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      Surgical and conservative methods for restoring impaired motor function - facial nerve, spinal accessory nerve, hypoglossal nerve (not including vagal nerve or swallowing)

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          Abstract

          The present review gives a survey of rehabilitative measures for disorders of the motor function of the mimetic muscles (facial nerve), and muscles innervated by the spinal accessory and hypoglossal nerves. The dysfunction can present either as paralysis or hyperkinesis (hyperkinesia). Conservative and surgical treatment options aimed at restoring normal motor function and correcting the movement disorders are described. Static reanimation techniques are not dealt with. The final section describes the use of botulinum toxin in the therapy of dysphagia.

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

          P Jannetta, David Albin, M Abbasy … (1977)
          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.
          Article 0 comments Cited 65 times – based on 0 reviews     Review now
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            Microvascular decompression for hemifacial spasm.

            E-h Jho, Peter J. Jannetta, M Larkins … (1995)
            The authors report the results of 782 microvascular decompression procedures for hemifacial spasm in 703 patients (705 sides), with follow-up study from 1 to 20 years (mean 8 years). Of 648 patients who had not undergone prior intracranial procedures for hemifacial spasm, 65% were women; their mean age was 52 years, and the mean preoperative duration of symptoms was 7 years. The onset of symptoms was typical in 92% and atypical in 8%. An additional 57 patients who had undergone prior microvascular decompression elsewhere were analyzed as a separate group. Patients were followed prospectively with annual questionnaires. Kaplan-Meier methods showed that among patients without prior microvascular decompression elsewhere, 84% had excellent results and 7% had partial success 10 years postoperatively. Subgroup analyses (Cox proportional hazards model) showed that men had better results than women, and patients with typical onset of symptoms had better results than those with atypical onset. Nearly all failures occurred within 24 months of operation; 9% of patients underwent reoperation for recurrent symptoms. Second microvascular decompression procedures were less successful, whether the first procedure was performed at Presbyterian-University Hospital or elsewhere, unless the procedure was performed within 30 days after the first microvascular decompression. Patient age, side and preoperative duration of symptoms, history of Bell's palsy, preoperative presence of facial weakness or synkinesis, and implant material used had no influence on postoperative results. Complications after the first microvascular decompression for hemifacial spasm included ipsilateral deaf ear in 2.6% and ipsilateral permanent, severe facial weakness in 0.9% of patients. Complications were more frequent in reoperated patients. In all, one operative death (0.1%) and two brainstem infarctions (0.3%) occurred. Microvascular decompression is a safe and definitive treatment for hemifacial spasm with proven long-term efficacy.
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              Motor reorganization after upper limb amputation in man. A study with focal magnetic stimulation.

              L. G. Cohen, S Bandinelli, T Findley … (1991)
              To evaluate reorganization in motor pathways following amputation, we studied motor evoked potentials (MEPs) to transcranial magnetic stimulation in 7 patients with unilateral upper limb amputations, a patient with congenital absence of a hand, and 10 normal subjects. Electromyographic recordings were made from biceps and deltoid muscles immediately proximal to the stump and the same contralateral muscles. Magnetic stimulation was delivered by a Cadwell MES-10 magnetic stimulator through a 'figure eight' magnetic coil over scalp positions separated by 1-2.5 cm. Maximal M responses were elicited by peripheral nerve stimulation at Erb's point. The amplitude of MEPs was expressed both as absolute values and as a percentage of maximal responses to peripheral nerve stimulation. Threshold for activation of muscles ipsilateral and contralateral to the stump and the region of excitable scalp positions were also determined in 7 patients. Magnetic scalp stimulation induced a sensation of movement in the missing hand or fingers in the patients with acquired amputation, but failed to do so in the patient with congenital absence of a limb. It evoked larger MEPs, recruited a larger percentage of the motoneuron pool, and elicited MEPs at lower intensities of stimulation in muscles ipsilateral to the stump than in contralateral muscles. Muscles ipsilateral to the stump could be activated from a larger area than those contralateral to the stump. These results are compatible with cortical or spinal reorganization in adult human motor pathways targeting muscles proximal to the stump after amputations.
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                Author and article information

                Journal
                Journal ID (nlm-ta): GMS Curr Top Otorhinolaryngol Head Neck Surg
                Journal ID (publisher-id): GMS Curr Top Otorhinolaryngol Head Neck Surg
                Title: GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery
                Publisher: German Medical Science
                ISSN (Electronic): 1865-1011
                Publication date (Electronic): 28 September 2005
                Publication date Collection: 2005
                Volume: 4
                Electronic Location Identifier: Doc10
                Affiliations
                [1 ]Otorhinolaryngological Clinic, University of Göttingen Medical School
                Author notes
                *To whom correspondence should be addressed: R. Laskawi, Universitäts-HNO-Klinik, Robert-Koch-Str. 40, 37075 Göttingen, Tel.: 0551-392801, Fax: 0551-392809, E-mail: rlaskawi@ 123456med.uni-goettingen.de
                Article
                Publisher ID: cto000016
                PMC ID: 3201015
                PubMed ID: 22073058
                SO-VID: 8453a70d-d146-49ae-b2f1-499185187f75
                Copyright © Copyright © 2005 Laskawi et al.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free to copy, distribute and transmit the work, provided the original author and source are credited.

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                Subject: Article

                ScienceOpen disciplines: Surgery
                Keywords: surgical and conservative therapy,movement disorders,spinal accessory nerve,facial nerve,hypoglossal nerve
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: surgical and conservative therapy, movement disorders, spinal accessory nerve, facial nerve, hypoglossal nerve

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