Surgical approaches to facial nerve deficits.
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ABSTRACT:
SUBMITTER: Birgfeld C
PROVIDER: S-EPMC3312111 | biostudies-other | 2011 May
REPOSITORIES: biostudies-other
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Project description:Objective: This communication is the first assessment of outcomes after surgical repair of cochlea-facial nerve dehiscence (CFD) in a series of patients. Pre- and post-operative quantitative measurement of validated survey instruments, symptoms, diagnostic findings and anonymous video descriptions of symptoms in a cohort of 16 patients with CFD and third window syndrome (TWS) symptoms were systematically studied. Study design: Observational analytic case-control study. Setting: Quaternary referral center. Patients: Group 1 had 8 patients (5 children and 3 adults) with CFD and TWS who underwent surgical management using a previously described round window reinforcement technique. Group 2 had 8 patients (2 children and 6 adults) with CFD who did not have surgical intervention. Interventions: The Dizziness Handicap Inventory (DHI) and Headache Impact Test (HIT-6) were administered pre-operatively and post-operatively. In addition, diagnostic findings of comprehensive audiometry, cervical vestibular evoked myogenic potential (cVEMP) thresholds and electrocochleography (ECoG) were studied. Symptoms before and after surgical intervention were compared. Main outcome measures: Pre- vs. post-operative DHI, HIT-6, and audiometric data were compared statistically. The thresholds and amplitudes for cVEMP in symptomatic ears, ears with cochlea-facial nerve dehiscence and ears without CFD were compared statistically. Results: There was a highly significant improvement in DHI and HIT-6 at pre- vs. post-operative (p < 0.0001 and p < 0.001, respectively). The age range was 12.8-52.9 years at the time of surgery (mean = 24.7 years). There were 6 females and 2 males. All 8 had a history of trauma before the onset of their symptoms. The mean cVEMP threshold was 75 dB nHL (SD 3.8) for the operated ear and 85.7 dB (SD 10.6) for the unoperated ear. In contrast to superior semicircular canal dehiscence, where most ears have abnormal ECoG findings suggestive of endolymphatic hydrops, only 1 of 8 operated CFD ears (1 of 16 ears) had an abnormal ECoG study. Conclusions: Overall there was a marked improvement in DHI, HIT-6 and symptoms post-operatively. Statistically significant reduction in cVEMP thresholds was observed in patients with radiographic evidence of CFD. Surgical management with round window reinforcement in patients with CFD was associated with improved symptoms and outcomes measures.
| S-EPMC6923767 | biostudies-literature
Project description:Masseteric-facial anastomosis has gained popularity in recent days compared to the facial-hypoglossal anastomosis. Masseteric nerve has numerous advantages like its proximity to the facial nerve, stronger motor impulse, its reliability, low morbidity in harvesting and sacrificing the nerve and faster re-innervation that is achievable in most patients. The present case series demonstrate the surgical technique and the effectiveness of the masseteric nerve as donor for early facial reanimation. Between January 2017 and February 2019, 6 patients (2 male, 4 female) with iatrogenic unilateral complete facial paralysis (grade VI, House Brackmann scale) who underwent masseteric-facial nerve anastomosis were included in the study. The time interval between the onset of paralysis and surgery ranged from 4 to 18 months (mean 8.5 months). In all patients pre-operative electromyography had facial mimetic muscle fibrillation potentials. All patients underwent end to end anastomosis except for one patient where greater auricular interposition graft was used. In all cases, the facial muscles showed earliest sign of recovery at 2-5 months. These movements were first noticed on the cheek musculature when the patients activated their masseter muscle. Eye movements started appearing at 6-9 months (in 3 cases) and forehead movements at 18 months (in 1 case). According to the modified House-Brackmann grading scale, one patient had Grade I function, two patients had Grade II function, and three had Grade V function. There was no morbidity except one patient who underwent interposition graft had numbness in the ear lobule. None of the patients could feel the loss of masseteric nerve function. Masseteric facial nerve anastomosis is a versatile, powerful early facial dynamic reanimation tool with almost negligible morbidity compared to other neurotization procedures for patients with complete facial nerve paralysis.
| S-EPMC7040122 | biostudies-literature
Project description:Surgery of the skull base has evolved over the past 100 years. The importance of combined otorhinological and neurosurgical approach in the management of lesions of the skull base has been realised in recent years. Through this strategy, lesions which were once thought unresectable are being removed completely with reduction in mortality. However, the morbidity due to facial palsy in lateral skull base surgery is common. To avoid this, intraoperative facial nerve monitoring was introduced in the late 70's and has been refined to such a point that it is now possible to safely predict the recovery of the temporary facial paralysis after lateral skull base surgery. The present study which was carried out in the Armed Forces for the first time has evaluated this by comparing 5 patients who underwent this surgery without intraoperative facial nerve monitoring with 5 patients who were operated with intraoperative facial nerve monitoring. The results have proved the efficacy of this tool in reducing the severity and duration of facial palsy after this surgery.
| S-EPMC5531971 | biostudies-other
Project description:Background During orbitozygomatic (OZ) approaches, the frontotemporal branch (FTB) of the facial nerve is exposed to injury if proper measures are not taken. This article describes in detail the nuances of the two most common techniques (interfascial and subfascial dissection). Design The FTB of the facial nerve was dissected and followed in its tissue planes on fresh-frozen cadaver heads. The interfascial and subfascial dissections were performed, and every step was photographed and examined. Results The interfascial dissection is safe to be started from the most anterior part of the superior temporal line and followed to the root of the zygoma. The dissection is continued on the deep temporalis fascia (DTF), and the interfascial fat pad is elevated. With the subfascial dissection, both the superficial temporalis fascia and the DTF are elevated. The interfascial dissection exposes the zygomatic arch directly, whereas the subfascial dissection requires an additional cut on the DTF to expose the zygomatic arch. Proper subperiosteal dissection on the zygomatic arch is another important step in FTB preservation. Conclusion Detailed understanding of the complex relationship of the tissue planes in the frontotemporal region is needed to perform OZ exposures safely.
| S-EPMC4433393 | biostudies-other
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: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: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:Dysfunction of the facial nerve is a common complication of parotidectomy. The functional deficit may be total or partial, and may include all or a single branch of the nerve. Despite a wide variety of the facial nerve grading systems, most of them have a limited utility in patients after parotidectomy. Therefore, existing scales assessing facial nerve function are compared to describe facial nerve outcomes after parotidectomy. The regional House-Brackmann, Sydney, and Yanagihara classification systems were utilized. The post-parotidectomy facial nerve grading system (PPFNGS) was created based on these three grading systems and also used for this study. The facial nerve function was assessed and recorded on the first postoperative day following conservative parotidectomy in 200 patients using all 4 scales by 3 otolaryngologists. The validity of the PPFNGS and existing facial nerve grading systems was examined by assessment of interrater agreement, intraclass correlation coefficient, internal consistency and construct validity. A deficit in the facial nerve function was found in 54 patients (27 %). Although results were consistent in all tested scales, the PPFNGS had a higher interrater agreement than the other three scales. PPFNGS is a new grading system designed for assessing the facial nerve function after parotidectomy in a quantitative and qualitative way and has a higher interrater agreement than other scales used to examine function of the 7th nerve.
| S-EPMC4526578 | 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