Search Results (100)

Background: Orbital dermoid cysts are common benign lesions; however, deep-seated or recurrent lesions near the orbital apex pose major surgical challenges due to their proximity to critical neurovascular structures. Lateral orbitotomy remains the reference approach, but accurate osteotomies and stable reconstruction can be difficult to achieve using conventional techniques. This study reports our initial experience using a fully digital, hospital-based point-of-care (POC) workflow to enhance precision and safety in complex orbital dermoid cyst surgery. Methods: We present a case series of three patients with orbital dermoid cysts treated at a tertiary center (2024–2025) using a comprehensive digital workflow. Preoperative assessment included CT and/or MRI followed by virtual surgical planning (VSP) with orbit–tumor segmentation and 3D modeling. Cutting guides and patient-specific implants (PSIs) were manufactured in-house under a certified hospital-based POC protocol. Surgical strategies were tailored to each lesion and included piezoelectric osteotomy, intraoperative navigation, intraoperative CT, and structured-light scanning when indicated. Results: Complete en bloc resection was achieved in all cases without capsular rupture or optic nerve injury. Intraoperative CT confirmed complete lesion removal and accurate PSI positioning and fitting. Structured-light scanning enabled radiation-free postoperative monitoring when used. All patients preserved full ocular motility, visual acuity, and facial symmetry, with no complications or recurrences during follow-up. Conclusions: The integration of VSP, in-house POC manufacturing, and image-guided surgery within a lateral orbitotomy approach provides a reproducible and fully integrated workflow. This strategy appears to improve surgical precision and safety while supporting optimal long-term functional and aesthetic outcomes in challenging orbital dermoid cyst cases. Full article

Background/Objectives: Facial nerve injury from conditions such as Bell’s palsy, trauma, surgery, and infection leads to facial asymmetry and motor deficits. Axotomy models reproduce peripheral nerve disruption and consequent motor impairment. To compare the effects of forward versus reverse autologous nerve suturing on neural regeneration and motor recovery within the facial nucleus after axotomy. Methods: In rats subjected to facial nerve axotomy, motor recovery was assessed at 8 weeks using whisker movement and blink reflex tests. Immunohistochemistry quantified choline acetyltransferase (ChAT), sirtuin 1 (SIRT1), and Iba-1 as indices of cholinergic function, cellular stress/inflammation modulation, and microglial activation in the facial nucleus. Results: Axotomy significantly reduced whisker and blink scores compared with sham. Both forward and reverse suturing significantly improved these behavioral outcomes versus axotomy. Within the facial nucleus, axotomy decreased ChAT- and SIRT1-positive cells and increased Iba-1 expression, while both suturing techniques increased ChAT and SIRT1 and reduced Iba-1. These changes suggest enhanced cholinergic function, mitigation of stress/inflammatory responses, and attenuation of microglial activation following repair. Conclusions: Forward and reverse suturing were each associated with improved motor function and favorable molecular and cellular changes in the facial nucleus after facial nerve axotomy. These findings support the utility of surgical repair irrespective of graft orientation and highlight involvement of key pathways—cholinergic signaling, SIRT1-related regulation, and microglial activity—in nerve restoration. This work extends our previous study, which focused on peripheral nerve regeneration after forward and reverse suturing, by elucidating how graft orientation affects central facial nucleus responses. By integrating behavioral outcomes with ChAT, Iba-1, and SIRT1 expression, the present study provides novel insight into the central mechanisms underlying motor recovery after facial nerve repair and helps explain why comparable functional outcomes are achieved regardless of graft polarity. Full article

Eyelid retraction, cicatricial entropion, and deformities associated with facial nerve palsy are among the eyelid malpositions most detrimental to the ocular surface, as they cause exposure, tear film instability, inflammation, and potentially significant visual impairment. These conditions present major functional and esthetic challenges, underscoring the need for a clear understanding of their mechanisms and management. A narrative review was conducted using PubMed, MEDLINE, Embase, and Google Scholar to identify English and non-English studies (with English abstracts) addressing eyelid malpositions related to thyroid eye disease, cicatricial processes, and facial nerve palsy. Screening and cross-referencing yielded 115 relevant publications. Studies were excluded if they lacked clinical relevance, did not address the target disorders, involved animals, consisted of insufficient case reports, lacked an English abstract, or were non–peer-reviewed or duplicated. Extracted information included patient demographics, clinical presentations, diagnostic methods, treatments, complications, and outcomes. In thyroid eye disease, eyelid retraction results from adrenergic overstimulation, increased Müller muscle tone, and fibrosis involving the levator–superior rectus complex. Temporary improvement may be achieved with botulinum toxin, corticosteroids, or soft-tissue fillers, whereas sustained correction requires individualized surgical approaches. Cicatricial entropion arises from posterior lamellar contraction caused by inflammatory or iatrogenic injury and is best treated with lamellar repositioning or grafting procedures. In facial nerve palsy, incomplete blinking, punctal malposition, and lacrimal pump dysfunction contribute to tearing and ocular surface instability; management prioritizes corneal protection, eyelid rebalancing, and adjunctive measures such as botulinum toxin or physiotherapy. Across all conditions, tailored, multidisciplinary care is essential to maintain ocular surface integrity, restore eyelid function, and preserve quality of life. Full article

Background: Maxillofacial trauma can impair crucial functions of the stomatognathic system. Mandibular condyle fractures, in particular, often lead to temporomandibular joint (TMJ) dysfunction. Methods: This study evaluated the effectiveness of open rigid internal fixation (ORIF) in restoring TMJ function, using the Helkimo Index to compare pre- and post-operative outcomes. Results: A total of 395 patients who underwent ORIF for condylar fractures were analyzed (302 males, 93 females). TMJ function improved significantly from baseline to 6-month follow-up (p < 0.001), with a mean reduction of 2.18 grades on the Helkimo Index. Higher post-operative Helkimo grades (2–3) occurred more frequently during warm months than during cold months (p < 0.05). Low body mass index (BMI) was associated with a greater risk of post-surgical TMJ dysfunction (p < 0.001). TMJ function correlated with facial nerve recovery: patients with poorer pre-operative TMJ function showed additionally slower facial nerve recovery during the first five months after surgery. Age, gender, place of residence, injury characteristics, comorbidities, delay of surgery, duration of surgery, surgical approach, fixing material and laboratory blood tests showed no significant association with post-operative TMJ function. Residual TMJ dysfunction was observed in 3% of treated patients (Di = 3). Conclusions: ORIF, combined with appropriate post-operative physiotherapy, effectively restores TMJ function after condylar fractures—including severe injuries. Simple clinical indices such as the Helkimo Index reliably capture functional improvement. Full article

Objectives: Facial paralysis is a devastating yet frequent complication of skull base surgery, significantly impacting quality of life through functional impairments and psychosocial consequences. Management is complex and requires an individualized approach based on duration of paralysis, etiology and extent of nerve injury, overall prognosis, and rehabilitative goals. This review provides a comprehensive overview of current strategies for managing post-skull base surgery facial paralysis. Methods: A narrative review of the literature was performed, analyzing surgical reanimation techniques (nerve grafting, nerve transfers, regional and free muscle transfers), static procedures for facial symmetry and ocular protection, and non-surgical interventions such as physical therapy, botulinum toxin injections, and psychological support. Key criteria guiding treatment selection, including muscle viability and timing since injury, were examined. Results: Dynamic surgical approaches remain central to restoring movement. Nerve grafting and transfers are effective when viable musculature is present, whereas regional or free muscle transfers are required in long-standing paralysis with irreversible atrophy. Static procedures provide adjunctive improvements in resting symmetry and eye protection. Non-surgical strategies, including rehabilitation therapy and botulinum toxin, enhance functional outcomes and reduce synkinesis. Psychological counseling addresses the profound emotional burden associated with facial disfigurement. Across modalities, individualized treatment planning is crucial. Conclusions: Management of facial paralysis after skull base surgery demands a multidisciplinary, patient-centered approach. Combining surgical and non-surgical interventions optimizes functional and aesthetic outcomes, helping restore both facial movement and psychosocial well-being. Full article

Background: Facial nerve palsy is a relatively common complication following open rigid internal fixation (ORIF) of a mandibular condylar fracture. The aim of this study was to investigate the risk factors that influence post-operative facial nerve function and the recovery process. Methods: A retrospective study was conducted based on the medical records of 329 patients who underwent ORIF treatment for condyle fractures, with the follow-up period being 24 months long. Results: During the initial post-operative examination, 50.45% of patients exhibited some signs of facial nerve dysfunction, ranging from slight to severe, and 48.63% of patients presented transient palsy, while only 1.82% presented permanent facial nerve palsy. Female patients were found to be more susceptible to post-operative facial nerve palsy. Patients with multiple mandibular fractures and bilateral condyle fractures had a worse prognosis. The preauricular approach and its modifications were identified as posing the greatest risk to the facial nerve. The safest approach was the retromandibular approach. Patients treated for injuries resulting from traffic accidents or falls had a worse prognosis than those treated for assault injuries. Conclusions: Post-operative facial nerve palsy following ORIF of the mandibular condyle is, in most cases, transient and can be effectively treated. However, it is important to choose the safest possible surgical approach. The safer approach, the retromandibular approach, should be considered when possible. Full article

Background: Peripheral nerve injuries, especially involving the facial nerve, present unique reconstructive challenges due to their complex functional demands and limited regenerative potential. While autografts remain the gold standard, their drawbacks—such as donor-site morbidity and limited availability—have driven interest in processed nerve allografts. Acellular grafts, in particular, offer promising off-the-shelf alternatives without the need for immunosuppression. Methods: We conducted a narrative review of the literature (1990–2023), identifying 55 peer-reviewed studies via PubMed, Embase, and Cochrane Library. The studies included clinical and preclinical work on motor nerve regeneration using processed nerve allografts, with particular attention to outcomes in facial nerve repair. Two independent reviewers conducted abstract screening, full-text review, and data extraction. Results: Processed nerve allografts show encouraging motor recovery in gaps under 50 mm, with recovery rates of up to 85% reported. Outcomes decrease significantly in longer gaps (>50–60 mm) and in complex cases, including facial nerve repairs, where evidence remains sparse and largely extrapolated from broader motor nerve data. Registry data (e.g., RANGER) support their use but are limited by heterogeneity and lack of randomization. Conclusions: Processed nerve allografts represent a viable alternative to autografts in selected cases—especially short to mid-length motor nerve defects. However, their role in facial nerve reconstruction remains insufficiently studied. Further trials are needed to address specific anatomical and functional challenges in this subgroup and to clarify long-gap efficacy. Full article

Many surgical and nonsurgical options are available to patients seeking facial rejuvenation. In this review, we aim to provide an overview of the current trends in facelift and necklift procedures while simultaneously highlighting the utility of nonsurgical treatments. A comprehensive literature review was performed using the PubMed, Google Scholar, and Cochrane Library databases, with the objective of including recent literature published on facelift and necklift procedures from 2015 to 2025. Articles were selected based on relevance, with a specific focus on including a wide breadth of techniques. A considerable body of literature has been published to further classify the soft-tissue anatomy of the face and neck. In particular, these studies focus on the characterization of the three-dimensional anatomy of the facial nerve with emphasis on safe planes of dissection to avoid inadvertent facial nerve injury. The current literature continues to debate both the theoretical and practical advantages and disadvantages of various facelift techniques. Broadly speaking, facelift techniques can be divided into those that manipulate the superficial musculoaponeurotic system (SMAS) layer on its superficial surface and those that undermine the SMAS to varying extents. Numerous approaches are available to improve the contour of the neck and jawline, including manipulation of the platysma muscle and subplatysmal volume reduction. Other surgical procedures and nonsurgical treatments should be considered to optimize and enhance facelift and necklift results. Advancements in patient safety include a focus on minimizing complications while reducing the length of recovery. Facelift and necklift procedures remain the foundational pillars for facial rejuvenation. With attention to patient-specific anatomy, surgeons can work collaboratively with patients to provide global facial optimization by choosing appropriate facelift and necklift techniques in combination with other ancillary procedures. Doing so will deliver enduring, elegant results. Full article

Background/Objectives: The hypoglossal nerve plays a crucial role in cervical surgery, requiring precise anatomical knowledge to prevent iatrogenic injury. This study examined its position relative to key structures using cadaveric dissections and assessed ChatGPT-4’s reliability in providing anatomical insights. Methods: Ten cadavers were dissected to identify the hypoglossal nerve’s course in relation to the internal jugular vein, carotid arteries, thyro-linguo-facial trunk, hyoid bone, and digastric muscle. Measurements were taken, and ChatGPT was queried for anatomical guidance and surgical recommendations. Results: The hypoglossal nerve was consistently medial to the internal jugular vein and lateral to the carotid arteries. The measured distances to the surrounding structures showed notable variability, particularly with the thyro-linguo-facial trunk. ChatGPT accurately described major landmarks but overlooked lesser-known anatomical triangles and provided no additional dissection guidance. It primarily suggested intraoperative monitoring and preoperative imaging. Conclusions: The carotid and submandibular triangles serve as reliable landmarks for identifying the hypoglossal nerve. This study highlights an unreported variability in its relationship with the thyro-linguo-facial trunk. ChatGPT, while informative, lacked detailed surgical applicability for dissection. Full article

Background/Objectives: This study identifies and characterizes temporal bone fractures over a five-year period at a level one trauma center, focusing on the injury mechanism, otic capsule involvement, facial nerve involvement, fracture orientation, and the impact of the COVID-19 pandemic on skull base trauma. Methods: This retrospective cross-sectional study from a single level one trauma center reviewed skull base fractures from March 2018 to July 2023, identified with ICD-10 codes. Temporal bone fractures were categorized as otic capsule-sparing or -involving and by orientation (transverse, longitudinal, or oblique). Data were grouped into before, during, and after the COVID-19 lockdown period to address the impact of the COVID-19 pandemic. Data were also grouped into facial nerve injury and no facial nerve injury. Fisher’s exact test (5% significance) and descriptive statistics were used to compare groups. Results: A total of 364 fractures were identified. Facial nerve injuries (6.1%) were more likely in otic-capsule-involving (p < 0.001) and transverse or oblique fractures (p < 0.001). During the COVID-19 lockdown, hospital stays (p = 0.011) and ICU days (p = 0.035) were shorter. Among 22 facial nerve injury cases, half received high-dose steroids, but 6 died before evaluation. Six had complete paralysis; all received steroids, and three had surgical decompression. Only two had documented recovery. Of the 10 patients with partial paralysis, 5 received steroids, but only 2 showed improvement. All patients with incomplete eye closure received protective measures. Conclusions: Temporal bone fractures involving the otic capsule or transverse/oblique patterns are more likely to result in facial nerve injury. There are treatment discrepancies, which highlight a lack of a standard approach to treating those with facial nerve injury. An analysis of the impact of the COVID-19 pandemic revealed shorter hospital and intensive care stays during this time. Full article

Facial nerve injury (FNI) induces complex molecular and cellular responses, with reactive oxygen species (ROS) and free radicals (FRs) playing pivotal roles in nerve degeneration and regeneration. However, to date, no systematic review has specifically investigated the involvement of ROS and FRs in FNI. To address this unmet need, we reviewed the literature on the subject, comprehensively searching SCOPUS, PubMed, Cochrane Library, EMBASE, and Google Scholar to identify studies that assessed the roles of FRs and ROS in FNI and summarize their findings. A total of 15 studies that satisfied search criteria were identified. Key findings showed that excessive ROS and FR lead to mitochondrial dysfunction, lipid peroxidation, and ferroptosis, exacerbating nerve degeneration after facial nerve injury. These effects are modulated by antioxidants, including alpha-lipoic acid, edaravone, N(ω)-nitro-L-arginine methyl ester (L-NAME), glutathione peroxidase 4, glutathione, methylprednisolone sodium succinate, Si-based agents, superoxide dismutase, and tirilazad mesylate. The insights gained from this review suggest that levels of FRs and ROS are strongly associated with the pathophysiology of facial nerve injury and underscore the therapeutic potential of targeting ROS and FR pathways in facial nerve injuries. Full article

Background: Intraoperative facial nerve monitoring (IFNM) is becoming increasingly prevalent as an established intraoperative aid in parotid gland surgery. To date, however, there are few scientific studies on the postoperative outcomes of submandibular gland surgery, particularly on the postoperative injury of the marginalis mandibulae branch (MMB) of the facial nerve (FN). This branch represents the most frequent and feared complication of this surgery, with an incidence of 1–7% of cases. Objective: This retrospective study aims to evaluate the incidence of postoperative MMB paralysis in patients undergoing submandibular sialoadenectomy for benign conditions from 2014 to 2023, focusing on the role of IFNM. Materials and Methods: The patients were divided into two groups: the subjects of Group 1 (G1) had undergone submandibular sialoadenectomy after identification and clamped facial vessels, without the aid of IFNM (from 1 January 2014 to 31 December 2018). Conversely, subjects in Group 2 (G2) underwent IFNM procedures (from 1 January 2019 to 31 December 2023). The classification of any FN malfunctions was conducted following the House–Brackmann grading system. A descriptive analysis was performed, and univariate and multivariate logistic regressions were used to examine the impact of IFNM on surgical timing and the association between G2 deficit (vs. G1) corrected for age, sex, and smoking status. Results: The study population comprised a total of 101 patients with a mean age of 55 ± 16 years. The sample population comprised 50 subjects assigned to Group 1 (49.5%, 24 females and 26 males) and 51 subjects assigned to Group 2 (50.5%, 21 males and 30 females). Postoperative paralysis of the MMB occurred in 23 subjects (22.77%), including 12 of G1 (4 had a grade II and 8 grade III dysfunction) and 11 of G2 (8 had a grade II and 3 grade III dysfunction). A six-month evaluation revealed that only five patients in G1, previously diagnosed with grade II dysfunction, exhibited a residual deficit. The mean surgical time for the entire patient cohort was 99 ± 44 min: 110 ± 43 min for Group 1 and 92 ± 42 min for Group 2 (Beta = −19; 95% CI −37 at −0.16; p-value = 0.048). Furthermore, a longer operative time was observed in smokers than in non-smokers (p-value = 0.008), suggesting that smoking affects the length of surgery (Beta = 0.32; 95% CI −0.08 to −0.55). Discussion and Conclusions: MMB paralysis is one of the most prevalent complications that may arise in submandibular gland surgery. IFNM provides surgeons with a valuable tool for identifying MMB in submandibular sialoadenectomy. The efficacy of IFNM as an aid is contingent upon the expertise of the operating surgeon. Full article

Facial nerve injury can lead to significant functional impairment, emotional impacts, and difficulties in social and economic activities. Although peripheral nerves have the potential for recovery, incomplete regeneration can pose challenges. Suppressor of Mothers Against Decapentaplegic Homolog (SMAD) proteins are crucial in the nerve-regeneration process. The study aimed to investigate the changes in SMAD protein expression involved in peripheral nerve regeneration following facial nerve injury induced by compression or axotomy in a pre-clinical study conducted on Sprague Dawley rats. Facial nerve recovery was assessed at 1, 2, 3, 4, 8, and 12 weeks post-facial nerve compression and axotomy using behavioral tests, including whisker movement and eyelid blink-reflex tests. Additionally, the role of SMAD proteins in the nerve regeneration process was evaluated by analyzing the expression of SMAD1–8 proteins at 2 and 12 weeks post-injury. Behavioral tests revealed significant impairment in facial nerve function in both the Compression and Axotomy groups compared with the Sham group at early time points. Recovery was observed in the Compression group by 2 weeks, whereas the Axotomy group exhibited prolonged impairment through 12 weeks. SMAD protein analyses showed increased expression of SMAD2, SMAD7, and SMAD8 following compression injury, whereas axotomy led to more extensive increases in expression that included SMAD1, SMAD2, SMAD3, SMAD4, SMAD6, SMAD7, and SMAD8. These findings suggest that SMAD proteins play differential roles in nerve regeneration following facial nerve injuries caused by compression versus axotomy. The distinct expression patterns of SMAD proteins highlight their potential as therapeutic targets for enhancing nerve regeneration and functional recovery in peripheral nerve injuries. Full article

Background/Objectives: The regeneration of the facial nerve using low-level laser therapy (LLLT) has been infrequently reported. Polydeoxyribonucleotides (PDRNs), a blend of short deoxyribonucleotide polymers known for their non-toxic and non-allergic properties, are recognized as a stimulator of cell growth that enhances cell proliferation and supports wound healing. This study investigates the synergistic effect of the topical sustained release of PDRN/F-127 and LLLT on facial nerve regeneration following crush injury-induced paralysis in rats. Methods: The main trunk of the facial nerve was compressed for 1 min using a hemostat. Animals were divided into five groups: a control group (n = 4), group I (Pluronic F-127 only, n = 4), group II (Pluronic F-127/PDRN, n = 4), group III (Pluronic F-127 + LLLT, n = 4), and group IV (Pluronic F-127/PDRN + LLLT, n = 4). We measured the recovery of vibrissa fibrillation, action potential, and facial nerve blood flow (FNBF). Results: Group IV exhibited a comparatively faster development of vibrissa fibrillation over time than the other groups. After the intervention, significant differences in vibrissa fibrillation values were observed at all time points (p = 0.0028) according to the repeated one-way ANOVA. Regarding the threshold of action potential, all five groups revealed a significant difference (one-way ANOVA, p < 0.0001; multiple comparisons via Tukey’s test). Among the groups, group IV showed a significantly reduced threshold of action potential compared to the other groups. Group IV showed the most notable recovery in FNBF compared to the other groups. One-way ANOVA showed a significant difference (p < 0.0001; multiple comparisons by Dunnett’s test). Conclusions: These findings suggest that PDRN and LLLT may work together synergistically to enhance peripheral nerve regeneration. Future studies should investigate the underlying molecular mechanisms and evaluate the potential clinical applications of this combined treatment strategy. Full article

Objectives: Slag injuries in industrial settings pose risks of hearing loss and complications. The aim of this study is to provide specialists with a better understanding of the sequelae, treatment, and long-term outcomes that a patient may have following a slag injury to the tympanic membrane. Data Sources: PubMed, Embase, and Web of Science. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), multiple databases were queried for articles published from inception to 2023 describing Tympanic membrane injuries from welding. The publications were screened by two independent viewers. The Joanna Briggs Institute 2017 Critical Appraisal Checklist was used to assess the quality of studies. Results: A total of 227 articles were identified, and 9 full-text articles were included in this review, comprising a total of 18 patients. The patients’ ages ranged from 18 to 75 years. Most commonly, patients were welding overhead in a tight working space, and none of the patients were wearing protective ear equipment in addition to their welding masks. Patients experienced otalgia (n = 10; 55%), hearing loss (n = 11; 65%), vertigo (n = 6; 35%), chronic otorrhea (n = 5; 29%), and facial paralysis (n = 4; 23%). A total of 12 patients (70.6%) required surgery, most requiring debridement of metallic foreign body multiple times, some undergoing surgery up to four years post-injury. Conclusions: Tympanic membrane injuries from welding are often overlooked. They cause hearing loss and facial nerve damage. Following a period of observation, sturdy reconstruction with cartilage grafting is recommended, given the poor vasculature and inflammation after this injury. Full article