CO2 laser repair of the facial nerve: an experimental study in the rat

AbstractThe facial nerve is often injured by trauma, infection or during the course of tumour resection. Many techniques of nerve anastomosis have been described with the current standard nerve repair using the microscope and monofilament suture. The purpose of this study was to evaluate the CO2 surgical laser as a tool for facial nerve anastomosis. Following preliminary electrical measurements 36 nerves were anastomosed using either laser or conventional monofilament suture. Laser anastomosis had neither beneficial nor detrimental effects on nerve regeneration. This method of anastomosis may be advantageous when surgical access is limited. In addition this study found that the use of CO2 laser as a dissecting or vapourizing tool in proximity to intact facial nerves results in degenerative changes.

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Anastomotic Methods of Facial Nerve Repair-How to Do It

Otolaryngology ◽

10.1016/s0194-5998(05)80434-6 ◽

1995 ◽

Vol 112 (5) ◽

pp. P164-P164

Author(s):

Ricardo F. Bento

Keyword(s):

Facial Nerve ◽

Nerve Repair ◽

Nerve Degeneration ◽

Educational Objectives ◽

Nerve Anastomosis

Educational objectives: To know about nerve degeneration and regeneration and how to choose the best technique for facial nerve anastomosis.

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Facial Reanimation after Facial Nerve Injury

Neurosurgery ◽

10.1227/00006123-199110000-00014 ◽

1991 ◽

Vol 29 (4) ◽

pp. 568-574 ◽

Cited By ~ 28

Author(s):

Robert H. Rosenwasser ◽

Emil Liebman ◽

Fernando D. Jimenez ◽

William A. Buchheit ◽

David W. Andrews

Keyword(s):

Facial Nerve ◽

Nerve Repair ◽

Surgical Techniques ◽

Nerve Transfers ◽

Muscle Transfers ◽

Facial Reanimation ◽

Nerve Anastomosis ◽

Difficult Challenge ◽

And Function ◽

Regional Muscle

Abstract Patients with facial paralysis are often seen in neurosurgical practice. Obtaining full facial symmetry and function after facial nerve damage presents the neurosurgeon with a difficult challenge. Various surgical techniques have been developed to deal with this problem. These include primary nerve repair, nerve to nerve anastomosis, nerve grafting, neurovascular pedicle grafts, regional muscle transposition, microvascular muscle transfers, and nerve transfers. Patient selection, timing of surgery, and details of surgical technique are discussed. The results of hvpoglossal-facial anastomosis in 24 patients are described.

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Long-term Functional Outcome in Facial Nerve Repair Using Exclusively Fibrin Glue in Terminoterminal Facial Nerve Anastomosis and Facial Nerve Grafting

Otology & Neurotology ◽

10.1097/00129492-200200001-00212 ◽

2002 ◽

Vol 23 (Sup 1) ◽

pp. S81

Author(s):

Bozorg A Grayeli ◽

I Mosnier ◽

P Crosara ◽

D Bouccara ◽

L Cazelles ◽

...

Keyword(s):

Facial Nerve ◽

Functional Outcome ◽

Fibrin Glue ◽

Nerve Repair ◽

Nerve Grafting ◽

Nerve Anastomosis

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Cross-Face Facial Nerve Anastomosis: Historical Notes

Ear Nose & Throat Journal ◽

10.1177/014556139607500607 ◽

1996 ◽

Vol 75 (6) ◽

pp. 343-354 ◽

Cited By ~ 24

Author(s):

L. F. Scaramella

Keyword(s):

Facial Nerve ◽

Petrous Bone ◽

Automobile Accident ◽

Facial Nerve Surgery ◽

Proximal Stump ◽

Facial Nerves ◽

Nerve Anastomosis ◽

Acoustic Tumor ◽

Nerve Surgery ◽

Original Concept

The anastomosis between the two facial nerves for the treatment of facial paralysis, in which the proximal stump of the severed facial nerve is not accessible, was utilized in eleven patients. The palsy was secondary to resection of an acoustic tumor in nine patients, sarcoma of the petrous bone was the cause in one and an automobile accident in the other. The original concept of anastomosing a branch of the normal pes anserinus to the trunk of the paralyzed facial nerve, as first presented by the author at the Second International Symposium on Facial Nerve Surgery held in Japan in September, 1970, has been modified. The technique of anastomosing the cervicofacial division of the normal facial nerve, and directing it to the temporo-facial division of the paralyzed facial nerve via a sural autograft 20–22 cm long, was combined with the utilization of the ipsilateral descendens cervicalis (hypoglossi).17 This nerve was anastomosed to the cervicofacial division of the paralyzed facial nerve and utilized in four patients. The technique is illustrated in detail.

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Surgical anatomy for direct hypoglossal—facial nerve side-to-end “anastomosis”

Journal of Neurosurgery ◽

10.3171/jns.1999.91.2.0268 ◽

1999 ◽

Vol 91 (2) ◽

pp. 268-275 ◽

Cited By ~ 59

Author(s):

Katsuyuki Asaoka ◽

Yutaka Sawamura ◽

Masabumi Nagashima ◽

Takanori Fukushima

Keyword(s):

Facial Nerve ◽

Hypoglossal Nerve ◽

Surgical Anatomy ◽

Microsurgical Anatomy ◽

Content Type ◽

Pes Anserinus ◽

Nearest Point ◽

Facial Nerves ◽

Nerve Anastomosis ◽

Fine Print

Object. In this study the authors investigated the histomorphometric background and microsurgical anatomy associated with surgically created direct hypoglossal—facial nerve side-to-end communication or nerve “anastomosis.”Methods. Histomorphometric analyses of the facial and hypoglossal nerves were performed using 24 cadaveric specimens and three surgically obtained specimens of severed facial nerve. Both the hypoglossal nerve at the level of the atlas and the facial nerve just distal to the external genu were monofascicular. The number of myelinated axons in the facial nerve (7228 ± 950) was 73.2% of those in the normal hypoglossal nerve (9778 ± 1516). Myelinated fibers in injured facial nerves were remarkably decreased in number. The cross-sectioned area of the normal facial nerve (0.948 mm2) accounted for 61.5% of the area of the hypoglossal nerve (1.541 mm2), whereas that of the injured facial nerve (0.66 mm2) was less than 50% of the area of the hypoglossal nerve. Surgical dissection and morphometric measurements were performed using 18 sides of 11 adult cadaver heads. The length of the facial nerve from the pes anserinus to the external genu ranged from 22 to 42 mm (mean 30.5 ± 4.4 mm). The distance from the pes anserinus to the nearest point on the hypoglossal nerve ranged from 14 to 22 mm (mean 17.3 ± 2.5 mm). The former was always longer than the latter; the excess ranged from 6 to 20 mm (mean 13.1 ± 3.4 mm). Surgical anatomy and procedures used to accomplish the nerve connection are described.Conclusions. The size of a half-cut end of the hypoglossal nerve matches a cut end of the injured facial nerve very well. By using the technique described, a length of facial nerve sufficient to achieve a tensionless communication can consistently be obtained.

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Repair of facial nerve after removal of cerebellopontine angle tumors: a comparative study

Journal of Neurosurgery ◽

10.3171/jns.1993.78.5.0720 ◽

1993 ◽

Vol 78 (5) ◽

pp. 720-725 ◽

Cited By ~ 19

Author(s):

T. T. King ◽

O. C. Sparrow ◽

J. M. Arias ◽

A. F. O'Connor

Keyword(s):

Facial Nerve ◽

Nerve Repair ◽

Previous Treatment ◽

Kappa Statistic ◽

Complete Agreement ◽

Grading System ◽

Content Type ◽

Nerve Tumor ◽

Facial Nerves ◽

Fine Print

✓ The results of repair of 18 facial nerves were examined by means of a modified House-Brackmann grading system. Six were repaired by end-to-end anastomosis and 12 by nerve graft. The reliability of the simplified House-Brackmann grading system was also assessed, using the kappa statistic to analyze the agreement between pairs of observers who examined the function of 40 nerves in 37 patients. Facial nerves studied had been either preserved, repaired or grafted, or divided and treated by faciohypoglossal nerve anastomosis. One nerve was not treated. The grading system proved to be somewhat unreliable, with complete agreement between observers in only 25% of cases. Facial nerve repair produced a fair return of function in just under two-thirds of the cases. The ability of an examiner ignorant of the patient's history to assess from the end result how the nerve had been managed was also estimated. Observers showed little ability to decide correctly on the previous treatment of the nerve when the patient showed moderate dysfunction postoperatively. The implications of these findings for grading systems and for management of the facial nerve in acoustic nerve tumor surgery are discussed.

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