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At least 631 records · Page 35Linked to original sources
PubMed1992

Facial paralysis in temporal bone trauma.

A retrospective review of 36 patients with delayed-onset (19 patients) and immediate-onset (17 patients) traumatic facial paralysis was performed. We hypothesized that traumatic delayed-onset facial paralysis does not necessitate surgical decompression under any routine circumstances. Of 19 patients in this group, normal recovery (House grade 1) occurred in 94 percent of the patients without surgical intervention. The small percentage (6%) of these patients who failed to recover completely demonstrated mild degrees of weakness and synkinesis (House grade 2). Immediate-onset paralysis occurred in 17 patients. It has a much poorer prognosis. Seven patients with penetrating wounds had facial nerve transections, usually of the vertical portion of the facial nerve. Closed head injured patients with immediate-onset facial paralysis sustained injuries usually to the horizontal and perigeniculate portion of the facial nerve. For those cases in which surgical exploration of the traumatized facial nerve is indicated, the operating surgeon should have the capacity to enlarge the exposure with a translabyrinthine or middle-fossa dissection.

Adolescent↗
PubMed1992

[HTLV-I associated myelopathy with bilateral abductor vocal cord paralysis--case report].

We have reported a 50-year-old woman with HTLV-I associated myelopathy (HAM) who had bilateral abductor vocal cord paralysis. The symptoms and signs were slowly progressive spastic paraplegia, dysuria, inspiratory stridor, and snoring during sleep. She had no hoarseness. Titers of anti-HTLV-I antibody were elevated in both the serum and cerebrospinal fluid. FEV1.0% on the spirogram was reduced to 66%. The fiberscopic examination demonstrated the abductor limitation of the vocal cords during the inspiratory phase. During induced sleep after the intravenous administration of thiopental sodium, this abductor paralysis was worsened, producing a high pitched inspiratory stridor. The adduction was not disturbed at all. Needle electromyogram of the posterior crico-arytenoid muscle which is a sole abductor muscle revealed the high amplitude up to approximately 1.0 mV (normal less than 0.8 mV) with poor interference pattern, indicating neurogenic changes. After 2 months course of prednisolone (60 mg/alternative day), FEV1.0% was recovered to be 92% with the improvement of the gait disturbance, which suggests the abductor vocal cord paralysis is related to HAM. The abductor vocal cord paralysis in HAM would require a careful follow-up observation to protect the respiratory failure in the advanced stage.

Electromyography↗
PubMedDate not supplied

Acute hyperkalemic paralysis in a uremic patient.

Hyperkalemia is a less-recognized life-threatening cause of paralysis. We describe a 38-year-old uremic man on regular hemodialysis (HD) without interruption who suffered from muscle weakness progressing to ascending symmetric paralysis, and inability to masticate. Physical examination revealed flaccid paralysis with areflexia of the four limbs. Computed tomography of the brain and cervical spine did not demonstrate any organic lesions. Laboratory investigations revealed serum K+ 8.1 mmol/L, urea nitrogen 32 mmol/L, creatinine 919 micromol/L. Of note, electrocardiography (ECG) did not show typical features of hyperkalemia. Emergent HD with low K+ dialysate (1.0 mmol/L) rapidly normalized serum K+ (4.7 mmol/L) and reversed all neuromuscular symptoms within one hour. Upon reviewing his food and medication history, he admitted drinking 750 ml of raw coconut juice per day (K+ concentration 44.3 mmol/L) to quench his thirst for three consecutive days. Hyperkalemia should be born in mind in the differential diagnosis of acute paralysis despite no ECG changes. Hidden sources of K+ intake, such as coconut juice, should not be overlooked, especially in patients with impaired renal function.

Adult↗
PubMed2005

[Long-term results of intracordal or neocordal autologous fat injection in patients with unilateral vocal cord paralysis and cordectomy].

OBJECTIVES: We investigated the long-term results of autologous fat injections for unilateral vocal cord paralysis and laryngofissure and cordectomy defects. PATIENTS AND METHODS: We evaluated the efficacy of autologous fat injections in 21 patients (16 males, 5 females; mean age 57 years; range 24 to 72 years) with unilateral vocal cord paralysis (n=11) and cordectomy defects (n=10) in the light of computed acoustic analysis, phonatory functions, and videolaryngostroboscopic findings and the effect of injections on swallowing. The mean follow-up was 14 months (range 10 to 22 months). RESULTS: Voice quality improved in 14 patients. Glottic insufficiency recurred in three patients in the early period, and in two patients in the late period. Phonatory functions showed significant improvement in all parameters except for jitter and functional interference (p<0.05). Videolaryngostroboscopy showed significant improvement in glottic closure, but mucosal waves remained unchanged. Of 18 patients with swallowing disorders, aspiration symptoms improved in 15 patients. Patients with unilateral vocal cord paralysis had better results compared to those with cordectomy defects. CONCLUSION: Autologous fat injections may be considered effective in patients with cordectomy defects or unilateral vocal cord paralysis.

Adipose Tissue↗
PubMed2005

[Experimental study on simultaneous selective reinnervation of the adductors and the abductor muscle for the treatment of the laryngeal paralysis].

OBJECTIVE: The aim of this study is to estimate the value of a new surgical procedure in the treatment of the chronic unilateral laryngeal paralysis. METHODS: The recurrent laryngeal nerve of the left side of the dog was totally cut and served as a model of unilateral laryngeal paralysis at the first step of the research. The adductor and abductor branches of the recurrent laryngeal nerve were then, selected and cut. Afterwards, they were micro-sutured respectively with one branch of ansa cervicalis and phrenic nerve immediately (group 1) and 4 months later (group 2). Six months after this reinnervation, the laryngeal physiologic function of the lateral crico-arytenoid muscle (LCA) and the posterior crico-arytenoid muscle (PCA) have been checked by the methods of electromyography (EMG) and direct laryngoscopy. All the data have been analysed by the statistic methods. RESULTS: Among all the data of EMG, only the wave amplitude of action potential of the LCA muscle of the group 2 was diminished (p < 0.05). Under the direct laryngoscopy, the adductor movement of the left vocal cord of the group 2 was also lightly reduced. But the adductor and abductor movements of the left vocal cord were synchronous with the mouvements of the right vocal cord. CONCLUSION: Though the result of nervous reinnervation of a four month's laryngeal paralysis was not so good by comparison with that of an immediate reinnervation, this surgical procedure can however on the clinical point of view, reach a satisfactory level. The duration maximum of the reinnervation operation after laryngeal paralysis, is, at the present, not clear. It is necessary for us to make further studies.

Animals↗
PubMed2005

[Unilateral diaphragmatic paralysis in a diabetes patient].

Bilateral or unilateral diaphragmatic paralysis may be caused by motor neuron or muscle disease. Diabetic neuropathy, which is a common complication in diabetic patients, has a wide range of clinical manifestations. This is a case history of a 52 year old diabetic woman hospitalized with new paralysis of the right diaphragm. A thorough evaluation revealed no reason for diaphragmatic paralysis, other than diabetic neuropathy. A six month follow-up revealed significant clinical improvement. This article includes a summary of the literature, discussing the relationship between diabetes mellitus and diaphragmatic paralysis.

Diabetes Complications↗
PubMed2006

[Study on clinical effectiveness of acupuncture and moxibustion on acute Bell's facial paralysis: randomized controlled clinical observation].

OBJECTIVE: To investigate the adverse effects of acupuncture on the prognosis, and effectiveness of acupuncture combined with far infrared ray in the patient of acute Bell's facial paralysis within 48 h. METHODS: Clinically randomized controlled trial was used, and the patients were divided into 3 groups: group A (early acupuncture group), group B (acupuncture combined with far infrared ray) and group C (acupuncture after 7 days). The facial nerve functional classification at the attack, 7 days after the attack and after treatment, the clinically cured rate of following-up of 6 months, and the average cured time, the cured time of complete facial paralysis were observed in the 3 groups. RESULTS: There were no significant differences among the 3 groups in the facial nerve functional classification 7 days after the attack, the clinically cured rate of following-up of 6 months and the average cured time (P > 0.05), but the cured time of complete facial paralysis in the group A and the group B were shorter than that in the group C (P < 0.05). CONCLUSION: The patient of acute Bell's facial paralysis can be treated with acupuncture and moxibustion, and traditional moxibustion can be replaced by far infrared way.

Acupuncture Therapy↗
PubMed2006

[Observation on therapeutic effect of aponeurotic system penetration needling on peripheral facial paralysis].

OBJECTIVE: To observe therapeutic effect of aponeurotic system penetration needling on peripheral facial paralysis. METHODS: One hundred and ten cases of peripheral facial paralysis were randomly divided into a Jingjin group (n=68) and a control group (n=42). The therapeutic effects of acute stage, resting stage and sequela stage, and the relation between the facial nerve lesion degree and the therapeutic effect were investigated. RESULTS: The effective rates of the two needling methods were respectively 98.5% and 90.5%, the Jing1in group being better than the control group (P < 0.05); at the acute stage, the therapeutic effect of acupuncture was obvious, and the therapeutic effect at the sequela stage and for the patient of nerve faulty type in the Jingjin group were better than that of the control group (P < 0.05). CONCLUSION: Acupuncture and moxibustion has definite therapeutic effect on facial paralysis at the acute stage and in the patient of nerve active type, and aponeurotic system penetration needling can be used for the patient of facial paralysis at the sequela stage or with nerve faulty type.

Acupuncture Points↗
PubMed2006

[Point-through-point acupuncture for treatment of peripheral facial paralysis].

OBJECTIVE: To search for a more effective penetration needling method for peripheral facial paralysis. METHODS: The patients were divided into a treatment group and a control group according to visiting sequence. The treatment group of 50 cases were treated with Yangbai (GB 14)-through-Touwei (ST 8), Yangbai (a little above the original point)-through-Shangxing (GV 23), Sizhukong (TE 23)-through-Yuyao (EX-HN 4), Qianzheng-through-Yingxiang (LI 20), Dicang (ST 4)-through-Jiache (ST 6) and Jiache-through-Yingxiang, at an angle about 45 degrees between the penetration needling direction and local paralysis muscle bundle, and the control group (n=45) with Yangbai-through-Yuyao, Zanzhu (BL 2)-through-Yuyao, Dicang-through-Jiache, Jiache-through-Dicang, Qianzheng-through-Dicang, Sibai (ST 2)-through-Yingxiang. RESULTS: The cured rate and the cured and markedly effective rate were 76.0% and 92.0% in the treatment group, and 55.6% and 75.6% in the control group respectively, with significant differences between the two groups in the cured rate, the cured and markedly effective rate and the therapeutic times for cure. CONCLUSION: The penetration needling method at an angle about 45 degrees between the penetration needling and paralysis muscle bundle is more beneficial to recovery of facial paralysis.

Acupuncture Points↗
PubMed2006

[Bilateral wedge-shaped cordectomy for treatment of bilateral vocal cord paralysis].

OBJECTIVE: A clinical evaluation of CO2 laser endoscopic bilateral posterior wedge-shaped cordectomy (EBPC) in patients with severely compromised airway due to bilateral paralysis of the vocal fold. METHOD: The CO2 laser EBPC was performed in four cases of bilateral vocal cord paralysis. Follow-up has ranged from five months to 36 months. RESULT: Three patients achieved satisfactory airway after one laser procedure and one patient received second laser operation to manage her posterior webbing. Final voice quality was subjectively good in all patients. CONCLUSION: The authors' data confirm the safety, ease of performance, and efficiency of the CO2 laser EBPC in patients with bilateral vocal fold paralysis. The advantages of the procedure are simplicity in concept, reliability of outcome, no need for prophylactic tracheotomy, low risk of complications, adequate airway and good voice preservation. CO2 laser endoscopic bilateral posterior wedge-shaped cordotomy is an alternative management option for relief of upper airway obstruction due to bilateral vocal cord paralysis in abduction. The procedure is worthy to apply in clinical use.

Aged↗
PubMed1991

Congenital and acquired facial nerve paralysis in children.

Facial nerve paralysis in children should be considered distinct from that which occurs in adults. The author submits a slightly different classification of facial nerve paralysis in children based on traditional thinking. Specifically, acquired facial nerve paralysis is thought to be influenced by both prenatal and postnatal factors. This segregated approach toward acquired paralysis should allow a clearer understanding of the pathophysiology of in utero factors.

Child↗
PubMed1991

Association of facial paralysis with HIV positivity.

Facial paralysis, although a rare complication of AIDS related complex (ARC) or AIDS, may well be the presenting symptom of HIV positivity. A case report of facial paralysis followed closely by discovery of HIV positivity is described, along with a pertinent and extensive literature review. Seroconversion to HIV-positive status should be suspected in any high-risk patient presenting with idiopathic facial paralysis. HIV testing should be included in the evaluation of Bell's palsy and other idiopathic forms of facial paralysis in the at-risk patient.

Facial Paralysis↗
PubMed1990

The paralysis associated with myelomeningocele: clinical and experimental data implicating a preventable spinal cord injury.

Paralysis seen in children with myelomeningocele has been attributed to congenital myelodysplasia. We suspected that paralysis may be due in part to a spinal cord injury caused by exposure of the neural tube to the amniotic fluid. This hypothesis was tested using a fetal rat model of surgically created dysraphism. Each pup from the experimental group of rats in which the spinal cord was intentionally exposed to the amniotic fluid was born with severe deformity and weakness of the hind limbs and tail. Control fetal rats, subjected to the same procedure without directly exposing the spinal cord to the intrauterine environment, were normal at birth. Histological studies of the exposed spinal cord revealed extensive erosion and necrosis, findings similar to those described in children with myelomeningocele. We therefore propose a "two-hit" hypothesis to explain the paralysis seen in children with myelomeningocele: congenital myelodysplasia complicated by an intrauterine spinal cord injury. Intrauterine protection of the exposed spinal cord might prevent some or all of the paralysis. The possible implications of these findings for the future treatment of myelomeningocele are discussed.

Amniotic Fluid↗
PubMed1990

[Analysis of 138 cases of superior oblique muscle paralysis].

Congenital or early infantile paralysis of the superior oblique muscle is primarily caused by congenital anomaly of the ocular muscles or by birth trauma, while the acquired is mostly caused by trauma, influenza, or acute infection. The diagnosis is done by Lancaster's test, the synoptophore, and the cover test in combination with prisms. For incooperative children, Park's three step test may be used. The angle of strabismus can be measured with the cover test and prisms, or by the synoptophore. For treatment, the patients were divided into (1) the group of prism correction, (2) the group of inferior oblique attenuation in the same eye, (3) the group of inferior rectus attenuation in the other eye, (4) the group of inferior oblique attenuation in the same eye combined with inferior rectus attenuation in the other eye, and (5) the group of superior oblique paralysis complicated with horizontal heterotropia. The immediate and longterm curative effect had been satisfactory. It is important to differentiate congenital cases from the acquired, the primary torticollis from that of ophthalmic origin, and the paralysis of superior oblique in one eye from the paralysis of the superior rectus in the other eye.

Adolescent↗
PubMed1990

[The evaluation of intracordal silicone injection in patients with postoperative recurrent nerve paralysis].

This study aimed to evaluate the usefulness and efficacy of intracordal silicone injection in the treatment of cordal paralysis after thoracic surgery or due to tumor invasion of the recurrent nerve. A total of twenty two patients with cordal paralysis was treated with this procedure. The cause of the cordal paralysis was injury to the recurrent nerve incurred during operation for oesophageal or lung cancer in nineteen patients, and direct invasion of malignant neoplasm to the recurrent nerve in the other three patients. Among the nineteen postoperative patients, fifteen underwent silicone injection 15 to 75 days after thoracic operations during hospitalization. The other four patients were treated after discharge from the hospital. The complaints of the fifteen patients who were treated during hospitalization were dysphonia, aspiration and inability to remove sputum. After treatment, dysphonia had improved in all of these fifteen patients, and aspiration had disappeared in thirteen patients. In four patients who were treated with this procedure 7 months following thoracic operation and three who had cordal paralysis due to invasion of malignant tumors, in all of whom aspiration had not been noted, dysphonia disappeared completely after the silicone injection. To evaluate the effect of silicone injection on the patients' cough force, the intratracheal pressure during cough was measured in patients before and immediately after the treatment. The maximum intrathecal pressure was 25 (+/- 16.57) mmHg before silicone injection. After the procedure, the maximum pressure rose to 95 (+/- 18.13) mmHg. Following the procedure, the patients who had suffered severe debilitating aspiration could remove sputum easily.

Adult↗
PubMed1989

Respiratory paralysis as a presenting symptom in Japanese encephalitis--a case report.

In the literature there are rare reports on Japanese encephalitis (JE) mimicking poliomyelitis or presenting as respiratory paralysis. A case of JE presenting as respiratory paralysis is described. The 22-year-old male was well until five days earlier, when he experienced the acute onset of headache and fever. Four days after onset he developed dysphagia and respiratory difficulty, and a tracheotomy was performed. The following day he lapsed into semicoma and the respiration had to be maintained by an artificial ventilator. He regained consciousness by the 10th day after onset. He became able to comprehend questions and express himself by gestures. But the respiration was still paralytic, and assisted ventilation via a tracheotomy had to be continued. The case was clinically diagnosed as encephalitis. Bulbar poliomyelitis was initially considered due to the clinical features of aseptic meningitis, respiratory paralysis, pharyngeal paralysis with pooling secretions in the pharynx, tachycardia and elevated blood pressure. But poliovirus culture obtained from stool and appropriate serological studies were negative. The diagnosis of encephalitis due to JE virus was confirmed by hemagglutination inhibition test (acute phase HI titer 1:320; convalescent phase HI titer 1.1280).

Adult↗
PubMed1989

[Bilateral abductor vocal cord paralysis (Gerhardt syndrome) in the Shy-Drager syndrome].

Ten consecutive patients with a progressive pan-autonomic failure of the Shy-Drager syndrome were investigated. Movement disorders of the vocal cords were examined with a fiber-optic laryngoscope as well as a video-recorder. Moderate to severe vocal cord paralysis was present in five of ten patients. The vocal cords were almost immobile during inspiration, while there was no limitation of the adduction during phonation. In two cases, grade of vocal cord paralysis was asymmetric. One patient developed peculiar twisting-like dystonic movements of the vocal cord. Polygraphic studies revealed that SaO2 was lowered in spite of tachypnea during sleep. In two cases, the expiratory flow volume curve in effort-dependent portion near TLC showed a plateau and the inspiratory part of the curve also showed a plateau indicating constant flow. These functional disorders suggest an upper airway obstruction probably due to the vocal cord dysfunction. There was no vocal cord paralysis in two patients who had neither snore nor stridor. Development of a severe vocal cord dysfunction usually manifested itself clinically as stridor, snore or respiratory failure requiring tracheostomy. There was little information on the pathology of the vagal nerves and nuclei supplying motor control to the laryngeal muscles. The mechanism of the selective involvement of abductor muscle (posterior muscle) of the vocal cord (Gerhardt syndrome) remains unsolved. Vocal cord paralysis should be looked for since it can result in respiratory failure leading to death.

Adult↗
PubMed1989

The assessment and treatment of facial paralysis.

A facial paralysis is a major cosmetic handicap and can be an emotional and occupational disaster. There are, in addition, problems with speech and the eye. These problems are more severe if the facial paralysis is combined with other cranial nerve palsies. This discussion will be limited to lower motor neurone paralysis. Every patient with a facial paralysis can be helped to some degree and, in some, facial function can be restored to near normality. It is important that the underlying condition be diagnosed early to ensure a good prognosis.

Facial Paralysis↗