Coronectomia: percepção dos buco-maxilo-faciais em hospitais do Recife-PE / Coronectomy: perception of bucco-maxillofacials in hospitals in Recife-PE

Introdução: A Coronectomia é um tratamento alternativo à remoção total do terceiro molar inferior impactado/incluso, removendo apenas a região coronária do dente, preservando suas raízes. O objetivo desta pesquisa é mensurar o nível de conhecimento e percepção dos Cirurgiões e Residentes Buco-Maxilo-Faciais, em três hospitais da rede pública da cidade do Recife, Pernambuco, sobre a técnica da Coronectomia. Metodologia: A amostra foi composta por 40 profissionais, dentre os quais 50% de todos os entrevistados declararam não realizar a técnica da Coronectomia na remoção de terceiros molares. Foi realizado o Teste Exato de Fisher que não apontou dependência entre as categorias de participante da entrevista quanto ao grau de conhecimento sobre a técnica de Coronectomia. Resultados: Os entrevistados conhecem a técnica de Coronectomia, mas a sua indicação não é frequente e as contraindicações mais citadas foram lesões neoplásicas e terceiros molares com patologia apical. Consideram muito importantes e importantes as vantagens do procedimento em relação à remoção total dos terceiros molares. 70% dos entrevistados veem a necessidade de reintervenção como a maior desvantagem na técnica, porém, estudos dizem que raramente ocorrem erupções dessas raízes. Conclusão: A técnica da Coronectomia é eficaz quando corretamente indicada e realizada, pois, reduz o risco de uma lesão ao nervo alveolar inferior... (AU)

Introduction: Coronectomy is an alternative treatment to the total removal of the impacted / included lower third molar, removing only the coronary region of the tooth, preserving its roots. The objective of this research is to measure the level of knowledge and perception of Surgeons and Buco-Maxillofacial Residents, in three public hospitals in the city of Recife, Pernambuco, on the technique of Coronectomy. Methodology: The sample consisted of 40 professionals, among whom 50% of all respondents stated that they did not perform the Coronectomy technique in the removal of third molars. Fisher's Exact Test was performed, which did not show any dependence between the interviewee categories regarding the degree of knowledge about the Coronectomy technique. Results: The interviewees are familiar with the Coronectomy technique, but its indication is not frequent and the most frequently mentioned contraindications were neoplastic lesions and third molars with apical pathology. The advantages of the procedure in relation to the total removal of third molars are considered very important and important. 70% of respondents see the need for reintervention as the biggest disadvantage in the technique; however, studies say that eruptions of these roots rarely occur. Conclusion: The Coronectomy technique is effective when correctly indicated and performed, as it reduces the risk of injury to the lower alveolar nerve... (AU)

CRB modification to retromandibular approach for management of subcondylar fractures

The aim of this study was to evaluate the efficacy of CRB modification of retromandibular approach to gain surgical access for open reduction and internal fixation of mandibular sub-condylar fractures. A total number of 264 sustained extra-capsular subcondylar fractures from 230 patients were selected for the study over the period of 5 years. Evaluation of intraoperative accessibility, postoperative facial nerve function, postoperative complications and scar was ca-rried out. All the patients were treated using CRB Curvilinear approach. Patient follow up was re-corded for 1 year on a regular interval basis. Symptoms of postoperative facial nerve injury were seen in 2 patients which recovered with time, postoperative complications were not encountered in any case and minimum scar mark hidden in the cervical skin crease. Hence open reduction and internal fixation for Subcondylar fracture of mandible by using the CRB modification of re-tromandibular approach is a good alternative for other conventional approaches in having ease of access, ease of fixation, reduced incidences of injury to facial nerve and its branches with good aesthetic outcome

Parotidectomy-related facial nerve lesions: proposal for a modified Sunnybrook Facial Grading System / Lesões do nervo facial relacionadas à parotidectomia: proposta de um sistema Sunnybrook de graduação facial modificado

ABSTRACT Facial nerve injury, affecting mainly the marginal mandibular branch, is the most frequent neurologic complication from parotidectomy. Objective To test a modified Sunnybrook Facial Grading System as a new tool to assess the facial nerve function following parotidectomy, emphasizing the marginal mandibular branch. Methods We reviewed the medical records of 73 post-parotidectomy patients (40 female, 18-84 years old, mean age 53.2 years) with facial nerve sparing, referred to the Department of Physical Therapy. All patients had parotid neoplasms or advanced skin cancer, and were followed by the principal author between 2006 and 2014. Results The muscles innervated by the marginal mandibular branch were the most frequently affected (72.6%), particularly in patients undergoing neck dissection (p = 0.023). The voluntary movement scores obtained with the modified system were significantly lower compared with the original version (p < 0.001). The best and worst scores were observed in patients with benign parotid tumors and skin cancer, respectively. Patients requiring neck dissection (p = 0.031) and resection of other structures (p = 0.021) had the lowest scores, evidenced only with the modified version. Patients with malignant tumors had significantly worse ratings, regardless of the Sunnybrook system version. The post-physiotherapy analysis involved 50 patients. The worst facial rehabilitation outcomes were related to the marginal mandibular branch function. Conclusion The modified Sunnybrook Facial Grading System improved the marginal mandibular branch assessment, preserving the evaluation of other facial nerve branches.

RESUMO A lesão do nervo facial é a principal complicação neurológica relacionada às parotidectomias e, em geral, o ramo marginal mandibular é o mais frequentemente acometido. Objetivo Testar um Sistema Sunnybrook de Graduação Facial modificado (mS-FGS) como uma nova ferramenta para avaliar a função do nervo facial após a parotidectomia, enfatizando o ramo marginal mandibular. Métodos Estudo retrospectivo, baseado em prontuários de 73 casos (40 do sexo feminino, 18-84 anos, idade média = 53,2), submetidos à parotidectomia, com preservação do nervo facial. Todos os pacientes apresentavam neoplasias parotídeas ou câncer de pele avançado, e foram tratados pela autora principal entre 2006 e 2014. Resultados Neste estudo, os músculos inervados pelo ramo marginal mandibular foram os mais acometidos (72,6% dos casos), principalmente nos pacientes que realizaram esvaziamento cervical (p = 0,023). Os Escores de Movimento Voluntário obtidos pelo sistema modificado foram inferiores aos obtidos pelo original (p < 0,001). As melhores pontuações foram observadas em pacientes com tumores benignos parotídeos e os piores resultados, naqueles com câncer de pele. Pacientes que necessitaram de esvaziamento cervical e ressecção de outras estruturas, além da parótida, apresentaram escores menores (p = 0,031 e p = 0,021), evidenciados apenas pelo sistema modificado. Os tumores malignos geraram escores significativamente menores, independentemente do instrumento empregado. A análise pós fisioterapia envolveu 50 casos. Os piores resultados, após a intervenção fisioterapêutica, também foram observados nos músculos inervados pelo ramo marginal mandibular. Conclusão A avaliação da disfunção facial pós-parotidectomia, através do Sistema Sunnybrook com a modificação proposta permitiu uma apreciação mais detalhada do ramo marginal mandibular, sem prejuízo à avaliação dos demais ramos.

Neuromonitorización intraoperatoria del nervio facial: a propósito de un caso / Intraoperative neuromonitoring of the facial nerve: a case report

Introdução: A preservação do nervo facial (NF) é uma das principais preocupações do cirurgião durante o tratamento aberto das fraturas mandibulares, uma vez que uma lesão nessa estrutura anatômica pode causar sequelas estéticas e funcionais permanentes. A existência de variações anatômicas (anastomoses e ramificações incomuns) aumenta o risco de danos no NF, mesmo nas mãos de cirurgiões experientes. O neuromonitoramento intraoperatório tem-se mostrado um grande aliado para evitar lesões nos ramos nervosos que podem estar envolvidos na área cirúrgica. Considerando a escassez desse assunto na literatura referente à cirurgia maxilo-facial, objetivamos demonstrar o uso da técnica de neuromonitoração do NF durante o acesso submandibular para o tratamento da fratura bilateral do ângulo mandibular. Relato de caso: No presente relato de caso, as abordagens cirúrgicas de ambos os lados não apresentaram danos permanentes ao NF. Esse resultado assim como a literatura sugerem que o neuromonitoramento intraoperatório proporciona maior segurança durante a realização de abordagens cirúrgicas, nas quais os ramos do nervo facial estão envolvidos, reduzindo, assim, o risco de sequelas nervosas. Considerações Finais: Esse recurso pode ser de grande auxílio no treinamento hospitalar ao longo do processo de formação de cirurgiões bucomaxilofaciais... (AU)

Introduction: Facial nerve (FN) preservation is one of the surgeon's major concerns during the open treatment of mandibular fractures since an injury to this anatomical structure can cause permanent aesthetic and functional sequelae. The existence of anatomical variations (anastomosis and unusual branching) increases the risk of FN damage even in the hands of experienced surgeons. Intraoperative neuromonitoring has proven to be a great ally to avoid injury to the nerve branches that may be involved in the surgical area. Considering the scarcity of this subject in the maxillofacial surgery literature, we aimed to demonstrate the use of the FN neuromonitoring technique during the submandibular approach for the treatment of bilateral mandibular angle fracture. Case report: In the present case report, the surgical approaches of both sides presented no permanent damage to the FN. Results: This result, as well as previous literature, suggests that intraoperative neuromonitoring provides greater safety during the performance of surgical approaches in which the facial nerve branches are involved and thus, reduces the risk of nerve sequelae. Final considerations: This resource can be of special assistance in teaching hospitals throughout the training process of maxillofacial surgeons... (AU)

Manejo médico de las fracturas nasales / Nasal fractures medical management

Las fracturas nasales son frecuentes en los traumas centro faciales, debido a que la pirámide nasal está constituida por hueso delgado, que se proyecta de forma prominente en la parte media de la cara siendo susceptible cuando ocurre un trauma facial. La información sobre el manejo de fracturas nasales, establece que el tratamiento óptimo de las mismas constituye el pilar para evitar secuelas funcionales o estéticas en los pacientes. Objetivo: recopilar información actualizada acerca de anatomía nasal, signos clínicos, diagnóstico y tratamiento de las fracturas nasales para el manejo correcto de estos traumas nasales. Material y métodos:la información obtenida es el resumen de 20 artículos que contienen puntos esenciales y recientes, seleccionados de 147 artículos en inglés y español. Se consultaron bases de datos como Hinari, Scielo, Biblioteca Cochrane y Pubmed; utilizando palabras claves fractura nasal y manejo Conclusión: es fundamental contar con un manejo estandarizado para saber qué conducta seguir de acuerdo al tipo de fractura nasal y así hacer una distinción clara sobre que fracturas se pueden resolver de forma inmediata y en cuales se puede postergar la reducción...(AU)

Tumores de glándula parótida: experiencia quirúrgica Hospital Guillermo Grant Benavente / Parotid gland tumors: surgical experience Hospital Guillermo Grant Benavente

RESUMEN Introducción: La glándula parótida es el sitio más común de tumores de glándulas salivales, correspondiendo al 75%-85% de éstos y al 3% de todos los tumores de cabeza y cuello. Ochenta por ciento de ellos corresponden a tumores benignos. Objetivos: Analizar la experiencia quirúrgica en tumores parotídeos operados en el Hospital Guillermo Grant Benavente. Material y método: Revisión de todos los pacientes con tumores parotídeos operados en el Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello, del Hospital Guillermo Grant Benavente entre enero del año 2011 y abril del año 2016. Las cirugías fueron realizadas por el mismo equipo quirúrgico. Se registraron datos demográficos, clínicos, quirúrgicos, histológicos y resultados posoperatorios. Resultados: En el periodo descrito se operó un total de 94 pacientes. 84,3% correspondieron a tumores benignos y 15,7% a tumores malignos. El 62,9% corresponde a pacientes de sexo femenino y 37,1% de sexo masculino, representando una relación de 1,69:1. La incidencia de parálisis facial transitoria fue de 16,1%, y de ellos solo un paciente mantuvo una parálisis permanente. Conclusión: Los tumores malignos representaron el 15,7%, siendo menor a lo reportado en la literatura. Se presenta una gran serie de tumores parotídeos tratados quirúrgicamente a nivel nacional, con una baja tasa de complicaciones.

Abstract Introduction: Parotid gland is the most common site of salivary gland tumors, corresponding to 75-85% of these and 3% of all head and neck tumors. 80% of them correspond to benign tumors. Aim: To analyze the surgical experience in parotid tumors operated in the Guillermo Grant Benavente Hospital. Material and Method: Review of all patients with parotid tumors operated in the Otorhinolaryngology and Head and Neck Surgery Unit of Hospital Guillermo Grant Benavente between January 2011 and April 2016. All surgeries were performed by the same surgical team. Demographic, clinical, surgical, histological and postoperative results were recorded. Results: In the period described, a total of 94 patients were operated on. 84.3% corresponded to benign tumors and 15.7% to malignant tumors. 62.9% corresponds to female patients and 37.1% male, representing a ratio of 1.69:1. The incidence of transient facial paralysis was 16.1%, and of these, only one patient maintained permanent paralysis. Conclusions: Malignant tumors represented 15.7% of cases, being less than reported in the literature. This article presents a large series of parotid tumors treated surgically in our country, with a low associated complication rate.

Expansion and phenotypic changes of mouse bone marrow mesenchymal cells cultured with FGF-2 and facial nerve-conditioned medium / Expansión y cambios fenotípicos de células mesenquimales de médula ósea de ratón cultivadas con FGF-2 y medio condicionado por el nervio facial

Mesenchymal cells (MCs) exhibit great regenerative potential due to their intrinsic properties and ability to restore tissue function, either directly through transdifferentiation or indirectly through paracrine effects. This study aimed to evaluate morphometric and phenotypic changes in MCs grown with facial nerve-conditioned medium in the presence or absence of fibroblast growth factor 2 (FGF-2). For quantitative phenotypic analysis, the expression of GFAP, OX-42, MAP-2, β-tubulin III, NeuN, and NF-200 was analyzed by immunocytochemistry. Cells cultured with facial nerve-conditioned medium in the presence of FGF-2 expressed GFAP, OX-42, MAP-2, β-tubulin III, NeuN, and NF-200. On average, the area and perimeter of GFAP-positive cells were higher in the group cultured with facial nerve-conditioned medium compared to the group cultured with conditioned medium and FGF-2 (p=0.0001). This study demonstrated the plasticity of MCs for neuronal and glial lineages and opens up new research perspectives in cell therapy and trans.differentiation.

Las células mesenquimales (CM) exhiben un gran potencial regenerativo debido a sus propiedades intrínsecas y la capacidad de restaurar la función del tejido, ya sea directamente, a través de la transdiferenciación, o indirectamente, a través de efectos parácrinos. Este estudio tuvo como objetivo evaluar los cambios morfométricos y fenotípicos en CM cultivadas con medio condicionado por nervio facial en presencia o ausencia de factor de crecimiento de fibroblastos 2 (FGF-2). Para el análisis fenotípico cuantitativo, se analizó la expresión de GFAP, OX-42, MAP-2, β-tubulina III, NeuN y NF-200 mediante inmunocitoquímica. Las células cultivadas con medio condicionado por el nervio facial en presencia de FGF-2 expresaban GFAP, OX-42, MAP-2, β-tubulina III, NeuN y NF-200. En promedio, el área y el perímetro de las células positivas para GFAP fueron mayores en el grupo cultivado con medio condicionado por el nervio facial en comparación con el grupo cultivado con medio acondicionado y FGF-2 (p = 0,0001). Este estudio demostró la plasticidad de CM para linajes neuronales y gliales y abre nuevas perspectivas de investigación en terapia celular y transdiferenciación.

Bilateral mandibular nerve injury following mask ventilation: a case report / Lesão do nervo mandibular bilateral após ventilação com máscara: um relato de caso

Abstract Background and objectives Nerve injury following mask ventilation is a rare but serious anesthetic complication. The majority of reported cases are associated with excessive pressure applied to the face mask, long duration of mask ventilation, excessive digital pressure behind the mandible to relieve airway obstruction and pressure exerted by the plastic oropharyngeal airway. Case report We present a case of bilateral mandibular nerve injury following mask ventilation with short duration, most likely due to a semi-silicone facemask with an over-inflated cushion. Conclusion An over-inflated sealing cushion of a facemask may trigger difficult mask ventilation leading to mandibular nerve injury following mask ventilation. Alternative airway management techniques such as laryngeal mask airway should be considered when airway maintenance can only be achieved with strong pressure applied to the facemask and/or mandible.

Resumo Justificativa e objetivos A lesão nervosa após ventilação com máscara é uma complicação anestésica rara, mas grave. A maioria dos casos relatados está associada à pressão excessiva aplicada à máscara facial, ao tempo prolongado de ventilação, à pressão digital excessiva atrás da mandíbula para aliviar a obstrução das vias aéreas e à pressão exercida pela cânula orofaríngea. Relato de caso Apresentamos um caso de lesão do nervo mandibular bilateral após uma ventilação de curta duração via máscara, provavelmente devido ao uso de uma máscara facial (de semissilicone) com insuflação excessiva da almofada. Conclusão A insuflação excessiva da almofada de uma máscara facial pode desencadear uma ventilação com máscara difícil, levando à lesão do nervo mandibular após a ventilação. Técnicas alternativas de manejo das vias aéreas, como o uso de máscara laríngea, devem ser consideradas quando a manutenção das vias aéreas só pode ser obtida com forte pressão aplicada à máscara facial e/ou mandíbula.

Protetor Facial: relato de caso / Facial Mask: case report

A Odontologia do Esporte é uma nova especialidade odontológica, que tem, dentre os seus objetivos, prevenir, tratar e reabilitar atletas. Uma das atuações do cirurgião-dentista que atua nessa área é a confecção de protetores faciais e bucais individualizados. Atualmente, existe um maior número de investigação científica sobre protetores bucais que os faciais; consequentemente, os bucais são normatizados, e os faciais, ainda não. Eles são utilizados somente depois de o atleta ter sofrido traumas, porque evitam que o osso sofra refratura ou deslocamento, permitindo ao atleta não se manter temporariamente afastado da prática dos esportes... (AU)

Sports Dentistry is a new dental specialty whose goal is to prevent, treat and rehabilitate athletes. One of the activities of the dentist that acts with the Sports Dentistry is the confection of individualized facial masks and mouthguards. There is a greater number of scientific research on mouthguards than on facial masks, as a result of which mouthguards are normalized and facial masks not yet. They are used only after the athlete has suffered traumas, so with their use it prevents the bone from suffering refraction or displacement and allows the athlete not to stay temporarily away from the practice of sports... (AU)

Avaliação das complicações pós-operatórias em pacientes idosos submetidos à parotidectomia / Evaluation of postoperative complications in elderly patients submitted to parotidectomy

RESUMO Objetivo: avaliar subtipos histológicos mais incidentes e as principais complicações pós-operatórias em pacientes idosos portadores de tumor de parótida e submetidos à parotidectomia. Métodos: estudo retrospectivo de 57 pacientes idosos submetidos à parotidectomia, no período de 2003 a 2017, no Hospital Municipal São José de Joinville, Santa Catarina, Brasil. Resultados: trinta e três (57,9%) pacientes tinham tumores benignos, sendo o mais frequente o tumor de Warthin, e 17(29,8%) tumores malignos, sendo o carcinoma escamoso o mais frequente. Sete (12,3%) pacientes evoluíram com complicações clínicas, sendo a labilidade pressórica e as complicações respiratórias as mais incidentes em quatro (7%) e três (5,3%) casos, respectivamente. Treze (22,1%) pacientes apresentaram complicações cirúrgicas relacionadas à ferida operatória, sendo o hematoma e a infecção de ferida as mais incidentes, com seis (10,5%) casos cada. Vinte e quatro (42,1%) pacientes tiveram algum grau de disfunção do nervo facial no pós-operatório, sendo o grau III de Brackman-House, em 11 casos (19,3%), o mais frequente. O tempo cirúrgico e a linfadenectomia mostraram associação com complicações clínicas. As principais variáveis que apresentaram associação com complicações cirúrgicas foram: tamanho do tumor, tempo cirúrgico mais longo, reoperação e volume de infusão de cristaloides no transoperatório. Conclusão: as neoplasias parotídeas apresentam perfil diferenciado na população idosa, destacando-se o tumor de Warthin e o carcinoma escamoso. Hematoma e infecção da ferida operatória, e as lesões do nervo facial foram as complicações mais prevalentes no pós-operatório.

ABSTRACT Objective: to evaluate the most incident histological subtypes and the main postoperative complications in elderly patients with parotid tumors submitted to parotidectomy. Methods: we conducted a retrospective study with 57 elderly patients submitted to parotidectomy from 2003 to 2017, at the São José County Hospital of Joinville, Santa Catarina, Brazil. Results: thirty-three (57.9%) patients had benign tumors, the most frequent being Warthin's tumor, and 17 (29.8%), malignant tumors, squamous cell carcinoma being the most frequent. Seven patients (12.3%) presented clinical complications, arterial pressure instability and respiratory complications being the most frequent, in four (7%) and three (5.3%) cases, respectively. Thirteen (22.1%) patients presented complications related to the surgical wound, hematoma and wound infection being the most frequent, with six (10.5%) cases each. Twenty-four (42.1%) patients had some degree of facial nerve dysfunction in the postoperative period, Brackman-House grade III being the most frequent, in 11 cases (19.3%). Surgical time and lymphadenectomy were associated with clinical complications. The main variables that showed an association with surgical complications were tumor size, longer surgical time, reoperation, and perioperative crystalloid infusion volume. Conclusion: parotid neoplasms present a differentiated profile in the elderly population, especially Warthin's tumor and squamous cell carcinoma. Hematoma and infection of the operative wound and facial nerve lesions were the most prevalent complications in the postoperative period.

An Experimental Study on the Optimal Timing for the Repair of Incomplete Facial Paralysis by Hypoglossal-facial 'Side'-to-side Neurorrhaphy in Rats / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the optimal timing for the repair of persistent incomplete facial paralysis by hypoglossal-facial 'side'-to-side neurorrhaphy in rats.</p><p><b>METHODS</b>A total of 30 adult rats with crushed and bulldog-clamped facial nerve injury were randomly divided into 5 groups (n = 6 each) that were subjected to injury without nerve repair or with immediate repair, 2-week-delayed repair, 4-week-delayed repair, or 8-week-delayed repair. Three months later, the effects of repair in each rat were evaluated by facial symmetry assessment, electrophysiological examination, retrograde labeling, and axon regeneration measurement.</p><p><b>RESULTS</b>At 3 months after injury, the alpha angle significantly increased in the group of rats with 4-week-delayed repair compared with the other four groups. Upon stimulation of the facial nerve or Pre degenerated nerve, the muscle action potentials MAPs were recorded in the whisker pad muscle, and the MAP amplitude and area under the curve in the 4-week-delayed repair group were significantly augmented at 3 months post-injury. Similarly, the number of retrograde-labeled motor neurons in the facial and hypoglossal nuclei was quantified to be significantly greater in the 4-week-delayed repair group than in the other groups, and a large number of regenerated axons was also observed.</p><p><b>CONCLUSION</b>The results of this study demonstrated that hemiHN-FN neurorrhaphy performed 4 weeks after facial nerve injury was most effective in terms of the functional recovery of axonal regeneration and activation of facial muscles.</p>

Treatment of intractable parotid sialocele occurred after open reduction-fixation of mandibular subcondylar fracture

A sialocele is a subcutaneous cavity containing saliva, most often caused by facial trauma or iatrogenic complications. In subcondylar fractures, most surgeons are conscious of facial nerve injury; however, they usually pay little attention to the parotid duct injury. We report the case of a 41-year-old man with a sialocele, approximately 5×3 cm in size, which developed 1 week after subcondylar fracture reduction. The sialocele became progressively enlarged despite conservative management. Computed tomography showed a thin-walled cyst between the body and tail of the parotid gland. Fluid leakage outside the cyst was noted where the skin was thin. Sialography showed a cutting edge of the inferior interlobular major duct before forming the common major duct that seemed to be injured during the subcondylar fracture reduction process. We decided on prompt surgical treatment, and the sialocele was completely excised. A duct from the parotid tail, secreting salivary secretion into the cyst, was ligated. Botulinum toxin was administrated to block the salivary secretion and preventing recurrence. Treatment was successful. In addition, we found that parotid major ducts are enveloped by the deep lobe and extensive dissection during the subcondylar fracture reduction may cause parotid major duct injury.

Comparison between early and delayed facial nerve decompression in traumatic facial nerve paralysis - A retrospective study

ABSTRACT Purpose To study the intraoperative findings in case of early and delayed decompression of facial nerve paralysis and compare their results. Methods Retrospective data analysis of 23 cases of longitudinal temporal bone fracture with House-Brackmann grade V and VI facial nerve paralysis. All cases were thoroughly evaluated and underwent facial nerve decompression through the transmastoid approach. All cases were under regular follow-up till the date of manuscript submission. Results Clinical improvement of the facial nerve function was observed for early vs. delayed facial nerve decompression. In the early decompression group, facial nerve function improved to grade II in eight cases (80%) and grade III in two cases (20%), whereas in the delayed decompression group it improved to grade II in one case (7.70%), grade III in four cases (30.76%), grade IV in seven cases (53.84%), and grade V in one case (7.70%). Conclusions Early decompression of facial nerve provides better results than delayed decompression because it enables early expansion of the nerve.

Perfil epidemiológico de pacientes con trauma facial en la ciudad de Azogues-Ecuador / Epidemiological profile of patients with facial trauma in Azogues-Ecuador

Objetivos: Conocer el perfil epidemiológico de pacientes con trauma facial que acudieron a emergencia del Hospital Homero Castanier Crespo en la ciudad de Azogues en el año 2015. Material y métodos: Este estudio fue transversal retrospectivo de 22.652 fichas de emergencia obteniendo un total de 401 casos de traumatismos faciales representando esto el 2% de los casos de emergencia que acudieron al hospital Homero Castanier Crespo en el año 2015. Resultados: De los 401 pacientes la mayoría era del sexo masculino (66%). El grupo de edad más afectado fue los adultos de 20 a 64 años (51%), seguido de los niños de 0 a 9 años (30%). En cuanto a la etiología existió mayor frecuencia en las caídas (45%), seguido de agresiones físicas (39%) y los accidentes de tránsito (4%). En el sexo masculino se vio que pudo influir el estado etílico (39,8%). El factor etiológico más común de traumatismos faciales en mujeres adultas son las agresiones físicas (59%). Se pudo observar que al igual que en estudios realizados en el 2011 el sexo masculino es el más afectado por este tipo de traumatismos, si bien otros autores consideran a los accidentes de tránsito como el principal factor etiológico, en este estudio pudimos observar que entre las principales causas tenemos caídas y agresiones físicas. La mandíbula conocida como un "paragolpes" la nombran como el principal hueso afectado sin embargo nosotros encontramos más común la fractura nasal. Conclusiones: Los adultos de sexo masculino tienen mayor predisposición a traumatismos faciales, siendo más comunes las lesiones de los tejidos blandos, seguidos de fracturas nasales y traumatismos dentoalveolares, en hombres es más frecuente la relación de estos traumatismos con la ingesta de bebidas alcohólicas y en mujeres podemos ver una alta influencia de agresiones físicas. (AU)

Objectives: The purpose of this research was to determine the epidemiological profile of patients with facial trauma attending emergency Homero Crespo Castanier Hospital in the city of Azogues in 2015. Material and methods: A retrospective cross-sectional study of 22,652 sheets was conducted emergency obtaining a total of 401 cases of facial trauma that representing 2% of emergency cases admitted to hospital Homero Castanier Crespo in 2015. Results: of the 401 patients the majority were male (66%). The most affected age group were adults who consider them 20 to 64 years (51%), followed by infants from 0 to 5 years (21%). As for the etiology the prevalence was: falls (45%), followed by physical aggression (39%) and traffic accidents (5%). In the male looks that can influence the drunk state (39.8%). The most common of facial trauma in adult women etiological factor is physical assault (59%). It was observed that as in studies conducted in 2011 the male is the most affected by this type of trauma, although other articles considere that traffic accidents are the main etiological factor in this study we observed that the main causes are fallen and physical attacks. The jaw bone is named the main affected however we find most common nasal fracture. Conclusions: adult males are more prone to facial trauma, being more common injuries of soft tissues, followed by nasal fractures and dentoalveolar trauma in men is more common the relationship of these injuries with the intake of alcoholic beverages and women can see a high influence of physical aggression. (AU)

Effects of ozone therapy on facial nerve regeneration / Efeitos da terapia com ozônio na regeneração do nervo facial

Abstract Introduction: Ozone may promote moderate oxidative stress, which increases antioxidant endogenous systems. There are a number of antioxidants that have been investigated therapeutically for improving peripheral nerve regeneration. However, no previous studies have reported the effect of ozone therapy on facial nerve regeneration. Objective: We aimed to evaluate the effect of ozone therapy on facial nerve regeneration. Methods: Fourteen Wistar albino rats were randomly divided into two groups with experimental nerve crush injuries: a control group, which received saline treatment post-crush, and an experimental group, which received ozone treatment. All animals underwent surgery in which the left facial nerve was exposed and crushed. Treatment with saline or ozone began on the day of the nerve crush. Left facial nerve stimulation thresholds were measured before crush, immediately after crush, and after 30 days. After measuring nerve stimulation thresholds at 30 days post-injury, the crushed facial nerve was excised. All specimens were studied using light and electron microscopy. Results: Post-crushing, the ozone-treated group had lower stimulation thresholds than the saline group. Although this did not achieve statistical significance, it is indicative of greater functional improvement in the ozone group. Significant differences were found in vascular congestion, macrovacuolization, and myelin thickness between the ozone and control groups. Significant differences were also found in axonal degeneration and myelin ultrastructure between the two groups. Conclusion: We found that ozone therapy exerted beneficial effect on the regeneration of crushed facial nerves in rats.

Resumo Introdução: O ozônio pode promover estresse oxidativo moderado, o que aumenta sistemas endógenos antioxidantes. Há determinado número de antioxidantes sendo investigados terapeuticamente para melhorar a regeneração do nervo periférico. No entanto, nenhum estudo anterior relatou o efeito da terapia com ozônio na regeneração do nervo facial. Objetivo: Nosso objetivo foi avaliar o efeito da terapia com ozônio na regeneração do nervo facial. Método: Ao todo, 14 ratos albinos Wistar foram divididos aleatoriamente em dois grupos com lesões experimentais por esmagamento do nervo: um grupo controle, que recebeu tratamento com solução salina pós-esmagamento; e um grupo experimental, que recebeu tratamento com ozônio. Todos os animais foram submetidos a cirurgia na qual o nervo facial esquerdo foi exposto e esmagado. O tratamento com solução salina ou ozônio se iniciou no dia do esmagamento do nervo. Os limiares de estimulação do nervo facial esquerdo foram medidos antes do esmagamento, imediatamente após o esmagamento e após 30 dias. Depois de medir limiares de estimulação do nervo aos 30 dias pós-lesão, o nervo facial esmagado foi excisado. Todas as amostras foram estudadas por meio de microscopia óptica e eletrônica. Resultados: Após o esmagamento, o grupo tratado com ozônio apresentou menores limiares de estimulação do que o grupo da solução salina. Embora isso não tenha significância estatística, é indicativo de maior melhoria funcional no grupo do ozônio. Foram encontradas diferenças significativas na congestão vascular, macrovacuolização e espessura da mielina entre os grupos do ozônio e controle. Diferenças significativas também foram encontradas na degeneração axonal e ultraestrutura de mielina entre os dois grupos. Conclusão: Verificou-se que a terapia com ozônio teve efeito benéfico sobre a regeneração dos nervos faciais esmagados em ratos.

The Effect of Insulin Like Growth Factor-1 on Recovery of Facial Nerve Crush Injury

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 < 0.05). CONCLUSION: Local application of IGF-1 in a slow releasing gel was found efficacious in the recovery of the facial nerve crush injury in rabbits. IGF-1 was considered worthy of being tried in clinical studies in facial nerve injury cases.

Alteraciones de las células de la microglía del sistema nervioso central provocadas por lesiones del nervio facial / Facial nerve injuries cause changes in central nervous system microglial cells

Resumen Introducción. El grupo de investigación del Laboratorio de Neurofisiología Comportamental de la Universidad Nacional de Colombia ha descrito modificaciones estructurales y electrofisiológicas en neuronas piramidales de la corteza motora producidas por la lesión del nervio facial contralateral en ratas. Sin embargo, poco se sabe sobre la posibilidad de que dichos cambios neuronales se acompañen también de modificaciones en las células gliales circundantes. Objetivo. Caracterizar el efecto de la lesión unilateral del nervio facial sobre la activación y proliferación de las células de la microglía en la corteza motora primaria contralateral en ratas. Materiales y métodos. Se hicieron pruebas de inmunohistoquímica para detectar las células de la microglía en el tejido cerebral de ratas sometidas a lesión del nervio facial, las cuales se sacrificaron en distintos momentos después de la intervención. Se infligieron dos tipos de lesiones: reversible (por compresión, lo cual permite la recuperación de la función) e irreversible (por corte, lo cual provoca parálisis permanente). Los tejidos cerebrales de los animales sin lesión (grupo de control absoluto) y de aquellos sometidos a falsa cirugía se compararon con los de los animales lesionados sacrificados 1, 2, 7, 21 y 35 días después de la lesión. Resultados. Las células de la microglía en la corteza motora de los animales lesionados irreversiblemente mostraron signos de proliferación y activación entre el tercero y séptimo días después de la lesión. La proliferación de las células de la microglía en animales con lesión reversible fue significativa solo a los tres días de infligida la lesión. Conclusiones. La lesión del nervio facial produce modificaciones en las células de la microglía de la corteza motora primaria. Estas modificaciones podrían estar involucradas en los cambios morfológicos y electrofisiológicos descritos en las neuronas piramidales de la corteza motora que comandan los movimientos faciales.

Abstract Introduction: Our research group has described both morphological and electrophysiological changes in motor cortex pyramidal neurons associated with contralateral facial nerve injury in rats. However, little is known about those neural changes, which occur together with changes in surrounding glial cells. Objective: To characterize the effect of the unilateral facial nerve injury on microglial proliferation and activation in the primary motor cortex. Materials and methods: We performed immunohistochemical experiments in order to detect microglial cells in brain tissue of rats with unilateral facial nerve lesion sacrificed at different times after the injury. We caused two types of lesions: reversible (by crushing, which allows functional recovery), and irreversible (by section, which produces permanent paralysis). We compared the brain tissues of control animals (without surgical intervention) and sham-operated animals with animals with lesions sacrificed at 1, 3, 7, 21 or 35 days after the injury. Results: In primary motor cortex, the microglial cells of irreversibly injured animals showed proliferation and activation between three and seven days post-lesion. The proliferation of microglial cells in reversibly injured animals was significant only three days after the lesion. Conclusions: Facial nerve injury causes changes in microglial cells in the primary motor cortex. These modifications could be involved in the generation of morphological and electrophysiological changes previously described in the pyramidal neurons of primary motor cortex that command facial movements.

Early Stage Steroid Treatment for Acute Facial Paralysis in Korea / 대한이비인후과학회지

Facial nerve paralysis is an unexpected or embarrassed disease which unilateral facial musculatures are suddenly or gradually paralyzed by various causes. However, the most common cause of acute facial paralysis is known to be Bell's palsy. Until now, various treatments are recommended to patients with acute facial paralysis. Especially in Asian countries such as Korea, Japan, and China, there are so many patients who be managed by acupuncture therapy as the initial treatment, even if there exists clearly proven steroid therapy that minimizes neural damage and the incidence of permanent facial complications could be reduced. In Korea, various procedures not clearly unverified or unproven such as acupuncture treatment, massage therapy and thermotherapy are performed without standards regimen instead of administering steroid to patients with acute facial paralysis in the early stages. It has been already known that any initial trials with un-established treatment without full understanding of pathophysiology of facial nerve injury worsen prognosis after acute facial paralysis. There are reports showing that the prognosis of Korean patients with Bell's palsy is worse than globally known prognosis of patients with Bell's palsy. Such reports may reflect unverified procedures and consequently putting off steroid treatment in the early stages. Therefore, this is a paper intended to investigate issues occurring in treating a patient with acute facial paralysis in Korea in order to prepare the medical guidelines for the better solution.

How to Avoid Facial Nerve Injury in Mastoidectomy?

Unexpected iatrogenic facial nerve paralysis not only affects facial disfiguration, but also imposes a devastating effect on the social, psychological, and economic aspects of an affected person's life at once. The aims of this study were to postulate where surgeons had mistakenly drilled or where obscured by granulations or by fibrous bands and to look for surgical approach with focused on the safety of facial nerve in mastoid surgery. We had found 14 cases of iatrogenic facial nerve injury (IFNI) during mastoid surgery for 5 years in Korea. The medical records of all the patients were obtained and analyzed injured site of facial nerve segment with surgical technique of mastoidectomy. Eleven patients underwent facial nerve exploration and three patients had conservative management. 43% (6 cases) of iatrogenic facial nerve injuries had occurred in tympanic segment, 28.5% (4 cases) of injuries in second genu combined with tympanic segment, and 28.5% (4 cases) of injuries in mastoid segment. Surgeons should try to identify the facial nerve using available landmarks and be kept in mind the anomalies of the facial nerve. With use of intraoperative facial nerve monitoring, the avoidance of in order to avoid IFNI would be possible in more cases. Many authors emphasized the importance of intraoperative facial nerve monitoring, even in primary otologic surgery. However, anatomical understanding of intratemporal landmarks with meticulous dissection could not be emphasized as possible to prevent IFNI.

Differences in clinical features between cholesteatoma in external auditory meatus and middle ear / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#Differences in clinical features, especially facial nerve canal leision between cholesteatoma in external auditory meatus and middle ear were compaired.@*METHOD@#A retrospective clinical analysis was made. Clinical data included 125 cases of middle ear cholesteatoma with facial nerve canal leision and 28 cases of cholesteatoma occurred in external auditory canal from 2003-01-2014-08 in our hospital.@*RESULT@#Clinical course of cholesteatoma in external auditory canal was 4.97 ± 7.51 years, course of middle ear cholesteatoma was 16.60 ± 14.42 years (P < 0.01). 21 cases (75%) of external auditory canal cholesteatoma were manifested as pneumatic mastoid and 110 cases (88%) of middle ear cholesteatoma were manifested as diploic mastoid respectively. 22 cases (78.6%) of facial nerve canal damage-in mastoid segment in cholesteatoma of external auditory meatus and 76 cases (60.8%) of facial nerve canal damage in tympanic segment in cholesteatoma of middle ear were observed (P < 0.01). The incidence rate of ossicular errosion in middle ear chol-esteatoma was significantly higher than that in external auditory meatus (P < 0.01). The incidence of semicircular canal defects in middle ear cholesteatoma (30.4%), was significantly higher when comparing to the incidence (10.7%) in cholesteatoma of external auditory meatus (P < 0.05).@*CONCLUSION@#The site of facial nerve canal lesion in middle ear cholesteatoma and cholesteatoma of external auditory meatus were different. More attention should be paid before and during operation to avoid facial nerve injury, including physical examinations, especial otologic exams, radiological reading and careful operation.