Introduction  Facial trauma can cause damage to the facial nerve, which can have negative effects on function, aesthetics, and quality of life if left untreated. Objective  To evaluate the effectiveness of peripheral facial nerve direct end-to-end anastomosis and/or nerve grafting surgery for patients with facial nerve injury after facial trauma. Methods  Fifty-nine patients with peripheral facial nerve paralysis after facial injuries underwent facial nerve rehabilitation surgery from November 2017 to December 2021 at Ho Chi Minh City National Hospital of Odontology. Results  All 59 cases of facial trauma with damage to the peripheral facial nerve underwent facial nerve reconstruction surgery within 8 weeks of the injury. Of these cases, 25/59 (42.3%) had end-to-end anastomosis, 22/59 (37.3%) had nerve grafting, and 12/59 (20.4%) had a combination of nerve grafting and end-to-end anastomosis. After surgery, the rates of moderate and good recovery were 78.4% and 11.8%, respectively. All facial paralysis measurements showed statistically significant improvement after surgery, including the Facial Nerve Grading Scale 2.0 (FNGS 2.0) score, the Facial Clinimetric Evaluation (FaCE) scale, and electroneurography. The rate of synkinesis after surgery was 34%. Patient follow-up postoperatively ranged from 6 to > 36 months; 51 out of 59 patients (86.4%) were followed-up for at least 12 months or longer. Conclusion  Nerve rehabilitation surgery including direct end-to-end anastomosis and nerve grafting is effective in cases of peripheral facial nerve injury following facial trauma. The surgery helps restore nerve conduction and improve facial paralysis.

Sural nerve is the most common nerve used as a source for nerve grafting. Open harvest with longitudinal incisions produces unsightly scars, and this have led to development of less invasive techniques using endoscopes, nerve stripper, and mini-incisions. Several anatomical classifications have also been proposed due to the variations in the anatomy of the sural nerve. A simple and practical surgicoanatomical classification of the sural nerve based on which we have refined our minimal access technique, the multiple mini-incision technique for sural nerve harvest is proposed. In this technique, the incisions required for harvest of the sural nerve are standardized and predictable. A fibular incision is required when the sural nerve has major contribution from the common peroneal nerve. We have found this a simpler and reliable technique of harvest of sural nerve in nerve reconstructive surgery.

Communications between cranial nerves or their branches have been described previously. The exact functional significance of some of these neural communications remains to be fully understood. This paper reports a unique communication between the auriculotemporal and inferior alveolar nerves within the infratemporal fossa. The histological examination indicates an antegrade connection from the inferior alveolar nerve to the auriculotemporal nerve, which could potentially be implicated in referred pain from the anatomical territory of one nerve to the other.

UNASSIGNED: Peripheral-type facial palsy could be caused by a lesion in the tegmentum of the pons, such as infarction, with a rare occurrence. We herein described a case of unilateral peripheral-type facial palsy induced by dorsolateral pontine infarction and treated this patient using modified hypoglossal-facial nerve anastomosis.
UNASSIGNED: A 60-year-old female presented with dizziness, hearing drop, diplopia, and peripheral-type facial palsy. Brain Magnetic Resonance Imaging showed a dorsolateral pontine infarction on the right side which exactly refers to the location of the ipsilateral facial nucleus or facial nerve fascicles at the pons. Subsequent electrophysiological examinations confirmed poor facial nerve function of this patient and modified hypoglossal-facial nerve anastomosis was then performed.
UNASSIGNED: This case reminded medical practitioners not to ignore the possibility of involvement of a central cause in peripheral-type facial palsy patients. In addition, modified hypoglossal-facial nerve anastomosis served as a useful skill improvement that may help reduce hemiglossal dysfunction while restoring facial muscle function.

Meningioma originating from the oculomotor nerve without dural attachment in children has been rarely reported. A 6-year-old patient presented ptosis of the right eye for 5 years. MRI indicated an occupying lesion in the right cavernous sinus. A tumor originating from the oculomotor nerve without dural attachment was found during subsequent surgery and confirmed as meningioma by pathology. Subsequently, the tumor was removed completely, and the oculomotor nerve was reconstructed using the sural nerve. The patient\'s symptoms were relieved partially after 3 months. The findings of this case suggested that the mechanisms underlying meningioma involve ectopic arachnoid cap cells within the nerve sheath. Thus, the tumor should be removed completely; also, nerve reconstruction is suggested.

OBJECTIVE: The use of the masseteric nerve develops in the surgery of facial paralysis rehabilitation. The objective of this study was to determine the topography of the masseteric nerve and to deduce and predict a precise and reproducible anatomical cluster to facilitate its clinical identification during V-VII neurotization surgery.
METHODS: For the purpose of this work, a cadaveric study was performed on 31 hemi-faces. All dissections were performed bilaterally and comparatively, following steps aiming at simulating, as close as possible, the clinical conditions of a facial palsy rehabilitation by V-VII anastomosis.
RESULTS: For the identification of the masseteric nerve, bony reference points were used, i.e., the temporomandibular joint (TMJ) and the chin point (CT). A virtual axis was drawn between the TMJ and the CT, and the distance [TMJ-MN] determining the smallest length h was then plotted against the distance [TMJ-CT] determining the largest length H, thus allowing the calculation of an h/H proportion ratio (PR) indicating the proximal part of the masseteric nerve from the TMJ. The average length h between the TMJ and the NM was 3.5 cm (± 0.1 cm) from the TMJ, i.e., an average ratio h/H [TMJ-MN]/[TMJ-CT] of 28.1% 4.0 and a median ratio of 28.6% of the distance [TMJ-CT].
CONCLUSIONS: Our study opens new perspectives for facilitating its identification and use, offering practitioners a tool to make V-VII the neurotization procedure less complex, with the eventual prospect of a minimally invasive procedure combining imaging, surgery, and augmented reality.

Median and ulnar nerve interconnections commonly occur in the brachial plexus, forearm, and hand. Each is classified based on location, fiber type (sensory fibers, motor fibers, or both), and directionality (ie, carrying fibers from median to ulnar or vice versa). There are 4 main interconnections found in the forearm and hand: Martin-Gruber and Marinacci anastomoses in the forearm and Riche-Cannieu and Berrettini anastomoses in the hand. The presence of an interconnection may skew electrodiagnostic findings, possibly resulting in misdiagnosis and iatrogenic injury. Clinicians should perform nerve studies of both nerves at proximal and distal stimulation sites to rule out interconnections and guide treatment. This review details anatomy, electrodiagnostic findings, and clinical approach.

Background: Peripheral nerve injuries may affect all age groups and exert devastating impacts on the professional and personal life of the patients. The investigation of nerve regeneration and use of biomaterials and synthetic materials have resulted in advancements in the treatment of peripheral nerve injuries and lesions. Nerve conduits can be used to adjoin the digital sensory nerve spaces of less than 3 cm, especially when the direct tension-free repair of peripheral nerve lesions is not possible. The present study was conducted to evaluate the use of nerve conduits by functional and nonfunctional parameters (i.e. histological study). Methods: This experimental study was conducted on 30 male rabbits. After cutting or crushing the right femoral nerve of the rabbits, they were divided into 3 groups: group 1, with right femoral nerve cut; group 2, with right femoral nerve crushed; and group 3, with right femoral nerve cut using a conduit. The 3 groups were evaluated after 1, 8, and 16 weeks for functional parameters (i.e. walking track analysis). In addition, they were subjected to nonfunctional examination (i.e. histological study) after 16 weeks, then, the results were compared. Results: The 3 groups showed no statistically significant differences in motor recovery in the eighth and 16th weeks (p>0.05). Based on the histological study, group 3 with an end-to-end nerve cutting using a conduit, showed a significantly higher axon count compared to groups 2 and 3 (p<0.05). Conclusion: End-to-end anastomosis using conduit led to axon growth; moreover, comparable functional recovery was observed with end-to-end neurorrhaphy in a rabbit model. Given that the diameter of the nerves and muscles, which might be neurotized in humans, and is much bigger and not comparable to that of the rabbits, it is highly recommended to conduct studies on animals with the larger size, such as primates, to facilitate the generalization of the results to humans.

BACKGROUND: Hypoglossal nerve injury may result in swallowing and speech problems. To reduce this morbidity and allow the performance of the hypoglossal-facial nerve anastomosis bilaterally, a technique that includes partial splitting of the hypoglossal nerve and skeletonization of the facial nerve within the mastoid process has been applied. The aim of this study is to present clinical results regarding the facial and hypoglossal nerves after the procedure.
METHODS: Prospectively collected data from 56 consecutive patients who underwent hemihypoglossal-facial nerve anastomosis (HHFA) were analyzed. The outcome was correlated with epidemiologic data, initial disease, the presence of neurofibromatosis type 2, previous radiosurgery, and the time between nerve injury and reconstructive surgery.
RESULTS: Forty-eight (84%) patients achieved satisfactory outcomes; 8 of them (14%) showed some improvement, and in 1 patient (2%) there was no improvement during long-term observation. The result at follow-up was not related to the time interval between the 2 procedures. However, recovery times for facial tonicity were statistically significantly longer if the procedure was performed after 12 months (P = 0.044). There was no statistically significant association between patient age (P = 0.96) or sex (P = 0.13) and facial nerve function. HHFA resulted in no or minimal tongue atrophy without deviation in 53 patients (93%), and the remainder had mild hemiatrophy with tongue deviation <30 degrees.
CONCLUSIONS: HHFA is an effective technique for facial nerve reanimation with acceptable morbidity related to tongue function. Patients with a longer duration of facial palsy still have a good chance for restoration of facial movement but require longer recovery periods.

Suturing peripheral nerve transections is the predominant therapeutic strategy for nerve repair. However, the use of sutures leads to scar tissue formation, hinders nerve regeneration, and prevents functional recovery. Fibrin-based adhesives have been widely used for nerve reconstruction, but their limited adhesive and mechanical strength and inability to promote nerve regeneration hamper their utility as a stand-alone intervention. To overcome these challenges, we engineered composite hydrogels that are neurosupportive and possess strong tissue adhesion. These composites were synthesized by photocrosslinking two naturally derived polymers, gelatin-methacryloyl (GelMA) and methacryloyl-substituted tropoelastin (MeTro). The engineered materials exhibited tunable mechanical properties by varying the GelMA/MeTro ratio. In addition, GelMA/MeTro hydrogels exhibited 15-fold higher adhesive strength to nerve tissue ex vivo compared to fibrin control. Furthermore, the composites were shown to support Schwann cell (SC) viability and proliferation, as well as neurite extension and glial cell participation in vitro, which are essential cellular components for nerve regeneration. Finally, subcutaneously implanted GelMA/MeTro hydrogels exhibited slower degradation in vivo compared with pure GelMA, indicating its potential to support the growth of slowly regenerating nerves. Thus, GelMA/MeTro composites may be used as clinically relevant biomaterials to regenerate nerves and reduce the need for microsurgical suturing during nerve reconstruction.