机构：[a]Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China研究所北京市神经外科研究所首都医科大学附属天坛医院[b]Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China重点科室诊疗科室神经外科神经病学中心神经外科神经病学中心首都医科大学附属天坛医院[c]U 1195, INSERM and Universit′e Paris-Sud and Universit′e Paris-Saclay, 94276 Le Kremlin-Bicetre, France
Background: Closed temporal bone fractures due to cranial trauma often result in facial nerve injury, frequently inducing incomplete facial paralysis. Conventional hypoglossal-facial nerve end-to-end neurorrhaphy may not be suitable for these injuries because sacrifice of the lesioned facial nerve for neurorrhaphy destroys the remnant axons and/or potential spontaneous innervation. Objective: we modified the classical method by hypoglossal-facial nerve "side-to-side" neurorrhaphy using an interpositional predegenerated nerve graft to treat these injuries. Methods: Five patients who experienced facial paralysis resulting from closed temporal bone fractures due to cranial trauma were treated with the "side-to-side" neurorrhaphy. An additional 4 patients did not receive the neurorrhaphy and served as controls. Results: Before treatment, all patients had suffered House-Brackmann (H-B) grade V or VI facial paralysis for a mean of 5 months. During the 12-30 months of follow-up period, no further detectable deficits were observed, but an improvement in facial nerve function was evidenced over time in the 5 neurorrhaphy-treated patients. At the end of follow-up, the improved facial function reached H-B grade II in 3, grade III in 1 and grade IV in 1 of the 5 patients, consistent with the electro-physiological examinations. In the control group, two patients showed slightly spontaneous innervation with facial function improved from H-B grade VI to V, and the other patients remained unchanged at H-B grade V or VI. Conclusions: We concluded that the hypoglossal-facial nerve "side-to-side" neurorrhaphy can preserve the injured facial nerve and is suitable for treating significant incomplete facial paralysis resulting from closed temporal bone fractures, providing an evident beneficial effect. Moreover, this treatment may be performed earlier after the onset of facial paralysis in order to reduce the unfavorable changes to the injured facial nerve and atrophy of its target muscles due to long-term denervation and allow axonal regrowth in a rich supportive environment.
基金：
Institut pour la Recherche sur la Moelle Epiniere et l'Encephale (IRME, Paris, France); National Natural Science Foundation of China (Beijing, China)National Natural Science Foundation of China [81471239]; Capital Health Research and Development of Special (Beijing, China) [2014-2-1073]
第一作者机构：[a]Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China
通讯作者：
通讯机构：[a]Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing, China[b]Department of Neurosurgery and China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China[c]U 1195, INSERM and Universit′e Paris-Sud and Universit′e Paris-Saclay, 94276 Le Kremlin-Bicetre, France[*1]Beijing Neurosurgical Institute and Beijing Key Laboratory of Central Nervous System Injury, Capital Medical University, Beijing 100050, China[*2]Inserm U 1195, 80 rue du G′en′eral Leclerc, 94276 Le Kremlin- Bicetre Cedex, France
推荐引用方式(GB/T 7714)：
Diya Su,Dezhi Li,Shiwei Wang,et al.Hypoglossal-facial nerve "side-to-side" neurorrhaphy for facial paralysis resulting from closed temporal bone fractures[J].RESTORATIVE NEUROLOGY AND NEUROSCIENCE.2018,36(4):443-457.doi:10.3233/RNN-170794.
APA：
Diya Su,Dezhi Li,Shiwei Wang,Hui Qiao,Ping Li...&Song Liu.(2018).Hypoglossal-facial nerve "side-to-side" neurorrhaphy for facial paralysis resulting from closed temporal bone fractures.RESTORATIVE NEUROLOGY AND NEUROSCIENCE,36,(4)
MLA：
Diya Su,et al."Hypoglossal-facial nerve "side-to-side" neurorrhaphy for facial paralysis resulting from closed temporal bone fractures".RESTORATIVE NEUROLOGY AND NEUROSCIENCE 36..4(2018):443-457
