Neuroanatomical correlation of the House-Brackmann grading system in the microsurgical treatment of vestibular schwannoma

2012 ◽  
Vol 33 (3) ◽  
pp. E7 ◽  
Author(s):  
Matthew Z. Sun ◽  
Michael C. Oh ◽  
Michael Safaee ◽  
Gurvinder Kaur ◽  
Andrew T. Parsa
Keyword(s):  
Facial Nerve ◽  
Nerve Injury ◽  
Vestibular Schwannoma ◽  
Grading System ◽  
Psychological Consequences ◽  
Factors Affecting ◽  
Functional Deficits ◽  
Facial Nerve Injury ◽  
Ability To Regenerate ◽  
Nerve Recovery

Avoidance of facial nerve injury is one of the major goals of vestibular schwannoma (VS) surgery because functional deficits of the facial nerve can lead to physical, cosmetic, and psychological consequences for patients. Clinically, facial nerve function is assessed using the House-Brackmann grading scale, which also allows physicians to track the progress of a patient's facial nerve recovery. Because the facial nerve is a peripheral nerve, it has the ability to regenerate, and the extent of its functional recovery depends largely on the location and nature of its injury. In this report, the authors first describe the facial nerve anatomy, the House-Brackmann grading system, and factors known to be predictors of postoperative facial nerve outcome. The mechanisms and pathophysiology of facial nerve injury during VS surgery are then discussed, as well as factors affecting facial nerve regeneration after surgery.

scholarly journals Facial nerve elongation as predictive factors of facial nerve outcome after the vestibular schwannoma resection

2021 ◽  
Author(s):  
Zhi Zhu ◽  
Weichao Jiang ◽  
Xi Chen ◽  
Sifang Chen ◽  
Guowei Tan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Facial Nerve ◽  
Nerve Injury ◽  
Logistic Regression Analysis ◽  
Vestibular Schwannoma ◽  
Functional Outcomes ◽  
Tumor Volume ◽  
Facial Nerve Injury

Abstract Background: To analyze risk factors affecting the long-term facial nerve functional outcomes in patients receiving vestibular schwannoma surgery. Method: A total of 89 cases receiving vestibular schwannoma surgery via retrosigmoid sinus approach were analyzed retrospectively. The facial nerve functional outcomes of all enrolled patients were evaluated 6 months after the operation according to House-Brackmann grading scale. The relationships between facial nerve injury and its potential risk factors were analyzed. Results: Postoperative facial nerve injury was found in 53 patients (59.6%) 6 months after the operation. The results of univariate logistic regression analysis indicated that the tumor volume, the maximum tumor diameter, the facial nerve elongation, the enlargement of internal auditory canal (IAC), the IAC size on the affected side, and the facial nerve adhesion to tumor were significantly correlated with the occurrence of facial nerve injury. The multivariate logistic regression analysis revealed that the facial nerve elongation, the facial nerve adhesion to tumor, the tumor volume, and the enlargement of IAC were the independent risk factors of facial nerve injury 6 months after vestibular schwannoma surgery. The ROC curve showed that the cut-off points of the facial nerve elongation, tumor volume and enlargement of IAC were 2.925cm,10.965 cm³ and 1.818 respectively. When the cut-off points were exceeded, the possibility of facial nerve injury would largely increase. Conclusion: With the growth of the facial nerve elongation, the tumor volume, the facial nerve adhesion to tumor, and the enlargement of IAC, the possibility of facial nerve injury after the vestibular schwannoma surgery would accordingly increase.

scholarly journals Assessment of facial nerve injury using Deep Subfascial approach to Temporo-mandibular joint

2021 ◽  
Vol 12 (1) ◽  
pp. 106-111
Author(s):  
Ankit Kumar ◽  
Sourav Kumar ◽  
Musaab Khan ◽  
Dipti Nayak ◽  
Ashish Sharma ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Nerve Injury ◽  
Randomized Study ◽  
Distinct Advantage ◽  
Grading System ◽  
Temporal Region ◽  
Tmj Ankylosis ◽  
Facial Nerve Injury ◽  
Additional Layer ◽  
Surgical Access

Background: Surgical access to the temporomandibular joint (TMJ) and zygomatic arch is a challenge even to the experienced maxillofacial surgeon. The conventional subfascial approach to these structures carries the potential risk of transient paralysis of the frontalis and orbicularis oculi muscles. The deep subfascial approach provides an additional layer of protection (the deep layer of the temporalis fascia and the superficial temporal fat pad) to the temporal and zygomatic branches of the facial nerve and thus, is the safest method to avoid facial nerve injury. Aims and Objective: To assess facial nerve injury (FN) following TMJ surgery using deep Subfascial approach and measuring it on House and Brackman facial nerve grading system (HBFNGS). Materials and Methods: A randomized study was performed from August 2013 to March 2017 on 24 patients with unilateral and bilateral TMJ ankylosis. All patients were evaluated objectively for facial nerve injury using with house and brackmann facial nerve injury grading system post-operatively and subjectively inthe various time periods, i.e. 24 hours, 1 week, 1month, 3 months and 6 months. Results: Brackmann facial nerve grading system at 24 hours post operatively– in the deep subfascial approach group, 91.7% of patients (23 cases) had Grade 1 injury and 8.3% (1case) had Grade 3 injury. The condition improved with time with full recovery of facial nerve injury (FN) at all surgical sites at 6 months. Conclusion: The deep subfascial approach has a distinct advantage over the conventional approaches when dissecting the temporal region and is thesafest method to avoid injury to facial nerve injury (FN).

Case Report: Facial Nerve Bifurcation Noted During Resection of Vestibular Schwannoma

2018 ◽  
Vol 15 (4) ◽  
pp. 36-39 ◽  
Author(s):  
Jennifer D Sokolowski ◽  
Douglas S Ruhl ◽  
Bradley W Kesser ◽  
Ashok R Asthagiri
Keyword(s):  
At Risk ◽  
Case Report ◽  
Facial Nerve ◽  
Nerve Injury ◽  
Vestibular Schwannoma ◽  
Cerebellopontine Angle ◽  
Clinical Presentation ◽  
Anatomic Variations ◽  
Facial Nerve Injury ◽  
Facial Nerve Anatomy

Abstract BACKGROUND AND IMPORTANCE Resection of cerebellopontine angle tumors is challenging because the proximity of the facial nerve puts it at risk of inadvertent injury and subsequent dysfunction. It is critical to consider variations in anatomy and be aware of the potential deviations in the course of the nerve in order to avoid damage. CLINICAL PRESENTATION We present a case of a facial nerve bifurcation identified during resection of a vestibular schwannoma. CONCLUSION This is the only reported case of proximal facial nerve bifurcation. We review what is known about variations in proximal facial nerve anatomy, the rates of facial nerve injury after schwannoma resection, and the importance of neuromonitoring in identifying the nerve and predicting function postoperatively. Ultimately, understanding possible anatomic variations in the nerve is critical to minimize iatrogenic injury during surgery.

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