Contralateral Deviation Research Articles

Non-recurrent Laryngeal Nerve - A Rare Anatomical Anomaly that Increases the Risk of Nerve Injury during Thyroidectomy.

Nonrecurrent laryngeal nerve (NRLN), a rare anatomical variation of recurrent laryngeal nerve, is a branch of the vagus nerve (Morais M, Capela-Costa J, Matos-Lima L, Costa-Maia J (2015) Nonrecurrent Laryngeal Nerve and Associated Anatomical Variations: The Art of Prediction. Eur Thyroid J 4(4):234-238). On the right side, the prevalence of NRLN is 0.3-0.8%, while on the left side, it is extremely rare with a prevalence of 0.004%. A female in her twenties presented with thyroid swelling for 3 years with an ultrasound neck showing a TIRADS IV lesion in the left thyroid lobe. Contrast-enhanced tomography of the neck reported a lesion in the left thyroid lobe causing mass effect in the form of contralateral deviation of trachea and splaying of bilateral common carotid arteries from its common origin - probability of thyroid neoplasm along with aberrant right subclavian artery with a retroesophageal course was noted. Intraoperatively, the right laryngeal nerve was identified near its entry point in right cricothyroid joint and was traced laterally and was found to be nonrecurrent lying superior to inferior thyroid artery. Total thyroidectomy was done preserving the left recurrent laryngeal nerve and right non recurrent laryngeal nerve. NRLN should be suspected in cases with vascular anomalies based on preoperative imaging. Meticulous dissection during thyroid surgery for identification of the recurrent laryngeal nerve or NRLN is still considered to be the precise approach to avoid nerve injury.

Intravascular papillary endothelial hyperplasia of the maxillary sinus extending into the contralateral nasal cavity

IntroductionIntravascular papillary endothelial hyperplasia (IPEH) predominantly occurs in the subcutaneous and dermal regions and rarely originates from the sinonasal mucosa.Case presentationWe report on the case of a 58-year-old male patient who presented with progressive bilateral nasal obstruction, left-sided epiphora, and intermittent epistaxis. Computed tomography revealed a soft tissue opacity in the left maxillary sinus with intersinusoidal nasal wall demineralization, extending into the surrounding ethmoid cells and the right nasal cavity through a contralateral deviation of the nasal septum. Contrast-enhanced T1-weighted magnetic resonance imaging further confirmed these findings. The IPEH originating from the maxillary sinus extended into the contralateral nasal cavity, and it was successfully removed using an endoscopic endonasal approach, avoiding overly aggressive treatment.ConclusionThis case report highlights the diagnostic challenges of IPEH in the sinonasal region and the importance of considering IPEH as a differential diagnosis in patients presenting with nasal obstruction, epiphora, and intermittent epistaxis.

Three-dimensional Analysis of Facial Asymmetry in Unilateral Lambdoid Craniosynostosis.

Unilateral lambdoid synostosis (ULS) is characterized by occipital flattening, mastoid bulging, and contralateral parietal bossing. Anterior craniofacial features are less well-defined. This study utilizes volumetric, craniometric, and composite heat maps of three-dimensional (3D) rendered CT scans to analyze anterior craniofacial asymmetry in ULS and compared to controls. A retrospective review of three-dimensional CT scans. Tertiary care pediatric institution. 30 ULS and 30 control patients. Volumetric and craniometric analysis of the anterior fossa, orbits, zygomas, maxilla, and mandible was performed. The anterior fossa volume was greater bilaterally (0.047, 0.038), and the fossa angle was more anterior contralaterally (<0.001) and more anterior bilaterally than controls (0.038, 0.033). The orbits had greater height and lesser depth bilaterally compared to controls (0.006, 0.009; < 0.001, < 0.001). Zygoma length was significantly greater on the contralateral side than controls (0.048; < 0.001). Nasal contralateral deviation of 3.57 ± 1.97°. The maxillary length was longer on the contralateral side (0.045). The mandibular angle was more anterior on the ipsilateral side and posterior on the contralateral side (<0.001) compared to controls (0.042, < 0.001). Chin had a contralateral deviation of 1.04 ± 3.74°. ULS has significant asymmetry in the anterior craniofacial skeleton. There is a bilateral expansion of the anterior cranial fossa with greater frontal bossing on the contralateral side. Increased orbital height and decreased depth. Contralateral zygomatic and mandibular body lengthening with posterior mandibular deviation. These features may provide more effective diagnosis and potential clinical management strategies.

Spatial artistic displays of emotional valence

ABSTRACT Background: While right-left hemispheric valence dichotomies have been demosntrated in various lesion stidues, it not entirely known if these dichotomies are portrayed in art. Methods: We examined 192 paintings to learn if there is an association between paintings that portray happy-positive or sad-negative scenes and the agent looking to the right or left side relative to their head’s midsagittal plane. Results: There were 38 paintings with a positive valence and 32 with a negative valence in which the eyes were turned rightward or leftward. Of 38 positive valence paintings, 28 had the agent looking rightward, and 10 looking leftward. Of 32 negative valence paintings, 15 had the agent looking rightward and 17 leftward. Discussion: Hemisphere activation is associated with contralateral deviation of the eyes. Whereas the right hemisphere mediates negative emotions allocates spatial attention to both left and right hemispace, the left hemisphere primarily allocates attention to the right. Since the left hemisphere appears to mediate positive emotions and the right hemisphere negative emotions, results from this study are consistent with hemispheric emotional valence attentional hypotheses. However, the relationship between artist knowledge about gaze and the utilization of gaze direction to portray emotional experiences is not known.

Congenital pulmonary airway malformation and bronchopulmonary sequestration in infants - a rare diagnosis

Herein is described the case of a two-month-old female infant with recurrent respiratory infections, admitted to the Pediatric Emergency Department with productive cough, respiratory distress, and fever. Chest radiography showed an heterogenous hypotransparent image in the left pulmonary field and contralateral deviation of the mediastinum. Angiotomography revealed bilateral bronchopulmonary sequestration and a systemic vessel contributing to area irrigation. The patient was submitted to vessel occlusion and lacquering, left inferior lobectomy, and resection of a right lower lobe segment. Histological examination confirmed intralobar bronchopulmonary sequestration and type 2 congenital pulmonary airway malformation in the left lung, and extralobar bronchopulmonary sequestration in the right lung.With this report, the authors intend to emphasize the importance of clinical suspicion of congenital anomalies in infants with recurrent respiratory infections.

Tratamento precoce da hiperplasia condilar com condilectomia alta

A hiperplasia condilar (HC) é caracterizada por um crescimento excessivo do côndilo mandibular provocando problemas estéticos e funcionais. O tratamento da HC ainda não é um consenso na literatura, sendo possível encontrar diversos protocolos de manejo cirúrgico. Diante disso, esse estudo tem o objetivo de relatar o tratamento cirúrgico precoce da HC por meio de um estudo descritivo, qualitativo, do tipo relato de caso. Paciente sexo masculino, 13 anos de idade, com histórico de severa assimetria facial. Ao exame físico apresentava assimetria em terço inferior de face, desvio contralateral do mento, inclinação do plano oclusal e maloclusão. O exame tomográfico evidenciou uma hiperplasia em região condilar esquerda, com alongamento do processo condilar, aumento do corpo mandibular ipsilateral e desvio contralateral do mento. O procedimento cirúrgico de condilectomia alta por acesso pré auricular foi realizado com a ressecção de 7 mm do processo condilar esquerdo. Paciente em acompanhamento ambulatorial, há mais de dois anos do procedimento, apresentava simetria facial, boa abertura bucal, oclusão estável e ausência de queixa álgica. Dessa forma, a condilectomia alta pode ser considerada uma alternativa racional de tratamento precoce nos casos de HC ativa no inicio da puberdade, diminuindo o estimulo de crescimento do côndilo afetado e reduzindo a necessidade de cirurgia ortognática posterior.

Impact of a thin plantar orthopaedic insert on posture and locomotion

Introduction Podiatrists might use thin plantar insert such as EMI® (medio-intern element) to treat postural deficiency. EMI® could induce contralateral medio-lateral (ML) deviation of the Centre of Pressure (CoP) position of healthy participants in quasi-static standing. Our aim is to evaluate EMI® effect on locomotion. Hypothesis Motor control studies on locomotion showed a modified walking stereotypy (eyes closed) after 30 min podokinetic stimulation. We expected a contralateral deviation of the trajectory when EMI® was located under one foot. Material and methods Twenty healthy participants volunteered to the study and were involved in 3 different sessions performed in a randomized order: 1 without EMI®, 2 with EMI® (right or left foot). Each session included: – static tasks (with and without vision) to compare with previous work; – dynamic locomotor tasks: 6 conditions, i.e. 3 trajectories (straight, left or right 90° turn), with/without vision. In static conditions, we calculated the average CoP ML position and between and within trials variabilities. In dynamic conditions, we analyzed the difference in the final orientation of the locomotor trajectory with and without vision with a EMI® with respect to this difference without the EMI®. Results No significant effect of the EMI was observed neither for static nor dynamic conditions. Conclusions Our results do not confirm previous work in static conditions. Recently it has been demonstrated that EMI® has an impact on eyes vergence, especially in population with plantar postural dysfunction. Future work is needed to evaluate effect of such insert on participants with postural deficiencies.

STUDY OF NORMAL ANATOMICAL VARIATIONS IN PARA-NASAL SINUSES USING COMPUTED TOMOGRAPHY SCAN: A CROSS SECTIONAL STUDY FROM CENTRAL INDIA

Background: The standard imaging in the assessment of the para-nasal sinuses is currently computed tomography scanning. This provides an applied anatomical view of the area as well as the common anatomical variants. The advancement and improvement of computed tomography scans has provided for a comprehensive evaluation of patients' para-nasal sinuses, allowing Functional Endoscopic Sinus Surgery surgeons to operate with a guide chart.&#x0D; Objectives: To study normal anatomical variations in para-nasal sinuses using Computed Tomography.&#x0D; Material and Methods: This research took place in a tertiary healthcare center's radiology department over the course of two years. Axial para-nasal sinuses cuts were taken using a multi-slice (128 slice scanner), followed by coronal and sagittal reconstruction.&#x0D; Results: The most common anatomic variation, according to the findings, was nasal septal deviation. The rarest variation in our sample was Haller cell and pneumatized septum. There was also a close connection between unilateral Concha bullosa and contra-lateral septal deviation, as evidenced by the research.&#x0D; Conclusion: A wide range of lesions can affect the para-nasal sinus area. Normal anatomical differences and congenital abnormalities in this area are significant because they can have pathological consequences or cause difficulty/complication during surgery.&#x0D; Keywords: Para-nasal sinuses, Computed Tomography, Functional Endoscopic Sinus Surgery.

Craniosynostosis of the Sphenofrontal Suture: Definition of the Main Signs of Craniofacial Deformity.

Aims:The aim of this study is to compare clinical features of sphenofrontal craniosynostosis (SFC) and unilateral coronary craniosynostosis.Settings and Design:This was a retrospective study with two groups of patients with sphenofrontal and coronary craniosynostosis.Materials and Methods:This was a retrospective study of the 1999–2016 archive data in Russian Children's Clinical Hospital. Ninety-five patients were diagnosed with frontal plagiocephaly. Eighty-three had deformations of unilateral craniosynostosis of coronary suture, 12 had premature closures of sphenofrontal suture. The age at the time of diagnosis varied from 5 months to 2, 5 years.Results:SFC is featured by ipsilateral flattening of forehead and supraorbital margin, and ipsilateral dystopia of supraorbital margin downward. X-ray signs are the closure of sphenofrontal suture on the lesion side with open and symmetrically located remaining skull sutures and contralateral deviation of the midline of the ethmoid.Conclusions:SFC distinguishes from other plagiocephalias by following signs: supraorbital margin on the affected side is shifted downward; tip of the nose is displaced toward the affected side, root of the nose toward the healthy side. These signs facilitate correct diagnosis and treatment tactics.

Systematic analysis of clinical deficits in unilateral hypoglossal nerve palsy.

The clinical characteristics of unilateral hypoglossal neuropathy have not been systematically analyzed. We documented subjective abnormalities of speech and swallowing, and photographed 9 specific tongue movements and positions. Objective deficits were scored independently by 2 examiners. Eight patients were analyzed. Some degree of dysarthria and dysphagia was noticed by 7 and 8 patients, respectively, mostly resolving within a few months. In all subjects, there was contralateral deviation of the tongue at rest and ipsilateral deviation upon forward protrusion. Furthermore, 7 of 8 patients had deficits in using the tongue to indent the ipsilateral cheek and cover the upper lip. Unilateral hypoglossal nerve palsy produces mostly subtle and transient patient symptoms, even when complete. Beyond the classic sign of ipsilateral deviation on protrusion, reliable signs are contralateral deviation at rest, paresis of ipsilateral movement inside the mouth, and paresis of elevation of the tongue tip. Muscle Nerve 54: 1055-1058, 2016.

Anterior plagiocephaly: epidemiology, clinical findings,diagnosis, and classification. A review

Anterior plagiocephaly due to the early unilateral fusion of the coronal suture is associated to a clinical phenotype characterized by the unilateral flattening of the frontal bone and the orbit and by the distortion and maldevelopment of adjacent cranial and facial bones. Homolateral anterior displacement of the ear and contralateral deviation of the nasal pyramid and mandible are other prominent clinical features. The differential diagnosis includes a variety of conditions characterized by facial asymmetry, namely, due to muscular alterations, anomalies of the visual function, congenital anomalies of the cervical spine and craniovertebral junction, abnormal pregnancy, and birth injuries. Anterior plagiocephaly is the direct cause of oculomotor anomalies, with a characteristic strabismus, and of progressive asymmetrical maldevelopment of the face, craniovertebral junction, and cervical spine. The medical literature was reviewed in regard to the epidemiology, clinical features, and radiological findings. Different categorization of the affected infants in specific subtypes according to the severity of the condition was analyzed. The aim was to contribute to a practical clinical classification to be utilized for the surgical indication and for predicting the prognosis according to the severity of the condition at presentation. Anterior plagiocephaly represents the most challenging simple suture craniosynostosis. The clinical differential diagnosis with other forms of cranial asymmetry is possible on the grounds of mere clinical findings. A classification system is necessary not only for the establishment of surgical planning but also to predict the late cosmetic and functional outcomes.

Nasenatmungsbehinderung nach Septumplastik: Deviation der Lamina perpendicularis bei Schiefnase

Functional septorhinoplasty (SRP) is a surgical procedure for improvement of symptomatic deformity of the inner and outer nose. Due to inadequate preoperative analysis and consequently insufficient surgical indication, septoplasty (SPL) alone may be performed. A frequent cause for revision septorhinoplasty (rSRP) in our institution was found to be due to a deviated bony pyramid in compound with a contralateral high deviation of the perpendicular plate, ipsilateral reluxation of the cartilaginous septum and a resulting nasal valve stenosis. The medical records of all patients undergoing revision septorhinoplasty in our institution from 2005-2011 were evaluated retrospectively.398 patients underwent rSRP, in 57 patients (14%) a deviated bony nose after septoplasty was diagnosed. In all cases a deviated bony nose and contralateral deviation of the perpendicular plate was found and corrected by rSRP. The nasal breathing was improved in all cases. This was also shown in an increase of endonasal volume and nasal air flow in acoustic rhinometry and active anterior rhinomanometry. A deviated nasal pyramid and perpendicular plate was found to be a common cause for persistent nasal obstruction after septoplasty. A careful preoperative analysis of the nose, the pathology of the bony and cartilaginous septum and the nasal valves is mandatory in order to recognize anatomical details and set up the right indication for rhinosurgical interventions.

Free Will, Agency, and the Synthetic Function of the Ego: An Investigation Using Cortical Stimulation

The experience that I feel myself to be the agent of my own movements is inherent to any volitional action. Impairments of this basic experience both in normal subjects and in patients with focal brain lesions may help to shed light on the nature of this perceptual mechanism, entitled authorship processing. We here report a perceptual illusion during invasive electrical cortical stimulation in a patient who underwent presurgical evaluation for epilepsy surgery. While stimulating the right frontal eye field electrically, which induced a contralateral eye and head deviation, the patient repeatedly had the illusion of performing this movement volitionally. Our observation suggests that ambiguous contextual situations may produce impairment of authorship processing. The findings are in line with current neuroscientific data, suggesting that authorship knowledge is not inherent to any volitional act, but requires information and inference for any given action. This notion also shows striking similarities to the Freudian concept of the synthetic function of the ego. By harmonizing conflicting elements, the synthetic function of the ego ensures unanimity of action and—as shown in our patient—also of authorship and free will.

Occipital seizures manifesting as visual loss with post-ictal Anton's syndrome

Focal occipital seizures are typically associated with simple isual phenomenon, such as scotomas or flashes of light. With pread to the temporal and parietal regions, symptoms of greater isual complexity may occur, including metamorphopsia (distorion of shape), micropsia or macropsia (distortion of size), and allucinations consisting of colorful imagery. Nonvisual manifesations, such as blinking and contralateral eye or head deviation, ay also occur [1]. Less frequently, occipital seizures may present ith visual loss, as an ictal or postictal phenomenon, which may e transient or permanent [2]. Visual anosognosia or denial of loss f vision, also know by its eponym, Anton’s syndrome, as an ictal r post-ictal phenomenon, has rarely been reported [3]. Herein, we iscuss a patient whose visual anosognosia was prominent during he post-ictal period.

Oral contraceptive therapy modulates hemispheric asymmetry in spatial attention

Background Functional cerebral asymmetries (FCAs) are known to fluctuate across the menstrual cycle. The visual line-bisection task administered to normally cycling women showed different patterns of the interhemispheric interactions during menses and the midluteal cycle phase. However, the contribution of estrogens and progestins hormones to this phenomenon is still unclear. Study Design The aim of our study was to show a variation of FCAs in women administered oral contraceptives (OCs) using the visual line-bisection task. Visual line-bisection task with three horizontal lines was administered to 36 healthy women taking a 21-day OC. Twenty-nine patients were right handed. The task was administered during OC intake (day 10) and at the end of the pill-free period. Results The right-handed women showed a significant leftward bias of veridical center on the first and third lines during OC intake compared with an opposite rightward bias during the pill-free period. The same phenomenon of contralateral deviation was observed in left-handed women on day 10 of OC intake. Conclusions The results of this study confirm a hormonal modulation on interhemispheric interaction and suggest that OCs may improve the interhemispheric interaction reducing FCAs compared with the low hormone level period. This opens new insights in OC prescription and choice of administration schedule in order to improve cognitive performances.

Directional bias in the body while walking through a doorway: its association with attentional and motor factors

Recent studies indicate that cognitively intact individuals experience frequent rightward collisions while walking through narrow doorways. Such a directional bias has been attributed to an attentional bias in spatial perception. However, these studies did not investigate the involvement of any motor factor that could affect the directional bias in the body. In the present study, three experiments were conducted to quantify the impact of the leading foot when crossing a doorway threshold on the directional bias in the body midpoint when passing through the doorway. Participants walked through the perceived center of a relatively wide doorway. Measurements of the deviation of the upper-body midpoint from the center of the doorway demonstrated that the leading foot had a very strong influence on the directional bias. Some participants showed rightward deviation irrespective of which foot was used to step through the doorway (Experiment 1). However, a consistent rightward bias in the body was not observed in other experiments. Both the movement of one hand (Experiment 2) and covert visual attention to one side of the door (Experiment 3) caused contralateral deviation of the body. It is likely that the movement of the hand and a visual stimulus serve as an attentional cue and are effective to avoid neglect of the ipsilateral side; as a result, the body midpoint is deviated to the contralateral side. From these findings, we conclude that the directional bias in locomotor trajectories while passing through a doorway results from the combination of a motor factor, particularly the leading foot, and attentional/brain factors.

Unilateral Lumbar Spondylolysis on Radiography and MRI: Emphasis on Morphologic Differences According to Involved Segment

The objective of our study was to retrospectively compare the radiography and MRI findings of unilateral spondylolysis in the upper lumbar segment and in the lower lumbar segment and to consider how these radiologic findings can be applied in the diagnosis of unilateral spondylolysis. Thirty patients with unilateral lumbar spondylolysis were categorized into one of two groups according to the lumbar levels involved with pars interarticularis defects: group A (L1, L2, and L3) or group B (L4 and L5). On radiographs, we evaluated contour bulging of the affected pars interarticularis, reactive sclerosis in the contralateral pedicle, anterolisthesis of the involved vertebra, and deviation of the spinous process. On MRI, we assessed pseudoarticulation of the pars interarticularis defect, uneven distribution of posterior epidural fat, the interspinous distance between adjacent segments, facet and disk degeneration in adjacent segments, and other anomalous changes. Among the 63 patients with unilateral spondylolysis, the upper lumbar segment was involved in 29 and the lower lumbar segment, in 34. Group A often displayed contour bulging of the affected pars interarticularis, reactive sclerosis of the contralateral pedicle, and contralateral deviation of the spinous process, all of which were easily detectable on radiography. Group B frequently showed anterolisthesis, pseudoarticulation of the pars interarticularis defect, adjacent facet-disk degeneration, and other anomalous changes that were well observed on MRI. Unilateral lumbar spondylolysis displayed radiologic differences in morphology of the isthmic defect itself and in ancillary findings of the adjacent structures based on the segment involved. Recognition of different ancillary features of unilateral spondylolysis with the use of a feasible diagnostic tool can be helpful for the diagnosis of cases in which a direct sign of isthmic defect is equivocal.

Unilateral isolated frontosphenoidal craniosynostosis causing frontal plagiocephaly

Synostotic frontal plagiocephaly is most commonly caused by frontoparietal (unicoronal) synostosis, but may be caused by other fusions along the coronal hemiring. Frontosphenoidal synostosis is a rare cause of frontal plagiocephaly, with only five previously reported cases. We present the case of an 8-month-old male infant with frontal plagiocephaly caused by unilateral isolated frontosphenoidal synostosis mimicking frontoparietal (unicoronal) synostosis. The clinical and radiological features included flattened ipsilateral forehead, retruded ipsilateral maxilla, a midline chin, contralateral deviation of the nasal root and endocranial base, and anomalies of the bony orbit. Unilateral isolated frontosphenoidal synostosis may be misdiagnosed as unicoronal synostosis. Careful physical and radiological assessment is necessary to recognise this synostotic disorder of the coronal hemiring.

Direct hypoglossal nerve stimulation in obstructive sleep apnea.

To determine the motor responses resulting from direct electrical stimulation of the hypoglossal (HG) nerve and to correlate these responses to changes in upper airway patency during sleep. The motor effects of direct electrical stimulation of the main trunk of the HG nerve and the branch that supplies the genioglossus muscle during anesthesia and wakefulness were assessed visually. Responses in airflow during sleep to HG nerve stimulation were assessed with standard polysomnographic techniques. University medical center. Fifteen patients undergoing a surgical procedure that involved the neck that exposed the HG nerve and 5 volunteer patients with obstructive sleep apnea constituted the study population. The main trunk (n = 3) and genioglossus branch (n = 2) of the HG nerve were stimulated electrically with a half-cuff tripolar electrode. Stimulation of the branch of the HG nerve that innervates the genioglossus muscle caused protrusion and contralateral deviation of the tongue. Stimulation of the main trunk of the HG nerve caused slight ipsilateral deviation and retrusion of the tongue. The arousal threshold for stimulation exceeded the motor recruitment threshold by 0.8 +/- 0.4 V. Inspiratory airflow increased in all patients by 184.5 +/- 61.7 mL/s (mean +/- SD; P = .02, analysis of variance) with stimulation. Direct HG nerve stimulation below the arousal threshold can improve airflow in patients with obstructive sleep apnea.

Hemangioma of the nasal vault: MR and CT features.

Six patients with a history of epistaxis (five patients) or nasal obstruction (one patient) were found to have a capillary hemangioma of the nasal vault that involved one or more nasal turbinates. Four patients underwent computed tomographic (CT) examination; two of these also underwent magnetic resonance (MR) imaging. Four others underwent only MR imaging. At CT and MR, all of the lesions were well circumscribed and intensely enhancing, with contralateral deviation of the nasal septum. Remodeling of the surrounding bone was present in three patients. On T1-weighted MR images, the masses were intermediate in signal intensity. Varying degrees of T2 shortening were shown on T2-weighted MR images, with an appearance that suggested the presence of blood products surrounding an inner matrix of higher-signal-intensity tumor. Intense enhancement at CT and MR assisted differentiation of tumor from retained sinonasal secretions. In two patients, external carotid arteriography revealed small foci of pooling contrast material; in one of these patients, arteriovenous shunting was also present. Pathologic examination in all patients demonstrated capillary hemangiomas with varying degrees of fibrosis and hemosiderin deposition.