Fasiyal sinir ve orofarinks

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.90 ABSTRACT OBJECTIVE: The aim of this study was to investigate the role of facial nerve in the oropharyngeal phase of swallowing. MATERIALS AND METHODS: The study was prospectively designed and performed on patients with peripheric facial nerve palsy (FNP) (Bell's palsy), in acute (n=30), subacute and chronic (n=14) stages of the disease. A control group was formed with 20 healthy subjects of the same age and gender distribution with the study group. The patients were clinically evaluated and then standard electromyography of facial, median and ulnar nerve distributions was completed. A swallowing test was performed in both groups by a laryngeal sensor that was placed over the coniotomy area and the upward-downward movements of the larynx were recorded. The myographic activity of the submental muscle group was synchronously recorded by means of superficial electrodes. The records were obtained during swallowing of 3 ml_ of water through midline, right and left sides of the mouth. Then, dysphagia limit examination was done by giving water consequently increased to 3, 5, 10, 15 and 20 ml and test was completed with the same procedure of three-sided swallowing. The amount of water of which the patients began to swallow as piece meal pattern was accepted as the dysphagia limit. RESULTS: Seventy-nine percent of patients with FNP was found to have disturbances in oral phase of swallowing and experince difficulties in control of bolus. Dysphagia limit was abnormal on paretic side in 54% (16/30) of acute and 55% (24/44) of all FNP patients. The disturbance in dysphagia limit was not only observed on the affected side but also present on non-paretic side of FNP (%28)91 and on the midline (%41). In control examinations, it was observed that %88 of patients had normal dysphagia limit. The motor unit potentials in orbicularis oris muscle were diminished or lost in 57% of patients with disturbed dysphagia limit. The clinical examination revealed hypoesthesia or hypoalgesia in oral cavity, tongue and face or loss of taste on the same side of disturbed dysphagia limit. Dysphagia limit was found to be more affected in patients with loss of sensation of mouth than those with loss of taste. CONCLUSION: It may be stated that the facial nerve has a contribution to the oral phase of swallowing and the patients with FNP experience a subclinical disturbance of swallowing.72 ÖZET SONUÇLAR; 1) Akut ve kronik PFF ile başvuran olgularda %79 (35/44) oranında bolus kontrolünde güçlük, ağza alınan lokmaların kontrolünün tam sağlanamamsı şeklinde yakınmalar mevcuttur. 2) Akut ya da kronik PFF ile başvuran olgularda yutmanın oral döneminde bozukluk meydana gelmektedir. Akut grupta %54 (16/30) oranında, toplamda ise %55 (24/44) oranında paretik yandan elde edilen DL değerleri bozulma göstermektedir. 3) Bu yutma bozukluğu sadece paretik yandan ortaya çıkmamakta aynı zamanda ortadan yutma sırasında akutlarda %43 (13/30), toplamda % 41 (18/44) oranında, paretik olmayan taraftan yutma sırasında ise akutlarda %20 (5/25), toplamda % 28 (9/33) oarnında disfaji ortaya çıkmakladır. 4) Olguların longitudinal izlemi sırasında disfaji limitindeki bozulma II. kontrolde % 88 oranında düzelme göstermiştir (Şekil-43). 5) Hastalarda elde edilen disfaji limiti değerleri ile EMG dercelendirme sonuçları arasında korrelasyon saptanmamakla birlikte orb. oriste MÜP yitimi ile DLInde patolojik düşme oranı %57'dir. 6) Bu olguların önemli bir yüzdesinde en fazla ağız içi ve ipsilateral dil yarısında daha sonra da yüz yansında olmak üzere hipoestezi saptanmıştır. 30 akut olgunun %47(14/30)/sinde ağız içi ve dilde, %27 (8/30)'sinde yüz yansında, tüm olgularda %43 (19/44)'ünde ağız içi ve dil yansında, %25 (ll/44)'inde ise yüz yarısında duyu kusuru saptanmıştır. Akut hasta grubunda bu duyu kusuru tat duyum bozukluğu ile birlikte oldukça yüksek oranda görülmektedir, ağız içi ve dile duyu kusuru olan olguların %71'inde tat duyusu da bozulmuştur.73 7) Tat duyusu bozukluğu ve hipoestezi yakınması olan olgularda bu bulguların olmadığı olgulara göre paretik yandan DL daha belirgin bozulmuştur. Akut grupta tat duyusu bozuk olan ya da duyu kusuru bulunan 12 olguda DL bozuk bulunurken (%40), duyum bozukluğu olmayan olguların 7 tanesinde DL patolojik bulunmuştur (%23). Toplam olgularda düşünüldüğünde bu oranlar 17 olguya, 12 olgu olmaktadır (%39, %27). 8) 3 mi su yutma sırasında elde edilen A-C, A-0 ve 0-2 intervallerinin paretik yandan yutma sırasında ortadan yutma değerlerine göre uzadıkları, SM-EMG amplitüdünün paretik yanda ufaldığı, yutma jitterinin de yine paretik yanda arttığı dikkati çekmektedir, ancak istatistiksel olarak sadece amplitüd değerleri anlamlılık özelliği taşımaktadır (p=0.018 r=0.68). 9) Tüm bu bulgulara rağmen PFF ciddi klinik boyutlara varmayan kompanse edilen bazen klinik çoğu kez subklinik oral dönem yutma bozukluğu yaratmaktadı

Lumbar Spinal Stenosis and Intermittent Neurogenic Claudication

Lumbar spinal stenosis and intermittent neurogenic claudication is a disease that occurs frequently after the age of 55 and becomes complicated after the age of 65 in clinical, radiological and therapeutic aspects. In this review, acquired spinal stenosis secondary to degenerative osteoarthritis is evaluated. In this disease, lumbar and extremity pain and paresthesia are frequent; however, the most characteristic feature of the disease is the occurrence and worsening of these findings with erect posture and walking (intermittent neurogenic claudication). Even though the radiological findings of spinal stenosis are apparent, 1/4-1/5 of the patients may be asymptomatic. In order to support the clinical findings, neurophysiological tests have been used at rest and motion. Certain electrophysiological signs have been found to change after motion. The most helpful signs are the denervation of paravertebral and leg muscles, H-reflex abnormalities, and the findings obtained with the recently used radicular excitation methods. Electrophysiological methods have been found to be more compatible with the clinical findings. Lumbar surgical approach is considered in patients with impaired life quality and in those unresponsive to conservative treatmen

Adult-Onset Metachromatic Leukodystrophy: Two Cases

Metachromatic Leukodystrophy(MLD) is a lisosomal storage disorder which is characterized with arylsulphatase A deficiency. Enzyme deficiency results with demiyelination and storage of sulphatides in central nervous system.According to onset age;the disease has three major clinical forms as late infantile,juvenile and adult form. It is a rare disorder. For the patients who did not develop neurological findings bone marrow or hematopoietic stem cell transplantation may be effective as treatmen

Adult-Onset Metachromatic Leukodystrophy: Two Cases

Metachromatic Leukodystrophy(MLD) is a lisosomal storage disorder which is characterized with arylsulphatase A deficiency. Enzyme deficiency results with demiyelination and storage of sulphatides in central nervous system.According to onset age;the disease has three major clinical forms as late infantile,juvenile and adult form. It is a rare disorder. For the patients who did not develop neurological findings bone marrow or hematopoietic stem cell transplantation may be effective as treatment

THE FREQUENCY OF DEMENTIA AND MILD COGNITIVE DISORDER IN THE NURSİNG HOME POPULATION

INTRODUCTION: The frequency of dementia is increasing all over the world. The aim of this study is to determine the prevalence of dementia mild cognitive impairment in the target nursing home population. MATERIAL-METOD: The diagnosis of dementia was made clinically. Imaging and biochemical tests were requested for differential diagnosis. RESULTS: Of the 102 patients who participated in the study, 57 were males and 45 were females. The average age of the total group was 74,81 years, the average age of demented group was 77,96 years and the average age of non-demented group was 72,62 years. The prevalence of dementia was 22.5% and the prevalence of mild cognitive impairment was 25.5%. Dementia was detected in 17.5% of males and 28.9% of females. In the dementia group was 25% who did not attend school, primary school-secondary school was 22,6%, high school and college graduate was 18,8%. CONCLUSION: As the elderly population in Turkey has increased rapidly in recent years, an increase in the prevalence of dementia is expected. As in many other countries, this is a significant public health problem. Future epidemiological studies should aim to increase the quality of life of patients through diagnosis in the early stages and the necessary precautions should be taken

Normal pressure pseudotumor cerebri

Pseudotumor cerebri is a disorder of unknown etiology. An unknown condition characterized with increased intracranial pressure. The primary problem is chronically elevated intracranial pressure, and the most important neurological manifestations are papilledema, which may lead to progressive optic atrophy and blindness and diplopia. We present a patient who developed pseudotumor cerebri without increased intracranial pressure. To our knowledge, this is the second report describing pseudotumor cerebri in a case without increased intracranial pressur

Physiological changes in oropharyngeal swallowing with age:An electrophysiological study

It is important to distinguish the effects of normal aging on oropharyngeal swallowing from many disorders which may lead to dysphagia. The purpose of this study was to determine the neurophysiological alterations of normal aging on the oropharyngeal swallowing in normal subjects with different age groups. We studied three different age groups, a total of 110 healthy volunteers with an age range between 17 and 81 years by using electrophysiological methods. The EMG activity of submental / suprahyoid muscles (SM-EMG) and mechanical upward and downward laryngeal movements were recorded during dry and wet (3 ml water) swallowing. By this method, the total duration and the amplitude of SM-EMG, the time of upward displacement of the larynx, swallowing variability (jitter) and A-0 interval (an interval related to triggering of the swallowing reflex) were measured from subjects of the three different age groups. All parameters were influenced by advanced age. Several parameters, including total duration of SM-EMG, time necessary for triggering of the swallowing reflex and swallowing variability were significantly increased in the oldest age group compared with those in the younger age groups. It was also found that the delay in triggering the pharyngeal stage of swallowing is one of the important parameters that altered in the elderly. In this study, it has been demonstrated that some physiological changes occur in oropharyngeal swallowing with increasing age without any alteration in the basic pattern of deglutition.Normal yaşlanmanın orofaringiyal yutma üzerine olan etkilerini disfaji ile ilişkili olan bozukluklarından ayırt etmek önemlidir. Bu çalışmada farklı yaş gruplarından oluşan normal erişkin bireylerde orofaringiyal yutmanın yaşla birlikte ortaya çıkan nörofizyolojik değişikliklerini saptamak amaçlanmıştır. Bu çalışma yaşları 17-81 arasında değişen 3 farklı yaş grubundaki toplam 110 sağlıklı erişkinde elektrofizyolojik yöntemler kullanılarak yapılmıştır. Kuru ve 3 ml su yutma sırasında submental/suprahyoid kasların EMG aktivitesi (SM-EMG) yüzeyel elektrodlar aracılığıyla yazdrılımış ve larinks hareketleri bir piezo-elektrik sensor kullanılarak kayıtlanmıştır. Bu yöntem ile yutma sırasında SM-EMG total süre ve amplitüdü, larinksin yukarı pozisyonda kalış süresi, yutmanın değişkenliği (yutma jitteri) ve yutma refleksinin tetiklenme süresi (A-0 intervali) 3 farklı yaş grubunda ölçülerek karşılaştırılmıştır. Tüm bu parameterler yaş ile birlikte etkilenmektedir. SM-EMG amplitüdü dışında tüm parametrelerde yaş artışı ile uzama ortaya çıkmaktadır. SM-EMG total süresi, yutmanın tetiklenme süresi ve yutma jitteri genç grub ile karşılaştırıldğında yaşlı grupta anlamlı olarak artış göstermektedir. SM-EMG amplitüdü ise yaşlı grupta anlamlı olarak düşüktür. Yutmanın faringiyal refleks fazının tetiklenmesinde gecikme ve orofaringiyal fazın total süresinin uzaması yaşlı grupta değişen en önemli parametrelerdir. Sonuç olarak, bu çalışmada artan yaş ile birlikte orofaringiyal yutmada önemli fizyolojik değişiklikler ortaya çıkmasına karşın yutmanın temel paterninde bir değişiklik olmadığı saptanmıştır