tag:blogger.com,1999:blog-8621317379873499702.post4444380009282764718..comments2024-01-14T03:48:36.601-05:00Comments on Fauquier ENT Blog: Lawsuit Alleges Transcranial Magnetic Stimulation Paralyzed Patient's FaceFauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.comBlogger2125tag:blogger.com,1999:blog-8621317379873499702.post-88340964441974803002013-09-10T06:26:30.097-04:002013-09-10T06:26:30.097-04:00Thanks for your great response and input pertainin...Thanks for your great response and input pertaining to surgical decompression. Not many communities have ENoG testing as you have stated... but also lack nearby otologic surgeon to perform nerve decompression since the vast majority of general ENT's would certainly not be comfortable performing this type of operation.Fauquier ENThttps://www.blogger.com/profile/18011731559130483399noreply@blogger.comtag:blogger.com,1999:blog-8621317379873499702.post-54624012742353980512013-09-09T11:46:49.704-04:002013-09-09T11:46:49.704-04:00In patients that have more than 90% degeneration o...In patients that have more than 90% degeneration on electroneurography (ENOG), decompression has been shown to improve outcomes. It has only been shown to improve outcomes if performed in the first two weeks from onset of facial paralysis. There are several problems.<br /><br />1. Most places do not routinely get ENOGs to determine the severity of the injury.<br />2. Patients often present outside of the two week window when the surgery would be beneficial<br />3. The surgery improves the chance of some facial nerve function return. If it is severe enough to decompress, it is a pretty severe trauma to the nerve and unlikely that patient will get full return of nerve function. It also will likely take several months before final outcome presents itself.<br />4. The number of cases of facial paralysis with an ENOG showing <br /><br />This occurred at the University of Iowa where Dr. Bruce Gantz is the chairman of Otolaryngology. He is the author of the study that demonstrated the benefit of facial nerve decompression in when there is greater than 90% degeneration on ENOG. It took him years to accrue enough patients to prove his theory which was published in 1999.<br /><br />Laryngoscope. 1999 Aug;109(8):1177-88. Surgical management of Bell's palsy. Gantz BJ, Rubinstein JT, Gidley P, Woodworth GG.<br /><br />I am sure that she had greater than 90% degeneration on ENOG because Dr. Gantz, or Dr. Hansen, the neurootologist at the University of Iowa, would not have operated unless that was the case. <br /><br />Outside of an academic center, I have found it difficult to find out where to send a patient for an ENOG, so often will send to a neurootologist who is capable of performing this test.<br /><br />I agree with your post about the steroids and the antivirals. No studies have shown benefit with antivirals. I routinely place patients on steroids if they present within the two week window from onset of complete paralysis. Usually treat patients with higher dose of steroids than ER's or PCP's are willing to start. Usually they need more than a medrol dosepack.<br /><br />One other point is that is often forgotten in cases of Bell's Palsy is that it is a diagnosis of exclusion. I would imagine that every otolaryngologist has seen those patients that were labeled as having Bells Palsy without any workup, only to find an invasive parotid tumor or other diagnosis that was causing the facial paralysis.Anonymousnoreply@blogger.com