On the restoration of co-ordinated movements after nerve-crossing, with interchange of function of the cerebral cortical centres / by Robert Kennedy.
- Kennedy, Robert, -1924.
- Date:
- 1901
Licence: In copyright
Credit: On the restoration of co-ordinated movements after nerve-crossing, with interchange of function of the cerebral cortical centres / by Robert Kennedy. Source: Wellcome Collection.
Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.
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![Present Condition.—The patient appears to be healthy. On the right side of tlie face there is constant twitching, and tlie riuiit anoie of the mouth is ahnost con- stantly pulled up in a tonic spasm. The clonic contractions most evidently involve the zygomatici and levator lahii superioris, while the linger inserted into the moutli recognises a hard contracted l)Ucciuator. The only thing which momentarily arrests the twitching is when the patient opens lier mouth to the full extent. The orl^icularis palpebrarum also contracts synchronously with the other muscles, giidng the ap})ea]-ance of winking. When she is resting, she frequently has a peculiar sensation just below the lobe (jf the right ear. The eye, nasal fossse, throat, and ear were examined, without slK)wing anything likely to be of impoilance in the condition. The vocal cords were passive while the twitching was proceeding in the face. The patient's past history revealed nothing considei'ed to be of importance in the case. Operation.—On 4th May, 1899, the facial nerve was divided close to its exit from the stylo-mastoid foramen. The peripheral end of the nerve was tlien drav/n down- wards to meet the trunk of the spinal accessory nerve at the lower border of the digastric muscle. At tliis point the trunk of the spinal accessory was divided, l)ut one side of the perineurium was left intact so as to maintain the two divided ends in proximity. Into this gap the peiij)heral end of the facial nerve was fixed hj a suture. On recovery from anaesthesia the face Avas inspected, and was found, of course, to be in complete right-sided paralysis. Asked to close lier eyes, the rigljt eye remained completely open, and the eyeball rolled up. The angle of the nmuth droojied, and, asked to open lier mouth, tlie lower lip opened incompletely on tlie right side. The brow on the right side was smooth and could not 1je v/rinkled, the buccinator was flaccid, and the naso-labial sulcus was badly marked. On the 7th day the paralytic conditioTi of the face lemained in the snme condition as it was immediately after the o})eration, except that there was a very slight move- ment of the upper eyelid possible, but it could not effect closure ol the jjalpebral fissure more than about a quarter. On the 18th day the condition of facial paralysis still continued. Only very slight movements of the upper eyelid were ])ossible, but it was still impossi1»le for her to close the right eye voluntarily. The brow could not be wi'inkled on the right side. When she was eating, she was very much troubled with food accunndating Ijetween her cheek and gums. She was cpiite unable to pionijunce correctly the labinl letters. The ])icture of unilateral paralysis was still complete, except as legards the slight movement of the upper eyelid. An electrical examination of the condition showed that tlie faradic irritability of the entire musculature of the right side of the lace was lost, except lor some doubtful VOL. CXCIV. B. X](https://iiif.wellcomecollection.org/image/b21456513_0031.jp2/full/800%2C/0/default.jpg)
