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Correlations between the clinical, histological and neurophysiological examinations in patients before and after parotid gland tumor surgery: verification of facial nerve transmission.

Wiertel-Krawczuk A, Huber J, Wojtysiak M, Golusiński W, Pieńkowski P, Golusiński P - Eur Arch Otorhinolaryngol (2014)

Bottom Line: CMAP amplitudes after stimulation of mandibular marginal branch were reduced at about 25 % in patients with benign tumors after surgery.A similar trend was found for BR results.Needle EMG, ENG and BR examinations allow for the evaluation of face muscles reinnervation and facial nerve regeneration.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathophysiology of Locomotor Organs, Wiktor Dega Clinical Orthopaedic and Rehabilitation Hospital, University of Medical Sciences, 28 Czerwca 1956r. No 135/147, 61-545, Poznań, Poland, zpnr@wp.pl.

ABSTRACT
Parotid gland tumor surgery sometimes leads to facial nerve paralysis. Malignant more than benign tumors determine nerve function preoperatively, while postoperative observations based on clinical, histological and neurophysiological studies have not been reported in detail. The aims of this pilot study were evaluation and correlations of histological properties of tumor (its size and location) and clinical and neurophysiological assessment of facial nerve function pre- and post-operatively (1 and 6 months). Comparative studies included 17 patients with benign (n = 13) and malignant (n = 4) tumors. Clinical assessment was based on House-Brackmann scale (H-B), neurophysiological diagnostics included facial electroneurography [ENG, compound muscle action potential (CMAP)], mimetic muscle electromyography (EMG) and blink-reflex examinations (BR). Mainly grade I of H-B was recorded both pre- (n = 13) and post-operatively (n = 12) in patients with small (1.5-2.4 cm) benign tumors located in superficial lobes. Patients with medium size (2.5-3.4 cm) malignant tumors in both lobes were scored at grade I (n = 2) and III (n = 2) pre- and mainly VI (n = 4) post-operatively. CMAP amplitudes after stimulation of mandibular marginal branch were reduced at about 25 % in patients with benign tumors after surgery. In the cases of malignant tumors CMAPs were not recorded following stimulation of any branch. A similar trend was found for BR results. H-B and ENG results revealed positive correlations between the type of tumor and surgery with facial nerve function. Neurophysiological studies detected clinically silent facial nerve neuropathy of mandibular marginal branch in postoperative period. Needle EMG, ENG and BR examinations allow for the evaluation of face muscles reinnervation and facial nerve regeneration.

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Example of modified Blair’s approach during parotid gland tumor removal
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Fig1: Example of modified Blair’s approach during parotid gland tumor removal

Mentions: As presented in Table 1 the majority of tumors were small (1.5–2.4 cm) and located in superficial lobe of parotid gland. As far as the type of surgery is concerned extracapsular tumor removal, or superficial parotidectomy surgeries from modified Blair’s approach (Fig. 1) were applied in patients with benign tumor. When the function of nerve is preoperatively normal, it should be preserved during surgery whenever it is possible. Facial nerve scarifying is only required when the tumor invasion into the facial nerve has been confirmed functionally by palsy or histologically. Facial paresis before surgery is an important, negative prognostic factor [16]. In our study, in all four cases of the patients with malignant tumor, it completely encased branches of the facial nerve. In each case the surgeon strived but was not able to totally separate the nerve from the tumor without leaving its macroscopically visible structures. Therefore, radical parotidectomy without facial nerve preservation was applied in all patients with malignant tumor. Fig. 1


Correlations between the clinical, histological and neurophysiological examinations in patients before and after parotid gland tumor surgery: verification of facial nerve transmission.

Wiertel-Krawczuk A, Huber J, Wojtysiak M, Golusiński W, Pieńkowski P, Golusiński P - Eur Arch Otorhinolaryngol (2014)

Example of modified Blair’s approach during parotid gland tumor removal
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4372688&req=5

Fig1: Example of modified Blair’s approach during parotid gland tumor removal
Mentions: As presented in Table 1 the majority of tumors were small (1.5–2.4 cm) and located in superficial lobe of parotid gland. As far as the type of surgery is concerned extracapsular tumor removal, or superficial parotidectomy surgeries from modified Blair’s approach (Fig. 1) were applied in patients with benign tumor. When the function of nerve is preoperatively normal, it should be preserved during surgery whenever it is possible. Facial nerve scarifying is only required when the tumor invasion into the facial nerve has been confirmed functionally by palsy or histologically. Facial paresis before surgery is an important, negative prognostic factor [16]. In our study, in all four cases of the patients with malignant tumor, it completely encased branches of the facial nerve. In each case the surgeon strived but was not able to totally separate the nerve from the tumor without leaving its macroscopically visible structures. Therefore, radical parotidectomy without facial nerve preservation was applied in all patients with malignant tumor. Fig. 1

Bottom Line: CMAP amplitudes after stimulation of mandibular marginal branch were reduced at about 25 % in patients with benign tumors after surgery.A similar trend was found for BR results.Needle EMG, ENG and BR examinations allow for the evaluation of face muscles reinnervation and facial nerve regeneration.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathophysiology of Locomotor Organs, Wiktor Dega Clinical Orthopaedic and Rehabilitation Hospital, University of Medical Sciences, 28 Czerwca 1956r. No 135/147, 61-545, Poznań, Poland, zpnr@wp.pl.

ABSTRACT
Parotid gland tumor surgery sometimes leads to facial nerve paralysis. Malignant more than benign tumors determine nerve function preoperatively, while postoperative observations based on clinical, histological and neurophysiological studies have not been reported in detail. The aims of this pilot study were evaluation and correlations of histological properties of tumor (its size and location) and clinical and neurophysiological assessment of facial nerve function pre- and post-operatively (1 and 6 months). Comparative studies included 17 patients with benign (n = 13) and malignant (n = 4) tumors. Clinical assessment was based on House-Brackmann scale (H-B), neurophysiological diagnostics included facial electroneurography [ENG, compound muscle action potential (CMAP)], mimetic muscle electromyography (EMG) and blink-reflex examinations (BR). Mainly grade I of H-B was recorded both pre- (n = 13) and post-operatively (n = 12) in patients with small (1.5-2.4 cm) benign tumors located in superficial lobes. Patients with medium size (2.5-3.4 cm) malignant tumors in both lobes were scored at grade I (n = 2) and III (n = 2) pre- and mainly VI (n = 4) post-operatively. CMAP amplitudes after stimulation of mandibular marginal branch were reduced at about 25 % in patients with benign tumors after surgery. In the cases of malignant tumors CMAPs were not recorded following stimulation of any branch. A similar trend was found for BR results. H-B and ENG results revealed positive correlations between the type of tumor and surgery with facial nerve function. Neurophysiological studies detected clinically silent facial nerve neuropathy of mandibular marginal branch in postoperative period. Needle EMG, ENG and BR examinations allow for the evaluation of face muscles reinnervation and facial nerve regeneration.

Show MeSH
Related in: MedlinePlus