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Journal articles on the topic 'Facial Nerve'
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Gaivoronsky, Alexey I., Bogdan V. Skaliitchouk, Vyacheslav V. Vinogradov, Dmitriy E. Alekseev, and Dmitriy V. Svistov. "Variants of facial nerve neurotization." Bulletin of the Russian Military Medical Academy 24, no. 1 (April 20, 2022): 155–64. http://dx.doi.org/10.17816/brmma90966.
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This study presents facial nerve neurotization, a common method of surgical treatment of facial muscle paralysis. In this surgical procedure, a trunk or some portions of individual fibers are sewn to an intact nerve-neurotizator to the injured facial nerve that can act as sublingual, masseteric, phrenic, accessory, glossopharyngeal nerves, as well as the descending branch of the sublingual nerve and anterior branches of the C2C3 cervical spinal nerves. Often, neurosurgeons combine various donor nerves and autotransplanting inserts for better results. The main stages of neurotization of the facial nerve includes isolation and transection of the facial nerve, isolation and transection of the trunk or separate fibers of the neurotizer, and nerve suturing in an end-to-end or end-to-side fashion. Facial cross-plasty, the most innovative method of facial nerve neurotization, should be carefully performed, during which an anastomosis is performed between the damaged and intact facial nerves using autotransplantation inserts from the calf nerve or from a free muscle graft, including a tender muscle and an anterior branch of the locking nerve. Recovery of facial nerve function and regression of characteristic symptoms takes time and specialized recovery treatment. Generally, among the lesions of the cranial nerves, injuries and diseases of the facial nerve rank first and are one of the most common pathologies of the peripheral nervous system. The clinical picture of facial nerve injuries in various origins is quite monotonous and manifested by persistent paralysis or paresis of the facial muscles. Various highly effective techniques are aimed at restoring the function of the facial nerve and facial muscles. Many conservative and operative methods of treating facial nerve neuropathy have been presented in the modern medical literature. However, all methods of facial nerve neurotization have several disadvantages, and the leading ones are the inability to achieve 100% efficiency and development of one degree or another neurological deficit.
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Tayebi Meybodi, Ali, Leandro Borba Moreira, Xiaochun Zhao, Evgenii Belykh, Michael T. Lawton, Jennifer M. Eschbacher, and Mark C. Preul. "Using the Post-Descendens Hypoglossal Nerve in Hypoglossal-Facial Anastomosis: An Anatomic and Histologic Feasibility Study." Operative Neurosurgery 19, no. 4 (January 15, 2020): 436–43. http://dx.doi.org/10.1093/ons/opz408.
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Abstract BACKGROUND Hypoglossal-facial anastomosis (HFA) is a popular facial reanimation technique. Mobilizing the intratemporal segment of the facial nerve and using the post-descendens hypoglossal nerve (ie, the segment distal to the take-off of descendens hypoglossi) have been proposed to improve results. However, no anatomic study has verified the feasibility of this technique. OBJECTIVE To assess the anatomic feasibility of HFA and the structural compatibility between the 2 nerves when the intratemporal facial and post-descendens hypoglossal nerves are used. METHODS The facial and hypoglossal nerves were exposed bilaterally in 10 sides of 5 cadaveric heads. The feasibility of a side-to-end (ie, partial end-to-end) HFA with partial sectioning of the post-descendens hypoglossal nerve and the mobilized intratemporal facial nerve was assessed. The axonal count and cross-sectional area of the facial and hypoglossal nerves at the point of anastomosis were assessed. RESULTS The HFA was feasible in all specimens with a mean (standard deviation) 9.3 (5.5) mm of extra length on the facial nerve. The axonal counts and cross-sectional areas of the hypoglossal and facial nerves matched well. Considering the reduction in the facial nerve cross-sectional area after paralysis, the post-descendens hypoglossal nerve can provide adequate axonal count and area to accommodate the facial nerve stump. CONCLUSION Using the post-descendens hypoglossal nerve for side-to-end anastomosis with the mobilized intratemporal facial nerve is anatomically feasible and provides adequate axonal count for facial reanimation. When compared with use of the pre-descendens hypoglossal nerve, this technique preserves C1 fibers and has a potential to reduce glottic complications.
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Schwartz, Ilsa, David V. Martini, Gady Har-El, Joseph McPhee, and Frank E. Lucente. "Rapid Intraoperative Facial Nerve Expansion." Otolaryngology–Head and Neck Surgery 114, no. 4 (April 1996): 605–12. http://dx.doi.org/10.1016/s0194-59989670254-1.
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The repair of nerve length defect presents a reconstructive challenge after trauma and oncologic resection. This study examined rapid intraoperative nerve expansion as a method of repairing nerve length defects with the cat facial nerve model. We compared expanded nerves with grafted nerves and intact nerves 1 year after repair using the criteria of gross function (symmetry and blink reflex according to a modified House scale), electromyography thresholds, nerve-conduction velocity, morphology, and axon count. Three of the five expanded nerves regenerated, and all of the grafted nerves regenerated. Functional results were similar for the regenerated expanded and the grafted facial nerves, and both methods achieved an equivalent level of function. The facial nerves of the regenerated expanded group, grafted group, and intact group had mean electromyography thresholds of 132 mV, 98 mV, and 134 mV, respectively, and mean conduction velocities of 48.3 mg/second, 47.9 m/second, and 44.7 m/second, respectively. Morphologic examination of all five expanded nerves immediately after the expansion process revealed an intact fascicular structure. However, 1 year after excision of the expanded segment and repair, only three of the five nerves regenerated. Axon count at 1 year was as follows: 404 for the regenerated expanded nerves, 449 for the grafted nerves, and 403 for the intact nerves. The potential advantages of rapid intraoperative nerve expansion over nerve grafting for the repair of nerve gap defects include a single suture line and absence of donor site morbidity. This pilot study demonstrates that rapid intraoperative nerve expansion and regeneration is possible and can be used to repair a nerve length deficit. The development of a rapid and reliable method of intraoperative nerve expansion deserves further study.
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Grabb, Paul A., A. Leland Albright, Robert J. Sclabassi, and Ian F. Pollack. "Continuous intraoperative electromyographic monitoring of cranial nerves during resection of fourth ventricular tumors in children." Neurosurgical Focus 1, no. 2 (August 1996): E3. http://dx.doi.org/10.3171/foc.1996.1.2.4.
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The authors reviewed the results of continuous intraoperative electromyographic (EMG) monitoring of muscles innervated by cranial nerves in 17 children whose preoperative imaging studies showed compression or infiltration of the fourth ventricular floor by tumor to determine how intraoperative EMG activity correlated with postoperative cranial nerve morbidity. Bilateral lateral rectus (sixth) and facial (seventh) nerve musculature were monitored in all children. Cranial nerve function was documented immediately postoperatively and at 1 year. Of the 68 nerves monitored, nine new neuropathies occurred in six children (sixth nerve in four children and seventh nerve in five). In five new neuropathies, intraoperative EMG activity could be correlated in one of four sixth nerve injuries and four of five seventh nerve injuries. Electromyographic activity could not be correlated in four children with new neuropathies. Of 59 cranial nerves monitored that remained unchanged, 47 had no EMG activity. Twelve cranial nerves (three sixth nerves and nine seventh nerves) had EMG activity but no deficit. Of four children with lateral rectus EMG activity, three had new seventh nerve injuries. Lateral rectus EMG activity did not predict postoperative abducens injury. The absence of lateral rectus EMG activity did not assure preserved abducens function postoperatively. Likely because of the close apposition of the intrapontine facial nerve to the abducens nucleus, lateral rectus EMG activity was highly predictive of seventh nerve injury. Although facial muscle EMG activity was not an absolute predictor of postoperative facial nerve dysfunction, the presence of facial muscle EMG activity was associated statistically with postoperative facial paresis. The absence of facial muscle EMG activity was rarely associated with facial nerve injury. The authors speculate that EMG activity in the facial muscles may have provided important intraoperative information to the surgeon so as to avoid facial nerve injury.
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Grabb, Paul A., A. Leland Albright, Robert J. Sclabassi, and Ian F. Pollack. "Continuous intraoperative electromyographic monitoring of cranial nerves during resection of fourth ventricular tumors in children." Journal of Neurosurgery 86, no. 1 (January 1997): 1–4. http://dx.doi.org/10.3171/jns.1997.86.1.0001.
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✓ The authors reviewed the results of continuous intraoperative electromyographic (EMG) monitoring of muscles innervated by cranial nerves in 17 children whose preoperative imaging studies showed compression or infiltration of the fourth ventricular floor by tumor to determine how intraoperative EMG activity correlated with postoperative cranial nerve morbidity. Bilateral lateral rectus (sixth) and facial (seventh) nerve musculatures were monitored in all children. Cranial nerve function was documented immediately postoperatively and at 1 year. Of the 68 nerves monitored, nine new neuropathies occurred in six children (sixth nerve in four children and seventh nerve in five). In five new neuropathies, intraoperative EMG activity could be correlated in one of four sixth nerve injuries and four of five seventh nerve injuries. Electromyographic activity could not be correlated in four children with new neuropathies. Of 59 cranial nerves monitored that remained unchanged, 47 had no EMG activity. Twelve cranial nerves (three sixth nerves and nine seventh nerves) had EMG activity but no deficit. Of four children with lateral rectus EMG activity, three had new seventh nerve injuries. Lateral rectus EMG activity did not predict postoperative abducens injury. The absence of lateral rectus EMG activity did not assure preserved abducens function postoperatively. Likely because of the close apposition of the intrapontine facial nerve to the abducens nucleus, lateral rectus EMG activity was highly predictive of seventh nerve injury. Although facial muscle EMG activity was not an absolute predictor of postoperative facial nerve dysfunction, the presence of facial muscle EMG activity was associated statistically with postoperative facial paresis. The absence of facial muscle EMG activity was rarely associated with facial nerve injury. The authors speculate that EMG activity in the facial muscles may have provided important intraoperative information to the surgeon so as to avoid facial nerve injury.
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Hirouchi, Hidetomo, Ryu Suzuki, Ichiro Morimoto, Teruaki Oyanagi, Hsiu-Kuo Chen, Akihiro Takahashi, Masahito Yamamoto, and Shinichi Abe. "Communicating Branch of the Mental Nerve and Facial Nerve." International Journal of Human Anatomy 2, no. 3 (March 20, 2021): 35–43. http://dx.doi.org/10.14302/issn.2577-2279.ijha-21-3769.
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As peripheral branches of the mandibular nerve, the mental nerve and facial nerve communicate with each other. However, investigations have not always been described in the classic anatomical texts. It remains unknown how nerve fibers of this communicating branch converge at the micro level. Thus, the objective of the present study was to observe in detail the macro and micro levels of the communicating branch of mental and facial nerves. We used five cadavers (10 samples) to conduct experiments in anatomical practice at Tokyo Dental College. A macroscopic observation was made, and the communicating branch of the mental and facial nerves was removed as a single mass. We created serial sections of this branch using the standard method and observed communicating branches of these two nerves under microscopy. As a result, the communicating branch of the mental and facial nerves was completely fused at the perineurium level. It has been reported that the mental nerve includes a small amount of autonomic nerve fiber. As for these findings, similar findings were observed for all 5 bodies and 10 sides. Thus, we believe that autonomic nerve fibers derived from the facial nerve converge with the mental nerve via this communicating branch.
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Vandewalle, Giovani, Jean-Marie Brucher, and Alex Michotte. "Intracranial facial nerve rhabdomyoma." Journal of Neurosurgery 83, no. 5 (November 1995): 919–22. http://dx.doi.org/10.3171/jns.1995.83.5.0919.
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✓ Nerve rhabdomyomas are exceedingly rare benign tumors of the peripheral nerves consisting of well-differentiated striated muscle fibers admixed with parental nerve fibers. Only one case of intracranial nerve rhabdomyoma has been described, which affected the trigeminal nerve. This report presents the detailed neuropathological description of a nerve rhabdomyoma arising in the schwannian portion of the facial nerve root in a 41-year-old Caucasian man. The nerve fibers were arranged chaotically as in a traumatic neuroma. Because of the intimate intermingling of this slowg-rowing tumor with the parental nerve fibers, complete excision should be avoided.
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Sarafoleanu, Dorin, and Andreea Bejenariu. "Facial nerve paralysis." Romanian Journal of Rhinology 10, no. 39 (September 1, 2020): 68–77. http://dx.doi.org/10.2478/rjr-2020-0016.
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AbstractThe facial nerve, the seventh pair of cranial nerves, has an essential role in non-verbal communication through facial expression. Besides innervating the muscles involved in facial expression, the complex structure of the facial nerve contains sensory fibres involved in the perception of taste and parasympathetic fibres involved in the salivation and tearing processes. Damage to the facial nerve manifested by facial paralysis translates into a decrease or disappearance of mobility of normal facial expression.Facial nerve palsy is one of the common causes of presenting to the Emergency Room. Most facial paralysis are idiopathic, followed by traumatic, infectious, tumor causes. A special place is occupied by the child’s facial paralysis. Due to the multitude of factors that can determine or favour its appearance, it requires a multidisciplinary evaluation consisting of otorhinolaryngologist, neurologist, ophthalmologist, internist.Early presentation to the doctor, accurate determination of the cause, correctly performed topographic diagnosis is the key to proper treatment and complete functional recovery.
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Vasconcelos, Belmiro Cavalcanti do Egito, Cosme Gay Escoda, Ricardo José de Holanda Vasconcellos, and Riedel Frota Sá Nogueira Neves. "Conduction velocity of the rabbit facial nerve: a noninvasive functional evaluation." Pesquisa Odontológica Brasileira 17, no. 2 (June 2003): 126–31. http://dx.doi.org/10.1590/s1517-74912003000200005.
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The aim of this study was to evaluate standardized conduction velocity data for uninjured facial nerve and facial nerve repaired with autologous graft nerves and synthetic materials. An evaluation was made measuring the preoperative differences in the facial nerve conduction velocities on either side, and ascertaining the existence of a positive correlation between facial nerve conduction velocity and the number of axons regenerated postoperatively. In 17 rabbits, bilateral facial nerve motor action potentials were recorded pre- and postoperatively. The stimulation surface electrodes were placed on the auricular pavilion (facial nerve trunk) and the recording surface electrodes were placed on the quadratus labii inferior muscle. The facial nerves were isolated, transected and separated 10 mm apart. The gap between the two nerve ends was repaired with autologous nerve grafts and PTFE-e (polytetrafluoroethylene) or collagen tubes. The mean of maximal conduction velocity of the facial nerve was 41.10 m/s. After 15 days no nerve conduction was evoked in the evaluated group. For the period of 2 and 4 months the mean conduction velocity was approximately 50% of the normal value in the subgroups assessed. A significant correlation was observed between the conduction velocity and the number of regenerated axons. Noninvasive functional evaluation with surface electrodes can be useful for stimulating and recording muscle action potentials and for assessing the functional state of the facial nerve.
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Asaoka, Katsuyuki, Yutaka Sawamura, Masabumi Nagashima, and Takanori Fukushima. "Surgical anatomy for direct hypoglossal—facial nerve side-to-end “anastomosis”." Journal of Neurosurgery 91, no. 2 (August 1999): 268–75. http://dx.doi.org/10.3171/jns.1999.91.2.0268.
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Object. In this study the authors investigated the histomorphometric background and microsurgical anatomy associated with surgically created direct hypoglossal—facial nerve side-to-end communication or nerve “anastomosis.”Methods. Histomorphometric analyses of the facial and hypoglossal nerves were performed using 24 cadaveric specimens and three surgically obtained specimens of severed facial nerve. Both the hypoglossal nerve at the level of the atlas and the facial nerve just distal to the external genu were monofascicular. The number of myelinated axons in the facial nerve (7228 ± 950) was 73.2% of those in the normal hypoglossal nerve (9778 ± 1516). Myelinated fibers in injured facial nerves were remarkably decreased in number. The cross-sectioned area of the normal facial nerve (0.948 mm2) accounted for 61.5% of the area of the hypoglossal nerve (1.541 mm2), whereas that of the injured facial nerve (0.66 mm2) was less than 50% of the area of the hypoglossal nerve. Surgical dissection and morphometric measurements were performed using 18 sides of 11 adult cadaver heads. The length of the facial nerve from the pes anserinus to the external genu ranged from 22 to 42 mm (mean 30.5 ± 4.4 mm). The distance from the pes anserinus to the nearest point on the hypoglossal nerve ranged from 14 to 22 mm (mean 17.3 ± 2.5 mm). The former was always longer than the latter; the excess ranged from 6 to 20 mm (mean 13.1 ± 3.4 mm). Surgical anatomy and procedures used to accomplish the nerve connection are described.Conclusions. The size of a half-cut end of the hypoglossal nerve matches a cut end of the injured facial nerve very well. By using the technique described, a length of facial nerve sufficient to achieve a tensionless communication can consistently be obtained.
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McRackan, Theodore R., Alejandro Rivas, George B. Wanna, Mi Jin Yoo, Marc L. Bennett, Mary S. Deitrich, Michael E. Glasscock, and David S. Haynes. "Facial Nerve Outcomes in Facial Nerve Schwannomas." Otology & Neurotology 33, no. 1 (January 2012): 78–82. http://dx.doi.org/10.1097/mao.0b013e31823c8ef1.
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&NA;. "Facial Nerve Outcomes in Facial Nerve Schwannomas." Otology & Neurotology 33, no. 3 (April 2012): 472. http://dx.doi.org/10.1097/mao.0b013e31824ac02a.
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Kew, T. Y., and A. Abdullah. "Duplicate internal auditory canals with facial and vestibulocochlear nerve dysfunction." Journal of Laryngology & Otology 126, no. 1 (August 26, 2011): 66–71. http://dx.doi.org/10.1017/s0022215111002258.
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AbstractObjective:We report an extremely rare case of duplication of the internal auditory canal associated with dysfunction of both the facial and vestibulocochlear nerves. We also review the literature regarding the integrity of the facial and vestibulocochlear nerves in such cases.Case report:A 34-year-old man presented with unilateral, right-sided, sensorineural hearing loss and facial nerve palsy since childhood. Facial nerve function was observed to be House–Brackmann grade III. Computed tomography and magnetic resonance imaging demonstrated ipsilateral duplicate, vacant internal auditory canals. Based on the clinical presentation, we interpreted these radiological findings as aplasia of the vestibulocochlear nerve and severe hypoplasia of the facial nerve.Conclusion:To our best knowledge, this is the first report of vestibulocochlear nerve aplasia and severe facial nerve hypoplasia in a case of ipsilateral duplication of the internal auditory canal. High resolution gradient echo magnetic resonance imaging sequences are advocated for assessment of neural integrity in patients with an abnormal internal auditory canal and facial and/or vestibulocochlear nerve dysfunction.
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Henares, A., M. Vicente-Ruiz, and B. Hontanilla. "Masseteric nerve vs. hypoglossal nerve: choice of donor nerve in the reanimation of short-term facial palsy." ANALES RANM 140, no. 140(03) (2023): 298–304. http://dx.doi.org/10.32440/ar.2023.140.03.rev07.
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A number of techniques have been developed to repair the aesthetic and functional defects in patients affected by facial paralysis. The choice of technique in the dynamic rehabilitation of the smile is influenced by factors such as the patient’s age, facial phenotype, time of evolution or the surgeon’s preferences, among others. When a nerve transfer or the neurotization of a muscle transplant are performed, the dilemma arises of selecting the ideal donor nerve. The hypoglossal and masseteric nerves are usually used for this type of procedure. Although the hypoglossal nerve can achieve effective facial movements, mass facial movements and synkinesis have also been described. Depending on the level of nerve coaptation, these side effects could be avoided to some extent. Moreover, the recovery of spontaneous facial smiling using the hypoglossal nerve is almost anecdotal. On the other hand, the masseteric nerve allows neurotization of the facial nerve without the use of nerve grafting, provides a high axonal load, faster recovery and, above all, a higher percentage of spontaneous smile, especially in women. Therefore, the masseteric nerve would be the donor nerve of choice in the rehabilitation of short-term facial paralysis.
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Tubbs, R. Shane, Marios Loukas, Mohammadali M. Shoja, Leslie Acakpo-Satchivi, John C. Wellons, Jeffrey P. Blount, and W. Jerry Oakes. "The nerve to the mylohyoid as a donor for facial nerve reanimation procedures: a cadaveric feasibility study." Journal of Neurosurgery 106, no. 4 (April 2007): 677–79. http://dx.doi.org/10.3171/jns.2007.106.4.677.
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Object Facial nerve injury with resultant facial muscle paralysis is disfiguring and disabling. Reanimation of the facial nerve has been performed using different regional nerves. The nerve to the mylohyoid has not been previously explored as a donor nerve for facial nerve reanimation procedures. Methods Five fresh adult human cadavers (10 sides) were dissected to identify an additional nerve donor candidate for facial nerve neurotization. Using a curvilinear cervicofacial skin incision, the nerve to the mylohyoid and facial nerve were identified. The nerve to the mylohyoid was transected at its point of entrance into the anterior belly of the digastric muscle. Measurements were made of the length and diameter of the nerve to the mylohyoid, and this nerve was repositioned superiorly to the various temporofacial and cervicofacial parts of the extracranial branches of the facial nerve. All specimens had a nerve to the mylohyoid. The mean length of this nerve available inferior to the mandible was 5.5 cm and the mean diameter was 1 mm. In all specimens, the nerve to the mylohyoid reached the facial nerve stem and the temporofacial and cervicofacial trunks without tension. No gross evidence of injury to surrounding neurovascular structures was identified. Conclusions To the authors' knowledge, the use of the nerve to the mylohyoid for facial nerve reanimation has not been explored previously. Based on the results of this cadaveric study, the use of the nerve to the mylohyoid may be considered for facial nerve reanimation procedures.
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Kumar Nirala, Santosh, Bodh Bikram Karki, Lei Yuan, Rishikesh Pratap Sah, and Syed Mushraf. "Variations in the Branching Pattern of Facial Nerve." Nepal Medical Journal 6, no. 2 (December 31, 2023): 30–33. http://dx.doi.org/10.37080/nmj.173.
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The seventh cranial nerve, known as the facial nerve, is situated in the head and neck region and governs the mimic muscles responsible for facial expressions. The anatomy of the facial nerve exhibits variations, a matter of particular interest for surgeons operating in the head and neck areas. Incidents of facial nerve injury during such surgeries are frequent and can significantly impact the patient’s quality of life, potentially leading to facial nerve paralysis. The facial nerve’s main trunk emerges from the stylomastoid foramen which passes through the parotid gland, and divides into upper (temporofacial) and lower (cervicofacial) divisions which further gives rise to five terminal branches: temporal, zygomatic, buccal, marginal mandibular, and cervical. A comprehensive understanding of the branching and anastomosis patterns of the facial nerve is of significant importance for the surgeons to avoid inadvertent injury to the facia nerve which has devastating effects.
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Seckel, Brooke R. "Facial Danger Zones: Avoiding Nerve Injury in Facial Plastic Surgery." Canadian Journal of Plastic Surgery 2, no. 2 (June 1994): 59–66. http://dx.doi.org/10.1177/229255039400200207.
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BR Seckel. Facial danger zones: Avoiding nerve injury in facial plastic surgery. Can J Plast Surg 1994;2(2):59-66. with today's new emphasis on more aggressive and deeper facial dissection during rhytidectomy, the peripheral nerve branches of cranial nerves V and VII in the face are more often exposed closer to the plane of dissection and more likely to be injured in the course of composite, extended sub-submuscular aponeurotic system (sub-SMAS), and subperiosteal rhytidectomy. It is important to have a keen and thorough understanding of the location of these nerves to avoid injury. I divide the face into seven facial danger zones based on known anatomic locations of the branches of the peripheral nerves of the face and the location in which they are most easily injured in the course of facial dissection. A description of the nerve and consequence of injury, the anatomic location of the zone, and the technique for safe surgical dissection for each facial danger zone is presented.
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Yoshino, Masanori, Taichi Kin, Akihiro Ito, Toki Saito, Daichi Nakagawa, Kenji Ino, Kyousuke Kamada, et al. "Combined use of diffusion tensor tractography and multifused contrast-enhanced FIESTA for predicting facial and cochlear nerve positions in relation to vestibular schwannoma." Journal of Neurosurgery 123, no. 6 (December 2015): 1480–88. http://dx.doi.org/10.3171/2014.11.jns14988.
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OBJECT The authors assessed whether the combined use of diffusion tensor tractography (DTT) and contrast-enhanced (CE) fast imaging employing steady-state acquisition (FIESTA) could improve the accuracy of predicting the courses of the facial and cochlear nerves before surgery. METHODS The population was composed of 22 patients with vestibular schwannoma in whom both the facial and cochlear nerves could be identified during surgery. According to DTT, depicted fibers running from the internal auditory canal to the brainstem were judged to represent the facial or vestibulocochlear nerve. With regard to imaging, the authors investigated multifused CE-FIESTA scans, in which all 3D vessel models were shown simultaneously, from various angles. The low-intensity areas running along the tumor from brainstem to the internal auditory canal were judged to represent the facial or vestibulocochlear nerve. RESULTS For all 22 patients, the rate of fibers depicted by DTT coinciding with the facial nerve was 13.6% (3/22), and that of fibers depicted by DTT coinciding with the cochlear nerve was 63.6% (14/22). The rate of candidates for nerves predicted by multifused CE-FIESTA coinciding with the facial nerve was 59.1% (13/22), and that of candidates for nerves predicted by multifused CE-FIESTA coinciding with the cochlear nerve was 4.5% (1/22). The rate of candidates for nerves predicted by combined DTT and multifused CE-FIESTA coinciding with the facial nerve was 63.6% (14/22), and that of candidates for nerves predicted by combined DTT and multifused CE-FIESTA coinciding with the cochlear nerve was 63.6% (14/22). The rate of candidates predicted by DTT coinciding with both facial and cochlear nerves was 0.0% (0/22), that of candidates predicted by multifused CE-FIESTA coinciding with both facial and cochlear nerves was 4.5% (1/22), and that of candidates predicted by combined DTT and multifused CE-FIESTA coinciding with both the facial and cochlear nerves was 45.5% (10/22). CONCLUSIONS By using a combination of DTT and multifused CE-FIESTA, the authors were able to increase the number of vestibular schwannoma patients for whom predicted results corresponded with the courses of both the facial and cochlear nerves, a result that has been considered difficult to achieve by use of a single modality only. Although the 3D image including these prediction results helped with comprehension of the 3D operative anatomy, the reliability of prediction remains to be established.
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Feroze, Rafey A., Michael M. McDowell, Jeffrey Balzer, Donald J. Crammond, Partha Thirumala, and Raymond F. Sekula. "Estimation of Intraoperative Stimulation Threshold of the Facial Nerve in Patients Undergoing Microvascular Decompression." Journal of Neurological Surgery Part B: Skull Base 80, no. 06 (January 29, 2019): 599–603. http://dx.doi.org/10.1055/s-0038-1677538.
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Introduction Facial weakness can result from surgical manipulation of the facial nerve. Intraoperative neuromonitoring reduces functional impairment but no clear guidelines exist regarding interpretation of intraoperative electrophysiological results. Most studies describe subjects with facial nerves encumbered by tumors or those with various grades of facial nerve weakness. We sought to obtain the neurophysiological parameters and stimulation threshold following intraoperative facial nerve triggered electromyography (t-EMG) stimulation during microvascular decompression for trigeminal neuralgia to characterize the response of normal facial nerves via t-EMG. Methods Facial nerve t-EMG stimulation was performed in seven patients undergoing microvascular decompression for trigeminal neuralgia. Using constant current stimulation, single stimulation pulses of 0.025 to 0.2 mA intensity were applied to the proximal facial nerve. Compound muscle action potentials, duration to onset, and termination of t-EMG responses were recorded for the orbicularis oculi and mentalis muscles. Patients were evaluated for facial weakness following the surgical procedure. Results Quantifiable t-EMG responses were generated in response to all tested stimulation currents of 0.025, 0.05, 0.1, and 0.2 mA in both muscles, indicating effective nerve conduction. No patients developed facial weakness postoperatively. Conclusions The presence of t-EMG amplitudes in response to 0.025 mA suggests that facial nerve conduction can take place at lower stimulation intensities than previously reported in patients with tumor burden. Proximal facial nerve stimulation that yields responses with thresholds less than 0.05 mA may be a preferred reference baseline for surgical procedures within the cerebellopontine angle to prevent iatrogenic injury.
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Dogru, Salim, Douglas Van Daele, and Marlan R. Hansen. "Retrograde Labeling of the Rat Facial Nerve with Carbocyanine Dyes to Enhance Intraoperative Identification." Annals of Otology, Rhinology & Laryngology 117, no. 10 (October 2008): 753–58. http://dx.doi.org/10.1177/000348940811701009.
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Objectives: Removal of head and neck neoplasms, especially those of the parotid gland and those of the internal auditory canal and cerebellopontine angle, often requires microdissection of the facial nerve. Displacement or splaying of the nerve can make it difficult to identify facial nerve fibers and/or distinguish them from surrounding tissues. Here we tested a method of labeling the facial nerve with fluorescent lipophilic dyes as a method of providing intraoperative visual confirmation of nerve fibers. Methods: The facial nerves of adult rats were retrogradely labeled with 1,1′-dioctadecyl-3,3,3′,3′-tetramethylindocarbocyanine perchlorate (DiI), 3,3′-dioctadecyloxacarbocyanine perchlorate (DiO), or 3,3′-dilinoleyloxacarbocyanine perchlorate (Fast DiO) either by direct application to the nerve sheath or by microinjection into the facial muscles. The nerves were examined 30 days after dye application by means of a dissecting stereomicroscope equipped with epifluorescence filters. Results: Of the dyes tested, Fast DiO proved to be the most effective, providing labeling of the nerve sufficient to be seen with combined fluorescent and bright field stereomicroscopy. Nerve conduction studies indicated that fluorescent labeling did not adversely affect nerve function. Conclusions: These results raise the possibility of using fluorescent lipophilic dyes to label nerves as a method of enhancing identification and distinguishing nerve fibers during surgery.
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Radhakrishnan, Rupa, Shamima Ahmed, Joshua Cole Tilden, and Humberto Morales. "Comparison of normal facial nerve enhancement at 3T MRI using gadobutrol and gadopentetate dimeglumine." Neuroradiology Journal 30, no. 6 (July 11, 2017): 554–60. http://dx.doi.org/10.1177/1971400917719714.
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Background and purpose The facial nerve is unique among cranial nerves in demonstrating normal enhancement of particular segments. The effect of varying T1 relaxivities of gadolinium-based contrast agents on facial nerve enhancement is unclear. In this study, we assess differences in normal facial nerve enhancement with two different gadolinium-based contrast agents, gadobutrol and gadopentetate dimeglumine. In addition, we evaluate differences in facial nerve enhancement with spin-echo (SE) T1 versus 3D inversion recovery prepared fast spoiled gradient-echo (FSPGR) post-contrast sequences. Methods A total of 140 facial nerves in 70 individuals were evaluated (70 with gadobutrol and 70 with gadopentetate dimeglumine) by two blinded reviewers. Differences in enhancement of facial nerve segments between the two agents were analyzed. Differences in enhancement between SE T1 and FSPGR imaging were also evaluated. Results There was no significant difference in facial nerve enhancement between gadobutrol and gadopentetate dimeglumine. Enhancement was commonly observed in the geniculate, tympanic and mastoid segments (98%–100%) with either contrast agent; enhancement was less common in the labyrinthine segments (9%–14%) and lateral canalicular segment (2%–5%). There was a smaller enhancing proportion of labyrinthine and tympanic segments with FSPGR as compared to SE T1 images with gadobutrol. Conclusion There is no significant difference in overall enhancement of the facial nerve between gadobutrol and gadopentetate dimeglumine. Mild enhancement of the lateral canalicular portion of the facial nerve may be a normal finding. With FSPGR sequence, there is lesser perceived enhancement of the labyrinthine and tympanic segments of the facial nerve with gadobutrol.
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Wan, Hong, Liwei Zhang, Dezhi Li, Shuyu Hao, Jie Feng, Jean Paul Oudinet, Michael Schumacher, and Song Liu. "Hypoglossal-facial nerve “side”-to-side neurorrhaphy for persistent incomplete facial palsy." Journal of Neurosurgery 120, no. 1 (January 2014): 263–72. http://dx.doi.org/10.3171/2013.9.jns13664.
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Object Hypoglossal-facial nerve neurorrhaphy is a widely used method for treating complete facial palsy. However, the classic surgical procedure using a “side”-to-end neurorrhaphy is not suitable for incomplete facial palsy (IFP), because sectioning of the facial nerve for neurorrhaphy compromises remnant axons and potential spontaneous reinnervation. For the treatment of persistent IFP, the authors investigated in rats a modified method using hypoglossal-facial nerve “side”-to-side neurorrhaphy. Methods An IFP model was created by crushing the facial nerve and then ligating the injury site to limit axonal regeneration. After 9 weeks, rats with IFP were submitted to hypoglossal-facial nerve “side”-to-side neurorrhaphy: The gap between the 2 nerves was bridged with a predegenerated peroneal nerve graft, which was sutured to only one-half of the hypoglossal nerve and to the remnant facial nerve through a small window created by removing the epineurium, thus preserving regenerating facial axons. Results Four months after repair surgery, double innervation of the target whisker pad by hypoglossal and facial motor neurons was supported by the recording of muscle action potentials and their retrograde labeling. Regenerated hypoglossal and facial motor neurons effectively participated in the reinnervation of the whisker pad, significantly improving facial symmetry without evident synkinesis, compared with rats that underwent IFP without hypoglossal-facial nerve neurorrhaphy. Conclusions This study demonstrates that hypoglossal-facial nerve “side”-to-side neurorrhaphy with a predegenerated nerve graft can lead to rapid functional benefits for persistent IFP without compromising the remnants of facial axons, thus providing a proof-of-feasibility for further studies in humans.
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Yon, Dong Keon, Yong Jun Kim, Dong Choon Park, Su Young Jung, Sung Soo Kim, Joon Hyung Yeo, Jeongmin Lee, Jae Min Lee, and Seung Geun Yeo. "Induction of Autophagy and Its Role in Peripheral Nerve Regeneration after Peripheral Nerve Injury." International Journal of Molecular Sciences 24, no. 22 (November 11, 2023): 16219. http://dx.doi.org/10.3390/ijms242216219.
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No matter what treatment is used after nerve transection, a complete cure is impossible, so basic and clinical research is underway to find a cure. As part of this research, autophagy is being investigated for its role in nerve regeneration. Here, we review the existing literature regarding the involvement and significance of autophagy in peripheral nerve injury and regeneration. A comprehensive literature review was conducted to assess the induction and role of autophagy in peripheral nerve injury and subsequent regeneration. Studies were included if they were prospective or retrospective investigations of autophagy and facial or peripheral nerves. Articles not mentioning autophagy or the facial or peripheral nerves, review articles, off-topic articles, and those not written in English were excluded. A total of 14 peripheral nerve studies that met these criteria, including 11 involving sciatic nerves, 2 involving facial nerves, and 1 involving the inferior alveolar nerve, were included in this review. Studies conducted on rats and mice have demonstrated activation of autophagy and expression of related factors in peripheral nerves with or without stimulation of autophagy-inducing factors such as rapamycin, curcumin, three-dimensional melatonin nerve scaffolds, CXCL12, resveratrol, nerve growth factor, lentinan, adipose-derived stem cells and melatonin, basic fibroblast growth factor, and epothilone B. Among the most studied of these factors in relation to degeneration and regeneration of facial and sciatic nerves are LC3II/I, PI3K, mTOR, Beclin-1, ATG3, ATG5, ATG7, ATG9, and ATG12. This analysis indicates that autophagy is involved in the process of nerve regeneration following facial and sciatic nerve damage. Inadequate autophagy induction or failure of autophagy responses can result in regeneration issues after peripheral nerve damage. Animal studies suggest that autophagy plays an important role in peripheral nerve degeneration and regeneration.
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Ibn Essayed, Walid, Emad Aboud, and Ossama Al-Mefty. "Interposition Grafting of the Facial Nerve After Resection of a Large Facial Nerve Schwannoma: 2-Dimensional Operative Video." Operative Neurosurgery 21, no. 4 (July 7, 2021): E340—E341. http://dx.doi.org/10.1093/ons/opab240.
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Abstract Facial nerve schwannomas can develop at any portion of the facial nerve.1 When arising from the mastoid portion of the facial nerve, the tumor will progressively erode the mastoid, giving the schwannoma an aggressive radiological appearance.1,2 The facial nerve is frequently already paralyzed, or no fascicles can be saved during resection. In these cases, end-to-end interposition grafting is the best option for facial reanimation.1,3-5 The healthy proximal and distal facial nerves are prepared prior to grafting. The great auricular nerve is readily available near the surgical site and represents an excellent graft donor with minimal associated morbidity.4,6 We demonstrate this technique through a case of a 48-yr-old male who presented with a complete right-sided facial nerve palsy due to a large facial schwannoma that invaded the mastoid and extended to the hypoglossal canal, causing hypoglossal nerve paralysis, and petrous carotid canal. His 4-yr follow-up showed no recurrent tumor with restored facial nerve function palsy to a House-Brackman grade III, and full recovery of his hypoglossal nerve function. The patient consented to the surgery and the publication of his image.
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Madhavan, Ajay A., David R. DeLone, and Jared T. Verdoorn. "Bilateral facial nerve involvement in a patient with Tolosa–Hunt syndrome." Neuroradiology Journal 33, no. 5 (July 10, 2020): 424–27. http://dx.doi.org/10.1177/1971400920939293.
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Tolosa–Hunt syndrome is characterized by unilateral retro-orbital headaches and cranial nerve palsies, usually involving cranial nerves III–VI. It is rare for other cranial nerves to be involved, although this has previously been reported. We report a 19-year-old woman presenting with typical features of Tolosa–Hunt syndrome but ultimately developing bilateral facial nerve palsies and enhancement of both facial nerves on magnetic resonance imaging. The patient presented with unilateral retro-orbital headaches and palsies of cranial nerves III–VI. She was diagnosed with Tolosa–Hunt syndrome but was non-compliant with her corticosteroid treatment due to side effects. She returned with progressive left followed by right facial nerve palsy. Her corresponding follow-up magnetic resonance imaging scans showed sequential enhancement of the left and right facial nerves. She ultimately had clinical improvement with IV methylprednisolone. To our knowledge, Tolosa–Hunt syndrome associated with bilateral facial nerve palsy and corroborative facial nerve enhancement on magnetic resonance imaging has not previously been described. Moreover, our patient’s clinical course is instructive, as it demonstrates that this atypical presentation of Tolosa–Hunt syndrome can indeed respond to corticosteroid treatment and should not be mistaken for other entities such as Bell’s palsy.
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Nakao, Yoshiaki, Noriyuki Sakihama, Tomizo Tabuchi, and Shigeto Nakajima. "Extracellular Fluid Pathway inside the Facial Nerve Fascicles." Annals of Otology, Rhinology & Laryngology 106, no. 6 (June 1997): 503–5. http://dx.doi.org/10.1177/000348949710600611.
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The extracellular fluid pathway in the facial nerve and the diffusion of a tracer from the facial nerve to other cranial nerves was examined in the rabbit. Sodium fluorescein solution was injected into either the facial nerve fascicles or the epineurial connective tissue as a tracer at the stylomastoid foramen and then localized by fluorescence microscopy. In the facial nerve, fluorescence was observed in the endoneurium and external nerve sheath (epineurium and perineurium) through the geniculate ganglion following injection into the nerve fascicles. The vestibular, trigeminal, and glossopharyngeal ganglia also showed fluorescence on the injection side in ganglion cells and intercellular connective tissues. The results suggested that the endoneurial connective tissue constitutes a diffusion pathway inside the facial nerve fascicles and that the extracellular fluid pathway from the facial nerve to these cranial ganglia may be related to the neural spread of inflammation or neoplastic metastasis.
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Scaramella, L. F. "Cross-Face Facial Nerve Anastomosis: Historical Notes." Ear, Nose & Throat Journal 75, no. 6 (June 1996): 343–54. http://dx.doi.org/10.1177/014556139607500607.
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The anastomosis between the two facial nerves for the treatment of facial paralysis, in which the proximal stump of the severed facial nerve is not accessible, was utilized in eleven patients. The palsy was secondary to resection of an acoustic tumor in nine patients, sarcoma of the petrous bone was the cause in one and an automobile accident in the other. The original concept of anastomosing a branch of the normal pes anserinus to the trunk of the paralyzed facial nerve, as first presented by the author at the Second International Symposium on Facial Nerve Surgery held in Japan in September, 1970, has been modified. The technique of anastomosing the cervicofacial division of the normal facial nerve, and directing it to the temporo-facial division of the paralyzed facial nerve via a sural autograft 20–22 cm long, was combined with the utilization of the ipsilateral descendens cervicalis (hypoglossi).17 This nerve was anastomosed to the cervicofacial division of the paralyzed facial nerve and utilized in four patients. The technique is illustrated in detail.
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Roche, Pierre-Hugues, Nicolas Lari, Jean-Marc Thomassin, and Jean Régis. "Facial Nerve." Journal of Neurosurgery 104, no. 1 (January 2006): 175–76. http://dx.doi.org/10.3171/jns.2006.104.1.175.
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Lesse, Stanley. "Facial Nerve." American Journal of Psychotherapy 41, no. 2 (April 1987): 318. http://dx.doi.org/10.1176/appi.psychotherapy.1987.41.2.318.
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Rochmah, Yayun Siti. "OSTEOMYELITIS KRONIS MANDIBULA PASCA EKSTRAKSI GIGI DISERTAI BELL’S PALSY." ODONTO : Dental Journal 6 (July 11, 2019): 52. http://dx.doi.org/10.30659/odj.6.0.52-55.
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Background: Chronic osteomyelitis mandibula is one of the complications from dental extraction. Inadequate wound handling can have an impact on the spread of infection in the surrounding tissue like nerve which results in facial nerve paralysis. The purpose is to present a rare case that facilitative nerve paralysis as a result of the spread of osteomyelitis infectionCase Management: A 69 years old woman with chief complains numbness onher lips accompanied by pus out beside the lower teeth. No sistemic disease. Panoramic radiograph showed abnormal bone-like sequester. Extraoral examination appeared the bluish color on the right cheek and there was right facial muscle paralysis. Debridement, sequesterectomy by general anesthesia and medication using ceftriaxone intravenous, ketorolac injection, multivitamin, and corticosteroid, physiotherapy for facial nerve paralyze, also.Discussion: Pathogenesis mandibular osteomyelitis involves contiguous spreadfrom an odontogenic focus infection. The bacteria produce an exotoxin, which, while unable to cross the blood-brain barrier, can have deleterious effects on thePeripheral Nerve System (Fasialis Nerve) in up to 75% of cases, with the severity of presentation correlating with the severity of the infection.Conclusion: Chronic mandibular osteomyelitis can spread the infection to around another anatomy oral cavity like facials nerves.
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Beck, Douglas. "Facial Nerve Electrophysiology: Electroneurography and Facial Nerve Monitoring." Seminars in Hearing 14, no. 02 (May 1993): 123–32. http://dx.doi.org/10.1055/s-0028-1085109.
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Kunert, Przemysław, Anna Podgórska, Robert Bartoszewicz, and Andrzej Marchel. "Hemihypoglossal-facial nerve anastomosis for facial nerve palsy." Neurologia i Neurochirurgia Polska 45, no. 5 (2011): 452–60. http://dx.doi.org/10.1016/s0028-3843(14)60313-3.
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Murofushi, Toshihisa, David V. Pohl, and G. Michael Halmagyi. "Perineural Spread of Facial Squamous Cell Carcinoma to the Vestibulocochlear Nerve." Otolaryngology–Head and Neck Surgery 116, no. 3 (March 1997): 392–94. http://dx.doi.org/10.1016/s0194-59989770280-8.
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Perineural spread of facial squamous cell carcinoma (SCC) is a well-recognized cause of trigeminal and of facial nerve palsies. 1 Vestibulocochlear nerve involvement by perineural spread has not been convincingly demonstrated. Here we report a patient with perineural spread of facial SCC not only to the trigeminal and facial nerves but also to the ipsilateral vestibulocochlear nerve. The anatomic and pathophysiologic basis of this spread is discussed.
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Durie, Matthew, and Mark Faragher. "Bilateral facial nerve palsies due to leptomeningeal progression of lung adenocarcinoma and response to osimertinib." BMJ Case Reports 14, no. 5 (May 2021): e239958. http://dx.doi.org/10.1136/bcr-2020-239958.
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A 39-year-old female Chinese non-smoker was diagnosed with epidermal growth factor receptor mutation-positive lung adenocarcinoma with cerebral metastases and commenced erlotinib. After 5 weeks, she presented with a 3-day history of severe bilateral facial weakness (House-Brackmann grade V/VI) and hypogeusia consistent with bilateral facial nerve palsies. MRI demonstrated new, symmetrical contrast-enhancing foci at the expected location of the facial nerves, consistent with leptomeningeal progression. Erlotinib was ceased and osimertinib was commenced. Facial nerve motor and sensory function began to improve within 1 week and by 2 weeks had returned to near normal. Review at 2 and 6 months demonstrated normal facial nerve function and progressive resolution of the facial nerve lesions on MRI. While rare, leptomeningeal malignancy may present as simultaneous bilateral facial nerve palsies. Osimertinib has superior central nervous system penetration and in this case was associated with rapid and sustained clinical and radiographical resolution of the facial nerve lesions.
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Braund, Kyle G., Jagjivan R. Mehta, Karen A. Amling, and Maria Toivio-Kinnucan. "Morphologie and morphometric study of the facial nerve in clinically normal adult dogs." American Journal of Veterinary Research 52, no. 11 (November 1, 1991): 1879–82. http://dx.doi.org/10.2460/ajvr.1991.52.11.1879.
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SUMMARY A morphologic and morphometric study was carried out on the facial nerve: to determine normal histologic data in myelinated fibers of clinically normal young adult dogs; to establish reference values for mean fiber diameter, and to delineate the relative diameter frequency distribution curve. Few degenerative changes were observed in single teased-nerve fibers and semithin cross-sectional nerve preparations. Statistical difference was not observed between left and right facial nerves. The distribution of fiber diameters in the facial nerve was unimodal. Mean ( ± sd) fiber diameter of the facial nerve was 3.92 ± 1.18 μm. Approximately 89% of fibers in the facial nerve had diameter between 3 and 6 μm. Fiber diameter ranged from 2 to 12 μm; however, < 1% of fibers had diameter > 8 μm.
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Baek, Seol-Hee, Yoo Hwan Kim, Ye-Ji Kwon, Joo Hye Sung, Myeong Hun Son, Jung Hun Lee, and Byung-Jo Kim. "The Utility of Facial Nerve Ultrasonography in Bell’s Palsy." Otolaryngology–Head and Neck Surgery 162, no. 2 (December 24, 2019): 186–92. http://dx.doi.org/10.1177/0194599819896298.
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Objective This study aimed to investigate the utility of facial nerve ultrasonography in the functional and structural assessment of early-stage Bell’s palsy and the prognostic value of facial nerve ultrasonography in Bell’s palsy. Study Design Prospective longitudinal study. Setting Single center, a university-affiliated neurology clinic. Subjects and Methods Patients with unilateral Bell’s palsy who had visited our clinic within 3 days of symptom onset were enrolled in this study. Demographic information and House-Brackmann grade were collected. Electrophysiologic studies and facial nerve ultrasonography were then performed. The facial nerves on each side were scanned longitudinally with a 5- to 12-MHz probe. The diameter of the facial nerves with and without the sheath was measured at the proximal and distal portions. Follow-up examinations, including House-Brackmann grade analysis, electrophysiologic studies, and facial nerve ultrasonography, were performed after 2 months. Results Fifty-four patients with unilateral Bell’s palsy were enrolled, and 22 underwent the follow-up examinations. The diameters of the facial nerves were larger on the affected side than on the unaffected side at the proximal and distal portions ( P < .01). On the affected side, the enlarged facial nerve at the proximal portion had decreased in size after 2 months ( P < .05). The initial ultrasonography findings were positively correlated with the initial severity of Bell’s palsy, but they did not predict prognosis. Conclusion Ultrasonography could be a useful tool for evaluating the facial nerve in Bell’s palsy. Nevertheless, further studies are needed to demonstrate its prognostic value.
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Green, J. Douglas, Clough Shelton, and Derald E. Brackmann. "Surgical Management of Iatrogenic Facial Nerve Injuries." Otolaryngology–Head and Neck Surgery 111, no. 5 (November 1994): 606–10. http://dx.doi.org/10.1177/019459989411100511.
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Surgical management of an latrogenic facial nerve injury represents a significant challenge for the otologic surgeon. The decision to perform facial nerve grafting is a difficult one and is based on the extent of injury to the nerve. We conducted a review of 22 patients who had sustained latrogenic facial nerve injuries during otologic surgery that required surgical exploration. The facial nerve was transected more than half its diameter in 13 of the patients. All of these patients' nerves were repaired either with direct reanastomosis of the facial nerve or with a cable nerve graft. The transection was less than 50% in nine of the patients in the study group. Eight of these patients underwent only decompression of the facial nerve. No patient with a neural repair (direct anastomosis or cable graft) had better than a House grade III result. All of the patients undergoing direct anastomosis of the nerve obtained a House grade III result. The most common result in patients undergoing cable nerve grafting was a House grade IV. The only patients with normal or near-normal facial nerve function (House grade I or II) had only decompression of the facial nerve. Five of the eight patients undergoing decompression had results similar to those undergoing cable nerve grafts. We conclude that acceptable results can be obtained when the facial nerve is repaired by direct anastomosis or a cable nerve graft. These results are comparable with those of patients treated with decompression only. When in doubt as to the extent of injury, it is preferable to repair the facial nerve, because the extent of injury may be underestimated.
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King, T. T., O. C. Sparrow, J. M. Arias, and A. F. O'Connor. "Repair of facial nerve after removal of cerebellopontine angle tumors: a comparative study." Journal of Neurosurgery 78, no. 5 (May 1993): 720–25. http://dx.doi.org/10.3171/jns.1993.78.5.0720.
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✓ The results of repair of 18 facial nerves were examined by means of a modified House-Brackmann grading system. Six were repaired by end-to-end anastomosis and 12 by nerve graft. The reliability of the simplified House-Brackmann grading system was also assessed, using the kappa statistic to analyze the agreement between pairs of observers who examined the function of 40 nerves in 37 patients. Facial nerves studied had been either preserved, repaired or grafted, or divided and treated by faciohypoglossal nerve anastomosis. One nerve was not treated. The grading system proved to be somewhat unreliable, with complete agreement between observers in only 25% of cases. Facial nerve repair produced a fair return of function in just under two-thirds of the cases. The ability of an examiner ignorant of the patient's history to assess from the end result how the nerve had been managed was also estimated. Observers showed little ability to decide correctly on the previous treatment of the nerve when the patient showed moderate dysfunction postoperatively. The implications of these findings for grading systems and for management of the facial nerve in acoustic nerve tumor surgery are discussed.
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Watanabe, Shiho, Hiroko Ochiai, Hisashi Sakuma, Taisuke Mori, Masaki Yazawa, Aiko Oka, and Kazuo Kishi. "Muscle Fiber Composition Changes after Selective Nerve Innervation." International Journal of Molecular Sciences 23, no. 14 (July 16, 2022): 7856. http://dx.doi.org/10.3390/ijms23147856.
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Facial nerve paralysis interferes with mimetic muscle function. To reconstruct natural facial movement, free muscle flaps are transplanted as new muscles. However, it is difficult to maintain resting tonus. A dual innervation technique in which other nerves such as the hypoglossal nerve or contralateral facial nerve are added is often applied. Using 10-week-old rats (n = 10), the masseteric and hypoglossal nerves were cut, and the distal stump of the masseteric nerve and the proximal stump of the hypoglossal nerve were then sutured (suture group). In the other group, the masseteric nerve was cut and cauterized (cut group). Immunohistochemistry and microarray were performed on the extracted masseter muscle. The immunohistochemistry results suggested that the muscles in the suture group obtained oxidative characteristics. The microarray showed the genes involved in mitochondrial function, including Perm1. In summary, our data support the validity of the dualinnervation technique for facial paralysis treatment.
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Prasad, Sampath Chandra, Melissa Laus, Manjunath Dandinarasaiah, Enrico Piccirillo, Alessandra Russo, Abdelkader Taibah, and Mario Sanna. "Surgical Management of Intrinsic Tumors of the Facial Nerve." Neurosurgery 83, no. 4 (September 29, 2017): 740–52. http://dx.doi.org/10.1093/neuros/nyx489.
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Abstract BACKGROUND Intrinsic tumors of the facial nerve are a rare entity. Dealing with this subset of tumors is challenging both in terms of decision making and surgical intervention. OBJECTIVE To review the outcomes of surgical management of facial nerve tumors and cable nerve graft interpositioning. METHODS A retrospective analysis was performed at a referral center for skull base pathology. One hundred fifteen patients who were surgically treated for facial nerve tumors were included. In case of nerve interruption during surgery, the cable nerve interpositioning technique was employed wherein the facial nerve palsy lasted for less than 1-yr duration. In cases of facial nerve palsy lasting for greater than 1 yr, the nerve was restituted by a hypoglossal facial coaptation. RESULTS Various degrees of progressive paralysis were seen in 84 (73%) cases. Sixty nine (60%) of the tumors involved multiple segments of the facial nerve. Sixty-two (53.9%) tumors involved the geniculate ganglion. Seventy four (64.3%) of the cases were schwannomas. Hearing preservation surgeries were performed in 60 (52.1%). Ninety one (79.1%) of the nerves that were sectioned in association with tumor removal were restituted primarily by interposition cable grafting. The mean preoperative House-Brackmann grading of the facial nerve was 3.6. The mean immediate postoperative grading was 5.4, which recovered to a mean of 3.4 at the end of 1 yr. CONCLUSION In patients with good facial nerve function (House-Brackmann grade I-II), a wait-and-scan approach is recommended. In cases where the facial nerve has been interrupted during surgery, the cable nerve interpositioning technique is a convenient and well-accepted procedure for immediate restitution of the nerve.
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Mowry, Sarah, and Claudia Kirsch. "S127 – Idiopathic Facial Nerve Paralysis: Analysis of 3T MRI Images." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (August 2008): P119. http://dx.doi.org/10.1016/j.otohns.2008.05.300.
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Objectives 1) To describe the findings on 3 Tesla (T) MRI in patients with idiopathic facial nerve paralysis (IFP). 2) To compare 3T MRI and 1.5 T MRI images of the facial nerve in patients with and without facial paralysis. Methods A retrospective review of 3T MRI image from 2005–2008 for temporal bone imaging revealed 123 patients; 4 patients underwent imaging for facial paralysis. Images from 3T MRI and 1.5T MRI for these 4 patients were retrospectively assessed by a board-certified neuroradiologist and otolaryngologist blinded to the affected side and compared to normative controls. Results All patients with facial palsy demonstrated significant enhancement of the affected nerve on post-gadolinium T1 weighted images. In 3 patients with residual facial weakness (>12 months) demonstrated facial nerve enhancement at the geniculate ganglion and descending portions. In 1 patient, despite resolution of IFP, the nerve continued to enhance at the geniculate ganglion and descending portion of the facial nerve compared to the contralateral nerve. The 3T MRI images demonstrated improved visualization of the entire course of the facial nerve in both normal and IFP patients. Interestingly, in both normal and affected patients, the uninvolved facial nerve also demonstrated slight contrast enhancement throughout its entire course, although not as pronounced as the affected side. Conclusions 3T imaging provides significantly improved visualization of the temporal facial nerve in both normal and patients with IFP. Gadolinium enhanced 3T imaging allowed better anatomical delineation of both normal and affected facial nerves when compared to 1.5T MRI.
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Hato, Naohito, Hisanobu Kisaki, Nobumitu Honda, Hirotaka Takahashi, Shingo Murakami, Hiroyuki Wakisaka, and Kiyofumi Gyo. "Pathophysiology of Facial Nerve Paralysis Induced by Herpes Simplex Virus Type 1 Infection." Annals of Otology, Rhinology & Laryngology 111, no. 7 (July 2002): 616–22. http://dx.doi.org/10.1177/000348940211100709.
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Herpes simplex virus type 1 (HSV-1) has been proven to be a cause of Bell's palsy; however, the underlying pathophysiology of the facial nerve paralysis is not fully understood. We established a mouse model with facial nerve paralysis induced by HSV-1 infection simulating Bell's palsy and investigated the pathophysiology of the facial nerve paralysis. The time course of the R1 latency in the blink reflex tests paralleled the recovery of the facial nerve paralysis well, whereas electroneurographic recovery tended to be delayed, compared to that of the paralysis; these responses are usually seen in Bell's palsy. On histopathologic analysis, intact, demyelinated, and degenerated nerves were intermingled in the facial nerve in the model. The similarity of the time course of facial nerve paralysis and the electrophysiological results in Bell's palsy and the model strongly suggest that the pathophysiological basis of Bell's palsy is a mixed lesion of various nerve injuries.
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Rosenwasser, Robert H., Emil Liebman, Fernando D. Jimenez, William A. Buchheit, and David W. Andrews. "Facial Reanimation after Facial Nerve Injury." Neurosurgery 29, no. 4 (October 1, 1991): 568–74. http://dx.doi.org/10.1227/00006123-199110000-00014.
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Abstract Patients with facial paralysis are often seen in neurosurgical practice. Obtaining full facial symmetry and function after facial nerve damage presents the neurosurgeon with a difficult challenge. Various surgical techniques have been developed to deal with this problem. These include primary nerve repair, nerve to nerve anastomosis, nerve grafting, neurovascular pedicle grafts, regional muscle transposition, microvascular muscle transfers, and nerve transfers. Patient selection, timing of surgery, and details of surgical technique are discussed. The results of hvpoglossal-facial anastomosis in 24 patients are described.
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Campero, Alvaro, and Mariano Socolovsky. "Facial Reanimation by Means of the Hypoglossal Nerve: Anatomic Comparison of Different Techniques." Operative Neurosurgery 61, suppl_3 (September 1, 2007): ONS—41—ONS—50. http://dx.doi.org/10.1227/01.neu.0000289710.95426.19.
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Abstract Objective: The goal of this study was to determine the various anatomical and surgical relationships between the facial and hypoglossal nerves to define the required length of each for a nerve transfer, either by means of a classical hypoglossal-facial nerve anastomosis or combined with any of its variants developed to reduce tongue morbidities. Methods: Five adult cadaver heads were bilaterally dissected in the parotid and submaxillary regions. Two clinical cases are described for illustration. Results: The prebifurcation extracranial facial nerve is found 4.82 ± 0.88 mm from the external auditory meatus, 5.31 ± 1.50 mm from the mastoid tip, 15.65 ± 0.85 mm from the lateral end of C1, 17.19 ± 1.64 mm from the border of the mandible condyle, and 4.86 ± 1.29 mm from the digastric muscle. The average lengths of the mastoid segment of the facial nerve and the prebifurcation extracranial facial nerve are 16.35 ± 1.21 mm and 18.93 ± 1.41 mm, respectively. The average distance from the bifurcation of the facial nerve to the hypoglossal nerve turn is 31.56 ± 2.53 mm. For a direct hypoglossal-facial nerve anastomosis, a length of approximately 19 mm of the hypoglossal nerve is required. For the interposition nerve graft technique, a 35 mm-long graft is required. For the technique using a longitudinally dissected hypoglossal nerve, an average length of 31.56 mm is required. Exposure of the facial nerve within the mastoid process drilling technique requires 16.35 mm of drilling. Conclusion: This study attempts to establish the exact graft, dissection within the hypoglossal nerve, and mastoid drilling requirements for hypoglossal to facial nerve transfer.
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Lalwani, Anil K., Fidelia Yuan-Shin Butt, Robert K. Jackler, Lawrence H. Pitts, and Charles D. Yingling. "Facial Nerve Outcome after Acoustic Neuroma Surgery: A Study from the Era of Cranial Nerve Monitoring." Otolaryngology–Head and Neck Surgery 111, no. 5 (November 1994): 561–70. http://dx.doi.org/10.1177/019459989411100505.
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The introduction of intraoperative cranial nerve monitoring in posterior fossa surgery has greatly aided the surgeon in identification and anatomic preservation of cranial nerves. As a result, the long-term function of the facial nerve continues to improve after removal of acoustic neuroma. Herein, we report our long-term (1 year or greater) facial nerve outcome in 129 patients who underwent surgical removal of their acoustic neuromas with the aid of Intraoperative neurophysiologic monitoring between 1986 and 1990. The facial nerve was anatomically preserved in 99.2% of the patients, and 90% of all the patients had grade 1 or 2 facial nerve function 1 year after surgery. Long-term facial function was inversely correlated with the size of tumor (chi-squared, p < 0.02) and was not related to the side of tumor, the age and sex of the patient, or the surgical approach. In a comparison among tumor groups matched for size, no statistically significant difference in facial nerve outcome between the translabyrinthine and retrosigmoid approaches was detected. The proximal facial nerve stimulation threshold at the end of surgical removal was predictive of long-term facial nerve function (analysis of variance, p < 0.02). At 1 year, 98% (87 of 89) of the patients with electrical thresholds of 0.2 V or less had grade 1 or 2 facial nerve function compared with only 50% (8 of 16) of those with thresholds between 0.21 and 0.6 V. In the era of cranial nerve monitoring, patients can be better advised about long-term facial nerve outcome after surgical intervention. Preoperatively, the size of the tumor is the most critical factor in predicting long-term facial function. Postoperatively, the proximal seventh nerve stimulation threshold at the end of the surgical procedure can be used as one prognostic measure of long-term facial nerve function.
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Lee, Jae-Min, You Jung Choi, Myung Chul Yoo, and Seung Geun Yeo. "Central Facial Nervous System Biomolecules Involved in Peripheral Facial Nerve Injury Responses and Potential Therapeutic Strategies." Antioxidants 12, no. 5 (May 1, 2023): 1036. http://dx.doi.org/10.3390/antiox12051036.
Full textAbstract:
Peripheral facial nerve injury leads to changes in the expression of various neuroactive substances that affect nerve cell damage, survival, growth, and regeneration. In the case of peripheral facial nerve damage, the injury directly affects the peripheral nerves and induces changes in the central nervous system (CNS) through various factors, but the substances involved in these changes in the CNS are not well understood. The objective of this review is to investigate the biomolecules involved in peripheral facial nerve damage so as to gain insight into the mechanisms and limitations of targeting the CNS after such damage and identify potential facial nerve treatment strategies. To this end, we searched PubMed using keywords and exclusion criteria and selected 29 eligible experimental studies. Our analysis summarizes basic experimental studies on changes in the CNS following peripheral facial nerve damage, focusing on biomolecules that increase or decrease in the CNS and/or those involved in the damage, and reviews various approaches for treating facial nerve injury. By establishing the biomolecules in the CNS that change after peripheral nerve damage, we can expect to identify factors that play an important role in functional recovery from facial nerve damage. Accordingly, this review could represent a significant step toward developing treatment strategies for peripheral facial palsy.
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Voormolen, Eduard H. J., Marijn van Stralen, Peter A. Woerdeman, Josien P. W. Pluim, Herke Jan Noordmans, Max A. Viergever, Luca Regli, and Jan Willem Berkelbach van der Sprenkel. "Determination of a Facial Nerve Safety Zone for Navigated Temporal Bone Surgery." Operative Neurosurgery 70, suppl_1 (September 20, 2011): ons50—ons60. http://dx.doi.org/10.1227/neu.0b013e31822e7fc3.
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Abstract BACKGROUND: Transtemporal approaches require surgeons to drill the temporal bone to expose target lesions while avoiding the critical structures within it, such as the facial nerve and other neurovascular structures. We envision a novel protective neuronavigation system that continuously calculates the drill tip-to-facial nerve distance intraoperatively and produces audiovisual warnings if the surgeon drills too close to the facial nerve. Two major problems need to be solved before such a system can be realized. OBJECTIVE: To solve the problems of (1) facial nerve segmentation and (2) calculating a safety zone around the facial nerve in relation to drill-tip tracking inaccuracies. METHODS: We developed a new algorithm called NerveClick for semiautomatic segmentation of the intratemporal facial nerve centerline from temporal bone computed tomography images. We evaluated NerveClick's accuracy in an experimental setting of neuro-otologic and neurosurgical patients. Three neurosurgeons used it to segment 126 facial nerves, which were compared with the gold standard: manually segmented facial nerve centerlines. The centerlines are used as a central axis around which a tubular safety zone is built. The zone's thickness incorporates the drill tip tracking errors. The system will warn when the tracked tip crosses the safety zone. RESULTS: Neurosurgeons using NerveClick could segment facial nerve centerlines with a maximum error of 0.44 ± 0.23 mm (mean ± standard deviation) on average compared with manual segmentations. CONCLUSION: Neurosurgeons using our new NerveClick algorithm can robustly segment facial nerve centerlines to construct a facial nerve safety zone, which potentially allows timely audiovisual warnings during navigated temporal bone drilling despite tracking inaccuracies.
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Vrinceanu, Daniela, Mihai Dumitru, Matei Popa-Cherecheanu, Andreea Nicoleta Marinescu, Oana-Maria Patrascu, and Florin Bobirca. "Extracranial Facial Nerve Schwannoma—Histological Surprise or Therapeutic Planning?" Medicina 59, no. 6 (June 17, 2023): 1167. http://dx.doi.org/10.3390/medicina59061167.
Full textAbstract:
Schwannomas (neurilemomas) are benign, slow-growing, encapsulated, white, yellow, or pink tumors originating in Schwann cells in the sheaths of cranial nerves or myelinated peripheral nerves. Facial nerve schwannomas (FNS) can form anywhere along the course of the nerve, from the pontocerebellar angle to the terminal branches of the facial nerve. In this article, we propose a review of the specialized literature regarding the diagnostic and therapeutic management of schwannomas of the extracranial segment of the facial nerve, also presenting our experience in this type of rare neurogenic tumor. The clinical exam reveals pretragial swelling or retromandibular swelling, the extrinsic compression of the lateral oropharyngeal wall like a parapharyngeal tumor. The function of the facial nerve is generally preserved due to the eccentric growth of the tumor pushing on the nerve fibers, and the incidence of peripheral facial paralysis in FNSs is described in 20–27% of cases. Magnetic Resonance Imaging (MRI) examination is the gold standard and describes a mass with iso signal to muscle on T1 and hyper signal to muscle on T2 and a characteristic “darts sign.” The most practical differential diagnoses are pleomorphic adenoma of the parotid gland and glossopharyngeal schwannoma. The surgical approach to FNSs requires an experienced surgeon, and radical ablation by extracapsular dissection with preservation of the facial nerve is the gold standard for the cure. The patient’s informed consent is important regarding the diagnosis of schwannoma and the possibility of facial nerve resection with reconstruction. Frozen section intraoperative examination is necessary to rule out malignancy or when sectioning of the facial nerve fibers is necessary. Alternative therapeutic strategies are imaging monitoring or stereotactic radiosurgery. The main factors which are considered during the management are the extension of the tumor, the presence or not of facial palsy, the experience of the surgeon, and the patient’s options.
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Taha, Jamal M., John M. TEW, and Robert W. Keith. "Proximal-to-distal facial amplitude ratios as predictors of facial nerve function after acoustic neuroma excision." Journal of Neurosurgery 83, no. 6 (December 1995): 994–98. http://dx.doi.org/10.3171/jns.1995.83.6.0994.
Full textAbstract:
✓ Electrophysiological studies (for example, electroneuronography, nerve action potentials, absolute amplitudes of the muscle compound action potentials, and stimulation thresholds) do not accurately predict facial nerve function after the excision of acoustic neuromas. To eliminate individual nerve variability, the authors measured the ratio of the amplitudes of muscle compound action potentials produced by stimulating the facial nerve at the brainstem proximally and at the internal auditory meatus near the transverse crest distally after total tumor excision in 20 patients. The mean tumor size was 36 mm. The facial nerves were anatomically intact in all patients after tumor excision. The follow-up period ranged from 14 to 28 months. Facial nerve outcome was determined by a modified House—Brackmann grading scale. Initial facial nerve function was measured at Days 4 to 7 postoperatively, and final function was the grade at last follow up. The following results were obtained: all patients with proximal-to-distal amplitude ratios greater than 2:3 had Grade III or better initial function and Grade I final facial nerve function; 90% of patients with amplitude ratios between 1:3 and 2:3 had Grade III or worse initial facial nerve function, and 100% of these patients had Grade III or better final facial nerve function; all patients with amplitude ratios less than 1:3 had Grade IV or worse initial and final facial nerve function. The authors conclude that the proximal-to-distal amplitude ratios after acoustic neuroma excision can accurately predict postoperative facial nerve function.
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Libreros-Jiménez, Hugo M., Jorge Manzo, Fausto Rojas-Durán, Gonzalo E. Aranda-Abreu, Luis I. García-Hernández, Genaro A. Coria-Ávila, Deissy Herrera-Covarrubias, César A. Pérez-Estudillo, María Rebeca Toledo-Cárdenas, and María Elena Hernández-Aguilar. "On the Cranial Nerves." NeuroSci 5, no. 1 (December 28, 2023): 8–38. http://dx.doi.org/10.3390/neurosci5010002.
Full textAbstract:
The twelve cranial nerves play a crucial role in the nervous system, orchestrating a myriad of functions vital for our everyday life. These nerves are each specialized for particular tasks. Cranial nerve I, known as the olfactory nerve, is responsible for our sense of smell, allowing us to perceive and distinguish various scents. Cranial nerve II, or the optic nerve, is dedicated to vision, transmitting visual information from the eyes to the brain. Eye movements are governed by cranial nerves III, IV, and VI, ensuring our ability to track objects and focus. Cranial nerve V controls facial sensations and jaw movements, while cranial nerve VII, the facial nerve, facilitates facial expressions and taste perception. Cranial nerve VIII, or the vestibulocochlear nerve, plays a critical role in hearing and balance. Cranial nerve IX, the glossopharyngeal nerve, affects throat sensations and taste perception. Cranial nerve X, the vagus nerve, is a far-reaching nerve, influencing numerous internal organs, such as the heart, lungs, and digestive system. Cranial nerve XI, the accessory nerve, is responsible for neck muscle control, contributing to head movements. Finally, cranial nerve XII, the hypoglossal nerve, manages tongue movements, essential for speaking, swallowing, and breathing. Understanding these cranial nerves is fundamental in comprehending the intricate workings of our nervous system and the functions that sustain our daily lives.