Radiofrequency lesioning and treatment of chronic pain
Harald Breivik, William I Campbell, Michael K Nicholas in Clinical Pain Management, 2008
The patient is placed in a horizontal recumbent position. The patient’s head is fixed on a radiolucent head rest by an adhesive bandage. The intervention is performed under intermittent intravenous anesthesia with propofol. Great care must be taken to obtain an optimal picture of the foramen ovale. For this purpose, the C-arm of the image intensifier is placed in a caudal/cranial direction at an angle of approximately 45° to the horizontal plane and rotated 15–20° sideways. Consequently, a suborbital–occipital projection is obtained. The projection shows the ascending ramus and the angle of the mandible. The foramen ovale can be discerned medial to the ascending ramus. Subsequently, a marker ruler is placed on a spot on the skin overlying the projection of the foramen and an ink mark is made.
Head and Neck
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
The muscles of facial expression are innervated by the facial nerve (CN VII) (Plates 3.16, 3.26, and 3.27). Just anterior to the ear lobe, a few branches of the facial nerve emerge from the stylomastoid foramen, including the branches that form the parotid plexus within the parotid gland. The parotid plexus of the facial nerve gives off the temporal branch crossing the zygomatic arch; the zygomatic branch crossing the zygomatic bone; the buccal branches crossing the superficial surface of the masseter muscle; the mandibular (or marginal mandibular) branch that parallels the inferior margin of the mandible; and the cervical branch that crosses the angle of the mandible to enter the neck. In human anatomy, these are usually considered to be branches of the facial nerve, and not discrete nerves themselves. For instance, the buccal branch of the facial nerve crosses the superficial surface of the masseter muscle to provide motor innervation to the buccinator muscle, while the buccal nerve of the trigeminal mandibular division (CN V3) emerges from deep to the masseter muscle to innervate the skin of the cheek, and to pierce the buccinator to provide sensory innervation to the cheek mucosa. Other branches of the facial nerve are the posterior auricular nerve, which innervates some facial expression muscles, and the nerves to the stylohyoid muscle and to the posterior digastric muscle, which innervate the stylohyoid and posterior digastric muscles, respectively.
Long and short cases
Vivian A. Elwell, Ramez Kirollos, Syed Al-Haddad in Neurosurgery, 2014
Examination of cranial nerve V is straightforward. The time taken for this examination is variable. The most sensitive test for cranial nerve V dysfunction is the loss of corneal reflex. (This is usually the only deficit even with a large trigeminal schwannoma.) In cases where you do not detect a blink reflex, ask the patient whether he or she can feel the stimulus. If the patient wears contact lenses, the blink reflex would be absent bilaterally. When testing the sensory branches of the cranial nerve V, it is important to apply the stimulus to each division (ophthalmic, maxillary and mandibular branches). For testing sensation in the maxillary division, apply the stimulus near the nasolabial fold or on the midline of the cheek. For testing sensation over the mandibular division, apply the stimulus on the anterior chin nearest to the midline. Avoid the skin over the angle of the mandible because this can also be supplied by the upper cervical cutaneous nerves. When testing for light touch and pinprick in the three divisions, a discrete lesion in the brainstem may only affect one modality. In cases of central brainstem lesions such as syringobulbia, patients may present with an appearance of an ‘onion peel’, ‘onion skin’ or a ‘balaclava helmet’. Examination of the motor component of cranial nerve V should be quick. Palpate for the contraction of the masseter while the patient clenches the teeth, then assess lateral lower jaw movements against resistance.
Improving mandibular contour: A pilot study for indication of PPLA traction thread use
Published in Journal of Cosmetic and Laser Therapy, 2018
Stefania Guida, Flavia Persechino, Giuseppe Rubino, Giovanni Pellacani, Francesca Farnetani, Giacomo Giovanni Urtis
A schematic representation of threads and the appearance of the skin immediately after the procedure are reported in Figure 1. PLLA threads (Silhouette Lift S.L., Barcelona, Spain. Silhouette Lift Inc Irvine, CA) show bidirectional cones. We used threads with four cones, each composed of lactide glicolide per direction (eight in total), separated by knots. After local anesthesia in entry and exit points, a hole is performed in the skin 1 cm above and below the mandibular angle with an 18G needle. The thread is introduced in a depth of about 5 mm (5 cm from the exit point in two different directions) through the hole. In particular, the superior entry point should be located along the line linking the angle of the mandible and ala nasi, whereas for the inferior one a skin fold should be performed in order to avoid any damage to underlying structures when creating the entry point. Furthermore, establishing the exit point is essential to exert the maximum traction effect. In detail, the upper exit point of both threads should anchor the thread to the temporal (for the upper thread) and mastoid (for the lower thread) fascia. When each branch of the thread has been introduced, the skin is tightened between the two ends and the thread is cut at the level of the skin (Figure 1).
A novel treatment of pediatric bilateral condylar fractures with lateral dislocation of the temporomandibular joint (TMJ) using transfacial pinning
Published in Case Reports in Plastic Surgery and Hand Surgery, 2023
Kerry A. Morrison, Roberto L. Flores
After right nasal endotracheal tube insertion with general anesthesia was achieved, attention was drawn to closed reduction of the fracture, as significant widening of the bigonial width and lateral dislocation of the left TMJ was a consequence of this tripartite fracture. Firm medial pressure at the mandibular angle was required to relocate the condyle on the left side and reduce the lower facial width. Appropriate reduction was confirmed by resolution of the anterior crossbite when the patient was brought into occlusion. Furthermore, temporomandibular joint was externally palpated with the jaw both open and closed, confirming reduction of the laterally dislocated left condyle. 1% lidocaine with 1:100,000 epinephrine was then injected into the skin overlying the left angle of the mandible. After 10 min elapsed, a 15-blade scalpel was used to make a puncture in the lower aspect of the cheek, and blunt dissection was used to reach the left angle of the mandible. A 2.8 mm threaded Steinman pin was engaged into left mandibular angle and carefully advanced to the right mandibular angle in a transfacial trajectory. Care was taken to avoid the tongue and endotracheal tube. This pin was advanced until the right angle of the mandible was penetrated however the tip of the pin remained within the soft tissue of the right cheek. This Steinman pin was cut, and a red rubber catheter with a xeroform dressing was placed over the external portion of the pin for protection (Figure 2).
Design and application of submental island flap to reconstruct non-circumferential defect after hypopharyngeal carcinoma resection: a prospective study of 27 cases
Published in Acta Oto-Laryngologica, 2020
Wenting Pang, Aobo Zhang, Cheng Lu, Jun Tian, Wan-xin Li, Zhenxiao Wang, Yanbo Dong, Shuoqing Yuan, Zihao Niu, Yiyuan Zhu, M. Shahed Quraishi, Liangfa Liu
The surgical procedure used was based on the technique originally described by Martin et al. [14] and modified by Patel et al. [17] In brief, the size of the flap was designed to be as large as possible by the skin pinch test to ensure that the donor site could be closed primarily [13,15]. The patient was positioned supine with the head extended and an elliptical skin paddle was marked according to the size of the defect, in a manner that it could be extended from one angle of the mandible to the other. An upper incision was made 1.5 cm below the mandible in the midline so as to put the upper border of the flap was just under the mandibular arch, and the lower limit was marked by a pinch test for primary closure. Neck dissection was first started, with extreme caution to preserve the facial vessels. The strategy regarding neck treatment was individualized for every patient.
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