Nerve Palsy In Patients Research Articles

Facial Nerve Paralysis in Patients With Chronic Ear Infections: Surgical Outcomes and Radiologic Analysis.

ObjectivesThe purpose of this study was to investigate the clinical features, radiologic findings, and treatment outcomes in patients of facial nerve paralysis with chronic ear infections. And we also aimed to evaluate for radiologic sensitivities on facial canal, labyrinth and cranial fossa dehiscences in middle ear cholesteatomas.MethodsA total of 13 patients were enrolled in this study. Medical records were retrospectively reviewed for clinical features, radiologic findings, surgical findings, and recovery course. In addition, retrospective review of temporal bone computed tomography (CT) and operative records in 254 middle ear cholesteatoma patients were also performed.ResultsOf the 13 patients, eight had cholesteatomas in the middle ear, while two patients exhibited external auditory canal cholesteatomas. Chronic suppurative otitis media, petrous apex cholesteatoma and tuberculous otitis media were also observed in some patients. The prevalence of facial paralysis in middle ear cholesteatoma patients was 3.5%. The most common involved site of the facial nerve was the tympanic segment. Labyrinthine fistulas and destruction of cranial bases were more frequently observed in facial paralysis patients than nonfacial paralysis patients. The radiologic sensitivity for facial canal dehiscence was 91%. The surgical outcomes for facial paralysis were relatively satisfactory in all patients except in two patients who had petrous apex cholesteatoma and requiring conservative management.ConclusionFacial paralyses associated with chronic ear infections were observed in more advanced lesions and the surgical outcomes for facial paralysis were relatively satisfactory. Facial canal dehiscences can be anticipated preoperatively with high resolution CTs.

Complications following recurrent laryngeal nerve lymph node dissection in oesophageal cancer surgery.

The recurrent laryngeal nerve lymph node is one of the most common metastatic sites in oesophageal cancer, and dissection of this lymph node is considered beneficial. Although the risk of complications from this procedure, such as recurrent laryngeal nerve palsy, is well known, few reports have detailed those risks in a large number of cases. Our study examined the risks of recurrent laryngeal nerve lymph node dissection, with a special focus on recurrent laryngeal nerve palsy. Retrospectively collected data from 661 patients, who underwent transthoracic oesophagectomy for oesophageal cancer, were analysed. Recurrent laryngeal nerve palsy occurred in 36% of the patients. Among these patients, except those in whom recurrent laryngeal nerve was intentionally excised due to metastatic lymph node, permanent palsy was detected in 12%. Bilateral recurrent laryngeal nerve lymph node dissection, cervical anastomosis and upper oesophageal cancer were independent risk factors for recurrent laryngeal nerve palsy. Although recurrent laryngeal nerve palsy was a risk factor for aspiration, tracheostomy and postoperative pneumonia, it did not directly correlate with death caused by pneumonia. Among postoperative complications, only recurrent laryngeal nerve palsy correlated with bilateral recurrent laryngeal nerve lymph node dissection. Recurrent laryngeal nerve palsy is a complication that should be avoided but does not seem to be severe enough to affect patient survival after surgery. Although bilateral recurrent laryngeal nerve lymph node dissection can induce recurrent laryngeal nerve palsy in patients who undergo transthoracic oesophagectomy, this procedure did not correlate with aspiration and pneumonia.

Clinical efficacy of acupuncture and rehabilitation treatment on oculomotor nerve palsy patients

Clinical efficacy of acupuncture and rehabilitation treatment on oculomotor nerve palsy patients

Transient facial nerve palsy after auriculotemporal nerve block in awake craniotomy patients.

In this case series, we describe transient postoperative facial nerve palsy in patients after awake craniotomy using selective scalp nerve blocks. In a 1-year period, 7 of the 42 patients receiving scalp nerve blocks at our institutions developed this complication. This is significant because there is only 1 previously reported case of postoperative facial nerve palsy related to scalp nerve blocks. The exact cause of transient postoperative facial nerve palsy after auriculotemporal nerve block is unknown and likely multifactorial. This technique may need to be refined to avoid such complications.

Contralateral Reinnervation in Patients With Facial Nerve Palsy

To demonstrate a phenomenon of contralateral reinnervation in facial nerve palsy patients. Retrospective case review of 9 patients whose facial muscles were electrophysiologically proven to be reinnervated contralaterally. The duration from symptom onset spanned from 3 to 114 months. All subjects had moderate-to-severe facial palsy initially. Contralateral reinnervation was observed in both traumatic and idiopathic causes, also in both complete and incomplete palsies. Cross-innervation is more frequently reported in muscles near the midline; however, this is the first report demonstrating evidence of cross-innervation in muscles far from the midline--the frontalis, the orbicularis oculi, and the zygomaticus. Although contralateral reinnervation after facial nerve palsy is a common observation, it has not gained appropriate attention. Without recognition of this phenomenon, misinterpretation of the electromyography may mislead the proper timing of nerve repair or reanimation procedure. Therefore, routine examination of motor action potential by contralateral stimulation during electromyography, especially in patients with moderate-to-severe palsy, would provide accurate assessment of the injured nerves and would help in appropriate decision making for further treatment.

Cases and Medico-Legal Aspects Regarding Bilateral Iatrogenic Injury of the Recurrent Laryngeal Nerve

Cases and Medico-Legal Aspects Regarding Bilateral Iatrogenic Injury of the Recurrent Laryngeal Nerve On the basis of the observation of 5 cases of recurrent nerve paralysis in patients undergoing surgical thyroidectomy, the authors evaluate the medicolegal implications related to the onset of this serious complication deriving from surgical operations in the thyroid gland. We describe the possible surgical techniques to preserve and not damage the RLN, in the course of a surgical procedure involving the thyroid gland. The medicolegal evaluation examines the possibility to detect, in the different cases analyzed, a surgical malpractice that might entails the existence of a professional responsibility, distinguishing this situation from cases in which the error can be defined as “excusable.” We also have considered the importance of informed consent and of the medical chart, which is the main tool to evaluate the conduct of the surgeon.

Effect of surgical clipping versus endovascular coiling on recovery from oculomotor nerve palsy in patients with posterior communicating artery aneurysms: A retrospective comparative study and meta-analysis

Background:Oculomotor nerve palsy (OMNP) is a well-recognized complication of posterior communicating artery (PCOM) aneurysms. Only a few comparative studies have assessed the effect of clipping versus coiling on recovery from OMNP in PCOM aneurysms. A retrospective review and meta-analysis was conducted to assess the relationship between PCOM aneurysm treatment and OMNP.Materials and Methods:Medical records of all patients presenting between January 2000 and February 2013 with intracranial aneurysm were searched. All patients with OMNP secondary to PCOM aneurysm were included for analysis. Patients undergoing surgical clipping or endovascular coiling were compared with respect to complete resolution of OMNP after aneurysm surgery (i.e., primary outcome). A meta-analysis of published studies of OMNP associated with PCOM aneurysm was performed after a MEDLINE search.Results:Seventeen patients with OMNP secondary to PCOM aneurysms met the inclusion criteria. Surgical clipping (seven of eight patients, or 87.5%) resulted in greater complete resolution of OMNP compared with endovascular coiling (four of nine patients, or 44.4%), P = 0.13. A meta-analysis of similar studies revealed that complete resolution of OMNP was more commonly associated with surgical clipping (36 of 43 patients, or 83.7%) than with endovascular coiling (29 of 55 patients, or 52.7%), yielding an adjusted odds ratio (OR) of 6.04 [confidence interval (CI) =1.88-19.45, P = 0.003]. Multivariate analysis found that the degree of pre-operative OMNP (OR = 0.07, CI = 0.02-0.28, P = 0.001) and surgical clipping (OR = 6.37, CI = 1.73-23.42, P = 0.005) were significant factors that affected the complete recovery of OMNP.Conclusion:Complete recovery of OMNP with PCOM aneurysms is more commonly associated with surgical clipping than with endovascular coiling. Also, the degree of pre-operative OMNP and the treatment modality are significant factors that affect the complete recovery of OMNP.

Vertical muscle transposition augmented with lateral fixation (Foster) suture for Duane syndrome and sixth nerve palsy

To report the postoperative results of full-tendon vertical rectus transposition (VRT) augmented with lateral fixation suture for the treatment of type 1 Duane syndrome and sixth nerve palsy and to determine whether there was a decrease in the effect of the Foster suture over time. This retrospective, consecutive case series included patients who underwent a full-tendon VRT transposition with lateral fixation for type 1 Duane syndrome or sixth nerve palsy. The primary outcome measures included deviation, abnormal head posture(AHP), abduction deficiency, and postoperative binocular single visual field (BSVF). Eighty-seven patients (87 eyes: 40 eyes with Duane syndrome and 47 eyes with sixth nerve palsy) were included in this study. In Duane syndrome patients, the deviation was reduced by a mean of 95%, the AHP was eliminated in 86% of patients, the abduction was improved by 42%, and a useful BSVF of ≈ 67% of normal was achieved at 1 year post operation. In sixth nerve palsy patients, the deviation was reduced by 99%, the abduction was improved by 59%, and a useful BSVF of ≈ 71% of normal was achieved at 1 year post operation. In both groups, the improvements in deviation angle and abduction were stable postoperatively. Sixteen patients needed reoperation for undercorrection. VRT surgery with posterior fixation is an effective treatment method for complete sixth nerve palsy and Duane syndrome with esotropia, AHP, and abduction deficiency. The procedure carries a small risk of reoperation for undercorrection. The effect of the Foster suture did not decline over time.

Orthodromic Transfer of the Temporalis Muscle in Incomplete Facial Nerve Palsy

BackgroundTemporalis muscle transfer produces prompt surgical results with a one-stage operation in facial palsy patients. The orthodromic method is surgically simple, and the vector of muscle action is similar to the temporalis muscle action direction. This article describes transferring temporalis muscle insertion to reconstruct incomplete facial nerve palsy patients.MethodsBetween August 2009 and November 2011, 6 unilateral incomplete facial nerve palsy patients underwent surgery for orthodromic temporalis muscle transfer. A preauricular incision was performed to expose the mandibular coronoid process. Using a saw, the coronoid process was transected. Three strips of the fascia lata were anchored to the muscle of the nasolabial fold through subcutaneous tunneling. The tension of the strips was adjusted by observing the shape of the nasolabial fold. When optimal tension was achieved, the temporalis muscle was sutured to the strips. The surgical results were assessed by comparing pre- and postoperative photographs. Three independent observers evaluated the photographs.ResultsThe symmetry of the mouth corner was improved in the resting state, and movement of the oral commissure was enhanced in facial animation after surgery.ConclusionsThe orthodromic transfer of temporalis muscle technique can produce prompt results by applying the natural temporalis muscle vector. This technique preserves residual facial nerve function in incomplete facial nerve palsy patients and produces satisfying cosmetic outcomes without malar muscle bulging, which often occurs in the turn-over technique.

難聴を合併したMPO-ANCA関連血管炎患者の3D-FLAIR MR画像評価

Patients with MPO-ANCA related angitis sometimes experience the onset of sonsorineural hearing loss and facial palsy. The main aim of this study was to investigate the relationship between the inflammation in the inner ear and sensorineural hearing loss, or between the inflammation of the facial nerve and facial nerve palsy in patients with MPO-ANCA related angitis. From 2007 to 2011, the inner ear was evaluated in 16 ears from 8 patients with MPO-ANCA related angitis with 3D-FLAIR MRI. In 12 ears of the 16 ears the onset of sensorineural hearing loss was noted, and the signal intensity ratio (SIR) in the cochlea was 0.62 +/- 0.15 on pre-enhancement 3D-FLAIR MRI, and 0.97 +/- 0.5 on post-enhancement. These SIR values were significantly higher than the SIR of non-sensorineural hearing loss patients. The onset of facial palsy was noted in 9 of 16 sides and the facial nerve SIR was 0.83 +/- 0.23 on post-contrast 3D-FLAIR MRI. The SIR in the facial nerve of facial nerve palsy patients was higher than non-facial palsy patients. The conclusion is that sensorineural hearing loss and facial palsy in patients with MPO-ANCA related angitis occurred due to strong inflammation in the cochlea or facial nerve. 3D-FLAIR MRI made this pathology clear.

Bell's palsy treatment strategies: Antivirals may help some patients.

Is there a rational basis for treating facial nerve palsy (FNP) patients—or a definable subgroup—with antiviral agents? There is substantial evidence that infections—including with herpesviruses1—can play an important etiologic role in FNP, although there are no systematic data to indicate the proportion in which this is the case. Paradoxically, the role of anti-infectious therapy is much less clear. An upcoming American Academy of Neurology Guideline2 concludes, much like the original 2001 one, “Because of the possibility of a modest increase in recovery, patients may be offered antivirals (in addition to steroids).” Despite similarly cautious wording, the original guideline was followed by widespread use of antivirals in FNP—use that has decreased substantially in light of more recent data.

Predictive factors and radiological features of radiation-induced cranial nerve palsy in patients with nasopharyngeal carcinoma following radical radiotherapy

To identify the key predictive factors of radiation-induced cranial nerve palsy in patients with nasopharyngeal carcinoma (NPC). From November 1998 to December 2007, all consecutive patients with newly diagnosed NPC who were curatively treated with radiotherapy and subsequently developed radiation-induced cranial nerve palsy (RICNP) were included in our study. Patients with cranial nerve palsy due to disease recurrence were excluded. Their records were retrospectively reviewed. Amongst 965 patients with NPC treated with radical radiotherapy, 41 developed new cranial nerve palsy. After exclusion of 5 patients with cranial nerve palsy due to recurrence, 36 (3.7%) developed RICNP. The median follow-up was 8.9 years (range, 3.2-11.3 years). Ten of the 36 patients had cranial nerve palsy at presentation. Twenty-seven patients had single cranial nerve palsy and 9 patients had multiple cranial nerve palsy. The most commonly involved cranial nerve was cranial nerve XII, with 30 patients having palsy of cranial nerve XII and 6 of them having bilateral cranial nerve XII palsies. Magnetic resonance imaging features of radiation-induced hypoglossal nerve palsy were demonstrated in our study. Multivariate analysis revealed that cranial nerve palsy at presentation was an independent prognostic factor for the development of RICNP. Other factors including T staging, N staging, gender, age, radiotherapy technique and the use of chemotherapy have no significant relationship with the risk of developing RICNP. RICNP in patients with NPC is not a rare complication, and cranial nerve palsy at presentation is an important prognostic factor.

Surgical options and clinical outcomes of cervical ossification of the posterior longitudinal ligament

To discuss the options and clinical outcomes of surgical treatment of cervical ossification of the posterior longitudinal ligament (OPLL). From January 2006 to December 2010, 63 patients of cervical OPLL treated surgically by same team were retrospectively analyzed. There were 49 males, 14 females, with a mean age of 56.2 years (from 38 to 76 years). The duration of symptoms ranged from 2 months to 20 years (mean 3.2 years). The ossified ligament was classified via sagittal and coronal images on CT scan. The cervical curvature was measured. Choice of surgical methods was determined according to the type of ossified ligament and cervical curvature. All complications occurred was recorded. The Japanese Orthopedic Association (JOA) scoring system was used to evaluate the neurological status. The severity of cervical pain was assessed with visual analogue scale (VAS) method. The results of preoperative, postoperative and follow-up were statistically compared with student t test. The JOA scores of 35 patients performed with anterior approach improved from 9.8 ± 2.3 preoperatively to 11.7 ± 2.1 at final follow-up (t = 3.28, P < 0.05). The VAS sore was significantly decreased at final follow-up compared with preoperative (t = 3.15, P < 0.05). While the JOA scores improved from 10.4 ± 2.7 preoperatively to 12.5 ± 2.3 at final follow-up (t = 3.81, P < 0.05) in 12 patients with laminectomy and from 9.7 ± 2.5 to 11.6 ± 2.6 in 14 patients with laminoplasty (t = 3.56, P < 0.05). The VAS score either in laminectomy or in laminoplasty has not significantly difference between preoperative, 3 month postoperative and final follow-up (P > 0.05). Two patients underwent a combined anterior-posterior approach procedure. Complications in patients included 1 patient of postoperative neurologic deterioration and 2 cases of cerebrospinal fluid leakage in patients with anterior approach, and 2 cases of C(5) nerve palsy in patients with laminectomy. Surgical options of cervical OPLL should be determined by detailed study of type and range of ossified ligament, as well as the cervical curvature of patients. Good neurological function can be expected in case of appropriate choosing the method for treating the cervical OPLL.

Carotid Stenting Versus Endarterectomy

Since the landmark NASCET and ECST trials demonstrated the superiority of carotid endarterectomy over medical therapy in the prevention of stroke for patients with symptomatic carotid artery stenosis, surgical intervention as a part of secondary prevention of stroke has become widespread. However, the newer technology of carotid artery angioplasty and stenting challenges this mode of intervention, promising the benefits of a procedure under local anesthesia and potentially avoiding the surgical complications of cranial nerve palsy and hematoma. Pooled evidence from randomized controlled trials of endarterectomy versus stenting shows a higher rate of stroke or death in the stenting groups-but this finding is mitigated to an extent by the lower incidence of myocardial infarction and cranial nerve palsy in patients undergoing stenting. At present, carotid endarterectomy combined with optimal drug therapy remains the standard of care for symptomatic 70%-99% stenosis of the internal carotid artery, but stenting might be an option in younger patients and in those not suitable for endarterectomy.

중성어혈 약침치료를 병행한 요골신경마비 환자 치험 4례

Abstract Objectives: This study was to investigate the clinical effect of additional Jungsongouhyul Pharmacopuncture on radial nerve palsy patients. Methods & Results: The patients were hospitalized or outpatients in Department of traditional kore-an medical hospital, Dongshin University from 28th, Oct. 2009 to 25th, Aug, 2010. All patients weretreated by additional Jungsongouhyul Pharmacopuncture. To evaluate the wrist drop and numbness offingers, coding result, Verbal numerical scale (VNS) were used. As the result, symptoms areimproved remarkably according to improvement of coding result, VNS score. Conclusions: Patients were treated during 3.5 weeks in average. All cases were excellent results byadditional Jungsongouhyul Pharmacopuncture. But further studies are required to investigate exacteffects. 63 http://dx.doi.org/10.3831/KPI.2011.14.4.063 ISSN 2093-6966
dJournal of Pharmacopuncture O| £-!+± n{-!+ŽV £+ n{-!++-W{-! ]xWMA AS A‰ UA A× U ASO-!+WMA AS A‰ UA AaX ASO-!++WMA AS A‰ UA A  USO

Radiation-Induced Ocular Motor Cranial Nerve Palsies in Patients With Pituitary Tumor

Radiation therapy is often used in the treatment of pituitary tumor. Diplopia due to radiation damage to the ocular motor cranial nerves has been infrequently reported as a complication in this clinical setting. Retrospective case series of 6 patients (3 men and 3 women) with pituitary adenoma, all of whom developed diplopia following transsphenoidal resection of pituitary adenoma with subsequent radiation therapy. None had evidence of tumor involvement of the cavernous sinus. Five patients developed sixth nerve palsies, 3 unilateral and 2 bilateral, and in 1 patient, a sixth nerve palsy was preceded by a fourth cranial nerve palsy. One patient developed third nerve palsy. Five of the 6 patients had a growth hormone-secreting pituitary tumor with acromegaly. Following transsphenoidal surgery in all 6 patients (2 had 2 surgeries), 4 had 2 radiation treatments consisting of either radiosurgery (2 patients) or external beam radiation followed by radiosurgery (2 patients). Patients with pituitary tumors treated multiple times with various forms of radiation therapy are at risk to sustain ocular motor cranial nerve injury. The prevalence of acromegalic patients in this study reflects an aggressive attempt to salvage patients with recalcitrant growth hormone elevation and may place the patient at a greater risk for ocular motor cranial nerve damage.

Oral antibiotic treatment and long-term outcomes of Lyme facial nerve palsy

To study the long-term functional outcomes of patients with Lyme facial nerve palsy treated with oral antibiotics. We conducted a retrospective double-cohort study involving patients with Lyme facial nerve palsy treated with oral antibiotics matched to three controls with early localized Lyme disease. Chart review was completed and an SF-36 health questionnaire and standardized symptom questionnaire administered. Lyme facial nerve palsy patients were treated with oral antibiotics for a median duration of 21days (range 7-30days). Only three patients underwent lumbar puncture and each demonstrated lymphocytic pleocytosis. Fourteen of 15 patients with Lyme facial nerve palsy completely regained nerve function. The long-term outcomes were similar between patients with Lyme facial nerve palsy and controls after a median follow-up duration of 4.6years. Patients with Lyme facial nerve palsy had significantly higher reported rates of fatigue (60%) than controls (27%) (p=0.019), but similar energy and vitality scores on the SF-36 questionnaire (55.0 vs. 58.4, p=0.621). SF-36 social functioning domain scores were significantly lower in patients with Lyme facial nerve palsy (77.5) than in controls (88.6) (p=0.044). There were no other significant differences noted between the two cohorts. For patients with Lyme facial nerve palsy in North America, treatment with oral doxycycline appears to be an effective therapeutic strategy.

Adjustable suture technique for enhanced transposition surgery for extraocular muscles

To evaluate the results of 2 methods of vertical rectus muscle transposition surgery for sixth (abducens) nerve palsy. Retrospective, comparative case series. Historically at our institution, transposed vertical rectus muscles were adjusted toward or attached at the adjacent corners of the lateral rectus muscle ("conventional transposition") before the development of a technique in which adjustable sutures are passed beneath the lateral rectus muscle to attach at its opposite corners ("crossed-adjustable transposition"). Comparative outcomes with these 2 techniques were analyzed in a consecutive series of sixth nerve palsy patients. The change from preoperative to postoperative deviation at distance was 39.3(Δ) ± 22.7(Δ) in 23 conventional transposition cases and 48.5(Δ) ± 27.8(Δ) in 19 crossed-adjustable transposition cases, which demonstrated no statistically significant difference (p = 0.24, t-test). Simultaneous medial rectus weakening was needed less in the crossed-adjustable transposition group (37%) than in the conventional transposition group (83%), and this difference was statistically significant. (p = 0.004, Fisher exact test). Adjustable vertical rectus muscle transposition surgery for the management of chronic sixth nerve palsy, enhanced by passing the adjustable sutures beneath the lateral rectus muscle, requires simultaneous medial rectus muscle weakening less than half as often for satisfactory results.

Vascular Findings in the Facial Nerve Canal in Human Temporal Bones With Diabetes Mellitus

To identify pathological changes to vessels in the facial nerve canal among patients with diabetes mellitus. Histopathologic human temporal bone study. This study examined 26 temporal bones from 13 patients with type 1 diabetes mellitus and 40 temporal bones from 20 patients with type 2 diabetes mellitus. Temporal bones from patients with type 2 diabetes mellitus were divided into 2 groups according to the method of diabetes management: insulin (n = 11) and oral hypoglycemic agents (n = 9). For the control groups, 16 age-matched normal temporal bones from 11 subjects were recruited for type 1 diabetes mellitus and 11 age-matched normal temporal bones from 8 subjects were recruited for type 2 diabetes mellitus. Thicknesses of vessel walls in the labyrinthine, tympanic, and mastoid portions of the facial nerve canal were examined under light microscopy. Vessel walls for all portions of the facial nerve canal were significantly thicker in diabetic patients than in normal controls for both types 1 and 2 diabetes. In type 2 diabetic patients, vessel wall thickness was significantly greater in patients treated with insulin therapy than in patients treated via oral hypoglycemic agents. The facial nerve in patients with diabetes mellitus is ischemic compared with normal controls. These findings suggest a histologic basis for the high incidence and difficulty in achieving improvement of facial nerve palsy in patients with diabetes mellitus.

특발성 동안신경마비의 자하거 약침 치료 3례

Objective : Oculomotor nerve palsy is a disorder which causes eyeball movement trouble, diplopia, dizziness and eyelid ptosis. It is caused by aneurysm, mass, trauma, infection and so on. But sometimes we can`t establish the cause. We observed 3 cases of idiopathic oculomotor nerve palsy patient treated with hominis placenta pharmacopuncture. Method & Result : We treated three idiopathic oculomotor nerve palsy patients with hominis placenta pharmacopuncture and electroacupuncture. As the result, symptoms of three patients were improved remarkably. Conclusion : In this cases, the hominis placenta pharmacopuncture is effective on idiopathic oculomotor nerve palsy. We need further study about idiopathic oculomotor nerve palsy and hominis placenta pharmacopuncture.