Wound botulism: a clinical experience.
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Biomedical subjects
F Y Butt
Publications and source records attributed to F Y Butt.
Delayed onset facial nerve dysfunction following acoustic neuroma surgery.
Delayed onset facial nerve dysfunction following acoustic neuroma surgery is an under-appreciated phenomenon. The authors have recently reviewed long-term (> 1 year) facial nerve outcome in 129 patients who underwent acoustic neuroma removal with the aid of cranial nerve monitoring between 1986 and 1990. The facial nerve was anatomically preserved in 99.2% of the patients, and at one year, 90% of all the patients had House-Brackmann (H-B) grade I or II facial nerve function. Delayed onset worsening of facial nerve function was noted in 38 of 129 (29%) patients, most of which occurred in the first few postoperative days. The incidence increases to 41% (38 of 93) when corrected for those with immediate H-B grade VI weakness, and who therefore could not manifest further deterioration. The facial nerve function either deteriorated from normal to abnormal or increased in severity of weakness. Delayed facial palsy was not related to the size of tumor or the surgical approach. The most common occurrence was that of a patient with H-B grade I or II facial nerve function worsening to H-B grade VI in the postoperative period. The prognosis for recovery of facial nerve function following delayed palsy was excellent. In the majority of cases, the recovery was complete within the first 6 months without specific treatment. Comparable to the patients without delayed palsies, 89% (34 of 38) of the cases had H-B grade I or II and 97% (37 of 38) had H-B grade III or better facial nerve function at 1 year. This review suggests a surprisingly high incidence of delayed facial palsy following acoustic neuroma surgery, which fortunately has an excellent prognosis for spontaneous recovery.
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Facial nerve outcome after acoustic neuroma surgery: a study from the era of cranial nerve monitoring.
The introduction of intraoperative cranial nerve monitoring in posterior fossa surgery has greatly aided the surgeon in identification and anatomic preservation of cranial nerves. As a result, the long-term function of the facial nerve continues to improve after removal of acoustic neuroma. Herein, we report our long-term (1 year or greater) facial nerve outcome in 129 patients who underwent surgical removal of their acoustic neuromas with the aid of intraoperative neurophysiologic monitoring between 1986 and 1990. The facial nerve was anatomically preserved in 99.2% of the patients, and 90% of all the patients had grade 1 or 2 facial nerve function 1 year after surgery. Long-term facial function was inversely correlated with the size of tumor (chi-squared, p < 0.02) and was not related to the side of tumor, the age and sex of the patient, or the surgical approach. In a comparison among tumor groups matched for size, no statistically significant difference in facial nerve outcome between the translabyrinthine and retrosigmoid approaches was detected. The proximal facial nerve stimulation threshold at the end of surgical removal was predictive of long-term facial nerve function (analysis of variance, p < 0.02). At 1 year, 98% (87 of 89) of the patients with electrical thresholds of 0.2 V or less had grade 1 or 2 facial nerve function compared with only 50% (8 of 16) of those with thresholds between 0.21 and 0.6 V. In the era of cranial nerve monitoring, patients can be better advised about long-term facial nerve outcome after surgical intervention. Preoperatively, the size of the tumor is the most critical factor in predicting long-term facial function. Postoperatively, the proximal seventh nerve stimulation threshold at the end of the surgical procedure can be used as one prognostic measure of long-term facial nerve function.
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Bilateral temporal bone encephaloceles after cranial irradiation. Case report.
Irradiation of the central nervous system may cause significant morbidity, including endocrine dysfunction and intellectual impairment. The authors report a case of bilateral temporal bone encephaloceles in a 21-year-old man who had received prophylactic central nervous system irradiation for acute lymphocytic leukemia in early childhood. Endaural encephaloceles are uncommon, and most occur as a complication of mastoid surgery. The etiology, clinical features, radiological diagnosis, and surgical treatment of temporal bone encephaloceles are discussed.
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