Facial nerve trauma: Optimal timing for repair

Barrs, David M.

doi:10.1288/00005537-199108000-00007

Cited by 71 publications

(7 citation statements)

References 61 publications

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“…This knowledge is also the basis for instituting adequate therapeutic measures to prevent potentially fatal hemorrhage while preserving functionally significant structures such as the FN [ 49 – 56 ]. This avoided the subsequent need to repair the FN either primarily or with resort to nerve grafts or nerve flaps [ 24 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report

Casal¹,

Pelliccia²,

Pais³

et al. 2017

J Med Case Reports

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BackgroundOpen injuries to the face involving the external carotid artery are uncommon. These injuries are normally associated with laceration of the facial nerve because this nerve is more superficial than the external carotid artery. Hence, external carotid artery lesions are usually associated with facial nerve dysfunction. We present an unusual case report in which the patient had an injury to this artery with no facial nerve compromise.Case presentationA 25-year-old Portuguese man sustained a stab wound injury to his right preauricular region with a broken glass. Immediate profuse bleeding ensued. Provisory tamponade of the wound was achieved at the place of aggression by two off-duty doctors. He was initially transferred to a district hospital, where a large arterial bleeding was observed and a temporary compressive dressing was applied. Subsequently, the patient was transferred to a tertiary hospital. At admission in the emergency room, he presented a pulsating lesion in the right preauricular region and slight weakness in the territory of the inferior buccal branch of the facial nerve. The physical examination suggested an arterial lesion superficial to the facial nerve. However, in the operating theater, a section of the posterior and lateral flanks of the external carotid artery inside the parotid gland was identified. No lesion of the facial nerve was observed, and the external carotid artery was repaired. To better understand the anatomical rationale of this uncommon clinical case, we dissected the preauricular region of six cadavers previously injected with colored latex solutions in the vascular system. A small triangular space between the two main branches of division of the facial nerve in which the external carotid artery was not covered by the facial nerve was observed bilaterally in all cases.ConclusionsThis clinical case illustrates that, in a preauricular wound, the external carotid artery can be injured without facial nerve damage. However, no similar description was found in the reviewed literature, which suggests that this must be a very rare occurrence. According to the dissection study performed, this is due to the existence of a triangular space between the cervicofacial and temporofacial nerve trunks in which the external carotid artery is not covered by the facial nerve or its branches.

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Section: Discussionmentioning

confidence: 99%

Stab injury to the preauricular region with laceration of the external carotid artery without involvement of the facial nerve: a case report

Casal¹,

Pelliccia²,

Pais³

et al. 2017

J Med Case Reports

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“…In this sense, the supramaximal stimulus, which is the minimum intensity necessary to depolarize all the nerve fibers plus 20%, 5 6 7 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 27 28 29 is ideal. 1 28 29 Mattox and Felix 2 did not describe the intensity of the stimulus used. Shi et al used a constant current of 0.5 mA, 24 and Byrne et al found a supramaximal stimulus of 1.5 mA, 23 different from the value that our group obtained in a series of experiments.…”

Section: Discussionmentioning

confidence: 99%

“…To study the processes that affect facial nerve degeneration and regeneration, several experimental models were created. Large animals such as pigs have a long vertical (mastoid) segment of the facial nerve, great for surgical procedures but difficult to use because of their handling, high maintenance costs, and small resistance to infections, 1 besides having a high incidence of anesthetic complications. 2 Medium to small mammals such as cats, rabbits, and guinea pigs are easier to handle and cost less compared with large animals, 2 have facial nerves that anatomically resemble the human facial nerve, 2 3 and have well-known reactions to posttraumatic microbiological exposure.…”

Section: Introductionmentioning

confidence: 99%

“… 4 However, such animals are relatively difficult to handle and maintain, are more prone to infections, and are less tolerant to bilateral facial paralysis. 1 2 At the same time, small animals such as rats are being widely employed in experimental research for their advantages, such as easy caretaking and handling, high resistance to infections and interventions, low-cost and convenient housing, besides having well-described growth, anatomic, and metabolic parameters. 1 2 5 6 Regarding facial nerve studies, rats endure well bilateral facial paralysis and exhibit similar anatomic nerves as primates.…”

Section: Introductionmentioning

confidence: 99%

“… 6 7 However, this nerve divides itself after leaving the sacrum, possibly altering the results of functional or histologic investigations. 1 2 3 4 5 8 9 Furthermore, authors such as Aldskogius et al, 10 Labelle and Allen, 11 McCoy and Boyle, 12 Spector et al, 13 and Szal and Miller 14 refer that, because of its long path inside a bony canal, the facial nerve has remarkable differences in regeneration and therefore cannot be compared with the sciatic nerve.…”

Section: Introductionmentioning

confidence: 99%

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Mandibular Branch of the Facial Nerve in Wistar Rats: New Experimental Model to Assess Facial Nerve Regeneration

Bento

Salomone

Nascimento

et al. 2014

Int. Arch. Otorhinolaryngol.

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Introduction The ideal animal model for nerve regeneration studies is the object of controversy, because all models described by the literature have advantages and disadvantages. Objective To describe the histologic and functional patterns of the mandibular branch of the facial nerve of Wistar rats to create a new experimental model of facial nerve regeneration. Methods Forty-two male rats were submitted to a nerve conduction test of the mandibular branch to obtain the compound muscle action potential. Twelve of these rats had the mandibular branch surgically removed and submitted to histologic analysis (number, partial density, and axonal diameter) of the proximal and distal segments. Results There was no statistically significant difference in the functional and histologic variables studied. Conclusion These new histologic and functional standards of the mandibular branch of the facial nerve of rats establish an objective, easy, and greatly reproducible model for future facial nerve regeneration studies.

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