Book Review

The Paralyzed Face

N Engl J Med 1993; 329:1050September 30, 1993

Article

The Paralyzed Face
Edited by Leonard R. Rubin. 278 pp., illustrated. St. Louis, Mosby-Year Book, 1991. $95. ISBN: 0-8016-4570-0

Dr. Rubin has brought together 28 authors, many of them national and international authorities in the fields of surgery, research, rehabilitation, and therapy for disorders affecting the seventh nerve. The Paralyzed Face expands and updates Reanimation of the Paralyzed Face, also edited by Rubin (St. Louis: Mosby, 1977).

The book has two parts. The first covers facial muscles and nerves; the second is more clinically oriented and discusses techniques for reanimating the paralyzed face. In part I, the anatomy of the facial nerve and facial muscles is well covered. There are detailed discussions of the pathophysiology of the facial nerve and muscles, nerve degeneration and regeneration, grafting, and the role of various biologic and mechanical forces affecting sensory and motor regeneration. Some of these topics are esoteric but of value to those interested in research. The lengthy bibliographies are excellent. For the clinical researcher, there are encouraging statements -- for example, that end plates do recur and that muscle tension enhances reinnervation. Also, the concept that sensory nerves tend to find their own, sensory, end organs, and motor nerves theirs, helps to reinforce the clinical approach to facial-nerve repair and muscle transplantation.

Part II covers the techniques of reanimation fairly completely. It surveys the various nerve transfers, free-muscle transplants, and microsurgical functional-muscle transplants, as well as the classic techniques involving fifth-nerve muscles that Rubin has developed. The discussion of nonsurgical techniques for treating Bell's palsy and Ramsay Hunt syndromes will be of interest to a rather small body of clinical and experimental investigators. Some of the nerve and muscle transfers, including those of the digastric and ansa hypoglossal nerves and the sternocleidomastoid muscles, are not discussed. The results of transplantation of some free muscles, such as the extensor digitorum brevis and palmaris longus, are quite striking, but one wonders whether they have a place here in view of the chapters by distinguished international authorities on cross-face nerve grafting and functional-muscle transplantation.

The final chapter, on biofeedback in electromyographic rehabilitation, is quite detailed and documents good responses to training to reduce synkinesis and hyperkinesia.

Anyone interested in entering the field of facial-nerve surgery will want to have a copy of this book. It certainly has a place in a complete medical library. Like all multiauthor efforts, particularly those in which the authors are not from the same institution, this work has some repetition and variation in style. I have found it a valuable resource and will refer to it frequently.

Harry K. Buncke, Jr., M.D.
Davies Medical Center, San Francisco, CA 94114