MyMedR

Fulltext Review of an 11-year Experience in Retrosigmoid Approach for Treatment of Acoustic Neuromas

Lim SL, Wong SH

Med J Malaysia, 2013 Jun;68(3):253-8.

This study reviews surgery on acoustic neuromas by the second author using retrosigmoid approach from January 2000 to June 2010 in the state of Sarawak. There was a total of 32 patients in this study. The commonest presenting symptom was hearing loss (81.3%), followed by headache and tinnitus (each 37.5%), ataxia (34.4%) and facial numbness (21.9%). Twenty-seven patients (84.4%) had large tumor (≥ 3cm) while 5 patients (15.6%) had medium size tumor (1.5-2.9cm). The mean tumor size was 3.6 cm. Facial nerve outcome was good to moderate in 93.7% (House and Brackmann Grade I-IV). The most common complications were CSF leak with 3 patients(9.4%) and facial numbness with 2 patients(6.3%). All either resolved with treatment or improved. There was no mortality. Excision of acoustic neuromas using retrosigmoid approach could achieve acceptable facial nerve outcome with a low incidence of morbidity without mortality.

Matched MeSH terms: Facial Nerve*

Fulltext Intraparotid facial nerve schwannoma: a case report

Irfan M, Shahid H, Yusri MM, Venkatesh RN

Med J Malaysia, 2011 Jun;66(2):150-1.

PMID: 22106700 MyJurnal

Schwannoma in the head and neck region is very rare. The tumour occurring in the intraparotid facial nerve is even rarer. A patient presenting with a parotid swelling with facial nerve paralysis is not pathognomonic of a facial nerve schwannoma. However it may occur because enlargement of the parotid, by any kind of tumour especially a malignant one can cause facial nerve paralysis. We report a case of an intraparotid facial nerve schwannoma, in a patient who presented with parotid enlargement and facial nerve paralysis.

Matched MeSH terms: Facial Nerve Diseases/diagnosis*; Facial Nerve Diseases/surgery

Fulltext Parotid mass: a 5-year review of parotid surgery

Chew YK, Noorizan Y, Khir A, Brito-Mutunayagam S

Med J Malaysia, 2007 Dec;62(5):388-9.

PMID: 18705472

This study is to analyze the incidence of facial nerve paralysis after parotidectomy and the type of pathologic condition involved in Hospital Pakar Sultanah Fatimah, Muar between 2002 and 2006. There were 20 parotidectomies done on 20 patients over this period of time. Fourteen were done for tumour and six for inflammatory conditions. The pathology involved were pleomorphic adenoma 9 (45%) cases, Kimura disease 2 (10%) cases, carcinoma 5 (25%) cases and inflammatory condition 4 (20%) cases. Out of 20 parotidectomies done (13 for superficial and 7 for total), 4 (20%) patients had complication of facial nerve paralysis, 2 Malignant tumour, 1 benign tumor and 1 was inflammatory condition. In conclusion, preservation of the facial nerve and its function, wherever possible, is very important to reduce social and functional morbidity.

Matched MeSH terms: Facial Nerve Diseases/etiology

Fulltext Embryonal rhabdomyosarcoma of the middle ear presenting with aural polyp and facial nerve palsy

Vasiwala R, Burud I, Lum SK, Saren RS

Med J Malaysia, 2015 Oct;70(5):314-5.

PMID: 26556123 MyJurnal

Rhabdomyosarcoma is a rare tumour in the middle ear and mastoid cavity in children and the diagnosis is difficult. Repeated histological examination may be essential to confirm the diagnosis. We report a 6 year old boy with a left aural polyp, otorrhoea and facial nerve palsy who was initially thought to have otitis media and mastoiditis. He had polypectomy and the tissue taken for histopathology suggested an inflammatory condition. Subsequently he had mastoidectomy. Tissue taken during mastoidectomy was however reported as rhabdomyosarcoma. The child developed a cerebral abscess and eventually succumbed. A literature review of the disease, radiological findings, immunohistochemical features and treatment options is described.

Matched MeSH terms: Facial Nerve

Fulltext Parotid swellings: report of 110 consecutive cases

Arshad AR

Med J Malaysia, 1998 Dec;53(4):417-22.

PMID: 10971987

Parotid swellings are uncommon. Over a twelve-year period, 110 cases of parotid swellings were treated at the Department of Plastic Surgery, Hospital Kuala Lumpur, of which 97 cases were histologically proven to be parotid tumours. 75% of these tumours were benign tumours, and 80% of the benign tumours were pleomorphic adenomas. Among the malignant tumours, 6 cases were adenoid cystic carcinoma and 5 were carcinoma ex-pleomorphic adenoma. There were equal number of male to female patients, with an age range of 14 to 83 years. There is a positive correlation between the final histological diagnosis and FNAC results in 74% of cases. Surgical treatment of choice for benign parotid tumours was near-total parotidectomy whilst for malignant tumours was total radical parotidectomy with sural nerve graft.

Matched MeSH terms: Facial Nerve Diseases/etiology

Fulltext The clinical significance of the branching pattern of the facial nerve in Malaysian subjects

Myint K, Azian AL, Khairul FA

Med J Malaysia, 1992 Jun;47(2):114-21.

PMID: 1494331

Fine dissection was carried out in 79 facial halves from formalin fixed Malaysian adult cadavers of various races, to trace the extracranial part of the facial nerve and its peripheral branches. The facial nerve trunk, after leaving the stylomastoid foramen was located at a depth of 1 to 2 cm from the skin in the vagino-mastoid angle. It bifurcates at the posterior border of the ramus of the mandible and in 3.8% trifurcation was found. Mean distance of bifurcation from the angle of the mandible was 28.06 mm and 81.0% were within the range of 21 to 35 mm. The branching patterns were classified into six types, and the frequency of occurrence was type I 11.39%, type II 15.9%, type III 34.18%, type IV 18.98%, type V 7.59% and type VI 12.67%. Type I, a classical text book pattern was found to be one of the least common patterns. There is no significant difference in percentage of each type between the present study and that of Koreans, though some differences with Caucasians were noted in three uncommon types. The frontal branch could be outlined between the two diverging lines from the earlobe to the lateral ends of the eyebrow and the highest frontal crease. Posterior to the facial artery, the mandibular branch was seen passing below the inferior border of the mandible in 20%; anterior to the artery, this nerve divides into one to four branches. In almost all the cases, branches to the mentalis and the depressor labii inferioris muscles and infrequently branches to the depressor angular oris were seen below the inferior border of the mandible.(ABSTRACT TRUNCATED AT 250 WORDS)

Matched MeSH terms: Facial Nerve/anatomy & histology*

Fulltext Surgical intervention in traumatic facial nerve paralysis

Yeoh TL, Mahmud R, Saim L

Med J Malaysia, 2003 Aug;58(3):432-6.

PMID: 14750385

A four years review from June 1998 to June 2002 of traumatic facial nerve paralysis from temporal bone fractures that required surgical intervention is presented. The aim of this clinical presentation was to determine the current pattern of cases with traumatic facial paralysis which required surgical intervention at our center. There were six cases, of which four (66%) were longitudinal fractures, one each (17%) had transverse fracture and fracture over the lateral wall of mastoid. Hearing loss (83%) was the commonest associated clinical symptom. All cases underwent decompression via the transmastoid surgical approach. Intraoperative findings revealed oedema of facial nerve involving vertical segment and horizontal segment in three cases each respectively. Two cases had concomitant bony impingement. The facial nerve functions in four cases (66%) and one case recovered to House Brackmann grade 2 and 4, 12 months and 3 months respectively postsurgery. The case with transverse fracture remained as House Brackmann grade 5 after two years.

Matched MeSH terms: Facial Nerve Injuries/complications*; Facial Nerve Injuries/surgery*

Fulltext The different faces of facial nerve schwannomas

Abdullah A, Mahmud MR, Sabir HA, Saim L

Med J Malaysia, 2003 Aug;58(3):450-3.

PMID: 14750390

Facial nerve schwannomas are rare benign tumors. The tumor can arise anywhere along the course of the facial nerve. The most common presentation for this tumor is a slowly progressive facial nerve paralysis. Sensorineural hearing loss (SNHL) and tinnitus are later symptoms. The symptoms and signs depend on the site of tumor along the nerve. We report three cases of facial nerve schwannomas with different clinical presentations. Appropriate management of a facial nerve schwannoma should be based on the site and extent of the tumor and status of the nerve function.

Matched MeSH terms: Facial Nerve Diseases/complications; Facial Nerve Diseases/diagnosis*

Ramsay-Hunt syndrome with complete recovery of cranial nerves

Ponniah RD

Med J Malaysia, 1975 Dec;30(2):156-9.

PMID: 1228383

Matched MeSH terms: Facial Nerve*

Surgical outcomes of transmastoid facial nerve decompression: Preliminary data from a Malaysian tertiary hospital from 2013-2018

Siang PG, Ying XT, Dayang Suhana AM, Ing PT

Med J Malaysia, 2020 05;75(3):281-285.

PMID: 32467545

INTRODUCTIONS: Facial nerve palsy (FNP) occurs in 7-10% of temporal bone fractures. The aim of this study was to review the surgical outcome of nine patients with severe to complete traumatic facial nerve (FN) injury.

METHODS: The patients were evaluated clinically and FNP was graded using the House Brackmann (HB) scale. High resolution computerized tomography (HRCT) of the temporal bone was used to evaluate temporal bone fractures. Transmastoid facial nerve decompression was performed and the facial nerve function was re-evaluated in subsequent follow ups.

RESULTS: There were five cases with immediate onset and four with delayed onset of FNP. Only three cases had pure temporal bone fractures, the others were associated with other life threatening injuries. The sensitivity and specificity of HRCT temporal bone to detect the obvious facial canal fracture line were 50% and 40% respectively. 75% of patients with immediate onset of HB grade VI FN palsy who were operated within a month recovered completely. Surgeries for the delayed onset FNP were performed at a mean of 70 days (range 51-94). All recovered to HB grade II-III from severe FNP.

CONCLUSIONS: Our study demonstrated that transmastoid FN decompression surgery was beneficial to traumatic nerve injury. Early intervention resulted in better outcomes. However, FN function could still be salvaged even in delayed FN decompression.

Matched MeSH terms: Facial Nerve Injuries/surgery*

Fulltext Facial nerve paralysis: a rare complication of parotid abscess

Sabir Husin Athar PP, Yahya Z, Mat Baki M, Abdullah A

Malays J Med Sci, 2009 Apr;16(2):38-9.

PMID: 22589657

Benign parotid neoplasm and inflammatory processes of the parotid resulting in facial paralysis are extremely rare. We report a 72-year-old Malay female with poorly-controlled diabetes mellitus who presented with a painful right parotid swelling associated with right facial nerve palsy. The paralysis (Grade VI, House and Brackmann classification) remained after six months.

Matched MeSH terms: Facial Nerve

Duplicate internal auditory canals with facial and vestibulocochlear nerve dysfunction

Kew TY, Abdullah A

J Laryngol Otol, 2012 Jan;126(1):66-71.

PMID: 21867589 DOI: 10.1017/S0022215111002258

We report an extremely rare case of duplication of the internal auditory canal associated with dysfunction of both the facial and vestibulocochlear nerves. We also review the literature regarding the integrity of the facial and vestibulocochlear nerves in such cases.

Matched MeSH terms: Facial Nerve/abnormalities*; Facial Nerve/physiopathology

Rare middle ear anomaly in a patient with Turner's syndrome

Hamzah AR, Jalaluddin MA, Raman R

Ann Otol Rhinol Laryngol, 1999 Mar;108(3):253-4.

PMID: 10086617

A patient with Turner's syndrome presented with a rare anomaly of absent oval window, inferiorly placed facial nerve, and abnormal stapes. To our knowledge, this is the first report of this combination of malformations.

Matched MeSH terms: Facial Nerve/abnormalities

Fulltext Concomitant abducens and facial nerve palsies: A rare presentation in anti-aquaporin-4 antibody-positive neuromyelitis optica

Oo KT, Tay KS, Law WC, Shatriah I

Taiwan J Ophthalmol, 2019 12 05;10(3):235-238.

PMID: 33110759 DOI: 10.4103/tjo.tjo_69_19

Over the past decade, the discovery of disease-specific aquaporin-4 antibodies has led to a better understanding of the diverse spectrum of disorders that are associated with neuromyelitis optica. Brainstem manifestations have been increasingly recognized in this disease. However, multiple cranial nerve palsies as an initial presentation of neuromyelitis optica are uncommon. We report a rare case of anti-aquaporin-4 antibody-positive neuromyelitis optica that presented with unilateral abducens and facial nerve palsies. Notably, this case did not involve the optic nerve or the spinal cord. Diagnosing neuromyelitis optica that presents as an isolated acute brainstem syndrome is challenging, but the outcome may be devastating if the diagnosis is delayed.

Matched MeSH terms: Facial Nerve

Fulltext Recurrent Bell's palsy in a young woman

Ngow HA, Wan Khairina WM, Hamidon BB

Singapore Med J, 2008 Oct;49(10):e278-80.

PMID: 18946598

Bell's palsy is a benign lower motor neuron facial nerve disorder. It is almost always unilateral. We report a 20-year-old nulliparous woman with five episodes of recurrent Bell's palsy. A review of recent medical literature revealed a paucity of case reports involving an individual with five episodes of recurrent Bell's palsy, with none found in Asian neurology medical literature. Despite the multiple episodes of Bell's palsy recurrences, the patient did not suffer much neurological sequelae from the disease.

Matched MeSH terms: Facial Nerve Diseases/diagnosis

Surgical outcomes in cystic vestibular schwannoma versus solid vestibular schwannoma

Tang IP, Freeman SR, Rutherford SA, King AT, Ramsden RT, Lloyd SK

Otol Neurotol, 2014 Aug;35(7):1266-70.

PMID: 24841920 DOI: 10.1097/MAO.0000000000000435

To review the postoperative surgical outcomes of cystic vestibular schwannomas (CVSs), especially facial nerve outcomes, and compare these results with those from matched solid vestibular schwannomas (SVS) resected during the same period at a tertiary referral center.

Matched MeSH terms: Facial Nerve Injuries/etiology*

Case Report: Ocular Tilt Reaction with Internuclear Ophthalmoplegia and Multiple Cranial Nerve Palsies

Teo SK, Mohd Khialdin S, Yong MH, Othman O, Ami M

Optom Vis Sci, 2020 Dec;97(12):1018-1022.

PMID: 33252541 DOI: 10.1097/OPX.0000000000001607

SIGNIFICANCE: Ocular tilt reaction (OTR) is an abnormal eye-head postural reaction that consists of skew deviation, head tilt, and bilateral ocular torsion. Understanding of the pathway of the vestibulo-ocular reflex (VOR) is essential because this will help to localize the pathology.

PURPOSE: The aim of this study was to report a case of OTR with contralateral internuclear ophthalmoplegia (INO) and fifth and seventh cranial nerve palsies.

CASE REPORT: A 51-year-old gentleman with underlying diabetes mellitus presented with sudden onset of diplopia for 3 days. On examination, his visual acuity was 20/30 bilaterally without a relative afferent pupillary defect. He had a right OTR consisting of a right head tilt, a skew deviation with a left eye hypertropia, and bilateral ocular torsion (right excyclotorsion and left incyclotorsion) with nystagmus. He also had a left adduction deficit and right abduction nystagmus consistent with a left INO. Ocular examination revealed evidence of proliferative diabetic retinopathy bilaterally. Two days after the initial presentation, the patient developed left seventh and fifth cranial nerve palsies. MRI showed left pontine infarction and multiple chronic lacunar infarctions. There was an incidental finding of a vascular loop compression on cisternal portions of the left trigeminal, facial, and vestibulocochlear nerves. Antiplatelet treatment was started on top of a better diabetic control. The diplopia was gradually resolved with improved clinical signs. In this case, the left pontine infarction had likely affected the terminal decussated part of the vestibulocochlear nerve from the right VOR pathway, medial longitudinal fasciculus, and cranial nerve nuclei in the left pons.

CONCLUSIONS: The OTR can be ipsilateral to the lesion if the lesion is before the decussation of the VOR pathway in the pons, or it can be contralateral to the lesion if the lesion is after the decussation. In case of an OTR that is associated with contralateral INO and other contralateral cranial nerves palsy, a pathology in the pons that is contralateral to the OTR should be considered. Neuroimaging study can hence be targeted to identify the possible cause.

Matched MeSH terms: Facial Nerve Diseases/diagnosis; Facial Nerve Diseases/etiology*; Facial Nerve Diseases/physiopathology

Fulltext Carcinoma Ex Pleomorphic Adenoma Presented as a Gigantic Tumor: Treatment and Diagnostic Challenges

Maruthamuthu T, Saniasiaya J, Mohamad I, Nadarajah S, Lazim NM, Wan Abdul Rahman WF

Oman Med J, 2018 Jul;33(4):342-345.

PMID: 30038735 DOI: 10.5001/omj.2018.62

Parotid gland surgery can be challenging due to intricate relationship between the gland and facial nerve. Besides complete removal of the lesion, the main focus of surgery is centered on the facial nerve. Surgery can be technically demanding especially when the tumor is large or involves the deep lobe. We report a patient with a 30-year history of gigantic parotid mass, which initial fine-needle aspiration cytology reported as pleomorphic adenoma. The tumor, weighing 1.3 kg, was successfully resected with facial nerve preservation. Histopathological examination of the excised mass confirmed as carcinoma ex pleomorphic adenoma (CaExPA) of adenocarcinoma, not otherwise specified type. We describe the specific surgical and reconstruction techniques for successful removal of large parotid tumors with facial nerve preservation. To our knowledge, this is the heaviest CaExPA of the parotid gland in South-East Asian region.

Matched MeSH terms: Facial Nerve

Fulltext Retrospective review of facial nerve schwannomas: the universiti kebangsaan malaysia medical centre experience

Mazita, A., Zahirrudin, Z., Saim, L., Asma, A.

Medicine & Health, 2010;5(2):86-92.

MyJurnal

Facial nerve schwannoma is a rare slow growing benign tumour which arises from the Schwann cell of the neurilemma. A retrospective review of 6 patients who had been diagnosed with facial nerve schwannoma between 1998 and 2008 was conducted. There was equal distribution of male and female patients. The mean age was 42 years (range 19 to 66 years). The tumour originated in the internal auditory canal (2 patients), intra-temporal (3 patients) and intraparotid (1 patient) segments of the facial nerve. All tumours were successfully removed and facial nerve continuity was pre-served in 2 cases. The presenting symptoms of facial nerve schwannoma are non specific and dependent on the site of tumour origin. It is a great mimicker of other lesions that can present at the same location. The surgeon should have a high index of suspicion when patients present with progressive facial nerve palsy. Patients should always be counselled regarding risk of facial paralysis because the diagnosis of facial nerve schwannoma is often confirmed intra-operatively.

Matched MeSH terms: Facial Nerve

Fulltext Facial nerve palsy in a child: Bell’s palsy? Think again!

Jo Ee Sam, Nasser Abdul Wahab, Priya Sharda

Malays Fam Physician, 2017;12(3):30-32.

MyJurnal

Introduction: Half of facial paralysis in children is idiopathic at origin. However, dismissing facial
paralysis as being idiopathic without a thorough history and meticulous examination could be
disastrous as illustrated by this case.

Case report: We report a case of sphenoid wing meningioma in a 4-year-old girl. She first
presented with only facial asymmetry that was noticed by her mother. Examination suggested a
left upper motor neuron facial nerve palsy. A sphenoid wing meningioma was found on magnetic
resonance imaging (MRI) of her brain. She underwent craniotomy and total tumour excision.
Histopathological examination of the tumour showed a grade 1 transitional type meningioma.
Meningiomas in children are rare compared to the adult population. Presentations in children
may be delayed due to their inability to recognise or communicate abnormalities. Distinguishing
between upper and lower motor neuron facial palsy is crucial in decision making for facial paralysis
in children.

Matched MeSH terms: Facial Nerve

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