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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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Examples of CMAP recordings: A at three periods of observation (1st blue line, 2nd red line, 3rd green line) and B needle EMG recordings from orbicularis oris muscle in one of patients with benign tumor proving the regeneration and reinnervation processes
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Fig6: Examples of CMAP recordings: A at three periods of observation (1st blue line, 2nd red line, 3rd green line) and B needle EMG recordings from orbicularis oris muscle in one of patients with benign tumor proving the regeneration and reinnervation processes

Mentions: The progress of regeneration in facial nerve fibers is presented in Fig. 6 for one of the patients with benign tumor. The low-amplitude CMAP (A) at the second period of observation and both fibrillations and positive sharp waves in EMG recordings from orbicularis oris muscle were recorded. The third observation period revealed the occurrence of CMAP with larger amplitude and prolonged latency, which indicated regeneration of motor fibers. This phenomenon led to the muscle’s reinnervation which was manifested by disappearing of positive sharp waves with still observed fibrillations, increased parameter of MUAPs duration and low-frequency EMG pattern (B). Fig. 6


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)

Examples of CMAP recordings: A at three periods of observation (1st blue line, 2nd red line, 3rd green line) and B needle EMG recordings from orbicularis oris muscle in one of patients with benign tumor proving the regeneration and reinnervation processes
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig6: Examples of CMAP recordings: A at three periods of observation (1st blue line, 2nd red line, 3rd green line) and B needle EMG recordings from orbicularis oris muscle in one of patients with benign tumor proving the regeneration and reinnervation processes
Mentions: The progress of regeneration in facial nerve fibers is presented in Fig. 6 for one of the patients with benign tumor. The low-amplitude CMAP (A) at the second period of observation and both fibrillations and positive sharp waves in EMG recordings from orbicularis oris muscle were recorded. The third observation period revealed the occurrence of CMAP with larger amplitude and prolonged latency, which indicated regeneration of motor fibers. This phenomenon led to the muscle’s reinnervation which was manifested by disappearing of positive sharp waves with still observed fibrillations, increased parameter of MUAPs duration and low-frequency EMG pattern (B). Fig. 6

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