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At least 1,405 records · Page 78Linked to original sources
PubMed1993

Result of decompression surgery in late-stage severe facial paralysis.

We investigated the usefulness of decompression surgery in the treatment of the facial nerve in 23 patients with severe complete facial paralysis regardless of etiology. All patients were followed up for at least one year after onset. Nine patients underwent decompression surgery within a month of onset (Group A), 10 underwent surgery at a later time (Group B), and 4 did not receive surgery (Group C). In Group A, 2 patients showed satisfactory recovery and 2 fair recovery. In Group B, 4 patients showed satisfactory outcome, and one patient who underwent surgery 131 days after onset showed fair outcome. No patient in Group C showed satisfactory or fair recovery. There were no significant differences among the three groups in the percentage showing sequelae after treatment. We conclude that decompression surgery is indicated even for patients with severe facial paralysis who have a history of palsy of 2 months' or more duration.

Facial Muscles↗
PubMed1994

Clinical advantages of electroneurography in patients with Bell's palsy within two weeks after onset.

One of the advantages of applying ENoG to patients with Bell's palsy resides in its quantitative determinability for the axons which do not undergo wallerian degeneration. The relation between the ENoG value each day after onset and during the recovery process was investigated in 551 patients with Bell's palsy within 2 weeks after onset in order to consider the diagnostic value of ENoG. It was discovered that ENoG on patients with Bell's palsy makes it possible to reveal the extent of wallerian degeneration by 7 days after the onset of palsy. Accordingly, treatment of Bell's palsy should be administered within the above 7 days; as early as 8 days after onset, exact prognostic diagnosis and judgment of therapeutic effect from ENoG values were concluded to be practicable.

Action Potentials↗
PubMed1994

Facial nerve palsy in children: clinical aspects of diagnosis and treatment.

Eighty-two children with facial palsy aged less than 6 years were examined. Sixty-four cases, excluding patients with congenital and traumatic palsy, were distributed through the ages, but a predominant tendency to symptomatic palsy for cases aged less than 2 years was observed. Facial movement scoring was not practical in prognostic diagnosis in cases aged under 4 years, while ENoG was useful in all age-groups. Of 58 cases of acute peripheral facial palsy, 29 were observed clinically but given no treatment, 9 were given steroids, and 16 were given vitamins and other drugs. In the patients with acute peripheral facial palsy in whom a follow up study was performed, 56 cases (96.6%) showed complete recovery. The time of recovery was independent of treatment. Facial palsy in children is considered to have a good prognosis regardless of treatment. Steroid administration thus does not appear to be necessary in children with acute facial palsy.

Acute Disease↗
PubMed1994

Electrophysiological study on the pathology of synkinesis after facial nerve paralysis.

By conducting electrophysiological tests on patients with facial nerve paralysis, the characteristics of synkinesis and the mechanisms of its manifestations were examined. The subjects were 114 patients of facial nerve paralysis on whom electroneurography (ENoG) and the blink reflex were conducted. As a result, it was indicated that synkinesis could be determined by the blink reflex, and that the frequency of synkinesis manifestation increased with severity of paralysis. From examination during the latent period, early component (SI) recognized in the cases of synkinesis was found to be the waveform which passed the fibers with a slow conducting speed. It was not related to the degree of degeneration of nerves for either the severe or light degeneration of nerves. From the above result it was concluded that synkinesis is generated as a misdirection of reproduced nerves.

Adolescent↗
PubMed1984

Tinnitus--incidence and handicap.

A questionnaire investigation, comprising 1091 patients, was conducted at a hearing centre. A majority of patients, 59%, claimed that they were troubled by tinnitus. A strong correlation was found between the laterality of tinnitus and that of subjective hearing loss. Neither a greater degree of hearing loss nor a longer duration of tinnitus was shown to be associated with more severe tinnitus. Among patients with both subjective hearing loss and tinnitus, 23% stated that tinnitus was the greater problem and 38% that their tinnitus and hearing loss were equally troublesome. The corresponding figures for patients with hearing impairment of such a degree that a hearing aid had been fitted were 9% and 41% respectively. Stress symptoms such as headache, tension of facial muscles and sleep disturbances were correlated to tinnitus. Psychosomatic complaints should therefore be taken into account in the treatment of tinnitus. Of patients with tinnitus, 83% were interested in obtaining treatment for their tinnitus. It is postulated that the previously reported predominance of left-sided tinnitus is due to a higher frequency of left-sided hearing impairment. A majority of patients with tinnitus and hearing impairment regarded their tinnitus as the major problem. Efforts towards investigation and treatment of tinnitus might therefore considerably improve the prospects for hearing rehabilitation.

Hearing Aids↗
PubMed1993

Hemifacial spasm: early postoperative normalization of blink reflex latency.

Electrophysiological improvement in the blink reflex latency after neurovascular decompression of the facial nerve in patients with hemifacial spasm is believed to be related to remyelination and occurs 2-8 months after surgery. We report a patient with hemifacial spasms for 3 years, in whom the increased blink reflex latency returned to normal within a week after surgery. This suggests that compression without demyelination may be responsible for increased blink reflex latency in some of the patients with hemifacial spasms.

Adult↗
PubMed1993

Asthma and emotion: a review.

This review of the empirical literature on the relationship between asthma and emotion presents an explanatory model of the connection between them. Asthmatics tend to report and display a high level of negative emotion, and asthma exacerbations have been linked temporally to periods of heightened emotionality. Causality may be bidirectional. Hypothesized mediators for the relationship between asthma and emotionality include vagal and alpha-sympathetic hyperreactivity, predominant obstruction in the larger airways, individual response stereotypy, direct effects of emotion-related facial muscle tension on the airways, the emotional effects of asthma medications, heightened respiratory drive, and hyperventilation. Predictions are presented for research on this model of asthma and emotion, and for the psychological treatment of asthma.

Asthma↗
PubMed1977

Etiology and definitive microsurgical treatment of hemifacial spasm. Operative techniques and results in 47 patients.

The clinical and operative findings are reviewed in 47 patients with intractable hemifacial spasm. The syndrome was classical in its features in 45 patients and atypical in two. Mechanical compression distortion of the root exit zone of the facial nerve was noted in all 47 patients. In 46 the abnormality was vascular cross-compression, usually by an arterial loop. In one patient, a small cholesteatoma was discovered and removed. Morbidity and postoperative results are discussed.

Adult↗
PubMed1984

Tic convulsif: results in 11 cases treated with microvascular decompression of the fifth and seventh cranial nerves.

The syndrome of tic convulsif consists of ipsilateral concurrent trigeminal neuralgia and hemifacial spasm. Since Cushing's 1920 description of this syndrome in three patients, 37 additional cases have been reported in the world literature. Of the 15 with adequate operative descriptions, 10 had vascular abnormalities and five had tumors. The authors report 11 cases of tic convulsif treated by microvascular decompression of both the fifth and seventh cranial nerves. At operation, 21 of 22 nerves were found to have root entry zone vascular compression. One trigeminal nerve was considered normal. One seventh nerve had a tumor displacing the anterior inferior cerebellar artery into its root entry zone. The average follow-up period in this series was 6 years 2 months (range 1 to 8 1/2 years). Eight patients (73%) were pain-free, two (18%) had frank recurrences, and one (9%) had mild discomfort. Eight patients (73%) were totally free of facial spasm, and two others (18%) had only a trace of residual spasm. These results are comparable to those achieved by treating the individual syndromes with microvascular decompression. Therefore, microvascular decompression of both the fifth and seventh cranial nerves is recommended as the treatment of choice in tic convulsif.

Aged↗
PubMed1991

Familial hemifacial spasm associated with arterial compression of the facial nerve. Case report.

This report of an 88-year-old woman with familial hemifacial spasm includes the first published postmortem description of hemifacial spasm with cross-compression of the seventh cranial nerve root exit zone by a redundant loop of the anterior inferior cerebellar artery and associated vascular plexus. Histological examination of the seventh and eighth cranial nerve complex suggested nerve degeneration because increased numbers of corpora amylacea were present just distal to the compression concavity. There was no evidence of demyelination or gliosis of the nerve. This case suggests that vascular compression of the nerve root exit zone is an important condition in the etiology of most of these cases. This is the third reported case of familial hemifacial spasm; to date, all such patients have had left facial involvement. The family pedigree in this case suggests a pattern of autosomal-dominant inheritance with partial penetrance. The genetic basis for familial hemifacial spasm may involve anatomical variants or anomalies of the posterior circulation, since both posterior inferior cerebellar arteries were congenitally absent in this case.

Aged↗
PubMed1991

Microvascular decompression for hemifacial spasm. Patterns of vascular compression in unsuccessfully operated patients.

To determine the causative factors of unsuccessful microvascular decompression for hemifacial spasm, the follow-up results in 53 patients were assessed retrospectively. The mean follow-up period was 36 months. There were 32 patients who had compression of the seventh cranial nerve ventrocaudally by an anterior inferior cerebellar artery (AICA) or a posterior inferior cerebellar artery. Of these 32 patients, 30 (94%) had excellent postoperative results. Of 14 patients with more severe compression by the vertebral artery, nine (64%) had excellent results, three (21%) had good results, and two (14%) had poor results; in this group, three patients with excellent results experienced transient spasm recurrence. There were seven patients in whom the meatal branch of the AICA coursed between the seventh and eighth cranial nerves and compressed the dorsal aspect of the seventh nerve; this was usually associated with another artery compressing the ventral aspect of the nerve ("sandwich-type" compression). Of these seven patients, five (71%) had poor results including operative failure in one and recurrence of spasm in four. The authors conclude that the clinical outcome was closely related to the patterns of vascular compression.

Adult↗
PubMed1992

Oblique sagittal magnetic resonance imaging visualizing vascular compression of the trigeminal or facial nerve.

An oblique sagittal magnetic resonance (MR) imaging method was developed to provide better visualization of vascular compression of nerves. The MR images of 12 patients with trigeminal neuralgia and 24 with hemifacial spasm were analyzed. The oblique sagittal views were obtained along the nerve identified by the axial view at an angle of 105 degrees between the line along the dorsal brain stem and the line along the margin of the pontomedullary junction (in patients with hemifacial spasm) or by the midsagittal view through the midpons (in patients with trigeminal neuralgia). The T1- and T2-weighted, proton-density, and/or gradient-echo MR images were evaluated to optimize imaging conditions. The oblique sagittal gradient-echo MR image most clearly visualized vascular compression of the nerves as high-intensity lines in six patients with trigeminal neuralgia, which was confirmed intraoperatively in four. Fifteen (75%) of 20 oblique sagittal gradient-echo MR images demonstrated vascular compression of the facial nerves in patients with hemifacial spasm; 12 of these were confirmed intraoperatively. The control study used 15 oblique sagittal gradient-echo MR images of nonaffected contralateral and normal sites. Four false-positive findings were found. Oblique sagittal gradient-echo MR images are a useful planning aid, allowing differential diagnosis prior to microvascular decompression in trigeminal neuralgia and hemifacial spasm.

Adult↗
PubMed1994

Coexistent trigeminal neuralgia, hemifacial spasm, and hypertension: preoperative imaging of neurovascular compression. Case report.

The case is reported of a 60-year-old woman with left-sided trigeminal neuralgia, hemifacial spasm, and hypertension. Compression of the left trigeminal, facial, and vagus nerves by the anterior and posterior inferior cerebellar arteries and a persistent trigeminal artery variant were demonstrated by magnetic resonance angiography using a novel sequence. At operation the angiographic appearances were confirmed, and decompression was performed with the placement of polyvinyl sponge at all three levels. Postoperatively, the patient had complete relief from the trigeminal neuralgia and hemifacial spasm and has sustained normotension without medication.

Arteries↗
PubMed1995

Diagnosis of vascular compression in facial spasm by stereoscopic short-range magnetic resonance angiography. Technical note.

The authors describe the use of stereoscopic short-range magnetic resonance (MR) angiography to diagnose whether and by what means the brainstem is compressed in a case of facial spasm. The MR images were obtained on a 1.5-tesla imaging system with three-dimensional time-of-flight pulse sequence (repetition time 39 msec, echo time 9 msec). Six-source MR images, in which the internal acoustic meatuses were described, were processed using a maximum-intensity projection technique to reconstruct the MR angiograms. The internal acoustic meatuses, the posterior fossa, and the nearby arteries are shown on a single MR angiogram. When two MR angiograms with projection angles 10 degrees apart are placed side by side and observed through polarized glasses, a stereoscopic view of the compressing artery can easily be seen.

Brain Stem↗
PubMed1996

Schwannoma arising from the intermediate nerve and manifesting as hemifacial spasm. Case report.

This 35-year-old man presented with left facial spasm that had persisted for 10 months. Microvascular decompression was performed to relieve the symptom. No responsible vessel could be identified during surgery, but a small mass seeming to arise from the intermediate nerve and compressing the seventh cranial nerve was removed. The histological diagnosis was Antoni-B type schwannoma. This unique case of schwannoma arising from the intermediate nerve was recognized by means of an operative microscope, and supports the idea that portions of the seventh nerve schwannoma originate from the components of the intermediate nerve.

Adult↗
PubMed1997

Hearing preservation in the removal of intracanalicular acoustic neuromas via the retrosigmoid approach.

In a series of 514 consecutive operations for complete excision of acoustic neuromas, 94 procedures were performed via a retrosigmoid approach to preserve the patient's hearing. Twenty-six of these procedures (5.1%) were performed in cases of intracanalicular tumor and 68 (13.2%) were for larger lesions in which most of the tumor was located medial to the porus acusticus within the cerebellopontine angle. Preservation of useful hearing was achieved in 13 (50%) of 26 patients with intracanalicular tumors and in 20 (29%) of 68 with larger tumors. A trend toward higher success rates in intracanalicular tumors appears to be present, although the difference is not statistically significant (p = 0.09). Normal or near normal facial function (House and Brackmann Grades I and II) was present postoperatively in 25 (96%) of 26 patients. Indications for treatment of intracanalicular acoustic neuromas are considered and treatment alternatives are reviewed. Results from other series reporting removal of intracanalicular acoustic neuromas are considered with respect to hearing conservation and postoperative facial nerve function. Surgical excision of intracanalicular acoustic neuromas in otherwise healthy patients appears to be warranted if preservation of useful binaural hearing is considered a worthwhile objective and if perioperative morbidity can be maintained at an acceptably low level. The retrosigmoid approach is familiar to all neurosurgeons and offers a comparable success rate for hearing conservation and probably a superior outcome in terms of facial nerve function when compared with the middle fossa approach.

Action Potentials↗
PubMed1999

New technique of side-to-end hypoglossal-facial nerve attachment with translocation of the infratemporal facial nerve.

OBJECT: The goal of this study was to assess the clinical results of hypoglossal-facial nerve attachment (HFA), which was primarily performed in patients following excision of tumors of the cerebellopontine angle. In six of the patients a new side-to-end procedure was used. METHODS: The authors have performed a retrospective study of 33 patients who underwent HFA, including 24 classic end-to-end, three May, and six side-to-end procedures. For the latter procedure, a hemihypoglossal-facial nerve attachment was performed by rerouting the intratemporal facial nerve; this avoided the jump-cable graft used in May's technique. The goal of the new procedure is to reduce the incidence of morbidity due to hemilingual paralysis (difficulty in chewing, speaking, and swallowing). The incidence of hemilingual paralysis was evaluated based on the findings of a questionnaire that was completed by the patients. The patient's facial mobility was assessed using the House and Brackmann grading system and the author's analytic scoring system. CONCLUSIONS: The HFA offers good functional results. Of the 28 cases evaluated, nine had House and Brackmann Grade III, 17 Grade IV, and only two Grade V at 18 months. When the new technique of side-to-end hemihypoglossal-facial nerve attachment was used, there was considerable reduction, if not complete disappearance, of lingual morbidity and the facial functional results were constant and satisfactory: there were five patients with House and Brackmann Grade III and one with Grade IV, and their mean percentage of facial mobility was 43.3%.

Adolescent↗