SP7.1.13 Facial nerve morbidity after superficial parotidectomy in the absence of nerve conductor: a general surgeon experience from a low resource country

Aims After superficial parotidectomy, the incidence of facial nerve injury, for pleomorphic adenoma of the parotid gland, remains the topic of interest despite different techniques to identify the nerve during surgery. We aim to evaluate the incidence of facial nerve injury in patients undergoing superficial parotidectomy in the absence of nerve conductor. Methods After calculating sample size, 101 patients irrespective of age and gender were included in this cross-sectional study at the Department of Surgery, for nine years, from 1st January 2012. The primary outcome was the incidence of temporary or permanent facial nerve injury with a follow-up period of 12 months. The data was calculated using SPSS version 23, where mean and standard deviation were calculated for continuous variables, and frequencies were calculated for categorical data. Results Facial nerve injury was evident in 16/101 (15.8%) patients. Among these, the main truck of facial nerve was involved in 6(5.9%); temporary loss of function in 4(4.0%) while permanent injury in 2(2.0%). Most common branch of facial nerve affected was marginal mandibular nerve (6, 5.9%), of which 4(4.0%) had a permanent loss. Additionally, four (4.0%) patients developed salivary fistula whereas (2%) patients developed Frey’s syndrome. Conclusion Facial nerve injury should be clearly explained, in the consent, to the patient as a medicolegal purpose. Where the nerve stimulator is not available, identification of the proposed anatomical landmarks allows a safe recognition of the facial nerve.

Classic Eagle’s Syndrome: Styloidectomy via the Transcervical Approach

Eagle’s syndrome was first described by Watt Eagle in 1937, as a syndrome of vague orofacial and cervical pain. He reported two variants, classic styloid and stylocarotid artery syndrome. Eagle’s syndrome is a non-perceived and underdiagnosed clinical condition of the head and neck. This anomalous entity presents with neck pain, globus sensation, difficulty in turning the head, dysphagia, odynophagia and various other symptoms occurring as a result of irritation to the nearby structures. The surgical management of Eagle’s syndrome consists of two major approaches: the transoral and the transcervical approaches. We report a case of classic bilateral elongated styloid process syndrome, treated with transcervical styloidectomy for painful left elongated styloid process. This gave permanent relief to the patient. The transcervical surgical approach for resection of elongated styloid process in patients with Eagle’s syndrome appears to be safe and effective, although the risk for transient marginal mandibular nerve weakness is notable.

Marginal mandibular nerve — a wandering enigma and ways to tackle it

Background This study aims to propose surgical approaches intended to localize and preserve the marginal mandibular nerve (MMN) during routinely performed head and neck surgical procedures. Main body of abstract Preservation of the functional integrity of the MMN is a critical measure in the success of orofacial surgeries involving the submandibular triangle. This study systematically reviews the anatomical description of the nerve including origin, course relative to fascial planes, relation to the parotid gland and facial pedicle, branching pattern and anastomosis of nerve and consolidate the findings of several significant studies to determine the “surgically safe” approaches to avoid iatrogenic injury to MMN. Short conclusion The systematic approaches described in this study have helped the authors precisely determine which particular MMN preserving approach to be adopted for each aspect of head and neck surgery. This has definitely enhanced the quality of surgery performed and the postoperative satisfaction of the patients.

Retrospective Study on Clinico-Pathological Presentations and Complications of Parotidectomy

Introduction Salivary gland tumors are rarely seen. It constitutes approximately 3% of all head-neck tumors. 75-80% of these tumors originate from the parotid gland. In this study, 98 patients who underwent parotidectomy in a tertiary otorhinolaryngology clinic were analyzed retrospectively, the frequency of different pathologies and our treatment modalities for parotid masses are presented in the light of current literature. Materials and Methods In this study, 98 patients who underwent parotidectomy in our clinic between 2011 and 2018 were retrospectively analyzed, the frequency of different pathologies, our treatment approach, and complications of treatment for parotid masses are presented in the light of current literature. Results The mean age was 48 years (between the range of 7-82 years). 41 cases were female and 57 cases were male. In the results of FNAB, there were 65 (66%) benign cases, 28 (29%) malignancy suspects and 5 (5%) malignant cases, 68 (69%) benign cases, and 30 (31%) malignant cases in surgical pathologies. The most frequent lesion of all parotid masses was pleomorphic adenoma (24%). The most common benign lesion was pleomorphic adenoma (35%) and the most frequent malignant tumor was mucoepidermoid carcinoma (27%). The most common surgery type was superficial parotidectomy (82 cases). The most common complication was marginal mandibular nerve paresis (6). Conclusion The treatment modality of the parotid tumors varies from case to case according to the nature of the tumor and extension.

Discerning a Smile -- The Intricacies of Analysis of Post-Neck dissection Asymmetr

Introduction Iatrogenic facial nerve palsy is distressing to the patient and clinician. The deformity is aesthetically displeasing, and can be functionality problematic for oral competence, dental lip trauma and speech. Furthermore such injuries have litigation implications. Marginal mandibular nerve (MMN) palsy causes an obvious asymmetrical smile. MMN is at particular risk during procedures such as rhytidoplasties, mandibular fracture, tumour resection and neck dissections. Cited causes for the high incidence are large anatomical variations, unreliable landmarks, an exposed course and tumour grade or nodal involvement dictating requisite nerve sacrifice. An alternative cause for post-operative asymmetry is damage to the cervical branch of the facial nerve or platysmal dysfunction. This tends to have a transient course and recovers. Distinction between MMN palsy and palsy of the cervical branch of the facial nerve should therefore be made. In 1979 Ellenbogen differentiated between MMN palsy and “Pseudo-paralysis of the mandibular branch of the facial nerve”. Despite this, there is paucity in the literature & confusion amongst clinicians in distinguishing between these palsies, and there is little regarding these post-operative sequelae and neck dissections. Method This article reflects on the surgical anatomy of the MMN and cervical nerve in relation to danger zones during lymphadenectomy. The authors review the anatomy of the smile. Finally, we utilise case studies to evaluate the differences between MMN palsy and its pseudo-palsy to allow clinical differentiation. Conclusion Here we present a simple method for clinical differentiation between these two prognostically different injuries, allowing appropriate reassurance, therapy & management.

Management of mandibular condylar fractures by the retromandibular approach – An evaluation of its complications

Background: Mandibular condyle fractures are commonly encountered in the practice of maxillofacial surgeon. Even though being a commonly seen fracture, the fracture condyle of the mandible demands meticulous diagnosis and a tailor made treatment plan for each and every patient. The treatment plan largely depends on the age of the patient and the displacement of the fractured fragment. This retrospective study provides an insight in to the management of fracture mandibular condyle by retromandibular approach. Aims and Objectives: The aim of this study was to evaluate the complications of the retromandibular transparotid approach in surgically operated patients with mandibular condylar fractures. Materials and Methods: A retrospective study was performed by analyzing the treatment records of patients who underwent open reduction and internal fixation (ORIF) by the retromandibular transparotid approach for seven years. Thirty-five patients who fulfilled the criteria were included in the study. Clinical parameters such as marginal mandibular nerve weakness, sialocele, occlusal derangement and decreased mouth opening were recorded during the first, fourth and twelfth weeks postoperatively. The retrieved data were analyzed for complications of the retromandibular approach in the management of mandibular condylar fractures. Results: In patients (N= 35) who underwent ORIF by the retromandibular transparotid approach, findings recorded at the end of the first week included 5 patients with sialocele, 2 patients with derangement of occlusion, 6 patients with restricted mouth opening and 1 patient with marginal mandibular nerve weakness. However, postoperatively, at the end of 4 weeks, the only complication observed was sialocele in 3 patients. Furthermore, at the end of 12 weeks, sialocele had completely resolved in all 3 patients, and they were free of complications. Conclusion: The retromandibular transparotid approach is a reliable and straightforward technique with manageable complications.

Liposuction of the Neck Using Reciprocating Power Assisted Liposuction

Neck liposuction in local anesthesia is a minimally invasive technique for fat reduction and skin tightening. The purpose of this study was to evaluate the clinical safety of reciprocating power assisted liposuction (PAL) of the neck. Neck liposuction with PAL was performed on 104 consecutive patients (male = 39, female = 65), and the occurrence of side effects were noted. There were no hematomas and no marginal mandibular nerve dysfunction. Transient alopecia at the site of liposuction was found in 3 out of the 39 male patients. In the hands of an experienced surgeon, reciprocating PAL of the neck is a safe method with a very low complication rate.

Pseudoparalysis of Marginal Mandibular Nerve Branch by Big Submandibular Gland Sailolith: A Case Report

Sailolithiasis is the second most common etiology of salivary gland after sialadenitis. Present case of 29 years old male patient with giant submandibular sailolith with stony hard feel below the left angle of the mandible. X ray and CECT neck used for confirmation. Because of big stone incidental finding of pressure paresis of marginal mandibular nerve was noticed. Even patient unaware of that. En-block Submandibular salivary gland excision was done by trans-cervical approach with complete recovery of the nerve within 3-4 post-operative weeks.