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Biomedical subjects

M May

Publications and source records attributed to M May.

At least 163 records · Page 9Linked to original sources
PubMed1989

Floating petrous bone fracture.

Floating petrous bone fracture appears to occur when the elastic pediatric skull is subjected to large compressive forces. Unlike a longitudinal fracture, a floating petrous bone fracture does not involve the ear canal and squamous cortex. Rather, the fracture line runs through the middle ear, separating the petrous apex from its lateral and inferior bony attachments. Characteristic clinical findings include immediate onset of conductive hearing loss, with ipsilateral sixth and seventh cranial nerve paralysis. This article details the third known occurrence of this type of fracture, and includes a discussion of the pathophysiologic mechanism and treatment rationale.

Child↗
PubMed1989

Bell's palsy: management of sequelae using EMG rehabilitation, botulinum toxin, and surgery.

Fifteen percent of patients who have had an acute episode of Bell's palsy will be left with debilitating facial dysfunction. This chapter describes our approach to managing a variety of hypo- and hyperkinetic disorders caused by injury and faulty regeneration of the facial nerve, using electromyographic rehabilitation (EMGR) (13 patients), Oculinum toxin injection (14 patients), or surgical reanimation (72 patients). Improvement was noted after EMGR in 12 of 13 patients (92%), all 14 patients treated with Oculinum experienced temporary improvement, and improvement was noted in 66 of 72 patients who underwent surgery (92%). The indications, techniques, and results of these three rehabilitative methods are discussed.

Biofeedback, Psychology↗
PubMed1989

The role of rigid skeletal fixation in bone-graft augmentation of the craniofacial skeleton.

The type of fixation (rigid skeletal vs. wire) was assessed against embryologic origin (membranous vs. endochondral) and recipient site (depository vs. resorptive) as variables affecting inlay and onlay bone-graft survival in 20 mature dogs. Wet weight and volume measurements were made at operation and at sacrifice (16 weeks). The results were as follows: (1) Rigid skeletal fixation increased bone-graft volume survival over wire fixation (p less than 0.05). (2) Fixation (i.e., rigid skeletal) and embryologic origin (i.e., membranous) were equal determinants of bone-graft volume survival (p less than 0.001); the recipient site was not significant for onlay bone graft survival. (3) Embryologic origin was the only significant determinant of weight survival (p less than 0.001). (4) Inlay bone grafts demonstrated greater weight and volume survival than onlay bone grafts (p less than 0.05). (5) Histologic and microradiographic studies demonstrated bony union of bone grafts fixed with rigid skeletal fixation, while fibrous union predominated in bone grafts fixed with wire technique.

Alveolar Ridge Augmentation↗
PubMed1988

Management of facial spasm with Clostridium botulinum toxin, type A (Oculinum)

One hundred five patients received 391 graded injections of Clostridium botulinum type A toxin (Oculinum) to treat uncontrollable facial muscle spasm. Patients had essential blepharospasm (n = 61), hemifacial spasm (n = 24), or aberrant regeneration of the seventh cranial nerve (n = 20). Muscle spasms were reduced within two days of the first injection of toxin and, in most cases, the drug effect lasted three to four months. Control of facial muscle spasm was achieved in all patients. Complications related to treatment included transient blepharoptosis (n = 7), diplopia (n = 2), and altered facial expression (n = 11). Systemic side effects were not observed. Select chemodenervation of facial muscles with graded injections of botulinum toxin is a useful adjunct to control blepharospasm, hemifacial spasm, and facial spasm due to aberrant regeneration of the facial nerve.

Blepharoptosis↗
PubMed1988

Facial paralysis: traumatic neuromas vs. facial nerve neoplasms.

Traumatic neuromas (TN) are benign proliferations of neural tissue that may occur without disruption of the facial nerve. The clinical presentation, as well as the radiographic appearance, may suggest neoplastic involvement of the facial nerve. Histologically, they may closely resemble neurilemomas (Schwannomas) or neurofibromas. Three cases of TN of the facial nerve associated with facial paralysis are presented here. Unlike previously reported cases, these tumors were not associated with chronic inflammatory middle ear disease. TN must be considered in the differential diagnosis and treatment of facial paralysis.

Adolescent↗
PubMed1988

Paralyzed eyelids reanimated with a closed-eyelid spring.

Implantation of gold weights and open wire springs to close the eyelid have provided good corneal protection in selected patients with eyelid paralysis. These techniques, however, do not overcome lower eyelid drooping. The closed-eyelid spring technique was developed to address this problem, and, to date, the author has implanted 27 closed-eyelid springs. This technique has reestablished a voluntary blink, provided corneal protection, and effectively held the lower lid in a relatively normal position in 25 of 27 patients. This report describes patient selection, surgical technique, and results of implanting closed-eyelid springs to reanimate paralyzed eyelids.

Eyelid Diseases↗
PubMed1988

Thrombocytopenia in the neonatal lupus syndrome.

Thrombocytopenia has been documented infrequently in association with congenital heart block or lupus dermatitis in the neonatal lupus erythematosus syndrome. We report the cases of two infants with transient neonatal thrombocytopenia born to mothers with connective-tissue disease. Both mother/infant pairs were Ro(SS-A) antibody positive. Although the finding of neonatal thrombocytopenia in the presence of maternal connective-tissue disease suggests an autoimmune thrombocytopenia, platelet antibody studies were negative in both mother/infant pairs. We have found the Ro (SS-A) antibody with increased frequency in idiopathic thrombocytopenic purpura and thrombocytopenia associated with Sjögren's syndrome, but the nature of the association is unknown. We suggest that thrombocytopenia in our patients is a manifestation of the neonatal lupus erythematosus syndrome. This syndrome should be included in the differential diagnosis of neonatal thrombocytopenia.

Adult↗
PubMed1987

Gold weight and wire spring implants as alternatives to tarsorrhaphy.

Tarsorrhaphy has been the classic method of providing corneal protection in patients with eyelid paralysis. However, tarsorrhaphy is cosmetically unsatisfactory, limits vision, and provides poor corneal protection. The results of implanting 94 gold weights and 139 wire springs in 202 patients over a period of eight years have shown that these methods can provide good corneal protection in selected patients without the shortcomings of tarsorrhaphy. The gold weights worked best for patients with lid paresis, whereas the spring was most effective in patients with total eyelid paralysis. In selected patients these techniques reestablished a voluntary blink and provided corneal protection without the limitations of tarsorrhaphy. This report describes patient selection, surgical technique, and advantages as well as limitations of gold weight or spring implantation.

Adolescent↗
PubMed1987

"Ossifying" hemangiomas of the temporal bone: evaluation with CT.

Hemangiomas of the temporal bone that affect the facial nerve are more frequent than previously suspected. Six patients with slowly progressive or recurrent facial paralysis were evaluated with computed tomography. In each case, a lesion was demonstrated that enlarged the facial nerve canal and contained intratumoral spicules of bone. Typically the temporal bone was expanded by a lesion with an indistinct margin. Demonstration of the typical radiologic findings, especially the intratumoral bone spicules, makes hemangioma a much more likely diagnosis than schwannoma.

Adult↗