Slattery III WH, Azizzadeh B. The Facial Nerve. Thieme; 2014; 236 pp; 62 illustrations; $129.99
Historically, the facial nerve as an isolated and independent subject for an entire text was unique for the cranial nerves. Mark May edited several contemporary editions based on his clinical and academic focus on the myriad conditions related to dysfunction of CN 7 (The Facial Nerve, 2nd Edition, Thieme Publishing Group, 1999). The face remains one of humanity’s most important features, both visually and as a mode of communication through emotive expressions. Most of us take for granted our good health and rarely, if ever, consider the possibility that we might awaken with half of our visage immobilized. When the possibility of facial paralysis looms, patients become willing to sacrifice almost any other part of their functional anatomy to maximize the chances of leaving the face unscathed. Surgeons of the brain and head/neck regions fear injury to this nerve more than almost any other complication (frequently avoiding close dissection for identification to the point of increasing the chances of iatrogenic injury).
It is in this context that The Facial Nerve, edited by Drs. Slattery and Azzizadeh, provides a fresh, easy-to-read update to previous texts on the subject. The topic addresses the seventh nerve from cerebral cortex to the brainstem, through the temporal bone into the parotid gland, terminating into the neuromuscular junctions. Anatomy, physiology, history, examination, testing, imaging, disorders, treatment, and associated issues are addressed comprehensively. For beginners and seasoned professionals alike, the authors of most chapters examine their topics with enough coverage yet without overwhelming detail.
The text is organized in a standard fashion, starting with the basics of anatomy/physiology/histopathology. Following the “Overview” is a nice section on the various methods of assessment of facial nerve function. The physical examination chapter includes not only the observational findings but also the ancillary tests of integrity, such as audiometry/reflex tests, electrical testing, and serology. The various grading scales are reviewed in chapter 5. Next comes one of the chapters most germane to this journal, “Imaging of the Facial Nerve.” Unfortunately, and perhaps by design, this chapter is rather basic and limited. It may have been deliberate to discuss imaging in later chapters as it pertains to each disorder. In addition, it may have been preferable to review the detailed imaging anatomy of the facial nerve using not only the standards (CT and MRI) but also plain films and newer techniques (eg, fiber Fiber track imaging or DTI (Deep Tensor Imaging)fiber fiber tracking imaging or deep tensor imaging).
Disorders of the nerve and affecting nerve function are covered well without giving an encyclopedic feel. Extratemporal, central, and spasm-related disorders are also discussed well. Some chapters are more biased than others, influenced by the authors’ experiences, as happens in edited texts. However, there did not appear to be any conflicts of interest, inappropriate treatment recommendations, or management discussions outside commonly accepted clinical care. In the selected topics section, the chapter on acute management would be especially useful to a clinician who might face a patient with CN 7 dysfunction. Historically, acoustic neuromas (aka vestibular schwannomas) were a significant source of new cases of iatrogenic facial paresis and paralysis.
Rehabilitation of permanent facial paralysis addresses the surgical management, ocular issues, grafting, and static/dynamic reanimation techniques and philosophies. An important chapter is the nonsurgical therapy involving neuromuscular retraining. Physical therapy almost always is indicated as part of the treatment plan (with some specific exceptions). Ending with a discussion on the long-term effects side effects of synkinesis and spasm seems appropriate, as these findings may become the chronic and difficult-to-treat remainders of the acute disorders affecting facial function.
Overall, this book was well-conceived, concise, and timely. It comprehensively reviews the major themes related to disorders of the facial nerve, facial function, and related disorders. The figures are illustrative and of reasonable number. The tables are especially good at communicating information. The writing is clear and the overall length appropriate. I would recommend this textbook to medical students and to postgraduate programs that could make it available to trainees for whom facial nerve disorders may be part of the clinical practice. The book provides a good review for individual physicians regardless of their experience level.
I applaud the editors and contributing authors for a fine work.
