Facial nerve grading after parotidectomy.
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ABSTRACT:
SUBMITTER: Stodulski D
PROVIDER: S-EPMC4526578 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Objectives/hypothesisAdditional 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 designTwenty-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.MethodsTwenty-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.ResultsPostoperative 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.ConclusionsNP41 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.Level of evidenceNA Laryngoscope, 126:2711-2717, 2016.
| S-EPMC5107163 | biostudies-literature
Project description:ObjectiveThe intra-parotid facial nerve (FN) can be visualized using three-dimensional double-echo steady-state water-excitation sequence magnetic resonance imaging (3D-DESS-WE-MRI). However, the clinical impact of FN imaging using 3D-DESS-WE-MRI before parotidectomy has not yet been explored. We compared the clinical outcomes of parotidectomy in patients with and without preoperative 3D-DESS-WE-MRI.Materials and methodsThis prospective, non-randomized, single-institution study included 296 adult patients who underwent parotidectomy for parotid tumors, excluding superficial and mobile tumors. Preoperative evaluation with 3D-DESS-WE-MRI was performed in 122 patients, and not performed in 174 patients. FN visibility and tumor location relative to FN on 3D-DESS-WE-MRI were evaluated in 120 patients. Rates of FN palsy (FNP) and operation times were compared between patients with and without 3D-DESS-WE-MRI; propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to adjust for surgical and tumor factors.ResultsThe main trunk, temporofacial branch, and cervicofacial branch of the intra-parotid FN were identified using 3D-DESS-WE-MRI in approximately 97.5% (117/120), 44.2% (53/120), and 25.0% (30/120) of cases, respectively. The tumor location relative to FN, as assessed on magnetic resonance imaging, concurred with surgical findings in 90.8% (109/120) of cases. Rates of temporary and permanent FNP did not vary between patients with and without 3D-DESS-WE-MRI according to PSM (odds ratio, 2.29 [95% confidence interval {CI} 0.64-8.25] and 2.02 [95% CI: 0.32-12.90], respectively) and IPTW (odds ratio, 1.76 [95% CI: 0.19-16.75] and 1.94 [95% CI: 0.20-18.49], respectively). Conversely, operation time for surgical identification of FN was significantly shorter with 3D-DESS-WE-MRI (median, 25 vs. 35 min for PSM and 25 vs. 30 min for IPTW, P < 0.001).ConclusionPreoperative FN imaging with 3D-DESS-WE-MRI facilitated anatomical identification of FN and its relationship to the tumor during parotidectomy. This modality reduced operation time for FN identification, but did not significantly affect postoperative FNP rates.
| S-EPMC10462904 | biostudies-literature
Project description:PurposeAn accurate understanding of the anatomy, identification and preservation of facial nerve is critical in performing successful functional parotidectomies. The current literature is replete with inconsistencies of various landmarks when used alone for identification of facial nerve trunk (FNT). The purpose of the paper is to introduce a new anatomical triangle, Borle's triangle (BT) for safer and reliable operative identification of FNT during parotodectomies.Patients and methodsBetween Aug 2014 and Dec 2017, twelve patients who reported with unilateral disease of the parotid gland with intact facial nerve function who underwent superficial or complete parotidecomies were included in the study. BT was conceptualized by intersection of three imaginary lines drawn along anatomical structures and forming a triangle comprising of angles a, b and c.ResultsIntroperatively, BT helped reliably identify the FNT and its branches successfully in all the cases. The mean distance of FNT from angle b was found to be 12.18?±?1.7?mm. Transient neurological deficits with one or more branches were seen in four cases whilst, one case had transient deficit with all the five peripheral branches. All of them spontaneously resolved completely by the end of three months post operatively.ConclusionsWhen used in isolation, substantial variations exist in distances measured from anatomic landmarks to the main FNT in the literature. The BT utilizes three commonly used anatomical landmarks. It predictably helps in proper anatomic orientation, identification and preservation of FNT and branches with ease in parotidectomies.
| S-EPMC6126203 | biostudies-literature
Project description:Objective:We aimed to adapt the Facial Nerve Grading System 2.0 (FNGS 2.0) to Turkish and to investigate the validity and the reliability of the Turkish version. Methods:The original FNGS 2.0 was translated into Turkish and validated by international standards. Six Turkish physicians, three specialists and three residents, independently rated the videos, two times each, of 40 adult facial palsy patients. Inter-rater and intra-rater reliability were assessed using the intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient. As another indication of reliability, "generalizability" was also evaluated. For all analyses, a p value of <0.05 was considered statistically significant. Results:ICC and Cronbach's alpha coefficients for the inter-rater reliability of the total score of the FNGS 2.0 were 0.970 and 0.979 for the first assessment, 0.973 and 0.979 for the second assessment, respectively. The intra-rater reliability ICC results for the total score of the FNGS 2.0 were 0.95, 0.976, 0.982, 0.956, 0.96 and 0.931 for the six raters, respectively. The generalizability coefficient was found as G=0.894. Conclusion:In this study, we adapted the FNGS 2.0 to Turkish, and confirmed its reliability and validity as a facial palsy scale. The Turkish version of the FNGS 2.0 can be safely used to assess.
| S-EPMC7397538 | biostudies-literature
Project description:ObjectivesFacial nerve sacrifice during radical parotidectomy can impair quality of life. This study assessed the effectiveness of single-stage facial reanimation surgery performed concurrently with radical parotidectomy in restoring facial function.MethodsA retrospective analysis was conducted on patients who underwent single-stage facial reanimation combined with radical parotidectomy. The techniques employed included selective reinnervation and orthodromic temporalis tendon transfer. Outcomes were evaluated using the modified House-Brackmann and Terzis grading systems, Emotrics facial assessment, and the Facial Disability Index (FDI).ResultsAmong the 13 patients studied (median age, 54 years; 69% male), 10 underwent selective reinnervation. Of these, nine patients demonstrated improvement, achieving House-Brackmann grade III and Terzis grade 4 or 5. The other three patients underwent tendon transfer and achieved moderate functional outcomes. Emotrics analysis revealed balanced facial symmetry in the selective reinnervation group. Furthermore, FDI scores indicated satisfactory physical and social/well-being functions.ConclusionSingle-stage facial reanimation effectively restores facial function in patients undergoing radical parotidectomy. This approach offers meaningful benefits in the early recovery of facial function.
| S-EPMC11375167 | biostudies-literature
Project description:A few approaches can be used to decompress traumatic facial nerve paralysis including the middle cranial fossa approach or transmastoid approach depending on the site of injury. In some specific situation of treating traumatic facial nerve palsy whose injured site was confined from the geniculate ganglion to the second genu, transcanal endoscopic approach for facial nerve decompression can be used. We performed two cases of total endoscopic transcanal facial nerve decompression in patients with traumatic facial nerve palsy. After a six month follow-up, both patients showed improvement in facial function by 2 grades according to House-Brackmann grade system. In terms of treatment outcomes, total transcanal endoscopic facial nerve decompression for traumatic facial nerve palsy is an alternative for lesions limited to the tympanic segment I, and has an advantages of being minimally invasive and is cosmetically acceptable without an external scar or bony depression due to drilling.
| S-EPMC5890000 | biostudies-literature
Project description: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.
| S-EPMC4677084 | biostudies-literature
Project description: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.
| S-EPMC5655551 | biostudies-literature
Project description:IntroductionPatients' quality of life (QoL), facial nerve (FN), and cochlear nerve (CN) (if conserved) functions should be pursued as final outcomes of vestibular schwannoma (VS) surgery. In regard to FN function, different morphologic and neurophysiological factors have been related to postoperative outcomes. The aim of the current retrospective study was to investigate the impact of these factors on the short- and long-term FN function after VS resection. The combination of preoperative and intraoperative factors resulted in designing and validating a multiparametric score to predict short- and long-term FN function.MethodsA single-center retrospective analysis was performed for patients harboring non-syndromic VS who underwent surgical resection in the period 2015-2020. A minimum follow-up period of 12 months was considered among the inclusion criteria. Morphological tumor characteristics, intraoperative neurophysiological parameters, and postoperative clinical factors, namely, House-Brackmann (HB) scale, were retrieved in the study. A statistical analysis was conducted to investigate any relationships with FN outcome and to assess the reliability of the score.ResultsSeventy-two patients with solitary primary VS were treated in the period of the study. A total of 59.8% of patients showed an HB value < 3 in the immediate postoperative period (T1), reaching to 76.4% at the last follow-up evaluation. A multiparametric score, Facial Nerve Outcome Score (FNOS), was built. The totality of patients with FNOS grade A showed an HB value < 3 at 12 months, decreasing to 70% for those with FNOS grade B, whereas 100% of patients with FNOS grade C showed an HB value ≥ 3. The ordinal logistic regression showed three times increasing probability to see an HB value ≥ 3 at 3-month follow-up for each worsening point in FNOS score [Exp(B), 2,999; p < 0.001] that was even more probable [Exp(B), 5.486; p < 0.001] at 12 months.ConclusionThe FNOS score resulted to be a reliable score, showing high associations with FN function both at short- and long-term follow-up. Although multicenter studies would be able to increase its reproducibility, it could be used to predict the FN damage after surgery and the potential of restoring its function on the long-term period.
| S-EPMC10291180 | biostudies-literature
Project description:We have previously demonstrated that CD4(+) Th2 lymphocytes are required to rescue facial motoneuron (FMN) survival after facial nerve axotomy through interaction with peripheral antigen presenting cells, as well as CNS resident microglia. Furthermore, the innate immune molecule, toll-like receptor 2 (TLR2), has been implicated in the development of Th2-type immune responses and can be activated by intracellular components released by dead or dying cells. The role of TLR2 in the FMN response to axotomy was explored in this study, using a model of facial nerve axotomy at the stylomastoid foramen in the mouse, in which blood-brain-barrier (BBB) permeability does not occur. After facial nerve axotomy, TLR2 mRNA was significantly upregulated in the facial motor nucleus and co-immunofluorescence localized TLR2 to CD68(+) microglia, but not GFAP(+) astrocytes. Using TLR2-deficient (TLR2(-/-)) mice, it was determined that TLR2 does not affect FMN survival levels after axotomy. These data contribute to understanding the role of innate immunity after FMN death and may be relevant to motoneuron diseases, such as amyotrophic lateral sclerosis (ALS).
| S-EPMC2825370 | biostudies-literature