Therapy for the Rheumatoid Hand.

Rheumatoid arthritis (RA) of the hand results in the progressive, inflammatory destruction of multiple tissue types resulting in significant functional deficit. Occupational therapy for the hand often plays a synergistic role in the improvement of health-related quality of life outcomes when employed alongside biological, disease-modifying antirheumatic drugs, and surgical regimens. Furthermore, postoperative therapeutic rehabilitation protocols in patients with RA have been shown to optimize surgical outcomes.

Anatomy and Histology of Sensorimotor Connections Between the Facial and Trigeminal Nerve in the Buccinator Muscle.

Background: Despite indications of a close interaction between the trigeminal (CN V) and facial nerve (CN VII) within the buccinator muscle, a combination of anatomical dissection and histological analysis has not been reported.

Methods: Five formalin-fixed and fresh-frozen hemifaces were dissected to reveal the buccal fat pad, the buccinator muscle, and anastomotic connections between CN V and CN VII within it. Samples were taken for histological processing and immunostaining.

Prophylactic Regenerative Peripheral Nerve Interface (RPNI) Surgery in Pediatric Lower Limb Amputation Patients.

Objective: To evaluate the prophylactic effect of Regenerative Peripheral Nerve Interface (RPNI) surgery on pediatric post-amputation pain.

Summary Of Background Data: Chronic post-amputation pain is a debilitating and refractory sequela of limb amputation affecting up to 83% of pediatric patients with limb loss, resulting in disability and decreased quality of life. We postulate that prophylactic RPNI surgery performed during amputation may decrease the incidence of symptomatic neuroma and development of phantom limb pain, as well as limit analgesic use among pediatric patients with limb loss.

Effect of Lower Extremity Nerve Decompression in Patients With Painful Diabetic Peripheral Neuropathy: The Diabetic Neuropathy Nerve Decompression Randomized, Observation Group and Placebo Surgery-Controlled Clinical Trial.

Objective: To evaluate the effect of nerve decompression on pain in patients with lower extremity painful diabetic peripheral neuropathy (DPN).

Background: Currently, no treatment provides lasting relief for patients with DPN. The benefits of nerve decompression remain inconclusive.

Neurofibromatosis Type II and Facial Paralysis: Clinical Evaluation and Management.

Background: Facial paralysis secondary to neurofibromatosis type 2 (NF2) presents the reconstructive surgeon with unique challenges because of its pathognomonic feature of bilateral acoustic neuromas, involvement of multiple cranial nerves, use of antineoplastic agents, and management. Facial reanimation literature on managing this patient population is scant.

Methods: A comprehensive literature review was performed.

Facial Nerve High-Resolution Microanatomy Analysis of the Distal Intratemporal to Extracranial Pes Segment: Reconstructive Implications.

Background: Current knowledge of facial nerve topography between the stylomastoid foramen to the pes anserinus is very limited. Elucidating this segment's intraneural microanatomy may be advantageous in certain clinical settings: the planning of nerve grafts for gaps extending from the proximal facial nerve trunk to distal branches or in determining coaptation sites for hypoglossal jump grafts to provide selective upper and lower facial tone. This study is the first to provide high-definition intraneural topography of the aforementioned segment to optimize reconstructive outcomes.

Do Preoperative Depressor Anguli Oris Muscle Blocks Predict Myectomy Outcomes? A Single-Cohort Comparison in Postparetic Facial Synkinesis.

Summary: The complexity of facial synkinesis will likely benefit from an individualized approach to intervene on discrete synkinetic facial subunits. This overarching treatment algorithm requires understanding each synkinetic mimetic subunit. The depressor anguli oris muscle, because of its antagonistic relationship to the zygomaticus major, is of particular interest.

Depressor Anguli Oris Myectomy versus Transfer to Depressor Labii Inferioris for Facial Symmetry in Synkinetic Facial Paralysis.

Background:  Postparalytic synkinesis presents with a combination of hypo- and hypertonic muscles, leading to facial asynchrony with animation and at rest. One ubiquitous finding is a hypertonic depressor anguli oris (DAO) muscle and a weak depressor labii inferioris (DLI) muscle. The goal of this study was to evaluate the utility of DAO myectomy with or without its transfer to the weakened DLI in improving critical components of the dynamic smile.

Topographic and Neural Anatomy of the Depressor Anguli Oris Muscle and Implications for Treatment of Synkinetic Facial Paralysis.

Background: Synkinetic patients often fail to produce a satisfactory smile because of antagonistic action of a hypertonic depressor anguli oris muscle and concomitantly weak depressor labii inferioris muscle. This study investigated their neurovascular anatomy to partially explain this paradoxical depressor anguli oris hypertonicity and depressor labii inferioris hypotonicity and delineated consistent anatomical landmarks to assist in depressor anguli oris muscle injection and myectomy.

Methods: Ten hemifaces from five fresh human cadavers were dissected to delineate the neurovascular supply of the depressor anguli oris and depressor labii inferioris muscles in addition to the depressor anguli oris muscle relation to consistent anatomical landmarks.

Orbicularis Oculi Muscle Reinnervation Confers Corneal Protective Advantages over Static Interventions Alone in the Subacute Facial Palsy Patient.

Background: Corneal protection is a priority in flaccid facial palsy patients. Denervation of the orbicularis oculi muscle results in weak palpebral closure and predisposes patients to severe corneal sequelae. While periorbital static procedures enhance corneal coverage in repose, voluntary closure is only regained through dynamic reinnervation of the muscle.

Reuse of the Masseteric Nerve for Dynamic Reanimation in Facial Palsy Patients with Previously Failed One-Stage Dynamic Smile Reanimation.

Failed primary dynamic smile reanimation procedures present significant challenges for the patient and surgeon alike. This is particularly true in older patients with a history of previous neck dissection and radiation therapy who underwent previous reconstruction with a free functional muscle transfer innervated with an ipsilateral masseter nerve. The objective of this study was to demonstrate feasibility, describe surgical technique, and assess results of reusing the masseter nerve to reinnervate a new free functional muscle transfer.