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PubMed1976

Function and innervation of the involuntary m. retroauricularis.

Beside the automatic, obligatory and tonic coinnervation of the involuntary m. retroauricularis in conjugate lateral gaze (oculoauricular phenomenon, nystagmus) several other physiological ways of accidental coinnervation are described. In talking, chewing, swallowing and during involuntary inspiration irregular bursts of innervation may be registered. In sleep regular rhythmic inspiratory innervation is demonstrated as well as myoclonic jerks. With reservation, an allusion is made to rem-sleep. In "nervous subjects" irregular involuntary innervation of the m. retroauricularis might serve as a measurement instrument for the involuntary somatomotor nervous system, i.e. the degree of neurotic tensity. An early myasthenic reaction is gained from the M. retroauricularis in patients with ocular forms of the disease. A common motor nucleus of abducens and facial nerve is discussed. Complementary studies are announced on the various forms of facial paralysis, strabismus and nystagmus. A further diagnostic use is presumed.

Abducens Nerve↗
PubMed1977

[Contribution to facial spasm (author's transl)].

Clinical, electromyographic, neurographic, and nystagmographic results of 20 cases of facial spasm are reported. The syndrome is discussed with reference to parabiosis of the facial nerve and the "ephapse" theory, the localization of facial nerve lesions, and possible etiologic factors of parabiotic changes. For the pathogenesis chronic and subclinical preimpairments of facial nerve axons are postulated as causing, after subsequent additional affections, an "ephaptic" transfer to neighboring fibers. Therapeutic possibilities are discussed.

Adult↗
PubMed1978

Blink reflex in facial-hypoglossal anastomosis.

The blink reflex was investigated in two patients after a facial-hypoglossal anastomosis had been performed. In each case the first component of the blink reflex could be demonstrated with normal latency on the operated side after ipsilateral supraorbital stimulation. These findings give further evidence that the first component of the blink reflex is not monosynaptic in nature. The second component of the blink reflex was distinctly retarded in the first case and was not seen at all in the second case. The second component of the blink reflex is influenced strongly by alteration of the intrabulbar and efferent part of the reflex circuits; it shows some correlation with voluntary motor activity.

Aged↗
PubMed1983

[Polyneuropathy caused by disulfiram poisoning].

Disulfiram is known to produce toxic encephalopathy and peripheral neuropathy. The case of a 37-year-old alcoholic who attempted to commit suicide by taking 22.5 g disulfiram is described. During the first 6 days after the intoxication he was stuporous and had cerebellar ataxia and dysarthric speech. Then he became comatose, and as he recovered from coma, he showed peripheral neuropathy including diplegia faciei and severe tetraparesis. Denervation potentials were detected in both facial muscles and distal muscles of the upper and lower limbs, while conduction velocity was normal. Axonal degeneration was verified by sural nerve biopsy. In addition neurofilamentous axonopathy was documented. The recovery from his paresis lasted 2 years.

Adult↗
PubMed1993

Magnetic resonance tomographic angiography in the investigation of hemifacial spasm.

Magnetic resonance angiography (MRA), combined with submillimeter magnetic resonance tomographic angiographic sections (MRTA) showed vascular compression of the 7th cranial nerve or its root exit zone (REZ) in the brain stem in 24 of 37 patients (64.86%) with hemifacial spasm. MRA alone was positive for REZ compression in only 19 (51.4%) cases, while conventional MRI was even less revealing, only 10 (27%) cases being positive.

Facial Muscles↗
PubMed1992

Magnetic resonance imaging and angiography in hemifacial spasm.

We used magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) to investigate 14 patients with unilateral hemifacial spasm (HS) and 20 controls. The relationship of the seventh and eighth cranial nerves to adjacent vessels was best visualized on the contiguous flow sensitive 3D-FISP images. Reconstruction of projectional MRA was helpful to assess the complex architecture of the vertebrobasilar system. Neurovascular contact in the facial nerve root exit zone was present in 4 of 20 controls and in 12 of 14 patients, in whom it predicted the affected side. These results support previous findings of surgical and electrophysiological investigations that local irritation of the facial nerve is the most possible explanation for HS. MRI and MRA provide vascular and brain tissue diagnosis in a single non-invasive examination and should be recommended as primary neuroradiological procedure in HS.

Aged↗
PubMed1988

Ultrastructural study of chromatolytic neurons in an adult-onset sporadic case of amyotrophic lateral sclerosis.

Ultrastructural features of chromatolytic neurons observed in a sporadic case with amyotrophic lateral sclerosis (ALS) are reported. A 70-year-old woman died of weakness and atrophy of the four limbs, bulbar and facial muscles, and hyperreflexia, of 3 1/2 years' duration. Neuronal loss was marked in the anterior horn of the spinal cord, with degeneration of the pyramidal tracts. Most of the remaining neurons showed chromatolysis. Some of the chromatolytic neurons contained faintly eosinophilic inclusions with a halo. Few spheroids were observed. Hypoglossal nuclei, nucleus ambiguus, motor nuclei of N.VII and N.V were well populated, but contained several chromatolytic neurons. Ultrastructurally, the chromatolytic neurons contained aggregates of fibrils thicker than the 10-nm neurofilaments. These fibrils were arranged randomly, and were closely associated with granular materials as well as rough endoplasmic reticulum. Neurofilamentous accumulations reported to be common in sporadic ALS were rare in this case. No Bunina body was observed.

Actin Cytoskeleton↗
PubMed1986

Correlation of the main peripheral branches of the facial nerve with the cytoarchitectonic subdivisions of the facial nucleus in the guinea pig.

Correlation of the main peripheral branches of the facial nerve with morphological subdivisions of the facial nucleus was examined in the guinea pig by the retrograde horseradish peroxidase method. The facial nucleus of the guinea pig was divided cytoarchitectonically into the dorsolateral, lateral, intermediate, medio-intermediate, medial, and ventromedial divisions; the ventromedial division was further divided into the major, dorsal and lateral parts. Six main branches of the facial nerve were identified; the zygomatico-orbital, cervical, posterior auricular, anterior auricular, superior labial, and inferior labial branches. After applying HRP to the main branches of the facial nerve, the pattern of distribution of HRP-labelled neuronal cell bodies within the facial nucleus was examined: the dorsolateral division, dorsal part of the ventromedial division, major part of the ventromedial division, lateral part of the ventromedial division, or medial division contained the cell bodies of respectively the zygomatico-orbital, cervical, posterior auricular, anterior auricular, or superior labial branches, while each of the lateral, intermediate, and medio-intermediate divisions contained the cell bodies of both the superior labial and inferior labial branches.

Animals↗
PubMed1982

The selective inhibition of hippocampal glutamic acid decarboxylase in zinc-induced epileptic seizures.

The intracerebroventricular administration of Zn2+ (0.3 mumol/10 microliters) causes epileptic seizures characterized by running fits, jumping, vocalization, fasiculation of facial muscles, myoclonic movements of the limbs and tonic-clonic convulsions. These episodes are blocked or reversed by gamma-aminobutyric acid (0.4 mumol/10 microliters). When assayed under conditions where pyridoxal phosphate was not added, the activity of glutamic acid decarboxylase decreased significantly in hippocampus from 18.9 to 15.3 and 9.7 mumols 14CO2 formed/gram proteins/20 min, 15 and 30 min following administration of Zn2+. The inhibition of glutamic acid decarboxylase by Zn2+ was selective occurring only in hippocampus and not in the hypothalamus, amygdala, caudate or thalamus. The inhibition of glutamic acid decarboxylase was not due to a reduction in the concentration of endogenous pyridoxal phosphate which remained unaltered in hippocampus following Zn2+ administration.

Animals↗
PubMed1982

Microstimulation of the supplementary motor area (SMA) in the awake monkey.

The supplementary motor area of three Macaca fascicularis was mapped using intracortical microstimulation (ICMS). Both forelimb and hindlimb movements were evoked using currents of 30 microA or less. However, thresholds for evoking movements were higher than those in the primary motor cortex. Proximal motor effects predominated, but distal joint movements were also elicited. Forelimb points were clustered in mesial cortex of area 6, anterior to the precentral hindlimb and tail region. Distal joint effects were located deep in the cortex, intermingled with proximal effects. Hindlimb response which were less spatially localized, were found both ventral to the forelimb area, in the dorsal bank of the cingulate sulcus, and in mesial cortex, well anterior to area 4. No movements of facial muscles were elicited. Injections of HRP were made into the spinal cord at the cervical level in two animals and the lumbar level in the third one. An area of labelled cells was seen in mesial area 6 which corresponded closely to the region from which ICMS effects were elicited. No movements were evoked from the anterior portions of the fundal region of the cingulate sulcus which were also labelled.

Animals↗
PubMed1991

Technical improvements in the lateral suboccipital approach for neurovascular decompression of the trigeminal and facial nerves.

Some refinements of the surgical procedure are described in 12 patients (five females, seven males) operated on for neurovascular decompression (ND) in the presence of trigeminal neuralgia and hemifacial spasm. The patients were operated upon in the supine position, in which the use of a lumbar drainage facilitates the dissection from the beginning. The lateral suboccipital approach was performed by means of a semi-osteoplastic craniotomy with the use of bone chips to close the bone defects so that a good cosmetic effect could be achieved.

Adult↗
PubMed1996

Intra-operative monitoring by facial electromyographic responses during microvascular decompressive surgery for hemifacial spasm.

The facial electromyographic response was monitored intraoperatively in 40 patients with hemifacial spasm who were operated on by microvascular decompression of the facial nerve. All 40 patients showed an abnormal facial electromyographic response (lateral spread response) with a latency of about 10 msec after stimulation. The abnormal response resolved before decompression in 22, resolved immediately with decompression in 16, and failed to resolve in two. Of the 38 patients in whom the abnormal response disappeared during surgery, 36 were postoperatively free from hemifacial spasm and two had mild hemifacial spasm. The two patients in whom the lateral spread response did not disappear during surgery showed persistent hemifacial spasm. In conclusion. Disappearance of the lateral spread response during surgery correlated with the absence of hemifacial spasm in the early postoperative period. The prognosis of hemifacial spasm was good in cases in whom the lateral spread response disappeared. Therefore, the authors think that intra-operative facial electromyography is very useful in assessing the efficacy of microvascular decompression and in predicting the prognosis of hemifacial spasm.

Adult↗
PubMed1997

Reanimation of the paralyzed face with new gold weight implants and Goretex soft-tissue patches.

Although dynamic reconstruction procedures are preferred for treating patients with complete facial paralyses, static procedures are useful for various conditions. One such technique involves the implantation of gold weights into the upper eyelid. We have reported our experiences with 58 patients who underwent gold weight implantation for rehabilitation of eyelid closure with satisfactory results. To obtain better cosmetic results we developed newly shaped thinner weights. Four instead of three perforations in each weight enable better fixation to soft tissue. Since 40% of all cases also required additional surgery to rehabilitate other portion of the face, polytetrafluoroethylene (Goretex) soft-tissue patches were used for suspension to help correct midfacial and perioral asymmetry. From 1990 to 1996, 22 patients underwent this technique under local or general anesthesia. Except for 2 patients, no complications were observed. Overall, both gold implants and Goretex patches were found to provide good results in patients selected for facial reanimation.

Adolescent↗
PubMed1986

Freeman-Sheldon syndrome: report of three cases and the anaesthetic implications.

The Freeman-Sheldon syndrome is a rare congenital myopathy and dysplasia. Fibrotic contractures of the facial muscles result in the characteristic "whistling face". Difficulties with intubation may be attributed in part to microstomia and micrognathia. In addition to other deformities, limb myopathy results in ulnar flexion contractures of the hand and equinovarus/valgus deformities of the feet. Intravenous access may be difficult because of limb deformities and thickened subcutaneous tissues. Limbs may be encased in plaster casts or splints limiting the available sites for venepuncture. Three case reports of children with Freeman-Sheldon syndrome are presented. The pathophysiology and anaesthetic problems encountered are discussed.

Anesthesia↗
PubMed2004

[Diagnostics of diseases and the function of the facial nerve].

The facial nerve has a complicated course from the brainstem to the periphery. It not only contains motor, but also secretory, sensory, and sensitive fibres. Thus, the functional measure of symptoms can be multi-faceted. The nerve is not directly accessible over an extensive distance because of its long course through the temporal bone. Therefore, diagnostics of nerve function and the differential diagnostics of its diseases could be a great challenge for the otolaryngologist. In this review, the most important methods for clinical examination, electrodiagnostics, and modern imaging techniques are critically surveyed. In addition, the significance of facial nerve monitoring for surgery in the cerebello-pontine angle, parotid surgery, and ear surgery is presented.

Diagnosis, Differential↗