Note: This page contains sample records for the topic laryngeal nerve paralysis from
While these samples are representative of the content of,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of
to obtain the most current and comprehensive results.
Last update: November 12, 2013.

High risk of unilateral recurrent laryngeal nerve paralysis after esophagectomy using cervical anastomosis  

Microsoft Academic Search

The goal of this study was to estimate the incidence of temporary and permanent unilateral recurrent laryngeal nerve paralysis\\u000a (URLNP) after esophagectomies with cervical anastomosis and to determine the impact of surgical technique, tumor type, tumor\\u000a localization and age on the incidence of URLNP. From March 2002 to November 2009, 84 patients underwent a laryngoscopical\\u000a evaluation before and after esophagectomy

L. Pertl; J. Zacherl; G. Mancusi; J. N. Gächter; R. Asari; S. Schoppmann; W. Bigenzahn; B. Schneider-Stickler


Understanding facial nerve paralysis.  


Facial nerve paralysis has many causes and can be acute or chronic. Understanding the signs and symptoms, performing a careful patient evaluation, and obtaining appropriate diagnostic testing can help guide clinicians and improve outcomes. PMID:24153089

Matthaeus, Jaime; Hayden, Richard; Kim, Michael; Donald, Carrlene



Recurrent Laryngeal Nerve Injury in Thyroid Surgery  

PubMed Central

Objectives Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve (RLNI) is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the present study is to assess the risk factors of recurrent laryngeal nerve injury during thyroid surgery. Methods Patients who had thyroid surgery between 1990 and 2005 and were admitted to the surgical department of King Fahd hospital of the University, Al-Khobar, Saudi Arabia were enrolled for this retrospective review, Factors predisposing to recurrent laryngeal nerve injury were evaluated such as pathology of the lesions and the type of operations and identification of recurrent laryngeal nerve intra-operatively. Preoperative and postoperative indirect laryngoscopic examinations were performed for all patients. Results 340 patients were included in this study. Transient unilateral vocal cord problems occurred in 11 (3.2%) cases, and in 1 (0.3%) case, it became permanent (post Rt. Hemithyroidectomy). Bilateral vocal cord problems occurred in 2 cases (0.58%), but none became permanent. There were significant increases in the incidence of recurrent laryngeal nerve injury in secondary operation (21.7% in secondary vs. 2.8% in primary, p=0.001), total/near total thyroidectomy (7.2% in total vs. 1.9% in subtotal, p=0.024), non-identification of RLN during surgery (7.6% in non-identification vs. 2.6% in identification, p=0.039) and in malignant disease (12.8% in malignant vs. 2.9% in benign, p=0.004). However, there was no significant difference in the incidence of recurrent laryngeal nerve injury with regards to gender (4.1% in male vs 3.8% in female, p=0.849). Conclusion The present study showed that thyroid carcinoma, re-operation for recurrent goiter, non-identification of RLN and total thyroidectomy were associated with a significantly increased risk of operative recurrent laryngeal nerve injury.

Zakaria, Hazem M.; Al Awad, Naif A.; Al Kreedes, Ali S.; Al-Mulhim, Abdul Mohsin A.; Al-Sharway, Mohammed A.; Hadi, Maha Abdul; Al Sayyah, Ahmed A.



Juvenile laryngeal paralysis in three Siberian husky x Alaskan malamute puppies.  


Three three-month-old Siberian husky x Alaskan malamute crossbreds had suffered episodic inspiratory dyspnoea and stridor for four to eight weeks and their endurance had decreased. In two of them bilateral, and in the other unilateral, laryngeal paralysis was diagnosed by laryngoscopy. In the nucleus ambiguus of the dogs there was a depletion of motor neurons, neuronal degeneration and mild gliosis, but there were no lesions in the root and peripheral segments of the recurrent laryngeal nerves. PMID:14653342

Polizopoulou, Z S; Koutinas, A F; Papadopoulos, G C; Saridomichelakis, M N



Stretch-induced nerve injury as a cause of paralysis secondary to the anterior cervical approach  

Microsoft Academic Search

The anterior approach to the cervical spine, first described 40 years ago, has become a popular and widely used procedure by spine surgeons to expose the anterior vertebral bodies from C3 to T1. A significant complication of this procedure is transient or permanent ipsilateral recurrent laryngeal nerve paralysis. In a previous review at our institution of patients with hoarseness after




Unilateral laryngeal and hypoglossal paralysis (Tapia's syndrome) following rhinoplasty in general anaesthesia: case report and review of the literature.  


Extracranial involvement of the recurrent laryngeal nerve and the hypoglossal nerve is known as Tapia's syndrome. Ipsilateral paralysis of the vocal cord and tongue is present. Lesion of these nerves may be a rare complication of airway management. Herein, a case of Tapia's Syndrome complicating transoral intubation during general anaesthesia in a rhinoplasty operation, together with a review of pertinent literature to evaluate the incidence and the possible pathogenic mechanism of the lesion. There are recent reports in the literature on mono or bilateral paralysis of the XII or laryngeal recurrent nerve after use of laryngeal mask with a pathogenic mechanism of compression. Furthermore, there are reports, following oro-tracheal intubation, of recurrent laryngeal paralysis, likely legacies to the compression of the anterior branch of inferior laryngeal nerve by the cuff of the oro-tracheal tube against the postero-medial part of the thyroid cartilage. Hypoglossal nerve damage could be caused by a stretching of the nerve against the greater horn of the hyoid bone by a laryngeal mask or oro-tracheal tube or compression of the posterior part of the laryngoscope or oro-tracheal tube. In our case, the lesion probably occurred as the result of a two-fold compressive mechanism: on one hand, compression by the cuff of the endo-tracheal tube due to excessive throat pack in the oro-pharynx; on the other hand a prolonged stretching mechanism of these nerves may have occurred due to excessive anterior and lateral flexion of the head. From the data reported in the literature, as in our case, complete recovery of function is generally achieved within the first six months. This progressive recovery of function suggests nerve damage of a neuro-praxic type, which is typical of compression injury. In conclusion, the response of this rare complication confirms the importance not only of the position of the head and patient on the operating table but also the meticulous and correct performance of the routine manoeuvres of airway management. PMID:18236639

Tesei, F; Poveda, L M; Strali, W; Tosi, L; Magnani, G; Farneti, G



Unilateral laryngeal and hypoglossal paralysis (Tapia's syndrome) following rhinoplasty in general anaesthesia: case report and review of the literature  

PubMed Central

Summary Extracranial involvement of the recurrent laryngeal nerve and the hypoglossal nerve is known as Tapia’s syndrome. Ipsilateral paralysis of the vocal cord and tongue is present. Lesion of these nerves may be a rare complication of airway management. Herein, a case of Tapia’s Syndrome complicating transoral intubation during general anaesthesia in a rhinoplasty operation, together with a review of pertinent literature to evaluate the incidence and the possible pathogenic mechanism of the lesion. There are recent reports in the literature on mono or bilateral paralysis of the XII or laryngeal recurrent nerve after use of laryngeal mask with a pathogenic mechanism of compression. Furthermore, there are reports, following oro-tracheal intubation, of recurrent laryngeal paralysis, likely legacies to the compression of the anterior branch of inferior laryngeal nerve by the cuff of the oro-tracheal tube against the postero-medial part of the thyroid cartilage. Hypoglossal nerve damage could be caused by a stretching of the nerve against the greater horn of the hyoid bone by a laryngeal mask or oro-tracheal tube or compression of the posterior part of the laryngoscope or oro-tracheal tube. In our case, the lesion probably occurred as the result of a two-fold compressive mechanism: on one hand, compression by the cuff of the endo-tracheal tube due to excessive throat pack in the oro-pharynx; on the other hand a prolonged stretching mechanism of these nerves may have occurred due to excessive anterior and lateral flexion of the head. From the data reported in the literature, as in our case, complete recovery of function is generally achieved within the first six months. This progressive recovery of function suggests nerve damage of a neuro-praxic type, which is typical of compression injury. In conclusion, the response of this rare complication confirms the importance not only of the position of the head and patient on the operating table but also the meticulous and correct performance of the routine manoeuvres of airway management.

Tesei, F; Poveda, LM; Strali, W; Tosi, L; Magnani, G; Farneti, G



Unilateral laryngeal and hypoglossal paralysis (Tapia's syndrome) following rhinoplasty in general anaesthesia: case report and review of the literature Paralisi laringea e linguale unilaterale (Sindrome di Tapia) dopo intervento di rinoplastica in anestesia generale: caso clinico e revisione della letteratura  

Microsoft Academic Search

Summary Extracranial involvement of the recurrent laryngeal nerve and the hypoglossal nerve is known as Tapia's syndrome. Ipsilate- ral paralysis of the vocal cord and tongue is present. Lesion of these nerves may be a rare complication of airway manage- ment. Herein, a case of Tapia's Syndrome complicating tran- soral intubation during general anaesthesia in a rhinoplasty operation, together with



Laryngeal paralysis: a study of 375 cases in a mixed-breed population of horses.  


Referred cases (n = 375) of laryngeal paralysis (1985-1998) from a mixed-breed equine population included 351 (94%) cases of recurrent laryngeal neuropathy (RLN) (idiopathic laryngeal hemiplegia) and 24 cases (6%) of laryngeal paralysis from causes other than RLN. Laryngeal movements were classified endoscopically into one of 6 grades, in contrast to the usual 4 grades. The RLN cases had a median grade 4 laryngeal paralysis, of which 96% were left-sided, 2% right-sided and 2% bilaterally affected. RLN cases included 204 (58%) Thoroughbred, 96 (27%) Thoroughbred-cross, 23 (7%) draught, 16 (5%) Warmbloods and 10 (3%) other breeds, including only 4 (1%) ponies. The median age of RLN cases at referral was 6 years (range 2-12) and their median height was 170.2 cm. The work of RLN horses included National Hunt racing (42%), flat racing (1%), hunting (19%), eventing (16%) and miscellaneous work (22%). Reported presenting signs in RLN-affected horses included abnormal exercise-related respiratory sounds in 90% and reduced exercise tolerance in only 64%. However, many horses were referred before their exercise tolerance could be fully assessed. Forty percent of the RLN cases had intercurrent disorders, including 10% with additional upper respiratory and 7% with lower respiratory tract diseases. The 24 nonidiopathic RLN cases included 12 with bilateral laryngeal paralysis, 11 (92%) of which were ponies. Bilateral laryngeal paralysis occurred with hepatic encephalopathy in 7 cases and following general anaesthesia in 2 cases. The 12 cases of acquired unilateral laryngeal paralysis included 7 caused by guttural pouch mycosis. PMID:11558739

Dixon, P M; McGorum, B C; Railton, D I; Hawe, C; Tremaine, W H; Pickles, K; McCann, J



The recurrent laryngeal nerve (RLN): application to transhiatal oesophagectomy  

Microsoft Academic Search

To emphasize the risks of recurrent laryngeal nerve lesions during transhiatal oesophagectomy an anatomical study of the course of the recurrent laryngeal nerve (RLN) was performed. Twenty RLN were dissected in their thoracic portion. This work showed the constancy of the low origin of the nerve in the adult under the aortic arch, and its course in the tracheal angle.

A. Dia; D. Valleix; B. Dixneuf; D. Philippi; B. Descottes; M. Caix; A. Ndiaye; M. L. Sow



[Facial nerve paralysis and mandibular fracture].  


The authors describe three cases of peripheral facial nerve paralysis in patients with a mandibular fracture. In two cases, in which the onset of palsy was uncertain, the facial nerve injury was contralateral to the fractured side. Topodiagnostic tests showed neural damage at the third intrapetrosal portion and at the genicular ganglion. In one of the two patients tomography revealed a fracture line through the anterio-superior wall of the external auditory canal homolateral to the facial palsy. In the third subject palsy set in immediately after the trauma and was ipsilateral to the mandibular fracture; the facial lesion was localized at the genicular ganglion. In the first two cases, functional recovery was spontaneous (40 and 0 days after the trauma respectively). In the third subject, the nerve was decompressed surgically with a complete functional recovery two months later. The functional and clinical findings of these three cases show that a contralateral facial palsy secondary to a mandibular fracture resolves spontaneously while the traumatic displacement of the mandibular condyle may determine a temporal bone fracture sometimes followed by a lesion in the intratemporal portion of the facial nerve. An event such as the latter may delay functional recovery and thus warrant surgery such as in cases of Bell's palsy. PMID:1298156

Salonna, I; Fanizzi, P; Quaranta, A


[Paralysis of the femoral nerve after abdominal and vaginal surgery].  


Damages of the femoral nerve during gynaecological operations are more frequent than generally supposed. They are observed after abdominal and vaginal operations caused by pressure on the nerve. During abdominal procedures an unsuitable self-retaining retractor is due to the paralysis. If the legs of the patients are deposited on the shoulder-back-parties of the assistants during vaginal procedures there is the danger of pressing the femoral nerve against the inguinal ligament by strong bending and abduction of the thighs. We report about 3 cases of paralysis of this nerve; recommendations for avoidance are given. PMID:919868

Lau, H U



Imaging diagnosis--acquired pectus excavatum secondary to laryngeal paralysis in a dog.  


A 13-year-old neutered female Labrador retriever had inspiratory dyspnea secondary to bilateral laryngeal paralysis. Radiographically, there was pectus excavatum with a mediastinal shift to the right. Arytenoid lateralization was performed, relieving the upper respiratory obstruction, and the sternal deformity also resolved. Chronic upper respiratory obstruction should be considered in dogs with pectus excavatum. Furthermore, correction of upper respiratory obstruction has the potential to result in resolution of pectus excavatum. PMID:22145690

Kurosawa, Tsumugi Anne; Ruth, Jeffrey D; Steurer, Jeffrey; Austin, Brenda; Heng, Hock Gan



Voice changes after thyroidectomy: role of the external laryngeal nerve.  

PubMed Central

Hitherto voice changes have been regarded as an infrequent complication of thyroidectomy and damage to the recurrent laryngeal nerve has been given as their major cause. Voice function was assessed in 325 patients after thyroidectomy. Permanent changes occurred in 35 (25%) after subtotal thyroidectomy and in 19 (11%) after lobectomy. The commonest cause of voice change appeared to be injury to the external laryngeal nerves on one or both sides. Damage to the recurrent laryngeal nerve, which was routinely identified and protected, was rarely a cause. When the external laryngeal nerves were identified and preserved, permanent voice changes occurred in only 5% of cases; this was similar to the incidence of 3% in controls after endotracheal intubation alone. The course of the external laryngeal nerve is variable, and consequently mass ligation of the vessels at the top of the upper pole will damage it in a high proportion of cases. To minimise this serious complication these nerves should be identified and protected as well as the recurrent nerves and voice function should be assessed early in the postoperative period by laryngoscopy and by a speech therapist.

Kark, A E; Kissin, M W; Auerbach, R; Meikle, M



Localization of the superior laryngeal nerve during carotid endarterectomy  

Microsoft Academic Search

Knowledge of the topographic anatomy is essential to prevent iatrogenic damage of the superior laryngeal nerve (SLN) in carotid endarterectomy (CEA). The purpose of this study was to analyze the anatomic relationship between the SLN and carotid arteries in order to prevent iatrogenic nerve injury. Anatomic dissections similar to CEA were performed bilaterally in 50 fresh human adult cadavers. The

J. C. Furlan; R. de Magalhães; E. de Aguiar; S. Shiroma



Hypoglossal nerve paralysis in a burn patient following mechanical ventilation  

PubMed Central

Summary Traumatic injury resulting in isolated dysfunction of the hypoglossal nerve is relatively rare and described in few case reports. We present a patient with isolated unilateral palsy of the twelfth cranial nerve (CN XII) resulting from recurrent airway intervention following extensive burn injuries. The differential diagnosis for paralysis of the CN XII is also discussed herein. This case illustrates the significance of comprehensive diagnostic evaluation and the need for refined airway manipulation in patients that require multiple endotracheal intubations

Weissman, O.; Weissman, O.; Farber, N.; Berger, E.; Grabov Nardini, G.; Zilinsky, I.; Winkler, E.; Haik, J.



The Role of Immediate Recurrent Laryngeal Nerve Reconstruction for Thyroid Cancer Surgery  

PubMed Central

Unilateral vocal fold paralysis (UVFP) is one of the most serious problems in conducting surgery for thyroid cancer. Different treatments are available for the management of UVFP including intracordal injection, type I thyroplasty, arytenoid adduction, and laryngeal reinnervations. The effects of immediate recurrent laryngeal nerve (RLN) reconstruction during thyroid cancer surgery with or without UVFP before the surgery were evaluated with videostroboscopic, aerodynamic, and perceptual analyses. All subjects experienced postoperative improvements in voice quality. Particularly, aerodynamic analysis showed that the values for all patients entered normal ranges in both patients with and without UVFP before surgery. Immediate RLN reconstruction has the potential to restore a normal or near-normal voice by returning thyroarytenoid muscle tone and bulk seen with vocal fold denervation. Immediate RLN reconstruction is an efficient and effective approach to the management of RLN resection during surgery for thyroid cancer.

Sanuki, Tetsuji; Yumoto, Eiji; Minoda, Ryosei; Kodama, Narihiro



Laryngeal elevation by selective stimulation of the hypoglossal nerve  

NASA Astrophysics Data System (ADS)

Objective. Laryngeal elevation protects the airway and assists opening of the esophagus during swallowing. The GH, thyrohyoid, and MH muscles provide a majority of this elevatory motion. This study applied functional electrical stimulation to the XII/C1 nerve complex using a nerve cuff electrode to determine the capabilities of neural stimulation to induce laryngeal elevation. Approach. Multi-contact FINE electrodes were implanted onto the XII/C1 nerve complex at locations proximal and distal to the thyrohyoid branching point in five anesthetized canines. Motion of the thyroid cartilage and the hyoid bone was recorded during stimulation of nerve cuffs and intramuscular electrodes. Main Results. Nerve stimulation induced 260% more laryngeal elevation than intramuscular stimulation (18.8 mm versus 5.2 mm, p ? 0.01), and 228% higher velocity (143.8 versus 43.9 mm s–1, p ? 0.01). While stimulation at all cuff and electrode locations elevated the larynx, only the proximal XII/C1 nerve cuff significantly elicited both thyroid–hyoid approximation and hyoid elevation. In all proximal XII/C1 nerve cuffs (n = 7), stimulation was able to obtain selectivity of greater than 75% of at least one elevatory muscle. Significance. These results support the hypothesis that an implanted neural interface system can produce increased laryngeal elevation, a significant protective mechanism of deglutition.

Hadley, Aaron J.; Kolb, Ilya; Tyler, Dustin J.



Trigeminal neuralgia and facial nerve paralysis.  


The trigeminal nerve is the largest of the cranial nerves. It provides sensory input from the face and motor innervation to the muscles of mastication. The facial nerve is the cranial nerve with the longest extracranial course, and its main functions include motor innervation to the muscles of facial expression, sensory control of lacrimation and salivation, control of the stapedial reflex and to carry taste sensation from the anterior two-thirds of the tongue. In order to be able adequately to image and follow the course of these cranial nerves and their main branches, a detailed knowledge of neuroanatomy is required. As we are dealing with very small anatomic structures, high resolution dedicated imaging studies are required to pick up normal and pathologic nerves. Whereas CT is best suited to demonstrate bony neurovascular foramina and canals, MRI is preferred to directly visualize the nerve. It is also the single technique able to detect pathologic processes afflicting the nerve without causing considerable expansion such as is usually the case in certain inflammatory/infectious conditions, perineural spread of malignancies and in very small intrinsic tumours. Because a long course from the brainstem nuclei to the peripheral branches is seen, it is useful to subdivide the nerve in several segments and then tailor the imaging modality and the imaging study to that specific segment. This is particularly true in cases where topographic diagnosis can be used to locate a lesion in the course of these nerves. PMID:15690205

Borges, Alexandra



Facial nerve paralysis secondary to chronic otitis media without cholesteatoma.  


Numerous papers have been written on facial nerve paralysis caused by chronic suppurative otitis media. However the authors found none documenting the results of therapy in a series of patients in whom facial nerve dysfunction was caused by chronic otitis media without cholesteatoma. Thus, there is little factual information available to help select a specific therapeutic plan for such cases. Over the past decade, the senior author has managed five cases (6 ears) of chronic suppurative otitis media without cholesteatoma in which facial paresis (4 ears) or paralysis (2 ears) developed 10 days or less before surgery. The chronic otitis media involved the mastoid and middle ear in five cases; and the mastoid, middle ear, and petrous apex in one case. Modified radical mastoidectomy was performed in four ears, tympanomastoidectomy with facial recess exposure in one ear, and complete mastoidectomy with middle cranial fossa petrous apicectomy in one ear. Five patients had complete recovery of facial nerve function (House grade I), and one patient had 90 percent recovery (House grade II). The results provide support for semi-emergent surgery in the management of chronic suppurative otitis media when facial nerve paralysis supervenes. PMID:1415504

Harker, L A; Pignatari, S S



Intralaryngeal neuroanatomy of the recurrent laryngeal nerve of the rabbit  

PubMed Central

We undertook this study to determine the detailed neuroanatomy of the terminal branches of the recurrent laryngeal nerve (RLN) in the rabbit to facilitate future neurophysiological recordings from identified branches of this nerve. The whole larynx was isolated post mortem in 17 adult New Zealand White rabbits and prepared using a modified Sihler's technique, which stains axons and renders other tissues transparent so that nerve branches can be seen in whole mount preparations. Of the 34 hemi-laryngeal preparations processed, 28 stained well and these were dissected and used to characterize the neuroanatomy of the RLN. In most cases (23/28) the posterior cricoarytenoid muscle (PCA) was supplied by a single branch arising from the RLN, though in five PCA specimens there were two or three separate branches to the PCA. The interarytenoid muscle (IA) was supplied by two parallel filaments arising from the main trunk of the RLN rostral to the branch(es) to the PCA. The lateral cricoarytenoid muscle (LCA) commonly received innervation from two fine twigs branching from the RLN main trunk and travelling laterally towards the LCA. The remaining fibres of the RLN innervated the thyroarytenoid muscle (TA) and comprised two distinct branches, one supplying the pars vocalis and the other branching extensively to supply the remainder of the TA. No communicating anastomosis between the RLN and superior laryngeal nerve within the larynx was found. Our results suggest it is feasible to make electrophysiological recordings from identified terminal branches of the RLN supplying laryngeal adductor muscles separate from the branch or branches to the PCA. However, the very small size of the motor nerves to the IA and LCA suggests that it would be very difficult to record selectively from the nerve supply to individual laryngeal adductor muscles.

Ryan, Stephen; McNicholas, Walter T; O'Regan, Ronan G; Nolan, Philip



Unusual complication of otitis media with effusion: facial nerve paralysis.  


Facial nerve paralysis (FNP) is a very rare complication of otitis media with effusion (OME). There are few patients with OME and FNP in the literature. A 5-year-old girl was admitted to our department with right facial weakness. Right FNP and right OME were diagnosed on the examination. After medical treatment and ventilation tube insertion, FNP completely resolved. The symptoms, signs, and management of this patient are presented. PMID:21778856

Vayisoglu, Yusuf; Gorur, Kemal; Ozcan, Cengiz; Korlu, Sava?



Sound-induced facial synkinesis following facial nerve paralysis.  


Facial synkinesis (or synkinesia) (FS) occurs frequently after paresis or paralysis of the facial nerve and is in most cases due to aberrant regeneration of (branches of) the facial nerve. Patients suffer from inappropriate and involuntary synchronous facial muscle contractions. Here we describe two cases of sound-induced facial synkinesis (SFS) after facial nerve injury. As far as we know, this phenomenon has not been described in the English literature before. Patient A presented with right hemifacial palsy after lesion of the facial nerve due to skull base fracture. He reported involuntary muscle activity at the right corner of the mouth, specifically on hearing ringing keys. Patient B suffered from left hemifacial palsy following otitis media and developed involuntary muscle contraction in the facial musculature specifically on hearing clapping hands or a trumpet sound. Both patients were evaluated by means of video, audio and EMG analysis. Possible mechanisms in the pathophysiology of SFS are postulated and therapeutic options are discussed. PMID:18539550

Ma, Ming-San; van der Hoeven, Johannes H; Nicolai, Jean-Philippe A; Meek, Marcel F



Huge middle ear adenoma with delayed facial nerve paralysis.  


Middle ear adenoma is a rare disease that arises from the mucosa of the middle ear. Only a few cases of associated facial nerve paralysis have been reported. Facial nerve involvement is most likely related to nerve compression rather than tumor invasion of the nerve. We describe a case of a huge middle ear adenoma in a 63-year-old man. He presented with a 1-month history of right-sided otalgia, otorrhea, and facial palsy; he also had a 10-year history of right-sided hearing loss. A tympanomastoidectomy was performed. Intraoperatively, the tumor was found to fill the middle ear cavity as well as the entire diameter of the external auditory canal. The tumor had eroded the wall of the facial canal at the second genu, and it was tightly adherent to the epineurium. Focal inflammation around the tumor was observed at the exposed facial nerve. The tumor was removed and the facial nerve was decompressed. Immediately after surgery, the patient's aural symptoms resolved. The final pathology evaluation established the diagnosis of a middle ear adenoma. At the 3-year follow-up, the ear cavity was completely healed and facial nerve function was improved. PMID:22711394

Lee, Seung Ho; Choi, Hoseok; Chu, Young Chae; Kim, Young Hyo; Kim, Kyu-Sung



Delayed appearance of hypaesthesia and paralysis after femoral nerve block  

PubMed Central

We report on a female patient who underwent an arthroscopy of the right knee and was given a continuous femoral nerve block catheter. The postoperative course was initially unremarkable, but when postoperative mobilisation was commenced, 18 hours after removal of the catheter, the patient noticed paralysis and hypaesthesia. Examination confirmed the diagnosis of femoral nerve dysfunction. Colour duplex sonography of the femoral artery and computed tomography of the lumbar spine and pelvis yielded no pathological findings. Overnight the neurological deficits decreased without therapy and were finally no longer detectable. We speculate that during the administration of the local anaesthetic a depot formed, localised in the medial femoral intermuscular septa, which was leaked after first mobilisation. To our knowledge no similar case has been published up to now. We conclude that patients who are treated with a nerve block should be informed and physician should be aware that delayed neurological deficits are possible.

Landgraeber, Stefan; Albrecht, Thomas; Reischuck, Ulrich; von Knoch, Marius



Altered distribution of motor neurons in experimental facial nerve paralysis.  


The alteration of motor neurons in the brainstem after recovery from experimental facial nerve paralysis was examined by the retrograde horseradish peroxidase (HRP) technique in the rabbit. Six months after nerve crush injury at the center of the vertical portion, HRP was injected into the zygomatic muscle on the recovered side. The distribution of labelled neurons in the brainstem was compared with that in the normal rabbit. In control animals, motor neurons in the facial nucleus were somatotopically organized, and there were no labelled neurons in other nuclei in the brainstem. In recovered animals, on the contrary, the somatotopic organization of the facial nucleus was obscure and multipolar neurons of varying size were labelled bilaterally in the reticular formation from the pons to the medulla. PMID:1481671

Nakao, Y; Matsumoto, K; Kumagami, H



[Clinical-electroneuromyographical characteristics of facial nerve paralysis in children].  


A clinical-electroneuromyographical study of 40 children (32 (80%) of them aged from 12 to 17 years, mean age 13,9+/-1,8 years, and 8 (20%) - from 1 to 8 years, mean age 4,4+/-2,1 years) were studied in the acute period of facial nerve paralysis (FNP). Six (15%) children had FNP in the anamnesis. Among precipitating factors were the cold exposure the day before disease onset (20 (50%) patients), symptoms of flu (13 (32,5%) patients) and psycho-emotional tension (3 (7,5%) patients). No precipitation was noted in 4 (10%) children. The degree of muscle paresis was 81,9+/-7% that corresponded to clinical stages III-IV according to K. Rosler. An electroneuromyographical analysis of motor ortho- and antidromic response to the facial nerve stimulation on the side of paresis and on the contralateral side in patients and controls revealed the presence of proximal axon- and myelinopathy of facial nerve with the involvement of its own motorneurons and brain stem interneurons. The maintenance of wink reflex and F-wave blocks in the period over 3 weeks are prognostically unfavorable factors for restoration of mimic muscle function in the early stage of disease. PMID:20032948

Gribova, N P; Galitskaia, O S



A Closer Look at Laryngeal Nerves during Thyroid Surgery: A Descriptive Study of 584 Nerves  

PubMed Central

Morbidity after thyroidectomy is related to injuries to the parathyroids, recurrent laryngeal (RLN) and external branch of superior laryngeal nerves (EBSLN). Mostly these are due to variations in the surgical anatomy. In this study we analyse the surgical anatomy of the laryngeal nerves in Indian patients undergoing thyroidectomy. Materials and Methods. Retrospective study (February 2008 to February 2010). Patients undergoing surgery for benign goitres, T1, T2 thyroid cancers without lymph node involvement were included. Data on EBSLN types, RLN course and its relation to the TZ & LOB were recorded. Results. 404 thyroid surgeries (180 total & 224 hemithyroidectomy) were performed. Data related to 584 EBSLN and RLN were included (324 right sided & 260 left sided). EBSLN patterns were Type 1 in 71.4%, Type IIA in 12.3%, and Type IIB in 7.36%. The nerve was not seen in 4.3% cases. RLN had one branch in 69.34%, two branches in 29.11% and three branches in 1.36%. 25% of the RLN was superficial to the inferior thyroid artery, 65% deep to it and 8.2% between the branches. TZ was Grade 1 in 65.2%, Grade II in 25.1% and Grade III in 9.5%. 31.16% of the RLN passes through the LOB. Conclusions. A thorough knowledge of the laryngeal nerves and anatomical variations is necessary for safe thyroid surgery.

Pradeep, P. V.; Jayashree, B.; Harshita, Skandha S.



A "Pilot light" of the right non-recurrent laryngeal nerve  

PubMed Central

Summary Total thyroidectomy was performed in a 53-year-old male, with Graves-Basedow’s disease. At surgery, the vagus nerve was found to be located medially to the carotid artery associated with a non-recurrent laryngeal nerve arising directly from the cervical vagus: this association has never been described in the literature. These results indicate that a medial location of the vagus nerve may be considered as a “pilot light” of the non-recurrent laryngeal nerve.

Toniato, A; Merante Boschin, I; Pagetta, C; Casalide, E; Pelizzo, M



Reinnervation of Bilateral Posterior Cricoarytenoid Muscles Using the Left Phrenic Nerve in Patients with Bilateral Vocal Fold Paralysis  

PubMed Central

Objective To evaluate the feasibility, effectiveness, and safety of reinnervation of the bilateral posterior cricoarytenoid (PCA) muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. Methods Forty-four patients with bilateral vocal fold paralysis who underwent reinnervation of the bilateral PCA muscles using the left phrenic nerve were enrolled in this study. Videostroboscopy, perceptual evaluation, acoustic analysis, maximum phonation time, pulmonary function testing, and laryngeal electromyography were performed preoperatively and postoperatively. Patients were followed-up for at least 1 year after surgery. Results Videostroboscopy showed that within 1 year after reinnervation, abductive movement could be observed in the left vocal folds of 87% of patients and the right vocal folds of 72% of patients. Abductive excursion on the left side was significantly larger than that on the right side (P < 0.05); most of the vocal function parameters were improved postoperatively compared with the preoperative parameters, albeit without a significant difference (P > 0.05). No patients developed immediate dyspnea after surgery, and the pulmonary function parameters recovered to normal reference value levels within 1 year. Postoperative laryngeal electromyography confirmed successful reinnervation of the bilateral PCA muscles. Eighty-seven percent of patients in this series were decannulated and did not show obvious dyspnea after physical activity. Those who were decannulated after subsequent arytenoidectomy were not included in calculating the success rate of decannulation. Conclusions Reinnervation of the bilateral PCA muscles using the left phrenic nerve can restore inspiratory vocal fold abduction to a physiologically satisfactory extent while preserving phonatory function at the preoperative level without evident morbidity.

Zheng, Hongliang; Chen, Donghui; Zhu, Minhui; Wang, Wei; Liu, Fei; Zhang, Caiyun



The recurrent laryngeal nerve in relation to the inferior constrictor muscle of the pharynx.  


The point of penetration of the recurrent laryngeal nerve into the larynx is recognized as the most frequent site of injury to the nerve during surgical procedures of the thyroid gland. The anatomical relationships of 25 right and left recurrent laryngeal nerves in 25 anatomical blocks from formalin-fixed human corpses have been studied. In 34 cases (68%), the recurrent laryngeal nerve penetrated into the larynx below the lower fibers of the inferior constrictor muscle of the pharynx (type 1 of penetration). In the remaining 16 cases (32%), the nerve crossed through those muscle fibers to penetrate into the larynx (type 2 of penetration). The thyroid gland was found to involve the recurrent laryngeal nerve at the penetration point into the larynx in 19 of 50 cases (38%). PMID:1921637

Wafae, N; Vieira, M C; Vorobieff, A



Aerodynamic and Nonlinear Dynamic Acoustic Analysis of Tension Asymmetry in Excised Canine Larynges  

ERIC Educational Resources Information Center

|Purpose: To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. Method: SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension…

Devine, Erin E.; Bulleit, Erin E.; Hoffman, Matthew R.; McCulloch, Timothy M.; Jiang, Jack J.



Hypoglossal Nerve Palsy as Complication of Oral Intubation, Bronchoscopy and Use of the Laryngeal Mask Airway  

Microsoft Academic Search

Hypoglossal nerve injury is a recognized but rare complication of oropharyngeal manipulation during intubation, bronchoscopy and use of a laryngeal mask airway. We present 2 new cases of temporary hypoglossal nerve palsy after orotracheal intubation for general anesthesia. The relevant literature is reviewed and different hypotheses concerning the pathophysiological mechanisms of nerve damage are discussed.

Rainer Dziewas; Peter Lüdemann



Quantitative PCR Analysis of Laryngeal Muscle Fiber Types  

ERIC Educational Resources Information Center

|Voice and swallowing dysfunction as a result of recurrent laryngeal nerve paralysis can be improved with vocal fold injections or laryngeal framework surgery. However, denervation atrophy can cause late-term clinical failure. A major determinant of skeletal muscle physiology is myosin heavy chain (MyHC) expression, and previous protein analyses…

Van Daele, Douglas J.



Reorganization of laryngeal motoneurons after crush injury in the recurrent laryngeal nerve of the rat.  


Motoneurons innervating laryngeal muscles are located in the nucleus ambiguus (Amb), but there is no general agreement on the somatotopic representation and even less is known on how an injury in the recurrent laryngeal nerve (RLN) affects this pattern. This study analyzes the normal somatotopy of those motoneurons and describes its changes over time after a crush injury to the RLN. In the control group (control group 1, n?=?9 rats), the posterior cricoarytenoid (PCA) and thyroarytenoid (TA) muscles were injected with cholera toxin-B. In the experimental groups the left RLN of each animal was crushed with a fine tip forceps and, after several survival periods (1, 2, 4, 8, 12?weeks; minimum six rats per time), the PCA and TA muscles were injected as described above. After each surgery, the motility of the vocal folds was evaluated. Additional control experiments were performed; the second control experiment (control group 2, n?=?6 rats) was performed labeling the TA and PCA immediately prior to the section of the superior laryngeal nerve (SLN), in order to eliminate the possibility of accidental labeling of the cricothyroid (CT) muscle by spread from the injection site. The third control group (control group 3, n?=?5 rats) was included to determine if there is some sprouting from the SLN into the territories of the RLN after a crush of this last nerve. One week after the crush injury of the RLN, the PCA and TA muscles were injected immediately before the section of the SLN. The results show that a single population of neurons represents each muscle with the PCA in the most rostral position followed caudalwards by the TA. One week post-RLN injury, both the somatotopy and the number of labeled motoneurons changed, where the labeled neurons were distributed randomly; in addition, an area of topographical overlap of the two populations was observed and vocal fold mobility was lost. In the rest of the survival periods, the overlapping area is larger, but the movement of the vocal folds tends to recover. After 12?weeks of survival, the disorganization within the Amb is the largest, but the number of motoneurons is similar to control, and all animals recovered the movement of the left vocal fold. Our additional controls indicate that no tracer spread to the CT muscle occurred, and that many of the labeled motoneurons from the PCA after 1?week post-RLN injury correspond to motoneurons whose axons travel in the SLN. Therefore, it seems that after RLN injury there is a collateral sprouting and collateral innervation. Although the somatotopic organization of the Amb is lost after a crush injury of the RLN and does not recover in the times studied here, the movement of the vocal folds as well as the number of neurons that supply the TA and the PCA muscles recovered within 8?weeks, indicating that the central nervous system of the rat has a great capacity of plasticity. PMID:23444899

Hernández-Morato, Ignacio; Valderrama-Canales, Francisco J; Berdugo, Gabriel; Arias, Gonzalo; McHanwell, Stephen; Sañudo, José; Vázquez, Teresa; Pascual-Font, Arán



Phrenic nerve injury and diaphragmatic paralysis following pacemaker pulse generator replacement.  


Diaphragmatic paralysis (DP) is a common condition. It can be unilateral or bilateral and the diagnosis is usually based on a clinical and radiological findings. Bilateral diaphragmatic paralysis is usually symptomatic with dyspnea and acute respiratory failure while unilateral diaphragmatic paralysis is typically asymptomatic and when present, symptoms usually depend on the presence of underlying pulmonary or neurologic disease. DP can be the result of various chest conditions that affect the phrenic nerve such as tumors, vascular abnormalities or traumatic incidents during surgery as well as blunt or penetrating chest or neck injuries. We report a unique case of phrenic nerve injury and unilateral diaphragmatic paralysis secondary to pacemaker pulse generator replacement that was successfully treated with diaphragmatic plication. PMID:23083538

Harris, Kassem; Maniatis, Gregory; Siddiqui, Faraz; Maniatis, Theodore



Inferior alveolar nerve injury with laryngeal mask airway: a case report  

PubMed Central

Introduction The incidence of damage to the individual cranial nerves and their branches associated with laryngeal mask airway use is low; there have been case reports of damage to the lingual nerve, hypoglossal nerve and recurrent laryngeal nerve. To the best of our knowledge we present the first reported case of inferior alveolar nerve injury associated with laryngeal mask airway use. Case presentation A 35-year-old Caucasian man presented to our facility for elective anterior cruciate ligament repair. He had no background history of any significant medical problems. He opted for general anesthesia over a regional technique. He was induced with fentanyl and propofol and a size 4 laryngeal mask airway was inserted without any problems. His head was in a neutral position during the surgery. After surgery in the recovery room, he complained of numbness in his lower lip. He also developed extensive scabbing of the lower lip on the second day after surgery. The numbness and scabbing started improving after a week, with complete recovery after two weeks. Conclusion We report the first case of vascular occlusion and injury to the inferior alveolar nerve, causing scabbing and numbness of the lower lip, resulting from laryngeal mask airway use. This is an original case report mostly of interest for anesthetists who use the laryngeal mask airway in day-to-day practice. Excessive inflation of the laryngeal mask airway cuff could have led to this complication. Despite the low incidence of cranial nerve injury associated with the use of the laryngeal mask airway, vigilant adherence to evidence-based medicine techniques and recommendations from the manufacturer's instructions can prevent such complications.



The number of nerve cells in the substantia nigra in paralysis agitans  

Microsoft Academic Search

The number of melanin-containing and melanin-free nerve cells in the substantia nigra was determined in 10 brains with paralysis agitans and in 10 control brains, both groups from subjects with the same average age. The total count in the brains with paralysis agitans was shown to be 59% less than the total count in the control brains, the melanin-containing cell

H. Pakkenberg; H. Brody



Losing your voice: etiologies and imaging features of vocal fold paralysis.  


Neurogenic compromise of vocal fold function exists along a continuum encompassing vocal cord hypomobility (paresis) to vocal fold immobility (paralysis) with varying degrees and patterns of reinnervation. Vocal fold paralysis (VFP) may result from injury to the vagus or the recurrent laryngeal nerves anywhere along their course from the brainstem to the larynx. In this article, we review the anatomy of the vagus and recurrent laryngeal nerves and examine the various etiologies of VFP. Selected cases are presented with discussion of key imaging features of VFP including radiologic findings specific to central vagal neuropathy and peripheral recurrent nerve paralysis. PMID:23814687

Vachha, Behroze; Cunnane, Mary Beth; Mallur, Pavan; Moonis, Gul



Total Facial Nerve Decompression for Severe Traumatic Facial Nerve Paralysis: A Review of 10 Cases  

PubMed Central

Management of traumatic facial nerve disorders is challenging. Facial nerve decompression is indicated if 90–95% loss of function is seen at the very early period on ENoG or if there is axonal degeneration on EMG lately with no sign of recovery. Middle cranial or translabyrinthine approach is selected depending on hearing. The aim of this study is to present retrospective review of 10 patients with sudden onset complete facial paralysis after trauma who underwent total facial nerve decompression. Operation time after injury is ranging between 16 and105 days. Excitation threshold, supramaximal stimulation, and amplitude on the paralytic side were worse than at least %85 of the healthy side. Six of 11 patients had HBG-II, one patient had HBG-I, 3 patients had HBG-III, and one patient had HBG-IV recovery. Stretch, compression injuries with disruption of the endoneurial tubules undetectable at the time of surgery and lack of timely decompression may be associated with suboptimal results in our series.

Yetiser, Sertac





... viruses. It may also be caused by: Allergies Bacterial infection Bronchitis Gastroesophageal reflux disease (GERD) Injury Irritants and chemicals Pneumonia Laryngitis often occurs with an upper respiratory infection . ...


Right hypoglossal nerve paralysis after tracheal intubation for aesthetic breast surgery  

PubMed Central

Aesthetic and functional complications caused by general anesthesia have been rarely described after aesthetic surgery. We report a case of unilateral right hypoglossal nerve paralysis following the use of a cuffed endotracheal airway in a 24-year-old woman undergoing aesthetic breast surgery. Neurological examination and magnetic resonance imaging of the head failed to provide additional insights into the cause of the nerve injury. Postoperatively, the patient was carefully monitored and made a full recovery within 2 weeks without any pharmacological treatment. The transient hypoglossal nerve paralysis seemed to be due to neuropraxia. In this patient, we postulate that the right hypoglossal nerve was compressed between the endotracheal tube cuff and the hyoid bone, which was inflated with 30 cm H2O. Patients undergoing aesthetic surgery must be appropriately and adequately informed that postoperative aesthetic and functional deficits can occur due to anesthesia as well as the surgery.

Al-Benna, Sammy



Right hypoglossal nerve paralysis after tracheal intubation for aesthetic breast surgery.  


Aesthetic and functional complications caused by general anesthesia have been rarely described after aesthetic surgery. We report a case of unilateral right hypoglossal nerve paralysis following the use of a cuffed endotracheal airway in a 24-year-old woman undergoing aesthetic breast surgery. Neurological examination and magnetic resonance imaging of the head failed to provide additional insights into the cause of the nerve injury. Postoperatively, the patient was carefully monitored and made a full recovery within 2 weeks without any pharmacological treatment. The transient hypoglossal nerve paralysis seemed to be due to neuropraxia. In this patient, we postulate that the right hypoglossal nerve was compressed between the endotracheal tube cuff and the hyoid bone, which was inflated with 30 cm H2O. Patients undergoing aesthetic surgery must be appropriately and adequately informed that postoperative aesthetic and functional deficits can occur due to anesthesia as well as the surgery. PMID:24015142

Al-Benna, Sammy





... laryngitis /DS00366 ">Laryngitis Guidelines for sites linking to Advertisement Mayo Clinic Store Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. Try Mayo Clinic Health Letter ... answers to live stronger, longer and healthier at any age ...


[A case of Churg-Strauss syndrome with subarachnoid hemorrhage and left phrenic nerve paralysis].  


A 60-year-old woman was given a diagnosis of Churg-Strauss syndrome (CSS) in 2000 because of peripheral blood eosinophilia, eosinophilic pneumonia, asthma, polyarticular pain, and limb numbness. She was treated with prednisolone (PSL), and the above symptoms improved but then relapsed on tapering of PSL. In September 2009, after 7 days of tapering of PSL to 5mg/day, the patient developed a subarachnoid hemorrhage and was admitted. MRA and cerebral angiography revealed no aneurysm; the source of bleeding could not be determined, but her symptoms indicated a benign course. A chest X-ray 27 days after admission showed left diaphragmatic elevation, and left phrenic nerve paralysis was diagnosed by a phrenic nerve stimulation test. Peripheral blood eosinophilia had progressed gradually during the admission period, and although it is rare for subarachnoid hemorrhage and phrenic nerve paralysis to be associated with CSS, we regarded these as vasculitis symptoms related to CSS. PMID:22073608

Shimizu, Kyoko; Ohoba, Hiromi; Shimada, Hiroyuki; Inoue, Yukihisa; Jinn, Yasuto; Yoshimura, Nobuyuki



A new anchor electrode design for continuous neuromonitoring of the recurrent laryngeal nerve by vagal nerve stimulations  

Microsoft Academic Search

Purpose  Intraoperative neuromonitoring has the limitation that the recurrent laryngeal nerve (RLN) is still at risk for damage between\\u000a two stimulations with a handheld bipolar stimulation electrode. The purpose of this study was to establish the vagal anchor\\u000a electrode for real-time monitoring of the RLN in surgical routine and to be alerted to imminent nerve failure by electromyography\\u000a (EMG) signal analysis

Rick Schneider; Joanna Przybyl; Michael Hermann; Johann Hauss; Sven Jonas; Steffen Leinung



Intrathoracic blood supply of the left vagus and recurrent laryngeal nerves  

Microsoft Academic Search

The arteries and veins of the left vagus (VN) and left recurrent laryngeal (RLN) nerves from the thoracic inlet to the subaortic region are described following vascular casting with red colored latex in 6 adult fresh non-embalmed cadavers. In all specimens the anterior bronchoesophageal artery supplied at least one vessel to the VN and RLN in the subaortic region. For

M. Filaire; J.-M. Garçier; Y. Harouna; S. Laurent; T. Mom; A. Naamee; G. Escande; G. Vanneuville



Esophagectomy with three-field lymph node dissection for esophageal carcinoma with a nonrecurrent inferior laryngeal nerve  

Microsoft Academic Search

In rare cases, the inferior laryngeal nerve branches directly from the vagus trunk. A 58-year-old man with carcinoma of the\\u000a thoracic esophagus was referred to our hospital. A nonrecurrent anomaly of the right recurrent laryngeal nerve associated\\u000a with an aberrant right subclavian artery was detected preoperatively by computed tomography and magnetic resonance imaging.\\u000a This artery ran on the right side

Hiroshi Sato; Yasuhiro Tsubosa; Toru Ugumori



Quantitative analysis of the anatomy of the epineurium of the canine recurrent laryngeal nerve  

PubMed Central

The purpose of this investigation was to determine the amount of epineurium surrounding the recurrent laryngeal nerve (RLN) compared with a limb nerve, that to flexor hallicus longus (NFHL). Nerve samples were obtained from 10 adult dogs and studied using scanning electron microscopy and light microscopy to measure the relative proportion of epineurium and the relative proportions of adipose and collagenous tissue comprising the epineurium in both nerves. Significantly greater relative epineurial cross-sectional areas and adipose content were found in the RLN than in the NFHL. Based on observations on noncranial peripheral nerves, the findings indicate that the RLN is better protected against deformational forces associated with compression than stretching forces. The RLN may not be structured well for successful reinnervation after injury. The patterns observed for adipose tissue in RLN epineurial tissue appeared unique compared with those previously reported in peripheral nerves. The primary role associated with adipose tissue is to ‘package’ the nerve for protection. The RLN is considered to be a vital nerve in the body, as are other cranial nerves. The large proportions of adipose tissue in the epineurium may relate to the importance of protecting this nerve from injury.




Vocal cord paralysis and reoperative parathyroidectomy. A prospective study.  

PubMed Central

One hundred sixty-three patients undergoing reoperative parathyroidectomy were evaluated before and after operation to determine the incidence of, risk factors for, and morbidity of vocal cord paralysis. These patients were compared to 77 patients undergoing initial parathyroid operation, only one of whom had vocal cord paralysis on postoperative indirect laryngoscopy (1.3%). Preoperative examination of the reoperative patients revealed vocal cord paralysis from initial exploration in 11 patients who were excluded from this study. After re-exploration, 10 patients (6.6%) had vocal cord paralysis, eight unilateral and two bilateral. Right vocal cords were paralyzed twice as often as left. In 90%, vocal cord paralysis was associated with removal or biopsy of an ipsilateral gland. Vocal cord paralysis occurred despite intraoperative visualization of the recurrent laryngeal nerves. Preoperative localization, parathyroid gland pathology, and concomitant thyroidectomy were not associated with increased risk of vocal cord paralysis. Hoarseness was the major symptom. Tracheostomy was required for two patients, one was permanent. One patient was treated for aspiration with a temporary gastrostomy. Nine of 10 patients had return of normal voice quality in an average of 4 months time. On examination 4 years or more after surgery, two of five patients had normal vocal cord motion. The oblique anatomic course of the right recurrent laryngeal nerve may account for the greater frequency of right vocal cord paralysis. Images FIG. 1.

Patow, C A; Norton, J A; Brennan, M F



Identifying the Non-recurrent Laryngeal Nerve: Preventing a Major Risk of Morbidity During Thyroidectomy.  


Non-recurrent laryngeal nerve (NRLN) is a rare anomaly which is reported in 0.3%-0.8% of people on the right side and in 0.004% (extremely rare) on the left side. Damage to this nerve during the surgical procedure may lead to severe iatrogenic morbidity and should therefore be prevented from being damaged. The best way to avoid this damage to the nerve is to identify the nerve with a systematic diligent dissection based on usual anatomical landmarks and awareness about the possibility of their existence. Hereby, we are going to present a 26-year-old woman, a case of NRLN on the right side which was identified during thyroidectomy. The nervous anomaly was accompanied with vascular abnormality which was confirmed by computerized tomography (CT) angiography, post-operatively. PMID:23543847

Mahmodlou, Rahim; Aghasi, Mohammad Reza; Sepehrvand, Nariman



Bilateral vocal cord paralysis secondary to head and neck surgery.  


Even endotracheal intubation could be considered safe in operations under general anesthesia; rarely, it could cause recurrent laryngeal nerve paralysis as a complication. As mentioned in the literature, as a possible reason for this, anterior branches of the recurrent laryngeal nerve in the larynx could suffer from compression between the posteromedial part of the thyroid cartilage and the cuff of the tube. In the literature, unilateral vocal cord paralysis due to endotracheal intubation occurs more frequently in comparison to bilateral vocal cord paralysis. These types of palsies usually totally improve in approximately 6 months. A patient who experienced bilateral vocal cord paralysis in the early postoperative period after undergoing an endotracheal intubation process for general anesthesia and primary partial lip resection and supraomohyoid neck dissection due to lower lip carcinoma is presented in our article. Although vocal cord paralysis occurring after head and neck surgery is first thought as a complication of the surgery, endotracheal intubation should be considered as a possible cause of this paralysis. In relation with this patient, causes, clinical symptoms, and treatment procedures of vocal cord paralysis due to endotracheal intubation are discussed under guidance of the literature. PMID:22337390

Tekin, Muhammet; Acar, Gul Ozbilen; Kaytaz, Asim; Savrun, Feray Karaali; Çelik, Melek; Cam, Osman Halit



Role of the ventrolateral region of the nucleus of the tractus solitarius in processing respiratory afferent input from vagus and superior laryngeal nerves  

Microsoft Academic Search

The role of respiratory neurons located within and adjacent to the region of the ventrolateral nucleus of the tractus solitarius (vlNTS) in processing respiratory related afferent input from the vagus and superior laryngeal nerves was examined. Responses in phrenic neural discharge to electrical stimulation of the cervical vagus or superior laryngeal nerve afferents were determined before and after lesioning the

D. R. McCrimmon; D. F. Speck; J. L. Feldman



Analysis of the Prognosis and the Recovery Process of Profound Facial Nerve Paralysis Secondary to Acoustic Neuroma Resection  

Microsoft Academic Search

The prognosis and the recovery process of facial nerve paralysis were reviewed in 74 patients who, despite preservation of nerve continuity, showed no facial movement after acoustic neuroma resection. In 50 or 67.6% of patients, facial movement recovered sufficiently so as not to require any reanimation procedures. However, no apparent sign of remission was observed for 7–49 months in the

Takanobu Kunihiro; Jin Kanzaki; Shigemitsu Yoshihara; Yasuo Satoh



[Larynx reinnervation by the main branch of ansa cervicalis use in the thyroid surgery in case of unilateral vocal fold paralysis].  


The effectiveness of laryngeal reinnervation by anza cervicalis abduction in the treatment of unilateral vocal fold paralysis in thyroid surgery was study. The prospectively examined 11 patients with abduction paralysis of the larynx, which were treated by ipsilateral anastomosis of anza cervicalis main branch to the distal stump of the recurrent laryngeal nerve were performed. The survey was conducted on the pre- and postoperative stages and included videolaryngoscopy, acoustic analysis, and patient self-assessment of voice. Average follow-up was (2.98 +/- 1.04) years. The use of videolaryngoscopy showed significant improvement of the spatial positioning of the vocal folds in the postoperative period and acoustical parameters. Laryngeal reinnervation by anza cervicalis is an effective treatment for laryngeal paralysis related to operations on the thyroid gland and laryngeal function can be improve to almost normal of the spoken voice parameters and the basic functions of the larynx. PMID:24171297



Facial Nerve Paralysis due to Chronic Otitis Media: Prognosis in Restoration of Facial Function after Surgical Intervention  

PubMed Central

Purpose Facial paralysis is an uncommon but significant complication of chronic otitis media (COM). Surgical eradication of the disease is the most viable way to overcome facial paralysis therefrom. In an effort to guide treatment of this rare complication, we analyzed the prognosis of facial function after surgical treatment. Materials and Methods A total of 3435 patients with COM, who underwent various otologic surgeries throughout a period of 20 years, were analyzed retrospectively. Forty six patients (1.33%) had facial nerve paralysis caused by COM. We analyzed prognostic factors including delay of surgery, the extent of disease, presence or absence of cholesteatoma and the type of surgery affecting surgical outcomes. Results Surgical intervention had a good effect on the restoration of facial function in cases of shorter duration of onset of facial paralysis to surgery and cases of sudden onset, without cholesteatoma. No previous ear surgery and healthy bony labyrinth indicated a good postoperative prognosis. Conclusion COM causing facial paralysis is most frequently due to cholesteatoma and the presence of cholesteatoma decreased the effectiveness of surgical treatment and indicated a poor prognosis after surgery. In our experience, early surgical intervention can be crucial to recovery of facial function. To prevent recurrent cholesteatoma, which leads to local destruction of the facial nerve, complete eradication of the disease in one procedure cannot be overemphasized for the treatment of patients with COM.

Kim, Jin; Jung, Gu-Hyun; Park, See-Young



Effects of Various Ion Transport Inhibitors on the Water Response in the Superior Laryngeal Nerve in Rats  

Microsoft Academic Search

The effects of inhibitors (acetazolamide, an inhibitor of carbonic anhydrase; amiloride, an inhibitor of the Na channel; furosemide, an inhibitor of the Na\\/K\\/2Cl transporter; 4,4'-diisothiocyanostilbene-2,2'-disulfonic acid (DIDS), an inhibitor of the Cl channel) on the water response in the superior laryngeal nerve (SLN) were investigated using whole nerve recordings from the SLN of anesthetized and paralyzed rats. Changes in spontaneous

Takamitsu Hanamori



Life-threatening complication of recurrent laryngeal nerve monitoring with EMG reinforced silicone ETT.  


We present 2 cases with complication of herniation of a specially designed endotracheal tube (ETT) cuff used for laryngeal nerve monitoring during thyroid surgery. Abrupt and total blockage of ventilation has occurred at 35th and 40th minutes of general anesthesia. In an animal trachea, we showed that overinflated cuff may herniate and block ETT tip easily. A 25-mm upward movement of the ETT is found as a contributing factor to cuff herniation.In patients intubated with electromyographic reinforced ETT, any event suggesting sudden ventilation blockage should be managed initially by prompt deflation of the cuff. The cuff should be inflated at the minimal necessary volume, and operating room staff should pay maximum attention to the stability of endotracheal and breathing tubes. PMID:22134299

Oysu, Cagatay; Demir, Kadri



Paralysis of cranial nerve and striking prognosis of cervical necrotizing fasciitis.  


Necrotizing soft-tissue infection (NSTI) is a bacterial infection with necrosis of the cutaneous, subcutaneous tissue and fascia with sparing of the underlying muscle. The most frequent initiating factor reported, for necrotizing fasciitis, in the head and neck region is a primary odontogenic infection or postextraction infection, abrasion, and laceration of the face or scalp. Necrotizing fasciitis can progress rapidly to systemic toxicity and even death if not promptly diagnosed and treated. If the patient has any risk factors, this can worsen the prognosis. In this study, 2 cases of NSTI with dental pathology history (one with the spreading to mediastinum and the other spreading to suprahyoid) were discussed with a review of the literature. One of the cases had diabetes mellitus, but interestingly, she had a better prognosis, and she was discharged asymptomatic. In addition, the other case had no any risk factors, but he had a worse clinical cranial nerve paralysis (a rare complication of NSTI) and died. As a conclusion, despite the intensive therapy, large debridement, and antibiotics with large spectrum, the delay in the patient's diagnosis and treatment increased mortality. We aimed to attract attention to the importance of dental pathologies and early diagnosis. PMID:23147345

Ulu, Sahin; Ulu, Sena Memnune; Oz, Gürhan; Kaçar, Emre; Yüceda?, Fatih; Ayçiçek, Abdullah



Post-traumatic dissection of the internal carotid artery associated with ipsilateral facial nerve paralysis: Diagnostic and forensic issues.  


Traumatic internal carotid artery dissection may result from a direct blow to anterolateral aspect of the neck, or an extreme extension and rotation of the neck. Traumas involved are variable ranging from high speed motor vehicle accident to trivial traumas. The most frequent presentations of carotid artery dissection are stroke, Hörner syndrome, and paralysis of a cranial nerve. Time of ischemic signs onset is very variable too, diverging from immediate to several months delay. We report the case of a 60-year-old woman, who was assaulted by a young man. Immediately, she complained of headache and posterior cervical pain. Three months later she developed a left hemifacial paralysis. MRI and MRA showed a dissection of the left internal carotid artery. The causal relationship between the trauma and the carotid artery dissection as well as forensic issues are discussed. PMID:24112338

Makhlouf, F; Scolan, V; Detante, O; Barret, L; Paysant, F



Facial nerve paralysis and frey syndrome in an infant following removal of an internal mandibular distraction device.  


Mandibular distraction using an implantable device has become a widely accepted and utilized procedure for the treatment of retrognathia. Although excellent results have been reported and observed with distraction osteogenesis, complications such as facial nerve injury have been previously reported. Often, this injury is usually temporary and corrects over the course of time. Frey syndrome has been classically described as an injury or severance of the auricotemporal branch of the trigeminal nerve. It is commonly seen as a complication of parotid surgery and has never been reported in association with mandibular distraction. The authors report a unique case of both facial nerve paralysis and Frey syndrome in a patient following the removal of an internal mandibular distraction device. A review of the literature along with diagnosis and management are discussed. PMID:23714921

Kapadia, Sameer Mehbub; Golinko, Michael Samuel; Williams, Joseph Kerwin



The pathology of equine laryngeal hemiplegia  

Microsoft Academic Search

Laryngeal muscles and nerves were obtained from 42 horses, 3 of which suffered from laryngeal hemiplegia. Of the remaining 39 clinically normal horses, 30% (12) demonstrated pathological changes in the laryngeal musculature.

Ian D. Duncan; I. R. Griffiths; A. McQueen; G. O. Baker



Transient total facial nerve paralysis: an unusual complication of transoral endoscopic-assisted management of subcondylar fracture.  


Endoscopic-assisted repair of subcondylar fractures is an additional tool for management; however, there is a steep learning curve. Generally, this technique allows good visualization of the fracture site for reduction through an incision with an acceptable cosmetic result. Recently, the surgical techniques and technology as well as the indications for endoscopic facial fracture repair are in development; there are few available data in the literature regarding detail complications and recovery processes following endoscopic fracture treatment. The purpose of this article was to reveal unusual complication following endoscopic repair of subcondylar fracture in terms of radiographic, photographic, and recovering orders of the facial nerve and facial reanimations. In our case, no damage to the facial nerve was observed intraoperatively, but the patient had total facial paralysis, immediately postoperatively. At long-term follow-up, the facial nerve function was recovered well within 6 months. The authors consider that transoral endoscopic-assisted open reduction constitutes a valid alternative to a transcutaneous approach for the reduction and fixation of subcondylar fractures. It provides the benefits of open reduction and internal fixation without the permanent complications, such as facial nerve injury. PMID:22627456

Choi, Hwan Jun; Lee, Young Man



Vocal cord paralysis and recovery with thyroid lymphoma.  


Vocal cord paralysis has been reported in 33 patients with thyroid lymphoma for an estimated overall incidence of 17%. There is little expectation of vocal cord function recovery, both because neoplastic invasion is believed irreversible and since surgery often necessitates sacrifice of the recurrent laryngeal nerve. Unlike in most well differentiated thyroid malignancies, external radiation therapy plays a vital role in the treatment of thyroid lymphoma. The patient presented here had complete recovery of vocal cord function following radiation therapy for a large thyroid lymphoma associated with vocal cord paralysis. This is the first reported case of such recovery following treatment for a thyroid neoplasm. The rather rapid and complete recovery of neural function suggests that, at least in some, paralysis is caused by reversible compression rather than by neural invasion or tumor-induced neurolysis. PMID:3965829

Jiu, J B; Sobol, S M; Grozea, P N



A comparison between succinylcholine and rocuronium on the recovery profile of the laryngeal muscles during intraoperative neuromonitoring of the recurrent laryngeal nerve: A prospective porcine model.  


The use of succinylcholine and rocuronium are reportedly feasible during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) in thyroid surgery. This study aimed to investigate and compare the recovery profiles of succinylcholine and rocuronium on the laryngeal muscle during IONM of the RLN in a porcine model. Nine male Duroc-Landrace piglets were anesthetized with thiamylal and underwent tracheal intubation without neuromuscular blocking agents (NMBAs). Needle electrodes were inserted into the vocalis muscles through the cricothyroid ligament. The RLN was exposed and stimulated. Electromyographic (EMG) signals were obtained before and after the intravenous administration of a NMBA. The EMG amplitudes were measured before and after (at 1-minute intervals) the administration of the study drug until complete recovery. The study NMBA regimen included succinylcholine (1 mg/kg), low-dose rocuronium (0.3 mg/kg), and standard dose rocuronium (0.6 mg/kg). The maximal neuromuscular blockade and 80% recovery (i.e., duration) of the control responses were recorded and analyzed. The 80% recovery of the control response for succinylcholine (1 mg/kg) was 19.7 ± 1.5 minutes; low-dose rocuronium (0.3 mg/kg), 16.3 ± 2.5 minutes; and standard dose rocuronium (0.6 mg/kg), 29.3 ± 5.7 minutes. Succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had significantly shorter durations than standard dose rocuronium (0.6 mg/kg). The EMG signal recovery returned to baseline within 30 minutes in the succinylcholine and low-dose rocuronium groups, but it did not return to baseline until 1 hour after surgery in the rocuronium (0.6 mg/kg) group. In this study, succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had favorable recovery profiles on the laryngeal muscle. It is recommended that low-dose rocuronium may replace succinylcholine for the induction of general anesthesia during IONM of the RLN in thyroid surgery. PMID:24018151

Lu, I-Cheng; Chang, Pi-Ying; Hsu, Hung-Te; Tseng, Kuang-Yi; Wu, Che-Wei; Lee, Ka-Wo; Ho, Kuen-Yao; Chiang, Feng-Yu



[Paralysis of the posterior branch of the radial nerve caused by a lipoma].  


A case of compression of the posterior branch of the radial nerve by a lipoma is reported. This case is unusual because of the large size of the tumor (13 cm x 6 cm) and the interest of CT to exclude a liposarcoma. The risk of liposarcoma is greater with large size tumors. Reported 27 cases have been analyzed. The posterior branch of the radical nerve is particularly vulnerable because of the anatomic relationships. Thus benign extraneural sof-tissue tumors of the extremities may be responsible of nerves compressions. PMID:3423585

Mariette, X; Leche, J; Lecanuet, P; Fenelon, G; Guillard, A



Electrophysiologic monitoring of the recurrent laryngeal nerves may not predict bilateral vocal fold immobility after thyroid surgery.  


Two cases of bilateral vocal fold immobility (VFI) after identification and preservation of the recurrent laryngeal nerves (RLNs) required tracheotomy until vocal fold recovery. The first patient underwent thyroid surgery without preoperative or postoperative evaluation of the vocal folds, administration of postoperative intravenous steroids, or electrophysiologic monitoring of the RLNs, whereas the second patient underwent a thyroid procedure in which all of the aforementioned were executed. Preoperative and postoperative clinical evaluation of the RLNs is strongly suggested in patients undergoing thyroid surgery, especially revision surgery. Patients potentially undergoing total thyroidectomy should be counseled about the remote chance of airway obstruction and should be properly selected for this operation. Subclinical stretching of the RLNs or ischemia from the endotracheal tube cuff can result in unilateral VFI, and rarely bilateral VFI, requiring reintubation, tracheotomy, or vocal fold lateralization. Electrophysiologic monitoring may not always predict bilateral VFI. PMID:15193661

Witt, Robert L



Laryngeal brain stem evoked response.  


Sensory stimuli to the larynx evoke a laryngeal adductor reflex mediated by the brain stem via superior and recurrent laryngeal nerves. Aberrant laryngeal reflexes have been proposed to explain a number of poorly understood disorders, including "reflex apnea," idiopathic laryngospasm, and sudden infant death syndrome. The purpose of the present study was to evaluate far field brain stem recordings following stimulation of the superior laryngeal nerve to determine whether laryngeal brain stem response is a valid measure of laryngeal activity at the brain stem level. The nerve was stimulated electrically in adult cats, and the resultant laryngeal adductor response as well as far field brain stem activity was recorded. For the latter, six reproducible positive and five reproducible negative waves were obtained via posterior pharyngeal (+) and posterior cervical (-) recording electrodes. Response threshold and latencies were measured and evaluated as a function of stimulus parameters. Wave latencies corresponded closely to those reported in prior near and far field evoked response recordings. PMID:2782801

Anonsen, C K; Lalakea, M L; Hannley, M



Residual chemoresponsiveness to acids in the superior laryngeal nerve in "taste-blind" (P2X2/P2X3 double-KO) mice.  


Mice lacking both the P2X2 and the P2X3 purinergic receptors (P2X-dblKO) exhibit loss of responses to all taste qualities in the taste nerves innervating the tongue. Similarly, these mice exhibit a near total loss of taste-related behaviors in brief access tests except for a near-normal avoidance of acidic stimuli. This persistent avoidance of acids despite the loss of gustatory neural responses to sour was postulated to be due to continued responsiveness of the superior laryngeal (SL) nerve. However, chemoresponses of the larynx are attributable both to taste buds and to free nerve endings. In order to test whether the SL nerve of P2X-dblKO mice remains responsive to acids but not to other tastants, we recorded responses from the SL nerve in wild-type (WT) and P2X-dblKO mice. WT mice showed substantial SL responses to monosodium glutamate, sucrose, urea, and denatonium-all of which were essentially absent in P2X-dblKO animals. In contrast, the SL nerve of P2X-dblKO mice exhibited near-normal responses to citric acid (50 mM) although responsiveness of both the chorda tympani and the glossopharyngeal nerves to this stimulus were absent or greatly reduced. These results are consistent with the hypothesis that the residual avoidance of acidic solutions by P2X-dblKO mice may be attributable to the direct chemosensitivity of nerve fibers innervating the laryngeal epithelium and not to taste. PMID:22362867

Ohkuri, Tadahiro; Horio, Nao; Stratford, Jennifer M; Finger, Thomas E; Ninomiya, Yuzo



Residual Chemoresponsiveness to Acids in the Superior Laryngeal Nerve in "Taste-Blind" (P2X2/P2X3 Double-KO) Mice  

PubMed Central

Mice lacking both the P2X2 and the P2X3 purinergic receptors (P2X-dblKO) exhibit loss of responses to all taste qualities in the taste nerves innervating the tongue. Similarly, these mice exhibit a near total loss of taste-related behaviors in brief access tests except for a near-normal avoidance of acidic stimuli. This persistent avoidance of acids despite the loss of gustatory neural responses to sour was postulated to be due to continued responsiveness of the superior laryngeal (SL) nerve. However, chemoresponses of the larynx are attributable both to taste buds and to free nerve endings. In order to test whether the SL nerve of P2X-dblKO mice remains responsive to acids but not to other tastants, we recorded responses from the SL nerve in wild-type (WT) and P2X-dblKO mice. WT mice showed substantial SL responses to monosodium glutamate, sucrose, urea, and denatonium—all of which were essentially absent in P2X-dblKO animals. In contrast, the SL nerve of P2X-dblKO mice exhibited near-normal responses to citric acid (50 mM) although responsiveness of both the chorda tympani and the glossopharyngeal nerves to this stimulus were absent or greatly reduced. These results are consistent with the hypothesis that the residual avoidance of acidic solutions by P2X-dblKO mice may be attributable to the direct chemosensitivity of nerve fibers innervating the laryngeal epithelium and not to taste.

Ohkuri, Tadahiro; Horio, Nao; Stratford, Jennifer M.; Finger, Thomas E.; Ninomiya, Yuzo



Hypokalaemic paralysis  

PubMed Central

Hypokalaemic paralysis is a relatively uncommon but potentially life-threatening clinical syndrome. If recognised and treated appropriately, patients recover without any clinical sequellae. The syndrome of hypokalaemic paralysis represents a heterogenous group of disorders characterised clinically by hypokalaemia and acute systemic weakness. Most cases are due to familial or primary hypokalaemic periodic paralysis; sporadic cases are associated with numerous other conditions including barium poisoning, hyperthyroidism, renal disorders, certain endocrinopathies and gastrointestinal potassium losses. The age of onset, race, family history, medications, and underlying disease states can help in identifying the cause of hypokalaemic paralysis. Initial therapy of the patient with hypokalaemic paralysis includes potassium replacement and search for underlying aetiology. Further management depends on the aetiology of hypokalaemia, severity of symptoms, and duration of disease. This review presents the differential diagnosis for hypokalaemic paralysis and discusses management of the syndrome.???Keywords: hypokalaemia; periodic paralysis

Ahlawat, S.; Sachdev, A.



Bilateral Internal Superior Laryngeal Nerve Palsy of Traumatic Cervical Injury Patient Who Presented as Loss of Cough Reflex after Anterior Cervical Discectomy with Fusion  

PubMed Central

Injury to the bilateral internal branch of superior laryngeal nerve (ibSLN) brings on an impairment of the laryngeal cough reflex that could potentially result in aspiration pneumonia and other respiratory illnesses. We describe a patient with traumatic cervical injury who underwent bilateral ibSLN palsy after anterior cervical discectomy with fusion (ACDF). An 75-year-old man visited with cervical spine fracture and he underwent ACDF through a right side approach. During the post-operative days, he complained of high pitched tone defect, and occasional coughing during meals. With a suspicion of SLN injury and for the work up for the cause of aspiration, we performed several studies. According to the study results, he was diagnosed as right SLN and left ibSLN palsy. We managed him for protecting from silent aspiration. Swallowing study was repeated and no evidence of aspiration was found. The patient was discharged with incomplete recovery of a high pitched tone and improved state of neurologic status. The SLN is an important structure; therefore, spine surgeons need to be concerned and be cautious about SLN injury during high cervical neck dissection, especially around the level of C3-C4 and a suspicious condition of a contralateral nerve injury.

Shin, Dong-Uk; Nam, Kyung-Hun; Cho, Dae-Chul



Reversal of BoNT/A-mediated inhibition of muscle paralysis by 3,4-diaminopyridine and roscovitine in mouse phrenic nerve-hemidiaphragm preparations.  


Botulinum neurotoxins (BoNTs) comprise a family of neurotoxic proteins synthesized by anaerobic bacteria of the genus Clostridium. Each neurotoxin consists of two polypeptide chains: a 100kDa heavy chain, responsible for binding and internalization into the nerve terminal of cholinergic motoneurons and a 50kDa light chain that mediates cleavage of specific synaptic proteins in the host nerve terminal. Exposure to BoNT leads to cessation of voltage- and Ca(2+)-dependent acetylcholine (ACh) release, resulting in flaccid paralysis which may be protracted and potentially fatal. There are no approved therapies for BoNT intoxication once symptoms appear, and specific inhibitors of the light chain developed to date have not been able to reverse the consequences of BoNT intoxication. An alternative approach for treatment of botulism is to focus on compounds that act by enhancing ACh release. To this end, we examined the action of the K(+) channel blocker 3,4-diaminopyridine (3,4-DAP) in isolated mouse hemidiaphragm muscles intoxicated with 5pM BoNT/A. 3,4-DAP restored tension within 1-3min of application, and was effective even in totally paralyzed muscle. The Ca(2+) channel activator (R)-roscovitine (Ros) potentiated the action of 3,4-DAP, allowing for use of lower concentrations of the K(+) channel blocker. In the absence of 3,4-DAP, Ros was unable to augment tension in BoNT/A-intoxicated muscle. This is the first report demonstrating the efficacy of the combination of 3,4-DAP and Ros for the potential treatment of BoNT/A-mediated muscle paralysis. PMID:22841859

Adler, Michael; Deshpande, Sharad S; Apland, James P; Murray, Bridget; Borrell, Andrew



Description of Laryngeal Pathologies in Children Evaluated by Otolaryngologists.  

ERIC Educational Resources Information Center

|Data were collected on 731 patients (age birth to 18) at a children's hospital otolaryngology clinic. Most frequent laryngeal pathologies were subglottic stenosis, vocal nodules, laryngomalacia, and vocal fold paralysis. Laryngeal pathologies were more common to males than females, were most common in the youngest patients, and were distributed…

Dobres, Rachel; And Others



Idiopathic facial paralysis in the dog  

Microsoft Academic Search

Facial nerve paralysis of acute onset is reported in seven mature dogs, five of which were cocker spaniels. The clinical signs were characterised by ear drooping, lip commissural paralysis, sialosis, and collection of food on the paralysed side of the mouth. All dogs showed absent menace responses and trigeminofacial\\/acousticofacial reflexes. Horner's syndrome was not present in any dog. In four

KG Braund; PJ Luttgen; DC Sorjonen; RW Redding



Adductor laryngeal dystonia (spastic dysphonia): treatment with local injections of botulinum toxin (Botox).  


Adductor spastic dysphonia (SD) is a laryngeal dystonia characterized by a choked, constrained voice pattern with breaks in vocal flow. Treatment with a variety of therapies including speech and pharmacotherapy have minimal benefit; only one-third of patients undergoing recurrent laryngeal nerve section have benefitted at 3 years. We have used local injections of botulinum toxin (Botox) bilaterally into vocalis muscles in 42 patients with SD. Injections were through a teflon-coated hollow electromyography (EMG) recording needle. Unilateral small doses (2.5-3.75 U) were of no clinical benefit. Bilateral small doses resulted in sustained improvement lasting 84.4 +/- 9.3 days. The degree of improvement was 61.1 +/- 4.6%. Common side-effects included a brief period of breathy hypophonia (8.5 +/- 2.5 days) and a mild sensation of choking/aspiration of fluids (1.7 +/- 0.6 days); there were no serious adverse effects. Vocal cord paralysis was not necessary for benefit. Follow-up vocalis muscle EMGs revealed denervation. All patients responded to retreatment (longest follow-up 3.5 years). Patients with prior recurrent laryngeal nerve surgery and residual uncomplicated dysphonia had similar results. Our results indicate that local injection of low-dose Botox is the treatment of choice for SD. PMID:2811888

Brin, M F; Blitzer, A; Fahn, S; Gould, W; Lovelace, R E



Vocal Fold Paralysis  


... Voice, Speech and Language Vocal Fold Paralysis Vocal Fold Paralysis On this page: What is vocal fold ... can I get additional information? What is vocal fold paralysis? Structures involved in speech and voice production ...



PubMed Central

At the recent Forty-fourth Annual Meetings of the American Public Health Association, Cincinnati, Ohio, there was held a Round Table Discussion on Infantile Paralysis, in which health authorities throughout the country took part. This discussion was held under the auspices of the Section on Public Health Administration. Dr. George W. Goler, Health Officer of Rochester, N. Y., Chairman of this Section, presided. We take great pleasure in being able to reproduce for readers of the Journal what took place at this most important session.



Trapezius transfer in deltoid paralysis  

Microsoft Academic Search

Summary  \\u000a In most cases the genesis of brachial plexus palsy is traumatic, often because of bike accidents. If physiotherapy and neurosurgical\\u000a procedures such as nerve repair do not have the desired outcome, muscle transfer operations are possible. The results of our\\u000a favored transfer of the trapezius muscle to compensate paralysis of the deltoid muscle will be presented. Preoperatively radiological,\\u000a clinical

O. Rühmann; C. J. Wirth; F. Gossé



Children and Facial Paralysis  


... en Español About Otolaryngology ENT History Children and Facial Paralysis About 40,000 people in the United States develop facial paralysis each year with children comprising a small percentage ...


Vocal Cord Paralysis  


... Accessed April 17, 2012. Rubin RT, et al. Vocal fold paresis and paralysis. Otolaryngologic Clinics of North America. 2007;40:1109. Vocal cord paralysis. American Speech-Language-Hearing Association. ...


Using Laryngeal Electromyography to Differentiate Presbylarynges from Paresis  

ERIC Educational Resources Information Center

|Purpose: Differential diagnosis of patients over 64 years of age reporting hoarseness is challenging. Laryngeal electromyography (LEMG) was used to determine the status of the recurrent and superior laryngeal nerves. The authors hypothesized that individuals with hoarseness but normal LEMG would have measures similar to those of patients from…

Stager, Sheila V.; Bielamowicz, Steven A.



Reversible electrophysiological abnormalities in hypokalemic periodic paralysis.  


Compound muscle action potential (CMAP) amplitude declines during a paralytic attack in patients with hypokalemic periodic paralysis (HPP). However, serial motor nerve conduction studies in HPP have not been commonly reported. We report a 9 year old girl with HPP, who had severely reduced CMAPs in all motor nerves at presentation during the episode of quadriparesis. However, the amplitude of CMAPs increased and reached normal levels as the serum potassium concentration and motor power returned to normal state. PMID:18250508

Rajshekher, Garikapati; Kumar, Sudhir; Prabhakar, Subhashini



Pediatric bilateral facial paralysis.  


Bilateral facial paralysis is an unusual clinical entity that occurs in less than 1% of patients with facial paralysis. In children bilateral facial paralysis is even more rare, and establishing its etiology can be challenging. Four pediatric patients ranging in age from 3 to 17 years are presented who developed bilateral facial paralysis as a result of acute otitis media, Lyme disease, recurrent central nervous system leukemia, and acute disseminated encephalomyelitis. The diagnosis and treatment of pediatric bilateral facial paralysis are reviewed, as well as the pertinent literature. PMID:9546263

Smith, V; Traquina, D N



Laryngeal pseudosarcoma  

SciTech Connect

In the past laryngeal pseudosarcomas have been diagnosed as a. carcinosarcomas, b. pleomorphic or spindle cell carcinomas, or c. squamous cell carcinomas with pseudosarcomatous reactive stroma. Arguments have centered around the nature of the sarcomatous stroma. Because of this confusion there is disagreement as to the treatment and prognosis of these tumors. Seven pseudosarcomas were treated between 1969-1979, 4 were pedunculated and 3 exophytic. Treatment consisted of primary CO60 irradiation in 2 patients, surgery in 3 cases and combined therapy in 2 cases with no recurrences. Three of the 7 have died, 1 of a poorly differentiated adenosquamous carcinoma of the right main stem bronchus and the other 2 of natural causes at ages 77 and 85. From a review of the literature as well as our experience, we have reached the following conclusions. 1. Stromal cells are a malignant morphologic variant of the squamous cell and are best termed spindled cells. 2. Neck metastasis at any time is a poor prognostic sign. 3. The pattern of metastasis and survival seems to parallel laryngeal squamous cell carcinoma, and thus treatment should be similar for given stages.

Giordano, A.M.; Ewing, S.; Adams, G.; Maisel, R.



Late ulnar paralysis. Study of seventeen cases.  


Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralysis are emphasized. A very prolonged symptom free interval, a rapid onset and a severe involvement. The ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are notable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal procedure of the neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury. PMID:9336632

Mansat, M; Bonnevialle, P; Fine, X; Guiraud, B; Testut, M F



Isolated sleep paralysis  

PubMed Central

Sleep paralysis (SP) is a cardinal symptom of narcolepsy. However, little is available in the literature about isolated sleep paralysis. This report discusses the case of a patient with isolated sleep paralysis who progressed from mild to severe SP over 8 years. He also restarted drinking alcohol to be able to fall asleep and allay his anxiety symptoms. The patient was taught relaxation techniques and he showed complete remission of the symptoms of SP on follow up after 8 months.

Sawant, Neena S.; Parkar, Shubhangi R.; Tambe, Ravindra



Evidence-based practice: evaluation and management of unilateral vocal fold paralysis.  


This article discusses the causes and symptoms, evaluation, and management of unilateral vocal fold paralysis (UVFP). Cross-sectional imaging is appropriate in the work-up of idiopathic UVFP, but the routine use of serology is not well supported. The usefulness of laryngeal electromyography has remained controversial. Predictors of poor prognosis for functionally meaningful recovery include fibrillation potentials, positive sharp waves, and absent/reduced voluntary motor unit potentials. Voice therapy may be helpful. Injection and laryngeal framework surgery (medialization thyroplasty) improve vocal quality. The vocal impact of laryngeal reinnervation is comparable with that of medialization. Some patients may benefit from multiple procedures. PMID:22980687

Misono, Stephanie; Merati, Albert L



Sleep paralysis: Psychodynamics  

Microsoft Academic Search

Summary A patient with sleep paralysis is discussed in view of the paucity of such reports in current American literature. It is believed, however, that this disability is more common than realized and reported heretofore. This case is of additional interest in view of the still less frequent presentation of patients with sleep paralysis in the absence of narcolepsy or

Jerome M. Schneck



Improvement of hind-limb paralysis following traumatic spinal cord injury in rats by grafting normal human keratinocytes: new cell-therapy strategy for nerve regeneration.  


Somatic (adult) stem cells are thought to have pluripotency, just as do embryotic stem (ES) cells. We investigated the possibility that grafted epithelial keratinocytes could induce spinal cord regeneration in an animal model of spinal cord injury (SCI). Normal human keratinocytes were cultured by the routine technique, and normal human dermal fibroblasts were cultured by a similar method as a control group. SCI model was prepared by dropping a 10-g weight onto the exposed spinal cord of rats from a height of 25 mm, and 8 days later, the cultured cells were grafted into the injury site. Motor function was significantly improved in the cultured-keratinocyte-grafted group compared with that in the fibroblast-grafted group. After functional observation, human nestin- and nuclei-positive cells were found at the grafted spinal cord. Grafted cultured keratinocytes induced in vitro morphological changes in the neural induction medium. These results indicated one possibility that some of the grafted cultured keratinocytes survived and could have contributed to neural regeneration. On the other hand, it should be noted that the grafted cultured keratinocytes secreted a large amount of enzymes and/or growth factors. Therefore, another possibility is that the grafted-keratinocyte-derived factors could induce survived cell growth and endogenous neural differentiation of spinal-nerve-derived stem cells surrounding the injured spinal cord, leading to functional recovery. Epithelial stem cell therapy may be applied clinically in the near future to treat SCI. PMID:21842261

Inoue, Hajime; Takenaga, Mitsuko; Ohta, Yuki; Tomioka, Miyuki; Watabe, Yu-Ichi; Aihara, Masaki; Kumagai, Norio



Diaphragmatic weakness and paralysis  

Microsoft Academic Search

Diaphragmatic weakness implies a decrease in the strength of the diaphragm. Diaphragmatic paralysis is an extreme form of\\u000a diaphragmatic weakness. Diaphragmatic paralysis is an uncommon clinical problem while diaphragmatic weakness, although uncommon,\\u000a is probably frequently unrecognized because appropriate tests to detect its presence are not performed. Weakness of the diaphragm\\u000a can result from abnormalities at any site along its neuromuscular

Pearce G. Wilcox; Richard L. Pardy



Ophthalmic surgical management of facial paralysis.  


Combinations of these procedures have been performed on more than 50 patients to date, with the longest follow-up being greater than 8 years. All of these patients presented with complaints of ocular irritation, tearing, photophobia, and impaired vision. Several had severe epithelial keratopathy. Some patients have also been treated following neurosurgical procedures which caused paralysis of the fifth and seventh cranial nerves, resulting in both corneal anesthesia and facial paralysis. Patients have done very well after these procedures and have achieved ocular comfort, reduced tearing, and corneal protection without the need for disfiguring and visually occluding tarsorrhaphies or other procedures. In some instances, they may still require artificial tears during the day or a lubricating protective ointment for the eye at bedtime. There have been no significant complications in this series; no cases of gold weight extrusion, recurrent ectropion, or persistent corneal epithelial keratopathy. Some patients have complained of continued excessive tearing which is most likely due to paralysis of the lacrimal pump, resulting in ineffective tear drainage to the nasal lacrimal duct. However, these patients have still noted markedly reduced tearing compared to their preoperative condition. One patient underwent secondary release of her medial canthoplasty following return of facial nerve function.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2230707

Patipa, M



Laryngeal Paralyses: Theoretical Considerations and Effects on Laryngeal Vibration.  

ERIC Educational Resources Information Center

A theoretical four-mass model of the larynx was developed to simulate laryngeal biomechanical behavior and used to evaluate states of asymmetric laryngeal vibration. Simulations of laryngeal paralyses were compared with data on glottal vibration in observed laryngeal function. (Author/JDD)

Smith, Marshall E.; And Others



Laryngeal Paralyses: Theoretical Considerations and Effects on Laryngeal Vibration.  

ERIC Educational Resources Information Center

|A theoretical four-mass model of the larynx was developed to simulate laryngeal biomechanical behavior and used to evaluate states of asymmetric laryngeal vibration. Simulations of laryngeal paralyses were compared with data on glottal vibration in observed laryngeal function. (Author/JDD)|

Smith, Marshall E.; And Others



Advances in laryngeal imaging  

Microsoft Academic Search

Imaging and image analysis became an important issue in laryngeal diagnostics. Various techniques, such as videostroboscopy,\\u000a videokymography, digital kymograpgy, or ultrasonography are available and are used in research and clinical practice. This\\u000a paper reviews recent advances in imaging for laryngeal diagnostics.

Antanas Verikas; Virgilijus Uloza; Marija Bacauskiene; Adas Gelzinis; Edgaras Kelertas



Arthur Guedel's laryngeal plug.  


The laryngeal plug is a little-known device developed by Arthur E. Guedel in the 1930s. The device was an alternative to the inflatable cuff used on tracheal tubes. Guedel did not publish a description of the laryngeal plug and the most detailed description of it was published by Gilbert Troup, an Australian anaesthetist. PMID:23808557

Haridas, R P; Nichols, T T



Transient facial paralysis (a report of three cases).  


Local anesthetic infiltrated into the external auditory meatus prior to ear surgery is a cause of transient ipsilateral facial nerve paralysis in the immediate post-operative period. This phenomenon is only rarely described. Three such cases are reported. PMID:3950487

Lancer, J M; Jones, A S; Moir, A A




PubMed Central

1. The attempt to infect young rabbits and guinea pigs with material containing in all probability the virus of human infantile paralysis failed. 2. Failure to infect the primary animals almost of necessity brought failure with the secondary flea-bitten animals. It is, however barely conceivable that a non-infectious form of an organism might circulate in the blood of the primary animal and that this form, through development in an intermediate host, the flea, might become virulent for the secondary flea-bitten animal. 3. Incidentally, and presumably accidentally, a paralytic disease was observed in young rabbits associated with the presence of an organism showing certain definite characters. So far as we know this paralysis and the associated organism have not been previously described. 4. This organism is found widely distributed in the organs of the affected animals and can be demonstrated in the urine. The active destruction by the organism of the nerve cells of the spinal cord is particularly striking, and gives complete explanation for the paralysis observed clinically. 5. With the organism present in the urine the spread of the disease by contact can be easily understood. 6. The transfer of the infection from animal to animal by fleabites is possible but not probable. 7. The nature of the observed organisms is in doubt. They represent probably an intermediate stage in the life history of some protozoan parasite.

Wright, J. Homer; Craighead, Eugene M.



Abrupt-onset oculomotor paralysis: an endocrine emergency.  


Pituitary apoplexy is a severe and potentially life-threatening condition that may be highly variable in its clinical presentation. We report a 37-year-old man presenting to the emergency department with diplopia that abruptly developed while he was eating canned and bottled food prepared at home. A computed tomography scanning revealed an isodense mass within the sellar region and, subsequently, a magnetic resonance imaging showed a pituitary apoplexy causing a compression of the right III and VI oculomotor nerves. There was no improvement with hydrocortisone therapy and the patient underwent a transsphenoidal excision of the mass with an uneventful course. Pituitary apoplexy may raise in the appropriate setting the suspicion of botulism. The abrupt-onset paralysis of oculomotor nerves has been described as the chief presenting sign of pituitary apoplexy in only few cases including this. A pathophysiology, differential diagnosis with botulism and other causes of multiple cranial nerve paralysis, and treatment are described. PMID:11587471

Famularo, G; Pozzessere, C; Piazza, G; De Simone, C



Hypnagogic Hallucinations and Sleep Paralysis  

Microsoft Academic Search

\\u000a Hypnagogic hallucinations and sleep paralysis are two associated features of narcolepsy that can also be found as isolated\\u000a phenomena or within the context of other clinical conditions. Hypnagogic hallucinations are abnormal sensory perceptions experienced\\u000a in the transition between wakefulness and sleep, whereas analogous hallucinations that occur upon awakening are called hypnopompic.\\u000a Sleep paralysis is a transient paralysis of skeletal muscles

Armando D’Agostino; Ivan Limosani


Pacing for Unilateral Diaphragm Paralysis  

Microsoft Academic Search

Symptoms of unilateral diaphragmatic paralysis can range from sleep-related symptoms to exert ional dyspnea or orthopnea.\\u000a At times unilateral diaphragm paralysis is found on routine chest radiograph alone when an elevated hemidiaphragm is seen.\\u000a Ventilatory failure will usually only result if there is bilateral diaphragmatic involvement. When diaphragmatic paralysis\\u000a is suspected, confirmatory testing is done by inspiratory fluoroscopy (sniff test)

Raymond P. Onders


Laryngeal Tuberculosis: A Case Report  

PubMed Central

A case of laryngeal tuberculosis, in a 21-year-old female, is presented. The pathophysiology and natural course of the disease are discussed. The incidence of apical tuberculosis and associated laryngeal spread is noted. ImagesFigure 1

Jones, Christine E.; Jones, Beulah D.



Laryngeal adenoid cystic carcinoma  

PubMed Central

Summary Adenoid cystic carcinomas are malignant tumours and occur in the major and the minor salivary glands. Laryngeal adenoid cystic carcinomas are rare and account for less than 1% of all malignant tumours in the larynx. Adenoid cystic carcinoma is characterised by slow progression, multiple recurrences and late distant metastasis. The aetiology of adenoid cystic carcinoma remains unknown. They usually originate in the supraglottic or subglottic area. Wide-margin surgery alone or in combination with post-operative radiotherapy is the best tumour management. In this article, the case of laryngeal adenoid cystic carcinoma is described in a 55-year-old male patient who presented with a 3-month history of prelaryngeal pain. The patient underwent total laryngectomy and post-operative radiotherapy. For patients with laryngeal adenoid cystic carcinomas, regular and long-term follow-up is mandatory, in order to detect relapses and metastases.

Zvrko, E; Golubovic, M



Laryngeal thrush: Merf experience.  


Fungal infection of the larynx is a relatively uncommon condition. The lesions max be confined to the vocal folds or may involve various other sites in the larynx. There is, invariably, a risk factor that predisposes to fungal infection viz. immune deficiency, inhaled or systemic steroids, antibiotic usage, etc. These lesions may mimic malignancy or a premalignant condition. There have been very few cases of laryngeal thrush reported in the literature. Awareness of this entity is essential because the management depends on an accurate diagnosis. These lesions invariably respond to a course of oral antifungal therapy and correction of risk factors. We report 3 cases of laryngeal thrush. PMID:23120336

Kameswaran, Mohan; Anand Kumar, R S; Natarajan, Kiran; Karthikeyan, K; Nagasundaram, Jawahar; Murali, Sathiya



Periodic paralysis with cardiac arrhythmia  

Microsoft Academic Search

In 1963, Klein et al. first described two girls with normokalemic periodic paralysis and cardiac arrhythmia. We have observed a 15-year-old girl with cardiac arrhythmia and normokalemia but with some features of hyperkalemic, periodic paralysis. The patient showed a waddling gait and Gower's sign. She had atrophy of the proximal muscles and deep tendon reflexes were reduced. Her ECG showed

T. Yoshimura; M. Kaneuji; T. Okuno; M. Yoshioka; T. Ueda; H. Mikawa; T. Kowata; T. Kamiya



Transient paralysis of the bladder due to wound botulism.  


In the last 10 years, wound botulism has increasingly been reported and nearly all of these new cases have occurred in injecting-drug abusers. After absorption into the bloodstream, botulinum toxin binds irreversibly to the presynaptic nerve endings, where it inhibits the release of acetylcholine. Diplopia, blurred vision, dysarthria, dysphagia, respiratory failure and paresis of the limbs are common symptoms of this intoxication. Surprisingly and despite the well-known blocking action of the botulinum toxin on the autonomic nerve system, little attention has been paid to changes in the lower urinary tract following acute botulinum toxin poisoning. Here we report a case of bladder paralysis following wound botulism. Early diagnosis and adequate management of bladder paralysis following botulism is mandatory to avoid urologic complications. Accordingly, the prognosis is usually favorable and the bladder recovery complete. PMID:11464047

Sautter, T; Herzog, A; Hauri, D; Schurch, B



Sleep paralysis as spiritual experience.  


This article presents an overview of the sleep paralysis experience from both a cultural and a historical perspective. The robust, complex phenomenological pattern that represents the subjective experience of sleep paralysis is documented and illustrated. Examples are given showing that, for a majority of subjects, sleep paralysis is taken to be a kind of spiritual experience. This is, in part, because of the very common perception of a non-physical 'threatening presence' that is part of the event. Examples from various cultures, including mainstream contemporary America which has no widely known tradition about sleep paralysis, are used to show that the complex pattern and spiritual interpretation are not dependent on cultural models or prior learning. This is dramatically contrary to conventional explanations of apparently 'direct' spiritual experiences, explanations that are summed up as the 'Cultural Source Hypothesis.' This aspect of sleep paralysis was not recognized through most of the twentieth century. The article examines the way that conventional modern views of spiritual experience, combined with medical ideas that labeled 'direct' spiritual experiences as psychopathological, and mainstream religious views of such experiences as heretical if not pathological, suppressed the report and discussion of these experiences in modern society. These views have resulted in confusion in the scientific literature on sleep paralysis with regard to its prevalence and core features. The article also places sleep paralysis in the context of other 'direct' spiritual experiences and offers an 'Experiential Theory' of cross-culturally distributed spiritual experiences. PMID:15881267

Hufford, David J



Low-reactive-level laser treatment in facial paralysis  

NASA Astrophysics Data System (ADS)

This study was carried out with a 41-year-old female patient with facial paralysis as a consequence of facial nerve injury during neurosurgery. Low-reactive level laser treatment (LLLT) with a diode laser of 830 nm, 40 mw, continuous wave, spot area 3 mm2, was applied twice a week for 2 weeks, then 1 weekly session following up to 30 sessions, resulting in about 80% improvement of the motor activity.

Brugnera, Aldo; Ladalardo, Theresa C.; Bologna, Elisangela; Garrini, Ana E.; Pinheiro, Antonio L.; Campos, Roberto



Hereditary distal spinal muscular atrophy with vocal cord paralysis.  

PubMed Central

A large kindred is described in which an unusual form of spinal muscular atrophy is segregating in an autosomal dominant manner. The disease presents most commonly in the teens with small muscle wasting in the hands, particularly involving median nerve musculature. Subsequently distal muscle wasting and weakness occur in the lower limbs. Vocal cord paralysis is a characteristic and potentially hazardous feature. No previous report of this condition has been found. Images

Young, I D; Harper, P S



Inuit interpretations of sleep paralysis.  


Traditional and contemporary Inuit concepts of sleep paralysis were investigated through interviews with elders and young people in Iqaluit, Baffin Island. Sleep paralysis was readily recognized by most respondents and termed uqumangirniq (in the Baffin region) or aqtuqsinniq (Kivalliq region). Traditional interpretations of uqumangirniq referred to a shamanistic cosmology in which the individual's soul was vulnerable during sleep and dreaming. Sleep paralysis could result from attack by shamans or malevolent spirits. Understanding the experience as a manifestation of supernatural power, beyond one's control, served to reinforce the experiential reality and presence of the spirit world. For contemporary youth, sleep paralysis was interpreted in terms of multiple frameworks that incorporated personal, medical, mystical, traditional/shamanistic, and Christian views, reflecting the dynamic social changes taking place in this region. PMID:15881270

Law, Samuel; Kirmayer, Laurence J



Retrospective study of the functional recovery of men compared with that of women with long-term facial paralysis.  


Sex is likely to play an important part in reanimation of the face after paralysis, with women being superior in terms of resistance to neural injury and regeneration. Our aim was to evaluate the influence of the sex of the patient on the recovery of facial paralysis after surgical reanimation by comparing the degree of restored movement between men and women with long-standing paralysis that was reanimated by transfer of the hypoglossal nerve or cross-face nerve grafting. Between 1999 and 2010 we operated on 174 patients with facial paralysis. Of these we studied 26 cases (19 women and 7 men) with complete long-standing paralysis reanimated with either cross-face nerve grafting (n=14) or transfer of the hemihypoglossal nerve (n=12). The degree of movement restored was recorded in each case. Statistical analysis showed that in cases with long-standing paralysis women had significantly more movement restored than men for both cross-face nerve grafting (p=0.02) and hypoglossal transposition (p=0.04). We conclude that, after a neural injury, women tend to maintain the viability of the facial musculature longer than men, which suggests that they are more resistant to both denervation and the development of muscular atrophy. Whether this phenomenon can be explained by neural or muscular processes, or both, warrants further studies. PMID:23684625

Hontanilla, Bernardo; Marre, Diego



A simple cuff electrode for nerve recording and stimulation in acute experiments on small animals  

Microsoft Academic Search

We describe a cuff-type electrode specifically designed for recording from, and electrical stimulation of, cut nerves in acute experiments on small animals. Unlike existing designs of cuff electrodes, it is simple to manufacture, inexpensive and takes little time to implant. The electrode was tested on the hypoglossal, phrenic, recurrent laryngeal, and superior laryngeal nerves in anesthetized rats. It provides satisfactory

Victor Fenik; Polina Fenik; Leszek Kubin




PubMed Central

1. Fowl paralysis (neurolymphomatosis gallinarum) is a disease entity, with characteristic clinical and pathological features. 2. The disease occurs in all parts of the United States, Holland, Austria and probably South America. 3. The disease appears to be endemic in certain foci. Having once appeared, the disease tends to persist through successive years. 4. It occurs with about equal frequency in both sexes; all common breeds may be affected. 5. Symptoms appear between the 3rd and 18th months. Typical clinical cases have not been observed outside of these limits. 6. The conspicuous symptoms are (a) asymmetrical, partial and progressive paralysis of the wings and both legs, and rarely of neck muscles; (b) occasional grey discoloration of iris, with blindness. Nutrition is usually preserved. 7. The duration is variable; the outcome is usually fatal, but spontaneous recovery may rarely occur. 8. The principal pathological changes are found in the nervous system. In the peripheral nerves, the essential feature is an intense infiltration of lymphoid, plasma cells, and large mononuclears. This is accompanied by a myelin degeneration in the more advanced lesions, but the cellular infiltrations appear to precede the degenerative changes. In brain, cord and meninges, there are similar infiltrations predominantly perivascular. Infiltrations of the iris with lymphoid and plasma cells are found in the cases showing gross discoloration of the iris. Visceral lymphomata, originating usually in the ovary, are associated in a certain percentage of the cases. Evidence is presented in favor of the view that this association is not accidental, and that the lymphomata are a manifestation of the disease. 9. Infiltrations of the spinal cord and brain, rarely of the peripheral nerves, are frequently present in birds showing no clinical symptoms. These are interpreted as mild cases of the same disease. 10. No microorganisms of etiological significance have been demonstrated in the tissues or by cultural methods.

Pappenheimer, Alwin M.; Dunn, Leslie C.; Cone, Vernon



New-onset facial paralysis and undiagnosed recurrence of cutaneous malignancy: evaluation and management.  


Perineural invasion of cranial nerves, including the facial nerve by squamous cell carcinoma of the skin, is a poor prognostic factor for recurrent disease and disease-specific mortality. We discuss 2 patients who presented to the Otolaryngology/Head and Neck Surgery service with complete facial nerve paralysis and a history of skin cancer. Based on our experience with these patients, we recommend that patients who present with facial nerve paralysis and a history of cutaneous malignancy undergo aggressive management including early intervention and complete exploration of the facial nerve from the geniculate ganglion out to the periphery. Such rigorous care achieves the best possible oncologic outcomes for a proven aggressive disease. PMID:16500480

Scurry, W Cooper; Isaacson, Jon E; Fedok, Fred G


Laryngeal Involvement of Multiple Myeloma  

PubMed Central

The objectives of this paper are to discuss a rare cause of laryngeal multiple myeloma, to review unique pathologic findings associated with plasma cell neoplasms, to discuss epidemiology, differential diagnosis, and treatment options for plasma cell neoplasms of the larynx. Laryngeal multiple myeloma, also noted in the literature as “metastatic” multiple myeloma, presenting as a de novo laryngeal mass is extremely rare with few reported cases. Laryngeal involvement of extramedullary tumors is reported to be between 6% and 18% with the epiglottis, glottis, false vocal folds, aryepiglottic folds, and subglottis involved in decreasing the order of frequency. We present the case of a 58-year-old male with a history of IgA smoldering myeloma who presented to a tertiary care laryngological practice with a two-month history of dysphonia, which was found to be laryngeal involvement of multiple myeloma. We review the classification of and differentiation between different plasma cell neoplasms, disease workups, pathologic findings, and treatment options.

Grobman, Ariel B.; Vivero, Richard J.; Campuzano-Zuluaga, German; Ganjei-Azar, Parvin; Rosow, David E.



Progressive bulbar paralysis associated with neural deafness. A nosological entity.  


A complete autopsy verification of progressive bulbar palsy associated with neural deafness was performed. Hearing loss and speech difficulties developed in a five-year-old girl. When she was 24 years old, clinical examination demonstrated deafness and bulbopontine paralysis together with retinitis pigmentosa, peripheral amyotrophies, pyramidal signs, and ataxia. The patients died at 27 years and the autopsy disclosed degenerative changes characterized by simple atrophy and loss of neurons accompanied by gliosis and loss of myelinated fibers. The structures principally affected were the anterior horns and the motor nuclei of the brain stem together with the eighth cranial nerve nuclei. Loss of myelinated fibers was found in the spinocerebellar and pyramidal tracts and in the fasciculus gracilis. Our study suggests that progressive bulbar paralysis with neural deafness should be considered as a nosological entity. PMID:7362486

Alberca, R; Montero, C; Ibañez, A; Segura, D I; Miranda-Nieves, G



Muscle Paralysis in Herpes Zoster  

PubMed Central

Herpes zoster may, in some instances, cause motor paralysis as well as the usual sensory and cutaneous manifestations. It is suggested that the presence of electromyographic denervation potentials be used as the criterion of muscle paresis in order to avoid mistaking atrophy of disuse for true lower motor neuron disease. Use of the proper physical therapy procedures hastens the recovery of function and may serve to retard denervation atrophy and fibrosis in patients with muscle paralysis. ImagesFigure 1 (Case 1).Figure 1 (Case 1).

Rubin, David; Fusfeld, Robert D.



Computed tomographic imaging of dogs with primary laryngeal or tracheal airway obstruction.  


Seventeen dogs with clinical signs attributable to nonneoplastic obstruction of the larynx, trachea, or large bronchi underwent computed tomography (CT) imaging. In 16 of the 17 dogs, CT was performed without general anesthesia using a positioning device. Fifteen of these 16 dogs were imaged without sedation or general anesthesia. Three-dimensional (3D) internal rendering was performed on each image set based on lesion localization determined by routine image planes. Visual laryngeal examination, endoscopy, video fluoroscopy, and necropsy were used for achieving the cause of the upper airway obstruction. The CT and 3D internal rendering accurately indicated the presence and cause of upper airway obstruction in all dogs. CT findings indicative of laryngeal paralysis included failure to abduct the arytenoid cartilages, narrowed rima glottis, and air-filled laryngeal ventricles. Laryngeal collapse findings depended on the grade of collapse and included everted laryngeal saccules, collapse of the cuneiform processes and corniculate processes, and narrowed rima glottis. Trachea abnormalities included hypoplasia, stenosis, or collapse syndrome. The CT findings in tracheal hypoplasia consisted of a severely narrowed lumen throughout the entire length. Tracheal stenosis was represented by a circumferential decrease in tracheal lumen size limited to one region. Tracheal collapse syndrome was diagnosed by severe asymmetric narrowing. Lobar bronchi collapse appeared in CT images as a narrowed asymmetric lumen diameter. CT imaging of unanesthetized dogs with upper airway obstruction compares favorably with traditional definitive diagnostic methods. PMID:21447037

Stadler, Krystina; Hartman, Susan; Matheson, Jodi; O'Brien, Robert



[Late ulnar paralysis. Study of a series of 17 cases].  


Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralyses are emphasized: very prolonged symptom free interval, rapid onset and severe involvement. Ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are undependable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal step of neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury. PMID:6322339

Mansat, M; Bonnevialle, P; Fine, X; Guiraud, B; Testut, M F



[Thyroid carcinoma and the recurrent nerve. Recurrence fall-out, incidence and causal circumstances in a large case-load of patients with thyroid carcinoma].  


Impairment of vocal cord function is a threat to patients with thyroid carcinoma; either due to the tumor having infiltrated the larynx or the recurrent nerve, or to accidental damage to the laryngeal nerves during thyroid surgery. We have reviewed 1,245 patients' records which were filed under the diagnosis of thyroid carcinoma at Det Norske Radiumhospital from 1956 to 1978. Pareses of vocal cords were noted in 465 patients (37.3%) during the course of their illness. In 135 patients (10.8%) the pareses were due to infiltration by the tumor, most commonly seen in anaplastic carcinoma. In 267 patients (21.4%) the pareses followed surgery; planned resections of the recurrent nerves were performed in 48 patients (3.9%). Transient pareses with normal vocal cord movements within months were experienced in 137 cases (11%). Permanent paralysis caused accidentally during surgery was seen in 82 patients, representing 6.6% of all patients and 4.7% of the surgically exposed nerves. We stress the need for pre- and postoperative evaluation of vocal cord movement as an aid to future diagnosis and optimal surgical planning. PMID:2321224

Høie, J; Jørgensen, O G; Karlsen, K O; Winther, F O



Identification of the tracheal and laryngeal afferent neurones mediating cough in anaesthetized guinea-pigs  

PubMed Central

We have identified the tracheal and laryngeal afferent nerves regulating cough in anaesthetized guinea-pigs. Cough was evoked by electrical or mechanical stimulation of the tracheal or laryngeal mucosa, or by citric acid applied topically to the trachea or larynx. By contrast, neither capsaicin nor bradykinin challenges to the trachea or larynx evoked cough. Bradykinin and histamine administered intravenously also failed to evoke cough. Electrophysiological studies revealed that the majority of capsaicin-sensitive afferent neurones (both A?- and C-fibres) innervating the rostral trachea and larynx have their cell bodies in the jugular ganglia and project to the airways via the superior laryngeal nerves. Capsaicin-insensitive afferent neurones with cell bodies in the nodose ganglia projected to the rostral trachea and larynx via the recurrent laryngeal nerves. Severing the recurrent nerves abolished coughing evoked from the trachea and larynx whereas severing the superior laryngeal nerves was without effect on coughing. The data indicate that the tracheal and laryngeal afferent neurones regulating cough are polymodal A?-fibres that arise from the nodose ganglia. These afferent neurones are activated by punctate mechanical stimulation and acid but are unresponsive to capsaicin, bradykinin, smooth muscle contraction, longitudinal or transverse stretching of the airways, or distension. Comparing these physiological properties with those of intrapulmonary mechanoreceptors indicates that the afferent neurones mediating cough are quite distinct from the well-defined rapidly and slowly adapting stretch receptors innervating the airways and lungs. We propose that these airway afferent neurones represent a distinct subtype and that their primary function is regulation of the cough reflex.

Canning, Brendan J; Mazzone, Stuart B; Meeker, Sonya N; Mori, Nanako; Reynolds, Sandra M; Undem, Bradley J



A toddler with acute flaccid paralysis due to West Nile virus infection.  


We report on a 2-year-old boy with acute flaccid paralysis due to West Nile neuroinvasive disease. Serum and cerebrospinal fluid serology as well as nerve conduction studies were consistent with the diagnosis. He received intravenous immunoglobulin and showed gradual improvement and complete recovery of his muscle strength, gait and deep tendon reflexes. PMID:23538519

Soldatou, Alexandra; Vartzelis, George; Vorre, Stella; Papa, Anna; Voudris, Konstantinos; Garoufi, Anastasia



[Professor Wu Bing-huang's experiences in acupuncture treatment of facial paralysis].  


Professor WU Bing-huang's unique experiences in acupuncture treatment of facial paralysis are introduced. He excellently uses anatomical and pathological knowledge of facial nerves, selecting acupoints according to nervous distribution, selecting needling methods according to the nervous trend, selecting acupuncture stimulation amount according to pathological changes and judging prognosis according to affected position. PMID:18447227

Huang, Dong-e; Wu, Qiang; Chen, Chuan-jiang



Management of facial paralysis resulting from temporal bone fractures: Our experience in 115 cases  

Microsoft Academic Search

Objective: The goal of this study was to review decision factors and overall results regarding surgical and nonsurgical management of post-traumatic facial nerve paralysis (FP). Study design: A retrospective study and literature review were performed. Methods: Between 1984 and 1990, 115 cases of post-traumatic FP were handled. Patients were evaluated through clinical, audiologic, radiologic, and electromyogram assessment. Depending on examination

Vincent Darrouzet; Jean-Yves Duclos; Dominique Liguoro; Yves Truilhe; Camille De Bonfils; Jean-Pierre Bebear



Successful Training of HEMS Personnel in Laryngeal Mask Airway and Intubating Laryngeal Mask Airway Placement  

Microsoft Academic Search

IntroductionTo evaluate laryngeal mask airway (LMA) and intubating laryngeal mask airway (ILMA) placement by helicopter emergency medical services (HEMS) personnel after a comprehensive training program.

R. J. Frascone; Greg Pippert; William Heegaard; Paul Molinari; David Dries



Children and Teens with Paralysis  


... of children with disabilities. Read more . Back to School in a Chair Back-to-school supplies include books, pencils, new clothes and for ... of all ages who will be hearing the school bell ring this coming fall. Read more. ... The information provided in the Paralysis Resource Center was supported by Cooperative ...


Laryngeal fracture after coughing.  


Nontraumatic laryngeal fractures are exceedingly rare disease entities. Only 3 prior instances have been described in the medical literature (Br Med J 1950;1:1052; Acta Otorrinolaringol Esp 2007;58:73-4; Otolaryngol Head Neck Surg 2012;147:801-2). We present a case of thyroid cartilage fracture and associated phlegmon formation after a vigorous coughing spell in a 47-year-old man. On presentation, the patient's symptoms included the triad of odynophagia, dysphagia, and dysphonia as well as diffuse swelling and tenderness over the thyroid cartilage. Computed tomography and magnetic resonance imaging revealed a mildly displaced anterior thyroid cartilage fracture as well as a phlegmon in the strap muscle compartment adjacent to the fracture (Figs. 1 and 2). Intravenous dexamethasone and antibiotics were initiated, and the patient was admitted to the medical intensive care unit. On fiberoptic examination with the flexible laryngoscope, the patient was found to have slightto-moderate watery edema of the right aryepiglottic fold and right greater than left arytenoid cartilages. After 48 hours, the patient's neck swelling and pain significantly improved. On hospital day 4, the patient was discharged with a course of oral antibiotics. One week later, the patient reported only mild odynophagia and persistent dysphonia. He otherwise felt well and was tolerating fluids and soft food without difficulty. A preexisting, congenital abnormality resulting in a focal weakness in the thyroid cartilage might predispose patients to nontraumatic fractures (Otolaryngol Head Neck Surg 2012;147:801-2). Patients in prior case reports of nontraumatic laryngeal fractures presented with similar symptoms (Table). The triad of odynophagia, dysphagia, and dysphonia after a severe coughing or sneezing episode should raise the clinician's suspicion of a thyroid cartilage fracture. PMID:23806730

Fenig, Mark; Strasberg, Stephen; Cohen, Justin C; Almadi, Rami; Gold, Menachem



Facial nerve hemangioma: a case report.  


Although hemangiomas are relatively common in the head and neck, those that originate in the facial nerve are extremely rare. These benign tumors have the potential to compress or invade the adjacent facial nerve and thereby produce facial paralysis and other associated symptoms. We present a case of facial nerve hemangioma in a 15-year-old girl that initially manifested as unilateral facial weakness. We also discuss the diagnostic imaging and management options. PMID:23780592

Wu, Edward C; Rothholtz, Vanessa S; Zardouz, Shawn; Lee, Alice D; Djalilian, Hamid R



Onset dynamics of type A botulinum neurotoxin-induced paralysis  

Microsoft Academic Search

Experimental studies have demonstrated that botulinum neurotoxin serotype A (BoNT\\/A) causes flaccid paralysis by a multi-step\\u000a mechanism. Following its binding to specific receptors at peripheral cholinergic nerve endings, BoNT\\/A is internalized by\\u000a receptor-mediated endocytosis. Subsequently its zinc-dependent catalytic domain translocates into the neuroplasm where it\\u000a cleaves a vesicle-docking protein, SNAP-25, to block neurally evoked cholinergic neurotransmission. We tested the hypothesis

Frank J. Lebeda; Michael Adler; Keith Erickson; Yaroslav Chushak



The Target Plasma Concentration of Propofol Required to Place Laryngeal Mask Versus Cuffed Oropharyngeal Airway  

Microsoft Academic Search

To determine the target plasma concentration of propo- fol required to place either a laryngeal mask airway (LMA) or a cuffed oropharyngeal airway (COPA), we started a continuous target-controlled infusion of propofol in 60 ASA physical status I or II unpremedi- cated patients scheduled for minor orthopedic surgery with peripheral nerve block. The target plasma concen- tration of propofol was

Andrea Casati; Guido Fanelli; Elisabetta Casaletti; Valeria Cedrati; Fabrizio Veglia; Giorgio Torri



The Effects of Chronic Electrical Stimulation on Laryngeal Muscle Physiology and Histochemistry  

Microsoft Academic Search

The present study examined the effects of functional neuromuscular stimulation (FNS) on posterior cricoarytenoid (PCA) muscle physiology and histochemistry. In 4 canines, 10 cm of the recurrent laryngeal nerve was resected. A patch electrode array was implanted for PCA stimulation. FNS was applied to 2 canines for a period of 4 weeks with 2 additional animals serving as nonstimulated controls.

David L. Zealear; Cheryl R. Billante; Cheerasook Chongkolwatana; Young S. Rho; Abdul-Latif Hamdan; Garrett D. Herzon



Helicobacter pylori infection in laryngeal diseases.  


Clinical studies have shown that Helicobacter pylori can be found not only in the mucosa of the stomach, but in the pharyngeal and laryngeal regions as well. The aim of this prospective case-control study was to identify H. pylori infection in the biopsy material from the larynx of the patients suffering from benign laryngeal diseases (vocal fold polyps, laryngitis) and laryngeal cancer and to investigate the possible relationships between the laryngeal H. pylori and patients' socio-demographic data and laryngopharyngeal reflux. The results of the biopsy material from 67 adult patients treated for benign laryngeal diseases and laryngeal cancer and 11 individuals of the control group revealed that H. pylori infection could be identified in more than one-third of the patients. In the majority of cases H. pylori was found in the patients with chronic laryngitis (45.5%) and laryngeal cancer (46.2%). The findings of these sub-groups significantly differed from those of the control group (9.1%) (p < 0.05). No significant relationships between H. pylori infection found in the laryngeal region and patients' demographic data, their unhealthy habits and reflux-related symptoms or signs were obtained. It could be concluded that H. pylori can colonize in the larynx of patients with benign laryngeal diseases and laryngeal cancer. To clarify the role of H. pylori as a risk factor for laryngeal diseases further research is needed. PMID:23572292

Siupsinskiene, Nora; Jurgutaviciute, Vilma; Katutiene, Inga; Janciauskas, Dainius; Vaitkus, Saulius; Adamonis, K?stutis



Earwax and level of paralysis  

Microsoft Academic Search

Study design: Inception cohort.Objectives: The clinical impression that earwax is uncommonly frequent among spinal cord injury patients with high levels of paralysis was tested.Setting: Veterans Administration Hospital, USA.Methods: A cohort of 15 chronically paralyzed patients, motor complete, living as residents in a long-term care facility was offered monthly irrigations of the ears for removal of wax over a 6-month period.

J H Frisbie; E H Zahn



The effects of botulinum toxin injections into the cricopharyngeus muscle of patients with cricopharyngeus dysfunction associated with pharyngo-laryngeal weakness.  


This prospective, open study was carried out in order to assess changes in the swallowing and dietary status after injection of Botulinum toxin A (BoNT-A) into the upper esophageal sphincter (UES) in a series of patients with cricopharyngeus (CP) muscle dysfunction associated with pharyngo-laryngeal weakness during at least 1 year follow-up after treatment. Patients who had a cricopharyngeus (CP) muscle dysfunction associated with pharyngo-laryngeal weakness and who were at risk for aspiration were included in the study. The upper border of the cricoid cartilage was identified and the CP muscle localized using a standard electromyogram (EMG). The dose of BoNT-A was determined depending on the results of EMG performed just before the injection. Outcomes were assessed by the penetration-aspiration scale (PAS), the level of residue in the pyriform sinus and the National Institute of Health-Swallow Safety Scale (NIH-SSS) on a video fluoroscopic swallowing (VFSS) assessment, the patient's subjective impressions of their ability to swallow by the Deglutition Handicap Index (DHI), and changes in dietary status by the Functional Oral Intake Scale. Eleven patients underwent the complete assessment of swallowing function at 1, 3, 6, and 12 months. After the first set of treatment, seven patients had a good response and four did not respond. A significant decrease in the PAS score (p = 0.03), the amount of residue (p = 0.04) and the NIH-SSS score (p = 0.03) was observed 3 months after the injection in comparison with the first VFSS before the treatment. A relapse of dysphagia occurred in 3 out of the 11 treated patients; at 3 and 4 months for 2 patients with a Wallenberg syndrome, and at 11 months for a patient with cranial nerve paralysis after a surgery for a glomus tumor. Two of them underwent a second injection. One patient had a good response and remained stable for at least 1 year. The second did not respond either to the second injection or to a myotomy of the cricopharyngeal muscle. The third one is waiting for further surgery (myotomy). Therefore, at the end of the study and after a follow-up of at least 12 months, 5 patients out of the 11 enrolled had a good result. Percutaneous injection of BoNT-A into the UES can be a useful solution to improve cricopharyngeal dysfunction, despite the underlying pharyngo-laryngeal weakness. PMID:22865104

Woisard-Bassols, Virginie; Alshehri, Sarah; Simonetta-Moreau, Marion



Proteomic Signatures in Laryngeal Squamous Cell Carcinoma  

Microsoft Academic Search

Laryngeal cancer remains a worldwide health problem. The identification of biomarkers unique to laryngeal cancer may provide new insights into its pathogenesis, as well as provide potential targets for novel therapies and early detection. In order to identify potential biomarkers, we performed a proteomic analysis of laryngeal cancer specimens. Using two-dimensional differential in-gel electrophoresis and mass spectroscopy, protein expression profiles

Duane A. Sewell; Chao-Xing Yuan; Erle Robertson



Paralysis Analysis: Investigating Paralysis Visit Anomalies in New Jersey  

PubMed Central

Objective To describe the investigation of a statewide anomaly detected by a newly established state syndromic surveillance system and usage of that system. Introduction On July 11, 2012, New Jersey Department of Health (DOH) Communicable Disease Service (CDS) surveillance staff received email notification of a statewide anomaly in EpiCenter for Paralysis. Two additional anomalies followed within three hours. Since Paralysis Anomalies are uncommon, staff initiated an investigation to determine if there was an outbreak or other event of concern taking place. Also at question was whether receipt of multiple anomalies in such a short time span was statistically or epidemiologically significant. Methods In New Jersey, 68 of 81 total acute care and satellite Emergency Departments (EDs) are connected to EpiCenter, an online syndromic surveillance system developed by Health Monitoring Systems, Inc (HMS) that incorporates statistical management and analytical techniques to process health-related data in real time. Chief complaint text is classified, using text recognition methods, into various public health-related and other categories. Anomalies occur when any of several statistical methods detect increases in incoming data that are outside of established thresholds. After receiving three anomaly notifications related to Paralysis in a 4-hour time period, NJDOH surveillance data staff enlisted CDS and local epidemiologist colleagues to review the data and determine if there was an infectious cause. Results The first EpiCenter anomaly notification was received on July 11, 2012 at 1:22 pm as a result of increased ED visits classified as Paralysis based on facility location for the period beginning at noon on July 10, 2012. Using Cusum EMA analysis, 76 reported interactions exceeded the predicted value of 50.49 and the threshold of 70.72. The second anomaly, also based on facility location, was received at 3:20 pm and the third anomaly notification, based on home location, was received at 4:32 pm. Cusum EMA and Exponential Moving Average analysis methods detected these anomalies. Table 1 describes the anomalies in more detail. Compiled data from all anomalies were reviewed by CDS epidemiology and surveillance staff to determine whether there was a public health event taking place. A total of 89 patients were seen in 39 (57%) of the 68 NJ facilities reporting to EpiCenter with no geographic centralization. Age and gender of patients were reviewed with no clear pattern discerned. Figure 1 shows the time distribution of these visits. Upon further investigation, it was determined that a moderate increase in Paralysis visits over a relatively short time span was sufficient to create an anomaly under the default threshold for those visits. Multiple analysis methods created multiple anomalies which gave an impression the event was of greater significance compared to a single anomaly. To follow up, NJDOH requested that local epidemiologists investigate within their jurisdictions by contacting hospitals directly where EpiCenter data proved inconclusive. Their reports confirmed NJDOH’s findings that the anomalies did not signal an event of public health concern. Conclusions This investigation of three Paralysis anomalies is an important introduction to the newly implemented system’s capabilities in anomaly detection, and also to anomaly investigation procedures developed by NJDOH for local surveillance staff. As a result of this experience, these anomaly investigation procedures are being fine-tuned. The fact that these sequential anomalies resulted in an investigation being undertaken highlights the importance in setting investigation- generating alert thresholds within EpiCenter at a level that will minimize “false” positives without risking the missing of “true” positives.

Hamby, Teresa; Tsai, Stella; Genese, Carol; Walsh, Andrew; Bradford, Lauren; Lifshitz, Edward



Genetics Home Reference: Hypokalemic periodic paralysis  


... and Families Resources for Health Professionals What glossary definitions help with understanding hypokalemic periodic paralysis? autosomal ; autosomal dominant ; calcium ; carbohydrate ; cell ; channel ; contraction ; familial ; gene ; hypokalemia ; ...


An unrecognized cause of paralysis in ED: Thyrotoxic normokalemic periodic paralysis  

Microsoft Academic Search

Hypokalemic paralysis associated with hyperthyroidism (TPP) is a well-known acute electrolyte and muscle function disorder. Lesser known is normokalemic periodic paralysis associated with hyperthyroidism. We describe two cases of young men with acute muscular paralysis and bilateral impairment of sensation over the lower legs who had normal plasma potassium concentrations. They were initially misdiagnosed as having Guillain-Barré syndrome or hysterical

Chia-Chao Wu; Tom Chau; Chao-Jiieh Chang; Shih-Hua Lin



Carcinoma erysipeloides of laryngeal origin.  


The term "carcinoma erysipeloides" (CE) designates an uncommon form of cutaneous metastasis. CE is most often associated with carcinoma of the breast. However, there have been reports of CE from carcinoma of the uterus, prostate, lung, ovary, stomach, tonsils, thyroid, pancreas, rectum, parotid glands and melanoma. To our knowledge, CE of laryngeal origin has not been previously reported. We describe a patient diagnosed with human immunodeficiency virus and hepatitis C virus coinfection who developed a supraglottic laryngeal squamous cell carcinoma and erythematous cutaneous lesions. A skin biopsy demonstrated invasion of dilated dermal lymphatics by clusters of atypical squamous cells with polymorphic nuclei and extensive infiltration of the dermis by tumor cells. The histology of the metastatic cells was similar to that of the laryngeal carcinoma. PMID:22668578

Álvarez, María Á; Casas, Enrique; Ruano, Juan; Vélez, Antonio; Salvatierra, Juan; Moreno, Jose C



Occupational causes of laryngeal cancer.  

PubMed Central

In a case-control study of all new cases of laryngeal cancer in Denmark from 1980 to 1982, 326 cases and 1134 community selected controls participated. Questionnaires were used to obtain information on education, occupation, and number of occupational exposures as well as smoking and drinking habits. High risk ratios for laryngeal cancer were found for semiskilled and unskilled workers, workers exposed to dust, out of doors workers, drivers, and people working in the cement industries and port services. The study hypothesis was that exposure to chromium or nickel increases the incidence rate of laryngeal cancer. No support for this was found concerning chromium, but exposure to nickel had a statistically significant risk ratio of 1.7.

Olsen, J; Sabroe, S



Novel Approach of Medialization Thyroplasty with Arytenoid Adduction Performed under General Anesthesia with a Laryngeal Mask.  


Objective. To objectively assess the voice outcomes of patients with unilateral vocal fold paralysis treated with medialization thyroplasty and arytenoid adduction suture.Study Design. Case series of patients who underwent medialization thyroplasty and arytenoid adduction suture. Preoperative and postoperative voice testing was performed and the data were compared by statistical analysis.Setting. Tertiary referral teaching hospital in Sydney, Australia.Subjects. All patients had a unilateral vocal fold paralysis, with a large posterior glottic gap and vocal symptoms affecting their quality of life.Methods. Thirteen patients with a diagnosis of a unilateral vocal fold paralysis with a large posterior glottic gap, vocal symptoms, and total denervation of the vocal fold underwent medialization thyroplasty and arytenoid adduction suture. The surgery was performed in a novel method under a general anesthetic using a laryngeal mask and with direct intraoperative endoscopic feedback. Preoperative and postoperative measures of voice performance were compared, including acoustic analysis (fundamental frequency, speech intensity against quiet and loud background noise, speech rate) and aerodynamic assessment (airflow, maximum phonation time).Results. Medialization thyroplasty with arytenoid adduction suture significantly improved aerodynamic assessment and phonation duration for both male and female subjects overall. There were 2 of 13 treatment failures. Median follow-up time was 6 months.Conclusion. Preliminary results indicate that in selected patients with vocal fold paralysis, medialization thyroplasty with arytenoid adduction suture leads to significant improvements in objective voice measures. Longer follow-up data are required to further quantify the voice outcomes after this procedure. PMID:22075075

Stow, Nicholas W; Lee, Jennifer W; Cole, Ian E



A case of paramyotonia congenita without periodic paralysis: electrophysiological and molecular genetic studies.  


Paramyotonia congenita (PC), first described in 1886 by Eulenberg, is characterized by cold and exercise-induced muscle stiffness and intermittent flaccid paresis not necessarily related to cold or myotonia. Several authors segregated a pure form of PC, which has no periodic paralysis, even after cold exposure. The existence of this phenotype has been debated in the literature. We describe electrophysiological and molecular genetic features of a patient with PC who had no history of periodic paralysis. Immersion in cold water or potassium load could not induce clinical paralysis. However, repetitive nerve stimulation and exercise test demonstrated a drop in compound muscle action potential amplitude. Genetic analysis revealed the substitution of valine for glycine on the human skeletal muscle sodium channel (SCN4A) gene. The G1306V mutation is rare in the classic form of PC, and moreover might be the first in pure paramyotonia. PMID:20445432

Park, Jeong Ho; Lee, Young Wha; Park, Sun Ah; Lee, Tae Kyeong; Rho, Hak Jae; Sung, Ki Bum



Restoration of sensibility in irreparable ulnar and median nerve lesions with use of sensory nerve transfer: Long-term follow-up of 20 cases  

Microsoft Academic Search

A prospective study was conducted to evaluate patient outcomes following sensory nerve transfer. Twenty patients with irreparable ulnar or median nerve lesions underwent the procedure. Nerve involvement was bilateral in 5 cases. The mean age of the patients at the time of surgery was 29 years. The mean paralysis time and the average length of follow-up were 59 and 78

Türker Özkan; Ka?an Özer; Ayan Gülgönen



Laryngeal Microweb and Vocal Nodules  

Microsoft Academic Search

The etiology and pathogenesis of laryngeal microwebs are heterogeneous, and in most cases they are an incidental finding. It has also been suggested that microwebs could be a familial trait, representing a postblastogenic embryonic vestigial structure that might alter the biomechanical and vibratory properties of the vocal fold. Vocal nodules are small benign swellings along the margins of the vocal

Daniela Maria Cury Ferreira Ruiz; Paulo Pontes; Mara Behlau; A. Richieri-Costa



Pediatric mumps with laryngeal edema.  


Mumps virus infection primarily affects the salivary glands and may incur various complications. Laryngeal edema is such a rare complication that few adult cases have been reported. We report the first known pediatric patient with mumps with laryngeal edema. An 8-year-old boy developed dyspnea after a rapidly progressive swelling of his face and neck. Laryngoscopy revealed edematous changes in the supraglottic and subglottic regions, and computed tomography confirmed significant laryngeal edema in addition to swelling of the cervical soft tissue and the salivary glands. Laboratory findings revealed a high serum amylase level and confirmed the diagnosis of mumps. Intravenous steroid administration alleviated the dyspnea, although the patient required temporary tracheal intubation to maintain airway patency. He did not need tracheotomy and did not experience any other complications. Laryngeal edema must be regarded as a rare, potentially life-threatening complication of mumps. When mumps is diagnosed with significant swelling of the neck, an emergency airway should be established to prevent airway obstruction. PMID:24084609

Hattori, Yujiro; Oi, Yasufumi; Matsuoka, Ryo; Daimon, Yumi; Ito, Asami; Kubota, Wataru; Konishi, Kyoko; Onguchi, Toshimi; Sato, Akihiro; Yamashita, Yukio; Ishihara, Jun



Dosimetric Predictors of Laryngeal Edema  

SciTech Connect

Purpose: To investigate dosimetric predictors of laryngeal edema after radiotherapy (RT). Methods and Materials: A total of 66 patients were selected who had squamous cell carcinoma of the head and neck with grossly uninvolved larynx at the time of RT, no prior major surgical operation except for neck dissection and tonsillectomy, treatment planning data available for analysis, and at least one fiberoptic examination of the larynx within 2 years from RT performed by a single observer. Both the biologically equivalent mean dose at 2 Gy per fraction and the cumulative biologic dose-volume histogram of the larynx were extracted for each patient. Laryngeal edema was prospectively scored after treatment. Time to endpoint, moderate or worse laryngeal edema (Radiation Therapy Oncology Group Grade 2+), was calculated with log rank test from the date of treatment end. Results: At a median follow-up of 17.1 months (range, 0.4- 50.0 months), the risk of Grade 2+ edema was 58.9% {+-} 7%. Mean dose to the larynx, V30, V40, V50, V60, and V70 were significantly correlated with Grade 2+ edema at univariate analysis. At multivariate analysis, mean laryngeal dose (continuum, hazard ratio, 1.11; 95% confidence interval, 1.06-1.15; p < 0.001), and positive neck stage at RT (N0-x vs. N +, hazard ratio, 3.66; 95% confidence interval, 1.40-9.58; p = 0.008) were the only independent predictors. Further stratification showed that, to minimize the risk of Grade 2+ edema, the mean dose to the larynx has to be kept {<=}43.5 Gy at 2 Gy per fraction. Conclusion: Laryngeal edema is strictly correlated with various dosimetric parameters; mean dose to the larynx should be kept {<=}43.5 Gy.

Sanguineti, Giuseppe [Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX (United States)]. E-mail:; Adapala, Prashanth [Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX (United States); Endres, Eugene J. C [Department of Medical Physics, University of Texas Medical Branch, Galveston, TX (United States); Brack, Collin [Department of Medical Physics, University of Texas Medical Branch, Galveston, TX (United States); Fiorino, Claudio [Department of Physics, Ospedale San Raffaele, Milan (Italy); Sormani, Maria Pia [Biostatistics Unit, University of Genoa, Genoa (Italy); Parker, Brent [Department of Medical Physics, University of Texas Medical Branch, Galveston, TX (United States)



Surgical and conservative methods for restoring impaired motor function - facial nerve, spinal accessory nerve, hypoglossal nerve (not including vagal nerve or swallowing)  

PubMed Central

The present review gives a survey of rehabilitative measures for disorders of the motor function of the mimetic muscles (facial nerve), and muscles innervated by the spinal accessory and hypoglossal nerves. The dysfunction can present either as paralysis or hyperkinesis (hyperkinesia). Conservative and surgical treatment options aimed at restoring normal motor function and correcting the movement disorders are described. Static reanimation techniques are not dealt with. The final section describes the use of botulinum toxin in the therapy of dysphagia.

Laskawi, R.; Rohrbach, S.



The functional anatomy of suggested limb paralysis.  


Suggestions of limb paralysis in highly hypnotically suggestible subjects have been employed to successfully model conversion disorders, revealing similar patterns of brain activation associated with attempted movement of the affected limb. However, previous studies differ with regard to the executive regions involved during involuntary inhibition of the affected limb. This difference may have arisen as previous studies did not control for differences in hypnosis depth between conditions and/or include subjective measures to explore the experience of suggested paralysis. In the current study we employed functional magnetic resonance imaging (fMRI) to examine the functional anatomy of left and right upper limb movements in eight healthy subjects selected for high hypnotic suggestibility during (i) hypnosis (NORMAL) and (ii) attempted movement following additional left upper limb paralysis suggestions (PARALYSIS). Contrast of left upper limb motor function during NORMAL relative to PARALYSIS conditions revealed greater activation of contralateral M1/S1 and ipsilateral cerebellum, consistent with the engagement of these regions in the completion of movements. By contrast, two significant observations were noted in PARALYSIS relative to NORMAL conditions. In conjunction with reports of attempts to move the paralysed limb, greater supplementary motor area (SMA) activation was observed, a finding consistent with the role of SMA in motor intention and planning. The anterior cingulate cortex (ACC, BA 24) was also significantly more active in PARALYSIS relative to NORMAL conditions - suggesting that ACC (BA 24) may be implicated in involuntary, as well as voluntary inhibition of prepotent motor responses. PMID:23351848

Deeley, Quinton; Oakley, David A; Toone, Brian; Bell, Vaughan; Walsh, Eamonn; Marquand, Andre F; Giampietro, Vincent; Brammer, Michael J; Williams, Steven C R; Mehta, Mitul A; Halligan, Peter W



The ultrastructure of rat laryngeal epithelia.  

PubMed Central

The histology and ultrastructure of the rat laryngeal epithelia are described. Five epithelial types were identified. Stratified squamous epithelium was found over most of the epiglottis, arytenoid projections and lateral ventricles. The vocal folds were covered by a low squamoid type of epithelium. Respiratory epithelium, similar to that found elsewhere in the respiratory tract, occupied all the mucosa caudal to the vocal folds, small areas at the base of the epiglottis and along the inner aspects of the arytenoid projections. Two forms of relatively unusual pseudostratified cuboidal epithelium were present in the ventrolateral aspect at the level of the arytenoid projections and within the ventral pouch. Non-myelinated, intro-epithelial nerve fibres were found throughout the larynx, and were abundant in areas at the base of the epiblottis covered by respiratory epithelium and to a lesser extent in the cuboidal epithelium of the ventral pouch. Globule leucocytes were frequently found within respiratory epithelium, less frequently in cuboidal epithelium and only rarely in squamous areas. Images Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11 Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 16 Fig. 17

Lewis, D J; Prentice, D E



Case of Bartter Syndrome Presenting With Hypokalemic Periodic Paralysis  

Microsoft Academic Search

Hypokalemic periodic paralysis can occur secondarily to excessive potassium loss. Thyrotoxicosis, diuretic ingestions, hyperaldosteronism, barium poisoning, Gitelman syndrome, and Bartter syndrome are among the disorders causing secondary hypokalemic periodic paralysis. Clinical presentation of Bartter syndrome with hypokalemic periodic paralysis is rare. A 12-year-old boy was admitted to our hospital because of transient paralysis. He had been suffering from transient weakness

Özgür Duman; Mustafa Koyun; Sema Akman; Ayfer Gür Güven; ?enay Haspolat



Electrotherapy for Treatment of Facial Nerve Paralysis (Bell's Palsy).  

National Technical Information Service (NTIS)

The Office of Health Technology Assessment (OHTA) emphasizes three basic principles in its assessment activities: (1) broad and open participation both within and outside of the Federal government, (2) reliance onthe expertise and research abilities of ou...

B. Waxman



[Isolated unilateral hypoglossal nerve paralysis in carotid dissection].  


A 41-year-old man presented with a unilateral atrophy and paresis of his tongue which were not explained by any pathological finding in the brainstem or at the base of the skull. The diagnosis of right internal carotid artery dissection was suggested by magnetic resonance imaging and ultrasound examination and confirmed by arterial angiography. During anticoagulant therapy clinical recovery and angiographical improvement occurred. PMID:8105395

Zipp, F; Herdt, P; Goetz, G F; Klös, G; Enzensberger, W; Fischer, P A



Multidisciplinary Management of Laryngeal Carcinoma  

SciTech Connect

The management of head and neck cancer has evolved into a multidisciplinary approach in which patients are evaluated before treatment and decisions depend on prospective multi-institutional trials, as well as retrospective outcome studies. The choice of one or more modalities to use in a given case varies with the tumor site and extent, as exemplified in the treatment of laryngeal squamous cell carcinomas. The goals of treatment include cure, laryngeal voice preservation, voice quality, optimal swallowing, and minimal xerostomia. Treatment options include transoral laser excision, radiotherapy (both definitive and postoperative), open partial laryngectomy, total laryngectomy, and neck dissection. The likelihood of local control and preservation of laryngeal function is related to tumor volume. Patients who have a relatively high risk of local recurrence undergo follow-up computed tomography scans every 3-4 months for the first 2 years after radiotherapy. Patients with suspicious findings on computed tomography might benefit from fluorodeoxyglucose positron emission tomography to differentiate post-radiotherapy changes from tumor.

Mendenhall, William M. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States)], E-mail:; Mancuso, Anthony A. [Department of Diagnostic Radiology, University of Florida College of Medicine, Gainesville, FL (United States); Hinerman, Russell W.; Malyapa, Robert S. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Werning, John W. [Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL (United States); Amdur, Robert J. [Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL (United States); Villaret, Douglas B. [Department of Otolaryngology, University of Florida College of Medicine, Gainesville, FL (United States)



Tick paralysis: first zoonosis record in Egypt.  


Tick paralysis caused by the secretion of toxin with saliva while taking a blood meal is an important veterinary disease, but is rare in humans. Although it has certain geographical proclivities, it exists worldwide. Tick paralysis was demonstrated for the first time in Egypt among four children living in rural area at Giza Governorate. The clinical pictures were confused with rabies; myasthensia gravis; botulism; diphtheritic polyneuropathy encountered in rural areas. The recovery of tick infesting the four little children and negative clinical and laboratory data of all diseases denoted tick paralysis. The encountered ticks infesting their animals were Rhipicephalus sanguineus on dogs, Hyalomma dromedarii on camels and Hyalomma anatolicum excavatum and Haemaphysalis sp. on goats. The case was recognized as first record of tick paralysis in Egypt. PMID:22662597

Mosabah, Amira A Abd El-rahman; Morsy, Tosson A



Genetics Home Reference: Hyperkalemic periodic paralysis  


... that can trigger attacks include rest after exercise, potassium-rich foods such as bananas and potatoes, stress, ... with hyperkalemic periodic paralysis have increased levels of potassium in their blood (hyperkalemia) during attacks. Hyperkalemia results ...


Landmarks of the facial nerve: implications for parotidectomy  

Microsoft Academic Search

Facial nerve paralysis is a daunting potential complication of parotid surgery and is widely reported. Knowledge of the key\\u000a landmarks of the facial nerve trunk is essential for safe and effective surgical intervention in the region of the parotid\\u000a gland. In current practice, wide ranges of landmarks are used to identify the facial nerve trunk, however, there is much debate

N. Pather; M. Osman



Laryngeal sarcocystosis accompanying laryngeal squamous cell carcinoma: case report and literature review.  


Laryngeal sarcocystosis is an uncommon zoonotic coccidian protozoal infestation of human beings. The authors reviewed the pathology of 1,063 laryngeal biopsies over the past 10 years (2000 to 2009). Only one case of laryngeal sarcocystosis accompanying laryngeal squamous cell carcinoma was identified. The overall prevalence of laryngeal sarcocystosis was 0.094%. The case was a 66-year-old man who presented with voice hoarseness for six months. Physical examination and computed tomography revealed an ulcerative exophytic mass on the right true vocal cord, suggestive of laryngeal carcinoma. He underwent a right frontolateral partial laryngectomy. Histopathology showed a nonkeratinizing squamous cell carcinoma with Sarcocystis spp in the vocalis muscle. He was followed up and enrolled in speech therapy. The authors briefly review the clinicopathologic features and pathogenesis of muscular sarcocystosis and concurrent laryngeal sarcocystosis and squamous cell carcinoma. PMID:22299431

Larbcharoensub, Noppadol; Cheewaruangroj, Wichit; Nitiyanant, Prawat



Functional and electrophysiological evaluation of the effect of laser therapy in the treatment of peripheral facial paralysis  

NASA Astrophysics Data System (ADS)

This clinical case report relates to a total of 4 patients, carriers of idiopathic facial paralysis, treated with Low Level Laser Therapy using a Gallium-Aluminum-Arsenide diode laser of 780 nm, 50 mW, continuous wave emission, spot size 3 mm2 and total dosage of 20 joules per session distributed to the peripheral trajectory of the injured nerve in a point by point contact mode. Altogether 24 treatment sessions were performed in a period of 12 consecutive weeks twice a week All treated patients presented recovery signs from the initial degree of paralysis.

Ladalardo, Thereza C.; Brugnera, Aldo; Takamoto, Marcia; Pinheiro, Antonio L.; Campos, Roberto A.; Garrini, Ana E.; Bologna, Elisangela D.; Settanni, Flavio



Applications of Robotics for Laryngeal Surgery  

Microsoft Academic Search

The anatomy of the upper airway lends difficulty to the surgical treatment of laryngeal disease. Open surgery of the larynx allows for increased expo- sure of the surgical field and dexterity of instrumentation; however, healthy tissue, especially the delicate vibratory tissues and framework of the larynx, may be damaged during the procedure. In contrast, endoscopic laryngeal surgery uses natural body

Alexander T. Hillel; Ankur Kapoor; Nabil Simaan; Russell H. Taylor; Paul Flint



The Acute bee paralysis virus–Kashmir bee virus–Israeli acute paralysis virus complex  

Microsoft Academic Search

Acute bee paralysis virus (ABPV), Kashmir bee virus (KBV) and Israeli acute paralysis virus (IAPV) are part of a complex of closely related viruses from the Family Dicistroviridae. These viruses have a widespread prevalence in honey bee (Apis mellifera) colonies and a predominantly sub-clinical etiology that contrasts sharply with the extremely virulent pathology encountered at elevated titres, either artificially induced

Joachim R. de Miranda; Guido Cordoni; Giles Budge



Diaphragm recovery by laryngeal innervation after bilateral phrenicotomy or complete C2 spinal section in rats.  


This study aimed to highlight the functional aspects of diaphragm reinnervation by laryngeal motoneurons after bilateral phrenicotomy or complete cervical transection. The left recurrent laryngeal nerve was connected to the left phrenic nerve in 14 rats. Five months later, all bridged rats presented a substantial ipsilateral diaphragm recovery (74.2 +/- 10% of contralateral activity) whereas the diaphragm remained paralysed in non-bridged rats (n = 5/5). After additional right phrenicotomy, functional breathing persisted in bridged rats whereas all non-bridged died. After complete C2 spinal transection, diaphragm respiratory discharges persisted in bridged rats. The reinnnervation by laryngeal motoneurons was confirmed by retrograde labeling, stimulus-elicited diaphragm response by vagal stimulation and diaphragm inactivation after vagotomy. In conclusion, the recurrent-phrenic nerve anastomosis induces a reliable functional diaphragm outcome even after contralateral diaphragm denervation or complete high cervical spinal cord injury, and could be considered as a clinical repair strategy for re-establishing diaphragm autonomy following spinal cord trauma. PMID:16843001

Gauthier, P; Baussart, B; Stamegna, J C; Tadié, M; Vinit, S



Neurovascular free-muscle transfer to treat facial paralysis associated with hemifacial microsomia.  


Despite the wide spectrum of hemifacial microsomia manifestations, treatment mainly focuses on mandible and ear abnormalities, rather than on facial paralysis. In fact, the surgical treatment of facial paralysis associated with hemifacial microsomia is quite underdeveloped, because the degree of paralysis is frequently incomplete or partial. Timing and type of surgery are also difficult to determine. Neurovascular free-muscle transfer is now a standard procedure for the dynamic smile reconstruction of longstanding facial paralysis. This type of strategy has considerable potential in the treatment of facial paralysis in patients with hemifacial microsomia. We present here our experience with neurovascular free-muscle transfer for smile reconstruction in eight patients with facial paralysis associated with hemifacial microsomia. The age of the patients at the time of surgery ranged from 7 to 28 years old, (average, 13.9 years). Six were male patients and two were female patients. The two-stage method combining gracilis muscle transfer with cross-face nerve grafting was performed in three patients, whereas the one-stage transfer of the latissimus dorsi muscle was performed in five. To construct a natural or near-natural smile, the muscles were transferred into the paralyzed cheek in all except one patient, in whom the latissimus dorsi muscle was transferred into the sublabial area to reconstruct a paralyzed lower lip. A dermal flap segment vascularized with perforating vessels from the latissimus dorsi muscle was simultaneously inserted into the underdeveloped cheek for soft-tissue augmentation in this patient. Muscle contraction was evident in all patients between 4 and 8 months after muscle transfer. Our present series revealed that neurovascular free-muscle transfer is a good option not only for smile reconstruction but also for restoration of the facial contours of patients with hemifacial microsomia. Compared with the two-stage method combining gracilis muscle transfer with cross-face nerve grafting, the one-stage method using the latissimus dorsi muscle has some advantages, including a one-stage operation, a shorter recovery period, and the absence of sequelae that occur after harvesting a sural nerve. PMID:11964969

Takushima, Akihiko; Harii, Kiyonori; Asato, Hirotaka; Yamada, Atsushi



Preservation of the marginal mandibular branch of the facial nerve using a plexus block nerve stimulator.  


Preserving the marginal mandibular branch of the facial nerve is essential in submandibular neck dissection to avert disfiguring complications. Despite the high incidence of postoperative palsy, old-fashioned techniques of nerve identification remain widespread. The use of disposable plexus block nerve stimulators as a safe and accurate method to localize the nerve intraoperatively is suggested herein. Such devices are significantly more affordable and user-friendly than larger facial nerve monitoring devices, which are rather favored for those procedures more extensively jeopardizing the branches of the facial nerve. In this report, disposable stimulators led to successful identification of the nerve in 100% of 25 patients between 2003 and 2005, with no postoperative paralysis. In addition, stimulation devices are constantly gaining in reliability and safety, and the number of surgical fields supporting their use is expanding. Therefore, their routine use for surgery on the submandibular area is recommended by the authors. PMID:16955012

Sadoughi, Babak; Hans, Stéphane; de Monès, Erwan; Brasnu, Daniel F



Laryngeal electroglottography as a predictor of laryngeal electromyography.  


We evaluate a group of patients who have mobile vocal folds, but have flexible laryngeal examinations suspicious for mild vocal fold paresis. The purpose of this retrospective study is to evaluate if electroglottography (EGG) can predict the probability of having an abnormal laryngeal electromyography (LEMG). Charts of patients evaluated and suspected of having mild vocal fold paresis between August 1, 2004 and March 30, 2006 were reviewed. We compared average EGG contact quotients (CQs), average absolute difference of recorded CQ from normal (|CQ-50%|), and EGG waveforms between patients with normal and abnormal LEMG. Waveforms were evaluated in blinded fashion. Statistical analysis was performed using chi square and t test analyses. One hundred and sixteen patients received both flexible laryngoscopy and LEMG as part of their evaluation. Forty-eight patients (41%) had confirmed paresis by LEMG and 68 patients (59%) had normal LEMGs. Only 9.1% of patients with a normal EGG waveform had an abnormal LEMG. In contrast, 40.4% of patients with an abnormal EGG waveform had abnormal LEMGs. The negative predictive value of a normal EGG waveform for an abnormal LEMG was 90.9%. No significant differences were identified between patients with normal versus abnormal LEMG in terms of average CQ (47.8% vs 46.4%) or |CQ-50%| (6.2 vs 5.6). Patients with a normal EGG waveform are unlikely to have an abnormal LEMG. PMID:18031990

Mayes, Russell W; Jackson-Menaldi, Cristina; Dejonckere, Philippe H; Moyer, Cheryl A; Rubin, Adam D



Occupational risk for laryngeal cancer  

SciTech Connect

In a case-control analysis, we studied the effects of type of employment on laryngeal cancer risk using the interview data from the Third National Cancer Survey. Effects were measured relative to the risk for those employed in a group of arbitrarily defined industries and occupations with low risk. We excluded females and controlled for age, tobacco use, alcohol use, and race in the analysis. We found ratio estimates above 3.0 for workers in the railroad industry and the lumber industry; and for sheetmetal workers, grinding wheel operators, and automobile mechanics.

Flanders, W.D.; Rothman, K.J.



Occupational risk for laryngeal cancer.  

PubMed Central

In a case-control analysis, we studied the effects of type of employment on laryngeal cancer risk using the interview data from the Third National Cancer Survey. Effects were measured relative to the risk for those employed in a group of arbitrarily defined industries and occupations with low risk. We excluded females and controlled for age, tobacco use, alcohol use, and race in the analysis. We found ratio estimates above 3.0 for workers in the railroad industry and the lumber industry; and for sheetmetal workers, grinding wheel operators, and automobile mechanics.

Flanders, W D; Rothman, K J



Effects of Dopamine D1 and D2 Receptor Antagonists on Laryngeal Neurophysiology in the Rat  

PubMed Central

Hypophonia is an early symptom in Parkinson's disease (PD) that involves an increase in laryngeal muscle activity, interfering with voice production. Our aim was to use an animal model to better understand the role of different dopamine receptor subtypes in the control of laryngeal neurophysiology. First, we evaluated the combined effects of SCH23390—a D1 receptor antagonist with a D2 receptor antagonist (eticlopride) on laryngeal neurophysiology, and then tested the separate effects of selective receptor antagonists. Thyroarytenoid (TA) and gastrocnemius (GN) muscle activity was measured at rest and while stimulating the internal branch of superior laryngeal nerve to elicit the laryngeal adductor response (LAR) in alpha-chloralose–anesthetized rats. Paired stimuli at different interstimulus intervals between 250 and 5,000 ms measured central conditioning of the LAR. Changes in resting muscle activity, response latency, amplitude, and LAR conditioning after each drug were compared with the saline control. SCH23390 alone increased the resting TA muscle activity (P < 0.05). With the combined SCH23390 + eticlopride or SCH23390 alone, response latency decreased (P < 0.01), amplitude increased (P < 0.01), and the test LAR was reduced at 2,000-ms ISI (P < 0.01). No LAR changes occurred when eticlopride was administered alone at a low dose and only a tendency to suppress responses was found at a high dose. No changes in GN muscle activity occurred in any of the groups. The results suggest that a loss of stimulation of D1 receptors plays a significant role in laryngeal pathophysiology in PD.

Feng, Xin; Henriquez, Victor M.; Walters, Judith R.; Ludlow, Christy L.



Bilateral mediastinal neurofibroma of the vagus nerves in a patient with neurofibromatosis type 1.  


Bilateral mediastinal vagus neurogenic tumors are very rare. We herein report the case of Neurofibromatosis type 1 (NF-1) patient with bilateral neurofibromas originating from the mediastinal vagus just distal site of the recurrent nerve, who underwent two-staged extirpations that successfully preserved both recurrent nerves. A 31-yearold female with a history of NF-1 was admitted to our hospital under a diagnosis of multiple tumors in the upper mediastinum. First, the tumor at the right paratracheal to precarinal site was completely resected through a median sternotomy, preserving the right recurrent nerve. After confirming no right recurrent nerve paralysis, thoracoscopic resection of the tumor at the aorto-pulmonary window was then performed preserving the left recurrent nerve. The histopathological diagnosis was neurofibroma originating from the bilateral mediastinal vagus nerves. A two-staged operation can be an option in cases with bilateral mediastinal vagus nerve tumors to avoid the risk of bilateral recurrent nerve paralysis. PMID:23232267

Kanzaki, Ryu; Inoue, Masayoshi; Minami, Masato; Sawabata, Noriyoshi; Shintani, Yasushi; Nakagiri, Tomoyuki; Okumura, Meinoshin



Motor inhibition in hysterical conversion paralysis.  


Brain mechanisms underlying hysterical conversion symptoms are still poorly known. Recent hypotheses suggested that activation of motor pathways might be suppressed by inhibitory signals based on particular emotional situations. To assess motor and inhibitory brain circuits during conversion paralysis, we designed a go-nogo task while a patient underwent functional magnetic resonance imaging (fMRI). Preparatory activation arose in right motor cortex despite left paralysis, indicating preserved motor intentions, but with concomitant increases in vmPFC regions that normally mediate motivational and affective processing. Failure to execute movement on go trials with the affected left hand was associated with activations in precuneus and ventrolateral frontal gyrus. However, right frontal areas normally subserving inhibition were activated by nogo trials for the right (normal) hand, but not during go trials for the left hand (affected by conversion paralysis). By contrast, a group of healthy controls who were asked to feign paralysis showed similar activation on nogo trials and left-go trials with simulated weakness, suggesting that distinct inhibitory mechanisms are implicated in simulation and conversion paralysis. In the patient, right motor cortex also showed enhanced functional connectivity with the posterior cingulate cortex, precuneus, and vmPFC. These results suggest that conversion symptoms do not act through cognitive inhibitory circuits, but involve selective activations in midline brain regions associated with self-related representations and emotion regulation. PMID:19450695

Cojan, Yann; Waber, Lakshmi; Carruzzo, Alain; Vuilleumier, Patrik



Laryngeal Sensation Before and After Clearing Behaviors  

PubMed Central

Purpose People frequently present to voice clinics with complaints of irritating laryngeal sensations. Clinicians attempt to reduce the irritating sensations and their common sequela, coughing and throat clearing, by advocating for techniques that remove the irritation with less harm to the vocal fold tissue. Despite the prevalence of patients with these complaints, it is not known if the less harmful techniques recommended by clinicians are effective at clearing irritating laryngeal sensations or that irritating laryngeal sensations are, in fact, more frequent in people with voice disorders than people without voice disorders. Method Assessments of participant reported laryngeal sensation, pre- and post- clearing task, were obtained from 22 people with and 24 people without a voice disorder. Six clearing tasks were used to preliminarily evaluate the differing effects of tasks believed to be deleterious and ameliorative. Results People with and without voice disorders reported pre-clear laryngeal sensation at a similar rate. Post-clear sensation was less likely to be completely or partially removed in people with voice disorders than in the non-voice disordered group. Hard throat clear and swallow with water were the most effective techniques at removing laryngeal sensation. Conclusions The findings provide initial evidence for some of the clinical practices common to treating patients with voice disorders and chronic clearing such as advocating for swallowing a sip of water as a replacement behavior instead of coughing or throat clearing. However, the findings raise questions about other practices such as associating irritating laryngeal sensation with a voice disorder.

Bonilha, Heather Shaw; Gerlach, Terri Treman; Sutton, Lori Ellen; Dawson, Amy Elizabeth; Nietert, Paul J



Facial Paralysis and Lymphocytic Facial Neuritis in a Rhesus Macaque (Macaca mulatta) Positive for Simian Retrovirus Type D2  

PubMed Central

Simian retrovirus type D (SRVD) is a naturally occurring betaretrovirus in nonhuman primates of the genus Macaca. Infection can lead to a variety of clinical, hematologic, and histopathologic abnormalities. We report an unusual clinical presentation of facial paralysis and histologic lymphocytic neuritis in an SRVD type 2 (SRVD2)-infected rhesus macaque (Macaca mulatta) with a catheter-associated vena caval thrombus, anemia, thrombocytopenia, and multisystemic lymphoid hyperplasia. At initial presentation, a right atrial mass was detected by echocardiography. The macaque was clinically asymptomatic but had persistent anemia, thrombocytopenia, hyperglobulinemia, and later neutropenia. It was seropositive for SRV and PCR-positive for SRVD 2. Approximately 1 mo after initial presentation, the macaque developed right facial paralysis and was euthanized. Histologic lesions included lymphoplasmacytic aggregates affecting multiple organs, consistent with SRV-related lymphoid hyperplasia. The right facial nerve showed lymphoplasmacytic inflammation. The nerve itself was negative immunohistochemically for SRV antigen, but antigen was present infrequently in pericapillary lymphoid cells within the facial nerve and abundantly within lymphoid aggregates in the adjacent parotid salivary gland, bone marrow, and soft tissue. Known neurotropic viruses could not be identified. Given the widespread inflammation in this macaque, particularly in the area surrounding the facial nerve, lymphocytic neuritis and facial paralysis likely were an indirect effect of SRV infection due to local extension of SRV-related inflammation in the surrounding tissue.

Hampton, Anna L; Colby, Lesley A; Bergin, Ingrid L



Medialization vs. Reinnervation for Unilateral Vocal Fold Paralysis: A Multicenter Randomized Clinical Trial  

PubMed Central

Purpose Vocal fold medialization laryngoplasty (ML) and laryngeal reinnervation (LR) as treatments for unilateral vocal fold paralysis (UVFP) were compared in a multicenter, prospective, randomized clinical trial. Methods Previously untreated patients with UVFP were randomized to undergo either ML or LR. Voice results were compared pre-treatment and at 6 and 12 months post-treatment using perceptual ratings by untrained listeners (RUL), blinded speech pathologist GRBAS scores, and voice-related quality of life (VRQOL) scores. Other secondary data included maximum phonation time (MPT), cepstral analysis, and EMG findings. Results 24 patients from 9 sites completed the study, 12 in each group. There were no significant intergroup differences in pre-treatment variables. At 12 months, both study groups showed significant improvement in RUL, GRBAS and VRQOL scores, but no significant differences were found between the two groups. However, patient age significantly affected the LR, but not the ML, group results. The age<52 LR subgroup had significantly (p<0.05) better scores than the age>52 LR subgroup, and had better RUL and GRBAS scores than the age<52 ML subgroup. The age>52 ML subgroup results were significantly better than the age>52 LR subgroup. The secondary data generally followed the primary data, except that the MPTs for the ML patients were significantly longer than for the LR patients. Conclusion ML and LR are both effective surgical options for patients with UVFP. Laryngeal reinnervation should be considered in younger patients, while medialization laryngoplasty should be favored in older patients.

Paniello, Randal C.; Edgar, Julia D.; Kallogjeri, Dorina; Piccirillo, Jay F.



Hemidiaphragmatic paralysis in preterm neonates: a rare complication of peripherally inserted central catheter extravasation.  


Unilateral diaphragmatic paralysis was diagnosed in 2 preterm neonates born at 29 and 25 weeks of gestation, respectively. In both instances, the pathophysiology was phrenic nerve injury after extravasation of parenteral nutrition fluid. Misplacement and infection were predisposing factors. Diaphragmatic movement analysis by time-motion-mode ultrasonography was helpful in achieving a diagnosis. The first neonate required a diaphragmatic placation, whereas the other infant was managed nonoperatively. These cases confirm a rare etiology of diaphragmatic paralysis and possible spontaneous recovery. In neonates with very low birth weight, general anesthesia and thoracic surgery may be associated with a high morbidity, suggesting that nonoperative medical treatment, when possible, is preferable if the neonate does not require supplemental oxygen. PMID:21763820

Tosello, Barthelemy; Michel, Fabrice; Merrot, Thierry; Chaumoître, Kathia; Hassid, Sophie; Lagier, Pierre; Martin, Claude



Unilateral diaphragmatic paralysis: an electrophysiological study.  

PubMed Central

An electrophysiological study was carried out on four patients with unilateral diaphragmatic paralysis. Whereas neurogenic involvement of the paralysed hemidiaphragm was roughly similar in all cases, neurogenic patterns could be detected in the normally moving contralateral hemidiaphragm in three cases, and the degree of involvement could be correlated with the respiratory state of the patients. EMG also showed that the neuropathic process affected the limb muscles. Thus unilateral diaphragmatic paralysis may be, at least in some cases, the localised expression of a more diffuse neuropathy, perhaps a peculiar form of neuralgic amyotrophy.

Lagueny, A; Ellie, E; Saintarailles, J; Marthan, R; Barat, M; Julien, J



The Dehiscent Facial Nerve Canal  

PubMed Central

Accidental injury to the facial nerve where the bony canal defects are present may result with facial nerve dysfunction during otological surgery. Therefore, it is critical to know the incidence and the type of facial nerve dehiscences in the presence of normal development of the facial canal. The aim of this study is to review the site and the type of such bony defects in 144 patients operated for facial paralysis, myringoplasty, stapedotomy, middle ear exploration for sudden hearing loss, and so forth, other than chronic suppurative otitis media with or without cholesteatoma, middle ear tumors, and anomaly. Correlation of intraoperative findings with preoperative computerized tomography was also analyzed in 35 patients. Conclusively, one out of every 10 surgical cases may have dehiscence of the facial canal which has to be always borne in mind during surgical manipulation of the middle ear. Computerized tomography has some limitations to evaluate the dehiscent facial canal due to high false negative and positive rates.

Yetiser, Sertac



Recurrent layngeal nerve section for spasmodic dysphonia.  


Spasmodic dysphonia is a severe disorder of phonation accompanied by extreme tension of the entire phonatory system. The expressive functions of speech such as laughter, singing, and whispering are much less affected if at all. Psychotherapy, speech therapy, stimulant and psychotropic drugs, hypnotism and acupuncture have all been tried as treatment without success. In 1976, Dedo reported 34 patients who were managed with recurrent laryngeal nerve section for spasmodic dysphonia. All of these patients had marked improvement in voice with relief of spasticity. Twenty-two patients with documented spasmodic dysphonia present for at least one year have been managed at the Cleveland Clinic since Dedo's report. None of them had any improvement with conventional voice therapy and were subjected, therefore, to recurrent laryngeal nerve section. PMID:475250

Levine, H L; Wood, B G; Batza, E; Rusnov, M; Tucker, H M


[Contribution of electroglottography to laryngeal motion disorders].  


Electroglottography allows a precise observation of the vocal folds behavior in phonation of laryngeal motion deficiencies; the therapy can be improved by compared evaluation of the vocal fold contact area. PMID:8927830

Roch, J B; Dubreuil, C; André, L



Computerized Parameterization of Laryngeal Function from Images.  

National Technical Information Service (NTIS)

A semiautomated system using digital image processing techniques to measure quantitative parameters from ultra high speed laryngeal films was implemented. The method described is an improved modification of a recent digital image processing technique. Thi...

J. S. Mott



[Laryngeal schwannoma: a case report].  


The authors report the case of a patient of 67 years, an active teacher active with no relevant history, which noticed several months ago, a gradually progressive dysphonia, though not major (G1R2B0). The stroboscopic examination which proved extremely difficult, could only demonstrate normal laryngeal mobility, while the left ventricular band and left vocal fold appeared affected by a subepithelial tumoral aspect, appearing as a regular swelling. These data were confirmed by naso-fibroscopy, and later by computed tomography. Endoscopy, which was also extremely difficult, brought about the diagnosis of schwannoma in the region of the left ventricular band. We will discuss the nosology of this lesion, particularly thanks to Kleinsasser, and the surgical management that can be offered. PMID:23074826

Perouse, R; Coulombeau, B





... messing with cigarettes). Did you ever notice that people who smoke a lot have rough, raspy voices? Infections from ... keep your throat from drying out. Also, never smoke and try not to be around people who are smoking. Tonight, when you open your ...


Fluorescent peptides highlight peripheral nerves during surgery in mice.  


Nerve preservation is an important goal during surgery because accidental transection or injury leads to significant morbidity, including numbness, pain, weakness or paralysis. Nerves are usually identified by their appearance and relationship to nearby structures or detected by local electrical stimulation (electromyography), but thin or buried nerves are sometimes overlooked. Here, we use phage display to select a peptide that binds preferentially to nerves. After systemic injection of a fluorescently labeled version of the peptide in mice, all peripheral nerves are clearly delineated within 2 h. Contrast between nerve and adjacent tissue is up to tenfold, and useful contrast lasts up to 8 h. No changes in behavior or activity are observed after treatment, indicating a lack of obvious toxicity. The fluorescent probe also labels nerves in human tissue samples. Fluorescence highlighting is independent of axonal integrity, suggesting that the probe could facilitate surgical repair of injured nerves and help prevent accidental transection. PMID:21297616

Whitney, Michael A; Crisp, Jessica L; Nguyen, Linda T; Friedman, Beth; Gross, Larry A; Steinbach, Paul; Tsien, Roger Y; Nguyen, Quyen T



Traumatic facial nerve injuries: review of diagnosis and treatment.  


Both blunt and penetrating craniofacial trauma may lead to severe facial nerve injury and sequelae of facial paralysis. Initial evaluation involves quantitation of motor deficits using a clinical grading system, such as the House-Brackmann scale. High resolution computed tomography is used for localization of nerve injury in suspected cases of temporal bone trauma. In the absence of gross radiographic abnormalities, electrophysiologic testing helps predict the likelihood of spontaneous recovery. In patients with deteriorating facial nerve injuries by electroneuronography, surgical exploration is the preferred management. Primary end-to-end neurorrhaphy is the preferred management for transection injuries, while facial nerve decompression may benefit other forms of high-grade nerve trauma. Secondary facial reanimation procedures, such as cranial nerve crossovers, dynamic muscle slings or various static procedures, are useful adjuncts when initial facial nerve repair is unsuccessful or impossible. A review of facial nerve trauma management and case illustrations are presented. PMID:11951487

Davis, R E; Telischi, F F



Intralesional Cidofovir application in recurrent laryngeal papillomatosis.  


Recurrent laryngeal papillomatosis is a benign disease of the larynx often leading to organic and functional restrictions. The therapeutic treatment of choice in larynx-obstructing papillomatosis is at present surgical laser ablation. The effectiveness of adjuvant intralesional injection of the virustaticum Cidofovir has been investigated recently in a variety of therapeutic models. The present case study deals with the treatment of recurrent laryngeal papillomatosis by means of surgical laser ablation of the laryngeal papillomas with adjuvant local injection of the virustaticum Cidofovir (dose of 5 mg/1 ml). Within the period from October 2001 to August 2004, ten patients aged between 5- and 70 years were treated with intralesional injections of Cidofovir. Papillomatosis was confirmed histologically in all cases, and the virus types were defined in part. Each of the patients underwent clinical-phoniatric examinations and was photographed for documentation. After 2-7 treatments with surgical laser papilloma ablation and intralesional Cidofovir injections, all patients showed a definite papilloma reduction, while in six cases complete remission was achieved. During the follow-up period of 8-30 months, not a single recurrence of the laryngeal papillomatosis occurred. In the majority of patients, a clear improvement in the voice was achieved. There were no local or systemic side effects caused by the virustaticum. Intralesional injection of Cidofovir is an adjuvant, but not a curative therapeutic option in recurrent laryngeal papillomatosis. Remission of previously frequently recurrent laryngeal papillomas can be achieved, but recurrence after longer treatment-free intervals is also possible. PMID:17058091

Pudszuhn, Annett; Welzel, Cornelia; Bloching, Marc; Neumann, Kerstin



Side-to-end hypoglossal-facial anastomosis via transposition of the intratemporal facial nerve  

Microsoft Academic Search

Summary  The technique of facial nerve repair with side-to-end hypoglossal-facial anastomosis is presented and evaluated in five patients\\u000a who were operated on for facial nerve paralysis after acoustic schwannoma surgery, or had cranial base trauma.\\u000a \\u000a The end-to-end hypoglossal-facial anastomosis is accompanied by hemilingual paralysis, with difficulty in swallowing, chewing\\u000a and speaking. In this new technique, the facial nerve is mobilised in

J. Rebol; V. Milojkovi?; V. Didanovi?



A Videographic Analysis of Laryngeal Exposure Comparing the Articulating Laryngoscope and External Laryngeal Manipulation  

Microsoft Academic Search

Activation of the articulating laryngoscope and exter- nal laryngeal manipulation (ELM) improve laryngeal exposure during direct laryngoscopy. We used a head- mounted direct laryngoscopy imaging system and a previously validated scoring system for assessing la- ryngeal view (the percentage of glottic opening or POGO score) on 33 adult patients undergoing laryngos- copy. On each patient, we videotaped the initial laryn-

E. Andrew Ochroch; Richard M. Levitan



Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma  

Microsoft Academic Search

Background  Injuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle dorsiflexion.\\u000a Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and ankle-foot orthotics have\\u000a been the standard treatment for foot drop.\\u000a \\u000a \\u000a \\u000a \\u000a Questions\\/purposes  We (1) describe an alternative surgical technique to obtain ankle dorsiflexion by partial tibial nerve transfer to

Jennifer L. Giuffre; Allen T. Bishop; Robert J. Spinner; Bruce A. Levy; Alexander Y. Shin


Spinal Cord and Nerve Root Decompression  

Microsoft Academic Search

Tumors of the vertebral column include both primary and metastatic lesions. These tumors can cause significant morbidity consisting\\u000a of lesional pain and pain from deformity. Compression of the spinal cord and spinal nerve roots can also cause radicular pain\\u000a as well as neurologial deterioration including sensory deficits, weakness, paralysis, and\\/or sexual\\/bowel\\/ bladder dysfunction.\\u000a In cases of metastatic lesions, the spine

Keith R. Lodhia; Paul Park; Gregory P. Graziano


Laryngeal dystonia causing upper airway obstruction in progressive supranuclear palsy.  


A 58-year-old man with progressive supranuclear palsy (PSP) developed two episodes of respiratory failure associated with laryngeal spasm. It was revealed he had adductor laryngeal breathing dystonia, a relatively unrecognized complication of PSP. PMID:16597502

Panegyres, Peter K; Hillman, David; Dunne, John W



What's New in Laryngeal and Hypopharyngeal Cancer Research and Treatment?  


... Additional resources for laryngeal and hypopharyngeal cancer What’s new in laryngeal and hypopharyngeal cancer research and treatment? ... to better tests for early detection and to new targeted treatments. Chemoprevention Chemoprevention is the use of ...


Use of GDNF-Releasing Nanofiber Nerve Guide Conduits for the Repair of Conus Medullaris/Cauda Equina Injury in the Non-Human Primate.  

National Technical Information Service (NTIS)

Cauda equina and conus medullaris forms of spinal cord injury result in paralysis, sensory impairment, and autonomic dysfunction. This study investigates the effects of neural repair in nonhuman primates using a GDNF- releasing nerve guidance channel. The...

A. Hoke K. Christe L. Havton



[A case of Churg-Strauss syndrome in which oculomotor paralysis developed].  


A 74-year-old man had severe persistent asthma, poorly controlled by treatment with an inhaled steroid (beclomethasone dipropionate [BDP-CFC]), an oral steroid (prednisolone), a sustained-release theophylline preparation, and a leukotriene receptor antagonist. The oral steroid dose was tapered and discontinued because the patient achieved good control by switching to inhaled steroids (fluticasone propionate [FP-DPI]) and adding inhaled cromoglycate and an inhaled beta 2 agonist. On this regimen, the peripheral-blood eosinophil count increased significantly, followed by numbness in the right hand and right foot and left oculomotor paralysis. The patient was given a diagnosis of Churg-Strauss syndrome because his symptoms improved with re-administration of the oral steroid. This syndrome is rarely accompanied by cranial nerve paralysis, and oculomotor paralysis has been reported in only 4 Churg-Strauss patients. The clinical course of this patient was considered to be consistent with Churg-Strauss syndrome, which had been suppressed by steroids for asthma control, but then manifested with dose tapering and discontinuation of the systemic steroid therapy. PMID:19195201

Naitoh, Tatsuo



Preoperative clinical prediction of difficult laryngeal exposure in suspension laryngoscopy  

Microsoft Academic Search

We investigated general and physical predictors of difficult laryngeal exposure in patients undergoing suspension laryngoscopy;\\u000a 93 patients were included in this prospective study. The patients were classified as difficult laryngeal exposure group or\\u000a non-difficult laryngeal exposure group based on the laryngeal view in suspension laryngoscopy. Twelve parameters (age, sex,\\u000a body mass index, neck circumference, full mouth opening, modified mallampati index,

Ercan Pinar; Caglar Calli; Semih Oncel; Burcu Selek; Bekir Tatar



[Posterior interosseous nerve palsy due to lipoma].  


A 45-year-old male patient presented with paralysis of slow onset in the right forearm and hand muscles. Electromyographic assessment revealed severe denervation in the muscles innerved by the posterior interosseous nerve. Magnetic resonance imaging demonstrated a tumoral mass compressing the nerve. The patient underwent surgical excision with an initial diagnosis of lipoma. Surgical exploration and a biopsy confirmed the diagnosis. Active wrist movements and digital extension were possible after three weeks and the patient resumed full strength six weeks after the operation. PMID:16905900

Eralp, Levent; Ozger, Harzem; Ozkan, Korhan



Laryngeal malformation in Richieri-Costa Pereira syndrome: new findings.  


Laryngeal structural anomalies were described in 13 cases of Richieri-Costa Pereira syndrome, and four previously reported cases were reviewed. The 17 individuals examined had the typical laryngeal anomalies and vocal disorders previously described. The new findings are the laryngeal microweb observed in three cases and arytenoid anteriorization movement observed in 14 cases. PMID:22711187

Miguel, Haline Coracine; Carneiro, Christiano Giácomo; Tabith, Alfredo; Zechi-Ceide, Roseli Maria; Genaro, Katia Flores



Peripheral nerve injuries in athletes. Treatment and prevention.  


Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete's safe return to sports. Early, accurate anatomical diagnosis is essential. Nerve lesions may be due to acute injury (e.g. from a direct blow) or chronic injury secondary to repetitive microtrauma (entrapment). Accurate diagnosis is based upon physical examination and a knowledge of the relative anatomy. Palpation, neurological testing and provocative manoeuvres are mainstays of physical diagnosis. Diagnostic suspicion can be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. Proper equipment, technique and conditioning are the keys to prevention. Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment. In the shoulder, spinal accessory nerve injury is caused by a blow to the neck and results in trapezius paralysis with sparing of the sternocleidomastoid muscle. Scapular winging results from paralysis of the serratus anterior because of long thoracic nerve palsy. A lesion of the suprascapular nerve may mimic a rotator cuff tear with pain a weakness of the rotator cuff. Axillary nerve injury often follows anterior shoulder dislocation. In the elbow region, musculocutaneous nerve palsy is seen in weightlifters with weakness of the elbow flexors and dysesthesias of the lateral forearm. Pronator syndrome is a median nerve lesion occurring in the proximal forearm which is diagnosed by several provocative manoeuvres. Posterior interosseous nerve entrapment is common among tennis players and occurs at the Arcade of Froshe--it results in weakness of the wrist and metacarpophalangeal extensors. Ulnar neuritis at the elbow is common amongst baseball pitchers. Carpal tunnel syndrome is a common neuropathy seen in sport and is caused by median nerve compression in the carpal tunnel. Paralysis of the ulnar nerve at the wrist is seen among bicyclists resulting in weakness of grip and numbness of the ulnar 1.5 digits. Thigh injuries include lateral femoral cutaneous nerve palsy resulting in loss of sensation over the anterior thigh without power deficit. Femoral nerve injury occurs secondary to an iliopsoas haematoma from high energy sports. A lesion of the sciatic nerve may indicate a concomitant dislocated hip. Common peroneal nerve injury may be due to a direct blow or a traction injury and results in a foot drop and numbness of the dorsum of the foot. Deep and superficial peroneal nerve palsies could be secondary to an exertional compartment syndrome. Tarsal tunnel syndrome is a compressive lesion of the posterior tibial nerve caused by repetitive dorsiflexion of the ankle--it is common among runners and mountain climbers.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8378668

Lorei, M P; Hershman, E B



Laryngeal foreign body mistreated as recurrent laryngitis and croup for one year.  


Foreign body aspiration (FBA) is a common, dangerous problem among children of all ages. Laryngeal foreign bodies may present with less severe symptoms compared to lower respiratory tract foreign bodies, resulting in misdiagnosis, confusion and delay. We present the case of a 20-month-old girl with laryngeal foreign body unrecognized for one year. She was treated for recurrent laryngitis and infectious croup several times. A triangular-shaped, red plastic material with sharp edges was removed from the larynx by direct laryngoscopy. The clinical presentation and management are discussed. PMID:19378893

Atmaca, Sinan; Unal, Recep; Se?en, Teoman; Kiliçarslan, Hizir; Unal, Asude


Flaccid Leg Paralysis Caused by a Thoracic Epidural Catheterization: A Case Report  

PubMed Central

We report a case of a 44-year-old patient with paralysis of the left leg who had a thoracic epidural catheterization after general anesthesia for abdominal surgery. Sensory losses below T10 and motor weakness of the left leg occurred after the surgery. Magnetic resonance image study demonstrated a well-defined intramedullary linear high signal intensity lesion on T2-weighted image and low-signal intensity on T1-weighted image in the spinal cord between T9 and L1 vertebral level, and enhancements of the spinal cord below T8 vertebra and in the cauda equina. Electrodiagnostic examination revealed lumbosacral polyradiculopathy affecting nerve roots below L4 level on left side. We suggest that the intrinsic spinal cord lesion and nerve root lesion can be caused by an epidural catheterization with subsequent local anesthetic injection.

Jeon, Byoung Hyun; Bang, Heui Je; Lee, Gyung Moo; Kwon, Oh Pum



Laryngeal plexiform neurofibroma in a child.  


Neurofibromatosis (NF) is a genetically inherited, autosomal dominant disease, characterized by multiple cafe au lait spots, cutaneous neurofibromas and "Lisch nodules." Neurofibromatosis can develop from a neural source at any age. However, neurofibroma of the larynx is extremely rare and is usually manifested by obstructive airway symptoms. We encountered a 5-year-old child presenting with stridor and dyspnea, who had a diagnosis of laryngeal plexiform neurofibroma. The purpose of our report is the consideration of laryngeal NF in the differential diagnosis of dyspnea in infants and children. PMID:23780601

Kasapoglu, Fikret; Ozdemircan, Talip; Erisen, Levent



Miraculous healings of paralysis: a preliminary study on sources.  


The aim of the present paper has been to explore the medieval evidence on miraculous healings of paralysis and to confront it with modern medical knowledge. Paralysis has been selected as a model for such a study and St. Bernardino of Siena (1380-1444) as a model of a saintly healer. Analyzed were the primary sources and modern literature. Paralysis was found to be among the most frequent diseases in medieval miracle reports, including the healings by St. Bernardino. According to the hypothesis offered in the paper, the majority of medieval cases of "miraculously healed paralysis" was of conversive origin. PMID:23697246

Muzur, Amir; Rinci?, Iva



The pattern of isolated sleep paralysis among Nigerian medical students.  

PubMed Central

In a cross-sectional study of the patterns of isolated sleep paralysis among 164 Nigerian medical students, 26.1% admitted having experienced this phenomenon. About 31% of the females and 20% of the males had had this experience. Of those with sleep paralysis, 32.6% had hypnogenic hallucinations during the episode, mainly visual. Sleep paralysis was not significantly associated with psychosocial distress or differences in personality profile. Although the rate differs across cultures, the myths associated with sleep paralysis are similar.

Ohaeri, J. U.; Odejide, A. O.; Ikuesan, B. A.; Adeyemi, J. D.



Lifetime Prevalence Rates of Sleep Paralysis: A Systematic Review  

PubMed Central

Objective To determine lifetime prevalence rates of sleep paralysis. Data Sources Keyword term searches using “sleep paralysis”, “isolated sleep paralysis”, or “parasomnia not otherwise specified” were conducted using MEDLINE (1950-present) and PsychINFO (1872-present). English and Spanish language abstracts were reviewed, as were reference lists of identified articles. Study Selection Thirty five studies that reported lifetime sleep paralysis rates and described both the assessment procedures and sample utilized were selected. Data Extraction Weighted percentages were calculated for each study and, when possible, for each reported subsample. Data Synthesis Aggregating across studies (total N = 36533), 7.6% of the general population, 28.3% of students, and 31.9% of psychiatric patients experienced at least one episode of sleep paralysis. Of the psychiatric patients with panic disorder, 34.6% reported lifetime sleep paralysis. Results also suggested that minorities experience lifetime sleep paralysis at higher rates than Caucasians. Conclusions Sleep paralysis is relatively common in the general population and more frequent in students and psychiatric patients. Given these prevalence rates, sleep paralysis should be assessed more regularly and uniformly in order to determine its impact on individual functioning and better articulate its relation to psychiatric and other medical conditions.

Barber, Jacques P.



Diaphragmatic Paralysis: A Critical Review of its Use as a Therapeutic Measure in Respiratory Disease  

PubMed Central

Diaphragmatic paralysis first suggested as a therapeutic measure in lung disease by Steurtz (1911), who did simple phrenicotomy. Felix (1922) showed in 25% of cases this was ineffective owing to the presence of an accessory phrenic, and suggested phrenic exairesis, i.e. complete evulsion of the phrenic nerve. Goetze (1922) suggested radical phrenicotomy, i.e. division of the phrenic and excision of the nerve to the subclavius. Effects of diaphragmatic paralysis.—The diaphragm rises to the full expiratory position (4-8 cm.). Paradoxical movement (Kienböch's phenomenon) on affected side. Muscle atrophies. Collapse of the lung produced, affecting base and apex also. Lung volume reduced by ?th to ?rd. Physical signs.—Indrawing of the epigastrium. Thoracic breathing. Litten's sign absent. Less resistance to abdominal palpation on affected side. Diminished resonance at border of sternum and at base. Deficient inspiratory murmur at base. Radiography.—Paradoxical movement. Bittorf's test. Indications.—(A) Pulmonary tuberculosis. I. As the sole therapeutic measure. (1) In cases where pneumothorax has failed. (2) For relief of symptoms such as: (a) hæmoptysis; (b) cough; (c) tachycardia (d) nausea and vomiting; (e) pain; (f) hiccup. II. Combined with pneumothorax. (a) For basal adhesions; (b) alternative to bilateral pneumothorax; (c) to lengthen interval between refills; (d) at conclusion of pneumothorax treatment. III. Combined with thoracoplasty. (B) Other diseases. Unresolved pneumonia, fibrosis of the lung, bronchiectasis, abscess of the lung, hydatid disease.

Campbell, A. J.



Correlation of ECM1 expression level with the pathogenesis and metastasis of laryngeal carcinoma  

PubMed Central

Objective: To investigate the expression of extracellular matrix protein 1 (ECM1) in benign laryngeal lesions, precancerous lesions and malignant laryngeal lesions and analyze the clinical significance of ECM1 changes in the pathogenesis and metastasis of laryngeal carcinoma. Methods: A total of 46 patients with laryngeal lesions were recruited with a median age of 48.2 years (range: 33-67 years). Among these patients, 29 had laryngeal carcinoma (12 with metastasis and 17 without metastasis), 8 had benign laryngeal lesions and 9 had precancerous laryngeal lesions (laryngeal leukoplakia). Immunofluorescence staining was employed to detect the protein expression of ECM1 in benign laryngeal lesions, laryngeal leukoplakia and malignant laryngeal lesions; RT-PCR was used to measure the mRNA expression of ECM1 in laryngeal carcinoma and benign laryngeal lesions. Results: ECM1 expression was detected in 25% (2/8) of patients with benign laryngeal lesions, 78% (7/9) of patients with precancerous laryngeal lesions, and 100% (29/29) of patients with laryngeal carcinoma. Among the laryngeal carcinoma patients, high ECM1 expression (+++) was found in 64.7% (11/17) of patients without lymph node metastasis and 91.7% (11/12) of patients with lymph node metastasis. Increased ECM1 expression was found in laryngeal carcinoma when compared with other laryngeal lesions and the ECM1expression in patients with metastasis was significantly higher than that patients without metastasis (P<0.01). RT-PCR showed that the mRNA expression of ECM-1 in laryngeal carcinoma was markedly higher than that in benign laryngeal lesions. Conclusion: ECM1 expression is in an increasing order in benign laryngeal lesions, precancerous laryngeal lesions and malignant laryngeal lesions. Meanwhile, the metastatic laryngeal carcinoma has higher ECM1 expression than laryngeal carcinoma without metastasis. Our findings suggest that ECM1 plays promotive roles in the occurrence, development and metastasis of laryngeal carcinoma.

Gu, Meizhen; Guan, Jian; Zhao, Limin; Ni, Kun; Li, Xiaoyan; Han, Zhao



Response of laryngeal receptors to water solutions of different osmolality and ionic composition.  


Water-responsive laryngeal receptors with fibres in the superior laryngeal nerve were studied to characterize the specific physicochemical properties of aqueous solutions that activate these endings. The responses to water (37 degrees C) of 141 receptors were studied in 39 anaesthetized dogs breathing through a tracheostomy with the larynx functionally isolated. Of the 89 receptors stimulated by water, 53 were also challenged with isosmotic (275-315 mOsm) solutions of dextrose and sodium gluconate at 37 degrees C. Receptors that only responded to water (n = 31) with a long delay, long duration discharge were generally respiratory modulated. On the other hand, laryngeal receptors that responded to all test solutions (n = 22) with a short delay, short duration discharge were generally not respiratory modulated. We conclude that the former type of receptor responds to lower osmolality, whereas the latter responds to the lack of chloride ions in the test solutions. These two types of receptor may be responsible for the cough and bronchoconstriction induced by inhaled aerosols of different osmolalities and ionic compositions. PMID:2034837

Sant'Ambrogio, G; Anderson, J W; Sant'Ambrogio, F B; Mathew, O P



Barium-induced skeletal muscle paralysis in the rat, and its relationship to human familial periodic paralysis  

PubMed Central

An in vivo study of skeletal muscle paralysis induced by intravenous barium chloride has been made in curarized and non-curarized rats. The influence of potassium and calcium chlorides, propranolol, ouabain, and prior adrenalectomy on the paralysis has also been studied. Paralysis is found to be due to a direct effect on skeletal muscle, and to correlate well with the development of hypokalaemia. Possible mechanisms of action of barium are discussed, and attention is drawn to the similarity between barium poisoning and hypokalaemic familial periodic paralysis.

Schott, G. D.; McArdle, B.



Paediatric blunt laryngeal trauma: a review.  


Paediatric blunt laryngeal trauma is infrequently encountered; however, it can have fatal consequences if managed inappropriately. This paper provides an overview of the relatively limited literature available on the subject and highlights current controversies and recent advances in the management of these injuries. PMID:22164168

Oosthuizen, J C



Paediatric Blunt Laryngeal Trauma: A Review  

PubMed Central

Paediatric blunt laryngeal trauma is infrequently encountered; however, it can have fatal consequences if managed inappropriately. This paper provides an overview of the relatively limited literature available on the subject and highlights current controversies and recent advances in the management of these injuries.

Oosthuizen, J. C.



Epidemiological evidence indicates asbestos causes laryngeal cancer  

SciTech Connect

A variety of opinions have been expressed in the literature concerning asbestos and laryngeal cancer. This paper presents an analysis of epidemiological studies based on criteria that prioritized the most heavily exposed cohorts. Emphasis was given to the six cohorts or subcohorts with lung cancer relative risk estimates of 2 or more. The two groups of workers with the highest lung cancer relative risk estimates (4.06 and 3.28) both gave strong support for a causal association of asbestos and laryngeal cancer, with relative risk estimates of 1.91 (90% confidence limits 1.00 to 3.34) and 3.75 (90% confidence limits 1.01 to 9.68), respectively. Confounding with cigarette smoking or alcohol consumption does not explain the findings. Case-control studies gave mixed results, but generally supported the hypothesis. It was concluded that asbestos is a probable cause of laryngeal cancer in view of the reasonable consistency of the studies, the strength of the association in key studies, the evidence for dose-response relationships, and the biological plausibility for asbestos being a cause of laryngeal cancer. 48 references.

Smith, A.H.; Handley, M.A.; Wood, R. (Univ. of California, Berkeley (USA))



Laryngeal biomechanics of the singing voice  

Microsoft Academic Search

By transnasal fiberoptic laryngoscopy, patients with functional voice disorders often demonstrate abnormal laryngeal biomechanics, commonly supraglottic contraction. Appropriately, such conditions are sometimes termed muscle tension dysphonias. Singers working at the limits of their voice may also transiently demonstrate comparable tension patterns. However, the biomechanics of normal singing, particularly for different singing styles, have not been previously well characterized. We used




Total facial nerve decompression: technique to avoid complications.  


Exposure of the facial nerve from the brainstem to the parotid can be accomplished without injury to the nerve, tympanic membrane, external auditory canal, ossicular chain, inner ear or structures within the cerebello-pontine angle. The procedure has reliably provided good results for patients who have had the proper indications with facial paralysis from Bell's palsy, herpes zoster oticus, infection, hemi-facial spasm, temporal bone fracture and tumors. The current technique for exposure through the mastoid, middle cranial fossa and retrolabyrinthine combined approaches are described. This technique, properly performed, is a valuable treatment for facial nerve lesions. PMID:8764701

Pulec, J L



Nerve and Nerve Root Biomechanics  

Microsoft Academic Search

\\u000a Together, the relationship between the mechanical response of neural tissues and the related mechanisms of injury provide\\u000a a foundation for defining relevant thresholds for injury. The nerves and nerve roots are biologic structures with specific\\u000a and important functions, and whose response to mechanical loading can have immediate, long-lasting and widespread consequences.\\u000a In particular, when nerves or nerve roots are mechanically

Kristen J. Nicholson; Beth A. Winkelstein


Nerve conduits for nerve reconstruction  

Microsoft Academic Search

Although autogenous nerve grafting remains the gold standard for repair of peripheral nerve defects, the use of various conduits can be a substitute provided these conduits meet the above-mentioned prerequisites. For the moment, autogenous vein grafts or denatured muscle grafts can be used to bridge short defects, especially in distal sensory nerves. Incorporation of muscle into a vein graft expands

Huan Wang; William C. Lineaweaver



[Comparison of cross face nerve graft with masseteric nerve as donor nerves for free functional muscle transfers in facial reanimation surgery].  


Several surgical techniques have been proposed for the reconstruction of the smile in facial paralysis. The 2-stage approach utilising a cross-facial nerve graft (CFNG) and subsequent free functional muscle transfer represents the "gold standard". A single-stage alternative is the use of the masseteric nerve as donor nerve. Here we have retrospectively analysed the outcome of 8 patients who were treated with either of these procedures (4 per treatment group). We compared the oral commisure excursion between the 2 groups. Use of the masseteric nerve led to reinnervation of the muscle graft within 3 months. The 2-stage procedure required more than 12 months from the first procedure until first muscle contractions could be observed. A spontaneous smile could not be achieved in all patients when the masseteric nerve was used. The oral commisure excursion was symmetrical when compared to the healthy side in both groups, however the excursion was significantly higher in the masseteric nerve group compared to the CFNG group of patients. Most patients with the masseteric nerve as a donor nerve underwent a secondary procedure, which involved thinning of the muscle flap. In conclusion, the use of the masseteric nerve as a donor nerve for facial reanimation surgery is a single-stage alternative to the use of a CFNG as donor nerve. It delivers reliable results with strong muscle contractions with limitations in regard to achieving a spontaneous smile. PMID:23970401

Eisenhardt, S U; Thiele, J R; Stark, G B; Bannasch, H



Hypokalaemia with paralysis: don't forget the thyroid  

PubMed Central

The authors report the case of a 33-year-old Italian man who had three episodes of hypokalaemia with paralysis linked to hyperthyroidism. Because of its low prevalence in western populations, the diagnosis of thyrotoxic hypokalaemic periodic paralysis can be easily missed in non-Asian countries.

Catalano, Concetta; Caridi, Graziella; Postorino, Maria Concetta; Enia, Giuseppe



Isolated sleep paralysis elicited by sleep interruption.  


We elicited isolated sleep paralysis (ISP) from normal subjects by a nocturnal sleep interruption schedule. On four experimental nights, 16 subjects had their sleep interrupted for 60 minutes by forced awakening at the time when 40 minutes of nonrapid eye movement (NREM) sleep had elapsed from the termination of rapid eye movement (REM) sleep in the first or third sleep cycle. This schedule produced a sleep onset REM period (SOREMP) after the interruption at a high rate of 71.9%. We succeeded in eliciting six episodes of ISP in the sleep interruptions performed (9.4%). All episodes of ISP except one occurred from SOREMP, indicating a close correlation between ISP and SOREMP. We recorded verbal reports about ISP experiences and recorded the polysomnogram (PSG) during ISP. All of the subjects with ISP experienced inability to move and were simultaneously aware of lying in the laboratory. All but one reported auditory/visual hallucinations and unpleasant emotions. PSG recordings during ISP were characterized by a REM/W stage dissociated state, i.e. abundant alpha electroencephalographs and persistence of muscle atonia shown by the tonic electromyogram. Judging from the PSG recordings, ISP differs from other dissociated states such as lucid dreaming, nocturnal panic attacks and REM sleep behavior disorders. We compare some of the sleep variables between ISP and non-ISP nights. We also discuss the similarities and differences between ISP and sleep paralysis in narcolepsy. PMID:1621022

Takeuchi, T; Miyasita, A; Sasaki, Y; Inugami, M; Fukuda, K



9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.  

Code of Federal Regulations, 2013 CFR

...Disposition of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue shall not be used for human food. (b) Livestock thyroid glands and laryngeal muscle tissue may be distributed to...



9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.  

Code of Federal Regulations, 2010 CFR

...2009-01-01 false Disposition of thyroid glands and laryngeal muscle tissue...INSPECTION § 310.15 Disposition of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue...



9 CFR 310.15 - Disposition of thyroid glands and laryngeal muscle tissue.  

Code of Federal Regulations, 2010 CFR

...2010-01-01 false Disposition of thyroid glands and laryngeal muscle tissue...INSPECTION § 310.15 Disposition of thyroid glands and laryngeal muscle tissue. (a) Livestock thyroid glands and laryngeal muscle tissue...



Chest pain and paralysis after pulse prednisolone therapy an unusual case presentation of thyrotoxic periodic paralysis: a case report  

PubMed Central

Thyrotoxic periodic paralysis is a disease characterized by recurrent episodes of paralysis and hypokalemia during a thyrotoxic state. Thyrotoxic periodic paralysis is a common complication of hyperthyroidism in Asian populations, but can affect other ethnic groups as well. Due to population mobility, Thyrotoxic periodic paralysis is increasingly common in Western countries. Early diagnosis and prompt treatment of the thyrotoxic state and potassium supplementation prevent life-threatening complications associated with hypokalemia and muscle weakness. We present a young Turkish man who developed acute flaccid paralysis after receiving pulse prednisolone therapy for treatment of Pityriasis versicolor. His muscle strength and serum potassium fully recovered after potassium replacement and treatment of the thyrotoxic state which was a consequence of underlying Graves’ disease.

Elznerova, Tereza; Dietrich, Wenke; Schrauzer, Thomas; John, Stefan



Using image processing technology combined with decision tree algorithm in laryngeal video stroboscope automatic identification of common vocal fold diseases.  


This study used the actual laryngeal video stroboscope videos taken by physicians in clinical practice as the samples for experimental analysis. The samples were dynamic vocal fold videos. Image processing technology was used to automatically capture the image of the largest glottal area from the video to obtain the physiological data of the vocal folds. In this study, an automatic vocal fold disease identification system was designed, which can obtain the physiological parameters for normal vocal folds, vocal paralysis and vocal nodules from image processing according to the pathological features. The decision tree algorithm was used as the classifier of the vocal fold diseases. The identification rate was 92.6%, and the identification rate with an image recognition improvement processing procedure after classification can be improved to 98.7%. Hence, the proposed system has value in clinical practices. PMID:23915804

Jeffrey Kuo, Chung-Feng; Wang, Po-Chun; Chu, Yueng-Hsiang; Wang, Hsing-Won; Lai, Chun-Yu



Transoral laser microsurgery for early laryngeal cancer.  


The decision to treat patients suffering from glottic cancer with either radiotherapy or surgery is both complex and controversial. Transoral laser microsurgery is a surgical technique that offers an attractive alternative therapy for laryngeal cancer. In addition to excellent oncologic outcomes and organ preservation, the benefits of transoral laser microsurgery include low morbidity and mortality, shorter periods of hospitalization and exceptional functional results. As the evidence base for the effectiveness of laser surgery grows, transoral laser microsurgery has become established as a valid surgical option for the treatment of early laryngeal cancer. In this article we examine the surgical technique and discuss the oncologic and functional outcomes of transoral laser microsurgery. Furthermore, we offer a vision of the future of endoscopic laser surgery for the management of cancer of the larynx and the upper aerodigestive tract. PMID:20214514

Grant, David G; Repanos, Costa; Malpas, Gemma; Salassa, John R; Hinni, Michael L



Primary laryngeal leishmaniasis: a rare case report.  


Laryngeal leishmaniasis is extremely rare. We report a case of primary laryngeal leishmaniasis in a 70-year-old male who was admitted with complaints of gradual progressive hoarseness of the voice, dyspnea, cough for the past 3 months and noisy breathing for the past 5 days. An X-ray of the soft tissue of the neck showed a prevertebral soft tissue mass causing narrowing of the airway at the C6-C7 vertebral level. A computerized tomography (CT) scan showed a soft tissue mass in the subglottic region causing significant narrowing of the airway. A direct laryngoscopy showed a pinkish-white, friable mass involving the subglottic region and the anterior half of the vocal cords. With the clinical suspicion of malignancy, an endoscopic biopsy was done. A histopathological examination showed diffuse mixed inflammatory cell infiltrate in subepithelium with numerous Leishmania donovani bodies in the cytoplasm of histiocytes. PMID:19136784

Kumar, Bipin; Ghimire, Anand; Karki, Smriti; Upadhyaya, Paricha


Changes in the immunoreactivity of substance P and calcitonin gene-related peptide in the laryngeal taste buds of chronically hypoxic rats.  


The distribution of substance P (SP)- and calcitonin gene-related peptide (CGRP)-immunoreactive nerve fibers in the taste buds of the epiglottis and aryepiglottic folds was compared between normoxic control and chronically isocapnic hypoxic rats (10% O2 and 3-4% CO2 for 3 months). In the normoxic laryngeal taste buds, SP- and CGRP-immunoreactive fibers were detected within the taste buds, where they appeared as thin processes with many varicosities. Most CGRP fibers showed coexistence with SP, but a few fibers showed the immunoreactivity of CGRP only. The density of intra- and subgemmal SP and CGRP fibers penetrating into the laryngeal taste buds was significantly higher in chronically hypoxic rats than in normoxic control rats. Water intake in the hypoxic rats was significantly lower than in the normoxic rats. These results indicate that the increased density of SP- and CGRP-containing nerve fibers within the laryngeal taste buds is a predominant feature of hypoxic adaptation. The altered peptidergic innervation and reduced water intake support the hypothesis that the laryngeal taste buds are involved in water reception, and that the water reception may be under the control of peptidergic innervation. PMID:10963111

Kusakabe, T; Yoshida, T; Matsuda, H; Yamamoto, Y; Hayashida, Y; Kawakami, T; Takenaka, T



Pituitary adenylatecyclase-activating polypeptide-immunoreactive nerve fibers in the rat epiglottis and pharynx.  


The distribution of pituitary adenylatecyclase-activating polypeptide-immunoreactive (PACAP-IR) nerve fibers was studied in the rat epiglottis and pharynx. PACAP-IR nerve fibers were located beneath the mucous epithelium, and occasionally penetrated the epithelium. These nerve fibers were abundant on the laryngeal side of the epiglottis and in the dorsal and lateral border region between naso-oral and laryngeal parts of the pharynx. PACAP-IR nerve fibers were also detected in taste buds within the epiglottis and pharynx. In addition, many PACAP-IR nerve fibers were found around acinar cells and blood vessels. The double immunofluorescence method demonstrated that distribution of PACAP-IR nerve fibers was similar to that in CGRP-IR nerve fibers in the epithelium and taste bud. However, distributions of PACAP-IR and CGRP-IR nerve fibers innervating mucous glands and blood vessels were different. The retrograde tracing method also demonstrated that PACAP and CGRP were co-expressed by vagal and glossopharyngeal sensory neurons innervating the pharynx. These findings suggest that PACAP-IR nerve fibers in the epithelium and taste bud of the epiglottis and pharynx which originate from the vagal and glossopharyngeal sensory ganglia include nociceptors and chemoreceptors. The origin of PACAP-IR nerve fibers which innervate mucous glands and blood vessels may be the autonomic ganglion. PMID:21955674

Kano, Mitsuhiro; Shimizu, Yoshinaka; Suzuki, Yujiro; Furukawa, Yusuke; Ishida, Hiroko; Oikawa, Miho; Kanetaka, Hiroyasu; Ichikawa, Hiroyuki; Suzuki, Toshihiko



Capnometry and the paediatric laryngeal mask airway  

Microsoft Academic Search

The laryngeal mask airway (LMA), an alternative to tracheal intubation in certain situations, has gained popularity in recent\\u000a years. Initially designed for use in adults it has now become available in suitable sizes for paediatric anaesthesia. The\\u000a objectives of this study were to identify the preferred site of sampling the end-tidal carbon dioxide (PetCO2 with the LMA and to determine

I. A. Spahr-Schopfer; B. Bissonnette; E. J. Hartley



Laryngeal biomechanics of the singing voice.  


By transnasal fiberoptic laryngoscopy, patients with functional voice often demonstrate abnormal laryngeal biomechanics, commonly supraglottic contraction. Appropriately, such conditions are sometimes termed muscle tension dysphonias. Singers working at the limits of their voice may also transiently demonstrate comparable tension patterns. However, the biomechanics of normal singing, particularly for different singing styles, have not been previously well characterized. We used transnasal fiberoptic laryngoscopy to study 100 healthy singers to assess patterns of laryngeal tension during normal singing and to determine whether factors such as sex, occupation, and style of singing influence laryngeal muscle tension. Thirty-nine male and 61 female singers were studied; 48 were professional singers, and 52 were amateurs. Examinations of study subjects performing standardized and nonstandardized singing tasks were recorded on a laser disk and subsequently analyzed in a frame-by-frame fashion by a blinded otolaryngologist. Each vocal task was graded for muscle tension by previously established criteria, and objective muscle tension scores were computed. The muscle tension score was expressed as a percentage of frames for each task with one of the laryngeal muscle tension patterns shown. The lowest muscle tension scores were seen in female professional singers, and the highest muscle tension scores were seen in amateur female singers. Male singers (professional and amateur) had intermediate muscle tension scores. Classical singers had lower muscle tension scores than nonclassical singers, with the lowest muscle tension scores being seen in those singing choral music (41%), art song (47%), and opera (57%), and the highest being seen in those singing jazz/pop (65%), musical theater (74%), bluegrass/country and western (86%), and rock/gospel (94%). Analyzed also were the influences of vocal nodules, prior vocal training, number of performance and practice hours per week, warm-up before singing, race, smoking, and alcohol consumption. PMID:8969758

Koufman, J A; Radomski, T A; Joharji, G M; Russell, G B; Pillsbury, D C



Erythromycin in acute laryngitis in adults.  


Moraxella catarrhalis and Hemophilus influenzae are isolated from the nasopharynx in 50% to 55% and 8% to 15%, respectively, of cases of acute laryngitis in adults. This finding indicates that these organisms, M catarrhalis in particular, are in some way involved in the pathogenesis of the disorder. In the present double-blind, placebo-controlled trial, the effect of erythromycin ethylsuccinate (0.5 g twice a day for 5 days) on the elimination of nasopharyngeal pathogens and reduction of clinical signs of upper respiratory tract infection, as well as on subjective complaints, was evaluated in 106 adults with acute laryngitis. The bacterial isolation rates at presentation were M catarrhalis 50%, H influenzae 18%, and Streptococcus pneumoniae 4%. In the 99 patients who completed the study, the elimination of M catarrhalis after 1 week was better in the erythromycin group (25 of 30 cases) than in the placebo group (6 of 19 cases; p < or = .00038). The elimination of H influenzae was unaffected by erythromycin. Otolaryngologic examination did not reveal any significant group differences regarding laryngitis, pharyngitis, or rhinitis. Voice quality was improved after 1 week, irrespective of treatment. However, as compared to the placebo group, the erythromycin group reported fewer voice complaints after 1 week and fewer coughing complaints after 2 weeks. As acute laryngitis in adults is self-limiting, and subjective symptoms are spontaneously reduced after 1 week in most cases, antibiotic treatment does not seem warranted as a general policy. However, erythromycin may be justified in patients who are professionally dependent on voice function. PMID:8457123

Schalén, L; Eliasson, I; Kamme, C; Schalén, C



Extramedullary laryngeal plasmacytoma in a dog  

Microsoft Academic Search

CASE HISTORY:?An 8-year-old, female, spayed Border Collie presented with a 3-week history of coughing, choking and haemoptysis.CLINICAL FINDINGS:?Inspiratory stridor was evident on clinical examination. Cervical radiographs revealed a round soft-tissue mass on the dorsal aspect of the epiglottis. A laryngeal mass was evident on examination under anaesthesia, and an incisional biopsy was obtained. Histopathology revealed a dense proliferation of neoplastic

AI Witham; KE Hill



Extramedullary laryngeal plasmacytoma in a dog  

Microsoft Academic Search

AbstractCASE HISTORY: An 8-year-old, female, spayed Border Collie presented with a 3-week history of coughing, choking and haemoptysis. CLINICAL FINDINGS: Inspiratory stridor was evident on clinical examination. Cervical radiographs revealed a round soft-tissue mass on the dorsal aspect of the epiglottis. A laryngeal mass was evident on examination under anaesthesia, and an incisional biopsy was obtained. Histopathology revealed a dense

A I Witham; A F French; K E Hill



Impact of radiotherapy on laryngeal intrinsic muscles.  


Ionizing radiation as a cancer therapy is associated with a variety of undesirable side effects. Consequently, radiotherapy can negatively affect neuromuscular function. Clinical observations have identified problems with swallowing and voice function. Our study aims to evaluate the impact of radiotherapy on laryngeal soft tissues using image analysis to quantify its effect on the structure of the vocalis and thyroarytenoid muscles. Case control study, retrospective analysis. We collected total laryngectomy specimens from six patients with persistent or recurrent cancer who had received preoperative radiotherapy (60-66 Gy). The control group consisted of total laryngectomy specimens from six patients who underwent surgery as primary treatment. Sampling of the specimens only included non-cancerous laryngeal tissue. Laryngeal histological slices were evaluated using digital morphometric analysis system. Percentage of fibrosis and density of muscle fibers within the thyroarytenoid muscle were evaluated in both groups. We found no significant quantitative differences in muscle fibrosis (7.92% vs. 7.52%, P > 0.1). Changes were rather qualitative and included changes in the organization of the muscular fibers. A significant reduction in muscle fibers, however, was observed in the samples from irradiated larynges (66.45% vs. 42.03%, P < 0.01). Our analysis suggests that radiotherapy is responsible for a significant reduction in muscle fibers in the thyroarytenoid muscle and that these changes occur during treatment or relatively early after its completion. Loss of muscle mass after irradiation correlates with clinical observations of muscle weakness and decreased function in patients who undergo radiotherapy. PMID:21739096

Tedla, Miroslav; Valach, Matúš; Carrau, Ricardo L; Varga, Ivan; Profant, Milan; Mráz, Peter; Weismann, Peter



Thyrotoxic periodic paralysis: clinical and molecular aspects.  


Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism that most often affects young East Asian males but increasingly also in other ethnic groups. The typical presentation is acute attacks varying from mild weakness to total paralysis starting at night or in the early morning a few hours after a heavy meal, alcohol abuse or strenuous exercise with complete recovery within 72 h. Signs and symptoms of hyperthyroidism may not be obvious. The hallmark is hypokalemia from increased cellular sodium/potassium-ATPase pump activity with transport of potassium from the extracellular to the intracellular space in combination with reduced potassium output. Recently, KCNJ18 gene mutations which alter the function of an inwardly rectifying potassium channel named Kir2.6 have been detected in 0-33 % of cases. Hence, the pathophysiology in TPP includes a genetic predisposition, thyrotoxicosis and environmental influences and the relative impact from each of these factors may vary. The initial treatment, which is potassium supplementation, should be given with caution due to a high risk of hyperkalemia. Propranolol is an alternative first-line therapeutic option based on the assumption that hyperadrenergic activity is involved in the pathogenesis. If thyroid function tests are unobtainable in the acute situation the diagnosis is supported by the findings of hypokalemia, low spot urine potassium excretion, hypophosphatemia with hypophosphaturia, high spot urine calcium/phosphate ratio, and electrocardiographic abnormalities as tachycardia, atrial fibrillation, high QRS voltage, and atrioventricular block. Definitive treatment is cure of the hyperthyroidism. The underlying mechanisms of TPP remain, however, incompletely understood awaiting further studies. PMID:22918841

Falhammar, Henrik; Thorén, Marja; Calissendorff, Jan



Paralysis agitans and levodopa in "Ayurveda": ancient Indian medical treatise.  


Neurologic diseases (Vata rogas, Sanskrit) and the pharmacologic treatment of them were described in the ancient Indian medical system--Ayurveda. This article explores paralysis agitans, which was described under the name Kampavata. Mucuna pruriens (Atmagupta, Sanskrit), which contains levodopa, was used in the treatment of Kampavata. Existence of paralysis agitans prior to the industrial revolution is not just of historical interest, but would also suggest that under the hypothesis of exposure to environmental toxins as a possible cause of paralysis agitans, natural organic compounds with worldwide distribution should also be considered. PMID:2404203

Manyam, B V



Parkinson disease affects peripheral sensory nerves in the pharynx.  


Dysphagia is very common in patients with Parkinson disease (PD) and often leads to aspiration pneumonia, the most common cause of death in PD. Current therapies are largely ineffective for dysphagia. Because pharyngeal sensation normally triggers the swallowing reflex, we examined pharyngeal sensory nerves in PD patients for Lewy pathology.Sensory nerves supplying the pharynx were excised from autopsied pharynges obtained from patients with clinically diagnosed and neuropathologically confirmed PD (n = 10) and healthy age-matched controls (n = 4). We examined the glossopharyngeal nerve (cranial nerve IX), the pharyngeal sensory branch of the vagus nerve (PSB-X), and the internal superior laryngeal nerve (ISLN) innervating the laryngopharynx. Immunohistochemistry for phosphorylated ?-synuclein was used to detect Lewy pathology. Axonal ?-synuclein aggregates in the pharyngeal sensory nerves were identified in all of the PD subjects but not in the controls. The density of ?-synuclein-positive lesions was greater in PD patients with dysphagia versus those without dysphagia. In addition, ?-synuclein-immunoreactive nerve fibers in the ISLN were much more abundant than those in cranial nerve IX and PSB-X. These findings suggest that pharyngeal sensory nerves are directly affected by pathologic processes in PD. These abnormalities may decrease pharyngeal sensation, thereby impairing swallowing and airway protective reflexes and contributing to dysphagia and aspiration. PMID:23771215

Mu, Liancai; Sobotka, Stanislaw; Chen, Jingming; Su, Hungxi; Sanders, Ira; Nyirenda, Themba; Adler, Charles H; Shill, Holly A; Caviness, John N; Samanta, Johan E; Sue, Lucia I; Beach, Thomas G



Long-term follow-up study of browlift for treatment of facial paralysis.  


Browlift for patients with irreversible paralysis of the frontalis muscle was evaluated in a review of 40 patients who had undergone follow-up studies for durations of more than 3 years. The procedure consists of a lazy S-shaped excision above the upper border of the eyebrow and upward fixation of the lower skin margin. The results were as follows: (1) The percentage of patients for whom symmetrical positioning of the eyebrow was achieved was 65%. (2) The greater the preoperative severity of ptosis, the more often did recurrence occur. (3) Recurrence progressed rapidly during the first postoperative year, but thereafter recurrence was seen only in those patients in whom the affected eyebrow was still in a position higher than its counterpart. (4) No relationship could be seen between age at the time of surgery and postoperative position of eyebrow. (5) Improvement in contraction of the visual field was seen in 85% of patients postoperatively, and complaints were eliminated in 50%. (6) Careful preservation of the sensory nerve is required. (7) The postoperative scar was acceptable. This procedure is a simple and effective method of correction of paralytic ptosis. Although a degree of skill is required to obtain satisfactory results and a surgical scar remains at the upper border of the eyebrow, the advantages of the procedure surpass its disadvantages. It is believed that this method should be used more often in the treatment of facial paralysis. PMID:8192367

Ueda, K; Harii, K; Yamada, A



Posterior interosseous nerve palsy caused by parosteal lipoma: a case report.  


An 83-year-old woman presented with weakness in her right-hand and wrist extensors and swelling in the proximal part of the right forearm. Electromyography (EMG) confirmed involvement of posterior interosseous nerve at the level of proximal forearm. MR imaging demonstrated the characteristics of lipoma which extended on the anterolateral aspect of the right forearm and at the level of the radius neck. The lesion was parosteal lipoma causing compression and paralysis of the posterior interosseous nerve without sensory deficit. In this paper, posterior interosseous nerve palsy due to compression of a parosteal lipoma recovered after excision of the lipoma followed by intensive rehabilitation for six month. Surgical excision should be performed to ensure optimal recovery from the nerve paralysis. PMID:20811574

Salama, Hatem; Kumar, Pradeep; Bastawrous, Salah



Genetics Home Reference: Infantile-onset ascending hereditary spastic paralysis  


... hereditary spastic paralysis are usually wheelchair-bound by late childhood or early adolescence. Over time, muscle weakness and ... body from the legs to the head. By late childhood or early adolescence, arm and hand muscles are ...


Vocal fold medialization with tragal cartilage and perichondrium in high vagal paralysis.  


The goal of this pilot study was to test vocal fold medialization using autologous tragal cartilage and perichondrium by direct approach for treating high vagal paralysis. Five patients with the skull base tumors with involvement of the vagus nerve underwent concurrent vocal fold medialization with surgical excision. The patients were evaluated preoperatively, and at 14, 60 days, and 6 months later. Complete medialization with horizontal and vertical realignment was achieved. Improvement of voice and breathiness was correlated with the increase of closed quotient; the contact area of the vocal fold mucosa has increased. This advancement reduces breathiness and induced an improvement in subglottic pressure with aerodynamic parameters improvement, which led to stabilization of the vocal fold oscillation and a better voice quality recovery. This method can be considered a safe, quick, and efficient phonosurgical procedure combined with a skull-base surgical procedure. PMID:23494284

Chiril?, Magdalena; Mure?an, Rodica



Diaphragmatic paralysis in children: Diagnosis by TM-mode ultrasound  

Microsoft Academic Search

Diaphragmatic paralysis, a difficult diagnosis in the pediatric age group, has classically been made by fluoroscopy or B-mode ultrasound. We report our experience with TM-mode exploration. Twenty-seven patients suspected to have diaphragmatic paralysis were examined by means of inspiratory and expiratory chest radiography, fluoroscopy and B-mode ultrasound. The diaphragmatic echo was recorded on TM-tracing during spontaneous breathing using coronal oblique

E. Urvoas; D. Pariente; C. Fausser; J. Lipsich; R. Taleb; D. Devictor



Ultrasound monitoring of diaphragm activity in bilateral diaphragmatic paralysis.  

PubMed Central

Recovery of diaphragm activity after bilateral diaphragmatic paralysis was monitored in a term infant using a mechanical sector scanner fitted with a 5 MHz transducer. The ratio of diaphragmatic excursion during spontaneous breathing and ventilator assistance was used an objective measure for comparison of diaphragmatic activity during recovery. Ultrasound assessment of diaphragm contraction may be used to study progress in diaphragmatic paralysis. Images Fig. 1 Fig. 2 Fig. 3

Ambler, R; Gruenewald, S; John, E




Microsoft Academic Search

When producing an ascending scale, e.g. from C2 to E5, two different laryngeal mechanisms, M1 and M2, are used one after the other. To smooth both laryngeal and timbre transitions, singers develop a vocal technique called \\

Nathalie. Henric


Management of laryngeal radionecrosis: Animal and clinical experience  

Microsoft Academic Search

Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are

Randy W. Oppenheimer; Yosef P. Krespi; Robert K. Einhorn



Preservation of the Larynx in Laryngeal and Hypopharyngeal Cancer  

Microsoft Academic Search

In the last decade the primary treatment of laryngeal and hypopharyngeal cancer was shifted towards organ preservation, i.e. preservation of the larynx. The treatment of laryngeal cancer was changed from standard radiotherapy towards hyperfractionated radiotherapy. Hypopharyngeal cancer is nowadays mostly treated with a combination of chemotherapy and radiotherapy instead of primary surgery. Therefore, the greatest shift in treatment protocols found

Aniel Sewnaik



Laryngeal scleroma associated with Klebsiella pneumoniae subsp. ozaenae.  


Klebsiella pneumoniae subsp. ozaenae was isolated from the pharynx of a woman with laryngeal scleroma. K. pneumoniae subsp. ozaenae is rarely isolated from clinical infections and has never been reported in laryngeal scleroma, which is usually caused by K. pneumoniae subsp. rhinoscleromatis. PMID:16272528

De Champs, C; Vellin, J F; Diancourt, L; Brisse, S; Kemeny, J L; Gilain, L; Mom, T



Laryngeal Scleroma Associated with Klebsiella pneumoniae subsp. ozaenae  

PubMed Central

Klebsiella pneumoniae subsp. ozaenae was isolated from the pharynx of a woman with laryngeal scleroma. K. pneumoniae subsp. ozaenae is rarely isolated from clinical infections and has never been reported in laryngeal scleroma, which is usually caused by K. pneumoniae subsp. rhinoscleromatis.

De Champs, C.; Vellin, J. F.; Diancourt, L.; Brisse, S.; Kemeny, J. L.; Gilain, L.; Mom, T.



Laryngitis from Reflux: Prevention for the Performing Singer  

Microsoft Academic Search

Laryngitis is a generic term for inflammation or irritation of the laryngeal tissues. The inflammation can be caused by any kind of injury, including infection, smoking, contact with caustic or acidic substance, allergic reaction, or direct trauma. Inflammatory response of the tissues includes leakage of fluid from blood vessels with edema or swelling, congregation of white blood cells, which release

David G. Hanson; Jack J. Jiang


Observation of the laryngeal movements for throat singing  

Microsoft Academic Search

Throat singing is a traditional singing style of people who live around the Altai Mountains. Khoomei in Tyva and Khoomij in Mongolia are representative styles of throat singing. The laryngeal voices of throat singing is classified into (i) a drone voice which is the basic laryngeal voice in throat singing and used as drone and (ii) a kargyraa voice which

Ken-Ichi Sakakibara; Tomoko Konishi; Emi Z. Murano; Hiroshi Imagawa; Masanobu Kumada; Kazumasa Kondo; Seiji Niimi



Congenital Laryngeal Cyst: A Rare Cause of Polyhydramnios  

PubMed Central

Congenital laryngeal cyst is a rare cause of airway obstruction that may require urgent diagnosis and treatment. We report a case of a neonate having history of polyhydramnios and severe respiratory distress at birth. A laryngeal cyst detected during intubation. The outcome of laryngoscopic treatment of the cyst was favorable.

Suslu, Nilda; Demirel, Gamze; Celik, Istemihan; Canpolat, Fuat Emre; Erdeve, Omer; Akyol, Umut; Dilmen, Ugur



Laryngeal Motor Cortex and Control of Speech in Humans  

PubMed Central

Speech production is one of the most complex and rapid motor behaviors and involves a precise coordination of over 100 laryngeal, orofacial and respiratory muscles. Yet, we lack a complete understanding of laryngeal motor cortical control during production of speech and other voluntary laryngeal behaviors. In recent years, a number of studies have confirmed the laryngeal motor cortical representation in humans and provided some information about its interactions with other cortical and subcortical regions that are principally involved in vocal motor control of speech production. In this review, we discuss the organization of the peripheral and central laryngeal control based on neuroimaging and electrical stimulation studies in humans and neuroanatomical tracing studies in non-human primates. We hypothesize that the location of the laryngeal motor cortex in the primary motor cortex and its direct connections with the brainstem laryngeal motoneurons in humans, as oppose to its location in the premotor cortex with only indirect connections to the laryngeal motoneurons in non-human primates, may represent one of the major evolutionary developments in humans towards the ability to speak and vocalize voluntarily.

Simonyan, Kristina; Horwitz, Barry



[The use of eurespal for the treatment of chronic laryngitis].  


The author provides a rationale for the use of eurespal for the treatment of chronic laryngitis based on the pathogenetic concept of pathological condition. The results of a clinical study designed to evaluate the efficiency and safety of eurespal therapy in patients with chronic laryngitis are presented. PMID:21378745

Riabova, M A



Selective activation of the human tibial and common peroneal nerves with a flat interface nerve electrode.  


Objective. Electrical stimulation has been shown effective in restoring basic lower extremity motor function in individuals with paralysis. We tested the hypothesis that a flat interface nerve electrode (FINE) placed around the human tibial or common peroneal nerve above the knee can selectively activate each of the most important muscles these nerves innervate for use in a neuroprosthesis to control ankle motion. Approach. During intraoperative trials involving three subjects, an eight-contact FINE was placed around the tibial and/or common peroneal nerve, proximal to the popliteal fossa. The FINE's ability to selectively recruit muscles innervated by these nerves was assessed. Data were used to estimate the potential to restore active plantarflexion or dorsiflexion while balancing inversion and eversion using a biomechanical simulation. Main results. With minimal spillover to non-targets, at least three of the four targets in the tibial nerve, including two of the three muscles constituting the triceps surae, were independently and selectively recruited in all subjects. As acceptable levels of spillover increased, recruitment of the target muscles increased. Selective activation of muscles innervated by the peroneal nerve was more challenging. Significance. Estimated joint moments suggest that plantarflexion sufficient for propulsion during stance phase of gait and dorsiflexion sufficient to prevent foot drop during swing can be achieved, accompanied by a small but tolerable inversion or eversion moment. PMID:23918148

Schiefer, M A; Freeberg, M; Pinault, G J C; Anderson, J; Hoyen, H; Tyler, D J; Triolo, R J



Selective activation of the human tibial and common peroneal nerves with a flat interface nerve electrode  

NASA Astrophysics Data System (ADS)

Objective. Electrical stimulation has been shown effective in restoring basic lower extremity motor function in individuals with paralysis. We tested the hypothesis that a flat interface nerve electrode (FINE) placed around the human tibial or common peroneal nerve above the knee can selectively activate each of the most important muscles these nerves innervate for use in a neuroprosthesis to control ankle motion. Approach. During intraoperative trials involving three subjects, an eight-contact FINE was placed around the tibial and/or common peroneal nerve, proximal to the popliteal fossa. The FINE's ability to selectively recruit muscles innervated by these nerves was assessed. Data were used to estimate the potential to restore active plantarflexion or dorsiflexion while balancing inversion and eversion using a biomechanical simulation. Main results. With minimal spillover to non-targets, at least three of the four targets in the tibial nerve, including two of the three muscles constituting the triceps surae, were independently and selectively recruited in all subjects. As acceptable levels of spillover increased, recruitment of the target muscles increased. Selective activation of muscles innervated by the peroneal nerve was more challenging. Significance. Estimated joint moments suggest that plantarflexion sufficient for propulsion during stance phase of gait and dorsiflexion sufficient to prevent foot drop during swing can be achieved, accompanied by a small but tolerable inversion or eversion moment.

Schiefer, M. A.; Freeberg, M.; Pinault, G. J. C.; Anderson, J.; Hoyen, H.; Tyler, D. J.; Triolo, R. J.



Variations in the surface anatomy of the spinal accessory nerve in the posterior triangle  

Microsoft Academic Search

Iatrogenic injury to the spinal accessory nerve has been widely documented and can have medico-legal implications. The resulting\\u000a syndrome of pain, paralysis and winging of the scapula are often the source of considerable morbidity. This paper researches\\u000a the degree of accuracy achievable in mapping the surface anatomy of the spinal accessory nerve in the region of the posterior\\u000a triangle with

A Symes; H Ellis



Shortness of breath after AV ablation: case of left phrenic nerve palsy  

PubMed Central

Phrenic nerve palsy has been recognized as a complication of catheter ablation with a prevalence of 0.11–0.48% after atrial fibrillation ablation, independent of the type of ablation catheter or energy source, likely due to the anatomical relationship of the nerves. This report describes a case of new onset of shortness of breath (SOB) due to left diaphragm paralysis following transcatheter radiofrequency ablation in a patient with underlying chronic obstructive pulmonary disease.

Lambiris, Irene; Mehta, Jinesh; Helguera, Marcelo



Hypokalemic periodic paralysis as first sign of thyrotoxicosis  

PubMed Central

Background: periodic paralysis related to hypokalemia is seldom reported in thyrotoxicosis, and it usually occurs in Asian males. Patients and methods: Two Romanian (Caucasian) young patients presented with hypokalemic paralysis. TSH, FT4, TT3 was measured by immunochemiluminescence. Case report 1. Patient O.R, aged 19, presented marked asthenia and lower limbs paralysis, following high carbohydrate meal. He declared 10 kg weight loss on hypocaloric diet and mild sweating. Biochemical data revealed moderate hypokalemia (K+=2.6 mmol/L) and thyrotoxicosis (TSH<0.03 mIU/L, FT4=30 pmol/L, TT3=315 ng/dL). Case report 2. Patient T.A., aged 18, presented 2 episodes of weakness and flaccid paralysis, with hypokalemia, precipitated by effort, without any sign of thyrotoxicosis. Biochemical data revealed severe hypokalemia (K+=1.8 mmol/L) and thyrotoxicosis (TSH<0.03 mIU/L, FT4=24 pmol/L, TT3=190 ng/dL). Treatment with intravenous potassium, thereafter methimazole and propranolol were administered in both cases, with the maintenance of normal kalemia and thyrotoxicosis’ control. Conclusion: these 2 cases of hypokalemic periodic paralysis occurring in young Caucasian teenagers with mild thyrotoxicosis underlined the importance of thyroid screening in patients with symptomatic hypokalemia, even in the absence of symptoms and signs of thyrotoxicosis. Abbreviations: THPP=Thyrotoxic periodic paralysis, BMI=body mass index, TRAb=TSH receptor antibody, ECG=electrocardiogram.

Trifanescu, RA; Danciulescu Miulescu, R; Carsote, M; Poiana, C



Sleep paralysis, sexual abuse, and space alien abduction.  


Sleep paralysis accompanied by hypnopompic ('upon awakening') hallucinations is an often-frightening manifestation of discordance between the cognitive/perceptual and motor aspects of rapid eye movement (REM) sleep. Awakening sleepers become aware of an inability to move, and sometimes experience intrusion of dream mentation into waking consciousness (e.g. seeing intruders in the bedroom). In this article, we summarize two studies. In the first study, we assessed 10 individuals who reported abduction by space aliens and whose claims were linked to apparent episodes of sleep paralysis during which hypnopompic hallucinations were interpreted as alien beings. In the second study, adults reporting repressed, recovered, or continuous memories of childhood sexual abuse more often reported sleep paralysis than did a control group. Among the 31 reporting sleep paralysis, only one person linked it to abuse memories. This person was among the six recovered memory participants who reported sleep paralysis (i.e. 17% rate of interpreting it as abuse-related). People rely on personally plausible cultural narratives to interpret these otherwise baffling sleep paralysis episodes. PMID:15881271

McNally, Richard J; Clancy, Susan A



Paralaryngeal Abscess with Laryngeal Hemiplegia and Fistulation in a Horse  

PubMed Central

A three year old Thoroughbred filly was examined because of bilateral nasal discharge and external swelling of the left laryngeal area. Endoscopy revealed an enlarged left arytenoid cartilage, left laryngeal hemiplegia and drainage of purulent material into the lumen of the larynx. Radiographs showed a large fluid and gas filled cavity overlying the caudal larynx and cranial trachea. Surgical drainage and debridement of the abscess led to complete healing by secondary intention. Laryngeal ventriculectomy was performed as a treatment for left laryngeal hemiplegia, but a grave prognosis for respiratory soundness was given due to the extensive laryngeal fibrosis. The etiology of the Staphylococcus aureus abscess is unknown but may have originated from oral trauma to the larynx. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.

Barber, S. M.



Paralaryngeal abscess with laryngeal hemiplegia and fistulation in a horse.  


A three year old Thoroughbred filly was examined because of bilateral nasal discharge and external swelling of the left laryngeal area. Endoscopy revealed an enlarged left arytenoid cartilage, left laryngeal hemiplegia and drainage of purulent material into the lumen of the larynx. Radiographs showed a large fluid and gas filled cavity overlying the caudal larynx and cranial trachea. Surgical drainage and debridement of the abscess led to complete healing by secondary intention. Laryngeal ventriculectomy was performed as a treatment for left laryngeal hemiplegia, but a grave prognosis for respiratory soundness was given due to the extensive laryngeal fibrosis. The etiology of the Staphylococcus aureus abscess is unknown but may have originated from oral trauma to the larynx. PMID:7337917

Barber, S M



Neurotherapeutic action of testosterone on hamster facial nerve regeneration: temporal window of effects  

Microsoft Academic Search

Neurotherapeutic or neuroprotective effects of gonadal steroids on the injured nervous system have been demonstrated in our laboratory and others. We have previously demonstrated that testosterone propionate (TP) administered systemically at supraphysiological levels accelerates both recovery from facial paralysis and regeneration rates following facial nerve injury in the hamster. Initial temporal studies of steroidal enhancement of functional recovery from facial

Lisa Tanzer; Kathryn J Jones



Pinched Nerve  


... take about one hour: Nerve conduction study. Patch-style electrodes are placed on your skin to stimulate ... not-for-profit organization and proceeds from Web advertising help support our mission. Mayo Clinic does not ...


Nerve Injuries  


... educated." After the nerve has recovered, sensory re-education may be needed to improve feeling to the hand or finger. This involves physician therapy and the appropriate therapy based on the nature of the injury will be recommended ...


Nerve conduction  

MedlinePLUS Videos and Cool Tools

... fascicles) that contain hundreds of individual nerve fibers (neurons). Neurons consist of dendrites, axon, and cell body. The ... tree-like structures that receive signals from other neurons and from special sensory cells that sense the ...


Direct Brain Control and Communication in Paralysis.  


Despite considerable growth in the field of brain-computer or brain-machine interface (BCI/BMI) research reflected in several hundred publications each year, little progress was made to enable patients in complete locked-in state (CLIS) to reliably communicate using their brain activity. Independent of the invasiveness of the BCI systems tested, no sustained direct brain control and communication was demonstrated in a patient in CLIS so far. This suggested a more fundamental theoretical problem of learning and attention in brain communication with BCI/BMI, formulated in the extinction-of-thought hypothesis. While operant conditioning and goal-directed thinking seems impaired in complete paralysis, classical conditioning of brain responses might represent the only alternative. First experimental studies in CLIS using semantic conditioning support this assumption. Evidence that quality-of-life in locked-in-state is not as limited and poor as generally believed draise doubts that "patient wills" or "advanced directives"signed long-before the locked-in-state are useful. On the contrary, they might be used as an excuse to shorten anticipated long periods of care for these patients avoiding associated financial and social burdens. Current state and availability of BCI/BMI systems urge a broader societal discourse on the pressing ethical challenges associated with the advancements in neurotechnology and BCI/BMI research. PMID:23536247

Birbaumer, Niels; Gallegos-Ayala, Guillermo; Wildgruber, Moritz; Silvoni, Stefano; Soekadar, Surjo R



Laryngeal neurofibroma: case report of a child.  


Neurofibromatosis is characterized by multiple café-au-lait spots and cutaneous neurofibromas. Laryngeal involvement in neurofibromatosis is rare and is usually manifested by obstructive airway symptoms. We encountered a 1 year 8-month-old girl who was a victim of neurofibromatosis with the presentation of stridor. Fiberoptic laryngoscopy revealed a round smooth mass over the right aryepiglottic fold which prolapsed into the larynx during inspiration. Carbon dioxide laser excision was performed and histopathologic examination revealed a plexiform neurofibroma. The patient had regular follow up for almost 4 years. Even though there seemed to be a recurrence, she remained symptom free. PMID:12176190

Chen, Yu-Chun; Lee, Kuo-Sheng; Yang, Cheng-Chien; Chang, Ke-Chang



[Oral blastomycosis, laryngeal papillomatosis and esophageal tuberculosis].  


Esophageal involvement is an extremely rare complication of tuberculosis even in countries with high prevalence of infection. We report the case of a 57 year-old hiv-seronegative patient with simultaneous diagnoses of oral blastomycosis and laryngeal papillomatosis. Both were confirmed by anatomopathological analysis. The esophageal biopsy revealed granulomatous esophagitis with necrosis and ziehl-neelsen stain showed acid-fast alcohol resistant bacilli suggestive of tuberculosis. The patient's history included pulmonary tuberculosis twice and previous abandonment of therapy. Thus, it was necessary to use oral itraconazole combined with second-line anti-tuberculosis drugs administered through a gastrostomy tube. The clinical development was favorable. PMID:22858774

Montoya, Manuel; Chumbiraico, Robert; Ricalde, Melvin; Cazorla, Ernesto; Hernández-Córdova, Gustavo



Autofluorescence spectroscopic imaging for laryngeal cancer detection  

NASA Astrophysics Data System (ADS)

Autofluorescence imaging has shown a high sensitivity for early diagnosis and detection of cancer and precancer in humans, however, this diagnostic technique has a limitation with high false positive rates resulting in a low diagnostic specificity. In this study, we develop an endoscope-based autofluorescence imaging system in combination with spectroscopy measurement system for tissue diagnostics and characterization in the head and neck. The results show that combining the spectroscopy and imaging techniques can improve both the diagnostic sensitivity and specificity for discriminating laryngeal carcinoma from normal tissue.

Kan, Lin; Zheng, Wei; Huang, Zhiwei



Functional reconstruction after facial paralysis: A survey  

Microsoft Academic Search

The attempt to achieve symmetrical harmonious facial expression represents a complex surgical challenge, necessitating an individualized approach. Clinical investigations and laboratory experiments have demonstrated how to better reconstruct a “smile.” In long-standing deformities, ipsilateral or crossfacial nerve grafting followed by functional muscle transfer in a 2-stage procedure seems to give the most acceptable results; however, hypoglossal-facial anastomosis and dynamic muscle

Alfred Berger; Hans J. G. Bargmann



The Acute bee paralysis virus-Kashmir bee virus-Israeli acute paralysis virus complex.  


Acute bee paralysis virus (ABPV), Kashmir bee virus (KBV) and Israeli acute paralysis virus (IAPV) are part of a complex of closely related viruses from the Family Dicistroviridae. These viruses have a widespread prevalence in honey bee (Apis mellifera) colonies and a predominantly sub-clinical etiology that contrasts sharply with the extremely virulent pathology encountered at elevated titres, either artificially induced or encountered naturally. These viruses are frequently implicated in honey bee colony losses, especially when the colonies are infested with the parasitic mite Varroa destructor. Here we review the historical and recent literature of this virus complex, covering history and origins; the geographic, host and tissue distribution; pathology and transmission; genetics and variation; diagnostics, and discuss these within the context of the molecular and biological similarities and differences between the viruses. We also briefly discuss three recent developments relating specifically to IAPV, concerning its association with Colony Collapse Disorder, treatment of IAPV infection with siRNA and possible honey bee resistance to IAPV. PMID:19909972

de Miranda, Joachim R; Cordoni, Guido; Budge, Giles



Influence of age on laryngeal carcinoma.  


The constant increase in human life expectancy has led to a higher proportion of oncologic patients of advanced age. The clinical characteristics of 272 patients with laryngeal carcinoma diagnosed when they were 70 or older are compared with those of a group of younger patients with the same kind of tumor. The advanced age group showed a higher proportion of women, less tobacco and alcohol use, a predominance of glottic location, and a higher previous morbidity. The T category was similar in both groups, but the advanced age group had a higher proportion of N0 tumors. The planning of treatment was similar in the two groups of patients, except for less use of both chemotherapy and partial larynx surgery in the advanced age group. Results in terms of local and regional control, distant metastasis, and 5-year adjusted survival were similar in both groups of patients. The results suggest that advanced age is not a determining factor when considering radical treatment in a patient with laryngeal carcinoma. PMID:9486912

León, X; Quer, M; Agudelo, D; López-Pousa, A; De Juan, M; Diez, S; Burgués, J



Diet, cigarettes and alcohol in laryngeal cancer  

SciTech Connect

Diet and other risk factors for cancer of the larynx were examined in a case-control study among white males in Western New York, conducted in 1975-1985. Incident, pathologically-confirmed cases and age- and neighborhood-matched controls were interviewed to determine usual diet, and lifetime use of tobacco and alcohol. Because response rates were low for both cases and controls, this cannot be considered a population-based study. A strong association of risk with cigarette but not pipe and cigar smoking was found. Beer and hard liquor but not wine were associated with increased risk. After control for cigarettes, alcohol and education, the upper quartile odds ratio for fat was 2.40, while the odds ratio for high intake of carotenoids was 0.51. There was effect modification by smoking. Carotenoids were most negatively associated with risk among lighter smokers; dietary fat was most positively associated with risk among heavier smokers. Total calories, protein, and retinol were associated with increased risk; there was no relationship between laryngeal cancer and vitamins C and E or carbohydrate. This study again demonstrates the strong association between tobacco and alcohol and laryngeal cancer and also suggests that diets low in carotenoids and high fat may increase risk.

Freudenheim, J.L.; Graham, S.; Byers, T.E.; Marshall, J.R.; Haughey, B.P.; Swanson, M.K.; Wilkinson, G. (State Univ. of New York, Buffalo (United States))



[Incomplete anterior interosseous nerve syndrome in a guitar player].  


A rare case of median nerve compression syndrome is reported in a guitar player who had changed the posture and position of his instrument so that the edge of the guitar exerted sharp pressure on the median nerve close to the branching of the interosseous anterior nerve. There was partial paralysis of the interosseous anterior nerve with complete failure of the deep flexor of the index finger, while the flexor pollicis longus was intact. There was also paresthesia of the index finger. Treatment was conservative with a sleeve including a gel cushion which protected the forearm against the edge of the instrument. Function recurred completely within six weeks without ever interrupting instrument practice. PMID:16388458

Rieck, B



Bilateral facial nerve palsy: a diagnostic dilemma.  


Introduction. Bilateral facial nerve palsy (FNP) is a rare condition, representing less than 2% of all cases of FNP. Majority of these patients have underlying medical conditions, ranging from neurologic, infectious, neoplastic, traumatic, or metabolic disorders. Objective. The differential diagnosis of its causes is extensive and hence can present as a diagnostic challenge. Emergency physicians should be aware of these various diagnostic possibilities, some of which are potentially fatal. Case Report. We report a case of a 43-year-old female who presented to the emergency department with sequential bilateral facial nerve paralysis which could not be attributed to any particular etiology and, hence, presented a diagnostic dilemma. Conclusion. We reinforce the importance of considering the range of differential diagnosis in all cases presenting with bilateral FNP. These patients warrant admission and prompt laboratory and radiological investigation for evaluation of the underlying cause and specific further management as relevant. PMID:23326715

Pothiawala, Sohil; Lateef, Fatimah



Respiratory neuronal activity during apnea and other breathing patterns induced by laryngeal stimulation.  


Respiration cycles through three distinct phases (inspiration, postinspiration, and expiration) each having corresponding medullary cells that are excited during one phase and inhibited during the other two. Laryngeal stimulation is known to induce apnea in newborn animals, but the cellular mechanisms underlying this effect are not known. Intracellular recording of ventral respiratory group neurons was accomplished in intact anesthetized, paralyzed, and mechanically ventilated piglets. Apnea was induced by insufflation of the larynx with ammonia-saturated air, smoke, or water. Laryngeal insufflation induced phrenic nerve apnea, stimulation of postinspiratory neurons, and stable membrane potentials in inspiratory and expiratory cells consistent with postinspiratory inhibition. Usually the membrane potential of each neuronal type cycled through an expiratory level before onset of the first recovery breath. Variants of the apnea response, probably reflecting the aspiration reflex or sniffing, sneezing, coughing, and swallowing, were also observed. These latter patterns showed oscillation between inspiration and postinspiration without an apparent intervening stage II expiratory phase. However, stage II expiratory activity always preceded onset of the first ramp inspiration after such a pattern. These findings suggest that activation of postinspiratory mechanisms causes profound alterations in the respiratory pattern and that stage II expiration importantly modulates recovery of ramp inspiratory activity. The mechanism of this latter effect may be inhibition of early inspiratory neurons with consequent postinhibitory rebound. PMID:1885471

Lawson, E E; Richter, D W; Czyzyk-Krzeska, M F; Bischoff, A; Rudesill, R C



Laryngeal sarcoidosis: a case report presenting transglottic involvement.  


Isolated laryngeal sarcoidosis is a very rare disease. In most cases, it will present as a supraglottic pale edematous swelling. In our case, the patient presented with hoarseness and dyspnea during exertion. Laryngeal examination did show not only supraglottic edema but also prominent subglottic swelling and edematous true vocal folds. Histology showed noncaseating granulomas. After excluding other causes and localizations, the patient was diagnosed with laryngeal sarcoidosis and treated with systemic corticosteroid with good result. We describe our case of isolated transglottic sarcoidosis and discuss the disease, its presentation, diagnosis, and therapeutic options. PMID:23688969

van den Broek, Emke M J M; Heijnen, Bas J; Verbist, Berit M; Sjögren, Elisabeth V



Causes of death of patients with laryngeal cancer.  


Despite remarkable advances in the care of patients with laryngeal cancer over the past several decades, including a growing awareness of therapeutic complications and attention to quality of life, little is known about the causes of mortality in this population. In addition to the laryngeal malignancy itself, acute and late or chronic treatment-associated causes, second primary cancers, intercurrent disease and psychosocial factors are all responsible for patient morbidity and mortality. We examine the current literature related to the causes of death in patients with laryngeal cancer, in the hope of guiding future interventions to improve the longevity and quality of life of individuals with this cancer. PMID:23591796

Ferlito, Alfio; Haigentz, Missak; Bradley, Patrick J; Suárez, Carlos; Strojan, Primož; Wolf, Gregory T; Olsen, Kerry D; Mendenhall, William M; Mondin, Vanni; Rodrigo, Juan P; Boedeker, Carsten C; Hamoir, Marc; Hartl, Dana M; Hunt, Jennifer L; Devaney, Kenneth O; Thompson, Lester D R; Rinaldo, Alessandra; Takes, Robert P



Malignant granular cell tumor in larynx mimicking laryngeal carcinoma.  


A 72-year-old man presented to our clinic with progressed husky voice, dysphagia and globus pharyngeus. Fiberoptic laryngoscopy showed a large subglottic mass with an irregular surface. A chest roentgenogram revealed multiple nodules over the right upper and lower lobes. Under the impression of malignant laryngeal tumor with lung metastasis, he underwent direct laryngeal biopsy and excision. Pathologic findings showed malignant granular cell tumor. Postoperative palliative chemotherapy was done for his lung metastasis. The multiple pulmonary nodules were decreased in size and number but not complete remission. The laryngeal tumor has not recurred after a 14-month follow-up. PMID:15239036

Chiang, Ming-Ju; Fang, Tuan-Jen; Li, Hseuh-Yu; Chen, I-How; Lee, Kam-Fai



PubMed Central

1. Inoculation of suspensions of brain, cord, ganglia or nerves of chickens with neurolymphomatous lesions, into newly hatched chicks, is followed by the development of typical lesions in approximately 25 per cent of cases. 2. In control chickens kept under laboratory conditions the incidence of the disease is about 7 per cent. 3. The disease does not become manifest until at least 2 months after inoculation; symptoms may not appear until after 4 months. 4. The active agent is not destroyed by 50 per cent glycerol in 9 days at ice box temperature.

Pappenheimer, Alwin M.; Dunn, Leslie C.; Seidlin, S. M.



Early diagnosis and stage classification of vocal cord abductor paralysis in patients with multiple system atrophy.  

PubMed Central

OBJECTIVES: Vocal cord abductor paralysis (VCAP) is a life threatening complication which may cause nocturnal sudden death in patients with multiple system atrophy. However, the early diagnosis of VCAP is often difficult to make on routine laryngoscopy performed during wakefulness, as stridor, which is the sole symptom of VCAP in the early stage, develops only during sleep. The aim was to investigate laryngeal dysfunction in patients with multiple system atrophy while awake and asleep. METHODS: Seven patients with multiple system atrophy with nocturnal stridor and five control patients were studied. Vocal cord movement was analysed by laryngoscopy while the patients were awake and also during sleep induced by intravenous diazepam. RESULTS: When awake, for the seven patients with multiple system atrophy normal movement of the vocal cords occurred in three, mild abduction restriction in three, and paradoxical movement in one. When asleep, however, all showed obvious paradoxical movement with high pitched inspiratory stridor. In controls, there were no differences in the vocal cord movement between wakefulness and sleep. From these findings, VCAP could be divided into four stages: stage 0 (normal) with normal vocal cord movement during both wakefulness and sleep, stage 1 (mild VCAP) with normal movement during wakefulness and paradoxical movement during sleep, stage 2 (moderately severe VCAP) with abduction restriction during wakefulness and paradoxical movement during sleep, and stage 3 (severe VCAP) with an almost midline position for the vocal cords during both wakefulness and sleep. CONCLUSIONS: Laryngoscopy during sleep can disclose subclinical VCAP, making an early diagnosis of VCAP in patients with multiple system atrophy. Stage 2 of VCAP seems to be a suitable stage for tracheostomy in patients with multiple system atrophy. Images

Isozaki, E; Naito, A; Horiguchi, S; Kawamura, R; Hayashida, T; Tanabe, H



Prediction of Facial Nerve Function After Surgery for Cerebellopontine Angle Tumors  

PubMed Central

A series of 18 patients undergoing surgery for cerebellopontine angle tumors is reported. Patients were grouped according to size of tumor (0 to 2.5 cm, 11 cases; more than 2.5 cm, 7 cases). In all, the facial nerve was identified and conductance assessed by monitoring the facial electromyographic response to facial nerve stimulation. Postoperative facial nerve function was graded clinically after 3 months according to the House scale. Tumor removal was complete in all cases. In patients with tumors up to 2.5 cm the facial nerve was intact to visual inspection at the end of the procedure in all but one, where partial division was evident. In this group intraoperative facial nerve stimulation indicated electrical integrity in 8 of the 11 cases, all of which regained good facial nerve function postoperatively (House grades I and II). Nerve conduction was lost during the operation in the remaining three patients with small tumors; two subsequently developed a moderately severe (grade IV) dysfunction and the third, a total paralysis (grade VI). In the large (more than 2.5 cm) tumor group the facial nerve was anatomically intact in five of the seven cases, partially divided in one, and completely sectioned in the remaining case. Facial nerve stimulation indicated functional integrity in three patients, two of whom developed moderate (grade III) and the third a severe (grade V) dysfunction. In the other four cases nerve function could not be detected at operation; three of these developed a moderate facial nerve dysfunction (grade III/IV) and the final case a complete paralysis (grade VI). Intraoperative facial nerve monitoring appeared to predict eventual facial function accurately in the small tumor group, but did not predict facial nerve recovery reliably following surgery for larger tumors.

Kirkpatrick, P. J.; Watters, G.; Strong, A. J.; Walliker, J. R.; Gleeson, M. J.



Not all facial paralysis is Bell's palsy: a case report.  


Bell's palsy or idiopathic facial paralysis is the most common cause of unilateral facial paralysis. This case report describes a patient referred for physical therapy evaluation and treatment with a diagnosis of Bell's palsy. On initial presentation in physical therapy the patient had unilateral facial paralysis, ipsilateral regional facial pain and numbness, and a history of a gradual, progressive onset of symptoms. The process of evaluating this patient in physical therapy, as well as the recognition of signs and symptoms typical and atypical of Bell's palsy, are described. This report emphasizes the importance of early recognition of the signs and symptoms inconsistent with a diagnosis of Bell's palsy, and indications for prompt, appropriate referral for additional diagnostic services. PMID:10414775

Brach, J S; VanSwearingen, J M



Clinical features of Todd's post-epileptic paralysis.  

PubMed Central

Two hundred and twenty nine patients with generalised tonic-clonic seizures were prospectively evaluated. Fourteen were identified who had transient focal neurological deficits thought to be Todd's post-epileptic paralysis (PEP). Eight of these 14 patients had underlying focal brain lesions associated with the postictal deficits. All patients with PEP were weak, but there was wide variation in the pattern (any combination of face, arm, leg), severity (plegia to mild), tone (spastic, flaccid, or normal), and reflexes (increased, decreased, or normal). Significant sensory loss occurred in only one patient. The only other signs of PEP were aphasia (in five patients all with underlying lesions) and gaze palsy (in four patients). Post-epileptic paralysis persisted from half an hour to 36 hours (mean of 15 hours). Post-epileptic paralysis may occur with the first seizure or after many years of seizures and does not appear after every seizure. The clinical features of PEP are thus heterogeneous.

Rolak, L A; Rutecki, P; Ashizawa, T; Harati, Y



Facial reanimation with masseteric nerve: babysitter or permanent procedure? Preliminary results.  


The authors are presenting a series of 10 cases of complete unilateral facial paralysis submitted to (I) end-to-end microsurgical coaptation of the masseteric branch of the trigeminal nerve and distal branches of the paralyzed facial nerve, and (II) cross-face sural nerve graft. The ages of the patients ranged from 5 to 63 years (mean: 44.1 years), and 8 (80%) of the patients were females. The duration of paralysis was no longer than 18 months (mean: 9.7 months). Follow-up varied from 6 to 18 months (mean: 12.6 months). Initial voluntary facial movements were observed between 3 and 6 months postoperatively (mean: 4.3 months). All patients were able to produce the appearance of a smile when asked to clench their teeth. Comparing the definition of the nasolabial fold and the degree of movement of the modiolus on both sides of the face, the voluntary smile was considered symmetrical in 8 cases. Recovery of the capacity to blink spontaneously was not observed. However, 8 patients were able to reduce or suspend the application of artificial tears. The authors suggest consideration of masseteric-facial nerve coaptation, whether temporary (baby-sitter) or permanent, as the principal alternative for reconstruction of facial paralysis due to irreversible nerve lesion with less than 18 months of duration. PMID:19801918

Faria, Jose Carlos Marques; Scopel, Gean Paulo; Ferreira, Marcus Castro



21 CFR 874.3730 - Laryngeal prosthesis (Taub design).  

Code of Federal Regulations, 2013 CFR

...3730 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES EAR, NOSE, AND THROAT DEVICES Prosthetic Devices § 874.3730 Laryngeal prosthesis (Taub design). (a)...



Laryngeal spasm after general anaesthesia due to Ascaris lumbricoides.  


Postoperative upper airway obstruction during recovery from general anaesthesia may have several causes. This is a report of a young girl who developed laryngeal spasm as a result of an ectopic roundworm Ascaris lumbricoides. PMID:23679043

Finsnes, K D



Electroglottography and laryngeal articulation in speech.  


Electroglottography (EGG) has been used for investigating the functioning of the vocal folds during vibration. EGG is related to the patterns of vocal fold vibration during phonation and characterizes the temporal patterns of each vibratory cycle. The purpose of this study was to investigate the dynamic changes in EGG waveforms during continuous speech. Aerodynamic signals, air pressure and airflow were evaluated simultaneously with EGG waveforms. Fundamental frequency (F0), open quotient (OQ) and baseline shift of the EGG during speech production were measured for three types of Korean consonants using EGG waveforms. The glottal airway resistance during speech production was measured using aerodynamic waveforms, and evaluated for the relationship with F0, OQ and baseline shift. The results indicated that the EGG waveforms seem to be significantly affected by the articulatory activities of the larynx, airflow and subglottic pressure, and may be a useful method to describe dynamic laryngeal articulatory activity during continuous speech. PMID:9311157

Hong, K H; Kim, H K



Nerve Racking  

NSDL National Science Digital Library

This lesson describes the function and components of the human nervous system. It helps students understand the purpose of our brain, spinal cord, nerves and the five senses. How the nervous system is affected during spaceflight is also discussed in this lesson.

Integrated Teaching And Learning Program


[Respiratory stridency by larynx paralysis. Anusual beginning of miastenia].  


A case of severe miastenia beginning with dyspnea, secondary to a bilateral larynx paralysis in aduction is presented. During the evolution of the severe miastenia the affectation of the larynx musculature does not result infrequent, but however, after having realized a bibliographic revision, the infrequency resulting in this disease of the beginning through a bilateral larynx paralysis in aduction was verified. A wide exposition of the clinic case, methods of exploration to obtain the diagnosis of severe miastenia, and the different treatment options actually in use to control these disease, are realized. PMID:16881557

Padilla Parrado, M; Morales Puebla, J M; Díaz Sastre, M A; Caro García, M A; Cabeza Alvarez, C I; Velázquez Pérez, J M; Menéndez Loras, L M



Propofol or sevoflurane for laryngeal mask airway insertion  

Microsoft Academic Search

Purpose  Sevoflurane is a volatile anesthetic agent, which combines rapid, smooth inhalational induction of anesthesia with rapid recovery,\\u000a making it particularly suitable for day case anesthesia. The laryngeal mask airway is often also used in ambulatory anesthesia,\\u000a with intravenous propofol being the agent of choice for its insertion. Our objective was to compare the conditions for laryngeal\\u000a mask airway (LMA) insertion

Mary E. Molloy; Donal J. Buggy; Patrick Scanlon



Pediatric laryngeal cancer with 5-year follow up: case report.  


Larynx cancer is the commonest malignancy of upper aerodigestive tract. However, laryngeal cancer is extremely rare in childhood since these tumors are generally not suspected in the differential diagnosis of hoarseness, dysphagia and/or progressive airway obstruction in children; diagnosis can be made relatively late. In this report we would like to present a case of advanced stage pediatric laryngeal carcinoma who was treated with chemoradiotherapy and remained well on her 5-year follow-up. PMID:23673162

Olgun, Yuksel; Erdag, Taner Kemal; Aydin, Barbaros; Mutafoglu, Kamer; Ozer, Erdener; Ikiz, Ahmet Omer; Akman, Fadime



Phrenic nerve palsy: A rare cause of respiratory distress in newborn.  


Birth injury is defined as an impairment of a newborn's body function or structure due to adverse influences that occurred at birth. Phrenic nerve palsy may result from birth trauma during a traumatic neonatal delivery from a stretch injury due to lateral hyperextension of the neck at birth. This could be a rare cause of respiratory distress in the newborn period with irregular respiration. Respiratory distress due to phrenic nerve damage leading to paralysis of the ipsilateral diaphragm may require continuous positive airway pressure or mechanical ventilation and if unresponsive, surgical plication of diaphragm. Herein, we report a case of phrenic nerve palsy in a newborn presenting with respiratory distress. PMID:23560016

Murty, V S S Yerramilli; Ram, K Dinedra



Abnormal pupillary function in third nerve regeneration (the pseudo-Argyll robertson pupil). A case report.  


A case of congenital oculomotor paralysis demonstrating retraction of the upper lid and constriction of the pupil in response to eye movements is described. The pupil was found to be unresponsive to light, but to contract promptly on attempted ocular movements which involved motor neurons of the third nerve. As demonstrated by infrared pupillography, the duration of the constriction phase was found to be remarkably long. Also, very little hippus was noted during constriction. The findings are explained on basis of the 'misdirection' hypothesis according to which regenerating nerve fibres find a wrong path in the peripheral part of the damaged nerve. PMID:6720273

Olsen, T; Jakobsen, J



Incidence of neonatal sixth nerve palsy in relation to mode of delivery.  


During a 10-year period on a level I neonatal service the total incidence (0.4%) and incidence by mode of delivery of neonatal lateral rectus paralysis occurring among 6886 term neonates was determined. The incidence of abducens nerve injury in this population increased progressively from 0% for deliveries by cesarean section to 0.1% for spontaneous vaginal delivery, to 2.4% for forceps delivery, and to 3.2% for vacuum extraction. This suggests that increased complexity of instrumentation during delivery is associated with an increased risk of sixth nerve palsy. A proposed mechanism for the injury to the sixth nerve is described. PMID:8166202

Galbraith, R S



Phrenic nerve palsy: A rare cause of respiratory distress in newborn  

PubMed Central

Birth injury is defined as an impairment of a newborn's body function or structure due to adverse influences that occurred at birth. Phrenic nerve palsy may result from birth trauma during a traumatic neonatal delivery from a stretch injury due to lateral hyperextension of the neck at birth. This could be a rare cause of respiratory distress in the newborn period with irregular respiration. Respiratory distress due to phrenic nerve damage leading to paralysis of the ipsilateral diaphragm may require continuous positive airway pressure or mechanical ventilation and if unresponsive, surgical plication of diaphragm. Herein, we report a case of phrenic nerve palsy in a newborn presenting with respiratory distress.

Murty, V. S. S. Yerramilli; Ram, K. Dinedra



Cholecystectomy and risk of laryngeal and pharyngeal cancer.  


Duodeno-gastro-esophageal reflux of bile might cause laryngeal and pharyngeal cancer, but more research is required. Since cholecystectomy is followed by an increased risk such reflux, the risk of developing laryngeal or pharyngeal cancer after cholecystectomy was addressed. A population-based cohort study was conducted in Sweden during the period 1965-2008. The number of laryngeal or pharyngeal cancer cases observed in a large cohort of cholecystectomized patients was compared with the expected number, calculated from the entire Swedish population of corresponding age, gender and calendar year. Risk of laryngeal or pharyngeal cancer was calculated as standardized incidence ratio (SIR) with 95% confidence interval (CI). The cholecystectomy cohort included 345,251 patients who were followed up for 1-43 years and contributed 4,854,969 person-years at risk. The 192 new cases of laryngeal cancer and the 175 cases of pharyngeal cancer were not greater than the expected, providing SIR 0.99 (95% CI 0.85-1.14) and SIR 1.06 (95% CI 0.91-1.23), respectively. A longer latency period after cholecystectomy was not associated with any increased risk of any of these tumors. No differences between age groups or sexes were detected. Analyses restricted to verified squamous-cell carcinomas revealed similar results. In conclusion, cholecystectomy does not appear to be followed by any increased risk of laryngeal or pharyngeal cancer. PMID:21717451

Lagergren, Jesper; Mattsson, Fredrik



Laryngeal dislocation after ventral fusion of the cervical spine  

PubMed Central

We report on a 70-year-old patient who underwent ventral fusion of the cervical spine (C3/4 and C4/5) for spinal canal stenosis performed by the neurosurgery department. The patient suffered an exceedingly rare complication of the surgery – laryngeal dislocation. Had the deformed laryngeal structures been overlooked and the patient extubated as usual after surgery, reintubation would have been impossible due to the associated swelling, which might have had disastrous consequences. Leftward dislocation of the larynx became apparent post-operatively, but prior to extubation. Extubation was therefore postponed and a subsequent computed tomography (CT) scan revealed entrapment of laryngeal structures within the osteosynthesis. A trial of repositioning using microlaryngoscopy performed by otolaryngology (ears, nose and throat) specialists failed, making open surgical revision necessary. At surgery, the entrapped laryngeal tissue was successfully mobilised. Laryngeal oedema developed despite prompt repositioning; thus, necessitating tracheotomy and long-term ventilation. Laryngeal dislocation may be an unusual cause of post-operative neck swelling after anterior cervical spine surgery and should be considered in the differential diagnosis if surgical site haematoma and other causes have been ruled out. Imaging studies including CT of the neck may be needed before extubation to confirm the suspicion and should be promptly obtained to facilitate specific treatment.

Krauel, Jenny; Winkler, Dietrich; Munscher, Adrian; Tank, Sascha



Alterations in the laryngeal mucosa after exposure to asbestos.  

PubMed Central

The laryngeal mucosa of 195 workers in an asbestos cement factory (Salonit Anhovo, Yugoslavia) and in a control group was examined. The factory manufactures asbestos cement products containing about 13% of asbestos (8% amosite, 12% crocidolite, and 80% chrysotile) of different provenance. Alterations in the laryngeal mucosa were more frequent in the factory workers than in the control group. The changes, mostly consistent with chronic laryngitis, were closely related to the degree of workplace pollution and less so to the duration of employment Ten workers exhibiting the most severe clinical changes underwent biopsy, the results of which showed histomorphological changes characteristic of hyperplastic chronic laryngitis. Four tissue specimens were examined also by scanning electron microscopy and in three of them asbestos fibres were found on the epithelial surface. No case of laryngeal carcinoma was identified. On the basis of our results it is thought that asbestos related changes of the larynx should receive more attention and that the use of the term "laryngeal asbestosis" is justified. The clinical picture is non-specific but in view of their frequency such changes should be considered a consequence of exposure to asbestos. Images

Kambic, V; Radsel, Z; Gale, N



Bcl-2 expression predicts radiotherapy failure in laryngeal cancer  

PubMed Central

Early stage laryngeal cancer can be effectively cured by radiotherapy or conservative laryngeal surgery. In the UK, radiotherapy is the preferred first line treatment. However, up to 25% of patients with T2 tumours will demonstrate locally persistent or recurrent disease at the original site, requiring salvage surgery to achieve a definitive cure. Patients experiencing treatment failure have a relatively poor prognosis. A retrospective analysis was conducted consisting of 124 patients with early stage (T1–T2, N0) laryngeal squamous cell carcinoma. In total, 62 patients who failed radiotherapy were matched for T stage, laryngeal subsite and smoking history to a group of 62 patients successfully cured by radiotherapy. Using immunohistochemistry the groups were compared for expression of apoptotic proteins: bcl-2, bcl-XL, bax, bak and survivin. Radioresistant laryngeal cancer was associated with bcl-2 (P<0.001) and bcl-XL (P=0.005) expression and loss of bax expression (P=0.012) in pretreatment biopsies. Bcl-2 has an accuracy of 71% in predicting radiotherapy outcome. The association between expression of bcl-2, bcl-XL and bax with radioresistant cancer suggests a potential mechanism by which cancer cells avoid the destructive effects of radiotherapy. Predicting radioresistance, using bcl-2, would allow the clinician to recommend conservative laryngeal surgery as an alternative first line treatment to radiotherapy.

Nix, P; Cawkwell, L; Patmore, H; Greenman, J; Stafford, N



Pathogenesis of laryngeal narrowing in patients with multiple system atrophy  

PubMed Central

We do not fully understand the pathogenesis of nocturnal laryngeal stridor in patients with multiple system atrophy (MSA). Recent studies suggest that inspiratory thyroarytenoid (TA) muscle activation has a role in the development of the stridor.The breathing pattern and firing timing of TA muscle activation were determined in ten MSA patients, anaesthetized with propofol and breathing through the laryngeal mask airway, while the behaviour of the laryngeal aperture was being observed endoscopically.Two distinct breathing patterns, i.e. no inspiratory flow limitation (no-IFL) and IFL, were identified during the measurements. During IFL, significant laryngeal narrowing was observed leading to an increase in laryngeal resistance and end-tidal carbon dioxide concentration. Development of IFL was significantly associated with the presence of phasic inspiratory activation of TA muscle. Application of continuous positive airway pressure suppressed the TA muscle activation.The results indicate that contraction of laryngeal adductors during inspiration narrows the larynx leading to development of inspiratory flow limitation accompanied by stridor in patients with MSA under general anaesthesia.

Isono, Shiroh; Shiba, Keisuke; Yamaguchi, Mika; Tanaka, Atsuko; Hattori, Takamichi; Konno, Akiyoshi; Nishino, Takashi



Thyrotoxic Hypokalaemic periodic paralysis, a Rare Cause of Acute Muscle Weaknes s  

Microsoft Academic Search

Thyrotoxic periodic paralysis is a rare neuromuscular disorder related to a defect in muscle ion channels and manifest by episodes of painless muscle weakness. Periodic paralysis is classified as hypokalaemic when episodes occur in association with low potassium levels or as hyperkalaemic when episodes can be induced by elevated potassium. Thyrotoxic hypokalaemic periodic paralysis may present as a life threatening

Shaji Varughese


Acute onset of facial nerve palsy associated with Lyme disease in a 6-year-old child  

Microsoft Academic Search

Pediatric facial nerve palsy (FNP) can result from a variety of etiologies including Lyme disease, varicella, primary gingivostomatitis, herpes zoster oticus (Ramsay Hunt syn- drome), coxsackievirus, trauma, otitis media, HIV, diseases causing tumors or demyelinations, compressions, and possibly Epstein Barr virus. Lyme disease has been implicated as the cause of over 50% of the FNPs in children. The paralysis of

Joy M. Siwula


Age-related changes in sensory and secretomotor nerve endings in the larynx of F344/N rat.  


The aim of the present study was to define the age-related changes in sensory and secretomotor nerve endings in the larynx of F344/N rats. For this purpose, laryngeal tissue sections obtained from 12-, 24- and 35-month-old F344/N rats were compared with respect to the density, distribution and morphology of various types of sensory and secretomotor nerve endings immunoreactive for protein gene product 9.5 (PGP 9.5), calcitonin gene-related peptide (CGRP) and substance P (SP). Two distinct forms of PGP 9.5-immunoreactive motor end-plates were noted; the large sized motor end-plates localized in thyroarytenoid and cricoarytenoid muscles were degenerated in aged rats, while the small sized motor end-plates, localized predominantly in vocal muscles, did not show any age-related changes. CGRP- and SP-immunoreactive nerve fibres of the laryngeal glands did not show any age-related changes. Subepithelial laminar nerve endings immunoreactive to PGP 9.5 showed degeneration with ageing. Aggregates of terminal arborisations in the subepithelial region were smaller in aged animals. PGP 9.5-immunostained taste cells and well-developed subgemmal network were abundant in 12- and 24-month-old rats, but only a few were noted in aged rats. The total number of taste buds decreased significantly with ageing. CGRP- and SP-immunostained taste bud-nerve endings were noted in 12- and 24-month-old rats, but only rarely in 35-month-old rats. The laryngeal epithelium contained PGP 9.5-, CGRP- and SP-immunoreactive thin free nerve endings with many varicosities; their number and distribution were similar between 12- and 24-month-old rats, while only a few endings were observed in 35-month-old rats. Our results indicated that ageing is associated with the reduction of laryngeal sensory and secretomotor nerve endings. PMID:12849090

Yamamoto, Yoshio; Tanaka, Shin; Tsubone, Hirokazu; Atoji, Yasuro; Suzuki, Yoshitaka


Peripheral nerve regeneration through optic nerve grafts  

Microsoft Academic Search

Grafts of optic nerve were placed end-toend with the proximal stumps of severed common peroneal nerves in inbred mice. It was found that fraying the proximal end of adult optic nerve grafts to disrupt the glia limitans increased their chances of being penetrated by regenerating peripheral nerve fibres. Suturing grafts to the proximal stump also enhanced their penetration by axons.

P. N. Anderson; P. Woodham; M. Turmaine



Hemidiaphragmatic paralysis, an unusual presentation of Parsonage-Turner syndrome  

Microsoft Academic Search

A previously healthy 38-year-old man presented a typical Parsonage-Turner syndrome (PTS) three weeks after a cold and unusual muscular exercise. In addition to the motor and sensory defects of the upper limbs, a right hemidiaphragmatic paralysis occurred, which proved to be reversible after several months. A brief review of the hemidiaphragmatic injury in PTS is presented.

T. Pieters; M. Lambert; J. P. Huaux; C. Nagant de Deuxchaisnes



Herpes simplex virus meningitis complicated by ascending paralysis.  


A case of herpes simplex virus (HSV) meningitis complicated by ascending paralysis with almost complete recovery following antiviral treatment is reported. We present this case to illustrate the importance of including HSV-induced neuropathy in the differential diagnosis of acute neurologic symptoms following the viral illness. PMID:23814385

Benjamin, Mina M; Gummelt, Kyle L; Zaki, Rabeea; Afzal, Aasim; Sloan, Louis; Shamim, Sadat



Acute Flaccid Paralysis from Echovirus Type 33 Infection  

PubMed Central

During a community echovirus type 33 outbreak, the virus was detected in the feces and cerebrospinal fluid of a 3-year-old boy with right arm weakness that followed a mild nonspecific febrile illness. This is the first time an association between echovirus type 33 infection and acute flaccid paralysis has been reported.

Grimwood, Keith; Huang, Q. Sue; Sadleir, Lynette G.; Nix, W. Allan; Kilpatrick, David R.; Oberste, M. Steven; Pallansch, Mark A.



Marek's disease virus induced transient paralysis--a closer look  

Technology Transfer Automated Retrieval System (TEKTRAN)

Marek’s Disease (MD) is a lymphoproliferative disease of domestic chickens caused by a highly cell-associated alpha herpesvirus, Marek’s disease virus (MDV). Clinical signs of MD include depression, crippling, weight loss, and transient paralysis (TP). TP is a disease of the central nervous system...


Side-to-end hypoglossal-facial anastomosis via transposition of the intratemporal facial nerve.  


The technique of facial nerve repair with side-to-end hypoglossal-facial anastomosis is presented and evaluated in five patients who were operated on for facial nerve paralysis after acoustic schwannoma surgery, or had cranial base trauma. The end-to-end hypoglossal-facial anastomosis is accompanied by hemilingual paralysis, with difficulty in swallowing, chewing and speaking. In this new technique, the facial nerve is mobilised in the temporal bone, transected at the second genu and transposed to the hypoglossal nerve where a tensionless side-to-end anastomosis is performed. The hypoglossal nerve is transected in oblique fashion to about one third of its circumference. We were able to achieve a tensionless anastomosis in all patients. The idea is to bring about re-innervation of the previously denervated tissue via a collateral sprouting of axons of the donor nerve through the site of coaptation without sacrificing the innervation of the donor nerve's original targets. With side-to-end hypoglossal-facial anastomosis, two patients attained a House- Brackmann grade of III (one of them with independent movement of eyelids and mouth); one achieved grade IV, another grade V and grade VI. No patient had hemilingual atrophy nor any problems associated with swallowing or chewing. PMID:16493524

Rebol, J; Milojkovi?, V; Didanovic, V



Ramsay Hunt syndrome with unilateral polyneuropathy involving cranial nerves V, VII, VIII, and XII in a diabetic patient.  


Ramsay Hunt syndrome is a rare complication of the varicella zoster virus, defined as a peripheral facial palsy that typically results from involvement of the facial and auditory nerves. Ramsay Hunt syndrome can be associated with cranial nerves V, VI, IX, and X but rarely with XII. We describe an atypical case of Ramsay Hunt syndrome with multiple cranial nerve involvement of nerves V, VII, VIII, and XII. Antiviral drugs, antibiotics, insulin, and traditional Chinese drugs were administered immediately after admission. After 3 months of combination therapy, the patient had recovered satisfactorily. Herpes zoster can cause severe infections in diabetic patients and should be treated as soon after detection as possible. Ramsay Hunt syndrome should be recognized as a polycranial neuritis characterized by damage to sensory and motor nerves. In addition to facial and vestibular nerve paralysis, Ramsay Hunt syndrome may also involve cranial nerves V and XII. PMID:22026001

Sun, Wei-Lian; Yan, Jian-Liang; Chen, Li-Li


Unilateral oculomotor nerve palsy: unusual sign of hydrocephalus.  


We report an unusual case of hydrocephalus in which unilateral oculomotor nerve paralysis was the predominant sign. Misinterpretation of such an atypical clinical sign may lead to inappropriate therapy. We outline the role of intracranial pressure monitoring as an adjunctive diagnostic tool and we suggest a presumptive mechanism to explain the correlation between enlarged ventricles and 3(rd) nerve dysfunction. A 16-year-old boy presented with a complete left oculomotor nerve palsy associated with imaging findings of dilated ventricles and Dandy-Walker variant cystic malformation. Monitoring of intracranial pressure through a ventricular catheter was undertaken. In the first phase (no cerebrospinal fluid drainage [CSF] drainage) mean intracranial pressure (ICP) values were >0 mmHg. A second phase (with progressively longer CSF draining) further defined the diagnosis. A ventriculo-peritoneal shunt was then placed and the nerve function returned to normal within few days. Third cranial nerve dysfunction as a predominant sign of hydrocephalus is very rare and may raise doubts as to the real significance of the imaging findings of enlarged ventricles. In this ground, ICP monitoring is a safe and helpful diagnostic tool that can afford a more accurate evaluation and proper treatment. The supposed mechanism of 3(rd) nerve dysfunction was bending/stretching of the nerve. PMID:19546847

Cultrera, F; D'Andrea, M; Battaglia, R; Chieregato, A



Brachial plexus trauma: the morbidity of hemidiaphragmatic paralysis  

Microsoft Academic Search

Phrenic nerve palsy has previously been associated with brachial plexus root avulsion; severe unilateral phrenic nerve injury is not uncommonly associated with brachial plexus injury. Brachial plexus injuries can be traumatic (gunshot wounds, lacerations, stretch\\/contusion and avulsion injuries) or non-traumatic in aetiology (supraclavicular brachial plexus nerve block, subclavian vein catheterisation, cardiac surgeries, or obstetric complications such as birth palsy). Despite

O I Franko; Z Khalpey; J Gates



Considerations in nerve repair  

Microsoft Academic Search

ome nerve injuries require repair in order to regain sen- sory or motor function. Although this article focuses pri- marily on trigeminal nerve (TN) injuries and repairs, the facts presented may apply to any peripheral nerve repair. The primary indications for nerve repair or grafting are 1) an injury or continuity defect in a nerve, as a result of trauma,



Exolaryngoscopy: a new technique for laryngeal surgery.  


The aim of this study is to assess the use of a telescope with a high definition endoscopic video system as an alternative to the operating microscope in endoscopic laryngeal surgery. The system is economic, and allows optimal vision and improved surgeon comfort and ease. In exolaryngoscopy, the optic vitom is positioned in place of the microscope. An extracorporeal optical system (exoscope) is positioned 25 cm from the surgical field. Under exoscopic control, it is possible to use the same series of instruments using a long handle through the laryngoscope. The CO2 laser may also be used by fixing it coaxially to the optical system, and it is possible to use a classic set of microinstruments for phonosurgery. Endoscopic study with auto-fluorescence (NBI; narrow band imaging) can be easily used to visualize both precancerous and cancerous lesions. We treated 12 patients with benign and malign pathologies of the vocal cords; in all cases, the predicted result was reached, and the optic vitom showed its potential advantages in ease and comfort of the surgeon. PMID:23326013

Carlucci, C; Fasanella, L; Ricci Maccarini, A



State of the Art Laryngeal Imaging: Research and Clinical Implications  

PubMed Central

Purpose of Review This paper provides a review of the latest advances in videostroboscopy, videokymography and high-speed videoendoscopy, and outlines the development of new laryngeal imaging modalities based on optical coherence tomography, laser depth-kymography, and magnetic resonance imaging, published in the past 2 years. Recent Findings Videostroboscopy and Videokymography Image quality has improved and several image processing and measurement techniques have been published. High-speed videoendoscopy Significant progress has been made through increased sensitivity and frame rates of the cameras, and the development of facilitative playbacks, phonovibrography and several image segmentation and measurement methods. Clinical evidence was presented through applications in phonosurgery, comparisons with videostroboscopy, normative data, and better understanding of voice production. Optical coherence tomography Latest developments allow for the capture of dynamic high resolution cross-sectional images of the vibrating vocal fold mucosa during phonation. Depth-kymography New laser technique allowing recording of the vertical movements of the vocal folds during phonation in calibrated spatial values. Laryngeal magnetic resonance New methods allow high-resolution imaging of laryngeal tissue microstructure, or measuring of dynamic laryngeal structures during phonation. Summary The endoscopic laryngeal imaging techniques have made significant advances increasing their clinical value, while techniques providing new types of potentially clinically-relevant information have emerged.

Deliyski, Dimitar D.; Hillman, Robert E.



The cuff leak test to predict failure of tracheal extubation for laryngeal edema  

Microsoft Academic Search

Objective. Laryngeal edema secondary to endotracheal intubation may require early re-intubation. Prior to extubation the absence of leak around an endotracheal tube may predict laryngeal edema after extubation. We evaluated the usefulness of a quantitative assessment of such a leak to identify the patients who will require early re-intubation for laryngeal edema. Methods. This prospective study included 76 patients with

Yann De Bast; Daniel De Backer; Jean-Jacques Moraine; Muriel Lemaire; Cécile Vandenborght; Jean-Louis Vincent



Nerve conduction velocity  


Nerve conduction velocity (NCV) is a test to see how fast electrical signals move through a nerve. ... travel between electrodes are used to determine the speed of the nerve signals. Electromyography (recording from needles ...


Bilateral Deep Peroneal Nerve Paralysis Following Kerosene Self-Injection into External Hemorrhoids  

PubMed Central

Along with conventional therapies, some abrogated traditional treatment had been used for hemorrhoids like local Kerosene injection especially for extremely irritated external hemorrhoids. We report a rare case of Kerosene self-injection into the hemorrhoid. Despite antibiotics therapy, extent debridement, and colostomy, the patient died after 24 hours because of heart attack. Moreover, we discuss here the case with contact or injection of hydrocarbon materials and early care action to decrease the extensions of injury and side effects.

Rostami, Khalil; Farzaneh, Esmaeil; Abolhassani, Hassan



Reconstruction of the face through cross-face-nerve transplantation in facial paralysis  

Microsoft Academic Search

With definitive and irreparable interruption of the N. facialis a reanimation of the paralysed face can only be brought about through reinnervation of the muscles from the N. facialis of the unparalysed side.

H. Anderl; P. Wilflingseder



Facial nerve paralysis due to intra-aural Hyalomma tick infestation.  


We present the case of a 33 year-old man from a village of the north-eastern part of central Anatolia admitted to the otolaryngology department of Yeditepe University Hospital with right facial asymmetry and pain on the right ear. A tick of the genus Hyalomma was observed in the external auditory canal of the right ear and it was removed with fine cup forceps under otomicroscopy. We are of the opinion that in patients presenting with sudden acute ear pain and facial palsy, the ear canal should be examined to exclude an infestation by ticks. PMID:23339950

Do?an, Müzeyyen; Devge, Cem; Tanr?över, Ozlem; Pata, Yavuz Selim; Sönmezo?lu, Meral




PubMed Central

1. When appropriate chromatic nerves are cut caudal bands, cephalic areas, and the pelvic fins of the catfish Ameiurus darken. In pale fishes all these areas will sooner or later blanch. By recutting their nerves all such blanched areas will darken again. 2. These observations show that the darkening of caudal bands, areas, and fins on cutting their nerves is not due to paralysis (Brücke), to the obstruction of central influences such as inhibition (Zoond and Eyre), nor to vasomotor disturbances (Hogben), but to activities emanating from the cut itself. 3. The chief agents concerned with the color changes in Ameiurus are three: intermedin from the pituitary gland, acetylcholine from the dispersing nerves (cholinergic fibers), and adrenalin from the concentrating nerves (adrenergic fibers). The first two darken the fish; the third blanches it. In darkening the dispersing nerves appear to initiate the process and to be followed and substantially supplemented by intermedin. 4. Caudal bands blanch by lateral invasion, cephalic areas by lateral invasion and internal disintegration, and pelvic fins by a uniform process of general loss of tint equivalent to internal disintegration. 5. Adrenalin may be carried in such an oil as olive oil and may therefore act as a lipohumor; it is soluble in water and hence may act as a hydrohumor. In lateral invasion (caudal bands, cephalic areas) it probably acts as a lipohumor and in internal disintegration (cephalic areas, pelvic fins) it probably plays the part of a hydrohumor. 6. The duration of the activity of dispersing nerves after they had been cut was tested by means of the oscillograph, by anesthetizing blocks, and by cold-blocks. The nerves of Ameiurus proved to be unsatisfactory for oscillograph tests. An anesthetizing block, magnesium sulfate, is only partly satisfactory. A cold-block, 0°C., is successful to a limited degree. 7. By means of a cold-block it can be shown that dispersing autonomic nerve fibers in Ameiurus can continue in activity for at least 6½ hours. It is not known how much longer they may remain active. So far as the duration of their activity is concerned dispersing nerve fibers in this fish are unlike other types of nerve fibers usually studied.

Parker, G. H.



Laryngeal mask airway for airway control during percutaneous dilatational tracheostomy.  


Percutaneous dilatational tracheostomy is a common bedside procedure in critical care for patients requiring prolonged mechanical ventilation. The traditional technique requires withdrawal of the endotracheal tube to a proximal position to facilitate tracheostomy insertion, but this carries the risk of inadvertent extubation and does not prevent cuff rupture. Use of a supraglottic airway such as the laryngeal mask airway may avoid these risks and could provide a safe alternative to the endotracheal tube. We present an appraisal of the literature to date. We found reasonable evidence to show improved ventilation and bronchoscopic visualisation with the laryngeal mask airway, but this has not been translated into improved outcome. There is currently insufficient evidence to draw conclusions about the safety of the laryngeal mask airway during percutaneous dilatational tracheostomy. PMID:22165351

Pratt, T; Bromilow, J



Detection of diphtheritic polyneuropathy by acute flaccid paralysis surveillance, India.  


Diphtheritic polyneuropathy is a vaccine-preventable illness caused by exotoxin-producing strains of Corynebacterium diphtheriae. We present a retrospective convenience case series of 15 children (6 girls)<15 years of age (mean age 5.2 years, case-fatality rate 53%, and 1 additional case-patient who was ventilator dependent at the time of last follow-up; median follow-up period 60 days) with signs and symptoms suggestive of diphtheritic polyneuropathy. All cases were identified through national acute flaccid paralysis surveillance, which was designed to detect poliomyelitis in India during 2002-2008. We also report data on detection of diphtheritic polyneuropathy compared with other causes of acute flaccid paralysis identified by this surveillance system. PMID:23965520

Mateen, Farrah J; Bahl, Sunil; Khera, Ajay; Sutter, Roland W



Bilateral Facial Paralysis Case Presentation and Discussion of Differential Diagnosis  

PubMed Central

Bilateral facial paralysis is a rare condition and therefore represents a diagnostic challenge. We report the case of a 34-year-old healthy woman with sequential bilateral facial paralysis as a sole manifestation of sarcoidosis. She initially presented with an isolated left sided Bell's palsy without any symptoms to suggest alternative diagnoses. Within a month there was progression to peripheral facial paresis on the contra lateral side, prompting a diagnosis of Lyme disease. Her physical examination and chest x-ray did not reveal any clinical evidence of sarcoidosis. After failing to respond to an empiric trial of intravenous ceftriaxone for a presumptive diagnosis of Lyme disease, computed tomography scan of the chest was ordered which demonstrated bilateral hilar lymphadenopathy. Bronchoscopic biopsy confirmed a diagnosis of sarcoidosis. The patient then made a complete recovery on steroid therapy. We discuss the differential diagnosis of facial diplegia and focus on the clinical presentation, diagnosis and treatment of neurosarcoidosis.

Jain, Vishal; Deshmukh, Anagha; Gollomp, Stephen



Hyperkalemic periodic paralysis episode during halothane anesthesia in a horse.  


A 7-month-old Quarter Horse filly was admitted for surgical repair of a right olecranon fracture. Anesthesia was achieved with xylazine hydrochloride, guaifenesin, ketamine hydrochloride, and halothane. Two and a half hours after induction of anesthesia, myotonia, muscle fasciculations, and sweating, concurrent with high serum potassium concentration and associated electrocardiographic changes consistent with hyperkalemic periodic paralysis, were observed. Treatment included intermittent positive-pressure ventilation, changing intravenous administration of fluids from lactated Ringer's solution to 0.9% NaCl solution, and administration of calcium gluconate, glycopyrrolate, dopamine, and sodium bicarbonate. Clinical signs resolved with the return of serum potassium concentrations to the reference range. The horse was confirmed to be heterozygous for hyperkalemic periodic paralysis by DNA testing. PMID:8675475

Bailey, J E; Pablo, L; Hubbell, J A



Nerve Impulses in Plants  

ERIC Educational Resources Information Center

|Summarizes research done on the resting and action potential of nerve impulses, electrical excitation of nerve cells, electrical properties of Nitella, and temperature effects on action potential. (GS)|

Blatt, F. J.



Nerve Impulses in Plants  

ERIC Educational Resources Information Center

Summarizes research done on the resting and action potential of nerve impulses, electrical excitation of nerve cells, electrical properties of Nitella, and temperature effects on action potential. (GS)

Blatt, F. J.



Abrupt hypokalemia with paralysis from a clinician’s perspective  

Microsoft Academic Search

Monogenic hypokalemic periodic paralysis (HypoPP) is an autosomal dominant genetic disease. HypoPP is more common in males than females and has a reduced penetrance in females. Attacks generally begin during adolescence. They are aggravated by exercise, sleep, stress, alcohol, and meals rich in carbohydrates and salt. The episodes last 324h. Attacks often feature a prodrome of stiffness or heaviness in

Friedrich C. Luft



Electrophysiological evaluation of phrenic nerve injury during cardiac surgery - a prospective, controlled, clinical study  

PubMed Central

Background According to some reports, left hemidiaphragmatic paralysis due to phrenic nerve injury may occur following cardiac surgery. The purpose of this study was to document the effects on phrenic nerve injury of whole body hypothermia, use of ice-slush around the heart and mammary artery harvesting. Methods Electrophysiology of phrenic nerves was studied bilaterally in 78 subjects before and three weeks after cardiac or peripheral vascular surgery. In 49 patients, coronary artery bypass grafting (CABG) and heart valve replacement with moderate hypothermic (mean 28°C) cardiopulmonary bypass (CPB) were performed. In the other 29, CABG with beating heart was performed, or, in several cases, peripheral vascular surgery with normothermia. Results In all patients, measurements of bilateral phrenic nerve function were within normal limits before surgery. Three weeks after surgery, left phrenic nerve function was absent in five patients in the CPB and hypothermia group (3 in CABG and 2 in valve replacement). No phrenic nerve dysfunction was observed after surgery in the CABG with beating heart (no CPB) or the peripheral vascular groups. Except in the five patients with left phrenic nerve paralysis, mean phrenic nerve conduction latency time (ms) and amplitude (mV) did not differ statistically before and after surgery in either group (p > 0.05). Conclusions Our results indicate that CPB with hypothermia and local ice-slush application around the heart play a role in phrenic nerve injury following cardiac surgery. Furthermore, phrenic nerve injury during cardiac surgery occurred in 10.2 % of our patients (CABG with CPB plus valve surgery).

Canbaz, Suat; Turgut, Nilda; Halici, Umit; Balci, Kemal; Ege, Turan; Duran, Enver



Multidimensional voice analysis of reflux laryngitis patients.  


The aim of the study was to analyze and quantify the voice characteristics of reflux laryngitis (RL) patients and to determine the most important voice tests and voice-quality parameters in the functional diagnostics of RL. The voices of 83 RL patients and 31 persons in the control group were evaluated. Vocal function was assessed using a multidimensional set of video laryngostroboscopic, perceptual, acoustic, aerodynamic and subjective measurements according to the protocol elaborated by the Committee on Phoniatrics of the European Laryngological Society. The mean values of the hoarseness visual analogue scale assessment and voice handicap index were significantly higher (P<0.05) in the group of RL patients as compared to the controls. Objective voice assessment revealed a significant increase in mean values of jitter, shimmer and normalized noise energy (NNE), along with a significant decrease in pitch range, maximum frequency, phonetogram area (S) and maximum phonation time (MPT) in RL patients, both in the male and female subgroups. According to the results of discriminant analysis, the NNE, MPT, S and intensity range were determined as an optimum set for functional diagnostics of RL. The derived function (equation) makes it possible to assign the person to the group of RL patients with an accuracy of 86.7%. The sensitivity and specificity of eight voice parameters were found to be higher than 50%. The results of the present study demonstrate a reduction of phonation capabilities and voice quality in RL patients. Multidimensional voice evaluation makes it possible to detect significant differences in mean values of perceptual, subjective and objective voice quality parameters between RL patients and controls groups. Therefore, multidimensional voice analysis is an important tool in the functional diagnostics of RL. PMID:15004705

Pribuisienë, Rûta; Uloza, Virgilijus; Saferis, Viktoras



Apparent tick paralysis by Rhipicephalus sanguineus (Acari: Ixodidae) in dogs.  


Certain tick species including Ixodes holocyclus can inoculate neurotoxins that induce a rapid, ascending flaccid paralysis in animals. Rhipicephalus sanguineus, the most widespread tick of dogs, is recognized as a vector of several pathogens causing diseases in dogs and humans. A single report suggests its role as cause of paralysis in dogs. This study presents the clinical history of 14 young dogs heavily infested by R. sanguineus (intensity of infestation, 63-328) in an endemic area of southern Italy. During May to June of 2011, dogs were presented at the clinical examination with neurological signs of different degrees (e.g., hind limb ataxia, generalized lethargy, and difficulty in movements). All animals were treated with acaricides and by manual tick removal but ten of them died within a day, displaying neurological signs. The other 4 dogs recovered within 3 days with acaricidal and supportive treatment. Twelve dogs were positive by blood smear examination for Hepatozoon canis with a high parasitemia, two also for Babesia vogeli and two were negative for hemoparasites. Low-grade thrombocytopenia, hypoalbuminemia, and pancytopenia were the haematological alterations most frequently recorded. Other causes of neurological disease in dogs were excluded and the diagnosis of tick paralysis by R. sanguineus was confirmed (ex juvantibus) by early and complete recovery of 4 dogs following acaricidal treatment and tick removal. PMID:22546547

Otranto, Domenico; Dantas-Torres, Filipe; Tarallo, Viviana Domenica; Ramos, Rafael Antonio do Nascimento; Stanneck, Dorothee; Baneth, Gad; de Caprariis, Donato



Surgical treatment for thyrotoxic hypokalemic periodic paralysis: case report  

PubMed Central

Thyrotoxic hypokalemic periodic paralysis (THPP) is a rare, potentially life-threatening endocrine emergency. It is characterized by recurrent muscle weakness and hypokalemia. Because many THPP patients do not have obvious symptoms and signs of hyperthyroidism, misdiagnosis may occur. The published studies revealed that definitive therapy for THPP is control of hyperthyroidism by medical therapy, radioactive iodine or surgery, but the long-term post-operative follow-up result was not observed. We reported two cases of medically refractory THPP with recurrent paralysis of extremities and hypokalemia, and both were combined with thyroid nodules. Both patients were treated with total thyroidectomy; the pathology revealed that one is Graves' disease with thyroid papillary carcinoma, and the other is adenomatous goiter with papillary hyperplasia. No episode of periodic paralysis was noted and laboratory evaluation revealed normal potassium level during the post-operative follow up. Our experience suggests that total thyroidectomy by experienced surgeon is an appropriate and definite treatment for medically refractory THPP, especially in cases combined with thyroid nodules.



Restoration of grasp following paralysis through brain-controlled stimulation of muscles  

PubMed Central

Patients with spinal cord injury lack the connections between brain and spinal cord circuits essential for voluntary movement. Clinical systems that achieve muscle contraction through functional electrical stimulation (FES) have proven to be effective in allowing patients with tetraplegia to regain control of hand movement and to achieve a greater measure of independence in activities of daily living 1,2. In typical systems, the patient uses residual proximal limb movements to trigger pre-programmed stimulation that causes the paralyzed muscles to contract, allowing use of one or two basic grasps. Instead, we have developed, in primates, an FES system that is controlled by recordings made from microelectrodes permanently implanted in the brain. We simulated some of the effects of the paralysis caused by C5-C6 spinal cord injury 3 by injecting a local anesthetic to block the median and ulnar nerves at the elbow. Then, using recordings from approximately 100 neurons in the motor cortex, we predicted the intended activity of several of the paralyzed muscles, and used these predictions to control the intensity of stimulation of the same muscles. This process essentially bypassed the spinal cord, restoring to the monkeys voluntary control of their paralyzed muscles. This achievement represents a major advance toward similar restoration of hand function in human patients through brain-controlled FES. We anticipate that in human patients, this neuroprosthesis would allow much more flexible and dexterous use of the hand than is possible with existing FES systems.

Ethier, C.; Oby, E.R.; Bauman, M.J.; Miller, L.E.



The brain under self-control: modulation of inhibitory and monitoring cortical networks during hypnotic paralysis  

Microsoft Academic Search

Brain mechanisms of hypnosis are poorly known. Cognitive accounts proposed that executive attentional systems may cause selective inhibition or disconnection of some mental operations. To assess motor and inhibitory brain circuits during hypnotic paralysis, we designed a go-no-go task while volunteers underwent functional magnetic resonance imaging (fMRI) in three conditions: normal state, hypnotic left-hand paralysis, and feigned paralysis. Preparatory activation

Yann Cojan; Lakshmi Waber; Sophie Schwartz; Laurent Rossier; Alain Forster; Patrik Vuilleumier



Successful Treatment with Intravenous Immunoglobulin of Acute Flaccid Paralysis Caused by West Nile Virus  

PubMed Central

West Nile virus (WNV) is one of the leading causes of insect-borne encephalitis and acute flaccid paralysis in the US. Acute flaccid paralysis is a potentially serious illness, which manifests itself as a Guillain-Barré-like syndrome with generalized weakness and shortness of breath. We report a case involving a patient who presented with acute flaccid paralysis due to WNV infection and was successfully treated with intravenous immunoglobulin from Israeli donors.

Walid, Mohammad Sami; Mahmoud, Fade Aziz



The effect of cocaine on the responses of the differently innervated laryngeal and bronchial ends of the guinea pig trachea in vitro to clinically used bronchodilators.  


Fluorescent histochemical studies indicate that guinea pig tracheal smooth muscle has sparse adrenergic innervation with the greatest nerve density being located at the laryngeal end. In the present study, log dose-response lines were obtained for dl-isoprenaline (ISO), l-adrenaline (ADR) l-noradrenaline (NOR), salbutamol (SALB), and orciprenaline on isolated tracheal chains prepared from both the laryngeal (L) and bronchial (B) ends of the trachea. Responses were obtained in the absence and presence of the Uptake1 blocker, cocaine (0.67 and 6.7 muM) which markedly potentiated responses to NOR and ADR but failed to significantly alter responses to ISO and SALB on L preparations. The degree of potentiation obtained on B preparations was significantly less for NOR and ADR and was not significant for the other agents. In addition, experiments were carried out on tracheal chains which developed their normal tone in the absence of carbachol, and also on preparations obtained from 6-hydroxydopamine treated animals. The present findings, based on selective potentiation of NOR and ADR, support evidence that the degree of adrenergic innervation to the guinea pig trachea is greater at the laryngeal end, and the results obtained with cocaine strengthen the argument that it has a pre-synaptic site of action. PMID:1201486

Jones, T R; Hamilton, J T; Lefcoe, N M



Etiological spectrum of hypokalemic paralysis: A retrospective analysis of 29 patients  

PubMed Central

Background: Hypokalemic paralysis is characterized by episodes of acute muscle weakness associated with hypokalemia. In this study, we evaluated the possible etiological factors in patients of hypokalemic paralysis. Materials and Methods: We reviewed the records of 29 patients who were admitted with a diagnosis of hypokalemic paralysis. Modified Guillain-Barre´ Syndrome disability scale was used to grade the disability. Results: In this study, 15 (51.7%) patients had secondary causes of hypokalemic paralysis and 14 patients (42.3%) had idiopathic hypokalemic paralysis. Thyrotoxicosis was present in six patients (20.6%), dengue infection in four patients (13.7%), distal renal tubular acidosis in three patients (10.3%), Gitelman syndrome in one patient (3.4%), and Conn's syndrome in one patient (3.4%). Preceding history of fever and rapid recovery was seen in dengue infection-induced hypokalemic paralysis. Approximately 62% patients had elevated serum creatinine phosphokinase. All patients had recovered completely following potassium supplementation. Patients with secondary causes were older in age, had significantly more disability, lower serum potassium levels, and took longer time to recover. Conclusion: In conclusion, more than half of patients had secondary causes responsible for hypokalemic paralysis. Dengue virus infection was the second leading cause of hypokalemic paralysis, after thyrotoxicosis. Presence of severe disability, severe hypokalemia, and a late disease onset suggested secondary hypokalemic paralysis.

Garg, Ravindra Kumar; Malhotra, Hardeep Sing; Verma, Rajesh; Sharma, Pawan; Singh, Maneesh Kumar



The evolving role of the laryngeal mask airway in obstetrics  

Microsoft Academic Search

HI Sedition of the Journal contains a repor t that can be considered as astounding in tw o regards: first, that 1067 healthy women fo r elective Cesarean section were given a gene ral anesthetic (GA); and second, a laryngeal mask airwa y (LMA) was used for airway management\\/ventilation . 1 Both practices go against the mantra that obstetric ane

Roanne Preston



Laryngeal Aerodynamics Associated with Oral Contraceptive Use: Preliminary Findings  

ERIC Educational Resources Information Center

|The purpose of this study was to examine possible differences in laryngeal aerodynamic measures during connected speech associated with oral contraceptive (OC) use. Eight women taking an OC, and eight others not taking an OC, participated in the study. Three trials of syllable /p[subscript alpha] /repetitions were obtained using a…

Gorham-Rowan, Mary; Fowler, Linda



Transoral laser microsurgery for locally advanced laryngeal cancer.  


In recent years, surgical treatment of laryngeal cancer has evolved towards transoral resections. Transoral laser microsurgery (TLM) combines microscopic control with the precise cutting and coagulation capability that laser equipment has, making it possible to remove laryngeal tumours by the transoral approach, with very good oncological and functional outcomes. In early tumours, local control with TLM has been proved to be as good as in open surgery and totally comparable to that achieved under radiation protocols, at a much lower cost. Consequently, TLM is presently considered a first line treatment in early laryngeal cancer. These good oncological and functional results have led to an increase in TLM indications for intermediate or advanced carcinomas. In this article we review the role of TLM in the treatment of locally advanced tumours of the larynx, with special emphasis on appropriate patient selection and different technical considerations. Although TLM is not presently considered a standard treatment for locally advanced laryngeal tumours, the outcomes published in the literature are very encouraging, with results comparable to other treatment alternatives in appropriately selected patients. Compared to external surgical procedures, TLM reduces patient morbidity, provides faster recovery and makes it possible to avoid tracheotomy in a high number of patients. PMID:22503567

Vilaseca, Isabel; Bernal-Sprekelsen, Manuel



Laryngeal Muscles Are Spared in the Dystrophin Deficient "mdx" Mouse  

ERIC Educational Resources Information Center

|Purpose: "Duchenne muscular dystrophy (DMD)" is caused by the loss of the cytoskeletal protein, dystrophin. The disease leads to severe and progressive skeletal muscle wasting. Interestingly, the disease spares some muscles. The purpose of the study was to determine the effects of dystrophin deficiency on 2 intrinsic laryngeal muscles, the…

Thomas, Lisa B.; Joseph, Gayle L.; Adkins, Tracey D.; Andrade, Francisco H.; Stemple, Joseph C.



Laryngeal Mask Airway Position and the Risk of Gastric Insufflation  

Microsoft Academic Search

A potential risk of the laryngeal mask airway (LMA) is an incomplete mask seal causing gastric insufflation or oropharyngeal air leakage. The objective of the present study was to assess the incidence of LMA mal- positions by fiberoptic laryngoscopy, and to determine their influence on gastric insufflation and oropharyn- geal air leakage. One hundred eight patients were studied after the

Federico Latorre; Balthasar Eberle; Norbert Weiler; Rolf Mienert; Ales Stanek; Rainer Goedecke; Wolfgang Heinrichs



Blood gas changes in patients undergoing laryngeal microsurgery  

Microsoft Academic Search

BackgroundThe aim of this prospective, single-blind study was to assess the variations in the blood levels of PaO2, PaO2\\/FiO2, PaCO2, and acid–base balance of patients undergoing laryngeal microsurgery under general anesthesia using small-bore endotracheal tubes.

Surhan Ozer Cinar; Berna Uslu Coskun; Ugur Cinar; Melahat Karatmanl? Erol; Sibel Oba; Burhan Dadas



Laryngeal findings and acoustic changes in hubble-bubble smokers.  


The purpose of our investigation was to evaluate the laryngeal findings and acoustic changes in hubble-bubble smokers. A total of 42 subjects with history of hubble-bubble smoking were recruited for this study. A corresponding group with a history of cigarette smoking and controls were matched. All subjects underwent laryngeal video-endostroboscopic evaluation and acoustic analysis. In the hubble-bubble smoking group, 61.9% were males. The average age was 30.02 +/- 9.48 years and the average number of years of smoking was 8.09 +/- 6.45 years. Three subjects had dysphonia at the time of examination. The incidence of benign lesions of the vocal folds in the hubble-bubble group was 21.5%, with edema being the most common at 16.7% followed by cyst at 4.8%. The incidence of laryngeal findings was significantly higher in the hubble-bubble group compared to controls. In the cigarette-smoking group, the most common finding was vocal fold cyst in 14.8% followed by polyps in 7.4%, and edema, sulcus vocalis and granuloma. These findings were not significantly different from the hubble-bubble group except for the thick mucus, which was significantly higher in the latter. There were no significant changes in any of the acoustic parameters between hubble-bubble smokers and controls except for the VTI and MPT, which were significantly lower in the hubble-bubble group. In comparison with the cigarette-smoking group, hubble-bubble smokers had significantly higher Fundamental frequency and habitual pitch (p value 0.042 and 0.008, respectively). The laryngeal findings in hubble-bubble smokers are comparable to cigarette smokers. These laryngeal findings are not translated acoustically, as all the acoustic parameters are within normal range compared to controls. PMID:20480370

Hamdan, Abdul-latif; Sibai, Abla; Oubari, Dima; Ashkar, Jihad; Fuleihan, Nabil



Temporal Constraints on Androgen Directed Laryngeal Masculinization in Xenopus laevis  

PubMed Central

Temporal constraints on androgen regulated masculinization of three sexually dimorphic laryngeal properties—tension, fiber type, and fiber recruitment—were examined in Xenopus laevis frogs. Endocrine state was manipulated at PM0 when the larynx is similar in males and females, at PM2 when the larynx begins sexual differentiation, and at PM6 when sexual differentiation is complete. Removing the testes in developing males (PM0 or PM2) completely arrests laryngeal masculinization. Masculinization resumes when testosterone is replaced later in development (PM2 or PM6, respectively). Thus, testicular secretions, in particular androgens, are required for laryngeal masculinization. The ability of androgens to masculinize tension, fiber type, and fiber recruitment in developing and adult larynges was also determined. Five weeks of testosterone treatment in PM0 or PM2 males and females completely masculinizes laryngeal tension and fiber type, but only partially masculinizes fiber recruitment. However, fiber recruitment can be fully masculinized in PM6 males castrated at PM2. We conclude that androgen induced masculinization of tension and fiber type are not temporally constrained but that androgen induced masculinization of fiber recruitment is. Prolonged androgen treatment can override the temporal constraints on masculinization of the larynx. Testosterone treatment for more than 6 months fully masculinizes fiber recruitment in developing (PM0 or PM2) females. In addition, prolonged treatment (>9 months) completely masculinizes tension, fiber type, and fiber recruitment in adult females; these properties were not fully masculinized by shorter (1–3 months) treatments in adult females. Testosterone induced masculinization in females is maintained for up to 8 months following testosterone removal; thus androgen effects are long lasting and possibly permanent.

Tobias, Martha L.; Marin, Melanie L.; Kelley, Darcy B.



Phonation threshold pressure and flow in excised human larynges  

PubMed Central

Objectives/Hypothesis 1. To determine the phonation threshold pressure (PTP) and phonation threshold flow (PTF) in excised human larynges. 2. To determine the effects of posterior glottal width, glottal area, and gender on PTP and PTF. 3. To test the hypothesis that hysteresis is present in excised human laryngeal phonation. 4. To compare these results to those from canine experiments and human subject measurements. Study Design Induced phonation of excised human larynges in the laboratory. Methods Nine human larynges were harvested within 24 hours post-mortem. PTP and PTF at phonation onset and offset were measured on a bench apparatus. The effects of posterior glottal width, glottal area, and gender were examined. Results Large inter-subject variability was observed in PTP and PTF. PTP was comparable to those measured in vivo, whereas PTF was substantially higher. One-way ANOVA showed no significant dependence of PTP and PTF on posterior glottal width. Hysteresis was observed, with offset PTP and PTF lower than onset values. Offset measurements had significantly less variability than onset measurements (P = 0.012 for PTP, P = 0.0001 for PTF). Conclusions This study is one of the first to report onset and offset PTP and PTF in fresh excised human larynges. The high PTF observed likely reflects a large DC flow component due to vocal fold bowing. Offset PTP and PTF values may be intrinsically more reliably measured than onset values. The large inter-subject variability in PTP and PTF may have implication for the clinical application of these aerodynamic parameters of phonation. Level of Evidence N/A (Laboratory study).

Mau, Ted; Muhlestein, Joseph; Callahan, Sean; Weinheimer, Kent T.; Chan, Roger W.



Na+,K+-pump stimulation improves contractility in isolated muscles of mice with hyperkalemic periodic paralysis.  


In patients with hyperkalemic periodic paralysis (HyperKPP), attacks of muscle weakness or paralysis are triggered by K(+) ingestion or rest after exercise. Force can be restored by muscle work or treatment with ?(2)-adrenoceptor agonists. A missense substitution corresponding to a mutation in the skeletal muscle voltage-gated Na(+) channel (Na(v)1.4, Met1592Val) causing human HyperKPP was targeted into the mouse SCN4A gene (mutants). In soleus muscles prepared from these mutant mice, twitch, tetanic force, and endurance were markedly reduced compared with soleus from wild type (WT), reflecting impaired excitability. In mutant soleus, contractility was considerably more sensitive than WT soleus to inhibition by elevated [K(+)](o). In resting mutant soleus, tetrodotoxin (TTX)-suppressible (22)Na uptake and [Na(+)](i) were increased by 470 and 58%, respectively, and membrane potential was depolarized (by 16 mV, P < 0.0001) and repolarized by TTX. Na(+),K(+) pump-mediated (86)Rb uptake was 83% larger than in WT. Salbutamol stimulated (86)Rb uptake and reduced [Na(+)](i) both in mutant and WT soleus. Stimulating Na(+),K(+) pumps with salbutamol restored force in mutant soleus and extensor digitorum longus (EDL). Increasing [Na(+)](i) with monensin also restored force in soleus. In soleus, EDL, and tibialis anterior muscles of mutant mice, the content of Na(+),K(+) pumps was 28, 62, and 33% higher than in WT, respectively, possibly reflecting the stimulating effect of elevated [Na(+)](i) on the synthesis of Na(+),K(+) pumps. The results confirm that the functional disorders of skeletal muscles in HyperKPP are secondary to increased Na(+) influx and show that contractility can be restored by acute stimulation of the Na(+),K(+) pumps. Calcitonin gene-related peptide (CGRP) restored force in mutant soleus but caused no detectable increase in (86)Rb uptake. Repeated excitation and capsaicin also restored contractility, possibly because of the release of endogenous CGRP from nerve endings in the isolated muscles. These observations may explain how mild exercise helps locally to prevent severe weakness during an attack of HyperKPP. PMID:21708955

Clausen, Torben; Nielsen, Ole Bækgaard; Clausen, Johannes D; Pedersen, Thomas Holm; Hayward, Lawrence J



Na+,K+-pump stimulation improves contractility in isolated muscles of mice with hyperkalemic periodic paralysis  

PubMed Central

In patients with hyperkalemic periodic paralysis (HyperKPP), attacks of muscle weakness or paralysis are triggered by K+ ingestion or rest after exercise. Force can be restored by muscle work or treatment with ?2-adrenoceptor agonists. A missense substitution corresponding to a mutation in the skeletal muscle voltage-gated Na+ channel (Nav1.4, Met1592Val) causing human HyperKPP was targeted into the mouse SCN4A gene (mutants). In soleus muscles prepared from these mutant mice, twitch, tetanic force, and endurance were markedly reduced compared with soleus from wild type (WT), reflecting impaired excitability. In mutant soleus, contractility was considerably more sensitive than WT soleus to inhibition by elevated [K+]o. In resting mutant soleus, tetrodotoxin (TTX)-suppressible 22Na uptake and [Na+]i were increased by 470 and 58%, respectively, and membrane potential was depolarized (by 16 mV, P < 0.0001) and repolarized by TTX. Na+,K+ pump–mediated 86Rb uptake was 83% larger than in WT. Salbutamol stimulated 86Rb uptake and reduced [Na+]i both in mutant and WT soleus. Stimulating Na+,K+ pumps with salbutamol restored force in mutant soleus and extensor digitorum longus (EDL). Increasing [Na+]i with monensin also restored force in soleus. In soleus, EDL, and tibialis anterior muscles of mutant mice, the content of Na+,K+ pumps was 28, 62, and 33% higher than in WT, respectively, possibly reflecting the stimulating effect of elevated [Na+]i on the synthesis of Na+,K+ pumps. The results confirm that the functional disorders of skeletal muscles in HyperKPP are secondary to increased Na+ influx and show that contractility can be restored by acute stimulation of the Na+,K+ pumps. Calcitonin gene-related peptide (CGRP) restored force in mutant soleus but caused no detectable increase in 86Rb uptake. Repeated excitation and capsaicin also restored contractility, possibly because of the release of endogenous CGRP from nerve endings in the isolated muscles. These observations may explain how mild exercise helps locally to prevent severe weakness during an attack of HyperKPP.

Nielsen, Ole Baekgaard; Clausen, Johannes D.; Pedersen, Thomas Holm; Hayward, Lawrence J.



Neural repair in facial paralysis: Clinical and experimental studies  

Microsoft Academic Search

Acute facial nerve injuries involving the total facial nerve (n = 202) and its segmental branches (n = 63) were repaired with a variety of neural (n = 225) and myofascial transfer (n = 40). A system for evaluating results based on facial symmetry and tone at rest, recovery of voluntary mimetic activity,\\u000a synkinesis, and recovery of selective function in

J. G. Spector



Transient perioperative brainstem paralysis secondary to a local anesthetic.  


Local anesthesia is widely used, in isolation or in conjunction with general anesthesia. The authors describe 2 adolescent patients presenting with absent brainstem reflexes and delayed awakening following elective foramen magnum decompression for Chiari Type I malformation. In both cases, neurological deficits were closely associated with the administration of a levobupivacaine field block following wound closure. In the absence of any structural or biochemical abnormalities, and with spontaneous recovery approximating the anesthetic half-life, the authors' observations are consistent with transient brainstem paralysis caused by perioperative local anesthetic infiltration. PMID:22702331

Joannides, Alexis J; Santarius, Thomas; Fernandes, Helen M; Laing, Rodney J C; Trivedi, Rikin A



Phylogenetic Analysis of Acute Bee Paralysis Virus Strains  

PubMed Central

Reverse transcription-PCR assays have been established for a quick, sensitive, and specific diagnosis of acute bee paralysis virus (ABPV), a common virus of the honeybee (Apis mellifera), directly from clinical samples. A 3,071-nucleotide fragment of the ABPV genome, which includes the entire capsid polyprotein gene, was amplified from Austrian, German, Polish, and Hungarian ABPV samples and sequenced, and the sequences were compared. The alignment of a smaller fragment with ABPV sequences from the United States and the United Kingdom revealed nucleotide identity rates between 89 and 96%, respectively. Phylogenetic trees which display the molecular relationship between the viruses of different geographic origin were constructed.

Bakonyi, Tamas; Grabensteiner, Elvira; Kolodziejek, Jolanta; Rusvai, Miklos; Topolska, Grazyna; Ritter, Wolfgang; Nowotny, Norbert



Brain correlates of hypnotic paralysis—a resting-state fMRI study  

Microsoft Academic Search

Hypnotic paralysis has been used since the times of Charcot to study altered states of consciousness; however, the underlying neurobiological correlates are poorly understood. We investigated human brain function during hypnotic paralysis using resting-state functional magnetic resonance imaging (fMRI), focussing on two core regions of the default mode network and the representation of the paralysed hand in the primary motor

M. Pyka; M. Burgmer; T. Lenzen; R. Pioch; U. Dannlowski; B. Pfleiderer; A. W. Ewert; G. Heuft; V. Arolt; C. Konrad



Paralysis of Upward Gaze as a Presenting Symptom of Vitamin B12 Deficiency  

Microsoft Academic Search

A 47-year-old woman presented with paralysis of upward gaze associated with Addison’s pernicious anaemia. Administration of cyanocobalamin resulted in significant improvement of eye movements and haematological parameters. Isolated paralysis of upward gaze may be a feature of vitamin B12 deficiency.Copyright © 1984 S. Karger AG, Basel

R. Sandyk



Natural history of vocal fold paralysis in Arnold-Chiari malformation  

Microsoft Academic Search

Objective: Neurologic disease is the most common cause of bilateral vocal fold paralysis in children. Arnold-Chiari malformations (ACM) account for the majority. Early decompression results in the resolution of preoperative symptoms in the majority of patients. The purpose of present study is to describe the time to vocal fold function recovery following neurosurgical management of children with vocal fold paralysis

Ericka F. King; Marike Zwienenberg-Lee; Steve Maturo; Peter Siao Tick Chong; Christopher Hartnick; David J. Brown


Reduction of airspace after lung resection through controlled paralysis of the diaphragm  

Microsoft Academic Search

Objectives: Residual airspace following thoracic resections is a common clinical problem. Persistent air leak, prolonged drainage time, and reduced hemostasis extend hospital stay and morbidity. We report a trial of pharmacologic-induced diaphragmatic paralysis through continuous paraphrenic injection of lidocaine to reduced residual airspace. The objectives were confirmation of diaphragmatic paralysis and possible procedure related complications. Methods: Six eligible patients undergoing

Giovanni L. Carboni; Andreas Vogt; Jan R. Küster; Peter Berg; Dirk Wagnetz; Ralph A. Schmid; André E. Dutly



Reduction of airspace after lung resection through controlled paralysis of the diaphragm  

Microsoft Academic Search

Objectives: Residual airspace following thoracic resections is a common clinical problem. Persistent air leak, prolonged drainage time, and reduced hemostasis extend hospital stay and morbidity. We report a trial of pharmacologic-induced diaphragmatic paralysis through continuous paraphrenic injection of lidocaine to reduced residual airspace. The objectives were confirmation of diaphragmatic paralysis and possible procedure related complications. Methods: Six eligible patients undergoing

Giovanni L. Carboni; Andreas Vogt; Jan R. Kuster; Peter Berg; Dirk Wagnetz; Ralph A. Schmid



The Prevalence of Sleep Paralysis Among Canadian and Japanese College Students  

Microsoft Academic Search

Although sleep paralysis had been treated as one of the symptoms of narcolepsy, recently it has become recognized as occurring frequently in normal individuals. However, among the few published studies that have examined sleep paralysis, there are great discrepancies in its reported prevalence. These discrepancies could be attributed to differences in survey methods, to the description of the symptom employed

Kazuhiko Fukuda; Robert D. Ogilvie; Lisa Chilcott; Ann-Marie Vendittelli; Tomoka Takeuchie



Practical aspects in the management of hypokalemic periodic paralysis  

PubMed Central

Management considerations in hypokalemic periodic paralysis include accurate diagnosis, potassium dosage for acute attacks, choice of diuretic for prophylaxis, identification of triggers, creating a safe physical environment, peri-operative measures, and issues in pregnancy. A positive genetic test in the context of symptoms is the gold standard for diagnosis. Potassium chloride is the favored potassium salt given at 0.5–1.0 mEq/kg for acute attacks. The oral route is favored, but if necessary, a mannitol solvent can be used for intravenous administration. Avoidance of or potassium prophylaxis for common triggers, such as rest after exercise, high carbohydrate meals, and sodium, can prevent attacks. Chronically, acetazolamide, dichlorphenamide, or potassium-sparing diuretics decrease attack frequency and severity but are of little value acutely. Potassium, water, and a telephone should always be at a patient's bedside, regardless of the presence of weakness. Perioperatively, the patient's clinical status should be checked frequently. Firm data on the management of periodic paralysis during pregnancy is lacking. Patient support can be found at .

Levitt, Jacob O



Congenital bilateral vocal fold paralysis and Charcot-Marie-Tooth disease.  


We present the case of a patient with Charcot-Marie-Tooth disease (CMT) type 1 with congenital bilateral vocal fold paralysis in order to emphasize the treatment options and long-term outcome. The case is reviewed with regard to presentation, differential diagnosis, and treatment. We also reviewed the literature to determine the frequency of congenital and childhood presentations of bilateral vocal fold paralysis associated with CMT, most specifically CMT type 1. We found only 14 children reported to have bilateral vocal fold paralysis associated with CMT, and only 1 of these cases was associated with CMT type 1. None of these patients had congenital vocal fold paralysis. Because of the degenerative nature of the disease, our patient underwent endoscopic cordotomy to avoid tracheotomy. We conclude that CMT should be included in the differential diagnosis in evaluating neonates with bilateral vocal fold paralysis. If CMT is definitively diagnosed, it could alter the course of treatment. PMID:20128187

Lewis, Andrea F; Carron, Jeffrey D; Vedanarayanan, Vetta



Thyrotoxic hypokalemic periodic paralysis as the presenting symptom of silent thyroiditis  

PubMed Central

Silent thyroiditis is a rare cause of thyrotoxic periodic paralysis. The objective was to present a case of silent thyroiditis presenting as periodic paralysis. A 23-year-old man presented with recurrent acute flaccid predominantly proximal weakness of all four limbs. He had a similar episode 3 weeks back. On examination he was found to have hypokalemia secondary to thyrotoxicosis. Clinically there were no features of thyrotoxicosis or thyroiditis. He was initially treated with intravenous and later oral potassium supplementation and propranolol. At 8 weeks of follow-up his thyroid profile became normal and his propranolol was stopped. He had no further recurrence of paralysis. He was diagnosed as a case silent thyroiditis presenting as thyrotoxic periodic paralysis. In cases of recurrent or acute flaccid muscle paralysis, it is important to suspect thyrotoxicosis, even if asymptomatic. Definitive treatment of thyrotoxicosis prevents recurrence.

Sanyal, Debmalya; Bhattacharjee, Shakya



Abnormal brain activation during movement observation in patients with conversion paralysis.  


Dissociative paralysis in conversion disorders has variably been attributed to a lack of movement initiation or an inhibition of movement. While psychodynamic theory suggests altered movement conceptualization, brain activation associated with observation and replication of movements has so far not been assessed neurobiologically. Here, we measured brain activation by functional magnetic resonance imaging during observation and subsequent imitative execution of movements in four patients with dissociative hand paralysis. Compared to healthy controls conversion disorder patients showed decreased activation of cortical hand areas during movement observation. This effect was specific to the side of their dissociative paralysis. No brain activation compatible with movement inhibition was observed. These findings indicate that in dissociative paralysis, there is not only derangement of movement initiation but already of movement conceptualization. This raises the possibility that strategies targeted at reestablishing appropriate movement conceptualization may contribute to the therapy of dissociative paralysis. PMID:16213162

Burgmer, Markus; Konrad, Carsten; Jansen, Andreas; Kugel, Harald; Sommer, Jens; Heindel, Walter; Ringelstein, Erich B; Heuft, Gereon; Knecht, Stefan



Brachial neuritis involving the bilateral phrenic nerves.  


Brachial neuritis with bilateral hemidiaphragmatic paralysis has been reported in two previous cases in the literature. We report a patient who experienced severe right shoulder discomfort three weeks prior to hospital admission which evolved to include both shoulders. Two weeks prior to admission he noticed the onset of discomfort in breathing in the supine position and shortness of breath with minor exertion. The admitting diagnoses were myocardial infarction due to significant ECG changes and idiopathic elevated bilateral hemidiaphragms. The patient had findings significant for tachypnea, dyspnea, decreased breath sounds at the bases bilaterally, impaired motion of the bilateral lung bases on inspiration and paradoxical respirations. Comprehensive medical testing and evaluation revealed bilateral elevated hemidiaphragms and vital capacity 40% of normal. Weakness of the proximal shoulder girdle and bicep musculature bilaterally was noted. Electromyography was significant for reduced recruitment pattern in the bilateral shoulder girdle musculature. Nerve conduction studies suggested bilateral phrenic neuropathy. This case is an unusual presentation of brachial neuritis affecting the bilateral shoulder girdle with phrenic nerve involvement. The differential diagnosis of acute shoulder pain associated with respiratory symptomatology should therefore include brachial neuritis. PMID:3800625

Walsh, N E; Dumitru, D; Kalantri, A; Roman, A M



Positron emission tomography\\/computed tomography as a method for detection and monitoring of laryngeal chondritis  

Microsoft Academic Search

Infections of the laryngeal cartilages occur clinically as local pain, dysphonia, dysphagia or dyspnoea and may lead to destruction\\u000a of the laryngeal skeleton. We present positron emission tomography\\/computed tomography (PET–CT) as a new method for detection\\u000a and monitoring of laryngotracheal chondritis. We prospectively analyzed all patients undergoing PET–CT examination, of whom\\u000a we were clinically suspicious of laryngeal cartilage chondritis. When

Markus Gugatschka; Thomas Schwarz; Gerhard Friedrich



The role of host behaviour in tick-host interactions: a domestic host-paralysis tick model  

Microsoft Academic Search

The aim of this study was to quantify the infestation densities of Karoo and brown paralysis ticks on sheep and goats and explain it in terms of the etho-ecology of these ticks and their domestic hosts. The Karoo paralysis tick usually quests from a vantage point on the vegetation whereas the brown paralysis tick displays an appetence response from the

L. J. Fourie; O. B. Kok



Facial nerve palsy due to birth trauma  


... way on both sides while crying No movement (paralysis) on the affected side of the face (from the forehead to the chin in severe ... goes away on its own. Infants with permanent paralysis need special therapy.


Ulnar nerve damage (image)  


... arm. The nerve is commonly injured at the elbow because of elbow fracture or dislocation. The ulnar nerve is near ... surface of the body where it crosses the elbow, so prolonged pressure on the elbow or entrapment ...


Nerves and Tissue Repair.  

National Technical Information Service (NTIS)

Studies have been conducted with regenerating amphibian sciatic nerves in organ culture to characterize further transport and release of transferrin in growing axons of peripheral nerves. The hypothesis under investigation is that transferrin, the iron-tr...

A. L. Mescher



Tibial nerve dysfunction  


... nerve dysfunction is a loss of movement or sensation in the foot from damage to the tibial ... the leg. The tibial nerve supplies movement and sensation to the calf and foot muscles. A problem ...


Optic Nerve Disorders  


... each eye carries impulses to the brain, where visual information is interpreted. Damage to an optic nerve ... determine where the problem is in the pathway. Visual Pathways and the Consequences of Damage Nerve signals ...


Common peroneal nerve dysfunction  


... type of peripheral neuropathy (damage to nerves outside the brain or spinal cord). This condition can affect people ... people: Who are very thin (for example, from anorexia nervosa ) ... damage the common peroneal nerve Charcot-Marie-Tooth disease is ...


Nerve Injuries in Athletes.  

ERIC Educational Resources Information Center

|Over a two-year period this study evaluated the condition of 65 athletes with nerve injuries. These injuries represent the spectrum of nerve injuries likely to be encountered in sports medicine clinics. (Author/MT)|

Collins, Kathryn; And Others



Skin and Nerve Biopsies  

Center for Drug Evaluation (CDER)

Text VersionPage 1. Skin and Nerve Biopsies RA Malik Page 2. ... Nerve Biopsy • Evidence from Clinical Trials • Skin Biopsy • Evidence from Clinical Trials ... More results from


Surgical treatment of laryngeal papillomatosis using narrow band imaging.  


Laryngeal papillomatosis has a high rate of recurrence after surgery. Narrow band imaging (NBI) is a novel optical enhancement technology used for the diagnosis. This is the first report to date to indicate the availability of the combination of laryngomicro surgery and videoendoscopic surgery for laryngeal papillomatosis using NBI technology. The patients were a 34-year-old man and a 30-year-old man. Both patients underwent surgery in another hospital. However, due to recurrence, they were subsequently referred to the authors' department for further evaluation. The presence of papillomas was confirmed by NBI, and the papillomas were removed using an XPS Micro Debrider and a CO2 laser. Using the NBI system, the border between the normal mucosa and the papillomas could be clearly identified, allowing precise resection. Further treatment on the lesions has been carried out several times to date using NBI. The lesions have now been eradicated without further recurrence. PMID:22597574

Imaizumi, Mitsuyoshi; Okano, Wataru; Tada, Yasuhiro; Omori, Koichi



Speed, accuracy, and stability of laryngeal movement in singing  

NASA Astrophysics Data System (ADS)

Motor performance is often quantified in terms of speed, strength, accuracy, and stability of a target gesture, or maintaining a given posture. In the vocal system, this involves primarily the intrinsic laryngeal muscles and the respiratory muscles. Agonist-antagonist pairs of muscles are used to position the vocal folds for phonation (vocal onset), for pitch change, and for registration (as in yodeling). Maximum speed and accuracy are discussed for vocal embellishments such as trills, trillo, scales, arpeggios, yodel, and glissando. This speed and accuracy are interpreted in terms of muscle twitch and tetanic responses obtained in vitro on animal muscles, from electromyographic recordings on humans, and from muscles not easily tested on humans. The laryngeal reflex system is also described, particularly with regard to its ability to stabilize (or destabilize) neurologic tremor originating from the central nervous system.

Titze, Ingo R.



Acute laryngitis in adults: results of erythromycin treatment.  


Previous studies of acute laryngitis in adults have shown high nasopharyngeal isolation rates of B. catarrhalis and H. influenzae. Phenoxymethylpenicillin had no effect on the clinical course. In the present study, 106 patients with acute laryngitis were treated with erythromycin 0.5 g x 2 V or placebo. During the first week the isolation rate of B. catarrhalis was reduced from 60 to 10% in the erythromycin group compared to 34 to 27% in the placebo group (p less than 0.01). The elimination of H. influenzae, isolated in 19% at the acute visit, did not differ between the two groups. As compared to controls, erythromycin treated patients reported significantly lower scores of subjective voice disturbance after 1 week and cough after 2 weeks. Laryngological examination and voice evaluation failed to reveal any differences between the groups. PMID:1632252

Schalén, L; Eliasson, I; Fex, S; Kamme, C; Schalén, C



Isolated Laryngeal Leishmaniasis in Immunocompetent Patients: An Underdiagnosed Disease  

PubMed Central

We describe a case of isolated primary laryngeal leishmaniasis in an immunocompetent Italian patient with a previous medical history negative for visceral or cutaneous leishmaniasis, presenting with hoarseness. We also summarize the epidemiological, clinical, and diagnostic features and the therapeutic management of other cases of laryngeal leishmaniasis in immunocompetent subjects, described in the literature. Considering the insidious and nonspecific clinical presentation, the increasing number of different forms of mild or underestimated immunosuppressive conditions, and the number of people travelling in endemic zones, along with the ability of Leishmania amastigotes to survive for a long period in the body, we believe it is important for pathologists and clinicians to be aware of this unusual form of leishmaniasis in order to avoid delayed recognition and treatment. The rarity of the presentation and the lack of guidelines on mucosal leishmaniasis may contribute to the potential undiagnosed cases or delayed diagnosis, the possible relapses, as well as the correct pharmacological and/or surgical therapeutic approach.

Cocuzza, Salvatore; Strazzulla, Alessio; Pinzone, Marilia Rita; Cosentino, Stefano; Serra, Agostino; Caltabiano, Rosario; Lanzafame, Salvatore; Cacopardo, Bruno; Nunnari, Giuseppe



Detection of helicobacter pylori in benign laryngeal lesions by polymerase chain reaction: a cross sectional study  

PubMed Central

Background Although Helicobacter Pylori (HP) was detected in some cases of chronic laryngitis, the results were not confirmed by polymerase chain reaction (PCR). By this time, it has not been found in laryngeal lesions by in house PCR, the most sensitive method for detecting the genome tracks. Regarding the previous results and also few numbers of studies about the presence of HP in benign laryngeal lesions, specifically by PCR, we aimed to investigate the presence of HP in benign laryngeal lesions by in-house PCR. Methods The samples were taken from 55 patients with benign laryngeal lesions and frozen in ?20°C. One milliliter (ml) of lysis buffer was added to 100 mg (mg) of each sample and the tube was placed in 56°C overnight. Then DNA extraction was carried out. Results To find HP DNA, in-house PCR was performed that revealed 5 positive results among 55 patients with benign laryngeal lesions. Of them, 3 were polyp, 1 was nodule and 1 was papilloma. Conclusion Although the number of positive results was not a lot in this study, it was in contrast with previous studies which could not find any HP tracks in benign laryngeal lesions by other methods. More studies about the prevalence of HP in benign laryngeal lesions improve judging about the effect of this infection on benign laryngeal lesions.



Rotational vs. standard smooth laryngeal mask airway insertion in adults  

Microsoft Academic Search

OBJECTIVE: To compare the ease of insertion between rotational laryngeal mask airway (LMA) insertion and Brain's LMA insertion technique in terms of number of LMA insertion attempts, time duration of LMA insertion and complications: trauma, laryngospasm, and hypoxaemia.STUDY DESIGN: Randomized control study.PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from September 2006 to May 2007.METHODOLOGY: One hundred

Dileep Kumar; Mueenullah Khan; Muhammad Ishaq



Laryngeal mask airway can be inserted with inhaled desflurane induction  

Microsoft Academic Search

Purpose. In this prospective, randomized, controlled trial, we investigated the reliability of laryngeal mask airway (LMA) insertion with inhaled desflurane. Methods. Eighty patients undergoing elective surgery were randomized into two groups to receive either 2.5 mg·kg 1 propofol (n 40) or tidal breath desflurane (n 40) induction followed by LMA insertion. All patients received fentanyl 1 µg·kg 1 2 min

Wai May Leong; Ee Lyn Ong



Phosphatidylinositol 3-kinase regulates early differentiation in human laryngeal keratinocytes  

Microsoft Academic Search

Summary  Epidermal growth factor receptor (EGFR) signaling regulates a variety of cellular functions, including proliferation, gene\\u000a expression, and differentiation. Infection of laryngeal epithelial cells by human papillomaviruses causes recurrent respiratory\\u000a papillomas, benign tumors characterized by an altered pattern of differentiation. Papilloma cells overexpress the EGFR and\\u000a have constitutively active extracellular signal-regulated kinase (ERK) and enhanced phosphatidylinositol 3-kinase (PI3K) activity,\\u000a but overexpression

Raduwan Dackour; Timothy Carter; Bettie M. Steinberg



[Endotracheal tube for laryngeal CO2 laser microsurgery. 208 cases].  


To suppress the risk inherent in laryngeal microsurgery performed with a CO2 laser beam, the authors suggest to use a reinforced silicone endotracheal tube, the cuff of which is protected by a silicone plus aluminium powder shield. The resistance of silicone to fire is augmented during laser shots by a nitrogen flow on the upper side of the shield at the rates of 2 l/min in patients breathing air and 30 l/min in patients give oxygen. PMID:3161063

Brille, P; Milhaud, A; Starobinsky, E; Postel, J P; Buffet, J P; Vaquette, C; Boudin, G; Daelman, F; Lemoine, E



Usefulness of ultrasonography in assessment of laryngeal carcinoma.  


Objective: To evaluate the usefulness of ultrasonography in assessing laryngeal cancer. Methods: 72 patients with laryngeal carcinoma proven by surgery and pathology were enrolled. The pre-therapeutic ultrasonography and CT images were retrospectively evaluated, including tumour detection, localisation and invasion of intra- and extralaryngeal structures. A comparative assessment was made between the detection rate, correspondence rate of localisation and sensitivity and specificity of ultrasonography and CT. The mobility of the larynx was observed on real-time ultrasonography and compared with laryngoscopy. Results: The detection rate of ultrasonography [63 (87.5%)/72] was lower than that of CT [72 (100.0%)/72] (p=0.006). The primary foci were accurately located in 59 (93.7%) of 63 lesions using ultrasonography compared with 70 (97.2%) of 72 lesions using CT (p=0.392). In the evaluation of invasion, the sensitivity and specificity of ultrasonography were similar to that of CT in most of the intra- and extralaryngeal structures (p=0.059-1.000). A higher specificity was obtained during the assessment of the paraglottic space involvement when using ultrasonography than CT (94.9% vs 66.7%, p=0.001). For vocal cord fixation, no statistical difference was found between ultrasonography and laryngoscopy (p=0.223). Conclusion: Ultrasonography could be used as a valuable supplementary imaging method to CT and laryngoscopy in the assessment of laryngeal carcinoma, even in male adults with some calcifications of the thyroid cartilage. Advances in knowledge: Our study demonstrates that ultrasonography, which has been used scarcely in the larynx, could supply useful information on the detection, localisation and intra- and extralaryngeal invasion of laryngeal carcinoma. PMID:24004487

Xia, C-X; Zhu, Q; Zhao, H-X; Yan, F; Li, S-L; Zhang, S-M



Radiation therapy of laryngeal cancer: a twenty year experience.  


This paper reviews a 20 year experience of radiation treatment of 286 laryngeal cancers and presents results with a minimum five year follow-up. All cases presented had glottic or supraglottic squamous cell carcinomas with no clinical evidence of nodal metastasis. A policy of primary radiotherapy with surgery for salvage of treatment failures, produced control of primary disease and prevention of metastases superior to most other regimes documented in the literature. PMID:2230577

Robson, N L; Oswal, V H; Flood, L M



Engineering peripheral nerve repair.  


Current approaches for treating peripheral nerve injury have resulted in promising, yet insufficient functional recovery compared to the clinical standard of care, autologous nerve grafts. In order to design a construct that can match the regenerative potential of the autograft, all facets of nerve tissue must be incorporated in a combinatorial therapy. Engineered biomaterial scaffolds in the future will have to promote enhanced regeneration and appropriate reinnervation by targeting the highly sensitive response of regenerating nerves to their surrounding microenvironment. PMID:23790730

Marquardt, Laura M; Sakiyama-Elbert, Shelly E



From Grunts to Words: Experiments in Laryngeal Transplantation  

PubMed Central

INTRODUCTION Laryngeal transplantation remains an increasingly viable option for patients with irreversible disease or damage to the larynx. Successful organ transplantation relies on minimising surgical, ischaemic and immunological insults. The inherent immunogenicity of an organ is dependent on the amount of immunologically active cells within it. The presence of immunologically active cells within non-transplanted NIH-minipigs was investigated and an in vivo laryngeal transplant model was developed. MATERIALS AND METHODS Quantitative, multiple-colour immunofluorescence using pig-specific monoclonal antibodies was used to assess the normal immunological architecture and the short-term immunological changes associated with 3 h of cold ischaemia and 8 h of reperfusion in an MHC-matched animal model. RESULTS AND CONCLUSIONS There is a complex immunological architecture within the non-transplanted, healthy pig larynx. In addition, an in vivo laryngeal transplant model was developed that allowed successful perfusion for 8 h post transplantation. There were significant changes in cell numbers within different anatomical subsites of the larynx. However, the biological significance remains debatable in view of the large range of cell numbers both within and between individual animals.

Barker, Emma V



p53 Overexpression in laryngeal squamous cell carcinoma and dysplasia  

PubMed Central

Aim—To investigate the expression of p53 protein in invasive squamous cell carcinoma (SCC) of the larynx and dysplasia in relation to histological grade and tobacco smoking. Method—Paraffin wax embedded tissue sections from 41 cases of invasive SCC of the larynx, 28 cases of dysplasia and 14 control laryngeal biopsy specimens were studied immunohistochemically using two anti-p53 monoclonal antibodies (DO7 and 1801). The Streptavidin/horseradish peroxidase method was used after microwave antigen retrieval and a semiquantitative method was applied to assess the extent of p53 expression. Results—Of the cases of invasive SCC of the larynx, 78% (32/41), regardless of histological grade, overexpressed p53 compared with only 30% (eight of 28) of cases of mild dysplasia. A gradual increase in p53 expression from mild to severe dysplasia (60%) was observed, and only three of 14 control biopsy specimens of laryngeal nodules showed occasional weakly positive basal cells. Conclusion—The gradual increase in p53 expression from mild to severe dysplasia to invasive SCC indicates that p53 overexpression is an early event in laryngeal carcinogenesis which may lead to invasive malignancy. p53 overexpression may be related to environmental factors as most of the patients smoked tobacco. Microwave postfixation may be essential for the reliable detection of p53. Images

Barbatis, C; Loukas, L; Grigoriou, M; Nikolaou, I; Tsikou-Papafragou, A; Marsan, N; Gatter, K C; Kaklamanis, L



Laryngeal mask airway position and the risk of gastric insufflation.  


A potential risk of the laryngeal mask airway (LMA) is an incomplete mask seal causing gastric insufflation or oropharyngeal air leakage. The objective of the present study was to assess the incidence of LMA malpositions by fiberoptic laryngoscopy, and to determine their influence on gastric insufflation and oropharyngeal air leakage. One hundred eight patients were studied after the induction of anesthesia, before any surgical manipulations. After clinically satisfactory LMA placement, tidal volumes were increased stepwise until air entered the stomach, airway pressure exceeded 40 cm H2O, or air leakage from the mask seal prevented further increases in tidal volume. LMA position in relation to the laryngeal entrance was verified using a flexible bronchoscope. The overall incidence of LMA malpositions was 40% (43 of 108). Gastric air insufflation occurred in 19% (21 of 108), and in 90% (19 of 21) of these patients, the LMA was malpositioned. Oropharyngeal air leakage occurred in 42%, and was independent of LMA position. We conclude that clinically unrecognized LMA malposition is a significant risk factor for gastric air insufflation. Implications: Routine placement of laryngeal mask airways does not require laryngoscopy. In our study, fiberoptic verification of mask position revealed suboptimal placement in 40% of cases. Such malpositioning considerably increased the risk of gastric air insufflation. PMID:9539617

Latorre, F; Eberle, B; Weiler, N; Mienert, R; Stanek, A; Goedecke, R; Heinrichs, W



Cranial Nerves Model  

NSDL National Science Digital Library

Lesson is designed to introduce students to cranial nerves through the use of an introductory lecture. Students will then create a three-dimensional model of the cranial nerves. An information sheet will accompany the model in order to help students learn crucial aspects of the cranial nerves.

Juliann Garza (University of Texas-Pan American Physician Assistant Studies)



Characteristics of Nerve Agents.  

National Technical Information Service (NTIS)

There are three types of nerve agents currently stored in chemical stockpiles in the United States: VX, GB and GA. All three nerve agents are members of the organophosphate family. Nerve agent VX, a clear, odorless and tasteless liquid, has an appearance ...



Evaluation of the thoraco-laryngeal reflex ('slap test') as an indicator of laryngeal adductor myopathy in the horse.  


A study was conducted over a 12 month period to assess the accuracy of the 'slap test' in the diagnosis of laryngeal adductor myopathy. The thoraco-laryngeal reflexes of 15 horses with no clinical signs of idiopathic laryngeal hemiplegia (ILH) were recorded using a video-endoscope. These 'slap test' responses were examined independently by 3 assessors. The horses were subsequently subjected to euthanasia and samples taken from the cricoarytenoideus lateralis (CAL) muscles for histopathological examination and assessment of denervation atrophy. Despite normal adductory responses, moderate to severe atrophy of the left CAL muscles was seen in 5 horses. The remaining horses had varying degrees of adductor myopathy, invariably worse in the left side of the larynx. The 'slap test' as performed in this study was therefore unable to differentiate between horses with moderate to severe muscle changes and those without, making it useless as a diagnostic test for adductor myopathy. The reason for the preservation in adductor function despite advanced histological atrophy of the muscle may lie in the degree of reinnervation found in the muscles. PMID:7988536

Newton-Clarke, M J; Divers, T J; Valentine, B A



ProSeal laryngeal mask airway improves oxygenation when used as a conduit prior to laryngoscope guided intubation in bariatric patients  

PubMed Central

Background: The primary objective of this study was to compare the effect of ventilation using the ProSeal™ laryngeal mask airway (PLMA) with facemask and oropharyngeal airway (FM), prior to laryngoscopy, on arterial oxygenation in morbidly obese patients undergoing bariatric surgery. Methods: Forty morbidly obese patients were randomly recruited to either PLMA or FM. After pre-oxygenation (FiO2 1.0) in the ramp position with continuous positive airway pressure of 10 cm H2O for 5 min, anaesthesia was induced. Following loss of jaw thrust oropharyngeal airway, the FM and PLMA were inserted. On achieving paralysis, volume control ventilation with PEEP (5 cm H2O) was initiated. The difficulty in mask ventilation (DMV) in FM, number of attempts at PLMA and laryngoscopy were graded (Cormack and Lehane) in all patients. Time from onset of laryngoscopy to endotracheal tube confirmation was recorded. Hypoxia was defined as mild (SpO2 ?95%), moderate (SpO2 ?90%) and severe (SpO2 ?85%). Results: Significant rise in pO2 was observed within both groups (P=0.001), and this was significantly higher in the PLMA (P=0.0001) when compared between the groups. SpO2 ? 90% (P=0.018) was seen in 19/20 (95%) patients in PLMA and 13/20 (65%) in FM at confirmation of tracheal tube. A strong association was found between DMV and Cormack Lehane in the FM group and with number of attempts in the PLMA group. No adverse events were observed. Conclusion: ProSeal™ laryngeal mask airway as conduit prior to laryngoscopy in morbidly obese patients seems effective in increasing oxygen reserves, and can be suggested as a routine airway management technique when managing the airway in the morbidly obese.

Sinha, Aparna; Jayaraman, Lakshmi; Punhani, Dinesh; Panigrahi, Bishnu



Phrenic nerve injury after image-guided insertion of a tunnelled right internal jugular central venous catheter.  


Central venous catheters (CVC) are now commonly inserted by radiologists. Although complications are infrequent, they must be avoided where possible and recognized when they occur. We present a 10-year-old boy who developed right hemidiaphragmatic paralysis, requiring surgical plication, following US-guided insertion of a tunnelled right internal jugular CVC. The needle trajectory for internal jugular puncture must be planned to avoid the phrenic nerve. PMID:22057361

Shawyer, Andrew; Chippington, Samantha; Quyam, Sadia; Schulze-Neick, Ingram; Roebuck, Derek



Nerve sprouting in innervated adult skeletal muscle induced by exposure to elevated levels of insulin-like growth factors  

Microsoft Academic Search

Partial denervation or paralysis of adult skeletal muscle is followed by nerve sprouting, proba- bly due to release of diffusible sprout-inducing activity by inactive muscle. Insulin-like growth factors (IGF1 and IFG2) are candidates for muscle-derived sprouting activity, because (a) they induce neurite growth from peripheral neurons in vitro; and (b) their mRNA lev- els in adult skeletal muscle increase severalfold

Pico Caroni; Pedro Grandes



Hypoxic respiratory failure due to phrenic nerve palsy from an interscalene brachial plexus block and previously asymptomatic pulmonary embolism  

Microsoft Academic Search

Interscalene brachial plexus block is a common regional anesthesia method for upper extremity surgery. A rare complication\\u000a of this procedure is dyspnea secondary to phrenic nerve palsy and hemidiaphragm paralysis. In our case, this rare complication\\u000a diagnosed using ultrasound led to the diagnosis of a previously asymptomatic pulmonary embolism. The use of ultrasonography\\u000a was key in the diagnosis of the

Danielle M. Minett; Jason T. Nomura



Optic Nerve Elongation  

PubMed Central

The length of the optic nerves is a reflection of normal postnatal cranio-orbital development. Unilateral elongation of an optic nerve has been observed in two patients with orbital and skull base neoplasms. In the first case as compared to the patient's opposite, normal optic nerve, an elongated length of the involved optic nerve of 45 mm was present. The involved optic nerve in the second patient was 10 mm longer than the normal opposite optic nerve. The visual and extraocular function was preserved in the second patient. The first patient had only light perception in the affected eye. In this paper, the embryology, anatomy, and physiology of the optic nerve and its mechanisms of stretch and repair are discussed. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9Figure 10Figure 11Figure 13

Alvi, Aijaz; Janecka, Ivo P.; Kapadia, Silloo; Johnson, Bruce L.; McVay, William



The SOOF lift as an adjunct in rehabilitation of facial paralysis: help or hype?  


Rehabilitation of the midface in chronic facial paralysis is one of the last frontiers in global facial reanimation. The suborbicularis oculi fat pad lift, or SOOF lift, also known as the midface lift, has been popularized in aesthetic surgery literature as a way to restore midface fullness with a youthful appearance while eliminating midface sag associated with aging. These techniques of midface aesthetic rejuvenation have recently been applied in cases of chronic facial paralysis. This article analyzes the role of the midface lift or SOOF lift in cases of facial reanimation and determines whether or not it is of benefit to patients affected by chronic facial paralysis. PMID:11460300

Alford, E L



Maturation and transformation of reflexes that protect the laryngeal airway from liquid aspiration from fetal to adult life  

Microsoft Academic Search

Several reflexes are initiated in the fetus and newborn when hypochloremic or strongly acidic solutions contact the epithelium that surrounds the entrance to the laryngeal airway. These reflexes, known collectively as the laryngeal chemoreflex (LCR), include startle, rapid swallowing, apnea, laryngeal constriction, hypertension, and bradycardia. Many studies have shown that prolonged apnea associated with the LCR may be life threatening

Bradley T. Thach



Clinical usefulness of 3-dimensional computed tomography laryngography in laryngeal and hypopharyngeal cancer  

Microsoft Academic Search

This study was designed to evaluate the clinical usefulness of 3-dimensional computed tomography (CT) laryngography for the determination of subglottic extension in laryngeal cancer and for the involvement of the pyriform sinus apex in hypopharyngeal cancer. Twenty-one patients with laryngeal cancer and 19 patients with hypopharyngeal cancer underwent spiral CT during quiet breathing, \\/E\\/ phonation, Valsalva's maneuver, and modified Valsalva's

Soo-Geun Wang; Cheol-Ju Seo; Kyong-Myong Chon; Eui-Kyung Goh; Byung-Joo Lee; Hak Jin Kim



Comparison between Classic Laryngeal Mask and Cobra Perilaryngeal Airway during Mechanical Ventilation  

Microsoft Academic Search

Background: Selection of an optimal method for the safe preoperative airway management is the base of a successful general anaesthesia. To achieve this goal various methods and devices are used including endotracheal tube and laryngeal mask airway, each has its own advantages and disadvantages. In this study, we compared a new supraglottic instrument (cobra perilaryngeal airway) with laryngeal mask airway

Mahvash Agah; Peyman Yahyavi; Fatemeh Roudneshin


Respiratory and Laryngeal Function during Spontaneous Speaking in Teachers with Voice Disorders  

ERIC Educational Resources Information Center

|Purpose: To determine if respiratory and laryngeal function during spontaneous speaking were different for teachers with voice disorders compared with teachers without voice problems. Method: Eighteen teachers, 9 with and 9 without voice disorders, were included in this study. Respiratory function was measured with magnetometry, and laryngeal

Lowell, Soren Y.; Barkmeier-Kraemer, Julie M.; Hoit, Jeannette D.; Story, Brad H.



Airway Management Using the Intubating Laryngeal Mask Airway for the Morbidly Obese Patient  

Microsoft Academic Search

We studied the effectiveness of the intubating laryngeal mask airway (ILMA) in morbidly obese patients sched- uled for bariatric surgery. We included 118 consecutive morbidly obese patients (body mass index, 45 5 kg\\/m2). After the induction of general anesthesia, the laryngeal view was classified by the first observer according to the method of Cormack and Lehane. The ILMA was then

Thierry Guenoun; Didier Journois; Emma Aka; Philippe Cadi; Jacqueline Silleran-Chassany; Denis Safran



Laryngeal involvement in pediatric neurofibromatosis: a case report and review of the literature  

Microsoft Academic Search

A case of neurofibroma of the larynx occurring in generalized neurofibromatosis (von Recklinghausen's disease) is presented, and the previously reported pediatric cases are reviewed. Laryngeal involvement in neurofibromatosis is rare and the predominant signs and symptoms include dyspnea, stridor, loss or change of voice and dysphagia. Problems posed related to diagnosis, management and course of this infrequent laryngeal localization are

M. J. Masip; E. Esteban; C. Alberto; F. Menor; H. Cortina



Laryngeal somatosensory deficits in Parkinson's disease: implications for speech respiratory and phonatory control  

PubMed Central

Parkinson’s disease (PD) is often associated with substantial impairment of speech respiratory and phonatory control. However, the degree to which these impairments are related to abnormal laryngeal sensory function is unknown. This study examined whether individuals with PD exhibited abnormal and more asymmetric laryngeal somatosensory function compared with healthy controls, and whether these deficits were associated with disease and voice severity. Nineteen PD participants were tested and compared with 18 healthy controls. Testing included endoscopic assessment of laryngeal somatosensory function, with aerodynamic and acoustic assessment of respiratory and phonatory control, and clinical ratings of voice and disease severity. PD participants exhibited significantly abnormal and asymmetric laryngeal somatosensory function compared with healthy controls. Sensory deficits were significantly associated with timing of phonatory onset, voice intensity, respiratory driving pressure, laryngeal resistance, lung volume expended per syllable, disease severity, and voice severity. These results suggest that respiratory and phonatory control are influenced by laryngeal somatosensory function, that speech-related deficits in PD are related to abnormal laryngeal somatosensory function, and that this function may degrade as a function of disease severity. Thus, PD may represent a model of airway sensorimotor disintegration, highlighting the important role of the basal ganglia and related neural networks in the integration of laryngeal sensory input for speech-related motor control.

Barlow, Steven M.



Respiratory and Laryngeal Responses to an Oral Air Pressure Bleed during Speech  

ERIC Educational Resources Information Center

|Researchers have hypothesized that the respiratory and laryngeal speech subsystems would respond to an air pressure bleed, but these responses have not been empirically studied. The present study examined the nature of the responses of the respiratory and laryngeal subsystems to an air pressure bleed in order to provide information relevant to…

Huber, Jessica E.; Stathopoulos, Elaine T.



Gastric mucosal nerve density  

PubMed Central

Background: Autonomic neuropathy is a frequent diagnosis for the gastrointestinal symptoms or postural hypotension experienced by patients with longstanding diabetes. However, neuropathologic evidence to substantiate the diagnosis is limited. We hypothesized that quantification of nerves in gastric mucosa would confirm the presence of autonomic neuropathy. Methods: Mucosal biopsies from the stomach antrum and fundus were obtained during endoscopy from 15 healthy controls and 13 type 1 diabetic candidates for pancreas transplantation who had secondary diabetic complications affecting the eyes, kidneys, and nerves, including a diagnosis of gastroparesis. Neurologic status was evaluated by neurologic examination, nerve conduction studies, and skin biopsy. Biopsies were processed to quantify gastric mucosal nerves and epidermal nerves. Results: Gastric mucosal nerves from diabetic subjects had reduced density and abnormal morphology compared to control subjects (p < 0.05). The horizontal and vertical meshwork pattern of nerve fibers that normally extends from the base of gastric glands to the basal lamina underlying the epithelial surface was deficient in diabetic subjects. Eleven of the 13 diabetic patients had residual food in the stomach after overnight fasting. Neurologic abnormalities on clinical examination were found in 12 of 13 diabetic subjects and nerve conduction studies were abnormal in all patients. The epidermal nerve fiber density was deficient in skin biopsies from diabetic subjects. Conclusions: In this observational study, gastric mucosal nerves were abnormal in patients with type 1 diabetes with secondary complications and clinical evidence of gastroparesis. Gastric mucosal biopsy is a safe, practical method for histologic diagnosis of gastric autonomic neuropathy.

Selim, M.M.; Wendelschafer-Crabb, G.; Redmon, J.B.; Khoruts, A.; Hodges, J.S.; Koch, K.; Walk, D.; Kennedy, W.R.



Attempts to restore abduction of the paralyzed equine arytenoid cartilage. I. Nerve-muscle pedicle transplants.  

PubMed Central

The purpose of this project was to adapt a surgical technique from humans and dogs to horses in which a portion of an accessory muscle of respiration and its nerve supply is transplanted to a denervated dorsal cricoarytenoid muscle. Anatomical dissections in seven horses revealed two possible donor nerve-pedicle grafts: the omohyoid and the sternothyrohyoid, both innervated by a branch of the first and second cervical nerves. Histochemical evaluations in two ponies of the dorsal cricoarytenoid, omohyoid and sternothyrohyoid muscles revealed similar proportions of fiber types 1 and 2 in all three muscles. Electromyographic studies in these two ponies revealed that the omohyoid and sternothyrohyoid muscles contract synchronously with respirations during forced inspiration under general anesthesia. Based on surgical ease of access, a 1 cm2 portion of the omohyoid muscle at the point of penetration of the second cervical nerve was used as a nerve-muscle pedicle graft in an attempt to reinnervate the left dorsal cricoarytenoid muscle in four ponies. These four ponies (as well as three others which served as controls) had previously undergone left recurrent laryngeal nerve transection. All seven ponies endoscopically showed signs of complete left laryngeal hemiplegia immediately postoperatively. Animals were monitored endoscopically for 30 weeks after surgery. The three control ponies showed no abduction of the arytenoid cartilage. In addition, in these three ponies, histological and histochemical expected changes of muscle fiber atrophy and fibrosis were present in the dorsal cricoarytenoid muscle.(ABSTRACT TRUNCATED AT 250 WORDS) Images Fig. 1. Fig. 4. Fig. 5. Fig. 6. Fig. 7. Fig. 8.

Ducharme, N G; Horney, F D; Partlow, G D; Hulland, T J



A Novel Model for Examining Recovery of Phonation after Vocal Nerve Damage  

PubMed Central

Objectives/Hypothesis Recurrent laryngeal nerve injury remains a dominant clinical issue in laryngology. To date, no animal model of laryngeal reinnervation has offered an outcome measure that can reflect the degree of recovery based on vocal function. We present an avian model system for studying recovery of learned vocalizations following nerve injury. Study Design Prospective animal study. Methods Digital recordings of bird song were made from 11 adult male zebra finches; 9 underwent bilateral crushing of the nerve supplying the vocal organ, and two birds underwent sham surgery. Song from all birds was then recorded regularly and analyzed based on temporal and spectral characteristics using computer software. Indices were calculated to indicate the degree of similarity between pre-operative and post-operative song. Results Nerve crush caused audible differences in song quality and significant drops (p<0.05) in measured spectral and, to a lesser degree, temporal indices. Spectral indices recovered significantly (mean=43.0%; SD=40.7; p<0.02), and there was an insignificant trend towards recovery of temporal index (mean=28.0%; SD=41.4;p=0.0771). In 5/9(56%) birds, there was a greater than 50% recovery of spectral indices within a four week period. Two birds exhibited substantially less recovery of spectral indices, and two had a persistent decline in spectral indices. Recovery of temporal index was highly variable as well, ranging from persistent further declines of 45.1% to recovery of 87%. Neither sham bird exhibited significant (p>0.05) differences in song following nerve crush. Conclusion The songbird model system allows functional analysis of learned vocalization following surgical damage to vocal nerves.

Bhama, Prabhat K.; Hillel, Allen D.; Merati, Albert L.; Perkel, David J.



ProSeal(TM) laryngeal mask airway cuff pressure changes with and without use of nitrous oxide during laparoscopic surgery  

PubMed Central

Background: The ProSeal™ laryngeal mask (PLMA) is increasingly being used as an airway device for laparoscopic surgery. Its silicone cuff allows diffusion of nitrous oxide, carbon dioxide and other gases with resultant rise in its intracuff pressure during anesthesia. The present study was designed to investigate the intracuff pressure changes during anesthesia with and without nitrous oxide in patients undergoing laparoscopic surgery lasting up to two hours. Materials and Methods: One hundred patients, American Society of Anesthesiologists physical status 2 and 3, undergoing general anesthesia with muscle paralysis, were randomized into two groups of 50 patients each to receive an anesthetic gas mixture containing either oxygen and nitrous oxide (group N) or oxygen and air (group A). Following insertion of an appropriate size PLMA, its cuff was inflated with air to an intracuff pressure of 45 mm Hg. The cuff pressure was measured every 10 minutes for the entire course of anesthesia. The position of the device was also assessed fiberoptically and postoperative airway complications were recorded. Results: The maximum intracuff pressure recorded in group N was 103 ± 4.7 mm Hg vs. 45.5 ± 1.5 mm Hg in group A. The percentage rise in cuff pressure every 10 minutes was also highly significant (P < 0.001) being maximum in first 10 min in group N. The incidence of postoperative airway complications was comparable between the two groups. Conclusion: The results of this study demonstrate that the intracuff pressure of the PLMA increases progressively over time when the breathing gas mixture contains nitrous oxide.

Sharma, Bimla; Gupta, Rajat; Sehgal, Raminder; Koul, Archna; Sood, Jayashree



Conservation of salivary secretion and facial nerve function in partial superficial parotidectomy.  


Conventional total superficial parotidectomy (TP) has commonly been used, but partial superficial parotidectomy (PP) offers the possibility of better preserving glandular function and avoiding palsy of the facial nerves. In this study, the extent to which saliva secretion and facial nerve function were conserved in patients who received TP vs. PP was compared. Data were collected from patients who received a PP (n=163) or a TP (n=105) for benign primary tumours in the superficial lobe of the parotid glands between 1995 and 2009 at a single hospital. The incidence of transient facial paralysis was significantly lower in patients who received PP than in those who received TP. Secretory function was preserved for patients with a conserved Stensen's duct, whereas patients in whom the duct had been ligated lost secretory function. Partial superficial parotidectomy reduces the incidence of postoperative facial nerve dysfunction and is conducive to preserving Stensen's duct and saliva secretion. PMID:23623783

Zhang, S S; Ma, D Q; Guo, C B; Huang, M X; Peng, X; Yu, G Y



Course of recovery from isolated thumb paralysis due to cerebral infarction  

Microsoft Academic Search

A 67-year old right-handed man with isolated left thumb paralysis was evaluated by transcranial magnetic stimulation and functional MRI. Recovery was observed in each neurophysiological examination, corresponding to neurological recovery of his thumb function.

Kazumasa Sudo; Riichiro Kishimoto; Yasutaka Tajima; Masayoshi Takigami; Akihisa Matsumoto; Tsutomu Sohma; Kunio Tashiro



Thyrotoxic Periodic Paralysis: Case Reports and an Up-to-Date Review of the Literature  

PubMed Central

Objectives. To describe 2 cases of thyrotoxic periodic paralysis. Methods. We report of 2 cases of thyrotoxic periodic paralysis in 2 individuals from 2 different backgrounds with emphasis on their presentation and treatment. We also conducted a literature search to put together an update review of thyrotoxic periodic paralysis. Results. A 47-year-old Chinese and 28-year-old Caucasian male presented with profound yet reversible weakness associated with hypokalemia on admission bloods and thyrotoxicosis. Both were given definitive therapy to prevent recurrence of attacks with any future relapse of thyrotoxicosis. Conclusion. Thyrotoxic periodic paralysis (TPP) is a rare but potentially serious complication of thyrotoxicosis resulting in temporary but severe muscle weakness. Recent discovery of a novel mutation in the KCNJ18 gene which codes for an inwardly rectifying potassium channel and is controlled by thyroid hormones may provide greater insight into the pathogenesis of TPP.

Lulsegged, Abbi; Wlodek, Christina; Rossi, Michela



The effectiveness of neuromuscular facial retraining combined with electromyography in facial paralysis rehabilitation  

Microsoft Academic Search

ObjectiveThe study goal was to present the effectiveness of neuromuscular facial retraining techniques used in combination with electromyography for improving facial function even in cases of longstanding paralysis.

Gaye W Cronin; Ronald Leif Steenerson



Sleep paralysis in medieval Persia - the Hidayat of Akhawayni (?-983 AD)  

PubMed Central

Among the first three manuscripts written in Persian, Akhawayni’s Hidayat al-muta’allemin fi al-tibb was the most significant work compiled in the 10th century. Along with the hundreds of chapters on hygiene, anatomy, physiology, symptoms and treatments of the diseases of various organs, there is a chapter on sleep paralysis (night-mare) prior to description and treatment of epilepsy. The present article is a review of the Akhawayni’s teachings on sleep paralysis and of descriptions and treatments of sleep paralysis by the Greek, medieval, and Renaissance scholars. Akhawayni’s descriptions along with other early writings provide insight into sleep paralysis during the Middle Ages in general and in Persia in particular.

Golzari, Samad EJ; Khodadoust, Kazem; Alakbarli, Farid; Ghabili, Kamyar; Islambulchilar, Ziba; Shoja, Mohammadali M; Khalili, Majid; Abbasnejad, Feridoon; Sheikholeslamzadeh, Niloufar; Shahabi, Nasrollah Moghaddam; Hosseini, Seyed Fazel; Ansarin, Khalil



Laryngeal mask versus endotracheal tube in a ferret model.  


Acquired subglottic stenosis in infants is a difficult iatrogenic problem with notable morbidity, primarily caused by prolonged endotracheal intubation. The laryngeal mask airway (LMA) is a recently developed, alternative airway device that does not contact the subglottis. To explore the possibility of preventing subglottic stenosis, we compared the endotracheal tube (ETT) and the LMA in terms of the incidence and severity of glottic and subglottic injury resulting from prolonged intubation in the adult ferret model of the infant airway. Ten adult ferrets were randomly intubated under inhalational anesthesia with either a 4.0 cuffless ETT or a size 1 LMA for a 24- to 48-hour period. Rigid laryngeal endoscopy was used to detect pharyngeal or glottic injury during the period of intubation and on a routine basis for 3 months after extubation. All 5 ferrets in the ETT group developed endoscopically evident glottic and subglottic injury; 2 of the 5 developed a symptomatic, mature subglottic stenosis. The 5 ferrets in the LMA group had endoscopically normal larynges. However, all ferrets in the LMA group developed significant tongue edema and cyanosis during the first 24 hours of intubation, and 3 of the 5 died of respiratory failure due to airway obstruction. In the 2 LMA survivors, evidence of oropharyngeal injury persisted until 6 weeks after extubation. We conclude that the LMA does not cause subglottic injury in this model. However, its prolonged use results in significant pharyngeal morbidity that raises serious doubt as to its potential routine use in infants requiring prolonged ventilatory support. PMID:11558758

Brietzke, S E; Mair, E A



Transient Paralysis of the Bladder due to Wound Botulism  

Microsoft Academic Search

In the last 10 years, wound botulism has increasingly been reported and nearly all of these new cases have occurred in injecting–drug abusers. After absorption into the bloodstream, botulinum toxin binds irreversibly to the presynaptic nerve endings, where it inhibits the release of acetylcholine. Diplopia, blurred vision, dysarthria, dysphagia, respiratory failure and paresis of the limbs are common symptoms of

Th. Sautter; A. Herzog; D. Hauri; B. Schurch



Nerve and Blood Vessels  

Microsoft Academic Search

From the histologic point of view, nerves are round or flattened cords, with a complex internal structure made of myelinated\\u000a and unmyelinated nerve fibers, containing axons and Schwann cells grouped in fascicles (Fig. 4.1a) (Erickson 1997). Along the course of the nerve, fibers can traverse from one fascicle to another and fascicles can split and merge. Based\\u000a on the fascicular

Maura Valle; Maria Pia Zamorani


Intraoperative photodynamic therapy in laryngeal part of pharynx cancers  

NASA Astrophysics Data System (ADS)

In clinic intraoperative photodynamic therapy (IPT) was done in patients with primal squamous cells cancer of the laryngeal part of the pharynx. The He-Ne laser and methylene blue as a photosensibilizator were used. Cobalt therapy in the postoperative period was done in dose 45 Gr. Patients of control groups (1-th group) with only laser and (2-th group) only methylene blue were controlled during three years with the main group. The statistics show certain differences of recidives in the main group compared to the control groups. These facts are allowing us to recommend the use of IPT as an additional method in ENT-oncology diseases treatment.

Loukatch, Erwin V.; Trojan, Vasily; Loukatch, Vjacheslav



Desflurane requirements for laryngeal mask airway insertion during inhalation induction  

Microsoft Academic Search

Purpose  We hypothesized that the simultaneous use of low concentrations (2O), and fentanyl would allow a laryngeal mask airway (LMA) to be inserted safely with inhalation induction of desflurane,\\u000a even in nonparalyzed patients. This prospective, observational study was performed to determine the 50% effective concentration\\u000a (EC50) of desflurane for LMA insertion in such patients.\\u000a \\u000a \\u000a \\u000a Methods  Twenty-two adult patients undergoing ambulatory surgical procedures

Hwa-Yong Shin; Jung-Ae Lim; Seong-Hyop Kim; Seung-Woo Baek; Duk-Kyung Kim



The quality of voice in patients irradiated for laryngeal carcinoma  

SciTech Connect

Data from 150 patients with laryngeal carcinoma, consecutively treated primarily by radiotherapy from 1965 through 1974 was analyzed to assess the quality of voice. The voice appears to improve in majority of the successfully irradiated patients. In 76% of the evaluable patients in this group, the quality of voice appears to have attained normalcy or near normalcy. Smoking appears to have a negative influence. High incidence of bronchogenic carcinoma along with the negative influence of smoking on the quality of voice in this series of patients indicate that the patients should be advised against smoking in day-to-day clinical practice.

Karim, A.B.; Snow, G.B.; Siek, H.T.; Njo, K.H.



Homogeneous irradiation of the ''short-necked'' laryngeal cancer patient  

SciTech Connect

A technique for homogeneous irradiation of the ''short-necked'' laryngeal cancer patient is presented. The method is similar to a previously described technique in that inferiorly angled opposed lateral beams are used with tissue compensators and beam wedges. The advantages of the technique presented here are that the patient is treated supine rather than sitting and therapy simulation is more easily carried out. Experimental verification of the calculated radiation distributions was carried out in a water phantom having the same shape as the patient. These results show the extent of dose homogeneity and in addition show that neglecting tissue inhomogeneity, the measured and calculated dose distribuion agree within 2%.

Andrew, J.W.; Eapen, L.; Kulkarni, N.S.



Herpes zoster laryngitis accompanied by ramsay hunt syndrome.  


The most common presentation of herpes zoster in the head and neck region is called Ramsay Hunt syndrome (RHS), which rarely accompanies multiple cranial neuropathy. Herpes zoster also involves the mucous membrane of the tongue, palate, pharynx, and larynx. Herpes zoster infection of the larynx accompanied by Ramsay Hunt syndrome with cranial polyneuropathy is extremely rare, with only few reported cases in the literature. At the time of this report, a review of the medical literature disclosed 4 reported cases of herpes zoster laryngitis accompanied by Ramsay Hunt syndrome. Herein, we present 2 additional cases and report the clinical outcome of cranial polyneuropathy with a review of the literature. PMID:24036828

Lee, Dong Hoon; Yoon, Tae Mi; Lee, Joon Kyoo; Joo, Young Eun; Lim, Sang Chul



Fried foods: a risk factor for laryngeal cancer?  

PubMed Central

The role of fried foods on laryngeal cancer risk was investigated in a case–control study from Italy and Switzerland on 527 cases and 1297 hospital controls. A significant increased risk was found for high consumption of fried meat, fish, eggs and potatoes, with odds ratios of 1.6, 3.1, 1.9 and 1.9, respectively. British Journal of Cancer (2002) 87, 1230–1233. doi:10.1038/sj.bjc.6600639 © 2002 Cancer Research UK

Bosetti, C; Talamini, R; Levi, F; Negri, E; Franceschi, S; Airoldi, L; La Vecchia, C



Time-course of motor inhibition during hypnotic paralysis: EEG topographical and source analysis.  


Cognitive hypotheses of hypnotic phenomena have proposed that executive attentional systems may be either inhibited or overactivated to produce a selective alteration or disconnection of some mental operations. Recent brain imaging studies have reported changes in activity in both medial (anterior cingulate) and lateral (inferior) prefrontal areas during hypnotically induced paralysis, overlapping with areas associated with attentional control as well as inhibitory processes. To compare motor inhibition mechanisms responsible for paralysis during hypnosis and those recruited by voluntary inhibition, we used electroencephalography (EEG) to record brain activity during a modified bimanual Go-Nogo task, which was performed either in a normal baseline condition or during unilateral paralysis caused by hypnotic suggestion or by simulation (in two groups of participants, each tested once with both hands valid and once with unilateral paralysis). This paradigm allowed us to identify patterns of neural activity specifically associated with hypnotically induced paralysis, relative to voluntary inhibition during simulation or Nogo trials. We used a topographical EEG analysis technique to investigate both the spatial organization and the temporal sequence of neural processes activated in these different conditions, and to localize the underlying anatomical generators through minimum-norm methods. We found that preparatory activations were similar in all conditions, despite left hypnotic paralysis, indicating preserved motor intentions. A large P3-like activity was generated by voluntary inhibition during voluntary inhibition (Nogo), with neural sources in medial prefrontal areas, while hypnotic paralysis was associated with a distinctive topography activity during the same time-range and specific sources in right inferior frontal cortex. These results add support to the view that hypnosis might act by enhancing executive control systems mediated by right prefrontal areas, but does not produce paralysis via direct motor inhibition processes normally used for the voluntary suppression of actions. PMID:23211547

Cojan, Yann; Archimi, Aurélie; Cheseaux, Nicole; Waber, Lakshmi; Vuilleumier, Patrik



Ten cases of bladder paralysis associated with sabulous urolithiasis in horses.  


Bladder paralysis and sabulous urolithiasis were diagnosed in 10 horses with urinary incontinence. Additional neurological deficits in the hindquarters were detected in five of them. Treatment by catheter drainage and bladder lavage was unsuccessful, and all the horses were destroyed within 14 months of presentation. Neuritis of the cauda equina was diagnosed post mortem in one horse, but the cause of the paralysis was not identified in the others, although radiography revealed abnormal lumbosacral vertebral angulation in one case. PMID:2219631

Holt, P E; Mair, T S



Monkey Median Nerve Repaired by Nerve Graft or Collagen Nerve Guide Tube  

Microsoft Academic Search

Nerve regeneration was followed in 15 median and 1 ulnar nerve of eight Macaca fascicularis monkeys by serial elec- trophysiological assessments over a period of three and a half years. Nerve gaps of 5 mm at the wrist were bridged by collagen-based nerve guides, nerve autografts, or direct suture repairs. Thenar muscle reinnervation occurred be- tween 50 and 70 d

S. J. Archibald; J. Shefner; C. Krarup; R. D. Madison



Removal of the connector on the laryngeal mask airway provides a useful alternative to the intubating laryngeal mask  

Microsoft Academic Search

Purpose  We describe two cases in which fiberoptic intubation through the standard laryngeal mask airway (LMA) was successful with\\u000a large-bore tracheal tubes (TTs) when an intubating LMA (ILMA) could not be used.\\u000a \\u000a \\u000a \\u000a Clinical features  Patient # I, with obstructive sleep apnea, underwent elective surgical repair. His mouth opening was just under 25 mm, but\\u000a difficult intubation was not anticipated. We induced general

Carsten Preis; Irene Preis



Electrophysiological responses from vagus nerve stimulation in rats.  


The mechanism of action of vagus nerve stimulation (VNS) for pharmacoresistant epilepsy is unknown and the therapeutic outcome is highly variable. We investigated stimulation-induced vagus nerve electrophysiological responses in rats using various stimulation parameters. Conduction velocity, I 50, rheobase and chronaxie were calculated. We identified an early and late component corresponding to an afferent compound action potential (CAP) and a remote laryngeal motor-evoked potential (LMEP), respectively. The conduction velocity (CAP: 26.2 ± 1.4 m/s; LMEP: 32.4 ± 2.4 m/s) and I 50 (CAP: 2.4 ± 0.3 mA; LMEP: 1.8±0.2 mA) were significantly different for both components, the rheobase (CAP: 140±30 ?A; LMEP: 110±26 ?A) and chronaxie (CAP: 66±7 ?s; LMEP: 73±9 ?s) were not. Using a pulse of 10 ?s, the CAP saturated between 4-5 mA. Our method can be used to record VNS-induced electrophysiological responses in rats and provides an objective biomarker for electrical stimulation with various parameters in an experimental set-up. Our findings are potentially useful for clinical purposes in the sense that combination of VNS and recording of vagal nerve CAPs may help clinicians to determine the individual optimal intensity required to fully activate fast-conducting afferent fibers. PMID:24156670

Mollet, Lies; Raedt, Robrecht; Delbeke, Jean; El Tahry, Riëm; Grimonprez, Annelies; Dauwe, Ine; DE Herdt, Veerle; Meurs, Alfred; Wadman, Wytse; Boon, Paul; Vonck, Kristl



Eucapnic voluntary hyperventilation in diagnosing exercise-induced laryngeal obstructions.  


Exercise-induced laryngeal obstructions (EILOs) cause exercise-related respiratory symptoms (ERRS) and are important differential diagnoses to exercise-induced asthma. The diagnostic method for EILOs includes provocation to induce the obstruction followed by a verification of the obstruction and the degree thereof. The objective of the present study was to examine if a eucapnic voluntary hyperventilation (EVH) test could induce laryngeal obstructions laryngoscopically identical in subtypes and development as seen during an exercise test. EVH and exercise testing with continuous laryngoscopy were performed during a screening of two national athletic teams (n = 67). The laryngoscopic recordings were examined for usability, abnormalities and maximal supraglottic and glottic obstruction using two currently available methods (Eilomea and CLE-score). The participants were asked questions on ERRS, and whether the symptoms experienced during each provocation matched those experienced during regular training. A total of 39 completed both tests. There were no significant differences in subtypes and development thereof, the experience of symptoms, and specificity and sensitivity between the methods. Significantly more recordings obtained during the exercise test were usable for evaluation primarily due to resilient mucus on the tip of the fiber-laryngoscope in the EVH test. Only recordings of six athletes from both provocation methods were usable for evaluation using the Eilomea method (high-quality demand). Amongst these, a linear correlation was found for the glottic obstruction. EVH tests can induce EILOs. However, the present test protocol needs adjustments to secure better visualisation of the larynx during provocation. PMID:23732952

Christensen, Pernille M; Rasmussen, Niels



Investigating the complexity of respiratory patterns during the laryngeal chemoreflex  

PubMed Central

Background The laryngeal chemoreflex exists in infants as a primary sensory mechanism for defending the airway from the aspiration of liquids. Previous studies have hypothesized that prolonged apnea associated with this reflex may be life threatening and might be a cause of sudden infant death syndrome. Methods In this study we quantified the output of the respiratory neural network, the diaphragm EMG signal, during the laryngeal chemoreflex and eupnea in early postnatal (3–10 days) piglets. We tested the hypothesis that diaphragm EMG activity corresponding to reflex-related events involved in clearance (restorative) mechanisms such as cough and swallow exhibit lower complexity, suggesting that a synchronized homogeneous group of neurons in the central respiratory network are active during these events. Nonlinear dynamic analysis was performed using the approximate entropy to asses the complexity of respiratory patterns. Results Diaphragm EMG, genioglossal activity EMG, as well as other physiological signals (tracheal pressure, blood pressure and respiratory volume) were recorded from 5 unanesthetized chronically instrumented intact piglets. Approximate entropy values of the EMG during cough and swallow were found significantly (p < 0.05 and p < 0.01 respectively) lower than those of eupneic EMG. Conclusion Reduced complexity values of the respiratory neural network output corresponding to coughs and swallows suggest synchronous neural activity of a homogeneous group of neurons. The higher complexity values exhibited by eupneic respiratory activity are the result of a more random behaviour, which is the outcome of the integrated action of several groups of neurons involved in the respiratory neural network.

Dragomir, Andrei; Akay, Yasemin; Curran, Aidan K; Akay, Metin



Functional organ preservation in laryngeal and hypopharyngeal cancer  

PubMed Central

The principles of open versus laser microsurgical approaches for partial resections of the larynx are described, oncologic as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications.

Ambrosch, Petra; Fazel, Asita



Laryngeal aging and acoustic changes in male rat ultrasonic vocalizations.  


This study examined changes in the acoustic and temporal structure of ultrasonic vocalizations as a function of age and correlated acoustic changes with vocal fold microstructure. Ultrasonic vocalizations were recorded in three age groups of male rats: aged (24-26 months), middle-aged (17-18 months), and young (4-5 months). Acoustic and structural changes in vocal fold tissue were evident by 18 months of age. Histological analyses revealed decreased density of elastin and hyaluronic acid and increased collagen density in the middle-aged and aged groups compared to the young rats. Laryngeal microstructure correlated with some of the ultrasonic acoustic features. These results show that male Long Evans rats experience changes in ultrasonic acoustic structure by middle age, and these changes correlate with deterioration in laryngeal microstructure. Ultrasonic vocalizations can be used as a model system for age-related degeneration in vocal fold structure and function. © 2012 Wiley Periodicals, Inc. Dev Psychobiol 55: 818-828, 2013. PMID:22821353

Peterson, Jennifer R; Watts, Christopher R; Morris, Jesse A; Shelton, John M; Cooper, Brenton G



Extracellular potassium homeostasis: insights from hypokalemic periodic paralysis.  


Extracellular potassium makes up only about 2% of the total body's potassium store. The majority of the body potassium is distributed in the intracellular space, of which about 80% is in skeletal muscle. Movement of potassium in and out of skeletal muscle thus plays a pivotal role in extracellular potassium homeostasis. The exchange of potassium between the extracellular space and skeletal muscle is mediated by specific membrane transporters. These include potassium uptake by Na(+), K(+)-adenosine triphosphatase and release by inward-rectifier K(+) channels. These processes are regulated by circulating hormones, peptides, ions, and by physical activity of muscle as well as dietary potassium intake. Pharmaceutical agents, poisons, and disease conditions also affect the exchange and alter extracellular potassium concentration. Here, we review extracellular potassium homeostasis, focusing on factors and conditions that influence the balance of potassium movement in skeletal muscle. Recent findings that mutations of a skeletal muscle-specific inward-rectifier K(+) channel cause hypokalemic periodic paralysis provide interesting insights into the role of skeletal muscle in extracellular potassium homeostasis. These recent findings are reviewed. PMID:23953801

Cheng, Chih-Jen; Kuo, Elizabeth; Huang, Chou-Long



Case of childhood laryngeal papillomatosis with metastatic carcinoma esophagus in adulthood  

PubMed Central

A young male patient was diagnosed to have laryngeal papillomas at the age of 3 years for which he underwent permanent tracheostomy and also multiple surgical and laser excision procedures. Then, later in life, the patient had progressive breathlessness and dysphagia. On examination, he had supraclavicular lymphadenopathy showing squamous carcinoma pathology. Since laryngeal papillomas have a high propensity to transform into laryngeal squamous cell carcinoma, he was first evaluated for laryngeal carcinoma which was negative. Esophagoscopy showed a growth in the esophagus, the biopsy of which was positive for squamous malignant cells. Patient was then started on palliative chemotherapy with combination of paclitaxel and carboplatin, and at progression with weekly nanoxel with stable disease. This is a rare case of childhood laryngeal papillomatosis progressing to metastatic esophageal carcinoma. This case has been presented to highlight the fact that patients with laryngeal papillomas are not only at high risk of progressing to laryngeal carcinoma but can also have other malignancies of the upper aerodigestive tract and lung. Most of them have been correlated to human papilloma virus (HPV), but in our patient HPV DNA was negative.

Shetty, Nishitha; Prabhash, Kumar; Joshi, Amit; Sayed, Suhail I.; Sharma, Shilpi; Noronha, Vanita; Deshmukh, Anuja; Chaukar, Devendra; Kane, S.; Gopal; D'cruz, Anil K.



Avian enteric nerve plexuses  

Microsoft Academic Search

The enteric nerve plexuses of the domestic fowl (Gallus domesticus) were investigated in sections and stretch preparations by means of the cholinesterase and glyoxylic acid fluorescence histochemical techniques. Cholinesterase-positive and varicose and non-varicose fluorescent nerve fibres were distributed at all levels of the gut in myenteric, submucosal, muscle and mucosal plexuses, and in a perivascular plexus. The density of the

H. A. Ali; J. McLelland



Nerves of Simplicial Complexes.  

National Technical Information Service (NTIS)

If a simplicial complex K is considered as covered by its maximal (closed) faces, its nerve N(K) may be defined in the usual manner. Generalizing known results on interchange graphs of graphs, simplicial complexes which are nerves of d-dimensional simplic...

B. Grunbaum



Peripheral nerve and muscle.  


This review of the past year's literature on neurophysiology of muscles and peripheral nerves emphasizes areas with direct clinical interest. The subject is diversified but will be discussed under the following major headings: nerve conduction studies, electromyography, magnetic motor evoked potentials, quantitative sensory testing, assessment of peripheral pain fibers, and autonomic function assessment. PMID:8293143

Jamal, G A; Mann, C



[Obturator nerve block].  


Obturator nerve block is commonly used for transurethral resections of the bladder in order to inhibit reflectory adductor muscle reaction during electrocoagulation and to reduce the risk of bladder wall perforation during transurethral surgery. Furthermore, obturator block is used to complete regional blocks for major knee surgery in addition to femoral and sciatic nerve blocks. Continuous techniques are sometimes used to treat chronic pain problems such as adductor spasm. During a so called "3 in 1" block (femoral nerve block) the obturator nerve will only be anaesthetized in 0-62% of the patients. Therefore, a specific approach to the obturator nerve is deemed appropriate. In addition, an accessory branch of the obturator nerve will accompany the femoral nerve in 10-30% of the patients. The classical approach uses the tuberculum pubicum as an anatomical landmark, inserting the needle approximately 1.5cm lateral and caudal until bone contact is established. After laterocaudal redirection the canalis obturatorius is reached and the local anaesthetic is injected. The alternative approach is more often used: At the proximal tendon insertion of the adductor longus muscle the needle is introduced and advanced towards the anterior superior iliac spine. For both approaches a nerve stimulator is used and 15-20ml of local anaesthetic solution are injected. PMID:20455186

Freisburger, Christian; Nachtigall, Bernd; Wulf, Hinnerk



Diagnosis of zygomaticus muscle paralysis using needle electromyography with ultrasonography.  


A 22-year-old woman visited our clinic with a history of radiofrequency volumetric reduction for bilateral masseter muscles at a local medical clinic. Six days after the radiofrequency procedure, she noticed a facial asymmetry during smiling. Physical examination revealed immobility of the mouth drawing upward and laterally on the left. Routine nerve conduction studies and needle electromyography (EMG) in facial muscles did not suggest electrodiagnostic abnormalities. We assumed that the cause of facial asymmetry could be due to an injury of zygomaticus muscles, however, since defining the muscles through surface anatomy was difficult and it was not possible to identify the muscles with conventional electromyographic methods. Sono-guided needle EMG for zygomaticus muscle revealed spontaneous activities at rest and small amplitude motor unit potentials with reduced recruitment patterns on volition. Sono-guided needle EMG may be an optimal approach in focal facial nerve branch injury for the specific localization of the injury lesion. PMID:23869344

Yoo, Seung Han; Kwon, Hee Kyu; Lee, Sang Heon; Lee, Seok Jun; Ha, Kang Wook; Yun, Hyeong Suk



Diagnosis of Zygomaticus Muscle Paralysis Using Needle Electromyography With Ultrasonography  

PubMed Central

A 22-year-old woman visited our clinic with a history of radiofrequency volumetric reduction for bilateral masseter muscles at a local medical clinic. Six days after the radiofrequency procedure, she noticed a facial asymmetry during smiling. Physical examination revealed immobility of the mouth drawing upward and laterally on the left. Routine nerve conduction studies and needle electromyography (EMG) in facial muscles did not suggest electrodiagnostic abnormalities. We assumed that the cause of facial asymmetry could be due to an injury of zygomaticus muscles, however, since defining the muscles through surface anatomy was difficult and it was not possible to identify the muscles with conventional electromyographic methods. Sono-guided needle EMG for zygomaticus muscle revealed spontaneous activities at rest and small amplitude motor unit potentials with reduced recruitment patterns on volition. Sono-guided needle EMG may be an optimal approach in focal facial nerve branch injury for the specific localization of the injury lesion.

Yoo, Seung Han; Kwon, Hee Kyu; Lee, Seok Jun; Ha, Kang Wook; Yun, Hyeong Suk



Distinct patterns of motor nerve terminal sprouting induced by ciliary neurotrophic factor vs. botulinum toxin.  


Both diffusible and surface-bound molecules are thought to induce sprouting of motor nerve terminals in response to paralysis. Here we report that the sprouting induced by ciliary neurotrophic factor (CNTF) is qualitatively different from the sprouting induced by botulinum toxin (BoTX). We show first that subcutaneous application of CNTF to levator auris longus muscles of adult mice evokes sprouting from nearly all nerve terminals. Surprisingly, however, most terminal sprouts remain within the boundaries of the endplate region and rarely grow extrasynaptically even if CNTF is administered chronically. In contrast, terminal sprouts induced by BoTX extend vigorously along the extrasynaptic muscle surface. The different patterns of sprout elongation are attributable in part to different patterns of initiation: whereas CNTF-induced sprouts emerge randomly from the surface of terminal branches, BoTX-induced sprouts emerge exclusively along the perimeter of terminal branches in direct apposition to muscle fiber membranes. Combined treatment with CNTF and BoTX produces exceptionally robust extraterminal sprouting with little if any intrasynaptic growth of terminal sprouts. We interpret these results as showing that paralysis induces sprouting primarily by muscle-associated, surface-bound molecules rather than by diffusible factors. Our findings may be useful in defining the physiological role of the numerous candidate sprouting-inducers and in promoting compensatory sprouting after nerve injury for therapeutic benefit. PMID:17614103

Wright, Megan C; Cho, Wha-Ja; Son, Young-Jin



Podoplanin expression in the development and progression of laryngeal squamous cell carcinomas  

PubMed Central

Background Podoplanin expression is attracting interest as a marker for cancer diagnosis and prognosis. We therefore investigated the expression pattern and clinical significance of podoplanin during the development and progression of laryngeal carcinomas. Results Podoplanin expression was determined by immunohistochemistry in paraffin-embedded tissue specimens from 84 patients with laryngeal premalignancies and 53 patients with laryngeal squamous cell carcinomas. We found podoplanin expression extending from the basal to the suprabasal layer of the epithelium in 37 (44%) of 84 dysplastic lesions, whereas normal epithelium showed negligible expression. Patients carrying podoplanin-positive lesions had a higher laryngeal cancer incidence than those with negative expression reaching borderline statistical significance (51% versus 30%, P = 0.071). Podoplanin expression in laryngeal carcinomas exhibited two distinct patterns. 20 (38%) cases showed diffuse expression in most tumour cells and 33 (62%) focal expression at the proliferating periphery of tumour nests. High podoplanin expression was inversely correlated with T classification (P = 0.033), disease stage (P = 0.006), and pathological grade (P = 0.04). There was a trend, although not significant, towards reduced disease-specific survival for patients with low podoplanin levels (P = 0.31) and diffuse expression pattern (P = 0.08). Conclusions Podoplanin expression increases in the early stages of laryngeal tumourigenesis and it seems to be associated with a higher laryngeal cancer risk. Podoplanin expression in laryngeal squamous cell carcinomas, however, diminishes during tumour progression. Taken together, these data support a role for podoplanin expression in the initiation but not in the progression of laryngeal cancers.



Ulnar nerve tuberculoma.  


The authors report a very rare case of tuberculoma involving the ulnar nerve. The patient, a 7-year-old girl, presented with swelling over the medial aspect of her right forearm just below the elbow joint, with features of ulnar nerve palsy, including paresthesias along the little and ring fingers and claw hand deformity. There was a history of trauma and contact with a contagious case of tuberculosis. There were no other signs of tuberculosis. At surgical exploration the ulnar nerve was found to be thickened, and on opening the sheath there was evidence of caseous material enclosed in a fibrous capsule compressing and displacing the nerve fibers. The lesion, along with the capsule, was subtotally removed using curettage, and a part of the capsule that was densely adherent to the nerve fibers was left in the patient. Histopathological examination of the specimen was consistent with tuberculoma. The patient received adequate antitubercular treatment and showed significant improvement. PMID:23082843

Ramesh Chandra, V V; Prasad, Bodapati Chandramowliswara; Varaprasad, Gangumolu



Acute Flaccid Paralysis in Infants and Young Children with Enterovirus 71 Infection: MR Imaging Findings and Clinical Correlates  

Microsoft Academic Search

BACKGROUND AND PURPOSE: Enterovirus 71 (EV71) infection is now considered an important cause of childhood acute flaccid paralysis. The purpose of our study was to determine whether EV71-infection-related acute flaccid paralysis in infants and young children has char- acteristic MR imaging patterns. METHODS: Seven infants and young children with acute paralysis of the upper or lower extremities and positive EV71

Cheng-Yu Chen; Ying-Chao Chang; Chao-Ching Huang; Chun-Chung Lui; Kwo-Wei Lee; Song-Chei Huang



Is papillomavirus detectable in the plume of laser-treated laryngeal papilloma  

SciTech Connect

The carbon dioxide laser is widely used for the vaporization of lesions in patients with laryngeal papillomatosis. In this study, the smoke plume resulting from the laser treatment of laryngeal papillomas was analyzed for the presence of human papillomavirus DNA. Plumes were collected with a suction tip and trapped in phosphate-buffered saline. The aspirates were then analyzed for the presence of human papillomavirus DNA by Southern blot hybridization. Human papillomavirus DNA cannot be detected in the smoke plume from vaporization of laryngeal papillomas unless direct suction contact is made with the papilloma tissue during surgery. The implications of these findings are discussed.

Abramson, A.L.; DiLorenzo, T.P.; Steinberg, B.M. (Long Island Jewish Medical Center, New Hyde Park, NY (USA))



The acute treatment of nerve agent exposure.  


Nerve agents (NA) are simple and cheap to produce but can produce casualties on a massive scale. They have already been employed by terrorist organizations and rogue states on civilians and armed forces alike. By inhibiting the enzyme acetylcholine esterase, NAs prevent the breakdown of the neurotransmitter acetylcholine. This results in over-stimulation of muscarinic and nicotinic receptors in the autonomic and central nervous systems and at the neuromuscular junction. Increased parasympathetic stimulation produces miosis, sialorrhea, bronchospasm and bronchorrhea. Effects at the neuromuscular junction cause weakness, fasciculations, and eventually paralysis. Central effects include altered behavior and mental status, loss of consciousness, seizures, or apnea. Most deaths are due to respiratory failure. Treatment with atropine competitively blocks the parasympathetic effects. Oximes like pralidoxime salvage acetylcholine esterase by "prying off" NA, provided the attachment has not "aged" to an irreversible bond. This reverses weakness. Benzodiazepines like diazepam are effective against NA induced seizures. Mortality has been surprisingly low. If victims can survive the first 15 to 20 min of a vapor attack, they will likely live. The low mortality rate to date underscores that attacks are survivable and research reveals even simple barriers such as clothing offer substantial protection. This article reviews the properties of NAs and how to recognize the clinical features of NA intoxication, employ the needed drugs properly, and screen out anxious patients who mistakenly believe they have been exposed. PMID:16945386

Cannard, Kevin



A Nerve Cuff Electrode for Controlled Reshaping of Nerve Geometry  

Microsoft Academic Search

The purpose of this study is the development of a nerve electrode that reorganizes nerve geometry slowly and controllably. The Flat Interface Nerve Electrode (FINE) can reshape the nerve into an elongated oval and provide selective stimulation. However, the rate of closure of this electrode is difficult to control. The Slowly Closing - FINE (SC-FINE) is designed with an opening

Anthony V. Caparso; Dominique M. Durand; Joseph M. Mansour



Whole sensory nerve recordings with spiral nerve cuff electrode  

Microsoft Academic Search

We have used a self-curling nerve cuff electrode to record sensory information from a cutaneous nerve. This type of cuffs has previously been used only for stimulation, but its mechanical properties could make it very suitable for recording also, since it can be fitted closer to the nerve than traditional cuffs without compromising the nerve. In this study we show

T. Sinjar; B. Hinge; A. Jorgensen; M. L. Jensen; M. Haugland



Percutaneous peripheral nerve stimulation.  


Since its inception in the 1970s, peripheral neuromodulation has become an increasingly common procedure to treat chronic neuropathic disorders. Historically, peripheral nerve stimulation (PNS) originated with the placement of large surface cuff electrodes, which was refined by the introduction of functional nerve mapping with circumferential electrical stimulation. This substantially improved the targeting of sensory fascicles. Surgical placement of spinal cord stimulation (SCS) 'button type' paddle electrodes was replaced when the introduction of percutaneous cylindrical SCS electrodes expanded the spectrum of PNS applications and improved the ability to target afferent sensory fibers as well as reducing the complication rate. To further refine functional mapping for the placement of these percutaneous electrodes, radiofrequency needle probes have more recently been employed to elicit paresthesias in awake patients to map the pain generators and guide treatment. In this chapter, we provide a description of the development and basic mechanisms of peripheral nerve stimulation, as well as a more detailed description of the two most commonly employed forms of peripheral nerve stimulation: occipital nerve stimulation for occipital neuralgia, and subcutaneous peripheral nerve field stimulation to stimulate free nerve endings within the subcutaneous tissue when the pain is limited to a small, well-localized area. The closely related ideas of internal and external targeted subcutaneous stimulation are also discussed. PMID:21422775

Aló, Kenneth M; Abramova, Marina V; Richter, Erich O



Antinociception and paralysis induced by intrathecal dynorphin A.  


Intrathecal administration of dynorphin A in rats produced dose-dependent antinociceptive effects in the tail-flick test to radiant heat and on a limb-flexion test to pressure. The potency of dynorphin A as an analgesic agent on the tail-flick test was dependent upon the duration of cannula implantation. When a short-term procedure was used (drug injected 1 day after catheter implantation) dynorphin A was approximately equipotent to morphine, whereas in animals with long-term implants (drug injected 7 or more days after catheter implantation) dynorphin A was an