The Study of Higher Origin of Facial Artery and its Surgical Significance

Facial artery plays a key role in blood supply of the face. Facial artery one of the anterior branches of the external carotid artery originates within the carotid triangle. Variation in the origin of the facial artery was observed on two sides out of 60 sides in 30 cadavers. Facial artery was observed originating at the level just below the maxillary artery within the parotid gland. Facial artery may originate as linguo-facial trunk or thyro-linguo-facial trunk. Other developmental variations have also been described in the literature like, agenesis of facial artery, enlarged facial artery, hypoplastic facial artery. Variability in situation may complicate the surgery. Therefore maxillofacial surgeon, plastic surgeons and head & neck surgeon should be aware of such variation.     

Movement Disorders in Adult Patients With Classical Galactosemia

Classical galactosemia is an autosomal recessive inborn error of metabolism leading to toxic accumulation of galactose and derived metabolites. It presents with acute systemic complications in the newborn. Galactose restriction resolves these symptoms, but long‐term complications, such as premature ovarian failure and neurological problems including motor dysfunction, may occur despite adequate treatment. The objective of the current study was to determine the frequency and phenotype of motor problems in adult patients with classical galactosemia. In this cross‐sectional study, adult patients with a biochemically confirmed diagnosis of galactosemia attending our clinic were assessed with an interview and neurological examination and their notes retrospectively reviewed. Patients were classified according to the presence/absence of motor dysfunction on examination. Patients with motor dysfunction were further categorized according to the presence/absence of reported motor symptoms. Forty‐seven patients were included. Thirty‐one patients showed evidence of motor dysfunction including: tremor (23 patients), dystonia (23 patients), cerebellar signs (6 patients), and pyramidal signs (4 patients). Tremor and dystonia were often combined (16 patients). Thirteen patients reported motor symptoms, with 8 describing progressive worsening. Symptomatic treatment was effective in 4 of 5 patients. Nonmotor neurological features (cognitive, psychiatric, and speech disorders) and premature ovarian failure were more frequent in patients with motor dysfunction. Motor dysfunction is a common complication of classical galactosemia, with tremor and dystonia the most frequent findings. Up to one third of patients report motor symptoms and may benefit from appropriate treatment. Progressive worsening is not uncommon and may suggest ongoing brain damage in a subset of patients. © 2013 Movement Disorder Society     

Should we do early and frequent charcoal hemoperfusion in phenytoin toxicity?

Phenytoin toxicity or adverse drug reaction is common due to its narrow therapeutic window. Mild and moderate toxicity require supportive care and enteral activated charcoal. In severe toxicity, charcoal hemoperfusion (CHP) have been shown to decrease serum phenytoin half-life and early recovery. Here, we report two cases with phenytoin toxicity who showed marked clinical improvement after early and frequent CHP treatment.