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Facial Plastic Surgery & Aesthetic... 2022Hypoglossal and masseteric nerve transfer are currently the most popular cranial nerve transfer techniques for patients with facial paralysis. The authors performed a... (Meta-Analysis)
Meta-Analysis
Hypoglossal and masseteric nerve transfer are currently the most popular cranial nerve transfer techniques for patients with facial paralysis. The authors performed a systematic review and meta-analysis to compare functional outcomes and adverse effects of these procedures. A review of online databases was performed to include studies with four or more patients undergoing hypoglossal or masseter nerve transfer without muscle transfer or other cranial nerve transposition. Facial nerve outcomes, time to reinnervation, and adverse events were pooled and studied. A total of 71 studies were included: 15 studies included 220 masseteric-facial transfers, and 60 studies included 1312 hypoglossal-facial transfers. Oral commissure symmetry at rest was better for hypoglossal transfer (2.22 ± 1.6 mm vs. 3.62 ± 2.7 mm, = 0.047). The composite Sunnybrook Facial Nerve Grading Scale was better for masseteric transfer (47.7 ± 7.4 vs. 33.0 ± 6.4, < 0.001). Time to first movement (in months) was significantly faster in masseteric transfer (4.6 ± 2.6 vs. 6.3 ± 1.3, < 0.001). Adverse effects were rare (<5%) for both procedures. Both nerve transfer techniques are effective for facial reanimation, and the surgeon should consider the nuanced differences in selecting the correct procedure for each patient.
Topics: Facial Paralysis; Humans; Hypoglossal Nerve; Mandibular Nerve; Nerve Transfer; Treatment Outcome
PubMed: 33635144
DOI: 10.1089/fpsam.2020.0523 -
Neuromodulation : Journal of the... Dec 2022Transcutaneous electrical nerve stimulation (TENS) is a noninvasive electrical stimulation therapy indicated for pain control that has been applied for the regeneration... (Review)
Review
OBJECTIVE
Transcutaneous electrical nerve stimulation (TENS) is a noninvasive electrical stimulation therapy indicated for pain control that has been applied for the regeneration of nerves. This systematic review aimed to analyze the evidence on TENS effectiveness on nerve regeneration.
MATERIALS AND METHODS
A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria: PubMed/MEDLINE, Web of Science, ScienceDirect, and SciELO data bases. Primary research that evaluated TENS on nerve regeneration was considered.
RESULTS
Several studies have investigated the use of TENS for pain treatment. A total of six animal studies analyzed TENS for nerve regeneration. The selected articles showed high quality (Animal Research: Reporting of In Vivo Experiments guidelines), with many unclear points related to bias opportunities (Systematic Review Center for Laboratory Animal Experimentation Risk of Bias tool). In general, TENS accelerated functional and motor recovery and increased axon quantity and diameter. More specifically, the application of low-frequency TENS resulted in a continuous basal lamina; a higher density of fibers with normal diameters, indicating normal myelination, showed signs of deterioration and delayed nerve regeneration. In contrast, the high-frequency TENS application stimulated motor regeneration and increased the diameter of the regenerated axons but revealed a small number of axons, demyelination, dark axoplasm, and an increase in the predisposition of neuropathic pain.
CONCLUSIONS
Although there is some heterogeneous evidence in animal research, TENS seems to be a promising treatment for nerve injury that should be better explored. It is still necessary to improve the analysis of its application parameters, which can lead to the most satisfactory regeneration results and improve the understanding of its mechanisms on peripheral nerve regeneration.
Topics: Animals; Transcutaneous Electric Nerve Stimulation; Nerve Regeneration; Pain Management; Neuralgia; Disease Models, Animal
PubMed: 35088718
DOI: 10.1016/j.neurom.2021.12.009 -
Clinical Anatomy (New York, N.Y.) Jan 2016With thyroid cancer fast becoming one of the most common endocrine cancers, the frequency of thyroid surgery has increased. A common and debilitating concern with... (Review)
Review
With thyroid cancer fast becoming one of the most common endocrine cancers, the frequency of thyroid surgery has increased. A common and debilitating concern with thyroid surgery is recurrent laryngeal nerve (RLN) paralysis leading to glottal obstruction and airway compromise. A systematic review regarding the anatomical variation of the recurrent laryngeal nerve was performed to determine the position of anatomical variants of the RLN in relation to the inferior thyroid artery (ITA) as well as the prevalence of nonrecurrent laryngeal nerve (NRLN). MEDLINE, Web of Science, MEDITEXT, AMED, CINAHL, Cochrane, ProQuest, Pubmed, and ScienceDirect. Databases were searched using the search terms "inferior thyroid artery," "recurrent laryngeal nerve," "nonrecurrent laryngeal nerve," and "anatomical variation." The reference sections of the articles found were searched for additional reports. The references of all articles were searched to find articles missed in the database search. A total of 8,655 RLN sides were included in this study. One thousand eight hundred and thirteen (20.95%; 95% confidence interval (CI) 20.09, 2,182) showed a Type A configuration of RLN in relation to the ITA, 2,432 (28.10%; 95% CI 27.15, 29.06) showed a Type B configuration and 4,410 (50.95%; 95% CI 49.89, 52.01) showed a Type C configuration between the RLN and the ITA. The second search returned with 38,568 recurrent laryngeal sides and only 221 (0.57%; 95%CI 0.5, 0.65) NRLN documented. The RLN is most commonly found in the posterior position, relative to the ITA. The incidence of the NRLN is low, only occurring in 0.57% of people.
Topics: Anatomic Variation; Cadaver; Humans; Recurrent Laryngeal Nerve
PubMed: 26297484
DOI: 10.1002/ca.22613 -
Otology & Neurotology : Official... Sep 2023There is a paucity of data reporting the rate of chorda tympani nerve injury during cochlear implantation (CI) surgery. To better provide clarity to patients and... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
There is a paucity of data reporting the rate of chorda tympani nerve injury during cochlear implantation (CI) surgery. To better provide clarity to patients and surgeons regarding the risk of taste change, we performed a systematic review and meta-analysis of prospective studies examining taste change after CI.
DATA SOURCES
PubMed, Embase, and Cochrane Library databases were queried.
METHODS
Databases were queried according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Search terms included "(chorda tympani OR gustatory OR taste OR chemosensory OR dysgeusia OR nervus intermedius) AND (cochlea OR cochlear implant OR cochlear implantation)." Prospective studies were included and further divided into "objective" and "subjective" assessments of taste dysfunction. A systematic review was performed for all studies. A random-effects model was used to compare studies with similar methods and patient demographics.
RESULTS
The initial database query yielded 2,437 articles, which were screened according to inclusion and exclusion criteria. Nine appropriate studies were identified, including 442 total patients-254 with subjective assessment and 271 with objective assessment of gustation. Seventeen of 144 patients (11.8%) reported short-term taste change (incidence = 0.09 [0.02-0.16], 95% confidence interval with pooled data). Twenty-six of 265 patients (9.8%) reported long-term taste change (incidence = 0.07 [0.01-0.13]). Objective results were heterogenous and therefore not amenable to pooled meta-analysis.
CONCLUSIONS
Taste change from chorda tympani nerve injury is a likely underrecognized complication of CI and may be the most common adverse consequence of CI surgery. Surgeons should counsel prospective patients on this potential complication and that the risk of taste change may persist longer than the immediate postoperative period.
Topics: Humans; Dysgeusia; Cochlear Implantation; Prospective Studies; Taste; Taste Disorders; Chorda Tympani Nerve
PubMed: 37464451
DOI: 10.1097/MAO.0000000000003949 -
Revista Brasileira de Ortopedia Apr 2022Peripheral nerve damage is an important cause of seeking medical attention. It occurs when the continuity of structures is interrupted and the propagation of nervous...
Peripheral nerve damage is an important cause of seeking medical attention. It occurs when the continuity of structures is interrupted and the propagation of nervous impulses is blocked, affecting the functional capacity of individuals. To assess the effects of the immunosuppressants tacrolimus and cyclosporine on the regeneration of peripheral nerves, a systematic review of the literature was carried out. The articles included were published until September 2018 and proposed to evaluate the effects of the immunosuppressants tacrolimus and cyclosporine on nerve regeneration and neuroprotection, available in the MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database, and LILACS databases. The research analysed a total of 56 articles, of which 22 were included in the meta-analysis. Statistical analysis suggests the protective effect of tacrolimus in the regeneration of the number of myelinated axons (95% confidence interval [CI]: 0.93-2.39; < 0.01); however, such effect was not observed in relation to cyclosporine (95%CI: - 0.38-1.18; = 0.08) It also suggests that there is a significant relationship between the use of tacrolimus and myelin thickness (95%CI= 2.00-5.71; < 0. 01). The use of immunosuppressants in the regeneration of peripheral nerve damage promotes an increase in the number of myelinated axons in general, regardless of the administered dose. In addition, it ensures greater myelin thickness, muscle weight and recovery of the sciatic functional index. However, heterogeneity was high in most analyses performed.
PubMed: 35652029
DOI: 10.1055/s-0041-1736467 -
Neuroscience and Biobehavioral Reviews Dec 2022Childhood adversity (CA) is associated with increased risk for physical and mental health problems, with alterations in vagal regulation (an aspect of autonomic... (Meta-Analysis)
Meta-Analysis Review
Childhood adversity (CA) is associated with increased risk for physical and mental health problems, with alterations in vagal regulation (an aspect of autonomic functioning indexed by vagally-mediated heart rate variability [vmHRV]) implicated as a mechanism. Three-level meta-analyses were conducted to synthesize research on the relationship between CA and 1) baseline vagal activity, and 2) vagal reactivity to challenges including stress tests, emotion-eliciting tasks and cognitive tasks. No significant overall association was found between CA and vagal activity (r = -.015; p = .11) or vagal reactivity (r = -.017; p = .13). However, analyses controlling for moderator interrelatedness revealed an association between CA and lower baseline vagal activity in samples including participants diagnosed with a psychiatric disorder, and for direct adversities such as maltreatment. For vagal reactivity, CA was associated with lower reactivity if the adversity was experienced less recently, and for studies operationalizing reactivity using task mean levels of vmHRV. These findings indicate that small alterations in vagal functioning occur for specific CA subtypes and subgroups of individuals.
Topics: Humans; Adverse Childhood Experiences; Vagus Nerve; Heart Rate; Mental Disorders
PubMed: 36272580
DOI: 10.1016/j.neubiorev.2022.104920 -
Facial Plastic Surgery & Aesthetic... 2024Hypoglossal-facial nerve (12-7) anastomosis can restore symmetry and voluntary movement on the face in patients with facial nerve paralysis. Traditional 12-7 transfer... (Meta-Analysis)
Meta-Analysis Review
Hypoglossal-facial nerve (12-7) anastomosis can restore symmetry and voluntary movement on the face in patients with facial nerve paralysis. Traditional 12-7 transfer includes direct end-to-end nerve anastomosis, sacrificing the entire hypoglossal nerve. Contemporary, end-to-side anastomosis, or split anastomosis techniques limit tongue morbidity by preserving some hypoglossal nerve. Direct outcome comparisons between these techniques are limited. To compare reported outcomes of facial movement, tongue, speech, and swallow outcomes among the different types of hypoglossal-facial nerve anastomosis schemes. For this systematic review and meta-analysis, a comprehensive strategy was designed to search PubMed, Scopus, and the Cochrane Database from inception to January 2021, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, reporting guideline yielding 383 results. Any participant who underwent 12-7 transfer using any of the three techniques, with or without an interposition graft, and had documented preoperative and postoperative evaluation of facial nerve function with a validated instrument such as House-Brackmann (HB), was considered for inclusion. Secondary outcomes of synkinesis, tongue atrophy, and speech or swallowing dysfunction were also compared. Forty-nine studies met inclusion criteria, representing data from 961 total patients who underwent 12-7 transfer. The proportion of good HB outcomes (HB I-III) did not differ by anastomosis type: End-to-side and end-to-end anastomosis (73% vs. 59%, = 0.07), split and end-to-end anastomosis (62% vs. 59%, = 0.88), and end-to-side anastomosis and split anastomosis (73% vs. 62%, = 0.46). There was no difference in reported synkinesis rates between the anastomosis types. However, end-to-side anastomosis ( = 6.55, < 0.01) and split anastomosis ( = 3.58, < 0.01) developed less tongue atrophy than end-to-end anastomosis. End-to-side anastomosis had less speech/swallowing dysfunction than end-to-end anastomosis ( = 3.21, < 0.01). End-to-side and split anastomoses result in similar HB facial nerve outcomes as the traditional end-to-end 12-7 anastomosis. End-to-side anastomosis has decreased complications of tongue atrophy and speech/swallow dysfunction compared to end-to-end anastomosis. In addition, split anastomosis has decreased rates of tongue atrophy compared to end-to-end anastomosis.
Topics: Humans; Facial Nerve; Hypoglossal Nerve; Synkinesis; Treatment Outcome; Facial Paralysis; Atrophy
PubMed: 38153410
DOI: 10.1089/fpsam.2023.0144 -
Archives of Physical Medicine and... Dec 2014To systematically review the medical literature and comprehensively summarize clinical research done on rehabilitation with a novel portable and noninvasive electrical... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To systematically review the medical literature and comprehensively summarize clinical research done on rehabilitation with a novel portable and noninvasive electrical stimulation device called the cranial nerve noninvasive neuromodulator in patients suffering from nervous system disorders.
DATA SOURCES
PubMed, MEDLINE, and Cochrane Database of Systematic Reviews from 1966 to March 2013.
STUDY SELECTION
Studies were included if they recruited adult patients with peripheral and central nervous system disorders, were treated with the cranial nerve noninvasive neuromodulator device, and were assessed with objective measures of function.
DATA EXTRACTION
After title and abstract screening of potential articles, full texts were independently reviewed to identify articles that met inclusion criteria.
DATA SYNTHESIS
The search identified 12 publications: 5 were critically reviewed, and of these 5, 2 were combined in a meta-analysis. There were no randomized controlled studies identified, and the meta-analysis was based on pre-post studies. Most of the patients were individuals with a chronic balance dysfunction. The pooled results demonstrated significant improvements in the dynamic gait index postintervention with a mean difference of 3.45 (95% confidence interval, 1.75-5.15; P<.001), Activities-specific Balance Confidence scale with a mean difference of 16.65 (95% confidence interval, 7.65-25.47; P<.001), and Dizziness Handicap Inventory with improvements of -26.07 (95% confidence interval, -35.78 to -16.35; P<.001). Included studies suffered from small sample sizes, lack of randomization, absence of blinding, use of referral populations, and variability in treatment schedules and follow-up rates.
CONCLUSIONS
Given these limitations, the results of the meta-analysis must be interpreted cautiously. Further investigation using rigorous randomized controlled trials is needed to evaluate this promising rehabilitation tool for nervous system disorders.
Topics: Cranial Nerves; Electric Stimulation Therapy; Gait; Humans; Nervous System Diseases; Postural Balance; Sensation Disorders
PubMed: 24814561
DOI: 10.1016/j.apmr.2014.04.018 -
The Journal of Foot and Ankle Surgery :... 2021Although nerve transfer and repair are well-established for treatment of nerve injury in the upper extremity, there are no established parameters for when or which... (Meta-Analysis)
Meta-Analysis Review
Although nerve transfer and repair are well-established for treatment of nerve injury in the upper extremity, there are no established parameters for when or which treatment modalities to utilize for tibial nerve injuries. The objective of our study is to conduct a systematic review of the effectiveness of end-to-end repair, neurolysis, nerve grafting, and nerve transfer in improving motor function after tibial nerve injury. PubMed, Cochrane, Medline, and Embase libraries were queried according to the PRISMA guidelines for articles that present functional outcomes after tibial nerve injury in humans treated with nerve transfer or repair. The final selection included Nineteen studies with 677 patients treated with neurolysis (373), grafting (178), end-to-end repair (90), and nerve transfer (30), from 1985 to 2018. The mean age of all patients was 27.0 ± 10.8 years, with a mean preoperative interval of 7.4 ± 10.5 months, and follow-up period of 82.9 ± 25.4 months. The mean graft repair length for nerve transfer and grafting patients was 10.0 ± 5.8 cm, and the most common donor nerve was the sural nerve. The most common mechanism of injury was gunshot wound, and the mean MRC of all patients was 3.7 ± 0.6. Good outcomes were defined as MRC ≥ 3. End-to-end repair treatment had the greatest number of good outcomes, followed by neurolysis. Patients with preoperative intervals less than 7 months were more likely to have good outcomes than those greater than 7 months. Patients with sport injuries had the highest percentage of good outcomes in contrast to patients with transections and who were in MVAs. We found no statistically significant difference in good outcomes between the use of sural and peroneal donor nerve grafts, nor between age, graft length, and MRC score.
Topics: Adolescent; Adult; Humans; Nerve Transfer; Neurosurgical Procedures; Peroneal Nerve; Sural Nerve; Tibial Nerve; Treatment Outcome; Wounds, Gunshot; Young Adult
PubMed: 34366221
DOI: 10.1053/j.jfas.2021.07.001 -
Journal of Plastic, Reconstructive &... Mar 2022Within the field of peripheral nerve surgery, the use of fibrin glue as an alternative to conventional microsurgical suture repair is becoming increasingly popular.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Within the field of peripheral nerve surgery, the use of fibrin glue as an alternative to conventional microsurgical suture repair is becoming increasingly popular. Advantages of fibrin glue for nerve reconstruction include technical ease of use, less tissue manipulation, and shorter operation times. Although fibrin glue seems a promising alternative to conventional microsurgical repair, further insight into the outcomes of nerve recovery is essential.
OBJECTIVE
To summarize the current literature on the use of fibrin glue for peripheral nerve repair and compare these results with outcomes following conventional suture repair.
METHODS
A systematic search in Embase, MEDLINE, Web of Science, Cochrane, and Google Scholar databases was performed. The search included animal, cadaveric, and human studies assessing outcomes following peripheral nerve repair using fibrin glue. Data on outcomes were subdivided into functional outcomes, electrophysiology, histopathology, biomechanical outcomes, and operation times. We calculated standardized mean differences and combined these in a random effects model to estimate the overall effect.
RESULTS
From a total of 2057 references, 37 animal, two cadaveric, and four human studies were included. Fibrin glue repairs resulted in similar functional and electrophysiology outcomes and shorter operation times than suture repairs. However, fibrin glue alone resulted in lower strength and more dehiscence. No dehiscence was reported when fibrin glue was combined with one or two sutures. Yet, we also found that methodological details were poorly reported in animal studies, resulting in an unclear risk of bias. This should be taken into consideration when interpreting the results.
CONCLUSION
The results indicate that nerve regeneration may be similar in fibrin glue repairs and suture repairs. Combining fibrin glue with one or two positional sutures allows for a precise realignment of the nerve fibers and seems to provide sufficient strength to prevent dehiscence.
Topics: Animals; Fibrin Tissue Adhesive; Humans; Nerve Regeneration; Peripheral Nerves; Suture Techniques; Sutures; Tissue Adhesives
PubMed: 35125308
DOI: 10.1016/j.bjps.2022.01.007