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

OBJECTIVETo investigate the optimal timing for the repair of persistent incomplete facial paralysis by hypoglossal-facial 'side'-to-side neurorrhaphy in rats.

METHODSA total of 30 adult rats with crushed and bulldog-clamped facial nerve injury were randomly divided into 5 groups (n = 6 each) that were subjected to injury without nerve repair or with immediate repair, 2-week-delayed repair, 4-week-delayed repair, or 8-week-delayed repair. Three months later, the effects of repair in each rat were evaluated by facial symmetry assessment, electrophysiological examination, retrograde labeling, and axon regeneration measurement.

RESULTSAt 3 months after injury, the alpha angle significantly increased in the group of rats with 4-week-delayed repair compared with the other four groups. Upon stimulation of the facial nerve or Pre degenerated nerve, the muscle action potentials MAPs were recorded in the whisker pad muscle, and the MAP amplitude and area under the curve in the 4-week-delayed repair group were significantly augmented at 3 months post-injury. Similarly, the number of retrograde-labeled motor neurons in the facial and hypoglossal nuclei was quantified to be significantly greater in the 4-week-delayed repair group than in the other groups, and a large number of regenerated axons was also observed.

CONCLUSIONThe results of this study demonstrated that hemiHN-FN neurorrhaphy performed 4 weeks after facial nerve injury was most effective in terms of the functional recovery of axonal regeneration and activation of facial muscles.

Animals ; Disease Models, Animal ; Facial Nerve ; surgery ; Facial Nerve Injuries ; complications ; surgery ; Facial Paralysis ; etiology ; surgery ; Hypoglossal Nerve ; surgery ; Nerve Regeneration ; Neurosurgical Procedures ; methods ; Rats, Sprague-Dawley ; Treatment Outcome

Unilateral forehead paralysis is a well-documented symptom which follows the superficial temporal branch of the facial nerve injury. The temporal branch holds the highest risk of injury during head and neck surgery among facial nerve branches because it runs superficially above the level of the zygomatic arch, and is not protected by the galea-parietotemporal fascia. Injury to the nerves prior to its innervations into the frontalis muscles will result in unilateral frontalis paralysis which leads to a flattened forehead, eyebrow ptosis and an inability to raise the eyebrow. However, the postoperative forehead paralysis does not always leave permanent sequale. The restorations for motor functions of the nerves sometimes occur without any interventions from several days to several months after the injury. This transient forehead paralysis may result from inhibitory effects for local anesthetics of motor nerve function, neural edema, or direct nerve injury during the operation. Therefore, it is important to predict clinical courses and take appropriate management of postoperative facial nerve paralysis through the understanding neuroanatomy for temporal branch of facial nerves and sophisticated surgical techniques. Herein, we report a case of transient unilateral forehead paralysis which follows Mohs' micrographical surgery for basal cell carcinoma of left temple regions where the superficial temporal branch of the facial nerve runs.
Anesthetics, Local ; Carcinoma, Basal Cell ; Edema ; Eyebrows ; Facial Nerve ; Facial Nerve Injuries ; Fascia ; Forehead* ; Head ; Mohs Surgery* ; Muscles ; Neck ; Neuroanatomy ; Paralysis* ; Zygoma

Fine needle aspiration (FNA) is a highly accurate and safe procedure for the evaluation of salivary gland lesions. Although complications are extremely rare, salivary gland FNA may cause hemorrhage, facial nerve injury, or cellulitis at the entry point. The risk of these complications increases in tumors of high vascularity. We report a case of unexpected facial nerve palsy following a fine needle aspiration in a patient with lymphangioma. The patient received a total parotidectomy with preservation of the facial nerve function, and recovered without developing complications after the surgery.
Biopsy, Fine-Needle* ; Cell Biology* ; Cellulitis ; Facial Nerve ; Facial Nerve Injuries ; Facial Paralysis* ; General Surgery ; Hemorrhage ; Humans ; Lymphangioma* ; Paralysis ; Parotid Gland ; Salivary Glands

Posterior tympanotomy is a procedure performed to access the posterior mesotympanum through a mastoid exposure while preserving the posterior external auditory canal wall. It is dangereous to drill the the site of procedure, as it is surrounded by incuidal fossa superiorly, facial nerve posteriomedially, and chorda tympani nerve anterolaterally, and forms a very narrow pathway. There is always a risk of surgical trauma involving important surgical structures, especially facial nerve and chorda tympani nerve. The development of image-guided surgery (IGS) has significantly improved the performance of many surgical procedures by aiding the identification of surgical landmarks, improving surgical outcomes, rendering the procedure safer and more efficient, especially for beginner otologic surgery, in revision operations, in cases of massive bleeding and tumor of complex anatomy. To see how IGS could help otologic surgeons to identify fine, important structures during posterior tympanotomy, we report a case of posterior tympanotomy in chronic otitis media, which was done using the image-guided surgical technique.
Chorda Tympani Nerve ; Ear Canal ; Facial Nerve ; General Surgery ; Hemorrhage ; Mastoid ; Otitis Media* ; Otitis* ; Surgery, Computer-Assisted ; Wounds and Injuries

The repair of congenital aural atresia remains one of the most challenging otologic procedures because of the scarcity of surgical landmarks, the complexity and the variety of the temporal bone anatomy, and the limited space for reconstruction. The risks of facial nerve injury and profound sensorineural hearing loss following atresia surgery are common concerns. Furthermore, the rarity of the disease makes it difficult to improve surgical learning. Image-guided surgery may aid otologic surgeons in repairing atresia as it allows identifying the exact position of surgical instruments in relation to the specific anatomy. To our knowledge, there have been no published reports on image-guided atresia surgery in Korea. Herein, we report a case of congenital aural atresia, which was repaired using image-guided surgical technique.
Facial Nerve Injuries ; Hearing Loss, Sensorineural ; Korea ; Learning ; Surgery, Computer-Assisted* ; Surgical Instruments ; Temporal Bone

OBJECTIVE: To construct a biodegradable PLGA nerve conduit (NC) filled with NSCs in order to improve facial nerve regeneration. METHOD: SD rats were subjected to right facial nerve transection, and PLGA NCs filled with NSCs were used to bridge the nerve gap. Facial nerve regeneration was assessed 4 and 12 weeks after surgery, through electrophysiological testing, and morphometric analysis of axons. RESULT: Nerve action potential amplitude, and axonal area were significantly greater in the NSCs group than the empty NC group. CONCLUSION NSCs transplantation may improve regeneration of the facial nerve.
Animals ; Facial Nerve Injuries ; surgery ; Female ; Lactic Acid ; Nerve Regeneration ; Neural Stem Cells ; transplantation ; Polyglycolic Acid ; Polylactic Acid-Polyglycolic Acid Copolymer ; Pregnancy ; Rats ; Rats, Sprague-Dawley

Diplopia ; etiology ; Enophthalmos ; etiology ; Exophthalmos ; etiology ; Facial Nerve Injuries ; etiology ; Hemorrhage ; etiology ; Humans ; Intraoperative Complications ; etiology ; prevention & control ; Orbit ; blood supply ; surgery ; Orbital Fractures ; surgery ; Postoperative Complications ; etiology ; prevention & control ; Reconstructive Surgical Procedures ; adverse effects ; Reflex, Trigeminocardiac ; Vision, Low ; etiology

nerve damage, open bite, malunion or nonunion, and facial nerve palsy occur, but these rarely develop. Facial nerve palsy causes the muscles involved in facial expression to depress, which results in ocular dryness or retinal damage. When facial nerve palsy develops, early management involving steroid medication and physical therapy is effective. In the case of severe damage, surgical intervention should be considered. A 20-year-male patient came to the oral and maxillofacial surgery department for orthognathic surgery. The mandible was set back by BSSRO under general anesthesia. Facial nerve palsy was observed on the left side of the face: steroid and vitamins were administered early and physical therapy was performed daily. These forms of management can aid in function and allow for gradual esthetic recovery. Presumed causes were excessive soft tissue retraction or soft tissue injury by the osteotome at the horizontal osteotomy of the ramus. Careful dissection, retraction and a precise osteotomy are needed for protection of the facial nerve. If nerve damage is observed, early management can help in the recovery of facial nerve function and esthetics.]]>
Anesthesia, General ; Congenital Abnormalities ; Esthetics ; Facial Expression ; Facial Nerve ; Facial Nerve Injuries ; Humans ; Mandible ; Mandibular Nerve ; Mouth ; Muscles ; Open Bite ; Orthognathic Surgery ; Osteotomy ; Paralysis ; Porphyrins ; Retinaldehyde ; Soft Tissue Injuries ; Surgery, Oral ; Temporomandibular Joint Disorders ; Vitamins

INTRODUCTION: The placement of a single miniplate is not sufficient to achieve rigid fixation in mandibular angle fractures. It often causes difficulties in reducing the intermaxillary fixation (IMF) period. Consequently, the placement of 2 miniplates is preferable. The intraoral approach in an open reduction and internal fixation (ORIF) of a mandibular angle fracture with 2 miniplates is often challenging. Accordingly, an alternative of transbuccal approach is performed. However, this method leaves a scar on the face and can result in facial nerve injury. This clinical study suggests a protocol that can maintain rigid fixation without a transbuccal approach in mandibular angle fractures. MATERIALS AND METHODS: The subjects were 7 patients who sustained fractures of the mandibular angle and treated at Department of Oral and maxillofacial surgery, Sacred Heart Hospital, Hallym University. ORIF under general anesthesia was done using the intraoral approach. One miniplate was inserted on external oblique ridge of the mandible, and the other was placed on lateral surface of the mandibular body with contra-angle drill and driver. A radiographic assessment and occlusal contact point examination was carried out before surgery, and 2, 4 and 6 weeks after surgery. RESULTS: The mean operation time was 80 minutes. Regarding the occlusion state, the number of contact points increased after surgery. Paresthesia and infection were reported to be complications before surgery. CONCLUSION: The placement of 2 miniplates using contra-angle drill for ORIF of mandibular angle fractures allows early movement of the mandible without IMF. We propose this approach to reduce the patients' discomfort and simplify the surgical procedure.
Anesthesia, General ; Cicatrix ; Facial Nerve Injuries ; Heart ; Humans ; Mandible ; Mandrillus ; Paresthesia ; Prospective Studies ; Surgery, Oral