Orthodontic Abstracts and Reviews 817

of the muscles of the healthy side, whereas the alteration of facial appearance caused by paralysis of other muscle groups, such as those of the upper lip, eye- lids, and brow, is not exaggerated by the activity of the muscles on the nor- mal side.

Reconstructive operations such as decompression of the nerve in the bony canal, direct suture and nerve graft have been advocated (Bunnel, et al.) for lesions in or peripheral to the bony canal, when the location of the lesion is favorable for such procedures. The author, from his personal experience, feels that suture and graft of the trunk of the facial nerve fail to restore emotional expression or to prevent mass movements of the face. This failure is due to defective regeneration of the nerve. On the other hand, the results are much more favorable after the successful repair of one or more peripheral branches of the facial nerve.

According to Coleman, anastomosis of the facial nerve with another motor cranial nerve is the only procedure which will restore innervation to the para- lyzed facial muscles following an intracranial lesion of the nerve. Facio-hypo- glossal anastomosis will restore movement in practically every case. However, function of the muscle groups, after facie-hypoglossal anastomosis, cannot be individualized. When the patient responds to emotional stimuli the expres- sion of emotion is registered only on the healthy side; smiling is accompanied by slight deviation of the mout.h to the healthy side.

Although anastomosis requires the sacrifice of another cranial nerve (the hypoglossal), the resulting atrophy of the tongue causes no appreciable inter- ference with speech or deglutition. The results of the anastomosing operation can be greatly improved by voluntary suppression of facial movements and emotional expression on the normal side. According to Brown! incomplete recovery and residual paralysis of important muscle groups, may be improved by supporting the face with facial strips. The author feels that this combina- tion of nerve anastomosis and facial support gives the best result and should be used much more frequently. The author then describes the technique of the operation in detail. The text is illustrated by photographs of patients before, and at various periods a.fter the operation. Semidiagrammatic drawings show the relationship of the nerves in question as well as the method of approach for accomplishing the anastomosis.

One must bear in mind, however, the fact that maximum recovery follow- ing all operations leaves much to be desired, and that the patient’s facial ap- pearance is never restored to normal. Facie-hypoglossal anastomosis for the relief of paralysis following intracranial lesions of the facial nerve will bal- ance the face in repose, restore movement of the paralyzed muscles, and prevent further disfigurement resulting from atrophy of the muscles.

Hurry A. Sdzmann, M.D.

BOOK REVIEWS

Babies Are Human Bebgs. An Interpretation of Growth: By C. Anderson Aldrich, M.D., Assoc. Prof. of Pediatrics, Northwestern Univ. Med. School, and Mary M. Aldrich. Pp. 128, Price $1.75, New York, 1938, The Mac- millan Co.