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PubMed1976

Extratemporal facial nerve injury.

Isolated traumatic facial nerve injury, frequently seen in wartime combat, may also be encountered among civilians. The clinical picture occurring as a result of such injury may be confusing because partial, or incomplete, damage to the peripheral nerve may mimic impairment of the central facial motor mechanism. In treating the patient with facial injury, life-threatening aspects of the injury must be assessed and stabilized first. Then, attention may be focused on the injured facial nerve, for which prompt surgical repair is the treatment of choice. Prior to surgery, the assessment of taste and hearing, as well as mastoid and skull x-ray films and electrodiagnostic tests are helpful in localizing the facial nerve injury.

Electrodiagnosis↗
PubMed1996

Pre-operative information in mastoidectomy: what about the facial nerve and hearing loss?

Facial nerve palsy and hearing impairment are accepted risks of mastoid surgery. However, at present there are no guidelines as to whether a patient must be informed of the potential risk to the facial nerve and hearing during mastoid surgery. Currently the law states that the surgeon should do what a 'reasonable doctor' would do under similar circumstances but exactly what this entails is not clear. A recent publication established that 16 per cent of British surgeons did not tell their patients about the risk to the facial nerve and 13 per cent about the risk of hearing loss. A survey of South African surgeons showed a different picture with only 57 per cent of surgeons informing their patients of possible facial nerve injury and 71 per cent about hearing loss. One of the reasons stated was that this information might deter the patient from having a necessary operation. This raises the question of excessive information disclosure and its possible legal consequences if excessive information leads a patient into making an unbalanced judgment owing to his/her lack of medical training, prejudices or personality. In this survey 25 per cent of South African surgeons have had patients refuse surgery after being informed of the risk to facial nerve and hearing. The decision whether to inform the patient about these risks should be individualized for every patient after the surgeon has audited his/her results and assessed the patients prejudices, personality and level of education.

Facial Nerve Injuries↗
PubMed1987

Surgical anatomy of the rat facial nerve.

Animal models of facial nerve healing and regeneration are becoming increasingly important as new techniques of facial nerve repair and grafting are developed. We have described in detail the peripheral branching pattern of the rat facial nerve and performed axon counts on the main trunk and peripheral branches. Similarities and differences between the human and rat facial nerve are emphasized and the branches of the rat nerve amenable to experimental manipulation are identified. In addition, electrophysiologic data from the rat show a more diffuse pattern of innervation of the face from the individual branches than seen in humans.

Action Potentials↗
PubMed1975

Surgical exposure of the facial nerve indications and techniques.

Lesions producing facial nerve palsy may occur within the temporal bone anywhere between the internal auditory canal and the stylomastoid foramen. Surgical exposure of this nerve may be necessary for decompression, grafting, rerouting, or removal of such lesions as acoustic tumour, meningioma, facial nerve neuroma, and cholesteatoma. Contemporary surgical exposure of the facial nerve has as its aim adequate exposure of the facial nerve at any point in its course, with preservation of hearing and vestibular function, without further injury to the facial nerve and the necessity for producing a mastoid cavity. When hearing and balance function are present, the transcanal-transtympanic approach to the horizontal segment of the facial nerve offers limited access to the facial nerve in its tympanic course. Wider exposure is obtained by postauricular transmastoid exposure of the tympanic and mastoid portions of the facial nerve. The middle fossa approach to the facial nerve offers access to the internal auditory canal and labyrinthine portions of the nerve, whereas the retrolabyrinthine approach offers access to the facial nerve in the posterior fossa. Total facial nerve exposure with preservation of hearing and balance function is obtained by the combined transmastoid and middle cranial fossa approach. In individuals who have lost all function of hearing and balance, the postauricular translabyrinthine approach offers total exposure of the facial nerve within the temporal bone and posterior fossa. The aim of this discussion was to present in succinct fashion a systematized approach to surgical exposure of the facial nerve within the temporal bone and posterior fossa.

Cochlea↗
PubMed2000

Magnetic resonance imaging of the facial nerve in children with idiopathic facial paralysis.

The role of gadolinium-enhanced MRI (Gd-MRI) in the diagnosis of idiopathic facial paralysis (IFP) in children is not well defined. Fourteen children with IFP were evaluated to assess the use of Gd-MRI for the presence and pattern of enhancement and its usefulness in predicting the recovery of facial function. Six of 14 children had enhancement of the facial nerve on Gd-MRI, whereas 8 had none. Enhancement was noted in the tympanic, mastoid, and most commonly in the distal intracanalicular and labyrinthine segments. The average time from onset of paresis to recovery in patients with enhancement was 19.3 weeks, whereas in those with no enhancement, mean recovery time was 9.5 weeks (P = 0.003, t test). All 14 patients eventually had recovery to House-Brackmann grade I or II. Gd-MRI is not required for all children with IFP but may yield information about the time course of recovery of facial function.

Adolescent↗
PubMed1990

Experiments on herpes simplex viral infections of the facial nerve in the tympanic cavity.

An experimental protocol was developed to study viral infection of the facial nerve. Facial palsy was induced in a guinea pig model by inoculating type 1 herpes simplex virus (HSV-1) directly onto the facial nerve in the temporal bone. Partial removal of the bony wall of the fallopian canal was effected, and virus was placed on the nerve after incising its sheath on the right side and without incision of the sheath on the left side. All animals exhibited subsequent bilateral facial palsies, but with severe changes occurring on the right side. The animals were then sacrificed sequentially following infection. Immunofluorescence and histopathological studies revealed the presence of HSV antigen, infiltration of inflammatory cells, hemorrhage, and degeneration of the right facial nerve. In the left nerves, a slight hemorrhage was recognized without cellular infiltration or HSV antigens. These results suggest that the intact facial nerve is rather resistant to HSV infection, but this defense mechanism is easily destroyed by damage to the facial nerve sheath.

Animals↗
PubMed2005

Delayed presentation of traumatic facial nerve (CN VII) paralysis.

Facial nerve paralysis (Cranial Nerve VII, CN VII) can be a disfiguring disorder with profound impact upon the patient. The etiology of facial nerve paralysis may be congenital, iatrogenic, or result from neoplasm, infection, trauma, or toxic exposure. In the emergency department, the most common cause of unilateral facial paralysis is Bell's palsy, also known as idiopathic facial paralysis (IFP). We report a case of delayed presentation of unilateral facial nerve paralysis 3 days after sustaining a traumatic head injury. Re-evaluation and imaging of this patient revealed a full facial paralysis and temporal bone fracture extending into the facial canal. Because cranial nerve injuries occur in approximately 5-10% of head-injured patients, a good history and physical examination is important to differentiate IFP from another etiology. Newer generation high-resolution computed tomography (CT) scans are commonly demonstrating these fractures. An understanding of this complication, appropriate patient follow-up, and early involvement of the Otolaryngologist is important in management of these patients. The mechanism as well as the timing of facial nerve paralysis will determine the proper evaluation, consultation, and management for the patient. Patients with total or immediate paralysis as well as those with poorly prognostic audiogram results are good candidates for surgical repair.

Accidents, Traffic↗
PubMed1998

[Nerve-plasty interventions on the facial nerve in the elderly patient--morphological evaluation of disappointing functional results].

BACKGROUND: Nerve sutures such as facial-facial anastomosis are helpful methods for recovery of facial movements after peripheral nerve lesions. Most of the results on neuronal regeneration were based on experiments with young or young adult animals. In contrary the vast majority of the diseases (cholesteatoma or tumors of the parotid gland) causing facial nerve lesions are in aged patients. METHODS: Therefore, we compared the original data from two recently published articles concerning the axonal outgrowing process after facial-facial-anastomosis in young-adult and aged rats. In additional, we tried to explain the clinically observed postparalytic syndrome (synkinesia, autoparalytic syndrome,...) after surgical interventions on the facial nerve with the experimental results in the rat. RESULTS: As an important result, we could not find spontaneous loss of facial motoneurons on the control side in the aged rats. On the operated side, two results have to be emphasized. The initial regeneration (10-42 days after the operation) showed a significant faster reinnervation in the group of young rats. The aged rats showed an apparent hyperinnervation after axonal outgrow to the mimic muscles has been accomplished. CONCLUSION: Both experimental observations are in agreement with our clinical experiences. After facial nerve surgery, aged patients show a delayed recovery of the mimic functions and a more pronounced postparalytic syndrome. A morphological explanation one can bear is that the delayed reinnervation causes the extreme hyerinnervation, which leads to a simultaneous innervation of different muscles by same facial motoneurons.

Adult↗
PubMed1993

[Funicular structure and nerve fiber topography in the extratemporal facial nerve of the guinea pig].

The intratemporal portion of the facial nerve has a single bundle, while the extratemporal portion has multiple funiculi. In the guinea pig, the funiculi repeatedly divide and fuse between the stylomastoid foramen and the origin of the inferior labial branch. It remains unknown whether the nerve fibers in each funiculus are topographically organized or not. In this paper, the topographic organization of nerve fibers in a funiculus was clarified in the extratemporal facial nerve trunk of the guinea pig using an anterograde nerve degeneration technique. The author developed a technique in which one funiculus is cut selectively proximal to the origin of the cervical branch or peripheral to the origin of the inferior labial branch using microscissors under an operation microscope. Four to six days after sectioning, the main trunk just peripheral to the sectioned site was examined with toluidine blue staining to confirm that the resultant degeneration was limited to only one funiculus. Then all six main peripheral branches were sectioned and the distribution of degenerated nerve fibers in each branch was examined with toluidine blue staining. In six out of eleven nerves sectioned just proximal to the origin of the cervical branch, the degenerated nerve fibers were localized in one main peripheral branch. In the remaining five nerves, the degenerated nerve fibers spread into two or three main peripheral branches. In all nerves sectioned just peripheral to the origin of the inferior labial branch, the degenerated nerve fibers were localized in only one main peripheral branch, even though they distributed to several funiculi in the same branch.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2003

Delayed facial palsy following laser stapedectomy: in vitro study of facial nerve temperature.

Delayed facial palsy following conventional stapes surgery is a rare event, but this complication appears to be more common when a laser is used. We have investigated the temperature in the facial canal during stapes surgery using a KTP laser or a microdrill in preserved human temporal bones. Thermocouples were placed in the facial canal and under the foot plate. The results show maximum rises in temperature of between 1.4 degrees C and 15.2 degrees C in the facial canal during laser surgery (mean 6.1 degrees C, SD 4.5 degrees C), but only between 0.45 degrees C and 2 degrees C during procedures in which a microdrill was used (mean 0.9 degrees C, SD 0.9 degrees C) (P = < 0.009). In addition, the facial nerve undergoes repeated heating and cooling cycles during the laser surgery. We conclude that heating of the facial nerve during laser surgery causes oedema, which in turn leads to compression of the nerve within its bony canal.

Adult↗
PubMed1999

Contralateral trigeminal nerve lesion reduces polyneuronal muscle innervation after facial nerve repair in rats.

Functional recovery after facial nerve surgery is poor. Axotomized motoneurons (hyperexcitable upon intracellular current injections, but unable to discharge upon afferent stimulation) outgrow supernumerary branches which are misrouted towards improper muscles. We hypothesized that alterations in the trigeminal input to axotomized electrophysiologically silent facial motoneurons might improve specificity of reinnervation. To test this we compared, in the rat, behavioural, electrophysiological, and morphological parameters after transection and suture of the buccal facial nerve (buccal-buccal anastomosis, BBA) with those after BBA plus excision of the ipsi- or contralateral infraorbital nerve (ION). After BBA, the mystacial vibrissae dropped and remained motionless until 18-21 days post operation (days PO). After BBA plus ipsilateral ION excision, there was no recovery of vibrissae whisking at all. Following BBA plus contralateral ION excision, full restoration of whisking occurred at 7-10 days PO. Electromyography of whiskerpad muscles showed normal waveform and amplitude was also most rapidly restored after BBA plus contralateral ION excision. Neuron counts after retrograde tracing showed that the intact buccal nerve contained axons of the superior (91%) and inferior (9%) buccolabial nerves. After BBA, the superior nerve comprised 56%, the inferior 21%, and 23% of the motoneurons projected within both nerves. After BBA plus ipsilateral ION excision, misdirection worsened and values changed to 48, 39 and 13%, respectively. After BBA plus contralateral ION excision, portions improved to 69, 23 and 8%. We conclude that, by reducing the redundant axon branching, lesion of contralateral ION provides the best conditions for recovery of vibrissae rhythmical whisking after reconstructive surgery on the facial nerve.

Anastomosis, Surgical↗
PubMed1991

Congenital and acquired facial nerve paralysis in children.

Facial nerve paralysis in children should be considered distinct from that which occurs in adults. The author submits a slightly different classification of facial nerve paralysis in children based on traditional thinking. Specifically, acquired facial nerve paralysis is thought to be influenced by both prenatal and postnatal factors. This segregated approach toward acquired paralysis should allow a clearer understanding of the pathophysiology of in utero factors.

Child↗
PubMed2001

Stimulation electromyography as a method of intraoperative localization and identification of the facial nerve during parotidectomy: review of 15 consecutive parotid surgeries.

INTRODUCTION: It has been widely recognized that one of the major hazards during operation of the parotid gland, mainly in tumor resection, is the injury of the facial nerve. Facial nerve monitoring has achieved wide application in otologic and neurotologic procedures to help localization and protection of the facal nerve in the temporal bone. MATERIAL AND METHODS: The authors analyze localization and identification of 15 nerves in 15 patients who underwent parotid gland surgery in the Department of Ear Nose and Throat Diseases of the Medical University in Plovdiv from September 15, 2000 to December 15, 2000. Nerve integrity monitor Neurosign 100 and specially designed electromyographic electrodes were used. RESULTS: In all patients stimulation electromyography of the facial nerve was successfully used to locate, identify and evaluate the integrity of the facial nerve during and at the end of the operation. No postoperative facial nerve injury was detected clinically. In two patients with parotid gland cancer the inferior division of the facial nerve was found infiltrated by the cancer growth. CONCLUSION: The results indicate that identification of the facial nerve by electromyography is a safe, effective and simple method of electrophysiologic monitoring during parotid gland surgery. This method allows assessment of the nerve integrity at the end of the operation.

Electric Stimulation↗