1911.] 



Muscles by means of Nerve Anastomosis. 



77 



proved that the recovery of movements which had taken place in the face 

 •was wholly due to impulses reaching the face vid the substitute nerve. In 

 both cases in which the examination was not made before death the animals 

 died unexpectedly. In one of these no voluntary function had returned 

 (dog), and in the other, in which restoration had taken place (monkey), the 

 post-mortem examination showed that there had been no reunion with 

 the central end of the facial, as the stylo-mastoid foramen was found 

 completely obliterated by a bone plug which had been hammered into it at 

 the operation. 



As an Addendum, reports of two cases of spino-facial anastomosis are 

 given. The first is a report twelve years after the operation, performed in 

 a woman, and published in the ' Philosophical Transactions ' in 1901, in 

 order to show the ultimate result. The second is a report of a case of 

 facial paralysis of three years' standing, in which spino-facial anastomosis 

 was performed, and in which recovery commenced about three years after 

 the operation. 



The following general conclusions follow from the observations which are 

 fully recorded in the paper : — 



1. In any case of facial paralysis due to division or compression of the 

 facial nerve, the best procedure, should spontaneous recovery fail, or be 

 deemed impossible, is to attempt restoration of the damaged nerve. 



2. Should efficient restoration of the nerve be impossible or be deemed 

 impossible, anastomosis with the spinal accessory or hypoglossal holds out 

 the most favourable prospects of recovery, given that the facial muscles are 

 still recoverable from the point of view of duration of complete severance 

 from the nutritive influence of the central nervous system. 



3. Of the two substitutes, spinal accessory and hypoglossal, when the 

 latter is used the restoration appears to commence sooner, but there does 

 not seem to be a great difference in the ultimate result of the two substitutes, 

 .as far as the recovery of the face is concerned. 



4. Of the new paralysis produced as a result of cutting the substitute 

 nerve that which is produced when the spinal accessory is cut is much less 

 objectionable than that produced when the hypoglossal is cut, and when 

 the paralysis is to be left as a permanent defect, namely, when the 

 peripheral segment of the substitute nerve is to be left unattached, the 

 hypoglossal paralysis is not justifiable. 



5. When, in consequence of the anastomosis, association movements are 

 present in addition to voluntary co-ordinated and dissociated movements, 

 these associated movements give no trouble and are not noticeable with 

 ordinary movements when the spinal accessory has been used, but, if present, 



