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Benign tumor surgery resulting into 7th nerve palsy and ptosis

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maclester manahan
maclester manahan

The document discusses benign tumor surgery that resulted in 7th nerve palsy and ptosis. It describes how benign tumors are non-cancerous growths that can form anywhere in the body. The case study involves a 70-year old female patient who experienced blurry vision, double vision, glare and tearing after undergoing benign tumor surgery in 2006 that resulted in 7th nerve palsy, ptosis and hearing loss. Her examination revealed cataracts and ptosis in the left eye. She was diagnosed with ptosis, Bell's palsy, cataracts and hearing loss, and her management plan included corrective lenses, cataract extraction and potential ptosis surgery.

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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 TEST NPC 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 REFRACTION OD -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

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Benign tumor surgery resulting into 7th nerve palsy and ptosis

  • 1. BENIGN TUMOR SURGERY RESULTING INTO 7TH NERVE PALSY AND PTOSIS MANAHAN, MACLESTER T.
  • 2. 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.
  • 3. • 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.
  • 4. • 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
  • 5. 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.
  • 6. 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
  • 7. 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
  • 8. PRELIMINARY TEST NPC 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 REFRACTION OD -0.25 SPH ADD 2.25 PLANO ADD 2.25
  • 9. OPHTHALMOSCOPY FOVEA AND BACKGROUND (+) ROR
  • 10. DIAGNOSIS • PTOSIS • BELL’S PALSY • CATARACT • HEARING DEFICIENCY
  • 11. 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.
  • 12. MANAGEMENT • CORRECTIVE LENSES TO AID IN THE PATIENTS DISCOMFORT AT FAR AND NEAR. • CATARACT EXTRACTION • PTOSIS SURGERY IF NEEDED