Sir Charles Alfred Ballance (1856–1936) and the introduction of facial nerve crossover anastomosis in 1895

SummarySir Charles Ballance (1856–1936) was the first surgeon in history to perform a facial nerve crossover anastomosis in 1895. Although, recently, several papers on the history of facial nerve surgery have been published, little is known about this historically important operation, the theoretical reasoning behind the operation or the surgical perspective in which Ballance developed this method. An original document on the operation, dated in 1895, is not known. The earliest report of the operation is a paper by Ballance, published in 1903. Study of this 1903 paper reveals that Ballance stopped performing the operation after his first attempt in 1895 until he resumed in December 1901. What was the reason for this interruption? Why did Ballance start doing it again in 1901? Between 1895 and Ballance's 1903 paper, several other surgeons had published the results of their facial nerve crossovers. Were they inspired by Ballance's operation from 1895 to do the same or did they invent the method independently? To enhance our knowledge about the early history of facial nerve surgery, the original manuscripts by Ballance and his contemporaries have been studied.Ballance's first facial nerve crossover from 1895 is described in the surgical perspective of the end of the 19th century. The theoretical reasoning for the operation is discussed. It was discovered that Ballance's operation was first recorded in St. Thomas's Hospital Report of 1895, which was published in 1897. However, this report was probably hardly known by Ballance's contemporaries and consequently could not have stimulated them to perform the operation themselves. Jean Louis Faure (1863–1944), from France, appears to have been the first to have performed the operation until Ballance's 1903 paper was published. In 1903, after Ballance's paper had been published, many other accounts of this method were reported in the literature. At that moment facial nerve crossover seems to have been widely regarded as a potential successful technique, a technique which, a century later, is still part of our repertoire.