[Magnetic stimulation in patients with essential blepharospasm]

In 31 patients with an essential blepharospasm investigations were undertaken with transcranial cortical and cisternal magnetic stimulation of the facial nerve. Cortical stimulation was performed contralaterally, whereas cisternal stimulation was ipsilateral; the latencies and amplitudes of the potentials were determined. However, the extracranial part of the facial nerve was stimulated in the region of the stylomastoid foramen for neuromyography electrically. In most measurements the response potentials in the orbicularis oculi muscle and the levator labii muscle were determined. Cisternal stimulation yielded normal latencies, whereas cortical stimulation showed an increase of latency in some blepharospasm patients. A difference between the orbicularis oculi muscle and the levator labii muscle as known in patients with hemifacial spasm (20) could not be observed. The mean values of all latencies after cortical stimulation were normal. The method of transcranial magnetic stimulation is an important part of the complete investigation of patients with facial hyperkinesias as shown here in blepharospasm patients.

The effects of botulinum toxin on hemifacial spasm: an electrophysiologic investigation

Forty-one patients with unilateral or bilateral facial spasm were studied by electrophysiologic examination. All patients received local treatment with botulinum toxin. In the patients and controls, the measurements of the blink reflex revealed changes that (1) may indicate a central origin of the spasm in some cases, and (2) make it likely that the trigeminal nerve influences the facial nucleus and is thus involved in the regulation of the spasm.

[Squamous cell carcinoma in the area of the parotid gland. Metastasis or primary tumor?]

A total of 61 patients with a histological diagnosis of squamous cell carcinoma of the parotid gland were studied. The patients were classified into three categories. There were 34 patients with a metastasis to the parotid gland from a squamous cell carcinoma elsewhere within the head and neck who presented on average 2.1 years (range 3 months to 7 years) after diagnosis of the primary tumour; in one case a salivary gland tumor presented 32 years after irradiation of a squamous cell carcinoma of the temple. Six patients had histological evidence of a metastasis within the parotid gland, but no evidence of a primary tumour. Twenty-one patients presented with a primary epidermoid carcinoma of the parotid gland. Two patients showed a primary squamous cell carcinoma of the parotid arising in myoepithelial sialadenitis.

[Esophageal caustic injury in childhood. A critical elucidation with indication for esophagoscopy]

From 1983 through 1988, esophagoscopies were performed in 41 children because of suspected caustic esophageal injury. Of these 41 children, 11 had endoscopically significant esophageal burns and were treated with steroids and antibiotics. Of these 11 patients, two had no chemical burns of the facial skin, mouth, or pharyngeal mucosa. The authors therefore believe that esophagoscopy must not be omitted in cases of suspected caustic ingestion.

[Magnetic stimulation in patients with facial hemispasm]

A total of 28 patients with a hemifacial spasm were examined using transcranial magnetic stimulation. The potentials were evoked cortically and cisternally; latencies and amplitudes of each potential were measured in the levator labii muscle and in the orbicularis oculi muscle. After cortical stimulation, differences in latencies were found between the healthy and the diseased side of the levator labii muscle. Prolonged latencies were measured more frequently on the diseased side (cortical stimulation). The method of magnetic stimulation is an important addition to electrophysiological diagnostic procedures in facial hyperkinesias. Cortical stimulation combined with measurements of the blink reflex and neuromyography may allow separate parts of the route of the whole facial nerve and supranuclear structures to be examined.

[Relevance of combined electrodiagnosis in facial hyperkinesia]

We present a combined electrophysiological diagnostic procedure for patients with facial hyperkinesia. With the new method of magnetic stimulation a central cortical stimulation is possible to represent the total way of the facial nerve. The combination of magnetic stimulation with other methods such as the blink reflex may lead to topodiagnostic statements in facial hyperkinesias.

[Hydroxyethyl starch in the treatment of Bell's facial paralysis. A clinical study]

Nowadays an infusion therapy composed of cortisone, low-molecular dextran, and pentoxifylline is the most common treatment of Bell's palsy. During recent years it has become well known that low-molecular dextran has several severe side effects (e.g. acute renal failure). - At the ENT Department of the University of Göttingen 33 patients with Bell's palsy were treated with an infusion therapy which replaced low-molecular dextran by hydroxyethyl starch. Before and after therapy patients underwent a special diagnostic procedure for the facial nerve function consisting of --determination of the degree of paralysis and secondary defects (14) --a complete electrophysiological examination. The patients were followed up for at least 6 months. It was found that 97% of the patients had a complete functional recovery.

[FANDOS--a new standardized computer-assisted documentation and evaluation of diseases of the facial nerve]

The personal computer program package FANDOS (Facial Nerve Documentation System) has been designed especially for diseases of the facial nerve. It provides a very simple and exact method of documentation; it does not require much time and is easy to handle. In the ENT department of the University of Göttingen, this program has been tested in the clinical routine. In this paper we present the program package and explain its use in prospective studies.

[Essential blepharospasm and botulinum toxin. An electrophysiologic study]

Thirty-five patients with essential blepharospasm were investigated electrophysiologically after local treatment with subcutaneous periocular injections of botulinum toxin. In all patients the blink reflex was measured on both sides. The results showed in some cases reproducible changes in the reflexes, indicating a central supranuclear origin for the spasm. Furthermore, an influence of afferent information on the "spasm threshold" via the trigeminal nerve is suggested.

[The trigemino-facial reflex in patients with essential blepharospasm. A contribution to the etiology of the disease picture]

We conducted electrophysiological investigations in altogether 11 patients with an essential blepharospasm. In all patients the blink reflex - ipsi- and contralateral - was measured. We found reproducible pathologic changes (direct R1/R2 transition, contralateral early component with and without direct transition into the R2-component, increase of R2-duration). These findings point to a central genesis of blepharospasm in some cases.

[Manifestation of malignant lymphoma of the head and neck with special reference to the salivary glands]

We found that thirteen per cent of all head and neck malignomas are malignant lymphomas. In 75% of these cases the Non-Hodgkin type could be found. The major salivary glands were involved by the lymphoma in 55% out of 104 patients. Paraglandular lymph nodes of the parotid gland were affected as well as intraglandular lymph nodes and the lymphoid tissue within the gland proper. The submandibular gland normally shows an involvement only with its paraglandular lymph nodes. Two thirds of the Non-Hodgkin lymphomas located in the salivary glands were low-grade. In case of clinical suspicion of a malignant lymphoma, fine needle biopsy is required for cytological diagnosis. However, surgery is mandatory for histological diagnosis, not as a therapeutic measure.

[Long-term study of patients with severe forms of Sjögren syndrome and/or myoepithelial sialadenitis]

It is well known that the incidence of malignant lymphomas (non-Hodgkin type) is increased in patients with Sjögren's syndrome. The occurrence of malignant diseases was retrospectively studied in 62 patients. In the course of the disease two patients developed a non-Hodgkin lymphoma, one patient developed a transitional-cell carcinoma located in the nasopharynx and three patients developed a squamous-cell carcinoma located in the salivary glands. The large quantity of epithelial carcinomas seems to be remarkable, especially compared with the number of non-Hodgkin lymphomas. It might be possible that early surgical treatment of persistent or progressive swelling of the salivary glands helps to prevent the occurrence of malignant lymphoma in patients with known myoepithelial sialadenitis.

[The significance and limits of cytologic diagnosis in myoepithelial sialadenitis]

In case of myoepithelial sialadenitis cytological diagnosis by fine-needle aspiration biopsy is not a reliable measure, because the typical islets of myoepithelial cells can be demonstrated by cytology in only 6% of cases. Since lymphocytic infiltrations dominate the histological aspect a cytological specimen that contains these cell elements, may be taken as an indication for the presence of myoepithelial sialadenitis if a sicca syndrome exists at the same time. If a non-Hodgkin lymphoma has to be suspected after cytology, this must be followed by a histological verification (despite the fact that this suspicion was unfounded in all the cases mentioned here), because it is well known that in myoepithelial sialadenitis there is a danger of transformation into a malignant lymphoma. By detailed anamnestic data, especially by mentioning an existing sicca syndrome, the clinician can help the cytologist in assessing his findings properly.

[Therapy of facial paralysis in herpes zoster oticus with acyclovir]

In the present study patients suffering from facial nerve palsy caused by a herpes zoster oticus were treated with aciclovir. After therapy all patients could be controlled via clinical grading system and electromyographic observations. Aciclovir therapy did not yield any results superior to those obtained with other forms of therapy presented in the literature.

[Scintigraphic search for metastases in patients with neoplasms of the head and neck]

Pretherapeutic staging is essential for the management of head and neck cancer. The diagnostic value of liver, brain and bone scanning was estimated by a retrospective study of 281 patients. Bone and liver scans are useful for detecting distant metastases from head and neck cancer. Brain scanning should be replaced by computed tomography, if there is clinical suspicion of intracerebral metastases. Nowadays ultrasound examination of the liver is more useful than liver scans. Thus, bone scanning remains the only radioisotope method used in the routine pretherapeutic staging of head and neck cancer. Chest X-ray, abdominal ultrasound examination and bone scans are adequate methods for the detection of metastases. The management of malignant lymphoma needs a special and more detailed diagnostic approach.

Detection of pancreatic steatorrhea by oral pancreatic function tests

Pancreolauryl and NBT-PABA tests were performed in urine of 54 patients with exocrine pancreatic insufficiency and, additionally, in serum of 29 of these patients. All patients underwent a secretin-pancreozymin test and a 72-hr fecal fat analysis. Pancreatic steatorrhea occurred (with only three exceptions) when the pancreolauryl test revealed a T/C ratio [recovery of the fluorescein of the test (T) and the control (C) day] of less than 10, or when serum fluorescein concentrations were below 0.5 microgram/ml. The NBT-PABA test also showed a negative correlation between urinary PABA excretion or serum PABA concentration and fecal fat excretion, but there was no diagnostically useful cutoff limit indicating decompensation of exocrine pancreatic insufficiency. These findings indicate that the pancreolauryl test may facilitate clinical evaluation of patients with chronic pancreatitis by simultaneously assessing exocrine pancreatic insufficiency as a cause and predicting pancreatic steatorrhea as a sequel of maldigestion. In clinical practice, the pancreolauryl test can be used as a parameter for deciding whether to initiate pancreatic enzyme substitution if direct pancreatic function tests and fecal fat analysis are not available.

[Occlusion therapy in chronic recurrent parotitis? A report of clinical experiences with the use of a fibrin glue-gentamycin mixture]

Treatment of chronic recurrent parotitis was attempted in 12 patients by occlusion of Stensen's duct with a mixture of fibrin glue and gentamycin. This therapy failed to induce long-term improvement. It is recommended to undertake surgical intervention as soon as possible in all cases of progressive chronic recurrent parotitis.

Pancreolauryl and NBT-PABA tests. Are serum tests more practicable alternatives to urine tests in the diagnosis of exocrine pancreatic insufficiency?

Serum fluorescein and p-aminobenzoic acid were measured during a urine pancreolauryl and an N-benzoyl-l-tyrosyl-p-aminobenzoic acid (NBT-PABA) test in 22 healthy controls, 17 patients with gastrointestinal nonpancreatic diseases (normal secretin-pancreozymin test), and 31 patients with abnormal exocrine pancreatic function due to chronic pancreatitis. The optimal cutoff point for separating normal from abnormal pancreatic function was after 210 min in the pancreolauryl test and after 150 min in the NBT-PABA test. The latter test was slightly less sensitive and specific than the pancreolauryl test. Serum tests seem to offer a practicable alternative to the established indirect pancreatic function tests in urine and may be used in the elderly and severely ill, as well as in outpatients in whom correct collection of the urine may be difficult.