2000 to December 2008. A total of 22 patients were included in the study. The average age at presentation was 6.08 years (range, 4 months to 16 years). Only one patient (4.54%) had bilateral FNP and 21 cases (95.45%) had unilateral FNP. Seventeen patients (77.27%) had congenital palsy and of these, five patients had a syndromic association, three had birth trauma and nine patients had idiopathic palsy. Five patients (22.72%) had an acquired palsy, of these, two had a traumatic cause and one patient each had neoplastic origin of the palsy, iatrogenic palsy after surgery for hemangioma and idiopathic palsy. Three patients had ipsilateral sixth nerve palsy, two children were diagnosed to have Moebius syndrome, one child had an ipsilateral Duane's syndrome with ipsilateral hearing loss. Corneal involvement was seen in eight patients (36.36%). Amblyopia was seen in ten patients (45.45%). Neuroimaging studies showed evidence of trauma, posterior fossa cysts, pontine gliosis and neoplasms such as a chloroma. Systemic associations included hemifacial macrosomia, oculovertebral malformations, Dandy Walker syndrome, Moebius syndrome and cerebral palsy FNP in children can have a number of underlying causes, some of which may be life threatening. It can also result in serious ocular complications including corneal perforation and severe amblyopia. These children require a multifaceted approach to their care.

Glucose transporters GLUT4 and GLUT8 are upregulated after facial nerve axotomy in adult mice.

PubMed

Gómez, Olga; Ballester-Lurbe, Begoña; Mesonero, José E; Terrado, José

2011-10-01

Peripheral nerve axotomy in adult mice elicits a complex response that includes increased glucose uptake in regenerating nerve cells. This work analyses the expression of the neuronal glucose transporters GLUT3, GLUT4 and GLUT8 in the facial nucleus of adult mice during the first days after facial nerve axotomy. Our results show that whereas GLUT3 levels do not vary, GLUT4 and GLUT8 immunoreactivity increases in the cell body of the injured motoneurons after the lesion. A sharp increase in GLUT4 immunoreactivity was detected 3 days after the nerve injury and levels remained high on Day 8, but to a lesser extent. GLUT8 also increased the levels but later than GLUT4, as they only rose on Day 8 post-lesion. These results indicate that glucose transport is activated in regenerating motoneurons and that GLUT4 plays a main role in this function. These results also suggest that metabolic defects involving impairment of glucose transporters may be principal components of the neurotoxic mechanisms leading to motoneuron death. © 2011 The Authors. Journal of Anatomy © 2011 Anatomical Society of Great Britain and Ireland.

Plastic Surgeons' Opinions of Facial Surgery for Individuals with Down Syndrome.

ERIC Educational Resources Information Center

May, Deborah C.; Turnbull, Nancy

1992-01-01

One hundred plastic surgeons responded to a survey on opinions toward facial plastic surgery for individuals with Down's syndrome. Twenty-four of the surgeons had performed the surgery. Surgeons indicated appropriate circumstances for the surgery, consent requirements, degree of understanding expected of the patient, and degree of discomfort…

Clinical studies of photodynamic therapy for malignant brain tumors: facial nerve palsy after temporal fossa photoillumination

NASA Astrophysics Data System (ADS)

Muller, Paul J.; Wilson, Brian C.; Lilge, Lothar D.; Varma, Abhay; Bogaards, Arjen; Fullagar, Tim; Fenstermaker, Robert; Selker, Robert; Abrams, Judith

2003-06-01

In two randomized prospective studies of brain tumor PDT more than 180 patients have been accrued. At the Toronto site we recognized two patients who developed a lower motor neuron (LMN) facial paralysis in the week following the PDT treatment. In both cases a temporal lobectomy was undertaken and the residual tumor cavity was photo-illuminated. The surface illuminated included the temporal fossa floor, thus potentially exposing the facial nerve to the effect of PDT. The number of frontal, temporal, parietal, and occipital tumors in this cohort was 39, 24, 12 and 4, respectively. Of the 24 temporal tumors 18 were randomized to Photofrin-PDT. Of these 18 a temporal lobectomy was carried out exposing the middle fossa floor as part of the tumor resection. In two of the 10 patients where the lobectomy was carried out and the fossa floor was exposed to light there occurred a postoperative facial palsy. Both patients recovered facial nerve function in 6 and 12 weeks, respectively. 46 J/cm2 were used in the former and 130 J/cm2 in the latter. We did not encounter a single post-operative LMN facial plasy in the 101 phase 2 patients treated with Photofrin-PDT. Among 688 supratentorial brain tumor operations in the last decade involving all pathologies and all locations no case of early post-operative LMN facial palsy was identified in the absence of PDT. One further patient who had a with post-PDT facial palsy was identified at the Denver site. Although it is possible that these patients had incidental Bell's palsy, we now recommend shielding the temporal fossa floor during PDT.

Transient facial nerve paralysis (Bell's palsy) following administration of hepatitis B recombinant vaccine: a case report.

PubMed

Paul, R; Stassen, L F A

2014-01-01

Bell's palsy is the sudden onset of unilateral transient paralysis of facial muscles resulting from dysfunction of the seventh cranial nerve. Presented here is a 26-year-old female patient with right lower motor neurone facial palsy following hepatitis B vaccination. Readers' attention is drawn to an uncommon cause of Bell's palsy, as a possible rare complication of hepatitis B vaccination, and steps taken to manage such a presentation.