Stapes fixation accompanied with abnormal facial nerve pathway

Inagaki, Taro; Kawano, Atsushi; Ogawa, Yasuo; Negishi, Miho; Kawada, Yuri; Suzuki, Mamoru

doi:10.1016/j.anl.2013.12.010

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…If suspicious conditions of FN abnormities are encountered during these surgeries or are confirmed by nerve monitoring, an experienced surgeon should be employed given the increased risk in these cases. In order to reduce the potential iatrogenic FN injury or unnecessary biopsy, it should be stressed that any soft tissue tubular structure or white band (so called by Inagaki et al [15]) encountered in the middle ear, regardless of its location, should be examined and avoided. It is recommended that a neural stimulator is used to help recognize the FN if there is a nerve-like structure in the surgical path.…”

Section: Discussionmentioning

confidence: 99%

“…In order to reduce the potential iatrogenic FN injury or unnecessary biopsy, it should be stressed that any soft tissue tubular structure or white band (so called by Inagaki et al [15]) encountered in the middle ear, regardless of its location, should be examined and avoided. It is recommended that a neural stimulator is used to help recognize the FN if there is a nerve-like structure in the surgical path.…”

Section: Discussionmentioning

confidence: 99%

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Unexpected Branch Malformation of the Facial Nerve during Stapes Surgery: Comparison between Intraoperative and Radiographic Findings

Fang

Zhang

et al. 2022

ORL

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The aim of this study was to determine the prevalence of facial nerve (FN) bifurcation in patients who undergo stapes surgery, and to ascertain the correlation between the intraoperative and radiographic findings in cases where an unexpected branch malformation for patients undergoing stapes surgery. Patients who underwent stapes surgery were retroactively examined for confirmed FN bifurcation. Among the 887 patients, 10 had a bifurcated FN confirmed during surgery and had a preoperative high-resolution computed tomography (HRCT) scan. The HRCT scans were examined by two radiologists who were blinded to the operational findings. The diagnostic accuracy of HRCT imaging was examined along with their preoperative audiometry. In total, 887 patients underwent stapes surgery and among them the prevalence of FN bifurcation was 1.13%. These 10 patients had a 1:1 male-female ratio with a mean age of 17.9 ± 7.0 years. From a surgical review, all cases had bifurcation at the horizontal segment of FN, including 1 case of FN trifurcation. The diagnostic difference between HRCT imaging and intraoperation observations for malformations in the middle ear varies widely depending on the location, ranging from 0% to 90%. The prevalence of incus and stapes malformations was high in both imaging and operation findings (≥60%). The detection rate of abnormal positioning and bifurcation of the FN during HRCT imaging was 30% and 0%, respectively. The mean air-bone gap hearing threshold for patients was significantly improved from 42.3 dB preoperatively to 15.6 dB postoperatively without any complications. These results showed that it is extremely difficult to predict the FN bifurcation prior to surgery with a detection rate of 0%. The diagnostic difference between HRCT imaging and intraoperation observations for malformations of different parts of the middle ear varies widely. These results highlight the importance of being vigilant in regard to FN anatomical variation during stapes surgery for any unexpected malformations that are not detected during HRCT evaluation. In addition, the surgical outcomes for these patients were optimal when treatment was performed by senior surgeons.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Unexpected Branch Malformation of the Facial Nerve during Stapes Surgery: Comparison between Intraoperative and Radiographic Findings

Fang

Zhang

et al. 2022

ORL

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“…The congenital malformation of facial nerve was gradually recognized, but still mainly in cases with microtia (Dickinson et al, 1968) or Treacher Collin's syndrome (Sando et al, 1968). For decades, accumulating data of aberrant facial nerve in congenital malformation of middle ear with no co-existing malformation of the outer ear were reported in a form of case report (Kieff et al, 1998; Inagaki et al, 2014) until very recently when Jahrsdoefer studied 54 patients with congenital middle ear malformations. He reported finding aberrant courses of facial nerve in up to almost 1/4 of ears (Jahrsdoerfer, 1981).…”

Section: Introductionmentioning

confidence: 99%

Classification of facial nerve aberration in congenital malformation of middle ear: Implications for surgery of hearing restoration

Hao

et al. 2018

Journal of Otology

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ObjectivesFacial nerve aberration is the most troublesome situation in congenital malformations of middle ear. The aim of our study is to investigate its imaging and clinical features as well as relevant choice of surgical techniques for hearing improvement.MethodsA retrospective study involving review of clinical data of 227 patients (256 ears) with congenital middle ear anomaly was undertaken, including preoperative computed tomography (CT) data, surgical records and videos.ResultsAberration involving intratemporal facial nerve was found in 82/256 ears (32.03%) with congenital middle ear anomaly. The most common forms of aberration included overhanging over the oval window (50/82 ears, 60.98%), bifurcation (3/82 ears, 3.66%) and transverse over the promontory (3/82 ears, 3.66%), counting for 68.29% (56/82) of the cases with facial nerve aberration. Concomitant stapes malformation was found in 76/82 ears (92.68%) and atresia or stenosis of the oval window in 27/82 ears (32.93%). In 9/82 ears (10.98%) both stapes and oval window was absent. Elective surgeries for the purpose of hearing improvement included stapodotomy + piston implantation, labyrinthotomy, labyrinthotomy + total ossicular replacement prosthesis (TORP) implantation and Vibrant Soundbridge (VSB) implantation.ConclusionThe majority of facial nerve aberration in congenital malformation of middle ear involves displacement of facial nerve, in addition to concomitant malformations of the stapes and/or oval window, which may influence the choice of surgery for hearing improvement. VSB implantation may be considered as a useful option.

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“…Moreover, understanding the shape of the OW is clinically important. The OW may be obscured by variation in local neurovascular structures including a ptotic facial nerve or persistent stapedial artery, resulting in considerable difficulty for the surgeon attempting to fenestrate the stapes (14, 15). Therefore, an understanding of oval window shape variation can eschew intraoperative confusion.…”

Section: Introductionmentioning

confidence: 99%

Oval Window Size and Shape: a Micro-CT Anatomical Study With Considerations for Stapes Surgery

Zdilla

Skrzat

Kozerska

et al. 2018

Otology &Amp; Neurotology

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Stapes fixation accompanied with abnormal facial nerve pathway

Cited by 4 publications

References 11 publications

Unexpected Branch Malformation of the Facial Nerve during Stapes Surgery: Comparison between Intraoperative and Radiographic Findings

Unexpected Branch Malformation of the Facial Nerve during Stapes Surgery: Comparison between Intraoperative and Radiographic Findings

Classification of facial nerve aberration in congenital malformation of middle ear: Implications for surgery of hearing restoration

Oval Window Size and Shape: a Micro-CT Anatomical Study With Considerations for Stapes Surgery

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