1/19. Facial palsy after glomus jugulare tumour embolization.Facial palsy after pre-operative embolization of glomus tumours is a rare complication. In our case, complete facial palsy occurred within four hours after embolization with polyvinyl alcohol foam. Three days later, embolization material was found in the perineural vessels of the facial nerve in its mastoidal segment. Six months after complete tumour removal, facial decompression with perineural incision, and steroid therapy, facial function recovered completely. In cases of embolization of both stylomastoid and branches of the middle meningeal artery with resorbable material, temporary facial palsy can occur.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/19. Ahhh, that's a strange eye movement.A 57-year-old woman presents with sudden onset of horizontal diplopia following surgical repair of a ruptured posterior fossa aneurysm. Neuro-ophthalmic examination revealed a left gaze palsy, right abducens palsy, bilateral facial nerve palsy, reverse ocular bobbing and oculopalatal myoclonus. These findings can be localized to the anterior pons caused by damage to the midline perforator vessels resulting in anterior pontine pathology. A video demonstration of the oculopalatal myoclonus and other types of vertical nystagmus is provided. The etiology and characteristics of these forms of nystagmus is discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/19. The three-stage concept to optimize the results of microsurgical reanimation of the paralyzed face.From the authors three-dimensional video analyses they had to learn that the advantages of a one-stage procedure is outweighed by far by the disadvantages. A three-stage concept to a one-stage procedure was preferred for the following reasons: 1. safety of having a cross-face nerve graft to cover the distance from the healthy facial nerve to the nerve of the muscle transplant without problems and without the danger of tension on the nerve suture line because of shortage of the muscle nerve. 2. Independence of anatomical variations like a very proximal muscle hilus in the latissimus dorsi muscle e.g., resulting in a too short muscle nerve. 3. Only face-lift incisions are necessary without the need of an additional incision in the nasolabial fold while using a cross-face nerve graft. 4. freedom of positioning the muscle graft on the paralyzed side with free choice of the position of the transplant hilus. 5. The superficial temporal vessels can be used for microvascular anastomoses. 6. Prevention of a scar in the submandibular region with its tendency of hypertrophy, especially if it is connected to the preauricular incision. Different functional territories of one muscle transplant for eye closure and for smile is only possible in combination with two cross-face nerve grafts. Further on the three-dimensional video analysis showed clearly that Final surgical corrections for improvement of the static and dynamic symmetry should be performed. when the muscle transplant or the transposed muscle have gained their final functional result, which is often not before one or one and a half year after muscle transplantation. Therefore a three-stage concept is needed for the majority of patients. Detailed analyses of the movements in the different regions and the comparison of both sides clarify preoperatively the indication for the operative techniques to be used, and describe exactly the improvement of the overall result. It is not only possible to show, eg, the better positioning of the alar of the nose by a nasolabial dermal suspension plasty on the paralyzed side in millimeter, but also the influence on the relation of all the different points in the face (Fig. 5). The comparison of the right and the left side gives exact data on the symmetry of the face on rest and during the different movements. Of course, also qualities of facial reanimation like prevention of mass movements or synkinesias are detected in the three-dimensional graphs of all the points at the same time or in the repeated reviews of the original movement in the original video sequence. In conclusion, three-dimensional video analysis of facial movements became an important tool for online planning of operative procedures for the individual patient, and an excellent tool for comparative studies of different operative concepts and alternative operative techniques within a standardized registry of one center treating facial palsy or within international multicenter studies.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/19. A case of inflammatory demyelinating polyradiculoneuropathy associated with T-cell lymphoma.Malignant lymphoma may present prominent peripheral nervous system disorders with variable etiologies. We describe a patient who presented with chronic relapsing polyradiculoneuropathy accompanied by right facial nerve palsy. gadolinium enhancement of the right facial nerve and cervical spinal roots was noted on magnetic resonance imaging (MRI). sural nerve biopsy specimens showed mononuclear cell infiltration around the vessels in the epineurium. Histopathological and immunohistochemical investigations of sural nerve specimens revealed perivascular infiltration of lymphocytes with T-cell dominancy. No apparent direct invasion of lymphoma cells was seen. The results of nerve conduction studies, sural nerve biopsy and cerebrospinal fluid examination were suggestive of immune-mediated inflammatory demyelinating neuropathy. The chronic and relapsing fashion and unique radiological findings in our patient expand on the previously reported features of peripheral neuropathy associated with peripheral T-cell lymphoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/19. Free proximal gracilis muscle and its skin paddle compound flap transplantation for complex facial paralysis.Gracilis functioning free-muscle transplantation for the correction of pure facial paralysis has been a preferred method used by many reconstructive microsurgeons. However, for complex facial paralysis, the deficits include facial paralysis along with soft-tissue, mucosa, and/or skin defects. No adequate solution has been proposed. Treatment requests in those patients are not only for facial reanimation but also for correction of the defects. Of 161 patients with facial paralysis treated with gracilis functioning free-muscle transplantation from 1986 to 2002, eight patients (5 percent) presented with complex deficits requiring not only facial reanimation but also aesthetic correction of tissue defects. The tissue defects included an intraoral defect created following contracture release (one patient), infra-auricular radiation dermatitis with contour depression (one patient), temporal depression following a temporalis muscle-fascia transfer (one patient), ear deformity (two patients), and infra-auricular atrophic tissue with contour depression (three patients). A compound flap, consisting of a gracilis muscle with its overlying skin paddle separated into two components, was transferred for simultaneous correction of both problems. The blood supply to the gracilis and to the skin paddle originated from the same source vessel and therefore required the anastomosis of only one set of vessels. The versatility of this compound flap allows for a wide arc of rotation of the skin paddle around the muscle. All flaps were transferred successfully without complications. Satisfactory results of facial reanimation were recorded in five patients after all stages were completed. The remaining three patients are undergoing physical therapy and waiting for revision of the skin paddle.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
6/19. Neurovascular free-muscle transfer for the treatment of established facial paralysis following ablative surgery in the parotid region.Neurovascular free-muscle transfer for facial reanimation was performed as a secondary reconstructive procedure for 45 patients with facial paralysis resulting from ablative surgery in the parotid region. This intervention differs from neurovascular free-muscle transfer for treatment of established facial paralysis resulting from conditions such as congenital dysfunction, unresolved bell palsy, Hunt syndrome, or intracranial morbidity, with difficulties including selection of recipient vessels and nerves, and requirements for soft-tissue augmentation. This article describes the authors' operative procedure for neurovascular free-muscle transfer after ablative surgery in the parotid region. Gracilis muscle (n = 24) or latissimus dorsi muscle (n = 21) was used for transfer. With gracilis transfer, recipient vessels comprised the superficial temporal vessels in 12 patients and the facial vessels in 12. For latissimus dorsi transfer, recipient vessels comprised the facial vessels in 16 patients and the superior thyroid artery and superior thyroid or internal jugular vein in four. Facial vessels on the contralateral side were used with interpositional graft of radial vessels in the remaining patient with latissimus dorsi transfer. Cross-face nerve grafting was performed before muscle transfer in 22 patients undergoing gracilis transfer. In the remaining two gracilis patients, the ipsilateral facial nerve stump was used as the primary recipient nerve. Dermal fat flap overlying the gracilis muscle was used for cheek augmentation in one patient. In the other 23 patients, only the gracilis muscle was used. With latissimus dorsi transfer, the ipsilateral facial nerve stump was used as the recipient nerve in three patients, and a cross-face nerve graft was selected as the recipient nerve in six. The contralateral facial nerve was selected as the recipient nerve in 12 patients, and a thoracodorsal nerve from the latissimus dorsi muscle segment was crossed through the upper lip to the primary recipient branches. A soft-tissue flap was transferred simultaneously with the latissimus muscle segment in three patients. Contraction of grafted muscle was not observed in two patients with gracilis transfer and in three patients with latissimus dorsi transfer. In one patient with gracilis transfer and one patient with latissimus dorsi transfer, acquired muscle contraction was excessive, resulting in unnatural smile animation. The recipient nerves for both of these patients were the ipsilateral facial nerve stumps, which were dissected by opening the facial nerve canal in the mastoid process. From the standpoint of operative technique, the one-stage transfer for latissimus dorsi muscle appears superior. Namely, a combined soft-tissue flap can provide sufficient augmentation for depression of the parotid region following wide resection. A long vascular stalk of thoracodorsal vessels is also useful for anastomosis, with recipient vessels available after extensive ablation and neck dissection.- - - - - - - - - - ranking = 10keywords = vessel (Clic here for more details about this article) |
7/19. Neurovascularized free short head of the biceps femoris muscle transfer for one-stage reanimation of facial paralysis.The single-stage technique for cross-face reanimation of the paralyzed face without nerve graft is an improvement over the two-stage procedure because it results in early reinnervation of the transferred muscle and shortens the period of rehabilitation. On the basis of an anatomic investigation, the short head of the biceps femoris muscle with attached lateral intermuscular septum of the thigh was identified as a new candidate for microneurovascular free muscle transfer. The authors performed one-stage transfer of the short head of the biceps femoris muscle with a long motor nerve for reanimation of established facial paralysis in seven patients. The dominant nutrient vessels of the short head were the profunda perforators (second or third) in six patients and the direct branches from the popliteal vessels in one patient. The recipient vessels were the facial vessels in all cases. The length of the motor nerve of the short head ranged from 10 to 16 cm, and it was sutured directly to several zygomatic and buccal branches of the contralateral facial nerve in six patients. One patient required an interpositional nerve graft of 3 cm to reach the suitable facial nerve branches on the intact side. The period required for initial voluntary movement of the transferred muscles ranged from 4 to 10 months after the procedures. The period of postoperative follow-up ranged from 5 to 42 months. Transfer of the vascularized innervated short head of the biceps femoris muscle is thought to be an alternative for one-stage reconstruction of the paralyzed face because of the reliable vascular anatomy of the muscle and because it allows two teams to operate together without the need to reposition the patient. The nerve to the short head of the biceps femoris enters the side opposite the vascular pedicle of the muscle belly, and this unique relationship between the vascular pedicle and the motor nerve is anatomically suitable for one-stage reconstruction of the paralyzed face. As much as to 16 cm of the nerve can be harvested, and the nerve is long enough to reach the contralateral intact facial nerve in almost all cases. The lateral intermuscular septum, which is attached to the short head, provides "anchor/suture-bearing" tissue, allowing reliable fixations to the zygoma and the upper and lower lips to be achieved. In addition, the scar and deformity of the donor site are acceptable, and loss of this muscle does not result in donor-site dysfunction.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
8/19. Ruptured petrous carotid aneurysm presenting with otorrhagia and epistaxis.aneurysm formation and rupture within the petrous internal carotid artery (ICA) is an extremely rare occurrence with approximately 10 such cases in the literature. Etiologies of petrous ICA aneurysms include atherosclerosis, closed head trauma, iatrogenic injury during mastoid surgery, chronic middle ear infections, and congenital causes. Therapeutic options include carotid artery ligation, aneurysm resection with or without reconstruction, and radiographically controlled vessel occlusion. The case of a patient who presented with otorrhagia, epistaxis, and transient focal neurologic signs due to a ruptured petrous ICA aneurysm is presented. The incidence, etiology, and anatomy of these aneurysms is reviewed, and the various tests for determining adequacy of collateral cerebral blood flow are described. Factors that affect the selection of surgical versus radiologic control of these lesions are also discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/19. Treatment of chronic facial palsy by transplantation of the neurovascularized free rectus abdominis muscle.We performed neurovascularized free rectus abdominis muscle transplantations in two patients with chronic facial palsy. In one patient, the postoperative course was uneventful, but the patient died from rupture of esophageal varices. In the other patient, both morphologic and functional results were satisfactory. Therefore, the rectus abdominis muscle is considered to be a suitable donor for muscle transplantation for the treatment of chronic facial palsy. The rectus abdominis muscle is advantageous in that (1) simultaneous operations by two teams are possible with the patient in the supine position, (2) it is supplied by long nerves and long and large vessels, (3) it is flat and consists of segments with appropriate lengths, (4) the force and distance of contraction are appropriate, and (5) the tendinous intersections are suitable for anchoring sutures.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/19. Overwhelming strongyloidiasis in a diabetic patient following ACTH treatment and keto-acidosis.A non insulin-dependent Zairian patient developed ketoacidosis and then overwhelming strongyloidiasis following ACTH treatment. Severe cardiovascular and respiratory failure, associated with severe acute hypoprotidemia, preceded death, which occurred within three days. Pathologic examination revealed a massive parasitic infiltration of the gastro-enteric mucosa, mesenteric lymph nodes, and the pulmonary tissue and vessels. We suggest that ACTH treatment and keto-acidosis induced immune deficiency and triggered the acute parasitic episode, in a patient originating from an endemic area. Badly controlled diabetes should be known as a risk factor of hyperinfection by strongyloides stercoralis in latent carriers.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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