Objective To evaluate the clinical effect of end-to-end neurorrhaphy following rapid expansion of the nerve in repairing facial nerve defect. Methods From August 2000 to February 2005, 9 patients suffering from facial nerve defect were treated by the surgical method. The defect was caused by traffic injury(4 cases) , by cutting injury (2 cases) and falling wound(1 case). Seven cases showed prominent facial paralysis. The other 2 cases were invaded by parotid carcinoma, without remarkable paralysis. One case had unibranch defect, and the other 8 cases had multibranch defect. The nerve gap ranged from 1.5cm to 3.0 cm. After both the proximal and the distal segment had been dissected,the nerve was elongated by the expander designed and manufactured. The expansionwas done at a speed of 2.0 cm/30 min, and it lasted until the end-to-end neurorrhaphy can be done easily. The treatment result was evaluated according to Baker’s classification and HouseBrackmann’s grading system. Results Nine patients were followed up 618 months. In 5 cases achieving good result, both dynamic look and static look of face were symmetric, the EMG peak value of mimetic muscle was 82%95% of normal side. In 3 cases achieving fair result, thedynamic look and static look of face were basically symmetric, and the EMG peak value of mimetic muscle was 60%90% of normal side. In 1 case achieving poor result, the function of mimetic muscle was improved slightly, and the EMG peak value of mimetic muscle was 55% of normal side. Conclusion The satisfactory resultcan be obtained by endtoend neurorrhaphy following rapid expansion of the nerve in condition that nerve defect is less than 3.0 cm.
In order to investigate the histological and stereological change of the rapidly expanded skin tube, 15 Japanese Long Ear Rabbits were divided into 3 groups: (1) Rapid expansion group, injecting once a day for 7 days; (2) Routine expansion group, injecting every 3 days for 21 days and (3) Control group, no expander implanted. The results showed that: in the rapid expansion group, the thickness of the epidermis and dermis were both increased, fibroblast proliferation was active, a large amount of new capillaries was observed, the collagen fiber was in loose type, and the mitochondria and rough endoplasmic net of epithelial cell were increased. In the routine expansion group, similar changes were observed. The vascular density and volume fraction were significantly higher in rapid expansion group than those in the control group (P lt; 0.05). It was concluded that the rapid expansion of skin tube was feasible.