Outcomes with microsurgery of common peroneal nerve lesions.

Objectives: The purpose of this retrospective study is to present our results with peroneal nerve lesions, to examine the relative significance of various factors, to assess their effect on outcome, and to establish guidelines of treatment for the microsurgical management of these difficult lesions.

Methods: Over a 33-year period, a total of 62 patients were treated at McGill University and the Microsurgical Research Center, Eastern Virginia Medical School. The clinical records of all patients treated for peroneal nerve lesions were reviewed for retrospective analysis.

Morphometric analysis of the effect of scapula stabilization on obstetric brachial plexus paralysis patients.

Background: Scapular position and size deficiency is evident in obstetric brachial plexus paralysis (OBPP) patients due to the absence of balanced muscular forces acting on the scapula. Scapula stabilization (SS) procedures aim to restore a balanced musculature and anatomic position and to augment shoulder function and enhance developmental potential.

Methods: Retrospective chart review of 106 patients with OBPP between March 1979 and March 2007 was performed.

Morphometric analysis of the association of primary shoulder reconstruction procedures with scapular growth in obstetric brachial plexus paralysis patients.

Background: Obstetric brachial plexus paralysis (OBPP) has been associated with shoulder deformities, scapular growth, and shoulder function impairment. The absence of balanced muscular forces acting on the scapula has been considered responsible for scapula dysplasia and impaired growth as compared with the normal side. Scapula growth impairment may also lead to shoulder and upper extremity dysfunction.

Novel use of platysma for oral sphincter substitution or countering excessive pull of a free muscle.

Background: The present study demonstrates our experience with a novel use of the Platysma in facial reanimation, as a balancing procedure by counteracting an overactive free muscle transfer, and improving oral continence by re-establishing the oral sphincter mechanism.

Material And Methods: Twelve patients, nine female (75%) and three male (25%), with a mean age of thirty-eight years (range: 2-66) are presented. Of these, in seven patients (58%) who had excessive excursion of the free muscle, the contralateral pedicled platysma was transferred to counteract the excessive pull.

Reanimation of facial palsy following tumor extirpation in pediatric patients: our experience with 16 patients.

The aim of this study was to present our experience with reanimation of facial palsy (FP) following tumor extirpation in pediatric patients and to analyze the functional outcomes based on different types of procedures performed considering demographic and electrophysiological data of the patients. Sixteen patients with FP post-tumor extirpation who underwent facial reanimation were reviewed. Three independent assessors evaluated the preoperative and postoperative videos using the Terzis' grading scale for eye closure, smile, depressor and overall esthetic and functional outcomes.

FK506 and nerve regeneration: past, present, and future.

Promoting neurological recovery requires strategies that simultaneously provide protection to injured neurons and increase the numbers of neurons that extend axons while inducing more rapid and extensive axon regeneration across long nerve gaps. An agent that facilitates the speed and success of reinnervation will have direct applicability to the clinical management of severe peripheral nerve injuries. The immunosuppressive drug FK506 has been proven to have neuroprotective and neurotrophic actions in experimental models, increasing neurite elongation and accelerating the rate of nerve regeneration in vitro and in vivo.

Experience with 60 adult patients with facial paralysis secondary to tumor extirpation.

Background: The aim of this study was to present the authors' experience with facial reanimation in adult patients following tumor extirpation and to analyze the functional outcomes.

Methods: From 1978 to 2006, 60 adult patients underwent facial reanimation for facial paralysis following tumor extirpation. There was one patient with bilateral facial paralysis.

Therapeutic strategies in post-facial paralysis synkinesis in adult patients.

Background: Facial synkinesis comprises unwanted facial muscle contractions in different facial muscle groups following voluntary ones, in cases of incomplete recovery from facial paralysis. Facial expressivity and function are impaired, and the psychological integrity of the patients is seriously affected.

Methods: Thirty-one adult patients (older than 18 years) presenting with post-facial paralysis synkinesis were included in this study.

Therapeutic strategies in post-facial paralysis synkinesis in pediatric patients.

Unlabelled: Synkinetic movements comprise abnormal involuntary contractions of one or more facial muscle groups which follow the desired contraction of another facial muscle group. They are frequently encountered in patients with long standing facial paralysis and seriously affect their psychological status due to the impairment of their facial appearance, function and emotional expressivity.

Patients And Methods: Eleven pediatric patients (2 male and 9 female) presenting with post-facial paralysis synkinesis were included in the study.

Extratemporal facial paralysis.

Purpose: This report summarizes our experience in the management of extratemporal facial paralysis with a variety of reconstructive techniques and explores those parameters which are considered to be useful in achieving better outcomes.

Methods: In all, 56 patients with extratemporal facial paralysis were studied. All the patients had a mean follow-up of 5 years (standard deviation: 3.

Experience with developmental facial paralysis: part II. Outcomes of reconstruction.

Background: The purpose of this study was to document the 30-year experience of the authors' center in the management of developmental facial paralysis and to analyze the outcomes of microsurgical reconstruction.

Methods: Forty-two cases of developmental facial paralysis were identified in a retrospective clinical review (1980 to 2010); 34 (80.95 percent) were children (age, 8 ± 6 years) and eight (19.

Our experience with triceps nerve reconstruction in patients with brachial plexus injury.

Although elbow extension is facilitated by gravity, triceps muscle provides elbow joint stability; in patients with brachial plexus injuries stable elbow is necessary for obtaining useful hand function. This study presents the senior author's experience with triceps nerve reconstruction and the functional results in patients with brachial plexus injuries. Outcomes were analyzed in relation to denervation time, severity score, length of the interposition nerve graft and donor nerves used.

Bone discrepancy as a powerful indicator for early surgery in obstetric brachial plexus palsy.

Objectives: One of the unfortunate sequelae in obstetric brachial plexus palsy (OBPP) is upper limb length discrepancy. However, the influence of primary nerve reconstruction remains undetermined. In this study, the resultant discrepancy in children with OBPP who underwent primary reconstruction was analyzed in relation to the severity of the lesion, the timing of surgery, and the functional outcome following surgery.

Primary restoration of elbow flexion in adult post-traumatic plexopathy patients.

Restoration of elbow flexion is one of the priorities in brachial plexus palsy, as this function brings the hand to the mouth. This study analyses the results of musculocutaneous nerve reconstruction in 194 patients with devastating paralysis. Results were analyzed in relation to denervation time, severity score, length of nerve grafts, and donor nerves used.

Experience with developmental facial paralysis: Part I. Diagnosis and associated stigmata.

Background: This study is a thorough literature review of the clinical presentation and evaluation of developmental facial paralysis, with a systematic description of the various stigmata and associated anomalies. It is hoped that this approach will facilitate the differentiation of developmental facial paralysis from other causes of facial paralysis present at birth.

Methods: Forty-two cases of developmental facial paralysis were identified in a retrospective clinical review (1980 to 2010); 34 were children (80.

Supraclavicular approach for thoracic outlet syndrome.

Unlabelled: The authors' experience with the supraclavicular approach for the treatment of patients with primary thoracic outlet syndrome (TOS) and for patients with recurrent TOS or iatrogenic brachial plexus injury after prior transaxillary first rib resection is presented. The records of 33 patients (34 plexuses) with TOS who presented for evaluation and treatment were analyzed. Of these, 12 (35%) plexuses underwent surgical treatment, and 22 (65%) plexuses were managed non-operatively.

Developmental facial paralysis: a review.

The purpose of this study is to clarify the confusing nomenclature and pathogenesis of Developmental Facial Paralysis, and how it can be differentiated from other causes of facial paralysis present at birth. Differentiating developmental from traumatic facial paralysis noted at birth is important for determining prognosis, but also for medicolegal reasons. Given the dramatic presentation of this condition, accurate and reliable guidelines are necessary in order to facilitate early diagnosis and initiate appropriate therapy, while providing support and counselling to the family.

Secondary shoulder reconstruction in patients with brachial plexus injuries.

Restoration of shoulder stability in post-traumatic plexopathy patients is very important because more distal functions depend on a stable and functioning shoulder. The purpose of this study is to present our experience with secondary surgeries in patients with devastating paralysis. Functional outcomes were analyzed in relation to age, severity score and type of reconstruction.

Radial nerve injuries and outcomes: our experience.

Background: The purpose of this study was to evaluate retrospectively the patients who had undergone radial nerve reconstruction.

Methods: The medical charts of 35 patients with radial nerve lesions and 13 patients with superficial radial nerve lesions who underwent surgical exploration and repair in the authors' center were reviewed. The outcomes were analyzed in relation to various factors, such as age at injury, denervation time, level of injury, length of nerve graft, and type of reconstruction.

Our experience with secondary reconstruction of external rotation in obstetrical brachial plexus palsy.

Background: Restoration of shoulder external rotation is very important for upper extremity function. The purpose of this study was to present the authors' experience with secondary restoration of external rotation in patients with obstetrical brachial plexus palsy.

Methods: From 1978 to 2002, 46 children underwent secondary surgery for restoration of external rotation.

Free muscle transfer in posttraumatic plexopathies: part 1: the shoulder.

Microsurgical restoration of shoulder abduction with free muscle transfers is one of the most challenging reconstructions. The purpose of this study was to analyze retrospectively the outcomes of free muscle transfer for shoulder abduction. Since 1981, 22 muscles have been transferred for shoulder abduction in posttraumatic brachial plexopathy.

Outcomes of direct muscle neurotisation in adult facial paralysis.

Fifty-seven adult patients with facial paralysis, who underwent direct muscle neurotisation, were reviewed and divided into three categories depending on the function that direct neurotisation was aiming to augment. Group 1 included 30 patients who underwent direct neurotisation for eye closure and blink, group 2 consisted of 23 patients for smile augmentation, and group 3 comprised 31 patients for depressor. The age of the patients ranged from 21 to 74 years.

Blink restoration in adult facial paralysis.

Background: Impaired eyelid function in facial paralysis patients is a serious disability that can even threaten vision. Eye reanimation techniques and specifically blink restoration reinstates the cornea's protective mechanism and recovers a more natural appearance and eye function. Both dynamic and static procedures have been used to augment eye closure, but only dynamic procedures can lead to blink restoration.

Novel use of C7 spinal nerve for Moebius.

Background: The purpose of this study was to introduce the use of selective ipsilateral C7 spinal nerve transfer to the armamentarium of the dynamic procedures used for facial reanimation in Moebius patients.

Methods: Between 1991 and 2007, the selective ipsilateral C7 technique was used in four patients. In three patients with bilateral paralysis, both C7 spinal nerves were utilized as nerve donors.

Corneal neurotization: a novel technique for the anesthetic cornea.

Purpose: This report describes and evaluates the efficacy of a novel procedure, direct corneal neurotization using contralateral, supraorbital, and supratrochlear nerves in patients with unilateral facial palsy and corneal anesthesia.

Methods: The charts of 6 patients were thoroughly reviewed. Evaluated outcome parameters included corneal sensibility, improvement in best-corrected visual acuity, blink reflex, donor deficit, synesthesia, long-term corneal health, several psychosocial measures, and overall patient satisfaction.