Facial Nerve

Reinnervation of facial muscles with only a cross-facial nerve graft in a 25-year-old patient with congenital facial palsy

July 13, 2014     Kamal Seyed-Forootan, MD; Hamid Karimi, MD; Esmaiil Hasani, MD
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Abstract

The standard method for managing chronic facial palsy is the two-stage free-muscle flap. We report a case involving a 25-year-old patient who had facial palsy from her birth. Twelve months after the first stage of a cross-facial nerve graft, we found that the voluntary movements of her facial muscles had returned. Within the following 12 months, she gained complete recovery of her movements on the affected side, as confirmed by electromyography studies. This case demonstrates that neurotization of facial muscles in chronic facial palsy is possible. However, further studies are needed to define the trophic effects or trophic mediators that can restore function to atrophied facial muscles and to determine which patients might benefit from the cross-facial nerve graft procedure without the free-muscle graft procedure.

Facial nerve palsy associated with a cystic lesion of the temporal bone

March 18, 2014     Na Hyun Kim, MD; Seung-Ho Shin, MD
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Abstract

Facial nerve palsy results in the loss of facial expression and is most commonly caused by a benign, self-limiting inflammatory condition known as Bell palsy. However, there are other conditions that may cause facial paralysis, such as neoplastic conditions of the facial nerve, traumatic nerve injury, and temporal bone leions. We present a case of facial nerve palsy concurrent with a benign cystic lesion of the temporal bone, adjacent to the tympanic segment of the facial nerve. The patient's symptoms subsided after facial nerve decompression via a transmastoid approach.

Facial nerve preservation in total parotidectomy for parotid tumors: A review of 27 cases

June 11, 2013     Soliman El-Shakhs, MD; Yaser Khalil, MD; and Asmaa Gaber Abdou, MD
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Abstract

We conducted a study to evaluate the success of facial nerve preservation in 27 adults with a parotid tumor who underwent total parotidectomy. Of this group, 11 patients had a malignant tumor, 10 had a recurrent benign tumor, and 6 had a primary benign tumor. Preoperatively, 7 patients had facial nerve paresis. Postoperatively, facial nerve preservation was achieved in all but 1 case; in the exception, the nerve was sacrificed and grafting was necessary. In conclusion, facial nerve preservation can be achieved in almost all cases of total parotidectomy.

Facial nerve sheath hematoma and paralysis after cochlear implant surgery

January 24, 2013     Christopher V. Lisi, MD; Tré Landrum, DO; Robert T. Sataloff, MD, DMA, FACS
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Facial nerve injury with resulting facial paralysis is perhaps the most feared complication of middle ear and mastoid surgery.

Huge middle ear adenoma with delayed facial nerve paralysis

June 4, 2012     Seung Ho Lee, MD; Hoseok Choi, MD, PhD; Young Chae Chu, MD; Young Hyo Kim, MD; Kyu-Sung Kim, MD, PhD
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Abstract

Middle ear adenoma is a rare disease that arises from the mucosa of the middle ear. Only a few cases of associated facial nerve paralysis have been reported. Facial nerve involvement is most likely related to nerve compression rather than tumor invasion of the nerve. We describe a case of a huge middle ear adenoma in a 63-year-old man. He presented with a 1-month history of right-sided otalgia, otorrhea, and facial palsy; he also had a 10-year history of right-sided hearing loss. A tympanomastoidectomy was performed. Intraoperatively, the tumor was found to fill the middle ear cavity as well as the entire diameter of the external auditory canal. The tumor had eroded the wall of the facial canal at the second genu, and it was tightly adherent to the epineurium. Focal inflammation around the tumor was observed at the exposed facial nerve. The tumor was removed and the facial nerve was decompressed. Immediately after surgery, the patient’s aural symptoms resolved. The final pathology evaluation established the diagnosis of a middle ear adenoma. At the 3-year follow-up, the ear cavity was completely healed and facial nerve function was improved.

Otomastoiditis with acute left facial nerve paralysis caused by Mycobacterium chelonae

December 15, 2011     Kang-Chao Wu, MD, Min-Tsan Shu, MD, and Bo-Nien Chen, MD
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Abstract

Mycobacterium chelonae usually causes soft-tissue and skin infection. It is a rare cause of otomastoiditis. The clinical presentation and operative findings are similar to those of other nontuberculous mycobacterial infections. We describe a case of left-sided otomastoiditis with acute facial nerve paralysis caused by this organism in a previously well middle-aged woman. Her facial palsy totally resolved after tympanomastoidectomy plus a 7-week regimen of clarithromycin and moxifloxacin. To our knowledge, a case of otomastoiditis with acute facial nerve paralysis caused by M chelonae has not been reported previously.

The effect of early division of the chorda tympani on gustatory function

November 22, 2011     Bruno Kenway, BMedSci, MRCS, DOHNS, Anand Kasbekar, BMedSci, MRCS, DOHNS, Neil Donnelly, MSc, FRCS (ORLHNS), and Patrick Axon, MD, FRCS (ORLHNS)
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Abstract

This study was undertaken to assess dysgeusia in patients who have undergone middle ear surgery for chronic suppurative otitis media (CSOM) when the surgeon's practice was to cleanly divide the chorda tympani without prior manipulation, if it in any way hindered operative access or the aims of surgery. We wanted to determine whether lower rates of taste disturbance might be obtained by early, clean division of the nerve. We followed 110 patients prospectively and asked them to complete a postoperative dysgeusia questionnaire 1 year after surgery. The “cut nerve” group included 81 patients, and the “uncut nerve” group included 29 patients. In the uncut group, the nerve was untouched or underwent minimal handling. In the cut nerve group, 68% of patients had no taste disturbance after surgery; 4% of patients in this group had ongoing symptoms at 1 year postoperatively. In the uncut nerve group, 67% were asymptomatic, while 11% had ongoing taste disturbance at 1 year. Statistical analysis of symptoms beyond 1 year showed a mean difference of 7%, but this is not statistically significant (p = 0.38). These results suggest that early division of the chorda tympani without prior manipulation in patients with chronic suppurative otitis media does not result in higher rates of taste disturbance than in patients with uncut nerves. Indeed rates of taste disturbance in our cut group were lower than in the uncut group, and lower than or comparable to those seen in other studies.

Facial nerve paralysis following transtympanic penetrating middle ear trauma

November 22, 2011     Alfred Marc Iloreta, MD and Benjamin D. Malkin, MD
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Delayed facial nerve palsy after endolymphatic sac surgery

August 15, 2011     Helen X. Xu, MD, Armin Farajzadeh Deroee, MD, Shruti Joglekar, MD, Natasha Pollak, MD, Francis Hobson, MD, Tristin Santori, HIS, and Michael M. Paparella, MD
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Abstract

Data on delayed facial nerve palsy (DFNP) following endolymphatic sac enhancement surgery are limited. We conducted a retrospective chart review to determine the incidence, possible predisposing factors, treatment, and prognosis of DFNP in such cases. We reviewed the records of 779 patients who had undergone endolymphatic sac surgery for intractable Ménière disease from January 1997 through December 2007 at a tertiary care otologic referral center. We found 5 cases (0.64%) of postoperative DFNP. The length of time between surgery and the onset of DFNP ranged from 7 to 20 days (mean: 11). Paralysis was incomplete in all 5 patients. Four of these patients had an abnormal mastoid bone anatomy, as the sigmoid sinus was either anteriorly or anteromedially displaced. The 5 patients had been treated with a steroid, either with or without an antiviral, and all 5 experienced a complete recovery of facial nerve function within 8 weeks of the onset of their paralysis. It is difficult to delineate the exact etiology of DFNP following endolymphatic sac surgery, but we speculate that factors such as physical injury to the nerve and/or a viral reactivation might have played a role. Also, the unusual mastoid bone anatomy seen in 4 of these patients might have been responsible, as well.

Reconstruction of the paralyzed face

June 13, 2011     Ashley B. Robey, MD and Mary C. Snyder, MD
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Abstract

Facial nerve paralysis can be difficult to treat because it presents a variety of functional, aesthetic, and psychosocial challenges. The goals of treatment include facial symmetry at rest, corneal protection, oral competence, restoration of voluntary and spontaneous facial movements, and minimal synkinesis. A multitude of static and dynamic procedures have been used to achieve these goals. Facial nerve reapproximation or interpositional grafting is associated with the best end results. The results of dynamic procedures are generally better than those of static procedures. Optimal reconstruction of the paralyzed face usually requires multiple surgeries with both types of procedures. Patients must be extensively counseled regarding expected results before they embark on what is an oftentimes lengthy reconstructive process. In this article, we discuss the anatomy of the facial nerve, the etiologic factors associated with facial nerve paralysis, the evaluation of the patient with facial paralysis, and the various surgical options for static and dynamic reconstruction of the paralyzed face. We also review the literature.

Measurements of the facial recess anatomy: Implications for sparing the facial nerve and chorda tympani during posterior tympanotomy

September 30, 2010     Caglar Calli, MD, Ercan Pinar, MD, Semih Oncel, MD, Bekir Tatar, MD, and Mehmet Ali Tuncbilek, MD
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Abstract

Posterior tympanotomy is commonly performed through the facial recess to facilitate cochlear implantation. A rare but serious complication of this procedure is paralysis of the facial nerve and/or the chorda tympani. These complications generally occur because of a limited understanding of the anatomy of the facial recess. To help further define this area, we used computer-aided design software to measure (1) the angle between the facial nerve and the chorda tympani nerve and (2) the distance between the takeoff point of the chorda tympani and the posteriormost prominent point of the short process of the incus in 30 cadaveric adult temporal bones. The mean angle was 23.58° (±6.84), and the mean distance was 7.78 mm (±2.68). Our most important finding was that there was a correlation between the two measurements in that the distance tended to be greater when the angle was less than the mean and vice versa. This trend approached but did not quite reach statistical significance (r = -0.248, p = 0.059).

Therapeutic approaches to complicated cholesteatoma of the external auditory canal: A case of associated facial paresis

July 31, 2010     Malek Belcadhi, MD, Houda Chahed, PhD, Radhouane Mani, MD, and Kamel Bouzouita, MD
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Abstract

Spontaneous cholesteatoma of the external auditory canal (EAC) is an uncommon condition that is difficult to diagnose. In a patient with such a possibility, serious clinical investigation along with radiologic and histologic exploration should be performed early on because a delay in treatment can lead to severe complications. Given the rarity of EAC cholesteatoma, no therapeutic consensus has emerged. The type of management depends on the extensiveness of invasion and bone erosion and the status of the neighboring structures. The primary therapeutic objectives are to eradicate the cholesteatoma and then to fill in the residual cavity, which in our opinion can be best accomplished with a muscle flap and EAC reconstruction. Postoperative follow-up should be carried out to look for infections, stenosis, and recurrence. We report a new case of spontaneous EAC cholesteatoma, and we review its diagnostic and therapeutic challenges.

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