Agnieszka Wiertel-Krawczuk

Saphenous vein stripping surgical technique and frequency of saphenous nerve injury

Objectives Saphenous nerve injury is the most common complication after surgical treatment of varicose veins. The aim of this study was to establish its frequency at great saphenous vein long stripping when four methods of surgery were applied. Methods Eighty patients were divided into four groups depending on different stripping methods. Sensory transmission in saphenous nerve and sensory perception of shank were examined before surgery and two weeks, three and six months afterwards with clinical neurophysiology methods. Results In 36% of patients, surgeries caused the injury of saphenous nerve mainly by proximal stripping without invagination (65%, group I). Transmission disturbances ceased completely after three months in patients undergoing distal stripping with invagination (group IV), while in group I they persisted for six months in 35%. Group IV patients were the least injured and group I the most. Conclusion Neurophysiological findings may suggest that distal stripping with vein invagination gives the best saphenous nerve sparing.

Pre- and postoperative evaluation of patients with lumbosacral disc herniation by neurophysiological and clinical assessment.

Study Design. The application of complex neurophysiological examination including motor evoked potentials (MEP) for pre- and postoperative evaluation of patients experiencing acute sciatica. Objective. The assessment of sensitivity and specificity of needle electromyography, MEP, and H-reflex examinations. The comparative analysis of preoperative and postoperative neurophysiological examination. Summary of Background Data. In spite of the fact that complex neurophysiological diagnostic tools seem to be important for interpretation of incompatible results of neuroimaging and clinical examination, especially in the patients qualified for surgical treatment, their application has never been completely analyzed and documented. Methods. Pre- and postoperative electromyography, electroneurography, F-waves, H-reflex, and MEP examination were performed in 23 patients with confirmed disc-root conflict at lumbosacral spine. Clinical evaluation included examination of sensory perception for L5–S1 dermatomes, muscles strength with Lovetts scale, deep tendon reflexes, pain intensity with visual analogue scale, and straight leg raising test. Results. Sensitivity of electromyography at rest and MEP examination for evaluation of L5–S1 roots injury was 22% to 63% and 31% to 56% whereas specificity was 71% to 83% and 57% to 86%, respectively. H-reflex sensitivity and specificity for evaluation of S1 root injury were 56% and 67%, respectively. A significant improvement of root latency parameter in postoperative MEP studies as compared with preoperative was recorded for L5 (P = 0.039) and S1 roots levels (P = 0.05). Conclusion. The analysis of the results from neurophysiological tests together with neuroimaging and clinical examination allow for a precise preoperative indication of the lumbosacral roots injury and accurate postoperative evaluation of patients experiencing sciatica. Level of Evidence: 3

Relations between the results of complex clinical and neurophysiological examinations in patients with temporomandibular disorders symptoms

Abstract Objective: Reinvestigation of clinical importance of surface electromyography recordings (sEMG) from the masticatory, neck and shoulder girdle muscles in patients with various clinically detected temporomandibular disorders (TMDs). Methods: Fifty women with myalgia diagnosis of Axis I DC/TMD and the same number of healthy female volunteers were studied clinically and neurophysiologically by means of sEMG. Results: Unilateral more than bilateral complex symptoms of TMDs were related to the non-neurogenic masticatory rather than neck and shoulder girdle muscles dysfunctions at rest. A strong negative correlation between masticatory muscles activity at rest and during maximal contraction was found (rs = −0.778), mainly in the masseter muscle. Conclusion: sEMG is a suitable tool for prosthodontists because it provides objective results on the stomatognathic system muscles function. Pain and other temporomandibular symptoms detected mostly unilaterally significantly increase muscle tension of the masticatory muscles and diminish muscle motor units recruitment during maximal contraction. Effects may spread to the neck and shoulder girdle muscles.

Standard neurophysiological studies and motor evoked potentials in evaluation of traumatic brachial plexus injuries – A brief review of the literature

PURPOSE Traumatic damage to the brachial plexus is associated with temporary or permanent motor and sensory dysfunction of the upper extremity. It may lead to the severe disability of the patient, often excluded from the daily life activity. The pathomechanism of brachial plexus injury usually results from damage detected in structures taking origin in the rupture, stretching or cervical roots avulsion from the spinal cord. Often the complexity of traumatic brachial plexus injury requires a multidisciplinary diagnostic process including clinical evaluation supplemented with clinical neurophysiology methods assessing the functional state of its structures. Their presentation is the primary goal of this paper. METHODS The basis for the diagnosis of brachial plexus function is a clinical examination and neurophysiology studies: electroneurography (ENG), needle electromyography (EMG), somatosensory evoked potentials (SEPs) and motor evoked potentials (MEPs) assessing the function of individual brachial plexus elements. CONCLUSIONS The ENG and EMG studies clarify the level of brachial plexus damage, its type and severity, mainly using the Seddon clinical classification. In contrast to F-wave studies, the use of the MEPs in the evaluation of traumatic brachial plexus injury provides valuable information about the function of its proximal part. MEPs study may be an additional diagnostic in confirming the location and extent of the lesion, considering the pathomechanism of the damage. Clinical neurophysiology studies are the basis for determining the appropriate therapeutic program, including choice of conservative or reconstructive surgery which results are verified in prospective studies.

Śródoperacyjne monitorowanie czynności nerwu twarzowego w chirurgii ślinianki przyusznejIntraoperative facial nerve monitoring for parotid gland surgery

INTRODUCTION The route of the facial nerve in its extracranial part determines the technique of parotid gland surgery. Permanent facial nerve paralysis after parotidectomy is not rare. It is the most devastating complication for the patient and surgeon. Facial nerve monitoring by observing or palpating the face during the surgery is a long-standing practice. Using an EMG device is a standard procedure at present. AIM OF THE STUDY Evaluation of the effectiveness of intraoperative facial nerve monitoring for parotid gland surgery. MATERIAL AND METHODS Fifty three patients operated on due to parotid gland tumour in the Head and Neck Surgery and Laryngological Oncology Department of the Greater Poland Cancer Center in 2007-2008. All patients had been provided with EMG and ENG examinations of the facial nerve before the surgery and continuous facial nerve monitoring during the operation. Facial nerve function after surgery was assessed according to the House-Brackmann grading system. RESULTS Six (12%) patients presented facial nerve dysfunction after surgery. Three (6%) patients had temporary paralysis grade III H-B with complete recovery in 6 weeks. Three (6%) patients with deep lobe tumour had grade V H-B with complete recovery in one patient after 3 months, and two (4%) patients had grade III H-B after one year since the surgery. CONCLUSIONS Intraoperative facial nerve monitoring should be a standard procedure during parotid gland surgery in most clinical situations.Summary Introduction The route of the facial nerve in its extracranial part determines the technique of parotid gland surgery. Permanent facial nerve paralysis after parotidectomy is not rare. It is the most devastating complication for the patient and surgeon. Facial nerve monitoring by observing or palpating the face during the surgery is a long-standing practice. Using an EMG device is a standard procedure at present. Aim of the study Evaluation of the effectiveness of intraoperative facial nerve monitoring for parotid gland surgery. Material and methods Fifty three patients operated on due to parotid gland tumour in the Head and Neck Surgery and Laryngological Oncology Department of the Greater Poland Cancer Center in 2007–2008. All patients had been provided with EMG and ENG examinations of the facial nerve before the surgery and continuous facial nerve monitoring during the operation. Facial nerve function after surgery was assessed according to the House-Brackmann grading system. Results Six (12%) patients presented facial nerve dysfunction after surgery. Three (6%) patients had temporary paralysis grade III H-B with complete recovery in 6 weeks. Three (6%) patients with deep lobe tumour had grade V H-B with complete recovery in one patient after 3 months, and two (4%) patients had grade III H-B after one year since the surgery. Conclusions Intraoperative facial nerve monitoring should be a standard procedure during parotid gland surgery in most clinical situations.

Śródoperacyjne monitorowanie czynności nerwu twarzowego w chirurgii ślinianki przyusznej

INTRODUCTION The route of the facial nerve in its extracranial part determines the technique of parotid gland surgery. Permanent facial nerve paralysis after parotidectomy is not rare. It is the most devastating complication for the patient and surgeon. Facial nerve monitoring by observing or palpating the face during the surgery is a long-standing practice. Using an EMG device is a standard procedure at present. AIM OF THE STUDY Evaluation of the effectiveness of intraoperative facial nerve monitoring for parotid gland surgery. MATERIAL AND METHODS Fifty three patients operated on due to parotid gland tumour in the Head and Neck Surgery and Laryngological Oncology Department of the Greater Poland Cancer Center in 2007-2008. All patients had been provided with EMG and ENG examinations of the facial nerve before the surgery and continuous facial nerve monitoring during the operation. Facial nerve function after surgery was assessed according to the House-Brackmann grading system. RESULTS Six (12%) patients presented facial nerve dysfunction after surgery. Three (6%) patients had temporary paralysis grade III H-B with complete recovery in 6 weeks. Three (6%) patients with deep lobe tumour had grade V H-B with complete recovery in one patient after 3 months, and two (4%) patients had grade III H-B after one year since the surgery. CONCLUSIONS Intraoperative facial nerve monitoring should be a standard procedure during parotid gland surgery in most clinical situations.Summary Introduction The route of the facial nerve in its extracranial part determines the technique of parotid gland surgery. Permanent facial nerve paralysis after parotidectomy is not rare. It is the most devastating complication for the patient and surgeon. Facial nerve monitoring by observing or palpating the face during the surgery is a long-standing practice. Using an EMG device is a standard procedure at present. Aim of the study Evaluation of the effectiveness of intraoperative facial nerve monitoring for parotid gland surgery. Material and methods Fifty three patients operated on due to parotid gland tumour in the Head and Neck Surgery and Laryngological Oncology Department of the Greater Poland Cancer Center in 2007–2008. All patients had been provided with EMG and ENG examinations of the facial nerve before the surgery and continuous facial nerve monitoring during the operation. Facial nerve function after surgery was assessed according to the House-Brackmann grading system. Results Six (12%) patients presented facial nerve dysfunction after surgery. Three (6%) patients had temporary paralysis grade III H-B with complete recovery in 6 weeks. Three (6%) patients with deep lobe tumour had grade V H-B with complete recovery in one patient after 3 months, and two (4%) patients had grade III H-B after one year since the surgery. Conclusions Intraoperative facial nerve monitoring should be a standard procedure during parotid gland surgery in most clinical situations.