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PubMed1983

Brainstem auditory evoked potential abnormalities in vascular malformations of the posterior fossa.

Recent reports indicate that malformations of arteries and veins in the posterior fossa are a common cause of facial spasm and trigeminal neuralgia. More rarely they may also cause facial nerve paresis and hearing loss. When vascular malformations are present, brainstem auditory evoked potentials (BAEPs) sometimes show abnormalities similar to those usually recorded in patients with tumours in the cerebellopontine angle. In three patients with facial spasm, one with trigeminal neuralgia and one with facial paresis pathologically delayed absolute latencies and/or interpeak latencies of BAEPs associated with vascular malformations were found. It is concluded that those BAEP abnormalities associated with tumours in the posterior fossa may also be caused by vascular malformations. BAEPs are valuable aids to the diagnosis of such malformations.

Adult↗
PubMed2006

Bilateral conjugacy of movement initiation is retained at the eye but not at the mouth following long-term unilateral facial nerve palsy.

Voluntary eyelid closure and smiling were studied in 11 normal subjects and 11 patients with long-term unilateral facial nerve palsy (FNP). The conjugacy of eyelid movements shown previously for blinks was maintained for voluntary eye closures in normal subjects, with movement onset being synchronous in both eyes. Bilateral onset synchrony of the sides of the mouth was also observed in smiling movements in normal subjects. In FNP patients, initiation of movement of the paretic and non-paretic eyelids was also synchronous, but markedly delayed relative to normal (by 136 ms = 32%). The initiation of bilateral movements at the mouth was similarly delayed, but in contrast to the eyes, it was not synchronous. Central neural processing in the FNP subjects was normal, however, since unilateral movements at the mouth were not delayed. The delays therefore point to considerable additional information processing needed for initiating bilateral facial movements after FNP. The maintenance of bilateral onset synchrony in eyelid closure and its loss in smiling following FNP is an important difference in the neural control of these facial regions. Bilateral conjugacy of eyelid movements is probably crucial for coordinating visual input and was achieved apparently without conscious effort on the part of the patients. Bilateral conjugacy of movements at the sides of the mouth may be less critical for normal function, although patients would very much like to achieve it in order to improve the appearance of their smile. Since the everyday frequency of eyelid movements is considerably greater than that of smiling, it is possible that the preserved eyelid conjugacy in these patients with long-term FNP is merely a product of greater experience. However, if synchrony of movement onset is found to be preserved in patients with acute FNP, then it would suggest that eyelid conjugacy has a privileged status in the neural organisation of the face.

Case-Control Studies↗
PubMed1998

Delayed facial weakness after microvascular decompression of cranial nerve VII.

BACKGROUND: Retromastoid craniectomy and microvascular decompression of cranial nerve VII for hemifacial spasm is a well accepted and effective treatment. Risks of the operation relate to the surgical approach in general and to the seventh nerve in particular. Delayed facial weakness is an unusual and little-described complication of the procedure. The purpose of this review is to describe this complication and the characteristics of the patients so affected. METHODS: Between 1972 and 1996, 985 patients have undergone microvascular decompression for hemifacial spasm. During this time, 28 patients (2.8%) undergoing decompression of the facial nerve and 1 patient undergoing decompression of the cochlear nerve for tinnitus developed delayed facial palsy. RESULTS: The weakness was at least a House Grade III or worse and was complete in 11 of the patients. The time to occurrence averaged 12 days, with a tight range of 7 to 16 days. There were no factors such as duration of symptoms, intraoperative findings, or preoperative botulinum injections that were predictive of this postoperative weakness. In all patients there was almost complete recovery (House Grade I or II). CONCLUSIONS: Delayed facial weakness after MVD of CN VII can occur in up to 3% of cases. The onset of weakness after operation is consistent in its timing, occurring on average 12 days after the procedure. Although the etiology of this complication is uncertain, the palsy spontaneously resolves with a good or excellent outcome.

Adult↗
PubMed2006

Incidence and characteristics of facial nerve stimulation in children with cochlear implants.

OBJECTIVES: Electrical stimulation from a cochlear implant can spread beyond the auditory nerve. The aims of this study were to accurately measure facial nerve stimulation in pediatric implant users and to determine the characteristics and incidence of this unwanted activity. Part A consisted of a prospective study of a randomized sample of 44 pediatric implant users. Part B consisted of a retrospective analysis of 121 children with previously recorded electrically evoked auditory brainstem responses (EABR). STUDY DESIGN AND METHODS: Responses were evoked by 3 electrodes along the implant array in three groups of children: 1) postmeningitic, 2) abnormal cochlea, and 3) neither. Intraoperative measures were obtained under anesthesia; all other recordings were completed in awake children. RESULTS: Intraoperative recordings revealed large nonauditory responses in a number of channels, including the midline EABR. Under paralysis, these responses disappeared, and clear EABRs were recorded. Similarly, prospective postoperative electromyographic (EMG) responses from the facial nerve were found in more than 59% (26 of 44) of experienced implant users (Nucleus 24): 31% of postmeningitic children (4 of 13), 80% of those with abnormal cochlea (8 of 10), and 66% of those with neither (14 of 21). Retrospective analysis of previously recorded postoperative EABRs demonstrated facial nerve stimulation in 35% (42 of 121). In most cases, facial nerve stimulation occurred when levels were perceptually loud but comfortable. CONCLUSIONS: 1) Facial nerve potentials can be recorded using EMG in a large proportion of cochlear implant users at high levels of stimulation. 2) The EABR can be obscured in the presence of facial nerve stimulation and care should be taken to distinguish it from the EMG response, particularly when auditory brainstem activity is in question. 3) Use of surface EMG provides an additional objective measure to ensure the safe and comfortable use of cochlear implants.

Auditory Perception↗
PubMed1994

Multidimensional evaluation of craniomandibular dysfunction. II: Pain assessment.

To standardize clinical history taking, a comprehensive anamnestic questionnaire was developed (Screen). Screen includes questions about: (i) pain, (ii) other symptoms of craniomandibular dysfunction (CMD), (iii) correlates of CMD, (iv) psychosocial factors, and (v) general health. The current study focuses on variables in Screen concerning pain reported somewhere in the head, neck and/or shoulders. This study was performed to assess whether subgroups of patients with signs and symptoms of CMD and a control group of dental patients with and without signs and symptoms of CMD can be characterized by differences in areas reported to be painful, in quantitative and qualitative characteristics of pain, and in factors exacerbating pain. Results indicate that several characteristics of pain as measured in Screen can be used to discriminate between: (i) subgroups of subjects with signs and/or symptoms of CMD and controls without signs or symptoms of CMD, (ii) subgroups of clinical cases and controls with signs or symptoms of CMD, and (iii) patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component. The results of logistic regression analysis indicate that four adverbs describing pain correctly classified 75% of patients with CMD-myo and patients with CMD-arthro. Differences between patients and controls are interpreted with regard to the correct classification of patients with CMD with a mainly myogenous component and patients with CMD with a mainly arthrogenous component and the subjective treatment need for CMD. Implications for further research are discussed.

Adolescent↗
PubMed1993

Intraoperative facial nerve monitoring in posterior fossa acoustic neuroma surgery.

Intraoperative facial nerve monitoring has become an indispensable tool during cerebellopontine angle surgery. Ninety-seven patients underwent surgical removal of an acoustic neurinoma with the use of a pneumatic sensor monitoring between January 1, 1986, and December 31, 1990. In the early postoperative period, a normal or near-normal facial function (grades I and II) was achieved in 86% of the patients, a moderate dysfunction (grade III) was present in 7%, and a total or severe dysfunction (grades V or VI) was present in 6%. Normal function at 1 year was achieved in 90.5% of the patients, 4% were grade II, a moderate dysfunction (grade III) was present in 2%, and 3% showed a total or severe dysfunction (grade V and VI). The incidence of normal function decreased with tumor size, with an occurrence rate of 100%, 94%, and 91% in small, medium, and large tumors, respectively. In eight consecutive patients, all responses detected by the monitoring during the operation were collected and analyzed according to intraoperative events. Analysis of the results indicate that 95% of the 316 mechanically induced stimulations were of small or extremely small amplitude, and only 5% were of moderate amplitude. A medial-to-lateral strategy of dissection, preservation of the arachnoid veil over the facial nerve, a control by the monitoring of the amount of traction, and a more widespread use of sharp dissection were the major approaches to reduce surgical trauma during dissection.

Adult↗
PubMed2003

Function of beta 2-adrenergic receptors in chronic localized myalgia.

AIMS: To investigate alteration of beta 2-adrenergic receptor (beta 2 AR) function in chronic localized myalgia subjects by evaluating levels of the beta 2 AR second messenger, cyclic adenosine monophosphate (cAMP), in mononuclear cells after beta AR-agonist stimulation. METHODS: Eleven chronic localized myalgia subjects and 21 matched healthy controls participated in this study. Peripheral blood (30 cc) was drawn from the subjects' anterocubital vein. Mononuclear cells were isolated from the total blood by using the Ficoll-Hypaque gradient technique. Basal and stimulated intracellular cAMP levels were determined by enzyme immunoassay using a commercially available kit. Aliquots of 5 x 10(6) cells were incubated with or without stimulation of the beta AR-agonist isoproterenol for 5 minutes. Five different concentrations of isoproterenol (10(-3) M to 10(-7) M) were utilized. cAMP levels in both groups were tested statistically by a 2-way repeated-measures ANOVA with 2 predictors, group difference and isoproterenol concentration difference. As with isoproterenol stimulation, the cAMP responses to forskolin, which activates adenylyl cyclase directly and produces cAMP, bypassing the cell surface receptors were also measured. RESULTS: The basal cAMP levels in both groups (myalgia: 0.33 +/- 0.02 pmol/5 x 10(6) cells; control: 0.43 +/- 0.10 pmol/5 x 10(6) cells) were almost identical, and isoproterenol-produced cAMP levels increased dose-dependently in both groups. No significant differences in the mean cAMP levels were observed between the groups (P = .909). Significant increases were observed according to the isoproterenol concentration increase (P < .0001). The cAMP responses to forskolin stimulation also showed no significant group difference (P = .971). CONCLUSION: These results suggest that beta 2 AR function is not different between localized myalgia subjects and healthy individuals.

Adrenergic beta-Agonists↗
PubMed1984

Scapuloperoneal myopathy.

Two members of a family are described with muscle weakness and wasting affecting distal muscles of the lower limbs and muscles of the shoulder girdles. An autosomal dominant mode of inheritance is suggested with involvement of a 39-year-old female and her 15-year-old daughter. The disease in the mother has taken a relatively benign course with slow progression while the daughter has a short history of mild weakness. In both, the symptoms in the legs developed first, with foot-drop and a gait disturbance, and shoulder girdle weakness developed at a later stage. The facial muscles were mildly affected in the mother only. Results of electromyography and muscle biopsy in both these cases support a diagnosis of muscular dystrophy. The scapuloperoneal pattern of muscle involvement occurs in a number of pathological and genetic entities. The differential diagnosis includes scapuloperoneal syndrome with distal sensory loss in the limbs (Davidenkow's syndrome). The nosology of this disorder is discussed in relation to the cases presented.

Adolescent↗
PubMed1984

Neuromuscular and cardiovascular effects of pancuronium bromide in calves anesthetized with halothane.

Pancuronium bromide was administered to calves to define the dosage level necessary to produce surgical relaxation (90% to 99% reduction of base-line evoked, hindlimb digital-extensor muscle twitch tension). Initial dosage level requirement was 43 +/- 9 micrograms/kg of body weight. Calves with this degree of relaxation required 26 +/- 14 minutes to achieve 50% recovery and 43 +/- 19 minutes to achieve complete return of base-line muscle twitch. Calves given a repeat injection of pancuronium at base-line muscle twitch required 27 +/- 9 micrograms/kg to achieve relaxation similar to that of the 1st dose. The 2nd dose did not last as long as the 1st, with complete recovery occurring in 37 +/- 12 minutes. Maximum evoked tension occurred at 200- to 400-g resting tension on the hoof. There was an absence of heart rate or blood pressure changes after injection of relaxant and a variable and inconsistent fade response to train-of-four and tetanic stimulus of the facial muscles. Acid-base values were alkalemic (pHa 7.5 +/- 0.08) when ventilation was controlled at eucapnia (PaCO2, 25 to 45 mm of Hg).

Anesthesia, General↗
PubMed1988

Anatomic surgical dissection of the extraparotid portion of the facial nerve.

The direction followed by the facial nerve branches beyond their emergence from the ventral, cephalic, and caudal borders of the parotid gland up to the facial muscles has been studied by several anatomists, but no consistent description of them has been given so far. This research, based on the dissection of 30 hemifaces, studies the characteristics of those branches using three points of reference: the intertragal notch, the palpebral lateral commissure, and the labial commissure. Tables showing average length and number of branches have been computed with a statistical level of confidence of 99 percent. No fixed common pattern suitable to represent the distribution of branches of the facial nerve in a model was found, but as a rule, these branches run beneath the superficial musculoaponeurotic system (SMAS) in their path below the zygomatic arch, and approximate emergence points have been identified. In the opinion of the authors, such points may be of more surgical relevance than a theoretical pattern of arborization.

Adult↗
PubMed2001

Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods.

OBJECT: The goal of this study was to define tumor control and complications of radiosurgery encountered using current treatment methods for the initial management of patients with unilateral acoustic neuroma. METHODS: One hundred ninety patients with previously untreated unilateral acoustic neuromas (vestibular schwannomas) underwent gamma knife radiosurgery between 1992 and 1997. The median follow-up period in these patients was 30 months (maximum 85 months). The marginal radiation doses were 11 to 18 Gy (median 13 Gy), the maximum doses were 22 to 36 Gy (median 26 Gy), and the treatment volumes were 0.1 to 33 cm3 (median 2.7 cm3). The actuarial 5-year clinical tumor-control rate (no requirement for surgical intervention) for the entire series was 97.1+/-1.9%. Five-year actuarial rates for any new facial weakness, facial numbness, hearing-level preservation, and preservation of testable speech discrimination were 1.1+/-0.8%, 2.6+/-1.2%, 71+/-4.7%, and 91+/-2.6%, respectively. Facial weakness did not develop in any patient who received a marginal dose of less than 15 Gy (163 patients). Hearing levels improved in 10 (7%) of 141 patients who exhibited decreased hearing (Gardner-Robertson Classes II-V) before undergoing radiosurgery. According to multivariate analysis, increasing marginal dose correlated with increased development of facial weakness (p = 0.0342) and decreased preservation of testable speech discrimination (p = 0.0122). CONCLUSIONS: Radiosurgery for acoustic neuroma performed using current procedures is associated with a continued high rate of tumor control and lower rates of posttreatment morbidity than those published in earlier reports.

Actuarial Analysis↗
PubMed1992

Computerized quantitative dynamic analysis of facial motion in the paralyzed and synkinetic face.

Diagnosis, treatment, prognosis, and the neurobiology of recovery of facial paralysis has been impeded by the inability to quantitate facial movement objectively. The purpose of this paper is to report our preliminary results in the study of the paralyzed face using a newly developed computerized quantitative dynamic analysis system. Five normal volunteer subjects, and 17 patients with facial paralysis or paresis, from a wide range of etiologies, were analyzed utilizing the computerized analysis system; eight of these patients had synkinesis. Raw data image-change intensity: duration curves, numeric and graphic displays of curve parameter descriptive statistics, and rank order correlation analyses showed high levels of correlation between the computerized facial motion analysis and the House-Brackmann facial nerve grading system and a clinical grading scale for synkinesis. These data suggest that it is possible to develop a computerized image-difference analysis system that approximates the human ability to access facial movement and, additionally, deliver an equal-interval continuous quantitative data scale dynamic over a spectrum of time during facial motion.

Adolescent↗
PubMedDate not supplied

[Hemifacial spasm: study using magnetic resonance angiography].

Nine patients with "idiopathic" hemifacial spasm were evaluated with cranial magnetic resonance imaging and angiography. Alterations of the posterior fossa vasculature, possibly related to the facial nerve irritation, were found in 8 patients (88%). Magnetic resonance angiography is a noninvasive procedure and appears to be a sensitive method to evaluate the hemifacial spasm etiology.

Adult↗