Treatment of extracapsular fractures of the mandibular condylar process: A retrospective evaluation of 377 cases.

BACKGROUND/AIM: Mandibular condylar fractures represent 25%-35% of all mandibular fractures. Despite profound research, there is still a controverse debate about treating these fractures conservatively or by open reduction and internal fixation (ORIF). The aim of this study is to analyse the outcome after open and closed treatment of extracapsular mandibular condyle fractures regarding general characteristics, post-treatment malocclusion, facial nerve palsy (FNP), maximum mouth opening (MMO) and parotid complications. METHODS: A retrospective cohort of 377 fractures (350 open, 27 closed treatment) was reviewed by reference to clinical and radiological pre- and postoperative documentation. Follow-up period was 12 months. Pearsons' chi-square-test, correlations, Kruskal-Wallis test and t-test were carried out for statistical analysis. RESULTS: The dominant type of fracture was type II in Spiessl and Schroll classification (50.1%). In the open treated fractures, the most common approach was retromandibular transparotid (91.7%). Post-treatment malocclusion occurred in 18.0% and was significantly increased in bilateral fractures (p = .039), in luxation fractures (p = .016) and in patients with full dentition (p = .004). After open reduction and internal fixation (ORIF), temporary FNP was documented in 7.1% whereas a permanent paresis occurred in 1.7%. FNP was significantly associated with high fractures (p = .001), comminution (p = .028) and increased duration of surgery (p = .040). Parotid complications were significantly associated with revision surgery (p = .009). Post-treatment reduction of MMO mainly occurred in female patients (p < .001) as well as in patients with bilateral fractures (p < .001), high fractures (p = .030) and concomitant mandibular (p = .001) and midfacial fractures (p = .009). CONCLUSION: Malocclusion seems to be the most frequent long-term complication after open reduction and osteosynthesis of extracapsular mandibular condyle fractures. We suggest ORIF by a transparotid approach to be an appropriate treatment with a low complication rate regarding especially FNP for extracapsular fractures of the mandibular condyle.

Discerning a smile - The intricacies of analysis of post-neck dissection asymmetry.

INTRODUCTION: Iatrogenic facial nerve palsy is distressing to the patient and clinician. The deformity is aesthetically displeasing, and can be functionality problematic for oral competence, dental lip trauma and speech. Furthermore such injuries have litigation implications. Marginal mandibular nerve (MMN) palsy causes an obvious asymmetrical smile. MMN is at particular risk during procedures such as rhytidoplasties, mandibular fracture, tumour resection and neck dissections. Cited causes for the high incidence are large anatomical variations, unreliable landmarks, an exposed neural course and tumour grade or nodal involvement dictating requisite nerve sacrifice. An alternative cause for post-operative asymmetry is damage to the cervical branch of the facial nerve or platysmal dysfunction due to its division. The later tends to have a transient course and recovers. Distinction between MMN palsy and palsy of the cervical branch of the facial nerve or platysma division should therefore be made. In 1979 Ellenbogen differentiated between MMN palsy and "Pseudo-paralysis of the mandibular branch of the facial nerve". Despite this, there is paucity in the literature & confusion amongst clinicians in distinguishing between these palsies, and there is little regarding these post-operative sequelae and neck dissections. METHOD: This article reflects on the surgical anatomy of the MMN and cervical nerve in relation to danger zones during lymphadenectomy. The authors review the anatomy of the smile. Finally, case studies are utilised to evaluate the differences between MMN palsy and its pseudo-palsy to allow clinical differentiation. CONCLUSION: Here we present a simple method for clinical differentiation between these two prognostically different injuries, allowing appropriate reassurance, ongoing therapy & management.

Operator Experience and Fracture Location Affects the Rate of Facial Nerve Injury in Condylar Fractures: An Analysis of 89 Cases.

PURPOSE: The purpose of this study was to measure the frequency and identify risk factors for facial nerve injury (FNI) in the open treatment of condylar neck and subcondylar fractures. MATERIALS AND METHODS: A prospective cohort study was conducted over 5 years on patients who were treated surgically for mandibular condylar fractures using the retomandibular transparotid approach (RMTA). The primary result was FNI occurrence (yes/no). The predictor variables were demographic, fracture location, and pattern (dislocation, present or not), as well as surgeon experience. Post-treatment functional facial nerve changes were initially assessed in the operating room as the patient regained consciousness and documented thereafter within, the 1st and 3rd weeks, and 3rd and 6th months. Appropriate statistics were computed and, SPSS version 16 was used to analyze the data. χ2 test and Fisher exact test were used to assess significance (P ≤ 0.05). RESULTS: Eighty-nine patients with 102 condylar fractures (63 subcondylar and 26 condylar neck), with a mean age of 28.5±7.5 years and 91% men were evaluated. There were 15 subjects (16.8%) with FNI and among them 6 subjects had persistent facial weakness for 6-8 weeks that completely resolved within 3 months, with no permanent facial nerve paralysis. The marginal mandibular (n = 7), buccal (n = 6), and zygomatic (n = 2) were the facial nerve branches involved. Risk factors for FNI were operator' inexperience, fracture-dislocation, and condylar neck fracture to the site and location of the fracture. Multivariate logistic regression showed that the location of the fracture at neck level (0.030∗), fracture dislocation (<0.001∗), and operator's inexperience (0.003∗) were significant risk factors for postoperative facial nerve injury (P ≤ 0.05). CONCLUSIONS: If conducted properly, the RMTA is a safe method for treating condylar fractures with rare major complications; however, fracture dislocation, fractured condylar neck, and operator' in-experience were significantly associated with increased risk of developing transient postoperative FNI.

Facial nerve neurorrhaphy due to unexpected facial nerve injury during parotid gland tumor surgery.

BACKGROUND: Unexpected facial nerve damage can occur during parotid gland tumor surgery. We sought to determine the incidence and treatment outcomes of unexpected facial nerve injuries in patients with parotid gland tumor surgery. METHODS: We retrospectively enrolled in this study five patients, who underwent facial nerve neurorrhaphy due to unexpected facial nerve injury during parotid gland tumor surgery January 2012-August 2019. RESULTS: There were five patients (0.008%) with unexpected facial nerve injuries during the parotid gland tumor surgery of 577 patients in our hospital for approximately 8 years. The most common injury site of facial nerve was the marginal mandibular branch (n = 3), followed by the buccal branch (n = 1), and the cervicofacial division (n = 1). In the case of unexpected facial nerve damage, our treatment is immediate primary neurorrhaphy and steroid treatment. Three patients of five recovered and two did not worsen immediately after surgery. CONCLUSION: Unexpected facial nerve injury during parotid gland tumor surgery is extremely unfortunate. In this case, immediate primary neurorrhaphy and systemic steroids are recommended to restore facial function and reduce cosmetic deficits.

Longitudinal study of risk for facial nerve injury in mandibular condyle fracture surgery: marginal mandibular branch-traversing classification of percutaneous approaches.

OBJECTIVE: This study aimed to longitudinally assess the risk of facial nerve injury (FNI) in the surgical repair of mandibular condylar neck and subcondylar fractures (CN/SCFs) and to explore its predictors. MATERIALS AND METHODS: In a retrospective cohort study, the outcome was defined as FNI at 1 week and 1, 3, and 6 months postoperatively. Potential predictors included age, sex, etiology, fracture site and pattern (dislocation/non-dislocation), concomitant facial fractures, interval to surgery, surgeons' experience, plate types, and the marginal mandibular branch-traversing approach (deep/superficial group). We employed generalized estimating equations (GEEs) for repeated measurements throughout the 6-month follow-up period. RESULTS: Among 102 patients with 114 fractures, 27 patients (26.5%) developed FNI within 1 week. Prolonged FNI (≥ 1 month) occurred in 19 (19.2%) of 99 patients. Multivariate GEE analyses revealed that deep surgical approaches (i.e., traditional submandibular and retroparotid approaches; odds ratio [OR], 18.90; p = 0.011), fractures with dislocation (OR, 3.60; p = 0.025), and female gender (OR, 2.71; p = 0.040) were independently associated with the overall FNI risk. Additionally, the deep approaches (OR, 15.91; p = 0.014) and female gender (OR, 3.41; p = 0.035) were correlated with a prolonged FNI risk. Sensitivity analyses for the outcomes identified the same predictors. CONCLUSION: The predictors longitudinally associated with FNI in CN/SCF surgeries included a deep MMB-traversing approach, dislocated fracture, and female gender. CLINICAL RELEVANCE: The superficial surgical approaches (i.e., transparotid, transmasseteric anteroparotid, and high perimandibular approaches) should be adopted for CN/SCF treatment to minimize postoperative morbidity, especially for female patients with dislocated condyles.

Modified Tragus Edge and Transmasseteric Anteroparotid Approach for Intracapsular and Condylar Neck Fractures.

The aim of this study was to evaluate the effects of protecting the facial nerve and reducing the scar visibility using a modified tragus edge and transmasseteric anteroparotid approach compared to classic preauricular approach for intracapsular and condylar neck fractures. This retrospective study included 64 patients (78 sides) who underwent surgical treatment for intracapsular or condylar neck fractures from January 2014 to June 2018. Patients were divided into the experimental group (treated via a modified tragus edge and transmasseteric anteroparotid approach), and the control group (treated via the classical preauricular approach). Therapeutic outcome assessment parameters included facial nerve injury, salivary fistulae, wound infection, restricted mouth opening, postoperative occlusion disorders, and scar visibility. In the control group, there were 3 cases of facial nerve injuries and 2 cases of salivary fistulae. One case of temporary facial nerve injury occurred in the experimental group, with complete recovery within 1 month. The scars were less visible in the experimental group than in the control group. These results suggest that a modified tragus edge and transmasseteric anteroparotid approach reduced the incidences of facial nerve injuries, minimized the scar visibility, improved exposure of the operative site and fixation of titanium screws or plates, and did not increase the frequency of other complications.

Facial nerve repair: the impact of technical variations on the final outcome.

OBJECTIVES: To analyze the outcome of facial nerve (FN) reconstruction, the impact of technical variations in different conditions and locations, and the importance of additional techniques in case of suboptimal results. STUDY DESIGN: Retrospective study. SETTING: University-based tertiary referral center. PATIENTS: Between 2001 and 2017, reconstruction of the FN was performed on 36 patients with varying underlying diseases. INTERVENTIONS: FN repair was performed by direct coaptation (n = 3) or graft interposition (n = 33). Microsurgical sutures were used in 17 patients (47%) and fibrin glue was used in all cases. Additional reinnervation techniques (hypoglossal-facial or masseter-facial transfers) were performed in five patients with poor results after initial reconstruction. MAIN OUTCOME MEASURES: FN function was evaluated using the House-Brackmann (HB) and the electronic clinician-graded facial function (eFACE) grading systems. Minimum follow-up was 12 months. RESULTS: FN reconstruction yielded improvement in 83% of patients, 21 patients (58.3%) achieving a HB grade III. The eFACE median composite, static, dynamic and synkinesis scores were 69.1, 78, 53.2, and 88.2 respectively. A tendency towards better outcome with the use of sutures was found, the difference not being significant. All patients undergoing an additional reinnervation procedure achieved a HB grade III, eFACE score being 74.8. CONCLUSIONS: FN reconstruction offers acceptable functional results in most cases. No significant differences are expected with technical variations, different locations or conditions. In patients with poor initial results, additional reinnervation techniques should be always considered. The eFACE adds substantial information to the most used HB scale.

Facial Nerve Injury and Other Complications Following Retromandibular Subparotid Approach for the Management of Condylar Fractures.

PURPOSE: To estimate the prevalence and identify risk factors for facial nerve paralysis (FNP) and other postoperative complications after the use of the retromandibular subparotid approach (RMSA) for the treatment of condylar fractures. MATERIALS AND METHODS: Radiologic and clinical data from all patients who underwent an RMSA from 2007 through 2015 at the University Hospital of Geneva (Geneva, Switzerland) were retrospectively reviewed. The primary and secondary outcome variables were, respectively, FNP and other complications (unesthetic scars, infection, nonunion, malocclusion, salivary fistula, Frey syndrome, and loosening or breaking of plates and screws). Predictor variables included age, gender, mechanism of injury, delay from injury to surgery, surgeon's experience, location of fracture, side and pattern of fracture, concomitant facial fractures, and status of healing. Univariable logistic regression statistics were computed. RESULTS: Forty-eight subcondylar fractures in 43 consecutive patients were treated using the RMSA. Six fracture sites (12.5%) developed a temporary FNP that completely resolved within 4 months. Fractures at the neck level and with the comminution pattern were significant risk factors of postoperative FNP (P = .04 and P < .001, respectively; odds ratio = 82). Eight patients (18.6%) developed a slight transient malocclusion that was completely corrected within 3 to 4 weeks using guiding elastics and 1 patient (2.3%) had a wound dehiscence that resolved with a visible but thin and linear scar. CONCLUSION: The present study showed that 1) the FNP rate after the RMSA to surgery for condylar fractures was similar to that reported after the transparotid variant; 2) the FNP was transient and completely resolved in all patients; 3) neck and comminuted condylar fractures were statistically associated with increased risk of developing a postoperative temporary FNP; and 4) the final outcome was favorable with no major complications in any of the patients.

Facial Nerve Paralysis-A Rare Complication of Open Reduction of Zygomaticomaxillary Complex Fractures.

Facial nerve paralysis is an unusual formidable complication that can manifest after various maxillofacial surgeries, including open reduction of facial trauma. The branches more predisposed to such injury are the zygomatic and marginal mandibular branches. Zygomaticomaxillary complex (ZMC) fractures are frequently encountered in maxillofacial trauma. The facial nerve has not been described as endangered during ZMC surgery. Paralysis of the buccal branch after ZMC repair with delayed onset has been reported only once. This report describes a patient with immediate facial nerve paralysis after open reduction and internal fixation of an isolated ZMC fracture through an intraoral approach. This is a previously unreported rare complication after ZMC fracture repair that should be discussed as a possibility when obtaining preoperative consent.

The Periangular Approach to the Posterior Mandible: A Novel Approach and Technique.

There exist 2 classic extraoral approaches to the posterior aspect of the mandible, namely the submandibular or Risdon approach, and the retromandibular approach. Despite their widespread use, there still exist concerns of damage to surrounding structures, in particular cranial nerve VII, as well as vascular structures and salivary glands. Evidence of facial nerve palsy has been shown to be as high as 48% in the patient with the Risdon approach, and as high as 30% in the retromandibular approach. The authors wish to propose a more conservative, technically easier, and less time-consuming approach to the posterior mandible, with less risk of damage to the branches of the facial nerve, as well as other structures such as the facial vessels and the parotid gland.

Does a Retromandibular Transparotid Approach for the Open Treatment of Condylar Fractures Result in Facial Nerve Injury?

PURPOSE: The retromandibular transparotid approach (RMA) to condylar fractures of the mandible provides excellent access, but can increase the risk of complications. The aim of this study was to estimate the frequency of facial nerve paralysis (FNP) and associated postoperative complications after open reduction and rigid internal fixation (ORIF) of subcondylar fractures through the RMA. MATERIALS AND METHODS: This was a retrospective cohort study of patients with condylar fractures requiring ORIF through the RMA. The inclusion criteria were 1) a medical record of surgical treatment of a subcondylar fracture by RMA; 2) preoperative and postoperative radiographs; 3) mental status permitting an adequate neuromotor examination; 4) absence of a post-injury or pretreatment functional facial nerve deficit; and 5) regular postoperative follow-up longer than 6 months with documentation of complications, functional results, and fixation stability. The predictive variables were age, gender, fracture site, fracture pattern, concomitant fractures, etiology, and plate types. The outcome variable was FNP. Univariate, bivariate, and multiple logistic regression statistics were computed. RESULTS: Fifty patients with 55 displaced mandibular subcondylar fractures (35 men, 15 women; mean age, 44.5 yr; range, 17 to 87 yr) met the inclusion criteria. The condylar fracture involved the neck in 35 patients (63.6%) and the base in 20 patients (36.4%). The fracture pattern was deviation in 11 patients (20.0%), displacement in 23 (41.8%), and dislocation in 21 (38.2%). Precise ORIF with double-buttress fixation resulted in immediate functional recovery in all patients. Seven fractures (12.7%) were associated with FNP that resolved completely within 6 months. Further statistical analysis showed that dislocated and displaced condylar neck fractures were significant risk factors for postoperative FNP (P < .05). Other postoperative complications were minimal. CONCLUSION: The RMA for subcondylar fractures is feasible and safe. Dislocated condylar neck fractures are associated with a highly increased risk of temporary postoperative FNP as a surgical complication.

A Modified Preauricular Approach for Treating Intracapsular Condylar Fractures to Prevent Facial Nerve Injury: The Supratemporalis Approach.

PURPOSE: The facial nerve remains at risk of injury with the preauricular approach; thus, preservation of the functional integrity of the facial nerve is considered an important factor in the success of temporomandibular joint surgery. The aim of this study was to prevent facial nerve injury using the supratemporalis approach in the treatment of intracapsular condylar fractures. MATERIALS AND METHODS: In this prospective cohort study, the population consisted of patients diagnosed with intracapsular condylar fractures who received surgical treatment from July 2005 to May 2014. Patients in the experimental group were treated with the supratemporalis approach, and patients in the control group were treated with the traditional preauricular surgical technique. The primary outcome variable was facial never injury. The continuity correction χ(2) and test Student t test were used. RESULTS: Eighty-four patients (112 sides) with intracapsular condylar fractures were treated surgically (56 men, 28 women; mean age, 29.85 yr; range, 4 to 70 yr); 44 patients (64 sides) were treated with the supratemporalis approach and 40 patients (48 sides) were treated with the traditional preauricular approach. Facial contours and functions recovered well postoperatively in all 84 patients. Seven cases of facial nerve injury, 2 of which were permanent, were observed in the group treated with the traditional preauricular approach, and no facial nerve injuries were observed in the group treated with the supratemporalis approach. None of the patients sustained auriculotemporal syndrome or wound infection complications. CONCLUSIONS: The supratemporalis approach prevented facial nerve injury and did not increase the frequency of other complications.

Sensitive and Motor Neuroanastomosis After Facial Trauma.

Facial nerve has great functional and aesthetic importance to the face, and damage to its structure can lead to major complications. This article reports a clinical case of neuroanastomosis of the facial nerve after facial trauma, describing surgical procedure and postoperative follow-up. A trauma patient with extensive injury cut in right mandibular body causing neurotmesis of the VIIth cranial nerve and mandibular angle fracture right side was treated. During surgical exploration, the nerve segments were identified and a neuroanastomosis was performed using nylon 10-0, after reduction and internal fixation of the mandibular fracture. Postoperatively, an 8-month follow-up showed good evolution and preservation of motor function of the muscles of facial mime, highlighting the success of the surgical treatment. Nerve damage because of facial trauma can be a surgical treatment challenge, but when properly conducted can functionally restore the damaged nerve.

Modified submandibular access for open reduction and internal rigid fixation in condylar fractures.

PURPOSE: The purpose of the present study was to describe a surgical technique for treatment of condylar fractures through the modified submandibular access, by means of a small incision in the mandibular angle that promotes a dissection between the parotideomasseteric and the transmasseteric fascia in a quick way and with low morbidity. Fixation may be made with plates and screws according to the technique prescribed by the surgeon. METHODS: Owing to the high incidence and importance of condylar fractures, various therapeutic methods have been described and may be divided into conservative and surgical methods. Various open surgical techniques are recommended in the treatment of mandibular condylar fractures, and the methods of internal rigid fixation and surgical accesses vary. The techniques that offer an adequate treatment of these fractures with shorter surgical time very often remain matters of controversy among surgeons. The procedure must guarantee maximum safety for the facial nerve and must provide a good cosmetic outcome, besides providing a suitable surgical field. RESULTS: A modified submandibular access is a safe and reproducible procedure providing excellent functional results. This procedure has been routinely performed in our department.

Mandibular condylar fractures: a 5-year retrospective analysis comparing open versus closed reduction.

BACKGROUND: Mandibular fractures are common facial fractures, and contemporary management of mandibular condylar fractures is controversial. The purpose of this study was to compare the outcomes of patients who sustained a mandibular condylar fracture between 2016 and 2020, who were managed by either open or closed techniques. The outcomes of this study were: post-operative facial nerve function, occlusion, and maximal mouth opening. METHODS: This study is a retrospective multicentre cohort study which assessed clinical records for 246 patients with mandibular condyle fractures in three hospitals in Perth, Western Australia. The primary outcome measure was changes in post-operative facial nerve function. RESULTS: One hundred and thirty-two patients underwent open reduction and internal fixation (ORIF), and 114 patients had closed management. The overall rate of temporary facial nerve injury following ORIF was 3.28%. The overall rate of permanent facial nerve injury was 0.82%. Sialocoele occurred in 2.46% of all patients who underwent ORIF. 6.14% of patients had persisting malocclusion across both groups. There was a statistically significant association between the degree of fragment shortening and facial nerve injury (P = 0.0063), with more facial nerve changes in the group with 5 mm or greater of fragment shortening. CONCLUSIONS: There is still significant debate over the management of mandibular condylar injuries. This study demonstrates a similar rate of temporary and permanent facial nerve injury as previously described, as well as a similar rate of sialocoele occurrence. Further prospective studies may provide clarity about important characteristics that will help guide decision making for mandibular condylar fractures.

The "low preauricular" transmasseteric anteroparotid (TMAP) technique as a standard way to treat extracapsular condylar fractures.

Condylar fracture treatment is a debated topic among maxillofacial surgeons. Various surgical techniques are used today, each one with advantages and disadvantages. The aim of this study is to present and evaluate our technique adopted for treatment of any type of extracapsular condylar fractures. Between 2020 and 2022, 16 condylar fractures were treated. In two patients with bilateral condylar fractures, the present technique was compared to the mini-retromandibular approach. All the patients were checked for clinical and radiological outcomes, facial nerve injury, scar visibility and presence of salivary complications. Dental occlusion was always restored, and facial nerve damage or salivary disorders were not observed. The skin incision, limited to the caudal two-thirds of the auricle, made the scar almost invisible and greatly improved the surgical field in the condylar neck area, facilitating the treatment. The proposed technique provides easier internal fixation for both neck and base condylar fractures with good cosmetic results, ensuring better protection of the facial nerve and parotid gland. The surgical technique described has not shown disadvantages in terms of operational difficulty, results, and complications. This novel surgical technique could represent a new choice in the treatment of extracapsular condylar fractures, although further studies are needed to support this new proposal.

Facial nerve paralysis and frey syndrome in an infant following removal of an internal mandibular distraction device.

Mandibular distraction using an implantable device has become a widely accepted and utilized procedure for the treatment of retrognathia. Although excellent results have been reported and observed with distraction osteogenesis, complications such as facial nerve injury have been previously reported. Often, this injury is usually temporary and corrects over the course of time. Frey syndrome has been classically described as an injury or severance of the auricotemporal branch of the trigeminal nerve. It is commonly seen as a complication of parotid surgery and has never been reported in association with mandibular distraction. The authors report a unique case of both facial nerve paralysis and Frey syndrome in a patient following the removal of an internal mandibular distraction device. A review of the literature along with diagnosis and management are discussed.

Retaining ligaments of the face: review of anatomy and clinical applications.

The retaining ligaments of the face are important in understanding concepts of facial aging and rejuvenation. They are located in constant anatomic locations where they separate facial spaces and compartments. Their superficial extensions form subcutaneous septa that separate facial fat compartments. Their main significance relates to their surgical release in order to achieve the desired aesthetic outcome. Furthermore, they have a sentinel role in their anatomic relationship to facial nerve branches. When performing facial aesthetic surgery, plastic surgeons should select a plane of dissection, release the appropriate ligaments depending on the desired aesthetic goals, and avoid nerve injury by using the ligaments as anatomic landmarks. Descriptions of the retaining ligaments are variable in the literature; due to different interpretations of anatomy, several classifications, locations, and nomenclature systems have been proposed. This article will review and clarify the anatomy of the retaining ligaments of the face, including the cheek, mandible, temporal, and periorbital areas.

Facial palsy after orthognathic surgery: A systematic review.

It was the aim of the systematic review to evaluate the incidence of facial palsy following orthognathic surgery, and to assess the possible mechanisms of injury, subsequent management, and eventual outcomes. The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews. A thorough search of PubMed, Scopus, Cochrane Library, and CINAHL databases up to April 2022 was conducted. In total, 34 articles were selected for this review, including 54 facial palsies in 53 patients. The incidence of facial palsy was estimated to range from 0.04% to 0.77%. Most of the possible etiologies proposed involved intraoperative nerve compression or postoperative edema. Physical therapy and steroid administration were the most frequently employed management approaches. Surgical exploration for the facial nerve was executed in one patient. Forty-three facial palsies (79.6%) attained complete recovery with conservative management, whereas 11 facial palsies (20.4%) continued to show incomplete recovery during the follow-up period. Earlier facial palsy onset (timing after surgery) was related to a higher risk of continuing palsy (p = 0.018). Within the limitations of this review it seems that facial palsy following orthognathic surgery should be treated conservatively whenever appropriate.

Surgical treatment for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis in children.

PURPOSE: To compare surgical excision with surgical curettage in the treatment of nontuberculous mycobacterial (NMT) cervicofacial lymphadenitis in children. PATIENTS AND METHODS: Fifty children, 22 boys and 28 girls, with a PCR- or cultured-confirmed diagnosis of cervicofacial NTM infection were included in the study. Twenty-five children were randomized to surgical excision of the involved lymph nodes, and 25 children to surgical curettage. RESULTS: The median age of the children was 36 months (range, 14-120 months). All children had a red, fluctuating lymphadenitis, and there were no marked differences between the treatment groups with respect to mean duration of lymph node swelling before presentation, location, and the size of the lymph node swelling. Most (84%) of the involved nodes were located in the submandibular region and 6% were located in the preauricular region. Multiple locations (both preauricular and submandibular) were observed in the remaining 10%. Mycobacterium avium (74%) and Mycobacterium haemophilum (22%) were the predominant NTM species. Mean wound healing time for the excision group was 3.6 ± 1.2 weeks versus 11.4 ± 5.1 weeks for the curettage group (P ≤ .05). Postoperative transient marginal mandibular nerve weakness of the facial nerve was seen in 4 patients (16%) of the excision group. In all these patients the function of the nerve returned to normal within 12 weeks. No facial nerve problems were observed in the curettage group. Postoperative infections were not observed. CONCLUSIONS: Surgical excision leads to a quick resolution of NTM cervicofacial lymphadenitis. Curettage leads to delayed healing but might be considered as an alternative if excision of the necrotized lymph nodes is technically difficult in cases of adherence of the facial nerve branche.