Incidence Of Facial Nerve Dysfunction Research Articles

Ultrasound-guided percutaneous thermal ablation of parotid tumors: experience from two-centers

Objective: To evaluate the efficacy and feasibility of ultrasound-guided percutaneous thermal ablation (TA) for treating benign parotid tumors. Methods: Patients with benign parotid tumors who underwent ultrasound-guided microwave ablation (MWA) or radiofrequency ablation (RFA) between January 2020 and March 2023 were included in this retrospective study. Change in tumor size (maximum diameter, tumor volume(V), volume reduction rate (VRR)) and cosmetic score (CS) were evaluated during a one-year follow-up period. We also recorded the incidence of any complications associated with TA. Results: A total of 23 patients (13 males and 10 females; median age 65 years, range 5–91 years) were included. The mean VRR at 1, 3, 6, and 12 months after TA was 37.03%±10.23%, 56.52%±8.76%, 82.28%±7.89%, and 89.39%±6.45%, respectively. Mean CS also changed from 3.39 ± 0.66 to 1.75 ± 0.93 (p < 0.001) by the end of follow-up time. Subgroup analysis showed that tumors with smaller initial maximum diameter had a faster CS reduction rate than those with larger initial diameter. The incidence of facial nerve dysfunction was 8.70%. Conclusion: Ultrasound-guided percutaneous TA is an effective and safe treatment option for patients with benign parotid tumors.

A RETROSPECTIVE ANALYSIS OF INCIDENCE OF FACIAL NERVE DYSFUNCTION IN SUPERFICIAL PAROTIDECTOMY PATIENTS

Salivary gland neoplasms constitute 5 percent of head and neck tumors. Among them 80% arise from parotid gland , 10% from submandibular gland, 10% from sublingual and other minor salivary glands.In parotid neoplasms, 80% are benign and 20% are malignant. Most common benign tumor is pleomorphic adenoma, which accounts for 40-70% of all salivary gland neoplasms. Other benign parotid tumors are various monomorphic adenomas (warthin tumor, oncocytoma, basal cell adenoma, canalicular adenoma), ductal papilloma and capillary hemangioma. Most common malignant tumor is mucoepidermoid carcinoma, which is further divided into low and high grade tumors. Adenoid cystic carcinoma constitute 10% of all salivary gland neoplasms with characteristic indolent growth and perineural invasion. Rapid increase in size, pain and facial nerve palsy are signs of malignancy.Based on the location of tumor and pathological status supercial or total conservative parotidectomy can be done. Facial nerve as well as it's branches are very close to the gland, they are at high risk of injury.Therefore successful surgery depends on the indentication and preservation of facial nerve. Marginal mandibular nerve damage is most commonly encountered complication. Temporary neuropraxia is common and expected to recover with in few months following Surgery. It is mainly due to stretching of Vasa vasorum. The main objective of this AIMS AND OBJECTIVES: study is to access the incidence of facial nerve dysfunction as temporary or permanent, complete or incomplete in post supercial parotidectomy Patients. MATERIALS AND METHODS: A retrospective study was conducted from June 2016 to June 2019 in the department of general surgery, government general hospital, kakinada among the Patients who underwent surgery for parotid neoplasms. Am RESULTS: ong 50 remaining Patients, 36 were female and 14 were male patients with male to female ratio of 1:2.5. The mean age was 39+/-9 years. Among 54 Patients 50 underwent supercial parotidectomy .Among 50 Patients who underwent surgery, 18 were observed to have no complications in the immediate postoperative period. And 28 patients presented with transient facial weakness, which was incomplete and temporary in the immediate postoperative period. Only 4 patients had permanent facial weakness which was complete Overall inc CONCLUSION: idence of temporary and permanent facial nerve dysfunction in this study is 63.3% and 6.6% respectively without using any intraoperative monitoring with a nerve stimulator or magnication.And the incidence is mainly depending on the location of the tumor, extent of the surgery, excessive traction, proper anatomical knowledge and experience of the surgeon.

Dynamic Reconstruction of Facial Paralysis in Craniofacial Microsomia.

Craniofacial microsomia is associated with maxillomandibular hypoplasia, microtia, soft-tissue deficiency, and variable severity of cranial nerve dysfunction, most often of the facial nerve. This study evaluated the incidence of facial paralysis in patients with craniofacial microsomia and outcomes after free functioning muscle transfer for dynamic smile reconstruction. A single-center, retrospective, cross-sectional study was performed from 1985 to 2018 to identify pediatric patients with craniofacial microsomia and severe facial nerve dysfunction who underwent dynamic smile reconstruction with free functioning muscle transfer. Preoperative and postoperative facial symmetry and oral commissure excursion during maximal smile were measured using photogrammetric facial analysis software. This study included 186 patients with craniofacial microsomia; 41 patients (21 male patients, 20 female patients) had documented facial nerve dysfunction (22 percent) affecting all branches (51 percent) or the mandibular branch only (24 percent). Patients with severe facial paralysis (n = 8) underwent smile reconstruction with a free functioning muscle transfer neurotized either with a cross-face nerve graft (n = 7) or with the ipsilateral motor nerve to masseter (n =1). All patients achieved volitional muscle contraction with improvement in lip symmetry and oral commissure excursion (median, 8 mm; interquartile range, 3 to 10 mm). The timing of orthognathic surgery and facial paralysis reconstruction was an important consideration in optimizing patient outcomes. The authors' institution's incidence of facial nerve dysfunction in children with craniofacial microsomia is 22 percent. Free functioning muscle transfer is a reliable option for smile reconstruction in children with craniofacial microsomia. To optimize outcomes, a novel treatment algorithm is proposed for craniofacial microsomia patients likely to require both orthognathic surgery and facial paralysis reconstruction. Therapeutic, IV.

Management of Benign Parotid Lesions: An Overview of Complications and Extent of Surgical Resection

Background The surgical management of benign lesions of the parotid gland is focused on the complete removal of the lesion, minimizing the chances of recurrence and to preserve facial nerve function. There is a relative paucity of literature regarding the post-operative complications of the surgical procedures for benign parotid lesions. The aim of this study is to evaluate the post- operative complications of a limited surgical procedure, namely partial superficial parotidectomy. Material and Method This retrospective cohort study included all parotid surgeries performed for benign parotid pathology from January 2008 to December 2018. The patient’s demographic data, presenting symptoms, type of surgery performed, complications, presence of post operative facial nerve paralysis and grade, histopathology type and follow up period were collected from hospital records of Al Shifa system. The mean follow-up time was 12.5 months. Results The study yielded a total of 125 partial superficial parotidectomies performed on 123 patients with a mean age of 44.5 years (range 8-87 years). Pleomorphic adenoma (n= 68, 54.4%) and Warthins tumor (n=32, 25.6%), were the most common neoplastic lesions. Non-neoplastic lesions were 18 (14.4%). Temporary facial nerve weakness occurred in 11 patients (8.8%). All cases of facial nerve weakness improved within three months post-operatively. The rate of salivary fistula and sialocele were 5.5% and 1.5% respectively. One patient who had histologically proven pleomorphic adenoma had recurrence of tumor (0.8%). Conclusion Partial superficial parotidectomy was associated with low incidence of facial nerve dysfunction which was mostly transient, and no permanent facial nerve dysfunction was reported. Other complications like sialocele, salivary fistula and Frey’s syndrome were reported at lower rates than the reported rates in the literature for the conventional superficial parotidectomy. The findings support partial superficial parotidectomy approach for the treatment of benign parotid pathology, which entails less extensive resection of parotid parenchyma and less extensive dissection of facial nerve branches thereby minimizing the risk of post-operative complications.

Value of the Use of Facial Nerve Monitoring in Otorhinolaryngological Surgeries

Abstract Background The anatomy of the facial nerve is among the most complex of the cranial nerves. Facial nerve is not just a pure voluntary motor nerve but comprises parasympathetic, general sensory, and special sensory components as well. Facial nerve monitoring is one of the most exciting innovations in neurotologic surgery in the past decade. Objective To determine the effect of intraoperative facial nerve monitoring on postoperative facial nerve function and on operative time. Patients and Methods In general terms, FNM means electrophysiological monitoring. This technique provides for monitoring of facial muscle activity via electromyography (EMG).The EMG is typically recorded with needle electrodes placed in facial nerve muscles. Voluntary activation of the facial nerve in the alert patient as well as intraoperative electrical stimulation or mechanical irritation during surgery generates motor evoked potentials. In this meta-analysis, the included studies are ten in number with total 593 patient (control= 311, IOFNM = 282) Results Comparison of facial nerve monitoring vs. no monitoring as regards incidence of facial nerve dysfunction shows there is no evidence of heterogeneity and statistically significant (p-value &amp;lt;0.01) which indicate that the incidence of FN dysfunction in the monitoring group is lower than the dysfunction in the no monitoring group. Comparison of facial nerve motoring vs. no monitoring as regards operative time shows there is no evidence of heterogeneity. Under the random effect model, the standardized mean difference (SMD) is -0.62 which is statistically significant (p-value &amp;lt;0.01) favoring facial nerve motoring over no monitoring. Which indicate that the mean surgery time was lower in the group of patients operated with facial monitoring as compared with the unmonitored group. Conclusion So, our meta-analysis shows statistically significant results which favor facial nerve monitoring over no monitoring as regards decreasing the operative time and improving of postoperative facial nerve dysfunction.

Indications for partial parotidectomy using retrograde dissection of the marginal mandibular branch of the facial nerve for benign tumours of the parotid gland

The aims of this study were to evaluate the efficacy of partial parotidectomy using retrograde dissection of the marginal mandibular branch of the facial nerve for benign tumours of the parotid gland and to establish the indications for its use. We examined 106 consecutive patients with previously untreated benign tumours in the lower portion of the parotid gland who were treated by parotidectomy. The first group (anterograde group, n=52) consisted of those who had standard anterograde parotidectomy. The remaining patients, who underwent retrograde parotidectomy, were further divided into two groups: those in whom the upper edge of the tumour was located below the mastoid tip (below mastoid group, n=46) or those in whom it was above the mastoid tip (above mastoid group, n=8). The operating time was significantly shorter in the below mastoid group (141.2, 127.5, and 98.1minutes, respectively) as was intraoperative blood loss (41.1, 53.0, and 24.4ml, respectively), compared with the other two groups. There was a higher incidence of facial nerve dysfunction in the above mastoid group postoperatively (4/8) than in the other two groups. The results suggested that the presence of a tumour of any size located below the mastoid tip is a good indication for parotidectomy using retrograde dissection of the marginal mandibular branch of the facial nerve.

Association Between Facial Nerve Monitoring With Postoperative Facial Paralysis in Parotidectomy.

Electrophysiologic facial nerve monitoring is becoming an established intraoperative aid to assist the surgeon in facial nerve trunk or branch location and dissection. Limited studies have addressed the postoperative outcomes of parotid surgery with and without monitoring. To examine the influence of intraoperative facial nerve monitoring on postoperative facial nerve function and procedure duration in parotid surgery. An 8-year retrospective review of parotidectomies performed at the Department of Otorhinolaryngology-Head and Neck Surgery, University of Münster. The study analyzed 120 patients undergoing parotidectomy without monitoring from January 1, 1988, to December 31, 1991, and 147 patients undergoing parotidectomy with monitoring from January 1, 2003, to December 31, 2006. The patients were further subdivided in partial parotidectomy (PP) (n = 222) and total parotidectomy (TP) (n = 45) groups. An evaluation of operative time was performed to test the hypothesis of shorter duration of surgery with facial nerve monitoring. Final follow-up was completed on December 31, 2008, and data were analyzed from June 1 to December 31, 2013. Comparison of the incidence of facial nerve dysfunction and operative time between the PP and TP subgroups with and without monitoring. A total of 267 patients (127 men [47.6%] and 140 women [52.4%]; mean [SD] age, 51.3 [17.6] years; range, 3-90 years) were included in the analysis. A significant reduction in postoperative facial nerve dysfunction with the use of nerve monitoring could be seen in the PP group (46 of 99 without monitoring [46.5%] vs 18 of 123 with monitoring [14.6%]; P = .001). A similar finding was evident in the TP group when comparing moderate and severe nerve dysfunction (9 of 21 without monitoring [42.9%] vs 2 of 24 with monitoring [8.3%]; P = .01). The mean (SD) operative time in the PP subgroup without nerve monitoring was 115.3 (37.8) minutes; with nerve monitoring, 110.1 (33.6) minutes. The mean (SD) operative time in the TP subgroup without nerve monitoring was 134.5 (50.4) minutes; with nerve monitoring, 158.3 (56.3) minutes. There was no statistical difference between these groups. Facial nerve monitoring in primary parotid surgery for benign and malignant disease does not necessarily reduce the operative time, but the rate of transient postoperative facial nerve dysfunction or the grade of palsy is reduced.

A rare case of Ramsay Hunt syndrome following temporomandibular joint surgery

Surgical approaches to the temporomandibular joint (TMJ) have been designed specifically to minimize injury to the temporal branch of the facial nerve. In spite of this, facial nerve dysfunction occurs in 1–32% of patients undergoing TMJ surgery. Ramsay Hunt syndrome is characterized by peripheral facial paralysis that often involves other cranial nerves, mostly cranial nerve VIII. The pathology is attributed to the reactivation of latent varicella zoster virus in the geniculate ganglion. The diagnosis is based mostly on history and physical findings. Surgical procedures have been known to reactivate varicella zoster virus, but Ramsay Hunt syndrome subsequent to TMJ surgery has not been described yet. This report describes a case of Ramsay Hunt syndrome associated with TMJ surgery. Because of the relatively high incidence of facial nerve dysfunction associated with TMJ surgery, patients with varicella zoster virus reactivation may initially be misdiagnosed with iatrogenic facial palsy, or vice versa.

Avoiding the complications of parotidectomy for benign disease: Intraoperative techniques

Parotidectomy for benign disease is the most common indication for parotidectomy. Surgical treatment of benign parotid disease remains a challenging undertaking that is associated with significant postoperative morbidity. The aim of this study is to present our experience with a series of 29 cases of superficial parotidectomies, regarding the incidence of the common complications and the techniques we used to reduce the incidence of these complications. We encountered 2 cases (6.9%) of facial nerve dysfunction; both were of a mild degree. We used Ligasure, loupes, nerve monitoring and certain intra operative techniques to achieve such a low incidence of facial nerve dysfunction. No case of Frey syndrome was encountered, due to the use of expanded poly tetrajluoroethylene sheets. Only 3 cases suffered partial anaesthesia of the ear pinna, as we preserved the trunk or the posterior branch of the great auricular nerve. Salivary fzstula occued in 17.2% of cases, and was mild and was treated conservatively. We recommend sticking to our techniques to decrease the postoperative complications of parotidectomy.

Parotidectomy under microscope for benign parotid tumor

Parotidectomy with preservation of facial nerve function is the standard treatment for tumors of the parotid gland. The main author routinely uses an operation microscope to confirm and follow the facial nerve for parotidectomy. We report the incidence of facial nerve dysfunction following microscopic parotidectomy. Materials were 13 patients (14 surgeries) with benign parotid tumor. All cases were primary operations. Tumor existed in the superficial lobe in 10 cases and in the deep lobe in 4 cases. The main trunk of the nerve was confirmed and its peripheral branches in the parotid gland were followed, and tumor with a cuff of normal surrounding tissue was removed under strict microscopic control. The mean operative time was 173 minutes. The operative time with tumor in the deep lobe was longer than that in the superficial lobe. Perioperative transient facial nerve dysfunction occurred in 2 cases (14%), which were cured within 3 months. There were no permanent cases. Parotidectomy under microscope may reduce the incidence of perioperative facial nerve dysfunction, but its operative time may be longer than that of parotidectomy without microscope.

Facial Nerve Dysfunction After Parotidectomy: The Role of Local Factors

The objective was to analyze the incidence and factors associated with facial nerve dysfunction after conservative parotidectomy with facial nerve dissection. A retrospective unicentric study in a tertiary care center with prospective record of studied factors. Over a 10-year period, 131 patients with normal facial nerve function underwent a superficial or total conservative parotidectomy with nerve dissection performed by one surgeon for primary benign or malignant tumors. Facial nerve function was assessed on the first postoperative day and at 1 month and 6 months after the parotidectomy. Extent of surgery, histopathological findings, tumor size, close contact of tumor with facial nerve, and sex and age of the patient were reviewed. These variables were studied in a chi2 statistical univariate and stratified analysis to determine their association with postoperative facial nerve dysfunction. Incidence of postoperative facial nerve dysfunction was 42.7% on the first postoperative day, 30.7% at 1 month after the parotidectomy, and 0% at 6 months after the parotidectomy. The most common dysfunction was paresis in a single nerve branch (48.2%), in particular, the marginal mandibular branch. Total parotidectomy was associated with a significantly higher incidence of facial nerve dysfunction during the first postoperative period (60.5% at day 1 and 44.7% at month 1) than superficial parotidectomy (18.2% at day 1 and 10.9% at month 1) (P < .001). In patients with total parotidectomy, close contact of the tumor with the facial nerve was found to have statistical causal relation with facial nerve weakness. In patients with superficial parotidectomy, inflammatory conditions were found as factors that increased postoperative facial nerve dysfunction. In the study series of conservative parotidectomies with facial nerve dissection, only extent of surgery and particular local conditions of nerve dissection, especially the close contact of tumor with facial nerve and inflammatory conditions, were found to be associated with postoperative facial nerve dysfunction.

Facial nerve function after parotidectomy.

To analyze the incidence of facial nerve dysfunction following parotidectomy and to correlate this with the extent of parotid gland resection, the pathological diagnosis, and the clinical setting. A review of prospectively collected data from a dedicated computerized head and neck database. Tertiary care center. Between 1987 and 1995, 248 patients underwent 259 parotidectomies performed by the same surgeon (C.J.O'B.). Indications were clinical tumor (n=213) or sialadenitis (n=46). There were 235 previously untreated patients and 13 who had undergone a prior operation on that side. Facial nerve function was normal in 242 patients and abnormal before surgery in 6. Cancers accounted for 88 parotidectomies and benign disease accounted for 171. Of 213 clinical tumors, 41 (19%) were situated deep to the plane of the facial nerve. The facial nerve was intentionally sacrificed in 28 of 259 operations (18 total and 10 partial sacrifice). In 230 parotidectomies in which facial nerve function was normal before surgery and the nerve was preserved, the incidence of initial postoperative facial weakness was 29%. Based on the diagnosis and extent of surgery, rates of facial weakness were 16.5% and 13%, respectively, for benign and malignant tumors located in the superficial lobe and treated with limited superficial parotidectomy; 30% and 34% for sialadenitis treated with complete superficial parotidectomy and near-total parotidectomy, respectively; 31% and 100%, respectively, for benign and malignant lobe tumors treated with near-total parotidectomy; 83% for parotidectomy associated with a neck dissection; and 33% for patients who had previous parotid surgery. Permanent weakness occurred in 13 (5.6%) of 230 patients, but 10 of these 13 had simultaneous neck dissection and facial nerve dysfunction involved only the marginal mandibular branch. Recovery of normal facial movements occurred within 6 months in 46 (68%) of 67 of those with initial weakness. The likelihood of temporary facial weakness correlated with the extent of surgery and was especially influenced by tumor location deep to the plane of the facial nerve, previous parotid surgery, a diagnosis of sialadenitis, and the addition of neck dissection to the parotidectomy. Permanent weakness mainly affected the marginal mandibular branch when neck dissection was included.