[Facial nerve canal. Technique of radiological investigation and its value for the diagnosis of intratemporal facial nerve palsy of various etiology (author's transl)].
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Facial Paralysis↗
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Surgical management of iatrogenic facial nerve injuries.
Surgical management of an iatrogenic facial nerve injury represents a significant challenge for the otologic surgeon. The decision to perform facial nerve grafting is a difficult one and is based on the extent of injury to the nerve. We conducted a review of 22 patients who had sustained iatrogenic facial nerve injuries during otologic surgery that required surgical exploration. The facial nerve was transected more than half its diameter in 13 of the patients. All of these patients' nerves were repaired either with direct reanastomosis of the facial nerve or with a cable nerve graft. The transection was less than 50% in nine of the patients in the study group. Eight of these patients underwent only decompression of the facial nerve. No patient with a neural repair (direct anastomosis or cable graft) had better than a House grade III result. All of the patients undergoing direct anastomosis of the nerve obtained a House grade III result. The most common result in patients undergoing cable nerve grafting was a House grade IV. The only patients with normal or near-normal facial nerve function (House grade I or II) had only decompression of the facial nerve. Five of the eight patients undergoing decompression had results similar to those undergoing cable nerve grafts. We conclude that acceptable results can be obtained when the facial nerve is repaired by direct anastomosis or a cable nerve graft. These results are comparable with those of patients treated with decompression only. When in doubt as to the extent of injury, it is preferable to repair the facial nerve, because the extent of injury may be underestimated.
Adolescent↗
[Viral diseases of the acoustic and facial nerves with special reference to herpetic origin].
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Cochlear Nerve↗
The bony crescent sign--a new sign of facial nerve schwannoma.
Schwannomas of the facial nerve are rare slowly growing lesions that have a predilection for the geniculate ganglion. Radiological evaluation is important in their diagnosis and in the assessment of their extent. In our series of 4 cases the facial nerve schwannoma was seen on high resolution CT as a soft tissue mass bounded anteriorly by a thin rim of bone. This bony crescent sign is a previously undescribed sign of facial nerve schwannoma which appears on the basis of this small series to be strongly indicative of the presence of this tumour. Schwannomas are relatively uncommon intracranial tumours. They most commonly involve the acoustic nerve followed in frequency by the trigeminal nerve. Other cranial nerves are rarely involved. Facial nerve schwannomas occurring within the petrous temporal bone are very rare. Their diagnosis may be missed prospectively even when appropriate CT scans are performed. Even in retrospect the site of abnormality may be difficult to identify, especially if there is an associated middle ear mass such as a cholesteatoma. Lesions occurring in the petrous area are all rare. The differential diagnosis includes cholesterol granuloma, epidermoid, carotid aneurysm and, very rarely, primary and secondary bone tumours. We describe a new sign associated with facial nerve schwannoma on CT, that of a bony crescent. Recognition of this sign makes those tumours arising in the region of the geniculate ganglion easy to diagnose prospectively.
Adolescent↗
[Evaluation methods of the degree of regeneration after experimental nerve repair. Evaluation model for the facial nerve in rats].
The AA. after sever the facial nerve trunk of Wistar mice (so interrupting its path owing to the loss of about 4 mm of its anatomical continuity) repair the faulty portion with several grafts, and 4 months later consider the gained results achieved in each of the following parameters: functional, morphological, biochemical and electrophysiological and, finally, compare the own outcomes with bibliographic references of literature regarding this subject.
Animals↗
Intraparotid facial nerve schwannoma: diagnosis and management.
OBJECTIVE: Facial nerve schwannomas are rare neoplasms that present a challenge in diagnosis and management. We sought to gain insight into the clinical presentation and its implications in management. STUDY DESIGN AND SETTING: A group of patients diagnosed with schwannoma was reviewed, with focus on tumor arising in the intraparotid region of the facial nerve. The patient population consisted of 3722 patients evaluated retrospectively over 38 years at the Shadyside Facial Paralysis Center, a tertiary referral center. From this population, 29 patients (18 women and 11 men) with the diagnosis of schwannoma were selected for review. RESULTS: Twenty-nine patients had facial nerve schwannoma. The average age at diagnosis was 44 years (range, 7 to 78 years). Eight patients had intraparotid involvement, with 5 having a palpable mass in the parotid. The duration of symptoms averaged 8.4 years overall, with intraparotid involvement averaging 10.9 years. The 8 intraparotid schwannomas had a mean House-Brackmann grade of 1.5/6 at initial presentation. Postoperative facial nerve function was only 4.4/6 for resected intraparotid schwannomas. CONCLUSIONS: Intraparotid facial nerve schwannomas are slow growing tumors, which are usually asymptomatic but can be painful. Schwannoma should be suspected if the facial nerve cannot be found intraoperatively or if the tumor is intimately associated with the facial nerve. In cases where schwannoma is suspected, biopsy is recommended, while complete resection is postponed to obtain imaging studies to evaluate the extent of disease and to discuss possible outcomes with the patient. SIGNIFICANCE: This article provides guidance for the appropriate management of intraparotid facial nerve schwannoma.
Adolescent↗
Intraoperative facial nerve monitoring in acoustic neuroma surgery.
Intraoperative facial nerve monitoring simultaneously using electromyography and mechanical pressure sensors is being used in retrosigmoid and translabyrinthine approaches for acoustic neuroma resection. Insulated electrified microsurgical instruments and air drills are used to stimulate the facial nerve with a pulsed, constant current through bone and tumor, before the facial nerve is visually encountered. Electrical stimulation is used to help locate the facial nerve, map the course of the facial nerve within tumor, warn the surgeon of unexpected facial nerve locations, and help predict facial nerve function postoperatively. In 57 unmonitored cases a House-Brackmann (H-B) grade I or II result was obtained in 77 percent of small, 81 percent of medium, and 60 percent of large tumors. In 64 monitored cases H-B grade I or II was obtained in 88 percent of small, 79 percent of medium, and 90 percent of large tumors. Overall, facial nerve outcomes were better after monitored procedures (p < 0.02). A modified H-B classification for acute facial nerve injury is introduced to grade facial weakness immediately postoperatively and until function is stable at 1 year. In the unmonitored group there were five (9%) cases with a complete facial paralysis, facial nerve intact (i.e., acute H-B grade VIA) and seven (13%) cases with the facial nerve transected (i.e., acute H-B grade VIB). In the monitored group there were five (8%) acute H-B grade VIA and two (3%) acute H-B grade VIB results. In the unmonitored group of large tumors, there were statistically more patients with an acute H-B grade VIB result (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Facial nerve paralysis.
Bell's palsy, an idiopathic facial nerve palsy, is the most common cause for acute facial nerve paralysis. Bell's palsy is not synonymous with facial nerve paralysis but is a diagnosis of exclusion for acute onset of idiopathic facial nerve paralysis. The differential diagnosis for facial nerve paralysis should be considered to correctly evaluate and give appropriate therapy in a timely fashion for the treatable causes of facial nerve paralysis. The status of facial nerve paralysis should be monitored by repeat electrical examinations, preferably ENoG. Most importantly, no one treatment is appropriate for all patients with facial nerve paralysis.
Diagnosis, Differential↗
Facial nerve neuroma management.
Three facial nerve neuromas were identified in the academic year 1994-1995. Each case illustrates different management dilemmas. One patient with a grade III facial nerve palsy had a small geniculate ganglion neuroma with the dilemma of decompression versus resection clear nerve section margins. The second patient underwent facial neuroma resection with cable graft reconstruction, but the permanent sections were positive. The last patient had a massive neuroma in which grafting versus other facial reconstructive options were considered. These three cases illustrate some of the major controversies in facial nerve neuroma management. We discuss our decision-making plan and report our results.
Case Reports↗
The incidence of facial nerve dehiscence at surgery for cholesteatoma.
OBJECTIVE: Facial paralysis can occur after surgery for cholesteatoma. The risk of facial nerve injury is great when the nerve is not covered by its normal bony Fallopian canal. The objective of this study was to identify the incidence of facial nerve dehiscence in patients undergoing surgery for cholesteatoma. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral hospital. PATIENT POPULATION: An assessment of all cases performed by the senior author from 1991 to 1999 revealed 59 patients with adequate data available for analysis. These patients ranged in age from 3 to 92 years. In all, 67 surgical procedures. INTERVENTION: Surgery for cholesteatoma, including tympanoplasty and mastoidectomy. MAIN OUTCOME MEASURE: The presence of facial nerve bony dehiscence after exenteration of disease, and postoperative facial nerve function. RESULTS: In 33% of the total procedures analyzed, 30% of the initial procedures, and 35% of the revision procedures, the patients were found to have facial nerve bony dehiscence. The dehiscence was present in the tympanic portion of the facial nerve in the vast majority of patients. Of the 97% of patients with normal preoperative facial nerve function, all retained normal function postoperatively. CONCLUSIONS: Facial nerve dehiscence in our series was far greater than that reported in the literature, underscoring the fact that this is an under-appreciated condition. These findings suggest that surgeons should be highly vigilant when dissecting near the facial nerve. Intraoperative facial nerve monitoring has been shown to be of value in facial nerve preservation during acoustic neuroma resections, and may have a role during surgery for cholesteatoma.
Adolescent↗
The repair of combat-injured facial nerves.
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Adult↗
[Microanatomical relationships of the anterior inferior cerebellar artery and the facial nerve].
The microanatomical relationships between facial nerve and anterior inferior cerebellar artery were examined in 30 adult cadavers. Seventeen of the 60 arteries were situated ventrally to the facial nerve; 8 dorsally to the facial nerve root; 26 passed between the seventh and eighth cranial nerves; 9 round the seventh and eighth cranial nerves. Forty-one of the 60 nerves were in contact with the arteries. The significance of microanatomical relationships between the anterior inferior cerebellar artery and the facial nerve was discussed.
Arteries↗
[Histopathological study of the recovery process in experimental facial nerve palsy induced by freezing].
The facial nerve has a specific anatomical feature in that it pursues a relatively long course through a bony canal, originating in the fundus of the internal auditory meatus, until emerging at the stylomastoid foramen. Facial nerve palsy, which is often observed clinically, exhibits a high recovery rate of facial movement. There is no consensus, however, as to the influence of the anatomical features of the facial nerve on the pathological evolution of the palsy. The purpose of this study is to investigate how histological alterations, following injury of the nerve, are influenced by the anatomical feature mentioned above. Mongolian gerbils, weighing 60 g-90 g, were used. Facial nerve palsy was induced by freezing the tympanic part of the facial nerve. Myringotomy was then performed using microscope. The middle ear space was frozen at -2 degrees C to -8 degrees C for 30 seconds through perforation with dimethylether liquid propane gas. Facial nerve palsy was confirmed by loss of the blink reflex and whisker movement. Specimens were removed from the tympanic part of the facial nerve, embedded in epon, and the sections were examined under light and electron microscopy. Out of 16 ears (13 animals) thus frozen, 15 (94%) exhibited complete facial palsy. Facial movement recovered within the 21-to 35-day period after freezing. At thirty-six hours after freezing, thin regenerating axons were seen in Schwann cell basal lamina scaffolds. Even on the seventh day after freezing, when connective tissue around the nerve trunk was thickest, regenerating axons continued to grow and did not degenerate.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Optimal stimulus duration for intraoperative facial nerve monitoring.
OBJECTIVES/HYPOTHESIS: The charge delivered to the facial nerve during intraoperative facial nerve monitoring (IOFNM) is the product of the stimulation amplitude and the duration for which the pulse of charge is applied. In the literature, no standard for pulse duration exists, precluding meaningful comparison of IOFNM between studies. The optimal stimulus pulse duration can be derived from facial nerve strength duration curve analysis and calculation of chronaxy. Chronaxy is directly related to the time constant, tau, of the neuronal membrane, and is a function of neuronal membrane resistance and capacitance. STUDY DESIGN: A prospective trial of facial nerve stimulation in both an animal and a human model. METHODS: Five rabbits and 17 humans underwent intraoperative stimulation of healthy facial nerves. Pulse durations using pulses of 10, 20, 50, and 100 microseconds were employed, and the corresponding threshold stimulation amplitudes were recorded. From these data sets, strength duration curves were plotted and chronaxy values calculated. RESULTS: Average chronaxy values of 18 microseconds in the rabbit and 32 microseconds in the human were found. Given IOFNM system accuracy limitations, the optimal pulse duration for facial nerve stimulation is 50 microseconds. CONCLUSION: Most commercially available intraoperative monitoring systems employ a pulse duration default setting of 100 microseconds. Doubling of the 50-microsecond optimal pulse duration may result in a loss of sensitivity of predictive facial nerve data. Both the stimulation amplitude and the selected pulse duration should be reported by investigators so that meaningful comparison of the IOFNM data in the literature can be made.
Animals↗
Posterior geniculate artery: a surgeon's guide to the facial nerve.
Locating the facial nerve is an essential step in most mastoid procedures. A constantly occurring, easily identifiable, arterial bleeding point has been identified arising on the posterosuperior-lateral eminence of the posterior genu of the nerve, passing posterosuperiorly. The vessel permits exact sitting of the genu before the nerve is seen, and provides a timely warning of the nerve's presence.
Carotid Artery, External↗
Primary neoplasms of the facial nerve.
A series of 30 primary facial nerve tumors is reviewed. Most of them were benign (n = 26); there were four malignant tumors. Neoplasms originating within the temporal bone were found to have preoperative facial paralysis in 84 percent of cases; the extracranial tumors had a 35 percent incidence of preoperative facial paralysis. All tumors in this series were treated surgically--by means of a middle fossa or transmastoid approach for the intratemporal group of tumors; the extracranial tumors were removed by the technique of parotid tumor surgery with complete facial nerve dissection. All the patients with preoperative facial weakness required facial nerve transection. Facial paralysis was rehabilitated with nerve grafts, hypoglossal crossover, or muscle transfers. Because "normal" facial expression is still not attainable following repair of complete facial nerve transection, an early diagnosis, hopefully prior to total neurotmesis, is essential. All patients with unexplained facial weakness, especially that which is progressive and persistent, should have the entire course of the facial nerve investigated for the possibility of treatable etiology.
Cranial Nerve Neoplasms↗
[Treatment of facial nerve paralysis using static suspension methods].
After the injury of facial nerve, facial muscles are subjected to complex series of biochemical and histological changes, which lead to muscular atrophy if reinnervation is not restored. Facial palsy is very difficult to manage completely. Regardless this fact, the plan of correction has to be directed towards the following: restoration of normal function, normal facial appearance at rest, symmetry in voluntary movements as well as symmetry in involuntary and emotional movements. Static suspension methods were used in our study. All patients had unilateral complete facial nerve palsy but one female patient who experienced the palsy of frontal branch of n.facialis. This method was successfully used to lift the eyebrow, the lid and to improve lagophthalmus on the paralytic side, then the angle and paralytic part of the lip, to reinforce buccal wall of oral cavity as well as to reconstruct new nasolabial fold. The results were satisfactory and permanent.
Facial Muscles↗
Motoneurons innervating facial muscles after hypoglossal and hemihypoglossal-facial nerve anastomosis in rats.
Hypoglossal-facial nerve anastomosis (HFA) is the most popular surgical procedure to reinnervate facial muscles after injury of the facial nerve. Section of the hypoglossus causes paralysis and atrophy of the hemi-tongue. In the attempt to overcome this consequence, the hemihypoglossal-facial nerve anastomosis (HHFA) has been proposed and only a half of the main trunk of the hypoglossus is connected to the distal stump of the facial nerve. In the rat, we have studied experimentally the anatomical nuclear changes after HFA and HHFA with the aim of establishing the quantitative motoneuron innervation of facial muscles obtained with each one of the two operative options. Horseradish peroxidase (HRP) injected in both types of anastomosis labeled not only hypoglossal motoneurons, but also facial motoneurons. HFA appeared to offer a significant quantitative motoneuron innervation higher than HHFA and then a higher probable better functional recovery. Both HFA and HHFA performed immediately after section of the facial nerve in rats did not result in a phenomenon of motor hyperinnervation. In our experimental model, the proximal facial nerve stump was coagulated at the stylomastoid foramen to avoid regeneration. Then, the labeled motoneurons into the facial nucleus could really be the expression of axonal projections from facial motoneurons to the hypoglossus nerve and facial muscles. No labeled motoneurons were seen contralaterally as we observed previously after section and repair of several nerves.
Anastomosis, Surgical↗