Congenital facial nerve agenesis

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.

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Complete Facial Paralysis Caused by Stabbing With a Car Key at the Stylomastoid Foramen

Ear Nose & Throat Journal ◽

10.1177/01455613211056548 ◽

2021 ◽

pp. 014556132110565

Author(s):

Bo Yang ◽

Fang Zhang ◽

Ying Tian ◽

Huijun Yang

Keyword(s):

Facial Nerve ◽

Facial Paralysis ◽

Bone Fracture ◽

Nerve Function ◽

Facial Nerve Function ◽

Peripheral Facial Paralysis ◽

Nerve Branch ◽

Temporal Bone Fracture ◽

Stylomastoid Foramen ◽

Great Auricular Nerve

Non-iatrogenic traumatic facial paralysis is most common in intratemporal facial nerve injury caused by temporal bone fracture, followed by intraparotid facial nerve branch injury. Facial paralysis caused by injury to the extratemporal trunk of the facial nerve is extremely rare. We present a case of a 60-year-old man suffering from immediate complete left peripheral facial paralysis due to blunt transection of extratemporal trunk of facial nerve by stabbing with a car key. There was a facial nerve defect about 1 cm in length. The great auricular nerve was grafted to repair the facial nerve. Over 12 months, his facial nerve function improved to a House–Brackmann III/VI.

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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

Journal of Clinical Medicine ◽

10.3390/jcm11010248 ◽

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.

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Intraoperative electromyography has a favorable impact on facial nerve function in patients with parotid gland tumor

Journal of the Neurological Sciences ◽

10.1016/j.jns.2019.10.1645 ◽

2019 ◽

Vol 405 ◽

pp. 48-49

Author(s):

P. Sowa ◽

M. Zielinski ◽

M. Misiolek ◽

M. Adamczyk-Sowa

Keyword(s):

Parotid Gland ◽

Facial Nerve ◽

Nerve Function ◽

Facial Nerve Function ◽

Gland Tumor ◽

Parotid Gland Tumor

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Causes of Facial Nerve Paresis after Translabyrinthine Surgery for Acoustic Neuroma

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949210101004 ◽

1992 ◽

Vol 101 (10) ◽

pp. 821-826 ◽

Cited By ~ 18

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.

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Comparison of Facial Nerve Function Outcomes in the Surgical Treatment of Cerebellopontine Angle Lesions with or without Intraoperative Neurophysiological Monitoring

Cerrahpasa Medical Journal ◽

10.5152/cjm.2021.21011 ◽

2021 ◽

Vol 45 (1) ◽

pp. 5-9

Author(s):

Baris Kucukyuruk ◽

◽

Emine Taskiran ◽

Keyword(s):

Surgical Treatment ◽

Facial Nerve ◽

Cerebellopontine Angle ◽

Intraoperative Neurophysiological Monitoring ◽

Neurophysiological Monitoring ◽

Nerve Function ◽

Facial Nerve Function

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Role of electrophysiology in guiding near-total resection for preservation of facial nerve function in the surgical treatment of large vestibular schwannomas

Journal of Neurosurgery ◽

10.3171/2016.11.jns161737 ◽

2018 ◽

Vol 128 (3) ◽

pp. 903-910 ◽

Cited By ~ 11

Author(s):

Daniele Bernardeschi ◽

Nadya Pyatigorskaya ◽

Antoine Vanier ◽

Franck Bielle ◽

Mustapha Smail ◽

...

Keyword(s):

Surgical Treatment ◽

Facial Nerve ◽

Residual Tumor ◽

Incomplete Resection ◽

Nerve Function ◽

Inclusion Criteria ◽

Facial Nerve Function ◽

Total Resection ◽

Supramaximal Stimulation ◽

Stimulation Of

OBJECTIVEIn large vestibular schwannoma (VS) surgery, the facial nerve (FN) is at high risk of injury. Near-total resection has been advocated in the case of difficult facial nerve dissection, but the amount of residual tumor that should be left and when dissection should be stopped remain controversial factors. The objective of this study was to report FN outcome and radiological results in patients undergoing near-total VS resection guided by electromyographic supramaximal stimulation of the FN at the brainstem.METHODSThis study was a retrospective analysis of a prospectively maintained database. Inclusion criteria were surgical treatment of a large VS during 2014, normal preoperative FN function, and an incomplete resection due to the strong adherence of the tumor to the FN and the loss of around 50% of the response of supramaximal stimulation of the proximal FN at 2 mA. Facial nerve function and the amount and evolution of the residual tumor were evaluated by clinical examination and by MRI at a mean of 5 days postoperatively and at 1 year postoperatively.RESULTSTwenty-five patients met the inclusion criteria and were included in the study. Good FN function (Grade I or II) was observed in 16 (64%) and 21 (84%) of the 25 patients at Day 8 and at 1 year postoperatively, respectively. At the 1-year follow-up evaluation (n = 23), 15 patients (65%) did not show growth of the residual tumor, 6 patients (26%) had regression of the residual tumor, and only 2 patients (9%) presented with tumor progression.CONCLUSIONSNear-total resection guided by electrophysiology represents a safe option in cases of difficult dissection of the facial nerve from the tumor. This seems to offer a good compromise between the goals of preserving facial nerve function and achieving maximum safe resection.

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Viral Titers and Delayed Facial Palsy after Acoustic Neuroma Surgery

Otolaryngology ◽

10.1067/mhn.2002.129817 ◽

2002 ◽

Vol 127 (5) ◽

pp. 427-431 ◽

Cited By ~ 25

Author(s):

Gerard J. Gianoli

Keyword(s):

Herpes Simplex Virus ◽

Herpes Simplex ◽

Facial Nerve ◽

Acoustic Neuroma ◽

Facial Palsy ◽

Nerve Function ◽

Facial Nerve Function ◽

Acoustic Neuroma Surgery ◽

Simplex Virus ◽

Viral Titers

OBJECTIVE: Delayed facial palsy (DFP) after acoustic neuroma surgery has been reported to occur in up to one third of cases. Reactivation of latent virus has been proposed as an etiology for DFP. However, only retrospective case reports and case series have offered data to support this theory. The objective of this study was to correlate DFP with change in viral titers. PATIENTS AND METHODS: Twenty consecutive patients who underwent acoustic neuroma surgery were prospectively evaluated for viral titers immediately preoperatively and at 3 weeks postoperatively. Viral titers measured included herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2), and varicella zoster virus (VZV) and included both IgG and IgM titers. The status of facial nerve function was documented preoperatively and throughout the postoperative period. Patients were categorized according to the presence or absence of DFP. RESULTS: Seven patients developed DFP after acoustic neuroma surgery, while the remaining 13 patients did not. There was no difference in preoperative and 3-week postoperative IgG titers for any of the 3 viruses tested. However, IgM titers were much higher postoperatively in DFP patients for all 3 viruses tested. The average HSV-1 IgM titer rose 92% in DFP patients compared with only 4.5% in the patients who did not develop DFP. Average HSV-2 IgM titers rose 70% compared with a decline of 8.5% in non-DFP patients. Most strikingly, VZV IgM titers rose an average 495% postoperatively among DFP patients compared with a decline of 14% in the non-DFP patients. CONCLUSION: Elevation of the IgM titers of the viruses measured in this study implies that recrudescence of the virus has occurred. The absence of this rise among patients who did not develop DFP implies that viral recrudescence plays a role in the etiology of DFP. These findings support treatment or prophylaxis of DFP with antiviral therapy. Although the finding of normal facial nerve function immediately after acoustic neuroma surgery is an excellent prognostic indicator for the ultimate outcome of facial nerve function, it is not uncommon for the patient to exhibit deterioration of facial nerve function in the first few days to weeks after surgery. When facial palsy is not complete, the prognosis remains excellent. However, when there is total loss of facial nerve function, the final outcome is more variable. Delayed facial palsy (DFP) after acoustic neuroma surgery has been defined as initially normal facial nerve function noted immediately postoperative with subsequent deterioration of facial nerve function. 1 This phenomenon has been noted to occur in up to one third of cases. Numerous causes for this entity have been proposed, including neural devascularization, vasospasm, edema, immune reactions, and viral reactivation. Varicella zoster virus (VZV) and herpes simplex virus (HSV) are ubiquitous, with more than 90% of the adult population demonstrating evidence of prior infection. 2 Reactivation of latent VZV has been implicated as the cause of Ramsay Hunt syndrome. 3 There is mounting evidence that HSV reactivation is the cause of Bell's palsy. 4 In the present study, viral titers for VZV and HSV were assessed before and after acoustic neuroma surgery. DFP and non-DFP patients were compared in an attempt to determine whether there was any correlation between viral recrudescence and DFP.

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Differential Facial Nerve Function in Tumors of the Internal Auditory Meatus

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948309200109 ◽

1983 ◽

Vol 92 (1) ◽

pp. 39-41 ◽

Cited By ~ 12

Author(s):

J. Gail Neely ◽

Charles R. Neblett

Keyword(s):

Facial Nerve ◽

Facial Paralysis ◽

Postoperative Period ◽

Tumor Infiltration ◽

Nerve Function ◽

Internal Auditory Meatus ◽

Facial Nerve Function ◽

Eighth Nerve ◽

Auditory Dysfunction ◽

Facial Nerves

Fifty-five consecutive cases of neoplastic involvement of the internal auditory meatus resulting in ipsilateral retrocochlear auditory dysfunction were reviewed. The majority of these tumors (89%) were solitary schwannomas of the eighth nerve. Eleven percent were other tumors. Preoperative facial paralysis was unusual in eighth nerve schwannomas (6.1%) and much more common in other tumors (66.6%). These data tend to suggest that facial paralysis preoperatively increases the probability that the tumor is other than an eighth nerve schwannoma. Furthermore, facial paralysis resulting from an eighth nerve schwannoma indicates a poorer prognosis for ultimate facial nerve function. The small numbers in this series, though far from conclusive, suggest that normally functioning facial nerves may be infiltrated by eighth nerve schwannomas. Failure of eventual recovery of facial nerve function in the postoperative period may suggest tumor infiltration.

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Traumatic facial nerve palsy: evaluation and surgical management

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202209 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1111

Author(s):

Chaitry K. Shah ◽

Shalu Gupta ◽

Bela J. Prajapati ◽

Devang P. Gupta ◽

Viral Prajapati

Keyword(s):

Facial Nerve ◽

Surgical Management ◽

Facial Palsy ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Cranial Nerves ◽

Surgical Decompression ◽

Nerve Function ◽

Good Recovery ◽

Facial Nerve Function

Background: Acute facial paralysis can result from various causes, among which intra temporal facial palsy is relatively common. Of all the cranial nerves, the facial nerve is most susceptible to injury due to its long course within the skull. Diagnosis of facial palsy is usually made by a good clinical history, examination and radiological investigations. Electrophysiological tests are important for prognosis and optimal time for surgery. The aim is to study the evaluation and surgical management in traumatic cause of facial nerve palsy.Methods: This prospective cross-sectional study was carried out in 50 patients presented with facial nerve palsy due to trauma in civil hospital Ahmedabad over a period of 1 year from May 2018 to 2019. Patients were examined and graded using House and Brackmann grading system. All the patients were evaluated and treated by surgical decompression. Follow up was carried out upto 6 months. Results: The cause of facial nerve palsy in all 50 patients was accidental head trauma. All the patients were managed by surgical decompression. 46 out of 50 patients managed surgically had good recovery with restoration of complete facial nerve function. 4 out 50 patients had poor recovery due to late presentation. Conclusions: Early initiation of treatment is important for favorable recovery of facial nerve function after trauma. Surgical treatment is indicated in suspected bony impingement of nerve. Surgical decompression if done early usually results in very good recovery.

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