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1.
World Neurosurg ; 133: 49-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562973

RESUMO

BACKGROUND: Subdural lymphomas are a rare subtype of primary central nervous system lymphomas that can radiographically mimic epidural blood and pose a diagnostic challenge. They can complicate treatment if not preemptively identified. METHODS: We present a case report of a subdural lymphoma that mimicked a compressive subdural hematoma, and we review the PubMed database for similar cases. RESULTS: A 77-year-old woman presented with a transient left facial droop and what appeared to be a subdural hematoma on computed tomography scan. The patient underwent surgery, during which grossly abnormal solid epicortical adherent tissue was noted instead of the expected appearance of a subdural hematoma. An intraoperative biopsy was suggestive of lymphoma, and the surgery was converted to a craniectomy. Pathology confirmed the diagnosis of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. The patient underwent radiotherapy with no complications or recurrence. Magnetic resonance imaging demonstrated complete resolution of the mass at 3 months after treatment, at which time the patient underwent a synthetic cranioplasty. Seven case reports of primary dural lymphomas mimicking subdural blood were found, with variable pathologic subclassifications. CONCLUSIONS: Although rare, a primary dural lymphoma can be mistaken for a subdural hematoma on computed tomography scan. The most common subtype is low-grade extranodal marginal zone lymphomas. It is important to keep these diseases in the differential diagnosis, especially when there is incongruence between imaging and the clinical picture, as earlier detection correlates to a stronger therapeutic response.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Paralisia Facial/diagnóstico por imagem , Hematoma Subdural/diagnóstico por imagem , Linfoma de Células B/diagnóstico por imagem , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Craniotomia , Diagnóstico Diferencial , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Feminino , Humanos , Linfoma de Células B/complicações , Linfoma de Células B/cirurgia , Imagem por Ressonância Magnética , Espaço Subdural/diagnóstico por imagem , Espaço Subdural/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
J Craniomaxillofac Surg ; 47(12): 1952-1962, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31812306

RESUMO

PURPOSE: This study investigated the outcome of lower eyelid ectropion (LEE) treatment in patients with another primary periorbital or mid-facial pathology. MATERIALS AND METHODS: This 18-year monocentric retrospective cohort study included patients admitted for various leading mid-facial pathologies and presenting with a LEE. The primary diagnosis, surgical pretreatment, ectropion type, ectropion severity score (ESS), and surgical techniques were recorded. The primary endpoint was the postoperative ESS score. RESULTS: Overall, 40 patients (female n = 16, male n = 24, average age 70.8 years), primarily with periorbital skin cancer (n = 21, 52.5%), facial palsy (n = 7, 17%), trauma (n = 6, 15%), or other pathologies (n = 6, 15%), were included. Surgical procedures mostly addressed a correction of anterior and posterior lamellae (n = 22, 55%), with isolated anterior lamellae in only a few cases (n = 10, 25%). The ESS score significantly decreased from 4.8 ± 1.8 to 1.3 ± 1.3 (paired t-test, p < 0.001) after a mean follow-up of 23.8 months. CONCLUSION: LEE constitutes a relevant problem. Due to preexisting canthal ligament laxity in patients undergoing oncologic or traumatic midface surgery, the risk of ectropion has so far been underestimated. Bilamellar approaches in elderly patients are likely to be obligatory in any case.


Assuntos
Ectrópio/cirurgia , Pálpebras/cirurgia , Paralisia Facial/etiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ligamentos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
4.
Muscle Nerve ; 60(6): 716-723, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531862

RESUMO

INTRODUCTION: Guillain-Barré syndrome (GBS) is an inflammatory polyradiculoneuritis. Our aim in this study was to describe the clinical characteristics and the long-term sequelae of GBS in a French pediatric population. METHODS: In this multicenter, retrospective study we evaluated clinical signs, radiological examinations, laboratory tests, treatments, and outcomes. RESULTS: One hundred ten children were included in this investigation. These children presented with walking difficulties, muscle weakness, and cranial nerve impairment. Electrodiagnostic testing revealed 70% with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and 16% with acute motor axonal neuropathy (AMAN). One hundred children received immunoglobulins. At follow-up, 77% were cured, whereas 9% had sequelae, associated with an axonal form (P < .01) and a short interval between symptom onset and hospitalization (P < .01). The need for intubation was correlated with peripheral facial paralysis (P < .01) and dysautonomia (P < .01). DISCUSSION: Although AIDP and AMAN present in a similar way, the axonal form is associated with a worse outcome.


Assuntos
Paralisia Facial/fisiopatologia , Síndrome de Guillain-Barré/fisiopatologia , Disautonomias Primárias/fisiopatologia , Adolescente , Criança , Pré-Escolar , Paralisia Facial/etiologia , Feminino , França , Síndrome de Guillain-Barré/complicações , Hospitalização , Humanos , Lactente , Intubação Intratraqueal/estatística & dados numéricos , Masculino , Condução Nervosa , Disautonomias Primárias/etiologia , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo
5.
BMC Neurol ; 19(1): 208, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455262

RESUMO

BACKGROUND: Peripheral-type facial palsy very rarely arises from pontine stroke. We attempted to identify unique clinico-radiologic patterns associated with this condition. CASE PRESENTATION: Patients with pontine tegmentum stroke and acute onset of peripheral-type facial weakness were reviewed from the acute stroke registry of a tertiary hospital. The clinico-radiologic patterns of 10 patients were classified into one of three types based on the respective stroke mechanism. Type A (n = 5) was characterized by relatively diverse clinical presentations and larger, multiple infarctions resulting from large-artery atherosclerosis. Three cases with small lacunar infarcts were classified to type B (small vessel occlusion), and they showed only limited symptoms including horizontal gaze disturbance and facial paralysis. The two hemorrhagic cases (type C) presented with a focal pontine hemorrhage, likely due to a cavernous hemangioma. CONCLUSIONS: Peripheral-type facial palsy often occurs in pontine stroke with specific patterns. Type recognition helps to determine the underlying mechanism and the appropriate clinical approach. In particular, focal pontine tegmental infarctions showing stereotypic combinations of ophthalmoplegia and peripheral-type facial weakness (type B) might be recognized as a new type of lacunar syndrome.


Assuntos
Paralisia de Bell/diagnóstico , Paralisia Facial/diagnóstico , Paralisia Facial/etiologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tegmento Pontino/irrigação sanguínea , Tegmento Pontino/patologia
6.
Medicine (Baltimore) ; 98(34): e16888, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441865

RESUMO

RATIONALE: Facial nerve palsy (FNP) is one of the rare neurologic symptoms of Kawasaki disease (KD), associated with a higher incidence of coronary arteries lesions and may be an indicator of more severe disease. PATIENT CONCERNS: A 3-month-old male infant with persistent fever, irritability, and facial asymmetry. DIAGNOSES: KD with FNP. INTERVENTIONS: The infant received intravenous immunoglobulin (IVIG) (2 g/kg/16 hours) and aspirin (50 mg/kg/day) were started on the 8th day of illness. OUTCOMES: Fever and FNP resolved within 48 hours after IVIG treatment. The inflammatory markers all improved to normal or near-normal levels before discharge; all infectious studies returned negative. His left facial weakness was unappreciable at day of discharge. LESSONS: FNP associated with KD is an uncommon finding but may indicate an increased risk of coronary artery involvement. KD should always be kept in mind in the differential diagnosis of a child who presents with prolonged unexplained fever, even with incomplete diagnostic features, as well as the need to be aware of unusual manifestations, such as FNP.


Assuntos
Anomalias dos Vasos Coronários/etiologia , Assimetria Facial/etiologia , Paralisia Facial/etiologia , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Assimetria Facial/tratamento farmacológico , Paralisia Facial/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações
7.
Laryngoscope ; 129(11): E412-E414, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31400145

RESUMO

Facial nerve baroparesis is a rare complication of middle ear barotrauma reported almost exclusively in overpressure events related to diving and flying. Until the development of Eustachian tube balloon dilation, no diving compatible options existed to effectively and safely prevent recurrence. We present a case of a U.S. Navy diver with a history of repeated ipsilateral facial nerve paresis that occurred during diving. The patient underwent Eustachian tube balloon dilation of the affected side. Following surgery, the patient completed a recompression chamber simulated dive that allowed the patient to return to diving. The patient has been symptom-free for 12 months following dilation. Laryngoscope, 129:E412-E414, 2019.


Assuntos
Barotrauma/cirurgia , Dilatação/métodos , Mergulho/efeitos adversos , Traumatismos do Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Traumatismos Ocupacionais/cirurgia , Barotrauma/etiologia , Dilatação/instrumentação , Tuba Auditiva/cirurgia , Nervo Facial/cirurgia , Traumatismos do Nervo Facial/etiologia , Paralisia Facial/etiologia , Humanos , Masculino , Militares , Traumatismos Ocupacionais/etiologia , Estados Unidos , Adulto Jovem
8.
J Med Case Rep ; 13(1): 221, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31324211

RESUMO

BACKGROUND: Guillain-Barré syndrome is an acute inflammatory polyradiculoneuropathy. Nearly half of patients with Guillain-Barré syndrome have cranial nerve involvement. However, isolated bilateral ptosis without ophthalmoplegia is a rare manifestation, and isolated unilateral ptosis without ophthalmoplegia in Guillain-Barré syndrome has not previously been reported in the literature. Furthermore, only few cases of Guillain-Barré syndrome with cranial nerve enhancement visualized by gadolinium-enhanced magnetic resonance imaging have previously been reported. We describe the first reported case of unilateral ptosis without ophthalmoplegia in Guillain-Barré syndrome and associated multiple cranial nerve enhancement seen by gadolinium-enhanced magnetic resonance imaging. CASE PRESENTATION: Our patient was a 55-year-old Sinhalese man who was admitted to a tertiary care hospital in Sri Lanka with acute-onset progressive weakness in the lower limbs followed by the upper limbs. He had bilateral symmetrical flaccid quadriparesis with absent reflexes and flexor plantar response. Left-sided isolated partial ptosis without associated ophthalmoplegia was noted with normal pupils. The patient's neurological examination was otherwise normal. A nerve conduction study showed a severe demyelinating type of polyneuropathy. No decremental response to repetitive nerve stimulation was observed, and the result of a single-muscle-fiber electromyogram was negative. A diagnosis of Guillain-Barré syndrome was made, and the patient was treated with intravenous immunoglobulin. His condition gradually deteriorated over the next few days, and he became quadriplegic despite the completion of immunoglobulin therapy. Later he developed multiple cranial nerve palsies, including bi-lateral lower motor neuron type facial nerve palsy, and he required mechanical ventilation. By this time, he had complete left-sided ptosis with a normal right eye. He never developed ophthalmoplegia or ataxia. Magnetic resonance imaging of the brain showed contrast enhancement in the intracranial part of multiple cranial nerve roots and basal leptomeninges. He gradually improved with plasmaparesis, and ptosis was the first to improve. CONCLUSIONS: Even though Guillain-Barré syndrome was recognized a century ago, there are still many unanswered questions about it and its florid presentation. Large-scale studies are needed for better understanding of its pathophysiology and prototypes and to find answers for still-unanswered questions. The clinician must have a high index of suspicion and be familiar with mimics and prototypes to diagnose Guillain-Barré syndrome accurately without delay.


Assuntos
Blefaroptose/etiologia , Síndrome de Guillain-Barré/complicações , Paralisia Facial/etiologia , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Sri Lanka
10.
J Craniofac Surg ; 30(5): e415-e418, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299798

RESUMO

Kimura's disease (KD) is a benign, rare and chronic inflammatory disorder of unknown etiology and it affects subcutaneous tissues, lymph nodes, and salivary glands. The clinical manifestation of cases reported is mainly small neoplasms or enlarged lymph nodes, while cases for large masses are rarely reported. This case reveals a female patient of KD with large masses in the head and neck region. The scope of the tumor is huge, which seriously affects the facial shape and psychology of the patient, thereby affecting the daily life of the patient. Although the patient had surgically removed the same site tumor 8 years ago, it was not possible to determine whether it was a recurrent case because the postoperative pathological diagnosis of first treatment was not confirmed. Under the general anesthesia, the right head and neck masses were removed. During the operation, the facial nerve branches were wrapped by the masses. After consulting the family members, it was agreed that the facial nerve should not be preserved for maximum extent removal of the tumor. Although the patient has facial paralysis symptoms after surgery, the facial shape and patient's psychology are greatly improved, and the patient is satisfied with the treatment effect. Surgical treatment is one of the effective ways to treat huge tumors in the head and neck of KD. This study has certain guiding significance for clinicians to treat huge tumors of head and neck in KD.


Assuntos
Hiperplasia Angiolinfoide com Eosinofilia/diagnóstico por imagem , Face , Pescoço , Hiperplasia Angiolinfoide com Eosinofilia/complicações , Hiperplasia Angiolinfoide com Eosinofilia/patologia , Face/patologia , Nervo Facial/patologia , Paralisia Facial/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Pescoço/patologia
11.
Ann Otol Rhinol Laryngol ; 128(8): 721-727, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31307215

RESUMO

OBJECTIVES: To investigate the effectiveness of make-up therapy for patients with facial nerve palsy. METHODS: Seven female patients with facial nerve palsy who received specialist make-up therapy were enrolled. The objective of the make-up therapy was to obtain a symmetrical facial appearance. RESULTS: Overall score for the Facial Clinimetric Evaluation (FaCE) scale was significantly improved after make-up therapy. There was a tendency for symptoms of depression to be improved among patients after make-up therapy. CONCLUSION: Make-up therapy to improve the symmetry of facial appearance could afford a noninvasive and low-cost treatment for patients with facial nerve palsy, especially in terms of patient quality of life and psychological condition.


Assuntos
Técnicas Cosméticas , Cosméticos , Assimetria Facial/terapia , Doenças do Nervo Facial/complicações , Paralisia Facial/terapia , Adulto , Estudos de Coortes , Assimetria Facial/etiologia , Paralisia Facial/etiologia , Facies , Feminino , Humanos , Pessoa de Meia-Idade , Qualidade de Vida
12.
Pediatr Neurosurg ; 54(4): 253-257, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31266048

RESUMO

Arachnoid cysts are benign, cerebrospinal fluid-filled collections that can be located in the brain or spinal cord. Arachnoid cysts form approximately 1% of all intracranial lesions. They are accepted as arachnoid developmental anomaly and arise from membrane splitting or duplication. Generally, lesion growth causes symptoms because of mass effect or obstruction. Arachnoid cyst growing mechanisms are a largely controversial issue. We report the case of a neonatal female patient who presented with congenital facial paralysis. Magnetic resonance imaging showed a right cerebellopontine angle arachnoid cyst causing severe mass effect on the brain stem. Cyst fenestration and cystocisternal shunt was performed through retrosigmoid suboccipital craniotomy.


Assuntos
Cistos Aracnóideos , Ângulo Cerebelopontino , Paralisia Facial/etiologia , Cistos Aracnóideos/congênito , Cistos Aracnóideos/cirurgia , Tronco Encefálico , Ângulo Cerebelopontino/fisiopatologia , Craniotomia , Drenagem , Feminino , Humanos , Recém-Nascido , Imagem por Ressonância Magnética , Lobo Occipital
13.
Cir Cir ; 87(4): 377-384, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264987

RESUMO

Objective: To describe the clinical presentation of the facial nerve schwannomas according to the anatomical site of origin. Method: A retrospective study in which the clinical presentation, diagnostic protocol and treatment of facial nerve tumors in adults was evaluated. Results: We found 6 cases, 4 cases of tympanic-mastoid location at the spectrum of its possible clinical presentation: from symptomatic cases with facial paralysis, to an asymptomatic case in the tympanic portion found as intraoperative finding; and also found two cases located at the parotid gland, one with complete facial paralysis and one without facial palsy. Conclusions: For the diagnosis of intratemporal and parotid schwannomas of the facial nerve, a high clinical suspicion is required given its heterogeneous presentation; its clinical course depends on the segment of origin and expansion: more frequently asymptomatic at the tympanic horizontal portion and symptomatic at the mastoid vertical portion. These tumors must be assessed with imaging studies, incisional biopsy is not recommended. The treatment is surgical resection in symptomatic patients with facial paralysis greater than grade III of House-Brackmann, with immediate reconstruction of the nerve.


Assuntos
Neoplasias dos Nervos Cranianos/complicações , Doenças do Nervo Facial/complicações , Processo Mastoide/inervação , Neurilemoma/complicações , Neoplasias Parotídeas/complicações , Membrana Timpânica/inervação , Adulto , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/cirurgia , Doenças do Nervo Facial/patologia , Doenças do Nervo Facial/cirurgia , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Feminino , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Neurilemoma/patologia , Neurilemoma/cirurgia , Glândula Parótida/inervação , Neoplasias Parotídeas/patologia , Neoplasias Parotídeas/cirurgia , Estudos Retrospectivos , Zumbido/etiologia , Adulto Jovem
14.
J Stroke Cerebrovasc Dis ; 28(10): 104297, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31358355

RESUMO

OBJECTIVES: To study the applicability of National Institutes of Health Stroke Scale (NIHSS) in early predicting the prognosis of poststroke dysphagia in an acute ward. METHODS: This is an observational retrospective cohort study including adult patients with ischemic stroke. Patients with various factors affecting swallowing were excluded to obtain a representative sample of 165 patients. The main outcome measure was the improvements of oral intake function. RESULTS: The scores of facial palsy (NIHSS item 4) (odds ratio [OR]: 0.484, 95% confidence interval [CI]: 0.279-0.838, P = .0096] and language/aphasia (NIHSS item 9) (OR: 0.562, 95% CI: 0.321-0.982, P = .0430) demonstrated significantly negative effects on the early improvement of dysphagia. Moreover, the improved patients had a 4.14-fold (95% CI: 2.53-11.23, P = .005) increased odds of returning home compared with nonimproved patients. CONCLUSIONS: Our findings provide evidence that early improvement of poststroke dysphagia was significantly associated with a favorable discharge destination and NIHSS items of facial palsy and language/aphasia can be used at the onset of stroke to identify dysphagic patients at risk of achieving limited improvement. These findings provide valuable prognostic indicators for clinicians to make a precise outcome prediction at very early stage.


Assuntos
Isquemia Encefálica/diagnóstico , Transtornos de Deglutição/diagnóstico , Deglutição , Avaliação da Deficiência , Acidente Vascular Cerebral/diagnóstico , Idoso , Afasia/diagnóstico , Afasia/etiologia , Afasia/fisiopatologia , Isquemia Encefálica/complicações , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/reabilitação , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Transtornos de Deglutição/reabilitação , Paralisia Facial/diagnóstico , Paralisia Facial/etiologia , Paralisia Facial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral , Fatores de Tempo , Resultado do Tratamento
15.
Ann R Coll Surg Engl ; 101(6): e1-e3, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31155905

RESUMO

Tortuous vertebral arteries are a rare anatomical variant. Mild tortuosity is usually asymptomatic whereas severe tortuosity may present with ischaemic symptoms or compressive symptoms (focal neurological deficit). While a resulting hemifacial spasm has been previously described, sparse literature exists for its association with facial palsy. We present a rare case of facial spasm along with facial palsy in a 67-year-old woman who was found to have an anatomical variant in the posterior basilar circulation with an ectatic basilar artery and significantly displaced posterior vertebral artery impinging on the facial nerve.


Assuntos
Artéria Basilar/anormalidades , Paralisia Facial/etiologia , Espasmo Hemifacial/etiologia , Idoso , Artéria Basilar/diagnóstico por imagem , Paralisia Facial/diagnóstico por imagem , Espasmo Hemifacial/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Neuroimagem
16.
Undersea Hyperb Med ; 46(1): 87-90, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154690

RESUMO

Middle ear barotrauma is common in diving. However, facial nerve baroparesis is a relatively rare complication. A dehiscent facial nerve canal may be a predisposing factor to developing this complication. Although there is an increasing number of facial baroparesis cases in the literature, they are likely still under-reported. In order to avoid unnecessary recompression treatments or detrimental effects to a professional diver's career, it is important to consider this in the differential diagnosis while evaluating dive injuries. This case report describes recurrent facial baroparesis in a military diver, which manifested on contralateral sides of his face. His initial presentation was misdiagnosed as an arterial gas embolism, which led to recompression treatment and a cardiac procedure. Upon recurrence about one year later, a complete work-up was done, which included an ENT evaluation and a CT scan. Imaging demonstrated a predisposing anatomic variant bilaterally. His symptoms resolved quickly and spontaneously both times, and he has been able to return to diving.


Assuntos
Barotrauma/complicações , Mergulho/efeitos adversos , Paralisia Facial/etiologia , Adulto , Barotrauma/diagnóstico , Doença da Descompressão/diagnóstico , Erros de Diagnóstico , Embolia Aérea/diagnóstico , Nervo Facial/diagnóstico por imagem , Forame Oval Patente/diagnóstico , Humanos , Masculino , Militares , Recidiva , Retorno ao Trabalho , Água do Mar , Osso Temporal/diagnóstico por imagem
17.
Acta Otolaryngol ; 139(7): 576-580, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31050582

RESUMO

Background: Petrous bone cholesteatoma (PBC) is a rare but local aggressive lesion which can lead to severe complications. Surgery is the mainstay for its treatment. Objectives: To analyse the clinical characteristics and surgical outcomes in a series of patients with PBC, paying special attention to cochlea preservation and use of endoscope. Materials and methods: Retrospective study of 51 patients with PBC who underwent surgery at our centre. Results: Hearing loss (72.5%) and facial paralysis (58.8%) were the two most common symptoms. According to Sanna's classification, supralabyrinthine subtype (51.0%) was the most common subtype, followed by the massive subtype (33.3%). In most patients, PBC was radically removed using subtotal petrosectomy (80.4%). Endoscope was used for assistance in six cases. Various managements of facial nerve were used in different cases. Hearing rehabilitation was not emphasized (44 postoperative dead ear); however, cochlea was preserved as far as possible (45.3%). Recurrence was identified in five patients by MRI with diffusion weighted imaging (DWI) sequence. No recurrence was detected in patients underwent surgery with endoscope assistance. Conclusions and significance: radical excision and functional reconstruction constitute the framework of PBC surgery. Cochlea preservation is critical for possible cochlear implantation in the future. Use of endoscope has the potential to enhance surgical precision and reduce recurrence.


Assuntos
Colesteatoma da Orelha Média/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tratamentos com Preservação do Órgão/métodos , Otoscopia/métodos , Osso Petroso/cirurgia , Adulto , Colesteatoma da Orelha Média/patologia , Colesteatoma da Orelha Média/cirurgia , Estudos de Coortes , Endoscopia/métodos , Paralisia Facial/diagnóstico , Paralisia Facial/etiologia , Feminino , Seguimentos , Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osso Petroso/diagnóstico por imagem , Osso Petroso/patologia , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
18.
J Int Adv Otol ; 15(1): 177-180, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31058605

RESUMO

Adenoid cystic carcinoma (ACC) isolated in the mastoid is very rare. Its diagnosis, especially in the early stage, is often challenging as during that stage, the signs and symptoms may be nonspecific. Our paper describes a case of a patient with an isolated mass in the left mastoid with persistent peripheral facial paralysis, and this was initially diagnosed as facial neuritis and granulation. However, histological examination later revealed an ACC exhibiting tubular and cribriform patterns. Our paper discusses the diagnostic basis, treatment, and outcomes for this case to improve the understanding of ACC isolated in the mastoid.


Assuntos
Ageusia/etiologia , Carcinoma Adenoide Cístico/patologia , Paralisia Facial/etiologia , Processo Mastoide/patologia , Adulto , Ageusia/diagnóstico , Carcinoma Adenoide Cístico/radioterapia , Descompressão/métodos , Células Epiteliais/metabolismo , Nervo Facial/patologia , Doenças do Nervo Facial/tratamento farmacológico , Doenças do Nervo Facial/patologia , Paralisia Facial/diagnóstico , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Processo Mastoide/diagnóstico por imagem , Processo Mastoide/cirurgia , Mastoidectomia/métodos , Doenças Raras , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
19.
Ann Otol Rhinol Laryngol ; 128(9): 862-868, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31067979

RESUMO

OBJECTIVE: Compare experts' ability to differentiate malignant and benign causes of facial nerve paralysis (FNP) using the initial presenting magnetic resonance image (MRI) for each patient. METHODS: This retrospective case-controlled study compared MRIs for 9 patients with a malignant cause for FNP, 8 patients with Bell's palsy, and 9 cochlear implant patients serving as controls. The initial presenting MRI for each condition was used such that raters were evaluating real-world rather than optimal studies. Three blinded expert raters independently evaluated each segment of the facial nerve for abnormalities, provided a diagnosis, and graded MRI quality. Cohen's and Light's kappa were used to calculate interrater reliability and overall index of agreement, respectively. RESULTS: MRI protocols for the malignancy group were universally suboptimal. There was poor agreement among raters for abnormalities of the facial nerve along the brainstem (0.13), geniculate (0.10), tympanic segment (0.12), and mastoid segment (0.13); moderate agreement along the cisternal segment (0.58) and internal auditory canal (0.55); and fair agreement along the labyrinthine segment (0.26) and extratemporal segment (0.36). Agreement regarding final diagnosis was fair (0.37) when compared to the true diagnosis. There were 2 false negative interpretations (failure to correctly identify malignancy) and 1 false positive interpretation. CONCLUSION: MRI for FNP is often initially performed with an incorrect protocol and thus may fail to reliably differentiate neoplastic from inflammatory FNP even when interpreted by experienced clinicians. Nevertheless, expert readers correctly diagnosed 87.5% of malignant causes of FNP despite these limitations.


Assuntos
Paralisia de Bell/diagnóstico , Nervo Facial , Paralisia Facial/diagnóstico , Imagem por Ressonância Magnética/métodos , Neoplasias/diagnóstico , Adulto , Paralisia de Bell/etiologia , Diagnóstico Diferencial , Nervo Facial/diagnóstico por imagem , Nervo Facial/patologia , Paralisia Facial/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Reprodutibilidade dos Testes
20.
Eur Arch Otorhinolaryngol ; 276(9): 2397-2403, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31111254

RESUMO

PURPOSE: To evaluate the surgical experience and auditory functions and progress of speech development of cochlear implantation in malformed ears. MATERIALS AND METHODS: Between November 1995 and July 2017, thirty-seven patients (26 females and 11 males; mean age: 138.275 ± 96.24 months) with diverse anomalies of the inner ear were retrospectively examined for surgical and audiological results. Speech Intelligibility Rating (SIR), Categories of Auditory Perception (CAP), Pure Tone Average (PTA), Speech Intelligibility Rating (SRT), and Word Discrimination Score (WDS) were the audiological tests used to evaluate the efficacy of CI in the malformed inner ears. RESULTS: CSF gusher was experienced by six patients (three with LVA (large vestibular aqueduct), one with IP (incomplete partition) I, and two with both IP II Mondini malformations and LVA). Two patients had transient facial paresis after surgery. All patients fully recovered within 6 months. The postoperative PTA, SRT, and WDS test results showed significant differences between progressive and congenital sensorineural hearing loss (p values < 0.05 for all). On the other hand, the postoperative CAP and SIR test results revealed no significant differences between the two groups. According to etiology, the PTA and SRT values were significantly lower in common cavity patients than the LVA patients (p values < 0.01); no significant differences were found among the other etiological groups. CONCLUSIONS: Cochlear implantation is safe in children with inner ear malformations. However, the success rate is low compared to patients with normal anatomy in terms of audiological results; the most successful group of patients with inner ear malformation is large vestibular aqueduct.


Assuntos
Implante Coclear , Implantes Cocleares , Orelha Interna/anormalidades , Perda Auditiva Neurossensorial/cirurgia , Adolescente , Adulto , Percepção Auditiva , Criança , Pré-Escolar , Implante Coclear/efeitos adversos , Orelha Interna/cirurgia , Paralisia Facial/etiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inteligibilidade da Fala , Resultado do Tratamento
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