BENIGN TUMOR SURGERY RESULTING INTO 7TH NERVE

PALSY AND PTOSIS

MANAHAN, MACLESTER T.

INTRODUCTION• BENIGN TUMORS ARE NONCANCEROUS GROWTHS IN THE BODY. UNLIKE

CANCEROUS TUMORS, THEY DO NOT SPREAD TO OTHER PARTS OF THE

BODY.

• BENIGN TUMORS CAN FORM ANYWHERE IN THE BODY.

• WHILE THE UNDERLYING CAUSES FOR TUMOR GROWTH CAN VARY, THE

PROCESS BY WHICH THEY GROW IS THE SAME. NORMALLY, CELLS IN

YOUR BODY WILL NATURALLY REFRESH THEMSELVES BY DIVIDING. THIS

ALLOWS FOR DEAD CELLS TO BE DISPOSED OF NATURALLY. IN THE CASE

OF TUMORS, DEAD CELLS MAY REMAIN BEHIND AND FORM A GROWTH

KNOWN AS A TUMOR. CANCER CELLS GROW IN THIS WAY AS WELL;

HOWEVER, UNLIKE THE CELLS IN BENIGN TUMORS, THEY ALSO INVADE

NEARBY TISSUE. OUT-OF-CONTROL GROWTH OF ABNORMAL CELLS

CAUSES DAMAGE TO THESE ADJACENT TISSUES AND ORGANS, AND CAN

LEAD TO CANCEROUS TUMORS IN OTHER PARTS OF THE BODY.

• NOT ALL BENIGN TUMORS NEED TREATMENT. IF YOUR TUMOR IS SMALL AND IS

NOT CAUSING ANY SYMPTOMS, YOUR DOCTOR MAY RECOMMEND TAKING A

WATCH-AND-WAIT APPROACH. IN THESE CASES, TREATMENT COULD BE MORE

RISKY THAN LETTING THE TUMOR BE.

• IF THE DOCTOR DECIDES TO PURSUE TREATMENT, THE SPECIFIC TREATMENT

WILL DEPEND ON THE LOCATION OF THE BENIGN TUMOR. TUMORS MAY BE

REMOVED FOR COSMETIC REASONS IF THEY ARE LOCATED ON THE FACE OR

NECK. OTHER TUMORS THAT AFFECT ORGANS, NERVES, OR BLOOD VESSELS ARE

COMMONLY REMOVED WITH SURGERY TO PREVENT FURTHER PROBLEMS.

• TUMOR SURGERY IS OFTEN DONE USING ENDOSCOPIC TECHNIQUES, MEANING

THE INSTRUMENTS ARE CONTAINED IN TUBE-LIKE DEVICES. THIS TECHNIQUE

REQUIRES SMALLER SURGICAL INCISIONS AND REQUIRES LESS HEALING TIME.

• IF TUMOR CANNOT BE SAFELY ACCESSED FOR SURGERY, RADIATION THERAPY

MAY BE USED TO HELP REDUCE THE SIZE OF THE TUMOR OR PREVENT IT FROM

GROWING LARGER.

• THE 7TH CRANIAL (FACIAL) NERVE IS LARGELY MOTOR IN FUNCTION (SOME SENSORY FIBRES FROM EXTERNAL ACOUSTIC MEATUS, FIBRES CONTROLLING SALIVATION AND TASTE FIBERS FROM THE ANTERIOR TONGUE IN THE CHORDA TYMPANI BRANCH). IT ALSO SUPPLIES THE STAPEDIUS (SO A COMPLETE NERVE LESION WILL ALTER AUDITORY ACUITY ON THE AFFECTED SIDE). FROM THE FACIAL NERVE NUCLEUS IN THE BRAINSTEM, FIBRES LOOP AROUND THE 6TH NUCLEUS BEFORE LEAVING THE PONS MEDIAL TO 8TH AND PASSING THROUGH THE INTERNAL ACOUSTIC MEATUS. IT PASSES THROUGH THE PETROUS TEMPORAL IN THE FACIAL CANAL, WIDENS TO FORM THE GENICULATE GANGLION (TASTE AND SALIVATION) ON THE MEDIAL SIDE OF THE MIDDLE EAR, WHENCE IT TURNS SHARPLY (AND THE CHORDA TYMPANI LEAVES), TO EMERGE THROUGH THE STYLOMASTOID FORAMEN TO SUPPLY ALL THE MUSCLES OF FACIAL EXPRESSION, INCLUDING THE PLATYSMA.

• FACIAL NERVE PARALYSIS ALSO KNOWN AS BELL’S PALSY IS A COMMON PROBLEM THAT INVOLVES THE PARALYSIS OF ANY STRUCTURES INNERVATED BY THE FACIAL NERVE. THE PATHWAY OF THE FACIAL NERVE IS LONG AND RELATIVELY CONVOLUTED, AND SO THERE ARE A NUMBER OF CAUSES THAT MAY RESULT IN FACIAL NERVE PARALYSIS.

• PTOSIS IS THE MEDICAL TERM FOR A DROOPING EYELID. IT REFERS ONLY TO THE UPPER EYELID; IT DOES NOT REFER TO LOWER EYELID SAGGING. UPPER EYELID DROOPING CAN SOMETIMES AFFECT VISION IF THE DROOPING IS SEVERE. PTOSIS IS NOT A DISEASE, BUT A SYMPTOM OF ANOTHER CONDITION THAT MUST BE

CASE HISTORY

• C.M, 70 YEARS OLD FEMALE FROM BAGONG BARRIO CALOOCAN CITY CAME TO

THE CLINIC FOR EYE EXAMINATION. SHE EXPERIENCED BLURRING OF VISION AT

FAR AND NEAR, DOUBLING OF VISION AT NEAR, GLARE AND TEARING.

• WHEN SHE UNDERGONE SURGERY DUE TO BENIGN TUMOR AT THE HEAD IN

2006, SHE HAD 7TH NERVE PALSY, PTOSIS AND HEARING DEFICIENCY.

• THE PATIENT ALSO HAS HYPERTENSION AND HAD A SURGERY FOR MYOMA THE

SAME YEAR SHE HAD A SURGERY FOR THE TUMOR.

VISUAL ACUITY

VASC FAR VASC NEAR VAPH

OD: 20/80 OD: 16/80 OD: 20/40

OS: 20/80 OS: 16/200 OS: 20/80

OU: 20/60 OU: 16/60

GENERAL OBSERVATION AND INSPECTION

OCULAR ADNEXA OD OS

LIDS/LASHES NO MASS DROOPING

SCLERA YELLOWISH YELLOWISH

CONJUNCTIVA CLEAR W/ TINY BLOOD VESSELS

CLEAR W/ TINY BLOOD VESSELS

CORNEA CLEAR CLEAR

IRIS DARK BROWN DARK BROWN

LENS CLOUDY WHITE CLOUDY WHITE

PRELIMINARY TESTNPC 16/18

PUSH-UP AMPLITUDE 14CM= 7.14D

ALTERNATE COVER TEST ORTHOPHORIA

CORNEAL REFLEX SLIGHTLY NASAL

COLOR VISION 15/18

VISUAL FIELD FULL/ INTACT

DIRECT LIGHT REFLEX OU 2+

INDIRECT LIGHT REFLEX OU 2+

ACCOMMODATION OU CONSTRICTED

SWINGING FLASH LIGHT TEST (-) MARCUS GUNN

SUBJECTIVE REFRACTIONOD -0.25 SPH ADD 2.25

PLANO ADD 2.25

OPHTHALMOSCOPY

FOVEA AND BACKGROUND

(+) ROR

DIAGNOSIS

• PTOSIS

• BELL’S PALSY

• CATARACT

• HEARING DEFICIENCY

ASSESSMENT

• THE PATIENT EXPERIENCING BLURRING OF VISION AT FAR AND NEAR, DOUBLING

OF VISION AT NEAR, GLARE AND TEARING. BENIGN TUMOR SURGERY RESULT TO

FACIAL NERVE PARALYSIS OR BELL’S PALSY AND AFFECT OCULOMOTOR NERVE

RESULT TO PTOSIS.

MANAGEMENT

• CORRECTIVE LENSES TO AID IN THE PATIENTS

DISCOMFORT AT FAR AND NEAR.

• CATARACT EXTRACTION

• PTOSIS SURGERY IF NEEDED