The Facial Nerve

Review by L Flood
Middlesborough, UK

Arguably, the facial nerve is the most important of the temporal bone contents. Given a choice, most of us would rather sacrifice unilateral vestibular function or hearing (let us ignore the carotid artery for this purpose though), than suffer a permanent and complete facial paralysis. We may not all resort to Botox or facelifts to enhance our features, but even the more senior amongst us still values our appearance and the role of facial movements and expression in our social interactions.

The UK neurotologist, however, views the facial nerve as the poor relation of the temporal bone. Steroids for any problem, antivirals if one sees blisters (ideally even before that) and surgery only if there is no prospect of spontaneous recovery: this might summarise our practice.

In just over 200 pages, this multi-author work is consistently good in covering the basic sciences, clinical examination, diseases of the nerve and rehabilitation measures. This is, very much, an up-to-date and practical clinician’s guide, and it makes for easy reading. There are very high quality line diagrams and colour illustrations (the endoscopic pictures of the posterior fossa are superb) on every page.

In exam preparation courses, I regularly find myself having to explain Bell’s phenomenon, and demonstrating that a lesion of the marginal mandibular branch of the nerve does not cause the angle of the mouth to droop. Both are well shown here, for once. The imaging, whether computed tomography (CT) or magnetic resonance imaging, is superbly reproduced in true black and white. This is not the faded fuzzy grey seen in many textbooks. For novelty, try Table 7.2 which shows the list of causes of bilateral (yes, bilateral) facial paralysis, or Table 7.3 on the diagnosis and treatment of ‘unusual causes’ of nerve loss. I predict Meretoja disease as the next hot tip for the exit exam and I will surely be seeking the information out. I had long wondered what to do with a young lady’s facial schwannoma, which presented with nothing beyond a conductive loss, a bulging drum and a marvellous CT scan. Now I know. I was intrigued (and encouraged) by the fact that this largely US text still concedes that routine operative nerve monitoring remains ‘surgeon dependent’. The final surgical chapters will attract most Journal of Laryngology & Otology readers, with excellent descriptions and again illustrations of nerve repair, reanimation and management of the eye.

If you do see this book on a stand, flick through it and you will be impressed. It strikes me as particularly good value. Thieme regularly produce books of this quality and surely one day must produce ‘a turkey’. However, as in the closing line of Gladiator, the movie, ‘But not yet my friend’.

Amazon Link: The Facial Nerve
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