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PubMed2005

Delayed segmental motor paralysis following laminoplasty: two case reports.

STUDY DESIGN: Two patients who experienced the onset of segmental motor paralysis several years after laminoplasty are presented. OBJECTIVES: To discuss the mechanism of development of delayed segmental motor paralysis following laminoplasty. SETTING: A department of orthopaedic surgery in Japan. METHODS: One patient experienced motor weakness in his deltoid and biceps muscles on the left side 5 years after laminoplasty. The other patient noticed motor weakness in his deltoid and biceps on the right side 7 years after laminoplasty. CT myelography revealed posterior spur formation and hypertrophic facet joints on the hinged side at the C4-C5 level in both patients. RESULTS: Posterior foraminotomy was performed at the C4-C5 level on the hinged side in both patients. Postoperatively, motor weakness in the deltoid and biceps muscles was improved in both patients. CONCLUSIONS: Although spondylotic changes, including spur formation and disc herniation, have occasionally developed in operated segments after laminoplasty, few patients have required additional surgery for treatment of relapse of neurological deficits. It has been believed that spinal cord is rarely compressed by the spondylotic changes since it shifts posteriorly in the enlarged spinal canal. However, laminoplasty disturbs the facet joints since the medial portion of dorsal cortex and cancellous bone in facet joints is drilled out to make a trough. Facet joints disturbed in this fashion undergo degeneration over time after surgery. Nerve roots may occasionally be compressed by degenerated facet joints and spurs that have developed at the entrance of root canal, resulting in segmental motor paralysis several years after laminoplasty. Careful long-term observation is necessary after this procedure.

Aged↗
PubMed1998

Petrous bone cholesteatoma and facial paralysis.

This paper describes a series of patients with a petrous temporal bone cholesteatoma paying particular attention to the complications and their management. Sixteen patients who underwent surgery in our department were reviewed. Topographically, the petrous bone cholesteatomas were grouped into five categories according to the classification proposed by Sanna et al. There were five massive labyrinthine; five infralabyrinthine; one apical; four supralabyrinthine; and one infralabyrinthine-apical. Clinically, the presenting symptom of these lesions were facial nerve paralysis (10 patients) and unilateral deafness (13 patients). Total removal of the cholesteatomas was achieved in all patients using different surgical approaches according to their site and extent. Recurrences were observed in two patients after 8 months and 24 months, respectively. The facial nerve was infiltrated and compressed by the cholesteatoma in eight patients. Seven were managed with cable grafts using sural nerve. One of these patients was treated using a facial-hypoglossal anastomosis because of the failure of the graft. In the remaining patient, a baby-sitter procedure was employed. In the other two patients, the preoperative facial paralysis was due to compression by the cholesteatoma, and its removal allowed partial recovery of facial function. The rationale of the surgical management of petrous bone cholesteatoma is its radical and total removal. Our present policy is to prefer approaches which result in a closed cavity obliterating the eustachian tube and closing the auditory canal as a blind sac. Facial nerve function is the main complication of these lesions, Facial nerve involvement requires rapid management because the duration of the paralysis is directly related to poor recovery of facial function.

Adult↗
PubMed2001

Disturbances in airflow dynamics and tracheal sounds during forced and quiet breathing in subjects with unilateral vocal fold paralysis.

Variable extra thoracic obstruction has been found in spirometric studies in subjects with unilateral vocal fold paralysis. The aim of the study was to further evaluate airflow dynamics in these subjects with body plethysmography and tracheal sound analysis. Ten patients with unilateral vocal fold paralysis without a history of chronic pulmonary diseases and 10 healthy control subjects were studied. Flow-volume spirometry, body plethysmography and tracheal sound analysis were performed within 1 day. The study shows that peak inspiratory flow (PIF) and specific airway conductance (SG(aw)) expressed as percentage of Finnish reference values were significantly lower and airway resistance (R(aw)) was higher among the patients than among the controls (P=0.004, P=0.026 and P=0.004, respectively). The patients had higher sound amplitude of both inspiratory and expiratory tracheal sounds than the controls [root mean square (RMS) values of the power spectra were 31.5 and 25 dB, P=0.006 in inspiration and 31.5 and 26 dB, P=0.013 in expiration, respectively]. Quartile frequencies (F25 and F50) and RMS of expiratory tracheal sounds had significant negative correlation with PIF (P=0.02, P<0.001, P=0.02, respectively) and forced inspiratory volume in 1 s (FIV(1)) (P=0.01, P<0.001, P=0.01, respectively). There was also an association between F50 and peak expiratory flow (PEF) (P=0.02). According to the present study, both quiet breathing and forced inspiration are disturbed in subjects with unilateral vocal fold paralysis. A close relationship between tracheal sounds and respiratory function tests exists.

Aged↗
PubMed1999

Relations among hypnagogic and hypnopompic experiences associated with sleep paralysis.

The Waterloo Sleep Experiences Scale was developed to assess the prevalence of sleep paralysis and a variety of associated hypnagogic and hypnopompic hallucinoid experiences: sensed presence, felt pressure, floating sensations, auditory and visual hallucinations, and fear. Consistent with results of recent surveys, almost 30% of 870 university students reported at least one experience of sleep paralysis. Approximately three-quarters of those also reported at least one hallucinoid experience, and slightly more than 10% experienced three or more. Fear was positively associated with hallucinoid experiences, most clearly with sensed presence. Regression analyses lend support to the hypothesis that sensed presence and fear are primitive associates of sleep paralysis and contribute to the elaboration of further hallucinoid experiences, especially those involving visual experiences.

Adult↗
PubMed2002

Situational factors affecting sleep paralysis and associated hallucinations: position and timing effects.

Sleep paralysis (SP) entails a period of paralysis upon waking or falling asleep and is often accompanied by terrifying hallucinations. Two situational conditions for sleep paralysis, body position (supine, prone, and left or right lateral decubitus) and timing (beginning, middle, or end of sleep), were investigated in two studies involving 6730 subjects, including 4699 SP experients. A greater number of individuals reported SP in the supine position than all other positions combined. The supine position was also 3-4 times more common during SP than when normally falling asleep. The supine position during SP was reported to be more prevalent at the middle and end of sleep than at the beginning suggesting that the SP episodes at the later times might arise from brief microarousals during REM, possibly induced by apnea. Reported frequency of SP was also greater among those consistently reporting episodes at the beginning and middle of sleep than among those reporting episodes when waking up at the end of sleep. The effects of position and timing of SP on the nature of hallucinations that accompany SP were also examined. Modest effects were found for SP timing, but not body position, and the reported intensity of hallucinations and fear during SP. Thus, body position and timing of SP episodes appear to affect both the incidence and, to a lesser extent, the quality of the SP experience.

Adult↗
PubMed1999

Unilateral transient forehead paralysis following injury to the temporal branch of the facial nerve.

BACKGROUND: Cutaneous surgery in the temporal region of the forehead can lead to injury to the superficial temporal branch of the facial nerve. A flattened forehead and with ipsilateral forehead paralysis can occur with damage to this nerve. METHODS: A case is presented of transient forehead paralysis resulting from Mohs' micrographic surgery with reconstruction of the defect. The paralysis resolved over a period of fifteen months. RESULTS: The anatomy of the nerve makes it susceptible to injury during cutaneous surgery. The area of danger is the area superior to the zygomatic arch and lateral to the lateral eyebrow where the nerve is closest to the skin. CONCLUSIONS: Restoration of motor function usually occurs without intervention, but may take several months. Should motor function not recur, nerve grafting of a repair of the ptotic brow may be needed. The anatomy of the nerve is reviewed and brow lifting options are discussed.

Aged↗
PubMed2002

Aristolochic acid-induced Fanconi's syndrome and nephropathy presenting as hypokalemic paralysis.

Hypokalemic paralysis rarely is seen as the presenting feature in patients with Fanconi's syndrome. We describe a 60-year-old man who presented with the inability to ambulate on awakening in the morning. The pertinent history revealed he had consumed Chinese herbs for leg edema for 5 months. Physical examination was unremarkable except for extracellular fluid volume depletion and total paralysis of both lower extremities. Laboratory investigation showed hypokalemia (1.8 mEq/L), hyperchloremic metabolic acidosis (Cl-, 111 mEq/L, and HCO3-, 14.0 mEq/L), hypophosphatemia (0.9 mg/dL) with hyperphosphaturia, hypouricemia (1.3 mg/dL) with hyperuricosuria, and glycosuria, consistent with Fanconi's syndrome. Mild renal insufficiency (serum creatinine, 1.7 mg/dL) also was noticed. Blood and urine screens for heavy metals, autoantibodies, and monoclonal gammopathy were negative. A renal biopsy specimen revealed typical findings of aristolochic acid-associated nephropathy. Aristolochic acids were detected in the consumed Chinese herbs. This case highlights that consumption of Chinese herbs containing aristolochic acids may cause Fanconi's syndrome and should be considered as a cause of hypokalemic paralysis.

Acute Kidney Injury↗
PubMed2000

Facial paralysis: is there a role for a therapist?

Rehabilitation for peripheral facial paralysis is often neglected and patients are left untreated. This article explains how nonsurgical rehabilitation, specifically facial neuromuscular retraining, restores function in these patients. Patients with facial paralysis resulting from viral causes, postsurgical tumor resection, traumatic injury, or congenital paresis may be candidates for treatment. Typical patients present with flaccid paralysis acutely and may develop abnormal movement patterns (synkinesis) as recovery progresses. Neuromuscular retraining is effective. It provides specific strategies that inhibit synkinesis based on individual function and unique facial nerve and muscle properties. Successful rehabilitation results in improved patient satisfaction, self-esteem, and quality of life. Electrical stimulation should not be used at any time in facial rehabilitation. There is evidence that it may be contraindicated, and it is unnecessary. The imperative in treating synkinesis is to inhibit abnormally contracting muscles, not stimulate flaccid ones. The unfounded use of electrical stimulation is an unnecessary expense for patients and third-party payers.

Allied Health Personnel↗
PubMed2000

The SOOF lift as an adjunct in rehabilitation of facial paralysis: help or hype?

Rehabilitation of the midface in chronic facial paralysis is one of the last frontiers in global facial reanimation. The suborbicularis oculi fat pad lift, or SOOF lift, also known as the midface lift, has been popularized in aesthetic surgery literature as a way to restore midface fullness with a youthful appearance while eliminating midface sag associated with aging. These techniques of midface aesthetic rejuvenation have recently been applied in cases of chronic facial paralysis. This article analyzes the role of the midface lift or SOOF lift in cases of facial reanimation and determines whether or not it is of benefit to patients affected by chronic facial paralysis.

Adipose Tissue↗
PubMed2002

[Lateral fixation of the vocal cord instead of tracheotomy in acute bilateral vocal cord paralysis].

UNLABELLED: BACKGROUND AND STATEMENT OF THE PROBLEM: The dyspnea resulting from an acute bilateral paralysis of the recurrent nerve often requires tracheotomy. Such a situation occurs most frequently after thyroid resection. It was analysed how the endo-extralaryngeal laterofixation of one vocal cord can contribute to avoid tracheotomy. PATIENTS AND METHODS: 40 patients (37 women, three men; mean age 42.9 years, range: 20-78 years, standard deviation: 9.2 years) with bilateral paralysis of the recurrent nerve after thyroid resection were treated by performing the technique mentioned below. The surgery was performed with an endo-extralaryngeal suture technique by Lichtenberger. Monofilament threads were looped around a vocal cord and transfixed through the skin. RESULTS: 39 of 40 patients described an immediate improvement of the breathing situation and thus tracheotomy could be avoided. With reinnervation of the vocal cords the sutures could be removed in 17 of 40 patients within the first 12 months. In the other 23 patients the reversible treatment was changed into a permanent posterior glottic dilatation via endoscopy. CONCLUSIONS: Laterofixation via endo-extralaryngeal suture technique improves the airway situation immediately in patients suffering from bilateral vocal cord paralysis due to benign or malignant thyroid surgery. Thus tracheostomy can be avoided. The advantage of the reversibility of this technique becomes evident by the fact that the threads can be removed with recovery of the function of the vocal cords. The limits of this method seem to be achieved when the vocal cord is previously damaged due to e.g. a long-term intubation which results in an increased vulnerability of the vocal cords. Thus they cannot sufficiently resist the suture material.

Acute Disease↗
PubMed1985

Free gracilis transfer in the treatment of gluteus medius paralysis after poliomyelitis.

Paralysis of the gluteus medius after poliomyelitis often gives rise to secondary spinal deformity and inclination of the pelvis; the patient presents with a typical waddling gait. The paralysis is usually associated also with varying degrees of involvement and deformity of the extremities. Current treatment for paralysis of the gluteus medius has not been totally satisfactory. With the development of micro-neurovascular procedures, transfer of free muscle grafts for paralyzed or functionless muscles can be performed with functional recovery. The authors present a series of 12 cases, of which 10 were followed-up from 12 to 35 months. All of them had good cosmetic and functional results, with increased hip stability and stable gait. The operative technique, as well as the surgical anatomy, are described.

Adult↗
PubMed1996

[Early indications for surgical vocal cord medial relocation in unilateral recurrent nerve paralysis in advanced age].

BACKGROUND: Unilateral vocal cord paralysis is usually treated conservatively. Phonosurgery is not indicated before 1 year after the onset of the palsy as during this period spontaneous recovery can be expected. In the elderly patient conservative voice rehabilitation is often limited by a restricted general condition. In these cases a severe communication disorder may result unless vocal cord function recovers spontaneously. PATIENTS AND METHODS: In 4 patients aged 68 to 79 years who had suffered from latrogenic unilateral vocal cord paralysis for 6 to 9 months, surgical medialisation of the paralysed vocal cord was carried out in local anaesthesia as an Isshiki-Type-I-operation after unsuccessful conservative treatment prior to surgery. RESULTS: In all cases a definite amelioration of voice function could be reached. There were no local or general complications. No spontaneous recovery of nerve function could be detected by electromyography between 6 to 9 months after the operation. Voice function remained stable during this period. CONCLUSIONS: We conclude that in elderly patients with unilateral vocal cord paralysis with no signs of spontaneous recovery and unsuccessful conservative treatment, surgical voice rehabilitation may be indicated before 1 year after the onset of the palsy.

Aged↗
PubMed1993

[Facial paralysis in benign parotid tumor: case report and review of the literature].

Generally, typical symptoms are significant for malignant parotid tumours: The infiltration of surrounding structures and facial paralysis. A case is reported where a benign parotid tumour (lymphadenitis) caused facial paralysis. Parotidectomy and the removal of the lymph node near the stylomastoid foramen led to complete restitution. A review of the literature of the past 40 years mentions 16 cases of benign neoplasms of the parotid gland that caused facial paralysis, such as pleomorphic adenoma, Warthin's tumour, oncocytoma, benign parotid cysts, chronic parotitis, lymphadenitis and parotid abscess.

Adult↗
PubMed1984

[Femoral nerve paralysis after vaginal hysterectomy. Its causes and forensic significance].

Paralysis of the femoral nerve following vaginal hysterectomy is a rare peripheral lesion the pathogenesis of which is still under dispute. However, after abdominal hysterectomy it is much more frequent, with a largely clarified aetiology. During 1975 to 1984 three clinically and electrodiagnostically established cases of paralysis of the n. femoralis following vaginal hysterectomy were seen; in one case, paralysis was bilateral. The question whether lesion of the n. femoralis is due to malpractice is still a moot point.

Adult↗
PubMed2003

Transgenic mouse model for echovirus myocarditis and paralysis.

Echoviruses have been implicated in multiple human disease syndromes, including aseptic meningitis, paralysis, and heart disease, but no animal model is available for studying the pathogenesis of infection. Production of human integrin very late antigen 2, a receptor for echovirus type 1, in transgenic mice conferred susceptibility to viral infection. Intracerebral inoculation of newborn transgenic mice with echovirus leads to paralysis and wasting. No disease was observed in infected nontransgenic mice. In paralyzed mice significant damage was observed in the outer layers of the cerebrum, and numerous condensed neuronal nuclei were present. In contrast, intracerebral inoculation of adolescent (3- to 4-week-old) transgenic mice with echovirus type 1 did not lead to paralysis but an acute wasting phenotype and myocarditis. These findings establish human very late antigen 2 transgenic mice as a model for echovirus pathogenesis.

Aging↗
PubMed2004

Thyroplasty type I without arytenoid adduction in patients with unilateral laryngeal nerve paralysis: the montgomery implant versus the Gore-Tex implant.

OBJECTIVE: The current series was designed to compare the results achieved with the Montgomery and Gore-Tex implants in thyroplasty type I without arytenoid adduction in patients with unilateral laryngeal nerve paralysis. MATERIAL AND METHODS: An inception cohort of 57 French language speakers with unilateral laryngeal nerve paralysis were managed with thyroplasty type I using Gore-Tex (Group GT; n = 24) or Montgomery (Group M; n = 33) implants. The two groups had similar patient characteristics. Morbidity, phonatory results according to self assessment by the patient and selected speech and voice parameters (fundamental frequency, jitter, shimmer, noise:harmonic ratio, phonation time, phrase grouping and speech rate) were analyzed 1 month postoperatively in both groups. RESULTS: Dyspnea, as noted in three patients, was the only immediate complication. Late complications included persistent inflammation of the vocal cord after insertion of a Gore-Tex implant, endolaryngeal extrusion of the Gore-Tex implant and dislodgment of the Montgomery implant in one patient each. Postoperatively, all patients reported improvements in speech and voice. Secondary degradation of speech and voice was noted in one patient in each group. Comparison of selected speech and voice parameters at 1 month postoperatively showed (i) a statistically significant (p < 0.01) decrease in the jitter, shimmer and noise:harmonic ratio values and (ii) a statistically significant (p < 0.01) increase in the speech rate values in Group M compared to Group GT patients. Also, a trend (0.05 <p < 0.1) was noted towards an increase in the phrase grouping values in Group M compared to Group GT patients. CONCLUSIONS: Although limitations exist in the interpretation of the reported data, our results suggest that in patients with unilateral laryngeal nerve paralysis managed with a thyroplasty type I technique without arytenoid adduction, the use of a Montgomery compared to a Gore-Tex implant does not influence the success of the procedure according to the patient's self evaluation or the morbidity but does lead to a significant improvement in the values of selected speech and voice parameters.

Adult↗
PubMed2005

Direct pull of lateral cricoarytenoid muscle for unilateral vocal cord paralysis.

CONCLUSION: Lateral cricoarytenoid muscle-pull surgery (LCA pull) is a safe and effective method for the treatment of unilateral vocal cord paralysis. OBJECTIVE: To evaluate the results of an improved method of LCA pull for unilateral vocal cord paralysis. MATERIAL AND METHODS: Thirteen patients with unilateral vocal cord paralysis underwent LCA pull between April 2003 and January 2004. A small window was made in the posterior lower part of the thyroid cartilage and 2-3 mm in a cranial direction to the lower edge of the thyroid cartilage. The inner perichondrium was carefully removed to expose the LCA muscle. A 4-0 nylon suture placed through the LCA muscle was pulled to adduct the arytenoid and was tied to the anterior lower part of the thyroid cartilage. All cases were treated by LCA pull alone. In all cases, the maximum phonation time was measured and an auditory evaluation was performed using the grade, roughness, breathiness, asthenia and strain scale. The airflow rate was measured in five cases. RESULTS: Vocal improvement was obtained in 11/13 cases (85%). One of the unimproved cases had cricoarytenoid joint ankylosis. No complications were observed.

Adult↗
PubMed1979

Herpes zoster oticus. Uncommon but recognizable cause of facial paralysis.

Three cases of herpes zoster oticus illustrate the manifestations of this relatively uncommon cause of facial paralysis. Topographic analysis, in which functions of facial nerve branches are assessed, helps establish the level of facial nerve involvement. Sequential faradic stimulation testing often is a sensitive prognostic indicator of recovrey of facial nerve function, particularly if nerve excitability persists. A few recent reports support the use of systemic steroid therapy for herpes zoster oticus; opinions vary regarding the efficacy of surgical decompression for facial paralysis. Although general principles cannot be deduced from three cases, each case discussed exemplifies an important aspect of management. The prognostic significance of results of nerve stimulation tests is illustrated by the complete return of facial nerve function in our first patient. Our second patient's response to systemic steroid therapy supports recent reports of the value of such agents in herpes zoster oticus. Partial return of facial nerve function in our third patient two months after onset of paralysis accentuates the importance of a period of observation before a nerve graft or other rehabilitative procedures are undertaken.

Adult↗