Limits...
Effectively Axonal-supercharged Interpositional Jump-Graft with an Artificial Nerve Conduit for Rat Facial Nerve Paralysis.

Niimi Y, Matsumine H, Takeuchi Y, Sasaki R, Watanabe Y, Yamato M, Miyata M, Sakurai H - Plast Reconstr Surg Glob Open (2015)

Bottom Line: Interpositional jump graft (IPJG) is a nerve graft axonally supercharged from the hypoglossal nerve.Thirteen weeks after the surgery, the outcome was histologically and physiologically compared with conventional IPJG with autograft using the great auricular nerve.In the autograft and silicone tube groups, the regeneration of myelinated axons was observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, Yachiyo-shi, Chiba, Japan; Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Department of Physiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; and Department of Oral and Maxillofacial Surgery, Global Center of Excellence (COE) Program, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.

ABSTRACT

Background: Interpositional jump graft (IPJG) is a nerve graft axonally supercharged from the hypoglossal nerve. However, for using the technique, an autologous nerve, which should contain the great auricular and sural nerves, must be obtained. Depending on the donor site, unavoidable issues such as nerve disorders and postoperative scarring may appear. To reduce the issues, in this study, the authors developed an end-to-side neurorrhaphy technique with the recipient nerve and an artificial nerve conduit and investigated the efficacy of an IPJG with an artificial nerve conduit in a rat facial nerve paresis model.

Methods: A ligature clip was used to crush the facial nerve trunk, thereby creating a partial facial nerve paresis model. An artificial nerve conduit was then prepared with a 10-mm-long silicone tube containing 10 μL type I collagen and used to create an IPJG between the facial nerve trunk and the hypoglossal nerve (the silicone tube group). Thirteen weeks after the surgery, the outcome was histologically and physiologically compared with conventional IPJG with autograft using the great auricular nerve.

Results: Retrograde tracer test confirmed a double innervation by the facial and hypoglossal nerve nuclei. In the autograft and silicone tube groups, the regeneration of myelinated axons was observed.

Conclusion: In this study, the authors successfully developed an end-to-side neurorrhaphy technique with the recipient nerve and an artificial nerve conduit, and revealed that an IPJG in the conduit was effective in the rat facial nerve paresis model.

No MeSH data available.


Related in: MedlinePlus

Schematic illustration of end-to-side neurorrhaphy with the silicone tube. End-to-side neurorrhaphy using the silicone tube is described in a step-by-step manner from the top to bottom illustrations in the left and right columns. (1) Gaps (1.5 mm long and 1 mm wide) were created at both ends of the tube (length, 10 mm; internal diameter, 1 mm; external diameter, 2 mm) (left column, first). (2) After epineural windows in the facial nerve trunk and hypoglossal nerve were created, neurorrhaphy was performed as follows. First, a 9-0 nylon suture (Nescosuture, Alfresa, Osaka, Japan) was passed from the external margin of the posterior wall of silicone tube (pink side) into the lumen (left column, second). (3) Then, the suture was passed from the epineural window through the epineurium toward the outside (left column, third). (4) The suture was then passed again from outside the epineural window through the epineurium into the lumen, from the lumen of the silicone tube toward the outside, and left in place without a ligature (left column, fourth). (5) Then, the silicone tube was rotated 180° vertically, and the anterior wall of the silicone tube (green side) was sutured by the same procedure for the posterior wall (right column, first). (6) The anterior and posterior wall sutures were carefully stretched (right column, second). (7) The facial nerve trunk was allowed to insert into the gaps initially created in the silicone tube (right column, third). (8) The facial nerve trunk was confirmed to be firmly inserted into the gaps on the left and right and ligatured with 2 sutures (right column, fourth).
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4494486&req=5

Figure 2: Schematic illustration of end-to-side neurorrhaphy with the silicone tube. End-to-side neurorrhaphy using the silicone tube is described in a step-by-step manner from the top to bottom illustrations in the left and right columns. (1) Gaps (1.5 mm long and 1 mm wide) were created at both ends of the tube (length, 10 mm; internal diameter, 1 mm; external diameter, 2 mm) (left column, first). (2) After epineural windows in the facial nerve trunk and hypoglossal nerve were created, neurorrhaphy was performed as follows. First, a 9-0 nylon suture (Nescosuture, Alfresa, Osaka, Japan) was passed from the external margin of the posterior wall of silicone tube (pink side) into the lumen (left column, second). (3) Then, the suture was passed from the epineural window through the epineurium toward the outside (left column, third). (4) The suture was then passed again from outside the epineural window through the epineurium into the lumen, from the lumen of the silicone tube toward the outside, and left in place without a ligature (left column, fourth). (5) Then, the silicone tube was rotated 180° vertically, and the anterior wall of the silicone tube (green side) was sutured by the same procedure for the posterior wall (right column, first). (6) The anterior and posterior wall sutures were carefully stretched (right column, second). (7) The facial nerve trunk was allowed to insert into the gaps initially created in the silicone tube (right column, third). (8) The facial nerve trunk was confirmed to be firmly inserted into the gaps on the left and right and ligatured with 2 sutures (right column, fourth).

Mentions: End-to-side neurorrhaphy was performed with the silicone tube of which 2 gaps, 1.5 mm long and 1 mm wide, were made at both ends of the tube (length, 10 mm; internal diameter, 1 mm; external diameter, 2 mm) (Fig. 2). After epineural windows in the facial nerve trunk and hypoglossal nerve were created, neurorrhaphy was performed. The detail of the surgical procedure is given in Figure 2 in a step-by-step manner and in the video. (See Video 1, Supplemental Digital Content 1, which displays end-to-side neurorrhaphy with a silicone tube and facial nerve, http://links.lww.com/PRSGO/A105.) The same procedure was performed for the hypoglossal nerve, resulting in a 7-mm silicone tube bridge.


Effectively Axonal-supercharged Interpositional Jump-Graft with an Artificial Nerve Conduit for Rat Facial Nerve Paralysis.

Niimi Y, Matsumine H, Takeuchi Y, Sasaki R, Watanabe Y, Yamato M, Miyata M, Sakurai H - Plast Reconstr Surg Glob Open (2015)

Schematic illustration of end-to-side neurorrhaphy with the silicone tube. End-to-side neurorrhaphy using the silicone tube is described in a step-by-step manner from the top to bottom illustrations in the left and right columns. (1) Gaps (1.5 mm long and 1 mm wide) were created at both ends of the tube (length, 10 mm; internal diameter, 1 mm; external diameter, 2 mm) (left column, first). (2) After epineural windows in the facial nerve trunk and hypoglossal nerve were created, neurorrhaphy was performed as follows. First, a 9-0 nylon suture (Nescosuture, Alfresa, Osaka, Japan) was passed from the external margin of the posterior wall of silicone tube (pink side) into the lumen (left column, second). (3) Then, the suture was passed from the epineural window through the epineurium toward the outside (left column, third). (4) The suture was then passed again from outside the epineural window through the epineurium into the lumen, from the lumen of the silicone tube toward the outside, and left in place without a ligature (left column, fourth). (5) Then, the silicone tube was rotated 180° vertically, and the anterior wall of the silicone tube (green side) was sutured by the same procedure for the posterior wall (right column, first). (6) The anterior and posterior wall sutures were carefully stretched (right column, second). (7) The facial nerve trunk was allowed to insert into the gaps initially created in the silicone tube (right column, third). (8) The facial nerve trunk was confirmed to be firmly inserted into the gaps on the left and right and ligatured with 2 sutures (right column, fourth).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494486&req=5

Figure 2: Schematic illustration of end-to-side neurorrhaphy with the silicone tube. End-to-side neurorrhaphy using the silicone tube is described in a step-by-step manner from the top to bottom illustrations in the left and right columns. (1) Gaps (1.5 mm long and 1 mm wide) were created at both ends of the tube (length, 10 mm; internal diameter, 1 mm; external diameter, 2 mm) (left column, first). (2) After epineural windows in the facial nerve trunk and hypoglossal nerve were created, neurorrhaphy was performed as follows. First, a 9-0 nylon suture (Nescosuture, Alfresa, Osaka, Japan) was passed from the external margin of the posterior wall of silicone tube (pink side) into the lumen (left column, second). (3) Then, the suture was passed from the epineural window through the epineurium toward the outside (left column, third). (4) The suture was then passed again from outside the epineural window through the epineurium into the lumen, from the lumen of the silicone tube toward the outside, and left in place without a ligature (left column, fourth). (5) Then, the silicone tube was rotated 180° vertically, and the anterior wall of the silicone tube (green side) was sutured by the same procedure for the posterior wall (right column, first). (6) The anterior and posterior wall sutures were carefully stretched (right column, second). (7) The facial nerve trunk was allowed to insert into the gaps initially created in the silicone tube (right column, third). (8) The facial nerve trunk was confirmed to be firmly inserted into the gaps on the left and right and ligatured with 2 sutures (right column, fourth).
Mentions: End-to-side neurorrhaphy was performed with the silicone tube of which 2 gaps, 1.5 mm long and 1 mm wide, were made at both ends of the tube (length, 10 mm; internal diameter, 1 mm; external diameter, 2 mm) (Fig. 2). After epineural windows in the facial nerve trunk and hypoglossal nerve were created, neurorrhaphy was performed. The detail of the surgical procedure is given in Figure 2 in a step-by-step manner and in the video. (See Video 1, Supplemental Digital Content 1, which displays end-to-side neurorrhaphy with a silicone tube and facial nerve, http://links.lww.com/PRSGO/A105.) The same procedure was performed for the hypoglossal nerve, resulting in a 7-mm silicone tube bridge.

Bottom Line: Interpositional jump graft (IPJG) is a nerve graft axonally supercharged from the hypoglossal nerve.Thirteen weeks after the surgery, the outcome was histologically and physiologically compared with conventional IPJG with autograft using the great auricular nerve.In the autograft and silicone tube groups, the regeneration of myelinated axons was observed.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Yachiyo Medical Center, Yachiyo-shi, Chiba, Japan; Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; Department of Physiology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan; and Department of Oral and Maxillofacial Surgery, Global Center of Excellence (COE) Program, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.

ABSTRACT

Background: Interpositional jump graft (IPJG) is a nerve graft axonally supercharged from the hypoglossal nerve. However, for using the technique, an autologous nerve, which should contain the great auricular and sural nerves, must be obtained. Depending on the donor site, unavoidable issues such as nerve disorders and postoperative scarring may appear. To reduce the issues, in this study, the authors developed an end-to-side neurorrhaphy technique with the recipient nerve and an artificial nerve conduit and investigated the efficacy of an IPJG with an artificial nerve conduit in a rat facial nerve paresis model.

Methods: A ligature clip was used to crush the facial nerve trunk, thereby creating a partial facial nerve paresis model. An artificial nerve conduit was then prepared with a 10-mm-long silicone tube containing 10 μL type I collagen and used to create an IPJG between the facial nerve trunk and the hypoglossal nerve (the silicone tube group). Thirteen weeks after the surgery, the outcome was histologically and physiologically compared with conventional IPJG with autograft using the great auricular nerve.

Results: Retrograde tracer test confirmed a double innervation by the facial and hypoglossal nerve nuclei. In the autograft and silicone tube groups, the regeneration of myelinated axons was observed.

Conclusion: In this study, the authors successfully developed an end-to-side neurorrhaphy technique with the recipient nerve and an artificial nerve conduit, and revealed that an IPJG in the conduit was effective in the rat facial nerve paresis model.

No MeSH data available.


Related in: MedlinePlus