Objective:To explore the clinical characteristics and treatment methods of middle ear cholesteatoma with intracranial and extracranial complications as the first diagnosis. Methods:A total of 244 patients were initially diagnosed with intracranial and/or extracranial complications associated with middle ear cholesteatoma at the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2022, and medical records were collected and retrospectively analyzed. Results:Among 244 patients with intracranial and extracranial complications of middle ear cholesteatoma, 203 cases had one complication, 34 cases had 2 complications, and 7 cases had 3 or more complications. One hundred and eighty-six cases presented labyrinthitis, 41 cases had peripheral facial paralysis, 27 cases had periauricular abscess, 12 cases had meningitis, 10 cases had brain abscess, 7 cases had sigmoid sinus lesions, 6 cases had epidural abscess, and 4 cases demonstrated hydrocephalus. Conclusion:The destructive nature of middle ear cholesteatoma can lead to intracranial and extracranial complications. The incidence rate of extracranial complications is highest for labyrinthitis. Patients with otitis media who complained dizziness should raise clinical suspicion for potential labyrinthitis. The second most prevalent extracranial complication is peripheral facial paralysis, and early facial nerve decompression surgery is critical for better recovery of facial paralysis symptoms. Brain abscess is the most common intracranial complications, which has the highest fatality rate. Clinicians should be alert to otogenic brain abscess. Otolaryngology and neurosurgery teams should cooperate and evaluate patients' middle ear lesions and brain abscess, and jointly develop personalized treatment plans.
Humans ; Cholesteatoma, Middle Ear/surgery* ; Retrospective Studies ; Facial Paralysis/etiology* ; Brain Abscess/diagnosis* ; Male ; Female ; Otitis Media/complications* ; Meningitis/etiology* ; Labyrinthitis/etiology* ; Adult ; Middle Aged ; Young Adult

Objective: To explore the diagnosis, surgical management and outcome of jugular foramen chondrosarcoma (CSA). Methods: Fifteen patients with jugular foramen CSA hospitalized in the Department of Otorhinolaryngology Head and Neck Surgery of Chinese PLA General Hospital from December 2002 to February 2020 were retrospectively collected,of whom 2 were male and 13 were female, aging from 22 to 61 years old. The clinical symptoms and signs, imaging features, differential diagnosis, surgical approaches, function of facial nerve and cranial nerves IX to XII, and surgical outcomes were analyzed. Results: Patients with jugular foramen CSA mainly presented with facial paralysis, hearing loss, hoarseness, cough, tinnitus and local mass. Computed tomography (CT) and magnetic resonance (MR) could provide important information for diagnosis. CT showed irregular destruction on bone margin of the jugular foramen. MR demonstrated iso or hypointense on T1WI, hyperintense on T2WI and heterogeneous contrast-enhancement. Surgical approaches were chosen upon the sizes and scopes of the tumors. Inferior temporal fossa A approach was adopted in 12 cases, inferior temporal fossa B approach in 2 cases and mastoid combined parotid approach in 1 case. Five patients with facial nerve involved received great auricular nerve graft. The House Brackmann (H-B) grading scale was used to evaluate the facial nerve function. Preoperative facial nerve function ranked grade Ⅴ in 4 cases and grade Ⅵ in 1 case. Postoperative facial nerve function improved to grade Ⅲ in 2 cases and grade Ⅵ in 3 cases. Five patients presented with cranial nerves Ⅸ and Ⅹ palsies. Hoarseness and cough of 2 cases improved after operation, while the other 3 cases did not. All the patients were diagnosed CSA by histopathology and immunohistochemistry, with immunohistochemical staining showing vimentin and S-100 positive, but cytokeratin negative in tumor cells. All patients survived during 28 to 234 months' follow-up. Two patients suffered from tumor recurrence 7 years after surgery and received revision surgery. No complications such as cerebrospinal fluid leakage and intracranial infection occurred after operation. Conclusions: Jugular foramen CSA lacks characteristic symptoms or signs. Imaging is helpful to differential diagnosis. Surgery is the primary treatment of jugular foramen CSA. Patients with facial paralysis should receive surgery in time as to restore the facial nerve. Long-term follow-up is necessary after surgery in case of recurrence.
Humans ; Male ; Female ; Young Adult ; Adult ; Middle Aged ; Facial Paralysis/etiology* ; Diagnosis, Differential ; Jugular Foramina ; Retrospective Studies ; Cough ; Hoarseness ; Neoplasm Recurrence, Local ; Chondrosarcoma/surgery*

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

Abnormalities, Multiple ; Child, Preschool ; Facial Paralysis ; etiology ; Female ; Humans

Biopsy, Fine-Needle ; Diagnosis, Differential ; Facial Paralysis ; diagnosis ; etiology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Parotid Gland ; pathology ; Sclerosis ; Sialadenitis ; diagnosis

Acupuncture Therapy ; instrumentation ; Adult ; Aged ; Facial Paralysis ; complications ; Humans ; Lacrimal Apparatus Diseases ; etiology ; therapy ; Male ; Middle Aged ; Needles ; 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

Child ; Facial Paralysis ; etiology ; Humans ; Male ; Wounds and Injuries ; complications

OBJECTIVETo observe the clinical efficacy of acupuncture at Hegu (LI 4) on central facial nerve paralysis after ischemic stroke, and explore dose-effect relationship among different stimulation intensities of acupuncture at Hegu (LI 4) as well as its optimal treatment plan.

METHODSAccording to different acupuncture stimulation intensities which were based on treatment time and needle insertion direction, fifty patients were randomly divided into a Hegu 1 group, a Hegu 2 group, a Hegu 3 group, a Hegu 4 group and a control group, ten cases in each one. Different stimulation intensities of acupuncture at Hegu (LI 4) combined with facial paralysis acupoints, including Yingxiang (LI 20), Dicang (ST 4), Jiache (ST 6) and Quanliao (SI 18), were applied in Hegu 1 to 4 groups; meanwhile acupuncture at stroke acupoints, including Neiguan (PC 6), Shuigou (GV 26) and Sanyinjiao (SP 6), and medication treatment were adopted. Except acupuncture at Hegu (LI 4), the treatment of the control group was identical as Hegu groups. The treatment duration lasted for 14 days. The House-Brackmann facial never grading systems (H-B), Toronto facial grading system (TFGS), degrees of facial never paralysis (DFNP), facial disability index (FDI) and clinical efficacy were compared among groups.

RESULTS(1) Compared before the treatment, H-B, TFGS, DFNP and physical function score in FDI were all improved significantly in the Hegu 1 to 4 groups (all P < 0.05), but social function score in FDI was not obviously improved (all P > 0.05); all the scores in the control group were not evidently changed (all P > 0.05). (2) Compared with the control group, differences of H-B before and after treatment in the Hegu 1 to 4 groups, differences of TFGS in the Hegu 2 group and differences of DFNP in the Hegu 1 and Hegu 2 group were significantly improved (all P < 0.05). The differences of any scale among Hegu 1 to 4 groups were not significant (all P > 0.05), in which the most evident change was found in Hegu 2 group. (3) The total effective rate was 90.0% (9/10), 100.0% (10/10), 90.0% (9/10) and 80.0% (8/10) in Hegu 1 to 4 groups, which were significantly higher than 60.0% (6/10) in the control group (all P < 0.05).

CONCLUSIONAcupuncture at Hegu (LI 4) has affirmative clinical efficacy on central facial nerve paralysis after ischemic stroke, in which oblique insertion along the opposite direction of meridian for 5 s of twirling manipulation has the best clinical effect.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Facial Paralysis ; etiology ; therapy ; Female ; Humans ; Male ; Middle Aged ; Stroke ; complications

OBJECTIVE: To heighten the awareness of the facial nerve tumors. METHOD: The clinical data of twenty-three patients complaining of facial paralysis who were diagnosed postoperatively as facial nerve tumors were analyzed. The hearing assessment of all patients was based on pure tone audiometry at the frequency of 0. 5, 1, 2, 4 kHz. Temporal bone high resolution CT scan and temporal bone MRI with gadolinium enhancement were conducted on all patients. Facial nerve function was assessed with the House-Brackmann (HB) grading system. Facial electroneurography (ENoG) was conducted on 20 patients to quantify the degree of nerve degeneration preoperatively. The pathological types of tumor were determined by postoperative pathological reports. RESULT: Nineteen out of 23 cases presented hearing loss (82.6%), 10 cases suffered from tinnitus (43.5%), otalgia (17.4%) affected 4 cases, 3 cases manifested otorrhea (13.0%), and 2 cases presented vertigo (8.7%). Geniculate ganglion was the most commonly involved site (20 cases, 87.0%), followed by tympanic segments (18 cases, 78.3%), pyramid segment (16 cases, 69.6%), mastoid segment (10 cases, 43.5%), labyrinthine segment (9 cases, 39.1%), internal auditory canal segment and parotid gland segment (5 cases, 21.7%, respectively). Twenty-one cases (91.3%) of schwannomas, 1 case (4.3%) of neurofibroma and 1 case (4.3%) of hemangiomas were identified with histopathology postoperatively. The tumors were all completely excised, and the facial nerve function could recovered to HB III at the best after facial nerve repairment. CONCLUSION Facial nerve tumor is a rare and often misdiagnosed disease which was commonly manifested as facial nerve paralysis. Temporal bone CT and MRI can help to clarify the diagnosis preoperatively. Pure tone audiometry and electroneurography also plays a some certain roles in the diagnosis of facial nerve tumors. The tumors should be completely resected and the surgical approaches were determined based on tumor size, facial nerve function and preoperative auditory function.
Cranial Nerve Neoplasms ; complications ; Facial Nerve ; pathology ; Facial Nerve Diseases ; complications ; Facial Paralysis ; etiology ; Hearing Loss ; Hemangioma ; Humans ; Neurilemmoma ; Temporal Bone