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Background: Facial nerve paralysis induced by acute traumatic facial nerve injuries limited to the zygomatic and buccal branches shows unique complications, such as strong co-contractions of the lower facial muscles around the lips during voluntary blinking (ocular-oral synkinesis). We investigated the characteristics of facial complications after facial nerve injury in the mid-face area and reported the treatment results., Methods: A total of 21 patients with facial nerve injuries to the zygomatic and/or buccal branches were evaluated for the degree of facial synkinesis and mouth asymmetry. Patients with mild-to-moderate symptoms were treated using physical rehabilitation therapy combined with botulinum toxin (Botox) injection, and patients with severe or uncontrolled symptoms were treated using surgical therapy., Results: Initial/final mean synkinesis scores and mouth asymmetry degrees were 2.17/1.75 and 0.85/0.66 in the physical therapy group and 3.11/0.78 and 2.41/-0.31 in the surgery group, respectively. Physical therapy with Botox injection alone did not show significant improvements in synkinetic symptoms of the patients with mild-to-moderate synkinesis (p > 0.05), whereas surgical therapy resulted in significant improvements in synkinesis and mouth asymmetry (p < 0.05)., Conclusions: Surgical treatment is an effective adjustment procedure for the management of facial complications in patients with severe or uncontrolled synkinesis after facial nerve injury to the mid-face area., (Copyright © 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objectives: The optimal treatment and associated clinical outcomes for lymphoepithelial carcinoma of the major salivary gland (LECSG) are currently unclear. As such, the purpose of this study was to assess the survival rates of LECSG patients who received either upfront surgery or upfront chemoradiotherapy (CRT)., Materials and Methods: In this retrospective study, we analyzed cases of LECSG patients treated at our center from January 2010 to April 2021. The cumulative incidences of overall survival rate (OS) and locoregional failure-free survival rate (LRFFS) were evaluated using the Kaplan-Meier method. In order to balance potential risk factors between the treatment groups, we conducted propensity score matching (PSM) at a 1:1 ratio., Results: The study enrolled a total of 107 patients, among whom 24 received surgery alone, 56 underwent surgery combined with postoperative radiotherapy, and 27 underwent definitive radiotherapy. The 5-year LRFFS rate and 5-year OS rate for the entire cohort were 86.6% and 84.4%, respectively. Following PSM, the 5-year LRFFS and OS rates for the upfront CRT cases were comparable to those of upfront surgery, both before and after matching. However, the upfront surgery group showed a tendency toward more de novo facial nerve injury and post-treatment facial nerve injury., Conclusion: The results of this study suggest that upfront CRT is as effective as upfront surgery in terms of locoregional control and overall survival for LECSG patients. Therefore, upfront CRT could be considered a viable treatment option, potentially avoiding the risks associated with surgical intervention., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objectives: The purpose of this study was to evaluate the treatment outcomes of patients with T1-2, high-grade parotid cancer, and to analyze the prognostic factors and treatment failure patterns., Materials and Methods: Of the 101 patients who were diagnosed with high-grade parotid cancer from March 2003 to December 2018, a total of 39 males and 23 females who had T1-2 tumor were enrolled in this study., Results: The average follow-up period of patients in this study was 63.9 months. The 5-year overall survival rate was 73.0%, and the 5-year disease-free survival rate was 57.6%. Thirty-nine patients underwent less-than-total parotidectomies, and the remaining 23 patients underwent total parotidectomies. After surgery, 50 patients received adjuvant treatment. During the study, 25 recurrences were documented, including nine local recurrences and 16 distant metastases. The average time period between the end of initial treatment and disease relapse was 17.0 months. A total of 16 patients succumbed to disease progression. Multivariate Cox proportional regression analysis showed that lymphovascular invasion (LVI) was an independent prognostic factor affecting disease recurrence and patient deaths. Among various factors, LVI and lymph node (LN) metastasis showed statistically significant correlations with distant metastasis., Conclusion: Although we achieved favorable therapeutic results using standard treatments in selected patients, T1-2 high-grade parotid cancers generally have poor prognosis. Distant metastases that occur during follow-up are a major factor in treatment failure and LVI and LN metastasis are significantly associated with distant metastasis., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: Comparison of low-level laser therapy (LLLT) and ozone therapy (OT) methods for the treatment of facial nerve injury (FNI) in rats, evaluated by histomorphometric measurement analysis., Materials and Methods: Thirty rats were randomly divided into control (C), LLLT, and OT groups. The left facial nerves (FNs) of all rats (n = 30) were used in this study. These were held in a surgical clamp for 30 s to create neuropathic damage. The non-injured right FNs of the rats in the control group formed the fourth, sham (S) group in this study (n = 10). Therefore the total number of evaluated samples was 40. The injured FNs of rats in the control group were left to heal spontaneously, whereas LLLT was applied for 21 consecutive days (output 100 mW/cm 2 and wavelength 850 nm) and OT (2 ml; 80 μm/ml) once every 2 days for 21 days., Results: After histomorphological evaluation, the OT group revealed statistically significant outcomes following FNI compared with the OT and control groups in terms of branching of nerve fibers (p = 0.003), nerve fiber diameters (p = 0.0398), nerve fiber areas (p = 0.042), and axon numbers (p = 0.0327). Although the LLLT group revealed a better healing process than the control group, the outcome was not statistically significant in terms of branching of nerve fibers (p = 0.6804), nerve fiber diameters (p = 0.7424), nerve fiber areas (p = 0.7048), and axon numbers (p = 0.7588)., Conclusions: OT resulted in statistically significant differences in outcome when compared with the LLLT and control groups, and provided a safe and effective treatment for FNI in rats. OT could therefore be considered as an alternative treatment of FNI. Clinical studies should now be performed to establish whether comparable results can be achieved in humans., Competing Interests: Declaration of Competing Interest All authors declare that they have no conflicts of interest., (Copyright © 2020 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

When facial nerve axotomy (FNA) is performed on immunodeficient recombinase activating gene-2 knockout (RAG-2 -/- ) mice, there is greater facial motoneuron (FMN) death relative to wild type (WT) mice. Reconstituting RAG-2 -/- mice with whole splenocytes rescues FMN survival after FNA, and CD4+ T cells specifically drive immune-mediated neuroprotection. Evidence suggests that immunodysregulation may contribute to motoneuron death in amyotrophic lateral sclerosis (ALS). Immunoreconstitution of RAG-2 -/- mice with lymphocytes from the mutant superoxide dismutase (mSOD1) mouse model of ALS revealed that the mSOD1 whole splenocyte environment suppresses mSOD1 CD4+ T cell-mediated neuroprotection after FNA. The objective of the current study was to characterize the effect of CD4+ T cells on the central molecular response to FNA and then identify if mSOD1 whole splenocytes blocked these regulatory pathways. Gene expression profiles of the axotomized facial motor nucleus were assessed from RAG-2 -/- mice immunoreconstituted with either CD4+ T cells or whole splenocytes from WT or mSOD1 donors. The findings indicate that immunodeficient mice have suppressed glial activation after axotomy, and cell transfer of WT CD4+ T cells rescues microenvironment responses. Additionally, mSOD1 whole splenocyte recipients exhibit an increased astrocyte activation response to FNA. In RAG-2 -/-  + mSOD1 whole splenocyte mice, an elevation of motoneuron-specific Fas cell death pathways is also observed. Altogether, these findings suggest that mSOD1 whole splenocytes do not suppress mSOD1 CD4+ T cell regulation of the microenvironment, and instead, mSOD1 whole splenocytes may promote motoneuron death by either promoting a neurotoxic astrocyte phenotype or inducing Fas-mediated cell death pathways. This study demonstrates that peripheral immune status significantly affects central responses to nerve injury. Future studies will elucidate the mechanisms by which mSOD1 whole splenocytes promote cell death and if inhibiting this mechanism can preserve motoneuron survival in injury and disease., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: The main objective of this retrospective study is to analyze and report on our operative experiences and outcomes using the ultrasonic BoneScalpel™ (BoneScalpel) versus a conventional reciprocating saw (RecipSaw) for the purpose of completing the osteotomies in total temporomandibular joint reconstruction (TJR) surgery., Materials and Methods: 23 consecutive patients presented with a diagnosis of either degenerative joint disease (n = 23), a failing autogenous TJR (n = 1), heterotrophic bone formation (n = 1) or a subcondylar fracture (n = 1) for a total of 26 joints that received a TJR. 13 unique TJR surgeries employed the use of the BoneScalpel to perform the osteotomies and 13 used the RecipSaw., Results: There was a 49% reduction in the average volume of blood loss in the BoneScalpel group compared to the RecipSaw group (130cc vs. 268cc, p ≤ 0.004), unpaired t-test). For the other variables it was observed that there were more favorable clinical results using the BoneScalpel but without statistically significant differences given the small sample size relative to the prevalence of the outcome that was being measured., Conclusions: Use of the BoneScalpel in TMJ reconstruction is overall safer and results in less blood loss compared to surgeries employing the use of the conventional RecipSaw for completing osteotomies., (Published by Elsevier Ltd.)

Purpose: To document facial nerve (FN) injuries after surgical treatment of mandibular condylar fractures using the retromandibular transparotid approach and to identify risk factors associated with these injuries., Materials and Methods: A retrospective study of patients surgically treated for mandibular condylar fractures using the retromandibular transparotid approach over seven years was conducted. The primary study variable was the postoperative change in FN function after fracture fixation. Risk factors were categorized as demographic, anatomic, experience of the operator, fracture displacement/dislocation and number of miniplates placed at the fracture site. Appropriate statistics were computed., Results: Ninety patients with 102 fractures were analysed. Thirty two fractures (31%) were located in the condylar neck and 70 fractures (69%) were subcondylar (located below the sigmoid notch). The condylar segment was undisplaced in twelve cases (12%), displaced medially in thirty five (34%), laterally displaced in thirty (29%) and dislocated in 25 (24.5%). In 18 fractures (18%), postoperative examination revealed various degrees of damage to the FN. All nerve injuries recovered completely in 8-24 weeks. In a multivariate model, condylar neck fractures, fracture dislocation and operator inexperience were associated with a statistically significant risk of postoperative deterioration of FN function (P ≤ 0.05)., Conclusion: The majority of facial nerve injuries after surgical treatment of condylar fractures by the retromandibular transparotid approach are transient in nature. Condylar neck fractures, fracture dislocation and operator inexperience were associated with an increased risk for FN injury., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease involving motoneuron (MN) axonal withdrawal and cell death. Previously, we established that facial MN (FMN) survival levels in the SOD1(G93A) transgenic mouse model of ALS are reduced and nerve regeneration is delayed, similar to immunodeficient RAG2(-/-) mice, after facial nerve axotomy. The objective of this study was to examine the functionality of SOD1(G93A) splenic microenvironment, focusing on CD4(+) T cells, with regard to defects in immune-mediated neuroprotection of injured MN. We utilized the RAG2(-/-) and SOD1(G93A) mouse models, along with the facial nerve axotomy paradigm and a variety of cellular adoptive transfers, to assess immune-mediated neuroprotection of FMN survival levels. We determined that adoptively transferred SOD1(G93A) unfractionated splenocytes into RAG2(-/-) mice were unable to support FMN survival after axotomy, but that adoptive transfer of isolated SOD1(G93A) CD4(+) T cells could. Although WT unfractionated splenocytes adoptively transferred into SOD1(G93A) mice were able to maintain FMN survival levels, WT CD4(+) T cells alone could not. Importantly, these results suggest that SOD1(G93A) CD4(+) T cells retain neuroprotective functionality when removed from a dysfunctional SOD1(G93A) peripheral splenic microenvironment. These results also indicate that the SOD1(G93A) central nervous system microenvironment is able to re-activate CD4(+) T cells for immune-mediated neuroprotection when a permissive peripheral microenvironment exists. We hypothesize that a suppressive SOD1(G93A) peripheral splenic microenvironment may compromise neuroprotective CD4(+) T cell activation and/or differentiation, which, in turn, results in impaired immune-mediated neuroprotection for MN survival after peripheral axotomy in SOD1(G93A) mice., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: This study was undertaken to evaluate the effect of change of shift for physicians and nurses on complications associated with cesarean delivery., Study Design: 17,996 term women undergoing an unscheduled cesarean delivery in 13 centers from 1999-2000 were included. Maternal and neonatal morbidities were evaluated by time of infant delivery vis-à-vis nursing change of shift (6 AM-8 AM, 2 PM-4 PM, 10 PM-12 AM vs all other hours). The sample was then limited to weekdays only and physician shift changes were evaluated (physician shift change 6 AM-8 AM, 5 PM-7 PM vs all others). A composite of 30 maternal morbidities was also evaluated by logistic regression, controlling for potentially confounding factors., Results: Physician change of shift had no measurable effect on maternal and neonatal outcomes. Neonatal facial nerve palsies were increased at nursing change of shift (5 vs 0) as were hysterectomies (33 [0.24%] vs 23 [0.53%]; P < .007). Nursing change of shift had no impact on composite maternal morbidity after controlling for age, race, insurance, medical problems, prior incision type, weekend day, and prenatal care (odds ratio = 0.98; 95% confidence interval = 0.89-1.08)., Conclusion: Physician change of shift does not appear to be associated with an increase in morbidities. However, cesarean delivery during nursing change of shift is associated with increased risk of neonatal facial nerve palsy and hysterectomy. Further investigation is needed to understand the cause of this association.

Cranial nerve impairment is one of the more serious complications in neurosurgery. Nevertheless, the important question of how many neurons are required for cranial nerve functions remains unanswered. The VIIth cranial nerve (facial nerve) in mice was subjected to graded crush injuries. After assessment of the facial function, the number of uninjured, healthy facial motor neurons was quantified with a retrograde neuronal tracer. We report that normal facial function is preserved if intact neurons account for more than 56% of the control value, while complete facial paralysis occurs if intact neurons are reduced to less than 32% of the control value.

Objective: The purpose of this study was to evaluate the clinical and radiologic results in patients whose condylar neck fractures were reduced and stabilized through use of a standard preauricular approach involving systematic exposure of the facial nerve., Study Design: We performed open reductions of high condylar neck fractures with exposure of the facial nerve in a prospective series of 34 patients. In this article, we describe clinical and radiologic results in 25 patients with follow-up longer than 6 months., Results: Immediate postoperative radiographs showed excellent reduction of the fractures in 24 patients. The postoperative course was uneventful in most patients. The incidence of complications was low; there were 5 patients with temporary facial nerve palsies, 3 patients with plate fractures or screw loosenings, 5 patients with transitory auricular hypoesthesia, 1 patient with inadequate reduction, and 1 patient with limited mouth opening., Conclusions: The results of this study showed that accurate reduction and rigid fixation of high condylar neck fractures were possible through use of an approach in which the facial nerve was exposed.

This article describes the treatment of oral complications that arose after surgery for the removal of an acoustic brain tumor. The authors contend that a thorough oral examination can pinpoint the cranial nerves that have been affected by the tumor or the surgery, and that dental appliances can offer special protection after surgery.

Transverse sphenoidal fractures may be associated with a variety of skull base injuries and neural deficits. Among those nerve injuries, oculomotor palsies and particularly sixth cranial nerve palsy, are quite common. Blows on the side of the head in the squamous temporal region may run across the floor of the middle cranial fossa through the greater wing of the sphenoid in the transverse cranial axis. We report three cases of patients who had sustained craniofacial injury which included a transverse fracture of the middle cranial fossa through the sphenoid sinus, extending to the petrous apex and producing abducent, facial, and eighth nerve dysfunction. Spontaneous recovery from diplopia occurred in all cases within 4 months. The management of the patients and the patterns of transverse cranial base fractures and their associated clinical features are discussed.

Facial nerve palsy following a sagittal split osteotomy is a rare but serious complication. The incidence of facial nerve injury in a group of 1747 patients who had undergone a bilateral sagittal split osteotomy (3494 sagittal splits) was determined and proved to be 0.26% (9 cases). The case histories of 2 patients are presented, and the etiology, diagnosis, treatment and prevention of this complication are discussed.

The frequency of frontal paralysis due to surgical trauma of the temporo-frontal nerve seems to be increasing due to the growing number of operations in the temporo-frontal area and the complexity of surgical techniques. A series of 20 anatomical dissections demonstrates the course of the temporo-frontal nerve. Frontal myomectomy of the healthy side to allow facial equilibration seems to us to be the best technique of reconstructive surgery for definitive frontal paralysis.

A case in a young child of blunt trauma to the facial nerve, distal to the stylomastoid foramen, is reported. Although the patient made an uneventful recovery, an understanding of the possible sites of injury of the facial nerve and further investigations available to aid diagnosis is important. This child was followed up in the Accident and Emergency Department, however, early referral of this rare condition to an otolaryngologist is advisable.

A temporary facial nerve palsy is described in a female patient who underwent bimaxillary surgery for the correction of an anterior open bite associated with mandibular prognathism. A possible mechanism pertinent to this distressing complication is discussed.

A series of 100 surgical procedures on the parotid gland affected by tumours is reported, with a detailed analysis of facial nerve function after parotid surgery. A low percentage of temporary lesions (28%) affecting only one branch of the facial nerve, all of which regressed in a short time, and only one case of a permanent lesion affecting the whole nerve, anatomically intact, however, was observed. The authors confirm the safety of parotidectomy, if correctly performed.