Surgery of the parotid gland is usually indicated for the relief of an inflammatory disorder or for control of neoplasia. In all these procedures, the overriding critical factor is the management of the facial nerve. The facial nerve is embedded within the substance of the gland and is at risk of injury during any parotid gland operation. The various surgical approaches described in our study comprised a common thread, the surgeon’s awareness of facial nerve anatomy and efforts to protect the nerve from an inadvertent injury.
Parotid Gland ; Facial Nerve ; surgery ; Wounds and Injuries

Facial Nerve Injuries ; rehabilitation ; surgery ; Humans

OBJECTIVETo investigate the morphological changes after chemically extracted acellular nerve allografts transplant.

METHODSSeventy-two rabbits were divided into four groups. Acellular allografts of facial nerve were used in experimental group, and facial nerve autografts, acellular peroneal nerve allografts and peroneal nerve autografts respectively used in three control groups. The morphological changes after transplant were evaluated by modified trichrome staining, immunohistological staining and transmission electron microscope.

RESULTSThe two facial nerve grafts showed numerous regenerated nerve fibers, vessels and as well as a spindle schwann cells arranged longitudinally. No significant difference was observed in the fiber number and myelin thickness between the two groups,while the two peroneal nerve groups showed poor regeneration 6 months after operation.

CONCLUSIONSThe facial nerve allografts showed more neurite regeneration six months after transplant, and the regenerated axons passed through the distal stoma and there were well revascularized and proliferated schwann cells in the grafts.

Animals ; Disease Models, Animal ; Facial Nerve ; pathology ; transplantation ; Facial Nerve Injuries ; pathology ; surgery ; Nerve Regeneration ; Rabbits ; Transplantation, Homologous

No abstract available.
Arachnoid* ; Cranial Nerves* ; Facial Nerve* ; Microvascular Decompression Surgery*

The paper summarizes the academic thought and clinical experience of professor LI De-hua in treatment of facial nerve injury after total parotidectomy with blade needle based on jingjin (muscle region of meridian, sinew/fascia) theory. This disease is located at muscle regions of hand-/foot-three yang meridians; and the sinew/fascia adhesion is its basic pathogenesis, manifested by "transversely-distributed collaterals" and "knotted tendons". In treatment, the knotted tendons are taken as the points. Using the relaxation technique of blade needle, the lesions of sinews/fascia are dissected and removed to release the stimulation or compression to the nerves and vessels so that the normal function of sinews/fascia can be restored.
Humans ; Facial Nerve Injuries/surgery* ; Fascia ; Foot ; Hand ; Lower Extremity

PURPOSE: Facial paralysis is an uncommon but significant complication of chronic otitis media (COM). Surgical eradication of the disease is the most viable way to overcome facial paralysis therefrom. In an effort to guide treatment of this rare complication, we analyzed the prognosis of facial function after surgical treatment. MATERIALS AND METHODS: A total of 3435 patients with COM, who underwent various otologic surgeries throughout a period of 20 years, were analyzed retrospectively. Forty six patients (1.33%) had facial nerve paralysis caused by COM. We analyzed prognostic factors including delay of surgery, the extent of disease, presence or absence of cholesteatoma and the type of surgery affecting surgical outcomes. RESULTS: Surgical intervention had a good effect on the restoration of facial function in cases of shorter duration of onset of facial paralysis to surgery and cases of sudden onset, without cholesteatoma. No previous ear surgery and healthy bony labyrinth indicated a good postoperative prognosis. CONCLUSION: COM causing facial paralysis is most frequently due to cholesteatoma and the presence of cholesteatoma decreased the effectiveness of surgical treatment and indicated a poor prognosis after surgery. In our experience, early surgical intervention can be crucial to recovery of facial function. To prevent recurrent cholesteatoma, which leads to local destruction of the facial nerve, complete eradication of the disease in one procedure cannot be overemphasized for the treatment of patients with COM.
Adult ; Aged ; Chronic Disease ; Facial Nerve/surgery ; Facial Nerve Diseases/*etiology/*surgery ; Facial Paralysis/*etiology/*surgery ; Female ; Humans ; Male ; Middle Aged ; Otitis Media/*complications ; Retrospective Studies ; Young Adult

OBJECTIVE: To observe the recovery process of facial behavior and function in rat, and then to supply reliable functional parameters for the researches in such fields. METHOD: Rat models of facial nerve paralysis were set up by sectioning and anastomosis of facial nerve. The behavioral change included whisker movement and blink reflex were observed weekly. Electroneurography (ENoG) and blink reflex (BR) were examined dynamically and all data were analyzed by statistic soft ware. RESULT: Postoperatively, the whisker movement ceased, blink reflex was lost or sluggish but the fibrillation of vibrissae appeared. Whisker movement and evoke blink reflex were seen 1-2 months following operation gradually, which subsequently increased in intensity and frequency. Mass contraction of the periauricular muscles were observed at the same time as eye closure 2 month following operation. The latency of compound muscle action potential (CMAP) at experimental side began to prolong at 21 day, reached climax at 1 month and was stabilized at 3-4 month postoperatively, but it could not get full recovery. The latencies of 28-63 day were longer than other time points (P<0.05). The amplitude and intensity didn't change characteristically. The R1 can be observed repetitively, which disappeared at 7-14 day and gradually recovered 1 month following operation. At experimental side, the R1-type wave (R1oris) in orbicularis oris could be observed at the same time as R1 recorded 2 month following operation, which indicated the facial synkinesis, one hyperkinetic post-paralytic sequela happened. Then the latency of both R1 and R1oris decreased concomitantly. There were correlations between them, but only the significant difference of R1oris latency presented between 2 month and other time points (P<0.05). CONCLUSION It is concluded that the methods of ENoG and BR could examine the recovery process of facial movement, which would help studying the pathophysiological mechanism of facial nerve injury and regeneration after being revised.
Anastomosis, Surgical ; Animals ; Blinking ; Facial Nerve ; surgery ; Facial Nerve Injuries ; physiopathology ; surgery ; Facial Paralysis ; physiopathology ; surgery ; Male ; Rats ; Rats, Sprague-Dawley ; Recovery of Function

BACKGROUND AND PURPOSE: Hemifacial spasm is clinically characterized by involuntary co-contraction of unilateral facial muscles innervated by facial nerve and presence of synkinetic response between facial muscles innervated by different branches of facial nerve is considered as the electrophysiological hallmark of this disease. We performed this study in order to analyse and thereby to approach the pathogenesis of these synkinetic responses in detail. METHODS: Blink reflex test was applied to the 21 patients with hemifacial spasm. With some modification of conventional blink reflex methodology, synkinetic responses between orbicularis oculi and orbicularis oris muscles were recorded on both affected and unaffected sides. RESULTS: Among 21 patients, 10( 47.6% ) showed synkinetic responses both on affected and unaffected side, 8( 38.1% ) only on affected side, and 3( 14.3% ) did not show any evidence of synkinesis on either side. CONCLUSION: These findings could be considered as additional supportive evidence that the facial neuronal hyperexcitability is working in hemifacial spasm as synkinesis on unaffected side cannot be explained solely by peripheral mechanism. Further research on change of synkinetic behavior after microvascular decompression surgery seems to be needed.
Blinking* ; Facial Muscles ; Facial Nerve ; Hemifacial Spasm* ; Humans ; Microvascular Decompression Surgery ; Muscles ; Neurons ; Synkinesis

OBJECTIVETo study the anatomy of angular nerve (AN), so as to provide safe approach for the denervation surgery of corrugator supercilii, depressor supercilii and procerus.

METHODS10 fresh cadaver (20 sides)were perfused and fixed with formalin. Dissection was performed in the 10 x operating microscope. The plexus of the zygomatic branch and the buccal branch were detected to confirm the AN. The relationship of AN with the surrounding blood vessels was observed. We tracked AN until it entered corrugator supercilii, depressor supercilii and procerus.

RESULTS(1) AN was classified into I, II, III type according to its formation pattern. Type I (20%, 4/20 sides) AN is single, which is mainly from the plexus of buccal branch plus the zygomatic branch from the orbicularis oculi muscle. In type II (20%, 4/20 sides), the single AN was formed by buccal branch plexus and zygomatic branch plexus in the "Four Muscle Gap". In type III (60%, 12/20 sides), the AN had two branches in the "Four Muscle Gap". (2) The three types AN passed inferior to the support ligament at the suborbital part, and then transversed medial to the support ligament at the medial canthus, along the vessels of medial canthus. (3) The branch of AN enters the depressor supercilii or procerus 2.19 to 4.28 mm above the medial canthus ligament. The backward branch enters the levator labii superioris alaeque nasi 6.89 to 9.38 mm below the medial canthus ligament.

CONCLUSIONSThe approach of denervation surgery for AN should be performed medial to the support ligation, between 2.19 mm above the medial canthus and 6.89 mm below the medial canthus.

Adult ; Cadaver ; Denervation ; Facial Muscles ; innervation ; Facial Nerve ; anatomy & histology ; surgery ; Female ; Humans ; Male

PURPOSE: Corrugator supercilii muscle pulls eyebrow to inferomedial direction and produces the vertical component of the glabellar line formation. Current techniques for eliminating of glabellar frown include direct resection of corrugators and botulinum toxin injection. Muscle resection in endoscopic face lift procedure is relatively complex and has many disadvantages such as possible nerve injury, postoperative edema, pain and a long recovery period. The Botox treatment on the other hand is much more simple in technique but has a short duration of action. The authors have attempted new ways of finding improved treatment of the glabellar frown by selectively blocking of motor nerves innervating the corrugator supercili muscle by using radiofrequency ablation technique. METHODS: A total of 80 patients were recruited in our study during the period from Feb. 2007 to June 2008. A probe was introduced from the supraorbital ridge and advanced to the corrugator supercilii muscle. Nerve stimulator was then used to locate the nerve innervating the corrugator and radiofrequency ablation of the nerve was done. RESULTS: In all patients, there were marked improvement in glabellar frown after treatment. There were no reported cases of any relapses during the follow up period. No complication was noted such as facial nerve injury. No patient complained of any adverse symptoms other than slight discomfort due to swelling of the operation site. CONCLUSION: The treatment of glabellar frown lines using selective nerve block with radiofrequency ablation was not only less invasive but also excellent in surgical outcomes.
Botulinum Toxins ; Botulinum Toxins, Type A ; Edema ; Eyebrows ; Facial Muscles ; Facial Nerve ; Facial Nerve Injuries ; Follow-Up Studies ; Hand ; Humans ; Muscles ; Nerve Block ; Recurrence ; Rhytidoplasty ; Surgery, Plastic