Alternativas Microquirúrgicas (Autoinjertos Nerviosos / Aloinjertos Nerviosos / Conductos Nerviosos) para la Recuperación Sensitiva Funcional de Nervio Alveolar Inferior y Nervio Lingual: Revisión de la Literatura / Microsurgical Alternatives (Nerve Autografts / Nerve Allografts/ Nerve Ducts) for Functional Sensory Recovery of the Lower Alveolar Nerve and Lingual Nerve: Review of the Literature

RESUMEN: Objetivo: analizar y comparar las modalidades actuales de reconstrucción microquirúrgica (autoinjertos, aloinjertos y conductos nerviosos) para lograr recuperación sensitiva funcional (RSF) en reparaciones de nervio alveolar inferior (NAI) y nervio lingual (NL). Materiales y Métodos: se realizó una revisión de la literatura para identificar estudios relacionados con reconstrucciones de NAI y NL. Los estudios incluidos proporcionaron un tamaño de muestra definido, modalidad de reconstrucción microquirúrgica y tasas de RSF. Se realizó un test de proporciones para saber si existían diferencias estadísticamente significativas (P <0,05) entre las modalidades de reconstrucción mencionadas. Resultados: se seleccionaron y analizaron 9 estudios que dieron como resultado una muestra de 130 reconstrucciones de NAI y 102 de NL. Entre las reconstrucciones de NAI, se encontró que los autoinjertos y aloinjertos eran superiores para lograr una RSF sobre los conductos nerviosos (P de 0,033 y 0,0397 respectivamente). Entre las reconstrucciones de NL, no se encontraron diferencias estadísticamente significativas. Y al comparar reconstrucciones mediante autoinjertos con aloinjertos, no hubo diferencias estadísticamente significativas para NAI y NL. Conclusiones: Las reconstrucciones mediante aloinjertos y autoinjertos tiene tasas de RSF equivalentes y mejores que los conductos nerviosos. Además, con el uso de aloinjertos, se evitan comorbilidades asociadas al sitio donante.

ABSTRACT: Objective: to analyze and compare the current modalities of microsurgical reconstruction (autografts, allografts, and nerve ducts) to achieve functional sensory recovery (RSF) in repairs of the inferior alveolar nerve (NAI) and lingual nerve (NL). Materials and Methods: a literature review was performed to identify studies related to NAI and NL reconstructions. The studies included provided a defined sample size, microsurgical reconstruction modality, and RSF rates. A test of proportions was performed to find out if there were statistically significant differences (P <0.05) between the mentioned reconstruction modalities. Results: 9 studies were selected and analyzed that resulted in a sample of 130 reconstructions of NAI and 102 of NL. Among the NAI reconstructions, autografts and allografts were found to be better in achieving an RSF than the nerve ducts (P of 0.033 and 0.0397 respectively). Among the NL reconstructions, no statistically significant differences were found. And when comparing reconstructions using autografts with allografts, there were no statistically significant differences for NAI and NL. Conclusions: Reconstructions using allografts and autografts have equivalent and better RSF rates than nerve conduits. Furthermore, with the use of allografts, comorbidities associated with the donor site are avoided.

Advances in atrial fibrillation and cardiac autonomic nerve and its remodeling area / 医学研究生学报

Atrial fibrillation (AF) is the most common arrhythmia in clinical work, accounting for about 1/3 of patients in hospital due to arrhythmia. Recently, more and more studies have shown that cardiac autonomic nerve and its remodeling are involved in the occurrence and maintenance of AF, which is one of the important mechanisms of AF. At present, the treatment methods of AF include drug therapy and radiofrequency ablation. As we all know, drug therapy has many limitations. In this paper, the mechanism of sympathetic, parasympathetic nerve and AF and the changes of cardiac autonomic nerve and its remodeling area before and after the occurrence of AF were studied, so as to explore a better treatment method of AF, and then simplify the tedious steps of radiofrequency ablation, reduce the scope of ablation, more accurately locate ectopic trigger point and vulnerable matrix, reduce the intensity of ablation, improve the success rate of operation and obtain good economic benefits.

t-PA negatively regulating p75NRT for involving in atherosclerosis by changing reconstruction of vascular outer membrane autonomic nerve / 重庆医学

Objective To study the effect of tissue plasminogen activator (t-PA) on p57NTR ,inflammatory reaction ,immune regulation and oxidative stress and its effect on intimal hyperplasia .Methods The vascular injury treatment was performed in the diabetic rabbit model with carotid arterial adventitia stripping ,meanwhile t-PA controlled release microspheres were given ,the nerve distribution in the local blood vessels was observed by immunohistochemical staining .The change of nerve remodeling in the control group and treatment group was observed ,meanwhile the effect of giving t-PA controlled release microspheres on the release of ace-tylcholine and norepinephrine was detected .RT-PCR was used to detect local vascular tissue inflammation ,immune effects and oxi-dative stress .The sympathetic neurons and smooth muscle cell co-culture was adopted ,then giving glyoxal treatment as the athero-sclerosis cell model .With the t-PA treatment group as the intervention group ,the effect of t-PA on the number of cholinergic neu-ron ,and synaptic connections between the smooth muscle cells and acetylcholine secretion was observed .The change of t-PA-MMP-p75NTR and NF-kappa B signaling pathway were detected by RT-PCR .Results The vascular injury treatment was performed in the diabetic rabbit model with carotid arterial adventitia stripping ,meanwhile t-PA controlled release microspheres were given ,the nerve distribution in the local blood vessels was observed by immunohistochemical staining .The change of nerve remodeling in the control group and treatment group was observed ,meanwhile the effect of giving t-PA controlled release microspheres on the release of acetylcholine and norepinephrine was detected .RT-PCR was used to detect local vascular tissue inflammation ,immune effects and oxidative stress .The sympathetic neurons and smooth muscle cell co-culture was adopted ,then giving glyoxal treatment as the ath-erosclerosis cell model .With the t-PA treatment group as the intervention group ,the effect of t-PA on the number of cholinergic neuron ,and synaptic connections between the smooth muscle cells and acetylcholine secretion was observed .The change of t-PA-MMP-p75NTR and NF-kappa B signaling pathway were detected by RT-PCR .Conclusion t-PA activates MMPs and feedback in-hibits p75NTR-NF-kappa B signaling pathway to increase vascular adventitia autonomic nerve reconstruction and delay the occur-rence and development of atherosclerosis disease .

Surgery Effects in a Cohort of 42 Patients Received Facial SchwannomaResection and Facial Nerve Reconstruction Simultaneously / 听力学及言语疾病杂志

Objective To evaluate the effects of facial nerve reconstruction surgery by reviewing the clinical information and follow-up results of 42 cases.Methods The clinical data of 42 patients who were diagnosed as facial schwannoma and received tumor resection and facial nerve reconstruction simultaneously from January 2004 to December 2015 in our department were studied.The surgeries included anastomosis between the two faical nerves(3 cases), facial nerve transplantation(4 cases), Hypoglossal/masseteric-facial nerve anastomosis(27 cases) and cross-facial nerve graft(8 cases).We evaluated the facial nerve function using H-B grade and Fisch score post-operation (1 week, 3 months,6 months and 1 year after surgery).Results The Fisch scores were significantly different between 1 week and 3 months, 3 months and 6 months post-operation for patients received cross-facial nerve graft.The facial nerve function became better as time went by.While there were no difference between 6 months and 1 year post-operation.On the other hand, the scores were significantly different between 6 months and 1 year post-operation for patients received hypoglossal/masseteric facial nerve anastomosis.Conclusion Most patients received tumor section and facial nerve reconstruction simultaneously could gain good results, it took a long time for the facial nerve function to return to a stable state and some of them were still in recovering 1 year after surgery.

Outcome of different facial nerve reconstruction techniques / Resultados de diferentes técnicas de reconstrução do nervo facial

Abstract Introduction: There is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III. Objective: To evaluate the efficacy and safety of different facial nerve reconstruction techniques. Methods: Facial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years. Results: For facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit. Conclusion: Among various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique.

Resumo Introdução: Não existe uma técnica de reconstrução do nervo facial que garanta a recuperação da função facial até o grau III. Objetivo: Avaliar a eficácia e segurança de diferentes técnicas de reconstrução do nervo facial. Método: Ao todo, 22 pacientes foram submetidos a reconstrução do nervo facial (enxerto com interposição do nervo facial em 11 pacientes e com transferência do nervo hipoglosso facial em 11 pacientes). Todos os pacientes apresentavam função facial de grau VI (de acordo com a classificação de House-Brackmann - HB) causada por trauma ou pela ressecção de um tumor. A reconstrução do nervo principal foi efetuada, exceto em sete pacientes, nos quais a reconstrução foi realizada entre duas semanas a quatro meses após a cirurgia inicial. O período de acompanhamento foi de, no mínimo, dois anos. Resultados: Para a técnica de enxerto com interposição de nervo facial, o grau de função facial obtido foi HB III em oito pacientes e HB IV em três pacientes. Sincinesia foi observada em oito pacientes e contratura facial com sincinesia em dois pacientes. Em relação à transferência do nervo hipoglosso facial com o uso de diferentes modificações, obtivemos função facial HB grau III em nove pacientes e HB grau IV em dois pacientes. Contratura facial, sincinesia e atrofia lingual foram observadas em três pacientes e sincinesia observada em cinco pacientes. No entanto, aqueles submetidos a anastomose primária direta hipoglosso-facial término-lateral apresentaram o melhor resultado, sem qualquer déficit neurológico. Conclusão: Entre as várias técnicas de reanimação, sempre que possível, a anastomose direta término-lateral hopoglosso-facial por meio de sutura epineural é a técnica mais eficaz, com excelentes resultados para reanimação facial e preservação do movimento da língua, especialmente quando realizada como técnica primária.

Clinical experience in facial nerve tumors:A review of 27 cases / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the clinical manifestations and the diagnosis of the facial nerve tumor according to the clinical information, and evaluate the different surgical approaches depending on tumor location.Method:Twenty-seven cases of facial nerve tumors with general clinical informations available from 1999.9 to 2006.12 in the Shanghai EENT Hospital were reviewed retrospectively.Result:Twenty(74.1%) schwannomas,4 (14.8%)neuofibromas ,and 3(11.1%)hemangiomas were identified with histopathology postoperatively.During the course of the disease,23 patients(85.2%)suffered facial paralysis,both hearing loss and tinnitus affected 11 (40.7%)cases,5(18.5%)manifested infra-auricular mass and the others showed some of otalgia or vertigo or ear fullness or facial numbness/twitched. CT or/and MRI results in 24 cases indicated that the tumors originated from the facial nerve.Intra-operative findings showed that 24(88.9%)cases involved no less than 2 segments of the facial nerve,of these 24 cases 87.5%(21/24)involved the mastoid protion,70.8%(17/24)involved the tympanic protion, 62.5%(15/24)involved the geniculate ganglion, only 4.2%(1/24)involved the internal acoustic canal(IAC),and 3 cases (11.1%)had only one segments involved. In all of these 27 cases ,the tumors were completely excised,of which 13 were resected followed by an immediate facial nerve reconstruction,including 11 sural nerve cable graft,1 facial nerve end-to-end anastomosis and 1 hypoglossal-facial nerve end-to-end anastomosis.Tumors were removed with preservation of facial nerve continuity in 2 cases.Conclusion:Facial nerve tumor is a rare and benign lesion,and has numerous clinical manifestations.CT and MRI can help surgeons to make a right diagnosis preoperatively.When and how to give the patients an operation depends on the patients individually.

Facial Nerve Paralysis and Surgical Management

The facial nerve coursing through the temporal bone provides a challenge to the otologic surgeon. Advances in surgical instrumentation and refinements of surgical strategies enable the otologist to uncover the entire course of the facial nerve safely from brainstem to its exit from temporal bone. The most common cause of facial nerve paralysis is Bell's palsy, followed by traumatic facial paralysis, herpes zoster oticus, and intratemporal tumous lesion. The surgical approaches to the injured facial nerve depend on its causes. Acute, severe facial nerve paralysis caused by viral infection or trauma can be managed by early use of transmastoid approach, middle cranial approach, or combined approach. In case of intratemporal benign tumor with favorable facial function, great care must be taken not to damage the facial nerve with nerve preservation technique. However, in malignant tumor with favorable facial function, the priority must be placed on the complete resection than to the facial nerve preservation. In consideration of selecting surgical technique of facial nerve paralysis reconstruction, clinician must find out the cause, degree and duration of paralysis for the appropriate technique.

The Reconstruction of the Recurrent Laryngeal Nerve after the Combined Resection of the Recurrent Laryngeal Nerve and the Papillary Thyroid Cancer

BACKGROUND: The function of the recurrent laryngeal nerve might be normal even though there is some extent of cancer invasion. The recurrent laryngeal nerves are usually saved when the preoperative vocal function is normal. However, it is difficult to save a nerve with a minimal amount of remnant cancer tissue when the cancer invasion is deep and broad. In a such instance, combined resection of the recurrent nerve and reconstruction of the recurrent nerve could be considered if the postoperative recovery of the vocal function is acceptable. METHODS: We tried reconstruction of the recurrent laryngeal nerve with the ansa hypoglossi-recurrent nerve (n=6) and with direct end-to-end anastomosis (n=4). The postoperative vocal function of these patients were compared to that of 11 patients whose recurrent nerves were resected and left without reconstruction. RESULTS: The maximal comfortable phonation time of the reconstruction group was significantly longer (mean 11.4+/-3.8 sec) than that of the no reconstruction group (mean 6.9+/-3.2 sec). There was, however, no significant difference between the ansa hypoglossi-recurrent nerve anastomosis group (mean 11.5+/-4.5 sec) and the direct end-to-end anastomosis group (mean 11.3+/-3.0 sec). Median fixation of the vocal cord and no or minimal glottic gap were observed in the reconstructed group. On the other hand, in the no reconstruction group paramedian fixation of the vocal cord and a wider glottic gap were observed. CONCLUSIONS: We feel that the recovery of the vocal function after the reconstruction of the recurrent nerve is acceptable and is enough to try a combined resection of a recurrent nerve severely invaded by papillary thyroid cancer even though the pre operative vocal function is normal.

Facial Nerve Reconstruction with Nerve Graft following Ablative Parotid Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Sacrifice of the facial nerve may be unavoidable during parotid resections for malignancy. In these cases, facial nerve reconstruction is helpful to minimize postoperative facial dysfunction. Many surgical techniques have been described to improve the dysfunction of facial nerve but immediate nerve suture, or grafting if direct suture is not possible, achieves the best results and allows maximal return of function. MATERIALS AND METHODS: We retrospectively studied 8 patients with parotid malignancies undergoing ablative parotid surgery with sacrifice of the seventh cranial nerve and facial nerve reconstruction with interposition graft between 1992 and 1997. They had been followed up for at least 6 months. Seven patients were reconstructed with simple interposition graft and the other was reconstructed with end-to-side facial-hypoglossal interposition graft. All the patients were treated with adjuvant radiotherapy. Each patient was evaluated on the basis of facial symmetry, eye closure and smile by means of photograph taken on the follow-up visit. RESULT: Facial symmetry, eye closure, and smile were improved satisfactorily in five, six, and four patients respectively. Recovery of patients who have had preoperative facial paralysis exhibited rather poor results. CONCLUSION: Nerve grafting performed immediately after resection of the tumor can provide a significant improvement of function in patients with sacrifice of the facial nerve.

Experimental Study for Peripheral Nerve Reconstruction using Skeletal Muscle and Omentum / 대한정형외과학회잡지

The experimental study for peripheral nerve reconstruction was performed using degenerated skeletal muscle and omentum. At the sciatic nerves of 26 rabbits, about 10mm gaps were made under ketamine anesthesia. Degenerated skeletal muscles were made through the procedure of freezing with liquid nitrogen and thawing in distilled water. And omenta were taken through midline abdominal incisions. On 14 rabbits of experimental group, the nerves were connected with the degenerated skeletal muscles and surrounded with the omenta. On 6 rabbits of control group, the nerve gaps were connected with the degenerated skeletal muscles without surrounding with the omenta. And the other 6 rabbits of control group, the gaps were lets without further treatment. After 3, 6, 9 and 12 weeks, the results were compared using light microscope and transmission electron microscope. There were contractions and fragmentations at the skeletal muscles during the freezing and thawing. There were nerve regenerations through the degenerated skeletal muscles. The nerve tissues of the experimental group were more abundant than the control group using the degenerated skeletal muscles only.