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Upper Airway Obstruction and Tracheostomy
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Surgery is directed at improving the aperture of the posterior glottis. Endoscopic partial posterior cordectomy and partial arytenoidectomy can be performed using the CO2 laser or where there is potential for recovery in time, a tracheostomy or vocal cord suture lateralisation procedure may be performed temporarily. Various reinnervation operations have been described; however, these are infrequently performed. Inter-arytenoid scarring can be treated with posterior laryngeal mucosal advancement flaps or posterior cricoid split with cartilage grafting; however, aspiration is almost universal post-operatively.
Skeletal Muscle
Published in Manoj Ramachandran, Tom Nunn, Basic Orthopaedic Sciences, 2018
Mike Fox, Steve Key, Simon Lambert
Reinnervation:Early: reduced amplitude motor action potentials, longer duration;poor recruitment.Late: large amplitude, stable, consistent firing motor action potentials;good recruitment of units gives polyphasic signal.
The Facial Nerve and its Non-Neoplastic Disorders
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Christopher Skilbeck, Susan Standring, Michael Gleeson
Spontaneous axonal regeneration following this type of injury will be imperfect and disorderly, and may not occur at all. Distance is a significant factor in recovery, particularly after proximal injuries in limb nerves, because regrowing axons may fail to reach their target organs before the latter disappear. Changes in fibre type and loss of striated muscle mass begin within days after denervation; up to 80% of muscle volume may be lost by 4 months and irreversible muscle fibrosis and fatty infiltration occurs after 2 years.75–77 Some reconstructive surgeons regard functional reinnervation as unlikely beyond 12–18 months. Even after repair, muscles usually exhibit weakness, impaired coordination and reduced stamina; regeneration of the largest diameter axons and coactivation of ± and ³ efferents may fail. Cutaneous sensory receptors undergo a slow degenerative change after denervation and may disappear after 3 years. Their reinnervation tends to reverse these changes, particularly if the injury occurs close to the end organs and the nerves involved are sensory, however, the longer the period of denervation, the less complete will be the regeneration. Attempts to increase the rate of axonal regrowth in various experimental animal models remain disappointing.
Clinical Outcomes of Minimally Invasive Corneal Neurotization After Cerebellopontine Angle Neurosurgical Procedures
Published in Current Eye Research, 2022
Yue Wu, Jiaying Zhang, Wei Ding, Gang Chen, Chunyi Shao, Jin Li, Wenjin Wang, Wei Wang
In our study, 12 patients all had a long duration of NK for 3.7 ± 5.0 years after the cranial tumor surgery and conventional treatments did not show efficacy for them. Clinical outcomes have shown that 12 months after MICN, both corneal sensation and corneal nerve fiber length significantly improved. And 18 months after MICN, the clinical evaluative indicators of cornea including corneal sensation, corneal subbasal nerve fiber length and recovery of corneal defects were all close to normal. As a result of these clinical outcomes, MICN is proved to be an effective approach to help restore corneal innervation in patients with the trigeminal nerve injury after cranial tumor surgeries. The process of corneal reinnervation has been reported varying from 6 months to 4 years, and quicker recoveries were seen in younger patients. In 2019, Catapano et al. reported that mean CCS was 30 mm at 6 months after MICN in 16 patients whose mean age at the time of surgery was 12.5 years.17 In our study, mean age of the 12 patients at the time of surgery was 32.5 years, which may be responsible for the longer process of recovery.
Contralateral orbicularis oculi muscle transposition in facial paralysis: functional, aesthetic and electromyographic outcomes. A case report and literature update
Published in Orbit, 2022
Pedro Fernández-Pérez, Ricardo Romero-Martín, Bárbara González-Ferrer, Margarita Sánchez-Orgaz, Álvaro Arbizu-Duralde, Rafael Montejano-Milner
The viability of orbicularis flaps was first described by Hockman et al14 in 1992, in a study conducted on cats and dogs with intentionally severed facial nerves. In the mentioned study, the authors restored synchronous reflex blinking to the denervated eyelid using a narrow strip of orbital and preseptal orbicularis oculi muscle raised from the contralateral side. Hockman et al believed that this could be explained by motor fibres of the facial nerve coursing through the medial canthal region supplying the upper lid portion of the muscle. Thus, despite the innervation fibres of the facial nerve being cut on the temporal side, this orbicularis flap may maintain motor innervation from the facial nerve on the healthy side from the nasal edge. After the procedure, reinnervation takes place in the orbicularis oculi of the affected side, restoring its function.
Identifying priorities and developing strategies for building capacity in amputation research in Canada
Published in Disability and Rehabilitation, 2021
Sander L. Hitzig, Amanda L. Mayo, Ahmed Kayssi, Ricardo Viana, Crystal MacKay, Michael Devlin, Steven Dilkas, Aristotle Domingo, Jacqueline S. Hebert, William C. Miller, Jan Andrysek, Fae Azhari, Heather L. Baltzer, Charles de Mestral, Douglas K. Dittmer, Nancy L. Dudek, Sharon Grad, Sara J. T. Guilcher, Natalie Habra, Susan W. Hunter, W. Shane Journeay, Joel Katz, Sheena King, Michael W. Payne, Heather A. Underwood, José Zariffa, Andrea Aternali, Samantha L. Atkinson, Stephanie G. Brooks, Stephanie R. Cimino, Jorge Rios
In Québec, osseointegration [89], which consists of a surgically inserted titanium rod into the residual limb to connect to an individual’s prosthesis, is now listed as a covered procedure under its public health insurance plan, and offers a unique opportunity to embed a variety of evaluations (lived experience, economic, functional, etc.) to help gather much needed data to facilitate this procedures inclusion in other provincial health care insurance plans. In Alberta, there is recently approved funding for a case series of lower limb osseointegration. These approvals emphasize the need for a standard approach across Canada to provide equal treatment opportunities for all Canadians with limb amputation. Targeted reinnervation surgery has also been clinically available for over a decade in Alberta, and has led to international collaborations exploring novel UEA prostheses and the development of outcome measures to assess their effectiveness [35,90]. Finally, British Columbia has had success in accessing national data sets related to amputation [26] and experience in conducting nationwide surveys to evaluate clinical capacity for rehabilitation care [26,41]. This expertise and experiences can be useful for outreach to limb loss rehabilitation programs across Canada.