Functional Recovery After Facial Nerve Cable Grafting in a Rodent Model

Hohman, Marc H.; Kleiss, Ingrid J.; Knox, Christopher; Weinberg, Julie S.; Heaton, James T.; Hadlock, Tessa A.

doi:10.1001/jamafacial.2013.1431

Cited by 15 publications

(14 citation statements)

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“…). Animals achieved approximately a 20% of normal whisking amplitude, which was consistent with previously reported values …”

Section: Resultssupporting

confidence: 92%

“…In this study, by employing a quantitative technique for measuring the recovery of whisking, in combination with triple‐retrograde labeling of nerves, we observed the results of two neural suture methods and found that facial nerve suture with venous ensheathment failed to apparently improve the quality of regenerated axons in terms of functions and morphology. To some extent, our study provided more information that might help resolve the contradictions with respect to venous ensheathment.…”

Section: Discussionmentioning

confidence: 95%

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The effects of venous ensheathment on facial nerve repair in the rat

et al. 2017

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Objective To investigate the protective effect of autologous venous ensheathment on sutured rat facial nerve and to test whether the ensheathment could improve the functional recovery of repaired nerve and accuracy of axonal growth. Study design In vivo study. Methods Forty-six rats were examined, with 6 rats serving as normal controls and 40 receiving facial nerve transection and suture repair (SR) or transection and suture repair with an additional venous ensheathment (VE). Then they were subjected to functional testing, histological assessment of nerve specimens or retrograde tracing, respectively. Results At the postoperative day (POD) 60, the venous ensheathment showed no adhesion at the surrounding tissues. No significant difference in neuroma formation was found between the two surgical manipulations (SR and VE groups) (p<0.05). Retrogradely-labeled motoneurons in facial nuclei were extremely disorganized after the facial nerve undertook surgical manipulation. In all manipulated groups, double retrogradely-labeled neurons, indicative of aberrant axonal branching during regeneration, could be observed after peripheral manipulation across all time points. With the two facial surgical manipulations, the average count of double-labeled neurons at POD 60 was significantly less than at POD 21 (p<0.05). Conclusions Autologous venous ensheathment couldn’t help with the functional recovery of facial nerve or improve the accuracy of axonal regeneration. Further studies are warranted to elucidate the effects of venous ensheathment in other motor and sensory nerve models.

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“…). Animals achieved approximately a 20% of normal whisking amplitude, which was consistent with previously reported values …”

Section: Resultssupporting

confidence: 92%

Section: Discussionmentioning

confidence: 95%

The effects of venous ensheathment on facial nerve repair in the rat

et al. 2017

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“…9 Recent studies have shown that cable nerve graft interpositioning provides as good a result as a primary end-to-end coaptation. 2,17,47,50 However, the best possible postoperative outcome is HB Grade III, regardless of the graft material used or the technique employed, because the frontal muscle function rarely recovers and a certain degree of synkinesis is unavoidable after grafting. 2,30,39 The factors that could influence the results of FN reconstruction are discussed below.…”

Section: Discussionmentioning

confidence: 99%

Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases

Prasad¹,

Karthikeyan²,

Piccirillo³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE The aim in this study was to review the technique and outcomes of cable graft interpositioning of the facial nerve (FN) in lateral skull base surgeries. METHODS The authors retrospectively evaluated data from patients who had undergone cable graft interpositioning after nerve sacrifice during skull base tumor removal between June 1987 and May 2015. All patients had undergone lateral skull base approaches to remove tumors at a quaternary referral center in Italy. Facial nerve function was evaluated before and after surgery using the House-Brackmann (HB) grading system. RESULTS Two hundred thirteen patients were eligible for study. The mean follow-up was 44.3 months. The most common pathology was vestibular schwannoma (83 cases [39%]), followed by FN tumor (67 cases [31%]). Facial nerve tumors had the highest incidence of nerve interruption (67 [66%] of 102 cases). Preoperative FN function was normal (HB Grade I) in 105 patients (49.3%) and mild (HB Grade II) in 19 (8.9%). At the last postoperative follow-up, 108 (50.7%) of the 213 patients had recovered to Grade III nerve function. Preoperative HB grading of the FN was found to have a significant effect on outcome (p = 0.002). CONCLUSIONS Cable graft interpositioning is a convenient and well-accepted procedure for immediate restoration of the FN. The study results, over a large number of patients, showed that the stitch-less fibrin glue-aided coaptation technique yields good results. The best possible postoperative result achieved was an HB Grade III. The chances of a good postoperative result increase when FN function is normal preoperatively. Slow-growing tumors of the cerebellopontine angle had a favorable outcome after grafting.

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“…In general, we tell patients that 6 to 12 months are required to see recovery of facial tone followed by onset of facial movement. 7,14 Patients who undergo radical parotidectomy typically have advanced disease and may not survive long enough after treatment to realize the benefit of cable grafting. The duration of paralysis before nerve reconstruction also affects reconstructive options.…”

Section: Discussionmentioning

confidence: 99%

Facial Nerve Reconstruction With Concurrent Masseteric Nerve Transfer and Cable Grafting

Owusu

Truong

Kim

2016

JAMA Facial Plast Surg

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ost tumors of the parotid gland are benign and can be adequately treated with facial nerve-sparing parotidectomy. Malignant tumors constitute approximately 20% of all tumors of the parotid gland, and about 20% of these will have facial nerve involvement. 1,2 Total parotidectomy with resection of the involved portion of the facial nerve is recommended when the tumor infiltrates or is adherent to the facial nerve. Immediate reconstruction of the resected nerve should be performed when feasible to mitigate the devastating effects of facial paralysis. 3 Facial paralysis has functional and aesthetic effects, including an asymmetric smile, oral incompetence, nasal obstruction, and lagophthalmos with a potential for corneal injury. These physical effects can have a significant psychosocial impact and result in a decline in the patient's quality of life. 4 Three options exist for nerve reconstruction, which depend on the extent of the nerve resection. Primary tension-free coaptation of the nerve segments is the best option when feasible. Cable grafting between the proximal and distal nerve stump is performed when the length of the resected nerve segment prevents primary coaptation, and a mastoid dissection may be indicated to gain access to the proximal stump of the facial nerve in some cases. 5 Nerve substitution is indicated when the proximal segment of the facial nerve is not accessible. Donor nerve graft options frequently used in facial nerve reconstruction include the great auricular nerve, sural nerve, and medial antebrachial cutaneous nerve. The medial antebrachial cutaneous nerve can be harvested with multiple branches that make it suitable for reconstruction of multiple peripheral branches. Compared with primary nerve repair, cable grafting has a slower return of nerve function and an increased rate of synkinesis. 5-7 Synkinesis results from aberrant axonal regeneration, which causes simultaneous movement of multiple muscle groups when 1 group is activated. Using a separate neural input for innervation of the upper and lower facial muscle groups can prevent or decrease synkinesis. A 2011 report by IMPORTANCE Reconstruction of the facial nerve after radical parotidectomy is commonly performed with cable grafting, which is associated with slow recovery of nerve function and synkinesis. OBJECTIVE To describe facial nerve reconstruction after radical parotidectomy using concurrent masseteric nerve transfer and cable grafting. DESIGN, SETTING, AND PARTICIPANTS This retrospective medical record review at a tertiary referral hospital included 9 patients who underwent concurrent masseteric nerve transfer and cable grafting for facial nerve reconstruction performed by a single surgeon from January 1, 2014, to October 31, 2015. Final follow-up was completed on March 14, 2016. MAIN OUTCOMES AND MEASURES Improvement in resting facial symmetry and oral commissure excursion and synkinesis. RESULTS Nine patients (6 women; mean age, 62.6 years; age range, 51-73 years) underwent immediate facial nerve reconstruction after radic...

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Functional Recovery After Facial Nerve Cable Grafting in a Rodent Model

Cited by 15 publications

References 15 publications

The effects of venous ensheathment on facial nerve repair in the rat

The effects of venous ensheathment on facial nerve repair in the rat

Surgical technique and results of cable graft interpositioning of the facial nerve in lateral skull base surgeries: experience with 213 consecutive cases

Facial Nerve Reconstruction With Concurrent Masseteric Nerve Transfer and Cable Grafting

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