scholarly journals 4362 The Utilization of Polyethylene Glycol Fusion to Improve Facial Reanimation

2020 ◽  
Vol 4 (s1) ◽  
pp. 103-103
Author(s):  
Marissa Suchyta ◽  
Si-Gyun Roh ◽  
Diya Sabbagh ◽  
Mohammed Morsy ◽  
Huan Wang ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Polyethylene Glycol ◽  
Facial Nerve ◽  
Nerve Regeneration ◽  
Facial Paralysis ◽  
Fusion Technology ◽  
Axonal Diameter ◽  
Facial Nerves ◽  
Facial Reanimation ◽  
Study Population

OBJECTIVES/GOALS: This study’s goal is to determine whether intraoperative treatment of facial nerves with polyethylene glycol (PEG) fusion technology improves facial paralysis outcomes. Improved facial nerve regeneration in facial paralysis patients would lead to improved recovery time and effectiveness. METHODS/STUDY POPULATION: 30 rats were utilized; 15 underwent facial nerve regeneration without PEG fusion, and 15 with PEG fusion. Facial paralysis was initiated on the left by transection of the buccal and marginal mandibular branches of facial nerve. The buccal branch was repaired though microsuture technique. Neurorrhaphy sites of rats in the PEG group were exposed to calcium free saline, methylene blue, and polyethylene glycol. Nerve continuity was assessed post-operative in 5 animals in each group through electron microscopy. Functionality was assessed in the other 10 per group by EMG and whisker analysis after surgery, and weekly for 8 weeks. At 8 weeks, nerves and distal muscles were histologically analyzed. RESULTS/ANTICIPATED RESULTS: PEG fusion technology immediately restored axonal continuity following surgery, demonstrated by electron microscopy. Electrophysiology was also similarly restored across the site immediately, determined through intraoperative nerve stimulation, in the PEG fusion group. The nonintervention group showed dramatically reduced functional recovery than the PEG fusion group following surgery, shown by lower whisking activity and poor electrophysiology outcomes. Furthermore, the PEG fusion group showed statistically significant higher fascicle counts, myelination diameter, axonal diameter, and distal muscle fibers histologically. DISCUSSION/SIGNIFICANCE OF IMPACT: This study demonstrates that polyethylene fusion technology may improve facial reanimation outcomes. PEG is already a FDA-approved drug, and thus the pathway to translational clinical application of this work may thus be streamlined, bringing new options to patients with facial paralysis.

scholarly journals Rehabilitation of a Patient with Bell’s Palsy

2021 ◽  
Vol 10 (20) ◽  
pp. 1551-1554
Author(s):  
Vrushali K. Athawale ◽  
Dushyant P. Bawiskar ◽  
Pratik Arun Phansopkar
Keyword(s):  
Herpes Simplex ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Bell’S Palsy ◽  
Pharmacological Therapy ◽  
Bell's Palsy ◽  
Facial Reanimation ◽  
Simplex Virus

Facial nerve palsy is the disease of cranial nerve. From the total number of cases, 60 to 75 % of Bell's palsy cases are idiopathic form of facial palsy. Facial nerve palsy results in weakness of facial muscles, atrophy, asymmetry of face and also disturbs the quality of life. Bell’s palsy occurs in every class of population affecting people of all the age groups but the most common age group affected is 15 - 50 years with equal sex prediliction accounting 11 - 40 cases per 100,000. If facial palsy is not treated properly then it may result in variety of complications like motor synkinesis, dysarthria, contractures of facial muscles, and crocodile tear. Currently facial paralysis treatment consists of combination of pharmacological therapy, facial neuromuscular re-entrainment physiotherapy or surgical intervention by static and dynamic facial reanimation techniques. Physiotherapy treatment is effective for treating facial paralysis with minimal complications and can be individualized. Bell's palsy is the idiopathic form of facial nerve palsy which accounts for 60 to 75 % of cases and male to female ratio is 1:3.1 The aetiology of facial paralysis is not yet thoroughly understood. Cases of varicella-zoster, mononucleosis, herpes simplex virus, mumps and measles have demonstrated good serology in several reports for their association but still stands unclear. 2 Peripheral facial nerve palsy may be idiopathic (primary cause) or Bell’s palsy (secondary). Causes of the secondary unilateral facial nerve palsy are diabetes, stroke, Hansen's disease, herpes simplex infection, birth injury, trauma, tumour, Guillain-Barre syndrome, and immune system disorders. Causes of the bilateral facial nerve palsy are leukemia, brainstem encephalitis, leprosy, and meningitis. The most prominent current theories of facial nerve paralysis pathophysiology include the reactivation of herpes simplex virus infection (HSV type 1). Current facial paralysis treatment consists of a combination of pharmacological therapy, facial neuromuscular re-entrainment physiotherapy or surgical intervention by dynamic and static facial reanimation techniques.7 This is a diagnosed case of right facial nerve palsy which was treated under physiotherapy department with proper rehabilitation protocol.

Role of Herpes Simplex Virus Infection in the Pathogenesis of Facial Paralysis in Mice

1996 ◽  
Vol 105 (1) ◽  
pp. 49-53 ◽  
Author(s):  
Shingo Murakami ◽  
Naohito Hato ◽  
Takashi Doi ◽  
Mutsuhiko Mizobuchi ◽  
Naoaki Yanagihara
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Facial Nerve ◽  
Brain Stem ◽  
Facial Paralysis ◽  
Antibody Titer ◽  
Model Following ◽  
Facial Nerves ◽  
Simplex Virus ◽  
Neutralization Antibody Titer

To clarify the role and site of herpes simplex virus (HSV) infection in the pathogenesis of facial paralysis, we examined the viral genome by the polymerase chain reaction and the neutralization antibody titer using microplates in an animal model. Following inoculation with HSV type 1 of the KOS strain into mouse auricles, HSV DNA appeared in the ipsilateral facial nerve on the 3rd day, and in bilateral facial nerves and the brain stem on the 10th day only in animals with facial paralysis. In animals without facial paralysis, no HSV DNA was detected in these tissues. The neutralization antibody titer was elevated between 4 and 20 days in all animals, with or without facial paralysis. Facial paralysis developed only on the inoculated side, even though HSV DNA was also present in the contralateral facial nerve. We conclude that HSV infection in the facial nerve and brain stem is prerequisite for facial paralysis, and suggest that an immunologic reaction following viral infection plays a key role in the pathogenesis.

Using the Post-Descendens Hypoglossal Nerve in Hypoglossal-Facial Anastomosis: An Anatomic and Histologic Feasibility Study

2020 ◽  
Vol 19 (4) ◽  
pp. 436-443
Author(s):  
Ali Tayebi Meybodi ◽  
Leandro Borba Moreira ◽  
Xiaochun Zhao ◽  
Evgenii Belykh ◽  
Michael T Lawton ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Anatomic Study ◽  
Nerve Stump ◽  
Cross Sectional ◽  
Facial Nerves ◽  
Facial Reanimation ◽  
Structural Compatibility

Abstract BACKGROUND Hypoglossal-facial anastomosis (HFA) is a popular facial reanimation technique. Mobilizing the intratemporal segment of the facial nerve and using the post-descendens hypoglossal nerve (ie, the segment distal to the take-off of descendens hypoglossi) have been proposed to improve results. However, no anatomic study has verified the feasibility of this technique. OBJECTIVE To assess the anatomic feasibility of HFA and the structural compatibility between the 2 nerves when the intratemporal facial and post-descendens hypoglossal nerves are used. METHODS The facial and hypoglossal nerves were exposed bilaterally in 10 sides of 5 cadaveric heads. The feasibility of a side-to-end (ie, partial end-to-end) HFA with partial sectioning of the post-descendens hypoglossal nerve and the mobilized intratemporal facial nerve was assessed. The axonal count and cross-sectional area of the facial and hypoglossal nerves at the point of anastomosis were assessed. RESULTS The HFA was feasible in all specimens with a mean (standard deviation) 9.3 (5.5) mm of extra length on the facial nerve. The axonal counts and cross-sectional areas of the hypoglossal and facial nerves matched well. Considering the reduction in the facial nerve cross-sectional area after paralysis, the post-descendens hypoglossal nerve can provide adequate axonal count and area to accommodate the facial nerve stump. CONCLUSION Using the post-descendens hypoglossal nerve for side-to-end anastomosis with the mobilized intratemporal facial nerve is anatomically feasible and provides adequate axonal count for facial reanimation. When compared with use of the pre-descendens hypoglossal nerve, this technique preserves C1 fibers and has a potential to reduce glottic complications.

Interposition Grafting of the Facial Nerve After Resection of a Large Facial Nerve Schwannoma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Walid Ibn Essayed ◽  
Emad Aboud ◽  
Ossama Al-Mefty
Keyword(s):  
Facial Nerve ◽  
Hypoglossal Nerve ◽  
Nerve Function ◽  
Nerve Paralysis ◽  
Carotid Canal ◽  
Great Auricular Nerve ◽  
Facial Nerves ◽  
Facial Reanimation ◽  
Graft Donor ◽  
Facial Nerve Schwannoma

Abstract Facial nerve schwannomas can develop at any portion of the facial nerve.1 When arising from the mastoid portion of the facial nerve, the tumor will progressively erode the mastoid, giving the schwannoma an aggressive radiological appearance.1,2 The facial nerve is frequently already paralyzed, or no fascicles can be saved during resection. In these cases, end-to-end interposition grafting is the best option for facial reanimation.1,3-5 The healthy proximal and distal facial nerves are prepared prior to grafting. The great auricular nerve is readily available near the surgical site and represents an excellent graft donor with minimal associated morbidity.4,6 We demonstrate this technique through a case of a 48-yr-old male who presented with a complete right-sided facial nerve palsy due to a large facial schwannoma that invaded the mastoid and extended to the hypoglossal canal, causing hypoglossal nerve paralysis, and petrous carotid canal. His 4-yr follow-up showed no recurrent tumor with restored facial nerve function palsy to a House-Brackman grade III, and full recovery of his hypoglossal nerve function. The patient consented to the surgery and the publication of his image.

Role of post-operative electroneuronography in predicting facial nerve recovery after acoustic neuroma removal: a pilot study

1989 ◽  
Vol 103 (1) ◽  
pp. 60-62 ◽  
Author(s):  
G. R. Croxson ◽  
D. A. Moffat ◽  
D. G. Hardy ◽  
D. M. Baguley
Keyword(s):  
Pilot Study ◽  
Facial Nerve ◽  
Facial Paralysis ◽  
Acoustic Neuroma ◽  
Rapid Improvement ◽  
Recovery Profile ◽  
Facial Nerves ◽  
Nerve Recovery ◽  
Initial Recovery

AbstractComplete clinical facial paralysis immediately after acoustic neuroma removal occurs in between 40 to 90 per cent of patients despite the fact that the facial nerve has been preserved anatomically. Some of these patients improve rapidly with adequate cosmetic and functional recovery. Others however, have incomplete or no return of useful function.A pilot study to assess the prognostic value of electroneuronography (ENOG) in 14 patients following acoustic neuroma removal was performed. The results suggest that post operative ENOG is of value in dividing those patients with anatomically intact facial nerves yet complete clinical paralysis post-operatively into groups: one with rapid improvement to an acceptable functional and cosmetic result and one with prolonged paralysis with incomplete or no recovery. Electroneuronography may thus be used to predict the initial recovery profile in patients with complete facial paralysis after surgery.

scholarly journals Hypoglossal-facial nerve side-to-end anastomosis for preservation of hypoglossal function: results of delayed treatment with a new technique

1996 ◽  
Vol 1 (2) ◽  
pp. E8 ◽  
Author(s):  
Yutaka Sawamura ◽  
Hiroshi Abe
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Hypoglossal Nerve ◽  
Mastoid Process ◽  
Mastoid Cavity ◽  
Distal Stump ◽  
Delayed Treatment ◽  
Stylomastoid Foramen ◽  
Facial Reanimation ◽  
Nerve Anastomosis

This report describes a new surgical technique to improve the results of conventional hypoglossal-facial nerve anastomosis that does not necessitate the use of nerve grafts or hemihypoglossal nerve splitting. Using this technique, the mastoid process is partially resected to open the stylomastoid foramen and the descending portion of the facial nerve in the mastoid cavity is exposed by drilling to the level of the external genu and then sectioning its most proximal portion. The hypoglossal nerve beneath the internal jugular vein is exposed at the level of the axis and dissected as proximally as possible. One-half of the hypoglossal nerve is transected: use of less than one-half of the hypoglossal nerve is adequate for approximation to the distal stump of the atrophic facial nerve. The nerve endings, the proximally cut end of the hypoglossal nerve, and the distal stump of the facial nerve are approximated and anastomosed without tension. This technique was used in four patients with long-standing facial paralysis (greater than 24 months), and it provided satisfactory facial reanimation, with no evidence of hemitongue atrophy or dysfunction. Because it completely preserves glossal function, the hemihypoglossal-facial nerve anastomosis described here constitutes a successful approach in patients with long-standing facial paralysis who do not wish to have tongue function compromised.

Effect of Bumetanide on Facial Nerve Regeneration in Rat Model

2020 ◽  
pp. 019459982093767
Author(s):  
Ecem Sevim Longur ◽  
Özgür Yiğit ◽  
Çiğdem Kalaycık Ertugay ◽  
Ela Araz Server ◽  
Turgut Adatepe ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Nerve Regeneration ◽  
Facial Paralysis ◽  
Control Group ◽  
Treatment Groups ◽  
Group 4 ◽  
Nerve Recovery ◽  
Electron And Light Microscopy ◽  
Group 2 ◽  
Group 1

Objective We investigated the effects of bumetanide alone and in combination with dexamethasone on facial nerve regeneration in rats with facial paralysis. Study Design A prospective controlled animal study. Setting An animal laboratory. Subjects and Methods Facial paralysis was induced in 32 Wistar rats that we then divided into 4 groups: group 1, control; group 2, bumetanide; group 3, dexamethasone; group 4, bumetanide and dexamethasone. Electroneurography was performed 1, 2, and 4 weeks later, and nerve regeneration was evaluated by electron and light microscopy and Western blotting in week 4. Results Regarding the comparison between preoperative values and week 4, the latency difference in group 1 (1.25 milliseconds) was significantly higher than those of groups 2 to 4 (0.56, 0.34, and 0.10 milliseconds, respectively; P = .001). The latency increment in groups 2 and 3 was higher than that of group 4 ( P = .002 and P = .046) in week 4, whereas groups 2 and 3 did not differ significantly ( P = .291). Amplitude difference was not statistically significant from week 4 among all groups (all P > .05). The number of myelinated axons was significantly higher in all treatment groups than in the control group ( P = .001). Axon number and intensity were significantly higher in group 4 as compared with groups 2 and 3 ( P = .009, P = .005). Conclusion After primary neurorrhaphy, dexamethasone and bumetanide alone promoted nerve recovery based on electrophysiologic and histologic measures. Combination therapy was, however, superior.

scholarly journals Hypoglossal Facial Nerve Anastomosis for Post-Operative and Post-Traumatic Complete Facial Nerve Paralysis

2019 ◽  
Vol 7 (23) ◽  
pp. 3984-3996
Author(s):  
Amr Abdelmonam Abdelaziz M. Elkatatny ◽  
Hany Abdelrahim Abdelrazik Abdallah ◽  
Dina Ghoraba ◽  
Tarek Ahmed Amer ◽  
Tarek Hamdy
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Cerebellopontine Angle ◽  
Bone Fractures ◽  
Petrous Bone ◽  
Facial Nerve Paralysis ◽  
Nerve Paralysis ◽  
Facial Reanimation ◽  
Nerve Anastomosis ◽  
End To End

AIM: This study aims to evaluate the outcome of patients with complete facial paralysis following surgery to cerebellopontine angle tumours or following traumatic petrous bone fractures after reanimation by hypoglossal-facial anastomosis as regards clinical improvement of facial asymmetry and facial muscle contractility as well as complications associated with hypoglossal-facial reanimation procedure. METHODS: This thesis included a prospective study to be carried out on 15 patients with unilateral complete lower motor neuron facial paralysis (11 patients after cerebellopontine angle tumour resection and 4 patients after traumatic transverse petrous bone fracture) operated upon by end to end hypoglossal-facial nerve anastomosis in Cairo university hospitals in the period between June 2015 and January 2017. RESULTS: At one year follow up the improvement of facial nerve functions were as follows: Three cases (20%) had improved to House Hrackmann grade II, eleven cases (73.33%) had improved to grade III, and one patient (6.66%) had improved to House Brackmann grade IV. CONCLUSION: Despite the various techniques in facial reanimation following facial nerve paralysis, the end to end hypoglossal-facial nerve anastomosis remains the gold standard procedure with satisfying results in cases of the viable distal facial stump and non-atrophic muscles. Early hypoglossal-facial anastomotic repair after acute facial nerve injury is associated with better long-term facial function outcomes and should be considered in the management algorithm.

Hypoglossal-Facial Side-to-End Neurorrhaphy With Concomitant Masseteric-Zygomatic Nerve Branch Coaptation and Muscle Transfer for Facial Reanimation: Technique and Case Report

2020 ◽  
Vol 19 (3) ◽  
pp. E230-E235
Author(s):  
Nobutaka Yoshioka
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Mass Movement ◽  
Nerve Transfer ◽  
Nerve Graft ◽  
Gracilis Muscle ◽  
Muscle Transfer ◽  
Nerve Branch ◽  
Facial Reanimation ◽  
Healthy Side

Abstract BACKGROUND Hypoglossal-facial direct side-to-end neurorrhaphy has become widely used for facial reanimation in patients with irreversible facial nerve damage. Although this procedure achieves good restoration of facial function, it has disadvantages such as mass movement and lack of spontaneity. OBJECTIVE To present a new facial reanimation technique using hypoglossal-facial direct side-to-end neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and secondary muscle transfer to reduce mass movement and achieve a spontaneous smile in patients with facial paralysis. METHODS This article describes a novel facial reanimation technique that employs hypoglossal and masseteric nerve transfer combined with secondary vascularized functional gracilis muscle transfer. RESULTS Details of the technique are reported in a patient with complete facial paralysis after brain surgery. The hypoglossal nerve was partially served and connected to the mastoid segment of the facial nerve by side-to-end anastomosis to restore facial symmetry. A nerve supplying the masseter muscle was coapted with a zygomatic branch by end-to-end anastomosis to restore voluntary movement of the oral commissure, as well as to assist with eye closure. A cross face sural nerve graft was connected to zygomatic branches on the healthy side. In the second stage, a vascularized functional gracilis muscle graft was transplanted using the cross face nerve graft as the donor nerve to restore a natural smile. CONCLUSION Hypoglossal-facial neurorrhaphy with concomitant masseteric-zygomatic nerve branch coaptation and muscle transfer is an alternative facial reanimation technique that reduces mass movement and achieves a natural smile.

Hemihypoglossal nerve transfer for acute facial paralysis

2013 ◽  
Vol 118 (1) ◽  
pp. 160-166 ◽  
Author(s):  
Ayato Hayashi ◽  
Masanobu Nishida ◽  
Hisakazu Seno ◽  
Masahiro Inoue ◽  
Hiroshi Iwata ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Hypoglossal Nerve ◽  
Severe Infection ◽  
Nerve Transfer ◽  
Average Period ◽  
Success Rates ◽  
Functional Deficits ◽  
Facial Reanimation ◽  
Nerve Anastomosis

Object The authors have developed a technique for the treatment of facial paralysis that utilizes anastomosis of the split hypoglossal and facial nerve. Here, they document improvements in the procedure and experimental evidence supporting the approach. Methods They analyzed outcomes in 36 patients who underwent the procedure, all of whom had suffered from facial paralysis following the removal of large vestibular schwannomas. The average period of paralysis was 6.2 months. The authors used 5 different variations of a procedure for selecting the split nerve, including evaluation of the split nerve using recordings of evoked potentials in the tongue. Results Successful facial reanimation was achieved in 16 of 17 patients using the cephalad side of the split hypoglossal nerve and in 15 of 15 patients using the caudal side. The single unsuccessful case using the cephalad side of the split nerve resulted from severe infection of the cheek. Procedures using the ansa cervicalis branch yielded poor success rates (2 of 4 cases). Some tongue atrophy was observed in all variants of the procedure, with 17 cases of minimal atrophy and 14 cases of moderate atrophy. No procedure led to severe atrophy causing functional deficits of the tongue. Conclusions The split hypoglossal-facial nerve anastomosis procedure consistently leads to good facial reanimation, and the use of either half of the split hypoglossal nerve results in facial reanimation and moderate tongue atrophy.

Sign in / Sign up

Export Citation Format

Share Document