Clinical and experimental study on improving cellular immunological function of uterine myoma patients by xiaoliu tablet

Dehiscences of the bony horizontal segment of the facial canal are rather common in human adults. These facial canal dehiscences occur most often in the region of the oval window. This study presents the observations of the facial canal in the oval window region in 427 operations for otosclerosis. The incidence of dehiscences in the facial canal to the middle ear space in otosclerosis was studied. Dehiscences were observed in 14 of the 427 patients (3.27%) who had a stapedotomy. This incidence is very low compared to the anatomical studies of the facial nerve in human cadaver temporal bones. Dehiscences of the facial canal are a variation of the normal anatomy of the facial nerve and these dehiscences occur sporadically in otosclerosis.     

Spatial organization of cortical and subcortical afferent projections of the neostriatum in dogs

Injury to the facial nerve in the temporal bone presents a challenge to the recovery of nerve function, in that the fallopian canal in which it lies is poorly vascularized. This study was designed to determine if wrapping an intratemporal facial nerve defect repaired with a cable graft with a well-vascularized temporoparietal fascial (TPF) flap would improve facial nerve regeneration. To evaluate this question, a defect was created in the intratemporal left facial nerve of 10 rabbits. All nerves were repaired using cable grafts. In 5 animals, the nerve graft was wrapped with temporoparietal fascia, whereas in the other 5 rabbits it was not. Three additional animals underwent exposure only. The contralateral nerve served as a control in all animals. Quantitative analysis of the nerve graft 12 weeks after repair revealed greater recovery of original fiber diameter and myelin sheath thickness in TPF flap-wrapped repairs. Histological evidence of improved neural regeneration and functional nerve recovery was also seen in the repairs where the TPF flap was utilized. Nerve conduction and electromyographic studies of the cable-grafted nerve at 6 and 12 weeks were equivocal, however.     

Persistent parvovirus B19 infections in immunocompromised children

Significant anatomical variations within the middle ear are described as well as atypical histopathological findings in 13 selected human temporal bones. Bones studied included such vascular and bony abnormalities as carotid artery canal dehiscence, a high jugular bulb, persistent stapedial artery and facial nerve canal dehiscences. Bones also included obliterative otosclerosis, malleus head fixation and a variety of chronic inflammatory changes and/or sequelae. Those features considered to render cases prone to complications are detailed.     

Computer-aided 3-D reconstruction and measurement of the facial canal and facial nerve. I. Cross-sectional area and diameter: preliminary report

Using a computer-aided three-dimensional (3-D) reconstruction method, measurements were made at eight representative sites of diameters and the cross-sectional area of the facial canal, facial nerve, and the space between the canal and nerve. Materials used were serial histology sections of seven normal human temporal bones obtained from individuals of different ages. Two areas of decreased cross-sectional area of the facial canal were found: the proximal part of the labyrinthine portion and the middle part of the tympanic portion. These narrowings in the canal appeared to be correlated with decreased superior-inferior diameter of the facial canal in those portions, especially in adult temporal bones, and also with decreased cross-sectional area, both of the nerve and of the space between the canal and the nerve, in these portions. The developmental etiology of these narrowings is speculated on, and their possible relationship to Bell's palsy is discussed.     

A case of crushing head injury with bilateral abducens and facial nerve palsies

A 20-year-old male was admitted to our hospital suffering from a crushing head injury. At accident, his head had been compressed by the printing machine on both temporal regions. He remained at dull conscious. On admission one hour after the injury, he showed bilateral sixth-nerve and seventh nerve palsies and bleeding from the nose. CT scan showed marked pneumocephalus, traumatic subarachnoid hemorrhage, fluid collections in the bilateral sphenoid sinuses and right mastoid air cells. Bone CT disclosed bilateral temporal bone fractures. MRI did not show cerebral parenchymal damage. He recovered fully conscious at four hours after the injury, but cranial nerve palsies sustained over 30 days after the injury. Bilateral decompression of the facial canal were performed at day 31. At one year after the injury, bilateral abducens nerve palsies and facial nerve palsies recovered incompletely (grade III). The case report and the mechanism of such cranial nerve injuries by low-velocity crushing head injury is described.     

MRI of inner ear anatomy using 3D MP-RAGE and 3D CISS sequences

The aim of this study was to compare contrast enhanced 3D MP-RAGE (magnetization prepared rapid gradient echo), unenhanced 3D MP-RAGE and 3D CISS (constructive interference in steady state) in the evaluation of anatomical detail of the inner ear and facial nerve. 60 persons with no abnormalities and no or non-specific symptoms were examined with MRI. All examinations were performed using a 1.5 T MR unit. The detectability of anatomical details was evaluated by agreement of three radiologists. Statistical evaluation of the results was achieved by the two-tailed Wilcoxon's test. In 86-95% of the cases, 3D CISS resulted in excellent visibility of the basal and second turn and apex of the cochlea, the vestibule and semicircular canals, as well as the nerves within the internal auditory canal. There was a significantly better visualization with CISS than with MP-RAGE. Detectability of the extrameatal facial nerve was best using contrast enhanced 3D MP-RAGE in 91-96% of the cases (labyrinthine segment 96.7%; geniculate ganglion 95%; tympanic segment 91.7%; vertical segment 95%). The detection of the meatal seventh nerve was best using CISS, whilst unenhanced MP-RAGE gave significantly better results than contrast enhanced MP-RAGE. These results suggest that unenhanced and contrast enhanced 3D MP-RAGE and 3D CISS sequences are complementary and not alternative MRI techniques. Both T1 and T2 weighted 3D MR imaging of the temporal bone is of advantage when compared with 2D MR sequences due to improved contrast, geometrical resolution and the possibility of adequate reconstruction of anatomical structures.     

Effects of WR-2721 (amifostine) and its metabolite WR-1065 on the antiproliferative activity of chemotherapeutic agents on neuroblastoma cells in vitro

Approaches through the middle cranial fossa directed at reaching the internal auditory canal (IAC) invariably employ exposure of the geniculate ganglion, the superior semicircular canal (SSC) or the epitympanum. This involves risk to the facial nerve and hearing apparatus. To minimize this risk, we conducted a laboratory study on 9 cadaver temporal bones by using an image-interactive guidance system (StealthStation) to provide topographic orientation in the middle fossa approach. Surface anatomic fiducials such as the umbo of the tympanic membrane, Henle's spine, the root of the zygoma and various sutures were used as fiducials for registration of CT-images of the temporal bone. Accurate localization of the IAC was achieved in every specimen. Mean target localization error varied from 1.20 to 1.38 mm for critical structures in the temporal bone such as the apex of the cochlea, crus commune, ampula of the SSC and facial hiatus. Our results suggest that frameless stereotaxy may be used as an alternative to current methods in localizing the IAC in patients with small vestibular schwannomas or intractable vertigo undergoing middle fossa surgery.     

Facial palsy from Masson's vegetant intravascular hemangioendothelioma

Masson's vegetant intravascular hemangioendothelioma (VIH) is a rare benign tumor that has a propensity for the head and neck but has been overlooked in the otolaryngology literature. Herein, we present the first report of facial palsy resulting from a small VIH growing in the fundus of the internal auditory canal and the labyrinthine segment of the fallopian canal.     

Hemifacial spasm caused by a hemangioma at the geniculate ganglion: case report

OBJECTIVE AND IMPORTANCE: Hemifacial spasm is rarely caused by facial nerve lesions in the temporal bone. Intratemporal facial nerve hemangiomas may initially present as facial spasm. CLINICAL PRESENTATION: A 30-year-old woman developed right hemifacial spasm. Physicians observed slight weakness on the right side of her face, in addition to the hemifacial spasm, but routine radiological examinations did not detect any abnormal findings along the course of the facial nerve. Although the patient underwent neurovascular decompression, the spasm persisted postoperatively. Two years after surgery, the right facial palsy progressed. Concurrently, the hemifacial spasm diminished. High-resolution computed tomography demonstrated a small mass lesion expanding the cortex of the right petrosal bone involving the geniculate ganglion of the facial nerve. INTERVENTION: The patient underwent a second craniotomy through a subtemporal extradural route, and the tumor was completely removed. A pathological examination demonstrated a cavernous hemangioma. CONCLUSION: Routine radiological examinations may fail to detect small intratemporal facial nerve hemangiomas, particularly at the geniculate ganglion. Therefore, when physicians encounter atypical facial spasm, the intratemporal portion of the facial nerve should be carefully examined using high-resolution computed tomography.     

Sunlight, cholesterol and coronary heart disease

An anomaly of the tympanic segment of the facial nerve in an adult cadaver specimen is reported. The second portion of the facial nerve crossed between the stapedal pillars. The rarity of this anomaly, particularly in a well constituted temporal bone, is discussed.     

Facial nerve neuromas presenting as acoustic tumors

Facial nerve tumors can present as masses in the internal auditory canal or cerebellopontine angle and may mimic an acoustic neuroma. These tumors can occur in any segment of the nerve from the brain stem to the neuromuscular junction. Prior to the advent of computed tomography and magnetic resonance imaging with gadolinium, facial nerve tumors were often difficult to diagnose. Even with these modalities it may be difficult to distinguish preoperatively between an acoustic neuroma and a facial schwannoma. Particular signs and symptoms associated with facial nerve tumors (in the spasms, and a facial tic. These symptoms, combined with modem radiologic studies, should allow for more accurate diagnosis, patient counseling, and treatment. This report presents a series of 32 facial nerve tumors diagnosed and treated at The Otology Group from 1975 to 1992. Of these lesions, 12 (38%) were thought to be acoustic neuromas. Eighteen tumors were correctly identified preoperatively as facial nerve tumors. Two facial nerve tumors were found incidentally.     

Total facial nerve decompression: technique to avoid complications

Exposure of the facial nerve from the brainstem to the parotid can be accomplished without injury to the nerve, tympanic membrane, external auditory canal, ossicular chain, inner ear or structures within the cerebello-pontine angle. The procedure has reliably provided good results for patients who have had the proper indications with facial paralysis from Bell's palsy, herpes zoster oticus, infection, hemi-facial spasm, temporal bone fracture and tumors. The current technique for exposure through the mastoid, middle cranial fossa and retrolabyrinthine combined approaches are described. This technique, properly performed, is a valuable treatment for facial nerve lesions.     

On the duality of the facial nerve ganglion

OBJECTIVES: Describe quantitatively the number of ganglion cells in the geniculate (G) and meatal (M) segments of the human facial nerve. STUDY DESIGN: One hundred human temporal bone specimens that were sectioned horizontally and stained with hematoxylin and eosin were selected from a temporal bone collection on the basis of minimal artifact and absence of pathology involving the facial nerve. METHODS: Cells with a nucleolus in all sections through the facial nerve were projected on tracing paper with a camera lucida and counted manually. A modified Abercrombie technique was employed to compute total cells in the G and M segments. RESULTS: Ages of patients ranged from 1 month to 92 years; the male-to-female ratio was 56:44. The total number of cells in individual temporal bones ranged from 589 to 4183 (mean, 2162 cells). The range of cells in the G ganglion was from 66 to 4017 (mean, 1713 cells); in the M ganglion the number ranged from 0 to 2764 (mean, 448 cells). There was no correlation of total ganglion cell number to age or sex. The majority of cells were found in the G ganglion in 88% of temporal bones. In 8% temporal bones the majority of cells were in the M ganglion and in 4% the M and G ganglions contained an equal number of cells. CONCLUSIONS: The facial nerve sensory ganglion consists of two components: G and M. The G ganglion outnumbers the M component in the majority of temporal bones (88%). The M ganglion was equal to or greater in number than the G ganglion in 12% of temporal bones.     

Sudden deafness and facial palsy from metastatic bronchogenic carcinoma

A 52-year-old man developed sudden total bilateral deafness, and unilateral facial palsy, without other symptoms and findings. He died two months later of of bronchogenic carcinoma metastatic to dura, brainstem, pons, carebellopontine angle, cerebellum and cranial nerves III, VI, VII and VIII. There was bilateral internal auditory canal erosion. Tumour replaced right facial, acoustic and vestibular nerves. Tumour infiltrated spiral ganglion, cochlear nerve, cochlear aqueduct, and destroyed nearly all facial nerve fibres to the level of the stapedius muscle. No tumour cells were found on the left, but few fibres of facial, acoustic and vestibular nerves survived. Both ears showed some cochlear outer hair cell destruction. Metastatic tumour to temporal bone or dura should be considered when loss of peripheral VIIth or VIIIth nerve function occurs.     

3-D morphological study of the temporal bone

OBJECTIVE: To establish the 3-D(three-dimensional) morphological study of the temporal bone by means of computer graphic techniques. METHODS: The serial sections of the temporal bone were processed by the technique of computer-aided 3-D reconstruction. The 3-D images of the multi-structures in the temporal bone were displayed on the monitor. The 3-D parameters of these structures were measured by a special software. The stereo-images of the structures in the temporal bone were obtained by stereoscopy and stereo-pairs. RESULTS: Most structures of the temporal bone were reconstructed in 37 instances for the different purpose of study. Each set of the stereo-pair corresponding to the structures in the temporal bones and many 3-D parameters were obtained. The complex spatial relationship among the reconstructed structures such as the facial nerve, endolymphatic sac, posterior tympanum and posterior ampullary nerve was revealed and the mechanic model of the ossicular chain was set up. According to these results, the surgical approach of the posterior ampullary nerve transection was designed and simulated on the graphic computer. CONCLUSION: The technique of computer-aided 3-D reconstruction provides a new tool for the study of the temporal bone. It is also helpful for the designs and simulations of the surgical approaches. The results of this study contribute to developmout of a new branch of pathology of the temporal bone and a primary 3-D morphological study of the temporal bone.     

Intraoperative facial nerve monitoring in acoustic neuroma surgery

Intraoperative facial nerve monitoring simultaneously using electromyography and mechanical pressure sensors is being used in retrosigmoid and translabyrinthine approaches for acoustic neuroma resection. Insulated electrified microsurgical instruments and air drills are used to stimulate the facial nerve with a pulsed, constant current through bone and tumor, before the facial nerve is visually encountered. Electrical stimulation is used to help locate the facial nerve, map the course of the facial nerve within tumor, warn the surgeon of unexpected facial nerve locations, and help predict facial nerve function postoperatively. In 57 unmonitored cases a House-Brackmann (H-B) grade I or II result was obtained in 77 percent of small, 81 percent of medium, and 60 percent of large tumors. In 64 monitored cases H-B grade I or II was obtained in 88 percent of small, 79 percent of medium, and 90 percent of large tumors. Overall, facial nerve outcomes were better after monitored procedures (p < 0.02). A modified H-B classification for acute facial nerve injury is introduced to grade facial weakness immediately postoperatively and until function is stable at 1 year. In the unmonitored group there were five (9%) cases with a complete facial paralysis, facial nerve intact (i.e., acute H-B grade VIA) and seven (13%) cases with the facial nerve transected (i.e., acute H-B grade VIB). In the monitored group there were five (8%) acute H-B grade VIA and two (3%) acute H-B grade VIB results. In the unmonitored group of large tumors, there were statistically more patients with an acute H-B grade VIB result (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Abnormal branching of facial nerve with ossicular anomalies: report of two cases

Two cases with almost identical anomalies of the facial nerve and ossicles were reported. The two girls, ages 9 and 14 years, with unilateral hearing loss underwent exploratory tympanotomy. A huge suprameatal spine and tumor-like swelling of the facial nerve at the tympanic portion as well as its abnormal branching at the pyramidal bend were noted; one of the branches of the facial nerve appeared on the surface of the temporal bone running through the tympanomastoid suture. The distal parts of the long process and lenticular process of incus were missing as if they were eroded by the swollen facial nerve, and the superstructure of the stapes also was absent. No anomaly was seen in any other part of their ears or bodies. This specific type of anomaly is considered rare and important in that surgeons may misdiagnose the swollen facial nerve as a tumor, resulting in facial nerve paralysis due to injury or unnecessary biopsy.     

Gap junctions and nerve terminals among stromal cells in human fallopian tube ampullary mucosa

The purpose of the present study is to investigate the ultrastructure and immunohistochemistry of the stromal cells and terminal nerve fibers in human fallopian tube ampullar mucosa to achieve a detailed characterization of this tissue to permit a better assessment of possible functions. Tissues were obtained during surgery or at autopsy from 26 patients. Specimens were studied by the conventional histologic technique, immunohistochemistry (Cx43, synaptophysin, neurofilament proteins, and S-100 protein), and electron microscopy. Gap junction and nerve terminal frequency between stromal cells were studied by direct assessment on ultrathin sections in the transmission electron microscope. Gap junctions were observed between the cytoplasmic processes of subepithelial stromal cells. There were approximately 23 gap junctions per 73 nucleated stromal spindle cells. Immunohistochemistry using Cx43 antibody confirmed the dot-like distribution of gap junctions. The frequent and intimate association of stromal cell processes with nerve terminals was also demonstrated. Nerve terminals were immunostained by antibodies to nerve-specific molecules and ultrastructurally as axonal profiles containing dense-cored granules or empty vesicles. Analysis of nerve terminal frequency revealed 18 nerve profiles containing 51 axonal profiles per 73 nucleated stromal spindle cells. The present paper documents the participation of autonomic nerve endings and gap junctions in the stromal cell network in human fallopian tube stroma. Similarities to the unique anatomical unit referred to as the 'neuro-reticular complex' in bone marrow tissue (Yamazaki and Allen, 1990) are discussed.     

Translabyrinthine--transtentorial approach for removal of large acoustic neuromas

In 30 consecutive patients with large acoustic neuromas, which were more than 4.0 cm in diameter, tumor excision was performed by a one-stage combined translabyrinthine-transtentorial approach. The tumors were totally removed in 29 patients (96.7%), without death. The facial nerve was preserved anatomically in 16 patients (53.3%), and functionally in 11 (36.7%). Main advantages of this approach include: (1) direct approach with a more extensive exposure; (2) identification of both the origin of the facial nerve at the brain stem or in the internal auditory canal: (3) minimal postoperative reaction; (4) combination with other approaches. A brief discussion is been made on operative technique, prevention of postoperative complications and facial nerve preservation.     

Temporal bone findings in Pierre Robin syndrome

This is the first complete report on the histopathologic study of the temporal bones from an infant with a well-documented Pierre Robin syndrome (micrognathia, glossoptosis and cleft palate), demonstrating multiple middle and inner ear anomalies. The anomalies are basically architectural malformations rather than neutral or end organ developmental anomalies. The anomalies in this case, except for a few points, are somewhat similar in both ears. Multiple anomalies include: abnormal narrowing of the crus commune-utricle junction, superiorly located crus commune and posterior semicircular canal, underdeveloped modiolus, absence of the bony septum between the middle and apical coil (existence of scala communis in left ear), abnormally small internal auditory meatus, and abnormal direction of internal auditory canal, large cartilaginous mass around the superior semicircular canal and in the tympanic end of the fissula ante fenestram, small facial nerve, large facial bony canal dehiscence, anomalic stapes, etc.