Our Management of Vestibular Schwannomas and Review of Literatures

There is no a clear consensus provided in the literature and there remain controversial on the treatment especially for small to medium size Vestibular schwannomas (VSs). Thus the treatment technique and approach preference vary from centre to centre. This problem too exists in our centre. The purpose of this paper is to develop a consensus in our hospital among our colleagues on the treatment of our VSs patients. We have been treating VSs patient by translabyrinthine approach from time to time for the last 5 years and found it to be a very efficient approach. This approach gives the most direct route to the tumor with excellent exposure of the internal acoustic meatus, cerebropontine angle (CPA) area without the need to retract the brain with facial nerve totally in control early in the surgery. The only problem was, when there is large posterior fossa component of the tumor present. This approach is safe with direct exposure to CPA area and have minimum intraoperative or postoperative complications.

Facial Nerve Involvement During Temporal Bone Resection: Overall Survival And Locoregional Recurrence Outcomes.

Purpose: Facial nerve resection is often required in lateral temporal bone resection for tumors extending to the lateral skull base. Limited data exists to guide facial nerve reanimation strategies. Methods: This is a retrospective cohort study. Patients undergoing lateral temporal bone resection in a national referral center were included and divided into two groups: facial nerve preservation or resection. Survival and locoregional recurrence outcomes were analyzed by Kaplan-Meier survival analysis. Prognostic factors were identified using univariate and multivariate analysis. Facial nerve reconstructive methods were collected.Results: 39 patients were included with 20 having facial nerve resection at surgery. Squamous cell carcinoma (SCC) was the most common pathology. 48% of patients died during follow-up. Mean overall survival (OS) was 27 months and mean time to locoregional recurrence (LRR) 23 months in the facial nerve preservation group. Mean OS was 16 months and mean time to LRR was 13 months in the facial nerve resection groups (logrank OS p=0.330 and LRR p=0.445). 75% of patients in the facial nerve resection group had static facial nerve reanimation using tarsorrhaphy, gold-weight eyelid implant and fascia lata sling. Middle ear cavity extension was a negative predictor of OS and LRR.Conclusion: Facial nerve resection during lateral temporal bone surgery is associated with poor overall survival and locoregional control outcomes. Multidisciplinary surgical management and static facial reanimation should be offered to maintain function and quality of life in this group of patients.

Multidisciplinary Care of Patients with Facial Palsy: Treatment of 1220 Patients in a German Facial Nerve Center

To determine treatment and outcome in a tertiary multidisciplinary facial nerve center, a retrospective observational study was performed of all patients referred between 2007 and 2018. Facial grading with the Stennert index, the Facial Clinimetric Evaluation (FaCE) scale, and the Facial Disability Index (FDI) were used for outcome evaluation; 1220 patients (58.4% female, median age: 50 years; chronic palsy: 42.8%) were included. Patients with acute and chronic facial palsy were treated in the center for a median of 3.6 months and 10.8 months, respectively. Dominant treatment in the acute phase was glucocorticoids ± acyclovir (47.2%), followed by a significant improvement of all outcome measures (p < 0.001). Facial EMG biofeedback training (21.3%) and botulinum toxin injections (11%) dominated the treatment in the chronic phase, all leading to highly significant improvements according to facial grading, FDI, and FaCE (p < 0.001). Upper eyelid weight (3.8%) and hypoglossal–facial-nerve jump suture (2.5%) were the leading surgical methods, followed by improvement of facial motor function (p < 0.001) and facial-specific quality of life (FDI, FaCE; p < 0.05). A standardized multidisciplinary team approach in a facial nerve center leads to improved facial and emotional function in patients with acute or chronic facial palsy.

Facial Nerve Dysfunction After Mandibular Distraction Osteogenesis in Patients with Robin Sequence: A Systematic Review and Meta-Analysis

Objective Robin Sequence (RS), characterized by micrognathia, glossoptosis, and upper airway obstruction, is an increasingly recognized diagnosis. An effective surgical intervention is mandibular distraction osteogenesis (MDO). This study analyzes published evidence regarding facial nerve dysfunction (FND) associated with MDO. Design and Setting According to PRISMA guidelines, a systematic review was carried out with databases queried in June 2019 using MESH terms, or equivalent terms, as follows: “distraction osteogenesis” and “Robin Sequence”. A review of original Spanish and English articles, were included. Outcome measures included the prevalence of FND; the affected branches; the rate of permanent vs. transient FND; the use of an internal vs. external device; the daily distraction rate; and finally, the overall distraction length. Subsequently, a meta-analysis was conducted to collate results regarding the prevalence of FND and the factors associated with it. Results Of 239 unique studies identified, 19 studies with 729 patients met inclusion criteria; 52 patients developed FND after MDO. A random-effects meta-analysis yielded a pooled prevalence of FND of 6.40%, with moderately heterogeneous studies (I2 = 41%, τ2 = 0.006). Marginal mandibular nerve involvement was most commonly noted. Nine studies reported transient FND, six permanent, one both, and two unspecified. Internal distractors were used in 8 studies and external in 3 and both in 2. Distraction rate was 1.00 to 2.00 mm/day and total distraction length ranged from 13.00 to 22.3 mm. Sample size was the only parameter inversely associated with rate of FND (p = 0.04). Conclusion This analysis of FND associated with MDO for patients with RS demonstrates a lack of consistent documentation. MDO-associated FND does not appear to be uncommon, and permanent dysfunction can occur. This review underscores the importance of thorough documentation to elucidate the mechanism of FND.

Diagnosis of Peripheral Facial Palsy Associated with Parvovirus B19 Infection by Polymerase Chain Reaction

Human parvovirus B19 (PVB19) infection causes neurological manifestations, including encephalitis, meningitis, and neuropathy, but facial nerve palsy is rare. Moreover, no case of facial nerve palsy related to PVB19 infection that was diagnosed by PCR and serology has been reported. A 19-month-old boy without the medical history developed facial nerve palsy and was treated with prednisolone and valacyclovir. On the 19th day, erythema appeared on his body, and the PVB19-specific IgM and PVB19 DNA were detected in the serum, leading to the diagnosis of infectious erythema associated with PVB19 infection. This case indicates that PVB19 may be one of the causative agents of facial nerve palsy.