Background:Donor nerve selection is a crucial factor in determining clinical outcomes of facial reanimation.Although dual innervation approaches using two neurotizers have shown promise,there is a lack of evidence-bas...Background:Donor nerve selection is a crucial factor in determining clinical outcomes of facial reanimation.Although dual innervation approaches using two neurotizers have shown promise,there is a lack of evidence-based comparison in the literature.Furthermore,no animal model of dual reinnervation has yet been published.This study aimed to establish such a model and verify its technical and anatomical feasibility by performing dual-innervated reanimation approaches in Wistar rats.Methods:Fifteen Wistar rats were divided into four experimental groups and one control group.The sural nerve was exposed and used as a cross-face nerve graft(CFNG),which was then anastomosed to the contralateral buccal branch of the facial nerve through a subcutaneous tunnel on the forehead.The CFNG,the masseteric nerve(MN),and the recipient nerve were coapted in one or two stages.The length and width of the utilized structures were measured under an operating microscope.Return of whisker motion was visually confirmed.Results:Nine out of the eleven rats that underwent surgery survived the procedure.Whisker motion was observed in all experimental animals,indicating successful reinnervation.The mean duration of the surgical procedures did not differ significantly between the experimental groups,ensuring similar conditions for all groups.Conclusions:Our experimental study confirmed that the proposed reanimation model in Wistar rats is anatomically and technically feasible,with a high success rate,and shows good prospects for future experiments.展开更多
Both interposition nerve grafts and masseter nerve transfers have been successfully used for facial reanimation after irreversible injuries to the cranial portion of the facial nerve.However,no comparative study of th...Both interposition nerve grafts and masseter nerve transfers have been successfully used for facial reanimation after irreversible injuries to the cranial portion of the facial nerve.However,no comparative study of these two procedures has yet been reported.In this two-site,twoarm,retrospective case review study,32 patients were included.Of these,17 patients(eight men and nine women,mean age 42.1 years)underwent interposition nerve graft after tumor extirpation or trauma between 2003 and 2006 in the Ear Institute,School of Medicine,Shanghai Jiao Tong University,China,and 15 patients(six men and nine women,mean age 40.6 years)underwent masseter-to-facial nerve transfer after tumor extirpation or trauma between November 2010 and February 2016 in Shanghai Ninth People's Hospital,China.More patients achieved House-Brackmann III recovery after masseter nerve repair than interposition nerve graft repair(15/15 vs.12/17).The mean oral commissure excursion ratio was also higher in patients who underwent masseter nerve transfer than in patients subjected to an interposition nerve graft.These findings suggest that masseter nerve transfer results in strong oral commissure excursion,avoiding obvious synkinesis,while an interposition nerve graft provides better resting symmetry.This study was approved by the Institutional Ethics Committee,Shanghai Ninth People's Hospital,China(approval No.SH9 H-2019-T332-1)on December 12,2019.展开更多
BACKGROUND Treatments involving stem cell(SC)usage represent novel and potentially interesting alternatives in facial nerve reanimation.Current literature includes the use of SC in animal model studies to promote graf...BACKGROUND Treatments involving stem cell(SC)usage represent novel and potentially interesting alternatives in facial nerve reanimation.Current literature includes the use of SC in animal model studies to promote graft survival by enhancing nerve fiber growth,spreading,myelinization,in addition to limiting fibrotic degeneration after surgery.However,the effectiveness of the clinical use of SC in facial nerve reanimation has not been clarified yet.AIM To investigate the histological,neurophysiological,and functional outcomes in facial reanimation using SC,compared to autograft.METHODS Our study is a systematic review of the literature,consistently conducted according to the preferred reporting items for systematic reviews and meta-analyses statement guidelines.The review question was:In facial nerve reanimation on rats,has the use of stem cells revealed as effective when compared to autograft,in terms of histological,neurophysiological,and functional outcomes?Random-effect meta-analysis was conducted on histological and neurophysiological data from the included comparative studies.RESULTS After screening 148 manuscript,five papers were included in our study.43 subjects were included in the SC group,while 40 in the autograft group.The meta-analysis showed no significative differences between the two groups in terms of myelin thickness[CI:-0.10(-0.20,0.00);I^(2)=29%;P=0.06],nerve fibers diameter[CI:0.72(-0.93,3.36);I^(2)=72%;P=0.6],compound muscle action potential amplitude[CI:1.59(0.59,3.77);I^(2)=89%;P=0.15]and latency[CI:0.66(-1.01,2.32);I^(2)=67%;P=0.44].The mean axonal diameter was higher in the autograft group[CI:0.94(0.60,1.27);I^(2)=0%;P≤0.001].CONCLUSION The role of stem cells in facial reanimation is still relatively poorly studied,in animal models,and available results should not discourage their use in future studies on human subjects.展开更多
Aim:Informed consent for paediatric facial reanimation requires effective patient/parent education and involvement in a shared decision-making(SDM)process to help set their expectations and understanding from the outs...Aim:Informed consent for paediatric facial reanimation requires effective patient/parent education and involvement in a shared decision-making(SDM)process to help set their expectations and understanding from the outset.No article in the current literature has systematically reviewed the available tools for facilitating effective patient/parent education and the validity of informed consent in the context of paediatric facial reanimation.Methods:A systematic literature review was undertaken,following the Preferred Reporting Items of Systematic Reviews and Meta-analyses(PRISMA)2020 guidelines.MEDLINE via PubMed,Embase and Cochrane Library were searched and the results screened and reviewed in accordance with pre-defined inclusion and exclusion criteria.Results:The initial search yielded 478 articles,of which only 4 fulfilled the study’s inclusion criteria.One cohort study evaluated qualitative feedback from patients and their relatives participating in a family education and support day for paediatric facial palsy,while another article from the same group reviewed the readability of online education resources.The remaining two articles represented educational reviews focusing on treatment and patient education based on expert opinion without providing original outcome data.Conclusion:There is a paucity of evidence regarding patient/parent education to support the informed consent process for children undergoing paediatric facial reanimation.There remains a need for further resources and platforms to be developed that may support children and their parents in engaging in a SDM process,setting appropriate expectations,and providing valid informed consent for their surgery.展开更多
Nerve transfers for peripheral nerve injuries have become increasingly popular over the past two decades.While techniques for ulnar nerve repair have been well-documented,more recent techniques for median and radial n...Nerve transfers for peripheral nerve injuries have become increasingly popular over the past two decades.While techniques for ulnar nerve repair have been well-documented,more recent techniques for median and radial nerve branch reinnervation are still being explored.This review describes the outcomes of common and emerging techniques for reinnervation of the distal branches of the median and radial nerves.展开更多
Nerve transfer procedures have the potential to restore innervation and function to the native facial musculature.This review summarizes the existing literature on facial nerve injury,regeneration,and reinnervation te...Nerve transfer procedures have the potential to restore innervation and function to the native facial musculature.This review summarizes the existing literature on facial nerve injury,regeneration,and reinnervation techniques with a focus on nerve transfer and its various options.Utilizing nerve transfer as early as possible,and ideally during the first 12 months of paralysis,is recommended.Prolonged paralysis is frequently not amenable to nerve transfer.The masseteric nerve provides excellent smile restoration after coapation to midfacial nerve branches with minimal morbidity.Several modifications to the hypoglossal nerve transfer have been described to limit its morbidity in speech and swallowing.The cross facial nerve,while appealing and able to achieve a true spontaneous smile,has limitations in terms of axonal load,time to reinnervation,unpredictable outcomes,and utility in older patients,who have less regenerative potential.Finally,there are exciting new developments in the field,combining reanimation techniques to harness advantages of various donor nerves,and research in peripheral nerve regeneration.展开更多
Gracilis free muscle transfer(GFMT)is considered the gold standard in dynamic smile reanimation in patients with long-standing facial paralysis.There are multiple motor nerves in the head and neck that can be used to ...Gracilis free muscle transfer(GFMT)is considered the gold standard in dynamic smile reanimation in patients with long-standing facial paralysis.There are multiple motor nerves in the head and neck that can be used to provide innervation to the GFMT,either alone or in combination.In this article,we review the literature about these donor nerve options and discuss their advantages and disadvantages in terms of smile excursion,spontaneity,reliability,and timing.Furthermore,we discuss the use of multiple donor nerve sources in dually-innervated GFMT and areas for future investigation.展开更多
Aim:Facial paralysis inflicts devastating functional and aesthetic deficits.Several solutions are being developed,including implantable bionics to correct paralytic lagophthalmos.The temporal fossa has been postulated...Aim:Facial paralysis inflicts devastating functional and aesthetic deficits.Several solutions are being developed,including implantable bionics to correct paralytic lagophthalmos.The temporal fossa has been postulated to be a suitable location for such devices.Anatomical studies of this fossa have limited application in the design of implants with complex internal components that are constrained by specific functional requirements.In this study,we assess the variation in temporal fossa volumes that could be utilized by a functional implantable device.Methods:CT scans of 18 hemifaces were used to create a 10-point template for measuring tissue thickness in the temporal fossa.Using this data,linear models were used to perform a volumetric analysis of the temporalis muscle and temporal fat pad concerning key anatomical landmarks.Results:The estimated temporalis muscle,temporal fat,and total combined volumes were 19.2 mL(95%CI:10.4-32.9),10.3 mL(95%CI:6.1-16.1),and 29.5 mL(95%CI:16.7-48.9)respectively,consistent with other publications.The temporalis muscle volume increases rapidly and then plateaus moving posteriorly along the zygomatic arch and superiorly along the lateral orbital rim.Whereas the temporal fat increases similarly along the lateral orbital rim,it increases at a uniform rate along the zygomatic arch.Conclusion:Simple geometric modelling of the functional soft tissue space in the temporal fossa is feasible and can be readily applied to aid in the development of implantable devices.展开更多
基金Grant Agency of Masaryk University,Grant/Award Number:MUNI/11/SUP/01/2020 and MUNI/A/1457/2021。
文摘Background:Donor nerve selection is a crucial factor in determining clinical outcomes of facial reanimation.Although dual innervation approaches using two neurotizers have shown promise,there is a lack of evidence-based comparison in the literature.Furthermore,no animal model of dual reinnervation has yet been published.This study aimed to establish such a model and verify its technical and anatomical feasibility by performing dual-innervated reanimation approaches in Wistar rats.Methods:Fifteen Wistar rats were divided into four experimental groups and one control group.The sural nerve was exposed and used as a cross-face nerve graft(CFNG),which was then anastomosed to the contralateral buccal branch of the facial nerve through a subcutaneous tunnel on the forehead.The CFNG,the masseteric nerve(MN),and the recipient nerve were coapted in one or two stages.The length and width of the utilized structures were measured under an operating microscope.Return of whisker motion was visually confirmed.Results:Nine out of the eleven rats that underwent surgery survived the procedure.Whisker motion was observed in all experimental animals,indicating successful reinnervation.The mean duration of the surgical procedures did not differ significantly between the experimental groups,ensuring similar conditions for all groups.Conclusions:Our experimental study confirmed that the proposed reanimation model in Wistar rats is anatomically and technically feasible,with a high success rate,and shows good prospects for future experiments.
基金supported by Shanghai Municipal Commission of Health and Family Planning Program,China,No.201504253(to WW)Special Fund for Science and Technology Innovation by Shanghai Jiao Tong University,China,No.YG2016MS10(to WW)the National Natural Science Foundation of China,Nos.81570906(to HW)and 81371086(to ZYW)。
文摘Both interposition nerve grafts and masseter nerve transfers have been successfully used for facial reanimation after irreversible injuries to the cranial portion of the facial nerve.However,no comparative study of these two procedures has yet been reported.In this two-site,twoarm,retrospective case review study,32 patients were included.Of these,17 patients(eight men and nine women,mean age 42.1 years)underwent interposition nerve graft after tumor extirpation or trauma between 2003 and 2006 in the Ear Institute,School of Medicine,Shanghai Jiao Tong University,China,and 15 patients(six men and nine women,mean age 40.6 years)underwent masseter-to-facial nerve transfer after tumor extirpation or trauma between November 2010 and February 2016 in Shanghai Ninth People's Hospital,China.More patients achieved House-Brackmann III recovery after masseter nerve repair than interposition nerve graft repair(15/15 vs.12/17).The mean oral commissure excursion ratio was also higher in patients who underwent masseter nerve transfer than in patients subjected to an interposition nerve graft.These findings suggest that masseter nerve transfer results in strong oral commissure excursion,avoiding obvious synkinesis,while an interposition nerve graft provides better resting symmetry.This study was approved by the Institutional Ethics Committee,Shanghai Ninth People's Hospital,China(approval No.SH9 H-2019-T332-1)on December 12,2019.
文摘BACKGROUND Treatments involving stem cell(SC)usage represent novel and potentially interesting alternatives in facial nerve reanimation.Current literature includes the use of SC in animal model studies to promote graft survival by enhancing nerve fiber growth,spreading,myelinization,in addition to limiting fibrotic degeneration after surgery.However,the effectiveness of the clinical use of SC in facial nerve reanimation has not been clarified yet.AIM To investigate the histological,neurophysiological,and functional outcomes in facial reanimation using SC,compared to autograft.METHODS Our study is a systematic review of the literature,consistently conducted according to the preferred reporting items for systematic reviews and meta-analyses statement guidelines.The review question was:In facial nerve reanimation on rats,has the use of stem cells revealed as effective when compared to autograft,in terms of histological,neurophysiological,and functional outcomes?Random-effect meta-analysis was conducted on histological and neurophysiological data from the included comparative studies.RESULTS After screening 148 manuscript,five papers were included in our study.43 subjects were included in the SC group,while 40 in the autograft group.The meta-analysis showed no significative differences between the two groups in terms of myelin thickness[CI:-0.10(-0.20,0.00);I^(2)=29%;P=0.06],nerve fibers diameter[CI:0.72(-0.93,3.36);I^(2)=72%;P=0.6],compound muscle action potential amplitude[CI:1.59(0.59,3.77);I^(2)=89%;P=0.15]and latency[CI:0.66(-1.01,2.32);I^(2)=67%;P=0.44].The mean axonal diameter was higher in the autograft group[CI:0.94(0.60,1.27);I^(2)=0%;P≤0.001].CONCLUSION The role of stem cells in facial reanimation is still relatively poorly studied,in animal models,and available results should not discourage their use in future studies on human subjects.
文摘Aim:Informed consent for paediatric facial reanimation requires effective patient/parent education and involvement in a shared decision-making(SDM)process to help set their expectations and understanding from the outset.No article in the current literature has systematically reviewed the available tools for facilitating effective patient/parent education and the validity of informed consent in the context of paediatric facial reanimation.Methods:A systematic literature review was undertaken,following the Preferred Reporting Items of Systematic Reviews and Meta-analyses(PRISMA)2020 guidelines.MEDLINE via PubMed,Embase and Cochrane Library were searched and the results screened and reviewed in accordance with pre-defined inclusion and exclusion criteria.Results:The initial search yielded 478 articles,of which only 4 fulfilled the study’s inclusion criteria.One cohort study evaluated qualitative feedback from patients and their relatives participating in a family education and support day for paediatric facial palsy,while another article from the same group reviewed the readability of online education resources.The remaining two articles represented educational reviews focusing on treatment and patient education based on expert opinion without providing original outcome data.Conclusion:There is a paucity of evidence regarding patient/parent education to support the informed consent process for children undergoing paediatric facial reanimation.There remains a need for further resources and platforms to be developed that may support children and their parents in engaging in a SDM process,setting appropriate expectations,and providing valid informed consent for their surgery.
文摘Nerve transfers for peripheral nerve injuries have become increasingly popular over the past two decades.While techniques for ulnar nerve repair have been well-documented,more recent techniques for median and radial nerve branch reinnervation are still being explored.This review describes the outcomes of common and emerging techniques for reinnervation of the distal branches of the median and radial nerves.
文摘Nerve transfer procedures have the potential to restore innervation and function to the native facial musculature.This review summarizes the existing literature on facial nerve injury,regeneration,and reinnervation techniques with a focus on nerve transfer and its various options.Utilizing nerve transfer as early as possible,and ideally during the first 12 months of paralysis,is recommended.Prolonged paralysis is frequently not amenable to nerve transfer.The masseteric nerve provides excellent smile restoration after coapation to midfacial nerve branches with minimal morbidity.Several modifications to the hypoglossal nerve transfer have been described to limit its morbidity in speech and swallowing.The cross facial nerve,while appealing and able to achieve a true spontaneous smile,has limitations in terms of axonal load,time to reinnervation,unpredictable outcomes,and utility in older patients,who have less regenerative potential.Finally,there are exciting new developments in the field,combining reanimation techniques to harness advantages of various donor nerves,and research in peripheral nerve regeneration.
文摘Gracilis free muscle transfer(GFMT)is considered the gold standard in dynamic smile reanimation in patients with long-standing facial paralysis.There are multiple motor nerves in the head and neck that can be used to provide innervation to the GFMT,either alone or in combination.In this article,we review the literature about these donor nerve options and discuss their advantages and disadvantages in terms of smile excursion,spontaneity,reliability,and timing.Furthermore,we discuss the use of multiple donor nerve sources in dually-innervated GFMT and areas for future investigation.
文摘Aim:Facial paralysis inflicts devastating functional and aesthetic deficits.Several solutions are being developed,including implantable bionics to correct paralytic lagophthalmos.The temporal fossa has been postulated to be a suitable location for such devices.Anatomical studies of this fossa have limited application in the design of implants with complex internal components that are constrained by specific functional requirements.In this study,we assess the variation in temporal fossa volumes that could be utilized by a functional implantable device.Methods:CT scans of 18 hemifaces were used to create a 10-point template for measuring tissue thickness in the temporal fossa.Using this data,linear models were used to perform a volumetric analysis of the temporalis muscle and temporal fat pad concerning key anatomical landmarks.Results:The estimated temporalis muscle,temporal fat,and total combined volumes were 19.2 mL(95%CI:10.4-32.9),10.3 mL(95%CI:6.1-16.1),and 29.5 mL(95%CI:16.7-48.9)respectively,consistent with other publications.The temporalis muscle volume increases rapidly and then plateaus moving posteriorly along the zygomatic arch and superiorly along the lateral orbital rim.Whereas the temporal fat increases similarly along the lateral orbital rim,it increases at a uniform rate along the zygomatic arch.Conclusion:Simple geometric modelling of the functional soft tissue space in the temporal fossa is feasible and can be readily applied to aid in the development of implantable devices.
