Partial lesions of the intratemporal segment of the facial nerve: graft versus partial reconstruction.

OBJECTIVES: In cases of partial lesions of the intratemporal segment of the facial nerve, should the surgeon perform an intraoperative partial reconstruction, or partially remove the injured segment and place a graft? We present results from partial lesion reconstruction on the intratemporal segment of the facial nerve. METHODS: A retrospective study on 42 patients who presented partial lesions on the intratemporal segment of the facial nerve was performed between 1988 and 2005. The patients were divided into 3 groups based on the procedure used: interposition of the partial graft on the injured area of the nerve (group 1; 12 patients); keeping the preserved part and performing tubulization (group 2; 8 patients); and dividing the parts of the injured nerve (proximal and distal) and placing a total graft of the sural nerve (group 3; 22 patients). RESULTS: Fracture of the temporal bone was the most frequent cause of the lesion in all groups, followed by iatrogenic causes (p < 0.005). Those who obtained results lower than or equal to III on the House-Brackmann scale were 1 (8.3%) of the patients in group 1, none (0.0%) of the patients in group 2, and 15 (68.2%) of the patients in group 3 (p <0.001). CONCLUSIONS: The best surgical technique for therapy of a partial lesion of the facial nerve is still questionable. Among these 42 patients, the best results were those from the total graft of the facial nerve.

Brown tumor of the facial bones: case report and literature review.

Brown tumor, an uncommon focal giant-cell lesion, arises as a direct result of the effect of parathyroid hormone on bone tissue inpatients with hyperparathyroidism. The initial treatment involves the correction of hyperparathyroidism, which usually leads to tumor regression. We report a case of brown tumor of the right nasal fossa in a 71-year-old woman. The tumor had caused nasal obstruction and epistaxis. Laboratory evaluation revealed that the patient had primary hyperparathyroidism. Anatomicopathologic investigation revealed the presence of a giant-cell tumor We performed a partial parathyroidectomy, but the tumor in the right nasal fossa failed to regress. One year later we performed surgical resection of the lesion. The patient recovered uneventfully, and she remained asymptomatic and recurrence-free at the 1-year follow-up. Facial lesions with histologic features of a giant-cell tumor should be evaluated from a systemic standpoint. Hyperparathyroidism should always be investigated by laboratory tests because most affected patients are asymptomatic. Surgical resection of a brown tumor should be considered if the mass does not regress after correction of the inciting hyperparathyroidism or if the patient is highly symptomatic.

Caloric test as a predictor tool of postural control in CI users.

CONCLUSIONS: Balance was improved at 365 days after CI in all patients. Caloric test findings were important determinants of balance outcomes over a year after CI. Pre-operative vestibular assessment findings should be documented because postural recovery over time depends on this information. OBJECTIVE: To verify the importance of the caloric test as a pre-operative predictor tool of postural control after CI surgery. METHODS: Prospective observational study made with 24 post-lingual deafness patients who underwent unilateral CI surgery. Vestibular assessments: questionnaire assessing vertigo, caloric tests, rotary chair (RC) testing, and computerized dynamic posturography (CDP), were sequentially performed for all patients before and 60, 120, 180, and 365 days after CI. RESULTS: Thirteen patients (54.2%) reported dizziness before CI. At the end of the study, dizziness remained unchanged in one (7.7%) patient, ameliorated in 11 (84.6%), and worsened in one (7.7%). Baseline caloric tests identified 29.2% patients with normal reflexes, 33.3% with unilateral areflexia or hyporeflexia, 12.5% with bilateral hyporeflexia, and 25% with bilateral vestibular loss (BVL). Most patients exhibited objective improvements in postural stability. At 365 days, the CDP condition (particularly C5) and CS were higher for caloric tests responders at baseline than for those with BVL at baseline.

Distúrbios da Comunicação em Pacientes Pediátricos ­ um Algoritmo da Avaliação Audiológica / Communication Disorders in Pediatric Patients - An Algorithm of Audiological Evaluation

Introdução: Foi instituído Teste de Triagem Auditiva Neonatal Universal (TANU). Crianças podem passar no teste e apresentar surdez tardia ou progressiva ou, ainda, serem portadoras de perdas leves e moderadas que não são observadas. Objetivo: Através deste relato de caso, discutir os exames auditivos pertinentes em cada situação e a orientação dos profissionais de saúde que primeiramente recebem estes pacientes. Descrição do Caso: O caso mostra a importância da avaliação da audição para auxílio no diagnóstico. Paciente foi encaminhado por quadro de atraso de linguagem e hipótese de perda auditiva. Apresentava dificuldades na interação social e alterações comportamentais. Avaliação audiológica foi normal, sendo feito diagnóstico de transtorno de espectro autista (TEA). Comentários: Pacientes com atraso e dificuldades na comunicação podem ser difíceis de avaliar, visto que muitos dos exames auditivos são subjetivos e dependem da interação do examinador com a criança. O caso relatado mostra uma das várias situações com que os profissionais podem se deparar e revela quais são os exames adequados para uma avaliação auditiva apropriada.

Introduction: Universal Newborn Hearing Screening (UNHS) Test was instituted to detect cases with higher probability of hearing loss. Children may pass the test and have late or progressive deafness or even mild and moderate losses that are not observed. Objective: To discuss, through this report of case, the pertinent auditory exams in each situation and the orientation of the health professionals who first receive these patients. Case Description: The case shows the importance of hearing evaluation for diagnostic assistance. Case 1 was referred for language delay and hypothesis of hearing loss. He presented difficulties in social interaction and behavioral changes. Audiological evaluation was normal, being diagnosed as Autistic Spectrum Disorder (ASD). Comments: Patients with delayed communication may be difficult to assess, since many of the auditory exams are subjective and depend on the interaction of the examiner with the child. The reported case presents one of the several situations that professionals may face and reveals what examinations are appropriate for an adequate auditory assessment.

Grave complicação do tratamento de epistaxe: relato de caso / Severe complication in the treatment of epistaxis: a case report

Epistaxe é uma afecção muito comum, sendo geralmente autolimitada ou tratada com medidas mais conservadoras como compressão local, compressas frias, controle da pressão arterial, cauterização sob anestesia local (química ou termo-elétrica) ou tamponamento nasal anterior. Contudo, podem se apresentar como quadros graves e de difícil tratamento, sendo necessárias medidas mais agressivas como tamponamento nasal antero-posterior, ligadura arterial cirúrgica ou embolização. Apresentamos o caso de um paciente de 49 anos de idade que cursou com epistaxe de difícil controle e evoluiu com uma grave complicação relacionada ao tratamento realizado em outro serviço.