Management of peripheral facial nerve palsy

Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell’s palsy). Three quarters of peripheral FNP are primary and one quarter secondary. The most prevalent causes of secondary FNP are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. The diagnosis of FNP relies upon the presence of typical symptoms and signs, blood chemical investigations, cerebro-spinal-fluid-investigations, X-ray of the scull and mastoid, cerebral MRI, or nerve conduction studies. Bell’s palsy may be diagnosed after exclusion of all secondary causes, but causes of secondary FNP and Bell’s palsy may coexist. Treatment of secondary FNP is based on the therapy of the underlying disorder. Treatment of Bell’s palsy is controversial due to the lack of large, randomized, controlled, prospective studies. There are indications that steroids or antiviral agents are beneficial but also studies, which show no beneficial effect. Additional measures include eye protection, physiotherapy, acupuncture, botulinum toxin, or possibly surgery. Prognosis of Bell’s palsy is fair with complete recovery in about 80% of the cases, 15% experience some kind of permanent nerve damage and 5% remain with severe sequelae

Grass, Legume and Forb Cultivation

Photograph of Sericea lespedeza. The grass is cut and raked in windrows on 4 acres of an idle, cultivated field, which was seeded at the rate of 25 pounds per acre on June 10, 1942 with a cyclone seeder. The field was flattened, disked and harrowed. Three and one half acres were fertilized with 200 pounds of 20% phosphate per acre and the seed bed packed with a cultipacker. Seeds were covered with a second rolling of the cultipacker. A severe drought in 1943 prevented all but one hay crop. Freddie Brown, the District Supervisor, estimated that he harvested 1.5 tons of hay per acre for a total of 6 tons. One hay crop in 1944 yielded 8 tons. A seed crop will be harvested later this year. One-half acre was left unphosphated at the time of seeding for a field test. The area phosphate yielded 50% more hay than the untreated area. Soil is very infertile. Adjacent land sodded to Bermuda grass in June and July, 1942 is living but making no growth whatever. L to R: Maynard Collins, Freddie Brown and John Moberly. OK-8960

Grass, Legume and Forb Cultivation

Photograph of Sericea lespedeza. The grass is cut and raked in windrows on 4 acres of an idle, cultivated field, which was seeded at the rate of 25 pounds per acre on June 10, 1942 with a cyclone seeder. The field was flattened, disked and harrowed. Three and one half acres were fertilized with 200 pounds of 20% phosphate per acre and the seed bed packed with a cultipacker. Seeds were covered with a second rolling of the cultipacker. A severe drought in 1943 prevented all but one hay crop. Freddie Brown, the District Supervisor, estimated that he harvested 1.5 tons of hay per acre for a total of 6 tons. One hay crop in 1944 yielded 8 tons. A seed crop will be harvested later this year. One-half acre was left unphosphated at the time of seeding for a field test. The area phosphate yielded 50% more hay than the untreated area. Soil is very infertile. Adjacent land sodded to Bermuda grass in June and July, 1942 is living but making no growth whatever. L to R: Maynard Collins, Freddie Brown and John Moberly. OK-8961

Translaryngeale Schrotschussverletzung bei einem 65-jährigen Patienten- eine Falldarstellung

Bei einem 65-jährigen männlichen Patienten war eine Schrotschußverletzung durch einen Jagdunfall eingetreten. Auf Grund vielfacher Lokalisationen der Bleikugeln wurde der Patient interdisziplinär operiert. Von Seiten der HNO zeigte sich in der Bildgebung eine Kugel von ca. 2 mm Durchmesser, welche rechts durch den Thyroidknorpel in die innere Kehlkopfmuskulatur penetriert war und lateral des Aryknorpels zum Liegen kam. Die präoperative laryngoskopische Untersuchung zeigte eine regelgerechte Beweglichkeit der Stimmlippen. Auf Grund der Fraktur des Thyroidknorpels und der schweren Erreichbarkeit der Kugel von endolaryngeal entschlossen wir uns zu einem transcervicalen Zugang. In der Operation konnte die Kugel durch Kippung des Schildknorpels nach links zur Darstellung der Larynxrückseite und unter Röntgendurchleuchtung aus dem M. cricoarytaenoideus lateralis geborgen werden. In den postoperativen Nachuntersuchungen zeigte sich ein Hämatom des rechten Hemilarynx und eine deutliche Minderbeweglichkeit der rechten Stimmlippe. Nach drei Wochen war vermutlich auf Grund des Vernarbungsprozesses keine Beweglichkeit der rechten Stimmlippe mehr nachweisbar. Es zeigte sich ein persistierender Spalt bei der Phonation über die gesamte Stimmlippe. Auch die akustischen Tests zeigten im Göttinger Heiserkeitsdiagramm eine Verschlechterung der Stimme hinsichtlich des Noise Errors, des Jitters und des Shimmers. Auf Grund der starken dysphonischen Einschränkungen des Patienten wird als weitere Therapie eine Medialisationsthyroplastik oder eine Augmentation nach einem geeigneten Zeitabstand in Erwägung gezogen