I. About facial palsy
Facial palsy is the result of facial nerve paralysis. Facial palsy can be divided into central facial palsy and peripheral facial palsy.
The causes of peripheral facial palsy.
1.Bell’s facial palsy (Bell,sPalsy)
It is an acute facial palsy of unknown cause, probably related to viral infection. About 70% of acute facial palsy is caused by Bell facial palsy, with an incidence of about 15-20/100,000 and a high incidence at the age of 20-40. The indications for facial nerve decompression for this disease are still controversial, and it is generally believed that patients with complete facial palsy (ENOG showing nerve degeneration >90%) should undergo facial nerve decompression early.
2. Facial nerve trauma: surgery should be performed as soon as possible to obtain early decompression of the facial nerve. The earlier the surgery, the better the recovery of facial palsy.
3.Cranial skull base surgery: including CPA area surgery, transvagal and inferior temporal fossa skull base surgery, etc.
4.Neck surgery: such as parotidectomy, etc.
5.Otitis media: Patients with otitis media who have been examined and confirmed to have inflammation or destruction of the mastoid bone should be operated as soon as possible so that the facial nerve can be decompressed early. The earlier the surgery, the better the recovery of facial palsy, and those with insignificant improvement are related to severe inflammatory damage to the facial nerve and prolonged loss of nerve function.
6.Hunt syndrome (Ramsey-HuntSyndrome) is a special type of herpes zoster with typical otalgia, external ear herpes and peripheral facial palsy.
Other diseases: facial nerve tumors, temporal bone and lateral skull base tumors, etc.
The clinical manifestations of facial nerve tumors vary depending on their growth sites, and the early symptoms are hidden, making them easy to be misdiagnosed clinically. The most common symptom of facial nerve sheath tumor is progressive facial nerve palsy, and the first symptom can be hearing loss or facial muscle spasm. The differential diagnosis should be made with Bell’s palsy, primary hemifacial spasm, and auditory neuroma. Most scholars recognize that primary facial neuroma should be treated by surgery as much as possible, and the mass should be removed early and completely.
Surgical treatment of vertigo
Surgical treatment of peripheral vertigo is mainly for patients with refractory vertigo. For those who have no or poor effect of medication and rehabilitation treatment, it can relieve vertigo symptoms, and some patients can achieve the effect of curing vertigo. In principle, unilateral peripheral vertigo with good vestibular function on the opposite side can be solved by surgical operation if other treatments are ineffective or have poor results, but of course there are specific regulations according to different types of peripheral vertigo and different surgical methods.
1. Ménière’s disease (MD)
MD is an idiopathic inner ear disease, the basic pathological change is membrane vagus fluid accumulation, the cause of membrane vagus fluid accumulation has not been elucidated, but the theory of multifactorial pathogenesis is accepted by most people; clinical characteristics are recurrent vertigo, fluctuating hearing loss, with tinnitus and ear swelling; surgical treatment includes endolymphaticsacdecompression (ESD ), vestibular neurectomy (VE), labyrinthectomy, posteriorsemicircular canalocclusion, etc.
Various surgical treatment methods for MD have their own advantages and disadvantages. Clinically, the corresponding surgical treatment method can be selected according to the patient’s hearing condition, surgical efficacy and the patient’s willingness to be treated, among which endolymphatic sac surgery is considered the preferred surgical treatment for MD because of its simple operation, no effect on hearing and vertigo control rate up to 75%.
2.Benign paroxysmal positional vertigo (BPPV)
90% of BPPV symptoms can be relieved by physical therapy, including otolith repositioning and training, etc. Only a few patients with BPPV whose physical therapy is ineffective and whose symptoms recur need surgical treatment to control vertigo symptoms. At present, posteriorsemicircularcanalocclusion is mostly used to treat refractory BPPV.
Temporal bone – lateral skull base disease
Due to the high surgical mortality and disabling surgical complications in the past, the lateral skull base was once considered a “no-go area” for surgery. However, as the surgical approach to the lateral skull base continues to improve, the complications have decreased, and the success rate and postoperative survival rate have increased significantly.
The creation and development of modern lateral skull base surgery is the result of the tireless exploration of various disciplines in the path of clinical medicine, including otolaryngology, otolaryngology, neurosurgery, head and neck tumor surgery, and imaging, including the results of modern science and technology. With the improvement of surgical methods and equipment, as well as the gradual improvement of comprehensive tumor treatment methods, the cure rate of lateral skull base tumors and the quality of patients’ survival will be further improved.
Temporal bone – lateral skull base diseases mainly include
1.Tumors originating from the temporal bone, including: middle ear cancer, facial neuroma, tympanic body tumor, congenital cholesteatoma or epithelioid cyst, temporal bone giant cell tumor, etc.
2.Tumors originating from the base of the brain on the temporal bone, including: auditory neuroma, trigeminal neuroma, meningioma, etc.
3.Tumors originating from the inferior temporal bone are commonly known as jugular venous bullae tumors.
Currently, they are treated by various temporal bone and rock bone resection surgeries, infratemporal fossaapproaches, middlefossaapproach and posterior sigmoid sinus approach.