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Yoshioka N, Fernandez-Miranda JC. Nerve to the zygomaticus major muscle: An anatomical study and surgical application to smile reconstruction. Clin Anat 2024; 37:376-382. [PMID: 37283304 DOI: 10.1002/ca.24079] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/08/2023]
Abstract
Smile reconstruction using the branches that supply the zygomaticus major muscle as a motor source is an established procedure in facial reanimation surgery for facial paralysis. However, the anatomy of the nerve to the muscle remains unclear. Therefore, we herein examined the topographical anatomy of the nerve to the zygomaticus major muscle to obtain more detailed information on donor nerve anatomy. Preserved cadaver dissection was performed under a microscope on 13 hemifaces of 8 specimens. The branches that innervate the zygomaticus major muscle and their peripheral routes medial to the muscle were traced and examined. A median of four (ranges 2-4) branches innervated the zygomaticus major muscle. The proximal two branches (near the muscle origin) arose from the zygomatic branch, the second of which was the major branch. The distal branches (near the oral commissure) arose from the buccal branch or zygomaticobuccal plexus. The vertical distance from the caudal margin of the zygomatic arch to the major branch intersecting point was 19 ± 4.0 mm, while the horizontal distance parallel to the Frankfort plane was 29 ± 5.2 mm. The proximal two branches innervating the zygomaticus major muscle were detected in the majority of specimens. The anatomical findings obtained herein on the nerve to the zygomaticus major muscle will allow for more reliable donor selection in facial reanimation surgery.
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Affiliation(s)
- Nobutaka Yoshioka
- Department of Neurosurgery, Stanford University, Palo Alto, California, USA
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Cai Y, Yang W, Peng X, Yuan L, Ge M. Experience in treating children with ocular dyskinesia and hemifacial spasm secondary to pontine tumours adjacent to the fourth ventricle and systematic review. Childs Nerv Syst 2024; 40:1349-1360. [PMID: 38227027 DOI: 10.1007/s00381-024-06280-4] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To investigate the treatment plan and prognosis of children with ocular dyskinesia and hemifacial spasm secondary to pontine tumours adjacent to the fourth ventricle. METHODS In this retrospective study, the clinical information of 10 consecutively collected children with ocular dyskinesia and hemifacial spasm secondary to pontine tumours adjacent to the fourth ventricle was analyzed. All 10 children underwent pontine tumour resection through a trans-cerebellomedullary fissure approach; 4 children underwent preoperative diffusion tensor imaging scans to determine the relationship between the tumour and facial nerve nucleus, and the other 6 children underwent intraoperative deep electroencephalography (EEG) tumour monitoring, in which the tumour electrical discharge activity of the tumour was recorded. A voxel distribution map was established to describe the distribution of the tumour location, and patient prognosis was evaluated through clinical and imaging follow-up. RESULTS All 10 children achieved total tumour resection; 9 tumours were pathologically suggested to be ganglioglioma (WHO grade I), and 1 was a hamartoma. The symptoms of the original ocular dyskinesia and hemifacial spasm disappeared immediately after the operation. The children were followed up for 4-75 months, and none of the symptoms recurred; four cases with preoperative diffusion tensor imaging showed that the tumour was close to the facial nerve. Four in six intraoperative electrophysiological monitoring showed that the tumour had electrical discharge behaviour, and the tumour distribution map indicates a high density of tumour presence in the facial nerve nucleus and the nucleus of the abducens nerve. CONCLUSIONS In paediatric patients, the facial symptoms are related to the location and abnormal electrical discharge of the tumour. There is no significant correlation between ocular dyskinesia and the location of the tumour. Conventional antiepileptic therapy for this disease is ineffective, and early surgical intervention for total tumour resection can achieve a clinical curative effect.
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Affiliation(s)
- Yingjie Cai
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Wei Yang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Xiaojiao Peng
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Liu Yuan
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Ming Ge
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China.
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Freeman LM, Ung TH, Thompson JA, Ovard O, Olson M, Hirt L, Hosokawa P, Thaker A, Youssef AS. Refining the predictive value of preoperative apparent diffusion coefficient (ADC) by whole-tumor analysis for facial nerve outcomes in vestibular schwannomas. Acta Neurochir (Wien) 2024; 166:168. [PMID: 38575773 DOI: 10.1007/s00701-024-06059-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Apparent diffusion coefficient (ADC) in MRI has been shown to correlate with postoperative House-Brackmann (HB) scores in patients with vestibular schwannoma despite limited methodology. To rectify limitations of single region of interest (ROI) sampling, we hypothesize that whole-tumor ADC histogram analysis will refine the predictive value of this preoperative biomarker related to postoperative facial nerve function. METHODS Of 155 patients who underwent resection of vestibular schwannoma (2014-2020), 125 patients were included with requisite clinical and radiographic data. After volumetric analysis and whole-tumor ADC histogram, regression tree analysis identified ADC cutoff for significant differences in HB grade. Outcomes were extent of resection, facial nerve function, hospital length of stay (LOS), and complications. RESULTS Regression tree analysis defined three quantitative ADC groups (× 10-6 mm2/s) as high (> 2248.77; HB 1.7), mid (1468.44-2248.77; HB 3.1), and low (< 1468.44; HB 2.3) range (p 0.04). The mid-range ADC group had significantly worse postoperative HB scores and longer hospital LOS. Large tumor volume was independently predictive of lower rates of gross total resection (p <0.0001), higher postoperative HB score (p 0.002), higher rate of complications (p 0.04), and longer LOS (p 0.003). CONCLUSIONS Whole-tumor histogram yielded a robust regression tree analysis that defined three ADC groups with significantly different facial nerve outcomes. This likely reflects tumor heterogeneity better than solid-tumor ROI sampling. Whole-tumor ADC warrants further study as a useful radiographic biomarker in patients with vestibular schwannoma who are considering surgical resection.
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Affiliation(s)
- Lindsey M Freeman
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Timothy H Ung
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Olivia Ovard
- Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Madeline Olson
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Lisa Hirt
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Patrick Hosokawa
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ashesh Thaker
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A Samy Youssef
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Otolaryngology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Zohdy YM, Alawieh AM, Bray D, Pradilla G, Garzon-Muvdi T, Ashram YA. An Artificial Neural Network Model for Predicting Postoperative Facial Nerve Outcomes After Vestibular Schwannoma Surgery. Neurosurgery 2024; 94:805-812. [PMID: 37962366 DOI: 10.1227/neu.0000000000002757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/25/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The emergence of machine learning models has significantly improved the accuracy of surgical outcome predictions. This study aims to develop and validate an artificial neural network (ANN) model for predicting facial nerve (FN) outcomes after vestibular schwannoma (VS) surgery using the proximal-to-distal amplitude ratio (P/D) along with clinical variables. METHODS This retrospective study included 71 patients who underwent VS resection between 2018 and 2022. At the end of surgery, the FN was stimulated at the brainstem (proximal) and internal acoustic meatus (distal) and the P/D was calculated. Postoperative FN function was assessed using the House-Brackmann grading system at discharge (short-term) and after 9-12 months (long-term). House-Brackmann grades I-II were considered good outcome, whereas grades III-VI were considered fair/poor. An ANN model was constructed, and the performance of the model was evaluated using the area under the ROC curve for internal validation and accuracy, sensitivity, specificity, and positive and negative predictive values for external validation. RESULTS The short-term FN outcome was grades I-II in 57.7% and grades III-VI in 42.3% of patients. Initially, a model using P/D had an area under the curve of 0.906 (internal validation) and an accuracy of 89.1% (95% CI: 68.3%-98.8%) (external validation) for predicting good vs fair/poor short-term FN outcomes. The model was then refined to include only muscles with a P/D with a proximal latency between 6 and 8 ms. This improved the accuracy to 100% (95% CI: 79%-100%). Integrating clinical variables (patient's age, tumor size, and preoperative HB grade) in addition to P/D into the model did not significantly improve the predative value. A model was then created to predict the long-term FN outcome using P/D with latencies between 6 and 8 ms and had an accuracy of 90.9% (95% CI: 58.7%-99.8%). CONCLUSION ANN models incorporating P/D can be a valuable tool for predicting FN outcomes after VS surgery. Refining the model to include P/D with latencies between 6 and 8 ms further improves the model's prediction. A user-friendly interface is provided to facilitate the implementation of this model.
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Affiliation(s)
- Youssef M Zohdy
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
| | - Ali M Alawieh
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
| | - David Bray
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University, Atlanta , Georgia , USA
| | | | - Yasmine A Ashram
- Department of Physiology, Faculty of Medicine, Alexandria University, Alexandria , Egypt
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Kaufman Goldberg T, Flynn JP, Xiao R, Trzcinski LO, Hadlock TA. Favorable Outcome Perception in Facial Selective Neurectomy. Otolaryngol Head Neck Surg 2024; 170:1045-1050. [PMID: 38050420 DOI: 10.1002/ohn.598] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/16/2023] [Accepted: 11/02/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVE Facial selective neurectomy (SN) improves facial function by denervation of muscles antagonistic to the smile in nonflaccid facial paralysis (NFFP) patients. This study aims to assess whether and which objective facial function metrics affect favorable SN outcome in NFFP patients, as perceived by facial nerve (FN) practitioners. STUDY DESIGN Retrospective cohort study. SETTING NFFP patients who underwent SN at the facial nerve center. METHODS Standardized preoperative and postoperative facial photographs of patients undergoing SN were analyzed using clinician-graded measures (eFACE) and automated facial measurement (Emotrics). Favorable outcome was ranked subjectively by 3 independent FN practitioners. Correlations between objective metrics and favorable subjective outcome were examined. RESULTS Fifty-eight SN cases were included. Oral commissure excursion with smile, interlabial distance, and lower lip movement were all considered statistically significantly important for favorable outcome perception. Each +1 mm of smile excursion increases the odds of a favorable outcome by 75.4% (odds ratio [OR]: 1.754). Each +1 mm of interlabial distance asymmetry decreases the odds of a favorable outcome by 24.7% (OR: 0.753). Each +1-point change in lower lip movement eFACE score increases the odds of a favorable outcome by 2.7% (OR: 1.027). CONCLUSION Several smile metrics contribute to favorable SN outcome perception among FN practitioners. Smile excursion, interlabial distance, and lower lip movement were significant predictors of success. These observations may be extrapolated to other facial reanimation interventions and serve surgeons and patients during counseling and expectation management, and during surgery.
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Affiliation(s)
- Tal Kaufman Goldberg
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - John P Flynn
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Roy Xiao
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lauren O Trzcinski
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology-Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Shi X, Liu Y, Zhang Z, Tao B, Zhang D, Jiang Q, Chen G, Ma H, Feng Y, Xie J, Zheng X, Zhang J. The value of radiographic features in predicting postoperative facial nerve function in vestibular schwannoma patients: A retrospective study and nomogram analysis. CNS Neurosci Ther 2024; 30:e14526. [PMID: 37990346 PMCID: PMC11017437 DOI: 10.1111/cns.14526] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE The purpose of this study was to identify significant prognostic factors associated with facial paralysis after vestibular schwannoma (VS) surgery and develop a novel nomogram for predicting facial nerve (FN) outcomes. METHODS Retrospective data were retrieved from 355 patients who underwent microsurgery via the retrosigmoid approach for VS between December 2017 and December 2022. Univariate and multivariate logistic regression analysis were used to construct a radiographic features-based nomogram to predict the risk of facial paralysis after surgery. RESULTS Following a thorough screening process, a total of 185 participants were included. The univariate and multivariate logistic regression analysis revealed that tumor size (p = 0.005), fundal fluid cap (FFC) sign (p = 0.014), cerebrospinal fluid cleft (CSFC) sign (p < 0.001), and expansion of affected side of internal auditory canal (IAC) (p = 0.033) were independent factors. A nomogram model was constructed based on these indicators. When applied to the validation cohort, the nomogram demonstrated good discrimination and favorable calibration. Then we generated a web-based calculator to facilitate clinical application. CONCLUSION Tumor size, FFC and CSFC sign, and the expansion of the IAC, serve as good predictors of postoperative FN outcomes. Based on these factors, the nomogram model demonstrates good predictive performance.
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Affiliation(s)
- Xudong Shi
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Yuyang Liu
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Zehan Zhang
- Department of Neurosurgerythe Air Force Hospital of Southern Theater CommandGuangzhouChina
| | - Bingyan Tao
- Department of Neurosurgery961th Hospital of Joint Logistics Support ForceQiqiharChina
| | - Ding Zhang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Qingyu Jiang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Guilin Chen
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Hengchao Ma
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
- Medical School of Chinese PLABeijingChina
| | - Yaping Feng
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Jiaxin Xie
- Department of Neurosurgery920th Hospital of Joint Logistics Support ForceKunmingChina
| | - Xuan Zheng
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
| | - Jun Zhang
- Department of Neurosurgery, The First Medical CentreChinese PLA General HospitalBeijingChina
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Oliveira LM, Peres CMA, Figueiredo EG. Facial nerve inflammation after trigeminal microvascular decompression. Br J Neurosurg 2024; 38:542-543. [PMID: 33491500 DOI: 10.1080/02688697.2021.1876212] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
In this article, we will discuss a rare complication after microvascular decompression for trigeminal neuralgia: peripheral facial palsy.
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Luzha J, Kopp M, Wiesmüller M, Taha L, Rupp R, Mantsopoulos K, Koch M, Iro H, Sievert M. Diagnostic Challenges and Imaging Considerations for Intraparotid Facial Nerve Schwannoma: A Case Report and Literature Review. Am J Case Rep 2024; 25:e942870. [PMID: 38549237 PMCID: PMC10985418 DOI: 10.12659/ajcr.942870] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 02/09/2024] [Accepted: 01/12/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND A mass in the parotid gland usually indicates parotid gland neoplasia. Warthin tumors or pleomorphic adenomas are common differential diagnoses. Less frequently, other differential diagnoses and sites of origin are considered. Schwannomas are rare, benign tumors in the head and neck region. Even more rarely, these tumors occur in the intraparotid course of the facial nerve. In the following, we report about 2 patients in whom a mass in the right parotid gland was found incidentally during magnetic resonance imaging (MRI). CASE REPORT We reviewed data from the literature on intraparotid facial nerve schwannomas (IPFNS) and compared them with those from our cases. The focus was on data such as clinical history, clinical symptoms, electroneurography, and various imaging modalities, such as ultrasonography and MRI combined with diffusion-weighted imaging. CONCLUSIONS It is challenging to distinguish facial nerve schwannomas from other neoplasms. Patient's history, clinical symptoms, MRI examination with diffusion-weighted imaging, and high-resolution ultrasound imaging are decisive factors for diagnosis and should be performed when IPFNS is suspected. Diagnosis and therapy for IPFNS remain challenging. A wait-and-scan approach could be an option for patients with small tumors and good facial nerve function. On the other hand, patients with advanced tumors associated with limited facial nerve function can benefit from surgical approaches or stereotactic radiosurgery.
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Affiliation(s)
- Jeton Luzha
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Markus Kopp
- Department of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marco Wiesmüller
- Department of Radiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Lava Taha
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Robin Rupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Koch
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Kosaraju N, Moore LS, Mulders JY, Blevins NH. Sporadic vestibular schwannoma in a pediatric population: a case series. Childs Nerv Syst 2024; 40:635-645. [PMID: 37889276 DOI: 10.1007/s00381-023-06184-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE To describe the characteristics, management, and outcomes of pediatric patients with sporadic vestibular schwannoma (sVS). METHODS This was a case series at a tertiary care center. Patients were identified through a research repository and chart review. Interventions were microsurgery, stereotactic radiosurgery (SRS), and observation. Outcome measures were tumor control, facial nerve function, and hearing. RESULTS Eight patients over 2006-2022 fulfilled inclusion criteria (unilateral VS without genetic or clinical evidence of neurofibromatosis type 2 (NF2); age ≤ 21) with a mean age of 17 years (14-20). Average greatest tumor length in the internal auditory canal was 9.7 mm (4.0-16.1). Average greatest tumor dimension (4/8 tumors) in the cerebellopontine angle was 19.1 mm (11.3-26.8). Primary treatment was microsurgery in five (62.5%) patients, observation in two (25%), and SRS in one (12.5%). Four (80%) surgical patients had gross total resections, and one (20%) had regrowth post-near total resection and underwent SRS. One observed patient and the primary SRS patient have remained radiographically stable for 3.5 and 7 years, respectively. The other observed patient required surgery for tumor growth after 12 months of observation. Two surgical patients had poor facial nerve outcomes. All post-procedural patients developed anacusis. Mean follow-up was 3 years (0.5-7). CONCLUSIONS We describe one of the largest reported cohorts of pediatric sVS in the USA. Diligent exclusion of NF2 is critical. Given the high likelihood of eventually requiring intervention and known adverse effects of SRS, microsurgery remains the preferred treatment. However, observation can be considered in select situations.
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Affiliation(s)
- Nikitha Kosaraju
- Division of Otology/Neurotology, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, Stanford, CA, 94305-5739, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lindsay S Moore
- Division of Otology/Neurotology, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, Stanford, CA, 94305-5739, USA
| | - Jip Y Mulders
- Division of Otology/Neurotology, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, Stanford, CA, 94305-5739, USA
- Leiden University Medical Center, Leiden, The Netherlands
| | - Nikolas H Blevins
- Division of Otology/Neurotology, Department of Otolaryngology - Head & Neck Surgery, Stanford University School of Medicine, 801 Welch Rd, Palo Alto, Stanford, CA, 94305-5739, USA.
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Jun D, Park IS, Kim J. Ocular-oral synkinesis caused by partial injury of the zygomatic and buccal branches of the facial nerve after mid-face trauma. J Plast Reconstr Aesthet Surg 2024; 90:1-9. [PMID: 38280337 DOI: 10.1016/j.bjps.2023.11.053] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND Facial nerve paralysis induced by acute traumatic facial nerve injuries limited to the zygomatic and buccal branches shows unique complications, such as strong co-contractions of the lower facial muscles around the lips during voluntary blinking (ocular-oral synkinesis). We investigated the characteristics of facial complications after facial nerve injury in the mid-face area and reported the treatment results. METHODS A total of 21 patients with facial nerve injuries to the zygomatic and/or buccal branches were evaluated for the degree of facial synkinesis and mouth asymmetry. Patients with mild-to-moderate symptoms were treated using physical rehabilitation therapy combined with botulinum toxin (Botox) injection, and patients with severe or uncontrolled symptoms were treated using surgical therapy. RESULTS Initial/final mean synkinesis scores and mouth asymmetry degrees were 2.17/1.75 and 0.85/0.66 in the physical therapy group and 3.11/0.78 and 2.41/-0.31 in the surgery group, respectively. Physical therapy with Botox injection alone did not show significant improvements in synkinetic symptoms of the patients with mild-to-moderate synkinesis (p > 0.05), whereas surgical therapy resulted in significant improvements in synkinesis and mouth asymmetry (p < 0.05). CONCLUSIONS Surgical treatment is an effective adjustment procedure for the management of facial complications in patients with severe or uncontrolled synkinesis after facial nerve injury to the mid-face area.
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Affiliation(s)
- Dongkeun Jun
- Department of Plastic and Reconstructive Surgery, Hallym University College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, South Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology, Hallym University College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, South Korea
| | - Jin Kim
- Department of Otorhinolaryngology, Hallym University College of Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, South Korea.
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Hamdi OA, Jones MK, Ziegler J, Basu A, Oyer SL. Hypoglossal Nerve Transfer for Facial Nerve Paralysis: A Systematic Review and Meta-Analysis. Facial Plast Surg Aesthet Med 2024; 26:219-227. [PMID: 38153410 DOI: 10.1089/fpsam.2023.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Background: Hypoglossal-facial nerve (12-7) anastomosis can restore symmetry and voluntary movement on the face in patients with facial nerve paralysis. Traditional 12-7 transfer includes direct end-to-end nerve anastomosis, sacrificing the entire hypoglossal nerve. Contemporary, end-to-side anastomosis, or split anastomosis techniques limit tongue morbidity by preserving some hypoglossal nerve. Direct outcome comparisons between these techniques are limited. Objective: To compare reported outcomes of facial movement, tongue, speech, and swallow outcomes among the different types of hypoglossal-facial nerve anastomosis schemes. Evidence Review: For this systematic review and meta-analysis, a comprehensive strategy was designed to search PubMed, Scopus, and the Cochrane Database from inception to January 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, reporting guideline yielding 383 results. Any participant who underwent 12-7 transfer using any of the three techniques, with or without an interposition graft, and had documented preoperative and postoperative evaluation of facial nerve function with a validated instrument such as House-Brackmann (HB), was considered for inclusion. Secondary outcomes of synkinesis, tongue atrophy, and speech or swallowing dysfunction were also compared. Forty-nine studies met inclusion criteria, representing data from 961 total patients who underwent 12-7 transfer. Results: The proportion of good HB outcomes (HB I-III) did not differ by anastomosis type: End-to-side and end-to-end anastomosis (73% vs. 59%, p = 0.07), split and end-to-end anastomosis (62% vs. 59%, p = 0.88), and end-to-side anastomosis and split anastomosis (73% vs. 62%, p = 0.46). There was no difference in reported synkinesis rates between the anastomosis types. However, end-to-side anastomosis (z = 6.55, p < 0.01) and split anastomosis (z = 3.58, p < 0.01) developed less tongue atrophy than end-to-end anastomosis. End-to-side anastomosis had less speech/swallowing dysfunction than end-to-end anastomosis (z = 3.21, p < 0.01). Conclusion: End-to-side and split anastomoses result in similar HB facial nerve outcomes as the traditional end-to-end 12-7 anastomosis. End-to-side anastomosis has decreased complications of tongue atrophy and speech/swallow dysfunction compared to end-to-end anastomosis. In addition, split anastomosis has decreased rates of tongue atrophy compared to end-to-end anastomosis.
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Affiliation(s)
- Osama A Hamdi
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Marieke K Jones
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - John Ziegler
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Annesha Basu
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Samuel L Oyer
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, Virginia, USA
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Wang Y, Piras G, Lauda L, Caruso A, Russo A, Taibah A, Sanna M. Superior petrosal vein sacrifice in translabyrinthine approach for resection of vestibule schwannoma. Eur Arch Otorhinolaryngol 2024; 281:1195-1203. [PMID: 37665344 DOI: 10.1007/s00405-023-08208-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The aim of this study was to evaluate the safety and surgical outcome of superior petrosal vein (SPV, Dandy's vein) sacrifice in translabyrinthine approach (TLA) for resection of vestibule schwannoma (VS) as compared with SPV preservation, with further investigation of preoperational factors associated with the implement of SPV sacrifice. METHODS The authors prospectively collected data from patients surgically treated for VS through TLA between June 2021 and April 2022 at the Gruppo Otologico. RESULTS There were 30 and 49 patients in SPV sacrifice and preservation groups, respectively. SPV sacrifice group had significantly larger tumor size (2.46 vs. 1.40 cm), less percentage of solid tumor (26.7% vs. 83.7%), higher incidence of brainstem compression (80% vs. 26.5%), and higher percentage of facial numbness (20.0% vs. 4.1%) than SPV preservation group. Gross total resection (GTR) rates were 73.3% after SPV sacrifice and 87.8% after SPV preservation. Facial nerve preservation rates were similar. No complication related with SPV sacrifice was observed. Logistic regression analysis showed tumor size and complete solid consistency as significant risk factors associated with SPV sacrifice. ROC curve further demonstrated tumor size as a fair predictor (AUC = 0.833), with optimum cutoff value of 1.68 cm. CONCLUSION SPV sacrifice via TLA as needed is a safe and effective maneuver for removal of relatively large VS. Tumor size and consistency can be used as a guidance in preoperational decision-making, with cutoff value of 1.68 cm and cystic formation as predictive indicators.
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Affiliation(s)
- Yongjie Wang
- Department of Neurosurgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, #88 Jiefang Road, Hangzhou, Zhejiang, China
| | - Gianluca Piras
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy.
| | - Lorenzo Lauda
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Antonio Caruso
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Alessandra Russo
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Abdelkader Taibah
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
| | - Mario Sanna
- Gruppo Otologico, c/o Casa di Cura, Via Emmanueli, 42-29100, Piacenza, Italy
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Lee LN, Brenner MJ. Commentary on: "Masseteric Nerve Transfer for Facial Paralysis Secondary to Parotid Malignancy: A Retrospective Case Series" by Valencia-Sanchez et al: Watch and Wait or Immediately Reanimate? Facial Plast Surg Aesthet Med 2024; 26:109-110. [PMID: 37428611 DOI: 10.1089/fpsam.2023.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Affiliation(s)
- Linda N Lee
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Michael J Brenner
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Khanna O, Hogan E, Alvarez R, Youssef AS. How I do it: hearing preservation in large vestibular schwannomas using vestibular nerve fiber preservation technique. Acta Neurochir (Wien) 2024; 166:105. [PMID: 38403779 DOI: 10.1007/s00701-024-05998-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/03/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND To improve hearing function after resection of large vestibular schwannomas, we describe a strategy of vestibular-nerve-fiber preservation. Anatomical considerations and stepwise dissection are described. METHOD Steps include locating the vestibular nerve at the brainstem and identifying a dissection plane between nerve fibers and tumor capsule. Using this plane to mobilize and resect tumor reduced manipulation and maintained vascularity of underlying cochlear and facial nerves. CONCLUSION Preservation of hearing function is feasible in large vestibular schwannomas with vestibular-nerve-fiber preservation. Reducing manipulation and ischemic injury of underlying cochlear and facial nerves thereby helped facilitate hearing preservation, even in large tumors.
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Affiliation(s)
- Omaditya Khanna
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Elizabeth Hogan
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Reinier Alvarez
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - A Samy Youssef
- Department of Neurosurgery, University of Colorado Anschutz School of Medicine, Aurora, CO, USA.
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Zhao Y, Xue SB, Tian X, Feng GD, Gao ZQ. [A sampling survey of intraoperative facial nerve monitoring in China]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 59:122-126. [PMID: 38369790 DOI: 10.3760/cma.j.cn115330-20231027-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Objective: This study aims to investigate the current application and the level of knowledge of intraoperative facial nerve monitoring among medical staff in China. Methods: A comprehensive online questionnaire was conducted among medical professionals across different regions in China from October 2022 to February 2023. The survey exclusively targeted departments specializing in otolaryngology, head and neck surgery, neurosurgery, and oral and maxillofacial surgery. The questionnaire covered various aspects including general information, intraoperative facial nerve monitoring practices, training history, indications for monitoring, parameters used during monitoring procedures, as well as factors influencing its implementation. Results: A total of 417 participants from 31 provincial, municipal, and autonomous regions were included. Intraoperative facial nerve monitoring was found to be implemented in 227 (54.4%,227/417) repondents of 53 institutions (24.9%, 53/213). The top three indications for implementing this technique were acoustic neuroma, parotid gland surgery, and modified middle ear surgery (mastoidectomy). Herein 81.1%(184/227) medical staff involved in intraoperative facial nerve monitoring had received relevant training, 57.3%(130/227)-92.1%(209/227) reported a lack of clear description regarding recording thresholds, stimulation currents/frequencies/wave widths. Conclusion: The majority of the institutions surveyed have not yet adopted intraoperative facial nerve monitoring. Furthermore, significant gaps concerning the procedure exist. It is imperative to establish standards or guidelines to promote its better development and application.
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Affiliation(s)
- Y Zhao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - S B Xue
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - X Tian
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - G D Feng
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Z Q Gao
- Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Subspecialty Group of Otology, Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Subspecialty Group of Otology, Society of Otorhinolaryngology Head and Neck Surgery, Chinese Medical Association. [Expert consensus on intraoperative facial nerve monitoring]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 59:97-106. [PMID: 38320971 DOI: 10.3760/cma.j.cn115330-20231225-00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
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17
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Mohanty AJ, DeVahl J, Kutz WJ, Rozen SM. Neurofibromatosis Type II and Facial Paralysis: Clinical Evaluation and Management. Plast Reconstr Surg 2024; 153:415e-423e. [PMID: 37075282 DOI: 10.1097/prs.0000000000010561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Facial paralysis secondary to neurofibromatosis type 2 (NF2) presents the reconstructive surgeon with unique challenges because of its pathognomonic feature of bilateral acoustic neuromas, involvement of multiple cranial nerves, use of antineoplastic agents, and management. Facial reanimation literature on managing this patient population is scant. METHODS A comprehensive literature review was performed. All patients with NF2-related facial paralysis who presented in the past 13 years were reviewed retrospectively for type and degree of paralysis, NF2 sequelae, number of cranial nerves involved, interventional modalities, and surgical notes. RESULTS Twelve patients with NF2-related facial paralysis were identified. All patients presented after resection of vestibular schwannoma. Mean duration of weakness before surgical intervention was 8 months. On presentation, one patient had bilateral facial weakness, 11 had multiple cranial nerve involvement, and seven were treated with antineoplastic agents. Two patients underwent gracilis free functional muscle transfer, five underwent masseteric-to-facial nerve transfer (of whom two were dually innervated with a crossfacial nerve graft), and one patient underwent depressor anguli oris myectomy. Trigeminal schwannomas did not affect reconstructive outcomes if trigeminal nerve motor function on clinical examination was normal. In addition, antineoplastic agents such as bevacizumab and temsirolimus did not affect outcomes if stopped in the perioperative period. CONCLUSIONS Effectively managing patients with NF2-related facial paralysis necessitates understanding the progressive and systemic nature of the disease, bilateral facial nerve and multiple cranial nerve involvement, and common antineoplastic treatments. Neither antineoplastic agents nor trigeminal nerve schwannomas associated with normal examination affected outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Affiliation(s)
| | | | - Walter J Kutz
- Otolaryngology and Head and Neck Surgery, University of Texas Southwestern Medical Center
| | - Shai M Rozen
- From the Departments of Plastic and Reconstructive Surgery
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18
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Thierry A, Barbe C, Labrousse M, Makeieff M, Merol JC, Carsin-Vu A, Truong F, Dubernard X, Brenet E. Intra-parotid facial nerve path by MRI tractography: radio-clinical comparison in parotid tumors. Eur Arch Otorhinolaryngol 2024; 281:925-934. [PMID: 37917163 DOI: 10.1007/s00405-023-08301-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE The objective of our study was to evaluate the ability of preoperative MRI tractography to visualize and predict the path of the facial nerve with respect to an intra-parotid mass. METHODS We performed an observational bicentric study from June 2019 to August 2020. All patients older than 18 years old, treated for a parotid mass with surgical indication, without MRI contraindication and who agreed to participate in the study were enrolled prospectively. All patients underwent a cervico-facial MRI with tractographic analysis. Postprocessed tractography images of the intra-parotid facial nerve were analyzed by two expert radiologists in head and neck imaging. The intraoperative anatomical description of the facial nerve path and its relationship to the mass was performed by the surgeon during the operation, with no visibility on MRI examination results. A statistical study allowed for the description of the data collected as well as the measurement of inter-observer agreement and agreement between tractography and surgery using kappa coefficients. RESULTS Fifty-two patients were included. The facial nerve trunk and its first two divisional branches were visualized via tractography in 93.5% of cases (n = 43). The upper distal branches were visualized in 51.1% of cases (n = 23), and the lower branches were visualized in 73.3% of cases (n = 33). Agreement with the location described per-operatively was on average 82.9% for the trunk, 74.15% for the temporal branch, and 75.21% for the cervico-facial branch. CONCLUSION Fiber tractography analysis by MRI of the intra-parotid facial nerve appears to be a good test for predicting the path of the nerve over the parotid mass and could be an additional tool to guide the surgeon in the operative procedure.
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Affiliation(s)
- Axelle Thierry
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Reims, Reims, France
- University of Reims-Champagne Ardennes, Reims, France
- Department of Radiology, University Hospital of Reims, Reims, France
| | - Coralie Barbe
- University Department of Health Research, University of Reims Champagne Ardennes, Reims, France
- Department of Radiology, University Hospital of Reims, Reims, France
| | - Marc Labrousse
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Reims, Reims, France
- University of Reims-Champagne Ardennes, Reims, France
- Department of Radiology, University Hospital of Reims, Reims, France
| | - Marc Makeieff
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Reims, Reims, France
- University of Reims-Champagne Ardennes, Reims, France
- Department of Radiology, University Hospital of Reims, Reims, France
| | - Jean-Claude Merol
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Reims, Reims, France
- Department of Radiology, University Hospital of Reims, Reims, France
| | - Aline Carsin-Vu
- University Department of Health Research, University of Reims Champagne Ardennes, Reims, France
- Department of Radiology, University Hospital of Reims, Reims, France
| | - France Truong
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Reims, Reims, France
- University of Reims-Champagne Ardennes, Reims, France
- Department of Radiology, University Hospital of Reims, Reims, France
| | - Xavier Dubernard
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Reims, Reims, France
- University of Reims-Champagne Ardennes, Reims, France
- Department of Radiology, University Hospital of Reims, Reims, France
| | - Esteban Brenet
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital of Reims, Reims, France.
- University of Reims-Champagne Ardennes, Reims, France.
- Department of Radiology, University Hospital of Reims, Reims, France.
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Seo HW, Lee JY, Kim Y, Cho J, Cho YS. Infiltrative fibrous lesion of the facial nerve mimicking a facial nerve tumor. Eur Arch Otorhinolaryngol 2024; 281:655-661. [PMID: 37486425 DOI: 10.1007/s00405-023-08128-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE To report three cases of facial nerve lesions that were clinically expected to be facial nerve tumors but showed fibrotic infiltration without any apparent signs of a specific tumor on histopathological findings. We also aimed to investigate the clinical characteristics of these cases. METHODS Medical records of patients who underwent surgery for facial nerve lesions were reviewed. RESULTS All three cases initially had House-Brackmann (HB) grade IV-V facial nerve palsy. On radiological imaging, schwannoma or glomus tumor originating from the facial nerve was suspected. All patients underwent complete surgical removal of the neoplasm followed by facial nerve reconstruction using the sural nerve. The lesions were histologically confirmed as infiltrative fibrous lesions without tumor cells. In two cases, facial nerve palsy improved to HB grade III by nine months post-surgery, and there were no signs of recurrence on follow-up MRI. The other case, after 1 year of follow-up, showed persistence of HB grade V facial nerve palsy without any evidence of recurrence. CONCLUSION Fibrotic lesions of the facial nerve could mimic primary facial nerve tumors. Clinicians should consider this condition even when a facial nerve tumor is suspected.
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Affiliation(s)
- Hee Won Seo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Jung-Yup Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yikyung Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junhun Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yang-Sun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Sangrador-Deitos MV, Uribe-Pacheco R, Guinto-Nishimura GY, Paíz M, Baldoncini M, Villalonga J, Campero A. Novel Hybrid Technique for Preservation of Frontal Branch of Facial Nerve: Subgaleal Preinterfascial Dissection. World Neurosurg 2024; 182:29-34. [PMID: 37944859 DOI: 10.1016/j.wneu.2023.11.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE The pterional approach is the workhorse of skull-base neurosurgery, which allows virtual access to any intracranial lesion around the circle of Willis. Preserving the frontotemporal branch of the facial nerve and conserving the temporal muscle's symmetry are fundamental objectives besides the access that can be obtained through this versatile neurosurgical technique. This manuscript proposes a subgaleal preinterfascial dissection, a novel hybrid technique that provides advantages of previously described temporal muscle dissection techniques while preserving the integrity of facial nerve branches and the unobstructed broad pterional region. We describe the subgaleal preinterfascial dissection as a safe and simple to technique to achieve preservation of the facial nerve frontal branches during anterolateral approaches. METHODS Two cadaveric heads were skillfully dissected and studied to perform a proper subgaleal preinterfascial dissection on both sides of each cadaver. Afterward, the same technique was employed in 108 patients during a pterional approach for different neurosurgical diseases, with a postoperative follow-up of 6 months. RESULTS None of the 108 patients presented postoperative frontotemporal branch palsy during postoperative follow-up. Likewise, no complications related to the proposed technique were present. CONCLUSIONS The subgaleal preinterfascial dissection is a reliable, safe technique that may be employed during a pterional approach with an unobstructed surgical view and excellent cosmetic and functional results, preserving the frontotemporal branch of the facial nerve.
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Affiliation(s)
- Marcos V Sangrador-Deitos
- Department of Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico.
| | - Rodrigo Uribe-Pacheco
- Department of Neurological Surgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Gerardo Y Guinto-Nishimura
- Department of Neurological Surgery, Specialty Hospital National Medical Center Siglo XXI, Mexico City, Mexico
| | - Martín Paíz
- Department of Neurological Surgery, Hospital Padilla, Tucumán, Argentina
| | - Matías Baldoncini
- Department of Neurological Surgery, Hospital San Fernando, Buenos Aires, Argentina
| | - Juan Villalonga
- LINT, Facultad de Medicina, National University of Tucumán, Tucumán, Argentina
| | - Alvaro Campero
- Department of Neurological Surgery, Hospital Padilla, Tucumán, Argentina
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Nunta-Aree S, Kateyoi T, Sitthinamsuwan B. Delayed complete remission of hemifacial spasms following microvascular decompression and the implications for optimal time of revision surgery. Acta Neurochir (Wien) 2024; 166:12. [PMID: 38227077 DOI: 10.1007/s00701-024-05891-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Microvascular decompression (MVD) is an effective method for directly treating hemifacial spasms (HFS). The timing for the consideration of failed MVD and reoperation has been paradoxical. OBJECTIVE This study aimed to investigate the delayed complete remission of HFS in terms of prevalence rate, duration between surgery and delayed complete remission, and predictive factors. METHODS A hundred patients with HFS who underwent MVD from 2012-2021 were enrolled in the study. All HFS occurred as a result of compression of the facial nerve by adjacent blood vessels. Clinical information, intraoperative findings, and surgical outcomes were incorporated for data analysis. RESULTS In the first week after MVD, 67 of 100 patients achieved complete remission of HFS, while the remaining 33 had incomplete remission. In long-term follow-up, 26 individuals gradually developed delayed complete remission with a median duration of 9.1 months. Finally, 86 of 100 patients achieved complete long-term remission. Recurrent HFS and incomplete remission were found in 7 and 7 patients, respectively. Factors associated with postoperative complete remission in the first week were a severe degree of facial nerve compression (p = 0.047, OR 2.75, 95% CI 1.01-7.40), with long-term complete remission was left-sided HFS (p = 0.012, OR 5.73, 95% CI 1.47-22.36), and with the appearance of delayed complete remission was the prolonged duration of HFS at least 3 years before MVD (p = 0.046, OR 3.75, 95% CI 1.03-13.76). Transient facial paresis was found in 11% of the patients. Of them, facial nerve function recovered completely in all cases. CONCLUSIONS A delayed complete remission of HFS could be expected in long-term follow-up after MVD and is probably related to a longer duration of HFS before surgery. Unnecessary reoperation should be avoided in the early years following the first surgery.
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Affiliation(s)
- Sarun Nunta-Aree
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
| | - Thanthip Kateyoi
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand
- Department of Surgery, Prajuabkirikhan Hospital, Prajuabkirikhan, Thailand
| | - Bunpot Sitthinamsuwan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wang Lang Road, Bangkok Noi, Bangkok, 10700, Thailand.
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22
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Noro S, Asayama B, Amano Y, Okuma M, Honjo K, Seo Y, Nakamura H. [Surgical Techniques for Microvascular Decompression in Hemifacial Spasm]. No Shinkei Geka 2024; 52:119-128. [PMID: 38246678 DOI: 10.11477/mf.1436204887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
This study discusses the key microvascular decompression(MVD)techniques for the treatment of hemifacial spasm(HFS). The author's experience is based on their institution's cases, highlighting three critical techniques. (1)Vertebral artery(VA)repositioning: Repositioning the VA is essential in challenging cases. This article focuses on the relocation of the proximal portion of the VA and the importance of careful dissection. (2)Relocating vessels compressing the peripheral branches of the facial nerve: HFS can result from nerve compression at various locations, including the cisternal portion. This study addressed cisternal compression and considered the nearby nerves. (3)Considering the perforating branches during repositioning, cases may involve complex branching of the perforating arteries. This paper describes an approach that carefully repositions the vessels without damaging the perforating branches. The results from 100 VA-involved cases showed excellent outcomes, with 91.2% of patients experiencing T0(excellent)results. This study emphasized the need to adapt the surgical approach to each unique case to ensure the safety and effectiveness of MVD. This study provides insights into the critical MVD techniques for HFS, emphasizing the importance of continuous experience and knowledge accumulation. These techniques can be learned by other neurosurgeons, thereby expanding the availability of safe and successful MVD procedures for HFS.
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Affiliation(s)
- Shusaku Noro
- Department of Neurosurgery, Nakamura Memorial Hospital
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Kaufman Goldberg T, Trzcinski LO, McGonagle ER, Hadlock TA. Does supercharging with cross-face nerve graft enhance smile in non-flaccid facial paralysis patients undergoing selective neurectomy? Microsurgery 2024; 44:e31118. [PMID: 37772398 DOI: 10.1002/micr.31118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND Cross face nerve grafting (CFNG) is a well-established nerve transfer technique in facial reanimation; however, no study has assessed outcome of supercharging the smile with CFNG in patients with synkinesis. The goal of this study was to examine the smile outcome in non-flaccid facial paralysis (NFFP) patients after supercharging with CFNG during selective neurectomy. METHODS NFFP patients who underwent CFNG with end-to-side coaptation to a smile branch on the paralyzed side during selective neurectomy were retrospectively identified and their charts were reviewed. Pre-operative and post-operative facial function was assessed with the electronic clinician-graded facial function tool (eFACE), and an automated computer-aided facial assessment tool (Emotrics). Smile metrics were compared pre-operatively, in early post-operative time (EPO, <6 months), and late post-operative time (LPO, >9 months) when CFNG contribution would be expected. RESULTS Thirteen cases were performed between June 2019 and December 2021. No objective smile metrics improved following supercharging with CFNG. Oral commissure excursion improved by 1.23 points in eFACE (p = .812), and by 0.84 in Emotrtics (p = .187) from EPO to LPO. EFACE dynamic score was improved by 0.08 points from EPO to LPO (p = .969). CONCLUSIONS Using CFNG for supercharging the smile during selective neurectomy in NFFP patients may not enhance smile. Longer term results following supercharging and long term natural history of selective neurectomy should be assessed.
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Affiliation(s)
- Tal Kaufman Goldberg
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lauren O Trzcinski
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Elizabeth R McGonagle
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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24
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Mezaki T. [Historical Review of Hemifacial Spasm]. No Shinkei Geka 2024; 52:12-17. [PMID: 38246664 DOI: 10.11477/mf.1436204873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Facial spasm is a disorder characterized by mostly unilateral(hemifacial)involuntary facial muscle contractions, usually caused by vascular compression of the facial nerve. It has been known since ancient times and we can currently find both old medical and artistic presentations. Charles Bell has described at least one definite case(No. IV)with hemifacial spasm in his textbook published in 1830 as did the following physicians like Romberg, Hammond, Gowers, and Brissaud. Babinski coined the name hemispasme facial in 1905 and its English term "hemifacial spasm" appeared in the article by Ehni et al. in 1945. Neurovascular or microvascular decompression surgery was applied to treat this disease in the 1960s and remains a curative therapeutic procedure. Therapy with botulinum toxin appeared as a less invasive procedure in the 1980s and is currently the preferred treatment because of its high safety and efficacy. Secondary facial spasms may occur as a consequence of facial paresis or space-occupying lesion along the facial nerve pathway.
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Zhang L, Ostrander BT, Duhon B, Moshitaghi O, Lee J, Harris M, Hardesty DA, Prevedello DM, Schwartz MS, Dodson EE, Friedman RA, Adunka OF, Ren Y. Comparison of Postoperative Outcomes in Cystic Versus Solid Vestibular Schwannoma in a Multi-institutional Cohort. Otol Neurotol 2024; 45:92-99. [PMID: 38085765 PMCID: PMC10993235 DOI: 10.1097/mao.0000000000004062] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE Cystic vestibular schwannomas (cVSs) have more variable and less favorable clinical outcomes after microsurgical resection compared with solid VS (sVS). This study compares the preoperative presentation and postoperative outcomes between cVS and sVS. STUDY DESIGN Retrospective cohort study. SETTING Two tertiary skull base referral centers. METHODS Consecutive adult patients who underwent VS resection from 2016 to 2021 were included. Univariate and multivariate analyses compared differences in baseline symptoms and postoperative outcomes between cVS and sVS. RESULTS There were a total of 315 patients (64% female; mean age, 54 yrs) and 46 (15%) were cystic. cVS were significantly larger than sVS (maximum diameter, 28 vs. 18 mm, p < 0.001) and had higher rates of dysphagia and dysphonia preoperatively (p < 0.02). cVSs were more likely to undergo translabyrinthine resection (76 vs. 50%, p = 0.001) and have a higher rate of subtotal resection (STR) compared with sVS (30 vs. 13%, p = 0.003). At latest follow-up, fewer cVS achieved good facial nerve (FN) outcome (House-Brackmann [HB] I/II) (80 vs. 90%, p = 0.048). Subanalysis of cVS and sVS matched in tumor size, and surgical approach did not show differences in the rate of STR or FN outcomes (HB I/II, 82 vs. 78%, p = 0.79). CONCLUSION In this large multi-institutional series, cVSs represent a distinct entity and are characterized by larger tumor size and higher incidence of atypical symptoms. Although cVSs were more likely to undergo STR and portend worse FN outcomes than sVSs, this may be due to their larger tumor size rather than the presence of the cystic component.
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Affiliation(s)
- Lisa Zhang
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Benjamin T. Ostrander
- Division of Otolaryngology—Head and Neck Surgery, Department of Otolaryngology, University of California, San Diego, La Jolla, California
| | - Bailey Duhon
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Omid Moshitaghi
- Division of Otolaryngology—Head and Neck Surgery, Department of Otolaryngology, University of California, San Diego, La Jolla, California
| | - Joshua Lee
- Division of Otolaryngology—Head and Neck Surgery, Department of Otolaryngology, University of California, San Diego, La Jolla, California
| | - Micah Harris
- Department of Otolaryngology, University of Pittsburgh
| | - Douglas A. Hardesty
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Daniel M. Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Marc S. Schwartz
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Edward E. Dodson
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rick A. Friedman
- Division of Otolaryngology—Head and Neck Surgery, Department of Otolaryngology, University of California, San Diego, La Jolla, California
| | - Oliver F. Adunka
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yin Ren
- Division of Otology, Neurotology and Cranial Base Surgery, Department of Otolaryngology—Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Tai A, Kim J, Croci D, Mhaskar R, Allen K, Danner C, Boyev K, van Loveren H, Agazzi S. Significant tumor compression of the middle cerebellar peduncle is associated with worse facial nerve outcomes and lower extent of resection in surgery for medium-sized vestibular schwannomas - A radiographic analysis of a case series. Clin Neurol Neurosurg 2024; 236:108114. [PMID: 38232608 DOI: 10.1016/j.clineuro.2024.108114] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/30/2023] [Accepted: 01/02/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND AND OBJECTIVE Optimizing the extent of resection (EOR) and facial nerve outcomes (FNO) remain a challenge in medium to large vestibular schwannomas (VS). Currently, tumor size has been the only consistently reported factor predicting FNO and EOR. Here, we sought to evaluate whether the degree of the tumor's compression on the middle cerebellar peduncle (PC) influences FNO and EOR in medium to large VS. METHODS This retrospective case series included 99 patients who underwent surgical resection of their VSs from 2014 to 2022. Preoperative MR imaging was used to measure the degree of PC. Patient medical records were queried to determine the EOR and FNO. RESULTS Patients with unfavorable FNO (HB 3 +) immediately post-op had significantly greater PC than those with favorable FNO (19.9 vs. 15.4 mm, P = .047). This significance was not observed at the last follow-up but there was a trend. When medium-sized tumors (15-30 mm) were analyzed separately, patients with unfavorable FNO immediate post-op and at last follow-up had significantly greater PC than their favorable counterparts (14.1 vs 8.7 mm). Significantly greater PC was also observed in patients who underwent subtotal resection (20.7 mm) compared to near (14.3 mm) and gross total resection (10.8 mm). Multivariate analyses confirmed these findings in medium-sized tumors, but not large-sized tumors. CONCLUSION The degree of PC as measured on preoperative imaging can predict FNO and EOR in medium-sized vestibular schwannomas. Medium-sized tumors with > 15 mm of PC likely will have worse FNO and lower EOR.
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Affiliation(s)
- Alexander Tai
- Department of Neurosurgery and Brain Repair, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - John Kim
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Davide Croci
- Department of Neurosurgery and Brain Repair, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Rahul Mhaskar
- University of South Florida Morsani College of Medicine, 560 Channelside Drive, Tampa, FL 33602, USA
| | - Kyle Allen
- Tampa Bay Hearing and Balance Center, 5 Tampa General Circle Suite 610 Harborside Medical Tower, Tampa, FL 33606, USA
| | - Christopher Danner
- Tampa Bay Hearing and Balance Center, 5 Tampa General Circle Suite 610 Harborside Medical Tower, Tampa, FL 33606, USA
| | - Kestutis Boyev
- Department of Otolaryngology, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Harry van Loveren
- Department of Neurosurgery and Brain Repair, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
| | - Siviero Agazzi
- Department of Neurosurgery and Brain Repair, University of South Florida, 2 Tampa General Circle, Tampa, FL 33606, USA
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Dandinarasaiah M, Grinblat G, Keshavamurthy VB, Di Rubbo VM, Alessandra R, Lauda L, Sanna M. Characteristics and Management of Facial Nerve Schwannomas and Hemangiomas. Otol Neurotol 2024; 45:83-91. [PMID: 37853739 DOI: 10.1097/mao.0000000000004033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVES To characterize facial nerve (FN) schwannomas (FNSs) and FN hemangiomas (FNHs) and their clinical features and management strategies, and to describe the results of cable nerve grafting after FN sectioning during tumor removal. METHODS This retrospective study included 84 FNS cases and 42 FNH cases managed between July 1989 and July 2020 at a quaternary referral center for skull base pathology. Clinical details, locations, management, and results of cable nerve grafting at 1 year and during an average period of 3.12 years were evaluated. Sural nerve interpositioning was performed for patients who experienced FN paralysis for less than 1 year and underwent nerve sectioning during tumor removal. RESULTS FNSs more often involved multiple segments compared with FNHs. The cerebellopontine angle and the mastoid segments were involved in 16 (19.1%) and 34 (40.5%) FNS cases, respectively; however, the cerebellopontine angle and the mastoid segments were involved in 0 and 7 (16.7%) FNH cases, respectively. Sectioned nerves of 99 patients (78.6%) were restored using interposition cable grafting. At the last follow-up evaluation, 56.3% of FNSs and 60.7% of FNHs attained House-Brackmann (HB) grade III. Lower preoperative HB grades were associated with poorer postoperative outcomes. For FNSs, the mean HB grades were 4.13 at 1 year postoperatively and 3.75 at the last follow-up evaluation ( p = 0.001); however, for FNHs, the mean HB grades were 4.04 postoperatively and 3.75 at the last follow-up evaluation. Therefore, extradural coaptation yielded better outcomes. CONCLUSION FNSs can occur along any part of the FN along its course, and FNHs are concentrated around the area of geniculate ganglion. The results of cable inter positioning grafts are better in patients with preoperative FN-HB-III or less when compared with higher grades. The outcome of the interpositioning continues to improve even after 1 year in extradural coaptation.
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Affiliation(s)
| | | | | | - Vittoria M Di Rubbo
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Russo Alessandra
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Lorenzo Lauda
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
| | - Mario Sanna
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Rome, Italy
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Fukuda M, Oishi M, Fujii Y. [Intraoperative Monitoring During Microvascular Decompression]. No Shinkei Geka 2024; 52:177-186. [PMID: 38246685 DOI: 10.11477/mf.1436204894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
During microvascular decompression(MVD)for hemifacial spasm(HFS), trigeminal neuralgia(TN), and glossopharyngeal neuralgia(GPN), brainstem auditory-evoked potential monitoring is widely used to preserve hearing function. In MVD for HFS, abnormal muscle response monitoring is useful for identifying the offending vessels compressing the facial nerve and confirming the completion of decompression intraoperatively. The amplitude of facial motor-evoked potential by transcranial electrical stimulation in the orbicularis oculi muscle is reported to decrease after completing MVD. The Z-L response(ZLR)probably confirms the true offending vessels by stimulating the culprit vessels; then, the ZLR could disappear after decompressing the offending vessels away from the compression sites. Spontaneous electromyographic activities obtained from the mentalis muscles by injection of saline into the facial nerve reportedly decreased after MVD compared with those before MVD. In MVD for the GPN, glossopharyngeal motor-evoked potential by transcranial electrical stimulation is used to preserve swallowing function and not to assess the completion of MVD. Because MVD for both the TN and GPN can result in normalization of the hyperactivity of the sensory nerve, it may be difficult to develop any monitoring to confirm the completion of MVD during surgery.
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Gulati S, Tripathy S, Gupta T, Gaba S. Facial nerve communication with ansa cervicalis - An unusual anatomical variation. J Postgrad Med 2024; 70:60-63. [PMID: 38037772 PMCID: PMC10947731 DOI: 10.4103/jpgm.jpgm_454_23] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 08/03/2023] [Accepted: 08/14/2023] [Indexed: 12/02/2023] Open
Abstract
Neural connections of the seventh cranial nerve with its neighboring nerves are common and well documented; however, communication with ansa cervicalis is as yet unknown. We present a case with such a connection found during cadaveric dissection, with hitherto unknown consequences. In this specimen, after giving the marginal mandibular and cervical branches, the cervicofacial division continued distally to communicate with the distal loop of ansa cervicalis. Presence of such connection may result in facial muscle paralysis on injury to the ansa or strap muscle paralysis on injury to the facial nerve, depending on the direction of nerve fibers. Such unusual connections bring to light the need for extreme care during surgeries in the neck to safeguard any such connections and when using the ansa as donor.
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Affiliation(s)
- S Gulati
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Tripathy
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - T Gupta
- Department of Anatomy, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - S Gaba
- Department of Plastic Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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30
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Liang H, Yang Z, Ma N, Wang W, Li Y. Comparison of Outcomes of Facial Reanimation Between the Use of Cross-facial Nerve Graft and the Masseteric Nerve as the Donor Nerve for Reinnervation of Gracilis Muscle Flap Transfer. J Craniofac Surg 2024; 35:172-176. [PMID: 38294299 DOI: 10.1097/scs.0000000000009775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 08/20/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND In patients with facial paralysis, the free functional gracilis muscle transfer is preferred for facial reanimation. The choice of an adequate motor nerve to innervate the transplanted gracilis muscle is one of the procedure's key components. We present a comparative study between cross-facial nerve graft (CFNG) and masseteric nerve as donor nerves for reinnervated gracilis flap transfer in patients with complete facial paralysis. MATERLALS AND METHODS Retrospective analysis was performed on all patients with complete facial paralysis who had a free functional gracilis muscle transfer for facial reanimation between January 2014 and December 2021. Only those who received gracilis transfer reinnervated by either CFNG or masseteric nerve were included in this study. The smile excursion and lip angle were measured for evaluating the outcomes postoperatively. RESULTS The inclusion criteria were met by a total of 21 free functional gracilis muscle transfers, of which 11 were innervated by CFNG and 10 by the masseteric nerve. Both surgical procedures resulted in a highly considerable smile excursion of the reanimated side and postoperative improvement of static or dynamic lip angle. Masseteric nerve coaptation led to greater smile excursion and more significant improvement of dynamic lip angle than CFNG. CONCLUSIONS For patients who have complete facial paralysis, face reanimation can be successfully accomplished by free gracilis transfer reinnervated by the CFNG or the masseteric nerve. In particular, the masseteric nerve is a reliable choice for dynamic smile reanimation.
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Affiliation(s)
- Hongyu Liang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Targino da Costa MGES, Maranhão-Filho PDA, Santos IC, Luiz RR. Post-parotidectomy facial nerve rehabilitation outcomes: Comparison between benign and malignant neoplasms. NeuroRehabilitation 2024; 54:259-273. [PMID: 38306064 DOI: 10.3233/nre-230220] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Facial nerve dysfunction can be a devastating trouble for post-parotidectomy patients. OBJECTIVE To assess rehabilitation outcomes concerning patients with post-parotidectomy facial nerve dysfunction, comparing benign versus malignant neoplasms. METHODS Prospective study enrolling adults who underwent parotidectomy with facial nerve sparing between 2016 and 2020. The Modified Sunnybrook System (mS-FGS) was used for facial assessments. Physiotherapy began on the first post-operative day with a tailored program of facial exercises based on Neuromuscular Retraining, to be performed at home 3 times/day. From the first outpatient consultation, Proprioceptive Neuromuscular Facilitation was added to the treatment of cases with moderate or severe facial dysfunctions. RESULTS Benign and malignant groups had a statistically significant improvement in mS-FGS (p < 0.001 and p = 0.005, respectively). There was no significant difference between groups regarding treatment duration or number of physiotherapy sessions performed. The history of previous parotidectomy resulted in more severe initial dysfunctions and worse outcome. Age over 60 years and initially more severe dysfunctions impacted the outcome. CONCLUSION Patients with benign and malignant parotid neoplasms had significant and equivalent improvement in postoperative facial dysfunction following an early tailored physiotherapy program, with no significant difference in the final facial score, treatment duration, or number of sessions required.
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Affiliation(s)
| | - Péricles de Andrade Maranhão-Filho
- Department of Neurology, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Izabella Costa Santos
- Department of Head and Neck Surgery, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Ronir Raggio Luiz
- Institute for Studies in Public Health (IESC), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
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Mandour M, Amer M, Elzayat S, Covelli E, Barbara M, Lotfy R, Elfarargy HH, Tomoum MO. Localization of the Vertical Part of the Facial Nerve in the High-Resolution Computed Tomography During Pediatric Cochlear Implantation. J Int Adv Otol 2024; 20:8-13. [PMID: 38454282 PMCID: PMC10895885 DOI: 10.5152/iao.2024.231212] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/15/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND This study proposed a classification of the vertical portion of the facial nerve (VPFN) location, incorporating the previous classifications regarding the posterior-to-anterior and medial-to-lateral dimensions. We also evaluated the implication of this proposed classification on the round window visibility during pediatric cochlear implantation (CI). METHODS It was a retrospective multicenter observational cohort study. This study included 334 cases that underwent CI between 2015 and 2022 at multiple referral institutes. Two physicians evaluated the preoperative computed tomography images of 334 patients and determined the radiological type of the VPFN. These types were matched with intraoperative round window accessibility. RESULTS The Spearman's correlation coefficient showed a strong correlation between the proposed VPFN type and the intraoperative round window visibility, as the P-value was <.001. CONCLUSION This classification could provide the surgeon preoperatively with the precise location of the VPFN in the lateral-to-medial and posterior-to-anterior dimensions. Furthermore, this location classification of the VPFN was significantly correlated with intraoperative round window accessibility, with an accuracy of 90.42%. Therefore, types C and D were expected to have difficult accessibility into the round window, and more surgical interventions were needed to modify the posterior tympanotomy or use other approaches.
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Affiliation(s)
- Mahmoud Mandour
- Department of Otorhinolaryngology, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - Mohamed Amer
- Department of Otorhinolaryngology, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - Saad Elzayat
- Department of Otorhinolaryngology, Kafrelsheikh University, Faculty of Medicine, Kafrelsheikh, Egypt
| | - Edoardo Covelli
- Department of Neuroscience, Mental Health and Sensory Organs, Sant’ Andrea University Hospital, Sapienza University, Faculty of Medicine and Psychology, Rome, Italy
| | - Maurizio Barbara
- Department of Neuroscience, Mental Health and Sensory Organs, Sant’ Andrea University Hospital, Sapienza University, Faculty of Medicine and Psychology, Rome, Italy
| | - Rasha Lotfy
- Department of Radiology, Tanta University, Faculty of Medicine, Tanta, Egypt
| | - Haitham H. Elfarargy
- Department of Otorhinolaryngology, Kafrelsheikh University, Faculty of Medicine, Kafrelsheikh, Egypt
| | - Mohamed Osama Tomoum
- Department of Otorhinolaryngology, Tanta University, Faculty of Medicine, Tanta, Egypt
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Fujita Y, Uozumi Y, Sasayama T, Kohmura E. Subclassification of Koos grade 4 vestibular schwannoma: insights into tumor morphology for predicting postoperative facial nerve function. J Neurosurg 2024; 140:127-137. [PMID: 37503933 DOI: 10.3171/2023.5.jns23715] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/24/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Koos grade 4 vestibular schwannoma (KG4VS) is a large tumor that causes brainstem displacement and is generally considered a candidate for surgery. Few studies have examined the relationship between morphological differences in KG4VS other than tumor size and postoperative facial nerve function. The authors have developed a landmark-based subclassification of KG4VS that provides insights into the morphology of this tumor and can predict the risk of facial nerve injury during microsurgery. The aims of this study were to morphologically verify the validity of this subclassification and to clarify the relationship of the position of the center of the vestibular schwannoma within the cerebellopontine angle (CPA) cistern on preoperative MR images to postoperative facial nerve function in patients who underwent microsurgical resection of a vestibular schwannoma. METHODS In this paper, the authors classified KG4VSs into two subtypes according to the position of the center of the KG4VS within the CPA cistern relative to the perpendicular bisector of the porus acusticus internus, which was the landmark for the subclassification. KG4VSs with ventral centers to the landmark were classified as type 4V, and those with dorsal centers as type 4D. The clinical impact of this subclassification on short- and long-term postoperative facial nerve function was analyzed. RESULTS In this study, the authors retrospectively reviewed patients with vestibular schwannoma who were treated surgically via a retrosigmoid approach between January 2010 and March 2020. Of the 107 patients with KG4VS who met the inclusion criteria, 45 (42.1%) were classified as having type 4V (KG4VSs with centers ventral to the perpendicular bisector of the porous acusticus internus) and 62 (57.9%) as having type 4D (those with centers dorsal to the perpendicular bisector). Ventral extension to the perpendicular bisector of the porus acusticus internus was significantly greater in the type 4V group than in the type 4D group (p < 0.001), although there was no significant difference in the maximal ventrodorsal diameter. The rate of preservation of favorable facial nerve function (House-Brackmann grades I and II) was significantly lower in the type 4V group than in the type 4D group in terms of both short-term (46.7% vs 85.5%, p < 0.001) and long-term (82.9% vs 96.7%, p = 0.001) outcomes. Type 4V had a significantly negative impact on short-term (OR 7.67, 95% CI 2.90-20.3; p < 0.001) and long-term (OR 6.05, 95% CI 1.04-35.0; p = 0.045) facial nerve function after surgery when age, tumor size, and presence of a fundal fluid cap were taken into account. CONCLUSIONS The authors have delineated two different morphological subtypes of KG4VS. This subclassification could predict short- and long-term facial nerve function after microsurgical resection of KG4VS via the retrosigmoid approach. The risk of postoperative facial palsy when attempting total resection is greater for type 4V than for type 4D. This classification into types 4V and 4D could help to predict the risk of facial nerve injury and generate more individualized surgical strategies for KG4VSs with better facial nerve outcomes.
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Affiliation(s)
- Yuichi Fujita
- 1Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; and
| | - Yoichi Uozumi
- 1Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; and
| | - Takashi Sasayama
- 1Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; and
| | - Eiji Kohmura
- 1Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan; and
- 2Department of Neurosurgery, Kinki Central Hospital, Itami, Hyogo, Japan
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Seeberger S, Schlattmann P, Guntinas-Lichius O. Surgery for patients with facial palsy in Germany: a diagnosis-related-groups-based nationwide analysis, 2005-2019. Eur Arch Otorhinolaryngol 2024; 281:451-459. [PMID: 37755497 PMCID: PMC10764378 DOI: 10.1007/s00405-023-08259-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/20/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE Chronic flaccid paralysis of the facial nerve leads to permanent dysfunction of eye closure, problems with drinking and eating, and lack of emotional expression. Modern facial surgery can help those affected. An analysis of the development of facial surgery in Germany over time is presented. METHODS Nation-wide population-baes diagnosis-related case group (DRG) data of virtually all inpatients who underwent facial surgery for facial palsy between 2005 and 2019 were included. Binomial regression models for changes in surgery rates over time were calculated in relation to gender and treating specialty. RESULTS Between 2005 and 2019, there were 28,622 inpatient stays for facial surgery. Most surgeries were provided by otolaryngology (39%) and ophthalmology or dentistry, oral and maxillofacial surgery (20% each). The mean treatment rate was 2.33 ± 0.53 surgeries per 100,000 person-years. The surgery rate was highest for nerve reconstruction surgery (0.46 ± 0.15) and static sling surgery (0.44 ± 0.0.16). The greatest increase was seen in men for nerve surgery (3.9-fold; relative risk [RR] = 3.68; confidence interval [CI] = 3.18-4.26) and sling surgery (5.0-fold; RR = 4.25; CI = 3.38-5.33). CONCLUSIONS While nerve and sling surgery increased significantly over time, this was less true or not true at all for surgical techniques. Surgical rates and their change over time were greater in men, without explanation from the data.
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Affiliation(s)
- Susanna Seeberger
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, 07747, Jena, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
- Facial-Nerve-Center, Jena University Hospital, 07747, Jena, Germany.
- Center for Rare Diseases, Jena University Hospital, 07747, Jena, Germany.
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Laxague F, Sahovaler A, Fnais N, Tran C, Wehrli B, Matic D, Nichols A, Mendez A, Gill R, Yoo J. The Ansa Hypoglossi: Quantifying Axonal Density of a Donor Nerve for Facial Reinnervation. Facial Plast Surg Aesthet Med 2024; 26:47-51. [PMID: 37192498 DOI: 10.1089/fpsam.2022.0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Background: There are a number of nerve grafting options for facial reanimation and the ansa hypoglossi (AH) may be considered in select situations. Objective: To compare axonal density, area, and diameter of AH with other nerves more usually used for facial reanimation. Methods: AH specimens from patients undergoing neck dissections were submitted in formalin. Proximal to distal cross sections, nerve diameters, and the number of axons per nerve, proximally and distally, were measured and counted. Results: Eighteen nerve specimens were analyzed. The average manual axon count for the distal and proximal nerve sections was 1378 ± 333 and 1506 ± 306, respectively. The average QuPath counts for the proximal and distal nerve sections were 1381 ± 325 and 1470 ± 334, respectively. The mean nerve area of the proximal and distal nerve sections was 0.206 ± 0.01 and 0.22 ± 0.064 mm2, respectively. The mean nerve diameter for the proximal and distal nerve sections were 0.498 ± 0.121 and 0.526 ± 0.75 mm, respectively. Conclusion: The histological characteristics of the AH support clinical examination of outcomes as a promising option in facial reanimation.
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Affiliation(s)
- Francisco Laxague
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Department of Head and Neck Surgery, Hospital Aleman of Buenos Aires, Buenos Aires, Argentina
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Department of Head and Neck Surgery, University College London Hospitals, London, United Kingdom
| | - Naif Fnais
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
- Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Christopher Tran
- Department of Pathology, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Bret Wehrli
- Department of Pathology, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Damir Matic
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Anthony Nichols
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Rabia Gill
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, London, Canada
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Kehrer A, Engelmann S, Knoedler L, Klein SM, Anker AM, Heidekrueger P, Tamm E, Bleys RL, Prantl L, Ruewe M. The masseteric nerve for facial reanimation: Macroscopic and histomorphometric characteristics in 106 human cadavers and comparison of axonal ratio with recipient nerves. J Craniomaxillofac Surg 2024; 52:8-13. [PMID: 38129186 DOI: 10.1016/j.jcms.2023.09.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/05/2023] [Indexed: 12/23/2023] Open
Abstract
Peripheral facial palsy causes severe impairments. Sufficient axonal load is critical for adequate functional outcomes in reanimation procedures. The aim of our study was to attain a better understanding of the anatomy of the masseteric nerve as a donor, in order to optimize neurotization procedures. Biopsies were obtained from 106 hemifaces of fresh frozen human cadavers. Histological cross-sections were fixed, stained with PPD, and digitized. Histomorphometry and a validated software-based axon quantification were conducted. Of the 154 evaluated branches, 74 specimens were of the main trunk (MT), 40 of the anterior branch (AB), and 38 of the descending branch (DB), while two halves of one cadaver featured an additional branch. The MT showed a diameter of 1.4 ± 0.41 mm (n = 74) with 2213 ± 957 axons (n = 55). The AB diameter was 0.9 ± 0.33 mm (n = 40) with 725 ± 714 axons (n = 30). The DB diameter was 1.15 ± 0.34 mm (n = 380) with 1562 ± 926 axons (n = 30). The DB demonstrated a high axonal capacity - valuable for nerve transfers or muscle transplants. Our findings should facilitate a balanced selection of axonal load, and are potentially helpful in achieving more predictable results while preserving masseter muscle function.
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Affiliation(s)
- Andreas Kehrer
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.
| | - Simon Engelmann
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Leonard Knoedler
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Silvan M Klein
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Alexandra M Anker
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Paul Heidekrueger
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Tamm
- Department of Human Anatomy and Embryology, University of Regensburg, Regensburg, Germany
| | - Ronald Law Bleys
- Department of Anatomy, University Medical Center (UMC) Utrecht, Utrecht, Netherlands
| | - Lukas Prantl
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Marc Ruewe
- Department of Plastic, Hand, and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
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Kaufman Goldberg T, Flynn JP, Trzcinski LO, McGonagle ER, Banks CA, Hadlock TA. Understanding the Relationship Between Facial Nerve Branch Sacrifice and Selective Neurectomy Outcome. Facial Plast Surg Aesthet Med 2024; 26:58-64. [PMID: 37428614 DOI: 10.1089/fpsam.2022.0422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
Introduction: While there is great interest in selective neurectomy (SN) for patients with synkinesis, outcomes can be inconsistent. Objective: To examine the relationships between intraoperative facial nerve branch transection and both postoperative outcome and functional deficits. Methods: SN cases, with minimal follow-up of 4 months, were retrospectively identified between 2019 and 2021; outcome was assessed using FaCE instrument, eFACE and Emotrics. Correlations between intraoperative facial nerve branch preservation or transection, and functional outcome and new functional deficits were examined. Results: Fifty-six cases were performed: 88% were females, and median age was 53 years (range 11-81). Mean follow-up was 19.5 months (range 4-42). Oral commissure excursion improved in patients where all smile branches were preserved, no vertical vector smile branches were transected, and more than three smile antagonist branches were transected. A linear trend between smile antagonist branch sacrifice and favorable smile outcome was found. Lower lip movement was improved in patients in whom more than half of the identified lower lip branches were transected. Thirty percent of patients experienced untoward postoperative functional deficits, from which 47% recovered with interventions. Conclusions: Several correlations between SN intra-operative decisions and outcome were identified; new or worsening functional deficit rate can be high. However, chemodenervation or fillers can help diminish these deficits.
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Affiliation(s)
- Tal Kaufman Goldberg
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - John P Flynn
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Lauren O Trzcinski
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Elizabeth R McGonagle
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Caroline A Banks
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Tessa A Hadlock
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology Head & Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
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Bayezid KC, Morkuzu S, Karabulut E, Bajus A, Streit L. Restoring the spontaneous smile through free functional muscle transfer. A systematic review and meta-analysis of the last twenty years' experience. J Plast Reconstr Aesthet Surg 2024; 88:196-207. [PMID: 37988971 DOI: 10.1016/j.bjps.2023.10.124] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/04/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND The recovery of the spontaneous smile has become a primary focus in facial reanimation surgery and its major determinant is the selected neurotizer. We aimed to compare the spontaneity outcomes of the most preferred neurotization methods in free functional muscle transfer for long-standing facial paralysis. METHODS The Embase, Ovid Medline, and PubMed databases were queried with 21 keywords. All clinical studies from the last 20 years reporting the postoperative spontaneity rate for specified neurotization strategies [cross-face nerve graft (CFNG), contralateral facial nerve (CLFN), motor nerve to the masseter (MNM), and dual innervation (DI)] were included. A meta-analysis of prevalence was performed using Freeman-Tukey double arcsine transformation, I2 statistic, and generic inverse variance with a random-effects model. Risk Of Bias In Non-randomized Studies of Interventions and Newcastle-Ottawa scale were used to assess bias and study quality. RESULTS The literature search produced 2613 results and 473 unique citations for facial reanimation. Twenty-nine studies including 2046 patients were included in the systematic review. A meta-analysis of eligible data (1952 observations from 23 studies) showed statistically significant differences between the groups (CFNG: 0.94; 95% confidence interval [CI], 0.76-1.00, CLFN: 0.91; 95% CI, 0.49-1.00, MNM: 0.26; 95% CI, 0.05-0.54, DI: 0.98; 95% CI, 0.90-1.00, P < 0.001). In pairwise comparisons, statistically significant differences were found between MNM and other neurotization strategies (P < 0.001 in CFNG compared with MNM, P = 0.013 for CLFN compared with MNM, P < 0.001 for DI compared with MNM). CONCLUSIONS DI- and CLFN-driven strategies achieved the most promising outcomes, whereas MNM showed the potential to elicit spontaneous smile at a lower extent. Our meta-analysis was limited primarily by incongruency between spontaneity assessment systems. Consensus on a standardized tool would enable more effective comparisons of the outcomes.
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Affiliation(s)
- K Can Bayezid
- Department of Burns and Plastic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Plastic and Aesthetic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Suat Morkuzu
- Institute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell School of Medicine, Houston, TX, United States
| | - Erdem Karabulut
- Department of Biostatistics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Adam Bajus
- Department of Plastic and Aesthetic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Libor Streit
- Department of Burns and Plastic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Plastic and Aesthetic Surgery, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Ren JW, Xu J, Huang X, Xu M, Chen MY, Wang Y, Wang W, Zhong P. [Analysis of the influencing factors of short-term and long-term facial nerve function after vestibular schwannoma resection via suboccipital retrosigmoid approach]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 58:1183-1190. [PMID: 38186092 DOI: 10.3760/cma.j.cn115330-20231015-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Objective: To summarize the experience of facial nerve(FN) preservation in microsurgical treatment of vestibular schwannoma (VS) resection via suboccipital retrosigmoid approach and to analyze the influencing factors of facial function prognosis in short-term and long-term period. Methods: Patients with VS who underwent microsurgery via suboccipital retrosigmoid approach by the skull base surgery team in Huashan Hospital from January 2013 to February 2018 were enrolled. A total of 308 patients were included in this study, including 132 males and 176 females. The average age was 47.9 year-old (Range: 17-79 year-old). The patient's clinical data and FN function prognosis were recorded. Univariate and multivariate analysis by SPSS 23.0 statistical software were performed to evaluate the factors affecting facial function prognosis and its recovery. Results: Gross total resection was achieved in 304 cases, and subtotal resection was in 4 cases. The facial nerve preservation rate anatomically was 99.4%. The facial nerve of 2 cases was thin due to large tumor compression and severed, and a one-stage reconstruction was performed during surgery.Of the 308 patients, 300 cases were successfully followed up, and 8 cases were lost to follow-up. The mean follow-up time was 52 months. In short-term (2 weeks after surgery), satisfactory facial nerve function (House-Brackmann (H-B) grade Ⅰ-Ⅱ) was achieved in 96 cases, and 212 cases were unsatisfactory function (H-B grade Ⅲ-Ⅵ). After 1 year, 198 were satisfactory function and 97 were unsatisfactory. After 3 years, 219 were satisfactory function and 75 were unsatisfactory. Five years later, 155 were satisfactory function and 34 were unsatisfactory. According to the results of logistic regression analysis, the impact factors of FN function in short-term were tumor size (P=0.011) and stimulation threshold (ST) of EMG monitoring (P<0.001). The impact factors in long-term were tumor size (P=0.005), ST of EMG monitoring (P=0.005) and FN rehabilitation training. Conclusions: Tumor diameter is an independent factor related to FN function, and the larger the tumor, the worse the postoperative FN function. The ST of EMG (ST≤0.05 mA) can predict short-term and long-term FN function. The systematic facial rehabilitation training can effectively promote the recovery of FN after surgery.
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Affiliation(s)
- J W Ren
- Department of Neurosurgery, Fudan University Huashan Hospital, National Center for Neurological Disorders, Shanghai Key Lab. of Brain Function and Regeneration, Neurosurgical Institute, Shanghai Medical College-Fudan University, Shanghai 200040, China
| | - J Xu
- Department of Neurosurgery, Fudan University Huashan Hospital, National Center for Neurological Disorders, Shanghai Key Lab. of Brain Function and Regeneration, Neurosurgical Institute, Shanghai Medical College-Fudan University, Shanghai 200040, China
| | - X Huang
- Department of Neurosurgery, Fudan University Huashan Hospital, National Center for Neurological Disorders, Shanghai Key Lab. of Brain Function and Regeneration, Neurosurgical Institute, Shanghai Medical College-Fudan University, Shanghai 200040, China
| | - M Xu
- Department of Neurosurgery, Fudan University Huashan Hospital, National Center for Neurological Disorders, Shanghai Key Lab. of Brain Function and Regeneration, Neurosurgical Institute, Shanghai Medical College-Fudan University, Shanghai 200040, China
| | - M Y Chen
- Department of Neurosurgery, Fudan University Huashan Hospital, National Center for Neurological Disorders, Shanghai Key Lab. of Brain Function and Regeneration, Neurosurgical Institute, Shanghai Medical College-Fudan University, Shanghai 200040, China
| | - Y Wang
- Department of Neurosurgery, Fudan University Huashan Hospital, National Center for Neurological Disorders, Shanghai Key Lab. of Brain Function and Regeneration, Neurosurgical Institute, Shanghai Medical College-Fudan University, Shanghai 200040, China
| | - W Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China
| | - P Zhong
- Department of Neurosurgery, Fudan University Huashan Hospital, National Center for Neurological Disorders, Shanghai Key Lab. of Brain Function and Regeneration, Neurosurgical Institute, Shanghai Medical College-Fudan University, Shanghai 200040, China
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Daneshi A, Asghari A, Mirsalehi M, Kiani Asiabar M, Mohebbi S. Totally endoscopic transcanal facial nerve decompression in patients with traumatic facial nerve paralysis: from geniculate ganglion to mastoid segment. J Laryngol Otol 2023; 137:1334-1339. [PMID: 36382446 DOI: 10.1017/s0022215122002341] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The current study evaluated the effectiveness of endoscopic transcanal facial nerve decompression in patients with post-traumatic facial nerve paralysis. METHODS This retrospective study included 10 patients with post-traumatic complete facial nerve paralysis who underwent endoscopic transcanal facial nerve decompression. The surgical technique was explained step by step, and the surgical complications, hearing status and facial nerve function 12 months post-operatively were reported. RESULTS Endoscopic transcanal facial nerve decompression allowed exposure of the geniculate ganglion to the mastoid segment. The facial nerve function improved from House-Brackmann grade VI to grades I and II in 8 of 10 (80 per cent) patients, and 2 patients experienced partial recovery (House-Brackmann grades III and IV). No severe complication was reported. CONCLUSION Endoscopic transcanal facial nerve decompression, involving the nerve from the geniculate ganglion to the mastoid segment, is a safe and effective approach in patients with post-traumatic facial nerve paralysis.
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Affiliation(s)
- A Daneshi
- ENT and Head and Neck Research Centre and Department, The Five Senses Health Institute, School of Medicine, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - A Asghari
- Skull Base Research Centre, The Five Senses Health Institute, School of Medicine, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - M Mirsalehi
- ENT and Head and Neck Research Centre and Department, The Five Senses Health Institute, School of Medicine, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - M Kiani Asiabar
- ENT and Head and Neck Research Centre and Department, The Five Senses Health Institute, School of Medicine, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - S Mohebbi
- Skull Base Research Centre, The Five Senses Health Institute, School of Medicine, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
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Van Der Kelen L, Ureel M, Bauters W, Vermeersch H, Coopman R. Neurectomy of the Masseteric Nerve Using an Extra-Oral Approach to Treat Masseter Hypertrophy: Case Report and Literature Review. J Oral Maxillofac Surg 2023; 81:1476-1484. [PMID: 37709258 DOI: 10.1016/j.joms.2023.08.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023]
Abstract
Masticatory muscle hypertrophy is a benign clinical anomaly which leads to facial asymmetry or a squared face appearance. We report a case of masticatory muscle hypertrophy, particularly on the right side, that was successfully treated by neurectomy of the right masseteric nerve through an extra-oral approach. Clinical examination showed significant aesthetic improvement of the facial symmetry with complete paralysis and atrophy of the right masseter muscle. The impaired postoperative function of the frontal branch of the right facial nerve was fully restored 10 weeks postoperatively. The patient no longer experiences headaches or discomfort with eating or sleeping on her right side.
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Affiliation(s)
- Louise Van Der Kelen
- Co-Assistant, Department of Oral and Maxillofacial Surgery, University Hospital Ghent, Ghent, Belgium
| | - Matthias Ureel
- Resident, Department of Oral and Maxillofacial Surgery, University Hospital Ghent, Ghent, Belgium
| | - Wouter Bauters
- Department Head, Department of Radiology and Imaging, University Hospital Ghent, Ghent, Belgium
| | - Hubert Vermeersch
- Resident, Department of Oral and Maxillofacial Surgery, University Hospital Ghent, Ghent, Belgium; Department Head, Department of Plastic, Reconstructive and Esthetic Surgery, University Hospital Ghent, Ghent, Belgium
| | - Renaat Coopman
- Department Head, Department of Plastic, Reconstructive and Esthetic Surgery, University Hospital Ghent, Ghent, Belgium.
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42
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Lee AS, Teh BM, Alexiades G. Transmastoid Facial Nerve Decompression for Craniometaphyseal Dysplasia. Otol Neurotol 2023; 44:1082-1085. [PMID: 37939359 DOI: 10.1097/mao.0000000000004010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE We document the first successful transmastoid surgical treatment of facial nerve palsy for a patient with craniometaphyseal dysplasia (CMD), a rare genetic disease. PATIENT A 9-month-old girl with bilateral facial nerve palsies and conductive hearing loss. Genetic testing made a diagnosis of CMD, and imaging showed narrowing of the facial nerve canals and ossicular fixation. INTERVENTION Right transmastoid facial nerve decompression and ossicular chain reconstruction. MAIN OUTCOME MEASURE Facial nerve function (House-Brackmann grade). RESULTS Facial nerve function initially worsened, then improved within 12 months from House-Brackmann grade IV-V to grade III. CONCLUSION Surgical cranial nerve decompression of and ossicular chain reconstruction may be effective treatments for patients with CMD.
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Affiliation(s)
- Andrew S Lee
- Weill-Cornell School of Medicine, New York, New York
| | - Bing M Teh
- Department of Otolaryngology-Head & Neck Surgery and Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - George Alexiades
- Department of Otolaryngology/Head and Neck Surgery, New York-Presbyterian/Weill-Cornell Medical Center, New York, New York
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Biglio A, Rossetti G, Gibelli DM, Dolci C, Cappella A, Allevi F, Vaira LA, De Riu G, Sforza C, Biglioli F. Three-dimensional evaluation of symmetry in facial palsy reanimation using stereophotogrammetric devices: A series of 15 cases. J Craniomaxillofac Surg 2023; 51:766-771. [PMID: 37858482 DOI: 10.1016/j.jcms.2023.09.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023] Open
Abstract
Facial palsy can severely compromise quality of life, significantly altering the harmony and symmetry of the face, which can be restored by surgical rehabilitation. The aim of the study was the quantification of facial symmetry following facial reanimation. Fifteen consecutive adult patients were surgically treated through triple innervation for reanimation of flaccid unilateral facial paralysis (contralateral facial nerve, masseteric nerve, and hypoglossal nerve) and fascia lata graft for definition of the nasolabial sulcus. In the preoperative stage and at least 11 months after the surgical treatment, three-dimensional facial images were recorded through stereophotogrammetry in a neutral (rest) position, and with Mona Lisa and full-denture (maximum) smiles. Labial commissure inclination relative to the interpupillary axis, and a surface assessment of local facial asymmetry at rest and while smiling were obtained for the upper, middle, and lower facial thirds. The angle between the interpupillary axis and the labial commissure significantly improved in post-surgical acquisitions, regaining symmetry at rest (t-test; p < 0.001). Facial symmetry increased significantly when passing from pre-to postsurgical facial scans, from the lower to the upper facial third, and from the full smile to the rest position (ANOVA; p < 0.001). After treatment, the full smile recovered more symmetry than the other two expressions. In summary, surgical treatment significantly reduced facial asymmetry, but this reduction differed significantly among the various animations and facial thirds. The results of this study confirmed clinical findings of significant static and dynamic improvements in facial symmetry after triple innervation reanimation surgery.
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Affiliation(s)
- Andrea Biglio
- Maxillofacial Surgery, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy; Maxillofacial Surgery Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
| | - Giulia Rossetti
- Maxillofacial Surgery, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy
| | | | - Claudia Dolci
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Annalisa Cappella
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Operative Unit, Laboratorio di Morfologia Umana Applicata, IRCSS San Donato, San Donato Milanese, Milan, Italy
| | - Fabiana Allevi
- Maxillofacial Surgery, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Luigi Angelo Vaira
- Maxillofacial Surgery Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy; School of Biomedical Sciences, Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Giacomo De Riu
- Maxillofacial Surgery Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Chiarella Sforza
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Federico Biglioli
- Maxillofacial Surgery, Department of Health Sciences, San Paolo University Hospital, Azienda Socio Sanitaria Territoriale Santi Paolo e Carlo, University of Milan, Milan, Italy
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Charters E, Low THH. Improving the oral function of patients with upper and lower lip tensor fascia lata slings for patients with flaccid facial nerve palsy. Oral Oncol 2023; 147:106601. [PMID: 37925897 DOI: 10.1016/j.oraloncology.2023.106601] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Facial nerve paralysis (FNP) often causes decreased quality of life and may lead to significant facial dysfunction. Oral competence is frequently raised as a concern by patients as it impacts nutrition, hydration, social participation, and mental health. This can result in social isolation and reduced capacity to return to vocational roles. Despite its prevalence, it is incompletely understood and rarely described. This study prospectively evaluated the impact that facial nerve static and dynamic reanimation has on oral competence, with a specific focus on speech intelligibility and the oral phase of the swallow. MATERIALS AND METHODS Patients who had a static or dynamic facial reanimation at Chris O'Brien Lifehouse due to facial nerve paralysis were recruited consecutively between September 2020 and October 2022. Their speech and swallow were analysed using patient reported outcome measures including the speech handicap index and the oral competence questionnaire, and speech intelligibility rated by the patient and their speech pathologist at baseline (up to 2-weeks prior to surgery), then at 6- and 12- months post-surgery. Outcomes were evaluated firstly by a paired analysis (pre- compared to post-operative oral competence outcomes), and secondly by a cohort analysis of static, compared to dynamic reanimation. RESULTS 19 participants underwent a facial nerve reconstruction (10 static, 9 dynamic and static) due to pre-operative facial nerve paralysis. At 12-months improvements in both the oral competence questionnaire (OCQ) and the speech handicap index (SHI) (score reduced at a rate of 0.3 points per week and the 0.2 points respectively) and that this change met statistical significance (OCQ; p = p < 0.003, SHI; p < 0.001). Patient rated intelligibility increased 0.3 and clinician rated intelligibility increased 0.2 points per week which also significantly improved (p = 0.001 and p < 0.001 respectively). CONCLUSIONS Both static and dynamic facial reanimation procedures significantly improved both speech and swallowing measures for oral competence at 6- and 12- months post-procedure. There was not a significant difference found between static and dynamic procedures.
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Affiliation(s)
- Emma Charters
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; Sydney Facial Nerve Clinic, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia.
| | - Tsu-Hui Hubert Low
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia; Sydney Facial Nerve Clinic, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Department of Otolaryngology - Head & Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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Carlson ML, Lohse CM, Agazzi S, Babu SC, Barker FG, Barnett S, Bi WL, Biggs N, Boahene KD, Breen JT, Brown KD, Cayé-Thomasen P, Cosetti MK, Deep NL, Dey JK, Dornhoffer JR, Forner D, Gurgel RK, Hansen MR, Hunter JB, Kalamarides M, Kim IA, King AT, Kircher ML, Lassaletta L, Link MJ, Lloyd SKW, Lund-Johansen M, Marinelli JP, Matthies C, Mehta V, Moore EJ, Nassiri AM, Neff BA, Nelson RF, Olson JJ, Patel NS, Celda MP, Plitt AR, Price DL, Thomas Roland J, Sweeney AD, Tasche KK, Tatagiba M, Tveiten Ø, Van Gompel JJ, Vrabec JT, Wanna GB, Weisskopf PA. Rationale for the Development of a Novel Clinical Grading Scale for Postoperative Facial Nerve Function: Results of a Multidisciplinary International Working Group. Otol Neurotol 2023; 44:e747-e754. [PMID: 37875014 DOI: 10.1097/mao.0000000000004039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
OBJECTIVE The objective of the current study was to present the results of an international working group survey identifying perceived limitations of existing facial nerve grading scales to inform the development of a novel grading scale for assessing early postoperative facial paralysis that incorporates regional scoring and is anchored in recovery prognosis and risk of associated complications. STUDY DESIGN Survey. SETTING A working group of 48 multidisciplinary clinicians with expertise in skull base, cerebellopontine angle, temporal bone, or parotid gland surgery. RESULTS House-Brackmann grade is the most widely used system to assess facial nerve function among working group members (81%), although more than half (54%) agreed that the system they currently use does not adequately estimate the risk of associated complications, such as corneal injury, and confidence in interrater and intrarater reliability is generally low. Simplicity was ranked as the most important attribute of a novel postoperative facial nerve grading system to increase the likelihood of adoption, followed by reliability and accuracy. There was widespread consensus (91%) that the eye is the most critical facial region to focus on in the early postoperative setting. CONCLUSIONS Members were invited to submit proposed grading systems in alignment with the objectives of the working group for subsequent validation. From these data, we plan to develop a simple, clinically anchored, and reproducible staging system with regional scoring for assessing early postoperative facial nerve function after surgery of the skull base, cerebellopontine angle, temporal bone, or parotid gland.
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Affiliation(s)
| | - Christine M Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Siviero Agazzi
- Department of Neurosurgery, University of South Florida, Tampa, Florida
| | | | - Frederick G Barker
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel Barnett
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nigel Biggs
- Department of Otolaryngology, Head, Neck and Skull Base Surgery, St Vincent's Hospital, Sydney, Australia
| | - Kofi D Boahene
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Joseph T Breen
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Jacksonville, Florida
| | - Kevin D Brown
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology-Head and Neck Surgery and Audiology, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Maura K Cosetti
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine of Mount Sinai, New York, New York
| | - Nicholas L Deep
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
| | - Jacob K Dey
- Department of Otolaryngology-Head and Neck Surgery
| | | | - David Forner
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Richard K Gurgel
- Department of Otolaryngology, University of Utah Health, Salt Lake City, Utah
| | - Marlan R Hansen
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jacob B Hunter
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michel Kalamarides
- Department of Neurosurgery, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Irene A Kim
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Andrew T King
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester, UK
| | - Matthew L Kircher
- Department of Otolaryngology-Head and Neck Surgery, Loyola University Medical Center, Chicago, Illinois
| | - Luis Lassaletta
- Department of Otolaryngology, IdiPAZ Institute for Health Research, La Paz University Hospital; Biomedical Research Networking Centre on Rare Diseases (CIBERER-U761), Institute of Health Carlos III, Madrid, Spain
| | | | - Simon K W Lloyd
- Department of Otolaryngology Head and Neck Surgery, Manchester Royal Infirmary, Manchester Academic Health Science Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | | | - Cordula Matthies
- Department of Neurosurgery, University of Würzburg, Würzburg, Germany
| | - Vikas Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery
| | - Ashley M Nassiri
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Brian A Neff
- Department of Otolaryngology-Head and Neck Surgery
| | - Rick F Nelson
- Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, Indiana
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University, Atlanta, Georgia
| | - Neil S Patel
- Department of Otolaryngology, University of Utah Health, Salt Lake City, Utah
| | | | | | | | - J Thomas Roland
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Alex D Sweeney
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | | | - Marcos Tatagiba
- Neurosurgical Clinic, Department of Neurosurgery and Neurotechnology, Eberhard Karls University, Tuebingen, Germany
| | - Øystein Tveiten
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | | | | | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine of Mount Sinai, New York, New York
| | - Peter A Weisskopf
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona
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Bubeníková A, Vlasák A, Fík Z, Sedlák V, Tesařová M, Bradáč O. Application of diffusion tensor imaging of the facial nerve in preoperative planning for large vestibular schwannoma: a systematic review. Neurosurg Rev 2023; 46:298. [PMID: 37950058 DOI: 10.1007/s10143-023-02214-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/28/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
The accurate identification and preservation of the facial nerve (FN) during vestibular schwannoma (VS) surgery is crucial for maintaining facial function. Investigating the application of diffusion tensor imaging (DTI) in preoperative planning for large VS surgery is provided. PubMed, Cochrane Library, Science Direct, ISI Web of Science, Embase, and additional sources were searched to identify cohort studies about the preoperative DTI usage for the FN tracking before large VS (≥ 2.5 cm) surgery published between 1990 and 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed; the Newcastle-Ottawa Scale was used to assess the risk of bias and to evaluate limitations based on selection/outcome biases. A total of 8 publications yielding 149 VS (mean size 3.66 ± 0.81 cm) were included. Surgical concordance with preoperative DTI FN tracking was 91.67% (range 85-100%). Overall DTI reliability was 88.89% (range 81.81-95.83%). Larger tumor size predicted either DTI inaccurate finding or complete DTI failure (p = 0.001). VS size above > 3.5 cm was associated with a higher risk of DTI failure (p = 0.022), with a higher risk of inaccurate DTI finding preoperatively (p = 0.033), and with a higher House-Brackman score postoperatively (p = 0.007). Application of DTI in larger VS surgery is a valuable FN identification along with electrophysiological monitoring and neuronavigation, therefore also in its preservation and in lowering risk of complications. DTI represents a valuable adjunct to electrophysiological monitoring and neuronavigation in FN identification, applicable not only for smaller, but also larger VS.
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Affiliation(s)
- Adéla Bubeníková
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Prague, Czech Republic
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Aleš Vlasák
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Prague, Czech Republic.
| | - Zdeněk Fík
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Vojtěch Sedlák
- Department of Radiology, Military University Hospital, Prague, Czech Republic
| | - Michaela Tesařová
- Department of Otorhinolaryngology, Head and Neck Surgery, 1st Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Ondřej Bradáč
- Department of Neurosurgery, 2nd Faculty of Medicine, Charles University and Motol University Hospital, V Úvalu 84, 150 06 Prague 5, Prague, Czech Republic
- Department of Neurosurgery and Neurooncology, 1st Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
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47
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Orhan KS, Sönmez S, Kara H, Avcı K, Polat B, Çelik M, Orhan EK, Güldiken Y. Long-term outcomes of facial nerve decompression by transmastoid versus middle cranial fossa approach for traumatic facial paralysis. Am J Otolaryngol 2023; 44:103983. [PMID: 37531887 DOI: 10.1016/j.amjoto.2023.103983] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 08/04/2023]
Abstract
OBJECTIVES To evaluate and compare the long-term results of patients who underwent facial nerve decompression surgery with either transmastoid-supralabyrinthine (TMSL) or combined transmastoid- middle cranial fossa (MCF) approach for traumatic facial nerve paralysis. MATERIALS AND METHODS This is a single-center retrospective case-control study. The medical records of traumatic facial paralysis patients with House Brackmann (HB) Grade 6 who underwent facial nerve decompression surgery at via either TMSL or MCF approach between January 2011 and December 2017 were reviewed. The patients who had otic capsule involvement and total sensorineural hearing loss, therefore underwent translabyrinthine facial nerve decompression, and the patients follow-up period has not yet reached four years were excluded from the study. Postoperative HB score and hearing status were compared. RESULTS Eleven patients were operated with MCF approach (group 1), while 9 patients with TMSL approach (group 2). Average age of patients was 20.04 + 15.2 (range:4-47) years. Three (15 %) patients were female, while 17 (85 %) was male. Geniculate ganglion (90 %) was the most affected segment of the facial nerve. Facial nerve edema was observed in all cases, while intraneural hematoma were encountered in 4 (20 %) cases. Statistically significant improvement in median HB scores were reached in both groups, and no significant difference was observed in post-operative HB scores between both techniques. No significant difference in median AC 0,5-4 khZ and BC 0,5-3 kHz thresholds was observed between both techniques. CONCLUSION Even middle fossa approach is the best surgical technique to explore geniculate ganglion and labyrinthine segment of facial nerve, the functional results of transmastoid supralabrynthine approach, which is not needed craniotomy with low complication rate are as successful as middle fossa approach in selected patients.
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Affiliation(s)
- Kadir Serkan Orhan
- University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey.
| | - Said Sönmez
- University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey.
| | - Hakan Kara
- University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Kagan Avcı
- University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey.
| | - Beldan Polat
- University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Mehmet Çelik
- University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey.
| | - Elif Kocasoy Orhan
- University of Istanbul, Istanbul Faculty of Medicine, Department of Neurology, Division of Electro-neurophysiology, Istanbul, Turkey.
| | - Yahya Güldiken
- University of Istanbul, Istanbul Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey
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48
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Targino da Costa MGES, Maranhão-Filho PDA, Santos IC, González CRA, Almeida CHSD, Luiz RR. Post-parotidectomy facial nerve function: comparison between original and modified Sunnybrook Facial Grading Systems. Arq Neuropsiquiatr 2023; 81:970-979. [PMID: 38035582 PMCID: PMC10689100 DOI: 10.1055/s-0043-1777003] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/06/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Facial nerve dysfunction is the principal postoperative complication related to parotidectomy. OBJECTIVE To test the hypothesis that the modified Sunnybrook Facial Grading System (mS-FGS) is superior to the original S-FGS in the assessment of facial nerve function following parotidectomy. METHODS Prospective, longitudinal study evaluating patients with primary or metastatic parotid neoplasms undergoing parotidectomy with facial nerve-sparing between 2016 and 2020. The subjects were assessed twice, on the first postoperative day and at the first outpatient evaluation, 20-30 days post-surgery. Facial assessments were performed using the original and modified (plus showing the lower teeth) versions of the Sunnybrook System and documented by pictures and video recordings. Intra- and inter-rater agreements regarding the assessment of the new expression were analyzed. RESULTS 101 patients were enrolled. In both steps, the results from the mS-FGS were significantly lower (p < 0.001). Subjects with a history of previous parotidectomy and those who underwent neck dissection had more severe facial nerve impairment. The mandibular marginal branch was the most frequently injured, affecting 68.3% of the patients on the first postoperative day and 52.5% on the first outpatient evaluation. Twenty patients (19.8%) presented an exclusive marginal mandibular branch lesion. The inter-rater agreement of the new expression assessment ranged from substantial to almost perfect. The intra-rater agreement was almost perfect (wk = 0.951). CONCLUSION The adoption of the Modified Sunnybrook System, which includes evaluation of the mandibular marginal branch, increases the accuracy of post-parotidectomy facial nerve dysfunction appraisal.
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Affiliation(s)
| | - Péricles de Andrade Maranhão-Filho
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Departamento de Neurologia, Rio de Janeiro RJ, Brazil.
| | - Izabella Costa Santos
- Hospital do Câncer I, Instituto Nacional de Câncer, Departamento de Cirurgia de Cabeça e Pescoço, Rio de Janeiro RJ, Brazil.
| | | | | | - Ronir Raggio Luiz
- Universidade Federal do Rio de Janeiro, Instituto de Estudos em Saúde Coletiva, Rio de Janeiro RJ, Brazil.
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Bengur FB, Komatsu C, Fedor CN, Loder S, Baker JS, Totwani A, Irgebay Z, Nerone WV, Solari MG, Marra KG. Biodegradable Nerve Guide with Glial Cell Line-Derived Neurotrophic Factor Improves Recovery After Facial Nerve Injury in Rats. Facial Plast Surg Aesthet Med 2023; 25:478-486. [PMID: 36877591 PMCID: PMC10664574 DOI: 10.1089/fpsam.2022.0346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Background: Bioengineered nerve guides with glial cell line-derived neurotrophic factor (GDNF) support recovery after facial nerve injury by acting as regenerative scaffolds. Objective: To compare functional, electrophysiological, and histological outcomes after repair of rat facial nerve transection in control, empty nerve guide, and nerve guide with GDNF conditions. Methods: Rats underwent transection and primary repair of the buccal branch of the facial nerve and were divided into (1) transection and repair only, (2) transection and repair augmented with empty guide, (3) transection and repair augmented with GDNF-guide groups. Weekly measurements of the whisking movements were recorded. At 12 weeks, compound muscle action potentials (CMAPs) at the whisker pad were assessed, and samples were collected for histomorphometric analysis. Results: Rats in GDNF-guide group displayed the earliest peak in normalized whisking amplitude. CMAPs were significantly higher after GDNF-guide placement. Mean fiber surface area of the target muscle, axonal count of the injured branch, and the number of Schwann cells were highest with GDNF guides. Conclusion: The biodegradable nerve guide containing double-walled GDNF microspheres enhanced recovery after facial nerve transection and primary repair.
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Affiliation(s)
- Fuat Baris Bengur
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Chiaki Komatsu
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Caroline Nadia Fedor
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shawn Loder
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jocelyn S. Baker
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aanchal Totwani
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zhazira Irgebay
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - W. Vincent Nerone
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mario G. Solari
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kacey G. Marra
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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50
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Wen YE, Rozen SM. Optimizing Facial Function in Patients With High-Risk Recurrent Pleomorphic Adenoma and a History of Facial Nerve Injury. Ann Plast Surg 2023; 91:553-563. [PMID: 37823622 DOI: 10.1097/sap.0000000000003639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
BACKGROUND Parotid pleomorphic adenoma (PA) patients present significant diagnostic and surgical challenges rendering them high risk for facial nerve injury. Recurrent PA patients often present with history of facial nerve injury or previous reanimations making salvage of the facial nerve or previous reanimations significantly more complex. The study aim is to share our experience with this high risk for facial nerve injury population and review the literature. METHODS Adult patients with recurrent PA and history of facial nerve injury with at least 3 months of follow-up were analyzed for demographics, facial palsy history, previous head and neck surgeries, previous facial paralysis reconstruction, preoperative imaging, surgical approach, and postoperative outcomes. RESULTS Four female patients were identified with an average age of 62 years. All patients underwent an initial protective dissection of the facial nerve or previous reanimation reconstruction by the facial nerve reconstructive team followed by the extirpative team. The average number of previous head and neck surgeries was 5, the number of recurrences was 2, and follow-up was 20 months. Half had prior dynamic facial reanimation. Two patients underwent complete preextirpative dissection of the facial nerve resulting in neuropraxia, which recovered completely after an average of 143 days. A third patient presented with 2 recurrences, both during and after reanimation with a dually innervated free functional muscle transfer. The reconstruction was salvaged, and motion was achieved. A fourth patient presented with benign preoperative findings, but intraoperative findings confirmed malignancy, necessitating facial nerve sacrifice, followed by immediate intratemporal grafting of the facial nerve and masseteric nerve transfer. Motion appeared 139 days postoperatively. CONCLUSIONS A multidisciplinary effort should be implemented in this high risk for facial nerve injury population with the primary goal of protecting the facial nerve or any previous reanimation procedures, yet with preparedness to apply any reconstructive strategy based on intraoperative findings.
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Affiliation(s)
- Y Edward Wen
- From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
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