Facial nerve neuroma in the geniculate ganglion extending into the internal auditory canal: A case report.

Facial nerve schwannoma is a very rare benign tumor representing less than 1% of intrapetrous lesions. Our patient is a forty-one year old female who has suffered from recurrent right facial palsy for the last six years. She was first misdiagnosed as having Bell's palsy and received corticosteroids which resulted in little improvement. She then had facial nerve decompression surgery which resulted in a partial improvement. Since then, she has suffered from recurrent attacks of facial palsy. Two years ago, she came to our hospital seeking further treatment options. The final diagnosis made by MRI was a possible facial nerve tumor. To obtain a better facial outcome, total tumor removal was performed through the middle cranial fossa approach along with facial-hypoglossal nerve end-to-side anastomosis through transmastoid approach. Her hearing was preserved, and she obtained a better facial outcome than that of her preoperative level. In conclusion, facial nerve schwannoma has the potential to be misdiagnosed as Bell's palsy which might lead to a delay in diagnosis, and end-to-side neurorrhaphy may be an effective alternative in a selected case.

Outcome of different facial nerve reconstruction techniques / Resultados de diferentes técnicas de reconstrução do nervo facial

Abstract Introduction: There is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III. Objective: To evaluate the efficacy and safety of different facial nerve reconstruction techniques. Methods: Facial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years. Results: For facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit. Conclusion: Among various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique.

Resumo Introdução: Não existe uma técnica de reconstrução do nervo facial que garanta a recuperação da função facial até o grau III. Objetivo: Avaliar a eficácia e segurança de diferentes técnicas de reconstrução do nervo facial. Método: Ao todo, 22 pacientes foram submetidos a reconstrução do nervo facial (enxerto com interposição do nervo facial em 11 pacientes e com transferência do nervo hipoglosso facial em 11 pacientes). Todos os pacientes apresentavam função facial de grau VI (de acordo com a classificação de House-Brackmann - HB) causada por trauma ou pela ressecção de um tumor. A reconstrução do nervo principal foi efetuada, exceto em sete pacientes, nos quais a reconstrução foi realizada entre duas semanas a quatro meses após a cirurgia inicial. O período de acompanhamento foi de, no mínimo, dois anos. Resultados: Para a técnica de enxerto com interposição de nervo facial, o grau de função facial obtido foi HB III em oito pacientes e HB IV em três pacientes. Sincinesia foi observada em oito pacientes e contratura facial com sincinesia em dois pacientes. Em relação à transferência do nervo hipoglosso facial com o uso de diferentes modificações, obtivemos função facial HB grau III em nove pacientes e HB grau IV em dois pacientes. Contratura facial, sincinesia e atrofia lingual foram observadas em três pacientes e sincinesia observada em cinco pacientes. No entanto, aqueles submetidos a anastomose primária direta hipoglosso-facial término-lateral apresentaram o melhor resultado, sem qualquer déficit neurológico. Conclusão: Entre as várias técnicas de reanimação, sempre que possível, a anastomose direta término-lateral hopoglosso-facial por meio de sutura epineural é a técnica mais eficaz, com excelentes resultados para reanimação facial e preservação do movimento da língua, especialmente quando realizada como técnica primária.

Outcome of different facial nerve reconstruction techniques.

INTRODUCTION: There is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III. OBJECTIVE: To evaluate the efficacy and safety of different facial nerve reconstruction techniques. METHODS: Facial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years. RESULTS: For facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit. CONCLUSION: Among various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique.

Giant Cell Tumor of the Temporal Bone Invading into the Pterygoid Muscle through the Temporomandibular Joint.

We report a case of giant cell tumor of the temporal bone invading into the pterygoid muscle through the temporomandibular joint. The patient was a 43-year-old woman who developed left ear fullness 2 years earlier with a mass in the external auditory canal. Radiologic evaluation revealed extension into the infratemporal fossa and confirmed that the tumor was invading into pterygoid muscle. A middle cranial fossa approach along with tympanoplasty was used for total resection of the tumor. Once a tumor invades into muscle tissue, meticulous care is required to remove it because identification of tumor tissue becomes extremely difficult.

Large middle ear schwannoma of the Jacobson's nerve with intracranial extension.

The patient is a 64-year-old woman who developed a sensation of right ear fullness and hearing loss in early November 2010. Physical examination revealed a painless reddish granular lesion filling in the right external auditory canal. Her right ear was deaf, and no facial palsy was noted. Computed tomography, magnetic resonance imaging and positron emission tomography revealed a middle ear mass extending to the external auditory canal with intracranial invasion causing temporal lobe retraction and inferiorly extending just anterior to the jugular bulb as well. A combination of transmastoid and middle cranial fossa approach along with anterior rerouting of the facial nerve was employed for a near-total removal of the tumor. Based upon the operative findings, it was deemed that the tumor could have arisen from the Jacobson's nerve.

Gait instability caused by vestibular disorders - analysis by tactile sensor.

OBJECTIVE: To elucidate instability of gait performance in patients with vestibular lesions by the use of a tactile sensors placed under both feet. METHODS: Gait analysis was conducted by the use of tactile sensors in 92 patients who had various types of vestibular lesions including vestibular neuritis (VN), acoustic neuroma (AN), and spinocerebellar degeneration (SCD). 26 healthy adults served as a control. Variables were coefficient of variation of stance, swing, and double support durations. Morphological analysis of foot pressure progression during stance was also performed. In addition, differences in each foot's integrated foot pressure in a gait test were measured, especially in cases with unilateral vestibular lesions. All data was comparatively analyzed between each pathological group and control group. A comparative study between intact side foot and lesion side foot was performed in those unilateral vestibular disorder cases as well. RESULTS: Those gait phase related variables were significantly greater in the pathologic group than in the control group, especially under gait with eyes closed. Morphological irregularity of foot pressure progression during stance was shown in cases with VN and SCD and was greatest in SCD cases. As for integrated foot pressure, in most cases with VN, it has become greater in the lesion side foot, suggesting that body center of gravity could shift toward the lesion side during gait. CONCLUSIONS: Gait analysis by the use of tactile sensors could provide additional important information regarding vestibular patho-physiology in patients with vestibular system disorders. Accordingly, gait performance tests should also be taken into consideration as a vestibular function test for patients with vertigo.

Insulin-like growth factor 1 protects vestibular hair cells from aminoglycosides.

This study investigated the therapeutic potential of insulin-like growth factor-1 (IGF-1) for vestibular hair cells using explant cultures of mouse utricles. After incubation with the ototoxic drug gentamicin, explants from neonatal mouse utricles were cultured in medium containing IGF-1 at various concentrations. Histological evaluation revealed significant increases in the number of surviving hair cells cultured with IGF-1 at concentrations reflecting a clinical setting. Immunostaining for trio-binding protein and espin showed the maintenance of functional structures in hair bundles at the apex of surviving hair cells. An FM1-43 assay indicated the presence of mechanoelectrical transduction channels in surviving hair cells. These findings indicate that IGF-1 may protect the functionality of vestibular hair cells against drug-induced injury.