Xie Yanjun, Schneider Kevin J, Ali Syed A, Hogikyan Norman D, Feldman Eva L, Brenner Michael J
Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA.
Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA.
Neural Regen Res. 2020 Sep;15(9):1639-1649. doi: 10.4103/1673-5374.276325.
The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatrogenic insults and causes devastating functional impairment and disfigurement. Surgical innovations directed towards restoring function to injured motor cranial nerves and their associated organs have evolved to include nerve repair, grafting, substitution, and muscle transposition. In parallel with this progress, research on tissue-engineered constructs, development of bioelectrical interfaces, and modulation of the regenerative milieu through cellular, immunomodulatory, or neurotrophic mechanisms has proliferated to enhance the available repertoire of clinically applicable reconstructive options. Despite these advances, patients continue to suffer from functional limitations relating to inadequate cranial nerve regeneration, aberrant reinnervation, or incomplete recovery of neuromuscular function. These shortfalls have profound quality of life ramifications and provide an impetus to further elucidate mechanisms underlying cranial nerve denervation and to improve repair. In this review, we summarize the literature on reconstruction and regeneration of motor cranial nerves following various injury patterns. We focus on seven cranial nerves with predominantly efferent functions and highlight shared patterns of injuries and clinical manifestations. We also present an overview of the existing reconstructive approaches, from facial reanimation, laryngeal reinnervation, to variations of interposition nerve grafts for reconstruction. We discuss ongoing endeavors to promote nerve regeneration and to suppress aberrant reinnervation and the development of synkinesis. Insights from these studies will shed light on recent progress and new horizons in understanding the biomechanics of peripheral nerve neurobiology, with emphasis on promising strategies for optimizing neural regeneration and identifying future directions in the field of motor cranial neuron research.
颅神经复杂的解剖结构和生理功能激发了临床医生和科学家对其在神经系统中作用的研究。运动性颅神经损伤可能由多种器质性或医源性损伤引起，会导致严重的功能障碍和容貌损毁。旨在恢复受损运动性颅神经及其相关器官功能的外科创新已经发展到包括神经修复、移植、替代和肌肉转位。与此同时，关于组织工程构建体的研究、生物电接口的开发以及通过细胞、免疫调节或神经营养机制对再生微环境的调节也大量涌现，以增加临床上适用的重建选择。尽管取得了这些进展，但患者仍因颅神经再生不足、异常再支配或神经肌肉功能恢复不完全而存在功能受限问题。这些不足对生活质量有深远影响，并促使人们进一步阐明颅神经去神经支配的潜在机制并改善修复效果。在本综述中，我们总结了各种损伤模式后运动性颅神经重建和再生的文献。我们重点关注七种主要具有传出功能的颅神经，并突出损伤和临床表现的共同模式。我们还概述了现有的重建方法，从面部表情重建、喉再支配到用于重建的间置神经移植的各种变体。我们讨论了促进神经再生、抑制异常再支配和联带运动发展的持续努力。这些研究的见解将揭示在理解周围神经神经生物学生物力学方面的最新进展和新视野，重点是优化神经再生的有前景策略以及确定运动性颅神经研究领域的未来方向。
