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than on the right, although the mouth could be neurontin 300 mg pain made to close very satisfactorily. Electrical examination showed that the reaction was decidedly less on the left than on the right side, excepting for the orbicular mus- cles of the mouth. We thus had at the end of two months after operation a facial paresis instead of a paralysis, more particularly evident in the upper branches of the facial nerve. The reaction neurontin 300 mg for nerve pain of degener- ation was less marked than before the operation. The patient was again seen seven months later for the last time, when the condition of alTairs was found to be practically the same as at the last examination, al- though siK'cch was nearly perfect. neurontin price streets Tl)e principal question to decide is when surgical interference should be undertaken in cases of fa- neurontin price increase cial paralysis. Animal experiments show that re- generation always takes place if an anastomosis is done innnediately after section of the nerves. This applies to patients who have l)een neurontin 800mg operated ui>on very shortly after the commencement of the (•..|i\rlt!lit. in07. by A. II Ki.i III 526 CUMSTON: FACI.ll. PARALYSIS. paralysis, because the result in them has been far better than in those operated upon after the affection has been present for some time. We know, how- ever, that certain cases of facial paralysis, which are considered as incurable, neurontin 200 mg may, after a number of months or a year or more, completely disappear, and this fact is the embarrassing point in the ques- tion, because in a given case, one may always ques- generic neurontin 300mg tion whether or not the paralysis may disappear of itself without any interference. From this reason alone, and all writers appear to be in accord on this point, it may be admitted that operation should only he undertaken some months after the appearance of the atfection. ■ Such is the opinion of Taylor, Alex- ander, Munsch, and others, but, when one has the certitude that the causative factor of the generic neurontin gabapentin paralysis has resulted in a complete destruction of the facial nerve, operation should not be delayed... In generic neurontin available paralysis of peripheral origin, no matter what may be its cause, operation is neurontin mg justifiable if electrical treatment gives no results and when the paralysis has become definitely established. Surgical interference may also be resorted to in instances of facial paralysis a frigore when no improvement by a long continued electrical treatment can be obtained. I am not pre- pared to neurontin prices generic emit any opinion as to surgical treatment when facial paralysis has a central origin. The vari- ous nuclei of the motor nerves which arise in the bulb are very near together, and one is ignorant whether or not the lesion, which may be limited to the nucleus of one of these nerves will not increase as time goes on and whether or not the neighboring bulbar nuclei are not already or will not later on Ijecome involved. In this case the patient will be submitted to a neurontin price useless operation, and, consequently, when doubt e.xists, I believe it preferable to abstain. A more serious objection to operative interfer- ence is the occurrence of a supplementary paralysis in the territory' of the spinal or hypoglossus nerve, because, if the operation is unsuccessful, this result would certainly add to the inconveniences already present, but from what I have been able to ascer- tain, it would seem that end to end anastomosis is not an essential in the technique and that lateral im- plantation will give quite as good results without giving rise to the possible inconveniences mentioned Ijefore. It is certain that the associated movements occur- ring in the face neurontin price comparison and in the territory of the nerve chosen to fulfill the functions of the neurontin discounts facial are not particularly esthetic, but, neurontin discount card by education, some pa- tients may cause a dissociation neurontin price without insurance of these movements. In sudden movements caused by raising the shoul- der a simultaneous contraction of the face occurs at the same time, while in slow, slight movements, this may be avoided. By holding the arm on the side operated on this' subtei-fuge permits them to move the muscles of their face without any move- ment in the shoulder. .-\s to the question of edu- cation and how the bulbar and cortical centres will work, it may be said that it is unknown. The f|uestion now comes as to the method of su- ture which should be employed, whether, or not an end to end anastomosis neurontin 600 mg high Vv'ith the central end of the spinal or hypoglossus to the perii)heral end of tlie facial sliould be done or wljetlur lateral implanta- tion of the end of the facial into the generic neurontin manufacturers trunk of one generic neurontin solution of these nerves after longitudinal incision of its sheath lias been done, will now be discussed. It is quite

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