Abstract:Local IGF-1 treatment reverses age-related declines in recovery after peripheral nerve injuries by suppressing p75(NTR) upregulation and pro-apoptotic complexes. IGF-1 may be considered a viable adjuvant therapy to current treatment modalities. Muscle Nerve 54: 769-775, 2016.
“…The mean age in our study was 10 years, in contrast to 30 years in the report by Guelinckx and 46 years in the adult report by Terzis and Karypidis. The literature supports that axonal regeneration is poorer with increasing age, 44,46 and this is likely to be the principal cause for the difference. Currently, we choose to limit this procedure as a rule of thumb to patients younger than 30 years.…”
Section: Discussionmentioning
confidence: 93%
“…The second technical difference is the choice of how the platysma muscle is innervated. It is clear that direct neurotization can lead to de novo formation of neuromuscular junctions; however, studies have shown this to be inferior to reinnervation through neurorrhaphy, 44 except in situations of prolonged denervation. 41,42,45 By introducing a vascularized muscle, the nerve to the platysma can be raised with the flap and superior reinnervation of the muscle can be expected through a direct neurorrhaphy.…”
Background:
Facial palsy patients experience an array of problems ranging from functional to psychological issues. With regard to the eye, lacrimation, lagophthalmos, and the inability to spontaneously blink are the main symptoms and, if left untreated, can compromise the cornea and vision. This article reports the outcomes of 23 free functional vascularized platysma transfers used for reanimation of the eye in unilateral facial paralysis.
Methods:
Data were collected prospectively for all patients undergoing reanimation of the paralyzed eye using free functional platysma transfer. The only exclusion criterion was that a minimum of a 2-year follow-up was required. Patients were assessed preoperatively and postoperatively and scored using the eFACE tool focusing on eye-symmetry with documentation of blink reflex.
Results:
A total of 26 free functional platysma transfers were completed between 2011 and 2018; three patients were excluded because of inadequate follow-up. The mean age was 9.1 ± 7.1 years and there were 12 boys and 11 girls. Preoperatively, no patients had evidence of a blink reflex in comparison to 22 patients at 2-year follow-up. There was a statistically significant improvement in palpebral fissure (P < 0.001) and full eye closure (P < 0.001) scores at 2-year follow-up; however, there was no statistically significant difference in gentle eye closure (P = 0.15).
Conclusions:
This is the first report of free functional platysma long-term outcomes in eye reanimation. The results demonstrate that successful restoration of the blink reflex can be achieved and full eye closure is obtainable following surgery.
CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
“…The mean age in our study was 10 years, in contrast to 30 years in the report by Guelinckx and 46 years in the adult report by Terzis and Karypidis. The literature supports that axonal regeneration is poorer with increasing age, 44,46 and this is likely to be the principal cause for the difference. Currently, we choose to limit this procedure as a rule of thumb to patients younger than 30 years.…”
Section: Discussionmentioning
confidence: 93%
“…The second technical difference is the choice of how the platysma muscle is innervated. It is clear that direct neurotization can lead to de novo formation of neuromuscular junctions; however, studies have shown this to be inferior to reinnervation through neurorrhaphy, 44 except in situations of prolonged denervation. 41,42,45 By introducing a vascularized muscle, the nerve to the platysma can be raised with the flap and superior reinnervation of the muscle can be expected through a direct neurorrhaphy.…”
Background:
Facial palsy patients experience an array of problems ranging from functional to psychological issues. With regard to the eye, lacrimation, lagophthalmos, and the inability to spontaneously blink are the main symptoms and, if left untreated, can compromise the cornea and vision. This article reports the outcomes of 23 free functional vascularized platysma transfers used for reanimation of the eye in unilateral facial paralysis.
Methods:
Data were collected prospectively for all patients undergoing reanimation of the paralyzed eye using free functional platysma transfer. The only exclusion criterion was that a minimum of a 2-year follow-up was required. Patients were assessed preoperatively and postoperatively and scored using the eFACE tool focusing on eye-symmetry with documentation of blink reflex.
Results:
A total of 26 free functional platysma transfers were completed between 2011 and 2018; three patients were excluded because of inadequate follow-up. The mean age was 9.1 ± 7.1 years and there were 12 boys and 11 girls. Preoperatively, no patients had evidence of a blink reflex in comparison to 22 patients at 2-year follow-up. There was a statistically significant improvement in palpebral fissure (P < 0.001) and full eye closure (P < 0.001) scores at 2-year follow-up; however, there was no statistically significant difference in gentle eye closure (P = 0.15).
Conclusions:
This is the first report of free functional platysma long-term outcomes in eye reanimation. The results demonstrate that successful restoration of the blink reflex can be achieved and full eye closure is obtainable following surgery.
CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
“…Mini-osmotic pumps provide a sustained, local delivery of exogenous IGF-1 ( Table 5 ; Kanje et al, 1989 ; Sjoberg and Kanje, 1989 ; Ishii and Lupien, 1995 ; Tiangco et al, 2001 ; Fansa et al, 2002 ; Apel et al, 2010 ; Luo et al, 2016 ). This technique involves subcutaneous implantation of an osmotic pump in the abdomen with extension of a catheter from the pump to the transected nerve site.…”
Patients who sustain peripheral nerve injuries (PNIs) are often left with debilitating sensory and motor loss. Presently, there is a lack of clinically available therapeutics that can be given as an adjunct to surgical repair to enhance the regenerative process. Insulin-like growth factor-1 (IGF-1) represents a promising therapeutic target to meet this need, given its well-described trophic and anti-apoptotic effects on neurons, Schwann cells (SCs), and myocytes. Here, we review the literature regarding the therapeutic potential of IGF-1 in PNI. We appraised the literature for the various approaches of IGF-1 administration with the aim of identifying which are the most promising in offering a pathway toward clinical application. We also sought to determine the optimal reported dosage ranges for the various delivery approaches that have been investigated.
“…Yet, reduced physical activity seen during elderly may alter brain activation, impairing motor status and increasing motor deficits (Godde and Voelcker-Rehage, 2017 ). Functional deficits may be the consequence of a loss of nerve fibers (Knox et al, 1989 ; Hashizume and Kanda, 1995 ; Ugrenovic et al, 2016 ), myelin sheath abnormalities (Ceballos et al, 1999 ), changes in extracellular matrix (Esquisatto et al, 2014 ), as well as changes in neuronal or glial expression of membrane channels, neurotrophic factors, and cell adhesion molecules, thereby decreasing axoplasmic transport (Milde et al, 2015 ; Krishman et al, 2016 ; Luo et al, 2016 ; Moldovan et al, 2016 ; Takagishi et al, 2016 ). Although many mechanisms seeking explanations for functional deficits have already been suggested, it is not known whether the weight-bearing capacity of Wistar rats declines with advancing age.…”
The present study aimed to analyze the morphology of the peripheral nerve, postsynaptic compartment, skeletal muscles and weight-bearing capacity of Wistar rats at specific ages. Twenty rats were divided into groups: 10 months-old (ADULT) and 24 months-old (OLD). After euthanasia, we prepared and analyzed the tibial nerve using transmission electron microscopy and the soleus and plantaris muscles for cytofluorescence and histochemistry. For the comparison of the results between groups we used dependent and independent Student's t-test with level of significance set at p ≤ 0.05. For the tibial nerve, the OLD group presented the following alterations compared to the ADULT group: larger area and diameter of both myelinated fibers and axons, smaller area occupied by myelinated and unmyelinated axons, lower numerical density of myelinated fibers, and fewer myelinated fibers with normal morphology. Both aged soleus and plantaris end-plate showed greater total perimeter, stained perimeter, total area and stained area compared to ADULT group (p < 0.05). Yet, aged soleus end-plate presented greater dispersion than ADULT samples (p < 0.05). For the morphology of soleus and plantaris muscles, density of the interstitial volume was greater in the OLD group (p < 0.05). No statistical difference was found between groups in the weight-bearing tests. The results of the present study demonstrated that the aging process induces changes in the peripheral nerve and postsynaptic compartment without any change in skeletal muscles and ability to carry load in Wistar rats.
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