The Spinal Accessory Nerve for Functional Muscle Innervation in Facial Reanimation Surgery: An Anatomical and Histomorphometric Study.

Introduction: Facial reanimation surgery is performed in severe cases of facial palsy to restore facial function. In a 1-stage procedure, the spinal accessory nerve can be used as a donor nerve to power a free gracilis muscle transplant for the reanimation of the mouth. The aim of this study was to describe the surgical anatomy of the spinal accessory nerve, provide a guide for reliable donor nerve dissection, and analyze the available donor axon counts.

The surgical anatomy of the supraclavicular lymph node flap: A basis for the free vascularized lymph node transfer.

Background: Vascularized lymph node transfer is an effective surgical method in reducing lymphedema. This study provides the first detailed description of the surgical anatomy of the supraclavicular lymph node flap in regard to pedicle length, pedicle diameter, and the number of lymph nodes and their exact location inside the flap.

Methods: Bilateral supraclavicular dissections of nine fresh cadavers (five female) were performed.

ErbB2 blockade with Herceptin (trastuzumab) enhances peripheral nerve regeneration after repair of acute or chronic peripheral nerve injury.

Objective: Attenuation of the growth supportive environment within the distal nerve stump after delayed peripheral nerve repair profoundly limits nerve regeneration. Levels of the potent Schwann cell mitogen neuregulin and its receptor ErbB2 decline during this period, but the regenerative impact of this change is not completely understood. Herein, the ErbB2 receptor pathway is inhibited with the selective monoclonal antibody Herceptin (trastuzumab) to determine its significance in regulating acute and chronic regeneration in a rat hindlimb.

Delayed peripheral nerve repair: methods, including surgical 'cross-bridging' to promote nerve regeneration.

Despite the capacity of Schwann cells to support peripheral nerve regeneration, functional recovery after nerve injuries is frequently poor, especially for proximal injuries that require regenerating axons to grow over long distances to reinnervate distal targets. Nerve transfers, where small fascicles from an adjacent intact nerve are coapted to the nerve stump of a nearby denervated muscle, allow for functional return but at the expense of reduced numbers of innervating nerves. A 1-hour period of 20 Hz electrical nerve stimulation via electrodes proximal to an injury site accelerates axon outgrowth to hasten target reinnervation in rats and humans, even after delayed surgery.

Enhancement of facial nerve motoneuron regeneration through cross-face nerve grafts by adding end-to-side sensory axons.

Background: In unilateral facial palsy, cross-face nerve grafts are used for emotional facial reanimation. Facial nerve regeneration through the grafts takes several months, and the functional results are sometimes inadequate. Chronic denervation of the cross-face nerve graft results in incomplete nerve regeneration.

Macroscopic in vivo imaging of facial nerve regeneration in Thy1-GFP rats.

Importance: Facial nerve injury leads to severe functional and aesthetic deficits. The transgenic Thy1-GFP rat is a new model for facial nerve injury and reconstruction research that will help improve clinical outcomes through translational facial nerve injury research.

Objective: To determine whether serial in vivo imaging of nerve regeneration in the transgenic rat model is possible, facial nerve regeneration was imaged under the main paradigms of facial nerve injury and reconstruction.

The ErbB2 inhibitor Herceptin (Trastuzumab) promotes axonal outgrowth four weeks after acute nerve transection and repair.

Accumulating evidence suggests that neuregulin, a potent Schwann cell mitogen, and its receptor, ErbB2, have an important role in regulating peripheral nerve regeneration. We hypothesized that Herceptin (Trastuzumab), a monoclonal antibody that binds ErbB2, would disrupt ErbB2 signaling, allowing us to evaluate ErbB2's importance in peripheral nerve regeneration. In this study, the extent of peripheral motor and sensory nerve regeneration and distal axonal outgrowth was analyzed two and four weeks after common peroneal (CP) nerve injury in rats.

Facial synkinesia before and after surgical reanimation of the paralyzed face.

Background: Facial synkinesia is a common sequela of facial palsy, affecting 15 to 20 percent of patients. The rate of postoperative synkinesia after facial reanimation is not clearly established. The severity and type of synkinesia determine the degree of clinical relevance.

Comparison of three-dimensional surface-imaging systems.

Background: In recent decades, three-dimensional (3D) surface-imaging technologies have gained popularity worldwide, but because most published articles that mention them are technical, clinicians often have difficulties gaining a proper understanding of them. This article aims to provide the reader with relevant information on 3D surface-imaging systems. In it, we compare the most recent technologies to reveal their differences.

3D video analysis of facial movements.

This article presents a review of 3D video analysis for use in patients with facial paralysis. The difficulties inherent in quantifying the degree of facial paralysis and the effect of therapeutics that has led to the use of videos and computer-assisted 3D analysis are discussed, which can yield quantifiable results of treatment, allow the description and quantification of facial paralysis, and become a tool in the planning of operative procedures. The authors provide a step-by-step overview of video analysis, and present case studies from two specific techniques they have used in reconstruction surgery.

Evolution of the 3-dimensional video system for facial motion analysis: ten years' experiences and recent developments.

Since the implementation of the computer-aided system for assessing facial palsy in 1999 by Frey et al (Plast Reconstr Surg. 1999;104:2032-2039), no similar system that can make an objective, three-dimensional, quantitative analysis of facial movements has been marketed. This system has been in routine use since its launch, and it has proven to be reliable, clinically applicable, and therapeutically accurate.