78 Restoration of Paralysed Muscles by Nerve Anastomosis. 



may be most objectionable and noticeable with ordinary movements when 

 the hypoglossal has been used. 



6. As regards the interval during which the paralysis has lasted before 

 anastomosis has been performed., there appears to be no difference in the 

 date of commencing recovery and ultimate result, whether anastomosis 

 immediately follows section of the facial, or whether one month's interval 

 at least is allowed to elapse before the anastomosis is performed after the 

 facial has been cut. 



7. The only way to make an efficient union between two nerves is com- 

 pletely to cut across all the nerve fibres in both nerves ; methods such 

 as Manasse's, designed to maintain the integrity of the nerve fibres, give 

 inefficient unions. 



8. In the course of recovery of independent voluntary co-ordinated move- 

 ments, the orbicularis palpebrarum is first to exhibit recovery, and usually 

 is the muscle which recovers best, and in no case has a perfect recovery in 

 the movements of the face been proved to take place. 



9.. Eeunion of the facial nerve is to be preferred to restoration by 

 means of an anastomosis, as the latter involves interference with the 

 distribution of another nerve, and association movements are sometimes 

 troublesome. 



10. The distribution of the facial nerve is, in dogs and monkeys, limited to 

 its own side of the face, and recoveries cannot therefore be attributed to a 

 supply from the opposite facial. 



11. The distal segment of the divided facial, except for a short period 

 immediately following division, on being irritated gives no response in the 

 muscles, if no connections at a subsequent date have been made with the 

 centres, either through its own central segment or by some other path, 

 and, conversely, the occurrence of muscular responses on irritating the 

 peripheral segment is proof that such connections have been established. 



