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Krane NA, Loyo M, Pollock J, Hill M, Johnson CZ, Stevens AA. Exploratory Study of the Brain Response in Facial Synkinesis after Bell Palsy with Systematic Review and Meta-analysis of the Literature. AJNR Am J Neuroradiol 2022; 43:1470-1475. [PMID: 36574328 PMCID: PMC9575525 DOI: 10.3174/ajnr.a7619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Facial synkinesis, characterized by unintentional facial movements paired with intentional movements, is a debilitating sequela of Bell palsy. PURPOSE Our aim was to determine whether persistent peripheral nerve changes arising from Bell palsy result in persistent altered brain function in motor pathways in synkinesis. DATA SOURCES A literature search using terms related to facial paralysis, Bell palsy, synkinesis, and fMRI through May 2021 was conducted in MEDLINE and EMBASE. Additionally, an fMRI study examined lip and eyeblink movements in 2 groups: individuals who fully recovered following Bell palsy and individuals who developed synkinesis. STUDY SELECTION Task-based data of the whole brain that required lip movements in healthy controls were extracted from 7 publications. Three studies contributed similar whole-brain analyses in acute Bell palsy. DATA ANALYSIS The meta-analysis of fMRI in healthy control and Bell palsy groups determined common clusters of activation within each group using activation likelihood estimates. A separate fMRI study used multivariate general linear modeling to identify changes associated with synkinesis in smiling and blinking tasks. DATA SYNTHESIS A region of the precentral gyrus contralateral to the paretic side of the face was hypoactive in synkinesis during lip movements compared with controls. This region was centered in a cluster of activation identified in the meta-analysis of the healthy controls but absent from individuals with Bell palsy. LIMITATIONS The meta-analysis relied on a small set of studies. The small sample of subjects with synkinesis limited the power of the fMRI analysis. CONCLUSIONS Premotor pathways show persistent functional changes in synkinesis first identifiable in acute Bell palsy.
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Affiliation(s)
- N A Krane
- From the Division of Facial Plastic and Reconstructive Surgery (N.A.K., M.L., C.Z.J.), Department of Otolaryngology-Head and Neck Surgery
| | - M Loyo
- From the Division of Facial Plastic and Reconstructive Surgery (N.A.K., M.L., C.Z.J.), Department of Otolaryngology-Head and Neck Surgery
| | - J Pollock
- Division of Neuroradiology (J.P.), Department of Diagnostic Radiology
| | - M Hill
- Department of Otolaryngology-Head and Neck Surgery (M.H.), University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - C Z Johnson
- From the Division of Facial Plastic and Reconstructive Surgery (N.A.K., M.L., C.Z.J.), Department of Otolaryngology-Head and Neck Surgery
| | - A A Stevens
- Advanced Imaging Research Center (A.A.S.), Oregon Health & Science University, Portland, Oregon
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Bermedo-García F, Zelada D, Martínez E, Tabares L, Henríquez JP. Functional regeneration of the murine neuromuscular synapse relies on long-lasting morphological adaptations. BMC Biol 2022; 20:158. [PMID: 35804361 PMCID: PMC9270767 DOI: 10.1186/s12915-022-01358-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background In a broad variety of species, muscle contraction is controlled at the neuromuscular junction (NMJ), the peripheral synapse composed of a motor nerve terminal, a muscle specialization, and non-myelinating terminal Schwann cells. While peripheral nerve damage leads to successful NMJ reinnervation in animal models, muscle fiber reinnervation in human patients is largely inefficient. Interestingly, some hallmarks of NMJ denervation and early reinnervation in murine species, such as fragmentation and poly-innervation, are also phenotypes of aged NMJs or even of unaltered conditions in other species, including humans. We have reasoned that rather than features of NMJ decline, such cellular responses could represent synaptic adaptations to accomplish proper functional recovery. Here, we have experimentally tackled this idea through a detailed comparative study of the short- and long-term consequences of irreversible (chronic) and reversible (partial) NMJ denervation in the convenient cranial levator auris longus muscle. Results Our findings reveal that irreversible muscle denervation results in highly fragmented postsynaptic domains and marked ectopic acetylcholine receptor clustering along with significant terminal Schwann cells sprouting and progressive detachment from the NMJ. Remarkably, even though reversible nerve damage led to complete reinnervation after 11 days, we found that more than 30% of NMJs are poly-innervated and around 65% of postsynaptic domains are fragmented even 3 months after injury, whereas synaptic transmission is fully recovered two months after nerve injury. While postsynaptic stability was irreversibly decreased after chronic denervation, this parameter was only transiently affected by partial NMJ denervation. In addition, we found that a combination of morphometric analyses and postsynaptic stability determinations allows discriminating two distinct forms of NMJ fragmentation, stable-smooth and unstable-blurred, which correlate with their regeneration potential. Conclusions Together, our data unveil that reversible nerve damage imprints a long-lasting reminiscence in the NMJ that results in the rearrangement of its cellular components. Instead of being predictive of NMJ decline, these traits may represent an efficient adaptive response for proper functional recovery. As such, these features are relevant targets to be considered in strategies aimed to restore motor function in detrimental conditions for peripheral innervation. Supplementary Information The online version contains supplementary material available at 10.1186/s12915-022-01358-4.
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Affiliation(s)
- Francisca Bermedo-García
- Laboratory of Neuromuscular Studies (NeSt Lab), Group for the Study of Developmental Processes (GDeP), Department of Cell Biology, Faculty of Biological Sciences, Universidad de Concepción, Concepción, Chile
| | - Diego Zelada
- Laboratory of Neuromuscular Studies (NeSt Lab), Group for the Study of Developmental Processes (GDeP), Department of Cell Biology, Faculty of Biological Sciences, Universidad de Concepción, Concepción, Chile
| | - Esperanza Martínez
- Laboratory of Neuromuscular Studies (NeSt Lab), Group for the Study of Developmental Processes (GDeP), Department of Cell Biology, Faculty of Biological Sciences, Universidad de Concepción, Concepción, Chile
| | - Lucía Tabares
- Department of Medical Physiology and Biophysics, School of Medicine, Universidad de Sevilla, Sevilla, Spain
| | - Juan Pablo Henríquez
- Laboratory of Neuromuscular Studies (NeSt Lab), Group for the Study of Developmental Processes (GDeP), Department of Cell Biology, Faculty of Biological Sciences, Universidad de Concepción, Concepción, Chile.
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Ma J, Hua XY, Zheng MX, Wu JJ, Huo BB, Xing XX, Ding W, Xu JG. Spatial patterns of intrinsic brain activity and functional connectivity in facial synkinesis patients. Br J Neurosurg 2020; 35:730-735. [PMID: 32500814 DOI: 10.1080/02688697.2020.1773396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives: As one of the most objectionable sequelae of facial paralysis, patients with facial synkinesis are more likely to be depressed and have lower quality of life than other facial paralysis patients. However, there is no research on the spatial patterns of intrinsic brain activity and functional connectivity in these patients. The objective of this study was to investigate the spatial patterns and cerebral plasticity of facial synkinesis patients.Methods: A total of 20 facial synkinesis patients (18 men and 2 women; mean age: 33.35 ± 6.97 years old) and 19 healthy controls (17 men and 2 women; mean age: 33.21 ± 6.75 years old) were enrolled in this study. resting-state functional magnetic resonance imaging (rs-fMRI) data were collected, and the amplitude of low frequency fluctuation (ALFF), regional homogeneity (ReHo), and degree centrality (DC) were calculated for each participant. Two-sample t-tests were performed to compare the ALFF, ReHo, and DC maps between the two groups.Results: Compared with the healthy controls, facial synkinesis patients exhibited decreased ALFF in the fusiform gyrus, lingual gyrus, parahippocampal gyrus, triangular inferior frontal gyrus, precentral gyrus, postcentral gyrus, cingulate gyrus, superior frontal gyrus, precuneus, caudate nucleus and thalamus; decreased ReHo in the cingulate gyrus, superior frontal gyrus, insula, superior temporal gyrus, orbital middle frontal gyrus, caudate nucleus and thalamus; and decreased DC in the frontal lobe, insula, cingulate gyrus, superior temporal gyrus, lenticular putamen, hippocampus and parahippocampal gyrus. We found significant overlap in the superior frontal gyrus across the ALFF, ReHo and DC analyses.Conclusions: In facial synkinesis patients, the neurological activity in brain areas is reduced and the local synchronization in motion-related brain regions is decreased. The superior frontal gyrus could be a crucial region in the unique spatial patterns of intrinsic brain activity and functional connectivity in these patients.
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Affiliation(s)
- Jie Ma
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Traumatology and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Rehabilitation Section, Spine Surgery Division of Department of Orthopedics, Tongji Hospital, Affiliated to Tongji University School of Medicine, Shanghai, China.,Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration of Ministry of Education of the People's Republic of China, Tongji University, Shanghai, China
| | - Mou-Xiong Zheng
- Department of Traumatology and Orthopedics, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bei-Bei Huo
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang-Xin Xing
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wei Ding
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People Hospital, Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Center of Rehabilitation Medicine, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Brown BL, Sandelski MM, Drejet SM, Runge EM, Shipchandler TZ, Jones KJ, Walker CL. Facial nerve repair utilizing intraoperative repair strategies. Laryngoscope Investig Otolaryngol 2020; 5:552-559. [PMID: 32596500 PMCID: PMC7314485 DOI: 10.1002/lio2.411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/27/2020] [Accepted: 05/18/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To determine whether functional and anatomical outcomes following suture neurorrhaphy are improved by the addition of electrical stimulation with or without the addition of polyethylene glycol (PEG). METHODS In a rat model of facial nerve injury, complete facial nerve transection and repair was performed via (a) suture neurorrhaphy alone, (b) neurorrhaphy with the addition of brief (30 minutes) intraoperative electrical stimulation, or (c) neurorrhaphy with the addition electrical stimulation and PEG. Functional recovery was assessed weekly for 16 weeks. At 16 weeks postoperatively, motoneuron survival, amount of regrowth, and specificity of regrowth were assessed by branch labeling and tissue analysis. RESULTS The addition of brief intraoperative electrical stimulation improved all functional outcomes compared to suturing alone. The addition of PEG to electrical stimulation impaired this benefit. Motoneuron survival, amount of regrowth, and specificity of regrowth were unaltered at 16 weeks postoperative in all treatment groups. CONCLUSION The addition of brief intraoperative electrical stimulation to neurorrhaphy in this rodent model shows promising neurological benefit in the surgical repair of facial nerve injury. LEVEL OF EVIDENCE Animal study.
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Affiliation(s)
- Brandon L. Brown
- Department of Anatomy, Cell Biology and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Anatomical Sciences and NeurobiologyUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Morgan M. Sandelski
- Department of Anatomy, Cell Biology and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Sarah M. Drejet
- Department of OtolaryngologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Elizabeth M. Runge
- Department of Anatomy, Cell Biology and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Taha Z. Shipchandler
- Department of OtolaryngologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Kathryn J. Jones
- Department of Anatomy, Cell Biology and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
- Research and Development ServiceRichard L Roudebush Veterans Affairs Medical CenterIndianapolisIndianaUSA
| | - Chandler L. Walker
- Department of Anatomy, Cell Biology and PhysiologyIndiana University School of MedicineIndianapolisIndianaUSA
- Research and Development ServiceRichard L Roudebush Veterans Affairs Medical CenterIndianapolisIndianaUSA
- Department of Biomedical Sciences and Comprehensive CareIndiana University School of DentistryIndianapolisIndianaUSA
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Brown BL, Asante T, Welch HR, Sandelski MM, Drejet SM, Shah K, Runge EM, Shipchandler TZ, Jones KJ, Walker CL. Functional and Anatomical Outcomes of Facial Nerve Injury With Application of Polyethylene Glycol in a Rat Model. JAMA FACIAL PLAST SU 2020; 21:61-68. [PMID: 29800078 DOI: 10.1001/jamafacial.2018.0308] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Functional and anatomical outcomes after surgical repair of facial nerve injury may be improved with the addition of polyethylene glycol (PEG) to direct suture neurorrhaphy. The application of PEG has shown promise in treating spinal nerve injuries, but its efficacy has not been evaluated in treatment of cranial nerve injuries. Objective To determine whether PEG in addition to neurorrhaphy can improve functional outcomes and synkinesis after facial nerve injury. Design, Setting, and Subjects In this animal experiment, 36 rats underwent right facial nerve transection and neurorrhaphy with addition of PEG. Weekly behavioral scoring was done for 10 rats for 6 weeks and 14 rats for 16 weeks after the operations. In the 16-week study, the buccal branches were labeled and tissue analysis was performed. In the 6-week study, the mandibular and buccal branches were labeled and tissue analysis was performed. Histologic analysis was performed for 10 rats in a 1-week study to assess the association of PEG with axonal continuity and Wallerian degeneration. Six rats served as the uninjured control group. Data were collected from February 8, 2016, through July 10, 2017. Intervention Polyethylene glycol applied to the facial nerve after neurorrhaphy. Main Outcomes and Measures Functional recovery was assessed weekly for the 16- and 6-week studies, as well as motoneuron survival, amount of regrowth, specificity of regrowth, and aberrant branching. Short-term effects of PEG were assessed in the 1-week study. Results Among the 40 male rats included in the study, PEG addition to neurorrhaphy showed no functional benefit in eye blink reflex (mean [SEM], 3.57 [0.88] weeks; 95% CI, -2.8 to 1.9 weeks; P = .70) or whisking function (mean [SEM], 4.00 [0.72] weeks; 95% CI, -3.6 to 2.4 weeks; P = .69) compared with suturing alone at 16 weeks. Motoneuron survival was not changed by PEG in the 16-week (mean, 132.1 motoneurons per tissue section; 95% CI, -21.0 to 8.4; P = .13) or 6-week (mean, 131.1 motoneurons per tissue section; 95% CI, -11.0 to 10.0; P = .06) studies. Compared with controls, neither surgical group showed differences in buccal branch regrowth at 16 (36.9 motoneurons per tissue section; 95% CI, -14.5 to 22.0; P = .28) or 6 (36.7 motoneurons per tissue section; 95% CI, -7.8 to 18.5; P = .48) weeks or in the mandibular branch at 6 weeks (25.2 motoneurons per tissue section; 95% CI, -14.5 to 15.5; P = .99). Addition of PEG had no advantage in regrowth specificity compared with suturing alone at 16 weeks (15.3% buccal branch motoneurons with misguided projections; 95% CI, -7.2% to 11.0%; P = .84). After 6 weeks, the number of motoneurons with misguided projections to the mandibular branch showed no advantage of PEG treatment compared with suturing alone (12.1% buccal branch motoneurons with misguided projections; 95% CI, -8.2% to 9.2%; P = .98). In the 1-week study, improved axonal continuity and muscular innervation were not observed in PEG-treated rats. Conclusions and Relevance Although PEG has shown efficacy in treating other nervous system injuries, PEG in addition to neurorraphy was not beneficial in a rat model of facial nerve injury. The addition of PEG to suturing may not be warranted in the surgical repair of facial nerve injury. Level of Evidence NA.
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Affiliation(s)
- Brandon L Brown
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis.,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky
| | - Tony Asante
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis
| | - Haley R Welch
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis
| | - Morgan M Sandelski
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis
| | - Sarah M Drejet
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
| | - Kishan Shah
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis
| | - Elizabeth M Runge
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis
| | - Taha Z Shipchandler
- Department of Otolaryngology, Indiana University School of Medicine, Indianapolis
| | - Kathryn J Jones
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis.,Research and Development Service, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Chandler L Walker
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis.,Research and Development Service, Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Department of Biomedical and Applied Sciences, Indiana University School of Dentistry, Indianapolis
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6
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Rink S, Bendella H, Akkin SM, Manthou M, Grosheva M, Angelov DN. Experimental Studies on Facial Nerve Regeneration. Anat Rec (Hoboken) 2019; 302:1287-1303. [DOI: 10.1002/ar.24123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/09/2018] [Accepted: 11/02/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Svenja Rink
- Department of Prosthetic Dentistry, School of Dental and Oral MedicineUniversity of Cologne Cologne Germany
| | - Habib Bendella
- Department of NeurosurgeryUniversity of Witten/Herdecke, Cologne Merheim Medical Center (CMMC) Cologne Germany
| | - Salih Murat Akkin
- Department of Anatomy, School of MedicineSANKO University Gaziantep Turkey
| | - Marilena Manthou
- Department of Histology and EmbryologyAristotle University Thessaloniki Thessaloniki Greece
| | - Maria Grosheva
- Department of Oto‐Rhino‐LaryngologyUniversity of Cologne Cologne Germany
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Motor Control Deficits in Facial Synkinesis Patients: Neuroimaging Evidences of Cerebral Cortex Involvement. Neural Plast 2019; 2019:7235808. [PMID: 31049055 PMCID: PMC6458910 DOI: 10.1155/2019/7235808] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/05/2019] [Accepted: 03/03/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Facial synkinesis is a severe sequelae of facial nerve malfunction. Once the synkinesis is established, it is extremely difficult for patients to recover. Given that the restoration of motor or sensory function after peripheral nerve injury was closely related with cortical plasticity, we investigated cortical plasticity in facial synkinesis patients by the frequency-specific data which remains largely uncharacterized. Materials and Methods Resting-state fMRI was conducted in 20 facial synkinesis patients and 19 healthy controls, and the amplitude of low-frequency fluctuation (ALFF) in five different frequency bands (slow-6: 0-0.01 Hz; slow-5: 0.01-0.027 Hz; slow-4: 0.027-0.073 Hz; slow-3: 0.073-0.167 Hz; and slow-2: 0.167-0.25 Hz) was calculated, respectively. And the relationship between ALFF and clinical outcomes was also analyzed. Results Comparing with the healthy controls, facial synkinesis patients showed significantly different ALFF values, mainly in the sensorimotor areas. Furthermore, increased ALFF of the ipsilateral insula in the slow-6 band was significantly related with better facial nerve function. Conclusion Increased ALFF values in the ipsilateral insula might reflect an abnormal state of hypercompensation in motor control of facial synkinesis patients. It provided valuable spatial information about the functionally aberrant regions, which implied the possible involvement of motor control system in facial synkinesis.
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Abstract
OBJECTIVES The researchers analyzed facial patterns in subjects with facial synkinesis after facial paralysis and evaluated the involved muscles to aid in the development of effective treatments for facial synkinesis. METHODS A total of 142 subjects were included in the study, the primary measure for synkinesis was determined by video analysis involving the strongest combination of two muscle groups that contributed to facial expression. The secondary measure of synkinesis was the analysis of its severity using the SB grading system, while observing the number of facial synkinetic movements. RESULTS The most common type of facial synkinesis was oral-ocular synkinesis (n = 137). Other synkinesis such as ocular-oral, ocular-nasal, ocular-chin, ocular-stapedial, chin-ocular and chin-oral synkinesis continued to coexist together with oral-ocular synkinesis. The results of BTX-A treatment are assessed based on the number of facial synkinetic movements observed and the evaluation of initial facial function. CONCLUSION The effectiveness of botulinum toxin A (BTX-A) treatment should be considered on an individual basis, according to the initial state of facial function. A patient with mild facial synkinesis restricted to the oral-ocular area and with a high score on the Sunnybrook (SB) facial nerve grading system would be the best candidate for BTX-A treatment.
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Affiliation(s)
- Cecilia Montalban Maria
- Department of Otorhinolaryngology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Korea
| | - Jin Kim
- Department of Otorhinolaryngology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang-si, Gyeonggi-do, Korea
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Chen P, Knox CJ, Yao L, Li C, Hadlock TA. The effects of venous ensheathment on facial nerve repair in the rat. Laryngoscope 2017; 127:1558-1564. [PMID: 28224625 DOI: 10.1002/lary.26501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 12/25/2016] [Accepted: 12/28/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the protective effect of autologous venous ensheathment on sutured rat facial nerve and to test whether the ensheathment could improve the functional recovery of repaired nerve and accuracy of axonal growth. STUDY DESIGN In vivo study. METHODS Forty-six rats were examined, with six rats serving as normal controls and 40 receiving facial nerve transection and suture repair (SR) or transection and suture repair with an additional venous ensheathment (VE). The rats were then subjected to functional testing, histological assessment of nerve specimens, or retrograde tracing, respectively. RESULTS At the postoperative day (POD) 60, the venous ensheathment showed no adhesion at the surrounding tissues. No significant difference in neuroma formation was found between the two surgical manipulations (SR and VE groups) (P < 0.05). Retrogradely labeled motoneurons in facial nuclei were extremely disorganized after the facial nerve undertook surgical manipulation. In all manipulated groups, double retrogradely labeled neurons, indicative of aberrant axonal branching during regeneration, could be observed after peripheral manipulation across all time points. With the two facial surgical manipulations, the average count of double-labeled neurons at POD 60 was significantly less than at POD 21 (P < 0.05). CONCLUSION Autologous venous ensheathment could not help with the functional recovery of facial nerve or improve the accuracy of axonal regeneration. Further studies are warranted to elucidate the effects of venous ensheathment in other motor and sensory nerve models. LEVEL OF EVIDENCE NA. Laryngoscope, 127:1558-1564, 2017.
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Affiliation(s)
- Pei Chen
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Wuhan Integrated TCM and Western Medicine Hospital (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Christopher J Knox
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Linli Yao
- Department of Otolaryngology, Wuhan Integrated TCM and Western Medicine Hospital (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Chunli Li
- Department of Otolaryngology, Wuhan Integrated TCM and Western Medicine Hospital (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Tessa A Hadlock
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A
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Shim SW, Kwon DY, Lee BN, Kwon JS, Park JH, Lee JH, Kim JH, Lee IW, Shin JW, Lee HB, Kim WD, Kim MS. Evaluation of small intestine submucosa and poly(caprolactone-co-lactide) conduits for peripheral nerve regeneration. Tissue Eng Part A 2015; 21:1142-51. [PMID: 25435200 PMCID: PMC4356220 DOI: 10.1089/ten.tea.2014.0165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/30/2014] [Indexed: 01/26/2023] Open
Abstract
The present study employed nerve guidance conduits (NGCs) only, which were made of small intestine submucosa (SIS) and poly(caprolactone-co-lactide) (PCLA) to promote nerve regeneration in a peripheral nerve injury (PNI) model with nerve defects of 15 mm. The SIS- and PCLA-NGCs were easily prepared by rolling of a SIS sheet and a bioplotter using PCLA, respectively. The prepared SIS- and PCLA-NGCs fulfilled the general requirement for use as artificial peripheral NGCs such as easy fabrication, reproducibility for mass production, suturability, sterilizability, wettability, and proper mechanical properties to resist collapsing when applied to in vivo implantation. The SIS- and PCLA-NGCs appeared to be well integrated into the host sciatic nerve without causing dislocations and serious inflammation. All NGCs stably maintained their NGC shape for 8 weeks without collapsing, which matched well with the nerve regeneration rate. Staining of the NGCs in the longitudinal direction showed that the regenerated nerves grew successfully from the SIS- and PCLA-NGCs through the sciatic nerve-injured gap and connected from the proximal to distal direction along the NGC axis. SIS-NGCs exhibited a higher nerve regeneration rate than PCLA-NGCs. Collectively, our results indicate that SIS- and PCLA-NGCs induced nerve regeneration in a PNI model, a finding that has significant implications in the future with regard to the feasibility of clinical nerve regeneration with SIS- and PCLA-NGCs prepared through an easy fabrication method using promising biomaterials.
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Affiliation(s)
- Sun Woo Shim
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
| | - Doo Yeon Kwon
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
| | - Bit Na Lee
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
| | - Jin Seon Kwon
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
| | - Ji Hoon Park
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
| | - Jun Hee Lee
- Nature-Inspired Mechanical System Team, Korea Institute of Machinery and Materials, Daejeon, Korea
| | - Jae Ho Kim
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
| | - Il Woo Lee
- Department of Neurosurgery, Catholic University of Korea, Daejeon, Korea
| | - Jung-Woog Shin
- Department of Biomedical Engineering, Inje University, Gimhae, Korea
| | - Hai Bang Lee
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
| | - Wan-Doo Kim
- Nature-Inspired Mechanical System Team, Korea Institute of Machinery and Materials, Daejeon, Korea
| | - Moon Suk Kim
- Department of Molecular Science and Technology, Ajou University, Suwon, Korea
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The potential of electrical stimulation to promote functional recovery after peripheral nerve injury — comparisons between rats and humans. HOW TO IMPROVE THE RESULTS OF PERIPHERAL NERVE SURGERY 2011; 100:3-11. [DOI: 10.1007/978-3-211-72958-8_1] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Chen P, Song J, Luo LH, Zhong G, Xiao HJ, Gong SS. Abnormal motor reflexes and dormant facial motor neurons in rats with facial-facial anastomosis. J Int Med Res 2009; 37:705-16. [PMID: 19589254 DOI: 10.1177/147323000903700314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
After facial nerve injury, some post-paralysis sequelae, such as synkinesis, hemispasm and 'crocodile tears' syndrome appear. The psychosocial impact of these sequelae is unavoidable. Despite recent advances and the growing popularity of this field, the pathophysiological mechanisms of facial nerve injury and regeneration are still not well understood. In this report, an abnormal motor reflex coincident with synkinetic facial movement was examined in a rat model using the blink reflex technique. Some dormant facial motor neurons were found which could not innervate through the suture site but remained alive. These results suggest that such dormant neurons might exert roles distinct from those of re-innervated neurons during facial nerve injury and regeneration. Further study is required to elucidate the biomolecular structure and electrophysiological features of such neurons.
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Affiliation(s)
- P Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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