ABSTRACT
Trismus is commonly caused by temporomandibular joint disorders and maxillofacial fractures. We report the case of a 62-year-old woman with trismus and difficulty in mastication caused by bilateral mandibular fractures. She had a maximal interincisal opening distance (MID) of 22 mm. Mouth-opening training was administered using a novel dental mouth-training device custom-made using ethylene vinyl acetate sheets and according to the dentition and extent of mouth-opening of the patient. After 2 months of training, the MID increased to 42 mm. With adequate training, this device is effective in treating trismus due to scarring.
Subject(s)
Brain Ischemia/prevention & control , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnostic imaging , Catheterization, Central Venous/methods , Intraoperative Complications/prevention & control , Plaque, Atherosclerotic/complications , Plaque, Atherosclerotic/diagnostic imaging , Stroke/prevention & control , Aged , Aged, 80 and over , Carotid Arteries/diagnostic imaging , Catheterization, Central Venous/adverse effects , Female , Humans , Jugular Veins/diagnostic imaging , Male , Middle Aged , UltrasonographyABSTRACT
STUDY DESIGN: Retrospective study of C5 palsy after laminoplasty for cervical myelopathy. OBJECTIVE: The objectives of this study were to investigate the morphologic characteristic of C5 palsy patients undergoing cervical laminoplasty with the intraoperative motor-evoked potential (MEP). SUMMARY OF BACKGROUND DATA: A study reported prophylactic foraminotomy for C5 paralysis after laminoplasty for cervical myelopathy. However, no indications have been established. There have been few reports on the intraoperative monitoring of the C5 palsy. This palsy is reported to happen a few days after the surgery in many cases, and the possibility of its detection by intraoperative spinal cord monitoring is unclear. METHODS: Of 153 patients with cervical myelopathy, 9 showed a decrease in upper muscle strength by 1 grade or more by postoperative manual muscle test. Of the 9 patients, 4 patients underwent segmental monitoring of upper limbs by MEP and were included in the paralysis group. Of the 153 patients, 74 (444 muscles) in whom both preoperative and postoperative manual muscle test of the upper limbs showed grade 5, and in whom the MEP monitoring of all these muscles was performed, were included in the nonparalysis group. We investigated the presence of intraoperative changes in 4 MEP parameters: amplitude, latency, duration, and waveform pattern, and the presence of foraminal stenosis in the cross-sectional view of preoperative myelographic computed tomography. RESULTS: In the paralysis group (9 muscles) and nonparalysis group (444 muscles), delay in latency was not observed in any muscle (0% and 0%), and 50% or more reduction of amplitude in 1 muscle (11%) and 22 (5%), prolongation of duration in 1 (11%) and 6 (1%), changes of waveform pattern in 3 (33%) and 40 (9%), and foraminal stenosis in 5 (56%) and 80 (18%), respectively. CONCLUSIONS: In the paralysis group, the incidences of waveform pattern change on intraoperative MEP and stenosis of the intervertebral foramen were higher than those in the nonparalysis group.
