Main description:

I have been privileged to work with Dr. Esslen for more than ten years and to have witnessed howsurgical progress combinedwith accurate clinical and electrophysiological investigations have revolutionized the diagnostic and therapeutic approach to the para- lysed face. The longjourneyofthe VIIth nerve through the temporal bone has been consid- ered for years responsible for the particular liabilityofthis nerve to acute palsies. The disappointing results obtainedwith surgical decompression confined ofnecessity to the mastoid and tympanic segmentsofthe fallopian canalled us in the sixties to apply modern otoneurosurgical techniques in orderto achieve total exposure ofthe intra- temporal course ofthe facial nerve. At that time Esslen started to record with surface electrodes the compound action potential evoked by maximal percutaneous stimulation in representative areas ofthe facial muscles. With this method, called electroneurono- graphy, exact determination ot the percentageofdegenerated nerve fibers could be achieved in the early stagesofthe palsy.
Precise electroneuronographic criteria for the selectionofpatients requiring surgery in order possibly to improve the outcome oftheir disfiguring paralysis were worked out. At surgery d[yen]ect stimulationofthe totally exposed intratemporal portionofthe facial nerve was used for the first time in combina- tion with electroneurography in order to determine objectively the degree ofthe lesion. In contrast to what hasbeen believed for years the pathology related with acute facial palsy has been found to be situated in the majorityofthe cases at the entrance and not toward the exit ofthe fallopian canal.

Contents:

1. Introduction.- 1.1. Anatomical Considerations.- 1.1.1. Course of the Facial Nerve in the Petrosal Bone.- 1.1.2. Composition and Fiber Spectrum of Facial Nerve.- 1.1.3. Intraneural Topography of Facial Nerve.- 1.2. Evaluation of Present Views on Etiology and Pathogenesis of Acute Facial Nerve Palsy.- 1.2.1. Idiopathic Facial Palsy (Bell's Palsy).- 1.2.2. Herpes Oticus with Concomitant Facial Palsy (Ramsey Hunt Syndrome).- 1.2.3. Bilateral Facial Palsies.- 2. Investigations, Part I: Intratemporal Stimulation of Facial Nerve for Localization of Conduction Block in Idiopathic Facial Palsy, Herpes Oticus, and Melkersson-Rosenthal Syndrome.- 2.1. Operative Access to the Internal Auditory Channel and Other Intrapetrosal Sections of the Facial Nerve.- 2.1.1. Intraoperative Stimulation and Recording Technique.- 2.1.2. Results of Intraoperative Stimulation of Facial Nerve in the Internal Acoustic Meatus and Facial Canal. Aspect of the Facial Nerve Under the Operative Microscope.- 2.2. Findings in Favor of a Revised Conception of the Relevant Pathogenetic Factors in Acute Facial Palsies.- 2.2.1. Histopathologic Findings in Idiopathic Facial Palsy.- 2.2.2. Histopathologic Findings in Herpes Oticus.- 2.2.3. Integration of Morphologic and Electrophysiologic Findings.- 3. Investigations, Part II: Electrophysiologic Investigations on the Natural History of Acute Facial Palsies.- 3.1. Electrodiagnosis of the Facial Nerve.- 1. General Considerations.- 2. Special Problems of Electrodiagnosis of the Facial Nerve.- 3. Electrodiagnostic Methods Hitherto Applied for Diagnosis in Facial Palsy.- 4. A New Method for the Determination of the Degree of Degeneration of Facial Nerve.- 3.2. Remarks on Some Clinical Features of Acute Facial Palsies.- 3.2.1. Implications of Topical Diagnosis.- 3.3. Case Reports.- 3.3.1. Discussion of the Graphical Presentation of Results.- 3.4. Results.- 3.4.1. Idiopathic Facial Palsy (Groups 1-9).- 3.4.2. General Principles that Emerge from the Histories of Idiopathic Facial Palsy.- 1. Nerve Fiber Degeneration.- 2. Conduction Block and the Beginning of its Recovery.- 3. Latency.- 4. Completion of Recovery from Conduction Block.- 5. Degree of Nerve Regeneration.- 6. Degree of Functional Recovery.- 7. Age.- 3.4.3. Herpes Oticus (Groups 1 and 2).- 3.4.4. Principles of Disease Evolution in Facial Palsy Associated with Herpes Oticus.- 3.4.5. Bilateral Facial Palsies: Case Reports.- 3.4.6. Bilateral Facial Palsies: Principles of Evolution.- 3.4.7. Acute Facial Palsies of Different Etiologies.- 3.4.8. Facial Palsies in Petrosal Bone Fractures.- 3.5. Prognosis of Acute Facial Palsies.- 3.6. Operation in Acute Facial Palsy: Transtemporal Decompression.- 3.6.1. Evolution of Operated Cases.- 3.7. Indications for Transtemporal Decompression of the Facial Nerve.- 3.8. On Drug Therapy of Idiopathic Facial Palsy.- Summary.- References.- Cases.- Author's Postscript.