Postoperative efficacy analysis of patients with facial nerve palsy associated with cholesteatoma otitis media: Our experience with 32 patients

Wang, J.-J.; Feng, Yi; Wang, H.; Wu, Ya‐Fen; Shi, Haibo; Chen, Z.-N.; Yin, Shankai

doi:10.1111/coa.13035

Cited by 6 publications

(8 citation statements)

References 9 publications

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“…Table 3 shows the preoperative HB grades of FP and the facial recovery rates after surgery in the different studies of our review. Postoperatively, about 24% of patients still had unfavorable outcome (HB III-VI), which was comparable to 21.4% of our study; inversely, satisfactory recovery of facial function (HB I-II) was shown in a mean of 70.8% of patients [87.5% [ 6 ], 81.2% [ 1 , 4 ], 80% [ 5 ], 69.2% [ 3 ], 60.4% [ 12 ], 36.3% [ 2 ], respectively].…”

Section: Discussionsupporting

confidence: 83%

“…However, in other studies [ 5 , 6 ] a facial decompression was performed along the entire length of the nerve from the geniculate ganglion to the stylomastoid foramen (near-complete decompression). Wang et al [ 4 ] concluded that there was no statistical significance for the facial recovery between partial decompression and near-complete decompression, supporting that, as observed in some cases, extent exposure of the facial nerve has been found with minimal involvement of the nerve. Controversies exist whether an incision of the epineurium should be realized; Cawthorne [ 13 ] reported that the nerve sheath incision was not necessary for patients suffering from incomplete FP, but might be performed for patients with complete facial paralysis; other authors [ 1 , 6 ] did not perform nerve sheath incision even when the fallopian canal was opened.…”

Section: Discussionmentioning

confidence: 99%

“…Our review revealed seven studies analyzing data and interpreting results regarding the FP complicated by middle ear cholesteatoma [ 1 , 2 , 3 , 4 , 5 , 6 , 12 ]. Based on this review studies, male and middle-aged patients were mostly involved, with a cholesteatoma usually located in the left middle ear ( Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…Facial palsy (FP) is an uncommon but recognized complication of cholesteatoma; its incidence ranges from 1% to 3.4% of cholesteatoma presentations [ 1 , 2 , 3 ]. Facial palsy secondary to cholesteatoma has several causes; osteitis, bony erosion, direct compression resulting from edema, and inflammation of the nerve by bacteria or neurotoxic substances, which may be secreted from the cholesteatoma matrix can damage the facial nerve [ 4 , 5 ]. It has been shown that the facial nerve fills 35 to 65% of the fallopian canal; the remaining portion is filled with extra neural blood vessels and connective tissue, without leaving any empty space [ 5 , 6 ]; thus, edema secondary to infection can easily affect the neural transmission [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Facial Palsy Secondary to Cholesteatoma: A Case-Series of 14 Patients

Psillas

Constantinidis

2023

Audiology Research

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Background: To evaluate patients with middle ear cholesteatoma presenting with facial palsy (FP). Material-Methods: A total of 14 subjects (10 males and 4 females), with a mean age of 42.5 years, were included in our study. The majority of patients presented with incomplete FP (House–Brackmann HB II-IV, 11 cases) and the remaining 3 patients had complete facial paralysis (HB V-VI). A canal wall down mastoidectomy was performed in all the patients, followed by partial facial nerve decompression. Results: At the one-year follow-up, eleven (78.5%) patients demonstrated satisfactory recovery to HB I-II. Facial function recovered to HB grade I-II in 9 (100%) patients who were surgically treated within one month, and in 2 (40%) patients who underwent surgery after one month. The tympanic segment of facial nerve was the most common site of involvement (8 patients). The multiple regression analysis showed that a higher preoperative HB grade combined with a gradual than sudden onset of FP more likely resulted in worse postoperative HB grade. Conclusion: Early surgical removal of cholesteatoma associated with FP is more likely to result in good facial nerve recovery (78.5% of cases), when it is performed within one month from the onset of FP. According to the literature, the tympanic segment of the facial nerve was more frequently damaged (77.7%), followed by the mastoid segment (22.9%), labyrinthine segment (11.1%), and geniculate ganglion (11.1%). Labyrinthine fistula, mainly of the lateral semicircular canal, can be expected in cases of facial nerve dehiscence. The canal wall down mastoidectomy combined with partial decompression surgery was the most preferred surgical treatment for the FP secondary to cholesteatoma.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Facial Palsy Secondary to Cholesteatoma: A Case-Series of 14 Patients

Psillas

Constantinidis

2023

Audiology Research

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“…However, even patients receiving delayed surgical treatment show improvement more readily than those receiving none at all. Post-operative corticotherapy is routinely administered in order to maximize paralysis improvement [9].…”

Section: Introductionmentioning

confidence: 99%

Facial Nerve Paralysis in a 54-Year-Old Woman with Exacerbated Chronic Suppurative Otitis Media and Chronic Mastoiditis: A Case Report

Boboc¹,

Ciocani²,

Morar³

et al. 2019

CEACR

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We present the case of a 54-year old woman diagnosed with chronic suppurative otitis media, who was admitted to the ENT Department with four-week-old, sudden-onset, left-sided facial nerve paralysis, and ipsilateral otalgia and hemicrania. Physical examination revealed positive signs of acute postaural inflammation. The patient’s facial nerve paralysis was scored as VI, according to the House-Brackmann scale. A cranio-facial computer tomography examination revealed mastoid cavity opacification, mucosal hypertrophy, and signs of chronic osteitis, with minimal mucous accumulation. The patient underwent a radical modified mastoidectomy with type-I tympanoplasty to verify the presence of a cholesteatoma, and to remove the offending lesions. Post-operatively, patient evolution was favorable, and prognosis remained encouraging. The patient’s evolution will be followed by check-ups every three months to assess progress and benefits of the treatment.

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Postoperative efficacy analysis of patients with facial nerve palsy associated with cholesteatoma otitis media: Our experience with 32 patients

Cited by 6 publications

References 9 publications

Facial Palsy Secondary to Cholesteatoma: A Case-Series of 14 Patients

Facial Palsy Secondary to Cholesteatoma: A Case-Series of 14 Patients

Facial Nerve Paralysis in a 54-Year-Old Woman with Exacerbated Chronic Suppurative Otitis Media and Chronic Mastoiditis: A Case Report

A case of congenital cholesteatoma in adult patient with intermittent episodes of facial palsy

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