Facial Function Outcomes Research Articles

Surgery After Primary Radiation Treatment for Sporadic Vestibular Schwannomas: Case Series.

As radiation has become an increasingly popular primary treatment option for sporadic vestibular schwannomas, there is a minority of tumors that do not respond favorably to radiation. Data on repeat radiosurgery are emerging, and salvage surgery has been associated with increased technical difficulty and poor facial nerve outcomes. To review the current literature and report our results with surgical resection of sporadic vestibular schwannomas that have failed primary radiation treatment. This is a retrospective, single-surgeon case series of patients with sporadic vestibular schwannomas who failed primary radiation treatment and underwent subsequent surgical resection. We analyze demographics, clinical information, and intraoperative findings, focusing on facial nerve functional outcomes and extent of resection. Between 2006 and 2015, 10 patients with sporadic vestibular schwannomas whose only prior treatment was radiation underwent microsurgical resection. Eight of 10 patients had a postoperative House-Brackmann score of 1 at a median follow-up of 14 months, while 2 patients had House-Brackmann score of 4. Gross total resection was achieved in 7 of 10 cases. Near total resection was achieved in 2 cases, and only subtotal resection was achieved in 1 case. Salvage surgery is a safe and effective option after failure of primary radiation and may offer benefits over repeat radiosurgery.

Onset of bell's palsy in late pregnancy and early puerperium is associated with worse long-term outcomes.

The incidence of Bell's palsy (BP) is elevated in the late phases of pregnancy. Controversy exists as to whether pregnancy is a risk factor for worse outcomes in BP, and whether such outcomes are the result of factors intrinsic to pregnancy or the tendency to withhold medical therapy in this cohort. Long-term facial function outcomes in cases of pregnancy-associated BP (PABP) were compared against outcomes in cases affecting nonpregnant adult women of child-bearing age by a blinded expert using the electronic clinician-graded facial function scale (eFACE) facial grading system. Fifty-one pregnancy-associated cases and 58 nonpregnancy-associated cases were included. Among patients who received early corticosteroid therapy, significantly worse static, synkinesis, and composite facial function eFACE scores were demonstrated among cases of PABP compared to nonpregnancy-associated cases (static median = 86 vs. 92.5, P = 0.005; synkinesis median = 79 vs. 86, P = 0.007; composite median = 78 vs. 84, P = 0.023). Among those not treated with corticosteroids, significantly worse dynamic and composite facial function eFACE scores were demonstrated in cases of PABP compared to those for nonpregnancy-associated cases (dynamic median = 74 vs. 92.5, P = 0.038; composite median = 73 vs. 86.5, P = 0.038). A trend toward improved outcomes was demonstrated within both groups for those treated with corticosteroids compared to those who were not. In comparison to cases unrelated to pregnancy, late-term PABP is associated with worse long-term outcomes to a degree that cannot solely be explained by differences in medical therapy. 4. Laryngoscope, 127:2854-2859, 2017.

Functional outcome and complications after the microsurgical removal of giant vestibular schwannomas via the retrosigmoid approach: a retrospective review of 16-year experience in a single hospital

BackgroundIntracranial vestibular schwannoma still remain to be difficulty for its unique microsurgical technique and preservation of neuro-function, as well as reducing common complications that may arise in surgery.MethodsWe consecutively enrolled 657 unilateral giant (>4 cm diameter) vestibular schwannoma patients treated in Huashan Hospital via the suboccipital retrosigmoid approach in the past 16 years. The extension of tumor removal, surgical mortality, facial nerve function, hearing, and the other main short and long-term complications were the studied parameters.ResultsGross total resection was performed in 556 patients (84.6%); near-total resection was achieved in 99 patients (15.1%). The mortality rate is 0.6%. The main short-term complications included ‘new’ deafness (47.6%), intracranial infection (7.6%), lower cranial nerve defects (7.5%) and pneumonia (6.2%). The facial nerve was preserved anatomically in 589 cases (89.7%). Good facial nerve functional outcome (House-Brackmann Grades I and II) postoperatively was achieved in 216 patients (32.9%). Other 308 cases (46.9%) were House-Brackmann grade III, and 133 patients (20.2%) were House-Brackmann grade IV–VI. Follow-up data were available for 566 of the 657 patients (86.1%). The common long-term complications were hearing loss (85.2%), facial paralysis (HB grade IV–VI, 24.4%) and facial numbness (15.7%).ConclusionsTrends in the data lead the authors to suggest that the microsurgical technique, intraoperative nerve monitoring, and multidisciplinary cooperation, were the keys to improving prognostic outcomes in giant intracranial vestibular schwannoma patients.

Facial functional outcome in monitored versus not-monitored patients in vestibular schwannomas surgery.

Objective:Even though advances in surgical techniques have improved facial nerve outcomes, functional preservation is still an issue because injury to the facial nerve has significant physical and psychological consequences for the patient. We retrospectively review our data in VS surgery to compare the facial outcome in intraoperative facial monitored versus not-monitored patients.Materials and Methods:51 consecutive patients with unilateral vestibular schwannoma in the period from 2005 to 2010 were treated in our Institution. In according to the type of neurophysiological tool used during surgical procedures, two patients groups were identified: Group 1 (facial stimulator only) and Group 2 (stimulator and facial monitoring). Statistical comparison of the two groups was made with the t- test, and facial function results were evaluated with the Fisher's exact test.Results:In the Group 1, of the 22 patients with anatomically preserved facial nerves, 3 (13.6%) showed excellent facial nerve function, 14 (63.6%) showed intermediate function, and 5 (22.7%) showed poor function. In the Group 2, all the 27 patients got anatomically preserved facial nerves, and 18 (66.7%) showed excellent facial nerve function, 9 (33.3%) showed intermediate function, and no one showed poor function.Conclusions:We found that retrosigmoid approach associated with continuous EMG facial monitoring combined with the use of bipolar stimulation is a safe and effective treatment for vestibular schwannomas.

ACTA OTORHINOLARYNGOLOGICA ITALICA

SUMMARYThe management of sporadic vestibular schwannoma (VS) has evolved in the last decades. The aim of this study was to analyse the evolution in surgical outcomes of VSs operated by a neurotological team between 1990 and 2006 by different approaches. A monocentric retrospective review of medical charts of 1006 patients was performed. In order to assess eventual changes and progress, the 17-years period was divided in three periods, each one comprehending 268 VS (1990-1996), 299 VS (1997-2001), and 439 VS (2002-2006). Mean follow-up was 5.9 ± 2.4 years. Overall, complete VS removal was achieved in 99.4% of cases. Mortality rate was 0.3%, meningitis and CSF leaks were observed in 1.2 % and 9 % of the cases, respectively. CSF leakage decreased from 11.6% to 7.1% between the first and last period (p < 0.01) as well as revision surgery from 3.4 % to 0.9 % (p < 0.05). Facial nerve was anatomically preserved in 97.7% of cases. At one year, a good facial nerve function was observed in 85.1% of patients (grade I and II of House-Brackmann grading scale), which ranged between the first and last period from 78.4% to 87.6% (p <0.05). At one year, hearing preservation was obtained in 61.6% of patients, which increased from the first period to the last one from 50.9% to 69.0% (p < 0.05) (class A+B+C from the AAO-HNS classification). Useful hearing (class A+B) was observed in 33.5% of cases overall, with 21.8% and 42% in the first and last period, respectively (p < 0.01). Surgical outcomes of sporadic vestibular schwannoma have improved concerning facial nerve function outcomes, hearing preservation and cerebrospinal fluid (CSF) leaks, mainly due to the neuro-otological team's experience. Functional results after complete microsurgical removal of large VS depend on experience gained on small VS removal.

Role of Facial Nerve Motor-Evoked Potential Ratio in Predicting Facial Nerve Function in Vestibular Schwannoma Surgery Both Immediate and at 1 Year.

To determine whether transcranial electrical stimulation-induced facial motor-evoked potential (FMEP) monitoring of the facial nerve (FN) during vestibular schwannoma (VS) tumor resection can predict both immediate and 1 year postoperative FN functional outcome. Prospective consecutive non-comparative observational case series. Tertiary referral center. Facial function, immediate post operation and at 1 year using House-Brackmann (HB) grading scale. The study included 367 consecutive patients (men 178; women 189; age 13-81 years) monitored during primary sporadic VS microsurgery between November 2002 and April 2015. Neurofibromatosis type II, revision surgery, previous radiotherapy treatment, preoperative facial nerve weakness, and non-VS cases were excluded retrospectively during analysis of data. Data of facial function were missing from eight patients at 1 year and were excluded. The correlation between the final-to-baseline FMEP ratio and immediate and 1 year facial nerve function was examined. Using logistic regression model, the cut-off points of FMEP ratio were 0.62 (PPV 0.96) and 0.59 (PPV 0.98) which predicted satisfactory FN function (HB grades 1 or 2) immediately postoperative and at 1 year after surgery, respectively. Transcranial electrical stimulation FMEP is a valuable tool for monitoring facial nerve function during resection of vestibular schwannoma. Maintaining a FMEP event-to-baseline ratio of 60% or greater is predictive of satisfactory long-term FN function.

Surgical strategy for postburn facial scar contracture

Postburn facial scar contracture, which can cause disfigurement and functional impairment, is a major therapeutic challenge. Except for some scars with severe functional impairments such as ectropion of lid, obstruction of nostril, microstomia, and so on, other kinds of facial scars are recommended to be reconstructed after they become sufficiently softened. The selection of specific methods depends on the characteristics of the facial scar. The methods includ direct closure after resection, full or split-thickness skin transplantation, pedicled flap, distant flap, and free flap transfer, and tissue expansion. For the resurfacing of subtotal or total face deformity, composite facial tissue allotransplantation and prefabricated flap combined with tissue expansion and autologous fat injection are increasingly used to improve the facial aesthetic and functional outcome.

Geniculate Ganglion Tumors: Clinical Presentation and Surgical Results.

Facial nerve tumors are rare lesions mostly located in the geniculate ganglion. This study aims to compare those tumors limited to the geniculate ganglion in terms of clinical features and postoperative outcomes. Case series with chart review. University tertiary reference center. Medical charts were reviewed for 17 patients who had surgery for geniculate ganglion tumor removal (10 hemangiomas, 6 schwannomas, 1 meningioma). Hemangiomas and schwannomas were compared for preoperative facial nerve function, hearing, tumor size, and postoperative outcomes. Facial palsy was observed in all cases. Regarding the preoperative facial nerve function, severe facial palsy (House-Brackmann grades V and VI) was present in 70% of cases for hemangiomas and for no case of schwannoma (P = .01), although hemangiomas were significantly smaller tumors (P = .01). Hearing loss was observed in 4 cases (23.5%) and was related to tumor volume (P < .0001). A complete excision was achieved in all cases, and a facial nerve graft was performed immediately after interruption in 16 patients (94%). Postoperative facial nerve function was improved or stabilized in 94% of cases. A preoperative House-Brackman grade VI was shown as a negative factor for postoperative facial nerve function. Differences in clinical presentations could help in establishing the good therapeutic option depending on the tumor type. Surgery, when indicated, is safe and effective, and postoperative outcomes are not related to tumor type.

Surgical Treatment of Giant Vestibular Schwannomas: Facial Nerve Outcome and Tumor Control

Surgical treatment of giant vestibular schwannomas (GVS) is challenging. The philosophy of incomplete tumor resection may balance the preservation of facial nerve function and long-term tumor control. We aimed to evaluate the outcome of facial nerve function and tumor control in treating GVS via our institutional surgical strategy. From September 2009 to August 2014, 218 patients who underwent surgical treatment of GVS were enrolled in our study. The clinical features, extent of resections, facial nerve outcome, and the tumor regrowth free rate of these patients were retrospectively analyzed. The treatment strategy of this disease was discussed. All patients had anatomic preservation of the facial nerve. Gross total resection (GTR) was achieved in 58 patients (28.6%), near-total resection (NTR) in 103 (50.7%), and subtotal resection (STR) in 42 (20.7%). Two patients died because of postoperative complications. After a mean follow-up of 39.7 ± 18.3 months, a favorable facial nerve outcome was achieved in 58.6%, 79.6%, and 83.3% of patients who underwent GTR, NTR, and STR, respectively. During follow-up, 20 patients had tumor regrowth and were treated by stereotactic radiosurgery (SRS), and tumor regrowth free rates were 96.6%, 92.2%, and 76.2% in GTR, NTR, and STR, respectively. The extent of resection was the independent risk factor for poor facial nerve function (P= 0.006). A surgical philosophy of prioritizing facial nerve preservation over total tumor resection was recommended in treatment of GVS. Favorable facial nerve outcome and tumor control were achieved after NTR of the tumors.

Relationship and influencing factors between the amplitude change of supramaximal facial nerve stimulation during acoustic neuroma removal and facial function outcome

To investigate the relationship between the amplitude change of supramaximal facial nerve stimulation during acoustic neuroma removal and facial function outcome, and discuss its influencing factors. Retrospective study of 34 acoustic neuroma patients. Intraoperative amplitude by supramaximal stimulation, facial function outcome, tumor size, surgical approach, facial nerve course pattern, and tumor cystic status, as well as tumor adhesion degree were collected and analyzed by SPSS 17.0. Acoustic neurnomas were removed in all 34 patients without intra- and postoperative complications, the facial nerve were all anatomically preserved. Two weeks later, 5 cases showed facial function HB Grade Ⅰ, 13 HB Ⅱ, 11 HB Ⅲ and 5 HB Ⅳ. The amplitude changes under supramaximal stimulation after tumor removal were 12.9%-100%, average (63.9±25.7)%. The facial function outcomes were poor (HB Ⅳ) in the cases whose intraoperative amplitude decreases were more than 70%. Different postoperative facial function group showed significantly different intraoperative amplitude changes (F=7.585, P=0.001), except HB Ⅰ group and HB Ⅱ group. The existence of cystic degeneration showed strong correlation (r=-0.635) to the amplitude changes, the level of tumor adhesion showed moderately negative correlation (r=-0.455), and tumor size showed weak negative correlation (r=-0.292), surgical approach and the facial nerve course pattern were not statistically relevant. The amplitude change of facial nerve supramaxial stimulation can predict the postoperative facial function. The amplitude change is valuable for early treatment of facial nerve damage.

Facial nerve repair after operative injury: Impact of timing on hypoglossal-facial nerve graft outcomes

PurposeReanimation of facial paralysis is a complex problem with multiple treatment options. One option is hypoglossal-facial nerve grafting, which can be performed in the immediate postoperative period after nerve transection, or in a delayed setting after skull base surgery when the nerve is anatomically intact but function is poor. The purpose of this study is to investigate the effect of timing of hypoglossal-facial grafting on functional outcome. Materials and methodsA retrospective case series from a single tertiary otologic referral center was performed identifying 60 patients with facial nerve injury following cerebellopontine angle tumor extirpation. Patients underwent hypoglossal-facial nerve anastomosis following facial nerve injury. Facial nerve function was measured using the House–Brackmann facial nerve grading system at a median follow-up interval of 18months. Multivariate logistic regression analysis was used determine how time to hypoglossal-facial nerve grafting affected odds of achieving House–Brackmann grade of ≤3. ResultsPatients who underwent acute hypoglossal-facial anastomotic repair (0–14days from injury) were more likely to achieve House–Brackmann grade ≤3 compared to those that had delayed repair (OR 4.97, 95% CI 1.5–16.9, p=0.01). ConclusionsEarly hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm.

Functional Outcome of the Facial Nerve After Surgery for Vestibular Schwannoma: Prediction of Acceptable Long-Term Facial Nerve Function Based on Immediate Postoperative Facial Palsy

To examine the relationship between immediate postoperative facial palsy and long-term facial palsy and identify a treatment strategy for vestibular schwannoma considering long-term outcomes of facial nerve function and tumor control. Patients (N= 385) who underwent surgery in a single institution were reviewed retrospectively; 12 patients with neurofibromatosis, 6 with preoperative radiosurgery, and 14 with multiple surgeries were excluded. The generalized estimating equation method was used to show the correlation between immediate and later postoperative facial palsy and to identify the cutoff grade of immediate postoperative facial palsy. The tumor control rates for 1 year, 3 years, and 5 years were 88.7%, 83.9%, and 80.0%. Preservation of facial function above House-Brackmann (H-B) grades 1 and 2 was achieved in 47.9% of patients immediately postoperatively, in 50.1% after 1 month, and in 74.5% after >2 years. The immediate postoperative facial palsy grade showed a statistically significant relationship with the facial palsy grade on long-term follow-up (P < 0.001). H-B grade 3 immediate postoperative facial palsy was identified as the cutoff grade that showed the most significant relationship between the grade of immediate postoperative facial palsy and the grades above the cutoff (H-B grade 1-3) on long-term follow-up (P < 0.001). H-B grade of immediate postoperative facial palsy can predict facial palsy at long-term follow-up. H-B grade 3 immediate postoperative facial palsy is the lowest tolerable grade that guarantees functional improvement on long-term follow-up. Planned facial nerve preservation surgery followed by radiosurgery is thought to be optimal treatment in patients with vestibular schwannoma for both tumor control and facial nerve function.

Microsurgical management of vestibular schwannoma after failed previous surgery.

OBJECTIVE Microsurgical treatment of recurrent vestibular schwannoma (VS) is difficult and poses specific challenges. The authors report their experience with 53 cases of surgically treated recurrent VS. Outcome of these tumors was compared to that of primarily operated on VS. Special attention was given to the facial nerve functional outcome. METHODS A retrospective analysis was performed of the patients who underwent surgery for recurrent VS at one institution from 2000 to 2013. The preoperative data, intraoperative findings, and outcome in terms of facial nerve function and improvement of the preoperative symptoms were analyzed and compared with those in a control group of 30 randomly selected patients with primarily operated on VS. A multivariate regression analysis was performed to test the factors that could affect the facial nerve outcome in each group. RESULTS Fifty-three consecutive patients underwent surgery for recurrent VS. Seventeen patients were previously operated on and received postoperative radiosurgery (Group A). Thirty-six patients were previously operated on but did not receive postoperative radiosurgery (Group B). The overall postoperative facial nerve function was significantly worse in Groups A and B in comparison with the control group (Group C). Interestingly, there was no significant difference in the facial nerve outcome among the 3 groups in patients who had good preoperative facial nerve function. The tumor size and the preoperative facial nerve function are variables that significantly affect the facial nerve outcome. Most of the patients showed improvement of the preoperative symptoms, such as trigeminal hypesthesia, gait disturbance, and headache. CONCLUSIONS Complete microsurgical tumor removal is the optimal management for patients with recurrent or regrowing VS. The procedure is safe, associated with favorable facial nerve outcome, and may also improve existing neurological symptoms.

Facial Nerve Monitoring.

Facial nerve monitoring has been increasingly routinely used as an intraoperative adjunctive method to help the head and neck surgeon to identify and minimize facial nerve injury during parotid surgery. The goals, current applications, recent technical advances, and limitations of the method are reviewed. A main focus of this chapter is a review of several prospective clinical trials that have been performed in recent years that have analyzed the benefit of electrophysiological nerve monitoring during parotid surgery. It has been demonstrated that nerve monitoring reduces the risk of early postoperative facial nerve dysfunction in primary surgery, but not in revision surgery. The effect is more pronounced in total than in superficial parotidectomy. Monitoring is associated with shorter surgical times in primary superficial parotidectomy compared to total parotidectomy. Facial nerve stimulation at the completion of parotidectomy helps to prognosticate the facial nerve functional outcome. A lower postdissection to predissection ratio of the maximal response amplitude is associated with early postoperative facial dysfunction. Facial nerve monitoring also helps the surgeon to avoid facial nerve injury when the facial nerve is not exposed during parotid surgery, such as during extracapsular dissection of a parotid neoplasm or sentinel node biopsy.

Reconstruction of facial nerve after radical parotidectomy

Conclusion: Most patients benefitted from immediate facial nerve grafting after radical parotidectomy. Even weak movement is valuable and can be augmented with secondary static operations. Post-operative radiotherapy does not seem to affect the final outcome of facial function. Objectives: During radical parotidectomy, the sacrifice of the facial nerve results in severe disfigurement of the face. Data on the principles and outcome of facial nerve reconstruction and reanimation after radical parotidectomy are limited and no consensus exists on the best practice. Method: This study retrospectively reviewed all patients having undergone radical parotidectomy and immediate facial nerve reconstruction with a free, non-vascularized nerve graft at the Helsinki University Hospital, Helsinki, Finland during the years 1990–2010. There were 31 patients (18 male; mean age = 54.7 years; range = 30–82) and 23 of them had a sufficient follow-up time. Results: Facial nerve function recovery was seen in 18 (78%) of the 23 patients with a minimum of 2-year follow-up and adequate reporting available. Only slight facial movement was observed in five (22%), moderate or good movement in nine (39%), and excellent movement in four (17%) patients. Twenty-two (74%) patients received post-operative radiotherapy and 16 (70%) of them had some recovery of facial nerve function. Nineteen (61%) patients needed secondary static reanimation of the face.

Paralysie faciale idiopathique de l’enfant

Idiopathic facial palsy is the most common cause of facial nerve palsy in children. Controversy exists regarding treatment options. The objectives of this study were to review the epidemiological and clinical characteristics as well as the outcome of idiopathic facial palsy in children to suggest appropriate treatment. A retrospective study was conducted on children with a diagnosis of idiopathic facial palsy from 2007 to 2012. A total of 37 cases (13 males, 24 females) with a mean age of 13.9 years were included in this analysis. The mean duration between onset of Bell's palsy and consultation was 3 days. Of these patients, 78.3% had moderately severe (grade IV) or severe paralysis (grade V on the House and Brackmann grading). Twenty-seven patients were treated in an outpatient context, three patients were hospitalized, and seven patients were treated as outpatients and subsequently hospitalized. All patients received corticosteroids. Eight of them also received antiviral treatment. The complete recovery rate was 94.6% (35/37). The duration of complete recovery was 7.4 weeks. Children with idiopathic facial palsy have a very good prognosis. The complete recovery rate exceeds 90%. However, controversy exists regarding treatment options. High-quality studies have been conducted on adult populations. Medical treatment based on corticosteroids alone or combined with antiviral treatment is certainly effective in improving facial function outcomes in adults. In children, the recommendation for prescription of steroids and antiviral drugs based on adult treatment appears to be justified. Randomized controlled trials in the pediatric population are recommended to define a strategy for management of idiopathic facial paralysis.

20. Correlation between blink reflex (br) and corticobulbar motor evoked potentials (comeps) in skull base surgery and role as a predictor of clinical outcome

In 2009, Deletis et al. were the first to describe a method for eliciting the R1 component of BR in patients under general anaesthesia. The R1 includes trigeminal afferents, brainstem connections between trigeminal and facial nuclei and facial nerve. Therefore this technique might be considered a tool to intraoperatively monitor the involved structures in the reflex arc. In this work we compare the neurophysiologic behaviour of R1 component of BR and facial and/or trigeminal CoMEPs in 21 patients. The study includes 21 patients diagnosed of skull base tumours that underwent surgery by the retrosigmoidal approach. Multimodal intraoperative monitoring was performed including: BR, lower facial and trigeminal CoMEPs, SEPs, MEPs and cranial nerve mapping. We used the published methodology by Deletis et al. to elicit BR and CoMEPs. Of the 21 patients, two patients with previous facial paresis did not have a BR. Of the 19 who had a BR; nine did not show changes in BR or CoMEPs during surgery. None of those had facial or trigeminal deficit postoperatively. Eight patients lost BR and presented significant decrement in amplitude of CoMEPs. Of these eight, five recovered all responses after stopping surgery momentarily, the other three didn’t recover responses and presented postoperative facial paresis. The last two patients lost BR during the surgery while CoMEPs didn’t show any change. We assumed that these changes in BR were due to changes in depth of anaesthesia. There is a strong correlation between BR and CoMEPs changes during skull base surgery. BR and CoMEPs help to predict the clinical outcome of facial and trigeminal nerve function. BR should be included in the routine methodology for intraoperative monitoring skull base surgeries since is a reliable tool to monitor the structures involved in the reflex arc.

Hearing and facial function outcomes for neurofibromatosis 2 clinical trials

Vestibular schwannomas are the hallmark of neurofibromatosis 2 (NF2), occurring in >95% of patients. These tumors develop on the vestibulocochlear nerve and are associated with significant morbidity due to hearing loss, tinnitus, imbalance, facial weakness, and risk of early mortality from brainstem compression. Although hearing loss and facial weakness have been identified as important functional outcomes for patients with NF2, there is a lack of consensus regarding appropriate endpoints in clinical trials. The functional outcomes group reviewed existing endpoints for hearing and facial function and developed consensus recommendations for response evaluation in NF2 clinical trials. For hearing endpoints, the functional group endorsed the use of maximum word recognition score as a primary endpoint, with the 95% critical difference as primary hearing outcomes. The group recommended use of the scaled measurement of improvement in lip excursion (SMILE) system for studies of facial function. These recommendations are intended to provide researchers with a common set of endpoints for use in clinical trials of patients with NF2. The use of common endpoints should improve the quality of clinical trials and foster comparison among studies for hearing loss and facial weakness.

Long-Term Outcomes of Facial Nerve Function in Irradiated and Nonirradiated Nerve Grafts

We reviewed the long-term results of facial nerve repair in a tertiary head and neck institution in the north of England. We performed a case notes review of patients who had facial nerve repair over a 10-year period and had completed 24 months of follow-up. The study population comprised 18 female patients and 24 male patients, with an overall mean age of 53.2 years (range, 16 to 80 years). Of the 24 patients who had a cable nerve graft, the greater auricular nerve was used in 15 cases. The sural nerve was used as the donor in a cross-facial nerve graft in 9 patients. Sixteen patients had transposition nerve repair: hypoglossal and ansa cervicalis in 7 and 9 cases, respectively. Two patients had primary anastomosis after surgery for extensive malignant tumors. In this series, no patients achieved a House-Brackmann (HB) grade of II. Overall, the HB grades III, IV, and V were the best postoperative facial nerve functions achieved in 11.9%, 33.3%, and 26.2% of patients, respectively. Failure (HB grade VI) was observed in 28.6% of patients. More than half of patients (62.5%) who had either a sural nerve cable graft or a faciohypoglossal transposition had a good outcome (HB grade III or IV). In the present series, 45% of patients had an HB grade of III or IV at long-term follow-up. The best outcome (HB grade III) was observed after cross-facial grafting with the sural nerve.

Impact of various screwed implant prostheses on oral health-related quality of life as measured with the QoLIP–10 and OHIP–14 scales: A cross-sectional study

ObjectivesThis study aimed to validate the Quality of Life with Implant-Prostheses (QoLIP–10) questionnaire for assessing the impact of screwed implant-supported rehabilitations on oral health-related quality of life (OHRQoL). Methods131 patients wearing screw-retained implant restorations were assigned to the following groups: Group 1 (HP; n=50): fixed-detachable hybrid prostheses (control), Group 2 (S-PD; n=43): metal–ceramic screwed partial dentures, and Group 3 (S-CD; n=38): metal–ceramic screwed complete dentures. Impacts on OHRQoL were evaluated using the QoLIP–10 and Oral Health Impact Profile (OHIP–14sp) scales. Data on global oral satisfaction, socio-demographics, health-behaviours, and prosthetics were gathered. Reliability and validity of the QoLIP–10 were investigated for screwed prosthesis wearers. The Spearman's rank test was applied to determine the correlation between both indices. Descriptive and non-parametric probes were run to evaluate the influence of the study variables on OHRQoL. ResultsThe QoLIP–10 confirmed its psychometric capacity for screwed prosthesis wearers. Both tests were inversely correlated. HP wearers reported the worst dental–facial aesthetics, performance, and functional limitation outcomes. Gender, education level, complaints about the mouth, perception of treatment needs, and prosthetic status modulated the OHRQoL. ConclusionsScrewed implants restorations provide better OHRQoL than do fixed-detachable hybrid prostheses.