This document discusses the anatomy and classification of peripheral nerve injuries. It begins by describing the cellular components of nerves, types of nerve fibers, and classifications of nerve injuries including Seddon's and Sunderland's. It then discusses signs and symptoms of nerve injuries, common sites of injury, Wallerian degeneration, nerve regeneration, and various surgical and non-surgical treatment options including neurolysis, nerve grafting, and nerve repair. Classification of injuries is based on damage to nerve components and ability for spontaneous recovery. Surgical treatment depends on the degree and severity of injury.
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
Facial pain is pain felt in any part of the face, including the mouth and eyes.
It’s normally due to an injury or a headache, occasionally facial pain may also be due to neurological or vascular causes, but equally well may be dental in origin.
BELL'S PALSY IS AN IDIOPATHIC LMN TYPE FACIAL PALSY..THE SEMINAR TELLS YOU OF COURSE OF NERVE..FACIAL MUSCLES THEIR ACTION..HOW TO EXAMINE..THE SEQUELAE OF FACIAL PALSY...LOOK AT IT..
Facial pain is pain felt in any part of the face, including the mouth and eyes.
It’s normally due to an injury or a headache, occasionally facial pain may also be due to neurological or vascular causes, but equally well may be dental in origin.
BELL'S PALSY IS AN IDIOPATHIC LMN TYPE FACIAL PALSY..THE SEMINAR TELLS YOU OF COURSE OF NERVE..FACIAL MUSCLES THEIR ACTION..HOW TO EXAMINE..THE SEQUELAE OF FACIAL PALSY...LOOK AT IT..
Peripheral nerve injuries-ASSESSMENT AND TENDON TRANSFERS IN RADIAL NERVE PALSYsuchitra_gmc
A presentation to understand peripheral nerve injuries assessment, evaluation and management. Includes principles of tendon transfer and techniques of tendon transfer for radial nerve palsy. Also, post operative rehabilitation is included.
Axons of the peripheral nervous system have the potential for regeneration, after they are severed.
Axons of the peripheral nervous system have the potential for regeneration, after they are severed.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
4. Cranial - Motor, sensory, mixed
Spinal nerves – sympathetic , parasympathetic
Myelinated , non myeliniated
Nerve fibres:
A - alpha – largest fibre, fastest conduction, fine
touch , position
A-beta – proprioception
A – delta – sharp pain , fast
C fibres – slow pain
5. Classification of nerve injury is based on
the damage sustained by the nerve
components,
nerve functionality, and
the ability for spontaneous recovery
10. Degree of nerve
injury
Spontaneour
recovery
Rate of recovery Surgery
First neuropraxia Full Days to 3 months none
Second
axonotmesis
full Regenerates at the
rate of
1mm/month
none
third partial Regenerates at the
rate of
1mm/month
None/
neurolysis
fourth none Following surgery
at the rate of
1mm/month
Nerve repair,graft
or transfer
Fifth
neurotmesis
none Following surgery
at the rate of
1mm/month
Nerve repair,graft
or transfer
Sixth –mixed
injury
Recovery &type of surgery vary depends on combination
of degrees of injury
11. Paralysis- loss of motor function
Paresis – incomplete loss of motor function
Anesthesia – loss of all sensation
Hyperesthesia – excessive sensation
Hypoesthesia – diminished sensation
Hyperalgia- excessive sensitivity to painful stimuli
Hypoalgesia – lowered pain sensitivity
12. IAN - injured in case of mandibular fractures and
ORIF, tooth extraction, injection, orthognathic
surgeries,minor surgical procedures.
Lingual nerve – most commonly in third molar
extraction,
13. Mental N- fracture of mandible, genioplasty,
minor surgical procedures, abnormal pressure
from denture
Infra orbital N – fracture of infra orbital rim
ASA/ PSA - osteotomy of maxilla, apicoectomy
Facial N- penetrating injury, parotid surgeries,
TMJ surgeries
Auriculo temporal N- TMJ surgeries
14. Segmental demyelination: it is the selective
dissolution of the myelin sheath segment &
is characterized by slowing of conduction
velocity as nerve impulses travel along the
de
associated with minor neuropraxia injury of
axons.
15. It is a process that results when a nerve fibre is cut
or crushed, in which the part of the axon separated
from the neuron's cell body degenerates distal to
the injury. This is also known
as anterograde or orthograde degeneration
16. Some times wallerian degeneration begins in the
most peripheral tissue and progress centrally from
that point – common in trigeminal system caused by
metabolic intoxication like metal poisoning, isoniazid
and penicillin therapy
17. If the tissue deinnervated for a long period of time
, certain clinical changes may take place, which are
called as neurotophic effect.
Skeletal muscles – early spontaneous muscle
spasm, flaccid paralysis,with progressive atrophy
and lack of muscle definition and tone.
Skin & mucosa –cold, dry and inelastic,
susceptibility to injury, poor healing, irregular
keratinization, scaly , cracked skin.
18. Classic physical and occupational therapy:
Like lubrication, protection of surface tissue from
trauma, manual stimulation of glandular tissue,
warming and temperature control, electric
stimulation of intact motor neuron
19. Starts at the coaptation site .
In ideal suituation after injury,
clearance of debris
(by macropages & schwann cells)
spourtings from proximal axon
growth cones by cell elongation
20.
21. secreation of neurotropic factors 7 folds
in 14 days
NGF,BDNF,GDNF
(schwann cells in distal basal lamina)
attraction of GC towards neurotropic
gradient
guided by formation of fibroblast & collagen
matrix
Migration of schwann cell formation
of band of bungner
22.
23. interaction of axon with CAM
Functional reconnection with target at basal
lamina
The thin nerve fibres will then gradually
thickened to their original diameter,and the
investing schwann cell form the myelin
sheath.
24. Provocation test of regeneration of nerve
sprouts. Light palpation over suspected area
of injury, produce distal referred tingling
sensation at the target site. – indicate small
nerve fibre recovery. But poorly correlate
with functional recovery, may confused wit
neuroma formation
25. The growing axonal sprouts may be
inhibited by the scar tissue / foreign
bodies which act as a barrier. When this
happen the growth cone proliferate as
aimless tumour along with the fibrous
tissue to form a tumour called neuroma.
27. Neuroma incontinuity:
neuroma along the nerve line – may produce
artificial synapses
Leads to abnormal chain reaction to original
stimuli. This may be a common explaination
for trigeminal neuralgia,& post traumatic
casualgia.
29. Anaesthesia dolorosa -it is a constant
boring penetrating or grinding pain in the
distribution of numbness .
30. Triggered tick like neuralgiform pain:
some case with in first week after nerve injury, pt
may experience stabbing , flashing pain
secondary to mechanical irritation/ inflammation
in the still intact nerve trunk.
Peripheral microneurosurgery is effective in pt
with neuromas, pharmacological therapy are
most appropriate in cases of central
neuropathology
31. means burning sensation
pain begins at least 2 weeks after penetrating
missile inury in mixed peripheral nerves, region
due to the artificial synapse of demyelinated
somatic sensory nerve segment with
unmyelinated efferent sympathetic fibre
32. sense of awareness of missing body part
after amputation is called phantom
phenomenon.
Paroxysomal stabbing , itching deep
burning of missing part appx 10 mins of
duration. Triggered by tactile sensation
36. Local anaesthesia - EMLA
Analgesics-The use of analgesics can help patients control
pain
Anticonvulsants –now a days carbamazepine is the drug of
choice 200- 800 mg/ day
Corticosteroids – reduce the inflammation
Narcotic analgesia
Muscle relaxant
Tranquilizers – benzodiazepienes used in chronic pain
Antidepressents
40. Neurolysis is performed on intra-neural and
extra-neural scar tissue to release
regenerating nerve fibres in the hope of
improving functional recovery
External
Internal
41. It is the process of nerve
decompression.
Microdissection of nerve
involves liberation of nerve
from the surrounding scar
tissue , fixation of fracture
segment
Done under magnification 4X
& 8X
turnover epineural sheath tube in primary repair of
peripheral nerves. Ann Plast Surg. 2002 Apr;48(4):392-400
Yavuzer R1esAyhan S (Latifoğlu Ox8Atabay K
42. Indicated in case of incomplete return of normal
sensory function of previously injured nerve. Under
magnification,12x/ 16x epineurium dissected
longitudinally to release the adhesion around or
within the fascicles
44. Goals of Primary nerve repair < 1 wk
Proper coaptation
Vascularity
Free of tension
45. Failure to perform primary repair
Late Repair > 1 wk
Crush injury
46. Glial scars
Astrocytes form a barrier preventing further
growth by forming gap junctions
Tension in the rejoined nerve
47. Anastomosis of proximal and distal nerve
ending
Epineurial
Fascicular
Perineuial
48.
49. adequate exposure
Proper anesthesia
Magnification with loupes 8x- 10 x
The nerve ends are then sharply transected
perpendicular to the long axis.
Minimum of two epineural sutures with 8-0/
9-0 nylon 180° to each other.
Careful alignment is the critical factor in this
first step
50.
51. Perineurial repair involves the individual
fascicles and placing sutures through the
perineurium, the protective sheath
surrounding fascicles
Drawback:
Trauma to nerve
Fibrosis
Tissue reaction
53. Single site of suturing
Better coaptation & vascularity
Less chance of mismatch & collateral axonal
micro sprouting outside epineurium.
54. Reconstruction after peripheral nerve injury
may require management of segmental
defects or "gaps" in the injured nerve
A nerve graft will be about 10 % longer than
the gap between the nerves, and the cross-
section of the nerve end will be a quite larger
than the diameter of the nerve graft to allow
for growth
57. Donor Nerve
Sural nerve
2.1mm
Greater auricular
N
1.5 mm
Greater auricular
cable
3mm
Inferior alveolar
nerve 2.4 mm
88% 63% 125%
Lingual nerve
3.2mm
66% 47% 94%
58. .Tension of the suture line and inadequate
preparation of the nerve stumps are the 2 leading
causes of regenerative failure across the suture site,
resulting in poor recovery of nerve function.
The nerve graft act as a distal nerve stump, so it ll
undergo wallerian degeneration, to provide a conduit
for axon regeneration, schwann cell regeneration is
critical for this
59. Need for adequate revacularisation – initially occurs
through diffusion from tissue bed reaches
supranormal in 4-5 days.
Grafr size – in case of increased graft size , central
necrosis occurs due to increased volume of tissue
beyond perfusion
Sensory loss, scarring and neuroma formation can
cause morbidity to the donor site of the patient the
nerve is harvested from
60. Primary repair
Interpositional grafting
Cross facial nerve repair
Cross over graft or split graft
61. The use of allograft nerve material is
particularly appealing because of its available
quantity and lack of donor site morbidity.
Need for prolonged immunosuppression
required to maintain Schwann cell viability
limits clinical implementation of this method.
62. Various materials are used as conduits,
Autogeneous materials – muscles , fascia, veins
collagen
Alloplastic material –polyglycolic acid,
Polyester,PTFE , scilicone
Used in case if the gap is
0.5mm- 3mm
63. Type of injury
Time of surgery.
Patient age,
level of injury,
mechanism of injury,
and associated medical conditions all
influence outcome.
66. Postoperative management after nerve repair
or reconstruction is aimed toward wound
healing, and re-establishing longitudinal
excursion of the nerve
Repairs are immobilized for approximately 3
weeks by splinting.
Nerve Repair and Grafting in the Upper Extremity
S. Houston Payne, Jr., MD
J South Orthop Assoc. 2001;10(2)
67. Sensory re-education is designed to help the
patient recognize new input in a useful manner
Sensory re-education is carried out in three
stages:
desensitization, early-phase discrimination
localization, late-phase discrimination
tactile gnosis
68. Transcutaneous nerve stimulations (TNS) –
cutaneous bipolar surface electrodes are
placed in painful regions of body &low
voltage electric current is administered.
Best results will obtained if intense of
stimulation is maintained for 1 hour daily >
3 weeks
69. Coaptation of nerve tissue without suture is
appealing and would potentially eliminate the
trauma associated with traditional suturing
technique. (1) more efficient,
(2) eliminate variables of tension due to
suture placement and technique,
(3) improve alignment of fascicles
70. The two techniques that have been most
carefully evaluated are coaptation by fibrin
glue and by laser gallium-alluminium
arsenide at 820 nm wavelength
72. Frozen nerve repair
Metabolic manipulations using pulsating electric fields –
include growth factors to influence neurite growth
Vascularized nerves can be useful to repair nerves longer
than 8 cm and grafts placed in poor vascular beds that are
heavily scarred
Microsurgery 989;10(3):220-5.
Sciatic nerve regeneration in the rat. Validity of walking track assessment in
the presence of chronic contractures.
Dellon AL1, Mackinnon SE
73. Immediate primary repair in sharp injuries
with suspected transsection of nerve
because delay leads not only to retraction
but also to severe scaring
Bluntly transsected nerve best repaired after
a delay of several weeks.
74. A focally injured nerve should be explored if no
functional return within 8-10 weeks
Decision - making as to whether neurolysis or
resection & repair in a lesion in gross continuity
based on intraoperative electrophysiological
evaluation
Split repair with usually graft – lesion in continuity
,partial function or undergoing partial regeneration
75. Careful patient selection for operation
Nerve anastomosis failure
① inadequate resection of scarred nerve
ends
② nerve suture distration
A good end result requiring rehabilitation from
onset of treatment.
Prevention of disuse, relief of pain, predicting
probable end results of operative procedures
76. References:
Peterson’s principle of oral &maxillofacial surgery 2nd edt
Text book of Oral and maxilla facial surgery – Gustav kruger 6th edt
Nerve injury and repair – sussan E mackinnon, Washington university school of
medicine
Peripheral nerve injuries anr repair – Adam osbourn – review of surgeries
turnover epineural sheath tube in primary repair of peripheral nerves. Ann Plast
Surg. 2002 Apr;48(4):392-400
Nerve Repair and Grafting in the Upper Extremity S. Houston Payne, Jr., MD J
South Orthop Assoc. 2001;10(2)
Static and dynamic repairs of fascial nerve injury -Hillary White, Eben Rosenthal-
oral & maxillofacial surgery clinics of north America 25(2013) 303- 312
Lingual nerve repair to graft or not? Michael millaro DMD et al YJOMS