Levator recession and minimal lateral tarsorrhaphy for the management of lagophthalmos and corneal exposure in facial palsy

2019 ◽  
pp. 112067211988198
Author(s):  
Bahram Eshraghi ◽  
Hadi Ghadimi ◽  
Mojgan Nikdel
Keyword(s):  
Facial Paralysis ◽  
Facial Palsy ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Case Series ◽  
Levator Muscle ◽  
Vehicle Accident ◽  
Parotid Surgery ◽  
Common Etiology ◽  
Additional Procedure

Purpose: Recession of levator muscle can potentially decrease the severity of corneal exposure by reducing margin-reflex distance 1. The purpose of this study is evaluation of effects of levator recession on lagophthalmos in facial palsy. Materials and methods: In a non-comparative case series of consecutive patients with exposure keratopathy due to facial paralysis between 2012 and 2017, levator recession was performed through lid crease incision. Small-size (⩽3 mm) lateral tarsorrhaphy was performed on a case-by-case basis for those with moderate-to-severe keratopathy. Preoperative and postoperative measurements of margin-reflex distance 1 and lagophthalmos were compared using paired t-test. Results: Thirty-four patients (14 men and 20 women) were enrolled with an average age of 52.3 years. Mean follow-up was 13.3 months (range, 6–36 months). The most common etiology of facial paralysis was Bell’s palsy (22 cases), followed by motor vehicle accident (8), parotid surgery (3), and brain tumor surgery (1). No additional procedure was performed for eight patients, while lateral tarsorrhaphy was performed in 26 cases. Mean margin-reflex distance 1 decreased from 5.0 ± 0.4 mm to 4.0 ± 0.5 mm ( p < 0.001) and mean lagophthalmos decreased from 3.3 ± 0.9 mm to 1.8 ± 0.9 mm ( p < 0.001). Subgroups of patients with additional lateral tarsorrhaphy and without tarsorrhaphy experienced the same amount of reduction in margin-reflex distance 1 and lagophthalmos. Conclusion: Recession of levator muscle was effective in reduction of margin-reflex distance 1 and lagophthalmos in facial palsy patients. This procedure can be added to the surgical armamentarium for management of patients with facial palsy and lagophthalmos.

COMPARTMENT SYNDROME AFTER ISOLATED CLOSED FIBULA FRACTURE- A CASE SERIES

2021 ◽  
pp. 45-46
Author(s):  
Vimal Singh ◽  
Ashish Chopra ◽  
Vidya Bhushan Singh
Keyword(s):  
Range Of Motion ◽  
Compartment Syndrome ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Case Series ◽  
Shaft Fracture ◽  
Vehicle Accident ◽  
Active Range Of Motion ◽  
History Of ◽  
Repeat Examination

Compartment syndrome in lower extremity has been commonly associated with fractures of the tibial plateau, tibia shaft, and tibial plafond. Three patients were included in our study with history of a motor vehicle accident. All of them sustained a closed bular shaft fracture and had fullness in anterior/lateral compartments of leg but no pain with passive or active range of motion of ankle on initial presentation. Repeat examination demonstrated tense compartments of leg with severe pain during ankle range of motion. 2 out of 3 patients were on anticoagulant therapy. They were taken to operating room for four-compartment fasciotomies. On postoperative day 3 debridement & primary closure was done. Post-operative course in hospital was uneventful. No post compartment syndrome sequelae were seen in 2 months follow up. In conclusion, compartment syndrome in isolated closed bula fracture is a rare possibility.

scholarly journals Case Series on Chronic Whiplash Related Neck Pain Treated with Intraarticular Zygapophysial Joint Regeneration Injection Therapy

2007 ◽  
Vol 2;10 (3;2) ◽  
pp. 313-318
Author(s):  
R. Allen Hooper
Keyword(s):  
Neck Pain ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Neck Disability Index ◽  
Case Series ◽  
Injection Therapy ◽  
Neck Stiffness ◽  
Zygapophysial Joint ◽  
Vehicle Accident ◽  
Chronic Whiplash

Background: Although in clinical use, there is only 1 published case report on the efficacy of intraarticular regeneration injection therapy (RIT) (a.k.a. prolotheraphy). This report supports a rationale for future clinical trials of this technique. Objective: To assess the efficacy of intraarticular zygapophysial joint RIT in patients with chronic whiplash related neck pain that failed other conservative and interventional procedures. Patients were treated with intraarticular RIT and reassessed over 1 year. Design: Retrospective case review of prospective data. Materials and Methods: Eighteen consecutive patients were treated with intraarticular prolotherapy by placing 0.5 – 1mL of 20% dextrose solution into each zygapophysial joint, after confirmation of intraarticular location with radiographic contrast, using 25-gauge spinal needles and fluoroscopic guidance. Solution was prepared by diluting D50W with 1% lidocaine. Results: Fifteen patients completed treatment. Three patients had bilateral treatment, leaving 18 sides for analysis. Mean Neck Disability Index (NDI) pre-treatment was 24.71 and decreased post-treatment to 14.21 (2 months), 13.45 (6 months), 10.94 (12 months). Average change NDI=13.77 (p<0.0001) baseline versus 12 months. Symptoms for 14 patients were from motor vehicle accident, of which 13 were in litigation. Patients attending physiotherapy over the course of treatment had better outcomes than those without physiotherapy. Women needed more injections (5.4) than men (3.2) p=0.0003. Conclusion: Intraarticular RIT improved pain and function in this case series. The procedure appears safe, more effective than periarticular RIT, and lasted as long, or longer, than those patients with previous radiofrequency neurotomy. Concurrent physiotherapy helped reduce post-procedure neck stiffness. Future trials should consider gender when deciding how many treatments to administer. Litigation was not a barrier to recovery. Key words: regenerative injection therapy, RIT, prolotherapy, zygapophysial joint, motor vehicle accident, whiplash

Virtual reality and computer games in the treatment of driving phobia induced by a motor vehicle accident

2003 ◽  
Author(s):  
David Walshe ◽  
Elizabeth Lewis ◽  
Kathleen O'Sullivan ◽  
Brenda K. Wiederhold ◽  
Sun I. Kim
Keyword(s):  
Virtual Reality ◽  
Computer Games ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Vehicle Accident

Machine Learning of Motor Vehicle Accident Categories from Narrative Data

1996 ◽  
Vol 35 (04/05) ◽  
pp. 309-316 ◽  
Author(s):  
M. R. Lehto ◽  
G. S. Sorock
Keyword(s):  
Machine Learning ◽  
Bayesian Model ◽  
Keyword Search ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Computer Search ◽  
Vehicle Accident ◽  
Learning Technique ◽  
Expert Ratings ◽  
Keyword Searches

Abstract:Bayesian inferencing as a machine learning technique was evaluated for identifying pre-crash activity and crash type from accident narratives describing 3,686 motor vehicle crashes. It was hypothesized that a Bayesian model could learn from a computer search for 63 keywords related to accident categories. Learning was described in terms of the ability to accurately classify previously unclassifiable narratives not containing the original keywords. When narratives contained keywords, the results obtained using both the Bayesian model and keyword search corresponded closely to expert ratings (P(detection)≥0.9, and P(false positive)≤0.05). For narratives not containing keywords, when the threshold used by the Bayesian model was varied between p>0.5 and p>0.9, the overall probability of detecting a category assigned by the expert varied between 67% and 12%. False positives correspondingly varied between 32% and 3%. These latter results demonstrated that the Bayesian system learned from the results of the keyword searches.

Aspirated teeth - rigid or flexible bronchoscopy

2019 ◽  
pp. 1-2
Keyword(s):  
Clinical Practice ◽  
Foreign Bodies ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Flexible Bronchoscopy ◽  
Vehicle Accident

Tracheobronchial foreign bodies are a common problem in clinical practice. We present the case of a patient with three aspirated teeth following a motor vehicle accident.

Isolated second trimester uterine rupture following a motor vehicle accident

2021 ◽  
Vol 258 ◽  
pp. 461-463
Author(s):  
Tal Margaliot Kalifa ◽  
Misgav Rottenstreich ◽  
Eyal Mazaki ◽  
Hen Y. Sela ◽  
Schwartz Alon ◽  
...  
Keyword(s):  
Uterine Rupture ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Second Trimester ◽  
Vehicle Accident

scholarly journals Obstructive Sleep Apnea and Risk of Motor Vehicle Accident

2021 ◽  
Author(s):  
Gaia S. Pocobelli ◽  
Mary A. Akosile ◽  
Ryan N. Hansen ◽  
Joanna Eavey ◽  
Robert D. Wellman ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Vehicle Accident ◽  
Obstructive Sleep
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