scholarly journals Total conservative parotidectomy for management of benign parotid neoplasms

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Tarek Abd El-Rahman Abd El-Hafez ◽  
Yasser Abd El-Wahab Khalil ◽  
Mohamed El Noaman ◽  
Ahmad Helmy Zayan ◽  
Ashraf Ali El-Demerdash
Keyword(s):  
Side Effects ◽  
Facial Nerve ◽  
Skin Flap ◽  
Facial Nerve Function ◽  
Warthin Tumor ◽  
Parotid Neoplasms ◽  
Parotid Tumors ◽  
Nerve Paresis ◽  
Nerve Dysfunction ◽  
Skin Flap Necrosis

Abstract Background This study assesses the outcomes of total conservative parotidectomy in the management of benign parotid neoplasms. A retrospective review was conducted for all parotidectomies for benign superficial parotid neoplasms from 2013 to 2018. Facial nerve dysfunction, recurrence, and other side-effects were collected and statistically analyzed. Results A total of 21 patients were included in our study. Our series included a pleomorphic adenoma (16 patients), Warthin tumor (4 patients), and oncocytoma (1 patient). Overall, 12 patients had temporary facial nerve paresis (57.1%), 3 patients had temporary paralysis (14.3%)—no reported cases of permanent paralysis—and 6 patients sustained postoperative good facial nerve function (28.6%). No recurrence was reported in our study period. Other side effects included hemorrhage (1 patient), hematoma (2 patients), seroma (4 patients), and partial skin flap necrosis (2 patients). As well, Frey’s syndrome was reported in 11 patients, and most of them were managed conservatively. Conclusions Total conservative parotidectomy is a valuable approach for removing parotid tumors. The rate of complications after this procedure (facial nerve dysfunction and recurrence) is low provided that the technique was performed with meticulous care.

scholarly journals The Offprint of an Abnormal Pre-Parotidectomy Electrodiagnostic Finding in a Normally Functioning Facial Nerve: Correlation with Intraoperative Findings, Histology and Postoperative Facial Nerve Function

2022 ◽  
Vol 11 (1) ◽  
pp. 248
Author(s):  
Verena Katheder ◽  
Matti Sievert ◽  
Sarina Katrin Müller ◽  
Vivian Thimsen ◽  
Antoniu-Oreste Gostian ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Malignant Tumor ◽  
Facial Palsy ◽  
Benign Lesion ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Preservation ◽  
Clinically Normal ◽  
Parotid Tumors ◽  
Supramaximal Stimulation

The aim of this study was to search for associations between an electrodiagnostically abnormal but clinically normal facial nerve before parotidectomy and the intraoperative findings, as well as the postoperative facial nerve function. The records of all patients treated for parotid tumors between 2002 and 2021 with a preoperative House–Brackmann score of grade I but an abnormal electrophysiologic finding were studied retrospectively. A total of 285 patients were included in this study, and 222 patients had a benign lesion (77.9%), whereas 63 cases had a malignant tumor (22.1%). Electroneurographic facial nerve involvement was associated with nerve displacement in 185 cases (64.9%) and infiltration in 17 cases (6%). In 83 cases (29.1%), no tumor–nerve interface could be detected intraoperatively. An electroneurographic signal was absent despite supramaximal stimulation in 6/17 cases with nerve infiltration and in 17/268 cases without nerve infiltration (p < 0.001). The electrophysiologic involvement of a normal facial nerve is not pathognomonic for a malignancy (22%), but it presents a rather rare (~6%) sign of a “true” nerve infiltration and could also appear in tumors without any contact with the facial nerve (~29%). Of our cases, two thirds of those with an anatomic nerve preservation and facial palsy had already directly and postoperatively recovered to a major extent in the midterm.

Causes of Facial Nerve Paresis after Translabyrinthine Surgery for Acoustic Neuroma

1992 ◽  
Vol 101 (10) ◽  
pp. 821-826 ◽  
Author(s):  
Mirko Tos ◽  
Jens Thomsen ◽  
Mahmoud Youssef ◽  
Suat Turgut
Keyword(s):  
Facial Nerve ◽  
Brain Stem ◽  
Acoustic Neuroma ◽  
Facial Palsy ◽  
Cerebellopontine Angle ◽  
Patient Records ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Common Site ◽  
Nerve Paresis

Forty-six consecutive video-recorded translabyrinthine operations at Gentofte Hospital, for tumors of 5 to 25 mm, were investigated for possible damage to the facial nerve from cauterization, suction, stretching, pushing, and other instrumental trauma at the following regions: fundus, internal meatus, porus, cerebellopontine angle, and brain stem. House-Brackmann grading of the postoperative facial nerve function was determined from the patient records for the 1st, 3rd, and 10th days and 3 months and 6 months postoperatively, as well as the final status. Suction on the nerve seems to be the most important factor for perioperative facial nerve damage. The most common site of damage was the porus region. This investigation shows thermic drilling lesions to be very relevant. There was no correlation between the degree and character of damage and the postoperative facial nerve function. In eight patients we cannot explain the postoperative facial palsy.

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 Delayed facial nerve palsy after vestibular schwannoma surgery

2018 ◽  
Vol 20 (1) ◽  
pp. 84-88
Author(s):  
Walter J. Fagundes Pereyra ◽  
Alonso Luis De Sousa ◽  
Karlo Faria Nunes ◽  
Deborah Nunes De Angeli
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Surgical Removal ◽  
Electromyographic Activity ◽  
Immunological Study ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Dysfunction

Background: Facial nerve dysfunction may occur immediately after vestibular schwanoma surgery. Electromyographyc monitoring of motor cranial nerves during cerebellopontine angle surgery has become an essential tool. Although delayed onset of facial nerve dysfunction hours to months following vestibular schwanoma surgery are rare. Case description: We describe the case of a 70-years-old male who was admitted with a left side tinnitus and hearing loss of the last 3 years. Magnetic resonance imaging (MRI) T1-weighted demonstrated an isointensity lesion, 30mm in diameter, at the left cerebello-pontine angle with a small portion in the internal auditory canal. The patient was surgically treated by means of a standart suboccipital retrosigmoid approach. The facial nerve was monitored by continuously during surgery. Surgical removal was macroscopically complete. The facial nerve was well-preserved during surgery and showed at the end of the procedure normal electromyographic activity. The patient did well postoperatively and was discharged at the 4th postoperative day and facial function was normal (House-Brackmann grade I). On the 10th postoperative day he notices difficult closing his left eye that progressed to complete facial nerve palsy (House-Brackmann grade III). Steroid therapy was performed for five days associated with physical therapy. One month later his facial nerve function had completely recovered. After six months, the patient remains asymptomatic and neurologically intact. MRI obtained at the 16th postoperative day showed intense enhancement of the intracranial facial nerve segment and also demonstrated no residual tumor. Immunological study at the time of onset showed herpes simplex virus antibody titer normal as well as those for herpes zoster virus. Conclusions: Delayed facial nerve palsy remains an under reported and consequently not very known phenomenon in the neurosurgical practice and literature. Because of the 2009favorable rate of recovery, patients should be reassured in the interim and should not undergo any corrective surgical procedures to improve facial nerve function. Delayed facial nerve palsy is uncommon after vestibular schwannoma surgery. Excellent recovery of facial nerve function to the original postoperative status nearly always occurs in those circumstances.

scholarly journals Patient- versus physician-reported facial disability in vestibular schwannoma: an international cross-sectional study

2017 ◽  
Vol 127 (5) ◽  
pp. 1015-1024 ◽  
Author(s):  
Øystein Vesterli Tveiten ◽  
Matthew L. Carlson ◽  
Frederik Goplen ◽  
Erling Myrseth ◽  
Colin L. W. Driscoll ◽  
...  
Keyword(s):  
Risk Factors ◽  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Well Being ◽  
Control Group ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
The Social ◽  
Patient Reported ◽  
Nerve Dysfunction

OBJECTIVEPatient-reported outcomes are increasingly used in studies of vestibular schwannoma (VS); however, few studies have examined self-evaluated facial nerve function and its relation to physician-reported outcomes. The primary objective of this study was to compare patient self-evaluations of facial disability with physician-evaluated facial nerve status and with self-evaluations of a healthy control group. The second objective was to provide insight into the controversial subject of the optimal initial management of small- and medium-sized VSs; consequently, the authors compared patient-reported facial nerve disability following treatment via observation (OBS), Gamma Knife surgery (GKS), or microsurgery (MS). Lastly, the authors sought to identify risk factors for facial nerve dysfunction following treatment for small- and medium-sized VSs.METHODSAll patients with a VS 3 cm or smaller that was singly treated with OBS, GKS, or MS at either of 2 independent treatment centers between 1998 and 2008 were retrospectively identified. Longitudinal facial nerve measures and clinical data, including facial nerve evaluation according to the House-Brackmann (HB) grading system, were extracted from existing VS databases. Supplementing the objective data were Facial Disability Index (FDI) scores, which were obtained via survey of patients a mean of 7.7 years after initial treatment.RESULTSThe response rate among the 682 eligible patients was 79%; thus, data from a total of 539 patients were analyzed. One hundred forty-eight patients had been managed by OBS, 247 with GKS, and 144 with MS. Patients who underwent microsurgery had larger tumors and were younger than those who underwent OBS or GKS. Overall, facial nerve outcomes were satisfactory following treatment, with more than 90% of patients having HB Grade I function at the last clinical follow-up. Treatment was the major risk factor for facial nerve dysfunction. Almost one-fifth of the patients treated with MS had an objective decline in facial nerve function, whereas only 2% in the GKS group and 0% in the OBS cohort had a decline. The physical subscale of the FDI in the VS patients was highly associated with HB grade; however, the social/well-being subscale of the FDI was not. Thus, any social disability caused by facial palsy was not detectable by use of this questionnaire.CONCLUSIONSThe majority of patients with small- and medium-sized VSs attain excellent long-term facial nerve function and low facial nerve disability regardless of treatment modality. Tumor size and microsurgical treatment are risk factors for facial nerve dysfunction and self-reported disability. The FDI questionnaire is sensitive to the physical but not the social impairment associated with facial dysfunction.

Facial nerve monitoring in skull base surgery

1994 ◽  
Vol 108 (7) ◽  
pp. 557-559 ◽  
Author(s):  
Giuseppe Magliulo ◽  
Roberto Petti ◽  
Gianluca Maria Vingolo ◽  
Piera Cristofari ◽  
Roberta Ronzoni
Keyword(s):  
Facial Nerve ◽  
Skull Base ◽  
Normal Function ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Nerve Monitoring ◽  
Lateral Skull Base ◽  
Facial Nerve Monitoring ◽  
Skull Base Lesions ◽  
Nerve Dysfunction

AbstractThe purpose of this work was to compare pre- and post-operative facial nerve function between unmonitored and monitored cases of skull base lesions. The study involved 32 patients suffering from lateral skull base tumours (10 unmonitored and 22 monitored). Facial nerve function was monitored intraoperatively by an acoustic facial electromyographic system (NIM-2). Post-operative facial function was graded according to the House-Brackmann scale. In the group of monitored cases, facial nerve function was normal (Grade 1 or 2) in 79 per cent of the patients, while the unmonitored patients showed normal function in only 50 per cent of the cases.These results confirm previous observations that audible evoked electromyographic monitoring significantly reduces permanent facial nerve dysfunction.

Facial nerve paresis caused by benign parotid neoplasms: A case report and review of the literature

2011 ◽  
Vol 121 (S5) ◽  
pp. S252-S252
Author(s):  
Andrew J. Kleinberger ◽  
Zan Mra ◽  
Benjamin D. Malkin
Keyword(s):  
Case Report ◽  
Facial Nerve ◽  
Review Of The Literature ◽  
Parotid Neoplasms ◽  
Nerve Paresis

Train time as a quantitative electromyographic parameter for facial nerve function in patients undergoing surgery for vestibular schwannoma

2007 ◽  
Vol 106 (5) ◽  
pp. 826-832 ◽  
Author(s):  
Julian Prell ◽  
Stefan Rampp ◽  
Johann Romstöck ◽  
Rudolf Fahlbusch ◽  
Christian Strauss
Keyword(s):  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Operative Procedure ◽  
Automated Detection ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Quantitative Parameter ◽  
Time Intervals ◽  
Nerve Paresis ◽  
Free Running

Object The authors describe a quantitative electromyographic (EMG) parameter for intraoperative monitoring of facial nerve function during vestibular schwannoma removal. This parameter is based on the automated detection of A trains, an EMG pattern that is known to be associated with postoperative facial nerve paresis. Methods For this study, 40 patients were examined. During the entire operative procedure, free-running EMG signals were recorded in muscles targeted by the facial nerve. A software program specifically designed for this purpose was used to analyze these continuous recordings offline. By automatically adding up time intervals during which A trains occurred, a quantitative parameter was calculated, which was named “train time.” A strong correlation between the length of train time (measured in seconds) and deterioration of postoperative facial nerve function was demonstrated. Certain consecutive safety thresholds at 0.5 and 10 seconds were defined. Their transgression reliably indicated postoperative facial nerve paresis. At less than a 10-second train time, discrete worsening, and at more than 10 seconds, profound deterioration of facial nerve function can be anticipated. Conclusions Train time as a quantitative parameter was shown to be a reliable indicator of facial nerve paresis after surgery for vestibular schwannoma.

scholarly journals Retrospective Study of Facial Nerve Function following Temporomandibular Joint Arthroplasty Using the Endaural Approach

2015 ◽  
Vol 8 (2) ◽  
pp. 88-93 ◽  
Author(s):  
Frederick Liu ◽  
Helen Giannakopoulos ◽  
Peter D. Quinn ◽  
Eric J. Granquist
Keyword(s):  
Facial Nerve ◽  
Temporomandibular Joint ◽  
Nerve Injury ◽  
Total Joint Replacement ◽  
Nerve Function ◽  
Facial Nerve Function ◽  
Retrospective Case ◽  
Facial Nerve Injury ◽  
Nerve Dysfunction

The aim of this retrospective case–control study is to evaluate the incidence of facial nerve injury associated with temporomandibular joint (TMJ) arthroplasty using the endaural approach for the treatment of TMJ pathology. The sample consisted of 36 consecutive patients who underwent TMJ arthroplasty. A total of 39 approaches were performed through an endaural incision. Patients undergoing total joint replacement and/or with preexisting facial nerve dysfunction were excluded from the study. Five patients were lost to follow-up and were excluded from the study. Facial nerve function of all patients was clinically evaluated by resident physicians preoperatively, postoperatively, and at follow-up appointments. Facial nerve injury was determined to have occurred if the patient was unable to raise the eyebrow or wrinkle the forehead (temporalis branch), completely close the eyelids (zygomatic branch), or frown (marginal mandibular branch). Twenty-one of the 36 patients or 22 of the 39 approaches showed signs of facial nerve dysfunction following TMJ arthroplasty. This included 12 of the 21 patients who had undergone previous TMJ surgery. The most common facial nerve branch injured was the temporal branch, which was dysfunctional in all patients either as the only branch injured or in combination with other branches. By the 18th postoperative month, normal function had returned in 19 of the 22 TMJ approaches. Three of the 22 TMJ approaches resulted in persistent signs of facial nerve weakness 6 months after the surgery. This epidemiological study revealed a low incidence of permanent facial nerve dysfunction. A high incidence of temporary facial nerve dysfunction was seen with TMJ arthroplasty using the endaural approach. Current literature reveals that the incidence of facial nerve injury associated with open TMJ surgery ranges from 12.5 to 32%. The temporal branch of the facial nerve was most commonly affected, followed by 4 of the 22 approaches with temporary zygomatic branch weakness. Having undergone previous TMJ surgery did not increase the incidence of facial nerve injury using the endaural approach. This information is important for patients and surgeons in the postoperative period, as a majority of patients will experience recovery of nerve function.

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