Reflex Response of Orbicularis Oculi Muscle to Supraorbital Nerve Stimulation

Abstract

A REFLEX blink was first described by Overend1 in 1896. Wartenberg2 in 1945ognized that blink reflexes evoked with different maneuvers were probably identical and proposed the term "orbicularis oculi reflex." Kugelberg3 studied the response of the orbicularis oculi muscle to a tap over the brow. He recognized two different responses, an early ipsilateral reflex (latency: 12 msec) and a late bilateral reflex (latency: 21 to 40 msec). From a comparison with the masseter reflex (latency: 7.5 msec), he postulated that the early reflex was transmitted through a simple arc compatible with a myotatic reflex. However, the nature and pathway of this arc is still in dispute. On the basis of animal experiments, Tokunaga et al4 suggested that the early reflex was relayed through the main sensory nucleus of the trigeminal nerve rather than through the mesencephalic nucleus. The late bilateral reflex is probably transmitted through a multisynaptic arc, perhaps implicating the spinal tract of the trigeminal nerve, although details of the reflex connec¬ tions are not known.46 The reflex to electri¬ cal stimulation of the supraorbital nerve also has two components and bears a great resemblance to the response to glabellar tap,57 being almost identical in latency and in relation to a unilateral initial response and a bilateral late response. The use of electrical stimulation of the nerve is more convenient in the electromyographic labora¬ tory, since equipment ordinarily used for nerve conduction studies is applicable. Modification of the reflexes in facial paresis and other diseases of the nervous system has been described,57 but no previous at¬ tempt has been made to correlate serial changes in latency and amplitude of these reflexes with the clinical course of peripher¬ al facial paresis.The purpose of this paper is to describe normal values and variations of the reflex response of the orbicularis oculi muscle elic¬ ited by electrical stimulation of the supraor¬ bital nerve. Application of this technique to the study of four cases of peripheral facial paresis will be described. The serial changes in this reflex during the early course of Bell's palsy and its improvement are of considerable interest and appear to have value in the prognosis of facial paralysis, especially for those who may be considering surgical decompression of the nerve. MethodsThe facial nerve was stimulated percutaneously with the cathode placed just anterior to the mastoid process. The supraorbital nerve was also stimulated percutaneously with the cathode placed over the supraorbital foramen.The initial stimulus was a shock of 0.1 msec and 50 v. Then the voltage was advanced slowly to a level above which the evoked potential remained constant.The responses were recorded with surface electrodes placed over the right and the left orbicularis oculi muscles. Reference electrodes were located on each side of the nasal bone, and a ground electrode was placed under the chin. The evoked potentials were displayed on a dual trace oscilloscope after conventional am¬ ...

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“…10 The afferent arc of the reflex is the trigeminal nerve, and the efferent output is produced by a pontine oligosynaptic (1 or 2 interneurons) pathway that give a unilateral short latency response (R1), and a spinal polysynaptic pathway (multiple interneurons) that gives bilateral long latency responses (R2 and R2C). The eventual output of both these circuits is through the efferent fibers of the facial nerve so a unilateral block in the facial nerve will cause absent R1 and R2 responses on the ipsilateral side but a normal R2C response on the contralateral side.…”

Neurophysiological assessment of craniofacial pain

“…R1 is a stable response and is uninfluenced by suprasegmental dysfunction, such as supratentorial lesions, disorders of consciousness and cognitive factors [6]. The R1 response is regarded as delayed if its latency exceeds 13.0 ms; a latency difference between the two sides exceeding 1.5 ms is also abnormal [13].…”

Blink reflex: comparison of latency measurements in different human races

“…As respostas R1, R2i e R2c não mostraram diferenças de latências estatisticamente significativas entre as 3 diferentes raças analisadas neste estudo. PALAVRAS-CHAVE: reflexo trigêmino-facial, raças.The blink reflex is a very practical reproducible electrical response, that can be used in comparative clinical studies and experimental models [1][2][3] . At the beginning of XX th century, there was a dispute about the authorship of the original description of the blink reflex 4 .…”

“…The blink reflex is a very practical reproducible electrical response, that can be used in comparative clinical studies and experimental models [1][2][3] . At the beginning of XX th century, there was a dispute about the authorship of the original description of the blink reflex 4 .…”

“…Electrical stimulation of the supraorbital nerve was first employed by Rusworth 10 to obtain a reflex response first named "blink reflex". Blink reflex normative studies were made by many authors 9,[11][12][13] , although the work of Kimura et al 1 is still accepted as the standard.…”