Thyroid storm triggered by thyroid nodule fine needle aspiration biopsy: a case report.

Background: Thyroid storm is a potentially fatal thyrotoxicosis triggered by an event, such as manipulation of the thyroid gland, acute iodine load, trauma, or infection. Prior to deciding on fine needle aspiration (FNA) biopsy, patients who have been diagnosed with hyperthyroidism or low thyroid stimulating hormone and multinodular goiter (MNG) should be imaged via radionuclide thyroid scan. Case Description: We present a case of a 62-year-old female patient with history of MNG, who had thyrotoxicosis on presentation due to medication noncompliance and was found to have Graves' disease. Computed tomography scan without intravenous iodine contrast injection showed a heterogeneously appearing and notably enlarged thyroid gland with a 6.2 cm × 5.8 cm right thyroid lobe and 5.5 cm × 5.0 cm left lobe. There was a resultant narrowing of the trachea measuring 6 mm in the transverse dimension at its narrowest point. Further evaluation with dedicated ultrasound of the thyroid showing bilateral MNG with coarse calcifications as well as a notable left thyroid cyst measuring 1.6 cm × 1.2 cm × 2.3 cm, isoechoic, with smooth margins. The patient was started on methimazole 40 mg/day, cholestyramine 4 mg four times per day, prednisone 20 mg/day, saturated solution of potassium iodide 50 mg three times daily, and propranolol for heart rate control. Another service recommended FNA biopsy of the right 3 cm thyroid nodule. Two days after undergoing an FNA, she experienced a thyroid storm, requiring emergent total thyroidectomy as a life-saving procedure. Conclusions: FNA is rarely needed in the case of a hyperfunctioning thyroid nodule, as it can be seen on radionuclide thyroid scan. However, when executed, a euthyroid state needs to be achieved before attempting to perform an FNA. Total thyroidectomy is warranted in a hyperthyroid state in an emergent setting without ample time for medical therapy to be effective, as seen in our reported case.

Correlation between Echocardiographic Diastolic Parameters and Invasive Measurements of Left Ventricular Filling Pressure in Patients with Takotsubo Cardiomyopathy.

BACKGROUND: The extent of diastolic dysfunction is of clinical importance in the risk stratification and management of patients with Takotsubo cardiomyopathy (TC). Standard echocardiographic indices of diastolic dysfunction have robust predictive ability in assorted disease states, but have not been validated in TC. The aim of this study was to compare Doppler metrics of diastolic function against catheterization-measured filling pressures in TC. METHODS: Patients with TC who met inclusion and exclusion criteria were evaluated using echocardiography and catheterization performed within 24 hours. Both left ventricular (LV) end-diastolic pressure and LV pre-A diastolic pressure were obtained from catheterization tracings. The echocardiographic parameters for diastolic function were extracted using the American Society of Echocardiography recommendations and a previously validated regression equation for mean left atrial pressure (mLAP). RESULTS: A total of 51 patients with TC were included. Patients were predominantly women (72.5%), with a mean age of 58 ± 13 years and a mean ejection fraction of 24 ± 10 %. E/e' ratio (septal, average, and lateral) and calculated mLAP correlated positively with catheterization LV pre-A, with fair to moderate correlation (coefficient range, 0.38-0.44). The t-test mean difference between LV pre-A pressure and calculated mLAP was 0.77 ± 7.34 mm Hg (95% CI, ±14.68 mm Hg) suggesting inconsistent measures. mLAP also exhibited poor diagnostic ability to discriminate elevated LV pre-A diastolic pressure, with an area under the receiver operating characteristic curve of 0.69 (95% CI, 0.50-0.88). CONCLUSIONS: Commonly used echocardiographic parameters for diastolic function demonstrated less-than-optimal correlation, with poor sensitivity and specificity, compared with invasively measured LV end-diastolic pressure or LV pre-A wave diastolic pressure in patients with TC. Precise characterization of LV filling pressure in patients with TC using contemporary noninvasive echocardiographic parameters appears challenging. Invasive measurements of filling pressure should remain the gold standard for optimal risk stratification and management of patients with TC.

The Pulmonary Embolism Response Team: Rationale, Operation, and Outcomes.

The pulmonary embolism response team (PERT) is an institutionally based multidisciplinary team that is able to rapidly assess and provide treatment for patients with acute pulmonary embolism (PE). Intrinsic to the team's structure is a formal mechanism to execute a full range of medical, endovascular, and surgical therapies. In addition, the PERT provides appropriate multidisciplinary follow-up of patients. In the 10 years since the PERT was first introduced, it has gained acceptance in many centers in the United States and around the world. These PERTs have joined together to form an international association, called the PERT Consortium. The mission of this consortium is to advance the diagnosis, treatment, and outcomes of patients with PE. There is considerable evidence that the PERT model improves delivery and standardization of care of PE patients, particularly those patients with massive and submassive PE. However, it is not yet clear whether PERTs improve clinical outcomes. A large prospective database is currently being compiled by the PERT Consortium. Analysis of this database will likely further delineate the role of PERTs in the management of intermediate-to-high risk PE patients and, importantly, help determine in which PE patients PERT may improve clinical outcomes.

Concepto de hombre emprendedor: tendencias disciplinares / Concept of the entrepreneurial man: disciplinary trends

Resumen Exploramos el concepto de Hombre Emprendedor (HE) que ha emergido en dos campos del conocimiento, a partir de los cambios estructurales impuestos por el nuevo orden social neoliberal en las últimas décadas del siglo XX. En el campo de la Economía el HE ha sido asociado a prácticas de asumir riesgos, innovar y detectar oportunidades, lo cual muestra una tendencia a incorporar nociones, conceptos, constructos y categorías típicamente tratadas por la Psicología en general. En la Psicología organizacional y del trabajo, el concepto HE estuvo inicialmente asociado a rasgos de personalidad, noción que actualmente coexiste con un abordaje que destaca la interacción individuo-contexto, que tiende a privilegiar nociones, conceptos, constructos y categorías de corte psicosocial. Finalmente se proponen algunas cuestiones de contraste y convergencia analítica del HE en los dos campos; así como la importancia de explicitar la influencia recíproca entre ciencias sociales aplicadas y su contexto histórico, sin desconocer las tensiones actuales.

Abstract We explore the concept of the Entrepreneurial Man (EM) that has emerged in two fields of knowledge, from the structural changes imposed by the new neoliberal social order in the last decades of the 20th century. In the field of Economics, the EM has been associated with risks-taking practices, innovating and detecting opportunities, which shows a tendency to incorporate notions, concepts, constructs and categories typically treated by Psychology in general. In organizational and work Psychology, the concept of the EM was initially associated with personality traits, a notion that currently coexists with an approach that emphasizes the individual-context interaction, which tends to privilege psychosocial notions, concepts, constructs and categories. Finally, some issues of contrast and analytical convergence of the EM in the two fields are proposed; as well as the importance of making explicit the reciprocal influence between applied social sciences and their historical context, without ignoring current tensions.

Prediction of sulfadiazine solubility in some cosolvent mixtures using non-ideal solution models / Predicción de la solubilidad de la sulfadiazina en algunas mezclas cosolventes utilizando modelos de solución no ideales

SUMMARY The experimental data of sulfadiazine in (methanol + water), (ethanol + water) and (1-propanol + water) cosolvent mixtures at some temperatures were correlated using non-ideal solution models, namely, the modified Apelblat and Buchowski-Ksiazaczak equations and the van't Hoff equation. The calculated results agreed well with the experimental data. According to the Buchowski equation, the solubility of sulfadiazine in the three co-solvent mixtures shows important deviations from ideality, which is consistent with the literature.

RESUMEN Los datos experimentales de sulfadiazina en mezclas de cosolvente de (metanol + agua), (etanol + agua) y (1-propanol + agua) a algunas temperaturas se correlacionaron utilizando modelos de solución no ideales, a saber, las ecuaciones modificadas de Apelblat y Buchowski y la ecuación de van't Hoff. Los resultados calculados coincidieron bien con los datos experimentales. Según la ecuación de Buchowski, la solubilidad de la sulfadiazina en las tres mezclas de cosolventes muestra importantes desviaciones de la idealidad, lo que concuerda con la literatura.

Clinical Impact of Atrial Fibrillation on Short-Term Outcomes and In-Hospital Mortality in Patients with Takotsubo Syndrome: A Propensity-Matched National Study.

INTRODUCTION: Takotsubo Syndrome (TS) patients are at high risk of developing atrial fibrillation. We sought to investigate the outcomes and economic impact of atrial fibrillation on TS patients utilizing the National Inpatient Sample. METHODS: Patients with TS were identified in the National Inpatient Sample (NIS) database between 2010 and 2014 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and subsequently were divided into two groups, those with and without atrial fibrillation. The primary outcome was all-cause in-hospital mortality in the two groups. Secondary outcomes were in-hospital complications. We also evaluated the length of hospital stay and the cost of hospitalization. Propensity score-matched analysis was performed to address potential confounding factors. RESULTS: Among the study population, the prevalence of atrial fibrillation was 17.57%. After matching, the atrial fibrillation group had no significant increase of in-hospital mortality (OR: 1.13; 95% CI: 0.94-1.35, p = 0.211). However, atrial fibrillation patients were more likely to develop cardiac arrest and ventricular arrhythmias (OR: 1.51, 95% CI: 1.26-1.80, p < 0.0001), have higher rate of major cardiac complications when combined as a single endpoint in-hospital complication (OR: 1.16, 95% CI: 1.04-1.29, p: 0.006), also they were more likely to stay longer in hospital (OR: 1.13, 95% CI: 1.08-1.19, p < 0.0001), and have increased cost of hospitalization (OR: 1.13, 95% CI 1.07-1.20, p < 0.0001). CONCLUSION: Atrial fibrillation does not increase in-hospital mortality in patients presenting with TS. However atrial fibrillation is associated with an increased risk of ventricular arrhythmias, length of stay, non-routine discharges and cost of hospitalization.

The Human Laryngeal Innervation Revisited-The Role of the Neural Connections.

In spite that vascular inconvenients or immunological rejections have been solved in relation with larynx transplant, a successful functional reinnervation has not been achieved. Some studies have suggested that laryngeal nerve connection may contain motor fibers, which could explain unexpected evoked responses in electromyographic studies or the different positions adopted of the vocal folds after similar nerve lesions. Ten patients with unexpected evoked responses after laryngeal nerve stimulation were selected. All the patients underwent a total laryngectomy due to oncological causes. In every case, laryngeal nerve connections were observed. All of them were morphologic and histologic processed for choline-acetyltransferase immunohistochemistry. The presence of motor axons in the nerve connections has been demonstrated, which would explain that the motor innervation to the laryngeal muscles could be dual through these variable connections. This also would justify the difficulty of carrying out laryngeal nerve reinnervation procedures. Anat Rec, 302:646-651, 2019. © 2018 Wiley Periodicals, Inc.

Anatomical Variations of the Intrapetrous Portion of the Facial Nerve.

The intrapetrous facial nerve has the second longest intraosseous course of all cranial nerves, after the mandibular nerve. But it is by far the most complex considering the anatomical structures closely related to it. The auditory and vestibular portions of the inner ear, the dura of the middle fossa and posterior fossa, the sigmoid sinus and jugular bulb, and the internal carotid artery are close enough to merit attention. This article includes an anatomical study on 100 temporal bones with anatomical references as seen from the middle fossa and from the transmastoid approaches that may help identifying the facial nerve and protecting surrounding structures. Anatomical variability was present and noteworthy when considering the venous drainage system through the temporal bone and the mastoid pneumatization. The distance from the geniculate ganglion to the hiatus falopii offered the highest variability with a range of 0 to 7.75 mm and a mean of 3.30 mm. The geniculate ganglion was dehiscent in 20.8% of the specimens and the superior semicircular canal was spontaneously blue-lined in 27% of the cases. Through the transmastoid approach, the highest variability was found regarding the distance between the vertical portion of the facial nerve and the jugular bulb (range from 1.5 to 10.0 mm), the sigmoid sinus (range from 0 to 13.25 mm) and the internal carotid artery (range from 6.0 to 15.0 mm). This study highlights the importance of the relative variability of the facial nerve to other surrounding structures within the petrous portion of the temporal bone. Anat Rec, 302:588-598, 2019. © 2018 Wiley Periodicals, Inc.

Peritonsillar and deep neck infections: a review of 330 cases / Infecções peritonsilares e cervicais profundas: revisão de 330 casos

Abstract Introduction: Deep neck infections are defined as suppurative infectious processes of deep visceral spaces of the neck. Objective: The aim of this study is to review different factors that may influence peritonsillar and deep neck infections and may play a role as bad prognosis predictors. Methods: We present a retrospective study of 330 patients with deep neck infections and peritonsillar infections who were admitted between January 2005 and December 2015 in a tertiary referral hospital. Statistical analysis of comorbidities, diagnostic and therapeutic aspects was performed with Excel and SPSS. Results: There has been an increase in incidence of peritonsilar and deep neck infections. Systemic comorbidities such as diabetes or hepatopathy are bad prognosis factors. The most common pathogen was S. viridans (32.1% of positive cultures). 100% of the patients received antibiotics and corticosteroids, 74.24% needed surgical treatment. The most common complications were mediastinitis (1.2%) and airway obstruction (0.9%). Conclusion: Systemic comorbidities are bad prognosis predictors. Nowadays mortality has decreased thanks to multidisciplinary attention and improvements in diagnosis and treatment.

Resumo Introdução: Infecções cervicais profundas são definidas como processos infecciosos supurativos dos espaços viscerais profundos do pescoço. Objetivo: Analisar diferentes fatores que podem influenciar as infecções peritonsilares e cervicais profundas que podem desempenhar um papel como preditores de mau prognóstico. Método: Apresentamos um estudo retrospectivo de 330 pacientes portadores de infecções cervicais profundas e de infecções peritonsilares admitidos entre janeiro de 2005 e dezembro de 2015 em um hospital terciário de referência. A análise estatística de comorbidades, aspectos diagnósticos e terapêuticos foi realizada utilizando-se os programas Excel e o SPSS. Resultados: Houve um aumento na incidência de infecções peritonsilares e infecções cervicais profundas. Comorbidades sistêmicas como diabetes ou doença hepática são fatores de mau prognóstico. O patógeno mais comum foi S. viridans (32,1% das culturas positivas). 100% dos pacientes receberam antibióticos e corticosteroides, e 74,24% necessitaram de tratamento cirúrgico. As complicações mais comuns foram mediastinite (1,2%) e obstrução das vias aéreas (0,9%). Conclusão: Comorbidades sistêmicas são preditores de mau prognóstico. Atualmente, a mortalidade diminuiu graças ao cuidado multidisciplinar e melhorias no diagnóstico e tratamento.

Solitary pigmented lesions in oral mucosa in Latin American children: A case series.

BACKGROUND: A variety of local and systemic processes caused exogenous and endogenous pigmentation of the oral mucosa. Solitary melanotic pigmentation is rare, hence the scarce number of studies in children and adolescents. METHODS: Clinical and histopathologic features of 10 Latin American children with solitary pigmented lesions of the oral mucosa were reviewed. RESULTS: The area most affected was the gingiva, followed by the palate. All lesions were flat and <1 cm in diameter. A brown color was observed in oral melanocytic macules and nevi. The exogenously pigmented lesion was bluish gray. Histopathology showed that the biopsied lesions corresponded to melanotic macules, junctional nevus, blue nevus, and exogenous pigmentation. CONCLUSION: Solitary pigmented lesions on the oral mucosa of children, from melanin pigment or exogenous pigment, may have a similar clinical presentation, but melanotic lesions such as oral melanotic macules and nevi can be differentiated from one another only with histopathologic examination.

Peritonsillar and deep neck infections: a review of 330 cases.

INTRODUCTION: Deep neck infections are defined as suppurative infectious processes of deep visceral spaces of the neck. OBJECTIVE: The aim of this study is to review different factors that may influence peritonsillar and deep neck infections and may play a role as bad prognosis predictors. METHODS: We present a retrospective study of 330 patients with deep neck infections and peritonsillar infections who were admitted between January 2005 and December 2015 in a tertiary referral hospital. Statistical analysis of comorbidities, diagnostic and therapeutic aspects was performed with Excel and SPSS. RESULTS: There has been an increase in incidence of peritonsilar and deep neck infections. Systemic comorbidities such as diabetes or hepatopathy are bad prognosis factors. The most common pathogen was S. viridans (32.1% of positive cultures). 100% of the patients received antibiotics and corticosteroids, 74.24% needed surgical treatment. The most common complications were mediastinitis (1.2%) and airway obstruction (0.9%). CONCLUSION: Systemic comorbidities are bad prognosis predictors. Nowadays mortality has decreased thanks to multidisciplinary attention and improvements in diagnosis and treatment.

Practical management of periprosthetic leakage in patients rehabilitated with a Provox® 2 voice prosthesis after total laryngectomy. / Manejo práctico de fugas periprótesis en pacientes rehabilitados con prótesis fonatorias tipo Provox®2 tras laringectomía total.

INTRODUCTION AND OBJECTIVES: Periprosthetic leakage of liquids is a common complication in patients rehabilitated with voice prostheses. Our objective was to describe and review the results of procedures for treating periprosthetic leakage. MATERIALS AND METHODS: This was a retrospective analysis of 41 patients rehabilitated with Provox® 2 voice prostheses between 1997 and 2015. We describe 3 techniques: periprosthetic silicon collar placement, injection of hyaluronic acid into the tracheoesophageal wall and the combination of the 2 techniques. We present a method to reduce the diameter of the tracheoesophageal fistula by removing the voice prosthesis and placing a nasogastric tube through the fistula. RESULTS: In the 3 groups treated with silicone collar (n=5, 13 procedures), hyaluronic acid injection (n=5, 9 procedures) and the combination of both techniques (n=3, 5 procedures), we observed an increase in prosthesis lifespan of an average of 56 days (range 7-118 days), 32 days (range 3-55 days) and 63 days (range 28-136 days), respectively. The tracheoesophageal fistula diameter reduction was performed in 100% (n=6) of patients. CONCLUSIONS: The use of silicone collars, injection of hyaluronic acid into the tracheoesophageal wall and the combination of both techniques for the treatment of periprosthesis leakage increase the lifespan of the prosthesis. Temporary prosthesis removal and placement of nasogastric tube has also been shown effective in our experience. These techniques are simple, inexpensive and reproducible, thereby reducing healthcare costs.

Surgical treatment of vestibular schwannoma. Review of 420 cases. / Tratamiento quirúrgico del schwannoma vestibular. Revisión de 420 casos.

INTRODUCTION AND OBJECTIVES: Vestibular schwannoma is the most frequent cerebellopontine angle tumor. The aim of our study is to reflect our experience in the surgical treatment of this tumor MATERIAL AND METHODS: Retrospective study of 420 vestibular schwannomas operated in our hospital between 1994-2014. We include tumor size, preoperative hearing, surgical approaches, definitive facial and hearing functional results, and complications due to surgery. RESULTS: A total of 417 patients with 420 tumors were analyzed, 209 female (50.1%) and 208 male (49.9%). Mean age at diagnosis was 49.8±13.2 years. The majority of the tumors were resected through a translabyrinthine approach (80.2%). Total tumor removal was achieved in 411 tumors (98.3%), and anatomic preservation of facial nerve in 404 (96.2%). Definitive facial nerve outcome was House-Brackmann grade I and II in 69.9%, and was significantly better in tumors under 20mm. Surgical complications included cerebrospinal fluid leakage in 3 patients (0.7%) and retroauricular subcutaneous collection in 16 (3.8%), 5 cases of meningitis (1.2%), 4 patients with intracraneal bleeding (0.9%), and death in 3 patients (0.7%). CONCLUSIONS: Surgery is the treatment of choice for vestibular schwannoma in the majority of patients. In our experience, the complication rate is very low and tumor size is the main factor influencing postoperative facial nerve function.

Does Intensive Glucose Control Prevent Cognitive Decline in Diabetes? A Meta-Analysis.

Diabetes mellitus is associated with cognitive decline and impaired performance in cognitive function tests among type 1 and type 2 diabetics. Even though the use of tight glucose control has been limited by a reported higher mortality, few reports have assessed the impact of treatment intensity on cognitive function. We conducted a meta-analysis to evaluate if an intensive glucose control in diabetes improves cognitive function, in comparison to standard therapy. We included 7 studies that included type 1 or type 2 diabetics and used standardized tests to evaluate various cognitive function domains. Standardized mean differences (SMDs) were calculated for each domain. We found that type 1 diabetics get no cognitive benefit from a tight glucose control, whereas type 2 diabetics get some benefit on processing speed and executive domains but had worse performances in the memory and attention domains, along with a higher incidence of mortality when using intensive glucose control regimes.

Management of vagal paragangliomas: review of 17 patients.

Vagal paragangliomas are very rare benign vascular tumors of neuroendocrine nature, and are much less frequent than carotid and jugulo-tympanic tumors. The goal of this retrospective study is to review the clinical and genetic findings, surgical treatment, and complications of vagal paragangliomas, as well as to discuss the management options. During the period 1990-2013, 17 patients with vagal paragangliomas were referred to our institution. There were ten patients with isolated tumors, and seven with multicentric paragangliomas. There were nine women and eight men. Mean age of patients was 51.4 years. Five cases had a positive family history of paraganglioma (29.4 %). Germline mutations of SDH genes were found in six of our patients (35.3 %). Many options were considered in the management of vagal paragangliomas. Surgical treatment was performed in 11 young patients (64.7 %) using different approaches: in 4 patients the tumor was resected through a transcervical approach; in 3 through a transcervical-transmandibular approach; in 1 it was resected using a transcervical-transmastoid approach, and in 3 a type A infratemporal fossa approach was performed. In all operated cases, the removal of the tumor led to sacrificing of the vagus nerve. Postoperative hypoglossal nerve deficit was reported in 4 cases (36.3 %). In six elderly patients (35.3 %), we decided to "wait-and-scan" in order to avoid creating greater morbidity than that of the tumor itself. Many factors should be considered in the treatment of vagal paragangliomas: the age and general condition of the patient, the biological behavior of the tumor, tumor size, genetic results, bilaterality, multicentricity, lower cranial nerve function, and of course the potential morbidity of the surgical treatment itself. Rehabilitation and, possibly surgery, are necessary to treat postoperative lower cranial nerve deficits.

Conservative management of vestibular schwannoma.

INTRODUCTION: Vestibular schwannoma (VS) is a benign, slow-growing tumour originating in the 8th cranial nerve. The treatment includes microsurgery, stereotactic radiotherapy and conservative management of tumours with periodic radiological tests. METHODS: This was a retrospective study of patients with VS following conservative management in a tertiary hospital between 1993 and 2013. A total of 73 patients were enrolled in our protocol. The mean age at diagnosis was 59.7 years. The average size was 11.9mm (4-27mm); 58.9% of the tumours were intracanalicular and 41.1%, extracanalicular. The mean follow-up period was 35.75 months. RESULTS: In 87.7% of patients there was no evidence of tumour growth. A total of 9 tumours (12.3%) increased in size. The average growth rate was 0.62mm/year. The percentage of extracanalicular tumours that grew (20%) was higher than that of intracanalicular tumours (7%). Seven patients (9.5%) experienced significant changes in their symptoms and 6 of these (8.2%) experienced a loss of useful hearing. Six patients (8.2%) left follow-up and underwent surgery. CONCLUSIONS: Periodic monitoring of vestibular schwannomas with magnetic resonance imaging represents an option for management, because most small tumours experience little or no growth over time.

Hyaluronic acid gel weight: a nonsurgical option for the management of paralytic lagophthalmos.

OBJECTIVES/HYPOTHESIS: Management of lagophthalmos should be a priority in the treatment of patients with facial palsy. The aim of the study was to evaluate the safety and efficacy of injecting hyaluronic acid gel into the upper eyelid as a nonsurgical alternative for patients with temporary facial palsy. METHOD/STUDY DESIGN: Retrospective study of 26 patients treated with hyaluronic acid gel injected into the pretarsal region of the upper eyelid. Measurements taken before and after treatment were standardized and compared using digitized photographs. Patients were followed up for 1 year, and overall outcomes were assessed. RESULTS: All patients initially demonstrated improvement in lagophthalmos, which decreased to 0.0 mm. After 1 month, a significant increase in lagophthalmos was observed in two patients (initial fissure of 8 and 9 mm), and a platinum weight was implanted to control keratopathy. The remaining patients (initial lagophthalmos below 6.5 mm) maintained the improvement until facial restoration. Only three patients had recurrent lagophthalmos (2 mm) due to resorption, which was resolved by injecting an additional 0.3 cc. The mean improvement in lagophthalmos was 4.6 mm (range, 3.5-6.5 mm). Complications included transient ecchymosis and minimal blepharoptosis due to nonreabsorption in five patients. These patients were successfully treated with hyaluronidase. CONCLUSIONS: Hyaluronic acid gel has proven effective in reducing paralytic lagophthalmos and controlling keratopathy in patients with temporary facial palsy, especially those with palpebral fissure with attempted closure no greater than 6.5 mm. Injection of hyaluronic acid gel is safe, quick, and easily performed. In addition, it is more cost-effective than surgery.