A case of Oppenheim's underwent first tenotomy, then elongation, and
finally resection of the spinal accessory, with the result that, in
spite of complete atrophy of the sternomastoid and partial atrophy of
the trapezius, spasm settled with renewed intensity on the splenius,
omohyoid, and remaining fibres of the trapezius. Application of a seton
was equally negative, but the patient soon after made astonishing
improvement by a mineral water "cure"!
In face of such facts, it is truly surprising to see the increasing
support given to surgical intervention. Walton,[212] for an instance,
admits the central origin and progressive nature of the disease, and
recognises the futility of surgical procedures, yet constitutes himself
their advocate. Would it not be more in accordance with the dictates of
reason and wisdom to refrain?
We must not omit to mention the extraordinary method devised by
Corning[213] of injecting into the muscles a warm mixture of tallow and
oil which will solidify at 37° C., to which proceeding he proposes to
give the fantastic name of _elœomyenchisis_. The idea is to fix
previously relaxed muscles. He does not seem to have had many imitators.
* * * * *
Torticollis apart, few tics invite treatment at the hands of the
surgeon, with the exception of facial tics or spasms.
Here, too, the results have usually been anything but encouraging.
Stewens[214] reports three cases of facial tic cured by the correction
of errors of refraction, while elongation of the facial nerve failed of
its object. Resection of a branch of the trigeminal is valueless; facial
elongation only causes a corresponding paralysis, and should this latter
accident be transient, as in a case of Bernhardt's, so is the relief
from the tic.
To obviate the much more frequent inconvenience of a permanent facial
paralysis, J. L. Faure[215] suggests spino-facial anastomosis. In a
woman suffering from contracture and spasmodic twitchings in the region
of the facial, Kennedy, of Glasgow, divided the nerve and immediately
anastomosed the cut end laterally with the spinal accessory. At the end
of fifteen months the spasm had vanished and the paralysed facial nerve
had recovered its functions.[216]
Strictly speaking, then, in certain cases of genuine facial spasm the
possibility of some such treatment may be entertained if all other means
have failed, but persistence of the facial palsy and the grave
consequences it may entail are always to be dreaded. In facial tics,
however, under no pretext whatever is the surgeon justified in
attempting to interfere.
Public-domain text, read in full here on John Shaqi.
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