Facial Paresis Research Articles

Temporal Profile of CT and T2*-Weighted Gradient-Echo MRI in a Patient with Unilateral Thalamostriate Vein Thrombosis

Deep cerebral venous system thrombosis (DCVST) is an uncommon variety of thrombosis that accounts for 11% of cases of cerebral venous thrombosis. Thalamostriate vein (TSV) thrombosis is further rare among patients with DCVST. Although patients with cerebral venous thrombosis commonly have characteristic neurological deficits including headache, deterioration of consciousness, and seizures, patients with DCVST do not necessarily show such symptoms. Therefore, diagnose of DCVST is sometimes difficult. Here we report a case of TSV thrombosis with a unilateral basal ganglion lesion presenting with right-sided hemiparesis. A 61-year-old Japanese female was referred to our hospital. On neurological examination, she had no headache but presented with right facial paresis with dysarthria. Her right hemiparesis was present in the upper and lower extremities. We repeatedly performed brain computed tomography (CT) and T2*-weighted conventional gradient-echo (GRE) magnetic resonance imaging, and conclusively diagnosed as left TSV thrombosis. We firstly report a case of unilateral DCVST associated with TSV thrombosis in which a temporal profile of CT and T2*-weighted GRE images was obtained. Although DCVST is a rare clinical entity, physicians should be aware that repeated radiological observations can be useful for the diagnosis and early medical treatment for DCVST.

Axonal supercharged interpositional jump-graft with a hybrid artificial nerve conduit containing adipose-derived stem cells in facial nerve paresis rat model.

Interpositional jump-graft (IPJG) technique with the hypoglossal nerve for supercharging can be applied in a facial nerve paresis case. In IPJG, an autologous nerve is required, and the donor site morbidity is unavoidable. Biodegradable nerve conduits are made from polyglycolic acid (PGA) and used recently without donor site complications after providing autologous grafts. Hybrid artificial nerve conduits with adipose-derived stem cells (ASCs) also attract attention as a nerve-regeneration enhancing agent. This study examined the effect of hybrid artificial nerve conduit on IPJG. A total of 34 Lewis rats were used and divided into 4 groups by the bridge materials: autograft (n = 8), PGA nerve conduit (n = 8), hybrid PGA nerve conduit with ASCs (n = 8), and the nontreated control groups (n = 8). ASCs were collected from 2 rats and cultured. The animals were assessed physiologically and histopathologically at 13 weeks after surgery. In compound muscle action potential, the amplitude of hybrid PGA group (3,222 ± 1,779 μV) was significantly higher than that of PGA group (1,961 ± 445 μV, P < .05), and no significant difference between hybrid PGA and autograft group. All treated groups showed a myelinated nerve regeneration with double innervation in hypoglossal and facial nerve nuclei for vibrissal muscle. This study showed the effectiveness of IPJG with a hybrid PGA conduit especially in physiological examination.

Facial motor and non-motor disabilities in patients with central facial paresis: a prospective cohort study.

Although central facial paresis (CFP) is a major symptom of stroke, there is a lack of studies on the motor and non-motor disabilities in stroke patients. A prospective cohort study was performed at admission for inpatient rehabilitation and discharge of post-stroke phase of 112 patients (44% female, median age: 64 years, median Barthel index: 70) with CFP. Motor function was evaluated using House-Brackmann grading, Sunnybrook grading and Stennert Index. Automated action unit (AU) analysis was performed to analyze mimic function in detail. Non-motor function was assessed using the Facial Disability Index (FDI) and the Facial Clinimetric Evaluation (FaCE). Median interval from stroke to rehabilitation was 21 days. Rehabilitation lasted 20 days. House-Brackmann grading was ≥ grade III for 79% at admission. AU activation in the lower face was significantly lower in patients with right hemispheric infarction compared to left hemispheric infarction (all p < 0.05). Median total FDI and FaCE score were 46.5 and 69, respectively. Facial grading and FDI/FaCE scores improved during inpatient rehabilitation (all p < 0.05). There was a significant increase of the activation of AU12 (Zygomaticus major muscle), AU13 (Levator anguli oris muscle), and AU24 (Orbicularis oris muscle) during inpatient rehabilitation (all p < 0.05). Multivariate analysis revealed that activation of AU10 (Levator labii superioris), AU12, AU17 (Depressor labii), and AU 38 (Nasalis) were independent predictors for better quality of life. These results demonstrate that CFP has a significant impact on patient's quality of life. Therapy of CFP with focus on specific AUs should be part of post-stroke rehabilitation.

CAR 10. Endarterectomy for Acute Symptomatic Thrombotic Occlusion of the Entire Extracranial Internal Carotid Artery: A Case Report

We report the case of a 60-year-old woman who was admitted with a sudden onset of numbness of the left upper extremity. Two weeks before admission, the patient presented with a right hemispheric transient ischemic attack and temporary right facial paresis. Duplex ultrasound and magnetic resonance (MR) angiography revealed an occlusion of the right internal carotid artery (ICA) as well as a high-grade stenosis of the left ICA with patency of the cerebral arteries (middle cerebral artery [MCA]). A cranial computed tomography scan showed a small hypodense lesion of the right hemisphere and several lacunar infarctions without signs of intracranial bleeding. An exploration of the right carotid bifurcation was performed, and an atherosclerotic plaque at the carotid bifurcation with a fresh clot downstream was found. Thrombectomy was performed using a 2F balloon catheter, resulting in a sufficient backflow from the ICA. In addition, thromboendarterectomy with patch plasty was performed. On the final intraoperative angiogram, the entire right ICA and the downstream intracranial vessels were patent. Intraoperative duplex ultrasound confirmed a sufficient hemodynamic profile without major turbulences. The postoperative MR angiogram confirmed patency of the ICA with an undisturbed perfusion of the right hemisphere. The postoperative course was uneventful; no neurologic symptoms occurred, and she was discharged on postoperative day 8. Six weeks later, the left ICA stenosis (North American Symptomatic Carotid Endarterectomy Trial [NASCET] 90%) was treated successfully by conventional thromboendarterectomy. During follow-up of 61 months, no neurologic or cardiac events occurred. A recurrent ICA stenosis was not detected. Comparing the perfusion of the right MCA with the preoperative MR angiogram, we conclude that a sufficient blood supply to the right MCA could probably not have been achieved by a simple left-sided carotid thromboendarterectomy. Whereas chronic ICA occlusion is generally accepted as a condition not suitable for extracranial reconstruction, our patient profited from revascularization as she suffered from an acute occlusion on top of a chronic stenosis. It remains uncertain which occluded artery should be explored and, specifically, at what time. In symptomatic patients, exploration of the ICA and carotid bifurcation might be justified to restore blood flow and to prevent a severe stroke event.

Acute Otitis Media and Associated Complications in United States Emergency Departments.

Complications due to acute otitis media (AOM), while rare, are associated with significant morbidity and are not well characterized from an epidemiological perspective. We analyze the pattern of presentation and emergency department (ED) utilization in patients with AOM and associated complications. Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011. Emergency Department. Patients who presented with a primary diagnosis of AOM or acute mastoiditis. Diagnostic. NEDS was queried for patient encounters with a diagnosis of AOM or acute mastoiditis based on ICD-9 codes. Complications of severe infection, including petrositis, Gradenigo's syndrome, facial paresis, labyrinthitis, meningitis, intracranial abscess, venous sinus thrombosis, and cerebrospinal fluid leak, were assessed. Weighted estimates for demographics, types of complications, socioeconomic status, and trends over time were extracted. A weighted total of 5,811,127 ED visits were identified. The majority of patients were less than 18 years old (79.9%) with an average age of 10.1 years. Most were discharged (99.4%). There were 15,243 (0.26%) patients who presented with a complication. The most common complications were acute mastoiditis (0.16%), labyrinthitis (0.06%), and facial paresis (0.03%). Compared with patients with uncomplicated AOM, patients with complicated AOM were older (37 vs. 10-yr old), insured by Medicare (18% vs. 2.1%), and more likely to be admitted (43.6% vs. 0.4%) (p < 0.0001, for all comparisons). ED visits related to AOM or mastoiditis are common and complications are rare. An in-depth analysis on a national level is useful for assessing healthcare utilization trends.

Adenomatous Neuroendocrine Tumors of the Middle Ear: A Multi-institutional Investigation of 32 Cases and Development of a Staging System.

To date, less than 150 cases of middle ear adenomatous neuroendocrine tumors (MEANTs) have been reported in the English literature. The objective of this study was to provide a contemporary analysis of these rare lesions and develop a consensus-driven staging system. Multi-institutional retrospective histopathologic, radiologic, and clinical review. Six tertiary referral centers. Thirty-two patients with pathologically confirmed MEANT. Surgical resection, adjuvant therapy. Clinical manifestations, outcomes, staging system. Patients commonly presented with progressive conductive or mixed hearing loss (90%), aural fullness (50%), and tonal tinnitus (46%). Pulsatile tinnitus (16%), carcinoid syndrome (4%), and facial nerve paresis (4%) were less commonly observed. MEANTs frequently mimicked temporal bone paraganglioma (31%) and cholesteatoma (15%) at presentation. According to a novel T/N/M/S staging system (S = secretory tumor) proposed herein, there were 6 (19%) T1, 19 (59%) T2, and 7 (22%) T3 MEANTs. T3 tumors were significantly more likely to undergo subtotal or near total resection compared with lower staged tumors secondary to adherence to critical neurovascular structures such as the petrous internal carotid artery and facial nerve (p = 0.027). Patients with T3 MEANTs were more likely to experience multiple recurrences, require adjuvant therapy with a somatostatin analogue, or develop permanent facial nerve paresis compared with lower staged tumors. At last follow up, no patients with T1 MEANTs had developed recurrence, whereas 37% (7/19) of patients with T2 MEANT and 57% (4/7) of patients with T3 MEANT experienced either disease recurrence after gross total resection (GTR) or regrowth of known residual tumor requiring additional surgery at a median duration of 72 months (95% CI, 24-84). Patients with MEANTs can present with nonspecific symptomatology that overlaps with more commonly encountered middle ear lesions. MEANT exhibits a proclivity for recurrence according to T-stage and long-term clinical follow up is necessary, particularly for advanced stage tumors.

Morbidity Rate of the Retrosigmoid versus Translabyrinthine Approach for Vestibular Schwannoma Resection.

Background and ObjectivesControversy related to the choice of surgical approach for vestibular schwannoma (VS) resection remains. Whether the retrosigmoid (RS) or translabyrinthine (TL) approach should be performed is a matter of debate. In the context of a lack of clear evidence favoring one approach, we conducted a retrospective study to compare the morbidity rate of both surgical approaches.Subjects and Methods168 patients underwent surgical treatment (2007-2013) for VS at our tertiary care center. There were no exclusion criteria. Patients were separated into two groups according to the surgical approach: TL group and RS group. Signs and symptoms including ataxia, headache, tinnitus, vertigo and cranial nerve injuries were recorded pre- and postoperatively. Surgical complications were analyzed. Perioperative facial nerve function was measured according to House-Brackmann grading system.ResultsTumor resection was similar in both groups. Facial paresis was significantly greater in RS group patients preoperatively, in the immediate postoperative period and at one year follow-up (p<0.05). A constant difference was found between both groups at all three periods (p=0.016). The evolution of proportion was not found to be different between both groups (p=0.942), revealing a similar rate of surgically related facial paresis. Higher rate of ataxic gait (p=0.019), tinnitus (p=0.039) and cranial nerve injuries (p=0.016) was found in RS group patients. The incidence of headache, vertigo, vascular complications, cerebrospinal fluid leak and meningitis was similar in both groups. No reported mortality in this series.ConclusionsBoth approaches seem similar in terms of resection efficacy. However, according to our analysis, the TL approach is less morbid. Thus, for VS in which hearing preservation is not considered, TL approach is preferable.

Use of the masseteric nerve to treat segmental midface paresis

Segmental midface paresis with or without synkinesis reflects incomplete recovery from Bell’s palsy, operations on the cranial base or parotid, or trauma, in 25%–30% of cases. To correct the deficit, the masseteric nerve was used to deliver a powerful stimulus to the zygomatic muscle complex, with the addition of a cross-face sural nerve graft to ensure more spontaneous smiling. By doing this, the orbicularis oculi muscle continues to have an appropriate stimulus from the facial nerve, and the zygomatic muscle complex is separately innervated, which considerably reduces synkinesis between the two muscle compartments. For those patients with muscular contractures of the midface, the new healthy neural stimulus relaxes muscles at rest. From January 2011 to March 2017, 20 patients presented with segmental facial paresis of the midface and were operated on using this new technique. All patients were evaluated before and after operation using Clinician-Graded Electronic Facial Paralysis Assessment (eFACE), and they showed considerable postoperative improvements in static, dynamic, and synkinetic variables. Our proposed use of the masseteric nerve to treat segmental facial paresis produces favourable results, but our initial data require confirmation by further studies.

Magnetic resonance imaging of developmental facial paresis: a spectrum of complex anomalies.

Despite its clinical implications, the MRI features of developmental facial paresis (DFP) were described in a few case reports. This study aims to describe MRI features of DFP in relation to the embryological development with a proposed radiological new grading system. The clinical records and MRI of the brain and internal auditory canal of 11 children with DFP were retrospectively reviewed. The following sequences were analyzed: axial, oblique sagittal SPACE of the internal auditory canal and brainstem; axial T2, T1WI and coronal T2WI of the brain. The severity of the maldevelopment of the seventh nerve was graded from 0 to 4: 0 = no abnormalities, 1 = unilateral facial nerve hypoplasia, 2 = unilateral facial nerve aplasia, 3 = aplasia or hypoplasia involving facial nerves on both sides, and 4 = facial nerve aplasia or hypoplasia associated with other cranial nerve palsy. Isolated facial nerve palsy was diagnosed in seven patients. It was of grade 1 in five and grade 3 in two. Hypoplasia of the nerve with interrupted course was encountered in two cases. Other associated cranial nerve abnormalities (grade 4) were seen in four patients; two of them were diagnosed previously as Moebius syndrome. In addition to inner ear anomalies, middle and external ear and parotid gland anomalies were described. To our knowledge, this is the largest series of patients with DFP that represents a continuum of isolated and combined malformations. Understanding of embryological basis can give insights into the anomalous development of the facial nerve.

Safety and predictors of stroke mimics in The Norwegian Tenecteplase Stroke Trial (NOR-TEST)

Stroke mimics are frequently treated with thrombolysis in clinical practice and thrombolytic trials. Although alteplase in stroke mimics has proven to be safe, safety of tenecteplase in stroke mimics has not been assessed in an ischemic stroke study setting. We aimed to assess clinical characteristics and safety of stroke mimics treated with thrombolysis in the Norwegian Tenecteplase Stroke Trial. We also aimed to identify possible predictors of stroke mimics as compared to patients with acute cerebral ischemia. Norwegian Tenecteplase Stroke Trial was a phase-3 trial investigating safety and efficacy of tenecteplase vs. alteplase in patients with suspected acute cerebral ischemia. Two groups were defined based on diagnose at discharge: patients with a different diagnose than ischemic stroke or transient ischemic attack (stroke mimics group) and patients diagnosed with ischemic stroke or transient ischemic attack (acute cerebral ischemia group). Logistic regression analyses were performed with stroke mimics vs. acute cerebral ischemia as dependent variable to identify predictors of stroke mimics. Of 1091 randomized patients, 181 (16.6%) were stroke mimics. Migraine (22.2%) and peripheral vertigo (11.4%) were the two most frequent stroke mimic-diagnoses. There was no symptomatic intracerebral hemorrhage in the stroke mimics group. Stroke mimics were independently associated with age ≤60 years (OR 2.75, p < 0.001), female sex (OR 1.48, p = 0.026), no history of myocardial infarction (OR 2.03, p = 0.045), systolic BP ≤ 150 mmHg (OR 2.33, p < 0.001), NIHSS ≤ 6 points (OR 1.83, p = 0.011), sensory loss (OR 1.55, p = 0.015), and no facial paresis (OR 2.41, p < 0.001) on admission. Thrombolysis with tenecteplase seems to be as safe as with alteplase in stroke mimics. Predictors were identified for stroke mimics which may contribute to differentiate stroke mimics from acute cerebral ischemia in future stroke trials.

Otitis media: definition, pathogenesis, clinical presentation, diagnosis and therapy

A number of diseases of the middle ear are summed up under the term otitis media: acute otitis media, recurrent acute otitis media, otitis media with effusion, chronic suppurative otitis media and chronic otitis media epitympanalis (= cholesteatoma). Acute otitis media belongs to the most common pediatric diseases and is often caused by bacterial infection. Since the advent of pneumococcal vaccines the quantity of AOM caused by pneumococci has declined; vaccination against NTHi and Moraxella catarrhalis are being developed. Main pillar of conservative treatment of AOM is symptomatic therapy of otalgia and fever as well as restoring the Eustachian tubal function. When indicated, amoxicillin represents antibiotic medication of choice. Acute mastoiditis, facial nerve paresis, labyrinthitis, Gradenigo syndrome, sinus vein thrombosis, meningitis and brain abscess belong to the complications of AOM among others. Both innate and adaptive immune system are involved in recovery of OM with innate immunity playing a critical role. Dysfunction of the Eustachian tube often underlies OM. Manometric measurement of Eustachian tube function may be useful for indication of balloon Eustachian tuboplasty. Several theories explain pathogenesis of cholesteatoma and multiple pro-inflammatory processes promote its progress in the course of the disease.

Improve of dysphagia with electrostimulation after a stroke

Patients who have suffered a stroke may have dysphagia in more than 30% of cases. When the alteration is located in the bulbar area, since the neural control of swallowing is located at the bulbar level, where the centers responsible for processing the afferent sensory signals and programming the motor deglutory sequence are located this percentage increases. The goal of treatment is to obtain secure and sufficient oral intake for adequate hydration and nutrition. Treatment techniques are designed to change the physiology of swallowing. Neuromuscular electrical stimulation can also be performed as studies have shown that this treatment appears to help people with moderate dysphagia. Clinical observation: we present the case of a 44-year-old woman who suffered laterobulbar ischemic Ictus. The physical exam, showed dysarthria, facial paresis and limb dysmetry without motor deficit and severe alteration of swallowing. Fibroendoscopic studies were performed and oral diet was contraindicated thus enteral nutrition was required from the time of admission. Speech therapy plus the application of electrostimulation was initiated. After 4 months of treatment, enteral nutrition was removed and the patient was able to change to a complete oral diet. Patients who are diagnosed of a bulbar stroke have a high percentage of swallowing dysfunction. Swallowing therapy with electrical stimulation may help clinical improvement of dysphagia.

Closed Loop Microfabricated Facial Reanimation Device Coupling EMG-Driven Facial Nerve Stimulation with a Chronically Implanted Multichannel Cuff Electrode.

Permanent facial paralysis and paresis (FP) results from damage to the facial nerve (FN), and is a debilitating condition with substantial functional and psychological consequences for the patient. Unfortunately, surgeons have few tools with which they can satisfactorily reanimate the face. Current strategies employ static (e.g., implantation of nonmuscular material in the face to aid in function/cosmesis) and dynamic options (e.g., gracilis myoneurovascular free tissue transfer) to partially restore volitional facial function and cosmesis. Here, we propose a novel neuroprosthetic approach for facial reanimation that utilizes electromyographic (EMG) input coupled to a chronically implanted multichannel cuff electrode (MCE) to restore instantaneous, volitional, and selective hemifacial movement in a feline model. To accomplish this goal, we developed a single-channel EMG-drive current source coupled with a chronically implanted MCE via a portable microprocessor board. Our results demonstrated a successful feasibility trial in which human EMG input resulted in FN stimulation with subsequent concentric contraction of discrete regions of a feline face.

Degree of praxis of command for facial muscles in healthy individuals to develop a new clinical scale for facial motor function in peripheral facial paresis

Clinical scales evaluating facial motor function in peripheral facial paresis (PFP) have poor precision and evaluate only few muscle groups, making the assessment of the disorder and of potential therapeutic interventions difficult. It is likely that healthy subjects do not share the same degree of praxis for all facial movements. The main objective was to assess the degree of praxis for command to each muscle group innervated by the facial nerve (VII) in a healthy subject population, to select those to include in a new PFP clinical motor scale. Reliabilities of the praxis rating performance were also evaluated. This monocentric prospective study included video recordings of adult healthy subjects performing 23 bilateral facial movements, on both oral command and mime of the investigator. Primary endpoint was the degree of praxis rated ordinally with a 3-point scale (0 = total apraxia; 0.5 = partial praxis; 1 = perfect praxis). Each video was assessed twice by each rater four days apart. Intra- and inter-rater reliabilities were evaluated via kappa coefficients. Facial muscles were selected through a threshold of perfect praxis set at 80% of the total praxis in the sample, also taking into account reliability findings and clinical relevance. Facial video recordings of 50 healthy subjects (13 M; 37.1 ± 14.6 yo) were rated on two occasions by 3 PMR specialists (experience in PFP: 24.6 ± 31.0 months). Eleven muscle groups were characterized by a praxis greater than the 80% threshold; 4 muscle groups were between 70 and 80% and 8 below 70%. Intra- and inter-rater agreements were very strong (kappa coefficients > 0.60) for 10 and 14 muscle groups, respectively. Healthy individuals do not have the same degree of praxis on all facial muscle groups. Ten muscle groups were selected to be included in a new PFP clinical motor scale.

Idiopatic facial nerve palsy in pregnancy – facts and myths

Idiopathic facial nerve palsy, called also Bell palsy, can be a challenge for clinicians if a pregnant woman reports symptoms of facial paresis. The incidence of Bell's paralysis in pregnant women is almost three times higher than in the non-pregnant women's age group. The problem is the lack of guidelines for the treatment of idiopatic facial nerve palsy in this group of patients. In randomized studies, but without participation of pregnant women, greater efficacy was found in the return of nerve function after early treatment with corticosteroids than with other methods. The dilemma concerning therapy is intensified by the fact that the prognosis regarding the return of facial nerve function in pregnant women is significantly worse than in the remaining population and the weakness of facial muscles is yet diagnosed in a young woman. In the article we present the example of a patient consulted in our department and the review of current literature. We introduce recommendations for the treatment of pregnant women with facial nerve palsy. There are discussed benefits, advised medicines, doses, necessary precautions and potential side effects of corticosteroids, which are the only ones that have proven efficacy in the treatment of Bell's paralysis in pregnant women.

A rare case of facial nerve schwannoma masked by a concomitant temporomandibular disorder pain

Abstract Facial nerve schwannoma (FNS) is an uncommon benign tumor that arises from the Schwann cells of the facial nerve (FN). Although rare, this is the most frequent type of FN tumor, potentially affecting any segment of the nerve. Nevertheless, a higher incidence of intracranial lesions and a predilection for the geniculate ganglion has been reported. Hearing loss, facial paresis and tinnitus are the most frequent symptoms. Conversely, pain, is not among the most prominent complaints and when present, it can be misdiagnosed as an orofacial pain of other source, including pain due to a temporomandibular disorder (TMD). In this paper, we describe a rare case of a patient presenting a FNS located in the intratemporal part and geniculate ganglion of the FN, which was initially masked by the symptoms of a coexistent TMD. It highlights the importance of considering intracranial tumors in the differential diagnosis of orofacial pains.

Ayurvedic management of Bells Palsy - A Case Report

Bells palsy an acute paresis of facial mimetic muscles is most common in the third decade of life with an incidence of about 20 cases per 1,00,000 population. The complete recovery rates within 3 months vary from 80-85%. Major complications of the condition include chronic loss of taste, chronic facial spasm, facial pain, corneal infections making early intervention essential. Ardita clinically correlates to Bells palsy. Its cause is mainly vitiated Vata due to Avarana or Dhatukshaya and management is primarily based on Vatahara and Urdhva Sharira Chikitsa. Methods: The current report is based on a case of Bells palsy that presented as left sided facial paresis with deviated angle of mouth to the right, diagnosed as Ardita due to Vata and Kapha Anubandha. Treatment included Nasya Karma, Shiro Pichu, Mukhabhyanga followed by Panasa Patra Sweda and internal medications. Result: Improvement in motor functioning was noticed from day 3 of treatment. Speech enhancement and sensory perception was also noted. Discussion: Ayurvedic management with Ardita Chikitsa provided brisk results in this case.

Current Treatment of Endolymphatic Sac Tumor of the Temporal Bone.

An endolymphatic sac tumor (ELST) is a rare, indolent but locally aggressive tumor arising in the posterior petrous ridge. Patients present with sensorineural hearing loss and tinnitus. As the tumor progresses, patients may experience vertigo, ataxia, facial nerve paresis, pain and otorrhea. Most patients present in their 4th or 5th decade with a wide age range. Patients with von Hippel-Lindau disease have an increased likelihood of developing ELST. Histologically, ELST is a low-grade adenocarcinoma. As it progresses, it destroys bone and extends into adjacent tissues. The likelihood of regional or distant metastases is remote. The optimal treatment is resection with negative margins. Patients with positive margins, gross residual disease, or unresectable tumor are treated with radiotherapy or radiosurgery. Late recurrences are common, so long follow-up is necessary to assess efficacy. The likelihood of cure depends on tumor extent and is probably in the range of 50-75%.

C.01 Endoscopic versus open microvascular decompression of trigeminal neuralgia: a systematic review and comparative meta-analysis

Background: Microvascular decompression (MVD) is commonly used in the treatment of trigeminal neuralgia with positive clinical outcomes. Fully endoscopic microvascular decompression (E-MVD) has been proposed as a minimally invasive, effective alternative, but a comparative review of the two approaches in the literature has not been conducted. Methods: We performed a meta-analysis comparing patient outcome rates and complications for both techniques. From a pool of 1,039 studies, 22 articles were selected for review: 12 open MVD and 10 E-MVD. The total number of patients was 6,734. Results: Good pain relief was achieved in 81% of MVD and 88% of E-MVD patients, with a mean recurrence rate of 14% and 9% respectively. Average rates of complications in MVD versus E-MVD included facial paresis or weakness, 9%, 3%; -hearing loss, 4%, 1%; cerebrospinal leak, both 3%; cerebellar damage and infection, 2%, &lt;1%; and mortality &lt;1%, 0% respectively. Conclusions: The reviewed literature revealed similar clinical outcomes with respect to pain relief for both approaches. Recurrence rate and incidence of complications, notably facial paresis and hearing loss were higher for MVD. We concluded that E-MVD appears to offer at least as good a surgical outcome as MVD, with possibly a shorter operative time, smaller craniectomy and lower recurrence rates.

A hybrid technique to address exposure keratopathy secondary to facial nerve paresis: A combination of a lateral tarsorrhaphy and lateral wedge resection

PurposeTo present the results of treating combined lower eyelid laxity, retraction and midface descent secondary to facial nerve weakness with a hybrid surgical procedure. Materials and methodsA retrospective analysis of patients from January 2015 to January 2017 who underwent a hybrid surgical technique for the treatment of corneal exposure secondary to facial nerve paresis with a single surgeon was performed. Age, gender, and presence of exposure symptoms were recorded pre-operatively. Outcomes assessed included improvement of lower eyelid laxity and position, operative complications, and post-operative symptomatic relief. ResultsA total of 11 patients underwent unilateral eyelid surgery. All patients had symptomatic relief and good functional outcomes defined as improvement in eyelid laxity, lower eyelid position, and objective corneal exposure. No cases required reoperation during an average follow up of 174.5 days. ConclusionsCombining portions of a tarsorrhaphy and lateral wedge resection technique is a simple and effective procedure to improve lower eyelid position and limit corneal exposure secondary to facial nerve paresis.