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

Pus overflow from patent's fistula belew the left face near mandibular angle 2 years agowith a little pain. Symptoms relieved after oral antibiotics. This symptom frequently occurred in the past six months. Postoperative facial paralysis occurred after surgery, and recovered after treatment. It was diagnosed as the postoperative facial paralysis after first branchial fistula surgery.
Branchial Region ; pathology ; surgery ; Face ; Facial Paralysis ; etiology ; Fistula ; pathology ; surgery ; Humans ; Mandible ; Pain

Adult ; Cranial Fossa, Middle ; surgery ; Decompression, Surgical ; methods ; Facial Nerve ; surgery ; Facial Paralysis ; etiology ; surgery ; Humans ; Male ; Middle Aged ; Trauma, Nervous System ; complications

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

OBJECTIVETo analyze the long-term results after the correction of the paralytic ectropion in leprosy.

METHODSSeventy-four patients with 115 paralytic ectropion eyes after leprosy were treated with the surgical procedures included medial canthoplasty, medial canthal tendon plication, lateral tarsal strip, medial canthal resection, lateral canthoplasty, and lid shortening. The results were evaluated with the follow-ups from 2 to 4 years.

RESULTSThe eye-redness was reduced from 93 to 40 while the epiphora from 107 eyes (24 mild, 36 moderate and 47 severe) to 90 (40 mild, 32 moderate and 18 severe). The mean lid gap in mild eye closure was reduced from 6.8 mm to 5.3 mm and the cornea lesion was reduced from 53 to 36. The results were excellent in 18 eyes (15.7%), good in 45 eyes (39.1%), fair in 41 eyes (35.7%) and poor in 11 eyes (9.6%). However, the mean visual acuity remained same pre- and postoperatively.

CONCLUSIONSSurgical correction of ectropion is helpful for cornea protection and could improve the signs and symptoms of the eyes such as epiphora and red [abstract truncated].

Adult ; Aged ; Aged, 80 and over ; Ectropion ; surgery ; Eyelids ; abnormalities ; surgery ; Facial Paralysis ; etiology ; surgery ; Female ; Humans ; Leprosy ; complications ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Treatment Outcome

OBJECTIVE: To investigate the clinical outcomes of facial nerve decompression via transmastoid, extra labyrinthine,subtemporal approach for management of facial paralysis in temporal bone fracture. METHOD: Twenty-six cases of traumatic facial paralysis (House-Brackmann grade III-V) hospitalized between January 2006 and April 2008 received facial nerve decompression surgery. There were 4 patients diagnosed as House-Braekmann Grade III, 12 as Grade V in and 10 as Grade VI. The preoperative mean air conduction threshold was 52 dB in 16 cases with longitudinal temporal bone fracture and serious sensorineural heating loss in 10 cases with transverse temporal bone fracture. The fracture lines were detected in 13 cases by temporal bone axial CT scans and ossicular disruption could be determined in 9 cases by virtual endoscopy. The geniculate ganglion,the tympanic and mastoid segment of the facial nerve displayed an irregular morphology in curved planar reformation images of the facial nerve canal. RESULT: All cases had primary healing and no complication occurred. At following-up times ranging from 0.5 to 3 years (average 1.2 years), facial nerve function recovered to House-Brackmann Grades I in 15, II in 6, III in 5. Overall air conduction pure tone averages improved 33 dB. CONCLUSION Facial nerve decompression with rebuilding of ossicular chain through transmastoid, extralabyrinthine, subtemporal approach is a good approach for the treatment of facial paralysis in temporal bone fracture.
Adolescent ; Adult ; Decompression, Surgical ; methods ; Facial Paralysis ; etiology ; surgery ; Female ; Fractures, Bone ; complications ; surgery ; Humans ; Male ; Mastoid ; surgery ; Middle Aged ; Otologic Surgical Procedures ; Temporal Bone ; surgery ; Young Adult

OBJECTIVETo study the clinical value of muscle autograft denatured by microwave for repair of gap in removal of facial neuroma.

METHODSA case of patient with a larger facial nerve Schwann cell neuroma was reported. Based on the good results of our experimental research on rats recently, we completed the operation by transmastoid approach for removal of facial neuroma, and the gap of the nerve was repaired with muscle autograft denatured by microwave.

RESULTSThe patient was followed up for one year, and her facial function recovery on the affected side was satisfactory.

CONCLUSIONMuscle autograft denatured by microwave technique is convenient, highly efficient for repairing facial nerve gap after removal of facial neuroma.

Adult ; Facial Neoplasms ; complications ; surgery ; Facial Nerve ; physiology ; Facial Paralysis ; etiology ; surgery ; Female ; Follow-Up Studies ; Humans ; Microwaves ; Muscle, Skeletal ; transplantation ; Nerve Regeneration ; Neurilemmoma ; complications ; surgery ; Protein Denaturation ; Transplantation, Autologous

OBJECTIVETo explore the common complications related to acoustic neuromas and to search methods for preventing from them.

METHODSOne hundred and five patients with acoustic neuromas underwent 110 operations with the retrosigmoid approach, middle cranial fossa approach and labyrinth approach. All cases were followed up more than 1 month after surgery.

RESULTSOf 110 cases, the most frequent complication was hearing disability which occurred in 95 cases (95/110, 86.4%). and the facial paralysis was in 63.6% (70/110) after one month. Other complications were cerebrospinal fluid fistulas (CSF, 12.7%, 14/110) , intracranial hematoma (5.5%, 6/110), cranial nerve palsies (4.5%, 5/110), meningitis (3.6%, 4/110), tetraparesis (3.6%, 4/110), balance disturbance (1.8%, 2/110), hemiparalysis and anepia (0.9%, 1/110). Effective stopping bleeding during operation and controlling blood pressure after operation, as well as keeping effective sedation in 24 hours after operation were the important ways to prevent from intracranial hematoma The haemorrhage often accrued in 48 hours post-operation. CSF in this series was another common complication in acoustic neuroma surgery. Ten cases with CSF subcutaneous retro-auricular had been successfully controlled by conservative treatment. Of 4 cases with rhinorrhea CSF, 3 of them were required surgical management, another one got self-cure by bed rest. The ventricular drainage pro-operation was the most important procedure for drawdown the hypsi-cranium pressure.

CONCLUSIONSThe key factors to avoid the complications include mastering the anatomy of different surgical approach, how much of the tumor size, surgical experience and preoperative evaluation of patients' imaging information and other clinical data.

Adolescent ; Adult ; Aged ; Cerebrospinal Fluid Otorrhea ; etiology ; prevention & control ; Cerebrospinal Fluid Rhinorrhea ; etiology ; prevention & control ; Facial Paralysis ; etiology ; prevention & control ; Female ; Humans ; Male ; Meningitis ; etiology ; prevention & control ; Middle Aged ; Neuroma, Acoustic ; surgery ; Postoperative Complications ; etiology ; prevention & control ; Young Adult

OBJECTIVE: To evaluate the surgical treatment to facial nerve paralysis of different pathogeny. METHOD: Thirty-seven patients were reviewed, including Bell's Palsy (5 patients), temporal bone fracture (20 patients), media otitis (cholesteatoma) (4 patients), facial neuroma and cranio-maxillo-facial operation trauma (8 patients). All the patients were treated by different surgical methods according different pathogeny. RESULT: The mean percentage facial function improvement (House-Brackmann Grade I-II) was 80% to Bell's Palsy and temporal bone fracture, 100% to media otitis (cholesteatoma). Facial function of three patients improved from House-Brackmann Grade IV to III, two patients had no obvious improvement about facial neuroma; three patients improved from Grade V to III, one improved to IV about cranio-maxillo-facial operation trauma. CONCLUSION Patients of facial nerve paralysis got better curative effect if treated by proper surgical therapy according different pathogeny.
Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Facial Paralysis ; etiology ; surgery ; Female ; Humans ; Infant ; Male ; Middle Aged ; Neurosurgical Procedures ; methods ; Treatment Outcome ; Young Adult

OBJECTIVE: To explore the clinical features, pathologic characteristics and treatments of the facial paralysis caused by temporal bone tumors. METHOD: Retrospective analyzed the 23 clinical data of peripheral facial paralysis caused by temporal bone tumors, including 11 cases of facial nerve tumor: facial nerve neurilemmoma in 8 cases, facial nerve neurofibroma in 3 cases; 12 cases of temporal bone malignant tumor: temporal bone squamous cell carcinoma in 9 cases, chondrosarcoma in 1 case, rhabdomyosarcoma in 2 cases. All the patients accepted the CT scan examination and MRI examination. Twenty-three cases were surgically treated: facial nerve tumor resection were performed in 11 cases, among those, through mastoid approach in 7 cases, combined mastoid with middle cranial fossa approach in 3 cases, combined mastoid with parotid approach in 2 cases. Eight cases underwent facial nerve graft following the surgical removal of tumors. Twelve cases were temporal bone malignant tumor resection: among those, extended mastoidotympanectomy in 5 cases, subtotal temporal bone resection in 6 cases, total temporal bone resection in 1 case, all were treated by radiotherapies after surgeries. RESULT: Whether the tumors go along the facial nerve in imaging is the major identification method to identify the facial nerve tumors or no-facial nerve tumors. During the 3-8 years follow-up, 10 patients who were totally removed the facial nerve tumor were no recurrence, 1 patient had tumors present. The recurrence rate of temporal bone malignancy was 41. 7% (5/12), 5 cases of Stell stage T2 and 5 cases of stage T3. The 5-year survival rate was 66.7% (8/12). CONCLUSION Most of facial nerve tumors that cause the facial palsy are benign, and no-facial nerve tumors are most common among the malignant tumors. CT and MRI films are valuable for the diagnosis. Operation is the major treatment, the manner of the operation bases on the type and the extent of the tumors. Facial nerve grafting can improve the facial neurological function after the tumor excision. Malignancy should be treated by combination of operation and radiotherapy, etc.
Adolescent ; Adult ; Aged ; Bone Neoplasms ; complications ; pathology ; Child ; Facial Paralysis ; diagnosis ; etiology ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Temporal Bone ; Young Adult