Ylikoski J
Department of ORL, Helsinki City Laakso Hospital, Finland.
J Laryngol Otol. 1990 Apr;104(4):294-300. doi: 10.1017/s0022215100112538.
Facial nerve specimens obtained during reinnervation surgery from 31 patients with facial palsy of varying aetiology were studied. In patients who had a facial palsy after attenuation during acoustic schwannoma removal the facial nerve had normal populations of myelinated nerve fibres in the sensory zone but their numbers and sizes were severely reduced and fibrosis was increased in the motor zone. The latter also had large numbers of endoneurial tubes with thin unmyelinated axons. When the facial nerve had been severed in tumour removal, it had practically no remaining nerve fibres. In three out of four patients with middle ear cholesteatoma, the distal facial nerve stump showed severe fibrosis. In patients with iatrogenic trauma and skull fracture, the distal stump usually showed few myelinated nerve fibres, endoneurial tubes with thin unmyelinated fibres and increased fibrosis. The pathological changes observed indicate that in all cases the motor fibres distal to the lesion have undergone Wallerian degeneration and demyelination and in most a subsequent partial regeneration. However, the regeneration remained incomplete. The distal stump of the facial nerve with numerous endoneurial tubes in most cases of the material presented appear to provide favourable structural preconditions for reinnervation surgery.
对31例病因各异的面瘫患者在神经再支配手术中获取的面神经标本进行了研究。在听神经鞘瘤切除术中面神经受损后发生面瘫的患者中，感觉区的面神经有正常数量的有髓神经纤维，但其数量和大小严重减少，运动区的纤维化增加。运动区还有大量含有细无髓轴突的神经内膜管。当在肿瘤切除术中面神经被切断时，几乎没有剩余的神经纤维。在四例中耳胆脂瘤患者中有三例，面神经远端残端显示严重纤维化。在医源性创伤和颅骨骨折患者中，远端残端通常显示有髓神经纤维较少、含有细无髓纤维的神经内膜管以及纤维化增加。观察到的病理变化表明，在所有病例中，病变远端的运动纤维都经历了华勒变性和脱髓鞘，并且在大多数情况下随后有部分再生。然而，再生仍然不完全。在所呈现材料的大多数病例中，含有大量神经内膜管的面神经远端残端似乎为神经再支配手术提供了有利的结构前提条件。
