scholarly journals Anomalies of the facial nerve: a surgeon’s nightmare

2018 ◽  
Vol 4 (5) ◽  
pp. 1202
Author(s):  
James Thomas ◽  
Girija Ghate ◽  
Ashutosh Kumar
Keyword(s):  
Congenital Anomaly ◽  
Facial Nerve ◽  
Facial Palsy ◽  
Facial Deformity ◽  
High Definition ◽  
Nerve Monitoring ◽  
Fallopian Canal ◽  
Anatomical Abnormality ◽  
Facial Nerve Anatomy ◽  
Temporal Bones

<p class="abstract"><strong>Background:</strong> Most of the anomalies of the facial nerve have been encountered during otological surgery or dissection of the temporal bones. ENT surgeons are taught from a nascent stage to always be wary of an anomalous facial nerve during otological surgery. Today’s surgeon is assisted with high definition imaging and nerve monitoring; yet iatrogenic facial palsy still is encountered even today.</p><p class="abstract"><strong>Methods:</strong> This study was conducted in a select population of patients who reported with aural symptoms with an aim to see the number of facial nerve anomalies one encounters during aural surgery. The filter applied was no patient with congenital anomaly was considered and patients with squamous COM were also excluded.  </p><p class="abstract"><strong>Results:</strong> Almost 4.5% of the patients subjected to surgery had varying kinds of facial nerve anomaly, the most common being dehiscence of the fallopian canal.</p><p class="abstract"><strong>Conclusions:</strong> Facial nerve anomalies are not so uncommon as one expects it to be. So it is mandatory that every ENT surgeon should be well versed with facial nerve anatomy and be wary of any structural anatomical abnormality, and irrespective of the experience it pays to be extra cautious when operating on the ear because in the event of damage to the facial nerve the patient has to carry the stigma of a facial deformity for his/her life.</p>

scholarly journals The role of continuous intraoperative neuromonitoring followed by facial nerve stimulation during parotidectomy

2016 ◽  
Vol 6 (23) ◽  
pp. 161-165
Author(s):  
Georgiana Pasu
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Continuous Monitoring ◽  
Benign Tumors ◽  
Neural Function ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Parotid Surgery ◽  
Electrophysiological Signals ◽  
Neural Monitoring

Abstract BACKGROUND. Intraoperative neural monitoring (IONM) has begun to be studied in detail by surgeons around the world since several decades ago from the need to verify functional integrity of the neural elements. Parotid gland surgery requires a thorough knowledge of the anatomy of this region by ENT surgeons. Also, the surgeons performing parotid surgery need to have important strategies of management which include: handiness to identify facial nerve, dissection nerve branches and application of neuromonitoring in order to preserve nerve functions. OBJECTIVE. This study has analysed the usefulness of intraoperative continuous monitoring in superficial or in total parotidectomy. It identifies the facial nerve and reduces the risk of postoperative facial palsy. We have been using intraoperative continuous monitoring - evoked facial nerve electromyograms (EMG). MATERIAL AND METHODS. Continuous intraoperative facial nerve monitoring was prospectively achieved in the case of three patients diagnosed with benign tumors, on which parotidectomy with the preservation of the nerve was carried out in order to highlight the value and efficacy of this method. RESULTS. In our country, continuous intraoperative facial nerve monitoring performance is still not a common practice in ENT Departments. It revealed postoperatively that the incidence of temporary or permanent facial palsy was 0% and the minimal stimulation was obtained at levels equal to 0,5 mA, which implies integral functioning of the facial nerve. CONCLUSION. In parotid surgery, facial nerve IONM represents the gold standard in recognition of real-time electrophysiological signals, electromyography waves and auditory signals to enable the correct approach wherever possible, avoiding extensive nerve damage. It is known the importance of continuous IONM in postoperative prognosis of the neural function and intraoperative decision making regarding the technical surgery.

Anatomy and physiology of the facial nerve and aetiology of facial nerve palsy

2021 ◽  
pp. 963-968
Author(s):  
Onur Gilleard ◽  
Kalliroi Tzafetta
Keyword(s):  
Natural History ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Facial Palsy ◽  
Nerve Palsy ◽  
Social Consequences ◽  
Detailed Knowledge ◽  
Anatomy And Physiology ◽  
History Of ◽  
Facial Nerve Anatomy

Facial paralysis can have significant functional and social consequences and presents a challenging reconstructive problem for plastic surgeons. Detailed knowledge of facial nerve anatomy and an understanding of the natural history of the different conditions which result in facial palsy is a prerequisite for clinicians who are involved in the management of this devastating affliction.

Ectopic Striated Muscle in the Fallopian Canal: A Histopathologic Report

1979 ◽  
Vol 87 (1) ◽  
pp. 75-83
Author(s):  
Richard W. Babin
Keyword(s):  
Facial Nerve ◽  
Striated Muscle ◽  
Geniculate Ganglion ◽  
Histologic Finding ◽  
Fallopian Canal ◽  
Temporal Bones

Two temporal bones are discussed that contain ectopic striated muscle in the horizontal fallopian canal. In one instance, this muscle was clearly innervated by a branch from the geniculate ganglion. This is an unusual histologic finding and the innervation to such a muscle has been rarely identified. The facial nerve surgeon should be aware that a mass encountered during decompression may be developmental rather than neoplastic.

Stratifying the risk of facial nerve palsy after benign parotid surgery

2014 ◽  
Vol 128 (2) ◽  
pp. 159-162 ◽  
Author(s):  
N Sethi ◽  
P H Tay ◽  
A Scally ◽  
S Sood
Keyword(s):  
Risk Factors ◽  
Facial Nerve ◽  
Facial Palsy ◽  
Significant Risk ◽  
Chi Square ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Parotid Surgery ◽  
Potential Risk Factors ◽  
Chi Square Test

AbstractIntroduction:Post-operative facial palsy is the most important potential complication of parotid surgery for benign lesions. The published prevalence of facial weakness is up to 57 per cent for temporary weakness and up to 7 per cent for permanent weakness. We aimed to identify potential risk factors for post-operative facial palsy.Materials and methods:One hundred and fifty patients who had undergone parotid surgery for benign disease were retrospectively reviewed. Tumour factors (size, location and histopathology), patient factors (age and sex) and operative factors (operation, surgeon grade, surgeon specialty and use of intra-operative facial nerve monitoring) were all analysed for significant associations with post-operative facial palsy.Results and analysis:The overall incidence of facial palsy was 26.7 per cent for temporary weakness and 2.6 per cent for permanent weakness. The associations between facial palsy and all the above factors were analysed using Pearson's chi-square test and found to be non-significant.Conclusion:These outcomes compare favourably with the literature. No significant risk factors were identified, suggesting that atraumatic, meticulous surgical technique is still the most important factor affecting post-operative facial palsy.

Prognostic factors for the incidence and recovery of delayed facial nerve palsy after vestibular schwannoma resection

2011 ◽  
Vol 114 (2) ◽  
pp. 375-380 ◽  
Author(s):  
Ryan P. Morton ◽  
Paul D. Ackerman ◽  
Marc T. Pisansky ◽  
Monika Krezalek ◽  
John P. Leonetti ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Facial Palsy ◽  
Late Onset ◽  
Postoperative Recovery ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Patient Groups

Object Preservation of facial nerve function in vestibular schwannoma (VS) resections remains a significant operative challenge. Delayed facial palsy (DFP) is one specific challenge yet to be fully elucidated. The aim of this study was to evaluate DFP among VS resection cases to identify significant prognostic factors associated with its incidence and clinical recovery. Methods This investigation involves a retrospective review of 104 cases of VS resection that occurred between December 2005 and May 2007. Patients who developed DFP were compared with patients exhibiting no facial palsy postoperatively with regard to surgical approach, severity and day of palsy onset, tumor size, intraoperative facial nerve monitoring, and postoperative recovery and treatment. Patients who demonstrated immediate facial palsy (IFP) following VS resection were also analyzed. Furthermore, specific analyses were performed in 2 distinct DFP patient groups: those who developed DFP after postoperative Day 3 (“late onset DFP”), and those whose palsy worsened after initial DFP identification (“deteriorators”). Results Of the 104 patients who underwent VS resection, 25.0% developed DFP and 8.6% demonstrated IFP postoperatively. The DFP group did not differ significantly in any measure when compared with patients with no postoperative facial palsy. However, patients with DFP presented with significantly smaller tumor sizes than patients with IFP. This IFP group averaged significantly smaller intraoperative facial nerve responses than patients without facial palsy, and larger tumor sizes than both the DFP and no facial palsy groups. Within the DFP group, patients with late onset DFP showed diminished intraoperative facial nerve responses when compared with the total DFP patient population. In total, 25 (96.2%) of 26 patients with DFP and 7 (77.8%) of 9 patients with IFP recovered to normal or near-normal facial function (House-Brackmann Grade I or II) at longest clinical follow-up. Conclusions Although patients with DFP did not exhibit any distinguishable characteristics when compared with patients without postoperative facial palsy, our analysis identified significant differences in patients with palsy presenting immediately postoperatively. Further study of patients with DFP should be undertaken to predict its incidence following VS resection.

Intraoperative Facial Nerve Monitoring

1991 ◽  
Vol 24 (3) ◽  
pp. 709-725 ◽  
Author(s):  
Herbert Silverstein ◽  
Seth Rosenberg
Keyword(s):  
Facial Nerve ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring

Facial nerve outcome after acoustic neuroma surgery: A study from the era of cranial nerve monitoring

1994 ◽  
Vol 111 (5) ◽  
pp. 561-570 ◽  
Author(s):  
A LALWANI ◽  
F BUTT ◽  
R JACKLER ◽  
L PITTS ◽  
C YINGLING
Keyword(s):  
Facial Nerve ◽  
Acoustic Neuroma ◽  
Cranial Nerve ◽  
Nerve Monitoring ◽  
Acoustic Neuroma Surgery

Otopathologic Abnormalities in CHARGE Syndrome

2021 ◽  
pp. 019459982110089
Author(s):  
Rafael da Costa Monsanto ◽  
Renata Malimpensa Knoll ◽  
Norma de Oliveira Penido ◽  
Grace Song ◽  
Felipe Santos ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Middle Ear ◽  
Spiral Ganglion ◽  
Internal Auditory Canal ◽  
Semicircular Canals ◽  
Charge Syndrome ◽  
University Of Minnesota ◽  
Bony Canal ◽  
Ganglion Neurons ◽  
Temporal Bones

Objective To perform an otopathologic analysis of temporal bones (TBs) with CHARGE syndrome. Study Design Otopathologic study of human TB specimens. Setting Otopathology laboratories. Methods From the otopathology laboratories at the University of Minnesota and Massachusetts Eye and Ear Infirmary, we selected TBs from donors with CHARGE syndrome. These TBs were serially sectioned at a thickness of 20 µm, and every 10th section was stained with hematoxylin and eosin. We performed otopathologic analyses of the external ear, middle ear (middle ear cleft, mucosal lining, ossicles, mastoid, and facial nerve), and inner ear (cochlea, vestibule, internal auditory canal, and cochlear and vestibular nerves). The gathered data were statistically analyzed. Results Our study included 12 TBs from 6 donors. We found a high prevalence of abnormalities affecting the ears. The most frequent findings were stapes malformation (100%), aberrant course of the facial nerve (100%) with narrow facial recess (50%), sclerotic and hypodeveloped mastoids (50%), cochlear (100%) and vestibular (83.3%) hypoplasia with aplasia of the semicircular canals, hypoplasia and aplasia of the cochlear (66.6%) and vestibular (91.6%) nerves, and narrowing of the bony canal of the cochlear nerve (66.6%). The number of spiral ganglion and Scarpa’s ganglion neurons were decreased in all specimens (versus normative data). Conclusions In our study, CHARGE syndrome was associated with multiple TB abnormalities that may severely affect audiovestibular function and rehabilitation.

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