Streppel M, Angelov D N, Guntinas-Lichius O, Neiss W F
Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals_Chirurgie, Universität Köln.
Laryngorhinootologie. 1998 Jun;77(6):332-6. doi: 10.1055/s-2007-996983.
Nerve sutures such as facial-facial anastomosis are helpful methods for recovery of facial movements after peripheral nerve lesions. Most of the results on neuronal regeneration were based on experiments with young or young adult animals. In contrary the vast majority of the diseases (cholesteatoma or tumors of the parotid gland) causing facial nerve lesions are in aged patients.
Therefore, we compared the original data from two recently published articles concerning the axonal outgrowing process after facial-facial-anastomosis in young-adult and aged rats. In additional, we tried to explain the clinically observed postparalytic syndrome (synkinesia, autoparalytic syndrome,...) after surgical interventions on the facial nerve with the experimental results in the rat.
As an important result, we could not find spontaneous loss of facial motoneurons on the control side in the aged rats. On the operated side, two results have to be emphasized. The initial regeneration (10-42 days after the operation) showed a significant faster reinnervation in the group of young rats. The aged rats showed an apparent hyperinnervation after axonal outgrow to the mimic muscles has been accomplished.
Both experimental observations are in agreement with our clinical experiences. After facial nerve surgery, aged patients show a delayed recovery of the mimic functions and a more pronounced postparalytic syndrome. A morphological explanation one can bear is that the delayed reinnervation causes the extreme hyerinnervation, which leads to a simultaneous innervation of different muscles by same facial motoneurons.
神经缝合术，如面神经-面神经吻合术，是周围神经损伤后恢复面部运动的有效方法。大多数关于神经元再生的研究结果是基于对幼年或年轻成年动物的实验。相反，导致面神经损伤的绝大多数疾病（胆脂瘤或腮腺肿瘤）发生在老年患者中。
因此，我们比较了最近发表的两篇文章中的原始数据，这两篇文章涉及年轻成年大鼠和老年大鼠面神经-面神经吻合术后的轴突生长过程。此外，我们试图用大鼠的实验结果来解释面神经手术干预后临床上观察到的麻痹后综合征（联带运动、自动麻痹综合征等）。
一个重要的结果是，我们在老年大鼠的对照侧未发现面神经运动神经元的自发丢失。在手术侧，有两个结果需要强调。初始再生阶段（术后10 - 42天），年轻大鼠组的神经再支配明显更快。在轴突生长至表情肌完成后，老年大鼠出现明显的神经支配过度。
这两个实验观察结果与我们的临床经验一致。面神经手术后，老年患者的表情功能恢复延迟，麻痹后综合征更明显。一种可能的形态学解释是，神经再支配延迟导致了极度的神经支配过度，进而导致同一面神经运动神经元同时支配不同的肌肉。
