Facial synkinesis,a sequela of peripheral facial nerve palsy,is characterized by simultaneous involuntary facial movement during a voluntary desired one.Maladaptive cortical plasticity might be involved in the dysfunc...Facial synkinesis,a sequela of peripheral facial nerve palsy,is characterized by simultaneous involuntary facial movement during a voluntary desired one.Maladaptive cortical plasticity might be involved in the dysfunction of facial muscles.This cohort study investigated the cortical functional alterations in patients with unilateral facial synkinesis,using the task functional magnetic resonance imaging.Facial motor tasks,including blinking and smiling,were performed by 16 patients（aged 30.6 ± 4.5 years,14 females/2 males） and 24 age-and sex-matched healthy controls（aged 29.1 ± 4.2 years,19 females/5 males）.Results demonstrated that activation in the cortico-facial motor representation area was lower during tasks in patients with facial synkinesis compared with healthy controls.Facial movements on either side performed by patients caused more intensive activation of the supplementary motor area on the contralateral side of the affected face,than those on the unaffected side.Our results revealed that there was cortical reorganization in the primary sensorimotor area and the supplementary motor area.This study was registered in Chinese Clinical Trial Registry（registration number： Chi CTR1800014630）.展开更多
目的探讨A型肉毒毒素(botulinum toxin type A,BoNT-A)治疗原发性及面瘫后面肌痉挛患者痉挛及伴随联带运动的疗效差异。方法选取2009年1月-2018年7月具有联带运动的面瘫后面肌痉挛患者12例,按照1∶2配比性别无差异且具有联带运动的原发...目的探讨A型肉毒毒素(botulinum toxin type A,BoNT-A)治疗原发性及面瘫后面肌痉挛患者痉挛及伴随联带运动的疗效差异。方法选取2009年1月-2018年7月具有联带运动的面瘫后面肌痉挛患者12例,按照1∶2配比性别无差异且具有联带运动的原发性面肌痉挛患者24例,分析2组BoNT-A治疗后痉挛严重程度以及伴随联带运动的改善差异。结果面瘫后及原发性面肌痉挛患者在起效时间[(4.38±2.17)vs.(4.67±4.14)d],维持时间[(3.83±2.94)vs.(4.96±2.48)d],注射剂量[(31.35±12.30)vs.(26.98±8.75)U]方面无明显差异(P>0.05)。原发性面肌痉挛组患者满意度显著较高(84.79±19.81vs.64.17±31.54,P<0.05)。2组痉挛改善有效率均高于90%,组间无明显差异(91.67%vs.95.83%,P>0.05)。2组联带运动均有改善,但无明显差异(83.33%vs.58.33%,P>0.05)。5个自主动作相关联带运动改善方面仅发现原发性面肌痉挛患者噘嘴引起联带运动的改善有明显差异(P<0.05)。结论 BoNT-A可以显著改善原发性与面瘫后面肌痉挛患者的痉挛严重程度,在联带运动严重程度改善方面有一定疗效。原发性面肌痉挛患者噘嘴引起的联带运动在BoNT-A治疗后显著改善。展开更多
The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatroge...The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatrogenic insults and causes devastating functional impairment and disfigurement. Surgical innovations directed towards restoring function to injured motor cranial nerves and their associated organs have evolved to include nerve repair, grafting, substitution, and muscle transposition. In parallel with this progress, research on tissue-engineered constructs, development of bioelectrical interfaces, and modulation of the regenerative milieu through cellular, immunomodulatory, or neurotrophic mechanisms has proliferated to enhance the available repertoire of clinically applicable reconstructive options. Despite these advances, patients continue to suffer from functional limitations relating to inadequate cranial nerve regeneration, aberrant reinnervation, or incomplete recovery of neuromuscular function. These shortfalls have profound quality of life ramifications and provide an impetus to further elucidate mechanisms underlying cranial nerve denervation and to improve repair. In this review, we summarize the literature on reconstruction and regeneration of motor cranial nerves following various injury patterns. We focus on seven cranial nerves with predominantly efferent functions and highlight shared patterns of injuries and clinical manifestations. We also present an overview of the existing reconstructive approaches, from facial reanimation, laryngeal reinnervation, to variations of interposition nerve grafts for reconstruction. We discuss ongoing endeavors to promote nerve regeneration and to suppress aberrant reinnervation and the development of synkinesis. Insights from these studies will shed light on recent progress and new horizons in understanding the biomechanics of peripheral nerve neurobiology, with emphasis on promising strategies for optimizing neural regeneration and identifying future direc展开更多
Both interposition nerve grafts and masseter nerve transfers have been successfully used for facial reanimation after irreversible injuries to the cranial portion of the facial nerve.However,no comparative study of th...Both interposition nerve grafts and masseter nerve transfers have been successfully used for facial reanimation after irreversible injuries to the cranial portion of the facial nerve.However,no comparative study of these two procedures has yet been reported.In this two-site,twoarm,retrospective case review study,32 patients were included.Of these,17 patients(eight men and nine women,mean age 42.1 years)underwent interposition nerve graft after tumor extirpation or trauma between 2003 and 2006 in the Ear Institute,School of Medicine,Shanghai Jiao Tong University,China,and 15 patients(six men and nine women,mean age 40.6 years)underwent masseter-to-facial nerve transfer after tumor extirpation or trauma between November 2010 and February 2016 in Shanghai Ninth People's Hospital,China.More patients achieved House-Brackmann III recovery after masseter nerve repair than interposition nerve graft repair(15/15 vs.12/17).The mean oral commissure excursion ratio was also higher in patients who underwent masseter nerve transfer than in patients subjected to an interposition nerve graft.These findings suggest that masseter nerve transfer results in strong oral commissure excursion,avoiding obvious synkinesis,while an interposition nerve graft provides better resting symmetry.This study was approved by the Institutional Ethics Committee,Shanghai Ninth People's Hospital,China(approval No.SH9 H-2019-T332-1)on December 12,2019.展开更多
Facial synkinesis is a troublesome sequelae of facial nerve malfunction.It is difficult to recover from synkinesis,despite improved surgical techniques for isolating the peripheral facial nerve branches.Furthermore,it...Facial synkinesis is a troublesome sequelae of facial nerve malfunction.It is difficult to recover from synkinesis,despite improved surgical techniques for isolating the peripheral facial nerve branches.Furthermore,it remains unclear whether long-term dysfunction of motor control can lead to irreversible plasticity-induced structural brain changes.This case-control study thus investigated the structural brain alterations associated with facial synkinesis.The study was conducted at Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China.Twenty patients with facial synkinesis(2 male and 18 female,aged 33.35±6.97 years)and 19 healthy volunteers(2 male and 17 female,aged 33.21±6.75 years)underwent magnetic resonance imaging,and voxel-based and surface-based morphometry techniques were used to analyze data.There was no significant difference in brain volume between patients with facial synkinesis and healthy volunteers.Patients with facial synkinesis exhibited a significantly reduced cortical thickness in the contralateral superior and inferior temporal gyri and a reduced sulcal depth of the ipsilateral precuneus compared with healthy volunteers.In addition,sulcal depth of the ipsilateral precuneus was negatively correlated with the severity of depression.These findings suggest that there is a structural remodeling of gray matter in patients with facial synkinesis after facial nerve malfunction.This study was approved by the Ethics Review Committee of the Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China(approval No.2017-365-T267)on September 13,2017,and was registered with the Chinese Clinical Trial Registry(registration number:ChiCTR1800014630)on January 25,2018.展开更多
Dear Editor,Evidence of oculomotor nerve（ON）synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of ...Dear Editor,Evidence of oculomotor nerve（ON）synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy,following intracranial aneurysm,trauma,展开更多
Determine the impact of upper eyelid weight placement at 3 months post onset of idiopathic facial paralysis(IFP)on the recovery of facial function in patients with lagophthalmos.Methods:This is a retrospective review ...Determine the impact of upper eyelid weight placement at 3 months post onset of idiopathic facial paralysis(IFP)on the recovery of facial function in patients with lagophthalmos.Methods:This is a retrospective review of patients with incomplete recovery of IFPddefined as a Sunnybrook Facial Grading Scale(FGS)score of less than 100,3 months after onset.Only patients with FGS and Facial Clinimetric Evaluation(FaCE)scores recorded at 3 and 12 months were included.Patients were categorized into 3 groups:Group A,lagophthalmos with eyelid weight placement;Group B,lagophthalmos without eyelid weight placement;Group C,complete eye closure(CEC)without eyelid weight placement.The eye comfort domain and composite score of the FaCE questionnaire were analyzed.Voluntary eye closure,synkinesis with eye closure,overall synkinesis and the composite score of the FGS were also analyzed.Paired two-tailed t-test was used to evaluate the data comparing the 3 and 12 month FaCE and FGS scores within and between the 3 groups.Results:The change in composite FGS score significantly increased from month 3 to month 12 in Group A as compared to Group B(37 vs 4.25,P=0.01).While Group A had significantly lower eye comfort(-12.5,P=0.01),voluntary eye closure(-1.75,P=0.05)and overall FGS scores(-28.75,P=0.04)at 3 months compared to those in Group C,there were no differences between these two groups at 12 month follow-up.Conclusions:For patients with lagophthalmos at 3 months,early eyelid weight placement may lead to improved facial function at 12 months.展开更多
Facial synkinesis is one of the most severe sequelae of facial nerve paralysis,and it can result in facial movement disorders,abnormal facial expressions,and even problems of social communication.The underlying mechan...Facial synkinesis is one of the most severe sequelae of facial nerve paralysis,and it can result in facial movement disorders,abnormal facial expressions,and even problems of social communication.The underlying mechanism of postparalysis facial synkinesis remains unclear.In recent years,researchers have demonstrated several possible mechanisms of facial synkinesis,including aberrant regeneration,ephaptic transmission,overacting of the facial nucleus in the pons,and changes in the cerebral cortex.Management includes botulinum toxin type A(BTX-A)injection,surgery,and neuromuscular reeducation.展开更多
基金supported by the Youth Researcher Foundation of Shanghai Municipal Commission of Health and Family Planning,No.20144Y0095
文摘Facial synkinesis,a sequela of peripheral facial nerve palsy,is characterized by simultaneous involuntary facial movement during a voluntary desired one.Maladaptive cortical plasticity might be involved in the dysfunction of facial muscles.This cohort study investigated the cortical functional alterations in patients with unilateral facial synkinesis,using the task functional magnetic resonance imaging.Facial motor tasks,including blinking and smiling,were performed by 16 patients（aged 30.6 ± 4.5 years,14 females/2 males） and 24 age-and sex-matched healthy controls（aged 29.1 ± 4.2 years,19 females/5 males）.Results demonstrated that activation in the cortico-facial motor representation area was lower during tasks in patients with facial synkinesis compared with healthy controls.Facial movements on either side performed by patients caused more intensive activation of the supplementary motor area on the contralateral side of the affected face,than those on the unaffected side.Our results revealed that there was cortical reorganization in the primary sensorimotor area and the supplementary motor area.This study was registered in Chinese Clinical Trial Registry（registration number： Chi CTR1800014630）.
文摘目的探讨A型肉毒毒素(botulinum toxin type A,BoNT-A)治疗原发性及面瘫后面肌痉挛患者痉挛及伴随联带运动的疗效差异。方法选取2009年1月-2018年7月具有联带运动的面瘫后面肌痉挛患者12例,按照1∶2配比性别无差异且具有联带运动的原发性面肌痉挛患者24例,分析2组BoNT-A治疗后痉挛严重程度以及伴随联带运动的改善差异。结果面瘫后及原发性面肌痉挛患者在起效时间[(4.38±2.17)vs.(4.67±4.14)d],维持时间[(3.83±2.94)vs.(4.96±2.48)d],注射剂量[(31.35±12.30)vs.(26.98±8.75)U]方面无明显差异(P>0.05)。原发性面肌痉挛组患者满意度显著较高(84.79±19.81vs.64.17±31.54,P<0.05)。2组痉挛改善有效率均高于90%,组间无明显差异(91.67%vs.95.83%,P>0.05)。2组联带运动均有改善,但无明显差异(83.33%vs.58.33%,P>0.05)。5个自主动作相关联带运动改善方面仅发现原发性面肌痉挛患者噘嘴引起联带运动的改善有明显差异(P<0.05)。结论 BoNT-A可以显著改善原发性与面瘫后面肌痉挛患者的痉挛严重程度,在联带运动严重程度改善方面有一定疗效。原发性面肌痉挛患者噘嘴引起的联带运动在BoNT-A治疗后显著改善。
基金supported by the United States National Institute of Health grant 1K08DC012535(to MJB)Program for Neurology Research and Discoverythe Sinai Medical Staff Foundation Neuroscience Scholar Fund(to ELF)
文摘The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatrogenic insults and causes devastating functional impairment and disfigurement. Surgical innovations directed towards restoring function to injured motor cranial nerves and their associated organs have evolved to include nerve repair, grafting, substitution, and muscle transposition. In parallel with this progress, research on tissue-engineered constructs, development of bioelectrical interfaces, and modulation of the regenerative milieu through cellular, immunomodulatory, or neurotrophic mechanisms has proliferated to enhance the available repertoire of clinically applicable reconstructive options. Despite these advances, patients continue to suffer from functional limitations relating to inadequate cranial nerve regeneration, aberrant reinnervation, or incomplete recovery of neuromuscular function. These shortfalls have profound quality of life ramifications and provide an impetus to further elucidate mechanisms underlying cranial nerve denervation and to improve repair. In this review, we summarize the literature on reconstruction and regeneration of motor cranial nerves following various injury patterns. We focus on seven cranial nerves with predominantly efferent functions and highlight shared patterns of injuries and clinical manifestations. We also present an overview of the existing reconstructive approaches, from facial reanimation, laryngeal reinnervation, to variations of interposition nerve grafts for reconstruction. We discuss ongoing endeavors to promote nerve regeneration and to suppress aberrant reinnervation and the development of synkinesis. Insights from these studies will shed light on recent progress and new horizons in understanding the biomechanics of peripheral nerve neurobiology, with emphasis on promising strategies for optimizing neural regeneration and identifying future direc
基金supported by Shanghai Municipal Commission of Health and Family Planning Program,China,No.201504253(to WW)Special Fund for Science and Technology Innovation by Shanghai Jiao Tong University,China,No.YG2016MS10(to WW)the National Natural Science Foundation of China,Nos.81570906(to HW)and 81371086(to ZYW)。
文摘Both interposition nerve grafts and masseter nerve transfers have been successfully used for facial reanimation after irreversible injuries to the cranial portion of the facial nerve.However,no comparative study of these two procedures has yet been reported.In this two-site,twoarm,retrospective case review study,32 patients were included.Of these,17 patients(eight men and nine women,mean age 42.1 years)underwent interposition nerve graft after tumor extirpation or trauma between 2003 and 2006 in the Ear Institute,School of Medicine,Shanghai Jiao Tong University,China,and 15 patients(six men and nine women,mean age 40.6 years)underwent masseter-to-facial nerve transfer after tumor extirpation or trauma between November 2010 and February 2016 in Shanghai Ninth People's Hospital,China.More patients achieved House-Brackmann III recovery after masseter nerve repair than interposition nerve graft repair(15/15 vs.12/17).The mean oral commissure excursion ratio was also higher in patients who underwent masseter nerve transfer than in patients subjected to an interposition nerve graft.These findings suggest that masseter nerve transfer results in strong oral commissure excursion,avoiding obvious synkinesis,while an interposition nerve graft provides better resting symmetry.This study was approved by the Institutional Ethics Committee,Shanghai Ninth People's Hospital,China(approval No.SH9 H-2019-T332-1)on December 12,2019.
基金This study was financially supported by the National Key R&D Program of China,Nos.2018YFC2001600(to JGX),2018YFC2001604(to CLS)Shanghai Jiao Tong University Multidisciplinary Research Fund of Medicine and Engineering,China,No.YG 2016QN13(to WD)+2 种基金Intelligent Medical Program of Shanghai Health Commission,China,No.2018ZHYL0216(to CLS)Clinical Science and Technology Innovation Project of Shanghai Shen Kang Hospital Development Center,China,No.SHDC12018126(to JGX and CLS)Shanghai Health Commission Accelerated the Development of Traditional Chinese Medicine Three-Year Action Plan Project,China,No.ZY(2018-2020)-CCCX-2001-06(to CLS).
文摘Facial synkinesis is a troublesome sequelae of facial nerve malfunction.It is difficult to recover from synkinesis,despite improved surgical techniques for isolating the peripheral facial nerve branches.Furthermore,it remains unclear whether long-term dysfunction of motor control can lead to irreversible plasticity-induced structural brain changes.This case-control study thus investigated the structural brain alterations associated with facial synkinesis.The study was conducted at Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China.Twenty patients with facial synkinesis(2 male and 18 female,aged 33.35±6.97 years)and 19 healthy volunteers(2 male and 17 female,aged 33.21±6.75 years)underwent magnetic resonance imaging,and voxel-based and surface-based morphometry techniques were used to analyze data.There was no significant difference in brain volume between patients with facial synkinesis and healthy volunteers.Patients with facial synkinesis exhibited a significantly reduced cortical thickness in the contralateral superior and inferior temporal gyri and a reduced sulcal depth of the ipsilateral precuneus compared with healthy volunteers.In addition,sulcal depth of the ipsilateral precuneus was negatively correlated with the severity of depression.These findings suggest that there is a structural remodeling of gray matter in patients with facial synkinesis after facial nerve malfunction.This study was approved by the Ethics Review Committee of the Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,China(approval No.2017-365-T267)on September 13,2017,and was registered with the Chinese Clinical Trial Registry(registration number:ChiCTR1800014630)on January 25,2018.
文摘Dear Editor,Evidence of oculomotor nerve（ON）synkinesis is a common occurrence following both acquired and congenital III nerve palsy[1].It is generally accepted that aberrant regeneration is the likely aetiology of synkinesis in acquired III nerve palsy,following intracranial aneurysm,trauma,
文摘Determine the impact of upper eyelid weight placement at 3 months post onset of idiopathic facial paralysis(IFP)on the recovery of facial function in patients with lagophthalmos.Methods:This is a retrospective review of patients with incomplete recovery of IFPddefined as a Sunnybrook Facial Grading Scale(FGS)score of less than 100,3 months after onset.Only patients with FGS and Facial Clinimetric Evaluation(FaCE)scores recorded at 3 and 12 months were included.Patients were categorized into 3 groups:Group A,lagophthalmos with eyelid weight placement;Group B,lagophthalmos without eyelid weight placement;Group C,complete eye closure(CEC)without eyelid weight placement.The eye comfort domain and composite score of the FaCE questionnaire were analyzed.Voluntary eye closure,synkinesis with eye closure,overall synkinesis and the composite score of the FGS were also analyzed.Paired two-tailed t-test was used to evaluate the data comparing the 3 and 12 month FaCE and FGS scores within and between the 3 groups.Results:The change in composite FGS score significantly increased from month 3 to month 12 in Group A as compared to Group B(37 vs 4.25,P=0.01).While Group A had significantly lower eye comfort(-12.5,P=0.01),voluntary eye closure(-1.75,P=0.05)and overall FGS scores(-28.75,P=0.04)at 3 months compared to those in Group C,there were no differences between these two groups at 12 month follow-up.Conclusions:For patients with lagophthalmos at 3 months,early eyelid weight placement may lead to improved facial function at 12 months.
文摘Facial synkinesis is one of the most severe sequelae of facial nerve paralysis,and it can result in facial movement disorders,abnormal facial expressions,and even problems of social communication.The underlying mechanism of postparalysis facial synkinesis remains unclear.In recent years,researchers have demonstrated several possible mechanisms of facial synkinesis,including aberrant regeneration,ephaptic transmission,overacting of the facial nucleus in the pons,and changes in the cerebral cortex.Management includes botulinum toxin type A(BTX-A)injection,surgery,and neuromuscular reeducation.
