Impact of Different Types of Facial Nerve Reconstruction on the Recovery of Motor Function

Guntinas‐Lichius, Orlando; Hundeshagen, Gregor; Paling, Thomas; Angelov, Doychin N.

doi:10.1227/01.neu.0000306107.70421.a4

Cited by 28 publications

(26 citation statements)

References 38 publications

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“…Elimination and/or pruning of axons are also supported by the early transient increase and later reduction in axonal numbers in the MeB12 and MeB12+PTN-treated groups in the present study. This effect of MeB12 is likely critical to enhance the outcome of neurorrhaphy as hyperinnervation and/or polyinnervation are detrimental to functional recovery [36]. The remaining axons, although less numerous than those of the vehicle-treated, developed effective and robust connections to generate sizable CMAPs upon stimulation and to move the affected upper limb in removing the sticker in the modified grooming test.…”

Section: Discussionmentioning

confidence: 99%

Methylcobalamin Facilitates Collateral Sprouting of Donor Axons and Innervation of Recipient Muscle in End-to-Side Neurorrhaphy in Rats

et al. 2013

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Using ulnar nerve as donor and musculocutaneous nerve as recipient we found earlier that end-to-side neurorrhaphy resulted in weak functional reinnervation after lengthy survival. End-to-side neurorrhaphy however is the sole choice of nerve repair at times and has the advantage of conserving donor nerve function. Here, we investigated whether myelination-enhancing agent methylcobalamin and motoneuron trophic factor pleiotrophin enhances the recovery after end-to-side neurorrhaphy. Methylcobalamin significantly increased the expression of growth associated protein 43 and S100 protein and βIII tubulin in musculocutaneous nerve 1 month after neurorrhaphy suggesting the ingrowth of ulnar axonal sprouts in reactive Schwann cell environment. Upper limb functional test, compound muscle action potential measurements, motor end plate counts, and axon and myelin analyses showed that methylcobalamin treatment alone or with pleiotrophin improved the recovery significantly, 3 and 6 months post-surgery. There were fewer axons, closer in number to that of the intact recipient nerve, found in the distal repaired nerve of the methylcobalamin-treated than that of the vehicle control, suggesting that methylcobalamin facilitates axonal maturation and eliminates supernumerary sprouts. In conclusion, our results showed that methylcobalamin does indeed enhance the recovery of peripheral nerve repaired in end-to-side configuration.

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Section: Discussionmentioning

confidence: 99%

Methylcobalamin Facilitates Collateral Sprouting of Donor Axons and Innervation of Recipient Muscle in End-to-Side Neurorrhaphy in Rats

et al. 2013

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“…Although the donor UN contained more motoneurons than the recipient McN in our model, the developed connection was not more powerful than that of the control McN as estimated from CMAP responses. Whether our UN‐McN EEN reconnected nerve could build up into more powerful connections (Guntinas‐Lichius et al. 2007) with protracted survival remains to be explored.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of end‐to‐end and end‐to‐side nerve repair (neurorrhaphy) in the rat brachial plexus

et al. 2009

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Proximal nerve injury often requires nerve transfer to restore function. Here we evaluated the efficacy of endto-end and end-to-side neurorrhaphy of rat musculocutaneous nerve, the recipient, to ulnar nerve, the donor. The donor was transected for end-to-end, while an epineurial window was exposed for end-to-side neurorrhaphy. Retrograde tracing showed that 70% donor motor and sensory neurons grew into the recipient 3 months following end-to-end neurorrhaphy compared to 40-50% at 6 months following end-to-side neurorrhaphy. In end-to-end neurorrhaphy, regenerating axons appeared as thick fibers which regained diameters comparable to those of controls in 3-4 months. However, end-to-side neurorrhaphy induced slow sprouting fibers of mostly thin collaterals that barely approached control diameters by 6 months. The motor end plates regained their control density at 4 months following end-to-end but remained low 6 months following end-to-side neurorrhaphy. The short-latency compound muscle action potential, typical of that of control, was readily restored following end-to-end neurorrhaphy. End-to-side neurorrhaphy had low amplitude and wide-ranging latency at 4 months and failed to regain control sizes by 6 months. Grooming test recovered successfully at 3 and 6 months following end-to-end and end-to-side neurorrhaphy, respectively, suggesting that powerful muscle was not required. In short, both neurorrhaphies resulted in functional recovery but end-to-end neurorrhaphy was quicker and better, albeit at the expense of donor function. End-to-side neurorrhaphy supplemented with factors to overcome the slow collateral sprouting and weak motor recovery may warrant further exploration.

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“…Sprouts originating from the same motoneuron may therefore end up in different distal target branches. Especially after facial nerve repair, a high percentage of multiple projections to the zygomatic, buccal, and marginal mandibular branches has been found (15%), 28,30 compared with 2.2% double projections after sciatic nerve repair. 63 When interpreting these results, however, it is important to realize that this percentage may only represent part of the dispersion that may occur, because axons within the same branch but inside different fascicles may still project toward different target muscles (such as, for example, the gastrocnemius and soleus muscles for the tibial nerve).…”

mentioning

confidence: 99%

“…In addition to the sciatic nerve model, motion analysis has recently also been applied in the rat facial nerve model to investigate the recovery of whisker movement. 28 …”

mentioning

confidence: 99%

Misdirection and guidance of regenerating axons after experimental nerve injury and repair

Ruiter

Spinner

Verhaagen

et al. 2014

JNS

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Misdirection of regenerating axons is one of the factors that can explain the limited results often found after nerve injury and repair. In the repair of mixed nerves innervating different distal targets (skin and muscle), misdirection may, for example, lead to motor axons projecting toward skin, and vice versa-that is, sensory axons projecting toward muscle. In the repair of motor nerves innervating different distal targets, misdirection may result in reinnervation of the wrong target muscle, which might function antagonistically. In sensory nerve repair, misdirection might give an increased perceptual territory. After median nerve repair, for example, this might lead to a dysfunctional hand.Different factors may be involved in the misdirection of regenerating axons, and there may be various mechanisms that can later correct for misdirection. In this review the authors discuss these different factors and mechanisms that act along the pathway of the regenerating axon. The authors review recently developed evaluation methods that can be used to investigate the accuracy of regeneration after nerve injury and repair (including the use of transgenic fluorescent mice, retrograde tracing techniques, and motion analysis). In addition, the authors discuss new strategies that can improve in vivo guidance of regenerating axons (including physical guidance with multichannel nerve tubes and biological guidance accomplished using gene therapy). 493Abbreviations used in this paper: BDNF = brain-derived neurotrophic factor; DY = diamidino yellow; FB = fast blue; GC = growth cone; GDNF = glial cell line-derived neurotrophic factor; LV = lentiviral vector; NGF = nerve growth factor.

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Impact of Different Types of Facial Nerve Reconstruction on the Recovery of Motor Function

Abstract: No type of immediate facial nerve reconstruction results in a full recovery in the rat. However, the morphological and functional recovery was significantly better after grafting and HFN than after FFN.

Cited by 28 publications

References 38 publications

Methylcobalamin Facilitates Collateral Sprouting of Donor Axons and Innervation of Recipient Muscle in End-to-Side Neurorrhaphy in Rats

Methylcobalamin Facilitates Collateral Sprouting of Donor Axons and Innervation of Recipient Muscle in End-to-Side Neurorrhaphy in Rats

The efficacy of end‐to‐end and end‐to‐side nerve repair (neurorrhaphy) in the rat brachial plexus

Misdirection and guidance of regenerating axons after experimental nerve injury and repair

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