Facial Paresis Research Articles

An audit of parotid gland surgeries in Kano, Nigeria: A review of 34 cases

Neoplasms both benign and malignant are the most common indications for parotidectomy. About 70%-80% of all salivary gland tumours are located in the parotid gland with up to 80% being benign. Parotidectomy is a common surgical procedure performed by the otorhinolaryngologist and oral and maxillofacial surgeons. This study aimed to document our experience on parotid gland surgeries, and occurrence of facial nerve palsy. The records of all patients that had parotidectomy between January 2014 and December 2018 were evaluated. Demographic, clinical and operative data were retrieved and analysed using Statistical Product and Service Solution version 23.0 software (SPSS Inc., Chicago, Illinois, USA). A total of 34 cases were reviewed and there were 12 (35.3%) males and 22 (64.7%) females with a male-to-female ratio of 1:1.8 and mean age ± standard deviation of 39.3 ± 18.4 years. Patients with primary disease constituted the majority 29 (85.3%) in this series. Most of them (26, 76.5%) had superficial parotidectomy. Cervicomastoidfacial incision was the most preferred incision employed among 33 (97.1%) of our patients. Complication following surgery was observed in 12 (35.3%) patients. Majority, 7 (63.6%), had temporary facial nerve paresis. Pleomorphic adenoma was the most common histological diagnosis noted in 19 (55.9%) patients postoperatively. There is a statistically significant association between fine-needle aspiration cytology (FNAC) findings and final histological diagnosis. Pre-operative FNAC could be a reliable tool in the evaluation of our patients being prepared for parotidectomy even in our resource-poor setting.

Peripheral Facial Paresis and COVID-19 Case Report

Among the neurological complications that occurred during Corona Virus Disease 2019 (COVID-19) infection, peripheral facial paresis is one of the conditions that can occur both during and after the Severe Acute Respiratory Tract Syndrome Corona Virus 2 (SARS-CoV-2) infection period. We present the case of a young man, aged 29 years, who presented the appearance of a peripheral facial paresis on the 14th day after the onset of symptoms, isolation and PCR detection of SARS-CoV-2 infection. The patient was evaluated clinically, neurologically, underwent laboratory tests, EKG, chest Radiography, Magnetic Resonance Imaging (MRI)/Magnetic resonance Angiography (MRA) and received corticotherapy, gastric antisecretory medication, antiviral medication, vitamin B group, neurotrophic medication and facial gymnastics, with good evolution and complete remission of clinical symptoms after 21 days. It is particularly important to carefully evaluate patients during the isolation period, symptomatic/asymptomatic for COVID-19 infection, as a possible complication could be peripheral facial paresis, which is why, we should evaluate, detect and treat early to reduce any persistent long-term neurological effects. Future studies are needed to identify and correlate peripheral facial paresis with SARS-CoV-2 infection as well as to detect the causes of neurological complications during or after COVID-19 infection.

Specifics of surgical treatment of a neglected caseof complete central facial paresis

Specifics of surgical treatment of a neglected caseof complete central facial paresis

A Case of Recurrent Facial Palsy Associated with Anti-GM2: is it anyway Guillain-barré syndrome?

Objective: A rare case of possible hereditary predisposition to autoimmune neuropathy Background: This case report is of a patient who presented two episodes of Facial paresis in her live without ascertained apparent causes. Bell’s palsy is commonly known as peripheral idiopathic facial nerve palsy, because in the most cases the triggers remain unknown (1). Case Report: I want to present a case of a 34 year old woman who we will call A.B. and who came to us to evaluate the severity of the sequelae of a Bell´s palsy and any eventual need for cosmetic measure. But she had another Bell´s Palsy 9 years ago, so I started to investigate the most common and treatable causes of Facial paresis. I found a significate increase of anti-bodies against ganglioside GM2. When I explained to her that these anti-bodies is commonly related with several neurological diseases, she started to investigate her family history and she found that his father’s brother died of GuillainBarré syndrome about 40 years ago.

Intraparotid Facial Nerve Schwannoma in a 40-Year-Old Male with Hearing Loss – A Case Report

Schwannoma is a benign tumor of axonal nerve sheath. Head and neck area, particularly parotid gland is an uncommon site for Schwannoma, however it can rarely arise from the intraparotid part of facial nerve and present as either a symptomless mass or facial paresis. Its diagnosis before surgical intervention is important for the conservation of parotid gland and facial nerve. On clinical examination and imaging studies, it can be misdiagnosed easily. FNAC is a helpful tool for its diagnosis. This entity should not be ignored while dealing with parotid masses. We present a case of a patient who came with the complaint of a parotid mass. Magnetic imaging resonance (MRI) scan suggested a parotid tumor which proved to be a spindle cell neoplasm on Fine Needle Aspiration Cytology (FNAC). A definite diagnosis of schwannoma of intraparotid facial nerve was made on histopathological examination of the excision sample.

Advanced Statistical Analysis of 3D Kinect Data: Mimetic Muscle Rehabilitation Following Head and Neck Surgeries Causing Facial Paresis.

An advanced statistical analysis of patients’ faces after specific surgical procedures that temporarily negatively affect the patient’s mimetic muscles is presented. For effective planning of rehabilitation, which typically lasts several months, it is crucial to correctly evaluate the improvement of the mimetic muscle function. The current way of describing the development of rehabilitation depends on the subjective opinion and expertise of the clinician and is not very precise concerning when the most common classification (House–Brackmann scale) is used. Our system is based on a stereovision Kinect camera and an advanced mathematical approach that objectively quantifies the mimetic muscle function independently of the clinician’s opinion. To effectively deal with the complexity of the 3D camera input data and uncertainty of the evaluation process, we designed a three-stage data-analytic procedure combining the calculation of indicators determined by clinicians with advanced statistical methods including functional data analysis and ordinal (multiple) logistic regression. We worked with a dataset of 93 distinct patients and 122 sets of measurements. In comparison to the classification with the House–Brackmann scale the developed system is able to automatically monitor reinnervation of mimetic muscles giving us opportunity to discriminate even small improvements during the course of rehabilitation.

Surgery After Surgery for Vestibular Schwannoma: A Case Series.

ObjectiveWe retrospectively evaluated the oncological and functional effectiveness of revision surgery for recurrent or remnant vestibular schwannoma (rVS).MethodsWe included 29 consecutive patients with unilateral hearing loss (16 women; mean age: 42.2 years) that underwent surgery for rVS. Previous surgeries included gross total resections (GTRs, n=11) or subtotal resections (n=18); mean times to recurrence were 9.45 and 4.15 years, respectively. House–Brackmann (HB) grading of facial nerve (FN) weakness (grades II-IV) indicated that 22 (75.9%) patients had deep, long-lasting FN paresis (HB grades: IV-VI). The mean recurrent tumor size was 23.3 mm (range: 6 to 51). Seven patients had neurofibromatosis type 2.ResultsAll patients received revision GTRs. Fourteen small- to medium-sized tumors located at the bottom of the internal acoustic canal required the translabyrinthine approach (TLA); 12 large and small tumors, predominantly in the cerebellopontine angle, required the retrosigmoid approach (RSA); and 2 required both TLA and RSA. One tumor that progressed to the petrous apex required the middle fossa approach. Fifteen patients underwent facial neurorrhaphy. Of these, 11 received hemihypoglossal–facial neurorrhaphies (HHFNs); nine with simultaneous revision surgery. In follow-up, 10 patients (34.48%) experienced persistent deep FN paresis (HB grades IV-VI). After HHFN, all patients improved from HB grade VI to III (n=10) or IV (n=1). No tumors recurred during follow-up (mean, 3.46 years).ConclusionsAggressive microsurgical rVS treatment combined with FN reconstruction provided durable oncological and neurological effects. Surgery was a reasonable alternative to radiosurgery, particularly in facial neurorrhaphy, where it provided a one-step treatment.

Preoperative Evaluation and Surgical Outcome of Cochlear Implantation in NIENT

Background: Sensory neural hearing loss (SNHL) is the most common congenital sensory deficit, with an incidence of one to three per 1000 live births. Acoustic deprivation during the first 3 years of life can hinder speech and language acquisition with significant negative consequences on a child’s educational and psychosocial development. The gold standard intervention for permanent severe to profound hearing loss is cochlear implantation. Cochlear implant (CI); is a semi implantable electronic device that bypass the cochlea.
 Objectives: An observational study was carried out on 40 cases of pre-lingual deaf to find out the causes of pre-lingual deaf, to evaluate the preoperative procedures to set ideal criteria for pre -lingual cochlear implantation and to evaluate surgical procedure and outcome of cochlear implantations.
 Methods: Evaluation of the candidates included patient medical history, general health checkup, ENT examination, audiometric evaluation, CT and MRI scans, psychological profile of the candidate. A limited cortical mastoidectomy was performed. The facial recess was opened using the fossa of incudis as an initial landmark. The round window niche was visualized through the facial recess about 2 mm inferior to the stapes. A cochleostomy created by drilling over the basal turn of the cochlea anterior and inferior to the annulus of the round window membrane. The electrode array was then carefully inserted through the fenestra into the scala tympani of the cochlea. Electrophysiological testing (Neural Response Telemetry: NRT) was performed to verify the correct placement of active electrodes.
 Resulst: Among them 22 (55%) were male and 18 (45%) were female. Male female ratio was 1.2:1. Age distribution at implantation was 3.3±1.054(SD). Average hearing loss was 96.4±5.3(SD) dB and in aided audiogram was 63.7±4.6(SD) dB. Overall complications occurred in 10 (25%) cases. Transient facial nerve paresis in 2 (5%), injury of tympanic membrane in 1(2.5%), seroma 4(10%) and delayed otitis media in 1(2.5%) were observed. Major postoperative complications occurred in 2 cases including facial nerve palsy in 1(2.5%) case and spontaneous device failure in 1(2.5%) case.
 Conclusion: The result of this survey was find out the risk factor of congenital hearing loss. With a thorough preoperative evaluation, we can select proper candidates for CI which is a reliable and safe procedure with a low percentage of severe complication.
 Bangladesh J Otorhinolaryngol; October 2020; 26(2): 128-135

Assessing anxiety, depression and quality of life in patients with peripheral facial palsy: a systematic review.

ObjectivePeripheral facial palsy (PFP) is predominantly a unilateral disorder of the facial nerve, which can lead to psychological disorders that can result in decreased quality of life. The aim of this systematic review was to assess anxiety, depression and quality of life symptoms associated with PFP.Data sourcesWe searched the Medline, PEDro, CINAHL and Google Scholar databases to conduct this systematic review while following Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards. The search was performed by two independent reviewers, and differences between the two reviewers were resolved by consensus.Study SelectionThe search terms used were derived from the combination of the following MeSH terms: “facial paralysis”, “bell palsy”, “anxiety”, “anxiety disorders”, “depression”, “depressive disorders”, “quality of life” and not MeSH: “facial palsy”, “hemifacial paralysis”, “facial paresis”, “Peripheral Facial Paralysis”, using the combination of different Boolean operators (AND/OR).Data ExtractionOn November 1st (2019).Data SynthesisIn total, 18 cross-sectional articles and two case-control studies were selected.ConclusionsThe cross-sectional articles showed low methodological quality, while the case-control studies showed acceptable methodological quality. Limited evidence suggests that patients with PFP might have increased levels of anxiety and depressive symptoms. A qualitative analysis also showed limited evidence that quality of life might be diminished in patients with PFP.PROSPEROCRD42020159843.

Location of emotional corticobulbar tract in the internal capsule

Emotional facial paresis (EFP) is a rare neurological symptom with intact volitional facial movement. The exact location of emotional corticobulbar tract remains unclear. EFP was frequently recognized following the surgery of stereotactic radiofrequency thermocoagulation for hypothalamic hamartoma in 84.5% of 58 patients. To examine our hypothesis that EFP might be caused by stereotactic trajectories passing through an area including the internal capsule (IC), topographical locations of trajectories were analyzed and compared between the EFP-positive group (n = 41) and the EFP-negative group (n = 8). In the EFP-positive group, multiple (2 to 5) trajectories focused within the genu of the IC in 31 (75.6%) cases, whereas a single trajectory passed through the genu in 8 (19.5%) cases. In the EFP-negative group, 6 (75.0%) of 8 patients had a single trajectory and only one patient had two trajectories passing through the genu of the IC. The ratio between multiple trajectories and a single trajectory relevant to the genu differed significantly between two groups (p < 0.01). The multiple trajectories focusing in the genu have high risks of EFP, whereas a single trajectory seemed to incidentally cause EFP. The results proved our hypothesis and provided a high probability that the emotional corticobulbar tract passes through the genu rather than anterior or posterior limbs of the IC. The location of the emotional corticobulbar tract is in the genu of the IC.

Assessment of anti-HSV antibodies in patients with facial palsy in the course of neuroborreliosis.

There are many causes of facial nerve palsy. The most common causes are neuroborreliosis (NB), idiopathic paralysis or Herpes simplex virus (HSV) reactivation. The aim of this study was to characterize patients with facial palsy in the course of NB and to determine whether HSV-1 reactivation takes place during the acute phase of NB. A retrospective analysis of 66 patients with facial nerve palsy was performed. In 38 patients, facial palsy was caused by Borrelia burgdorferi sl infection. Immunological tests for HSV-1, tick-borne encephalitis virus and B burgdorferi sl in serum and cerebrospinal fluid (CSF) were performed. In this analysis, 55.2% of NB patients had right nerve palsy and 21% bilateral palsy; 15.8% of patients had erythema migrans (EM). Lymphocytic meningitis was diagnosed in 92% of patients and Bannwarth's syndrome was diagnosed in 47% of patients. IgM anti-HSV-1 antibodies were detected in four patients with NB and two patients with facial nerve palsy of other origin. IgM anti-HSV-1 antibodies were detected in the CSF of three patients (7.9%) with NB, and one of them had bilateral VII paresis and EM simultaneously. Treatment with ceftriaxone or doxycycline led to complete recovery. Neuroborreliosis should always be considered as a cause of peripheral facial nerve palsy. Peripheral facial nerve palsy is a significant symptom in the course of NB, especially in patients accompanied by meningitis. Pathomechanism of facial nerve paresis has not been well explained so far and may depend on two independent mechanisms in NB, including HSV-1 reactivation.

Prognostic Factors for the Outcome of Translabyrinthine Surgery for Vestibular Schwannomas.

Objective:To identify predictors of tumor recurrence and postoperative facial nerve function after translabyrinthine surgery for unilateral vestibular schwannomas.Study Design:Retrospective study.Setting:Tertiary referral center.Patients:Between 1996 and 2017 a total of 596 patients with unilateral vestibular schwannoma underwent translabyrinthine surgery. Pre- and postoperative clinical status, radiological, and surgical findings were evaluated.Intervention(s):Translabyrinthine surgery.Main Outcome Measure(s):Potential predictors for tumor recurrence and facial nerve outcome were analyzed using Cox regression and ordinal logistic regression, respectively.Results:The extent of tumor removal was total in 32%, near-total in 58%, and subtotal in 10%. In 5.5% (33/596) of patients the tumor recurred. Subtotal tumor resection (p = 0.004, hazard ratios [HR] = 10.66), a young age (p = 0.008, HR = 0.96), and tumor progression preoperatively (p = 0.042, HR = 2.32) significantly increased the risk of recurrence, whereas tumor size or histologic composition did not. A good postoperative facial nerve function (House–Brackmann grade 1–2) was achieved in 85%. The risk of postoperative facial nerve paresis or paralysis increased with tumor size (p < 0.001, OR = 1.52), but was not associated with the extent of tumor removal, histologic composition, or patient demographics.Conclusions:Translabyrinthine surgery is an effective treatment for vestibular schwannoma, with a good local control rate and facial nerve outcome. The extent of tumor removal is a clinically relevant predictor for tumor recurrence, as are young patient age and preoperative tumor progression. A large preoperative tumor size is associated with a higher risk of postoperative facial nerve paresis or paralysis.

Enhanced fallopian canal as a potential marker for temporal bone vasculitis.

ObjectivesThis study aimed to test the hypothesis that contrast‐enhanced 3D MRI with gradient‐echo sequences (CE‐3D‐GRE) can detect signs of vasculitis in the fallopian canal, which may cause otologic involvement, in four patients with antineutrophil cytoplasmic antibody‐associated vasculitis (AAV).MethodsCE‐3D‐GRE acquired at 3.0 Tesla was performed on four patients diagnosed with granulomatosis with polyangiitis or eosinophilic granulomatosis with polyangiitis, at onset or relapse of the disease, and in remission. Clinical correlations between otologic symptoms and radiological findings were examined for each patient. Furthermore, signal intensity of the mastoid segment of the fallopian canal was compared between the ears with active disease (n = 3) and those in remission or without vasculitis (n = 3).ResultsIntense enhancement in the tympanic and mastoid segments of the fallopian canal was associated with development of external otitis, otitis media, and sensorineural hearing loss, and was unrelated to the presence of facial paresis. Maximal intensity projection images visualized the close relationship between the enhanced fallopian canal and middle ear inflammation. The findings were absent in remission. Signal intensity of the mastoid segment of the fallopian canal was higher in ears with active disease than in normal ears (P < .001) and decreased to normal levels during remission (P = .597).ConclusionCE‐3D‐GRE can demonstrate vasculitis in the temporal bone, reflecting disease activity and the severity of otologic manifestations, including cochlear involvement, in AAV patients. Intense enhancement of the fallopian canal on CE‐3D‐GRE can be a potential marker for vasculitis of the temporal bone.Level of Evidence5.

Neurootological manifestations of Lyme borreliosis

Introduction: The incidence of tick-borne diseases in Poland and Europe is increasing which is considered to be due to climate warming which promotes the growth of tick populations. Lyme borreliosis is the most prevalent leptospirosis in the US and Europe. Due to the potential for serious complications and the lack of specific prevention, diagnostic vigilance is essential so as to ensure early diagnosis and implementation of treatment. The main pathogen-transmitting vector is the tick species Ixodex ricinus. The suborder of ticks (Ixodida) belongs to the Acari subclass of arachnids. The natural reservoir of B. burgdorferi consists of small and medium-sized mammals and birds. Around ¾ of patients with Lyme disease report complaints and present disease symptoms within in the head and neck. The symptoms are diverse and may occur at all stages of the disease. These include headaches, neck pain and stiffness, sore throat, dizziness, cervical lymphadenopathy, otalgia, tinnitus, sudden hearing loss, and facial muscle paresis. Despite numerous papers being published on neurological manifestations of Lyme disease, the issues regarding the location of damage within the course of the auditory pathway and the balance system remain unanswered. In some cases hearing disorders may be due to central damage while others may be due to peripheral damage. Objective: The article provides an overview of reports on the clinical course and manifestation of Lyme borreliosis.

Microsurgical Resection of a Large Dumbbell-Shaped Jugular Foramen Schwannoma via Infralabyrinthine, Retrofacial, and Transjugular Approach.

Surgical removal of large jugular foramen schwannomas with intra- and extracranial extension is challenging. The treatment goal is a gross total resection of the tumor without causing surgical complications, including facial nerve paresis, hearing disturbance, dysphagia, hoarseness, and cerebrospinal fluid (CSF) leakage, in addition to the brain stem injury.We present a surgical video in a patient with a dumbbell-shaped glossopharyngeal schwannoma. The combination of posterior fossa craniotomy, mastoidectomy, and unroofing of the jugular foramen with high cervical exposure was selected. Although transposition of the mastoid segment of the facial nerve provides an excellent surgical corridor, it may affect normal facial nerve function. Sufficient drilling of the infralabyrinthine, retrofacial area of the mastoid without facial nerve transposition is important for the safe gross total removal of the tumor. Subcapsular removal behind the jugular vein is also important for preservation of the lower cranial nerve functions. The patient underwent a gross total removal of the tumor ( Figs. 1 and 2 ). Facial nerve function was preserved and hearing disturbance improved. Although dysphagia and hoarseness complicated postoperatively, he became able to take foods orally 16 days after the surgery. In summary, successful removal of a large dumbbell-shaped jugular foramen tumor can be completed via infralabyrinthine, retrofacial, and transjugular approach without facial nerve transposition. The link to the video can be found at: https://youtu.be/U4CwOW78id4 .

Adverse Events Associated With Botox as Reported in a Food and Drug Administration Database.

Botulinum toxin treatment is the most frequently performed noninvasive cosmetic procedure performed in the USA. Because of its widespread use, an analysis of the adverse event (AE) profile of Botox injections is needed. The FDA Adverse Event Report System was queried using an online web-based tool to determine the top 15 adverse events reported for four Botox brand names: Botox/Botox Cosmetic, Dysport, and Xeomin. The proportional reporting ratios (PRR) and relative odds ratios (ROR) were determined. A literature review was performed for eight AEs of clinical significance: eyelid/eyebrow ptosis, asthenia, muscular weakness, facial paresis, dysphagia, botulism, and death. Botox/Botox Cosmetic had 38367 AEs. Dysport had 3582 AEs. Xeomin had 1405 AEs. All drugs with reported cases of eyelid and eyebrow ptosis had significant PRR and ROR values. The PRR and ROR values for asthenia were not significant in any of the drugs and only reached significance for Dysport for muscular weakness and dysphagia. Both Botox/Botox Cosmetic and Dysport had elevated PRRs and RORs for facial paresis and botulism. While all drugs had at least one reported case of death related to Botox injection use, none of the PRR or ROR values were significant. Known AEs for Botox injection use include eyelid/brow ptosis and muscular weakness. Feared but rare complications of Botox injection use include dysphagia, botulism, and possibly death, owing to systemic spread of the toxin. This is the first study to analyze the AE data reported to the FDA on Botox injection use. III.

Total conservative parotidectomy for management of benign parotid neoplasms

BackgroundThis study assesses the outcomes of total conservative parotidectomy in the management of benign parotid neoplasms. A retrospective review was conducted for all parotidectomies for benign superficial parotid neoplasms from 2013 to 2018. Facial nerve dysfunction, recurrence, and other side-effects were collected and statistically analyzed.ResultsA total of 21 patients were included in our study. Our series included a pleomorphic adenoma (16 patients), Warthin tumor (4 patients), and oncocytoma (1 patient). Overall, 12 patients had temporary facial nerve paresis (57.1%), 3 patients had temporary paralysis (14.3%)—no reported cases of permanent paralysis—and 6 patients sustained postoperative good facial nerve function (28.6%). No recurrence was reported in our study period. Other side effects included hemorrhage (1 patient), hematoma (2 patients), seroma (4 patients), and partial skin flap necrosis (2 patients). As well, Frey’s syndrome was reported in 11 patients, and most of them were managed conservatively.ConclusionsTotal conservative parotidectomy is a valuable approach for removing parotid tumors. The rate of complications after this procedure (facial nerve dysfunction and recurrence) is low provided that the technique was performed with meticulous care.

Proton Radiotherapy For Vestibular Schwannomas: A Cohort Study

Radiotherapy for vestibular schwannomas (VS) achieves excellent tumor control rates (90-100%). As long-term survival is excellent in these patients, a paramount focus in therapy is prevention of long-term toxicity. Radiotherapy with proton therapy may improve patient outcomes by reducing radiation dose to surrounding normal tissues. Chart review and volumetric MRI-analyses were performed on vestibular schwannoma patients treated with proton radiotherapy (PT) between 2003-2018 at a single institution. Patients with a minimum radiological follow-up of 12 months were included. Tumor control was defined as not requiring salvage treatment. Available toxicity data were collected. Of 276 identified patients, 221 patients met the inclusion criteria. Tumor control was 96% with a median radiological follow-up of 4.4 years. The majority of patients (62%) received single fraction proton stereotactic radiosurgery (PSRS), and the remaining (38%) received standard fractionated therapy. Fractionated radiated patients had larger median tumor volumes and larger extracanalicular tumor diameters at baseline (p < 0.001). Cystic tumors showed an increased shrinkage rate after treatment, although this did not reach significance (p = 0.084). Facial paresis was seen in 1%, trigeminal neuralgia in 4%, hydrocephalus in 2%, and severe dizziness in 6% of patients receiving proton radiotherapy as primary treatment. Trigeminal neuralgia occurred more often in patients with larger tumor volumes (OR 1.44, p-value 0.005) and in patients that received fractionated therapy (OR 5.0, p = 0.0496). Cochlear mean doses were 8.8 and 43.4 Gy (RBE) for PSRS and fractionated patients, however with wide ranges (0.3 - 12.4 and 1.4 - 53.9 Gy (RBE)). Audiological follow-up was available for 51 patients. Median maximal speech discrimination decreased from 78% to a one-year post-irradiation of 54% to last follow-up (median 48 months) of 33%. Proton radiotherapy for vestibular schwannoma achieves high tumor control and reasonably low toxicity rates. Some sequelae of radiation (vestibular functioning, cognitive functioning, quality of life) warrant further evaluation. Patient subgroups that may significantly benefit from proton therapy should be identified to merit its higher costs as compared to photon therapy.Abstract 3662; TableFractionated treatmentSingle doseSignificanceAge, median, years (range)59 (28 - 85)66 (23 - 86)P < 0.001Tumor volume, median, cc (range)1.04 (0.1 - 10.5)0.6 (0.1 - 4.6)P < 0.001Cystic tumor16 unknown: 1612 unknown: 36P = 0.068Dmean tumor, mean Gy (RBE) (range)52.7 (46.6 - 56.8)13.1 (10.9 - 24.0)-Dmax brainstem, mean Gy (RBE) (range)49.5 (6.5 - 57.9)9.8 (0 - 13.7)-Dmean cochlea, mean Gy (RBE) (range)43.4 (1.4 - 53.9) unknown: 78.8 (0.3 - 12.4) unknown: 50-Facial paresis *20-Trigeminal neuralgia*62OR: 5.089, p = 0.0496Severe dizziness*67-*New onset or increase in symptoms; PT as primary treatment Open table in a new tab

Single-surgeon parotidectomy outcomes in an academic center experience during a 15-year period.

ObjectiveAs large single‐surgeon series in the literature are lacking, we sought to review a single‐surgeon's experience with parotidectomy in an academic center, with a focused analysis of pathology, technique, and facial nerve (FN) weakness. Benchmark values for complications and operative times with routine trainee involvement and without continuous FN monitoring are offered.Materials and MethodsAll patients who underwent parotidectomy, performed by D. G. D., for benign and malignant disease between January 2004 and December 2018 at an academic center were reviewed.ResultsA total of 924 parotidectomies, with adequate evaluatable data were identified. The majority of patients had benign tumors (70.9%). Partial/superficial parotidectomy was the most common approach (65.7%). Selective FN branch sacrifice was rare (12.3%), but significantly more common among patients with malignant pathology (33.8% vs 3.5% for benign, P < .0001). Among patients with intact FN, post‐operative short‐ and long‐term FN weaknesses were rare (6.5% and 1.7%, respectively). These rates were lower among patients with benign tumors (5.4% and 1.3%). Partial/superficial parotidectomy for benign tumors was associated with a low rate of short‐ and long‐term FN weaknesses (2.7% and 0.9%). Mean OR time was 185 minutes.ConclusionThis is the largest single‐surgeon series on parotidectomy, spanning 15 years. We demonstrate excellent long‐ and short‐term FN paresis rates with acceptable operative times without regular use of continuous FN monitoring and with routine trainee involvement. These findings may provide valuable insight into parotid tumor pathology, FN outcomes, and feasibility and expectations of performing parotidectomy in an academic setting.Level of Evidence4.

Endoscope-assisted facial nerve decompression for traumatic tympanic segment of facial nerve paresis

Traumatic facial nerve paresis is an undesired sequel following temporal bone fractures. The choice of surgical approach for this condition is largely dependent on the site of the lesion. A 33-year-old woman presented with delayed facial nerve paresis following a motor vehicle accident, which did not show any improvement with conservative treatment for 3 months. Preoperatively, she had facial nerve paresis House–Brackmann grade V. She underwent endoscope-assisted facial nerve decompression involving the tympanic segment of the facial nerve. A standard postauricular mastoidectomy was performed. The mastoid segment of the facial nerve was identified but there was no obvious fracture or bony spicule seen. An extended posterior tympanotomy was done and endoscope was used by way of this corridor to examine the tympanic segment of the facial nerve until the second genu which appeared to be emaciated with lack of lustre. Finally, neurolysis was done under endoscopic guidance. She regained significant improvement in her facial nerve function 8 months postoperatively to House–Brackmann grade II.