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PubMed2005

Horizontal branch of the supraorbital nerve and temporal branch of the facial nerve.

The aim of this article is to describe anatomical detail of the course and territory of the horizontal branch of the supraorbital nerve, which connects with temporal branch of the facial nerve. Eighteen hemifaces of Korean cadavers (11 male, 7 female) fixed in 10% formaldehyde solution were dissected. All 18 specimens had horizontal branch of the supraorbital nerve. The horizontal branch emerges out of the supraorbital foramen, runs upward about 12 mm, and then turns laterally at an angle of 104.7 degrees toward the end of the eyebrow. The average number of horizontal branches was 1.7 +/- 0.8. The skin boundary supplied by the horizontal branch was a circle with a diameter of 30 mm. The center was located at 30 mm lateral to the supraorbital foramen and 12 mm above. Grossly, the horizontal branch of the supraorbital nerve connected with the temporal branch of the facial nerve in 8 of 18 (44%) specimens. Microscopically, both nerve branches had common epineurium, but the perineuria were separated. The horizontal branch of the supraorbital nerve is in touch with the temporal branch of the facial nerve, and there are actual connections between them in 44% of cases.

Aged↗
PubMed1996

Primary neuroblastoma of the facial nerve presenting as a recurrent facial paralysis.

A case is described of a primary neuroblastoma of the facial nerve in a 13-year-old boy presenting with a recurrent facial paralysis. This tumour was excised preserving the nerve and followed with post-operative radiotherapy. The pathology of the tumour is described and facial nerve tumours briefly discussed as a cause of facial palsy. There have been no other cases of a primary neuroblastoma of the facial nerve arising at this site reported in the last 20 years.

Adolescent↗
PubMed1983

Auditory brain stem response and audiologic tests in idiopathic facial nerve paralysis.

Idiopathic facial nerve paralysis is believed by some to represent one aspect of a polyneuropathy. Conventional audiologic tests have not demonstrated involvement of the auditory portion of the eighth cranial nerve in this disorder. A case history is given of a patient with this disorder and an associated abnormal auditory brain stem response (ABR). Our study involved onetime evaluations of 17 patients with idiopathic facial nerve paralysis of varying durations. Each examination included clinical presentation and history, an audiogram, acoustic reflex, and ABR. Another patient had abnormal acoustic reflex test results ("unibox" pattern) suggestive of a brain stem lesion. On reexamination concurrent recovery of the paralysis and acoustic reflex was demonstrated. No auditory system disturbances secondary to the paralysis were detectable by ABR in this survey. The concurrent recovery of the "unibox" acoustic reflex and the facial paralysis suggests the association of a brain stem lesion with idiopathic facial nerve paralysis in this case.

Adolescent↗
PubMed1997

Medial antebrachial cutaneous nerve: a new donor graft for repair of facial nerve defects at the skull base.

When grafting a facial nerve defect after resection of a skull base cancer, the use of the greater auricular nerve is generally contraindicated because of concern of malignant involvement. In the past, the sural nerve was used as a donor graft for reconstruction of the facial nerve. We have found a sensory branch of the median nerve of the upper arm, the medial antebrachial cutaneous (MAC) nerve, to be a suitable option for facial nerve grafting. The MAC nerve provides a good diameter match for the facial nerve and has branching to allow reconstruction of the distal facial nerve in the parotid bed. The length is adequate to graft from the brainstem to the distal facial branches. Loss of sensation is limited and well tolerated by the patient. The MAC nerve has been used in grafting in 15 patients with skull base disease and facial nerve defects. No complications have been encountered, and the functional return appears to be similar to other grafts. In our practice the MAC nerve is a valuable option for facial nerve repair at the skull base.

Adult↗
PubMed2006

Temporal bone rhabdomyosarcoma presenting as acute peripheral facial nerve paralysis.

Facial palsy is not an uncommon presentation to an emergency department. Whereas most patients will ultimately receive a diagnosis of Bell palsy (idiopathic peripheral seventh cranial nerve palsy), a subset will have an identifiable cause for their facial paralysis. Children are more likely to have an identifiable cause than are adults. We present a case in which a child presented with acute peripheral facial nerve palsy and was found to have temporal bone rhabdomyosarcoma. The key clinical finding was the presence of both 7th and 12th cranial nerve palsy.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Prognostic significance of intraoperative facial nerve stimulus thresholds.

OBJECTIVE: Intraoperative facial nerve monitoring has reduced the incidence of facial nerve paralysis associated with acoustic neuroma surgery, but poor facial nerve outcomes continue to occur. Intraoperative prediction of facial nerve outcome would be advantageous in patient management and counseling. This study seeks to evaluate intraoperative facial nerve stimulus thresholds as a tool for predicting postoperative facial nerve outcome. STUDY DESIGN: This study is a prospective clinical study of the prognostic value of intraoperative stimulus thresholds. SETTING: The study was performed at a tertiary referral center. PATIENTS: There were 109 patients undergoing excision of acoustic neuromas included in this study. INTERVENTIONS: The minimum current required to stimulate the facial nerve at the brain stem was prospectively recorded after excision of the acoustic neuroma. MAIN OUTCOME MEASURES: Facial nerve outcome was evaluated by the House-Brackmann grade. RESULTS: A statistically significant relationship was found between poor initial facial nerve outcome and higher stimulus thresholds. Long-term impaired facial function was also more common in the higher stimulus group compared to that of the lower stimulus groups. CONCLUSIONS: Although these findings suggest that intraoperative stimulus thresholds have prognostic potential, other prognostic factors should also be considered and additional research is needed.

Electromyography↗
PubMedDate not supplied

[Intraoperative facial nerve monitoring: results].

Intraoperative facial nerve monitoring is performed by electromyographic recording of motor action potentials generated by facial nerve stimulation or mechanical damage of the facial nerve, and helps the surgeon to localize the course of this nerve, reduce the possibility of its injury during surgery, and assure its anatomical and functional integrity. We report our experience on the intraoperative facial nerve monitoring in 35 patients, ten of which belong to absolute indications for monitoring, and to relative indications the remaining cases. In every case, we used the Nerve Integrity Monitor (NIM-2), manufactured by Xomed. Assessment of facial nerve integrity degree is performed pre- and postoperatively using the House-Brackmann classification. We only found in two cases (5.7%) some degree of palsy in the late postoperative period. No correlation was found between the recorded intraoperative response and the functional results in the early postoperative period.

Adolescent↗
PubMed2005

Free vascularized nerve grafting for immediate facial nerve reconstruction.

OBJECTIVES/HYPOTHESIS: To obtain better functional results after reconstruction to treat facial palsy in the patients with preoperative and intraoperative factors that might inhibit functional recovery, the authors have used free vascularized nerve grafts to immediately reconstruct severed facial nerves. STUDY DESIGN: The indications for vascularized nerve grafts were 1) scarred recipient bed attributable to previous operations, 2) a history of previous irradiation at the wound, 3) facial skin defects over the nerve graft after tumor ablation, 4) patient age greater than 60 years, and 5) preoperative facial palsy. METHODS: Four types of free vascularized nerves were used. Functional recovery after reconstruction could be assessed with two facial nerve grading systems.Ten patients who underwent immediate reconstruction of severed facial nerve after ablative surgery of malignant tumors of the parotid gland were reviewed. RESULTS: Functional recovery after reconstruction could be assessed with the House-Brackmann grading system and a 40-point grading system in 6 of the 10 patients after a mean follow-up period of 29.8 months (range, 10-60 mo). Results with the House-Brackmann system were grade II in 1 patient, grade III in 4 patients, and grade IV in 1 patient; scores on the 40-point grading system were 20 in 1 patient, 22 in 3 patients, 24 in 1 patient, and 28 in 1 patient. CONCLUSION: The study results indicated that muscle movement recovers satisfactorily after free vascularized nerve grafting. Although a study comparing vascularized nerve grafts and conventional nerve grafts would be necessary to confirm the superiority of vascularized nerve grafts, free vascularized nerve grafts are effective for immediate reconstruction of the severed facial nerve in patients with preoperative and intraoperative factors that might inhibit functional recovery.

Aged↗
PubMed1995

Intraparotid facial nerve schwannoma.

Intraparotid facial nerve schwannomas have been documented sporadically throughout the medical literature. These benign tumours of neurogenic origin should be considered in the differential diagnosis of parotid region masses. A case report is presented, followed by a brief literature review and discussion of appropriate diagnostic and treatment modalities.

Cranial Nerve Neoplasms↗
PubMed2006

Side-to-end hypoglossal-facial anastomosis via transposition of the intratemporal facial nerve.

The technique of facial nerve repair with side-to-end hypoglossal-facial anastomosis is presented and evaluated in five patients who were operated on for facial nerve paralysis after acoustic schwannoma surgery, or had cranial base trauma. The end-to-end hypoglossal-facial anastomosis is accompanied by hemilingual paralysis, with difficulty in swallowing, chewing and speaking. In this new technique, the facial nerve is mobilised in the temporal bone, transected at the second genu and transposed to the hypoglossal nerve where a tensionless side-to-end anastomosis is performed. The hypoglossal nerve is transected in oblique fashion to about one third of its circumference. We were able to achieve a tensionless anastomosis in all patients. The idea is to bring about re-innervation of the previously denervated tissue via a collateral sprouting of axons of the donor nerve through the site of coaptation without sacrificing the innervation of the donor nerve's original targets. With side-to-end hypoglossal-facial anastomosis, two patients attained a House- Brackmann grade of III (one of them with independent movement of eyelids and mouth); one achieved grade IV, another grade V and grade VI. No patient had hemilingual atrophy nor any problems associated with swallowing or chewing.

Adult↗
PubMed2000

Delayed rat facial nerve repair leads to accelerated and enhanced muscle reinnervation with reduced collateral axonal sprouting during a definite denervation period using a cross-anastomosis paradigm.

To establish the influence of prolonged denervation on the recovery of a motor nerve, the rat facial nerve was transected and denervated for 0 to 224 days. Then, the freshly transected hypoglossal nerve was sutured to the predegenerated facial nerve (hypoglossal-facial nerve anastomosis, HFA). Using this nerve cross-anastomosis paradigm we analyzed the nerve regeneration and muscle reinnervation 7 to 112 days post-suture operation (DPSO). After HRP injection into the whiskerpad 931+/-27 hypoglossal neurons were labeled at 112 DPSO after immediate HFA. Following 14 to 112 days denervation the number of labeled neurons increased to 138% (14 days delay), 154% (56 days), and 145% (112 days). In contrast, the reinnervation was poorer after 7 days denervation with the number of neurons increasing to 84%, and after long-term denervation of 224 days the number of neurons increased to 81%. The increase in amplitude of evoked electromyography wave after nerve suture correlated with the number of labeled neurons. After immediate HFA each regenerated motoneuron established on average 5.1 myelinated sprouts at 112 DPSO. The number of sprouts remained constant after delayed suture of 14 to 112 days, whereas the slower reinnervation after 7 or 224 days delay was accompanied by a massive sprouting of 9.1 or 8.1, respectively, sprouts per neuron. The muscles showed recovery after any denervation time. The muscle cross-sectional area continuously decreased with longer denervation time. This decrease was only significant after 224 days denervation (67% of the normal value). We conclude that motor nerve reconstruction achieves better functional results after a definite period of denervation when using a nerve cross-anastomosis paradigm.

Anastomosis, Surgical↗
PubMed1989

[A case of facial nerve neurinoma originated from the cerebellopontine angle portion].

Facial nerve neurinomas are relatively rare and most of them appear at the vertical portion of the facial nerve. Facial nerve neurinoma originated from the cerebellopontine (c-p) angle portion is less frequently reported. A 51-year-old woman was admitted to our hospital complaining of severe headache and nausea. She had had dizziness and unsteady gait for the previous two weeks. She did not complain of hearing disturbance, but otological examination revealed sensorineural deafness. She had no facial palsy. Skull x-ray showed no erosion of the internal auditory canal. Plain CT-scan revealed a large, unenhanced, low-density mass in the right c-p angle cistern. At the time of the operation, this tumor originated from the right facial nerve. Histological diagnosis of this tumor was schwannoma. After the operation, right facial nerve palsy appeared but hardness of hearing was no worse than previously. This tumor seemed to be facial nerve neurinoma in the c-p angle cistern. To the present, 121 facial nerve neurinomas have been reported in the previous literature. Facial nerve neurinomas in the c-p angle cistern, however, have only been reported in 5 cases. The most frequent symptom of facial nerve neurinoma in the temporal bone is facial nerve palsy, but that of facial nerve neurinoma in the c-p angle cistern is hearing loss, as in an acoustic neurinoma. Preoperative diagnosis of facial neurinoma in the c-p angle cistern using neurological symptoms alone is difficult. Furthermore, differential diagnosis from acoustic neurinoma in the c-p angle cistern using only skull x-rays and CT-scanning is also difficult.(ABSTRACT TRUNCATED AT 250 WORDS)

Cerebellar Neoplasms↗
PubMed2002

Temporal bone hemangiomas involving the facial nerve.

OBJECTIVE: Hemangiomas of the facial nerve are rare tumors that can mimic more common temporal bone tumors such as vestibular schwannomas and facial nerve schwannomas. This article reviews the diagnostic challenges in the surgical treatment of facial nerve hemangiomas. STUDY DESIGN: Two case reports and literature review. RESULTS: Early diagnosis and surgical excision of facial nerve hemangiomas can sometimes allow tumor removal with facial nerve preservation. In patients in whom the facial nerve needs to be resected to remove the hemangioma, primary anastomosis or cable nerve grafting can yield House-Brackmann Grade III/VI postoperative facial nerve function. CONCLUSION: Complete surgical excision of facial nerve hemangiomas with primary facial nerve repair (when necessary) is the treatment of choice for these lesions.

Bone Neoplasms↗