Unilateral Paralysis Research Articles

A model of transient laryngeal hemiplegia in dogs through conduction blockade of the recurrent laryngeal nerve.

To create a model of transient unilateral laryngeal paralysis (LP) that will allow the study of cricoarytenoideus dorsalis dysfunction and a method for quantification of varying degrees of LP in dogs. 5 castrated male research Beagles. Between January and February 2018, dogs were anesthetized and instrumented with a laryngeal mask airway and a flexible endoscope to record the rima glottidis. The left or right recurrent laryngeal nerve (RLn) was localized using ultrasonography and electrical stimulation, then conduction blockade was induced with perineural lidocaine. The normalized glottal gap area (NGGA) was measured before and every 15 minutes after the block. Inspired 10% carbon dioxide (CO2) was administered for 1 minute at each sampling time. The inspiratory increase in NGGA (total and each side) was measured at peak inspiration. The change in hemi-NGGA for the control side versus the anesthetized side was evaluated with a mixed-effect model. During CO2 stimulation, the increase in inspiratory hemi-NGGA was consistently less (P < .001) for the treated side (-8% to 13%) versus the control side (49% to 82%). A compensatory increase (larger than at baseline) in the control hemi-NGGA was observed. The total NGGA remained unaffected. Unilateral local anesthesia of the RLn produced transient unilateral LP with a compensatory increase in the hemi-NGGA for the contralateral side. This model could facilitate the evaluation of respiratory dynamics, establishment of a grading system, and collection of other important information that is otherwise difficult to obtain in dogs with LP.

Etiology and Management of Bilateral Vocal Fold Paralysis: a Retrospective Cohort Study

<h2>Summary</h2><h3>Objectives</h3> Bilateral vocal fold immobility can occur secondary to bilateral nerve injuries, resulting in paralysis of both vocal folds, known as bilateral vocal fold paralysis (BVFP). BVFP can cause airway obstruction and is associated with significant morbidity. Treatment options include tracheotomy, cordotomy, and arytenoidectomy, which are designed to increase the caliber of the upper airway. In the largest BVFP study to date, we set out to review cases of BVFP to better understand the etiologies of paralysis and subsequent surgical interventions. <h3>Methods/Study Design</h3> A retrospective review of patients with BVFP over a 17-year period within a single institution was performed. For each patient included in the study, the etiology of paralysis, simultaneous vs sequential onset of paralysis, subsequent surgeries, and spontaneous recovery were reviewed. Logistic regression was performed to determine whether patient factors predicted tracheotomy or recovery of vocal fold motion. <h3>Results</h3> 86 patients with BVFP followed for greater than 180 days were included in this retrospective cohort study. The majority of patients (84.9%) did not recover any vocal fold motion, while 13 patients (15.1%) recovered motion in at least one vocal fold. Iatrogenic injury was the most common etiology of paralysis. Sixty-seven patients (77.9%) underwent a tracheotomy placement, the most commonly performed procedure. Age, gender, or paralysis progression did not predict whether patients underwent tracheotomy or experienced spontaneous vocal fold motion recovery. <h3>Conclusions</h3> The most common etiology of BVFP was iatrogenic injury during thyroid surgery. A greater number of patients developed simultaneous paralysis of both vocal folds compared to sequential unilateral paralysis. Tracheotomy was the most commonly performed surgery, and the minority of patients were successfully decannulated. This study helps define the etiologies and treatments of patients with BVFP to better describe the patient-related morbidity associated with this condition.

Prognostic model of the absence of larynx motility recovery in unilateral lesions of the recurrent laryngeal nerve in thyroid surgery

One of the most serious complications in thyroid surgery is damage to the recurrent laryngeal nerve, which can significantly worsen the patient’s quality of life, so predicting the course of the disease is very important, as it contributes to timely and targeted aid to patients and the determination of optimal treatment tactics.&#x0D; Objective — construction of the prognostic model of the absence of larynx motility recovery in unilateral lesions of the recurrent laryngeal nerve in thyroid surgery&#x0D; Materials and methods. In the years 2018 — 2021, a prospective single‑center study was conducted at the Ukrainian Scientific and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine. Investigation involved 164 patients after thyroidectomy with unilateral motility disorder of the larynx. The investigated patients are divided into two groups: the main group (n = 33) included patients with unilateral paralysis of larynx (the mean age 49.7 ± 11.1 years), and control group consisted of 131 patients with unilateral paresis of larynx (the mean age 43.2 ± 14.6 years).&#x0D; Results. Prognostication of disease was conducted by means of three methodologies. The method of statistical analysis of Wald was conducted taking into account the most meaningful informing laryngoscopy signs with their gradations (9 laryngoscopy signs and 1 sign that is related to age), that were distinguished by us in previous prognostic research. Diagnostic coefficients and information measures of Kullback J of selected features were determined and a special template was developed using the MS Excel program to automate diagnostic analysis. Method of binary logistic regression allows the expectation of dependence of binary initial variable (present/absent paralysis) after influence of factor variables. Three factor signs that remained after recalculation have been investigated. To ensure quick and convenient execution of calculations, a corresponding template has also been created in the MS Excel program. The prognostic express test, which enabled us to build an easy‑to‑use test based on the most significant two predictors and their gradations, which were converted into ranks. A comparison of the occurrence of paresis/paralysis of the larynx was made for different sums of ranks.&#x0D; Conclusions. The diagnostic method based on the sequential Wald analysis, despite good performance in the case of a definite result, gave about 25 % indeterminate results and therefore needs further improvement based on a more representative sample. The diagnostic model built using binary logistic regression led to good results, but working with it requires a personal computer and an appropriate template for calculations in the Excel program. The prognostic express test, which is based on the consideration of only two predictors, is convenient, does not require complex calculations and provides an acceptable level of sensitivity and specificity, which can be widely used in the clinical practice of first‑line otorhinolaryngologists for a timely decision on further conservative or surgical treatment.&#x0D;

Facial reanimation using free partial latissimus dorsi muscle transfer: Single versus dual innervation method

The aim of the present study was to analyze the consequences of partial free latissimus dorsi muscle flap with nerve splitting technique (Partial LD transfer) for facial reanimation and compare outcomes according to innervation method (singer versus dual innervation).Patients with complete unilateral facial paralysis underwent either the single (ipsilateral masseteric nerve only) or dual (ipsilateral masseteric nerve plus contralateral buccal branch of the facial nerve) nerve innervation method for facial reanimation. An assessment was carried out to compare the outcomes between the single and dual innervation.Total of 21 patients were involved in this study. In the single innervation group, 7 out of 8 patients developed a voluntary smile. However, none were able to achieve a spontaneous smile. On the other hand, 9 out of 13 patients developed a voluntary smile and 3 out of 13 patients achieved a spontaneous smile. The mean increases of smile excursion assessed by Emotrics software and Terzis grades showed no significant differences between two groups.Within the limitations of the study it seems that partial LD transfer approach utilizing the dual innervation method has a positive effect on achieving a spontaneous smile and could be a valuable option for facial reanimation.

Rare Manifestation of Sjögren's Syndrome as Unilateral Facial Paralysis: A Case Report and Literature Review.

Herein, we present a unique case of Sjögren's syndrome (SS) first presenting as facial palsy, as well as a literature review of case reports describing SS-associated facial paralysis. A PubMed search for papers containing the keywords Sjögren's syndrome or Sjögren's disease, as well as facial paralysis, facial paresis, facial palsy, or Bell's palsy, was performed. Articles not in English and cases of SS not involving facial paralysis were excluded. Appropriate articles were reviewed for patient demographics and symptoms of SS, including laterality of facial paralysis, cranial nerve involvement, and comorbid diseases. House-Brackmann grades were annotated based on either assignment by individual case reports or the authors' descriptions when sufficient details were present. Of 43 peer-reviewed articles found, 14 were both in the English language and provided adequate information on a total of 16 patients with facial paralysis and SS diagnosis. Ultimately, SS and other systemic autoimmune disorders should be considered in the differential diagnosis of patients presenting with insidious onset facial paralysis.

Bell’s Palsy

Bell’s palsy is described by prompt, unilateral paralysis of the cranial nerve. It is the most common cause of acute facial paralysis. Even though the pathogenesis of the condition is poorly understood it is considered to be caused by cranial nerve inflammation.Timely diagnosis and appropriate intervention can improve symptoms and ensure a speedy recovery. This article is a representation of a case report of proper treatment and intervention of a patient diagnosed with Bell’s Palsy who fully recovered.

Office-Based Structural Autologous Fat Injection Laryngoplasty for Unilateral Vocal Fold Paralysis.

Unilateral vocal fold paralysis (UVFP) is a common cause of incomplete glottic closure, leading to significant somatic and social disabilities. Office-based autologous fat injection laryngoplasty (AFIL) has been proposed as an effective treatment for glottic insufficiency but has not been well-studied for UVFP. We enrolled 23 patients who underwent office-based structural AFIL due to unilateral vocal paralysis at our institution between February 2021 and January 2022. In the procedure, autologous fat was harvested and injected into the vocal fold under the guidance of flexible digital endoscopy for structural fat grafting. The voice handicap index-10 (VHI-10) score and perceptual voice measurements were collected before the operation, 2 weeks postoperatively, and 3 months postoperatively. Twenty-two patients were followed-up for at least 3 months. The VHI-10 score improved significantly from 29.65 ± 8.52 preoperatively to 11.74 ± 7.42 at 2 weeks (p < 0.0001) and 5.36 ± 6.67 at 3 months (p < 0.0001). Significant improvements in grades of dysphonia (p < 0.0001), breathiness (p < 0.0001), and asthenia (p = 0.004) were also noted at 3 months postoperatively when perceptual measurements were investigated. Office-based structural AFIL is an effective treatment for improving voice-related disability for UVFP patients.

A fascia bow traction method for the treatment of unilateral marginal mandibular nerve paralysis after mandibulectomy for head and neck cancer

BackgroundUnilateral paralysis of the marginal mandibular nerve (UPMMN) after head and neck cancer surgery is a relatively common condition that causes deformity and an asymmetric appearance of the lower lip and impairs the quality of life of patients. We developed a novel fascia grafting method to improve the appearance of the lower lip in patients with UPMMN. MethodsTwo fascia strips and a small fascia loop connecting the two strips are used: one is fixed horizontally to pull the lower lip toward the paralyzed side, and the other is fixed in a bow shape at rest to avoid approaching the lateral mandibular margin. When patients smile or open their mouths, the bow-shaped graft straightens, pulling the paralyzed lower lip laterally downward through the small connecting loop. We used this method to treat four patients with UPMMN who had undergone head and neck cancer ablation. The symmetry and movement of the lower lip were assessed using preoperative and postoperative photographs of three poses (at rest, smiling, and opening the mouth). ResultsThe fascia grafting procedure restored the symmetry of the lower lip at rest and greatly improved symmetrical lower lip movement when smiling and opening the mouth. According to photographic evaluation scores, all patients had poor lower lip symmetry in the three poses before the procedure, whereas after the procedure, three had excellent lower lip symmetry, and one had good lower lip symmetry. There was a significant difference between the scores before and after the surgery. ConclusionsFascia grafting is easy and minimally invasive, allows patients to generate an almost symmetrical smile, and consequently improves their QOL. This method may be particularly useful when the lateral mandibular bone is resected during cancer surgery, and the defect is reconstructed with metal plates/soft tissue, as the method does not require approaching the lateral mandibular region.

Surgical treatment of unilateral laryngeal paralysis by selective reinnervation in thyroid surgery

State of the problem: One of the complications in thyroid surgery is a lesion of RLN which can be bilateral with a violation of respiratory function of the larynx and unilateral, in which the first priority is a violation of vocal function of the larynx. The most effective treatment for paralysis of the larynx is the method of laryngeal reinnervation, which can be non-selective, which is usually used in unilateral laryngeal paralysis and promotes reinnervation of both abductors and laryngeal adductors. Selective reinnervation is selectively focuses on the reinnervation of individual target muscles, so it is more often used in bilateral laryngeal paralysis. But despite this, it was used in unilateral laryngeal paralysis during surgery on the thyroid gland during intentional resection of the anterior branch of RLN with partial invasion of its tumour process. Aim: evaluation of the results of surgical treatment unilateral laryngeal paralysis by the method selective reinnervation in thyroidectomy. Materials and Methods: clinical case results of patient A. 15 years old with papillary thyroid cancer and metastases to regional lymph nodes of the neck (T4aN1M0) with absence disorders of laryngeal motility before surgery were analyzed. Examination of the larynx and voice examination were performed before surgery, 2-3 days and 6,12 months after surgery. Changes of laryngoscopic images and evaluation of the Indicators: maximum pho- nation time, fundamental frequency, noise to harmonic ratio, Jitter (loc), Shimmer (loc), Voice Handicap Index-30 (VHI-30), completed version of Jacobcon B. Results: Considering extralaryngeal bifurcation of the recurrent laryngeal nerve (RLN) and invasion of the tumor into the adductive branch of RLN on the left, its dissection was performed and end-to-end neuroanastomosis was formed, completed is selective laryngeal reinnervation. In the immediate postoperative period, patients complained of voice disorders. Study of voice parameters corresponded to severe voice disorders. Partial resumption of the mobility of the larynx and voice function was after 6 months. The signs of the laryngoscopic picture and the spectral analysis of the voice corresponded to the indicators before the operation after 12 months Сonclusions 1. Primary selective reinnervation of the larynx can be used to treat unilateral laryngeal paralysis under the following conditions: extralaryngeal branching of the recurrent laryngeal nerve (bifurcation), lesion of only one of its branches, which will provide sufficient coaxiality to perform anastomosis "end-to-end" and preservation electrical integrity of another branch. 2. This method allows you to restore the motility of the denervated vocal folds and the main indicators of the voice. 3. Given only one clinical case of treatment of unilateral laryngeal paralysis by selective reinnervation, this technique needs further study and refinement.

The Split Hypoglossal Nerve and Cross-Face Nerve Graft for Dual Innervation of the Functional Muscle Transfer in Facial Reanimation.

Facial paralysis is a disabling deformity. The affected individual is seriously affected both esthetically and functionally. Free functional muscle transfer is currently the corner stone in the management of long-standing facial nerve paralysis. Several nerve options are available to supply the free muscle transfer. These nerves can be used alone or in combination. The aim of this work is to study the possibility and results of dually innervating the free functioning muscle transfer. The dual innervation is done using the split hypoglossal nerve and cross-face nerve graft (CFNG) both sutured in an end-to-end manner to the nerve to gracilis. Twenty-nine patients with unilateral long-standing facial nerve paralysis (more than 1y) were treated using free gracilis muscle transfer dually supplied by the split hypoglossal nerve and CFNG, both sutured in an end-to-end manner. The gained excursion after the free gracilis transfer was 9 to 29mm (mean: 17.24mm). A statistically significant increase ( P -value=0.0001) in the distance from where the midline crosses the lower vermilion border to commissure occurred from preoperative (mean: 16.55mm) to postoperative setting (mean: 33.79mm). Spontaneity was achieved in 26 patients (89.6%). In conclusion, dual innervation of the free muscle transfer using both the split hypoglossal nerve and CFNG (both sutured in an end-to-end manner to the nerve to gracilis) is a good possible option to treat long-standing cases of facial nerve paralysis. It yields adequate muscle excursion with acceptable spontaneity.

CASE REPORT OF BELL’S PALSY FOLLOWING SECOND DOSE OF COVISHIELD VACCINE

Bell’s palsy, also known as acute peripheral facial palsy of unidentified reason, is caused by the acute onset of problems with the facial nerve’s lower motor neuron. Several case reports and series have described peripheral facial nerve palsy associated with COVID-19. In addition, since the US food and drug administration’s (FDA) emergency use authorization of several COVID-19 vaccines, there have been media reports of Bell’s palsy associated with vaccination. This case concerns a 26-year-old female with Bell’s palsy (confirmed by clinical diagnosis – an acute unilateral facial nerve paresis or paralysis with onset in &gt;72 h) after receiving second dose of Covishield vaccine (ChAdOx1 nCoV-19). She experienced decreased sleep, dizziness, and left side eye watering post-vaccination. Next day after vaccination, she noticed muscle weakness on the left side of the face, preventing her from close left eye, drinking fluids, and facial droop accompanied by reduced mobility. The patient was treated with methylprednisolone and eye drops (lubricants).

Effect of demographic factors, anthropometric factors, and comorbid diseases on recovery in the Bell's palsy subjects – A correlation study

OBJECTIVES: Bell's palsy is a condition of unilateral facial paralysis with the recovery rate varying from person to person. Various factors influence the prognosis of Bell's palsy subjects. Hence, the aim of this research was to examine the relationship between recovery of Bell's palsy and demographic, anthropometric, and the presence of comorbid diseases. METHODOlOGY: A correlation study was conducted on a total of 70 (both male and female) subjects. Independent outcome measures were age, gender, side, height, weight, body mass index, presence of diabetes, hypertension, and dyslipidemia. Dependent outcome measure was Sunnybrook Facial Grading System which grades the recovery following Bell's palsy. Outcome measures were taken at baseline, after 20 days, and after 1 month. RESULTS: Statistical analysis indicates that age, weight, diabetes, hypertension, and dyslipidemia have a significant correlation with recovery in Bell's palsy patients. CONCLUSION: The positive correlation between weight and recovery indicated that low weight leads to delayed recovery. A negative correlation of recovery with age, diabetes, hypertension, and dyslipidemia indicates that increased age leads to delayed or incomplete recovery and the presence of comorbid diseases leads to delayed/incomplete recovery.

Functional characterization of patients with cerebral palsy living in the Magallanes region and the Chilean Antarctic

To functionally characterize patients with Cerebral Palsy (CP) living in the Magallanes Re gion and the Chilean Antarctic. Descriptive-retrospective observational study of patients with cerebral palsy, registered in the Outpatient Rehabilitation Program of the Corporación de Rehabilitación Club de Leones Cruz del Sur de Punta Arenas between 1986 and 2018. Patients with CP were clinically categorized and then functionally characterized according to gross motor skills (GMFCS), manual ability (MACS), feeding ability (EDACS), and communication function (CFCS). 106 patients were included. Regarding the clinical classification, the most common type of CP was bilateral spastic paralysis, with the highest percentage of functional involvement in each of the evaluated areas, followed by unilateral spastic paralysis, while cases of dystonic CP and other non-classifiable types presented were less frequent. According to the clinical subclassification, spastic diplegia was more frequent, especially affecting manual and communication skills level I compared with hemiplegia, while cases of mixed and unclassifiable quadriplegia were less frequent with greater overall involvement of level I feeding skills. The observed results of CP in the Magalla nes Region and the Chilean Antarctic are similar to studies available in the literature. The complete evaluation and classification of patients with CP enable a better understanding of the pathology for future studies.

Assessment of the effectiveness of laryngeal protection mechanisms in patients with iatrogenic, unilateral laryngeal paralysis

Introduction: Postoperative paresis of the laryngeal nerves may disrupt the protection function of the larynx during swallowing. Material and method: Stage 1: Retrospective analysis of FEES reports in patients with unilateral laryngeal paralysis (n = 99) in terms of the occurrence of penetration or aspiration of saliva and liquid and solid food. Stage 2: Prospective analysis of the results of the EAT-10 screening questionnaire and reports (n = 12) of FEES examination performed in the early postoperative period (up to 7 days after the surgery) in patients with iatrogenic palsy of the X cranial nerve. Assessment of: sensory of the larynx, effectiveness for cough and pressure tests, presence of "white out", PAS scale for a regular diet according to IDDSI (ST 0; ST 7). Results: Stage 1: Penetration or aspiration was found in 65% of patients, in 29% of patients it were silent symptoms. Salivary penetration or aspiration concerned 60.60% of patients. Among people who developed silent disorders, 20 had isolated n. X paralysis, and 79% - polyneuric palsy. The PAS level between 2-8 was found in 65% of patients. Stage 2: 11/12 patients obtained the result of the EAT 10 questionnaire &gt; = 3. "White out" elongation and sensory loss were found in 75% of patients, ineffective cough in 33%. In oral trials, residue (50% ST0), premature swallowing (8% ST0), penetration (33% ST0, 8% ST7) and aspiration (16% ST0, 8% ST7) were found. Adaptive and compensatory techniques were the most frequently combined (66%), and the dominant technique was turning the head towards the affected side. Conclusions: In every sixth patient with iatrogenic laryngeal paralysis, aspiration of non-condensed fluids occurs early after the surgery, and the penetration of these contents into the larynx occurs in every third patient. It is therefore advisable to improve the comfort associated with the quality of life dependent on swallowing and to prevent complications of dysphagia in the study group. Therefore, it is justified to extend diagnostics to include clinical assessment of swallowing and qualify patients for FEES assessment. Key words: dysphagia, penetration, aspiration, laryngeal paralysis, FEES, vocal fold paresis, oropharyngeal dysphagia

Improved Symptoms of Peripheral Facial Nerve Palsy in ChAdOx1 nCoV-19 Vaccine Recipients Following Complex Korean Medicine Treatment

Peripheral facial nerve palsy is a neurological condition/disease characterized by unilateral paralysis of the facial muscles. We report the effects of complex Korean medicine treatment in 2 patients diagnosed with Bell’s palsy who developed symptoms 3-4 days following vaccination with ChAdOx1 nCoV-19 and who received oral steroids and antiviral medications. Complex Korean medicine treatments including acupuncture, electroacupuncture, bee venom acupuncture, cupping therapy, herbal medicine, and physical therapy were performed. Symptom improvement was evaluated daily using the Numerical Rating Scale, House- Brackmann Grade, and Yanagihara’s Score. Patient 1 was hospitalized for 22 days and Patient 2 visited the outpatient clinic 20 times. In both cases, postauricular pain caused by Bell’s palsy disappeared, and symptoms of facial paralysis improved following completion of treatment. These findings could suggest that combined Korean medicine treatment may improve symptoms of peripheral facial nerve palsy.

EFFECT OF COMPREHENSIVE APPROACH ON FEEDING ABILITY OF INFANT WITH FACIAL NERVE PALSY &amp; MICROTIA GRADE 4: A CASE REPORT

Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. it can be congenital or acquired. The unilateral facial paralysis can be suspected when, in absence of front and nasolabial groove motility, there is also asymmetry of the face with buccal deviation when crying. The custom-made Facial splint of low-temperature thermoplastic material can support the weak muscle &amp; prevent the deviation. The infant was referred to Occupational Therapy with facial palsy grade IV. The aim of our study is evaluating the immediate functional outcome, while using the custom-made splint. The patient was assessed twice (i.e. Baseline &amp; after 6 weeks) on Neonatal Behavioral Assessment scale (NBAS), Neonatal Oral Motor Assessment Scale (NOMAS), Nonnutritive sucking scoring system, Preterm Infant Feeding Readiness Assessment Scale &amp; Parent stress scale was used to track the feeding readiness &amp; parental stress respectively during intervention. On NBAS, Level 3 to level 5. On NNSS, infant scored 2 to 6 scoring system on non-nutritive sucking &amp; on NOMAS baby scored from 19 to 22. Her ability to initiate suck was improved considerably. Improvement in scores of Preterm Infant Feeding Readiness Assessment Scale at baseline &amp; after 6 weeks. Infant scored 65 to 57 on Parent Stress Scale. In this study, Family Centered approach &amp; the need-based intervention, a custom-made facial splint of low-temperature thermoplastic material along with face strap effective to facial palsy patient, along with conventional Occupational Therapy intervention.

Minimally Invasive Diaphragm Plication for Acquired Unilateral Diaphragm Paralysis: A Systematic Review.

Objective: Diaphragm paralysis is a relatively uncommon entity that can be both congenital and acquired in nature. While commonly asymptomatic, it can also cause a significant decrease in pulmonary function and reserve, particularly in patients with underlying pulmonary diseases. Our aim was to summarize the current literature regarding the minimally invasive techniques used in the surgical correction of acquired diaphragm paralysis via traditional and robotic minimally invasive approaches. Methods: We conducted a systematic review of available literature using the Cochrane methodology and reported findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Results: A total of 6,561 citations were identified through initial database and reference searches, of which 90 articles met the inclusion criteria for review. After further assessment, 33 appropriate full-text studies were selected for the review. Of the selected publications, the majority represented case reports and single-center retrospective studies with level of evidence 4. Only 1 level 2b study (individual cohort study) was identified, comparing minimally invasive and open approaches. Conclusions: Each of the minimally invasive approaches has its unique benefits and disadvantages, which are summarized and delineated in this article. Ultimately, no preferred method of diaphragm plication for diaphragm paralysis can be recommended at this time based on clinical data. The choice of procedure and surgical approach continues to be selected based on the surgeon's experience and preference.

Active and Passive Bioimplants for Vocal Fold Paralysis.

Vocal fold paralysis is one of the diseases that particularly affect quality of life. While unilateral paralysis leads to glottis closure insufficiency and hoarseness, bilateral paralysis compromises respiration and limits the exercise tolerance. Bioimplants have been used to treat persistent paralysis for over 100 years. The spectrum ranges from autologous tissue transfer and resorbable or permanent injection materials to composite thyroplasty implants and active electrical implants for neurostimulation of the larynx. If bioimplants are used in accordance with the recommendations, the quality of life of affected patients can be significantly improved today.

Botulinum toxin injection in masseter muscle evokes musculoskeletal impairment of the masticatory system

The masticatory system is a finely coordinated machine, where minimal deregulation induces alterations of the whole system. Botulinum toxin type A (BoNTA) injection in masseter muscle is widely used as a clinical/aesthetic procedure. However, the non‐desirable effects of masseter muscle paralysis in neighbor masticatory muscles or mandibular bone are unknown. In the current work, we aimed to evaluate musculoskeletal loss at the masticatory system after BoNTA‐injection in masseter muscle of adult mice.Unilateral paralysis of masseter muscles was induced in male BalbC mice (8 weeks‐old) by single‐injection of BoNTA (0.2U/10 µL) in the right muscle and saline solution in the left muscle. Masticatory muscles (masseter, temporalis, lateral‐ and medial‐pterygoid) and mandibles were dissected after 2‐7‐14d for molecular measurements (qPCR), histology, or morphology (microcomputed tomography). All procedures were approved by the IACUC‐Universidad de Chile (# 20381‐ODO‐UCH). T‐test or Wilcoxon‐test were used for statistical comparisons between BoNTA‐ and Control‐side (n=3‐10, p&lt;0,05).The expression of molecular markers of atrophy (Atrogin1, Murf1) and regeneration (myogenin) significantly increased in the BoNTA‐side, as early as 2‐7d, in the intervened masseter but also in the ipsilateral temporalis and medial pterygoid muscles. There was a time‐dependent reduction in masseter fibers diameter from 2d to 14d. Masseter, temporalis, and medial pterygoid’s volumes significantly reduced in the BoNTA‐injected side at 14d. Interestingly, the volume of lateral pterygoid increased in the BoNTA side, with no change in atrophy/regeneration markers. Microstructural analysis of mandibular condyles demonstrated a progressive bone loss in the BoNTA‐injected side, starting as early as 7d and worsening 14d after the intervention.In conclusion, BoNTA injection in the masseter muscle impairs the whole masticatory system, inducing atrophy of masseter but also the ipsilateral temporalis and medial pterygoid, and even early‐bone loss of the mandibular condyle at the injected side. Then, clinical uses of BoNTA in masticatory muscles should be avoided or carried out under strict morpho‐functional monitoring.

A novel classification of tracheal defects and the reconstruction strategies: A retrospective study based on 106 cases.

The study aims to present a novel classification of tracheal defects and the corresponding reconstruction strategies. The retrospective study was designed to analyze patients with diagnosed primary or secondary tracheal tumors from 1991 to 2020. Surgical techniques, complications and prognosis were reviewed. Airway status and patient outcomes were the principal follow-up measures. Tracheal defects were classified into two plane sizes (vertical (V) and horizontal (H) planes). Vertical defects were further categorized into three groups based on their tracheal ring numbers (V1, ≤ 5 rings; V2, 6-10 rings; and V3, > 10 rings). Tracheal defects with horizontal plane size H1 and H2 represent defects less and more than one-half the circumference of trachea. Thus, suitable reconstruction strategies were planned primarily based on "V" and "H" classifications. The reconstruction strategies performed were sleeve resection followed by an end-to-end anastomosis, window resection with sternocleidomastoid myoperiosteal flap reconstruction, defects conversion with rotation anastomosis, and modified tracheostomy with secondary flap reconstruction. A total of 106 patients diagnosed with tracheal defects were enrolled in the study, of whom 59 patients underwent sleeve resection followed by end-to-end anastomosis; 40 patients received window resection alongside sternocleidomastoid (SCM) myoperiosteal flap reconstruction; five patients received converting defects with rotation anastomosis and two patients underwent modified tracheostomy with secondary stage flap reconstruction. Lumen stenosis occurred in three V2H1 defect cases and were treated by a second reconstruction surgery. Iatrogenic unilateral recurrent laryngeal nerve paralysis occurred in two patients with the V3H2 defect type, who were treated by temporary tracheotomy and partial vocal cord resection and extubated successfully during follow-up. All 106 patients achieved airway patency with adequate laryngeal function at the end of follow-up. No anastomotic dehiscence or bleeding occurred in any patient postoperatively. Though a significant number of multicenter studies concerning the reconstruction and classification of tracheal defects are needed, the study herein provides a novel classification of tracheal defects, which is primarily developed on the defect size. Therefore, the study might serve as a potential source for identifying suitable reconstruction strategies for practitioners.