Chronic daily headache (CDH) located in the frontal region is a common problem. We have previously described the positive results that were achieved with botulinum toxin (BTX) injections in the musculus corrugator supercilii (MCS) for this disorder. Nowadays, we offer transection of this muscle to patients following a minimum of two BTX injections, provided these injections result in a significant reduction of pain. This procedure is based on the assumption that the pathophysiological mechanism in some of these patients suffering from CDH is a neural entrapment of the supratrochlear nerve in the corrugator muscle. To assess the effect of transection, we have evaluated all the consecutive patients (n = 10) so far. Treatment was successful in nine of these patients. Prior to the treatment, the mean pain score in the 9 successfully treated patients was 8.1 (range 6-9), after transection this had been reduced to 0.8 (range 0-3). All of these successfully treated patients ceased their daily use of pain relief medication for their frontally localised headaches. Moreover, they stated that they would definitely undergo surgery, if they were to find themselves in the same situation again. Therefore, we conclude that transection of the MCS is an efficient and successful procedure for a carefully selected group of patients suffering from CDH in the frontal region. Most of all we intend to popularise this pathophysiological concept based on the distinct possibility that some headaches might be due to neural entrapment.
The pectoralis major is reliable for reconstruction of large defects in the head and neck area. In 2001, we introduced a muscle-sparing technique with preservation of the clavicular part of the muscle. So far, we did not report on its reliability and clinical outcome at the receptor site.Fifty-four pedicled segmental pectoralis major island flaps were used in 53 patients, from 2001 through 2006. As outcome measures, we studied the overall rate of complications, the rate of major complications, and the final outcome at the receptor sites. We differentiated for the types of complications and assessed operation indication (primary vs. salvage procedure), site of reconstruction, previous radiotherapy, and completeness of tumor excision as possible risk factors for complications. We compared our findings to those of a meta-analysis of 16 other studies.Complications at the receptor site were observed after 21 of the 54 operations (0.39). Eleven of these cases (0.52) required repeated surgery that was successful in 8 cases (0.72). Conservative treatment was successful in 8 cases (0.80). Final outcome was successful in 49 of the 54 operations (0.91). Previous radiotherapy was a significant risk factor for persisting complications. Salvage procedures were a significant risk factor for developing clinical fistulas and the risk of partial flap loss was significantly correlated with nonhypopharyngeal reconstructions. Our results were comparable with those found in the meta-analysis.Our muscle-sparing technique proved to be reliable with clinical results comparable with conventional techniques in addition to function preservation at the donor site.
An intraparotid facial nerve schwannoma is often not recognised in pre-treatment work-up and frequently results in subsequent significant postoperative morbidity. We have evaluated the literature regarding pre-treatment work-up and facial nerve function outcome. Two of our own cases are presented. A minority of the intraparotid schwannomas can be removed by resection while preserving facial nerve integrity and function. In the event of preoperative facial nerve dysfunction, tumour resection and subsequent nerve repair should be considered. If resection of an intraparotid facial nerve schwannoma cannot be performed with preservation of facial nerve integrity and function, a wait-and-see policy seems justified due to the indolent behaviour of the tumour and moderate results of facial nerve reconstruction.
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