1/12. The interdisciplinary approach to oral, facial and head pain.BACKGROUND: Chronic oral, facial and head pain is a common clinical problem, and appropriate diagnosis and management are a challenge for health care professionals. patients often will first seek the care of dentists because of the pain's localization in the oral cavity and surrounding structures. This article emphasizes the importance of establishing accurate diagnoses and conducting appropriate triage of the patient with complex orofacial pain. CASE DESCRIPTIONS: The authors present two case reports illustrating the complex nature of oral, facial and head pain, and the potential and actual pitfalls in management of this condition. These representative cases demonstrate how orofacial pain--which appears to be localized in the peripheral dental and oral structures--can have extremely complex etiologies involving other anatomical structures, the central nervous system and psychological factors. The reports point to the need for the expertise of a number of specialists in such cases. CLINICAL IMPLICATIONS: If the symptoms and clinical findings do not appear to be consistent with typical oral disease, or if standard treatments do not alleviate the pain, the dental clinician must consider other, more complex orofacial pain diagnoses. The dental professional should not hesitate to make referrals to key specialists or to members of an interdisciplinary team at a pain treatment center who have the expertise to appropriately diagnose and manage chronic oral, facial and head pain.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/12. Management options for cerebrospinal fluid leak after vestibular schwannoma surgery and introduction of an innovative treatment.OBJECTIVE: To review the management of cerebrospinal fluid leak after vestibular schwannoma removal reported in the literature and to present a novel approach to management of recalcitrant cases. DATA SOURCES: medline and pubmed literature search using the terms "cerebrospinal fluid leak" or "cerebrospinal fluid fistula" and "acoustic neuroma" or "vestibular schwannoma" covering the period from 1985 to present in English. A review of bibliographies of these studies was also performed. STUDY SELECTION: Criteria for inclusion in this meta-analysis consisted of the availability of extractable data from studies presenting a defined group of patients who had undergone primary vestibular schwannoma removal and for whom the presence and absence of cerebrospinal fluid leakage was reported. Studies reporting combined approaches were excluded. No duplications of patient populations were included. Twenty-five studies met the inclusion criteria. DATA EXTRACTION: Quality of the studies was determined by the design of each study and the ability to combine the data with the results of other studies. All of the studies were biased by their retrospective, nonrandomized nature. DATA SYNTHESIS: Significance (p < 0.05) was determined using the chi test. CONCLUSIONS: Incisional cerebrospinal fluid leakage responded well to local management and lumbar drainage. Rhinorrhea often necessitated surgical intervention. No specific reoperation techniques correlated exclusively with better reoperation outcomes. The transaural/transnasal approach presents an alternative for surgical management of cerebrospinal fluid rhinorrhea.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/12. Isolated tongue tremor after gamma knife radiosurgery for acoustic schwannoma.We describe a patient who had an isolated tongue tremor with an audible click after gamma knife radiosurgery for acoustic schwannoma. The nature of the tongue tremor was clearly demonstrated by videofluoroscopy. The possible pathogenic mechanisms are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/12. Cerebello-pontine angle paraganglioma simulating an acoustic neurinoma.An unusual case of paraganglioma arising from the internal auditory meatus and growing into the cerebello-pontine angle is reported. Clinical features, pre-operative radiological appearances and intra-operative findings were indistinguishable from those of an acoustic neurinoma. However, the paraganglionic nature of the tumour was confirmed by the electron microscopic evidence of neurosecretory features.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/12. Contemporary management of neurofibromatosis.The neurofibromatoses are two distinct entities with different genetic origins. The phenotypic expressions and required treatments are different. The devastating nature of neurofibromatosis-2 may be more effectively controlled through the application of advanced imaging techniques and contemporary neurotologic procedures. The most common manifestation of neurofibromatosis-2 is that of bilateral acoustic neuromas. The eventual total bilateral sensorineural deafness associated with this condition can be obviated in selected cases if the diagnosis is established early. Follow-up data are reported for three patients in whom hearing was preserved in at least one ear. When removal with hearing preservation is not possible, subtotal tumor removal with decompression of the internal auditory canals may delay progression of hearing loss. A new approach to tumors of the pterygomaxillary fossa that have extended to the middle cranial fossa has been successfully applied and is described.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/12. Stereotactic radiosurgery of small intracranial tumors: neuropathological correlation in three patients.The mechanism by which radiosurgery can stop the growth of some tumors is poorly understood, in part because postmortem neuropathological findings in patients have been reported only rarely. To define further the effects of radiosurgery, we present the correlation among clinical, neuroimaging, and neuropathological data in three patients with different intracranial tumors who died between 2 and 39 weeks after radiosurgery. The target volumes in two patients with malignant tumors showed sharply demarcated coagulative necrosis. In the third patient, who had a benign acoustic nerve tumor, neuropathological examination found intratumoral hemorrhage and cyst formation, but no necrosis. radiosurgery appears to cause acute necrosis of malignant cells, although its effectiveness may be limited by the infiltrative nature of some tumors. In benign tumors, necrosis following radiosurgery is relatively delayed, and may not be required for growth arrest.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/12. Craniocervical manifestations of neurofibromatosis: MR versus CT studies.Craniocervical manifestations of neurofibromatosis on magnetic resonance (MR) imaging are described in three patients and compared with those on CT. Using MR, intracranial gliomas, schwannomas, and neurofibromas were detected as well as with CT. In addition, a brain stem lesion that was not visualized on CT and a cervical cord lesion that was not suspected clinically were diagnosed with MR. Taking into account the noninvasive nature of MR, we believe that this technique should be the primary imaging modality for screening and follow-up studies in patients with known or suspected neurofibromatosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/12. Surgery of the skull base.Tumors involving the base of the skull are often occult and may become quite large before detection is possible. Symptomology varies depending upon the nature of the tumor and its placement. These neoplasms have frequently been considered inoperable simply because of their location, but in recent years microsurgical technique and high speed air drills have allowed the modern temporal bone surgeon to gain improved access to the skull base. A wide variety of surgical approaches to tumors in this area have been described in the past 20 years: translabyrinthine, middle fossa, transcochlear, retrolabyrinthine, retrosigmoid, transpalatal-transclival, and through the jugular bulb. The purpose of this paper is to review the indications, complications, and results of each of these procedures in relation to specific tumors involving the skull base. case reports illustrate the diagnosis and surgical management of a variety of unusual neoplasms, including an extradural meningioma of the temporal bone and clivus, a low grade squamous cell carcinoma on the tegmen in a radical cavity, a large primary cholesteatoma, an osteoblastoma of the temporal and occipital bones, an XIth nerve neuroma in the jugular bulb area, and an osseous hemangioma involving the facial nerve at the geniculate ganglion.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/12. The argon laser in acoustic tumor surgery.CO2 laser surgery has been employed successfully in the larynx for the past ten years. Because of the nature of the CO2 beam, it is necessary to mount the laser itself onto the operating microscope, thereby making it difficult to adapt to otologic microsurgery. The ability of the argon laser to be transferred through a fiber optic bundle has made it possible to introduce a whole new concept to microsurgery of the ear and adjacent structures. The argon laser has been used by the authors, on a routine basis, in all acoustic neuroma surgery for the past ten months (30 cases). The purpose of this paper is to present their preliminary experience. Surgical technique is covered in detail describing the many advantages the laser has provided in the management of these difficult lesions.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/12. Concurrent trigeminal, abducens, and facial nerve palsies presenting as false localizing signs: case report.Multiple cranial nerve dysfunction presenting as false localizing signs is rare. We report a 20-year-old woman who had concurrent trigeminal sensory disturbance, abducens, and peripheral facial nerve palsies in association with a contralateral acoustic neuroma. After surgery, the trigeminal nerve disturbance and the abducens nerve palsy completely recovered, but the peripheral facial nerve palsy persisted. The nature of tumor, the presence of brain stem distortion, the anatomic variation of posterior fossa, and the relationships of cranial nerves and nearby blood vessels, which are factors influencing the occurrence of false localizing, are briefly discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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