Motor fiber organization in the extratemporal trunk of the facial nerve in rats: A retrograde Fluoro-Gold study

Experimental Cranial Nerve Models in the Rat

BACKGROUND

 The intricacies of nerve regeneration following injury have prompted increased research efforts in recent years, with a primary focus on elucidating regeneration mechanisms and exploring various surgical techniques. While many experimental animals have been used for these investigations, the rat continues to remain the most widely used model due to its cost-effectiveness, accessibility, and resilience against diseases and surgical/anesthetic complications. A comprehensive evaluation of all the experimental rat models available in this context is currently lacking.

METHODS

 We summarize rat models of cranial nerves while furnishing descriptions of the intricacies of achieving optimal exposure.

RESULTS

 This review article provides an examination of the technical exposure, potential applications, and the advantages and disadvantages inherent to each cranial nerve model.

CONCLUSION

 Specifically in the context of cranial nerve injury, numerous studies have utilized different surgical techniques to expose and investigate the cranial nerves in the rat.

Two-photon excitation fluorescent spectral and decay properties of retrograde neuronal tracer Fluoro-Gold

Fluoro-Gold is a fluorescent neuronal tracer suitable for targeted deep imaging of the nervous system. Widefield fluorescence microscopy enables visualization of Fluoro-Gold, but lacks depth discrimination. Though scanning laser confocal microscopy yields volumetric data, imaging depth is limited, and optimal single-photon excitation of Fluoro-Gold requires an unconventional ultraviolet excitation line. Two-photon excitation microscopy employs ultrafast pulsed infrared lasers to image fluorophores at high-resolution at unparalleled depths in opaque tissue. Deep imaging of Fluoro-Gold-labeled neurons carries potential to advance understanding of the central and peripheral nervous systems, yet its two-photon spectral and temporal properties remain uncharacterized. Herein, we report the two-photon excitation spectrum of Fluoro-Gold between 720 and 990 nm, and its fluorescence decay rate in aqueous solution and murine brainstem tissue. We demonstrate unprecedented imaging depth of whole-mounted murine brainstem via two-photon excitation microscopy of Fluoro-Gold labeled facial motor nuclei. Optimal two-photon excitation of Fluoro-Gold within microscope tuning range occurred at 720 nm, while maximum lifetime contrast was observed at 760 nm with mean fluorescence lifetime of 1.4 ns. Whole-mount brainstem explants were readily imaged to depths in excess of 450 µm via immersion in refractive-index matching solution.

Facial Nerve Repair: Bioengineering Approaches in Preclinical Models

Injury to the facial nerve can occur after different etiologies and range from simple transection of the branches to varying degrees of segmental loss. Management depends on the extent of injury and options include primary repair for simple transections and using autografts, allografts, or conduits for larger gaps. Tissue engineering plays an important role to create artificial materials that are able to mimic the nerve itself without extra morbidity in the patients. The use of neurotrophic factors or stem cells inside the conduits or around the repair site is being increasingly studied to enhance neural recovery to a greater extent. Preclinical studies remain the hallmark for development of these novel approaches and translation into clinical practice. This review will focus on preclinical models of repair after facial nerve injury to help researchers establish an appropriate model to quantify recovery and analyze functional outcomes. Different bioengineered materials, including conduits and nerve grafts, will be discussed based on the experimental animals that were used and the defects introduced. Future directions to extend the applications of processed nerve allografts, bioengineered conduits, and cues inside the conduits to induce neural recovery after facial nerve injury will be highlighted.

Perfusion maintains functional potential in denervated mimic muscles in early persistent facial paralysis which requires early microsurgical treatment - the histoanatomic basis of the extratemporal facial nerve trunk assessing axonal load in the context of possible nerve transfers

BACKGROUND AND OBJECTIVES

Early persistent facial paralysis is characterized by intact muscles of facial expression through maintained perfusion but lacking nerve supply. In facial reanimation procedures aiming at restoration of facial tone and dynamics, neurotization through a donor nerve is performed. Critical for reanimating target muscles is axonal capacity of both donor and recipient nerves. In cases of complete paralysis, the proximal stump of the extratemporal facial nerve trunk may be selected as a recipient site for coaptation. To further clarify the histological basis of this facial reanimation procedure we conducted a human cadaver study examining macro and micro anatomical features of the facial nerve trunk including its axonal capacity in human cadavers. Axonal loads, morphology and morbidity of different donor nerves are discussed reviewing literature in context of nerve transfers.

METHODS

From 6/2015 to 9/2016 in a group of 53 fresh frozen cadavers a total of 106 facial halves were dissected. Biopsies of the extratemporal facial nerve trunk (FN) were obtained at 1 cm distal to the stylomastoid foramen. After histological processing and digitalization of 99 specimens available, 97 were selected eligible for fascicle counts and 87 fulfilled quality criteria for a semi-automated computer-based axon quantification software using ImageJ/Fiji.

RESULTS

An average of 3.82 fascicles (range, 1 to 9) were noted (n = 97). 6684±1884 axons (range, 2655- 12457) were counted for the entire group (n = 87). Right facial halves showed 6364±1904 axons (n = 43). Left facial halves demonstrated 6996±1833 axons (n = 44) with no significant difference (p = 0.73). Female cadavers featured 6247±2230 (n = 22), male showed 6769±1809 axons (n = 40). No statistical difference was seen between genders (p = 0.59). A comparison with different studies in literature is made. The nerve diameter in 82 of our specimens could be measured at 1933±424 μm (range, 975 to 3012).

CONCLUSIONS

No donor nerve has been described to match axonal load or fascicle number of the extratemporal facial nerve main trunk. However, the masseteric nerve may be coapted for neurotization of facial muscles with a low complication rate and good clinical outcomes. Nerve transfer is indicated from 6 months after onset of facial paralysis if no recovery of facial nerve function is seen.

Effect of Epineurial Neurorrhaphy on Restoration of Facial Nerve Injuries with Different Levels of Neurotmesis in a Rat Model: A Pilot Study

BACKGROUND

Different degrees of neurotmesis of the peripheral facial nerve frequently are encountered in clinic, for which the epineurial neurorrhaphy is the preferred technique. However, because of the capability of self-restoration of nerves and the side effects of surgery, neurorrhaphy may not be an optimal choice for various degrees of neurotmesis. In this study, we explored the necessity of epineurial neurorrhaphy for different degrees of neurotmesis, in addition to investigating factors that impact neural functional recovery.

METHODS

Rat models were divided into 6 groups: intact, noninjured controls; A, one-third cross-sectional facial nerve disconnected injury after epineurial neurorrhaphy; B, one-third cross-sectional facial nerve disconnected injury without epineurial neurorrhaphy; C, two-thirds cross-sectional facial nerve disconnected injury after epineurial neurorrhaphy; D, two-thirds cross-sectional facial nerve disconnected injury without epineurial neurorrhaphy; and E, two-thirds cross-sectional facial nerve disconnection followed by complete transection and neurorrhaphy. Facial functional recovery was assessed with the use of behavioral assessments and electrophysiologic tests. The morphologic changes of trunk of the facial nerve were analyzed by osmium-toluidine blue staining and immunofluorescence. The modification of central nervous system was evaluated by retrograde labeling and Nissl's staining of facial nerve nuclei.

RESULTS

Concerning morphologic and functional assessments, there were no statistically significant differences between one-third facial nerve disconnected injury with or without epineurial neurorrhaphy and the intact model. For two-thirds facial nerve disconnected injury, direct neurorrhaphy was superior to complete transection followed by neurorrhaphy. For two-thirds facial nerve disconnected injury, the nerves can largely self-restore in neural structure and function without the use of epineurial neurorrhaphy. For the facial nerve nuclei, the number of neurons decreased in the more than two-thirds nerve disconnected models, and models with two-thirds disconnection and without neurorrhaphy had the least number of neurons. For the distribution of neurons in different facial nerve subnuclei, both models with two-thirds nerve disconnection without neurorrhaphy and models with two-thirds nerve disconnection after complete transection and neurorrhaphy demonstrated disorganization of neurons, in which the latter was more serious.

CONCLUSIONS

For one-third disconnected facial nerve injury, there's no need to suture the nerve stump, although for residual one-third connected nerve injury, direct suture is preferable if permitted than pre-performing a complete transection to trim the stump. Residual one-third connected nerve fibers largely can self-restore. The results from this study indicate that neural functional defect may be attributed to the damage and misdirection of peripheral nerve fibers and central neurons.

End-to-side neurorrhaphy repairs peripheral nerve injury: sensory nerve induces motor nerve regeneration

End-to-side neurorrhaphy is an option in the treatment of the long segment defects of a nerve. It involves suturing the distal stump of the disconnected nerve (recipient nerve) to the side of the intimate adjacent nerve (donor nerve). However, the motor-sensory specificity after end-to-side neurorrhaphy remains unclear. This study sought to evaluate whether cutaneous sensory nerve regeneration induces motor nerves after end-to-side neurorrhaphy. Thirty rats were randomized into three groups: (1) end-to-side neurorrhaphy using the ulnar nerve (mixed sensory and motor) as the donor nerve and the cutaneous antebrachii medialis nerve as the recipient nerve; (2) the sham group: ulnar nerve and cutaneous antebrachii medialis nerve were just exposed; and (3) the transected nerve group: cutaneous antebrachii medialis nerve was transected and the stumps were turned over and tied. At 5 months, acetylcholinesterase staining results showed that 34% ± 16% of the myelinated axons were stained in the end-to-side group, and none of the myelinated axons were stained in either the sham or transected nerve groups. Retrograde fluorescent tracing of spinal motor neurons and dorsal root ganglion showed the proportion of motor neurons from the cutaneous antebrachii medialis nerve of the end-to-side group was 21% ± 5%. In contrast, no motor neurons from the cutaneous antebrachii medialis nerve of the sham group and transected nerve group were found in the spinal cord segment. These results confirmed that motor neuron regeneration occurred after cutaneous nerve end-to-side neurorrhaphy.