IN December 1976 a 3-cm acoustic neuroma was removed from a 37-year-old Woman. A combined suboccipital and retrolabyrinthine approach was used, anatomically sparing the facial nerve. During the last stages of tumor removal from the Internal auditory canal, the facial nerve was stimulated using a Week disposable stimulator. The face was observed to move well with stimulation, although the 2-mamp setting was required. Observation through the operating microscope at 16 power magnification showed that the stimulator actually blanched the neural sheath and bubbled the surface fluids. The stimulator was then applied to the dura, the edge of which curled as if cauterized. Six months postoperatively the patient has yet to regain facial function.Subsequent clinical applications were observed when the marginal mandibularis branch of the facial nerve was stimulated during a submaxillary gland removal. A paresis of this branch resulted, TX 77550 (Mrs Suzanne Crow). lasting four months with eventual full recovery. Another case prompted more study when, during a parotidectomy, the stimulator tip visualized through the operating microscope appeared to cauterize a small vessel.Although absolute conclusions from such observations cannot be made, several points were obvious: (1) Few observations of the tissues stimulated are made due to the usual short length of stimulation and the failure to visualize the field through the operating microscope. (2) Some careful studies should be instigated to determine any deleterious effect, if any, upon normal nerve tissue.Immediate steps were taken to employ careful use of the stimulator and to use the operating microscope whenever possible. Studies were then begun to evaluate the stimulator and its effect upon tissues.
We report the case of a 3-year-old girl whose internal carotid artery was pierced during a myringotomy. Postoperative computed tomography demonstrated that the complication was caused by a dehiscent carotid canal wall; contralateral dehiscence was also present. The patient had previously received two sets of middle ear ventilation tubes with no complications. This article addresses the epidemiology and anatomy of carotid dehiscence, and discusses methods to potentially prevent this complication, including screening and imaging modalities.
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