Risk Of Facial Palsy Research Articles

Facial paralysis after superselective intra-arterial chemotherapy via the middle meningeal artery in maxillary cancer

Previous studies have suggested that the severity of facial paralysis after superselective intra-arterial chemotherapy (SSIAC) is usually mild. Here we present two cases of facial paralysis after SSIAC via the middle meningeal artery (MMA). In case 1, the patient completely recovered from his facial paralysis (to H-B grade I) in 6 months after the onset of paralysis. However, in case 2, his facial movement remained at House-Brackmann (H-B) grade IV with severe synkinesis. We must be careful that SSIAC via the MMA may potentially increase the risk of facial paralysis.

Optimal Extent of Resection in Vestibular Schwannoma Surgery: Relationship to Recurrence and Facial Nerve Preservation

Surgical treatment of vestibular schwannoma is targeted at complete removal with preserved neurological function. Complete removal may cause significant deficits, whereas subtotal tumor removal is associated with a high recurrence rate. The present study assessed the risk of tumor recurrence and postoperative facial nerve function in relation to the extent of surgical resection by reviewing the clinical records and radiological findings of 116 patients with vestibular schwannoma treated between 1990 and 1999. The extent of resection was classified as follows: gross total resection (GTR), near total resection (NTR), and subtotal resection (STR). Facial nerve function was graded using the modified House-Brackmann grade, and patients grouped into good (grades 1-2) and intermediate or poor (grades 3-6). Of the 116 patients, 26 (22%) underwent GTR, 32 (28%) NTR, and 58 (50%) STR. The recurrence rates were 3.8% (1/26 cases), 9.4% (3/32), and 27.6% (16/58) for GTR, NTR, and STR, respectively. GTR and NTR showed no statistically significant difference in terms of recurrence rate (p=0.620). However, recurrence was significantly less after NTR than STR (p=0.043). Immediately postoperative facial nerve function was good in 15.4% of patients after GTR, 40.6% after NTR, and 46.6% after STR. The STR and NTR carried a lower risk of facial nerve palsy than GTR in the immediately postoperative stage (p=0.006 and 0.036, respectively). Nevertheless, no statistical significance was observed in extent of resection and postoperative facial nerve outcome between the groups at last follow up (p=0.227). GTR is the ideal surgical treatment for vestibular schwannoma, but NTR is a good option, with better facial nerve function preservation than GTR without significantly increasing the risk of recurrence.

Risk of facial palsy and severe Frey's syndrome after conservative parotidectomy for benign disease: analysis of 610 operations

Conclusions: Advanced age, long operation time and large specimen volume were significant risk factors for transient facial palsy after conservative parotidectomy. Revision operation was the only risk factor for development of a permanent palsy. Risk factors for Frey's syndrome were not found. The incidence of Frey's syndrome was not altered by the use of a sternocleidomastoid muscle flap or other implantation material. Objectives: The results of studies identifying risk factors for facial palsy and Frey's syndrome after parotidectomy are contradictory. This study attempted to identify these risk factors by performing a retrospective review of a large series of patients. Patients and methods: A total of 610 standardized conservative parotidectomies for benign diseases performed between 1989 and 2004 were studied retrospectively. The risk factors for facial palsy and Frey's syndrome were determined by univariate and if possible by multivariate analysis of variables related to patient demographics and operation characteristics. Results: The rates of transient facial palsies, permanent facial palsies and Frey's syndrome were 18%, 4%, and 4%, respectively. Significant univariate and multivariate risk factors for development of a transient facial palsy were age >70 years, operation time >260 min, and a specimen volume >70 cm3. The only significant risk factor for the development of a permanent palsy was prior surgery. A significant risk factor for the development of Frey's syndrome could not be estimated.

Endoscope-assisted fixation of condylar fractures of the mandible

The reduction and plate osteosynthesis of condylar fractures often require a wide extraoral approach with the risk of facial nerve palsy. The endoscopic technique is an alternative. Seven condylar fractures were operated on under endoscopic control. In three patients a newly developed device for endoscopically controlled plate application was clinically tested for osteosynthesis. In two cases fracture healing was achieved. In the third case the plate had to be removed early due to insufficient screw fixation. The new device and the application technique are described in detail. This technique may be helpful in further minimizing trauma surgery.

Ossicular coupling of an implantable hearing aid transducer using an Er:YAG laser

Special coupling devices made of pure gold or titanium have been developed to connect a new implantable hearing aid transducer (Tübingen implant) to the ossicular chain. They allow piezotransducer probe-tip connection to the long process of the incus or the stapedial head. Similar to the design of conventional PORPs (partial ossicular replacement prostheses), the coupling devices can be fixed at the ossicular chain, e.g., with the eye loop of stapedial piston prostheses or the bell element of golden wire PORPs. A crimp technique allows connection between coupling device and transducer probe tip [5]. The main disadvantage in connecting the long process of the incus or the stapes having is to drill a dorsal tympanotomy in the posterior wall of the ear canal during surgery. The short distance between tympanotomy and N. facialis contains serious surgical risks. To avoid the risk of facial paralysis, Fredrickson's alternative coupling technique for the body of the incus is investigated in this paper [2]. In this case, the transducer probe tip will be positioned to the incus body and placed on its surface with controlled elastic displacement of the ossicular chain. The simple direct attachment of the probe-tip end on the surface of the incus, however, will not guarantee a stable long-term connection. Thus, by creating a conical, 0.5-to 0.7-mm-deep hole in the incus, the probe tip will be fitted much better. With a novel surgical Erbium-YAG laser this can be done in a contactless procedure. In this paper, first results of microsurgical laser applications with human temporal bones will be shown.

Clinical and experimental results with focused ultrasound.

Focused ultrasound was applied at the lateral semicircular canal in 19 patients and at the round window in 12 patients, all of whom had intractable vertigo caused by Meniere's disease. Postoperatively, the vertigo was relieved or diminished in 75% of the lateral canal cases and in 25% of the round window cases. The results indicate that the lateral canal approach may have some therapeutic value, but the treatment is arduous for the patient and the risk of facial palsy is always nettlesome. Utilizing similar techniques, ultrasound irradiation was given to the lateral canals of 6 squirrel monkeys and to the round windows of 15 cats. After survival times of up to 3 months, light microscopic studies of the temporal bones of these animals show no morphological changes which can be attributed to the ultrasound irradiation. In general, these findings are in concert with the reports of other investigators and show that selective ablation of the vestibular sense organs cannot be achieved by current techniques of ultrasound irradiation. It seems doubtful that prolonged relief of vertigo can be expected to occur without a more complete morphological ablation of the vestibular sense organs than is possible with the current methods of ultrasound treatment.