Facial palsy in closed head injuries : the prognosis / J.W. Aldren Turner.

  • Turner, J. W. Aldren (J. William Aldren), 1864-1945.
Date:
[1944]
Catalogue details

Licence: Public Domain Mark

Credit: Facial palsy in closed head injuries : the prognosis / J.W. Aldren Turner. Source: Wellcome Collection.

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    as, and at the same time as, the acute otitis media, and 6 months later there was no clinical evidence of any recovery in the facial nerve. A mastoid operation had been done in the interval, but the facial nerve had not been inspected. Immediate facial palsy.—Of these cases, 17 were only partial, the other 19 complete. As in the delayed palsies, a group (9 cases) started to recover in a few days and were normal within about 3 weeks, in another group (15 cases) recovery started within 3 weeks and was complete within 6—8 weeks. There was, however, a considerably larger proportion of slow and incomplete recoveries in the immediate than in the delayed palsies. Of the remaining 12 cases of immediate palsy, 3 began to recover within 6-8 weeks and had recovered completely within 3 months : 6 showed no improvement for, 3 months after injury and then slow recovery started and progressed for some months. In these cases normal facial movements did not return ; for though eventually there was fairly good voluntary power some contracture of the facial muscles remained with deepening of the nasolabial and other grooves on the face. The most disfiguring feature, however, was the development of associated facial movements which interfered with the normal free play of facial expression ; when the eyebrow was raised the corner of the lip on the same side would retract and on smiling there might be involuntary wrinkling of the forehead. In addition, in most of these cases some impairment of voluntary power persisted so that there was facial asymmetry when the patient was smiling or talking. In this group of cases, where delayed and imperfect recovery takes place and associated movements develop, there has been actual regeneration of the facial nerve ; while in tlio cases showing quicker and complete recovery the neural lesion has been a physiological block without actual nerve degeneration. The physiology of the associated movements has been given an anatomical basis by the experimental work of Howe, Tower and Duel (1937), who studied the facial recovery in monkeys after freezing, alcohol injection, section, and suture of the nerve. They found that as voluntary power in the face returned mass movements similar to those seen in man appeared and that as the paralysis became less these movements spread over a progressively wider area. They made histological studies of the regenerating nerves in