Effects of a sensory branch to the posterior external ear canal: coughing, pain, Ramsay Hunt's syndrome and Hitselberger's sign

2017 ◽  
Vol 131 (4) ◽  
pp. 329-333 ◽  
Author(s):  
S Mulazimoglu ◽  
R Flury ◽  
S Kapila ◽  
T Linder
Keyword(s):  
Facial Nerve ◽  
Close Relation ◽  
Clinical Implications ◽  
External Ear ◽  
Canal Wall ◽  
Bone Specimen ◽  
Posterior Canal ◽  
Neuralgic Pain ◽  
Communicating Branch ◽  
Cerumen Removal

AbstractBackground:A distinct nerve innervating the external auditory canal can often be identified in close relation to the facial nerve when gradually thinning the posterior canal wall. This nerve has been attributed to coughing during cerumen removal, neuralgic pain, Hitselberger's sign and vesicular eruptions described in Ramsay Hunt's syndrome. This study aimed to demonstrate the origin and clinical impact of this nerve.Methods and results:In patients with intractable otalgia or severe coughing whilst inserting a hearing aid, who responded temporarily to local anaesthesia, the symptoms could be resolved by sectioning a sensory branch to the posterior canal. In a temporal bone specimen, it was revealed that this nerve is predominantly a continuation of Arnold's nerve, also receiving fibres from the glossopharyngeal nerve and facial nerve. Histologically, the communicating branch from the facial nerve was confirmed.Conclusion:Surgeons should be aware of the posterior auricular sensory branch and its clinical implications.

scholarly journals The depth of the facial nerve in the mastoid bone

2018 ◽  
Vol 4 (3) ◽  
pp. 666
Author(s):  
B. Y. Praveen Kumar ◽  
K. T. Chandrashekhar ◽  
M. K. Veena Pani ◽  
Sunil K. C. ◽  
Anand Kumar S. ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Temporal Bone ◽  
Significant Variation ◽  
Canal Wall ◽  
Stylomastoid Foramen ◽  
Cortical Mastoidectomy ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy ◽  
The Mean ◽  
Temporal Bones

<p class="abstract"><strong>Background:</strong> The hallmark of the temporal bone is variation. Various important structures like the facial nerve run in the temporal bone at various depths which can be injured during mastoidectomy.</p><p class="abstract"><strong>Methods:</strong> Twenty wet cadaveric temporal bones were dissected. A cortical mastoidectomy was performed followed by a canal wall down mastoidectomy and the depth of the vertical segment of the facial nerve in the mastoid was determined.  </p><p class="abstract"><strong>Results:</strong> The mean depth of the second genu was 13.82 mm. The mean depth of the stylomastoid foramen was 12.75 mm and the mean distance from the annulus at 6’0 clock to the stylomastoid foramen was 10.22 mm.</p><p><strong>Conclusions:</strong> There is significant variation in the average depth of the facial nerve in the mastoid. </p>

scholarly journals Four layers reconstruction of the posterior ear canal wall in one stage surgery

2021 ◽  
Author(s):  
Khaled M. Mokbel Khalefa
Keyword(s):  
Otitis Media ◽  
Recurrent Infection ◽  
Posterior Wall ◽  
Chronic Suppurative Otitis Media ◽  
Canal Wall ◽  
Suppurative Otitis Media ◽  
Posterior Canal ◽  
One Stage ◽  
Canal Wall Down ◽  
Canal Wall Down Mastoidectomy

<p class="abstract"><strong>Background:</strong> Canal wall down mastoidectomy are still practiced in cases of chronic suppurative otitis media with cholesteatoma to ensure complete disease removal. The resulting cavity is prone to recurrent infection, chronic discharge and frequent care. Reconstruction of the posterior canal wall should be planned by the surgeon. Various techniques for external auditory canal (EAC) reconstruction have been recommended to eliminate open cavity problems. The surgeon should choose the type of grafts either autologous, homografts or synthetic materials. Furthermore, the surgeon should decide whether to do the reconstruction either immediate in the first stage of surgery or delayed as a second stage.</p><p class="abstract"><strong>Methods:</strong> In this study, the ridge was reconstructed at the same time of mastoidectomy by autologous tissues. The presenting study reconstructed the posterior canal wall in four layers; skin, perichondrial flap, cartilage and periosteal flap in that order from the meatal side to the mastoid side. The presenting study included 48 patients (32 males and 16 females) with age ranged from 18-55 and 20-50 years. All included patients were presented at the outpatient clinic with unilateral chronic suppurative otitis media with persistent discharge. They had been operated at our tertiary hospital between January. 2012 to March 2014.</p><p class="abstract"><strong>Results:</strong> Successful reconstruction was obtained in all cases, with no dehiscence or necrosis.</p><p class="abstract"><strong>Conclusions:</strong> The reconstruction of the posterior wall by the four layers technique was successful and efficient. It is recommended to do this repair concomitantly with canal wall down mastoidectomy as one stage surgery.</p>

Posterior Canal Wall Reconstruction With Titanium Micro-Mesh and Bone Pat??Age

2002 ◽  
Vol 112 (4) ◽  
pp. 753-756 ◽  
Author(s):  
Carlo Zini ◽  
Nicola Quaranta ◽  
Fabio Piazza
Keyword(s):  
Canal Wall ◽  
Posterior Canal ◽  
Canal Wall Reconstruction

Anterior Facial Nerve Rerouting in Cranial Base Surgery: A Comparison of Three Techniques

1996 ◽  
Vol 115 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Peter G. Von Doersten ◽  
Robert K. Jackler
Keyword(s):  
Facial Nerve ◽  
Jugular Foramen ◽  
Jugular Bulb ◽  
Cranial Base ◽  
Clinical Impression ◽  
Canal Wall ◽  
Posterior Aspect ◽  
Pivot Point ◽  
Carotid Canal ◽  
Canal Wall Down

Anterior rerouting of the facial nerve is a maneuver designed to enhance exposure of the jugular foramen and carotid canal during resection of cranial base tumors. Our clinical impression is that the degree of additional exposure afforded by moving the facial nerve varies considerably according to both anatomic variations and the technique used. Three possible techniques exist based on the extent of facial nerve mobilization and point of rotation: canal wall up-second genu pivot point (CWU-2G); canal wall down-second genu pivot point (CWD-2G); and canal wall down-first genu pivot point (CWD-1G). We anatomically studied 20 human cadaver heads to establish clinically relevant guidelines for the selective use of these techniques. At the level of the dome of the jugular bulb, the facial nerve mobilized anteriorly a mean of 4.2 mm for CWU-2G, 10 mm for CWD-2G, and 14 mm for CWD-1G. Detailed analysis of numerous measurements and rotation angles suggests that the typical exposure afforded by the various rerouting techniques is as follows: CWU-2G, complete exposure of the jugular bulb; CWD-2G, exposure of the jugular bulb and a mean of 6 mm of the posterior aspect of the carotid artery; and CWD-1G, exposure of the jugular bulb and entire carotid genu. Minimizing the amount of facial nerve manipulation needed to achieve sufficient surgical exposure helps optimize postoperative functional status.

Vastus lateralis vascularized nerve graft in facial nerve reconstruction: An anatomical cadaveric study and clinical implications

Microsurgery ◽  
2014 ◽  
Vol 35 (2) ◽  
pp. 135-139 ◽  
Author(s):  
Nikolaos Agrogiannis ◽  
Shai Rozen ◽  
Gangadasu Reddy ◽  
Thorir Audolfsson ◽  
Andres Rodriguez-Lorenzo
Keyword(s):  
Facial Nerve ◽  
Vastus Lateralis ◽  
Nerve Graft ◽  
Cadaveric Study ◽  
Clinical Implications ◽  
Nerve Reconstruction ◽  
Facial Nerve Reconstruction

Pediatric Cholesteatoma: An Individualized, Single-Stage Approach

1996 ◽  
Vol 115 (1) ◽  
pp. 107-114 ◽  
Author(s):  
Simon C. Parisier ◽  
Matthew B. Hanson ◽  
Jin C. Han ◽  
Adam J. Cohen ◽  
Bryan A. Selkin
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Nerve Injury ◽  
Single Stage ◽  
Canal Wall ◽  
Facial Nerve Injury ◽  
Related Disease ◽  
One Stage ◽  
Canal Wall Down ◽  
Pediatric Cholesteatoma

We report our experience with a one-stage surgery for pediatric cholesteatoma in 216 ears. Our technique is based on three main principles: (1) the surgery is individualized; (2) the goal of surgery is to completely remove cholesteatoma and related disease in one operation; and (3) the reconstruction is performed to provide both good hearing and a dry, trouble-free ear. The incidence of recidivism was 10.2%, and the rate achieved was 13.3% at 5 years and 24% at 10 years. Canal wall down surgery was the predominant procedure used. The incidence of intraoperative neurosensory hearing loss, vertigo, and facial nerve injury was extremely low. The postoperative cavity problems encountered were minimal.

Outcome After Microsurgery for Meningiomas Involving the Internal Auditory Canal

Neurosurgery ◽  
2010 ◽  
Vol 67 (5) ◽  
pp. 1236-1242 ◽  
Author(s):  
Kajetan L von Eckardstein ◽  
Colin L W Driscoll ◽  
Michael J Link
Keyword(s):  
Facial Nerve ◽  
Internal Auditory Canal ◽  
Entire Group ◽  
Surgical Removal ◽  
Nerve Function ◽  
Canal Wall ◽  
Facial Nerve Function ◽  
Clinical Exam ◽  
Hearing Outcomes

Abstract BACKGROUND: The subset of patients suffering from meningiomas truly originating in or extending into the internal auditory canal is not well described in the literature. OBJECTIVE: To evaluate postoperative facial motor and hearing outcomes in patients undergoing resection of meningiomas originating in or extending into the internal auditory canal. METHODS: Chart reviews were done of 19 consecutive patients undergoing surgery for meningiomas originating in or extending into the internal auditory canal at the Mayo Clinic, Rochester, with emphasis on clinical exam and audiometry. RESULTS: Median follow-up for the entire group was 29 months. Seventy-four percent of patients had stable facial nerve function. One patient experienced improvement. Postoperative cochlear nerve function was unchanged in 74% of patients and worsened in 21% of patients. One patient with a sudden preoperative hearing loss improved to full hearing at 3 months. CONCLUSION: Every attempt should be made to preserve hearing and facial motor function in surgical removal of posterior fossa meningiomas that originate in or extend into the internal auditory canal. Normal or nearly normal facial nerve function can be preserved in 88% of patients presenting with normal facial nerve function; serviceable hearing can be preserved in 92% of patients who present with normal hearing. A standard retrosigmoid craniotomy with drilling of the posterior canal wall of the internal auditory canal worked well in the majority of cases.

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