In 10 adult specimens, we observed the distribution of the temporal branches of the facial nerve and its relation with the superficial temporal artery. The 6.3±0.9 temporal branches (5-8 branches, mean 6.3+0.9) went across the lateral margin of the M. frontalis and 10.3±2.2 branches entered the muscle. Their in-let, points were 2.86±5.35 mm upwardand outward of the outer canthus, and all points were about in one line. In conclusion, it was safe for surgeons, to operate in the "safe area" of the temporal region, medial to thevertical line to the outer canthus, without the risk to damage the branches of the facial nervc .
Objective To explore the arterial origin and the distribution of the extracranial branches of the facial nerve. Methods Red latex or red chlorinated polyvinyl chloride was injected into the arteries of 15 fresh adult head specimens by both common carotid artery catheterization. The arterial origin and distribution of the extracranial branches of the facial nerve were observed. Results The nutrient arteries of the extracranial branches of the facial nerve originated from stylomastoid artery of the posterior auricular artery, the facial nervous branch of superficial temporal artery, transverse facial artery, superior and inferior facial nervous branches of external carotid artery and the posteriorand anterior facial nervous branches of external carotid artery. The outer diameters of them were (0.8±0.2) mm, (0.9±0.4) mm, (1.9±0.3) mm, (1.0±0.2) mm, (1.1±0.4) mm, (1.0±0.2) mm and (1.1±0.6) mm respectively. The sub-branches ofthe attendant artery of the facial nerve anastomosed each other in addition to supplying their own nerve, and a rich vascular network was formed between the facial nerve and adjacent tissue. Conclusion The study on blood supply of the extracranial segment of the facial nerve can provide anatomic basis for avoiding injury of the nutrient arteries of the facial nerve during operation of the parotidean and masseteric region clinically.
Objective To study the microsurgical anatomy of the facial nerve (FN ) trunk and provide some important morphometric data about facialhypoglossal nerve anastomosis (FHA). Methods Bilateral microsurgical dissection was performed on the heads of 9 cadarers fixed with formalinwith three different methods. In the first method, the posterior belly of the digastric muscle was used as a mark, and the FN trunk was identified on the medial side ofthis muscle. In the second method, dissection was initiated at the parotid gland, the FN trunk was identified at its entrance into the parotid gland. In the third method, the styloid process was identified and traced back to the stylomastoid foramen (SMF). The FN trunk was identified on its emergence from the SMF. In every dissection, the whole FN trunk was exposed; its diameter and depth at the the SMF and its length were measured; its relationship, with other structures was studied. Results The FN invariably emerged from the cranial base through the SMF. Its diameter upon its emergence from the foramen was 2.57±0.60mm. The mean minimal distance of the FN trunk from the skin surface in this area was 22.62±2.88 mm. The length of the FN trunk was 15.71±1.97 mm. The distance between the bifurcation and the mastoidale was 18.20±4.41 mm. The distance between the bifurcation and the mandibular angle was 39.91±8.38 mm. The distance between the mastoidale and the SMF was 17.91±2.68 mm. The branches fromthe FN trunk proximal to its bifurcation were the posterior auricular nerve, the digastric muscle nerve and the stylohyoid muscle nerve.Conclusion The third method to expose the FN trunk on its emergence from the SMFis safe and reliable. It is feasible to use only part of the hypoglossal nerve fibers for anastomosis with the FN trunk.
ObjectivesTo assess the efficacy and safety of corticosteroid and antiviral agents for idiopathic facial nerve paralysis (IFNP) by network meta-analysis.MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WangFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) of corticosteroid and antiviral agents for IFNP from inception to January 31th, 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. The meta-analysis was performed by R 3.3.3 and Stata 13.0 software.ResultsA total of 16 RCTs involving 3 061 patients were included. The results of network meta-analysis showed that: for the facial function recovery rates, corticosteroid plus antiviral agents was superior to placebo and antiviral agents alone at 3-month follow-up. Corticosteroid plus antiviral agents was superior to placebo, antiviral agents or corticosteroid alone at 6-month follow-up (if the satisfactory recovery was defined as a House-Brackmann grade class Ⅱ or below). When the follow-up exceeded 6 months, corticosteroid alone was superior to placebo and antiviral agents alone, corticosteroid plus antiviral agents was superior to placebo and antiviral agents alone. All of the differences above were statistically significant. For the sequelae, corticosteroid plus antiviral agents and corticosteroid alone were superior to placebo and antiviral agents alone. Corticosteroid plus antiviral agents was superior to corticosteroid alone. The differences were statistically significant. For the adverse events, there were no significant differences between any other pairwise comparisons of these different interventions.ConclusionConsidering the efficacy and safety, patients with IFNP treated corticosteroid plus antiviral agents are more likely to have a better recovery of facial function and less likely to develop sequelae, followed by corticosteroid alone. More high-quality, large scaled and multicenter RCTs are required to verify the conclusions above, and focus on the treatment of children and patients with severe facial paralysis.
OBJECTIVE: To study the feasibility of α-cyanoacrylate medical adhesive in fixation of intratemporal facial nerve when nerve was repaired within chitin chamber, and to investigate the nerve regeneration. METHODS: Nerve defect of 6 mm was made in left intratemporal facial nerves of 48 rabbits. All the defects were bridged with chitin chamber and were fixed by α-cyanoacrylate medical adhesive, surgical suture and natural union. Nerve function test and histomorphological examination were carried out at 1 month and 3 months after repair. RESULTS: It was observed that the nerve was fixed firmly to the chamber with no crack or crease by α-cyanoacrylate medical adhesive. The regenerated new nerve fibers were more regular and denser and the neurological function recovered much better in the group fixed by alpha-cyanoacrylate medical adhesive than in the groups those fixed by surgical suture and natural union. CONCLUSION: The medical adhesive is b in adhesion and beneficial to nerve repair; repair of intratemporal facial nerve defect within chitin chamber fixed by alpha-cyanoacrylate medical adhesive is feasible, simple and timesaving.
Objective To investigate the effectiveness of facial nerve-sublingual nerve parallel bridge anastomosis for facial nerve injury resulting from closed temporal bone fractures. Methods Between January 2017 and December 2019, 9 patients with facial nerve injury resulting from closed temporal bone fracture caused by head and face trauma were treated. Among them, 5 patients were treated with facial nerve-sublingual nerve parallel bridge anastomosis (operation group), and 4 patients were treated with neurotrophic drugs combined with rehabilitation exercise (conservative group). There was no significant difference in gender, age, side, cause of injury, duration of facial nerve injury before surgery, House-brackmann grading (hereinafter referred to as HB grading) of facial nerve injury, and other general information between 2 groups (P>0.05). HB grading was used to evaluate the improvement of facial nerve function before and after treatment. At the same time, facial nerve neuroelectrophysiological test was performed to evaluate the electrical activity of facial muscles before and after treatment. Tongue function, atrophy, and tongue deviation were evaluated after nerve anastomosis according to the tongue function scale proposed by Martins et al. Results Patients in both groups were followed up 12-30 months, with an average of 25 months. None of the 5 patients in the operation group showed symptoms such as tongue muscle atrophy, tongue extension deviation, hypoglossal nerve dysfunction (mainly including slurred speech, choking with water), postoperative infection, bleeding, lower limb muscle atrophy or lower limb motor dysfunction after sural nerve injury. Postoperative skin sensory disturbance in lateral malleolus area was found, but gradually recovered to normal. During the follow-up, facial nerve and sublingual motor neurons were innervated to paralyzed facial muscle in the operation group. At last follow-up, the HB grading of 5 patients in the operation group improved from preoperative grade Ⅴ in 2 cases, grade Ⅵ in 3 cases to grade Ⅱ in 3 cases, grade Ⅲ in 1 case, and grade Ⅳ in 1 case. And in the conservative group, there were 1 patient with grade Ⅴ and 3 patients with grade Ⅵ before operation, facial asymmetry continued during follow-up, and only 2 patients improved from grade Ⅵ to grade Ⅴ at last follow-up. There was significant difference in prognosis HB grading between the two groups (t=5.693, P=0.001). In the operation group, the amplitude and frequency of F wave were gradually improved, and obvious action potential could be collected when the facial muscle was vigorously contracted. On the contrary, there was no significant difference in neuroelectrophysiological results before and after treatment in the conservative group. ConclusionFacial nerve-sublingual nerve parallel bridge anastomosis can effectively retain the integrity of the facial nerve, while introducing the double innervation of the sublingual nerve opposite nerve, which is suitable for the treatment of severe incomplete facial nerve injury caused by closed fracture.
目的：探讨和分析巨大听神经瘤手术面神经保留技术。方法:在面神经监护的条件下，57例巨大听神经瘤病人,采用枕下乙状窦后入路,显微外科切除肿瘤。术中观察肿瘤与面神经的病理解剖关系,术后随访时间6个月至5年。结果:肿瘤全切除54例（94.7％）,次全切3例(5.3%)。面神经解剖完整保留52例(91%),面神经解剖部分保留5例(9%)。结论:在有效的术中面神经功能监测条件下，出色的显微外科技术以及对面神经解剖关系的充分认识是面神经解剖保留的基础。识别不与肿瘤粘连的面神经脑干端或内听道端,再沿面神经锐性分离肿瘤,是面神经解剖保留的技术关键。
Objective To evaluate the therapeutic effect and complications of modified surgical treatment for parotid benign tumors. Methods Forty-nine patients with parotid tumors treated between February 2007 and February 2013 were randomly divided improved surgery group (trial group,n=24) and traditional surgery group (control group,n=25). Follow-up lasted from two months to two years after surgery. Postoperative complications (facial paralysis, Fery’s syndrome, local deformity, and salivary fistula) and recurrence were observed and compared between the two groups. Results All the 49 patients were followed up from two months to one year after surgery. Two years after surgery, three patients in the trial group and four in the control group were missing during the follow-up. No recurrence occurred in all the patients. There were no permanent facial paralysis cases in both groups. No temporary facial paralysis occurred in the trial group, while there were five such cases in the control group with an incidence rate of 20.0%. The trial group had one case of Fery’s syndrome with an incidence rate of 4.2%, and the control group had 4 such cases with an incidence rate of 16.0%. After surgery, the 24 patients in the trail group achieved general facial symmetry without any facial depression deformity, while there were 3 cases of mild facial depression and 1 obvious facial depression in the control group with an incidence rate of 16.0%. Five patients in the control group had saliva fistula with an incidence rate of 24.0% while one in the trail group (4.2%). The differences in the total rate of complications occurrence between the two groups were statistically significant (P<0.05). Conclusion The improved surgical treatment can effectively reduce complications after surgery for parotid benign tumors, which is worthy of clinical promotion.
Using transplantation of free muscle with microneurovascular anastomosis for 46 cases of late facial paralysis, we selected M. latissimus dorsi as neurovascularized muscle bundle graft in 28 of them. This was not only an operation for facial dynamic reconstruction but also a new method for reinnervation of oral and ocular sphincter. After operation all of them revealed symmetry with voluntary motions. The results were satisfactory. The indications for surgical treatment, the procedure, and the management after the treatment were discussed in details. The importance of reeducation of the regenerating nerve and the necessity of twostaged operation were also discussed.