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Facial nerve dissection

Min-Hui Hung, Chun-Ta Liao, Chung-Jan Kang, Shiang-Fu Huang
Most parotid tumors grow slowly, and sometimes these patients do not request surgical treatment until the tumors become large and affect their appearance. The surgical treatment of these large tumors is usually accompanied by large skin defects after excision, and it is challenging for surgeons to close the defect primarily. This report describes the case of a 68-year-old man with a left parotid gland tumor (largest dimension, 110 mm) and the case of a 79-year-old man with a left parotid gland tumor measuring approximately 77 mm that had existed for decades...
September 21, 2016: Journal of Oral and Maxillofacial Surgery
Pierre R Bourque, Gabrielle Bourque, William Miller, John Woulfe, Jodi Warman Chardon
Perineural invasion is a targeted cellular proliferation guided by neurotrophins, rather than a simple diffusion of tumor in a path of least resistance. Invasion of cranial nerves by squamous cell carcinoma can represent an important diagnostic dilemma. It commonly presents as a distinct clinical neurological syndrome of combined isolated trigeminal and facial neuropathies. The focal cancer source may have been overlooked or remain occult. This case series illustrates diverse clinical presentations and neuroimaging challenges in four patients with squamous cell carcinoma of the cranial nerves...
October 11, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Eva Placheta, Ines Tinhofer, Melanie Schmid, Lukas F Reissig, Igor Pona, Wolfgang Weninger, Thomas Rath, David Chwei-Chin Chuang, Chieh-Han John Tzou
INTRODUCTION: Facial reanimation surgery is performed in severe cases of facial palsy to restore facial function. In a 1-stage procedure, the spinal accessory nerve can be used as a donor nerve to power a free gracilis muscle transplant for the reanimation of the mouth. The aim of this study was to describe the surgical anatomy of the spinal accessory nerve, provide a guide for reliable donor nerve dissection, and analyze the available donor axon counts. METHODS: Dissections were performed on 10 nonembalmed cadavers (measurements of 20 nerves)...
October 6, 2016: Annals of Plastic Surgery
Mathieu Veyrat, Benjamin Verillaud, Philippe Herman, Damien Bresson
BACKGROUND: Endoscopic endonasal approaches (EEA) are an alternative for removing challenging nasopharyngeal or skull base lesions. In some cases, a nasoseptal flap (NSF) is not always available and such complex procedures may lead to carotid arteries exposition and/or dura mater (DM) wide opening. Meticulous carotid coverage and DM reconstruction are crucial for preventing early and delayed complications. METHOD: We propose a step-by-step description of the pedicled temporoparietal fascia flap (TPFF) technique, with a focus on its pitfalls, advantages and limits...
October 7, 2016: Acta Neurochirurgica
Azer Majeed, Nuno Pedro Lobato Ribeiro, Asem Ali, Mohsen Hijazi, Hina Farook
Spontaneous internal carotid artery dissection (sICAD) is an uncommon cause of isolated cranial nerve palsies. Commonly patients present with stroke, headache, facial pain and Horner's syndrome, with upto 16% having cranial nerve palsies. We present the case of a 55-year-old man who presented with hoarseness, dysphagia and tongue swelling, mimicking a tongue base tumor. He was found to have unilateral VIIth, Xth and XIIth nerve palsies with Horner's syndrome. Magnetic resonance imaging showed high signal changes and loss of signal void in right internal carotid artery, later confirmed by Angiography as a dissection with pseudo-aneurysm...
October 2016: Oxford Medical Case Reports
Cliff P Connery
There is a small subset of patients who have undergone endoscopic thoracic sympathectomy for hyperhidrosis or facial blushing who are dissatisfied and would wish reversal. Compensatory sweating is the most common side effect that causes a person to regret surgery. Treatment options are limited and usually not effective in patients with severe side effects from sympathectomy. Nerve graft interposition has been proven to be effective in experimental models and small clinical series. Da Vinci robotic nerve graft reconstruction with interposition graft and direct suturing of nerve and high magnification dissection most closely mirrors standard nerve reconstruction principles when done as a minimally invasive procedure...
November 2016: Thoracic Surgery Clinics
M Bohac, M Palkovic, J Fedeles, J Hodosy
BACKGROUND: Gracilis muscle and its motor nerve belongs to most commonly used flap for facial reanimation. However, it is performed in two steps, which is time consuming. One stage technique can be also performed, but the length of the motor nerve cannot be currently determined before surgery. AIM: The present study was conducted in order to evaluate the body composition on the length and suitability of the motor nerve of gracilis muscle for one stage facial reanimation...
2016: Bratislavské Lekárske Listy
Barbara Buffoli, Marco Ferrari, Francesco Belotti, Davide Lancini, Marco Angelo Cocchi, Mauro Labanca, Manfred Tschabitscher, Rita Rezzani, Luigi Fabrizio Rodella
Additional extrinsic muscles of the tongue are reported in literature and one of them is the myloglossus muscle (MGM). Since MGM is nowadays considered as anatomical variant, the aim of this study is to clarify some open questions by evaluating and describing the myloglossal anatomy (including both MGM and its ligamentous counterpart) during human cadaver dissections. Twenty-one regions (including masticator space, sublingual space and adjacent areas) were dissected and the presence and appearance of myloglossus were considered, together with its proximal and distal insertions, vascularisation and innervation...
September 26, 2016: Folia Morphologica (Warsz)
P A Brennan, A S Elhamshary, P Alam, R Anand, M Ammar
Anastomoses in the neck between the sensory transverse cervical nerve (C2,3) and the cervical branch of the facial nerve are common, but communications with more superior branches of the facial nerve are rare. After we had identified a case where the transverse cervical nerve joined the marginal mandibular branch of the facial nerve in the submandibular triangle during a selective neck dissection, we searched for this variant in 86 neck dissections to see if it occurs more often than expected. We found it in one further patient...
September 21, 2016: British Journal of Oral & Maxillofacial Surgery
Austin Hembd, Purushottam A Nagarkar, Salim Saba, Dinah Wan, J Walter Kutz, Brandon Isaacson, Sachin Gupta, Charles L White, Rod J Rohrich, Shai M Rozen
PURPOSE: Donor nerve axonal count over 900 in two-stage reconstructions using cross facial nerve grafts is possibly associated with improved outcomes in facial reanimation. Facial nerve axonal analysis was performed to determine the ideal location for optimizing axonal load. Correlation between axonal number, branch diameter, and age was also assessed. METHODS: 28 fresh unpreserved cadaveric hemi-faces were dissected exposing the extracranial facial nerve branches...
September 14, 2016: Plastic and Reconstructive Surgery
Nam-Gyu Ryu, Jin Kim
Unexpected iatrogenic facial nerve paralysis not only affects facial disfiguration, but also imposes a devastating effect on the social, psychological, and economic aspects of an affected person's life at once. The aims of this study were to postulate where surgeons had mistakenly drilled or where obscured by granulations or by fibrous bands and to look for surgical approach with focused on the safety of facial nerve in mastoid surgery. We had found 14 cases of iatrogenic facial nerve injury (IFNI) during mastoid surgery for 5 years in Korea...
September 2016: Journal of Audiology & Otology
Yusu Ni, Kaishi Wang, Yi Jiang, Ren Zhou, Yan Sha, Huawei Li
OBJECTIVE: To explore and quantify the surgically relevant anatomic relationships and three-dimensional (3D) morphology of the supralabyrinthine space, and enable a deeper, clearer understanding of its regional anatomy. MATERIALS AND METHODS: 3D-DOCTOR software was used to create a 3D reconstruction of the axial CT images and multiplanar reformatting of 55 slices of temporal bone in 29 patients (17 males and 12 females), whose average age was 38.69 ± 17.81 years...
September 10, 2016: ORL; Journal for Oto-rhino-laryngology and its related Specialties
Tracey A Hotta
Advanced rejuvenation procedures for the upper face are becoming increasingly popular for aesthetic providers but are considered a high-risk treatment area for dermal filler/contouring products. Risks may range from bruising, which is manageable, to blindness, most often irreversible. Detailed comprehension of the facial anatomy is imperative when performing aesthetic injections including neuromodulators and dermal filler/contouring products. Understanding the location and function of the muscles, as well as landmarking the blood vessels and nerves, will assist the aesthetic provider to perform safe, confident injection procedures...
July 2016: Plastic Surgical Nursing
Ahmed-Abdel-Fattah Nofal, Mohammad-Waheed El-Anwar
INTRODUCTION: Intraparotid neurofibromas of the facial nerve are extremely rare and mostly associated with neurofibromatosis type 1 (NF1). CASE REPORT: This is a case of a healthy 40-year-old man, which underwent surgery for a preoperatively diagnosed benign parotid gland lesion. After identification of the facial nerve main trunk, a single large mass (6 x 3 cm) incorporating the upper nerve division was observed. The nerve portion involved in the mass could not be dissected and was inevitably sacrificed with immediate neuroraphy of the upper division of the facial nerve with 6/0 prolene...
July 2016: Iranian Journal of Otorhinolaryngology
Phillip B Dauwe, Austin Hembd, Erika De La Concha-Blankenagel, Salim Saba, Charles White, Alexander Cardenas-Mejia, Shai M Rozen
BACKGROUND: Facial paralysis has a profound impact on the brow, and currently static procedures are the mainstay of treatment. The deep temporal branches of the trigeminal nerve, given their proximity to the brow, may serve as possible donor nerves for both potential innervation of a free muscle transfer in patients with prolonged facial palsy or nerve transfers in acute or subacute palsy. As such, the authors present the detailed surgical anatomy of the deep temporal nerve, assessing feasibility for both functional muscle and nerve transfers, including a proposed surgical technique...
September 2016: Plastic and Reconstructive Surgery
Misako Kaido, Yoshihito Yuasa, Tameyoshi Yamamoto, Satoru Munakata, Naohiro Tagawa, Keiko Tanaka
We report the case of a patient who had developed multiple cranial nerve palsies in the course of possible paraneoplastic neurological syndrome (PNS) associated with gallbladder cancer. Twelve days prior to visiting our hospital, a 69-year-old man began experiencing neurological symptoms, beginning with diplopia and progressing to ptosis of the left palpebra and subsequent complete closure of the eye within 8 days. Results of the initial medical examination indicated paresis of left oculomotor (III) and abducens (VI) nerves...
September 29, 2016: Rinshō Shinkeigaku, Clinical Neurology
Caitlin P McMullen, Richard V Smith, Thomas J Ow, Andrew Tassler, Bradley A Schiff
OBJECTIVE: Extracapsular dissection (ECD) has become an accepted, less invasive alternative for the removal of select benign parotid lesions that may reduce complications. Minimal margin extracapsular dissection (MECD) with dissection on or closer to the tumor capsule may be a reasonable alternative to ECD. The objective of this study is to review the complications and safety of the MECD technique at a single institution. SUBJECTS AND METHODS: Medical records for patients who underwent MECD for suspected benign parotid lesions were reviewed...
November 2016: Annals of Otology, Rhinology, and Laryngology
Ryosuke Tomio, Kazunari Yoshida, Maya Kohno, Dai Kamamoto, Shuji Mikami
BACKGROUND: The membranous structure of vestibular schwannoma is an important factor in its surgical treatment. Herein, we report intraoperative and microscopic findings relating to an outermost dura-like membrane in cases of vestibular schwannoma and the importance of these findings. METHODS: Intraoperative findings of 16 cases of vestibular schwannoma treated with an initial surgery were studied with an aim to determine if the cases had a dura-like membrane. Then we studied microscopic findings of the dura-like membrane using hematoxylin and eosin, Masson trichrome, and immunohistochemical staining in 2 cases...
2016: Surgical Neurology International
María Fe García Reija, Julia C Blasco Palacio
The segment of the facial nerve (FN) between its emergence from the skull through the stylomastoid foramen and its bifurcation at the parotid area is referred to as the FN trunk (FNT). Injury to the facial nerve trunk is among the most undesirable outcomes following different otologic, plastic, maxillofacial, and neurosurgical procedures. These procedures frequently involve manipulation and isolation of this segment, and meticulous dissection should be practiced to avoid iatrogenic damage to the nerve. Identification and exposure of the FN trunk, however, may be difficult because it is surrounded by dense connective tissue...
September 2016: Journal of Craniofacial Surgery
Sunil Manjila, Kunal Kumar, Ashish Kulhari, Gagandeep Singh, Richard S Jung, Robert W Tarr, Nicholas C Bambakidis
The external carotid artery's lingual branch to retromandibular venous fistula following a carotid endarterectomy has not been reported earlier in literature. We report a unique case of an 87-year-old man who had a right-sided carotid endarterectomy in 2009 and presented four years later with complaints of fullness and discomfort in the area of right parotid gland with associated pulsatile tinnitus. A computed tomography (CT) scan of the neck revealed a deep portion of the right parotid gland having abnormal aneurysmal dilatation of a vascular structure, which appeared to be an arteriovenous fistula between branches of right external carotid artery and the retromandibular vein...
June 2016: Journal of Vascular and Interventional Neurology
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