AAHS ASPN ASRM - 2013 Annual Meeting - American Association ...

Cross Facial Nerve Grafting for Facial Paralysis with Incomplete Recovery
Institution where the work was prepared: National Taiwan University Hospital, Taipei, Taiwan
Yueh-Bih Chen Tang, MD, Ph, D1; Hui-Hsiu Chang, resident1; Hung-Chi Chen, MD, FACS2; (1)National Taiwan University Hospital, (2)E-da/I-I Shou University Hospital
Facial palsy with partial or incomplete recovery is not infrequently seen among patients. Weakness at the muscles for facial expression is usually noticeable
albeit it's incomplete. The patients usually look for possible corrections. In this group of patients, 52 cross facial nerve grafting from sural nerve to reanimate
facial expression has been conducted in our center since 20 years ago. The age of the patients ranged from 18 years to 42 years, averaging 28 years. The harvested
sural nerve was anastomosed to either marginal mandibular nerve ( 25 patients) or buccal branch ( 17) of the facial nerve at the well side. The cross
facial nerve grafts were placed orthodromically with branches lying atop the facial expression muscles, whereas the main trunks were anastomosed to the buccal
branch of the facial nerve at the ill side. The follow up period ranged from 1 year to 20 years. Significant amount of improvements have been noticed in
all patients starting from 3 months. Increase in the intensity of elevation of upper lip and mouth angle, contraction of the orbicularis oris muscle, orbicularis
oculi muscle, or corrugator muscles can be observed significantly at 6 months after surgery. In those patients whose cross facial nerve grafts were anastomosed
to marginal mandibular branch of the facial nerve, can obtain better lower lip balance due to simultaneous weakening of the well side lower lip depressors. In
those patients whose donor nerves were the buccal branch of the facial nerve, the lower lip balance need further treatment such as depressor myectomy or
injection of botulinum toxin A.
Research on Traumatic Paraplegia: Microsurgical Connection of the Above the Lesion Cord with Peripheral
Nerves (C.N.S.-P.N.S. Connection)
Institution where the work was prepared: Fondazione ricerca lesioni mdollo spinale, Brescia, Italy
Giorgio Brunelli, professor; Fondazione ricerca midollo spinale
Our previous research started in 1980 and was done on rats and monkeys. It showed that muscles surgically disconnected from lower motoneurons responded
to the stimuli of upper motoneurons. Numerous groups of rats were operated on with different surgical protocols during the years. Results obtained in rats,
when presented at an international meeting, at the end of the years ‘80s, stired up scepticism. Therefore during the years ‘90s four groups of monkeys were
operetad on by connecting the cortico spinal tract of the above the lesion cord with the motor nerves of gluteus maximus, gluteus medius and quadriceps with
good results checked by eng and histology. Recently, after having obtained the permission of the ethical committee of the national health service, three human
beings have been operated on. The first one who had undergone guillotine severance of the cord by dislocation of T8 is now able to walk with tripod sticks.
The other two are still to recent. Research was done on animals to see whether it is the motor end-plate which changes its receptors from cholinergic into glutamatergic
or if it is the upper motorneuron which changes its neurotransmitter from Glutamate to Acetylcholine. A graft was put from the severed lateral or
posterior white matter (rubrospinal and cortico spinal tracts) to the muscular nerve of obliquus muscle in rats. Functional reinnervation of the muscle was
shown by E.M.G. and immunostaining. Genes codifying for receptors as well as the neurotransmitter were searched for. The administration of curare paralysed
all the muscles but not the operated one, whereas inhibitor for glutamate paralysed the operated side. Immunoblot test showed that the operated muscle contains
vesicular glutamate transporter-1 (VGluT-1) whereas the control muscle still contains ChAT and VAChT. Direct muscular innervation by the upper
motoneuron makes the muscles function probably due to changement of the receptors of the motor end-plates under glutammatergic stimulation.
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