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1.
BMJ Case Rep ; 20182018 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-30042100

RESUMO

Foreign bodies cause a remarkable number of otolaryngological emergency visits and occasionally result in life-threatening conditions and later-emerging complications. Patient recovery depends on the detection and proper extraction of all foreign materials. Despite various obtainable diagnostic tools, adequate anamnesis forms the basis of clinical reasoning and should direct later examinations and radiological imaging. This case report describes a challenging patient with a unique trauma mechanism: many pieces of a fragmented organic foreign body emerged within 1 year of the initial injury, leading to repeated operations, a long period in an intensive care unit and a long-term swallowing and speech dysfunction.


Assuntos
Abscesso/diagnóstico por imagem , Traumatismos dos Nervos Cranianos/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Infecções por Klebsiella/diagnóstico por imagem , Lesões do Pescoço/diagnóstico por imagem , Abscesso/complicações , Abscesso/tratamento farmacológico , Abscesso/cirurgia , Idoso , Traumatismos dos Nervos Cranianos/complicações , Traumatismos dos Nervos Cranianos/tratamento farmacológico , Traumatismos dos Nervos Cranianos/cirurgia , Diagnóstico Diferencial , Corpos Estranhos/complicações , Corpos Estranhos/tratamento farmacológico , Corpos Estranhos/cirurgia , Humanos , Infecções por Klebsiella/complicações , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/cirurgia , Klebsiella pneumoniae/isolamento & purificação , Imagem por Ressonância Magnética , Masculino , Lesões do Pescoço/complicações , Lesões do Pescoço/tratamento farmacológico , Lesões do Pescoço/cirurgia , Tomografia Computadorizada por Raios X
2.
Clin Neurol Neurosurg ; 165: 50-54, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29306766

RESUMO

OBJECTIVES: Both traumatic orbital apex syndrome (OAS) and traumatic superior orbital fissure syndrome (SFOS) are rare conditions after craniofacial injury. Few types of researches investigate the difference in clinical characteristics and outcome between them. We describe clinical features and cranial nerves functional recovery of traumatic OAS or SOFS and to discuss surgical decompression of these patients. PATIENTS AND METHODS: A retrospective study was performed of 15 patients diagnosed with traumatic OAS and 39 patients with traumatic SOFS from July 2010 to July 2017 in our hospital. The initial status and functional recovery of cranial nerve were evaluated based on visual perception and extraocular muscle movement. The average follow-up period was 11.8 months. RESULTS: 41 males' and 13 females' patients with a mean age of 38.3 years were included. 12 patients were diagnosed with internal carotid artery injury. In the OAS group, there is no visual recovery of those 10 totally blindness patients and only 5 functional recovery patients at 6-months follow up. No visual dysfunction occurred in the SOFS group. Cranial nerves Ⅲ, Ⅳ, and Ⅵ function recovery were better in the SOFS group than in the OAS group. CONCLUSION: Patients with OAS might undergo more severe cranial nerves injury and worse functional recovery. Due to the occurrence of internal carotid artery injury, CTA or DSA are recommended. Surgical decompression should be considered when there is evidence of optical canal fracture or bone fragment impingement of the superior orbital fissure.


Assuntos
Traumatismos dos Nervos Cranianos/cirurgia , Nervos Cranianos/cirurgia , Órbita/lesões , Órbita/cirurgia , Adulto , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Síndrome , Resultado do Tratamento
3.
Biomed Res Int ; 2017: 8640908, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29259989

RESUMO

Objective: Traumatic orbital apex syndrome (TOAS) is a rare disease characterized by the damage of cranial nerves (CNs) II, III, IV, and VI. The aim of our study was to analyze the functional recovery of CNs in TOAS and discuss the management of these patients. Methods: We retrospectively reviewed 28 patients with TOAS treated in the Department of Neurosurgery, Shanghai Changzheng Hospital from February 2006 to February 2016. Functional recovery of CNs was evaluated based on extraocular muscle movement and visual perception. Follow-up duration was at least 6 months. Results: There were 26 males and 2 females with a mean age of 35.3 years. The most common cause of TOAS was traffic accident. CN IV suffered the lightest injury among CNs III, IV, and VI. CN II achieved obvious improvement at 3-month follow-up, while other CNs enjoyed evident improvement at 6-month follow-up. There was no significant difference between conservative treatment and surgical decompression. Conclusion: CNs passing through orbital apex region might recover to different degrees several months after proper management. Clinical decision should be individualized and surgical decompression could be considered with evidence of fracture, hematoma, or deformation.


Assuntos
Traumatismos dos Nervos Cranianos/fisiopatologia , Nervos Cranianos/fisiopatologia , Fraturas Ósseas/fisiopatologia , Recuperação de Função Fisiológica , Adolescente , Adulto , Criança , China , Traumatismos dos Nervos Cranianos/cirurgia , Nervos Cranianos/cirurgia , Descompressão Cirúrgica , Feminino , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Córtex Pré-Frontal/fisiopatologia , Córtex Pré-Frontal/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
4.
Laryngoscope ; 127(7): 1525-1530, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-27859300

RESUMO

OBJECTIVES/HYPOTHESIS: Cranial nerve transection during head and neck surgery is conventionally repaired by microsuture reanastomosis. Laser nerve welding (LNW), using CO2 laser to spot-weld the epineurium of transected nerve endings, has been shown in animal models to be a novel alternative to microsuture repair. This method avoids needle/suture material and minimizes instrumentation of the nerve. We hypothesized that potassium titanyl phosphate (KTP) laser would be superior to CO2 laser in repairing transected nerves. Using a rat posterior tibial nerve injury model, we compared CO2 laser, KTP laser, and microsuture reanastomosis. STUDY DESIGN: Animal study. METHODS: Animals underwent unilateral posterior tibial nerve transection. The injury was repaired by microsuture repair (n = 15), CO2 laser repair (n = 15), or KTP laser repair (n = 15). Weekly walking tracks were performed to measure functional recovery. Nerve segments were harvested for axon counting. RESULTS: At 6 weeks, the KTP LNW had the best functional recovery (92.4 ± 8.6%) compared to microsuture repair (84.5 ± 10.2%, difference 7.9%, 95% confidence interval [CI]: 0.84%-14.96%). CO2 laser repair had a functional recovery of 86.8 ± 11.2%. KTP LNW had better axon recovery compared to transection/repair (difference 530.7 axons, 95% CI: 329.9-731.5). Operative time for the microsuture repair was 18.2 ± 6.8 minutes, compared to 5.8 ± 3.7 minutes for the LNW groups (difference 12.4 minutes, 95% CI: 8.6-16.2 minutes). CONCLUSIONS: KTP, CO2 , and microsuture repair all showed good functional recovery following complete transection of the posterior tibial nerve. Following complete nerve transection during head and neck surgery, KTP LNW may be a novel alternative to microsuture repair. LEVEL OF EVIDENCE: NA Laryngoscope, 127:1525-1530, 2017.


Assuntos
Traumatismos dos Nervos Cranianos/cirurgia , Modelos Animais de Doenças , Complicações Intraoperatórias/cirurgia , Terapia a Laser/métodos , Lasers de Gás/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Microcirurgia/métodos , Animais , Masculino , Regeneração Nervosa/fisiologia , Ratos , Ratos Sprague-Dawley , Nervo Tibial/lesões , Nervo Tibial/cirurgia
5.
BMJ Case Rep ; 20142014 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-25139921

RESUMO

Patients affected by facial palsy suffer from failure to fully close the eyelids; the resulting eye exposure can lead to dry eye syndrome, loss of epithelial integrity, corneal ulceration and infections. Corneal anaesthesia exacerbates risk of corneal damage in these patients. Eyelid paralysis-associated corneal lesions may induce severe visual impairment, for which the ideal treatment is corneal transplantation, a procedure contraindicated in patients with corneal sensitivity and inadequate eyelid closure. We present the case of a patient affected by unilateral facial palsy associated with corneal anaesthesia, due to seventh and fifth cranial nerve damage following homolateral eighth cranial nerve surgery. The patient underwent surgery to re-establish eyelid and corneal competence, and then received a corneal graft with consequent amelioration of visual acuity. This is the first case of associated corneal anaesthesia and facial palsy that was comprehensively treated with a set of surgical procedures, including a corneal transplant.


Assuntos
Córnea/cirurgia , Doenças da Córnea/cirurgia , Transplante de Córnea , Traumatismos dos Nervos Cranianos/cirurgia , Pálpebras/cirurgia , Paralisia Facial/cirurgia , Transferência de Nervo , Córnea/patologia , Doenças da Córnea/etiologia , Traumatismos dos Nervos Cranianos/complicações , Nervos Cranianos/cirurgia , Pálpebras/patologia , Paralisia Facial/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Acuidade Visual
6.
Rev. chil. neurocir ; 40(1): 37-41, jul. 2014. ilus
Artigo em Inglês | LILACS | ID: biblio-831381

RESUMO

La lesión de los nervios craneales es un acompañamiento común de un trauma en la cabeza. Lesiones de los nervios craneales asociados con la lesión cerrada de la cabeza ha sido encontrado para ser asociado con una mayor gravedad de la lesión. Los objetivos de este estudio son documentar la incidencia de lesiones de los nervios craneales en lesiones en la cabeza, que se correlaciona con la incidencia de los hallazgos radiológicos, para evaluar el tiempo de recuperación con respecto a los signos y síntomas en la presentación inicial. Se presenta un caso de un varón de 51 años de edad, con lesiones nerviosas del segundo, sexto, séptimo, octavo, noveno y décimo después de una lesión grave en la cabeza. Lo admitieron a la víctima con un historial de conducir una motocicleta utilizando un casco y con una caída a alta velocidad. Su Resonancia Magnética (RM) presenta contusión en el tronco cerebral y su tomografía computarizada (TC) simple mostró pequeña hemorragia a la derecha del tronco cerebral y el paciente fue tratado de forma conservadora. Por otra parte, si se detectan múltiples lesiones de los nervios craneales hay una necesidad de evaluar más a fondo la lesión del tronco cerebral por RM con el fin de evaluar mejor el tronco cerebral. La mayoría de las lesiones de los nervios craneales pueden recibir tratamento conservador, aunque algunos autores indican intervención quirúrgica temprana para el tratamiento de la parálisis facial con fractura a través del canal facial.


Injury to the cranial nerves is a common accompaniment of head trauma. Cranial nerve injuries associated with closed head trauma has been found to be associated with injuries of a higher severity. The incidence of cranial nerve injury in head trauma varies in the literature, ranging from 5 to 23 percent. The objectives of this study are: to document the incidence of cranial nerve injuries in head trauma; to correlate the incidence with radiological findings and to assess recovery time according with signs and symptoms at initial presentation. We report a case of a 51-year-old male having second, sixth, seventh, eighth, ninth and tenth nerve injuries after severe head trauma. He was admitted after an accident with a history of riding a motorcycle wearing a helmet and falling at high speed. Study by Magnetic Resonance Imaging (MRI) of this case presented stem contusion and a plain Computerized Tomography (CT) showed small hemorrhage on the right of the brain stem. The patient was managed conservatively. Multiple cranial nerve palsies after head injury may not carry a bad prognosis as previously thought, and may be reversible. Moreover, if multiple cranial nerve injuries are detected, a better evaluation of the stem brain is needed by MRI in order to evaluate possible lesions in this site. The majority of the cranial nerve injuries are treated conservatively, although some authors indicate early surgical intervention to treat facial palsy with fracture through the facial canal.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Acidentes por Quedas , Acidentes de Trânsito , Hemorragia do Tronco Encefálico Traumática , Traumatismos Cranianos Fechados/complicações , Traumatismos dos Nervos Cranianos/cirurgia , Traumatismos dos Nervos Cranianos/diagnóstico , Traumatismos dos Nervos Cranianos , Espectroscopia de Ressonância Magnética , Tomografia Computadorizada por Raios X
7.
J Craniofac Surg ; 24(6): 2044-6, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24220401

RESUMO

Typical associated signs and symptoms of displaced zygomatic fractures include lack of zygoma projection, diplopia, and sensory disturbances of the infraorbital nerve (ION). The aim of this article was to assess eventual associations between ION sensory disturbances and zygomatic fractures patterns. This study is based on 2 databases that have continuously recorded patients hospitalized with maxillofacial fractures in 2 Departments of Maxillofacial Surgery in Amsterdam, The Netherlands, and Turin, Italy between 2001 and 2010. The following data for patients surgically treated for displaced zygomatic fractures were considered: gender, age, site and severity of facial fractures, etiology, and presenting symptoms. Statistically significant associations were found between ION sensory disturbances and assaults (P = 0.007) and sport accidents (P = 0.00003), as well as between ION sensory disturbances and isolated zygomatic fractures (P = 0.000002) and between ION sensory disturbances and diplopia (P = 0.00009).The severity of injury and the absorption of middle-energy and high-energy forces by the zygomatic complex only were associated with ION sensory disturbances. The etiology and severity of the injury as well as the presence of associated symptoms should be thoroughly investigated when a zygomatic fracture is suspected.


Assuntos
Traumatismos dos Nervos Cranianos/cirurgia , Nervo Maxilar/lesões , Fraturas Zigomáticas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Traumatismos dos Nervos Cranianos/diagnóstico , Traumatismos dos Nervos Cranianos/etiologia , Feminino , Humanos , Escala de Gravidade do Ferimento , Itália , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Retrospectivos , Adulto Jovem , Fraturas Zigomáticas/diagnóstico , Fraturas Zigomáticas/etiologia
9.
J Neurosurg Pediatr ; 8(6): 588-92, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22132917

RESUMO

OBJECT: A large volume of patients presented to a Level I pediatric trauma center during and after a recent tornado disaster. Injuries of the central and peripheral nervous systems and the medical responses of a pediatric neurosurgical team are reviewed. METHODS: The clinical courses of patients who suffered cranial, spinal, and peripheral nerve injuries due to the tornado storm are reported. The clinical actions taken by the neurosurgical team during and after the event are reviewed and the lessons learned are discussed. RESULTS: The tornado storm system moved through the Tuscaloosa and Birmingham metropolitan areas on the early evening hours of April 27, 2011. Twenty-four patients received care from the neurosurgical team. A total of 11 cranial (including placement of an external ventricular drain), 2 spine, and 2 peripheral procedures were performed for the victims. Nine procedures were performed within the first 12 hours of the event, and an additional 6 surgeries were performed in the following 24 hours. Injuries of the peripheral nervous system often presented in a delayed fashion. Several key components were identified that enabled adequate neurosurgical care for a large influx of acute patients. CONCLUSIONS: Massive casualties due to tornados are rare. A well-organized physician team working with the hospital administration may decrease the mortality and morbidity of such events.


Assuntos
Traumatismos dos Nervos Cranianos/cirurgia , Desastres , Neurocirurgia , Traumatismos dos Nervos Periféricos/cirurgia , Traumatismos da Coluna Vertebral/cirurgia , Tornados , Alabama , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Procedimentos Neurocirúrgicos/métodos , Centros de Traumatologia
10.
Rev. bras. cir. plást ; 26(4): 591-595, out.-dez. 2011. tab
Artigo em Português | LILACS | ID: lil-618236

RESUMO

INTRODUÇÃO: A paralisia facial é a perda temporária ou permanente dos movimentos da mímica facial em decorrência do acometimento do nervo facial. São vários os fatores que influenciam a evolução das lesões do nervo facial. Este estudo teve como objetivo avaliar os aspectos epidemiológicos e a frequência de sequelas após paralisia facial em um serviço de reabilitação. MÉTODO: Estudo retrospectivo dos pacientes com paralisia facial atendidos em hospital de reabilitação no período de janeiro de 2001 a janeiro de 2005. As sequelas foram avaliadas quanto a sexo, idade, etiologia, graduação funcional conforme a escala de House-Brackmann, tempo de evolução, seguimento e intervenções cirúrgicas. Para realização da análise estatística utilizou-se o programa Epi-Info versão 3.2.2. RESULTADOS: Foram admitidos para programa de reabilitação 285 pacientes portadores de paralisia facial, sendo 157 do sexo masculino e 128 do feminino. Todos os pacientes se submeteram a programa de reabilitação e 29 (10,2 por cento), a cirurgia. Dentre os pacientes analisados, 80 por cento foram admitidos a partir da terceira semana do surgimento da paralisia, e 121 (42,5 por cento) tiveram recuperação gradual em 3 meses, espontaneamente, com tratamento clínico ou fisioterápico. Por outro lado, 119 (41,8 por cento) pacientes permaneceram com paralisia facial parcial ou completa e irreversível. CONCLUSÕES: Os casos admitidos foram mais frequentes em pacientes com menos de 20 anos de idade, com causas diversas e quando admitidos em graus menores segundo a escala de House-Brackmann, pois muitos deles se associavam a déficits neurológicos consequentes a paralisia facial de origem central ou congênita.


BACKGROUND: Facial paralysis is characterized by permanent or temporary loss of facial expression due to facial nerve injury. Several factors influence the development of facial nerve lesions. The purpose of this study was to evaluate the epidemiological aspects and incidence of sequelae after facial paralysis at a rehabilitation institution. METHODS: We performed a retrospective study of facial paralysis patients admitted to a rehabilitation hospital between January 2001 and January 2005. Sequelae were analyzed according to gender, age, etiology, functional status as measured by the House-Brackmann scale, evaluation time, follow-up, and surgical procedures. Statistical analyses were performed with Epi-info 3.2.2 software. RESULTS: A total of 285 facial paralysis patients, 157 male and 128 female, were admitted for a rehabilitation program. All subjects followed a rehabilitation program, and 29 (10.2 percent) underwent surgery; 80 percent were admitted during the 3rd week of the paralysis or later, and 121 (42.5 percent) showed gradual recovery after 3 months, either spontaneously or after clinical or physical therapies. Nevertheless, 119 (41.8 percent) sustained irreversible partial or complete facial paralysis. CONCLUSIONS: The prevalence of facial paralysis was greater among patients younger than 20 years. Among these patients, paralysis had different causes, and these patients were admitted with lower House-Brackmann grades. Most cases were associated with neurological deficits leading to facial paralysis of central or congenital origin.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Estudos Epidemiológicos , Traumatismos Faciais , Doenças do Nervo Facial , Hospitalização , Nervo Facial/cirurgia , Paralisia Facial/reabilitação , Traumatismos dos Nervos Cranianos/cirurgia , Traumatismos dos Nervos Cranianos/reabilitação , Métodos , Paralisia , Pacientes , Estudos Retrospectivos
13.
J Oral Maxillofac Surg ; 69(9): 2284-8, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21550706

RESUMO

PURPOSE: There is little information available on the long-term effects on patients of permanent involvement of the inferior alveolar or lingual nerve because of dental treatment. This study has attempted to document this information from patients who were reviewed between 3 and 9 years after injury. MATERIALS AND METHODS: All patients with an ICD-9 diagnosis of 951.2 (injury to the trigeminal nerve) because of dental treatment, seen in the Oral and Maxillofacial Surgery Clinic at the University of California, San Francisco between January 1, 2001 and December 31, 2006, were contacted in an attempt to complete a telephone survey of long-term effects. RESULTS: Of the 727 patients who were eligible for the study, 145 patients (95 female and 50 male) completed the telephone surveys. Many patients had sought both conventional and alternative treatments after consultation at University of California, San Francisco. A small number of patients had undergone subsequent surgery elsewhere. Many patients reported significant life changes, including adverse effects on employment (13%), relationship changes (14%), depression (37%), problems speaking (38%), and problems eating (43%). In general, however, patients reported improvement over time, often using a number of different coping mechanisms. Males had a greater decrease in symptoms than females, and those older than 40 years reported more pain in the long term than those under 40. Lingual nerve symptoms improved more than inferior alveolar nerve symptoms. CONCLUSIONS: Although most patients continue to have long-term problems that affect the overall quality of life, for most patients there has been improvement in symptoms over time.


Assuntos
Traumatismos dos Nervos Cranianos/etiologia , Traumatismos do Nervo Lingual , Procedimentos Cirúrgicos Bucais/efeitos adversos , Parestesia/etiologia , Traumatismos do Nervo Trigêmeo , Adaptação Psicológica , Adulto , Fatores Etários , Traumatismos dos Nervos Cranianos/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Qualidade de Vida , São Francisco , Fatores Sexuais , Inquéritos e Questionários , Resultado do Tratamento
16.
Artigo em Inglês | MEDLINE | ID: mdl-21084201

RESUMO

This article presents a simple deroofing technique to retrieve a broken endodontic file lodged in the mandibular canal and causing dysesthesia with pain. Many unsuccessful attempts were made to retrieve the broken instrument. The deroofing technique described is simple, requiring local anesthesia and done on an outpatient basis with minimum morbidity. A brief review of the literature on dysesthesia of the inferior alveolar nerve caused by endodontic materials is also presented.


Assuntos
Traumatismos dos Nervos Cranianos/cirurgia , Instrumentos Odontológicos/efeitos adversos , Corpos Estranhos/cirurgia , Mandíbula/cirurgia , Preparo de Canal Radicular/efeitos adversos , Traumatismos do Nervo Trigêmeo , Traumatismos dos Nervos Cranianos/etiologia , Falha de Equipamento , Feminino , Corpos Estranhos/complicações , Humanos , Pessoa de Meia-Idade , Osteotomia/métodos , Dor/etiologia , Dor/cirurgia , Preparo de Canal Radicular/instrumentação , Transtornos das Sensações/etiologia , Transtornos das Sensações/cirurgia , Resultado do Tratamento
18.
Injury ; 41(9): 918-23, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20399426

RESUMO

OBJECTIVE: To discuss the epidemiology, diagnosis and surgical treatment of cranial nerve injury following traumatic brain injury (TBI) for the sake of raising the clinical treatment of this special category of TBI. PATIENTS AND METHODS: A retrospective analysis was made of 312 patients with cranial nerve injury among 3417 TBI patients, who were admitted for treatment in this hospital. RESULTS: A total of 312 patients (9.1%) involving either a single nerve or multiple nerves among the 12 pairs of cranial nerves were observed. The extent of nerve injury varied and involved the olfactory nerve (66 cases), optic nerve (78 cases), oculomotor nerve (56 cases), trochlear nerve (8 cases), trigeminal nerve (4 cases), abducent nerve (12 cases), facial nerve (48 cases), acoustic nerve (10 cases), glossopharyngeal nerve (8 cases), vagus nerve (6 cases), accessory nerve (10 cases) and hypoglossal nerve (6 cases). Imaging examination revealed skull fracture in 217 cases, complicated brain contusion in 232 cases, epidural haematoma in 194 cases, subarachnoid haemorrhage in 32 cases, nasal cerebrospinal fluid (CSF) leakage in 76 cases and ear CSF leakage in 8 cases. Of the 312 patients, 46 patients died; the mortality rate associated with low cranial nerve injury was as high as 73.3%. Among the 266 surviving patients, 199 patients received conservative therapy and 67 patients received surgical therapy; the curative rates among these two groups were 61.3% (122 patients) and 86.6% (58 patients), respectively. CONCLUSION: TBI-complicated cranial nerve injury is subject to a high incidence rate, a high mortality rate and a high disability rate. Our findings suggest that the chance of recovery may be increased in cases where injuries are amenable to surgical decompression. It is necessary to study all 12 pairs of cranial nerves systematically. Clinically, it is necessary to standardise surgical indications, operation timing, surgical approaches and methods for the treatment of TBI-complicated cranial nerve injury.


Assuntos
Lesões Encefálicas/cirurgia , Traumatismos dos Nervos Cranianos/cirurgia , Descompressão Cirúrgica/métodos , Adolescente , Adulto , Lesões Encefálicas/complicações , Lesões Encefálicas/epidemiologia , Criança , China/epidemiologia , Traumatismos dos Nervos Cranianos/complicações , Traumatismos dos Nervos Cranianos/epidemiologia , Feminino , Escala de Coma de Glasgow , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
J Oral Maxillofac Surg ; 68(4): 715-23, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20036042

RESUMO

PURPOSE: Injury to the lingual nerve (LN) is a known complication associated with several oral and maxillofacial surgical procedures. We have reviewed the demographics, timing, and outcome of microsurgical repair of the LN. MATERIALS AND METHODS: A retrospective chart review was completed of all patients who had undergone microsurgical repair of the LN by one of us (R.A.M.) from March 1986 through December 2005. A physical examination, including standardized neurosensory testing, was completed of each patient preoperatively. All patients were followed up periodically after surgery for at least 1 year, with neurosensory testing repeated at each visit. Sensory recovery was determined from the patient's final neurosensory testing results and evaluated using the guidelines established by the Medical Research Council Scale. The following data were collected and analyzed: patient age, gender, nerve injury etiology, chief sensory complaint (numbness or pain, or both), interval from injury to surgical intervention, intraoperative findings, surgical procedure, and neurosensory status at the final evaluation. The patients were classified according to whether they achieved "useful sensory recovery" or better, according to the Medical Research Council Scale, or had unsatisfactory or no improvement in sensation. Logistic regression methods and associated odds ratios (OR) were used to quantify the association between the risk factors and improvement. Receiver operating characteristic curve analysis was used to find the age threshold and duration that maximally separated the patient outcomes. RESULTS: A total of 222 patients (51 males and 171 females; average age 31.1 years, range 15 to 61) underwent LN repair and returned for at least 1 year of follow-up. The most common cause of LN injury was mandibular third molar removal (n = 191, 86%), followed by sagittal split mandibular ramus osteotomy (n = 14, 6.3%). Most patients complained preoperatively of numbness (n = 122, 55%) or numbness with pain (n = 94, 42.3%). The average interval from injury to surgery was 8.5 months (range 1.5 to 96). The most commonly performed operation was excision of a proximal stump neuroma with neurorrhaphy (n = 154, 69%), followed by external decompression with internal neurolysis (n = 29, 13%). Nineteen patients (8.6%) underwent an autogenous nerve graft procedure (greater auricular or sural nerve) for reconstruction of a nerve gap. A collagen cuff was placed around the repair site in 8 patients (3.6%; external decompression with internal neurolysis in 2 and neurorrhaphy in 6). Recovery from neurosensory dysfunction (defined by the Medical Research Council Scale as ranging from "useful sensory function" to a "complete return of sensation") was observed in 201 patients (90.5%; 146 patients with complete recovery and 55 patients with recovery to "useful sensory function"), and 21 patients (9.5%) had no or inadequate improvement. Using the logistic regression model, a shorter interval between nerve injury and repair resulted in greater odds of improvement (OR 0.942, P = .0064); with each month that passed, the odds of improvement decreased by 5.8%. The receiver operating characteristic analysis revealed that patients who waited more than 9 months for repair were at a significantly greater risk of nonimprovement. Statistical significance was observed between patient age and outcome (OR 0.945, P = .0067) representing a 5.5% decrease in the chance of recovery for every year of age in patients 45 years old and older. The odds of a return of acceptable neurosensory function were better when the patient's presenting symptom was pain and not numbness (OR 0.04, P < .001). CONCLUSIONS: Microsurgical repair of LN injury has the best chance of successful restoration of acceptable neurosensory function if done within 9 months of the injury. The likelihood of recovery after nerve repair decreased progressively when the repair occurred more than 9 months after injury and with increasing patient age.


Assuntos
Traumatismos dos Nervos Cranianos/cirurgia , Traumatismos do Nervo Lingual , Nervo Lingual/cirurgia , Adolescente , Adulto , Fatores Etários , Traumatismos dos Nervos Cranianos/etiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Neuroma/etiologia , Neuroma/cirurgia , Procedimentos Neurocirúrgicos , Razão de Chances , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Distúrbios Somatossensoriais/etiologia , Distúrbios Somatossensoriais/cirurgia , Nervo Sural/transplante , Fatores de Tempo , Extração Dentária/efeitos adversos , Resultado do Tratamento , Adulto Jovem
20.
J Craniofac Surg ; 20(6): 2243-5, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19934682

RESUMO

A 38-year-old woman presented with a tender mass with mild erythematous change above the left eyebrow area. She had received curettage in another clinic after a diagnosis of infected epidermal cyst 5 years previously. On examination, a round, irregular scar and a mass of 1-cm diameter associated with mild erythematous region were observed above the right eyebrow.Exploration disclosed a 1-cm neuroma with mild adhesion to a branch of the supraorbital nerve. The neuroma was completely removed. However, although partial transection of the supraorbital nerve was performed during surgery, the nerve was not repaired. The open wound was repaired securely. A histopathologic examination of the resected specimen resulted in a diagnosis of traumatic neuroma. The patient had no forehead numbness before or after surgery.


Assuntos
Curetagem/efeitos adversos , Cisto Epidérmico/cirurgia , Testa/inervação , Neoplasias de Cabeça e Pescoço/etiologia , Neuroma/etiologia , Adulto , Traumatismos dos Nervos Cranianos/etiologia , Traumatismos dos Nervos Cranianos/cirurgia , Feminino , Testa/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Neuroma/cirurgia
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