| A SUGGESTIVE CASE OF NERVE-ANASTOMOSIS. |
By Professor GEORGE T. LADD,
YALE UNIVERSITY.
SUCCESSFUL cases of the anastomosis of motor nerves presiding over different groups of muscles have been several times reported since 1897. Some of these cases have resulted in the transference of function between the flexor and the extensor nerves of the same extremity; in other cases, nerves serving so different purposes as the sympathetic and the pneumo-gastric have been successfully crossed. The anastomosis of mixed nerves offers, of course, a more complicated problem.
In 1898 Dr. Faure attempted to cure a case of facial paralysis due to destruction of the Nervus facialis by uniting its peripheral end with that portion of the Nervus accessorius which supplies the trapezius muscle. But in this case a satisfactory restoration of the function of the facial nerve was not secured. Still later experiments upon animals in Munk's laboratory, with a view to effect a functionally satisfactory anastomosis of the same two nerves, resulted in a partial success. And one instance of this particular operation in the case of a man, which was attended by a somewhat marked recovery of function, was communicated to the Royal Society by Dr. Kennedy, of Glasgow, in November, 1900. The same authority reported several instances of the same class of cases in the London Lancet for March 1, 1902. In one of these cases, Dr. Kennedy, operating "for facial spasm, divided the facial nerve and united it to the spinal accessory with the result that the face recovered its power of movement to a great extent, but that whenever the patient lifted the right arm a spasm of the face was produced."
The case of anastomosis, to which I wish now to call your attention, was performed by Dr. Harvey Cushing of Baltimore, in the spring of 1902; and it consisted in transferring the proximal stem of the divided accessory nerve in toto into the distal end of the injured and paralyzed facial. The injury to the facial nerve was in this case caused by a bullet wound which completely severed the nerve on the right side of the face; and it involved a loss of the sensations of sweet, sour and bitter substances over the anterior two thirds of the tongue on that side, and a total motor paralysis of the same side. The patient could not close his right eye; lachrymation and other discomforts of facial paralysis were present; and none of the muscles
