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Owing to a high recurrence rate, radical jaw resection is regarded as the first choice of treatment for odontogenic myxoma. However, there have been several reports on the effectiveness of conservative surgical treatment preserving inferior alveolar nerve for odontogenic myxoma of the mandible. A 37-year-old woman presented with a complaint of pain around her mandibular left third molar. Odontogenic myxoma was diagnosed by using biopsy. The tumor occupied a part of the cortical bone and contained the inferior alveolar nerve. We performed enucleation and curettage, which preserved the inferior alveolar nerve. Ten years after the treatment, there were no symptoms of recurrence or nerve paralysis. Here, we discuss the conservative treatment of odontogenic myxoma, focusing on inferior alveolar nerve preservation.

Thumb resistance is a basic activity of thumb. Middle nerve paralysis meddles with an enormous number of customary exercises like resistance. This investigation planned to survey the result of ligament move for reclamation of resistance in instances of low middle nerve injury in regards to hand grasp and scope of movement and useful result. Thirty patients, 19 guys and 11 females with a mean time of was 29 years, with a standard deviation of 11 years were remembered for this examination. The interim between wounds to a medical procedure was 17 months, with a standard deviation of 3 months. All patients experienced segregated low middle nerve injury with lost resistance were incorporated for and flexor digitorum superficialis (FDS) opponensplasty. Evaluation of resistance by Kapandji score and appraisal of level of agony by VAS and hand grasp by QuickDASH score. Every one of the patients will have nerve conduction and electromyogram, clinically assessment following fourteen days and evacuation of the skin stitch then at about a month expulsion of the piece and consider controlled scope of movement, and at 3, 4 months postoperatively FDS opponensplasty give better outcomes in low middle nerve paralysis. The volar slanted cut offers clear perception while isolating the FDS ligament, diminishing the frequency of flexion distortion of the ring finger.

Objective Intrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear. This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy. Methods In a prospectively gathered cohort undergoing thyroid surgery (2010–2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a ‘standard’ thyroidectomy (N = 1500). Results An intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%). Conclusion In patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy. Level of evidence IV

Objective: To assess acute otitis media with facial nerve paralysis, its prognosis, and treatment. Materials and Methods: It is a retrospective study. Thirteen patients of acute otitis media associated with facial nerve paralysis attended the outpatient department of otorhinolaryngology between May 2017 and April 2019. All patients were clinically assessed with appropriate investigations, prognosis, and treatment. Results: Out of 13 patients, 2 were identified with complete facial paralysis and the remaining 11 patients presented with incomplete paralysis. Medical treatment including antibiotics and corticosteroids failed, while myringotomy and facial nerve decompression were done with a favourable outcome. Eleven patients recovered to grade-I (House-Brackmann) and 2 cases to grade-II (House-Brackmann). Conclusion: Peripheral facial nerve paralysis in acute otitis media is rare. Antibiotics and steroids yield good outcome as conservative management. In case of failure by conservative treatment, facial nerve decompression yields a favourable outcome. Keywords: Acute otitis media, Facial nerve paralysis Myrigotomy, Facial nerve decompression.

Background: Facial paralysis is the most common pathologyof the cranial nerves. The most reliable muscle transferspresently being used include the temporalis and massetertransfers. The aim of this study is to evaluate the clinicalusefulness of transposition of the temporalis muscle in treatinglong-standing facial palsy.Methods: Ten patients attended the outpatient clinic ofPlastic Surgery Department at Assiut University Hospitalbetween April, 2014 and May, 2015 with unilateral longstandingfacial nerve paralysis. Temporalis muscle transfer usedfor correction of eye and mouth movements to improve facialsymmetry at rest as well as to recreate a new smile.Results: Patient satisfaction was moderate to high. Patientsphotographs were generally evaluated as good. There was nodonor site morbidity noted after the surgery.Conclusion: Using temporalis muscle transfer for correctionof eye closure in patients with longstanding facial paralysisis superior to other classic methods

Nicolau dermatitis (ND) is a well-known but rare adverse drug reaction involving the skin and the subcutaneous and even muscle tissues at the site of intramuscular injection (IMI). Benzathine penicillin (BP) is the most frequent medication causing serious and acute complications such as limb ischemia, compartment syndrome (CS), and nerve paralysis. The subsequent damage to the lower limb (LL) might be due to microemboli, leading to progressive deterioration of the downstream tissue bed. We describe a 7-year-old boy with a diagnosis of ND after IMI of BP and diclofenac sodium to the medial mid-right thigh. Two days earlier, the patient seemed to experience an acute suppurative complication of circumcision and underwent the aforementioned treatment (September 15, 2018). The circumcision and injection of drugs were illicitly carried out by a nonmedical practitioner. The child complained of severe pain and disability of his right LL. On admission (September 16, 2018), he was found to have acute LL ischemia and CS with cyanosis, hypoesthesia and paresis. Fasciotomy was achieved and medical therapy with heparin, corticoid, and an antibiotic was made for 7 days. Postoperative periods were uneventful. Livedoid violaceous patch and erythematous plaque and ecchymosis have evolved progressively during 10th day, with formation of a diffuse necrotic spot before healing up within 2 months. The length of hospital stay was 10 days. The rehabilitation for walking was started 2 weeks after the operation. Between 6 and 12 months of follow-up, the motor deficit involved the entire LL and persisted despite the tremendous achievement of regular neuromuscular physiotherapy. The paralysis was considered permanent.

The purpose of this study is to determine the incidence and etiology of III, IV and VI nerve paralysis with binocular diplopia in RSUD dr. Wahidin Sudiro Husodo General Hospital Mojokerto. Method of this study was descriptive study using secondary medical record data. Incidence rates are adjusted for age and sex distribution of the population. The mean age of onset was 45.6 years, seven male subjects (58.3%) and five female subjects (41.7%). We identified 12 cases of acquired III, IV and VI nerve palsy over a 4-year period. The most common cause of binocular diplopia was sixth nerve palsy (33.3%), 3 patients experienced partial third nerve palsy (25%), one patient with third nerve palsy with pupil sparing (8.3%). Most common etiology was microvascular (58,3%), neoplasms (16.7%), aneurysms (8.3%) trauma (8.3%), and post meningioma neurosurgery (8.3%). Six patients (50%) with microvascular third nerve palsy had diabetes mellitus, while 1 patient (8.3%) had grade 2 hypertension. The most common cause of binocular diplopia was VI nerve palsy. Risk factors such as hypertension and diabetes mellitus which have a significant effect on diplopia. Patients with N. III, IV and VI palsy need to be done early MRI examination so that complications and progression can be prevented.

Tapia's syndrome is characterized by peripheral damage of the hypoglossal and vagal nerves in the recurrent laryngeal branch at the cervical level. It is associated with trauma due to endotracheal intubation, direct damage to nerves X and XII, carotid dissection involving the ascending pharyngeal artery, fungal infections, and tumors. Diagnosis is based on clinical findings, primarily alterations in swallowing, speech, and tongue mobility. Reports of this syndrome are scarce in the Oral and Maxillofacial Surgery literature and the treatment remains controversial. The present report describes a 25-year-old male patient who presented Tapia's syndrome with a fracture of the mandibular ramus and the first cervical vertebra due to a firearm projectile.

In the last decade, the introduction of continuous intraoperative recurrent laryngeal nerve (RLN) monitoring (C-IONM) has enabled the operator to verify the functional integrity of the vagus nerve-recurrent laryngeal nerve (VN-RLN) axis in real-time. We aim to present the current evidence on C-IONM utility for thyroid surgery by conducting the first meta-analysis on this technique. A systematic review of literature was conducted by two independent reviewers via Ovid in the Medline, EMBASE, and Cochrane reviews databases. The search was limited to human subject research in peer-reviewed articles of all languages published between Jan 1946 and April 2020. Medical subject headings (MeSH) terms utilized were thyroid surgery, thyroidectomies, recurrent laryngeal nerve, vagal nerve, monitor, and stimulation. Thirty-eight papers were identified from Ovid, another six papers were identified by hand-search. A random effect meta-analysis was performed with assessment of heterogeneity using the I2 value. A total of 23 papers that investigated the use of continuous vagal nerve monitoring during thyroid surgery were identified. The proportion of nerves at risk (NAR) with temporary RLN paralysis postoperation was 2.26% (95% CI: 1.6-2.9, I2 = 37). The proportion of NAR with permanent RLN palsy postoperation was 0.05% (95% CI: 0.08-0.2, I2 = 0). In this meta-analysis, there is one case of temporary vagal nerve paralysis secondary to VN electrode dislodgement, and a case of hemodynamic instability manifested in bradycardia and hypotension in the initial phase of surgery shortly after calibration. C-IONM is a safe and effective means by which RLN paralyses in thyroid surgery can be reduced.

Impacted third molar is more likely to have inferior alveolar nerve involvement. Surgical extraction of this tooth without proper evaluation of pre operative investigations can lead to neurovascular damage which will lead to sensory loss in lower lip that is extremely unpleasant to the patient. This review article is to gain knowledge about how to know the association of nerve injury in the surgical extraction of mandibular third molar and its preservation technique

PURPOSE Lemierre syndrome is a life-threatening condition characterized by head/neck bacterial infection, local suppurative thrombophlebitis and septic embolic complications in a range of sites of distant organs. No prior study focused on the course and characteristics of ophthalmic complications of Lemierre syndrome. METHODS We analysed data of 27 patients with ophthalmic complications from a large cohort of 712 cases with Lemierre syndrome reported globally between 2000 and 2017. We focused on initial manifestations, early (in-hospital) course and long-term ophthalmic deficits at the time of hospital discharge or during postdischarge follow-up. The study protocol was registered in the International Prospective Register of Systematic Reviews PROSPERO (CRD42016052572). RESULTS Nine (33%) patients were women; the median age was 20 (Q1-Q3: 15-33) years. Fusobacterium spp. was involved in 56% of cases. The most prevalent initial manifestations were decreased vision (35%) and periocular oedema (38%), followed by impaired eye movements/nerve palsy (28%) and proptosis (28%). Venous involvement, notably cerebral vein thrombosis (70%) and ophthalmic vein thrombosis (55%), explained the symptomatology in most cases. Septic embolism (7%), orbital abscesses (2%) and carotid stenosis (14%) were also present. Ophthalmic sequelae were reported in 9 (33%) patients, often consisting of blindness or reduced visual acuity, and nerve paralysis/paresis. CONCLUSION Ophthalmic complications represent a severe manifestation of Lemierre syndrome, often reflecting an underlying cerebral vein thrombosis. Visual acuity loss and long-term severe complications are frequent. We call for an interdisciplinary approach to the management of patients with Lemierre syndrome and the routine involvement of ophthalmologists.

Pure neuritic leprosy involves single or multiple nerves, often in different limbs (mononeuritis multiplex); however, it may rarely present with symmetrical distal neuropathy, referred to as “mononeuritis multiplex summation.”

Background : Temporohyoid osteoarthropathy (THO) is a progressive disease that causes acute onset of peripheral vestibular signs with or without facial paralysis. Ankylosis of temporhyoid joint occurs which predispose to fractures of the involved bones and consequently causes the commonly neurological signs observed. Clinical signs vary depending on the stage of the disease and the nerves affected. Surgical treatment is advised to improve survival rates in which the ceratohyoidectomy is currently known as the most advantageous. The aim of the present study is to report a case and outcome of a ceratohyoidectomy procedure in a Criollo mare presenting THO of the right temporohyoid joint. Case : A 17-year-old Criollo mare was referred to the Equine clinical hospital of the Federal University of Pelotas with a 5-day history of facial paralysis on the right side, head tilt and difficulty to chew and swallow. Auricular, palpebral and labial ptosis along with deviation of the lip and nostril to the left were observed. A corneal ulcer was also identified in the right eye. Complementary imaging exams (endoscopy of the guttural pouches and radiography of the head) were performed and showed thickening of the right stylohyoid bone confirming a diagnosis of THO. Anti-inflammatory and antibiotic therapy were administered and the corneal ulcer was treated with topical antibiotics and autologous serum. Due to rapid deterioration of clinical signs, the mare was referred to surgery. A ceratohyoidectomty procedure was performed under general anesthesia. In this procedure, the ceratohyoid bone was disarticulated from the ceratohyoid-basihyoid joint and removed. During the procedure, a branch of the linguofacial vein was accidentally incised causing hemorrhage, the branch was identified and successfully ligated. Recovery was uneventful. Supportive treatment with anti-inflammatory and antibiotics was continued after surgery and two sessions of electro-acupuncture was also performed to improve the nerve paralysis. The electro-acupuncture was discontinued due to mare’s negative behavior on needle insertion in the face. The treatment of the ulcer was changed since no improvement was observed in the first days. Twenty-eight days after hospitalization, the mare was discharged with the ulcer healed and significant improvement of neurological signs. A complete recovery occurred within three months. Discussion : The Criollo mare was referred to the hospital presenting mild neurological signs consistent with vestibular alteration and facial nerve paralysis. The THO diagnosis was confirmed using complementary imaging exams in which the endoscopy of the guttural pouch is considered the most common when computed tomography, a more sensitive one, is not available. Unilateral ceratohyoidectomy was performed as a surgical choice of treatment since it has a higher survival rate and lower recurrence rate in comparison to medical treatment and to stylohyoidectomy. As the main intraoperative complication, a vessel was accidentally incised, however this is described to occur in some cases. Despite that, the procedure was successfully performed and the mare had a complete recovery of the neurological signs and corneal ulcer. In conclusion, this report showed that it is important to have a complete diagnosis of these diseases and a consistent treatment plan to improve patient’s survival and quality of life. Keywords: neurologic disease, peripheral vestibular signs, facial paralysis, ceratohyoid bone, ceratohyoidectomy.

RESUMEN La parálisis facial producida por tumoraciones a nivel parotídeo suele ser sugestiva de malignidad. Es extremadamente infrecuente su asociación con procesos tumorales benignos o cuadros infecciosos. Menos de veinte casos de parálisis facial secundaria a la presencia de un absceso parotídeo están descritos en la literatura. El mecanismo por el cual se produce es desconocido. Se postula que los productos tóxicos secretados por el patógeno, así como la compresión del nervio debida a la inflamación glandular podrían desencadenar una perineuritis y una neuropatía isquémica que justificarían el cuadro. La hidratación y antibioterapia de amplio espectro asociada a un drenaje quirúrgico precoz constituyen el tratamiento de elección. En la mayoría de los pacientes, esta actitud consigue resolver el cuadro infeccioso agudo y, con ello, la parálisis facial asociada. Presentamos el caso de una paciente de 48 años que desarrolló una parálisis de la rama marginal del nervio facial izquierda en el contexto de un absceso intraparotídeo.

KD is an acute, self-limited febrile illness. Although significant long-term sequelae are confined to the coronary arteries, multiple other organs and tissues are inflamed during the acute illness and causing clinical symptoms. Likewise, irritability and a culture-negative pleocytosis of the cerebrospinal fluid in infants with prolonged fevers suggest that aseptic meningitis may develop in patients with KD. But it is usually overlooked. Common complications of nervous system in KD children include: aseptic meningitis as the most common one, seizures, temporary hemiplegia, facial paralysis, ataxia, hearing impairment, visual abnormalities, and behavioral abnormalities can also be associated (Alves et al., Rev Assoc Med Bras 57(3):299–300, 2011; Poon et al., Hong Kong Med J 6(2):224–226, 2000; Knott et al., Am J Otolaryngol 22(5):343–348, 2001). Neurological involvement in children with KD may be due to ischemic effects of small vessel inflammation which cause neuritis, ischemia, and increased intracranial pressure. The symptoms of abducens nerve palsy in some children with KD recovered after 2–6 weeks of treatment (Amano and Hazama, Acta Pathol Jpn 30(3):365–373, 1980). Histopathological examination of KD nervous system showed edema, necrosis, glial cell hyperplasia, lymphocyte invasion, etc. (Guven et al., Pediatr Int 52(2):334, 2010; Rodriguez-Lozano et al., Allergol Immunopathol (Madr) 42(1):82–83, 2014). In our department, aseptic meningitis is the most common one. We saw abduction nerve paralysis in one KD patient, and abnormal EEG lasted over 4 months in another patient. In most of the children, neurological impairments were recovered within one month.

Advancements in thoracoscopic surgery have provided us with a deeper anatomical understanding of recurrent laryngeal nerve paralysis (RLNP), which is likely to occur after lymph node dissection. Taking a novel approach to researching the diagnosis of RLNP, we evaluated movement of the vocal cords and arytenoid cartilages using ultrasonography in patients who underwent thoracoscopic esophagectomy. RLNP occurred in six of the 24 patient cohort. The rate of hoarseness and difficulty in discharging sputum was significantly higher in the paralyzed group than in the non-paralyzed group. The diagnostic accuracy of RLNP by ultrasonography had a sensitivity of 83.3% (5/6), a specificity of 88.8% (16/18), a false positive rate of 5.6% (1/18), and a false negative rate of 0% (0/6). Although it is not completely accurate, our findings indicate that ultrasonography is quite effective for diagnosing RLNP, more so in combination with clinical symptoms. Ultrasonography may also be effective for identifying patients who are amenable to laryngoscopy for diagnosing RLNP, or for evaluating the recovery status of nerve paralysis.

BACKGROUND No dynamic technique, such as tendon transfer, has been described for scapular winging due to levator scapulae or rhomboid major and minor palsies resulting from an isolated dorsal scapular nerve injury. Thus, we evaluated how the contralateral trapezius compound osteomuscular flap transfer would work in stabilizing lateral scapular winging, and the case is reported here. A literature review was also conducted, and articles relevant to the case are presented. CASE SUMMARY A 37-year-old male patient who had sustained an isolated dorsal scapular nerve injury underwent reconstructive surgery using the contralateral trapezius compound osteomuscular flap transfer technique to treat scapular winging and the consequent pain, and to restore function from the shoulder impairment. As a result, the involved shoulder showed an improved Constant-Murley score, from 19.5% to 81.88%. CONCLUSION Contralateral trapezius osteomuscular flap transfer succeeded in stabilizing scapular winging in this case, improving shoulder function and affording pain relief.

Herpes zoster (HZ) is related with the reactivation of latent varicella-zoster virus (VZV) infection. This infection is associated with HZ-oticus, HZ-ophthalmicus, and disseminated-cutaneous HZ. Here, we report a case of an adolescent male who presented with vesicular-eruptions in the left-forehead. The physical examination showed vesicles on the left V1-dermatome and external auditory canal, associated with ipsilateral periorbital oedema, peripheral VII nerve paralysis, hyperacusis, and tinnitus. Acyclovir, eye lubrication, and ophthalmic prednisolone were started. On second admission day, he developed vesicular lesions throughout the body. Polymerase chain reaction (PCR) of the draining vesicles was VZV-positive.

One of the most prevalent neurological illnesses affecting the VII cranial nerve is paralysis of facial nerve. The loss of sophisticated and multidimensional capabilities such as expression of emotions via facial mimicry, face identification, and communication is caused by nerve paralysis. Through stimulation of the proprioceptors, the Kabat rehabilitation therapy for facial paralysis can trigger or restore the neuromuscular circuit, restoring the normal functionality of nerve terminals in the muscles.This study aims to show how a patient can gain functional & aesthetic benefits through detailed clinical evaluation followed by kabat rehabilitation. Functionality evaluation of the facial nerve was based on the SFGS,FDI and H- B scales Patients who were treated with kabat rehabilitation method restored motor capacities of the paralysed hemifacia. Keywords: Kabat rehabilitation, facial nerve, facial palsy, proprioceptive facilitation, rehabilitation.

Background and objective Microfocused ultrasound (MFUS) technology has been utilized since 2009 for improvement in mild to moderate skin and soft tissue laxity of the face and neck. Few complications have been previously reported, the majority of which include mild and transient erythema, edema, ecchymosis, and nerve paralysis. Rare yet serious potential complications of MFUS for noninvasive skin tightening of the face and neck are, however, possible. Methods & materials Retrospective multicenter case series of five patients from the authors' practice who developed serious adverse events directly related to MFUS with a commercially available device (Ultherapy; Merz North America, Inc., Raleigh, NC). Results Five patients developed blistering, erosion/ulceration, cutaneous, or subcutaneous tissue edema with resulting atrophy, and/or cutaneous necrosis following single sessions of MFUS. Conclusion Despite their rarity, serious adverse events secondary to MFUS are nevertheless possible and may be underreported. Early management of complications includes local wound care, patient reassurance, and topical corticosteroids and/or pulsed-dye laser to mitigate inflammatory sequelae. Other cosmetic and surgical therapies should be utilized when conservative measures have failed. Lasers Surg. Med. 50:13-19, 2018. © 2017 Wiley Periodicals, Inc.

Study DesignRetrospective, observational, single-center study.PurposeTo investigate the long-term outcomes of in situ fusion procedures for treating dysplastic spondylolisthesis.Overview of LiteratureIn situ fusion performed in patients with dysplastic spondylolisthesis avoids the development of nerve complications.MethodsIn total, 12 of 28 patients who underwent in situ fusion for treating dysplastic spondylolisthesis at Chiba University Hospital from 1974 to 2004 were followed up in August 2013. Surgical complications were evaluated. Low back pain and leg pain were assessed using a visual analog scale (VAS). Vertebral alignment, including the lumbosacral angle and lumbar lordosis angle measurement on radiographic images (profile view in the neutral standing position), was evaluated during preoperative, postoperative, and final examinations.ResultsThe mean follow-up duration, patient age at the final examination, and patient age at operation were 20.0±7.2, 42.3±13.3, and 22.3±11.4 years, respectively. No complications were reported. Mean VAS scores for low back pain and leg pain were significantly lower at the final examination than at the preoperative examination (ppConclusionsIn situ fusion performed in patients with dysplastic spondylolisthesis avoids the development of nerve complications such as nerve paralysis that may occur after repositioning operation and maintains appropriate long-term sagittal alignment, even 20 years after operation.

Herpes zoster oticus (Ramsay Hunt Syndrome) is characterized by facial nerve paralysis, ear pain and auricular skin rash. It occurs as a result of reactivation oflatent varicella zoster virus infection in the geniculate ganglion of the facial nerve. Major clinical symptoms include 7th nerve paralysis or cranial nerve paralysis and vesicles along the nerve with cocomitant ear pain. Other cranial nerve involvement although uncommon, can be found in some cases. In this study, a 74-year-old female patient had ipsilateral 8th, 9th and 10th cranial nerves injury. Cranial nerve paralysis accompanied with injury has been repor ted in R amsay Hunt Syndrome.

Objective: This study presents the effects of intraoperative nerve monitoring on RLN injuries in patients who underwent primary surgery for benign thyroid pathology. Methods: We retrospectively evaluated the data of 273 patients who had primary thyroidectomy due to benign thyroid pathology between January 2012 and July 2017. The patients were classified into two groups. Group-1 consists of patients whose nerves were monitored. We separated the patients whose nerves were not monitored into Group-2. Results: There were 140 and 133 patients in Groups 1 and 2, respectively. Regarding the age, gender and surgical indication between the groups, statistically significant difference was not found (P > 0.05). In Group-1, transient paralysis developed in four patients (2.9%). The permanent paralysis developed in one patient (0.7%). In Group-2, transient paralysis developed in nine patients (6.8%). The permanent paralysis developed in four patients (3%). When the groups were evaluated, there was statistically significant difference in terms of transient and permanent paralysis (P=0.01, P =0.001, respectively). Conclusions: In view of the negative effects of RLN injury on the patient, we think that intraoperative nerve monitoring should be used routinely in benign thyroid surgeries.

Background: Associated laryngeal paralysis (ALP) is defined as vagus nerve impairment combined with other lower cranial nerve paralysis. Traumatic ALP is reported infrequently. Case: A 72-year-old man was injured on the back of the head when a large tree fell on him; he was admitted to a general hospital, where he was diagnosed with brain concussion and Guillain-Barre syndrome (GBS). The patient developed aspiration pneumonia due to severe dysphagia. Although he underwent treatment and rehabilitation for 6 months, some disabilities persisted, and a percutaneous endoscopic gastrostomy tube was placed. Six months after the accident, the patient was transferred to our rehabilitation hospital. Videoendoscopic examination and videofluoroscopy revealed persistent upper esophageal sphincter (UES) opening, left dominant bilateral IX and X nerve paralysis, and left XII nerve paralysis; moreover, these examinations showed that the swallowing reflex was absent, although a bolus could pass through the UES. We suspected that the patient’s condition was not GBS and performed head computed tomography and magnetic resonance imaging; these revealed a bone fracture at the skull base. Consequently, the patient’s diagnosis was changed to bilateral ALP. He received swallowing rehabilitation for 2 months and could orally consume alternative nutrition. Finally, the patient was able to eat orally texture-modified foods (Food Intake LEVEL Scale level 8). Discussion: While post-trauma dysphagia due to bilateral ALP might be severe, patients can regain the ability to eat orally if clinicians understand the etiology of dysphagia and provide appropriate swallowing rehabilitation techniques, including patient position adjustment while eating and selection of food textures.

Botulinum neurotoxins (BoNTs) are a growing family of bacterial protein toxins that cause botulism, a rare but often fatal animal and human disease. They are the most potent toxins known owing to their molecular architecture, which underlies their mechanism of action. BoNTs target peripheral nerve terminals by a unique mode of binding and enter into their cytosol where they cleave SNARE proteins, thus inhibiting the neurotransmitter release. The specificity and rapidity of binding, which limits the anatomical area of its neuroparalytic action, and its reversible action make BoNT a valuable pharmaceutical to treat neurological and non-neurological diseases determined by hyperactivity of cholinergic nerve terminals. This review reports the progress on our understanding of how BoNTs cause nerve paralysis highlighting the different steps of their molecular mechanism of action as key aspects to explain their extreme toxicity but also their unique pharmacological properties.

WOS:000526932100054 PubMed: 32063974 Objective: This study presents the effects of intraoperative nerve monitoring on RLN injuries in patients who underwent primary surgery for benign thyroid pathology. Methods: We retrospectively evaluated the data of 273 patients who had primary thyroidectomy due to benign thyroid pathology between January 2012 and July 2017. The patients were classified into two groups. Group-1 consists of patients whose nerves were monitored. We separated the patients whose nerves were not monitored into Group-2. Results: There were 140 and 133 patients in Groups 1 and 2, respectively. Regarding the age, gender and surgical indication between the groups, statistically significant difference was not found (P > 0.05). In Group-1, transient paralysis developed in four patients (2.9%). The permanent paralysis developed in one patient (0.7%). In Group-2, transient paralysis developed in nine patients (6.8%). The permanent paralysis developed in four patients (3%). When the groups were evaluated, there was statistically significant difference in terms of transient and permanent paralysis (P=0.01, P = 0.001, respectively). Conclusions: In view of the negative effects of RLN injury on the patient, we think that intraoperative nerve monitoring should be used routinely in benign thyroid surgeries.

Author(s): Sahyouni, Ronald; Chang, David T; Moshtaghi, Omid; Mahmoodi, Amin; Djalilian, Hamid R; Lin, Harrison W | Abstract: Permanent injury to the cranial nerves can often result in a substantial reduction in quality of life. Novel and innovative interventions can help restore form and function in nerve paralysis, with bioelectric interfaces among the more promising of these approaches. The foreign body response is an important consideration for any bioelectric device as it influences the function and effectiveness of the implant. The purpose of this review is to describe tissue and functional effects of chronic neural implantation among the different categories of neural implants and highlight advances in peripheral and cranial nerve stimulation.Data Sources: PubMed, IEEE, and Web of Science literature search.Review Methods: A review of the current literature was conducted to examine functional and histologic effects of bioelectric interfaces for neural implants.Bioelectric devices can be characterized as intraneural, epineural, perineural, intranuclear, or cortical depending on their placement relative to nerves and neuronal cell bodies. Such devices include nerve-specific stimulators, neuroprosthetics, brainstem implants, and deep brain stimulators. Regardless of electrode location and interface type, acute and chronic histological, macroscopic and functional changes can occur as a result of both passive and active tissue responses to the bioelectric implant.A variety of chronically implantable electrodes have been developed to treat disorders of the peripheral and cranial nerves, to varying degrees of efficacy. Consideration and mitigation of detrimental effects at the neural interface with further optimization of functional nerve stimulation will facilitate the development of these technologies and translation to the clinic.3.

Facial nerve palsy is usually associated with a malignant parotid neoplasm; it is highly unusual for it to result from a benign situation, such as inflammation or infection of the parotid gland. Surgery along with prompt medical treatment is the mainstay, and in the majority of the patients, nerve paralysis recovers in the follow-up period. We report a case of a 50-year-old non-diabetic non-hypertensive female who presented with odynophagia, left-sided parotid swelling, and left facial nerve palsy. The diagnosis of facial nerve palsy due to a parotid abscess extending to the parapharyngeal space was made. Facial palsy fully recovered within 2 months.

Hemangiomas are benign vascular soft tissue tumors, which most frequently occur in the skin or subcutaneous tissue. Intramuscular hemangiomas typically occur in the trunk and extremities and less frequently in the head and neck. Among these, those occurring in the temporalis muscle are extremely rare. The authors report the case of a 43-year-old Japanese male with a mass in his left temporal fossa. Computed tomography images showed no erosion of the zygomatic bone, and magnetic resonance imaging revealed an ovoid well-marginated mass within the temporal muscle. The lesion was surgically excised with an endoscopy procedure used for minimally invasive lesions and complete removal. Histopathological examination confirmed the diagnosis of intramuscular cavernous hemangioma. The postoperative clinical course was good, with no indications of temporary nerve paralysis. No signs of local recurrence were observed postoperatively. Therefore, a cavernous hemangioma should be suspected when a mass occurs in the temporal region with accompanying radiologic findings suggesting vascular origin. In surgical treatment, the endoscopy-assisted technique is very useful to achieve complete tumor resection and prevent relapse while avoiding serious complications due to surgical procedures.

Needle electromyography is an important tool in the diagnosis of neuromuscular diseases and has also been applied successfully in the evaluation of the vocal cord paralysis. Laryngeal electromyography, initially described by Weddell, is used to determine the cause of vocal cord paralysis and to differentiate organic from nonorganic causes of speech disorders. This test allows the diagnosis of lower motor neuron and nerve paralysis as well as myopathies. Laryngeal electromyography also helps to determine the prognosis of paralysis caused by traumatic injury of the laryngeal nerves and is used for guidance during botulinum toxin injection in spasmodic dysphonias. Single fiber electromyography is used to diagnose abnormalities of neuromuscular transmission and is applied in the study the architecture of the motor unit in muscles. This article reviews the techniques of laryngeal muscles single fiber electromyography, provides limited informative data, and discusses its potential value in the evaluation of patients with dysphonia.