Sb. Shah et Rk. Jackler, Facial nerve surgery in the 19th and early 20th centuries: The evolution from crossover anastomosis to direct nerve repair, AM J OTOL, 19(2), 1998, pp. 236-245
The historical aspects of facial nerve(FN)anatomy and of Bell's palsy have
long been favorite topics of otologic historians. Little attention has been
paid, however, to the evolution of FN surgery, a subject with a remarkably
rich and engaging history. In the early 13th century, Roland, an Italian s
urgeon, used a red hot iron to coapt severed nerve endings. Tn the 17th cen
tury, Ferrara, another Italian, sutured injured nerves with tortoise tendon
dipped in hot red wine. It was not until the late 19th century that periph
eral nerve suture became a subject of serious scientific study. Although it
is ironic, the course of events suggests that the evolution of FN repair w
as greatly stimulated by the development of the modern mastoid operation. W
hereas the simple mastoid operation practiced by Wilde (1853) and others ca
rried little risk of FN injury, more adventuresome procedures such as radic
al mastoidectomy (Kessel, 1885) carried a much greater risk. The abundance
of iatrogenic palsies during this era undoubtedly did much to motivate surg
eons to seek a better means of restoring facial animation. Most surgeons wo
uld be surprised to learn that crossover anastomoses predated direct nerve
repair by nearly half a century. In 1879, the German surgeon Drobnik perfor
med the first facial-spinal accessory anastomosis. Over the next two decade
s, numerous articles were written (most notably by Sir Charles Balance and
Harvey Gushing) on crossovers between the FN and cranial nerves TX, X, XI,
and XII. Although a few tentative attempts at reapproximating severed FNs t
ook place in the first two decades of this century, it was not until 1925 t
hat an actual suture repair of an intratemporal injury was undertaken. This
feat was first accomplished by the famous hand surgeon Sterling Bunnell an
d shortly thereafter by the otolaryngologist Robert Martin. The evolution o
f FN surgery in the days predating the operating microscope is a rich tapes
try of colorful personalities and clashing egos, which saw promising advanc
es relegated to obscurity and some previously obscure techniques become pro
gressively more promising.