Management of facial nerve during parotid recurrent pleomorphic adenoma revision surgery.

Facial nerve (FN) palsy is the most serious complication of parotid gland surgery, with risk influenced by tumor size, location and pathology. To assess the incidence, severity, duration, and risk factors of FN palsy following parotidectomy, based on the Polish Salivary Network Database. This multicenter study included 2650 patients treated surgically between 2018 and 2022. FN function was evaluated using the House-Brackmann scale, consider-ing extent, severity and duration of FN dysfunction. Multiple potential risk factors were examined. FN palsy occurred in 20% of patients: 17.2% transient and 4.5% permanent. The marginal mandibular branch was most frequently affected. Multivariate analysis showed that parapharyngeal space involvement, presence of malignant neoplasm and preoperative FN dysfunction independently predicted complete paralysis. Additional risk factors for more extensive, severe, and prolonged FN impairment included clinical signs of malignancy, prior radiation, non-radical margins, larger tumor size (>4cm), and advanced stage of malignancy. A greater number of affected regions (defined by the European Salivary Gland Society (ESGS) classification) was identified as the most significant adverse risk factor for both the degree and persistence of postoperative facial nerve palsy. FN palsy remains a relevant risk in parotid surgery, particularly with large or malignant tumors. Early diagnosis and radical excision of smaller lesions are key to preserving nerve function.

Facial nerve crush injuries frequently lead to incomplete functional restoration owing to constrained regenerative approaches and suboptimal treatment methods. While hydrogel-based systems have emerged as viable alternatives among bioengineered scaffolds, their therapeutic potential remains compromised by inadequate biological activity and unfavorable inflammatory conditions. Our research engineered a photoactivated GelMA/HAMA composite hydrogel incorporating bone marrow mesenchymal stem cell-derived exosomes (BExos), with comprehensive characterization of its material attributes. We systematically assessed the biomaterial's regenerative capacity through in vitro experiments involving BMSCs and RAW264.7 macrophages, complemented by comprehensive in vivo evaluations in a rodent facial nerve injury model incorporating functional restoration metrics, neurophysiological testing, tissue analysis, and biomolecular profiling. The BExos-integrated hydrogel established a favorable niche promoting BMSCs transdifferentiation toward Schwann cell-mimetic lineages while demonstrating marked improvement in neuromuscular functional restoration. Compared to untreated cohorts, the composite hydrogel demonstrated enhanced axonal regrowth, improved remyelination processes, and notably reduced oxidative damage. The biomaterial effectively shifted macrophage differentiation from M1 pro-inflammatory states toward M2 anti-inflammatory phenotypes through modulation of PI3K/NF-κB/P38 signaling cascades, with Neuronatin emerging as a key regulatory element in this pathway. Mechanistic investigations demonstrated that the therapeutic benefits stemmed from synergistic structural reinforcement combined with exosome-mediated immune regulation, positioning this dual-action hydrogel as an innovative solution for facial nerve repair.

Facial nerve palsy in children leads to significant functional impairment and facial asymmetry. While free gracilis muscle transfer (FGMT) is a cornerstone technique for smile reanimation in both pediatric and adult patients, its evaluation has mainly focused on the single metric of commissure excursion. This study seeks to evaluate the effectiveness of FGMT in restoring dynamic smiles in pediatric patients with facial palsy using image analysis. A retrospective review was conducted in children who underwent FGMT for facial palsy at a major children's hospital between 2007 and 2020. Data collection included pre- and postoperative chart reviews and image analysis. Anthropometric measurements were obtained using a machine learning-based smile analysis software. Primary outcomes included commissure excursion, commissure angle, dental show, and smile symmetry. Statistical analysis was performed using the Wilcoxon signed-rank test. A total of 31 patients with an average age of 10 years underwent FGMT for smile reanimation during the study period. The most common diagnosis was Moebius syndrome (48%). Donor nerves for gracilis neurotization included 18 ipsilateral trigeminal nerves (58.1%) and 12 contralateral facial nerves via cross-face sural nerve grafts (38.7%). Overall, 84% of patients demonstrated active gracilis contraction within a mean of 2.5 years postoperative follow-up. Commissure excursion increased by 9.7 mm at 1 year (p < 0.05), and symmetry significantly improved for commissure height, commissure excursion, upper lip height, and smile angle. There were no significant improvements in dental show, commissure angle, symmetry of dental show, and lower lip height. Furthermore, only 16% of patients demonstrated clinically symmetric smiles within the follow-up period. While FGMT effectively restores commissure excursion in pediatric patients with facial palsy, achieving multidimensional smile reanimation remains a challenge. New techniques in multi-vector free tissue transfer may help optimize FGMT outcomes in pediatric patients.

Corticobulbar motor evoked potentials (coMEPs) were introduced in 2005 as an alternative to direct stimulation and free running electromyography for continuous monitoring of the facial nerve during skull base surgery. The technique has been expanded for monitoring of multiple cranial nerves (CNs) and adapted across diverse pathologies. Nonetheless, broad adoption has lagged. This study aimed to understand the basis of this disparity by systematically mapping current practices and characterizing the variations in technical implementation and reporting of coMEPs. We conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 adherent systematic review of all articles reporting coMEP neuromonitoring published through December 6, 2023. Multiple reviewers screened publications for inclusion. Data were extracted using a standardized template to enable quantitative and qualitative data synthesis. Aggregate data were analyzed to address incidence, reporting variability, and sensitivity/specificity of the method. We identified 2711 unique cases using coMEPs, reported across 72 studies (2005-2023). Significant heterogeneity was observed in the technique of coMEPs, including stimulation montages and measurements of accuracy. Overall, 81.9% (59/72) of studies reported clinical outcomes, whereas the remainder were technically focused. coMEPs were often used alongside other neuromonitoring modalities (87.5% of studies, 63/72), but performance was directly compared only 25% of the time (18/72). The facial nerve was the most common single target analyzed (n = 41 publications), followed by the vagus (n = 9). Twenty-two percent of studies analyzed multiple CNs (n = 16). Less than 50% of facial nerve studies, and no vagal nerve study, reported sensitivity or specificity of coMEPs. coMEPs are an evolving technique in intraoperative neuromonitoring, powerful for their continuous monitoring of the entire motor pathways involving a CN. Comparison of the sensitivity and specificity of coMEPs to other modalities was limited by inconsistent reporting, highlighting the need for further investigation and prospective studies. Standardization of technique may facilitate broader adoption and acceptance of coMEPs.

We hypothesize a large anatomic variability with a positive correlation between retrotympanic recess volume and depth classification and an inverse correlation between recess volume and facial nerve distance. The retrotympanum consists of various bony recesses and is of particular interest given its frequent involvement in cholesteatoma. As the structures are only partly accessible with established imaging techniques due to their size, we propose here to systematically analyze the different retrotympanic subsites and describe topographic relationships using synchrotron-based X-ray phase contrast imaging (SR X-PCI). Ten fresh-frozen human temporal bones underwent SR X-PCI at the TOMCAT beamline at the Swiss Light Source. Microtomographic data sets were acquired and segmented for visual inspection. In each specimen, sinus tympani, facial recess, posterior sinus, and lateral tympanic sinus were present and were identified for further analysis. Among the volumes of retrotympanic recesses, the posterior sinus was on average the smallest and sinus tympani the largest. A positive correlation was observed between the volumes of the sinus tympani and facial recess and their respective A-B-C classifications. Moreover, an inverse correlation between volume and distance to the facial nerve was found for the different retrotympanic recesses. In addition, a previously undescribed recess located above the facial recess, termed the suprafacial recess, was identified in 7 specimens, and its volume was quantified. SR X-PCI enabled 3D visualization and volumetric analysis of retrotympanic subspaces. Our findings confirmed the complex and variable anatomy of this region and revealed a consistent presence of a previously underreported suprafacial recess.

Introduction. Peripheral facial paralysis (PFP) is an acute neuropathy of the VII cranial nerve, a frequent reason for pediatric consultation due to its functional, aesthetic, and emotional impact. Children generally have a good prognosis; however, a lack of recovery may require specialized follow-up. Objective. To describe clinical and epidemiological characteristics and evaluate complete clinical recovery at one month in pediatric patients with peripheral facial paralysis. Population and methods. Observational, prospective, cohort study conducted in the Moderate Risk Clinic of a general hospital in the Buenos Aires metropolitan area from April 2019 to March 2021. Patients aged 1 month to 14 years with a first episode of PFP were included. Severity was assessed using the House-Brackmann (HB) scale. Primary variable: complete recovery at one month. Secondary variables: clinical and epidemiological characteristics (age, sex, seasonality, laterality, previous symptoms), initial severity, and pharmacological treatment. Results. Seventy-four patients were included. Median age: 8.5 years (IQR 3-13), 48 females. At one month, 57 patients were evaluated, of whom 40 (70%) had complete recovery. Those with mild initial involvement (HB = 2) recovered completely. No difference in recovery was observed with corticosteroid treatment.Conclusion. The outcome was favorable for most patients. Less severe initial symptoms were associated with recovery within one month, regardless of the treatment received.

To compare postoperative outcomes and complications between closed reduction and open reduction and internal fixation (ORIF) of condylar and subcondylar fractures. This is a multicenter, retrospective database study utilizing data from 64 healthcare organizations in the United States from January 1, 2010 to July 31, 2025. The TriNetX database was used to identify adult patients ages 18 years or older with a history of condylar or subcondylar fractures. These patients were either treated with closed reduction or ORIF. The relative risks (RRs) with 95% confidence intervals (CIs) for outcomes and complications were assessed within 1 year postoperatively. Infection at or around the surgical site was more common with ORIF (RR: 0.64 [0.47-0.88]), while jaw pain and malocclusion were more frequent after closed reduction (RR: 1.73 [1.29-2.33]; 1.61 [1.21-2.15]). Malunion/nonunion and wound disruption rates were similar between groups (RR: 0.95 [0.61-1.48]; 1.33 [0.69-2.59]), and there were no facial nerve injuries. Patients treated with closed reduction had higher 30- and 90-day emergency department visit rates (RR: 1.90 [1.55-2.33]; 1.73 [1.44-2.09]). Closed reduction is associated with a higher rate of jaw pain, malocclusion, and visits to the emergency department when compared to ORIF, but associated with an increased risk of infection. There was no risk of facial nerve injury or osteomyelitis with either treatment options. 3.

Functional and psychosocial outcomes of simultaneous condylectomy and bimaxillary orthognathic surgery for unilateral condylar hyperplasia: Retrospective study.

Psychological outcomes of botulinum toxin treatment for facial nerve palsy sequelae: A retrospective analysis of anxiety and depression.

Oral and maxillofacial schwannoma (OMSCH): An institutional study of 102 patients.

Surgery for advanced stage or recurrent parotid tumors often involves VII nerve sacrifice. Facial reanimation techniques aim to restore corneal protection and both static and dynamic facial symmetry, without compromising resection. Surgical strategies were based on tumor histology and intraoperative frozen section analysis. Masseteric to facial nerve branch (for the ZMM) neurorrhaphy was done in patients without perineural invasion, while temporalis muscle tendon lengthening was used when that nerve was resected. Facial symmetry and function were objectively assessed using the eFACE system preoperatively and in follow-up. Postoperative eFACE analysis demonstrated good results in both static and dynamic facial symmetry. Masseteric to facial neurorrhaphy achieved satisfactory smile excursion (81±14), while static symmetry parameters, including nasolabial fold orientation (90±4), were high across both surgical groups. Gentle and full eye closure scored lower (79±3 and 85±4), reflecting the limited impact of reanimation techniques on voluntary eyelid closure. The multimodal facial reanimation protocol adopted effectively addressed recovery of facial symmetry and function. Masseteric to ZMM branch neurorrhaphy combined with cross face nerve graft offers excellent dynamic results with minimal morbidity, while additional static techniques ensure immediate ocular protection and aesthetic outcomes.

To evaluate whether the nerve excitability test using a 10mA pulse current (NET10mA) can serve as a simple and reliable method of predicting the prognosis of Bell's palsy in infants and young children, and to compare its diagnostic value with that of electroneurography (ENoG). This retrospective study included 19 pediatric patients aged 0 to 5 years with Bell's palsy who underwent both a NET and ENoG 8 days to 3 weeks after paralysis onset. During the NET, the marginal mandibular branch of the facial nerve was stimulated with a 10-mA pulse current, and any movement in the depressor anguli oris muscle was recorded. ENoG values were expressed as a percentage of the compound action potential amplitude on the affected side relative to that on the healthy side. Prognostic accuracy was evaluated using sensitivity, specificity, predictive values, and likelihood ratios. All 8 patients with both a positive NET10mA and ENoG ≥ 10% achieved full recovery (positive predictive value: 100%). In 11 patients with a negative result on NET10mA or ENoG < 10%, only 2 achieved full recovery. The sensitivity and specificity of NET10mA was 0.8 and 1.0, respectively. The results of NET10mA closely corresponded with the ENoG 10% cutoff ( κ = 0.89). The median recovery time was significantly shorter in patients with NET10mA+ ENoG ≥ 10% (3 vs. 12mo; P < 0.001). NET10mA provided a simple, minimally invasive, and clinically reliable means of predicting the prognosis of Bell's palsy in infants and young children and closely mirrored the degree of nerve degeneration indicated by ENoG.

To determine the extent of possible dose reduction with photon-counting detector computed tomography (PCD-CT) while maintaining image quality equivalent to that of energy-integrating detector CT (EID-CT) images at standard dose in the temporal bone. PCD-CT and EID-CT imaging quality were compared by visual evaluation of clinical temporal bone images and visual scores with Welch's t-test at standard dose. A head phantom was used to evaluate imaging quality under dose reduction. The detectability index (d') of the PCD-CT images at various dose levels and the EID-CT images at standard dose was evaluated. Dose reduction limit with PCD-CT used in the subsequent clinical evaluation was determined as the lowest dose with image quality equal to or better than EID-CT. The clinical equivalence of PCD-CT image quality at the determined reduced dose to that with EID-CT at standard dose was evaluated using visual scores. Equivalence was determined if the 95% confidence intervals of differences did not exceed the equivalence margin of ±1. At standard doses, PCD-CT images demonstrated significantly higher visual scores than EID-CT images (3.73 vs. 2.56 for incudomalleolar joint, 3.75 vs. 2.63 for stapes, 3.54 vs. 2.52 for cochlea, and 3.58 vs. 2.46 for facial nerve canal; all P 0.001). In the phantom study, the d' value was 0.15 with EID-CT at standard dose and was 0.12 and 0.17 with PCD-CT at 25% and 50% of the standard dose, respectively. Clinically, the mean visual scores of PCD-CT images at 50% of the standard dose were equivalent to EID-CT images at standard dose in all regions (3.58 vs. 3.12 for incudomalleolar joint, 3.46 vs. 3.19 for stapes, 3.50 vs. 3.08 for cochlea, 3.58 vs. 3.27 for facial nerve canal). PCD-CT may preserve image quality even at 50% of the standard dose in the temporal bone.

The management of sporadic vestibular schwannoma (VS) with stereotactic radiosurgery (SRS) is becoming increasingly common worldwide. Despite its efficacy, treatment failure can occur in a subset of patients. This study aimed to describe the clinical outcomes of salvage microsurgery following failed primary SRS in patients with sporadic VS. This retrospective study included adult patients (≥ 18 years) who underwent salvage microsurgery following failed primary SRS at six European tertiary referral centers. Data collection was performed from January 2012 to December 2022, and data analysis was performed from July to September 2025. Among 28 patients (15 men, 13 women), surgery indication was radiological regrowth in 27/28 patients. The median interval from SRS to salvage microsurgery was 48 months (range, 24-120), and the median age at time of salvage microsurgery was 53 years (range, 30-74). Axial diameter increased from median 18.5mm (range, 7.5-27) before SRS to 25mm (range, 10.5-33) before surgery. Gross total resection was achieved in 13/28 (46.4%). Complications occurred in 3/28 patients (10.7%). Serviceable hearing (AAO-HNS class A/B) declined from 10/20 patients (50.0%) pre-SRS to 4/24 (16.7%) preoperatively; all patients with postoperative follow-up (14/28) were AAO-HNS class D. Preoperative facial nerve function was House-Brackmann (HB) grade I in 25/28 patients (89.3%); good facial function (HB I-II) was seen in 14/27 (51.9%) at discharge and 11/15 (73.3%) at 12 months, with 3/15 (20.0%) remaining HB grade V-VI. Salvage microsurgery is a viable therapeutic option for managing VS after failed SRS. GTR or NTR with a relatively low complication profile is achievable, although hearing preservation is not a realistic goal in this setting, whereas facial nerve function may improve postoperatively.

Endolymphatic sac tumours (ELSTs) are rare, locally aggressive neoplasms of the temporal bone that often present at an advanced stage due to their indolent clinical course. Complete surgical excision may be technically challenging when tumours involve the jugular foramen, cerebellopontine angle (CPA) or adjacent cranial nerves and may therefore be associated with significant neurological morbidity. To evaluate facial nerve and radiological outcomes following planned subtotal resection with selective use of adjuvant radiotherapy in patients presenting with advanced sporadic ELST. A retrospective review was performed of patients diagnosed with ELST and managed at the National Skull Base Centre, Beaumont Hospital. Clinical presentation, radiological findings, surgical approach, extent of resection, histopathological features, adjuvant therapy and postoperative outcomes were analysed. All patients underwent screening for von Hippel-Lindau (VHL) disease. Facial nerve function was assessed using the House-Brackmann (HB) grading system. Radiological stability was evaluated using serial postoperative magnetic resonance imaging (MRI). Two patients presented with locally advanced ELST involving the petrous temporal bone and skull base with cranial nerve involvement at diagnosis. Both patients underwent screening for von Hippel-Lindau disease. Both underwent transmastoid subtotal resection to preserve neurological function. One patient subsequently received adjuvant radiotherapy, while the second was managed with radiological surveillance alone. Patient 2 improved from House-Brackmann grade V to grade II, while Patient 1 maintained grade II function. Serial postoperative MRI demonstrated stable residual disease. In selected cases of advanced sporadic ELST, planned subtotal resection with selective adjuvant radiotherapy may preserve cranial nerve function while maintaining short-term radiological stability.

While prior literature has demonstrated that patients of lower socioeconomic groups may have larger tumors on presentation and poorer outcomes, there is limited literature on the impact of race and ethnicity on management of vestibular schwannoma (VS). The objective of this study was to determine whether race and ethnicity impacted treatment choice and postoperative management of VS. Retrospective review of patients diagnosed with VS (ICD9 225.1, ICD10 D33.3, and ICD 10 H93.3) who presented to a tertiary care center between January 1, 2018 and October 31, 2023 was completed (IRB H-45412). Primary outcomes, including treatment choice, time to treatment, and postoperative management, were compared among different racial and ethnic groups. Of the 78 patients diagnosed with VS, 46 (59.0%) patients were observed with serial imaging, 12 (15.4%) underwent radiation, and 14 (18.0%) pursued surgery initially. Treatment choice (P = .3917), time to treatment (P = .3310), and loss to follow up (P = .0579) were not significantly different between different races/ethnicities. In patients who pursued surgery, the duration of admission (P = .9300), need for rehabilitation (P = .6271), postoperative facial nerve paresis (P = .8233), and hospital readmission (P = .5680) did not differ significantly. The proportion of patients who qualified for hearing rehabilitation did not differ significantly (P = .3545). However, a significantly higher proportion of White patients chose to pursue hearing rehabilitation compared to the other groups ( P = .0096). Race and ethnicity did not significantly impact choice of treatment, management patterns, or postoperative course for patients with VS.

BACKGROUND Ulcerative colitis (UC) is a chronic inflammatory disease of the colon. Guillain-Barre syndrome (GBS) is an immune-mediated disease of the peripheral nervous system. GBS can present as a rare extraintestinal manifestation of UC when in remission or relapse. Herein, we report an uncommon case of a young woman with underlying ulcerative colitis, who developed facial diplegia as a rare variant of Guillain-Barre syndrome. CASE REPORT We describe the case of a 22-year-old woman who presented with sudden onset bilateral facial weakness during a relapse of UC. Cerebrospinal fluid showed albuminocytological dissociation and electromyography suggested an isolated lesion of the bilateral facial nerves. Diagnosis of facial diplegia variant of GBS was finally confirmed, and intravenous immunoglobulin therapy was given. However, only partial improvement was achieved. CONCLUSIONS This case shows that isolated facial diplegia, a variant of GBS, can occur in patients with UC as a neurological extraintestinal manifestation, which not been previously reported, suggesting that UC can be an underling cause or predisposing factor for bilateral facial palsy. We believe that this case report and literature review will encourage prompt diagnosis and accurate treatment of co-existent GBS and UC.

To investigate the association between partitioned internal auditory canal (IAC) and other inner ear abnormalities. The temporal bone computed tomography (CT) and magnetic resonance imaging (MRI) findings of ears with partitioned IAC were retrospectively analyzed. The IAC was considered narrow if its mid-portion diameter < 2 mm. Cochlear aperture (CA) was classified as normal (diameter more than 1.5 mm), stenotic (diameter < 1.5 mm), or atretic. The MRI images examined the cochlear nerve (CN). The CN's diameter was compared with the ipsilateral facial nerve to determine if it was normal, hypoplastic, or aplastic. Partitioned IAC was observed in 1.1% of ears with normal CA, 14.9% of ears with stenotic CA, and 20.9% of ears with atretic CA. Forty-eight right and 37 left ears with partitioned IAC were examined. The most common CA anomaly accompanying partitioned IAC was CA stenosis, while more than half of the cochleae were of normal size. IAC was mostly narrow in ears with partitioned IAC. When the CN was examined, partitioned IAC was almost always accompanied by CN aplasia (more frequently) or hypoplasia. This study demonstrates that CN deficiency, associated with CA abnormalities, may cause the aberrant location of the meatal segment of the facial nerve in a separate bony canal. Partitioned IAC is an inner ear malformation characterized by CN deficiency.

ABSTRACTObjectivePreservation of the facial nerve is critical in surgery for facial nerve schwannoma. Intra‐operative monitoring systems typically assess facial nerve function by delivering intermittent electrical stimulation through electrodes; however, this approach cannot effectively achieve continuous stimulation and quantitative assessment. This study aimed to assess the efficacy of a quantitative intra‐operative facial nerve continuous monitoring system for preserving post‐operative facial nerve function.MethodsTen patients who underwent continuous nerve monitoring using this system during surgery for facial nerve schwannoma were included. Clinical data, electrode placement sites, and pre‐ and postoperative facial nerve function assessed using the House–Brackmann grading system were retrospectively analyzed. In patients with conductive hearing loss, postoperative hearing outcomes were also analyzed.ResultsFacial nerve function was preserved in all patients, except for one patient who experienced transient postoperative functional deterioration. In several cases, conductive hearing loss improved following schwannoma resection.ConclusionContinuous and quantitative monitoring of facial nerve function is a reliable intraoperative evaluation that may help prevent unexpected facial nerve injury. This system represents a valuable tool for application in facial nerve schwannoma surgeries.Level of EvidenceLevel 4