PubMed · 3921901
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J W House, D E Brackmann. 1985. Facial nerve grading system.. https://doi.org/10.1177/019459988509300202
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A 53-year-old male patient had been suffering from severe aural symptoms (pulsatile right-sided tinnitus and paroxysmal dizziness attacks with nausea) and right hemifacial spasm. Treatment had involved stellate ganglion block with lignocaine and the injection of intravenous sodium bicarbonate solution for attacks of Menière's syndrome and facial nerve block with lidocaine for hemi-facial spasm. Despite these treatments, the dizzy attacks became more frequent, developing into the clustering state. Air CT cisternography and vertebral angiography demonstrated an enlarged and curved vertebral artery. Vascular cross-compression of the VIIth and VIIIth cranial nerves was therefore suspected. Microvascular decompression was performed. After operation, the pulsatile tinnitus, dizziness and hemifacial spasm disappeared. From the present case and a review of the literature, we conclude that vascular cross-compression of the VIIIth cranial nerve should be an indication for microvascular decompression only when symptoms of vascular cross-compression of the VIIth cranial nerve are also seen.
Although magnetic resonance (MR) imaging routinely is used to evaluate the facial nerve, the conventional axial, coronal, and sagittal planes are not optimal for demonstrating the tympanic and mastoid portions of the nerve. A vertical oblique plane for MR imaging of these portions of the facial nerve was evaluated. With this plane, the course of the nerve was effectively demonstrated on MR images and corresponding cryosections. The oblique plane can be used to supplant or supplement conventional planes in imaging of the facial nerve.
Forty-six consecutive video-recorded translabyrinthine operations at Gentofte Hospital, for tumors of 5 to 25 mm, were investigated for possible damage to the facial nerve from cauterization, suction, stretching, pushing, and other instrumental trauma at the following regions: fundus, internal meatus, porus, cerebellopontine angle, and brain stem. House-Brackmann grading of the postoperative facial nerve function was determined from the patient records for the 1st, 3rd, and 10th days and 3 months and 6 months postoperatively, as well as the final status. Suction on the nerve seems to be the most important factor for perioperative facial nerve damage. The most common site of damage was the porus region. This investigation shows thermic drilling lesions to be very relevant. There was no correlation between the degree and character of damage and the postoperative facial nerve function. In eight patients we cannot explain the postoperative facial palsy.