Surgical results for one-stage VII/VIII schwannoma resection and hemihypoglossal-facial neurorrhaphy.

BACKGROUND: This retrospective study evaluated the outcomes of patients undergoing one-stage resection of VII/VIII schwannomas and hemihypoglossal-facial neurorrhaphy via the translabyrinthine approach (TLA). METHODS: The study encompassed ten consecutive patients with unilateral hearing loss (six women, four men, mean age: 49.5 ± 12.1 years) who underwent surgery. The cohort included two patients with vestibular schwannomas (VSs), four with facial nerve schwannomas (FNSs) (two originating from the geniculate ganglion of the facial nerve and two from the cerebellopontine angle), one with VS regrowth, and three with residual VSs. Preoperative facial nerve function, assessed using the House-Brackmann (HB) scale, was Grade V in one and Grade VI in nine patients. The mean preoperative duration of facial paralysis was 7.5 ± 6.9 months. RESULTS: All patients underwent gross total resection. Postoperatively, one patient experienced cerebrospinal fluid leaks, which were successfully managed with lumbar drains and surgical revisions. At follow-up, facial nerve function improved in all patients: HB Grade V to III in one, HB Grade VI to III in one, HB Grade VI to IV in seven, and Grade VI to V in one. No tumor recurrence was observed during the follow-up period (mean duration: 16.6 ± 9.3 months), and no patient had hemilingual atrophy. CONCLUSION: The TLA for one-stage resection of VII/VIII schwannomas and facial nerve reconstruction is effective in treating both regrowth and residual VSs and FNSs in the cerebellopontine angle or petrosal bone in patients with severe preoperative facial palsy. This technique facilitates simultaneous tumor removal and nerve anastomosis, thereby reducing the need for multiple surgical interventions in patients with hearing loss and compromised facial nerve function.

The Role of Temporal Bone Pneumatization on Fracture Line and Involved Cranial Structures.

OBJECTIVE: Temporal bone pneumatization (TBP) is speculated to serve as a shock absorber in temporal bone fractures (TBF), directing the fracture line away from vital structures. This study correlates TBP extent with TBF patterns and preservations of vital TB structures. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral medical center. METHODS: All TBF patients referred to a single tertiary center 2017 to 2023 were evaluated. A pneumatization index score for each of their TBs was derived by counting automated-voxel density in a 0 to 100 scale. Results were correlated to the TBF type and the violated structure(s). The ossification index was compared to previously detailed qualitative classification systems of TBP. RESULTS: One hundred and forty-five patients were enrolled (mean age 43 ± 17 years). Kinematics were motor vehicle accidents (46%), scooter (15%), bicycle (14%), falls (13%), and assaults (8%). The mastoid ossification index we used showed a strong correlation to all qualitative classification systems (sigmoid = 0.829; labyrinthine = 0.849; carotis = 0.863, infralabyrinthine = 0.869, all P < .001). The pneumatization index strongly correlated with capsule-violating TBFs, with a mean of 44 ± 23 for otic capsule-sparing TBF and 61 ± 20 for otic capsule-violating (OCV) TBF (P < .001). The facial nerve was violated in 30 patients. Facial canal (FC) involvement was not correlated to the ossification index: it was 49 ± 23 for FC-sparing and 44 ± 23 for FC-violating (P = .620). CONCLUSION: TBP serves as a protective mechanism against OCV TBF. The more pneumatized the TB, the less likely the otic capsule will be violated in the event of a TBF with the exception of the carotid and FCs. TBP index is in strong agreement with qualitative TBP classification systems.

The functional and biological effects of systemic dexamethasone on mice with facial nerve crushing injury.

BACKGROUND: Corticosteroid therapy is commonly recommended for acute facial nerve weakness; however, its effectiveness in treating traumatic nerve injuries remains controversial. This study investigated the functional recovery and cellular effects of systemic dexamethasone administration after facial nerve injury. METHODS: C57BL/6 mice were assigned to two groups by intraperitoneal injection: the phosphate-buffered saline group and the dexamethasone group. Facial nerve crush injury was induced, followed by the functional grading of recovery. Cellular effects were investigated using transmission electron microscopy, flow cytometry, immunofluorescence, and intravital imaging. RESULTS: Macrophage infiltration into the facial nerves was significantly inhibited by systemic dexamethasone administration. However, dexamethasone group slightly delayed the functional recovery of the facial nerve compared to the PBS group. In addition, the morphological changes in the nerve were not significantly different between the two groups at 14 days post-injury. Macrophage migration analysis in the intravital imaging also showed no difference between groups. CONCLUSIONS: In summary, systemic dexamethasone successfully inhibited leukocyte infiltration; however, functional recovery was delayed compared to the PBS control group. Clinically, these findings indicate that more evidence and research are required to use steroid pulse therapy for the treatment of traumatic facial nerve injuries.

The Use of Mirror Therapy in Peripheral Seventh Nerve Palsy: A Systematic Review.

BACKGROUND: Conservative therapy is currently the elective treatment for peripheric facial palsy according to scientific literature. The success of conservative therapy is due to physiotherapy and the application of its methods. The aim of this systematic review was to assess mirror therapy, a physiotherapeutic method. OBJECTIVES: The aim of the following systematic review is to evaluate the effectiveness of using mirror therapy in patients with peripheral paralysis of the seventh cranial nerve. METHODS: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The screening of literature was carried out on Cochrane, PEDro, PubMed/Medline, Scopus and Web of Science databases up until August 2022. All studies were randomized controlled trials (RCTs) and 5 articles met the inclusion criteria and were included in this study. The risk of bias was evaluated with PEDro and Jadad scales. DISCUSSION: In the present study, we reviewed 5 RCTs that compared mirror therapy with other physiotherapy treatments or placebo to reduce pain, depression and improve range of motion in patients with peripheric facial nerve palsy. CONCLUSIONS: Further studies are needed to determine the effectiveness of this type of treatment, but nevertheless the data obtained are very encouraging.

Comparative Analysis on Vestibular Schwannoma Surgery with and without Intraoperative Fluorescein Sodium Enhancement.

BACKGROUND: Vestibular schwannoma (VS), also known as acoustic neuroma, is a benign, well-encapsulated, and slow-growing tumor that originates from Schwann cells, which form the myelin sheath around the vestibulocochlear nerve (VIII cranial nerve). The surgical treatment of this condition presents a challenging task for surgeons, as the tumor's location and size make it difficult to remove without causing damage to the surrounding structures. In recent years, fluorescein sodium (FS) has been proposed as a tool to enhance surgical outcomes in VS surgery. This essay will provide an analytical comparison of the use of FS in VS surgery, evaluating its benefits and limitations and comparing surgical outcomes with and without FS-assisted surgery. METHODS: In a retrospective study conducted at San Filippo Neri Hospital, we examined VS cases that were operated on between January 2017 and December 2023. The patients were divided into two groups: group A, which consisted of patients who underwent surgery without the use of FS until January 2020 (102 cases), and group B, which included patients who underwent surgery with FS after January 2020 (55 cases). All operations were performed using the retrosigmoid approach, and tumor size was classified according to the Koos, et al. classification system. The extent of surgical removal was evaluated using both the intraoperative surgeon's opinion and postoperative MRI imaging. Preoperatively and postoperatively, facial nerve function and hearing were assessed. In group B, FS was used to assist the surgical procedures, which were performed using a surgical microscope equipped with an integrated fluorescein filter. Postoperative clinical and MRI controls were performed at six months and annually, with no patients lost to follow-up. RESULTS: This study investigated the impact of intraoperative fluorescein exposure on tumor resection and clinical outcomes in patients with VS. The study found a statistically significant difference in the tumor resection rates between patients who received fluorescein intraoperatively (p = 0.037). Further analyses using the Koos classification system revealed a significant effect of fluorescein exposure, particularly in the Koos 3 subgroup (p = 0.001). Notably, no significant differences were observed in hearing loss or facial nerve function between the two groups. A Spearman correlation analysis revealed a positive correlation between tumor size and Koos, age, and size, but no significant correlation was found between facial nerve function tests. CONCLUSIONS: FS-assisted surgery for VS may potentially enhance tumor resection, allowing for more comprehensive tumor removal.

Induction of Nitric Oxide and Its Role in Facial Nerve Regeneration According to the Method of Facial Nerve Injury.

Nitric oxide (NO) is an important molecule in cell communication that also plays an important role in many biological processes. Given the dual role of NO in nerve degeneration and regeneration after facial nerve injury, we sought to delve deeper into its role through a systematic literature review. A comprehensive review of the literature employing SCOPUS, PubMed, Cochrane Library, EMBASE, and Google Scholar databases was conducted to evaluate the induction and role of NO in neurodegeneration and regeneration after facial nerve injury. From the 20 papers ultimately reviewed, the central findings were that neuronal nitric oxide synthase(nNOS), endothelial nitric oxide synthase (eNOS), and induced nitric oxide synthase (iNOS) increased or decreased depending on the method of facial nerve damage, damaged area, harvested area, and animal age, and were correlated with degeneration and regeneration of the facial nerve. Research conducted on rats and mice demonstrated that NO, nNOS, eNOS, and iNOS play significant roles in nerve regeneration and degeneration. However, the relationship between nerve damage and NO could not be defined by a simple causal relationship. Instead, the involvement of NOS depends on the type of nerve cell, source of NO, timing, and location of expression, age of the target animal, and proximity of the damage location to the brainstem. Consequently, nNOS, eNOS, and iNOS expression levels and functions may vary significantly.

Management of Petrous Bone Cholesteatoma: The Gruppo Otologico Experience.

BACKGROUND: The term petrous bone cholesteatoma (PBC) refers to lesions extending deep to the bony labyrinth via superior, inferior, and posterior cell tracts. PBC is a rare incidence accounting for only 4-9% of petrous bone lesions. Lesions of petrous bone represent a real surgical challenge due to its complex relationship with critical neurovascular structures. OBJECTIVE: To demonstrate our 40-plus years' experience in the management of PBC, depict the clinical features of PBC according to Sanna's Classification, evaluate the postoperative follow-up of surgically treated PBC patients, and determine the recurrence rate. STUDY DESIGN: Retrospective medical record review. MATERIAL AND METHODS: Medical records of 298 PBC cases operated from the year 1983 to 2024 were thoroughly evaluated. RESULTS: A total of 298 PBC cases were surgically treated at our center. The average age at presentation in this series was 47 years. Males are more affected than females with a male-to-female ratio of 2.2:1. The most common presenting symptoms were hearing loss (84%), tinnitus (48%), and facial nerve paralysis (45%). Mixed hearing loss (41%) was the commonest audiometric pattern of hearing loss followed by conductive hearing loss (26%) and profound sensorineural hearing loss (4%) and a total of 86 (29%) had anacusis at presentation. On preoperative facial nerve function examination, 133(45%) of patients had various degrees of paresis and complete paralysis whereas 55% had normal HB-I function. The commonest degree of paresis noted was HB-III (18%) followed by HB-VI (5%). A total of 150 (50%) patients had previous otologic surgery and two-thirds of these cases had two or more prior otologic surgeries. According to Sanna's PBC Classification system, we identified that the supralabyrinthine class (44%) is the commonest of all classes followed by massive (33%), infralabyrinthine-apical (9%), infralabyrinthine(8%), and apical (5%) classes in that order. However, only ten patients had congenital type of PBC. Extension to clivus, sphenoid, nasopharynx, intradural space, and occipital condyle was found in 8, 2, 1, and 2 cases respectively. The most commonly used surgical approaches at our center were TO, MTCA with rerouting of the facial nerve, and TLAB with external auditory canal (EAC) closure. Postoperative complications were minimal and the duration of follow-up ranged from one to 458 months with a mean duration of 65 months. Residual lesions were evident in 11 cases (3.7%), with the surgical cavity, middle and posterior fossa dura, and jugular bulb being the commonest sites. CONCLUSION: Petrous bone cholesteatoma represents diagnostically and surgically challenging lesions of temporal bone which are usually frustrating to the treating surgeon. A high index of clinical suspicion, thorough clinical evaluation examination, and preoperative radiologic evaluation make the diagnosis easier. Preoperative anatomic classification of the lesion enables the physician to choose the appropriate surgical approach. Sanna's classification is widely used to classify PBC in relation to the labyrinthine block. Radical disease removal should always come before hearing preservation. Cavity obliteration is the solution to the problems related to a large cavity. Finally, advancements in lateral skull base approaches create adequate surgical access for the complete removal of the lesion with excellent control of critical neurovascular structures.

Anatomical features of the mastoid segment of the facial canal.

BACKGROUND: Considering the tortuous course of the facial canal that houses the facial nerve, the stylomastoid artery and the homonymous vein, its morphological features are of great clinical significance in otologic, maxillofacial, oncologic, reconstructive and plastic surgery of the head and neck. The aim of this paper was to determine the individual specific features of the mastoid segment of facial canal and of the stylomastoid foramen. MATERIAL AND METHODS: The study was carried out on 82 temporal bones (41 right/41 left), at the Department of anatomy and clinical anatomy of Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova. The morphometry of the mastoid segment of the facial canal and of the stylomastoid foramen was performed. The morphometric parameters were statistically analyzed by descriptive and inferential statistics methods. RESULTS: The mastoid segment exited the facial canal by an obtuse, right and sharp angles, with a mean value of 113.1 ± 21.80° (right/left - 112.1 ± 23.85°/114.1 ± 19.76°), p = 0.701. The mean length of the mastoid segment was 15.1 ± 3.78 mm (right/left - 15.7 ± 3.66 mm/14.5 ± 3.84 mm), p = 0.153. The longitudinal diameter of the stylomastoid foramen had a mean of 3.0 ± 0.93 mm (right/left - 3.3 ± 0.96 mm/2.7 ± 0.81 mm), p = 0.007. The transverse diameter had a mean of 2.6 ± 0.74 mm (right/left - 2.9 ± 0.80 mm/2.4 ± 0.60 mm), p = 0.012. CONCLUSIONS: In otologic surgery and particularly in mastoidectomy, it should be taken into consideration that the mastoid segment of the facial canal could exit the temporal bone by a sharp, right and obtuse angles that along with high morphological variability of the stylomastoid foramen might be a predisposal factor for Bell's palsy.

The Relationship Between the Retromandibular Vein and the Extratemporal Segment of the Facial Nerve: A Prospective Cadaveric Study of 24 Hemifaces.

INTRODUCTION: Anatomical preservation and functional integrity of the facial nerve (FN) are the main concerns of parotid surgery. Even though a variety of anatomical landmarks have been proposed and widely utilized, temporal or permanent postoperative FN palsy is still a significant comorbidity of parotid surgery. Therefore, the literature must fully elucidate the consistency of the anatomical relationship between the FN and the retromandibular vein (RMV). METHODS: We conducted a cadaveric study of 24 hemifaces to map the relationship between the FN and the RMV. Three distinct patterns were identified. Fourteen of the hemifaces were males, and 10 were females. Thirteen cadaveric dissections were performed on the right side and 11 on the left side. RESULTS: Our study found three distinct patterns and proposed a classification system. Type I (66.7%) is when the nerve lies exclusively lateral to the RMV. Type II (29.2%) is when the FN lies superficial to the RMV, but its mandibular branch lies deep to the anterior branch of the RMV, and type III (4.1%) is when the FN lies exclusively medial to the RMV. CONCLUSION: The FN and RMV relationship is not constant, and surgeons should be aware of every anatomical variation. Especially in cases where the FN is estimated to lie more in-depth to the level of the RMV, a retrograde approach may be required to avoid a FN injury.

An updated protocol for mandibular reconstruction in nongrowing patients with craniofacial microsomia with temporomandibular joint total prosthesis.

The authors aim to present an updated protocol for mandibular reconstruction in nongrowing patients with Pruzansky/Kaban type IIb/III congenital craniofacial microsomia with customized temporomandibular joint (TMJ) prosthesis to reduce facial nerve (FN) damage and improve surgical accuracy. This is illustrated (using 3 cases) and is based on preoperative mapping of the FN using MRI for better virtual surgical planning of custom-made TMJ prosthesis. Intraoperative FN mapping and monitoring, as well as verification of the final result with intraoperative cone-beam computed tomography (CBCT) and 3D-reconstructed images is also achieved. All 3 patients presented mild transient postoperative facial palsy due to surgical soft tissue stretching which resolved within 2 months of surgery. All patients presented proper occlusion and mouth opening without pain, with an average incisal opening of 38.8 mm (range 35.5-42 mm) at two months of follow-up. Moreover, superposition of intraoperative and preoperative 3D reconstruction images ensured surgical accuracy and avoided the need for a potential reintervention. In conclusion, the proposed surgical protocol for mandibular reconstruction with customized alloplastic TMJ prosthesis in nongrowing patients with type IIb/III Pruzansky-Kaban congenital mandibular hypoplasia may reduce FN morbidity, improve surgical accuracy and final outcomes.

Graphene/ chitosan tubes inoculated with dental pulp stem cells promotes repair of facial nerve injury.

Introduction: Facial nerve injury significantly impacts both the physical and psychological] wellbeing of patients. Despite advancements, there are still limitations associated with autografts transplantation. Consequently, there is an urgent need for effective artificial grafts to address these limitations and repair injuries. Recent years have witnessed the recognition of the beneficial effects of chitosan (CS) and graphene in the realm of nerve repair. Dental pulp stem cells (DPSCs) hold great promise due to their high proliferative and multi-directional differentiation capabilities. Methods: In this study, Graphene/CS (G/CST) composite tubes were synthesized and their physical, chemical and biological properties were evaluated, then DPSCs were employed as seed cells and G/CST as a scaffold to investigate their combined effect on promoting facial nerve injury repair. Results and Disscussion: The experimental results indicate that G/CST possesses favorable physical and chemical properties, along with good cyto-compatibility. making it suitable for repairing facial nerve transection injuries. Furthermore, the synergistic application of G/CST and DPSCs significantly enhanced the repair process for a 10 mm facial nerve defect in rabbits, highlighting the efficacy of graphene as a reinforcement material and DPSCs as a functional material in facial nerve injury repair. This approach offers an effective treatment strategy and introduces a novel concept for clinically managing facial nerve injuries.

Left Hemifacial Spasms Due to Left Vertebrobasilar Dolichoectasia.

Hemifacial spasm (HFS) arises from involuntary, recurrent, irregular tonic-clonic-like contractions of the muscles innervated by the facial nerve. Typically, compression of the facial nerve root exit on the same side is attributed to either a vascular loop or a mass located in the cerebellopontine (CP) angle. Dolichoectasia, alternatively termed dilated arteriopathy, is characterized by arterial dilatation, elongation, and tortuosity. Here, we present a case involving vertebrobasilar dolichoectasia (VBD) as the cause of HFS, alongside relevant imaging findings.

Epiphora and Hyperlacrimation as Paradoxical Manifestations of Facial Nerve Injury: Mechanistic Insights.

The incidence of facial nerve paralysis is approximately 30 per 100,000 persons annually. Although it is often idiopathic, as in Bell's palsy, it can also result from infections, trauma, or neoplasms. Facial nerve paralysis may present with partial or total facial paresis, lagophthalmos, denervation of the lacrimal gland, and other ocular abnormalities. While dry eye is a commonly expected outcome of facial nerve injury, some patients may paradoxically experience epiphora and hyperlacrimation. In this review, we examine this phenomenon and its mechanisms in facial nerve injury. Several mechanisms have been proposed for epiphora and hyperlacrimation, including aberrant axonal regeneration, which is known to cause crocodile tears syndrome; ocular irritation due to dry eye, resulting in increased reflex lacrimation due to disruption of the tear film; and impaired drainage of tears caused by paralysis of the orbicularis oculi muscle and malposition of the eyelids. Understanding the pathophysiology of these symptoms is crucial in guiding the management of patients with facial nerve injury. Further experimental and clinical studies focusing on the quantification of tear production and localization of nerve damage will help improve our understanding of the neuroanatomical correlates of this paradoxical manifestation.

Facial nerve electrical motor evoked potential in cerebellopontine angle tumors for its anatomical and functional preservation.

Background: Among the technical measures to preserve facial nerve (FN) function, intraoperative neuromonitoring has become mandatory and is constantly being scrutinized. Hence, to determine the efficacy of FN motor evoked potentials (FNMEPs) in predicting long-term motor FN function following cerebellopontine angle (CPA) tumor surgery, an analysis of cases was done. Methods: In 37 patients who underwent CPA surgery, FNMEPs through corkscrew electrodes positioned at C5-C6 and C6-C5 (C is the central line of the brain as per 10-20 EEG electrode placement) were used to deliver short train stimuli and recorded from the orbicularis oculi, oris, and mentalis muscles. Results: In 58 patients, triggered electromyography (EMG) was able to identify the FN during resection of tumor, but 8 out of these (4.64%) patients developed new facial weakness, whereas 3 out of 38 (1.11%) patients who had intact FN function MEP (decrement of FN target muscles - CMAPs amplitude peak to peak >50-60%), developed new facial weakness (House and Brackmann grade II to III). Conclusion: The FNMEP has significant superiority over triggered EMG when tumor is giant and envelops the FN.

Multiple Cranial Nerve Palsies Without Limb Weakness: A Rare Cranial Variant of Guillain-Barré Syndrome.

We herein report a case of an unusual variant of Guillain-Barré syndrome (GBS) where the patient presented with multiple bilateral cranial nerve palsies involving nerves V, VII, IX, and X, leading to difficulties with eye closure, eyebrow-raising, chewing, swallowing, and speech. Sensation and motor examination were normal. Bilateral knee reflexes were absent. Lumbar puncture showed cerebrospinal fluid albuminoid-cytologic dissociation. Prompt initiation of plasmapheresis therapy facilitated a successful recovery. This case report underscores the significance of early identification and tailored intervention for atypical GBS presentations, highlighting the potential for improved patient outcomes through targeted management strategies.

Preoperative diffusion tensor imaging: Fiber-trajectory-distribution-based tractography to identify facial nerve in vestibular schwannoma.

PURPOSE: Tractography of the facial nerve based on diffusion MRI is instrumental before surgery for the resection of vestibular schwannoma, but no excellent methods usable for the suppression of motion and image noise have been proposed. The aim of this study was to effectively suppress noise and provide accurate facial nerve reconstruction by extend a fiber trajectory distribution function based on the fourth-order streamline differential equations. METHODS: Preoperative MRI from 33 patients with vestibular schwannoma who underwent surgical resection were utilized in this study. First, T1WI and T2WI were used to obtain mask images and regions of interest. Second, probabilistic tractography was employed to obtain the fibers representing the approximate facial nerve pathway, and these fibers were subsequently translated into orientation information for each voxel. Last, the voxel orientation information and the peaks of the fiber orientation distribution were combined to generate a fiber trajectory distribution function, which was used to parameterize the anatomical information. The parameters were determined by minimizing the cost between the trajectory of fibers and the estimated directions. RESULTS: Qualitative and visual analyses were used to compare facial nerve reconstruction with intraoperative recordings. Compared with other methods (SD_Stream, iFOD1, iFOD2, unscented Kalman filter, parallel transport tractography), the fiber-trajectory-distribution-based tractography provided the most accurate facial nerve reconstructions. CONCLUSION: The fiber-trajectory-distribution-based tractography can effectively suppress the effect of noise. It is a more valuable aid for surgeons before vestibular schwannoma resection, which may ultimately improve the postsurgical patient's outcome.

A full-head model to investigate intra and extracochlear electric fields in cochlear implant stimulation.

OBJECTIVE: Despite the widespread use and technical improvement of cochlear implant (CI) devices over past decades, further research into the bioelectric bases of CI stimulation is still needed. Various stimulation modes implemented by different CI manufacturers coexist, but their true clinical benefit remains unclear, probably due to the high inter-subject variability reported, which makes the prediction of CI outcomes and the optimal fitting of stimulation parameters challenging. A highly detailed full head model that includes a cochlea and an electrode array is developed in this study to emulate intracochlear voltages and extracochlear current pathways through the head in CI stimulation. APPROACH: Simulations based on the finite element method were conducted under monopolar, bipolar, tripolar, and partial tripolar modes, as well as for apical, medial, and basal electrodes. Variables simulated included: intracochlear voltages, electric field (EF) decay, electric potentials at the scalp and extracochlear currents through the head. To better understand CI side effects such as facial nerve stimulation, caused by spurious current leakage out from the cochlea, special emphasis is given to the analysis of the EF over the facial nerve. MAIN RESULTS: The model reasonably predicts EF magnitudes and trends previously reported in CI users. New relevant extracochlear current pathways through the head and brain tissues have been identified. Simulated results also show differences in the magnitude and distribution of the EF through different segments of the facial nerve upon different stimulation modes and electrodes, dependent on nerve and bone tissue conductivities. SIGNIFICANCE: Full head models prove useful tools to model intra and extracochlear EFs in CI stimulation. Our findings could prove useful in the design of future experimental studies to contrast FNS mechanisms upon stimulation of different electrodes and CI modes. The full-head model developed is freely available for the CI community for further research and use.

Endoscopic trans-canal facial nerve decompression in Melkersson-Rosenthal syndrome: A novel approach.

Key Clinical Message: Melkersson-Rosenthal syndrome can cause recurring bilateral facial paralysis. When steroids fail, surgical decompression of facial nerve is recommended, with endoscopic trans-canal decompression as a safe, minimally invasive, and effective option. Abstract: Melkersson-Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous disorder, clinically diagnosed by a triad of orofacial swelling, recurrent facial palsy, and fissured tongue. Due to the lack of a comprehensive understanding of MRS, there is no accepted standard of care. In this study we report a 30-year-old female patient, who was referred to the otolaryngology clinic of Rasool Akram Hospital, with classical triad of MRS that was managed by endoscopic trans-canal facial nerve decompression. Bilateral endoscopic trans-canal facial nerve decompression was done when we did not find any improvement with systemic steroids. Endoscopic trans-canal facial nerve decompression could be a safe, reliable minimal invasive treatment of facial paralysis in MRS patients. It needs no external incision or temporal bone drilling which makes this method more convenient for patients with shorter recovery time.

Physiotherapy in Bell's Palsy Secondary to Acute Otitis Media: A Case Report.

Acute suppurative otitis media can occasionally result in facial paralysis, which calls for prompt diagnosis and treatment. Facial paralysis, a synonym for Bell's palsy, is a condition that causes rapid weakening of one side of the face muscles, leading to drooping of the face on that side. A major factor in determining the course of the condition is rehabilitation through physiotherapy. Here, we present a case of a 26-year-old female who felt discomfort in her left ear on February 21, 2024, but chose to ignore it then. She observed an abrupt deviation in her mouth and visited a rural hospital, where she was admitted. Facial asymmetry was observed during the examination, and she was found to have a grade V on the House-Brackmann scale. A near-normal muscle action was initiated by mime therapy, and proprioceptive stimulation was given by facial proprioceptive neuromuscular facilitation along with electrical stimulation. All these approaches benefited the patient in a significant manner.

Patterns and timing of recovery from facial nerve palsy after nerve-sparing parotid surgery: the role of neuromuscular retraining.

OBJECTIVES: Among the complications of parotid surgery, facial palsy is frequent and burdened by high functional and social impact for the patient. There are few data on the efficacy of facial neuromuscular retraining (FNR) in patients with facial palsy after parotid surgery, and no data exist on its impact in timing and extent of recovery. MATERIAL AND METHODS: A retrospective study was conducted on patients undergoing FN sparing parotid surgery and suffering from postoperative facial palsy. Among 400 patients undergoing surgery between July 2016 and May 2023, those with the preservation of the FN and onset of facial palsy were selected. Nerve function was evaluated during 2 years follow up using the House-Brackman (H&Bs) and Sunnybrook scales (SBs). RESULTS: A total of 46 patients undergoing partial or total parotidectomy were included. At discharge 18 patients (39,1%) had IV to VI grade paralysis according to the H&Bs and the mean SBs value was 54. At 2 and 6 months after surgery, the average value of Sunnybrook increased to 76.5 and 95.4 respectively. After 12 months no patients with IV to VI grade paralysis were represent in our cohort. Two years after surgery, only five patients (10.9%) had persistent grade II paralysis according to HBs. CONCLUSIONS: Our study supports the efficacy of FNR in the rehabilitation of facial paralysis after nerve-sparing parotidectomy. The greater functional improvement is achieved within the first 6 months of rehabilitation. A significant improvement is detected still after 18 months, supporting the importance of long rehabilitation for patients without complete recovery after the first year.