Intracranial facial nerve decompression in the management of hemifacial spasm.
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Facial Muscles↗
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Hemifacial spasm associated with dolichomegavertebrobasilar anomaly.
3 patients suffering from long-lasting "cryptogenetic" hemifacial spasm in association with dolichomegavertebrobasilar anomaly, are described. The angiographic examinations confirm the anomaly and put in evidence the patholphysiologic value of segment V4 of the vertebral artery at the same side of the spasm. Classical electromyographic examinations, and methods used to study the blink reflex, seem to rule out the hypothesis of a brain stem involvement as the only and sufficient pathologic mechanism. The peripheral pathogenesis is the most likely one.
Aged↗
Treatment of hemifacial spasm with botulinum toxin. Value of preinjection electromyography abnormalities for predicting postinjection lower facial paresis.
Thirty-two patients with hemifacial spasm were treated with 61 botulinum toxin (BT) injections. Some patients had post-BT lower facial paresis (LFP+group) while others did not suffer this side effect (LFP-group). Abnormal electromyography (EMG) recordings were more frequent in the LFP+ group (6/11) than in the LFP- group (3/21; p < 0.05). This result suggests that an EMG performed before any BT injection could detect the patients with a higher risk for this side effect. The first dose of BT might be lowered in such cases.
Aged↗
Morphological, physiological, and behavioral studies of the facial musculature of the coati (Nasua).
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Animals↗
Denervation in Bell's Palsy. An evoked electromyographic study.
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Action Potentials↗
Facial nerve disorders: anatomical, histological and clinical aspects.
Three main problems of facial nerve pathology and surgery are considered in this paper. The intraneural anatomy of the facial nerve with its consequences for surgery, especially surgery for facial hyperkinesia, is studied and an original method of selective funicular neurolysis is proposed as a symptomatic operation. Quantitative and qualitative findings in the normal facial nerve are compared to findings in nerves after palsy. The results show that the introduction of neurometric methods for the quantitative assessment may yield further parameters in the judgement of past pathological processes within the nerve. Finally, prognosis of peripheral facial palsy, seen through electrophysiological testing methods, is discussed.
Adult↗
Eye tics and subjective hearing impairment during fluoxetine therapy.
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Adult↗
Bell's palsy: electrodiagnostics are not indicative of cerebrospinal fluid abnormalities.
Electrodiagnostic testing (electromyography, electroneuronography, and blink reflex) and cerebrospinal fluid (CSF) examination (cell count, immunoglobulins, and antigen-specific intrathecal immunoglobulin G synthesis against herpes simplex virus, varicella zoster virus, cytomegalovirus, and Borrelia burgdorferi sensu latu) were performed in 56 patients with Bell's palsy. The CSF was normal in 45 patients and abnormal in 11 patients. Acute borreliosis was the most common specific pathological CSF finding (4 of 11). Electromyography revealed abolished volitional activity in 22% of patients with normal CSF and in 36% with pathological CSF. Electroneuronographic tests with an amplitude decrease of more than 90% on the affected side or abolished responses were found in 20% of patients with normal CSF and in 18% with pathological CSF. Abolished orbicularis oculi reflexes were seen in 67% of patients with normal CSF and in 82% with pathological CSF Concerning electrodiagnostic testing, no statistically significant difference between patients with normal and abnormal CSF was found, so we conclude that electrodiagnostic testing has no indicative value for abnormal CSF in Bell's palsy.
Action Potentials↗
Objective grading of facial paralysis.
A totally objective method of grading facial palsy, based on the linear measurement of anatomic landmarks, has been tested in 34 randomly selected cases. To account for the pathologic characteristics of facial paralysis, the linear measurement index (LMI) underwent several adjustments from the ground plan devised for normal subjects. The distribution of results both from individual expressions and the entire LMI was examined.
Adult↗
Anomaly of the hypoglossal nerve: embryologic, anatomic, and surgical considerations.
An anomaly of the hypoglossal nerve was discovered during a procedure to anastomose the 12th and 7th cranial nerves. This anomaly is described, and an embryologic mechanism is proposed to explain the occurrence of this particular anomaly. The surgical anatomy of the hypoglossal nerve is reviewed, and reasonable approaches to the surgical identification of the hypoglossal nerve are discussed.
Anastomosis, Surgical↗
Intracranial longitudinal splitting of facial nerve: a new approach for hemifacial spasm.
A new surgical technique for the treatment of hemifacial spasm consisting of longitudinal splitting of the facial nerve in the cerebellopontine angle is described. Thirty-three cases have been treated with good results. Follow-up of 20 cases for 1 year or more showed no recurrence or facial paresis. One case required a second operation. The novelty of this approach lies in its effectiveness in relieving the symptoms without running the risk of overmanipulating the aberrant artery.
Adult↗
Three-dimensional quantification of "still" points during normal facial movement.
This study investigated the 3-dimensional displacement of points on the face that were thought to be still during facial movement. These points are currently used to measure displacement of moving facial regions during assessment of normal facial movement and treatment interventions following facial nerve paralysis. It is, however, unknown if these places are "still" points. The Expert Vision Motion Analysis System was used to collect and analyze data on 42 normal subjects during facial movement. No point on the face was found to be still during facial expression. However, several points were present with very small movements for each individual expression. These were termed "reference" points. These small movements may be the result of system noise, physiological tremor, skin movement, or head-holder movement during facial expressions. Future studies of the displacement of the markers during facial movement in both normal subjects and patients with facial nerve paralysis may take into account the contribution of the "reference" point displacements to the overall facial movement.
Adult↗
A limited epidemiological study of seropositive myasthenia gravis in Tayside.
Myasthenia gravis is an acquired disorder of the neuromuscular junction characterised by fatiguable weakness of the limbs, bulbar and facial muscles and may be complicated by respiratory muscle weakness and failure. One often confirms the diagnosis by a simple serological test looking for the presence of the nicotinic acetylcholine receptor antibody. However, seronegative myasthenia constitutes about 20% of cases and in the case of ocular myasthenia, only 50% will have the antibody. Therefore, the diagnosis can be less than straightforward especially if the patient presents with vague symptoms such as fatigue or presents to specialities other than neurology or ophthalmology. The fact that the diagnosis may prove to be challenging, compounded by the fact that the condition is relatively rare and that the antibody to the acetylcholine receptor is not always present, epidemiological data is often less than precise and indeed difficult to acquire. We felt it was necessary to try to establish the epidemiological data on seropositive myasthenia gravis in Tayside, (this has never been carried out) bearing in mind the above pitfalls, and see how the incidence compares with similar and previous studies.
Adult↗
Vaccine-induced polioencephalomyelitis in Scotland.
A six-month-old British female, living in Glasgow was admitted in June 1986 with a four-day history of fever and lower limb weakness following immunisation with oral polio and triple (DTP) vaccines. Examination revealed paralysis of all limbs, facial muscles and right diaphragm, scoliosis, opsoclonus and ocular flutter. Poliovirus types 1, 2 and 3, isolated from her stool specimens were all vaccine-like strains. Her serial serum IgA levels were persistently low and salivary IgA was undetectable. This appears to be the first fully authenticated case of poliovaccine damage in Scotland. It is unclear whether the selective IgA deficiency contributed to her vulnerability. It is essential to investigate elaborately and process viral isolates in every suspected case of acute poliomyelitis so as to determine the dimension and ramifications of poliovaccine damage in the UK population which is known to be rather apprehensive about vaccine dangers.
Feces↗
Seventh nerve spasm: effect of modification of cholinergic balance.
The seventh cranial nerve spasms of the face and the eyelids, including essential blepharospasm, are usually intractable and sometimes disabling. Deanol acetamidobenzoate was compared with the anticholinergic orphenadrine for relief of these spasms. Deanol cured two of 16 (12%) subjects and improved a third. Orphenadrine was much more effective, improving the conditions of 16 of 26 (62%) subjects between 57% and 100%. A crossover double-blind experiment showed high significance over a placebo.
Adult↗
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↗
Acoustic (loudspeaker) facial EMG monitoring: II. Use of evoked EMG activity during acoustic neuroma resection.
Facial electromyographic (EMG) activity was continuously monitored via loudspeaker during eleven translabyrinthine and nine suboccipital consecutive unselected acoustic neuroma resections. Ipsilateral facial EMG activity was synchronously recorded on the audio channels of operative videotapes, which were retrospectively reviewed in order to allow detailed evaluation of the potential benefit of various acoustic EMG patterns in the performance of specific aspects of acoustic neuroma resection. The use of evoked facial EMG activity was classified and described. Direct local mechanical (surgical) stimulation and direct electrical stimulation were of benefit in the localization and/or delineation of the facial nerve contour. Burst and train acoustic patterns of EMG activity appeared to indicate surgical trauma to the facial nerve that would not have been appreciated otherwise. Early results of postoperative facial function of monitored patients are presented, and the possible value of burst and train acoustic EMG activity patterns in the intraoperative assessment of facial nerve function is discussed. Acoustic facial EMG monitoring appears to provide a potentially powerful surgical tool for delineation of the facial nerve contour, the ongoing use of which may lead to continued improvement in facial nerve function preservation through modification of dissection strategy.
Adult↗
A new design for intraoperative facial nerve monitoring.
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Action Potentials↗