Iatrogenic facial nerve palsy: lessons to learn.

INTRODUCTION: This study aims to review the management and discuss the outcome of patients with iatrogenic facial nerve palsy. METHODS: 11 patients with iatrogenic facial nerve palsy (FNP) were evaluated retrospectively in a tertiary centre between June 1995 and September 2008. All the cases were referred from other centres. RESULTS: Ten patients had iatrogenic immediate FNP secondary to mastoidectomy and one had FNP secondary to superficial parotidectomy. Of the ten cases, three had concomitant profound sensorineural hearing loss and one had concomitant labyrinthine fistula. Ten patients underwent facial nerve exploration and one patient was managed conservatively. The second genu was the commonest site of injury (60 percent). Facial nerve recoveries were achieved to Grade I House Brackmann classification in five cases, Grade II in two cases and Grade III in two cases postoperatively. One case defaulted follow-up. One patient, managed conservatively, recovered to FNP Grade II after five months post-injury. CONCLUSION: Mistakes that most likely occurred during mastoid surgery are drilling towards the antrum, causing injury to the facial nerve at the second genu. Early facial nerve exploration and neurolysis resulted in good facial nerve recovery.

Sinonasal inverted papilloma with malignant transformation in the middle ear: a multicentric origin?

Inverted papilloma is a rare, benign tumour representing only 0.5 to 4 per cent of all sinonasal neoplasms; its involvement of the middle ear is extremely rare. We present a case of multicentric inverted papilloma in the sinonasal region and middle ear in a 54-year-old man. The patient later developed neck metastasis secondary to malignant transformation of the inverted papilloma in the middle ear.

Maxillary sinus tumours--a review of twenty-nine patients treated by maxillectomy approach.

A retrospective data of 29 patients who underwent various types of maxillectomy from January 1998 till January 2004 in UKM hospital were reviewed. There were 21 males (72%) and 8 females (28%) with mean age of 42 years. Malays were the majority of patients 17 (59%), Chinese 11 (38%) and Indian 1 (3%). Seventeen patients (59%) presented with malignant tumours while 12 patients (41%) with benign tumours. Inverted papilloma (50%) was the commonest benign tumour and squamous cell carcinoma (36%) was the commonest malignancy. Medial maxillectomy was performed in ten patients (35%), total maxillectomy in seven patients (24%), three patients (10%) had near total, three patients (10%) had partial maxillectomy and six patients (21%) underwent inferior maxillectomy.