Intraneural topography of the extratemporal facial nerve: microsurgical nerve reconstruction. 2007

Jorge O Güerrissi, and Maximiliano F Gil Miranda
guerrissi@speedy.com.ar

The fascicular pattern is the most important component of a nerve when a microsurgical reconstruction is made. The intraneural topography of the extratemporal facial nerve does not have a reliable fascicular pattern, although our study in 25 extratemporal facial nerves showed a definite fascicular pattern in the different studied levels. The microanatomic intraneural investigation was made in four different levels; we studied the diameter of the trunk, number and diameter of each fascicle, fascicular pattern, characteristics of the epineurium, perineurium, and interfascicular connective tissue, and extra- and intraneural blood supply. In the proximal and distal facial trunk, most axons are included in one to three big funiculus surrounded by a small amount of connective, interfascicular tissue; both epineurium and perineurium are thin and slender. The principal arteries are placed between funiculus and epineurium. Either epineurial or interfascicular neurorrhaphy could be produced and mono- or polyfascicular nerve grafts can be used. In both temporofacial and cervicofacial primary branches, the fascicular distribution was from four to five fascicles in 64% of cases with abundant connective interfascicular tissue involving the principal arteries. The interfascicular surgical technique is of election, but the epineurial suture must not be discarded. Nerve graft must be polyfascicular. The goal of nerve repair is to obtain the restoration of anatomic continuity of the most of axons by means of a complete fascicular alignment, in which detailed knowledge of the intraneural topography of the facial nerve must be required for reliable microsurgical reparation.

UI MeSH Term Description Entries
D008866 Microsurgery The performance of surgical procedures with the aid of a microscope.
D009412 Nerve Fibers Slender processes of NEURONS, including the AXONS and their glial envelopes (MYELIN SHEATH). Nerve fibers conduct nerve impulses to and from the CENTRAL NERVOUS SYSTEM. Cerebellar Mossy Fibers,Mossy Fibers, Cerebellar,Cerebellar Mossy Fiber,Mossy Fiber, Cerebellar,Nerve Fiber
D010525 Peripheral Nerves The nerves outside of the brain and spinal cord, including the autonomic, cranial, and spinal nerves. Peripheral nerves contain non-neuronal cells and connective tissue as well as axons. The connective tissue layers include, from the outside to the inside, the epineurium, the perineurium, and the endoneurium. Endoneurium,Epineurium,Perineurium,Endoneuriums,Epineuriums,Nerve, Peripheral,Nerves, Peripheral,Perineuriums,Peripheral Nerve
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D003238 Connective Tissue Tissue that supports and binds other tissues. It consists of CONNECTIVE TISSUE CELLS embedded in a large amount of EXTRACELLULAR MATRIX. Connective Tissues,Tissue, Connective,Tissues, Connective
D005154 Facial Nerve The 7th cranial nerve. The facial nerve has two parts, the larger motor root which may be called the facial nerve proper, and the smaller intermediate or sensory root. Together they provide efferent innervation to the muscles of facial expression and to the lacrimal and SALIVARY GLANDS, and convey afferent information for TASTE from the anterior two-thirds of the TONGUE and for TOUCH from the EXTERNAL EAR. Cranial Nerve VII,Marginal Mandibular Branch,Marginal Mandibular Nerve,Seventh Cranial Nerve,Nerve VII,Nerve of Wrisberg,Nervus Facialis,Nervus Intermedius,Nervus Intermedius of Wrisberg,Cranial Nerve VIIs,Cranial Nerve, Seventh,Facial Nerves,Mandibular Nerve, Marginal,Mandibular Nerves, Marginal,Marginal Mandibular Nerves,Nerve VIIs,Nerve, Facial,Nerve, Marginal Mandibular,Nerve, Seventh Cranial,Nerves, Marginal Mandibular,Nervus Faciali,Seventh Cranial Nerves,Wrisberg Nerve,Wrisberg Nervus Intermedius
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001158 Arteries The vessels carrying blood away from the heart. Artery
D001369 Axons Nerve fibers that are capable of rapidly conducting impulses away from the neuron cell body. Axon
D013536 Suture Techniques Techniques for securing together the edges of a wound, with loops of thread or similar materials (SUTURES). Suture Technics,Suture Technic,Suture Technique,Technic, Suture,Technics, Suture,Technique, Suture,Techniques, Suture

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