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Surgical Repair of Facial Nerve Branches: An Analysis of Different Sheathing and Suturing Techniques

Surgical Repair of Facial Nerve Branches: An Analysis of Different Sheathing and Suturing Techniques Abstract The distal branches of the facial nerve are sometimes severed in various forms of trauma. These distal branches respond to repair differently than do the main trunk or other peripheral nerves. Actual axon counts must be done to determine the percentage of regrowth rather than measuring nerve diameter. Physiologic and histologic techniques were used to analyze sheathing and suturing techniques in the repair of facial nerve branches in rabbits. Repair sites were examined at various intervals up to four months after repair. Very small suture material (10-0) must be used. Vein sheaths and silicone elastomer (Silastic) sheaths caused decreased axon regrowth, and strictures occurred when silicone elastomer sheaths were used. Seven stitches provided the best results in terms of axon regrowth, prevention of neuromas, and return of function. Three sutures or a continuous stitch produced poorer overall results. References 1. Migliavacca F: Facial nerve anastomosis for facial paralysis following acoustic neurinoma surgery . Acta Neurochir (Wien) 17:274-279,1967.Crossref 2. Labelle JL, Allen DE: The peripheral nerve repair: A review . J Maine Med Assoc 63:164-166, 1972. 3. McGovern FH: The return of function after damage to the facial nerve . Eye Ear Nose Throat Mon 49:451-454, 1970. 4. McCoy EG, Boyle WF: Reinnervation of the facial muscles following extratemporal facial nerve resection . Laryngoscope 81:1-7, 1971.Crossref 5. Ducker TB, et al: The metabolic background for peripheral nerve surgery . J Neurosurg 30:270-280, 1969.Crossref 6. Torvik A: Phagocytosis of nerve cells during retrograde degeneration: An electron microscopic study . J Neuropathol Exp Neurol 31:132-146, 1972.Crossref 7. McCabe BF: Facial nerve grafting . Plast Reconstr Surg 45:70-75, 1970.Crossref 8. Boyle WF: Facial nerve paralysis: An experimental investigation of facial nerve regeneration in monkeys . Laryngoscope 76:1921-1928, 1966.Crossref 9. Danilewicz B: Late results of posttraumatic suture of peripheral nerve of the upper extremity . Pol Med J 11:1311-1318, 1972. 10. Campbell JB: Peripheral nerve repair . Clin Neurosurg 17:77-98, 1970. 11. Khodadad G: Microsurgical techniques in repair of peripheral nerves . Surg Clin North Am 52:1157-1166, 1972. 12. Sunderland S: Nerves and Nerve Injuries . London, E & S Livingstone Ltd, 1968. 13. McCabe BF: Injuries to the facial nerve . Laryngoscope 82:1891-1896, 1972.Crossref 14. Kettel K: Surgery of the facial nerve . Arch Otolaryngol 81:523-526, 1965.Crossref 15. Grabb WC: Median and ulnar nerve suture: An experimental study comparing primary and secondary repair in monkeys . J Bone Joint Surg 50-A :964-972, 1968. 16. Gibb AG: Facial nerve sleeve graft . J Laryngol Otol 84:577-582, 1970.Crossref 17. McEwan LE: Median and ulnar nerve injuries . Aust NZ J Surg 32:89-104, 1962.Crossref 18. Weiss P: The technology of nerve regeneration: A review; Sutureless tubulation and related methods of nerve repair . J Neurosurg 1:400-450, 1944.Crossref 19. Maw RB, Loizeaux AD: Functional regeneration of facial nerves in dogs when filter tubes are used . J Oral Surg 29:848-852, 1971. 20. Campbell JB, Luzio J: Facial nerve repair: New surgical techniques . Trans Am Acad Ophthalmol Otolaryngol 68:1068-1075, 1964. 21. Gibb AG: Facial nerve repair using a vein graft cylinder . Arch Otolaryngol 82:267-269, 1965.Crossref 22. Kitamura T, et al: Extratemporal facial nerve surgery . Arch Otolaryngol 95:369-375, 1972.Crossref 23. Miglets AW, Thomas JR: Protection of facial nerve anastomosis with a vein graft . Laryngoscope 83:1027-1037, 1973.Crossref 24. Ducker TB, Hayes GJ: Experimental improvements in the use of Silastic cuff for peripheral nerve repair . J Neurosurg 28:582-587, 1968.Crossref 25. Ducker TB, Hayes GJ: Peripheral nerve injuries: A comparative study of the anatomical and functional results following primary nerve repair in chimpanzees . Milit Med 133:298-302, 1968. 26. Ducker TB: Metabolic factors in surgery of peripheral nerves . Surg Clin North Am 52:1109-1122, 1972. 27. Drake CG: Facial function after intracranial repair of facial nerve . Arch Otolaryngol 95:420-475, 1972.Crossref 28. Laage-Hellman JE: Facial nerve in parotidectomies . Arch Otolaryngol 81:527-533, 1965.Crossref 29. Smith JW: Factors influencing nerve repair: I. Blood supply of peripheral nerves . Arch Surg 93:335-341, 1966.Crossref 30. Smith JW: Factors influencing nerve repair: II. Collateral circulation of peripheral nerves . Arch Surg 93:433-437, 1966.Crossref 31. Bridger GP: Surgery and facial nerve grafting in malignant parotid disease . Aust NZ J Surg 39:232-238, 1970.Crossref 32. Krekorian EA: The repair of combat-injured facial nerves . Laryngoscope 81:1926-1945, 1971.Crossref 33. Smith JW: Advances in facial nerve repair . Surg Clin North Am 52:1287-1306, 1972. 34. Buncke HJ Jr, McLean DH: The advantage of a straight needle in microsurgery . Plast Reconstr Surg 47:602-603, 1971.Crossref 35. Hirasawa Y, Marmor L: The protective effect of irradiation combined with sheathing methods on experimental nerve heterografts: Silastic, autogenous veins, and heterogenous arteries . J Neurosurg 27:401-414, 1967.Crossref 36. Hubbard JH: The quality of nerve regeneration: Factors independent of the most skillful repair . Surg Clin North Am 52:1099-1108, 1972. 37. Wigand ME, Spreng M, Bumm P, et al: Electronic evaluation of electromyograms in facial nerve paralysis . Arch Otolaryngol 95:324-330, 1972.Crossref 38. Winer BJ: Statistical Principles in Experimental Design . New York, McGraw-Hill Book Co Inc, 1971, p 445. 39. Davis L, Ruge D: Functional recovery following the use of homogenous nerve grafts . Surgery 27:102-114, 1950. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology American Medical Association

Surgical Repair of Facial Nerve Branches: An Analysis of Different Sheathing and Suturing Techniques

Archives of Otolaryngology , Volume 101 (3) – Mar 1, 1975

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References (46)

Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0003-9977
DOI
10.1001/archotol.1975.00780320018004
Publisher site
See Article on Publisher Site

Abstract

Abstract The distal branches of the facial nerve are sometimes severed in various forms of trauma. These distal branches respond to repair differently than do the main trunk or other peripheral nerves. Actual axon counts must be done to determine the percentage of regrowth rather than measuring nerve diameter. Physiologic and histologic techniques were used to analyze sheathing and suturing techniques in the repair of facial nerve branches in rabbits. Repair sites were examined at various intervals up to four months after repair. Very small suture material (10-0) must be used. Vein sheaths and silicone elastomer (Silastic) sheaths caused decreased axon regrowth, and strictures occurred when silicone elastomer sheaths were used. Seven stitches provided the best results in terms of axon regrowth, prevention of neuromas, and return of function. Three sutures or a continuous stitch produced poorer overall results. References 1. Migliavacca F: Facial nerve anastomosis for facial paralysis following acoustic neurinoma surgery . Acta Neurochir (Wien) 17:274-279,1967.Crossref 2. Labelle JL, Allen DE: The peripheral nerve repair: A review . J Maine Med Assoc 63:164-166, 1972. 3. McGovern FH: The return of function after damage to the facial nerve . Eye Ear Nose Throat Mon 49:451-454, 1970. 4. McCoy EG, Boyle WF: Reinnervation of the facial muscles following extratemporal facial nerve resection . Laryngoscope 81:1-7, 1971.Crossref 5. Ducker TB, et al: The metabolic background for peripheral nerve surgery . J Neurosurg 30:270-280, 1969.Crossref 6. Torvik A: Phagocytosis of nerve cells during retrograde degeneration: An electron microscopic study . J Neuropathol Exp Neurol 31:132-146, 1972.Crossref 7. McCabe BF: Facial nerve grafting . Plast Reconstr Surg 45:70-75, 1970.Crossref 8. Boyle WF: Facial nerve paralysis: An experimental investigation of facial nerve regeneration in monkeys . Laryngoscope 76:1921-1928, 1966.Crossref 9. Danilewicz B: Late results of posttraumatic suture of peripheral nerve of the upper extremity . Pol Med J 11:1311-1318, 1972. 10. Campbell JB: Peripheral nerve repair . Clin Neurosurg 17:77-98, 1970. 11. Khodadad G: Microsurgical techniques in repair of peripheral nerves . Surg Clin North Am 52:1157-1166, 1972. 12. Sunderland S: Nerves and Nerve Injuries . London, E & S Livingstone Ltd, 1968. 13. McCabe BF: Injuries to the facial nerve . Laryngoscope 82:1891-1896, 1972.Crossref 14. Kettel K: Surgery of the facial nerve . Arch Otolaryngol 81:523-526, 1965.Crossref 15. Grabb WC: Median and ulnar nerve suture: An experimental study comparing primary and secondary repair in monkeys . J Bone Joint Surg 50-A :964-972, 1968. 16. Gibb AG: Facial nerve sleeve graft . J Laryngol Otol 84:577-582, 1970.Crossref 17. McEwan LE: Median and ulnar nerve injuries . Aust NZ J Surg 32:89-104, 1962.Crossref 18. Weiss P: The technology of nerve regeneration: A review; Sutureless tubulation and related methods of nerve repair . J Neurosurg 1:400-450, 1944.Crossref 19. Maw RB, Loizeaux AD: Functional regeneration of facial nerves in dogs when filter tubes are used . J Oral Surg 29:848-852, 1971. 20. Campbell JB, Luzio J: Facial nerve repair: New surgical techniques . Trans Am Acad Ophthalmol Otolaryngol 68:1068-1075, 1964. 21. Gibb AG: Facial nerve repair using a vein graft cylinder . Arch Otolaryngol 82:267-269, 1965.Crossref 22. Kitamura T, et al: Extratemporal facial nerve surgery . Arch Otolaryngol 95:369-375, 1972.Crossref 23. Miglets AW, Thomas JR: Protection of facial nerve anastomosis with a vein graft . Laryngoscope 83:1027-1037, 1973.Crossref 24. Ducker TB, Hayes GJ: Experimental improvements in the use of Silastic cuff for peripheral nerve repair . J Neurosurg 28:582-587, 1968.Crossref 25. Ducker TB, Hayes GJ: Peripheral nerve injuries: A comparative study of the anatomical and functional results following primary nerve repair in chimpanzees . Milit Med 133:298-302, 1968. 26. Ducker TB: Metabolic factors in surgery of peripheral nerves . Surg Clin North Am 52:1109-1122, 1972. 27. Drake CG: Facial function after intracranial repair of facial nerve . Arch Otolaryngol 95:420-475, 1972.Crossref 28. Laage-Hellman JE: Facial nerve in parotidectomies . Arch Otolaryngol 81:527-533, 1965.Crossref 29. Smith JW: Factors influencing nerve repair: I. Blood supply of peripheral nerves . Arch Surg 93:335-341, 1966.Crossref 30. Smith JW: Factors influencing nerve repair: II. Collateral circulation of peripheral nerves . Arch Surg 93:433-437, 1966.Crossref 31. Bridger GP: Surgery and facial nerve grafting in malignant parotid disease . Aust NZ J Surg 39:232-238, 1970.Crossref 32. Krekorian EA: The repair of combat-injured facial nerves . Laryngoscope 81:1926-1945, 1971.Crossref 33. Smith JW: Advances in facial nerve repair . Surg Clin North Am 52:1287-1306, 1972. 34. Buncke HJ Jr, McLean DH: The advantage of a straight needle in microsurgery . Plast Reconstr Surg 47:602-603, 1971.Crossref 35. Hirasawa Y, Marmor L: The protective effect of irradiation combined with sheathing methods on experimental nerve heterografts: Silastic, autogenous veins, and heterogenous arteries . J Neurosurg 27:401-414, 1967.Crossref 36. Hubbard JH: The quality of nerve regeneration: Factors independent of the most skillful repair . Surg Clin North Am 52:1099-1108, 1972. 37. Wigand ME, Spreng M, Bumm P, et al: Electronic evaluation of electromyograms in facial nerve paralysis . Arch Otolaryngol 95:324-330, 1972.Crossref 38. Winer BJ: Statistical Principles in Experimental Design . New York, McGraw-Hill Book Co Inc, 1971, p 445. 39. Davis L, Ruge D: Functional recovery following the use of homogenous nerve grafts . Surgery 27:102-114, 1950.

Journal

Archives of OtolaryngologyAmerican Medical Association

Published: Mar 1, 1975

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