Abstract
This study aimed to determine whether nerve regeneration by means of an artificial nerve conduit is promoted by ethanol-induced cervical sympathetic ganglion block (CSGB) in a canine model. This study involved two experiments—in part I, the authors examined the effect of CSGB by ethanol injection on long-term blood flow to the orofacial region; part II involved evaluation of the effect of CSGB by ethanol injection on inferior alveolar nerve (IAN) repair using polyglycolic acid-collagen tubes. In part I, seven Beagles were administered left CSGB by injection of 99.5% ethanol under direct visualization by means of thoracotomy, and changes in oral mucosal blood flow in the mental region and nasal skin temperature were evaluated. The increase in blood flow on the left side lasted for 7 weeks, while the increase in average skin temperature lasted 10 weeks on the left side and 3 weeks on the right. In part II, fourteen Beagles were each implanted with a polyglycolic acid-collagen tube across a 10-mm gap in the left IAN. A week after surgery, seven of these dogs were administered CSGB by injection of ethanol. Electrophysiological findings at 3 months after surgery revealed significantly higher sensory nerve conduction velocity and recovery index (ratio of left and right IAN peak amplitudes) after nerve regeneration in the reconstruction+CSGB group than in the reconstruction-only group. Myelinated axons in the reconstruction+CSGB group were greater in diameter than those in the reconstruction-only group. Administration of CSGB with ethanol resulted in improved nerve regeneration in some IAN defects. However, CSGB has several physiological effects, one of which could possibly be the long-term increase in adjacent blood flow.
Highlights
Adequate recovery from peripheral nerve injury continues to be a clinical challenge
cervical sympathetic ganglion block (CSGB) with ethanol might result in a long-term increase in blood flow to the region innervated by the inferior alveolar nerve (IAN)
A week after CSGB, nasal skin temperature and average oral mucosal blood flow on the left side had increased by 8.8 ± 1.1 ̊C and 51 ± 12%, respectively, in comparison with the baseline values (Fig 4A and 4B)
Summary
Adequate recovery from peripheral nerve injury continues to be a clinical challenge. Stellate ganglion block (SGB), a type of sympathetic blockade, has several physiological effects, one of which is increased blood flow to regional tissues in the head, face, and neck, depending on its sympatholytic effects [7,8,9]. Previous studies have used ethanol for achieving cervical sympathetic ganglion block (CSGB) instead of SGB [10, 11]. CSGB with ethanol might result in a long-term increase in blood flow to the region innervated by the inferior alveolar nerve (IAN). The objective of part I of this study was to develop a canine SGB model employing ethanol to achieve CSGB. The objective of part II was to perform electrophysiological and histological assessment of the rate of regeneration of the IAN in our canine SGB model following excision and reconstruction of the nerve using a PGA-C tube
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