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 11,717 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Four cases of lumbar disc protrusion with fragments of nucleus pulposus in the dural sac are reported, representing 0.3% of 1555 cases surgically treated over the past 35 years. All four cases were severely affected with distinct clinical manifestations of prolapsed disc, acute onset or sudden deterioration, pain, numbness, weakness, partial or complete paraplegia, and disturbances of urination and defecation accompanied by symptoms of severe and extensive spinal stenosis. They were treated with total laminectomy, section of dural sac, separation of adhesion and removal of fragments of nucleus pulposus. The results were excellent in one, Good in two and fair in one patient as revealed by the follow-up study which ranged from 4 months to 6 years. The clinical features, pathology, cause of prolapse, diagnosis, some points for attention concerning its management as well as that of adhesive arachnoiditis are discussed.
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PMID:[Operative treatment for lumbar disc protrusion with fragment of nucleus pulposus in the dural sac]. 133 46

Rhinocerebral mucormycosis developed in two poorly controlled diabetic patients with clinical manifestations of frontal headache, ophthalmoplegia, ptosis, proptosis, epistaxis and facial numbness. Early computed tomography (CT) of the head revealed fluid accumulation in paranasal sinuses. The diagnosis of this disease relied upon CT of the head, and biopsy or culture of the mucosa of sinuses. Remarkable improvement was noted following prompt surgical debridement and amphotericin-B therapy. We conclude that early diagnosis and aggressive treatment is the only way to save patient's life.
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PMID:Rhinocerebral mucormycosis: report of two cases. 217 26

In 1963, Calverley and Mohnac reported four cases with sensory disturbance of the mental nerve region. They emphasized the symptomatological significance of that finding because of the underlying ominous diseases. The purpose of this paper is to emphasize the clinical importance of this symptom especially as the initial manifestation of the underlying malignant diseases. A 56-year-old Japanese female was seen in consultation because of complaints of the paresthesia over the distribution of the right mental nerve, diplopia and ptosis of the right side. The patient had been well until a hundred days prior to admission, when she noted numbness with pain of the right mental nerve region. This symptom was followed by ptosis of the right side and diplopia after five weeks. MRI-CT scan revealed an abnormally low intensity echo (in T1 weighted image) of the bone around sphenoid sinus and tumor of the cavernous sinus (in T2 weighted image) compressing the right internal carotid artery. The patient was transferred to this hospital 100 days after the occurrence of the initial symptom. Physical examination revealed neither superficial lymph node swelling nor buccal tumor. Abnormal findings were restricted to the cranial nerve regions such as diplopia, adduction disturbance, sluggish light reflex of the right side and hypesthesia on the right chin, lower lip and buccal mucous membrane. Other neurological findings were not significant. Laboratory findings showed elevated LDH (1,503 IU/L). Leucocyte cell count was 7,500/mm3 with almost normal composition. CSF was normal. A diagnosis of Burkitt's lymphoma stage IV was done by nasopharynx and bone marrow biopsies.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of Burkitt's lymphoma with numb chin syndrome as the initial manifestation]. 258 91

An alcoholic man with uncontrolled diabetes mellitus had right conjunctivitis, facial numbness, and periorbital edema progressing to bilateral visual loss, and left ptosis in association with a large necrotic palatal ulcer due to zygomycosis. The infection progressed to bilateral retinal vein engorgement; left-sided ophthalmoplegia, fixed dilated pupil, and absent corneal reflex; and right-sided ophthalmoplegia, ptosis, and facial nerve paralysis. Work-up revealed disease of both ethmoid sinuses and the right maxillary sinus, with bilateral thromboses of the cavernous sinuses. An aggressive combined therapeutic attack (three Caldwell-Luc procedures, exploration of orbit walls, control of diabetes, systemic and local amphotericin therapy) led to survival with a three-year follow-up thus far.
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PMID:Survival in cerebro-rhino-orbital zygomycosis and cavernous sinus thrombosis with combined therapy. 370 11

A 62-year-old man presented with progressive diplopia, left ptosis, proptosis, complete ophthalmoplegia, facial numbness, and headache of 2 1/2 months' duration. The symptoms started 1 month after surgical resection of a squamous cell carcinoma in the left side of the forehead. Imaging studies helped localize the lesion, correlating with clinical features. The differential diagnosis is discussed. The final diagnosis was confirmed by autopsy.
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PMID:Ophthalmoplegia and facial numbness following treated squamous carcinoma of the forehead. 771 37

The coronal incision used for brow lift procedure has a high rate of localized alopecia, widening, and depression of the scar at the suture line. Other sequelae of the standard coronal brow lift incision procedure are "stretch-back" with a recurrent brow ptosis, poor brow elevation, and numbness beyond the incision line. Factors causing alopecia are tension, use of a monopolar cautery, use of key sutures with undue tension, one-layer closure, and sutures left too long. Recurrent brow ptosis may be due to anterior displacement of the posterior scalp flap, stretching of the anterior frontal skin flap, or insufficient power of the weakened frontalis muscle. Poor brow elevation may be due to unsatisfactory dissection on the glabella and orbital rims. Numbness and itching beyond the incision line are due to a low coronal incision. To avoid these problems, the following principles were followed: (1) If not contraindicated, the incision is made high on the vertex of the head, posterior to a biauricular line. (2) The pericranium is included in the frontal flap starting at the incision lines. (3) The subperiosteal dissection is continued down to the orbital rims and nasal bones. (4) The release of the periosteum at the arcus marginalis or just above allows repositioning of the brow structures. (5) The inelastic pericranium maintains the position of the elevated structures and avoids stretching of the frontal skin. (6) The integrity of the frontalis muscle is maintained completely. (7) Two large triangles of scalp resected in the posterior flaps allow fixing the position of the posterior scalp and match better the length of the anterior flap. (8) The galea periosteal rim flap allows anchoring of the frontal flap to the undersurface of the posterior scalp flap. This stabilizes the closure with minimal tension on the hair-bearing portion of the scalp. The wide surface of contact avoids depression and widening at the suture line. (9) Closure with skin staples avoids constriction of the hair follicles. (10) Hemostasis is done with a bipolar cautery. (11) No through-and-through key sutures are used. Some of these principles were introduced to the endoscopic subperiosteal forehead lift. The modifications mentioned above have been used in 92 open brow/face lift procedures with excellent aesthetic and functional results and minimal complications.
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PMID:The anchor subperiosteal forehead lift. 1130 18

Treatment of eyebrow ptosis to enhance the cosmetic effect from blepharoplasty is commonly done with a forehead lift using a coronal incision approach. The coronal scalp incision is associated with the annoying sequelae of frontoparietal scalp numbness, itching, and paresthesias, all of which can be permanent. A forehead lift technique with temporal scalp incisions only 4.5 to 5.0 cm in length can produce a result comparable with that of the coronal incision approach when combined with transpalpebral resection of the corrugator supercilii muscles and transection of the procerus muscle. This eyebrow elevation technique, like the endoscopic approach, minimizes the risk of permanently injuring the supraorbital nerve branches that innervate the frontoparietal scalp. Unlike the approach using only endoscopy, however, this technique can effectively treat cases of advanced eyebrow ptosis. The appropriate area of eyelid skin for excision may be difficult to assess when a forehead lift and upper blepharoplasty are done concomitantly. The described forehead lift incorporates a method to determine this area. This forehead lift technique, combined with a technique for protecting against overresecting upper eyelid skin, is described as used effectively on 140 blepharoplasty cases followed for 3 months to 4 years.
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PMID:Limited-incision forehead lift for eyebrow elevation to enhance upper blepharoplasty. 864 15

Botulinum toxin has become the initial treatment of choice for the management of essential blepharospasm, hemifacial spasm and other craniocervical dystonias. Numerous studies have confirmed a 90% to 95% response rate. Although a number of common side effects have been reported, the occurrence and incidence of rare local complications remains poorly understood. More importantly, the acute and chronic distant effects of botulinum toxin have not been clearly elucidated. A better understanding of such effects is essential if clinicians are to appropriately advise patients on the use of this therapeutic modality. This article is based on the Duke University experience in the management of over 500 patients with craniocervical spasm disorders, combined with a review of the published literature. These disorders include essential blepharospasm, oromandibular dystonia, hemifacial spasm, and torticollis. The incidence of side effects following more than 6000 treatments with botulinum toxin is presented. Pertinent research relating to the causes of these complications is also reviewed. The most common complications of treatment with botulinum toxin are related to acute local effects resulting from chemodenervation. The most important clinical effect in this group is weakening of the levator muscle resulting in ptosis, and the corneal consequences of lagophthalmos. The latter includes exposure keratitis, dry eyes, blurred vision, and hypersecretion epiphora. Less common local effects include facial numbness, diplopia, and ectropion. Some distant effects are being observed with increasing frequency. These include pruritus, dysphagia, nausea, and a flu-like syndrome. Most significant, however, are the rare reports of generalized weakness and the documentation of EMG abnormalities distant to the site of toxin injection. This has been seen with injections for both blepharospasm and torticollis. Until further studies on the long-term distant complications of botulinum toxin are available, it is recommended that patients receive as few life-time doses of toxin as possible, consistent with adequate management of their spasms. The practice of reinjecting patients routinely every three months, or at the first return of mild spasms should be discouraged.
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PMID:Botulinum-A toxin in the treatment of craniocervical muscle spasms: short- and long-term, local and systemic effects. 882 30

The use of an endoscope is a reliable way to perform facial rejuvenation, to correct eyebrow imbalance, periorbital and malar soft-tissue sagginess, and soft-tissue displacement in the lower face and neck. It allows great magnification and tissue dissection control while observing in situ tissue modification and the immediate results. In mild cases of brow ptosis without muscle hyperactivity, wide undermining and fixation can be a simple way to achieve a good result. When hyperactivity of the muscles is present with or without brow ptosis, a more complex procedure can be done, which requires the treatment of the appropriate musculatures. The result are comparable to those achieved with the open approach with the advantage of a shorter scar, minimal permanent numbness, and much better patient acceptability.
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PMID:Endoscopic facial rejuvenation. 914 66

Midface aging is characterized by soft-tissue ptosis with loss of cheek projection. Subperiosteal midface lifts may reposition the soft-tissue mounds and improve the tear trough, but may not fill the lateral cheeks in patients with significant jowls or poor bony support. Correction with alloplastic implants is helpful, but may not be accepted by many patients. During subperiosteal midface lifts, the author often excises Bichat's fat pad to decrease the jowl and to diminish face fullness. He has modified this approach and used a vascularized Bichat's fat flap to aid lateral cheek projection while still improving lower face fullness and the jowl. For the last 4 years, close to 150 patients undergoing subperiosteal midface lifts have had vascularized Bichat's fat pad flaps. The jowls were marked preoperatively. All patients had complete cheek undermining either through a buccal sulcus incision or through a crow's-foot incision, or through a muscle-sparing limited lower blepharoplasty incision. Bichat's fat pad is identified in its pocket medial to the masseter tendon. Mobilization of Bichat's fat pad is done by blunt dissection, preserving its thin fascial envelope. The "hernial saclike" pocket, excluding Stensen's duct and the buccal branches of the facial nerve, is identified and protected. Suspension is accomplished by fixation with 3-0 polydioxanone sutures either to the temporalis fascia (via the temporal incisions), to the arcus marginalis, or to the suborbicularis oculi fat pad. Fixation technique is dependent on where the fat pad is needed and the surgeon's preference. Fat pad repositioning is accomplished with a minor learning curve. The most common problems are tearing of the fat pad during fixation and temporary numbness of the long buccal nerve. Attention to leaving the capsule intact and gentle handling is essential to fixation. Nevertheless, in some patients with poor-quality fat pads, fixation is extremely difficult. Four-year results have been excellent. Further studies with magnetic resonance imaging of postoperative patients are necessary to assess longevity. Bichat's fat pad provides autologous vascularized tissue for midface fill. Placement may be lateral for cheek augmentation or medial for deep nasolabial folds. Jowl improvement also occurs with the removal of Bichat's fat pad from its pocket.
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PMID:Buccal fat pad pedicle flap for midface augmentation. 1045 14


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