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At least 19 recordsLinked to original sources
PubMed2003

[Reconstructive surgery of facial nerve injuries].

The facial nerve is main motor nerve of the face and its injury leads to total ipsilateral paralysis. There are several surgical procedures in reconstruction of the facial nerve, and the most frequent one is hypoglosso-facial anastomosis. In this study were analysed a series of 69 patients operated on Institute of neurosurgery from 1981 to 2000 year. The most frequent cause of injury was the operation of cerebellopontine angle tumors, as well as the skull base fractures. Hypoglosso-facial anastomosis was done in 57 patients, in 5 cases we performed nerve grafting in the cerebellopontine angle, and in 7 patients the facial nerve was operated peripherally. Results were analyzed in 27 of 57 patients with hipoglosso-facial nerve anastomosis. Functional recovery was achived in 22 (81.4%) patients.

Adolescent↗
PubMed1976

Extratemporal facial nerve injury.

Isolated traumatic facial nerve injury, frequently seen in wartime combat, may also be encountered among civilians. The clinical picture occurring as a result of such injury may be confusing because partial, or incomplete, damage to the peripheral nerve may mimic impairment of the central facial motor mechanism. In treating the patient with facial injury, life-threatening aspects of the injury must be assessed and stabilized first. Then, attention may be focused on the injured facial nerve, for which prompt surgical repair is the treatment of choice. Prior to surgery, the assessment of taste and hearing, as well as mastoid and skull x-ray films and electrodiagnostic tests are helpful in localizing the facial nerve injury.

Electrodiagnosis↗
PubMed1996

Iatrogenic facial nerve injury: the role of facial nerve monitoring.

Intraoperative facial nerve monitoring has emerged as a powerful tool for facilitation of surgery involving the facial nerve. This tool must be properly applied and maintained, however, in order to avoid untoward results and to maximize its potential benefits. Facial nerve monitoring is best suited for prevention of iatrogenic injury. Once injury has become established, its value may be severely limited, especially for moderate to severe injury, in which visual assessment of injury is still the most effective means to determine the need for repair. The most valuable derivative of facial nerve monitoring is enhanced awareness of the edge of the facial nerve contour. This allows strategic alterations in surgical technique for improved facial nerve functional preservation. Although facial nerve monitoring appears to have already had a favorable influence on facial nerve preservation, further improvement seems likely over time through an ongoing process of trial and error.

Ear Diseases↗
PubMed1979

Avoiding facial nerve injuries in rhytidectomy. Anatomical variations and pitfalls.

Injury to the facial nerve in rhytidectomy has been occurring in less than one percent of the cases, and a spontaneous return of function in more than 80 percent of these injuries has resulted within 6 months. With the introduction of the newer and more aggressive techniques of platysmal and subplatysmal flaps and SMAS dissections, the risk of injury to facial nerve branches is obviously increased. Though there has not yet been an increase in the facial nerve injuries reported, these techniques are still relatively recent additions to the face-lift operation-and usually they have been done by more experienced surgeons, taking more time and working under direct vision with a more careful dissection. More care is needed to prevent injuries. We discuss here the detailed anatomy of the muscular branches of the facial nerve, how to prevent injuries to them during rhytidectomy, and how to manage injuries when they do occur.

Face↗
PubMed2003

The surgical management of facial nerve injury.

Treatment of facial nerve injuries depends upon a detailed understanding of its anatomic course, accurate clinical examination, and timely and appropriate diagnostic studies. Reconstruction depends upon the extent of injury, the availability of the proximal stump. and the time since injury and duration of muscle denervation. Although no alternative is perfect, these techniques, in combination with static and ancillary procedures. can protect the eye, prevent drooling, restore the smile, and improve facial symmetry. New techniques (including single-stage free tissue transfers and bioengineered nerve grafts), further research on the characteristics of the facial musculature, and methods of preserving the neuromuscular junction will undoubtedly manifest themselves as further refinements of established surgical techniques.

Acute Disease↗
PubMed1994

Transtympanic facial nerve injury in welders.

The risk for ear injury from molten metal or hot sparks produced during welding procedures is small, but the effects can be significant. Burns, tympanic membrane perforations and chronic otorrhoea are the most common results. Rare cases of inner ear injury and facial nerve paralysis have also been reported. Two cases recently encountered at our institution highlight the risk that exists for facial nerve injury. One patient suffered a significant facial nerve injury and deafness, while the other had a transient facial paresis. The injuries occurred when molten metal (slag) and a hot spark fell into the ear canal while welding. Neither subject was using ear protection at the time. These two cases are presented to highlight the rare but significant hazard of transtympanic facial nerve injury that exists during welding procedures. The use of ear protection is strongly advocated during welding operations that place the ear at risk.

Adolescent↗
PubMed1999

Facial nerve injury caused by vestibular Schwannoma compression: severity and adaptation to maintain normal clinical facial function.

OBJECTIVES: To assess facial nerve injury caused by vestibular Schwannoma compression and the adaptive ability of the nerve/muscle complex to maintain normal clinical facial function. STUDY DESIGN: Prospective study. SETTING: Tertiary referral centre. PATIENTS: Thirty-four patients undergoing translabyrinthine resection of vestibular schwannoma. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: Facial nerve action potential (FNAP) amplitude recorded at the second genu enables direct assessment of motoneuron function. Comparison of FNAP amplitudes to stimulation proximal and distal to tumor compression allows calculation of motoneuron conduction block across the site of tumor compression. Recordings performed before tumor dissection from the facial nerve reflects nerve injury caused by vestibular Schwannoma compression alone. Comparison of compound muscle action potential (CMAP) amplitudes to stimulation proximal and distal to tumor compression measures motoneuron conduction block and compensatory collateral sprouting at the nerve/muscle interface. Comparison of FNAP and CMAP data demonstrates the extent of collateral sprouting, which helps maintain normal clinical facial function. RESULTS: Normal clinical facial function is maintained when only 10% of functioning motoneurons are active. The facial nerve is highly susceptible to tumor compression with significant motoneuron injury occurring with all sizes of tumors. Motoneuron injury correlates with tumor size but with exceptions. Collateral sprouting maintains muscle function despite severe motoneuron injury. There is a significant decrease in muscle function when >80% of functioning motoneurons are in conduction block. CONCLUSIONS: The facial nerve is highly susceptible to vestibular Schwannoma compression. Collateral sprouting of active functioning motoneurons reinnervate denervated muscle fibers so maintaining muscle function and therefore clinical facial function.

Adaptation, Physiological↗
PubMed1994

Iatrogenic facial nerve injury during otologic surgery.

Perhaps the most devastating complication in otologic surgery is that of inadvertent injury to the facial nerve. A review of 22 patients who had sustained an iatrogenic facial nerve injury was conducted. Although the most common procedure being performed during the injury was mastoidectomy (55%), a surprising number of patients had injury during tympanoplasty (14%) or during removal of exostoses (14%). The most common area of injury to the facial nerve in this series was in the tympanic segment. In 79% of the patients, the facial nerve injury was not detected at the time of surgery. All patients underwent surgical exploration of the facial nerve. Otologic surgeons are cautioned to be familiar with the normal course of the facial nerve and to be aware of the potential for facial nerve injury when performing transcanal surgery.

Adolescent↗
PubMed2004

[A study of 108 cases on facial nerve contralateral innervation after facial nerve injury].

OBJECTIVE: To investigate the facial nerve contralateral innervation of patients with facial nerve injury. METHODS: Electroneuronography (ENoG) of 22 university student volunteers (US) without any injury and systemic diseases and 108 patients with facial nerve injury were measured. The patients were divided into three groups: iatrogenic, traumatic, and Bell's palsy groups. When stimulating the facial nerve at the site below the lobule and behind the ramus, ENoGs of each branch of the facial nerve on ipsilateral and contralateral sides were recorded. A total of 76 branch I, 81 branch II, 88 branch III, and 66 branch IV were measured. RESULTS: (1) There were no significant differences among three patient groups (P > 0.05). (2) The ratios of contralateral innervation of the branch I and II of the patients were significantly. greater than those of the US group (P < 0.001). (3) The ratio of contralateral innervation of the branch I was greater than that of the branch II in the patients (P < 0.001). CONCLUSION: The contralateral innervation of the facial nerve increases after facial nerve injured.

Adolescent↗
PubMed2001

Surgical management of facial nerve injuries.

The comprehensive management of facial nerve injuries requires a surgeon with a number of available methods of reconstruction at his or her disposal. Comprehensive evaluation or documentation of injury is required to determine the most appropriate timing and method of surgical intervention. The majority of nerve injuries are limited, and direct repair or simple nerve grafting are the indicated treatment modalities. These procedures are easily applied to the management of the facial nerve by any well-trained microsurgeon. Accurate diagnosis and timely intervention are critical in achieving acceptable outcomes. Multidisciplinary collaboration is occasionally necessary for extremely proximal injuries wherein the skills of a lateral skull base surgeon are critical. Delayed facial reconstruction by facial reanimation requires subspecialty skills and necessitates referrals to centers experienced in such procedures.

Anastomosis, Surgical↗
PubMedDate not supplied

Botulinum toxin type A: fine-tuning treatment of facial nerve injury.

Treatment of patients following facial nerve injury can be daunting. A multitude of procedures have been developed to treat the paralyzed face. As patients recover from facial nerve injuries, a variety of asymmetries from nerve hypofunction (paresis or paralysis) or hyperfunction (synkinesis or spasm) often persist. Careful use of botulinum toxin type A can be very useful in improving symmetry in acute or chronic facial nerve abnormality by treating the relatively hyperfunctional side.

Bell Palsy↗
PubMed1999

[Changes of CGRP activity and distribution in facial nucleus after facial nerve injury of guinea pig].

OBJECTIVE: In order to study the changes of CGRP activity in facial nucleus of guinea pig after facial nerve injury. METHOD: The activity of CGRP was detected by the technique of immunohistochemical and image analysis methods were used. RESULT: It was showed the there were CGRP-immunoreactivity (IR) in normal facial nucleus and its' subnucleus. An initial increase of CGRP-IR was noted and the content of CGRP under image analysis were significantly different when compared with control group (P < 0.01) at day 1 after injury of facial nerve. CGRP continued to rise to a maximal level at day 7 (P < 0.001). And after which it gradually decreased. We noticed distinct bundle-shaped CGRP fibers elongated to the peripheral part from ventral facial nucleus in the period of 14 d-35 d. CONCLUSION: It suggests that during the course of facial nerve regeneration following injury, CGRP changed characteristically. CGRP may play the regulational role in facial nerve regeneration.

Animals↗
PubMed1994

Surgical management of iatrogenic facial nerve injuries.

Surgical management of an iatrogenic 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 iatrogenic 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.

Adolescent↗
PubMed2000

Transcranial magnetic stimulation in acute facial nerve injury.

OBJECTIVE/HYPOTHESIS: Available electrodiagnostic tests that are used to evaluate facial nerve injury examine the nerve distal to the stylomastoid foramen; because most facial nerve injuries are within the temporal bone, the tests cannot evaluate the nerve at or across the injury site. The interpretation of these tests depends on the predictability (or unpredictability) of distal degenerative process. Transcranial magnetic stimulation may be able to stimulate the nerve proximal to the injury site. The hypothesis of the present study is that in cases of mild traumatic facial nerve injury where axonal integrity is maintained, proximal stimulation of the nerve using higher than normal stimulus intensities to "overcome" the block at the injury site result in recordable facial nerve activity. STUDY DESIGN: A prospective controlled animal study comparing response to transcranial magnetic stimulation of the facial nerve in the following groups: mild injury, severe injury/transection, and control. METHODS: We studied 44 facial nerves in 22 cats. Fifteen nerves were subjected to mild trauma. Five nerves were severely crushed, 2 nerves were completely transected, and 22 nerves were not traumatized. All nerves were examined with the transcranial magnetic stimulation system before the trauma, immediately after the trauma, and at 3, 8, and 12 weeks after trauma. RESULTS: All nerves in the mild and severe trauma groups showed complete clinical paralysis immediately after trauma. The nerves in the mild trauma group showed significant increase in threshold as well as significant increase in latency for recordable facial muscle response to transcranial magnetic stimulation. Thresholds and latencies decreased gradually within 3 to 12 weeks and returned almost to preinjury levels. This paralleled the return of clinical facial muscle movement. In the severe trauma/transection group, the nerves had no facial muscle response to transcranial magnetic stimulation after trauma. Neither facial muscle response to transcranial magnetic stimulation nor facial muscle movements recovered. CONCLUSIONS: In cats transcranial magnetic stimulation can assess the integrity of the facial nerve after trauma and predict its potential for regeneration. This technique can excite the nerve proximal to the injury site and may play a role in the clinical evaluation of the acute traumatic facial nerve paralysis. It can be used immediately after trauma, because it does not depend on wallerian degeneration to occur.

Acute Disease↗
PubMed1991

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.

Accessory Nerve↗
PubMed1997

Facial nerve injury in acoustic neuroma (vestibular schwannoma) surgery: etiology and prevention.

Facial nerve injury associated with acoustic neuroma surgery has declined in incidence but remains a clinical concern. A retrospective analysis of 611 patients surgically treated for acoustic neuroma between 1973 and 1994 was undertaken to understand patterns of facial nerve injury more clearly and to identify factors that influence facial nerve outcome. Anatomical preservation of the facial nerve was achieved in 596 patients (97.5%). In the immediate postoperative period, 62.1% of patients displayed normal or near-normal facial nerve function (House-Brackmann Grade 1 or 2). This number rose to 85.3% of patients at 6 months after surgery and by 1 year, 89.7% of patients who had undergone acoustic neuroma surgery demonstrated normal or near-normal facial nerve function. The surgical approach appeared to have no effect on the incidence of facial nerve injury. Poor facial nerve outcome (House-Brackmann Grade 5 or 6) was seen in 1.58% of patients treated via the suboccipital approach and in 2.6% of patients treated via the translabyrinthine approach. When facial nerve outcome was examined with respect to tumor size, there clearly was an increased incidence of facial nerve palsy seen in the immediate postoperative period in cases of larger tumors: 60.8% of patients with tumors smaller than 2.5 cm had normal facial nerve function, whereas only 37.5% of patients with tumors larger than 4 cm had normal function. This difference was less pronounced, however, 6 months after surgery, when 92.1% of patients with tumors smaller than 2.5 cm had normal or near normal facial function, versus 75% of patients with tumors larger than 4 cm. The etiology of facial nerve injury is discussed with emphasis on the pathophysiology of facial nerve palsy. In addition, on the basis of the authors' experience with these complex tumors, techniques of preventing facial nerve injury are discussed.

Adolescent↗