Schwann Cells Overexpressing FGF-2 Alone or Combined with Manual Stimulation Do Not Promote Functional Recovery after Facial Nerve Injury

Purpose. To determine whether transplantation of Schwann cells (SCs) overexpressing different isoforms of fibroblast growth factor 2 (FGF-2) combined with manual stimulation (MS) of vibrissal muscles improves recovery after facial nerve transection in adult rat. Procedures. Transected facial nerves were entubulated with collagen alone or collagen plus naïve SCs or transfected SCs. Half of the rats received daily MS. Collateral branching was quantified from motoneuron counts after retrograde labeling from 3 facial nerve branches. Quality assessment of endplate reinnervation was combined with video-based vibrissal function analysis. Results. There was no difference in the extent of collateral axonal branching. The proportion of polyinnervated motor endplates for either naïve SCs or FGF-2 over-expressing SCs was identical. Postoperative MS also failed to improve recovery. Conclusions. Neither FGF-2 isoform changed the extent of collateral branching or polyinnervation of motor endplates; furthermore, this motoneuron response could not be overridden by MS

Reconstruction of complex defects of the extracranial facial nerve: technique of the trifurcation approach

PurposeReconstruction of complex defects of facial nerve (FN) after extensive cancer surgery requires individualized solutions. We describe the trifurcation technique as a modification of the combined approach on example of two patients with locally advanced parotid cancer.MethodsDue to perineural invasion, extensive resection of the FN from the mastoid segment to the peripheral branches was required. For reanimation of the upper face, a complex cervical plexus graft was sutured end-to-end to the mastoid segment of the FN trunk. The branches of the graft enabled reanimation of three peripheral temporal and zygomatic branches. The mandibular branch was sutured end-to-side to the hypoglossal nerve (hypoglossal-facial nerve transfer, HFNT). Additionally, the buccal branch was independently reanimated with ansa cervicalis.ResultsFacial reanimation was successful in both patients. Good resting tone and voluntary movement were achieved with a mild degree of synkinesis after 13months. Patient 1 showed the Sunnybrook (SB) composite score 69 [76 (voluntary movement score)-0 (resting symmetry score)-7 (synkinesis score)]. In patient 2, the SB composite score was 76 (80-0-4, respectively).ConclusionsIn this trifurcation approach, cervical cutaneous plexus provides a long complex nerve graft, which allows bridging the gap between proximal FN stump and several peripheral branches without great expenditure. In combination with the HFNT and ansa cervicalis transfer, this procedure enables the facial reanimation with low grade of synkinesis

СНИЖЕНИЕ РИСКОВ ИНФРАСТРУКТУРНЫХ ПРОЕКТОВ ЗА СЧЕТ ПРИВЛЕЧЕНИЯ КОНСОРЦИУМА ЧАСТНЫХ ИНВЕСТОРОВ

Beyond the shadow of a doubt, social, transport and informational infrastructures are vital for a territorial development. Understanding this fact, many countries build and reconstruct main infrastructure objects. However, the project development requires not only substantial investments but, to make matters worse, payback period is quite ambiguous. Taking into account the lack of budgetary funds to finance the projects, private investors are getting more and more involved by implementing different mechanisms of state-private partnership. At that, most experts share the opinion that private partner involvement allows to increase the quality of projects implementation, to reduce project and operational risks. At the same time, the analysis of the recently implemented transport infrastructure projects with the private partners’ involvement for the last 15 years in most cases indicate a significant primary budget excess expenditure, exceeding construction period, objects’ low payback.This situation can be explained by interests’ conflict of the stakeholders as well as the project at all its vital stages. In this case, under stakeholders we define all parts involved in the project implementation, from the government which receives rapid (electoral) and long-term (economic growth) effect from the project to contractors and suppliers who are interested in getting business, to the population and economic subjects who are to operate the object but at budget funds implementation they will be its real sponsors.In some cases the project is admittedly not profitable, useless and even environmentally unfriendly. However, the stakeholders’ interests win and the project is to be implemented.A new tool of infrastructure project implementation is being offered to reduce these negative effects i.e. the private partner is the consortium of private investors with the shares’ allocation of individual persons and agents of economic.Любая инфраструктура – социальная, транспортная, информационная – важна для территориального развития. Понимая это, во многих странах строят и реконструируют значимые объекты инфраструктуры, однако создание практически любого подобного проекта не только требует больших инвестиционных вложений, но и срок окупаемости их достаточно неопределен. Учитывая ограниченность бюджетных средств, к финансированию таких проектов все чаще привлекают частных инвесторов, используя различные механизмы государственно-частного партнерства. При этом большинство экспертов отмечает, что привлечение частного партнера позволяет повысить качество реализации проектов, снизить риски как на проектной, так и на эксплуатационной стадии [13]. В то же время анализ построенных за последние 15 лет проектов транспортной инфраструктуры, в которых принимали участие и частные партнёры, показал в большинстве случаев значительный перерасход первоначального бю-джета, превышение сроков строительства, низкую окупаемость объектов.Это можно объяснить конфликтом интересов стейкхолдеров и собственно проекта на всех стадиях жизненного цикла проекта. В данном случае под стейкхолдерами мы понимаем все заинтересованные стороны проекта – от правительства, которое получает и быстрый (электоральный) и долгосрочный (развитие экономики) эффект от такого проекта, до подрядчиков и поставщиков, которые заинтересованы в том, чтобы получить заказы, и до населения и субъектов экономики, которые будут эксплуатировать объект, но при реализации его за бюджетные средства являются его фактическими спонсорами. В ряде случаев проект является заведомо не выгодным, не нужным и даже экологически опасным, но интересы стейкхолдеров побеждают и проект реализуется.Для снижения этих негативных эффектов предлагается новый инструмент реализации инфраструктурных проектов – где частным партнером будет консорциум частных инвесторов с квотированием долей физических лиц и субъектов экономики

Hypoglossal-Facial-Jump-Anastomosis Without an Interposition Nerve Graft

Objectives/HypothesisThe hypoglossal-facial-anastomosis is the most often applied procedure for the reanimation of a long lasting peripheral facial nerve paralysis. The use of an interposition graft and its end-to-side anastomosis to the hypoglossal nerve allows the preservation of the tongue function and also requires two anastomosis sites and a free second donor nerve. We describe the modified technique of the hypoglossal-facial-jump-anastomosis without an interposition and present the first results. Study DesignRetrospective case study. MethodsWe performed the facial nerve reconstruction in five patients. The indication for the surgery was a long-standing facial paralysis with preserved portion distal to geniculate ganglion, absent voluntary activity in the needle facial electromyography, and an intact bilateral hypoglossal nerve. Following mastoidectomy, the facial nerve was mobilized in the fallopian canal down to its bifurcation in the parotid gland and cut in its tympanic portion distal to the lesion. Then, a tensionless end-to-side suture to the hypoglossal nerve was performed. The facial function was monitored up to 16 months postoperatively. ResultsThe reconstruction technique succeeded in all patients: The facial function improved within the average time period of 10 months to the House-Brackmann score 3. ConclusionThis modified technique of the hypoglossal-facial reanimation is a valid method with good clinical results, especially in cases of a preserved intramastoidal facial nerve. Level of EvidenceLevel 4. Laryngoscope, 123:2392-2396, 201

Contemporary Management of Benign and Malignant Parotid Tumors

Background: To report the standard of care, interesting new findings and controversies about the treatment of parotid tumors. Methods: Relevant and actual studies were searched in PubMed and reviewed for diagnostics, treatment and outcome of both benign and malignant tumors. Results: Prospective trials are lacking due to rarity of the disease and high variety of tumor subtypes. Conclusion: The establishment of reliable non-invasive diagnostics tools for the differentiation between benign and malignant tumors is desirable. Prospective studies clarifying the association between different surgical techniques for benign parotid tumors and morbidity are needed. The role of adjuvant or definitive radiotherapy in securing loco-regional control and improving survival in malignant disease is established. Prospective clinical trials addressing the role of chemotherapy/molecular targeted therapy for parotid cancer are needed. An international consensus on the classification of parotid surgery techniques would facilitate the comparison of different trials. Such efforts should lead into a clinical guideline

The Treatment of laryngeal Dystonia with Botulinum Toxin

The treatment of laryngeal dystonias with botulinum toxin is successful. Every patient suffering from a laryngeal dystonia should be assured of high quality therapeutic intervention. Therefore it is important to establish general standards by experts in this field. In this connection, we want to focus here on different relevant aspects of laryngeal dystonias. This includes new aspects in etiology, anatomical landmarks for the injection, standards in diagnostics and therapy and finally open issues needing discussion