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At least 127 records · Page 7Linked to original sources
PubMed2006

Treatment of atrophic mandibular fractures based on the degree of atrophy--experience with different plating systems: a retrospective study.

PURPOSE: The aim of this retrospective study was to evaluate the clinical outcome of fractures of the atrophic mandible based on the degree of atrophy and treatment by different plating systems. PATIENTS AND METHODS: Thirty patients with 40 fractures of atrophic mandibles were treated by open reduction and internal fixation at our department between 1994 and 2001. Twelve fractures occurred in Class I (between 15- and 20-mm bone height), 10 fractures in Class II (between 10 and 15 mm), and 18 fractures in Class III atrophy (<10 mm). The profile heights of plating systems used for stabilization varied from 0.5 to 2.2 mm and were applied with an intraoral (n = 37) and extraoral (n = 3) approach. RESULTS: In 36 fractures, bone healing was uneventful. Major complications (loose hardware or nonunion) occurred in 4 fractures: 2 in Class II and 2 in Class III atrophy. Major complications were observed with 1.4-mm (n = 3) and 2.2-mm (n = 1) plates. Minor complications (infections or dehiscence) were observed in 6 fractures: 3 in Class II and 3 in Class III atrophy. Hypesthesia of the inferior alveolar nerve was present 1 week and 1 year postoperatively in 39 and 16 fractures, respectively. CONCLUSIONS: Treatment of atrophic mandible fractures should be based on the degree of atrophy. More rigid fixation may be necessary in mandibles with less than 15 mm bone height.

Adult↗
PubMed1992

Corneal sensitivity after photorefractive keratectomy.

Corneal anesthesia or hypesthesia can complicate refractive surgical procedures such as epikeratophakia and radial keratotomy. An esthesiometer was used to measure the corneal sensitivity in unoperated-on corneas and fellow corneas after excimer laser photorefractive keratectomy. Decrease in corneal sensitivity was noted within six postoperative weeks, with mean sensitivity being 75.2% +/- 13.3% of normal. Within the first three postoperative months, the patients operated on for correction of compound astigmatism recovered 95.7% +/- 5.3% of the corneal sensitivity, whereas the patients operated on for correction of severe myopia recovered 86.2% +/- 11.2% (P = .07). None of the patients had delayed epithelial healing or recurrent corneal erosions during the time of decreased corneal sensitivity. In otherwise normal myopic eyes, photorefractive keratectomy measurably reduced corneal sensitivity for several postoperative weeks.

Adult↗
PubMed1994

The Alcock syndrome: temporary penile insensitivity due to compression of the pudendal nerve within the Alcock canal.

Penile insensitivity is a symptom commonly observed after traumatic or iatrogenic nerve lesions, or in association with neurological or vascular diseases. In contrast, we report 2 cases of intermittent genital hypesthesia that occurred in cyclists after long-term bicycle riding. Anatomical studies show that this condition was probably caused by an irritation of the pudendal nerve during its course through the Alcock canal as reported in the literature. No pathological findings were demonstrated on extensive physical examinations, medical history and all medical imagings (sonography of abdomen, prostate and testes, and magnetic resonance imaging of the pelvis and lumbar spine) as well as radiodiagnostics and Doppler sonography, nor was there evidence of other neurological disturbances. The symptoms in the 2 patients spontaneously resolved after 4 and 7 weeks, respectively, without specific medical therapy.

Bicycling↗
PubMed1996

Endoscopic forehead lift: technique and case presentations.

PURPOSE: The advent of the endoscopic forehead lift has provided an alternative to the conventional open approach. This article describes the basic technique, with some modifications, and reports three clinical cases. RESULTS: The subperiosteal forehead technique rejuvenates the upper third of the face with no scalp resection, minimal risks of hypesthesia, limited risk of alopecia, reduced tissue trauma, small camouflaged scars, less bleeding and edema, improved postoperative comfort and faster recovery compared with the standard open techniques. CONCLUSIONS: The endoscopic subperiosteal forehead lift is a useful technique for providing rejuvenation of the upper third of the face. It reduces or eliminates forehead rhytids by eliminating the reflex contracture of the frontalis and contributes to softening of the vertical glabellar rhytids. Longitudinal studies will be required to assess the effectiveness of this technique compared with open techniques.

Adult↗
PubMed1984

Neuropathy after bupivacaine (Marcaine) wrist and metacarpal nerve blocks.

A series of 49 wrist and metacarpal blocks were done with the use of 0.25% or 0.5% bupivacaine in 44 patients for surgical and therapeutic purposes. Seven patients developed hypesthesia in the blocked nerve distribution lasting from 1 week to 4 months. One patient had pain and a positive Tinel sign in a dorsal branch of a digital nerve lasting 2 1/2 months. Since no neuropathies were reported in large series of nerve blocks with bupivacaine in other anatomic areas, it is postulated that bupivacaine in anatomically confined areas can cause a transient neuropathy possibly caused by a large local dose of the drug.

Adult↗
PubMedDate not supplied

Cutaneous nerve lesions of the shoulder and arm after arthroscopic shoulder surgery.

Increasing use of shoulder arthroscopy has caused developing awareness of the associated complications. A consecutive series of patients who had undergone arthroscopic surgery of the shoulder was reviewed. The overall incidence of a sensory deficit was 21 (7%) in 304 patients at 2 weeks after operation, and in approximately half (3.3%) of these patients this condition was still present at 8 months' average follow-up. These deficits fell into three distinct patterns, suggesting that damage was occurring to three different nerve branches. Most of these areas of hypesthesia corresponded to lesions of cutaneous branches of the axillary nerve; the most likely cause was direct injury at the portal sites, particularly the lateral portal.

Adult↗
PubMed1996

Use of lag screws for the management of mandibular trauma.

OBJECTIVE: To test the effectiveness of lag screw fixation in their application in the treatment of mandibular fractures. MATERIAL AND METHODS: Sixty-nine mandibular fractures in 30 patients treated with lag screws were evaluated retrospectively regarding the cause, the type, and the site of fracture as well as the local situation and the complications encountered. RESULTS: In 19 fractures a neutralization plate was used and in another 17 the lag screw was applied in combination with a compression plate. In 33 cases at least 3 lag screws were inserted. Seventy-five percent of the cases were in patients between 10 and 39 years old; 70% were the result of road traffic accidents. Most patients presented two mandibular fractures; the symphyseal area were most frequently affected. Teeth in the line of fracture were not removed, and no drains were used. Complications included two minor malocclusions, one delayed union, two cases of temporary paresis, two cases of transient hypesthesia, two cases of scar formation on the incision line, and a case of temporary trismus. CONCLUSIONS: Approximately 30% of the patients treated with lag screws according to the methods outlined in this study developed complications that were either minor, transient, or both; some were related to the approach rather than the method. The most frequent complications were minor malocclusions, transient facial paralysis, hypoesthesia, and scar formation.

Accidents, Traffic↗
PubMed2001

Neurolymphomatosis associated with muscle and cerebral involvement caused by natural killer cell lymphoma: a case report and review of literature.

We report a biopsy-proven case of neurolymphomatosis (NL) presenting with sensory motor axonal polyneuropathy, polymyositis, and cerebral involvement. Ours is the second reported case of NL caused by natural killer-cell lymphoma defined by morphology and immunophenotyping. For 3 months, the patient developed stocking-glove distribution of hypesthesia, subacute progressive weakness and mental deterioration. EMG showed severe sensorimotor mixed axonal-demyelinating polyradiculoneuropathy. Lumbar puncture revealed mildly high protein level with normal glucose and cell count. Sural nerve biopsy demonstrated lymphomatous axonal neuropathy and muscle biopsy was indicative of lymphomatous polymyositis. Brain MRI revealed multiple white matter lesions, consistent either with progressive multifocal leukoencephalopathy or cerebral lymphoma. Bone marrow biopsy showed neoplastic infiltrates. The patient died of multiple organ failure prior to initiation of chemotherapy.

Bone Marrow↗
PubMed2000

Neurosensory differences after wire and rigid fixation in patients with mandibular advancement.

PURPOSE: The purpose of this analysis was to compare the frequency and severity of nerve damage with rigid and wire fixation in patients participating in a prospective, randomized clinical trial. PATIENTS AND METHODS: One hundred twenty-six patients who required a bilateral sagittal split osteotomy and mandibular advancement were randomly assigned to receive either rigid or wire fixation. Tactile sensation in the mental nerve region bilaterally was determined presurgically and throughout the subsequent 2 years by using monofilament detection and brush stroke direction. Neurosensory levels were compared between the types of fixation over time. RESULTS: Evaluation with monofilament detection showed no significant difference between types of fixation throughout the 2-year follow-up. However, brush stroke determination showed significantly greater hypesthesia with rigid compared with wire fixation from 8 weeks through 2 years postoperatively. CONCLUSION: Rigid fixation resulted in more anesthesia in the mental nerve distribution than wire fixation when tested with brush stroke direction. However, increased anesthesia was not present when measured with monofilament determination.

Adolescent↗
PubMed2003

[Quantitative analysis of contrast enhanced MRI of the inferior alveolar nerve in inflammatory changes of the mandible].

PURPOSE: To evaluate the role of contrast enhanced MRI in quantifying signal changes of the inferior alveolar nerve following inflammatory changes of the mandible. MATERIAL AND METHODS: 30 patients with inflammatory changes of the mandible underwent MRI of the face. Both sides of the mandible, the affected as well as the unaffected healthy side were evaluated retrospectively. Regions of interest were placed at 5 defined places on both sides to assess signal intensity before and after intravenous application of paramagnetic contrast agent. The results of the measurements were compared between the healthy and the affected side (t-test, p < 0.05) and correlated with clinical findings (t-test, p < 0.05). RESULTS: All patients with hypesthesia of the inferior alveolar nerve in areas of the lips or chin (n = 4) showed a marked increase in signal intensity from 35 % to 83 % distal to the inflammatory process. Patients without sensitivity disorders showed less increase in signal intensity with a maximum of 51 % distal to the inflammatory process. In nearly all patients no contrast enhancement was observed distal to the first molar on the unaffected side. CONCLUSIONS: Quantitative analysis of contrast enhanced MRI of the neurovascular bundle is able to show pathologic mandibular lesions. In case of inflammatory changes of the mandible the neurovascular bundle is able to show pathologic mandibular lesions. In case of inflammatory changes of the mandible, the neurovascular bundle shows a significant increase in signal intensity distal to the lesion compared to the unaffected healthy side of the mandible.

Adolescent↗
PubMed1995

[Lacunar cerebral infarction in a young woman].

HISTORY AND FINDINGS: A 29-year-old woman was admitted to hospital with an acute right-sided hemiplegia and sensory disorders, as well as upper right quadrant anopsia. There were no other significant abnormalities. She had previously been healthy and was free of any predisposing risk factors for thromboembolism. Neurological examination elicited a homonymous right upper quadrant hemianopsia, dysesthesia of the right half of the face and hypesthesia and hypalgesia of the right side of the body. In addition there was paresis of the right arm and a positive right Babinski reflex. INVESTIGATIONS: There was no evidence for any underlying haematological, metabolic, infectious or vascular disease. Computed tomography of the head revealed a small hypodense area immediately adjacent to the posterior part of the left internal capsule, compatible with a lacunar infarction, a finding confirmed by magnetic resonance imaging and relating to the area supplied by the thalamic branch of the posterior cerebral artery. Transoesophageal echocardiography demonstrated a patent foramen ovale. TREATMENT AND COURSE: Almost complete regression of all signs occurred within two months on anticoagulation with heparin intravenously for two weeks followed by oral phenprocoumon (Quick's value 30-40%) and intensive physiotherapy. Five weeks after onset of treatment the paresis was obviously regressing and pyramidal tract signs had disappeared. Sensitivity to touch over the right half of the body was still diminished and the homonymous paracentral scotoma still present. CONCLUSION: Lacunar infarction of the brain in young patients has an excellent prognosis, as long as it is treated intensively according to its cause.

Acute Disease↗
PubMed1995

Transient neurologic symptoms after spinal anesthesia.

We recently reported several cases consistent with transient radicular irritation after spinal anesthesia with hyperbaric 5% lidocaine. The present prospective, blind, nonrandomized study was performed to determine the incidence of these transient neurologic symptoms and to identify factors that might be associated with their occurrence. We studied 270 patients scheduled for gynecologic or obstetric procedures under spinal anesthesia. For spinal anesthesia, either 5% lidocaine in 7.5% glucose or 0.5% bupivacaine in 8.5% glucose was used. Patients were evaluated on postoperative day 3 by a quality assurance nurse who was unaware of the drug given or details of the anesthetic technique. Transient neurologic symptoms were observed in 37% of patients receiving 5% lidocaine, whereas only one patient receiving 0.5% bupivacaine had transient hypesthesia of the lateral aspect of the right foot. These results suggest that symptoms were the result of a specific drug effect. However, because of the limitations of the study one cannot conclude that lidocaine per se was the cause.

Adolescent↗
PubMed2003

Substance P in human tears.

PURPOSE: To determine the levels and biochemical characteristics of substance P-like immunoreactivity (SPLI) in human tears and ascertain whether substance P (SP) concentrations in tears reflect the condition of the ocular surface. METHODS: Unstimulated tears were collected with a micropipette. Tear samples were partially purified using C-18 cartridges. Levels of SPLI in purified samples were measured using an enzyme immunoassay (EIA). For biochemical characterization of SPLI, tear extracts were fractionated using high-performance liquid chromatography (HPLC); each fraction was then subjected to EIA. To determine the catabolism of SP in tears, synthetic SP was incubated in medium containing pooled tears and then analyzed using HPLC. RESULTS: The concentration of SPLI in normal human tears was 306.0 +/- 96.5 pg/mL (mean +/- SD, range 148-555 pg/mL). Levels of SPLI did not vary significantly by age or gender. Concentrations of SPLI in tears from eyes with unilateral corneal hypesthesia were lower than those in tears from contralateral healthy eyes. Diclofenac sodium eye drops reduced concentrations of prostaglandin E2 and SPLI in tears. Analysis using HPLC indicated that five different substances contributed to SPLI in tears and that SP was broken down into several fragments, including SP(8-11), by enzymes present in tears. CONCLUSIONS: Substance P is a normal component of human tears. Levels of SPLI in tears might reflect the denervated status of the ocular surface. Substance P is catabolized by degradative enzymes in tears to maintain the ocular surface by exerting the trophic effects of SP while avoiding undesirable effects.

Administration, Topical↗
PubMed2001

C1-C2 transarticular screw fixation for atlantoaxial instability: a 6-year experience.

OBJECTIVE: We review a 6-year, single-center experience using the technique of C1-C2 transarticular screw fixation for atlantoaxial instability in 75 consecutive operations. METHODS: The study group was composed of 43 men and 32 women, with a mean age of 44 years (range, 8-76 yr). Each patient had documented atlantoaxial instability. In 28 patients (37%), atlantoaxial instability was a result of trauma; in 22 patients, (29%), it was a result of rheumatoid arthritis; in 16 patients (21%), it was a result of prior surgery; and in 9 patients (12%), it was a result of congenital abnormalities. All patients underwent stabilization with C1-C2 transfacetal screws and a posterior interspinous construct. Nine patients had unilateral screws placed. Postoperatively, the patients were maintained in a rigid cervical orthosis for a mean of 11 weeks (range, 8-15 wk); five patients were immobilized with halo fixation for a mean of 13 weeks (range, 10-16 wk). The mean follow-up period was 2.4 years (range, 1-5.5 yr). RESULTS: Osseous fusion was documented in 72 patients (96%). There were no hardware failures; however, three patients developed pseudarthrosis. Two superficial wound infections (one at the graft site and one at the cervical incision site) required antibiotic therapy. Four patients had transient suboccipital hypesthesia. No instances of an errant screw, dural laceration, or injury to the vertebral artery, spinal cord, or hypoglossal nerve were noted. CONCLUSION: C1-C2 transarticular screw fixation supplemented with an interspinous construct yielded a 96% fusion rate, with a low incidence of complications. We attribute our successful outcomes to careful preoperative assessment and meticulous surgical technique.

Adolescent↗
PubMed1995

Donor-site morbidity of the gracilis flap.

To determine whether there is a specific donor-site morbidity inherent in the elevation of the gracilis flap, we retrospectively examined 42 patients who underwent elevation of their gracilis muscles. We found, on dynamometric measurement, that the adduction strength of the hip joint was decreased by 11 percent when the gracilis muscle was elevated. This decrease in strength was not noticed by the patients. We also found an area of hypesthesia corresponding to the cutaneous territory of the obturator nerve in 40.5 percent of the patients. In addition, many patients were dissatisfied with the aesthetic appearance of the donor site, and a contour deformity of the thigh was present when a myocutaneous flap was elevated. Therefore, we conclude that the gracilis flap has a low but definite rate of donor-site morbidity. The advantages of the flap outweigh by far, however, the sequelae at the donor site.

Adult↗
PubMedDate not supplied

Numb chin syndrome in Ewing sarcoma.

The numb chin syndrome consists of unilateral hypesthesia of the chin and lower lip. In adults, it is often associated with metastatic disease to the mandible, base of the skull, or leptomeninges. In children, it has been associated with infiltration of the inferior alveolar nerve by leukemic cells. We describe two cases of numb chin syndrome in children with Ewing sarcoma. In a child with a solid tumor, this symptom seems to have an ominous meaning and should lead to the investigation of progressive skeletal involvement.

Adolescent↗
PubMed2004

Sensibility of the abdomen after abdominoplasty.

Abdominal skin hypesthesia may occur after abdominoplasty. The purpose of this study was to find out (1) which sensibility modalities are decreased and (2) which areas of the abdominal wall are affected, so that patients can be warned preoperatively about this condition. Forty patients were divided in two groups of 20 patients each. In the control group, patients had no previous abdominal incisions. The sensibility evaluation of patients from the experimental group was made from 12 to 60 months after abdominoplasty, with an average of 31.5 months. These patients were divided into two groups of 10 patients each, a short-term follow-up group (12 to 30 months postoperatively) and a long-term follow-up group (31 to 60 months postoperatively). The abdominal skin was divided into 12 areas; nine were above the abdominoplasty incision and three were below it. Sensibility to superficial touch, superficial pain, and hot and cold modalities was recorded as positive in all areas by a variable number of patients of the experimental group. However, in area 8 (hypogastric area), a statistically significant number of patients had decreased sensibility in all sensibility modalities (Fisher's test and t test). Patients in the experimental group also showed decreased sensibility to hot and cold temperature in area 11 (pubic area). Sensibility to pressure decreased significantly in all areas of the abdomen when compared with the control group (t test). When patients of the short-term follow-up group were compared with those of the long-term follow-up group, there was no statistically significant difference for all modalities of sensibility in the areas studied, except for area 5. In this area it was found that long-term follow-up patients recovered sensibility to cold and hot temperatures. These findings help plastic surgeons to orient their patients about possible risk of exposure to injuries in the areas with decreased sensibility after abdominoplasty. Most importantly, as these patients have decreased sensibility to pressure and hot temperature in a more extensive area of the abdomen, they are exposed to a higher risk of burn injury.

Abdominal Wall↗
PubMed1990

Meningiomas of the lateral skull base: neurotologic manifestations and patterns of recurrence.

The eradication of basicranial meningiomas by traditional surgical techniques is often hindered by neoplastic entanglement with critical neurovascular structures. Apparent, complete tumor resection is frequently followed by extensive, yet clinically silent, recurrent disease with local infiltration of bone, cranial nerves, and brain. Fifty-five cases of sphenoid wing or parasellar meningioma were analyzed to identify clinical manifestations suggestive of early tumor recurrence. Regrowth patterns were then defined according to preoperative radiographic and intraoperative surgical findings. Medial tumor regrowth, involving the cavernous sinus, caused neurapraxia of cranial nerves III, IV, or VI, with associated diplopia or ophthalmoplegia. Inferior (caudal) regrowth of disease involved the infratemporal fossa, pterygomaxillary space, or paranasal sinuses by bony erosion of the middle cranial fossa floor or through natural anatomic foramina and fissures. Such inferior extension was manifested clinically by facial hypesthesia, trismus, and referred otalgia caused by trigeminal nerve involvement and by autophony or serous otitis media related to eustachian tube obstruction. Posterior tumor regrowth occurred along the petrous bone and horizontal carotid canal, resulting in internal auditory meatus erosion and cerebellopontine angle extension with associated tinnitus, hearing loss, unsteadiness, and occasional facial twitching. While the clinical and radiographic evaluations of any patient with a suspected recurrent basicranial meningioma are critical in planning the method and magnitude of reoperation, an understanding of potential recurrence patterns can be used in devising more extensive, combined approaches that may allow complete tumor extirpation at the initial surgical intervention.

Adult↗