This document discusses facial palsy and its management. It begins with an overview of grading scales used to assess recovery from facial nerve paralysis. It then describes various clinical tests that can localize facial nerve injuries, including taste tests, salivation tests, tearing tests, and blink reflex tests. Surgical management options for long-standing facial palsy are discussed, including nerve grafts, hypoglossal-facial nerve anastomoses, cross-facial nerve grafts, and the babysitter technique. Static and dynamic reanimation procedures are also summarized, such as sling plasties, temporalis muscle transfers, and free muscle transfers. The document concludes with a case example of Bell's pals
The document provides information on facial palsy/paralysis, including its causes, symptoms, diagnosis, and treatment options. It discusses how facial palsy can result from various congenital, traumatic, infectious, neoplastic, and metabolic disorders. Diagnostic tests are described that evaluate different branches of the facial nerve, such as the Schirmer test for the lacrimal branch. Management includes medical approaches like corticosteroids as well as surgical options when needed like nerve decompression or microsurgery. Prognosis depends on factors like results from electrophysiological tests measured within the first weeks.
This document outlines anatomy and management of facial paralysis. It discusses the facial nerve anatomy, classifications of nerve injuries, differential diagnosis of sites of injury, and evaluation including House-Brackmann grading and electrodiagnostic testing. Medical management of Bell's palsy includes corticosteroids and antivirals. Surgical management involves nerve decompression or repair through techniques like nerve grafting. Functional restoration uses approaches such as gold weights, botulinum toxin, and nerve transfers like hypoglossal-facial anastomosis.
This document discusses facial nerve palsy, also known as Bell's palsy. It begins by describing the facial nerve and the muscles it innervates. Facial nerve palsy is characterized by partial or complete loss of function of the facial nerve. The document then covers the causes, types (upper vs lower motor neuron), clinical features, investigations, and management of facial nerve palsy. Both non-surgical and surgical treatment options are described to restore facial symmetry and functions like eye closure and oral competence.
Prognostic test in facial nerve palsy in( ENT )haneen ayad
The document summarizes key information about the facial nerve (cranial nerve VII), including its anatomy, branches, paralysis, causes, signs, and prognostic tests. It notes that the facial nerve has motor, sensory and parasympathetic fibers. It can be divided into intracranial and extracranial parts. Causes of facial nerve paralysis include Bell's palsy, infection, trauma, tumors and stroke. Signs include facial asymmetry and inability to close the eye. Prognostic tests discussed include Schirmer test, stapedial reflex testing, electrogustometry, and electromyography.
The document discusses facial nerve paralysis, including:
- The facial nerve controls facial muscles and taste, emerging from the brainstem.
- It describes the anatomy and course of the facial nerve from the brainstem to its branches.
- Causes of facial nerve paralysis include Bell's palsy, infections, trauma, tumors, and other systemic diseases. Symptoms include facial drooping and difficulties with facial expressions. Exams and tests help diagnose the cause and location of damage. Management includes medical and sometimes surgical approaches, with varying prognosis and potential complications.
Facial nerve, its disorders & managementVikas Jorwal
This document discusses facial nerve paralysis and methods for evaluating it. It describes the components of nerve fibers and classifications of nerve injuries by Seddon and Sunderland. For facial paralysis, it evaluates clinical features, performs topographic tests like the Schirmer test and taste testing, and uses electrophysiological tests such as nerve excitability testing to localize the site of injury and assess prognosis. Electrophysiological tests can help determine if there is a conduction block and predict recovery potential.
The document provides information on facial palsy/paralysis, including its causes, symptoms, diagnosis, and treatment options. It discusses how facial palsy can result from various congenital, traumatic, infectious, neoplastic, and metabolic disorders. Diagnostic tests are described that evaluate different branches of the facial nerve, such as the Schirmer test for the lacrimal branch. Management includes medical approaches like corticosteroids as well as surgical options when needed like nerve decompression or microsurgery. Prognosis depends on factors like results from electrophysiological tests measured within the first weeks.
This document outlines anatomy and management of facial paralysis. It discusses the facial nerve anatomy, classifications of nerve injuries, differential diagnosis of sites of injury, and evaluation including House-Brackmann grading and electrodiagnostic testing. Medical management of Bell's palsy includes corticosteroids and antivirals. Surgical management involves nerve decompression or repair through techniques like nerve grafting. Functional restoration uses approaches such as gold weights, botulinum toxin, and nerve transfers like hypoglossal-facial anastomosis.
This document discusses facial nerve palsy, also known as Bell's palsy. It begins by describing the facial nerve and the muscles it innervates. Facial nerve palsy is characterized by partial or complete loss of function of the facial nerve. The document then covers the causes, types (upper vs lower motor neuron), clinical features, investigations, and management of facial nerve palsy. Both non-surgical and surgical treatment options are described to restore facial symmetry and functions like eye closure and oral competence.
Prognostic test in facial nerve palsy in( ENT )haneen ayad
The document summarizes key information about the facial nerve (cranial nerve VII), including its anatomy, branches, paralysis, causes, signs, and prognostic tests. It notes that the facial nerve has motor, sensory and parasympathetic fibers. It can be divided into intracranial and extracranial parts. Causes of facial nerve paralysis include Bell's palsy, infection, trauma, tumors and stroke. Signs include facial asymmetry and inability to close the eye. Prognostic tests discussed include Schirmer test, stapedial reflex testing, electrogustometry, and electromyography.
The document discusses facial nerve paralysis, including:
- The facial nerve controls facial muscles and taste, emerging from the brainstem.
- It describes the anatomy and course of the facial nerve from the brainstem to its branches.
- Causes of facial nerve paralysis include Bell's palsy, infections, trauma, tumors, and other systemic diseases. Symptoms include facial drooping and difficulties with facial expressions. Exams and tests help diagnose the cause and location of damage. Management includes medical and sometimes surgical approaches, with varying prognosis and potential complications.
Facial nerve, its disorders & managementVikas Jorwal
This document discusses facial nerve paralysis and methods for evaluating it. It describes the components of nerve fibers and classifications of nerve injuries by Seddon and Sunderland. For facial paralysis, it evaluates clinical features, performs topographic tests like the Schirmer test and taste testing, and uses electrophysiological tests such as nerve excitability testing to localize the site of injury and assess prognosis. Electrophysiological tests can help determine if there is a conduction block and predict recovery potential.
Facial nerve palsy BY DR. CHANDRA PRAKASH ARYA (B.Sc. B.D.S.; M.D.S.; P.M.S....DR. C. P. ARYA
This document provides an overview of facial nerve paralysis, including its structure, embryology, functions, signs and symptoms, causes, diagnosis, classification, prognosis, and treatment. The facial nerve is the seventh cranial nerve that controls facial expression muscles and conveys taste sensations. Facial nerve paralysis can result from various causes such as Bell's palsy, stroke, infections, tumors, and injuries. Diagnosis involves medical history, exam, and sometimes imaging or blood tests. Prognosis depends on the extent of nerve damage, with better recovery odds if some function remains. Treatment aims to reduce symptoms and promote nerve healing.
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.
This document provides information on facial paralysis (palsy) including its causes, types, treatments, and more. It begins with an introduction to facial function and paralysis. It then covers nerve anatomy and classifications of nerve injuries. Specific topics include facial nerve anatomy, types of facial paralysis (central vs peripheral), common causes like Bell's palsy, and surgical treatment options depending on when paralysis occurred (acute, intermediate, or chronic stages). Evaluation methods and the House-Brackmann grading scale for facial function are also summarized.
This document discusses temporal bone trauma, including evaluation, management, common injuries, and treatment approaches. It covers topics such as CSF otorrhea, hearing loss, dizziness, facial nerve injuries, and surgical versus conservative treatment options. Imaging techniques like CT and MRI are important for diagnosis. Prognosis depends on factors like nerve excitability test results and whether paralysis is immediate or delayed.
The facial nerve is a mixed nerve that carries motor, sensory and parasympathetic fibers. It has several branches that innervate the muscles of facial expression. Facial nerve palsy can result from a variety of causes including Bell's palsy (idiopathic, viral), Ramsay Hunt syndrome (herpes zoster virus), tumors, trauma, infections and other conditions. Clinical testing assesses for signs of facial asymmetry, eye problems and inability to move facial muscles. Treatment depends on the underlying cause but may include eye protection, steroids, antivirals, surgery and other approaches.
This document discusses quantitative tests used to evaluate facial nerve function, including physical examination, topognostic tests like lacrimal function and taste tests, and imaging. It describes the House-Brackmann grading system for facial paralysis and limitations in evaluating acute paralysis. Sunderland's classification of peripheral nerve injuries is explained, categorizing injuries from neurapraxia to neurotmesis. Pathophysiology of various types of facial nerve lesions is discussed.
This document discusses facial palsy, also known as Bell's palsy. It is a condition that causes partial or complete paralysis of the facial nerve resulting in drooping of the facial muscles. The document outlines the types of facial palsy as central or peripheral, and the potential causes such as idiopathic (Bell's palsy), trauma, infection, tumors, or Guillain-Barre syndrome. Signs and symptoms, diagnostic tests like EMG and imaging, and treatment options including corticosteroids, antivirals, and eye care are summarized. The prognosis is generally good with 85% of idiopathic cases fully recovering within 3 weeks, but recovery can take longer or be incomplete
This document discusses disorders and topodiagnostic tests of the facial nerve. It covers several infections that can cause facial nerve disorders like Herpes zoster oticus and various types of ear infections. Trauma from temporal bone fractures, iatrogenic injury from ear/mastoid/parotid surgery, or facial trauma can also cause facial nerve disorders. Topodiagnostic tests like the Schirmer test, stapedial reflex test, taste test, and submandibular salivary flow test can help locate the site of lesion or injury to determine the etiology and appropriate surgical treatment.
This document discusses facial nerve paralysis, including:
- The anatomy of the facial nerve and branches that innervate facial muscles.
- Common causes of facial nerve paralysis like Bell's palsy.
- Evaluating facial nerve paralysis through examining facial muscles, taste sensation, lacrimation, and nerve conduction velocity.
- Treating facial nerve paralysis with physical therapy including heat, electrotherapy, exercises and occasionally splinting.
This document discusses the ophthalmic clinical features and management of facial nerve palsy. It notes that facial nerve palsies most commonly affect those aged 15-45 and can be caused by Bell's palsy, trauma or brain tumors. The clinical evaluation examines features like eyelid retraction, blink reflex, lagophthalmos, tear production and synkinesis. Temporary treatments include artificial tears, ointment and taping the eyelids. Permanent treatments if no recovery is expected include gold weight insertion to improve eyelid closure and protect the cornea.
The document discusses the anatomy, examination, diagnosis, and treatment of facial nerve palsy. It describes the motor, parasympathetic, and sensory parts of the facial nerve and their origins and functions. Examination of the frontal branch and tests for synkinesis, lacrimation, gustation, and sialometry can localize lesions. Bell's palsy is an acute idiopathic peripheral palsy without other cranial nerve involvement. Treatment may include corticosteroids, antivirals, corneal protection, decompression, and physiotherapy. Complications can include incomplete recovery or synkinesis.
The document discusses facial nerve palsy and facial reanimation. It begins with an introduction to the facial nerve and its functions. It then covers anatomy of the facial nerve, classifications and etiologies of facial nerve palsy, presentation and evaluation, non-surgical and surgical management options. For surgical management it discusses various nerve repair techniques including cable grafting and nerve transfers. It also covers approaches to managing specific areas like the eyebrow, eyelids, and lips which may be paralyzed. Both static and dynamic reconstruction techniques are outlined.
facial nerve- pathophysiology, electrodiagnostic and imagingDr Ranjeet Kumar Lal
This document discusses the pathophysiology, electrodiagnostic tests, and imaging of the facial nerve. It begins by describing the anatomy and components of the facial nerve. It then discusses the classification systems used to grade facial nerve injuries based on the degree and type of injury. Various electrodiagnostic tests are described that can help evaluate facial nerve dysfunction and prognosis for recovery, including nerve excitability testing, maximal stimulation testing, nerve conduction velocity testing, and electromyography. Imaging may also be used to identify causes of facial nerve injury or pathology.
The document discusses the anatomy and function of the facial nerve, types and causes of facial palsy, diagnosis, treatment and prognosis. It provides details on Bell's palsy including symptoms, signs, investigations and management. Complications are more likely if there is complete paralysis, older age, pain on onset, or no recovery after several months. Most patients fully recover facial function within 9 months of Bell's palsy onset.
This document discusses facial paralysis, its causes, Bell's palsy, and treatment. It states that the most common cause of facial paralysis is Bell's palsy, which accounts for 60-70% of cases. Bell's palsy is an idiopathic, acute-onset paralysis or weakness of the facial nerve. It can be caused by viral infections like herpes simplex. Diagnosis involves clinical examination, laboratory tests, and electrophysiology tests. Treatment includes steroids, antivirals, physiotherapy, and in rare cases nerve decompression surgery. The prognosis is generally good, with 85-90% of patients recovering fully and 10-15% having some lingering effects.
Facial palsy, or facial paralysis, can be caused by lesions of the facial nerve that disrupt motor function on one side of the face. It is commonly unilateral and can result from various etiologies like Bell's palsy, tumors, trauma, or infections. Clinical features include weakness or paralysis of facial muscles on the affected side leading to issues like eyelid drooping, inability to fully close the eye, and drooping of the mouth corner. Treatment involves facial exercises and in severe cases, surgery or implants may help restore more natural movement. Prognosis is generally good with many cases recovering normal function, but some are left with minor to severe long-term weakness or contractures.
This document discusses disorders of the facial nerve. It begins by describing the anatomy and course of the facial nerve, including its motor and sensory functions. It then discusses specific disorders like Bell's palsy, Ramsay Hunt syndrome, and injuries from fractures or ear/parotid surgery. Bell's palsy is described as the most common cause of facial paralysis, affecting both sexes equally and possibly resulting from viral infection or vascular issues. Diagnosis involves ruling out other causes through examination and tests. Treatment focuses on steroids, antivirals, and physiotherapy. Outcomes range from full to incomplete recovery. Other topics covered include localization of facial lesions, topodiagnostic tests, complications, and surgical procedures.
- Patients with delayed-onset facial paralysis from temporal bone fractures are generally treated conservatively with corticosteroids unless contraindicated.
- Patients with immediate-onset complete paralysis undergo nerve stimulator testing between 3-7 days to determine if surgical exploration is needed.
- Two surgical approaches are used for otic capsule-sparing fractures - transmastoid/supralabyrinthine or transmastoid/middle cranial fossa, depending on mastoid aeration and ability to fully decompress the nerve.
- Translabyrinthine approach is used for otic capsule-disrupting fractures to fully expose the facial nerve from geniculate ganglion to stylomastoid for
This document provides an overview of facial palsy and updates on treatment options. It discusses the functions of the face, including facial expression, communication, attractiveness and sensory functions. Causes of facial palsy include Bell's palsy and lesions of the facial nerve. Treatment options discussed include steroids, antivirals for acute Bell's palsy, physical therapy techniques like exercises, mirror therapy and electrical stimulation, as well as coping strategies. Outcome measures for facial palsy are also reviewed. While many treatments are discussed, the evidence for most is limited and more research on interventions is still needed.
This document provides information on the facial nerve (cranial nerve VII) including its embryology, anatomy, functions, and various disorders. It discusses the facial nerve's motor and sensory roles. Disorders covered include Bell's palsy, Ramsay Hunt syndrome, Moebius syndrome, and Guillain-Barré syndrome. Classification systems for facial nerve paralysis and nerve injuries are also summarized. The document provides detailed information on evaluating facial nerve disorders.
This document discusses the anatomy, etiology, evaluation, and management of iatrogenic facial nerve injury. It describes the segments of the facial nerve and provides surgical landmarks. Common causes of facial nerve palsy include Bell's palsy, trauma, infection, tumors, and iatrogenic injury during procedures like mastoidectomy or parotid surgery. Evaluation involves tests like ENoG and EMG to determine the severity of injury. Management depends on the timing and location of injury, and may involve supportive care, steroids, nerve decompression, repair, grafting, or muscle transposition procedures. The goal is to restore facial muscle function through reinnervation of the nerve.
Facial nerve palsy BY DR. CHANDRA PRAKASH ARYA (B.Sc. B.D.S.; M.D.S.; P.M.S....DR. C. P. ARYA
This document provides an overview of facial nerve paralysis, including its structure, embryology, functions, signs and symptoms, causes, diagnosis, classification, prognosis, and treatment. The facial nerve is the seventh cranial nerve that controls facial expression muscles and conveys taste sensations. Facial nerve paralysis can result from various causes such as Bell's palsy, stroke, infections, tumors, and injuries. Diagnosis involves medical history, exam, and sometimes imaging or blood tests. Prognosis depends on the extent of nerve damage, with better recovery odds if some function remains. Treatment aims to reduce symptoms and promote nerve healing.
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.
This document provides information on facial paralysis (palsy) including its causes, types, treatments, and more. It begins with an introduction to facial function and paralysis. It then covers nerve anatomy and classifications of nerve injuries. Specific topics include facial nerve anatomy, types of facial paralysis (central vs peripheral), common causes like Bell's palsy, and surgical treatment options depending on when paralysis occurred (acute, intermediate, or chronic stages). Evaluation methods and the House-Brackmann grading scale for facial function are also summarized.
This document discusses temporal bone trauma, including evaluation, management, common injuries, and treatment approaches. It covers topics such as CSF otorrhea, hearing loss, dizziness, facial nerve injuries, and surgical versus conservative treatment options. Imaging techniques like CT and MRI are important for diagnosis. Prognosis depends on factors like nerve excitability test results and whether paralysis is immediate or delayed.
The facial nerve is a mixed nerve that carries motor, sensory and parasympathetic fibers. It has several branches that innervate the muscles of facial expression. Facial nerve palsy can result from a variety of causes including Bell's palsy (idiopathic, viral), Ramsay Hunt syndrome (herpes zoster virus), tumors, trauma, infections and other conditions. Clinical testing assesses for signs of facial asymmetry, eye problems and inability to move facial muscles. Treatment depends on the underlying cause but may include eye protection, steroids, antivirals, surgery and other approaches.
This document discusses quantitative tests used to evaluate facial nerve function, including physical examination, topognostic tests like lacrimal function and taste tests, and imaging. It describes the House-Brackmann grading system for facial paralysis and limitations in evaluating acute paralysis. Sunderland's classification of peripheral nerve injuries is explained, categorizing injuries from neurapraxia to neurotmesis. Pathophysiology of various types of facial nerve lesions is discussed.
This document discusses facial palsy, also known as Bell's palsy. It is a condition that causes partial or complete paralysis of the facial nerve resulting in drooping of the facial muscles. The document outlines the types of facial palsy as central or peripheral, and the potential causes such as idiopathic (Bell's palsy), trauma, infection, tumors, or Guillain-Barre syndrome. Signs and symptoms, diagnostic tests like EMG and imaging, and treatment options including corticosteroids, antivirals, and eye care are summarized. The prognosis is generally good with 85% of idiopathic cases fully recovering within 3 weeks, but recovery can take longer or be incomplete
This document discusses disorders and topodiagnostic tests of the facial nerve. It covers several infections that can cause facial nerve disorders like Herpes zoster oticus and various types of ear infections. Trauma from temporal bone fractures, iatrogenic injury from ear/mastoid/parotid surgery, or facial trauma can also cause facial nerve disorders. Topodiagnostic tests like the Schirmer test, stapedial reflex test, taste test, and submandibular salivary flow test can help locate the site of lesion or injury to determine the etiology and appropriate surgical treatment.
This document discusses facial nerve paralysis, including:
- The anatomy of the facial nerve and branches that innervate facial muscles.
- Common causes of facial nerve paralysis like Bell's palsy.
- Evaluating facial nerve paralysis through examining facial muscles, taste sensation, lacrimation, and nerve conduction velocity.
- Treating facial nerve paralysis with physical therapy including heat, electrotherapy, exercises and occasionally splinting.
This document discusses the ophthalmic clinical features and management of facial nerve palsy. It notes that facial nerve palsies most commonly affect those aged 15-45 and can be caused by Bell's palsy, trauma or brain tumors. The clinical evaluation examines features like eyelid retraction, blink reflex, lagophthalmos, tear production and synkinesis. Temporary treatments include artificial tears, ointment and taping the eyelids. Permanent treatments if no recovery is expected include gold weight insertion to improve eyelid closure and protect the cornea.
The document discusses the anatomy, examination, diagnosis, and treatment of facial nerve palsy. It describes the motor, parasympathetic, and sensory parts of the facial nerve and their origins and functions. Examination of the frontal branch and tests for synkinesis, lacrimation, gustation, and sialometry can localize lesions. Bell's palsy is an acute idiopathic peripheral palsy without other cranial nerve involvement. Treatment may include corticosteroids, antivirals, corneal protection, decompression, and physiotherapy. Complications can include incomplete recovery or synkinesis.
The document discusses facial nerve palsy and facial reanimation. It begins with an introduction to the facial nerve and its functions. It then covers anatomy of the facial nerve, classifications and etiologies of facial nerve palsy, presentation and evaluation, non-surgical and surgical management options. For surgical management it discusses various nerve repair techniques including cable grafting and nerve transfers. It also covers approaches to managing specific areas like the eyebrow, eyelids, and lips which may be paralyzed. Both static and dynamic reconstruction techniques are outlined.
facial nerve- pathophysiology, electrodiagnostic and imagingDr Ranjeet Kumar Lal
This document discusses the pathophysiology, electrodiagnostic tests, and imaging of the facial nerve. It begins by describing the anatomy and components of the facial nerve. It then discusses the classification systems used to grade facial nerve injuries based on the degree and type of injury. Various electrodiagnostic tests are described that can help evaluate facial nerve dysfunction and prognosis for recovery, including nerve excitability testing, maximal stimulation testing, nerve conduction velocity testing, and electromyography. Imaging may also be used to identify causes of facial nerve injury or pathology.
The document discusses the anatomy and function of the facial nerve, types and causes of facial palsy, diagnosis, treatment and prognosis. It provides details on Bell's palsy including symptoms, signs, investigations and management. Complications are more likely if there is complete paralysis, older age, pain on onset, or no recovery after several months. Most patients fully recover facial function within 9 months of Bell's palsy onset.
This document discusses facial paralysis, its causes, Bell's palsy, and treatment. It states that the most common cause of facial paralysis is Bell's palsy, which accounts for 60-70% of cases. Bell's palsy is an idiopathic, acute-onset paralysis or weakness of the facial nerve. It can be caused by viral infections like herpes simplex. Diagnosis involves clinical examination, laboratory tests, and electrophysiology tests. Treatment includes steroids, antivirals, physiotherapy, and in rare cases nerve decompression surgery. The prognosis is generally good, with 85-90% of patients recovering fully and 10-15% having some lingering effects.
Facial palsy, or facial paralysis, can be caused by lesions of the facial nerve that disrupt motor function on one side of the face. It is commonly unilateral and can result from various etiologies like Bell's palsy, tumors, trauma, or infections. Clinical features include weakness or paralysis of facial muscles on the affected side leading to issues like eyelid drooping, inability to fully close the eye, and drooping of the mouth corner. Treatment involves facial exercises and in severe cases, surgery or implants may help restore more natural movement. Prognosis is generally good with many cases recovering normal function, but some are left with minor to severe long-term weakness or contractures.
This document discusses disorders of the facial nerve. It begins by describing the anatomy and course of the facial nerve, including its motor and sensory functions. It then discusses specific disorders like Bell's palsy, Ramsay Hunt syndrome, and injuries from fractures or ear/parotid surgery. Bell's palsy is described as the most common cause of facial paralysis, affecting both sexes equally and possibly resulting from viral infection or vascular issues. Diagnosis involves ruling out other causes through examination and tests. Treatment focuses on steroids, antivirals, and physiotherapy. Outcomes range from full to incomplete recovery. Other topics covered include localization of facial lesions, topodiagnostic tests, complications, and surgical procedures.
- Patients with delayed-onset facial paralysis from temporal bone fractures are generally treated conservatively with corticosteroids unless contraindicated.
- Patients with immediate-onset complete paralysis undergo nerve stimulator testing between 3-7 days to determine if surgical exploration is needed.
- Two surgical approaches are used for otic capsule-sparing fractures - transmastoid/supralabyrinthine or transmastoid/middle cranial fossa, depending on mastoid aeration and ability to fully decompress the nerve.
- Translabyrinthine approach is used for otic capsule-disrupting fractures to fully expose the facial nerve from geniculate ganglion to stylomastoid for
This document provides an overview of facial palsy and updates on treatment options. It discusses the functions of the face, including facial expression, communication, attractiveness and sensory functions. Causes of facial palsy include Bell's palsy and lesions of the facial nerve. Treatment options discussed include steroids, antivirals for acute Bell's palsy, physical therapy techniques like exercises, mirror therapy and electrical stimulation, as well as coping strategies. Outcome measures for facial palsy are also reviewed. While many treatments are discussed, the evidence for most is limited and more research on interventions is still needed.
This document provides information on the facial nerve (cranial nerve VII) including its embryology, anatomy, functions, and various disorders. It discusses the facial nerve's motor and sensory roles. Disorders covered include Bell's palsy, Ramsay Hunt syndrome, Moebius syndrome, and Guillain-Barré syndrome. Classification systems for facial nerve paralysis and nerve injuries are also summarized. The document provides detailed information on evaluating facial nerve disorders.
This document discusses the anatomy, etiology, evaluation, and management of iatrogenic facial nerve injury. It describes the segments of the facial nerve and provides surgical landmarks. Common causes of facial nerve palsy include Bell's palsy, trauma, infection, tumors, and iatrogenic injury during procedures like mastoidectomy or parotid surgery. Evaluation involves tests like ENoG and EMG to determine the severity of injury. Management depends on the timing and location of injury, and may involve supportive care, steroids, nerve decompression, repair, grafting, or muscle transposition procedures. The goal is to restore facial muscle function through reinnervation of the nerve.
This document discusses techniques for rehabilitating facial paralysis. It begins with an overview of causes of facial paralysis and basics about nerve regeneration. It then describes several cranial nerve techniques used for rehabilitation, including hypoglossal-facial anastomosis and hypoglossal-facial nerve jump grafting. Factors for selecting surgical techniques are outlined. Muscle transposition techniques using the temporalis, masseter, and digastric muscles are also summarized. Post-operative care and expected results are briefly mentioned.
The document discusses various topics related to eyelid and facial reconstruction:
- It describes the different layers of the eyelid and techniques for repairing full-thickness eyelid lacerations.
- Entropion, ectropion, canalicular injuries, and dacryocystorhinostomy procedures are summarized.
- Facial nerve anatomy and various modalities for facial reanimation including nerve grafts, muscle transfers, and static procedures are outlined.
- Techniques for managing eyelid dysfunction in facial paralysis cases such as tarsorrhaphy and gold weights are also mentioned.
CSF is a clear fluid that cushions the brain and circulates through the ventricles and subarachnoid space. CSF leaks can occur due to trauma, spontaneous defects, meningoencephaloceles, or iatrogenically. Investigations like CT, MRI, and CSF tracer tests are used to locate the leak site. Small or localized leaks are managed conservatively but larger leaks or those at high risk for complications require surgical repair either extracranially via endoscopy or intracranially. Endoscopic techniques have high success rates using grafts, fat, fascia, or synthetic materials to plug the defect. Intrathecal fluorescein helps identify leak sites during surgery.
1) Parotidectomy involves surgically removing all or part of the parotid gland located in front of and below the ear.
2) The procedure begins by making incisions and developing skin flaps to expose the gland. The facial nerve is then identified, either at its main trunk or branches.
3) Dissection then proceeds along the plane of the facial nerve to remove portions of the gland while preserving the nerve branches. Hemostasis is achieved and any duct divisions are managed. Deep lobe tumors require additional care near the nerve.
Anesthesia consideration for parotidectomyTayyab_khanoo9
This document summarizes anesthesia considerations for parotidectomy surgery. It discusses the anatomy of the parotid gland and facial nerve. Parotidectomy is usually indicated for parotid tumors and may require facial nerve monitoring. The document presents a case of performing parotidectomy under local anesthesia in a high-risk patient with hypertension. It describes blocking the maxillary and cervical plexus nerves along with local infiltration to anesthetize the area. The surgery was performed successfully without complications under local anesthesia. Advantages of this technique include avoiding risks of general anesthesia and facilitating identification and protection of the facial nerve.
Evaluation and Management of Facial Nerve Palsy by Dr.Aditya Tiwari.Aditya Tiwari
The document discusses the evaluation and management of facial nerve palsy. It begins with an introduction and overview of causes, evaluation of nerve function, and goals of management. It then discusses factors governing the timing and treatment of facial nerve palsy, assessment and planning, and specific management techniques. Surgical options including nerve decompression, repair, grafting and transfers are outlined. Non-surgical treatments like physical therapy are also summarized.
This document provides information on relevant orbital anatomy and surgical spaces in the orbit. It describes the quadrilateral pyramid shape of the orbit and lists the measurements of its walls. It then outlines the five surgical spaces in the orbit - subperiosteal, peripheral orbital, central, sub-Tenon's, and apical - and notes the structures and tumors commonly found within each space. The document concludes by discussing types of ocular anesthesia, including advantages and techniques for local and general anesthesia.
This document provides information on various vocal fold surgeries and procedures. It begins with definitions and assessments used for vocal fold surgery. It then discusses different surgical techniques like microlaryngoscopy, vocal fold injections, and laryngeal framework surgery. Specific procedures for conditions like nodules, polyps, Reinke's edema, and papillomas are described. The document also covers topics like laser vs other instruments, anesthesia considerations, post-op voice rest, and complications of procedures. Key surgical principles and the advantages of microlaryngoscopy are highlighted. Different materials used for vocal fold injections and medialization thyroplasty are also discussed.
This document provides information on ophthalmic anatomy, physiology, and anesthesia. It discusses the layers of the eye, intraocular pressure regulation, types of local anesthesia including peribulbar and retrobulbar blocks, and considerations for general anesthesia. Key factors discussed include maintaining stable intraocular pressure during surgery and preventing complications.
This presentation talks about the anatomy of facial nerve and the facial nerve palsy. Few diagrams and tables have been taken from Neligan's textbook of Plastic Surgery.
Head and neck cancer reconstruction is arguably the
most challenging area of reconstruction for the reconstructive
surgeon. A clear understanding of the principles of use of local flaps and a comprehensive understanding of the anatomy of these flaps provides the head and neck surgeon with a plethora of local and regional options for primary and secondary reconstruction.
This document provides information about parotidectomy, which is the surgical removal of the parotid gland. It discusses the different types of parotidectomy including superficial and total parotidectomy. Superficial parotidectomy involves removing the superficial lobe of the parotid gland while preserving the facial nerve. The procedure is described in detail, including identifying landmarks to locate the facial nerve and carefully dissecting the gland superficial to the nerve. Complications involving the facial nerve are also addressed.
Complications of anaesthesia in opthalmic surgeryDevdutta Nayak
Local and regional anesthesia techniques are commonly used for ophthalmic surgery. Potential complications include retrobulbar hemorrhage, globe perforation, optic nerve injury, brainstem anesthesia from intravascular injection, and the oculo-cardiac reflex. Careful patient assessment, proper needle selection, knowledge of orbital anatomy, and gentle technique can help minimize risks. Regional techniques like peribulbar and sub-Tenon's blocks provide good akinesia while avoiding potential dangers of retrobulbar injection.
This document discusses upper eyelid reconstruction techniques. It begins with the anatomy of the eyelid, including the skin, orbicularis oculi muscle, orbital septum, tarsal plate, levator palpebrae superioris muscle, Muller's muscle, conjunctiva, canthal tendons, lacrimal system, blood supply, nerve supply, and lymphatic drainage. It then covers indications for reconstruction, requirements, and techniques for repairing anterior and posterior lamellar defects including direct closure, Tenzel flap, sliding tarsocunjunctival flap, posterior lamellar graft with local flap, Cutler-Beard flap, and pedicle flap from lower lid. Surgical techniques are
The document provides an overview of ear anatomy and surgery. It describes the external, middle, and inner ear. Common ear surgeries include those of the external, middle, and inner ear. It discusses considerations for anesthesia for ear surgery, including the use of local anesthesia, nerve blocks, or general anesthesia. General anesthesia requires securing the airway, avoiding nitrous oxide due to pressure changes, and facial nerve monitoring. Patient positioning, a bloodless field, and preventing postoperative nausea and vomiting are also discussed.
Short description about awake craniotomy, its indications, contraindications, complications,various techniques of providing awake craniotomy and drugs used.
This document describes different surgical procedures for lacrimal sac obstructions, including dacryocystorhinostomy (DCR) and dacryocystectomy. It outlines the anatomy, indications, preoperative requirements, steps of conventional DCR including osteotomy of the lacrimal bone and suturing of nasal and sac flaps, and post-operative care. It also discusses endoscopic and endolaser techniques for DCR and the indications for dacryocystectomy. Complications of DCR include wound infections, synechiae formation, and osteotomy stenosis leading to procedure failure.
a case of burn with post burn contracture posted for surgeryZIKRULLAH MALLICK
This document provides information on the classification, causes, and treatment of burn injuries. It discusses:
- The classification of burns as superficial (1st degree), partial thickness (2nd degree), full thickness (3rd degree), and deep full thickness (4th degree) based on the depth of tissue damage.
- Common causes of burns including scalds, fires, chemicals, and electricity. Burns can also be classified as thermal, chemical, electrical or radiation.
- Estimating burn size using the Rule of Nines or Rule of Fives.
- Considerations for fluid resuscitation to correct fluid shifts using formulas like Parkland or Brooke.
- Potential complications involving multiple organ
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
- Video recording of this lecture in English language: https://youtu.be/RvdYsTzgQq8
- Video recording of this lecture in Arabic language: https://youtu.be/ECILGWtgZko
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
Gene therapy can be broadly defined as the transfer of genetic material to cure a disease or at least to improve the clinical status of a patient.
One of the basic concepts of gene therapy is to transform viruses into genetic shuttles, which will deliver the gene of interest into the target cells.
Safe methods have been devised to do this, using several viral and non-viral vectors.
In the future, this technique may allow doctors to treat a disorder by inserting a gene into a patient's cells instead of using drugs or surgery.
The biggest hurdle faced by medical research in gene therapy is the availability of effective gene-carrying vectors that meet all of the following criteria:
Protection of transgene or genetic cargo from degradative action of systemic and endonucleases,
Delivery of genetic material to the target site, i.e., either cell cytoplasm or nucleus,
Low potential of triggering unwanted immune responses or genotoxicity,
Economical and feasible availability for patients .
Viruses are naturally evolved vehicles that efficiently transfer their genes into host cells.
Choice of viral vector is dependent on gene transfer efficiency, capacity to carry foreign genes, toxicity, stability, immune responses towards viral antigens and potential viral recombination.
There are a wide variety of vectors used to deliver DNA or oligo nucleotides into mammalian cells, either in vitro or in vivo.
The most common vector system based on retroviruses, adenoviruses, herpes simplex viruses, adeno associated viruses.
10. GRADING OF RECOVERY FROM FACIAL NERVE
PARALYSIS (HOUSE -BRACKMANN)
GRADE I NORMAL
GRADE II MILD DYSFUNCTION
GRADE III MODERATE DYSFUNCTION
GRADE IV MODERATELY SEVERE DYSFUNCTION
GRADE V SEVERE DYSFUNCTION
GRADE VI TOTAL PARALYSIS
13. Taste test
Drop of sugar or salt on one side of
protruded tongue or electro-gustometer.
Ageusia or atrophied papillae
injury to chorda tympani nerve.
14. Salivation
SUBMANDIBULAR SALIVARY FLOW TEST
This measures functions of chorda tympani
Polythene tubes are passed into both Wharton
ducts and drops of saliva are measured during
one minute period.
Decreased salivation injury to chorda
tympani
15. Tearing
SCHRIMER’S TEST
It compares lacrimation of both sides using a
strip of filter paper hooked in the lower fornix of
the eye
Decreased lacrimation lesion proximal to
geniculate ganglion
17. Corneal blink reflex
Mediated by sensory fibers of the trigeminal
nerve and motor fibers of the facial nerve
Bilateral blink reflex when cornea of one eye is
touched with a wisp of cotton is known as
consensual reflex
If the depression of the reflex were secondary
to seventh nerve hypofunction, only director
the affected side response would be
depressed, consensual reflex will remain
intact.
38. Bell’s Palsy A 54-year-old female reported
to “X” Dental College with a
complaint of missing teeth
and desired replacement of
her missing teeth. Patient’s
appearance was abnormal
and on observation the patient
had facial asymmetry,
involuntary continuous
blinking of the right eye and
twitching of the right cheek.
Patient was provisionally
diagnosed as having right
hemifacial palsy and was
referred to the Department of
Oral and Maxillofacial Surgery
for the management.
HOUSE BRACKMANN GRADE III
45. WILL IT RESOLVE?
An objective, standardized, quantifiable assessment of facial nerve function serves as
the basis for evaluating the clinical course. The most commonly used system is the
House– Brackmann score.
Many studies have been done which prove that almost 84 percent patients with
Bell’s Palsy have complete recovery especially In HBS I and II and III.
46. WE HAVE MADE A DIAGNOSIS OF ACUTE
BELL’S PALSY . WHAT DO WE DO NOW?
Eyecare
To prevent ulceration or dehydration of
the cornea, apply artificial tears(such as
Hypromellose drops) every one or two
hours during the day. At night,keep the
eye moist by using a thin strip of paraffin
based ointment(such as Lacrilube).
Also refer to the ophthalmologist for
consultation.
47. Corticosteroids
The maximum benefit is seen when steroids are
commenced within 72 hours of the onset of
symptoms. There is no optimum regimen, but in
adults 50–60 mg prednisolone daily for 10 days
has been commonly used. Prednisolone has been
used at a dose of 1 mg/kg/day up to a maximum
of 80 mg in some studies. Doses of more than
120 mg/day have been used safely in patients
with diabetes.
In a randomised controlled trial the recovery rate
at nine months with prednisolone was 94%.
48. Antiviral drugs
The antiviral drugs used in trials were aciclovir
(400 mg five times daily for five days) or
valaciclovir (1000 mg/day for five days).
Combination therapy
A randomised controlled trial found that at nine
months of diagnosis, facial function had
recovered in 94.4% of patients who took
prednisolone alone, 85.4% of those who took
aciclovir alone and 92.7% in patients who took a
combination of both.
49. OUR PATIENT WANTS TO EXPLORE
ALTERNATIVE THERAPIES. WHAT COULD WE
ADVICE?
• Electrical nerve stimulation (electrotherapy)
• Thermal therapies such as heat/ice and exercise
• Massage therapy
• Acupuncture
• Mime therapy
50.
51. SO THE ACUTE MANAGEMENT DIDN’T
WORK. WHAT NEXT?
Basis for the selection of the rehabilitation technique of choice
are the lesion site and the duration of palsy
54. INTERPOSITIONAL NERVE
GRAFTS
The repaired nerve begins the regeneration process re-
growing from the site of injury at a rate of approximately
1mm/day or one inch a month. It is imperative that the
nerves are united without tension.
If the gap between the nerve ends is to large to permit a
tension free repair then a interposition graft must be
used to guide the regenerating nerve fibers (axons).
An expendable segment of sensory nerve harvested from the calf (sural nerve graft) or neck (great
auricular nerve) is frequently used to bridge the gap (nerve graft).
Interpostion nerve grafts are frequently utilized to reconstruct the facial nerve after cancer surgery
where complete removal of the tumor necessitates the sacrifice of a facial nerve segment (for example
parotid tumors).
55.
56. Greater auricular nerve
The nerve is located 1cm below the
mastoid tip on the surface of the
sternocleidomastoid muscle.
Add 1 cm to the required graft length
to permit trimming of the ends of the
nerve graft.
The greater auricular nerve has the
disadvantage of not providing a long
length of graft because it divides
quickly (<10 cm). Similarly, it is not
advisable to use it in ipsilateral
parotid or temporal bone cancers
when the nerve is likely to be
affected by the disease.
57. Sural nerve
It is much less accessible and locating it is more
difficult. It requires a 2nd operating field and its
removal must be anticipated.
It has two important advantages: it is a very
fasciculated nerve that is easy to subdivide and
a long length can be harvested as it divides late.
These important benefits make it the preferred
choice when it comes to placing split grafts in
the parotid or temporal bone-to-parotid. It is
located 2cm behind the lateral malleolus,
almost subcutaneously .
It is possible to harvest it via horizontal
incisions along the leg.
58. Postoperatively the patient may have pain in the foot and leg
causing transient functional impairment. It may be necessary
to prescribe anticoagulants to avoid secondary venous
thrombosis. Sensory deficits caused by harvesting the sural
nerve are limited to the lateral edge of the foot and are not
very troublesome.
67. Lateral tarsal strip procedure for
ectropion of the lower lid. A lateral
canthotomy incision is shown (A).
Division of the lateral aspect of the
lower lid into an anterior
musculocutaneous layer and
posterior tarsal conjunctival layer
is shown (B). Tarsal strip is
grasped with skin hook (C). Tarsal
strip is positioned inside the lateral
rim of the orbit, which has been
exposed (D). Tarsal strip is sutured
to periosteum inside of lateral
orbital rim (E). Excess skin is
excised and wound closed (F).
68. HYPOGLOSSAL-FACIAL
JUMP ANASTOMOSIS
The very first method of the transposition and end-to-
end-suture of the hypoglossal nerve to the proximal trunk
of the facial nerve was described by Conley et al. in
1979.Because of the lost unilateral tongue function and
atrophy, this method was replaced by an end-to-side
hypoglossal-facial nerve suture. This technique was
modified by use of a free interposition nerve graft, usually
of the great auricular nerve, which was sutured end-to-
end to the distal facial nerve and end-toside to the incised
(1/3 to 1/2) hypoglossal nerve. Today, this method is
favored, but the presence of two anastomosis sites may
influence the reinnervation quality and time..
80. BABYSITTER TECHNIQUE
v
Shortcomings such as long distances for
regenerating axons to elongate and
prolonged denervation period could be
detrimental, leading to irreversible muscle
atrophy, unless the procedure occurs within
6 months from the onset of facial paralysis
of cross facial nerve grafting lead to the
introduction of babysitter procedure in
1984 by Terriz, which uses a portion of an
ipsilateral powerfulmotor donor nerve
(hypoglossal) to rapidly innervate the
paretic musculature, whereas cross-facial
nerve grafting regenerates across the face.
The procedure involves two stages.
81. In the first stage, 40 percent of the ipsilateral
hypoglossal (minihypoglossal) nerve is coapted
to the denervated facial nerve trunk, and three
or four cross-facial nerve grafts are placed
across the face. The minihypoglossal nerve
promptly provides regenerating motor fibers to
the facial nerve that quickly reach the affected
facial muscles.
At the second stage, 8 to 12 months later, the
distal end of the cross-facial nerve grafts are
connected to selected distal branches of the
affected facial nerve, whereas the
minihypoglossal to facial nerve coaptation
remains undisturbed. This is the original
“babysitter” procedure, and variations have
been reported since its inception
89. Intraoral approach harvests the
masseter muscle for transfer.
Incision is made along the
gingival sulcus (A). One
muscle is exposed; curved
scissors are used to transect
the muscle in the midportion
(B). Two slips of muscle are
attached to the dermal layers
of the skin for overcorrection of
the smile (C).
MASSTER MUSCLE
TRANSFER
90. MICROVASCULAR TRANSFER
Gracilis free flap transfer is the preferred option for facial reanimation
for patients with irreversible or long-standing facial paralysis.
It offers the best chance of obtaining facial symmetry, voluntary
movement, and natural appearing smile.
Other muscles used are Pectoralis Minor and Latissmus Dorsi muscle.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102. Four fixation points centered around
the commissure are identified in the
following order:
1.Oral commissure
2.Mid lower lateral lip
3.High point of Cupid's bowl
ipsilateral
4.Mid upper lateral lip
103.
104.
105.
106.
107.
108. SLING PLASTIES
Even a dynamic muscle plasty can be
technically impossible in cases of extended
tumour surgery. As third choice static slings are
part of the surgical arsenal. Slings allow
restoration of the resting tone and
improvement of facial asymmetry at rest in
direction of the inserted sling.
Autologic material like fascia lata or the tendon
of the palmaris longus muscle is first choice in
front of alloplastic material. Complications such
as wound healing problems, are seen more
frequently with alloplastic material .
116. J Oral Maxillofac Surg. 2016 May;74(5):1013-22. doi: 10.1016/j.joms.2015.12.013. Epub 2016 Jan 7.
A Modified Preauricular Approach for Treating Intracapsular Condylar
Fractures to Prevent Facial Nerve Injury: The Supratemporalis
Approach.
Li H1, Zhang G2, Cui J3, Liu W1, Dilxat D1, Liu L4.
Author information
1
Resident, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
2
Associate Professor, Department of Stomatology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
3
Attending Staff, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
4
Professor, Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China. Electronic address: drliulei@163.com.
122. • If the proximal segment of facial nerve is
obscured, retrograde dissection of 1 or more
of the peripheral branches may be necessary
to identify the main trunk.
• Ramus frontalis is located by a line from
tragus to lateral canthus.
• Ramus buccalis is located by a line from the
tragus towards alae of the nose parallel to the
zygoma but 1 cm below.
• Ramus mandibularis is near the angle of
mandible at a point 4-4.5 cm from the
attachment of the lobule of pinna.
123. MARGINAL MANDIBULAR NERVE
The distance of the marginal mandibular branch of the facial nerve from the inferior
border of the mandible from 1.4 to 1.75 cm.
The marginal mandibular branch of the facial nerve must be looked for in all operative
procedure near the angle of the mandible to a distance of 1.5 cm below the lower margin
of the mandible.
Therefore, in order to avoid damage to the nerve in the submandibular region, the incision
should be made 1.5 cm or more below the lower border of the mandible.
By giving an incision of two fingers breadth below and parallel to the angle of the
mandible, the marginal mandibular branch of the facial nerve can be isolated in the upper
flap.
124.
125. HAYES MARTIN MANEUVER
• The marginal mandibular nerve has available course in relation to
the inferior ramus of the mandible.
• Following its emergence from the anterior border of the parotid
gland, it swings inferiorly to a variable degree before crossing lateral
to the facial vascular pedicle. It remains in a plane lateral to the
superficial layer of the deep cervical fascia enveloping the
submandibular gland.
• Hayes Martin described a now well-known manoeuvre to prevent
injury to this nerve, which involved ligating the facial vein at a level
approximately two finger-breadths below the mandible and then
retracting the superficial layer of the deep cervical fascia with the
subplatysmal plane as far as the mandibular ramus. As a result of
this, the peri-facial nodal groups remain undissected.