A 30-year-old female patient with a benign tumor in the superficial lobe of the left parotid gland underwent tumor resection via a 5 cm intra-hairline incision, using the da Vinci Xi surgical robot combined with the NIM-Response 3.0 facial nerve monitoring system. During the operation, facial nerve branches were located and protected through facial nerve monitoring, and the robotic arms were used for precise tumor dissection. Postoperatively, the facial nerve function, incision healing, and tumor recurrence were observed. duration of the procedure was 120 minutes, and the tumor（2.0 cm×1.5 cm） was completely resected. Postoperative pathological examination indicated a pleomorphic adenoma. During the 3-month postoperative follow-up, the patient's facial nerve function remained normal, no salivary fistula occurred, the incision was hidden within the hairline, no tumor recurrence was found in the ultrasound reexamination, and the patient was highly satisfied with the appearance. The surgical approach of robot-assisted resection of benign parotid gland tumor via a hairline incision under facial nerve monitoring has significant advantages in facial nerve protection and cosmetic effect, and is suitable for patients with benign parotid gland tumors meeting specific conditions.
Humans ; Female ; Adult ; Parotid Neoplasms/surgery* ; Facial Nerve ; Robotic Surgical Procedures/methods* ; Adenoma, Pleomorphic/surgery* ; Parotid Gland/surgery* ; Monitoring, Intraoperative

Fibro-osseous lesions is a class of diseases with obvious similarities in clinical manifestations and pathological features, which has been attracting the attention of clinicians and pathologists. The latest WHO 2022 Classification (5th edition) included six of these diseases (cemento-osseous dysplasia, segmental odontomaxillary dysplasia, fibrous dysplasia, juvenile trabecular ossifying fibroma, psammomatoid ossifying fibroma and familial gigantiform cementoma) in the " fibro-osseous tumours and dysplasias ", and put forward new ideas on the diagnosis and treatment of these diseases. According to the latest WHO 2022 Classification (5th edition), the clinical and pathological features, diagnosis and differential diagnosis of these six diseases were described.
Humans ; Fibroma, Ossifying/pathology* ; Diagnosis, Differential ; Cementoma/pathology* ; Jaw Neoplasms ; Facial Bones

Humans ; Facial Nerve/surgery* ; Endolymphatic Sac/surgery* ; Cranial Sinuses ; Postoperative Complications ; Neoplasms

Objective: To explore the classification and reconstruction strategy of defects in lateral face region after operation of malignant tumors. Methods: Eighteen cases with the reconstruction of complicated defects after resection of tumors in the region of lateral face from January 2015 to January 2018 in Hunan Cancer Hospital were retrospectively reviewed. There were 14 males and 4 females, aged from 32 to 68 years. According to the presence or absence of bony scaffold, complicated defects were divided into two main categories: soft tissue perforating defects and soft tissue defects combined with bony scaffold defects. All soft tissue perforating defects in 5 cases were repaired with free anterolateral femoral flaps. Among 13 cases with soft tissue plus bony scaffold defects, 3 were repaired with free fibular flaps, 6 with free fibular flaps combined with free anterolateral femoral flaps, and 4 with chimeric deep circumflex iliac artery perforator flaps combined with anterolateral femoral flaps. Results: All flaps survived well. Two patients complicated with fistula in floor of mouth, but the wound healed after dressing change. Transoral feeding was resumed within 2 weeks after surgery in all patients. One year follow-up evaluation showed that 14 cases had symmetrical face and 10 cases had mouth opening more than 3 transverse fingers. After 36-50 months of follow-up, 6 patients died, with an overall 3-year survival rate of 66.7%. Conclusion: The classification of defects with or without bony stent loss is conducive to the overall repair design, the recovery of facial contour stent, the effective fill of dead space and the maintain of residual occlusal relationship. Good reconstruction results require a multi flap combination of osteocutaneous and soft tissue flaps.
Facial Neoplasms ; Female ; Free Tissue Flaps ; Humans ; Male ; Perforator Flap ; Reconstructive Surgical Procedures ; Retrospective Studies ; Skin Transplantation ; Soft Tissue Injuries/surgery* ; Thigh/surgery*

OBJECTIVE: To investigate the clinical efficacy of a modified paramedian lower lip-submandibular approach for maxillary (subtotal) total resection. METHODS: Eleven patients of maxillary tumors underwent maxillary (subtotal) total resection through the modified paramedian lower lip-submandibular approach. Clinical follow-up visits were conducted to evaluate appearance restoration, facial nerve functional status, parotid gland functional status, and orbital region complication. RESULTS: During the follow-up period of 6-36 months, the appearance of all 11 patients recovered well. All cases presented hidden scars. No facial nerve and parotid duct injury, lower eyelid edema, lower eyelid ectropion, or epiphora in all cases was observed. CONCLUSIONS Applying modified paramedian lower lip-submandibular approach to maxillary (subtotal) total resection effectively reduces incidence of orbital region complications including lower eyelid edema, lower eyelid ectropion, and epiphora, which often occur to traditional approach. The modified approach produces more subtle scars than other methods and should be applied to treatment of maxillary (subtotal) total resection.
Facial Nerve ; Humans ; Lip ; Maxilla ; Maxillary Neoplasms ; Surgical Flaps

OBJECTIVE: To propose and evaluate the clinical effect of midpiece facial nerve dissection through transparotid approach in regional parotidectomy. METHODS: A total of 136 patients with benign parotid tumors were categorized into three groups according to the way of facial nerve dissection: anterograde dissection from main trunk (anterograde, n=70), retrograde dissection from distal branches (retrograde, n=34), and midpiece dissection through transparotid approach (middle dissection, n=32). Surgery duration, facial nerve injury, salivary fistula, earlobe sensation, Frey's syndrome, and aesthetic evaluation were compared. RESULTS: The surgery duration in the middle dissection group was significantly shorter than that in the other two groups. The proportion of salivary fistula was higher in the anterograde group (9 cases, 12.9%; P<0.05) compared with that in the other groups. Postoperative facial nerve injury was similar between the middle dissection (1 case, 3.1%) and anterograde groups (3 cases, 4.3%) with lower injury rate compared with the retrograde group (7 cases, 20.6%). The anterograde group had more cases of hypoesthesia of the earlobe (12 cases, 17.1%; P<0.05) than the other two groups. Aesthetic score was higher in the anterograde and middle dissection groups compared with that in the retrograde group (P<0.05). CONCLUSIONS Midpiece facial nerve dissection is technically feasible and clinically viable in regional parotidectomy.
Esthetics, Dental ; Facial Nerve ; Humans ; Parotid Gland ; Parotid Neoplasms ; Postoperative Complications ; Retrospective Studies ; Sweating, Gustatory

PURPOSE: To understand the ophthalmic clinical features and outcomes of facial nerve palsy patients who were referred to an ophthalmic clinic for various conditions like Bell's palsy, trauma, and brain tumor. METHODS: A retrospective study was conducted of 34 eyes from 31 facial nerve palsy patients who visited a clinic between August 2007 and July 2017. The clinical signs, management, and prognosis were analyzed. RESULTS: The average disease period was 51.1 ± 20.6 months, and the average follow-up duration was 24.0 ± 37.5 months. The causes of facial palsy were as follows: Bell's palsy, 13 cases; trauma, six cases; brain tumor, five cases; and cerebrovascular disease, four cases. The clinical signs were as follows: lagophthalmos, 24 eyes; corneal epithelial defect, 20 eyes; conjunctival injection, 19 eyes; ptosis, 15 eyes; and tearing, 12 eyes. Paralytic strabismus was found in seven eyes of patients with another cranial nerve palsy (including the third, fifth, or sixth cranial nerve). Conservative treatments (like ophthalmic ointment or eyelid taping) were conducted along with invasive procedures (like levator resection, tarsorrhaphy, or botulinum neurotoxin type A injection) in 17 eyes (50.0%). Over 60% of the patients with symptomatic improvement were treated using invasive treatment. At the time of last following, signs had improved in 70.8% of patients with lagophthalmos, 90% with corneal epithelium defect, 58.3% with tearing, and 72.7% with ptosis. The rate of improvement for all signs was high in patients suffering from facial nerve palsy without combined cranial nerve palsy. CONCLUSIONS: The ophthalmic clinical features of facial nerve palsy were mainly corneal lesion and eyelid malposition, and their clinical course improved after invasive procedures. When palsy of the third, fifth, or sixty cranial nerve was involved, the prognosis and ophthalmic signs were worse than in cases of simple facial palsy. Understanding these differences will help the ophthalmologist take care of patients with facial nerve palsy.
Bell Palsy ; Brain Neoplasms ; Cerebrovascular Disorders ; Cranial Nerve Diseases ; Cranial Nerves ; Epithelium, Corneal ; Eyelids ; Facial Nerve ; Facial Paralysis ; Follow-Up Studies ; Humans ; Paralysis ; Prognosis ; Retrospective Studies ; Strabismus ; Tears

Giant cell reparative granuloma (GCRG) is a rare benign bone disease of unknown causes. Trauma is a suspected cause or contributor to the onset of GCRG, of which only a few cases have been reported worldwide. We report a case of temporal bone GCRG in a 4-month-old male newborn, who was born at full term via spontaneous vaginal delivery with recent presentation of right facial palsy. He had a right temporo-occipital craniectomy due to GCRG 1 month earlier. There had been no history of trauma. During the workup of the facial palsy complaint, we identified a lobulated mass in the right temporal bone by computed tomography and magnetic resonance imaging. The mass was mainly in the petrous portion of the temporal bone with extracranial extension through the occipital bone. This was consistent with a GCRG recurrence. The mass was removed via the transcrusal approach, and the final histopathology report confirmed it as recurrent GCRG.
Bone Diseases ; Bone Neoplasms ; Facial Paralysis ; Giant Cells ; Granuloma ; Humans ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging ; Male ; Occipital Bone ; Recurrence ; Temporal Bone

BACKGROUND AND OBJECTIVES: To find more accurate way to determine the location of parotid tumors that cross anatomical criteria for the facial nerve (FN). SUBJECTS AND METHOD: Two hundred patients were included in the study and retrospectively studied. Five anatomical criteria were used to predict the location of parotid tumors on computed tomography (CT). Deep portion of tumors was measured and then, cut-off value was obtained after receiver operator curve analysis. The location of tumor was predicted by using the cut-off value and by the conventional way, in which the side where most of the tumor is located is determined as the tumor site. RESULTS: The parotid tumors were located in superficial lobes in 148 cases, and in deep lobes in 52 cases by operative record. The tumors that cross the anatomical criteria were defined as ‘crossing tumor.’ The cut-off values for prediction of ‘crossing tumor’ location on CT were 6.7 mm for anatomical line, 6.4 mm for FN line, 11.2 mm for retromandibular vein, 4.9 mm for Utrecht line and 3.8 mm for Conn's arc. The accuracy of 5 anatomical criteria for ‘crossing tumor’ was between 55.9% and 81.6% when the cut-off value was used, whereas the accuracy was between 25.7% and 68.9% when conventional way was used. CONCLUSION: In cases of ‘crossing tumor,’ the cut-off value obtained by measurement of deep portion of tumor can be applied to improve the diagnostic performance for the prediction of tumor location.
Facial Nerve ; Humans ; Methods ; Parotid Gland ; Parotid Neoplasms ; Retrospective Studies ; Veins

Merkel cell carcinoma is a rare cutaneous carcinoma, featured by an aggressive clinical course and a mortality rate of 28% at 2 years. A 71-year-old female was affected by a 4.1-cm-wide locally advanced Merkel cell carcinoma of the upper eyelid, previously misdiagnosed as chalazion, with involvement of the extraocular muscles. Although the tumor showed a macroscopic spontaneous regression in size after the incisional biopsy, the mass was treated with neoadjuvant chemotherapy and surgical excision. Good functional and aesthetic result with preservation of the eyeball and absence of tumor recurrence were achieved at 3-year follow-up. In our experience, the combination of the inflammatory cascade due to the incisional biopsy and neoadjuvant chemotherapy led to the regression of a locally advanced large Merkel cell carcinoma of the eyelid.
Aged ; Biopsy ; Carcinoma, Merkel Cell ; Chalazion ; Drug Therapy ; Eyelid Neoplasms ; Eyelids ; Female ; Follow-Up Studies ; Humans ; Mortality ; Muscles ; Neoadjuvant Therapy ; Recurrence ; Skin Neoplasms