Comparison between early and delayed facial nerve decompression in traumatic facial nerve paralysis - A retrospective study.

Purpose To study the intraoperative findings in case of early and delayed decompression of facial nerve paralysis and compare their results. Methods Retrospective data analysis of 23 cases of longitudinal temporal bone fracture with House-Brackmann grade V and VI facial nerve paralysis. All cases were thoroughly evaluated and underwent facial nerve decompression through the transmastoid approach. All cases were under regular follow-up till the date of manuscript submission. Results Clinical improvement of the facial nerve function was observed for early vs. delayed facial nerve decompression. In the early decompression group, facial nerve function improved to grade II in eight cases (80%) and grade III in two cases (20%), whereas in the delayed decompression group it improved to grade II in one case (7.70%), grade III in four cases (30.76%), grade IV in seven cases (53.84%), and grade V in one case (7.70%). Conclusions Early decompression of facial nerve provides better results than delayed decompression because it enables early expansion of the nerve.

Comparison between early and delayed facial nerve decompression in traumatic facial nerve paralysis - A retrospective study

ABSTRACT Purpose To study the intraoperative findings in case of early and delayed decompression of facial nerve paralysis and compare their results. Methods Retrospective data analysis of 23 cases of longitudinal temporal bone fracture with House-Brackmann grade V and VI facial nerve paralysis. All cases were thoroughly evaluated and underwent facial nerve decompression through the transmastoid approach. All cases were under regular follow-up till the date of manuscript submission. Results Clinical improvement of the facial nerve function was observed for early vs. delayed facial nerve decompression. In the early decompression group, facial nerve function improved to grade II in eight cases (80%) and grade III in two cases (20%), whereas in the delayed decompression group it improved to grade II in one case (7.70%), grade III in four cases (30.76%), grade IV in seven cases (53.84%), and grade V in one case (7.70%). Conclusions Early decompression of facial nerve provides better results than delayed decompression because it enables early expansion of the nerve.

Electromyographic study in patients with surgically treated facial fractures.

This study, using surface electromyography, analyzed the activity of the masseter muscles of 30 patients with facial bone fractures that were surgically treated. Evaluations were made before surgery and in the 7th, 30th, and 60th days after surgery. The value of each measure and the average of 3 maximum voluntary isometric contractions lasting 5 seconds each were registered, and statistical analyses were performed. Patients had a mean age of 31 years and an average of 1.33 fractures. They were grouped according to the type of fracture as follows: mandibular (50%), zygomatic complex (33%), maxilla (10%), and associated fractures (6.7%). There was a lower masseter activity in the preoperative period, when compared with normal values in all groups of fractures. There was a sharp drop in the masseter activity in the postoperative period of 7 days, and all groups showed recovery of activity in 60 days but still below the normal value referenced in the literature. The mean values of the masseter activity, in descending order, were from the zygomatic complex, mandibular, maxillary, and associated fractures. The unilateral mandibular fractures showed higher values than the bilateral fractures in most of the evaluations. There was a highly significant difference in the comparison of the evolution of the masseter activity on both sides, for mandibular and zygomatic complex fractures, and the pairwise comparison showed significant difference between most groups. It was concluded that facial fractures and surgical procedures had negative effects in the muscle activity as observed using electromyography.

Epidemiología y resultado estético funcional de la reducción de la fractura nasal / Epidemiology and aesthetic and functional outcome in nasal bone fracture reduction

Introducción: Las lesiones faciales traumáticas más frecuentes son las fracturas nasales debido a la prominencia de la pirámide nasal. Existe cierto consenso en que cuanto antes se intente su reducción más posibilidades existen de obtener un resultado exitoso. Objetivo: Describir epidemiológicamente y evaluar los resultados funcionales y estéticos de las fracturas. Material y método: Se revisaron las fichas clínicas de los pacientes para describir los datos epidemiológicos, se realizó la encuesta SNOT-22 para evaluar los resultados funcionales y una encuesta cualitativa para la percepción estética de las reducciones. Resultados: De un total de 42 pacientes, predominó el sexo masculino 6:1, la edad promedio fue de 34,4 años. El 83,3 por ciento de la reducciones se realizó en policlínico con anestesia local y el procedimiento se realizó en promedio 8,6 días posfractura. Sobre el resultado funcional destaca la obstrucción nasal posreducción en 43,6 por ciento con un puntaje SNOT-22 promedio de 46,9 puntos y el 47,62 por ciento> consideró su resultado estético como peor. Discusión: Consideramos el resultado estético funcional como no satisfactorio, por lo que no sería inadecuado realizar cirugía de rinoseptoplastía inmediata o diferida para mejorar el resultado.

Introduction: Nasal fractures are the most common facial injuries because ol the prominence of the nose. There is some consensus that the sooner you try their reduction more likely is a successful outcome. Aim: Epidemiologically describe and evaluate functional and aesthetic results of nasal fractures. Material and method: We reviewed the medical records of patients to describe the epidemiológical data, perform the SNOT-22 survey to evaluate the functional results and a qualitative survey for aesthetic perception of the reductions. Results: Of a total of 42 patients, males predominated 6:1, average age was 34.4 years. 83.3 percent of the reductions took place in clinic with local anesthesia and the procedure was performed on average 8.6 days post-fracture. With regard to functional outcome highlights only nasal obstruction after reduction of 43.6 percent with a SNOT-22 scoring average of 46.9 points and 47.62 percent of patients considered a worse cosmetic outcome. Discussion: We believe that the functional and aesthetic result is not satisfactory, so we would recommend a septorhinoplasty immediate or detened for better results.

Positive predictive values of selected clinical signs associated with skull base fractures.

BACKGROUND: The goal of this study was to determinate the positive predictive values of selected clinical signs for skull base fractures and associated intracranial lesions. EXPERIMENTAL DESIGN: Clinical and radiological data were collected prospectively for all patients with selected clinical signs of skull base fractures, and their admission criteria were: 1) recent head injury story; 2) presence of one or more of following clinical signs: unilateral or bilateral blepharohaematoma, bloody otorrhea, and Battle's sign. SETTING: Emergency service of a institutional hospital. PATIENTS: One hundred forty two patients with the selected clinical signs for skull base fracture. RESULTS: Frontal bone fractures were the most frequent in patients with selected clinical signs. Battle's sign (100%) and unilateral blepharohaematoma (90%) were the signs with higher positive predictive values for skull base fractures; bilateral blepharohaematoma (70%) and bloody otorrhea (70%) were those with less values. The positive predictive values of the selected signs for intracranial lesions (acute extradural haematoma, pneumocephalus, brain contusion, brain sweLling, and acute subdural haematoma) were: unilateral and bilateral blepharohaematoma with positive predictive values of 85% and 68%, respectively; Battle's sign was 66%; and bloody otorrhea was 46%. For patients at admission on the 13-15 Glasgow Coma Scale only, the positive predictive values for that intracranial lesions were: blepharohaematoma=78%; Battle's sign=66%; and bloody otorrhea=41%. CONCLUSIONS: Our data demonstrated that the selected signs of skull base fractures have high positive predictive values for the presence of skull fracture and intracranial lesions, even in those patients classified in the Glasgow Coma Scale between 13 and 15. This indicates that all patients with the selected clinical signs should be submitted to computerized tomography of skull and with bone window, with the aim to detect associated lesions.

Disfunción de los nervios craneales en pacientes con fractura de la base de cráneo / Dysfunction of cranial nerves in patients with skull base fractures

Se estudiaron de forma prospectiva 150 pacientes que ingresaron en el Hospital Militar Central "Dr. Carlos J. Finlay" en el período comprendido desde enero de 1994 a diciembre de 1996, con el diagnóstico de fractura de la base de cráneo y con el objetivo de profundizar en el conocimiento del comportamiento clínico de estos pacientes. De ellos, 121 fueron hombres y el 32 porciento se encontraba en las edades comprendidas de 15 a 29 años. El 86 porciento de los pacientes llegó al cuerpo de guardia con algún grado de trastorno de la conciencia. La otorragia y la cefalea estuvieron presentes en el 76,6 y 69,3 porciento respectivamente. Fueron afectados 53 lesionados con la toma de algún nervio craneal (35,3 porciento), y fue el nervio facial el más afectado (13,3 porciento). En las primeras 24 h se desarrolló el 30,5 porciento de estas secuelas, y aumentó hasta el 69, 4 porciento en la primera semana(AU),