Extracranial Facial Nerve Schwannoma-Histological Surprise or Therapeutic Planning?

Effects of Intradermal Therapy (Mesotherapy) on Bilateral Cervicobrachial Pain

BACKGROUND

Mesotherapy is a procedure or a process of injecting drugs into the skin. This technique can help decrease the total drug dose due to its drug-sparing effect on the systemic route and can be utilized to treat nonspecific neck pain that occurs in the lateral and posterior neck.

METHODS

Ten patients with bilateral cervicobrachial pain were recruited and evaluated at T0 before treatments, T1 at the end of the treatment (42 days after T0), and T2 (72 days after T0). Assessments consisted of performing the Visual Analogue Scale (VAS) to evaluate pain evolution; a range of movement (ROM) and Bilateral trapezius' tone, elasticity, and dynamic stiffness mensuration were performed using MyotonPro®. All patients underwent mesotherapy treatment in the trapezius muscles with 1 cc of Diclofenac Sodium and 1 cc of lidocaine diluted in 3 cc of saline for a total of 6 weeks.

RESULTS

VAS value statistically decreased at T1 and T2; ROM of neck flexion statistically increased at T1 and T2, and miometric tone and stiffness value statistically improved at T1 and T2.

CONCLUSION

mesotherapy with Diclofenac Sodium reduced pain intensity and improved functional outcomes, with no significant adverse effects in patients with myofascial pain syndrome of cervicobrachial localization.

Late-Onset Type 1 Diabetes Mellitus and Unexplained Subcutaneous Lesions

Nodular fasciitis is considered a reactive lesion of connective tissue originating from the proliferation of fibroblasts and myofibroblasts. Nodular fasciitis preponderantly localizes within the higher extremities, trunk, head, and neck. We are presenting a report on the case of a 38-year-old Navy pilot who developed nodular lesions in the area of the sternum and upper back and was diagnosed concomitantly with insulin-dependent diabetes mellitus (type 1 diabetes). The patient was treated for diabetic ketoacidosis using intensive insulin therapy protocol, and the nodules were surgically excised. He was discharged from the hospital four weeks later. In our presentation, we intend to highlight the essential characteristics of this rare lesion through a review of the literature and to identify an attainable link between the development of type 1 diabetes and nodular fasciitis.

Lateral Spread Response: Unveiling the Smoking Gun for Cured Hemifacial Spasm

Hemifacial spasm (HFS) is a rare disorder characterized by involuntary facial muscle contractions. The primary cause is mechanical compression of the facial nerve by nearby structures. Lateral spread response (LSR) is an abnormal muscle response observed during electromyogram (EMG) testing and is associated with HFS. Intraoperative monitoring of LSR is crucial during surgery to confirm successful decompression. Proper anesthesia and electrode positioning are important for accurate LSR monitoring. Stimulation parameters should be carefully adjusted to avoid artifacts. The disappearance of LSR during surgery is associated with short-term outcomes, but its persistence does not necessarily indicate poor long-term outcomes. LSR monitoring has both positive and negative prognostic value, and its predictive ability varies across studies. Early disappearance of LSR can occur before decompression and may indicate better clinical outcomes. Further research is needed to fully understand the implications of LSR monitoring in HFS surgery.