A Case of Secondary Trigeminal Neuralgia Caused by Infected Postoperative Maxillary Cyst

Postoperative maxillary cyst (POMC) is relatively common complication among patients who underwent Caldwell-Luc surgery. Patients with POMC usually have no symptoms, although cyst extension can result in bone destruction or cystic infection with pain. The trigeminal nerve consists of the ophthalmic nerve, maxillary nerve, and mandibular nerve. Among these branches, the maxillary nerve runs to the lateral and frontal sides of the maxillary sinus wall. POMC can rarely lead to trigeminal neuropathy caused by cyst enlargement that compresses some branches of the trigeminal nerve. Recently, we experienced a case with trigeminal neuralgia due to POMC. The patient was successfully treated with inferior meatal antrostomy. We report this rare case with a literature review.

Efficacy observation on electroacupuncture in the treatment of oculomotor impairment caused by ophthalmic nerve injury / 中国针灸

<p><b>OBJECTIVE</b>To observe the difference in the clinical efficacy on oculomotor impairment between electroacupuncture and acupuncture and explore the best therapeutic method in the treatment of this disease.</p><p><b>METHODS</b>Sixty cases of oculomotor impairment were randomized into an electroacupuncture group and an acupuncture group, 30 cases in each one. In the electroacupuncture group, the points were selected on extraocular muscles, the internal needling technique in the eye was used in combination of electroacupuncture therapy. In the acupuncture group, the points and needling technique were same as the electroacupuncture group, but without electric stimulation applied. The treatment was given 5 times a week, 15 treatments made one session. After 3 sessions of treatment, the clinical efficacy, palpebral fissure size, pupil size, oculomotor range and the recovery in diplopia were compared before and after treatment in the two groups.</p><p><b>RESULTS</b>In the electroacupuncture group, the palpebral fissure size was (9.79+/-2.65)mm and the eyeball shifting distance was (18.12+/-1. 30)mm, which were hig-her than (8.23+/-2.74)mm and (16.71+/-1. 44)mm respectively in the acupuncture group. In the electroacupuncture group, the pupil diameter was (0. 44 +/-0. 42)mm, which was less than (0. 72 +/- 0. 53)mm in the acupuncture group, indicating the significant difference (all P<0. 05). The cured rate was 63. 33% (19/30) and the total effective rate was 93.33% (28/30) in the electroacupuncture group, which was better than 36.67% (11/30) and 83. 333 (25/30) in the acupuncture group separately, indicating the significant difference (all P<0. 05).</p><p><b>CONCLUSION</b>Electroacupuncture presents the obvious advantages in the treatment of oculomotor impairment, characterized as quick and high effect, short duration of treatment and remarkable improvements in clinical symptoms, there are important significance for the improvement of survival quality of patients.</p>

Síndrome de frey: revisión de literatura / Frey syndrome: review of the literature

El síndrome de Frey descrito inicialmente en 1923, es también conocido como Síndrome de la sudoración gustativa o Síndrome del Nervio aurículotemporal (N.auriculotemporalis), ya que las lesiones cutáneas asociadas a éste aparecen en la zona inervada por esta rama del nervio maxilar inferior (N. Mandibulares). Se caracteriza por sudoración gustativa y eritema en la región cervico-facial como respuesta a estímulos gustativos y excepcionalmente táctiles, pudiendo surgir como una complicación tras cirugía de la glándula parótida (parotidectomía), traumatismos o infección supurativa de esta glándula, como consecuencia de un daño ocasionado en las fibras parasimpáticas del nervio aurículotempora (N.auriculotemporalis). Los síntomas de sudoración y enrojecimiento de la piel suelen desarrollarse lentamente y resultan muy molestos. El tratamiento consiste en la colocación de anticolinérgicos locales o sistémicos, interposición de diversos materiales como colgajos regionales, tal como el músculo esternocleidomastoideo o la fascia temporoparietal

Frey's syndrome described initially in 1923, is also known as gustatory sweating syndrome or Auriculotemporal nerve Syndrome, since the cutaneous injuries associated with this one appear in the area supplied by this branch of the mandibularis nerve. It is characterized by gustatory perspiration and erythema in the cervico-facial region as response to gustatory and exceptionally tactile stimulation, being able to arise as a complication after surgery of the parotid gland (parotidectomy), traumatism or supurative infection of this gland, as consequence of a damage caused in the parasympathetic fibers from the auriculotemporal nerve. The symptoms of perspiration and reddening of the skin use to develop slowly and turn out to be very troublesome. The treatment consists of the placement of local or systemic anticolinergics, interposition of diverse materials as regional muscle flaps, such as the esternocleidomastoid muscle or the fascia temporoparietal

Estesiometria corneana pós cirurgia fotorrefrativa / Esthesiometry corneal after surgery photorefractive

OBJETIVO: Avaliar as alterações que ocorrem na sensibilidade corneanas após as cirurgias de LASIK e PRK MÉTODOS: Estudo prospectivo onde foram avaliados 60 olhos de 30 pacientes submetidos a LASIK bilateral simultaneamente e mais 30 olhos de 15 pacientes submetidos a PRK bilateral simultaneamente. De acordo com a quantidade de ablação intra-operatórias, os olhos foram divididos em dois grupos: Grupo 1 (menor que 40 µm) e Grupo 2 (Maior que 40 µm). A sensibilidade corneana foi medida na região central da córnea pelo estesiometro Cochet Bonnet® no pré operatório e após 30, 90 e 180 dias da cirurgias. RESULTADOS: A sensibilidade corneana na LASIK apresentou-se diminuída durante os três primeiros meses retornando as valores pré operatórios aos 6 meses; E de acordo com a quantidade de ablação o Grupo 1 apresentou diferença estatisticamente significante em relação ao Grupo 2 durante os três primeiros meses; No entanto a PRK recuperou seus valores pré operatório aos três meses e de acordo com a quantidade de ablação o Grupo 1 apresentou diferença estatisticamente significante somente no primeiro mês de pós operatório. CONCLUSÃO: A LASIK apresentou sensibilidade menor em relação ao PRK durante os 3 primeiros meses e somente aos 6 meses os valores da sensibilidade corneana foram similares; Os resultados também sugerem que a quantidade de ablação está relacionada com a diminuição da sensibilidade corneana durante os primeiros meses em ambas as técnicas cirúrgicas, principalmente na LASIK.

PURPOSE: To evaluate the alterations that occur on the cornea sensitivity after Lasik and PRK surgery. METHODS: Prospective studies have evaluated60 eyes from 30 patients subjected simultaneously to bilateral Lasik and 30 eyes from 15 patients subjected simultaneously to bilateral PRK. According to the amount of inner operatory ablation the eyes were divided into two groups: Group I (< 40 µm) and group II (> 40µm). The cornea sensitivity was measured in the central region of the cornea on the pre operatory and then again at 30, 90 and 180 days after the surgery with the esthesiometer. RESULTS: The cornea sensitivity in Lasik presented itself in a minor way during the first three months, returning to pre operatory values at six months; and according to the amount of ablation group I presented statistically significant difference in comparison to group II during the first three months; however PRK recovered its pre operatory values at three months and according to the amount of ablation group I presented statistically significant difference only on the first month of pre operatory. CONCLUSION: Lasik showed the least sensitivity in comparison to PRK during the first three months, only at six months the sensitivity values were similar to each other; the results suggest that the result of ablation endangers the cornea sensitivity during the first months on both surgical techniques especially Lasik.

Coexistencia de neuroblastoma olfatorio y aneurisma de la arteria carótida interna: presentación de un caso / Coexistence of an olfactory neuroblastoma and internal carotid artery aneurism: case report

El neuroblastoma olfatorio es una neoplasia neuroectodérmica maligna rara que afecta a la bóveda nasal y que tiende a invadir las estructuras vecinas, entre estas a la cavidad intracraneal. Su asociación con aneurismas intracraneales nunca ha sido descrita. Presentamos a una paciente con la coexistencia de un aneurisma del segmento oftálmico de la arteria carótida interna y un neuroblastoma olfatorio con invasión intracraneal. La coexistencia entre neoplasias del sistema nervioso central y aneurismas intracraneales es infrecuente. En este artículo analizamos las posibles causas de la asociación entre neoplasias y aneurismas intracraneales.

The olfactory neuroblastoma is a rare malignant neuroectodermal neoplasia of the nasal roof. It has a highly tendency of invades near structures including intracranial compartment. Associations between olfactory neuroblastoma with intracranial aneurysms have been never described. We show a case of a female with coexistence of an internal carotid artery aneurysm and olfactory neuroblastoma. The coexistence between nervous system tumors with intracranial aneurysms is not common. In this paper we analyze the association between intracranial neoplasia and aneurysms.

Revaluation of the Hutchinson's Sign / 대한피부과학회지

BACKGROUND: The appearance of skin lesions at the dermatome of the nasociliary nerve in herpes zoster involving the ophthalmic nerve (Hutchinson's sign) was associated with an increased incidence of ocular complications. OBJECTIVE: This study is aimed to revaluate the clinical usefulness of the original concept of Hutchinson's sign in herpes zoster involving the ophthalmic nerve. METHODS: A total of 70 patients with herpes zoster, involving the ophthalmic nerve, were enrolled in this study at the medical center, Daegu Catholic University from December 2004 to July 2006. Statistical analysis using chi-sqaure test in verified the relationship between the clinical parameters and the development of ocular lesions (p<0.05). RESULTS: Statistical analysis showed that the presence of underlying disease, severity of pain, severity of skin lesions and Hutchinson's sign were the predictive factors of the development of ocular lesions. A strong relationship formed between the Hutchinson's sign and the development of ocular lesions [Relative risk: 6.769 (Confidence interval 95%: 2.310~19.838)]. CONCLUSION: Hutchinson's sign may be a useful predictive factor in the development of ocular lesions in the herpes zoster involving the ophthalmic nerve.

Bilateral nevus of Ota

Nevus of Ota is a dermal melanocytosis seen in the distribution of ophthalmic, maxillary and mandibular divisions of the trigeminal nerve. Most of the cases reported are in females with a typical unilateral distribution. We describe a case of bilateral nevus of Ota in a male

Manejo neuroquirúrgico de los aneurismas paraclinoídeos / Neurosurgical management of paraclinoid aneurysms

Presentamos el manejo quirúrgico de los aneurismas paraclinoídeos. Discutimos los fundamentos microanatómicos, indicaciones, técnica quirúrgica empleada, complicaciones y resultados de una serie prospectiva de 10 pacientes operados por el equipo vascular del INC Asenjo entre noviembre de 1999 y julio de 2000. Las complicaciones correspondieron a una infección de herida operatoria y una colección extradural en la primera paciente de la serie, un hematoma cervical en otra enferma y un infarto de la arteria coroídea anterior en una paciente con aneurisma global de carótida. Se realizó control neurooftalmológico preoperatorio en todos los pacientes, registrandose en 3 compromisos de nervio óptico postquirúrgicos. No hubo mortalidad en la serie. Especial énfasis se aplica a la importancia del conocimiento microanatómico, al trabajo en equipo y a la planificación prequirúrgica para el manejo de esta compleja patología

Long Term Follow up of complications in 43 Cases after Skull Base Approach

Skull base surgery has developed through the evolution of imaging, anatomic research, surgical approach and reconstructive techiques. The basic disciplines of approaching skull base lesions are to provide direct vision, minimize brain retraction, allow excellent exposure and minimal blood loss. Although many advantages listed above are reported, objective long-term follow up results about post-operative complications of this procedures were not introduced. This study was designed to review the complications of skull base approach that we experienced 43 cases by a team approach with neurosurgery-supraorbital rim osteotomy, orbitozygomatic osteotomy, orbitozygom aticoglen-oidotomy, orbitozygomaticoglenoidocondylotomy, and transfrontonasomaxillary osteotomy-through objective evalutation criteria. The result of this study demonstrated that the type of complications were consisted with perioperative infection (5 cases), subdural empyema (1 case), CSF leakage(1 case), hematoma (1 case), meningitis (3 cases), ophthalmic nerve injury (1 case),facial nerve injury (2 cases), T-M joint problem ( 2 cases), & enophthalmos ( 2cases). In conclusion, after performing the different skull base approaches, we analyzed several complications of the above procedures. We analyzed with the purpose of preventing complications in the next skull base approach.

Successful Pain Management for the Postherpetic Neuralgia of Ophthalmic Nerve by Continuous Subcutaneous Infusion of Ketamine: A case report / 대한마취과학회지

A 25-year-old woman transferred to pain clinic complaining of severe throbbing eye ball pain, eyelid edema and severe tearing in her left eye under the diagnosis of herpes zoster ophthalmicus that was developed 3months ago. In addtion to conventional medication, she had been taken stellate ganglion block, supraorbital and supratrochlear nerve block to contol of pain, but the response was poor. So we tried to administer ketamine subcutaneously, because not only ketamine, NMDA receptor antagonist, played a significant role to reduce neuropathic pain and pain caused by nerve injury, but also she wanted to work in her office during the treatment. We used subcutaneous ketamine 3 mg/hr (0.06 mg/kg/hr) in patient with postherpetic neuralgia of the ophthalmic nerve, and accomplished almost complete pain relief without any sign of side effect.

MR Findings of Trigeminal Neurinoma

PURPOSE: To describe the MRI findings of trigeminal neurinoma. MATERIALS AND METHODS: We retrospectively analyzed the MRI findings of 19 patients with trigeminal neurinomas proven by surgery and pathologic examination. Axial T1-and T2-weighted MR images in all patients and gadolinium-enhanced T1-weighted images in 14 patients were obtained at 2.0T (8 cases), 1.5T (6 cases) or 0.5T (5 cases). These were analyzed in terms of tumor size, signal intensity, degree of contrast enhancement, the presence or absence of cystic change and denervation atrophy of the masticator muscles. RESULTS: Clinical manifestations included sensory abnormality or pain (n=12), headache (n=10), impaired visual acuity or diplopia (n=6), hearing loss or tinnitus (n=3), weakness of masticator muscles (n=2), and mass or nasal obstruction (n=2). On MR images, tumor size was seen to average 4.2 (range 1.5-6)cm; tumors were located in the posterior cranial fossa (n=8), middle cranial fossa (n=4), ophthalmic nerve (n=2), maxillarynerve (n=1), and mandibular nerve (n=1), and in three cases were dumb bell-shaped and extended into both the middle and posterior cranial fossa. On T1-weighted images, signals were isointense with cortical grey matter, in ten cases (53%), and of low intensity in nine (47%); on T2-weighted images, signals were of high intensity in 15 cases (79%) and were isointense in four (21%). Cystic change was seen in 12 cases (63%). After enhancement, all (14/14) the tumors enhanced. Denervation atrophy was seen in nine cases (47%) and all of these involved the trigeminal ganglion or mandibular nerve. CONCLUSION: A trigeminal neurinoma shows similar signal intensity and enhancement to other cranial neurinomas with a higher incidence of cystic degneration. Its location and shape are characteristic, and where there is involvement of the trigeminal ganglion or mandibular nerve, denervation atrophy may be seen.

Infiltraçäo anestésica da fossa ptérigo-maxilar e do nervo nasociliar: aspectos anátomo-fisiológicos / Anesthetic infiltration of the pterigum-maxilla fossa and nasociliar nerve: anatomo-physiological aspects

Säo discutidos os aspectos anatômicos da fossa ptérigo-maxilar e do nervo nasociliar, cujas infiltraçöes anestésicas säo atos simples, rápidos, eficazes e seguros em vários procedimentos odontológicos e otorrinolaringológicos, possibilitando a realizaçäo de cirurgias nasossinusais bem menos sangrantes com a utilizaçäo de doses bem menores de anestésicos gerais, em virtude da aboliçäo dos estímulos álgicos e consequente näo liberaçäo de catecolaminas

Microanatomy of Lateral Wall of the Cavernous Sinus

In the microsurgical dissection of the lateral wall of the cavernous sinus, interrelationships of its nerves have been studied in 100 Korean adult half heads. And in the serial coronal section of the cavernous sinus in 10 half heads, the structures of the lateral wall have been studied. The relationships of the nerves of the lateral wall were classified to five types according to the course of the trochlear nerve. Each length of the Parkinson's triangle and the angle between trochlear and ophthalmic nerves were measured. There data were compared with those of the other races. The lateral wall of the sinus was composed of two layers. The orientation of the fibers of the deep layer was variable in regions. The oculomotor nerve was enveloped with sheath extended from dura mater and it was connected with deep layer of the lateral wall. The trochlear nerve was enveloped with sheath formed y division of innermost part of the deep layer. The venous sinus was found between the two layers of the lateral wall. The neurosurgical significance of the lateral wall of the sinus was discussed.

Actualidades en anatomia: ganglio trigeminal / Updates in anatomy: trigeminal ganglion

El ganglio trigeminal también conocido como ganglio semilunar o ganglio de Gasser, contiene la mayoría de los cuerpos celulares de las neuronas sensitivas primarias, mientras que las restantes provienen del núcleo mesencefálico.

Alteraciones motoras: segunda parte; alteraciones de las ducciones / Motor alterations: second part; alteration in ductions

Se describen las alteraciones de las ducciones en cuatro grupos: por parálisis: III par, IV par, VI par; por hipofunción: agenesia muscular, sección traumática del músculo, debilitamiento quirúrgico excesivo, músculo suelto; por alteraciones inervacionales: síndrome de Duane, parálisis monocular de elevadores, síndrome de Moebius; por restricción: síndrome de Brown, estrabismo fijo, fibrosis del recto inferior, estrabismo tiroideo, fractura blow-out de órbita, adhesión post-quirúrgica

Morphometric study on the trigeminal ganglion and the intracranial ophthalmic, maxillary and mandibular nerves in Korean adults / 체질인류학회지

A morphometric study on the trigeminal ganglion and the intracranial portion of the ophthalmic, maxillary and mandibular nerves was done in 50 Korean adult cadavers. The shape of the ganglion was classified into 7 types and semicircular shape was most common (54%). Mean width of the trigeminal root at porus trieminus was 6.08mm. The length of the trigemnal root from porus to the trigeminal ganglion was 8.28mm at ophthalmic portion, 10.16mm at maxillary portion, and 8.90mm at mendibular portion. Maximum width of the ganglion was 15.48mm and the breadth of the ophthalmic, and maxillary portion were 5.25mm and 5.26mm, respectively, and that of the mandibular portion (4.92mm) was narrow than the other portion. Intracranial ophthalmic nerve was 4.30mm of width and 17.89mm of length, and this nerve inclined average 39.7。 (range 14.56。) from sagital plane. It was observed infrequently that the cavernous sinus extended to the lateral border of the maxillary nervw and the emissary sinus ran under the mandibular nerve.