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Claude C. Coleman

about the parotid region resulting in immediate inability to close the eye on the injured side or inability to retract the corner of the mouth means that one of the main branches of the facial nerve has been severed. The diagnosis of nerve division in this type of injury is easy if one bears in mind this simple fact. The failure to make a correct diagnosis early and to carry out proper surgical treatment in any nerve injury due to sharp instruments is most unfortunate inasmuch as there is inevitable retraction of the nerve segments and formation of neuromas, making

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R. Glen Spurling

. The most brilliant clinical results of human nerve grafting have been achieved in the repair of the facial nerve and of the small nerves of the hand. 2 Apparently, small nerves recover function much more completely after grafting than do the larger nerve trunks. Autografts undoubtedly have given the best results, although homografts are not far inferior. It is always an easy matter to obtain autografts for small nerves, but to obtain an autograft for a large nerve trunk is seldom practical. Alcohol or formalin fixed homografts have been tried repeatedly and

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Axel Olsen and Gilbert Horrax

April 8, 1937, a ventriculogram showed uniformly dilated lateral and third ventricles. On bilateral suboccipital exploration the same day, a left acoustic neuroma was exposed and removed completely. It was felt that the facial nerve was preserved during the removal and this has subsequently proved to be correct. The growth itself was of only moderate size, but there was a large arachnoid cyst overlying it. After an uneventful postoperative course, she was discharged on May 1 in good condition and with a little motion beginning to appear in the left side of the face

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Paul Weiss

any motor fiber is known to regenerate with equal ease into any motor nerve—witness the common crosses between the hypoglossal or spinal accessory and the facial nerve—and the analogous is true of the sensory system. As the functional implications of misregeneration are being made the subject of an extensive review under preparation, the problem need not be discussed here further. The case is not equally clear with regard to the cross regeneration of motor into sensory channels and vice versa . Sensory-motor cross connections can be achieved experimentally, 20

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I. M. Tarlov and J. A. Epstein

T he use of nerve grafts to bridge gaps is unavoidable in those instances in which the various manipulative measures for closing defects, such as the mobilization, rerouting or postural shortening of nerves with subsequent stretching, are insufficient or inadvisable. The use of autologous grafts, such as those employed by Bunnell 2 for the repair of nerves of the hand and by Ballance and Duel 1 for bridging gaps in the facial nerve within the Fallopian canal, has been successful in a high percentage of cases. 4 However, clinical success has been relatively

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I. Mark Scheinker

either side, a slight weakness of the right facial nerve, and a moderate degree of atrophy of the right half of the tongue. The deep reflexes were hypoactive. No paralysis of the extremities and no sensory disturbances could be detected. The cerebrospinal fluid was clear and was under 350 mm. of water pressure; it contained 4 lymphocytes and 83 mg. per 100 cc. of protein; the Wassermann reaction was negative. On Jan. 31, 1938 a posterior fossa exploration was made. The operation disclosed a sessile tumor arising from the floor of the fourth ventricle. A specimen

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Mac V. Edds Jr.

instances where the cap had contracted excessively, constricting the nerve end, the diameter of the nerve proximally was slightly larger than normal, but the typical bulbous enlargements associated with neuromas were not observed. The histological features of the capped segment are illustrated in Fig. 1 , showing the buccal branch of a facial nerve removed one year after operation. Proximally, the diameter of the nerve remains unchanged down to the level of the cap. Within the latter, the nerve tapers to a point; there is a space, apparently filled with serous fluid

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James Greenwood Jr.

spasm is unknown, but the history of direct trauma to the facial nerve was obtained in several cases. The condition has been observed following Bell's palsy. The lesion, according to the best evidence, lies in the nucleus of the seventh nerve. Of 663 patients examined at the Mayo Clinic for abnormal facial movements, 106 had hemifacial spasm. 2 Because there is no pain, there has been a tendency to minimize the suffering of these people. Women, particularly, become conscious of their appearance and dread the paroxysms precipitated by psychic factors; some have

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Leonard A. Titrud

Functional recovery after the use of transplants to bridge nerve defects in man has been largely unsuccessful except in the repair of the facial nerve in the facial canal. Ballance and Duel 1 are chiefly responsible for the stimulation of surgeons to carry on nerve grafting. They 1, 10 achieved phenomenal success in the use of human autografts for facial nerve defects. Bunnell, 4 and Bunnell and Boyes 5 reported recovery in several cases after the use of autogenous transplants to bridge nerve gaps, especially in the small nerves of the hands and a few in

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W. James Gardner, Averill Stowell and Robert Dutlinger

nerve, which is the parasympathetic portion of the facial nerve. Therefore, it was presumed that the unilateral head pain accompanying these phenomena was also due to abnormal parasympathetic discharges coming over this same nerve. In other words, these patients were presumed to have a “neuralgia” of the greater superficial petrosal nerve. In 1939 Horton, MacLean, and Craig 12 described this syndrome and suggested the term “erythromelalgia of the head.” Horton 11 in 1941 redescribed the condition and because of its response to histamine therapy suggested the