1
|
Hammami B, Kharrat I, Ayed MB, Hbaieb Y, Souissi B, Mahfoudh KB, Achour I, Mnejja M, Chaabouni MA, Charfeddine I. Aberrant Course of the Intratemporal Facial Nerve in Children with Congenital Hearing Loss. Indian J Otolaryngol Head Neck Surg 2024; 76:3051-3058. [PMID: 39130285 PMCID: PMC11306870 DOI: 10.1007/s12070-024-04596-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/01/2024] [Indexed: 08/13/2024] Open
Abstract
Congenital facial nerve (FN) malformations are uncommon. Our aim is to determine the clinical and radiological features of FN malformations along with the associated cochlear and vestibular malformations. We conducted a retrospective study including children with a profound sensorineural hearing loss who were candidates for cochlear implantation. We evaluated the presence of FN malformations through temporal bone computed tomography scan and magnetic resonance imaging. We recorded an aberrant FN course in five out of 165 patients in a total of 9 ears. They consisted of a bifurcation of the mastoid segment, an anterior or posterior displacement of the labyrinthine segment and a hypoplasia of the geniculate ganglion. Associated inner ear malformations included vestibular aqueduct dilation, cochlear hypoplasia and total labyrinthine aplasia. We noted a bilateral agenesis of the cochlear nerve in three patients. Facial nerve malformations should be suspected in patients presenting a congenital hearing loss especially in association with other temporal bone malformations. Their pre-operative discovery is helpful in planning the surgical procedure.
Collapse
Affiliation(s)
- Bouthaina Hammami
- Department of otorhinolaryngology head and neck surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
- Sfax Medical School, University of Sfax, Sfax, LR23ES01 Tunisia
| | - Ines Kharrat
- Department of otorhinolaryngology head and neck surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
- Sfax Medical School, University of Sfax, Sfax, LR23ES01 Tunisia
| | - Mariam Ben Ayed
- Department of otorhinolaryngology head and neck surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
- Sfax Medical School, University of Sfax, Sfax, LR23ES01 Tunisia
| | - Youssef Hbaieb
- Department of otorhinolaryngology head and neck surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
- Sfax Medical School, University of Sfax, Sfax, LR23ES01 Tunisia
| | - Basma Souissi
- Sfax Medical School, University of Sfax, Sfax, LR23ES01 Tunisia
- Department of Radiology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Kheireddine Ben Mahfoudh
- Sfax Medical School, University of Sfax, Sfax, LR23ES01 Tunisia
- Department of Radiology, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Achour
- Department of otorhinolaryngology head and neck surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
- Sfax Medical School, University of Sfax, Sfax, LR23ES01 Tunisia
| | - Malek Mnejja
- Department of otorhinolaryngology head and neck surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
- Sfax Medical School, University of Sfax, Sfax, LR23ES01 Tunisia
| | - Mohamed Amine Chaabouni
- Department of otorhinolaryngology head and neck surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
- Sfax Medical School, University of Sfax, Sfax, LR23ES01 Tunisia
| | - Ilhem Charfeddine
- Department of otorhinolaryngology head and neck surgery, Habib Bourguiba University Hospital, Sfax, Tunisia
- Sfax Medical School, University of Sfax, Sfax, LR23ES01 Tunisia
| |
Collapse
|
2
|
Miura Y, Noda M, Koshu R, Ito M. Stapedotomy for Pediatric Middle Ear Anomalies With Facial Nerve Bifurcation: A Case Report. Cureus 2024; 16:e65391. [PMID: 39184808 PMCID: PMC11344862 DOI: 10.7759/cureus.65391] [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] [Accepted: 07/25/2024] [Indexed: 08/27/2024] Open
Abstract
The intricate distribution of the facial nerve within the temporal bone is crucial in otological surgery. Anomalous facial nerve pathways are occasionally observed in middle ear malformations, although intra-tympanic bifurcation of the facial nerve is rare. When managing ossicular malformations with atypical facial nerve trajectories, hearing reconstruction should be prioritized based on the trajectory pattern and presence of the oval window. In this case, stapes surgery was performed due to facial nerve bifurcation within the tympanic cavity. In this case report, a 15-year-old female underwent stapes surgery due to gradually worsening conductive hearing loss. She was monitored at another hospital because of left-sided hearing loss at birth screening using automated auditory brainstem response. Her left ear initially had mild hearing loss, while her right ear remained within normal limits. However, her hearing deteriorated progressively, leading to significant daily challenges by age seven, prompting referral to our hospital. Intraoperatively, findings included defects in the incus-long process and stapes head, along with facial nerve bifurcation around the oval window, and the stapes footplate had poor flexibility. Stapedotomy was performed cautiously to preserve the facial nerve, utilizing a Teflon piston wire for sound transmission reconstruction. Postoperatively, the patient experienced no complications or facial nerve palsy, with hearing improving to 28.8 dB. Understanding the precise pathophysiology of middle ear anomalies is crucial for selecting appropriate surgical approaches. Even though the anomalies could not be evaluated prior to surgery, surgeons must carefully consider the risk of facial nerve injury and choose the optimal technique and reconstruction method tailored to each case, as predicting outcomes solely from preoperative evaluations can be challenging.
Collapse
Affiliation(s)
- Yuki Miura
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Masao Noda
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Ryota Koshu
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| | - Makoto Ito
- Otolaryngology - Head and Neck Surgery, Jichi Medical University, Shimotsuke, JPN
| |
Collapse
|
3
|
Silva VAR, Pauna HF, Lavinsky J, Hyppolito MA, Vianna MF, Leal M, Massuda ET, Hamerschmidt R, Bahmad Jr F, Cal RV, Sampaio ALL, Felix F, Chone CT, Castilho AM. Task force Guideline of Brazilian Society of Otology - hearing loss in children - Part II - Treatment. Braz J Otorhinolaryngol 2022; 89:190-206. [PMID: 36528468 PMCID: PMC9874354 DOI: 10.1016/j.bjorl.2022.11.001] [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: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To provide an overview of the main evidence-based recommendations for the diagnosis of hearing loss in children and adolescents aged 0-18 years. METHODS Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on childhood hearing loss were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS The topics were divided into 2 parts: (1) treatment of sensorineural hearing loss: individual hearing aids, bilateral cochlear implants, cochlear implants in young children, unilateral hearing loss, and auditory neuropathy spectrum disorder; and (2) treatment of conductive/mixed hearing loss: external/middle ear malformations, ventilation tube insertion, and tympanoplasty in children. CONCLUSIONS In children with hearing loss, in addition to speech therapy, Hearing AIDS (HAs) or implantable systems may be indicated. Even in children with profound hearing loss, both the use of HAs and behavioral assessments while using the device are important.
Collapse
Affiliation(s)
- Vagner Antonio Rodrigues Silva
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil,Corresponding author.
| | - Henrique Furlan Pauna
- Hospital Universitário Cajuru, Departamento de Otorrinolaringologia, Curitiba, PR, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Departamento de Cirurgia, Porto Alegre, RS, Brazil
| | - Miguel Angelo Hyppolito
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Melissa Ferreira Vianna
- Irmandade Santa Casa de Misericórdia de São Paulo, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Mariana Leal
- Universidade Federal de Pernambuco (UFPE), Departamento de Cirurgia, Recife, PE, Brazil
| | - Eduardo Tanaka Massuda
- Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Rogério Hamerschmidt
- Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Curitiba, PR, Brazil
| | - Fayez Bahmad Jr
- Universidade de Brasília (UnB), Programa de Pós-Graduação em Ciências da Saúde, Brasília, DF, Brazil,Instituto Brasiliense de Otorrinolaringologia (IBO), Brasília, DF, Brazil
| | - Renato Valério Cal
- Centro Universitário do Estado do Pará (CESUPA), Departamento de Otorrinolaringologia, Belém, PA, Brazil
| | - André Luiz Lopes Sampaio
- Universidade de Brasília (UnB), Faculdade de Medicina, Laboratório de Ensino e Pesquisa em Otorrinolaringologia, Brasília, DF, Brazil
| | - Felippe Felix
- Universidade Federal do Rio de Janeiro (UFRJ), Hospital Universitário Clementino Fraga Filho (HUCFF), Departamento de Otorrinolaringologia, Rio de Janeiro, RJ, Brazil
| | - Carlos Takahiro Chone
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| | - Arthur Menino Castilho
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil
| |
Collapse
|
4
|
Fang Y, Zhang K, Zhang F, Cheng X, Kiehn S, Shu Y, Chen B. Unexpected Branch Malformation of the Facial Nerve during Stapes Surgery: Comparison between Intraoperative and Radiographic Findings. ORL J Otorhinolaryngol Relat Spec 2022; 84:480-487. [PMID: 35797966 DOI: 10.1159/000523926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/09/2022] [Indexed: 11/19/2022]
Abstract
The aim of this study was to determine the prevalence of facial nerve (FN) bifurcation in patients who undergo stapes surgery, and to ascertain the correlation between the intraoperative and radiographic findings in cases where an unexpected branch malformation for patients undergoing stapes surgery. Patients who underwent stapes surgery were retroactively examined for confirmed FN bifurcation. Among the 887 patients, 10 had a bifurcated FN confirmed during surgery and had a preoperative high-resolution computed tomography (HRCT) scan. The HRCT scans were examined by two radiologists who were blinded to the operational findings. The diagnostic accuracy of HRCT imaging was examined along with their preoperative audiometry. In total, 887 patients underwent stapes surgery and among them the prevalence of FN bifurcation was 1.13%. These 10 patients had a 1:1 male-female ratio with a mean age of 17.9 ± 7.0 years. From a surgical review, all cases had bifurcation at the horizontal segment of FN, including 1 case of FN trifurcation. The diagnostic difference between HRCT imaging and intraoperation observations for malformations in the middle ear varies widely depending on the location, ranging from 0% to 90%. The prevalence of incus and stapes malformations was high in both imaging and operation findings (≥60%). The detection rate of abnormal positioning and bifurcation of the FN during HRCT imaging was 30% and 0%, respectively. The mean air-bone gap hearing threshold for patients was significantly improved from 42.3 dB preoperatively to 15.6 dB postoperatively without any complications. These results showed that it is extremely difficult to predict the FN bifurcation prior to surgery with a detection rate of 0%. The diagnostic difference between HRCT imaging and intraoperation observations for malformations of different parts of the middle ear varies widely. These results highlight the importance of being vigilant in regard to FN anatomical variation during stapes surgery for any unexpected malformations that are not detected during HRCT evaluation. In addition, the surgical outcomes for these patients were optimal when treatment was performed by senior surgeons.
Collapse
Affiliation(s)
- Yanqing Fang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Kun Zhang
- Department of Otorhinolaryngology, Qilu Hospital of Shandong University, NHC Key Laboratory of Otorhinolaryngology, Shandong University, Jinan, China
| | - Fang Zhang
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Xiaoting Cheng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Sebastian Kiehn
- Laryngeal Physiology Laboratory, University of Wisconsin - Madison, Madison, Wisconsin, USA
| | - Yilai Shu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Bing Chen
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Institutes of Biomedical Sciences, Fudan University, Shanghai, China.,NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| |
Collapse
|
5
|
Uchôa LRA, Luna LP, Farias LABG, Lima DLN, de Araujo Coimbra PP. Internal auditory canal hypoplasia associated with bilateral vestibulocochlear nerve aplasia and deviant facial nerve course: A case report and MRI findings. J Radiol Case Rep 2021; 15:17-23. [PMID: 34276875 DOI: 10.3941/jrcr.v15i5.3912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The evaluation of internal auditory canals and cochlea has gained significant importance due to the increasing number of cochlear implantations worldwide. This region's anatomical study is essential for cochlear implant surgery using magnetic resonance imaging as the method of choice. We report a case of a 6-year-old male patient diagnosed with a rare bilateral malformation of the internal auditory canals associated with an aberrant course of the facial nerve and vestibulocochlear nerve aplasia. This report raises the importance of identifying this rare malformation for appropriate management and reinforces awareness of possible complications.
Collapse
Affiliation(s)
| | - Licia Pacheco Luna
- Radiology Department, Fortaleza General Hospital (HGF), Fortaleza, Ceará, Brazil
- Department of Radiology, Division of Neuroradiology, Johns Hopkins Hospital, Baltimore, USA
| | | | | | | |
Collapse
|