Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Scien...Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we per-formed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduc-tion function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regener-ated potentials ifrst appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ‘ex-cellent’ and ‘good’ muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The func-tional recovery of a transplanted nerve can be dynamically observed after the surgery.展开更多
Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materi...Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materials and Methods: A 41-year-old man underwent subtotal glossectomy and retained the unilateral posterior mylohyoid and unilateral stylohyoid muscles. The structure of the flap was evaluated postoperatively. To assess swallowing function, video fluorography was performed before surgery, 1 month after surgery and 1 year after surgery. Testing involved 1) ability to hold 10 mL of liquid in the oral cavity, 2) epiglottis turnover, 3) the presence of aspiration, 4) hyoid bone movement, and 5) maximum width of the esophageal entrance. Results: The flap was protuberant postoperatively. The patient was able to hold the test diet in the oral cavity before and after surgery. Epiglottis turnover was good before surgery but insufficient after surgery. Aspiration during swallowing was not observed before or after surgery. At rest, the hyoid bone sagged postoperatively, in comparison with preoperatively. Hyoid bone movement and width of the esophageal entrance decreased after surgery;however, they demonstrated gradual recovery. Conclusions: For good postoperative swallowing function after subtotal glossectomy, it is necessary to perform reconstruction with protuberant flap and to retain the suprahyoid muscles as much as possible.展开更多
BACKGROUND Isolated musculocutaneous nerve injury is a rare condition.Herein,we report the first case of bilateral musculocutaneous neuropathy after vigorous stretching of both upper extremities with normal results of...BACKGROUND Isolated musculocutaneous nerve injury is a rare condition.Herein,we report the first case of bilateral musculocutaneous neuropathy after vigorous stretching of both upper extremities with normal results of sensory nerve action potential.Clinicians should be aware of this rare condition that can appear bilaterally.In addition,the interpretation of the aberrant electrodiagnostic study results of this case was discussed.CASE SUMMARY A 29-year-old male complaining of bilateral forearm tingling and upper extremity weakness visited the outpatient clinic.The symptoms began 6 mo prior,and he visited another hospital before visiting our department.The diagnosis was not made even after cervical spine magnetic resonance imaging,electrodiagnostic study,brain magnetic resonance imaging,and arteriography were conducted.The patient performed unique exercises that stretched the pectoralis minor and coracobrachialis muscles.On the follow-up electrodiagnostic study,abnormal spontaneous activities in the bilateral biceps and brachialis muscles were observed.The patient was diagnosed with bilateral musculocutaneous neuropathy.Steroid pulse therapy was administered for approximately 6 wk.After treatment,his muscle strength returned to the predisease condition.CONCLUSION Clinicians should be aware of this condition,have adequate understanding of anatomy,and advise to correct inappropriate exercises.展开更多
基金funded by the National High Technology Research and Development Program of China(863 Program),No.2008AA022400a grant from Science&Technology Department of Sichuan Province of China,No.2009JY0174
文摘Phrenic nerve transfer is a major dynamic treatment used to repair brachial plexus root avulsion. We analyzed 72 relevant articles on phrenic nerve transfer to repair injured brachial plexus that were indexed by Science Citation Index. The keywords searched were brachial plexus injury, phrenic nerve, repair, surgery, protection, nerve transfer, and nerve graft. In addition, we per-formed neurophysiological analysis of the preoperative condition and prognosis of 10 patients undergoing ipsilateral phrenic nerve transfer to the musculocutaneous nerve in our hospital from 2008 to 201 3 and observed the electromyograms of the biceps brachii and motor conduc-tion function of the musculocutaneous nerve. Clinically, approximately 28% of patients had brachial plexus injury combined with phrenic nerve injury, and injured phrenic nerve cannot be used as a nerve graft. After phrenic nerve transfer to the musculocutaneous nerve, the regener-ated potentials ifrst appeared at 3 months. Recovery of motor unit action potential occurred 6 months later and became more apparent at 12 months. The percent of patients recovering ‘ex-cellent’ and ‘good’ muscle strength in the biceps brachii was 80% after 18 months. At 12 months after surgery, motor nerve conduction potential appeared in the musculocutaneous nerve in seven cases. These data suggest that preoperative evaluation of phrenic nerve function may help identify the most appropriate nerve graft in patients with an injured brachial plexus. The func-tional recovery of a transplanted nerve can be dynamically observed after the surgery.
文摘Purpose: Swallowing function was in a patient with tongue cancer that was evaluated with video fluorography before and after subtotal glossectomy and reconstruction with a rectus abdominis muscuocutaneous flap. Materials and Methods: A 41-year-old man underwent subtotal glossectomy and retained the unilateral posterior mylohyoid and unilateral stylohyoid muscles. The structure of the flap was evaluated postoperatively. To assess swallowing function, video fluorography was performed before surgery, 1 month after surgery and 1 year after surgery. Testing involved 1) ability to hold 10 mL of liquid in the oral cavity, 2) epiglottis turnover, 3) the presence of aspiration, 4) hyoid bone movement, and 5) maximum width of the esophageal entrance. Results: The flap was protuberant postoperatively. The patient was able to hold the test diet in the oral cavity before and after surgery. Epiglottis turnover was good before surgery but insufficient after surgery. Aspiration during swallowing was not observed before or after surgery. At rest, the hyoid bone sagged postoperatively, in comparison with preoperatively. Hyoid bone movement and width of the esophageal entrance decreased after surgery;however, they demonstrated gradual recovery. Conclusions: For good postoperative swallowing function after subtotal glossectomy, it is necessary to perform reconstruction with protuberant flap and to retain the suprahyoid muscles as much as possible.
基金Supported by The Data Construction Learning Program for artificial intelligence(20200803-FS4T,Sector 20 Medical and Health AI Data)funded by the National Information Society Agency,Ministry of Science and ICT.
文摘BACKGROUND Isolated musculocutaneous nerve injury is a rare condition.Herein,we report the first case of bilateral musculocutaneous neuropathy after vigorous stretching of both upper extremities with normal results of sensory nerve action potential.Clinicians should be aware of this rare condition that can appear bilaterally.In addition,the interpretation of the aberrant electrodiagnostic study results of this case was discussed.CASE SUMMARY A 29-year-old male complaining of bilateral forearm tingling and upper extremity weakness visited the outpatient clinic.The symptoms began 6 mo prior,and he visited another hospital before visiting our department.The diagnosis was not made even after cervical spine magnetic resonance imaging,electrodiagnostic study,brain magnetic resonance imaging,and arteriography were conducted.The patient performed unique exercises that stretched the pectoralis minor and coracobrachialis muscles.On the follow-up electrodiagnostic study,abnormal spontaneous activities in the bilateral biceps and brachialis muscles were observed.The patient was diagnosed with bilateral musculocutaneous neuropathy.Steroid pulse therapy was administered for approximately 6 wk.After treatment,his muscle strength returned to the predisease condition.CONCLUSION Clinicians should be aware of this condition,have adequate understanding of anatomy,and advise to correct inappropriate exercises.
