Total facial nerve decompression in severe idiopathic recurrent facial palsy: its long-term follow-up results

Abstract

Background: The long-term outcomes of total facial nerve decompression (TFND) in severe idiopathic recurrent facial palsy (IRFP) are still unknown.

Aims/objectives: To explore the long-term follow-up results of TFND in IRFP.

Materials and methods: Twenty-eight patients suffering from severe IRFP were enrolled. Patients were offered conventional therapy or TFND and were categorized into control or operation group. The follow-up lasted for at least 6 years. Comparison was made in terms of relapse of facial palsy as well as outcomes of facial nerve.

Results: There were 16 participants in operation group, whose follow-up lasted for 10.4?±?1.3 years. In contrast, there were 12 participants in control group, who were followed up lasted for 11.2?±?1.2 years. No participants suffered relapse in the operation group while seven out of 12 participants (58.3%) encountered relapse with regard to control group (p?<?.05). In terms of facial nerve results, 16 out of 18 participants (88.9%) reached satisfactory outcomes of facial nerve (HB grade I or II) while only four out of 12 participants (33.3%) achieved satisfactory outcomes in control group (p?<?.05).

Conclusions and significance: In terms of severe IRFP, TFND can defend patients from relapse in a long period, and enhance recovery of facial nerve.     

Rehabilitation of facial nerve palsy

Forty-nine patients underwent 158 procedures (including 19 revisions) for complete facial palsy. The variety of causes of facial palsy are enumerated, with the various procedures used to rehabilitate the face. Some improvement is invariably achieved. It is concluded that a readiness to intervene with a wide choice of procedures as early as realistically possible offers the best outcome in function and cosmetic appearance.     

Intratemporal facial nerve ultrastructure in patients with idiopathic facial paralysis. Viral infection evidence study

The etiology of idiopathic peripheral facial palsy (IPFP) is still uncertain; however, some authors suggest the possibility of a viral infection.Aimto analyze the ultrastructure of the facial nerve seeking viral evidences that might provide etiological data.Material and MethodsWe studied 20 patients with peripheral facial palsy (PFP), with moderate to severe FP, of both genders, between 18-60 years of age, from the Clinic of Facial Nerve Disorders. The patients were broken down into two groups - Study: eleven patients with IPFP and Control: nine patients with trauma or tumor-related PFP. The fragments were obtained from the facial nerve sheath or from fragments of its stumps - which would be discarded or sent to pathology exam during the facial nerve repair surgery. The removed tissue was fixed in 2% glutaraldehyde, and studied under Electronic Transmission Microscopy.ResultsIn the study group we observed an intense repair cellular activity by increased collagen fibers, fibroblasts containing developed organelles, free of viral particles. In the control group this repair activity was not evident, but no viral particles were observed.ConclusionThere were no viral particles, and there were evidences of intense activity of repair or viral infection.     

Management of facial nerve schwannoma in patients with favorable facial function

OBJECTIVE: We report six cases of facial nerve schwannomas in which surgical management allowed the preservation of facial nerve function. Specifically, this paper reports that a stripping surgery may provide favorable functional outcomes. STUDY DESIGN: A retrospective review of preoperative and postoperative data for six patients with facial nerve schwannoma that had normal facial nerve function or a House-Brackmann grade II facial palsy before the surgery. METHODS: Stripping surgery, which removed the schwannoma from the remaining nerve fascicle, was attempted on the six patients. Postoperative facial nerve function and imaging (magnetic resonance imaging) were evaluated. RESULTS: Stripping surgery with gross total tumor removal of the mass was performed in four cases. In the two remaining cases, the stripping surgery was not possible, and decompression alone was performed. Favorable preservation of facial function was achieved in all six cases. CONCLUSION: It was possible to preserve facial function after surgery to remove facial nerve schwannoma. We suggest that stripping surgery, focused on the preservation of continuity of the facial nerve, may be attempted for facial nerve schwannoma in which favorable facial function has been preserved.     

Hypoglossal‐facial nerve anastomosis: assessment of clinical results and patient benefit for facial nerve palsy following acoustic neuroma excision

Despite advances in neuro‐otological techniques permanent complete facial palsy may still occur in up to 10% of patients undergoing removal of cerebellopontine angle tumours. Hypoglossal‐facial nerve anastomosis is the procedure of choice in our unit for facial reanimation in such patients and below we report the results of hypoglossal‐facial nerve anastomosis performed on 29 patients. Assessment of patient benefit from hypoglossal‐facial nerve anastomosis was obtained using a questionnaire based on the Glasgow Benefit Inventory. The results showed all patients to have an improvement in their House Brackmann grade following hypoglossal‐facial anastomosis with 65% achieving grade III or better. Of the 20 patients who completed the questionnaire, 18 showed a positive benefit (median score 59.5, range 40–77). There was a significant correlation (P < 0.045) between the Glasgow benefit inventory score and House Brackmann grade. Outcome was not affected by the time interval between the acoustic neuroma surgery and performing the hypoglossal‐facial nerve anastomosis, sex or length of follow‐up. However the Glasgow benefit score was significantly influenced by age (P = 0.023) with younger patients showing more benefit independent of improvement in facial nerve function.     

Reconstruction of complex peripheral facial nerve defects by a combined approach using facial nerve interpositional graft and hypoglossal-facial jump nerve suture

Objectives/Hypothesis:

To describe a modified facial nerve reconstruction technique for complex defects of the facial fan after parotid surgery that avoids synkinesis between upper and lower face.

Study Design:

Retrospective case series.

Methods:

Patients who had undergone radical parotidectomy with a large defect of the facial fan, reconstruction of the upper face by facial nerve interpositional graft, and reconstruction of the lower face by hypoglossal‐facial nerve jump nerve suture were included in this series.

Results:

Four patients underwent the modified combined approach after tumor resection and prior to postoperative radiotherapy in three of the four cases. Surgery was combined with an upper lid weight implantation. Regeneration of the face was successful in all cases within 12 to 16 months. Most important, the separated reanimation of the upper and lower face circumvented synkinesis of the upper and lower face. This factor was essential for good functional results. Using the hypoglossal jump technique instead of a classical cross‐nerve suture technique prevented the sacrifice of ipsilateral tongue function.

Conclusions:

The presented method offers satisfactory results for facial reanimation and avoids synkinesis between the upper and lower face. Using the jump technique instead of a classic hypoglossal transfer as it was described originally for the combined approach avoids long‐term sequelae for the tongue. Laryngoscope, 121:2402–2405, 2011     

面神经乳突段修复术后再生纤维三维构筑特点与功能恢复的关系

目的:研究端-端吻合术和耳大神经移植术修复面神经乳突段后再生纤维三维构筑特点与功能恢复的关系。方法:新西兰大白兔30只,随机分为端-端吻合组和耳大神经移植组,每组15只。对2组动物左侧耳分别实施面神经乳突段端-端吻合术或耳大神经移植术后30d、90d和120d检测肌电图,取双侧面神经乳突段及周围颞骨,脱钙,石蜡包埋,制作6μm连续切片后,利用Mimics 12.0软件重建显示再生神经的空间构筑。结果:2组动物比较再生纤维只有30d时差异有统计学意义,肌电图振幅30d和90d差异有统计学意义,三维重建结果显示随时间延长再生神经纤维髓鞘逐渐增厚、上下对接增多并聚集成簇。结论:不同修复术后面神经乳突段再生纤维三维构筑特点与功能逐渐恢复的趋势在时间上相应,但又不是完全一致。     

面神经瘤27例临床分析

目的:分析面神经瘤患者的临床表现和诊断,讨论不同部位面神经瘤手术方法的选择。方法:对1999-09-2006-12临床资料完整的27例面神经瘤患者进行回顾性研究。结果:27例面神经瘤患者经术后病理证实20例为面神经鞘膜瘤(74.1%),4例为面神经纤维瘤(14.8%),3例为面神经血管瘤(11.1%)。病程中表现为面瘫23例(85.2%);听力下降和耳鸣各11例(40.7%);表现为耳下肿块,且有耳痛、眩晕、耳闷、面部麻木、抽搐5例(18.5%)。24例(88.9%)CT或MRI提示为面神经来源肿瘤。24例(88.9%)累及2个或2个以上的面神经节段,其中累及乳突段处占87.5%(21/24),累及鼓室段处占70.8%(17/24),累及膝状神经节处占62.5%(15/24),累及内耳道占4.2%(1/24);只累及面神经的1个节段占11.1%(3/27)。27例均手术完整切除肿瘤,其中13例进行了同期面神经重建术,包括11例腓肠神经移植术,1例面-舌下神经吻合术,1例面神经端端吻合术。2例在切除肿瘤的同时保留了面神经解剖结构的完整性。结论:面神经瘤是一种较少见的良行肿瘤,临床症状多样,CT、MRI等影像学检...     

耳大神经移植修复面神经缺损的临床研究

目的:探讨采用耳大神经移植修复面神经缺损的可行性。方法:采用耳大神经移植修复面神经缺损14例,手术方式为经乳突进路面神经移植术。以House-Brackmann(HB)分级法评估手术前和手术后面神经功能。结果:在8例颞骨骨折所致面神经麻痹的患者中,颞骨骨折的类型均为纵形骨折,面神经受累及的部位主要在第2膝及其附近,术前面神经功能均为Ⅵ级。3例面神经肿瘤中面神经呈多节段受累,病理结果均为神经鞘膜瘤,术前面神经功能Ⅲ级1例、Ⅴ级2例。医源性损伤2例患者原发病均为胆脂瘤中耳炎,损伤部位分别为面神经乳突段和第2膝。1例钢水烧伤面神经损伤部位在面神经鼓室段,术前面神经功能Ⅵ级。除3例患者失访外,其余患者术后面神经功能恢复Ⅲ级4例、Ⅳ级3例、Ⅴ级2例、Ⅵ级2例。结论:颞骨骨折是导致面神经离断的最常见原因,以耳大神经移植修复面神经缺损是一种实用有效的方法,面神经移植后神经功能恢复最佳可达HBⅢ级。     

经乳突-上鼓室入路面神经手术主要解剖标志的多螺旋CT双斜位多平面重建

目的:探讨利用多螺旋CT双斜位多平面重建技术(MPR),进行经乳突-上鼓室入路面神经手术中涉及的面神经段及定位解剖标志同层重建的可行性及意义。方法:在1具尸头标本上模拟经乳突-上鼓室面神经手术入路,观察面神经暴露的范围及定位解剖标志。利用双斜位MPR,对30具完整的成年国人尸体头颅标本进行经乳突-上鼓室面神经手术入路中涉及到的面神经段及定位解剖标志同层面重建,并对4个不同方位图像同层显示解剖标志的程度进行分级评价。结果:经乳突-上鼓室入路可显露面神经垂直段、面神经锥段、水平全段、膝状神经节和迷路段远端,定位解剖标志有水平半规管、匙突、上鼓室前隐窝。以上解剖标志在双斜位MPR重建图像中可同层显示,显示成功率均为100%,显示程度双斜位均优于横断位、冠状位及矢状位,不同方位图像显示程度差异有统计学意义(P<0.05)。结论:双斜位MPR可清晰同层显示经乳突-上鼓室入路面神经手术中涉及的主要解剖标志,结合手术进路及手术目的,利用双斜位MPR,针对性地进行相关解剖标志的同层重建,能为术者提供更有使用价值的影像学信息。     

The prognostic value of facial nerve conduction velocity in patients with Bell's palsy

The facial nerve conduction velocity was measured in 30 healthy subjects (60 sides) and in 51 patients with a unilateral Bell's palsy. The normal value was 47.8 ± 5.1 m/s. Incomplete recovery was common in Bell's palsy when the velocity was below 30 m/s. Mild synkinesis was observed in only one patient when the nerve conduction velocity was above 30 m/s. When the degree of degeneration revealed by electroneuroneography did not exceed 60%, the conduction velocity was in the normal range. For degrees of degeneration in excess of this, the conduction velocity decreased in parallel with the increase in the degree of degeneration.     

虚拟手术辅助的腓骨肌（皮）瓣在上颌骨 精确重建中的应用

目的回顾性分析经虚拟手术辅助的血管化腓骨肌皮瓣行上颌骨精确重建的病例,并评价术后效果。方法2009年6月~2014年7月对34例上颌骨缺损患者术前通过虚拟手术模拟上颌骨全切或次全切除,并通过比较腓骨与健侧上颌骨镜像的形态,对重建上颌骨精确塑形。术中使用立体模型和手术导板再现术前计划,并将实际重建效果与虚拟手术结果进行对比。术后1年对所有患者面部外形进行满意度评估。结果34例上颌骨缺损患者术后1年随访显示重建的上颌骨均愈合良好、咬合关系正常,实际重建效果与虚拟手术结果基本一致;且患者对面部外形非常满意或满意。结论结合义齿修复,虚拟手术辅助的血管化腓骨肌皮瓣行上颌骨精确重建能重建上颌骨的理想外形和良好功能。     

虚拟手术辅助的血管化腓骨肌（皮）瓣行 下颌骨精确重建

摘要：目的回顾性分析经虚拟手术辅助的血管化腓骨肌（皮）瓣行下颌骨大型缺损精确重建的患者,评估其术后效果。方法2009年6月~2014年12月对42例不同类型的下颌骨缺损患者术前通过虚拟手术模拟下颌骨节段性切除、腓骨的截开和塑形,来选择最佳的腓骨截开线、骨块塑形的角度和需要切除的骨量。术中使用手术导板再现术前计划,实际重建效果与虚拟手术结果进行对比。术后1年对所有患者面部外形进行满意度评估。结果42例患者术后随访显示重建的下颌骨均愈合良好、咬合关系正常,实际重建效果与虚拟手术结果基本一致。患者对面部外形恢复满意。结论结合义齿修复,虚拟手术辅助的血管化腓骨肌（皮）瓣能精确重建下颌骨大型缺损的理想外形和良好功能。     

Re-innervation of facial nerve territory using a composite hypoglossal nerve — muscle autograft — facial nerve bridge. An experimental model in sheep

The hypoglossal nerve has been used both entirely and in part to repair the facial nerve. Using the partial technique it may be difficult to obtain sufficient length and a free interposed graft is then required to extend the hypoglossal element. In six sheep the facial nerve was excised between its emergence from the stylomastoid foramen and its bifurcation in the parotid gland. The hypoglossal nerve was exposed and split longitudinally producing a limb which was reflected towards the distal stump of the facial nerve. This left a gap of 4-5 cm which was bridged with a freeze-thawed coaxially aligned skeletal muscle autograft. The sheep were examined at 8 months. Laser doppler blood-flow studies showed the blood-flow distal to the graft to be about 25% of that at an equivalent site on the normal side. Peak nerve conduction velocities were also reduced on the repaired side but stimulation of the proximal hypoglossal nerve was nevertheless capable of causing adequate contraction of both facial and tongue muscles. Histological comparison of the repaired facial nerves with equivalent sites on the normal side showed a reduction in mean axon and fibre diameters with normal myelin sheath thickness for the regenerated axon sizes. All of these features are to be expected in a regenerated nerve and are consistent with a good level of recovery of function.