Schwarting S, Schröder M, Stennert E, Goebel H H
ORL J Otorhinolaryngol Relat Spec. 1984;46(5):248-56. doi: 10.1159/000275718.
17 biopsies of denervated facial muscles, the zygomatic, the orbicularis oris and the levator labii muscles, showed atrophic myofibers in most cases. There was loss of fiber typability when applying the NADH, the MAG and the alkaline ATPase reactions. The acid ATPase preparations allowed differentiation of myofibers into type I and type II without subtypes. Contrary to normal facial muscles that are richly endowed with motor endplates, no neuromuscular junctions were observed in denervated muscle fibers except one example which might have been obtained by false sampling from the marginal area of denervation or might be the result of partial reinnervation due to sprouting axons from the neighborhood. There was no correlation between the degree of muscle fiber atrophy and the duration of the paralysis. However, fibrosis corresponded to length of denervation. The presence of highly atrophic muscle fibers even 36 years after denervation indicates that the final aim of facial nerve surgery, namely the reinnervation of denervated facial musculature may still be achievable. However, endomysial and perimysial fibrosis may have a considerable impact on the final outcome of such facial nerve surgery. Unsatisfactory correlation between morphological and clinical as well as electromyographical findings in denervated facial muscles requires individual morphological study of each biopsy to assess the probable outcome of reconstructive facial nerve surgery. It therefore appears reasonable even in long-standing facial paralysis, to biopsy denervated facial muscles before or during surgical reanastomosation of the facial nerve. This study provides hints that morphological examination of denervated facial muscles may supplement clinical, electrophysiological, and possibly biochemical diagnostic findings.
对17例失神经支配的面部肌肉（颧肌、口轮匝肌和提上唇肌）活检发现，多数情况下存在肌纤维萎缩。应用NADH、MAG和碱性ATP酶反应时，出现纤维类型可辨性丧失。酸性ATP酶制剂可将肌纤维分为I型和II型，但无亚型。与富含运动终板的正常面部肌肉相反，在失神经支配的肌纤维中未观察到神经肌肉接头，仅1例可能是由于从失神经支配边缘区域的错误取样获得，或者可能是由于邻近轴突发芽导致部分再支配的结果。肌纤维萎缩程度与麻痹持续时间之间无相关性。然而，纤维化程度与失神经支配时间相对应。即使在失神经支配36年后仍存在高度萎缩的肌纤维，这表明面神经手术的最终目标，即失神经支配的面部肌肉组织再支配仍有可能实现。然而，肌内膜和肌束膜纤维化可能会对这种面神经手术的最终结果产生相当大的影响。失神经支配的面部肌肉形态学与临床及肌电图检查结果之间的相关性不令人满意，需要对每例活检进行个体形态学研究，以评估面神经重建手术的可能结果。因此，即使在长期面瘫的情况下，在面神经手术再吻合之前或期间对失神经支配的面部肌肉进行活检似乎也是合理的。本研究提示，失神经支配面部肌肉的形态学检查可能补充临床、电生理以及可能的生化诊断结果。
