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Li S, Xie S, Li Z, Ding M, Shan X, Zhang L, Yu G, Cai Z. Facial Reanimation After Peripheral Facial Nerve Paralysis: A Single-institution Surgical Experience. J Craniofac Surg 2023; 34:1841-1844. [PMID: 37427918 DOI: 10.1097/scs.0000000000009513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 07/11/2023] Open
Abstract
Facial nerve trauma occasionally develops during oral and maxillofacial surgery. This study was aimed at enhancing the available knowledge on facial nerve reanimation correlated to surgery and proposing our surgical algorithm. We retrospectively analyzed medical records of patients who underwent facial reanimation surgery at our hospital. The inclusion criterion was surgery for facial reanimation from January 2004 to June 2021. We included 383 eligible patients who underwent facial reanimation surgery. Trauma or maxillofacial neoplasms were noted in 208 of 383 and 164 of 383 cases, respectively. In 238 of 383 cases, nerve branches were likely more vulnerable. Facial nerve anastomosis was performed in 256 patients. Sixty-eight patients received nerve grafts. In 22 patients, distal facial nerve transfer to the masseteric nerve, sublingual nerve, or contralateral facial nerve was performed. Twenty-five patients received static surgery; in most cases, the temporalis fascia flap (20/25) was used. The nerve function outcomes were HB grade I (n=17), Grade Ⅱ (n=108), Grade Ⅲ (n=118), Grade Ⅳ (n=94), and Grade V (n=46). The mean follow-up time was 4.88 ± 3.93 years. Facial paralysis caused by trauma ( P =0.000), branch injury ( P =0.000), and the primary reconstruction of facial nerve ( P =0.000) were predictive of favorable treatment outcomes. Although facial nerve injury caused by trauma was more likely, cases of interference in facial expression could be limited, and so did the injury to branches. Nerve anastomosis was prioritized if a tension-free suture was possible. Maintaining the integrity of the nerve and shortening the duration of mimetic muscular denervation were crucial.
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Affiliation(s)
- Shijun Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Haidian District, Beijing, China
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[Facial nerve-sublingual nerve parallel bridge anastomosis for facial nerve injury caused by closed temporal bone fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:315-321. [PMID: 35293173 PMCID: PMC8923936 DOI: 10.7507/1002-1892.202111069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To investigate the effectiveness of facial nerve-sublingual nerve parallel bridge anastomosis for facial nerve injury resulting from closed temporal bone fractures. METHODS Between January 2017 and December 2019, 9 patients with facial nerve injury resulting from closed temporal bone fracture caused by head and face trauma were treated. Among them, 5 patients were treated with facial nerve-sublingual nerve parallel bridge anastomosis (operation group), and 4 patients were treated with neurotrophic drugs combined with rehabilitation exercise (conservative group). There was no significant difference in gender, age, side, cause of injury, duration of facial nerve injury before surgery, House-brackmann grading (hereinafter referred to as HB grading) of facial nerve injury, and other general information between 2 groups ( P>0.05). HB grading was used to evaluate the improvement of facial nerve function before and after treatment. At the same time, facial nerve neuroelectrophysiological test was performed to evaluate the electrical activity of facial muscles before and after treatment. Tongue function, atrophy, and tongue deviation were evaluated after nerve anastomosis according to the tongue function scale proposed by Martins et al. RESULTS Patients in both groups were followed up 12-30 months, with an average of 25 months. None of the 5 patients in the operation group showed symptoms such as tongue muscle atrophy, tongue extension deviation, hypoglossal nerve dysfunction (mainly including slurred speech, choking with water), postoperative infection, bleeding, lower limb muscle atrophy or lower limb motor dysfunction after sural nerve injury. Postoperative skin sensory disturbance in lateral malleolus area was found, but gradually recovered to normal. During the follow-up, facial nerve and sublingual motor neurons were innervated to paralyzed facial muscle in the operation group. At last follow-up, the HB grading of 5 patients in the operation group improved from preoperative grade Ⅴ in 2 cases, grade Ⅵ in 3 cases to grade Ⅱ in 3 cases, grade Ⅲ in 1 case, and grade Ⅳ in 1 case. And in the conservative group, there were 1 patient with grade Ⅴ and 3 patients with grade Ⅵ before operation, facial asymmetry continued during follow-up, and only 2 patients improved from grade Ⅵ to grade Ⅴ at last follow-up. There was significant difference in prognosis HB grading between the two groups ( t=5.693, P=0.001). In the operation group, the amplitude and frequency of F wave were gradually improved, and obvious action potential could be collected when the facial muscle was vigorously contracted. On the contrary, there was no significant difference in neuroelectrophysiological results before and after treatment in the conservative group. CONCLUSION Facial nerve-sublingual nerve parallel bridge anastomosis can effectively retain the integrity of the facial nerve, while introducing the double innervation of the sublingual nerve opposite nerve, which is suitable for the treatment of severe incomplete facial nerve injury caused by closed fracture.
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Zhuang Y, Ling M, Li Z, Li D, Wan H, Schumacher M, Liu S. Effects of the Remaining and/or Spontaneously Regenerated Facial Axons After Hypoglossal–Facial Nerve Neurorrhaphy for Facial Paralysis. Front Neurol 2020; 11:413. [PMID: 32547473 PMCID: PMC7272673 DOI: 10.3389/fneur.2020.00413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 04/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yuan Zhuang
- Department of Injury and Repair, Beijing Neurosurgical Institute, Beijing, China
- Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Miao Ling
- Department of Injury and Repair, Beijing Neurosurgical Institute, Beijing, China
- Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhen Li
- Department of Injury and Repair, Beijing Neurosurgical Institute, Beijing, China
- Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Dezhi Li
- Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hong Wan
- Department of Injury and Repair, Beijing Neurosurgical Institute, Beijing, China
- Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | | | - Song Liu
- Department of Injury and Repair, Beijing Neurosurgical Institute, Beijing, China
- Beijing Key Laboratory of Central Nervous System Injury, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China
- U1195, INSERM et Universite Paris-Sud, Le Kremlin-Bicêtre, France
- *Correspondence: Song Liu
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Qian T, Qian K, Xu T, Shi J, Ma T, Song Z, Xu C, Li L. Efficacy evaluation of personalized coaptation in neurotization for motor deficit after peripheral nerve injury: A systematic review and meta-analysis. Brain Behav 2020; 10:e01582. [PMID: 32129004 PMCID: PMC7177589 DOI: 10.1002/brb3.1582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/10/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Peripheral neurotization, recently as a promising approach, has taken effect in recovering motor function after damage to a peripheral nerve root. Neural anastomosis comprised of nerve conduit and neurorrhaphy participates in the nerve reconstruction. Current literature lacks evidence supporting an individualized coaptation for rescue of locomotor loss in rat subjects with paraplegia secondary to peripheral nerve injury (PNI). METHODS This meta-analysis intends to qualify the specificity of gap-specific coaptation in treating a paralyzed limb following PNI. We used a highly sensitive search strategy to identify all published studies in multiple databases up to 1 May 2019. All identified trials were systematically evaluated using specific inclusion and exclusion criteria. Cochrane methodology was also applied to the results of this study. RESULTS Twelve studies, including 349 rat subjects, met eligibility criteria. For a medium nerve defect (0.5-3.0 cm), nerve conduit was more likely than neurorrhaphy to precipitate axon regeneration and improve motor outcome of the hemiplegic limb (OR = 3.61, 95% CI = 1.80, 7.26, p < .0003) at 3-month follow-up, whereas neurorrhaphy might take its place in promoting limb motor function in a small nerve gap (<0.5 cm) (OR = 0.48, 95% CI = 0.22, 1.07, p < .007). For a small nerve defect, nerve conduit still demonstrated visible effectiveness in recovery of limb motion albeit poorer than neurorrhaphy (OR = 1.50, 95% CI = 0.92, 2.47, p < .05). CONCLUSION Selective neurotization facilitates motor regeneration after nerve transection, and advisable choice of neural coaptation can maximize functional outcome on an individual basis.
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Affiliation(s)
- TengDa Qian
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of Neurosurgery, Jintan Hospital affiliated to Jiangsu University, Jintan, China
| | - Kai Qian
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - TuoYe Xu
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Shi
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Ma
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Department of Neurosurgery, Changzhou first people's Hospital, Suzhou University, Changzhou, China
| | - ZeWu Song
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - ChengMing Xu
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - LiXin Li
- Department of Neurosurgery, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Saïd Z, Pauline C, Claire B, Celia D, Jean-Paul M, Nicolas BM. Olfactory Ecto-Mesenchymal Stem Cells in Laryngeal Nerve Regeneration in Rats. J Voice 2019; 35:349-359. [PMID: 31761693 DOI: 10.1016/j.jvoice.2019.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 10/06/2019] [Accepted: 10/22/2019] [Indexed: 12/20/2022]
Abstract
Selective intralaryngeal reinnervation has been shown to be effective in experimental models. This consists of independently reinnerving the adductor and abductor of laryngeal muscles of the larynx, in order to prevent any misalignment of the axonal regrowth, improve the functional recovery and tend toward reduction of synkinesis. The surgical technique remains complex. Current research focuses on simplifying and improving this technique. Olfactory ectomesenchymal stem cells (OEMSC) represent an interesting candidate for cell therapy and could be obtained from olfactory mucosa. Recent reports suggest a neuroregenerative potential in various animal models of central and peripheral nervous systems injuries. The aim of this study was dual: to develop a simple surgical model of selective reinnervation applicable in humans and to evaluate the relevance of OEMSC-based cell therapy for improving axonal guidance. Eight Fisher syngeneic rats were used to carry out the OEMSCs culture. Thirty-four Fisher syngeneic rats were operated on, divided into three groups depending on the transplanting. For all the rats, we have performed a side to end anastomosis of the vagal nerve with the inferior laryngeal nerve by interposition of a nerve graft from the left femoral nerve. Then, the first group didn't have any injection, the second group has an injection of thrombin and the third group has an injection of one million EOMSCs. Three months after surgery, laryngeal muscle activity was evaluated by videolaryngoscopy and electromyography recordings. In order to illustrate the quality of axonal regrowth, a fluorescent tracer was injected into the right posterior crico-arytenoid muscle (PCA) to reveal the cellular bodies of the motoneurons responsible for reinnervation of the PCA in the central nervous system. In our study, no improvement was found during the videolaryngological functional evaluation or with regard to the electrical activity of the PCA muscle. The cells colabelled in retrograde tracing were numerous in all groups, reflecting abnormal axonal regeneration. The interposition of a nerve graft, as side to end anastomosis between the vagus nerve and the inferior laryngeal nerve, filled with OEMSCs, does not provide better reinnervation of a hemilarynx.
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Affiliation(s)
- Zaer Saïd
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Rouen, Rouen, France.
| | - Charnavel Pauline
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Rouen, Rouen, France
| | - Batut Claire
- Department of Oral and Maxillofacial Surgery, University Hospital of Rouen, Rouen, France
| | - Duclos Celia
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Rouen, Rouen, France
| | - Marie Jean-Paul
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Rouen, Rouen, France
| | - Bon-Mardion Nicolas
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Rouen, Rouen, France
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Su D, Li D, Wang S, Qiao H, Li P, Wang B, Wan H, Schumacher M, Liu S. Hypoglossal-facial nerve "side-to-side" neurorrhaphy for facial paralysis resulting from closed temporal bone fractures. Restor Neurol Neurosci 2018; 36:443-457. [PMID: 29889081 DOI: 10.3233/rnn-170794] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Closed temporal bone fractures due to cranial trauma often result in facial nerve injury, frequently inducing incomplete facial paralysis. Conventional hypoglossal-facial nerve end-to-end neurorrhaphy may not be suitable for these injuries because sacrifice of the lesioned facial nerve for neurorrhaphy destroys the remnant axons and/or potential spontaneous innervation. OBJECTIVE we modified the classical method by hypoglossal-facial nerve "side-to-side" neurorrhaphy using an interpositional predegenerated nerve graft to treat these injuries. METHODS Five patients who experienced facial paralysis resulting from closed temporal bone fractures due to cranial trauma were treated with the "side-to-side" neurorrhaphy. An additional 4 patients did not receive the neurorrhaphy and served as controls. RESULTS Before treatment, all patients had suffered House-Brackmann (H-B) grade V or VI facial paralysis for a mean of 5 months. During the 12-30 months of follow-up period, no further detectable deficits were observed, but an improvement in facial nerve function was evidenced over time in the 5 neurorrhaphy-treated patients. At the end of follow-up, the improved facial function reached H-B grade II in 3, grade III in 1 and grade IV in 1 of the 5 patients, consistent with the electrophysiological examinations. In the control group, two patients showed slightly spontaneous innervation with facial function improved from H-B grade VI to V, and the other patients remained unchanged at H-B grade V or VI. CONCLUSIONS We concluded that the hypoglossal-facial nerve "side-to-side" neurorrhaphy can preserve the injured facial nerve and is suitable for treating significant incomplete facial paralysis resulting from closed temporal bone fractures, providing an evident beneficial effect. Moreover, this treatment may be performed earlier after the onset of facial paralysis in order to reduce the unfavorable changes to the injured facial nerve and atrophy of its target muscles due to long-term denervation and allow axonal regrowth in a rich supportive environment.
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Affiliation(s)
- Diya Su
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Dezhi Li
- Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiwei Wang
- U 1195, INSERM and Université Paris-Sud and Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Hui Qiao
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Ping Li
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Binbin Wang
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Hong Wan
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
| | - Michael Schumacher
- U 1195, INSERM and Université Paris-Sud and Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
| | - Song Liu
- Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China.,Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,U 1195, INSERM and Université Paris-Sud and Université Paris-Saclay, 94276 Le Kremlin-Bicêtre, France
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Takeuchi Y, Osaki H, Matsumine H, Niimi Y, Sasaki R, Miyata M. A method package for electrophysiological evaluation of reconstructed or regenerated facial nerves in rodents. MethodsX 2018; 5:283-298. [PMID: 30042925 PMCID: PMC6055010 DOI: 10.1016/j.mex.2018.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/28/2018] [Indexed: 12/18/2022] Open
Abstract
Compound muscle action potential (CMAP) recording via reconstructed or regenerated motor axons is a critical examination to evaluate newly developed surgical and regeneration techniques. However, there is currently no documentation on technical aspects of CMAP recordings via reconstructed or regenerated facial nerves. We have studied new techniques of plastic surgery and nerve regeneration using a rat facial nerve defect model for years, standardizing an evaluation pipeline using CMAP recordings. Here we describe our CMAP recording procedure in detail as a package including surgical preparation, data acquisition, analysis and troubleshooting. Each resource is available in public repositories and is maintained as a version control system. In addition, we demonstrate that our analytical pipeline can not only be applied to rats, but also mice. Finally, we show that CMAP recordings can be practically combined with other behavioral and anatomical examinations. For example, retrograde motor neuron labeling provides anatomical evidence for physical routes between the facial motor nucleus and its periphery through reconstructed or regenerated facial nerves, in addition to electrophysiological evidence by CMAP recordings from the same animal. •Standardized surgical, recording and analytical procedures for the functional evaluation of reconstructed or regenerated facial nerves of rats, extended to mice.•The functional evaluation can be combined with anatomical evaluations.•The methods described here are maintained in public repositories as version control systems.
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Affiliation(s)
- Yuichi Takeuchi
- Department of Physiology I (Neurophysiology), Tokyo Women’s Medical University, Tokyo, Japan
| | - Hironobu Osaki
- Department of Physiology I (Neurophysiology), Tokyo Women’s Medical University, Tokyo, Japan
| | - Hajime Matsumine
- Department of Plastic and Reconstructive Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yosuke Niimi
- Department of Plastic and Reconstructive Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Ryo Sasaki
- Department of Oral and Maxillofacial Surgery, Tokyo Women’s Medical University, Tokyo, Japan
| | - Mariko Miyata
- Department of Physiology I (Neurophysiology), Tokyo Women’s Medical University, Tokyo, Japan
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