颞骨内面神经缺损几丁质室修复的实验研究

目的探讨几丁质室修复颞骨内面神经缺损的可行性。方法采用生物材料几丁质室桥接兔骨内面神经缺损24只(侧),硅胶室作为对照组24只(侧),术后1、3和5个月对再生神经分别进行大体观察、电生理测试、组织学检查以及数字形态学分析。结果①术后3个月,近端神经纤维已通过几丁质室进入远端神经,术后5个月,新生神经更显成熟;②神经诱发电位显示再生神经传导功能恢复良好,实验组和对照组之间差异无显著性;③再生神经均以有髓神经纤维为主,轴突发育良好,超微结构显示髓鞘板层明暗相间、结构清晰,轴浆细胞器丰富;④术后5个月,几丁质组再生神经纤维面积恢复率、轴突面积恢复率及轴突数目恢复率均达71％以上,与硅胶组比较差异均无显著性。结论几丁质室修复颞骨内面神经缺损可取得良好的再生效果。     

颞骨内面神经缺损几丁质室修复的实验研究

目的 探讨几丁质室修复颞骨内面神经缺损的可行性。方法 采用生物材料几丁质室桥接兔骨内面神经缺损24只（侧）,硅胶室作为对照组24只（ 侧）,术后1、3和5个月对再生神经分别进行大体观察、电生理测试、组织学检查以及数字形态分析。结果 ①术后3个月,近端神经纤维已通过几丁质室进入远端神经,术后5个月,新生神经更显成熟;②神经诱发电位显示再生神经传导功能恢复良好,实验组和对照之间差异无显著性;③再生神经均有以髓神经纤维为主,轴突发育良好,超微结构显示髓鞘板层明暗相同、结构清晰,轴浆细胞器丰富;④术后5个月,几丁质组再生神经纤维面积恢复率、轴突面经及轴突数目恢复率均达71％以上,与硅胶组比较差异均无显著性。结论 几丁质室修复颞骨内面积神经损可取得良好的再生效果。     

应用HRP逆行示踪技术评价兔颞骨内面神经缺损的修复

目的探讨几丁质室修复颞骨内面神经缺损神经纤维的再通以及与神经元胞体的连续性。方法用几丁质室修复兔左侧颞骨内面神经缺损,术后1、3和5个月切断颞外段面神经主干,将辣根过氧化物酶(horseradish     

应用HRP逆行示踪技术评价兔颞骨内面神经缺损的修复

目的 探讨几丁质室修复颞骨内面神经缺损神经纤维的再通以及与神经元胞体的连续性。方法 用几丁质室修复兔左侧颞骨内面神经缺损,术后1、3和5个月切断颞外段面神经主干,将辣根过氧化物酶（horseradish peroxidase,HRP）涂于其近端,同法标记正常神经对照组,观察脑桥下段的神经元细胞。结果 术后3个月在同侧腹外侧面神经运动核区出现数量不等的标记细胞。术后5个月数量增多,与正常神经的神经元胞体来源相同。结论 HRP可沿再生神经纤维逆行运输,表明神经纤维再通,周围支到中枢的解剖通路重建。     

自体非神经组织移植修复面神经缺损的实验研究

为探讨以自体非神经组织移植修复面神经缺损的可行法，采用自体变性骨骼肌和静脉修复免而神经上颊支8mm缺损，术后20周面神经缺损均获修复，再生神经形态和电传导功能与自体神经移植组比较差异无显著性。表明非神经组织可有效地引导神经再生并修复面神经缺损。提示该方法具有临床应用价值。     

切断家兔外周面神经的轴突再生:轴突再生数目与行为和诱发面阻活动的关系

外周面神经压碎性损伤已成功地在人体和豚鼠实验中得到恢复。临床上,面神经横断性损伤立即作直接的端一端吻合术可获得最好的运动功能,尤其在神经远端分支。但是,面神经损伤患者中只有小部分可行直接吻合术．绝大多数面神经损伤需其他修复方式。该研究以切断家兔面神经颊支,用三种不同方式分析面神经的再生,神经修复５周后观察肌肉的自发行为、电生理学表现及有髓鞘运动轴突数目并研究它们之间的关系。三种修复方式为端一端直接吻合,自体神经移植及硅酮神经套管术。定量分析：９根家兔面神经各切除５ｍｍ节段,计算每段有髓鞘轴突总数…     

受区带蒂筋膜包绕耳大神经移植治疗面神经缺失性损伤

目的　评价带蒂筋膜包绕耳大神经移植治疗面神经缺失性损伤的临床疗效。方法耳源性与外伤性面神经缺失损伤 7例 ,取带蒂的颞肌筋膜或腮腺咬肌筋膜 ,在移植的耳大神经下方包绕移植神经和两端吻合口形成管筒 ,将移植神经首尾颠倒行束膜缝合。结果　 4例耳源性面瘫 ,神经移植术后随访 2 0～ 2 5年 ,面神经功能由Ⅳ级 3例 ,Ⅴ级 1例 ,恢复至Ⅲ级 3例 ,Ⅵ级 1例 ;3例外伤性面瘫神经移植术后随访 2年 ,面神经功能由Ⅵ级恢复均达Ⅲ级。结论　受区带蒂筋膜包绕耳大神经移植 ,提供血运良好的神经修复与再生的生物学环境 ,促进术后面神经功能的恢复     

面神经修复中再生室内髓鞘碱性蛋白的作用初探

目的探讨外源性髓鞘碱性蛋白（myelinbasicprotein,MBP）在家兔面神经再生室修复中的作用。方法将33只家兔横断的面神经干近、远端缝于硅胶管壁上,形成约12μL大小的神经再生室。一侧为实验组,将MBP注入再生室内;对侧为对照组不注任何物质。分别在术后4、6、8周处死动物,切取标本,在光镜下行组织形态学观察。结果形态学分析表明术后4周2组再生室内再生面神经的有髓轴突直径、髓鞘厚度及长入再生室远端有髓轴突数差异无显著性(P>0.05),随着时间的延长(术后6、8周),MBP组较对照组再生面神经显得更为成熟,6周时再生轴突成熟程度差异更明显。结论MBP有促进家兔面神经再生修复的作用,但在活体内增强受损轴突生长的机理以及MBP促进FN轴突再生的作用时间尚不清楚。     

受区带蒂筋膜包绕耳大神经移植治疗面神经缺失性损伤

目的 评价带蒂筋膜包绕耳大神经移植治疗面神经缺失性损伤的临床疗效。方法 耳源性与外伤性面神经缺失损伤7例，取带蒂的颞肌筋膜或腮腺咬肌筋膜，在移植的耳大神经下方包绕移植神经和两端吻合口形成管筒，将移植神经首尾颠倒行束膜缝合。结果 4例耳源性面瘫，神经移植术后随访2．0～2．5年，面神经功能由Ⅳ级3例，Ⅴ级1例，恢复至Ⅲ级3例，Ⅵ级1例；3例外伤性面瘫神经移植术后随访2年，面神经功能由Ⅵ级恢复均达Ⅲ级。结论 受区带蒂筋膜包绕耳大神经移植，提供血运良好的神经修复与再生的生物学环境，促进术后面神经功能的恢复。     

面神经

20050300 带胸锁乳突肌瓣的耳大神经移植在面神经缺损修复中的应用 /韩思源… //中国医科大学学报 2004, 33(4) 333~334目的:探讨腮腺癌切除面神经即刻功能性修复的新方法。方法:采取带胸锁乳突肌瓣的耳大神经移植的方法,对腮腺癌根治术切除面神经造成神经缺损即刻修复,与单纯利用耳大神经游离移植的修复方法进行比较。结果:带胸锁乳突肌瓣的耳大神经移植的方法,面神经功能的恢复率为 92 3%,面神经功能恢复时间平均为 21 5周;单纯利用耳大神经游离移植的修复方法,面神经功能的恢复率仅为54 3%,面神经功能恢复时间平均为 36 4周。两方法差…     

Preliminary study of the facial nerve regeneration in the chamber: the influence of myelin basic protein]

OBJECTIVE: To study the role of exogenous myelin basic protein(MBP) in neural repairment. METHODS: Adult New Zealand rabbits were employed in vivo preparation. A 12 microL nerve growth chamber was created by suturing the proximal and distal stumps of a transected facial never (FN) trunk into a tube. The regenerated nerves within the chambers were dissected and fixed for histological studies with light microscope at 4, 6 and 8 weeks respectively following the surgery. RESULTS: Morphological analysis of nerves showed no difference between the MBP and control group in the size of the regeneration FN within the chambers, diameters of myelinated axons, thickness of myelin sheath and number of myelin axons grew into the distal end of chamber at 4 weeks. At 6 and 8 weeks after operation, the MBP group showed a more mature-appearance regenerative nerve comparing to control group. Especially, the enhancement of maturation in the regeneration axons was very noticeable at 6 weeks. CONCLUSION: The study showed that pharmacological administration of exogenous MBP within a chamber at the time of entubational nerve repair enhances regeneration of myelinated axons across the sectioned ends of FN.     

体外培养诱导外周血淋巴细胞促进大鼠面神经再生的实验研究

目的:通过在神经缺损处局部回输体外分离培养纯化的淋巴细胞,了解此种方法促进面神经损伤修复的效果。方法:将20只Wistar大鼠的面神经颊支剪断并立即缝合(其余3支反折缝合)制成面神经损伤模型大鼠,将其分成淋巴细胞组和对照组,每组10只,每组再分成2周组和8周组。淋巴细胞组局部回输体外分离培养的外周血淋巴细胞,对照组作对照。于2周和8周测定面神经颊支-触须肌复合动作电位传导速度,辣根过氧化物酶(HRP)神经逆行示踪测定面神经核团的神经元阳性数目。结果:淋巴细胞组面神经颊支-触须肌复合动作电位传导速度8周时为0.64±0.07,与对照组(0.56±0.07)相比,差异有统计学意义(P<0.05)。HRP神经逆行示踪测定面神经核团神经元阳性数目,淋巴细胞组2周及8周与对照组同时间段相比差异均无统计学意义(均P>0.05)。结论:体外分离培养纯化的淋巴细胞在局部应用于神经损伤处对面神经再生修复可起一定的促进作用。     

神经生长因子在面神经损伤修复中作用的实验研究

OBJECTIVE: To elucidate the role of NGF in the regeneration of facial nerve. METHODS: The superior buccal division of facial nerve of adult New Zealand rabbit was transected and a nerve growth chamber created. The chamber of the experimental side was filled with NGF/normal saline and that of the control side with normal saline alone. Four and eight weeks after operation, the regenerated nerves in the chambers were dissected for histological studies. RESULTS: Four weeks after operation, the average thickness of myelin sheath and the average number of myelinated axons were 0.779 +/- 0.475 micron, 2.024 +/- 1.999 (n = 11) in experimental group and 0.413 +/- 0.132 micron, 368 +/- 171 (n = 8) in control sides respectively. There was significant difference between the experimental sides and control sides (P < 0.05). Eight weeks after operation, the regenerated nerve appeared more mature. There were significant difference in the average diameters, the thickness of myelin sheath and the number of myelinated axons between the experimental and control sides (P < 0.05). CONCLUSION: NGF within a silicone chamber enhanced facial nerve regeneration in New Zealand rabbits.     

颞骨骨折性面瘫手术减压时机的实验研究

目的制作颞骨骨折性面瘫的动物模型,初步探讨大鼠面瘫的自然发展过程,了解不同手术减压时机面瘫的治疗效果及减压后面瘫的恢复变化过程。方法选用Wistar大鼠32只,制作颞骨骨折性面瘫动物模型。将完全面瘫的大鼠随机分成4组:对照组即不减压组,2周减压组,4周减压组,8周减压组。分别于以上不同的时间行面神经减压术,并于不同时间测定面神经刺激阈值,以观察面神经的恢复情况。结果对完全面瘫的大鼠于面瘫后1周行面神经阈值检查,对最大电流刺激(3mA)无反应。4组大鼠面神经刺激阈值的恢复速度相比,2周、4周减压组比不减压组及8周减压组快;2周减压组面神经的恢复速度比4周减压组快。结论通过血管钳钳夹大鼠的面神经骨管,可以造成颞骨骨折性面瘫的大鼠模型。面神经减压术在面神经受损后4周内进行,可缩短其面神经阈值的恢复时间;且减压时间越早,面神经的恢复速度越快。     

Effect of platelet rich plasma and fibrin sealant on facial nerve regeneration in a rat model

OBJECTIVE: To investigate the effects of platelet rich plasma (PRP) and fibrin sealant (FS) on facial nerve regeneration. STUDY DESIGN: Prospective, randomized, and controlled animal study. METHODS: Experiments involved the transection and repair of facial nerve of 49 male adult rats. Seven groups were created dependant on the method of repair: suture; PRP (with/without suture); platelet poor plasma (PPP) (with/without suture); and FS (with/without suture) groups. Each method of repair was applied immediately after the nerve transection. The outcomes measured were: 1) observation of gross recovery of vibrissae movements within 8-week period after nerve transection and repair using a 5-point scale and comparing the left (test) side with the right (control) side; 2) comparisons of facial nerve motor action potentials (MAP) recorded before and 8 weeks after nerve transection and repair, including both the transected and control (untreated) nerves; 3) histologic evaluation of axons counts and the area of the axons. RESULTS: Vibrissae movement observation: the inclusion of suturing resulted in overall improved outcomes. This was found for comparisons of the suture group with PRP group; PRP with/without suture groups; and PPP with/without suture groups (P < .05). The PRP without suture group had a significantly greater degree of recovery than the PPP without suture group (P < .05), but it did not have better performance than suture group (P > .05). The movement recovery of the suture group was significantly better than the FS group (P = .014). The recovery of function of the PRP groups was better than that of the FS groups, although this did not reach statistical significance (P = .09). Electrophysiologic testing: there was a significantly better performance of the suture group when compared with the PRP and PPP without suture groups in nerve conduction velocity (P < .05). The PRP with suture group had the best results when compared with the suture as well as the PPP with suture groups in duration and latency-2 of MAP (P < .05). For the FS groups, no results were found demonstrating a biological effect. The PRP with suture group demonstrated the best performance in the latency-2 and the area under the curve of MAP when compared with the suture and FS with suture groups (P < .05). Histomorphometric analysis: PRP with suture demonstrated the greatest increase in axon counts when compared with suture, FS with suture, and PPP with suture groups (P < .05). There was no statistically significant difference seen in axon diameter. CONCLUSION: The best results for the return of function in our rat facial nerve axotomy models occurred when the nerve ends were sutured together. At the same time, the data demonstrated a measurable neurotrophic effect when PRP was present, with the most favorable results seen with PRP added to suture. There was an improved functional outcome with the use of PRP in comparison with FS or no bioactive agents (PPP). FS showed no benefit over conventional suturing in facial nerve regeneration. Our study provides the potential of a new clinical application for PRP in peripheral nerve regeneration.     

Surgical Treatment of Facial Paralysis

The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (<3 weeks duration), intermediate duration facial paralysis (3 weeks to 2 yr) and chronic facial paralysis (>2 yr). For acute facial paralysis, the main surgical therapies are facial nerve decompression and facial nerve repair. For facial paralysis of intermediate duration, nerve transfer procedures are appropriate. For chronic facial paralysis, treatment typically requires regional or free muscle transfer. Static techniques of facial reanimation can be used for acute, intermediate, or chronic facial paralysis as these techniques are often important adjuncts to the overall management strategy.     

Rabbit facial nerve regeneration in autologous nerve grafts after antecedent injury

OBJECTIVE: The effect of incomplete antecedent injuries on subsequent facial nerve regeneration within cable graft repairs is not known. The purpose of this study is to compare facial nerve regeneration after an immediate and delayed neural cable graft repair. METHOD: Rabbit facial nerve regeneration after complete transectional injuries of the buccal division was compared in two experimental models. In one, a 10-mm segment of the nerve was transected, rotated 180 degrees, and immediately repaired as a cable graft (N=8). In the second, a preliminary nerve crush was allowed to recover over a 4-week period and a 10-mm segment of nerve centered on the crush site was then transected, rotated 180 degrees, and delay repaired as a cable graft (N = 7). Data are presented as total numbers of regenerating myelinated axons that traverse the surgical repair to innervate the cable graft and distal nerve stumps, as well as the percentage of regenerating neurites compared with preoperative pooled and individual controls. Subpopulations of regenerating neurons are delineated to quantify the pattern of neural innervation. RESULTS: Five weeks after cable graft repair both groups had similar myelinated outgrowth from the proximal nerve stump across the proximal anastomosis to innervate the cable graft (3995 +/- 1209 vs. 3284 +/- 651; P = .89). However, the delayed repair group had more intrafascicular regeneration within cable grafts (2261 +/- 931 vs. 1660 +/- 1169; P = .02) and distal nerve stump (1532 +/- 281 vs. 445 +/- 120; P = .004) than the immediate repair group. The immediate repair group had greater extrafascicular nerve regeneration in the cable graft (2335 +/- 1954 vs. 437 +/- 236; P = .001) and more myelin and axonal debris in pre-existing neural fascicles of the cable graft (P = .02) and distal nerve stump (463 +/- 187 vs. 103 +/- 87; P = .02). CONCLUSIONS: Antecedent priming lesions do not enhance axonal survival as determined by regenerating myelinated axonal counts. However, antecedent injuries enhance the efficiency of neural innervation of the affected mimetic musculature by increasing the number of myelinated intrafascicular neural regenerants in the cable graft and distal nerve stump. This is accomplished by two factors: increased perineural fibrosis and decreased intrafascicular myelin and axonal debris.     

Long-term functional outcome in facial nerve graft by fibrin glue in the temporal bone and cerebellopontine angle

The aim of this study was to evaluate the functional outcome of facial nerve repair with fibrin glue in end-to-end anastomosis and intermediate nerve graft. Thirty-six patients undergoing facial nerve repair by end–to-end anastomosis or facial nerve grafting using exclusively fibrin glue between 1986 and 1999 were included in this retrospective study. The population comprised ten vestibular schwannomas (28%), nine temporal bone fractures (25%), seven facial nerve schwannomas (19%), four facial nerve hemangiomas (11%), two iatrogenic facial nerve interruptions (6%) and four miscellaneous facial nerve lesions (11%). Data were reviewed concerning etiology, location of the nerve interruption, type of repair and postoperative facial function according to the repaired facial nerve recovery scale (A: normal; B: independent movements of eyelid and mouth; C: strong closure of eyelids and mouth; D: incomplete eyelid closure; E: minimal movement; F: no movement). Eleven patients (31%) underwent end-to-end nerve anastomosis and 25 (69%) underwent intermediate facial nerve grafting. The mean follow-up period was 50 months (range: 3–95). Among patients followed-up more than 18 months (n=20), a score of B or C was obtained in 16 patients (80%), a score D in 2 cases (10%) and a score E in 2 cases (10%). The type of repair and the site of interruption did not influence the results. Fibrin glue is a simple, rapid and efficient means of facial nerve repair. In case of intraoperative facial nerve interruption, this type of repair can be attempted in any location at the time of the tumor removal.     

Improved facial nerve identification with novel fluorescently labeled probe

Objectives/Hypothesis:

By phage display, we have developed a novel peptide (NP41) that binds selectively to nerves following systemic administration. We evaluated the pattern of facial nerve labeling with fluorescently‐labeled NP41 (F‐NP41). We also tested whether F‐NP41 highlights facial nerves well enough to identify nerve stumps accurately several weeks after nerve transection.

Study Design:

Forty‐seven wild‐type mice were studied prospectively. One surgeon performed the nerve transection, reanastomoses, and monitoring of functional recovery.

Methods:

Fluorescent labeling: F‐NP41 was administered intravenously (20 mice). Nerve labeling was studied with fluorescence microscopy. Transection and reanastomosis: the right facial nerve was transected (25 mice). Three weeks after transection, F‐NP41 was administered intravenously and fluorescence microscopy was used to identify the nerve stumps and reanastomosis in one group. Nerve identification and renastomosis was performed with white light in another group without F‐NP41. The control group underwent sham surgery. Time to nerve identification was recorded. Functional recovery was monitored for at least 8 weeks.

Results:

We found excellent labeling of intact and transected facial nerves following F‐NP41 administration. Several weeks following nerve transection, F‐NP41 provided accurate identification of the proximal and distal nerve stumps. Following reanastomosis, time to recovery and level of functional recovery was similar in the absence and presence of F‐NP41.

Conclusions:

We show improved visualization of facial nerves with a novel systemically applied fluorescently labeled probe. Use of F‐NP41 resulted in accurate identification of facial nerve stumps several weeks following transection. Functional recovery was similar with and without the use of F‐NP41. Laryngoscope, 2011