Fibrovascular Tumor-Like Lesions of the Facial Nerve.

BACKGROUND: Facial nerve tumors (FNTs) are relatively rare benign lesions that arise from any segment of the facial nerve (FN). About half of all patients present with FN dysfunction, mainly long-standing or progressive facial paralysis. Diagnosis of an FNT is usually based on radiological imaging and confirmed by histological study. Most reported cases of FNTs are schwannomas and hemangiomas. OBJECTIVES: The aim of this study was to review 4 cases of lesions with clinical, radiological, and surgical findings that suggested an FNT, the pathology revealing a fibrovascular proliferation with no clear signs of a specific tumor. METHOD: Medical records of patients who had surgery due to an FN lesion were reviewed. Cases with known tumoral lesions were excluded. Four patients with tumor-like lesions were identified. Their imaging studies were re-evaluated. The pathological study included hematoxylin-eosin, Masson's trichrome, and immunohistochemistry for S100 protein, neurofilaments, CD31, Wilms' tumor 1 (WT1), and D240. RESULTS: The 4 cases revealed tumor-like fibrovascular lesions that could not be classified as typical pathological entities. All cases had a complete facial palsy preoperatively. Computed tomography and magnetic resonance imaging (MRI) suggested schwannoma or hemangioma. A complete excision was achieved, and a facial reconstruction was performed immediately after interruption. Postoperative FN function was improved in all cases. The histological study showed nervous tracts of normal morphology, with fibrous and vascular tissue interspersed in variable proportions. All cases showed areas of fibrosis with Masson's stain. In all cases, nervous tissue and Schwann cells tested positively for neurofilaments and S100, respectively. In vascular areas, endothelial cells stained positively for CD31, and negatively for D240 and WT1. CONCLUSIONS: Fibrovascular lesions of the FN may mimic primary FNTs, especially schwannomas and hemangiomas. Surgical excision with grafting or nerve transfer is the procedure of choice if a complete facial paralysis is found. This unusual condition should be considered when counseling patients with FN lesions. The lack of hyperintensity on MRI T2-weighted images may suggest the presence of fibrous tissue.

MRI after Bonebridge implantation: a comparison of two implant generations.

PURPOSE: Analysis of head magnetic resonance images (MRI) of patients with active bone conduction implants (BCIs) is challenging. Currently, there are two generations of the transcutaneous Bonebridge system (BCI601 and BCI602), the main difference between them being the transducer design and thickness. The aim was to compare the effect of transducer placement and artifact reduction sequences on legibility of MRI scans. METHODS: Four Thiel-fixed human head specimens were used: BCI601 was implanted in sinodural and middle fossa placement, and BCI602 in middle fossa and retrosigmoid approach. Images were obtained with a Signa® 1.5T MR. A metal artifact reduction sequence known as MAVRIC (multiacquisition variable-resonance image combination) was used. Each specimen was scanned using standard axial T2 SE and compared with axial MAVRIC artifact reduction sequences. RESULTS: Qualitatively, limits of the artifact produced by the implant were better defined with MAVRIC than with standard T2 sequences. Assessment of contralateral internal auditory canal (IAC) was possible in all cases. Placement of the BCI602 in the middle fossa allowed the view of the ipsilateral IAC using MAVRIC sequence. Quantitatively, the artifact was reduced with MAVRIC sequence from 6.3 to 59.7%, depending on the position of implant and model; the middle fossa placement and the BCI602 being those generating shorter artifact radio. CONCLUSION: Artifact optimized sequences as MAVRIC reduce the artifact caused by the Bonebridge system. The middle fossa approach allows a better visualization of IAC canal in the ipsilateral ear with both implant versions, but the effect is more prominent with the BCI602.

Parálisis facial: guía de práctica clínica de la Sociedad Española de ORL / Facial paralysis: Clinical practice guideline of the Spanish Society of Otolaryngology

La parálisis de Bell es la forma más común de paresia o parálisis facial. Sin embargo, no todos los pacientes con parálisis facial tienen una parálisis de Bell. Otras causas frecuentes incluyen las secuelas del tratamiento del neurinoma del VIII par, el cáncer de cabeza y cuello, la iatrogenia, el zóster ótico y los traumatismos. El abordaje de cada una de estas situaciones es totalmente diferente. El objetivo de esta guía es servir de consejo para el tratamiento y el seguimiento de los pacientes con parálisis facial. Nuestra idea es que la guía sea práctica, haciendo hincapié en recomendaciones efectivas y útiles en el manejo diario de los pacientes. Esta guía ha sido promovida por la Sociedad Española de ORL y escrita por médicos con experiencia en la enfermedad del nervio facial, incluyendo al menos un especialista de cada comunidad autónoma. Redactada en un formato de preguntas y respuestas, incluye 56 cuestiones relevantes relacionadas con el nervio facial

Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve

Hendidura laríngea: diagnóstico y tratamiento en un caso inusual de presentación en el adulto / Laryngeal cleft: Diagnosis and treatment of an unusual presentation in an adult

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Facial paralysis: Clinical practice guideline of the Spanish Society of Otolaryngology. / Parálisis facial: guía de práctica clínica de la Sociedad Española de ORL.

Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve.

Noninvasive imaging of carotid giant pseudoaneurysm.

PATIENT AND METHODS: A 54-year-old man presented an acute stroke in the right middle cerebral artery territory. The carotid duplex ultrasound revealed an aneurismatic mass in the right proximal internal carotid artery (ICA) with a lumen and an organized thrombus inside. The multislice angio-CT (MSACT) showed a giant saccular pseudoaneurysm involving the right ICA. Surgical resection of the aneurysm was performed, with proximal anastomosis between internal and external carotid artery. Pathological study revealed a pseudoaneurysm with a thrombosed wall. CONCLUSIONS: Spontaneus ICA pseudoaneurysms are a rare cause of stroke that must be considered in the differential diagnosis of cervical masses. Duplex ultrasound and carotid MSACT are noninvasive methods that may provide an accurate diagnosis.

Osteoblastoma of the temporal bone.

Benign osteoblastoma is an uncommon primary tumor of the bone. Any area of the skeleton may be affected by this tumor, but its occurrence in the temporal bone and middle ear is extremely rare. Clinical symptoms are nonspecific, even in the middle ear, and the diagnosis is often difficult in spite a complete physical and radiological examination. A biopsy is usually necessary for definitive diagnosis. Because of its potential for recurrence, local invasion, and, rarely, malignant transformation, a complete surgical excision remains the treatment of choice for osteoblastoma. We report a case of benign osteoblastoma involving the temporal bone and the middle ear and a review of the literature.

Imaging of orbital disorders in pediatric patients.

The spectrum of orbital lesions occurring in childhood is wide, including a variety of both benign and malignant disorders. Although physical examination and fundoscopy may aid in establishing the diagnosis of retro-ocular lesions, imaging remains a critical step in the evaluation of the pediatric orbit. Ultrasonography, CT, and MR imaging are the primary modalities for the evaluation of the diseased orbit, and careful observation of the characteristic radiological features usually leads to correct diagnosis; however, some of the lesions look very similar and are difficult to differentiate from each other. The purpose of this article is to review the common and unusual entities that may involve the pediatric orbit, to describe the radiological features, and to evaluate the efficacy of US, CT, and MRI in the diagnosis and management of these conditions.

Noninvasive study of endothelial function in white coat hypertension.

Several studies have demonstrated that endothelial dysfunction is present in patients with essential hypertension. However, the presence of endothelial dysfunction in patients with white coat hypertension has not been studied. We evaluated the variation in the diameter of the brachial artery produced by flow-mediated dilation after a mechanical stimulus in patients with recently diagnosed mild to moderate sustained essential hypertension compared with patients with white coat hypertension. A total of 29 patients fulfilled inclusion criteria; 15 healthy volunteers were also included. After 24-hour ambulatory blood pressure monitoring, 15 patients were classified with sustained essential hypertension; 14 patients with white coat hypertension. Vascular ultrasound scans were performed according to the method described by Celermajer et al, with modification for noninvasive determination of endothelial dysfunction. Basal brachial artery diameter did not differ significantly among the 3 groups. Changes in arterial diameter 60 seconds after cuff deflation were higher in the control group compared with both hypertensive groups, but no significant differences were found between the sustained essential hypertension group and the white coat hypertension group. Flow-mediated dilation was similar in white coat hypertensives and sustained essential hypertensives. The presence of endothelial dysfunction in subjects with white coat hypertension suggests that it should not be considered a harmless trait and that white coat hypertension has common features with sustained essential hypertension.

Radiation-induced osteochondroma of the T4 vertebra causing spinal cord compression.

A case of a radiation-induced osteochondroma arising from the vertebral body of T4 in an 18-year-old man is reported. The patient presented with a history of progressive left lower extremity weakness. At 7 years of age, he had undergone resection of a cerebellar medulloblastoma and received adjunctive craniospinal irradiation and systemic chemotherapy. Both CT and MR imaging revealed an extradural mass contiguous with the posteroinferior endplate of the T4 vertebral body. This case indicates that radiation-induced osteochondroma should be considered in the differential diagnosis of patients with symptoms of myelopathy or nerve root compression and a history of radiation therapy involving the spine in childhood.