Hypoglossal–facial nerve ‘side’-to-side neurorrhaphy using a predegenerated nerve autograft for facial palsy after removal of acoustic tumours at the cerebellopontine angle

Zhang, Liwei; Li, Dezhi; Wan, Hong; Hao, Shuyu; Wang, Shiwei; Wu, Zhen; Zhang, Junting; Qiao, Hui; Li, Ping; Wang, Mingran; Su, Diya; Schumacher, Michaël; Liu, Song

doi:10.1136/jnnp-2014-308465

Cited by 17 publications

(12 citation statements)

References 34 publications

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“…Pavese et al used voluntary EMG to confirm the functional reinnervation 5–6 months after masseteric‐facial nerve suture, but did not present a EMG time course of the reinnervation . Evoked CMAP analysis by Zhang et al in 12 patients with incomplete facial palsy who received a hypoglossal‐facial side‐to‐side nerve suture revealed a variable onset between 3–9 months after surgery . Here, it has to be taken into account that the peripheral nerve suture was performed much more distally compared to a standard end‐to‐side hypoglossal‐facial nerve jump suture, ie, the time course of reinnervation should be much shorter than for the standard hypoglossal‐facial nerve jump nerve suture.…”

Section: Discussionmentioning

confidence: 99%

“…14 facial palsy who received a hypoglossal-facial side-to-side nerve suture revealed a variable onset between 3-9 months after surgery. 15 Here, it has to be taken into account that the peripheral nerve suture was performed much more distally compared to a standard end-to-side hypoglossal-facial nerve jump suture, ie, the time course of reinnervation should be much shorter than for the standard hypoglossal-facial nerve jump nerve suture. Zhang et al did not perform a MUP analysis using voluntary EMG data.…”

Section: Discussionmentioning

confidence: 99%

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Quantitative facial electromyography monitoring after hypoglossal‐facial jump nerve suture

Volk

Granitzka

et al. 2017

Laryngoscope Investig Oto

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Objectives/HypothesisThe time course of the reinnervation of the paralyzed face after hypoglossal‐facial jump nerve suture using electromyography (EMG) was assessed. The relation to the clinical outcome was analyzed.Study DesignRetrospective single‐center cohort studyMethodsReestablishment of motor units was studied by quantitative EMG and motor unit potential (MUP) analysis in 11 patients after hypoglossal‐facial jump nerve suture. Functional recovery was evaluated using the Stennert index (0 = normal; 10 = maximal palsy).ResultsClinically, first movements were seen between 6 and >10 months after surgery in individual patients. Maximal improvement was achieved at 18 months. The Stennert index decreased from 7.9 ± 2.0 preoperatively to a final postoperative score of 5.8 ± 2.4. EMG monitoring performed for 2.8 to 60 months after surgery revealed that pathological spontaneous activity disappeared within 2 weeks. MUPs were first recorded after the 2nd month and present in all 11 patients 8–10 months post‐surgery. Polyphasic regeneration potentials first appeared at 4–10 months post‐surgery. The MUP amplitudes increased between the 3rd and 15th months after surgery to values of control muscles. The MUP duration was significantly increased above normal values between the 3rd and 24th months after surgery.ConclusionReinnervation can be detected at least 2 months earlier by EMG than by clinical evaluation. Changes should be followed for at least 18 months to assess outcome. EMG changes reflected the remodeling of motor units due to axonal regeneration and collateral sprouting by hypoglossal nerve fibers into the reinnervated facial muscle fibers.Level of Evidence3b.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quantitative facial electromyography monitoring after hypoglossal‐facial jump nerve suture

Volk

Granitzka

et al. 2017

Laryngoscope Investig Oto

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“…physiological recovery of facial function may be induced by FN reinnervation (27), indicating the importance of participation of FN axons in regaining facial function after HN-FN neurorrhaphy. In previous studies, HN-FN side-to-side neurorrhaphy preserved the remaining and/or spontaneously regenerating injured facial axons while inducing innervation of paralyzed facial muscles by HN fibers, leading to facial and hypoglossal double axonal innervation (2,3). In these patients, conversion of hypoglossal function to facial function occurred in most cases post-operatively.…”

Section: Discussionmentioning

confidence: 88%

“…However, this issue raises the question of how to address the injured FN when using hypoglossal-facial nerve neurorrhaphy (HN-FN) or other nerve transfer methods. In previous studies, we modified the classical method of HN-FN side-to-end neurorrhaphy by side-to-side to preserve the remaining FN fibers and the possibility of spontaneous regrowth of the FN, showing that innervations of both HN and FN fibers could be achieved with the return of certain facial functions (2,3). However, the importance and usefulness of the remaining or few spontaneously regenerated FN fibers in regaining facial function when using HN-FN neurorrhaphy to treat facial paralysis remain controversial.…”

Section: Introductionmentioning

confidence: 99%

Effects of the Remaining and/or Spontaneously Regenerated Facial Axons After Hypoglossal–Facial Nerve Neurorrhaphy for Facial Paralysis

Zhuang

Ling

et al. 2020

Front. Neurol.

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Background: The incidence of incomplete facial paralysis is now relatively higher in clinical practice, and surgical intervention is still desirable for patients with significant facial paralysis. However, the importance and usefulness of the remaining and/or spontaneously regenerated facial axons for regaining facial function when using hypoglossal-facial nerve (HN-FN) neurorrhaphy or other nerve-transferring methods to treat facial paralysis remain controversial. Objective: We designed a rat FN injury model with preservation of the anatomical structure followed by HN-FN side-to-side neurorrhaphy to investigate the effects of the remaining and/or spontaneously regenerated FN axons on restoration of facial function. Methods: After the evident return of facial function in 3 months following FN injury and HN-FN side-to-side neurorrhaphy, the FN was cross-sectioned again according to different ratios (0, 30, 70, and 100%) at the site rostral to the initial FN injury to retain, partially abolish, or completely abolish the spontaneously regenerated FN axons that had successfully reinnervated the paralyzed facial muscles. Then, FN function was assessed using clinical evaluation methods and electrophysiological examinations, as well as retrograde labeling and axonal counting assessments of the reconstructed nerve pathways. Results: The evaluations show that the remaining facial axons not only influenced the extent of regained function, such as facial symmetry, eye blinking activity, and vibrissae motion, but also had an impact on regeneration and innervation of hypoglossal motoneurons. Conclusion: Participation of remaining or spontaneously regenerated facial axons plays an important role in innervating paralyzed facial muscles by both facial and hypoglossal motoneurons, thus, reestablishing facial function.

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“…The surgical treatment of patients with facial nerve paralysis through a neurosurgery operation for facial nerve-hypoglossal nerve anastomosis allows restoration of the damaged facial nerve. Facial exercise training enables facial nerve function improvement or recovery [16]. The purpose of the operation is to bring new hope to patients a change in their psychological state.…”

Section: Patients Who Have Been Treated With Surgery Have High Levelsmentioning

confidence: 99%

Analysis of post-traumatic growth status and its influencing factors in patients with facial palsy

Fan

et al. 2018

Chin Neurosurg Jl

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Background: Facial nerve paralysis in patients occurs in varying degrees of self-image disorders, both physically and mentally, resulting in low self-esteem, anxiety, depression, and even suicide; however, there were few researches on psychological problems in facial palsy patients at home and abroad. This study's objective was to investigate post-traumatic growth (PTG) in facial nerve palsy patients and analyze its influencing factors. Methods: Using the convenience sampling method, a total of 47 patients with facial nerve paralysis were enrolled in the current study between June 1, 2016, and May 31, 2017. Post-traumatic growth rating scale was utilized to investigate the post-traumatic growth of these patients, and factors influencing patients' post-traumatic growth were analyzed through collecting the general sociological information, disease-related information, simple coping style questionnaire, and social support rating scale. Results: The total score of post-traumatic growth in patients with facial nerve paralysis was mean (M) = 63.1, standard deviation (SD) = 19.14. The ranking of five dimensional scores from high to low was as follows: new possibilities, personal strength enhancement, appreciation of life, mental changes, and improvement of relationships with others. Multiple linear regression analysis showed that six variables, namely, the personality type, duration with facial nerve paralysis, and four coping styles, consisting of three types of positive coping styles and one negative coping style, could explain 71.6% of the total post-traumatic growth score. Conclusions: Post-traumatic growth in facial nerve palsy patients is moderate. The personality type of patients, the disease duration, and the coping style are the primary influencing factors. Therefore, clinical staffs should perform personalized nursing protocol and psychological intervention for facial nerve palsy patients to reduce their negative mood, improve their compliance with treatment, and help them recover more rapidly.

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Hypoglossal–facial nerve ‘side’-to-side neurorrhaphy using a predegenerated nerve autograft for facial palsy after removal of acoustic tumours at the cerebellopontine angle

Abstract: JS2013-001-02.

Cited by 17 publications

References 34 publications

Quantitative facial electromyography monitoring after hypoglossal‐facial jump nerve suture

Quantitative facial electromyography monitoring after hypoglossal‐facial jump nerve suture

Effects of the Remaining and/or Spontaneously Regenerated Facial Axons After Hypoglossal–Facial Nerve Neurorrhaphy for Facial Paralysis

Analysis of post-traumatic growth status and its influencing factors in patients with facial palsy

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