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Objective: To describe the management of traumatic neuroma of the facial nerve in a child and literature review., Patient: Sixteen-month-old male subject., Intervention: Radiological imaging and surgery., Main Outcome Measures: Facial nerve function., Results: The patient presented at 16 months with a right facial palsy and was found to have a right facial nerve traumatic neuroma. A transmastoid, middle fossa resection of the right facial nerve lesion was undertaken with a successful facial nerve-to-hypoglossal nerve anastomosis. The facial palsy improved postoperatively., Conclusion: A traumatic neuroma should be considered in an infant who presents with facial palsy, even in the absence of an obvious history of trauma. The treatment of such lesion is complex in any age group but especially in young children. Symptoms, age, lesion size, growth rate, and facial nerve function determine the appropriate management.

Purpose: To report the presentation of a rare case of Kearns-Sayre-like syndrome (KSS) CASE: A 14-year-old boy presented with progressive drooping of both upper eyelids for 10 years. Past history of right sided hemi-plegia and left facial nerve palsy was present. Examination (OU) showed total external ophthalmoplegia, ptosis and pigmentary retinopathy. The patient also had a short stature (height 121.9 cm) for his age., (© Nepal Ophthalmic Society.)

Objective: We report a case of hemifacial spasm in a patient who had associated hearing loss, numbness throughout the face, tinnitus, and vertigo, all of which occurred when turning his head to the left. To our knowledge, these symptoms have not occurred in this pattern and with a single trigger., Clinical Presentation: A 45-year-old man presented with a 3-year history of right-sided hemifacial spasm initially treated with botulinum toxin. One month before presentation, he had an episode of acute hearing loss in the right ear when turning his head to the left, followed by multiple episodes of transient hearing loss in his right ear, numbness in his right face in all distributions of the trigeminal nerve, tinnitus, and vertigo. He was found to have decreased sensation in nerves V1 to V3 and House-Brackmann grade 3/6 weakness in his right face, despite not having botulinum toxin injections in more than a year. Magnetic resonance imaging/angiography showed an ectatic vertebrobasilar system causing compression of the fifth, seventh, and eighth cranial nerves., Intervention: The patient underwent a retromastoid craniotomy and microvascular decompression. Postoperatively, he had complete resolution of his symptoms except for his facial weakness. The benefit has been long-lasting., Conclusion: Multiple, simultaneous cranial neuropathies from vascular compression are rare, but this case is an example of safe and effective treatment with microvascular decompression with durable results.

This paper reports the case of a 50-year-old man who underwent superselective embolization after severe posterior rhinorrhagia caused by hypertension. Twelve hours after the procedure, left-sided hemiparesis and right-sided facial nerve paresis developed, followed by ulceration and necrosis of the soft palate, diaphragm, and right nasal ala. Reconstruction was implemented with porous polyethylene for the nasal pyramid, a forehead flap and a mucosal flap from the oral vestibulum for polyethylene coverage, and a rotational palatal flap for closure of the oroantral fistula. Exposure of the material occurred after 4 weeks, and removal was followed by satisfactory maintenance of the shape and function of the nose. Postembolization necrosis is a rare complication of the area, and there are very few similar reports in the literature.

A 44-year-old man with progressive ataxia, facial weakness, bilateral adduction deficits, and abducting nystagmus was initially misdiagnosed and treated for multiple sclerosis because a midbrain anatomic cleft had been overlooked on brain MRI. Six cases of "midbrain (or mesencephalic) cleft" or "keyhole aqueduct syndrome" have been previously reported. This developmental anatomic abnormality always manifests bilateral internuclear ophthalmoplegia (INO), often together with ataxia, which may be progressive and debilitating. Because the INO is chronic, patients may have no visual symptoms. The cause of a midbrain cleft is uncertain, but it may be the midbrain version of a syrinx. There is no known effective treatment.

Conclusions: Good hearing preservation can be achieved during acoustic neuroma surgery assisted by real-time dynamic auditory monitoring and ear endoscopic techniques. Preservation of the arachnoid and its blood supply are important for hearing preservation, and injury to the internal auditory artery is the most important cause of hearing loss., Objective: To explore techniques to preserve hearing during acoustic neuroma resection., Methods: This was a retrospective case review in a hospital setting. From July 2003 to July 2007, intraoperative auditory monitoring using auditory brainstem response (ABR) and electrocochleography (EcochG) was conducted in 18 of 138 patients undergoing surgery for acoustic neuroma who had preoperative hearing. The retrosigmoid approach was used for 16 complete resections and 2 patients underwent partial resections. Assisted endoscopic surgery was conducted for 10 ears. The main outcome measure was preservation of hearing, assessed using the classification method of the American Institute of Otolaryngology-Head and Neck Surgery., Results: Hearing was preserved in 11 of the 18 patients (61.1%): 2 of 5 patients whose tumors were larger than 20 mm (40%), and 9 of 13 patients with smaller tumors (69.2%). Among the 10 cases of ear endoscope-assisted surgery, hearing was preserved in 8 (80%). Intraoperative monitoring revealed that the waveform was influenced when the posterior labium of the internal acoustic meatus was ground and drilled, or when traction or electrocoagulation was performed near the opening of the internal acoustic meatus, especially when the internal auditory artery was clamped, the tumor in the internal acoustic meatus was treated, and the arachnoid vessels in the inner-most layer of the tumor surface were clamped or electrocoagulated.

Background: A variety of microorganisms have been shown to cause peripheral facial nerve palsy (PFNP) and/or aseptic meningitis in children. Clinical findings and history may help to predict the specific etiology of these entities., Method: Children > or =12 months old hospitalized at the University Children's Hospital Basel, Switzerland, from 2000 to 2005 with clinical signs of PFNP and/or aseptic meningitis were studied retrospectively. History, clinical, and laboratory findings were evaluated using analysis of variance with Bonferroni (Dunn) correction., Results: Of 181 patients, 123 (68%) had aseptic meningitis, 28 (15%) had PFNP, and 30 (17%) had a combination of both. PFNP with aseptic meningitis was associated with Borrelia burgdorferi (Bb) infection in the majority of patients (73%) compared with 11% and 9% of patients with PFNP or aseptic meningitis, respectively. The majority of patients with aseptic meningitis without PFNP had enterovirus infection (63%). In patients with aseptic meningitis, mean leukocyte counts in cerebrospinal fluid (CSF) were higher with enterovirus (565/microL) compared with Bb infection (191/microL; P < 0.01) or unknown causes (258/microL; P < 0.01). Further, CSF mean mononuclear cell proportion was higher in patients with Bb (89%) than in those with enterovirus infection (51%; P < 0.01) or unknown causes (60%; P < 0.01). Mean time interval between onset of disease and admission to hospital showed significant differences between Bb (7.6 days) and enterovirus infection (2.8 days; P < 0.01) or unknown causes (2.0 days; P < 0.01)., Conclusions: Time interval between onset of disease and hospital admission and CSF characteristics can contribute to distinguishing the etiology of aseptic meningitis with or without PFNP. As expected, the most common etiology for aseptic meningitis with PFNP was Bb infection whereas enterovirus infection was the predominant cause for aseptic meningitis alone.

Hamartomas of the parotid gland are very rare. We present the case of a parotid gland hamartoma with oncocytic and sebaceous metaplasia arising as a 3-cm mass in a 70-year-old man. To the best of our knowledge, there has been no previous report of a tumor with the same features. We present this case to create awareness of hamartomas as part of the differential diagnosis of parotid masses.

The aim of our study was the evaluation of two controversial procedures used in surgical management of parotid tumours in a university teaching hospital: fine needle aspiration cytology (FNAC) and continuous operative facial monitoring with nerve integrity monitor (NIM). We present a retrospective study of 96 consecutive cases of parotid gland surgical procedures, performed in our department of ENT Surgery (Bichat University Hospital) during a 2-year period. After the exclusion of nine patients (4 recurrent tumours, 3 insufficient data and 2 obviously malignant tumours with preoperative facial paralysis and necessary peroperative facial nerve sacrifice), the final group included 40 men and 47 women (mean age 46 years). FNAC, final histological diagnosis, NIM use, postoperative facial disorders and operative time were analysed. Other variables included age, sex, type of surgery and other postoperative complications. FNAC: 78 patients underwent FNAC. Positive predictive value for malignancy was 100%; negative predictive value 94.4%; sensitivity 63.6%; specificity 100%. NIM: surgery was performed without NIM for 41 patients, with for 46 patients. There was no significant difference in occurrence of facial disorders between the two groups. Operative time was significantly lower in group operated with NIM for extracapsular dissection, superficial parotidectomy and total parotidectomy. Because continuous efforts of modern health systems to improve operating room schedules may threaten resident surgeons training, using NIM and performing preoperative FNAC may help operative planning and improve medical education in a teaching hospital.

Cerebellopontine angle (CPA) ganglionic hamartomas are rare. We present a case of a 49-year-old woman who presented with left-sided hearing loss of more than 4 years' duration and vertigo since childhood. Magnetic resonance imaging revealed a mass on the intracanalicular segment of cranial nerve VIII on the left side, consistent with acoustic schwannoma. She opted for observation of the tumor. The patient returned 21 months after the initial evaluation with new-onset left facial weakness. At this time, a working diagnosis of facial nerve neuroma was made. The lesion was excised, and pathology confirmed a diagnosis of left-sided CPA ganglionic hamartoma. Otolaryngologists should be familiar with this uncommon tumor and include it in the differential diagnosis of CPA lesions.

Head and neck (H&N) eponyms serve to honour physicians who have made important contributions. Compared with more descriptive diagnostic names, eponyms can sometimes be confusing, especially to the novice. Adding to the confusion, eponyms are sometimes applied incorrectly. Nevertheless, their use remains common in the medical literature and clinical practice. Familiarity with H&N eponyms is important for accurate communication with radiology colleagues and clinicians. Some eponyms describe potentially fatal infections and their urgency should be appreciated. Other eponyms, such as those for inner ear congenital anomalies, are probably best avoided as they can be used imprecisely and cause confusion. This review summarizes the clinical and imaging findings of some common and important H&N eponyms under the following categories of disease: (1) neck infections, (2) diseases in the temporal bone, (3) orbital diseases, and (4) sinus disease., (Copyright (c) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

The authors report the case of a 35-year-old Arab man who presented with unilateral facial nerve palsy in the presence of an infected lower third molar. The paralysis occurred within hours of the development of a left-sided facial swelling. Surgical removal of the tooth and drainage of the abscess produced significant improvement in facial nerve function, and total resolution occurred prior to clinical follow-up 10 days later. The authors discuss the aetiology of this hemifacial paralysis and its significance as a clinical sign of third molar odontogenic infection., (Copyright 2009 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: To describe the diagnosis, management, and treatment outcome of jugular foramen (JF) tumors., Study Design: Retrospective chart review., Methods: Charts of the 83 patients diagnosed with JF tumors between January 1997 and May 2008 were reviewed. Presenting symptoms, otologic and neurotologic examination, audiologic thresholds, treatment procedure, surgical technique, tumor size and classification, and postoperative complications were recorded. Facial nerve function was graded using the House-Brackmann scale. Extent of tumor removal was determined at time of surgery, followed by routine radiographic follow-up., Results: The mean age of patients with JF tumors was 48.5 years (standard deviation, 16.3 yr), and women (79.5%) outnumbered men (20.5%). Most had glomus jugulare (GJ) tumors (n = 67, 80.7%); 9 patients had lower cranial nerve schwannomas (10.8%), and 7 patients had meningiomas (8.4%). The most frequent initial symptoms included pulsatile tinnitus (84.3%), conductive hearing loss (75.9%), and hoarseness (34.9%). Sixty-one patients (73.5%) underwent surgery, 18.1% had radiotherapy, and 8.4% were observed. Total tumor removal was achieved in 81% of surgery cases. New lower cranial nerve (CN) deficits occurred after surgery in 18.9% of GJ, 22.2% of schwannoma, and 50% of the 4 meningiomas. At last follow-up, 88.1% of surgical patients had normal or near-normal (House-Brackmann I or II) facial function., Conclusion: Total resection of GJ tumors, meningiomas, and lower CN schwannomas can be a curative treatment. However, subtotal removal may be required to preserve CN function, vital vascular structures, and the brainstem. Postoperative radiotherapy is used to control residual tumor. When postoperative complications develop in patients, early rehabilitation is important to decrease mortality and morbidity. Therefore, patients should be closely followed.

A case of emergency cesarean section due to a prolonged second stage of labor in a 29 year-old woman is presented. She had trigeminal nerve and facial nerve palsy after combined spinal-epidural anesthesia for cesarean section.

Object: The goal of this paper is to analyze the extension and relationships of glomus jugulare tumor with the temporal bone and the results of its surgical treatment aiming at preservation of the facial nerve. Based on the tumor extension and its relationships with the facial nerve, new criteria to be used in the selection of different surgical approaches are proposed., Methods: Between December 1997 and December 2007, 34 patients (22 female and 12 male) with glomus jugulare tumors were treated. Their mean age was 48 years. The mean follow-up was 52.5 months. Clinical findings included hearing loss in 88%, swallowing disturbance in 50%, and facial nerve palsy in 41%. Magnetic resonance imaging demonstrated a mass in the jugular foramen in all cases, a mass in the middle ear in 97%, a cervical mass in 85%, and an intradural mass in 41%. The tumor was supplied by the external carotid artery in all cases, the internal carotid artery in 44%, and the vertebral artery in 32%. Preoperative embolization was performed in 15 cases. The approach was tailored to each patient, and 4 types of approaches were designed. The infralabyrinthine retrofacial approach (Type A) was used in 32.5%; infralabyrinthine pre- and retrofacial approach without occlusion of the external acoustic meatus (Type B) in 20.5%; infralabyrinthine pre- and retrofacial approach with occlusion of the external acoustic meatus (Type C) in 41%; and the infralabyrinthine approach with transposition of the facial nerve and removal of the middle ear structures (Type D) in 6% of the patients., Results: Radical removal was achieved in 91% of the cases and partial removal in 9%. Among 20 patients without preoperative facial nerve dysfunction, the nerve was kept in anatomical position in 19 (95%), and facial nerve function was normal during the immediate postoperative period in 17 (85%). Six patients (17.6%) had a new lower cranial nerve deficit, but recovery of swallowing function was adequate in all cases. Voice disturbance remained in all 6 cases. Cerebrospinal fluid leakage occurred in 6 patients (17.6%), with no need for reoperation in any of them. One patient died in the postoperative period due to pulmonary complications. The global recovery, based on the Karnofsky Performance Scale (KPS), was 100% in 15% of the patients, 90% in 45%, 80% in 33%, and 70% in 6%., Conclusions: Radical removal of glomus jugulare tumor can be achieved without anterior transposition of the facial nerve. The extension of dissection, however, should be tailored to each case based on tumor blood supply, preoperative symptoms, and tumor extension. The operative field provided by the retrofacial infralabyrinthine approach, or the pre- and retrofacial approaches, with or without closure of the external acoustic meatus, allows a wide exposure of the jugular foramen area. Global functional recovery based on the KPS is acceptable in 94% of the patients.

Object: Observation is an important consideration when discussing management options for patients with vestibular schwannoma (VS). Most data regarding clinical outcomes after conservative management come from modestsized series performed at individual centers. The authors performed an analysis of the published literature on the natural history of VSs with respect to hearing outcome. Their objective was to provide a comprehensive and unbiased description of outcomes in patients whose disease was managed conservatively., Methods: The authors identified a total of 34 published studies containing hearing outcome data in patients with VSs < 25 mm in largest diameter who underwent observation management. The effects of initial tumor size and tumor growth rate on hearing function at latest follow-up were analyzed. Data from individual and aggregated cases were extracted from each study. Patients with poorer hearing (American Association of Otolaryngology-Head and Neck Surgery Classes C or D, or Gardner-Robertson Classes III, IV, or V) at the time of presentation were excluded., Results: A total of 982 patients met the inclusion criteria for this analysis, with a mean initial tumor size of 11.3 +/- 0.68 mm. The mean growth rate was 2.9 +/- 1.2 mm/year. The length of follow-up for these studies ranged from 26 to 52 months. Patients with preserved hearing at latest follow-up had a statistically larger initial tumor size than those whose hearing declined during the observation period (11.5 +/- 2.3 mm vs 9.3 +/- 2.7 mm, p < 0.0001), but the 2-mm difference of means was at the limit of imaging resolution and observer reliability. In contrast, patients with lower rates of tumor growth ( 2.5 mm/year is a better predictor of hearing loss than the initial tumor size for patients undergoing observation management of VSs < 25 mm in largest diameter.

We present a 17-y-old male who presented to the emergency room with left arm weakness along with slurred speech. On physical examination, he had stable vital signs with left facial weakness suggestive of lower motor neuron seventh nerve palsy. He was also noted to have a small pulsatile mass in the right infraclavicular region. Further questioning revealed that 3 mo earlier he had suffered blunt chest wall trauma during a football game with fracture-dislocation of the right clavicular head, which was managed conservatively. MRI of the brain showed right frontal cortical changes suggestive of infarct versus vasculitis or edema. Chest CT revealed a 2.5- to 3-cm pseudoaneurysm arising from the brachiocephalic artery, with thrombus formation, along with a surrounding 3 x 4.5 cm hematoma. The patient underwent a successful repair of the pseudoaneurysm with no further neurological sequelae. Traumatic pseudoaneurysm with thrombus formation is an extremely rare cause of stroke. It has been reported in association with the carotid artery, but to our knowledge, this is the first reported case with isolated innominate artery pseudoaneurysm. This case highlights the need for a broad differential when evaluating young patients with neurological deficits.

Schwannomas of the abducens nerve are extremely rare tumors affecting cavernous, cisternal or both segments of sixth cranial nerve. Clinical features and neuroradiological imagery are frequently insufficient to reach an accurate pre-operative diagnosis. We report a patient with a cystic tumor with ring-like contrast enhancement at the right anterior pontomesencephalic junction. Radical excision was performed via anterior transpetrosal approach and showed an extrinsic tumor originating from the sixth nerve. A postoperative sixth nerve palsy had disappeared completely 9 months after the surgery. The correct diagnosis of an abducens nerve schwannoma is established by the intraoperative finding of a tumor attachment to the sixth nerve and by histopathological analysis. The various differential diagnoses, the clinical and radiological features of this diagnosis and management are issues discussed in this illustrated review.

Objective: Review of postoperative morbidity and facial nerve outcomes of cystic vestibular schwannoma (CVS) patients compared with solid vestibular schwannoma (SVS) patients and a proposal for a new CVS classification system., Study Design: Retrospective review., Setting: Tertiary care facility., Patients: Ninety-six patients with surgically treated CVS (1998-2008). Outcomes were assessed in a subpopulation of 57 patients with greater than or equal to 1-year follow-up compared with 57 SVS patients., Intervention: Fifty-six CVS patients underwent the enlarged translabyrinthine approach with transapical extension (Type I), and 1 patient underwent a transcochlear/transzygomatic approach., Main Outcome Measure: Preoperative and postoperative (at least 1 yr) House-Brackmann facial nerve (HBFN) grade evaluation., Results: Favorable HBFN grades (I-III) were observed in 46 (81%) CVS patients, and unfavorable HBFN grades (IV-VI) were seen in 11 (19%) CVS patients. Comparison of tumor size and 1-year HBFN grades showed significant, moderate to strong, Pearson correlation (0.38). Comparison of long-term facial nerve outcomes with a sample of 57 matched SVS patients showed no significant difference (p = 0.74). When the tumor was adherent to the facial nerve and a dissection plane could not be developed between the cyst wall and the nerve, only subtotal resection could offer the CVS patients a normal facial nerve outcome., Conclusion: In most CVS cases, complete resection should be foreseen. Central and thick-walled tumors can be removed in almost all cases. However, when peripheral thin-walled, adherent, cystic tumors are confronted and the cysts are medially or anteriorly located, we recommend subtotal resection, leaving portions of the cyst walls on neurovascular structures and on the facial nerve. This surgical strategy allows us to improve facial nerve outcomes and to reduce complications.

Geniculate neuralgia is a rare cause of craniofacial pains. The anterior inferior cerebellar artery is the offending vessel which compress nervus intermedius in the patients with typical geniculate neuralgia. We report a patient whose pain was atypical for either geniculate neuralgia and trigeminal neuralgia. At operation the anterior inferior cerebellar artery was coursing with the nerves and was separated. After the decompression the pain resolved immediately.

It is generally accepted that hemifacial spasm (HFS) is caused by vascular compression at the root exit zone (REZ) of the facial nerve. We saw an HFS patient caused by vascular compression of the distal portion of the facial nerve associated with configuration variation of the facial-vestibulocochlear nerve complex. A 50-year-old female with left HFS was admitted to our hospital. Preoperative magnetic resonance image demonstrated no offending artery around the facial nerve at the nerve's REZ. Microvascular decompression of the left seventh cranial nerve was performed via a lateral suboccipital infrafloccular approach. The facial nerve arose more than 5 mm away from the vestibulocochlear nerve in the brain stem and both traveled apart toward the internal acoustic meatus in the cerebello-pontine cistern. No offending vessel was observed near the REZ of the facial nerve. The abnormal muscle responses of the mentalis muscle disappeared when the AICA was separated from the distal portion of the facial nerve. The patient was completely free of the HFS following surgery. The facial nerve arising away from the vestibulocochlear nerve in the brain stem is rare. It might influence the cause of HFS with compression of the distal portions of the seventh cranial nerve.

Objective: To report the clinical and electrophysiological features of a patient who presented with facial weakness and numbness as the initial manifestation of Chronic inflammatory demyelinating polyradiculopathy (CIDP)., Case Report: An 83-year-old woman presented with facial numbness and weakness. Examination demonstrated mild facial weakness with no other cranial abnormalities. Blink and jaw-jerk reflex latencies were prolonged bilaterally; myokymic discharges were seen in the right frontalis. Cerebrospinal fluid demonstrated an elevated protein. After 3 weeks of intravenous immunoglobulin treatment, the symptoms and electrophysiological findings improved but the symptoms recurred and became more generalized after cessation of intravenous immunoglobulin., Conclusions: This case represents a patient with an unusual initial presentation of cranial nerve involvement in CIDP. Blink reflexes may be a useful electrophysiological technique to assess for peripheral nerve demyelination in patients with suspected CIDP.

Conclusion: In this study, we concluded that electrode design and location did not have a high level of influence on the prevalence of facial nerve stimulation (FNS) in normal cochleae., Objective: To analysis the prevalence of FNS after cochlear implantation with Nucleus 24-channel devices according to types of electrodes arrays., Patients and Methods: We retrospectively analyzed medical and mapping records of 394 patients who received cochlear implants (CIs) manufactured by Cochlear Corporation from April 1999 to March 2007., Results: In all, 23 of 394 (5.8%) patients had FNS (CI24M 4 of 39 [10.3%], CI24RCS 9 of 192 [4.7%], CI24RST 9 of 21 [42.9%], and CI24RECA 1 of 87 [1.1%]). In addition, 4 of 324 (1.2%) patients with normal cochleae complained of FNS (CI24M 1 of 33 [3.0%], CI24RCS 2 of 173 [1.2%], and CI24RECA 1 of 71 [1.4%]). There was no difference between straight and perimodiolar electrode arrays in patients with normal cochleae. In addition, when comparing two types of Contour electrodes, Contour Advance (soft-tip) electrodes offered significantly lower incidence of FNS than Contour electrode arrays. We could manage these patients with methods such as decrease of C-level, selective channel turning off, and changes of mapping strategies.

Objective: The purpose of this study is to report 2 rare cases of congenital fallopian canal meningoceles., Interventions: Magnetic resonance imaging, computed tomography (CT) of the temporal bone, CT-cisternogram, and combined transmastoid approach with middle fossa craniotomy in 2 patients., Main Outcome Measures: Radiologic and operative diagnosis of congenital fallopian canal meningoceles., Results: Presentations included spontaneous cerebrospinal fluid (CSF) otorrhea and recurrent meningitis with intracranial hypertension. Postoperative complications included facial nerve palsy and persistent CSF leaks that necessitated ventriculoperitoneal shunt and lumbar drain placement., Conclusion: Use of CT of the temporal bone in combination with CT-cisternogram may define sites of active CSF leak. Intraoperative use of fluorescein may assist identification of cranial base defects to lower rates of recurrence, and intraoperative use of cranial nerve monitoring can minimize the risk of nerve injury during repair.

Tumefactive demyelinating lesions are a known but uncommon complication of multiple sclerosis, a disease rarely reported in children. This is the case of a 16-year-old African American patient with multiple sclerosis, who developed 2 tumefactive demyelinating lesions. Review of the literature and our own experience helped formulate an algorithm for therapeutic options during an acute attack.

The following case reports describe the clinical features, diagnosis and management of two patients who presented to their general dental practitioner with a complaint of orofacial paraesthesia. After appropriate investigations, both patients were diagnosed as having benign intracranial tumours and were managed by a neurosurgeon. These cases illustrate the important role the general dental practitioner has in the early recognition of potentially life-threatening conditions.

Melkersson-Rosenthal syndrome (MRS) includes the triad of oro-facial edema, facial nerve palsy and furrowed tongue. The exact etiology is unknown. However, genetic and acquired factors have been implicated. It is rare in children. In this study, we report a ten year old boy who was diagnosed with MRS with recurrent facial nerve paralysis and facial edema.

Objective: To investigate the possible thermal effects of microwaves from mobile phones on facial nerves (FN) and surrounding soft tissue., Study Design: A prospective study., Methods: We studied FN conduction rate and compound muscle action potentials (CMAP) on 12 rabbits before exposure to radiofrequency radiation (RFR) emitted from a mobile phone. Also, the temperature change in the soft tissues around the FN was investigated by a four channel Luxtron fiber optic system. A mobile phone with 1900 MHz frequency was placed over the ipsilateral ear of the rabbit for 25 minutes, and FN and surrounding tissues were exposed to a 1.5 watts pulse modulated (217 packets/s) electromagnetic field. During exposure to RFR, immediately after turning off the mobile phone, and 25 minutes after the exposure temperature change in the surrounding tissue of the FN was recorded and compared to preexposure values. Additionally, another recording regarding the FN functions was done and the data were compared to preexposure values., Results: The average temperature of the surrounding soft tissues was 0.39 K higher than the preexposure values during the exposure and immediately after turning off the mobile phone, and decreased to normal levels 25 minutes after the exposure, which was statistically significant. The amplitudes of FN CMAP after radiofrequency radiation exposure were significantly smaller than the preexposure amplitudes and the amplitudes were normal in the 25 minute measurement., Conclusion: The RFR emitted from a mobile phone can cause temporary FN dysfunction that can be due to temporary temperature increase in the soft tissue around the FN.

Childhood ischemic stroke is uncommon and may be associated with many causes and require extensive evaluation. Fibromuscular dysplasia is a rare cause of unknown etiology of childhood stroke which is mostly related with renovascular hypertension and in adults about 85% of cases renal artery has been involved, whereas the intracerebral circulation is the main area affected in children and the documented cause of stroke. We report a 4-year-old girl who presented with facial paralysis and diagnosed as intracranial fibromuscular dysplasia without renal artery involvement.

The most common sequelae in the treatment of head and neck chemodectomas are cranial nerve lesions; of these, the most frequently affected are the trigeminal, facial, glossopharyngeal, vagus and hypoglossus nerves. The lesions of the lower cranial nerves (IX, X, XI and XII) affect the oral and pharyngeal phases of swallowing and frequently lead to aspiration. The frequency with which these nerves are affected varies according to several factors, being 30% in glomus vagale tumors and 20% in carotid tumors. If the V and VII cranial nerves are affected, defects in oral preparation, bolus transport and drooling may occur. Lesions of the XI and X cranial nerves are associated with delayed initiation of the pharyngeal phase, nasal reflux, dysphonia, retained secretions in the piriform sinus, and aspiration. Lesions of the XII cranial nerves affect the oral phase of swallowing. Treatment of dysphagia and aspiration will often be managed with maneuvers to aid swallowing, and changes in food bolus consistency and/or volumes. The remaining complications that can be produced are facial palsy, cerebrospinal fluid fistula, and vascular complications. Facial palsy can be produced by two mechanisms: on the one hand, by central involvement, as a complication of preoperative embolization, and on the other, by direct involvement during surgery or during occasional treatment with radiotherapy. Treatment, whether functional or cosmetic, can be provided either during surgery or subsequently to treat the sequelae of facial palsy.

Background and Purpose: A retrospective study evaluating the role of hypofractionated stereotactic proton beam therapy for acoustic neuromas., Materials and Methods: The data of 51 patients treated with hypofractionation (3 fractions) and followed up for a minimum of 2 years, were analyzed. Mean dose prescribed to ICRU reference point (isocenter) was 26 cobalt gray equivalent (CGyE) in 3 fractions. Mean minimum tumor dose was 21.4 CGyE/3. Cranial nerve functions were evaluated clinically. Serial MR Scans were used to evaluate local control., Results: With a mean clinical and radiological follow-up of 72 and 60 months respectively, the 5-year results showed a 98% local control, with a hearing preservation of 42%, a facial nerve preservation of 90.5% and a trigeminal nerve preservation of 93%., Conclusion: For those patients harboring large acoustic neuromas that are inoperable, hypofractionated stereotactic proton beam offers long-term control with minimal side-effects.

We report a 54-year-old man with right abducent nerve palsy, right facial nerve palsy, and left segmental sensory disturbance, which progressed for 2 weeks. He was found to have cavernous angioma in the lower pons. When he visited our hospital, he had right facial palsy, sensory disturbance of left half of the face and left upper limb, and diplopia. He had suffered right abducent nerve palsy 5 years previously and had recently developed hypertension. Neurological examination further revealed right abducent nerve palsy, right peripheral facial nerve palsy, sensory impairment of the left half of the face, and sensory impairment on the left side from C2 to Th3. Magnetic resonance imaging of the head revealed hemorrhage with a rim at the right dorsal part of the lower pons. No abnormalities were identified on cerebral angiography. He was diagnosed as having hemorrhage originating from a cavernous angioma. We assumed that the segmental sensory disturbance was caused by medial involvement of the lateral spinothalamic tract, which is somatotopically arranged: the fibers from the sacral segments being most lateral. The ventral trigeminothalamic tract, right abducent nerve, and right facial nerve were also disturbed. Segmental sensory disturbance usually accompanies a spinal cord lesion. But several cases with similar symptoms following a brainstem lesion have been reported. Most of them had stroke, showing acute onset of illness. Our case showed subacute onset of illness; cranial nerve palsy and segmental sensory disturbance progressed for 2 weeks.

The lateral surgical approach to jugular foramen schwannomas (JFS) may result in complications such as temporary facial nerve palsy (FNP) and hearing loss due to the complicated anatomical location. Ten patients with JFS surgically treated by variable methods of lateral approach were retrospectively reviewed with emphasis on surgical methods, postoperative FNP, and lower cranial nerve status. Gross total removal of the tumors was achieved in eight patients. Facial nerves were rerouted at the first genu (1G) in six patients and at the second genu in four patients. FNP of House-Brackmann (HB) grade III or worse developed immediately postoperatively in six patients regardless of the extent of rerouting. The FNP of HB grade III persisted for more than a year in one patient managed with rerouting at 1G. Among the lower cranial nerves, the vagus nerve was most frequently paralyzed preoperatively and lower cranial nerve palsies were newly developed in two patients. The methods of the surgical approach to JFS can be modified depending on the size and location of tumors to reduce injury of the facial nerve and loss of hearing. Careful manipulation and caution are also required for short facial nerve rerouting as well as for long rerouting to avoid immediately postoperative FNP.

Objective: The objective of this study was to analyse the clinical presentations, treatment course, and outcomes for patients treated for chronic otitis media associated with facial paralysis in noncholesteatomatous ears., Methodology: The present study looked at 13 patients (10 men, 3 women; ranging in age from 15 to 59 years) treated for facial paralysis due to chronic otitis media without cholesteatoma., Results: Six patients had dehiscence of the fallopian canal whereas the bony canal was intact in the remaining patients. Decompression of the facial nerve was not performed in 5 of the 7 ears with an intact fallopian canal. Four ears underwent total decompression from the geniculate ganglion to the stylomastoid foramen, while the remaining 4 ears underwent partial nerve decompression. However, statistical analysis did not show any difference in recovery between the patients with surgical decompression and those without decompression (p = 0.171). All the patients not receiving decompression had successful outcomes (80% classified as Grade I and 20% as Grade II)., Conclusion: All patients not receiving decompression had successful outcomes. Intravenous antibiotic treatment in conjunction with steroid therapy is the mainstay management of facial paralysis due to chronic otitis media without cholesteatoma. It is therefore not necessary to decompress the facial nerve in cases of facial paralysis in noncholesteatomatous chronic otitis media.

Case Description: A 6-year-old 680-kg (1,496-lb) German Warmblood gelding was evaluated because of bilateral blepharospasm and head shaking., Clinical Findings: Moderate blepharospasm was evident bilaterally, and both eyes had hyperemic and edematous conjunctivas and lusterless corneas. For each eye, the Schirmer tear test value was only 7 mm/min. The horse's nasal mucosa was dry. Abnormal behaviors included mild repetitive vertical movement of the head, snorting, and flehmen response (classic signs of head shaking). Touching the horse's nostrils and face revealed paresthesia and dysesthesia with slight nasolabial muscle hypertrophy bilaterally. Cranial nerve examination revealed no other abnormalities. Serum thyroxine concentration was low, and results of thyrotropin-releasing hormone and thyroid-stimulating hormone stimulation tests were negative, indicating that the horse had hypothyroidism. The diagnoses included keratoconjunctivitis sicca and dry nares attributable to parasympathetic facial nerve dysfunction, head-shaking syndrome with paresthesia and dysesthesia of the face attributable to sensory trigeminal nerve disorder, and hypothyroidism. The 2 nerve dysfunctions were considered peripheral neuropathies that were most likely caused by hypothyroidism., Treatment and Outcome: Treatment of both eyes was initiated with topical applications of cyclosporine, 0.5% sodium hyaluronate, and vitamin A ointment. Levothyroxine (20 microg/kg [9.1 microg/lb], PO, q 24 h) was administered. Within 3 weeks to 4 months, serum thyroxine concentration was within reference range, and clinical signs and Schirmer tear test values improved., Clinical Relevance: Hypothyroidism should be considered as a differential diagnosis in horses with peripheral neuropathy or keratoconjunctivitis sicca. In affected horses, administration of levothyroxine may lead to resolution of neurologic signs.

A 62-year-old woman with relapsing-remitting multiple sclerosis suddenly complained of diplopia associated with bilateral adduction impairment, nystagmus of the abducting eye bilaterally, and sparing of abduction, convergence, and vertical eye movements, consistent with bilateral internuclear ophthalmoplegia. Within 1 week, she had developed a complete horizontal gaze paralysis even with the oculocephalic maneuver. Vertical saccades were slow and convergence was preserved. There was a right lower motor neuron seventh cranial nerve palsy. Brain MRI showed a new enhancing lesion involving the pontine tegmentum. Clinical and MRI follow-up showed recovery after 6 months. The slowing of vertical saccades may have been due to spread of the demyelinating lesion to the adjacent paramedian pontine reticular formation, which contains omnipause neurons lying in the raphe interpositus nucleus thought to inhibit excitatory burst neurons for horizontal and vertical saccades. Our patient verifies the fact that vertical saccadic abnormalities may occur from a lesion apparently confined to the pons.

Objective: Cellular schwannomas (CS) are rare in the cranial space. This report is the first of a patient with a greater superficial petrosal nerve CS presenting with abducens nerve palsy and xerophthalmia., Clinical Presentation: A 16-year-old female patient presented with a 1-month history of diplopia. Neurological examination was normal except for the presence of right abducens nerve palsy. Schirmer's test revealed decreased tear secretion in the right eye. Computed tomography and magnetic resonance imaging showed a mass in the right petrous apex. It was thought that the schwannoma in our patient originated from the greater superficial petrosal nerve, based on the location of the tumor in addition to the absence of partial Horner's syndrome and a persistent decrease in tear secretion., Intervention: The tumor was exposed with the use of a right subtemporal extradural approach and removed entirely. Pathological evaluation of the tumor revealed a CS., Conclusion: The abducens nerve palsy improved completely in the follow-up period, but the decreased tear secretion did not resolve. CS is one of the subtypes of ordinary schwannomas and exhibits malignant features on microscopic examination, although it has a good clinical prognosis. No adjuvant treatment was applied because of the tumor's benign character. The greater superficial petrosal nerve schwannoma should be considered in the differential diagnosis of the abducens nerve palsy and petrous apex mass.