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1.
Int J Mol Sci ; 23(14)2022 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-35887204

RESUMO

Facial nerve paralysis interferes with mimetic muscle function. To reconstruct natural facial movement, free muscle flaps are transplanted as new muscles. However, it is difficult to maintain resting tonus. A dual innervation technique in which other nerves such as the hypoglossal nerve or contralateral facial nerve are added is often applied. Using 10-week-old rats (n = 10), the masseteric and hypoglossal nerves were cut, and the distal stump of the masseteric nerve and the proximal stump of the hypoglossal nerve were then sutured (suture group). In the other group, the masseteric nerve was cut and cauterized (cut group). Immunohistochemistry and microarray were performed on the extracted masseter muscle. The immunohistochemistry results suggested that the muscles in the suture group obtained oxidative characteristics. The microarray showed the genes involved in mitochondrial function, including Perm1. In summary, our data support the validity of the dualinnervation technique for facial paralysis treatment.


Assuntos
Nervo Facial , Paralisia Facial , Animais , Músculos Faciais/inervação , Paralisia Facial/cirurgia , Nervo Hipoglosso/cirurgia , Nervo Hipoglosso/transplante , Fibras Musculares Esqueléticas , Ratos
2.
BMC Surg ; 21(1): 32, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419427

RESUMO

BACKGROUND: Early surgical repair to restore nerve integrity has become the most commonly practiced method for managing facial nerve injury. However, the evidence for the efficacy of surgical repair for restoring the function of facial nerves remains deficient. This study evaluated the outcomes of surgical repair for facial nerve lesions. METHODS: This retrospective observational study recruited 28 patients with the diagnosis of facial nerve injury who consecutively underwent surgical repairs from September 2012 to May 2019. All related clinical data were retrospectively analyzed according to age, sex, location of the facial nerve lesion, size of the facial nerve defect, method of repair, facial electromyogram, and blink reflex. Facial function was then stratified with the House-Brackmann grading system pre-operation and 3, 9, 15, and 21 months after surgical repair. RESULTS: The 28 patients enrolled in this study included 17 male and 11 female patients with an average age of 34.3 ± 17.4 years. Three methods were applied for the repair of an injured facial nerve, including great auricular nerve transplantation in 15 patients, sural nerve grafting in 7 patients, and hypoglossal to facial nerve anastomosis in 6 patients. Facial nerve function was significantly improved at 21 months after surgery compared with pre-operative function (P = 0.008). Following surgical repair, a correlation was found between the amplitude of motor unit potential (MUP) and facial nerve function (r = -6.078, P = 0.02). Moreover, the extent of functional restoration of the facial nerve at 21 months after surgery depended on the location of the facial nerve lesion; lesions at either the horizontal or vertical segment showed significant improvement(P = 0.008 and 0.005), while no functional restoration was found for lesions at the labyrinthine segment (P = 0.26). CONCLUSIONS: For surgical repair of facial nerve lesions, the sural nerve, great auricular nerve, and hypoglossal-facial nerve can be grafted effectively to store the function of a facial nerve, and MUP may provide an effective indicator for monitoring the recovery of the injured nerve.


Assuntos
Traumatismos do Nervo Facial/cirurgia , Nervo Facial , Paralisia Facial , Adolescente , Adulto , Anastomose Cirúrgica , Plexo Cervical/cirurgia , Nervo Facial/cirurgia , Traumatismos do Nervo Facial/complicações , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Feminino , Humanos , Nervo Hipoglosso/transplante , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Nervo Sural/transplante , Resultado do Tratamento , Adulto Jovem
3.
Am J Otolaryngol ; 37(6): 493-496, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27353412

RESUMO

PURPOSE: Reanimation of facial paralysis is a complex problem with multiple treatment options. One option is hypoglossal-facial nerve grafting, which can be performed in the immediate postoperative period after nerve transection, or in a delayed setting after skull base surgery when the nerve is anatomically intact but function is poor. The purpose of this study is to investigate the effect of timing of hypoglossal-facial grafting on functional outcome. MATERIALS AND METHODS: A retrospective case series from a single tertiary otologic referral center was performed identifying 60 patients with facial nerve injury following cerebellopontine angle tumor extirpation. Patients underwent hypoglossal-facial nerve anastomosis following facial nerve injury. Facial nerve function was measured using the House-Brackmann facial nerve grading system at a median follow-up interval of 18months. Multivariate logistic regression analysis was used determine how time to hypoglossal-facial nerve grafting affected odds of achieving House-Brackmann grade of ≤3. RESULTS: Patients who underwent acute hypoglossal-facial anastomotic repair (0-14days from injury) were more likely to achieve House-Brackmann grade ≤3 compared to those that had delayed repair (OR 4.97, 95% CI 1.5-16.9, p=0.01). CONCLUSIONS: 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.


Assuntos
Traumatismos do Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Nervo Hipoglosso/transplante , Complicações Intraoperatórias/cirurgia , Neuroma Acústico/cirurgia , Tempo para o Tratamento , Adulto , Traumatismos do Nervo Facial/etiologia , Traumatismos do Nervo Facial/reabilitação , Paralisia Facial/etiologia , Paralisia Facial/reabilitação , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/reabilitação , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
4.
J Hand Surg Am ; 40(3): 448-51, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25617219

RESUMO

Use of the entire hypoglossal nerve for nerve transfer in obstetric palsy is not recommended because of major donor nerve morbidity in terms of feeding and speech problems. We used a hemi-hypoglossal nerve transfer for biceps reinnervation in obstetric palsy in 3 infants with multiple root avulsions. Two of the 3 infants recovered normal or near-normal elbow flexion. There was no donor nerve morbidity in terms of feeding. Speech was assessed at age 20 to 27 months and was appropriate for age, which indicates that early speech development (speech intelligibility and articulation) were not affected. However, phonological development (expected to develop by age 3 y) and full consonant development (expected to be complete by age 5 y) could not be assessed because all children were younger than age 3 years at final follow-up. Our results confirm the relative safety of using a hemi-hypoglossal nerve transfer in infants. The transfer deserves study in a larger series and with longer follow-up, particularly regarding speech development.


Assuntos
Neuropatias do Plexo Braquial/cirurgia , Nervo Hipoglosso/transplante , Regeneração Nervosa/fisiologia , Transferência de Nervo/métodos , Paralisia Obstétrica/complicações , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/fisiopatologia , Feminino , Seguimentos , Humanos , Nervo Hipoglosso/cirurgia , Lactente , Masculino , Paralisia Obstétrica/diagnóstico , Paralisia Obstétrica/cirurgia , Recuperação de Função Fisiológica , Medição de Risco , Estudos de Amostragem , Índice de Gravidade de Doença , Sítio Doador de Transplante/fisiopatologia , Resultado do Tratamento
5.
Am J Otolaryngol ; 32(6): 511-6, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21093962

RESUMO

BACKGROUND: Several methods of neural rehabilitation for facial paralysis using 12-7 transfers have been described. The purpose of this study is to report on a series for dynamic reinnervation of the paralyzed face by using a split 12-7 nerve transposition. The goals of this procedure are to minimize tongue morbidity and to provide good facial reinnervation. METHODS: Prospective case series. Melolabial crease discursion, overall facial movement, and degree of tongue atrophy and mobility were recorded. RESULTS: Thirteen patients underwent facial reanimation using a split hypoglossal-facial nerve transfer with postoperative follow-up to 58 months (range, 6-58 months). All patients achieved excellent rest symmetry and facial tone. Of 13 patients, 10 had measurable coordinated movement and discursion of their melolabial crease. Of 13 patients, 12 had mild to moderate ipsilateral tongue atrophy. The mean time to onset of visible reinnervation was 3 months. CONCLUSION: Split hypoglossal-facial nerve transposition provides good rehabilitation of facial nerve paralysis with reduced lingual morbidity. Long-term rest symmetry and potential learned movement can be achieved. This technique may provide a favorable alternative to the traditional method of complete hypoglossal sacrifice or jump grafting.


Assuntos
Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Nervo Hipoglosso/cirurgia , Transferência de Nervo/métodos , Adulto , Idoso , Estudos de Coortes , Eletromiografia/métodos , Estética , Nervo Facial/transplante , Paralisia Facial/diagnóstico , Feminino , Seguimentos , Humanos , Nervo Hipoglosso/transplante , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Satisfação do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
6.
J Plast Reconstr Aesthet Surg ; 74(1): 160-167, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32631719

RESUMO

Early cases of facial nerve injury are best treated by restoring the neural pathway to the same existing facial muscles. Knowledge of the exact territory of facial nerve injury is required to design a plane for the reconstruction of these injuries and to compare results. The current study aims to design a classification system for territories of facial nerve injury based on the location of nearest healthy fascicles to the site of injury both proximally and distally. Two hundred-one patients with early facial nerve injury were assessed for treatment. According to the results of the exploration, 13 territories of injury were identified. The management strategy was planned according to the territory of injury. The current classification system is a simple, easy and effective method for the classification of territories of facial nerve injury. The classification system accurately describes the nearest possible healthy proximal and distal fascicles and can be employed to easily report cases and implement a management plan. This classification scheme also allows us to more effectively compare results.


Assuntos
Traumatismos do Nervo Facial/classificação , Traumatismos do Nervo Facial/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Músculos Faciais/inervação , Nervo Facial/cirurgia , Traumatismos do Nervo Facial/complicações , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Feminino , Humanos , Nervo Hipoglosso/transplante , Lactente , Masculino , Nervo Mandibular/transplante , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Adulto Jovem
7.
J Craniofac Surg ; 21(6): 1926-7, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21119457

RESUMO

Möbius syndrome is a rare congenital disorder characterized by a variety of cranial nerve defects. Although there are several variants of Möbius syndrome depending on which cranial nerves are affected, the commonest form involves facial and abducens cranial nerve paralysis. Despite several strategies for bilateral smile reconstruction that have been advocated, the condition still presents a challenge to the plastic surgeon. The most acceptable method nowadays is bilateral free neurovascularized muscle transfer. The author represents a new method of using a single hypoglossal nerve to supply both free flaps in a Möbius patient. The procedure is done on 2 stages using both latissimus dorsi muscles and a single hypoglossal nerve. The patient regained a natural symmetric smile 12 months after the first stage. Despite hemilingual atrophy, no tongue morbidity was observed. The author concludes that despite the limitation of the study, the hypoglossal nerve is a good nerve source to supply both free flaps for smile reconstruction in Möbius syndrome.


Assuntos
Paralisia Facial/cirurgia , Retalhos de Tecido Biológico , Nervo Hipoglosso/transplante , Síndrome de Möbius/cirurgia , Músculo Esquelético/transplante , Procedimentos de Cirurgia Plástica/métodos , Sorriso , Anastomose Cirúrgica , Músculos Faciais/cirurgia , Feminino , Seguimentos , Retalhos de Tecido Biológico/inervação , Sobrevivência de Enxerto , Humanos , Microcirurgia/métodos , Nervo Sural/transplante , Adulto Jovem
8.
Curr Opin Otolaryngol Head Neck Surg ; 27(4): 231-236, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31169528

RESUMO

PURPOSE OF REVIEW: The aim of this article is to review the recent literature on nerve transfers in facial paralysis. The discussion focuses on direct nerve repair and three types of nerve transfers, cross facial nerve graft, hypoglossal, and masseter nerve transfers. RECENT FINDINGS: Masseteric nerve transfers have a high probability of creating significant movement, although tone is poor. The hypoglossal to facial nerve transfer is reliable in affording facial tone and has been updated to involve a transposition technique that offers good results with minimal morbidity. Combination nerve transfer techniques using multiple cranial nerves or cross-face nerves are increasingly described. SUMMARY: Reinnervation of the facial nerve and neural regeneration in general are areas of intense research and novel surgical approaches continue to be explored. Although direct nerve repair is the most ideal, other nerve transfers can be performed with good results. More specifically, the masseteric nerve transfer can provide excellent movement and the hypoglossal transfer good tone. Combination transfers may afford the benefits of multiple nerves.


Assuntos
Paralisia Facial/cirurgia , Transferência de Nervo/métodos , Nervo Facial/cirurgia , Humanos , Nervo Hipoglosso/transplante , Músculo Masseter/inervação
9.
World Neurosurg ; 126: e688-e693, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30844532

RESUMO

OBJECTIVE: Neurorrhaphy with interpositional graft is a practical technique to achieve facial reanimation when the continuity of the facial nerve is interrupted and a large gap between the proximal and distal stump exists. The aim of this study was to report long-term outcomes of neurorrhaphy for facial reanimation with interpositional graft. The roles of some variable factors in the outcome of neurorrhaphy with interpositional graft were also evaluated and compared. METHODS: A retrospective case series from a single tertiary referral center comprised 23 patients with facial nerve interruptions who underwent neurorrhaphy with interpositional graft using either end-to-end anastomosis or end-to-side hypoglossal-facial technique. Preoperative data (age, sex, primary lesion, interval from paralysis to surgery, facial nerve function), intraoperative data (surgical approach, graft and type of neurorrhaphy), and postoperative data (facial nerve function) were collected and analyzed. RESULTS: Mean follow-up time was 26.6 ± 11.9 months. Patients who underwent neurorrhaphy for facial reanimation within 1 year after onset of facial paralysis were more likely to achieve House-Brackmann grade ≤3 compared with patients who underwent neurorrhaphy >1 year after onset of facial paralysis (odds ratio = 23.85, P = 0.04). No other factors were associated with improved outcomes. CONCLUSIONS: Early neurorrhaphy with interpositional graft (≤1 year) for facial reanimation resulted in better final facial nerve function outcomes compared with a delayed procedure.


Assuntos
Traumatismos do Nervo Facial/cirurgia , Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Nervo Hipoglosso/transplante , Transferência de Nervo/métodos , Adulto , Traumatismos do Nervo Facial/complicações , Paralisia Facial/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
10.
Otolaryngol Clin North Am ; 41(3): 619-32, x, 2008 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-18436002

RESUMO

Emotions are communicated through facial expression. Happiness, confusion, and frustration can be expressed with a slight smile, eyebrow shift, or wrinkled nose. Injury to the facial nerve and subsequent inability of perform volitional mimetic movement can provoke anxiety. This article explores the causes, treatment, and prevention of facial nerve paralysis.


Assuntos
Paralisia Facial/diagnóstico , Descompressão Cirúrgica , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Fraturas Ósseas/cirurgia , Humanos , Nervo Hipoglosso/transplante , Doença Iatrogênica , Complicações Intraoperatórias , Nervo Sural/transplante , Osso Temporal/lesões , Osso Temporal/cirurgia , Ferimentos Penetrantes/cirurgia
11.
Neurocirugia (Astur) ; 19(2): 127-32, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18500411

RESUMO

OBJECTIVE: The study presents the results of reconstruction surgery of lesions on n. facialis with n. hypoglossus and n. accessorius performed in our clinic. PATIENT GROUP AND METHODS: 10 patients were treated by anastomosis of n. facialis with n. hypoglossus (HFA), 1 patient by anastomosis of n. facialis with n. accessorius (AFA). All operations were performed under the microscope; HFA and AFA anastomoses were sewed without tension at perineurium. The techique of suturation of facial nerves did not differ from the suturation of peripheral nerves in extremities. For the connection of n. VII-XII was not used plasma pasting. We did not use end to side anastomosis or reconstruction of n. VIIVII in pontocerebellar angle, in pyramid, or symetrical anastomoses of n. VII-VII, in any case. The results were objectivized by a VI grade Brudny's modification of House-Brackman classification introduced originally for scaling of the outcome of HFA anastomosis. In this study, this classification has been used for the objectivization of AFA anastomosis results. RESULTS: Reconstruction surgery by HFA and AFA resulted in all cases in grade III of the scale. Glossal hemiatrophy or atrophy of m. sternocleidomastoideus and m. trapesius were observed in patients treated by cross anastomosis with n. hypoglossus or n. accessorius. In patients treated by HFA and even more pronounced in patient with AFA anastomosis, minute synkineses in the region of labial angle, chin, also in the region of lower eyelid, occurred in the excited emotional state or during a long-lasting speech. Major diskincses were not observed in any of reported treatments. Recovery in older patients up to 60 years was coming more slowly, in one case after 6 months. CONCLUSION: Compared to AFA anastomosis, HFA anastomoses resulted in improved mimics and synkineses present here were finer. We prefer HFA anastomosis also because the discomfort caused by atrophy of ni. trapesius and ni. sternocleidomastoideus was apparently more perceived by patient treated by AFA than the negative effects of hemiatrophy reported by patients treated by FIFA.


Assuntos
Paralisia Facial/cirurgia , Nervo Hipoglosso/transplante , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Anastomose Cirúrgica , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Oper Neurosurg (Hagerstown) ; 15(2): 174-178, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29088397

RESUMO

BACKGROUND: Hypoglossal nerve transfer is frequently employed to reanimate the paralyzed facial muscles after irreversible proximal facial nerve injury. However, it can cause significant postoperative synkinesis because it involves the reinnervation of the whole mimetic musculature using a single motor source. OBJECTIVE: To describe our experience with differential reanimation of the midface and lower face using separate motor sources in patients with short-term facial paralysis after brain surgery. METHODS: Seven patients underwent combined nerve transfer (the masseteric nerve to the zygomatic branch and the hypoglossal nerve to the cervicofacial division of the facial nerve) and cross-facial nerve grafting with the aim of achieving a spontaneous smile. The median duration of paralysis before surgery was 7 mo and follow-up ranged from 7 to 31 mo (mean: 18 mo). For evaluation, both physical examination and video analysis were performed. RESULTS: In all patients, reanimation of both the midface and the lower face was successful. A nearly symmetrical resting lip was achieved in all patients, and they were able to voluntarily elevate the corners of their mouths without visible synkinesis and to close their eyes while biting. No patient experienced impairment of masticatory function or tongue atrophy. CONCLUSION: Differential reanimation of the midface and lower face with the masseteric and hypoglossal nerves is an alternative method that helps to minimize synkinetic mass movement and morbidity at the donor site.


Assuntos
Face/inervação , Paralisia Facial/cirurgia , Nervo Hipoglosso/transplante , Nervo Mandibular/transplante , Transferência de Nervo/métodos , Adolescente , Adulto , Idoso , Expressão Facial , Músculos Faciais/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
J Plast Reconstr Aesthet Surg ; 71(5): 750-757, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29452877

RESUMO

Long-standing cases of facial paralysis are currently treated with free functional muscle transfer. Several nerves are mentioned in the literature to supply the free muscle transfer. The aim of this study is to compare the split hypoglossal nerve and the cross-face nerve graft to supply the free functional muscle transfer in facial reanimation. Of 94 patients with long-standing, unilateral facial palsy, 49 were treated using the latissimus dorsi muscle supplied by the split hypoglossal nerve, and 45 patients were treated using the latissmus dorsi muscle supplied by healthy contralateral buccal branch of the facial nerve. The excursion gained by the free muscle transfer supplied by the split hypoglossal nerve (mean 19.20 ± 6.321) was significantly higher (P value 0.001) than that obtained by the contralateral buccal branch of the facial nerve (mean 14.59 ± 6.245). The split hypoglossal nerve appears to be a good possible option to supply the free vascularised muscle transfer in facial reanimation. It yields a stronger excursion in less time than the contralateral cross-face nerve graft.


Assuntos
Nervo Facial/transplante , Paralisia Facial/cirurgia , Nervo Hipoglosso/transplante , Transferência de Nervo/métodos , Músculos Superficiais do Dorso/inervação , Músculos Superficiais do Dorso/transplante , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
14.
Curr Opin Otolaryngol Head Neck Surg ; 25(4): 280-285, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28562372

RESUMO

PURPOSE OF REVIEW: To review recent literature pertaining to the use of masseteric-facial nerve neurorrhaphy (MFNN) for facial reanimation in patients with facial paralysis. RECENT FINDINGS: First, MFNN effectively restores some midface tone and function, including the ability to smile. Second, use of the masseteric nerve minimizes synkinesis, dysarthria, and dysphagia that frequently occur after hypoglossal-facial nerve neurorrhaphy. Third, concurrent cable grafting to the zygomatic branch from an intact proximal facial nerve remnant - when available - can restore dynamic eye closure. SUMMARY: Masseteric nerve transfer is an alternative to hypoglossal nerve transfer that improves midface appearance and function for properly selected patients with facial paralysis.


Assuntos
Paralisia Facial/cirurgia , Músculo Masseter/transplante , Transferência de Nervo/métodos , Nervo Facial , Paralisia Facial/complicações , Humanos , Nervo Hipoglosso/transplante , Complicações Pós-Operatórias/prevenção & controle , Sorriso
15.
J Plast Reconstr Aesthet Surg ; 70(11): 1666-1674, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28684285

RESUMO

Nerve reconstructions are the preferred technique for short-standing facial paralysis, most commonly using the contralateral facial nerve or ipsilateral hypoglossal nerve. The hypoglossal nerve provides a strong motor signal, whereas the signal of a cross-face nerve graft is weaker but spontaneous. Spontaneity in facial expression is believed to be important for psychological wellbeing. Therefore, a combination of the two procedures incorporates the best of both: a strong motor signal and a spontaneous smile. This study aimed to objectify this expected benefit. Of the 20 patients who received a hypoglossal-facial nerve anastomosis from 1995 to 2015 in our institutions, 12 patients were included in this study, 5 with and 7 without a cross-face nerve graft. The outcomes were compared using photographs, disease-specific quality of life (Facial Clinimetric Evaluation (FaCE) scale), a self-reported synkinesis scale (Synkinesis Assessment Questionnaire) and the presence of a spontaneous smile. Significant differences were found in preoperative excursion of the affected side of the mouth and the change in excursion. Median Total FaCE scores were considerably larger (18.3 points) for patients who underwent the combined procedure. A spontaneous smile was observed both with (n = 2) and without (n = 1) a cross-face nerve graft. The addition of a cross-face nerve graft to a hypoglossal-facial nerve anastomosis resulted in a positive trend in disease-specific quality of life. This benefit could also be present with the combination of a cross-face nerve graft with another nerve transfer such as a masseteric-facial nerve anastomosis.


Assuntos
Nervo Facial/cirurgia , Paralisia Facial/cirurgia , Nervo Hipoglosso/transplante , Músculo Esquelético/transplante , Transferência de Nervo/métodos , Qualidade de Vida , Ritidoplastia/métodos , Adolescente , Adulto , Idoso , Criança , Expressão Facial , Paralisia Facial/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos , Sorriso , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
JAMA Otolaryngol Head Neck Surg ; 141(7): 620-7, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26042741

RESUMO

IMPORTANCE: Vocal fold immobility following injury to the recurrent laryngeal nerve (RLN) may lead to substantial morbidity. A reinnervation treatment strategy offers several theoretical benefits over static treatment options. This study evaluates the robustness of reinnervation of the larynx using a split-hypoglossal nerve graft in an animal model, with outcomes assessed by independent blinded review. OBJECTIVES: To assess whether a full-hypoglossal nerve graft to the RLN after RLN section can provide return of dynamic vocal fold motion in a canine model, and to validate that a split-hypoglossal nerve graft to the RLN may also provide dynamic vocal fold motion to rehabilitate laryngeal function in a canine model. DESIGN, SETTING, AND SUBJECTS: A pilot animal study to assess the feasibility and morbidity of laryngeal reinnervation following RLN injury with an end-to-end full-hypoglossal or split-hypoglossal nerve graft was performed at an animal care and research facility in 10 adult female dogs. The study dates were January to July 2013. INTERVENTIONS: We performed full-hypoglossal (full XII group [n = 5]) and split-hypoglossal (split XII group [n = 5]) nerve grafts to the RLN in a canine model following RLN section. MAIN OUTCOMES AND MEASURES: Morbidity was evaluated through scored feeding observation. Laryngeal function was assessed by video laryngoscopy and evoked laryngeal electromyography was performed at baseline and 6 months after surgery. Video laryngoscopy was graded by independent reviewers blinded to study intervention. RESULTS: No clinically significant morbidity was identified after surgery. On review of video laryngoscopy, all 5 animals in the full XII group and all 5 animals in the split XII group demonstrated vocal fold motion by at least 1 independent reviewer. All 3 reviewers agreed on motion in 1 of 5 animals in the full XII group and in 1 of 5 animals in the split XII group. Stimulation of the hypoglossal nerve demonstrated neural connection on evoked laryngeal electromyography in all animals at 6 months. CONCLUSIONS AND RELEVANCE: This study confirms that a full-hypoglossal or split-hypoglossal nerve graft may restore vocal fold motion, without significant functional morbidity, following RLN section in a canine model.


Assuntos
Nervo Hipoglosso/transplante , Traumatismos do Nervo Laríngeo Recorrente/cirurgia , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/inervação , Prega Vocal/fisiopatologia , Animais , Modelos Animais de Doenças , Cães , Eletromiografia , Estudos de Viabilidade , Feminino , Laringoscopia , Projetos Piloto , Traumatismos do Nervo Laríngeo Recorrente/complicações , Traumatismos do Nervo Laríngeo Recorrente/fisiopatologia , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/fisiopatologia
17.
Neurosurgery ; 50(2): 332-5, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11844268

RESUMO

OBJECTIVE: In multiple avulsions of the brachial plexus, the search for extraplexal donor nerves in the hope of achieving motor neurotization is a major goal. We explored the possibility of using the hypoglossal nerve as a transfer point to reanimate muscles in the upper limb. METHODS: The hypoglossal nerve was used as a donor nerve for neurotization in seven patients with avulsive injuries of the brachial plexus. The surgical technique--an end-to-side microsuture using approximately half of the nerve fascicles--is basically the same as that used in the hypoglossal nerve-facial nerve jump graft, which is a well-known technique in facial nerve reanimation. The recipient nerves were the suprascapular (two patients), the musculocutaneous (one patient), the posterior division of the upper trunk (two patients), and the medial contribution to the median nerve (two patients). RESULTS: In spite of a connection documented by electromyography and selective activation in three of seven patients, the functional results in our patients were extremely disappointing: no patient had an outcome better than M1 in the reinnervated muscles. CONCLUSION: This technique was of no help to the patients and thus has been abandoned at our institution.


Assuntos
Plexo Braquial/lesões , Nervo Hipoglosso/transplante , Transferência de Nervo/métodos , Adolescente , Adulto , Plexo Braquial/cirurgia , Eletromiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Complicações Pós-Operatórias/diagnóstico , Raízes Nervosas Espinhais/lesões , Raízes Nervosas Espinhais/cirurgia , Resultado do Tratamento
18.
Laryngoscope ; 88(4): 598-604, 1978 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-642658

RESUMO

The nerve-muscle pedicle technique for reinnervation of bilateral vocal cord paralysis has now been applied in 45 cases over the past four years. EMG studies, volume flow loop, pulmonary function studies, and the ability to extubate the patient with good to excellent exercise tolerance for day-to-day activity have been used as parameters to judge success or failure of this procedure. To date there has been a primary success rate of 91.1% (41/45) and a long-term success rate of 88.8% (40/45). There has been one serious complication in the entire series and no significant morbidity other than this. Age of the patient and length of paralysis are not necessarily contraindications to the procedure. These results suggest that the nerve-muscle pedicle technique may be successfully used for reinnervation of bilaterally paralyzed vocal cords without sacrificing residual voice, as is the case with arytenoidectomy type procedures.


Assuntos
Nervo Hipoglosso/transplante , Nervos Laríngeos , Músculos/transplante , Paralisia das Pregas Vocais/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Humanos , Pessoa de Meia-Idade , Transplante Autólogo , Prega Vocal/inervação
19.
Laryngoscope ; 110(5 Pt 1): 739-48, 2000 May.
Artigo em Inglês | MEDLINE | ID: mdl-10807353

RESUMO

OBJECTIVES/HYPOTHESIS: To determine whether the hypoglossal nerve (XII) can serve as a suitable donor for human laryngeal reinnervation. STUDY DESIGN: Prospective, nonrandomized. METHODS: Measurements were made on patients undergoing open neck procedures to determine the length of XII available and that required to perform XII-recurrent laryngeal nerve (RLN) anastomosis. The morbidity of combined XII and RLN injuries was studied using temporary lidocaine block of the ipsilateral XII in patients with unilateral vocal fold paralysis (UVFP). A pilot series of patients with UVFP who underwent XII-RLN reinnervation was evaluated for morbidity of the procedure, and for improvement in voice and swallowing. RESULTS: In 89 necks the average available length of XII was 2 cm less than that needed to reach the larynx, indicating the RLN stump must be at least 3 cm to allow tension-free anastomosis. Twenty-five patients with untreated UVFP underwent temporary lidocaine block of XII; 8 had slight changes in their speech, none had increased aspiration. Nine patients underwent XII-RLN reinnervation. Postoperative speech analysis correlated well with the findings of the temporary lidocaine block of XII. One-year follow-up of five patients showed excellent voice quality, resolution of any preoperative aspiration, and minimal morbidity. Slight adductory movement of the reinnervated vocal fold was seen during tongue thrust. Electromyography confirmed substantial polyphasic action potentials in the thyroarytenoid muscle. CONCLUSIONS: The hypoglossal nerve is a very suitable donor for reinnervation of patients with UVFP. There should be enough length for primary XII-RLN anastomosis in most patients. Donor site morbidity is acceptable. Preoperative lidocaine block of XII is a good predictor of actual donor site morbidity and could be used to assess patients undergoing facial-hypoglossal anastomosis as well.


Assuntos
Nervo Hipoglosso/transplante , Nervo Laríngeo Recorrente/cirurgia , Paralisia das Pregas Vocais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Eletromiografia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Regeneração Nervosa/fisiologia , Traumatismos do Nervo Laríngeo Recorrente , Resultado do Tratamento , Paralisia das Pregas Vocais/etiologia
20.
Laryngoscope ; 88(4): 689-96, 1978 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-347203

RESUMO

Historical investigations of the functional restoration for recurrent laryngeal nerve paralysis are reviewed and some advancement in recent studies are introduced. A preliminary experiment is reported in which the ansa hypoglossi and the sternothyroid muscle pedicle was implanted into the denervated posterior cricoarytenoid muscle in dogs. From these experiments we have concluded that the ansa hypoglossi and sternothyroid muscle pedicle, which has been shown to transmit efferent inspiratory bursts, is capable of restoring function to the paralyzed posterior cricoarytenoid muscle in some dogs.


Assuntos
Nervo Hipoglosso/transplante , Músculos/transplante , Paralisia das Pregas Vocais/cirurgia , Animais , Cães , Eletromiografia , História do Século XIX , História do Século XX , Pescoço/inervação , Nervo Laríngeo Recorrente/cirurgia , Transplante Autólogo , Paralisia das Pregas Vocais/história , Paralisia das Pregas Vocais/fisiopatologia
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