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1.
Laryngoscope ; 131 Suppl 4: S1-S42, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33729584

RESUMO

OBJECTIVES/HYPOTHESIS: Facial nerve monitoring (FNM) has evolved into a widely used adjunct for many surgical procedures along the course of the facial nerve. Even though majority opinion holds that FNM reduces the incidence of iatrogenic nerve injury, there are few if any studies yielding high-level evidence and no practice guidelines on which clinicians can rely. Instead, a review of the literature and medicolegal cases reveals significant variations in methodology, training, and clinical indications. STUDY DESIGN: Literature review and expert opinion. METHODS: Given the lack of standard references to serve as a resource for FNM, we assembled a multidisciplinary group of experts representing more than a century of combined monitoring experience to synthesize the literature and provide a rational basis to improve the quality of patient care during FNM. RESULTS: Over the years, two models of monitoring have become well-established: 1) monitoring by the surgeon using a stand-alone device that provides auditory feedback of facial electromyography directly to the surgeon, and 2) a team, typically consisting of surgeon, technologist, and interpreting neurophysiologist. Regardless of the setting and the number of people involved, the reliability of monitoring depends on the integration of proper technical performance, accurate interpretation of responses, and their timely application to the surgical procedure. We describe critical steps in the technical set-up and provide a basis for context-appropriate interpretation and troubleshooting of recorded signals. CONCLUSIONS: We trust this initial attempt to describe best practices will serve as a basis for improving the quality of patient care while reducing inappropriate variations. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:S1-S42, 2021.


Assuntos
Eletromiografia/métodos , Nervo Facial/fisiologia , Nervo Facial/cirurgia , Monitorização Intraoperatória/instrumentação , Guias de Prática Clínica como Assunto/normas , Idoso , Lista de Checagem , Análise Custo-Benefício , Traumatismos do Nervo Facial/epidemiologia , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Incidência , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Neurofisiologia/métodos , Neurofisiologia/estatística & dados numéricos , Preceptoria/normas , Qualidade da Assistência à Saúde , Reprodutibilidade dos Testes
2.
Cochrane Database Syst Rev ; 1: CD007468, 2021 01 26.
Artigo em Inglês | MEDLINE | ID: mdl-33496980

RESUMO

BACKGROUND: Bell's palsy is an acute unilateral facial paralysis of unknown aetiology and should only be used as a diagnosis in the absence of any other pathology. As the proposed pathophysiology is swelling and entrapment of the nerve, some surgeons suggest surgical decompression of the nerve as a possible management option; this is ideally performed as soon as possible after onset. This is an update of a review first published in 2011, and last updated in 2013. This update includes evidence from one newly identified study. OBJECTIVES: To assess the effects of surgery in the early management of Bell's palsy. SEARCH METHODS: On 20 March 2020, we searched the Cochrane Neuromuscular Specialised Register, CENTRAL, MEDLINE, Embase, ClinicalTrials.gov and WHO ICTRP. We handsearched selected conference abstracts for the original version of the review. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) or quasi-RCTs involving any surgical intervention for Bell's palsy. Trials compared surgical interventions to no treatment, later treatment (beyond three months), sham treatment, other surgical treatments or medical treatment. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trials for inclusion, assessed risk of bias and extracted data. We used standard methodological procedures expected by Cochrane. The primary outcome was complete recovery of facial palsy at 12 months. Secondary outcomes were complete recovery at three and six months, synkinesis and contracture at 12 months, psychosocial outcomes at 12 months, and side effects and complications of treatment. MAIN RESULTS: Two trials with 65 participants met the inclusion criteria; one was newly identified at this update. The first study randomised 25 participants into surgical or non-surgical (no treatment) groups using statistical charts. One participant declined surgery, leaving 24 evaluable participants. The second study quasi-randomised 53 participants; however, only 41 were evaluable as 12 declined the intervention they were allocated. These 41 participants were then divided into early surgery, late surgery or non-surgical (no treatment) groups using alternation. There was no mention on how alternation was decided. Neither study mentioned if there was any attempt to conceal allocation. Neither participants nor outcome assessors were blinded to the interventions in either study. There were no losses to follow-up in the first study. The second study lost three participants to follow-up, and 17 did not contribute to the assessment of secondary outcomes. Both studies were at high risk of bias. Surgeons in both studies used a retro-auricular/transmastoid approach to decompress the facial nerve. For the outcome recovery of facial palsy at 12 months, the evidence was uncertain. The first study reported no differences between the surgical and no treatment groups. The second study fully reported numerical data, but included no statistical comparisons between groups for complete recovery. There was no evidence of a difference for the early surgery versus no treatment comparison (risk ratio (RR) 0.76, 95% confidence interval (CI) 0.05 to 11.11; P = 0.84; 33 participants; very low-certainty evidence) and for the early surgery versus late surgery comparison (RR 0.47, 95% CI 0.03 to 6.60; P = 0.58; 26 participants; very low-certainty evidence). We considered the effects of surgery on facial nerve function at 12 months very uncertain (2 RCTs, 65 participants; very low-certainty evidence). Furthermore, the second study reported adverse effects with a statistically significant decrease in lacrimal control in the surgical group within two to three months of denervation. Four participants in the second study had 35 dB to 50 dB of sensorineural hearing loss at 4000 Hz, and three had tinnitus. Because of the small numbers and trial design we also considered the adverse effects evidence very uncertain (2 RCTs, 65 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS: There is very low-certainty evidence from RCTs or quasi-RCTs on surgery for the early management of Bell's palsy, and this is insufficient to decide whether surgical intervention is beneficial or harmful. Further research into the role of surgical intervention is unlikely to be performed because spontaneous or medically supported recovery occurs in most cases.


Assuntos
Paralisia de Bell/cirurgia , Descompressão Cirúrgica/métodos , Nervo Facial/cirurgia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tempo para o Tratamento
3.
BMC Surg ; 21(1): 32, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419427

RESUMO

BACKGROUND: Early surgical repair to restore nerve integrity has become the most commonly practiced method for managing facial nerve injury. However, the evidence for the efficacy of surgical repair for restoring the function of facial nerves remains deficient. This study evaluated the outcomes of surgical repair for facial nerve lesions. METHODS: This retrospective observational study recruited 28 patients with the diagnosis of facial nerve injury who consecutively underwent surgical repairs from September 2012 to May 2019. All related clinical data were retrospectively analyzed according to age, sex, location of the facial nerve lesion, size of the facial nerve defect, method of repair, facial electromyogram, and blink reflex. Facial function was then stratified with the House-Brackmann grading system pre-operation and 3, 9, 15, and 21 months after surgical repair. RESULTS: The 28 patients enrolled in this study included 17 male and 11 female patients with an average age of 34.3 ± 17.4 years. Three methods were applied for the repair of an injured facial nerve, including great auricular nerve transplantation in 15 patients, sural nerve grafting in 7 patients, and hypoglossal to facial nerve anastomosis in 6 patients. Facial nerve function was significantly improved at 21 months after surgery compared with pre-operative function (P = 0.008). Following surgical repair, a correlation was found between the amplitude of motor unit potential (MUP) and facial nerve function (r = -6.078, P = 0.02). Moreover, the extent of functional restoration of the facial nerve at 21 months after surgery depended on the location of the facial nerve lesion; lesions at either the horizontal or vertical segment showed significant improvement(P = 0.008 and 0.005), while no functional restoration was found for lesions at the labyrinthine segment (P = 0.26). CONCLUSIONS: For surgical repair of facial nerve lesions, the sural nerve, great auricular nerve, and hypoglossal-facial nerve can be grafted effectively to store the function of a facial nerve, and MUP may provide an effective indicator for monitoring the recovery of the injured nerve.


Assuntos
Traumatismos do Nervo Facial/cirurgia , Nervo Facial , Paralisia Facial , Adolescente , Adulto , Anastomose Cirúrgica , Plexo Cervical/cirurgia , Nervo Facial/cirurgia , Traumatismos do Nervo Facial/complicações , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Feminino , Humanos , Nervo Hipoglosso/transplante , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Nervo Sural/transplante , Resultado do Tratamento , Adulto Jovem
4.
Cancer Radiother ; 25(2): 155-160, 2021 Apr.
Artigo em Francês | MEDLINE | ID: mdl-33402291

RESUMO

PURPOSE: To describe the clinical, therapeutic and prognostic features of ductal carcinomas of the parotid gland. MATERIAL AND METHODS: Five patients with ductal carcinoma of the parotid gland (primary and secondary carcinoma) treated, between 2007 and 2019, in our ENT department, were reviewed. RESULTS: Four men and one woman were included. The mean age was 61,4 years. One patient had a history of an invasive ductal carcinoma of the breast. Four patients consulted for swelling in the parotid region. One patient referred to our department for dysfunction of facial nerve. Skin invasion was found in one case. Four patients underwent total parotidectomy with sacrifice of the facial nerve (three cases). One patient underwent extended parotidectomy involving the skin. An ipsilateral selective neck dissection was performed in four cases. One patient had a parotid gland biopsy. Ductal carcinoma was primary in four cases and metastatic from breast origin in one case. Four patients were treated with postoperative radiotherapy. Remission was obtained in three cases. One patient had a local and meningeal recurrence. The patient with metastatic carcinoma had pulmonary, bone, hepatic and brain progression. CONCLUSION: Ductal carcinoma is a rare and aggressive tumor of the parotid gland. It can be primary or secondary. The treatment is based on surgery and radiotherapy. The prognosis is poor.


Assuntos
Carcinoma Ductal/cirurgia , Neoplasias Parotídeas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Carcinoma Ductal/diagnóstico por imagem , Carcinoma Ductal/patologia , Carcinoma Ductal/secundário , Carcinoma Ductal de Mama/patologia , Carcinoma Ductal de Mama/secundário , Nervo Facial/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical/estatística & dados numéricos , Invasividade Neoplásica , Glândula Parótida/diagnóstico por imagem , Glândula Parótida/cirurgia , Neoplasias Parotídeas/diagnóstico por imagem , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/secundário , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/patologia
5.
Vestn Otorinolaringol ; 85(5): 24-28, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33140929

RESUMO

The article provides a brief overview of the epidemiology of facial nerve neuromas (FNN, schwannomas), its clinical signs, methods of diagnostic and treatment and indications for their use. A rare clinical case of diagnostics, surgical treatment of FNN with intracranial spread and its results are described in detail. The presented case demonstrates a possible low-symptom course of FNN with intracranial spread. The use of a combined surgical approach (translabyrinthine and extradural subtemporal) in conjunction with neurosurgeons makes it possible to remove FNN with intracranial spread with simultaneous intratemporal neuroplasty of the nerve trunk from the tympanic part of the canal to the bottom of the internal auditory canal with a fragment of the sural nerve with an improvement in the function of the affected nerve.


Assuntos
Orelha Interna , Neuroma , Nervo Facial/cirurgia , Humanos , Osso Petroso , Membrana Timpânica
6.
J Laryngol Otol ; 134(6): 519-525, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32613920

RESUMO

OBJECTIVE: To present our data evaluating the feasibility of simultaneous cochlear implantation with resection of acoustic neuroma. METHODS: This paper describes a case series of eight adult patients with a radiologically suspected acoustic neuroma, treated at a tertiary referral centre in Newcastle, Australia, between 2012 and 2015. Patients underwent cochlear implantation concurrently with removal of an acoustic neuroma. The approach was translabyrinthine, with facial nerve monitoring and electrically evoked auditory brainstem response testing. Standard post-implant rehabilitation was employed, with three and six months' follow-up data collected. The main outcome measures were: hearing, subjective benefit of implant, operative complications and tumour recurrence. RESULTS: Eight patients underwent simultaneous cochlear implantation with resection of acoustic neuroma over a 3-year period, and had 25-63 months' follow up. There were no major complications. All patients except one gained usable hearing and were daily implant users. CONCLUSION: Simultaneous cochlear implantation with resection of acoustic neuroma has been shown to be a safe treatment option, which will be applicable in a wide range of clinical scenarios as the indications for cochlear implantation continue to expand.


Assuntos
Implante Coclear/métodos , Terapia Combinada/métodos , Audição/fisiologia , Neuroma Acústico/cirurgia , Adolescente , Idoso , Austrália/epidemiologia , Terapia Combinada/estatística & dados numéricos , Potenciais Evocados Auditivos do Tronco Encefálico/fisiologia , Nervo Facial/cirurgia , Estudos de Viabilidade , Seguimentos , Testes Auditivos/métodos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/patologia , Neuroma Acústico/reabilitação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Centros de Atenção Terciária , Resultado do Tratamento
7.
Artigo em Chinês | MEDLINE | ID: mdl-32668880

RESUMO

Objective: To investigate the clinical manifestation and management strategy of intraparotid facial nerve schwannoma. Methods: The clinical data of 12 patients with parotid schwannoma treated in Henan Cancer Hospital from January 2009 to January 2019 were analyzed retrospectively, including 5 males and 7 females, aged from 23 to 72 years. All the 12 patients complained of a mass in the parotid region, of whom 4 patients had local discomfort and pain, and 6 patients had varying degrees of pain during palpation. Ultrasound examination showed solid mass in parotid region in 8 cases and mixed mass in 4 cases. The treatment methods, the relationship between tumor and facial nerve, the modes of treatments and the nerve functions before and after operation were analyzed and summarized with House-Brackmann grade. Results: All 12 patients received surgical treatment: 8 patients underwent tumor resection plus partial or total superficial parotidectomy, 1 patient underwent tumor resection and total parotidectomy, and 3 patients underwent tumor resection, with 1 patient in whom tumor could not be removed completely due to tumor extention to the skull base. In 9 cases, the tumor occurred in the trunk or main branch of the facial nerve, and there was no facial nerve injury occurred after surgery; in 1 case, the tumor occurred in the terminal branch of the facial nerve, and part of the severe small branches of adhesion were cut off during the operation; in 1 case, the total trunk of the facial nerve was not found and the broken end of the nerve could not be found during the operation, so the nerve transplantation was not performed. In 1 case, nerve grafting was performed after nerve transection because it was impossible to separate the trunk of the facial nerve from the tumor during the operation. Preoperatively, House-Brackmann grade (H-B)Ⅰfacial nerve function was shown in 10 patients, H-BⅡ in 1 patient and H-B Ⅴin 1 patient. Postoperatively, the facial nerve function recovered to H-B Ⅰfor 7 patients, H-B Ⅱfor 2 patients, H-B Ⅲ for 1 patient, grade Ⅳ for 1 patient with nerve transplantation, and H-B Ⅴfor 1 patient with a revised surgery due to tumor recurrence. Conclusions: The intraparotid facial nerve schwannoma is rare, and it is easy to be misdiagnosed before operation. Surgery is a main treatment for intraparotid facial nerve schwannoma. Attention should be paid to the protection of facial nerve during operation.


Assuntos
Neoplasias dos Nervos Cranianos , Doenças do Nervo Facial , Neurilemoma , Neoplasias Parotídeas , Adulto , Idoso , Neoplasias dos Nervos Cranianos/diagnóstico , Neoplasias dos Nervos Cranianos/cirurgia , Nervo Facial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias Parotídeas/diagnóstico , Neoplasias Parotídeas/cirurgia , Estudos Retrospectivos , Adulto Jovem
8.
J Craniomaxillofac Surg ; 48(7): 680-684, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32507669

RESUMO

The aim of the present study was to analyse the consequences of masseter muscle denervation. In facial palsy surgical treatment, the masseteric nerve constitutes an important nerve source for facial reanimation due to its anatomical position and large amount of available axons. Computed tomography and/or magnetic resonance imaging were performed in 30 control subjects, and three radiologists separately measured the longitudinal diameter (LD), anteroposterior diameter (APD), transverse diameter (TD), and skeletal muscle area (SMA) of the masseter muscles as reference values. Regarding the facial palsy group, from 2009 to 2018, 11 patients (4 men and 7 women) were selected on the following inclusion criteria: diagnosis of unilateral facial paralysis, minimum follow-up of 14 months, absence of temporomandibular dysfunction, presence of complete dentition (to minimise bias of stomatognathic evaluation), complete clinical and radiological records. The mean LD, APD, TD, and SMA values of the healthy and denervated masseter muscles were obtained and compared. Stomatognathic function was clinically examined through mean mouth opening (MMO) and Maximum Bite Force (MBF). Furthermore, facial symmetry analysis (FSA) was carried out using EMOTRICS Software. Reference values obtained were as follows: mean LD = 69 ± 5.9 mm (range: 59-85 mm); mean APD = 40.2 ± 3.3 mm (range: 34-48 mm); mean TD = 15.5 ± 3.1 mm (range: 11-26 mm); and mean SMA = 43.8 ± 13.5 mm3 (range: 26-85.8 mm3). No statistically significant difference was observed between the healthy facial palsy groups's masseter muscles and reference values. As the latter, in denervated masseter muscles, no statistically significant difference was observed for APD value in contrast to LD, TD and SMA that showed statistically significant difference in comparison with control population (p < 0.05, CI 95%). Moreover fibro-adipose degeneration was consistently observed, with its degree being directly proportional to the denervation time. MMO and MBF mean values were, respectively, 54.75 mm in men, 44.4 mm in women and 705N. None of the latter showed a statistically significant difference with respect to the control population and the parameters present in the literature, indicating that masseter-facial neurorrhaphy is a safe and effective procedure for facial reanimation with good functional and aesthetic outcomes.


Assuntos
Paralisia Facial/cirurgia , Transferência de Nervo , Procedimentos Cirúrgicos Reconstrutivos , Denervação , Estética Dentária , Nervo Facial/cirurgia , Feminino , Humanos , Masculino , Músculo Masseter
9.
Am J Otolaryngol ; 41(5): 102580, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32536423

RESUMO

OBJECTIVE: The aim of this study is to apply the modified stapedectomy technique in cases with dehiscent and prolapsed facial nerve canal, and to compare the postoperative results with those with normal facial nerve canal anatomy. MATERIAL AND METHOD: 28 patients who underwent primary stapedectomy were included. Of the patients, 17 were in the normal anatomical facial nerve group, and 11 were in the dehiscent and prolapsed facial nerve group. Facial nerve was retracted with micro elevator in dehiscent and prolapsed group. and Titanium-Teflon prosthesis was angled and used in accordance with facial nerve course at this group. RESULT: No facial paresis or paralysis was observed in any patient postoperatively. In the first year, no significant difference was found in terms of air-bone gap. CONCLUSION: It is safe to retract the facial nerve for a limited time in cases of stapedectomy in cases with dehiscent and prolapsed facial nerve canal. In these cases, modifying the stapedial prosthesis in accordance with the facial nerve course does not cause disadvantage in terms of hearing gain.


Assuntos
Doenças do Nervo Facial/cirurgia , Nervo Facial/cirurgia , Prótese Ossicular , Otosclerose/cirurgia , Complicações Pós-Operatórias/cirurgia , Prolapso , Cirurgia do Estribo/métodos , Adulto , Doenças do Nervo Facial/fisiopatologia , Tubas Uterinas/anormalidades , Feminino , Audição , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
10.
J Vis Exp ; (159)2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32449733

RESUMO

This protocol describes consistent and reproducible methods to study axonal regeneration and inhibition in a rat facial nerve injury model. The facial nerve can be manipulated along its entire length, from its intracranial segment to its extratemporal course. There are three primary types of nerve injury used for the experimental study of regenerative properties: nerve crush, transection, and nerve gap. The range of possible interventions is vast, including surgical manipulation of the nerve, delivery of neuroactive reagents or cells, and either central or end-organ manipulations. Advantages of this model for studying nerve regeneration include simplicity, reproducibility, interspecies consistency, reliable survival rates of the rat, and an increased anatomic size relative to murine models. Its limitations involve a more limited genetic manipulation versus the mouse model and the superlative regenerative capability of the rat, such that the facial nerve scientist must carefully assess time points for recovery and whether to translate results to higher animals and human studies. The rat model for facial nerve injury allows for functional, electrophysiological, and histomorphometric parameters for the interpretation and comparison of nerve regeneration. It thereby boasts tremendous potential toward furthering the understanding and treatment of the devastating consequences of facial nerve injury in human patients.


Assuntos
Axônios/fisiologia , Nervo Facial/fisiologia , Nervo Facial/cirurgia , Regeneração Nervosa , Animais , Modelos Animais de Doenças , Nervo Facial/fisiopatologia , Traumatismos do Nervo Facial/fisiopatologia , Traumatismos do Nervo Facial/cirurgia , Humanos , Masculino , Camundongos , Ratos , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes
11.
World Neurosurg ; 140: 332-337, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32473330

RESUMO

BACKGROUND: Salivary duct carcinoma (SDC) is a rare parotid tumor that often develops as a rapidly growing mass with a poor prognosis. It has a high rate of distant metastases, sometimes with infiltration along nerves. We describe a case of SDC that originated outside the cranium and extended into the cranium along the path of the facial nerve. CASE DESCRIPTION: A 74-year-old man underwent magnetic resonance imaging at a local hospital, which revealed a tumor in the left internal acoustic canal; the patient was referred to our department. A left facial schwannoma was suspected, and magnetic resonance imaging was performed again 6 months later. Rapid tumor growth was confirmed, and the tumor was resected. The tumor displayed atypical epithelial cells with comedo necrosis and cribriform structure and was diagnosed as SDC. All residual intracranial tumors were removed using the middle fossa approach. The tumor, which was considered to be a primary tumor, was found near the stylomastoid foramen, and it was removed with the parotid gland. Five months after the initial surgery, metastasis to the trigeminal nerve was observed, and this was removed using a retrosigmoid approach, followed by radiation therapy. CONCLUSIONS: All 4 surgical specimens of this case were presented, and the path of tumor progression was examined in detail. Although the primary lesion was small, intracranial invasion along the facial nerve occurred. SDC should be considered as a tumor that can extend into the cranium, even with a small primary lesion.


Assuntos
Nervo Facial/patologia , Invasividade Neoplásica/patologia , Ductos Salivares/patologia , Neoplasias das Glândulas Salivares/patologia , Idoso , Nervo Facial/diagnóstico por imagem , Nervo Facial/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Invasividade Neoplásica/diagnóstico por imagem , Procedimentos Neurocirúrgicos , Ductos Salivares/diagnóstico por imagem , Ductos Salivares/cirurgia , Neoplasias das Glândulas Salivares/diagnóstico por imagem , Neoplasias das Glândulas Salivares/cirurgia , Resultado do Tratamento
12.
Acta Neurochir (Wien) ; 162(5): 1205-1213, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32152754

RESUMO

BACKGROUND: Facial nerve palsy is a severe morbid condition that occurs after vestibular schwannoma (VS) surgery. The objective of this study was to evaluate facial nerve outcomes based on surgical techniques, tumour size, and immunohistochemical factors. METHODS: One hundred eighteen patients with VS were retrospectively analysed. Gross total resection (GTR) was achieved in 83 patients, and subtotal resection (STR) was achieved in 35 patients. Follow-up was 60 months (median). Facial nerve outcomes were assessed for 24 months after surgery. Analysis of the MIB-1 index was performed in 114 patients (97%) to evaluate recurrence and facial nerve outcomes. RESULTS: Immediately after surgery, 16 of 35 patients (45.7%) with STR and 21 of 83 patients (25.3%) with GTR had a good (House-Brackmann (HB) score ≤ 2) facial nerve outcome (p = 0.029). Semi-sitting positioning (p = 0.002) and tumour size class of 3 (> 4 cm) were also associated with worse HB outcomes after 2 years (p = 0.004) in univariate analyses. The MIB-1 index was significantly correlated with diffuse infiltration of tumour-associated CD45+ lymphocytes (r = 0.63, p = 0.015) and CD68+ macrophages (r = 0.43, p = 0.021). ROC analysis found an AUC of 0.73 (95% CI = 0.60-0.86, p = 0.003) for the MIB-1 index in predicting poor facial nerve outcomes. Binary logistic regression analysis revealed an MIB-1 index ≥ 5% (16/28 (57.1%) vs. 5/40 (12.5%); p < 0.001, OR = 14.0, 95% CI = 3.2-61.1) and a tumour size class of 3 (6/8 (75.0%) vs. 2/8 (25.0%); p = 0.01, OR = 14.56, 95% CI = 1.9-113.4) were predictors of poor HB scores (≥ 3) after 1 year. CONCLUSIONS: An MIB-1 index ≥ 5% seems to predict worse long-term facial nerve outcomes in VS surgery.


Assuntos
Paralisia Facial/epidemiologia , Antígeno Ki-67/metabolismo , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Nervo Facial/cirurgia , Paralisia Facial/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/metabolismo , Procedimentos Neurocirúrgicos/efeitos adversos
13.
Acta Neurochir (Wien) ; 162(5): 1197-1203, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32146526

RESUMO

OBJECT: Surgery of tumours in the cerebellopontine angle (CPA) can lead to loss of facial nerve function. Different methods of intra-operative nerve monitoring (IOM) (including free-running EMG, direct nerve stimulation and transcranial motor evoked potentials (TcMEP)) have been used to predict facial nerve outcome during surgery. Recent research has shown TcMEP threshold increase and the occurrence of A-trains on the EMG to have great potential in doing so. This study compares these two methods and correlates them to House-Brackmann (HB) scores post-op in patients with tumours in the cerebellopontine angle. METHOD: Forty-three patients (one was operated twice) with large CPA tumours treated surgically in the Radboud University Medical Center between 2015 and 2019 were included in this study. During surgery, TcMEP threshold increases and A-train activity were measured. Because our treatment paradigm aims at facial nerve preservation (accepting residual tumour), TcMEP threshold increase of over 20 mA or occurrence of A-trains were considered as warning signs and used as a guide for terminating surgery. HB scores were measured post-op, at 6 weeks, 6 months and 1 year after surgery. Spearman's correlation was calculated between the IOM-values and the HB scores for a homogeneous subgroup of 30 patients with vestibular schwannoma (VS) without neurofibromatosis type II (NF-II) and all patients collectively. RESULTS: TcMEP threshold was successfully measured in 39 (90.7%) procedures. In the homogeneous VS non-NFII group, we found a statistically significant moderate-to-strong correlation between TcMEP threshold increase and House Brackmann score immediately post-op, at 6 weeks, 6 months and 1 year after surgery (Spearman's rho of 0.79 (p < 0.001), 0.74 (p < 0.001), 0.64 (p < 0.001) and 0.58 (p = 0.002), respectively). For A-trains, no correlation was found. Similar results were found when including all patients with CPA tumours. A threshold increase of < 20 mA was a predictor of good facial nerve outcome. CONCLUSION: These results show that TcMEP threshold increases are strongly correlated to post-operative HB scores, while A-trains are not. This suggests TcMEP threshold increases can be a valuable predictor for facial nerve outcome in patients with large tumours when facial nerve preservation is prioritized over total resection. In this study, we found no use for A-trains to prevent facial nerve deficits.


Assuntos
Potencial Evocado Motor , Traumatismos do Nervo Facial/diagnóstico , Monitorização Intraoperatória/métodos , Neuroma Acústico/cirurgia , Complicações Pós-Operatórias/diagnóstico , Adulto , Idoso , Ângulo Cerebelopontino/cirurgia , Eletromiografia , Nervo Facial/fisiologia , Nervo Facial/cirurgia , Traumatismos do Nervo Facial/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Estimulação Transcraniana por Corrente Contínua/métodos
14.
Otolaryngol Head Neck Surg ; 163(2): 344-347, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32204639

RESUMO

We present the development and validation of a low-cost novel model for training of parotid surgery. The model consists of a 3-dimensionally printed skeleton, silicone-based soft tissue, and facial nerve replicated with copper wire, circuited to indicate contact with instruments. The face validity of the simulator was evaluated with a 21-item 5-point Likert survey. Content validity was evaluated through a survey completed by the trainees after their first live parotidectomy following the simulation. Twelve residents and 6 faculty completed the simulated procedure of superficial parotidectomy after watching a video demonstration. Completion of 16 surgical steps evaluated by this model was graded for each participant. The mean ± SD total assessment score for faculty was 15.83 ± 0.41, as compared with 13.33 ± 2.06 for residents (P = .0081). The simulator as a training tool was well received by both faculty and residents (5 vs 4, P = .0206). Participants strongly agreed that junior residents would benefits from use of the model.


Assuntos
Dissecação/educação , Nervo Facial/cirurgia , Procedimentos Neurocirúrgicos/educação , Procedimentos Cirúrgicos Otorrinolaringológicos/educação , Glândula Parótida/cirurgia , Treinamento por Simulação , Humanos , Modelos Anatômicos , Impressão Tridimensional , Autorrelato
15.
J Craniofac Surg ; 31(3): 608-611, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32068726

RESUMO

INTRODUCTION: Facial paralysis impairs the mimetic functions of the facial musculature. In pediatric patients, free functioning muscle transfer neurotized with an intact contralateral facial nerve is the gold standard for smile reanimation. In response to requests from families of children with facial paralysis, the Division of Plastic and Reconstructive Surgery at the Hospital for Sick Children hosted an inaugural "Facial Paralysis Family Day." The objective was to create an opportunity for families to meet, exchange stories, and build support networks. METHODS: This study was a quality improvement project to conduct a needs assessment and evaluate the feasibility and satisfaction of implementing a family support intervention for individuals living with facial paralysis. RESULTS: The needs assessment demonstrated that families were most interested in advances in medicine, therapy and coping sessions and meeting other families. The post-event evaluation questionnaire indicated that attendees enjoyed the event, would attend again and found it highly valuable connecting and networking other families. It also indicated that key needs identified were addressed, with excellent ratings for the presentation discussing advances in medicine (100% rated "good" or "very good"), the therapy sessions (92% rated "good" or "very good") and the presentations by patients and their families (100% rated "good" or "very good.") DISCUSSION:: Two areas of improvement highlighted were elaborating further on medical advances and facilitating interactions between families. Overall, this event was well regarded and will likely be repeated at our institution and serve as a valuable resource for other hospitals planning to organize a similar event.


Assuntos
Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Adolescente , Criança , Músculos Faciais/cirurgia , Humanos , Educação de Pacientes como Assunto , Melhoria de Qualidade , Procedimentos Cirúrgicos Reconstrutivos , Sorriso , Adulto Jovem
17.
Facial Plast Surg Aesthet Med ; 22(1): 57-60, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32053424

RESUMO

Importance: There are no surgical techniques described to treat synkinesis and concurrent facial asymmetry. We describe our innovative and effective approach and technique. Objective: To improve the spontaneous smile mechanism as well as facial symmetry in patients with synkinesis not only during the smile mechanism but also at rest. Design: Surgical pearls-surgical technique description. Setting: Private practice. Participants: Patients who underwent the operation.


Assuntos
Denervação/métodos , Assimetria Facial/cirurgia , Nervo Facial/cirurgia , Sorriso , Sincinesia/cirurgia , Humanos
18.
Plast Reconstr Surg ; 145(3): 791-801, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097327

RESUMO

BACKGROUND: Corneal protection is a priority in flaccid facial palsy patients. Denervation of the orbicularis oculi muscle results in weak palpebral closure and predisposes patients to severe corneal sequelae. While periorbital static procedures enhance corneal coverage in repose, voluntary closure is only regained through dynamic reinnervation of the muscle. This study aims to elucidate the added effect of dynamic reinnervation of the orbicularis oculi muscle on long-term corneal integrity as well as on dynamic closure of the palpebral aperture. METHODS: Retrospective review was performed on two groups of complete palsy patients: those who received solely periorbital static procedures and those who underwent concomitant orbicularis oculi muscle reinnervation and static lid procedures. Only patients with complete ophthalmic examinations were included. Corneal punctate epithelial erosions in addition to static and dynamic palpebral measurements were serially assessed preoperatively and postoperatively. RESULTS: Of 272 facial palsy patients, 26 fit the inclusion criteria. Eleven patients underwent combined muscle reinnervation involving facial-to-masseteric nerve coaptation in addition to static eye procedures, and 15 patients underwent solely static interventions. Analysis revealed a 65.3 percent lower mean punctate epithelial erosion score in reinnervation patients as compared with static patients when evaluated at more than 9 months postoperatively (p < 0.01). Reinnervation patients were also found to have 25.3 percent greater palpebral aperture closure (p < 0.05) and 32.8 percent higher closure velocity (p < 0.01) compared with static patients. CONCLUSION: In patients with subacute facial palsy, dynamic reanimation of the orbicularis oculi muscle with concomitant static interventions provides lasting corneal protection not seen in patients who receive solely static interventions. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Doenças da Córnea/prevenção & controle , Músculos Faciais/inervação , Doenças do Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Transferência de Nervo/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Piscadela/fisiologia , Criança , Córnea/diagnóstico por imagem , Córnea/patologia , Doenças da Córnea/diagnóstico , Doenças da Córnea/etiologia , Doenças da Córnea/fisiopatologia , Pálpebras/fisiopatologia , Pálpebras/cirurgia , Músculos Faciais/cirurgia , Nervo Facial/cirurgia , Doenças do Nervo Facial/complicações , Paralisia Facial/etiologia , Feminino , Humanos , Masculino , Nervo Mandibular/transplante , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Cir Cir ; 88(1): 71-75, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31967597

RESUMO

Background: Moebius syndrome is a clinical entity characterized by bilateral facial and abducens nerve palsies; other cranial nerver might be affected as well. So far, no studies have reported the electromyographic responses of the facial musculature in this group of patients. Objective: The objective of our study is to describe the electromyographic responses of the facial muscle and the main donor nerves for facial reanimation in patients with Moebius syndrome. Method: We analyzed electromyographies from the facial, hypoglossal, masseterine (trigeminal) and accessory nerves from patients with Moebius syndrome treated between 2010 and 2016. Results are presented as percentages and central tendency measures. Results: 24 patients were included, mean age 11.79 ± 9.39 years. The facial nerve showed complete unilateral recruitment in 4 patients, partial bilaterally in 11, 7 showed no activity bilaterally and two had unilateral inactivity. The masseterine was normal in 14 patients, had partial recruitment bilaterally in 4 and unilaterally in 4 cases. The accessory nerve was normal in 20 patients, showed partial recruitment bilaterally in 3 and unilaterally in 1 patients. The hypoglossal was normal in 22 patients, and altered in 2 cases. Conclusion: Patients with Moebius syndrome show several degrees of alteration in electromyographic evaluation of the facial nerve. Electromyography is a useful tool in evaluating potential motor donor nerves for facial reanimation surgery.


Assuntos
Eletromiografia , Músculos Faciais/fisiopatologia , Nervo Facial/fisiopatologia , Síndrome de Möbius/fisiopatologia , Cuidados Pré-Operatórios/métodos , Doenças do Nervo Abducente , Nervo Acessório/fisiopatologia , Criança , Estudos Transversais , Nervo Facial/cirurgia , Feminino , Humanos , Nervo Hipoglosso/fisiopatologia , Masculino , Nervo Mandibular/fisiopatologia , Síndrome de Möbius/cirurgia , Estudos Retrospectivos
20.
World Neurosurg ; 137: 89-92, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31953093

RESUMO

BACKGROUND: Nervus intermedius neuralgia is an extremely rare craniofacial neuralgia characterized by paroxysmal episodes of pain located deep in the ear, typically triggered by sensory or mechanical stimuli at the wall of the auditory canal without underlying pathology. Pain is sometimes associated with disorders of lacrimation, salivation, and taste. CASE DESCRIPTION: We present a case of a surgically treated 68-year-old man with left paroxysmal deep ear pain for 20 years before presentation. Preoperative 3-dimensional magnetic resonance cisternography/magnetic resonance angiography (3D-MRC/MRA) fusion imaging showed severe compression of the facial nerve by the anterior inferior cerebellar artery in the cisternal portion with associated nerve deformity. We suspected nervus intermedius neuralgia and decided to perform microvascular decompression of the facial nerve. Transposition of the artery led to sufficient decompression of the nerve. The pain disappeared immediately after surgery. CONCLUSIONS: It is important to keep in mind the possibility of nervus intermedius neuralgia in patients who present with intermittent episodes of pain located deep in the ear. Furthermore, 3D-MRC/MRA fusion imaging is useful for decision-making in surgery. Microvascular decompression was highly effective in our case. Based on radiological findings, microvascular decompression should be considered a viable treatment option.


Assuntos
Nervo Facial/patologia , Dor Facial/diagnóstico por imagem , Dor Facial/etiologia , Cirurgia de Descompressão Microvascular/métodos , Procedimentos Neurocirúrgicos/métodos , Idoso , Nervo Facial/diagnóstico por imagem , Nervo Facial/cirurgia , Dor Facial/cirurgia , Humanos , Imageamento Tridimensional/métodos , Angiografia por Ressonância Magnética/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Neuroimagem/métodos
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