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The Foix-Chavany syndrome is a neurological entity characterized by linguo-bucco-facial apraxia almost always caused by disturbed cerebral circulation. Three typical cases of this syndrome are described and the role of the CT scan to obtain a definite diagnosis is emphasized.
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.
This is a simple test for the early recognition of a clinically 'latent' facial motor lesion, which detects the difference in fatigability between the two sides of the peri-oral musculature. Fatigue is produced by the patient's effort to maintain maximal contraction against lateral traction of the angles of the mouth by two weighted hooks. Fatigue is expressed as the distance between the midline of the philtrum and a mark on each hook. Distance plotted against time gives a 'facial fatigue curve'. In the authors ' experience the test has revealed pathological fatigability in 8 cases, 2 intrameatal and 4 large acoustic neuromas--1 of the four not yet confirmed by surgery--and 2 inflammatory processes in the internal auditory meatus, but failed in 1 of intrameatal acoustic neuroma.
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The lip-length (LL) and snout (S) indices provide information on peri-oral muscular function. They were determined in 18 patients suffering from Bell's palsy and compared with the results obtained by scoring according to the House grading system. A high correlation was found. LL and S indices are continuous variables, which facilitates their statistical evaluation. Results of the House scoring system are given in an ordinal scale and reflect overall facial muscular function. It is concluded that the indices and the House scoring system produce a different kind of information, but they are complementary to each other in the assessment of facial muscular function.
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Over the past 3 1/2 years, 28 patients with blepharospasm have undergone, bilaterally, staged percutaneous thermolytic fractional destruction of branches of the facial nerve. This series consisted of 20 women and eight men ranging in age from 40 to 79 years, with symptoms for from 1 to over 10 years. At the time of follow-up, 12 patients had undergone one operation, 12 had had two operations, and four had had three to five operations. Sixteen of the 28 patients obtained excellent to good relief of symptoms for 1 to 3 1/2 years. The procedures performed using local anesthesia and intravenous analgesia allow the immediate recognition of any facial muscle weakness or asymmetry. The findings indicate that this procedure, in many patients with minimal complications, can significantly relieve the incapacitating symptoms of blepharospasm.
Facial nerve stimulation can develop because of the electric fields generated from an activated cochlear implant. This problem can usually be ameliorated by reducing or eliminating the current through the electrodes causing the undesirable stimulation. Occasionally there may be numerous electrodes that have to be deactivated in order to eliminate the facial nerve stimulation, and this may result in a marked reduction of auditory benefit to the cochlear implant user. Botulinum toxin causes transient neuromuscular blockade and has been shown to be effective in reducing or eliminating facial nerve hyperactivity due to a variety of causes. This report details the use of botulinum toxin in a patient with a cochlear implant who developed excessive facial nerve stimulation that necessitated the deactivation of 15 of the implant's 22 electrodes. After treatment with botulinum toxin, twice as many electrodes could be comfortably activated without causing facial nerve stimulation. The dynamic range was increased in 4 of the remaining 6 electrodes that were activated prior to treatment. The patient reported a marked improvement in sound quality and understanding of speech without lipreading as compared to her pretreatment performance. Treatment with botulinum toxin appears to be useful for patients who have excessive facial nerve stimulation after cochlear implantation.
Several surgical procedures have been proposed through the years for the treatment of facial paralysis. The multiplicity and diversity of techniques portray the complexity and challenge represented by this pathology. Two basic dynamic options are available: -Reconstruction of nerve continuity through direct micro suture, with interposition grafts or nerve transpositions. -Regional muscular transposition, most often using the temporalis. Facial reanimation with the temporalis transfer has withstood the test of time and still is a reference technique. In a few weeks, good results can be obtained with a single and rather simple surgical procedure. Functional free flaps have been used with increasing frequency in the last two decades, most often combining a cross-facial nerve graft followed by a gracilis free flap nine months later. With this method there is a potential for restoration of spontaneous facial mimetic function. Apparently there is a limit in microsurgical technique and expertise beyond which there is no clear improvement in nerve regeneration. Current research is now actively studying and identifying nerve growth factors and pharmacological agents that might have an important and complementary role in the near future.
Twelve patients with facial palsy after resection of acoustic neuromas were treated by hypoglossofacial anastomosis. The nerve anastomosis were performed 1-2 months after resection of the tumor in 10 cases (group A). Two cases (group B) had the anastomosis performed more than 2 years after damage to the facial nerve. All the cases had been followed for more than 9 months. The results of reinnervation of the paralyzed facial muscles were quite satisfactory, i.e., over 80% of the cases obtained a good functional recovery. Although there was a 2-month delay in functional recovery of group B patients, the final results were practically the same in both groups. Therefore, the effect of the duration of the paralysis of the facial nerve seems to be less important in facial nerve surgery than in nerve surgery of the extremities. The procedures of anastomosis of descendens hypoglossi to the distal stump to the hypoglossal in 7 of the 10 patients using the hypoglossal as the donor nerve was of little help in prevention or restoration of the hemiatrophy of the tongue. In spite of long-term inconvenience in speaking and eating after section of the hypoglossal, all the patients were able to make enough adjustments about 2-3 months after nerve surgery.
BACKGROUND AND PURPOSE: Few studies have used motion analysis in the study of facial animation. A facial animation model using an expert vision motion analysis system was developed in this study to quantitatively evaluate absolute movement during five facial animations. METHODS: Skin markers were adhered to the face of each subject at 16 anatomic landmarks selected to represent the functional movement of the facial muscles. Three of the 16 skin markers were used to establish a local face frame with the origin in the mid-point of the face. All of the coordinates measured in the laboratory frame were rotated and translated to the local face frame for analysis. The trajectory of the facial markers was evaluated from the local face frame when comparing two-dimensional (2-D) displacement of skin markers (frontal plane) with three-dimensional (3-D) values by paired Student's t-test. RESULTS: Although the correlation of 2-D and 3-D displacements of skin markers was high (r > 0.69), the differences between 2-D and 3-D motion were significant (p < 0.001). The 2-D displacement of skin markers underestimated the 3-D facial animation in each marker and animation. There were no significant differences in the movement of both mouth angles or of the eyes. Thirty repeated measurements of a subject revealed good concentration in 3-D displacement, velocity, and angle of movement in smiling. The measurement error was less than 0.06 mm. The normative displacement of individual anatomic landmarks was evaluated to avoid size differences of individual faces. CONCLUSIONS: We suggest that the expert vision motion analysis technique is feasible for quantitative evaluation of absolute facial movement and would be useful for further clinical evaluation of patients with facial palsy.
OBJECTIVE: To study the role of CNTF in regeneration of facial nerve. METHOD: SD Rat facial nerves in temporal bones were transected and then combined end to end. In ciliary neurotrophic factor group (n = 30), lesions were covered by gelatin sponge soaked with CNTF. In control group (n = 18), lesions were covered by gelatin sponge soaked with normal saline. 2, 4, 12 weeks after the operation, both CNTF group and SAL group undergone electrophysiology test and histopathology as well as quantity analysis. RESULT: Two weeks later, both CNTF and SAL group failed in eliciting muscular excitement by stimulating facial nerve; T-test showed significant difference between the two groups(P < 0.05) about the average of myelinated axons 4 weeks later, the latency of facial muscular excitement was 7.650 +/- 2.702 ms in CNTF group and 16.080 +/- 0.162 ms in SAL group. The average number of myelinated axons was 1614 +/- 411 in experimental group and 1094 +/- 343 in control group. T-test showed significant difference between them (P < 0.05). 12 weeks later, latency of facial muscle excitement was 2.016 +/- 0.122 ms in CNTF group and 2.060 +/- 0.162 ms in SAL group. The average number of myelinated axons was 1909 +/- 332 in experimental group and 1847 +/- 422 in control group. T-test showed no significant difference between the two groups (P > 0.05). CONCLUSION: CNTF enhance facial nerve regeneration in adult SD rats.
Mona Lisa has been pregnant shortly before the famous painting of Leonardo da Vinci was created (1503-1506). Recently, it has been speculated that Mona Lisa's famous smile is caused by facial muscle contracture and/or synkinesis after Bell's palsy with incomplete nerval regeneration. During pregnancy the incidence of Bell's palsy is increased up to 3.3 times compared to nonpregnant women. The etiology, associated factors as well as various treatment options aiming at the prevention of associated complications and improving recovery of facial nerve function have intensively been evaluated over the past three decades. However, the preferred mode of therapy management, particularly in pregnant women, remains undecided. Corticosteroids may be beneficial if they are applied after the first trimester.