Total facial nerve palsy following modified O'Brien facial nerve block

A 78-year-old white male developed a total facial palsy immediately following a modified O'Brien facial nerve block utilizing mepivacaine 2%, 10 cc. There was no apparent complication at the time of the nerve block. The facial palsy persisted unchanged for three months, at which time recovery of function was first detectable. Recovery was clinically complete nine months after the palsy occurred. The presumed cause was direct trauma by the needle at the time of the injection.     

Intratemporal facial nerve hemangiomas

Facial nerve hemangiomas are benign vascular tumors that arise within the temporal bone and have a histologic appearance similar to both cavernous hemangiomas and vascular malformations. In contrast to facial nerve schwannomas, these are extraneural tumors that cause symptoms by compression and tend to produce deficits when very small in size. We report our experience at the House Ear Clinic with 34 patients having these nonglomus intratemporal vascular tumors. Hemangiomas arising in the internal auditory canal tend to produce a progressive sensorineural hearing loss and are demonstrated with magnetic resonance imaging (MRI), whereas those at the geniculate ganglion are usually first seen with facial nerve symptoms and may require high-resolution computerized tomography (CT) for detection. Facial electromyography is helpful in establishing the diagnosis. Because of their extraneural nature, early diagnosis can permit removal of the tumor with preservation of facial nerves in some patients.     

Anterior facial nerve decompression

With the current interest in skull base surgery and the resurgence of cavity surgery in the management of cholesteatoma, the otologic surgeon should be able to approach the facial nerve anteriorly as well as posteriorly. The anatomy and identification of the facial nerve are traditionally taught from a transmastoid perspective. In many cases of skull base and chronic ear surgery, it would often be more efficacious if the facial nerve were identified by a transcanal or anterior approach. An anterior approach to the facial nerve expedites surgery in a small sclerotic mastoid process and gives maximum exposure of disease in the hypotympanum and tympanic recess.     

End-to-side nerve graft for facial nerve reconstruction

Reconstruction of multiple branches of the facial nerve by sural nerve graft using end-to-side nerve suture was performed successfully on a patient with advanced parotid tumor. In this technique, one end of the grafted nerve is sutured with the stump of the facial nerve trunk in an end-to-end manner. Epineural windows are made on the nerve graft, and the distal stumps of the facial nerve branches (temporal, zygomatic, and buccal branches) are sutured with the graft in an end-to-side manner. Functional recovery of all branches and satisfactory facial expression were obtained within 2 years postoperatively. Axonal regeneration through the graft was confirmed by electrodiagnosis. Regeneration through the anastomosis at the stump of the facial nerve trunk using this technique is more efficient than conventional cable grafting, and the length of the nerve required is minimal. This technique may be a useful option for facial nerve reconstruction managing multiple branches.     

面神经的角神经解剖学研究

Objective To study the anatomy of angular nerve (AN), so as to provide safe approach for the denervation surgery of corrugator supercilii, depressor supercilii and proceeas. Methods 10 fresh cadaver (20 sides)were perfused and fixed with formalin. Dissection was performed in the 10 X operating microscope. The plexus of the zygomatic branch and the buccal branch were detected to confirm the AN. The relationship of AN with the surrounding blood vessels was observed. We tracked AN until it entered corrugator supercilii, depressor supercilii and procerus. Results ①AN was classified into Ⅰ, Ⅱ ,Ⅲ type according to its formation pattern. Type Ⅰ (20% , 4/20 sides) AN is single, which is mainly from the plexus of buccal branch plus the zygomatic branch from the orbicularis oculi muscle. In type Ⅱ (20% , 4/20 sides) , the single AN was formed by buccal branch plexus and zygomatic branch plexus in the "Four Muscle Gap". In type Ⅲ (60% , 12/20 sides) , the AN had two branches in the "Four Muscle Gap". ②The three types AN passed inferior to the support ligament at the suborbital part, and then transversed medial to the support ligament at the medial canthus, along the vessels of medial canthus. ③ The branch of AN enters the depressor supercilii or procerus 2. 19 to 4. 28 mm above the medial canthus ligament. The backward branch enters the levator labii superioris alaeque nasi 6. 89 to 9. 38 mm below the medial canthus ligament. Conclusions The approach of denervation surgery for AN should be performed medial to the support ligation, between 2. 19 mm above the medial canthus and 6. 89 mm below the medial canthus.     

面神经的角神经解剖学研究

Objective To study the anatomy of angular nerve (AN), so as to provide safe approach for the denervation surgery of corrugator supercilii, depressor supercilii and proceeas. Methods 10 fresh cadaver (20 sides)were perfused and fixed with formalin. Dissection was performed in the 10 X operating microscope. The plexus of the zygomatic branch and the buccal branch were detected to confirm the AN. The relationship of AN with the surrounding blood vessels was observed. We tracked AN until it entered corrugator supercilii, depressor supercilii and procerus. Results ①AN was classified into Ⅰ, Ⅱ ,Ⅲ type according to its formation pattern. Type Ⅰ (20% , 4/20 sides) AN is single, which is mainly from the plexus of buccal branch plus the zygomatic branch from the orbicularis oculi muscle. In type Ⅱ (20% , 4/20 sides) , the single AN was formed by buccal branch plexus and zygomatic branch plexus in the "Four Muscle Gap". In type Ⅲ (60% , 12/20 sides) , the AN had two branches in the "Four Muscle Gap". ②The three types AN passed inferior to the support ligament at the suborbital part, and then transversed medial to the support ligament at the medial canthus, along the vessels of medial canthus. ③ The branch of AN enters the depressor supercilii or procerus 2. 19 to 4. 28 mm above the medial canthus ligament. The backward branch enters the levator labii superioris alaeque nasi 6. 89 to 9. 38 mm below the medial canthus ligament. Conclusions The approach of denervation surgery for AN should be performed medial to the support ligation, between 2. 19 mm above the medial canthus and 6. 89 mm below the medial canthus.     

面神经的角神经解剖学研究

目的 了解面神经的角神经解剖位置,为皱眉肌、降眉肌及降眉间肌去神经化手术寻找最佳入路提供安全保证.方法 对10具(20侧)成人新鲜尸头标本行甲醛血管灌注固定后.在10倍手术放大镜下显微解剖,寻找面神经颧支与颊支的分支,确定角神经,观察其与周围血管的位置关系,并追踪角神经到皱眉肌、降眉肌及降眉间肌的入肌点,照像留存.结果 ①按照角神经的形成及分支将角神经分为Ⅰ、Ⅱ、Ⅲ型.颊支形成复杂的吻合网后又开始形成集中向内眦方向走行,形成单一的角神经,并接收从眼轮匝肌中穿出的颧支,称为角神经Ⅰ型(20%,4/20侧);颊支吻合网与颧支吻合网在"四肌间隙"中形成1支角神经,称角神经Ⅱ型(20%,4/20侧);在"四肌间隙"中形成角神经为上下2支时,称为角神经Ⅲ型(60%,12/20侧).②3种类型的角神经在下眶部都走行于眼轮匝肌支持韧带的下方,在内眦部走行于眼轮匝肌支持韧带的内侧,并与内眦血管伴行.③角神经在内眦韧带水平上方2.19～4.28 mm即有分支进入降眉肌或降眉间肌.角神经有反折支进入上唇鼻翼提肌,最上入肌点距内眦角下方垂直距离为6.89～9.38 mm.结论 在内眦水平线上方2.19 mm至下方6.89 mm的范围内、眼轮匝肌支持韧带的内侧,对角神经进行失神经手术,是最佳的手术入路.     

Malignant schwannoma of facial nerve

The occurrence of malignant schwannoma in children is rare. A search of English language literature did not reveal involvement of cranial nerve among children.     

Magnetically evoked facial nerve potential

Facial nerve stimulation by electrical current is painful and tends to discourage serial studies. Transcutaneous magnetic stimulation of the facial nerve is painless, easily reproducible, and elicits facial muscle responses identical to electrical stimulation.     

Surgical rehabilitation of facial nerve

Summary The management of facial nerve lesions using microsurgical techniques should be part of the armamentarium of surgeons managing head and neck problems. One has to differentiate between techniques for repair of the nerve itself and secondary reconstructive operations. Direct nerve reconstruction, indirect nerve reconstruction and combined procedures are discussed in detail. Secondary reconstructive methods are indicated if repair of the nerve itself is not possible. The results of 31 cases of facial nerve rehabilitation are presented.