Olfactory ensheathing cells in facial nerve regeneration.

INTRODUCTION: Olfactory ensheathing cell is a unique kind of glia cells, which can promote axon growth. Little is known about the differences between olfactory mucosa olfactory ensheathing cells and olfactory bulb olfactory ensheathing cells in the capability to promote nerve regeneration. OBJECTIVE: To study the recovery of the rat facial nerve after olfactory ensheathing cells transplantation, and to compare the differences between the facial nerve regeneration of olfactory mucosa-olfactory ensheathing cells and olfactory bulb olfactory bulb olfactory ensheathing cells transplantation. METHODS: Institutional ethical guideline was followed (201510129A). Olfactory mucosa-olfactory ensheathing cells and olfactory bulb olfactory ensheathing cells were cultured and harvested after 7 days in vitro. 36 Sprague Dawley male rats were randomly divided into three different groups depending on the transplanting cells: Group A: olfactory mucosa-olfactory ensheathing cells; Group B: olfactory bulb olfactory ensheathing cells; Group C: DF-12 medium/fetal bovine serum. The main trunk of the facial nerve was transected and both stumps were inserted into a polylactic acid/chitosan conduit, then the transplanted cells were injected into the collagen in the conduits. After 4 and 8 weeks after the transplant, the rats of the three groups were scarified and the facial function score, facial nerve evoked potentials, histology analysis, and fluorescent retrograde tracing were tested and recorded, respectively, to evaluate the facial nerve regeneration and to analysis the differences among the three groups. RESULTS: Olfactory ensheathing cells can promote the facial nerve regeneration. Compared with olfactory bulb olfactory ensheathing cells, olfactory mucosa olfactory ensheathing cells were more effective in promoting facial nerve regeneration, and this difference was more significant 8 weeks after the transplantation than 4 weeks. CONCLUSION: We discovered that olfactory ensheathing cells with nerve conduit could improve the facial nerve recovery, and the olfactory mucosa olfactory ensheathing cells are more effective for facial nerve regeneration compared with olfactory bulb olfactory ensheathing cells 8 weeks after the transplantation. These results could cast new light in the therapy of facial nerve defect, and furnish the foundation of auto-transplantation of olfactory mucosa olfactory ensheathing cells in periphery nerve injury.

Translation, cultural adaptation and validation of the facial disability index into Brazilian Portuguese.

INTRODUCTION: Facial paralysis may occur due to a variety of causes. It is associated to the impairment of some basic daily activities such as eating, drinking, speaking and social communication, which affects the quality of life of these patients. The facial disability index is a short form auto reported outcome questionnaire used to assess patient with facial paralysis. It has been validated and proved to be superior to other general health related quality of life questionnaires. OBJECTIVE: We aim to do the cultural adaptation and validate the facial disability index into Brazilian Portuguese. METHODS: Translation and cultural-adaptation following the stages recommended by the International Society of Pharmacoeconomics Outcomes Research task force. The questionnaire was administered to 100 patients for evaluation of reliability and validation. RESULTS: The reliability of the Portuguese version of the facial disability index was found to be adequate, with a Cronbach's alfa coefficient of 0.73 for the complete scale. Intra-class correlation was 0.79 (95% CI: 0.71-0.85) and 0.85 (95% CI: 0.78-0.89) for the physical and social well-being subscales. There was a significant correlation between the social well-being subscale of the Portuguese version of the facial disability index and the social function and mental health components of the SF-36. There was also a correlation between the facial disability index and the degree of facial dysfunction according to the House-Brackmann global scale. CONCLUSION: This adapted version of the facial disability index provides a valid and reliable instrument to assess the physical and psychosocial impact of facial nerve dysfunction in Brazilian-speaking patients.

Applied anatomy of round window and adjacent structures of tympanum related to cochlear implantation.

INTRODUCTION: Various aspects of the round window anatomy and anatomy of posterior tympanum have relevant implications for designing cochlear implant electrodes and visualizing the round window through facial recess. Preoperative information about possible anatomical variations of the round window and its relationships to the adjacent neurovascular structures can help reduce complications in cochlear implant surgery. OBJECTIVE: The present study was undertaken to assess the common variations in round window anatomy and the relationships to structures of the tympanum that may be relevant for cochlear implant surgery. METHODS: Thirty-five normal wet human cadaveric temporal bones were studied by dissection for anatomy of round window and its relation to facial nerve, carotid canal, jugular fossa and other structures of posterior tympanum. The dissected bones were photographed by a digital camera of 18 megapixels, which were then imported to a computer to determine various parameters using ScopyDoc 8.0.0.22 version software, after proper calibration and at 1× magnification. RESULTS: When the round window niche is placed posteriorly and inferiorly, the distance between round window and vertical facial nerve decreases, whereas that with horizontal facial nerve increases. In such cases, the distance between oval window and round window also increases. Maximum height of the round window in our study ranged from 0.51-1.27mm (mean of 0.69±0.25mm). Maximum width of round window ranged from 0.51 to 2.04mm (mean of 1.16±0.47mm). Average minimum distance between round window and carotid canal was 3.71±0.88mm (range of 2.79-5.34mm) and that between round window and jugular fossa was 2.47±0.9mm (range of 1.24-4.3mm). CONCLUSION: The distances from the round window to the oval window and facial nerve are important parameters in identifying a difficult round window niche. Modification of the electrode may be a better option than drilling off the round window margins for insertion of cochlear implant electrodes.

Desmistificando a técnica de deep plane facelift com dissecção anatômica em cadáveres frescos / Demystifying the deep plane facelift technique with anatomical dissection in fresh cadavers

Introdução: Os estudos de anatomia em cadáveres permitiram um melhor entendimento das estruturas da face e, consequentemente, mais segurança ao explorar os planos profundos da região facial. Uma boa técnica deve ser segura, reprodutível e respeitar os pontos anatômicos. O objetivo deste trabalho é desmistificar a técnica de deep plane facelifting por meio da dissecção de cadáveres e exposição das estruturas faciais. Método: A reprodução da técnica de "deep plane facelifting" foi realizada em 14 hemifaces de 7 peças de cadáveres frescos no Instituto de Treinamento de Cadáver em Curitiba no ano de 2021. A técnica cirúrgica foi realizada conforme nossa prática clínica e reproduzida no cadáver. Após o procedimento, as estruturas anatômicas faciais foram dissecadas para correlacionar seu posicionamento junto aos espaços anatômicos da face. Foram avaliados os posicionamentos dos ligamentos da face, vascularização e os ramos do nervo facial. Resultados: Foram identificados os espaços anatômicos relevantes à técnica de deep plane facelifting, como os espaços massetéricos inferior e superior, espaço pré-zigomático, espaço bucal e espaço cervical. Os ramos do nervo facial foram identificados no plano subSMAS e correlacionados com os espaços e planos anatômicos. Conclusão: A técnica de deep plane facelift pode ser reproduzida com segurança desde que sejam respeitados dois parâmetros. O primeiro é a entrada correta nos espaços a fim de respeitar a anatomia. O segundo é o uso de descoladores rombos para dissecção nos planos profundos da face a fim de evitar lesão nervosa dos ramos do nervo facial.

Introduction: Anatomy studies on cadavers have allowed a better understanding of the structures of the face and, consequently, greater safety when exploring the deep planes of the facial region. A good technique must be safe, reproducible, and respect anatomical points. The objective of this work is to demystify the deep plane facelifting technique through the dissection of cadavers and exposure of facial structures. Method: The reproduction of the "deep plane facelifting" technique was performed on 14 hemifaces of 7 pieces of fresh cadavers at the Instituto de Treinamento de Cadáver (Cadaver Training Institute) in Curitiba in 2021. The surgical technique was performed according to our clinical practice and reproduced on the cadaver. After the procedure, the facial anatomical structures were dissected to correlate their positioning with the anatomical spaces of the face. The positioning of the facial ligaments, vascularization, and branches of the facial nerve were evaluated. Results: The anatomical spaces relevant to the deep plane facelifting technique were identified, such as the inferior and superior masseteric spaces, prezygomatic space, buccal space, and cervical space. The facial nerve branches were identified in the sub-SMAS plane and correlated with the anatomical spaces and planes. Conclusion: The deep plane facelift technique can be reproduced safely as long as two parameters are respected. The first is the correct entry into spaces to respect the anatomy. The second is the use of blunt detachers for dissection in the deep planes of the face to avoid nerve damage to the branches of the facial nerve.

Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience.

INTRODUCTION: The use of surgical decompression of facial hemispasm due to the loop in the internal auditory canal is not always accepted due to the risk related to the surgical procedure. Currently a new surgical technique allows surgeons to work in safer conditions. OBJECTIVE: To report the results with endoscope-assisted retrosigmoid approach for facial nerve microvascular decompression in hemifacial spasm due to neurovascular conflict. The surgical technique is described. METHODS: We carried out a prospective study in a tertiary referral center observing 12 (5 male, 7 female) patients, mean age 57.5 years (range 49-71) affected by hemifacial spasm, that underwent to an endoscope assisted retrosigmoid approach for microvascular decompression. We evaluated intra-operative findings, postoperative HFS resolution and complication rates. RESULTS: Hemifacial spasm resolution was noticed in 9/12 (75%) cases within 24h after surgery and in 12/12 (100%) subjects within 45 days. A significant (p<0.001) correlation between preoperative historical duration of hemifacial spasm and postoperative recovery timing was recorded. Only 1 patient had a complication (meningitis), which resolved after intravenous antibiotics with no sequelae. No cases of cerebrospinal fluid leak, facial palsy or hearing impairment were recorded. Hemifacial spasm recurrence was noticed in the only subject where the neurovascular conflict was due to a vein within the internal auditory canal. CONCLUSIONS: The endoscope assisted retrosigmoid approach technique offers an optimal visualization of the neurovascular conflict thorough a minimally invasive approach, thus allowing an accurate decompression of the facial nerve with low complication rates. Due to the less invasive nature, the procedure should be considered in functional surgery of the cerebellar pontine angle as hemifacial spasm treatment, specially when the procedure is performed by an otolaryngologist.

Da superfície para a profundidade: Curva de aprendizado em lifting facial profundo estendido - meus primeiros 100 casos / From Surface to Depth: Learning Curve in Extended Deep Facelift ­ my First 100 Cases

Introdução: O envelhecimento facial é um processo gradual, complexo e multifatorial. É o resultado de mudanças na qualidade, volume e posicionamento dos tecidos. Cirurgiões plásticos têm modificado sua abordagem na cirurgia do rejuvenescimento facial optando pelo plano subaponeurótico (SMAS). O objetivo deste estudo é analisar 100 casos de pacientes operados pela técnica de SMAS profundo, avaliando sua aplicabilidade e eficácia. Método: Foram avaliados 100 pacientes, submetidos a cirurgia plástica facial pela técnica de SMAS profundo - "Deep Smas", e acompanhados por 6 meses. Observou-se a satisfação dos pacientes, número de complicações, número de reoperações, riscos e vantagens da técnica. Resultados: Foram operados 100 pacientes, num período de 3 anos. A idade variou de 41 a 79 anos, sendo 95% sexo feminino. As complicações foram 8 casos (8%) de lesões de ramos do nervo facial, sendo: 4 casos lesão do zigomático, 3 casos de lesão do mandibular e 1 caso de lesão do bucal; houve 1 caso (1%) de queloide retroauricular; 1 caso (1%) de hematoma. Em relação às revisões cirúrgicas, houve 8 casos (8%) de complementação cirúrgica por insatisfação das pacientes. Houve 15% de lesões nervosas entre a 1ª e a 40ª cirurgia, 5% entre a 41ª e a 80ª, e nenhuma lesão entre o 81º e o 100º paciente. Conclusão: O lifting facial profundo ou subSMAS mostrou ser efetivo, proporcionando bons resultados estéticos. Apresenta baixa taxa de recidiva e baixa taxa de morbidade, porém, necessita de uma longa curva de aprendizagem.

Introduction: Facial aging is a gradual, complex, and multifactorial process. It is the result of changes in the quality, volume, and positioning of tissues. Plastic surgeons have modified their approach to facial rejuvenation surgery, opting for the subaponeurotic plane (SMAS). The objective of this study is to analyze 100 cases of patients operated on using the deep SMAS technique, evaluating its applicability and effectiveness. Method: 100 patients were evaluated, undergoing facial plastic surgery using the deep SMAS technique - "Deep Smas", and followed up for 6 months. Patient satisfaction, number of complications, number of reoperations, risks, and advantages of the technique were observed. Results: 100 patients were operated on over 3 years. Age ranged from 41 to 79 years, with 95% being female. The complications were 8 cases (8%) of injuries to branches of the facial nerve, of which 4 cases of zygomatic injury, 3 cases of mandibular injury, and 1 case of buccal injury; there was 1 case (1%) of post-auricular keloid; 1 case (1%) of hematoma. Regarding surgical revisions, there were 8 cases (8%) of surgical completion due to patient dissatisfaction. There were 15% of nerve injuries between the 1st and 40th surgery, 5% between the 41st and 80th, and no injuries between the 81st and 100th patient. Conclusion: Deep facial lifting or subSMAS has proven to be effective, providing good aesthetic results. It has a low recurrence rate and low morbidity rate; however, it requires a long learning curve.

Estudo topográfico dos giros e sulcos e do nervo facial em cadáveres de fetos humanos / Topographic study of gyri, sulci and facial nerve in human fetus corps / Estudio topográfico de giros, surcos y nervios faciales en cadáveres de fetos humanos

Introdução: Durante o desenvolvimento do encéfalo há formação de sulcos e giros que podem sofrer alterações morfológicas similarmente ao nervo facial (NC VII) que possui funções sensitivas e motoras e sua lesão pode gerar prejuízos clínicos e estéticos. Na literatura há informações sobre essas estruturas em adultos, porém pouco definidas em fetos. Objetivo: Descrever os giros e sulcos e o trajeto do NC VII em cadáveres de fetos humanos. Métodos: Selecionou-se sete fetos humanos, de ambos os sexos, do acervo do Laboratório de Anatomia da UFMS CPTL. Realizou-se três etapas: avaliação da idade fetal, dissecação e descrição anatômica. O estudo foi aprovado pelo Comitê de Ética em Pesquisa, CAEE: 75069617.5.0000.5386 2022. Resultados: observou-se na face dorsolateral sulcos frontal superior e médio e pós-central, temporal superior e inferior, circular da ínsula e central da ínsula. Há giro pré-central, pós-central, temporais, superior inferior e médio. Na face medial há sulco do cíngulo duplo, paracentral, parieto occipital e giro frontal superior. Em todos os fetos, há o tronco do NC VII e seus ramos perfurando o parênquima da glândula parótida na região infratemporal antes da divisão em ramos pela face Conclusão: A topografia dos giros e sulcos dos fetos é fundamental para identificar precocemente malformações corticais. Somado a isso, o estudo morfológico do NC VII poderá fomentar estudos futuros, haja vista que são poucos os registros a respeito das características deste nervo em fetos.

Introduction: In the development of the brain there are grooves and gyri that undergo morphological changes, similarly the facial nerve (CN VII) has sensory and motor functions and its injury generates clinical and aesthetic damage. In the literature there is information about these structures in adults, but little defined in fetuses. Objective: To describe the gyri and sulci and the course of CN VII in fetal cadavers. Methods: Seven human fetuses of both sexes were selected from the collection of the Anatomy Laboratory of the UFMS CPTL. Three steps were performed: assessment of fetal age, dissection and anatomical description. The study was approved by the Research Ethics Committee, CAEE 75069617.5.0000.5386. Results: in the studied brains, superior and medium frontal and postcentral, superior and inferior temporal, insula circular and insula central grooves were observed on the dorsolateral surface. There are precentral, postcentral, temporal, superior, inferior, and middle gyrus. On the medial surface there is the double cingulate sulcus, paracentral, parieto occipital and superior frontal gyrus. In all fetuses, there is the trunk of CN VII and its branches piercing the parotid gland parenchyma in the infratemporal region before dividing into branches across the face. Conclusion: The topography of the gyri and sulcus of fetuses is essential for early identification of cortical malformations. Added to this, the morphological study of CN VII may encourage future studies, given that there are few records regarding the characteristics of this nerve in fetuses.

Introducción: En el desarrollo del cerebro existen surcos y circunvoluciones que sufren cambios morfológicos, de igual manera el nervio facial (NC VII) tiene funciones sensoriales y motoras y su lesión genera daño clínico y estético. En la literatura existe información sobre estas estructuras en adultos, pero poco definidas en fetos. Objetivo: Describir las circunvoluciones y surcos y el curso del NC VII en cadáveres fetales. Métodos: Siete fetos humanos, de ambos sexos, fueron seleccionados de la colección del Laboratorio de Anatomía de la UFMS CPTL. Se realizaron tres pasos: evaluación de la edad fetal, disección y descripción anatómica. El estudio fue aprobado por el Comité de Ética en Investigación, CAEE 75069617.5.0000.5386. Resultados: en los cerebros estudiados, se observaron surcos en la superficie dorsolateral frontal superior y medio y poscentral, temporal superior e inferior, insular circular e insular central. Hay circunvolución precentral, poscentral, temporal, superior, inferior y media. En la superficie medial se encuentra el doble surco cingulado, paracentral, parieto occipital y giro frontal superior. En todos los fetos, el tronco del NC VII y sus ramas perforan el parénquima de la glándula parótida en la región infratemporal antes de dividirse en ramas a lo largo de la cara. Conclusión: La topografía de las circunvoluciones y surcos de los fetos es fundamental para la identificación temprana de malformaciones corticales. Sumado a esto, el estudio morfológico del NC VII puede alentar futuros estudios, dado que existen pocos registros sobre las características de este nervio en fetos.

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

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

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

Síndrome de Moebius y ortotropía en posición primaria: ¿es infrecuente esta asociación? (Colombia) / Moebius syndrome and orthotropia in primary position: is this association uncommon? (Colombia) / Síndrome de Moebius e ortotropia em posição primária: é uma associação incomum? (Colômbia)

El síndrome de Moebius es una enfermedad congénita poco común que se caracteriza por el compromiso unilateral o bilateral del VI y VII par craneal, lo que compromete los músculos que controlan la oculomotricidad, produciendo una parálisis en la abducción del globo ocular y los músculos involucrados en la expresión facial. Su presentación clínica y grados de severidad son variables, puede presentar compromiso simétrico o asimétrico. Adicionalmente, gran parte de los casos se relacionan con trastornos del lenguaje, anomalías musculoesqueléticas y orofaciales. En el presente artículo se presenta el caso de una paciente femenina de 3 años producto de un embarazo trigemelar con diagnóstico clínico de síndrome de Moebius al nacer, confirmado por neuroimagen en la que se evidencia la ausencia bilateral del nervio facial en ángulos pontocerebelosos, adicionalmente con un defecto completo en los movimientos oculares de abducción y aducción lo que impide el estrabismo convergente común en estos pacientes.

Moebius syndrome is a rare congenital disease characterized by unilateral or bilateral involvement of the VI and VII cranial nerves, which compromises the muscles that control ocular motricity with paralysis in the abduction of the eyeball and the muscles involved in the facial expression. Its clinical presentation and degrees of severity are variable, and it can be symmetric or asymmetric. Additionally, most of the cases are related to language disorders, musculoskeletal and orofacial anomalies. This paper presents the case of a 3-year-old female patient, product of a trigemellar pregnancy with a clinical diagnosis of Moebius syndrome at birth, confirmed by neuroimaging, which shows the bilateral absence of the facial nerve in point-lateral angles. Additionally she has a complete defect in abduction and adduction eye movements, which prevents the common convergent strabismus in these patients.

A síndrome de Moebius é uma doença congênita rara caracterizada pelo envolvimento unilateral ou bilateral dos nervos cranianos VI e VII, que compromete os músculos que controlam a oculomotricidade com paralisia na abdução do globo ocular e dos músculos envolvidos na expressão facial. Sua apresentação clínica e graus de gravidade são variáveis, podendo ser um comprometimento simétrico ou assimétrico. Além disso, a maioria dos casos está relacionada a distúrbios de linguagem, anomalias musculoesqueléticas e orofaciais. Este paper apresenta o caso de uma paciente de 3 anos de idade, fruto de uma gravidez trigêmea com diagnóstico clínico de Síndrome de Moebius ao nascimento, confirmado por neuroimagem em que é evidente a ausência bilateral do nervo facial nos ângulos ponto-cerebelares. Além disso, ela tem um defeito completo nos movimentos oculares de abdução e adução, o que impede o estrabismo convergente comum nesses pacientes.

Effects of ozone therapy on facial nerve regeneration.

INTRODUCTION: Ozone may promote moderate oxidative stress, which increases antioxidant endogenous systems. There are a number of antioxidants that have been investigated therapeutically for improving peripheral nerve regeneration. However, no previous studies have reported the effect of ozone therapy on facial nerve regeneration. OBJECTIVE: We aimed to evaluate the effect of ozone therapy on facial nerve regeneration. METHODS: Fourteen Wistar albino rats were randomly divided into two groups with experimental nerve crush injuries: a control group, which received saline treatment post-crush, and an experimental group, which received ozone treatment. All animals underwent surgery in which the left facial nerve was exposed and crushed. Treatment with saline or ozone began on the day of the nerve crush. Left facial nerve stimulation thresholds were measured before crush, immediately after crush, and after 30 days. After measuring nerve stimulation thresholds at 30 days post-injury, the crushed facial nerve was excised. All specimens were studied using light and electron microscopy. RESULTS: Post-crushing, the ozone-treated group had lower stimulation thresholds than the saline group. Although this did not achieve statistical significance, it is indicative of greater functional improvement in the ozone group. Significant differences were found in vascular congestion, macrovacuolization, and myelin thickness between the ozone and control groups. Significant differences were also found in axonal degeneration and myelin ultrastructure between the two groups. CONCLUSION: We found that ozone therapy exerted beneficial effect on the regeneration of crushed facial nerves in rats.

Effects of titanium prepared platelet rich fibrin on facial nerve regeneration: an experimental study / Efeitos da fibrina rica em plaquetas preparada com titânio na regeneração do nervo facial: um estudo experimental

Abstract Introduction: Facial nerve damage is a condition that causes functional, psychological, and cosmetic problems; and treatment methods need to be improved. Objective: We investigated the efficacy of titanium-prepared platelet-rich fibrin as a healing enhancer at the region of transection of the facial nerve. Methods: Twenty-seven New Zealand male rabbits were used in this study, divided into three experimental groups. Group 1, the sham group (n=7); Group 2, the suture group (n = 10); and Group 3, the suture + T-PRF group (n = 10). In Group 1, the facial nerve trunk was dissected, and no additional surgical intervention was performed. For Group 2, a transection was made to the facial nerve trunk and the nerve endings were sutured together. In Group 3, nerve endings were sutured after transection, and a titanium-prepared platelet-rich fibrin membrane was wrapped in a tube around the damaged area. All animals were followed up weekly for the presence of corneal reflex, whisker movement and low ears. Bilateral facial electromyography was performed both preoperatively and postoperatively at the 1st, 3rd, 5th, 7th, 10th weeks. Tissue samples obtained at the 10th week were histopathologically examined, and intra-group and inter-group comparisons were performed. Results: Subjects in Group showed improvement in whisker movement and ear drop one week earlier than Group 2. In Group 3, the nerve stimulation threshold required to trigger the compound muscle action potential had returned to values similar to the preoperative control values (11.31 ±2.16V) by 5 weeks postoperatively (12.51 ±3.97V), (p = 0.249). Conclusion: Titanium-prepared platelet-rich fibrin administration contributed to partial nerve healing both on a functional and an electrophysiological level.

Resumo Introdução: A lesão do nervo facial é uma condição que causa problemas funcionais, psicológicos e cosméticos e os métodos de tratamento precisam ser melhorados. Objetivo: Investigamos a eficácia da fibrina rica em plaquetas preparada com titânio como um intensificador de cura na transecção do nervo facial. Método: Vinte e sete coelhos machos da raça New Zealand foram usados neste estudo, divididos em três grupos experimentais. Grupo 1, o grupo simulado (n = 7); Grupo 2, o grupo de sutura (n = 10); e Grupo 3, o grupo sutura + fibrina rica em plaquetas preparada com titânio (n = 10). No Grupo 1, o tronco do nervo facial foi dissecado e nenhuma intervenção cirúrgica adicional foi feita. No Grupo 2, uma secção transversal foi feita no tronco do nervo facial e as terminações nervosas foram suturadas. No Grupo 3, as terminações nervosas foram suturadas após a transecção e uma membrana de fibrina rica em plaquetas preparada com titânio foi envolvida em um tubo ao redor da área danificada. Todos os animais foram acompanhados semanalmente quanto à presença do reflexo corneal, movimento dos bigodes e orelhas baixas. A eletromiografia facial bilateral foi feita no pré e pós-operatório na 1ª, 3ª, 5ª, 7ª e 10ª semanas. Amostras de tecido obtidas na 10- semana foram examinadas histopatologicamente e comparações intra- e intergrupos foram feitas. Resultados: Os animais do Grupo 1 apresentaram melhoria no movimento dos bigodes e orelhas baixas uma semana antes do Grupo 2. No Grupo 3, o limiar de estimulação do nervo necessário para acionar o potencial de ação muscular composta retornou a valores semelhantes aos valores de controle pré-operatório (11,31 ± 2,16 volts) em 5 semanas de pós-operatório (12,51 ± 3,97 volts), (p = 0,249). Conclusão: A administração de fibrina rica em plaquetas preparada com titânio contribuiu para a cicatrização parcial do nervo ao nível funcional e eletrofisiológico.

The role of facial canal diameter in the pathogenesis and grade of Bell's palsy: a study by high resolution computed tomography.

INTRODUCTION: The exact etiology of Bell's palsy still remains obscure. The only authenticated finding is inflammation and edema of the facial nerve leading to entrapment inside the facial canal. OBJECTIVE: To identify if there is any relationship between the grade of Bell's palsy and diameter of the facial canal, and also to study any possible anatomic predisposition of facial canal for Bell's palsy including parts which have not been studied before. METHODS: Medical records and temporal computed tomography scans of 34 patients with Bell's palsy were utilized in this retrospective clinical study. Diameters of both facial canals (affected and unaffected) of each patient were measured at labyrinthine segment, geniculate ganglion, tympanic segment, second genu, mastoid segment and stylomastoid foramen. The House-Brackmann (HB) scale of each patient at presentation and 3 months after the treatment was evaluated from their medical records. The paired samples t-test and Wilcoxon signed-rank test were used for comparison of width between the affected side and unaffected side. The Wilcoxon signed-rank test was also used for evaluation of relationship between the diameter of facial canal and the grade of the Bell's palsy. Significant differences were established at a level of p=0.05 (IBM SPSS Statistics for Windows, Version 21.0.; Armonk, NY, IBM Corp). RESULTS: Thirty-four patients - 16 females, 18 males; mean age±Standard Deviation, 40.3±21.3 - with Bell's palsy were included in the study. According to the HB facial nerve grading system; 8 patients were grade V, 6 were grade IV, 11 were grade III, 8 were grade II and 1 patient was grade I. The mean width at the labyrinthine segment of the facial canal in the affected temporal bone was significantly smaller than the equivalent in the unaffected temporal bone (p=0.00). There was no significant difference between the affected and unaffected temporal bones at the geniculate ganglion (p=0.87), tympanic segment (p=0.66), second genu (p=0.62), mastoid segment (p=0.67) and stylomastoid foramen (p=0.16). We did not find any relationship between the HB grade and the facial canal diameter at the level of labyrinthine segment (p=0.41), tympanic segment (p=0.12), mastoid segment (p=0.14), geniculate ganglion (p=0.13) and stylomastoid foramen (p=0.44), while we found significant relationship at the level of second genu (p=0.02). CONCLUSION: We found the diameter of labyrinthine segment of facial canal as an anatomic risk factor for Bell's palsy. We also found significant relationship between the HB grade and FC diameter at the level of second genu. Future studies (MRI-CT combined or 3D modeling) are needed to promote this possible relevance especially at second genu. Thus, in the future it may be possible to selectively decompress particular segments in high grade BP patients.

Outcome of different facial nerve reconstruction techniques.

INTRODUCTION: There is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III. OBJECTIVE: To evaluate the efficacy and safety of different facial nerve reconstruction techniques. METHODS: Facial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years. RESULTS: For facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit. CONCLUSION: Among various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique.

Facial paralysis after superficial parotidectomy: analysis of possible predictors of this complication.

INTRODUCTION: Salivary gland tumors represent 3-10% of all head and neck neoplasms. These tumors occur predominantly in major salivary glands. The parotid gland is affected most often, ranging from 36.6% to 83%. The pleomorphic adenoma comprises 45-60% of all salivary gland tumors. Several surgical approaches have been described to treat this tumor. Lesion of the facial nerve is one of the most serious complications that can occur after parotid gland surgery. OBJECTIVES: To determine possible predictive factors related to the occurrence of peripheral facial paralysis (PFP) after superficial parotidectomy in the surgical treatment of the pleomorphic adenomas of the parotid gland. METHODS: This was a primary, observational, case-control study performed through the revision of patients' charts and histopathological reports. Data was obtained from 1995 to 2014. The analyzed events were: tumor's length and depth; duration of the disease referred by the patient (more than 1, 5 or 10 years); primary or secondary surgical approach. RESULTS: The analysis showed that tumor lengths equal or superior to 3.0cm were a risk factor of PFP with an odds ratio of 3.98 (p=0.0310). Tumor depths equal or superior to 2.0cm were also a risk factor with an odds ratio of 9.5556 (p=0.0049). When the tested event was secondary surgery to recurrent tumors we have found an odds ratio of 6.7778 (p=0.0029). CONCLUSION: Tumors with 3.0cm or more in length and/or 2.0cm or more in depth have a significant higher risk of facial nerve injury. Secondary surgery to recurrent tumors also has a much higher risk of evolving with facial palsy after superficial parotidectomy.

Bem-estar e comprometimento motor facial em pacientes com paralisia facial periférica: um estudo transversal / Well-being and facial motor impairment in patients with peripheral facial paralysis: a cross-sectional study

A Paralisia Facial Periférica (PFP) é resultante da disfunção do nervo facial. A incapacidade de mover o rosto tem consequências sociais e funcionais para o paciente. OBJETIVO: Analisar a relação entre comprometimento motor facial e bem estar em pacientes com PFP. MÉTODO: Trata-se de uma pesquisa de caráter descritivo, observacional, do tipo transversal. Os critérios de elegibilidade consistiam em ter diagnóstico de paralisia facial e estar sendo atendido namclínica escola de Fisioterapia da FACISA. A amostra foi constituída porm20 pessoas com PFP. Os pacientes foram avaliados por uma ficha de avaliação sociodemográfica e pelos instrumentos: Escala de HouseBrackmann (HB) e o Índice de Incapacidade Facial (IIF).Utilizou-se o coeficiente de correlação de Spearman para analisar o grau de correlação entre HB, IF e o tempo de lesão. RESULTADOS: Os participantes foram 65% do sexo feminino, a mediana da idade foi de 50,5 anos, o tempo de lesão foi de 3 a 331 dias (mediana 17,5 dias), a etiologia predominante foi idiopática 65%, e ambas hemifaces foram acometidas em igual proporção (50%). Quanto as características clínicas da PFP, o nível de comprometimento motor facial graduado pela escala de HB obteve mediana 4, o IFF-física obteve mediana 60. IFF-função social obteve mediana 38. Nas correlações entre HB, tempo de lesão e IFF, foi observado que os valores obtidos indicaram que não houve correlações estatisticamente significantes. CONCLUSÃO: Mesmo que o nível de comprometimento motor facial esteja acentuado, não houve correlação com o bem-estar dos participantes.

Peripheral Facial Paralysis (PFP) is the result of facial nerve dysfunction. The inability to move the face has social and functional consequences for the patient. OBJECTIVE: To analyze the relationship between facial motor impairment and wellbeing in patients with Peripheral Facial Paralysis (PFP). METHOD: This is a descriptive, observational, cross-sectional study. The eligibility criteria consisted of having a diagnosis of facial paralysis and being seen at the FACISA School of Physiotherapy clinic. The sample consisted of 20 people affected by PFP. The patients were evaluated by a socio-demographic data sheet and by the instruments: House-Brackmann Scale (HB) and Facial Impairment Index (IIF). Spearman's correlation coefficient was used to analyze the degree of correlation between HB, IF and injury time. RESULTS: The participants were 65% female, the median age was 50.5 years, the injury time was 3 to 331 days (median 17.5 days), the predominant etiology was idiopathic 65%, and both hemifaces were affected in equal proportion (50%). As for the clinical characteristics of PFP, the level of facial motor impairment graded by the HB scale obtained a median of 4, the IFF-physics obtained a median of 60. IFFsocial function obtained a median of 38. In the correlations between HB, injury time and IFF, it was observed that the values obtained indicated that there were no statistically significant correlations. CONCLUSION: Even though the level of facial motor impairment is marked, there was no correlation with the participants' well-being.

Relação anatômica da Bola de Bichat com ramos terminais do nervo facial / Anatomical Correlation among Bichat's fat pad with the Facial Nerve Terminal Branches

Introdução: A cirurgia de Bichectomia está sendo muito procurada por pessoas que visam diminuir o volume facial. O corpo adiposo da bochecha, ou bola de Bichat, possui uma complexa relação anatômica com estruturas faciais. Uma das complicações que o procedimento pode causar é a paralisia facial temporária ou permanente, em decorrência de injúrias causadas aos ramos terminais do nervo facial, devido à proximidade dessas duas estruturas anatômicas. Metodologia: O objetivo do presente artigo é enfatizar a relação anatômica da bola de Bichat com alguns ramos terminais do nervo facial através da dissecação de cadáveres. Foram feitas dissecações em três hemifaces de cadáveres humanos para a exposição do corpo adiposo da bochecha e dos ramos extracranianos do nervo facial. Resultados: A anatomia dos ramos terminais zigomáticos e bucais do nervo facial se mostrou variável em cada hemiface dissecada, mas sempre intimamente relacionados a bola de Bichat. Conclusões: O profissional que realiza a Bichectomia deve ter pleno conhecimento não só da técnica cirúrgica, mas também da variabilidade anatômica da região... (AU)

Introduction: The Buccal Fat Extraction surgery has been sought by people who aim to reduce facial volume. The Buccal fat pad has a complex anatomical correlation among the facial structures. The facial nerve paralysis is one of Bichat's fat extraction complications which might be temporary or permanent, due to the proximity of those anatomical structures. Methodology: The present article aims to emphasize the anatomical correlation between the Buccal fat pad and a few terminal branches of the facial nerve through the human cadaveric dissection. The dissection was performed on three human cadaveric hemifacial to expose the buccal fat pad body and the facial nerve extracranial branches. Results: The zygomatic and buccal terminal branches anatomy of the facial nerve has shown variables in each dissected hemifacial part. However, it has always presented closely related to Bichat's fat pad. Conclusions: The professional that performs the Buccal Fat Removal surgery must have to have the full knowledge not only about the surgical technique but the anatomical variability of the region, as well... (AU)

Olfactory ensheathing cells in facial nerve regeneration / Células embainhantes olfatórias na regeneração do nervo facial

Abstract Introduction: Olfactory ensheathing cell is a unique kind of glia cells, which can promote axon growth. Little is known about the differences between olfactory mucosa olfactory ensheathing cells and olfactory bulb olfactory ensheathing cells in the capability to promote nerve regeneration. Objective: To study the recovery of the rat facial nerve after olfactory ensheathing cells transplantation, and to compare the differences between the facial nerve regeneration of olfactory mucosa-olfactory ensheathing cells and olfactory bulb olfactory bulb olfactory ensheathing cells transplantation. Methods: Institutional ethical guideline was followed (201510129A). Olfactory mucosa-olfactory ensheathing cells and olfactory bulb olfactory ensheathing cells were cultured and harvested after 7 days in vitro. 36 Sprague Dawley male rats were randomly divided into three different groups depending on the transplanting cells: Group A: olfactory mucosa-olfactory ensheathing cells; Group B: olfactory bulb olfactory ensheathing cells; Group C: DF-12 medium/fetal bovine serum. The main trunk of the facial nerve was transected and both stumps were inserted into a polylactic acid/chitosan conduit, then the transplanted cells were injected into the collagen in the conduits. After 4 and 8 weeks after the transplant, the rats of the three groups were scarified and the facial function score, facial nerve evoked potentials, histology analysis, and fluorescent retrograde tracing were tested and recorded, respectively, to evaluate the facial nerve regeneration and to analysis the differences among the three groups. Results: Olfactory ensheathing cells can promote the facial nerve regeneration. Compared with olfactory bulb olfactory ensheathing cells, olfactory mucosa olfactory ensheathing cells were more effective in promoting facial nerve regeneration, and this difference was more significant 8 weeks after the transplantation than 4 weeks. Conclusion: We discovered that olfactory ensheathing cells with nerve conduit could improve the facial nerve recovery, and the olfactory mucosa olfactory ensheathing cells are more effective for facial nerve regeneration compared with olfactory bulb olfactory ensheathing cells 8 weeks after the transplantation. These results could cast new light in the therapy of facial nerve defect, and furnish the foundation of auto-transplantation of olfactory mucosa olfactory ensheathing cells in periphery nerve injury.

Resumo Introdução: A célula embainhante olfatória é um tipo especial de célula glial que pode promover o crescimento do axônio. Pouco se sabe sobre as diferenças entre as células embainhantes olfatórias da mucosa olfatória e as células embainhantes olfatórias do bulbo olfatório em relação à sua capacidade de promover a regeneração nervosa. Objetivo: Estudar a regeneração do nervo facial de ratos após o transplante de células embainhantes olfatórias e comparar as diferenças entre a regeneração do nervo facial com o transplante de células embainhantes olfatórias da mucosa olfatória e de células embainhantes olfatórias do bulbo olfatório. Método: As recomendações éticas da instituição (201510129A) foram seguidas. Células embainhantes olfatórias da mucosa olfatória e células embainhantes olfatórias do bulbo olfatório foram cultivadas in vitro e coletadas após sete dias. Trinta e seis ratos Sprague Dawley machos foram divididos aleatoriamente em três grupos, dependeu das células transplantadas: Grupo A, células embainhantes olfatórias da mucosa olfatória; Grupo B, células embainhantes olfatórias do bulbo olfatório; Grupo C, meio de DF-12/soro fetal bovino. O tronco principal do nervo facial foi seccionado e ambos os cotos foram inseridos em um conduto de ácido polilático/quitosana; em seguida, as células transplantadas foram injetadas em colágeno nos condutos. Após quatro e oito semanas do transplante, os ratos dos três grupos foram agitados para a obtenção do escore da função facial, potenciais evocados do nervo facial, análise histológica e marcador fluorescente retrógrado, que foram testados e registrados, respectivamente, para avaliar a regeneração do nervo facial e analisar as diferenças entre os três grupos. Resultados: Células embainhantes olfatórias podem promover a regeneração do nervo facial. Em comparação com as células embainhantes olfatórias do bulbo olfatório, as células embainhantes olfatórias da mucosa olfatória foram mais eficazes na promoção da regeneração do nervo facial e essa diferença foi mais significativa oito semanas após o transplante em comparação com quatro semanas. Conclusão: Verificamos que células embainhantes olfatórias com conduto nervoso podem melhorar a recuperação do nervo facial e as células embainhantes olfatórias da mucosa olfatória são mais eficazes para a regeneração do nervo facial em comparação com as células embainhantes olfatórias do bulbo olfatório oito semanas após o transplante. Esses resultados podem lançar uma nova luz no tratamento de defeitos do nervo facial e fornecer a base do autotransplante de células embainhantes olfatórias da mucosa olfatória em lesões do nervo periférico.

Translation, cultural adaptation and validation of the facial disability index into Brazilian Portuguese / Tradução, adaptação cultural e validação do facial disability index para o português falado no Brasil

Abstract Introduction: Facial paralysis may occur due to a variety of causes. It is associated to the impairment of some basic daily activities such as eating, drinking, speaking and social communication, which affects the quality of life of these patients. The facial disability index is a short form auto reported outcome questionnaire used to assess patient with facial paralysis. It has been validated and proved to be superior to other general health related quality of life questionnaires. Objective: We aim to do the cultural adaptation and validate the facial disability index into Brazilian Portuguese. Methods: Translation and cultural-adaptation following the stages recommended by the International Society of Pharmacoeconomics Outcomes Research task force. The questionnaire was administered to 100 patients for evaluation of reliability and validation. Results: The reliability of the Portuguese version of the facial disability index was found to be adequate, with a Cronbach's alfa coefficient of 0.73 for the complete scale. Intra-class correlation was 0.79 (95% CI: 0.71-0.85) and 0.85 (95% CI: 0.78-0.89) for the physical and social well-being subscales. There was a significant correlation between the social well-being subscale of the Portuguese version of the facial disability index and the social function and mental health components of the SF-36. There was also a correlation between the facial disability index and the degree of facial dysfunction according to the House-Brackmann global scale. Conclusion: This adapted version of the facial disability index provides a valid and reliable instrument to assess the physical and psychosocial impact of facial nerve dysfunction in Brazilian-speaking patients.

Resumo Introdução: Paralisia facial periférica pode ocorrer devido a uma grande variedade de causas e está associada ao comprometimento de atividades diárias básicas, como comer, beber, falar e comunicação social, afeta a qualidade de vida dos pacientes. O facial disability index é um questionário autoaplicado desenvolvido especialmente para avaliar o impacto da disfunção facial sobre aspectos físicos e psicossociais dos pacientes. Embora tenha sido validado e se mostrado superior a outros questionários, ainda não fora submetido à adaptação transcultural e validação para a língua portuguesa. Objetivo: Realizar a tradução, adaptação cultural e validação do facial disability index para o português falado no Brasil. Método: A tradução e adaptação cultural do facial disability index foram realizadas em diferentes estágios conforme recomendações internacionais para adaptação de medidas de resultados. Para a verificação de confiabilidade e validação da versão em português, o facial disability index foi aplicado em 100 pacientes na forma de teste/reteste. Resultados: A confiabilidade da versão em português do facial disability index foi considerada adequada, com coeficiente alfa de Cronbach de 0,73. A avaliação de correlação intraclasse foi de 0,79 (95% IC 0,71-0,85 ) e de 0,85 (95% IC 0,78-0,89) para as subescalas física e de bem-estar social, respectivamente. Houve uma correlação significativa entre a escala de bem-estar social da versão em português do facial disability index e as dimensões de função social e saúde mental do questionário geral de qualidade de vida Short Form - 36. Também foi demonstrada uma correlação entre a versão em português do facial disability index e o grau de disfunção facial de acordo com a escala global de House-Brackmann. Conclusão: A versão adaptada do facial disability index para o português falado no Brasil se apresenta como um instrumento válido e confiável para avaliação do impacto da disfunção facial sobre aspectos físicos e psicossociais dos pacientes.

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

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

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

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

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

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