Repair of the mandibular branch of the rat facial nerve through transmedian grafting in one or two stages. Functional evaluation

A previous study examined the morphological outcome of axonal regeneration in the mandibular branch (ramus marginalis mandibulae) of the rat facial nerve after transmedian nerve grafting in one or two stages. The present study supplements the morphological data with a functional evaluation. Recordings of the force of tetanic muscle contractions elicited through stimulation of the mandibular branch showed that upper and lower lip data obtained from animals grafted in one stage did not differ significantly from control data. However, animals grafted in two stages exhibited significantly lower muscle forces compared to one-stage data and to control data. Electromyographic recordings of the M-response showed multiple prolonged potential fluctuations with subnormal amplitudes in grafted cases. In both groups of grafted rats, the mean voltage amplitudes recorded from the upper lip were weaker than the amplitudes seen at the angle of the mouth or the lower lip. The two-stage cases exhibited the most obvious deficit. In conclusion, the present results show that, with respect to the functional restoration achieved three months after nerve injury, repair through transmedian grafting in one stage gives better results than repair in two stages. This finding, which conforms with previous morphological data, suggests that the one-stage procedure should be considered for clinical use.     

Hemangioma of the mandibular branch of the trigeminal nerve in the Meckel cave presenting with facial pain and sixth nerve palsy.

In a 25-year-old woman with episodic periorbital-temporal pain who eventually developed a sixth nerve palsy, magnetic resonance imaging revealed a lesion predominantly in the Meckel cave that was found to be a capillary hemangioma arising from the mandibular division of the trigeminal nerve. Hemangiomas of the Meckel cave must be considered in cases of facial pain with a sixth nerve palsy. even if there are no clinical findings of trigeminal neuropathy.     

大鼠面神经切断和切断修复后面神经核内鞘脂激活蛋白原的变化

BACKGROUND： Studies have demonstrated that damaged facial nerves synthesize prosaposin to promote repair of facial neurons. OBJECTIVE： To observe time-course changes of prosaposin expression in the facial nerve nucleus of Sprague Dawley rats following facial nerve transection and repair. DESIGN, TIME AND SETTING： A randomized control neuropathological animal experiment was performed in Chongqing Medical University between March 2007 and September 2008. MATERIALS： A total of 48 adult, male, Sprague Dawley rats were selected and randomly divided into transection and transection ＋ end-to-end anastomosis groups （n =24）. Rabbit anti-rat prosaposin antibody, instant SABC immunohistochemical kit, and antibody dilution solution were purchased from Wuhan Uscn Science Co., Ltd., China. METHODS： In the transection group, the nerve trunk of the distal retroauricular branch of the left facial nerves was ligated in Sprague Dawley rats, and a 5-mm nerve trunk at the distal end of the ligation site was removed. In the transection ＋ end-to-end anastomosis group, epineurial anastomosis was performed immediately following transection of the left facial nerves. The right facial nerves in the two groups served as the normal control group. MAIN OUTCOME MEASURES： The number of prosaposin-positive neurons, as welt as intensity of immunostaining in facial nerve nucleus, following transection and end-to-end anastomosis were determined by immunohistochemistry at 1, 3, 7, 14, 21, and 35 days after injury. RESULTS： Transection group： transection of facial nerves resulted in increased number of prosaposin-positive neurons and immunoreactivity intensity in the facial nucleus on day 1. These values significantly increased by day 3. Expression was greater than in the control side. The peak of the reduction was reached at 7 days post-surgery. Transection ＋ end-to-end anastomosis group： the number of prosaposin-positive neurons and immunoreactivity intensity was reduced in the facial nerve nucleus following immediate end-to-end anastomosis on day 7 post-surgery. These values began to gradually increase by day 14 post-anastomosis. By day 35 post-anastomosis, the number of prosaposin-positive neurons in the operated side recovered to normal levels. The number of prosaposin-positive neurons, as well as immunoreactivity intensity, was significantly greater in the facial nerve nucleus, compared with the transection group on days 14, 21, and 35 post-surgery （P 〈 0.05）. The rhythmic whisking of vibrissa recovered, and recovery time was consistent with increased numbers of prosaposin-positive neurons. CONCLUSION： Within 7 days after injury, prosaposin expression in the facial nerve nucleus exhibited an initial increase, followed by a decrease, and was not affected by facial nerve repair. Following facial nerve damage, neural anastomosis was shown to increase prosaposin expression in the facial nerve nucleus after 14 days. Recovery of prosaposin occurred simultaneously with reinnervation.     

Manual stimulation of facial muscles improves functional recovery after hypoglossal-facial anastomosis and interpositional nerve grafting of the facial nerve in adult rats

The facial nerve in humans is often prone to injuries requiring surgical intervention. In the best case, nerve reconstruction is achieved by a facial-facial anastomosis (FFA), i.e. suture of the proximal and distal stumps of the severed facial nerve. Although a method of choice, FFA rarely leads to a satisfactory functional recovery. We have recently devised and validated, in an established experimental paradigm in rats, a novel strategy to improve the outcome of FFA by daily manual stimulation (MS) of facial muscles. This treatment results in full recovery of facial movements (whisking) and is achieved by reducing the proportion of functionally detrimental poly-innervated motor end-plates. Here we asked whether MS could also be beneficial after two other commonly used surgical methods of clinical facial nerve reconstruction namely hypoglossal-facial anastomosis (HFA) and interpositional nerve grafting (IPNG) which, however, seem to have a poorer outcome compared to FFA. Compared to FFA, daily MS for 2 months after HFA and IPGN did not completely restore function but, nevertheless, significantly improved the amplitude of whisker movements by 50% compared with untreated animals. Functional improvement was associated with a reduction in the proportion of polyinnervated end-plates. MS did not reduce the extent of axonal branching at the lesion site nor the subsequent misdirected axonal regrowth to inappropriate targets. Our data show that a simple approach leading to improved quality of muscle fiber reinnervation is functionally beneficial after different types of clinically relevant surgical interventions.     

颧骨缩小改良术式预防面神经额支损伤的临床研究

目的 研究改良颧骨缩小术对于预防面神经额支损伤的作用. 方法 南方医科大学珠江医院整形科自2008年3月至2010年4月共收治颧骨复合体高突患者62例,其中采用改良颧骨缩小术治疗32例,传统颧骨缩小术治疗30例,回顾性分析患者的临床资料并比较面神经额支的损伤情况和并发症的发生. 结果 改良颧骨缩小术治疗组患者面神经均无损伤,传统颧骨缩小术治疗组患者出现面神经损伤3例(轻中度损伤2例,重度损伤1例);传统颧骨缩小术治疗组患者中3例举眉困难,1例患侧额纹消失,2例患者额肌感觉障碍,改良颧骨缩小术治疗组患者无上述并发症发生. 结论 应用改良颧骨缩小术可有效避免面神经额支的损伤.     

Changes in expression of peptides in rat facial motoneurons after facial nerve crushing and resection.

In situ hybridization histochemistry was used to study changes in mRNAs coding neuropeptides such as alpha-calcitonin gene-related peptide (CGRP), beta-CGRP, cholecystokinin (CCK) and galanin, in rat facial motoneurons following axotomy of the facial nerve. In control rats, 38%, 55% and 7% of the facial motoneurons expressed alpha-CGRP, beta-CGRP and CCK mRNAs, respectively. No galanin mRNA-containing motoneurons were observed in these animals. The levels of mRNA for alpha-CGRP, CCK and galanin were increased while the beta-CGRP mRNA level was decreased after axotomy. The levels of mRNAs for these peptides returned to the control values by 2-4 weeks after nerve crush, whereas nerve resection had more prolonged effects. Within 3-4 weeks after injury, nerve resection had greater effects on beta-CGRP, CCK and galanin mRNAs than did nerve crush. Thus, there appear to be differences in the regulation of mRNA expression of these peptides in axotomized motoneurons.     

Morphological changes of Golgi apparatus in adult rats after facial nerve injuries

We examined the morphological changes of Golgi apparatus (GA) of the facial motor neurons in rats after facial nerve avulsion or axotomy. In rats after avulsion, the numbers of motor neurons showed reduction and fragmentation of GA, namely the organelle lost the normal network‐like configuration which was replaced by numerous small disconnected elements (fine fragmentation). This GA fragmentation was morphologically indistinguishable from that previously reported in amyotrophic lateral sclerosis (ALS). On the other hand, axotomy did not induce significant motor neuron loss, and the GA had lost the elongated profiles (coarse fragmentation). These results suggest that there may be a similar cascade leading to motor neuron death in rats after avulsion, and ALS and GA observed in rats after axotomy may not be related to neuronal death.     

额颞及额颞颧入路中面神经额颞支的保护

目的了解国人面神经额颞支在颞区的显微解剖。并结合此显微解剖学特点在临床额颞及额颞颧开颅中对面神经额颞支进行保护。方法应用国人成人头颅湿标本10例(20侧),模拟额颞颧入路进行面神经额颞支显微解剖学研究。对临床中24例利用筋膜间皮瓣技术进行额颞及额颞颧开颅的患者进行回顾分析。结果所有标本中,颞区均存在三层筋膜及三层脂肪垫。在颞区前下角的弧形区域内,颞浅筋膜与颞深筋膜浅层间存在粘连,失去了正常的疏松腱膜下组织层,而被粘连的纤维脂肪层所取代,面神经额颞支则穿行于此层。而在眶上外侧角水平以上,由于帽状腱膜完整且无粘连,面神经额颞支完全行走于帽状腱膜浅层。所有24例实施了筋膜间皮瓣技术的患者,术后均达到面神经额颞支功能保留。结论在额颞及额颞颧开颅时采用筋膜间皮瓣技术是进行面神经额颞支功能保护的有效方法。     

翼点锁孔入路中面神经额支保护的实验研究

目的通过研究面神经额支与发际的相对位置关系,设计既能满足手术暴露需要,又不损伤面神经,同时符合美容要求的翼点锁孔入路切口。方法在14例(28侧)10%甲醛溶液固定的成人尸头上解剖面神经额支,测量面神经额支、发际在耳上基点-外眦线(AE)、额颧点-翼点线(FP)上的位置,测量鬓角、面神经额支入额肌最高点到FP的垂直距离。结果在AE线上,面神经额支最后支从发际内的前部(耳上基点前39.3 mm)穿过,面神经在其后的向上走行过程中与发际无交叉。结论以蝶骨嵴根部的体表投影为中心,作起于鬓角,沿发际前缘弧形向下,止于耳上基点前39 mm,位于发际内的长约5 cm的翼点锁孔入路切口,是不损伤面神经的理想切口。     

Extensive neuronal cell death following intracranial transection of the facial nerve in the adult rat.

The aim of the present study is to examine the neuronal degeneration and the glial response following intracranial transection of the facial nerve close to the brainstem and furthermore to compare the results with a distal nerve injury. The facial nerve was cut either intracranially in the posterior cranial fossa or further distally, where it passes the parotid gland, in adult rats. Intracranial axotomy caused a massive loss of neuronal profiles. Only 26.8+/-11.3% of facial motor neuronal profiles were found ipsilateral to the nerve injury when compared to the contralateral side, following intracranial axotomy. This was statistically significant in comparison to the distal injury (72.4+/-9.5%), 4 weeks post-lesion. Reactive microglial cells expressed ED1 immunoreactivity following the intracranial axotomy but not following the distal nerve injury. In conclusion, there was a large discrepancy in neuronal degeneration as well as presence of phagocytic (ED1 positive) microglia between the two lesions. The intracranial lesion model used in the present study generates a massive neuronal cell death and should therefore be a useful tool for studies on proximal cranial nerve injuries and in particular mechanisms causing cell death, which may occur following, for example, head trauma.     

Behavioural and anatomical analysis of selective tibial nerve branch transfer to the deep peroneal nerve in the rat

Nerve transfer procedures involving the repair of a distal denervated nerve element with that of a foreign proximal nerve have become increasingly popular for clinical nerve repair as a surgical alternative to autologous nerve grafting. However, the functional outcomes and the central plasticity for these procedures remain poorly defined, particularly for a clinically relevant rodent model of hindlimb nerve transfer. We therefore evaluated the effect of selective tibial branch nerve transfer on behavioural recovery in animals following acute transection of the deep peroneal nerve. The results indicate that not only can hindlimb nerve transfers be successfully accomplished in a rat model but that these animals display a return of skilled locomotor function on a par with animals that underwent direct deep peroneal nerve repair (the current gold standard). At 2 months, ground reaction force analysis demonstrated that partial restoration of braking forces occurred in the nerve transfer group, whereas the direct repair group had fully restored these forces to similar to baseline levels. Ankle kinematic analysis revealed that only animals in the direct repair group significantly recovered flexion during the step cycle, indicating a recovery of surgically induced foot drop. Terminal electrophysiological and myological assessments demonstrated similar levels of reinnervation, whereas retrograde labelling studies confirmed that the peroneal nerve‐innervated muscles were innervated by neurons from the tibial nerve pool in the nerve transfer group. Our results demonstrate a task‐dependent recovery process, where skilled locomotor recovery is similar between nerve transfer and direct repair animals, whereas flat surface locomotion is significantly better in direct repair animals.     

Effects of nerve crush and transection on mRNA levels for nerve growth factor receptor in the rat facial motoneurons.

We found that the level of nerve growth factor receptor (NGF-R) mRNA in facial motoneurons was increased after both facial nerve crushing and transection by means of in situ hybridization histochemistry. The increased level of NGF-R mRNA was maintained for at least 8 weeks after facial nerve transection, while facial nerve crushing caused only a transient increase. Thus, expression of NGF-R mRNA paralleled the axonal regeneration process. In addition, the increase of NGF-R mRNA with crushing was more pronounced than with transection from the 3rd to the 14th day after the insult.     

Agmatine promotes expression of brain-derived neurotrophic factor in brainstem facial nucleus in the rat facial nerve injury model★

BACKGROUND: Studies have shown that agmatine can reduce inhibition of neuronal regeneration by increasing cyclic adenosine monophosphate and brain-derived neurotrophic factor (BDNF) in the hippocampus of morphine-dependent rats. The hypothesis that agmatine exerts similar effects on facial nerve injury deserves further analysis.OBJECTIVE: To study the effects of peritoneal agmatine injection on BDNF levels in the rat brainstem after facial nerve injury.DESIGN, TIME AND SETTING: A controlled animal experiment was performed at the Department of Otolaryngology-Head and Neck Surgery at the Second Affiliated Hospital, Chongqing University of Medical Sciences (Chongqing, China), between October and December in 2007.MATERIALS: Twenty-four male Sprague-Dawley rats were randomly divided into a control, a lesion, and an agmatine treatment group, with eight rats in each group. Bilateral facial nerve anastomosis was induced in the lesion and agmatine treatment groups, while the control group remained untreated. A rat BDNF Enzyme-linked immunosorbent assay kit was used to measure BDNF levels in the brainstem facial nucleus.METHODS: Starting on the day of lesion, the agmatine group received a peritoneal injection of 100 mg/kg agmatine, once per day, for a week, whereas rats in the lesion group received saline injections.MAIN OUTCOME MEASURES: BDNF levels in the brainstem containing facial nucleus were measured by ELISA.RESULTS: Twenty-four rats were included in the final analysis without any loss. Two weeks after lesion, BDNF levels were significantly higher in the lesion group than in the control group (P<0.01). A significant increase was noted in the agmatine group compared to the lesion group (P<0.01).CONCLUSION: Agmatine can substantially increase BDNF levels in the rat brainstem after facial nerve injury.     

Axonal regeneration in the foot branch of the superficial peroneal nerve and the lateral plantar nerve of the rat after sciatic nerve lesions

Hand injuries with nerve lesions often leave the patient with a persistent sensory deficit, particularly with respect to glabrous skin. The present study examines axonal regeneration in the foot branch of the superficial peroneal nerve (fSPN) and the lateral plantar nerve (LPN), supplying hairy skin and glabrous skin together with some intrinsic muscles, respectively, after sciatic nerve lesions in the rat. Following crush lesions, the number of myelinated axons is normal in the fSPN, and the occurrence of C-fibers appears slightly reduced. In the LPN, the numbers of myelinated axons and C-fibers are both significantly increased. Post-crush regenerated myelinated fSPN and LPN axons show normal size ranges, but the proportion of small myelinated axons is increased. After neurotomy and suture, the numbers of myelinated axons and C-fibers in the fSPN are not significantly different from normal. The LPN exhibits a significantly increased number of myelinated axons, but the number of C-fibers is not significantly abnormal. In both nerves, the myelinated axons present an abnormally narrow size range. These findings show that the quantitative outcome of regeneration in a nerve innervating glabrous skin (and some intrinsic muscles) differs significantly from that of branches to hairy skin of the foot, with respect to myelinated as well as unmyelinated axons. To what extent these differences mirror functional differences awaits elucidation.     

Magnetic brainstem stimulation of the facial nerve.

Electrophysiological evaluation of cranial nerves provides information on its functional aspects and may be a valuable adjunct to imaging. In 10 normal subjects, we used transcranial magnetic stimulation with a double cone coil at the posterior head region to obtain orbicularis oris motor evoked potentials. Our findings suggest activation of descending facial fibers proximal to brainstem motoneurons. This method is advocated as an adjunct in the electrodiagnostic workup of facial nerve dysfunction.