Transient Hypoglossal Nerve Palsy after Open Reduction of Zygomatic Complex Fracture

PURPOSE: Isolated hypoglossal nerve palsy is a rare manifestation of various underlying disease. This article presents a rare complication of general anesthesia associated with an surgical procedure on a case of zygomatic fracture. METHODS: An 18-year-old female patient was referred to our department by painful swelling on her left zygomatic area after the traffic accident. Left zygomatic complex fracture was identified on the simple x-ray and facial bone CT scan, and the fracture was treated with open reduction and internal fixation under general anesthesia. On the first postoperative day, she complained of difficulty in swallowing solid food, dysarthria and deviated tongue to her right side. There was no abnormal findings on the neurological examination, brain MRI and routine chemistry. She was diagnosed with transient hypoglossal nerve palsy and dexamethasone with multi-vitamins was administrated intravenously for 5 days. RESULTS: The symptoms were completely resolved by the ninth postoperative day and the patient was discharged without any other complications. CONCLUSION: The hypoglossal(cranial nerve XII)nerve supplies motor innervation to all of the ipsilateral extrinsic and intrinsic tongue muscles. The hypoglossal nerve damage may caused by the compression between the airway and the hyoid bone during the endotracheal intubation, and direct trauma due to excessive pressure or neck extension. We described a rare case of unintended injury to hypoglossal nerve and care must be taken not to cause the hypoglossal nerve damage especially in facial plastic surgery with excessive neck extension under general anesthesia.

The Effect of Administration of Steroid on the Wound Breaking Tensile Strength in Rats

PURPOSE: The successful wound healing implies the scarless wound with adequate strength. It has been shown in vivo and in vitro that steroid retards the collagen synthesis. We studied the effect of steroid on the wound breaking strength in rats. METHODS: 40 Sprague-Dawley rats were evenly divided into two groups. One group was served as control, the other group was experimental. We made dorsal midline incision and closed the wound. In the experimental group, we medicated methylprednisolone(0.15mg/g/day) for 1 week. Then, we compared the differences of the breaking strength and microscopic histology between control and experimental group in 2, 4, 6 and 8 week. RESULTS: Up to 4th week, the breaking strength of the experimental group markedly decreased than that of control group, while in 6th week the strength of experimental group attained to that of control group nearly. In histologic findings, control group demonstrated dense organization of collagen to experimental group in 4th week. CONCLUSION: In this experiment, steroid significantly inhibited the strength gain in wound at early period of the wound healing process. When using steroid after the surgery or the wound formation, it is desirable to administrate carefully and need thorough wound management to prevent delayed wound healing.

Consideration of Clinical Progress after Open Reduction with Retromandibular Approach in Treatment of Mandibular Condyle Fractures

PURPOSE: For several decades, open reduction has been a controversial issue in mandibular condyle fracture. The authors have successfully used the open reduction and internal fixation with retromandibular approach and have found it to be satisfactory for mandibular condyle fracture. METHODS: A total of 10 patients with mandibular condyle fracture underwent open surgical treatment using retromandibular approach. The incision for the retromandibular approach was carried below the ear lobe and the facial nerve branches were identified. Dissection was continued until the fracture site was exposed and internal fixation was performed with miniplate following intermaxillary fixation. The average period of joint immobilization was 1 weeks and the arch bars were removed in 3 weeks on average. The preoperative and postoperative panoramic view and three-dimensional computed tomography were compared. During the follow up period, we evaluated the presence of malocclusion, chin deviation, trismus, pain, click sound, facial nerve palsy, hypertrophic scar and skin fistula. RESULTS: According to the radiographic findings, the fractured condyle was reducted satisfactorily in all patients without any symptoms of facial palsy. During the follow up period ranged form 6 to 12 months, all clinical symptoms were improved except in one case with chin deviation and malocclusion. CONCLUSION: Using open reduction and internal fixation of mandibular condyle fracture with retromandibular approach, all results were satisfactory with good functional outcomes and minimal complication. We concluded that the open surgical treatment should be considered as the first choice for mandibular condyle fracture management.