BACKGROUND AND OBJECTIVES: The facial nerve grading system proposed by House and Brackmann is the most widely accepted for the clinical assessment of facial nerve injury. It is, however, subjective and discontinuous, and prone to interobserver variation. In order to remove subjectivity from analysis, we have therfore proposed the FEMA grading system at the Korean Otologic Study Group in 1995. This study describes the FEMA grading system and determines its reliability and usefulness by comparing it with the House-Brackmann system in assessing facial paralysis. MATERIALS AND METHODS: Ten experienced otolaryngologists using the FEMA and H-B systems studied 30 patients with various degrees of facial palsy. RESULTS: In the average of coincidence rate, the FEMA system showed 84.4% and the H-B system was 73.7% (p<0.05). The standard deviation in the grading by the FEMA system was lower than that by the H-B system (p=0.082). CONCLUSION: The study found that the FEMA grading system is more exact and objective in describing the severity of facial palsy than the House-Brackmann grading system. Especially, the FEMA grading system is more convenient to use in patients with partial weakness.
Facial Nerve ; Facial Nerve Injuries ; Facial Paralysis ; Humans ; Observer Variation

Facial Nerve ; Facial Nerve Diseases ; Facial Nerve Injuries ; Facial Paralysis ; Neurology ; trends

Facial Nerve Injuries ; rehabilitation ; surgery ; Humans

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

The mandibular contour determines the shape of the lower part of face and thus influences the appearance of head and neck. A prominent mandibular angle produce characteristic quadriangular, coarse and muscular appearance. To correct this facial contour to oval shape, the prominent angle can be contoured. the cutaneous approach has been used, but it leaves noticeble scar and has risk of facial nerve injury. Thus the intraoral approach has been used commonly. But because of restricition of operation field, the intraoral approach disadvantages of long operation time, high risk of complications. So, we have performed mandibular contouring procedure by new approach which uses reciprocating saw through stab incision under the mandibular body to correct the 9 patients of mandibular angle protrusion who visited our clinics recently. And we found that mandibular angle contouring by this new approach is easy, and makes the operation and recovery time shorter. There were no complications and cosmetic results were quite satisfactory.
Cicatrix ; Facial Nerve Injuries ; Head ; Humans ; Neck

There are various surgical fixation techniques for fractures of the mandible angle due to traumatic facial injuries. Among those surgical treatment modalities, fixation methods using plates, screws, lag screws and wires have been commonly used. With the introduction of absorbable plates, the plate fixation technique has been popularized. However, plate fixation requires an external incision or an external approach using trochar for the direction of screw fixation to be perpendicular to the mandible. The external approach has disadvantages in that it leaves a scar and involves some risk to damage the marginal mandibular branch of the facial nerve. To overcome these disadvantages, the authors used a plate platform formation technique on the fractured mandible angle. The result was satisfactory with no complications. Plate platform formation technique, as performed by the authors, can be a new and simple surgical technique for stable fixation and with minimal postoperative complication by an internal approach to avoid an external scar and nerve injury.
Cicatrix ; Facial Injuries ; Facial Nerve ; Mandible* ; Postoperative Complications

Skull base surgeons are frequently required to operate in close proximity to the facial nerve, making facial nerve paresis or paralysis the possible result of resection of skull base tumors. Serious functional problems can result following eyelid paralysis. The inability to blink and lubricate the eye can lead to exposure keratitis, corneal abrasions, and even blindness. Thus, management of paralysis following facial nerve injury should include provision of adequate corneal coverage. In the cases where the surgeon is certain that the facial nerve has been left intact and return of function is expected, methods are needed to meliorate the temporary paresis or paralysis of the eyelids. If the lower lid is in proper position, adequate eyelid closure can be achieved with placement of the gold weight alone in the upper eyelid. These weights also could be removed once facial nerve function returns normal. Presented is a report of the satisfactory outcome that we have achieved from gold implantation into the upper lid in temporary paralysis of the eyelids in facial nerve paralysis.
Blindness ; Eyelids* ; Facial Nerve ; Facial Nerve Injuries ; Facial Paralysis* ; Keratitis ; Paralysis ; Paresis ; Skull Base ; Weights and Measures

To evaluation effectiveness of internal anastomosis and facial-hypoglossal anastomosis the medical records of 29 patients with facial nerve injury in the course of operation for acoustic neurinoma were reviewed. In 8 patients, the interrupted facial nerves were anastomosed at the end of tumor operation, and facial-hypoglossal anastomoses were performed in 20 patients. One patient underwent facial-hypoglossal anastomosis 6 months after internal anastomosis. All the patients had been treated from January 1983 to March 1993 and were followed up for more than 1 year. After primary internal anastomoses, 7 patients resulted in symmetric face at rest and only one failed to show improvement of facial muscle tone. The mean time to the first evidence of facial reinnervation was 5.3 months. In 20 patients with facial-hypoglossal anastomosis, improvement of facial muscle tone was demonstrated in 19 patients and in one patient there was no improvement. Thirteen cases(68%) showed facial symmetry at rest and 5 of them could close their eyes completely. The first evidence of reinnervation was noted between 3 and 12 months after anastomosis with a mean of 6.3 months. The anastomoses were performed between 8 days and 22 months after injury of the facial nerve, and the time to reinnervation after anastomosis was significantly influenced by the duration of nerve injury(P=0.0439). Primary internal anastomosis revealed better recovery of facial muscle function compared with facial-hypoglossal anastomosis(P=0.0299).
Acoustics* ; Facial Muscles ; Facial Nerve Injuries* ; Facial Nerve* ; Humans ; Medical Records ; Neuroma, Acoustic*

OBJECTIVE: To assess the practical diagnostic value of facial nerve antidromic evoked potential (FNAEP), we compared it with the diagnostic value of the electroneurography (ENoG) test in Bell's palsy. METHODS: In total, 20 patients with unilateral Bell's palsy were recruited. Between the 1st and 17th days after the onset of facial palsy, FNAEP and ENoG tests were conducted. The degeneration ratio and FNAEP latency difference between the affected and unaffected sides were calculated in all subjects. RESULTS: In all patients, FNAEP showed prolonged latencies on the affected side versus the unaffected side. The difference was statistically significant. In contrast, there was no significant difference between sides in the normal control group. In 8 of 20 patients, ENoG revealed a degeneration ratio less than 50%, but FNAEP show a difference of more than 0.295+/-0.599 ms, the average value of normal control group. This shows FNAEP could be a more sensitive test for Bell's palsy diagnosis than ENoG. In particular, in 10 patients tested within 7 days after onset, an abnormal ENoG finding was noted in only four of them, but FNAEP showed a significant latency difference in all patients at this early stage. Thus, FANEP was more sensitive in detecting facial nerve injury than the ENoG test (p=0.031). CONCLUSION: FNAEP has some clinical value in the diagnosis of facial nerve degeneration. It is important that FNAEP be considered in patients with facial palsy at an early stage and integrated with other relevant tests.
Bell Palsy* ; Diagnosis ; Evoked Potentials* ; Facial Nerve Injuries ; Facial Nerve* ; Facial Paralysis ; Humans

A facial nerve palsy is described in a patient who underwent IVRO for the correction of a facial asymmetry and anterior openbite. A possible mechanism of facial nerve injury is discussed.
Facial Asymmetry ; Facial Nerve Injuries* ; Facial Nerve* ; Humans ; Open Bite ; Osteotomy* ; Paralysis