Reanimation in facial palsy

Abstract

THIS report is of the use in fifteen cases of the muscles of mastication to produce movement. Eleven palsies followed removal of acoustic neuromata, two were Bell's palsies, one resulted from injury to the facial nerve in the mastoid bone, and one followed removal of a carcinoma from the external auditory canal. All were adults except the case of injury to the nerve in the mastoid process. Prior to this series, reanimation had been attempted by nerve grafts in four cases but without success. Otherwise restoration of symmetry at rest had been the standard procedure in all cases of facial paralysis. The choice of the time at which to attempt a reanimation operation is difficult, and should be influenced by the cause of the palsy. When it is reasonably certain that spontaneous recovery cannot be expected, operation should be performed forthwith. Acoustic neuromata fall into this group since recovery is unlikely to occur or at best to be very slight. Similarly, palsies following injury to the nerve in which repair has been impossible or unsatisfactory should be reanimated forthwith. Bell's palsy presents most difficulty. In my opinion, unless an electromyograph and an experienced interpreter of its results are available, it is worth postponing operation and persisting with daily galvanism for as long as a year, even in the presence of a reaction of degeneration. Only in this way can one be certain of avoiding operative damage which might be permanently harmful to muscles or nerve fibres still capable of recovery ; such damage might well make the difference between an acceptable and an unacceptable degree of recovery. If, however, electro-myography fails to detect any signs of recovery after six months there is little hope of avoiding operation by further delay. Interference is certainly justifiable if the fibrillary twitchings of muscular degeneration are heard. Faradism has no place in the treatment of a recovering lesion except, perhaps, to assist in teaching a child to grimace and to practise voluntary movements. I f a policy of delay is adopted it is very important to resist passive stretching of the paralysed muscles. This may be achieved either by means of an acrylic appliance fitted to a dental cap splint or with a hook slung from the ear. A cap splint cannot be fitted to milk teeth, and in young children reliance will therefore have to be placed upon the hook.