Nerve Trunk Research Articles

The importance of individualized and multiple landmarks for the identification of facial nerve trunk: a narrative review

The identification of the facial nerve trunk(FNT) is an important step in surgical procedures involving the parotid gland and adjacent structures to minimize the risk of inadvertent nerve damage which leads to facial muscle paralysis. Despite the availability of various anatomic landmarks such as the tragal pointer, posterior belly of digastric muscle, tympanomastoid suture, digastric branch of facial nerve and styloid process, no single landmark is perfect, with variations observed between individuals. Therefore, a comprehensive knowledge of facial nerve anatomy is essential for FNT identification. In this review, we tried to introduce clinically meaningful methods for the localization of facial nerve trunk. The preference of landmark could be changed by the major of the surgeon or the location of the tumor of the patients. Understanding the characteristics and drawbacks of the landmarks and choosing multiple landmarks that were convenient for surgeon would be necessary.

ML-driven segmentation of microvascular features during histological examination of tissue-engineered vascular grafts.

The development of next-generation tissue-engineered medical devices such as tissue-engineered vascular grafts (TEVGs) is a leading trend in translational medicine. Microscopic examination is an indispensable part of animal experimentation, and histopathological analysis of regenerated tissue is crucial for assessing the outcomes of implanted medical devices. However, the objective quantification of regenerated tissues can be challenging due to their unusual and complex architecture. To address these challenges, research and development of advanced ML-driven tools for performing adequate histological analysis appears to be an extremely promising direction. We compiled a dataset of 104 representative whole slide images (WSIs) of TEVGs which were collected after a 6-month implantation into the sheep carotid artery. The histological examination aimed to analyze the patterns of vascular tissue regeneration in TEVGs in situ. Having performed an automated slicing of these WSIs by the Entropy Masker algorithm, we filtered and then manually annotated 1,401 patches to identify 9 histological features: arteriole lumen, arteriole media, arteriole adventitia, venule lumen, venule wall, capillary lumen, capillary wall, immune cells, and nerve trunks. To segment and quantify these features, we rigorously tuned and evaluated the performance of six deep learning models (U-Net, LinkNet, FPN, PSPNet, DeepLabV3, and MA-Net). After rigorous hyperparameter optimization, all six deep learning models achieved mean Dice Similarity Coefficients (DSC) exceeding 0.823. Notably, FPN and PSPNet exhibited the fastest convergence rates. MA-Net stood out with the highest mean DSC of 0.875, demonstrating superior performance in arteriole segmentation. DeepLabV3 performed well in segmenting venous and capillary structures, while FPN exhibited proficiency in identifying immune cells and nerve trunks. An ensemble of these three models attained an average DSC of 0.889, surpassing their individual performances. This study showcases the potential of ML-driven segmentation in the analysis of histological images of tissue-engineered vascular grafts. Through the creation of a unique dataset and the optimization of deep neural network hyperparameters, we developed and validated an ensemble model, establishing an effective tool for detecting key histological features essential for understanding vascular tissue regeneration. These advances herald a significant improvement in ML-assisted workflows for tissue engineering research and development.

Establishment of Facial Nerve Injury Rat Model for Idiopathic Facial Paralysis Research.

Idiopathic facial paralysis is the most common type of facial nerve injury, accounting for approximately 70% of peripheral facial paralysis cases. This disease can not only lead to a change in facial expression but also greatly impact the psychology of patients. In severe cases, it can affect the normal work and life of patients. Therefore, the research on facial nerve injury repair has important clinical significance. In order to study the mechanism of this disease, it is necessary to carry out relevant animal experiments, among which the most important task is to establish an animal model with the same pathogenesis as human disease. The compression of the facial nerve within the petrous bone, especially the nerve trunk at the junction of the distal end of the internal auditory canal and the labyrinthine segment, is the pathogenesis of idiopathic facial paralysis. In order to simulate this common disease, a compression injury model of the main extracranial segment of the facial nerve was established in this study. The neurological damage was evaluated by behavioral, neuroelectrophysiological, and histological examination. Finally, 50 g constant force and 90 s clamp injury were selected as the injury parameters to construct a stable idiopathic facial paralysis model.

Morton's Metatarsalgia: The Current State of the Issue

A typical complaint with Morton's neuroma is a burning paroxysmal pain in the area of the plantar surface of the metatarsal bones with irradiation into the III interdigital space, which forces the patient to take off his shoes and massage the foot in the most inappropriate situations. Given that women are mostly ill, clinical manifestations reduce the quality of life of patients, limit their daily professional and work activities. The paper presents the etiology, pathogenesis and clinical picture of this disease, diagnostic features. A radical method of treatment is surgery, which is relatively simple in technique and consists in dissecting the tissues that compress the nerve and creating optimal conditions for the nerve trunk, preventing its subsequent traumatization.

A Young Man With Hereditary Motor And Sensory Neuropathy: A Rare Genetic Association

Hereditary motor and sensory neuropathies with early onset are uncommon conditions that include Dejerine-Sottas neuropathy, which begins in infancy, and congenital hypomyelinating neuropathy, which manifests in the early postnatal period. However, these two historically defined disease entities are only small parts of the clinical spectrum. It is well recognized that very early onset hereditary neuropathies are frequently caused by de novo dominant mutations in PMP22, MPZ, and EGR2. In addition, mutations in several other dominant and recessive genes for Charcot-Marie-Tooth disease may lead to similar phenotypes. A 20-year-old boy had complaints of weakness of both lower limbs for 1 year, followed by wasting and foot drop, which subsequently involved the upper limbs. Nerve conduction velocity and electromyography of both lower limbs revealed demyelinating sensory motor polyneuropathy. Histological examination of the sural nerve revealed a nerve trunk with perineural soft tissue, with the nerve bundles being irregular and separated by fibrous tissue bands. The later reveals small perivascular infiltration of chronic inflammatory cells, and no granuloma or AFB is seen. The genetic test of whole exome screening for heriditatory neuropathy showed pathogenic (PM2, PVS, PP5) with a gene impact of (NF2: c.363+1G>T), which is a rare entity in our case study to consider the diagnosis despite negative family history. We highlight this rare disease in young man with a high index of clinical suspicion for its diagnosis. Bangladesh J Medicine 2024; 35: 101-105

Trigeminal nerve electrical stimulation attenuates early traumatic brain injury through the TLR4/NF-κB/NLRP3 signaling pathway mediated by orexin-A/OX1R system.

Traumatic brain injury (TBI) is a significant contributor to global mortality and disability, and emerging evidence indicates that trigeminal nerve electrical stimulation (TNS) is a promising therapeutic intervention for neurological impairment following TBI. However, the precise mechanisms underlying the neuroprotective effects of TNS in TBI are poorly understood. Thus, the objective of this study was to investigate the potential involvement of the orexin-A (OX-A)/orexin receptor 1 (OX1R) mediated TLR4/NF-κB/NLRP3 signaling pathway in the neuroprotective effects of TNS in rats with TBI. Sprague-Dawley rats were randomly assigned to four groups: sham, TBI, TBI+TNS+SB334867, and TBI+TNS. TBI was induced using a modified Feeney's method, and subsequent behavioral assessments were conducted to evaluate neurological function. The trigeminal nerve trunk was isolated, and TNS was administered following the establishment of the TBI model. The levels of neuroinflammation, brain tissue damage, and proteins associated with the OX1R/TLR4/NF-κB/NLRP3 signaling pathway were assessed using hematoxylin-eosin staining, Nissl staining, western blot analysis, quantitative real-time polymerase chain reaction, and immunofluorescence techniques. The findings of our study indicate that TNS effectively mitigated tissue damage, reduced brain edema, and alleviated neurological deficits in rats with TBI. Furthermore, TNS demonstrated the ability to attenuate neuroinflammation levels and inhibit the expression of proteins associated with the TLR4/NF-κB/NLRP3 signaling pathway. However, it is important to note that the aforementioned effects of TNS were reversible upon intracerebroventricular injection of an OX1R antagonist. TNS may prevent brain damage and relieve neurological deficits after a TBI by inhibiting inflammation, possibly via the TLR4/NF-κB/NLRP3 signaling pathway mediated by OX-A/OX1R.

GFP-labeled Schwann cell-like cells derived from hair follicle epidermal neural crest stem cells promote the acellular nerve allografts to repair facial nerve defects in rats

BackgroundAcellular nerve allografts (ANAs) have been successfully applied to bridge facial nerve defects, and transplantation of stem cells may enhance the regenerative results. Up to now, application of hair follicle epidermal neural crest stem cell-derived Schwann cell-like cells (EPI–NCSC–SCLCs) combined with ANAs for bridging facial nerve defects has not been reported. MethodsThe effect of ANAs laden with green fluorescent protein (GFP)-labeled EPI–NCSC–SCLCs (ANA + cells) on bridging rat facial nerve trunk defects (5-mm-long) was detected by functional and morphological examination, as compared with autografts and ANAs, respectively. Results(1) EPI–NCSC–SCLCs had good compatibility with ANAs in vitro. (2) In the ANA + cells group, the GFP signals were observed by in vivo imaging system for small animals within 8 weeks, and GFP-labeled EPI–NCSC–SCLCs were detected in the tissue slices at 16 weeks postoperatively. (3) The facial symmetry at rest after surgery in the ANA + cells group was better than that in the ANA group (p < 0.05), and similar to that in the autograft group (p > 0.05). The initial recovery time of vibrissal and eyelid movement in the ANA group was 2 weeks later than that in the other two groups. (4) The myelinated fibers, myelin sheath thickness and diameter of the axons of the buccal branches in the ANA group were significantly worse than those in the other two groups (P < 0.05), and the results in the ANA + cells group were similar to those in the autograft group (p > 0.05). ConclusionsEPI–NCSC–SCLCs could promote functional and morphological recovery of rat facial nerve defects, and GFP labeling could track the transplanted EPI–NCSC–SCLCs in vivo for a certain period of time. These may provide a novel choice for clinical treatment of peripheral nerve defects.

Multi-scale analysis of acupuncture mechanisms for motor and sensory cortex activity based on SEEG data.

Acupuncture, a traditional Chinese therapy, is gaining attention for its impact on the brain. While existing electroencephalogram and functional magnetic resonance image research has made significant contributions, this paper utilizes stereo-electroencephalography data for a comprehensive exploration of neurophysiological effects. Employing a multi-scale approach, channel-level analysis reveals notable $\delta $-band activity changes during acupuncture. At the brain region level, acupuncture modulated connectivity between the paracentral lobule and the precentral gyrus. Whole-brain analysis indicates acupuncture's influence on network organization, and enhancing $E_{glob}$ and increased interaction between the motor and sensory cortex. Brain functional reorganization is an important basis for functional recovery or compensation after central nervous system injury. The use of acupuncture to stimulate peripheral nerve trunks, muscle motor points, acupoints, etc., in clinical practice may contribute to the reorganization of brain function. This multi-scale perspective provides diverse insights into acupuncture's effects. Remarkably, this paper pioneers the introduction of stereo-electroencephalography data, advancing our understanding of acupuncture's mechanisms and potential therapeutic benefits in clinical settings.

Socioeconomic factors and outcome after repair and reconstruction of digital and major nerve trunk injuries in the upper limb

Peripheral nerve injuries in the upper limb can lead to substantial disability and pain. We aimed to assess how socioeconomic factors affect outcomes after repaired or reconstructed digital or major nerve trunk injuries in the upper limb. We identified 670 individuals, who underwent surgical nerve repair or reconstruction using sensory nerve autografts, in the Swedish National Quality Registry for Hand Surgery 2010–2018. Socioeconomic factors, including education, cohabitation, type of work, sick leave, immigrant status and income, were gathered from the Swedish statistical agency (www.scb.se) and National Diabetes Register (NDR). We calculated prevalence ratios (PR) to assess the relationship between socioeconomic factors and surgical outcomes for the nerve injuries. Individuals with a major nerve trunk injury had higher QuickDASH scores and lower income compared to those with digital nerve injury. Individuals with immigration background (adjusted PR = 2.0, 95% CI 1.2–3.2), history of > 4 weeks of sick leave the year before surgery (adjusted PR = 1.8, 95% CI 1.1–3.1), or education level below tertiary (adjusted PR = 2.8, 95% CI 1.7–4.7) had significantly higher QuickDASH scores. Recognizing impact of non-biological factors, including immigration, prior sick leave, and education level, on outcome after nerve surgery is crucial for improving prognosis in socioeconomically deprived individuals.

Different techniques for identification of facial nerve during superficial parotidectomy

Background Parotidectomy is a common surgical procedure for the treatment of benign and malignant lesions of the parotid gland. Identification of the facial nerve trunk is essential during surgery of the parotid gland to avoid facial nerve injury. A comprehensive knowledge of its anatomy and meticulous dissection are the keys for the identification of the facial nerve trunk and its branches. Aim To compare between the traditional antegrade parotidectomy and retrograde in identification of facial nerve during superficial parotidectomy, determination the best anatomical landmark, the time of exploration of facial nerve, outcomes, facial nerve complication, duration of surgery, patient satisfaction as well as other complications. Methods Twelve patients who were diagnosed with having parotid gland neoplasms, and had undergone superficial Parotidectomy were recruited and assessed for eligibility at General Surgery Department, Beni-Suef University Hospital. Patients were divided according to the surgical technique into two equal groups, group A (the antegrade dissection group), and group B (the retrograde dissection group), follow-up was 6 months. Results There was no statistically significant differences between both groups regarding pain, paresthesia and pathology postoperation (P value&gt;0.05). Longer mean operation time was observed in the antegrade dissection group in comparison with the retrograde dissection group (2.06±0.75 and 1.61±0.31 h, respectively), which was statistically insignificant (P value&gt;0.05). There was a statistically significant increase in facial nerve injury among patients in the antegrade dissection group in comparison with the retrograde dissection group (P value=0.046). There was no statistically significant difference between techniques regarding hospital stay duration and complications three months postoperation (P value&gt;0.05). Conclusion Retrograde facial nerve dissection technique is better than the classical antegrade technique in the superficial parotidectomy within this study.

The role of 18F-FDG PET/CT in Neurolymphomatosis: A Comprehensive Imaging Approach.

Neurolymphomatosis (NL) is an uncommon and rare neurologic disorder characterised by extranodal lymphoma, where the tumour cells invade the cranial nerves, nerve plexus, nerve root, spinal nerve roots, trunk nerves or peripheral nerves. MRI is the modality of choice, but is often challenging in detection of early recurrence, assessing residual disease and response evaluation. 18FFDG PET/CT has superior diagnostic performance compared with body CT in the evaluation of NL. 18F-FDG PET-CT is helpful in evaluation of disease extent and potential to guide biopsy. 18F-FDG PETCT is a highly sensitive technique for early localisation of NL than MRI or CT alone. Besides diagnostic and prognostic value in NL, it might be very helpful in response assessment.

A clinicoepidemiological study of leprosy among children and adolescents in a tertiary care centre in the post elimination era

Leprosy amongst younger age indicates active foci of transmission in the community. Our aim is to analyse the epidemiological profile, clinical spectrum, reactions and deformities of leprosy among children and adolescents. This is a prospective observational study conducted on all newly diagnosed leprosy patients under the age of 19 years for one year. Of 113 newly diagnosed leprosy cases, 38 patients were under 19 years of age. Male-female ratio was 5.3:1. Mean age was 16.6 years. Borderline tuberculoid (BT) was the most common type followed by borderline lepromatous (BL) and Indeterminate (I) leprosy most common manifestation was hypopigmented anaesthetic skin lesion over exposed parts. 79% had multiple nerve trunk involvement of which ulnar nerve was the most common. Reaction and deformity were found to be in 21% and 18.3%. Both were seen only in multibacillary cases and predominantly in 15-19years of age. Risk factors for reactions were male sex, increasing age, labourers, borderline spectrum, skin lesion involving the nerve trunk, multiple nerve involvement and smear positivity. Risk factors for deformities were migrants in lower socio-economic status, increased duration of active disease and delayed diagnosis. Leprosy, a disease of long incubation period, among adolescents may indicate missed cases of childhood leprosy. Training through integrated service in early diagnosis and its complication, introduction of an exclusive type of treatment (MB MDT) for all categories for a shortened duration and newer drugs for reactions, sustained commitment to follow-up care and health education among community is a need at this post elimination era.

Блокада плечевого сплетения подмышечным доступом. Обзор литературы

The main tasks of an anesthesiologist during the anesthesiological support of surgical interventions are the maximum possible protection of the patient from pain with minimal effect on homeostasis, creating comfortable conditions for the work of operating surgeons. These requirements fully comply with regional paintering methods, especially during operations on the upper limb, when the anesthesiologist has a choice: to perform general anesthesia or blockade of the shoulder plexus. The regional blockade will fully ensure adequate analgesia, hyporeflexia and relaxation in the operation zone. To increase the efficiency and safety of regional blockade, ultrasonic navigation and neuromuscular stimulation are used. One of the safest and easy-to-perform is axillar access. Objective. Summarize and present modern information about the regional blockade of the shoulder plexus from axillary access. Material and methods. During the writing of the article on regional methods of upper limb anesthesia, in particular on axillary access, a literature from open electronic scientific databases of Pubmed, the US National Electronic Medical Library and Databases of the Russian Scientific Electronic Library Elibary was analyzed. Results. An analysis of domestic and foreign literature dedicated to the blockade of the shoulder plexus with axillary access was carried out. The article discusses options for the location of the nerve trunks of the shoulder plexus in the axillary region, the technique of performing the axillar blockade, indications and possible complications. Conclusions. The priority when choosing access when blocking the shoulder plexus is to ensure the safety and efficiency of anesthesia, especially in high-risk patients. Axillar access using sonoscopy and neuromuscular stimulation fully complies with these requirements.

Anatomic evaluation to compare the dye spread with ultrasound-guided pericapsular nerve group (PENG) injection with or without an additional suprainguinal fascia iliaca (SIFI) injection in soft embalmed cadavers.

Novel interfascial plane blocks like PEricapsular Nerve Group (PENG) and SupraInguinal Fascia Iliaca (SIFI) blocks are effective for management of hip fracture pain. We compared the difference in the distribution of the dye injected and nerves stained by the addition of the SIFI block to the PENG block. A total of 24 designated dye injections were performed in eight soft-embalmed cadavers. Under ultrasound guidance 20ml green ink injected bilaterally in PENG block and 30ml methylene blue dye was injected in the SIFI block on the right side. The cadavers were dissected 24h later to assess the extent of dye spread. Extensive spread of dyes was seen on both side of iliacus muscle on the right side, but blue dye was not visible medial to the psoas tendon. The subcostal and iliohypogastric nerves were stained green in the infra-inguinal region. On the left side (PENG alone), the anterior division of the obturator, femoral and saphenous nerve (7/8) and iliohypogastric nerves (3/8) were stained in the infrainguinal region. In the suprainguinal region, the femoral nerve (5/8), accessory obturator nerve (3/8), lateral femoral cutaneous (1/8) and nerve to rectus femoris (4/8) were stained. The main obturator nerve trunk was spared with both injections while its anterior branch and accessory obturator nerve were stained with the PENG injection. The study findings indicate that combined PENG + SIFI injections lead to an extensive craniocaudal and longitudinal spread along the iliacus muscle. We perceive that the combination of these two injections will have a superior clinical outcome.

WITHDRAWN: Analysis of the efficacy of repetitive transcranial magnetic stimulation for neuromodulation in early Bell’s palsy: A prospective randomized controlled study

BackgroundThe current main treatment modality for Bell’s palsy (BP) is medication; however, some patients have a poor recovery or experience sequelae despite receiving medication. There is therefore an urgent need to explore new treatment modalities. We conducted this study to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for neuromodulation in early BP. MethodsSeventy-four patients with BP were randomly assigned to a stimulation (n = 36) or control (n = 38) group. Patients in both groups were treated with conventional medication; the stimulation group also received high-frequency rTMS for 2 weeks. Patients were followed up for a minimum of 9 months. Facial function was assessed in patients at baseline, post-treatment, and follow-up using the Facial Nerve Grading System (FNGS) 2.0. ResultsThere was a significantly larger decrease in FNGS 2.0 scores from before to after treatment in the stimulation group (7.08 ± 2.371) than in the control group (5.03 ± 2.615) (p = 0.001; decrease of 2.057, 95% confidence interval 0.898–3.216). Furthermore, the recovery time of cured individuals at follow-up was significantly shorter in the stimulation group than in the control group (Z = 2.157, p = 0.03), and the stimulated group had a lower complication rate than the control group (p = 0.026). ConclusionsrTMS-induced neuromodulation of the facial nerve trunk at the site at which it exits the mastoid foramen helps to promote the recovery of facial nerve function in BP patients, leading to earlier recovery and a reduced complication rate.

A case of pituitary apoplexy presented with isolated complete oculomotor nerve palsy

The oculomotor nerve (CN3) innervates four extra-ocular muscles and contains parasympathetic fibers controlling pupillary light reflex (PLR). CN3 palsy with impaired PLR or complete CN3 palsy usually suggests a compressive lesion against the CN3 because the parasympathetic fibers located superficially on the cranial nerve trunk are affected. A cerebral aneurysm originated from posterior communicating artery, posterior cerebral artery or superior cerebellar artery is a common cause of isolated complete CN 3 palsy. Here, we reported a less common intracranial lesion causing isolated complete CN3 palsy for which the preceding recurrent temporal headaches before the CN3 palsy assisted the neurological localization.

Three Useful Tips and Tricks for Intraoperative Nerve Stimulation.

Disposable handheld nerve stimulators are widely used in peripheral nerve surgery. Such devices stimulate a motor nerve or the motor component of a mixed nerve by applying electrical current to the proximal region, targeting the main nerve trunk. This stimulation then travels along the motor nerve, reaching the distal end to control the corresponding muscle(s). In this study, the authors demonstrate three useful tips and tricks for handheld nerve stimulation during targeted muscle reinnervation and peripheral nerve surgery. The three tips are (1) identification of proximal muscle contraction by retrograde electrical stimulation of a distal sensory nerve; (2) graded stimulation for identifying motor nerves within fibrotic scarred tissue beds or parallel to the major motor/mixed nerve of interest; and (3) proximal stimulation for validation of adequate post-targeted muscle reinnervation coaptation(s).

Effect of combined electrical stimulation and brief muscle lengthening on torque development.

This study aimed to evaluate torque production in response to the application of a brief muscle lengthening during neuromuscular electrical stimulation (NMES) applied over the posterior tibial nerve. Fifteen participants took part in three experimental sessions, where wide-pulse NMES delivered at 20 and 100 Hz (pulse duration of 1 ms applied during 15 s at an intensity evoking 5-10% of maximal voluntary contraction) was either applied alone (NMES condition) or in combination with a muscle lengthening at three distinct speeds (60, 180, or 300°/s; NMES + LEN condition). The torque-time integral (TTI) and the muscle activity following the stimulation trains [sustained electromyography (EMG)] were calculated for each condition. Results show that TTI and sustained EMG activity were higher for the NMES + LEN condition only when using 100-Hz stimulation, regardless of the lengthening speed (P = 0.029 and P = 0.007 for the two parameters, respectively). This indicates that superimposing a muscle lengthening to high-frequency NMES can enhance the total torque production, partly due to neural mechanisms, as evidenced by the higher sustained EMG activity. This finding has potential clinical relevance, especially when it comes to finding ways to enhance torque production to optimize the effectiveness of NMES training programs.NEW & NOTEWORTHY This study showed, for the first time, that the combined application of a brief muscle lengthening and wide-pulse neuromuscular electrical stimulation (NMES) delivered over the posterior tibial nerve can entail increased torque production as compared with the sole application of NMES. This observation, present only for high stimulation frequencies (100 Hz) and independently of the lengthening speed, is attributed to neural mechanisms, most probably related to increased afferents' solicitation, although muscular phenomena cannot be excluded.

The involvement of Neuregulin-1 in the process of facial nerve injury repair through the utilization of dental pulp stem cells

BackgroundFacial nerve injury often results in poor prognosis due to the challenging process of nerve regeneration. Neuregulin-1, a human calmodulin, is under investigation in this study for its impact on the reparative capabilities of Dental Pulp Stem Cells (DPSCs) in facial nerve injury.MethodsLentivirus was used to transfect and construct Neuregulin-1 overexpressed DPSCs. Various techniques assessed the effects of Neuregulin-1: osteogenic induction, lipid induction, Reverse Transcription Polymerase Chain Reaction, Western Blot, Cell Counting Kit-8 assay, wound healing, immunofluorescence, Phalloidin staining, nerve stem action potential, Hematoxylin-eosin staining, transmission electron microscopy, and immunohistochemistry.ResultsNeuregulin-1 effectively enhanced the proliferation, migration, and cytoskeletal rearrangement of DPSCs, while simultaneously suppressing the expression of Ras homolog gene family member A (RhoA) and Microfilament actin (F-actin). These changes facilitated the neural differentiation of DPSCs. Additionally, in vivo experiments showed that Neuregulin-1 expedited the restoration of action potential in the facial nerve trunk, increased the thickness of the myelin sheath, and stimulated axon regeneration.ConclusionNeuregulin-1 has the capability to facilitate the repair of facial nerve injuries by promoting the regenerative capacity of DPSCs. Thus, Neuregulin-1 is a significant potential gene in the reparative processes of nerve damage.

Rare case demonstrating a bifid facial nerve trunk encircling the posterior belly of digastric muscle

This case report describes a variation of facial nerve trunk (FNT) to the digastric muscle identified during parotidectomy where the superior temporofacial branch traverses anterior to the posterior belly of digastric muscle (PBD) and the inferior cervicofacial branch traversing through the muscle. The variation has not been described in literature previously.