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

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.

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Facial reanimation by hypoglossal-facial neurorrhaphy

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1626194 ◽

2014 ◽

Vol 33 (01) ◽

pp. 17-21

Author(s):

Yvens Barbosa Fernandes ◽

Ricardo Ramina ◽

Hélio Sérgio Fernandes Cyrino ◽

Marcílio Silva Prôa Júnior

Keyword(s):

Retrospective Study ◽

Facial Nerve ◽

Facial Palsy ◽

Vestibular Schwannomas ◽

Surgical Results ◽

Good Outcome ◽

Facial Reanimation ◽

Radical Removal ◽

One Year

Abstract Objective: Facial palsy may still occur after removal of large vestibular schwannomas. The aim of this paper is to describe the outcome of patients submitted to facial reanimation and make a concise revision about modern techniques available to reanimate a paralyzed face. Methods: A retrospective study of was performed about the surgical results of 12 patients submitted to hypoglossal-facial neurorrhaphy. These patients were submitted to radical removal of large vestibular schwannomas (> 3 cm) before and anatomic preservation of the facial nerve was not possible. Results: In 10 cases (83%) patients had a good outcome with House-Brackmann facial grading III. In two other cases the facial grading was IV and VI. All patients were follow-up for at least one year after the reanimation procedure. Conclusion: Hypoglossal-facial neurorrhaphy is a very useful technique to restore facial symmetry and minimize the sequela of a paralyzed face. Long last palsy seemed to be the main reason of poor outcome in two cases.

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

Otolaryngology ◽

10.1067/mhn.2002.126720 ◽

2002 ◽

Vol 127 (1) ◽

pp. 55-59 ◽

Cited By ~ 6

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.

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Functional outcome after complete surgical removal of giant vestibular schwannomas

Journal of Neurosurgery ◽

10.3171/2009.7.jns0989 ◽

2010 ◽

Vol 112 (4) ◽

pp. 860-867 ◽

Cited By ~ 114

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.

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

10.21203/rs.3.rs-515553/v1 ◽

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.

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Facial Palsy, Radiographic and Other Workup Negative: FROWN

Neurology Clinical Practice ◽

10.1212/cpj.0000000000001020 ◽

2020 ◽

pp. 10.1212/CPJ.0000000000001020

Author(s):

Jacqueline J Greene ◽

Reza Sadjadi ◽

Nate Jowett ◽

Tessa Hadlock

Keyword(s):

Facial Nerve ◽

Facial Palsy ◽

Malignant Tumors ◽

Malignant Neoplasm ◽

Acute Onset ◽

Peripheral Facial Palsy ◽

Facial Reanimation ◽

Term Evaluation ◽

Slow Onset

AbstractObjectives:Slow-onset peripheral facial palsy is far less common than acute-onset peripheral facial palsy and necessitates diagnostic evaluation for a benign or malignant tumors, or other less common etiologies. In the rare scenario when no clarifying etiology is discovered following long-term evaluation (no radiographic or hematologic abnormalities and an otherwise unremarkable evaluation), a diagnostic and management dilemma occurs. We present a series of patients with this possible new clinical entity: facial palsy, radiographic and other workup negative (FROWN), and propose a management strategy for this diagnosis of exclusion.Methods:A series of 3,849 patients presenting with facial palsy to a tertiary Facial Nerve Center was retrospectively assessed to identify those with progressive loss of facial function over at least 1 month. Exclusion criteria included history, physical or hematologic findings indicative of known diseases associated with facial palsy, and radiographic studies demonstrating a benign or malignant tumor.Results:Patients with slow-onset facial palsy constituted 5% (190 patients) of the cohort and were ultimately diagnosed with either a benign or malignant neoplasm or other facial nerve pathology. Fourteen patients with slow-onset facial palsy remained without a diagnosis following long-term evaluation and serial imaging. Eleven patients underwent dynamic facial reanimation surgery and facial nerve and muscle biopsy, with no clear histopathologic diagnosis.Conclusion:Patients with slow-onset facial palsy with negative radiographic and medical evaluations over several years may be characterized as having FROWN, an idiopathic and as yet poorly understood condition, which appears to be amenable to facial reanimation, but which requires further investigation as to its pathophysiology.

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

Otolaryngology ◽

10.1016/j.otohns.2004.09.071 ◽

2005 ◽

Vol 132 (4) ◽

pp. 577-580 ◽

Cited By ~ 20

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.

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A comparative study of adenoidectomy by microdebrider vs conventional method

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20181876 ◽

2018 ◽

Vol 4 (3) ◽

pp. 808

Author(s):

M. Muniraju ◽

Mohammed Saifulla

Keyword(s):

Pain Score ◽

Recovery Time ◽

Operative Time ◽

Recovery Period ◽

Collateral Damage ◽

Adenoid Tissue ◽

Post Operative Pain ◽

Group A ◽

The Mean ◽

Group B

Background: Adenoidectomy is a commonly performed ENT surgery. This present article aims to evaluate endoscopic powered adenoidectomy as an alternative for conventional curettage method.Methods: Sixty consecutive cases requiring adenoidectomy were randomized into two groups of thirty each. Group A underwent endoscopic assisted micro-debrider adenoidectomy and Group B underwent conventional adenoidectomy using the curettage method in study period from November 2015 to May 2017. Results: The average time taken in Group A was 34.10 minutes and in Group B was 22.83 minutes (p<0.001). The average blood loss in Group A was 29.57 ml as compared to 16.67 ml in Group B (p<0.001). The resection was invariably complete in Group A whereas five (16.7%) cases had more than 50% residual adenoid tissue in Group B. Four cases in group B had collateral damage whereas in Group A, there were no added injuries. Post operative pain was studied only in cases undergoing adenoidectomy alone. Group A (n=8) demonstrated a pain score of 3.50 – 3.09 whereas Group B (n=11) demonstrated a pain score of 2.75-2.55. In group A, the mean recovery period was 2.80 days and 8.23 days in Group B (p<0.001).Conclusions: Endoscopic powered adenoidectomy was found to be a safe and effective tool for adenoidectomy. The study parameters where endoscopic powered adenoidectomy fared better were completeness of resection, accurate resection under vision, lesser collateral damage and faster recovery time. On the other hand, conventional adenoidectomy scored in matter of lesser operative time and intra-operative bleeding.

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Management of Facial Palsy

Surgery of the Eyelid, Lacrimal System, and Orbit ◽

10.1093/oso/9780195340211.003.0017 ◽

2011 ◽

Author(s):

Ralph E. Wesley

Keyword(s):

Facial Nerve ◽

Temporal Bone ◽

Trigeminal Nerve ◽

Facial Palsy ◽

Cranial Nerve ◽

Gland Secretion ◽

Effective Management ◽

Blurred Vision ◽

Pterygopalatine Ganglion ◽

Sensory Fibers

Facial palsy can devastate patients. Facial appearance can be grossly distorted by the sagging of half the face, often accompanied by drooling of food and saliva from the paralyzed lip. Blurred vision and ocular pain from exposure and dryness may interfere with the patient’s ability to perform an occupation or interact socially. Many patients with facial palsy experience depression or severe discouragement. Effective management of ocular problems by the ophthalmologist can have a profound effect on the patient’s rehabilitation. The ophthalmologist managing facial palsy should be aware of wide-ranging choices in the medical and surgical armamentarium to treat facial palsy. This chapter describes the varying clinical dimensions of facial palsy so that treatment can be individualized for effective management. The facial nerve (cranial nerve VII) has four important functions: 1. The facial motor nucleus controls muscles of facial expression, including the orbicularis oculi. 2. The superior salivatory nucleus sends parasympathetic fibers for lacrimal gland secretion and salivary secretion. 3. The nucleus solitarius receives sensory fibers of taste for the anterior two thirds of the tongue. 4. The trigeminal sensory nucleus receives sensory fibers for a small portion of the external ear. Facial motor fibers constitute about 58% of the 7,000 fibers of the facial nerve, while preganglionic fibers for tearing and salivation represent about 24%. The facial nerve leaves the cerebellopontine angle caudal to the trigeminal nerve adjacent to the nervus intermedius and then enters the internal auditory canal of the temporal bone. Large lesions of cranial nerve VII or VIII may cause loss of corneal sensation from pressure on the trigeminal nerve. The 30-mm course through the temporal bone is the longest interosseous course of any cranial nerve, which makes the facial nerve vulnerable to swelling. Three branches leave the facial nerve within the temporal bone. The first, and most important, arises at the geniculate ganglion just as the nerve makes a sharp bend, or genu, to head posteriorly. These fibers for lacrimal and palatine gland secretion constitute the greater superficial petrosal nerve carrying lacrimal secretory fibers to the pterygopalatine ganglion.

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

Neurosurgery ◽

10.1093/neuros/nyz310_429 ◽

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.

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Comparative study between conventional adenoidectomy and adenoidectomy using micro-debrider

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00102-z ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Essam A. Abo Elmagd ◽

Mahmoud S. Khalifa ◽

Beshoy K. Abeskharoon ◽

Abdelrahman A. El Tahan

Keyword(s):

Pain Score ◽

Operative Time ◽

Recovery Period ◽

Study Groups ◽

Average Amount ◽

Left Behind ◽

Adenoid Tissue ◽

Group A ◽

The Mean ◽

Group B

Abstract Background Adenoidectomy is a common ENT procedure. This article aims to evaluate micro-debrider-assisted adenoidectomy as a substitute for the conventional curettage method. Results The study aimed to compare between two study groups: micro-debrider-assisted adenoidectomy (group A) and conventional adenoidectomy (group B). The average time needed in group A was 34.1 min while it was 22.83 min in group B (p<0.001). The average amount of blood lost in group A was 29.57 ml and 16.67 ml in group B (p<0.001). The resection was nearly complete in group A, while in group B, five (16.66%) cases had more than 50% of the adenoid tissue left behind. Four cases in group B had damage to collaterals while in group A no major injuries were noted. Postoperative pain has only been studied in cases where adenoidectomy solely was done. Candidates in group A (n=8) reported a pain score of 3.5-3.09 whereas candidates in group B (n=11) reported a pain score of 2.75-2.55. The mean recovery time was 2.8 days in group A and 8.23 days in group B (p<0.001). Conclusions Endoscopic adenoidectomy using micro-debrider is both an effective and safe adenoidectomy tool. The strengths of this technique include resection completeness, precise resection under vision, minor damage to collaterals, and a more rapid recovery period. Conventional adenoidectomy, however, scored better regarding lesser operative time and bleeding intraoperatively.

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