Further observations upon the facial nerve alarm syndrome in cases of chronic purulent medial otitis
G. E. Yannoulis
Professor of Otorhinolaryngology, University of Salonica , Greece
Some years ago, working with the late Prof. Ruttin, of Vienna, I observed that in some cases of chronic medial otitis, when the patient extended the head and closed slowly the eyes, the internal canthus closed later than the external one and occasionally it even remained open; this corresponded to the site of otitis. At that time an important number of similar cases were observed and some of them were treated surgically by Prof. Ruttin himself. During these operations he discovered that there existed bony lesions of the Fallopian canal at different levels.
Personally I have operated upon cases on which the nerve was entirely uncovered and litteraly bathed in pus, without any symptoms from the facial nerve. I presume that the difference lies in the fact that in Ruttin's cases the destruction probably was limited; the nerve was therefore swollen and under a high pressure. In my cases signs of pressure were absent and it is known how resistant is generally the facial nerve.
Later, in Athenas and Salónica, I have observed more than a hundred cases presenting the lid phenomenon, out of a total of some 100,000 ear, nose and throat examinations, of which many thousands belong to chronic medial otitis cases; the exact number of the latter cannot accurately be evaluated. Approximately one third of the above hundred cases were operated upon; in them I found the alterations observed by Ruttin.
It might be interesting to report on this occasion the craniometric examinations to which I proceeded in collaboration with Prof. Koumaris, of the Anthropological Institute of Athenas. From them it resulted that in cases of chronic otitis the paients were dolichocephalic and, adversely, in cases of acute infection the patients were brachycephalic. This is probably due to the difference of the position of the antrum in the lithoid bone.
As far the lid phenomenon is concerned, it was explained experimentally by Lother Hoffmann, who proved that the upper branch of the 7th nerve is peripheral, very fine and innerves especially the eye, while the lower branch is rather central and innerves the mouth area.
In recent observations of the Yougoslav Podvinec it is contended that the fibres of the 7th nerve have the contexture of the interlaced strands of hair. This explanation does not alter what I already have mentioned, for the upper ocular branch is at any rate the finest one and therefore the one presenting very low resistance.
Publication Dates
-
Publication in this collection
10 Apr 2014 -
Date of issue
Dec 1954
