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Facial nerve paralysis has many causes and can be acute or chronic. Understanding the signs and symptoms, performing a careful patient evaluation, and obtaining appropriate diagnostic testing can help guide clinicians and improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Unilateral paralysis of the marginal mandibular nerve (UPMMN) after head and neck cancer surgery is a relatively common condition that causes deformity and an asymmetric appearance of the lower lip and impairs the quality of life of patients. We developed a novel fascia grafting method to improve the appearance of the lower lip in patients with UPMMN., Methods: Two fascia strips and a small fascia loop connecting the two strips are used: one is fixed horizontally to pull the lower lip toward the paralyzed side, and the other is fixed in a bow shape at rest to avoid approaching the lateral mandibular margin. When patients smile or open their mouths, the bow-shaped graft straightens, pulling the paralyzed lower lip laterally downward through the small connecting loop. We used this method to treat four patients with UPMMN who had undergone head and neck cancer ablation. The symmetry and movement of the lower lip were assessed using preoperative and postoperative photographs of three poses (at rest, smiling, and opening the mouth)., Results: The fascia grafting procedure restored the symmetry of the lower lip at rest and greatly improved symmetrical lower lip movement when smiling and opening the mouth. According to photographic evaluation scores, all patients had poor lower lip symmetry in the three poses before the procedure, whereas after the procedure, three had excellent lower lip symmetry, and one had good lower lip symmetry. There was a significant difference between the scores before and after the surgery., Conclusions: Fascia grafting is easy and minimally invasive, allows patients to generate an almost symmetrical smile, and consequently improves their QOL. This method may be particularly useful when the lateral mandibular bone is resected during cancer surgery, and the defect is reconstructed with metal plates/soft tissue, as the method does not require approaching the lateral mandibular region., (© 2022 The Authors.)

Objective: To present a rare case of facial schwannoma manifesting as a parotid mass and discuss its diagnosis and treatment. Methods: Design: Case Report Setting: Tertiary Government Hospital Patient: One Results: A 48-year-old female was seen for a 2-year progressive left hemifacial paralysis and a 5-month gradually enlarging left infraauricular mass with episodes of tinnitus but intact hearing and balance. Physical examination showed a left-sided House Brackmann grade VI facial paralysis and a 5 x 4 x 3 cm soft, ill-defined, slightly movable, nontender, left infraauricular mass. Gadolinium-enhanced magnetic resonance imaging revealed a 5 cm heterogeneouslyenhancing lobulated mass centered within the deep lobe of the left parotid gland extending to the left mastoid, with facial nerve involvement. A diagnosis of a facial nerve tumor, probably a schwannoma, was entertained. Pure tone audiometry revealed normal hearing thresholds for both ears with dips at 6-8 KHz on the left. The patient underwent total parotidectomy with facial nerve tumor resection via transmastoid approach, with simultaneous facial – hypoglossal nerve anastomosis reconstruction. Histopathologic findings confirmed the diagnosis of a schwannoma. Postoperative facial function was Grade VI. Hearing and hypoglossal nerve function were preserved. Conclusion: A progressive hemifacial paralysis of chronic duration with or without the presence of an infra-auricular mass should raise the suspicion of a facial nerve tumor. Gadolinium-enhanced magnetic resonance imaging is valuable since intraparotid facial nerve schwannomas are mostly diagnosed intraoperatively when the neoplasm and the nerve are exposed and determined to be contiguous. The clinician should be aware that not all parotid masses are salivary gland in origin. Keywords: intraparotid facial nerve schwannoma, facial nerve paralysis, parotid mass

Two cases of temporohyoid osteoarthropathy ( THO) in young Australian horses are described. The pathogenesis of THO is yet to be fully elucidated, but current theories include extension of infection from otitis media or interna to the temporohyoid joint or a primary but non-infectious degenerative condition within the temporohyoid joint. The young age of the horses and the unilateral distribution suggested an infectious aetiology. Both horses partially responded to treatment with broad-spectrum antimicrobial and anti-inflammatory drugs with concurrent management of ulcerative keratitis. The management of violent head shaking in one horse included the administration of gabapentin, an anticonvulsant known to have antihyperalgesic effects and reduce neuropathic pain. [ABSTRACT FROM AUTHOR]

The article focuses on the demographics of postparotidectomy facial nerve dysfunction, a complication of parotidectomy, in pediatric patients. It reports that the rate of facial nerve dysfunction was high in the adult population and nerve function can be recovered within six months of surgery. It concludes higher rates of postoperative nerve dysfunction in patients with inflammatory lesions.

Summary: Background: The pedicled masseter muscle transfer (PMMT) is introduced as a new reconstructive option for dynamic smile restoration in patients with facial paralysis. The masseter muscle is detached from both its origin and insertion and transferred to a new position to imitate the function of the native zygomaticus major muscle. Methods: Part one of this study consisted of cadaveric dissections of 4 heads (eight sides) in order to determine whether the masseter muscle could be (a) pedicled solely by its dominant neurovascular bundle and (b) repositioned directly over the native zygomaticus major. The second part of the study consisted of clinical assessments in three patients in order to confirm the applicability of this muscle transfer. Commissure excursion and vector of contraction following PMMT were compared to the non-paralyzed side. Results: In all eight sides, the masseter muscles were successfully isolated on their pedicle and transposed on top of and in-line with the ipsilateral zygomaticus major. The mean length of the masseter and its angle from Frankfurt''s horizontal line after transposition compared favorably to the native zygomaticus major muscle. In the clinical cases, the mean commissure movements of the paralyzed and normal sides were 7 mm and 12 mm respectively. The mean angles of commissural movement for the paralyzed and normal sides were 62° and 59° respectively. Conclusions: The PMMT can be used as a dynamic reconstruction for patients with permanent facial paralysis. As we gain experience with the PMMT, it may be possible to use it as a first-line option for patients not eligible for free micro-neurovascular reconstruction. [Copyright &y& Elsevier]

Conclusion: In patients with cochleovestibular malformations, surgeons should always consider the possibility of an aberrant course or shape of the facial nerve (FN). In our series, the majority of cases could be successfully implanted without major complications through careful handling of the FN and ossicles. Objectives: To assess the frequency, type, and surgical implications of FN aberrations encountered during cochlear implantation (CI). Methods: Medical records and radiologic findings of 972 patients who underwent CI from 1988 to 2009 were reviewed retrospectively. Radiologic and intraoperative findings demonstrating malformations of the FN, ossicles, and inner ear were evaluated. Intraoperative events and postoperative FN outcome were reviewed. Results: Seven patients (0.7%) had an aberrant course or shape of the FN during CI. All these patients were pediatric. Four showed abnormal anterior or inferior location of the vertical segment, two had a bifurcated horizontal or vertical segment, and one had an inferiorly located horizontal segment. All seven patients displayed combined malformations of the cochlea and had malformed or missing ossicles. CIs were successfully performed via the facial recess approach and cochleostomy. There was no postoperative FN paralysis except in one case with immediate iatrogenic FN paralysis that recovered completely 1 month after FN decompression. [ABSTRACT FROM AUTHOR]

Purpose: Facial paralysis is an uncommon but significant complication of chronic otitis media (COM). Surgical eradication of the disease is the most viable way to overcome facial paralysis therefrom. In an effort to guide treatment of this rare complication, we analyzed the prognosis of facial function after surgical treatment. Materials and Methods: A total of 3435 patients with COM, who underwent various otologic surgeries throughout a period of 20 years, were analyzed retrospectively. Forty six patients (1.33%) had facial nerve paralysis caused by COM. We analyzed prognostic factors including delay of surgery, the extent of disease, presence or absence of cholesteatoma and the type of surgery affecting surgical outcomes. Results: Surgical intervention had a good effect on the restoration of facial function in cases of shorter duration of onset of facial paralysis to surgery and cases of sudden onset, without cholesteatoma. No previous ear surgery and healthy bony labyrinth indicated a good postoperative prognosis. Conclusion: COM causing facial paralysis is most frequently due to cholesteatoma and the presence of cholesteatoma decreased the effectiveness of surgical treatment and indicated a poor prognosis after surgery. In our experience, early surgical intervention can be crucial to recovery of facial function. To prevent recurrent cholesteatoma, which leads to local destruction of the facial nerve, complete eradication of the disease in one procedure cannot be overemphasized for the treatment of patients with COM. [ABSTRACT FROM AUTHOR]

The objectives of this article are to assess the frequency and significance of facial paralysis and undiagnosed nerve infiltration in patients with parotid malignancies. 103 patients with parotid gland malignancies were treated in a single institution, the tertiary center for ENT at the University Department in Poznan between 1996 and 2006. Facial palsy at the initial presentation was found in 32 patients. The stage of the primary tumor in the examined group of 103 patients is as follows: 20-T1, 31-T2, 20-T3, 32-T4. The correlation between facial nerve function before treatment and patients' characteristics, including the treatment methods, were analyzed. Intact facial nerve function at patient presentation was a very strong prognostic factor determining the treatment and final outcome for malignant neoplasms of parotid gland. Similarly, T stage and a high-grade malignant histology had a direct influence on the duration of patients' survival. [ABSTRACT FROM AUTHOR]

Objective:The temporal bone may be the first involved site in cases of systemic disease, and may even present with acute, mastoiditis-like symptomatology. This study aimed to evaluate the incidence of such non-infectious ‘acute mastoiditis’ in children.Materials and methods:Retrospective chart review of 73 children admitted to a tertiary referral centre for acute mastoiditis.Results:In 71 cases (97.3 per cent), an infectious basis was identified. In the majority of cases (33 of 73; 45 per cent), the responsible bacteria was Streptococcus pneumoniae. However, histopathological studies revealed a non-infectious underlying disease (myelocytic leukaemia or Langerhans' cell histiocytosis) in two atypical cases (2.7 per cent).Conclusion:‘Acute mastoiditis’ of non-infectious aetiology is a rare but real threat for children, and a challenging diagnosis for otologists. A non-infectious basis should be suspected in every atypical, persistent or recurrent case of acute mastoiditis. [ABSTRACT FROM PUBLISHER]

Objectives:To determine the implications of a functional approach to vestibular schwannoma surgery, with facial nerve function prioritised higher than total tumour excision.Study design:A case–control study in a tertiary referral neurotology clinic.Patients:A ‘functional’ surgical group treated after April 2007 (n = 44, mean cerebellopontine angle dimension 27 mm), and an ‘excisional’ surgical group matched for tumour size, treated from 1997 to April 2007 (n = 115).Intervention:Change to more functional surgical approach.Main outcomes measured:Primary outcome: facial nerve status. Secondary outcome: tumour recurrence in less-than-total tumour excision.Results:Facial nerve preservation: 77 per cent House–Brackmann grade I–II in functional group at 12 months, versus 57 per cent grade I–II in excisional group (p = 0.027). Tumour recurrence: 1 per cent in total excision group, 2 per cent in near-total group and 40 per cent in sub-total group.Conclusion:A functional approach to vestibular schwannoma surgery improves facial nerve preservation outcomes and reduces the requirement for facial nerve rehabilitative interventions. Tumour recurrence rates are low in near-totally excised lesions but significant if only sub-total excision is achieved. [ABSTRACT FROM PUBLISHER]

This report describes a rare case of histopathologically confirmed glomus faciale tumor. The role of imaging in the differential diagnosis is discussed and therapeutic options are evaluated, along with a review of the previous literature on glomus faciale tumors. A 39-year-old male patient presented with total peripheral facial nerve paralysis. He underwent radical tumor resection and facial nerve grafting for a histopathologically confirmed paraganglioma of the facial nerve. He is now tumor-free after a 4-year follow-up period, and the functional outcome after primary nerve grafting is satisfactory. Facial nerve paragangliomas are a rare cause of facial nerve paralysis. Early imaging using computed tomography and magnetic resonance imaging is essential to clarify the differential diagnosis and assess the location and extent of the tumor. Precise pathological diagnosis requires additional targeted immunohistochemical examinations. The treatment of choice in patients with preoperative facial nerve paralysis is radical tumor resection with nerve reconstruction. [ABSTRACT FROM AUTHOR]

Abstract: Craniometaphyseal dysplasia (CMD) is a rare congenital bone disorder with facial dysmorphism developing from early childhood. We describe an unusual case of CMD unnoticed until the patient was 19 years old. Her disorder was diagnosed for the first time from her facial nerve paralysis, and was treated with high-dose corticosteroids. This report indicates the need for extreme caution in dealing with facial nerve paralysis since early detection and accurate diagnosis is important in the treatment of bone diseases. High-dose corticosteroid could be effective in treating facial nerve paralysis, even when nerves have been directly constricted by a bony overgrowth. [Copyright &y& Elsevier]

Acquired toxoplasmosis, although relatively common in children, is usually asymptomatic but can also be clinically manifested by a benign and self-limited infectious mononucleosis-like syndrome. Neurological complications are very rare in immunocompetent children. The authors report a 5-year-old boy who presented with cervical lymphadenopathy because of acquired toxoplasmosis accompanied with unilateral facial nerve paralysis. Toxoplasma gondii DNA detection in blood by polymerase chain reaction, as well as elevated specific immunoglobulin M antibodies against it, established the diagnosis. Characteristic brain lesions on magnetic resonance imaging were absent and ophthalmologic examination revealed no inflammatory lesions in the retina and choroid. Treatment with pyrimethamine, sulfadiazine, and folic acid resulted in a complete recovery after 2 months of therapy. Although rare, acute facial nerve paralysis of unknown origin can be caused by acquired toxoplasmosis even in the immunocompetent pediatric population. Elevated titers of specific antibodies and the presence of parasite’s DNA are key findings for the correct diagnosis. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 49 year old man with unilateral facial nerve paralysis (FNP) developed after four weeks of intermittent cervical traction therapy. Nerve conduction velocity examination revealed a peripheral-type FNP and its symptoms subsided after prednisolone treatment and suspension of traction therapy. The cause of FNP in the patient was suspected to be a misplaced or an overstrained harness.

The article discusses the roles of growth factors and platelet-rich plasma (PRP) in the healing process of muscles. It explores several stages of healing process including homeostasis, acute inflammatory phase, and intermediate phase. It mentions several advantages of using PRP in the healing process that include little risk of immune response development, increased cell proliferation, and enhanced muscle repair. Issues concerning sports medicine are also discussed.

We present a clinical case of Melkersson-Rosenthal (M-R) syndrome associated with Down syndrome. No evidence of this association is described in the literature. We also present a technique for the macrocheilia treatment of lower lip caused by M-R syndrome in a patient with Down syndrome. This patient during pediatric age had many events of facial nerve paralysis and edematous episodes of lower lip with unknown etiology. This technique is based on a wedge full thickness central excision of the lower lip and on a transversal lozenge excision in the vermilion portion with orbicular muscle to reverse the chin-labial corner. The results are an agreeable aspect of the lip and physiological digestive and phonetic processes. The technique is safe and simple and the aesthetic functional result is very good. In our case, the postoperative complication is caused by an insufficient collaboration of the patient and it is solved in three weeks. [ABSTRACT FROM AUTHOR]

Hemifacial microsomia is a congenital malformation in which there is deficiency in the amount of hard and soft tissues on one side of the face. It is primarily a syndrome of first and second branchial arches involving underdevelopment of the temporomandibular joint, mandibular ramus, masticatory muscles, ears and occasionally defects in facial nerve and muscles. Here, we report three cases of hemifacial microsomia diagnosed based on clinical and radiographic findings. All three cases had variable presentations ranging from the mildest form that included facial asymmetry and ear deformity to the most severe and unusual form with facial nerve paralysis and spine deformity. [ABSTRACT FROM AUTHOR]

Bilateral and partial facial nerve paralysis in a bullock was diagnosed with clinical signs of ptosis of upper eyelids, ear droop ng and feed accumulation between cheeks and teeth. Ocular discharges were normal with moderate saliva drooling indicating non involvement of parasympathetic portion of facial nerve. Tongue movement was normal but prehension capacity was lost. The aetiology was attributed to chronic otitis media and extension of inflammation to facial nerve through eustachean tube. The case was successfully treated with Fluroquinolones, Flunixin and cortisones. It was concluded that partial bilateral paralysis of facial nerve due to otitis media could be treated successfully with corticosteroidal therapy. [ABSTRACT FROM AUTHOR]

Facial nerve palsy is a common cranial nerve disorder that affects facial mimic movements. Mostly, it is caused by idiopathic conditions, such as trauma or tumors located in parotid gland. Facial nerve palsy from dental infection is rare and only a few cases were reported up to date. The authors highlight the etiology of facial nerve paralysis and the effects of regional odontogenic infections on nerve damage. This article describes a case report of a 21-year-old female patient who represents unilateral facial nerve paralysis after endodontic therapy. The paralysis occurred in 2 days after endodontic treatment with a swelling at perimandibular and retromandibular regions. Her right mandibular first molar was extracted under antibiotic therapy and the swelling was disappeared. In her first follow-up session, she could move her lip slightly and facial nerve palsy decreased quite a lot. Physicians should be aware the effects of dental infections to facial nerve and should refer patients to a specialist for a proper management. [ABSTRACT FROM AUTHOR]

Tuberculosis is one of the oldest pathologies that affect human population, being a significant cause of morbidity/mortality in several countries. Middleear tuberculosis is a rare pathology, often misdiagnosed because of an atipic evolution, as a result leading to severe complications. This paper presents a case of tuberculous otitis media complicated with facial nerveparalysis House Brackmann type V in a patient who underwent multiple middleear surgeries before correct diagnosis was established. [ABSTRACT FROM AUTHOR]

Summary: Fungal mastoiditis caused by Aspergillus fumigatus predominantly occurs in immunocompromised patients. However, few cases were reported in the immunocompetent patients. These cases are usually challenging to cope with in terms of diagnosis and treatment. Facial nerve dysfunction is one of the accompanying complications of fungal mastoiditis. We present a case of facial paralysis due to fungal mastoiditis in a 5-year-old immunocompetent child. She had a history of prolonged use of broad spectrum antibiotics due to meningitis and ear surgery. [Copyright &y& Elsevier]

Due to various reasons, localized neural lesions following tonsillectomy are presumably an under-reported complication in the literature. This study was undertaken to compile our experiences including a literature review to disseminate useful insights in the etiology and prognosis of this rare entity. A retrospective chart review of expert reports written by at least one of the authors for malpractice claims in relation to tonsillectomy was undertaken. Additionally, a retrospective analysis of 648 patient documents that had undergone tonsillectomy in 2001 at our institution and a comprehensive literature review were performed. The research was restricted to the item “localized neural lesion”. Seven cases from the expert’s offices, one of our patients who had undergone tonsillectomy at our institution and 122 cases from the literature matched our search criteria. Including our own cases, the glossopharyngeal nerve was affected in 82 patients. Other lesions encompassed injury of the hypoglossal nerve as solitary (15) or combined (5) lesion, recurrent nerve paralysis with (2) or without additional nerve lesions (7), facial nerve paralysis (10) in combination with other nerve lesions (1), and a lingual nerve deficiency as solitary (4) or combined lesion (9). A single report existed for lesion of the phrenic nerve. There were five reported cases with blindness and nine cases with Horner’s syndrome. Albeit rare, localized neural lesions may occur as a troublesome complication following tonsillectomy and/or means to achieve hemostasis. Some of these cases may not result from the dissection itself but injection procedures. Surgical dissection should include careful mouth gag insertion and meticulous dissection to minimize the risk of localized neural complications. A long-term follow-up is recommended for patients with dysgeusia related to glossopharyngeal nerve injury and patients with recurrent nerve dysfunction. Other lesions are much less likely to resolve in the long-term. Localized neural lesions should adequately be included in the informed consent for tonsillectomy as well as for surgical treatment of post-tonsillectomy hemorrhage. [ABSTRACT FROM AUTHOR]

Abstract: Background: Delayed FNP due to HT is a rarely encountered clinical entity, and optimal treatment still remains to be elucidated. Methods: Twenty-five patients with delayed traumatic FNP without TBF, who had serviceable hearing, were included in our study. Thirteen patients underwent surgical decompression, whereas 12 were managed medically depending on the ENoG findings, which were obtained within the first 3 weeks after the onset of the facial paralysis. Pre- and postmanagement evaluation of the FN function was graded according to HB grading scale. Results: The mean follow-up period was 6.5 ± 4.06 years. Complete or nearly complete recovery of FN function had occurred in 66.6% and 76.9% in medically and surgically treated groups, respectively. Most of the patients showed good outcome, and the presented data supports that the choice of treatment in patients with hearing preserved delayed traumatic FNP without TBF depends mainly on the ENoG findings. Conclusions: Although timing of surgery in traumatic delayed FNP remains to be elucidated, we think that surgical exploration should be considered if serial ENoG demonstrates more than 90% nerve degeneration. [Copyright &y& Elsevier]

Abstract: Middle ear adenoma is a rare disease derived from the middle ear mucosa. It is usually lack specific findings and easily mistaken for other conditions, delaying a correct diagnosis. In particular, few cases with facial nerve paralysis have been reported. We describe a case of middle ear adenoma that caused hearing loss and recurrent facial paralysis in a 29-year-old woman. In an attempt to treat the facial nerve paralysis, we performed tympanomastoidectomy and facial nerve decompression. By pathological examination, we finally diagnosed it middle ear adenoma with neuroendocrine differentiation. Retrospectively, if we meet the antibiotic resistant mass in the middle ear, we should suspect the tumor. One year after surgery, the adenoma has not recurred but long-term observation is required. [Copyright &y& Elsevier]

Abstract: Background: A high rate of facial nerve paralysis (FNP) develops after parotid surgery, but there have been few clinical trials on treatments to improve recovery times. This study evaluated the efficacy of prednisolone in these patients. Methods: A total of 123 patients who underwent parotidectomy without injury to the facial nerve were assessed prospectively for postoperative FNP. These patients were assigned randomly to treatment with prednisolone or placebo for 10 days. FNP was evaluated by House-Brackmann grades. Recovery rates and adverse effects were monitored regularly for 6 months after surgery. Results: Of the 123 patients, 45 had postoperative FNP. All FNPs were grades II to IV, mostly on 1 or 2 facial areas. The incidence of FNP was increased significantly with malignant pathology, increased parotidectomy extent, and neck dissection (P < .01). Of 44 evaluable patients, 43 showed full recovery of FNP after 6 months, whereas 1 patient had permanent FNP. Recovery rates were equal in both groups, and there was no evidence of major adverse effects. Conclusions: Prednisolone was ineffective in early recovery from postparotidectomy FNP. [Copyright &y& Elsevier]

Objective: To compare the trends and specific outcomes of patients treated surgically for parotid neoplasms between 1994 and 2005 with those of patients who were treated between 1985 and 1993 at Mount Sinai Hospital in Toronto and to identify preoperative indicators of malignancy. Methods: A retrospective chart review was performed that included all patients who received treatment from 1994 to 2005 at Mount Sinai Hospital. The results of this review was compared with those of another group at the same institution. Results: The study included 242 patients. Of these patients, 183 (75.6%) had benign neoplasms. 51 (21.1%) had malignant neoplasms, and 8 (3.3%) had inflammatory or lymphatic lesions. The most common associated symptoms were swelling (17.4%) and pain (16.5%). Only 5.8% of patients presented with facial weakness; however, the likelihood of malignancy was high (64.3%). Total parotidectomy was reserved for 26.4% of patients; the majority (68.2%) received a subtotal parotidectomy. Common postoperative complications included temporary facial nerve palsy (23.6%), Frey syndrome (12.4%), and salivary fistula (5.0%). Analysis of the correlation between fine-needle aspiration and final cytology revealed that fine-needle aspiration sensitivity and specificity were 60.0% and 96.1%, respectively. Comparison of these results with the other study at our institution revealed no significant differences in patient predictors or outcomes. Conclusions: These results were compared with those of a previous study conducted at the same institution between 1985 and 1993. There was no significant deviation from former trends. The presenting symptoms of facial nerve weakness and lymphadenopathy were found to be strong indicators of malignant disease. Facial pain was found not to be a reliable prognostic feature for malignancy. [ABSTRACT FROM AUTHOR]

Facial nerve palsy following middle ear surgery is a terrible complication for every otology surgeon. Generally this happens due to identifiable causes like surgical trauma or local anaesthetic use. It is uncommon to see facial nerve palsy more than 72 hours following the surgery. In this study we report two cases of facial nerve paralysis appearing 11 and 5 days following a successful tympano-mastoid surgery and we performed a Viral screening for Herpes Virus type 1 for to confirm the viral aetiology of the Delayed Facial Paralysis. When an ipsilateral facial nerve palsy appears more than 72 hours after an uneventful middle ear procedure, without symptoms of any infection, a viral reactivation must be suspected. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Upper eyelid static weight loading is a technique commonly used to treat paralytic lagophthalmos. The traditional approach using the pretarsal crease incision leads to interruption of the anterior levator muscle fibers that attach to the face of the tarsus at its upper two thirds. This disruption can lead to permanent upper eyelid blepharoptosis. The retrograde approach avoids this problem but results in an incision at the lid margin, the dependent aspect of the weight. This increases the risk of implant extrusion. We hypothesize that a newly described modified retrograde approach is a safe and effective approach that avoids the pitfalls of previously described techniques. Study Design: Retrospective review. Methods: Eight patients were evaluated with preoperative and 3 to 6 month postoperative photographs with the eyes in the open and closed positions for the degree of lagophthalmos and blepharoptosis present. Patients were also evaluated for development of complications such as implant extrusion, pain, or infection. The surgical technique uses a supratarsal skin crease incision, supramuscular dissection to the lid margin, entry into the tarsal plane at its inferior-most aspect, creation of a pocket for implant insertion, and layered closure. Results: All patients had complete correction of lagophthalmos. No patients experienced infection, extrusion, or eye pain after surgery. All patients had less than 2-mm ptosis after surgery, with no patients experiencing any visual field disruption. Conclusions: The modified retrograde approach to upper eyelid static loading for paralytic lagophthalmos provides advantages over other techniques described. It is a safe, efficacious procedure, well tolerated by patients. [ABSTRACT FROM AUTHOR]

Of all the cranial nerves, the facial nerve is the one which is most commonly involved in disease. Facial paralysis leaves the patient severely disfigured. Timely diagnosis and treatment can lead to considerable recovery. 16 consecutive patients of facial paralysis of all age groups and due to different causes diagnosed and treated in a tertiary referral hospital have been studied retrospectively. The frequency of aetiological factors, the various factors governing the management of these cases and their actual outcomes after a minimum period of one year are discussed .The causes of facial nerve palsy included cholesteatomas, Bell's Palsy, iatrogenic, traumatic, neuroma and others. In general, earl), reporting, diagnosis and surgical intervention wherever indicated have resulted in better recovery. Surgical decompression of the facial nerve traditionally advocated have been questioned. Rare causes of facial nerve paralysis like postoperative BIPP pack allergy and bilateral congenital agenesis of facial nerve are also included. [ABSTRACT FROM AUTHOR]

Different results have been reported concerning the impact of agents used in the treatment of idiopathic facial nerve paralysis (FNP) generated by HSV type 1 (HSV-I) on the apoptotic process. We aimed at investigating the effects of different agents (steroids, acyclovir and interferon) used in the treatment of idiopathic FNP on the apoptotic process in animals in whom experimental FNP has been produced by HSV-I. After cleaning the auricles of 113 animals, linear injuries were produced, and then 25 micromole KOS HSV-I was inoculated with the solution containing 1.7 × 107 virus per milliliter. On the 6th day after the inoculation sixty animals (60/1 13, 53%) which developed facial paralysis were included in the study and were randomized into 4 groups consisted of 15 animals: steroid (SG), acyclovir (AG), interferon (IG) and control groups (CG). On the 21st day of the study (inoculation) and 15th day of the follow-up and treatment, the animals were decapitated. HSV-I DNA was assayed with PCR technique on the ipsilateral brain stems and temporal cortexes obtained from the animals. The animals that were HSV-I DNA positive were included in the study: CG group (5/15), SG (6/15), AG (4/15) and IG (4/15). To this end, flowcytometric analyses (apoptotic cell DNA index with propidium iodide stain and CD95 antibody stain) were evaluated in the ipsilateral brain stem and temporal cortex. The results demonstrated that the application of steroid to animals developing FNP resulted in significant suppression of CD95(+) CELLS ratios in the ipsilateral temporal cortex (P <0.05) acyclovir or interferon application on the other hand did not create any significant change in the apoptotic process of either of the brain regions (P > 0.05). Although the apoptotic cell DNA index in the control group was found at a higher ratio than in treatment groups, the ratio was not significant (P> 0.05). This study demonstrates that; (i) in FNP generated by HSV-I, not only the facial nerve but also other brain regions including the brain stem and the temporal cortex might be affected, and (ii) steroids might have a limited effect on the total apoptotic process and therefore they may have neuroprotective effects. [ABSTRACT FROM AUTHOR]

Summary: Congenital cholesteatoma of the middle ear is frequently seen in younger children including infant. By contrast, that of the petrous bone is rarely seen in younger children. We report an exceptional case occurring in 23-month-old infant who presented with unilateral facial nerve paralysis at about 18-month-old. Computed tomography and magnetic resonance imaging revealed congenital cholesteatoma measuring approximately 2cm in the area of the right geniculate ganglion. The mass was completely eradicated via the middle fossa approach, which allowed for preservation of hearing. The facial nerve maintained intact during surgery and paralysis showed partial recovery after the operation. To our knowledge, the present case seems to be the youngest case of congenital petrosal cholesteatoma reported, and also demonstrates congenital petrosal cholesteatoma could exhibit facial nerve paralysis in early childhood. [Copyright &y& Elsevier]

Summary: A conservative parotidectomy is defined as any procedure that is less than a classic superficial parotidectomy, and where less than a full facial nerve is dissected. The aim of this study was to evaluate the oncologic effects of a conservative parotidectomy in a series of patients with malignant tumors of the parotid gland. The medical records of 43 patients treated at Severance Hospital from 1992 to 2002 who had been diagnosed with parotid cancers confined to the superficial lobe, and had also undergone conservative parotidectomies were reviewed. There were 16 males and 27 females, ranging in age from 8 to 84 years. Sixteen tumors (37%) were high-grade and 27 tumors (63%) were low-grade cancers. Twenty-four patients underwent neck dissection simultaneously with the primary lesion. Surgical treatment was followed by radiotherapy in 10 patients. The follow-up period ranged from 8 to 130 months, with a mean duration of time at 57.7 months. The overall survival rate and the disease-free rate at five years were 88% and 79%, respectively. Univariate analyses showed histologic tumor grade (p =0.003) and pathologic neck node metastasis (p <0.001) to be significant variables. Based on multivariate analysis, only the presence of pathologically positive lymph nodes proved to be significant (p =0.001). Occult metastases rates was 25% (3 of 12 cases) for high-grade tumors and none of the low-grade tumors had microscopic metastases. Recurrences developed in eight cases (19%). Four cases (9%) had a local or locoregional failure. Of these cases, two cases were high-grade tumors (13%, 2 of 16) and the other two cases were low-grade tumors (7%, 2 of 27). The six cases (14%) of which four cases were high-grade (25%) and two cases were low-grade (7%) had positive surgical margin but showed no evidence of local recurrence after additional postoperative radiotherapy. The incidence of postoperative facial nerve paralysis (HB>1) was 12% (5 outof 43) for a temporary deficit, but there was no permanent paralysis. Conservative parotidectomy with appropriate postoperative radiotherapy may be an acceptable procedure without potential morbidity, such as postoperative facial palsy, in the treatment of low-grade parotid cancers confined to the superficial lobe if the facial nerve is sufficiently distant from the tumor. [Copyright &y& Elsevier]

Summary: Objective:: To characterize the causes and treatment of facial nerve paresis (FNP) in pediatric patients. Method:: Retrospective study in a tertiary care pediatric hospital. Thirty-four patients identified with partial or complete FNP evaluated between 1997 and 2003. A review of the medical records including sex, age, laterality, etiology, therapy, severity of paralysis according to House–Brackman (HB) six-point grading scale, duration, and degree of recovery. Results:: Thirty-five cases of FNP. Causes of FNP were infectious (13), traumatic (7), iatrogenic (5), congenital (4), Bell''s/Idiopathic (3), relapsing (2) and neoplastic (1). Peak age distributions for both infectious and traumatic etiologies were bimodal: 1–3 and 8–12 years. Of the 13 infectious cases, 11 were associated with acute otitis media with effusion (AOME). Four (4/11) were bacterial-culture negative. Seven (7/11) were bacterial-culture positive, four (4/7) of which required prolonged, broth-medium culture. Bacteria cultured predominantly included Staphylococcus non-aureus species (5/7) and Propionobacterium acnes (3/7). One (1/13) was viral culture positive (Herpes Simplex Virus). All six patients who received intravenous steroids for OME-associated FNP received the doses within the first week of presentation and had complete recovery (HB I/VI); three of five patients who did not receive steroids had complete recovery. There were five iatrogenic cases; two (2/5) were planned surgical sacrifices and three (3/5) were complications of middle ear/mastoid surgery. Facial nerve function associated with infection returned in 0.5–2 months while, when associated with trauma, returned in 0.25–30 months. Conclusions:: In infectious or traumatic FNP, children aged 1–3 and 8–12 years are the primary groups involved. In AOME FNP, culture-identified organisms may not be representative of traditional pathogens. Infectious FNP averaged 1 month for recovery while traumatic FNP averaged 9 months. Intravenous steroid therapy may improve the outcome. Recovery was complete (HB I/VI) in 8/10 infectious and 4/6 traumatic cases. [Copyright &y& Elsevier]

Lichen planus (LP) is a T-cell-mediated disorder that may involve the skin, nails and mucosal surfaces. Conjunctival, laryngeal and oesophageal involvement were reported to be extremely rare manifestations of the disease. In this report, we present an oral LP case who complained of severe burning pain on his tongue and oral mucosa caused by ulcerative lesions and associated with conjunctival, laryngeal and oesophageal involvement. In addition, neurological examination revealed facial and abducens nerve palsy. To the best of our knowledge, we are presenting the first case of erosive oral LP associated with facial and abducens nerve paralysis. Although this association may be coincidental, according to an immunological concept proposed to explain the pathogenesis of Bell's palsy, degranulation of mast cells activated by complement or specific allergens with the release of histamine and other substances were to be presented responsible from nerve oedema, ischaemia and paralysis. As mast cell mediators are likely to be involved in the immunopathogenesis of OLP, we think that the cause of facial and bilateral abducens nerve palsy could be explained by the same mechanism. This case is a good example of the need for team work in lichen planus patients undergoing interdisciplinary consultations. [ABSTRACT FROM AUTHOR]