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Vol. LXXXVI, No. 12. NEW YORK, SEPTEMBER 21, 1907. naprosyn 500 mg oral tablet Whole No. 1503. C^riainal Communirations. A CASE OF FACIAL PARALYSIS; With Remarks on the Surgical Treatment of this Affection. By Charles Greexe Cumston, M. D., Boston. Anastomosis of the peripheral end of the facial nerve with the spinal naprosyn generic naproxen or hypoglossus are two opera- naprosyn sr 1000 mg tive procedures which have been employed for the radical cure of facial paralysis. The facial nerve having been injured, either from an operative or nonoperative traumatism, or from a suppurative process of the middle ear, the interference of choice for its repair, if this were possible, would be a su- ture of the peripheral end of the ner\-e with its cen- tral end. But to find both ends of the facial ner\'e in its passage through the petrous bone and to bring the two ends together in the interior of this bone, must be considered as an operation materially im- possible. In man, as in the animal, an anastomosis between the facial and spinal ners'cs have given satisfactory results. Apparently always successful in dogs, when the nerves much does naprosyn cost operated on were not the ec-naprosyn generic seat of degeneration, in man. although less brilliant, the results have nevertheless been fair. naprosyn ec fort 500 mg Facial par- alvsis may consequently enter the domain of sur- gery. The perfect freedom from danger of the op- eration, its easy accomplishment, and the small dis- turbances that it may produce are all in favor of its undertaking in certain cases. Case. — J. M., a traveling salesman, years of age, was operated upon naprosyn 500 mg oblong yellow tablets for mastoid trouble in a western city the latter part of February, 1905. Four days following the operation all the phenomena of paralysis of tlic left facial nerve, this being the side on which the mastoid operation was performed, be- came manifest. After a few weeks, he having perfectly recovered from the operation, medical treatment was instituted for the paralysis and this, having where can i buy naprosyn hcen per- sisted in for three months without success, the patient, during a stay in Boston applied to me for advice as to the possibility of remedying the condition. Upon cnrcful naprosyn sr tablet 1000 mg examination the facial paralysis was found to he complete. The incision for the mastoid 0])cration was in perfect condition. Electrical examin- ation .showcfl an evident reaction of degeneration, al- though it was hoped that the ec-naprosyn price process had not gone l>c- vDiid the possibility of an improvement by a surgical interfiTi-nce, and, therefore, anastomosis hetwcen the facial and hypoglossus nerves was advised, for reasons to he given later. The operation was performed on May 13, 1005. the fi)l|i>wing technjciue being carried out. The patient's hc.-iil wns placed on a cushion with the face turned .'lu.iv from ec naprosyn rxlist the side of the o|icratiiin. .\n incision twelve centimetres long, was commenced at the base of the mastoid apophysis and carried down along the an- terior border of the can you get high off naprosyn 500mg sternomastoid muscle. The sub- cutaneous tissue, quite thick in this region, was then incised and the mastoid apophysis was denuded over its anterior aspect,- and, in order to give a freer opera- tive field, the sternomastoid muscle was dissected off at its insertion. The hypoglossus was then sought naprosyn gel costo for just above the great horn of the hyoid bone. Ligature was passed under it and it was then isolated by buy naprosyn tablets a careful dissection. I preferred searching for the nerve at the point named rather than to look for it at the upper part of the incision, because, when sought for at the transverse apophysis of the atlas, the spinal, hvpoglos- sus, pneumogastric, the internal carotid, and 'internal jugular are closely related to each other and, therefore, there is a little more risk at this point. After freely dissecting out the hypoglossus it was split and the fa'- cial nerve could then be implanted and the anastomosis readily accomplished. The sternomastoid was then stitched to its insertion, and the wound closed without drainage. Recovery from the operation was uneventful. The patient was seen two months after the operation, at which time the following notes were made. There was still some difficulty in his speech, but the marked par- alysis of the territory innervated by the hvpoglossus noted immediately after the operation had disappeared. When the face was in repose the folds of the skin of the forehead on naprosyn costochondritis the right side were marked, while on the left they would only be made evident when the pa- naproxen 500mg generic naprosyn tient frowned. The left eyebrow was slightlv higher than the right, while the palpabral opening was some- what larger on the left. The end of the nose appeared naprosyn ec 500 mg pl there generic naprosyn slightly deviated towards the healthv side. When the patient was asked to show his teeth, the nasolabial fold became evident, although less buy naprosyn 500mg so than on the right. The corner of the mouth was more marked on the left

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