Answers to Questions

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ANSWERS TO QUESTIONS ABOUT SELECTIVE DENERVATION

CARLOS A. ARCE. MD

DEPARTMENT OF NEUROSURGERY

UNIVERSITY OF FLORIDA HSC, JACKSONVILLE

What testing can be done before an appointment with Dr. Arce to help predetermine whether you are candidate in reference to a spinal problem?

The best test to find out if a patient with Torticollis has developed a fixed abnormal posture is an exam under anesthesia because under anesthesia a medication can be given to relax the muscles completely. If, while under anesthesia, the patient’s neck is stiff and fixed in an abnormal position, then a spine problem has developed. The exam under anesthesia is better performed by a surgeon with experience in treating patients with Torticollis and familiar with selective denervation. In order to have the best pre-operative evaluation and assessment regarding prognosis, the exam should be done by the surgeon who will be performing the surgery.

Can denervation surgery be performed on a person with a face lift without affecting the face life?

Yes, Denervation surgery should not affect a face lift.

If you have the denervation surgery first and then a face lift, will the face lift affect the denervation surgery?

No, it should not affect the denervation, however, it is important to explain to your plastic surgeon the type of surgery performed, and it would be preferable that the plastic surgeon contact the surgeon who performed the selective denervation, especially if they are planning to be using or being close to the incisions performed during the denervation.

In the second operation, is the scar tissue from the first operation ever a problem?

Yes, scar tissue makes it more difficult to find the nerves, and may decrease the success of a reoperation.

Is the correction of muscle control slowly acquired? Approximately how long with exercise?

If the denervation is successful, then the patient should be able to maintain a relatively normal position, however, immediately after the surgery the patient may still keep the head slightly turned, and this usually improves over the course of the following two or three months, and the same applies to the range of movement.

Any risk of affecting facial muscles as a result of denervation surgery?

No

Once the denervation surgery has been performed do the nerves ever grow back and will further surgery be required?

The nerves do not grow back, but there is a group of patients in whom there will be a recurrence of the Torticollis. This is most likely due to involvement of other muscles or an incomplete denervation. In some of these cases, further surgery could be performed to complete the denervation.

Are there books or videos with exercises for shoulder relaxation, as well as other exercises that you recommend?

I do not know of a particular video, however, I am hopeful that one will be developed in the future.

For a second surgery, will the other side of your head be numb?

Yes. In patients who need to have the denervation in two stages, ot=r in which there is a need to do denervation on both sides in the back of the head, there will be numbness in both sides of the head.

Can other oromandibular muscles besides the platysma be denervated?

Presently there are no denervation procedures for oromandibular dystonia.

Does the vertical incision provide a “cleaner” operation (less fluids, better visibility, etc.) than the “L” shaped incision?

It is important to note that there are two types od vertical incisions performed, one in the midline and one in the side. The one that I have developed and am performing is in the side. In my opinion, the visibility is better; however, the amount of dissection needed is probably the same. The most important aspect of the incision in the side is that it avoids detaching the trapezius from the midline and in that way decreases post-operative pain significantly.

What is the process to get an appointment?

The best way is to call the office. The phone number is 904-244-3950 and you can talk to my secretary or leave a message. It is very helpful if you can send a videotape showing the extent of your Torticollis and the range of movement. I will personally contact you to discuss your case and establish the date of your visit.

My mom and I wanted to thank you for hosting such a great symposium this year. This was our third year and we are looking forward to next years. E. Mathews