Facial Nerve Disorders and Diseases: Diagnosis and Management

The Foreword, by Eugene Myers, talks of a realisation that there was ‘no current textbook devoted entirely to disorders of the facial nerve’. Well, I opened this book fearing the opposite, having reviewed a couple for this journal quite recently. I soon appreciated that one cannot do better than this, if seeking an all-encompassing textbook on pathology, diagnosis and management of facial nerve disorders. Dr Myers’ Foreword actually does the work of any reviewer, informing us of what is different and novel. He tells of his own experience, forced into parotid surgery, as local colleagues had more sense than to tackle something that challenging. In a second Foreword, Johannes Manni recommends chapters on paediatric disorders, and intra-operative nerve monitoring and grading, and I freely admit I learnt much from each.

The text is set out in easily-followed paragraphs, with subheadings and, especially, bullet points. These can seem an afterthought in some books, but not here. There were countless ‘I did not know that’ moments for this ignorant reviewer. I may have been lost by ‘In contrast to spinal motoneurons, the facial motoneurons are not functionally coupled to γ motoneurons and feedback inhibitory (Renshaw) interneurons’, but feel I should know this and am better for it. More typical was ‘Contralateral recurrence is more common than ipsilateral in Bell’s palsy (2:1)’. Now I think about it…, but I never have.

Diagrams of anatomy and surgery are a model of clarity. I was fascinated to read of types I–VI for patterns of facial nerve branching, after leaving the ear. I wrongly guessed type III to be by far the commonest (which turns out to apply in only 27 per cent of cases!). Colour illustrations abound, many reflecting just how disfiguring a facial palsy can be, once atrophy sets in. I could not help but chuckle at the expression (asymmetric, but strangely appealing) of a white rat with a facial weakness, when contrasted with his more fortunate, identical companion. Imaging is superbly reproduced, with all the enhanced nerve trunks, skull base fractures and eroded bony canals that one expects.

For most of us, a patient with a sudden onset isolated facial palsy means the rapid start of steroids and assurance of early recovery. The list of systemic illness that may be involved is instructive, however. Sarcoidosis and Lyme disease (which get major coverage of course) we might consider. If you should open this book, see Table 4.2 for the ‘diagnostic work up’, and contrast it with most UK customs and practices. Mind you, go to Figure 4.5 and see what a facial nerve assessment laboratory should look like and weep.