Orocutaneous fistulas of odontogenic origin presenting as a recurrent pyogenic granuloma

Orocutaneous fistulas, or cutaneous sinuses of odontogenic origin, are uncommon but often misdiagnosed as skin lesions unrelated to dental origin by physicians. Accurate diagnosis and use of correct investigative modalities are important because orocutaneous fistulas are easily confused for skin or bone tumors, osteomyelitis, infected cysts, salivary gland fistulas, and other pathologies. The aim of this study is to present our experience with a patient with orocutaneous fistulas of odontogenic origin presenting as recurrent pyogenic granuloma of the cheek, and to discuss their successful treatment.

The Reliability of the Transconjunctival Approach for Orbital Exposure: Measurement of Positional Changes in the Lower Eyelid

BACKGROUND: Lower eyelid incisions are widely used for the orbital approach in periorbital trauma and aesthetic surgery. In general, the subciliary approach is known to cause disposition of the lower eyelid by scarring the anterior lamella in some cases. On the other hand, many surgeons believe that a transconjunctival approach usually does not result in such complications and is a reliable method. We measured positional changes in the lower eyelid in blowout fracture repair since entropion is one of the most serious complications of the transconjunctival orbital approach. METHODS: To measure the positional changes in the lower eyelids, we analyzed preoperative and postoperative photographs over various time intervals. In the analysis of the photographs, marginal reflex distance 2 (MRD2) and eyelash angle were used as an index of eyelid position. Statistical analyses were performed to identify the significance in the positional changes. All patients underwent orbital reconstruction through a transconjunctival incision by a single plastic surgeon. RESULTS: In 42 blowout fracture patients, there was no statistical significant difference in the MRD2 and eyelash angle. Furthermore, there were no clinical complications, such as infection, hematoma, bleeding, or implant protrusion, during the follow-up periods. CONCLUSION: The advantages of the transconjunctival approach for orbital access include minimal scarring and a lower risk of eyelid displacement compared with other approaches. Based on these results, we recommend the transconjunctival approach for orbital exposure as a safe and reliable method.

New Treatment in Facial Nerve Palsy Caused by Sagittal Split Ramus Osteotomy of Mandible

A 25-years-old woman with mandibular prognathism underwent a mandibular setback by way of mandibular sagittal split ramus osteotomy (MSSRO). After 2 days of operation, she developed difficulty of closing her right eye. The blink reflex test and motor nerve conduction study of the right orbicularis oris muscle were revealed right facial neuropathy of unknown origin and House-Brackmann facial nerve grading system (HBFNGS) grade V. For treatment, we initially prescribed oral prednisolone and nimodipine including physical therapy. The samples consisted of 11 facial nerve palsy patients caused by MSSRO and were analysed about onset of facial nerve palsy, postoperative HBFNGS, final HBFNGS, treatment method and recovery time. At 10 weeks of treatment of nimodipine, she had completely regained normal function (HBFNGS grade I) of the right facial nerve. The clinical results lead to assume a fast recovery of facial nerve function by the nimodipine medication, whereas average time of recovery is 16.32 weeks in references. Despite of the limited one patient treated, the result was very promising with respect to a faster recovery of the facial nerve function. Considering the use of nimodipine treatment for peripheral facial nerve palsy following a surgical approach with an anatomically preserved nerve can be recommended.

Ultrasonographic measurement of the axillary recess thickness in an asymptomatic shoulder

PURPOSE: The purpose of this study was to measure the axillary recess (AR) thickness in an asymptomatic shoulder by using ultrasonography (US) and to analyze the factors affecting it. METHODS: We recruited 141 patients (52 males; 89 females; age, 57.7±9.9 years) with unilateral shoulder pain and performed US on the unaffected shoulder. Two physiatrists measured the AR thickness of the unaffected shoulder independently. All patients were examined in an upright sitting position with 90° shoulder abduction. The ultrasonographic transducer was placed longitudinally on the mid-axillary line and along the long axis of the humeral shaft. The factors affecting the AR thickness values were analyzed, and intra-class correlation coefficients were used for assessing the reproducibility of each measurement. RESULTS: The intrarater reliability values for the two physiatrists were 0.98 and 0.96, respectively. The inter-rater reliability of the mean AR thickness measurements was 0.91. The mean AR thickness in all subjects, males, and females was 2.8±0.6 mm, 3.1±0.6 mm, and 2.6±0.5 mm (P<0.01), respectively. No difference between the left and the right sides (males, P=0.086; females, P=0.535) or between the dominant and the non-dominant sides (males, P=0.173; female, P=0.244) was found. The AR thickness correlated positively with the height (r=0.313, P<0.01) and the weight (r=0.319, P<0.01). However, it did not correlate with the body mass index (r=0.152, P=0.077) or the age (r=-0.056, P=0.515). CONCLUSION: US measurements of the AR thickness in asymptomatic shoulders demonstrated excellent intrarater and inter-rater reliabilities. The AR thickness showed anatomical variation with sex, height, and weight.

Effect of Cerebral Motor Cortex Stimulation in Amyotrophic Lateral Sclerosis Model: A Preliminary Controlled Study

OBJECTIVE: To observe the effect of the depolarizing stimulation in amyotrophic lateral sclerosis (ALS) mouse model on the survival and behavioral performance. METHOD: Transgenic male mouse model of ALS at the age of 9~11 weeks were divided into sham control group (n=10) and stimulation group (n=9). Electrode was implanted in the motor cortex in left hemisphere. Movement thresholds (MT) were regularly checked. Half threshold of MT, unipolar, and continuous electrical stimulation (frequency, 50 Hz; pulse duration, 220micron s) was delivered through implanted electrode. Behavioral tests including Rota-rod and Paw-grip endurance were checked every day. RESULTS: Induction of symptom was delayed in 8 days in stimulation than sham control group. However, there was no significant difference in survival in both groups. Behavioral tests showed that stimulation group is significantly better than sham group in Rota-rod (11~15 weeks) and in grip endurance (11~14, 16 weeks). MT was always between 1.0 volt and 3.2 volt in sham group, however, MT was between 0.8 volt and 2.8 volt in stimulation group. MT was jumped up around the time of death in both groups. CONCLUSION: Electrical stimulation is considered to be one of possible trial methods in ALS model. However, parameters of the stimulation in the experiment should be modified for better results.

The Effect of Functional Electrical Stimulation on the Motor Function of Lower Limb in Hemiplegic Patients

OBJECTIVE: To investigate the effect of functional electrical stimulation (FES) on the motor function of lower limb in hemiplegic patients with stroke or brain injury. METHOD: Fifty subjects (age, 56.66+/-9.85 years old; prevalence duration, 113.49+/-79.94 days after stroke or brain injury) were assigned randomly to 1 of 2 groups; the experimental group (n=25) received conventional rehabilitation with FES and the control group (n=25) received conventional rehabilitation without FES. FES was applied 20 minutes concomitant with rehabilitation, 5 days per week for 4 weeks. Outcome measurements included muscle strength, modified Ashworth scale, Brunnstrom stage, motricity index, 10 meter walking test (10 MWT), and circumference ratios of lower extremity (including thigh and calf). Subjects were evaluated before treatment and at 4 weeks after treatment. RESULTS: No significant differences were found in the baseline measurements. After 4 weeks of treatment, there was significant improvement in thigh circumference ratio and 10 MWT in the FES group, when compared with the control group (p<0.05). CONCLUSION: Twenty sessions of FES, applied to postacute stroke or brain injured patients plus conventional rehabilitation, improved their motor and walking ability.

Effects of Decompressive Craniectomy for the Management of Patients with Refractory Intracranial Hypertension

OBJECTIVE: The beneficial effect of decompressive craniectomy in the treatment of patients with uncontrolled intracranial hypertension is controversial. We conducted this study to evaluate the efficacy of decompressive craniectomy in patients with refractory intracranial hypertension. METHODS: We retrospectively investigated 38 patients who underwent decompressive craniectomy as the treatment of increased intracranial pressure in our hospital from October 1999 to March 2002. The causes of intracranial hypertension were traumatic brain injury(28 cases), cerebrovascular disease(8 cases), and tumor(2 cases). Age, Glasgow Coma Scale at admission, preop and postop, intracranial pressure and findings on Computed Tomography before and after decompressive craniectomy, and finally Glasgow Outcome Scale at 6 months after surgery were evaluated. RESULTS: Favorable outcome(good or moderate disability) was 39%(15 of 38 patients) and poor outcome(severe disability, vegetative state or death) was 61%(23 of 38 patients). Overall mortality rate was 47%(18 of 38 patients). After decompressive craniectomy, statistically significant decrease in intracranial pressure and improvement of midline shifting were observed. Two important prognostic factors in our study were neurological status before surgery and findings in follow-up brain CT after decompressive craniectomy. CONCLUSION: Decompressive craniectomy for the refractory intracranial hypertension is an effective strategy to decrease intracranial pressure. So it may contribute to improve the patient's outcome. But it is necessary to conduct the multi-institutional randomized prospective study to determine whether the decompressive craniectomy actually improves the patient's outcomes or not.

Cavernous Malformation after Radiation Therapy for Pilocytic Astrocytoma: Case Report

We report a case of de novo development of cavernous malformation after cranial irradiation. The patient was a 19-year-old male who had been operated on 10 years ago for cerebellar pilocytic astrocytoma. After subtotal tumor removal, he had received cranial irradiation for the residual tumor. He was readmitted for extraocular muscle palsy, dysarthria and facial weakness about 10 years after operation and irradiation. Magnetic resonance imaging of the brain showed an abnormal mixed signal lesion in the lower pons and pontomedullary junction. The patient underwent surgical removal of the hematoma in the pons and the cavernous malformation was identified.