Author(s)
Adeeb Derakhshan MD
Jacqueline J. Greene MD
Nate Jowett MD
Tessa A. Hadlock MD
Affiliation(s)
Massachusetts Eye and Ear
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should understand that polytetrafluoroethylene (ie Teflon) granuloma should be considered in the differential diagnosis for patients presenting with facial weakness and a remote history of microvascular decompression for hemifacial spasm. Objectives: Surgical management of hemifacial spasm (HFS) involves microvascular decompression (MVD) of the facial nerve by an offending vessel in the posterior cranial fossa. Polytetrafluoroethylene pledgets are implanted to prevent contact between the vessel and nerve. Rarely, the material incites a giant cell foreign body reaction. Here we present five cases in which formation of PTFE granuloma following MVD resulted in significant facial nerve weakness. Study Design: Retrospective case series. Methods: A database repository of approximately 4,000 patients presenting at a tertiary care facial nerve center was reviewed to identify individuals with new onset facial nerve weakness in the setting of previous MVD for HFS. Data collected include date of initial MVD surgery, date of presentation with recurrent facial nerve symptoms, presence of confirmatory imaging, and interventions undertaken. Results: Five patients were identified with new onset facial palsy following previous MVD of the facial nerve. The time between initial MVD and subsequent presentation with facial nerve weakness ranged from 17-35 years. All patients had imaging studies (MRI or CT) consistent with granuloma formation at the site of previous surgical intervention. Procedures performed to address new facial nerve symptoms included eyelid weight placement (n=2), tensor fascia lata static suspensions (n=2), tarsorrhaphy (n=1), temporalis muscle transfer (n=1), and 5-7 nerve transfer (n=1). Conclusions: The formation of a PTFE granuloma should be considered in the differential diagnosis for patients presenting with new onset facial weakness with previous history of microvascular decompression for hemifacial spasm. While ultimately irreversible, early diagnosis may lead to effective dynamic reinnervation before permanent muscle atrophy.