Leprosy affects facial nerves in a scattered distribution from the main trunk to all peripheral branches and neurolysis improves muscle function of the face.

Current literature rejects nerve release in leprous facial neuropathy and states that lesions are restricted to the peripheral zygomatic branches. Since there are approximately 500,000 patients with this disease throughout the world, we wanted to clarify the precise location of facial nerve's affection and the benefit of neurolysis. Our study showed that in patients with leprosy, the facial nerve's main trunk, the peripheral zygomatic branches, and all other branches were affected. Follow-up showed improvement in lagophthalmos and in misreinnervation, with no improvement in the control cohort. Nerve release improves muscle function in leprous facial neuropathy, provided surgery is performed on all affected segments. Intraoperative electroneurodiagnostics is an effective tool for detecting the most proximal site of lesion and ensuring effective surgery.

Leprosy affects facial nerves in a scattered distribution from the main trunk to all peripheral branches and neurolysis improves muscle function of the face

Current literature rejects nerve release in leprous facial neuropathy and states that lesions are restricted to the peripheral zygomatic branches. Since there are approximately 500,000 patients with this disease throughout the world, we wanted to clarify the precise location of facial nerve's affection and the benefit of neurolysis. Our study showed that in patients with leprosy, the facial nerve's main trunk, the peripheral zygomatic branches, and all other branches were affected. Follow-up showed improvement in lagophthalmos and in misreinnervation, with no improvement in the control cohort. Nerve release improves muscle function in leprous facial neuropathy, provided surgery is performed on all affected segments. Intraoperative electroneurodiagnostics is an effective tool for detecting the most proximal site of lesion and ensuring effective surgery.

[Surgical decompression treatment of leprous neuritis at the Bom-Pastor Hospital (Brazilian Amazonia)]. / Traitement chirurgical de décompression des névrites lépreuses à l'hôpital Bom-Pastor (Amazonie brésilienne).

PURPOSE: Only leprosy resource centres undertake surgery for neuritis. Patients' accessibility to this surgical procedure is poor because these centres are often far from their homes. The aim of our work is to study the feasibility of neuritis surgery in the field. METHODS: A surgeon trained in this surgery was recruited by Bom-Pastor hospital in Brazilian Amazonia, which is located 400 km away from the leprosy resource centre. Patients operated from May 1996 to December 1997 were enrolled in this retrospective study. RESULTS: A total of 45 operations were carried out during 17 procedures on 13 patients, among which 12 were multibacillary cases. The decompression surgery was performed with a median delay of 1 year after leprosy diagnosis and 3.5 months after the neuritis diagnosis. Among 17 operations, 14 were performed for painful neuritis of recent onset unsuccessfully treated with corticoids or recurring during the month after corticoids were withdrawn. The other three operations were performed for long-standing neuritis with paralysis and deformity. Pain was relieved in all the cases of recent neuritis, except for one patient who suffered from a serious steroid-dependant erythema nodosum leprosum. An improvement of motor function was observed in one out of three patients with long-standing neuritis. Adverse effects were few: a scar infection with a rapid recovery and a keloid scar. Two neurites recurred 2 and 10 months after the surgery. CONCLUSIONS: In an endemic leprosy region, field access to surgery for neuritis appears to prove real progress in the management of leprosy neuritis.

Facial nerve pathology in leprosy: searching for the proximal extent of the lesion in facial nerve biopsies.

A light and electron microscope study was made of resin embedded facial nerves in three cases of leprosy involving the facial nerve. The patients had irreversible facial nerve palsies and had requested facial reconstruction. No consistent pattern of nerve fibre damage was found. In one case the temporozygomatic was affected, but the cervical branch was normal, suggesting the damage begins distally. In two cases the loss of nerve fibres in the trunk and all branches was similar, and is likely to emanate from damage at a more proximal site. The presence of increased numbers of unmyelinated axons, often in clusters, is evidence of regeneration. These axons probably have the potential to develop into functional myelinated fibres provided that they can innervate a viable distal target such as a muscle graft. These regenerating axons are distal to the stylomastoid foramen suggesting that the most proximal level of involvement of the facial nerve could be intracranial. The finding of a more proximal level of nerve involvement, implies that the mis-reinnervation seen in partially recovered facial nerve palsies in leprosy, could be due to some regenerating axons being mis-directed at the level of the main trunk bifurcation.

Intraoperative electroneurodiagnostics to detect a second granuloma in the cubital area of median nerves affected by leprosy: a new approach to prevent incomplete surgery.

A recent work reports on the necessity to localize the most proximal site of leprous ulnar neuritis with intraoperative electroneurodiagnostics. In the present study we wanted to verify the applicability of this method on leprous median nerves. In six patients, seven median nerves were exposed at the wrist, all showing a typical leprous granuloma there. Spinal roots C5 to Th1 were then stimulated intraoperatively, evoking efferent mixed nerve compound action potentials (NCAPs) which were registered from the nerve's surface. No recordings could be obtained on the granuloma in all patients, neither distally nor shortly proximal from it, nor even further central at the forearm's proximal third where the median nerve exits the cubital area. Prior to dissecting the nerves in this precarious region, they were exposed at the arm's distal third, looking inconspicuous in all cases. Recordings could finally be obtained there, and subsequent exposure further proximal showed no increase in amplitude of the NCAPs, but there was a sharp decrease distally. In all cases, subsequent dissection of the cubital area revealed a second leprous granuloma extending variably from the distal third of the arm to the two heads of the pronator teres muscle, requiring microsurgical release. Intraoperative spinal root stimulation is an effective method to detect a second leprous granuloma and to avoid incomplete surgery in median nerves affected by leprosy.

Resultados de neurolise de nervo ulnar em neurite hansênica / Results of neurolysis of the ulnar nerve in leprosy neuritis

Um grupo de 33 pacientes de hanseníase apresentando neurite do nervo ulnar foram submetidos a neurolise com transposiçao anterior sub-cutânea deste nervo. A cirurgia foi indicada devido à progressiva piora da funçao neural mesmo com tratamento clínico. O teste com monofilamentos de Semme-Weinstein e avaliaçao de força motora foram utilizados para avaliar os pacientes antes e 12 meses após a cirurgia, 39,3 por cento apresentaram melhora, 39,3 por cento permaneceram estáveis e 21,4 por cento apresentaram piora da funçao neural.

Intraoperative spinal root stimulation to detect most proximal site of leprous ulnar neuritis.

In 10 patients with leprous ulnar neuritis, we investigated the most proximal site of lesion in the affected nerves. Spinal roots C8 and T1 were stimulated intraoperatively to evoke efferent mixed compound nerve action potentials which were recorded from the exposed ulnar nerves. The site at which amplitudes reached a maximum was considered the most proximal site of lesion. Nerve damage was found far proximally from the thickened segments in otherwise inconspicuous sections. Epineuriotomy within these apparently unaffected segments revealed fibrosis of the interfascicular epineurium in 9 patients, which is an indication for microsurgical interfascicular neurolysis.

[Surgical treatment of leprous neuritis. The results in 114 operations]. / Traitement chirurgical des névrites lépreuses. Résultats de 114 interventions.

One hundred and fourteen surgical operations for neuritis were performed in 50 patients coming from areas where leprosy is endemic. The neurological signs included pain and/or sensorimotor deficit. The surgical procedure consisted of transposition and/or neurolysis. Pain subsided in 86 per cent of the cases, and the sensorimotor deficit was reduced in 78.9 per cent. The effects of surgery on pain always appeared on recovery from anaesthesia or on the day following the operation. The results were particularly good in young subjects and in patients with neurological signs of recent onset. Poor results were observed only in cases of old and painless neuritis with motor deficit, the latter being usually unchanged. Few studies have been published on large series of leprous neuritis patients treated surgically. Surgery in such cases must be associated with a medical treatment, failing which the patient is exposed to relapses.

Tratamento do mal perfurante plantar com um extrato de sangue desproteinizado (Solcoseryl): primeiros resultados

Após considerações gerais sobre a importância do problema do mal perfurante plantar como incapacidade f¡sica e sua gênese, o autor expõe as caracter¡sticas de um produto obtido do sangue de amimais jovens (Solcoseryl) e usado no tratamento desta complicação tardia de lepra. Em quatorze anos obtem doze curas com um m¡nimo de cinco e um máximo de 38 aplicações, e em dois casos obtem melhora evidente. Os resultados são ilustrados por fotografias anteriores e posteriores ao tratamento. Concluiu-se que, pela ação cicatrizante rápida, é de utilidade no tratamento, em regime ambulatorial, do mal perfurante plantar de origem leprótica.

Lesions osseuses nasales et maxillaries superieures dans la lèpre en Afrique occidentale / Lesions bones nasal and maxillaries superieures in leprosy in Western Africa

Se basant sur l`examen radiologique systématique de 53 lèpreux traitès à Institut Marchoux (Bamako), les auters ont observé: 1.La frèquence de lésions osseuses maxillaires et nasales chez les lépreux africans, semblables à celles décrites sur des sujets scandinaves par Moller Christensen. 2. L´association également frequente de lésions osseuses du septum nasal des cornets et de la charpente nasale. 3. La predominance nette de ces lésions dans les formes lépromateuses quelle que soit la durée de la maladie; mais cette prèdominance n´est pas exclusive, certains malades tuberculoides sont atteints aussi et le probleme pathogénique reste à résoudre...