Horiuchi J
Department of Otolaryngology, Ehime University, School of Medicine.
Nihon Jibiinkoka Gakkai Kaiho. 1997 Mar;100(3):299-306. doi: 10.3950/jibiinkoka.100.299.
Hypoglossal facial nerve anastomosis (XII-VII anastomosis) or accessory-facial anastomosis (XI-VII anastomosis) have been chosen for facial rehabilitation when the facial nerve is widely sacrificed and end-to-end anastomosis or nerve grafting is unavailable. However, no detailed study has been conducted to determine which donor nerve is better for the anastomosis procedure in view of regeneration of the facial nerve. To compare and evaluate nerve regeneration after XII-VII anastomosis and XI-VII anastomosis, animal models of these anastomoses were made in guinea pigs by using a Y-shaped silicon tube. The proximal cut-ends of the hypoglossal nerve and accessory nerve were suspended in the paired inlet limbs of a Y-shaped silicone tube with a 9-0 nylon suture, and the distal cut-end of the facial nerve was suspended in the single outlet limb in a similar manner. After 4 and 8 weeks, histological studies were carried out. An electrophysiological study of conduction velocity and amplitude of evoked electromyography were measured at 8 weeks postoperation. The nerve fibers regenerated from the hypoglossal nerve were significantly more numerous than those from the accessory nerve at both 4 and 8 weeks after anastomosis. The amplitude of evoked electromyography elicited from the hypoglossal nerve was greater than that from the accessory nerve, even though there is no significant difference in conduction velocities between the two anastomoses. The nerve regeneration by the cross-over procedure was influenced by many factors such as the number of nerve fibers in the donor nerve and the affinity between donor and recipient nerves. The number of nerve fibers in the hypoglossal nerve was significantly greater than that in the accessory nerve. However, there was no significant difference in the ratios of regenerated nerve fibers to the preoperative nerve fibers. Accordingly, we concluded that the affinity of the hypoglossal or accessory nerve to the facial nerve is a minor factor if it exists, and the difference in the fiber count in these nerves is a major factor in the outcome of nerve regeneration.
当面神经被广泛切除且无法进行端端吻合或神经移植时，可选择舌下-面神经吻合术（XII-VII吻合术）或副神经-面神经吻合术（XI-VII吻合术）进行面部功能重建。然而，鉴于面神经的再生情况，尚未有详细研究来确定哪种供体神经更适合用于吻合手术。为了比较和评估XII-VII吻合术和XI-VII吻合术后的神经再生情况，在豚鼠身上使用Y形硅胶管制作了这些吻合术的动物模型。舌下神经和副神经的近端断端用9-0尼龙缝线悬吊于Y形硅胶管的成对入口肢中，面神经的远端断端以类似方式悬吊于单个出口肢中。4周和8周后，进行组织学研究。术后8周测量诱发肌电图的传导速度和波幅进行电生理研究。吻合术后4周和8周时，从舌下神经再生的神经纤维明显多于从副神经再生的神经纤维。尽管两种吻合术的传导速度没有显著差异，但舌下神经诱发的肌电图波幅大于副神经。交叉吻合术的神经再生受许多因素影响，如供体神经中的神经纤维数量以及供体和受体神经之间的亲和力。舌下神经中的神经纤维数量明显多于副神经。然而，再生神经纤维与术前神经纤维的比例没有显著差异。因此，我们得出结论，舌下神经或副神经与面神经的亲和力即使存在也是次要因素，这些神经中纤维数量的差异是神经再生结果的主要因素。
