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• Arq. Neuro-Psiquiatr. 12 (4) • Dec 1954 • https://doi.org/10.1590/S0004-282X1954000400003   copy

Pathology and surgery of bell's palsy: A report of 108 cases subjected to the ballance-duel operation

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

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.

Chief-Surgeon, Frederiksborg County Hospital, Hillerod, Denmark

SUMMARY

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.

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BIBLIOGRAPHY

1. Alexander, G. - Zur klinik und pathologischen Anatomie der sogennanten rheumatischen Facialislahmung. Arch. f. Psyehiat., 35:778, 1901-1902.

2. Arrieta, A. - Sur un cas de paralysie faciale d'origine emotive. Rev. de Laryng., 46:599, 1925.

3. Audibert, V.; Mattei, C.; Paganelli, A. - La paralysie faciale périphérique dite "a frigore" est fonction d'une atteinte artérielle des vasa nervorum. Presse Méd., 44:1049, 1936.

4. Ballance, C.; Duel, A. B. - The operative treatment of facial palsy. Arch. Otolaryng., 15:1-70 (January) 1932.

5. Bergonzi, M. - Paralisi del faciale "ex emotione". Zentralbl. f. Hals-, Nasen- u. Ohrenh., 35: 479, 1943.

6. Bernhardt - Cit. by Winternitz49.

7. Bunnell, S. - a) Suture of the facial nerve within the temporal bone. Surg., Gynec. a. Obst., pg. 7-12 (July) 1927; b) Surgical repair of the facial nerve. Arch. Otolaryng., 25:235-259, 1937; c) Summation of papers on management of facial paralysis. Arch. Otolaryng., 55: 417 (April) 1952.

8. Cawthorne, T. - a) Peripheral facial paralysis. Some aspects of its pathology. Laryngoscope, 56:653-664 (November) 1946; b) The pathology and surgical treatment of Bell's palsy. Paper read at the Fourth International Congress of Neurology, Paris, 1949; c) Bell's palsy. Lancet, no. 6683, pg. 593 (September 29) 1951; d) The rôle of surgery in the investigation and treatment of peripheral facial palsy. Lancet, pg. 1219 (June 21) 1952.

9. Collier, D. J. - a) Discussion on the limitations of operative treatment in traumatic tacial paralysis. Proc. Roy. Soc. Med., 34 (March 7) 1941; b) The present position of facial nerve surgery. Ann. Otol., Rhin. a. Laryng., 58:686 (September) 1949; c) The treatment of facial paralysis. Proc. Roy. Soc. Med., 43:746, 1950.

10. Dejerine, J.; Théohari, A. - Un cas de paralysis faciale périphérique dite rheumatismale, ou a frigore, suivi d'autopsie. Compt. Rend. Soc. Biol., 4:1033, 1897.

11. Denny-Brown, D.; Brenner, C. - a) Lesion in peripheral nerve resulting from compression by spring clip. Arch. Neurol, a. Psyehiat., 52:1 (July) 1944; b) Paralysis of nerve induced by direct pressure and by tourniquet. Arch. Neurol, a. Psyehiat., 51:1 (January) 1944.

12. Feinstein, B. - The application of electromyography to affections of the facial and the intrinsic laryngeal muscles. Proc. Roy. Soc. Med., 39:817 (October) 1946.

13. Findlay, J. - Facial Paralysis. Angus and Robertson Ltd., 89 Castlereagh St., Sydney, 1950.

14. Flodgren, E. - Contributions to the surgery of facial palsy. Acta Oto-Laryng., suppl. 74, pg. 188, 1948.

15. Gorders - Cit. by "Winternitz49.

16. Grundfest - Cit. by Lewis et al.24.

17. Hall, A. - a) Pathology of Bell's palsy. Arch. Otolaryng., 54:475 (November) 1951; b) Private communication to the author.

18. Hilger, J. A. - The nature of Bell's palsy. Laryngoscope, 59:228-235 (March) 1949.

19. House - Cit. by Lathrop 23.

20. Ingelstedt, S.; Thees, J. - Intravenös histamindropp vid Bell's paralys. Nord. Med., 48:1732, 1952.

21. James, J. A.; Russell, W. R. - Bell's palsy. Lancet, no. 6682, pg. 519 (September 22) 1951.

22. Kettel, K. - a) Bell's palsy; pathology and surgery; a report concerning fifty patients operated on after the method of Ballance and Duel. Arch. Otolaryng., 46:427 (October) 1947 ; b) Om den sakaldte rheumatiske facialisparese set fra et kirurgisk synspunkt. Ugesk. f. Laeger, no. 10, p. 353 (March 5) 1953; c) Neurinoma of the facial nerve. Arch. Otolaryng., 44:253, 1946; d) Infratemporal sarcoma of the facial nerve. Arch. Otolaryng., 52:778 (November) 1950; e) Melkersson's syndrome - Report of five cases, with special reference to the pathologic observations. Arch. Otolaryng., 46:341-360 (September) 1947; f) Facial palsy of otitic origin. Arch. Otolaryng., 37:303-348, 1943; g) Prognosen for nervesutur og nervetransplantation ved perifer traumatisk facialisparese. Nord. Med., 43:1066, 1950; h) The prognosis of nerve grafting and nerve suture in peripheral facial palsies. Acta Otolaryng., suppl. 74, pg. 180, 1948.

23. Lathrop, F. D. - a) Facial nerve surgery in the European theater of operations. Laryngoscope, 56:665-676 (November) 1946: b) The practical anatomical and surgical considerations for exposure of the facial nerve. Laryngoscope, 58:743-760 (August) 1948; c) Affections of the facial nerve. Bull. New York Acad. Med., 28:796-808, 1952; d) The facial nerve: technique of exposure and repair. S. Clin. North America, 33, no. 3 (June) 1953; e) Affections of the facial nerve. J.A.M.A., 152:19-25 (May 2) 1953.

24. Lewis, T.; Pickering, G. W.; Rotschild, P. - Centripetal paralysis arising out of arrested bloodflow to the limb, including notes on a form of tingling. Heart, 16:1, 1933.

25. Loomis, G. L. - Histamine treatment of Bell's palsy. Arch. Otolaryng., 52: 948, 1950.

26. Martin, R. C. - Prognosis in traumatic peripheral facial paralysis. Laryngoscope, 61:1004 (October) 1951; b) Bell's palsy. Arch. Otolaryng., 55, no. 4 (April) 1952.

27. Mayer, J. - Zur Genese und Prognose der otogenen Fazialisparesen. Wien. Med. Wehnschr., no. 16, pg. 302, 1952.

28. Melkersson, E. - Hygiea, 90:737, 1928.

29. Minkowski - Zur pathologischen Anatomie der rheumatischen Facialislahmung. Arch. f. Psychiat, 23:586, 1891.

30. Mirallié, M. C. - Paralysie faciale périphérique; autopsie. Rev. Neurol., 14:702, 1906.

31. Morris, W. M. - a) Surgical treatment of Bell's palsy. Lancet, 1:429, 1938; 6) Surgical treatment of facial paralysis. Lancet, 2:558, 1939; c) Surgical treatment of facial paralysis. Lancet, 2:1172, 1936.

32. Mygind, S. H.; Dederding, D. - Bidrag til de "rheumatiske" facialis paresers patbogenese og behandling. Dansk Otolaryng. Selsk. Fohandl., pg. 12, 1929.

33. Müller, R. - Facial paralysis; a follow-up study of 209 cases. Acta Med. Scandinav., 142:284, 1952.

34. Panneton, P. - Tentative d'explication des paralysies faciales périphériques improprement appelées "a frigore". Zentralbl. f. Hais-, Nasen- u. Ohrenh., 29:639, 1938.

35. Parkc and Watkins - Cit. by Müller33.

36. Philipp - Cit. by Winternitz

37. Rasmussen, H. - Den otogene facialisparese med saerlight henblik pa behandiingen. Nord, med. (Hospitalstid.), 28:2214, 1945.

38. Rothendler, H. H. - Bell's palsy treated with cortisone. Am. J. M. Sc., 225:358 (April) 1953.

39. Skinnner, D. A. - a) The use of histamine in Bell's palsy. Ohio State M. J., 45:565-566, 1949; b) The treatment of Bell's palsy with histamine. Ann. Otol., Rhin. a. Laryng., 59:197 (March) 1950.

40. Skoog - Private communication to the author.

41. Sullivan, J. - a) Facial nerve-plasma glue. Private communication; b) Modern Practice in Diseases of the Ear, Nose and Throat. Vol. 2, Section 1: Ear. Chapter 8. Injuries to ear (middle and inner) ; c) Recent advances in the surgical treatment of facial paralysis and Bell's palsy. Laryngoscope, 62:449 (May) 1952.

42. Sullivan, J. A.; Sith, J. B. - The otological concept of Bell's palsy and its treatment. Ann. Otol. Rhin. a. Laryng., 59, no. 4 (December) 1950.

43. Thomsen, K. A. - Overhebeplastik og corticotropin ved Melkerssons syndrom. Nord. Med., 49:718, 1953.

44. Tickle, Th. G. - a) The surgical treatment of facial paralysis. Loose-leaf Surgery of the Ear. Chapt. 14, pg. 355-365, 1938; b) Surgery of the facial nerve in 300 operated cases. Laryngoscope, 55:191-195 (May) 1945; c) Surgery of the seventh nerve. J.A.M.A., 136:969-972, 1948.

45. Tschiassny, K. - a) The site of the facial nerve lesion in cases of Ramsay Hunt's syndrome. Ann. Otol., Rhin. a. Laryng., 55:152 (March) 1946; b) Eight syndromes of facial paralysis and their significance in locating the lesion. Ann. Otol., Rhin. a. Laryng., 62:671 (September) 1953.

46. Violé, P. - Experiences in surgery of facial nerve. Laryngoscope, 54: 455, 1944.

47. Waterman - Cit. by Winternitz49.

48. Weddell; Feinstein; Pattle - Cit. by Feinstein12.

49. Winternitz, P. - a) Gibt es eine rheumatische Facialislähmung? Schweiz. Med. Wehnschr., 77:291-292, 1947; b) Gibt es eine rheumatische Facialislähmung? Monatschr. f. Psychiat. u. Neurol., 113:17-39, 1947.

Relatório apresentado ao XIX Congresso Internacional de Oto-Neuro-Oftalmologia, reunido em São Paulo em 11-17 de junho de 1954, subordinado ao 2º tema oficial: Fisiopatologia do nervo facial.

Postkonto 30279 - Hillerod, Denmark.

  • 1. Alexander, G. - Zur klinik und pathologischen Anatomie der sogennanten rheumatischen Facialislahmung. Arch. f. Psyehiat., 35:778, 1901-1902.
  • 2. Arrieta, A. - Sur un cas de paralysie faciale d'origine emotive. Rev. de Laryng., 46:599, 1925.
  • 3. Audibert, V.; Mattei, C.; Paganelli, A. - La paralysie faciale périphérique dite "a frigore" est fonction d'une atteinte artérielle des vasa nervorum. Presse Méd., 44:1049, 1936.
  • 4. Ballance, C.; Duel, A. B. - The operative treatment of facial palsy. Arch. Otolaryng., 15:1-70 (January) 1932.
  • 5. Bergonzi, M. - Paralisi del faciale "ex emotione". Zentralbl. f. Hals-, Nasen- u. Ohrenh., 35: 479, 1943.
  • 7. Bunnell, S. - a) Suture of the facial nerve within the temporal bone. Surg., Gynec. a. Obst., pg. 7-12 (July) 1927;
  • b) Surgical repair of the facial nerve. Arch. Otolaryng., 25:235-259, 1937;
  • c) Summation of papers on management of facial paralysis. Arch. Otolaryng., 55: 417 (April) 1952.
  • 8. Cawthorne, T. - a) Peripheral facial paralysis. Some aspects of its pathology. Laryngoscope, 56:653-664 (November) 1946;
  • b) The pathology and surgical treatment of Bell's palsy. Paper read at the Fourth International Congress of Neurology, Paris, 1949;
  • c) Bell's palsy. Lancet, no. 6683, pg. 593 (September 29) 1951;
  • d) The rôle of surgery in the investigation and treatment of peripheral facial palsy. Lancet, pg. 1219 (June 21) 1952.
  • 9. Collier, D. J. - a) Discussion on the limitations of operative treatment in traumatic tacial paralysis. Proc. Roy. Soc. Med., 34 (March 7) 1941;
  • b) The present position of facial nerve surgery. Ann. Otol., Rhin. a. Laryng., 58:686 (September) 1949;
  • c) The treatment of facial paralysis. Proc. Roy. Soc. Med., 43:746, 1950.
  • 10. Dejerine, J.; Théohari, A. - Un cas de paralysis faciale périphérique dite rheumatismale, ou a frigore, suivi d'autopsie. Compt. Rend. Soc. Biol., 4:1033, 1897.
  • 11. Denny-Brown, D.; Brenner, C. - a) Lesion in peripheral nerve resulting from compression by spring clip. Arch. Neurol, a. Psyehiat., 52:1 (July) 1944;
  • b) Paralysis of nerve induced by direct pressure and by tourniquet. Arch. Neurol, a. Psyehiat., 51:1 (January) 1944.
  • 12. Feinstein, B. - The application of electromyography to affections of the facial and the intrinsic laryngeal muscles. Proc. Roy. Soc. Med., 39:817 (October) 1946.
  • 13. Findlay, J. - Facial Paralysis. Angus and Robertson Ltd., 89 Castlereagh St., Sydney, 1950.
  • 14. Flodgren, E. - Contributions to the surgery of facial palsy. Acta Oto-Laryng., suppl. 74, pg. 188, 1948.
  • 17. Hall, A. - a) Pathology of Bell's palsy. Arch. Otolaryng., 54:475 (November) 1951;
  • 18. Hilger, J. A. - The nature of Bell's palsy. Laryngoscope, 59:228-235 (March) 1949.
  • 20. Ingelstedt, S.; Thees, J. - Intravenös histamindropp vid Bell's paralys. Nord. Med., 48:1732, 1952.
  • 21. James, J. A.; Russell, W. R. - Bell's palsy. Lancet, no. 6682, pg. 519 (September 22) 1951.
  • 22. Kettel, K. - a) Bell's palsy; pathology and surgery; a report concerning fifty patients operated on after the method of Ballance and Duel. Arch. Otolaryng., 46:427 (October) 1947 ;
  • b) Om den sakaldte rheumatiske facialisparese set fra et kirurgisk synspunkt. Ugesk. f. Laeger, no. 10, p. 353 (March 5) 1953;
  • c) Neurinoma of the facial nerve. Arch. Otolaryng., 44:253, 1946;
  • d) Infratemporal sarcoma of the facial nerve. Arch. Otolaryng., 52:778 (November) 1950;
  • e) Melkersson's syndrome - Report of five cases, with special reference to the pathologic observations. Arch. Otolaryng., 46:341-360 (September) 1947;
  • f) Facial palsy of otitic origin. Arch. Otolaryng., 37:303-348, 1943;
  • g) Prognosen for nervesutur og nervetransplantation ved perifer traumatisk facialisparese. Nord. Med., 43:1066, 1950;
  • h) The prognosis of nerve grafting and nerve suture in peripheral facial palsies. Acta Otolaryng., suppl. 74, pg. 180, 1948.
  • 23. Lathrop, F. D. - a) Facial nerve surgery in the European theater of operations. Laryngoscope, 56:665-676 (November) 1946: b) The practical anatomical and surgical considerations for exposure of the facial nerve.
  • Laryngoscope, 58:743-760 (August) 1948;
  • c) Affections of the facial nerve. Bull. New York Acad. Med., 28:796-808, 1952;
  • d) The facial nerve: technique of exposure and repair. S. Clin. North America, 33, no. 3 (June) 1953;
  • e) Affections of the facial nerve. J.A.M.A., 152:19-25 (May 2) 1953.
  • 24. Lewis, T.; Pickering, G. W.; Rotschild, P. - Centripetal paralysis arising out of arrested bloodflow to the limb, including notes on a form of tingling. Heart, 16:1, 1933.
  • 25. Loomis, G. L. - Histamine treatment of Bell's palsy. Arch. Otolaryng., 52: 948, 1950.
  • 26. Martin, R. C. - Prognosis in traumatic peripheral facial paralysis. Laryngoscope, 61:1004 (October) 1951;
  • b) Bell's palsy. Arch. Otolaryng., 55, no. 4 (April) 1952.
  • 27. Mayer, J. - Zur Genese und Prognose der otogenen Fazialisparesen. Wien. Med. Wehnschr., no. 16, pg. 302, 1952.
  • 28. Melkersson, E. - Hygiea, 90:737, 1928.
  • 29. Minkowski - Zur pathologischen Anatomie der rheumatischen Facialislahmung. Arch. f. Psychiat, 23:586, 1891.
  • 30. Mirallié, M. C. - Paralysie faciale périphérique; autopsie. Rev. Neurol., 14:702, 1906.
  • 31. Morris, W. M. - a) Surgical treatment of Bell's palsy. Lancet, 1:429, 1938;
  • 6) Surgical treatment of facial paralysis. Lancet, 2:558, 1939;
  • c) Surgical treatment of facial paralysis. Lancet, 2:1172, 1936.
  • 32. Mygind, S. H.; Dederding, D. - Bidrag til de "rheumatiske" facialis paresers patbogenese og behandling. Dansk Otolaryng. Selsk. Fohandl., pg. 12, 1929.
  • 33. Müller, R. - Facial paralysis; a follow-up study of 209 cases. Acta Med. Scandinav., 142:284, 1952.
  • 34. Panneton, P. - Tentative d'explication des paralysies faciales périphériques improprement appelées "a frigore". Zentralbl. f. Hais-, Nasen- u. Ohrenh., 29:639, 1938.
  • 37. Rasmussen, H. - Den otogene facialisparese med saerlight henblik pa behandiingen. Nord, med. (Hospitalstid.), 28:2214, 1945.
  • 38. Rothendler, H. H. - Bell's palsy treated with cortisone. Am. J. M. Sc., 225:358 (April) 1953.
  • 39. Skinnner, D. A. - a) The use of histamine in Bell's palsy. Ohio State M. J., 45:565-566, 1949;
  • b) The treatment of Bell's palsy with histamine. Ann. Otol., Rhin. a. Laryng., 59:197 (March) 1950.
  • 41. Sullivan, J. - a) Facial nerve-plasma glue. Private communication; b) Modern Practice in Diseases of the Ear, Nose and Throat. Vol. 2, Section 1: Ear. Chapter 8. Injuries to ear (middle and inner) ;
  • c) Recent advances in the surgical treatment of facial paralysis and Bell's palsy. Laryngoscope, 62:449 (May) 1952.
  • 42. Sullivan, J. A.; Sith, J. B. - The otological concept of Bell's palsy and its treatment. Ann. Otol. Rhin. a. Laryng., 59, no. 4 (December) 1950.
  • 43. Thomsen, K. A. - Overhebeplastik og corticotropin ved Melkerssons syndrom. Nord. Med., 49:718, 1953.
  • 44. Tickle, Th. G. - a) The surgical treatment of facial paralysis. Loose-leaf Surgery of the Ear. Chapt. 14, pg. 355-365, 1938;
  • b) Surgery of the facial nerve in 300 operated cases. Laryngoscope, 55:191-195 (May) 1945;
  • c) Surgery of the seventh nerve. J.A.M.A., 136:969-972, 1948.
  • 45. Tschiassny, K. - a) The site of the facial nerve lesion in cases of Ramsay Hunt's syndrome. Ann. Otol., Rhin. a. Laryng., 55:152 (March) 1946;
  • b) Eight syndromes of facial paralysis and their significance in locating the lesion. Ann. Otol., Rhin. a. Laryng., 62:671 (September) 1953.
  • 46. Violé, P. - Experiences in surgery of facial nerve. Laryngoscope, 54: 455, 1944.
  • 49. Winternitz, P. - a) Gibt es eine rheumatische Facialislähmung? Schweiz. Med. Wehnschr., 77:291-292, 1947;
  • b) Gibt es eine rheumatische Facialislähmung? Monatschr. f. Psychiat. u. Neurol., 113:17-39, 1947.

  • Pathology and surgery of bell's palsy. A report of 108 cases subjected to the ballance-duel operation

    Karsten Kettel

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      10 Apr 2014
    • Date of issue
      Dec 1954
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