Reanimation of Early Facial Paralysis With Hypoglossal/Facial End-to-Side Neurorrhaphy: A New Approach

Yoleri, Levent; Songür, Ecmel; Yoleri, Özlem; Vural, Tayfun; Cagdas, Arman

doi:10.1055/s-2000-7344

Cited by 33 publications

(19 citation statements)

References 17 publications

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“…Failure to restore injured nerves can lead to loss of muscle function, impaired sensation and/or painful neuropathies [1,2,3,4]. Traditionally, functional nerve defects have been remedied by many methods, including nerve transfer [5,6,7,8], nerve grafts, artificial nerve conduit bridging [9,10,11,12] and end-to-side neurorrhaphy [13,14,15,16,17,18,19,20,21]. However, all of these methods only provide a regenerative environment for injured nerves.…”

Section: Introductionmentioning

confidence: 99%

Maximum Number of Collaterals Developed by One Axon during Peripheral Nerve Regeneration and the Influence of That Number on Reinnervation Effects

Jiang¹,

Xi²,

Zhang³

et al. 2007

Eur Neurol

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This study investigated the maximum number of collaterals that can be maintained by 1 axon during regeneration of rat peripheral nerve. The tibial nerve was transected, the proximal residual, with its variable number of axons, was fixed to the distal stump and served as the donor nerve. The number of myelinated axons was calculated after 12 weeks. An increasing ratio of distal stump axon numbers to proximal donor nerve axon numbers of 1.0, 1.83, 3.64 and 7.97 yielded ratios of regenerative myelinated axon numbers to proximal donor axon numbers of 0.98, 1.51, 2.39, 2.89, respectively, with an estimated maximum value of approximately 3.3 using the Hill function. The tibial function indexes and nerve conduction velocities of the regenerated tibial nerve were –44.1 ± 5.1 and 43.2 ± 5.3 m/s, –57.5 ± 4.7 and 18.6 ± 4.3 m/s, –80.2 ± 7.1 and 12.7 ± 3.7 m/s, and –85.4 ± 5.7 and 10.5 ± 3.9 m/s, respectively. It has been suggested that 1 axon can regenerate and maintain up to 3 or 4 collaterals in regenerated rat peripheral nerve.

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Section: Introductionmentioning

confidence: 99%

Maximum Number of Collaterals Developed by One Axon during Peripheral Nerve Regeneration and the Influence of That Number on Reinnervation Effects

Jiang¹,

Xi²,

Zhang³

et al. 2007

Eur Neurol

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“…In the literature the reported results of end-to-side neurorrhaphy vary between complete failure [5] and excellent reinnervation [6,8,10,18,19,20]. The majority of reports are now positive.…”

Section: Discussionmentioning

confidence: 93%

End-to-side neurorrhaphy of sensory nerves

Frey

Giovanoli

2003

Eur J Plast Surg

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One century passed before end-to-side neurorrhaphy was rediscovered, and now it finds more frequent use in clinical practice. Experimental studies have improved our understanding of the underlying mechanism and its potential. However, still discussed is whether reinnervation by end-to-side neurorrhaphy works as well in sensory nerves as in motor nerves. The digital nerves are sensory nerves and therefore an ideal model to investigate this question. Two cases of successful sensory reinnervation by end-to-side nerve suture are reported. We began to use end-to-side nerve repair clinically in 1995 and have used it for motor or sensory reinnervation in a total of 13 cases. In two patients primary nerve repair using end-toside neurorrhaphy was performed in digital avulsion injuries. In one patient the avulsed ulnar nerve of the thumb was sutured end-to-side to the median nerve; in the other the ulnar digital nerve of the ring finger had been destroyed over a distance of 20 mm, and the distal stump was joined end-to-side to the radial nerve of the same finger. Sensory recovery was obtained in both patients. The static two-point discrimination was 3.0 mm, and dynamic two-point discrimination was 2-3 mm for the reinnervated finger compared to 2 mm for static and dynamic two-point discrimination in the adjacent "donor" finger. The sensation of the finger supplied by the "donor nerve" was not altered in relation to the corresponding contralateral finger site. Excellent sensory reinnervation is possible through an end-to-side nerve suture. Proximal avulsion, missing proximal nerve stumps, partial recovery, and prevention of nerve grafts are good indications for resensitization using end-to-side neurorrhaphy. No harm to the donor nerve is expected. Preference should be given to donor nerves that supply skin areas near to the anesthetic area.

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“…The indications for endto-side neurorrhaphy will expand and may show results comparable to end-to-end coaptation or end-to-end nerve graft interpositioning. Reports on end-to-side neurorrhaphy in the literature vary between failure [5] and excellent reinnervation, although most recent reports are positive [6,9,11,14,15,16,17,18]. Although some important questions about end-to-side neurorrhaphy have been answered by experimental studies, many others still remain: How does the end-to-side neurorrhaphy function?…”

Section: Discussionmentioning

confidence: 97%

End-to-side neurorrhaphy of motor nerves: reinnervation of free muscle transplants—first clinical application

Frey

Giovanoli

2003

Eur J Plast Surg

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End-to-side neurorrhaphy may offer a practical solution in limited cases of nerve reconstruction when no donor nerve or nerve transfer is available for direct end-to-end nerve suture, or when extremely long distances for nerve regeneration cause irreversible atrophy of the targets. We report our experience with the successful clinical use of a completely new technique of end-to-side neurorrhaphy for motor reinnervation of free functional muscle transplants. Since 1995 we have used end-to-side nerve repair for motor or sensory reinnervation in 13 cases. A free functional muscle graft was reinnervated by an end-to-side neurorrhaphy in four patients after tumor resection (two myocutaneous latissimus dorsi flaps), Volkmann's contracture (one myocutaneous latissimus dorsi flap), and in a long-standing brachial plexus lesion (one gracilis muscle flap). All four patients showed reinnervation of their muscle graft through the end-to-side nerve suture site. Two functional muscle grafts to the upper extremity had positive outcome of M3-M4 for elbow and finger extension in one case, and M4 for finger flexion in one case more than 2 years after transplantation. The transplant in the brachial plexus lesion is too early for a final functional result. One patient had a M3 for knee extension 8 months postoperatively. In the clinical cases there was no downgrading of the muscle functions supplied by the "donor" nerve. Good and clinically relevant reinnervation of a functional muscle graft is possible through an end-to-side nerve suture. Proximal avulsion, missing proximal nerve stumps, partial recovery, shortening of long distances for nerve regeneration, and prevention of long nerve grafts in proximal lesions are good indications for reinnervation of a functional muscle transplant by end-to-side neurorrhaphy without harm to the donor nerve. Donor nerves supplying synergists should be preferred.

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Reanimation of Early Facial Paralysis With Hypoglossal/Facial End-to-Side Neurorrhaphy: A New Approach

Cited by 33 publications

References 17 publications

Maximum Number of Collaterals Developed by One Axon during Peripheral Nerve Regeneration and the Influence of That Number on Reinnervation Effects

Maximum Number of Collaterals Developed by One Axon during Peripheral Nerve Regeneration and the Influence of That Number on Reinnervation Effects

End-to-side neurorrhaphy of sensory nerves

End-to-side neurorrhaphy of motor nerves: reinnervation of free muscle transplants—first clinical application

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