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Lyme borreliosis is a common vector-borne disease in Europe. The infection follows different stages with a broad variability of clinical symptoms and manifestations in different organs. A 49-year-old man presented with flu-like symptoms, facial nerve paralysis and multiple erythematous macular on his trunk and extremities. We diagnosed Lyme disease (stage II) with facial nerve paralysis and multiple erythema migrans. Intravenous ceftriaxone led to complete healing of hissymptoms within 2 weeks.

Background: The aim of the study was to retrospectively analyze the functional outcomes of microneurovascular facial reanimation using the masseteric innervation., Patients and Methods: Seventeen patients with irreparable facial paralyses resulting from benign lesions involving the facial nuclei (n=14) or Möbius syndrome (n=3) were treated with free muscle flaps for oral commissural reanimation using ipsilateral masseteric innervation and using temporalis muscle transfer for eyelid reanimation. The results were analyzed by a commissural excursion (CE) index and a patient self-evaluation score. The presence of synkinesis was documented. Follow-up ranged from 8 to 48 months (mean 26.4 months)., Results: Normalization of the CE index could be observed in 8 out of 17 patients (47%), an improvement in 7 out of 17 (41%) and failure in 2 out of 17 (12%). A natural smiling response was observed in 10 out of 17 (59%) patients. Patient self-evaluation scores were a level higher than objective indices., Conclusions: Innervation of free muscle flaps with the masseteric nerve for oral commissure reanimation might play an important role in patients with long-standing facial palsy (as in Möbius syndrome). Synkinesis persists for long periods after surgery. However, most of the patients had learned to express their emotions by overcoming this phenomenon. Despite hypercorrection or inadequate correction, patients evaluate themselves favorably.

The facial nerve has a complicated course from the brainstem to the periphery. It not only contains motor, but also secretory, sensory, and sensitive fibres. Thus, the functional measure of symptoms can be multi-faceted. The nerve is not directly accessible over an extensive distance because of its long course through the temporal bone. Therefore, diagnostics of nerve function and the differential diagnostics of its diseases could be a great challenge for the otolaryngologist. In this review, the most important methods for clinical examination, electrodiagnostics, and modern imaging techniques are critically surveyed. In addition, the significance of facial nerve monitoring for surgery in the cerebello-pontine angle, parotid surgery, and ear surgery is presented.

The role of high-resolution computed tomography (HRCT) and magnetic resonance imaging (MRI) in the diagnosis of preoperative and postoperative complications caused by acquired cholesteatomas will be described in this paper. The pre- and postoperative imaging of the temporal bone was performed with HRCT and MRI.HRCT and MRI were performed in the axial and coronal plane. MRI was done with T2 weighted and T1 weighted sequences both before and after the intravenous application of contrast material. All imaging findings were confirmed clinically or surgically. The preoperative cholesteatoma-caused complications depicted by HRCT included bony erosions of the ossicles, scutum, facial canal in the middle ear, tympanic walls including the tegmen tympani, and of the labyrinth. The preoperative cholesteatoma-caused complications depicted by MRI included signs indicative for labyrinthitis, and brain abscess. Postoperative HRCT depicted bony erosions caused by recurrent cholesteatoma,bony defects of the facial nerve and of the labyrinth, and a defect of the tegmen tympani with a soft tissue mass in the middle ear. Postoperative MRI delineated neuritis of the facial nerve, labyrinthitis, and a meningo-encephalocele protruding into the middle ear. HRCT and MRI are excellent imaging tools to depict either bony or soft tissue complications or both if caused by acquired cholesteatomas. According to our findings and to the literature HRCT and MRI are complementary imaging methods to depict pre- or postoperative complications of acquired cholesteatomas if these are suspected by clinical examination.

Introduction: The seventh and eighth cranial nerves course toward the internal auditory canal within the cerebellopontine angle. Lesions in this region are usually related to malfunctions of these cranial nerves. Although an acoustic schwannoma is one of the main etiologies of cerebellopontine angle pathology, various inflammatory processes and vascular anomalies even though rare must be considered., Patients/methods: We describe 5 cases with vascular loops of the basilar or vertebral arteries as a possible cause for hearing loss, vertigo and pulsatile tinnitus. In two cases the vascular lesion was confirmed at surgery, in which a decompression procedure was performed. The work-up for each patient included an auditory test battery and electronystagmography. Imaging studies included MRI and angiography in two cases., Results/conclusions: Our experiences show that while the cerebellopontine angle syndrome is mostly caused by benign tumors an abnormal vascular loop has to be considered in any differential diagnosis.

Background: Botulinum Toxin A produces muscle palsies by blocking the neuromuscular transmissions. The numerous applications of Botulinum-chemodenervation in ophthalmology are demonstrated., Results: In blepharospasm und facial hemispasm Botulinum Toxin A injections represent an excellent alternative to medical and surgical therapy. They have to be repeated after several weeks or month. Other indications are spastic entropium and lagophthalmos. In paralytic strabismus Botulinum Toxin injections (intramuscular under EMG control) serve to prevent contracture of the homolateral antagonist and thus to facilitate recovery of the agonist with restauration of binocular single vision or in non recovering cases to simplify the surgical treatment by making no more necessary the usual recession of the homolateral antagonist. In concomitant strabismus Botulinum-chemodenervation is applicable above alle in small angle deviations under 25 degrees, in sensory strabismus, in residual squint angles after surgery and in contraindications against surgery of any cause. Botulinum Toxin can also be used to stimulate a weakening procedure with control of resulting binocular function or disturbing diplopia., Conclusions: Botulinum Toxin A injections are of considerable therapeutic value in blepharospasm, spastic entropion, lagophthalmus, as well in paralytic strabismus and certain cases of concomitant strabismus.