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The treatment of hemifacial spasm with percutaneous radiofrequency thermocoagulation of the facial nerve.

The authors present their first results with the treatment of hemifacial spasm by controlled percutaneous thermocoagulation of the facial nerve. Seven patients have been treated to date with good immediate results on the movements, although a slight paresis of the homolateral facial musculature, aesthetically acceptable, persists after treatment. A long-term follow-up at more than 10 months was achieved in only 3 patients, who showed a complete regression of the spasm with partial disappearance of the facial hemiparesis.

Adult↗

Changes in glial fibrillary acidic protein immunoreactivity in the rat facial nucleus following various types of nerve lesions.

We report about changes on astrocytes in the facial nucleus of the rat following various types of peripheral nerve lesions. Astrocyte-specific glial fibrillary acidic protein (GFAP) was labeled by immunohistochemistry and served as a marker for these changes. Increased GFAP immunoreactivity was found in the facial nucleus on the lesioned side within 2-3 days after axotomy. This change lasted longer (up to 1 year) when axon regeneration was prevented or delayed by placing a metal clip on the proximal nerve stump. Lesion of the trigeminal nerve prior to axotomy reduced the degree of GFAP immunoreactivity. No side differences were observed after botulinum toxin application.

Animals↗

[Formation of a "crow's foot pattern" in the smoke residue in homicide by forehead gunshot injury].

We report a "crowsfoot-like" pattern in the smoke marks around the entrance of a close-range bullet wound in the center of the forehead; the weapon in this homicide was a revolver. This pattern only occurs if the facial muscles that form expression are completely contracted at the moment the shooting occurs and if the victim expects the event. The wrinkles gather around the entrance of the bullet, and this wound pattern may indicate that the shot was expected by the victim and represent a piece of the mosaic that might help clarify the circumstances in a case.

Brain Injuries↗

Subperiosteal brow and midface lifts.

The subperiosteal browlift and midface lift combination is a total mobilization of the composite full-thickness soft tissues from the bony skeleton with superior suspension. The object is to correct midfacial ptosis and the "tired" look of the lateral eyelids. It is done in conjunction with a browlift so that a composite correction of the upper and midface is achieved. When indicated, a modified lower cheeklift and the usual procedures for correcting neck deformities are utilized in combination. We believe the procedure is safe and the results reported are natural and long-lasting. This review of 130 cases also stresses technical aspects and the safety of the procedure.

Aged↗

Hemifacial spasm in a child.

Hemifacial spasm in a 10-year-old child is herein reported. Computed tomography and angiography were normal. Magnetic resonance imaging showed an anomalous vascular structure, probably a redundant loop arising from AICA or PICA, which was identified at surgery. The spasm, presumably due to vascular compression at the root entry zone of the right facial nerve, promptly and completely remitted after surgical decompression, without functional deficits. Atypical clinical features, as well as pre- and postoperative neurophysiological findings supporting the microvascular compression theory, are discussed.

Cerebellum↗

Recurrent Bell's palsy. Etiology, frequency, prognosis.

The etiology, frequency and prognosis of recurrent Bell's palsy were studied in patients with peripheral paresis of n.facialis of various etiology. Fourteen (11.9%) of 117 patients with Bell's palsy had a recurrent paresis of n.facialis. Nine of these were of homolateral and five contralateral type. Seven recurrent facial paralyses in idiopathic Bell's palsy (i.e. 10.4% of the patients with idiopathic facial palsy), 3 facial palsies of viral origin (i.e. 8.8% of the patients with viral facial palsy), one in association with diabetes mellitus, one during pregnancy, one combined with positive rheumatic serological tests, and one in a case of Melkersson-Rosenthal syndrome were found. The frequency and heterogenity of etiology of recurrent facial palsies suggest a predisposing factor or immune mechanisms. In eight patients there was within 6 to 8 weeks a good, in two patients a moderate and in four patients a poor recovery of function. The greater reduction of the compound action potential of the m.orbicularis oris in recurrent homolateral facial palsy in relation to patients with single manifestation point out the greater denervation and therefore the poorer prognosis of recurrent palsies. A prophylactic decompression to prevent a third attack of recurrent facial paresis is considered.

Action Potentials↗