Retrograde Degeneration of the Facial Nerve after Acute Traction on Parotid Gland: An Experimental Investigation

2002 ◽  
Vol 127 (1) ◽  
pp. 55-59 ◽  
Author(s):  
Zhengmin Wang ◽  
Chun-Fu Dai ◽  
Fanglu Chi
Keyword(s):  
Experimental Investigation ◽  
Parotid Gland ◽  
Facial Nerve ◽  
Histologic Examination ◽  
Nerve Degeneration ◽  
Electric Response ◽  
Retrograde Degeneration ◽  
Stylomastoid Foramen ◽  
Group A ◽  
Group B

The parotid gland of the cat underwent traction for 2 hours (group A) or until the facial nerve was broken (group B). The cats survived postoperatively for 1 day, 2 weeks, 1 month, and 3 months, respectively. Each cat underwent an electroneurography session before they were killed. The facial nerve was harvested and underwent histologic examination. The present study demonstrated that, in group A, the degree of facial nerve degeneration indicated with evoked electroneurography was 100% at 1 day and 2 weeks and 85% and 35%, respectively, at 1 and 3 months after damage. In group B, no electric response was recorded, epineurium of extratemporal segment was broken. This study also showed that the pronounced alteration of the facial nerve following acute traction on the parotid gland was retrograde degeneration; it involved up to its internal acoustic meatus segment. Furthermore, pronounced damage was noted in its stylomastoid foramen and extratemporal segment.

Facial Nerve Dissection Guided by Preoperative CT in Parotid Surgery

2019 ◽  
Vol 9 (8) ◽  
pp. 1782-1785
Author(s):  
Song Jin ◽  
Haili Tang ◽  
Rongyu Su
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Recovery Time ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Function Recovery ◽  
Parotid Surgery ◽  
Preoperative Ct ◽  
Group A ◽  
Group B

Objective: The parotid gland is closely related to the facial nerve. Appropriate facial nerve dissection is helpful to protect facial nerve function. The purpose of this study is to evaluate the parotid gland and its adjacent structures by preoperative CT, so as to guide the dissection of facial nerve during parotid surgery. Method: A total of 45 patients with parotid benign tumor diagnosed by pathology were collected. According the preoperative CT, two dissection methods of facial nerve was used. Twenty-one patients in group A were dissected by anterograde method from the trunk of facial nerve. Other 24 patients in Group B was dissected by retrograde method through the branch of facial nerve. The occurrence of facial nerve function injury and the recovery time of facial nerve function were observed. Result: Preoperative CT can evaluate the nature and adjacent relationship of parotid tumors. Anatomical localization markers of facial nerve can be evaluated. Group A has 1 case of facial nerve function injury (4.8%) occurred after surgery, and nerve function recovery time was (2.6 ± 0.5) m. Group B has 7 cases of facial nerve function damage (29.1%) occurred after surgery, and nerve function recovery time was (3.3 ± 0.7) m. Compared with Group A, the incidence of facial nerve function injury in Group B was higher, the nerve function recovery time was longer. Conclusion: Preoperative CT evaluation is helpful to the optimal selection of facial nerve anatomical pathway during parotid gland surgery. The anterograde and retrograde dissection of facial nerve can complete the operation successfully. The anterograde methods is the first choice as the lesser nerve function damage and faster recovery time.

Functional outcome after complete surgical removal of giant vestibular schwannomas

2010 ◽  
Vol 112 (4) ◽  
pp. 860-867 ◽  
Author(s):  
Madjid Samii ◽  
Venelin M. Gerganov ◽  
Amir Samii
Keyword(s):  
Mortality Rate ◽  
Facial Nerve ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Tumor Removal ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Dysfunction ◽  
Group A ◽  
Nerve Dysfunction ◽  
Group B

Object The authors evaluated the outcome of radical surgery in a consecutive series of patients with giant vestibular schwannomas (VSs). Methods Fifty patients with VSs > 4.0 cm in maximal extrameatal diameter were included in this retrospective study (Group A). The group was compared with a matched group of 167 patients with VSs < 3.9 cm (Group B). In all cases the retrosigmoid approach was used. Outcome measures included completeness of tumor removal, facial nerve function, hearing, and the surgery-related complication rate. Results The mean tumor size in Group A was 4.4 cm and that in Group B was 2.3 cm. Total removal was achieved in all Group A patients and in 97.6% of Group B patients. The anatomical integrity of the facial nerve was preserved in 92% in Group A and in 98.8% in Group B. At last follow-up 75% of the patients with giant VSs had excellent or good facial nerve function, 19% had fair function, and 6% had poor function. In 33% of patients (3 cases) with good preoperative hearing level, it was preserved. Newly developed lower cranial nerve dysfunction occurred in 3 patients but proved to be temporary in 2 of them. A CSF leak developed in 6% of those who not previously undergone surgery. Compared with Group B, a significant difference was found only in the rates of the following parameters: excellent facial nerve function, useful and good hearing, lower cranial nerve dysfunction, and blood collection (p < 0.05). The perioperative mortality rate in both groups was 0%. Conclusions In patients with a giant VS, total tumor removal can be achieved via the retrosigmoid approach with a 0% mortality rate and low morbidity rate, especially with regards to facial nerve function. In selected cases even hearing preservation is possible. Tumor size significantly correlates with postoperative outcome.

scholarly journals Facial Nerve Outcome and Results in Hypervascular Large Vestibular Schwannomas: Our Personal Experience in A Series of 32 Cases.

2021 ◽  
Author(s):  
Luciano Mastronardi ◽  
Alberto Campione ◽  
Fabio Boccacci ◽  
Carlo Giacobbo Scavo ◽  
Ettore Carpineta ◽  
...  
Keyword(s):  
Growth Rate ◽  
Facial Nerve ◽  
Personal Experience ◽  
Negative Impact ◽  
Vestibular Schwannomas ◽  
Tumor Diameter ◽  
Excessive Bleeding ◽  
Group A ◽  
Group B ◽  
Mib 1

Abstract BackgroundVestibular schwannomas (VS) are usually hypovascularized. Large VS with unusual vascular architecture are defined hyper-vascular (HVVS); excessive bleeding during microsurgery has negative impact on results. Methods Thirty-two consecutive patients were operated on for HVVS (Group-A). Results were compared with those of 25 patients (Group-B) operated on for large low-bleeding VS. Tendency to bleed and adherence of capsule to nervous structures were evaluated by reviewing video records. Cisternal facial nerve (FN) position was reported. Microsurgical removal was classified as total, near-total, subtotal or partial and MIB-1 index evaluated in all. FN results were classified according the House-Brackmann scale.Results Mean tumor diameter was 3,99cm in Group-A and 3,67 in Group-B; mean age was 42,3 and 58,1 years, respectively. Mean ASA class of Group-A was 1,72 versus 2,48 of Group-B (p<0,001). Total-NT resection was accomplished in 71,9% of HVVS versus 80,0% of Group-B. Tight capsule adhesion was observed in 68,7% HVVS versus 56,0% low-bleeding ones. Mean MIB-1 was 1,25% and 1,08%, respectively.Anterior-superior position of FN was observed in 48,6% of HVVS versus 32,0% of low-bleeding tumors (p<0,05). FN anatomical preservation was possible in 81,2% of Group-A versus 100% of Group-B (p<0,05); 62,5% of HVVS had HBI-II FN outcome versus 96,0% of low-bleeding (p<0,01). In Group-A 25,0% experienced postoperative complications versus 8,0% of Group-B (p<0,05). Recurrence/re-growth was observed in 7 HVVS versus 1 low-bleeding (p<0,05).Conclusions Microsurgery of large HVVS was associated with higher complication and recurrence/re-growth rate and poorer FN outcome, especially in cases with tight capsule adhesion.

Dual Coaptation of Facial Nerve Using Masseteric Branch of Trigeminal Nerve for Iatrogenic Facial Palsy: Preliminary Reports

2019 ◽  
Vol 129 (5) ◽  
pp. 505-511
Author(s):  
Yoon Se Lee ◽  
Joong Ho Ahn ◽  
Hong Ju Park ◽  
Ho Jun Lee ◽  
Mi Rye Bae ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Trigeminal Nerve ◽  
Facial Palsy ◽  
Recovery Period ◽  
Interposition Graft ◽  
Dynamic Movement ◽  
Facial Reanimation ◽  
Group A ◽  
Group B ◽  
Eye Closure

Objectives: Immediate facial nerve substitution or graft technique has been used for the repair of facial nerve defects occurring as a result of tumour dissection. However, some patients report unsatisfactory outcomes, such as difficulty in maintaining resting or smiling symmetry, due to persistent flaccid facial palsy. Here we evaluated the functional outcomes of transferring the masseteric branch of the trigeminal nerve to the facial nerve adjunct to facial nerve graft. Methods: We reviewed the medical records of seven patients who underwent facial reanimation surgery between 2014 and 2016. The patients were divided into two groups according to the type of facial reanimation surgery: group A, masseteric nerve innervation with interposition graft; group B, interposition graft only. The postoperative resting symmetry and dynamic movement were compared. Results: Facial contraction was first observed in group A at 4 months and in group B at 7.3 months. Most of the patients achieved reliable resting symmetry; however, one patient in group B exhibited unsatisfactory facial weakness on the affected side. Group A patients showed better dynamic movement than group B patients. Eye closure, oral excursion and oral continence were better in group A than in group B patients. Smile symmetry in both groups was similar due to hyperkinetic movement in group A patients and flaccidity in group B patients. Conclusions: Dual innervation of the masseteric branch of the trigeminal nerve improves the dynamic movement of paralysed facial muscles and shortens the recovery period in patients with iatrogenic facial palsy.

Congenital facial nerve agenesis

2001 ◽  
Vol 115 (1) ◽  
pp. 53-54 ◽  
Author(s):  
P. N. Jervis ◽  
P. D. Bull
Keyword(s):  
Surgical Treatment ◽  
Parotid Gland ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Facial Palsy ◽  
Surgical Procedure ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Stylomastoid Foramen ◽  
Unrelated Condition

We present a case of a seven-year-old child with a congenital facial palsy, diagnosed at birth, who subsequently developed a non-tuberculous mycobacterial (NTM) infection of the ipsilateral parotid gland. This required parotid exploration to treat the NTM disease with the intention of identifying and protecting the facial nerve to preserve any residual facial nerve function. At operation, thorough exploration revealed the complete absence of the nerve both at the stylomastoid foramen and more peripherally within the substance of the parotid gland. Exploration of the facial nerve for congenital facial paralysis is not normally indicated. Surgical treatment, if required, tends to involve the use of techniques such as cross facial nerve and free vascularized muscle grafting. To our knowledge this is the first reported case of complete congenital facial nerve agenesis, diagnosed incidentally during a surgical procedure for an unrelated condition.

Local Excision Procedure for Warthin's Tumor of the Parotid Gland

2005 ◽  
Vol 132 (4) ◽  
pp. 577-580 ◽  
Author(s):  
Hiroshi Iwai ◽  
Toshio Yamashita
Keyword(s):  
Facial Nerve ◽  
Local Excision ◽  
Operation Time ◽  
Warthin’S Tumor ◽  
Parotid Tumors ◽  
Significant Difference ◽  
Warthin's Tumor ◽  
Group A ◽  
Surgical Field ◽  
Group B

The aim of this work is to establish a local excision procedure (LEP) and indications of this procedure for Warthin's tumor. Seventy-three patients (82 sides) with Warthin's tumor were studied. Point I was located 1 cm from the intertragal notch in the direction indicated by the notch. Point S was located 5 mm superior to the inferior end of the mandibular angle. The trunk of the facial nerve and the marginal mandibular branch run at the points I and S, respectively. In surgical maneuvers below the I-S line, the marginal mandibular and colli branches may exist within the surgical field, but the trunk and other peripheral branches of the facial nerve will not be encountered. For Warthin's tumor estimated to be below the I-S line (Group A), LEP was used, involving resection of the tumor after locating and dissecting the marginal mandibular and colli branches. For tumors not meeting these criteria (Group B), partial superficial parotidectomy was performed. Results indicated that mean volume of hemorrhage was significantly smaller, and that mean operation time was significantly shorter in Group A than in Group B. Conversely, no significant difference in tumor size or incidence of postoperative facial paresis was identified between the 2 groups. Recurrence has not yet been noted in either group. In conclusion, LEP is useful for Warthin's tumor below the I-S line. This procedure seems applicable not only to Warthin's tumors, but also to other benign parotid tumors in the surgical field below the I-S line, such as pleomorphic adenoma and lymphoepithelial cyst.

scholarly journals Extra-Arachnoidal Dissection for Excision of Giant Vestibular Schwannomas: Improved Facial Nerve Preservation

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Sunil K Gupta
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannomas ◽  
Nerve Function ◽  
Total Excision ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Group A ◽  
Grade 3 ◽  
Group B

Abstract INTRODUCTION Surgical excision of giant vestibular schwannomas with preservation of facial nerve function remains a challenge. A modified surgical technique using an extra-arachnoid plane of dissection and limited meatal drilling is described here with the goal of improving the rated of functional preservation of facial nerve. METHODS The clinical material was analyzed for two groups: Group A patients of giant vestibular schwannomas operated between 2002 and 2009 with the “standard” surgical technique, Group B- patients of giant vestibular schwannomas operated between 2009 and 2015 using the new technique of pure extra-arachnoid dissection and limited meatal drilling. RESULTS Group A: Of the 115 patients in this group, total excision was possible in 103 (89.5%), near total excision in 7 (6%) and partial excision in 5 (4.3%) patients. Anatomical preservation of 7th nerve was achieved in 87.8% of patients. House and Brackman grade 1 and grade 2 facial nerve function was present in 68 (59.1%) patients, grade 3 in 10 (8.7%), grades 4 and 5 in 11 (9.6%), and 26 (22.6%) had grade 6 facial nerve involvement. Group B: Of the 127 patients operated by this technique, details and long term follow-up was available for 98 patients. Total excision was achieved in 70 (71.4%) patients, near total excision in 9 (9.2%), and subtotal excision in 19 (19.4%) cases. Four patients had repeat surgery and 14 patients underwent gamma knife radiosurgery. At follow-up, 78 (79.5%) patients had grade 1 and 2 facial nerve involvement, while 20 (20.4%) patients continued to have a poor function (grade 3-5). CONCLUSION Extra-arachnoid dissection and limited meatal drilling resulted in an improved rate of functional facial nerve preservation.

Rate and Extent of Early Axonal Degeneration of the Human Facial Nerve

1998 ◽  
Vol 107 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Erez Bendet ◽  
Christian Maranta ◽  
Istvan Vajtai ◽  
Ugo Fisch
Keyword(s):  
Peripheral Nerve ◽  
Facial Nerve ◽  
Wallerian Degeneration ◽  
Axonal Degeneration ◽  
Current Knowledge ◽  
Node Of Ranvier ◽  
Nerve Degeneration ◽  
Distal Stump ◽  
Retrograde Degeneration

Electrophysiologic and histologic studies on a severed human facial nerve have shown that 1) response to stimulation by electroneuronography was lost on the sixth day following injury, 2) wallerian degeneration progressed in a nonuniform “front,” leaving some of the distal stump axons still viable and responsive to intraoperative stimulation 2 days following injury, and 3) the extent of proximal retrograde degeneration was far greater than to the next node of Ranvier. These findings are discussed in light of the current knowledge regarding peripheral nerve degeneration, and explanations are suggested.

Microsurgical management of vestibular schwannoma after failed previous surgery

2016 ◽  
Vol 125 (5) ◽  
pp. 1198-1203 ◽  
Author(s):  
Madjid Samii ◽  
Hussam Metwali ◽  
Venelin Gerganov
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Multivariate Regression Analysis ◽  
Control Group ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Control Group Group

OBJECTIVE Microsurgical treatment of recurrent vestibular schwannoma (VS) is difficult and poses specific challenges. The authors report their experience with 53 cases of surgically treated recurrent VS. Outcome of these tumors was compared to that of primarily operated on VS. Special attention was given to the facial nerve functional outcome. METHODS A retrospective analysis was performed of the patients who underwent surgery for recurrent VS at one institution from 2000 to 2013. The preoperative data, intraoperative findings, and outcome in terms of facial nerve function and improvement of the preoperative symptoms were analyzed and compared with those in a control group of 30 randomly selected patients with primarily operated on VS. A multivariate regression analysis was performed to test the factors that could affect the facial nerve outcome in each group. RESULTS Fifty-three consecutive patients underwent surgery for recurrent VS. Seventeen patients were previously operated on and received postoperative radiosurgery (Group A). Thirty-six patients were previously operated on but did not receive postoperative radiosurgery (Group B). The overall postoperative facial nerve function was significantly worse in Groups A and B in comparison with the control group (Group C). Interestingly, there was no significant difference in the facial nerve outcome among the 3 groups in patients who had good preoperative facial nerve function. The tumor size and the preoperative facial nerve function are variables that significantly affect the facial nerve outcome. Most of the patients showed improvement of the preoperative symptoms, such as trigeminal hypesthesia, gait disturbance, and headache. CONCLUSIONS Complete microsurgical tumor removal is the optimal management for patients with recurrent or regrowing VS. The procedure is safe, associated with favorable facial nerve outcome, and may also improve existing neurological symptoms.

Surgical treatment of patients with vestibular schwannomas after failed previous radiosurgery

2012 ◽  
Vol 116 (4) ◽  
pp. 713-720 ◽  
Author(s):  
Venelin M. Gerganov ◽  
Mario Giordano ◽  
Amir Samii ◽  
Madjid Samii
Keyword(s):  
Facial Nerve ◽  
Previous Treatment ◽  
Neurological Symptoms ◽  
Vestibular Schwannomas ◽  
Control Group ◽  
Complication Rates ◽  
Tumor Removal ◽  
Group A ◽  
Group B ◽  
Tumor Enlargement

Object An increasing number of patients with vestibular schwannomas (VSs) are being treated with radiosurgery. Treatment failure or secondary regrowth after radiosurgery, however, has been observed in 2%–9% of patients. In large tumors that compress the brainstem and in patients who experience rapid neurological deterioration, surgical removal is the only reasonable management option. Methods The authors evaluated the relevance of previous radiosurgery for the outcome of surgery in a series of 28 patients with VS. The cohort was further subdivided into Group A (radiosurgery prior to surgery) and Group B (partial tumor removal followed by radiosurgery prior to current surgery). The functional and general outcomes in these 2 groups were compared with those in a control group (no previous treatment, matched characteristics). Results There were 15 patients in Group A, 13 in Group B, and 30 in the control group. The indications for surgery were sustained tumor enlargement and progression of neurological symptoms in 12 patients, sustained tumor enlargement in 15 patients, and worsening of neurological symptoms without evidence of tumor growth in 1 patient. Total tumor removal was achieved in all patients in Groups A and B and in 96.7% of those in the control group. There were no deaths in any group. Although no significant differences in the neurological morbidity or complication rates after surgery were noted, the risk of new cranial nerve deficits and CSF leakage was highest in patients in Group B. Patients who underwent previous radiosurgical treatment (Groups A and B) tended to be at higher risk of developing postoperative hematomas in the tumor bed or cerebellum. The rate of facial nerve anatomical preservation was highest in those patients who were not treated previously (93.3%) and decreased to 86.7% in the patients in Group A and to 61.5% in those in Group B. Facial nerve function at follow-up was found to correlate to the previous treatment; excellent or good function was seen in 87% of the patients from the control group, 78% of those in Group A, and 68% of those in Group B. Conclusions Complete microsurgical removal of VSs after failed radiosurgery is possible with an acceptable morbidity rate. The functional outcome, however, tends to be worse than in nontreated patients. Surgery after previous partial tumor removal and radiosurgery is most challenging and related to worse outcome.

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