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Predicting recovery of facial nerve function following injury from a basilar skull fracture
Abstracts
ELLIOT ABEMAYOR,
MD, PHD, EDITOR
Predicting Recovery of Facial Nerve Function Following Injury From a Basilar Skull Fracture. AB Adegbite, MI Khan, L Tan. J Neurosurg 75:X& 762, 1991
if only to see another point of view. However the results should be interpreted with caution.
In this report 25 patients with posttraumatic facial nerve palsy were studied. Fourteen had an isolated facial nerve palsy and 11 had multiple cranial nerve palsies. Facial palsy was complete in 10 patients and partial in 15. The onset was immediate in 7 and delayed in 16.All patients were followed expectantly except one patient who underwent decompression of the nerve and was excluded from the statistical analysis. The long-term outcome in these patients was studied. AT 5 months after trauma there was some recovery in 93% of those with a partial lesion compared with 10% of those with complete lesion. This was statistically significant. By 10.5 months, complete recovery in 93% of those with a partial lesion compared with 10% of those with complete lesion. This was statistically significant. By 10.5 months, complete recovery of nerve function had occurred in 54%. In 62% of patients with a partial lesion incomplete recovery had occurred compared with 0% in those with a complete lesion. There was no statistically significant difference in recovery of function between patients with an immediate as opposed to a delayed onset of facial nerve palsy. The thinking to date has been that when facial paralysis is incomplete or delayed in onset, the outlook is favorable. However, this study suggests that the degree of palsy rather than the time of onset is a major predictor of recovery. This is not surprising since immediate lesions are caused by different factors than delayed lesions. The authors come down against the idea of facial decompression. They allude to the possible morbidity of middle fossa approach. They also state that since several patients recovered with time, posttraumatic facial palsy may be well served by a conservative approach. They also discuss the good functional results obtained using hypoglossalfacial nerve anastomosis. Because it comes from the neurosurgical literature, this paper warrants careful study. Since neurosurgeons often participate in the care of basilar skull fractures, they may argue for a more conservative approach to facial nerve paralysis. Unfortunately, in the present series no breakdown is given as to the anatomic location of skull fractures. It is clear that facial palsy, even if delayed in onset due to a spicule of bone, would do well following decompression. Otolaryngologists participating in the care of individuals with facial nerve palsy should examine this report
Operative Monitoring of Parathyroid Gland Hyperfunction. GL Irvin, VD Dembrow, DL Prudhomme. Am J Surg 162:299-302, 1991
56
American
Journal of Otolaryngology,
Success in the treatment of hyperparathyroidism depends on the skill of the operating surgeon. At times, there is a question whether a patient has a single enlarged function gland, inaccessible glands, or hyperplasia. This report reviews a 20-year experience of more than 700 parathyroidectomies with a persistent hypercalcemic postoperative failure of 7%. The reasons for failure include misdiagnosis or an inability to excise all glands. The authors report their experience with a modified, commercially available immunoassay for PTH with a 15-minute turnaround time. Whole blood samples were taken 10 minutes after gland excision and intraoperatively monitored to confirm significant changes in the circulating hormone. Quantitative evidence was thus provided that all glands had been excised in 19 of 21 patients. Less than four glands were identified in 53% of patients. This PTH quick test correctly pointed to an inadequate excision in two patients, and made bilateral neck exploration unnecessary in two others. This quantitative rapid test may be important in the intraoperative monitoring of parathyroidectomy, particularly in patients who have previously failed exploration.
Outpatient Parotidectomy. RM Steckler. Am J Surg 162:303-306, 1991 Outpatient surgery is increasingly performed by head and neck surgeons in order to decrease the burgeoning cost of medical care. This report examines the outcome in 56 elective patients who underwent outpatient parotidectomy over 5 years. The indication for surgery in virtually all cases was a parotid mass that was, for the most part, benign. A standard parotidectomy with facial nerve dissection was performed. Patients were admitted only if the neoplasm was a carcinoma. Postoperative interviews were conducted with all patients; there is uniform satisfaction and no significant morbidity. Outpatient parotid surgery is a more efficient use of hospital facilities and may be a more effective use of a surgeon’s time. It is safe, cost effective, and
Vol 13, No 1 (January-February),
1992: pp 56-59
ELLIOT ABEMAYOR,
MD, PHD, EDITOR
Predicting Recovery of Facial Nerve Function Following Injury From a Basilar Skull Fracture. AB Adegbite, MI Khan, L Tan. J Neurosurg 75:X& 762, 1991
if only to see another point of view. However the results should be interpreted with caution.
In this report 25 patients with posttraumatic facial nerve palsy were studied. Fourteen had an isolated facial nerve palsy and 11 had multiple cranial nerve palsies. Facial palsy was complete in 10 patients and partial in 15. The onset was immediate in 7 and delayed in 16.All patients were followed expectantly except one patient who underwent decompression of the nerve and was excluded from the statistical analysis. The long-term outcome in these patients was studied. AT 5 months after trauma there was some recovery in 93% of those with a partial lesion compared with 10% of those with complete lesion. This was statistically significant. By 10.5 months, complete recovery in 93% of those with a partial lesion compared with 10% of those with complete lesion. This was statistically significant. By 10.5 months, complete recovery of nerve function had occurred in 54%. In 62% of patients with a partial lesion incomplete recovery had occurred compared with 0% in those with a complete lesion. There was no statistically significant difference in recovery of function between patients with an immediate as opposed to a delayed onset of facial nerve palsy. The thinking to date has been that when facial paralysis is incomplete or delayed in onset, the outlook is favorable. However, this study suggests that the degree of palsy rather than the time of onset is a major predictor of recovery. This is not surprising since immediate lesions are caused by different factors than delayed lesions. The authors come down against the idea of facial decompression. They allude to the possible morbidity of middle fossa approach. They also state that since several patients recovered with time, posttraumatic facial palsy may be well served by a conservative approach. They also discuss the good functional results obtained using hypoglossalfacial nerve anastomosis. Because it comes from the neurosurgical literature, this paper warrants careful study. Since neurosurgeons often participate in the care of basilar skull fractures, they may argue for a more conservative approach to facial nerve paralysis. Unfortunately, in the present series no breakdown is given as to the anatomic location of skull fractures. It is clear that facial palsy, even if delayed in onset due to a spicule of bone, would do well following decompression. Otolaryngologists participating in the care of individuals with facial nerve palsy should examine this report
Operative Monitoring of Parathyroid Gland Hyperfunction. GL Irvin, VD Dembrow, DL Prudhomme. Am J Surg 162:299-302, 1991
56
American
Journal of Otolaryngology,
Success in the treatment of hyperparathyroidism depends on the skill of the operating surgeon. At times, there is a question whether a patient has a single enlarged function gland, inaccessible glands, or hyperplasia. This report reviews a 20-year experience of more than 700 parathyroidectomies with a persistent hypercalcemic postoperative failure of 7%. The reasons for failure include misdiagnosis or an inability to excise all glands. The authors report their experience with a modified, commercially available immunoassay for PTH with a 15-minute turnaround time. Whole blood samples were taken 10 minutes after gland excision and intraoperatively monitored to confirm significant changes in the circulating hormone. Quantitative evidence was thus provided that all glands had been excised in 19 of 21 patients. Less than four glands were identified in 53% of patients. This PTH quick test correctly pointed to an inadequate excision in two patients, and made bilateral neck exploration unnecessary in two others. This quantitative rapid test may be important in the intraoperative monitoring of parathyroidectomy, particularly in patients who have previously failed exploration.
Outpatient Parotidectomy. RM Steckler. Am J Surg 162:303-306, 1991 Outpatient surgery is increasingly performed by head and neck surgeons in order to decrease the burgeoning cost of medical care. This report examines the outcome in 56 elective patients who underwent outpatient parotidectomy over 5 years. The indication for surgery in virtually all cases was a parotid mass that was, for the most part, benign. A standard parotidectomy with facial nerve dissection was performed. Patients were admitted only if the neoplasm was a carcinoma. Postoperative interviews were conducted with all patients; there is uniform satisfaction and no significant morbidity. Outpatient parotid surgery is a more efficient use of hospital facilities and may be a more effective use of a surgeon’s time. It is safe, cost effective, and
Vol 13, No 1 (January-February),
1992: pp 56-59