Orthodontic maxillary expansion and its effect on nocturnal enuresis.

A previous retrospective study of 10 children with varying degrees of nocturnal enuresis has shown that one side effect of rapid maxillary expansion (RME) is spontaneous reduction in bed-wetting at night. The aim of this prospective study was to analyze the effect of RME treatment (mean 2 weeks) in cases of chronic, long-standing nocturnal enuresis. Ten children, 8 to 13 years old, who had not responded to conventional medical treatment for bed-wetting, were referred from the pediatric department. Within 1 month of RME of 3 to 5 mm, 4 children were completely dry and 3 showed notable improvement. The results are encouraging, especially given the spontaneous recovery rate of about 15% per year. A reduction in nocturnal enuresis in children has also been reported after tonsillectomy. However, in this pilot study, no significant associations could be found between improvement in nocturnal enuresis and improvement in the nasal airway, age, amount of expansion, or nasopharyngeal dimension (measured on cephalograms).

Frey's syndrome: treatment with botulinum toxin.

Frey's syndrome, i.e. gustatory sweating on the cheek, is a fairly common embarrassment after parotid gland surgery. New surgical techniques have been proposed to avoid this complication, but are not widely in use. Hence, there is need for treatment of Frey's syndrome. All surgical and topical treatments have drawbacks. This study was set up in order to evaluate a recently described treatment. One hundred and two patients were interviewed after parotidectomy. Thirty-one of them had noticed gustatory sweating and 15 patients underwent Minor's starch iodine test before, and after, treatment with intracutaneous injections of botulinum toxin A (Botox, Allergan Inc., USA). Thirteen of the patients did not experience any gustatory sweating at follow-up (one to 13 months). Minor's starch test showed total disappearance of gustatory sweating in 12 of the 15 treated patients. The only side effect was a discreet, transitory affection of the orbicularis oris muscle in one patient. As this treatment is minimally invasive it could be an attractive treatment for Frey's syndrome if the effect is maintained. Complaints of local hypoaesthesia and pain were also common after parotid surgery.

Borreliosis as a cause of peripheral facial palsy: a multi-center study.

Borreliosis is known to be a common cause of peripheral facial palsy in Stockholm and its vicinity. The aim of the present study was to investigate the frequency and characteristics of borreliosis among patients with peripheral facial palsy in different parts of Sweden. All serological tests were performed in one laboratory. Ten Swedish Ear Nose and Throat clinics participated in a prospective 1-year study of patients seeking medical attention for acute peripheral facial palsy. Twenty-eight (6%) out of totally 446 patients fulfilled the criteria for the diagnosis of borreliosis. The frequency varied between 1 and 16% and was highest along the southeast coast of Sweden whereas no case was reported from the northern part of the country. Borreliosis was more common among children with facial palsy than among adults. The infection occurred during all seasons although it appears to be less frequent during the spring months. Only a minority of the borrelial patients had a history of a preceding tick bite or erythema migrans. The fairly low overall frequency of this secondary stage of borreliosis in the study may be a result of better knowledge of the disease and earlier treatment of its early manifestations. In Sweden's endemic areas borreliosis is a common cause of peripheral facial palsy, and therefore all patients with facial palsy in these regions should be examined for borrelial infection.

Peripheral facial palsy caused by the Borrelia spirochete.

Forty-three consecutive patients with peripheral facial palsy were examined to evaluate the incidence of facial palsy caused by the tick-borne Borrelia spirochete in a non-coastal area in the south of Sweden. Six (14%) of the patients were found to have a Borrelia infection. The incidence of Borrelia-induced facial palsy was 0.39/10,000 inhabitants, which is less than in neighbouring coastal areas but still high enough to cause serious concern when dealing with facial palsies. In contrast to Bell's palsy, a Borrelia infection can cause serious generalized illness if not properly treated. Negative Borrelia serology of the serum and the cerebrospinal fluid (CSF) and a normal CSF analysis did not exclude the Borrelia etiology. Tick bites, signs of polyneuropathy, meningeal symptoms and Borrelia-associated erythema proved to be important signs for the diagnosis.

Ramsay-Hunt syndrome in a preschool infant.

The Ramsay-Hunt syndrome affects mostly adults. The recovery of facial nerve function, according to recent literature, seems better than has been generally accepted. A small number of children with herpes zoster oticus have been reported. We describe a case of Ramsay-Hunt syndrome in a healthy 3 1/2-year-old girl. She still had an obvious facial palsy after 12 months. Three out of 6 reported children with herpes zoster oticus have had a slow recovery of the facial nerve function. This suggests a less favorable prognosis in children than in adults. Although not successful in this case, acyclovir should be tried early in the course of the disease.