Interposition Grafting of the Facial Nerve After Resection of a Large Facial Nerve Schwannoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Walid Ibn Essayed ◽  
Emad Aboud ◽  
Ossama Al-Mefty
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Nerve Function ◽  
Nerve Paralysis ◽  
Carotid Canal ◽  
Great Auricular Nerve ◽  
Facial Nerves ◽  
Facial Reanimation ◽  
Graft Donor ◽  
Facial Nerve Schwannoma

Abstract Facial nerve schwannomas can develop at any portion of the facial nerve.1 When arising from the mastoid portion of the facial nerve, the tumor will progressively erode the mastoid, giving the schwannoma an aggressive radiological appearance.1,2 The facial nerve is frequently already paralyzed, or no fascicles can be saved during resection. In these cases, end-to-end interposition grafting is the best option for facial reanimation.1,3-5 The healthy proximal and distal facial nerves are prepared prior to grafting. The great auricular nerve is readily available near the surgical site and represents an excellent graft donor with minimal associated morbidity.4,6 We demonstrate this technique through a case of a 48-yr-old male who presented with a complete right-sided facial nerve palsy due to a large facial schwannoma that invaded the mastoid and extended to the hypoglossal canal, causing hypoglossal nerve paralysis, and petrous carotid canal. His 4-yr follow-up showed no recurrent tumor with restored facial nerve function palsy to a House-Brackman grade III, and full recovery of his hypoglossal nerve function. The patient consented to the surgery and the publication of his image.

Masseter-to-Facial Cranial Nerve Anastomosis: A Report of 30 Cases

2020 ◽  
Vol 19 (5) ◽  
pp. 502-509
Author(s):  
Alexander V Zotov ◽  
Jamil A Rzaev ◽  
Sergey V Chernov ◽  
Alexander B Dmitriev ◽  
Anton V Kalinovsky ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Cerebellopontine Angle ◽  
Postoperative Recovery ◽  
Facial Nerve Paralysis ◽  
Tumor Surgery ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Paralysis ◽  
Cerebellopontine Angle Tumor ◽  
Facial Reanimation

Abstract BACKGROUND Facial nerve paralysis (FP) is a possible complication of cerebellopontine angle tumor surgery. Several donor nerves have been used in the past for facial reanimation. We report the results of 30 cases of masseter-to-facial anastomosis. OBJECTIVE To prospectively evaluate the efficacy of V to VII anastomosis after FP. METHODS In a prospective study, we included 30 consecutive patients with FP (20 women and 10 men) whose mean age was 48.8 yr (32-76 yr). In almost all cases, FP developed after cerebellopontine angle tumor surgery (29 patients), whereas in one case, FP occurred after skull base trauma. Pre- and postoperative evaluation of facial nerve function was performed using the House-Brackmann (HB) scale and the Sokolovsky scale, as well as by electromyography. Follow-up ranged from 11 to 51 mo and averaged 22 mo. RESULTS All patients achieved functional recovery of the facial nerve from VI to either III or IV HB degree. Patients with short time FP showed significantly better postoperative recovery. CONCLUSION The results of the V to VII anastomosis demonstrate a significant improvement of facial nerve function and virtually no complications.

Using the Post-Descendens Hypoglossal Nerve in Hypoglossal-Facial Anastomosis: An Anatomic and Histologic Feasibility Study

2020 ◽  
Vol 19 (4) ◽  
pp. 436-443
Author(s):  
Ali Tayebi Meybodi ◽  
Leandro Borba Moreira ◽  
Xiaochun Zhao ◽  
Evgenii Belykh ◽  
Michael T Lawton ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Anatomic Study ◽  
Nerve Stump ◽  
Cross Sectional ◽  
Facial Nerves ◽  
Facial Reanimation ◽  
Structural Compatibility

Abstract BACKGROUND Hypoglossal-facial anastomosis (HFA) is a popular facial reanimation technique. Mobilizing the intratemporal segment of the facial nerve and using the post-descendens hypoglossal nerve (ie, the segment distal to the take-off of descendens hypoglossi) have been proposed to improve results. However, no anatomic study has verified the feasibility of this technique. OBJECTIVE To assess the anatomic feasibility of HFA and the structural compatibility between the 2 nerves when the intratemporal facial and post-descendens hypoglossal nerves are used. METHODS The facial and hypoglossal nerves were exposed bilaterally in 10 sides of 5 cadaveric heads. The feasibility of a side-to-end (ie, partial end-to-end) HFA with partial sectioning of the post-descendens hypoglossal nerve and the mobilized intratemporal facial nerve was assessed. The axonal count and cross-sectional area of the facial and hypoglossal nerves at the point of anastomosis were assessed. RESULTS The HFA was feasible in all specimens with a mean (standard deviation) 9.3 (5.5) mm of extra length on the facial nerve. The axonal counts and cross-sectional areas of the hypoglossal and facial nerves matched well. Considering the reduction in the facial nerve cross-sectional area after paralysis, the post-descendens hypoglossal nerve can provide adequate axonal count and area to accommodate the facial nerve stump. CONCLUSION Using the post-descendens hypoglossal nerve for side-to-end anastomosis with the mobilized intratemporal facial nerve is anatomically feasible and provides adequate axonal count for facial reanimation. When compared with use of the pre-descendens hypoglossal nerve, this technique preserves C1 fibers and has a potential to reduce glottic complications.

scholarly journals Intraparotid Facial Nerve Schwannoma with Temporal Bone Extension

2012 ◽  
Vol 27 (1) ◽  
pp. 23-27
Author(s):  
Alexander T. Laoag ◽  
Antonio H. Chua ◽  
Thanh Vu T. De Guzman ◽  
Samantha S. Castañeda ◽  
Jose A. Malanyaon
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Tumor Resection ◽  
Facial Nerve Paralysis ◽  
Resonance Imaging ◽  
Nerve Paralysis ◽  
Nerve Tumor ◽  
Facial Nerve Schwannoma

Objective: To present a rare case of facial schwannoma manifesting as a parotid mass and discuss its diagnosis and treatment.Methods:     Design: Case Report     Setting: Tertiary Government Hospital     Patient: OneResults: A 48-year-old female was seen for a 2-year progressive left hemifacial paralysis and a 5-month gradually enlarging left infraauricular mass with episodes of tinnitus but intact hearing and balance. Physical examination showed a left-sided House Brackmann grade VI facial paralysis and a 5 x 4 x 3 cm soft, ill-defined, slightly movable, nontender, left infraauricular mass. Gadolinium-enhanced magnetic resonance imaging revealed a 5 cm heterogeneouslyenhancing lobulated mass centered within the deep lobe of the left parotid gland extending to the left mastoid, with facial nerve involvement. A diagnosis of a facial nerve tumor, probably a schwannoma, was entertained. Pure tone audiometry revealed normal hearing thresholds for both ears with dips at 6-8 KHz on the left. The patient underwent total parotidectomy withfacial nerve tumor resection via transmastoid approach, with simultaneous facial – hypoglossal nerve anastomosis reconstruction. Histopathologic findings confirmed the diagnosis of a schwannoma. Postoperative facial function was Grade VI. Hearing and hypoglossal nerve function were preserved.Conclusion: A progressive hemifacial paralysis of chronic duration with or without the presence of an infra-auricular mass should raise the suspicion of a facial nerve tumor. Gadolinium-enhanced magnetic resonance imaging is valuable since intraparotid facial nerve schwannomas are mostly diagnosed intraoperatively when the neoplasm and the nerve are exposed and determined to be contiguous. The clinician should be aware that not all parotid masses are salivary gland in origin.Keywords: intraparotid facial nerve schwannoma, facial nerve paralysis, parotid mass

Experimental Facial Nerve Paralysis: Influence of Decompression

1974 ◽  
Vol 83 (5) ◽  
pp. 582-595 ◽  
Author(s):  
James A. Greer ◽  
D. Thane R. Cody ◽  
Edward H. Lambert ◽  
Louis H. Weiland
Keyword(s):  
Facial Nerve ◽  
Facial Nerve Paralysis ◽  
Nerve Function ◽  
Test Results ◽  
Nerve Paralysis ◽  
Muscle Response ◽  
Nerve Decompression ◽  
Nerve Excitability ◽  
Facial Nerves ◽  
Recovery Times

An experimental model was employed to establish an endotemporal bone facial nerve paralysis in cats. Twelve facial nerves were initially surgically decompressed— Both bony decompression and sheath decompression—to determine if any harm was done to the nerves by these procedures. Transient harm was found in 3 of the 12 nerves. After the course of the facial paralysis without any decompression was determined, 39 cats underwent either bony or sheath nerve decompression, both immediately after injury and after a delay. The cats were followed clinically and electrophysiologically; the nerve excitability test and the amplitude and latency of muscle response evoked by nerve stimulation were used to evaluate nerve function. While immediate postinjury bony decompression resulted in slightly earlier recovery times, immediate sheath splitting significantly lengthened recovery times and worsened the electrophysiologic test results. Histologic studies confirmed the clinical and electrophysiologic results anatomically. Delayed nerve decompression, either bony or sheath, was not associated with faster recovery rates.

scholarly journals Facial Nerve Meningioma: A Case Mimicking Facial Nerve Schwannoma

2020 ◽  
pp. 014556132096258
Author(s):  
Wei Gao ◽  
Dingjing Zi ◽  
Lianjun Lu
Keyword(s):  
Facial Nerve ◽  
Internal Auditory Canal ◽  
Growth Patterns ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Reconstruction ◽  
Radiological Features ◽  
Facial Nerve Reconstruction ◽  
Facial Nerve Schwannoma ◽  
Grade Iii

Facial nerve meningioma is exceedingly rare and tends to affect the geniculate ganglion. We present a case of facial nerve meningioma located in the internal auditory canal with a “labyrinthine tail,” mimicking facial nerve schwannoma. The clinical and radiological features, growth patterns, and surgical management were reviewed. Progressive facial paralysis was the main syndrome, similar to other facial nerve tumors. When facial nerve function is worse than House-Brackmann grade III, surgical resection should be performed with facial nerve reconstruction.

scholarly journals Facial Nerve Schwannoma of Parotid Gland: Difficulties in Diagnosis and Management

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Murat Damar ◽  
Aykut Erdem Dinç ◽  
Sultan Şevik Eliçora ◽  
Sultan Bişkin ◽  
Gül Erten ◽  
...  
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Benign Tumors ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Seventh Cranial Nerve ◽  
Peripheral Facial Nerve Palsy ◽  
Painless Mass ◽  
Facial Nerve Schwannoma ◽  
Left Parotid Gland

Facial nerve schwannomas (FNS) are encapsulated benign tumors arising from Schwann cells of seventh cranial nerve. Most of the facial nerve schwannomas are localized in intratemporal region; only 9% of cases involve a portion of the extratemporal segment. Preoperative diagnosis is often unclear; diagnosis is often made intraoperatively. Management of intraparotid FNS is troublesome because of the facial nerve paralysis. In this report we presented a case of intraparotid schwannoma in a 55-year-old male patient complaining of a painless mass without peripheral facial nerve palsy in left parotid gland. Clinical features, preoperative and intraoperative diagnosis, and difficulties during management are discussed with the review of the literature.

The Influence of Prophylactic Vasoactive Treatment on Cochlear and Facial Nerve Functions after Vestibular Schwannoma Surgery

Neurosurgery ◽  
2007 ◽  
Vol 61 (1) ◽  
pp. 92-98 ◽  
Author(s):  
Christian Scheller ◽  
Hans-Peter Richter ◽  
Martin Engelhardt ◽  
Ralph Köenig ◽  
Gregor Antoniadis
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Cochlear Nerve ◽  
Nerve Function ◽  
Open Label ◽  
Exact Test ◽  
Number Of Patients ◽  
Facial Nerves ◽  
Prophylactic Use ◽  
Long Term Observation

Abstract OBJECTIVE Facial nerve paresis and hearing loss are common complications after vestibular schwannoma surgery. Experiments with facial nerves of the rat and retrospectively analyzed clinical studies showed a beneficial effect of vasoactive treatment on the preservation of facial and cochlear nerve functions. This prospective and open-label randomized pilot study is the first study of a prophylactic vasoactive treatment in vestibular schwannoma surgery. METHODS Thirty patients were randomized before surgery. One group (n = 14) received a vasoactive prophylaxis consisting of nimodipine and hydroxyethylstarch which was started the day before surgery and was continued until the seventh postoperative day. The other group (n = 16) did not receive preoperative medication. Intraoperative monitoring, including acoustic evoked potentials and continuous facial electromyelograms, was applied to all patients. However, when electrophysiological signs of a deterioration of facial or cochlear nerve function were detected in the group of patients without medication, vasoactive treatment was started immediately. Cochlear and facial nerve function were documented preoperatively, during the first 7 days postoperatively, and again after long-term observation. RESULTS Despite the limited number of patients, our results were significant using the Fisher's exact test (small no. of patients) for a better outcome after vestibular schwannoma surgery for both hearing (P = 0.041) and facial nerve (P = 0.045) preservation in the group of patients who received a prophylactic vasoactive treatment. CONCLUSION Prophylactic vasoactive treatment consisting of nimodipine and hydroxyethylstarch shows significantly better results concerning preservation of the facial and cochlear nerve function in vestibular schwannoma surgery. The prophylactic use is also superior to intraoperative vasoactive treatment.

Hypoglossal-Facial Nerve Anastomosis: A Meta-Analytic Study

2007 ◽  
Vol 116 (7) ◽  
pp. 542-549 ◽  
Author(s):  
Sertac Yetiser ◽  
Ugur Karapinar
Keyword(s):  
Facial Nerve ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Cranial Nerves ◽  
Facial Nerve Paralysis ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Reliable Technique ◽  
Nerve Paralysis ◽  
Nerve Anastomosis

Objectives: A meta-analysis was conducted on the outcome of facial nerve function after hypoglossal-facial nerve anastomosis in humans. The roles of the timing of and the underlying cause for surgery, the type of the repair, and previous facial nerve function in the final result were analyzed. Methods: Articles were identified by means of a PubMed search using the key words “facial-hypoglossal anastomosis,” which yielded 109 articles. The data were pooled from existing literature written in English or French. Twenty-three articles were included in the study after we excluded those that were technical reports, those describing anastomosis to cranial nerves other than the hypoglossal, and those that were experimental animal studies. Articles that reported facial nerve function after surgery and timing of repair were included. Facial nerve function had to be reported according to the House-Brackmann scale. If there was more than 1 article by the same author(s), only the most recent article and those that did not overlap and that matched the above criteria were accepted. The main parameter of interest was the rate of functional recovery of the facial nerve after anastomosis. This parameter was compared among all groups with Pearson's X2 test in the SPSS program for Windows. Statistical significance was set at a p level of less than .05. Results: Analysis of the reports indicates that early repair, before 12 months, provides a better outcome. The severity of facial nerve paralysis does not have a negative effect on prognosis. Gunshot wounds and facial neuroma are the worst conditions for favorable facial nerve recovery after anastomosis. Transection of the hypoglossal nerve inevitably results in ipsilateral tongue paralysis and atrophy. Modification of the anastomosis technique seems to resolve this problem. Nevertheless, the effect of modified techniques on facial reanimation is still unclear, because the facial nerve function results were lacking in these reports. Conclusions: Hypoglossal-facial nerve anastomosis is an effective and reliable technique that gives consistent and satisfying results.

scholarly journals Hypoglossal-facial nerve side-to-end anastomosis for preservation of hypoglossal function: results of delayed treatment with a new technique

1996 ◽  
Vol 1 (2) ◽  
pp. E8 ◽  
Author(s):  
Yutaka Sawamura ◽  
Hiroshi Abe
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Hypoglossal Nerve ◽  
Mastoid Process ◽  
Mastoid Cavity ◽  
Distal Stump ◽  
Delayed Treatment ◽  
Stylomastoid Foramen ◽  
Facial Reanimation ◽  
Nerve Anastomosis

This report describes a new surgical technique to improve the results of conventional hypoglossal-facial nerve anastomosis that does not necessitate the use of nerve grafts or hemihypoglossal nerve splitting. Using this technique, the mastoid process is partially resected to open the stylomastoid foramen and the descending portion of the facial nerve in the mastoid cavity is exposed by drilling to the level of the external genu and then sectioning its most proximal portion. The hypoglossal nerve beneath the internal jugular vein is exposed at the level of the axis and dissected as proximally as possible. One-half of the hypoglossal nerve is transected: use of less than one-half of the hypoglossal nerve is adequate for approximation to the distal stump of the atrophic facial nerve. The nerve endings, the proximally cut end of the hypoglossal nerve, and the distal stump of the facial nerve are approximated and anastomosed without tension. This technique was used in four patients with long-standing facial paralysis (greater than 24 months), and it provided satisfactory facial reanimation, with no evidence of hemitongue atrophy or dysfunction. Because it completely preserves glossal function, the hemihypoglossal-facial nerve anastomosis described here constitutes a successful approach in patients with long-standing facial paralysis who do not wish to have tongue function compromised.

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