Facial nerve hemangioma.
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Cranial Nerve Neoplasms↗
Biomedical subjects
D E Brackmann
Publications and source records attributed to D E Brackmann.
Goals and mechanisms for training otolaryngologists in the area of geriatric medicine.
Population dynamics indicate that the need for services by otolaryngologist-head and neck surgeons will increase. These requirements will also be more complex because of the prevalence of other diseases in the elderly and their varied social and psychological demands. To meet that need, additional research in head and neck disorders and physiology will be necessary. Current and newly developed information relating to geriatrics in otolaryngology must be incorporated into present training and continuing education programs to provide members of our specialty with enough background to adequately diagnose and treat head and neck disorders in the elderly. Otolaryngologist - head and neck surgeons and their elderly patients will benefit from the creation of centers and fellowships that study pathologic processes and normal physiologic change, and that train a new generation of physician-scientists committed to the care of elderly head and neck patients.
Aged↗
Glomus vagale tumor: the significance of early vocal cord paralysis.
Glomus body tumors most frequently originate in the middle ear (tympanicum) or on the jugular bulb (jugulare). Tumors that arise from the vagal body account for less than 2.5% of these unique paraganglionic neoplasms. Otologic manifestations of tympanicum and jugulare tumors usually precede or accompany neurologic findings. In reviewing five cases of glomus vagale tumors, the initial symptom of voice change, caused by vocal cord paralysis, preceded the presenting symptoms of hearing loss and tinnitus by an average of 2.5 years. The concept of early cranial nerve involvement by glomus vagale tumors is supported in a literature review. The evaluation of "idiopathic" vocal cord paralysis must include radiographic inspection of the skull base, whereas an accurate, temporal account of presenting symptoms may help distinguish vagal body tumors from other vascular neoplasms of this region.
Adult↗
Cavernous hemangiomas of the internal auditory canal.
Cavernous hemangiomas are vascular malformations that are seldom found in the central nervous system. Four cavernous hemangiomas of the internal auditory canal and one of the cerebellopontine angle have been reported previously. We present a series of seven (six of which have never been reported) cavernous hemangiomas limited primarily to the internal auditory canal. Whereas all cases but one had marked unilateral sensorineural hearing loss, only two had preoperative facial nerve dysfunction. There are no specific symptoms or physical or audiometric findings to differentiate cavernous hemangiomas from acoustic neuromas. However, a hemangioma should be suspected when facial paralysis is present in conjunction with a small intracanalicular tumor as demonstrated by computed tomography or magnetic resonance imaging. The former reveals calcium stippling in the lesions, whereas magnetic resonance imaging reveals a high signal intensity on both T1- and T2-weighted images.
Adult↗
Improved preservation of facial nerve function in the infratemporal approach to the skull base.
Although the infratemporal approach described by Fisch provides excellent exposure of the jugular foramen, intrapetrous carotid artery, and lateral skull base, the anterior displacement of the seventh cranial nerve often results in temporary facial paralysis. The use of a modified technique for facial nerve mobilization resulted in significant improvement of both early and final facial function. Since that earlier report, continuous intraoperative electrical facial nerve monitoring has been used during the infratemporal approach in 20 additional cases. Immediate postoperative facial function was normal in 93% of the monitored cases and in 70% of the cases in the unmonitored group. More importantly, no patients in the monitored group developed grade V or VI weakness after surgery, whereas 48% of the unmonitored patients had grade V or VI weakness during the early postoperative period. This article will describe how intraoperative facial nerve monitoring is used during infratemporal surgery and will compare early facial function in 31 unmonitored patients with early facial function in 20 monitored procedures.
Adult↗
Middle fossa acoustic tumor surgery: results in 106 cases.
Although the middle cranial fossa approach has been used less frequently in recent years than in the past, it continues to be a useful technique for the removal of small acoustic tumors with possible hearing preservation. The approach provides complete exposure of the contents of the internal auditory canal, thus allowing positive facial nerve identification and facilitating total tumor removal. This paper reports the results of 106 middle fossa acoustic tumor removals over a 25-year period. Measurable postoperative hearing remained in 59% of cases. In 89% of cases, normal or near-normal postoperative facial nerve function was obtained. Total tumor removal was achieved in 98% of cases. Preoperative selection criteria are discussed, and postoperative complications are reported.
Adult↗
Effects of preoperative embolization on glomus jugulare tumors.
The charts of 35 patients were reviewed retrospectively to determine the effects of embolization on glomus jugulare tumors. Eighteen patients underwent embolization; 17 did not. All tumors were removed with a type A infratemporal fossa approach. The charts were evaluated for operative blood loss, operative time, length of hospitalization, new postoperative cranial nerve deficits and recurrence of tumor. Embolized patients had significantly less operative blood loss and operative time. Embolization did not affect length of hospitalization or reduce the incidence of new postoperative cranial nerve deficits. The surgeon's experience also plays a central role in reducing operative blood loss and operative time. The potential risks of embolization must be considered in the treatment regimen of glomus jugulare tumors.
Adult↗
Neuromas of the facial nerve.
Forty-eight patients with facial nerve neuromas were treated at the Otologic Medical Group Inc. between 1974 and 1985. The most common presenting symptoms were hearing loss and tinnitus. Facial paralysis occurred in 22 patients (46%). A mass behind the tympanic membrane was seen on otoscopy in 14 patients (29%). These tumors typically involved more than one segment of the nerve and eroded otic capsule bone in 14 patients (29%). High resolution computed tomography (CT) was highly accurate in determining the extent and location of these tumors. Restoration of the continuity of the nerve was undertaken at the time of tumor removal. The major determinant of the ultimate status of facial nerve function was the duration of preoperative paralysis.
Adolescent↗
Actinomycosis otitis media.
Infection of the middle ear and mastoid by actinomycosis is uncommon. We report the 21st case in the English literature. Actinomycosis otitis media is characterized by an indolent course but may be fatal. Multiple recurrences after standard antibiotic therapy are common. Effective treatment consists of surgery and penicillin for several months.
Actinomycosis↗
Why do vestibular destructive procedures sometimes fail?
Vestibular nerve specimens and one temporal bone, from patients with vestibular symptoms after destructive surgery on the vestibular system, were studied by light microscopy. Surviving nerve axons in three specimens that followed retrolabyrinthine vestibular nerve section (RLVNS) were counted and compared to normative data. Results are consistent with persistence of the central processes of primary vestibular neurons in three specimens from patients who had persistent symptoms and ice-water caloric responses after RLVNS. Incomplete neurectomy probably results from anatomic variations in the plane of separation of the vestibular and cochlear portions of the eighth nerve in the posterior fossa. Regeneration neuromas were found in the vestibule after a complete transmastoid labyrinthectomy and a Fick sacculotomy; this indicates that wide degrees of injury to the labyrinth may provoke this response. Disabling unsteadiness after labyrinthectomy may or may not respond to revision surgery (translabyrinthine vestibular nerve section). The indications for revision surgery are discussed. The excision of Scarpa's ganglion by the translabyrinthine route offers the best chance to ensure complete removal of peripheral vestibular tissue, minimize postoperative unsteadiness, and prevent neuroma formation.
Adult↗
Retrolabyrinthine vestibular neurectomy: a reevaluation.
Selective vestibular neurectomy is considered an effective means of relieving intractable vertigo while preserving hearing. In order to determine the effectiveness of the retrolabyrinthine approach to selective vestibular neurectomy, we evaluated 161 patients who underwent vestibular neurectomy between April 1981 and September 1985. Questionnaire responses indicated that 97% of the Meniere's disease patients and 68% of the non-Meniere's disease patients experienced a substantial improvement or resolution of their vertiginous symptoms. Hearing was maintained within 10 dB of the preoperative level in the majority of the patients. Neurological complications were limited to 2 cases of meningitis which resolved with medical therapy, 7 cases of cerebral spinal fluid leaks, and 3 cases of complete sensorineural hearing loss. Based on this review, we concluded that retrolabyrinthine vestibular neurectomy continues to be a safe and effective approach to relieve ear-related vertigo.
Adult↗
Endolymphatic sac surgery in congenital malformations of the inner ear.
A retrospective analysis of 40 patients (49 ears) with congenital progressive sensorineural hearing loss who underwent endolymphatic sac surgery was performed. The inner ears were radiographically abnormal in 57% of operated ears. In the remaining cases, subtle malformations beyond the resolving power of radiographic studies were suspected. Early postsurgical hearing loss (defined as a loss greater than 10 dB in three-tone average or greater than 15% in speech discrimination score) was found in 29% of operated ears (14/49). However, only two of these patients lost all of their residual hearing postoperatively (2/49 or 4%). An enlarged endolymphatic sac was noted at surgery in 50% of those with significant postoperative hearing losses. Longer-term stability of hearing was assessed in 22 patients with bilateral inner-ear pathology who underwent surgery on one side only. A comparison of the hearing fate of the operated and nonoperated ears suggested no benefit from the surgical intervention when compared to the natural history of the disease. Based upon this experience, endolymphatic sac surgery for the purpose of hearing stabilization in patients with congenital malformations of the inner ear is no longer recommended.
Adolescent↗
The facial nerve in the infratemporal approach.
A new method of re-routing the facial nerve in the infratemporal fossa approach is presented. Exposure of the skull base is not compromised and better immediate and long-term facial function is achieved. A consecutive series of 31 cases is discussed.
Facial Nerve↗
Multiple sclerosis manifesting as sudden hearing loss.
We have presented a unique case in which sudden sensorineural hearing loss was the only initial symptom that developed in a patient who later displayed further symptoms consistent with multiple sclerosis. Although an uncommon cause of sudden hearing loss, multiple sclerosis should be suspected in patients whose symptoms are resistant to routine treatment modalities and in whom other (seemingly incongruous) cranial neuropathies develop.
Adult↗
Recommendations for the reporting of preoperative testing and postoperative results in cochlear implantation.
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Cochlear Implants↗
Vestibular nerve section in patients with chronic otitis media.
Retrolabyrinthine vestibular neurectomy preserves hearing and relieves intractable vertigo emanating from the inner ear. However, this approach must be modified in patients with prior "canal-wall-down" procedures. Traversing an exteriorized mastoid cavity risks bacterial contamination of the subarachnoid space. Three patients seen at the Otologic Medical Group with prior canal-wall-down procedures required vestibular neurectomy for persistent vertigo. Using the retrosigmoid approach, the vestibular nerve was sectioned without sacrificing hearing and without traversing a potentially infected mastoid cavity. It is recommended that this approach be considered in patients with intractable vertigo, serviceable hearing, and exteriorized mastoid cavities.
Aged↗
Xanthoma of the temporal bone and skull base.
Xanthomata are soft tissue tumors composed of lipid-laden "foamy" histiocytes associated with cholesterol clefts and inflammation. They are considered to be specialized granuloma rather than true neoplasms and are usually associated with disorders of lipid metabolism, most commonly one of the hyperlipoproteinemia syndrome. A rare case of a xanthoma involving the temporal bone and causing extensive destruction of the skull base is presented. Otalgia and infection are the most common presenting symptoms of this disorder, with multiple cranial nerve palsies resulting in some cases. Treatment includes conservative surgical debulking, dietary restriction of fat and cholesterol, and pharmacologic reduction of serum lipids.
Adult↗
Lateral sinus thrombosis: diagnosis and treatment--a case report.
Lateral sinus thrombosis is a difficult diagnostic problem. Specialized computerized tomography allows non-invasive preoperative visualization of sinus contents enabling the surgeon to make a definitive diagnosis with appropriate preoperative planning. This case report details these specialized techniques and their application to a case of lateral sinus thrombosis.
Child↗