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PubMed1994

Effect of neuromuscular blockade on facial nerve monitoring.

Direct facial nerve stimulation and monitoring during cerebellopontine angle (CPA) tumor surgery are critical for identification and preservation of function. Electrically evoked facial nerve monitoring was compared with ulnar train-of-four monitoring under progressive neuromuscular blockade. Using a rabbit model, the facial nerve function of six controls was compared to that of six specimens with acute or chronic injuries. Eight of 18 patients who had undergone CPA tumor resection during one year were also studied. Regression analysis correlated between ulnar nerve monitoring and facial electromyographic (EMG) peak voltage in all groups. Facial EMG was measurable, even with 75 percent receptor blockade. The results of this study support the hypothesis that high degrees of neuromuscular blockade do not preclude satisfactory EMG monitoring of the facial nerve during CPA tumor surgery. This study did demonstrate that chronically injured facial nerves may show greater sensitivity to the effects of neuromuscular blockade. Lower levels or avoidance of neuromuscular blockade should be employed under these circumstances.

Animals↗
PubMed1986

Total facial nerve decompression in recurrent facial paralysis and the Melkersson-Rosenthal syndrome: a preliminary report.

Recurrent facial paralysis is an infrequent problem for the otolaryngologist. This paralysis may be associated with the Melkersson-Rosenthal syndrome, a triad of recurrent facial paralysis, relapsing facial edema, and associated fissured tongue. Most patients do not have the accompanying stigmata of this syndrome. This paralysis may occur unilaterally or bilaterally. The usual sequelae of recurrent facial paralysis are progressive synkinesis and increasing residual paresis with each episode, and total facial paralysis may be the final outcome. Two patients, one with unilateral Melkersson-Rosenthal syndrome and the other with a bilateral recurrent idiopathic facial paralysis, were treated with combined transmastoid and middle cranial fossa total facial nerve exposure, decompression, and slitting of the fibrous nerve sheath. Postoperatively they have not suffered from facial paralysis during a follow-up period of three years. It appears that this surgical management safely and effectively prevents recurrent facial paralysis unilaterally or bilaterally, whether or not it is associated with the Melkersson-Rosenthal syndrome. Until further experience with this particular management of recurrent facial paralysis is reported, however, caution should be used in recommending it. Additionally, it should not be assumed from this experience that surgical treatment for idiopathic facial paralysis in Bell's palsy is necessarily implied.

Adolescent↗
PubMed1993

A quantitative study of nerve fibers in the human facial nerve.

The facial and intermediate nerves were quantitatively evaluated in seven patients who died from systemic malignancies not involving the facial nerve. In addition, five of the specimens were also qualitatively evaluated by measuring the total and axon diameters of the facial and intermediate nerve fibers. In two cases the facial nerve fibers were counted at five different levels. The total number of myelinated nerve fibers in the facial nerve varied from 7500 to 9370. The total number of myelinated nerve fibers in the intermediate nerve varied between 3120 and 5360. The peak diameter of the facial nerve axon was between 4 and 6 microns, and was between 2 and 3 microns in the intermediate nerve. When comparing nerve segments at different anatomical levels, the largest amount of nerve fibers was found at the level of the middle mastoid portion. However, this number did not reach the amount of nerve fibers counted in the internal acoustic meatus.

Adult↗
PubMed1990

Analysis of axonal regeneration through the silicone regeneration chamber: a retrograde tracing study in the rabbit facial nerve.

Transected facial nerve buccal branches in the adult rabbit were sutured to a silicone growth chamber and regeneration was observed at 3, 5, and 7 weeks postoperation. Using the retrograde axonal transport of horseradish peroxidase technique the soma in the facial motor nucleus were counted and the number was correlated with the number of axons found in the mid-cross section of the regenerating buccal branch and with the number of axons in the original nerve. The somatotopic reorganization in the facial motor nucleus was examined. The mean number of facial motoneuron soma labeled with HRP in the control was 68.0% (+/- 18.6, SE) of the axons counted at periphery. In the regenerating nerves, the labeled soma represented 2.4% of the preoperative controls after 3 weeks and rose to 8.6 and 43.9% at 5 and 7 weeks, respectively. At 3 weeks postoperative time, four of six regenerating nerves did not contain any myelinated axons at the center cross section. The ratios of labeled soma to the regenerating myelinated axons counted at the center cross section at 5- and 7-week time points were 42.2 and 61.1%, respectively. The location of the soma found in the early regeneration phase was similar to the normal distribution except in the dorsal subnucleus. After 7 weeks the proportion of labeled soma in the intermediate subnucleus declined but the general pattern replicated the distribution found in normal control preparations.

Animals↗
PubMed1986

The intrinsic vasculature of the cat facial nerve.

Treatment of facial nerve disorders is based in part on assumptions regarding the intrinsic blood supply of the nerve. This study was designed to comprehensively delineate the intrinsic facial nerve microcirculation and its relation to the extrinsic circulation in an animal model. Twenty-eight cat facial nerves were removed intact from brain stem to stylomastoid foramen following intravital fixation. Specimens were studied by gross dissection, silicone injection and tissue clearing, complete vessel counts on serial cross sections of individual nerves, and scanning electron microscopy or transmission electron microscopy. The labyrinthine segment of the cat facial nerve contains strikingly fewer intrinsic blood vessels than the mastoid and tympanic segments. The geniculate ganglion, however, has a distinct, rich vascular plexus. The ultrastructure of the intrinsic facial nerve vessels is similar to other small vessels of the body with tight junctions of the endothelium and overlapping spiral smooth muscle fibers of arterioles, as well as surrounding pericytes.

Animals↗
PubMed1985

Selective facial neurectomy for spastic disorders of the facial nerve.

Selective facial neurectomy in combination with bilateral musculocutaneous resection, plication brow lift, upper lid blepharoplasty, and limited rhytidectomy was performed on 18 patients with essential blepharospasm, eight with hemifacial spasm, and two with CNS vascular compression malformations. Microscopy showed the nerve tissues to be normal. Initial results were excellent. At 3 months there was a slight, persistent spastic twitching of the affected muscles in five nerves (a 14% failure rate in correcting blepharospasm). After 13 months there were four additional failures resulting from nerve regrowth in three and from one patient not completing therapy. The overall blepharospasm failure rate was 26%. On repeat neurectomy those with nerve regrowth presented with a diffuse, fine meshwork of nerve fibers reinnervating the mimetic facial musculature. In six of seven patients operated on again, spasticity was eliminated. The initial surgical failure rate has been corrected by resecting the frontal branch and the superior division of the buccal branch of the facial nerve. Only repeat neurectomy can correct long-term failures resulting from facial nerve regrowth.

Aged↗
PubMed1990

The anatomy of the facial nerve.

The facial (seventh cranial) nerve arises from the pontomedullary junction by two roots: (1) the motor root conveying fibers to muscles derived from second branchial arch mesoderm and (2) the nervus intermedius conveying visceral sensory fibers from the tongue and palate, and preganglionic parasympathetic fibers to the pterygopalatine and submandibular ganglia. The roots pass into the internal acoustic meatus where they join. At the lateral end of the meatus, the facial nerve passes into the facial canal. The nerve then turns sharply posteriorly at the geniculum. The geniculate (sensory) ganglion is situated here, and the greater petrosal nerve to the pterygopalatine ganglion arises from this region. The facial canal continues posteriorly on the medial wall of the tympanic cavity, passing above the fenestra vestibuli and arching downward and laterally to emerge at the stylomastoid foramen just after giving off the chorda tympani nerve. The posterior auricular nerve and the nerves to the stylohoid and posterior digastric muscles arise before the facial nerve enters the substance of the parotid gland. In the gland, the nerve divides into five groups of branches (temporal, zygomatic, buccal, mandibular, and cervical) that supply the muscles of facial expression.

Facial Nerve↗
PubMed2004

[Effects of aminoguanidine on the expression of NOS in facial nerve and surrounding tissues of traumatic facial paralysis rats].

OBJECTIVE: To study the effects of inducible NOS inhibitor aminoguanidine on the expression of NOS in facial nerve and surrounding tissue of traumatic facial paralysis rats. METHODS: A small dose of aminoguanidine were intraperitoneally injected into rats before and after facial paralysis. The facial nerve and surrounding tissues were cut at different time point. Immunohistochemical ABC method was used to study the changes of NOS expression in facial nerve and surrounding tissues. RESULTS: The inducible NOS immunoreactivity was obvious inhibited in the facial nerve and surrounding tissues in aminoguanidine group. CONCLUSION: Aminoguanidine chronic treatment can obvious inhibit the inducible NOS expression in the facial nerve and surrounding tissues. Aminoguanidine can improve the regeneration of facial nerve and the recovery of traumatic tissues.

Animals↗
PubMed1991

The porcine model for intratemporal facial nerve trauma studies.

Facial nerve anatomy was compared in the rat, rabbit, cat, and pig in an effort to develop a model for facial nerve trauma within the temporal bone. The porcine model was found to have the most suitable anatomy. Landmarks for the nerve were excellent. The pig had a definite facial nerve mastoid segment that was vertical, as in the human, and long enough to allow for performance of sequential procedures on the nerve. It was also large enough for grafting and electrical testing. A detailed description of the advantages of the pig model and the anatomy of the surgical approach to the facial nerve in the porcine model is presented.

Animals↗
PubMed2000

Facial nerve repair accomplished by the interposition of a collagen nerve guide.

OBJECT: Facial nerve paralysis due to a surgical procedure or trauma is a frequently observed complication. The authors evaluated facial nerve repair achieved by the interposition of a collagen nerve guide. METHODS: Ten cats were divided into three groups. Group 1 consisted of six animals in which a 5-mm facial nerve segment on one side was resected and replaced by a collagen tube that was sutured to bridge both nerve stumps. On the opposite side a 5-mm segment of facial nerve was resected, reversed 180 degrees, and sutured to the stumps as an autograft nerve. Group 2 consisted of two cats in which the collagen nerve guide was interposed on one side and the nerve on the other side was left intact. Group 3 consisted of two cats in which a reversed autograft nerve was placed on one side and the nerve on the other side was left intact. Histological, electrophysiological, and horseradish peroxidase labeling examinations were performed starting 3 weeks after surgery. Light and electron microscopic examinations of collagen tube-implanted specimens revealed a well-vascularized regenerated nerve. The electrophysiological study confirmed the recovery of electrical activity in regenerated axons. Horseradish peroxidase labeling also confirmed restoration of the whole facial nerve tract. CONCLUSIONS: The collagen nerve guide shows great promise as a nerve conduit.

Animals↗
PubMed2005

Diagnostic relevance of transcranial magnetic and electric stimulation of the facial nerve in the management of facial palsy.

OBJECTIVE: Earlier investigations have suggested that isolated conduction block of the facial nerve to transcranial magnetic stimulation early in the disorder represents a very sensitive and potentially specific finding in Bell's palsy differentiating the disease from other etiologies. METHODS: Stimulation of the facial nerve was performed electrically at the stylomastoid foramen and magnetically at the labyrinthine segment of the Fallopian channel within 3 days from symptom onset in 65 patients with Bell's palsy, five patients with Zoster oticus, one patient with neuroborreliosis and one patient with nuclear facial nerve palsy due to multiple sclerosis. RESULTS: Absence or decreased amplitudes of muscle responses to early transcranial magnetic stimulation was not specific for Bell's palsy, but also evident in all cases of Zoster oticus and in the case of neuroborreliosis. Amplitudes of electrically evoked muscle responses were more markedly reduced in Zoster oticus as compared to Bell's palsy, most likely due to a more severe degree of axonal degeneration. The degree of amplitude reduction of the muscle response to electrical stimulation reliably correlated with the severity of facial palsy. CONCLUSIONS: Transcranial magnetic stimulation in the early diagnosis of Bell's palsy is less specific than previously thought. While not specific with respect to the etiology of facial palsy, transcranial magnetic stimulation seems capable of localizing the site of lesion within the Fallopian channel. SIGNIFICANCE: Combined with transcranial magnetic stimulation, early electrical stimulation of the facial nerve at the stylomastoid foramen may help to establish correct diagnosis and prognosis.

Adult↗
PubMed1996

Patterns of facial nerve synkinesis.

Facial nerve synkinesis is an extremely distressing sequela of facial paralysis, and its prevention and treatment are less than adequate. Improved therapeutic interventions await better understanding of its pathogenesis. In this study, 11 patients with synkinesis and 11 normal control subjects were quantitatively assessed using a new computer-assisted, motion-sensitive system. Two additional, informative cases presenting at the completion of the study are also briefly reported. The observed synkinetic patterns appear predictable and nonrandom. In addition, these observations tend to raise doubts that the aberrant fiber regeneration hypothesis is the sole explanation of synkinesis. They further implicate facial nuclear hyperexcitability as an explanation in at least some cases of synkinesis. Understanding these patterns enhances clinical detection and evaluation and may lead to a better knowledge of the fundamental pathophysiology of synkinesis and its prevention.

Adult↗
PubMed1991

Detection of intraoperative laser injury to the facial nerve by electromyographic monitoring of facial muscles.

Injury to the facial nerve is a significant risk during resection of cerebellopontine angle tumors. To minimize the risk of facial nerve injury, intraoperative electromyographic monitoring of facial musculature is frequently used. However, the reliability of such monitoring systems for detection of thermal nerve injury resulting from the use of carbon dioxide lasers has not been systematically evaluated. We determined the sensitivity of a computerized electromyographic monitor for detection of laser facial nerve injury in an anesthetized rat model. The mandibular and buccal branches of the facial nerve were isolated in 12 rats. A carbon dioxide laser was used to create controlled sites of thermal injury to both nerves over a 3-hour period. When a laser injury was created distal to previous injury sites, electromyographic discharge was noted in 72% to 82% of injuries. Laser injury proximal to previous injury sites was detected with 33% efficiency. These detection rates did not change significantly over a 3-hour period. This preliminary data suggests that electromyographic monitoring of facial musculature allows detection of facial nerve injury caused by carbon dioxide lasers.

Animals↗
PubMed1994

Change in facial nerve innervation following hypoglossal-facial anastomosis. An animal study.

Hypoglossal-facial nerve anastomosis was carried out in 20 adult guinea pigs. Horseradish peroxidase (HRP) was applied to the buccal branch of the facial nerve at intervals of 2, 4 and 6 months after the anastomosis operation. HRP labeled neurons and the number of regenerated axons in the buccal branch were counted to determine postoperative nerve regeneration. The number of surviving neurons in the facial and hypoglossal nuclei was also counted to determine postoperative change of these nuclei. Following anastomosis, 97% of the hypoglossal neurons remained surviving, while the facial neurons underwent pronounced degeneration of 65% survival ratio at 2 months and 37% at 6 months after the anastomosis operation. In 80% of the animals, a new nerve bundle regenerated from the proximal stump of the facial nerve to the anastomotic trunk. A linear increase of HRP-labeled neurons in the facial and hypoglossal nuclei paralleled the increase of the axons in the buccal branch. The HRP-labeled neurons in the facial nucleus were demonstrated to have direct connection with the newly formed bundle and the facial mimetic muscles were dually innervated by both the hypoglossal and facial nerves. Although the present study design might not fully represent the clinical situation, possible advantages of hypoglossal-facial nerve anastomosis are discussed from the view of nerve regeneration.

Anastomosis, Surgical↗
PubMed1999

[Effect of decompression or transplantation of the facial nerve on serious advanced facial paralysis].

OBJECTIVE: To investigate operative effect on serious advanced facial paralysis. METHOD: 28 cases (28 sides) with serious facial paralysis underwent decompression or transplantation of facial nerve. RESULT: After following up 0.5-2 years postoperatively, the total, most or partial and no recovery were 14 cases (50%), 12 cases (42%) and 2 cases (7.1%) respectively. CONCLUSION: The operation performed as early as possible can be an effective procedure for correcting serious advanced facial paralysis if conservative treatment could be confirmed to be helpless.

Adolescent↗
PubMed2005

Müllerectomy for upper eyelid retraction and lagophthalmos due to facial nerve palsy.

BACKGROUND: Facial nerve palsy often results in symptoms of ocular irritation due to inadequate eyelid closure. Weakened protractor function results in relative upper eyelid retraction and contributes to lagophthalmos. OBJECTIVE: To evaluate the role of müllerectomy in the comprehensive surgical treatment of ocular exposure due to facial nerve palsy. METHODS: Thirty-four patients with chronic facial nerve palsy underwent unilateral transconjunctival removal of Müller muscle and were followed up for an average of 20 months postoperatively. Other procedures were performed to treat lower eyelid retraction, as required. Preoperative and postoperative ocular exposure symptoms, upper eyelid position, lagophthalmos, and keratopathy were compared. RESULTS: Of the 59 preoperative symptoms, 15 (25%) resolved and 39 (66%) improved. Upper eyelid position was lowered by an average of 1.35 mm (P<.001). Lagophthalmos (P = .002) and corneal exposure (P<.001) were significantly improved. Three patients required levator aponeurosis repair, 2 for preexisting dehiscence and 1 for inadvertent aponeurosis transection. CONCLUSION: Müllerectomy is a rapid, safe, and reproducible surgical method for lowering the upper eyelid and reducing ocular exposure symptoms and signs due to chronic facial nerve palsy.

Adolescent↗