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PubMed1995

Lacrimation induced by thermal stress in patients with a facial nerve lesion.

I measured facial sweating, flushing, and lacrimation during body heating in 10 patients with a facial nerve lesion compromising parasympathetic outflow. During heating, moisture accumulated in the symptomatic eye of patients with facial nerve palsy, particularly in patients with a long-standing lesion. Sweating and flushing in the forehead were symmetrical. These findings suggest that sympathetic neural discharge during heat stress influences lacrimation in the symptomatic eye of patients with a long-standing facial nerve lesion. Cross-innervation of lacrimal neurons by sympathetic fibers passing through the sphenopalatine ganglion or occupation of degenerated parasympathetic pathways by sympathetic fibers in the periphery could mediate this response.

Adult↗
PubMed1997

[Intra-parotid neurogenic tumors of the facial nerve. Value of MRI].

Facial nerve intraparotid neuromas are rare. We report two cases with no facial paralysis. In the first case, the clinical protocol for the evaluation of a parotid mass did not suggest the intramastoid tumor extension. This extension was shown by CT and MRI and confirmed by gross and microscopic appearance. In the second case, no intrapretrous extension was observed with MRI. The diagnosis of neuroma was made during surgery. With a literature review, we discuss the diagnostic difficulties encountered in the investigation of parotid facial nerve tumors, emphasizing on the usefulness of CT and MRI in its diagnosis.

Adult↗
PubMed1998

Preoperative percutaneous facial nerve mapping.

Peripheral branches of the facial nerve, the marginal mandibularis in particular, are vulnerable to injury during facial surgery, i.e., submandibular gland surgery, flap development in radical neck dissection, liposuction of the jowl area, percutaneous insertion of a screw for mandibular plating, especially at the angle of the mandible, and elevation of the superficial musculoaponeurotic system (SMAS) in rhytidectomy. There is no technique available to locate the peripheral branch of the facial nerve preoperatively so that the area containing the nerve branch can be avoided in making an incision or in developing a tissue plane. Unlike the otoneurological or neurosurgical procedures, the facial nerve branches are not actively explored in facial plastic surgery. Instead, the purpose of many techniques developed in the past is to avoid dissecting an area where the nerve might be located. The author developed a new method that can preoperatively and percutaneously identify and map the course of the peripheral branch of the facial nerve. Percutaneous facial nerve mapping (PFNM) allows a surgeon to make his or her incision in a more favorable location, as the exact course of the facial nerve is already visualized by the mapping technique. A tissue plane adjacent to a facial nerve can be dissected more safely and aggressively, where and whenever necessary. Of 57 cases studied since August of 1994, the mapping was possible in most patients, except for earlier cases in a developmental stage.

Electric Stimulation↗
PubMed1989

Magnetic resonance imaging of the facial nerve.

Magnetic resonance imaging (MRI) of the facial nerve was evaluated by studying normal volunteers and patients with diseases of the facial nerve with a 0.3 Tesla permanent-magnet MRI system with special surface coils. The normal MR images were correlated with the anatomy of thin cryosection specimens of fresh cadavers. The seventh nerve was followed from its nucleus in the brainstem through the temporal bone to the parotid gland bed. The entire labyrinth and tympanic portions, as well as the geniculate ganglion, could be shown with appropriate scan planes. Examples of brainstem diseases affecting the facial nerve and nucleus, facial neuromas, parotid tumors involving the facial nerve, and other diseases were studied. MRI is a technique that allows unique evaluation of the entire course of the facial nerve. It produces superior images of the facial nerve with high-contrast resolution. Unlike computed tomography, there is no beam-hardening artifact from the temporal bone or exposure to ionizing radiation and contrast agents. MRI also allows visualization of the main trunks of the facial nerve in the parotid bed not possible with any other imaging technique.

Facial Nerve↗
PubMed2004

[Experimental and clinical study on intraoperative monitoring of facial nerve].

OBJECTIVE: The aim of the study is to determine parameters that be predictive of function of facial nerve after facial nerve decompression surgery. METHOD: Fifteen New Zealand white rabbits (30 facial nerves) and 21 patients with peripheral facial paralysis were monitored intraoperatively during facial nerve decompression surgery. These patients were followed up for at least 6 months. RESULT: Threshold of EMG is a steady parameter of assessing the function of facial nerve. The threshold between different segments of facial nerve has no difference in New Zealand white rabbits. That there exist EMG events were correlated significantly with good postoperative facial nerve function. CONCLUSION: Threshold of EMG can be used as objective and steady parameter that assess the function of facial nerve. Intraoperative monitoring events can be used for assessment of postoperative facial nerve function.

Adolescent↗
PubMed1994

Blast injuries to the facial nerve.

The recommended treatment of penetrating traumatic facial nerve injuries associated with immediate, total paralysis of the ipsilateral facial muscles generally includes facial nerve exploration and repair. We reviewed our experience with bullet injuries to the extratemporal facial nerve to determine the efficacy of this approach. Five patients with immediate, total facial nerve paralysis caused by bullet wounds near the extratemporal facial nerve were seen between July 1990 and December 1992. Of four patients who underwent surgical exploration, only one demonstrated complete transection of the facial nerve. Two of these four were followed up with serial electroneuronography, which demonstrated complete degeneration within the first week after injury. The fifth patient was followed up with serial electroneuronography without complete degeneration, and partial recovery was observed. We conclude that penetrating bullet injuries with immediate, total facial paralysis may not necessarily be associated with transection of the facial nerve. We propose a method of treating patients with these injuries using electroneuronography.

Adult↗
PubMed2004

Expression of emotion and quality of life after facial nerve paralysis.

OBJECTIVE: To investigate the facial expression of emotion and quality of life in patients after long-term facial nerve paralysis. STUDY DESIGN: Cross-sectional. SETTING: Facial nerve paralysis clinic. PATIENTS: Twenty-four patients with facial nerve paralysis and 24 significant others (partner, relative, friend). INTERVENTION: Patients were assessed using Sunnybrook, Sydney, and House-Brackmann grading scales and SF-36, Glasgow Benefit Inventory, and Facial Disability Index quality-of-life measures. RESULTS: When patients identified themselves as either effective or not effective at facially communicating each of Ekman's primary emotions (happiness, disgust, surprise, anger, sadness, and fear), 50% classified themselves as not effective at expressing one or more of the six emotions. Significant others of the not effective patients rated the emotions as more difficult for their partner-patients to communicate facially than did the significant others of effective patients. The SF-36 quality-of-life survey revealed lower social functioning relative to physical functioning for not effective patients. From the Sunnybrook Facial Grading System, more synkinesis was found for those patients not effective at expressing happiness, less brow and eye movement for patients not effective at expressing sadness, and less voluntary movement for those not effective with surprise. CONCLUSION: Movement deficits associated with expressing specific emotions and an association with quality-of-life measures were identified in patients with long-term facial nerve paralysis who saw themselves as not effective at facial expression of emotions. To improve management of emotional expression in patients with facial nerve paralysis, a broader approach is recommended, linking the practitioner's treatment goals with patient-driven outcome goals.

Adolescent↗
PubMed1991

Hypoglossal-facial nerve interpositional-jump graft for facial reanimation without tongue atrophy.

The hemitongue paralysis that occurs as a result of a classic hypoglossal-facial nerve crossover procedure can result in profound functional deficits in speech, mastication, and swallowing. The procedure is not an option in patients with bilateral facial paralysis or those at risk for combined cranial nerve deficits. To address some of the drawbacks and limitations of this classic procedure, we developed the hypoglossal-facial nerve interpositional jump graft (12-7 jump graft) procedure. This procedure involves interposing a nerve graft between a partially severed but functionally intact twelfth cranial nerve and the degenerated seventh cranial nerve, and is often combined with other reanimation procedures. To date, we have performed 33 12-7 jump graft procedures in 30 patients (three were treated for bilateral facial paralysis); this report describes the procedure and its indications, and details the results of 23 procedures performed in 20 patients for whom 24-month follow-up data are available. Twelfth nerve deficits occurred in only three patients in this report. Recovery of facial function began between 3 and 24 months postoperatively. Facial tone and symmetry were achieved in every patient, no patient had significant mass movement, and 13 patients (two of whom were treated for bilateral facial paralysis) had excellent and three had superb restoration of facial movement. These results show the 12-7 jump graft to be a valuable adjunct for facial reanimation in selected patients.

Adolescent↗
PubMed1994

Facial nerve neuromas presenting as acoustic tumors.

Facial nerve tumors can present as masses in the internal auditory canal or cerebellopontine angle and may mimic an acoustic neuroma. These tumors can occur in any segment of the nerve from the brain stem to the neuromuscular junction. Prior to the advent of computed tomography and magnetic resonance imaging with gadolinium, facial nerve tumors were often difficult to diagnose. Even with these modalities it may be difficult to distinguish preoperatively between an acoustic neuroma and a facial schwannoma. Particular signs and symptoms associated with facial nerve tumors (in the spasms, and a facial tic. These symptoms, combined with modem radiologic studies, should allow for more accurate diagnosis, patient counseling, and treatment. This report presents a series of 32 facial nerve tumors diagnosed and treated at The Otology Group from 1975 to 1992. Of these lesions, 12 (38%) were thought to be acoustic neuromas. Eighteen tumors were correctly identified preoperatively as facial nerve tumors. Two facial nerve tumors were found incidentally.

Adult↗
PubMed2003

Medical malpractice and facial nerve paralysis.

BACKGROUND: Iatrogenic facial nerve paralysis is a devastating surgical complication that occasionally results in litigation. OBJECTIVE: To analyze litigation trends to better understand the causes and outcomes of suits involving facial nerve paralysis to prevent future litigation and improve physician education. DESIGN: Retrospective review. SETTING: All US civil trials. PARTICIPANTS: All state and federal civil trials alleging malpractice and facial nerve paralysis were reviewed. METHODS: Jury verdict reviews from January 1, 1985, to December 31, 2000, were obtained from a computerized legal database and analyzed. Reviews compile data on defendants, plaintiffs, allegations of wrong doing, and expert witness specialties, and provide case summaries. Fifty-three cases from 19 of the 50 states were obtained. Data were entered into a spreadsheet for analysis. MAIN OUTCOME MEASURES: Verdicts and indemnity payments. RESULTS: Suits reviewed were as follows: cosmetic, 12 (23%); otologic, 13 (25%); nonneoplastic disease of the parotid or other benign conditions of the head and neck, 15 (28%); benign neoplasms of the parotid, 9 (17%); malignant neoplasms of the parotid, 1 (2%); and temporomandibular joint operations, 3 (6%) (percentages do not total 100 because of rounding). Allegations of negligence were frequently multiple and included lack of informed consent (16 [30%] of 53), failure to diagnose (10 [19%] of 53), and surgical misadventures (47 [89%] of 53). Excluding failure to obtain consent or to diagnose, 28 suits still alleged negligence based solely on a surgical misadventure. Of these suits, 12 (63%) resulted in plaintiff awards. CONCLUSIONS: Surgeons must emphasize and document the likelihood and consequences of this devastating complication to all patients undergoing surgery in this area. Risk management goals include a thorough and timely examination and careful and thoughtful surgical approaches. However, patient rapport and bedside manner may be the only protection the surgeon has from litigation arising from this complication.

Adult↗
PubMed1987

Static syndrome after cross-facial nerve transplantation.

A cross-facial nerve graft connected to buccal branches of the healthy facial nerve may carry axons destined for the orbicularis oris muscle as well as axons destined for elevators and abductors of the corner of the mouth. If this nerve graft innervates a pedicled or free muscle flap, contractions of the flap or part of it will also occur when the patient purses his lips. This results in immobilization of the corner of the mouth. On the other hand, smiling may lead to simultaneous contraction of other erroneously reinnervated muscle fibers, equally immobilizing the corner of the mouth. Electromyography in these cases shows well-reinnervated musculature. The only solution to prevent this so-called static syndrome is to transplant smaller nerves connected at more peripheral levels to smaller facial nerve branches with more specific functions.

Adolescent↗
PubMed2006

Split facial nerve course in vestibular schwannomas.

OBJECT: The facial nerve in vestibular schwannomas (VSs) is located on the ventral tumor surface in more than 90% of cases; other courses are rare. A split facial nerve course with two distinct bundles has thus far been described exclusively for medial extrameatal tumors. METHODS: Between 1996 and 2005, 16 consecutive cases of 241 surgically treated VSs were observed to have distinct splitting of the facial nerve. The mean tumor size measured 27 mm. In one third of the cases, intrameatal tumor extension with obliteration of the fundus was documented. All patients underwent extensive intraoperative neurophysiological monitoring using multichannel electromyography recordings. Patients were reevaluated 12 months after surgery. In all 16 patients, distinct splitting of the facial nerve was demonstrated. The major portion of the facial nerve followed a typical course on the ventral tumor surface. The smaller nerve portion in all cases ran parallel to the brainstem up to the level of the trigeminal root exit zone and crossed on the cranial tumor pole to the internal auditory canal. The two nerve portions rejoined at the level of the porus acusticus. The smaller portion carried fibers exclusively to the orbicularis oris muscle, whereas the major portion supplied all three branches of the facial nerve. CONCLUSIONS: In VSs, an aberrant course with distinct splitting of the facial nerve adds considerably to the surgical challenge. Long-term facial nerve results are excellent with extensive neurophysiological monitoring, which allows the differentiation and identification of aberrant facial nerve fibers and avoids additional risks to facial nerve preservation.

Adult↗
PubMed2003

Facial nerve grafting.

OBJECTIVE: To evaluate the results of facial nerve reconstruction by means of grafting and to determine the influence of different variables on final functional recovery. STUDY DESIGN: Retrospective case review. SETTING: Tertiary otologic and skull base referral center. PATIENTS: Sixty nine patients underwent facial nerve grafting. Facial nerve tumors (24) or vestibular schwannomas (18) affected most of them. Preoperatively, 47 patients had a clinical facial nerve deficit lasting from 1 to 120 months, with a mean of 20.2 months. MAIN OUTCOME MEASURES: Final facial nerve motor function. RESULTS: Among the 56 patients with a follow-up time equal to or longer than 1 year, 26 recovered to a Grade III (46.4%), 14 to a Grade IV (25%), while 16 remained at Grade V or Grade VI according to the House-Brackmann scale. Patients with a preoperative facial nerve deficit for more than 1 year showed the lowest rate of recovery, with only 3 cases (19%) reaching Grade III. CONCLUSIONS: Duration of the preoperative facial nerve deficit emerged as the most important factor influencing final results. According to the authors' data, the 1-year period after the occurrence of the preoperative clinical deficit seemed to be the cutoff point in achieving a high rate of good postoperative recovery. Among the other factors that might have influenced the final outcome, only the underlying cause of the lesion played a significant role.

Adolescent↗
PubMed2000

Intracanalicular schwannoma of the facial nerve: a manifestation of neurofibromatosis type 2.

Primary facial nerve tumors, which are relatively uncommon, can present a diagnostic dilemma based on their location and variable pattern of symptoms. Of primary cranial nerve tumors, schwannomas of the facial nerve rank third in frequency after those of the eighth and fifth cranial nerves. We report an illustrative case of an intracanalicular schwannoma associated with several central nervous system tumors, consistent with neurofibromatosis type 2. Initially assumed to be an eighth cranial nerve tumor, the schwannoma was found intraoperatively to arise from the facial nerve. Early diagnosis and treatment enabled excision of the tumor without sacrifice of the facial nerve. Facial nerve schwannomas can resemble acoustic schwannomas in their clinical presentation. Only a heightened level of clinical vigilance will point to the correct diagnosis and result in an optimal therapeutic outcome for patients with these rare tumors.

Cranial Nerve Neoplasms↗
PubMed1995

Facial nerve neuromas: diagnosis and management.

Facial nerve neuromas are uncommon tumors that involve the facial nerve. There is no classic presentation of these tumors. This study presents a series of 22 patients with facial neuromas managed from 1977 to 1993. Facial nerve dysfunction was the most common complaint, present in 90.5% of cases. Hearing loss was the second most common complaint and was found in 76.2% of cases. High resolution computed tomography and magnetic resonance imaging with gadolinium proved to be the most accurate methods of preoperative assessment of these tumors and are complementary in selected cases. Different surgical approaches were performed according to tumor location and preoperative hearing level. In all cases long-term follow-up showed no tumor recurrence, and acceptable return of facial function was noted in 80% of cases.

Adolescent↗
PubMed1983

Tumor involvement of the facial nerve.

Tumors involving the facial nerve are rare and challenging in both diagnosis and treatment. In this paper we report 18 cases of benign and malignant neoplasms involving the temporal portion of the facial nerve. The selection of those patients with facial paralysis who require detailed evaluation is discussed. Often, despite thorough evaluation of these patients, a preoperative diagnosis is unavailable or erroneous. An occasional patient may require surgical exposure of the nerve from the middle cranial fossa to the parotid gland.

Adult↗
PubMed1988

Routine identification of the facial nerve using electrical stimulation during otological and neurotological surgery.

We routinely identify the facial nerve to avoid facial nerve injury during most otologic surgery. Since 1985, we have used a facial nerve stimulator/monitor as an added safety feature in 383 consecutive otologic and neurotologic cases. In our last 30 middle-ear, 8 retrolabyrinthine vestibular neurectomy, and 14 acoustic neuroma cases we used the monopolar stimulator probe-tip to determine threshold currents needed to produce facial twitch. Stimulation thresholds varied according to the amount of soft tissue or bone overlying the facial nerve. The stimulator was useful for predicting dehiscences in the bony facial canal during middle-ear and mastoid surgery. The exposed facial nerve usually stimulated at a level less than 0.1 mA (mean 0.05 mA), and the horizontal facial nerve covered by bone stimulated at 0.25 mA or greater (mean 0.6 mA). The stimulator was also used to predict the amount of bone overlying the vertical facial nerve at the annulus. An approximate relationship of 1.0 mA of threshold current to 1.0 mm of bony covering was found. After acoustic neuroma surgery, the stimulation threshold of the facial nerve at the brain stem helped predict postoperative facial function. Cases with current thresholds of 0.3 mA or less resulted in normal facial function. During ear surgery, routine identification of the facial nerve with the aid of a facial nerve stimulator will help avoid facial nerve injury.

Ear↗
PubMed1981

[Neurinoma of the third portion of the facial nerve. About a case cured after hypoglosso-facial anastomosis (author's transl)].

The authors report a case of a neurinoma of the third portion of the facial nerve, revelated by a progressive palsy completed four months later (but the muscle of the stapes was still working). After removing the neurinoma which was in the middle of the mastoïde an anastomosis between the XII and the VII nerves was performed and successful. The authors emphasize two facts: --The possibility of active reinervation by this method of the facial muscles even after a long delay of complete interruption of the facial nerve. --The advantage of performing the micro-anastomosis as close as possible to the myo-neural synapsis (just before the bifurcation of the facial nerve.

Cranial Nerve Neoplasms↗