Decompression of the facial nerve in cases of hemifacial spasm

Kettel, Karsten

doi:10.1590/S0004-282X1954000400004

Abstract

Among 11 patients a complete cure was obtained in one case, a fair result in 4 cases, while in 6 cases the effect of the operation has only been temporary and full recurrence has taken place. Even if decompression has thus resulted in a few recoveries and improvements, the results in the majority of cases have been disappointing. Everything points to hemifacial spasm being due to a disorder of the lower motor neuron. Intracranial lesions in the vicinity of the facial nerve are known to have resulted in irritation and spasm. It may be perfectly true that the majority of cases of hemifacial spasm are due to a lesion, the nature of which may vary, in the Fallopian canal near the stylomastoid foramen, not least the postparalytic following Bell's palsy. But the disappointing results of decompression seems to indicate that at the time of operation irreparable damage to the nerve has in the majority of cases been already done. Consequently I gave up decompression in cases of hemifacial spasm some years ago. Good results from injections of alcohol into the nerve have been reported13 but I prefer selective sections of the branches to the muscles involved as described by German and Greenwood8.

Chief-Surgeon, Frederiksborg County Hospital, Hillerod, Denmark

ABSTRACT

Among 11 patients a complete cure was obtained in one case, a fair result in 4 cases, while in 6 cases the effect of the operation has only been temporary and full recurrence has taken place. Even if decompression has thus resulted in a few recoveries and improvements, the results in the majority of cases have been disappointing.

Everything points to hemifacial spasm being due to a disorder of the lower motor neuron. Intracranial lesions in the vicinity of the facial nerve are known to have resulted in irritation and spasm. It may be perfectly true that the majority of cases of hemifacial spasm are due to a lesion, the nature of which may vary, in the Fallopian canal near the stylomastoid foramen, not least the postparalytic following Bell's palsy.

But the disappointing results of decompression seems to indicate that at the time of operation irreparable damage to the nerve has in the majority of cases been already done. Consequently I gave up decompression in cases of hemifacial spasm some years ago.

Good results from injections of alcohol into the nerve have been reported¹³ but I prefer selective sections of the branches to the muscles involved as described by German and Greenwood⁸.

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BIBLIOGRAPHY

1. Alajouanine, Th.; Thurel, R. - Les spasmes de la face et leur traitement. Paris Méd., 114:165, 1939.

2. Audibert, V.; Mattei, C; Paganelli, A. - La paralysie faciale périphérique dite "a frigore" est fonction d'une atteinte artérielle des vasa nervorum. Presse Méd., 44:1049, 1936.

3. Ballance, C; Duel, A. B. - The operative treatment of facial palsy. Arch. Otolaryng., 15:1-70 (January) 1932.

4. Cawthorne, T. - a) Peripheral facial paralysis: some aspects of its pathology. Laryngoscope, 56:653, 1946; b) The rôle of surgery in the investigation and treatment of peripheral facial palsy. Lancet, pg. 1219 (June 21) 1952.

5. Ehni, G.; "Woltman, H. W. - Hemifacial spasm: review of one hundred and six cases. Arch. Neurol, a. Psychiat., 53:205-211 (March) 1945.

6. Findlay, J. P. - Facial Paralyse. Angus & Robertson Ltd., 89 Castlereagh St., Sydney, 1950.

7. Flodgren, E. - Contributions to the surgery of facial palsy. Acta Otolaryng., suppl. 74, pg. 188, 1948.

8. German, W. J. - Surgical treatment of spasmodic facial tic. Surgery, 11:912-914, 1942.

9. Greenwood Jr., J. - The surgical treatment of hemifacial spasm. J. Neurosurg., 3:506, 1946.

10. Grindstein, A. - Über Contracturen des N. facialis. Zentralblatt f. Hals-, Nasen- u. Ohrenh., 8:299, 1926.

11. Hall, A. - Pathology of Bell's palsy. Arch. Otolaryng., 54: 475 (November) 1951.

12. Hilger, J. A. - The nature of Bell's palsy. Laryngoscope, 59: 228-235 (March) 1949.

13. Jessen, H. - Oni hemispasmus facialis og dens behandling. Ugeskr. f. Laeger, no. 42, pg. 1081, 1940.

14. Kettel, K. - a) Bell's palsy. Arch. Otolaryng., 46:427 (October) 1947; b) Melkersson's syndrome. Arch. Otolaryng., 46:341 (September) 1947; c) Om den sakaldte rheumatiske facialisparese set fra et kirurgisk synspunkt. Ugeskr. f. Laeger, no. 10, pg. 353, 1953.

15. Lathrop, F. D. - Discussion of paper by Williams, Lambert and Woltman²⁰.

16. Melkersson, E. - Hygiea, 90:737, 1928

17. O'Donnell, M. C. - Hemifacial spasm. Ann. Otol., Rhin. a. Laryngol., 62:969 (December) 1953.

18. Skoog, T. - Personal communication to the author.

19. Sullivan, J. A. - Recent advances in the surgical treatment of facial paralysis and Bell's palsy. Laryngoscope, 62:449 (May) 1952.

20. Williams, H. L.; Lambert, E. H.; Woltman, H. W. - The problem of synkinesis and contracture in cases of hemifacial spasm and Bell's palsy. Ann. Otol., Rhin. a. Laryng., 61:850, 1952.

21. Woltman, H. W.: Williams, H. L.; Lambert, E. H. - An attempt to relieve hemifacial spasm by neurolysis of the facial nerves. Proc. Staff Meet., Mayo Clin., 26:236-240 (June 6) 1951.

Relatório apresentado ao XIX Congresso Internacional de Oto-Neuro-Oftalmologia, reunido em São Paulo em 11-17 de junho de 1954, subordinado ao 2º tema oficial: Fisiopatologia do nervo facial.

Postkonto 30279 - Hillerod, Denmark.

1. Alajouanine, Th.; Thurel, R. - Les spasmes de la face et leur traitement. Paris Méd., 114:165, 1939.
2. Audibert, V.; Mattei, C; Paganelli, A. - La paralysie faciale périphérique dite "a frigore" est fonction d'une atteinte artérielle des vasa nervorum. Presse Méd., 44:1049, 1936.
3. Ballance, C; Duel, A. B. - The operative treatment of facial palsy. Arch. Otolaryng., 15:1-70 (January) 1932.
4. Cawthorne, T. - a) Peripheral facial paralysis: some aspects of its pathology. Laryngoscope, 56:653, 1946;
b) The rôle of surgery in the investigation and treatment of peripheral facial palsy. Lancet, pg. 1219 (June 21) 1952.
5. Ehni, G.; "Woltman, H. W. - Hemifacial spasm: review of one hundred and six cases. Arch. Neurol, a. Psychiat., 53:205-211 (March) 1945.
6. Findlay, J. P. - Facial Paralyse. Angus & Robertson Ltd., 89 Castlereagh St., Sydney, 1950.
7. Flodgren, E. - Contributions to the surgery of facial palsy. Acta Otolaryng., suppl. 74, pg. 188, 1948.
8. German, W. J. - Surgical treatment of spasmodic facial tic. Surgery, 11:912-914, 1942.
9. Greenwood Jr., J. - The surgical treatment of hemifacial spasm. J. Neurosurg., 3:506, 1946.
10. Grindstein, A. - Über Contracturen des N. facialis. Zentralblatt f. Hals-, Nasen- u. Ohrenh., 8:299, 1926.
11. Hall, A. - Pathology of Bell's palsy. Arch. Otolaryng., 54: 475 (November) 1951.
12. Hilger, J. A. - The nature of Bell's palsy. Laryngoscope, 59: 228-235 (March) 1949.
13. Jessen, H. - Oni hemispasmus facialis og dens behandling. Ugeskr. f. Laeger, no. 42, pg. 1081, 1940.
14. Kettel, K. - a) Bell's palsy. Arch. Otolaryng., 46:427 (October) 1947;
b) Melkersson's syndrome. Arch. Otolaryng., 46:341 (September) 1947;
c) Om den sakaldte rheumatiske facialisparese set fra et kirurgisk synspunkt. Ugeskr. f. Laeger, no. 10, pg. 353, 1953.
15. Lathrop, F. D. - Discussion of paper by Williams, Lambert and Woltman²⁰
16. Melkersson, E. - Hygiea, 90:737, 1928
17. O'Donnell, M. C. - Hemifacial spasm. Ann. Otol., Rhin. a. Laryngol., 62:969 (December) 1953.
18. Skoog, T. - Personal communication to the author.
19. Sullivan, J. A. - Recent advances in the surgical treatment of facial paralysis and Bell's palsy. Laryngoscope, 62:449 (May) 1952.
20. Williams, H. L.; Lambert, E. H.; Woltman, H. W. - The problem of synkinesis and contracture in cases of hemifacial spasm and Bell's palsy. Ann. Otol., Rhin. a. Laryng., 61:850, 1952.
21. Woltman, H. W.: Williams, H. L.; Lambert, E. H. - An attempt to relieve hemifacial spasm by neurolysis of the facial nerves. Proc. Staff Meet., Mayo Clin., 26:236-240 (June 6) 1951.