This study aimed to compare rates of facial nerve dysfunction after superficial parotidectomy with and without continuous intraoperative electromyographic monitoring. The prospective randomized pilot study assigned patients undergoing superficial parotidectomy for parotid tumors to either standard surgery alone or surgery with continuous electromyographic monitoring of the facial nerve. The main outcome measured was rates of transient facial nerve dysfunction within the first postoperative week. The study aimed to provide insight into whether continuous electromyographic monitoring during surgery could help reduce rates of facial nerve injury and dysfunction.
A 54 year old female, with history of uncontrolled Diabetes Mellitus presented with complaints of progressively severe frontal headaches with associated nausea and dizziness.
CT scan of the head revealed a 10 cm frontal bone lytic lesion extending into the nasal bones with evidence of sequestrum. Mucosal thickening and opacification of the frontal sphenoid and ethmoid sinuses was also noted. MRI was consistent with CT finding and revealed further cortical destruction of frontal calvarium outer table along with para-meningeal and dural enhancement. CSF studies were negative. Patient was started on intravenous antifungal therapy with Amphotericin B lipid complex. Frontal sinus trephination with irrigation/aspiration and simultaneous diagnostic nasal endoscopy revealed no frank pus or necrosis.
Aspirate’s bacterial and fungal culture were negative.
Patient underwent an open incision trephination of frontal sinus that revealed destruction/moth-eaten appearance of the anterior table of the frontal sinus, biopsies were taken, No pus was encountered.
Surgical treatment of paraphyrngeal and retropharyngeal abscessesMamoon Ameen
The document discusses various deep neck spaces including the parapharyngeal and retropharyngeal spaces. It describes parapharyngeal and retropharyngeal abscesses, including their etiology, clinical features, investigations, and surgical treatment which involves securing the airway followed by either a transoral or transcervical approach to drain the abscess completely while protecting nearby structures.
This document discusses the "danger area of the face" - the upper lip, lower part of the nose, and adjacent area, also known as the "triangle of death." Infections and injuries in this area can readily spread to the cavernous sinus through the anterior facial vein, resulting in the serious condition of cavernous sinus thrombosis. The anterior facial vein has no valves, allowing for bi-directional blood flow. This area of the face also lacks deep fascia, which normally acts as a barrier to the spread of infection. Early and aggressive antibiotic treatment administered intravenously for 3-4 weeks is the mainstay of therapy for cavernous sinus thrombosis.
The document summarizes the anatomy and functions of the pharynx. It is a fibromuscular tube approximately 12-14 cm long located behind the nasal cavity, mouth, and larynx. It functions in respiration, swallowing, and sound resonance. The pharynx has three parts - nasopharynx, oropharynx, and laryngopharynx. Its walls consist of mucosa, pharyngeal aponeurosis, a muscular coat with three constrictor muscles, and an outer buccopharyngeal fascia. The pharynx is supplied by branches of the vagus and glossopharyngeal nerves and drains into deep cervical lymph nodes.
Cavernous sinus thrombosis is a blood clot that forms within the cavernous sinus, a vein at the base of the brain. It typically results from a nearby infection spreading through tributary veins. Common symptoms include eye swelling, pain, and cranial nerve palsies affecting eye movement and sensation. Treatment involves high dose intravenous antibiotics targeting likely pathogens like Staphylococcus aureus, anticoagulants to prevent clot growth, and corticosteroids to reduce inflammation. Draining the primary infection site is also important once the patient is stabilized. Without timely treatment, cavernous sinus thrombosis can cause permanent vision loss or be life-threatening.
The document describes the anatomy of the larynx. It discusses the cartilages that make up the larynx, including the thyroid, cricoid, arytenoid, epiglottis, corniculate and cuneiform cartilages. It describes the ligaments that connect the cartilages, including the thyrohyoid membrane, cricothyroid membrane, quadrangular membrane, thyroepiglottic ligament and conus elasticus. The larynx contains the vocal folds and is involved in sound production and airway protection during breathing and swallowing.
The orbital bone forms the cavity in the skull that houses the eyeball and surrounding structures. It has several walls - medial, lateral, roof and floor - formed by various bones that together create a protective pyramidal shape around the eye. The orbit contains the eyeball, extraocular muscles, nerves, vessels, lacrimal gland and fat. It has several surgical spaces that tumors or other pathologies typically remain within, such as the subperiosteal, peripheral and central spaces. The orbit functions to securely anchor the eyeball and protect it from mechanical injury.
A 54 year old female, with history of uncontrolled Diabetes Mellitus presented with complaints of progressively severe frontal headaches with associated nausea and dizziness.
CT scan of the head revealed a 10 cm frontal bone lytic lesion extending into the nasal bones with evidence of sequestrum. Mucosal thickening and opacification of the frontal sphenoid and ethmoid sinuses was also noted. MRI was consistent with CT finding and revealed further cortical destruction of frontal calvarium outer table along with para-meningeal and dural enhancement. CSF studies were negative. Patient was started on intravenous antifungal therapy with Amphotericin B lipid complex. Frontal sinus trephination with irrigation/aspiration and simultaneous diagnostic nasal endoscopy revealed no frank pus or necrosis.
Aspirate’s bacterial and fungal culture were negative.
Patient underwent an open incision trephination of frontal sinus that revealed destruction/moth-eaten appearance of the anterior table of the frontal sinus, biopsies were taken, No pus was encountered.
Surgical treatment of paraphyrngeal and retropharyngeal abscessesMamoon Ameen
The document discusses various deep neck spaces including the parapharyngeal and retropharyngeal spaces. It describes parapharyngeal and retropharyngeal abscesses, including their etiology, clinical features, investigations, and surgical treatment which involves securing the airway followed by either a transoral or transcervical approach to drain the abscess completely while protecting nearby structures.
This document discusses the "danger area of the face" - the upper lip, lower part of the nose, and adjacent area, also known as the "triangle of death." Infections and injuries in this area can readily spread to the cavernous sinus through the anterior facial vein, resulting in the serious condition of cavernous sinus thrombosis. The anterior facial vein has no valves, allowing for bi-directional blood flow. This area of the face also lacks deep fascia, which normally acts as a barrier to the spread of infection. Early and aggressive antibiotic treatment administered intravenously for 3-4 weeks is the mainstay of therapy for cavernous sinus thrombosis.
The document summarizes the anatomy and functions of the pharynx. It is a fibromuscular tube approximately 12-14 cm long located behind the nasal cavity, mouth, and larynx. It functions in respiration, swallowing, and sound resonance. The pharynx has three parts - nasopharynx, oropharynx, and laryngopharynx. Its walls consist of mucosa, pharyngeal aponeurosis, a muscular coat with three constrictor muscles, and an outer buccopharyngeal fascia. The pharynx is supplied by branches of the vagus and glossopharyngeal nerves and drains into deep cervical lymph nodes.
Cavernous sinus thrombosis is a blood clot that forms within the cavernous sinus, a vein at the base of the brain. It typically results from a nearby infection spreading through tributary veins. Common symptoms include eye swelling, pain, and cranial nerve palsies affecting eye movement and sensation. Treatment involves high dose intravenous antibiotics targeting likely pathogens like Staphylococcus aureus, anticoagulants to prevent clot growth, and corticosteroids to reduce inflammation. Draining the primary infection site is also important once the patient is stabilized. Without timely treatment, cavernous sinus thrombosis can cause permanent vision loss or be life-threatening.
The document describes the anatomy of the larynx. It discusses the cartilages that make up the larynx, including the thyroid, cricoid, arytenoid, epiglottis, corniculate and cuneiform cartilages. It describes the ligaments that connect the cartilages, including the thyrohyoid membrane, cricothyroid membrane, quadrangular membrane, thyroepiglottic ligament and conus elasticus. The larynx contains the vocal folds and is involved in sound production and airway protection during breathing and swallowing.
The orbital bone forms the cavity in the skull that houses the eyeball and surrounding structures. It has several walls - medial, lateral, roof and floor - formed by various bones that together create a protective pyramidal shape around the eye. The orbit contains the eyeball, extraocular muscles, nerves, vessels, lacrimal gland and fat. It has several surgical spaces that tumors or other pathologies typically remain within, such as the subperiosteal, peripheral and central spaces. The orbit functions to securely anchor the eyeball and protect it from mechanical injury.
Deep space infections of Head and NeckSapna Vadera
The document discusses deep space neck infections, including their anatomy and clinical presentation. It describes several deep neck spaces that can become infected, such as the lateral pharyngeal space (prestyloid and poststyloid compartments), retropharyngeal space, peritonsillar space, and pretracheal space. Deep neck infections are serious due to the potential for life-threatening complications like airway obstruction, mediastinitis, or intracranial abscesses if the infection spreads beyond its original space. Proper management involves aggressive airway monitoring, antibiotic treatment, and surgical drainage if needed.
The document discusses the laryngeal muscles, which are divided into extrinsic and intrinsic muscles. The extrinsic muscles attach the larynx to surrounding structures and move the larynx as a whole, while the intrinsic muscles attach the laryngeal cartilages to each other and are responsible for their individual movements. The intrinsic muscles can be further divided based on their actions of opening/closing the laryngeal inlet, adducting/abducting the vocal cords, and increasing/decreasing vocal cord tension. Specific intrinsic muscles and their functions are described.
The facial nerve originates from the pons and has both motor and sensory components. It passes through the internal acoustic meatus, facial canal within the temporal bone, and exits at the stylomastoid foramen. Within the facial canal it has several segments separated by genu. Important surgical landmarks along the facial canal include the geniculate ganglion, cochleariform process, and digastric ridge. The main trunk divides into 5 terminal branches in the parotid gland which innervate muscles of facial expression. Careful knowledge of the anatomy is important for safe middle ear, mastoid, and parotid surgery.
Otoendoscopy - Types, Uses, Procedures performed, Advantages and DisadvantagesReshma Ann Mathew
Otoendoscopy involves using a rigid endoscope inserted into the ear canal to examine the outer and middle ear.
An otoendoscope is a short, rigid telescope that is available in varying diameters and angles between 0-70 degrees. It is connected to a light source and camera for illumination and recording findings. Commonly used otoendoscopes have diameters of 1.7mm and angles of 0 or 30 degrees.
Otoendoscopy allows visualization of the entire tympanic membrane and structures like the sinus tympani, facial recess, and eustachian tube that are usually hidden. It has advantages over microscopy like extending the surgical field and providing multiple angles. Common procedures performed with o
Nasal fractures are common injuries that result from blunt force trauma to the nose. The nasal bones are the most frequently fractured part of the facial skeleton due to their prominent location and thin structure. Nasal fractures are often classified based on the direction and extent of displacement. Diagnosis involves history, physical exam, and imaging. Treatment ranges from closed reduction for non-displaced fractures to open reduction for severely displaced fractures. Closed reduction involves manipulating the bones back into position using nasal speculums and forceps followed by splinting.
This document discusses the pneumatic system of the temporal bone, specifically:
1. It describes classifications of pneumatization from extensively to non-pneumatized.
2. Surgical techniques like canal wall up vs. canal wall down mastoidectomy are chosen based on pneumatization. More pneumatized ears are suitable for canal wall up.
3. Theories on pneumatization include both hereditary and environmental factors influencing development. Middle ear disease in childhood may impact future pneumatization.
The lateral wall of the nasal cavity is formed by several bones including the nasal, maxilla, lacrimal, ethmoid, palatine and sphenoid bones. It contains three bony projections called turbinates. Several anatomical structures are located within the lateral wall including the agger nasi cell, ethmoid bulla, uncinate process and ostiomeatal complex. The document describes the bones, turbinates, sinuses and various anatomical variations that can be present within the lateral wall of the nasal cavity.
Myringoplasty is a procedure to repair a perforated eardrum using a graft without examining the middle ear. It aims to replace the missing fibrous layer and allow regeneration of skin and mucosa over the graft. The document discusses the indications, contraindications, surgical approaches, techniques, post-op care, complications and advantages/disadvantages of the underlay and overlay techniques. The key steps of underlay involve freshening the perforation edges, elevating the tympanomeatal flap, placing the graft under the flap and reposing the flap. Overlay places the graft over the remaining eardrum and covers it with the elevated skin.
This document discusses the anatomy and anesthetic implications of the upper airway, including the nose, oral cavity, pharynx, and larynx. Key points include the vascular and sensitive nature of the nasal mucosa which can lead to bleeding, the importance of tongue position and mandible placement in maintaining an open airway, and how the collapsible soft tissues of the oropharynx make it particularly prone to obstruction. Proper understanding of upper airway anatomy is essential for airway management during anesthesia.
Surgical Management of Nasal Valve Insufficiency .pptxGierelma J.T.
This document discusses the surgical management of nasal valve insufficiency. There are multiple techniques used to address internal and external nasal valve collapse, including spreader grafts, butterfly grafts, batten grafts, and lateral crural strut grafts. For the external valve, techniques include lateral crural repositioning and strut graft placement to provide support to the lateral wall. Surgical management aims to improve nasal breathing and patency by strengthening weak nasal wall structures and correcting structural abnormalities.
Otitis media with effusion, also known as glue ear, is a condition where fluid builds up behind the eardrum without signs of infection. It is commonly seen in school-aged children and is caused by malfunction of the Eustachian tube, allergies, or prior ear infections. Symptoms include decreased hearing, but earaches are usually mild or absent. Diagnosis involves examining the ears and looking for fluid buildup or a dull appearance of the eardrum. Treatment may involve antibiotics, ear tube insertion, or watchful waiting depending on severity and duration of symptoms.
This document discusses infections of the submandibular space, which is divided into two compartments by the mylohyoid muscle. Dental infections are the most common cause, with roots above or below the mylohyoid muscle leading to sublingual or submaxillary infections, respectively. Symptoms include odynophagia, trismus, and swelling of the submental and submandibular regions. Treatment involves systemic antibiotics, incision and drainage of any abscesses either intraorally or externally, and tracheostomy if the airway is endangered. Complications can arise from spread of infection or airway obstruction.
This document provides an overview of diagnostic nasal endoscopy. It discusses that nasal endoscopy allows direct visualization of the nasal and sinus passages using an endoscope. It can be performed with flexible or rigid endoscopes. The document outlines the indications, contraindications, technical considerations, equipment, patient preparation, technique, and potential complications of nasal endoscopy. Nasal endoscopy is a commonly used diagnostic tool by otolaryngologists to evaluate nasal pathology.
CerebroSpinal Fluid Rhinorrhoea is the leakage of CSF from the subarachnoid space into the nasal cavity due to a skull base defect. CSF leaks can be caused by trauma, tumors, congenital defects, or idiopathic increased intracranial pressure. Diagnosis involves analyzing fluid samples for beta-2 transferrin or beta-trace protein and imaging studies using intrathecal dyes. Treatment begins with conservative measures to reduce CSF production and pressure but often requires surgical repair via an endoscopic, extracranial, or intracranial approach depending on the location and size of the defect. Endoscopic techniques have high success rates with less morbidity compared to open cranial
The document discusses the surgical anatomy of the osteomeatal complex (OMC). It defines the OMC as the final common drainage pathway for the frontal, maxillary, and anterior ethmoid sinuses. The OMC has boundaries anteriorly, superiorly, posteriorly, and inferiorly. It is composed of the maxillary ostium, infundibulum, ethmoid bulla, uncinate process, and hiatus semilunaris. Common anatomical variations include concha bullosa, paradoxical middle turbinate, uncinate process hypertrophy, and pneumatization of other structures. Knowledge of the OMC anatomy and its variations is important for functional endoscopic sinus surgery.
Anatomy of middle ear cleft microteaching, 06.03.17, dr.pkophthalmgmcri
This document discusses the anatomy of the middle ear, including the tympanic membrane and contents of the middle ear cavity. It describes the three layers of the tympanic membrane and its nerve supply. It lists the key contents of the middle ear as the three ossicles, two muscles, chorda tympani, and tympanic plexus. It also notes the epithelial lining changes from ciliated columnar to cuboidal moving from the anteroinferior to posteriorsuperior regions.
The paranasal sinuses develop as outgrowths of the nasal mucosa and have mucous membranes continuous with the nasal cavity. In newborns, sinuses are not present. Mucous builds up in the sinuses due to swelling, plugging the openings into the nose. Cilia move mucous toward the nasopharynx where it is swallowed. The four main sinuses are the sphenoid, ethmoid, maxillary, and frontal sinuses. Functions include lightening the skull, resonating voice, facilitating tooth eruption and facial bone growth. Diagnostic methods for sinus diseases include eliciting sinus tenderness, transillumination, radiological exams, diagnostic puncture, sinoscopy, ech
The retropharyngeal space is a potential space located posterior to the pharynx that contains areolar fat and lymph nodes. It allows for movement of the pharynx during swallowing and respiration. Lesions and fluid collections like abscesses or hematomas can develop in this space. Imaging like CT scans are useful for evaluating these conditions. Retropharyngeal abscesses require prompt treatment with antibiotics and drainage to prevent airway complications. Lymph nodes in this region can metastasize early from cancers like nasopharyngeal carcinoma.
This document provides an overview of the facial nerve, including its anatomy, course, branches, surgical landmarks, variations, injuries, and disorders. Some key points:
- The facial nerve is the 7th cranial nerve and emerges from the brainstem between the pons and medulla. It innervates the muscles of facial expression and provides taste sensation to the anterior tongue.
- It has both motor and sensory components. Surgically, its branches like the marginal mandibular nerve are at risk during procedures near the parotid gland, mandible, and temporal region.
- Common injuries include Bell's palsy, trauma, tumors, and infections like otitis media. Disorders
Facial nerve decompression is a surgical procedure to relieve pressure and reduce compression on the facial nerve fibers. It involves opening the bony canal and nerve sheath. There are several surgical approaches depending on the location of injury, including transmastoid, middle cranial fossa, and translabyrinthine. The middle cranial fossa approach provides exposure of the internal auditory canal and labyrinthine segments without risk of hearing loss. Landmarks are used to identify the various segments of the facial nerve during decompression. The goal is to maximize functional recovery from facial paralysis.
Deep space infections of Head and NeckSapna Vadera
The document discusses deep space neck infections, including their anatomy and clinical presentation. It describes several deep neck spaces that can become infected, such as the lateral pharyngeal space (prestyloid and poststyloid compartments), retropharyngeal space, peritonsillar space, and pretracheal space. Deep neck infections are serious due to the potential for life-threatening complications like airway obstruction, mediastinitis, or intracranial abscesses if the infection spreads beyond its original space. Proper management involves aggressive airway monitoring, antibiotic treatment, and surgical drainage if needed.
The document discusses the laryngeal muscles, which are divided into extrinsic and intrinsic muscles. The extrinsic muscles attach the larynx to surrounding structures and move the larynx as a whole, while the intrinsic muscles attach the laryngeal cartilages to each other and are responsible for their individual movements. The intrinsic muscles can be further divided based on their actions of opening/closing the laryngeal inlet, adducting/abducting the vocal cords, and increasing/decreasing vocal cord tension. Specific intrinsic muscles and their functions are described.
The facial nerve originates from the pons and has both motor and sensory components. It passes through the internal acoustic meatus, facial canal within the temporal bone, and exits at the stylomastoid foramen. Within the facial canal it has several segments separated by genu. Important surgical landmarks along the facial canal include the geniculate ganglion, cochleariform process, and digastric ridge. The main trunk divides into 5 terminal branches in the parotid gland which innervate muscles of facial expression. Careful knowledge of the anatomy is important for safe middle ear, mastoid, and parotid surgery.
Otoendoscopy - Types, Uses, Procedures performed, Advantages and DisadvantagesReshma Ann Mathew
Otoendoscopy involves using a rigid endoscope inserted into the ear canal to examine the outer and middle ear.
An otoendoscope is a short, rigid telescope that is available in varying diameters and angles between 0-70 degrees. It is connected to a light source and camera for illumination and recording findings. Commonly used otoendoscopes have diameters of 1.7mm and angles of 0 or 30 degrees.
Otoendoscopy allows visualization of the entire tympanic membrane and structures like the sinus tympani, facial recess, and eustachian tube that are usually hidden. It has advantages over microscopy like extending the surgical field and providing multiple angles. Common procedures performed with o
Nasal fractures are common injuries that result from blunt force trauma to the nose. The nasal bones are the most frequently fractured part of the facial skeleton due to their prominent location and thin structure. Nasal fractures are often classified based on the direction and extent of displacement. Diagnosis involves history, physical exam, and imaging. Treatment ranges from closed reduction for non-displaced fractures to open reduction for severely displaced fractures. Closed reduction involves manipulating the bones back into position using nasal speculums and forceps followed by splinting.
This document discusses the pneumatic system of the temporal bone, specifically:
1. It describes classifications of pneumatization from extensively to non-pneumatized.
2. Surgical techniques like canal wall up vs. canal wall down mastoidectomy are chosen based on pneumatization. More pneumatized ears are suitable for canal wall up.
3. Theories on pneumatization include both hereditary and environmental factors influencing development. Middle ear disease in childhood may impact future pneumatization.
The lateral wall of the nasal cavity is formed by several bones including the nasal, maxilla, lacrimal, ethmoid, palatine and sphenoid bones. It contains three bony projections called turbinates. Several anatomical structures are located within the lateral wall including the agger nasi cell, ethmoid bulla, uncinate process and ostiomeatal complex. The document describes the bones, turbinates, sinuses and various anatomical variations that can be present within the lateral wall of the nasal cavity.
Myringoplasty is a procedure to repair a perforated eardrum using a graft without examining the middle ear. It aims to replace the missing fibrous layer and allow regeneration of skin and mucosa over the graft. The document discusses the indications, contraindications, surgical approaches, techniques, post-op care, complications and advantages/disadvantages of the underlay and overlay techniques. The key steps of underlay involve freshening the perforation edges, elevating the tympanomeatal flap, placing the graft under the flap and reposing the flap. Overlay places the graft over the remaining eardrum and covers it with the elevated skin.
This document discusses the anatomy and anesthetic implications of the upper airway, including the nose, oral cavity, pharynx, and larynx. Key points include the vascular and sensitive nature of the nasal mucosa which can lead to bleeding, the importance of tongue position and mandible placement in maintaining an open airway, and how the collapsible soft tissues of the oropharynx make it particularly prone to obstruction. Proper understanding of upper airway anatomy is essential for airway management during anesthesia.
Surgical Management of Nasal Valve Insufficiency .pptxGierelma J.T.
This document discusses the surgical management of nasal valve insufficiency. There are multiple techniques used to address internal and external nasal valve collapse, including spreader grafts, butterfly grafts, batten grafts, and lateral crural strut grafts. For the external valve, techniques include lateral crural repositioning and strut graft placement to provide support to the lateral wall. Surgical management aims to improve nasal breathing and patency by strengthening weak nasal wall structures and correcting structural abnormalities.
Otitis media with effusion, also known as glue ear, is a condition where fluid builds up behind the eardrum without signs of infection. It is commonly seen in school-aged children and is caused by malfunction of the Eustachian tube, allergies, or prior ear infections. Symptoms include decreased hearing, but earaches are usually mild or absent. Diagnosis involves examining the ears and looking for fluid buildup or a dull appearance of the eardrum. Treatment may involve antibiotics, ear tube insertion, or watchful waiting depending on severity and duration of symptoms.
This document discusses infections of the submandibular space, which is divided into two compartments by the mylohyoid muscle. Dental infections are the most common cause, with roots above or below the mylohyoid muscle leading to sublingual or submaxillary infections, respectively. Symptoms include odynophagia, trismus, and swelling of the submental and submandibular regions. Treatment involves systemic antibiotics, incision and drainage of any abscesses either intraorally or externally, and tracheostomy if the airway is endangered. Complications can arise from spread of infection or airway obstruction.
This document provides an overview of diagnostic nasal endoscopy. It discusses that nasal endoscopy allows direct visualization of the nasal and sinus passages using an endoscope. It can be performed with flexible or rigid endoscopes. The document outlines the indications, contraindications, technical considerations, equipment, patient preparation, technique, and potential complications of nasal endoscopy. Nasal endoscopy is a commonly used diagnostic tool by otolaryngologists to evaluate nasal pathology.
CerebroSpinal Fluid Rhinorrhoea is the leakage of CSF from the subarachnoid space into the nasal cavity due to a skull base defect. CSF leaks can be caused by trauma, tumors, congenital defects, or idiopathic increased intracranial pressure. Diagnosis involves analyzing fluid samples for beta-2 transferrin or beta-trace protein and imaging studies using intrathecal dyes. Treatment begins with conservative measures to reduce CSF production and pressure but often requires surgical repair via an endoscopic, extracranial, or intracranial approach depending on the location and size of the defect. Endoscopic techniques have high success rates with less morbidity compared to open cranial
The document discusses the surgical anatomy of the osteomeatal complex (OMC). It defines the OMC as the final common drainage pathway for the frontal, maxillary, and anterior ethmoid sinuses. The OMC has boundaries anteriorly, superiorly, posteriorly, and inferiorly. It is composed of the maxillary ostium, infundibulum, ethmoid bulla, uncinate process, and hiatus semilunaris. Common anatomical variations include concha bullosa, paradoxical middle turbinate, uncinate process hypertrophy, and pneumatization of other structures. Knowledge of the OMC anatomy and its variations is important for functional endoscopic sinus surgery.
Anatomy of middle ear cleft microteaching, 06.03.17, dr.pkophthalmgmcri
This document discusses the anatomy of the middle ear, including the tympanic membrane and contents of the middle ear cavity. It describes the three layers of the tympanic membrane and its nerve supply. It lists the key contents of the middle ear as the three ossicles, two muscles, chorda tympani, and tympanic plexus. It also notes the epithelial lining changes from ciliated columnar to cuboidal moving from the anteroinferior to posteriorsuperior regions.
The paranasal sinuses develop as outgrowths of the nasal mucosa and have mucous membranes continuous with the nasal cavity. In newborns, sinuses are not present. Mucous builds up in the sinuses due to swelling, plugging the openings into the nose. Cilia move mucous toward the nasopharynx where it is swallowed. The four main sinuses are the sphenoid, ethmoid, maxillary, and frontal sinuses. Functions include lightening the skull, resonating voice, facilitating tooth eruption and facial bone growth. Diagnostic methods for sinus diseases include eliciting sinus tenderness, transillumination, radiological exams, diagnostic puncture, sinoscopy, ech
The retropharyngeal space is a potential space located posterior to the pharynx that contains areolar fat and lymph nodes. It allows for movement of the pharynx during swallowing and respiration. Lesions and fluid collections like abscesses or hematomas can develop in this space. Imaging like CT scans are useful for evaluating these conditions. Retropharyngeal abscesses require prompt treatment with antibiotics and drainage to prevent airway complications. Lymph nodes in this region can metastasize early from cancers like nasopharyngeal carcinoma.
This document provides an overview of the facial nerve, including its anatomy, course, branches, surgical landmarks, variations, injuries, and disorders. Some key points:
- The facial nerve is the 7th cranial nerve and emerges from the brainstem between the pons and medulla. It innervates the muscles of facial expression and provides taste sensation to the anterior tongue.
- It has both motor and sensory components. Surgically, its branches like the marginal mandibular nerve are at risk during procedures near the parotid gland, mandible, and temporal region.
- Common injuries include Bell's palsy, trauma, tumors, and infections like otitis media. Disorders
Facial nerve decompression is a surgical procedure to relieve pressure and reduce compression on the facial nerve fibers. It involves opening the bony canal and nerve sheath. There are several surgical approaches depending on the location of injury, including transmastoid, middle cranial fossa, and translabyrinthine. The middle cranial fossa approach provides exposure of the internal auditory canal and labyrinthine segments without risk of hearing loss. Landmarks are used to identify the various segments of the facial nerve during decompression. The goal is to maximize functional recovery from facial paralysis.
The document provides information on the operative technique of parotidectomy. It discusses the embryology, surgical anatomy, types (partial, superficial, total, radical), procedure, and complications of parotidectomy. The procedure involves raising skin flaps and identifying landmarks like the facial nerve to fully expose and dissect the parotid gland from surrounding tissues. The main steps are identification and preservation of the facial nerve branches, ligation of duct and vessels, and removal of the gland. Complications can include hematoma, facial nerve injury, salivary fistula, cosmetic deformity, and Frey's syndrome.
The document discusses the surgical anatomy of the major salivary glands - the parotid, submandibular, and sublingual glands. It describes the location, structure, relations, blood supply, nerve supply, and surgical approaches for each gland. For the parotid gland, it highlights the facial nerve branches that pass through the gland and risks of injury. For the submandibular gland, it emphasizes identifying and preserving the marginal mandibular nerve and lingual nerve during excision of the gland.
The document summarizes the anatomy and clinical applications of the facial nerve. It begins with the nuclear origin and functional components of the facial nerve. It then describes the intra cranial and extra cranial course of the nerve, its branches including the greater petrosal, chorda tympani, and terminal branches. Applications including facial nerve palsy, Bell's palsy, and preventing injury during dental procedures are discussed. Clinical testing and special tests of facial nerve function are also outlined.
The document discusses disorders of the salivary glands, focusing on the parotid and submandibular glands. It describes the anatomy of the major salivary glands and their duct systems. Common disorders are then outlined, including developmental abnormalities, infections (viral like mumps, bacterial), obstructions (stones), and tumors. Treatment options are provided for various disorders like parotidectomy for removal of tumors while preserving the facial nerve. Complications of parotid surgery are also summarized.
1) Parotidectomy is performed to remove tumors or treat infections of the parotid gland. It involves dissecting around the facial nerve to preserve function.
2) The facial nerve is the key anatomical structure and must be carefully identified and protected throughout the surgery. Landmarks like the tympanomastoid suture line help locate the nerve.
3) The surgery can range from partial removal of the superficial lobe for benign tumors to total removal of the entire gland for high grade malignancies. Meticulous hemostasis and drainage are important for wound healing.
1. A 31-year-old male presented with a swelling in the right parotid region for 1 year. On examination, a 2cmx3cm firm, non-tender swelling was found in the right parotid gland.
2. A provisional diagnosis of pleomorphic adenoma of the right parotid gland was made.
3. The anatomy and clinical features of the parotid gland were discussed, along with differential diagnoses and management of parotid tumors.
The major salivary glands are the parotid, submandibular, and sublingual glands. The parotid gland is the largest and is located below and in front of the ear. The submandibular gland is beneath the jawbone and the sublingual gland is beneath the floor of the mouth. Each gland has specific blood supply, nerve innervation and ducts through which saliva passes. Imaging modalities like ultrasound and CT are useful for evaluating salivary gland disorders. Surgical procedures like gland excision require careful dissection to preserve structures like nerves and ducts.
This document discusses techniques for reanimating facial paralysis. It begins by outlining general principles, including reinnervating muscles early, separately reanimating the upper and lower face, and tailoring the procedure to the patient's needs and assessment. Surgical techniques are then described, including neural methods like nerve grafting and transfers, musculofacial transpositions, and static procedures. The timing of different techniques depends on whether the paralysis is acute (<3 weeks), intermediate (3 weeks to 2 years), or chronic (>2 years). Assessment involves evaluating the cause and extent of paralysis along with patient factors. The goal is to restore facial symmetry, competence, protection, and dynamic smile.
The region on the lateral surface of the face that comprises the parotid gland & the structures immediately related to it
Largest of the salivary glands
Located subcutaneously, below and in front of the external auditory meatus
Occupies the deep hollow behind the ramus of the mandible
Wedge-shaped when viewed externally, with the base above & the apex behind the angle of the mandible
1. The document provides information on the salivary glands, including their embryology, microstructure, classification, and the surgical anatomy of the major salivary glands - the parotid and submandibular glands.
2. It describes the parotid gland as the largest salivary gland, located below the external ear. It discusses the gland's lobes, surfaces, borders, duct, blood supply and innervation.
3. It also summarizes the submandibular gland, located in the submandibular triangle, discussing its parts, surfaces, duct, blood supply and innervation.
This document describes the anatomy and physiology of the salivary glands. It discusses the embryology, microscopic anatomy, types of salivary glands including the major parotid gland. It describes the structures within the parotid gland such as arteries, veins, lymph nodes and the facial nerve. It also discusses surgical landmarks and applied anatomy concepts related to the parotid gland.
This document provides an overview of the anatomy and embryology of the facial nerve (cranial nerve VII). It discusses the nuclei of origin, functional components, course through the skull and branches/distribution. Key points include that the facial nerve has motor, secretomotor and sensory fibers and exits the skull via the stylomastoid foramen. It describes associated ganglia like the geniculate ganglion and presents variations, disorders like Bell's palsy, and evaluation methods involving tests of motor/sensory function.
The facial nerve originates from the brainstem and has both motor and sensory functions. It has 5 segments as it passes through the temporal bone: intracranial, meatal, labyrinthine, tympanic, and mastoid. Key landmarks help identify the nerve's location during middle ear and parotid surgery. The nerve gives off branches like the chorda tympani before terminating in 5 branches that innervate facial muscles. Precise knowledge of the facial nerve's anatomy is important for preventing injury during otologic and parotid procedures.
The document describes the major salivary glands - parotid, submandibular and sublingual glands. It details the location, structure, relations, blood supply and applied anatomy of each gland. The parotid gland is the largest salivary gland located in the preauricular region. The submandibular gland is situated in the submandibular triangle below the mandible. The sublingual gland is the smallest gland located beneath the oral mucosa.
The facial nerve originates from the pons and has both motor and sensory components. It passes through the internal acoustic meatus, facial canal within the temporal bone, and exits at the stylomastoid foramen. Within the facial canal it has several segments separated by genu. Important surgical landmarks along the facial canal include the geniculate ganglion, pyramidal eminence, and digastric ridge. The facial nerve gives off branches like the chorda tympani and greater petrosal nerve. It terminates in five branches that innervate muscles of facial expression. Knowledge of the facial nerve anatomy is important for otologic and parotid surgeries to avoid injury.
The document provides information on the facial nerve (CN VII) including its anatomy, branches, segments, development and disorders. Some key points:
- The facial nerve has motor and sensory components and contains fibers for facial expression, taste, and lacrimal/salivary glands.
- It exits the skull via the stylomastoid foramen and has segments within the skull, internal auditory canal, middle ear and mastoid.
- Injuries are classified using Seddon or Sunderland systems based on the level of nerve disruption.
- Evaluation includes tests of lacrimal, stapedius, taste and salivary functions to localize the lesion. Electrodiagnostic tests assess prognosis
The facial nerve develops from the second pharyngeal arch during gestation. It carries motor, sensory and parasympathetic fibers that innervate muscles of facial expression and glands. Bell's palsy is a temporary paralysis of the facial nerve causing drooping of the eyelid and mouth. It is diagnosed based on symptoms and ruled out other causes through tests. Treatment includes antiviral drugs, corticosteroids, facial exercises and physical therapy.
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FACIAL NERVE DYSFUNCTION AFTER SUPERFICIAL PAROTIDECTOMY WITH OR.pptx
1. Facial Nerve Dysfunction After Superficial Parotidectomy With Or
Without Continuous Intraoperative Electromyographic
Neuromonitoring – A Prospective Randomized Pilot Study
Moderator – Dr Vidya BT
Presenter – Dr Medha Krishnamurthy
2. CONTENTS
◦ Relevant anatomy and theory regarding parotid gland and Parotidectomy.
◦ Journal proper
Introduction
Aim
Materials and methods
Surgical and anaesthetic techniques
Electrophysiological monitoring of facial nerve
Facial motricity assessment
Results
Discussion
Limitations of the study
Conclusions
Other studies.
4. EMBRYOGENESIS AND ULTRASTRUCTURE
◦ There are 3 major salivary glands – Parotid, submandibular and sublingual glands and numerous
Minor salivary glands distributed along the oral cavity and pharynx.
◦ Major salivary glands – develop from the 6th to 8th weeks as outpouchings of oral ectoderm into
the surrounding mesenchyme.
◦ Parotid develops first followed by submandibular at 6 weeks and sublingual glands at 8 weeks.
◦ Minor salivary glands – oral ectoderm and nasopharyngeal endoderm.
◦ Parotid last to be encapsulated after lymphatics develop resulting in entrapment of lymphatics
deep to the capsule in the parenchyma.
◦ Made up of secretory acini and ducts. Acini can be either serous, mucous or mixture of both.
◦ Serous acini – small granules with salivary proteins and enzymes.
◦ Mucinous acini – cylindrical in shape, larger granules with mucoproteins.
◦ Acinar ducts Intercalated ducts striated ducts main excretory ducts.
5. CLINICAL ANATOMY – PAROTID GLAND
◦ Largest and mainly serous with few mucous acini.
◦ 15-25g, irregularly lobulated.
◦ 3 sided pyramid.
◦ Four surfaces – superior, superficial, anteromedial, posteromedial.
◦ Three borders – anterior, posterior and medial/pharyngeal.
◦ Apex- posterior belly of digastric and adjoining part of carotid
triangle.
◦ Cervical branch of facial nerve and retromandibular vein emerge
near the apex.
◦ Superior surface /base – EAC, posterior surface of TMJ, superficial
temporal vessels, ATN.
◦ Superficial surface – skin, superficial fascia (anterior branches of
greater auricular nerve, preauricular lymph nodes), parotid fascia,
deep lymph nodes
6. CLINICAL ANATOMY – PAROTID GLAND contd..
◦ Anteromedial surface – masseter, lateral surface of TMJ, medial
pterygoid, branches of facial nerve.
◦ Posteromedial surface – mastoid process, styloid process, ECA
enters the gland through this surface.
◦ Anterior border – parotid duct, terminal branches of facial nerve,
transverse facial vessels.
◦ Posterior border – overlaps SCM.
◦ Medial edge – lateral wall of pharynx.
Structures within the gland – medial to lateral
Arteries – ECA, maxillary artery, superficial temporal artery gives off
transverse facial artery.
Veins – retromandibular vein formed within the gland by the union of
maxillary and superficial temporal veins. Divided into anterior and
posterior branches in the lower part.
Facial nerve – exits from the cranium through the stylomastoid
foramen, enters gland at its posteromedial surface and divides into
terminal branches. Separates the gland into a superficial part and a
deep part.
7. CLINICAL ANATOMY – PAROTID GLAND contd..
Facial nerve divides into –
Branches radiate like goose feet – Pes anserinus.
BRANCHING PATTERNS – Katz and Catalano et al, McCormack et al
and Davis et al, Kwak et al.
Patey’s faciovenous plane – large superficial and small deep part
connected by isthmus around which facial nerve divides.
Temporofacial Cervicofacial
• Buccal
• Marginal mandibular
• Cervical
• Temporal
• Zygomatic
8.
9. PAROTID DUCT/STENSEN’S DUCT
◦ Named after Danish Anatomist – Niels Stenson in 1660.
◦ Thick walled, 5cm long.
◦ Emerges from middle of the anterior border, runs
forwards and slightly downwards on the masseter.
◦ Superiorly – accessory parotid gland, transverse facial
vessels, upper buccal branch of facial nerve.
◦ Inferiorly – lower buccal branch
◦ At anterior border of masseter, parotid duct pierces –
buccal pad of fat, buccopharyngeal fascia and
buccinators.
◦ Runs forwards between buccinators and buccal mucosa
and opens into the vestibule opposite crown of the
upper 2nd molar tooth.
10. BLOOD AND NERVE SUPPLY
◦ Blood supply – by ECA and its branches. Drains into the external and
internal jugular veins via retromandibular vein.
◦ Preganglionic secretomotor fibres – carried from inferior salivatory
nucleus along the IX nerve, its tympanic branch, tympanic plexus and
lesser petrosal nerve to otic ganglion.
◦ Post-ganglionic fibres carried via auriculotemporal nerve.
◦ Sympathetic vasoconstrictor fibres carried via plexus on the ECA and
middle meningeal arteries from superior cervical ganglion.
◦ Gland receives sensory fibres from ATN and fascia receives from great
auricular nerve (C1).
◦ Lymphatic drainage – first to parotid nodes and from there upper deep
cervical nodes.
11. SALIVA PRODUCTION
◦ 1500 ml/day saliva secreted.
◦ pH of resting saliva is 7; active saliva is 8.0.
◦ Contains lingual lipase secreted from minor glands, alpha
amylase from salivary glands.
◦ Mucin, glycoproteins, IgA, lysozymes, lactoferrin which binds
iron, proline rich proteins protects enamel and binds toxic
tannins.
◦ Parotid saliva – 20% of total secretion/day, serous and watery.
◦ Submandibular saliva- 70%, mucous and moderately viscous.
◦ Sublingual saliva – 5%, mucous and viscous.
◦ Minor and other oral glands – 5%.
◦ Facilitates swallowing, keeps mouth moist, solvent for taste buds,
facilitates speech, keeps oral cavity clean, antibacterial,
neutralizes the gastric acid to relieve reflux heartburn.
13. TYPES
◦ Superficial Parotidectomy – removal of entire superficial
lobe. Done in cases of benign diseases.
◦ Total conservative Parotidectomy – done in cases of
benign diseases of parotid either only deep lobe or both
lobes. Both lobes removed with preservation of facial nerve.
◦ Radical Parotidectomy – both lobes removed along with
facial nerve, fat, fascia, muscles (masseter, pterygoids and
buccinator), lymph nodes. Done in carcinoma parotid. Later
facial nerve reconstruction done using greater auricular
nerve graft,
◦ Suprafacial Parotidectomy – done in lower pole tumours
where all branches of facial nerve need not be dissected.
14. STEPS
◦ Lazy S incision – modified Blair’s/ Sistrunk’s approach and raising skin flaps.
◦ Mobilization of the gland
◦ Flap reflected in front just up to anterior margin of the parotid. After identifying SCM,
great auricular nerve identified and can be sacrificed. Posterior belly of digastric identified.
◦ Location of stylomastoid branch of posterior auricular artery anterior to facial nerve trunk
which enters the SMF.
◦ Put the artery forceps 5mm in front of the facial nerve; open the blades for 5mm; lift the
blades for 5mm.
◦ Facial nerve trunk identification.
◦ Dissection of gland off the facial nerve using bipolar cautery.
◦ Removal of the gland.
◦ Haemostasis and closure with a drain.
15.
16. FACIAL NERVE IDENTIFICATION
◦ Facial nerve is 1cm deep and below the tip of the inferior
portion of the cartilaginous canal – Conley’s point.
◦ Nerve stimulator
◦ Inferomedial to Tragal pointer.
◦ Deep to digastric muscle and tympanic plate.
◦ Nerve is just lateral to the styloid process.
◦ Tracing branching from distal to proximal – Hamilton-Bailey
technique.
17. COMPLICATIONS
◦ Facial nerve injury.
◦ Haemorrhage.
◦ Salivary fistulae.
◦ Infection – flap necrosis common.
◦ Frey’s syndrome.
◦ Sialocele.
◦ Numbness over the face and ear – injury to great auricular
nerve. Spontaneous recovery within 1.5 to 2 years.
19. Facial Nerve Dysfunction After Superficial Parotidectomy With Or
Without Continuous Intraoperative Electromyographic
Neuromonitoring – A Prospective Randomized Pilot Study
◦ Agnaldo J Gracaino, Carlos A Fischer, Guilherme V Coelho, Jose H Steck, Jorge R Paschoal, Carlos T Chone et
al.
◦ Department of Otorhinolaryngology- Head and Neck Surgery, University of Campinas, Brazil.
◦ Study published on – 19 September 2018.
◦ Journal – European Archives of Oto-Rhino-Laryngology.
◦ Study Design – Prospective randomised study.
20. INTRODUCTION
◦ Incidence of salivary gland neoplasm – 0.43/1000,000 to 13.5/1000,000.
◦ Parotid gland – most common site for primary tumour in 62-81%.
◦ Surgery – standard treatment for neoplasms.
◦ Surgical extension – still debated. Some suggest that superficial parotidectomy is one of the most
commonly performed procedures to treat such conditions.
◦ Other minimally invasive procedures with lower functional complications – partial superficial
parotidectomy (limited resection of a segment of superficial part of the gland with dissection of
selected branches of its main divisions) and extracapsular dissection (limited resection of the tumour
within a 2-3 mm margin of normal tissue without intentional dissection of the facial nerve).
21. INTRODUCTION contd..
◦ Transient facial nerve dysfunction (TFD) – most common complication following superficial
parotidectomy (SP), affecting 10-67% of patients.
◦ Most common risk factor for TFD – reoperation, surgery for chronic inflammatory diseases and surgical
extension (more common for total vs superficial parotidectomy).
◦ Facial nerve dysfunction – interruption of axonal conduction due to direct trauma (contusion or
stretching), neural ischemia, secondary to oedema and inflammation.
◦ Dysfunction appears within the first few hours after surgery, indicating that intraoperative events
associated with this condition are often unnoticed.
◦ `facial nerve monitoring via continuous electromyography (EMG) during parotidectomy described in
early 1990s.
22. INTRODUCTION contd..
◦ Various advantages – facilitating nerve location determination and dissection in complex cases,
distinguishing between nerve branches from similar structures and detecting facial nerve trauma
through early and possibly reversible electrophysiological responses.
◦ Intraoperative monitoring (IOM) for facial nerve is increasingly used during parotidectomy.
23. AIM
◦ To compare the incidence and grade of TFD in a homogenous group of patients with benign parotid
tumours exclusively subjected to superficial parotidectomy with or without electrophysiological
monitoring of facial nerve.
24. MATERIALS AND METHODS
STUDY DESIGN – pilot, prospective, randomised, controlled and parallel trial.
Study approved by the institutional research ethics committee.
Written informed consent obtained from all participants.
INCLUSION CRITERIA-
Adult patients (above 18 years) with benign parotid tumours confirmed on definitive HPE.
Exclusively subjected to HPE.
Normal facial motricity on preoperative clinical examination.
EXCLUSION CRITERIA –
Patients with chronic inflammatory diseases
Tumour recurrence
Subjected to parotidectomy for tumours located on the deep lobe of the gland.
25. MATERIALS AND METHODS contd..
Sample size – estimated as 50 patients per group (intervention and control).
Outcome measure – significant reduction in the immediate postoperative rate of facial nerve
dysfunction >/= House- Brackmann II as the main outcome and regional Sunnybrook System was
assessed as a secondary outcome.
Possible Risk factors related to TFD following surgery include –
o Surgical time greater than 120 minutes.
o Tumour size greater than 3-4 cm.
o Tumour location – parotid tail vs central (between mastoid tip and mandible angle) or superior (anterior to EAC).
o Age greater than 40, 60 and 70 years.
26. MATERIALS AND METHODS contd..
Patients randomly allocated at a a ratio of 1:1 to the monitored group (MG) – surgery performed with
continuous intraoperative EMG or the control group (CG) – without the intraoperative EMG.
Assessment of postoperative complications also recorded – hematoma, local infection, salivary fistula
and wound dehiscence.
27. SURGICAL AND ANESTHETIC TECHNIQUES
Patients subjected to SP – under surgical magnifying glasses with 2.5 or 3.3x magnification.
Anatomical reference points – cartilaginous tragal pointer, tympanomastoid fissure and posterior belly
of digastric muscle were used to locate the nerve trunk after its exit from thr stylomastoid foramen
followed by anterograde dissection of all branches of the nerve and complete resection of the
superficial part of the gland.
Retrograde dissection was performed in only 5 patients – difficulty to dissect a large tumour located
over the trunk or the occurrence of EMG events suggestive of neural irritation during antegrade
dissection.
All procedures performed – GA without muscle relaxants.
28. ELECTROPHYSIOLOGICAL MONITORING OF FACIAL
NERVE
The four-channel Neuro-MEP Neuromonitoring system was
used.
Following anaesthesia, paired monopolar needle electrodes
inserted into 4 facial areas - frontalis, orbicularis oculi,
orbicularis oris and depressor anguli oris muscles and the base
electrode was inserted into the ipsilateral trapezius muscle.
System adjusted to record any event with an amplitude over
100mV triggered by nerve irritation (stretching, compression)
or thermal stimuli.
29. ELECTROPHYSIOLOGICAL MONITORING OF FACIAL
NERVE contd..
Events recorded categorised as –
Sporadic peaks and bursts – polyphasic waves usually triggered by contact with the nerve without clinical
relevance.
A train – periodic Electromyographic activity with a sudden onset and end, lasting few seconds.
B train – regular/irregular series of motor potential peaks or bursts lasting for several minutes to hours- possible
neural damage in progression
C train – irregular and continuous EMG activity composed of overlapping elements with large amplitude variation
– established neural damage.
Responses computed during step of identification and confirmation of the facial nerve – visual
inspection and anatomical dissection of nerve during resection.
At the end of the surgery, nerve trunk stimulated again to assess the integrity of the conduction of the
trunk and of all dissected branches.
30. FACIAL MOTRICITY ASSESSMENT
To assess motricity (motor function) – high resolution movies created to evaluate symmetry at rest and
during execution of standardized movements (frowning, closing eyes gently, closing eyes with
maximum effort, smiling wide with lips apart, mouth opening, raising upper lip and puckering lips as if
whistling).
Movies created before surgery and 1 week, 90 days and up to 180 days after surgery.
Facial nerve function graded according to the global House-Brackmann (HB) scale and the regional
Sunnybrook System.
Self-report Facial Disability Index (FDI) – 10 questions distributed across the physical and psychosocial
subscales – to assess the impact of facial dysfunction as perceived by patients.
Applied 30 days after procedure – local edema would not influence the results and 90 days after
surgery (improvement in the degree of facial nerve dysfunction).
31. RESULTS
Total patients – 132 with parotid tumours assessed from March 2015 to September 2017.
Excluded patients – 8 (cytological features suggestive of malignancy = 4 or tumour located in the deep
lobe = 4).
124 patients randomly allocated MG (n=63) or CG (n=61).
Additional 15 excluded (8 – different type of surgery; 9 – whose final HPE revealed malignancy).
106 PATIENTS – with benign parotid tumour subjected to SP.
Mean duration – 147 mins and 146 mins for MG and CG.
33. RESULTS contd..
TFD - 45.3% patients and was the most common complication in the early postoperative period,
followed by tumor spillage (10.3%), salivary fistula (5.6%), hematoma (3.8%), seroma (1.9%), dehiscence
(1.9%) and local infection (0.9%).
Rate of immediate facial dysfunction - lower among the MG vs CG (38.1% vs. 51.8%) - not significant (p
= 0.16).
The rate of late facial dysfunction persisting for up to 6 months after surgery - similar between the
groups (3.8% vs. 5.5%, p = 0.6).
Using the regional Sunnybrook scale - immediate facial dysfunction significantly more severe in the
CG.
Marginal mandibular and buccal branches of the facial nerve - most frequently affected in 80% and
66% of the patients, respectively.
Total facial paralysis - 8.5% of the cases.
35. DISCUSSION
TFD – most common complication after SP.
Association of continuous intraoperative EMG with reductions in TFD following SP – debatable.
Present study – immediate facial dysfunction (IFD) in 45% patients.
Rate of IFD lower in MG (38%) than CG (50%) – not significant.
Questionable whether routine use of IOM – associated with reduction in the degree of FND after
parotid surgery.
Beneficial effect of IOM after parotidectomy – lower severity of TFD and reduced perceived disability
by patients in the early post operative period.
Incidence of late facial nerve dysfunction – similar between MG and CG.
Perzik reported – rate of TFD lower with tumours in parotid tail vs in the centre or superior part.
36. DISCUSSION contd…
Tumour size not associated with increased risk of TFD – similar to findings by Mra et al and Sethi et al.
Watanabe et al and Bittar et al – tumours greater than 3-4 cms had increased risk of TFD – series was
heterogenous and patients submitted to total parotidectomy.
Mra et al – increased risk for patients >40 years (no such association in the current study).
37. LIMITATIONS OF THE STUDY
Low sample size.
Not a standard evaluation method for grading facial nerve deficits.
Neither HB scale/Sunnybrook System provides an objective evaluation.
Further studies should consider the association of the Sunnybrook System and an objective tool, such
as postoperative electromyography, for evaluating patients with facial nerve dysfunction following
parotid surgery.
38. CONCLUSIONS
IOM in the present study did not significantly reduce the occurrence of immediate or late facial nerve
dysfunction after SP for benign tumours.
Facial nerve dysfunction – milder in patients subjected to IOM.
39. OTHER STUDIES
Woods et al – reported 41% incidence of IFD among 742 patients who underwent SP.
Grosheva et al – reported that 41 monitored patients and 38 controls subjected to SP had 29% and
42% rate of IFD respectively.
Lopez et al – reported rates of 29.4% and 56.2% respectively for facial paralysis in a small series of 17
monitored and 16 controls.
Savvas et al – evaluated 123 patients subjected to partial SP under IOM and 99 controls and observed
rate of 16% for MG and 46% for CG suggesting that surgical and technical experience accumulated
with routine IOM over 12 years was relevant in obtaining results.
Meta analysis assessing 288 monitored patients and 238 controls – global incidence of IFD was
significantly lower for surgeries performed under IOM.