Resumo em Inglês:

The majority of cases of Bell's palsy are due to ischaemia of the facial nerve near the stylomastoid foramen. Following lack of blood supply the nerve loses its power of conduction, and venous stasis arises with ensuing swelling of the nerve, which becomes secondarily compressed within the Fallopian canal. The therapy of choice is medical treatment aiming to relieve the vasoconstriction and maintain the contractility of the muscles. Surgical decompression of the facial nerve is indicated in a limited number of cases, and the results of 108 operations are briefly recorded. Decompression should be performed in both fresh and relapsing palsies if no signs of spontaneous movement are observed after two months of observation. With patients in whom spontaneous recovery has ceased be-fored complete restitution has been obtained, further improvement may be expected from decompression.

Resumo em Inglês:

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.

Resumo em Inglês:

Since 1939, 260 patients with a peripheral facial palsy have been operated on by me according to Ballance and Duel, and in 61 cases nerve grafting, in 8 nerve suture was performed; 66 of the patients have been re-examined by me, 2 have been operated upon lately and one could not be traced. If a complete facial palsy arises in direct conjunction with surgery or accident the repair should, if possible, be undertaken without delay; if it occurs after an interval of freedom and the continuity of the nerve is unbroken the prognosis on the whole is good. The technique is discussed and the importance of the after-treatment is stressed. The results may be divided into two groups according to the conditions for and the proceeding of the repair, illustrated in tables 1 and 2. Among 52 cases, in which no degeneration of the musc'es had taken place and in which the operation was successfully performed a clinically satisfactory result was obtained in 47 patients. If these conditions are not fulfilled the prospect of a satisfactory result is a priori poor. It must be born in mind that not even the most successful operation will be able to restore function completely.