Donor Nerve Selection in Facial Reanimation Surgery

Klebuc, Michael; Shenaq, Saleh M.

doi:10.1055/s-2004-823124

Cited by 30 publications

(10 citation statements)

References 14 publications

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“…46 Comparing the commonly used nerve-to-masseter and cross-facial nerve graft, the authors agree that the nerveto-masseter provides more excursion, a shorter convalescence time, but less spontaneity and the need for more intensive smile training, whereas the cross-facial nerve graft delivers spontaneous emotions and resting tone but less excursion and demands more recovery time. [47][48][49][50][51] Nevertheless, some studies suggest that spontaneity can also be achieved by a nonfacial donor source. [52][53][54] The deep temporal branch of the trigeminal nerve supplying the temporalis muscle has been described as nonfacial donor source for the reanimation of the forehead by Dauwe et al 7 They found 1496 axons at the level of the zygomatic arch and 534 axons at a distance of 3 cm for the temporal branch middle division.…”

Section: Discussionmentioning

confidence: 99%

Microanatomy of the Frontal Branch of the Facial Nerve: The Role of Nerve Caliber and Axonal Capacity

Ruewe

Engelmann

Huang

et al. 2021

Plastic &Amp; Reconstructive Surgery

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Background: A commonly seen issue in facial palsy patients is brow ptosis caused by paralysis of the frontalis muscle powered by the frontal branch of the facial nerve. Predominantly, static methods are used for correction. Functional restoration concepts include the transfer of the deep temporal branch of the trigeminal nerve and cross-facial nerve grafts. Both techniques can neurotize the original mimic muscles in early cases or power muscle transplants in late cases. Because axonal capacity is particularly important in cross-facial nerve graft procedures, the authors investigated the microanatomical features of the frontal branch to provide the basis for its potential use and to ease intraoperative donor nerve selection. Methods: Nerve biopsy specimens from 106 fresh-frozen cadaver facial halves were obtained. Histologic processing and digitalization were followed by nerve morphometric analysis and semiautomated axon quantification. Results:The frontal branch showed a median of three fascicles (n = 100; range, one to nine fascicles). A mean axonal capacity of 1191 ± 668 axons (range, 186 to 3539 axons; n = 88) and an average cross-sectional diameter of 1.01 ± 0.26 mm (range, 0.43 to 1.74 mm; n = 67) were noted. In the linear regression model, diameter and axonal capacity demonstrated a positive relation (n = 57; r² = 0.32; p < 0.001). Based on that equation, a nerve measuring 1 mm is expected to carry 1339 axons. Conclusion:The authors' analysis on the microanatomy of the frontal branch could promote clinical use of cross-facial nerve graft procedures in frontalis muscle neurotization and free muscle transplantations.

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Section: Discussionmentioning

confidence: 99%

Microanatomy of the Frontal Branch of the Facial Nerve: The Role of Nerve Caliber and Axonal Capacity

Ruewe

Engelmann

Huang

et al. 2021

Plastic &Amp; Reconstructive Surgery

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“…13 Complete sectioning of the spinal accessory nerve can produce significant shoulder weakness, and the transfer lacks the ''physiologic dynamism'' other cranial nerves provide. 14…”

Section: Other Available Optionsmentioning

confidence: 99%

“…However, this option is inferior for minimizing morbidity concerning shoulder weakness. 14 In the clinical scenario of soft tissue loss, options for reconstruction expand to incorporating a vascularized nerve graft with a free anterolateral thigh flap. 17 Vascularized nerve grafts have several benefits when compared to their non-vascularized counterparts, including an increase in the number of myelin fibres, thickness, axon diameter, faster axonal regeneration and higher axonal count.…”

Section: Other Available Optionsmentioning

confidence: 99%

Rethinking Oncologic Facial Nerve Reconstruction in the Acute Phase Through Classification of the Level of Injury

Winter,

Dimovska,

Tzou

et al. 2024

Facial Plast Surg

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Early facial nerve reconstruction should be offered in every patient with oncological resections of the facial nerve due to the debilitating functional and psychosocial consequences of facial nerve palsy. Oncologic pathology or oncologic resection accounts for the second most common cause of facial nerve palsy. In the case of these acute injuries, selecting an adequate method for reconstruction to optimize functional and psychosocial well-being is paramount. Authors advocate consideration of the level of injury as a framework for approaching the viable options of reconstruction systematically. Authors break down oncologic injuries to the facial nerve in three levels in relation to their nerve reconstruction methods and strategies: Level I (intracranial to intratemporal), Level II (intratemporal to extratemporal and intraparotid), and Level III (extratemporal and extraparotid). Clinical features, common clinical scenarios, donor nerves available, recipient nerve, and reconstruction priorities will be present at each level. Additionally, examples of clinical cases will be shared to illustrate the utility of framing acute facial nerve injuries within injury levels. Selecting donor nerves is critical in successful facial nerve reconstruction in oncological patients. Usually, a combination of facial and non-facial donor nerves (Hybrid) is necessary to achieve maximal reinnervation of the mimetic muscles. Our proposed classification of three levels of facial nerve injuries provides a selection guide, which prioritizes methods for function nerve reconstruction in relation of the injury level in oncologic patients while prioritizing functional outcomes.

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“…Der Patient kann auch ein "Masseter-Lachen" erlernen, indem er den M. masseter anspannt, ohne eine Kaubewegung mit den Backenzähnen durchzuführen. Zudem soll es möglich sein, durch kortikale Adaptation in der Großhirnrinde ein spontanes Lächeln zu entwickeln[28][29][30][31][32]. Es handelt sich um einen kräftigen Nerv.▪Die Auslenkung des Mundwinkels ist deutlich.…”

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Dynamische Verfahren zur Gesichtsnervenrekonstruktion

Kofler¹,

Ingels²

2021

Laryngorhinootologie

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Zu den chirurgischen Behandlungsmöglichkeiten von Patienten mit Gesichtsnervenlähmung gehören statische und dynamische OP-Verfahren. Für eine Wiederherstellung der Lidschlussfunktion sind statische Rekonstruktionen ausreichend; soll das Lächeln rekonstruiert werden, das für das psychosoziale Leben des Patienten wichtig ist, kommen dynamische Verfahren zum Einsatz wie verschiedene Nervenanastomosen, die Labbé-Prozedur und der Grazilis-Lappen.

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Donor Nerve Selection in Facial Reanimation Surgery

Cited by 30 publications

References 14 publications

Microanatomy of the Frontal Branch of the Facial Nerve: The Role of Nerve Caliber and Axonal Capacity

Microanatomy of the Frontal Branch of the Facial Nerve: The Role of Nerve Caliber and Axonal Capacity

Rethinking Oncologic Facial Nerve Reconstruction in the Acute Phase Through Classification of the Level of Injury

Dynamische Verfahren zur Gesichtsnervenrekonstruktion

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