Spector J G, Lee P, Peterein J, Roufa D
Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO 63110.
Laryngoscope. 1991 May;101(5):537-54. doi: 10.1288/00005537-199105000-00017.
Human facial nerve regeneration was compared in two systems: autologous neural cable grafts (N = 56) and direct end-to-end anastomosis (N = 34). The data were analyzed based on the following criteria: facial symmetry and muscle tone at rest, degree of total facial reinnervation, voluntary motion, synkinesis, and electrophysiologic testing. Facial tone and symmetry at rest, and electrophysiologic tests were similar, while voluntary motion and facial reinnervation were decreased and synkinesis increased in the autologous cable graft repairs. Electrophysiologic tests failed to distinguish between the two repair methods in successful regenerates. Neural cable grafts were associated with more mass movement and less fine precise emotive facial movement. Excellent cable graft repair results diminish with time because of continual progressive synkinesis, which may take up to 4 years to develop. Eight-millimeter neural cable graft repairs of the buccal division of the facial nerve in rabbits (N = 8) demonstrate, at 5 weeks, equal myelinated and more unmyelinated axons than in the normal nerve controls. Neural cable graft repairs demonstrate two features not found in the normal nerve: 1. myelin debris and 2. two subpopulations of axons--extrafascicular and intrafascicular. Myelin debris predisposes towards extrafascicular axon regeneration. Extrafascicular axons are the major neurite regenerates (63%). Intrafascicular axons are the major reinnervators of the distal transected nerve stump. Electrophysiologic studies demonstrate decreased conduction velocities which are related to the number and size of myelinated axonal regenerates. The implications for neurite reinnervation of the autologous cable graft and their role in synkinesis are discussed.
自体神经电缆移植（n = 56）和直接端端吻合术（n = 34）。根据以下标准对数据进行分析：静息时的面部对称性和肌张力、面部完全再支配程度、自主运动、联带运动以及电生理测试。静息时的面部肌张力和对称性以及电生理测试结果相似，而在自体电缆移植修复中，自主运动和面部再支配程度降低，联带运动增加。电生理测试无法区分成功再生的两种修复方法。神经电缆移植与更多的大规模运动相关，而精细精确的面部表情运动较少。由于持续进行性联带运动，出色的电缆移植修复结果会随时间而变差，这种联带运动可能需要长达4年的时间才会出现。对兔面神经颊支进行8毫米神经电缆移植修复（n = 8），在5周时显示，与正常神经对照相比，有同等数量的有髓轴突和更多的无髓轴突。神经电缆移植修复显示出正常神经中未发现的两个特征：1. 髓磷脂碎片；2. 轴突的两个亚群——束外和束内。髓磷脂碎片有利于束外轴突再生。束外轴突是主要的神经突再生部分（63%）。束内轴突是远端横断神经残端的主要再支配者。电生理研究表明传导速度降低，这与有髓轴突再生的数量和大小有关。讨论了自体电缆移植对神经突再支配的影响及其在联带运动中的作用。
