Evaluation of Clinical Outcome in Traumatic Facial Nerve Paralysis

Abstract Introduction The facial nerve is the most commonly paralyzed nerve in the human body, resulting in far-reaching functional, aesthetic and emotional concerns to the patient. Objective Evaluation of the clinical outcome of 47 patients with traumatic facial nerve paralyses, with respect to clinical recovery and audiological sequelae. Methods A descriptive longitudinal study was conducted over 24 months between January 2017 and December 2018 at a tertiary center with detailed clinical, topodiagnostic, audiometric and radiological evaluation and regular follow-up after discharge. Results Road traffic accidents constituted 82.98% of the trauma cases, out of which 76.60% were found to be under the influence of alcohol. Delayed facial paralysis was observed in 76.60% cases. Temporal bone fracture was reported in 89.36%, with otic capsule (OC) sparing fractures forming 91.49% of the cases. Topologically, the injury was mostly at the suprachordal region around the second genu. The majority of the patients (65%) attained full recovery of facial nerve function with conservative medical management. Audiometrically, 77.27% of the patients had hearing loss at the time of presentation, of which 64.71% were conductive in nature; 51.22% attained normal hearing at follow-up visits. Conclusion Early initiation of steroid therapy, concurrent eye care and physiotherapy are the cornerstones in the management of traumatic facial nerve paralysis.

Vocal cord dysfunction: analysis of 27 cases and updated review of pathophysiology & management

Introduction: Vocal cord dysfunction is characterized by unintentional paradoxical vocal cord movement resulting in abnormal inappropriate adduction, especially during inspiration; this predominantly manifests as unresponsive asthma or unexplained stridor. It is prudent to be well informed about the condition, since the primary presentation may mask other airway disorders. Objective: This descriptive study was intended to analyze presentations of vocal cord dysfunction in a tertiary care referral hospital. The current understanding regarding the pathophysiology and management of the condition were also explored. Methods: A total of 27 patients diagnosed with vocal cord dysfunction were analyzed based on demographic characteristics, presentations, associations and examination findings. The mechanism of causation, etiological factors implicated, diagnostic considerations and treatment options were evaluated by analysis of the current literature. Results: There was a strong female predilection noted among the study population ( n = 27), which had a mean age of 31. The most common presentations were stridor (44%) and refractory asthma (41%). Laryngopharyngeal reflux disease was the most common association in the majority (66%) of the patients, with a strong overlay of anxiety, demonstrable in 48% of the patients. Conclusion: Being aware of the condition is key to avoid misdiagnosis in vocal cord dysfunction. Fiberoptic laryngoscopy is the diagnostic gold standard to demonstrate paradoxical vocal cord adduction during an attack. A multidisciplinary approach should be adapted for the management, which should be specific and tailored for individual patients (AU)

Inner canthal distance and golden proportion as predictors of maxillary central incisor width in south Indian population.

Objectives: Even though the constant relation of golden proportion and inner canthal distance (ICD) with the width of the maxillary central incisor (CIW) has been found in European population, it may not be applied to Indian population as we differ from Europeans racially and genetically. Hence, this study was carried out with the objectives of determining if these parameters are applicable to our population also. Materials and Methods: Three hundred south Indian subjects between 18 and 26 years of age, free from facial and dental deformities were examined. Inner canthus of each eye was used as soft tissue landmark. The maxillary central incisors were measured at the contact point area with the help of digital vernier caliper. The CIW was also calculated using golden proportion ratio to obtain the calculated central incisor width. A comparison was made with measured width. Statistical analyses were done to identify any significant difference using "Z" tests. Pearson's Correlation Coefficient test was used to evaluate the measured and the calculated width of the central incisor. Results: ICD and the width of two maxillary incisors were in golden proportion in south Indian population. Also, ICD when multiplied by a decreasing function value of the golden proportion and divided by 2 is a reliable predictor of determining CIW. Conclusion: As in the European population, the ICD and the golden proportion are reliable predictors for determining the width of the maxillary central incisors in the south Indian population also.