China
Africa
Explore chapters and articles related to this topic
Surgery of the Peripheral Nerve
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ravikiran Shenoy, Gorav Datta, Max Horowitz, Mike Fox
After nerve decompression, patients are told to leave their bulky dressings in place until they have a wound inspection 2 weeks postoperatively. Instruction to begin early hand and finger mobilisation is encouraged in upper limb surgery.
Clefts and craniofacial
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
It is self-limiting (by about the patient’s 30s) but will not regress. The main options in treatment include curettage (20%–30% recurrence) or, preferably, total excision and reconstruction. Bone grafts placed in areas of disease tend to become replaced by fibrous dysplasia. Nerve decompression may be needed.
Ear trauma
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
Facial nerve paralysis can occur in approximately 50% of transverse and 20% of longitudinal fractures.7 It occurs most commonly in fractures involving the otic capsule. The two most important prognostic indicators of facial recovery following a temporal bone fracture include the time of onset (immediate or delayed) and the severity of the palsy (complete/total or incomplete/partial). This can be challenging to assess in patients with multiple injuries and especially in those who are sedated and ventilated. When possible, the facial nerve function should be assessed and documented using the House-Brackmann (HB) grading system. The decision to explore should be based on whether the facial palsy is complete and immediate, together with information from high-resolution CT imaging. Management options include nerve decompression, immediate anastomosis or cable nerve grafting using either the greater auricular or sural nerve.
Clinical efficacy of the ‘sandwich technique’ in repairing cholesteatoma with labyrinthine fistula
Published in Acta Oto-Laryngologica, 2022
Huanhuan Sun, Taiqin Wang, Liangwen Shi, Suling Zhuang, Jianzhi Liu
All of these patients had been treated by canal wall down mastoidectomy (CWDM) or canal wall up mastoidectomy (CWUM) with tympanoplasty. The cholesteatoma epithelium covering the labyrinth fistula is left until the final surgical treatment, gently peeled the cholesteatoma matrix from the fistula with a small cotton ball and particular care was applied in order to not suck the perilymph. Once the fistula is exposed, injected with dexamethasone (Figure 1); thereafter, the site was immediately sealed off using a ‘sandwich’ of the temporalis fascia, bone powder or cartilage, and temporalis fascia (Figure 2). Ossiculoplasty was carried out simultaneously in 31 cases (14 total ossicular replacement and 16 partial ossicular replacements). We performed facial nerve decompression on two patients with facial paralysis (decompression until normal epineurium is exposed). Muscle periosteal flaps were used to narrow the mastoid cavity, and gelatin sponges were used to maintain the reconstruction in place. Antibiotics were used for 3–7 days (mean 5 days) after surgery to prevent infection. All the surgeries were performed by the same surgeon.
Analysis on outcomes of facial paralysis complicated by middle ear cholesteatoma
Published in Acta Oto-Laryngologica, 2019
Qiang Li, Yanfei Jia, Qian Feng, Bo Tang, Xiaodong Luo, Peng Xu, Daowen Wang, Xuanfen Zhang
Facial paralysis is an uncommon complication of chronic otitis media, especially middle ear cholesteatoma (MEC). The reported incidence of facial paralysis in chronic otitis media ranges from 0.16 to 5.1% [1,2]. For such facial paralysis, conservative and surgical treatments are usually applied according to previous reports. Surgical treatments consist of facial nerve exploration, facial nerve decompression, facial nerve repair and facial nerve grafting [3–5]. For facial paralysis complicated by MEC, radical or modified radical mastoidectomy is usually applied to completely remove the cholesteatoma and the lesions, and intraoperative exploration is adopted. If necessary, facial nerve decompression will be performed. The prognostic factors of facial paralysis complicated by MEC are still largely unclear due to limited reports and smaller sample size, although it seems that early surgical intervention leads to better facial nerve outcomes [6,7]. Therefore, we performed a retrospective analysis on a large series of patients with facial paralysis complicated by MEC who received surgical treatment to analyze prognostic factors of facial paralysis.
Delayed transmastoid facial nerve decompression surgery in patients with Ramsay-Hunt syndrome presenting with neurophysiologically complete paralysis
Published in Acta Oto-Laryngologica, 2018
Yoshihiko Kumai, Momoko Ise, Satoru Miyamaru, Yorihisa Orita
Transmastoid facial nerve decompression surgery is generally considered for such patients with poor prospects of recovery. However, Gantz previously suggested that late surgical decompression to treat RHS patients should no longer be recommended because of a lack of evidence of success [4]. Transmastoid facial nerve decompression surgery to relieve acute facial paralysis is generally believed to be beneficial if performed within 14 d from paralysis onset especially for Bell’s palsy patients [5]. Fisch emphasized that the timing of surgery to treat maximal Wallerian degeneration in patients with acute facial nerve paralysis is critical for facial paralysis secondary to fractures, iatrogenic injury, and Bell’s palsy [6]. Obviously, capacity of the operating room is limited strictly and physicians of other medical department in our hospital are often faced with the need to deal with other life-threatening conditions in patients; thus, delays in transmastoid facial nerve decompression surgery of more than 3 weeks from symptom onset, which is not life-threatening, are common and not the first priority in our hospital.