Extension of Neuromuscular Pedicles and Direct Nerve Implants in the Rabbit

Goding, George S.; Cummings, Charles W.; Bright, Don A.

doi:10.1001/archotol.1989.01860260091021

Cited by 14 publications

(14 citation statements)

References 11 publications

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“…Muscle force measurement is widely used to assess the mechanical function and contractile properties of a muscle [35–41]. Our studies [28,30–33] and others [23,25,42,43] have demonstrated that force measurement is a reliable technique in determining the degree of functional recovery of a reinnervated muscle. The denervated muscle is characterized by reduced muscle mass, decreased fiber size, increased connective tissue, and reduced metabolic capacity [44,45] which can be reversed by reinnervation [28,33,46].…”

Section: Discussionmentioning

confidence: 90%

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Muscle reinnervation with nerve-muscle-endplate band grafting technique: correlation between force recovery and axonal regeneration

Sobotka

2015

Journal of Surgical Research

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Background This study was designed to determine the correlation between functional recovery and the extent of axonal regeneration after muscle reinnervation with our recently developed nerve-muscle-endplate band grafting (NMEG) technique in a rat model. Materials and methods The right experimentally paralyzed sternomastoid (SM) muscle by nerve transection was immediately reinnervated with a NMEG pedicle harvested from a neighboring sternohyoid (SH) muscle. The NMEG pedicle contained a muscle block (6x6x3 mm), a donor nerve branch with nerve terminals and a motor endplate band. Three months after surgery, the tetanic force of the SM muscle was measured and the regenerated axons in the muscle were detected using neurofilament immunohistochemistry. Results The results showed that the maximal tetanic force (a measure of muscle functional recovery) of the NMEG reinnervated SM muscle reached up to 66.0% of the normal control. The wet weight of the reinnervated SM muscle (a measure of muscle mass recovery) was 87.2% of the control. The area fraction of the regenerating axons visualized with neurofilament staining within the NMEG reinnervated SM muscle (a measure of muscle reinnervation) was 42.3%. A positive correlation was revealed between the extent of muscle reinnervation and maximal muscle force. Conclusions Our newly developed NMEG technique results in satisfactory functional outcomes and nerve regeneration. Further improvement in the functional recovery after NMEG reinnervation, could be achieved by refining the surgical procedure and creating an ideal environment that favors axon-endplate connections and accelerates axonal growth and sprouting.

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Section: Discussionmentioning

confidence: 90%

“…The only reconstructive option to reinnervate that muscle is direct nerve implantation (i.e., muscular neurotization) [17,18] or nerve-muscle pedicle (NMP) transfer. The NMP technique has been used for laryngeal [19–22] and facial reinnervation [23–25]. However, controversy exists concerning the success rate of the NMP method.…”

Section: Introductionmentioning

confidence: 99%

Muscle reinnervation with nerve-muscle-endplate band grafting technique: correlation between force recovery and axonal regeneration

Sobotka

2015

Journal of Surgical Research

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“…In 1980's, Cummings and colleagues applied the NMP technique to facial reinnervation in animal experiments. 72-74 Clearly, this method has been employed primarily to treat paralyzed larynx and face. Up to date, many studies on the NMP reinnervation procedure have been reported in the literature over the past 40 years.…”

Section: Discussionmentioning

confidence: 99%

“…Studies showed that NMP transfer resulted in functional outcomes similar to the DNI when evaluated by electromyography (EMG) and muscle tension. 72,74 NMP technique has been hampered by the fact that the muscle pedicle is harvested at the motor point (entry of the nerve into the muscle) where a nerve branch enters the muscle without considering the MEP band and nerve terminals. Some authors felt it probable that the small NMP might in fact contain cut ends of the nerve that acted in a fashion similar to that of a DNI.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors felt it probable that the small NMP might in fact contain cut ends of the nerve that acted in a fashion similar to that of a DNI. 72,74 This seems likely because the nerves supplying a given muscle do not immediately terminate on entering the muscles, but run up or down for several millimeters and then give off numerous terminals innervating the MEPs (Figure 6). While removing a 2- to 3-mm cube of the donor muscle at the motor point, 45,72-74 the donor nerve may be cut at the level of the main trunk or major branches.…”

Section: Discussionmentioning

confidence: 99%

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Nerve-Muscle-Endplate Band Grafting

Sobotka

2011

Operative Neurosurgery

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Background As currently existing reinnervation methods result in poor functional recovery, there is a great need to develop new treatment strategies. Objectives To investigate the efficacy of our recently developed nerve-muscle-endplate band grafting (NMEG) technique for muscle reinnervation. Methods Twenty-five adult rats were used in this study. Sternohyoid (SH) and sternomastoid (SM) muscles served as a donor and a recipient muscle, respectively. Neural organization of the SH and SM muscles and surgical feasibility of the NMEG technique were determined. A NMEG contained a muscle block, a nerve branch with nerve terminals, and a motor endplate (MEP) band with numerous neuromuscular junctions. After a 3-month recovery period, the degree of functional recovery was evaluated using maximal tetanic force measurement. Retrograde horseradish peroxidase (HRP) tracing was used to track the origin of the motor innervation of the reinnervated muscles. The reinnervated muscles were examined morphohistologically and immunohistochemicaly to assess the extent of axonal regeneration. Results Nerve supply patterns and locations of the MEP bands in the SH and SM muscles were documented. The results demonstrated that the reinnervated SM muscles gained motor control from the SH motoneurons. NMEG technique yielded extensive axonal regeneration and significant recovery of SM muscle force generating capacity (67% of the control). The mean wet weight of the NMEG reinnervated muscles (87% of the control) was greater than that of the denervated SM muscles (36% of the control). Conclusion NMEG resulted in successful muscle reinnervation and functional recovery. This technique holds promise in the treatment of muscle paralysis.

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Locations of the Motor Endplate Band and Motoneurons Innervating the Sternomastoid Muscle in the Rat

Zhang

et al. 2010

The Anatomical Record

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Sternocleidomastoid (SCM) is a long muscle with two bellies, sternomastoid (SM) and cleidomastoid (CM) in the lateral side of the neck. It has been widely used as muscle and myocutaneous flap for reconstruction of oral cavity and facial defects and as a candidate for reinnervation studies. Therefore, exact neuroanatomy of the SCM is critical for guiding reinnervation procedures. In this study, SM in rats were investigated to document banding pattern of motor endplates (MEPs) using whole-mount acetylcholinesterase (AChE) staining and to determine locations of the motoneurons innervating the muscle using retrograde horseradish peroxidase (HRP) tracing technique. The results showed that the MEPs in the SM and CM were organized into a single band which was located in the middle portion of the muscle. After HRP injections into the MEP band of the SM, ipsilaterally labeled motoneurons were identified in the caudal medulla oblongata (MO), C1, and C2. The SM motoneurons were found to form a single column in lower MO and dorsomedial (DM) nucleus in C1. In contrast, the labeled SM motoneurons in C2 formed either one (DM nucleus), two [DM and ventrolateral (VL) nuclei], or three [DM, VL, and ventromedial (VM)] columns. These findings are important not only for understanding the neural control of the muscle but also for evaluating the success rate of a given reinnervation procedure when the SM is chosen as a target muscle. Anat Rec, 294:295-304, 2011. V V C 2010 Wiley-Liss, Inc.

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Extension of Neuromuscular Pedicles and Direct Nerve Implants in the Rabbit

Cited by 14 publications

References 11 publications

Muscle reinnervation with nerve-muscle-endplate band grafting technique: correlation between force recovery and axonal regeneration

Muscle reinnervation with nerve-muscle-endplate band grafting technique: correlation between force recovery and axonal regeneration

Nerve-Muscle-Endplate Band Grafting

Locations of the Motor Endplate Band and Motoneurons Innervating the Sternomastoid Muscle in the Rat

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