RESUMO
The purpose of this study was to assess the effects of protecting the facial nerve with a modified endaural approach with a peripheral dissection of the superficial musculoaponeurotic system to access the temporomandibular joint which allows an excellent operative field of visualization, multiple surgical procedures of the temporomandibular joint, and general care which improves the immediate postoperative period, making this a less morbid surgery. This study included 33 patients (39 sides) who underwent surgical treatment for disorders of the temporomandibular joint from the years 2021 to 2023 at the maxillofacial department of the clinic "Colsanitas" located in Bogota, Colombia. Therapeutic results were evaluated by postoperative facial nerve injury, with the House-Brackman scale; every patient was examined for adequate facial musculature function immediately after surgery. Notably, zero patients presented facial nerve injury. These results imply that the modified endaural approach with a peripheral dissection of the superficial musculoaponeurotic system to access the temporomandibular joint reduces the incidence of facial nerve injuries, improves operative site exposure, and lowers the frequency of complications.
Assuntos
Traumatismos do Nervo Facial , Transtornos da Articulação Temporomandibular , Humanos , Traumatismos do Nervo Facial/prevenção & controle , Traumatismos do Nervo Facial/etiologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Transtornos da Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/prevenção & controle , Sistema Musculoaponeurótico Superficial/cirurgia , Dissecação/métodos , Articulação Temporomandibular/cirurgia , Articulação Temporomandibular/lesões , Complicações Pós-Operatórias/prevenção & controle , Idoso , Adolescente , ColômbiaRESUMO
PURPOSE: The purpose of the present study was to describe a surgical technique for treatment of condylar fractures through the modified submandibular access, by means of a small incision in the mandibular angle that promotes a dissection between the parotideomasseteric and the transmasseteric fascia in a quick way and with low morbidity. Fixation may be made with plates and screws according to the technique prescribed by the surgeon. METHODS: Owing to the high incidence and importance of condylar fractures, various therapeutic methods have been described and may be divided into conservative and surgical methods. Various open surgical techniques are recommended in the treatment of mandibular condylar fractures, and the methods of internal rigid fixation and surgical accesses vary. The techniques that offer an adequate treatment of these fractures with shorter surgical time very often remain matters of controversy among surgeons. The procedure must guarantee maximum safety for the facial nerve and must provide a good cosmetic outcome, besides providing a suitable surgical field. RESULTS: A modified submandibular access is a safe and reproducible procedure providing excellent functional results. This procedure has been routinely performed in our department.
Assuntos
Fixação Interna de Fraturas/métodos , Côndilo Mandibular/cirurgia , Fraturas Mandibulares/cirurgia , Placas Ósseas , Parafusos Ósseos , Dissecação , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/prevenção & controle , Fixação Interna de Fraturas/efeitos adversos , Humanos , Côndilo Mandibular/lesões , Resultado do TratamentoRESUMO
The classical surgical technique for the resection of vestibular schwannomas (VS) has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor.
Assuntos
Aracnoide-Máter/cirurgia , Nervo Facial , Microcirurgia/métodos , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Tratamentos com Preservação do Órgão/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/patologia , Complicações Pós-Operatórias , Período Pós-Operatório , Estudos Retrospectivos , Espaço Subaracnóideo/cirurgia , Resultado do Tratamento , Carga Tumoral , Adulto JovemRESUMO
The classical surgical technique for the resection of vestibular schwannomas (VS) has emphasized the microsurgical anatomy of cranial nerves. We believe that the focus on preservation of the arachnoid membrane may serve as a safe guide for tumor removal. Method The extracisternal approach is described in detail. We reviewed charts from 120 patients treated with this technique between 2006 and 2012. Surgical results were evaluated based on the extension of resection, tumor relapse, and facial nerve function. Results Overall gross total resection was achieved in 81% of the patients. The overall postoperative facial nerve function House-Brackmann grades I-II at one year was 93%. There was no recurrence in 4.2 years mean follow up. Conclusion The extracisternal technique differs from other surgical descriptions on the treatment of VS by not requiring the identification of the facial nerve, as long as we preserve the arachnoid envelope in the total circumference of the tumor. .
A técnica cirúrgica clássica para ressecção de schwannomas vestibulares enfatiza a anatomia microcirúrgica dos nervos cranianos. Acreditamos que o foco na preservação da membrana aracnóide pode servir como parâmetro seguro para a remoção do tumor. Método A abordagem extracisternal é descrita em detalhe. Analisamos o prontuário de 120 pacientes tratados com esta técnica entre 2006 e 2012. Os resultados cirúrgicos foram baseados em extensão de ressecção, recorrência tumoral e função do nervo facial. Resultados Ressecção total foi obtida em 81% dos pacientes. O resultado global da função do nervo facial (House-Brackmann graus I-II) após um ano da cirurgia foi de 93%. Não houve recidiva em um seguimento médio de 4,2 anos. Conclusão A técnica extracisternal difere de outras descrições cirúrgicas no tratamento de schwannoma vestibular pois não requer a identificação do nervo facial, contanto que o plano de aracnóide seja preservado em toda circunferência do tumor. .
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Aracnoide-Máter/cirurgia , Nervo Facial , Microcirurgia/métodos , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Tratamentos com Preservação do Órgão/métodos , Traumatismos do Nervo Facial/prevenção & controle , Neuroma Acústico/patologia , Complicações Pós-Operatórias , Período Pós-Operatório , Estudos Retrospectivos , Espaço Subaracnóideo/cirurgia , Resultado do Tratamento , Carga TumoralRESUMO
BACKGROUND: Surgical approaches to temporomandibular region have been the subject of numerous controversies in the literature. Pre-auricular approaches have been used with the observance of high success rate, and during surgery history, various modifications of this approach were conducted in order to reduce irreversible sequelae. Thus, given the relevance of the study, this article proposes to alert the professionals that carry out these surgical approaches in relation to the anatomical structures involved and to describe and emphasise the benefits of endaural approach. CASE REPORT: A Caucasian male patient, victim of a firearm injury, sustained a wound on the right pre-auricular region, and at the time of assessment, he complained of pain, mouth opening difficulty and dysphagia. On physical examination, there was oedema and ecchymosis in the right periorbital region. In the radiological examination, a foreign body compatible with a firearm projectile was observed in the right pre-auricular region, being in accordance with the information collected. The endaural incision and divulsion by plans was then made until the projectile. DISCUSSION: For proper exposure of the region, several studies were designed to evaluate the patterns of branching and anastomosis of the facial nerve. As for the best cosmetic result with the different pre-auricular approaches, the endaural approach was described as an approach that offers great cosmetic results because the incision design guides the surgeon in the wound closure and causes a decrease in the tension of flap, unlike that observed by some authors.
Assuntos
Orelha Externa/lesões , Orelha Externa/cirurgia , Endoscopia/métodos , Armas de Fogo , Migração de Corpo Estranho/cirurgia , Otoscopia , Ferimentos por Arma de Fogo/cirurgia , Adulto , Brasil , Estética , Traumatismos do Nervo Facial/prevenção & controle , Seguimentos , Humanos , Masculino , Tomografia Computadorizada por Raios X , Ferimentos por Arma de Fogo/diagnósticoRESUMO
The attachment of bilateral sagittal-split osteotomy of the mandibular ramus with bicortical screws or the combination of miniplates and a bicortical screw is complicated through the intraoral approach because of the angle required for insertion of screws, so it is necessary to use a trocater. This article aimed to report a technique developed and used in 60 patients, wherein an implant handpiece with adapted drills was used in the intraoral attachment. The setting was performed intraorally to prevent scarring and extraoral facial nerve damage, which may be caused by extraoral and transbuccal approaches routinely performed when using the trocater. The versatility of the handpiece implant allows for the insertion of monocortical and bicortical screws and rigid internal fixation of mandibular sagittal-split osteotomy, as well as surgical time reduction, decreasing postoperative morbidity.
Assuntos
Cicatriz/prevenção & controle , Traumatismos do Nervo Facial/prevenção & controle , Má Oclusão/cirurgia , Cirurgia Ortognática/instrumentação , Placas Ósseas , Parafusos Ósseos , Desenho de Equipamento , Humanos , TorqueRESUMO
PURPOSE: This study evaluated the functional and cosmetic results of mandibular basal osteotomy, introducing new indications and fixation alternatives. MATERIALS AND METHODS: Ten patients 19 to 46 years old (mean, 32.3 years) were treated by orthognathic surgery, including mandibular basal osteotomy for correction of deficiency, excess, or asymmetry of the inferior mandibular border. An intraoral approach based on 3 incisions to the anterior and posterior mandible was used to maintain and protect soft tissues surrounding the mental nerve. After marking the bone inferior to the nerve, a reciprocal saw completed the osteotomy design and individual rigid fixation according to movement was executed. All patients were 3-dimensionally treated and the evaluation included clinical, radiographic, and photographic analysis pre and postoperatively; all patients were followed for a minimum of 12 months. RESULTS: All patients showed excellent functional and cosmetic results. Nine patients (9/10) were treated for advancement of the inferior border (mean, 6.89 ± 2.57 mm; P < .05). One of them underwent simultaneous inferior (3 mm) and lateral (4 mm) repositioning and 3 had combined lateral movement (mean, 3.5 ± 0.58 mm; P < .05). One patient (1/10) required posterior (4 mm) and inferior (5 mm) repositioning of the basal segment. CONCLUSIONS: Mandibular basal osteotomy is an innovative technique that is strongly predictable for correction of deficiency, excess, and/or asymmetry of the inferior mandibular border, decreasing morbidity and many other complications of traditional bone grafts and alloplastic techniques.
Assuntos
Assimetria Facial/cirurgia , Técnicas de Fixação da Arcada Osseodentária , Mandíbula/cirurgia , Doenças Mandibulares/cirurgia , Procedimentos Cirúrgicos Ortognáticos/métodos , Osteotomia de Le Fort/métodos , Adulto , Queixo/patologia , Queixo/cirurgia , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Seguimentos , Humanos , Imageamento Tridimensional/métodos , Técnicas de Fixação da Arcada Osseodentária/instrumentação , Masculino , Mandíbula/patologia , Nervo Mandibular/anatomia & histologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
OBJECTIVE: This study was conducted to investigate the success rate of using the facial motor evoked potential (FMEP) of orbicularis oculi and oris muscles for facial nerve function monitoring with use of a stepwise protocol, and its usefulness in predicting facial nerve outcome during cerebellopontine angle (CPA) surgeries. METHODS: FMEPs were recorded intraoperatively from 60 patients undergoing CPA surgeries. Transcranial electrocortical stimulation (TES) was performed using corkscrew electrodes positioned at hemispheric montage (C3/C4 and CZ). The contralateral abductor pollicis brevis muscle was used as the control response. Stimulation was always applied contralaterally to the affected side using 1, 3, or 5 rectangular pulses ranging from 200 to 600 V with 50 micros of pulse duration and an interstimulus interval of 2 ms. Facial potentials were recorded from needles placed in the orbicularis oculi and oris muscles. RESULTS: FMEP from the orbicularis oris and oculi muscles could be reliably monitored in 86.7% and 85% of the patients, respectively. The immediate postoperative facial function correlated significantly with the FMEP ratio in the orbicularis oculi muscle at 80% amplitude ratio (P = .037) and orbicularis oris muscle at 35% ratio (P = .000). FMEP loss was always related to postoperative facial paresis, although in different degrees. CONCLUSION: FMEPs can be obtained reliably by using TES with 3 to 5 train pulses. Stable intraoperative FMEPs can predict a good postoperative outcome of facial function. However, further refinements of this technique are necessary to minimize artifacts and to make this method more reliable.
Assuntos
Neoplasias dos Nervos Cranianos/cirurgia , Estimulação Elétrica/métodos , Traumatismos do Nervo Facial/prevenção & controle , Nervo Facial/cirurgia , Monitorização Intraoperatória/métodos , Neuroma Acústico/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Neoplasias dos Nervos Cranianos/patologia , Neoplasias dos Nervos Cranianos/fisiopatologia , Nervo Facial/fisiologia , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/fisiopatologia , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/fisiopatologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Neuroma Acústico/patologia , Neuroma Acústico/fisiopatologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Adulto JovemRESUMO
BACKGROUND: Although cervical skin and platysmal laxity are more apparent at the lateral area of the neck, the reported treatments focus on performing plication on the anterior midline or releasing the muscle's lateral border and tractioning it back. Because of the ineffectiveness of such methods in solving more complex cases, surgeons have been trying more efficient procedures that are also riskier and could therefore increase the complication rate. OBJECTIVE: The author describes a simple method for treating cervical laxity using composite platysmaplasty. He also reports on the use of closed platysma myotomy to treat remaining or recurrent platsymal bands. METHODS: A vertical incision was made on the platysma, parallel to the midline, followed by the creation of a flap made of skin and platysma at the area where tone loss was more evident. When this flap was pulled back, it formed a double muscle layer that pressed on the submandibular gland, pushing it back into its original position. The tightening achieved by the fixation of the flap provided excellent definition of the mandible line. The platysma bands were approached by a method of percutaneous incision of the platysma. RESULTS: Between October 2005 and December 2008, 129 patients underwent surgery. Seventeen patients underwent closed percutaneous platysma myotomy in conjunction with platysmaplasty. Four patients underwent platysma myotomy to treat platysmal bands in a secondary procedure from two to eight months after the original surgery. All patients were satisfied with the aesthetic results of treatment. The only serious complications were two cases of temporary neuropraxia of the cervical branch and one hematoma with partial necrosis of retroauricular skin. CONCLUSIONS: Composite platysmaplasty, combined with closed platysma myotomy when indicated, has a short learning curve and provides satisfactory results with a low complication rate and fast recovery. While closed platysma myotomy has been performed by the author as an independent procedure, those operations are not covered in this report and deserve a separate study.
Assuntos
Cervicoplastia/métodos , Músculos do Pescoço/cirurgia , Ritidoplastia/métodos , Adulto , Idoso , Cervicoplastia/efeitos adversos , Traumatismos do Nervo Facial/prevenção & controle , Feminino , Humanos , Masculino , Ilustração Médica , Pessoa de Meia-Idade , Satisfação do Paciente , Resultado do TratamentoRESUMO
BACKGROUND: This study was conducted to clarify the relationships between the extracranial portion of the facial nerve (EFN) and the zygomatic arch (ZA). METHOD: Four cadaveric heads (8 parotid regions), examined under 3-40x magnification, were dissected from lateral to medial to expose the EFN. FINDINGS: In a vertical plane just anterior to the tragus, the distance from the superior edge of the ZA to the facial nerve (FN) is, on average, 26.88 mm. The FN then courses superiorly and anteriorly, crossing the ZA 18.65 mm anterior to the tragus on average. Thus, three points can be used to depict a triangle: A, at the level of the anterior border of the tragus, just above the superior edge of the ZA; B, 26 mm below A; and C, 18 mm anterior to A. This so called facial-zygomatic triangle represents the area where surgical dissection can be performed with no risk of damaging the FN. Thus, the closer one stays to the tragus, the lesser the risk of damaging the FN below the ZA. If the incision is carried out on a vertical plane closer to the tragus, the skin can be safely cut up to 2 cm below the ZA. CONCLUSION: The facial-zygomatic triangle is a very useful superficial landmark to avoid FN damage when working below the ZA.
Assuntos
Face/anatomia & histologia , Traumatismos do Nervo Facial/prevenção & controle , Nervo Facial/anatomia & histologia , Crânio/anatomia & histologia , Zigoma/anatomia & histologia , Cadáver , Craniotomia/métodos , Craniotomia/normas , Dissecação , Pavilhão Auricular/anatomia & histologia , Face/cirurgia , Nervo Facial/cirurgia , Traumatismos do Nervo Facial/patologia , Traumatismos do Nervo Facial/fisiopatologia , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/fisiopatologia , Complicações Intraoperatórias/prevenção & controle , Microcirurgia/métodos , Microcirurgia/normas , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas , Osso Parietal/anatomia & histologia , Osso Parietal/cirurgia , Crânio/cirurgia , Osso Esfenoide/anatomia & histologia , Osso Esfenoide/cirurgia , Osso Temporal/anatomia & histologia , Osso Temporal/cirurgia , Zigoma/cirurgiaRESUMO
The application of a new and simple method of facial cutaneous detachment using specially designed bifaceted rigid steel wands called Dilson Luz Vascular Dilation Wands is described. These wands considerably reduce the bleeding during face-lift surgery, reducing both postoperative hematomas and the risk of facial nerve injury. This technique involves stretching the blood vessels to the point of rupture by inserting progressively larger wands. At the point of rupture, a spontaneous coagulation within the vascular extremities occurs. This is attributable to a significant blood platelet migration induced by the stimulation from the rupture of the vascular intima. The wands, varying in dimension from 1.5 to 20 mm, and are used for cutaneous facial detachment. This method has been found to result in minimal bleeding across the detached surface as well as an excellent perfusion of the overlying skin. With the use of these Dilson Luz Vascular Dilation Wands in combination with this new technique, the authors have obtained improved cutaneous detachment; reduced postoperative swelling, edema, and ecchymosis; prophylaxis of facial nerve damage; reduced procedural time; and above all, greater reduction in immediate and late postoperative hematoma formation.