Melkersson-Rosenthal syndrome: a retrospective study of 44 patients.

CONCLUSION: When patients with recurrent facial paralysis are encountered, otolaryngologists should check for fissured tongue, and question those patients about orofacial edema, minor symptoms, and family history. Histologic evidence is not necessary for the diagnosis of Melkersson-Rosenthal syndrome (MRS), while coronary high-resolution CT (HRCT) reconstruction of temporal bone and food allergen detection may be beneficial. Prophylactic decompression of the facial nerve for patients with appropriate electrophysiological indication may prevent further facial palsy attacks. OBJECTIVES: The objective of this study was to analyze the clinical features of a group of patients with MRS with major complaints of facial palsy treated at the Department of Otorhinolaryngology, and to comment on MRS from the perspective of otolaryngologists. METHODS: A retrospective review of patient database for the last 6 years in the Department of Otorhinolaryngology in Beijing Shijitan Hospital was performed to find patients diagnosed with MRS. RESULTS: A total of 44 MRS patients were included in this study. The mean age at onset was 14.1 years. A total of 13 (29.5%) patients had family history, 17 (38.6%) revealed broadened fallopian canal on coronary HRCT reconstruction of temporal bone, and 20/23 (87.0%) patients showed positive results in food allergen detection. Thirty-one patients accepted subtotal facial nerve decompression and only one patient had facial palsy recurrence on the same side as the operation.

Subtotal facial nerve decompression for recurrent facial palsy in Melkersson Rosenthal syndrome.

CONCLUSIONS: Subtotal facial nerve decompression seems effective to prevent further episodes of facial palsy and promote facial nerve recovery for recurrent facial palsy in Melkersson Rosenthal syndrome (MRS). The main inflammatory sites of recurrent facial palsy in MRS may be the mastoid segment, tympanic segment, geniculate ganglion, and labyrinthine segment. OBJECTIVE: To present our surgical experience in preventing further episodes of facial palsy and improving facial nerve recovery of patients with recurrent facial palsy in MRS. METHODS: We performed transmastoid subtotal facial nerve decompression on eight patients with recurrent facial palsy in MRS. They were followed up for 3.3 years on average (range 2-5 years). RESULTS: There were no further attacks of facial palsy in any of the cases. Seven cases (87.5%) recovered to grade I or grade II, and three of eight cases (37.5%) recovered completely. We found obvious edema of the facial nerve at the mastoid segment in all cases, at the tympanic segment and geniculate ganglion in five cases (62.5%), and at the labyrinthine segment in only one case (12.5%).

Surgical experience of nine cases with intratemporal facial hemangiomas and a brief literature review.

CONCLUSIONS: It was practicable to remove hemangiomas at the labyrinth region and distal internal auditory canal with complete or serviceable hearing preservation by the transmastoid approach. The majority of cases where the nerve integrity was preserved achieved acceptable recovery of facial nerve function during the first few years according to our study. Long-term outcomes of nerve graft were acceptable, while short-term outcomes were unsatisfactory based on the literature. OBJECTIVE: This study aimed to present our surgical experience of nine intratemporal facial nerve hemangiomas and provide a brief literature review. METHODS: Clinical data for the cases were retrospectively analyzed. They were followed up for 5-59 months and related literature was reviewed. RESULTS: All of the hemangiomas were removed by the transmastoid approach, and only three cases developed mild conductive hearing loss. Nerve integrity was preserved for all cases. In all, 66.7% of patients maintained or recovered to grade III or better, and one patient with grade VI recovered to grade V during the average follow-up period of 2 years. In the literature the majority of grafted patients recovered to an acceptable level 5 years later, although recovery was usually poor during the first year.

Lateral hump anomaly of pyramid segment of facial nerve in living patients.

CONCLUSIONS: A lateral hump anomaly of the pyramid segment of the facial nerve deserves special attention during otologic surgery. Coronary high-resolution CT (HRCT) reconstruction of temporal bone was highly valuable in preoperative detection of the anomaly. OBJECTIVE: This study aimed to investigate lateral hump anomaly of the pyramid segment of the facial nerve in adult patients and assess the value of coronary HRCT reconstruction of the temporal bone in preoperative detection of the anomaly. METHODS: We carried out a prospective study in 439 Han Chinese adults who underwent unilateral facial nerve decompression due to Bell's palsy in our department between April 2005 and October 2012, focusing on lateral hump anomaly of the pyramid segment of the facial nerve, detection sensitivity, and accuracy of coronary HRCT reconstruction of the temporal bone. RESULTS: Lateral hump anomaly of the pyramid segment was observed in 21 cases (4.83%) undergoing surgery. The detection sensitivity and accuracy of coronary HRCT reconstruction were both 100%.

Surgical experience of intratemporal facial nerve neurofibromas.

CONCLUSIONS: The first presentation of intratemporal facial neurofibromas was variable, with facial palsy most common. The tumors often involve two or more segments of facial nerve. Outcomes of the tumors were closely related to nerve integrity, preoperative facial nerve function level, and follow-up period. OBJECTIVE: The aim of this study was to present surgical experience of 11 cases with intratemporal facial neurofibroma. METHODS: Clinical data of the 11 cases with the tumors was retrospectively collected and analyzed. They were followed up for 37.9 ± 1.7 months, range 13-59 months, except for one case that was only followed up for 5 months and was excluded from the analysis of outcomes. RESULTS: Facial palsy was the first presentation in 10 cases, with repetitive facial palsy and vertigo in 1 case; 6 cases (54.5%) were insidious and 5 (45.5%) were sudden in terms of onset. Ear pain around the onset of facial palsy was found in four cases (36.4%). The tumor involved more than one segment in six cases. Among the non-grafted cases one patient with grade V facial nerve function recovered to grade III and another patient with grade VI facial nerve function recovered to grade IV, whereas only one case with grade VI recovered to grade IV among the grafted cases.