• Archives of Craniofacial Surgery
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• v.22 no.6
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• pp.303-309
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• 2021

Background: Transferring the hypoglossal nerve to the facial nerve using an end-to-end method is very effective for improving facial motor function. However, this technique may result in hemitongue atrophy. The ansa cervicalis, which arises from the cervical plexus, is also used for facial reanimation. We retrospectively reviewed cases where facial reanimation was performed using the ansa cervicalis to overcome the shortcomings of existing techniques of hypoglossal nerve transfer. Methods: The records of 15 patients who underwent hypoglossal nerve transfer were retrospectively reviewed. Three methods were used: facial reanimation with hypoglossal nerve transfer (group 1), facial nerve reanimation using the ansa cervicalis (group 2), and sural nerve interposition grafting between the hypoglossal nerve and facial nerve (group 3). In group 1, the ansa cervicalis was coapted to neurotize the distal stump of the hypoglossal nerve in a subset of patients. Clinical outcomes were evaluated using the House-Brackmann (H-B) grading system and Emotrics software. Results: All patients in group 1 (n= 4) achieved H-B grade IV facial function and showed improvements in the oral commissure angle at rest (preoperative vs. postoperative difference, 6.48° ± 0.77°) and while smiling (13.88° ± 2.00°). In groups 2 and 3, the oral commissure angle slightly improved at rest (group 2: 0.95° ± 0.53°, group 3: 1.35° ± 1.02°) and while smiling (group 2: 2.06° ± 0.67°, group 3: 1.23° ± 0.56°). In group 1, reduced tongue morbidity was found in patients who underwent ansa cervicalis transfer. Conclusion: Facial reanimation with hypoglossal nerve transfer, in combination with hypoglossal nerve neurotization using the ansa cervicalis for complete facial palsy patients, might enable favorable facial reanimation outcomes and reduce tongue morbidity. Facial reanimation using the ansa cervicalis or sural nerve for incomplete facial palsy patients did not lead to remarkable improvements, but it warrants further investigation.

• Archives of Plastic Surgery
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• v.50 no.3
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• pp.264-273
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• 2023

The medial sural artery perforator (MSAP) flap is a versatile fasciocutaneous flap, and yet is less commonly utilized than other free flaps in microvascular reconstructions of the head and neck. The aim is to conduct a high-quality Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)- and Assessment of Multiple Systematic Reviews 2 (AMSTAR 2)-compliant systematic review comparing the use of the MSAP flap to other microvascular free flaps in the head and neck. Medline, Embase, and Web of Science databases were searched to identify all original comparative studies comparing patients undergoing head and neck reconstruction with an MSAP flap to the radial forearm free flap (RFFF) or anterolateral thigh (ALT) flap from inception to February 2021. Outcome studied were the recipient-site and donor-site morbidities as well as speech and swallow function. A total of 473 articles were identified from title and abstract review. Four studies met the inclusion criteria. Compared with the RFFF and the ALT flaps, the MSAP flap had more recipient-site complications (6.0 vs 10.4%) but less donor-site complications (20.2 vs 7.8%). The MSAP flap demonstrated better overall donor-site appearance and function than the RFFF and ALT flaps (p = 0.0006) but no statistical difference in speech and swallowing function following reconstruction (p = 0.28). Although higher quality studies reviewing the use of the MSAP flap to other free flaps are needed, the MSAP flap provides a viable and effective reconstructive option and should be strongly considered for reconstruction of head and neck defects.

• Journal of Korean Foot and Ankle Society
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• v.16 no.2
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• pp.79-86
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• 2012

Calcaneal fractures account for 2% of all fractures and approximately 60 to 70% of tarsal fractures. These fractures typically are the result of high-energy injury, such as a motor vehicle accident or a fall from a height. The potential for disabling malunion following intrarticular displaced calcaneal fracture is high, regardless of treatment. Fracture displacement typically results in loss of hindfoot height, varus and widening of the hindfoot, with possible subfibular impingement and irritation of the peroneal tendon and/or sural nerve. Frequently, subtalar joint develops posttraumatic arthritis. In symptomatic patients with calcaneal malunion, systemic evaluation is required to determine the source of pain. Nonsurgical treatment, such as activity and shoe modification, bracing, orthoses, and injection, is effective in many patients. Surgical treatment may involve simple ostectomy, subtalar arthrodesis with or without distraction, or corrective calcaneal osteotomy. A high rate of successful arthrodesis and of patient satisfaction has been reported with surgical manamgent.

• Annals of Clinical Neurophysiology
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• v.15 no.1
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• pp.19-23
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• 2013

Some patients with leprosy may present with atypical features, such as isolated peripheral neuropathy without skin lesions, or marked proprioceptive dysfunction. We report a 56-year-old female who presented with predominant proprioceptive loss without skin lesion, but was finally confirmed as leprous neuropathy by sural nerve biopsy. It is postulated that large myelinated fibers were affected by chronic immunological reactions triggered by inactive bacterial particles, producing a peripheral neuropathy presenting as predominant proprioceptive sensory loss without typical skin lesions.

• Archives of Reconstructive Microsurgery
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• v.2 no.1
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• pp.42-45
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• 1993

Although various methods had been reported for reanimination of facial nerve palsy, interposition nerve graft remains superior to other methods if there is a wide gap to be bridged. Dott described a excllent facial nerve reconstruction by sural nerve graft bypassing petrous bone. But his method needs two surgical fields and is performed in two stages. Authors desribe a traumatic facial nerve palsy treated by one stage facial nerve reconstruction that is performed in one surgical field by using a great auricular nerve interposition graft and bypass the petous bone.

• Annals of Clinical Neurophysiology
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• v.5 no.1
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• pp.39-41
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• 2003

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology ogenesis, and most frequently presented with bilateral hilar lymphadenopathy, pulmonary infiltration, skin and eye lesion. However, neurological involvement including peripheral neuropathy is relatively rare. We report a patient who had sensorimotor polyneuropathy without other systemic symptoms or organ involvements frequently reported in sarcoidosis. Laboratory investigation suggestive of sarcoidosis lead to sural nerve biopsy for confirmation, which demonstrated noncaseating granulomatous changes. Sarcoidosis shoud be included in the differential diagnosis in subacute polyneuropathy even if there is no usual symptoms or signs suggestive of the systemic disease.

• Annals of Clinical Neurophysiology
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• v.14 no.2
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• pp.72-75
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• 2012

Ischemic monomelic neuropathy and myopathy are rare complications of peripheral arterial occlusive disease. We report a case of ischemic monomelic neuropathy of the right sural, common peroneal and posterior tibial nerves and ischemic myopathy of the right tibialis anterior resulting from the occlusion of the right common femoral arteries despite successful revascularization. Ischemic monomelic neuropathy and myopathy can occur as a result of occlusion of the specific peripheral artery.

• Annals of Clinical Neurophysiology
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• v.9 no.2
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• pp.43-50
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• 2007

Analysis of intraepidermal nerve fibers using skin biopsy is a recently developed technique, providing diagnostic information on small fiber neuropathies. The specimens are obtained by 3 mm punch biopsy, which is safe and minimally invasive. Immunohistochemical staining by Protein gene product (PGP) 9.5 demonstrate not only intraepidermal nerve fibers but dermal structures, such as sweat gland and erector papillae. Up to now, many studies agree that intraepidermal nerve fiber density is dramatically reduced in various sensory neuropathies. The utility of density measure was confirmed with high sensitivity in the diagnosis of sensory neuropathy, comparable to sural nerve biopsy or quantitative sensory testing. Besides quantitative methods, morphological changes like axonal swelling and fragmentation can be used as predegenerative markers. This article reviews the technique of skin biopsy and clinical and experimental usefulness of skin biopsy in diagnosing and monitoring peripheral neuropathies.

• Archives of Reconstructive Microsurgery
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• v.19 no.2
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• pp.93-96
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• 2010

We report a case of 44 years old male patient with neuroma-in-continuity of ulna nerve. In the patient's past history, he had received operative treatment for the open supracondylar fracture of right distal humerus and ulnar nerve injury at 10 years ago, and neurolysis was tried 2 times due to severe neuropathic pain. Despite of these operations, the symptom was not improved. In operative field, we noticed neuroma-in-continuity and decided to resect the neuroma until normal nerve fascicle was noted. The nerve cable graft was done with auto sural nerve on the defect site and the nerve was wrapped with small saphenous vein. At post operative 7 months, pain was markedly decreased and sensory recovery was slightly improved and patient was satisfied with the result.

• Archives of Craniofacial Surgery
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• v.25 no.2
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• pp.99-103
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• 2024

Because facial nerve injuries affect the quality of life, leaving them untreated can have devastating effects. The number of patients with traumatic and iatrogenic facial nerve paralysis is considerably high. Early detection and prompt treatment during the acute injury phase are crucial, and immediate surgical treatment should be considered when complete facial nerve injury is suspected. Symptom underestimation by patients and clinical misdiagnosis may delay surgical intervention, which may negatively affect outcomes and in some cases, impair the recovery of the injured facial nerve. Here, we report two cases of facial nerve injury that were treated with nerve grafts during the subacute phase. In both cases, subacute facial nerve grafting achieved significant improvements. These cases highlight surgical intervention in the subacute phase using nerve grafts as an appropriate treatment for facial nerve injuries.