Facial canal decompression leads to recovery of combined facial nerve paresis and trigeminal sensory neuropathy: case report

BACKGROUND: Trigeminal sensory neuropathy is often associated with facial idiopathic nerve paralysis (Bell's palsy). Although a cranial nerve viral polyneuropathy has been proposed as the usual cause, in many instances the etiology remains unclear. This case report of recovery of both trigeminal and facial neuropathy after surgical decompression of the facial nerve suggests an anatomic link. METHODS: A case of a 39-year-old woman presenting with recurrent unilateral facial paralysis is summarized. Her fifth episode, which did not spontaneously recover, was associated with retroorbital and maxillary pain as well as sensory loss in the trigeminal distribution. RESULTS: A middle cranial fossa approach for decompression of the lateral internal auditory canal, labyrinthine segment of the facial nerve and the geniculate ganglion was performed. The patient's pain and numbness resolved immediately postoperatively, and the facial paralysis improved markedly. CONCLUSION: This result implicates a trigeminal-facial reflex as hypothesized by others. It suggests that decompression of the facial nerve can lead to improvement in motor and sensory function as well as relief of pain in some patients with combined trigeminal and facial nerve dysfunction.     

Facial reanimation after facial nerve injury

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 hypoglossal-facial anastomosis in 24 patients are described.     

Facial paralysis: traumatic neuromas vs. facial nerve neoplasms

Traumatic neuromas (TN) are benign proliferations of neural tissue that may occur without disruption of the facial nerve. The clinical presentation, as well as the radiographic appearance, may suggest neoplastic involvement of the facial nerve. Histologically, they may closely resemble neurilemomas (Schwannomas) or neurofibromas. Three cases of TN of the facial nerve associated with facial paralysis are presented here. Unlike previously reported cases, these tumors were not associated with chronic inflammatory middle ear disease. TN must be considered in the differential diagnosis and treatment of facial paralysis.     

Isolated marginal facial nerve paresis after TMJ discopexy: a case report

Isolated marginal facial nerve paresis after TMJ discopexy: a case report. This is the first report of a transient, isolated marginal facial nerve paresis after temporomandibular joint arthrotomy. The paresis seems to have resulted from a crush lesion by Backhaus forceps, placed transcutaneously during the operation to distract the intra-articular space.     

Facial nerve anastomosis for facial paralysis following acoustic neurinoma surgery

Summary A satisfactory long term result was obtained in 19 out of 25 cases of facial paralysis, consequent upon complete removal of an acoustic neurinoma, by anastomosis of the facial nerve, in 24 cases with the spinal accessory and in 1 case with the hypoglossal nerve. The technique ofBragdon andGray whereby the deep branch of the spinal accessory nerve is spared and only the superficial branch is used for the anastomosis has proved to be of great value.

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Zusammenfassung Aus einem Kollektiv von 25 Fällen mit Fazialislähmung nach Entfernung eines Akustikusneurinomes, bei denen 24mal eine Fazialis-Akzessoriusana-stomose und lmal eine Fazialis-Hypoglossusanastomose ausgeführt worden war, konnten 19 Fälle ausreichend lange nachuntersucht werden. Die Technik vonBragdon undGray, bei der die tiefen Äste des spinalen Akzessorius erhalten bleiben und nur der oberflächliche Nerventeil zur Anastomose verwendet wird, hat sich gut bewährt.

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Resumen Los resultados obtenidos en 25 casos de parálisis facial, después de la extirpación completa de neurinomas del acústico, fueron satisfactorios en 19 enfermos coh un largo periodo de observación. Se realizó una anastomosis espino-facial en 24 casos y en 1 caso con el nervio hipogloso. La técnica de Bragdon y Gray, con la cual la rama profunda del nervio espinal accesorio es respetada, usando solamente la rama superficial para la anastomosis ha resultado muy valiosa.

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Résumé Un résultat satisfaisant à long terme a été obtenu dans 19 cas sur 25 de paralysie faciale après l'extirpation complète du neurinome de l'acoustique en anastomosant le nerf facial dans 24 cas avec le spinal et dans 1 cas avec l'hypoglosse. La technique de Bragdon et Gray nous a donné satisfaction; elle consiste à anastomoser la branche superficielle du spinal et à préserver sa branche profonde.

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Riassunto Vengono riferiti gli esiti a distanza di 25 casi di anastomosi (24 spino-facciali e 1 ipoglosso-facciale) con risultato soddisfacente in 19 (76%). Si dimostró molto utile la tecnica di Bragdon e Gray secondo la qua le il ramo profondo del nervo accessorio spinale viene diviso e solo il ramo superficiale viene adoperato per l'anastomosi.

     

A modified frontalis sling in the treatment of combined blepharoptosis and facial nerve paresis

A surgical method is proposed to treat patients with combined severe blepharoptosis and peripheral facial nerve paresis. The operation involves construction of a sling from the contralateral active frontalis muscle to the affected eyelid tarsal plate. The method has been applied in one patient, with satisfactory results. Re-education of the patient was relatively easy to achieve.     

Facial nerve stimulation with cochlear implantation. VA Cooperative Study Group on Cochlear Implantation

The course of the facial nerve may place it within the current field generated by an activated cochlear implant to produce incidental facial movement. We investigated the presence of facial nerve stimulation associated with cochlear implants in the VA Cooperative Study of Advanced Cochlear implants. Twelve of 82 patients enrolled in this study demonstrated facial nerve stimulation within 2 years of implant activation. Facial nerve stimulation in six patients with multiple channel implants (Nucleus or ineraid devices) either resolved spontaneously (n = 2), or was eliminated by deactivating basal (n = 2) or apical (n = 2) electrodes. Two of six patients with single-channel electrodes (3-M/Vienna devices) demonstrated facial nerve stimulation that resolved spontaneously (n = 2), resolved with lowering current output (n = 2), or was refractory to processor adjustment (n = 2). Intraoperative assessment in one of the refractory cases indicated that facial nerve stimulation resulted from current spread through the modiolus to activate the facial nerve. A variety of factors, including implant design, stimulus parameters, and local tissue impedances, may interact to produce incidental facial stimulation. Low-impedance pathways between the scala tympani and the modiolus may deserve increased recognition as an interactive factor in cochlear implant performance.     

Facial nerve recording from the eardrum: a possible method for evaluating idiopathic facial nerve paralysis

A noninvasive technique has been developed for recording from the the facial nerve within the fallopian canal. Following transcutaneous stimulation of the nerve on the face, an antidromic nerve potential can be detected with electrodes placed on the eardrum and enhanced by the technique of averaging. In studies conducted on cats and normal human subjects it has been determined that the primary recording site of the nerve potential is along the tympanic segment of the nerve just distal to the geniculate ganglion. Disturbances in nerve conduction caused by an experimental lesion produced changes in the recorded nerve potential. Thus it seems likely that this technique could assess a developing lesion in a patient with idiopathic facial nerve paralysis. A more accurate and earlier prognosis could be obtained than with conventional peripheral nerve testing techniques, since the severity of the developing lesion itself could be assessed.