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

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.

Auditory Skills following Cochlear Implantation in Children with the Charge Syndrome

Objectives: To assess the auditory outcomes and skills of pediatric cochlear implant (CI) users with the CHARGE syndrome. To determine the influence of inner ear malformations on the surgical procedure and speech understanding outcomes in this population. Study Design: Observational, retrospective study. Materials and Methods: Imaging, auditory testing, intraoperative findings, complications, and postoperative auditory skills and outcomes of pediatric CI users with CHARGE syndrome were recorded. Results: 6 children (8 ears) were included, 5 of whom had prelingual deafness. Their mean age at implantation was 37 months. Six of the 8 ears presented cochlear malformation; the most frequent was hypoplasia type III. Intraoperatively, the transmastoid facial recess approach was used in 5 ears, and abnormalities of facial nerve anatomy were found in 5 ears. All electrode insertions were complete. All children were, to a varying degree, able to detect and identify sound. Verbalization skills were developed by 2 children, 1 of whom used oral language as his primary mode of communication. Conclusions: Cochlear implantation performed by an experienced surgeon in patients with the CHARGE syndrome is a safe procedure with adequate treatment planning. All children had improved auditory skills although the improvement was variable.

Anomalies of the facial nerve: a surgeon’s nightmare

<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>

Anomalous Extratemporal Facial Nerve in Oculoauriculovertebral Spectrum

Facial nerve dysfunction is common in oculoauriculovertebral spectrum (OAVS). However, the course of the nerve has rarely been described. A 23-year-old woman with OAVS underwent excision of microtic ear remnants in preparation for an osseointegrated prosthesis and suffered iatrogenic transection of the facial nerve—the pes anserinus was within the subcutaneous tissue 15 mm posterior and 15 mm cephalad to the external acoustic meatus. The patient underwent primary nerve repair and regained nearly complete preoperative function. When considering reconstruction for OAVS patients, clinicians should have a high index of suspicion for anomalous facial nerve anatomy.

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

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.