Hypoglossal-facial nerve “side”-to-side neurorrhaphy for persistent incomplete facial palsy

Laboratory investigation

Hong Wan Ph.D. 1 , Liwei Zhang M.D., Ph.D. 2 , Dezhi Li M.D. 2 , Shuyu Hao M.D. 2 , Jie Feng Ph.D. 1 , Jean Paul Oudinet Ph.D. 3 , Michael Schumacher Ph.D. 3 , and Song Liu M.D., Ph.D. 1 , 2 , 3
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  • 1 Beijing Neurosurgical Institute;
  • 2 Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, China; and
  • 3 UMR 788, INSERM et Université Paris-Sud, Le Kremlin-Bicêtre, France
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Object

Hypoglossal-facial nerve neurorrhaphy is a widely used method for treating complete facial palsy. However, the classic surgical procedure using a “side”-to-end neurorrhaphy is not suitable for incomplete facial palsy (IFP), because sectioning of the facial nerve for neurorrhaphy compromises remnant axons and potential spontaneous reinnervation. For the treatment of persistent IFP, the authors investigated in rats a modified method using hypoglossal-facial nerve “side”-to-side neurorrhaphy.

Methods

An IFP model was created by crushing the facial nerve and then ligating the injury site to limit axonal regeneration. After 9 weeks, rats with IFP were submitted to hypoglossal-facial nerve “side”-to-side neurorrhaphy: The gap between the 2 nerves was bridged with a predegenerated peroneal nerve graft, which was sutured to only one-half of the hypoglossal nerve and to the remnant facial nerve through a small window created by removing the epineurium, thus preserving regenerating facial axons.

Results

Four months after repair surgery, double innervation of the target whisker pad by hypoglossal and facial motor neurons was supported by the recording of muscle action potentials and their retrograde labeling. Regenerated hypoglossal and facial motor neurons effectively participated in the reinnervation of the whisker pad, significantly improving facial symmetry without evident synkinesis, compared with rats that underwent IFP without hypoglossal-facial nerve neurorrhaphy.

Conclusions

This study demonstrates that hypoglossal-facial nerve “side”-to-side neurorrhaphy with a predegenerated nerve graft can lead to rapid functional benefits for persistent IFP without compromising the remnants of facial axons, thus providing a proof-of-feasibility for further studies in humans.

Abbreviations used in this paper:CFP = complete facial palsy; CTB–Alexa 555 = cholera toxin subunit B conjugated with Alexa Fluor 555; DY = diamidino yellow; FN = facial nerve; HN = hypoglossal nerve; IFP = incomplete facial palsy; IFP-R = IFP treated with HN-FN “side”-to-side neurorrhaphy; MAP = muscle action potential; PNG = predegenerated nerve graft.

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Contributor Notes

Address correspondence to: Song Liu, M.D., Ph.D., UMR 788, INSERM et Université Paris-Sud, 80 rue du Général Leclerc, 94276 Le Kremlin-Bicêtre Cedex, France. email: song.liu@inserm.fr.

Drs. Wan and Zhang contributed equally to this work.

Please include this information when citing this paper: published online November 8, 2013; DOI: 10.3171/2013.9.JNS13664.

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