Surgery for pleomorphic adenoma recurrence presents a significant risk of facial nerve damage that can result in facial weakness effecting patients’ ability to communicate, mental health and self-image. We report two case studies that had marked facial weakness after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation. Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Neither subjects demonstrated adverse effects of treatment. We conclude that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. Larger studies would be difficult to pursue due to the low incidence of cases.
Traumatic aortic regurgitation is a rare complication of blunt chest wall injury. Cardiovascular decompensation can occur rapidly as the heart struggles to maintain cardiac output. As the condition is often not apparent at the time of injury, these patients may be brought by ambulance to trauma units without cardiothoracic facilities under the care of general and orthopaedic surgeons. Here, we report a case of traumatic aortic regurgitation secondary to a high-speed motor vehicle accident and the management in a district general trauma unit leading to transfer to a cardiothoracic centre. The diagnosis of traumatic aortic regurgitation should be considered in patients who experience blunt chest wall injuries and demonstrate signs of cardiac decompensation.
Examination revealed a firm thickening of the distal end of the radius, most marked on the palmar aspect. There was slight restriction of all movements of the wrist. X-ray revealed a cystic lesion of the radius (Fig. 1)
A 73-year-old woman presented with a 6-hour history of sudden onset lower abdominal pain. Her comorbidities included chronic obstructive pulmonary disease and hypertension. She was under surveillance for a known thoracoabdominal aneurysm. On presentation, she was hypotensive with a systolic blood pressure of 50 mm Hg and a pulse of 60 beats per minute. On examination, she had a pulsatile mass with bruit in her right lower abdomen. Pedal pulses were palpable in both feet. Blood gas analysis revealed a metabolic acidosis with a pH of 7.21 and a lactate of 7.1. Haemoglobin remained stable between 90-100 g/dL. Her other routine blood tests were unremarkable, and blood cultures were negative. Imaging showed a ruptured right common iliac artery aneurysm into the right common iliac vein with secondary arteriovenous fistula communication. Surgical intervention was discussed with the patient but due to her frailty, it was deemed not in the patient's best interests.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.