Facial Paresis Research Articles

Factors Associated With Facial Nerve Paresis Following Gamma Knife for Vestibular Schwannoma.

Evaluate the incidence of and potential contributory factors to facial nerve paresis and other cranial neuropathies (CN) following stereotactic radiosurgery with Gamma Knife (GK) for primary treatment of vestibular schwannoma (VS). Retrospective chart review. Tertiary referral center. Charts were reviewed for all adult patients receiving primary GK treatment for unilateral VS between 2005 and 2013. Patients with NF2 or previous surgery were excluded from analysis. GK radiosurgery. The incidence of new-onset facial nerve paresis after primary GK treatment of VS was evaluated. Secondary endpoints included other cranial neuropathies. One hundred thirty-three patients with VS received primary GK therapy. Posttreatment CN developed in 33 patients (24.8%). Twelve patients (9.0%) experienced trigeminal paresthesia, 11 (8.3%) developed sudden sensorineural hearing loss (SSNHL) requiring steroids, and seven (5.3%) demonstrated facial paresis. The mean maximum cochlear dose was 15.49 Gy in patients with facial paresis compared with 12.42 Gy in subjects without facial paresis (p = 0.032). Subjects with facial paresis were more likely to have a lateral tumor without fundal fluid on magnetic resonance imaging (MRI) (71%) compared with subjects without facial paresis (43%). In the treatment of VS with primary GK, maximum cochlear dose was significantly associated with facial paresis. Laterally extending tumors without fundal fluid on MRI experienced higher rates of facial paresis. These factors should be considered during GK treatment planning for VS.

Microsurgical Resection of Trigeminal Schwannomas: 3-Dimensional Operative Video.

Trigeminal schwannomas are benign lesions arising from the Schwann cells of the trigeminal nerve. This is an unusual tumor that accounts for less than 0.4% of intracranial pathologies, even though they are the second most frequent schwannoma after the vestibular schwannoma. The tumor spreads along the natural course of the V nerve at its cisternal portion, along the ganglion inside Meckel's cave or through its peripheral division. Even though the tumor can reach great size and become multicompartmental. We present a 51-yr-old woman, with an history of 3 mo of incapacitating facial pain, that was found on examination to be on the territory of the third division of the trigeminal nerve on the right side. The MRI depicted a large homogeneous enhancing lesion at the base of the right middle fossa with extension through the petrous apex to the most superior and medial part of the posterior fossa. The patient was operated by the senior author, through a middle fossa approach, dissecting between the two layers of the middle fossa dura (the apparent inner and the true outer layer of the cavernous sinus), the so called middle fossa "peeling". We achieved total resection of the tumor, but the patient presented after surgery with facial nerve paresis. This is thought to be related to geniculate ganglion manipulation, as it was unprotect by bone at the middle fossa and the patient maintained lacrimal function (post-geniculate alteration). It resolved completely after 6 mo. The patient consented to publication of her images.

Lyme Neuroborreliosis in a Critically Ill Patient

Lyme neuroborreliosis (LNB) is a nervous system infection caused by the species of the spirochete Borrelia. A woman, with a history of right facial palsy, was admitted to the physical and rehabilitation medicine (PRM) unit for the rehabilitation of presumed sequalae of aneurism rupture and neuromuscular weakness related to critical illness. She presented in the PRM unit with flaccid quadriparesis, right facial nerve paresis, bulbar paresis, aphonia, dysphagia, and hypoactive deep-tendon reflexes. Electromyography (EMG) revealed multifocal neuropathy and serologic tests revealed positive for Borrelia (IgG). The patient was treated with 2 weeks of intravenous ceftriaxone with a marked improvement in the following days. LNB diagnosis was made due to the clinical presentation, positive Borrelia serology, and great improvement with targeted therapy. Neuromuscular weakness related to critical illness was the main differential diagnosis; however, weakness in bulbar and facial musculature and the EMG findings were not consistent with this diagnosis.

Acute Peripheral Facial Palsy: Recent Guidelines and a Systematic Review of the Literature.

BackgroundThis study reviews recent literature on facial palsy guidelines and provides systematic reviews on related topics of interest.MethodsAn electronic database search was performed to identify recent guidelines dealing with facial nerve palsy, systematic reviews and recent meta-analysis published between 2011 and 2019 (inclusive). The literature search used the search terms “Bell's palsy,” “Ramsay-Hunt syndrome,” “Facial palsy,” “Facial paralysis,” “Facial paresis,” “Guideline,” “Meta-analysis,” “Systematic review,” and “Randomized controlled trial.” Only studies written in English were used.ResultsThe characteristics of treatment trends for facial palsy have been reviewed over the past decade. The most prominent change noted may be the shift from the conventional House-Brackmann facial nerve grading system to the Sunnybrook and eFACE systems. In addition, the results of serial meta-analyses indicate increasing agreement with the use of surgical decompression of the facial nerve. Beyond steroids or combined steroid-antiviral treatment, various novel drugs and treatments have been tried. For long-standing facial paralysis and postparetic synkinesis sequelae after facial palsy, facial reanimation has been highlighted and the necessity of new paradigms have been raised.ConclusionFor peripheral facial paralysis, various changes have been made, not only in the facial nerve grading systems, but also in medical treatments, from surgical procedures to rehabilitation, during the last decade.

Parotid gland neoplasms presenting as discrete infra-auricular swellings

Background: Parotid gland neoplasms usually present as pre-auricular swellings. Sometimes, they present as solitary infra-auricular swellings which make their localization difficult as they may be confused with submandibular gland or other lateral upper neck masses. Clinicopathological reports of discrete infra-auricular parotid lesions and their surgical managements are few. Objectives: To describe the clinical features and management of discrete infra-auricular parotid masses in a series of Nigerian patients seen during a surgical outreach mission. Methodology: This is a retrospective study of all infra-auricular swellings managed by a Nigerian surgical mission over 6 years. Patients' demographics, duration of swelling, symptoms, treatment, histopathological diagnosis, postoperative complications were retrieved from patients' records. Results: A total of 124 facial tumors were seen, of which 15 (12.1%) were parotid tumors. Eight cases (53.3%) of parotid tumors presented as discrete infra-auricular masses. Age range was 13–57 years (mean = 40.9 ± 15.4 years) with male predilection. Duration of swelling was between 1 and 15 years. All lesions were treated with extracapsular dissection. One patient had postoperative facial nerve paresis, but no facial palsy and sialocele. The histopathological results were 5 (62.5%) pleomorphic adenomas, 1 (12.5%) Warthin's tumor, and 2 (25%) low-grade mucoepidermoid carcinomas. Conclusion: Discrete infra-auricular swellings may present as benign and malignant parotid gland neoplasms.

Complications of Parotid Surgery—10 Years’ Experience

Background: Parotid surgery with dissection of the facial nerve branches is a technically challenging surgery. Even in experienced hands, parotidectomy has well-documented post-operative complications. We aim to evaluate complications following parotid surgery. Methods: We retrospectively reviewed the charts of 187 patients who underwent parotidectomy from January 2010 to January 2020 performed in surgical oncology department South Egypt Cancer Institute, Assiut University, from patients (57.3% males and 42.7% females, average age 42.96 years). Results: 78.4% Patients had benign tumors, the most frequent being pleomorphic adenoma 55.1% followed by Warthin’s tumour 16.9%, and 21.6% malignant tumors, mucoepidermoid carcinoma being the most frequent. Superficial parotidectomy was the most common surgery 40.4% performed followed by 25.3%, total conservative parotidectomy, while 1.1%, underwent radical parotidectomy, (extended radical parotidectomy was performed 2.2%), and revision total parotidectomy (Recurrence 6.7%, and parotidectomy with modified radical neck dissection (MRND) 7.9%. The most common complication following parotidectomy was transient facial nerve palsy 21.3%. Permanent facial nerve paresis was observed in 3.9%, sensory deficit in 20.2%, sialocele in 6.7%, hematoma formation 3.4% and wound infection in 7.3%, and recurrence 7.3%. Frey’s syndrome occurred in 7.3% and salivary fistula 5.1%. Conclusion: Parotidectomy is safe procedure causing minimal complications. Transient facial palsy is the most common postoperative complication.

Prospective outcomes following drainless superficial parotidectomy with sternocleidomastoid flap reconstruction

BackgroundPatients undergoing superficial parotidectomy for benign parotid lesions are at risk of postoperative complications, most notably cosmetic complications such as facial paralysis and contour defects, and functional complications including Frey’s syndrome. Traditionally, surgical drains have been placed at the end of surgery to prevent hematoma and sialocele formation. However, this can increase the risk of postoperative complications and contribute to a prolonged course in hospital. To try and prevent these risks and complications, we introduced a novel technique of a drainless parotidectomy by reconstructing the resulting parotid bed defect with a superiorly based sternocleidomastoid (SCM) rotational flap and by placement of gelfoam into the wound bed and a facelift dressing postoperatively to provide additional hemostasis and avoid drain placement.MethodsAll patients with benign parotid disease undergoing a drainless superficial parotidectomy and reconstruction with a superiorly based SCM rotational flap at our center were identified within a prospective cohort database between July 2010–2018. Primary outcomes included postoperative cosmetic and functional outcomes, complications and length of hospital stay. A secondary cost analysis was done to compare this novel technique to traditional superficial parotidectomy with surgical drain placement.ResultsFifty patients were identified within the database and were included in the final analysis. The average length of hospital stay was 1.02 days. All patients were satisfied with their aesthetic outcome at 1 year. During long term follow-up, 63% of patients reported normal appearance of the operated side. Seven patient’s (14%) developed temporary facial paresis following surgery. All patients had resultant normal facial function at follow-up in 1 year. No patients developed subjective Frey’s Syndrome. Two patients (4%) developed a postoperative sialocele requiring drainage and one patient (2%) developed a hematoma on extubation requiring evacuation and drain placement. Cost analysis demonstrated a cost savings of approximately $975 per person following surgery.ConclusionIn the current study, we introduced a novel approach of a drainless superficial parotidectomy using a superiorly based SCM flap, gelfoam and placement of a post-operative facelift dressing. This drainless approach was associated with good long-term cosmetic and functional outcomes with few postoperative complications. This new technique may also offer the potential for long-term savings to the health care system.

Ramsay-Hunt syndrome

A 27-year-old man consulting in the emergency room for an acute facial paralysis with deafness and vertigo for 4 days. Physical examination shows clustered vesicles in the external auditory canal without any oral involvement. Laboratory investigations and computed tomography imaging were unremarkable. Thus, we diagnosed herpes zoster octicus (RHS, type 2). Treatment consists in the combination of antiviral drugs (valaciclovir 3 g/day) and corticosteroids (methylprednisolone 80 mg/day) with topical antibiotics for crusty lesions of the ear. The patient was finally referred to the otorhinolaryngology department for the management of facial paresis. Ramsay Hunt syndrome (RHS) is a localized herpes zoster infection involving the seventh nerve and geniculate ganglia, resulting in hearing loss, vertigo, and facial nerve palsy and remains one of the major causes of atraumatic peripheral facial paralysis. Immunodeficiency states, particularly HIV infection, should be considered in younger patients, severe cases and patients with a history of specific risk behavior. In our patient, HIV serology was negative.

Signo de la arteria cerebral posterior hiperdensa migratoria tras trombólisis intravenosa

Computed tomography (CT) scanning of the brain continues to be the basic imaging mode in the acute phase of stroke. The hyperdense posterior cerebral artery sign is an early and infrequent radiological finding with topographic and prognostic value that must be taken into account in the initial CT scans. We report the case of a 79-year-old woman who suddenly presented with severe left homonymous hemianopsia, mild lower left facial paresis, 3/5 left hemiparesis and severe left hypaesthesia. In the initial brain CT scan, calcium hyper-density of the P1 segment is observed in the right posterior cerebral artery. Intravenous fibrinolytic therapy is administered. The patient shows clinical improvement, and in the follow-up brain CT scan at 24 hours after fibrinolysis, hyperdensity of the P3 segment is observed in the right posterior cerebral artery. Evidence of posterior cerebral artery hyperdensity is a rare radiological finding associated with an increased volume of ischaemic stroke. A computed tomography scan of the head in the acute phase is essential to try to clarify its causation. Calcium emboli are an under-diagnosed cause of stroke and occur spontaneously in a large proportion of cases. If calcium embolism is suspected, a study must be conducted in search of a carotid, valvular or aortic arch pathology. Migration of the arterial hyperdensity towards distal is associated with a better prognosis. This case presented good progress in contrast to the poor prognosis described in the literature in cases of arterial hyperdensity as an early marker of stroke in the acute phase.

Factors associated with facial nerve palsy in patients undergoing superficial parotidectomy for pleiomorphic adenoma: our experience of eight and half years

<p class="abstract"><strong>Background:</strong> The pleomorphic adenoma comprises 45-60% of all salivary gland tumors most often in parotid gland up to 80%. The association between the facial nerve and the gland is responsible for most of the technical difficulties and complications of the surgical approaches.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective observational study performed in a unit of General Surgery, Safdarjung Hospital, New Delhi from May 2011 to October 2019 of all patients who underwent superficial parotidectomy for pleomorphic adenoma of parotid gland. The data was tabulated and results made using SPSS 21.0 system. </p><p class="abstract"><strong>Results:</strong> Male:female ratios are 29:33. Average age was 47.1 years (31-61). Average duration of disease was 2.2 years (0.3-5). 4 were operated for recurrence. Facial paresis occurred in 7 out of 62 patients (11.3%), 4 females and 3 males. 11 patients have tumor greater than 4 cm, out of these 11 patients 2 patients had pre-op facial paresis. Out of 51 patients (size <4 cm), 2 suffered facial paresis and out of 11 patients (size >4 cm), 5 suffered same. Out of 59 patients with depth of tumor <2 cm, 4 patients had post-op facial paresis. All the three patients having tumor depth >2 cm suffered post op facial paresis. Patients with pre-op facial nerve paresis had mean duration of tumor 3.35 year (±0.92) while with post-op facial nerve paresis had mean duration of tumor 2.99 year (±1.35).</p><p class="abstract"><strong>Conclusions:</strong> Meticulous separation of facial nerve from parotid tissue is key to preservation of the facial nerve. But factors like size of tumor, depth of invasion, previous surgery do affect the outcome in parotid surgery.</p>

Ionophoresis and LASER applications in facial nerve palsy

Background and aim of the study. The aim of this article is to present the functional gain of the specific rehabilitation program in patients with facial nerve paralysis, irrespective of etiology, following a complex physiotherapeutic treatment, consisting of the combined application of ionophoresis and LASER. Material and Method. We performed a retrospective analysis of 26 patients having their consent and The Theaching Emergency Hospital “Bagdasar-Arseni” (TEHBA) ethics Committee’s approval, N.O. 683/21.02.2019. The patients were admitted to the Neuro-Muscular Rehabilitation Clinic Division of TEHBA between April 2011 and March 2019. The patients were over the age of 18, diagnosed with facial nerve palsy and received physiotherapy consisting of the combined application of: ionophoresis with 1% potassium iodide, applied to positive electrode, preauricular, and the negative electrode, retroauricular, for 20 minutes and LASER, to the temporomandibular joint on the affected part, 4 points : radiant exposure per dose 3 J/cm2, frequency 5 Hz, probe area 1 cm2, power 62 mW, for 10 sessions and two sets of the same formula at the temporomandibular joint on the opposite side. Results. From the etiological point of view, the study included an equal number of patients with peripheric facial palsy (PFP) and with central facial palsy (CFP), respectively 13 in each group. Overall, at least 1 patient in 2 had a positive response to physiotherapy. In the patients with PFP, 77% of patients responded to the treatment and 46% had complete remission. In the patients with CFP, only 30% responded to treatment and only one had complete remission. Approximately half of the patients did not have any adverse reactions (46%), while the rest showed temporary erythema (46%), or local tingling sensation over a variable period of time (8%). Conclusion. Applying the combination of ionophoresis and LASER as physiotherapic treatment is particularly effective in peripheric facial nerve paresis. The method is safe and well tolerated, therefore we propose its use in this type of pathology. Key words: Laser therapy, facial nerve paralysis, ionophoresis,

Clinical-evolutive particularities and a multimodal therapeutic-rehabilitative approach, as well as through connected care approach, in the case of hemiplegia after ischemic cardio-embolic stroke within a polypathological context – A case report

Introduction: Cardiac embolism is one of the most common causes of embolic CVA. The recovery of patients with cardio-embolic stroke is a complex process which requires taking into account all associated pathologies (e.g. diabetes mellitus) that can play a decisive role in the evolution of the patient. A multidisciplinary team is required for such a purpose. Material and methods: The paper presents the case of a 63-year old patient with hemiplegia after an ischemic cardio-embolic stroke within a poly-pathological context. In January 2019, the patient suffered from an ischemic stroke in the carotid region with an ataxic spastic hemiparesis and left facial paresis with cerebrasthenia and bradylalia and he was admitted to “St. Ioan” Clinical Emergency Hospital in Bucharest. After the patient was stabilized and received specialized treatment, following the investigations and the interdisciplinary consultations, he received indication of neuromuscular recovery and for this reason he was admitted to our clinic. The patient was clinically and functionally evaluated, according the standardized protocols implemented in our clinic, through the assessment scales (MMSE, GOS-E and Rankin, MoCA, FIM, FAC, QoL, Asworh and Penn) and also para-clinically, in order to evaluate his biological reserve and his bearing availability of the recovery program. Results: After a complex neuro-recovery program undertaken by a multidisciplinary team formed by doctors, kinesiotherapists, medium healthcare and paramedical personnel, the patient displayed a slowly favorable evolution (hardened by his multiple associated diseases due to the above-mentioned co-morbidities) from a functional point of view with the improvement of the walking program and the increase in the muscle force and self-autonomy. Conclusion: The recovery of patients with cardio-embolic stroke is a complex process, which requires taking into account all associated pathologies that can play a decisive role in the evolution of the patient. A multidisciplinary team is required for such purposes. Key words: stroke, hemiplegia, poly-pathologic, ischemic

Endoscopic versus open microvascular decompression for trigeminal neuralgia: a systematic review and comparative meta-analysis.

Microvascular decompression (MVD) is commonly used in the treatment of trigeminal neuralgia (TN) with positive clinical outcomes. Fully endoscopic MVD (E-MVD) has been proposed as an effective minimally invasive alternative, but a comparative review of the two approaches has not been conducted. The authors performed a meta-analysis of studies, comparing patient outcome rates and complications for the open versus the endoscopic technique. The PubMed/MEDLINE and Ovid databases were searched for studies published from database inception to 2017. The search terms used included, but were not limited to, "open microvascular decompression," "microvascular decompression for trigeminal neuralgia," and "endoscopic decompression for trigeminal neuralgia." Criteria for inclusion of studies in the meta-analysis were established as follows: adult patients, clinical studies with ≥ 10 patients (excluding case studies to obtain a higher volume of outcome rates), utilization of open MVD or E-MVD to treat TN, craniotomy and retrosigmoid incision, English-language studies, and articles that listed pain relief outcomes (complete, very good, partial, or absent), recurrence rate (number of patients), and complications (paresis, hearing loss, CSF leakage, cerebellar damage, infection, death). Relevant references from the chosen articles were also included. From a larger pool of 1039 studies, 23 articles were selected for review: 13 on traditional MVD and 10 on E-MVD. The total number of patients was 6749, of which 5783 patients (and 5802 procedures) had undergone MVD and 993 patients (and procedures) had undergone E-MVD. Analyzed data included postoperative pain relief outcome (complete or good pain relief vs partial or no pain relief), and rates of recurrence and complications including facial paralysis, weakness, or paresis; hearing loss; auditory and facial nerve damage; cerebrospinal fluid leakage; infection; cerebellar damage; and death.Good pain relief was achieved in 81% of MVD patients and 88% of E-MVD patients, with a mean recurrence rate of 14% and 9%, respectively. Average rates of reported complications were statistically lower in E-MVD than in MVD approaches, including facial paresis or weakness, hearing loss, cerebellar damage, infection, and death, whereas cerebrospinal fluid leakage was similar. The overall incidence of complications was 19% for MVD and 8% for E-MVD. The reviewed literature revealed similar clinical outcomes with respect to pain relief for MVD and E-MVD. The recurrence rate was lower in E-MVD studies, though not significantly so, and the incidence of complications, notably facial paresis and hearing loss, were statistically higher for MVD than for E-MVD. Based on these results, the use of endoscopy to perform MVD for TN appears to offer at least as good a surgical outcome as the more commonly used open MVD, with the possible added advantages of having a shorter operative time, smaller craniotomy, and lower recurrence rates. The authors advise caution in interpreting these data given the asymmetry in the sample size between the two groups and the relative novelty of the E-MVD approach.

The Diagnosis and Treatment of Idiopathic Facial Paresis (Bell's Palsy).

Peripheral facial nerve palsy is the most com- mon functional disturbance of a cranial nerve. 60-75% of cases are idiopathic. This review is based on a selective literature search proceeding from the current, updated German-language guideline on the diagnosis and treatment of idiopathic facial nerve palsy. The recommended drug treatment consists of prednisolone 25 mg bid for 10 days, or 60 mg qd for 5 days followed by a taper to off in decrements of 10 mg per day. This promotes full recovery (number needed to treat [NNT] = 10; 95% confidence interval [6; 20]) and lessens the risk of late sequelae such as synkinesia, autonomic disturbances, and contractures. Virostatic drugs are optional in severe cases (intense pain or suspicion of herpes zoster sine herpete) and mandatory in cases of varicella-zoster virus (VZV) infection. Corneal protection with dexpanthenol ophthalmic ointment, artificial tears, and a nocturnal moisture- retaining eye shield has been found useful in practice. In cases of incomplete recovery with residual facial weakness, both static and microsurgical dynamic methods can be used to restore facial nerve function. Because 25-40% of cases of facial nerve palsy are not idiopathic, differential diagnosis is very important; key diagnostic methods include a clinical neurological examin- ation, otoscopy, and a lumbar puncture for cerebrospinal fluid examination. High-level evidence supports corticosteroid treatment for the idiopathic form of the disorder.

Parotid gland surgery as iatrogenic cause of facial nerve palsy – The role of adipocytokines in the pathology of parotid gland tumors

Facial nerve paresis is an important implicator of human quality of life. The are many known causes of facial nerve palsy but some still remain unknown (Bell's palsy). The most often cause of iatrogenic nerve damage is parotid gland surgery (facial nerve runs through the gland). The surgery is the treatment of choice in both benign and malignant tumors. Finding the biomarker of those tumors might influence the treatment decision and preserve the function of facial nerve. In present study we investigated the serum levels of selected adipocytokines in patients with parotid gland tumors (benign: 36 patients with pleomorphic adenoma (PA group), 25 patients with Warthin's tumor (WT group) and 11 with malignant tumors). The control group included 30 healthy individuals. The mean adiponectin concentration was significantly higher in benign tumor patients compared to controls in both genders in PA and WT groups. Total serum leptin levels in all of our patients (males and females) did not differ between groups. Serum visfatin concentrations were similar in all tumor patients in PA, WT and malignant groups and were significantly higher compared to controls. In summary we showed that adiponectin plays an “anti-malignant” role in benign tumors. Furthermore, leptin and visfatin seem to play an important role in the pathology of salivary gland tumors, although in both genders in a different manner. Our findings may have a potential impact on decision of treatment and therefore the quality of life related with facial nerve function.

Skull Base Manifestations of Erdheim-Chester Disease: A Case Series and Systematic Review.

Erdheim-Chester disease (ECD) is a rare, non-Langerhans cell histiocytosis. Up to 50% of patients develop central nervous system involvement, and a subset of these patients can present with isolated tumor-like masses. To describe the skull base manifestations of ECD with an emphasis on aspects most pertinent to surgeons who may be referred such patients for primary evaluation. Scopus, Web of Science, and PubMed were searched from database inception to May 1, 2018 for articles reporting skull base ECD. An institutional retrospective analysis of all patients treated at the authors' institution since January 1, 1996 was also performed to supplement these data. Of 465 retrieved articles, 18 studies totaling 20 patients met inclusion criteria. Institutional review identified an additional 7 patients. Collectively, the median age at diagnosis was 49 yr (interquartile range, 42-58) with a 4:1 male-to-female ratio. Patients frequently presented with diplopia (48%), headache (30%), dysarthria (22%), and vertigo or imbalance (22%), though trigeminal hypesthesia (11%), facial nerve paresis (7%), hearing loss (7%), and trigeminal neuralgia (7%) were also observed. ECD commonly mimicked meningioma (33%), trigeminal schwannoma (8%), neurosarcoidosis (8%), and skull base lymphoma (8%). Discrete skull base lesions frequently mimic more common pathology such as meningioma or cranial nerve schwannomas. Medical therapy comprises the initial treatment for symptomatic skull base disease. Surgical resection is not curative and the utility of surgical intervention is largely limited to biopsy to establish diagnosis and/or surgical debulking to relieve mass effect.

Surgical complications and its management after parotidectomy: Our 4 years experience

Background: The majority of parotid tumours are benign. Nealy 80 % of parotid tumour involve the superficial lobe. Parotidectomy was first introduced into the world literature by Berard in 1823 who removed first parotid tumor. Parotidectomy has well-documented post-operative complications.Aims & Objectives: The aim is to study the postoperative complications and its management after parotidectomy.Methods: This prospective study was conducted on 60 patients who underwent parotidectomy by antegrade technique from July 2014-july 2019 for parotid tumours. Patients were submitted to careful history taking, complete clinical examination, and examination of facial nerve integrity before surgery.48 patients underwent superficial parotidectomy (44 patients for pleomorphic adenoma,4 patients for warthin’s tumour) and 12 patients underwent Total conservative parotidectomy (9 patients for parotid malignancy and 2 patients for pleomorphic adenoma recurrence and 1 patients for pleomorphic adenoma involving deep lobe of parotid).Results: In our study, out of 48 patients underwent superficial parotidectomy 18 patient developed complications and 12 patients underwent Total conservative parotidectomy 10 patients developed complication. Several complications have been reported in parotid surgery. Temporary facial nerve paresis was the most common postoperative complication followed by hypoesthesia of greater auricular nerve. Most patient regained normal facial nerve function within 2 months after surgery.Conclusion: Parotid tumours are the most common salivary gland tumours. Majority of parotid tumours are benign and involve the superficial lobe. Parotidectomy is the defenite procedure for parotid tumours. Parotidectomy is challenging procedure because of the intraparenchymal course of the facial nerve and has its own complications. Surgical complications are higher in total conservative parotidectomy than in superficial parotidectomy. Complications are reduced by proper dissection technique and treated carefully if complication arises.

Partial superficial parotidectomy versus superficial parotidectomy for treatment of parotid benign tumors: evidence-based medicine analysis

Objective:The aim of this study is to systematically assess the postoperative outcomes of partial superficial parotidectomy（PSP） and superficial parotidectomy（SP） by systematic literature review and Meta-analysis, and to provide a theoretical basis for the selection of the appropriate surgical approach in clinical process. Method:Relevant studies that compared the outcomes of PSP and SP for the parotid benign tumors were searched in Pubmed, CNKI and Wanfangdata databases, and Meta-analysis was performed using software RevMan 5.0. Result:24 studies were selected for the Meta-analysis. A total of 2 795 participants were included in those studies, of whom 1 301 underwent PSP and 1 494 underwent SP. The recurrence rates for PSP and SP were 1.14%（10 of 874） and 0.6%（6 of 993）, respectively. There were no statistically significant difference in recurrence rate between PSP and SP. The rates of transient facial nerve paresis for PSP and SP were 11.60%（122 of 1 052） and 27.37%（350 of 1 279）, respectively. The rates of permanent facial nerve paralysis for PSP and SP were 1.04%（6 of 579） and 4.46%（31 of 695）, respectively. The incidences of Frey's syndrome in PSP group and SP group were 9.20%（95 of 1 033） and 30.32%（409 of 1 349）, respectively. The rate of salivary fistulafor PSP and SP were 5.38%（37 of 688） and 11.25%（65 of 578）. PSP could reduce the risk for complications compared with SP. Conclusion:This systematic review with meta-analysis suggests that PSP has a similar recurrence rate as SP, but PSP can significantly reduce the postoperativecomplications.

Impacts of Two Rehabilitation Programs on Chronic Peripheral Facial Paresis

Impacts of Two Rehabilitation Programs on Chronic Peripheral Facial Paresis

Primary temporal bone chondrosarcoma: experience with 10 cases

Background: Temporal bone chondrosarcoma (TBC) are uncommon primary temporal bone malignancies, and clinicians lack experience in its diagnosis and treatment. The optimal management of patients with tumor of TBC also remains a topic of debate and controversy.Objectives: This article summarizes the experience of diagnosis and treatment of TBC, in order to improve the quality of life of cancer patients in the future.Material and methods: We conducted a retrospective analysis of 10 patients who were referred to our hospital from June 2009 to June 2018 for the treatment of TBC.Results: There were 3 males and 7 females. The most common presenting symptoms were facial paresis (50%) and hearing loss (40%), whereas otalgia (10%), vertigo (10%) and headache (10%) were less common. All tumors originated from the temporal bone, and 80% involved the jugular foramen area. All patients survived without evidence of disease at a median time of follow up of 28.8 months.Conclusions and significance: TBC mostly originated in the middle ear mastoid area, and easily extended to the jugular foramen area. An individualized surgical procedure that removes tumors integrally with minimal nerve and blood vessel damage provides long-term cancer control and minimal morbidity in most cases.