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PubMed1986

[Reconstructive measures in burn injuries of the face and neck].

Parts of the face and the neck are often affected by thermal damage which results in particularly disfiguring scars. Movement of the facial muscles is severely impaired and symmetry as well as contouring of the face is distorted by scarred skin which is always of lesser quality. Particular problems arise when the trauma results in partial loss of facial structures like the nose, lips or eyebrows. Plastic surgical treatment of burnt areas requires thorough knowledge of various procedures for best possible rehabilitation. Burn scars of the facial and neck region were treated by using local flaps and free skin transplantation or combination of both. The indication for the various methods is discussed and demonstrated in our cases.

Adolescent↗
PubMed1994

Cortical motor representation of the ipsilateral hand and arm.

We sought to determine whether motor evoked potentials (MEPs) as well as silent periods could be produced in hand and shoulder muscles by transcranial magnetic stimulation (TMS) of the ipsilateral cerebral hemisphere and, if so, whether their cortical representations could be mapped with respect to those of contralateral muscles. In six normal subjects, we delivered ten stimuli each to a grid of sites 1 cm apart on the scalp. The EMG was recorded and averaged from the contralateral first dorsal interosseous (FDI) and risorius (facial) muscles at rest and the ipsilateral FDI muscle, which was voluntarily contracted. In four of these subjects and an additional subject, we used the same mapping technique and recorded from the deltoid muscle on the right and left sides and the contralateral FDI during activation of the ipsilateral deltoid. In all subjects, the cortical representation of the contralateral risorius was anterolateral to that of the FDI. The contralateral deltoid could be activated in only three subjects. In them, its representation was slightly medial to that of the FDI. All subjects had at least one scalp site where TMS produced MEPs in the ipsilateral FDI. Two subjects had rich ipsilateral hand representations with multiple ipsilateral MEP sites. Both had ipsilateral MEP sites near the representation of the contralateral FDI, but the largest ipsilateral MEPs occurred with TMS at more lateral sites, which were near the representation of the contralateral risorius. In these subjects, the ipsilateral deltoid was preferentially activated at sites medial and posterior to those activating the contralateral muscle. Ipsilateral TMS also produced silent periods in the FDI in all subjects. These silent periods were much more frequent than the ipsilateral MEPs and tended to occur with TMS near the representation of the contralateral FDI. The excitatory cortical representation of the ipsilateral arm muscles is accessible to TMS in normal subjects and is different from that of the homologous contralateral muscles. The hand may have two ipsilateral representations, one of which produces silent periods and the other MEPs at the same stimulus intensity.

Adult↗
PubMed2006

[Operative neurosurgery: personal view and historical backgrounds (2) acoustic neurinoma].

Microsurgical removal of acoustic neurinoma is still one of the challenging topics in neurosurgery in spite of the development of Gamma-knife or radiosurgery, with which small and moderate sized tumors can be treated. Surgical technique necessitates more expertise in dealing with larger tumors. In this report ongoing microsurgical standard technique for removal of acoustic neurinomas of approx. 3 cm (extrameatal) in diameter is presented along with its historical backgrounds and literature review with reported techniques used by experienced neurosurgeons. 1) Standard sitting position with head turned (30) and flexed (20) head, and not semisitting position. 2) retromastoid retrosigmoid osteoplastic craniotomy following a linear incision. Special mention is made on how to manage the air embolism inherent to the sitting position in which the use of fibrin glue to seal the air entrance is presented along with early detection. 3) Intracapsular enucleation after the dural incision and retraction of the biventer lobule with special emphasis on the infrequent anatomical course of the facial and vestibulocochlear nerves on the posterior wall of neurinomas. 4) Localizing the facial nerve and vestibulocochlear nerve at the pontine side, so that decision of preserving or sacrificing the latter in the course of surgery can be made from the viewpoint of hearing preservation and concentrate on facial nerve function. 5) Drilling away of the posterior meatal lip in which sufficient drilling away should be performed to minimize opening of the posterior semicircular canal and that of mastoid cells. Complete sealing of either is necessary to prevent hearing loss or CSF rhinorrhoe. 6) Reduction of remaining tumor-capsule volume by sharp dissection or bipolar cutting, using intraoperative EMG-stimulation which identifies the presence of flattened facial nerve fibers on the capsule. Presence tiny remnant of the tumor capsule attached to the nerve bundles just before the entrance of internal acoustic porus (macroscopical "radical" resection) is considered to be acceptable for better postoperative quality of life. 7) Water tight dural closure and secure sealing of mastoid cells is necessary to prevent CSF rhinorrhoe. 8) Facial muscle EMG monitoring and AEP monitoring are mandaroty to accomplish surgery which enables postoperative good quality of life. 9) Results of 88 cases during last 10 years are: good function (HB I and II) of the facial nerve 90.5% at the time of two years follow-up, 11.5% hearing preservation, 1 mortality due to aspiration pneumonia. CSF rhinorrhoe 10%.

Craniotomy↗
PubMed2002

[Otoendoscopic tympanic segment and ganglion geniculi of facial nerve decompression via the attic approach].

OBJECTIVE: To research the practicability of otoendoscopic tympanic segment and ganglion geniculi of facial nerve decompression via the attic approach and the advantage of the operative procedure. METHOD: 12 patients with traumatic peripheral facial paralysis following temporal bone fracture (n = 11) and radical mastoidectomy (n = 1) underwent otoendoscopic tympanic segment, pyramidal segment or ganglion geniculi of facial nerve decompression via the attic approach. The injured positions were estimated before operation by high resolution CT scan, Schirmer test, acoustic reflex, taste test and hearing examination. RESULT: The facial muscle function of 6 cases (50%) recovered totally at time of discharge by Hosuse-Brackmann Standard. After 2-10 months of following up, 4 cases (33.3%) recovered totally and 2 cases (16.7%) remained light to medium facial paralysis. After operation, the hearing level unchanged (n = 8), descended (n = 2) and improved (n = 2) with auditory ossicle dislocation before operation. CONCLUSION: Otoendoscopic assisted tympanic segment and ganglion geniculi of facial nerve decompression via the attic approach can reach the target convenient and minimally destroyed normal structure. It is a mini-invasive approach for facial nerve decompression.

Adolescent↗
PubMed1998

Physiological response to a minimal social encounter: effects of gender, ethnicity, and social context.

This study examined physiological response to an encounter with and touch by an unfamiliar person. Fifty-five African American (23 male, 30 female) and 51 European American (23 male, 28 female) undergraduates participated. A Black or White interactor entered the room, introduced himself or herself, checked equipment for 30 s, and then took a pulse for 30 s. Entry of the interactor resulted in increased corrugator and zygomaticus facial muscle activity (EMG), increased skin conductance (SC), and heart rate (HR) acceleration. Corrugator EMG was greater among Black subjects; White subjects responded with more zygomatic EMG and SC and greater HR acceleration. Women showed a more positive facial expression than did men. Being touched reduced EMG and HR but resulted in increased SC. White and Black males showed more HR acceleration when encountering a Black male interactor.

Adolescent↗
PubMed1998

Facial pain in a case of cranial dystonia: a case report.

A 76-year-old man had shown sustained excruciating facial pain in the maxillary region for more than 30 years. Since he was suffering from blepharospasm, facial electromyography was performed and revealed a perioral dystonia. This possible cause of facial pain might have been overlooked had dystonia not been considered and electromyographical studies performed. Repeated intramuscular perioral injections of botulinum toxin brought about complete pain relief. This case shows that involuntary activity of facial muscles can cause a severe chronic pain syndrome. Possible mechanisms include irritation of ascending trigeminal fibers, muscle ischemia due to compression of blood -vessels, or release of pain-producing substances.

Aged↗
PubMed1997

Facial nerve paralysis after intratemporal and extratemporal blunt trauma.

Definitive facial nerve paralysis by intratemporal and extratemporal blunt injury is uncommon. Facial palsy as a result of closed temporal trauma is assumed to result if a petrous or temporal fracture is produced. Injury of the extratemporal trunk is extremely rare, but peripheral branches can be more easily injured. An exhaustive examination is necessary for an assessment if facial nerve damage is inside its bony canal or if it is severed distal to the stylomastoid foramen. Evaluation of facial muscle tone and motion, tear production, taste distribution, and stapedius muscle function must be evaluated. Electroneurography is mandatory because it is an important prognosis factor. Many prognosis factors must also be considered. Computed tomographic scan is also mandatory for providing localization of temporal fractures. Of 30 patients with facial paralysis registered by us between 1991 to 1996, 5 (17%) blunt trauma was the cause. In 2 of these patients with facial paralysis by extratemporal injury, showing selective facial branch injuries (one in the buccal branch and another in the marginal mandibular branch), recovery was complete and spontaneous. Another patient presented with a definitive selective buccal branch palsy after a complete facial paralysis produced by blunt preauricular injury. Of another 2 patients with facial paralysis by intratemporal injury without fracture, 1 recovered and the other did not. In 4 of the just-mentioned 5 patients, prednisolone was prescribed 1 week after trauma; no patients underwent surgical treatment. In conclusion, an extratemporal blunt trauma can produce a temporary facial palsy or paresis by injury of the main trunk or peripheral facial branch; however, recovery is usually complete. Intratemporal closed trauma with or without temporal fractures can produce a definitive facial nerve paralysis; recovery is uncertain.

Adult↗
PubMed2005

Catastrophizing is associated with clinical examination findings, activity interference, and health care use among patients with temporomandibular disorders.

AIMS: To examine whether catastrophizing is associated with clinical examination findings, pain-related activity interference, and health care use among patients with pain related to temporomandibular disorders (TMD). METHODS: Patients with TMD (n = 338; 87% female; mean age, 37 years) completed measures of pain, pain-related activity interference, health care use, and depression, and received a Research Diagnostic Criteria/ Temporomandibular Disorders (RDC/TMD) clinical examination from an oral medicine specialist. RESULTS: Catastrophizing was not significantly associated with the more objective clinical examination measures of maximum assisted jaw opening and jaw-joint sounds, but it was associated with the more subjective examination measures (unassisted opening without pain, extraoral muscle site palpation pain severity, joint site palpation pain severity) and with increased TMD-related activity interference and number of health care visits (P values for all < .01). Even after controlling for demographic variables, pain duration, and depression severity, catastrophizing remained significantly associated with extraoral muscle and joint site palpation pain severity and with activity interference and number of health care visits. CONCLUSION: TMD patients who catastrophize have higher scores on clinical examination measures reflecting more widely dispersed and severe pain upon palpation of TMD-related facial muscle and joint sites, as well as greater TMD-related activity interference and health care use. Clinicians should consider screening patients with moderate or greater TMD pain and activity interference for catastrophizing. Cognitive-behavioral interventions may help reduce pain, disability, and health care use of patients who catastrophize.

Activities of Daily Living↗
PubMedDate not supplied

Motor potentials of lower-lip mimetic muscles and distal arm muscles to cortical transcranial magnetic stimulation: the possibility of one-dimensional separation of two cortical representation areas.

The cortical representation of the abductor pollicis brevis muscle (APB) was investigated by transcranial magnetic stimulation (TMS) along the interaural line on the head surface in 17 healthy subjects. Comparing amplitudes of motor evoked potentials (MEPs) with those obtained by cortical TMS of lower-lip muscles, we found a considerable overlap between the areas from which reproducible MEPs of APB and lower-lip muscles could be elicited. However, there was a statistically significant separation of the two areas, the APB area being placed more medially. With regard to short examination procedures it can be concluded that a separation between distal arm and facial muscles is possible not only by two-dimensional cortical mapping procedures, but also by one-dimensional cortical TMS.

Adult↗
PubMed1978

Hemifacial spasm and the facial nucleus.

Spontaneous and associated hyperkinetic facial movements and contracture which follow injury to the seventh cranial nerve (postparalytic hemifacial spasm) or arise without known previous injury (cryptogenic hemifacial spasm) are pathological motor phenomena not found in the distribution of other cranial or somatic motor nerves. The commonly expressed hypotheses of pathogenesis--aberrant regeneration and fiber excitation by false synapse formation (ephapses) at the site of injury--cannot account for all aspects of these phenomena or for the uniqueness of such movements to the distribution of the seventh nerve. The suggestion is made that the existing diversity of facial motor behavior, which encompasses voluntary, emotional, and especially automatic, associated, and reflexive movements, is based on a unique central organization that sets it apart from other motor groups. I hypothesize that because of this organization, the changes following axonal injury--which include selective deafferentation, glial response, axonal sprouting, functional reconnection, and hyperexcitability from dendritic spike generation--can unmask and augment automatic, associated, and reflexive movements already present in the facial neuronal network to result in facial hyperkinesia.

Animals↗
PubMed2001

Facial myokymia in brain death.

BACKGROUND: Brain death (BD) is the irreversible loss of all functions of the brain and brainstem. Spontaneous and reflex movements of the limbs have been described in this condition. However, facial myokymia (FM) in BD has not been previously reported. The origin of that motor phenomenon in alive patients is still uncertain, since supranuclear, nuclear and peripheral mechanisms have been proposed. OBJECTIVE: We describe the presence of FM in a patient who fulfilled the criteria for BD. A 40-year-old-man had right-sided weakness and impaired consciousness. After 14 h admission, he fulfilled the criteria for BD. A CT scan of the head showed a large putaminal hemorrhage. The EEG was isoelectric. At that time, fine spontaneous twitches of the left cheek were noticed. They consisted of repetitive and rhythmic movements in groups of 3-5 lasting for < 5 s. These movements appeared every 2-10 min during 6 h. DISCUSSION: Spinal reflexes have been described in BD. The presence of any movements other than the recognized reflexes may question this diagnosis and limit organ procurement for transplantation. The recognition of FM as an accepted movement in BD patients has practical and legal implications.

Adult↗
PubMed1998

Quantitation of patterns of facial movement in patients with ocular to oral synkinesis.

As patients with facial paralysis regain facial nerve function, they must endure and adapt to complications associated with recovery, such as synkinesis. Synkinesis is the presence of unintentional movement in one area of the face when intentionally performing movement in another area of the face. We used the Maximal Static Response Assay of facial motion to better define the differences between eye closure-associated perioral motion in normal individuals, motion of the affected side in patients with synkinesis, and motion of the unaffected side in patients with synkinesis, thereby characterizing the syndrome of ocular to oral synkinesis. The study population consisted of 78 patients with clinically defined ocular to oral synkinesis of the left or right hemiface and 27 individuals without facial impairment (control subjects). We used the Maximal Static Response Assay to quantify facial motion on the affected and unaffected sides during the motions of eye closure and smile in both groups. Patients with ocular to oral synkinesis had decreased supraorbital and infraorbital motion of the orbicularis oculi during eye closure on both the affected and unaffected sides relative to control subjects. They also had increased modiolar motion during eye closure on both sides relative to control subjects. On the affected side, the modiolus tended to move laterally; on the unaffected side, the modiolus tended to move medially (i.e., toward the side affected by the synkinesis). Modiolar motion present during eye closure in patients with ocular to oral synkinesis was not statistically different from modiolar motion present during smile on the affected side (eye closure, 0.39 cm +/- 0.25; smile, 0.47 cm +/- 0.30, p > 0.05). Using the Maximal Static Response Assay, we have quantitatively defined synkinesis of the affected hemiface and have shown that movement of the unaffected hemiface is influenced by the synkinetic movements of the affected hemiface. These data may provide the basis for a rational system of facial neuromuscular rehabilitation in this patient group.

Adult↗
PubMed2006

Elimination of facial nerve stimulation by reimplantation in cochlear implant subjects.

HYPOTHESIS: Perimodiolar intracochlear electrodes with contacts facing towards the modiolus have limited current flow towards the outer wall of the cochlea and therefore, may reduce the occurrence of facial nerve stimulation (FN) in cochlear implant subjects. BACKGROUND: Facial nerve stimulation is a well-known complication in cochlear implant treatment especially in the group of subjects with otosclerosis. The possible explanation of this side effect is a change of the electrical properties of the otosclerotic bone leading to leakage current and resulting in facial nerve stimulation. METHODS: Four CI subjects who had been implanted with a Nucleus Mini22 device with a Nucleus Straight electrode between 9 to 12 years ago suffered from severe FN stimulation. Electrode contacts had to be switched off so that they could only use 4, 11, 13, and 15 electrodes of their usual set of 22. The switch off resulted in deteriorating speech understanding over time. Therefore, all subjects were reimplanted with a Nucleus 24R device with a Contour electrode. Preoperatively, the threshold of FN stimulation was obtained on all electrodes subjectively. Intraoperatively, FN stimulation thresholds were measured objectively with both, the old and the new device and were compared. NRT and SRT thresholds were also obtained with the reimplanted device to assure effective electrical stimulation of the auditory nerve. RESULTS: In all four cases the postoperative fitting demonstrated no FN stimulation on all electrodes up to maximum comfortable level. The insertion of the Contour electrode array was complete in three cases, in one case the array could only be inserted partially similarly to the situation before the reimplantation. Speech perception tests showed a significant improvement in all subjects with the new device. CONCLUSION: Electrodes with modiolar facing contacts and perimodiolar position like the Nucleus Contour electrode reduce the possibility of facial nerve stimulation significantly due to more focused electrical stimulation.

Adult↗
PubMed2002

Trismus in a 6 year old child: a manifestation of leukemia?

Trismus is a firm closing of the jaw due to tonic spasm of the muscles of mastication from disease or the motor branch of the trigeminal nerve. Trismus may be produced by a variety of reasons such as dental abscess, trauma, following mandibular block with local anesthesia, as a result of radiation to the facial muscles, and patients after chemotherapy. A case of a referral of a six-year-old boy to a dentist from an ENT due to severe limitation in jaw opening is presented. Intraoral examination and panoramic radiograph demonstrated no signs of infection and/or other pathology. After a diagnosis of trismus was made, due to his icteric appearance, the general fatigue and loss of appetite in the last few days, palpated and sensitive lymph nodes in the submandibular and cervical regions, the child was referred for a complete blood count and sedimentation rate. The laboratory and clinical findings resulted in the diagnosis of acute lymphoblastic leukemia (ALL). Dental and oral manifestations of ALL are discussed, and the trismus may be explained by an intensive infiltration of leukemic cells into the deep portion of the contracting muscles of the face. This case emphasizes the importance of physical examination and independent judgement made by dentists, even when patients are referred to them by other members of the medical communities.

Blood Cell Count↗
PubMedDate not supplied

[Congenital neuromyotonia. Retrospective study of 4 cases].

BACKGROUND: Fasciculation, double discharge, myokymia and neuromyotonia are different kinds of involuntary muscular activity that originate in ectopic discharges of the motor axons. Electrophysiological studies are needed in all cases for the diagnosis. Non rigorous electrophysiological studies in some cases is the cause of the historically unclear nosological delimitation of the neuromyotonic syndromes. OBJECTIVE: To report the clinical picture and electrophysiological findings in patients with congenital neuromyotonia. PATIENTS AND METHODS: Four patients with congenital neuromyotonia were studied. Electrophysiological exam included nerve conduction measurements, study of the after-discharges and conventional EMG. Spontaneous discharges were displayed after applying a low pass filter, signal trigger and delay line. RESULTS: In one case positive motor features predominate (continuous muscle fiber activity). On the contrary, two cases, showed neuropathic deficitary signs with a Charcot-Marie-Tooth type II disease phenotype; neuromyotonia was, in both cases, an electrophysiological feature. In the last patient, motor signs were limited to the facial muscles but electrophysiological study discovered generalized neuromyotonia. Treatment with carbamazepine or oxcarbazepine was useful in the four cases. CONCLUSION: Congenital neuromyotonia is a clinically heterogeneous syndrome with uniform electrophysiological features that permit its qualification.

Adolescent↗
PubMed2001

[Proximal myotonial myopathy (PROMM): clinical and histology study].

We report 13 French patients with proximal myotonic myopathy. PROMM is a recently delineated multisystem disorder with dystrophic myopathy, myotonia and cataracts. This syndrome is genetically distinct from myotonic dystrophy (DM) by the absence of abnormal CTG repeat expansion. The geographical origin varies but 4 families originated from Poland. Of late onset, muscle weakness is diffuse and predominantly affected proximal and axial muscles. Facial involvement and myotonia were moderate or absent, but in all cases myotonic discharges were detected on EMG. 6 patients suffered from myalgia. Cataracts occurred in 11 patients, mainly indistinguishable from those in DM. Cardiac arrythmia occurred in 7 patients. Muscle biopsy revealed rare structural changes of the muscle fibers and selective type I atrophy, common in DM, could not be found on morphometric analysis. PROMM has a distinct clinical spectrum from DM which includes a predominantly proximal muscle weakness, with troubling pain, a more favourable prognosis and a different histopathological pattern.

Adult↗