The Laryngoscope
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Multicenter Study Comparative Study Clinical Trial
Surgical management of Bell's palsy.
Incomplete return of facial motor function and synkinesis continue to be long-term sequelae in some patients with Bell's palsy. The aim of this report is to describe a prospective study in which a well-defined surgical decompression of the facial nerve was performed in a population of patients with Bell's palsy who exhibit the electrophysiologic features associated with poor outcomes. In addition, management issues related to Bell's palsy including herpes simplex virus typel etiology, the natural history, electrodiagnostic testing, and efficacy of surgical strategies are reviewed. ⋯ Electroneurography in combination with voluntary EMG successfully identified patients who will most likely return to normal from those who had a greater chance of long-term sequelae from Bell's palsy. Surgical decompression medial to the geniculate ganglion significantly improves the chances of normal or near-normal return of facial function in the group that has a high probability of a poor result. Surgical decompression must be performed within 2 weeks of onset of total paralysis for it to be effective.
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To determine the role of ciliary neurotrophic factor (CNTF) in the regeneration of the mouse sciatic nerve following injury by studying the CNTF knockout mouse in a blinded, randomized and controlled evaluation. ⋯ The absence of CNTF impairs the ability of mice to recover from a sciatic nerve crush injury. There is also a trend toward a greater rate of contracture formation after sciatic nerve transection and epineurial suture repair when CNTF is unavailable. These findings suggest that CNTF is important for recovery of neuronal function following crush and transection nerve injuries.
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To document that commercially available topical gentamicin-containing eardrops carry a risk of ototoxicity if they reach the middle ear through a tympanic membrane defect. ⋯ Physicians should consider the potential for ototoxicity if gentamicin-containing eardrops (and by extrapolation all topical aminoglycoside drops) are used for longer than 7 days in patients with a tympanic membrane defect. These preparations should not be used in the presence of healthy middle ear mucosa and should be discontinued shortly after the discharge has stopped. It is important to recognize that toxicity is primarily vestibular rather than cochlear.
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To define the most effect treatment plan of patients with oral cavity squamous cell carcinoma with clinically negative (NO) neck staging. ⋯ T1 tumors do well with neck treatment other than careful observation. The data suggest that patients with T2 and T3 oral squamous cell carcinoma should undergo surgical resection of their primary tumor site and elective neck dissection. Patients with T4 oral cavity lesions should routinely undergo neck dissection.
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The combination of intravenous sedation and local infiltration anesthesia is routinely utilized in otologic surgery. Advantages over general anesthesia with endotracheal intubation include ease and speed of induction and emergence, safety, and decreased postoperative discomfort. Anatomic and physiological patient constraints may preclude the use of intravenous sedation and anesthetists inexperienced in this technique may find it difficult to achieve a consistent level of anesthesia appropriate for major otologic surgery. Administration of anesthesia using the laryngeal mask airway (LMA) has been proposed to offer many of the advantages of intravenous sedation with less risk of oversedation and obstructive apnea. ⋯ The laryngeal mask airway is a safe and effective means of providing anesthesia during major otologic surgery.