Clinical Experiences in Surgical Treatment of Facial Palsy by Autoplastic Nerve Grafts: The Ballance-Duel Method

Abstract

I reported the results of a year's research on facial palsy, consisting of surgical experiments on baboons, monkeys, cats and frogs. We had aimed to evolve a method of restoring lost facial function which would eliminate associated movements.Cures hitherto effected by means of an anastomosis of the facial nerve with an adjacent nerve in the neck, such as the spinal accessory, the hypoglossal, the descendens noni and the glossopharyngeal, had invariably been marred by associated movements.Our experiments were carried out at my country place, where an experimental animal laboratory had been built for the purpose. There, the quiet environment, pure air, sunshine, protection from drafts, cleanliness, careful feeding and kindly treatment by trained attendants insured us against the vitiation of an experiment by the untimely death of any of the animals. A number of experiments and observations are still being carried out on animals which have been in captivity for more than two years.The last day of the meeting of the American Otological Society, in May, 1931, was given over to a visit to the animal laboratory at Laurelwood, where the members, and many invited guests, were shown sixty or more animals on which operations had been performed, exhibiting various phases of our experiments with anastomosis of the nerve and autoplastic nerve grafts.In the subsequent four months further experiments were made on more than fifty animals. The complete data, including the final experiments, were published in the January, 1932, issue of the ARCHIVES OF OTOLARYNGOLOGY. A reprinted monograph has been sent to all the members of the society.

Historical Commentary

“…[1,2,7] He even used the central end of the divided cervical sympathetic trunk in an attempt to restore facial and hypoglossal nerve function. However, at the end of his career he concluded that a divided facial nerve should be reunited directly or with a graft rather than being reinnervated by another cranial nerve.…”

Trophic Interactions of Neurons

“…In rabbit, Gutmann & Young (108) were able to reinnervate and get quite remarkable recovery in muscles that had been denervated for almost 2 yr. In man, nerve graft reinnervations with some functional recovery after as much as 22-yr denervation have been described (57).…”

Possibilities of Nerve Grafting

“…The problem arose in the last war, and attempts were made, by means of multiple strands of cutaneous nerves or lengths of vein and other hollow tubes, to guide the down-growing axons from the proximal end of the nerve across the gap into the distal end. The results on the whole were disappointing, and nerve grafting was discredited until the work of Duel and Ballance (1932). These workers were interested in the problem of bridging a gap in the facial nerve in the Fallopian canal, and they were able to show, in animals and in man, that this gap could be successfully bridged by means of a nerve graft taken from the external cutaneous nerve of the thigh.…”