Partial neurolysis of the hypoglossal nerve for selective lingual atrophy in a porcine model
Partial neurolysis of the hypoglossal nerve for selective lingual atrophy in a porcine model
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DOI：
10.1177/000348940611501111
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发表时间：
2006-11-01
影响因子：
1.4
通讯作者：
Forte, Vito
中科院分区：
文献类型：
--
作者：
Licup, Ana Teresa;Arkia, Homan;Forte, Vito
目的：儿童阻塞性睡眠呼吸暂停最常采用腺扁桃体切除术治疗；然而，在严重的舌底脱垂的情况下，这可能被证明是不够的。用于增加舌后气道的外科手术具有显著的发病率和低患者可接受性。我们的理论认为，舌下神经的部分去神经支配可以实现舌下神经的有效复位，该神经很容易在下颌间隙获得，且发病率最低。方法：我们进行了一项前瞻性的实验研究，通过刺激舌下主干和周围分支产生猪舌的地形神经支配图。测量单侧神经完全切断术对舌基体积和线性尺寸的影响，并与对侧对照侧进行比较。在最后阶段，只切除被确定为舌底主要神经供应的周围神经，并将结果与匹配的对照组进行比较。结果：舌下神经的内侧分支被一致地确定为舌基底的主要运动供应。与对照组相比，完全去神经导致舌底体积明显减少。部分神经松解在2名受试者中产生了不一致的变化，线性尺寸的减少与体积的减少不成比例。组织学上，与部分神经松解相比，完全去神经支配后，肌肉被脂肪和结缔组织取代的比例显著增加。结论：舌下神经部分松解术后舌底体积和线形尺寸在3个月的实验期间出现不一致的变化。
Objectives: Obstructive sleep apnea in children is most commonly treated with adenotonsillectomy; however, in cases of significant tongue base prolapse, this may prove inadequate. Surgical procedures used to increase the retroglossal airway have significant morbidities and low patient acceptability. We theorized that effective reduction of the tongue base can be achieved through partial denervation of the hypoglossal nerve, which is easily accessed in the submandibular space with minimal morbidity.Methods: We performed a prospective, experimental study in which topographic innervation maps of porcine tongue were generated by stimulating the hypoglossal main trunk and peripheral branches. The effects of complete unilateral nerve sectioning on tongue base volume and linear dimensions were measured and compared to the contralateral control side. In the final stage, only the peripheral nerve that was determined as the main supply to the tongue base was sectioned, and the results were compared to those in the matched controls.Results: A medial branch of the hypoglossal nerve was consistently identified as the main motor supply to the tongue base. Complete denervation resulted in a measurable decrease in the volume of the tongue base as compared to that of controls. Partial neurolysis produced inconsistent changes in 2 subjects, with decreases in linear dimensions that were not proportional to the decrease in volume. Histologically, complete denervation was followed by a significantly greater replacement of muscle with fat and connective tissue as compared with partial neurolysis.Conclusions: There were inconsistent changes in volume and linear dimensions of the tongue base following partial neurolysis of the hypoglossal nerve over the 3-month experimental period.