ABSTRACT
OBJECTIVE: To investigate the surgical outcomes in patients treated for recurrent facial nerve palsy (RFP) at a quaternary facial nerve referral center. METHODS: A retrospective chart review was performed on 132 patients with RFP who presented to our institution's facial nerve clinic from 2001 to 2021. Records were analyzed for etiology of palsy, facial nerve function, and recurrence rates. Pre- and post-operative audiometric outcomes were also assessed in surgically managed patients. RESULTS: 6.8% of RFP patients underwent surgical decompression. For patients who did not undergo surgery, the House-Brackmann (HB) score was 2.9 ± 1.3 (SD) at the initial clinic visit, and 2.4 ± 1.3 (SD) at the last clinic visit. This difference was significantly different (p = 0.01, t-test). For surgical patients, the pre-operative HB score was 2.9 ± 0.9 (SD) and post-operative HB score was 1.8 ± 0.6 (SD), which were significantly different (p = 0.01, t-test). The number of facial palsy episodes also decreased pre- and post-operatively from 3.5 ± 0.8 (SD) to 0.2 ± 0.4 (SD) episodes, which were significantly different (p < 0,001, t-test). Audiometric outcomes were not significantly different pre- and post-surgery (p = 0.31, t-test for PTA; p = 0.34, t-test for WRS). CONCLUSION: Facial nerve decompression for RFP patients with incomplete functional recovery may be an effective treatment for decreasing the frequency and severity of facial palsy episodes. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:1222-1227, 2023.
Subject(s)
Bell Palsy , Facial Paralysis , Humans , Facial Paralysis/etiology , Facial Paralysis/surgery , Retrospective Studies , Prevalence , Bell Palsy/surgery , Facial Nerve/surgery , Treatment Outcome , Decompression, SurgicalABSTRACT
OBJECTIVES: To describe the outcomes of cochlear implantation with mastoid obliteration in a patient with Alström Syndrome and chronic otorrhea. METHODS: This is a single case discussion of a patient with Alström Syndrome and chronic otorrhea who underwent unilateral cochlear implantation and mastoid obliteration in January 2019. Subsequent contralateral procedure was performed 4 months later. Implantation was pursued due to the progressive sensorineural hearing-loss that is characteristic of Alström Syndrome. Serial Audiograms were obtained before and after procedure. RESULTS: Following implantation, audiological reports improved to near normal thresholds from the previous 60-85 dB sloping hearing loss. The patient's language skills rapidly improved as well as the ability to express her personality. Mastoid obliteration effectively resolved the chronic otorrhea that further complicated this case. CONCLUSION: Cochlear implantation with mastoid obliteration was successful in improving hearing thresholds and resolving chronic otorrhea in a patient with Alström Syndrome.
Subject(s)
Alstrom Syndrome/complications , Cochlear Implantation/methods , Hearing Loss, Bilateral/rehabilitation , Hearing Loss, Sensorineural/rehabilitation , Mastoidectomy/methods , Child , Chronic Disease , Cochlear Implants , Deafness/complications , Disease Progression , Female , Hearing Loss/surgery , Hearing Loss, Bilateral/etiology , Hearing Loss, Sensorineural/etiology , Humans , Mastoid/surgery , Middle Ear Ventilation , Otitis Media with Effusion/complications , Otitis Media with Effusion/surgeryABSTRACT
Microsurgery via the suboccipital approach is a common treatment option for vestibular schwannomas (VS). The procedure is performed under general anesthesia with cranial nerve monitoring in the supine position. Following suboccipital craniectomy, durotomy, CSF release from the foramen magnum, and identification of cranial nerve position, the tumor is debulked internally. The internal auditory canal is drilled and dissection of the tumor progresses. Following resection, the IAC is waxed and a fat graft placed. A watertight pericranial graft is sewn in and a titanium mesh cranioplasty placed. The muscle and skin are closed in layers. The video can be found here: http://youtu.be/ialtKy3cuPU .