Normal and pathological findings for the facial nerve on magnetic resonance imaging.

AIM: To demonstrate the enhanced radiological anatomy and common pathological conditions of the facial nerve by using magnetic resonance imaging (MRI). MATERIALS AND METHODS: A retrospective review of the MRI findings of the facial nerve of 146 patients who visited a tertiary academic referral center was conducted. RESULTS: The radiological anatomy of the facial nerve was well illustrated using MRI, as were most of the common pathological conditions of the facial nerve. CONCLUSIONS: Enhancement of the facial nerve in MRI should be correlated with the clinical data. Normal individuals can show enhancement of the tympanic or vertical segments of the facial nerve. Enhancement of the labyrinthine portion of the nerve is almost diagnostic of Bell's palsy. No specific enhancement patterns were observed for tumours or for infections of the middle or external ear. A larger population study is required for the accurate assessment of facial nerve enhancement in multiple sclerosis patients.

Spontaneous and nonspontaneous internal jugular vein thrombosis.

Nonspontaneous internal jugular vein thrombosis (IJVT) is an uncommon condition historically associated with deep neck infections during the pre-antibiotic era. Today, trauma to the internal jugular vein from catheterization and repeated intravenous injections by drug users are the leading causes of thrombosis, with direct extension of tumor being a rare cause. Spontaneous IJVT occurs when there are no apparent predisposing causes, although many of these patients may harbor an occult malignant neoplasm. Therefore, careful investigation and follow-up are imperative in these patients. The diagnosis of IJVT is readily confirmed by contrast-enhanced computed tomography or magnetic resonance imaging. Management of IJVT involves anticoagulation, antibiotics, and with few indications for surgical intervention.

Juvenile nasopharyngeal angiofibroma.

This is a retrospective study of 17 patients with juvenile nasopharyngeal angiofibroma treated from 1983 to 1996. Patients with Stage I or II disease according to the Fisch classification system were treated surgically by a transpalatal approach. One patient underwent a Le Fort I osteotomy and down-fracture approach for access. Three patients underwent combined transpalatal and lateral rhinotomy for access, whereas one underwent a transcervical double mandibular osteotomy to facilitate the exposure. A patient with Stage IV disease underwent a combined subcranial frontonasal osteotomy plus a Le Fort I osteotomy for access to a massive angiofibroma. Initial surgical management prevented recurrence in 79% of patients. Two patients with intracranial extension were treated with primary irradiation therapy; their tumours became asymptomatic. Preoperative angiography and embolization were used to treat all surgical candidates. The use of newer craniofacial or subcranial techniques and infratemporal fossa approaches with osteotomies can provide access to large angiofibromas even when there is skull base or intracranial involvement. Surgical exposure may also be enhanced by the use of the Le Fort I osteotomy and down-fracture approaches.