浅谈周围性面瘫的分型辨证治疗

目的:观察中医治疗周围性面瘫疗效。方法:提出中医药辨证论治及中药塞鼻外用的方法共同治疗急性周围性面瘫,通过3例病案说明中医治疗周围性面瘫的有效性。结论:中医药在治疗周围性面瘫方面有着独特的优势,值得临床应用推广。     

Insulina tópica en queratopatía neurotrófica tras resección de neurinoma del acústico

Case report

A patient with a history of surgical resection of an acoustic neuroma presented with involvement of both the left facial nerve and the left trigeminal nerve. She initially consulted for exposure keratitis, but two weeks later presented with an infectious keratitis. After taking the corneal sample, she presented with persistent epithelial defect, which did not respond to medical management. Topical insulin was indicated, and a decrease in the area of the lesion was seen in the following 5 days. A therapeutic contact lens was also placed at that time and finally, two weeks after the initiation of insulin, the epithelial defect completely closed.

朱琏针灸治疗Bell's麻痹急性期疗效观察

目的:观察朱琏针灸治疗Bell’s麻痹急性期的临床疗效。方法:采用随机对照研究方法,将患者分为观察组(30例)和对照组(30例),观察组接受朱琏针灸,对照组接受常规针灸,比较两组面神经功能评分、Stennert继发损害面神经麻痹评分、瞬目反射情况等。结果:两组痊愈患者疗程及针刺次数比较,差异有统计学意义(P<0.05);对比两组治疗前、治疗1个疗程、治疗2个疗程后发现,HB量化评分及瞬目反射R1、R2波长比较,观察组评分均较对照组高,差异有统计学意义(P<0.05);治疗后1个月随访发现,观察组Stennert继发损害面神经麻痹评分明显低于对照组,差异有统计学意义(P<0.05)。结论:运用朱琏针灸疗法治疗Bell’s麻痹急性期,能够获得更为理想的治疗效果,可明显缩短疗程,并有效提高预后恢复。     

Olfactory ensheathing cells in facial nerve regeneration

IntroductionOlfactory ensheathing cell is a unique kind of glia cells, which can promote axon growth. Little is known about the differences between olfactory mucosa olfactory ensheathing cells and olfactory bulb olfactory ensheathing cells in the capability to promote nerve regeneration.ObjectiveTo study the recovery of the rat facial nerve after olfactory ensheathing cells transplantation, and to compare the differences between the facial nerve regeneration of olfactory mucosa-olfactory ensheathing cells and olfactory bulb olfactory bulb olfactory ensheathing cells transplantation.MethodsInstitutional ethical guideline was followed (201510129A). Olfactory mucosa-olfactory ensheathing cells and olfactory bulb olfactory ensheathing cells were cultured and harvested after 7 days in vitro. 36 Sprague Dawley male rats were randomly divided into three different groups depending on the transplanting cells: Group A: olfactory mucosa-olfactory ensheathing cells; Group B: olfactory bulb olfactory ensheathing cells; Group C: DF-12 medium/fetal bovine serum. The main trunk of the facial nerve was transected and both stumps were inserted into a polylactic acid/chitosan conduit, then the transplanted cells were injected into the collagen in the conduits. After 4 and 8 weeks after the transplant, the rats of the three groups were scarified and the facial function score, facial nerve evoked potentials, histology analysis, and fluorescent retrograde tracing were tested and recorded, respectively, to evaluate the facial nerve regeneration and to analysis the differences among the three groups.ResultsOlfactory ensheathing cells can promote the facial nerve regeneration. Compared with olfactory bulb olfactory ensheathing cells, olfactory mucosa olfactory ensheathing cells were more effective in promoting facial nerve regeneration, and this difference was more significant 8 weeks after the transplantation than 4 weeks.ConclusionWe discovered that olfactory ensheathing cells with nerve conduit could improve the facial nerve recovery, and the olfactory mucosa olfactory ensheathing cells are more effective for facial nerve regeneration compared with olfactory bulb olfactory ensheathing cells 8 weeks after the transplantation. These results could cast new light in the therapy of facial nerve defect, and furnish the foundation of auto-transplantation of olfactory mucosa olfactory ensheathing cells in periphery nerve injury.     

Estimation of the mandibular dimensions from linear cranial measurements for use in craniofacial reconstruction: A preliminary study

BackgroundA missing mandible is a common problem in facial identification cases requiring forensic facial approximation or reconstruction. The Sassouni and Sassouni-Plus methods which are currently used to predict the missing mandible from the cranium produce low levels of accuracy.AimsThis study proposes a new method for the estimation of the overall dimensions of the mandible based upon linear cranial measurements, the proposed method has the potential to be utilised in the facial reconstruction of a range of adult skulls with dentition.Sample and method21 measurements were taken from a sample of 90 skulls, 44 male, 43 female and three juvenile, originating from 9 different geographical areas. Ordinary least-squares regression, hierarchical cluster analysis and analysis of variance (ANOVA) were used to investigate trends in the data and to produce equations for the estimation of condylar height, corpus length and anterior height.ConclusionWhen tested the equations produced an overall mean error of 0.09 mm with a standard deviation of ±4.84. The proposed method offers an improvement upon the currently used methods. It can be used to estimate the overall mandibular dimensions with a good level of accuracy.     

An in-depth technical and medical investigation of facial injuries caused by car accidents

BackgroundMany studies have investigated the issue of facial injuries caused by car accidents, but only a few have addressed the technical and clinical aspects of such accidents and injuries in depth. The aim of this study was to identify risk factors and protective elements for facial injuries in car accidents.MethodsWe analysed the technical and clinical data of patients with facial injuries caused by car accidents over a 16-year period (2000–2016) and investigated the following factors: sitting position, sex, age, accident time, use of a seatbelt, deployment of the front airbag, direction of impact, speed at the time of collision, and occurrence and location of facial injuries.ResultsOf the 1291 patients involved in car accidents who were included in our study, 291 (22.5%) had suffered facial injuries. We found a significant association between occurrence of facial injuries and sex, speed at the time of collision, impact from the back, seatbelt usage, and deployment of the front airbag. In accidents occurring at speeds over 40 km/h, automobile security measures had no significant influence on the occurrence of facial injuries in drivers and front-seat passengers. In accidents occurring at speeds between 0 and 20 km/h, seatbelt usage (without airbag deployment) solely showed a significant protective influence against the occurrence of facial injuries (odd ratio [OR], 0.130; confidence interval [CI], 0.038–0.451). In contrast, patients who were in accidents at speeds between 21 and 40 km/h suffered significantly fewer facial injuries when wearing a seatbelt with the front airbag being deployed (OR, 0.245; CI, 0.091–0.665) or undeployed (OR, 0.216; CI, 0.084–0.561).ConclusionMale sex and a high speed at the time of collision are significant risk factors for the occurrence of facial injuries. The security measurements evaluated in this study only exerted a protective influence at low speeds (below 40 km/h). This indicates a possible weakness of these security systems with regard to preventing facial injuries. Engineers could benefit from these findings and improve the efficiency of existing security measures and eventually help decrease the incidence of facial injuries.     

Atypical first branchial cleft fistula: A case report

IntroductionFirst branchial cleft anomalies (FBCA) are rare. They have an estimated incidence of 1 in 100,000. Type I are those that embryologically duplicate the membrane (cutaneous) external auditory canal.The aim of this case is to describe an unusual path of a type II first branchial cleft fistula tract in a 3 years old child and its surgical management in the academic hospital of Casablanca.Case presentationThis case is about a 3 year old girl who presented to the Ear Nose Throat (ENT) consultation for recurrent right lateral cervical infection. Clinical examination found an unsightly scar attached to an orifice giving pus located near the right mandibular angle suggesting type II first branchial cleft anomaly.Surgical excision was performed under general anesthesia by the superficial parotidectomy approach, the facial nerve was identified and preserved. The fistula cord was dissected and followed, it went under the facial nerve and the parorid gland to end under the digastric muscle where we tied it up. The postoperative check-up did not show any complications. The follow-up period was 12 months; the clinical examination did not find any sign of recurrence.ConclusionFirst branchial cleft fistula are rare and can be in form of cyst or fistula. Its management is surgical excision keeping the tract cyst of the fistula intact with facial nerve preservation.     

异体面部移植的现状分析

各种严重外伤、肿瘤以及先天畸形常常可导致患者面容毁损,而异体面部移植可以在一次手术中矫正所有严重畸形,并且能达到兼顾功能和美观的效果。截至2018年,全世界实施的部分或全面部移植手术达到44例,此项手术属于非挽救生命的手术,存在很多问题和争议。作者结合以往经验,对手术适应证选择、手术原则和细节、术后并发症的防治、免疫抑制方案、术后功能恢复、伦理学问题、社会经济学问题等方面进行分析讨论。