The Journal of craniofacial surgery
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Case Reports
Microvascular decompression for the patient with painful tic convulsif after Bell palsy.
Painful tic convulsif is referred to as the concurrent trigeminal neuralgia and hemifacial spasm. However, painful tic convulsif after ipsilateral Bell palsy has never been reported before. We report a case of a 77-year-old woman with coexistent trigeminal neuralgia and hemifacial spasm who had experienced Bell palsy half a year ago. ⋯ Postoperatively, the symptoms of spasm ceased immediately and the pain disappeared within 3 months. In this article, the pathogenesis of the patient's illness was discussed and it was assumed that the adhesions developed from inflammatory reactions after Bell palsy and the anatomic features of the patient were the factors that generated the disorder. Microvascular decompression surgery is the suggested treatment of the disease, and the dissection should be started from the caudal cranial nerves while performing the operation.
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Crouzon syndrome is a rare, autosomal dominant disease from a fibroblast growth factor receptor 2 gene mutation, characterized by premature craniosynostosis, hypertelorism, orbital proptosis, psittichorina, hypoplastic maxilla, and mandibular prognathism. We present an adult 32-year-old Crouzon syndrome patient who underwent an elective High Le Fort I and bilateral split sagittal osteotomy for midface advancement with a background of jaw malocclusion and obstructive respiratory symptoms. The operation features a potential dynamic movement of the secured airway in the surgical field and close proximity to exposed ocular structures. ⋯ Perioperative issues include potential difficult airway management; ocular, auditory, and neurological injury prevention; surgery-specific anesthetic technique; and postoperative analgesia. Understanding the multisystemic issues facilitates the dynamic anesthetic management during surgery. Good communication among the multidisciplinary team is essential to ensure a successful operation and uneventful recovery.
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Case Reports
Catastrophic venous air embolism during craniotomy in the supine position: the bleeding pattern as a warning sign?
Venous air embolism is a serious complication during a neurosurgical procedure. Here is a case of a massive venous air embolism causing cardiac arrest in the supine position surgery. Identifying the alternative inflation and collapse of the sinus and taking emergency measures to avoid catastrophic result are important.
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Randomized Controlled Trial
Analgesic effects of preoperative peripheral nerve block in patients with trigeminal neuralgia undergoing radiofrequency thermocoagulation of gasserian ganglion.
Trigeminal neuralgia is the worst pain that human beings have ever experienced. Surgery might be the only solution for some patients because no other way can relieve their severe pain. They experience intolerable pain before operation and during radiofrequency thermocoagulation of the gasserian ganglion. ⋯ Compared with the control group, a single peripheral nerve block significantly attenuated average pain (P < 0.01) and worst pain (P < 0.01), ameliorated the quality of sleep (P < 0.01), and increased analgesia satisfaction (P < 0.01). Moreover, patients in the nerve block group experienced a decrease in incidence (P < 0.01) and intensity (P < 0.01) of episodic pain during surgery as compared with the participants in the control group. These results demonstrate that a single peripheral nerve block may be an effective way to relieve preoperative and perioperative intolerable pain of trigeminal neuralgia.
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The aim of this study is to follow longitudinally the prominent ears treated by percutaneous adjustable closed otoplasty (PACO) and evaluate this procedure in terms of technical efficiency, recurrence, complications, and patient satisfaction. ⋯ Percutaneous adjustable closed otoplasty is an efficient surgical procedure with positive outcome, low recurrence, and high patient satisfaction. In prominent ear deformities with soft cartilage, PACO should be the preferred surgical choice because of its advantages of shorter time in surgery, lack of need for prolonged postoperative compressive dressing, and allowing patients to view the results immediately after surgery. In contrast to the previously described techniques, auriculocephalic distances are adjustable while tightening the mattress sutures. Besides, it is a reversible technique, if the surgeon not satisfied with the result of the surgery can either redo the procedure or revert to CST. Percutaneous adjustable closed otoplasty does not cause serious complications, contour deformities, hematoma, or incision scars. For ear deformities presenting with stiff helical cartilage and conchal hyperthrophy, surgical indications can be extended by scoring and conchal resection, respectively.