Etiology, evaluation, and management of facial nerve trauma

A typical presenting concern in general practitioners' offices, emergency rooms, otolaryngology, and neurology departments are facial nerve paralysis. Penetrating injury to the facial nerve, especially iatrogenic damage, is one of the most frequent traumatic reasons of facial paralysis. The facial paralysis that results from blunt trauma that crushes the nerve frequently appears as an incomplete or delayed paralysis. The affected part of the nerve will determine how the injury manifests clinically. For adequate patient counseling with respect to prognosis and management, accurate diagnosis of facial nerve palsy must be achieved. The most often employed standardized instrument for determining the level of facial weakness is the House-Brackmann 6-grade instrument for facial nerve activity. The greatest success chances for reanimation occur in cases of a recent, sudden nerve transection i.e., less than 72 hours, where the nerve is quickly identified and repaired using direct coaptation or interposition grafts. The primary strategy of care is surveillance in situations with facial nerve paralysis where it is known that the nerve is physically intact such as blunt force trauma with incomplete or delayed complete paralysis. Neurological, muscular, static, and facial plastic treatments are some examples of facial reanimation approaches.

randomized comparative study of the use of vacuum extraction with metal and silastic cups in second stage management of deliveries in a Saudi military hospital

A prospective study was designed to determine the effectiveness and safety of different types of vacuum extraction cups. Northern Area Armed Forces Hospital, Saudi Arabia. We randomized 118 women, for whom instrumental vaginal delivery was decided, to vacuum extraction with the conventional metal cup or the Silastic, silicon pliable rubber cup. Delivery was completed with the silicon rubber cups in 77% of cases, while with metal cups there was a 80.7% success rate [p > 0.05]. However, there was a statistically significant greater incidence of maternal tissue injuries, extension of episiotomies, pelvic infection and fall of haemoglobin with the use of the metal cup vacuum extractor compared with the silicon cup extractor. There was a significant increase in neonatal morbidity for the metal cup group compared with silicon cup delivery especially scalp trauma and cephalohaematomata. There were no significant differences in the Apgar score, neonatal jaundice, and umbilical artery pH between the metal cup and the silicon cup vacuum extractors. We conclude that the use of the silicon vacuum extractor should be encouraged to replace metal cups, as the data of the present study indicated that the use of silicon rubber cups to effect delivery had a greater success rate than metal cups with significantly less maternal and neonatal morbidity