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Hypoglossal-facial nerve "side"-to-side neurorrhaphy for persistent incomplete facial palsy

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机构: [1]Capital Med Univ, Beijing Tiantan Hosp, Beijing Neurosurg Inst, Beijing, Peoples R China; [2]Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, Beijing, Peoples R China; [3]INSERM, UMR 788, F-94276 Le Kremlin Bicetre, France; [4]Univ Paris 11, F-94276 Le Kremlin Bicetre, France; [5]INSERM, UMR 788, 80 Rue Gen Leclerc, F-94276 Le Kremlin Bicetre, France
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关键词: facial symmetry facial reanimation nerve graft nerve regeneration peripheral nerve injury surgical technique

摘要:
Object. Hypoglossal-facial nerve neurorrhaphy is a widely used method for treating complete facial palsy. However, the classic surgical procedure using a "side"-to-end neurorrhaphy is not suitable for incomplete facial palsy (IFP), because sectioning of the facial nerve for neurorrhaphy compromises remnant axons and potential spontaneous reinnervation. For the treatment of persistent IFP, the authors investigated in rats a modified method using hypoglossal-facial nerve "side"-to-side neurorrhaphy. Methods. An IFP model was created by crushing the facial nerve and then ligating the injury site to limit axonal regeneration. After 9 weeks, rats with IFP were submitted to hypoglossal-facial nerve "side"-to-side neurorrhaphy: The gap between the 2 nerves was bridged with a predegenerated peroneal nerve graft, which was sutured to only one-half of the hypoglossal nerve and to the remnant facial nerve through a small window created by removing the epineurium, thus preserving regenerating facial axons. Results. Four months after repair surgery, double innervation of the target whisker pad by hypoglossal and facial motor neurons was supported by the recording of muscle action potentials and their retrograde labeling. Regenerated hypoglossal and facial motor neurons effectively participated in the reinnervation of the whisker pad, significantly improving facial symmetry without evident synkinesis, compared with rats that underwent IFP without hypoglossal-facial nerve neurorrhaphy. Conclusions. This study demonstrates that hypoglossal-facial nerve "side"-to-side neurorrhaphy with a predegenerated nerve graft can lead to rapid functional benefits for persistent IFP without compromising the remnants of facial axons, thus providing a proof-of-feasibility for further studies in humans.

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出版当年[2013]版:
大类 | 3 区 医学
小类 | 2 区 外科 3 区 临床神经病学
最新[2023]版:
大类 | 2 区 医学
小类 | 2 区 临床神经病学 2 区 外科
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出版当年[2012]版:
Q1 SURGERY Q2 CLINICAL NEUROLOGY
最新[2023]版:
Q1 CLINICAL NEUROLOGY Q1 SURGERY

影响因子: 最新[2023版] 最新五年平均 出版当年[2012版] 出版当年五年平均 出版前一年[2011版] 出版后一年[2013版]

第一作者:
第一作者机构: [1]Capital Med Univ, Beijing Tiantan Hosp, Beijing Neurosurg Inst, Beijing, Peoples R China;
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通讯机构: [1]Capital Med Univ, Beijing Tiantan Hosp, Beijing Neurosurg Inst, Beijing, Peoples R China; [2]Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, Beijing, Peoples R China; [3]INSERM, UMR 788, F-94276 Le Kremlin Bicetre, France; [4]Univ Paris 11, F-94276 Le Kremlin Bicetre, France; [5]INSERM, UMR 788, 80 Rue Gen Leclerc, F-94276 Le Kremlin Bicetre, France
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