Transtympanic facial nerve paralysis

In order to ascertain the immediate histopathological changes of rat brain following experimental surgical injury, fragments of left parietal cortex were obtained through craniotomy and fixed by immersion. Next, the animals were killed by perfusion with the same fixative used for the respective biopsy. Five groups of rats were tested, each for one different fixative. Dark neurons were by far the most prominent feature in surgically traumatized tissue, following both immersion and perfusion with all five fluids. They were morphologically identical at both sites, and fixatives with widely different chemical composition, e.g. Bouin's fluid and buffered glutaraldehyde, had no influence on their aspect. It is suggested that shrunken neurons are not to be interpreted systematically as artefacts, but also represent a form of short-latency cellular reaction to injury.     

针灸治疗面神经麻痹的疗效观察

目的:探讨针灸治疗对面神经麻痹的治疗效果.方法:75例患者随机分为针灸治疗组35例和对照组40例.结果:治疗组总有效率为97.14%,对照组总有效率为75%,治疗组疗效明显优于对照组(P<0.01).结论:针灸治疗面神经麻痹疗效确切,及时有效的治疗可以使大部分患者达到痊愈,但也和病情的轻重和患者的禀赋有关.     

The treatment of idiopathic facial paralysis

Louisiana's new Medical Assistance Programs Provider Agreement Law creates a complex contractual relationship between the state and every person providing care, items or services to the Louisiana Medicaid Program. In privately funded healthcare, it is called a "network contract." This new law gives the Department of Health and Hospitals at least 12 express reasons to cancel a person's contract to provide care to Medicaid beneficiaries. The law also, however, gives a right to either party--either the provider or the state--to cancel the contract at will, and even without cause, by the mere giving of a 30-day advance written notice, and thus this new law might be said by some to stretch the notion that "any willing provider" may participate in Medicaid to near the breaking point. There are many new rules and conditions, some of which have not yet even found their way into privately funded healthcare.     

Neurovascular free muscle transfer combined with cross-face nerve grafting for the treatment of facial paralysis in children

Microneurovascular free muscle transfer is fast becoming a standardized procedure in the treatment of established or long-standing facial paralysis. However, there is no general agreement as to whether muscle transfer should be employed for children who still are growing. A patient's natural growth may influence or disturb reproduction of a smile, or a child may not be able to collaborate with postoperative rehabilitation sufficiently well to obtain a satisfactory result. One may hesitate to employ the procedure for children aged under 10 out of fear of its technical difficulties. To investigate the influence of age, the results experienced by 23 patients under the age of 15 who underwent free muscle transfer combined with cross-face nerve grafting were compared with those of adult patients. The treatment employed was a two-stage operation consisting of cross-face nerve grafting and subsequent free muscle transfer.     

Prediction of prognosis in peripheral facial nerve paralysis using submandibular gland scintigraphy

In this study, we evaluated the ability of submandibular gland scintigraphy to predict the prognosis of peripheral facial nerve paralysis. METHODS: Submandibular gland scintigraphy was performed in 78 patients with acute peripheral facial nerve paralysis. After injection of 180-370 MBq [99mTc]pertechnetate, serial 1-min images were acquired for 25 min. At 15 min after injection of radionuclide, ascorbic acid was administered intraorally to stimulate salivary secretion. Regions of interest were set manually on both submandibular glands, and time-activity curves were generated. The ratios of peak count density (PCR) and washout (WR) of the affected side to the normal side were calculated. Parameters of > or = 0.8 suggested normal affected submandibular function and indicated a good prognosis. RESULTS: Complete recovery of facial nerve paralysis was observed in 52 of 78 patients. The sensitivity, specificity and accuracy of PCR for a good prognosis were 79%, 50% and 69%, and those of WR were 85%, 77% and 82%, respectively. Positive and negative predictive values for a good prognosis were 76% and 54% in PCR and 88% and 71% in WR, respectively. When WR obtained within 14 days of the onset was used, positive and negative predictive values for a good prognosis were 94% and 73%, respectively. None of the eight patients who had values of <0.8 for both parameters within 14 days of the onset recovered completely. CONCLUSION: Submandibular gland scintigraphy can serve as a reliable indicator to predict the prognosis of acute peripheral facial nerve paralysis in its early symptomatic period.     

Submandibular secretion of immunoglobulins IgA and IgG in peripheral paralysis of the facial nerve

INTRODUCTION: In all lesions of the facial nerve suprachoroidally localized, and due to disturbance of parasympathetic and sympathetic component, there comes to qualitative and quantitative disorders of the secretion of submandibular salivary gland. Glandular immunoglobulins IgA and IgG are the secretion of the specific plasma cells in the interstice of this gland. The mechanism of the secretion of immunoglobulins is not sufficiently clear, but it is certainly under the direct neurogenic control, since the disorders of the secretion emerge after the denervation of the submandibular salivary gland. The aim of the study was to prove the direct relation between the degree of submandibular immunoglobulin secretion IgA and IgG, and the degree of the lesion of the facial nerve U which is vitally important in the clinical estimation of the peripheral paralysis of this nerve. MATERIAL AND METHODS: In 35 patients with peripheral idiopathic facial nerve paralysis, the quantity of the secreted immunoglobulins IgA and IgG was examined by laser nephelometar BLN, Module 3. The quantity of the secreted immunoglobulins IgA and IgG (mg lit) in the saliva of the paralysed side was indirectly compared to the secreted immunoglobulins of the healthy, i.e. control side. The examination was performed three times: a) after the appearance of the disease, in the first 30 days; b) two to three months later; c) after six to twelve months. RESULTS: The quantity of the secreted immunoglobulins is significantly higher in the saliva samples taken from the paralysed side (9.50U204.77 mg lit), in comparison with the samples taken from the healthy side (9.50U70.36 mg lit). In the group of patients with favourable results and significantly higher secretion (p 0.01) normalization occurred in the final period of observation. In patients with unfavourable results the difference in secretion was continuously present (p 0.05) (table 1). DISCUSSION: In the lesions of the facial nerve suprachoroidally localized, there comes to disorder concerning the secretion of immunoglobulins IgA and IgG by submandibular salivary gland, which can be applied in the estimation of the degree of paralysis and the prognosis of the final result. CONCLUSION: The results of the research show that in the peripheral idiopathic facial nerve paralysis, there comes to increased secretion of immunoglobulins IgA and IgG in submandibular gland, at the paralysed side. In the patients who, during the paralysis, show quicker fall and normalization of the previously increased quantities of immunoglobulins, the recovery of the motor function of the facial nerve comes more successfully and more certainly. The degree of the secretion of immunoglobulins IgA and IgG can be used for the estimation of the severely of the pathological process in the suprachoroidal part of the nerve, and it can be used as a reliable parameter for the prognosis of the paralysis outcome.     

针刺联合本体神经肌肉促进技术治疗面瘫50例临床疗效分析

目的:探讨针刺结合本体神经肌肉促进技术(PNF)治疗面瘫的临床疗效.方法:对100例住院和门诊面瘫病人随机分为治疗组50例,采用针刺结合PNF方法治疗;对照组50例病人只使用针刺方法治疗.10天为一疗程,三疗程后观察治疗组和对照组和疗效.结果:治疗组痊愈痊愈率60%,显效率18%,好转率12%,总有效率90%,无效510%.对照组痊愈率40%,显效率14%,好转率20%,总有效率74%,无效26%.治疗组痊愈率和总有效率与对照组比较有明显差异(P=0.046,P=0.037,P＜0 05).结论:针刺结合PNF治疗面瘫能明显提高治愈有效率.     

按摩治疗早期周围性面瘫的临床体会

目的:研究按摩配合超短波等综合治疗对周围性面瘫早期患者治疗的作用.方法:100例早期周围性面瘫患者进行按摩配合超短波治疗,恢复期仍采用电针、按摩、超短波治疗.结果:早期周围性面瘫患者进行按摩配合超短波治疗疗效确切.结论:按摩配合超短波治疗早期周围性面瘫治疗更有利于面神经运动功能恢复,可有效的缩短治疗时间避免早期针灸的副作用.     

A simple method of restoring lidfunction in facial nerve paralysis with permanent magnets (author''s transl)

Anxiety arising from masturbatory guilt plays a major role in the production of frigidity and impotence. Reduction of this anxiety through greater community awareness of the normality of masturbation is therefore a fertile area for the principles of preventive medicine to be applied.     

A quantitative study of nerve fibers in the human facial nerve

The facial and intermediate nerves were quantitatively evaluated in seven patients who died from systemic malignancies not involving the facial nerve. In addition, five of the specimens were also qualitatively evaluated by measuring the total and axon diameters of the facial and intermediate nerve fibers. In two cases the facial nerve fibers were counted at five different levels. The total number of myelinated nerve fibers in the facial nerve varied from 7500 to 9370. The total number of myelinated nerve fibers in the intermediate nerve varied between 3120 and 5360. The peak diameter of the facial nerve axon was between 4 and 6 microns, and was between 2 and 3 microns in the intermediate nerve. When comparing nerve segments at different anatomical levels, the largest amount of nerve fibers was found at the level of the middle mastoid portion. However, this number did not reach the amount of nerve fibers counted in the internal acoustic meatus.     

周围性面神经断裂伤的外科治疗

目的:评估周围性面神经断裂损伤患者手术治疗后的效果,分析影响预后的相关因素.方法:自1999年至2009年因周围性面神经断裂在我院接受手术修复的患者104例,男75例,女29例,年龄2～77岁,中位年龄30岁.单纯面神经吻合术72例,随访至最终恢复的65例(90.2%).自体神经移植术32例,随访至最终恢复的24例(75.0%).面神经功能评价采用了整体及分区House-Brackmann(HB)评价方法,以卡方检验或Fisher确切概率法进行统计分析.结果:单纯面神经吻合术后总体恢复程度为HB Ⅰ级者37例(56.9%),Ⅱ级者11例(16.9%),Ⅲ级者15例(23.1%),Ⅳ级者2例(3.1%);各分区恢复至HB Ⅰ、Ⅱ级的比例分别为:眼部97.6%、面中部97.9%、口角78.6%、额部27.3%(P<0.001).自体神经移植术后总体恢复程度为HB Ⅰ级者4例(16.7%),Ⅱ级者5例(20.8%),Ⅲ级者7例(29.2%),Ⅳ级者8例(33.3%);各分区恢复程度达HB Ⅰ、Ⅱ级的分别为:眼部73.7%、面中部72.7%、口角44.4%、额部37.5%.神经吻合术后面神经功能恢复程度优于自体神经移植术(P=0.002).结论:面神经吻合术和自体神经移植是修复周嗣性面神经断裂损伤的有效方法;面神经受损分支、损伤范围、手术修复距离损伤的时间和患者年龄均对手术预后有所影响.     

Maxillary sinus augmentation: histomorphometric analysis of graft materials for maxillary sinus floor augmentation

OBJECTIVE: To compare efficacy and tolerance of recombinant interferon alfa-2b in the treatment of anti-HCV-positive chronic active hepatitis (CAH) in subjects aged 65 years and above with those less than 65. DESIGN: A randomized controlled trial. SETTING: Outpatients in two hospitals. PATIENTS: 65 consecutive outpatients with anti-HCV-positive CAH for 1 to 30 years, having basal aminotransferase levels at least twice the normal value. Those 65 and over were randomized to an interferon group (A, n = 22) or a no-treatment group (B, n = 22). All those under 65 received interferon (group C, n = 21). INTERVENTION: Interferon at a dose of 3 mU 3 times a week for a 6-month period. A normalization of serum aminotransferase levels was considered a positive response to therapy. RESULTS: Response to therapy was positive in 62% of the treated elderly compared to 57% of the adults (P = 0.85). The two groups of responders showed a common highly significant reduction of aminotransferase (P < 0.001). Side effects were similar in elderly and young. Two untreated elderly showed spontaneous normalization of aminotransferase. CONCLUSION: Interferon in anti-HCV-positive CAH is useful in the elderly, allowing normalization of aminotransferase, improvement of the histology and remission of the disease in 62% of the cases. Side effects seem to be independent of age. Further studies are required to assess both duration of remission and usefulness of cyclic therapy in previous responders.     

Surgical treatment of facial nerve involvement caused by leprosy

Complete and partial nerve paralysis can result from leprosy. The latter is more prevalent and results in lagophthalmos and corneal hypoesthesia. The former is characterized by loss of facial expression, deviation of the face to the nonparalyzed side, difficulty in chewing, and drooling, in addition to lagophthalmos and corneal hypoesthesia. Affected patients are at risk to develop blindness, as well as suffering social and economic deprivation because of the effects of facial nerve paralysis. Prevention of blindness and amelioration of the latter were successfully achieved by muscle transfer procedures, temporalis transfer to the eyelid, and masseter transfer to the mouth and nasolabial fold in small, minimally equipped hospitals in Africa.     

Rerouting of the intratemporal facial nerve: an analysis of the literature

Anterior rerouting of the intratemporal facial nerve in the infratemporal fossa approach is employed to access to the jugular bulb, hypotympanum, and lateral skull base, whereas posterior rerouting of the facial nerve, as employed in the transcochlear craniotomy, is most frequently used for surgery of the posterior fossa, cerebellopontine angle, prepontine region, and petrous apex. Facial nerve rerouting may lead to facial paresis or paralysis. This review of the literature is intended to define the physiologic "cost" of these procedures, so that the neurotologic surgeon can determine if the morbidity incurred in these techniques is worth the resultant exposure. Inconsistencies in reporting facial function places into question the validity of some of the cumulative data reported. Postoperatively, grades I-II facial nerve function was seen in 91% of patients undergoing short anterior rerouting, 74% of patients undergoing long anterior rerouting, and 26% of patients undergoing posterior complete rerouting. Although facial nerve rerouting allows unhindered exposure to previously inaccessible regions, it is achieved at the cost of facial nerve function. Facial nerve dysfunction increases with the length of facial nerve rerouted.     

Validation of objective measures for facial paralysis

A shift from subjective scales to objective measures of facial paralysis requires physical models against which to validate and calibrate the new objective techniques. The purpose of this report was to demonstrate such a model and to test the capacity of an objective computer system to accurately measure physical change. The physical model consisted of an advancing edge of a spreading gelatin film. The model was measured in submillimeter increments. Concurrent measurements were made using the computed system. Ten trials were conducted. The objective system proved to be exquisitely sensitive (0.03 mm) and highly correlated with the physical criterion model (Pearson's product moment correlation coefficient [r]=0.9849). Sensitive and calibrated objective methods of analysis of facial motion are crucial to the design of clinical trials, clinical studies of nerve regeneration, and comparisons of reanimation techniques.     

浅刺加推拿治疗面瘫132例疗效观察

目的:探索针刺治疗面瘫的更有效方法.方法:按就诊顺序随机分成治疗组76例,给予浅刺患侧面部加头颈部推拿治疗.对照组56例以常规捻转针刺法加头颈部推拿治疗.结果:两个疗程后,治疗组总有效率96.1%,对照组总有效率87.4%,P＜0.05,两组疗效有显著性差异.结论:浅刺患侧的治疗效果明显优于对照组.     

Cavernous haemangioma of the facial nerve

Facial nerve haemangiomas are probably the most frequent benign tumours involving the facial nerve in its intratemporal portion. Usually facial nerve dysfunction is present when these tumours are of extremely small size, the average tumour being less than 10 mm. We present a case of a 15 mm diameter cavernous haemangioma of the geniculate region, with histological findings of nerve infiltration, without facial nerve symptoms. The atypical clinical presentation justifies the report and subsequent literature review.