Uvulopalatopharyngoplasty for nasal blockage 21 years after total rhinectomy.

BACKGROUND: Total rhinectomy is an invasive procedure that significantly impairs the intranasal turbulence, humidification and heating of inspired air. The use of uvulopalatopharyngoplasty for the treatment of sleep-disordered breathing disorders such as primary snoring and obstructive sleep apnoea has diminished over the past years because of the emergence of less invasive procedures and alternative therapeutic options. This clinical record presents the treatment of a long-term side effect of total rhinectomy using uvulopalatopharyngoplasty. CASE REPORT: In 1997, a 62-year-old male underwent total rhinectomy for a nasal schwannoma, followed by rehabilitation with a nasal prosthesis. Twenty-one years later, he presented with severe complaints of nasal blockage and breathing difficulties during both daytime and night-time. Clinical examination revealed no major anomalies besides significant velopharyngeal narrowing. Thus, in 2019, uvulopalatopharyngoplasty was performed to re-establish velopharyngeal patency. Hereafter, the symptoms of nasal blockage disappeared, resulting in an improved quality of life. CONCLUSION: Uvulopalatopharyngoplasty may prove useful to treat selected patients with daytime breathing difficulties due to velopharyngeal narrowing.

Treatment and auditory rehabilitation of intralabyrinthine schwannoma by means of cochlear implants : English version.

BACKGROUND: To date, the therapy of intralabyrinthine schwannoma consists mainly of a wait-and-see approach, completely ignoring auditory rehabilitation. Only a few single-case reports are as yet available on treatment with cochlear implants (CI). AIM OF THE STUDY: This study aimed to assess the results of auditory rehabilitation after treatment with CI in a series of cases. MATERIALS AND METHODS: The demographic findings, symptoms, and results of surgical therapy in 8 patients were evaluated in a retrospective analysis. RESULTS: Prior to surgery, all patients presented with profound hearing loss and tinnitus. Episodic dizziness was reported by 3 patients. Among the patients, 4 had an intracochlear and 3 an intravestibular schwannoma, and a transmodiolar schwannoma was found in 1 patient. A total of 6 patients underwent treatment with CI. The results of auditory rehabilitation are favorable with open-set speech comprehension. CONCLUSION: CI treatment following resection of an intralabyrinthine schwannoma is a promising option for auditory rehabilitation, even in single-sided deafness. This is a new treatment concept in contrast to the wait-and-scan policy. Expectant management appears justified only if the patient still has usable hearing.

Intervenciones que mejoran el pronóstico en la neurofibromatosis tipo 2: a propósito de un caso / Interventions that improve the prognosis in neurofibromatosis type 2: a case report

La neurofibromatosis tipo 2 (NF2) es una enfermedad autosómica dominante (AD) que predispone a múltiples lesiones neoplásicas; el neurinoma del acústico bilateral es patognomónico. Es frecuente la presencia en el mismo paciente de varios tipos de tumores con estirpe patológica y localización diferentes, lo que hace más difícil las decisiones terapéuticas, especialmente en niños y adolescentes. El trastorno se localiza en el cromosoma 22q12. Las distintas modalidades de cirugía y radioterapia son armas fundamentales en el tratamiento de la NF2. El tratamiento rehabilitador individualizado influye en el pronóstico funcional final. El seguimiento clínico y de neuroimagen debe tener como objetivo el control evolutivo de los tumores y la decisión terapéutica(AU)

Neurofibromatosis type 2 (NF2) is an autosomal dominant (AD) disease that predisposes to multiple neoplasms; the bilateral acoustic neuroma is pathognomonic. The presence of several types of tumors having different pathological lineage and localization is frequent in the same patient. This hinds treatment decisions, especially in children and adolescents. The disorder is located on chromosome 22q12. The different types of surgery and radiotherapy are essential tools for the treatment of NF2. Therefore, individualized rehabilitation treatment influences the final functional prognosis. The purpose of the clinical and neuroimaging follow-up should be that of controlling the progression of tumors and therapeutic decision(AU)

Lesión del nervio espinal accesorio tras la intervención de un neurinoma cervical / Spinal accessory nerve injury alter operation for cervical neurinoma

Los neurinomas son tumores de la membranade las células de Schwann (neurilema) poco frecuentes ehistológicamente benignos. Pueden presentarse en cualquier lugar del sistema nervioso, siempre en relación con nervios periféricos o craneales. Representan aproximadamente un tercio de todos los tumores espinales y su localización más habitual es la extramedular e intradural. Dicha localización predispone a complicaciones compresivas y quirúrgicas.Se presenta el caso de un varón de 55 años intervenido deun neurinoma cervical de localización extramedular e intradural al que no se pudo realizar una extirpación completa. El posoperatorio cursó con la afectación de la rama externa del nervio espinal.Se describen las características clínico-anatomopatológicas de dicho tumor y la importancia de la electromiografía en el diagnóstico de la lesión del nervio espinal accesorio

Neurinomas are uncommon and histologicallybenign tumors of the Schwann cell membrane (neurilemma).They may occur in any site of the nervous system, alwaysin relationship with peripheral or cranial nerves. Theyrepresent approximately one third of all the spinal tumors, their most common site being extramedullary and intradural. This location predisposes to compression and surgical complications.The case of a 55 year old man operated on for intradural,extramedullary located cervical neurinoma that could notbe completely excised is presented. The post-operative period occurs with involvement of the external branch of the spinal nerve.The clinical and anatomical characteristics of this tumorand the importance of the electromyography in the diagnosis of the accessory spinal nerve injury are described

Postoperative ambulation of patients with intraspinal neurilemomas and meningiomas.

Factors affecting the postoperative ambulatory state of patients with intraspinal neurilemomas and meningiomas were evaluated in 92 patients who underwent surgery at the Chang Gung Memoriam Hospital. The patients' records were reviewed retrospectively and leg power grading was noted (Medical Research Council of Great Britain grading system, zero to five). Of the 89 patients with a preoperative leg power of 1 or better, 87 could walk with or without aids shortly after surgery. The remaining three patients, with a preoperative leg power of zero, were all wheelchair-bound postoperatively. The presence of sensory deficits and sphincter incontinence did not correlates with a poor postoperative ambulatory state, provided the preoperative leg power was above zero. The average period between the onset of the earliest symptoms and the establishment of the diagnosis was 68 weeks for patients with intraspinal neurilemomas and 71 weeks for those with meningiomas. Surgical for patients with neurilemomas were as good as those with meningiomas. Patients with multiple spinal neurilemomas did not fare any worse after surgery.

Prognostic factors of intraspinal neurilemmoma and meningioma with severe preoperative motor deficits.

A total of 20 cases of intraspinal benign tumors (13 neurilemmomas and seven meningiomas) with severe motor deficits operated on from 1978 to 1991 were reviewed. Motor deficits were graded according to the classification of Cooper and Ebstein. Grade IV represented slight movement of the lower extremities, but no ability to walk or stand; grade V was complete paralysis. There were 16 patients classified as grade IV and four classified as grade V. All patients underwent total excision of the tumor and postoperative physical therapy. After various periods of follow-up, 13 patients could walk independently, five could walk with assistance, one could stand, and one was still restricted to a wheelchair. For the 13 patients who could walk independently, 11 were able to stand within one month after surgery. In contrast, of the seven patients who could not walk independently, only two managed to stand within one month of surgery. Statistically, age, duration of paraplegia and tumor location all had a significant influence on the recovery of motor function. Being able to stand within one month of surgery was predictive of a good recovery.

[Total removal of acoustic neurinoma]. / O total'nom udalenii nevrinom slukhovogo nerva

The analysis is based on the results of a total removal of acoustic neurinomas in 120 patients operated on in 1967-1975. The facial nerve was preserved after surgery in 65 patients (54.2%). In the course of the recent 3 years the employment of microsurgical techniques permitted to preserve the VII nerve in 26 among 35 operated patients (74.3%). Among 103 examined postoperatively 96 retained their full or partial capacity for work (93.2%). Ten patients (8.3%) died after surgery. Within the recent 3 years 35 patients were operated on without a single mortality case.