Hideo Hosomi

The Blood Supply of the Facial Nerve in the Human Temporal Bone

The gross blood supply and intrinsic vascular anatomy of the facial nerve in the temporal bone are described, and their significance is discussed. At the vertical part of the facial nerve, the stylomastoid artery lies on its anteromedial side as far as the upper third of the nerve. The artery then loops around the lateral or medial side of the nerve, and divides into several branches. At the convex aspect of the genu, these branches anastomose with one another to form an arterial network, passing to the horizontal part. The petrosal branch of the middle meningeal artery reaches the geniculate ganglion and forms a profuse, fine arterial network. The main arterial trunk extends toward the second bend in the nerve, but it never reaches the vertical part. Studies on the draining veins are also described. Duplication of blood vessels from different sources was seen at the horizontal part of the nerve. This would suggest a special vulnerability of this area to vascular injury, since in our topographical study of Bells palsy within two weeks of its onset, 72 out of 117 cases (61.5%) were found to have suprastapedial lesions.

Conservative treatment of Bell's palsy with steroids and dextran-pentoxiphylline combined therapy

SummaryIn 1980, Stennert proposed for the treatment of Bells palsy an infusion therapy consisting of initially high dosages of steroids in combination with low-molecular dextran and pentoxiphylline. Excellent results were reported as a consequence of administering this treatment scheme. This “steroid-dextran” medication was modified (SD therapy) and administered in 172 cases of Bells palsy. The results were compared with those of a group of 59 patients who had been treated with orally administered low-dose steroids in combination with vasodilators, adenosine triphosphate and vitamins. All patients with incomplete palsies recovered completely, regardless of the mode of treatment. In cases of complete palsy, 87% of patients recovered completely when treated with SD therapy. In contrast, 68% of the patients treated with orally administered steroids recovered completely.

Medical Treatment of Bell's Palsy

Infusion therapy using low-molecular dextran in combination with high-dose cortisone was modified from Stennerts original protocol and indicated in 50 cases of Bells palsy. The effects of infusion were compared with the outcome in 36 cases treated by orally-administered steroids and vasodilators. In the case of incomplete palsy, the recovery rate was excellent regardless of the mode of treatment. If the palsy is not progressive, it is not necessary for patients with this condition to have infusion therapy. In the case of complete palsy, 95% of those with normal nerve excitability (NE) experienced complete recovery when treated by infusion. However, only 71% of this group experienced complete recovery when treated with oral administration. In the group with diminished or absent NE, complete recovery was obtained in 58% of the patients treated with infusion, whereas only 18% recovered completely when given oral administration. Thus, the recovery rate increased sharply in the case of infusion therapy. Therefore, the above-mentioned method of infusion therapy is indicated in cases of complete or progressively incomplete Bells palsy except in those cases where its use is contra-indicated for some other reason.

A New Animal Model of Facial Nerve Palsy Using a Freezing Method

The etiology of Bell’s palsy is still unknown. It is generally accepted that the edema and the ischemia in the fallopian canal are the major pathogenic factors of Bell’s palsy. From this standpoint, few animal models have been established. A new animal model of facial nerve palsy caused by freezing is reported. Mongoian gerbils were used. The middle ear space was frozen microscopically with dimethylether liquid propane gas, after myringotomy. The onset of palsy was confirmed by the loss of both blink and movement of the whiskers. Facial movement was evaluated, and the evoked EMG was recorded 1, 3, and 5 weeks later after the onset of facial palsy. Temporal bones were sectioned and subjected to histopathological study.

Therapeutic Policy for Bell’s Palsy and Hunt Syndrome

To obtain satisfactory recovery in Bell’s palsy and in Hunt syndrome, it is mandatory to commence the initial treatment within 1 week after onset. In 1979, Stennert proposed an excellent treatment modality with a high dose of cortisone and dextran and reported a high recovery rate [6]. Based on our experience [7, 2] with the modified modality (SD therapy) of the said protocol, however, this treatment was not always necessary for all patients with the disease. The present study was designed to evaluate the true benefit of SD therapy in treating Bell’s palsy and Hunt syndrome.

A Report of Forty Cases of Traumatic Facial Palsy: Conservative vs. Surgical Treatment

過去11年間で, 外傷性顔面神経麻痺患者56例を取扱い, このうち経過の明らかな40例に対して検討した.1) 麻痺は30～40才台の男性に多くみられた.2) 意識障害を伴なわない症例の麻痺回復の程度は良好で, 意識消失時間の長い症例ほど回復不良な傾向がみられた.3) 全症例の完全回復率は58%であった.4) 保存的治療で経過観察した26例では, 不全麻痺は全例完全回復し, 完全麻痺でもNE正常例はほぼ完全回復したが, NE低下例では, 受傷後25日以内に回復徴候を呈した症例は全例完全回復し, 2ヶ月以後に回復徴候を呈した症例の回復程度はきわめて不良であった.5) 手術例14例では, NE消失例でも回復良好な症例が多くみられ, かつ回復が遅れた症例でも回復良好な症例がみられた. 受傷後1ヶ月以内に手術を施行した症例は回復が良好であるが, 3ヶ月以後に手術をした症例は回復不良であった.6) 以上よりNE消失例は, 直ちに手術の適応となり, NEが消失していない症例でも受傷後1ヶ月を過ぎてもなお回復徴候のない症例では1～2ヶ月の間に手術を考慮するべきであると考える.7) 小児の回復程度は成人に比べて良好な傾向がみられた.

A Contribution to the Mechanism of Vestibular Nystagmus: The Role of Afferent Impulses

Lateral ampullary nerve and lateral ampulla were electrically stimulated with a single shock and repetitive shocks in anesthetized and unanesthetized cats with potentials in the vestibular and oculomotor nuclei were observed. The following results were obtained.1. Evoked potentials recorded in the vestibular and oculomotor nuclei in response to the repetitive shocks differed remarkably from the potentials produced by a single shock. A characteristic negative wave, termed an M wave, was evoked concomitant with the slow phase of nystagmus only by repetitive shocks. With the administration of muscle relaxant the nystagmus and the M waves disappeared at the same time.2. The possibility of afferent connections from the sensory endings in the extraocular muscles to the midbrain and the brain stem, was seriously considered.3. It was reasonably interpreted that the accumulation of M waves in the central nervous system was an important factor, which also was coordinated through the neural regulation of the CNS to ...