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

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 OBJECTIVES: The purpose of this study was to evaluate the feasibility and safety of a retroauricular hairline incision in partial superficial parotidectomy. SUBJECTS AND METHOD: Twenty-three patients who underwent partial superficial parotidectomy via retroauricular hairline incision from 2014 to 2016 were enrolled in the study. Patient's characteristics, surgical outcomes and postoperative complications were assessed. Subjective cosmetic satisfaction was assessed using a visual analog scale 3 months after surgery. RESULTS: In all 23 cases, parotid tumors were removed successfully via retroauricular hairline incision alone without any exposure failure. The mean operating time and the amount of postoperative drainage was 117.6 min (range, 75–163 min) and 51.5 mL (range, 25–91), respectively. Major complications such as permanent facial nerve paralysis and hematoma were not reported. The mean visual analogue scale score for subjective satisfaction with the incision scar was 9.0 (range, 6–10). CONCLUSION: We conclude that partial superficial parotidectomy via retroauricular hairline incision for the treatment of benign parotid tumor is technically feasible and it provides excellent cosmetic outcomes without an increase in complications.
Cicatrix ; Drainage ; Facial Nerve ; Hematoma ; Humans ; Methods ; Paralysis ; Parotid Gland ; Postoperative Complications ; Visual Analog Scale

BACKGROUND: In patients with leprosy, paralysis of the facial nerve results in the lower eyelid ectropion and lagophthalmos as a sequela even when the leprosy is cured. Paralytic ectropion causes many functional and cosmetic eye problems, leading to blindness if left untreated. OBJECTIVE: The purpose of this retrospective study is to evaluate the efficacy of surgical correction of paralytic ectropion, the lateral tarsal strip, in patients with leprosy. METHODS: Between 2010 and 2015, 40 Korean patients (44 eyelids) with paralytic ectropion who had visited Korean Hansen Welfare Association Hospital were treated with the lateral tarsal strip. Four-point patients' global assessment scale, local complications, and recurrence were assessed at the end of follow-up period. The average follow-up period was 12 months. RESULTS: In the 44 eyelids, recurrence was observed in 5 cases (5/44, 11.4%). There were no serious postoperative complications except mild size discrepancy of both eyes. Most patients were satisfied with the results and mean satisfaction scale was 2.6/3. CONCLUSION: The lateral tarsal strip is a simple, safe, and effective treatment method for the dermatologic surgeon to correct paralytic ectropion of mild to moderate degree in patients with leprosy.
Blindness ; Ectropion* ; Eyelids ; Facial Nerve ; Follow-Up Studies ; Humans ; Leprosy* ; Methods ; Paralysis ; Postoperative Complications ; Recurrence ; Retrospective Studies

INTRODUCTIONWith the advent of antibiotics, complications of otitis media have become less common. It is crucial for physicians to recognise otitis media and treat its complications early. Herein, we present our institution's experience with patients who required emergency surgical intervention for complications of otitis media.

METHODSData on patients who underwent emergency surgery for complications of otitis media from 2004 to 2011 was retrieved from the archives of the Department of Otolaryngology, Changi General Hospital, Singapore.

RESULTSA total of 12 patients (10 male, two female) underwent emergency surgery for complications of otitis media. The median age of the patients was 25 years. Otalgia, otorrhoea, headache and fever were the main presenting symptoms. Extracranial complications were observed in 11 patients, and six patients had associated intracranial complications. The primary otologic disease was acute otitis media in six patients, chronic otitis media without cholesteatoma in three patients and chronic otitis media with cholesteatoma in three patients. Mastoidectomy and drainage of abscess through the mastoid, with insertion of grommet tube, was the main surgical approach. Two patients required craniotomy. The mean length of hospital stay was 16.2 days and the mean follow-up period was 16.3 months. Five patients had residual conductive hearing loss; two patients with facial palsy had full recovery.

CONCLUSIONOtitis media can still result in serious complications in the post-antibiotic era. Patients with otitis media should be monitored, and prompt surgical intervention should be performed when necessary to attain good outcomes.

Adult ; Audiometry ; Chronic Disease ; Facial Paralysis ; complications ; Female ; Fever ; complications ; Hospitals ; Humans ; Length of Stay ; Male ; Middle Aged ; Otitis Media ; complications ; diagnostic imaging ; surgery ; Retrospective Studies ; Singapore ; Treatment Outcome ; Young Adult

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

Corrective rhinoplasty, a commonly performed plastic surgery, is occasionally followed by numerous risks and complications. In this report, we present, with discussion of the causes and proper management, a case of lagophthalmos that occurred after a rhinoplasty. A 35-year-old female visited our outpatient clinic due to continuous nasal obstruction even after septoplasty. After thorough evaluation, corrective rhinoplasty was performed to release the patient's nasal symptoms and manage the deviated external nose and nasal septum. During the surgery, we encountered excessive nasal bleeding after percutaneous osteotomy. In addition, immediate postoperative findings presented left periorbital edema without limited eye movement or reduced eye vision associated with the paralysis of the eyelid localized to the medial side of the left upper palpebra. Surgeons should be aware of rare but possible complications of corrective rhinoplasty such as lagophthalmos, and a rapid and intensive care is recommended for early management and better prognosis of postoperative complications.
Adult ; Ambulatory Care Facilities ; Ecchymosis ; Edema ; Epistaxis ; Eye Movements ; Eyelids ; Facial Paralysis ; Female ; Humans ; Critical Care ; Nasal Obstruction ; Nasal Septum ; Nose ; Osteotomy ; Paralysis ; Postoperative Complications ; Prognosis ; Rhinoplasty* ; Surgery, Plastic

Bilateral lower motor neuron type facial palsy is an unusual neurological disorder. There are few reports that associate it with the human immunodeficiency virus (HIV) infection on initial presentation. A 51-year-old married woman, who was previously healthy and had no risk of HIV infection, presented solely with bilateral simultaneous facial palsy. A positive HIV serology test was confirmed by an enzyme-linked immunosorbent assay test. Following a short course of oral prednisolone, the patient recovered completely from facial palsy in three months, even though an antiretroviral treatment was suspended. Exclusion of HIV infection in patients with bilateral facial palsy is essential for early diagnosis and management of HIV.
Administration, Oral ; Cerebrospinal Fluid Pressure ; Enzyme-Linked Immunosorbent Assay ; Facial Paralysis ; complications ; drug therapy ; Female ; HIV Infections ; complications ; diagnosis ; Humans ; Middle Aged ; Prednisolone ; therapeutic use ; Prednisone ; administration & dosage

OBJECTIVE: To explore the diagnosis, treatment and surgical approaches of parapharyngeal space tumors. METHOD: This retrospective study consisted of 112 patients with parapharyngeal space tumors underwent surgeries. The data included clinical symptoms and signs, pathological types, imaging examinations, surgical approaches and postoperative complications. RESULT: Computerized tomography (CT), magnetic resonance imaging (MRD and digital subtraction angiography (DSA) made clear the tumor size, localization and its relation to adjacent structures. The postoperative histopathology varied and showed benign in 98 cases consisting of salivary gland tumors (52 cases), neurogenic tumors(33 cases) and other types (13 cases). During the 3 years follow-up period, local recurrence appeared in 3 patients with salivary pleomorphic adenoma and 1 patient with neurofibromatosis. These recurrent tumor cases were cured with second surgery. In 14 patients with malignant tumors reported, 8 cases survived for 5 years, 2 cases (1 adenoid cystic carcinoma and 1 carcinoma in pleornorphic adenoma) recurred in the two and a half years cured with second surgery affiliated radiation therapy through 3 years follow-up time and the rest were followed up 1 to 3 years without recurrence. Peripheral facial paralysis was observed in 25 patients, and 3 patients experienced hypoglossal nerve palsy. Only 1 patient encountered vagus nerve injury, and 2 patients appeared Horner's syndrome, and 4 patients endured Frey syndrome. Gills leakage was discovered in 3 cases and cavity infection was noted in 1 patient. CONCLUSION CT, MRI and DSA were important in the diagnosis and differential diagnosis of parapharyngeal space tumors. The key to successful treatment is knowing the anatomy of the parapharyngeal space, preoperative assessment and appropriate surgical approach.
Adenoma, Pleomorphic ; complications ; Carcinoma, Adenoid Cystic ; complications ; Diagnosis, Differential ; Facial Paralysis ; complications ; Horner Syndrome ; complications ; Humans ; Magnetic Resonance Imaging ; Neoplasm Recurrence, Local ; Pharyngeal Neoplasms ; diagnosis ; therapy ; Pharynx ; pathology ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Salivary Gland Neoplasms ; complications ; Tomography, X-Ray Computed

OBJECTIVE: To study our experiences on deep lobe tumor parotidectomy with preservation of the superficial lobe of the parotid gland. METHOD: Eleven cases of benign tumor in the deep lobe of the parotid gland were analyzed restrospectively. Tumour recurrence, Frey's syndrome, paralysis of facial nerve, salivary fistula, dry mouth and feeling around the auricular lobule were evaluated. RESULT: Numbness around the auricular lobule appeared in 2 cases and salivary fistula appeared in 1 case, transient facial paralysis in 1 case. There were no patients appeared Frey's syndrome, dry mouth, permanent facial paralysis and recurrence in the 1-3 years followed up time. CONCLUSION Deep lobe tumor parotidectomy with preservation of the superficial lobe improves the cosmetics and the feeling around the auricular lobule, reduces the incidence rate of Frey's syndrome, facial paralysis and dry mouth.
Ear Auricle ; Face ; Facial Paralysis ; Humans ; Neoplasm Recurrence, Local ; Organ Sparing Treatments ; Parotid Gland ; surgery ; Parotid Neoplasms ; surgery ; Postoperative Complications ; pathology ; Retrospective Studies ; Sweating, Gustatory ; Xerostomia