Effect of Epineurial Neurorrhaphy on Restoration of Facial Nerve Injuries with Different Levels of Neurotmesis in a Rat Model: A Pilot Study.

Abstract

Different degrees of neurotmesis of the peripheral facial nerve frequently are encountered in clinic, for which the epineurial neurorrhaphy is the preferred technique. However, because of the capability of self-restoration of nerves and the side effects of surgery, neurorrhaphy may not be an optimal choice for various degrees of neurotmesis. In this study, we explored the necessity of epineurial neurorrhaphy for different degrees of neurotmesis, in addition to investigating factors that impact neural functional recovery. Rat models were divided into 6 groups: intact, noninjured controls; A, one-third cross-sectional facial nerve disconnected injury after epineurial neurorrhaphy; B, one-third cross-sectional facial nerve disconnected injury without epineurial neurorrhaphy; C, two-thirds cross-sectional facial nerve disconnected injury after epineurial neurorrhaphy; D, two-thirds cross-sectional facial nerve disconnected injury without epineurial neurorrhaphy; and E, two-thirds cross-sectional facial nerve disconnection followed by complete transection and neurorrhaphy. Facial functional recovery was assessed with the use of behavioral assessments and electrophysiologic tests. The morphologic changes of trunk of the facial nerve were analyzed by osmium-toluidine blue staining and immunofluorescence. The modification of central nervous system was evaluated by retrograde labeling and Nissl's staining of facial nerve nuclei. Concerning morphologic and functional assessments, there were no statistically significant differences between one-third facial nerve disconnected injury with or without epineurial neurorrhaphy and the intact model. For two-thirds facial nerve disconnected injury, direct neurorrhaphy was superior to complete transection followed by neurorrhaphy. For two-thirds facial nerve disconnected injury, the nerves can largely self-restore in neural structure and function without the use of epineurial neurorrhaphy. For the facial nerve nuclei, the number of neurons decreased in the more than two-thirds nerve disconnected models, and models with two-thirds disconnection and without neurorrhaphy had the least number of neurons. For the distribution of neurons in different facial nerve subnuclei, both models with two-thirds nerve disconnection without neurorrhaphy and models with two-thirds nerve disconnection after complete transection and neurorrhaphy demonstrated disorganization of neurons, in which the latter was more serious. For one-third disconnected facial nerve injury, there's no need to suture the nerve stump, although for residual one-third connected nerve injury, direct suture is preferable if permitted than pre-performing a complete transection to trim the stump. Residual one-third connected nerve fibers largely can self-restore. The results from this study indicate that neural functional defect may be attributed to the damage and misdirection of peripheral nerve fibers and central neurons.