Facial palsy reconstruction.

The facial nerve stimulates the muscles of facial expression and the parasympathetic nerves of the face. Consequently, facial nerve paralysis can lead to facial asymmetry, deformation, and functional impairment. Facial nerve palsy is most commonly idiopathic, as with Bell palsy, but it can also result from a tumor or trauma. In this article, we discuss traumatic facial nerve injury. To identify the cause of the injury, it is important to first determine its location. The location and extent of the damage inform the treatment method, with options including primary repair, nerve graft, cross-face nerve graft, nerve crossover, and muscle transfer. Intracranial proximal facial nerve injuries present a challenge to surgical approaches due to the complexity of the temporal bone. Surgical intervention in these cases requires a collaborative approach between neurosurgery and otolaryngology, and nerve repair or grafting is difficult. This article describes the treatment of peripheral facial nerve injury. Primary repair generally offers the best prognosis. If primary repair is not feasible within 6 months of injury, nerve grafting should be attempted, and if more than 12 months have elapsed, functional muscle transfer should be performed. If the affected nerve cannot be utilized at that time, the contralateral facial nerve, ipsilateral masseter nerve, or hypoglossal nerve can serve as the donor nerve. Other accompanying symptoms, such as lagophthalmos or midface ptosis, must also be considered for the successful treatment of facial nerve injury.

Post-parotidectomy facial nerve rehabilitation outcomes: Comparison between benign and malignant neoplasms.

BACKGROUND: Facial nerve dysfunction can be a devastating trouble for post-parotidectomy patients. OBJECTIVE: To assess rehabilitation outcomes concerning patients with post-parotidectomy facial nerve dysfunction, comparing benign versus malignant neoplasms. METHODS: Prospective study enrolling adults who underwent parotidectomy with facial nerve sparing between 2016 and 2020. The Modified Sunnybrook System (mS-FGS) was used for facial assessments. Physiotherapy began on the first post-operative day with a tailored program of facial exercises based on Neuromuscular Retraining, to be performed at home 3 times/day. From the first outpatient consultation, Proprioceptive Neuromuscular Facilitation was added to the treatment of cases with moderate or severe facial dysfunctions. RESULTS: Benign and malignant groups had a statistically significant improvement in mS-FGS (p < 0.001 and p = 0.005, respectively). There was no significant difference between groups regarding treatment duration or number of physiotherapy sessions performed. The history of previous parotidectomy resulted in more severe initial dysfunctions and worse outcome. Age over 60 years and initially more severe dysfunctions impacted the outcome. CONCLUSION: Patients with benign and malignant parotid neoplasms had significant and equivalent improvement in postoperative facial dysfunction following an early tailored physiotherapy program, with no significant difference in the final facial score, treatment duration, or number of sessions required.

Ocular-oral synkinesis caused by partial injury of the zygomatic and buccal branches of the facial nerve after mid-face trauma.

BACKGROUND: Facial nerve paralysis induced by acute traumatic facial nerve injuries limited to the zygomatic and buccal branches shows unique complications, such as strong co-contractions of the lower facial muscles around the lips during voluntary blinking (ocular-oral synkinesis). We investigated the characteristics of facial complications after facial nerve injury in the mid-face area and reported the treatment results. METHODS: A total of 21 patients with facial nerve injuries to the zygomatic and/or buccal branches were evaluated for the degree of facial synkinesis and mouth asymmetry. Patients with mild-to-moderate symptoms were treated using physical rehabilitation therapy combined with botulinum toxin (Botox) injection, and patients with severe or uncontrolled symptoms were treated using surgical therapy. RESULTS: Initial/final mean synkinesis scores and mouth asymmetry degrees were 2.17/1.75 and 0.85/0.66 in the physical therapy group and 3.11/0.78 and 2.41/-0.31 in the surgery group, respectively. Physical therapy with Botox injection alone did not show significant improvements in synkinetic symptoms of the patients with mild-to-moderate synkinesis (p > 0.05), whereas surgical therapy resulted in significant improvements in synkinesis and mouth asymmetry (p < 0.05). CONCLUSIONS: Surgical treatment is an effective adjustment procedure for the management of facial complications in patients with severe or uncontrolled synkinesis after facial nerve injury to the mid-face area.

Post-parotidectomy facial nerve function: comparison between original and modified Sunnybrook Facial Grading Systems / Função do nervo facial pós-parotidectomia: comparação entre os Sistemas Sunnybrook de Graduação Facial original e modificado

Abstract Background: Facial nerve dysfunction is the principal postoperative complication related to parotidectomy. Objective: To test the hypothesis that the modified Sunnybrook Facial Grading System (mS-FGS) is superior to the original S-FGS in the assessment of facial nerve function following parotidectomy. Methods: Prospective, longitudinal study evaluating patients with primary or metastatic parotid neoplasms undergoing parotidectomy with facial nerve-sparing between 2016 and 2020. The subjects were assessed twice, on the first postoperative day and at the first outpatient evaluation, 20-30 days post-surgery. Facial assessments were performed using the original and modified (plus showing the lower teeth) versions of the Sunnybrook System and documented by pictures and video recordings. Intra- and inter-rater agreements regarding the assessment of the new expression were analyzed. Results: 101 patients were enrolled. In both steps, the results from the mS-FGS were significantly lower (p < 0.001). Subjects with a history of previous parotidectomy and those who underwent neck dissection had more severe facial nerve impairment. The mandibular marginal branch was the most frequently injured, affecting 68.3% of the patients on the first postoperative day and 52.5% on the first outpatient evaluation. Twenty patients (19.8%) presented an exclusive marginal mandibular branch lesion. The inter-rater agreement of the new expression assessment ranged from substantial to almost perfect. The intra-rater agreement was almost perfect (wk = 0.951). Conclusion: The adoption of the Modified Sunnybrook System, which includes evaluation of the mandibular marginal branch, increases the accuracy of post-parotidectomy facial nerve dysfunction appraisal.

Resumo Antecedentes: A disfunção do nervo facial é a principal complicação pós-operatória relacionada à parotidectomia. Objetivo: Testar a hipótese de que o sistema Sunnybrook de graduação facial modificado (mS-FGS) é superior ao S-FGS original na avaliação da função do nervo facial após parotidectomia. Métodos: Estudo longitudinal prospectivo avaliando o pós-operatório de pacientes com neoplasias parotídeas primárias ou metastáticas, submetidos à parotidectomia com preservação do nervo facial, entre 2016 e 2020. Os indivíduos foram avaliados duas vezes, no primeiro dia de pós-operatório e na primeira avaliação ambulatorial, 20-30 dias após a cirurgia. As avaliações faciais foram realizadas usando as versões original e modificada (que incluem mostrar os dentes inferiores) do sistema Sunnybrook e documentadas por fotos e vídeos. Foram adicionalmente analisadas as concordâncias intra e interexaminadoras da avaliação da nova expressão. Resultados: Cento e um pacientes foram incluídos. Em ambas as etapas, os resultados do mS-FGS foram significativamente menores (p < 0,001). Indivíduos com história de parotidectomia prévia e aqueles submetidos ao esvaziamento cervical apresentaram comprometimento mais grave do nervo facial. O ramo marginal mandibular foi o mais afetado, acometendo 68,3% dos pacientes no primeiro dia de pós-operatório e 52,5% na primeira avaliação ambulatorial. Vinte pacientes (19,8%) apresentaram lesão exclusiva do ramo marginal mandibular. A concordância interexaminadores da avaliação da nova expressão variou de substancial a quase perfeita. A concordância intraexaminador foi quase perfeita (wk = 0,951). Conclusão: A adoção do sistema Sunnybrook modificado, que inclui a análise do ramo marginal mandibular, aumenta a precisão da avaliação da disfunção do nervo facial pós-parotidectomia.

Electromyography in the prognostication of recovery in patients with acute peripheral facial nerve palsy: A systematic review.

OBJECTIVES: Needle electromyography (EMG) may be used to characterise the severity of the injury in acute peripheral facial nerve palsy (FNP) to predict recovery and guide management, but its prognostic value and clinical utility remain controversial. The aim of this systematic review was to evaluate the role of EMG to prognosticate the recovery of facial motor function in patients with acute peripheral FNP. DESIGN: A comprehensive search strategy was applied in PubMed, Embase, and Web of Science based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The main outcome measure was the accuracy of EMG in predicting long-term facial function at least 6 months following symptom onset. RESULTS: Eleven studies were included comprising 3837 participants, with 91.6% of these diagnosed with Bell's palsy (BP). In BP patients, the positive predictive value and negative predictive value for a good outcome based on EMG findings ranged from 82.1% to 100% and 66.7% to 80.5%, respectively, with two out of three studies finding that EMG remained a significant predictor of the outcome on multivariate analysis. Three studies addressed the role of EMG in non-idiopathic FNP with two of these studies supporting EMG to predict prognosis. CONCLUSIONS: EMG is a useful tool to gain insight into the likely outcome to guide management decisions and counsel patients on their expectations, particularly in BP. However, given inconsistencies in its application and lack of evidence around non-idiopathic FNP, it should not currently be relied on to predict recovery. Ultimately, its prognostic value and widespread adoption are dependent on the implementation of a clear and standardised protocol in future high-quality studies and routine clinical settings.

Subfascial dissection and extended temporal muscle detachment for middle fossa approach.

BACKGROUND: The soft tissue dissection for the middle fossa approach requires adequate management of the neuro, vascular, and muscular structures in order to maximize exposure and diminish morbidities. METHODS: An incision anterior to the tragus is performed, extending from the zygomatic process to the superior temporal line. The superior temporal artery is exposed, followed by a subfascial dissection of the frontalis nerve. The temporal muscle is dissected and released from the zygoma. All cranial landmarks are exposed for the 5 × 5 cm temporal fossa craniotomy. CONCLUSION: This novel approach provides a safe and adequate access to perform an extended middle fossa craniotomy.

Extracapsular dissection with a transparotid facial nerve dissection approach versus partial superficial parotidectomy for benign tumours in the tail of the parotid gland: a single-centre retrospective study of 89 patients.

The aims of this study were (1) to evaluate the transparotid facial nerve dissection approach (TFND), in which the intraparotid cervicofacial or temporofacial division is identified first through a superficial lobe incision; and (2) to compare extracapsular dissection with a TFND (ECD-TFND) with partial superficial parotidectomy with a retrograde approach (PSP) for benign tumours in the tail of the parotid gland with respect to surgical outcomes. Eighty-nine patients underwent PSP or ECD-TFND for benign tumours in the tail of the parotid gland: 49 were treated surgically with PSP and 40 with ECD-TFND. The mean ( ± standard deviation) surgical time did not differ significantly between the groups: 64 ± 22.4 min for PSP and 59 ± 19.8 min for ECD-TFND (P = 0.302). There was a significant difference in sialocele: 18 (36.7%) patients in the PSP group and four (10%) in the ECD-TFND group (P = 0.002). There was also a significant difference in facial nerve injuries: temporary paralysis was observed in 13 (26.5%) patients in the PSP group and two (5%) in the ECD-TFND group (P = 0.007). It appears that TFND is a viable and safe approach when performing ECD for benign tumours in the tail of the parotid gland. ECD-TFND should be preferred over PSP for benign tumours in the tail of the parotid gland.

Extracapsular dissection (ECD) and extended ECD: description of the technique and outcome of treatment.

Over the last two decades the senior author has exclusively applied the technique of extracapsular dissection (ECD) and extended ECD to treat discrete, apparently benign parotid tumours. This article describes both techniques and evaluates their application. Simple principles are described to anticipate unexpected malignant tumours and manage lumps safely by wide excision. A retrospective analysis of 97 consecutive patients with discrete, apparently benign parotid lumps is presented. The tumours were classified using the European Salivary Gland Society (ESGS) classification for benign tumours of the parotid gland. The ECD or extended ECD technique was employed irrespective of tumour site or size. A review of patients was carried out after a minimum of six months post surgery by two independent clinicians. The mean (range) hospital stay was one (0-4) night (median 1). Complications were both modest and transient. The temporary facial nerve injury rate was 5/97 (6%). Other complications included haematoma (n=2), sialocele (n=2), and first-bite syndrome (n=2). Independent review post surgery demonstrated a mean Sunnybrook facial grading system score of 98/100 and a mean Stony Brook scar assessment score of 4.5/5. In this series 5/97 (5%) of discreet mobile lumps concealed a low-grade salivary cancer. Experience with the application of ECD in conjunction with its extended form in 97 consecutive patients with discrete parotid lumps is described. The technique is amenable to all parotid lumps, is not restricted by site or size, and has shown minimal morbidity. The risk of recurrent disease could not be addressed.

Neurorrhaphy in Presence of Polyethylene Glycol Enables Immediate Electrophysiological Conduction in Porcine Model of Facial Nerve Injury.

Facial nerve trauma often leads to disfiguring facial muscle paralysis. Despite several promising advancements, facial nerve repair procedures often do not lead to complete functional recovery. Development of novel repair strategies requires testing in relevant preclinical models that replicate key clinical features. Several studies have reported that fusogens, such as polyethylene glycol (PEG), can improve functional recovery by enabling immediate reconnection of injured axons; however, these findings have yet to be demonstrated in a large animal model. We first describe a porcine model of facial nerve injury and repair, including the relevant anatomy, surgical approach, and naive nerve morphometry. Next, we report positive findings from a proof-of-concept experiment testing whether a neurorrhaphy performed in conjunction with a PEG solution maintained electrophysiological nerve conduction at an acute time point in a large animal model. The buccal branch of the facial nerve was transected and then immediately repaired by direct anastomosis and PEG application. Immediate electrical conduction was recorded in the PEG-fused nerves (n = 9/9), whereas no signal was obtained in a control cohort lacking calcium chelating agent in one step (n = 0/3) and in the no PEG control group (n = 0/5). Nerve histology revealed putative-fused axons across the repair site, whereas no positive signal was observed in the controls. Rapid electrophysiological recovery following nerve fusion in a highly translatable porcine model of nerve injury supports previous studies suggesting neurorrhaphy supplemented with PEG may be a promising strategy for severe nerve injury. While acute PEG-mediated axon conduction is promising, additional work is necessary to determine if physical axon fusion occurs and the longer-term fate of distal axon segments as related to functional recovery.

Outcomes and prognostic factors of facial nerve repair: a retrospective comparative study of 31 patients and literature review.

PURPOSE: To evaluate functional results of facial nerve repair by direct nerve suture or grafting, compare results between a traumatic and a tumoral group and identify prognostic factors. METHODS: A retrospective monocentric cohort study was studied in a university ENT department. Thirty-one patients who benefited from facial nerve suture or grafting, with at least 12 months postoperative follow-up were included. Patients were divided into two groups according to the lesion type: traumatic (accident of the public road or iatrogenic) and tumoral. Preoperative data studied were sex, side, etiology documented by CT and/or MRI, facial palsy duration and grade according to House Brackmann grading system. Intraoperative data included: surgeon, age of patient, surgical technique, graft type, use of biological glue, facial nerve derivation, lesioned site. Postoperative data included: histological diagnosis, radiotherapy history, time to onset of the first signs of reinnervation, follow-up duration, and final facial function. RESULTS: Success rate, including grade III and IV, was 68% in the whole cohort, 79% in the traumatic group and 59% in the tumoral group. Patients presenting with facial palsy evolving less than 6 months had better recovery results than those evolving longer than 6 months (p = 0.02). No other prognostic factors were identified. CONCLUSIONS: The best outcome that can be achieved by suture or grafting of the facial nerve in traumatic or tumoral lesions is a grade III. Preoperative facial palsy duration is a prognostic factor and must be considered when establishing an operative indication.

The external jugular vein axis: a new anatomical landmark for pre-operative prediction of the location of parotid gland tumours.

The relationships between parotid tumours and the facial nerve determine duration of surgical procedure and risks involved. As the division of the facial nerve is not visible using standard imaging techniques, other anatomical landmarks are used to determine the pre-operative location of tumours. This retrospective study aimed to evaluate reliability of the 'external jugular vein axis' compared with other landmarks generally used in imaging, such as the retromandibular vein, Conn's arc, the facial nerve line and the Utrecht line. Forty-eight pre-operative imaging exams of patients who underwent parotid benign tumour surgery between 2010 and 2016 were examined. We determined the location of tumour using the five markers. A pre-operative simulation was compared with the description given by the surgeon intraoperatively, in terms of sensitivity and specificity for each marker. External jugular vein axis and retromandibular vein are the most sensitive markers for locating suprafacial tumours (Se = 1). External jugular vein axis and Conn's arc are the most specific markers for locating suprafacial tumours (Spe = 0.92). External jugular vein axis is reproducible and present on all radiological sections, thereby overcoming any anatomical and nomenclature variations. This landmark appears to be the most representative marker of the dividing branches of the facial nerve.

Monitorización intraoperatoria del nervio facial durante la cirugía de la glándula parótida en servicios de otorrinolaringología - cirugía de cabeza y cuello / Intraoperative monitoring of the facial nerve during parotid gland surgery in Otolaryngology services - Head and Neck Surgery

Introducción: La lesión del nervio facial continúa siendo la complicación más grave de la cirugía de la glándula parótida. Debido a la creciente evidencia sobre las ventajas del uso de la monitorización intraoperatoria del nervio facial, se distribuyó una encuesta entre los miembros de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello con el objetivo de determinar los patrones de uso en nuestro medio.Material y métodosSe distribuyó un cuestionario que incluía 12 preguntas separadas en 3 secciones en formato e-mail a través del correo oficial de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. La primera sección de preguntas evaluaba las características demográficas, la segunda sección estaba relacionada con el patrón de uso de los sistemas de monitorización intraoperatoria del nervio facial y la tercera sección se refería a los litigios relacionados con la parálisis facial.ResultadosSe enviaron un total 1.544 cuestionarios anónimos. Recibimos un total de 255 encuestas, para una tasa de respuesta global del 16,5%. De estos, 233 (91,3%) realizaban cirugía de glándula parótida y 94% usaban monitorización intraoperatoria del nervio facial. Un 94% de los encuestado usaba la monitorización intraoperatoria del nervio facial si realizaba menos de 10 parotidectomías por año y un 93,8% si realizaban más de 10 parotidectomías por año (OR, 1,02; IC del 95%, 0,68-1,45; p=0,991).ConclusiónNuestros datos demuestran que la mayoría de los otorrinolaringólogos y cirujanos de cabeza y cuello en España están empleando la monitorización del nervio facial durante la cirugía de la glándula parótida. Casi todos coinciden en que esto busca mejorar las medidas de seguridad quirúrgica y consideran que la monitorización del nervio facial es útil para prevenir lesiones inadvertidas. (AU)

Introduction: Facial nerve injury remains the most severe complication of parotid gland surgery. Due to the increasing evidence about the advantage of the use of intraoperative facial nerve monitoring, a survey was distributed among members of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery with the objective of determining patterns of its use.Material and methodsA questionnaire which included 12 separate questions in 3 sections was distributed via email through the official email of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery. The first section of questions was in relation to demographic characteristics, the second section was related to the pattern of monitoring use and the third section referred to litigation related to facial palsy.Results1544 anonymous questionnaires were emailed. 255 surveys were returned, giving an overall response rate of 16.5%. From these, 233 (91.3%) respondents perform parotid gland surgery. Two-hundred nineteen (94%) respondents use intraoperative facial nerve monitoring. Of the respondents,94% used intraoperative facial nerve monitoring if in their current practice they performed fewer than 10 parotidectomies per year and 93.8% if they performed more than 10 (OR, 1.02; 95% CI, 0.68-1.45; p=.991). With regard to lawsuits, just 3 (1.2%) of the respondents had a history of a parotid gland surgery–associated lawsuit and in just one case the facial nerve monitor was not used.ConclusionOur data demonstrate that most otolaryngologists in Spain use intraoperative facial nerve monitoring during parotid gland surgery. Almost all of them use it to improve patient safety and consider that facial nerve monitoring should be helpful preventing inadvertent injury. (AU)

Facial Nerve Adherence in Vestibular Schwannomas: Classification and Radiological Predictors.

Background Facial nerve palsy is one of the most frequent complications after resection of vestibular schwannomas (VS). Several mechanisms have been implicated in the poor postoperative facial nerve outcome. Adherence between the facial nerve and tumor capsule is one of the most relevant factors. There is no clear preoperative parameter permitting identification of these adhesions. Objective The aim of this study was to identify the correlation between the grade of adherence of the facial nerve to the tumor capsule and its functional outcome after VS resection. Methods A total of 26 patients with sporadic VS (tumor sized T3, T4A, and T4B according to Hannover classification) were evaluated. Grade of adherence of the facial nerve to the tumor capsule was checked during surgery and graduated according to a proposed scale into 1 to 3 different grades. Facial nerve function was assessed postoperatively and after 1-year follow-up. Size of tumor according to Hannover classification, presence of cystic components, "cerebrospinal fluid (CSF) cleft sign," and the contour of tumor capsule were tested as radiological predictors of grade of adherence to the facial nerve. Results and Conclusion Only Grade 2 (11 cases) and 3 (15 cases) of adherence were seen in large VS. Lower grade of adherence was associated with good facial nerve outcome after 1-year follow-up ( p = 0.029). Presence of the "CSF cleft sign" and regular contour of tumor capsule were independent predictors of adherence. When both factors were associated, sensitivity and specificity of this method were 83 and 80%, respectively.

Intraoperative monitoring of the facial nerve during parotid gland surgery in Otolaryngology services - Head and Neck Surgery. / Monitorización intraoperatoria del nervio facial durante la cirugía de la glándula parótida en servicios de otorrinolaringología - cirugía de cabeza y cuello.

INTRODUCTION: Facial nerve injury remains the most severe complication of parotid gland surgery. Due to the increasing evidence about the advantage of the use of intraoperative facial nerve monitoring, a survey was distributed among members of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery with the objective of determining patterns of its use. MATERIAL AND METHODS: A questionnaire which included 12 separate questions in 3 sections was distributed via email through the official email of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery. The first section of questions was in relation to demographic characteristics, the second section was related to the pattern of monitoring use and the third section referred to litigation related to facial palsy. RESULTS: 1544 anonymous questionnaires were emailed. 255 surveys were returned, giving an overall response rate of 16.5%. From these, 233 (91.3%) respondents perform parotid gland surgery. Two-hundred nineteen (94%) respondents use intraoperative facial nerve monitoring. Of the respondents,94% used intraoperative facial nerve monitoring if in their current practice they performed fewer than 10 parotidectomies per year and 93.8% if they performed more than 10 (OR, 1.02; 95% CI, 0.68-1.45; p=.991). With regard to lawsuits, just 3 (1.2%) of the respondents had a history of a parotid gland surgery-associated lawsuit and in just one case the facial nerve monitor was not used. CONCLUSION: Our data demonstrate that most otolaryngologists in Spain use intraoperative facial nerve monitoring during parotid gland surgery. Almost all of them use it to improve patient safety and consider that facial nerve monitoring should be helpful preventing inadvertent injury.

Outcomes of ossicular disruption in traumatic facial paralysis: a case series.

BACKGROUND: As tympanotomy using the transcanal approach was a routine surgical technique for traumatic ossicular disruption, the efficacy of the posterior tympanum approach was rarely explored. AIM: This study aimed to investigate whether the hearing outcomes improved after simultaneous ossiculoplasty and facial nerve decompression using the posterior tympanum approach compared with the transcanal approach. MATERIAL AND METHODS: The data of 11 patients who underwent ossiculoplasty and facial nerve decompression using the posterior tympanum approach and 21 patients who underwent ossiculoplasty via transcannal approach were analyzed. RESULTS: The average air-bone gap (ABG) of patients undergoing posterior tympanotomy showed a statistically significant improvement. Postoperative ABG within 20 dB was observed in 81.8% of patients in the posterior tympanum group and 76.2% of patients in the transcanal group. However, the ABG closure in the two groups was not statistically different. CONCLUSIONS AND SIGNIFICANCE: Simultaneous ossiculoplasty using the posterior tympanum approach was practical, and the hearing outcomes were promising for the patients with traumatic facial nerve paralysis and ossicular disruption.

Prognostic value of neuroelectromyography in peripheral facial paralysis and its correlation with House-Brackman classification / 中国基层医药

Objective:To investigate the prognostic value of neuroelectromyography in peripheral facial paralysis and its correlation with House-Brackman classification.Methods:Seventy-eight patients with peripheral facial paralysis who received treatment in Yiwu Central Hospital, China between January 2016 and January 2019 were included in this study. All patients underwent neuroelectromyography. Bilateral nerve conduction velocity, latency, amplitude, and the needle electrode electrogram of orbicularis oris muscles, rbicularis oculi muscles and frontal muscles were analyzed and recorded. After 3 months of treatment, the correlation between prognosis and House-Brackman classification was analyzed.Results:Electromyography examination of 78 patients revealed among 68 patients presenting with prolonged latency, the latency on the affected side was significantly longer than that on the healthy side [(3.78 ± 0.33) ms vs. (2.89 ± 0.35) ms], t = 15.256, P < 0.001]. Among 73 patients presenting with decreased M amplitude, M amplitude on the affected side was significantly lower than that on the healthy side [(0.60 ± 0.27) mV vs. (1.83 ± 0.29) mV, t = 26.522, P < 0.001]. Among 78 patients, normal electromyography findings were observed in 2 patients and abnormal findings in 76 patients, with an abnormal rate of 97.44%. Among 78 patients, 46 patients presented with fibrillation potentials and positive sharp waves in the resting state, 40 patients presented with long duration and multiphase wave percentage of motor unit action potential in mild contraction, and 52 patients presented with abnormal recruitment potential in severe contraction. Three months of follow-up revealed that 23 out of 25 patients with mild peripheral facial paralysis had a complete recovery, with the cure rate of 92.00% (23/25), 28 out of 36 patients with moderate peripheral facial paralysis had a complete recovery, with the cure rate of 77.78% (28/36), 7 out of 10 patients with mild and moderate peripheral facial paralysis had a complete recovery, with the cure rate of 70.00% (7/10), and 3 out of 5 patients with severe peripheral facial paralysis had a complete recovery, with the cure rate of 60.00% (3/5). Conclusion:Neuroelectromyography can improve the accuracy in the identification of injury degree of peripheral facial paralysis and has a strong correlation with House-Brackman classification. Therefore, neuroelectromyography can provide a reference for diagnosis and treatment of peripheral facial paralysis.

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.

Incidence of postoperative facial weakness in parotid tumor surgery: a tumor subsite analysis of 794 parotidectomies.

BACKGROUND: The reported incidence of facial weakness immediately after parotid tumor surgery ranges from 14 to 65%. The purpose of this study was to evaluate the incidence of postoperative facial weakness related to parotidectomy with use of preoperative computed tomography (CT), intraoperative facial nerve monitoring, and surgical magnification. Also, we sought to elucidate additional information about risk factors for postoperative facial weakness in parotid tumor surgery, particularly focusing on the tumor subsites. METHODS: We retrospectively reviewed 794 cases with parotidectomy for benign and malignant tumors arising from the parotid gland (2009-2016). Patients with pretreatment facial palsy were excluded from the analyses. Tumor subsites were stratified based on their anatomical relations to the facial nerve as superficial, deep, or both. Multivariable logistic regression analyses were conducted to identify risk factors for postoperative facial weakness. RESULTS: The overall incidences of temporary and permanent (more than 6 months) facial weakness were 9.2 and 5.2% in our series utilizing preoperative CT, intraoperative facial nerve monitoring, and surgical magnification. Multivariable analysis revealed that old age, malignancy, and recurrent tumors (revision surgery) were common independent risk factors for both temporary and permanent postoperative facial weakness. In addition, tumor subsite (tumors involving superficial and deep lobe) was associated with postoperative facial weakness, but not tumor size. Extent of surgery was strongly correlated with tumor pathology (malignant tumors) and tumor subsite (tumors involving deep lobe). CONCLUSION: Aside from risk factors for facial weakness in parotid tumor surgery such as old age, malignant, or recurrent tumors, the location of tumors was found to be related to postoperative facial weakness. This study result may provide background data in a future prospective study and up-to-date information for patient counseling.

Trauma do nervo facial e terapias de tratamento / Facial nerve trauma and treatment therapies

Os traumatismos bucomaxilofaciais, associados com as fraturas do osso temporal e lacerações na face, muitas vezes acabam causando algumas lesões em nervos periféricos, em específico, o nervo facial. Quando lesionado, o VII par craniano pode comprometer profundamente a vida dos pacientes, tanto com alterações fisiológicas significativas, quanto alterações psicológicas. O tratamento dessas lesões, geralmente é cirúrgico; no entanto, os resultados muitas vezes ainda são insatisfatórios. Com o intuito de aprimorar as técnicas cirúrgicas no tratamento das lesões aos nervos periféricos, muitos estudos têm sidos realizados pela engenharia de tecidos com o objetivo de desenvolver biomateriais associados com fatores neuroindutores, principalmente nas lesões nervosas em que há perda de substância. O estudo desses biomateriais parece ser bastante promissor, tornando-se uma fonte viável em substituição ao enxerto autólogo, que; embora seja o "padrão ouro", ainda apresenta limitações. Sendo assim, esse artigo consiste de uma revisão de literatura livre, pelo pubmed, sobre trauma de nervo facial e alternativas de tratamento.

Buccomaxillofacial trauma, associated with temporal bone fractures and lacerations on the face, often end up causing some lesions on peripheral nerves, specifically the facial nerve. When injured, the VII cranial torque can profoundly compromise patients' lives, both with significant physiological changes and psychological changes. The treatment of these lesions is usually surgical; However, the results are often still unsatisfactory. In order to improve surgical techniques in the treatment of peripheral nerve injuries, many studies have been carried out by tissue engineering in order to develop biomaterials associated with neuroindustrial factors, especially in nerve lesions in which there is loss of substance. The study of these biomaterials seems to be quite promising, becoming a viable source in replacement of the autologous graft, which; Although it is the "gold standard", still has limitations. Thus, this article consists of a review of free literature, by pubmed, on facial nerve trauma and treatment alternatives.

Neuromonitorización intraoperatoria del nervio facial: a propósito de un caso / Intraoperative neuromonitoring of the facial nerve: a case report

Introdução: A preservação do nervo facial (NF) é uma das principais preocupações do cirurgião durante o tratamento aberto das fraturas mandibulares, uma vez que uma lesão nessa estrutura anatômica pode causar sequelas estéticas e funcionais permanentes. A existência de variações anatômicas (anastomoses e ramificações incomuns) aumenta o risco de danos no NF, mesmo nas mãos de cirurgiões experientes. O neuromonitoramento intraoperatório tem-se mostrado um grande aliado para evitar lesões nos ramos nervosos que podem estar envolvidos na área cirúrgica. Considerando a escassez desse assunto na literatura referente à cirurgia maxilo-facial, objetivamos demonstrar o uso da técnica de neuromonitoração do NF durante o acesso submandibular para o tratamento da fratura bilateral do ângulo mandibular. Relato de caso: No presente relato de caso, as abordagens cirúrgicas de ambos os lados não apresentaram danos permanentes ao NF. Esse resultado assim como a literatura sugerem que o neuromonitoramento intraoperatório proporciona maior segurança durante a realização de abordagens cirúrgicas, nas quais os ramos do nervo facial estão envolvidos, reduzindo, assim, o risco de sequelas nervosas. Considerações Finais: Esse recurso pode ser de grande auxílio no treinamento hospitalar ao longo do processo de formação de cirurgiões bucomaxilofaciais... (AU)

Introduction: Facial nerve (FN) preservation is one of the surgeon's major concerns during the open treatment of mandibular fractures since an injury to this anatomical structure can cause permanent aesthetic and functional sequelae. The existence of anatomical variations (anastomosis and unusual branching) increases the risk of FN damage even in the hands of experienced surgeons. Intraoperative neuromonitoring has proven to be a great ally to avoid injury to the nerve branches that may be involved in the surgical area. Considering the scarcity of this subject in the maxillofacial surgery literature, we aimed to demonstrate the use of the FN neuromonitoring technique during the submandibular approach for the treatment of bilateral mandibular angle fracture. Case report: In the present case report, the surgical approaches of both sides presented no permanent damage to the FN. Results: This result, as well as previous literature, suggests that intraoperative neuromonitoring provides greater safety during the performance of surgical approaches in which the facial nerve branches are involved and thus, reduces the risk of nerve sequelae. Final considerations: This resource can be of special assistance in teaching hospitals throughout the training process of maxillofacial surgeons... (AU)