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PubMed2005

Changes in expression of prosaposin in the rat facial nerve nucleus after facial nerve transection.

Prosaposin is the precursor of saposins A, B, C and D, which are activators of sphingolipid hydrolases. In addition, unprocessed prosaposin functions as a neurotrophic factor in the central and peripheral nervous systems by acting to prevent neuronal apoptosis, to elongate neurites and to facilitate myelination. In this study, the expression pattern of prosaposin in the facial nerve nucleus after facial nerve transection was examined by immunohistochemistry and in situ hybridization. Prosaposin immunoreactivity in the neurons on the operated side facial nerve nucleus showed a biphasic pattern: it was significantly increased on day 3 after transection, decreased dramatically on day 7, started to increase gradually on day 14 and reached another peak on day 21 after transection. Significant increases in the levels of prosaposin mRNA were identified in the neurons on the operated side, suggesting that prosaposin was synthesized vigorously by the neurons themselves in the case of facial nerve transection. The diverse changes in prosaposin immunoreactivity during the process of facial nerve regeneration may reflect the diverse neurotrophic activities of prosaposin in facial motoneurons.

Animals↗
PubMed1997

Effect of delayed facial-facial nerve suture on facial nerve regeneration. A horseradish peroxidase tracing study in the rat.

In clinical practice, the lesioned facial nerve is usually restored by facial-facial nerve anastomosis (FFA) with some delay. The optimal time-point for facial nerve reconstruction is still unknown. This study, using rats, compared the effects of immediate and delayed FFA, i.e. FFA 7-56 days after interruption of the facial nerve. Muscle reinnervation was studied 42 days after nerve suture by counting all retrogradely labelled facial motoneurons after injection of horseradish peroxidase (HRP) into the whiskerpad of the rats. Immediate FFA caused a local hyperinnervation of the target muscle, i.e. the projection of more neurons into the whiskerpad muscles than under normal conditions. FFA delayed for 7 days resulted in a significant suppression of this hyperinnervation, whereas longer delay times of 10-56 days showed no difference from immediate FFA.

Analysis of Variance↗
PubMed1995

Re-innervation of facial nerve territory using a composite hypoglossal nerve--muscle autograft--facial nerve bridge. An experimental model in sheep.

The hypoglossal nerve has been used both entirely and in part to repair the facial nerve. Using the partial technique it may be difficult to obtain sufficient length and a free interposed graft is then required to extend the hypoglossal element. In six sheep the facial nerve was excised between its emergence from the stylomastoid foramen and its bifurcation in the parotid gland. The hypoglossal nerve was exposed and split longitudinally producing a limb which was reflected towards the distal stump of the facial nerve. This left a gap of 4-5 cm which was bridged with a freeze-thawed coaxially aligned skeletal muscle autograft. The sheep were examined at 8 months. Laser doppler blood-flow studies showed the blood-flow distal to the graft to be about 25% of that at an equivalent site on the normal side. Peak nerve conduction velocities were also reduced on the repaired side but stimulation of the proximal hypoglossal nerve was nevertheless capable of causing adequate contraction of both facial and tongue muscles. Histological comparison of the repaired facial nerves with equivalent sites on the normal side showed a reduction in mean axon and fibre diameters with normal myelin sheath thickness for the regenerated axon sizes. All of these features are to be expected in a regenerated nerve and are consistent with a good level of recovery of function.

Animals↗
PubMed1994

Chronic vascular irritation of the facial nerve causes facial spasm in rats.

The abnormal muscle response, elicited by electrical stimulation of one branch of the facial nerve and recorded from muscles innervated by another branch, has been used previously as an objective sign of hemifacial spasm in the development of animal models of this disorder. In the present study we recorded spontaneous electromyographic activity from the orbicularis oculi muscle from both sides in rats in which a demyelination of the peripheral portion of the facial nerve and vascular contact had been made previously. The root mean square value of the electromyographic activity on the affected side was significantly larger than that on the unaffected side in all rats in which the vascular irritation had caused the abnormal muscle response to appear. The results support our earlier finding that vascular contact together with demyelination of the peripheral facial nerve can cause the development of signs of hemifacial spasm, including involuntary muscle contractions.

Animals↗
PubMed2004

[A study of 108 cases on facial nerve contralateral innervation after facial nerve injury].

OBJECTIVE: To investigate the facial nerve contralateral innervation of patients with facial nerve injury. METHODS: Electroneuronography (ENoG) of 22 university student volunteers (US) without any injury and systemic diseases and 108 patients with facial nerve injury were measured. The patients were divided into three groups: iatrogenic, traumatic, and Bell's palsy groups. When stimulating the facial nerve at the site below the lobule and behind the ramus, ENoGs of each branch of the facial nerve on ipsilateral and contralateral sides were recorded. A total of 76 branch I, 81 branch II, 88 branch III, and 66 branch IV were measured. RESULTS: (1) There were no significant differences among three patient groups (P > 0.05). (2) The ratios of contralateral innervation of the branch I and II of the patients were significantly. greater than those of the US group (P < 0.001). (3) The ratio of contralateral innervation of the branch I was greater than that of the branch II in the patients (P < 0.001). CONCLUSION: The contralateral innervation of the facial nerve increases after facial nerve injured.

Adolescent↗
PubMed1997

Surgical treatment of the facial nerve in facial paralysis.

This article discusses the surgery for acute facial paralysis of idiopathic, traumatic, infectious, and neoplastic etiologic agents. Indications, results, and details of surgical techniques of facial nerve exploration, decompression, rerouting, and repair are provided.

Decompression, Surgical↗
PubMed1995

The anatomy of the lateral cutaneous nerve of the thigh--a possible donor nerve for facial nerve repair.

One hundred anterior branches of the lateral cutaneous nerve of the thigh were dissected and measured in 50 adult cadavers. The results show that this nerve was present in all sides, and the average length from the point of the nerve piercing the fascia lata to the point of its first branch was about 79 mm, the average width was 2.25 mm, and the average thickness was 0.79 mm. It was found that the nerve was approximately along the line between the anterior superior iliac spine and the midpoint of the upper margin of the patella. This study presents a simple method of locating this nerve for clinical reference. The results also reveal that this nerve is a possible donor for facial nerve repair.

Adult↗
PubMed1998

Intraoperative facial nerve monitoring (IFNM) predicts facial nerve outcome after resection of vestibular schwannoma.

Intraoperative facial nerve monitoring (IFNM) is a suitable technique for intraoperative facial nerve identification and dissection, especially in large vestibular schwannomas (VS) (acoustic neuroma). To evaluate its feasibility for estimating functional nerve outcome after VS resection 60 patients underwent surgery using IFNM. Out of this group the last 40 patients were included in a prospective study evaluating the prognostic value of various IFNM parameters (proximal and distal absolute EMG amplitude, stimulation threshold, and proximal-to-distal amplitude ratio) for prediction of initial postoperative facial nerve function and recovery of function. Stimulation threshold and absolute EMG amplitude proximally at the brain stem were both predictive for postoperative nerve function. Good initial facial nerve outcome (modified House Brackmann grading, mHB degree I and degree II) was found in 15/16 patients with a proximal EMG amplitude greater than 800 microV and in 19/22 patients with proximal stimulation threshold less than 0.3 mA. Sixteen of 16 patients with proximal stimulation threshold equal to or greater than 0.3 mA had moderate-to-severe facial palsy (mHB degree III or worse). Six of six patients without evokable proximal amplitude initially had insufficient nerve function (mHB degree IV). Intraoperative decrease of the proximal amplitude was associated with an unfavourable outcome, whereas distal amplitudes usually stayed unchanged. Mean distal EMG amplitudes were also found to be decreased with poor nerve function, which may mean that the tumour had already affected the nerve. A proximal amplitude of 300 microV or less and a proximal-to-distal amplitude ratio below 1:3 were found in the absence of functional recovery in 6/8 (75%) and 5/6 (83%) patients with initial mHB degree IV, respectively. Two patients with initial mHB degree IV improved to mHB degree III despite intraoperative evidence of missing functional nerve integrity. Therefore, functional recovery cannot be predicted by IFNM in all cases of anatomical nerve preservation. We conclude that a minimum follow-up period of 1 year may still be advisable even in certain patients without evidence of intraoperative functional nerve integrity.

Adult↗
PubMed1996

Iatrogenic facial nerve injury: the role of facial nerve monitoring.

Intraoperative facial nerve monitoring has emerged as a powerful tool for facilitation of surgery involving the facial nerve. This tool must be properly applied and maintained, however, in order to avoid untoward results and to maximize its potential benefits. Facial nerve monitoring is best suited for prevention of iatrogenic injury. Once injury has become established, its value may be severely limited, especially for moderate to severe injury, in which visual assessment of injury is still the most effective means to determine the need for repair. The most valuable derivative of facial nerve monitoring is enhanced awareness of the edge of the facial nerve contour. This allows strategic alterations in surgical technique for improved facial nerve functional preservation. Although facial nerve monitoring appears to have already had a favorable influence on facial nerve preservation, further improvement seems likely over time through an ongoing process of trial and error.

Ear Diseases↗
PubMed1975

[Successful decompression of the facial nerve in facial spasm (author's transl)].

A case of successful surgical treatment of facial spasm by seventh nerve decompression is reported in a female patient who failed to improve by usual methods of treatment. Prior to surgery, tomography of the facial canal was obtained, and revealed an osseous spine involving the posterior wall of the canal. During surgery, this spine was uncovered and removed with pneumatized retrofacial air cells. The patient's spasm disappeared completely following surgery. The present case indicates that the possibility of osseous spines impinging on the facial nerve should be considered in all cases of facial spasm.

Facial Nerve↗
PubMed2004

[A variant of Guillain-Barré syndrome with prominent bilateral peripheral facial nerve palsy--facial diplegia and paresthesias].

A patient with Facial diplegia and paresthesias, a rare regional variant of Guillain-Barré syndrome (GBS), is described. A 37-year-old woman developed paresthesias in the distal limbs and subsequently bifacial weakness. She had had a preceding episode of laryngitis. Neurological examination showed severe facial diplegia with loss of taste sensation on the tip of the tongue. Limb muscle power was preserved. Deep tendon reflexes were generally absent. She complained of paresthesias in the distal limbs, but sensory examination was normal. Cerebrospinal fluid showed albuminocytological dissociation. Electrophysiological studies revealed severe facial nerve involvements and demyelinative findings in her limbs. Intravenous immunoglobulin rapidly improved the abnormal sensation in her limbs. Although facial diplegia gradually lessened after the therapy, mild residual weakness was noted 6 months after the neurological onset. To diagnose facial diplegia and paresthesias, it is important to clarify the findings common to typical GBS such as the antecedent illness, acute and monophasic course, distal paresthesias, areflexia, cerebrospinal fluid albuminocytological dissociation, and demyelinative conduction abnormalities in the limbs.

Adult↗
PubMed1998

[Histopathology observations of the facial nerve on dehiscence of the facial nerve canal].

OBJECTIVE: To explore the possible histopathologic changes induced by the seriously defective epinurium on congenital dehiscent facial nerve canal. METHODS: The facial nerves at the dehiscent facial nerve canal of 885 human temporal bones from otopathology laboratory of the University of Minnesota, USA were observed histopathologically under light microscope. RESULTS: It showed that the seriously defective epineurium at the dehiscence was found in 48 ears. Of the 48 ears, the facial nerves in forty ears had herniated out from the dehiscence area, in thirteen ears on the outgrowing facial nerve had at the dehiscence areas and facial nerves in three ears with otitis media was obviously infiltrated with inflammatory cells. No similar pathologic change was found in all the 837 ears with the dehiscence covered by epineurium. CONCLUSION: The seriously defective epineurium at the dehiscencesite is a histological cause for the herniation of facial nerve and formation of outgrowing Schwannomas and inflammatory infiltration of facial nerve.

Facial Nerve↗
PubMed2006

[Side-to-end hypoglossal-facial nerve anastomosis with intratemporal facial nerve translocation. Long-term results and indications in 15 cases over 10 years].

OBJECTIVES: To describe functional results concerning facial and lingual mobility after side-to end hypoglossal facial nerve anastomosis. MATERIAL AND METHODS: 15 patients were operated on between 1993 and 2002 (11 cases of facial nerve injury during vestibular schwannoma surgery, and 4 cases of brainstem stroke). Were assessed at a minimum of 18 months postop tonus and facial voluntary movements recovery (modified House Brackmann (HB) grading), lingual mobility (amyotrophy and self-evaluation questionnaire), and patients' overall satisfaction (questionnaire). RESULTS: The mean delay to evaluation was 57.5 months. The tonus recovery appeared within 6 to 8 months (mean 28.5 weeks, SD 4.6 weeks). All patients recovered a normal tonus. The facial function was evaluated HB grade III in II cases (73.3%), grade IV in 3 cases (20%) and grade V in one (6.6%). Eye occlusion was obtained within 13.6 months on average (SD 2.6 months) in all cases except one. The blepharorraphy was maintained in 2 patients. No facial spasm was noted. The lingual motricity troubles were absent in 93.3% of cases. Patients were satisfied in 93.3% of cases. The less satisfactory results were observed when patients were managed late (>2 years after nerve section) and in case of brainstem stroke. CONCLUSION: This technique seems to be very efficient. It presents the advantage to preserve lingual motricity and to decrease postoperative problems of midface spasticity.

Adult↗