Early neuroborreliosis in children, Bannwart syndrome (clinical observations)

The problem of ixodic tick-borne borreliosis remains relevant due to its ubiquity, high incidence, especially in the Northwestern Federal District, a variety of clinical manifestations, as well as the possibility of chronization, including in children.Purpose: to describe our own clinical observations of Bannwart syndrome, which developed during the dissemination of the pathogen.Results. Bannwart syndrome is pathognomonic for borreliosis symptoms, including a triad of clinical manifestations: serous meningitis, single- or bilateral lesion of facial nerves, polyneuropathy. Timely clinical and adequate laboratory diagnostics determine the favorable course of the disease.

The Pattern of Facial Nerve Branching: A Cadaveric and Clinical Study

Background: Thorough understanding of the branches of the facial nerve is critical during parotidectomy. Many variations of the branching patterns have been observed among different populations. The objective of this study was to determine the different branching patterns in a Sudanese population. Materials and Methods: A total of 90 facial nerves were dissected. There were 40 cadavers (bilateral) and 10 patients (unilateral) who underwent parotidectomy. Only specimens with benign parotid pathology with intact facial nerve were included. Out of the 90 facial nerves examined, 41 were males and 9 females. Forty-six specimens (51%) were left; and 44 (49%) were right facial nerves. Facial nerve branching patterns were classified into 5 types as described by Katz and Kopuz. Results: The most common branching pattern was type III found in 42 cases (46.6%). The second most common was type I which was seen in 18 cases (20%). This is the most common type reported in the literature. Types II, IV, and V were found to be 8.8%, 12.2%, and 11% respectively. Conclusion: Facial nerve branching patterns are very variable and can be very complex. Significant differences exist between races. Surgeons who perform parotidectomy should be very familiar with these differences to avoid surgical misadventures.

Stimulating the Facial Nerve to Treat Ischemic Stroke: A Systematic Review

Acute ischemic stroke (AIS) is a common devastating disease that has increased yearly in absolute number of cases since 1990. While mechanical thrombectomy and tissue plasminogen activator (tPA) have proven to be effective treatments, their window-of-efficacy time is very short, leaving many patients with no viable treatment option. Over recent years there has been a growing interest in stimulating the facial nerves or ganglions to treat AIS. Pre-clinical studies have consistently demonstrated an increase in collateral blood flow (CBF) following ganglion stimulation, with positive indications in infarct size and neurological scores. Extensive human trials have focused on trans-oral electrical stimulation of the sphenopalatine ganglion, but have suffered from operational limitations and non-significant clinical findings. Regardless, the potential of ganglion stimulation to treat AIS or elongate the window-of-efficacy for current stroke treatments remains extremely promising. This review aims to summarize results from recent trial publications, highlight current innovations, and discuss future directions for the field. Importantly, this review comes after the release of four important clinical trials that were published in mid 2019.

Guillain–Barré syndrome with bilateral facial diplegia secondary to severe acute respiratory syndrome coronavirus-2 infection: a case report

Background The new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) owing to its similarity to the previous severe acute respiratory syndrome (SARS), is characterized by causing, in most patients, nonspecific symptoms similar to those of the common flu. It has been reported that many coronavirus disease 2019 (COVID-19) patients presented neurological symptoms that involve the central and peripheral nervous systems. In addition, there have been several reports of patients who presented Guillain–Barré syndrome related to COVID-19 , with sensory and motor compromise in the extremities. Case presentation In this report, we describe a rare case of Guillain–Barré syndrome in a 50-year-old Hispanic male with bilateral facial palsy as the only neurological manifestation, following SARS-CoV-2 infection. A complete neurophysiological study showed severe axonal neuropathy of the right and left facial nerves. Conclusion Regardless of severity, clinicians must to be aware of any neurological manifestation generated by COVID-19 and start performing more neurophysiological tests to determine if the infection induces an axonal, myelin, or mixed involvement of the peripheral nervous system.

Transoral Excision of a Large Accessory Parotid Gland Tumor

Accessory parotid gland (APG) tumors account for 1% to 7% of all parotid gland neoplasms but are more likely to be malignant than main parotid gland tumors. Management of APG neoplasms entails surgical excision. Four primary approaches to resection have been described in the literature with varying facial nerve outcomes. We report a case of a 4-cm APG pleomorphic adenoma utilizing a transoral approach for excision without postoperative facial nerve injury. A transoral approach is known to mitigate patients’ cosmetic concerns; however, prior reports utilized endoscopic assistance on patients with smaller tumors. We conclude that large APG tumors can be excised through a transoral approach without undue risk to the distal facial nerves, though this transoral approach ultimately may not be appropriate for malignant neoplasms or difficult dissections.

Three-Dimensional Sheath Inked Rapid Acquisition with Refocused Echoes Imaging (SHINKEI) MRI for Delineating the Intraparotid Facial Nerve Branches and Their Anatomical Relationship with Parotid Tumors

Background: Accurate imaging of the anatomical relationship between the intraparotid facial nerve branches and parotid tumor can be helpful for surgical planning and effective protection of the facial nerve during surgery. Three-dimensional sheath inked rapid acquisition with refocused echoes imaging (3D-SHINKEI) is a new MRI sequence with a high tissue contrast resolution, which has been used for imaging the peripheral nerves in several organs. Objectives: To evaluate the value of 3D-SHINKEI sequence in representing the intraparotid facial nerve branches and their anatomical relationship with neoplasms of the parotid gland. Patients and Methods: Thirty-six patients with parotid tumors underwent MRI with 3D-SHINKEI and 3D-T2-fast field echo (3D-T2-FFE) sequences in the coronal plane. The contrast-to-noise ratios (CNRs) and signal intensity ratios (SIRs) of the facial nerves in the two sequences were compared. The relationship between the intraparotid facial nerve branches and parotid tumor was also analyzed in 36 patients, and the results were compared with the intraoperative anatomy and postoperative pathological findings. Results: The image quality score of the 3D-SHINKEI sequence for anatomical representation of the intraparotid facial nerve branches was significantly higher than that of the 3D-T2-FFE sequence (Z = −6.197, P < 0.01). The SIRs and CNRs of the facial nerves were significantly higher in the SHINKEI images as compared to the 3D-T2-FFE images (t = 10.772, P < 0.01 and t = 11.586, P < 0.01, respectively). The delineation accuracy of the anatomy of the main trunk of the facial nerve and its first-level branches and their relationship with tumors was significantly higher with the 3D-SHINKEI sequence than with the 3D-T2-FFE sequence (P < 0.01). Besides, the relationship between parotid tumors and the main trunk of the facial nerve and its first-level branches was classified into six types. Conclusion: A high-resolution 3D-SHINKEI sequence could accurately represent the relationship between the intraparotid facial nerve branches and parotid gland neoplasms. It was also found to be more accurate than the 3D-T2-FFE sequence.

Photobiomodulation enhances facial nerve regeneration via activation of PI3K/Akt signaling pathway–mediated antioxidant response

Facial nerve dysfunction is a common clinical condition that leads to disfigurement and emotional distress in the affected individuals. This study aimed to evaluate whether photobiomodulation can enhance regeneration of crushed facial nerves and attempt to investigate the possible underlying mechanism of neuroprotective function and therapeutic target. Various parameters of photobiomodulation were assigned to the facial nerves and Schwann cells (SCs) separately during crushed injury in rats. Axonal regeneration, functional outcomes, and SC apoptosis, proliferation, and underlying mechanisms of action were evaluated by morphological, histopathological, and functional assessments, flow cytometry, western blotting, real-time PCR, and IncuCyte. The results showed that photobiomodulation improved axonal regeneration and functional recovery, and also promoted proliferation, and inhibited apoptosis of SCs, both of these were considered as the most effective parameters in 250mW group. In addition, the neuroprotective effects of photobiomodulation (500mW) were likely associated with oxidative stress–induced SC apoptosis via activation of the PI3K/Akt signaling pathway. Our results revealed that photobiomodulation significantly promoted axonal regeneration, functional recovery, and regeneration of the facial nucleus, and its mechanism was related to the up-regulation of the PI3K/Akt signaling pathway. These findings provide clear experimental evidence of photobiomodulation as an alternative therapeutic strategy for peripheral nerve damage.

Interposition Grafting of the Facial Nerve After Resection of a Large Facial Nerve Schwannoma: 2-Dimensional Operative Video

Facial nerve schwannomas can develop at any portion of the facial nerve.1 When arising from the mastoid portion of the facial nerve, the tumor will progressively erode the mastoid, giving the schwannoma an aggressive radiological appearance.1,2 The facial nerve is frequently already paralyzed, or no fascicles can be saved during resection. In these cases, end-to-end interposition grafting is the best option for facial reanimation.1,3-5 The healthy proximal and distal facial nerves are prepared prior to grafting. The great auricular nerve is readily available near the surgical site and represents an excellent graft donor with minimal associated morbidity.4,6 We demonstrate this technique through a case of a 48-yr-old male who presented with a complete right-sided facial nerve palsy due to a large facial schwannoma that invaded the mastoid and extended to the hypoglossal canal, causing hypoglossal nerve paralysis, and petrous carotid canal. His 4-yr follow-up showed no recurrent tumor with restored facial nerve function palsy to a House-Brackman grade III, and full recovery of his hypoglossal nerve function. The patient consented to the surgery and the publication of his image.

DIGESTIVE DISORDERS IN THE ORAL CAVITY

The progress made in fundamental medical research over the past decades, the scientific acquisitions in the field of genetics, molecular biology and biochemistry in relation to the explosive development of investigative technologies have revolutionized the clinical approach to many pathological entities, practically opening a new era in the evolution of clinical medicine. Dental medicine, as a science, feels the massive impact of the needs for knowledge and relaunches the interest of research in all its subspecialties. From this perspective, these are legitimized not only through the crisis in managing the immense volume of information, but also through the openings offered to the framework of conceptualizing and defining the identity of this branch of medicine, related to the need to particularize the specific problems in this discipline. Digestion is a fundamental process in the survival of an organism. It begins in the oral cavity, where the bolus is formed, and continues in the stomach, forming the chyme, which then reaches the small intestine and transforms into the chyle. Through mastication, the surface of food increases, thus the enzymes are able to act more easily on the substrate. The first enzymes to act on food are the salivary ones - salivary amylase, lingual lipase. Mastication is regulated through the contact of food with receptors in the oral cavity. These will send impulses by way of the trigeminal nerve towards the centre of mastication - located in the bolus. From the bolus, they will start the signals on the efferent pathway (trigeminal, hypoglossal and facial nerves) that will reach the masticatory muscles. Mechanical digestion (mastication) can thus begin. Mechanical digestion in the oral cavity results from mastication. During mastication, the food is manipulated by the tongue, crushed by the teeth and mixed with saliva. Concomitant with mechanical digestion, the chemical digestion takes place through the action of saliva. There are two types of salivary glands in the oral cavity: large glands - parotid, sublingual, submandibular and small glands - disseminated throughout the oral cavity. Within 24 hours, up to 1.5 liters of saliva are secreted, 99% of which is represented by water. The remaining 1% consists of enzymes, mucus, nitrogen content. After finalizing mastication, deglutition begins. This mechanical process consists of thrusting the bolus from the mouth towards the stomach, using the esophagus.