Facial N. Palsy
BJ, Rubinstein JT, Gidley P, et al (Univ of Iowa, Iowa City)
Surgical Management of Bell’s Palsy
Laryngoscope 109: 1177-1188, 1999
The association of poor outcome of the Bell’s Palsy recovery and electrical testing is studied.
Electroneurography (ENOG) combined with voluntary electromyography (EMG) identify patients most likely to return to normal and also patients which are likely to develop long term sequelae.
Surgical decompression medical to the geniculate ganglion significantly improved the palsy to near normal in those identified patients (likely to have poor return of function). Decompression must be done within 2 weeks of the onset of total paralysis.
M.M. Paparella: This prospective study began in 1982, when control subjects were not combined with acyclovir and steroids. Now with this combination it has considerably improved the outcome, it remains to be seen whether surgery is superior to these drugs as far as outcome is considered.
Jahrsdoerfer, PR Lambert (Univ of Virginia, Charlottesville)
Facial Nerve Injury in Congenital Aural Atresia Surgery.
Am J Otol 19:283-287, 1998.
Fear of injury to the facial nerve is a great deterrent to atresia surgery. Data on more than 1000 patients who underwent surgery for congenital aural atresia, were retrospectively reviewed. Ten patients sustained a facial nerve injury during atresia surgery.
The facial nerve is displaced in 25% to 30% patients with congenital aural atresia. For less experienced surgeons, the facial nerve is at greatest risk in the inferoposterior part of atretic bone, just lateral to the middle ear. For more experienced surgeons, patients with low-set ears canal stenosis and an accompanying cholesteatoma are at risk for facial nerve injury.
Ryu, s Yamamoto, K Sugiyama, et al (Hamamatsu Univ, Shizuoka, Japan; Seirei Mikatabara Gen Hosp, Hamamatsu, Shizuoka, Japan)
Hemifacial Spasm Caused by Vascular Compression of the Distal Portion of the Facial Nerve: Report of Seven Cases.
J Neurosurg 88:605-609, 1998.
In a recent series of 142 patients with Hemifacial Spasm (HFS), 5% (7 patients) were found to have compression of a distal portion of the seventh cranial nerve combined with compression at its root-entry zones (REZ) or compression of a distal portion of the nerve alone.
In all 7 patients, vascular compression distal to the REZ of the facial nerve caused HFS. Symptoms resolved when neurovascular decompression was performed at these sites.
Although the REZ is the primary site of vascular compression causing HFS in most cases, in these 7 cases compressed sites were definitely NOT at the REZs.