Facial Nerve

Facial Nerve
     

• RA Jahrsdoerfer, PR Lambert (Univ of Virginia, Charlottesville)
  Facial Nerve Injury in Congenital Aural Atresia Surgery.
  Am J Otol 19:283-287, 1998.
    
  Fear of injury to the facial nerve is a great deterrent to atresia surgery. Data on more than 1000 patients who underwent surgery for congenital aural atresia, were retrospectively reviewed. Ten patients sustained a facial nerve injury during atresia surgery.
      
  The facial nerve is displaced in 25% to 30% patients with congenital aural atresia. For less experienced surgeons, the facial nerve is at greatest risk in the inferoposterior part of atretic bone, just lateral to the middle ear. For more experienced surgeons, patients with low-set ears canal stenosis and an accompanying cholesteatoma are at risk for facial nerve injury.
      

• H Ryu, s Yamamoto, K Sugiyama, et al (Hamamatsu Univ, Shizuoka, Japan; Seirei Mikatabara Gen Hosp, Hamamatsu, Shizuoka, Japan)
  Hemifacial Spasm Caused by Vascular Compression of the Distal Portion of the Facial Nerve: Report of Seven Cases.
  J Neurosurg 88:605-609, 1998.
      
  In a recent series of 142 patients with Hemifacial Spasm (HFS), 5% (7 patients) were found to have compression of a distal portion of the seventh cranial nerve combined with compression at its root-entry zones (REZ) or compression of a distal portion of the nerve alone.
      
  In all 7 patients, vascular compression distal to the REZ of the facial nerve caused HFS. Symptoms resolved when neurovascular decompression was performed at these sites.
      
  Although the REZ is the primary site of vascular compression causing HFS in most cases, in these 7 cases compressed sites were definitely NOT at the REZs.
       

• JP Leonetti, T Origitano, et al (Loyola Univ, Maywood, III)
  Intracranial Complications of Temporal Bone Osteoradionecrosis
  Am J Otol 18:223-229, 1997
     
  Osteoradionecrosis of the temporal bone may follow radiation to the brain, parotid gland, nasopharynx, or superior cervical area. Life-threatening intracranial complications may follow.
     
  In 4 patients studied, complications observed were multiple brain abscesses, aneurysm of the internal carotid artery; a cholesteatoma of the external auditory canal with extensive destruction of the mastoid bone leading to thrombosis and meningitis of the sigmoid sinus; meningitis with a small epidural abscess over the middle fossa dura; and prolonged infection of the ear canal, middle ear, and mastoid resulting in fatal otitic meningitis. The 3 patients who underwent surgery (mastoid) survived requiring careful and regular follow-up.
      

• PA Fagan, JP Sheehy, et al (St. Vincent’s Hosp, Sydney, Australia)
  The Cerebellopontine Angle: Does the Translabyrinthine Approach Give Adequate Access?
  Laryngoscope 108: 679-682, 1998
      
  It was previously believed that the translabyrinthine approach provided inadequate access to the cerebellopontine angle. The authors after analyzing 33 patients undergoing translabyrinthine surgery and 13 undergoing the posterior fossa approach have concluded that the translabyrinthine approach enables superior visualization through a wider angle of surgical access with minimal cerebellar retraction.
      

• HM Dunniway, DB Welling (Ohio State Univ, Columbus)
  Intracranial Tumors Mimicking Benign Paroxysmal Positional Vertigo.
  Otolaryngol Head Neck Surg, 118:429-436, 1998.
    
  Benign positional vertigo may not always be benign, as indicated in this study where intracranial tumors were identified in five patients who presented as “benign paroxysmal vertigo.”
       
  When patients of “benign paroxysmal vertigo” do not improve after particle repositioning manoeuver, further assessment is needed to rule out intracranial new growths.
      

• RC O’Reilly, SB Kapadia, D.B. Kamerer (Univ of Pittsburgh, Pa)
  Primary Extracranial Meningioma of the Temporal Bone.
  Otolaryngol Head Neck Surg 118:690-694, 1998.
     
  Though meningiomas typically occur intracranially, they may rarely arise de novo in the temporal bone. Because of the invasive nature of this tumor, surgical resection is difficult, and postoperative surveillance is necessary.
     

• AE-M Moussa, KA Abou-Elhmd (South Valley Univ, Sohag, Egypt)
  Wegener’s Granulomatosis Presenting as Mastoiditis
  Ann Otol Rhinol Laryngol 107:560-563, 1998.
     
  Wegener’s granulomatosis is an uncommon auto-immune disorder, which has a peak incidence in the fifth decade of life with a slight male predominance. Typically, nasal problems are the initial manifestation. Otologic symptoms are rare.
     
  The authors report 2 cases of Wegener’s granulomatosis manifesting as mastoiditis (a fourteen-year-old girl and a 20-year-old woman).
     

• Harti DM, P Aidan, O Brugiere, et al (Universite Paris VII)
  Wegener’s Granulomatosis Presenting as a Recurrence of Chronic Otitis Media.
  Am J Otolaryngol 19: 54-60, 1998.
     
  This is a case report of Wegener’s Granulomatosis manifesting otitis media with facial palsy. Plasma antineutrophil cytoplasm antibodies were detected by means of immunofluorescence. After three weeks of immunosuppressive therapy, facial palsy disappeared, the ESR had normalized and the size of pulmonary nodules had decreased.
     
  This case report highlights the need to bear in mind non-infectious causes of chronic otitis media with otorrhea.
     

• R Indudharan, T Arni, KK Myint, et al (Universiti Sains Malaysia, Kelantan; Hosp Tengku Ampuan Afzan, Kuantan, Malaysia)
  Lymphoblastic Lymphoma/Leukemia Presenting as Perichondritis of the Pinna.
  J Laryngol Otol 112: 592-594, 1998
     
  A patient treated for perichondritis of the pinna was eventually determined to have B-lineage lymphoblastic lymphoma evolving to a leukemic phase. There was no pre-existing immunodeficiency.
     
  Though lymphoma is the second most common malignancy of the head and neck region, the pinna as the extranodal site of lymphoma, has been previously reported only once. Hence the need to broaden one’s diagnostic horizon when inflammatory lesions do not heal within a reasonable period.
     

• G Venkatraman, DE Mattox (Univ of Maryland Baltimore)
  External Auditory Canal Wall Cholesteatoma: A Complication of Ear Surgery.
  Acta Otolaryngol (Stockh) 117 :293-297, 1997.
     
  Large primary cholesteatomas of the external auditory canal are rare. Cases arising from previous surgery are even less common.
     
  This article presents five cases of cholesteatomas arising from the floor of the external auditory canal after ear surgery. In all these patients, the cholesteatomas were extensive enough to require surgery. The authors postulate that a careful surgical technique would help prevent canal wall cholesteatoma.
     

• E Gur, A Yeung, M Al-Azzawi, et al (Univ of Toronto)
  The Excised Preauricular Sinus in 14 Years of Experience : Is There a Problem ?
  Plast Reconstr Surg 102: 1405-1408, 1998.
     
  A few of the patients having a congenital pre-auricular sinus suffer from recurrent infections. In such cases surgical excision of the sinus tracts is required. Recurrence is very likely if the tract is not excised completely.
     
  The authors have reviewed 165 primary preauricular excision procedures in 146 patients over a period of 14 years.
     
  The recurrence rate was higher (15.79%) in patients who had active infection during surgery than in patients who did not have active infection (8.22%). The recurrence rate was higher (16.7%) in patients who had surgical drainage of an abscess before the procedure, and 8.16% in those who did not.
      
  Recurrence rates can be reduced by excising a piece of cartilage at the base of the tract and by demonstrating the sinus with dye injection and/or probing at the time of surgery.
         

• Vrabec JT (Univ of Texas, Galveston)
  Delayed Facial Palsy After Tympanomastoid Surgery
  Am J Otol 20: 26 – 30, 1999
     
  This entity causes great concern to patients as well as to operating surgeon because it also suspects technical skill of the surgeon. 
     
  In this study, 486 patients operated during 1993 to 1997 by a single surgeon to assess delayed facial palsy (DFP) i.e. after 72 hrs of surgery. 7 patients (1.4%) suffered from DFP. In 2 patients postoperative bacterial infection was the cause but 5 patients had viral reactivation.
     
  Management of these patients depends upon cause. Resolution of bacterial infection improves DFP. However, those 5 with viral reactivation though improves favourably without treatment, varicella zoster virus was the most common cause of reactivation, hence prophylaxis treatment with antiviral drug acyclovir 2-3 days before and 1 week after surgery is advisable in susceptible population patient, if can be defined.
     
  MM Paparella also thinks that some sort of anatomical variation can predispose to the reactivation process, such as the vulnerable to viral reactivation.