Post-parotidectomy facial nerve function: comparison between original and modified Sunnybrook Facial Grading Systems / Função do nervo facial pós-parotidectomia: comparação entre os Sistemas Sunnybrook de Graduação Facial original e modificado

Abstract Background: Facial nerve dysfunction is the principal postoperative complication related to parotidectomy. Objective: To test the hypothesis that the modified Sunnybrook Facial Grading System (mS-FGS) is superior to the original S-FGS in the assessment of facial nerve function following parotidectomy. Methods: Prospective, longitudinal study evaluating patients with primary or metastatic parotid neoplasms undergoing parotidectomy with facial nerve-sparing between 2016 and 2020. The subjects were assessed twice, on the first postoperative day and at the first outpatient evaluation, 20-30 days post-surgery. Facial assessments were performed using the original and modified (plus showing the lower teeth) versions of the Sunnybrook System and documented by pictures and video recordings. Intra- and inter-rater agreements regarding the assessment of the new expression were analyzed. Results: 101 patients were enrolled. In both steps, the results from the mS-FGS were significantly lower (p < 0.001). Subjects with a history of previous parotidectomy and those who underwent neck dissection had more severe facial nerve impairment. The mandibular marginal branch was the most frequently injured, affecting 68.3% of the patients on the first postoperative day and 52.5% on the first outpatient evaluation. Twenty patients (19.8%) presented an exclusive marginal mandibular branch lesion. The inter-rater agreement of the new expression assessment ranged from substantial to almost perfect. The intra-rater agreement was almost perfect (wk = 0.951). Conclusion: The adoption of the Modified Sunnybrook System, which includes evaluation of the mandibular marginal branch, increases the accuracy of post-parotidectomy facial nerve dysfunction appraisal.

Resumo Antecedentes: A disfunção do nervo facial é a principal complicação pós-operatória relacionada à parotidectomia. Objetivo: Testar a hipótese de que o sistema Sunnybrook de graduação facial modificado (mS-FGS) é superior ao S-FGS original na avaliação da função do nervo facial após parotidectomia. Métodos: Estudo longitudinal prospectivo avaliando o pós-operatório de pacientes com neoplasias parotídeas primárias ou metastáticas, submetidos à parotidectomia com preservação do nervo facial, entre 2016 e 2020. Os indivíduos foram avaliados duas vezes, no primeiro dia de pós-operatório e na primeira avaliação ambulatorial, 20-30 dias após a cirurgia. As avaliações faciais foram realizadas usando as versões original e modificada (que incluem mostrar os dentes inferiores) do sistema Sunnybrook e documentadas por fotos e vídeos. Foram adicionalmente analisadas as concordâncias intra e interexaminadoras da avaliação da nova expressão. Resultados: Cento e um pacientes foram incluídos. Em ambas as etapas, os resultados do mS-FGS foram significativamente menores (p < 0,001). Indivíduos com história de parotidectomia prévia e aqueles submetidos ao esvaziamento cervical apresentaram comprometimento mais grave do nervo facial. O ramo marginal mandibular foi o mais afetado, acometendo 68,3% dos pacientes no primeiro dia de pós-operatório e 52,5% na primeira avaliação ambulatorial. Vinte pacientes (19,8%) apresentaram lesão exclusiva do ramo marginal mandibular. A concordância interexaminadores da avaliação da nova expressão variou de substancial a quase perfeita. A concordância intraexaminador foi quase perfeita (wk = 0,951). Conclusão: A adoção do sistema Sunnybrook modificado, que inclui a análise do ramo marginal mandibular, aumenta a precisão da avaliação da disfunção do nervo facial pós-parotidectomia.

Prognostic value of neuroelectromyography in peripheral facial paralysis and its correlation with House-Brackman classification / 中国基层医药

Objective:To investigate the prognostic value of neuroelectromyography in peripheral facial paralysis and its correlation with House-Brackman classification.Methods:Seventy-eight patients with peripheral facial paralysis who received treatment in Yiwu Central Hospital, China between January 2016 and January 2019 were included in this study. All patients underwent neuroelectromyography. Bilateral nerve conduction velocity, latency, amplitude, and the needle electrode electrogram of orbicularis oris muscles, rbicularis oculi muscles and frontal muscles were analyzed and recorded. After 3 months of treatment, the correlation between prognosis and House-Brackman classification was analyzed.Results:Electromyography examination of 78 patients revealed among 68 patients presenting with prolonged latency, the latency on the affected side was significantly longer than that on the healthy side [(3.78 ± 0.33) ms vs. (2.89 ± 0.35) ms], t = 15.256, P < 0.001]. Among 73 patients presenting with decreased M amplitude, M amplitude on the affected side was significantly lower than that on the healthy side [(0.60 ± 0.27) mV vs. (1.83 ± 0.29) mV, t = 26.522, P < 0.001]. Among 78 patients, normal electromyography findings were observed in 2 patients and abnormal findings in 76 patients, with an abnormal rate of 97.44%. Among 78 patients, 46 patients presented with fibrillation potentials and positive sharp waves in the resting state, 40 patients presented with long duration and multiphase wave percentage of motor unit action potential in mild contraction, and 52 patients presented with abnormal recruitment potential in severe contraction. Three months of follow-up revealed that 23 out of 25 patients with mild peripheral facial paralysis had a complete recovery, with the cure rate of 92.00% (23/25), 28 out of 36 patients with moderate peripheral facial paralysis had a complete recovery, with the cure rate of 77.78% (28/36), 7 out of 10 patients with mild and moderate peripheral facial paralysis had a complete recovery, with the cure rate of 70.00% (7/10), and 3 out of 5 patients with severe peripheral facial paralysis had a complete recovery, with the cure rate of 60.00% (3/5). Conclusion:Neuroelectromyography can improve the accuracy in the identification of injury degree of peripheral facial paralysis and has a strong correlation with House-Brackman classification. Therefore, neuroelectromyography can provide a reference for diagnosis and treatment of peripheral facial paralysis.

Trauma do nervo facial e terapias de tratamento / Facial nerve trauma and treatment therapies

Os traumatismos bucomaxilofaciais, associados com as fraturas do osso temporal e lacerações na face, muitas vezes acabam causando algumas lesões em nervos periféricos, em específico, o nervo facial. Quando lesionado, o VII par craniano pode comprometer profundamente a vida dos pacientes, tanto com alterações fisiológicas significativas, quanto alterações psicológicas. O tratamento dessas lesões, geralmente é cirúrgico; no entanto, os resultados muitas vezes ainda são insatisfatórios. Com o intuito de aprimorar as técnicas cirúrgicas no tratamento das lesões aos nervos periféricos, muitos estudos têm sidos realizados pela engenharia de tecidos com o objetivo de desenvolver biomateriais associados com fatores neuroindutores, principalmente nas lesões nervosas em que há perda de substância. O estudo desses biomateriais parece ser bastante promissor, tornando-se uma fonte viável em substituição ao enxerto autólogo, que; embora seja o "padrão ouro", ainda apresenta limitações. Sendo assim, esse artigo consiste de uma revisão de literatura livre, pelo pubmed, sobre trauma de nervo facial e alternativas de tratamento.

Buccomaxillofacial trauma, associated with temporal bone fractures and lacerations on the face, often end up causing some lesions on peripheral nerves, specifically the facial nerve. When injured, the VII cranial torque can profoundly compromise patients' lives, both with significant physiological changes and psychological changes. The treatment of these lesions is usually surgical; However, the results are often still unsatisfactory. In order to improve surgical techniques in the treatment of peripheral nerve injuries, many studies have been carried out by tissue engineering in order to develop biomaterials associated with neuroindustrial factors, especially in nerve lesions in which there is loss of substance. The study of these biomaterials seems to be quite promising, becoming a viable source in replacement of the autologous graft, which; Although it is the "gold standard", still has limitations. Thus, this article consists of a review of free literature, by pubmed, on facial nerve trauma and treatment alternatives.

Neuromonitorización intraoperatoria del nervio facial: a propósito de un caso / Intraoperative neuromonitoring of the facial nerve: a case report

Introdução: A preservação do nervo facial (NF) é uma das principais preocupações do cirurgião durante o tratamento aberto das fraturas mandibulares, uma vez que uma lesão nessa estrutura anatômica pode causar sequelas estéticas e funcionais permanentes. A existência de variações anatômicas (anastomoses e ramificações incomuns) aumenta o risco de danos no NF, mesmo nas mãos de cirurgiões experientes. O neuromonitoramento intraoperatório tem-se mostrado um grande aliado para evitar lesões nos ramos nervosos que podem estar envolvidos na área cirúrgica. Considerando a escassez desse assunto na literatura referente à cirurgia maxilo-facial, objetivamos demonstrar o uso da técnica de neuromonitoração do NF durante o acesso submandibular para o tratamento da fratura bilateral do ângulo mandibular. Relato de caso: No presente relato de caso, as abordagens cirúrgicas de ambos os lados não apresentaram danos permanentes ao NF. Esse resultado assim como a literatura sugerem que o neuromonitoramento intraoperatório proporciona maior segurança durante a realização de abordagens cirúrgicas, nas quais os ramos do nervo facial estão envolvidos, reduzindo, assim, o risco de sequelas nervosas. Considerações Finais: Esse recurso pode ser de grande auxílio no treinamento hospitalar ao longo do processo de formação de cirurgiões bucomaxilofaciais... (AU)

Introduction: Facial nerve (FN) preservation is one of the surgeon's major concerns during the open treatment of mandibular fractures since an injury to this anatomical structure can cause permanent aesthetic and functional sequelae. The existence of anatomical variations (anastomosis and unusual branching) increases the risk of FN damage even in the hands of experienced surgeons. Intraoperative neuromonitoring has proven to be a great ally to avoid injury to the nerve branches that may be involved in the surgical area. Considering the scarcity of this subject in the maxillofacial surgery literature, we aimed to demonstrate the use of the FN neuromonitoring technique during the submandibular approach for the treatment of bilateral mandibular angle fracture. Case report: In the present case report, the surgical approaches of both sides presented no permanent damage to the FN. Results: This result, as well as previous literature, suggests that intraoperative neuromonitoring provides greater safety during the performance of surgical approaches in which the facial nerve branches are involved and thus, reduces the risk of nerve sequelae. Final considerations: This resource can be of special assistance in teaching hospitals throughout the training process of maxillofacial surgeons... (AU)

Analysis on clinical effect of supratemporalis approach scalp coronal incision for treating craniomaxillofacial fracture / 重庆医学

Objective To investigate the effect of supratemporalis approach scalp coronal incision for treating craniomaxillofacial fracture.Methods Fifty-two cases of traditional coronal scalp approach were retrospectively analyzed for understanding the facial nerve damage situation.Then 30 cases a.dopted the supratemporalis approach scalp coronal incision and the facial nerve damage situation was recorded.The follow-up observation lasted for 6-24 months.Results The facial contour,mouth opening and occlusion function recovered well after the operation in all 82 cases.Eight cases of temporary facial nerve injury were observed in the traditional approach group.No case of facial nerve injury occurred in the supratemporalis approach group(P＜0.05).Conclusion The supratemporalis approach scalp coronal incision can effectively avoid the facial nerve injuries.

Response of NG2 positive cells and other glial cells in the microenvironment of facial nucleus after facial nerve axotomy / 解放军医学杂志

Objective To study the response of NG2 positive and other glial cells in the facial nucleus after facial nerve axotomy,and explore the changes of the microenvironment in the facial nucleus.Methods Rat facial nerve axotomy models were established.Immunofluorescence double staining,and immunohistochemical staining combined with cresyl violet staining were used to observe the response of NG2 cells and other glial cells,and Western blotting was performed to test NG2 protein expression in facial nucleus at postoperative 1,2,7,14,and 28 days.Results Microglia formed dense circles closely around the injured neurons.Astrocytes formed wreath-like structure near the injured neurons.NG2 protein in the injured nucleus has a regular timephase change and NG2 positive cells showed an extensive detachment of synaptic terminals on the damaged neurons after facial nerve axotomy.NG2 cell response was almost the same as microglia.Conclusions All kinds of glial cells may be involved in the formation of glial scar.NG2 positive cells could insulate the damaged neurons against the potential damage from the excitatory input.

The Effect of Insulin Like Growth Factor-1 on Recovery of Facial Nerve Crush Injury

OBJECTIVES: The aim of this study is to investigate the efficacy of locally applied insulin-like growth factor 1 (IGF-1) on the recovery of facial nerve functions after crush injury in a rabbit model. METHODS: The rabbits were randomly assigned into three groups. Group 1 consisted of the rabbits with crush injury alone; group 2, the animals applied saline solution onto the crushed facial nerve and group 3, IGF-1 implemented to the nerve in the same manner. Facial nerve injury was first electrophysiologically studied on 10th and 42nd days of the procedure. The damage to the facial nerves was then investigated histopathologically, after sacrification of the animals. RESULTS: In the electrophysiological study, compound muscle action potential amplitudes of the crushed nerves in the second group were decreased. In pathological specimens of the first and second groups, the orders of axons were distorted; demyelination and proliferation of Schwann cells were observed. However, in IGF-1 treated group axonal order and myelin were preserved, and Schwann cell proliferation was close to normal (P < 0.05). CONCLUSION: Local application of IGF-1 in a slow releasing gel was found efficacious in the recovery of the facial nerve crush injury in rabbits. IGF-1 was considered worthy of being tried in clinical studies in facial nerve injury cases.

Anatomic study of the distance between the lower margin of the mandible and the marginal mandibular branch of the facial nerve: a systematic review / Estudio anatómico de la distancia entre el margen mandibular y la rama marginal mandibular del nervio facial: una revisión sistemática

The marginal mandibular branch of the facial nerve (MMB) has a significant variation in relation to the lower border of the mandible (LBM). That is why it is important to know its topographical description to prevent damage in submandibular surgical procedures. The objective of this study was to determine the distance between the MMB and LBM based on descriptive studies carried out on human corpses and surgical patients. A systematic review of literature in MEDLINE, "Science Citation Index Expanded" of Web of Science (ISI) databases and manual search was performed. The articles with number of samples greater than or equal to 10 facial samples and recording of measurements between the MMB and the LBM or Gonion were selected. From the selected articles, the authors registered year of publication, country of origin, number of samples, sample type (fresh, embalmed body/fixed cadavers or surgical patient), distribution percentage of the MMB in relation to LBM, average and maximum distance between MMB and LBM or Gonion. The results were presented in tables with descriptive statistic. Seventeen articles describing measurements of the distance between MMB and the lower border of the mandible carried out in cadavers and patients were selected. In these articles a total of 1,408 samples were dissected. The maximum distance observed was 4.01 cm (mean±SD 1.64±0.92 cm, Min= 0.69; Max= 4.01). Several reports suggest that an incision 2 cm below the lower border of the mandible would be enough to avoid damage of the MMB. However, according to the maximal distances registered, such an incision might involve risk for the MMB. For this reason, we propose that the MMB of facial nerve should be at least 4 cm below the lower border of the mandible.

La rama mandibular marginal del nervio facial (RMM) posee variaciones significativas en su relación con el margen inferior de la mandíbula (MIM), siendo importante su descripción topográfica para evitar su daño en procedimientos quirúrgicos submandibulares. El objetivo fue determinar la distancia RMM y MIM observadas en humanos. Se realizó una revisión sistemática de la literatura en las bases de datos MEDLINE, "Science Citation Index Expanded" de Web of Science (ISI) y una búsqueda manual. Se seleccionaron artículos con análisis de 10 o más muestras y que registraran la distancia entre el RMM y el MIM o Gonion. Se registró autor, países de origen, condición de la muestra, número de muestras, distancias promedio y máximas registradas. Los resultados se analizaron mediante estadística descriptiva y presentada en tablas. Se seleccionaron 17 artículos con mediciones de las distancias entre el RMM y MIM tanto en cadáveres como pacientes. En total, 1,408 muestras fueron disecadas. La distancia máxima registrada fue de 4.01 cm (promedio±DE 1.64±0.92 cm, Min= 0,69; Max= 4,01). Diversos reportes sugieren que una incisión a 2 cm bajo el margen inferior de la mandíbula sería suficiente para evitar el daño al RMM. Sin embargo, con las distancias máximas observadas dicha incisión podría generar un daño. Por lo tanto, esta revisión sugiere la presencia del RMM a lo menos a 4 cm bajo el margen inferior de la mandíbula.

Clinical Application of Fat Tissue Wraparound Splint after Facial Nerve Repair

Facial deformity after nerve injury changes ones' social life. We experienced a few patients with healthy early recovery of muscle contraction after the operation with soft tissue wraparound splint. Under general anesthesia, exploration to find as many injured nerve stumps with x 2.5 loopes was undertaken at first. Interfascicular repair was done with minimal tension by 10-0 nylon under a microscope, and the suture site was sealed by approximating the surrounding fat flaps. This conjoined adipose tissue flap was a splint as a wraparound environment to reduce the tension in the coaptation site, and to increase the relative concentration of releasing neurotrophic factors by surrounding it. A 45-year-old man fell down in a drunken state and had deep laceration by broken flowerpot fragments with facial muscle weakness on the right cheek. His injured mandibular branches of the facial nerve were found. A 31-year-old female suffered from motionlessnesss of frontalis muscle after a traffic accident. She had four frontal branches injured. The man had his cheek with motion after seven days, and the woman two months after the operation. The nerve conduction test of the woman showed normalized values. Facial nerve repair surrounded by adipose tissue wraparound splint can make the recovery time relatively short.

Paralisia facial: análise epidemiológica em hospital de reabilitação / Facial paralysis: epidemiological analysis in a rehabilitation hospital

INTRODUÇÃO: A paralisia facial é a perda temporária ou permanente dos movimentos da mímica facial em decorrência do acometimento do nervo facial. São vários os fatores que influenciam a evolução das lesões do nervo facial. Este estudo teve como objetivo avaliar os aspectos epidemiológicos e a frequência de sequelas após paralisia facial em um serviço de reabilitação. MÉTODO: Estudo retrospectivo dos pacientes com paralisia facial atendidos em hospital de reabilitação no período de janeiro de 2001 a janeiro de 2005. As sequelas foram avaliadas quanto a sexo, idade, etiologia, graduação funcional conforme a escala de House-Brackmann, tempo de evolução, seguimento e intervenções cirúrgicas. Para realização da análise estatística utilizou-se o programa Epi-Info versão 3.2.2. RESULTADOS: Foram admitidos para programa de reabilitação 285 pacientes portadores de paralisia facial, sendo 157 do sexo masculino e 128 do feminino. Todos os pacientes se submeteram a programa de reabilitação e 29 (10,2 por cento), a cirurgia. Dentre os pacientes analisados, 80 por cento foram admitidos a partir da terceira semana do surgimento da paralisia, e 121 (42,5 por cento) tiveram recuperação gradual em 3 meses, espontaneamente, com tratamento clínico ou fisioterápico. Por outro lado, 119 (41,8 por cento) pacientes permaneceram com paralisia facial parcial ou completa e irreversível. CONCLUSÕES: Os casos admitidos foram mais frequentes em pacientes com menos de 20 anos de idade, com causas diversas e quando admitidos em graus menores segundo a escala de House-Brackmann, pois muitos deles se associavam a déficits neurológicos consequentes a paralisia facial de origem central ou congênita.

BACKGROUND: Facial paralysis is characterized by permanent or temporary loss of facial expression due to facial nerve injury. Several factors influence the development of facial nerve lesions. The purpose of this study was to evaluate the epidemiological aspects and incidence of sequelae after facial paralysis at a rehabilitation institution. METHODS: We performed a retrospective study of facial paralysis patients admitted to a rehabilitation hospital between January 2001 and January 2005. Sequelae were analyzed according to gender, age, etiology, functional status as measured by the House-Brackmann scale, evaluation time, follow-up, and surgical procedures. Statistical analyses were performed with Epi-info 3.2.2 software. RESULTS: A total of 285 facial paralysis patients, 157 male and 128 female, were admitted for a rehabilitation program. All subjects followed a rehabilitation program, and 29 (10.2 percent) underwent surgery; 80 percent were admitted during the 3rd week of the paralysis or later, and 121 (42.5 percent) showed gradual recovery after 3 months, either spontaneously or after clinical or physical therapies. Nevertheless, 119 (41.8 percent) sustained irreversible partial or complete facial paralysis. CONCLUSIONS: The prevalence of facial paralysis was greater among patients younger than 20 years. Among these patients, paralysis had different causes, and these patients were admitted with lower House-Brackmann grades. Most cases were associated with neurological deficits leading to facial paralysis of central or congenital origin.

Ciliary neurotrophic factor in the regeneration of facial nerve / 中国耳鼻咽喉头颈外科

OBJECTIVE To study the role of ciliary neurotrophic factor(CNTF) in the generation of facial nerve.METHODS Twenty adult New Zealand rabbits' bilateral super buccals of facial nerves were transected and connected with silicone tube.CNTF was injected into a random side of silicone tube and normal saline in the other.At four and eight weeks after the operation, both the CNTF group and the SAL group underwent electrophysiology test and histopathology as well as quantity analysis.RESULTS Four weeks later, both CNTF and SAL group failed in eliciting muscular excitement upon stimulation; T-test showed a signifi-cant difference(P

Evaluation of facial nerve decompression for Bell’s palsy / 中国耳鼻咽喉头颈外科

OBJECTIVE To evaluate facial nerve decompression for Bell’s paralysis. METHODS The reports of facial nerve decompression for Bell’s paralysis were searched in PubMed and CHKD(China hospital knowledge database). Then an include criteria was made, and all the cases included were analyzed all together. The efficiency of different kinds of decompressions and time was discussed, while the steroid therapy was used as the control. RESULTS Five articles were include after search, in these reports there were 147 patients treated by surgery and 105 patients by steroid. The general rate of complete facial nerve recovery by decompression was 57.10 %, and 48.90 % by steroid therapy. The rate of complete recovery of facial nerve was 90.70 % if all segment decompression was done within 14 days after facial nerve paralysis, and it will decrease to 25.00 % if the surgery was done during 15 to 30 days after facial nerve paralysis. If the decompression was done during 15-30 days after facial nerve paralysis, the general recovery rate of mastoid and horizontal segment decompression was 45.70 %, but the all segments decompression was 25.00%. CONCLUSION Facial nerve decompression should be done within 14 days after facial nerve paralysis, the surgery done after 14 days will not improve facial nerve recovery. Till now there are no evidence can prove that all segment decompression be better than mastoid and horizontal segment decompression for Bell's palsy.

Facial nerve injury in the surgical management of benign parotid tumor / 中国耳鼻咽喉头颈外科

OBJECTIVE To observe the incidence of facial nerve injury and its relationship to the types of operation. METHODS The clinical data of 116 patients who underwent parotid surgery from 1999 to 2006 were analyzed retrospectively. RESULTS The facial injury rate in total parotidectomy(66.7 %) was significantly higher than that in superfacial parotidectomy(39.2 %) and partial parotidectomy(12.5 %). The facial nerve injury rate in the mandibular branch(31.9 %) was higher than that in the buccal branch(9.2 %) and the zygomaticofacial branch(2.9 %). CONCLUSION The injury of facial nerve branches was correlated with the surgical managements. A proper surgical managements and operative extent would reduce the incidence of facial nerve injury and decrease the complications of the operation.

Recurrence and Facial Nerve Function in Relation to the Extent of Resection of Vestibular Schwannoma Surgery

OBJECTIVE: The aims of the surgical treatment of vestibular schwannoma are complete removal with preserving facial nerve function. Complete removal, however, carries significant risk of facial nerve palsy. Alternatively with subtotal removal of tumor, recurrence rate was known to be high. The objective of this study was to assess the risk of tumor recurrence and postoperative facial nerve function in relation to the extent of surgical resection. METHODS: From 1990 to 1999, 125 cases of vestibular schwannoma were retrospectively reviewed. The degree of resection was classified as gross total resection (GTR), near total resection (NTR), Subtotal resection (STR). The tumor recurrence or re-growth was determined by the increase in its greatest dimension on follow-up imaging studies. Facial nerve function was graded with the modified House-Brackmann Grade postoperatively. For clinical comparison, these were grouped into the categories: good ; grade 1-2, intermediate or poor; 3-6. RESULTS: Of the 125 patients, 28(22%) underwent GTR, 37(30%) had NTR, and 60(48%) had STR. The recurrence rate were 3.5% (1 of 28), 7.8% (3 of 37) and 28% (16 of 60) for GTR, NTR and STR. GTR and NTR showed no statistical difference in recurrence rate (P=0.628). However NTR had less recurrence rate than STR (P=0.034). The postoperative good facial nerve function achieved in 22% of GTR, 53% of NTR and 53% of STR. NTR had lower risk of facial nerve palsy than GTR(P=0.028). CONCLUSION: In treating vestibular schwannoma, NTR had higher facial nerve sparing rate than GTR without significantly increasing the recurrence rate. NTR is a good surgical strategy.

Repair of facial nerve defects with acellular nerve allograft in rats / 中华创伤杂志

0.05). Conclusion Acellular nerve allograft may be a substitute to autograft repairing facial nerve defects.

Evaluation of diagnostic sensitivity of electroneurography for facial neurotmesis / 北京大学学报(医学版)

Objective:To evaluate diagnostic sensitivity of electroneurography(ENoG) for facial neurotmesis.Methods:The data of 24 patients suffering from facial neuratmesis on one side,having non-emergency operation,and having preoperative records of ENoG were collected.Among the patients,18 were men and 6 were women,aged from 3 to 55 years(median 28).The duration of injury before ENoG examination was from 1 to 56 days(mean 23.6 days) for them.The electroneurographic examination was carried out for facial nerves on both sides preoperatively.Percentages of evoked potential amplitude reduction on affected sides were calculated according to the value of normal side.The 90% reduction of amplitude was used as a cutting point.The facial neuratmesis was observed during operation.The sensitivity and false negative proportions of ENoG were analyzed.Results:Among the 24 patients with facial neurotmesis,22 had ENoG amplitude reduction over 90%,and 2 having this reduction less than 90%.The sensitivity and false negative proportions of ENoG in patients with facial neurotmesis were 91.7% and 8.3% respectively.Conclusion:The preoperative ENoG examination is high sensitivity for facial neurotmesis.The patients whose ENoG reduction over 90% should be advised to have a facial neurorrhaphy as soon as possible.

THE PATHOLOGY OF DOGS′ FACIAL NERVE AFTER SIMULATED EXPLOSIVE WOUND OF MAXILLOFACIAL REGION / 解放军医学杂志

To observe the injury process and pathological changes of the facial nerve,a primer was detonated at a distance of 10 cm from the face of each of 36 anesthelized dogs to simulate blast injury of the maxillofacial region. At the same time, a tangential wound of masseter was produced by a steel pellet fired with a musket to simulate a shrapnel injury. At different time points after injury, the action potential of the facial nerves was checke d and the pathological changes in axons and neurons of facial nerves were observed after HE and Nissle′s staining,respectively.One day after the injury,the facial nerve axons were found to be disrupted extensively,although the epineurium was still in continuity. There were degeneration and necrosis of neurons with infiltration of inflammatory cells in the facial nerve.One week later, the inflammation began to become milder, and the necrotic neurons were gradually absorbed. Four weeks later, the survived neurons appeared normal, and axons began to regenerate. Meanwhile, electromyography (EMG) showed that the action potential of facial nerve recovered. All the observations suggested that severe indirect injury to the facial nerve trunks in an explosive injury was the main pathological changes which involved an extensive area with severe damage in neurons.

The enlargement of geniculate fossa of facial nerve canal:a new CT finding of facial nerve canal fracture / 中华放射学杂志

Objective To discuss the value of enlargement of geniculate fossa of facial nerve canal in the diagnosis of facial nerve canal fracture.Methods Thirty patients with facial nerve canal fracture underwent axial and coronal CT scan.The correlation between the fracture and the enlargement of geniculate fossa of facial nerve canal was analyzed.The ability of showing the fracture and enlargement of geniculate fossa of facial nerve canal in axial and coronal imaging were compared.Results Fracture of geniculate fossa of facial nerve canal was found in the operation in 30 patients,while the fracture was detected in CT in 18 patients.Enlargement of geniculate ganglion of facial nerve was detected in 30 patients in the operation,while the enlargement of fossa was found in CT in 28 cases.Enlargement and fracture of geniculate fossa of facial nerve canal were both detected in CT images in 18 patients.Only the enlargement of geniculate fossa of facial nerve canal was shown in 12 patients in CT.Conclusion Enlargement of geniculate fossa of facial nerve canal was a useful finding in the diagnosis of fracture of geniculate fossa in patients with facial paralysis,even no fracture line was shown on CT images.