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Tuberculosis of the Temporal Bone
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Surgery may be required to obtain tissue for histology, drain a subperiosteal abscess or remove a bony sequestrum.4,18 The incidence of sequestrum formation may be as high as 30%.27 Surgery may be indicated in the presence of facial nerve palsy for the purposes of a facial nerve decompression if medical management fails to demonstrate clinical improvement in facial nerve function.4,18
Movement Disorders
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
Much more common is hemifacial spasm, in which intermittent rapid twitchy movements start at the lateral border of orbicularis oculi and spread to synchronously involve orbicularis oris on the same side. In addition, the affected side of the face may be drawn up by more prolonged spasms, and often there is mild facial weakness on the same side. The cause is usually irritation of the facial nerve entry zone by a pulsatile aberrant blood vessel. Most patients are helped by botulinum toxin injections. A more invasive, but usually permanently effective, alternative is facial nerve decompression via a posterior craniotomy.
Clinical efficacy of the ‘sandwich technique’ in repairing cholesteatoma with labyrinthine fistula
Published in Acta Oto-Laryngologica, 2022
Huanhuan Sun, Taiqin Wang, Liangwen Shi, Suling Zhuang, Jianzhi Liu
All of these patients had been treated by canal wall down mastoidectomy (CWDM) or canal wall up mastoidectomy (CWUM) with tympanoplasty. The cholesteatoma epithelium covering the labyrinth fistula is left until the final surgical treatment, gently peeled the cholesteatoma matrix from the fistula with a small cotton ball and particular care was applied in order to not suck the perilymph. Once the fistula is exposed, injected with dexamethasone (Figure 1); thereafter, the site was immediately sealed off using a ‘sandwich’ of the temporalis fascia, bone powder or cartilage, and temporalis fascia (Figure 2). Ossiculoplasty was carried out simultaneously in 31 cases (14 total ossicular replacement and 16 partial ossicular replacements). We performed facial nerve decompression on two patients with facial paralysis (decompression until normal epineurium is exposed). Muscle periosteal flaps were used to narrow the mastoid cavity, and gelatin sponges were used to maintain the reconstruction in place. Antibiotics were used for 3–7 days (mean 5 days) after surgery to prevent infection. All the surgeries were performed by the same surgeon.
Total facial nerve decompression in severe idiopathic recurrent facial palsy: its long-term follow-up results
Published in Acta Oto-Laryngologica, 2019
Fang Xing, Yudan Ouyang, Xiaowen Li
There has been much debate on surgical decompression in facial palsy. However, the majority of researchers believe that surgical decompression is beneficial if the proportion of facial nerve degradation arrives at no less than 90–95% based on electroneurography. Fisch [18] proved that patients missed 50% of opportunity to acquire autonomous good facial nerve recovery if no less than 95% of degradation was achieved in less than 2 weeks subsequent to the 1st attack. Gantz et al. [19] carried out facial nerve decompression in those who displayed more than 90% of degradation according to electroneurography and lacked voluntary motor unit potentials according to electromyography in less than 14 days of thorough paralysis. He discovered that 91% of participants who received operation reached grade I or II compared to 42% in non-surgery group. In consideration of our research, every participant reached more than 95% of facial nerve degradation prior to therapy. 88.9% participants who received operation reached grade I or II but only 33.3% in control group achieved satisfactory outcomes (p < .05), demonstrating that surgical decompression was beneficial to enhancing facial nerve recovery with regard to patients with over 95% of facial nerve degradation. Li et al. [17] stated that TFND had no influence on reinforcement of facial nerve recovery from IRFP. Findings of our research differed from the research above because only those with more than 95% of FN degradation were recruited in our research, which was narrower than their including criteria.
Analysis on outcomes of facial paralysis complicated by middle ear cholesteatoma
Published in Acta Oto-Laryngologica, 2019
Qiang Li, Yanfei Jia, Qian Feng, Bo Tang, Xiaodong Luo, Peng Xu, Daowen Wang, Xuanfen Zhang
Facial paralysis is an uncommon complication of chronic otitis media, especially middle ear cholesteatoma (MEC). The reported incidence of facial paralysis in chronic otitis media ranges from 0.16 to 5.1% [1,2]. For such facial paralysis, conservative and surgical treatments are usually applied according to previous reports. Surgical treatments consist of facial nerve exploration, facial nerve decompression, facial nerve repair and facial nerve grafting [3–5]. For facial paralysis complicated by MEC, radical or modified radical mastoidectomy is usually applied to completely remove the cholesteatoma and the lesions, and intraoperative exploration is adopted. If necessary, facial nerve decompression will be performed. The prognostic factors of facial paralysis complicated by MEC are still largely unclear due to limited reports and smaller sample size, although it seems that early surgical intervention leads to better facial nerve outcomes [6,7]. Therefore, we performed a retrospective analysis on a large series of patients with facial paralysis complicated by MEC who received surgical treatment to analyze prognostic factors of facial paralysis.