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1.
World Neurosurg ; 136: e262-e269, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31904436

RESUMO

BACKGROUND: Facial paralysis secondary to a complete and irreversible anatomic or functional lesion of the facial nerve (FN) causes severe functional and psychological disorders for the patient. A large number of surgical techniques have therefore been developed for FN repair. Our objective was to propose a surgical FN reanimation protocol for patients with irreversible anatomic or functional postsurgical injury of the FN in the cerebellopontine angle after vestibular schwannoma resection. METHODS: The clinical study included a total of 16 patients undergoing side-to-end hypoglossal-facial neurorrhaphy (SEHFN) since 2010, in which the FN injury was always secondary to vestibular schwannoma surgery in the cerebellopontine angle using a retrosigmoid approach. All patients had complete clinical facial paralysis at the time of the SEHFN. The anatomic study was conducted using 3 heads and necks (6 SEHFN). RESULTS: Twelve months after surgery, FN function assessment with the House and Brackmann scale showed 2 patients with grade II, 13 patients with grade III, and only 1 patient with grade IV, and after 2 years, 4 patients had grade II, 11 patients had grade III, and 1 patient had grade IV. The average length of the anastomotic translocation portion of the FN in the anatomic study was 34.76 mm. CONCLUSIONS: Side-to-end epineural suture of the FN, mobilizing its mastoid segment on the hypoglossal nerve with partial section of the dorsal aspect of the hypoglossal nerve, is a safe anatomic surgical technique for FN reanimation with outstanding clinical results.


Assuntos
Traumatismos do Nervo Facial/cirurgia , Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Nervo Hipoglosso/cirurgia , Transferência de Nervo/métodos , Neuroma Acústico/cirurgia , Adulto , Idoso , Anastomose Cirúrgica , Traumatismos do Nervo Facial/etiologia , Paralisia Facial/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia
2.
Facial Plast Surg Clin North Am ; 27(4): 519-527, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31587771

RESUMO

Complications of rhytidectomy are well known, yet often preventable. A thorough preoperative history and physical along with realistic patient expectations provide the surgeon and patient with insight into potential complications and postoperative management. Understanding of surgical pitfalls and avoidance are crucial in beginning to manage facelift complications. Possible complications of facelift techniques should not discourage surgeons from pursuing a particular technique as the majority of complications are temporary. Though, a strong patient-physician relationship is critical when complications occur. Complications may be frustrating for both the patient and surgeon, yet are overwhelmingly temporary and manageable without surgical intervention.


Assuntos
Hematoma/etiologia , Complicações Pós-Operatórias/etiologia , Ritidoplastia/efeitos adversos , Dermatopatias/etiologia , Retalhos Cirúrgicos/patologia , Anestesia Local/efeitos adversos , Cicatriz/etiologia , Deformidades Adquiridas da Orelha/etiologia , Estética , Traumatismos do Nervo Facial/etiologia , Humanos , Necrose/etiologia , Período Pré-Operatório
3.
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
5.
Neurodiagn J ; 59(2): 91-103, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31210607

RESUMO

Iatrogenic facial nerve (FN) injury is one of the most feared complications of otologic surgery. Dehiscence of the bony covering of the FN within the temporal bone increases FN vulnerability to accidental injury. High-resolution computed tomography (HRCT) of the temporal bone is used preoperatively to assess middle ear and mastoid anatomy; however, it is unreliable for detecting facial canal dehiscence. In this study, our aim was to determine if preoperative percutaneous FN stimulation could predict middle ear facial canal dehiscence. Between January 2015 and February 2017, we performed preoperative HRCT and percutaneous FN stimulation on adult patients who underwent otologic surgery at our institution. Stimulation was performed with a monopolar probe placed on the skin over the stylomastoid foramen. Electrical stimuli ranged from 0 to 40 milliamperes (mA). Recordings were made from ipsilateral facial muscles. Dependent variables included threshold to compound muscle action potential (CMAP), threshold to maximum amplitude of CMAP, and maximum amplitude of CMAP for each muscle. A retrospective chart review was performed. Seventy patients met inclusion criteria. Of the 24 with an intraoperatively confirmed dehiscence, 10 were identified preoperatively by the attending surgeon on HRCT. Averages of the lowest recorded threshold to CMAP (5.1mA v. 9.1mA), and an average of the threshold to CMAP (8.9 mA. 11.8 mA) of dehiscent versus non-dehiscent nerves were significantly different (p < .05). In conclusion, percutaneous FN stimulation is a simple and cost-effective tool that can give the surgeon important preoperative information about FN anatomy.


Assuntos
Traumatismos do Nervo Facial/prevenção & controle , Nervo Facial/fisiologia , Monitorização Neurofisiológica Intraoperatória/métodos , Procedimentos Cirúrgicos Otológicos/métodos , Osso Temporal/patologia , Adulto , Idoso , Traumatismos do Nervo Facial/etiologia , Feminino , Humanos , Doença Iatrogênica/prevenção & controle , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Estudos Retrospectivos , Adulto Jovem
6.
Acta Otolaryngol ; 139(7): 547-551, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31050576

RESUMO

Background: Patients may suffer postoperative facial nerve injury, hearing loss, or other postoperative complications after the operation, which seriously affect their postoperative life quality. Aims/objectives: To investigate the differences in QOL (quality of life) of patients with acoustic neuroma resection by the translabyrinthine or retrosigmoid approach. Material and methods: Patients with acoustic neuroma resection in our department were enrolled in this experimental study, among which fifty patients underwent the translabyrinthine approach resection, the other 50 patients underwent the retrosigmoid approach resection. Different scores by the SF-36 scale between these two groups of patients one month after discharge were then analyzed. Results: Scores of patients undergoing the retrosigmoid approach were higher in the three dimensions of Social Functioning, Role-emotional and Mental Health than those of patients undergoing the translabyrinthine approach with statistical significance. However, scores of patients undergoing the translabyrinthine approach were higher in the two dimensions of Body Pain and Vitality than those of the patients undergoing the retrosigmoid approach. Conclusions and significance: The results indicated that individual nursing interventions for different patients are necessary to improve the QOL of patients after hospitalization. Moreover, the operated patients with translabyrinthine approach were more advantage than patients with retrosigmoid approach.


Assuntos
Traumatismos do Nervo Facial/psicologia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Qualidade de Vida , Adulto , Bases de Dados Factuais , Orelha Interna/cirurgia , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/diagnóstico por imagem , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Inquéritos e Questionários , Resultado do Tratamento
7.
Eur Arch Otorhinolaryngol ; 276(7): 1915-1920, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30955064

RESUMO

OBJECTIVES: To assess the diagnostic capacity of intraoperative neurophysiological monitoring with respect to "gold standard" microscopic findings of facial canal dehiscence in middle ear cholesteatoma surgery. STUDY DESIGN, PATIENTS AND SETTING: We carried out a retrospective cohort study of 57 surgical interventions for cholesteatoma between 2008 and 2013 at Hospital Universitario de Canarias, Spain. DIAGNOSTIC INTERVENTIONS: Each patient underwent preoperative computed tomography (CT), intraoperative neurophysiological monitoring and intraoperative inspection of the facial nerve during microsurgery. Diagnostic concordance on the presence/absence of facial canal dehiscence was assessed in 54 surgical interventions. MAIN OUTCOME: Presence of facial canal dehiscence. RESULTS: Of 57 interventions, 39 were primary surgeries; 11 (28.2%) showed facial canal dehiscence. and 18 were revision surgeries; 6 (33.3%) showed facial canal dehiscence. The facial nerve was not damaged in any patient. Facial canal dehiscence was observed in 17 (29.82%) interventions. We used intraoperative microscopic findings as the gold standard. Neurophysiological study showed a sensitivity of 94.1, specificity 97.3, positive predictive value (PPV) 57.8 and negative predictive value of 97.2. CT showed a sensitivity of 64.7, specificity 78.4, PPV 57.8 and negative predictive value of 82. CONCLUSIONS: Our neurophysiological study showed greater sensitivity and higher PPV than CT for the detection of facial canal dehiscence. We found no relationship between disease progression time and the presence of facial canal dehiscence.


Assuntos
Colesteatoma da Orelha Média , Traumatismos do Nervo Facial , Complicações Intraoperatórias/prevenção & controle , Monitorização Neurofisiológica Intraoperatória/métodos , Procedimentos Cirúrgicos Otológicos , Adulto , Colesteatoma da Orelha Média/diagnóstico , Colesteatoma da Orelha Média/fisiopatologia , Colesteatoma da Orelha Média/cirurgia , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Procedimentos Cirúrgicos Otológicos/métodos , Estudos Retrospectivos , Sensibilidade e Especificidade , Espanha , Tomografia Computadorizada por Raios X/métodos
8.
Acta Otolaryngol ; 139(6): 541-546, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30987492

RESUMO

BACKGROUND: Prediction of facial function is a major concern when proposing surgery for patients with vestibular schwannoma (VS). AIMS/OBJECTIVES: To evaluate postoperative facial function of patients who underwent operation of VS via a translabyrinthine approach (TL), and to analyze factors that influence facial functions. MATERIAL AND METHODS: A total of 91 VS patients, who were operated via a TL approach, between March 1997 and December 2016, were analyzed. Demographics, tumor-related factors, and operative findings were collected. Facial function was assessed according to the House-Brackmann (HB) grading system before surgery, immediately after surgery, and 1-, 3-, 6-months, and 1 year after surgery. RESULTS: In cases of patients that had a tumor that extended to the CPA, an unsatisfactory facial outcome was noted in 12 (30.0%) patients. FN outcomes after tumor removal depend on tumor size (p = .040). Among FN-related factors, only the FN recovery timing was correlated with facial outcomes (p = .030). Univariable and multivariable analysis revealed that tumor size and the timing of FN recovery were significant as favorable prognostic factors for good facial outcomes. CONCLUSIONS AND SIGNIFICANCE: Tumor size and the FN recovery timing are significant prognostic factors of facial outcome in VS patients who underwent operations via a TL approach.


Assuntos
Traumatismos do Nervo Facial/etiologia , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/prevenção & controle , Vestíbulo do Labirinto/cirurgia , Adulto , Idoso , Análise de Variância , Estudos de Coortes , Traumatismos do Nervo Facial/fisiopatologia , Traumatismos do Nervo Facial/terapia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Análise Multivariada , Regeneração Nervosa/fisiologia , Neuroma Acústico/diagnóstico , Procedimentos Neurocirúrgicos/efeitos adversos , Cuidados Pós-Operatórios/métodos , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Centros de Atenção Terciária , Adulto Jovem
9.
World Neurosurg ; 127: e599-e608, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30930324

RESUMO

OBJECTIVE: The preservation of acceptable facial nerve (FN) function after surgery is the key concern for most patients with vestibular schwannomas (VS). To assess predictive factors of early postoperative and long-term FN function in patients harboring large VS operated with a FN-sparing technique. METHODS: Single-center retrospective cohort study with 169 consecutive large VS operated on between January 2003 and May 2015. Clinical, radiologic, and intraoperative factors were assessed according to FN function. RESULTS: At last follow-up examination, among the 145 patients without preoperative FN palsy, FN function was good (House-Brackmann [HB] grades I or II) in 84% and moderate (HB grade III) in 15% of patients. Only 1 patient presented with poor HB grade IV function. Multivariate logistic regression model showed the mean preoperative VS extrameatal diameter as being an independent predictor of an unfavorable initial FN outcome (odds ratio [OR], 1.062; P = 0.038). Surgical anatomic preservation of the cochlear nerve was associated with better FN outcomes (OR, 0.237; P = 0.012). A history of previous surgery seemed to be related to long-term impaired FN function (OR, 71.405; P = 0.042), as well as early postoperative FN function (OR, 19.068; P = 0.000). No correlation was found between a history of previous Gamma Knife surgery treatment (P = 0.225) or the extent of resection (P = 0.438) and impaired FN outcomes. History of previous surgery was identified as an unfavorable predictive recovery factor of impaired postoperative FN function (P = 0.034). CONCLUSIONS: As long as the extent of resection or additional Gamma Knife surgery have not been identified as predictive risk factors of postoperative FN palsy, we suggest that optimal resection is the main option for patients harboring large VS.


Assuntos
Traumatismos do Nervo Facial/cirurgia , Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Neuroma Acústico/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Nervo Facial/etiologia , Paralisia Facial/etiologia , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Tempo , Resultado do Tratamento , Adulto Jovem
10.
Int J Pediatr Otorhinolaryngol ; 122: 161-164, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31029951

RESUMO

OBJECTIVE: First branchial cleft anomalies (FBCAs) are rare and often misdiagnosed, which can delay proper management and increase surgical risks. Complete excision often requires parotidectomy with facial nerve dissection. The literature reports that younger patients more often have lesions deep to the nerve with higher rates of nerve injury. We hypothesized that the rate of nerve injury and complications in children with FBCAs was not different in those ≤2 years of age compared to those >2 years of age. METHODS: Retrospective review of pediatric patients who underwent resection of histopathologically confirmed FBCAs between 2007 and 2017 at a tertiary care, pediatric hospital. Presenting symptoms, lesion classification, prior procedures, imaging techniques, extent of surgery performed, facial nerve position, and complications were reviewed and compared between patients ≤2 years of age and >2 years of age at time of surgery. RESULTS: 43 cases of FBCAs were included in the study: 12 in the younger group and 31 in the older group. There was no difference between groups regarding the presenting symptoms, gender breakdown, lesion classification, prior procedures performed, or extent of surgery. Lesions were more commonly deep to or running between branches of the facial nerve in the younger group (33.3% vs 9.7%, p = .0496). Rates of postoperative complications and facial nerve weakness were comparable between the younger and older groups (8.3% vs 25.8%, p = .206; 25.0% vs 16.1%, p = .503). In combining the age groups, FBCAs located deep to the facial nerve had increased risk of nerve weakness postoperatively (RR 7.2) and those with a history of prior incision and drainage or resection had increased risk of postoperative complications (RR 2.36). Imaging was obtained on all subjects with accuracy rates of 80-100%. CONCLUSION: Presenting characteristics of FBCAs in patients ≤2 years of age and >2 years of age are comparable, but lesions in younger subjects had a greater likelihood of being deep to or coursing between branches of the facial nerve. However, the rates of facial nerve injury and postoperative complications are comparable in younger and older children, owing likely to accurate preoperative imaging and appropriate surgical planning.


Assuntos
Região Branquial/anormalidades , Anormalidades Craniofaciais/diagnóstico por imagem , Anormalidades Craniofaciais/cirurgia , Traumatismos do Nervo Facial/etiologia , Doenças Faríngeas/diagnóstico por imagem , Doenças Faríngeas/cirurgia , Fatores Etários , Região Branquial/diagnóstico por imagem , Região Branquial/cirurgia , Criança , Pré-Escolar , Dissecação , Drenagem , Músculos Faciais/fisiopatologia , Nervo Facial/cirurgia , Feminino , Humanos , Lactente , Masculino , Debilidade Muscular/etiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
11.
Neurol India ; 67(1): 149-154, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860114

RESUMO

Background: The goal of surgery in case of a large vestibular schwannoma is complete excision of tumor and preservation of facial nerve function. The identification and preservation of facial nerve is very difficult during surgery, particularly in case of large tumors. This prospective randomized study was conducted to find out the effectiveness of preoperative facial nerve diffusion tensor imaging tractography (DTI) to predict location of the nerve and preservation of facial nerve function in surgery for large vestibular schwannomas. Materials and Methods: In this prospective randomized study, we recruited 100 patients with a large vestibular schwannoma(> 3cm). After initial scrutiny, 94 patients were randomized based on a computer generated chart. In group I, preoperative DTI was done and the operating surgeon was informed about the position of facial nerve preoperatively. In group II, DTI was not done. The facial nerve preservation rates and clinical outcome at follow up was compared between the two groups. Results: Out of 94 patients, there were 47 patients in group I (DTI group) and 47 patients in group II (Non DTI group). In DTI group, 40 patients were left for comparison after the exclusion criteria was applied. Preoperative DTI predicted that the facial nerve position was concordant with its intraoperative position in 39 patients (97.5% concordance). Facial nerve preservation rates were statistically significant in group I (DTI group) (P value = 0.002). Conclusion: The study establishes the role of preoperative DTI tractography for better facial nerve preservation in surgery for large vestibular schwannomas (>3 cm).


Assuntos
Imagem de Tensor de Difusão/métodos , Nervo Facial/diagnóstico por imagem , Neuroma Acústico/diagnóstico por imagem , Procedimentos Neurocirúrgicos/efeitos adversos , Adolescente , Adulto , Idoso , Criança , Nervo Facial/cirurgia , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/cirurgia , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
12.
Auris Nasus Larynx ; 46(5): 779-784, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30922530

RESUMO

OBJECTIVE: Surgery for recurrent pleomorphic adenoma of the parotid gland is challenging since there is a considerable risk of facial nerve injury and a high re-recurrence rate. We investigated surgery for recurrent pleomorphic adenoma, focusing on management of the facial nerve. METHODS: We reviewed 29 patients who underwent surgery for recurrent benign pleomorphic adenoma of the parotid gland at our department between 1999 and 2018. We examined clinicopathologic features and risk factors for facial nerve injury during reoperation. RESULTS: Factors associated with difficulty in identifying the main trunk of the facial nerve during surgery were bilobar tumors, multiple tumors, and use of an S-shaped skin incision at the previous operation. When the facial nerve was identified intraoperatively, it could be preserved in 2/3 of patients, while the nerve was only preserved in 1/3 of patients when it was not identified. Factors related to permanent postoperative paralysis included recurrence in the deep lobe or both lobes and multiple tumors. CONCLUSION: The probability of successfully preserving the facial nerve is relatively high if the nerve can be identified during surgery for recurrent pleomorphic adenoma, although intentional resection is necessary in some patients. Factors associated with difficulty in identifying the facial nerve are similar to those related to permanent postoperative paralysis, including bilobar tumors and multiple tumors. In patients with recurrent pleomorphic adenoma, preservation of the facial nerve is difficult, when they may have undergone previous extensive resection or have multiple tumors requiring subtotal or more extensive resection.


Assuntos
Adenoma Pleomorfo/cirurgia , Traumatismos do Nervo Facial/epidemiologia , Paralisia Facial/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Neoplasias Parotídeas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adenoma Pleomorfo/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Nervo Facial , Traumatismos do Nervo Facial/etiologia , Paralisia Facial/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias Primárias Múltiplas/patologia , Procedimentos Cirúrgicos Otorrinolaringológicos/efeitos adversos , Neoplasias Parotídeas/patologia , Complicações Pós-Operatórias/etiologia , Reoperação , Fatores de Risco , Carga Tumoral , Adulto Jovem
13.
Acta Otolaryngol ; 139(5): 444-450, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30806131

RESUMO

BACKGROUND: Intraparotid facial nerve schwannoma (IFNS) is rare and its definite preoperative diagnosis is challenging. OBJECTIVE: To improve available knowledge regarding the diagnosis of IFNS and to suggest an appropriate treatment plan. MATERIAL AND METHODS: We retrospectively analyzed medical records of IFNS patients at our hospital. Inclusion criteria were surgery (from January 2000, to December 2016) for a parotid mass, pathologically diagnosed as a schwannoma. RESULTS: The study included 42 eligible patients who had undergone tumor resection from 5977 parotid tumor patients. Mostly presented hard-textured (18/39) or medium-textured (15/39), with limited mobility (21/39) mass (three tumors were not palpable). Their facial nerve function outcomes were House-Brackmann Grade I (n = 14), Grade II (n = 7), Grade III (n = 11), Grade IV (n = 5), Grade V (n = 3), and Grade VI (n = 2). Significant differences were noted in results based on different surgical methods used (p = .000) and tumor involvement (p = .002). CONCLUSIONS AND SIGNIFICANCE: A hard-textured tumor with limited mobility mass in the parotid gland should prompt the diagnosis of a schwannoma. Tumors involving main trunk usually lead to unsatisfactory facial nerve outcomes. Facial nerve preservation should always be essential, and stripping surgery or intracapsular enucleation could be the preferred surgical methods of choice.


Assuntos
Doenças do Nervo Facial/cirurgia , Traumatismos do Nervo Facial/etiologia , Recidiva Local de Neoplasia , Neurilemoma/cirurgia , Glândula Parótida/patologia , Adolescente , Adulto , Idoso , Doenças do Nervo Facial/patologia , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , Neurilemoma/patologia , Estudos Retrospectivos , Adulto Jovem
14.
Curr Opin Otolaryngol Head Neck Surg ; 27(2): 104-109, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30664053

RESUMO

PURPOSE OF REVIEW: Marginal mandibular nerve palsy (MMNP) is often an understated complication after neck dissection. This article reviews literature regarding anatomic landmarks that help define marginal mandibular nerve (MMN) during neck dissection, oncologic safety of surgical maneuvers, implications of MMNP, and reconstructive options. RECENT FINDINGS: A thorough knowledge of anatomy of the nerve can aid in its preservation. Course, branching pattern and communications of MMN are extremely variable. The Hayes Martin method classically described to preserve the nerve may not be oncologically safe in patients with prefacial nodal involvement. MMNP significantly affects quality of life after neck dissection. Cause, timing, and degree of neural damage play an important role in determining diagnostic and therapeutic options to correct the deformity resulting from MMNP. Owing to treatment-related factors, functionality of local structures may be compromised, which limits available reconstructive options for the surgeon. This should favor a shift of management option toward more conservative procedures in patients treated for head and neck cancer. SUMMARY: When oncologically safe, the MMN must always be preserved. The patient perceived deformity resulting from MMNP is significantly higher than clinician-detected rate. In select patients who are affected by significant smile asymmetry, multiple dynamic and static corrective procedures can be offered.


Assuntos
Traumatismos do Nervo Facial/prevenção & controle , Nervo Facial/anatomia & histologia , Neoplasias de Cabeça e Pescoço/cirurgia , Esvaziamento Cervical/efeitos adversos , Esvaziamento Cervical/métodos , Algoritmos , Nervo Facial/cirurgia , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/terapia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Qualidade de Vida
15.
Ugeskr Laeger ; 181(2)2019 Jan 07.
Artigo em Dinamarquês | MEDLINE | ID: mdl-30618373

RESUMO

Facial nerve paresis is a known complication to surgery in the facial region. Spontaneous regeneration of such injuries has been described, but little is known about the prognosis and optimal management. This is a case report of two patients with partial facial nerve paresis following surgery. The patients were treated conservatively. Both experienced a regeneration over ten months post-operatively. This suggests a favourable prognosis with conservative treatment in selected cases, which is reassuring for both doctors and patients.


Assuntos
Traumatismos do Nervo Facial/fisiopatologia , Nervo Facial/fisiopatologia , Paralisia Facial/fisiopatologia , Regeneração Nervosa/fisiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Tratamento Conservador , Nervo Facial/fisiologia , Traumatismos do Nervo Facial/etiologia , Paralisia Facial/etiologia , Humanos , Remissão Espontânea
16.
Dermatol Surg ; 45(3): 340-357, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30640780

RESUMO

BACKGROUND: The facial nerve and its branches are at risk of injury during dermatologic surgery. Few publications in the dermatologic literature discuss facial nerve injury and management. OBJECTIVE: To review facial nerve injury and management, including static and dynamic repair techniques, and to review outcomes in facial nerve reconstruction. METHODS: Two detailed literature reviews were performed using PubMed. First, articles reporting facial nerve injury and/or management in the dermatologic literature were identified. In addition, articles pertaining to outcomes in facial nerve reconstruction with a minimum of 20 patients were included. RESULTS: Fifty-three articles reporting outcomes in facial nerve reconstruction were identified and consist of retrospective reviews and case series. Most patients achieve improvement in facial symmetry and movement with nerve repair. CONCLUSION: Timing of facial nerve repair is an important consideration in management of facial nerve injury, with earlier repairs achieving better outcomes. Facial nerve repair does not result in normal facial movement, and improvements may require a year or more to be realized. Many options exist for facial nerve reconstruction, and patients with long-standing facial nerve injuries may still benefit from treatment.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/cirurgia , Músculos Faciais/cirurgia , Músculos Faciais/transplante , Nervo Facial/anatomia & histologia , Traumatismos do Nervo Facial/complicações , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Humanos , Complicações Pós-Operatórias/cirurgia , Fatores de Tempo
17.
Ann Otol Rhinol Laryngol ; 128(4): 357-359, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30600694

RESUMO

OBJECTIVES:: To report a case of total facial paralysis as the result of a core needle biopsy. METHODS:: Case report and literature review. RESULTS:: A 70-year-old man was diagnosed with a deep lobe parotid tumor on computed tomography. During a core needle biopsy, he developed complete facial paralysis. The cause was discovered to be a direct stab injury to the main trunk of the facial nerve. CONCLUSIONS:: When biopsying parotid lesions adjacent to the main trunk of the facial nerve, the use of smaller-gauge needles and additional patient counseling should be considered.


Assuntos
Biópsia com Agulha de Grande Calibre/efeitos adversos , Traumatismos do Nervo Facial , Paralisia Facial , Complicações Intraoperatórias , Neoplasias Parotídeas/patologia , Idoso , Biópsia com Agulha de Grande Calibre/métodos , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/prevenção & controle , Paralisia Facial/diagnóstico , Paralisia Facial/etiologia , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Neoplasias Parotídeas/diagnóstico , Risco Ajustado/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
18.
Otol Neurotol ; 40(2): 226-235, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30570604

RESUMO

OBJECTIVE: To study the early and late facial nerve (FN) outcomes in different tumor classes in addition to determining the predictive factors for the same. STUDY DESIGN: A retrospective clinical study. SETTING: A quaternary referral otology and skull base center. PATIENTS AND METHODS: A retrospective study of 1983 cases of vestibular schwannomas (VSs) with preoperative normal FN function, undergoing total excision with anatomical preservation of the nerve by enlarged translabyrinthine approach (ETLA) were included. FN status was recorded postoperatively at day 1, at discharge, and at 1-year follow-up and were analyzed in different tumor sizes. RESULTS: At 1 year, 988 patients with House-Brackmann (H-B) grade I and II FN at day 1 after surgery, 958 (96.9%) maintained their status up-to 1 year. Of the 216 patients with H-B grade III at day 1 after surgery, 113 (52.3%) improved to H-B grade I and II. Similarly, of the 779 patients with H-B grade IV and VI FN function at day 1 after surgery, improvement to H-B III and H-B I and II were noted in 442 (56.7%) and 80 (10.3%) of patients, respectively. Intrameatal and extrameatal tumors upto 2 cm showed better recovery from H-B grade III to H-B I and II and from H-B grade IV and VI to H-B I and III when compared with extrameatal tumors >2 cm (p = 0.001). CONCLUSION: Tumors of smaller sizes have good immediate postoperative FN results and recover well at the end of 1 year while more than 3 cm have poor outcomes and recover poorly at the end of 1 year. When the VSs reaches more than 1 cm, the HB I and II outcomes drop significantly.


Assuntos
Traumatismos do Nervo Facial , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias , Adulto , Idoso , Traumatismos do Nervo Facial/epidemiologia , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
19.
J Laryngol Otol ; 132(10): 885-890, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30387409

RESUMO

OBJECTIVE: To evaluate the therapeutic effect that the titanium partial ossicular reconstruction prosthesis and autologous ossicles have on hearing loss after reconstruction of a damaged ossicular chain. METHODS: Forty-two medical records of treatments carried out from 2013 to 2015 for ossicular chain damage with facial nerve paralysis due to temporal bone fractures were reviewed. The study assessed: causes of damage, pre-operative pure tone audiometry findings, types of intra-operative ossicular chain damage, intra-operative ossicular chain repair methods (titanium partial ossicular reconstruction prosthesis or autologous ossicles) and post-operative pure tone audiometry results. RESULTS: The titanium partial ossicular reconstruction prosthesis was used in 26 cases; the average air-bone gap was 32.3 ± 5.3 dB pre-operatively and 12.8 ± 5.3 dB post-operatively. Autologous ossicles were used in 16 cases; the average air-bone gap was 33.4 ± 4.5 dB pre-operatively and 17.8 ± 7.8 dB post-operatively. CONCLUSION: Ossicular chain reconstruction is an effective way of improving hearing in patients with ossicular chain damage. The results suggest that repair with either the titanium partial ossicular reconstruction prosthesis or autologous ossicles can improve hearing following ossicular chain injury with facial nerve paralysis caused by a temporal bone fracture.


Assuntos
Ossículos da Orelha/cirurgia , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva/reabilitação , Prótese Ossicular , Substituição Ossicular , Adulto , Audiometria de Tons Puros , Orelha Média/cirurgia , Traumatismos do Nervo Facial/etiologia , Feminino , Fraturas Ósseas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Substituição Ossicular/métodos , Estudos Retrospectivos , Osso Temporal/lesões , Titânio/uso terapêutico , Resultado do Tratamento
20.
J Craniofac Surg ; 29(8): e824-e826, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30320688

RESUMO

There exist 2 classic extraoral approaches to the posterior aspect of the mandible, namely the submandibular or Risdon approach, and the retromandibular approach. Despite their widespread use, there still exist concerns of damage to surrounding structures, in particular cranial nerve VII, as well as vascular structures and salivary glands. Evidence of facial nerve palsy has been shown to be as high as 48% in the patient with the Risdon approach, and as high as 30% in the retromandibular approach. The authors wish to propose a more conservative, technically easier, and less time-consuming approach to the posterior mandible, with less risk of damage to the branches of the facial nerve, as well as other structures such as the facial vessels and the parotid gland.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas Mandibulares/cirurgia , Redução Aberta/métodos , Adulto , Idoso , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Redução Aberta/efeitos adversos
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