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Silverstein JW, Avshalomov E, Ablyazova F, Stark KG, Ben-Shalom N. Comprehensive Mapping and Dynamic Monitoring of the Temporal Branch of the Facial Nerve in Complex Cranial Reconstruction Surgery and Revision Cranioplasty. J Craniofac Surg 2024:00001665-990000000-01861. [PMID: 39212390 DOI: 10.1097/scs.0000000000010578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
Facial nerve (FN) injury is a significant risk during complex cranial reconstruction surgeries, especially in revision cases where normal anatomy is distorted. The authors introduce a technique to mitigate FN injury, including preoperative FN mapping, intraoperative FN mapping, and continuous FN monitoring. Preoperative mapping uses a handheld ball-tip stimulator to elicit compound muscle action potentials (CMAP) in the frontalis muscle. Needle electrodes are placed above the orbital margin to record responses, starting at the stylomastoid foramen and extending until the entire temporal branch is mapped. Intraoperatively, continuous mapping is achieved using an electrified insulated suction device, allowing dynamic mapping during soft tissue dissection. Continuous monitoring involves placing stimulation electrodes near the stylomastoid foramen and recording CMAP responses from the frontalis and orbicularis oculi/orbicularis oris muscles. The authors tested this technique in 5 patients. The authors successfully mapped the temporal branch of the FN with isolated frontalis CMAP recordings in all patients. Intraoperative FN mapping and continuous monitoring were successfully performed in all cases. Two patients experienced complete cessation of FN CMAPs, which resumed upon loosening the tension on the myocutaneous flap held by fishhooks. One patient showed a 39% decrement in frontalis CMAP that did not recover. Despite these issues, all patients had intact FN function postoperatively and at follow-up. Our technique shows promise in mitigating FN injury during complex cranial reconstruction and cranioplasty revision surgery. Further research with a larger cohort is needed to confirm efficacy and statistical significance.
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Affiliation(s)
- Justin W Silverstein
- Department of Neurology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell
- Department of Clinical Neurophysiology, Neuro Protective Solutions
| | - Elizabeth Avshalomov
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, New York, NY
| | - Faina Ablyazova
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, New York, NY
| | - Katherine G Stark
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, New York, NY
| | - Netanel Ben-Shalom
- Department of Neurological Surgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, New York, NY
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Hassan SH, Salih KM, Salih AM, Qaradakhy AJ, Abdullah AM, Saeed YA, Muhialdeen AS, Habibullah IJ, Dhahir HM, Kakamad FH, Ahmed MK. Sporadic neurofibroma of facial nerve presenting as parotid gland tumor: a rare case report. J Surg Case Rep 2024; 2024:rjae434. [PMID: 38957521 PMCID: PMC11218767 DOI: 10.1093/jscr/rjae434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/08/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024] Open
Abstract
Intraparotid gland neurofibroma is a rare benign tumor that arises from Schwann cells of the facial nerve within the parotid gland. This case report discusses a 41-year-old woman who experienced a painless preauricular swelling on her right side for over 5 years. Clinical examination and ultrasound revealed a well-defined mass in the parotid gland. The patient underwent total mass excision, resulting in transient facial nerve dysfunction but complete recovery. These tumors often manifest as solitary masses in the parotid region and may compress nearby structures, causing facial paralysis or numbness. Their diagnosis can be challenging due to similarities with other parotid gland tumors and possible associations with neurofibromatosis. Managing intraparotid tumors, including neurofibromas, involves a multidisciplinary approach with input from cytopathologists, radiologists, and surgeons.
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Affiliation(s)
- Shko H Hassan
- Scientific Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Karzan M Salih
- Scientific Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Abdulwahid M Salih
- Scientific Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan 46001, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Zanko Street, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Aras J Qaradakhy
- Scientific Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan 46001, Iraq
- Department of Radiology, Shorsh Teaching Hospital, Shorsh Street, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Ari M Abdullah
- Scientific Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan 46001, Iraq
- Department of Pathology, Sulaymaniyah Teaching Hospital, Zanko Street, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Yadgar A Saeed
- Scientific Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Aso S Muhialdeen
- Scientific Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Imad J Habibullah
- Scientific Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Hardi M Dhahir
- Scientific Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Fahmi H Kakamad
- Scientific Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan 46001, Iraq
- Department of Surgery, College of Medicine, University of Sulaimani, Zanko Street, Sulaymaniyah, Kurdistan 46001, Iraq
- Kscien Organization, Hamdi Street, Azadi Mall, Sulaymaniyah, Kurdistan 46001, Iraq
| | - Masty K Ahmed
- Scientific Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan 46001, Iraq
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Psychogios G, Bohr C, Constantinidis J, Canis M, Vander Poorten V, Plzak J, Knopf A, Betz C, Guntinas-Lichius O, Zenk J. Review of surgical techniques and guide for decision making in the treatment of benign parotid tumors. Eur Arch Otorhinolaryngol 2020; 278:15-29. [DOI: 10.1007/s00405-020-06250-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
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