It is permissible, however, to doubt the definite and radical nature of these cures if we look at the long catalogue of admitted operative failures.
Linz's two cases[209] of resection were unsatisfactory. In Popoff's experience[210] tonic muscular spasm returned in spite of repeated neurectomies, in contradistinction to the notable improvement he accomplished by simple re-education. Tichoff[211] found the torticollis reappear four days after division of the spinal accessory, and though, in his opinion, relapse supervenes after this operation in more than fifty per cent. of cases, he expresses himself in favour of further operative interference.
Two of Dalwig's patients developed a functional torticollis to avoid the diplopia caused by a superior strabismus. Ocular tenotomy, as might have been foreseen, was quite ineffectual in checking the tic; indeed, the author himself seems to have been well aware of the necessity, in curing such vicious habits, of influencing the attention. He proceeds to emphasise the hopefulness of orthopædic, as opposed to surgical, treatment, and recommends the use of a cardboard collar, though any benefit thus derived is, in our experience, purely ephemeral.
A case of Oppenheim's underwent first tenotomy, then elongation, and finally resection of the spinal accessory, with the result that, in spite of complete atrophy of the sternomastoid and partial atrophy of the trapezius, spasm settled with renewed intensity on the splenius, omohyoid, and remaining fibres of the trapezius. Application of a seton was equally negative, but the patient soon after made astonishing improvement by a mineral water "cure"!
In face of such facts, it is truly surprising to see the increasing support given to surgical intervention. Walton,[212] for an instance, admits the central origin and progressive nature of the disease, and recognises the futility of surgical procedures, yet constitutes himself their advocate. Would it not be more in accordance with the dictates of reason and wisdom to refrain?
We must not omit to mention the extraordinary method devised by Corning[213] of injecting into the muscles a warm mixture of tallow and oil which will solidify at 37° C., to which proceeding he proposes to give the fantastic name of elœomyenchisis. The idea is to fix previously relaxed muscles. He does not seem to have had many imitators.
Torticollis apart, few tics invite treatment at the hands of the surgeon, with the exception of facial tics or spasms.
Here, too, the results have usually been anything but encouraging. Stewens[214] reports three cases of facial tic cured by the correction of errors of refraction, while elongation of the facial nerve failed of its object. Resection of a branch of the trigeminal is valueless; facial elongation only causes a corresponding paralysis, and should this latter accident be transient, as in a case of Bernhardt's, so is the relief from the tic.
To obviate the much more frequent inconvenience of a permanent facial paralysis, J. L. Faure[215] suggests spino-facial anastomosis. In a woman suffering from contracture and spasmodic twitchings in the region of the facial, Kennedy, of Glasgow, divided the nerve and immediately anastomosed the cut end laterally with the spinal accessory. At the end of fifteen months the spasm had vanished and the paralysed facial nerve had recovered its functions.[216]
Strictly speaking, then, in certain cases of genuine facial spasm the possibility of some such treatment may be entertained if all other means have failed, but persistence of the facial palsy and the grave consequences it may entail are always to be dreaded. In facial tics, however, under no pretext whatever is the surgeon justified in attempting to interfere.