Nerve conduction study in facial palsy

  • Naoaki Yanagihara
  • Masao Kishimoto
Article

Summary

The muscle action potential evoked by the facial nerve stimulation was investigated in 31 normal subjects and in 122 patients with facial palsy. The normal finding of this nerve conduction study was described in detail, and the results of the qualitative and quantitative analysis of the nerve conduction patterns obtained from the patients were presented. The following conclusions were derived from the present study.
  1. 1.

    The duration, size, threshold, latency, and relationship between the response and the stimulus intensity were the important factors involved in the diagnosis of the denervation in the facial nerve.

     
  2. 2.

    On the basis of the analysis of these factors, the grade of denervation could be differentiated into no denervation, slight denervation, moderate denervation, and severe denervation. The prognosis of the palsy largely depended upon the grade of denervation.

     
  3. 3.

    The nerve conduction study could reveal minor denervation which might be overlooked by the conventional nerve excitability measurement and

     
  4. 4.

    In the cases with moderate or severe denervation, decompression surgery facilitated earlier and better recovery of the facial movements.

     
  5. 5.

    The nerve conduction study was proved to be a valuable adjunct to the conventional nerve excitability measurement, S-D curve, and electromyography. The prognosis of facial palsy as well as the indication of surgical treatment could be established by careful evaluation of the results of different electrodiagnostic examinations including nerve conduction study.

     

Zusammenfassung

Das Muskelaktionspotential, hervorgerufen durch Stimulation des Facialisnerven, wurde bei 31 normalen Personen and bei 122 Patienten mit Facialisparese untersucht.

Der Normalbefund dieser Nervenleitungsuntersuchung wird im Detail beschrieben und die Resultate der qualitativen und quantitativen Analyse der Nervenleitungsmuster von den Patienten werden vorgelegt. Folgende Schlußfolgerungen werden aus der vorliegenden Untersuchung abgeleitet:
  1. 1.

    Die Dauer, Größe, Schwelle, Latenz und das Verhältnis zwischen Reaktion und Stimulusintensität waren die bedeutenden Faktoren für die Diagnose der Denervation des Facialisnerven.

     
  2. 2.

    Auf der Grundlage der Analyse dieser Faktoren könnte der Grad der Denervation differenziert werden in: fehlende, schwache, mäßige und schwere Denervation. Die Prognose der Lähmung hing weitgehend vom Grad der Denervation ab.

     
  3. 3.

    Die Nervenleitungsuntersuchung kann schwächere Denervationsformen auf-decken, welche bei der konventionellen Messung der Nervenerregbarkeit und der S-D-Kurve übersehen warden.

     
  4. 4.

    Bei Fällen mit mäßiger oder schwerer Denervation erleichtert die Dekompressionsoperation die frühere und bessere Erholung der Gesichtsmotilität.

     
  5. 5.

    Die Nervenleitungsuntersuchung hat sich als eine wertvolle Ergänzung der konventionellen Nervenerregbarkeitsmessung, der S-D-Kurve and der Elektromyographie erwiesen. Die Prognose der Facialislähmung und die Indikation zur chirurgischen Behandlung können gesichert warden durch eine sorgfältige Berechnung der Resultate der unterschiedlichen elektrodiagnostischen Prüfungen einschließlich der Nervenleitungsprüfung.

     

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Alford, B. R.: Electrodiagnostic studies in facial paralysis. Arch. Otolaryng. 85, 259 (1967).Google Scholar
  2. 2.
    Asakura, H.: Clinical investigations on peripheral facial palsy. Pract. Otol. (Kyoto) 62, 1237 (1969).Google Scholar
  3. 3.
    Buchthal, F.: Electromyography in paralysis of the facial nerve-general aspects. Arch. Otolaryng. 81, 463 (1965).Google Scholar
  4. 4.
    Campbell, E. D. R.: A simple prognostic test in facial palsy. J. Laryng. 77, 462 (1963).Google Scholar
  5. 5.
    −, Hickey, R. P., Nixon, K. J., Richardson, A. T.: Value of nerve excitability measurements in prognosis of facial palsy. Brit. med. J. 2, 7 (1962).Google Scholar
  6. 6.
    Cawthorne, T., Wilson, T.: Indication for intratemporal facial nerve surgery. Arch. Otolaryng. 78, 429 (1963).Google Scholar
  7. 7.
    Cohen, H. L., Brumlik, J.: A manual of electroneuromyography. New York: Hoeber Medical Division 1969.Google Scholar
  8. 8.
    Collier, J.: Electrodiagnosis and surgical indications in facial palsy. Arch. Otolaryng. 78, 421 (1963).Google Scholar
  9. 9.
    Currier, W. D.: Effects of electronic stimulation of the VII nerve. Ann. Otol. (St. Louis) 72, 289 (1963).Google Scholar
  10. 10.
    Feinstein, B.: Application of electromyography to affections of the facial and the intrinsic laryngeal muscles. Proc. roy. Soc. Med. 39, 817 (1946).Google Scholar
  11. 11.
    Giancarlo, H. R., Kenneth, F. M.: Facial palsy, facial nerve decompression. Arch. Otolaryng. 91, 30 (1970).Google Scholar
  12. 12.
    Gilliatt, R. W., Taylor, J. C.: Electrical changes following section of the facial nerve. Proc. roy. Soc. Med. 52, 1080 (1959).Google Scholar
  13. 13.
    Hiestand, P., Kaeser, H., Kocher, R., Pfaltz, C. R.: EMG und Facialisdekompression bei Bell'scher Lahmung. Pract. oto-rhino-laryng. (Basel) 31, 144 (1969).Google Scholar
  14. 14.
    Hilger, J. A.: Facial nerve stimulator. Trans. Amer. Acad. Ophthal. Otolaryng. 68, 74 (1964).Google Scholar
  15. 15.
    Isono, H., Asakura, H.: Early surgical indication in facial palsy. Pract. Otol. (Kyoto) 60ZZ, Suppl. 2, 78 (1967).Google Scholar
  16. 16.
    Jongkees, L. B. W.: Bell's Palsy: A Surgical emergency? Arch. Otolaryng. 81, 497 (1965).Google Scholar
  17. 17.
    −:Tests for facial nerve function. Arch. Otolaryng. 89, 153 (1969).Google Scholar
  18. 18.
    Lambert, E. H.: Diagnostic value of electrical stimulation of motor nerve. Electroenceph. clin. Neurophysiol., Suppl. 22, 9 (1962).Google Scholar
  19. 19.
    Laumans, E. P. J.: Nerve excitability tests in facial paralyses. Arch. Otolaryng. 81, 478 (1965).Google Scholar
  20. 20.
    −, Jongkees, L. B. W.: On the prognosis of peripheral facial paralysis of endotemporal origin. Part II. Ann. Otol. (St. Louis) 72, 621 (1963).Google Scholar
  21. 21.
    Loebell, E.: Untersuchungen über die Reizleitungsgeschwindigkeit in Nervus Facialis. Z. Laryng. Rhinol. 44, 685 (1965).Google Scholar
  22. 22.
    Matsunaga, K., Hazama, H., Sakamoto, M., Tamaoki, H., Iida, M.: Evoked electromyography in facial palsy. Pract. Otol. (Kyoto) 60, 1047 (1967).Google Scholar
  23. 23.
    Mawson, S. R.: Diseases of the ear (second edition). London: Edw. Arnold Ltd. 1967.Google Scholar
  24. 24.
    McGovern, F. H.: The use of the nerve excitability test in paralysis of the facial nerve. Laryngoscope (St. Louis) 76, 955 (1966).Google Scholar
  25. 25.
    McHugh, H. E.: Facial paralysis and muscle ageneses in the newborn. Arch. Otolaryng. 89, 157 (1969).Google Scholar
  26. 26.
    Minowada, Y.: Clinical investigations on facial palsy. Pract. Otol. (Kyoto) 62, 1309 (1969).Google Scholar
  27. 27.
    Nagakura, M.: Electromyography studies in postoperative facial palsy. Jap. J. Otol. (Tokyo) 69, 1616 (1966).Google Scholar
  28. 28.
    Parsons, R. C.: Electrical stimulation of the facial nerve. Laryngoscope (St. Louis) 76, 391 (1966).Google Scholar
  29. 29.
    Richardson, A. T.: Electrodiagnoses of facial palsies. Ann. Otol. (St. Louis) 72, 569 (1963).Google Scholar
  30. 30.
    Seddon, H. J.: Three types of nerve injury. Brain 66, 237 (1943).Google Scholar
  31. 31.
    Shambhaugh, G. E., Jr.: Surgery of the ear (second edition). Philadelphia: W. B. Saunders Comp. 1967.Google Scholar
  32. 32.
    Sullivan, J. A.: Surgical techniques of the facial nerve. Arch. Otolaryng. 78, 434 (1963).Google Scholar
  33. 33.
    Taverner, D.: Bell's palsy a clinical and electromyographic study. Brain 78, 209 (1955).Google Scholar
  34. 34.
    Taverner, D.: Electrodiagnosis in facial palsy. Arch. Otolaryng. 81, 470 (1965).Google Scholar
  35. 35.
    Tozuka, G., Hirose, H., Kobayashi, K.: Postoperative facial palsy, its electromyographic finding. Pract. Otol. (Kyoto) 60, 1033 (1967).Google Scholar
  36. 36.
    Wigand, M. E.: Die Prognose der idiopathischen (Bellschen) Fazialisparese bei electromyografischer Indiationsstellung zur Dekompressionsoperation. Z. Laryng. Rbnol. 46, 439 (1967).Google Scholar
  37. 37.
    −, Spreng, M., Bumm, P.: Computer-Analyse von Facialis-Elektromyogrammen I: Acta oto-laryng. (Stockh.) 66, 296 (1968).Google Scholar
  38. 38.
    Yanagihara, N., Kishimoto, M.: Significance of electrodiagnosis in facial palsy. Pract. Otol. (Kyoto) 62, 561 (1969).Google Scholar

Copyright information

© Springer-Verlag 1971

Authors and Affiliations

  • Naoaki Yanagihara
    • 1
  • Masao Kishimoto
    • 1
  1. 1.Department of Otolaryngology Faculty of MedicineKyoto UniversityKyotoJapan

Personalised recommendations