Facial Nerve

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


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.

Delayed facial paresis following tympanomastoid surgery in a pediatric patient

July 31, 2010     Marc C. Thorne, MD, Brian P. Dunham, MD, and Lawrence W.C. Tom, MD


Despite the presence of normal facial nerve function in the immediate postoperative period, patients may develop facial nerve dysfunction anywhere from several hours to several days after otologic surgery. This delayed facial paresis, following a broad range of otologic surgeries, has been well described in adults but not in pediatric patients. Viral reactivation is increasingly implicated as the underlying etiology of delayed facial paresis. We present a case of delayed facial paresis in a pediatric patient with a clinical course consistent with viral reactivation.

Complete obstruction of the stapes footplate by a dehiscent facial nerve in stapedectomy

October 31, 2009     Vanessa S. Rothholtz, MD, MSc and Hamid R. Djalilian, MD

Intraparotid facial nerve schwannoma: Clinician beware

July 31, 2009     Neil Tanna, MD, MBA, Philip E. Zapanta, MD, Leela Lavasani, MD, and Nader Sadeghi, MD


Intraparotid facial nerve schwannomas are rare neoplasms that are challenging to diagnose and manage. Many patients present with a painless, palpable facial mass. The presence of facial paralysis is variable. Imaging studies and fine-needle aspiration cytology are not always helpful in preoperative diagnosis. With early diagnosis of facial nerve schwannoma, management of the patient can be planned and, ultimately, facial nerve function optimized. By reviewing the literature and 2 cases from a series of patients seen in our practice, we provide insight into the current diagnosis and treatment of a rare pathology.

Facial nerve hemangioma of the middle ear

March 1, 2009     Issam Saliba, MD and Jose N. Fayad, MD

From the Department of Otolaryngology-Head and Neck Surgery, Montreal University Hospital Center (Dr. Saliba), and the House Ear Clinic, Los Angeles (Dr. Fayad)

An alternative treatment for facial nerve tumors: Short-term results of radiotherapy

September 25, 2008     Todd A. Hillman, MD, Douglas A. Chen, MD, FACS, and Russell Fuhrer, MD


A review of medical records of patients undergoing radiotherapy for facial nerve tumors was undertaken to determine subsequent facial nerve results, hearing results, and tumor control. Two patients with facial nerve tumors received this treatment. Facial nerve function remains excellent in one patient and significantly improved in the other. Neither tumor demonstrated growth. Current philosophies of facial nerve schwannoma management attempt to balance tumor control with facial nerve function. Radiotherapy for these tumors appears to preserve short-term facial function and may be a viable alternative to surgical management.

A facial nerve schwannoma masquerading as a vestibular schwannoma

August 31, 2008     Amit Prasai, MRCS, Stephen E.M. Jones, FRCS (ORL-HNS), Justin Cross, MRCP, FRCR, and David A. Moffat, MA, FRCS


Schwannoma of the facial nerve is an extremely rare condition with an incidence far lower than that of vestibular schwannoma. We discuss the case of a woman who had been diagnosed as having vestibular schwannoma and referred to our hospital. Initially, we concurred with the diagnosis, but on reassessment of magnetic resonance imaging scans before surgery, we revised the diagnosis to facial nerve schwannoma. This allowed us to counsel the patient appropriately preoperatively regarding the expected outcome. We discuss the importance of this case and the lessons to be learned from it.

Hemifacial Spasm

June 30, 2008     Enrique Palacios, MD, FACR, Jack Breaux, MD, and Jorge E. Alvernia, MD

Long-term results of microvascular free-tissue transfer reanimation of the paralyzed face: Three cases

March 31, 2008     John P. Leonetti, MD, Chad A. Zender, MD, Daryl Vandevender, MD, and Sam J. Marzo, MD


We conducted a retrospective case review at our tertiary care academic medical center to assess the long-term results of microvascular free-tissue transfer to achieve facial reanimation in 3 patients. These patients had undergone wide-field parotidectomy with facial nerve resection. Upper facial reanimation was accomplished with a proximal facial nerve-sural nerve graft, and lower facial movement was achieved through proximal facial nerve-long thoracic (serratus muscle) nerve anastomosis. Outcomes were determined by grading postoperative facial nerve function according to the House-Brackmann system. All 3 patients were able to close their eyes independent of lower facial movement, and all 3 had achieved House-Brackmann grade III function. We conclude that reanimating the paralyzed face with microvascular free-tissue transfer provides anatomic coverage and mimetic function after wide-field parotidectomy. Synkinesis is reduced by separating upper- and lower-division reanimation.

CT appearance of incudomalleolar dislocation

February 1, 2007     Henriëtte E. Westerlaan, MD; Joost Gravendeel, MD

Invasive metastatic skin cancer in the background of chronic lymphocytic leukemia

February 1, 2007     Sofia Avitia, MD; Jason S. Hamilton, MD; Ryan F. Osborne, MD, FACS
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