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PubMed1994

Recovery of facial palsy after crossed facial nerve grafts.

Crossed facial nerve grafts for treating congenital or acquired permanent facial palsy were studied in 23 patients, ages ranging from 2 months to 38 years. Patients were divided into groups according to time after onset of paralysis. It is concluded that although crossed facial nerve grafts offered the possibility of reinnervation after facial palsy, the degree of recovery was critically dependent upon the time after onset of the facial palsy before the reinnervation procedure.

Adolescent↗
PubMed1991

[Electrophysiological study on pathophysiology of Bell's palsy--distribution of nerve conduction velocities (DNCV) in facial nerve with collision method].

The etiology of Bell's palsy is still obscure, but the hypothesis that hypoxia and compression of the nerve induced by edema in the Fallopian canal are the main causes of Bell's palsy is widely accepted. Tojima (1988) reported that the motor nerve conduction velocity (MCV) gradually decreased as degeneration of the nerve fibers progressed in Bell's palsy. The majority of facial nerve fibers are myelinated, and the greater the fiber diameter, the faster the conduction velocity. For this reason, Tojima suggested that Wallerian degeneration in Bell's palsy would begin from the thicker myelinated fibers. The measurement of MCV, however, reveals only the activities of the fastest velocity motor nerve fiber in the nerve trunk. This weak point can be resolved by measurement of the distribution of nerve conduction velocities (DNCV), which was introduced by Hopf in 1962 as the collision method. In the present report, the DNCV of facial nerve was measured using the collision method to estimate the distribution of the diameter of nerve fibers in normal subjects and patients with Bell's palsy and to elucidate the pathophysiology of Bell's palsy. The subjects were 14 normal adults (19 measurements) and 14 patients with Bell's palsy who visited our university clinic within 7 days to 18 days after onset, with no other complications such as diabetes. Results obtained are as follows. 1) The mean DNCV in 14 normal subjects (19 measurements) was unimodal, showing a peak at 20 to 22 m/s. 2) In DNCVs of patients with Bell's palsy, loss of thicker fibers with faster conduction velocity was recognized (11/14, 79%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[MRI enhancement of the facial nerve with Gd-DTPA--second report--investigation of enhanced nerve portions in patients with facial palsy].

We performed enhanced MRI using Gd-DTPA in 84 patients with facial palsy. After assessing enhancement of the normal facial nerve, we examined enhancement in patients with Bell's palsy and Ramsay Hunt syndrome. The following results were obtained. 1. In 95% of patients with Bell's palsy, enhancement was obtained in the distal IAC and labyrinthine portions. In 72%, enhancement was significant from the distal IAC portion through the vertical portion. In some of the patients who underwent enhanced MRI twice, increased signal intensity was observed in distal portions such as the vertical portion. 2. In many cases with Ramsay Hunt syndrome, enhancement was seen extensively in the IAC portion through the vertical portion. In the subjects with internal auditory symptoms such as vertigo and tinnitus, enhancement of the IAC portion was seen not only in the facial nerve but also in the vestibular and the cochlear nerves. These results suggest that the vascular permeability of lesions in Bell's palsy may be increased from the distal IAC portion to the vertical portion. Judging from the present findings with Ramsay Hunt syndrome, symptoms related to the enhanced portions suggest that accompanying internal auditory symptoms occur due to inflammation of the IAC portions of cochlear and vestibular nerves.

Adult↗
PubMed1977

Effect of radiation therapy on facial nerve cable autografts.

Facial nerve cable autografts were performed on 20 cats with 10 animals receiving 6,000 Rads of postoperative irradiation over six weeks. Testing by clinical appearance, pontograms, and axon counts showed no statistical difference in the operated only and the operated plus irradiated groups. Pontograms illustrated the clinical observance of spasticity, delay and weakness often seen after grafting. This animal work tends to verify the clinical impression that in patients requiring postoperative irradiation for a malignancy necessitating excision and grafting of the facial nerve, anticipated results should be equivalent to the facial nerve cable autografts without postoperative irradiation.

Animals↗
PubMed2006

Postoperative functional evaluation of different reanimation techniques for facial nerve repair.

BACKGROUND: The facial nerve function after facial-facial nerve anastomosis, grafting, hypoglossal-facial nerve anastomosis, hypoglossal-facial interpositional jump nerve anastomosis, or a combined approach was analyzed. METHODS: Facial function was assessed after operation using a 7-point visual analog scale (VAS) and by electromyography (EMG) in 53 patients. The final result was judged by May's facial nerve grading system. RESULTS: Voluntary EMG activity occurred on average 4.52 +/- 1.31 months after operation. Initial facial movements were visible after 5.41 +/- 1.80 months. Facial function related to the VAS finally reached 44% of normal value. The result was judged May's grade I in 13%, grade II in 34%, grade III in 28%, and grade IV in 25% of patients. A significant difference in outcome between different reconstruction types was not seen. Age over 60 years was related to worse outcome. CONCLUSIONS: A correct selection of the best method in the individual situation presumed, all analyzed facial reanimation techniques seem to lead nearly similar and satisfactory results.

Adolescent↗
PubMed2006

[Clinical analysis of facial nerve decompression on the treatment of facial paralysis].

OBJECTIVE: To study the occasion and curative effect of facial nerve decompression on the treatment of facial paralysis. METHOD: Facial nerve decompression was applied to 57 cases of severe facial paralysis from 1997 -2004 in our hospital. They were divided into two groups: A group received treatment within two months and B group after two months. Their curative effects were compared and the chi2 test between groups was applied. RESULT: The clinical curative ratio of group A was significantly higher than that of group B (P < 0.05). CONCLUSION: To treat facial paralysis, the application of facial nerve decompression at early stage can improve the clinical curative ratio significantly.

Adolescent↗
PubMed1998

Update on facial nerve repair.

Facial paralysis is a complex clinical problem, and optimal management strategies continue to evolve. Areas of active investigation include improvements in neural repair techniques, and the examination of new anastomotic materials and methods, as well as the development of alternative neural bridging materials. Current controversies in nerve grafting techniques, the use of novel neural conduit materials, timing of facial nerve procedures, and frontiers in experimental nerve grafting techniques are reviewed.

Accessory Nerve↗
PubMed1999

Surgical management of the facial nerve in craniofacial trauma and long-standing facial paralysis: cadaver study and clinical presentations.

BACKGROUND AND OBJECTIVES: Examination of the extratemporal branches of the facial nerve reveals several branching patterns of the facial nerve, indicating the variability in the course of the nerve. Due to such variance, injury to this nerve often accompanies facial trauma and surgical dissection for the repair of facial bone injuries, and it may result in high morbidity. METHODS AND MATERIALS: A study of 12 fresh cadavers was performed to 1) review the variability in location of the extratemporal branches of the facial nerve, 2) identify the soft tissue injuries in which the facial nerve is at risk, and 3) discuss surgical options for repair. The authors identified the zygomatic and buccal and the extratemporal branches of the facial nerve. Among the five extratemporal branches, there is a significant crossover between all, except the temporal and the mandibular branches. This indicates that dissection should proceed with great caution, since injury to the temporal and marginal mandibular branches is unlikely to resolve spontaneously. The management of injuries within one year and those of longer duration is discussed. RESULTS AND/OR CONCLUSIONS: Two of the 5 major branches of the extratemporal facial nerve have a high morbidity following injury. Repair should be performed within the first 72 hours. Graft, if required, should be placed in 9 to 12 months.

Adolescent↗
PubMed1990

Neuropathy of the facial nerve in chronic otitis media without associated facial paralysis. A human temporal bone study.

In the present study we examined whether pathologic changes can exist in the facial nerve in chronic otitis media (COM) when facial nerve function is clinically normal. In so doing, 20 human temporal bones were examined. Each case had a premortem history of COM without facial paralysis. Nine normal temporal bones were also studied. Signs of degenerative neuropathy involving the facial nerve were found in 2 out of the 20 cases studied. In the first of these 2 cases the tympanic segment of the facial nerve showed focal areas of demyelinization, as well as hypertrophy and proliferation of the Schwann cells but without loss of the axons. These areas were also occasionally associated with increased numbers of mast cells. In the second case the most striking finding was the presence of small dark globules in the mastoid segment of the facial nerve. These formations were assumed to be products of cellular and myelin degeneration. Our studies suggest that COM may be associated with degenerative changes in the facial nerve without clinical impairment of its function. Nonetheless these changes may have the potential for the development of facial paralysis during COM.

Aged↗
PubMed1989

Nerve fiber analysis of the facial nerve.

Nerve fiber analyses were conducted on the human facial nerve with use of a new staining method (Luxol-PAS-hematoxylin stain; discriminative staining method) that permits simultaneous observation of the axon and surrounding myelin sheath. The following combination of equipment was employed in the study: an image-analyzing digitizer, a microscope with a drawing tube, and a computer for storing the data and performing statistical analyses. The numbers, transverse areas, and circularity ratios of axons were measured in 11 cases. The average number of axons composing one facial nerve was 6,254, and the average size of the axons was 6.23 microns 2. The results indicated that although the numbers of axons became reduced with age, the transverse areas and circularity ratios of the axons did not change with age.

Adult↗
PubMed1986

Facial nerve dissection by use of acoustic (loudspeaker) facial EMG monitoring.

The development of the surgical microscope in 1953, and the subsequent development of microsurgical instrumentation, signaled the beginning of modern-day acoustic neuroma surgery. Preservation of facial nerve function and total tumor removal is the goal of all acoustic neuroma surgery. The refinement of the translabyrinthine removal of acoustic neuromas by Dr. William House significantly improved preservation of facial nerve function. This is made possible by the anatomic identification of the facial nerve at the lateral end of the internal auditory canal. When the surgery is accomplished from a suboccipital or retrosigmoid approach, the facial nerve may be identified at the brain stem or within the internal auditory canal. Identifying the facial nerve from the posterior approach is not as anatomically precise as from the lateral approach through the labyrinth. The use of a facial nerve stimulator can greatly facilitate identification of the facial nerve in these procedures.

Acoustics↗
PubMed2000

History of facial nerve surgery.

The history of facial nerve surgery can be viewed as five overlapping periods, each characterized by a new understanding or approach to the management of facial nerve conditions. The first period, the period of discovery of the nerve of facial expression, began with Sir Charles Bell's description in 1829 of 3 cases of facial paralysis due to facial nerve trauma. The second period, from 1873 to 1960, was the era of facial nerve repair. Decompression of the facial nerve was the primary focus of facial nerve surgery in the third period, from 1908 to 1969. The fourth period, from 1970 to 2000, can be characterized as the "bottleneck" period in honor of the contributions to facial nerve surgery that resulted as Ugo Fisch and other surgeons sought ways to operate on this portion of the proximal nerve. In the current or fifth, period in the history of facial nerve surgery, we anticipate the advent of vaccines and antiviral medications to minimize the sequelae of Bell's palsy, further improvements in endoscopic equipment and techniques, and better surgical outcomes through the use of new technologies such as robotics.

Decompression, Surgical↗
PubMed1991

Inflammatory pseudotumor of the facial nerve as a cause of recurrent facial palsy: case report.

This is a report of a case presenting recurrent facial palsy due to inflammatory pseudotumor of the facial nerve. The patient was a 41-year-old man suffering from facial palsy on the right side once in 1983, which recurred in 1988. The initial facial palsy was cured after conservative treatments including steroid administration. Three months after the recurrence, the same treatments were attempted without noticeable effect. He was referred to our clinic two and half months later. Electromyographic examination indicated pronounced denervation of the facial nerve. Imaging study including high resolution CT and MRI revealed a mass lesion around the geniculate ganglion. Facial neuroma was initially suspected. Surgical exploration revealed a tumor involving the geniculate ganglion and the horizontal portion of the facial nerve. The tumor was resected through a combined transmastoid and middle cranial fossa approach, followed by nerve grafting. Histologically, the tumor proved to be an inflammatory pseudotumor originating from the nerve sheath, although the etiologic factor causing the inflammation was not verified.

Adult↗
PubMed2001

Inhibition of motor nerve regeneration in a rabbit facial nerve model.

OBJECTIVES/HYPOTHESIS: We hypothesized that intramuscular injection of vincristine into the upper lip selectively prevents reinnervation of the target muscle (quadratus labii superioris) after facial nerve transection. STUDY DESIGN: Prospective controlled experiment. METHODS: Transection injuries with primary neurorrhaphy were performed just proximal to the buccal and zygomatic branches of both facial nerves in 20 rabbits. The left (experimental) quadratus labii superioris muscle was injected with 200 microg vincristine 72 hours after injury; the right (control) side was injected with saline. Functional, electrophysiological and histological studies were performed 6 weeks after surgery. RESULTS: After 6 weeks, the control side had a mean axon count (distal buccal branch) of 1160, conduction velocity of 50.4 m/s, reduction of compound action potential amplitude of 44%, and functional index of 1.67 units. The experimental side had a mean axon count of 265, conduction velocity of 16.5 m/s, reduction of compound action potential amplitude of 88%, and a functional index of 0.176 units. All parameters were significantly reduced by vincristine blockade (P <.05). The zygomatic division (not exposed to vincristine) displayed a trend toward increased axon counts, but this was not statistically significant (P =.131). CONCLUSIONS: These results demonstrate that reinnervation of a selected muscle can be prevented by injection of vincristine. Enhanced reinnervation of adjacent muscle groups may also occur. Thus, nerve blockade by vincristine may be useful for the prevention of synkinesis.

Animals↗