1
|
Sun J, Wang R, Chen X, Wang J, Liu D, Sai N, Zhu Y, Liu J, Shen W, Dai P, Yang S, Han D, Han W. Surgical management and the prognosis of iatrogenic facial nerve injury in middle ear surgery: a 20-year experience. Head Face Med 2023; 19:31. [PMID: 37491262 PMCID: PMC10369826 DOI: 10.1186/s13005-023-00377-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/30/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Iatrogenic facial nerve injury is one of the severest complications of middle ear surgery, this study aims to evaluate surgical management and prognosis in the era of improved surgical instruments. METHODS Patients suffered from facial nerve paralysis after middle ear surgery between January 2000 and December 2019 were retrospectively collected. Demographic characters, primary disease and surgery, details of revision surgery were analyzed. RESULTS Forty-five patients were collected, of whom 8 were injured at our center and 37 were transferred. For 8 patients injured at our center, seven (87.5%) ranked House-Brackmann (H-B) grade V and one (12.5%) ranked H-B VI before revision surgery; postoperatively, two (25.0%) patients recovered to H-B grade I, four (50.0%) recovered to H-B II, and the other two (25.0%) recovered to H-B III. For 37 patients transferred, thirteen (35.1%) ranked H-B grade V and 24 (64.9%) ranked H-B VI preoperatively, final postoperative grade ranked from H-B grade I to grade V, with H-B I 6 (16.2%) cases, H-B II 6 (16.2%) cases, H-B III 18 (48.6%) cases, H-B IV 5 (13.5%) cases and H-B V 2 (5.4%) cases. The most vulnerable site was tympanic segment (5, 62.5% and 27, 73.0% respectively). Twenty-one (46.7%) patients suffered from mild injury and 24 (53.3%) suffered from partial or complete nerve transection. For surgical management, twenty-one (46.7%) patients received decompression, nineteen (42.2%) received graft and 5 (11.1%) received anastomosis. Those decompressed within 2 months after paralysis had higher possibility of H-B grade I or II recovery (P = 0.026), those received graft within 6 months were more likely to get H-B grade III recovery (P = 0.041), and for patients underwent anastomosis within 6 months, all recovered to H-B grade III. CONCLUSIONS Tympanic segment is the vulnerable site. If facial nerve paralysis happens, high-resolution computed tomography could help identify the injured site. Timely treatment is important, decompression within 2 months after paralysis, graft and anastomosis within 6 months lead to better recovery.
Collapse
Affiliation(s)
- Jianbin Sun
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Ruoya Wang
- Department of Otolaryngology, the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121012, China
| | - Xingrui Chen
- Department of Medical Oncology, Guangdong SanJiu Brain Hospital, Guangzhou, 510510, China
| | - Jianze Wang
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Da Liu
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
- PLA Air Demonstration Team, Tianjin, 301700, China
| | - Na Sai
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Yuhua Zhu
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Jun Liu
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Weidong Shen
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Pu Dai
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Shiming Yang
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Dongyi Han
- Medical School of Chinese PLA, Beijing, 100853, China
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China
| | - Weiju Han
- Medical School of Chinese PLA, Beijing, 100853, China.
- Department of Otolaryngology Head and Neck Surgery, the Six Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
- National Clinical Research Center for Otolaryngologic Diseases, Beijing, China.
| |
Collapse
|
2
|
Liu D, Wang JZ, Sun JB, Li Z, Zhang T, Sai N, Zhu YH, Shen WD, Huang DL, Dai P, Yang SM, Han DY, Han WJ. [Differential diagnosis and surgical management in chondrosarcoma of the jugular foramen]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 58:544-551. [PMID: 37339893 DOI: 10.3760/cma.j.cn115330-20220607-00334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Objective: To explore the diagnosis, surgical management and outcome of jugular foramen chondrosarcoma (CSA). Methods: Fifteen patients with jugular foramen CSA hospitalized in the Department of Otorhinolaryngology Head and Neck Surgery of Chinese PLA General Hospital from December 2002 to February 2020 were retrospectively collected,of whom 2 were male and 13 were female, aging from 22 to 61 years old. The clinical symptoms and signs, imaging features, differential diagnosis, surgical approaches, function of facial nerve and cranial nerves IX to XII, and surgical outcomes were analyzed. Results: Patients with jugular foramen CSA mainly presented with facial paralysis, hearing loss, hoarseness, cough, tinnitus and local mass. Computed tomography (CT) and magnetic resonance (MR) could provide important information for diagnosis. CT showed irregular destruction on bone margin of the jugular foramen. MR demonstrated iso or hypointense on T1WI, hyperintense on T2WI and heterogeneous contrast-enhancement. Surgical approaches were chosen upon the sizes and scopes of the tumors. Inferior temporal fossa A approach was adopted in 12 cases, inferior temporal fossa B approach in 2 cases and mastoid combined parotid approach in 1 case. Five patients with facial nerve involved received great auricular nerve graft. The House Brackmann (H-B) grading scale was used to evaluate the facial nerve function. Preoperative facial nerve function ranked grade Ⅴ in 4 cases and grade Ⅵ in 1 case. Postoperative facial nerve function improved to grade Ⅲ in 2 cases and grade Ⅵ in 3 cases. Five patients presented with cranial nerves Ⅸ and Ⅹ palsies. Hoarseness and cough of 2 cases improved after operation, while the other 3 cases did not. All the patients were diagnosed CSA by histopathology and immunohistochemistry, with immunohistochemical staining showing vimentin and S-100 positive, but cytokeratin negative in tumor cells. All patients survived during 28 to 234 months' follow-up. Two patients suffered from tumor recurrence 7 years after surgery and received revision surgery. No complications such as cerebrospinal fluid leakage and intracranial infection occurred after operation. Conclusions: Jugular foramen CSA lacks characteristic symptoms or signs. Imaging is helpful to differential diagnosis. Surgery is the primary treatment of jugular foramen CSA. Patients with facial paralysis should receive surgery in time as to restore the facial nerve. Long-term follow-up is necessary after surgery in case of recurrence.
Collapse
Affiliation(s)
- D Liu
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| | - J Z Wang
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| | - J B Sun
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| | - Z Li
- Department of Pathology, Chinese PLA General Hospital, Beijing 100853, China
| | - T Zhang
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| | - N Sai
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| | - Y H Zhu
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| | - W D Shen
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| | - D L Huang
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| | - P Dai
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| | - S M Yang
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| | - D Y Han
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| | - W J Han
- College of Otorhinolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otorhinolaryngology Disease, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing 100853, China
| |
Collapse
|