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OBJECTIVES@#This study aimed to analyze the application value of a modified tragus edge incision and transmasseteric anteroparotid approach to condyle reconstruction.@*METHODS@#Condyle reconstruction was performed in 16 patients (9 females and 7 males) with modified tragus edge incision and transmasseteric anteroparotid approach. After regular follow-up, the function of condyle reconstruction was evaluated by clinical indicators, such as parotid salivary fistula, facial nerve function, mouth opening, occlusal relationship, and facial scar. The morphology of rib graft rib cartilage was evaluated by imaging indicators, such as panoramic radiography, CT, and three-dimensional CT image reconstruction.@*RESULTS@#At 6-36 months postoperative follow-up, all patients had good recovery of facial appearance, concealed incisional scar, no parotid salivary fistula, good mouth opening, and occlusion. One case had temporary facial paralysis and recovered after treatment. Radiographic evaluation further showed that costochondral graft survived in normal anatomic locations.@*CONCLUSIONS@#The modified tragus edge incision and transmasseteric anteroparotid approach can effectively reduce parotid salivary fistula and facial nerve injury in condylar reconstruction. The surgical field was clearly exposed, and the incision scar was concealed without increasing the incidence of other complications. Thus, this approach is worthy of clinical promotion.
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Male , Female , Humans , Mandibular Condyle/surgery , Cicatrix/surgery , Fracture Fixation, Internal/methods , Mandibular Fractures/surgery , Oral Surgical Procedures/methods , Treatment OutcomeABSTRACT
Abstract Introduction: Facial nerve damage is a condition that causes functional, psychological, and cosmetic problems; and treatment methods need to be improved. Objective: We investigated the efficacy of titanium-prepared platelet-rich fibrin as a healing enhancer at the region of transection of the facial nerve. Methods: Twenty-seven New Zealand male rabbits were used in this study, divided into three experimental groups. Group 1, the sham group (n=7); Group 2, the suture group (n = 10); and Group 3, the suture + T-PRF group (n = 10). In Group 1, the facial nerve trunk was dissected, and no additional surgical intervention was performed. For Group 2, a transection was made to the facial nerve trunk and the nerve endings were sutured together. In Group 3, nerve endings were sutured after transection, and a titanium-prepared platelet-rich fibrin membrane was wrapped in a tube around the damaged area. All animals were followed up weekly for the presence of corneal reflex, whisker movement and low ears. Bilateral facial electromyography was performed both preoperatively and postoperatively at the 1st, 3rd, 5th, 7th, 10th weeks. Tissue samples obtained at the 10th week were histopathologically examined, and intra-group and inter-group comparisons were performed. Results: Subjects in Group showed improvement in whisker movement and ear drop one week earlier than Group 2. In Group 3, the nerve stimulation threshold required to trigger the compound muscle action potential had returned to values similar to the preoperative control values (11.31 ±2.16V) by 5 weeks postoperatively (12.51 ±3.97V), (p = 0.249). Conclusion: Titanium-prepared platelet-rich fibrin administration contributed to partial nerve healing both on a functional and an electrophysiological level.
Resumo Introdução: A lesão do nervo facial é uma condição que causa problemas funcionais, psicológicos e cosméticos e os métodos de tratamento precisam ser melhorados. Objetivo: Investigamos a eficácia da fibrina rica em plaquetas preparada com titânio como um intensificador de cura na transecção do nervo facial. Método: Vinte e sete coelhos machos da raça New Zealand foram usados neste estudo, divididos em três grupos experimentais. Grupo 1, o grupo simulado (n = 7); Grupo 2, o grupo de sutura (n = 10); e Grupo 3, o grupo sutura + fibrina rica em plaquetas preparada com titânio (n = 10). No Grupo 1, o tronco do nervo facial foi dissecado e nenhuma intervenção cirúrgica adicional foi feita. No Grupo 2, uma secção transversal foi feita no tronco do nervo facial e as terminações nervosas foram suturadas. No Grupo 3, as terminações nervosas foram suturadas após a transecção e uma membrana de fibrina rica em plaquetas preparada com titânio foi envolvida em um tubo ao redor da área danificada. Todos os animais foram acompanhados semanalmente quanto à presença do reflexo corneal, movimento dos bigodes e orelhas baixas. A eletromiografia facial bilateral foi feita no pré e pós-operatório na 1ª, 3ª, 5ª, 7ª e 10ª semanas. Amostras de tecido obtidas na 10- semana foram examinadas histopatologicamente e comparações intra- e intergrupos foram feitas. Resultados: Os animais do Grupo 1 apresentaram melhoria no movimento dos bigodes e orelhas baixas uma semana antes do Grupo 2. No Grupo 3, o limiar de estimulação do nervo necessário para acionar o potencial de ação muscular composta retornou a valores semelhantes aos valores de controle pré-operatório (11,31 ± 2,16 volts) em 5 semanas de pós-operatório (12,51 ± 3,97 volts), (p = 0,249). Conclusão: A administração de fibrina rica em plaquetas preparada com titânio contribuiu para a cicatrização parcial do nervo ao nível funcional e eletrofisiológico.
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Objective@#Hypoglossal nerve-facial nerve 'side'-to-side neurorrhaphy is a new method for the treatment of potential incomplete facial paralysis after acoustic neuroma. However, there are differences in postoperative outcomes among patients. This study analysed preoperative factors that may influence the treatment outcomes of neurorrhaphy.@*Methods@#We performed a retrospective study of 53 patients who were treated by neurorrhaphy for facial paralysis after acoustic neuroma resection. After a one-year follow-up period, the patients were divided into two groups according to facial functional outcome: better recovery or ordinary recovery. We analysed the following factors: gender, age, tumour size, and characteristics, tumour adhesion to the facial nerve, the duration of facial paralysis (DFP) and F wave appearance prior to neurorrhaphy (F wave).@*Results@#Univariate analysis showed significant differences between the two groups in DFP ( = 0.0002), tumour adhesion to the facial nerve ( = 0.0079) and F waves ( = 0.0048). Logistic regression analysis of these factors also showed statistical significance with values of 0.042 for the DFP, 0.043 for F waves, and 0.031 for tumour adhesion to the facial nerve.@*Conclusions@#Tumour adhesion to the facial nerve, F waves appearance and DFP prior to neurorrhaphy are the predominant factors that influence treatment outcomes.
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Mesenchymal cells (MCs) exhibit great regenerative potential due to their intrinsic properties and ability to restore tissue function, either directly through transdifferentiation or indirectly through paracrine effects. This study aimed to evaluate morphometric and phenotypic changes in MCs grown with facial nerve-conditioned medium in the presence or absence of fibroblast growth factor 2 (FGF-2). For quantitative phenotypic analysis, the expression of GFAP, OX-42, MAP-2, β-tubulin III, NeuN, and NF-200 was analyzed by immunocytochemistry. Cells cultured with facial nerve-conditioned medium in the presence of FGF-2 expressed GFAP, OX-42, MAP-2, β-tubulin III, NeuN, and NF-200. On average, the area and perimeter of GFAP-positive cells were higher in the group cultured with facial nerve-conditioned medium compared to the group cultured with conditioned medium and FGF-2 (p=0.0001). This study demonstrated the plasticity of MCs for neuronal and glial lineages and opens up new research perspectives in cell therapy and trans.differentiation.
Las células mesenquimales (CM) exhiben un gran potencial regenerativo debido a sus propiedades intrínsecas y la capacidad de restaurar la función del tejido, ya sea directamente, a través de la transdiferenciación, o indirectamente, a través de efectos parácrinos. Este estudio tuvo como objetivo evaluar los cambios morfométricos y fenotípicos en CM cultivadas con medio condicionado por nervio facial en presencia o ausencia de factor de crecimiento de fibroblastos 2 (FGF-2). Para el análisis fenotípico cuantitativo, se analizó la expresión de GFAP, OX-42, MAP-2, β-tubulina III, NeuN y NF-200 mediante inmunocitoquímica. Las células cultivadas con medio condicionado por el nervio facial en presencia de FGF-2 expresaban GFAP, OX-42, MAP-2, β-tubulina III, NeuN y NF-200. En promedio, el área y el perímetro de las células positivas para GFAP fueron mayores en el grupo cultivado con medio condicionado por el nervio facial en comparación con el grupo cultivado con medio acondicionado y FGF-2 (p = 0,0001). Este estudio demostró la plasticidad de CM para linajes neuronales y gliales y abre nuevas perspectivas de investigación en terapia celular y transdiferenciación.
Subject(s)
Animals , Male , Rats , Bone Marrow , Fibroblast Growth Factor 2/metabolism , Facial Nerve Injuries , Mesenchymal Stem Cells/metabolism , Phenotype , Immunohistochemistry , Cells, Cultured , Rats, Wistar , Cell TransdifferentiationABSTRACT
Facial nerve injury results in facial muscle movement disorders that interferes with patient's life. Acupuncture is an effective therapy for facial nerve injury, but its mechanism has not been clarified. The evidence supports that acupuncture can accelerate the repair of facial nerve injury by adjusting the electric wave of patient's facial muscle, improving facial blood circulation, and promoting the expression of cell and protein molecule.
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Objective To investigate the effects of different stimulation of electroacupuncture on the protein expressions of SOCS1 and SOCS3 in rabbits with acute facial nerve injury; To determine the better stimulation. Methods New Zealand rabbits were treated with special hemostatic forceps for 5 min, and the length of the lesion was about 2.5 cm. The model of facial nerve injury was induced. The experiment was divided into blank group, sham-operation group, model group, and electoracupuncture weak-, medium-, and strong-stimulation group. The model group received no intervention after surgery. After treatment, the damaged facial nerve of each group was intercepted. The protein expressions of SOCS1 and SOCS3 mediated by negative feedback regulation of JAK-STAT were detected by ABC-ELISA. Results Compared with the blank group, the protein expressions of SOCS1 and SOCS3 in the model group increased (P<0.01). Compared with the model group, the protein expressions of SOCS1 and SOCS3 protein in electroacupuncture weak- stimulation group decreased (P<0.01). Conclusion Electroacupuncture can make SOCS1, SOCS3 protein expressions normal for acute facial nerve injury, and acupuncture treatment effect does not increase with the increase of stimulation.
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Objective To study the clinical effect of mouse nerve growth factor in the treatment of patients with traumatic facial nerve injury .Methods From April 2015 to October 2017,60 patients with traumatic facial nerve injury in the People's Hospital of Sanmen County were selected and divided into observation group and control group by completely random assignment method ,with 30 cases in each group.All patients were given dexamethasone ,sodium aescinate and nimodipine treatment ,on this basis,the control group was given mecobalamin treatment ,the observation group was given mouse nerve growth factor treatment .The changes of facial nerve function before treatment were assessed,and the clinical efficacy was compared between the two groups .Results After treatment,the facial nerve function grade in the observation group (Ⅰ18 cases,Ⅱ8 cases,Ⅲ2 cases,Ⅳ0 case,Ⅴ1 case,Ⅵ1 case) was significantly better than those in the control group (Ⅰ 6 cases,Ⅱ4 cases,Ⅲ5 cases,Ⅳ8 cases,Ⅴ4 cases,Ⅵ3 cases),the difference was statistically significant (χ2＝12.87,P＜0.01).The total effective rate of the observation group was 93.33%,which was significantly higher than 70.00% of the control group,the difference was statistically significant (χ2＝7.81,P＜0.05).Conclusion Mouse nerve growth factor in the treatment of patients with traumatic facial nerve injury has important clinical value ,it is helpful to alleviate the clinical symptoms ,improve facial nerve function and clinical cure rate ,it is worthy of clinical application .
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Objective: To establish the rabbit facial nerve injury model by surgery and to explore the repair effect of dental pulp stem cells on the facial nerve injury in the rabbits, and to clarify its possible mechanism. Methods: The dental pulp stem cells were isolated, cultured and induced. A total of 45 rabbits were randomly divided into normal control group, model group and experiment group, and there were 15 rats in each group. Except for normal control group, the rabbits in the other groups were cut along the corner of mouth to the front of the ear to form a incision about 3 cm, the upper buccal branches were disconnected, and the facial nerve buccal injury models were established. After 1 week, 0. 1 mL dental pulp stem cell suspension (5×106) was injected into the operative cavity of the rats in experiment group, and the rabbits in normal control group did not receive any treatment. The rabbits in model group were injected with the same amount of phosphate buffer (PBS). Two weeks after operation, the behavior and movement function scores of facial beard of the rabbits in various groups were evaluated; the pathomorphology of facial nerve tissue of the rabbits in various groups was observed by HE staining; immunohistochemical staining was used to detect the number of brain derived nerve growth factor (BDNF) and ciliary neurotrophic factor (CNTF) positive cells; the number of regenerated nerve fibers, the diameter of fiber and the thickness of myelin sheath were observed under transmission electron microscope. Results: The primary dental pulp stem cells of young rabbits were successfully separated and identified. Most of them were fibroblast like and long fusiform. The HE staining results showed that the nucleus of the third generation of the dental pulp stem cells showed a dark blue and oval shape, and the spindle shaped hyperchromatic cells were fibroblast like cells. Compared with normal control group, the movement function score of facial beard of the rabbits in model group was significantly decreased (P
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Objective To apply the ultrasound microbubble to mediate basic fibroblast growth factor(bFGF) for conducting the injuried facial nerve(rat model) repair and to investigate its feasibility and efficiency.Methods After establishing the models of facial nerve injury,40 SD rats were divided into 4 groups,10 cases in each group:group A,bFGF +ultrasound+microbubble(bFGF + MB/US),group B,bFGF and microbuble(bFGF+ MB),group C,bFGF and ultrasound(bFGF + US) and group D,simple operation(PBS).The general status of rats on 1,10,20,28 d after bFGF gene transfection was observed.The nerve conduction velocity (NCV),incubation period and amplitude of facial nerve action potential were measured.After taking the facial nerve tissue in injuried site,mRNA expression was detected by RT-PCR.Western blot was used to detect the bFGF protein expression.Results On 20 d after transfection,small swing of a small quantity of beard in the operation site of the group A could be observed;on 28 d after transfection,the general slatws of recavely in rats in the group A was better than that in the group B,C and D.The nerve electrophysiology manifestations after facial nerve repair in the group A were superior to the group B,C and D;the amount of bFGF mRNA and protein pxpression in the group A was significantly higher than that in the group B,C and D.Conclusion Ultrasound microbubble mediated bFGF is conducive to the repair of facial nerve injury.
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<p><b>OBJECTIVE</b>This study aimed to examine the complications of supratemporalis approach with scalp coronal incision for the treatment of orbital-zygomatic fractures.</p><p><b>METHODS</b>A total of 206 patients with orbital-zygomatic fractures were treated with scalp coronal incision through the supratemporalis approach. The effects and complications of the treatment were analyzed.</p><p><b>RESULTS</b>The degree of fracture of the 206 patients was successfully reduced. The facial morphologies and functions were improved. No facial nerve injury was observed in all of the cases. However, the following complications were noted: fossa introcession in 1 case, forehead scalp pain or paresthesia in 11 cases, incision infection in 1 case, subcutaneous hematoma in 1 case, incision scar in 5 cases, and alopecia in 3 cases.</p><p><b>CONCLUSIONS</b>The supratemporalis approach prevents facial nerve injury and does not increase the frequency of other complications. Therefore, this approach can be applied as a routine and safe procedure in clinical settings. .</p>
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Humans , Face , Hematoma , Orbital Fractures , Scalp , Surgical Wound , Zygomatic FracturesABSTRACT
Objective To explore the effect of hyperbaric oxygen combined with acupuncture and moxibustion on traumatic peripheral facial nerve injury, and the results of electromyography. Methods From January, 2007 to January, 2013, a total of 160 patients with traumat-ic peripheral facial nerve injury were divided into treatment group (n=80) and control group (n=80). Both groups received routine drug treat-ment. Hyperbaric oxygen combined with acupuncture and moxibustion was applied to treatment group in addition. The clinical efficacy and the results of electromyography were analyzed before and 36 days after treatment. Results After treatment, the cure rate and total efficiency was significantly higher (χ2>7.657, P2.214, P3.116, P5.45, P<0.001) in the treatment group than in the control group. Conclusion Hyperbaric oxy-gen combined with acupuncture and moxibustion is more effective on traumatic peripheral facial nerve injury than routine.
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Objective To investigate the feasibility of combing the application of transforming growth factor-β3 (TGF-β3) with concentration of 100 ng/μl and dental pulp stem cells (DPSCs) for recovering rabbit facial nerve transverse trauma.Methods Thirty-six healthy adult Zelanian rabbits of clean-grade were selected and randomly divided into group DPSCs+TGF-β3 (experimental group), group TGF-β3 (control group 1) and group PBS (control group 2) with 12 rabbits in each group.The operations for all three groups were applied at rabbit's left cheek.A model of traumatic transection was set on upper buccal branch, then 100 ng/μl TGF-β3 solution and 0.1 ml of 1 ×108/L DPSCs suspension were added into regeneration chamber for the experimental group, while the same amount of 100 ng/μl TGF-β3 solution was added for group TGF-β3 and the same amount of PBS for group PBS.The recovery of facial nerve regeneration with the prepared animal's specimen was evaluated in the 1st, 4th and 12th week after the operation on sacrificed rabbits.Results The effects on nerve regeneration recovery for the experimental group was superior to that of control groups 1 and 2 with all the 36 models included in the result analysis, and that of control group 1 was superior to that of control group 2, which was getting better with the extension of time.Conclusions The combined application of TGF-β3 and DPSCs can effectively promote the facial nerve regeneration, which is better than that of single application of TGF-β3.Meanwhile, the effect with TGFβ3 application is better than that with application of PBS.
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Objective:Facial nerves can be dissected using anterograde and retrograde approaches. The optimal technique for the facial nerve dissection of a patient with benign parotid tumor has not yet been determined. This study focused on facial nerve dysfunc-tion and recovery rate after anterograde and retrograde facial-nerve dissections. Methods:The data of 110 patients with benign carotid adenoma from the Head and Neck Department of this hospital who were hospitalized between January 2011 and January 2013 were col-lected. These patients were divided into groups A (n=52) and B (n=58). Anterograde and retrograde dissections of the facial nerve were performed on group A and group B patients, respectively. Based on the preferential order of dissection, group B was divided into groups B1, B2, and B3 representing the zygomatic, buccal, and marginal mandibular branches, respectively. The patients were postoperatively observed to check for potential symptoms, such as facial paralysis along with its severity and recovery. The House-Brackmann grading system was used to assess all patients. Results:The operation could be successful, with better nerve exposure, using these approaches. Statistical differences were observed in the nerve injury and recovery rates between the groups, with group A better than group B, and group B2 better than the other two groups (P<0.05). Conclusion:Anterograde facial nerve dissection should be routinely used in be-nign parotid tumor, and the buccal branch of facial nerve dissection should be preferentially considered when no other option apart from retrograde dissection is available.
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Recently, the increasing rates of facial nerve preservation after vestibular schwannoma (VS) surgery have been achieved. However, the management of a partially or completely damaged facial nerve remains an important issue. The authors report a patient who was had a good recovery after a facial nerve reconstruction using fibrin glue-coated collagen fleece for a totally transected facial nerve during VS surgery. And, we verifed the anatomical preservation and functional outcome of the facial nerve with postoperative diffusion tensor (DT) imaging facial nerve tractography, electroneurography (ENoG) and House-Brackmann (HB) grade. DT imaging tractography at the 3rd postoperative day revealed preservation of facial nerve. And facial nerve degeneration ratio was 94.1% at 7th postoperative day ENoG. At postoperative 3 months and 1 year follow-up examination with DT imaging facial nerve tractography and ENoG, good results for facial nerve function were observed.
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Humans , Collagen , Diffusion , Diffusion Tensor Imaging , Electromyography , Facial Nerve Injuries , Facial Nerve , Fibrin , Follow-Up Studies , Monitoring, Intraoperative , Neuroma, AcousticABSTRACT
OBJECTIVE: Facial nerve palsy is a common complication of treatment for vestibular schwannoma (VS), so preserving facial nerve function is important. The preoperative visualization of the course of facial nerve in relation to VS could help prevent injury to the nerve during the surgery. In this study, we evaluate the accuracy of diffusion tensor tractography (DTT) for preoperative identification of facial nerve. METHODS: We prospectively collected data from 11 patients with VS, who underwent preoperative DTT for facial nerve. Imaging results were correlated with intraoperative findings. Postoperative DTT was performed at postoperative 3 month. Facial nerve function was clinically evaluated according to the House-Brackmann (HB) facial nerve grading system. RESULTS: Facial nerve courses on preoperative tractography were entirely correlated with intraoperative findings in all patients. Facial nerve was located on the anterior of the tumor surface in 5 cases, on anteroinferior in 3 cases, on anterosuperior in 2 cases, and on posteroinferior in 1 case. In postoperative facial nerve tractography, preservation of facial nerve was confirmed in all patients. No patient had severe facial paralysis at postoperative one year. CONCLUSION: This study shows that DTT for preoperative identification of facial nerve in VS surgery could be a very accurate and useful radiological method and could help to improve facial nerve preservation.
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Humans , Diffusion Tensor Imaging , Diffusion , Facial Nerve Injuries , Facial Nerve , Facial Paralysis , Neuroma, Acoustic , Paralysis , Prospective StudiesABSTRACT
Objective: The purpose of this prospective study was to evaluate the incidence and degree of facial nerve damage and time taken for its recovery following surgery for temporomandibular joint (TMJ) ankylosis. Materials and Methods: A total of 30 subjects with the TMJ ankylosis with or without history of previous surgery were included in this prospective study. House-Brackmann grading system was used to assess the function of the facial nerve post-operatively. Results: Most of the subjects were in the age range of 13-15 years. Eight subjects had bilateral ankylosis and remaining 22 had unilateral ankylosis. Out of 32 joints in which gap arthroplasty was performed, 4 had Grade 1 injury, 14 had Grade 2 injury, 12 had Grade 3, and 2 with the Grade 4 injury 24 h post-operatively. Whereas, out of 6 cases of interpositional arthroplasty 4 had Grade 1 injury and 2 had Grade 4 injury. According to House-Brackmann grading system, at 24 h, 78.9% patients had different grades of facial nerve injury, which gradually improved and came to normal limits within 1-3 months post-operatively. Comparison of change in the Grade of injury at 3 months follow-up as compared to baseline (24 h) showed full recovery in all the cases (100%) showing a statistically significant difference from baseline (P < 0.001). Conclusion: When proper care is taken during surgery for TMJ ankylosis, permanent facial nerve injury is rare. However, the incidence and degree of temporary nerve injury could be either due to the heavy retraction causing compression and or stretching of nerve fiber resulting in neuropraxia.
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BACKGROUND: Therapeutic methods for of peripheral facial nerve injury include surgery, physical therapy and drug treatment, but the treatment effect is not ideal in some certain cases. OBJECTIVE: To study the effect of autologous platelet rich plasma on repair of facial nerve injury. METHODS: The bilateral destroyed buccal nerve branches of the 10 white rabbits were put in silica gel nerve regeneration chamber, one side injected with platelet rich plasma as experimental group, the other side injected with normal saline as control group. The general observation, neuroelectrophysiology detection, histological observation, image analysis and evaluation of facial nerve regeneration recovery were performed at 8 weeks after surgery. RESULTS AND CONCLUSION: The action potential latency of the orbicularis oris at the experimental side was significantly lower than that at the control side, and the action potential amplitude (M wave) of compound nerve muscle of the experimental side was significantly higher than that of the control side (P < 0.01). Compared with the control side, the regenerative nerves of the experimental side were more mature with more regenerative axons, and the differentiation of myelin sheath was more mature and the thickness of myelin sheath was wel -distributed. Meanwhile, the diameters of axons were closed to the normal diameter, and the nerve axons were more intensive and arranged more regularly, the outer membrane of nerve fiber was thicker and the col agen fiber and elastic fiber layer were increased when compared with the control group. The number of regenerative axons of the control side was less, and the axons were distributed irregularly and poorly developed, and a large number of fibrous connective tissues were observed. The vacuolar degeneration at the control side was more than the experimental side. The regenerated nerve in the experimental side was better than the control side in the diameter of myelinated axon, area, myelin sheath thickness and axon count, and there were significant differences between two groups (P < 0.01). It indicates that platelet rich plasma has a promoting effect in the repair and regeneration of facial nerve.
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ObjectiveTo investigate the effects of using transforming growth factor-β3 (TGF-β3) combined with dental pulp stem cells (DPSCs) on the regeneration of rabbit facial nerve.MethodsSixteen New Zealand adult rabbits were selected randomly.These rabbits were divided into three groups (TGF-β3 and DPSCs treated group,TGF-β3 control group and PBS control group.treatment group (silicone guidance channel with collagen protein sponge were filled with TGF-β3 and DPSCs),TGF-β3 control group (silicone guidance channel with collagen protein sponge were filled with TGF-β3) and PBS control group(silicone guidance channel with collagen protein sponge were filled with PBS).After 3 months,a series of examinations were performed,including gross morphology,histological staining,neuroelectrophysiological tset.ResultsIn the experimental group,the diameter of the regenerating nerve and near distal nerve stem were almost the same.There were no formation of neuroma.The adventitial angiogenesis was rich and with tough texture.3 months after operation,in the experimental group,the facial nerve membrane integrity,nerve fibers arranged in neat rows,form a more complete,myelin swelling.The total number of regeneration of nerve fibers in the experimental group were more than of control groups,statistical analysis was significant (P＜0.05).Diameter of regenerating nerve fibers in the experimental group were greater than that of control groups,statistical analysis was significant (P＜0.05).The ultra-thin section showed that the regenerated fibers in the treatment group were mainly myelinated never fiber.The layer structure of myelin sheath was clear,and there were rich organells axoplasma.The neuroelectrophysiological examinations revealed that the latency of nerve and muscle action conduction in the treatment group was shorter than that of the control groups,the treatment group:(1.96±0.32) ms,the TGF-β3 control group:(2.35±0.41) ms,the PBS control group:(3.42±0.55) ms.The wave amplitude of nerve and muscle action conduction in the treatment group was obviously higher than that of control groups,the treatment group:(11.06±3.25) mV,the TGF-β3 control group:(8.40± 1.68) mV,the PBS control group:(4.62±0.77) mV.ConclusionThe combination of TGF-β3 and DPSCs can improve the effects on the repair of facial nerve injury.
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Humans , Anesthesia, General , Congenital Abnormalities , Esthetics , Facial Expression , Facial Nerve , Facial Nerve Injuries , Mandible , Mandibular Nerve , Mouth , Muscles , Open Bite , Orthognathic Surgery , Osteotomy , Paralysis , Porphyrins , Retinaldehyde , Soft Tissue Injuries , Surgery, Oral , Temporomandibular Joint Disorders , VitaminsABSTRACT
PURPOSE: After exposure of fracture site, the proximal segment must be reduced to their preinjury position for open reduction of fractured mandibular condyle. We examined the use of inter-maxillary fixation screws or titanium screws tied with stainless steel wire to assist in positioning of proximal segment. Since it enables to make a relatively small preauricular incision by not disturbing the operative field like Moule pin, we can reduce the danger of injury to the facial nerve. METHODS: A preauricular approach was used for exposure, reduction, and rigid fixation in 4 cases of mandibular condylar fractures. Inter-maxillary fixation screws or titanium screws tied with stainless steel wire were used to assist in aligning proximal segment. The joints were submitted to functional exercises and postoperative radiologic and clinical follow-ups were performed. RESULTS: No facial nerve lesions were found in all 4 cases. Radiologic follow-up showed correct reduction and fixation in all 4 cases. Clinical follow-up showed an initial limitation, but normal morbility of the condyle was achieved within 4 months after the operation, with a maximum mouth opening of 34.1+/-5.2 mm after 12 months. There found no occlusal disturbances, no trismus, no lateral deviations of the mandible. CONCLUSION: By using Inter-maxillary fixation screws tied with stainless steel wire, it was shown that reducing the proximal segment to their preinjury position is easy to perform and it enables us to make a minimal dissection below preauricular skin incision to avoid facial nerve injury.