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Objectives: This study aimed to report the complication rate associated with open reduction and internal fixation (ORIF) of mandibular condyle fractures in Oman. Methods: This retrospective cohort study was conducted among patients who underwent ORIF of mandibular condyle fractures at Al-Nahdha Hospital and the Sultan Qaboos University Hospital in Muscat, Oman, from January 2008 to December 2020. Data collected included patient demographics, fracture aetiology, fracture side and type, surgical approach and recorded complications and outcomes. Results: A total of 68 patients (59 males and 9 females; mean age of 30.1 years) with 83 mandibular condyle fractures underwent ORIF during the study period. Subcondylar fractures were the most common type, occurring in 62.7% of patients, while bilateral fractures were observed in 21 (30.8%) patients. The most common surgical approach was retromandibular, used in 42.2% of patients. The overall complication rate was 42.6%, with the most frequently reported complications being transient facial nerve palsy (18.1%), malocclusion (14.7%) and restricted mouth opening (10.3%). Subsequent surgical interventions to correct malocclusion were performed in 6 cases. There was no statistically significant association between the overall complication rate and the patients' clinical characteristics. Conclusion: Although ORIF of mandibular condyle fractures generally offers favourable outcomes, it carries a risk of complications. [ABSTRACT FROM AUTHOR]

Because facial nerve injuries affect the quality of life, leaving them untreated can have devastating effects. The number of patients with traumatic and iatrogenic facial nerve paralysis is considerably high. Early detection and prompt treatment during the acute injury phase are crucial, and immediate surgical treatment should be considered when complete facial nerve injury is suspected. Symptom underestimation by patients and clinical misdiagnosis may delay surgical intervention, which may negatively affect outcomes and in some cases, impair the recovery of the injured facial nerve. Here, we report two cases of facial nerve injury that were treated with nerve grafts during the subacute phase. In both cases, subacute facial nerve grafting achieved significant improvements. These cases highlight surgical intervention in the subacute phase using nerve grafts as an appropriate treatment for facial nerve injuries. [ABSTRACT FROM AUTHOR]

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. 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. 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). 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. [ABSTRACT FROM AUTHOR]

BACKGROUND: Facial nerve dysfunction can be a devastating trouble for post-parotidectomy patients. OBJECTIVE: To assess rehabilitation outcomes concerning patients with post-parotidectomy facial nerve dysfunction, comparing benign versus malignant neoplasms. METHODS: Prospective study enrolling adults who underwent parotidectomy with facial nerve sparing between 2016 and 2020. The Modified Sunnybrook System (mS-FGS) was used for facial assessments. Physiotherapy began on the first post-operative day with a tailored program of facial exercises based on Neuromuscular Retraining, to be performed at home 3 times/day. From the first outpatient consultation, Proprioceptive Neuromuscular Facilitation was added to the treatment of cases with moderate or severe facial dysfunctions. RESULTS: Benign and malignant groups had a statistically significant improvement in mS-FGS (p < 0.001 and p = 0.005, respectively). There was no significant difference between groups regarding treatment duration or number of physiotherapy sessions performed. The history of previous parotidectomy resulted in more severe initial dysfunctions and worse outcome. Age over 60 years and initially more severe dysfunctions impacted the outcome. CONCLUSION: Patients with benign and malignant parotid neoplasms had significant and equivalent improvement in postoperative facial dysfunction following an early tailored physiotherapy program, with no significant difference in the final facial score, treatment duration, or number of sessions required. [ABSTRACT FROM AUTHOR]

The facial nerve stimulates the muscles of facial expression and the parasympathetic nerves of the face. Consequently, facial nerve paralysis can lead to facial asymmetry, deformation, and functional impairment. Facial nerve palsy is most commonly idiopathic, as with Bell palsy, but it can also result from a tumor or trauma. In this article, we discuss traumatic facial nerve injury. To identify the cause of the injury, it is important to first determine its location. The location and extent of the damage inform the treatment method, with options including primary repair, nerve graft, cross-face nerve graft, nerve crossover, and muscle transfer. Intracranial proximal facial nerve injuries present a challenge to surgical approaches due to the complexity of the temporal bone. Surgical intervention in these cases requires a collaborative approach between neurosurgery and otolaryngology, and nerve repair or grafting is difficult. This article describes the treatment of peripheral facial nerve injury. Primary repair generally offers the best prognosis. If primary repair is not feasible within 6 months of injury, nerve grafting should be attempted, and if more than 12 months have elapsed, functional muscle transfer should be performed. If the affected nerve cannot be utilized at that time, the contralateral facial nerve, ipsilateral masseter nerve, or hypoglossal nerve can serve as the donor nerve. Other accompanying symptoms, such as lagophthalmos or midface ptosis, must also be considered for the successful treatment of facial nerve injury [ABSTRACT FROM AUTHOR]

Background: Facial nerve dysfunction is the principal postoperative complication related to parotidectomy.

Background: The soft tissue dissection for the middle fossa approach requires adequate management of the neuro, vascular, and muscular structures in order to maximize exposure and diminish morbidities. Methods: An incision anterior to the tragus is performed, extending from the zygomatic process to the superior temporal line. The superior temporal artery is exposed, followed by a subfascial dissection of the frontalis nerve. The temporal muscle is dissected and released from the zygoma. All cranial landmarks are exposed for the 5 × 5 cm temporal fossa craniotomy. Conclusion: This novel approach provides a safe and adequate access to perform an extended middle fossa craniotomy. [ABSTRACT FROM AUTHOR]

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ObjectivesFacial paralysis is a debilitating condition with substantial functional and psychological consequences. This feline-model study evaluates whether facial muscles can be selectively activated in acute and chronic implantation of 16-channel multichannel cuff electrodes (MCE).MethodsTwo cats underwent acute terminal MCE implantation experiments, 2 underwent chronic MCE implantation in uninjured facial nerves (FN) and tested for 6 months, and 2 underwent chronic MCE implantation experiments after FN transection injury and tested for 3 months. The MCE were wrapped around the main trunk of the skeletonized FN, and data collection consisted of EMG thresholds, amplitudes, and selectivity of muscle activation.ResultsIn acute experimentation, activation of specific channels (ie, channels 1-3 and 6-8) resulted in selective activation of orbicularis oculi, whereas activation of other channels (ie, channels 4, 5, or 8) led to selective activation of levator auris longus with higher EMG amplitudes. MCE implantation yielded stable and selective facial muscle activation EMG thresholds and amplitudes up to a 5-month period. Modest selective muscle activation was furthermore obtained after a complete transection-reapproximating nerve injury after a 3-month recovery period and implantation reoperation. Chronic implantation of MCE did not lead to fibrosis on histology. Field steering was achieved to activate distinct facial muscles by sending simultaneous subthreshold currents to multiple channels, thus theoretically protecting against nerve damage from chronic electrical stimulation.ConclusionOur proof-of-concept results show the ability of an MCE, supplemented with field steering, to provide a degree of selective facial muscle stimulation in a feline model, even following nerve regeneration after FN injury.Level of evidenceN/A.

Objectives: Needle electromyography (EMG) may be used to characterise the severity of the injury in acute peripheral facial nerve palsy (FNP) to predict recovery and guide management, but its prognostic value and clinical utility remain controversial. The aim of this systematic review was to evaluate the role of EMG to prognosticate the recovery of facial motor function in patients with acute peripheral FNP. Design: A comprehensive search strategy was applied in PubMed, Embase, and Web of Science based on Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. The main outcome measure was the accuracy of EMG in predicting long‐term facial function at least 6 months following symptom onset. Results: Eleven studies were included comprising 3837 participants, with 91.6% of these diagnosed with Bell's palsy (BP). In BP patients, the positive predictive value and negative predictive value for a good outcome based on EMG findings ranged from 82.1% to 100% and 66.7% to 80.5%, respectively, with two out of three studies finding that EMG remained a significant predictor of the outcome on multivariate analysis. Three studies addressed the role of EMG in non‐idiopathic FNP with two of these studies supporting EMG to predict prognosis. Conclusions: EMG is a useful tool to gain insight into the likely outcome to guide management decisions and counsel patients on their expectations, particularly in BP. However, given inconsistencies in its application and lack of evidence around non‐idiopathic FNP, it should not currently be relied on to predict recovery. Ultimately, its prognostic value and widespread adoption are dependent on the implementation of a clear and standardised protocol in future high‐quality studies and routine clinical settings. [ABSTRACT FROM AUTHOR]

Despite improvements in the imaging modalities, the optimal protocol for extracranial facial nerve imaging using 1.5 T MRI is still debatable. Pre-operative mapping of the facial nerve could provide valuable information for surgeons. The current study aimed to evaluate and choose proper 1.5 T MRI protocols for the extracranial segment of facial nerve pre-op imaging. Extracranial facial nerves on the tumoral and normal side of 19 patients (38 nerves) were imaged by 1.5 T MRI, using five sequences including T1-weighted, T2-weighted, T1-weighted-fat-saturated with contrast, Three-dimensional (3D) T1-weighted and 3D T2-weighted. The visibility of each of the three segments of the extracranial facial nerve (the main trunk, cervicofacial and temporofacial divisions and terminal branches) in each sequence was assessed. On the normal side, segments 1 and 2 of the nerve were identifiable in all patients and segment 3 was identifiable in 89.5% of patients in both 3D T1-weighted and 3D T2-weighted sequences. On the tumoral side, segments 1, 2 and 3 were identifiable in 89.5, 84.2 and 68.4% of patients, respectively, in 3D T1-weighted and T2-weighted sequences. 3D sequences showed significant improvement in visualizing extracranial facial nerve and its branches compared to routine T1-weighted and T2-weighted sequences. Our protocol showed favourable results in visualizing the extracranial facial nerve and its branches. We believe the protocol used in this study could be used as a pre-operative facial nerve mapping method using 1.5 T MRI. [ABSTRACT FROM AUTHOR]

The aims of this study were (1) to evaluate the transparotid facial nerve dissection approach (TFND), in which the intraparotid cervicofacial or temporofacial division is identified first through a superficial lobe incision; and (2) to compare extracapsular dissection with a TFND (ECD-TFND) with partial superficial parotidectomy with a retrograde approach (PSP) for benign tumours in the tail of the parotid gland with respect to surgical outcomes. Eighty-nine patients underwent PSP or ECD-TFND for benign tumours in the tail of the parotid gland: 49 were treated surgically with PSP and 40 with ECD-TFND. The mean (± standard deviation) surgical time did not differ significantly between the groups: 64 ± 22.4 min for PSP and 59 ± 19.8 min for ECD-TFND (P = 0.302). There was a significant difference in sialocele: 18 (36.7%) patients in the PSP group and four (10%) in the ECD-TFND group (P = 0.002). There was also a significant difference in facial nerve injuries: temporary paralysis was observed in 13 (26.5%) patients in the PSP group and two (5%) in the ECD-TFND group (P = 0.007). It appears that TFND is a viable and safe approach when performing ECD for benign tumours in the tail of the parotid gland. ECD-TFND should be preferred over PSP for benign tumours in the tail of the parotid gland. [ABSTRACT FROM AUTHOR]

Background/Aim. The injuries of the facial nerve lead to paralysis of the mimic musculature, which is conditioned by functional disorders accompanied by deformity of varying degrees depending on the intensity and location of the injury. Surgical treatment is a method of choice to treat an injured nerve. Injuries in the parotid lodge area are repaired by direct neurosuture in combination with platelet-rich plasma (PRP). Methods. The experimental study was carried out on 48 chinchilla male rabbits (Oryctolagus cuniculus), of about the same weight (2,500–3,000 gr), aged between 3 and 4 months in two surgical stages, in two different periods – six and ten weeks after the first surgical procedure. The animals were divided into four groups: Group I (suture); Group II [suture and fibrin glue (FG)]; Group III (suture and PRP); Group IV (sutures, FG, and PRP). Each group had two subgroups based on the duration of the experiment (six and ten weeks). A part of the dissected nerve in the length of 5 mm was subjected to histologic verification, where the number of axons and Schwann cells was determined and expressed numerically based on the histological sample of the tissue of the observed nerve. The extent of the presence of connective tissue and the degree of neo-vascularisation is shown by the description of histological samples by grades (connective tissue 1-4, neovascularisation 1-3). Results. Our results showed that all parameters of re-generation of damaged nerve showed a significantly higher regeneration efficiency after six and ten weeks of intervention in groups treated with PRP therapy with or without using FG. Conclusion. The use of PRP and the stimulating effect of activated growth factors results in the regeneration of the facial nerve in the sense of replication of the Schwann cells and the number of axons, with a high degree of neovascularization and minimal proliferation of connective tissue, which histologically corresponds to a healthy nerve.

Over the last two decades the senior author has exclusively applied the technique of extracapsular dissection (ECD) and extended ECD to treat discrete, apparently benign parotid tumours. This article describes both techniques and evaluates their application. Simple principles are described to anticipate unexpected malignant tumours and manage lumps safely by wide excision. A retrospective analysis of 97 consecutive patients with discrete, apparently benign parotid lumps is presented. The tumours were classified using the European Salivary Gland Society (ESGS) classification for benign tumours of the parotid gland. The ECD or extended ECD technique was employed irrespective of tumour site or size. A review of patients was carried out after a minimum of six months post surgery by two independent clinicians. The mean (range) hospital stay was one (0-4) night (median 1). Complications were both modest and transient. The temporary facial nerve injury rate was 5/97 (6%). Other complications included haematoma (n=2), sialocele (n=2), and first-bite syndrome (n=2). Independent review post surgery demonstrated a mean Sunnybrook facial grading system score of 98/100 and a mean Stony Brook scar assessment score of 4.5/5. In this series 5/97 (5%) of discreet mobile lumps concealed a low-grade salivary cancer. Experience with the application of ECD in conjunction with its extended form in 97 consecutive patients with discrete parotid lumps is described. The technique is amenable to all parotid lumps, is not restricted by site or size, and has shown minimal morbidity. The risk of recurrent disease could not be addressed. [ABSTRACT FROM AUTHOR]

Objective To investigate the risk factors of vestibular schwannoma without facial nerve functional preservation. Methods Total 95 patients with vestibular schwannoma who underwent surgery via the sigmoid sinus approach bewteen December 2018 to January 2020 were included. Tumor diameter and classification, tumor volume and surface area, tumor property were recorded according to MRI. The course of facial nerve, adhesion degree between tumor and facial nerve, extent of tumor resection and facial nerve anatomic preservation were recorded according to intraoperative observation. Facial nerve function after 8 d was evaluated. Univariate and multivariate Logistic regression analyses were performed to analyze risk factors associated without facial nerve functional preservation. Results Of the 95 patients, 80 patients (84.21%) underwent gross total resection, among which 3 patients had no anatomical preservation of facial nerve. 15 patients (15.79%) underwent near total resection, including 14 cases with thin layer of tumor remaining on the facial nerve, and one case with thin layer of tumor remaining on the brainstem and no anatomical preservation of facial nerve. Logistic regression analysis showed that severe adhesion between tumor and facial nerve was risk factor for functional impairment of facial nerve (OR = 22.349, 95%CI: 1.895-263.599; P = 0.014). Conclusions For severe adhesion, the operation should be more careful. If the tumor might not be completely removed under the premise of preserving the facial nerve function, a small amount of tumor could be left on the facial nerve.

BackgroundOur group has previously shown that activation of specific facial nerve (FN) fiber populations and selective activation of facial musculature can be achieved through acute intraneural multichannel microelectrode array (MEA) implantation in the feline model.HypothesisSelective stimulation of facial muscles will be maintained in the setting of 1) chronic and 2) acute MEA implantation after FN injury and subsequent recovery.MethodsThis study included seven cats. In three cats with normal facial function, 4-channel penetrating MEAs were implanted chronically in the FN and tested biweekly for 6 months. Electrical current pulses were delivered to each channel individually, and elicited electromyographic (EMG) voltage outputs were recorded for each of several facial muscles. For FN injury experiments, two cats received a standardized hemostat-crush injury, and two cats received a transection-reapproximation injury to the FN main trunk. These four underwent acute implantation of MEA and EMG recording in terminal experiments 4 months postinjury.ResultsStimulation through individual channels selectively activated restricted nerve populations, resulting in activation of individual muscles in cats with chronic MEA implantation and after nerve injury. Increasing stimulation current levels resulted in increasing EMG voltage responses in all patients. Nerve histology showed only minor neural tissue reaction to the implant.ConclusionWe have established in the animal model the ability of a chronically implanted MEA to selectively stimulate restricted FN fiber populations and elicit activations in specific facial muscles. Likewise, after FN injury, selective stimulation of restricted FN fiber populations and subsequent activation of discrete facial muscles can be achieved after acute MEA implantation.

Pituitary adenylate cyclase-activating polypeptide (PACAP, gene name Adcyap1) regulates a wide variety of neurological and physiological functions, including metabolism and cognition, and plays roles in of multiple forms of stress. Because of its preferential expression in nerve fibers, it has often been difficult to trace and identify the endogenous sources of the peptide in specific populations of neurons. Here, we introduce a transgenic mouse line that harbors in its genome a bacterial artificial chromosome containing an enhanced green fluorescent protein (EGFP) expression cassette inserted upstream of the PACAP ATG translation initiation codon. Analysis of expression in brain sections of these mice using a GFP antibody reveals EGFP expression in distinct neuronal perikarya and dendritic arbors in several major brain regions previously reported to express PACAP from using a variety of approaches, including radioimmunoassay, in situ hybridization, and immunohistochemistry with and without colchicine. EGFP expression in neuronal perikarya was modulated in a manner similar to PACAP gene expression in motor neurons after peripheral axotomy in the ipsilateral facial motor nucleus in the brainstem, providing an example in which the transgene undergoes proper regulation in vivo. These mice and the high-resolution map obtained are expected to be useful in understanding the anatomical patterns of PACAP expression and its plasticity in the mouse. J. Comp. Neurol. 524:3827-3848, 2016. © 2016 Wiley Periodicals, Inc.

The relationships between parotid tumours and the facial nerve determine duration of surgical procedure and risks involved. As the division of the facial nerve is not visible using standard imaging techniques, other anatomical landmarks are used to determine the pre-operative location of tumours. This retrospective study aimed to evaluate reliability of the 'external jugular vein axis' compared with other landmarks generally used in imaging, such as the retromandibular vein, Conn's arc, the facial nerve line and the Utrecht line. Forty-eight pre-operative imaging exams of patients who underwent parotid benign tumour surgery between 2010 and 2016 were examined. We determined the location of tumour using the five markers. A pre-operative simulation was compared with the description given by the surgeon intraoperatively, in terms of sensitivity and specificity for each marker. External jugular vein axis and retromandibular vein are the most sensitive markers for locating suprafacial tumours (Se = 1). External jugular vein axis and Conn's arc are the most specific markers for locating suprafacial tumours (Spe = 0.92). External jugular vein axis is reproducible and present on all radiological sections, thereby overcoming any anatomical and nomenclature variations. This landmark appears to be the most representative marker of the dividing branches of the facial nerve. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate functional results of facial nerve repair by direct nerve suture or grafting, compare results between a traumatic and a tumoral group and identify prognostic factors. Methods: A retrospective monocentric cohort study was studied in a university ENT department. Thirty-one patients who benefited from facial nerve suture or grafting, with at least 12 months postoperative follow-up were included. Patients were divided into two groups according to the lesion type: traumatic (accident of the public road or iatrogenic) and tumoral. Preoperative data studied were sex, side, etiology documented by CT and/or MRI, facial palsy duration and grade according to House Brackmann grading system. Intraoperative data included: surgeon, age of patient, surgical technique, graft type, use of biological glue, facial nerve derivation, lesioned site. Postoperative data included: histological diagnosis, radiotherapy history, time to onset of the first signs of reinnervation, follow-up duration, and final facial function. Results: Success rate, including grade III and IV, was 68% in the whole cohort, 79% in the traumatic group and 59% in the tumoral group. Patients presenting with facial palsy evolving less than 6 months had better recovery results than those evolving longer than 6 months (p = 0.02). No other prognostic factors were identified. Conclusions: The best outcome that can be achieved by suture or grafting of the facial nerve in traumatic or tumoral lesions is a grade III. Preoperative facial palsy duration is a prognostic factor and must be considered when establishing an operative indication. [ABSTRACT FROM AUTHOR]

Background: For a successful facial surgery, it is vital to have a good knowledge of the distribution of the facial nerve in the face. The aim of this study was to highlight the pattern in the branching of the end part of the facial nerve in adults and fetuses and to look for any anastomoses between them. The branching pattern in the two groups is compared for any significant association. Methodology: Cross sectional study done in cadavers and stillborn fetuses. Subjects and Methods: Done in 100 facial halves. Statistical Analysis Used: Chi square test is used to look for any significant association between the branching pattern and gender & side of the face. Results: The branching pattern was classified into six types as per Davis et al. classification in the two study groups – adults and fetuses. The frequencies of occurrence in the first group were Type I – 1%, Type II – 7%, Type III – 18%, Type IV – 17%, Type V – 4%, and Type VI – 3% and in the second group were Type I – 1%, Type II – 8%, Type III – 20%, Type IV – 15%, Type V – 5%, and Type VI – 1%. No significant association was found in the branching pattern with respect to gender and side of the face in the two groups of study. Conclusions: There are multiple anastomotic communications among the end branches of the facial nerve. More the anatomical knowledge of these communications, lesser will be any unwanted facial nerve injury.

Facial nerve trauma often leads to disfiguring facial muscle paralysis. Despite several promising advancements, facial nerve repair procedures often do not lead to complete functional recovery. Development of novel repair strategies requires testing in relevant preclinical models that replicate key clinical features. Several studies have reported that fusogens, such as polyethylene glycol (PEG), can improve functional recovery by enabling immediate reconnection of injured axons; however, these findings have yet to be demonstrated in a large animal model. We first describe a porcine model of facial nerve injury and repair, including the relevant anatomy, surgical approach, and naive nerve morphometry. Next, we report positive findings from a proof-of-concept experiment testing whether a neurorrhaphy performed in conjunction with a PEG solution maintained electrophysiological nerve conduction at an acute time point in a large animal model. The buccal branch of the facial nerve was transected and then immediately repaired by direct anastomosis and PEG application. Immediate electrical conduction was recorded in the PEG-fused nerves (n = 9/9), whereas no signal was obtained in a control cohort lacking calcium chelating agent in one step (n = 0/3) and in the no PEG control group (n = 0/5). Nerve histology revealed putative-fused axons across the repair site, whereas no positive signal was observed in the controls. Rapid electrophysiological recovery following nerve fusion in a highly translatable porcine model of nerve injury supports previous studies suggesting neurorrhaphy supplemented with PEG may be a promising strategy for severe nerve injury. While acute PEG-mediated axon conduction is promising, additional work is necessary to determine if physical axon fusion occurs and the longer-term fate of distal axon segments as related to functional recovery.

BACKGROUND: Facial nerve monitoring system has enabled facial muscle activity detection using electrodes placed over the target muscles. In an effort to enable the best and minimally invasive surgical approach, a midline facial nerve monitor was applied during bilateral cochlear implantation surgical intervention in our center and the feasibility of placing midline facial nerve monitor electrodes during bilateral cochlear implantation operations was evaluated. METHODS: The medical records and operative notes of all patients who underwent bilateral cochlear implantation surgery between January 2017 and April 2018 in a quaternary care center were retrospectively reviewed and divided into 2 groups based on the facial nerve monitoring methods: facial nerve monitoring with the midline (midline facial nerve monitor) or bilateral (bilateral facial nerve monitor) electrode placements. Basic demographic information, comorbidities, and facial nerve status (pre- and postoperatively) were collected from patient electronic medical charts. The operative notes were reviewed for abnormal facial nerve findings, as well as for any reported difficulties with the identification or stimulation of facial nerve. The primary outcome was facial nerve identification postoperative function. RESULTS: Seventy-eight patients met our inclusion criteria. Midline facial nerve monitor was used in 49 patients and bilateral facial nerve monitor was used in 29 patients. No documented difficulty was identified at the step of facial nerve identification in either group, and none of the patients developed facial nerve weakness postoperatively. CONCLUSION: Midline facial nerve monitor is a safe and reliable method that can be used in bilateral cochlear implantation surgeries and other surgeries requiring facial nerve monitoring. [ABSTRACT FROM AUTHOR]

Abstract Background The reported incidence of facial weakness immediately after parotid tumor surgery ranges from 14 to 65%. The purpose of this study was to evaluate the incidence of postoperative facial weakness related to parotidectomy with use of preoperative computed tomography (CT), intraoperative facial nerve monitoring, and surgical magnification. Also, we sought to elucidate additional information about risk factors for postoperative facial weakness in parotid tumor surgery, particularly focusing on the tumor subsites. Methods We retrospectively reviewed 794 cases with parotidectomy for benign and malignant tumors arising from the parotid gland (2009–2016). Patients with pretreatment facial palsy were excluded from the analyses. Tumor subsites were stratified based on their anatomical relations to the facial nerve as superficial, deep, or both. Multivariable logistic regression analyses were conducted to identify risk factors for postoperative facial weakness. Results The overall incidences of temporary and permanent (more than 6 months) facial weakness were 9.2 and 5.2% in our series utilizing preoperative CT, intraoperative facial nerve monitoring, and surgical magnification. Multivariable analysis revealed that old age, malignancy, and recurrent tumors (revision surgery) were common independent risk factors for both temporary and permanent postoperative facial weakness. In addition, tumor subsite (tumors involving superficial and deep lobe) was associated with postoperative facial weakness, but not tumor size. Extent of surgery was strongly correlated with tumor pathology (malignant tumors) and tumor subsite (tumors involving deep lobe). Conclusion Aside from risk factors for facial weakness in parotid tumor surgery such as old age, malignant, or recurrent tumors, the location of tumors was found to be related to postoperative facial weakness. This study result may provide background data in a future prospective study and up-to-date information for patient counseling.

Background  Facial nerve palsy is one of the most frequent complications after resection of vestibular schwannomas (VS). Several mechanisms have been implicated in the poor postoperative facial nerve outcome. Adherence between the facial nerve and tumor capsule is one of the most relevant factors. There is no clear preoperative parameter permitting identification of these adhesions. Objective  The aim of this study was to identify the correlation between the grade of adherence of the facial nerve to the tumor capsule and its functional outcome after VS resection. Methods  A total of 26 patients with sporadic VS (tumor sized T3, T4A, and T4B according to Hannover classification) were evaluated. Grade of adherence of the facial nerve to the tumor capsule was checked during surgery and graduated according to a proposed scale into 1 to 3 different grades. Facial nerve function was assessed postoperatively and after 1-year follow-up. Size of tumor according to Hannover classification, presence of cystic components, "cerebrospinal fluid (CSF) cleft sign," and the contour of tumor capsule were tested as radiological predictors of grade of adherence to the facial nerve. Results and Conclusion  Only Grade 2 (11 cases) and 3 (15 cases) of adherence were seen in large VS. Lower grade of adherence was associated with good facial nerve outcome after 1-year follow-up (p  = 0.029). Presence of the "CSF cleft sign" and regular contour of tumor capsule were independent predictors of adherence. When both factors were associated, sensitivity and specificity of this method were 83 and 80%, respectively. [ABSTRACT FROM AUTHOR]

Motoneuron death after transection of the axons (axotomy) in neonates is believed to share the same mechanistic bases as naturally occurring programmed cell death during development. The c-Jun N-terminal kinase pathway is activated in both forms of motoneuron death, but it remains unknown to what extent these two forms of motoneuron death depend on this pathway and which upstream kinases are involved. We found that numbers of facial motoneurons are doubled in neonatal mice deficient in either ZPK/DLK (zipper protein kinase, also known as dual leucine zipper kinase), a mitogen-activated protein kinase kinase kinase, or in MKK4/MAP2K4, a mitogen-activated protein kinase kinase directly downstream of ZPK/DLK, and that the facial motoneurons in those mutant mice are completely resistant to axotomy-induced death. Conditional deletion of MKK4/MAP2K4 in neurons further suggested that ZPK/DLK and MKK4/MAP2K4-dependent mechanisms underlying axotomy-induced death are motoneuron autonomous. Nevertheless, quantitative analysis of facial motoneurons during embryogenesis revealed that both ZPK/DLK and MKK4/MAP2K4-dependent and -independent mechanisms contribute to developmental elimination of excess motoneurons. In contrast to MKK4/MAP2K4, mice lacking MKK7/MAP2K7, another mitogen-activated protein kinase kinase directly downstream of ZPK/DLK, conditionally in neurons did not have excess facial motoneurons. However, some MKK7/MAP2K7-deficient facial motoneurons were resistant to axotomy-induced death, indicating a synergistic effect of MKK7/MAP2K7 on axotomy-induced death of these facial motoneurons. Together, our study provides compelling evidence for the pivotal roles of the ZPK/DLK and MKK4/MAP2K4-dependent mechanism in axotomy-induced motoneuron death in neonates and also demonstrates that axotomy-induced motoneuron death is not identical to developmental motoneuron death with respect to the involvement of ZPK/DLK, MKK4/MAP2K4 and MKK7/MAP2K7.

As tympanotomy using the transcanal approach was a routine surgical technique for traumatic ossicular disruption, the efficacy of the posterior tympanum approach was rarely explored. This study aimed to investigate whether the hearing outcomes improved after simultaneous ossiculoplasty and facial nerve decompression using the posterior tympanum approach compared with the transcanal approach. The data of 11 patients who underwent ossiculoplasty and facial nerve decompression using the posterior tympanum approach and 21 patients who underwent ossiculoplasty via transcannal approach were analyzed. The average air–bone gap (ABG) of patients undergoing posterior tympanotomy showed a statistically significant improvement. Postoperative ABG within 20 dB was observed in 81.8% of patients in the posterior tympanum group and 76.2% of patients in the transcanal group. However, the ABG closure in the two groups was not statistically different. Simultaneous ossiculoplasty using the posterior tympanum approach was practical, and the hearing outcomes were promising for the patients with traumatic facial nerve paralysis and ossicular disruption. [ABSTRACT FROM AUTHOR]

Objective: To investigate the regulatory effect of miR-132-3p on calmodulin-binding transcription activator 1 (CAMTA1) and Schwann cell activity in rats with facial nerve injury (FNI) treated with I-125 seeds., Methods: Rat Schwann cells were irradiated with I-125 seeds and transfected with miR-132-3p mimic, miR-132-3p inhibitor or sh-CAMTA1. The expressions of S100B and β-tubulin Ⅲ in the cells were detected with immunofluorescence assay, and the expressions of miR-132-3p and CAMTA1 protein were determined using RT-qPCR and Western blotting, respectively. EdU staining and Transwell assay were used to evaluate the changes in cell proliferation and migration ability. In a rat model of FNI, I-125 seeds were implanted into the facial tissues near the facial nerve 2 weeks before modeling, and miR-132-3p mimic was injected subcutaneously in the face after modeling. The pathologies of the facial nerve was assessed by HE, LFB and immunofluorescence staining. The targeting relationship between miR-132-3p and CAMTA1 was verified using StarBase v2.0 database and dual-luciferase reporter assay., Results: Rat Schwann cells showed high expressions of S100B and β-tubulin Ⅲ. I-125 seeds radiation significantly decreased miR-132-3p expression and repressed proliferation and migration of the cells ( P < 0.001). Overexpression of miR-132-3p or CAMTA1 knockdown obviously enhanced proliferation and migration of the Schwann cells, while miR-132-3p knockdown produced the opposite effect. MiR-132-3p negatively regulated CAMTA1 expression. In the rat models of FNI, miR-132-3p injection significantly inhibited CAMTA1 expression and attenuated I-125 seeds-induced exacerbation of FNI., Conclusion: Overexpression of miR-132-3p suppresses CAMTA1 expression and promotes Schwann cell proliferation and migration to alleviate I-125 seeds-induced exacerbation of FNI in rats.

Significance Statement: Facial nerve schwannoma is extremely uncommon. Despite its rarity, it is considered the most common facial nerve tumor and potentially affects any segment of the nerve. Presenting symptoms vary depending on the location of the neoplasm. Tumors pertaining to the extratemporal course of the nerve mainly appear as an asymptomatic parotid mass. We present a rare case of schwannoma of the zygomatic branch of the right facial nerve that was surgically resected, without facial nerve injury., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The facial nerve stimulates the muscles of facial expression and the parasympathetic nerves of the face. Consequently, facial nerve paralysis can lead to facial asymmetry, deformation, and functional impairment. Facial nerve palsy is most commonly idiopathic, as with Bell palsy, but it can also result from a tumor or trauma. In this article, we discuss traumatic facial nerve injury. To identify the cause of the injury, it is important to first determine its location. The location and extent of the damage inform the treatment method, with options including primary repair, nerve graft, cross-face nerve graft, nerve crossover, and muscle transfer. Intracranial proximal facial nerve injuries present a challenge to surgical approaches due to the complexity of the temporal bone. Surgical intervention in these cases requires a collaborative approach between neurosurgery and otolaryngology, and nerve repair or grafting is difficult. This article describes the treatment of peripheral facial nerve injury. Primary repair generally offers the best prognosis. If primary repair is not feasible within 6 months of injury, nerve grafting should be attempted, and if more than 12 months have elapsed, functional muscle transfer should be performed. If the affected nerve cannot be utilized at that time, the contralateral facial nerve, ipsilateral masseter nerve, or hypoglossal nerve can serve as the donor nerve. Other accompanying symptoms, such as lagophthalmos or midface ptosis, must also be considered for the successful treatment of facial nerve injury.

Objectives/hypothesisBy phage display, we have developed a novel peptide (NP41) that binds selectively to nerves following systemic administration. We evaluated the pattern of facial nerve labeling with fluorescently-labeled NP41 (F-NP41). We also tested whether F-NP41 highlights facial nerves well enough to identify nerve stumps accurately several weeks after nerve transection.Study designForty-seven wild-type mice were studied prospectively. One surgeon performed the nerve transection, reanastomosis, and monitoring of functional recovery.MethodsFluorescent labeling: F-NP41 was administered intravenously (20 mice). Nerve labeling was studied with fluorescence microscopy. Transection and reanastomosis: the right facial nerve was transected (25 mice). Three weeks after transection, F-NP41 was administered intravenously and fluorescence microscopy was used to identify the nerve stumps and reanastomosis in one group. Nerve identification and reanastomosis was performed with white light in another group without F-NP41. The control group underwent sham surgery. Time to nerve identification was recorded. Functional recovery was monitored for at least 8 weeks.ResultsWe found excellent labeling of intact and transected facial nerves following F-NP41 administration. Several weeks following nerve transection, F-NP41 provided accurate identification of the proximal and distal nerve stumps. Following reanastomosis, time to recovery and level of functional recovery was similar in the absence and presence of F-NP41.ConclusionsWe show improved visualization of facial nerves with a novel systemically applied fluorescently labeled probe. Use of F-NP41 resulted in accurate identification of facial nerve stumps several weeks following transection. Functional recovery was similar with and without the use of F-NP41.

Background: Unexpected facial nerve damage can occur during parotid gland tumor surgery. We sought to determine the incidence and treatment outcomes of unexpected facial nerve injuries in patients with parotid gland tumor surgery. Methods: We retrospectively enrolled in this study five patients, who underwent facial nerve neurorrhaphy due to unexpected facial nerve injury during parotid gland tumor surgery January 2012–August 2019. Results: There were five patients (0.008%) with unexpected facial nerve injuries during the parotid gland tumor surgery of 577 patients in our hospital for approximately 8 years. The most common injury site of facial nerve was the marginal mandibular branch (n = 3), followed by the buccal branch (n = 1), and the cervicofacial division (n = 1). In the case of unexpected facial nerve damage, our treatment is immediate primary neurorrhaphy and steroid treatment. Three patients of five recovered and two did not worsen immediately after surgery. Conclusion: Unexpected facial nerve injury during parotid gland tumor surgery is extremely unfortunate. In this case, immediate primary neurorrhaphy and systemic steroids are recommended to restore facial function and reduce cosmetic deficits. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study is to investigate the efficacy of locally applied insulin-like growth factor 1 (IGF-1) on the recovery of facial nerve functions after crush injury in a rabbit model. Methods The rabbits were randomly assigned into three groups. Group 1 consisted of the rabbits with crush injury alone; group 2, the animals applied saline solution onto the crushed facial nerve and group 3, IGF-1 implemented to the nerve in the same manner. Facial nerve injury was first electrophysiologically studied on 10th and 42nd days of the procedure. The damage to the facial nerves was then investigated histopathologically, after sacrification of the animals. Results In the electrophysiological study, compound muscle action potential amplitudes of the crushed nerves in the second group were decreased. In pathological specimens of the first and second groups, the orders of axons were distorted; demyelination and proliferation of Schwann cells were observed. However, in IGF-1 treated group axonal order and myelin were preserved, and Schwann cell proliferation was close to normal (P

Background: The reported incidence of facial weakness immediately after parotid tumor surgery ranges from 14 to 65%. The purpose of this study was to evaluate the incidence of postoperative facial weakness related to parotidectomy with use of preoperative computed tomography (CT), intraoperative facial nerve monitoring, and surgical magnification. Also, we sought to elucidate additional information about risk factors for postoperative facial weakness in parotid tumor surgery, particularly focusing on the tumor subsites.Methods: We retrospectively reviewed 794 cases with parotidectomy for benign and malignant tumors arising from the parotid gland (2009-2016). Patients with pretreatment facial palsy were excluded from the analyses. Tumor subsites were stratified based on their anatomical relations to the facial nerve as superficial, deep, or both. Multivariable logistic regression analyses were conducted to identify risk factors for postoperative facial weakness.Results: The overall incidences of temporary and permanent (more than 6 months) facial weakness were 9.2 and 5.2% in our series utilizing preoperative CT, intraoperative facial nerve monitoring, and surgical magnification. Multivariable analysis revealed that old age, malignancy, and recurrent tumors (revision surgery) were common independent risk factors for both temporary and permanent postoperative facial weakness. In addition, tumor subsite (tumors involving superficial and deep lobe) was associated with postoperative facial weakness, but not tumor size. Extent of surgery was strongly correlated with tumor pathology (malignant tumors) and tumor subsite (tumors involving deep lobe).Conclusion: Aside from risk factors for facial weakness in parotid tumor surgery such as old age, malignant, or recurrent tumors, the location of tumors was found to be related to postoperative facial weakness. This study result may provide background data in a future prospective study and up-to-date information for patient counseling. [ABSTRACT FROM AUTHOR]