• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.501-508
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• 2001

Objectives : Hemifacial spasm is painless uncommon disorder characterized by involuntary paroxysmal movement on one side of face. It is known that hemifacial spasm is mainly due to pulsatile compression by vessels at the root exit zone(REZ) of the facial nerve. Microvascular decompression at REZ of the facial nerve has become the standard treatment modality for hemifacial spasm. The authors have analized patients with hemifacial spasm treated with microvascular decompression to evaluate operation result and clinical course after operation. Patients and Methods : From 1992 to 1999, 41 patients with hemifacial spasm underwent this operation. Retrospective analysis of operation results and clinical recovery patterns was done. The length of observation had been more than 6 months in all cases. Results : The ratio of male to female was 1:1.4, and age at operation ranged from 24 to 66 years. Their mean age was 47.6 years and the mean preoperative duration of symptoms was 7.2 years. Most common offending vessels were AICA in 18 cases(48%) and second most common were PICA in 13 cases(31.7%). The rest of them were 3 case in vertebral artery, and 7 cases(13%) in multiple offending vessels. Patterns of improvement after surgery could be divided into 4 clinical types. There was complete recovery in 3 days after operation in 24 cases(58.6%, Immediate complete recovery). There was complete recovery in 3 days after operation, and symptom was recurred partially, which was gradually subsided in 2 weeks after operation in 4 cases(9.8%, Delayed complete recovery type I). There was partial recovery after operation and symptom was compretely disappeared gradually in 6 months after operation in 7 cases(17.1%, Delayed complete recovery type II). Finally, there was partial recovery after operation, and symptom was somewhat remained after 6 months later(14.5%, Delayed partial recovery). Conclusion : In conclusion, microvascular decompression for hemifacial spasm is a safe and reliable treatment modality with good results of improvement and there are 4 recovery patterns in clinical course after operation in our series. Therefore, follow-up observation after microvascular decompression is necessary to evaluate the operative results and complication, especially in the delayed resolved cases.

• Journal of Korean Neurosurgical Society
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• v.53 no.3
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• pp.194-196
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• 2013

Isolated abducens nerve paresis related to ruptured vertebral artery (VA) aneurysm is rare. It usually occurs bilaterally or ipsilaterally to the pathologic lesions. We report the case of a contralateral sixth nerve palsy following ruptured dissecting VA aneurysm. A 38-year-old man was admitted for the evaluation of a 6-day history of headache. Abnormalities were not seen on initial computed tomography (CT). On admission, the patient was alert and no signs reflecting neurologic deficits were noted. Time of flight magnetic resonance angiography revealed a fusiform dilatation of the right VA involving origin of the posterior inferior cerebellar artery. The patient suddenly suffered from severe headache with diplopia the day before the scheduled cerebral angiography. Neurologic examination disclosed nuchal rigidity and isolated left abducens nerve palsy. Emergent CT scan showed high density in the basal and prepontine cistern compatible with ruptured aneurismal hemorrhage. Right vertebral angiography illustrated a right VA dissecting aneurysm with prominent displaced vertebrobasilar artery to inferiorly on left side. Double-stent placement was conducted for the treatment of ruptured dissecting VA aneurysm. No diffusion restriction signals were observed in follow-up magnetic resonance imaging of the brain stem. Eleven weeks later, full recovery of left sixth nerve palsy was documented photographically. In conclusion, isolated contralateral abducens nerve palsy associated with ruptured VA aneurysm may develop due to direct nerve compression by displaced verterobasilar artery triggered by primary thick clot in the prepontine cistern.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.3
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• pp.313-317
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• 2000

Return of facial nerve function is important in patients with facial nerve paralysis by trauma. Sometimes, delay in diagnosis of facial nerve paralysis make recovery of facial nerve function difficult. Traumatic facial palsy mostly occur after temporal bone fracture in unilateral. Temporal bone fracture after head trauma are divided into the three group; longitudinal fracture, transverse fracture and mixed fracture. The most common symptoms are hearing impairment, bloody otorrhea, loss of consciousness and facial nerve paralysis. The early care of temporal bone fracture involves facial nerve paralysis. And there has been many discussion and study in the treatment of the immediate or delayed facial palsy ; examply, surgical approach, time and methods. We have managed a patient with unilateral facial nerve paralysis after longitudinal temporal bone fracture in mastoid process and conservative facial nerve decompression was performed. We have obtained good result and report this case with review of literatures.

• Korean Journal of Cleft Lip And Palate
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• v.4 no.1
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• pp.39-43
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• 2001

The design of osteotomy plane in orthognathic surgery has been developed to diminish the nerve injury. Intraoral Vertico-Sagittal Ramus Osteotomy (IVSRO) is the one of the best way to minimize untoward results, which is designed not to expose the lingula. We evaluated the nerve damage before and after with current perception threshold (CPT) test which is modem and numerically expressible way of nerve damages. Sixty patients underwent IVSRO since 1998 were evaluated. They were divided into 2 groups; one group underwent IVSRO only, and the other underwent IVSRO plus genioplasty. The both groups were evaluated with CPT test 1 week before surgery, and 1, 3 and 6 months after surgery. The CPT test was performed on A-beta, A-delta and C fiber respectively. 111e result showed that the recovery of sensory function of damaged nerve fibers was observed at the period of three to six months after surgery. There was no impairment of nerve function after only the IVSRO . But there were sensory disturbances in cases of additional genioplasty group. We thought that one of major factors on nerve damages were exposure of nerve and traction injury during genioplasty.

• Archives of Plastic Surgery
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• v.33 no.4
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• pp.510-513
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• 2006

Purpose: The Rectus abdominis muscle free flap is utilized in various reconstruction surgeries due to easiness in harvesting, consistency of vascular pedicle and reduced donor site morbidity. But rarely, femoral nerve injury during rectus abdominis harvesting can be resulted. We report a case of femoral nerve injury after rectus muscle harvesting and discuss the injury mechanism with the follow-up process of this injury. Methods: To reconstruct the defect of middle cranial base after wide excision of cystic adenocarcinoma of the external ear, rectus muscle free flap was havested in usual manner. To achieve a long vessel, inferior epigastric artery was dissected to the dividing portion of femoral artery and cut. Results: One week after the surgery, the patient noted sensory decrease in the lower leg, weakness in muscle strength, and disabilities in extension of the knee joint resulting in immobilization. EMG and NCV results showed no response on stimulation of the femoral nerve of the left leg, due to the defects in femoral nerve superior to the inguinal ligament. With routine neurologic evaluations and physical therapy, on the 75th day after the operation, the patient showed improvement in pain, sensation and muscle strength, and was able to move with walking frame. In 6 months after the operation, recovery of the muscle strength of the knee joint was observed with normal flexion and extension movements. Conclusion: Rarely, during dissection of the inferior epigastric artery, injuries to the femoral nerve can be resulted, probably due to excessive traction or pressure from the blade of the traction device. Therefore, femoral nerve injury can be prevented by avoiding excessive traction during surgery.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.6
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• pp.347-353
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• 2023

This case report presents inferior alveolar nerve (IAN) repositioning as a viable approach for implant placement in the mandibular molar region, where challenges of severe alveolar bone width and height deficiencies can exist. Two patients requiring implant placement in the right mandibular molar region underwent nerve transposition and lateralization. In both cases, inadequate alveolar bone height above the IAN precluded the use of short implants. The first patient exhibited an overall low alveolar ridge from the anterior to posterior regions, with a complex relationship with adjacent implant bone level and the mental nerve, complicating vertical augmentation. In the second case, although vertical bone resorption was not severe, the high positioning of the IAN within the alveolar bone due to orthognathic surgery raised concerns regarding adequate height of the implant prosthesis. Therefore, instead of onlay bone grafting, nerve transposition and lateralization were employed for implant placement. In both cases, the follow-up results demonstrated successful osseointegration of all implants and complete recovery of postoperative numbness in the lower lip and mentum area. IAN repositioning is a valuable surgical technique that allows implant placement in severely compromised posterior mandibular regions, promoting patient comfort and successful implant placement without permanent IAN damage.

• Journal of Korean Medicine Rehabilitation
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• v.19 no.1
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• pp.39-55
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• 2009

Objectives : This study was designed to evaluate effects of electroacupuncture and Cervi Pantortichum Cornu pharmacopuncture on pain and nerve regeneration after crush injury of sciatic nerve in rats. Methods : We divided the subjects into 5 groups : control group, acupuncture treated group, electroacupuncture treated group, Cervi Pantortichum Cornu pharmacopuncture treated group, electroacupuncture and Cervi Pantortichum Cornu pharmacopuncture group. Hot plate test and degree of Substance P antibody in each group were observed at the 1st, 2nd, 3rd and 5th day. Sciatic function index and change of BDNF immunoreactivity had been estimated at the 7th, 14th, 21st day respectively. Atrophy of the gastrocnemius at the 21st day was observed. Results : All the experimental groups showed significant changes in hot plate test, degree of Substance P antibody, sciatic function index and change of BDNF immunoreactivity compared with control group. Especially, when electroacupuncture and Cervi Pantortichum Cornu pharmacopuncture used together, results were more effective than other groups. Recovery of the gastrocnemius was also the same. Conclusions : It is suggested that electroacupuncture and Cervi Pantortichum Cornu pharmacopuncture may play a significant role on pain decrease and nerve regeneration after crush injury of sciatic nerve in rats and these two treatments could be more effective when used together.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.11 no.2
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• pp.178-184
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• 2000

Laryngeal evoked EMG is the objective and quantitative method to measure the innervation of laryngeal muscle. If there is a mobility disorder of vocal cords, the cause and location of neural lesion co be understood by the laryngeal evoked EMG and if there is a vocal cord paralysis, the degree of recovery and the policy of treatment can be determined by it. Recently, the studies of reinnervation after recurrent laryngeal nerve injury have been actively carried out. Laryngeal evoked EMC is useful to these studies. The aim of study is to know whether noninvasive methods for stimulating the recurrent laryngeal nerve and for recording of compound action potential(CAP) using surface electrode are as useful as the invasive method using needle electrode. We obtained EMG of laryngeal muscle by various stimulating and recording methods : 1) Direct nerve stimulation by placing nerve cuff electrode made out of silastic tube and platinum wire and recording by insertion of hook wire electrode into posterior cricoarytenoid(PCA) and thyroarytenoid(TA) muscles, respectively. 2) Recording of compound action potential by surface electrode after stimulation of recurrent laryngeal nerve by the insertion of 27 gauge of needle electrode. 3) Recording of compound action potential by surface electrode after stimulating the recurrent laryngeal nerve by transcutaneous blunt rod electrode at tracheoesophageal groove. The amplitude, duration and latency of the CAP evoked by recurrent laryngeal nerve stimulation were compared among the three groups. The amplitude of CAP was smallest in the group recorded from posterior cricoarytenoid and hyroarytenoid muscle, and that recorded by surface electrode after stimulation by needle electrode was largest. The difference in amplitude between the group by hook wire recording and the two groups by surface electrode recording was significant statistically. There is no significant difference in duration and latency among three groups. Since the waveform of CAP from all three methods has similar duration, latency, we concluded that noninvasive method is a useful as invasive methods.

• Archives of Plastic Surgery
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• v.41 no.6
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• pp.709-715
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• 2014

Background The distally based sural artery flap is a reliable, local reconstructive option for small soft tissue defects of the distal third of the leg. The purpose of this study is to describe an adipofascial flap based on a single sural nerve branch without sacrificing the entire sural nerve, thereby preserving sensibility of the lateral foot. Methods The posterior aspect of the lower limb was dissected in 15 cadaveric limbs. Four patients with soft tissue defects over the tendo-achilles and ankle underwent reconstruction using the adipofascial flap, which incorporated the distal peroneal perforator, short saphenous vein, and a single branch of the sural nerve. Results From the anatomical study, the distal peroneal perforator was situated at an average of 6.2 cm (2.5-12 cm) from the distal tip of the lateral malleolus. The medial and lateral sural nerve branches ran subfascially and pierced the muscle fascia 16 cm (14-19 cm) proximal to the lateral malleolus to enter the subcutaneous plane. They merged 1-2 cm distal to the subcutaneous entry point to form the common sural nerve at a mean distance of 14.5 cm (11.5-18 cm) proximal to the lateral malleolus. This merging point determined the pivot point of the flap. In the clinical cases, all patients reported near complete recovery of sensation over the lateral foot six months after surgery. All donor sites healed well with a full range of motion over the foot and ankle. Conclusions The distally based sural artery adipofascial flap allowed for minimal sensory loss, a good range of motion, an aesthetically acceptable outcome and can be performed by a single surgeon in under 2 hours.

• The Journal of Internal Korean Medicine
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• v.33 no.1
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• pp.83-101
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• 2012

Objectives : This study was aimed to investigate the therapeutic effect of Bogijetongtanggammi-bang (BJTG) on injury of the peripheral nerve tissues. Methods : Rats were divided into 2 groups. The rats of the first group were injected with Taxol (1.25 mg/kg) to their sciatic nerves, once each. The sciatic nerves of the rats of the second group were crushed by forcept for 30 seconds. Rats were administered with BJTG (400 mg/kg) or 0.9% saline for 5 days. Changes of DRG neurons, Schwann cells, Cdc2, caspase 3. phospho-p44/42 Erk1/2, phospho-vimentin and ${\beta}1$ integrin were observed by fluorescent microscope and analysed in western blot. Results : In Taxol-treated SD rat models, BJTG up-regulated neurite outgrowth, Schwann cells, Cdc2 and phospho-Erk1/2, and down-regulated caspase 3. In pressure-injured rat models, BJTG up-regulated axons of sciatic nerve, Schwann cells, Cdc2, phospho-vimentin, ${\beta}1$ integrin, and down-regulated caspase 3. Conclusions : Taken together, BJTG was promotive of nerve regeneration on SNI as well as Taxol-induced nerve injury. BJTG had a pharmaceutical property enhancing recovery of injured peripheral nerves and could be a candidate for drug development after further research.