The value of abnormal muscle response monitoring during microvascular decomprssion surgery for hemifacial spasm

Objective Abnormal muscle response (AMR) to the electrical stimulation of a branch of facial nerve is a specific electrophysiological feature of primary hemifacial spasm (HFS) . Although the correlation between intraoperative AMR findings and postoperative results in patients with HFS were investigated before,

Autogenous inside-out versus standard vein and skeletal muscle-combined grafting for facial nerve repair

BACKGROUND： In the repair of nerve defects, collapse of the venous wall, as a result of vein grafting alone, could impede nerve regeneration. Therefore, vein lumens filled with muscle and nerve segments have been used to bridge nerve defects. OBJECTIVE： To compare the effects of autogenous, inside-out, vein-skeletal, muscle-combined grafting versus standard, vein-skeletal, muscle-combined grafting for the repair of facial nerve defects. DESIGN, TIME AND SETTING： A randomized, controlled, neuroanatomical, animal study was performed at the Animal Experimental Center and Laboratories of the Capital Medical University Xuanwu Hospital and the Peking Union Medical College Hospital from September 2007 to October 2008.MATERIALS： A total of 10 healthy, male, New Zealand rabbits, aged 6 months, were randomly assigned to inside-out, vein-skeletal, muscle-combined grafting and standard, vein-skeletal, muscle-combined grafting groups, with 5 rabbits in each group. METHODS： A 20-mm gap in the buccal branch of the right facial nerve was made in each animal, which was respectively repaired with inside-out, vein-skeletal, muscle-combined grafts or standard vein-skeletal muscle-combined grafts.MAIN OUTCOME MEASURES： At 6 months after implantation, evoked maximal compound muscle action potentials were recorded on bilateral facial nerves using electromyogram. Myelinated nerve fibers of the regenerating nerves were quantified using myelin sheath osmic acid staining. RESULTS： There was no significant difference between the groups in terms of ratios of bilateral amplitude and latency of compound muscle action potential （P 〉 0.05）. Moreover, morphology of regenerating nerves and quantity of myelinated nerve fibers were similar between the groups （P 〉 0.05）. CONCLUTION： Compared with standard vein grafting, the inside-out vein grafting did not significantly improve nerve regeneration. Therefore, it is not necessary to utilize inside-out vein grafting for the repair of nerve defects, in particular with the combined use of autogenous vein and skeletal muscle grafts.

TREATMENT OF FACIAL SPASM BY PLUM-BLOSSOM NEEDLE TAPPING AND CUPPING THERAPY

Facial spasm is a frequently seen dis-ease characterized by unilateral involuntaryirregular twitching of the facial muscles.This disorder may be induced by intoxica-tion,infection,trauma and long-term facialparalysis which was not properly treated.

OBSERVATION ON CLINICAL THERAPEUTIC EFFECTS OF SCALP ACUPUNCTURE FOR FACIAL SPASM

Objective; To observe clinical therapeutic effect of scalp acupuncture in the treatment of facial spasm. Methods： Sixty-five cases of facial spasm were randomly divided into control group （n = 31 ） and treatment group（n = 34）. Patients of the treatment group were treated with penetrative acupuncture from Qienshencong（前神聪 Extra） to Xuanli（悬厘 GB 6）, Baihui（百会 GV 20） to Qubin（曲鬓 GB 7）, etc., and those of control group treated with acupuncture of Taiyang（太阳 EX-HN 5）, Yengbai（阳白 GB 14）, Quanliao（颧髎 SI 18） and Xiaguan（下关 ST 7）, etc. once daily, 20 sessions altogether. Results. After treatment, of the 31 cases and 34 cases in control and treatment groups, 5 and 12 were cured, 8 and 13 had remarkable improvement, 11 and 8 had improvement, 7 and 1 failed, with the total effective rates being 77.42% and 97.06% respectively; and the therapeutic elfact of treatment group was significantly superior to that of control group（P〈0.01）. Conclusion; Scalp acupurcture has an obvious therapeutic effect for facial spasm.

Intermittent facial spasms as the presenting sign of a recurrent pleomorphic adenoma

The intimate anatomical relationship of the facial nerve to the parotid parenchyma has a significant influence on the presenting signs and symptoms, diagnosis and treatment of parotid neoplasms.However, to our knowledge, hyperactivity of this nerve, presenting as facial spasm, has never been described as the presenting sign or symptom of a parotid malignancy.We report a case of carcinoma arising in a recurrent pleomorphic adenoma of the left parotid gland(i.e., carcinoma ex pleomorphic adenoma) that presented with hemifacial spasms.We outline the differential diagnosis of hemifacial spasm as well as a proposed pathophysiology.Facial paralysis, lymph node enlargement, skin involvement, and pain have all been associated with parotid malignancies.To date the development of facial spasm has not been reported with parotid malignancies.The most common etiologies for hemifacial spasm are vascular compression of the ipsilateral facial nerve at the cerebellopontine angle(termed primary or idiopathic)(62%), hereditary(2%), secondary to Bell's palsy or facial nerve injury(17%), and hemifacial spasm mimickers(psychogenic, tics, dystonia, myoclonus, myokymia, myorthythmia, and hemimasticatory spasm)(17%).Hemifacial spasm has not been reported in association with a malignant parotid tumor but must be considered in the differential diagnosis of this presenting symptom.

87 CASES OF FACIAL SPASM TREATED WITH MILD ACUPUNCTURE

Facial spasm is clinically a commonly en-countered and obstinate disease. This diseasewas treated by mild acupuncture with a satisfac-tory therapeutic effect, as summarized in thefollowing.GENERAL DATAThere were 87 cases in total in this series,52 males. and 35 females. The oldest and theyoungest patients were 60 and 28 years old re-spectively. The longest and the shortest

SHALLOW NEEDLING USED FOR THE TREATMENT OF 35 CASES OF FACIAL SPASM

In the present paper, the authors sum up results of acupuncture treatment of 35 cases of facial spasm. Of the 35 cases, 14 were male and 21 female, ranging in age from 19 to 62 years and in the disease duration from 1 week to 21 years. Shallow needling was applied to the surrounding region of Ahshi points (the twitching locus), Hegu (LI 4), Taichong (LR 3), etc., once daily, 4 weeks altogether. In addition, according to syndrome differentiation, other acupoints as Fengchi (GB 20), Waiguan (TE 5), Zusanli (ST 36), Sanyinjiao (SP 6), etc. were supplemented. After treatment, out of the 35 cases, 26 (74.3%) were cured, 5 (14.3%) experienced markedly improvement, and the rest 4 (11.4%) cases had a certain degree of amelioration. The key point for treating facial spasm is applying shallow needling around the twitching muscles.

Mobile Bearing Plate Dislocation in Total Knee Arthroplasty Due to Muscle Spasm:A Case Report

An unusual case of early dislocation of a mobile bearing posterior stabilized total knee arthroplasty in a 48-year-old Caucasian woman is described. Dislocation occurred one day postoperatively, attributed to a gap mismatch. Revision surgery reduced posterior dislocation, increased bearing plate thickness and rebalanced ligaments. A second dislocation occurred after revision surgery. The patient’s history was retaken and a hamstring spasm disease identified. A new revision utilized a more constrained design, without perioperative local nerve block. Two years following surgery, no further dislocation had occurred. A numerical musculoskeletal model of the case and implant configuration identified no trend to mobile bearing dislocation when regular muscle forces were applied. Muscle spasm is a risk factor for mobile bearing total knee arthroplasty dislocation, especially with femoral nerve block.

Study on The Likelihood Ratio Used to Evaluate the Muscle Tension of Upper Limb Spasm in Hemiplegia Patients

Aim:To evaluate the clinical usability of mechanomyography(MMG)in the evaluation of upper-limb spasticity states of hemiplegia patients with likelihood ratio analysis.Methods:The MMG signals from the 30 hemiplegia patients'biceps and triceps were recorded with three-dimensional wireless accelerometer(Trigno Wireless System,Delsys Inc),when they extended or bent their elbow passively.At the same time,the physiotherapist assessed the MAS(Modified Ashworth Scale)of all the patients who participated in the study and would be divided them into four groups based on the MAS values(MAS0,MAS1,MAS1+and MAS2).The MMG sensors were built with triaxial accelerometers named as X,Y and Z that represent the muscle fibers lengthwise movement,the cross movement and the vertical the muscle moving direction,respectively.The root mean square(RMS)value of the MMG signal was calculated for analysis.Likelihood ratio analysis were used in the study.Results:All of the variables of the X,Y,Z axis of signals of MMG of BB and TB have related with muscle spasticity grading during passive elbow flexion in multinomial logistic regression(P=0.000,P<0.001).The regression coefficient of Y axis signal of MMG of BB is the largest.The 5 variables of the X,Y,Z axis of signals of MMG of BB and X,Y axis of TB have related with Muscle spasticity grading during passive elbow extension in multinomial logistic regression(P=0.000,P<0.001).The regression coefficient ofY axis signal of MMG of BB is the largest in equation and the Y axis signal of MMG of TB is second large.Conclusions:The effect of agonist is more than the antagonist during the MAS assessment,especially the muscle fibers cross movement and the vertical movement by the MMG assessment.

Cartilage and facial muscle tissue engineering and regeneration： a mini review

Cartilage and facial muscle tissue provide basic yet vital functions for homeostasis throughout the body, making human survival and function highly dependent upon these somatic components. When cartilage and facial muscle tissues are harmed or completely destroyed due to disease, trauma, or any other degenerative process, homeostasis and basic body functions consequently become negatively affected. Although most cartilage and cells can regenerate themselves after any form of the aforementioned degenerative disease or trauma, the highly specific characteristics of facial muscles and the specific structures of the cells and tissues required for the proper function cannot be exactly replicated by the body itself. Thus, some form of cartilage and bone tissue engineering is necessary for proper regeneration and function. The use of progenitor cells for this purpose would be very beneficial due to their highly adaptable capabilities, as well as their ability to utilize a high diffusion rate, making them ideal for the specific nature and functions of cartilage and facial muscle tissue. Going along with this, once the progenitor cells are obtained, applying them to a scaffold within the oral cavity in the affected location allows them to adapt to the environment and create cartilage or facial muscle tissue that is specific to the form and function of the area. The principal function of the cartilage and tissue is vascularization, which requires a specific form that allows them to aid the proper flow of bodily functions related to the oral cavity such as oxygen flow and removal of waste. Facial muscle is also very thin, making its reproduction much more possible. Taking all these into consideration, this review aims to highlight and expand upon the primary benefits of the cartilage and facial muscle tissue engineering and regeneration, focusing on how these processes are performed outside of and within the body.

Influence of distal portion compression of facial nerve in hemifacial spasm surgery

Objective To study influence of distal portion compression of facial nerve in hemifacial spasm surgery. Methods 120 hemifacial spasm patients were undergone lateral spread response monitoring during microvascular decompression surgery. 39 patients’LSR remained after decompression of the root exit zone of the facial nerve.

深层肌肉刺激与肌电生物反馈干预脑卒中后患者小腿三头肌痉挛和步态的改变

背景:深层肌肉刺激疗法具有松解粘连、缓解痉挛、改善和恢复肌肉顺应性和弹性等作用;肌电生物反馈疗法能有效促进神经恢复和改善下肢运动功能和步态。目的:利用数字化肌肉检测仪和三维步态分析仪等手段综合评估深层肌肉刺激联合肌电生物反馈对脑卒中后小腿三头肌痉挛及步态改变的影响。方法:选取2020年10月至2023年10月在广东药科大学附属第一医院康复科住院且符合纳入标准的患者72例,随机分为对照组和联合组,每组36例。对照组接受常规康复治疗+肌电生物反馈+假性深层肌肉刺激,联合组在对照组基础上增加真性深层肌肉刺激治疗,5次/周,连续4周。统计分析两组治疗前、后患侧腓肠肌内外侧振荡频率和动态刚度、踝背屈主动关节活动度、胫骨前肌肌电信号、下肢Fugl-Meyer评分量表和三维步态分析相关参数。结果与结论:①两组患者治疗后患侧腓肠肌内外侧的振荡频率和动态刚度值较治疗前明显降低(P<0.05),联合组较对照组降低更明显(P<0.05);②两组患者治疗后踝背屈主动活动度、胫骨前肌肌电信号和下肢Fugl-Meyer量表评分较治疗前明显增大或提高(P<0.05),联合组较对照组增大或提高更明显(P<0.05);③两组患者步速、步频、步幅均较治疗前明显增大(P<0.05),联合组较对照组增大更明显(P<0.05);健患侧支撑相百分比时间较治疗前降低(P<0.05),联合组较对照组降低更明显(P<0.05);④除健侧支撑百分比治疗前后变化量两组间比较差异无显著性意义(P>0.05)外,其余指标治疗前后的变化量联合组均较对照组效果更明显(P<0.05);⑤结果说明,深层肌肉刺激治疗仪联合肌电生物反馈短期内能有效缓解脑卒中后小腿三头肌痉挛、改善踝背屈功能和提高下肢运动功能及改善步态,治疗效果显著。

Olfactory ensheathing cells promote nerve regeneration and functional recovery after facial nerve defects

Olfactory ensheathing cells from the olfactory bulb and olfactory mucosa have been tbund to increase axonal sprouting and pathfinding and promote the recovery of vibrissae motor performance in facial nerve transection injured rats. However, it is not yet clear whether olfactory ensheathing cells promote the reparation of facial nerve defects in rats. In this study, a collagen sponge and silicone tube neural conduit was implanted into the 6-mm defect of the buccal branch of the facial nerve in adult rats. Olfactory ensheathing cells isolated from the olfactory bulb of newborn Sprague-Dawley rats were injected into the neural conduits connecting the ends of tile broken nerves, the morphology and function of the regenerated nerves were compared between the rats implanted with olfactory ensheathing cells with the rats injected with saline. Facial paralysis was assessed. Nerve electrography was used to measure facial nerve-induced action potentials. Visual inspection, anatomical microscopy and hematoxylin-eosin staining were used to assess the histomorphology around the trans planted neural conduit and the morphology of the regenerated nerve. Using fluorogold retrograde tracing, toluidine blue staining and lead uranyl acetate staining, we also measured the number of neurons in the anterior exterior lateral f：acial nerve motor nucleus, the number of myelinated nerve fibers, and nerve fiber diameter and myelin sheath thickness, respectively. After surgery, olfactory ensheathing cells de- creased facial paralysis and the latency of the facial nerve-induced action potentials. There were no differences in the general morphology of the regenerating nerves between the rats implanted with olfactory ensheathing cells and the rats injected with saline. Between-group results showed that olfactory ensheathing cell treatment increased the number of regenerated neurons, improved nerve fiber morphology, and increased the number of myelinated nerve fibers, nerve fiber diameter, and myelin sheath thickness. In conclusion, implantation of olfactory ensheathing cells can promote regeneration and functional recovery after facial nerve damage in rats.

Repairing whole facial nerve defects with xenogeneic acellular nerve grafts in rhesus monkeys

Acellular nerve allografts conducted via chemical extraction have achieved satisfactory results in bridging whole facial nerve defects clinically,both in terms of branching a single trunk and in connecting multiple branches of an extratemporal segment.However,in the clinical treatment of facial nerve defects,allogeneic donors are limited.In this experiment,we exposed the left trunk and multiple branches of the extratemporal segment in six rhesus monkeys and dissected a gap of 25 mm to construct a monkey model of a whole left nerve defect.Six monkeys were randomly assigned to an autograft group or a xenogeneic acellular nerve graft group.In the autograft group,the 25-mm whole facial nerve defect was immediately bridged using an autogenous ipsilateral great auricular nerve,and in the xenogeneic acellular nerve graft group,this was done using a xenogeneic acellular nerve graft with trunk-branches.Examinations of facial symmetry,nerve-muscle electrophysiology,retrograde transport of labeled neuronal tracers,and morphology of the regenerated nerve and target muscle at 8 months postoperatively showed that the faces of the monkey appeared to be symmetrical in the static state and slightly asymmetrical during facial movement,and that they could actively close their eyelids completely.The degree of recovery from facial paralysis reached House-Brackmann grade II in both groups.Compound muscle action potentials were recorded and orbicularis oris muscles responded to electro-stimuli on the surgical side in each monkey.Fluoro Gold-labeled neurons could be detected in the facial nuclei on the injured side.Immunohistochemical staining showed abundant neurofilament-200-positive axons and soluble protein-100-positive Schwann cells in the regenerated nerves.A large number of mid-graft myelinated axons were observed via methylene blue staining and a transmission electron microscope.Taken together,our data indicate that xenogeneic acellular nerve grafts from minipigs are safe and effective for repairing whole facial nerve defects in rhesus monkeys,with an effect similar to that of autologous nerve transplantation.Thus,a xenogeneic acellular nerve graft may be a suitable choice for bridging a whole facial nerve defect if no other method is available.The study was approved by the Laboratory Animal Management Committee and the Ethics Review Committee of the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University,China(approval No.2018-D-1)on March 15,2018.

EXPERIENCE ON THE TREATMENT OF WRITING SPASM BY ACUPUNCTURE

Writing spasm, one aspect of the limbspasm in motor neurosis, is the involuntarycontraction of muscles resulted from distur-bance of the cerebrum. Occurring mainly inpupils and intellectuals, this disease is charac-terized by various degree of involuntary trem-bling of hand and arm when writing or draw-ing without obvious abnormality in the move-ment of wrist and shoulder. In TCM, the ill-ness is named "spasm when writing" or" over-work of wrist and is thought to be caused bymalnutrition of meridians and tendons due tostagnation of liver Qi when the patient suffersemotional stress. We have gained a little ex-perience in the treatment of the

First Evaluation of Zygomaticus Major Muscle Elastic Properties Using a US Elastography Technique

Facial expressions are linked to movements of muscles, which can be altered by pathological diseases. Assessment of facial muscle deficits is subjective (palpation) and operator-dependent, and these deficits are currently estimated with clinical scales. Thus, the quantification of facial muscle elastic properties is a key for the clinical adaption and evaluation of treatments for facial paralysis. We herein present a novel application of shear wave elastography (SWE) based on an ultrasound protocol to assess the morphological (thickness and texture) and elastic (Young’s modulus) properties of the zygomaticus major (ZM) muscle. Fifteen healthy volunteers underwent SWE tests, and the ultrasound acquisitions were obtained using a new linear transducer (SLH20-6, spatial resolution: 38 μm) and compared to those obtained using an SL10-2 probe (spatial resolution: 50 μm). The probe position was placed along the muscle fiber orientation. A semi-automatic method was developed to quantify the ZM muscle elasticity, and the repeatability was analyzed at one-week intervals. The mean elasticity for the two probes was about 15 kPa. The SLH20-6 probe yielded a higher mean elasticity (approximately 6 kPa) and less homogeneous echogenicity than the SL10-2 probe. Two distinct groups of texture profiles as a function of the transducer were obtained. This study will provide some guidance for clinical practices and will allow the construction of a reference database that could be used to evaluate treatments and develop numerical models of facial expression.

多部位肌肉面神经电图检测对贝尔麻痹患儿面神经功能及预后的评估价值

目的探讨面神经电图(ENoG)检测多块面肌方法在贝尔麻痹(BP)患儿面神经功能评估及早期预测预后中的价值。方法选取2020年6月至2022年9月在昆明医科大学附属儿童医院诊治的90例BP患儿,首诊时应用ENoG检测额肌、鼻肌、口轮匝肌、上眼轮匝肌及下眼轮匝肌等5块面肌的ENoG值及复合肌肉动作电位(CMAP)波幅,并采用House Brackmann分级系统(HBGS)对患儿的面神经功能进行评估,随访至完全恢复或至首诊后6个月,通过HBGS再次评估患儿的面神经功能。分析比较不同面肌的ENoG值在各年龄组(婴幼儿组、学龄前儿童组、学龄儿童组)及各预后组(完全恢复组、不完全恢复组)间的差异,以及与首诊HBGS评级的相关性。绘制受试者工作特征曲线并计算曲线下面积(AUC),以评估早期不同面肌的ENoG值对BP患儿预后的价值。结果首诊时患儿各部位ENoG值越低,则对应的首诊HBGS评级越高(P<0.05);鼻肌、上眼轮匝肌及下眼轮匝肌表现更显著(P<0.01)。首诊时的鼻肌、上眼轮匝肌及下眼轮匝肌的ENoG值显示,完全恢复组的秩平均值高于不完全恢复组(P<0.05);首诊时鼻肌、上眼轮匝肌及下眼轮匝肌的ENoG值可用于评估BP患儿的预后,AUC值分别为0.732、0.695及0.796(P<0.05);将上眼轮匝肌与鼻肌ENoG值联合、上眼轮匝肌与下眼轮匝肌ENoG值联合、下眼轮匝肌与鼻肌ENoG值联合,准确性进一步提升,AUC分别为0.740、0.799及0.806(P<0.01);首诊HBGSⅡ~Ⅲ级患儿的预后明显好于Ⅳ~Ⅴ级患儿(P<0.01)。结论BP发病初期鼻肌、上眼轮匝肌及下眼轮匝肌的ENoG值与HBGS评级一样可反映患儿病情的严重程度,较低的ENoG值提示BP可能恢复不完全,增加ENoG面肌检测部位可提高BP患儿预后评估的准确性。

基于3D Slicer的多模态影像融合技术及神经电生理监测在面肌痉挛微血管减压术中的应用

目的探讨基于3D Slicer的多模态影像融合技术及神经电生理监测在面肌痉挛微血管减压术中的应用价值。方法采用回顾性分析法,选取41例行血管减压术的面肌痉挛患者为研究对象。术前通过3D Slicer软件对责任血管进行多模态影像融合分析,确定手术方案,术中进行神经电生理监测以判断减压。观察手术效果并追踪术后复发情况。结果术前建模图像发现40例存在微血管压迫,1例未见微血管压迫。未见微血管压迫的1例经术中证实为岩静脉压迫,1例小脑前下动脉经术中证实为小脑上动脉,其余责任血管判定均与术中所见一致。术前建模图像的责任血管判定正确39例,正确率为95%。41例患者经手术治疗后症状均完全缓解,完全缓解率为100%。术后住院期间1例发生面瘫,1例发生听力下降,经对症处理后很快缓解,术后随访3~36个月无复发。结论在面肌痉挛微血管减压术中联合应用多模态影像融合技术可直观了解责任血管及周围重要结构解剖情况,配合神经电生理监测可避免术中减压过度或不充分的情况,两项技术的联合应用可有效提高手术疗效。

经筋刺法治疗周围性面瘫的疗效观察

目的观察经筋刺法治疗周围性面瘫的临床疗效及其对瞬目反射、面部肌电图、动脉分支血流动力学的影响。方法将120例周围性面瘫患者随机分为观察组和对照组,每组60例。观察组采用经筋刺法治疗,对照组采用常规针刺治疗。观察两组治疗前后瞬目反射、面部肌电图指标(R1、R2波及对侧R2’波潜伏期,口轮匝肌、眼轮匝肌、鼻肌潜伏期及患健侧波幅比值)、动脉分支血流动力学指标[患侧面动脉、下唇动脉、内眦动脉、上唇动脉收缩期峰值血流速度(peak systolic velocity,PSV)和血管阻力指数(resistance index,RI)]、面神经功能[House-Brackmann(H-B)]分级及面部残疾指数(facial disability index,FDI)各项评分(躯体功能及社会/行为功能评分)的变化情况,比较两组临床疗效。结果两组治疗后R1、R2波及对侧R2’波潜伏期和口轮匝肌、眼轮匝肌、鼻肌潜伏期均较同组治疗前显著缩短,口轮匝肌、眼轮匝肌、鼻肌患健侧波幅比值及患侧面动脉、下唇动脉、内眦动脉、上唇动脉PSV均显著升高,RI和FDI各项评分均显著下降,差异均具有统计学意义(P<0.05)。观察组治疗后R1、R2波及对侧R2’波潜伏期和口轮匝肌、眼轮匝肌、鼻肌潜伏期均明显短于对照组,口轮匝肌、眼轮匝肌、鼻肌患健侧波幅比值及患侧面动脉、下唇动脉、内眦动脉、上唇动脉PSV均高于对照组,RI和FDI各项评分均低于对照组,差异均具有统计学意义(P<0.05)。两组治疗后H-B分级与同组治疗前比较,差异均具有统计学意义(P<0.05)。观察组治疗后H-B分级与对照组比较,差异具有统计学意义(P<0.05)。观察组总有效率为96.7%,明显高于对照组的83.3%(P<0.05)。结论经筋刺法治疗周围性面瘫疗效确切,可改善瞬目反射、面部肌电图及动脉分支血流动力学相关指标,提升患者面神经功能和日常生活水平。