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

Objective:To observe the position and morphology of tubular cell in lateral facial recess by CT scanning and surgical finding, and its clinical significance. Methods:Thirty patients（32 ears） with cholesteatoma and/or adhesive otitis media requiring radical mastoidectomy and tympanoplasty were included in this study. To observe the morphology of the tubular cell in the lateral facial recess cavity through temporal bone HRCT and surgery, and to analyze its relationship with the facial nerve. Results:Tubular cell were found in 59.4%（19/32） ears by temporal bone HRCT and through surgeon. The length ranged from 1.5-6.5 mm, with median length of 2.5 mm. All of them opened in the facial recess, ran on the posterior wall of the facial recess, and even reached the bottom of the inferior tympanic cavity or the level of the inferior wall of the external auditory canal（sagittal view and surgical findings）. Probing from the inside out, the tubular cell located between the second genu of the facial nerve and the chorda tympani, which was a part of the lateral wall of the facial nerve（facial crest）. When the tubular cell is occupied by granulation tissue, it is easy to be regarded as the facial nerve. Fully drilling out the tubular cell is helpful to cut down the facial nerve crest. In the study, the follow-up and/or postoperative no facial paralysis happens during the operation and in the follow up. Conclusion:Preoperative temporal bone HRCT can clearly show the tubular cell in the lateral facial recess cavity. Comprehensive and accurate identification of these structures is helpful to fully cut down the facial nerve crest and remove the hidden lesions in the posterior tympanic cavity.
Humans ; Facial Nerve/diagnostic imaging* ; Tomography, X-Ray Computed ; Male ; Adult ; Temporal Bone/diagnostic imaging* ; Otitis Media/surgery* ; Female ; Middle Aged ; Cholesteatoma, Middle Ear/diagnostic imaging* ; Mastoidectomy/methods* ; Tympanoplasty/methods* ; Young Adult ; Adolescent ; Clinical Relevance

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

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

Objective: To investigate the outcomes of masseter nerve-innervated free gracilis muscle transfer for smile reanimation in adults and to explore surgical indications. Methods: A retrospective chart review of 37 patients (11 males, 26 females, with (40.3±12.7) years old)who underwent masseter nerve-innervated free gracilis muscle transfer for smile reanimation between 2016 and 2017 was performed. Patient-reported quality of life (facial clinimetric evaluation, FaCE), physician-reported facial function (eFACE facial grading scale), and oral commissure excursion were compared preoperatively and postoperatively. SPSS 11.0 software was used to analyze the data. Results: Thirty-seven patients were followed up in one year after surgery. Significant postoperative improvements were demonstrated for commissure excursion with smile (preoperatively: (-1.2±3.1) mm, postoperatively: (6.1±3.5) mm, t=-31.1, P<0.01), ipsilateral FaCE (preoperatively: (29.4±14.1), postoperatively: (57.6±23.4), t=-38.1, P<0.01), eFACE score (Composite score t=-35.8, Static score t=-29.1, Dynamic score t=-41.3,Midface score t=-43.9, all P<0.01), respectively. Conclusion: Masseter nerve-innervated free gracilis muscle transfer is an good option for dynamic smile reanimation in adult patients who have undergone treatment for long-standing facial paralysis.
Adult ; Facial Paralysis/surgery* ; Female ; Gracilis Muscle ; Humans ; Male ; Middle Aged ; Nerve Transfer ; Quality of Life ; Reconstructive Surgical Procedures ; Retrospective Studies ; Smiling

Hemifacial spasm (HFS) is due to the vascular compression of the facial nerve at its root exit zone (REZ). Microvascular decompression (MVD) of the facial nerve near the REZ is an effective treatment for HFS. In MVD for HFS, intraoperative neurophysiological monitoring (INM) has two purposes. The first purpose is to prevent injury to neural structures such as the vestibulocochlear nerve and facial nerve during MVD surgery, which is possible through INM of brainstem auditory evoked potential and facial nerve electromyography (EMG). The second purpose is the unique feature of MVD for HFS, which is to assess and optimize the effectiveness of the vascular decompression. The purpose is achieved mainly through monitoring of abnormal facial nerve EMG that is called as lateral spread response (LSR) and is also partially possible through Z-L response, facial F-wave, and facial motor evoked potentials. Based on the information regarding INM mentioned above, MVD for HFS can be considered as a more safe and effective treatment.
Decompression ; Electromyography ; Evoked Potentials, Auditory, Brain Stem ; Evoked Potentials, Motor ; Facial Nerve ; Hemifacial Spasm ; Intraoperative Neurophysiological Monitoring ; Microvascular Decompression Surgery ; Vestibulocochlear Nerve

Pseudoaneurysm of internal maxillary artery (IMA) after trauma is rare, and most cases reported are caused by maxilla-facial blunt trauma. Pseudoaneurysm is discontinuity in the vascular wall leading to an extravascular hematoma that freely communicates with the intravascular space producing pulsatile hematoma rapidly. A 44-years-old woman presented with a pulsatile swelling and pain in the left parotid region. She underwent the masticatory muscle reduction using needle injection in dentistry 1 month ago. The left facial pulsatile swelling developed after the procedure immediately and uncontrolled bleeding occurred on the day of visit to our institution. We performed emergency angiography and diagnosed pseudoaneurysm of left IMA. We treated by embolization with Histoacryl Glue through left IMA. IMA total occlusion was confirmed and symptoms improved. Pseudoaneurysm following blunt trauma of the face have been reported but are few. Furthermore, there is no report of IMA pseudoaneurysm due to direct injury by needle. Recently, many cosmetic surgery procedures using injection techniques have been performed, and it is necessary to pay attention to the direct vessel injury by the needle. And endovascular therapies can give early recovery with minimal morbidity and avoids injury to the facial nerve and its branches.
Adhesives ; Aneurysm, False ; Angiography ; Dentistry ; Emergencies ; Enbucrilate ; Facial Nerve ; Female ; Hematoma ; Hemorrhage ; Humans ; Masticatory Muscles ; Maxillary Artery ; Needles ; Parotid Region ; Surgery, Plastic

OBJECTIVES: The goal of this study was to evaluate the rates of complications, morbidity, and safety with the transparotid approach. MATERIALS AND METHODS: A retrospective study was conducted and consisted of 53 surgically treated patients in the past five years for low condylar neck and subcondylar fractures. Only patients with malocclusion and who underwent open reduction with internal fixation with the retromandibular transparotid approach were included. The examined parameters were postoperative suboptimal occlusion, deflection, saliva fistula, and facial nerve weakness. RESULTS: Fifty-three patients had an open reduction with internal fixation on 55 sides (41 males, 77.4%; mean age, 42 years [range, 18–72 years]). Four patients (7.5%) experienced transient facial nerve weakness of the marginal mandibular branch, but none was permanent. Four patients had a salivary fistula, and 5 patients showed postoperative malocclusion, where one needed repeat surgery after one year. One patient showed long-term deflection. No other complications were observed. CONCLUSION: The retromandibular transparotid approach is a safe procedure for open reduction and internal fixation of low condylar neck and subcondylar fractures, and it has minimal complications.
Facial Nerve ; Fistula ; Humans ; Male ; Malocclusion ; Mandibular Fractures ; Neck* ; Parotid Gland ; Reoperation ; Retrospective Studies* ; Saliva ; Surgery, Oral

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

BACKGROUND AND PURPOSE: Hemifacial spasm (HFS) is mostly caused by the compression of the facial nerve by cerebral vessels, but the significance of spasm severity remains unclear. We investigated the clinical significance of spasm severity in patients with HFS who underwent microvascular decompression (MVD). METHODS: We enrolled 636 patients with HFS who underwent MVD between May 2010 and December 2013 at Samsung Medical Center (SMC), Seoul, Korea. Subjects were divided into two groups based on spasm severity: severe (SMC grade 3 or 4) and mild (SMC grade 1 or 2). We compared demographic, clinical, and surgical data between these two groups. RESULTS: The severe-spasm group was older and had a longer disease duration at the time of MVD compared to the mild-spasm group. Additionally, hypertension and diabetes mellitus were more common in the severe-spasm group than in the mild-spasm group. Regarding surgical findings, there were more patients with multiple offending vessels and more-severe indentations in the severe-spasm group than in the mild-spasm group. Even though the surgical outcomes did not differ, the incidence of delayed facial palsy after MVD was higher in the severe-spasm group than in the mild-spasm group. Logistic regression analysis showed that severe-spasm was correlated with longer disease duration, hypertension, severe indentation, multiple offending vessels, and delayed facial palsy after MVD. CONCLUSIONS: Spasm severity does not predict surgical outcomes, but it can be used as a marker of pathologic compression in MVD for HFS, and be considered as a predictor of delayed facial palsy after MVD.
Diabetes Mellitus ; Facial Nerve ; Facial Paralysis* ; Hemifacial Spasm* ; Humans ; Hypertension ; Incidence ; Korea ; Logistic Models ; Microvascular Decompression Surgery ; Seoul ; Spasm