scholarly journals Facial Plexiform Neurofibroma excision with sequential muti-layer hemostatic sutures, the novel technique to reduce blood loss

2020 ◽  
Vol 10 (2) ◽  
pp. 17
Author(s):  
Jonathan Velazquez-Mujica ◽  
Willerd Cadavid ◽  
Andrea Don Francesco ◽  
Dicle Aksoyler ◽  
Hung-chi Chen
Keyword(s):  
Facial Nerve ◽  
Plexiform Neurofibroma ◽  
Surgical Excision ◽  
Massive Bleeding ◽  
Preoperative Embolization ◽  
The Novel ◽  
Iatrogenic Damage ◽  
Plexiform Neurofibromatosis ◽  
Safe Technique ◽  
Ischemic Attack

Plexiform neurofibromatosis is an autosomal dominant and is frequently seen at birth. Surgical excision is asociate to facial nerve damage and profussal bleeding. Sequential multi-layered hemostatic sutures is a technique frequently used in our practice for Arterio-veous malfromations (AVM). 15 patiets with facial plexiform neurofibroma were treated from 2004 to 2020 with surgical excision, in all patients the hemifacial area was affected. Although preoperative embolization is well known as a safe technique to reduce intraoperative bleeding, low rates of serious complications were reported as stroke, ischemic attack and necrosis. The multi-layered hemostatic sutures permit to remove piecewise the tumor avoiding dramatically bleeding in all our procedures, and is based on vessel collapse after mechanical ligation. The sequential multi-layer suture and the retrograde disection of the facial nerve in our practice has decresed the average of iatrogenic damage of nerve, and massive bleeding during the excision of the plexiform neurofibroma.

Keyhole Endoscopic-Assisted Transcervical Approach to the Upper and Middle Retrostyloid Parapharyngeal Space: An Anatomic Feasibility Study

2021 ◽  
Author(s):  
Aldo Eguiluz-Melendez ◽  
Sergio Torres-Bayona ◽  
María Belen Vega ◽  
Vanessa Hernández-Hernández ◽  
Erik W. Wang ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Parapharyngeal Space ◽  
Jugular Bulb ◽  
Occipital Condyle ◽  
Digastric Muscle ◽  
The Novel ◽  
Main Trunk ◽  
Transcervical Approach ◽  
Semiquantitative Evaluation ◽  
Neurovascular Structures

Abstract Objectives The aim of this study was to describe the anatomical nuances, feasibility, limitations, and surgical exposure of the parapharyngeal space (PPS) through a novel minimally invasive keyhole endoscopic-assisted transcervical approach (MIKET). Design Descriptive cadaveric study. Setting Microscopic and endoscopic high-quality images were taken comparing the MIKET approach with a conventional combined transmastoid infralabyrinthine transcervical approach. Participants Five colored latex-injected specimens (10 sides). Main Outcome Measures Qualitative anatomical descriptions in four surgical stages; quantitative and semiquantitative evaluation of relevant landmarks. Results A 5 cm long inverted hockey stick incision was designed to access a corridor posterior to the parotid gland after independent mobilization of nuchal and cervical muscles to expose the retrostyloid PPS. The digastric branch of the facial nerve, which runs 16.5 mm over the anteromedial part of the posterior belly of the digastric muscle before piercing the parotid fascia, was used as a landmark to identify the main trunk of the facial nerve. MIKET corridor was superior to the crossing of the accessory nerve over the internal jugular vein within 17.3 mm from the jugular process. Further exposure of the occipital condyle, vertebral artery, and the jugular bulb was achieved. Conclusion The novel MIKET approach provides in the cadaver straightforward access to the upper and middle retrostyloid PPS through a natural corridor without injuring important neurovascular structures. Our work sets the anatomical nuances and limitations that should guide future clinical studies to prove its efficacy and safety either as a stand-alone procedure or as an adjunct to other approaches, such as the endonasal endoscopic approach.

scholarly journals An Exceptional Case of Intraparotid Plexiform Neurofibroma Originating from Autonomic Fibers of the Auriculotemporal Nerve

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Sarantis Blioskas ◽  
Sotiris Sotiriou ◽  
Katerina Rizou ◽  
Triantafyllia Koletsa ◽  
Petros Karkos ◽  
...  
Keyword(s):  
Parotid Gland ◽  
Plexiform Neurofibroma ◽  
Surgical Excision ◽  
Neurofibromatosis Type ◽  
Exceptional Case ◽  
Benign Tumors ◽  
First Case ◽  
Superficial Lobe ◽  
The Right ◽  
Auriculotemporal Nerve

Plexiform neurofibromas are benign tumors that tend to occur in patients suffering from neurofibromatosis type 1 (NF-1). This report addresses a rare case where the tumor affected the parotid gland, deriving almost exclusively from the peripheral portion of the facial nerve. A 6-year-old male was referred to us complaining about a gradually enlarging swelling over the right parotid area. Imaging localized the lesion to the superficial lobe of the parotid gland, suggesting a neurofibroma. Cosmetic disfigurement and a functional deficit led us to perform complete surgical resection. Meticulous surgical dissection as well as auriculotemporal nerve origin made complete extirpation possible with almost zero morbidity and ensured alleviation of both aesthetic impairment and pain. This is the first case of an intraparotid PN in a pediatric NF-1 patient, which originated from branches of the auriculotemporal nerve and particularly from fibers of the autonomic nervous system. Radical surgical excision was decided according to established decision-making algorithms.

Is Surgical Excision of Facial Nerve Schwannomas Always Indicated?

1995 ◽  
Vol 113 (2) ◽  
pp. P153-P153
Author(s):  
Simón I. Angeli ◽  
Derald E. Brackmann
Keyword(s):  
Facial Nerve ◽  
Surgical Excision

LARGE PLEXIFORM NEUROFIBROMA OF THE SACRO-GLUTEAL REGION – A RARE CASE REPORT

2021 ◽  
pp. 30-31
Author(s):  
Surya Rao Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj ◽  
Narayanamurthy Sundaramurthy ◽  
Anand Prasath Jayachandiran ◽  
Suresh Rajendran
Keyword(s):  
Rare Case ◽  
Primary Closure ◽  
Plexiform Neurofibroma ◽  
Surgical Excision ◽  
Gluteal Region ◽  
Nerve Sheath Tumor ◽  
Nerve Sheath ◽  
Rare Case Report ◽  
Von Recklinghausen

Plexiform neurobroma is a rare benign nerve sheath tumor that develops in the perineurium and is often considered pathognomonic of neurobromatosis type 1 (NF1 or von Recklinghausen disease). They occur most frequently in the craniomaxillofacial region, rarely on back and extremities. These lesions are highly vascular and there is 15-20% potential for malignant transformation. Here, we present a 26-year-old female with neurobromatosis all over her body, but with a large plexiform neurobroma in the sacral region which was causing difculty in sitting and lying supine as well as disgurement of the gluteal region. Surgical excision with primary closure of the swelling was done. Histopathology ndings were consistent with neurobromatosis.

Ultrasound-guided TriVex™-powered phlebectomy for debulking of peripheral vascular anomalies – A novel treatment technique

2019 ◽  
Vol 34 (8) ◽  
pp. 523-529
Author(s):  
Kurosh Parsi ◽  
Mina Kang ◽  
Anthony Trimboli
Keyword(s):  
Treatment Options ◽  
Symptom Relief ◽  
Surgical Excision ◽  
Target Lesion ◽  
Vascular Anomalies ◽  
Treatment Technique ◽  
The Novel ◽  
Ultrasound Guided ◽  
Surgical Debulking ◽  
Fibrofatty Tissue

Background Large vascular anomalies on the trunk or limbs are rare and prove challenging to treat. Currently, treatment options include conservative management, embolisation, sclerotherapy or surgical excision. Once the lesion has been embolised, or if it spontaneously involutes, the residual fibrofatty tissue may be painful and require debulking. Surgical debulking may be associated with complicated wound healing, infection, scarring and may not be not feasible for large lesions. Method We present our technique of using TriVex™-powered phlebectomy to debulk vascular anomalies. Our modification involved performing sclero-emobolisation on the target lesion first to mitigate the risk of haematoma formation. We also used ultrasound guidance to increase the precision and eliminate the use of TriVex™ illuminator. Results Excellent symptom relief and cosmetic outcome were achieved in three patients treated using this method. Conclusion We believe the novel technique of ultrasound-guided TriVex™-powered system provides a viable alternative to surgical debulking of large or complex vascular anomalies.

scholarly journals Plexiform Neurofibroma during Pregnancy, a Case Report from College Teaching Hospital, Kohalpur

2019 ◽  
Vol 17 (1) ◽  
pp. 58-59
Author(s):  
Nirmala Sharma ◽  
Durga B.C.
Keyword(s):  
Case Report ◽  
Neurofibromatosis Type 1 ◽  
Plexiform Neurofibroma ◽  
College Teaching ◽  
Neurofibromatosis Type ◽  
Connective Tissues ◽  
Previous Pregnancy ◽  
Plexiform Neurofibromatosis ◽  
Made In

Plexiform neurofibromas are rare variant (30%) of neurofibromatosis type 1 (NF-1) in which neurofibromas arise as large deforming masses from multiple nerve endings involving also connective tissues and skin folds. We report a case of 24 years old female, second gravida and one parity with diagnosis of plexiform neurofibromatosis made in previous pregnancy with remission of symptoms after pregnancy and accentuation during second pregnancy with positive pregnancy outcome.

scholarly journals Nodular fasciitis of the parotid gland engulfing the facial nerve: a conservative approach

2019 ◽  
Vol 12 (10) ◽  
pp. e231203
Author(s):  
Stephen Bennett ◽  
Kristian Hutson ◽  
Olakunle Ajayi ◽  
Andreas Hilger
Keyword(s):  
Parotid Gland ◽  
Facial Nerve ◽  
Benign Lesion ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Nodular Fasciitis ◽  
Conservative Approach ◽  
Complete Excision ◽  
Diagnostic Uncertainty ◽  
Accepted Practice

Nodular fasciitis (NF) is a rapidly growing benign lesion rarely reported in the parotid gland. It shares cytological features with other benign and malignant parotid neoplasms and may be difficult to diagnose based on fine needle aspiration cytology alone. Given this diagnostic conundrum, surgical excision for histology is recommended to facilitate definitive diagnosis. A case with significant involvement of the facial nerve is described, which has not previously been reported in the literature. Despite features of potential malignancy, the decision was taken to biopsy the lesion and not proceed to complete excision in an attempt to reduce the risk of facial nerve injury. Expert opinion later diagnosed NF. Contrary to accepted practice, where diagnostic uncertainty remains around the malignant potential of a lesion, risks and benefits of complete excision versus a conservative approach should be carefully weighed especially when the facial nerve is involved and NF is a possible diagnosis.

Facial Palsy Following Embolization of a Juvenile Nasopharyngeal Angiofibroma

2018 ◽  
Vol 127 (5) ◽  
pp. 344-348 ◽  
Author(s):  
Kareem O. Tawfik ◽  
Jeffrey J. Harmon ◽  
Zoe Walters ◽  
Ravi Samy ◽  
Alessandro de Alarcon ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Facial Nerve ◽  
Blood Supply ◽  
Facial Palsy ◽  
Vascular Supply ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Potential Complication ◽  
Nasopharyngeal Angiofibroma

Objectives: To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. Methods: The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. Results: A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. Conclusions: Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.

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