Segment Of Facial Nerve Research Articles

Delayed Facial Nerve Dysfunction Following CyberKnife® Radiosurgery for Vestibular Schwannoma.

The incidence and risk factors for facial nerve dysfunction (FND) following CyberKnife® therapy for vestibular schwannoma (VS) remain poorly understood. This study investigates whether differential radiation doses to vulnerable segments of the facial nerve may be associated with FND outcomes. Patients were identified who underwent CyberKnife® radiosurgery for VS at a single institution. Basic demographics, tumor characteristics, and facial nerve function were collected. Total radiation doses to tumor, internal auditory canal (IAC), and labyrinthine segment of facial nerve (LSFN) were evaluated. Six out of 64 patients experienced FND following CyberKnife® treatment for VS (9.38%, 6/64). Patients with FND were compared to those without FND (control). Of the 64 patients, complete radiation records were obtained for 30 patients (6 FND vs. 24 control). There were no significant differences in demographic or tumor characteristics between control and FND cohorts. More severe FND (HB ≥ 4) had significantly larger tumors (3.74 vs. 1.27 cm3, p = 0.037) with directionally decreased time to FND (3.50 vs. 33.5 months, p = 0.106) than patients with HB < 4, respectively. There were directionally, nonsignificant differences between maximum radiation doses to the LSFN (2492.4 vs. 2557.0 cGy, p = 0.121) and IAC (2877.3 vs. 2895.5 cGy, p = 0.824) between the control and FND cohorts, respectively. FND may represent an underrecognized sequelae of CyberKnife® radiosurgery for VS that can occur many months following treatment. Further studies are needed to elucidate the effect of differential radiation exposure to the facial nerve with FND following treatment. III (Retrospective Cohort Study) Laryngoscope, 2024.

Transcanal Endoscopic Facial Nerve Decompression in Posttraumatic Facial Paralysis: A Tertiary Care Experience

Purpose: Facial nerve decompression (FND) for traumatic facial palsy with lesion at geniculate ganglion and tympanic segment can be done through transcanal approach, by a microscope or an endoscope without opening the mastoid. The study analyzes the outcomes of transcanal endoscopic approach (TEA) for FND with regard to improvement in facial nerve (FN) function and hearing status, in lesions limited to perigeniculate and tympanic segment of FN. Methodology: This was a retrospective analysis of the case series from a tertiary care center, of the patients with posttraumatic FN paralysis, surgically treated with TEA. From January 2014 to December 2018, nine patients of traumatic facial palsy were selected for surgery. The patients posted for surgery were selected only when they had immediate-onset FN paralysis after trauma and not responding to treatment of systemic corticosteroid for 14 days with, House Brackmann grading (HBG) IV–VI, lesions confined to perigeniculate ganglion and tympanic segment of FN. Outcome analysis following TEA for FND was performed in terms of postoperative FN function and hearing improvement. Results: The TEA showed a postoperative improvement of FN function (HBG I/II) in 77.7% of patients within 6-month follow-up period. There was no significant improvement in FN function between 6th and 12th month. Postoperative hearing improvement was seen in eight cases, and there was no improvement in one case due to preoperative sensorineural hearing loss. Conclusion: TEA for FND is a direct approach for lesions confined to perigeniculate ganglion area and tympanic segment without involvement of mastoid segment of FN. It requires minimal bone drilling, provides proper visualization, and accurate surgical site assessment. Surgeries performed even in late presentations may have favorable outcomes.

Revolutionizing Sales with Phone Systems: Design and Implementation Best Practices

The technique of classifying a face as recognized or unknown in computer vision is known as face recognition. The procedure follows a pipeline that includes steps for data collection, detection, pre-processing, and recognition. This research focuses on with the assumption that photos have already been processed at the end of the pipeline pre-processed and gathered Face recognition software in the past has relied on the full face. Their algorithms take a face picture as input. We propose a new method in which the individual facial segments, such as the left, are sent into the recognition algorithm. The four components that make up the face are the left eye, the right eye, the nose, and the mouth. After that, the output of each algorithm is labelled, and it is categorized as belonging to right feature class. According to the findings of our research, the granularity of information gathered for each subdivision class has the potential to be utilized in order to create a higher accuracy rate than can be achieved by using the complete face technique.

Radiological Parameters Predicting the Round Window Niche Visibility through Facial Recess Approach in Cochlear Implantation.

The aim was to study the radiological parameters using High Resolution Computed Tomography (HRCT) temporal bone to predict the Round Window Niche (RWN) visibility through the facial recess approach and to study radiological types of the round window niche. Prospective study was done in the patients underwent CI surgery from 2019 to 2021. HRCT radiological parameters of the patients and their intraoperative visualisation from video recordings were compared to predict the most feasible parameters to predict good visualisation of RWN. Among 51 patients (34 males, 17 females) in 48 children round window membrane insertion was done and in three children cochleostomy was done and in two children partial canal wall drilling was done due to poor visualisation of RWN area. Multiple parameters to assess the visibility of the RWN were used. Facial recess width (4.2mm), location of the mastoid segment of facial nerve (2mm), external auditory canal to basal turn of cochlea angle (< 13.50) and the radiological types (tunnel shape and semi-circular shape) of the RWN by HRCT were found to be significant parameters in predicting a good visualisation of the RWN. HRCT parameters prepare the surgeon to face the possibility of a difficult surgery and plan to deal with difficult situations. This would eventually lead to better preparedness of surgeons for management of complications.

Cranial nerve VII on gadolinium contrast-enhanced magnetic resonance imaging in the case of Bell’s palsy

Bell’s palsy is a rapid unilateral peripheral paralysis of cranial nerve VII whose etiology is varied, most commonly associated with an acute infectious or inflammatory demyelinating process. Nerve injury can result in edema because of increased permeability of vascular structures, which can sometimes be seen as a locus of enhancement of magnetic resonance imaging (MRI). Bell’s palsy is typically considered a clinical diagnosis and the specificity and sensitivity of imaging have been poorly studied. Herein is describe a case of a 73-year-old male who presented to the emergency department with left-sided facial droop and no other focal neurological abnormalities. With a history of a Janus kinase 2 (JAK2) mutation and the new initial facial drooping, acute cerebrovascular insult was high on the differential. Initial labs and computerized tomography (CT) head were inconclusive, but MRI showed pronounced enhancement of the left distal internal carotid artery (ICA) with contiguous enhancement of the labyrinthine, geniculate, and tympanic segments of the left facial nerve. Diagnosing Bell’s palsy can be a challenge as there are numerous postulated etiologies stemming from trauma, infection, and neoplasm; with infection (particularly viral) postulated to be the most likely source. Though MRI is currently not validated as a tool in expediting Bell’s palsy diagnosis, findings such as the enhancement seen here provide some insight into the benefit of MRI as a diagnostic modality in some cases. This case is unique both for the diagnostic dilemma between stroke and Bell’s palsy and the potential for MRI imaging to help guide clinical decision-making into treatment.

Intraoperative diagnosis of facial schwannomas: a multicenter summation of clinical experience, preoperative avoidance, and intraoperative management protocol.

Preoperative differentiation of facial nerve schwannoma (FNS) from vestibular schwannoma (VS) can be challenging, and failure to differentiate between these two pathologies can result in potentially avoidable facial nerve injury. This study presents the combined experience of two high-volume centers in the management of intraoperatively diagnosed FNSs. The authors highlight clinical and imaging features that can distinguish FNS from VS and provide an algorithm to help manage intraoperatively diagnosed FNS. Operative records of 1484 presumed sporadic VS resections between January 2012 and December 2021 were reviewed, and patients with intraoperatively diagnosed FNSs were identified. Clinical data and preoperative imaging were retrospectively reviewed for features suggestive of FNS, and factors associated with good postoperative facial nerve function (House-Brackmann [HB] grade ≤ 2) were identified. A preoperative imaging protocol for suspected VS and recommendations for surgical decision-making following an intraoperative FNS diagnosis were created. Nineteen patients (1.3%) with FNSs were identified. All patients had normal facial motor function preoperatively. In 12 patients (63%), preoperative imaging demonstrated no features suggestive of FNS, with the remainder showing subtle enhancement of the geniculate/labyrinthine facial segment, widening/erosion of the fallopian canal, or multiple tumor nodules in retrospect. Eleven (57.9%) of the 19 patients underwent a retrosigmoid craniotomy, and in the remaining patients, a translabyrinthine (n = 6) or transotic (n = 2) approach was used. Following FNS diagnosis, 6 (32%) of the tumors underwent gross-total resection (GTR) and cable nerve grafting, 6 (32%) underwent subtotal resection (STR) and bony decompression of the meatal facial nerve segment, and 7 (36%) underwent bony decompression only. All patients undergoing subtotal debulking or bony decompression exhibited normal postoperative facial function (HB grade I). At the last clinical follow-up, patients who underwent GTR with a facial nerve graft had HB grade III (3 of 6 patients) or IV facial function. Tumor recurrence/regrowth occurred in 3 patients (16%), all of whom had been treated with either bony decompression or STR. Intraoperative diagnosis of an FNS during a presumed VS resection is rare, but its incidence can be reduced further by maintaining a high index of suspicion and undertaking further imaging in patients with atypical clinical or imaging features. If an intraoperative diagnosis does occur, conservative surgical management with bony decompression of the facial nerve only is recommended, unless there is significant mass effect on surrounding structures.

Межплеменная изменчивость некоторых кефалометрических признаков у бедуинов Южного Синая и попытка ее визуализации методом обобщенного фотопортрета

Introduction. The article presents the results of the development data on kefalometry of the complex South Sinai anthropological expedition. The purpose was to study the variability of cephalometric traits in South Sinai Bedouins. Objectives: to identify possible phenotypic differences between the tribes, to assess the position of the Bedouin tribes against the background of the Middle Eastern and North African populations according to literary data; to create male composite photo portraits (CPP) from Bedouin tribes Awlad Said and Gebeliya. Materials and methods. Cephalometric data from three tribal samples were used: the tribes of Gebeliya, Muzeina and the combined group "other tribes", which includes data on the Awlad Said tribe. To identify intertribal differences, analysis of variance was applied. Literature data on Middle Eastern and North African samples were used for comparative analysis by the method of multidimensional scaling. To create composite photographic portraits (according to F. Galton´s method), an improved program "Face to face" by Syroezhkin-Maurer (by superposition of three points) was used. Full-face and profile individual Bedouins photographic images from the tribes of Gebeliya (N = 21), Awlad Said t (N=21) and Muzeina (N=19, only frontal) were selected for the work. Results. Statistically significant differences between the Bedouin tribal samples were revealed in such traits as: minimal forehead breadth and mandibular diameter, facial index, height of the lower facial segment and head circumference. Composite full-face and profile photo portraits of Bedouin men of the Awlad Said and Gebeliya tribes, full-face portraits of representatives of the Muzeina tribe were obtained. The results of biometric analysis on the latitudinal traits of the face partly coincide with the analysis of visual information on composite photo portraits. According to the measurement data of the face and head, it was revealed that Bedouin tribes form a compact cluster that differs from neighboring populations. Conclusion. In the male part of the combined Bedouin sample, for a number of cephalometric features, significant intertribal differences were revealed both by statistical methods and visually (when considering full-face and profile male composite photo portraits). It is shown that endogamous Bedouin tribes of the South Sinai Peninsula are very close to each other by a combination of cephalometric traits, and they significantly different from other neighboring populations. The South Sinai Bedouins form a kind of unique aggregation, whose peculiarity, probably, was formed under the influence of certain socio-historical and environmental factors. @ 2023. This work is licensed under a CC BY 4.0 license

Reestablishment of the Smile after Hypoglossal-Facial Nerve Transfer: What Can We Learn?

Objective The aim of this study was to assess the ability to smile following a hypoglossal-facial nerve transfer (N12-N7). Design This is a retrospective chart review. Setting National tertiary referral center for skull base pathology. Participants Seventeen patients. Main Outcome Measures The ability to smile following an N12-N7 transfer was assessed by five medical doctors on photographs of the whole face and frontal, orbital, and oral segments. The (segmented) photographs were scored for the symmetry, asymmetry, and correct or incorrect assessment of the affected side. Results Seventeen patients were analyzed by 5 assessors providing 85 assessments. The whole face at rest was judged symmetrical in 26% of the cases and mildly asymmetrical in 56%. Frontal, orbital, and oral segments were symmetrical in 63, 20, and 35%, respectively. The affected side was correctly identified in 76%. When smiling, the whole face was symmetrical in 6% and mildly asymmetric in 59%. The affected side was correctly identified in 94%. The frontal, orbital, and oral segments during smiling were symmetrical in 67, 15, and 6%, respectively. The affected side of the frontal, orbital, and buccal facial segments during smiling was correctly identified in 89, 89, and 96%, respectively. Interobserver variability with Fleiss' kappa analysis showed that the strength of the agreement during smile of the total face was good (0.771) Conclusion Following an N12-N7 transfer, a good facial symmetry at rest can be achieved. During smiling, almost all patients showed asymmetry of the face, which was predominantly determined by the orbital and oral segments. To improve the ability to smile after an N12-N7 transfer, additional procedures are needed.

The clinical availability of facial nerve enhancement in temporal bone MRI for the patients of idiopathic acute peripheral facial palsy.

This study is to evaluate the duration of facial nerve enhancement in gadolinium-enhanced temporal bone MRI after the onset of acute facial palsy. Gd-enhanced MRI imagines were examined in 13 patients with idiopathic acute facial palsy within 14days after the onset. The degree of facial nerve function was measured according to the House-Brackmann (H-B) grading system at their first visit at outpatient clinic. The follow-up MRI was taken about 16.5months (7-24months) after onset of disease. The degree of facial nerve enhancement was measured with signal intensity (SI) which was quantitatively analyzed using the region-of-interest (ROI) measurements for each segment of the facial nerve. SI was statistically analyzed by comparing SI values of contralateral site and ipsilateral site using the paired t test with SPSS program. The gadolinium enhancement was statistically increased at labyrinthine segment and geniculate ganglion area of facial nerve at initial temporal bone MRI. The gadolinium enhancement was statistically decreased at all the segments of facial nerve except tympanic segment (p < 0.05) at follow-up MRI. The facial nerve enhancement in Gd-enhanced MRI images prolonged more than 21months of the onset. The newly developed pathologic lesions of acute facial palsy especially occur at the site of labyrinthine and geniculate ganglion.

Long-term outcomes of facial nerve decompression by transmastoid versus middle cranial fossa approach for traumatic facial paralysis

ObjectivesTo evaluate and compare the long-term results of patients who underwent facial nerve decompression surgery with either transmastoid-supralabyrinthine (TMSL) or combined transmastoid- middle cranial fossa (MCF) approach for traumatic facial nerve paralysis. Materials and methodsThis is a single-center retrospective case-control study. The medical records of traumatic facial paralysis patients with House Brackmann (HB) Grade 6 who underwent facial nerve decompression surgery at via either TMSL or MCF approach between January 2011 and December 2017 were reviewed. The patients who had otic capsule involvement and total sensorineural hearing loss, therefore underwent translabyrinthine facial nerve decompression, and the patients follow-up period has not yet reached four years were excluded from the study. Postoperative HB score and hearing status were compared. ResultsEleven patients were operated with MCF approach (group 1), while 9 patients with TMSL approach (group 2). Average age of patients was 20.04 + 15.2 (range:4–47) years. Three (15 %) patients were female, while 17 (85 %) was male. Geniculate ganglion (90 %) was the most affected segment of the facial nerve. Facial nerve edema was observed in all cases, while intraneural hematoma were encountered in 4 (20 %) cases. Statistically significant improvement in median HB scores were reached in both groups, and no significant difference was observed in post-operative HB scores between both techniques. No significant difference in median AC 0,5–4 khZ and BC 0,5–3 kHz thresholds was observed between both techniques. ConclusionEven middle fossa approach is the best surgical technique to explore geniculate ganglion and labyrinthine segment of facial nerve, the functional results of transmastoid supralabrynthine approach, which is not needed craniotomy with low complication rate are as successful as middle fossa approach in selected patients.

Extracranial facial nerve imaging in parotid surgery candidates. Could 1.5 T MRI be beneficial?

AbstractBackground and aimDespite improvements in the imaging modalities, the optimal protocol for extracranial facial nerve imaging using 1.5 T MRI is still debatable. Pre-operative mapping of the facial nerve could provide valuable information for surgeons. The current study aimed to evaluate and choose proper 1.5 T MRI protocols for the extracranial segment of facial nerve pre-op imaging.Patients and methodsExtracranial facial nerves on the tumoral and normal side of 19 patients (38 nerves) were imaged by 1.5 T MRI, using five sequences including T1-weighted, T2-weighted, T1-weighted-fat-saturated with contrast, Three-dimensional (3D) T1-weighted and 3D T2-weighted. The visibility of each of the three segments of the extracranial facial nerve (the main trunk, cervicofacial and temporofacial divisions and terminal branches) in each sequence was assessed.ResultsOn the normal side, segments 1 and 2 of the nerve were identifiable in all patients and segment 3 was identifiable in 89.5% of patients in both 3D T1-weighted and 3D T2-weighted sequences. On the tumoral side, segments 1, 2 and 3 were identifiable in 89.5, 84.2 and 68.4% of patients, respectively, in 3D T1-weighted and T2-weighted sequences. 3D sequences showed significant improvement in visualizing extracranial facial nerve and its branches compared to routine T1-weighted and T2-weighted sequences.ConclusionsOur protocol showed favourable results in visualizing the extracranial facial nerve and its branches. We believe the protocol used in this study could be used as a pre-operative facial nerve mapping method using 1.5 T MRI.

Transmastoid/Infralabyrinthine Approach to the Jugular Foramen: 2-Dimensional Operative Video.

This approach is intended for tumors centered in the jugular foramen with extensions between intracranial and extracranial spaces, possible spread to the middle ear, and variable bony destruction. 1,2. Jugular foramen paragangliomas are complex lesions that usually invade and fill related venous structures. They present complex relationships with skull base neurovascular structures as internal carotid artery, lower cranial nerves (CNs), middle ear, and mastoid segment of facial nerve. In this way, it is essential to perform an adequate preoperative vascular study to evaluate sinus patency and the tumor blood supply, besides a computed tomography scan to depict bone erosion. Mastoidectomy through an infralabyrinthine route up to open the lateral border of jugular foramen, allowing exposure from the sigmoid sinus to internal jugular vein. Skeletonization of facial canal without exposure of facial nerve is performed and opening of facial recess to give access to the middle ear in way of a fallopian bridge technique. 2-10. If there is preoperative preservation of lower CN function, it is important to not remove the anteromedial wall of the internal jugular vein and jugular bulb. In addition, facial nerve should be exposed just in case of preoperative facial palsy to decompress or reconstruct the nerve. Variations are related mainly with temporal bone drilling depending on the extensions of the lesion, its source of blood supply, and preoperative preservation of CN function.Informed consent was obtained from the patient for the procedure and publication of his image.Anatomy images were used with permission from:• Ceccato GHW, Candido DNC, and Borba LAB. Infratemporal fossa approach to the jugular foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.• Ceccato GHW, Candido DNC, de Oliveira JG, and Borba LAB. Microsurgical Anatomy of the Jugular Foramen. In: Borba LAB and de Oliveira JG. Microsurgical and Endoscopic Approaches to the Skull Base. Thieme Medical Publishers. 2021.

Successful replantation of amputated facial tissues by supermicrosurgery

BackgroundAlthough replantation of amputated facial segments remains challenging in reconstructive surgery, it offers excellent aesthetic and functional outcomes. MethodsFrom May 2004 to October 2019, 12 patients underwent replantation of amputated facial tissues by supermicrosurgery. The case details, such as the rationale for replantation, the operation method, and postoperative therapy, are described. Four cases are discussed to demonstrate the replantation of different facial parts. ResultsFacial tissue replantation was successful in all 12 patients without secondary surgery. The cases included the nose (1 patient), ears (8 patients), lips (2 patients), and one of the soft tissue segments surrounding the lower jaw. Venous congestion occurred in three patients who received a solitary arterial repair and were treated with bloodletting. All patients expressed satisfaction with the cosmetic and functional results at the final follow-up. ConclusionsSupermicrosurgical facial tissue replantation is a promising and effective procedure for providing patients with the best aesthetic and functional outcomes.

Differentiation of geniculate ganglion venous malformation from schwannoma: dynamic T1-weighted imaging provides unique diagnostic value.

To distinguish geniculate ganglion venous malformation (GGVM) from schwannoma (GGS) by using high-resolution CT (HRCT), routine MRI, and dynamic T1-weighted imaging (T1WI) characteristics. Surgically confirmed GGVMs and GGSs between 2016 and 2021 were retrospectively included. Preoperative HRCT, routine MR, and dynamic T1WI were performed on all patients. Clinical data, imaging characteristics including lesion size, involvement of facial nerve (FN), signal intensity, enhancement pattern on dynamic T1WI, and bone destruction on HRCT were evaluated. Logistic regression model was developed to identify independent factors for GGVMs, and the diagnostic performance was accessed by receiving operative curve (ROC) analysis. Histological characteristics were explored for both GGVMs and GGSs. Twenty GGVMs and 23 GGSs with mean age of 31 were included. On dynamic T1WI, 18 GGVMs (18/20) showed "pattern A" enhancement (a progressive filling enhancement), while all 23 GGSs showed "pattern B" enhancement (a gradual whole-lesion enhancement) (p < 0.001). Thirteen GGVMs (13/20) showed the "honeycomb" sign whereas all GGS (23/23) showed extensive bone changes on HRCT (p < 0.001). Lesion size, involvement of FN segment, signal intensity on non-contrast T1WI and T2-weighted imaging (T2WI), and homogeneity on enhanced T1WI were obviously differed between two lesions (p < 0.001, p = 0.002, p < 0.001, p = 0.01, p = 0.02, respectively). Regression model showed the "honeycomb" sign and "pattern A" enhancement were independent risk factors. Histologically, GGVM was characterized by interwoven dilated and tortuous veins, while GGS was characterized by abundant spindle cells with dense arterioles or capillaries. The "honeycomb" sign on HRCT and "pattern A" enhancement on dynamic T1WI are the most promising imaging characteristics for differentiating GGVM from GGS. The characteristic sign and enhancement pattern on HRCT and dynamic T1-weighted imaging allow preoperative differentiation of geniculate ganglion venous malformation and schwannoma feasible, which will improve clinical management and benefit patient prognosis. • The "honeycomb" sign on HRCT is a reliable finding to differentiate GGVM from GGS. • GGVM typically shows "pattern A" enhancement (focal enhancement of the tumor on early dynamic T1WI, followed by progressive contrast filling of the tumor in the delayed phase), while "pattern B" enhancement (gradual heterogeneous or homogeneous enhancement of the whole lesion) is observed in GGS on dynamic T1WI.

Indications of and Efficacy of Facial Nerve Decompression Through Endoscopic Transcanal Approach for Patients with Traumatic Facial Paralysis.

The aim of this study is to evaluate the indications and efficacy of facial nerve decompression through an endoscopic transcanal approach for patients with traumatic facial paralysis. This single-center retrospective study included 11 patients with traumatic facial paralysis from February 2018 to April 2019. We compared the facial nerve and auditory function before and after operation so as to reveal the feasibility and effect of the surgical approach. All 11 patients have successfully received facial nerve decompression through endoscopic transcanal approach. Facial nerve function was objectively evaluated by electroneurography test and House-Brackmann facial nerve grading system. All patients were graded HB-VI with electroneurography ≥ 95% before surgery. The recovery of facial nerve function was good (HB-I or II) (90.9%) a year after surgery with only one case (9.1%) for HB-III. Preoperative high-resolution computed tomography showed that 1 patient had ossicular chain interruption, which was confirmed during operation. Meanwhile, 2 patients with air-bone gap >35 dBHL and whose computed tomography failed to diagnose were found with ossicular chain interruption during operation. The air-bone gap of patients with normal ossicular chain connection was all <30 dBHL. The average air-bone gap was reduced from 27.5 ± 10.1 dBHL to 7.8 ± 3.3 dBHL after operation. Preoperative high-resolution computed tomography combined with localization test can accurately estimate the location of facial nerve injury. Facial nerve decompression through endoscopic transcanal approach can decompress the geniculate ganglion to pyramidal segment of facial nerve, which is suitable for patients with traumatic facial paralysis of this segment. In addition, air-bone gap >35 dBHL may indicate the ossicular chain interruption when it is difficult to be completely judged by high-resolution computed tomography.

Facial Palsy Secondary to Cholesteatoma: A Case-Series of 14 Patients

To evaluate patients with middle ear cholesteatoma presenting with facial palsy (FP). A total of 14 subjects (10 males and 4 females), with a mean age of 42.5 years, were included in our study. The majority of patients presented with incomplete FP (House-Brackmann HB II-IV, 11 cases) and the remaining 3 patients had complete facial paralysis (HB V-VI). A canal wall down mastoidectomy was performed in all the patients, followed by partial facial nerve decompression. At the one-year follow-up, eleven (78.5%) patients demonstrated satisfactory recovery to HB I-II. Facial function recovered to HB grade I-II in 9 (100%) patients who were surgically treated within one month, and in 2 (40%) patients who underwent surgery after one month. The tympanic segment of facial nerve was the most common site of involvement (8 patients). The multiple regression analysis showed that a higher preoperative HB grade combined with a gradual than sudden onset of FP more likely resulted in worse postoperative HB grade. Early surgical removal of cholesteatoma associated with FP is more likely to result in good facial nerve recovery (78.5% of cases), when it is performed within one month from the onset of FP. According to the literature, the tympanic segment of the facial nerve was more frequently damaged (77.7%), followed by the mastoid segment (22.9%), labyrinthine segment (11.1%), and geniculate ganglion (11.1%). Labyrinthine fistula, mainly of the lateral semicircular canal, can be expected in cases of facial nerve dehiscence. The canal wall down mastoidectomy combined with partial decompression surgery was the most preferred surgical treatment for the FP secondary to cholesteatoma.

Buccal Fat Pad Excision for Facial Rejuvenation: The Relationship Between the Resected Position and Its Influence on Facial Shape and Volume.

To date, facelift surgery has been the most common choice for those seeking antiaging solutions. However, buccal fat pad (BFP) excision has also been utilized recently. An interrelation between the BFP, resection area, and its influence on facial shape and volume is scrutinized to achieve "tailor-made" outcomes in patients with BFP-related symptoms. Patients were categorized into 2 groups: Type I with a bottom-heavy face and Type II with ptotic lower cheeks, typically seen in older people. The lower face was divided into upper and lower segments bilaterally. Then, the relationship between the resected position of the BFP and its influence on facial shape and volume was studied. BFP excision was performed for 133 patients (118 females and15 males) between May 2020 and June 2022. Sixty-one of these patients were categorized into Type I (39 patients) and Type II (22 patients) and were followed up for 12 months postoperatively. The volume of all lower facial segments decreased postoperatively in both types of patients. The variation rate of the upper segment volume in Type II patients was less than that in Type I patients. The results were consistent with a technique that did not remove large chunks of the BFP from the upper segment in Type II patients. BFP excision is an effective facial rejuvenation treatment if proper candidates are selected. To improve the accuracy of BFP excision, the relationship between the resected position of the BFP and its influence on facial shape and volume should be well understood.

Anterolateral (juxtacondylar) approach with limited mastoidectomy to resect a jugular foramen meningioma.

The anterolateral (juxtacondylar) approach with limited mastoidectomy is a suitable option to expose the postero-inferior part of the jugular foramen (JF). It is particularly indicated for tumors extending in the neck beyond the jugular foramen, especially in those cases necessitating both neck control as well as control of the mastoid segment of facial nerve. We describe here the steps to safely perform an anterolateral approach with mastoidectomy along with a brief description of its indications and limits. This approach represents a valid option to reach the JF. Its knowledge can improve the process of optimal approach selection when dealing with complex pathology involving the JF.

Linearity and Surface Anatomy of the Face: From Embryo to Senescence.

Furrows, lines and wrinkles with distensibility and retractility are a biological need of skin in the service of skin integrity, plasticity and joint motion. The fundamental segmentation and linearity of skin is genetically coded, manifested early in embryonal life and remarkably constant throughout life. The basic pattern established early in embryonal life when facial segments expand and fuse is confounded by overlapping linearities of different backgrounds. Embryonal skin and skin in childhood, puberty, adult life and senescence undergo a general change in the direction of disturbed structure, nevertheless respecting the originally coded and segmented linearity. The fundamental linearity is expressed as the naso-frontal, maxillary and mandibular segments of the primitive face and the extremity buds forming extremities. The sensory nerves in this phase of morphogenesis follow and invade the segments of the face, trunk and extremities and form dermatomes,replicating the tissue segments. Early on, CREST cells migrate from behind, from the neural crest, and seed a normally hidden linearity in the tissues, which may appear as scleroderma lines, particularly the vertical "en coup de sabre" line(s) in the front. Later in pregnancy, during the phase of volume expansion, the resultant horizontal force applied to the outer skin results in gliding of epidermal structures relative to the underlying dermis, resulting in hair streams and whorls and bizarre V-shaped figures known as Blaschko's lines.Hairs in this process achieve their final distribution and inclination relative to the skin surface, known as Voigt's hairstreams and whorls. The dermatoglyphic lines and whorls of finger pulps share features with the two linearities explained by outer skin gliding. The fibre network of the dermis has uneven pretension, and circular wounds retract and become oval, systematically mapped as Langer's lines. Surgical incision lines influenced by static and dynamic forces to normal skin are described as Kraissl's linesand Borge's linesused to guide surgical incisions.Gravity acts as a constant vertical force on the face and entire body and results over years in gravitational lines, furrows and "hanging" skin. The sun creates its own pattern of disturbed linearity, photodamage lines and patterns that overrule the minute triangularlinearity, with accumulation of elastotic material in the dermis. Poor lifestyle and medical and psychiatric disease are associated with preterm skin ageing and increased furrowing. Skin linearity is complex with overlapping patterns. A broad insight into the essentials of skin linearity from the embryonal state to aged skin and senescence with an understanding and consideration of the ever-active influence of the genetic coding on skin linearities and ageing, including the forceful autoregulation aiming at the restauration of the natural state of the skin organ at any time and irrespective of interventions, is mandatory for professionals working on skin - plastic and aesthetic surgeons, dermatologists, cosmetologists, and cosmetic and decorative tattooists.

PHACE(S) SYNDROME - EARLY DIAGNOSTICS IN THE MAXILLOFACIAL AREA.

The aim: To determine the minimum criteria for early diagnosing PHACE(S) syndrome in neonates and infants with infantile hemangioma (IH) in the max¬illofacial area. Materials and methods: A total of 26 asymptomatic children from 20 days to six months of aged with IH of more than 5 cm² in the maxillofacial area were included in this study. A medical record of patients clinical examination, Holter monitoring, echocardiographic ultrasound and magnetic resonance imaging (MRI) were analysed. The IH treatment with β-blockers was carried out. Results: IH localization was diagnosed: 62% with a lesion of a part facial segment, 23% in one segment, 15% in several segments (p=0.018), and 12% with other parts of the body lesion (p=1.000). The patent foramen ovale was diagnosed in 35% of children. Central nervous system disorders were observed in 12% over two years of age. The indices of Holter monitoring and blood glucose changed in age norm range during treatment. Cardiovascular (the aortic coarctation (p=0.003) and brain (the Dandy-Walker malformation) (p=0.031) abnormalities were determined in two cases (8%) according to the MRI only. We diagnosed PHACE(S) syndrome in both these cases of children, only aged 12 months and 2.5 years old. Conclusions: Early diagnosis of PHACE(S) syndrome is possible on a contrast-enhanced MRI performed in asymptomatic neonates and infants with the facial several segmental IH with / without ulceration (p=0.018, p=0.046; p < 0.05) for recognition of presymptomatic cardiovascular and brain abnormalities.