The Laryngoscope C 2014 The American Laryngological, V
Rhinological and Otological Society, Inc.
How I Do It
Hydrogel Sutureless Facial Nerve Repair: Pilot Clinical Investigation Nathan E. Pierce, MD; Jeremiah A. Alt, MD, PhD; Patrick J. Antonelli, MD
Key Words: Facial nerve, nerve repair, techniques of nerve repair. Laryngoscope, 00:000–000, 2014
INTRODUCTION Facial nerve injury leads to significant disability and impairment in quality of life.1,2 Nerve repair is the best treatment for facial nerve injury.3,4 Suture neurorrhaphy under microscopic magnification has been considered the gold standard for repair, but this method can be technically challenging and time consuming.5 Furthermore, sutures are traumatic, leading to scar formation that contributes to postoperative complications of synkinesis and neuroma formation.6,7 Nerve repair at the cerebellopontine angle is further complicated by limited exposure and a lack of epineurium, which provides the tissue strength to hold the suture. To address these concerns, surgeons have investigated sutureless techniques using fibrin sealants and similar materials.8,9 The primary concern with fibrin sutureless techniques is poor tensile strength. To address these concerns we utilized a hydrogel sutureless nerve repair (HSNR) technique. Initial coaptation of the nerve ends is performed with fibrin sealant. Previously published biochemical data have demonstrated excellent holding strength of polyethylene glycol (PEG) hydrogels with less scar formation compared to fibrin glues.10 We therefore encased the initial fibrin repair with PEG hydrogel to provide additional strength to the repair. This study retrospectively evaluated facial
From the Department of Otolaryngology (N.E.P., P.J.A.), University of Florida, Gainesville, Florida; and the Rhinology, Sinus & Skull Base Surgery Program, Division of Otolaryngology–Head and Neck Surgery (J.A.A.), University of Utah, Salt Lake City, Utah, U.S.A. Editor’s Note: This Manuscript was accepted for publication November 10, 2014. Presented at the Triological Society Spring Meeting, Las Vegas, Nevada, U.S.A., May 15, 2014. This work was performed at the Department of Otolaryngology, University of Florida, Gainesville, Florida, U.S.A. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Patrick J. Antonelli, MD, University of Florida, Otolaryngology Head and Neck Surgery, PO Box 100264, Gainesville, FL 32610. E-mail: [email protected] DOI: 10.1002/lary.25072
Laryngoscope 00: Month 2014
nerve recovery in two patients who underwent repair with this novel technique.
MATERIALS AND METHODS The medical records of two patients with transected facial nerves repaired with the HSNR technique were retrospectively reviewed. Our institutional review board deemed this study to be exempt from review due to the number of patients involved (i.e.,
Rhinological and Otological Society, Inc.
How I Do It
Hydrogel Sutureless Facial Nerve Repair: Pilot Clinical Investigation Nathan E. Pierce, MD; Jeremiah A. Alt, MD, PhD; Patrick J. Antonelli, MD
Key Words: Facial nerve, nerve repair, techniques of nerve repair. Laryngoscope, 00:000–000, 2014
INTRODUCTION Facial nerve injury leads to significant disability and impairment in quality of life.1,2 Nerve repair is the best treatment for facial nerve injury.3,4 Suture neurorrhaphy under microscopic magnification has been considered the gold standard for repair, but this method can be technically challenging and time consuming.5 Furthermore, sutures are traumatic, leading to scar formation that contributes to postoperative complications of synkinesis and neuroma formation.6,7 Nerve repair at the cerebellopontine angle is further complicated by limited exposure and a lack of epineurium, which provides the tissue strength to hold the suture. To address these concerns, surgeons have investigated sutureless techniques using fibrin sealants and similar materials.8,9 The primary concern with fibrin sutureless techniques is poor tensile strength. To address these concerns we utilized a hydrogel sutureless nerve repair (HSNR) technique. Initial coaptation of the nerve ends is performed with fibrin sealant. Previously published biochemical data have demonstrated excellent holding strength of polyethylene glycol (PEG) hydrogels with less scar formation compared to fibrin glues.10 We therefore encased the initial fibrin repair with PEG hydrogel to provide additional strength to the repair. This study retrospectively evaluated facial
From the Department of Otolaryngology (N.E.P., P.J.A.), University of Florida, Gainesville, Florida; and the Rhinology, Sinus & Skull Base Surgery Program, Division of Otolaryngology–Head and Neck Surgery (J.A.A.), University of Utah, Salt Lake City, Utah, U.S.A. Editor’s Note: This Manuscript was accepted for publication November 10, 2014. Presented at the Triological Society Spring Meeting, Las Vegas, Nevada, U.S.A., May 15, 2014. This work was performed at the Department of Otolaryngology, University of Florida, Gainesville, Florida, U.S.A. The authors have no funding, financial relationships, or conflicts of interest to disclose. Send correspondence to Patrick J. Antonelli, MD, University of Florida, Otolaryngology Head and Neck Surgery, PO Box 100264, Gainesville, FL 32610. E-mail: [email protected] DOI: 10.1002/lary.25072
Laryngoscope 00: Month 2014
nerve recovery in two patients who underwent repair with this novel technique.
MATERIALS AND METHODS The medical records of two patients with transected facial nerves repaired with the HSNR technique were retrospectively reviewed. Our institutional review board deemed this study to be exempt from review due to the number of patients involved (i.e.,
