The Combination Therapy of Oral Steroids and Nerve Decompression for Ulnar Neuritis in Leprosy - Usefulness in Prevention of Progression of Hand Deformities

Hand, being an important functional part of the body, needs healthy complementing motor and sensory nerve supply. Both these functions get compromised following involvement of ulnar nerve in leprosy, which is the commonest nerve involved in Hansen’s disease. It is commonly involved at the elbow level and results in clawing of the hand. There are two routine management protocols viz medical and surgical to manage ulnar nerve damage in leprosy. Steroid therapy along with anti-leprosy regimen is the common medical approach for treatment for ulnar neuritis. Patients not improving with medical management are taken up for surgical decompression. However, when to switch from medical to surgical intervention is topic of debate. In this study we have given steroid therapy in early (4-6 weeks) duration of ulnar neuritis along with anti-leprosy drugs and attempted to determine an appropriate period of medical treatment, beyond which there is no significant benefit in continuing sole medical management if no response is seen. Of the 247 eligible patients, 210 did not respond to 12 months of steroid therapy – the results 193 such patients, treated with steroids and nerve decompression and which were available for follow up were analysed. A total 158/193 (81.8%) cases showed the sensory recovery for touch within 4-6 weeks, deep sensation of pin prick returned in 117/193 (60.62%) cases in 6-8 weeks. Motor recovery was slow, it took 24 to 54 weeks. While 117/193 (60.62%) cases showed improved motor function, in 58/193(30%) cases there was no change and only 18/193(9.3%) cases deteriorated. It appears that period of 12 weeks is an ample time for medical treatment to start showing any form of improvement (motor or sensory) and if there is no improvement, patient should be considered for surgical decompression along with continuation of medical management (Steroid therapy). Our study shows that cases who failed to respond to exclusive medical steroid therapy by 12 weeks responded to combined medical plus surgical treatment as surgical decompression helps in the release of pressure on nerve tissue and improves the functional status.

A retrospective analysis of facial palsy in patients of squamosal chronic suppurative otitis media with diabetes mellitus

Background: Facial nerve palsy is a common intra-temporal complication of untreated chronic suppurative otitis media (CSOM) causing erosion of the fallopian canal and its pressure effects leading to facial weakness. There is a less favorable outcome in patients of CSOM with diabetes as they are more prone to neural degeneration. In such patients, early surgical decompression of the facial nerve helps in resolving facial palsy to some extent. In our study of 22 patients, we analyzed the prognosis and advantage of doing early surgical facial nerve decompression along with modified radical mastoidectomy in patients of unsafe CSOM with diabetes mellitus. Materials and Methods: We present a retrospective study of 22 patients with a squamosal type of CSOM with diabetes mellitus who came to the outpatient department, from June 2019 to March 2021, with complaints of ear discharge and facial palsy grades 3–5, in whom we did early surgical facial nerve decompression along with modified radical mastoidectomy. We observed the incidence of facial palsy and recovery after facial nerve decompression with limited use of steroids in patients with diabetes mellitus. Results: In our retrospective study of 22 patients with squamosal type of CSOM with diabetes mellitus with complaints of facial palsy, 10 were males and 12 were females. Patients were assessed clinically using House– Brackmann grading: 55% are of grade III, 31% are of grade IV, and 14% are of grade V. About 82% of the patients from our study had lesions at the tympanic segment, 9% patients had lesions at the vertical segment, 4.5% patients had lesion at the first genu, and 4.5% patients had lesion at the second genu. In our study, 95% of the patients from the study improved with early facial nerve decompression along with modified radical mastoidectomy, 55% of the patients improved to grade I, 36% of the patients improved to grade II, and 9% of the patients improved to grade III. Conclusion: In squamosal-type CSOM patients with facial palsy, early facial nerve decompression along with modified radical mastoidectomy within 12 weeks of development of facial palsy provides better results than just modified radical mastoidectomy as it increases recovery rate and reduces the need for post-operative steroids which is an advantage in diabetics.

Advantages and necessity of multi-disciplinary treatment on diabetic lower extremity lesions / 中华内分泌外科杂志

Diabetic lower extremity lesions (DLEL) occur as lower extremity pain, sensory and motor disturbance, ulcers, destruction of deep tissues and subsequent infections related to lower extremity vasculopathy and neuropathy in diabetes. The disease affects multiple organ systems, leading to complicated pathogenesis and difficulty in treatment. This article reviews the pathogenesis and treatments of diabetic lower extremity lesions, hoping to expand new ideas for the multi-disciplinary treatment of DLEL.

Surgical outcomes of transmastoid facial nerve decompression: Preliminary data from a Malaysian tertiary hospital from 2013-2018

@#Introductions: Facial nerve palsy (FNP) occurs in 7-10% of temporal bone fractures. The aim of this study was to review the surgical outcome of nine patients with severe to complete traumatic facial nerve (FN) injury. Methods: The patients were evaluated clinically and FNP was graded using the House Brackmann (HB) scale. High resolution computerized tomography (HRCT) of the temporal bone was used to evaluate temporal bone fractures. Transmastoid facial nerve decompression was performed and the facial nerve function was re-evaluated in subsequent follow ups. Results: There were five cases with immediate onset and four with delayed onset of FNP. Only three cases had pure temporal bone fractures, the others were associated with other life threatening injuries. The sensitivity and specificity of HRCT temporal bone to detect the obvious facial canal fracture line were 50% and 40% respectively. 75% of patients with immediate onset of HB grade VI FN palsy who were operated within a month recovered completely. Surgeries for the delayed onset FNP were performed at a mean of 70 days (range 51-94). All recovered to HB grade II-III from severe FNP. Conclusions: Our study demonstrated that transmastoid FN decompression surgery was beneficial to traumatic nerve injury. Early intervention resulted in better outcomes. However, FN function could still be salvaged even in delayed FN decompression.

Effectiveness of lower extremity Dellon triple nerve decompression in treatment of early-stage diabetic Charcot foot / 中国修复重建外科杂志

Objective: To study the effectivenss of lower extremity Dellon triple nerve decompression in the treatment of early-stage diabetic Charcot foot. Methods: The clinical data of 24 patients with Eichenholtz stage 0-1 diabetic Charcot foot who were admitted between September 2017 and February 2019 were retrospectively analyzed. Among them, 14 cases were treated with lower extremity Dellon triple nerve decompression (treatment group), and 10 cases were treated with conservative treatment such as immobilization the affected limbs and nutritional nerve drugs (control group). There was no significant difference between the two groups ( P>0.05) in gender, age, diabetes duration, diabetic foot duration, Eichenholtz stage, and the blood glucose level, bone mineral density (T value), nerve conduction velocity, and two-point discrimination before treatment. Before treatment and at 6 months after treatment, bone mineral density (T value) was measured by dual energy X-ray absorptiometry to evaluate the improvement of osteoporosis. The electromyogram of the lower limbs was used to detect the conduction velocity of the common peroneal nerve, deep peroneal nerve, and tibial nerve, and to evaluate the recovery of nerve function. The two-point discrimination in plantar region was used to evaluate the recovery of skin sensation. Results: Both groups were followed up 6-12 months, with an average of 6.5 months. In the treatment group, 3 patients showed numbness around the incisions, all recovered after 12 months, without affecting the prognosis; all the incisions healed by first intention, and there was no complication such as incision infection, nonunion, or vascular and nerve injury. At 6 months after treatment, there was no significant difference in nerve conduction velocity, bone mineral density (T value), and two-point discrimination when compared with the values before treatment ( P>0.05) in the control group; but the above indicators in the treatment group were significantly improved when compared with preoperative ones, and were all significantly better than those in control group ( P<0.05). Conclusion: Lower extremity Dellon triple nerve decompression can improve the symptoms of Eichenholtz stage 0-1 diabetes Charcot foot, and has the advantages of less trauma, faster recovery, and fewer complications.

Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience / Abordagem retrosigmóidea assistida por endoscopia em espasmo hemifacial: nossa experiência

Abstract Introduction: The use of surgical decompression of facial hemispasm due to the loop in the internal auditory canal is not always accepted due to the risk related to the surgical procedure. Currently a new surgical technique allows surgeons to work in safer conditions. Objective: To report the results with endoscope-assisted retrosigmoid approach for facial nerve microvascular decompression in hemifacial spasm due to neurovascular conflict. The surgical technique is described. Methods: We carried out a prospective study in a tertiary referral center observing 12 (5 male, 7 female) patients, mean age 57.5 years (range 49-71) affected by hemifacial spasm, that underwent to an endoscope assisted retrosigmoid approach for microvascular decompression. We evaluated intra-operative findings, postoperative HFS resolution and complication rates. Results: Hemifacial spasm resolution was noticed in 9/12 (75%) cases within 24 h after surgery and in 12/12 (100%) subjects within 45 days. A significant (p < 0.001) correlation between preoperative historical duration of hemifacial spasm and postoperative recovery timing was recorded. Only 1 patient had a complication (meningitis), which resolved after intravenous antibiotics with no sequelae. No cases of cerebrospinal fluid leak, facial palsy or hearing impairment were recorded. Hemifacial spasm recurrence was noticed in the only subject where the neurovascular conflict was due to a vein within the internal auditory canal. Conclusions: The endoscope assisted retrosigmoid approach technique offers an optimal visualization of the neurovascular conflict thorough a minimally invasive approach, thus allowing an accurate decompression of the facial nerve with low complication rates. Due to the less invasive nature, the procedure should be considered in functional surgery of the cerebellar pontine angle as hemifacial spasm treatment, specially when the procedure is performed by an otolaryngologist.

Resumo Introdução: O uso de descompressão cirúrgica do espasmo hemifacial devido ao loop no canal auditivo interno nem sempre é aceito devido ao risco relacionado ao procedimento cirúrgico. Atualmente, uma nova técnica cirúrgica permite trabalhar em condições seguras. Objetivo: Relatar os resultados que obtivemos com a abordagem retrosigmóidea assistida por endoscopia para a descompressão microvascular do nervo facial em casos de espasmo hemifacial devido a conflito neurovascular. A técnica cirúrgica é descrita. Método: Realizamos um estudo prospectivo em um centro de referência terciária observando 12 pacientes (5M, 7F), com média de idade de 57,5 (intervalo 49-71) anos com espasmo hemifacial submetidos a uma abordagem retrosigmóide assistida por endoscopia para descompressão microvascular. Foram avaliados os achados intraoperatórios, a resolução pós-operatória do espasmo hemifacial e as taxas de complicações. Resultados: A resolução do espasmo hemifacial foi observada em 9/12 (75%) dos casos nas 24 horas após a cirurgia e em 12/12 (100%) dos indivíduos até 45 dias. Uma correlação significativa (p < 0,001) entre a duração do histórico pré-operatório de espasmo hemifacial e o tempo de recuperação pós-operatório foi registrado. Apenas um paciente apresentou uma complicação (meningite), que foi resolvida após administração de antibióticos por via intravenosa sem sequelas. Nenhum caso fístula liquórica, paralisia facial ou deficiência auditiva foi registrado. A recorrência do espasmo hemifacial foi observada em único indivíduo em quem o conflito neurovascular foi causado por um vaso no interior do canal auditivo interno. Conclusões: A técnica da abordagem retrosigmóidea assistida por endoscopia oferece uma ótima visualização do conflito neurovascular através de uma abordagem minimamente invasiva, permite assim uma descompressão precisa do nervo facial com baixas taxas de complicações. Por ser menos invasivo, o procedimento deve ser considerado na cirurgia funcional do ângulo pontocerebelar como tratamento de espasmo hemifacial, especialmente quando o procedimento é feito por um otorrinolaringologista.

Decompression and Anterior Transposition of Ulnar Nerve in Prevention and Progression of Claw Hand Deformity in Leprosy

Leprosy is very common disease in India. It is known for its deformities and social problem associated with it. Our study was aimed to follow that surgical decompression and its anterior transposition of ulnar nerve prevents the progress of claw hand in leprosy. During last 20 years study was conducted at centers mentioned and statistic collected. It was found that all cases which did not responded to drugs or had deformity beforehand did responded to surgery and were made patient comfortable. Methods: ?. Results: ?. Conclusion: ?.

Clinical Implication of Facial Nerve Decompression in Complete Bell's Palsy: A Systematic Review and Meta-Analysis

We compared the therapeutic efficacy of facial nerve decompression (FND) and conservative treatment in patients with Bell's palsy through a systematic review and meta-analysis. Primary database search was performed in PubMed, Medline, and Embase. After screening, 13 studies were assessed for their eligibility. Among them, seven studies employing either the House-Brackmann grading system (HBGS) or May's classification (modified HBGS) were selected for quantitative and qualitative analysis. Based on May's classification, the degree of recovery was classified into complete (HBGS I), fair (HBGS II–III), or failed (HBGS IV–VI) recovery. The outcomes were assessed between 6 and 12 months after surgery. The estimated pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using random effects model. Cohorts were comprised of patients who underwent FND (n=202, 53.0%) and conservative treatments (n=179, 47.0%). In pooled analysis, the rate of complete recovery was significantly higher in the FND group than in the control group (OR, 2.06; 95% CI, 1.22 to 3.48; P=0.007) showing neither heterogeneity nor publication bias. Meanwhile, the rates of fair recovery (OR, 0.71; 95% CI, 0.42 to 1.21; P=0.208) and failed recovery (OR, 0.60; 95% CI, 0.22 to 1.67; P=0.327) in the FND group were similar to that in the control group. In subgroup analyses, there was no significant difference in the OR according to the operation timing and surgical approach. FND can be a possible treatment option for patients with complete Bell's palsy, especially for complete recovery, which provide insights on decision-making and outcome prediction. However, FND should be determined carefully given the risk of small study effects and possible complications.

Advance in Facial Nerve Decompression for Facial Palsy Resulting from Zygomatic Fractures (review) / 中国康复理论与实践

@#The facial nerve is the longest nerve shaped the bone tube, which has many turnings and narrow path. About 7% to 10% of patients with temporal bone fracture have facial paralysis. Most of the patients showed loss of frontal lines, inability to close eyes, and deflection of the teeth. Facial nerve decompression has been an effective way to relieve the symptoms and restore facial nerve functions. However, the issue of surgical indications, timing of surgery, and scope of decompression still need further research.

Application of minimally invasive endoscopic optic nerve decompression in patients with traumatic optic neuropathy / 眼科新进展

Objective To analyze the application effects of endoscopic optic nerve decompression in patients with traumatic optic neuropathy and its effect on visual acuity.Methods From January 2014 to January 2016,100 patients (100 eyes) with traumatic optic neuropathy in our hospital were selected as observation objects.According to different treatment methods,the patients were divided into observation group and control group,50 cases in each group.The control group was treated with drugs,and the observation group with endoscopic sinus decompression of optic nerve on the basis of the control group after the stability of the disease.The patients in two groups were followed up at least 1 year.The clinical efficacy,visual acuity,VEP findings and incidence of adverse reactions were compared between the two groups.Results The effective rates in the observation group and control group were 76.0％ and 36.0％,there was significant difference between two groups (P ＜ O.05).In the observation group,the visual acuity of 16 eyes were improved in 22 eyes with no light perception,9 eyes in 13 eyes with light perception,9 eyes in 11 eyes with hand movement,and 4 eyes with finger counting were all improved;In the control group,the visual acuity of 6 eyes were improved in 20 eyes with no light perception,6 eyes in 14 eyes with light perception,5 eyes in 12 eyes with hand movement,1 eye in 4 eyes with finger counting.After treatment,the incubation period and amplitude of P1O0 in the observation group were (116.85 ±7.96) ms and (5.11 ± 1.16) μV,which were better than the control group (105.62 ±6.82) ms,(4.31 ± 1.25) μV.The incidence of adverse reaction in the observation group was significantly lower than that in the control group (P =O.000).Conclusion The endoscopic optic nerve decompression has a good application effect and safety in patients with traumatic optic neuropathy,can effectively improve the patient's visual acuity,help to improve the quality of life of patients,is worthy of clinical application.

Facial nerve decompression in treatment of patients with early peripheral traumatic facial paralysis / 局解手术学杂志

Objective To explore the effect of facial nerve decompression via mastoid-epitypanum approach on the treatment of early peripheral traumatic facial paralysis caused by temporal bone fracture.Methods The data of 21 patients with early peripheral traumatic facial paralysis caused by temporal bone fracture in our hospital from October 2011 to June 2016.The facial nerve electrogram and the blink reflex of the injured facial nerve of 21 patients who treated facial nerve decompression via mastoid-epitypanum approach were compared before and after operation.The degree of facial nerve function recovery was evluated by H-B grading method.Results The facial nerve function of all patients had improved in different degrees,85.7% patients recovered to Ⅰ~Ⅱ level.Compared with those before operation,the latency,amplitude and latent period of blink reflex of the ipsilateral facial electroneurography were significantly improved(P<0.05).Conclusion The facial nerve decompression has good effect in the treatment of early peripheral traumatic facial paralysis.

Nursing care in osteopetrosis treated by optic nerve decompression under image guidance system combined with endoscopic approach / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To explore the nursing cooperation highlights of eight osteopetrosis patients underwent optic nerve decompression via transsphenoidal microsurgical approach instead of routine pathway, and to improve the quality of nursing cooperation. ·METHODS: We enrolled 8 cases ( left eye in 3 cases, right eye in 5 cases ) of osteopetrosis patients referred from the Eye Hospital of Wenzhou Medical University during February 2012 to November 2016. Patients received ophthalmic examinations including visual acuity and diagnostic imaging tests in pre-operation and post -operation. All eyes were performed surgical optic nerve decompression through endoscopic approach in assist of image guidance system. We retrospectively analyzed the clinical data and surgical cooperation procedure of these cases and summarized nursing cooperation experience. ·RESULTS:The operations of 8 patients were completed successfully without massive hemorrhage. Mean visual acuity improved from pre-operation (2. 5±2. 1) to post-operation (3. 4±1. 9). Cerebrospinal fluid leakage occurred in 1 patient and was instantly repaired during the operation. We performed the nursing strategy as postural drainage, condition monitoring and conscious assessment intra-and post-operation. ·CONCLUSION: It is the critical for this kind of surgery that both circulating nurse's high-skilled cooperation to the connection and operation of the navigation system, to treat with complication during the surgery, and scrub nurse's sufficient preparation of surgical instruments and consumables, proficient equipment delivery, meticulous management, use and maintenance of equipment.

The applied anatomical study for transethmoidal-sphenoid optic nerve decompression under endoscopy / 中华显微外科杂志

Objective To explore the anatomy for transethmoidal-sphenoid optic nerve decompression under endoscopy and its significance in operation. Methods Fifteen cases (30 sides) of formalin-fixed adult optic canal specimens were dissected under the microscope. The anatomic characteristics of the optic canal and its adjacent were observed, and the relative parameters were evaluated according to nasal endoscopic approach. Results ①The relationship between the optic carotid triangle(OCT)with the optic canal, the ophthalmic artery, the cavernous sinus and the internal carotid artery were invariable, its present ratio were in 66.7%. ②The mean distance from the front margin of nasal columella floor to medial wall of the orbital opening, middle portion and the cranial opening in the optic canal were (72.79 ± 5.40)mm, (75.85 ± 5.10)mm and (79.34 ± 4.95)mm, respectively, and the elevation angles were (39.45 ± 3.68)°, (37.30±4.24)°and (35.45 ± 4.16)°, respectively. ③The mean thickness of sheath in the medial wall of the orbital opening,middle portion and the cranial opening were (0.70 ± 0. 18)mm, (0.51 ± 0.15)mm and (0.49-0.22)mm,respectively. The difference in thickness between the orbital opening and middle portion, the cranial opening were very remarkable(P ＜ 0.01 ). ④The lateral deviate distance from medial wall of the orbital opening, middle portion and cranial opening to sagittal median plane of cadaveric were 1/2 (12.69 ± 2.73)mm、1/2( 19.61± 3.47)mm and 1/2 (25.79 ± 3.23)mm, respectively. Conclusion OCT is the most reliable anatomic landmark to locate the optic canal, and the key point is at the orbital opening of the optic nerve in the optic nerve decompression. It is secure and feasible to cut the sheath from the place where the medial wall crosses the superior wall of the optic nerve.

Common Extensor Fasciotomy and Radial Nerve Decompression on Recurrent Lateral Epicondylitis

PURPOSE: This study was performed to evaluate the results after a combined surgical treatment of common extensor Fasciotomy & Radial nerve decompression in recurrent lateral epicondylitis patients. MATERIALS AND METHODS: We retrospectively reviewed the functional records of 6 cases of patients who were treated surgically from the February 2004 to June 2008. 2 cases had Radial tunnel syndrome, and The average duration from the time of diagnosis until operation was 23.5 months (7~38), the patients were given an average of 5.7 local steroid injections each, and they were followed up postoperatively for at least 1 year. We performed combined surgical treatment of common extensor Fasciotomy & Radial nerve decompression. The patients' pain intensity was evaluated by VAS score system before the operation, 6 months and 12 months after the operation. The objective assessment of the surgery was investigated according to the criteria by Roles and Maudsley. RESULTS: The grasping power of the lesion site was 11.7 before surgical treatment, 18.6 and 28.3 after 6 months and 12 months. The mean VAS score was 8.2 before surgical treatment, 4.2 and 1.3 after 6 months and 12 months, respectively. The mean Simple Elbow Test Score was 1.8 before operation, 7.0 and 10.3 after 6 and 12 months, respectively. In clinical evaluation by the Roles and Maudsley's Criteria, there were 3cases assessed as excellent and 3 cases assessed as good after 12 months of follow up. No recurrence was noted and all the patients returned to the occupational activity and the average duration was 4.5 months. CONCLUSIONS: The surgical treatment using common extensor fasciotomy and radial nerve decompression for recurrent lateral epicondylitis is considered to be one of the recommendable methods.

Surgical treatment of facial nerve palsy:an analysis of the operation efficacy in 29 patients / 中国基层医药

Objective To evaluate the effect of surgical treatment in facial nerve paralysis.Methods Clinical data of 29 cases in facial nerve paralysis were retrospectively analyzed.All of the 29 cases of facial paralysis,18 cases is the suppurative otitis media,9 cases is the temporal bone fracture,2 cases is the neoplasms of the temporal bone.The 29 cases of facial nerve paralysis were surgical treatment.8 cases by vertical segment or horizontal segment of facial nerve decompression,19 cases by the stylomastoid foramen to the geniculate ganglion of facial nerve decompression,2 cases by the itratemporal course of facial nerve decompression.1 case was underwent end-to-end anastomosis,2 cases of the greater auricular or the sural nerve graft for repairing facial nerve defect.All data were analyzed with Rank sum test.Results Makes a follow-up visit for 6～18 months,the facial nerve function(House-Brackman grading system)before the technique Ⅱ 6.9%,Ⅲ17.2%,Ⅳ34.5%,Ⅴ 31.0%,Ⅵ 10.3%,after the technique,restores Ⅰ 6.9%,Ⅱ27.6%,Ⅲ27.6%,Ⅳ 24.1%,Ⅴ 13.8%,statistics analysis facial nerve function restoreS has the significance difference(P＜0.005).Conclusions The facial nerve decompression and the nerve graft are useful method to treat facial paralysis.Surgical treatment of facial paralysis is satisfied in the suppurative otitis media and the temporal bone fracture.

Optic Nerve Decompression for Traumatic Optic Neuropathy: A Case Report

A case of visual loss following cranio-maxillofacial trauma is reported. The patient had acute optic nerve injury associated with a fracture of the right zygomaticomaxillary and fronto-naso-ethmoido-orbital bone and epidural hematoma on the right temporal lobe of brain. Bony fragments compressing the optic nerve on lateral side was identified on computed tomography. Decompression of the optic nerve combined with evacuation of epidural hematoma has been performed via transfrontal craniotomy. The patient had complete recovery of visual acuity without any complications. The role of optic nerve decompression in the management of patients with traumatic optic neuropathy is discussed. Surgical indication is controversial and the procedure should be considered only within the context of the specific indication of the individual patient.

Facial Nerve Decompression via Middle Fossa Approach: Report of Three Cases

OBJECTIVE: Several conservative treatments have been tried in peripheral facial nerve paralysis, because 80% of patients recover spontaneously. Surgical decompression may be helpful to the residual, medically intractable patients. We present here our experiences of facial nerve decompression via middle fossa approach, which seems to be one of good surgical therapeutic options for medically refractory peripheral facial nerve paralysis. METHOD:Three cases of medically intractable peripheral type facial paralysis were microscopically operated via middle cranial fossa approach to decompress the labyrinthine segment of the facial nerve and geniculate ganglion by searching landmarks of middle meningeal artery, greater superficial petrosal nerve and facial hiatus. RESULTS: After operation, two cases of Bell's palsy improved substantially and one case of post-traumatic facial paralysis improved partially. CONCLUSION: This report is presented to describe the surgical facial nerve decompression via middle fossa for early control of peripheral type facial paralysis. Surgical decompression of edematous peripherally paralysed facial nerve could be preferred to conservative treatment in some patients although more surgical experience should be required.

Report of facial nerve decompression in the traumatic facial palsy

Return of facial nerve function is important in patients with facial nerve paralysis by trauma. Sometimes, delay in diagnosis of facial nerve paralysis make recovery of facial nerve function difficult. Traumatic facial palsy mostly occur after temporal bone fracture in unilateral. Temporal bone fracture after head trauma are divided into the three group; longitudinal fracture, transverse fracture and mixed fracture. The most common symptoms are hearing impairment, bloody otorrhea, loss of consciousness and facial nerve paralysis. The early care of temporal bone fracture involves facial nerve paralysis. And there has been many discussion and study in the treatment of the immediate or delayed facial palsy ; examply, surgical approach, time and methods. We have managed a patient with unilateral facial nerve paralysis after longitudinal temporal bone fracture in mastoid process and conservative facial nerve decompression was performed. We have obtained good result and report this case with review of literatures.

Megadose Steroids and Intranasal Optic Nerve Decompression in the Treatment of Traumatic Optic Neuropathy

BACKGROUND AND OBJECTIVES: Traumatic optic neuropathy (TON) is a relatively rare complication associated with closed head injury. However, it represents an extremely poor prognosis, and its management remains controversial. We present the treatment results of 15 patients with immediate and complete TON who were treated with megadose steroids (MDS), and, in cases where MDS produced no response, intranasal optic nerve decompression (OND). PATIENTS AND METHODS: The diagnosis of TON was based on evidence of the following : complete loss of vision, absence of direct pupillary light reflex and intact consensual response. All of the patients underwent high resolution CT scans of the orbit and received a complete neuro-opthalmologic examination. MDS was started immediately after the diagnosis. If no response occurred by 48 hours, an intranasal OND was conducted. RESULTS: Two of the 15 patients exhibited improved vision after treatment with MDS, and six of the remaining 13 patients who were unresponsive to MDS demonstrated improved vision after OND. Overall, eight out of the 15 patients experienced improved vision. CONCLUSION: This study is uncontrolled, but suggests that our protocol of MDS and, in cases where this produced no response, OND may be an effective and valid treatment modality for patients with immediate complete TON, which is generally believed to represent an extremely poor prognosis regardless of treatment.

Clinical Evaluation of the Traumatic Optic Neuropathy

Traumatic optic neuropathy is one of true ophthalmic emergencies and there is no proven form of treatment for traumatic optic neuropathy. 82 cases of traumatic optic neuropathy were investigated to evaluate the effectiveness of high dose corticosteroid for the visual improvement. Age, sex, initial visual acuity, final visual acuity, interval to treatment, the type of trauma and the affected region were studied retrospectively.250 mg of Methylprednisolone was administered intravenously every 6 hours for 3 days, and then followed by tapering using oral prednisone The vision was improved in 36 of 82 cases[43.9%]. It was difficult to interpret the relation-ships between the affected region and visual improvement, the interval for each treatment and final visual acuity. However, the vision was improved in 45 of 50 cases who had an initial visual acuity of above light perception, but in the two of 32 cases with no light perception. If indicated, fifteen cases were treated with a combination of high dose corticosteroid and optic nerve decompression. In initial treatment of traumatic optic neuropathy, high dose corticosteroid was effecive. Whether or not initial visual acuity was better than light perception was a key risk factor in the outcome.